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Home My WebLink AboutMINUTES - 01042005 - C24 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY {,,,s • BOARD ACTION: JANUARY '04/05 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: $35,000.00 CLAIMANT: HEATHER JENNINGS ATTORNEY: SCOTT SEABAUGH DATE RECEIVED: DECEMBER 02/04 ADDRESS: 2 N. SECOND STREET, STE. 1400 BY DELIVERY TO CLERK ON:DECEMBER 02/04 SAN JOSE, CA 95113 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWE T erk Dated: DECEMBER 02, 2004 By: Deputy IT FROM: County Counsel, - TO: Clerk of the Board of Supefvisors Gy 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: ' -' " ' Y -&Zi `'° 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. ARI) 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. Date . O JOHN SWEETEN, CLERK., By Z , Deputy Clerk WARNING(Gov. code sectio;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 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 9!"4J0HN SWEETEN, CLERK.By Deputy Clerk BOARD OF SUPERVISORS OF CONTR COSTA COUNTY INSTRUCTIONS TO CLAIMANT A A claim relating to a cause of action for death or for injury to person or to personal property or growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be presented not later than one year after the accrual of the cause of action. (Gov. Code § 911.2.) B. Claims must be fled 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 Code Sec. 72 at the end of this form. aaassassaaaaassaaasaaaaaasa9amaamago asssassst inmost anaa0asaaaaasssaasaaaassr■ RE: Claim By: Reserved for Clerk's filing stamp HEATHER JENNINGS ) Against the County of Contra Costa or ) DEC U � CONTRA COSTA HEALTH SERVICES District) ��-ST�,RVISORs, na r� (Fill in the name) } CONTRA COSTA REGIONAL MEDICAL CENTER) The undersigned claimant hereby snakes claim against the County of Contra Costa or the above-named district in the sum of $_3 5,040 .00 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 8-19-04 at approximately 9 : 15 p.m. 2. Where did the damage or injury occur? (Include ..1ty and county) REGIONAL MEDICAL CENTER , MARTINEZ , CONTRA COSTA COUNTY 3. How did the damage or injury occur? (Give full details; use extra paper if required) CLAIMANT WAS A PATIENT AT THE HOSPITAL. WHILE SHE WAS ASLEEP, A HOUSEKEEPER CAME INTO THE ROOM AND MOPPED THE FLOOR . NO WARNINGS WERE PROVIDED TO 4. CLA�,IT. rti ular act or oAm�`iss ori onOtrte part o�county or districlt offfiicers seervants, or employees caused the injury or damage? CREATED A DANGEROUS CONDITION AND FAILED TO WARN OR MAKE SAFE THE DANGEROUS CONDITION. 5 What are the names of county or district officers, servants, or employees causing the damage or injury? HOUSEKEEPER RICARDO, NURSING STAFF INCLUDING NURSE C . FOOT. 6. What damage or injuries do your claim resulted` (Give full extent of injuries or damages claimed. attach two estimates for auto damage.) INJURIES TO THE MUSCULAR SKELETAL SYSTEM ADN TO THE SPINE . How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) ESTIMATED ECONOMIC DAMAGES IN THE SUM OF $5,000. 00 AND NON—ECONOMIC DAMAGES IN THE SUM OF $30,000.00. 8. Names and addresses of witnesses, doctors, and hospitals. HOUSEKEEPER RICARDS , NURSES FOOT, LAM, DEGUZMAN, DR . RILEY, DR. BLISS, ADDRESSES UNKNOWN. CLAIMANT IT CURRENTLY TREATING WITH DR. DARRIN FERGUSON, 4180 TREAT BLVD. , CONCORD, CA 9. List the expenditures you made on account of thiF accident or injury. DATE TIME AMOUNT CURRENTLY UNKNOWN—CLAIMANT IS STILL TREATING . "I iii*us son. move van ****Rom am **son ) Gov. Code See. 910.2 provides "The claim shall be )signed by the claimant or by some person on his }behalf." SEND NOTICES TO. (Attorney) Name.and address of Attorney SCOTT SEABAUGH } ' t=- r;''q.. 2 N. SECOND ST. ,S T E . 14 0 0 SAN JOSE , CA 95113 } imam' mature} 1.16 BLUE RIDGE DR . #B MARTINEZ, CA 94553 } (Address) } Telephone No. 408/298-6647 )Telephone No. 408/298--6647 _ +i iii*Nam*i i iii i hiwi.***so**Name iiiiiilil/i111111i ii i_ii h Ali i l i i ti i i i iitii i iiiieii�so one i NOTICE Section 72 of the Penal Code provides: Ever N7 person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, rite, or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claire, 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 tine of not exceeding one thousand dollars ($1,000.40), or by both such imprisonment and tine, or by imprisonment in the state prison, by a line of not exceeding ten thousand dollars ($30,000), or by both such imprisonment and fine. G nMAN, 9 •-Y '. ! ' Vii,. � ,, i +e, .:9 'rip U] 44741 C9 44 LQ GCC Uj U c Mew OC) L.LrY a� i r o o m 8:p o U) _WW MIX U) S3 A.E 4 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY �. BOARD ACTION: JANUARY 04/05 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: $500,000.00 CLAIMANT: RANDAL JEFFERY - ATTORNEY: JOHN HOLLINRAILE DATE RECEIVED: DECEMBER 03/04 ADDRESS: P.O. BOX 253 BY DELIVERY TO CLERK ON: DECEMBER 03/04 LINCOLN, CA 95648 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWE T Jerk Dated: DECEMBER 03, 2004- By: Deputy II. AtOM: County Counsel. TO: Cleric of the Board of Sup isors This claim complies substantially with Sections 910 and 910.2. 4 { } 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: > " f . f �� ' � By: Deputy County Counsf 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. BB� GIRDER: 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: ads' :JOHN SWEETEN, CLERK, By , Deputy Clerk WARNING (Gov. code secti n 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. AFFII)AVIT 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: OHN SWEETEN, CLERK By Deputy Clerk 12/03/2004 14:10 CONTRA COSTA COUNTY CLERK OF THS -� 92,5,680 40 NCS.227 fl02 BOARD OF SUPERVISORS OF CONTft k COSTA COUNTY A A claim relating to a cause of action for death or fo.- Injury to person or to personal property or growing crops shall be presented not Later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be presented not later titan one year after the accrual of the cause of action. (Gov. 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 Pine Street, Mardnez, 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. Fragd. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form. iiRitfoar'{{art{{frr►{aero{air{{rr{trot{{i•rr{ro ,1,�rrr t{A{rr{a♦r♦air{{i{raa{ir{♦{ RILE: Claim By. Reserved for Clerk's film;stamp . r Agg nst tho.County.ofCoantra Costa or RECTA F, (Fill in the name) ) The undersigned claimant hereby mattes claim against the County of Contra Costs or the above-named district in the sum of S 5 6`6c -`rand in support of this claim represents as fonows. L When did the damage or injury occur? (Give exact date and haus) { rz6o y f Z. Where did the damage or injury occur? (Include,.Ity and county) 3. How did the damage or injury occur? (Give fitll details; use extra paper if required) �✓�-•�s b ':'J �{+°�__ ' et-�,'.�v t�'��° ''�`"'j�t,3C�..-' t,.aG..'S l'�Sr'✓ lz b''c.% eS�~�4�. 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? fir ° 12/03/2004 14:10 CONTRA COSTA COUNTY CLE€€, OF THE 4 ' 2568040 N0.227 p03 5 What are the names of county or district officers, servants, or employees causing the damagie or Injury" t rt<f vt c3 .; :`a Ic4-c <n n i 6. Wham -damage or injuries do your claim resulted' (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) ,: mss �'., 6. vr .. * y-• %� , � ',.� 7. How was the amount claitne'S above computed:' (Include`vKthe'�'estimated amount of any prospective injury or damage.) �.;�'.,.4�ajY.'��P��..: Q...�� iff�f'S 1 s'C✓ � 'w W..+f�..^`:a.L+I '� .. A, d S. Names and addresses of witnesses, doctors, and hospitals. 9. List the expenditures you made on account of thin,accident or injury. DATE IDAAQUT N",iv- f*0rA lfii!■!f!a!!YlfalfalasYlfa■fai!!■Y►!am*as*!■fsfl*i!'iaa!!a Ylf i YY ial l****a*a yY!! Gov. Code Sec.914.2 provides "The claim shall be signed by the claimant or by some person on his }behalf." Name and address of Attorney } Il o } (Claimant' nature (Address) f 2-f �. Telephone No. ��i'1 � �' `"�`�7 )Telephone ZN o. � x�` ilaf OR*Ila ai!• aYfai ■!!Y fiYfi %fflRlfiffiYi!!!ai`!lfiMialf fi•!! #!!f!f •!lfiwY !f NOTICE Section 72 of the Penal Code provides: Every pet-son who, with intent to defraud,presents for allowance or for payment to IM, 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 ei