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HomeMy WebLinkAboutMINUTES - 10192004 - C12 CLAIM ir► Aw BOARD OF$UPERVLSQRS.0F CONTRA COSTA COUNTY ' BOARACTION:OCIOBER 19, 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: $256,907.00 CLAIMANT. SHANNON SWANK ATTORNEY: MARK V. MURPHY DATE RECEIVED: SEPTEMBER 14, 2004 ADDRESS: 18 CROWCANYON COURT #380 BY DELIVERY TO CLERK ON: SEPTEMBER. 14, 2004 SAN RAMON, CA 94583 BY MAIL POSTMARKED: SEPTEMBER 13, 2004 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. SEFMMBER 14, 2004, JOHN SWEETS Clerk Dated: By: Deputy II. FROM: County Counsel. TO: Clerk of the Board of Su*visors (,--)-,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 notiLying claimant. The Board cannot act for 15 days(Section 910.8). { } Claim is not timely filed. The Clerk should return claim can ground that it was filed late and send warning of claimant's right to apply for leave to present a late claire(Section 911.3). { } Other: Dated: By: Deputy County Counse III. FROM: Cleric 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 thef Board's Order entered in its minutes for this date. Dated: 7 ' y'/ JOHN SWEETEN, CLERK, By , :Deputy Clerk WARNING(Gov. code section 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. Sae 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.W!2!oag 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 Carder and Notice to Claimant, addressed to the claimant as shown above. Dated: % OFIN SWEETEN', CLERK By Deputy Cleric 9,,,09/2004 12.21 CONTRA COSTA COUNTY CLERK CE THE ? 9e318493 NO.899 naw t+ +Claim to. BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY a 2j=M0.NS.T«, W X 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 10&day after than accrual of the cause ofacticn. Claims reletting to catuses.of action for death or for injury to person or to personal prop"or lgrovAng crops and which accrue on or after January 1, 1988, must be presemd not later them six months after the wmal of the rause of'action. Claims relating to any other case of salon must be presented not later than one year after the accrual of the cause of action, (Gov't Code 911.2,) 18, Claims must be tiled with the Clerk of the Bwd of Supervisors art its office in Room 106,County Administration wilding, 651 Fine Street,Monti»ex,CA 9053. C If claim is against 1►district governed by the Board of Supervisors,rather than the County,the name of the District should be tilled in. 1`3. If the claim is against trxtra that one public entity, separate claims must be filed against each public entity. E. EMd# See penalty for fraudulent datimk Penal Code See. 72 at the end of this form. RE. Claim By Reserved for Clerk's filing stamp } SHANNON SWANK EIVEDVCU Against the County of Contra Costa or } SEP 1 4 2004 District) FOLEERKBOARD O SUPE V3 As ..„a,,,. ONTRA COSTA CO, (Fill in name) � The undersigned claimant hereby makes claim against tho'County of Contra stat or the above-named district in the Burn of 5..2 9..07..said in support of this claim repo Cnts U t'ollaws: 1. When did the damage or injury occur?(Giver exact date and hour) April 5, 2004 2. What did the damage or injury occur?(Include city and county) Intersection of Concord Avenue and Bailey Read, Concord, California . 3. How did the damage or injury o,�AwO(Give full+details,use extra paper if required) The signal light at the above intersection malfunctioned resulting in a two vehicle collision. Driver, Ashley Arata, who was making a left turn front, southbound Concord Avenue, told the Concord police she faced a green arrow. Ms. Swank, who was traveling northbound on Concord Avenue faced a green. The Concord police report is attached as Exhibit A. Claimant , is informed that the County of Contra Crista worked on the signal in question in the weeks before 4/5/04 and at least one other collision has occurred at the intersection due to a signal malfunction and maintenance. t?�/09f2em-4 12.21 CONTPA COSTP COLPI-ITY CLEW OF ''HE 4 90318463 h 0.888 D02 r 4. What particular act or omission on the part of county or district officers, servants, of employees mused the injury or damage? The County and its employees failed to maintain and properly coordinate the traffic signals at the intersection where the collision occurred. 5. What etre the names of county or district officers, servants; or employees ceasing tt:t damage or injury? Unknown at this time lr. What damage or injuries do you claire resulted?(Give full extent of its uties or damages claimed. Attach two eidniates for auto damage.) 1 . Neck sprain 2. Back sprain 3. Chest pain 4. Contusion, right knee 5. Sprained possible meniscus and ligament damage 5 . Head pain 7. flow was the arrount claimed above computed?(Include the estimated amount of any prospective injury of damage.) S. Names artd addresses ref witnesses, doctors,and hospitals. See Exhibit B which lists claimant' s treaters to date. 9. List the expenditures you made on account ofthis accident or injury. See Exhibit B tt*#+kimi�lsiwiiilstYisss�tiifiitslrssssisMissOsiwii�Riliit#�iiiil��6i*iiiiisl+iAtiii+�isress*I�+Iiii�Yt* Gov, Cade Sec. 910.2 provides"The clairn must be } signed by the claimant or by some person on his behalf.- SM W013CES TO, itornev Name and Address of Atterney ) Mark V. Murphy 18 Crow Canyon .Court #380 } (Caiman 'sSigrt r San Ramon, CA 94583 ) MARK V. MURPHY, Attorney for Claimant (Address) } 18 Crow Canyon Court, #380 San .Ramon, CA 94583 } Ttlephot hlo. -192-5) 552 41 Telephone No.r.f.9 2.,a—s52 -gam iiwiiisisilsi+f�is#+►ttssrM###siibiii+is#ts#iitiiitiisitYtt+iiri�siisM►i4sss##1ss'titii#sM�*�s*ss1�iM+Ysi 1077CE Sadao 72 at the PaW Cobjimvrdes: $vel person wbo.wMi intent to tSc mLA preicuu for do,*Aaa orft pgnwa to any state bwtalurd or officer,or tar my ■oaurr\tr,city. or distriot bwvd or ooffii+e�■er;ruthoriatd to allow or pay the sari h�.' uim.say fiJae orr,tmu�du.kast)G;Wnx.�bilk y�ouziI, F VuOer.ur VTiitint,is purkigiable eme?by imprisY�iN to County jalt fo a nd o not moi a LIUM one yar.raj it�e o not ac ee trtj one ftuasd 3100 or by boas risco trnpnowrnent lied lone,or by imosoemartt in the ass peach,by a fine tsf nm ex0r0&n;to tttortrand dollars($1 0,0W),or by botb such imosamum and it e. $A"W'IEZOLLISIONREPORT 55'5 Pay e 1 (Blau.& T} flF'k 042001 Alla pw of SPECIAL CONDITIONS U R wtam CITY JUIc"DISTRICT m"}(T MT 1 l W Nuilmto" mmamw CONY REPORTING DISTRICT BEAT COWSIONoCCURRE6ON - MO. DAY YEAR iTIME{2AOa1 NCKr3 OfFit�Rf.D, �. s Oq M7 70q � MILEPOST Myr MATS DAY OF WEEK TOWAWAY PHOTOGRA"BY: I NME FEL°TAIAR,E3 5 TWTFS YES E] NO OF C7 AT INTERSECTION WITH STATE MNY REL OR: FEETAAS.ES OF YES NO "ARTY DRIVERS LICENSE NUMBERSTATE CLASS SAFETY VLH.YEAR LICENSE NUMBER STATE ISITUN Pr�I s i 4A--Ac3*---CA- pglyEM NAME(F1[rR'ST;ARDLkE.LAST} f J� V G� 3 3 c�1 h g ti 1 "� OMER'S NAME (4 SAME AS DELIVER PEAU STREETADDRESS _.{r�` t �.+�J ' E �Y Two t,,,,,y ^y 1 -C,F'"Af OWNER'S ADDRESS 14 SAME AS DRIVER PAa33S C1TYISTATIP✓ ii w1J YENItiE -- I f 5 DISPOSITION OF VEHICLE.ON ORDERS OF: 1:1 OFFICER I ORNER E]OTHER 6CY, SFX ,HAIR EYES �11)111 kt`t`-"�K�.H'T WEI;�G,.ftHT MRTHOATE 4 RAGE t t 11Sr + � r'"" 140 kW. DSY Liar ) VV _. TAT{ PRIOR MECHANICAL DEFECTS: NdNE At'PAi{ENT RE6lkR TCY NAflRATtVC tITNE3 NOME PHONE BUSNJEaS PfiONE VEHICLE IDENTIFICATIONAUMSER: -669D DOV CHP 313E ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED ARE R+ E CARRIER POLICY^NUMBER VEHICLE TYPE �`'(UNK []NONE 0 MINOR � J s t 1;067 SGC ) E f MOD. MAJORE]RQl L OVER OfR or TRAVEL,ION STREET OR WG~Y SPEED LLMIT CA � y4� - - - .�......_..,.,..�. DOT >... ,. �,,, .:1 CAL-T ART!DRfV@R'a LICENSE NUMBER 8TATE CLASSWETY VEH.YEAR _MAK" LOR LICENSE NUMBER STATE x I 033 E - . CAYIy4�_JMA O 84 15_ , _Q_ atln'La NAME(PMNT MlE)OLF.1.A57) SW fi�/�+ { : iv�J�i 3 !Y L1�(f 71V(r OW%*R'S NAME SAME AS DRIVEL STREET ADDRESS 0 1 �Y 1 OWNER'S ADDRESS ( 1 SAME ASORWER XXM CITYISTATI&MIP 0#� OisPOalTsoN OF v++EH1y�cLE ON c�1EDERB OF; OFFICER ]ORNER OTkER 31CT•CUIT SEX HAIR EYES HEIGHT WEIGHT BIRTHDATE RACE YI J ol F' Is y�t � y.� ��"} � --M W PRIOR MEOHAMM DEFECTS: Rl Now AppARrw REFER TO NARRATIVE 0TNE3 HOME PHONE s•+ ISUS0088L+ PYONE t�r+7 VEHICLE IDEWIF"TION NLMABER:. Ellq�— � f CHP use Owy DESCRIBE VEHICLE DAMAGE SHADE W DAMAGE*AM INSURANCE CARRIER - 338.. .-+ «� POLICY NUMBER VEHICLE TYPE El U� :]NONE []MINOR I- fy 95 0 .C I ®MOLT. Mmol ROLL-OVER f� 4 DMR OF TRAVEL ON STREET OR MGHYstAY SPM UNIT CA DOT I 7`4d 5 CAL-7 TCPfPBC 1RTY DRIVER'S LICENSE NUMBER STATE GLASS SAFETY VEH.YEAR MA FAA3L'1EL.PCOLOR LICENSE NUMBER aTATE EQUIP. 3 - - - - --- - - - - _ __ ,. _ _ _ ___ _ ___ . SryFp NAME(FIRST,MIDDLE,LAS57 OWNER'S NAME (l SAME AS DRIVER EiIEd• STREET ADDRESS �� ss. Io ` OV4&-q'S ADDRESS ,{�^El� SAME DEPARTMENT ORWR �y r#� ' 13 CITYISTAT'MP CONCM R�tWtq_.p.L,ACE A�EPART ,i:+N DfaPOSIT/fayrQEt R DRIVER. OTHER OCT, sex HAIR HEIGHT IGHT i BIRTHDATE RACE 'lOz I M+s. Cay Year PRIOR MECHANICA,DRF S: AP'P REFER TO NARRATIVE TREK HOME PHONE ISUSINESS PHONE V SRR: d�rryyPOP USE rjLY Y DESCR DAMAGED AREA INSURANCE CARRIER POLICY NUMBER MOO. L I MAJOR M ROLL-OVER `� TATE OF CALIFORNIA ]RAFFIC COLLISION CODING :HP 555 Pa z Rev.8-2D OPI 042 P2.2 a l ITE OF COLLISION IMO. DAY YEAH TIM$0400 NCICt7FptCE t R I.D. NUINS44R ca _8qH OWNER'S NAME •. 4riYNERV AWRESS NOTIFf[?D VROPERfTY DYES N4 DAMAGE DESCRIPT"OF OAMADE SLATING POSITION SAFETY EQUIPMENT EJECTED FROM VEHICLE OCCUPANTS L-AIR BAG DEPLOYED M I C BICYCLE.HELMET' A-I f I VEHICLE M-AIR BAG NOT DEPLOYED 0-NOT EJECTED A S-UNKNOWN N-OTHER DRIVER i-FULLY EJECTED C-LAP BELT USED P-NOT REQUIRED V-NO 2-PARTIALLY EJECTED D-LAA BELT NOT USED W-YES 3-UNKNOWN 1 2 3 I-DRIVER E-SHOULDER HARNESS USED 4 5 6 2 TO 6-PASSENG)~RS F-SHOULDER HARNESS NOT USED CHILD RESTRAINT PASSENGER 7-ST$TION WAGON RfwAR G-LAWSHOULDER HARNESS USED �"EN mEr 01 QED X-NO 8.REAR OCC.TqK OR VAN H-LAP/SHOULDER HARNESS NOT USED R;IN VEHICLE NOT USED Y-YES 9-POSITION UNKNOWN J-PASSIVE RESTRAINT USED S-IN VEHICLE USE UNKNOWN 7 K-PASSIVE RESTRAINT NOT USED T-IN VEHICLE IMPROPER USE 0-OTHER U.NONE IN VEHICLE ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK(-)SHOULD BE EXPLAINED IN THE NARRATIVE. 18T NUMBER i1 OF PARTY ATFAULT TRAFFIC CONTROL DEVICES 1 2131 TYPE OF VEHICLE 1 3 MOVEMEN PRECEDINKi C A vc s€Ccwn Mau4EQ crr€o A CONTROLS FUNCTIONING � A PASSENGER CAR 1 STATION WAGON A STOPPED YES Pun S CONTROLS NOT FUNCTIONING' B PASSENGER CAR W 1 TRAILER X Q PRO EDING•STRAIGHT OTHER IMPROPER DRIVING... C CONTROLS OBSCURED i C MOTORCYCLE 1 SCOOTER C RAN OFF ROAD D NO CONTROLS PRESENT I FACTOR' D PICKUP OR PANEL TRUCK ID MAKIN RIGHT TURN C OTHER THAN DRIVER" TYPE Of COLLISION E PICKUP I PANEL TRUCK WI7 RAILER F_ MAKING LEFT TURN D UNKNOWN" A HEAD-ON �F TRUCK OR TRUCK TRACTOR F MAKING U TURN E FELL ASLEEP* 8 SIDE SWIPE D TRUCK I TRUCK TRACTOR W1 TRLR. D BACKING i C REAR END H SCHOOL BUS H SLOWING I STOPPING WEATHER PwAl4K I TO 2IT>Sib D BROADSIDE i OTHER BUS I PASSING OTHER VEHICLE A CLEAR I HIT OBJECT i EMERGENCY VEmtCLE J CHANGVNG-LANES CLOUDY F OVERTURNED K HIGHWAY CONST.EQUIPMENT IK PARKING MANEUVER C RA MING VEHICLE I PEDESTRIAN I L BICYCLE I L ENTERING TRAFFI D SNOWING OTHER*: IM OTHER VEHICLE M OTH 'UNWE TURNING E FOG I VISIBILITY FT. N PEDESTRIAN I N xwo INTO OPPOSIIG LANE F OTHER': MOTOR VEHICLE INVOLVED WIT" d MOPED O PARKEO A NOW-COLLISIONP MERGING LIGHTING PEDESTRIAN TRAVELING WRONG WAY A DAYLIGHT C OTHER MOTOR VEHICLE OTHER ASSOCIATED FACTOR(S) R OTHER•� _.W S DUSK-DAWN D MOTOR VEHICLE ON OTHER ROADWAY 1 2 3 (MARK I TO 2 ITEMS) C DARK-STREET LIGHTS E,PARKED MOTOR VEHICLE LVE nON caT"o'-.,�D DARK-NO STREET LIGHTS F TRAINY♦SE DARK-STREET LIGHTS NOT BICYCLE nar crxgoYE$ FUNCTIONING' ANIMAL SOBRIETY-DRUG SICAL ROADWAY SURFACE YES 3 (MARIK 117-0 22ITEMS) A DRY I FIXED OBJECT: NO$WET A HAD NOT BEEN DRINKING C SNOWY-ICY J OTHER OBJECT- E VISION OBSCUREMENT: B H8D--UNDER INFLUENCE SLIPPERY JMVDDY OILY ETC. F INATTENTION': C H80-NOT UNDER tNi LUENCt ROADWAY CONDITIONISl 1 G STOP 8 GO TRAFFIC D HBO-IMPAIRMENT UNKNOWA (MARK I TO 2ITE'MS) PEDESTRIAN'S ACTIONS _ �H ENTERING I LEAVING RAMP E UNDER DRUG INFLUENCE` HOLES,DEEP RUT" A NO'PEDESTRIANS INVOLVED 1 PREVIOUS COLLISION. F iMPAtRMENT-PHYSICAL• D LOOSE MATERIAL ON ROADWAY' R CROSSING IN CROSSWALK J UNFAMILIAR WITH ROAD 43 IMPAIRMENT NOT KNOWN C (OBSTRUCTION ON ROADWAY' AT INTERSECTION f K DEFECTIVE VEH.EQUIP.: CITED I I H NOT APPLICABLE I D CONSTRUCTION-REPAIR ZONE C CROSSING IN CROSSWALK-NOT �YES 11 sumpylFAT Eo E REDUCED ROADWAY WIDTH AT INTERSEECTIONyp SPECIAL INFORVATION I ;--FLOODED. D CROSSING-NOT IN CROSSWALK I L UNINVOLVED VEHICLE A HAZARDOUS MATERIAL G OTHER: I-IN ROAD-INCLUDES SHOULDER OTHER': H NO UNUSUAL CONDITIONS IF NOT IN ROAD N NONE APPARENT APPROACHING I LEAVING SCHOOL BUS RUNAWAY VEHICLE KETCH MISCELLANEOUS Aad INDICATE NORTH ti-e OF tFORNIA ,4JURED/WITNESS t PASSENGERS!�kp 556 E122 8-2n Opt 04.2 P . 2 or DATE OF COtikSN {IMO DAY �� TOMMOM NCiC! � AF ER 10 NUMBER It 1 OL4�+ wtyNEla PA>rIFENgEIi EXTENT OF INJURY("X"CINE) INJURED WAS("X"ONE) PA*ry SEAT SAFETY ONLY ONLY 1of Box YATAL fIEYERE OTHER vino @ COMPLMNT Nd[R ILII. gaw. EJEGTi plri3RY SiXURY LVJtlkY OF PAIN DREIER PA". M. M16YCL14T OTNEIt LRA ltjjM�V TELEPHONE o0iftEO ONLY}TRANBPORTT:f}SY; y� T TL7: i iJ L,�✓ DEScRiSE INJURIES ,((}},�'''/[jjf► VICTIM Of VIOLENT CRIME NOTIFIEO El# t �. - El D YAME! O. 7 EDS . ' " TuspHONE {INJURED ONLY) TELT BY: TAKE Ta: '` JB&CRISE INJURIES :rW YOM VICTIM OF VK7LENT CRIME NOTiFIEG 16 M 1;1 t NKt OW AUMS W ONUd thUt#TEO ONLY}T>y,HSNORTE[}8Y: TAKEW �SORISE INJURIES{A1• VSCTNR Of NIOI.ENT CRiME NOTTPIED Ah O.;=9 SY Da "Met)ONLYI TRA T $Y:. 7A0 i ESCRME INJURIES ii VICTIM OF VIOLENT CRIME NOMEO 1 fEl Q AMC 10-O.S.I ADDRESS TELEPHONE +UUREO ONLY)TRANSPORTED BY: TAKEN TO: ESCRISE INJURIES '�( '`` VICTIM LIP VIOLENT CMW NOTIFIED El 13 AIM 10,O.I!.I ADDRESS TELEPHONE NJUREO ONLY)TRANSPORTED 6Y: TAKEN TO: ESL)RISE INJURIES 04-8894 Notification-I was detailed to this collision at 1829 hrs and I arrived at 1833 hrs. All times, speeds, and measurements are approx. Measurements were paced. Summary Upon my arrival I contacted DI(Arata) and D2(Swank)at their vehicles. When I arrived both vehicles were still at their points of rest. Arata and Swank identified themselves as the drivers of their respective vehicles. They each presented their valid Calif DL. Arata told me the following, in summary; Arata said she was E/B on Concord BI approaching Bailey Rd. She was planning on turning left onto Bailey Rd. She entered the E/B left turn pocket on Concord BI at Bailey Rd and stopped at a red light. She said that her signal turned green and she began her left turn. She said That as she made the Wrn that V2(Chyr)ran a red light for WB Concord BI at Bailey Rd and the vehicles collided in the intersection. Arata told me that she faced a green left turn arrow before she entered the intersection. Swank told me the following, in summary; Swank said she was WB on Concord Bl in the #2 WIB lane. She said she was travelling at approx 35 MPD and she intended on travelling straight through the intersection of Bailey Rd. She said that her signal was green as she approached Bailey Rd. She said she entered the intersection on a green light,and as she did,V 1 made a left turn from EB Concord BI, in front of her. Swank said the vehicles collided in the intersection. Swank said she was certain she faced a circular green light as she entered the intersection, and she said that D1 had to have driven through a red light. At this intersection both East and Westbound traffic on Concord BI face circular green signals at the same time. Left turns from El$ Concord BI onto Bailey Rd are controlled by separate turn.signals(arrows.) I located no skid marks. I located no witnesses. Area of impact-18' South of the North curbline of Concord BI and 30 'East of the West curbline of Bailey Rd(Determined by debris.) Cause-Due to the conflicting statements and the lack of any physical evidence or witnesses I was unable to determine the cause of this collision. Recommendations-None Case Closed 4 of 4 Charges to Date 1. American Medical Response $ 999.71 801 1011 St. 4tn Floor Modesto, CA 95354 Tele: 800-913-9106 2. Mt. Diablo Medical Center $1,121.71 2540 East Street Concord, CA 94520 Tele: 925-674-2325 3. Hiromi Takekuma, D. 0. Estimated $ 500.00 2299 Bacon Street Concord, CA 94520 Tele: 925-798-9116 4. Spine & Sport Medicine Institute, PT $1,786.00 2525 Stanwell Dr. Ste 200 Concord, CA 94520 Tele: 925-686-5400 5. William Workmnan, M. D. Estimated $1,000.00 2123 Ygnacio Valley Road Ste K-100 Walnut Creek, CA 94598 Tele: 925-944-0110 6. Mt. Diablo Medical Center PT Estimated $1,500.00 2540 East Street Concord, CA 94520 Tele: 925-674-2325 TOTAL $6,907.42 Exhibit S i . C <AVED Law Offices of I S E P 14 2004 MARK. V. MURPHY -sor-s ?R CCS R C). Centerpoint Building * 18 Crow Canyon Court, Suite 380 i San Ramon, CA`04993' (925) 552-9900 • FAX (925) 831-8483 Email mark a.m�minjurylaw.com September 9, 2004 VIA CERTIFIED MAILIRETURN RECEIPT Clerk of the Board of Supervisors Room 106, County Administration Bldg. 651 Pine Street Martinez, CA 94553 Re: My Client: Shannon Swank Gate of Loss: 415/04 Dear Sir/Madam: Please find enclosed a claim form for the above referenced client. Very truly yours, �. A&*V'4f' / MARK V. MURPHY MVM/bkk Enclosure (as stated) C\data\Swank,ShannonitrCountyContraCosta.wpd REPLY TO SAN RAMON OFFICE ANTIOCH OFFICE LIVERMORE OFFICE PLEASANT HILL OFFICE 511 W.Third Street 197 South S Street 101 Gregory Lane#S2 Antioch CA Liven-,ore CA Pleasant Hill CA . CLAIM ,/,�• /� BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: OCTOBER 19, 201 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 Cosies. ) 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: $1,000,000.00 f r, CLAIMANT: TONY K. MORRIS C 82013 ATTORNEY: UNKNOWN DATE RECEIVED: SEPTEMBER 14, 2004 ADDRESS: SAN QUENTIN STATE PRISON BY DELIVERY TO CLERK:ON: SEPTEMBER 14, 2004 SAN QU�TIN, CA 94974 BY MAIL POSTMARKED: NO POSTMARK FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEET lerk Dated: SEPTEMBER 14, 2404. By Deputy II. MOM: County Counsel. TO: Clerk of the Board of Supervisors 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: " b''A 3._;' .33-"�;~� ,� t. ] ,<.- ..+'. `'t : { S 4.5 X n ,, f A ..rrs..S f: ... Dated. ' , By: G` : yt. _ . ,? V Deputy County Counse III. FROM: Clerk ofthe Board TO: County Counsel(1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3). IV. OARD ORDER: By unanimous vote of the Supervisors present: { This Clain 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 section 913) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or depositer 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 certifies)copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: '- '* OHN SWEETEN, CLERK By Deputy Clerk rS Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNT' { INSTRUCTIQ)N-S To CLAIMS T 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 I Oe 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 action. (Gov't Code 911.2.). B. Claims must be filed with the Clerk of the Board of Supervisors at its office-in Room 105, County Administration Building, 551 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 Code Sec. 72 at the end of this form. RE: Claim By Reserved for Clerk's filing stamp -rONI k. M0981 Against the County of Contra Costa or ) NRA (' A 61i MXW .District) SEP 14 2004 {Fill in name) ) st AR 0 sUgE -j-L-E�J9KPC ONNTTRRA cCoOS WSORS The undersigned claimant hereby makes claim against the County of Contra Costa or the above-warned district in the sum of$ 00012apand in support of this claim represents as follows: 1. When did the damage or injury occur?(Give enact date and hour) za o q 2. Where did the damage or injury occur?(Include city and county) AR A T1?i lez, � 3. How did the damage or injury occur?(Give full details;use extra paper if required) F-.,_.. „- .,-A.^'{`xi, �• h,.. b 2>..�i ti y,•; {k..... 'tom.' ..,.. .. } `$y{'' `. s' 4 k f {� r _k f p 4..v f. y': 1•\ .. r i t 4. What particular act or omission on the part of county or district officers, servants, or employees caused the - injury or damage?5 L P 7 fAL6E 1CPj 1' b1Q S. What are the names of county or district officers, servants,or employees causing the damage or injury? ARA AA 6. What damage or injuries do you claim resulted?(Clive full extent of injuries or damages claimed. Attach two estimates for auto damage.) PN t4 N� So M E/gTA L NN DAMAGES 7. How was the amount claimed above computed?(Include the estimated amount of any prospective injury or damage.) r4 j .. 8. Names and addresses of witnesses, doctors, and hospitals. DEPUT-i Newt zF. �Er44ASR MARK L166 Z 06 41$t R;C4Mt)AJD') 4 A '3'J"E Pi25 douaT 6-r MAAT`t#Jftx.s CA 9. Dist the expenditures you made on account o this accident or injury. DATE AIMEAM Gov. Mode Sec. 9113.2 provides"The claim must be } signed by the claimant or by some person on his behalf.,' SEM NOMES TQ A ]`tame and Address of Attorney ) } (Claimant's Signature) `A-16 # (Address) ) Telephone No. Telephone No. NO17CE Section 72 of the PerW Code,provides: Every person who,with intent to defraud,presorts 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 clairn,bill,account, voucher,or writing,is punishable either by imprisonment in the county jail for a period of not wort 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 state prison,by a fine of not exceeding ten thousand dollars($14,000),or by both such imprisonment and fine. i � 3 s wa•, 's. -0011 to TAD : vy . _ to n"I tit a cal3 , �v�s{r�r-ans--tis CG�;nta(77-" a 7. , aryt yin eons-��-1----qtr'-dor my ��' - au e-,tv/ -7� &.6and saa4i o45" nt, Mo-th�+�cr�-t4s zhoK-t-!Y a,F�arc atl�-mp-t- off. ✓ y occx Lice. .rix 044- tcG -fti¢-- Comrnuni-ty 2 cis �aisa�, alfri�� Serial aid Aa Vz IiQ, /v n -�,�5 Cw� ,-mow ,� �1 roc¢. ns a �oa�X7`0✓ �/iild��lasfru%.sexua� r�[y /ice-, .Sa�'�y , � 6d1-11 b¢-Ap? :�,�ployrne�r�- ,� rirY �rnurzr'fy W,l/ ,b.� r1.�✓y 46 PEOPLE fit_ TONY KING MORRIS NO. 276647--5 PAGE 4 DA NO. X 02 000366-5 SENTENCE FIXING AL:�EGATION "'THREE STRIKES" CALIFORNIA J ENILE ADJUDICATION It is further alleged, pursuant to subdivisions (b) through (i) of Penal Code section 667 , and Penal Cade section 1170 . 12, that prior to the commission of the offenses charged herein, on or about March 15, 1979, in the Superior Court of the State of California, in and for the County of Contra Costa., the Defendant, TONY KING MORRIS, suffered a juvenile adjudication pursuant to section 602 of the welfare and Institution: Code for the offense of Rape by Threat/Use of Firearm, a serious felony offense which was committed by the Defendant at the time the Defendant was 16 years of age or older, and the Defendant was adjudged a ward of the juvenile court in the same action for the commission of an offense listed in subdivision (b) of section 707 of the welfare and Institutions Cade. SENTENCE FIXING ALLEGATION "THREE S'T'RIVES" CALIFORNIA JUVENILE ADJLTD I CATION It is further alleged, pursuant to subdivisions (b) through (i) of Penal Cade section 567, and Penal Cade section 1170 . 12, that prior to the commission of the offenses charged herein, on or about �:h1 . .�, in the Superior Court of the State of California, in and for the aunty of Contra Costa, the Defendant, I' NY K 1y MORR�a, suffered a juvenile adjudication pursuant to section 602 of the Welfare and Institutions Code for the offense of mow. anal L� jr rfde '1 a serious felony offense which was committed the Defendant at the tune the D nda s 16 ear of age or r, and the Defendant was ad ' a w o in the same action for the commission of an offense listed in subdivision (b) of section 707 of the Welfare and Institutions- Code. ENHANCEMENT FEL014Y WITH PRIOR CALIFORNIA PRISON CONVICTION It is further alleged, pursuant to Penal Code section 667 .5 (b) , that prior to the commission of the offenses charged herein, on or about February 29, 1984, in the Superior Court .of the State of California, in and for the County of Contra Costa, the Defendant, TONY KING MOR.RiS, was convicted of Selling Controlled Substance, 2 counts, a felony, in violation of Health and Safety Cade section 11379, a crime for which the Defendant served a separate prison term, and the Defendant did not remain free for a period of five years of bath prison custody and the commission of an offense resulting in a felony conviction. Msg: 2817113 User: HWD4 022001 0959 IH R.QR.CA048055C.FBI/645424AA9 ( 1), -------------------------------------------------------------------------------- 4C7POU40000 . IJ 4L01 CA048055C ATN/BETTY 082013 THIS RECORD IS BASED ONLY ON THE FBI NUMBER IN YOUR REQUEST-645424AA9 . BECAUSE ADDITIONS OR DELETIONS MAY BE MADE AT ANY TIME, A NEW COPY SHOULD BE REQUESTED WHEN NEEDED FOR SUBSEQUENT USE . FBI IDENTIFICATION RECORD - WHEN EXPLANATION OF A CHARGE OR DISPOSITION I5 NEEDED, COMMUNICATE DIRECTLY WITH THE AGENCY THAT FURNISHED THE DATA TO THE FBI . ****NOTICE**** SUBJECT OF RECORD IS A REGISTERED SEXUAL OFFENDER SEE END OF RECORD FOR MORE INFORMATION NAME FBI NO. DATE REQUESTED MORRIS,TONY KING 645424AA9 2001/02/20 SEX RACE BIRTH DATE HEIGHT WEIGHT EYES HAIR BIRTH PLACE M B 1961/04/15 511 160 BRO BLK CALIFORNIA FINGERPRINT CLASS PATTERN CLASS CITIZENSHIP 10 02 06 10 17 RS RS RS RS RS LS RS LS LS LS UNI'T'ED STATES 07 52 03 09 12 AU WU WU AU AU * SEXUAL OFFENDER REGISTRY INFORMATION * * * THE SUBJECT OF THIS RECORD HAS REGISTERED AS A SEXUAL OFFENDER * WITH THE FOLLOWING AGENCY: * * AGENCY-POLICE DEPARTMENT RICHMOND (CA0071000) * AGENCY CASE -- 05311127 * NCIC NUMBER - NIC/X250169824 * REGISTERED AS - MORRIS,TONY KING * DATE REGISTERED - 1998/05/26 * REGISTRY EXPIRATION - NONEXP ALL ARREST ENTRIES CONTAINED IN THIS FBI RECORD ARE BASED ON FINGERPRINT COMPARISONS AND PERTAIN TO THE SAME INDIVIDUAL. THE USE OF THIS RECORD IS REGULATED BY LAW. IT IS PROVIDED FOR OFFICIAL USE ONLY AND MAY BE USED ONLY FOR THE PURPOSE REQUESTED. END OF RECORD -END-- , - 1- 0V -6. Q - REeUbe, Msg: 2817110 User: HWD4 022001 0959 IH QHY.CA048055C. 05311_27 .BETTYi 2) --------- -------------------------- - ---------- ----------- ------------------- ---- * FOR CURRENT REGISTRAhYT ADDRESS INFORMATION -INQUIRE INTO ** THE VCIN SYSTEM ** Yr 5F sr�:;k*sir*;F`k* Y�Nr'k�;rYr� t'�c�**�:4r�s'r�ck�:^lrk**~Ary't>k�:*9r��caF•k�rfr�*��sk* 'c*�:s49r*`1�*-kik***sr**Ir 7'r�: x k srr * ARR/DET/CITE: NAM: 01 19740810 CAID ALAMEDA CO CN-- :0-1 ##A-05423 220 PC-ASSAULT TO COMMIT RAPE DISPO:TO JUVENILE FALL ARR BY:CAPD LIVERMORE CUSTODY:CYA NAN1: 02 :9760123 CAYA PERKINS CNT: 01 #Y1297/1- GRAND #Y129'7yGRAND THEFT FROM PERSON CNT: 02 242 PC-BATTERY --- SEN FROM:CON'T'RA COSTA CO 19761208 DISPO:PAR.OLED FROM CYA RECVD BY:CAPA YOUTH AUTHORITY CUSTODY:CY NAM: 01 19790315 PAYA PERKINS CNT: 01 ##Y12971 207 PC-KIDNAPPING CNT: 02 261 .3 PC-RAPE BY THREAT -USED FIREARM 288A PC-ORAL COPULATION CN-- .- 04 211 PC-ROBBERY CNT: O5 236 PC-FALSE ?MPRISONMENT CNT: 06 211 PC-ROBBERY _USED WEAPON 198502fl1 .. DISPO:DISCHARaED Office of the SheriffWarren E. Rupf Contra Costa Com SFIERIFF Field Operations Ron Jarrell 1980 Muir Rd. UNDERSHERIFF Martinez,California 94553 � . (925)313-26.20 cam fax. (925),646-1389 Date: May 26, 2004 To: Captain Steve Fuqua Investigation division Commander via: Lt. Kathleen Parker,' Assistant Division Commander From: Sergeant Sandra Douglas i Supervisor, Sexual Assault Unit Subject: Corriplaint by Serious Sex Gender Tony Morris I have reviewed the complaint made against Detective Leslie "Skip" Warren by incarcerated Serious Sex Offender, Tony Morris. Mr. Morris is classified by the Department of Justice as a Serious Sex Offender and a Sexual Habitual Offender. Per the Penal Cada, the information about his Sex Offender status would be subject to public disclosure. His complaint is about events that occurred 2--3 years ago and are, therefore, outside of the 6-month time limit, per Sheriffs Policy 6-8:2(A)(2)(b). There is no allegation of a law violation by Detective Warren. I spoke to Detective Warren about Mr. Morris' complaint. Detective Warren did not conduct any public notification, either formally or informally about Mr. Morris. His memo is attached documenting his actions concerning Mr. Morris. Mr. Morris appears to be complaining about many issues, most of which are about the conditions of his parole and his unhappiness over his current incarceration_ Mr. Morris absconded white on parole and a warrant for his arrest was issued in October, 2001. He also failed to register under his obligations per PC 290. A second arrest warrant was obtained by Detective Warren in October, 2002, for the PC 290 violation. I have no knowledge what the Parole Department may have told citizens about him; but I do know that Detective Warren did not participate in any parole searches for him. Detective Warren inherited Mr. Morris'case from Detective Jess DeAnda,who had not finished it by the time he left the unit. Detective DeAnda did not participate in any parole searches or public notifications about Mr. Morris. Morris seems to be confused over which section of PC 288 he is convicted of. His RAP sheet lists PC 288a (Oral Copulation);the criminal I inti the D res PC 288 Child Molest. Morris'juvenile conviction record does contain victims who were under the age cff #4 vnnc�n o attacccced them; the record is currently unavailable. He will have to take up the issue with theteparEment of Justice and the Alarr�eda County DA, who sent information to DC3J. 3ur 290 violation was dismissed in lieu of his violation of Parole. I recommend his corr�plaint be deemed frivolous and closed. Attached is the response to his complaint. MWMmss sbn AN EQUAL OPPORTUNITY EMPLOYER 4 State of t alifornia-0opertinent of JusticeIST , GISTRA"TII. �OGAAM-P.O.Brix 5113387,Sacramento, 4203-3870 OTICE OF SEXOFFENDERREGISTRATION REQUIREMENT— SEI P.C. P1 sr informt3rrrm don (This Is not the Registration Form) FUL..L.NAME OF PERS6914ifiFIED #s,2 Fkst Middle ° M)1 '`` zf-t DATE;37F BIRTtd SEXRACE WIC#T EY)YS HAI#i iAY NUMBER 4-15-61 U1 OU DRWER`S LICENSE NUMBER Cif NUMB F3?II„ x .r INSTITUTION NUMBER 134 �► A�1 27 � 2A9 082013 �«�k j ARRESTING AGENCY ##ATE OF ABBESS PROSE 13 ENCY PROSECUTING COURT&CASE NUMBER ;jog= MANUA. 0= &BUR OTM CSM Y12971 usu. REGISTRABLE CONVI91 MI Ct { D11"I OF CONViCTjoN DATE of sGi~IEi AEO DISCHARGE DATE PAROL E OR PROBATION EXPIRES 3 PC 261 -79 ORREL.EASE"1;'. 41701 4-17-04 ADDRESS WHERE PERSON NOTI IED EXPEDISCHARGE,PAROLE,OR RELEASE(f=ull street address,city,and zip Dods) W �A'f.Ld.l V1YLlLY IN 1 -y;':3 r i� p ti E NAME OF AGCY SUPERVISING PAROLE OR PRtJF3A7 fQN NAND OF SUPERVISWG PAROLE OR PROBATION OFFICER OF THE DM CC; ADEIRESS a , k 5 x' TELEPt 1NE NtJN9SER 14 1515 CLAY M MCH, mum ( 514 } 622-x+7 SEX OFFENDER REGISTRATION - 'It ' }:S l have been notified of my duty register as a convicted,sex offender pursuers#to S�errr of the California Penal Cods(f�G).1 ands rrrd if is my duty to brow the legal requirements ass at�rted in 290 PC,including changee fio t &fad ch may t Th+ase requitsmersts include Dui ars not limited to the f0Nowin pAT : 0 My responsibillty to register as a sokk 9`+xWar Is a fiteViims roquiramont � 3 •1 must register within 5 working days odomrn into,or of changing residence or ft�cr `-on Iii '�� /am located orresidfng with the low enford:artehtagaIcyhatringiurisdCtion ouerttylOcAn ori � � *Upon changing my location Orplace of rslderlcn%eiflher in the present reglsterltlg agencytfl# llirl estate, 1 must inform in writing within 5 workio,""', s•the 1ei�enforCemerft agenC�w�h`'which l la M a or location in perm. AN INP 3i2MATI#3NIr NEPAWNE #Upon A slease from incancorst ion,placement or Commitment;I must register or reregister ffvt� w en rcement zagency havingiurisdicdon over my location or piece of residence, within 5 working day:of neisaa>a" �� Ul &f must annuaNy,within 5 working days of my birthday,go to the law enforcement agency hr rx taCe of resfds..Ca and update my registration information. •I must disclose t am a registeted sex offender to the licensee of a community cans facility before becoming a client of chat fedw.. *I must disclose i am a AV/stored sex offender if I apply for or accept a position or do volunteer worst for a person,group or organization where f wotk drectty with minor Children. Z i Within 5 woddog days of changing my name,l must notify the few enforcement agency havingiurrsdction ovsrmy location or place of residence. 0 •If I move out of Caiffomia,I am required to rogister in any state fn which I am located or reside,within 10 dsys,with the law enforcement agency havingiurisdfotion over my residence or location. 0 sir If I attend school or am employed in another state,I must register with the law enforcement agency in the sfate having Jurfsdiction over the school li or amplarMent location in addition to registering in my state of residence. 0 If f have no residence address,I must update my registration information at least once every 90 days and annually within 5 working dsyss of my 0 birtlrday including empicyor's name and address. •if I have ever been designated asexually violent predator, l must update my registration information at least once every 90 days and anfluslly within 5 working days of my birthday including employer's name and address. •If 1 have beery convicted of a felony sex offense and I have not previously given DIVA samples,I am required to submit two specimens of blood,a saliva Stemple,a tight thumbptirrt and a full palm print of each hand. *I must provide proof of residence with a California Drivers License or identification card or a recent rent or ufility bill. This proof is required within 30 days of registration. •If f am a parolee I must provide proof of registration to my parole agent within 5 working days of release on parole. 0 ff I am residing or I am located on a campus of the University of California,the Callfomis State University or a community 0011090,I wiff register with the chief of police of the campus in addition to registering with the local few t entbresment agency heving;udsdfction over my residence or location. s If I have more bran one rasidence address or location,I must register all addresses andlor locations write the agency or agencies havingiunsdiction over them. ' t „$ � . SIG�TLISE�OFRSMNNOT�IFIED C3ATE NOTIFYING AGENCY AT} TELEPHONE NUMBER 7 U. I c srttty that,I not d the Ind d described above of his or her duty to register under provisions of the applicable statute. ti U. NA ZE 00 NOTIFYING OPPICE 6 TEOF NOTIFICATION Y 1} b C Or x"-e C-r)0 r1J/9 j t�#Jrv�t t I?1�.. cru SAMPLES COLLECTED? .d NO a YES NAME AND TTTt E IFflOTIFYING OFFICER(Please print or type) DATE' DISTRIBUTION.TION. First Copy to DOJ(Goldenrod);Second Copy to Law Entorcernent Agency having jurisdiction over address(Canary);Third Copy to Notitying officer(Pink);Fourth Copy to Person Notified(White);Flfth Copy to Prosecuting Agency(Slue). 0SP 89 347% LllanntB iif t? nlra Tagta ( ffirr of 111 � prtff Warren E. Rupf Sheriff May 11, 21704 Mr. Tony Morris C-82013 'San Quentin State Prison San Quentin, CA 94874 Mr. Morris, I received your May 2, 2004 letter. The only issue that I could obtain from your letter regarding Office of the Sheriff Personnel was that you believe the disclosure to the public was not appropriate or unlawful. Your complaint is being forwarded to Commander Oble Anderson the Field Operations Bureau for resolution adfor investigation. The Office of the Sheriff always strives to provide the.highest quality of law enforcement service and appreciates you bringing your complaint forward. WARREN E. RUPF, Sheriff By: Lieutenant Mike Casten Professional Standards Unit (925) 335-1519 Post Office Box 391 • Martinez, California 94553-01039 (925) 335-15003 "Community Policing Sind 1850...." s� FILL LEIC"KI'ER State o f California Attorney General DEPARTMENT OF JUSTICE BUREAU OF CRIMINAL INFORMATION AND ANALYSIS VIOLENT CRIME INFORMATION CENTER P.O.BOX 903387 SACRAMENTO,CA 44203-3870 Facsimile:(916)227-4345 (916)227-3288 August 12,2044 Mr. Tony Morris C-82013 1-W-115 San Quentin State Prison San Quentin, CA 94974 RE: Inaccuracy of Record Clean Mr. Morris: We received your letter dated July 14, 2044. Thank you for your correspondence. Unfortunately,the Department of Justice is unable to give legal advise, therefore if you need further assistance regarding your civil rights or violations of your rights in the past,please contact an attorney, legal aide or public defender which may be able to assist you in that capacity. If you would litre to challenge your record which the Department of Justice may have on you, you may request a record review. To receive more information and an application for a record review, you can contact the Record Review Unit at(916) 227-3832 . Sincerely, N41CHAEL BORUFF,Assistant Manager Sex Offender Tracking Program For BILL LOCKYER Attorney General ra STATE OF CALIFORNIA DEPARTMENT OF CORRECTIONS INIVIA`tE/PAROLEE APPEALS SCREENING CDC 695(Rev 5) TO: (INMATES ENAME) CDC i E NUMR LOG NUMBER N11092LIIS, INSTITUTION UNIT Your appeal is being returned to you for the following reason(s): The action or decision being appealed is riot within the jurisdiction of the Department , INSTRUhONS ! v . QA r-R- 0 vx & 1 S l t7 L t�3 PX Ct $ .1 t v l A A- C.. -. t CU c t v t5 2. You have submitted a duplicate appeal on the sante Issue. CHECK ONE F.1 Your first appeal is currently under review at the level. Your first appeal has been completed at the Director's level. 3. You are appealing an action not yet taken. 4. You have not attempted to resolve the problem at the Informal level. INSTRUCTIONS El5. You have not adequately completed the Inmate/Parolee Appeal Form(CDC 602). INSTRUCTIONS 6. Documents not attached: --Reasonable Modification or Accommodation Request(CDC 1824) --CDC 115 and 115-A --CDC 1030 --CDC 128-G --CDC 128-0 --OTHER INSTRUCTIONS 7., There has been too great a time lapse between when the action or decision occurred and when you filed your appeal,with no explanation of why you did not,or could not,file in a timely manner. S. This issue has been appealed by: NAME CDC NUMBER UNIT EJ9. Abuse of the appeal procedure. INSTRUCTIONS ED10, You may not submit an appeal on behalf of another inmate. 11. The requested action has been granted at the second level of review and no further action is requited, APPEALS COORDI A R'S SIGNATURELATE SIGNED MAY 1 4 RECD? This screening decision may not be appealed unless you allege that the above reason is inaccurate. In such a case,phase return this form to the Appeals Coordinator with the necessary information +� s .Ir wl 14t "I' 1 ti r N �• Od CL O �• a C S yg L } .# /co iMT..'ni L � Lo Y+ •0. M co {Ct7 L p} [fl 5 0 - m L o ciO B to L CLAIM BOA—RD OF SUPER'V'ISORS OF CONTRA COSTA COUNTY BOARD ACTION: OCTOBER 19, 2004' Crim 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 Y 915.4. Please nate all"Warnings". AMOUNT: $6,000.00 CLAIMANT: PATRICIA AGUTAR ON, BEHALF OF GRACIELA BERNDORF-AGUTAR ATTORNEY: UNKNOWN DATE RECEIVED: SETT. 15. 2004 ADDRESS: 86 ANCHOR DRIVE BY DELIVERY TO CLERK:ON:SEPT. 15, 2004 BAY POINT, CA 94565 BY MAIL:POSTMARKED: LAND DELIVERED FROM: Clerk of the Board.of Supervisors TO: County Counsel Attached is a copy of the above-noted claim, Dated: SEPT. 15, 2004 JOHN SWEETS , 1 By: Deputy II. MOM: County Counsel, TO: Clerk of the Board of Supe sors (1 .4'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 yarning of claimant's right to apply.for leave to present a late claim(Section 911.3). { ) Other: Dated: w" `f, By: ¢,' w ,• Deputy County Counse 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 ''OARD 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: � JOHN SWEETEN, CLERK, By , Deputy Clerk WARNING(Gov. code sec on 913) Subject to certain exceptions, you have only six(6)months from the date this notice was personally served or deposite 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 tunes 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 f4113 prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: ✓+ Z0046HN SWEETEN, CLERK By Deputy Cleric Crim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY t INSTRUCTIONS TO CLAZIANT 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 I Ge 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 action. (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 Fine 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 PAIR I C-1 A AG W Ag- _ RECEIVED } SEP 15 2004 Against the County of Contra Costa or ) > CLLHK 80ARD OF SUPERVISORS t rt Yo n t^ VA sc District) CONTRA COSTA Co. (Fill in name) ) ^ The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of S. zar,f r'and in support of this claim represents as follows: 1. When did the damage or injury occur?(Give exact date and hour) NA 0 c�J 6 �e -21-IAOI� J P14 2. Where did the damage or injury occur?(Include city and county) 3. How did the damage or injury occur?(Give full details;use extra paper if required) e—"7; P— , S'h.—= 4114t> . 7zF7_-"rAj.4e_ AlF ..�s °7.-A r1 c: 63 eE�A5'r CAW'CeF�&. : � F)c,E�714 5,0,-6-AD -7"0 YLi&V_ .404) 6S 4 X,?D 47 t/�� .�,-- G .4 Al P 77P A 7"A4 e57-'7` 4 At 7-1,,04 6 �� k' ejz> tic) 7 ve/&,HA2 o1z 1D c, AA1 '� 7",��73� 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? f�,'t�. ,LSO TO P- A4i L TOO J VON leY 0//Q es V-4+a D 1_ 0 4>10 4'01 710 Art,,rys ,as T -`OEW 40,,,IEFA� /V� 5. What he names of con or district officers servants,or employees` caausi z tfie d a e or injury? ty , g g ' /!>h' 'T0,0 t OA1 R V PIA)6 V-4 fes? 0 Al, 0 W 15) 7- .43i V+ v depe, / �� fur CA e? y loS 6 ?c2S)-- jrI3! 6. 'What damage or tnjunas do you claim resulted7(Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) t e:�O C.4 A,_cera... Cvrt S A�t7 7-- ;;=- ,t, 0,,�1 7;141C PIZ) A <6 M,7 V EV X v AJ6S A,i.,'.-D 7. How was the amount claimed above computed?(Include the estimated amount of any prospective injury or damage.) FO a 4 4 4 v t C�S Aj - t- - r ,4 j_c— /t.��s T .fes,'�� �� PAIA,) 8. Names and addresses of witnesses, doctors, and hospitals. A r7 n 4- e4.4?u. le 1q,11 Q u G Z..V , UIJ C-15 Good rn a t L, 9. List the expenditures you made on account of this accident or injury. TATE TME Alyt©LT�IT 0< Gov. Code Sec. 910.2 provides"The claim must be signed by the claimant or by some person on his behalf." SE N U ES TO: Att me Name and Address of Attorney6t /J1 ) ' } (Claimant's gnature) (Address) } &AY x%1,'7` C,4 q 1 6S- Telephone No. ) 0 0 1 Telephone hl©. .� �5��` ��� N0710E Section 72 of the Penal Code provides: Every person who,with intend to defraud,presents for allowance or the payment to any state beard or officer,or to any county,city,or district board or officer,authorized to allow or fray the sante 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(t l,pt)t7� or by both such i mpr isonrnent and fine,or by imprisonment in the state prison,by a fine of not exceeding ten thousand dollars($I0,00D),or by both such imprisonment and fine. 8.- names addresses of witnesses, doctors, and hospitals. Anna Rafaield 1941 Keswick In, Concord CA 94518. P# 925-682-1003 Joyce Goodman 1880 6th Street,Concord CA 94518P#925- 680-8084 Dr.John Lee M.D ,Pittsburg Health Center 2311 Loveridge RD.,Pisttburg CA 94565 p#925-4312520 Dr.Agustin J.Argenal M.D ,MT Diablo Medical Center 2540 East Street, Concord CA 94524 Dr.John Hiss M.D, Mt Diablo Medical Center 2540 East Street,Concord CA 94524 Hospitals: John Muir Medical Center 1601 Ygnacio Valle Rd, Walnut Creek CA Hospital. Contra Costa Regional Medical &.Health Center 2500 Alhambra Ave. Martinez CA 94553 P# 925-370-5220 I.. ... , 11 -,. . ,. r. : 11 r}�nI I I I I ..... 1. 1. i1. -I. .11 .. 5< 11 , . I , :- 1: - . - I.:::".��..��].�:�;,.il:,::..: :�:��� �:,-- : .. '', --:.,,,�,.-,-::-, i��-.-,�--,�..;.",��'�;�,,',���:����:�:-,,,i.-,.;�� 1-:K..... :::{:, ::� T � I � I,�,,, - .-o :ry:: :i�:!i-,.::�*�ii�:i*;�.i:i:: � ,:,::: , : n :... ,� L .,.,-.,. ;.. . " - IOC . ,:� .-.I , 1-1---.'' .:....W. .,,.,.__ , :: ,� , ' rr r9 +S' •}• r,1 1 �}- �p :h f . 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M. i : i, ANO �> RRM v - 999-.999 ;$ { R± A 49 # Jfrre� �� off9Q : :ns9. 11 ,: Fy #3S CLAIM BOARD OF SUPERVISORS QF CONTRA COSTA COUNTY BOARD ACTIQN: OCTOBER 19, 2004 Crim 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: SUZY WRIGHT ATTORNEY: UNKNOWN DATE RECEIVED: SEPT. 16, 2004 ADDRESS: P.O. BOX 6483 BY DELIVERY TO CLERK.ON: SEPT. 16, 2004 CONCORD, CA 94524 BY MAIL POSTMARKED: BAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEE 1 rk Dated: SEPTEMBER 16, 2004. By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supe •sors { s 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 9117.8). { } Claim is not timely filed. The Clerk should return claim on ground that it was Fled late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). c r 3 i S -C .s 7 `.. £ j•1 ":i o f ♦ r+ Y. � '., ! _. 'C.b`fi' `' .,Y ° ' 46,5, -14 Dated: By: �r� sit 4n i6eidty County Count' cf.. III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) q/1, 4qt2., � { ) Claim was returned as untimely with notice to claimant(Section 911.3), IV. BOARD ORDER: By unanimous vote of the Supervisors present: (vK 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 se 'on 913) Subject to certain exceptions, you have only six(5)months from the date this notice was personally served or deposit in the mail to file a court action on this claim. See Government Code Section 945.5. 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 full prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:44&A** JOHN SWEETEN, CLERK By Deputy Cler OFFICE OF THE COUNTY COUNSEL ,s' SILVANO B.MARCHESI COUNTY OF CONTRA COSTA COUNTY COUNSEL Administration Building %; T $, 651 Pine Street, 91'1 Floor t SHARON L. ANDERSON Martinez, California 94553-1229 f� p J a=# CHIEF AssiSTANT t GREGORY C. HARVEY (925) 335-1800 } -. `0111 4Trw- ° VALERIE J. RANCHE (825) 646-1078 (fax) A5si5TANT5 3.` NOTICE OF UNTIMELINESS AS TO A PORTION OF THE CLAIM TO: Suzy Wright P.C . Box 6483 Concord, CA 94524 Please Take Notice as Follows: In regards to the claim you submitted on September 16, 2404, portions of your claim are timely and portions are untimely. The portions of your claire prior to March 16, 2004 that you presented against the County of Contra Costa governed by the Board of Supervisors fail to comply substantially with the requirements of California Government Code Sections 901 and 911.2, because they were not presented within six months after the event or occurrence as provided by law. Because the portions of the claim prior to March 16, 2004 were not presented within the time allowed by law, no action was taken on those portions of your claim.. The claim was forwarded to the Board for action only on the timely portions of the claims. Your only recourse at this time is to apply without delay to the County of Contra Costa governed by the Board of Supervisors for leave to present a late claim as to the claims which are untimely. See Sections 911.4 to 912.2, inclusive, and Section 946.6 of the Government Code. Under some circumstances, leave to present a late claim will be granted. See Section 911.6 of the Government Code. You may seek the advice of an attorney of your choice in connection with this matter. If you desire to consult an attorney,you should do so immediately. SILVANO B ARCHESI COUNTY UNSEL BY: , Monika= . Coop r Deputyi County Coun el Page 1 CERTIFICATE OF SERVICE BY MAIL (Code Civ. Proc., §§ 1012, 1013a, 2015.5; Evid. Code, §§ 641, 664) I am a resident of the State of California, over the age of eighteen years, and not a parry to the within action. My business address is Office of the County Counsel, 651 fine Street, 9th Floor, Martinez, CA 94553-1229. On September 28,2004, I served a true copy of this Notice of Untimeliness as to a Portion of the Claim by placing the document in a sealed envelope with postage thereon fully prepaid, in the United States mail at Martinez, California addressed as set forth above. I am readily familiar with Office of County Counsel's practice of collection and processing of correspondence for mailing. Under that practice, it would be deposited with the U.S. Postal Service on that same day with postage thereon fully prepaid in the ordinary course of business. I declare under penalty of perjury under the laws of the State of California and the United States of America that the above is true and correct. Executed on Senternber 28,2004, at Martinez, California. Kathleen O'Connell cc; Clerk of the Board of Supervisors(original) Risk Management Page 2 Claire to: BOARD OF SUPERVISORS OF Ct3N1RA COSTA COUNTY INSTRUCTIONS TO CLADiANT A. Clams relating to causes of action for death or for injurer to person or to per- sonal property or growing crops and which accrue on or before December 31, 198,1 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 injltxy 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 r>rust be presented not later than one year after the accria,1 of the cause of action. (Govt. Code §911.2.) B. Claim must be filed with the Clerk of the Hoard 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 clairrs must b-- filed efiled. against each public entity. E. ' Fraud. gee penalty for fraudulent claims, Penal. Code Sec. 72 at the end of this form. RE. Claim By ) Reserved for Clerk's filing stamp Suzy Wright " _ ) Against the County of Contra Costa } 6 004 or u District) �- R Rill In name The undersigned claimant hereby makes claim against the County of Contra Costa or the above--namd District in the sum of $ 1 don't know how to answer this. in sutra crt of this claim represents -as follows: I just want the parotid gland back in my mouth. 1. When did the damage or injury occur? (Clive exact date and hour) 12-18-03, 112/04, 4/15/04, 5/6/04, 7/10/04, 7/20/04 2. Where did the damage or injury occur? (Include city and county)�__,�_. Contra Costa Regional Medical Center Hospital, 2500 Alhambra Ave., Martinez, CA 94553 Contra Costa County 3. Hoer did the damage or injury occur? (Give full details; use extra paper if required) Complete right parotidectomy. 4. What particular act or omission on the part of col-mty or district officers, servants or ,employees caused, the injury or damage? Please see attached. 5. wrzar. are =e ra.—,-s of cour ry or district officers, servants or employees causing the damage or injury? y? Lorre T. Henderson,M.D.and Martha Corcoran,M.D. What damage or injuries do you claim resulted? give ful 1 extent; of injuries or damages claimed. Attach two estimates for auto damage. Please see attached. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Pain and suffering; future medical treatments; alternative medical treatments,such as acupuncture; cosmetic surgery;and prescriptions. 8. Names and addresses of witnesses, doctors and hospitals. Please see attached. - 9. List theexperndit;ures you�made on account of this accident or injury: Please see attached. Gov`. Code Sec. '91M provides: "The claim must be signed by the claimant SEO NOTICES TO: (Attorney) or by so erson on his. if." Name and Address of Attorney f Cl Ott s Si ure P.O. Box 6483 Address Concord,CA 94524 Telephone No. Telephone No. 41S-309-0241 NOTICE 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 claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than ane year, by a fine of not exceeding one thousand ($1.,000), or by bath such im�arisonment and fine;- or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,0100, or by both such imprisonment and fine. QUESTION 4. Negligent in reviewing my medical history and properly diagnosing the cause of the symptoms I had been seeking treatment for since 2002. Instead initiated an unjustifiable surgery that included the removal of the entire healthy right parotid gland that has resulted in assaulting all of my original symptoms to the degree of intolerable pain and suffering. Negligent in ever performing a simple and thorough examination of the inside of any mouth particularly all of the salivary glands to confirm if they were all functioning normally, ➢ '.Negligent in discussing with me at length,in depth,and in detail all of the possible adverse injuries, (in non-medical terms), I may or may not experience as a result of the surgery so(would make an informed decision about my life. Negligent in discussing with me the length of time for recovery from the surgery so I would make an informed decision about my life. QUESTION 6. ➢ My entire mouth is excruciatingly dry. (Xerostomia) The burning increases every day. )0- The irritation from the dryness inside my mouth is so severe that there is redness and flaky skin around the outside of my mouth. Especially the right comer of my mouth. ➢ Using toothpaste only increases the burning and painful irritation inside and outside of my mouth. Whenever I eat food perspiration flows down the right side of tray face. (Frey's Syndrome) I no longer enjoy eating any meals or drinking any beverages. I sometimes choke on food due to the lack of saliva in my mouth. ➢ My entire mouth is disfigured and not the same as it was before the surgery: I. The right upper lip of my mouth is sunken in. 2. My smile is now deformed and not the same as it was before the surgery. 3. My speech is sometimes difficult because of the dryness inside of my mouth and the shape of my mouth. Whenever I speak my mouth pulls to the right. 4. There is a vacuum between my gums and mouth on the inside upper right side of my mouth. ➢ My right eye is dry and irritated, The eyelid no longer closes the same as it did before the surgery. >' I am no longer able to tolerate taking antibiotic medications because they increase the dryness hence the burning inside my mouth causing my mouth to become even more painfully dry. ➢ My right ear lobe and surrounding area are still numb. The pressure in my right ear is worse than before the surgery. Page 1 of 2 QUESTION 8. HoVital: Contra Costa Regional Medical Center Hospital,2500 Alhambra Ave.,Martinez,CA 94553 Doctors: Dr. Henderson, Dr. Corcoran, Dr. Pramanik, Dr. Stone Contra Costa Regional Medical Center,2500 Alhambra Ave.,Martinez,CA 94553 Dr. White Contra Costa Health Services Pittsburg Clinic 2311 Loveridge Rd.,Pittsburg, CA 94565 Sean Sullivan,DDS 2222 Past St, Ste. 290 Concord,CA 94520 QUESTION 9. DATE ITEM AMOUNT 5/04- 10/04 Medical coverage $150 11/03 -4/04 Medical coverage $300 5/03- 10/03 Medical coverage $300 8/04 1 Dental exam,evaluation of salivaH glands $331 Jan 2004 Car repossessed due to being on disabilit y from sure $4647 Jul ,Au , Se t 2004 Co ies of medical records, mailing costs $110 Page 2 of 2 APPLICATION TO I"ILE LATE CLAIM + + ► BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA BOARD ACTION Application to File Late Claim } NOTICE TO APPLICANT OCTOBER 19, 2004 Against the County, Routing } The copy of this document trailed 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.)_ given pursuant to Government Code Sections 911.8 and 915.4. Please note the"WARNING"below. Claimant: HOPE LUCIDO AND DAUGHTER GRACE LUCIDO Attorney: UNKNOWN Address: P.O. BOX 1901 MARTINEZ, CA 94553 Amount: UNKNOWN By delivery to Clerk on: SEPTEMBER 14, 2004 Date Received: SEPTEMBER 14, 2004 By mail,postmarked on: HAND DELIVERED 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted Application to File Late Claim, DATED: SEPT. 14/04JOHN SWEETEN,Clerk,By: DEPUTY 11. FROM: County Counsel TO: Cler of the';Board of Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911.6). (, The Beard should deny this Application to File Late Claim (Section 911.6). DATED: r "j SILVANO B.MARCHESI, County Counsel, EPUTY III. BOARD ORDER By unanimous vote of Supervisors present (Check one only) ( ) This Application is 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. DA'Z'E: HN 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 relieving 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,you 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 trailing 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: JOHN SWEETEN,Clerk,By: DEPUTY V. FROM: (1)County Counsel (2)County Administrator TO: Cleric o the Board of Supervisors Received copies of this Application and Board Order. DATED: County Counsel,By: County Administrator,By: APPLICATION TO FILE LATE CLAIM PETITION TO FILE LATE CLAIM 1, HOPE LUCIDO, petition the county of Contra Costa to allow me to file this claim based on the foregoing: 00 tsps 1. Less than one year has passed since the wrongful actions, as set out in the accompanying claim, occurred. The county is not damaged by the delay. 2. 1 have been bedridden since my release from the County Medi- cal Center and have been unable to take care of even my most intimate personal care. 3. 1 was unaware of the six month deadline to file a claim against a government entity. 4. 1 am indigent and unable to hire an attorney to assist me in this matter. 5. I did not discover the surgeon's faulty conduct, wrongful actions and surgical error done to me that resulted in the complications of the internal bleeding that I suffered following the surgery until July 15, 2004. 1 declare that the foregoing is true and correct and if called upon could competently testify thereto. Executed under penalty of perjury in Martinez, California. Dated September 2004 _ H E UJCIDO CLAIM AGAINST CONTRA COSTA COUNTY �� Rk �P 142004 1. Name of Claimants: HOPE LUCIDO and her daughter, GRACE LUCIDO � � �pCO 2. Address: P.O. Box 1901 Martinez, CA 94553 3. Type of Loss: Medical Malpractice/Personal Injury/Negligent Infliction of Emotional Distress/Bystander Emotional Distress 4. Date of Injury: 09/24/2003 and ongoing 5. Location of Accident: Contra Costa Regional Medical center, Martinez 6. Description of Accident: Claimant Hope Lucido was hospitalized for surgical removal of her gallbladder and a dermoid tumor from near her right ovary. Dr. Beck performed on claimant a vaginal surgical procedure that was not consented. The only procedure that was consented was to be done abdominally, by doing so caused claimant excess trauma which resulted in the complications of internal bleeding that claimant suffered following the surgery. For nearly 24 hours after the surgery, she hemorrhaged profusely from her vagina and bled internally without any efforts to stop the bleeding. The delay in treatment caused a loss of blood, dangerously reduced blood pressure, elevated heart rate and a great risk of fatality. Claimant has not yet recovered, even though a year has passed. Claimant required two additional hospitalizations for pancreatitis, the infection which was caused by the County staff and doctors. Claimant Hope Lucido's daughter was a witness and bystander to the wrongful action of Dr. Beck, Dr. Diaz, and the Contra Costa County Nursing staff and suffered severe emotional distress and continues to suffer. 7. Liability: Dr. Beck and the staff at the Medical Center are liable for their negligent treatment, and failure to treat, claimant causing infection to set in which required additional hospitalization and caused debilitation of her health. Dr. Diaz is liable for intentional and negligent infliction of emotional health for screaming at claimant and humiliating Page 2. and degrading her while claimant was weak from loss of blood. 8. Damages: Claimant has been completely disabled as a result of the negligent treatment by the doctors and staff of Contra Costa County Health Services. She has required around-the-clock personal care. Her health will never recover to its pre- surgery state. 9. Witness: Daughter Grace Lucido 10. Amount of Claim: Unlimited case. Medical and personal caregiver costs are ongoing. All notices and communications should be sent to Grace Lucido, P.O. Box 1901, Martinez, CA 94553. Al DATED: � A \ Grace Lucido, daughter of claimant, Hope Lucido