HomeMy WebLinkAboutMINUTES - 02102004 - C16 ...............................................................................I........................I...........................................................................
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CLAIM
BO
_ARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION:FEBRUARY 101 20".04
Claim Against the County, or District Governed by
the Board of Supervisors,Routing Endorsements, NOTICE TO CLAIMANT
and Board Action. All Section refere= -:a
The copy of this document mailed to you is your
California Government Codes. ....
notice of the-action taken on your claim by the
Board of Supervisors. (Paragraph IV below), given
Pursuant to Government Code Section 913 and
915.4.Please note all"Warningsif
AMOUNT: $500.00
CLAIMANT: LAWS WAYNE STURGIS J-40508
ATTORNEY: UNKNOWN DATE RECEIVED: JANUARY 05, 2004
ADDRESS: SAN QUENTIN STATE PRISON BY DELIVERY TO CLERK ON: JANUARY 05, 2004
SAN QUENTIN, CA. 94974
BY MAIL POSTMARKED: JANUARY 02, 2004
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN SWEETEN,rlarl .
JANUARY 05, 2004
Dated: By. Deputy ZIA 19 A=
IT WOM County Counsel, TO: 3erk of the Board of Supervigbrs
(�his claim complies substantially with Sections 910 and 910.2.
This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The
Board cannot act for 15 days (Section 910.8).
Claim is not timely filed, The Clerk should return claim on ground that it was filed late and send warning of
claimant's right to apply for leave to present a late claim (Section 911.3).
Other:
Dated-
By�-,- Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel(1) County Administrator(2)
Claim was returned as untimely with notice to claimant(Section 911.3).
VIV R ARD ORDER: By unanimous vote of the Supervisors present:
oThis Claim is rejected in full,
Other,
I certify that this is a true and correct I copy of the Board's Order entered in its minutes for this date.
DateLi
46HN SWEETEN, CLERK,By Deputy Clerk
WARNING(Gov. code recti 913}
Subject to certain exceptions, you have only six(6) months from the date this notice was personally served or deposited
in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an
attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so
immediately. *For Additional Warning See Reverse Side of This Notice.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have,been a citizen of the United
States, overage 18; and that today I deposited.in the United States Postal Service in Martinez, California, postage fully
prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above,
Dated: 400,<0OHN SWEETEN, CLERK By Deputy Clerk
Crim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INDWNTS tS To CLAM i[ANT
A. Claims relating to causes of action for death or for injury to person or to personal property or growing
craps and which accrue on or before December 31, 1987, must be presented not later than the 10&day
after the accrual of the cause of action. Claims relating to causes of action for death or for injury to
person or to personal property or growing crops and which accrue on or after January 1, 1988, must be
presented not later than six months atter the accrual of the cause of action. Claims relating to any other
cause of action must be presented not later than one year after the accrual of the cause of action.
(Gov't Cade 911.2.)
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County
Administration Building,651 Pine Street,Martinez, CA 94553.
C. If claim is against a district governed by the Board of Supervisors,rather than the County,the name of
the District should be filled in.
D. if the claim is against more than one public entity, separate claims must be filed against each public
entity.
E. Fraud. See penalty for fraudulent claims,Penal Cade Sec. 72 at the end of this form.
RE: Claim By Reserved for Clerk's filing stamp
LA hA A WA u EIs
. , "'
Against the County of Contra Costa or ) JAS
) 0 5 2004
District) CLERK BOA#0 OF SUPERVtSaRS
(Fill in name) } CONTRA CO TA CO,
The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district
in the sum of S 5 0.C and in support of this claim represents as follows:
1. When did the damage or injury occur?(Give exact date ar:d hour)
2. Where did the damage or injury occur?(Include city and county)
J'f °r- � Gotsn+7r JA; l ;'Y,
3. How did the damage or injury occur?(['rive full details, use extra paper if required)
OP4 i>r'G ,;2100,3 0,e r Ol<;IHA el �r oa ,� � � L. a� c�U;1ra P'e r► �r►r� ra ����
ffopel-,. LA. - V4y Proper »e-v-er at'fr'v' 4.� s,t►.t*! QU1 r11YV,
r� r Ae._ ;SAtit j ,;rs n e ±»
jH6� JAI L t?!.f "'vc"C t {; ver J R �7� e� am r sof pFoPcl I
t11 t':.5 S i l _ {
4. What particular act or omission an the part of county or district officers, servants, or employees caused the
injury or damage? t4c 5 L c c i-z-P -no Sc tit rJ Pc R__','DMA L f-�o 97/
WJ 4 N V f.SC NA RG E tT 12c:rYl eO a/N X
i VrJ nJJ 7 10poloe
5. What are the names of county or district officers, servants, or employees causing the damage or injury?
�cCo2, ;200:3 y--010 4 t`I AnC,// 1,oe''a+,44,,7
6. 'What damage or injuries do you claim resulted?(Give full extent of injuries or damages claimed. Attach
two estimates for auto damage.) i�s> ' 10A i>^ a 1, /'0 an�f
B1% Ar �R--4Yc'nA/ ,/4,,Y-r � r,/4 Leh I,t�►ite l- rlt n j std -p g
7. How was the amount claimed above computed?(Include the estimated amount of any prospective injury or
damage`) j-,STS tf'�a z' `< rxr
8. Names and addresses of witnesses, doctors, and hospitals.
9. List the expenditures you made on account of this accident or injury.
DATE Mffi kM UNT
,A-19_03
} Gov. Code Sec. 910.2 provides "The claim must be
} signed by the claimant or by some person on his behalf.,'
END NOTICES TO: A orne
Name and Address of Attorney )
}
(Claimant's Signature)
)
)____ `r✓ t it ;:';, zz i� dr'. rJ„v!
(Address)
)
}
Telephone No. )Telephone No.
NOTICE
Section 72 of the Penal Cade provides:
Every person who,with intent to defraud,presents for allowance or the payment to any state board or officer,or to any
county,city,or district board or officer,authorized to allow or pay the same if genuine,any false or fraudulent claim,bill,account,
voucher,or writing,is punishable either by imprisonment in the county}ail for a period of not more than one year,by a fine of not
exceeding one thousand(S 1,000),or by both such imprisonment and fine,or by imprisonment in the sate prison,by a fine of not
exceeding ten thousand dollars(S 10,000),or by both such imprisonment and fine.
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CLAIM
B!QA.RD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION., FEBWARY 104,7_2 34
Claim Against the County, or District Governed by
the Board of Supervisors,Routing Endorsements, NOTICE TO CLAIMANT
and Board Action. All Section references are to The copy of this document mailed to you is your
California Government Codes, notice of the action taken on your claim by the
Board of Supervisors. (Paragraph IV below), given
Pursuant to Government Code Section 913 and
915.4. Please note all"Warnings".
AMOUNT. UNKNOWN
CLAIMANT: DONALD WINEBRENNER
ATTORNEY: UNKNOWN DATE RECEIVED- JANUARY 05, 2004
ADDRESS: 3120 WILART DRIVE BY DELIVERY TO CLERK ON:JANUARY 05, 2004
SAN PABLO, CA 94806
BY MAIL POSTMARKED: JANUARY 03, 2004
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
Dated: JANUARY 0L 2004 JOHN S7���
By: Deputy a
II. PRO—M: CountyCounsel. TO: Clerk of the Board of gupeflvisors
(,)"r,ws claim complies substantially with Sections 910 and 910.2.
This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant, The
Board cannot act for 15 days(Section 910.8).
Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of
claimant's right to apply for leave to present a late claim (Section 911.3).
Other:
Dated: Z6 Z-0 By: ------- Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel(1) County Administrator(2)
Claim was returned as untimely with notice to claimant(Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present:
This Claim is rejected in full.
Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date.
Dated: 4W4dOHN SWEETEN, CLERK, By Deputy Clerk
6�1 - WARNING(Gov. code secti6n 9131
Subject to certain exceptions, you have only six (6)months from the date this notice was personally served or deposited
in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an
attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so
immediately. *For Additional Warning See Reverse Side of This Notice.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United
States, over age 18; and that today I depositedin the United States Postal Service in Martinez, California, postage fully
prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above.
Dated:
&"&w* & 2kffg!�OHN SWEETEN, CLERK By Deputy Clerk
Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAI iPM
A. Claims relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and which accrue on or before December 31, 1987,
must be presented not later than the 100th day after the accrual;- of the cause of
action. Claims relating to causes of action for.death or for injuryto person
or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the accrual of the 'cause
of action. Claims relating to any other cause of action must be presented not
later than one year after the accrual of the cause of action. (Govt. Cade §911.2.)
B. Claims 'must be filed with the Clerk of the Board 0f Supervisors at its .office in
Room. 106, County Administration Building, 651 Pine>8tareet, Martinez, CA 94553.
C. If claim is against a district governed by the Board of Supervisors, rather than
the County, the name of the District should be filled in.
D. If the claim is against more than one public entity, separate claims must by
filed against each public entity.
E. ' Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the end of this
fora.
RE: Claim By ) Reserved for Clerk's filing stamp
Against the county 4f Contra Costal
District) c'Op �vrq� sip 11+
Fill in name
-A
The undersigned claimant hereby makes claim against the County o ra Costa or
the above-named District in the sum of $ and in support of
this claim represents -as follows:
1. When did the dame or injury o ur? (Give exact date and hoar)
_....___. ' tie k ..�.. .._.____....._. -----_______-..__
2. Where did the damage or injury occur? (Include city and county)
... .t. ... ..
3. Hoer did the damage or injury occur? (Give full details; use extra paper if
required)
4. What particular act or omission on the part of county or district officers,
servants or employees caused. the.injury or damage?
spe e P Iryw i ..• rn&�r— �:s t s�V7Y'w L_ `� e� � 'f lam_
wraat are the names of county or district officers, servants or employees causing
the danage or injury?
6. What damage or injuries do you claim resulted?(Give full extent of injuries or
damages claimed. Attach two estimates for auto damage.
ramount claimed above computed? (Include the estimated amount of any
7. How was the
prospective injury or damage.)
8. Names and addresses of witnesses, doctors and hospitals.
9. List the expenditures you made on acro t of this aANOUNTnt or injury:
DATE ITEM -
Gov. Code See. 910:2 provides:
"The claim must be signed by the claimant
SEND NOTICES T0: (Attorney
or some erson on his.behalf."
Name and Address of Attorney
A,.�.k�it�
Clalalant 5 S
40
Address
---------------
Telephone No. Telephone No.
* Ir W
�t * *
N 0 T I CE
Section 72 of the Penal Code provides;
"Every person who, with intent to defraud, presents for allowance or for
payment to any state board or officer, or to any county, city or district board or
officer, authorized to allow or pay the same if .genuine, any false or'fraudulent
punishable either by imprisoriment in
claim, bill, account, voucher, ar writing, is punis_
the county jail for a period of not more than rye t and y a ,fine
bof rnot
xc:eent gn
one thousand ($1,000) , or by both such impr
the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by
both such imprisonment and fine.
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CROCKETTS PREMIER AUTO BODY
900 SAN PABLO AVE
PINOLE, CA 94554
(510) 741-9001
CD LOG NO 11430-1- DATE 12/22/03
SLOP: CROCKETTS PREMIER AUTO BODY INS ' DATE: 12/22/03
ADDRESS : 900 SAN PABLO AVE, CONTACT: VINCE V'EGA
CITY STATE: PINOLE, CA PHONE 1 : (510) 741-9001
ZIP: 94564- FAX: {510} 741-9009
OWNER: WINEBRENNER, DON WORK PHONE: (510) 223-1376
ADDRESS : 3120 WILAR.T DR
CITY STATE : SAN PABLO, CA
ZIP: 94806-
LIC#: 5BTC939 STATE: CA VIN: IFTCR10Xl TA3'7019
BODY COLOR: WHITE `` MILEAGE: 182 , 842
CONDITION: GOOD ACCTNG CTL#:
PROD.DATE: 12/91 PAINT CODE:
*=USER-ENTERED VALUE E=REPLACE OEM NG=REPLLACE NAGS
ECS=REPLACE ECONOMY UC=RECONDITIONED PRT UM=REM 1/REBUILT PRT
EU=REPLACE SALVAGE EP-REPLACE PXN * PC=PXN RECONDITIONED
PM=PXN REMAN/REBUILT TE=PARTL REPL PRICE ET=PARTL REPL LABOR
IT=PARTIAL REPAIR I=REPAIR L=REFINISH
BR=BLEND REFINISH TT=TWO-TONE CG=CHIPGUARD
SB=SUBLET N=ADDITIONAL LABOR RI=R&I ASSEMBLY
P=CHECK AA=APPEAR ALLOWANCE RP=RELATED PRIOR
UP=UNRELATED PRIOR
ESTIMATE OPEN UNTIL TEAR DOWN
1992 FORD RANGER STX 2DOOR STANDARD CAB 6CYL GASOLINE 4 . 0
CODE: P8313A/D OPTNS H/24J
OPTIONS:
TWO-STAGE - EXTERIOR SURFACES TWO-STAGE - INTERIOR SURFACES
POWER STEERING
OP GDE MC DESCRIPTION MFG. PART NO. PRICE AJ% BSS HOURS R
E 0193 02 PNL,CAB SIDE OUTER LT E7TZ10280A59A 220.22 9 . 7 1
L 0193 13 PNL, CAB SIDE OUTER. LT REFINISH 2 .4 4
BR 0194 PNL,CAB SIDE OUTER RT BLEND REFINISH 0 . 8 4
BR 0341 PANEL,ROOF BLEND REFINISH 1. .4 4
I 0353 PANEL,CAB REAR REPAIR 2 . 0*1
L 0353 PANEL, CAB REAR REFINISH 1 . 7 4
RI 0325 # PANEL, REAR CAB TRIM R&I ASSEMBLY 0 . 3 1
# = 01, 02
EC 0533 TAILLAMP ASSEMBLY LT ECONOMY PART 54 . 88* 0 . 3 1
PAGE 1
12/22/03
1992 FORD RANGER STX 2DOOR STANDARD CAB
CD -LOG NO 11430-1
EC 0568 02 BUMPER,REAR ECONOMY PART 397 . 65* 1 , 8 1.
EC 0573 SUPT, RR BUMPER INNE LT ECONOMY PART 20 . 54* INC 1
EC 0574 SUPT,RR BUMPER INNE RT ECONOMY PART 22 . 62* INC 1
EC M14 CORROSION PROTECTION ECONOMY PART 10 . 00* 0 .2*:.' *
L M15 COLOR TINT REFINISH 0 . 5*4
EC M1:7 COVER CAR EXTERIOR ECONOMY PART 5 . 00* 0 . 2*1*
N M28 BATTERY ADDNL LABOR OPERA J .2*1
**D&R**
SB M60 HAZARD. WSTE. REM. SUBLET REPAIR 3 . 00* i
N M67 RESET ELECTRICAL CO ADDNL LABOR OPERA 0 .2>
*1.
EC M68 CAULK ECONOMY PART 12 . 50* 0 .2>
*1
EC WELD THRU PRIMER ECONOMY PART 15 . 50* "*
19 ITEMS
MC MESSAGE (S)
01 CALL DEALER FOR EXACT PART NUMBER / PRICE
02 PART NO. DISCONTINUED, CALL DEALER FOR EXACT PART NO
13 INCLUDES 0 . 6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE
FINAL CALCULATIONS & ENTRIES
GROSS PARTS 220 . 22
OTHER PARTS 538 . 40
PAINT MATERIAL 140 . 40
PARTS & MATERIAL TOTAL 949 . 27
TAX ON PARTS & MATERIAL 8 .254 78 . 31
LABOR RATE REPLACE HRS REPAIR HRS
1-SHEET METAL 68 . 00 12 . 7 2 . 4 1, 026- 80
2-MECH/ELEC 72 . 40
3-FRAME 72 . 00
4-REFINISH 68 . 00 6 . 8 462 .40
5-PAINT MATERIAL 28 . 00
LABOR TOTAL 1, 489 .20
3 . 00
SUBLET REPAIRS
TOWING
STORAGE
GROSS TOTAL 2 , 519 .78
NET TOTAL 2 , 519 .78
ADP SHOPLINK U0080 ES CD LOG 11.430-1 DATE 12/22/03 12 : 20 :29AM R6 . 35 CLQ 11/03
PXN: Y/00/00/00/00/00 CUM 00/00/00/00/00 GEOCODE 945525
HOST LOG
(C) 199$ - 2003 ADP CLAIMS SOLUTIONS GROUP, INC.
2 . 0 HRS WERE ADDED TO THIS EST. BASED ON ADP TWO-STAGE REFINISH FORMULA-
- - -- ----- ---- ------ ------------------- ----- -------
ORMULA-
THIS-ESTIM�T.ATE'-HAS BEEN- - - - -
PREPARED BASEDONTHEUSEOF CRASH PARTS SUPPLIED BY A
PAGE 2
12/22/03
.
.
. ........................................................ .................
.. .......... .
...................................... ..................................... ..
. .......................................................................... .
......................................................................
1992 FORD RANGER STX 2DOOR STANDARD CAB
CD LOG NO 11430-1
SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTIES
APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR
DISTRIBUTOR OF THE PARTS, RATHER THAN BY THE ORIGINAL MANUFACTURER OF YOUR
VEHICLE.
PAGE 3
12/22/03
. a.
....�_. .::....... ......... .LM1
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9
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BOARD OF SUPE CLAIM
VISORS OF CONTRA COSTA COUNTY �• �''
BOARD ACTION EBR APY 10:t 2004
Claim Against the County, or District Governed by )
the Board of Supervisors,Routing Endorsements, ) NOTICE TO CLAIMANT
and Board Action. All Section references are to ) The copy of this document mailed to you is your
California Government Codes. ) notice of the action taken on your claim by the
. ... :.. Board of Supervisors. (Paragraph IV below), given
Pursuant to Government Code Section 913 and
915.4. Please note all"turnings".
AMOUNT: UNKNOWN
CLAIMANT: DORS M. -OLDEN-,-
ATTORNEY:
LDENATTORNEY: UNKNOWN DATE RECEIVED JANUARY 07, 2004
ADDRESS: 2780 ESTATES AVENUE, APT. #D BY DELIVERY TO CLERK ON: JANUARY 07, 2004
PINOLE, CA 94564
RECEIVEI?r FRC?M RISK
BY MAIL POSTMARKED: mANAC.F_MFt
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN SWEE ,
Dated: JANUARY 07, 2004 $y; Deputy
II. MOM: County Counsel TO: Clerk of the Board of Supervi ors
{ ) This claim complies substantially with Sections 910 and 910.2.
J
Mr Tfhis Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The
Board cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed tate and send warning of
claimant's right to apply for leave to present a late claim(Section 911.3).
( ) Other:
Dated: By: Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2)
{ ) Claim was returned as untimely with notice to claimant(Section 911.3). .
IV. BOARD ORDER: By unanimous vote of the Supervisors present:
WY— This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date.
Dated. JOHN SWEETEN, CLERK, By , Deputy Clerk
WARNING(Gov. code sect'on 91 )
Subject to certain exceptions, you have only six(6)months from the date this notice was personally served or deposited
in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an
attorney of your choice in connection with this matter.If you want to consult an attorney, you should do so
immediately. *For Additional Warning See Reverse Side of This Notice.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned.,have been a citizen of the United
States, over age 18, and that today I deposited.in the United States Postal Service in Martinez, California,postage fully
prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above.
Dated: r1 JOHN SWEETEN, CLERK By Deputy Clerk
OF iCE OF THE COUNTY COUNSEL ` Sumo B.MARCHESI
COUNTY OF CONTRA COSTA 0 COUNTY COUNSEL
S /;
Administration Building SHARON L.
651 Pine Street, 9th Floor CHIEF AssISTANT
Martinez, California 94553-1229 %sal f" t Y
c'�= u433 GREGORY C.HARVEY
(925) 335-1800 VALERIE J. RANCHE
(925) 646-10378 (fax) 4 ' _ ` ' Assismisrrs
NOTICE OF INSUFFICIENCY
ANDIOR
NON-ACCEPTANCE OF CLAIM
TO: Dorothy M. Olden
2780 Estates Avenue, Atp. #B
Pinole, CA 94564
RE: CLAIM OF: DOROTHY M. OLDEN
Please Take Notice as Follows:
The claim you presented against the County of Contra Costa or District governed by the Board of
Supervisors fails to comply substantially with the requirements of California Government Code Section
910 and 910.2, or is otherwise insufficient for the reasons checked below:
[ ] L The claim fails to state the name and post office address of the claimant.
[ ] 2. The claim fails to state the post office address to which the person presenting the claim desires
notices to be sent.
[X] 3. The claim fails to state the date,place or other circumstances of the occurrence or transaction
which gave rise to the claim asserted.
[X] 4. The claim fails to state the name(s) of the public employee(s)causing the injury,damage, or
loss, if known.
[X] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000).
If the claim totals less than ten thousand dollars($10,000),the claim fails to state the amount
claimed as of the date of presentation,the estimated amount of any prospective injury,damage
or loss so far as known, or the basis of computation of the amount claimed.
[ ] 6. The claim is not signed by the claimant or by some person on his or her behalf.
Page 1
Dorothy M. Olden
Re: Claim
Page Two
[X] 7. You are required to submit your claim on the proper form, which is enclosed. Please resubmit
your claim on the enclosed form, including all the required information. Gov. Code, § 910.4.
Please be aware that you have only a limited period of time in which to file an amended claim.
See Gov. Code, § 910.6.
[ ] 8. Other:
SILVANO B. MARCHESI
COUNTY COUNSEL
By:
Deputy County Counsel
CERTIFICATE OF SERVICE BY MAIL
(C.C.P. §§ 1012, 1013a,2015.5;Evidence Code§§641,664)
1 declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California
94553;1 am a citizen of the United States,over 18 years of age,employed in Contra Costa County,and not a party to this action. I
served a true copy of this Notice of Insufficiency and/or Non-acceptance of Claim by placing it in an envelope addressed as shown
above,sealed and postage fully prepaid thereon,and thereafter was,deposited this day in the U.S.Mail at Martinez,California.
I certify under penalty of perjury that the foregoing is true and correct.
Dated:January 8,2004 at Martinez,California.
cc: Clerk of the Board of Supervisors(original)
Risk Management
(NOTICE OF INSUFFICIENCY OF CLAIM:GOVT.CODE§§910,410.2,924.4,910.8)
Page 2
Roh Har"y
Hershel D.Sr.and Dorothy M.Olden
2780 Estates Avenue Apt.913 JAN 0 7 2004
Pinole,CA 94654
(510)659-0668
December 29,2003
Contra Costa County Regional Medical Center
Attention: Jar.Richard Gurley,Psychiatric Ward _
2500 Alhambra Avenue REED
Martinez,CA 94553
Re: Autopsy for Brian K.{Aden 'SAN 0 7 2004
DOD: September 26, 2003 CLERK BOARD OF SUPE VISORS
DOB: July 22, 1970 CONTRA COSTA GO,
Dear Dr.Gurley:
I have reviewed Brian K.Olden(my son)Medical Records,Autopsy Report and Toxicology Report.
I am sending this letter as a formal request for additional tests to be done on my scan's Laboratory work.
After reviewing all documentation before me I have ruled inconclusively against the results of the Autopsy
Report as a justification, for the cause of my son's death. As a matter of fact, the Autopsy report was
unremarkable, i.e.;there seems to be no cause of death. Furthermore,I did notice some discrepancies in the
Toxicology Report; all of the test ran on my son were for what is known as Street Drags,trey son Brian,was
not at anytime in his short life addicted to any form of Drugs; especially to Drugs from the streets. As a
matter of fact, I would further appreciate knowing and understanding why these types of tests, would be
considered for testing as a significant reason for my son's cause of death. I have yet to receive any reports,
results,or levels given from any of the Medications my son received during his course of treatment at Contra
Costa County Regional Medical Center,from September 21,2003 through September 26,2003.
A copy of the Laboratory results ran on my son on, September 26, 2003, came back showing his
Creatnine level to be three times higher than the normal range and I would like to know why.?
On December 15, 2003, I spoke with, Sergeant England he said, "He would be sending one of his
deputies over to pick up some of the samples left to do testing himself," and I have yet to hear back from
him. I also spoke with you that same day and requested that additional tests be performed. You said, "You
had to contact, Glen Stewart to see if there were enough of the samples left to do the testing." You fully,
called me back on December 24, 2043, to explain; "There were no more samples left to examine." In the
case of my son Brian Olden, is it a standard policy that all samples be discarded after the initial Autopsy and
Toxicology reports are concluded? "What are your standard operating procedures for handling what should
have been a Coroner's case?"
Since your office is unable to fulfill this request and it seems as though you may be out of
compliance here,I am forwarding necessary documentation over to my Attorney's office pp file suit against
you and Contra Costa County Regional Medical Center for the death of my son Brian K.Olden.
Sincerely,
Dorothy M.Olden
Cc: Sergeant Daryl England,Assistant Division Commander
Coroner's Bureau
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APPLICATION TO F, ,LE LATF,CLAIM
BOARD OF SUPERVISORS OF CONMA COSTA COUNTY CALIFORNIA 6014
BOARD ACTION
Application to File Late Claim } NOTICE TO APPLICANT FEBRUARY 10, 2004
Against the County,Routing ) The copy of this document mailed to you is your
Endorsements, and Board Action.) notice of the action taken on your application by
{All Section References are to ) the Board of Supervisors(Paragraph III,below),
California Government Code,) 1 given pursuant to Government Code Sections 911.8
and 915.4. Please note the "WARNING"below.
Claimant: ,JAYLAH DAILEY, a minor by and through her Guardian
Ad Litem, Carlotta Dailey f
Attorney: VERNON C. GOINS, Esq. v
Address: TAYLOR & GOINS, LLP
1330 BROADWAY, SUITE 1701 Y •
Amount: OAKLAND, CA 94612 By delivery to Clerk on: JANUARY 07, 2004
Date Received: JANUARY 07, 2004 By mail, postmarked on:
1. FROM: Clerk of the Board of Supervisors TO: County Couns4
Attached is a copy of the above noted Application to File Late Claim.
DATED: JANUARY 07, 46i[N SWEETEN,Clerk,By: DEPUTY
ii. FROM: County'Counsel TO: Cler of thel pard of 19upervisors
{ } The Board should grant this Application to File Late Claim (Section 911.6)
{ The Board should deny this Application to File Late Claim (Section 911.6).
DATED: SILV"ANO B.MARCHESI,_County Counsel,Bk � DEPUTY
III. BOARD ORDER By unanimous vote of Supervisars present
(Check one only)
( } This ApplicationIs granted(Section 911.6).
This Application to File Late Claim is denied (Section 911.6).
I certify that this a true and correct copy of the Board's Order entered in its minutes for this date.
DATE:JtAkAA� 4WIIN SWEETEN,Clerk,By: DEPUTY
WARNING(Gov. Code§911.8)
If you wish to file a court action on this matter,you must first petition the appropriate court for an order
relievia.g you from the provisions of Government Code Section 945.4(claims presentation requirement).See
Government Code Section 946.6.Such petition must be filed with the court within six(6)months from the date
your application for leave to present a late claim was denied.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to
consult an attorney,Lou should do so immediately.
IV. FROM: Cleric of the Board TO: (1)County Counsel (2)County Administrator
Attached are copies of the above Application. We notified the applicant of the Board's action on this
Application by mailing a copy of this document, and a memo thereof has been filed and endorsed on the Board's
copy of this Claim in accordance with Section 29703.
DATED: f «ZOl Vfe JOHN SWEETEN,Clerk,By: DEPUTY
V. FROM: (l ounty Counsel (2)County Administrator TO: Clerk of the Gard of Supervisors
Received copies of this Application and Board Order.
DATED: County Counsel,By:
County Administrator,By:
aPPLICATION TO FILE LATE CLAIM
1 VERNON C. GOINS 11 (SBN 195461)
TAYLOR & GOINS LLP
2 1330 Broadway, Suite 17011
Oakland, CA 94612
3 +'
Telephone: (510) 893-9465 +14AI 0 �
Fax: (510) 893-4228 �A � ZQ
4 04
5 sr,�cR�l�,o
Attorney for Claimant ° R
6 JAYLAH DAILEY
7 )
8 In the Matter of the Claim of ) APPLICATION FOR PERMISSION
TO PRESENT LATE CLAIM
9 JAYLAH DAILEY, a minor, by and through ) [Gov.C. §911.4]
her Guardian Ad Litem, CARLOTTA )
10 DAILEY, )
11
against )
12 )
CONTRA COSTA COUNTY; )
13 FAIRGROUND CENTER HEADSTART )
(Antioch, California) )
14 )
15
TO: CONTRA COSTA COUNTY BOARD OF SUPERVISORS:
16
Application is hereby made for leave to present a late claim under Section 911.4
17
of the Government Code. The claim is founded on a cause of action for personal injuries
18 and infliction of extreme emotional distress which accrued on April 15, 2003, and for
19 which a claim was not timely presented to the appropriate agency. For additional
20 circumstances relating to the cause of action, reference is made to the (misdirected)>
21 proposed claim attached hereto as Exhibit A and made a part hereof.
22 (1) The reason for the delay in presenting this claim is the mistake and
23 inadvertence of the claimant and Vernon C. Goins, Attorney at Law, as is more
24 particularly shown in the declaration of Vernon C. Goins, attached hereto as Exhibit B.
25 The Contra Costa County Board of Supervisors was not prejudiced in the defense of the
- 1
1 claim by the failure to file the claim in a timely manner, as shown by the declaration of
2 Vernon C. Goins, attached as Exhibit B.
3 (2) Further, the claimant was a minor during all of the period when the claim
4 should have been presented, as shown by the declaration of Vernon C. Goins, attached
5 hereto as Exhibit B.
6 (3) This application is presented within a reasonable time after the accrual of the
7 cause of action, as shown by the declaration of Vernon C. Goins, attached hereto as
8 Exhibit B.
9 WHEREFORE, it is respectfully requested that this application be granted and
10 that the attached claim be received and acted on in accordance with Sections 912.4-
11 912.8 of th overnment C de.
12 Dat 04
13 f
14 V rnon C. Goins, Esq,
15 On Behalf of Claimant
16
17
18
19
20
21
22
23
24
25
- 2
EXHIBIT A
----.......................................... .............
.....................................
'""AYLOR & GOLVS.LLP
The Business Lawyers.
1330 Brnd Suite 1701 Phone:510.893.9465
Oakland,CA Fax:510.893.4228
wtaylor@thebusinesslawyers.com vgoins@thebusinesslawyers.com
September 3, 2003
VIA FACSIMILE AND U.S. MAIL
Head Start Bureau
330 C Street SW, Rm. 2018
Washington, DC 20447
(202) 260-9336
NOTICE OF CLAIM AND CLAIM AGAINST PUBLIC ENTITY
JAYLAH DAILEY hereby makes claim against the Fairground Center
Head Start in Antioch, California, and makes the following statements in support
of her claim:
1. Claimant's post office address is 2117 B Manzanita Way, Antioch,
California 94509.
2. Notices concerning this claim should be sent to Vernon C. Goins, Esq.
TAYLOR & GOINS, LLP, 1330 Broadway, Suite 1701, Oakland, CA 94612.
3. The date and place of the incident giving rise to this claim are on or
about April 15, 2003 at Fairground Center Head Start in Antioch, California.
4. The circumstances giving rise to this claim are as follows:
A. On or about April 15, 2003, Claimant Jaylah Dailey, was
injured at the hands of Zelmira Sanchez, an associate teacher at Fairg* round
Center Head Start in Antioch, California (hereinafter"Fairground"). Jaylah
suffered several scrapes and abrasions beneath her left eye when Ms. Sanchez
scratched her, in an apparent attempt to physically correct Jaylah's behavior.
B. Although Fairground did contact Claimant's mother, Carlotta
Dailey, Ms. Dailey was not advised of the severity of her daughter's injuries.
When she arrived to pick her up, she immediately became concerned, to the
extent that she felt it was necessary to take Jaylah to Sutter Delta Medical Center
for further evaluation.
www.thebusinesslawyers.com
......................
Claim.Dailey v. Head Start
September 3, 2003
Page 2 of 2
C. Ms. Dailey decided to remove Jayiah from Fairground when
it was reported to her that Jayiah, who was already potty-trained at the time,
urinated on herself on both April 17 and April 18, 2003.
D. Despite several attempts by Ms. Dailey to procure a copy of
the original incident report and discuss the incident in detail with school
authorities, the issue'remains unresolved. To date, Ms. Dailey has yet to receive
a copy of the original incident report and she remains unclear as to how her
daughter was injured in this manner.
5. Claimant's injuries are scarring beneath her left eye and emotional
distress resulting from fear, shock, humiliation, and shame. In addition, claimant
has suffered educational setbacks, which may impact her throughout her
academic career. Please note that this statement does not include every
injury or lass.
6. The names of the public employees causing the claimant's injuries are,
Zelmira Sanchez and other unknown Fairground Center Head Start personnel.
7. This claim, as of today's date, is in an amount that would place it within
the jurisdiction of the Superior Court. The claim is based njury, damage
and/or loss in an amount to be proved.
Dated: 0 3
V,
ernon C. Coins, Esq.
On Behalf of Claimant JAYLAH DAILEY
74YLOR & GOINS LLP 1330 Broadway,Suite 1701 . Oakland,CA 94612
EXHIBIT B
I VERNON C. COINS II (SBN 195461)
TAYLOR & GOINS LLE'
2 1330 Broadway, Suite 1701
Oakland, CA 94512
3 Telephone: (510) 893-9465
4 Fax: (510) 893-4228
5 Attorney for Claimant
6 JAYLAH DAILEY
7 }
8 In the Matter of the Claim of ) DECLARATION OF VERNON C.
} GOINS, EXHIBIT B IN SUPPORT OF
9 JAYLAH DAILEY, a minor, by and through } APPLICATION FOR PERMISSION
her Guardian Ad Litem, CARLOTTA } TO PRESENT LATE CLAIM
10 DAILEY, } (Gov.C. §911:4]
11 against )
12 }
CONTRA COSTA COUNTY; }
13 FAIRGROUND CENTER HEADSTART }
(Antioch, California) }
14 )
15 Vernon C. Goins declares as follows:
16 1) f am the attorney for Jaylah Dailey, a minor, and her parent, Carlotta Dailey.
17 2) As stated in the attached claim of Jaylah Dailey (hereinafter "Claim"),
18 claimant's cause of action accrued on or about April 15, 2003. Jaylah Dailey is
19 and, at the time of the incident, was a minor.
20 3) This Claim arises from an incident involving a teacher at the Fairground
21 Center Head Start in Antioch, California.
22 4) About August 2003, I directed my staff at the firm of Taylor & Coins LLP to
23 access the California Head Start-State Collaboration Office website
24 (http://www.cde.ca.gov/cyfsbranch/chssco/) in an attempt to gather information that
25 would ultimately lead to the determination of the appropriate entity upon whom the
1 Claim against Head Start should be served.
2 5) The Head Start Overview section of said site provided that "Head Start is
3 administered by the Head Start Bureau within the Administration on Children, Youthan
4 Families (ACYF), Administration for Children and Families (ACF), department of Health
5 and Human Services (DHHS)."
6 6) Can or about September 3, 2003, Taylor & Goins staff telephonically contacted
7 the Department of Health and Human Services at (202) 619-0257 in a continued effort
8 to determine the appropriate entity for service of the Claim against Head Start. At this
9 time, staff at the Department of Health and Human Services informed Taylor & Goins
10 staff that the Claim should be presented to the Claims Department of the Head Start
11 Bureau, located at 330 C Street, S.W., Rm. 2018, Washington, DC 20447, fax number
12 (202) 260-9336.
13 7) Pursuant to these instructions, on September 3, 2003„Taylor & Goins staff'
14 sent the original Claim via U.S. Mail to the above address and sent a copy via facsimile
15 transmission to the above fax number.
16 8) By December 16, 2003, Taylor& Goins had not received any response to the
17 Claim, l directed my staff on that date to contact the Head Start Bureau and inquire as
to the status of the Claim. At that time, Taylor & Goins staff was:informed that there
18
was no Claims Department at the Head Start Bureau and that any claim received by
19
their office would likely have been forwarded to Jerry Gomez, Associate Director at the
20
Office of the Associate Commissioner.
21
9) Can or about December 16, 2003, Taylor& Goins staff called and left a detailed
22
message for the Associate Director Jerry Gomez at (415)437-7966. This message was
23
not returned.
24 10) On or about December 17, 2003, i directed Taylor& Goins staff to contact'
25 the Head Start State Collaboration Office via e-mail. The recipient, Coordinator,
- 2
I Michael Zito, referred the e-mail inquiry to Carol Hargrow at the Head Start Regional
2 Office in San Francisco. Ms. Hargrow returned the e-mail, stating she would refer my
3 staff to the appropriate program specialist.
4 11) On or about December 17, 2003, Taylor& Goins staff received a call from
5 Ms. Hargrow, referring them to the Contra Costa County Program Specialist, Maria Fort.
6 1 directed my staff to immediately contacted Ms. Fort. My staff left a'detailed message
7 for Ms. Fort at (415)437-8445.
8 12) Can or about December 18, 2003, Ms. Fort returned the phone call and
9 informed Taylor& Goins staff that she believed that any claim made against a Head'
10 Start program would have to be forwarded to the governing County's Board of
11 Supervisors.
12 13) On December 18, 2003, 1 directed my staff to contact the Contra Costa
13 County Board of Supervisors. My staff left a message with Felicia, contact person for
14 the Contra Costa County Board of Supervisors, requesting confirmation that the Board
15 was, indeed, the proper entity upon wham the Claim should be served. Later that day,
16 Felicia returned the phone call and confirmed to Taylor & Goins staff that, based on her
17 conversation with Emy Sharp, Clerk of the Contra Costa County Board of Supervisors,
the Contra Costa County Board of Supervisors would be the proper recipient of this
18
Claim.
19
14) Pursuant to this conversation with Felicia, I directed Taylor& Goins staff to
20
forward a copy of the Claim, via U.S. Certified Mail, to the Clerk of the Board of
21
Supervisors, County of Contra Costa, 651 Pine Street, Room 106, Martinez, California
22
94553. This was done on December 18, 2003.
23
15) On or about December 24, 2003, Taylor& Goins received Contra Costa
24 County Board of Supervisors' Notice to Claimant (Of Late-Filed Claim) dated December
25 23, 2003.
- 3
1 16) Upon receipt of this Notice, I immediately drafted this Application for
2 Permission to present Late Claim.
3 17) As shown above, the failure to present the Claim was through mistake,
4 inadvertence, surprise and/or excusable neglect. As I am informed and believe
5 that all witnesses are locatable and able to be interviewed, and all records of the
6 incident and the injuries of Claimant are extant and available, the public entity
7 was not prejudiced in its defense of the claim by the failure to present the claim
8 within the time specified in Cal. Gov. Code § 911.2.
9 18)As shown above, the person who sustained the alleged injury,
10 damage or loss was a minor during all of the time specified in Cal. Gov. Code §
11 911.2 for the presentation of the claim.
12 1, Vernon Goins, Attorney for Claimant, declare under penalty of perjury
13 under the laws of the State of California that the foregoing is true and correct.
14
Dated: /
/C)
15
16 ;
L
17 VERNON"C. GOI'NS
18 Attorney for Claimant
19
20
21
22
23
24
25
_ 4
`T- YLOR & GOINS LLQ'
The Business Lawyers,.
1330 Broadway,Suite 1741 Phone:510.893.9465
Oakland,CA 94612 Fax:510.893.4228
wtaylor@thebusinesslawyers.com vgoins@thebusinesslawyers.com
January 6, 2004
VIA CERTIFIED MAIL
Clerk of the Board of Supervisors
County of Contra Costa
651 Pine Street, Room 106
Martinez, California 94553-1293
Re: Claim of Jaylah Dailey
Dear Sir or Madam:
Please find the enclosed documents:
1. APPLICATION FOR PERMISSION TO PRESENT LATE CLAIM
2. DECLARATION OF VERNON C. COINS,EXHIBIT B, IN SUPPORT
OF APPLICATION FOR PERMISSION TO PRESENT LATE CLAIM
Thank you for your time and consideration.
Very truly yours,
TAYLOR.& GOINS LLP
�?�- 04'0-�
Erika Casady
Secretary to Vernon C. Goins
Encls,
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............................................................
CLAIM
BOARD OF_SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTIONEBRUARY 10., 2004
Claim Against the County, or District Governed by
the Board of Supervisors,Routing Endorsements, NOTICE TO CLAIMANT
and Board Action. All Section references are to The copy of this document mailed to you is your
California Government Codes,
notice of the action taken on your claim by the
Board of Supervisors. (Paragraph IV below), given
Pursuant to Government Code Section 913 and
915.4. Please note all"Warnings".
AMOUNT: UNKNOWN
CLAIMANT: BELINDA ROUNDTREE
ATTORNEY; STEVEN H. HENDERSON DATE RECEIVED: JANUARY 07, 2004
ADDRESS: IAW OFFICES OF STEVEN H. HENDERSON BY DELIVERY TO CLERK ON:JANUARY 07 2004
3024 RAILROAD AVENUE
PITTSBURG, CA 94565 BY MAIL POSTMARKED: HAND DELIVERED
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
Dated: JANUARY 07, 2004 -, JOHN SWEET
By: Deputy_
H. PROM: County Counsel, TO; Clerk of the Board of Supervro—rs
(j,�"fhis claim complies substantially with Sections 910'and 910.2.
i
This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The
Board cannot act for 15 days (Section 910.8).
Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of
claimant's right to apply for leave to present a late claim(Section 911.3).
Other:
Dated:
By: --.-.r �_i Deputy County Counsel
III. FROM: Clerk ofthe Berard TO: County Counsel (1) County Administrator(2)
Claim was returned as untimely with notice to claimant(Section 911.3),
IV./BOARD ORDER: By unanimous vote of the Supervisors present:
(yJ This Claim is rejected in full.
Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date.
Dated: Q JOHN SWEETEN, CLERK, By Deputy Clerk
WARNING(Gov. code sec on 91 5)
Subject to certain exceptions, you have only six(6)months from the date this notice was personally served or deposited
in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an
attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so
immediately. *For Additional EarninSee Reverse Side of This Notice.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have,been a citizen of the United
States,over age 18; and that today I deposited,in the United States Postal Service in Martinez, California,postage fully
prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above.
Dated: JOHN SWEETEN,CLERK By Deputy Clerk
1
2 STEVEN H. HENDERSON - SB #88620
JILL STERN-HENDERSON - SB #148172
3 Attorneys -Abogados
4 3024 Railroad Avenue
Pittsburg, California 94565
5 (925) 427-1771
6 Attorneys for Claimant,
7 Belinda Roundtree
8 In the matter of the claim of,
BELINDA ROUNDTREE
9
10 BELINDA ROUNDTREE, CLAIM FOR DAMAGES
11 Claimant,
12 v5. RECEIVED
13 CONTRA COSTA COUNTY HEALTH
14
SERVICES DEPARTMENT, CONTRA JAN
COSTA COUNTY, RAMON BERGUER, CLERK BOAR50 OF SUPERVI
15 MD, DOES 1 through 25, and DOE CONTRA COSTA co,
16 CORPORATIONS, 1 through 25, inclusive,
17 Respondents.
18 I
19 BELINDA ROUNDTREE hereby presents this claim to CONTRA COSTA
20 COUNTY HEALTH SERVICES DEPARTMENT, CONTRA COSTA COUNTY, and DR.
21
RAMON BERGUER, MD, DOES 1 through 25 and DOE CORPORATIONS 1 through
22
23 25, inclusive, pursuant to Government Code ;910, et seq.
24 II
25 The name and post office address of claimant is:
26 Belinda Roundtree
27 430 Melinda Court, Bay Point, CA 94565
28 page_ 1
tf
1
2 III
3
4 The post office address to which claimant desires notice to this claim to be sent
5 is as follows:
6 Law Offices of Steven H. Henderson
7 3024 Railroad Avenue, Pittsburg, CA 94565
8 IV
9 At all times herein mentioned, the CONTRA COSTA COUNTY HEALTH
10
SERVICES DEPARTMENT, CONTRA COSTA COUNTY were public entities and at all
11
times herein mentioned defendants RAMON BERGUER and DOES 1 through 10, were
12
13 employees and/or agents of the above-named public entities and were acting in the
14 course and scope of their employment and/or agency.
15 V
16 On or about July 9, 2003, and at all times thereafter, at the CONTRA COSTA
17
COUNTY REGIONAL MEDICAL CENTER, defendants, and each of them, caused
18
19 injury to claimant BELINDA ROUNDTREE as the result of negligent medical treatment,
20 including, the unnecessary surgical removal of her colon and improper treatment of
21 post-surgical infections. Defendants and each of them also failed to properly obtain
22 informed consent from claimant for all of the medical procedures performed on her on
23 July 9, 2003, and therefore committed a medical battery:.
24
Dated: January 7, 2004
25 STEVEN H. HiENDERSON,
26 Attorney for claimant
27
28 Page -2
1
1
2 PROOF OF SERVICE
3 I, Ana Patricia Silveira, declare under penalty of perjury under the laws of the United
4 States of America that the following is true and correct.
5 I am employed in the City of Pittsburg, Contra Costa County, California. I am over the
age of eighteen (18)years and not a party to the within action. My business address is: 3024
6 Railroad Avenue, Pittsburg, CA 94555.
7 I caused to be served the following document(s):
8 Claim for Damages
I caused the above document(s)to be served on each person on the attached list by the
9 following means:
10 [] 1 enclosed true and correct copies of said document(s) in an envelope and placed it for
collection and mailing with the United States Post Office on following the ordinary
11 business practice.
12 (indicated on the attached address list by an[M]above the a&Iress.)
13 [] 1 enclosed true and correct copies of said document in an envelope, and placed it for
collection and mailing via Federal Express on , for guaranteed delivery on ,
14 following the ordinary business practice.
(indicated on the attached address list by an[FI)]above the address.)
15
16 [] I consigned true and correct copies of said documents for facsimile transmission on
17 (indicated on the attached address list by an[F]above the address.)
18 [Xj I enclosed true and correct copies of said document in an envelope, and consigned it for
hand delivery by messenger on January 7, 2004.
19 (Indicated on the attached address list by an[H]above the address.)
20 I am readily familiar with my firm's practice for collection and processing of
correspondence for delivery in the manner indicated above, to with, that correspondence will be
21 deposited for collection in the above-described manner this same ay in the ordinary course of
business.
22 Executed on January 7, 2004, Pittsburg, Califorr7i
24 A. Pat i ra Silveira'
25
26
27
28
SERVICE LIST
Key: [M] Delivery by mail [FD] Delivery by Federal Express [H] Delivery by hand
[F] Delivery by fax [FM] Delivery by fax and mail
[H] Clerk of the Board of Supervisors
651 Pine Street
Martinez, CA 94553
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD► ACTION. FiPAIt' , 2{JfJ4
Claim Against the County, or District Governed by )
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT
and Board Action. All Section references are to ) The copy of this document mailed to you is your
California Government Codes. ) notice of the action taken on your claim by the
Board of Supervisors . (.Paragraph IV below), given
Pursuant to Government Code Section 913 and
915.4. Please note all"Warnings".
AMOUNT: $676.40 PER PENNY BAILEY ORIGINAL COPY OF THE
CLAIM IS IN THEIR FILE.
CLAIMANT: PAULETTE AND JOHN WITUCKI
ATTORNEY: UNKNOWN DATE RECEIVED: JANUARY 08, 2444
ADDRESS: 4477 STONE CANYON COURT BY DELIVERY TO CLERK ON: `MARY 08, 2004
CONCORD, CA 94521-4403
BY MAIL POSTMARKED: RECEIVED FROM RISK
MANAG9SFN'I'
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN SWEETS C
Dated: JANUARY 08, 2004 By. Deputy
II. MOM: County Counsel TO: Clerk of the Board of Supervisors
{,This claim complies substantially with Sections 910 and 910.2.
{ } This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are;so notifying claimant.The
Board cannot act for 15 days(Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of
claimant's right to apply for leave to present a late claim (Section 911.3).
{ ) Other:
Dated: By: f Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel(1) County Administrator(2)
{ } Claim was returned as untimely with notice to claimant(Section 911.3).
{IV, ARD ORDER: By unanimous vote of the Supervisors present:
This Claim is rejected in full.
( ) Other.
I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date.
Dated. OHN SWEETEN,CLERK, By , Deputy Clerk
WARNING{Gov. code sectio 91 3}
Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited
in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an
attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so
immediately. *For Additional Warning;See Reverse Side of This Notice.
AFFIDAVIT OF MAILING
I declare under penalty of per ury that I am now, and at all times herein mentioned,have been a citizen of the United
States, over age 18; and that today I deposited-in the United States Postal Service in Martinez, California,postage fully
prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above.
Dated.NA �/ OHN SWEETEN, CLERK By Deputy Clerk
2
. # ra to BOARD OF SUPERVISORS OF CONMA =A CMM
INSI'RUMONS TO CLADim
A. Claims relating to causes of action for death or for injury to person or to per-
sonal property or g w ng crops and which accrue on or before December 31, 1987,
must be presented not Later than the 100th day after the accrual of the cause of
action. Claims relating to causes of .actioni for.death or for inJ ry to person
or to personal property or growing cis and which accrue on or after J*nuary 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause sof action must be presented not
later than cue.yeas after the accrual of the cause of action. (Govt. Cade
B. Claims must be filed with the Clerk of the Hczard of Supervisors at its .office in
Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553.
C. If claim is against a district governed by the Board of Supervisors, rather than
the County, the name of the District should be filled in.
D. 1f the claim is against more than one public entity, separate claims mast be
filed against each public entity.
E. ' Fraud. See penalty for fraudulent claims, Penal.Code Sec. 72 at the end of this
form.
BE: Claim By Xx.. eMe_ f 3 Reserved for Clerk's fil' 8' stamp
A Inst the County of Contra costs
r
or C
&'
District) �c lea
namp
in
The undersigned clair:t hereby makes claim agait the County cif Crritra or
the above-named District in the s= of and in supe of
this claim represents -as follows;
1. When did the damage or injury occur? (Give exact date and hour)
2. Where did the damage or injury (Include city and county)
3. How did the damage or injury occur? (Give fAl details; use extra paper if �_C'-
i
required)
. -
___Y_ k--)C
4. What particular acct or omission on the part of county or district off ers,
servants or.employees caused.
�the.injury or damage?
p. 2
5. Wnat are the names of county or district officers, servants or employees cawing
p the damage or injury?
'o VoL dl 1/} ``�.)
5. What a or in uries do a claim resd? :ve t of in i
damage j {Gt ful.l ex ent Jur es cr�
damages claimed. Attach two estimates for auto damage.
7. How was the amount cla.iraed abovel computed? (Include the estimated amount, of any
prospective injury or damage.)
MCI
_i3O
5. Names and addresses of witnesses., doctors and hospitals.
L b�'t
Ow r�jl
zi A-( lie r-A
9. List the expendit -s you made on account of this accident or injur-f:
DR'1v � AMU13Nfi
NJ/
Gov, Cade See. '910;2 prov3dess
"Tate claim must be signed bythe claimant
SM ROTIC.r5 TO: (Attorne ) Or some person an his.behalf."
Name and Address of Attorney < -
`�- A-..,
Claimant's Signature
(Address)
Telephone No. Telephone No 2-':51 . _31
NOTICE
Section 72 of the Penal Cane provides: -
"Every person who, with intent to defraud, presents for all"owaz ce or for
pay=t to any state board or officer, or to any county, city or district board or
Officer, authorized to allose or pay the same if genuine, any false or fraudulent
claim, bill, account, voucher, or writing, is punishable either by imprisodamt in
the county Jail for a period of not more than one-year, by a fine of not exeeedin-g
one thousand ($1,000), or by bath such' 1x0ftsonment and finei-or by imprisonment in
the state prison, by a fine of not exceeding ten thousand .dol,l..ars ($10,000, or by
both such IMrisonment and fine.
12/15/03 14:21 FAX 1 925 .372 6548 UTZ AUTO BODY 1402
12/15/2003 at 02:15 PM Job Number:
21975
MRTXNZZ J=0 BODY SHOP
License *:BAR ABOSS474 Federal ID 4:942574428
! 615 ALHAMBRA AVE
MARTINEZ, CA 94553
(92.5)228-3689 Fax: (925)372-6546
' PRE2.11l1'DTXRY ESTI�l21.T£
Written By: GAMY HERNANDEZ
Adjuster: PENNY HALEY
Insured: JOHN/PAULETTE WITUCKI claim X54661
Owner: JOHN/PAULETTE WITUCKI Policy #
Address: 4477 STONE CANYON CT Vieduucatable:
CONCORD, C.A. 94521-4403 data of Lose:
Day, (925)376-5646 Type of Loss:
Cellular: #9257212-8732 Point of Impact:
Inspect
Location:
Insurlmoe CO.CO COUNTY FIRE
Company: Days to Repair
d
2002 CHEV X2500 4X4 SILVERAUO EXT 8-6.0L-FI 4D P/U
t VIP: 1GCGK29U52Z136763 Lie: CA prod Deas: Odometer:
Tilt Wheel Intermittent wipers Dual Mirrors
Clear Coat Paint Power Steering Power Brakes
Power Windows AM Radio FM Radio
Stereo Cassette Search/Seek
Anti-Lack Brakes (4) Driver Air Bag Passenger Air Bag
4 Wheal Disc Brakes Split Hench Seats Rear Step Bumper
Styled Steel Wheals
-------------------------------------------------------------------------------
d NO. OP. DESCRIPTION OTY .EXT. PRICE LABOR PAINT
-------------------------------------------------------------------------------
t l REAR $LIMPER
2 O/H rear bumper 1.5
3 Rept Rear bumper chrome production 1 379.75 Incl.
4 Repl Step pad center 1 41.86 Incl.
5 Repl RT Step pad outer 1 54.31 Incl.
6 Repl LT Step pati outer 1 54.31 Incl.
-------------------------------------------------------------------------------
Subtotals 530.25 1.5 0.0
1
12/15/03 14:21 FAX 1 925 372 6548 MTZ AUTO BODY �b5
12/15/2003 at 02:15 PM ,lob Number:
21975
x+rAnumx SsTn4hTE
2002 CREV K2500 9X4 5ILVERADO EXT 8-6-OL-Fl 4D P/U
Parts 530.25
Body Labor 1,5 hrs 8 $ 68.00/hr 102.00
----------------------------------------------------
SUBTOTAL $ 632.25
Sales Tax 530.254 6.25008 43.75
----------------------------------------------------
GRAND TOTAL S 676.00
ADJUSTMENTS
Deductible 0.00
f
----------------------------------------------------
CUSTOMER
..._....___.._______..,._..__.._____.,__.,_ ________________CUSTOMER PAY S 0.00
INSURANCE PAY $ 676.00'
If you have coverage for damage to you vehicle under this policy it is our
obligation to inform you that Under California Code of Regulations, Title 10,
Chapter 5, Section 2695.8.d.2.e, you have the right to select the vehicle
repair facility of you choice.
we are prohibited by law from requiring that repairs be done at a specific
' shop. you are entitled to select the auto body shop to repair damage covered
I by us. we have recommended a repair shop that will repair your damaged
vehicle, As you have agreed to use our recommended repair shop, we will cause
the damaged vehicle to be restored to its condition prior to the loss at no
additional cost to you other than as stated in the policy or as otherwise
allowed by law, if you experience a problem with the repair of you vehicle,
please contact us immediately for assistance.
AUTO BODY REPAIR CONSUMER HILL OF RIGHTS
f
A CONSUMER I5 ENTITLED TO;
+ 1. SELECT THE AUTO BODY REPAIR SHOP TO REPAIR AUTO BODY DAMAGE COVERED BY THE
INSURANCE COMPANY. AN INSUPANCE COMPANY MAY NOT REQUIRE THE REPAIRS TO BE DONE
AT A SPECIFIC AUTO BODY SHOP.
2. AN ITEMIZED WRITTEN ESTIMATE FOR AUTO BODY REPAIRS AND, UPON COMPLETION OF
REPAIRS, A DETAILED INVOICE. THE ESTIMATE AND THE INVOICE MUST INCLUDE AN
ITEMIZED LIST OF PARTS AND LABOR ALONG WITH THE TOTAL PRICE FOR THE WORK
PERFORMER, THE ESTIMATE AND INVOICE MUST ALSO IDENTIFY ALL PARTS AS NEW, USED,
AFTERMARKET, RECONDITIONED, OR REBUILT.
f
3. BE INFORMED ABOUT COVERAGE FOR 'TOWING SERVICES. THE INSURER SHALL PAY
1 REASONABLE TOWING ANIS STORAGE CHARGES INCURRED BY THE INSURED TO PROTECT THE
VEHICLE AND PROVIDE REASONABLE NOTICE TO AN UNSURED BEFORE TERMINATINC PAYMENT
FOR STORAGE CHARGES SO THAT THE INSURED HAS TIME TO REMOVE THEVEHICLE FROM
2
12/15/03 14:21 FAX 1 925 ""2 6540 MTZ AUTO BODY Z04
12/15/2003 at 02:15 PH Job Number:
21975
r,ZbUMRar ZSTIMTZ
' 2002 CHEV K2500 4X4 SILVERADO EXT 9-6.0L-FI 4D P/U
STORAGE.
4. BE INFORMED ABOUT THE EXTENT OF COVERAGE, IF ANY, FOR A REPLACEMENT RENTAL
VEHICLE WHILE A DAMAGED VEHICLE IS BEING REPAIRED.
5. BE INFORMED OF WHERE TO REPORT SUSPECTED FRAUD OR OTHER COMPLAINTS AND
CONCERNS ABOUT AUTO BODY REPAIRS.
COMPLAINTS WITHIN THE JURISDICTION OF THE BUREAU OF AUTOMOTIVE REPAIR
Complaints concerning the repair of a vehicle by an auto body repair shop
should be directed to:
Toll Free (800) 952-5210
California Department of Consumer Affairs
Bureau of Automotive Repair
10240 Systems Parkway
Sacramento, CA 95827
t
The Bureau of Automotive Repair can also accept complaints over its web site
! at:
www.autorepair.ca.gov
COMPLAINTS WITHIN THE JURISDICTION OF TETE CALIFORNIA INSURANCE COMMISSIONER
Any concerns regarding how an auto insurance claim is being handled should be
submitted to the California Department of Insurance at:
(800) 927-HELP or (213) 897-8927
California Department of Insurance
! Consurmer Services Division
300 South Spring Street
Las Angeles, CA 90018
The California Department of Insurance can also accept complanted over its web
site at: www.insurance,ca,gov
All supplements must be pre-approved before any work can be completed.
a
.4
3
p. 1
FD
Claim to: �QARD a SVERvISO S OF COMM COSTA COU'ra
I� '�'i3Ci'IOtSS Td CLAIt��T
death or for injury to person or to per-
A. Claims relating to
causes of act uhichfor accrue on ar before Debi` 31, 1987,
sonal property or roaring crops after the accrual of the cause of
must be presented not 1a ter � the l act j day fordeath or for injury to Person
action. Claims. relating to causes. of.actiond which accrue on or afr January 1,
or to personal property or grnt rt8 crops an
1958, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any
Cather cause of action must be presented not
r tear' one year after the acct'-Ml of the cause of action. Go . Cone §911.2.
of the Boca Of Supervisors at i'ts ;office in
Claims mu
S. Clast be filed with the Cleric 651 Pine Stmt: Martinez,, CA 94553. .
Room lam, County' Administration Buildirzgr
an
C. if
claim is against a district governed by the Board of Srspery.sons, rather t!
the County, the nameof the Ditxict
should be filled in.
D. If the claim is aPa
Inst more than one public entity, separate claim must be
filed against each public entity.
' ty for fraudulent claims, Penal.Code Se—. 72 at the end of UP-'
h�s
E, gaud. See genial �
forte
* * * # } Reserved for Clerk's filing stamp
�
RE! Claim 8y PX '
ya it'
` t
Inst t County of Cdntra Ctsta
O
District)
in na=
The undersigned elaimar_t hereby crakes claim against tyre County Contra��t o f r
the above District n the sum of
this claim represents -as follows: ... --.---- -----,,-- . .,
1. When did the doge Or in-Jury occur? (Give exact date and hour)
2. 'there did the damage or ip.,�'uiwy O0MV? (Include city and county)
C Z, &k
_�- -- �
3. How did the damage or injury occur? {rive details; use extra paper if
required)
4. What particular act ar emission on the part of county or district off ers,�
servants or.employees caused.the injury or damage?
�,L_ c Q c..
CLAIM Ct . 14
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
-- Idol IM Irl
BOARD ACTION:FEBRUARY 14, 2004
Claim Against the County, or District Governed by )
the Board of Supervisors, Routing Endorsements, } NOTICE TO CLAIMANT
and Board Action. All Section references are to ) The copy of this document mailed to you is your
California Government Codes. ) notice of the action taken on your claim by the
Board of Supervisors. (Paragraph IV below), given
Pursuant to Government Code Section 913 and
915.4. Please note all "Warnings".
5
AMOUNT. UNKNOWN
CLAIMANT: SANDRIA HUSBAND
ATTORNEY: FRANK OFFEN DATE RECEIVED: JANUARY 09, 2004
ADDRESS: 3530 GRAND AVENUE, SUITE 3 BY DELIVERY TO CLERK.ON: JANUARY 09, 2004
OAKLAND, CA 94610
BY MAIL POSTMARKED: HAND DELIVERED
FROM. Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the'above-noted claim.
Dated: JANUARY 09, 2404 JOT-IN SWEE k
By: Deputy
II. FROM: County Counsel, TO: Clerk of the Board of Supe tsors
(''q'This claim complies substantially with Sections 910 and 910.2.
a
( } This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant.The
Board cannot act for 15 days(Section 910.8).
( } Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of
claimant's right to apply for leave to present a late claim(Section 911.3).
( ) Other:
Dated: By: t Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel(1) County Administrator(2)
{ ) Claim was returned as untimely with notice to claimant(Section 911.3). .
IV,,,,BOARD ORDER: By unanimous vote of the Supervisors present:
( This Claim is rejected in full.
{ ) Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date.
Dated: ' HN SWEETEN, CLERK., By , Deputy Clerk
WARNING(Gov. code secti n 91
Subject to certain exceptions, you have only six(6)months from the date this notice was personally served or deposited
in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an
attorney of your choice in connection with this matter. If you want to consult an attorney., you should do so
immediately. *For Additional Warning See Reverse Side of This Notice.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United
States, over age 18; and that today I deposited.in the United States Postal Service in Martinez, California,postage fully
prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above'.
Dated: t/ HN SWEETEN, CLERK By Deputy Clerk
Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
i
INSTRUCTIONS,TO CLAIMANT
A. Claims relating to causes of action for death or for injury to person or to personal property or growing
crops and which accrue on or before December 31, 1987, must be presented not later than the 100`day
after the accrual of the cause of action. Claims relating to causes of action for death or for injury to
person or to personal property or growing crops and which accrue on or after January 1, 1988, must be
presented not later than six months after the accrual of the cause of action. Claims relating to any other
cause of action must be presented not later than one year after the accrual of the cause of agtion.
(Gov't Code 911.2.)
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County
Administration Building, 651 bine Street, Martinez, CA 94553.
C. If claim is against a district governed by the Board of Supervisors,rather than the County, the name of
the District should be filled in.
D. If the claim is against more than one public entity, separate claims must be filed against each public
entity.
E. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form.
RE: Claim By Reserved for Clerk's filing stamp
SANDRIA HUSBAND }
REQIVED
'
Against the County of Contra Costa or ) JAN 0 9 2004
MARTINEZ }
District) CLERK BOARD aF SuPEPVtSORS
(Fill in name) CONTPACOSTACo.
SHERIFF DETENTION STATION }
The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district
in the sum of$ _and in support of this claim represents as follows: UNKNOWN AT THIS TIME.
1. When did the damage or injury occur?(Give exact date and hour) DULY 14. 2003 at 10:00pm
2. Where did the damage or injury occur?(Include city and county) MARTINEZ, CA (CCC)
3. Haw did the damage or injury occur?(Give full details;use extra paper if required) UNDUE FISCAL
FORCE AND VIOLENCE.
4. What particular act or onussion on the part of county or district officers, servants, or employees caused the
injury or damage? SHERIFF DETENTION STATION.
5. What are the names of county or district officers, servants,or employees causing the damage or injury?
SEE ATTACHED
6. What damage or injuries do you claim resulted?(Give full extent of injuries or damages claimed. Attach
two estimates for auto damage.) RIGHT POINTER FINGER TWISTED AND RIGHT SHOULDER DISLOCATED.
7. How was the amount claimed above computed?(Include the estimated amount of any prospective injury or
damage.) UNKNOWN AT THIS TIME.
8. Names and addresses of witnesses, doctors, and hospitals.
STILL PENDING.
9. List the expenditures you made on account of this accident or injury.
DATE TINM AlviQtfNT
STILL PENDING.
) Gov. Code Sec. 910.2 provides"The claim must be
) signed by the claimant or by some person on his behalf."
SEND NQTI ,EST .A.tt Dgy /N1
Name and Address of Attorney ) `
FRANK OFFEN (ATTORNEY)
3530 GRAND AVE. , SUITE 3 ) (Claimant's Signature)
OAKLAND, CA 94610 )
. ) 801 ALVAREZ AVE. , 6-2
(Address)
)
PINOLE, CA 94564
510-832-1104 )
Telephone No. )Telephone No. 510--964-1487
���*�«�*#*#����►.:�**#s�t�*#��****�***ss#*�**ss*���*##*s*s#*s*s*#*asp**_�*��*:��*��***�***�
NOTICE
Section 72 of the Penal Code provides:
Every person who,with intent to defraud,,presents for allowm=or the payment to any state board or officer,or to any
county,city,or district board or officer,authorized to allow or pay the saint if genuine,any false or fraudulent claim,bill,account;,
voucher,or writing,is punishable either by imprisonment in the county jail for a period of not more than one year,by a fine of not
exceeding one thousand(S 1,000or by both such imprisonment and fine,or by imprisonment in the state prison,by a fuse of not
exceeding ten thousand dollars(S 10.004),or by both such imprisonment and fine.
i
_
�l�-, VNA