HomeMy WebLinkAboutMINUTES - 01182005 - C9 CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY iii •
BOARD AC110N,-,JANUARY 1.8, 2005'
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. r" 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- $5,000.00 s
CLAIMANT: STEPHEN SAMUEL SIMONE'ITA
ATTORNEY: UNmow DATE RECEIVED: DECEMBER 13,2004
ADDRESS: 3788 CANYON WAY BY DELIVERY TO CLERK.ON: DECEMBER 13, 2004
,MARTINEZ, CA 94553
BY MAIL POSTMARKED: RECEIVED THRU FAX
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN SWEETEN ierk
Dated: DECEMBER 13, 2004_ By: Deputy
II. FROM: County Counsel. - TO: Clerk of the Board of Sup isors
(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
Beard 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: /Z By: Deputy County Counsy
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. 06ARD ORDER: By unanimous vote of the Supervisors present:
(V"' This Claire is rejected in full.
( ) Other:
t
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 91
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 fu113
prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above.
Dated: JOHN SWEETEN, CLERIC By Deputy Clerl
33 S- 19113,
BOARD OF SUS' RVISORS OF CONTRk COSTA COUNTY
INSTRUCTIONS TO.0 n1:AaN'T
A claim relating to a cause of action for death or fo:- ftijury 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 2ctioyl.
(Gov. Code § 91.1.2.)
B. Claims must be fi-Jedwith the Clerk of the Board of Supervisors at its office in Room
106, County Administration Building, 651 Pine Street, Martinez, CA 94:553.
tv
C. If claim is against 2 district governed by the Board of Supervisors, rather than the
1
County, the name of the District should be filled in.
D. if the claini is against more than one public entity, separate claims must be filed
against each public entity.
1Z.
L rKSee penalty for fraudulent claims, Penal Code See. 72 at the end of this form,
RE: Clain) By: Reserved for C'lerk's filing stamp
Stephen Samuel Simonetta RECEIVED
Against the County of Contra Costs or DEC 13 2004
District)
in-thename)-_ �RK BOARD OF SUPERVISORS'
A�nCITA rn
17he undersigned claimant hereby makes, c� 'm 8-gainst the County of Contra Costa or the
above-named district -in the suin of $ 5 100, g
.0 and in support of this claim represents
as follows:
I. Wben did the damage or injury occur? (Give exact date and hour)
Between November 2, 2004 and December 2 , 2004
2. Where did the damage or injury occur? (Include ,-.lty and county)
Discovery House Drug Treatment Program
4645 Pacheco Boulevard, Martinez , CA 94553
3- How did the damage or injury occur? (Give Rall details; use extra paper if required)
Anti-Depressant pills that were entrusted to the care of Discovery
House (Director) came up missing. (They were under lock and
4. What particular act or omission on the part of cotinty or district officers. servants. or
employees caused the injury or damage?
Director , Bob Reed failed to property assure that my medication
was secured and accounted for.
AsnOH ).,N3noOSIG Tt7:T2! t7o0E_0T_,)BG
ETEt6EESE6
-16101
5 What are the names of county or district officers. servants, or employees causing the
damage or injury?
Mr . Bob Reed , Director of Discovery House Program
6. What darnage or injuries do your claim resulted.' (Cave full extent of ;.njuries or
damaves. claimed. attach two estimates for auto dam,aae.)
Lass of medication (Prozac) approximately 60 tablets
mental anguish and distress and anxiety from no medication
7. 'Row was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
Medication repl.accement : $1 ,200 ($20 per pill x 60 pills )
Mental stress and anguish: $3, 400 / Doss of work : $400.00
8. Names and addresses of witnesses, doctors, and hospitals, n
Cur_iisJackson-Staff Counselor (was present when audit on pills was mane)
9. List the expenditures you made on account of thir-accident or injury.
None to date cannot afford to replace thesutpi.11s due to the high cast .
1 F!i P!i P R a P!i R i i 1u!!r i!r i i.a i.a a.a a k x i R i i P P a k!i P!i P a i P P i.!i.R x R i i P!!!•a r!!Pia♦a%P P R P.i
} Gov. Code Sec. 910.2 provides "The claim shall be
} signed by the claimant or by some person on his
} behalf."
SEN-D NOTICES TO: (Attorney ►
Name and address of Attorney }
} (Clailrnant's Signature)
} . 788 Canyon Way
}
} (Address)
Martinez, CA 94553
}
Telephone No. ) `i'`elephone No. (9 2 5) 228-7455
P P a%a a a P a a.P f R x t■x P i i r r a.R i k k i r a r r%a.!x r R w!a.!
NOTICE
Section 72 of the Penal Code provides:
Every person wbo, Mth intent to defraud, presents for allowance or for pad=Ment to an-,' state
beard of, o icer, or to any county, city, or district board or officer, authorized to alloys° nr g23= the
same if genuine, any false or Fraudulent claim bill, account voucher, or writing, is punishable either
by Imprisonment in the Counry jail for a period of not more than one-ear, by a fine of not exceeding
one thousand dollars ($1,000-00), ojr by both such imprisonment and fine, or by imprisonment in th-C
state prison. by a fine of not exceeding ten thousand dollars ($10,000), or by both such imprison meni
and fine.
CLAIM � Q
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY J
BOARD ACTION: JANUARY 15,, 2005
Claim Against the County, or District Governed by )
the Beard of Supervisors,Routing Endorsenpeots, ).., NOTICE TO CLAIMANT
and.Board Action. All Section ref . tis ) 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: In excess of $10,000.00 and
within unlimited Superior Court jurisdiction
CLAIMANT: EVISWI ;GLENN MESS, JR
MITCHELL MEES, a minor
ATTORNEY: J. ANTHONY ABBOTT DATE RECEIVED: DECEMBER 1 , 2004
ADDRESS: MAYALL, Ht1RLEY, KNTUTSEN, SMITH & CREW DELIVERY TO CLERK.ON:DECE 1BER 16, 2004
2453 GRAND CANAL BLVD. ,
STOCKTON, CA 95207 BY MAIL POSTMARKED: HAND DELIVERED
FROM: Clerk of the Hoard of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN SW T lerk.
Dated: DECEMBER 16, 2004 By: Deputy
II. a0_M: County Counsel. TO: Clerk of the Board of Supervisors
(/This claim complies substantially with Sections 910 and 910.2.
Phis Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The
Hoard 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: /Z —17-6By: 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 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: TOIIN SWEETEN, CLERK., By ,,Deputy Clerk
61 WARNING(Gov. code secti 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 seep 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: /P f200VJOHN SWEETEN, CLERK By Deputy Clerl
1 MAYALL,HURLEY,KNUTSEN,SMITH&GREEN
A Professional Corporation
2 2453 Grand Canal Boulevard,Second Floor
Stockton,California 95247-8253
3 Telephone(249)477.3833
I.Anthony Abbott,Esq.
4 CA State Bar No.483975 �®
Amanda R. Berlin,Esq. DEC 16 2004
5 CA State Bar No.229357
QR
6 Attorneys for Claimants,
Evison Tenn Mees, Jr., and Mitchell Mees " r'
7
B
9
1 a EVISON GLENN MESS,JR., and } No. None
MITCHELL MESS, a minor, by and )
1 through his mother,CHERYL ALLEN )
} GOVERNMENT TORT CLAIM
12 Claimants, } (Government Code Section 900 et. seq.)
13 vs. }
14 }
CONTRA COSTA COUNTY )
15 }
16 TO: THE BOARD OF SUPERVISORS, CONTRA COSTA COUNTY
17 Claimants, EVISON GLENN MEES, JR., and MITCHELL MESS, a minor, by and
18 through his mother, Cheryl Allen, present the following claim pursuant to Government Code
19 section 910 et. seq.:
20 L Names and post office addresses of claimants:
21 a. EVISON GLENN MESS, JR., 32 East Wallis Avenue, Gustine, CA 95322.
22 b. MITCHELL MESS, 305 North Kansas Avenue, Haven, KS 67543.
23 Z. Post office address to which claimants desire notices to be sent:
24 J. Anthony Abbott, MAYALL, HURLEY, KNUTSEN, SMITH & GREEN, P.C., 2453
2s Grand Canal Boulevard, Stockton, CA 95207.
26 H
27
Page I
$ Government Tort Claim.
f
1 3. Circumstances of the occurrence:
2 On September 11, 2004, a dangerous condition of public property owned, managed, and
3 maintained by the County of Contra Costa existed on Highland Road, approximately .1 miles
4 west of its intersection with Victorine Road. Specifically, but without limitation, the roadway
5 and its adjacent shoulder and ditch were in poor repair in the following particulars:
6 a. A large depression existed in the traveled portion of the eastbound lane.
7 b. The asphalt in the traveled portion of the eastbound lane was broken up.
8 C. The asphalt along the shoulder of the eastbound lane was broken up and uneven.
9 d. The shoulder was strewn with pieces of broken paving material.
10 e. The ditch adjacent to the road was filled with concrete blocks and other hazards.
11 f. These dangerous conditions would not have been reasonably apparent to a
12 motorist exercising due care.
13 These conditions of property created a substantial risk of harm when the property was used with
i4 due care in a manner in which it was reasonably foreseeable that it be used. These conditions
5 were created by employees of the County of Contra Costa, were conditions of which the County
6 of Contra Costa had actual notice, or were conditions of which the County of Contra Costa had
17 constructive notice within the meaning of Government Code section 835.
18 On September 11, 2004, claimants' decedent, Evison Glenn Mees, Sr., was operating his
1, Harley Davidson motorcycle eastbound on Highland Road when the aforementioned dangerous
20 conditions caused him to lose control of his motorcycle, which left the roadway, resulting in the
21 death of Evison Glenn Mees, Sr.
22 4. Description of damage or loss.
23 Claimants, and each of them, have suffered economic damage as a result of the loss of
24 support and other financial benefits afforded to them by decedent, their father, and which would
25 have continued but for decedent's untimely death. Claimants, and each of them, have suffered
26 the loss of the society, comfort, and care of the decedent, their father.
27
Page 2
2 e Government'fort Claim
I
f
1 5. Names of the public employees causing the loss.
2 Unknown at this time.
3 6. Amount claimed.
4 In excess of$10,000, and within unlimited superior court jurisdiction.
5 DATED: Dec. 9, 2004 MAYALLL,HURLEY TS N, SMITH& GREEN
6
By
7 J. AN Y ABBOTT
8
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Page 3
2 8 Government Tort Clain
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY •
BOARD ACTION: JANUARY 18, ;2005
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: $25,000.00
CLAIMANT: HARVALENE SPENCER AND
DONTE THOMAS
ATTORNEY: R. NICHOLAS HANEY DATE RECEIVED: DECEMBER 17, 2004
ADDRESS: 227 BROADWAY, BY DELIVERY TO CLERK.ON: DECEMBER 17, 2004
RICHMOND, CA 94804 DECEMBER 16 2004
BY MAIL POSTMARKED:
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN SWEE rk
DECEMBER 17 2004
Dated: r By: Deputy
II. MOM: County Counsel. TO: Clerk of the Board of Supervisors
(c),-s claim complies substantially with Sections 410 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 Counse
III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2)
{ } Claire 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.
Dated. •Af 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 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: JWVP JOHN SWEETEN, CLERK By Deputy Clerk
Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNT'
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,ni �e
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 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. (Govt. 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,Martinez, CA
94553, either by mail or in person.
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
Harvalene Spencer& Donte Thomas f
Against the County of Contra Costa DEC 74
or
The Housing Authority of Contra Costa (District)
(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_25,000 and in support of this claim
represents as follows:
June 29, 2004, 9 :30 a.m .
1. When did the damage or injury occur? (Give exact date and hour)
72 Hermosa Avenue , Pittsburg , Contra Costa County, California .
2. Where did the damage or injury occur? (Include city and county)
Ceiling of house fell on claimants due to water damage .
3. How did the damage or injury occur? (Give full details; use extra paper if required)
Failure to repair ceiling despite warnings of problems .
4. What particular act or omission on the part of county or district officers, servants or
employees caused the injury or damage?
clmform
5. What are the names of county or district officers, servants or employees causing the
damage or injury? Unknown, they are employees of the Contra Costa
County Housing Authority.
6. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attached two estimates for auto damage.) For H a r v a l e n e
Spencer - Injury to ankle , back, neck and headaches;
For Thomas , Injury to neck, back and headaches .
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.) Medical bills $5 ,000 for Spencer, $500
for Thomas , pain and suffering $7500 each.
8. Names and addresses of witnesses, doctors and hospitals.
Kaiser Permanente , Richmond, California .
901 Nevin Street
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
No out of pocket expenses yet to date .
Gov. Code Sec. 910.2 provides:
"The claim must be signed by the claiman
SEND NOTICE TO:__(Attorne or by some person on his behalf."
Name and Address of Attorney
� ��
R. Nicholas Haney, Esq •
Attorney at Law (Claimant's Signature)
227 Broadway
Richmond , Ca 94804
(Address)
Telephone No.237-1624( rte ) Telephone No.
NOTICE
Section 72 of the Penal Cade 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 one year, by a fine of not exceeding one thousand($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($10,000) or by both such imprisonment and fine."
clmform
IL NICHOLAS UANYY
Attorney at LAW
22.3 uXV241Wxt
16chmood,CaUtormiA 94804
(510)237-1624
FAX(510)237-7267
'To: G�
jnl 4010'
DA-VIF, OF LOSS:
Pursuant to Section 2695.20 or the C.dil`ou►ia Code of Refutations,Title, 10,
Chapter 5; l authorize R. NICHOLAS UA.NEY, my attorney, to handle my Persooal
IIIIXIR'y clairrz corder the above c:aptiooed loss.
'kills authorization shall be,valid Cor oirly one(1)year tiom the below date utfless
renc%Ned or revoked by the undersigned, Ally and all prior authorizations we 11creby
revoked by the us►dersit;rred as of the date of tills authorizatiotr.
rf
JCitxNT NAM
Altltltk�s
TELIKIMONY,
1 .
R. NICHOLAS HANEY
Attorney at Law
22"7 Broadway
Richmond, CA 948014
(510) 237-1.624
(510) 237-7267 Fax
FACSIMILE TRANISSION COVE' II SHEET
THIS FACSIMILE TRANSMISSION IS INTENDED FOR THE USE OF THE PERSON TO WHICH IT
IS ADDRESSED. IT MAY CONTAIN INFORMATION THAT IS CONFIDENTIAL,PRIVILEGED,OR
OTHERWISE EXEMPT FROM DISCLOSURE. IF YOU ARE,NOT THE INTENDED RECIPIENT,OR
THE PERSON AUTHORIZED TO DELIVER THIS FACSIMILE TRANSMISSION TO THE
INTENDED RECIPIENT,YOU ARE HEREBY NOTIFIED THAT ANY DISSEMINA'T'ION,
DISTRIBUTION OR COPYING OF THIS FACSIMILE TRANSMISSION IS PROHIBITED. IF YOU
HAVE RECEIVED THIS FACSIMILE TRANSMISSION IN ERROR,PLEASE NOTIFY US
IMMEDIATELY BY TELEPHONE(COLLECT)AND RETURN THE ORIGINAL FACSIMILE
TRANSMISSION TO US AT THE ABOVE ADDRESS BY FIRST CLASS MAIL.
rs"
DATE:
TIME:
TO-
PAX:
RE:
FROM: R.Nicholas Haney
FAX: �
TOTAL PAGES:
{including,face sheet)
'v. 6J'<�� �'Y£. 'F/ f 2 ..�'vf•� ,x^..,+T.nCa,*#'i"�� +' / LrWS.... �,�1�'�.� fi ✓+.�'F1�J�.a+R-a".�j
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If you do not receive all pages, please call Dorothy 51 33)-1624, Thank you
Original Will Not Follow _ Original Will Be Sent Via Regular Mail
APPLICATION TO FILE LATE CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA •
BOARD ACTION
Application to Fite Late Claim JANUARY 18, 2005
pp ) NOTICE TO APPLICANT
Against the County, Routing } The copy of this document mailed to you is your
Endorsements, and Board Action.} notice of the action takes on your application by
(All Section References are to } the Board of Supervisors (Paragraph III,below),
California Government Code;) ) given pursuant to Goverment Code Sections 911.8
and154 ;Please note the"WARNING"below.
Claimant: TARA BAILEY
Attorney: UNKNOWN'
Address: 137 CAVENDISH COURT
BRENTWOOD, CA 94513
Amount: 5,000.00 By delivery to Clerk on: DECEMBER 14, 2004
Date Received: DECEMBER 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: DECEMBER 14/04jOHN SWEETEN,Clerk,By: DEPUTY
II. FROM: County Counsel TO: CleAc of t eBoard of Supervisors
( ) 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:If—1420 SILVANO B.MARCHESI,County Counsel,By: DEPUTY
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.
DAT . JOHN 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: Clerk 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: *2*&V— JOHN SWEETEN,Clerk,By: DEPUTY
V. F M: (1)County Counsel (2) County Administrator WT7 Clerk of the Board of Supervisors
Received copies of this Application and Board Order.
DATED: County Counsel,By:
County Administrator,By:
APPLICATION TO FILE LATE CLAIM
BOARD OF SUPERVISORS OF CONTR k COSTA COUNTY `.,
INSTRUCTIONS TO CLAIMANT ,
A A claim relating to a cause of action for death or for injury to person or to per
property or growing crops shall be presented not later than six months after tits
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 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 Code Sec. 72 at the end of this form.
■r����v a��s�����e��aii�����rrirrrrrrr*■�ra�sa����������r�rrrrarr��r���arferr
RE: Claim By: y� 'e t l £ Reserved for Clerk's filing stamp
s �
4€ .s 3
Against the County of Contra Costa or )
District}
(Fill in the name) }
The undersigned claimant hereby makes claim against the County of Contra Costa or the
above-named district in the sum of 04 ,r,a' and in support of this claim represents
as follows: �
/.�✓at'..✓'/i;�* G'' df-{9'� +�, ,Cr'1Ei;✓`t'; M _,.bt• f✓>".'-,.f �,rcY3f"';�tf3'�ic.� '''wiJ?'� -,T'�s `? 7''" �.�3'?.�g''
1. When did the damage or injury occur? (Give exact date and hour)
'jet ✓31ss9` .T' ,c P`aa a n i _� �I ` t{`9d e zf•'#�
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2. Where did the damage or, injury occur? (Include ,.r and county)
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3. How did the damage or mjtary occur? (Give full details; use extra paper if required)
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4. What particular act or omission on the part of county or district officers, servants, or
employees caused the injury or damage?
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�,.'�'8f�.,.�-�f” b.,.1`�. fr`u.�� (.+{��.•+.�t'.i'1� ;+�G` Gd��-ti`S�d°.,.yr7 �1d't, tG�{' r S 1� �', 1 , �..
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5 What are the names of county or district officers, servants, or employees causing the
damage or injury? A/1,;
6. What damage or injuries do your claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for
utero- damage.) o/
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7. How was the amount Claimed above computed? (Include the estimated amount of any
prospective injury or,,damage ) X&z J, e¥ 4,
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,2 amen and a resses of witnesses, doctors,,an
r-'*n- /J'r'
9. List the expenditures you made on account of this: accident or injury.
DATE TIME AMOUNT
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) Gov. Code Sec. 910.2 provides "The claim shall be
) signed by the claimant or by some person on his
behalf."
SEND NOTICES TO:_IAttornev) )
Name and address of Attorney }
(Claimant' ignature)
(Address)
Telephone No. ) Telephone No. e, - ?`
,Busy*NOUN asaaararrt�rar��-s
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 one year, by a fine of not exceeding
one thousand dollars ($1,000.00), or by both such imprisonment and fine, or by imprisonment in the
state prison, by a fine of not exceeding ten thousand dollars ($10,000), or by both such imprisonment
and fine.
Welcome to Brwtwood School Distriefs Policy 4nfixe --A Service of the Missouri Schox,.. Page: I of 3
Jump to section: Go directly to code: Search by Keyword:
.Y_FG 1i K GO QCs
F JFG
CRITICAL
INTERROGATIONS,INTERVIEWS AND SEARCHES
Searches by School Personnel
School lockers,desks and other district property are provided for the convenience
of students and,as such,are subject to periodic inspection without notice.
Student property may be searched based on reasonable suspicion of a violation of
district rules,policy or law.Reasonable suspicion must be based on facts known to
the administration, credible Information or reasonable inference drawn from such
fay or information. Searches of student property shall be limited In scope based
on the original Justification of the search. The privacy and dignity of students shall
be respected.Searches shall be carried out in the presence of adult witnesses and
not in front of ether students,unless exigent circumstances exist.
It is a privilege, not a right, to park on school grounds. The school retains the
authority to conduct routine patrols of any vehicle parked on school grounds. The
Interior ,of a student's automobile on school premises may be searched if the
school authority has reasonable suspicion to believe that such a "arch win
produce svldence that the student has violated or is violating either the law or
district policy.
The administration will contact law enforcement officials to performr a search if the
administration reasonably suspects that a student Is concealing controlled
substances, drug paraphernalia, weapons, stolen goods or evidence of a crime
beneath his or her cathing and the student refuses to surrender such items. Lary
enforcement officials may be contacted for assistance in performing a search In
any rase In which a student rebases to allow a search or in which the search
cannot safely be conducted.
School employees and volunteers, other than commissioned law enforcament
officers,shall not strip search students,as defined In state lase,except In situations
where an employee reasonably believes that the student possesses a weapon,
explosive or substance that poses an imminent threat of physical harm to the
student or others and a commissioned law enforcement officer is not Immediately
available, If a student Is strip searched, as defined in state law, by a school
employee or a commissioned law enforcement officer, the district will attempt to
notify the students parents/guardians as soon as possible.
During an examination, and If reasonable under the circumstances, school
employees may require students to empty pockets or remove jackets,coats,shoes
and other articles of exterior clothing that when removed do not expose
underwear. Employees may also remove student clothing to investigate the
potential:abuse or neglect of a student,give medical attention to a student,provide
health services to a student or semen a student for medical conditions.
School Resource O#kers
h4://policy.msb t.esrg/brentwo od/showpolicy.php.file=JFC-C.1 J
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Welcome to Brentwood School Uistricfs Policy Ondine »-A Service of the Missouri Schcx... Page 2 of 3
The school resource officer(SRO) my interview or question students regarding
an alleged violation of low. A school resource officer may also accompany school
officials executing a search or may perform searches under the direction of school
officials.
Interview with Polite or Juvenile,tiffcsrst X)ther Low Enforcornant Metals
Law enforcement of k*9s may wish to interview students regarding their
knowledge of suspected criminal activity and may wish to interrogate students who
are themselves suspected of engaging In criminal activity. Such Interviews and
Interrogations are discouraged during class time, except when law enforcement
officials have a warrant or other court order or when an emergency or other
exigent circumstances exist. It Is the responsibility of the principal or designee to
take reasonable steps to prevent disruption of school operations while at the same
time cooperating with law enforcement efforts.
When law eaforcement officials find It necessary to question students during the
school day or during periods of extracurricular activities, the school principal or
designee will be present and the Interview will be conducted In private. The
principal will verify and record the Identity of the ofticer or other authority and
request an explanation of the need to question or Interview the student at school.
The principal ordins* will make reasonable efforts to notify the student's
parerntsfguardlons unless the interviewer raises a valid objection to the notlilcation.
Removal of Students from School by Law Enforcement Offic"
Before a student at school is arrested or taken Into custody by a law enforcement
official or rather legally authorized person, the principal will verify the official's
Identity. To the best of his or her ability, the principal will verify the official's
authority to take custody of the student. The school principal will attempt to notify
the students paren#siguardlons that the student Is being removed from school.
Interview with the Children's Division
Representatives of they Children's Division (CO) of the Department of Social
Services may meet with students on campus.The district liaison will work with CD
to arrange such meetings so they aro minimally disruptive to the student's
schedule. If the student is an alleged victim of abuse or neglect,CD may not meet
with the student In any school building or child care facility where the abuse of the
student allegedly occurred. The principal will va"and record the identity of any
CD representatives who request to most with or take custody of a student.
Contacts by Guardian Ad Utero and Court-Appointed Special Advocate
When a court-appointed guardian sad litem or special advocate Ands it necessary to
interview a student during the school day or during periods of extracurricular
activities,the school principal or designee must be notified.The principal will verity
and record the identity of the individual through the court order that appoints him or
her. The interview must be conducted In a privates setting and with the least
disruption to the student's schedule.
No#esE. The rsr odw Is enctwragred to check the index locoW at the boorr Wog
of this seedon for other pordpont policies and to review
odmirrWntiva fur es anoVar fauns for robftd irWorm ll on
Adopted. 01/1911999
Revised: O x120/2003;0611812004;09121/2004
Cross Refs: ECD,Traffic and Parking Controls
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Welcome to Brentwood School District`s Policy Online--A Service of the Missouri Schw— Page 3 of 3 w
KNAJ,Relatlans with Law Enforcement Authorities
legal Refs; ff 167.166,210,145,544.193,RSMo.
Now Jamey vs. T.L.0.,469 U.S.325(1985)
Brentwood School District,Brentwood,Missouri
jnk to M€ssogrl Rau€a�:ionja
0 2004, Missouri School Boards'Association, Registered in U.S. Copyright Office
For Office Use Only.JFG-C.1 J(07104)
http:/,Ipolicy.msbatiet.org/brentwoo&showpolicy.php?file=JFG-C.I J 12/10/2004
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