HomeMy WebLinkAboutMINUTES - 02052008 - C.7 AMENDED CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY C •
BOARD ACTION: FEBRUARY 05, 2007
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
California Government Codes. ) you is your notice of the action taken
r". �- ^ r on your claim by the Board of
!::; ti Supervisors. (Paragraph IV below),
MEC 2 8 2007given Pursuant to Government Code
AMOUNT: $157.03 Section 913 and 915.4. Please note all
COUNTY COUN!:;+--L "Warnings".
MARTiN`Z CALIF
CLAIMANT: MATRIX ABSENCE MANAGEMENT
ATTORNEY: UNKNOWN DATE RECEIVED:
DECEMBER 27, 2007
ADDRESS: 2208 PLAZA DRIVE, SUITE I(NY DELIVERY TO CLERK ON: DECEMBER 27, 2007
ROCKLIN, CA 95765 RECEIVED FROM COUNTY
BY MAIL POSTMARKED: COUNSEL
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN CULLEN, C k
Dated: DECEMBER 28, 2007 By: Deputy
1I. FROM: County Counsel T0: Clerk of the Board of Sup rvisors
(V/ 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: �' 0� By: m Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2)
O Claim was returned as untimely with notice to claimant (Section 911.3).
(1V. ARD ORDER: By unanimous vote of the Supervisors present:
This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this date.
Dated:fC HN CULLEN, CLERK, By Deputy Clerk
WARNING (Go . 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 fide a count 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. U you want to consult sur
altonney,you shoved do so immediately. *For Additional Warning See Reverse Side of This Notice.
AFFIDAVIT OF MAILING
I declare under penalty of pei jury 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, hostage fully prepaid a certified copy of this
Board Order and Notice to Claimant, addressed to the claimant as shown above.
Dated JO.HN CULLEN, CLERK By Deputy Clerk
Abnw&�00 01f
11/29/2007 09:25 FAX 925 335 1866 CONTRA COSTA CTY COUNSEL 2002/003
BOARD OF SUPERVISORS OF CONTRA. 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 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.
■■rr�rr■����■■■■rr■■err■•�■■■rr■r■■r■■■.■■■r■■■■■■■■■r■■■■■■■■rr■r■.■r■rrr■■r■
RE: Claim By: Reserved for Clerk's filing stamp
Against the County of Contra Costa or
g
District) 9c s i
(Fill in the name) ) os cOFgG�
—) ° so
qs,
The undersigned claimant hereby makes claim against the County of Con ra Costa or the above-named
district in the sum of$ \S"1 . 0 3 and in support of this claim represents as follows:
1. When did the damage or injury occur? (Give exact date and hour)
IV-)\(�-I O �55 (o
2. Where did the damage or injury occur? (Include city and county)
N XAe SN4 c e-C W CC ems . C c>rNNk— CoS CC`{AV0f
3. How did the damage or injury occur? (Give full details; use extra paper if required)
4. What particular act or omission on the part of county or district officers, servants, or employees
caused the injury or damage? R\e C,5X_-, R e-�.e r Ac" \k-a- f 6`\c f-
5
5 What are the names of county or district officers, servants, or employees causing the
damage or injury? �\C C,_c c\c--,, ON k�4-�-2 G.\e 2
11/29/ )07 09:25 FAX 925 335 1866 CONTRA COSTA CTY COUNSEL Z003/003
6. !What damage or injuries do your claim resulted? (Give full extent of injuries or damages
claimed. Attach two estimates for auto damage.) -C\,,
Afv,,poS4cr.,� ��cy.ex, W-6 \A .
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.) Q`t as` see cv�e \1 : -�
\ �: \�
\0--- to 4-',Ce c1 --,,S P"et ,s-e- C vA M.PJ, cwt Free ScNke,AJ
8. Names and addresses of witnesses, doctors, and hospitals: A�S� 13
\Ggl N . Q�,C-0IkAu� SA' -e \h.o l.Ja\A-.A ereeK CA C�t-15`1 , - -s t?
9. List the expenditures you r6de on account of this accident or injury:
DATE TIME AMOUNT
-� \S--?
■■no ENDS ONE WEESEENEW ERROR N E E M E N N■.■■■..MEMO■1■E.E M ENE.E■E O.■D■O.O■E N■1■M M.M M S O.MON MEN
Gov. Code Sec. 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 N I,p, )
(Claimant's Signature)
(Address)
Telephone No. ) Telephone No. U
.N..........ED.NMDN.........M.......................................M................
PUBLIC RECORDS NOTICE:
Please be advised ;hat this claim form, or any claim filed with the County under the Tort Claims Act, is subject to
public disclosure under the California Public Records Act. (Gov. Code, §§ 6500 et seq.) Furthermore, any
attachments, addendums, or supplements attached to the claim form, including medical records, are also subject to
public disclosure.
..........M.MMM....■........DM.■MM.M.....M■N...DMD.ED■.MM..■■■:■.EM..MERNow MMEN.■■..l
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.
08; 7/2007. 06:39 9259308786 DIRITO BROS PAGE 04
�TF.TF OF�_IFORN'.4
TRAFFIC COLLISION REPOR
CHP 555 CARS Page 1 (Rev 1-03)OR 061 Pxgc 1 4
of
$>yC 1 rn,*axR wramxe CITY JUDICIAL DISTRICT LOCAL REPORT NUMBER
lN7ED FELOKr
1 WALNUT CREEK WC SUPERIOR
++M 'k"UEO HTARUN COUNTY REPORTING OISTRIC,T BEAT 07-16213
1NbP[M[ANOR
0 CONTRA COSTA TWO
COLLISION OCCURRED ON: MO DAY YEAR ME(2400 NCIC 0 OFPICCR L0.
z PINE STREET 7/17/2007 0856 0712 11253
MILEPOST INFORMATION: DAY OF WEEK TOW AWAY PHOTOGRAPHS BY: -NONE
U 'THURSDAY X YES D No SO SGT,
0 AT INTER5ECTION WITH: STATE HWY REL
X oR: 150 FEET WEST OF NORTH BROADWAY n YE$ n NO
PARTY ffZFJCARDO
LICENSEE NUMBER STATE CLASS AIR SAG SAFETY EQUIP. VEH.YEAR MAKE!MODEL ICOLOR LICENSE NUMBER STATE
B5303943 CA 3 L G 2005 ORD CROWN VI WRI 1186978 CA
DRIVERST.MIDDLE,LAST) ON DUET VEHICLE
GONZALEZ OWNER'S NAME -ME AS DRIVER
PEDES- STREET ADDRESS
TRIAN CONTRA COSTA.COUNTY
1980 MUIR ROAD OWNER'S ADDRESSI�
ICLSAM[AS ORNEA
PARKED CITY/srArelzlP 2467 WATERBIRD WAY MARTINEZ CA 94553
VEHE
MARTINEZ CA 94553 DISPOSITION OF VEHICLE ON ORDERS OF: OFFICER DRIVER OTHER
BLIT- SEX HAIR LYES HEIGHT WEIGHT BIRTHDATE RACE BA'X POINT TOW
CL19T
M HLK $RN 5-07 160 M10/2/1978 Tex W PRIOR MECH,DEMCCTS X NONE APP. REFER TO NARRATrvC
OTHER HOW PHONE BUSINESS PHONL! VEHICLE;IDENTIrICATK)N NUMBER:
(925)646-2441 VEHICLE TYPE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA
INSURANCE CARRIER POLICY NUMBER UNK C NDNE MINOR
COUNTY SELF INSURED 01 X M00 MAJOR OVER
DLR OF 7RAVELl CN STREET OR HOHWAY SPEED LIMIT DOT
E PINE STREET 25 CALlT rcP/Psc MC/MX
PARTY DRIVER'S LICENSE;NUMBER STATE CLASS AIR BAG SAFETY EQUIP. VEH.YEAR MAKE 1 MODEL[COLOR LICENSE NUMBER STAT[
2 A5593826 CA 3 M G 1999 VW JETTA BLK 405H548 CA
DRIVEER NAME(FIRST,MIODL2,LAST)
MARK DAVIS JOHNSON OWNER'SNAKIE f SAME As DRIVER
PERE&
TRIASTREET ADDRESS FREDERICK LEITZ
❑N LUJ
234 PHEASANT CIRCLE owNER'$ADDkE55 �SAME AS DRIYER
F
CITY/WAYtr/aP 4OYSTER SHOALS ALAMEDA CA 94502
PITTSBURG CA 94565
DISPOSITION OF VEHICLE ON ORDERS OF; �OPMCER DRIVER r�OTIgR
SEX HAIR EYES HEIQHT WEIGHT BIRTHDARACE11M BBN RN 5-08 170 4/23/1977 w PRIOR MECHANICALDEFECTB NONE APP, REFER TO NARRATIVEHOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER:
(925)915-0529 (925)934-8224 VEHICLE TYPE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA
INSURANCE CARRIER POLICY NUMBERL11K NONE ❑MINOR _
SENTRY SELECT 49-48985-03-50 ok X OR ROLLOVER
DIR OF TRAVEL ON STREET OR HIGHWAY SPEED LIMIT CA _ _OOT
E PINE STREET 25 CAL-T TCPAPSC MGMX
PARTY ORIVER'S LICENSE NUMBER STATE CLASS AIR BAS SAFETY EQUw. VER YEAR MAKE I MODEL/COLOR LICENSE NUMBER $TATE,
3
DRIVLR NAME(FIRST,MICDLE,LAST)
OWNE'R'S NAME ❑SAME AS DRIVER
PEDES-
TRIAN STREET MbRE55
OWNER'S ADDRESS SAME AS DRIVER
PARKED CITY STATE/ZIP
VEHICLE
OISPO$LTION OF VEHICLE ON ORDERS DF: OFFICER ❑DRIVER NEER
BICY- BEY HAIR [YES HEIGHT WEIGHT BIRTHDATE' RACE
CLIST MO Day Tex
PRIOR MECHANCLAL DEFECTS 71 NONE APP. ER TO NARRATIVE
OTHER HOME—ONt OUSINEBS PHONE VEHICLE IDENTIFICATION NUMBER
11 VEHICLE TYPE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA
INSURANCE CARRIER POLJCY NVMBeR UNKNONE MWpR
MOD MAJOR ROLLrCVER
DIR OF TRAVEL ON STREET OR HIGHWAY SPEED LIMIT
CA DOT
CA-LT TCPIPSC MC'm
F'R£P�i�
E CASPATCHNOTIF1Eb RCvIEWER'S NAME ' OA7Ep4V
K.MAAN P 2 5 3 X YES No WA 1(
r�: I : q 0 q
MUIR/DIABLO OCCUPATIONAL MEDICINE INVOICE
An Affiliate of the John Muir/Mt. Diablo Health System Worker's Compensation
REMIT TO Invoice Date 07/16/07
Muir Diablo Occupational Medicine Medical Group,Inc. Invoice# 2002-175281
Federal Tax ID#680346329
2231 Galaxy Court Po#
Concord,CA 94520
Ph:925-685-7744 Fax:925-682-1915 Terms Net 60 Days
Date of Injury: 07/12/07
For services rendered at: Claim Number: AGE533507
Muir/Diablo Occupational Medicine-Walnut Creek Exam Type: Injury-New
BILL TO: Provider. Weslev Chan,M.D.
FOR: G77368
Matrix Absence Management/Rocklin Johnson, Mark D
2208 Plaza Drive Ste. 100 136-56-0617
Rocklin, CA 95765
Dirito Brothers/Walnut Creek
1840 North Main Street
Walnut Creek, CA 94596
Diagnosis: 846.0 Sprain/Strain, Lumbosacral
E813.0 My-Oth Veh Coll-Driver
Date of Service CPT Descri Ptiori x Unit Cost Qty Amotinf " BalanGe,�4-e,
� � _.,
07/13/07 99204 Office Visit New Mod Severity 146.12 1` ' 14F.12,t 146'12
07/13/07 E0238 Hot/Cold Pack With Straps Take Home 25.00 1 25.`Ob` ' 25,0,0
07/13/07 J8499 Ibuprofen 200Mg#90 NDC00904791540 10.91 1 10.91 10.91
Balance: I` 182.111182.03
Please write invoice number on payment check
Rev:02052005- invwc Page: 1
08/27/2007 06:39 92593""786 DIRITO BROS PAGE 05
STATE C.JbF;0RN;N
TRAFFIC COLLISION CODING
CHP 555 CARS Paget(Rev. 1-03)OPI 061 Page 2 of 4`
DATE OF COLLISION(MO.DAY YEAH) TIME(2400) NOIC>< OFFICER I.O. NUMBER
7/12/2007 0856 0712 P25
3 07-16213
OWNER OWNER ADDRESS NOTIFIED
PROPERTY []YES [ NC)
DAMAGE DESCRIPTION OF DAMAGE
SEATING POSITION SAFETY EQUIPMENT INATTENTION CODES
OCCUPANTS L-AIR BAG DEPLOYED MIC BICYCLE,HELMET
A-NONE IN VEHICLE M-AIR BAG NOT DEPLOYED DRIVER PASSENGER A-CELL PHONE HANDHELD
EE
8-UNKNOWN N-OTHER V-NO X-NO B-CELL RO IC EQUIHANDPMENT
W-YES Y•YES C-ELECTRONIC EQUIPMENT
C-LAP BELT USED P•NOT REQUIRED p.RADIO f CD
1 3 T-DRIVER D-LAP BELT NOT USED E-SMOKING
E-SHOULDER HARNESS USED CHILD RESTRAINT F-EATING
'� S 6 2 TO 4-PASSENGERS EJECTED FROM VEHICLE
7•STA.WGN REAR F-SHOULDER HARNESS NOT USED Q-IN VEHICLE USED G•CHILDREN
G-LAP/SHOULDER HARNESS USED 1-NOT EJECTED H-ANIMALS
8-RR OCC TRK,OR VAN R-IN VEHICLE NOT USED 1•FULLY EJECTED
H-LAP/SHOULDER HARNE53 NOT USED
9- ON UNKNOWN J•PASSIVE RESTRAINT USED S-IN VEHICLE USE UNKNOWN 2-PARTIALLY EJECTED I- PERSONNEL HYGIENE
0•OTHEOTHER T-N VEHICLE IMPROPER USE 3-UNKNOWN J- READING
K•PASSIVE RESTRAINT NOT USED U-NONE IN VEHICLE K-OTHER
ITEMS MARKED BELOW FOLLOWED BY AN ASTI=RISK I')SHOULD BE EXPLAINED IN THE NAPRATIVE,
PRIMARY C,QLLISION FACTOR -2 j - MOVEMENT PRECEDING
LIST NUMBER(a)OF PARTY AT FAULT TP 1FFiC CONTROL DEVICES j 2 SPS;41aL IN�ORNtA iTON i COLLIB!GN
VC SECTION VIOLATED: CITEDES A CONTROLS FUNCTIONING I JA HAZARDOUS MATERIAL IX I JA STOPPED
A 22350 �10 B CONTROLS NOT FUNCTIONING' B CELL PHONE HANDHELD IN USE X 8 PROCEEDING STRAIGHT
B OTHER IMPROPER DRIVING' C CONTROLS OBSCURED C CELL PHONE HANDSFREE IN USE C RAN OFF ROAD
X D NO CONTROLS PRESENT/FACTOR- X X D CELL PHONE NOT IN USE D MAKING RIGHT TURN
C OTHER THAN DRIVER' TYPE OF COLLISION E SCHOOL BUS RELATED E MAKING LEFT TURN
0 UNKNOWN' A HEAD-ON F 75 FT MOTORTRUCK COMBO F MAKINOUTURN
B SIDESWIPE p WFT TRAILERCOM60 ___'0_BACKING
X C REAR END H H SLOWING/STOPPING
WEATHER (MARK 1 TO 2 ITEMS) D BROADSIDE I I PASSING OTHER VEHICLE
X JA CLEAR E HIT OBJECT J J CHANGING LANES
B CLOUDY F OVERTURNED K I IK PARKING MANEUVER
C RAINING G VEHICLE/PEDESTRIAN L I IL ENTERING TRAPPTC
D SNOWING IH OTHER': M I IM OTHER UNSAFE TURNING
R FOG/VISIBILITY FT. N IN XING INTO OPPOSING LANE
F OTHER:' MOTOR VEHICLE INVOLVED WITH 0 10 PARKED
G WIND A NON-COLLISION P P MERGING
LIGHTING B PEDESTRIAN Q U TRAVELING WRONG WAY
X JA DAYLIGHT )( C OTHER MOTOR VEHICLE OTHER ASSOCIATED FACTORS R OTHER':
B DUSK-DAWN b MOTOR VEHICLE ON OTHER ROADWAY 1 2 (MARK 1 TO 2 ITEMS)
C DARK•STREET LIGHTS E PARKED MOTOR VEHICLE A v BECTlo"O ATev CITLD BYES
D DARK-NO STREET LIGHTS F TRAIN No
E DARK-S'TREET LIGHTS NOT 0 BICYCLE B VO GGOMN VIOLATED. Vm BYES
FUNCTIONING' H ANIMAL' NO SOgR1ETY-DRUG
ROADWAY SURFACE C vcaEcnvnviouTav orrm YES 1 2 3 (MARK 71 OPHYSICAL
X A DRY I FIXED OBJECT! e NO
2 ITEMS)
B WET D X X A HAI)NOT SEEN DRINKING
C SNOWY-ICY J OTHER OBJECT: E VISION OBSCUREMENT: 8 HOD-UNDER INFLUENCE
D SLIPPERY(MUDDY.OILY.ETC.) F I!7ATTENTION';C-ELECTRONIC EQ C NBD-NOT UNDER INFLUENCE'
ROADWAY CONDMON(S) G STOP&GO TRAFFIC D HBD-IMPAIRMENT UNKNOWN'
(MARK 1 TO 2 ITEMS) PEDESTRIAMs ACTIONS H ENTERING!LEAVING RAMP R UNDER DRUG INFLUENCE'
A HOLES,DEEP RUT' X A NO PEDESTRIANS INVOLVED I PREVIOUS COLLISION F IMPAIRMENT-PHYSICAL'
5 LOOSE MATERIAL ON ROADWAY' B OR038ING IN CROSSWALK J UNFAMILIAR WITH ROAD Q IMPAIRMENT NOT KNOWN
G OOSTRUCTION ON ROADWAY' AT INTERSECTION K DEFECTIVE VEH.EQUIP,; CITED H NOT APPLICABLE
D CONSTRUCTION-REPAIR ZONE C CROSSING IN CROSSWALK-NOT n YES I SLEEPY!FATIGUED
E REDUCED ROADWAY WIDTH AT INTERSECTION IL-J-�NO
F FLOODED' D CROSSING-NOT IN CROSSWALK L UNINVOLVED VEHICLE ---
G OTHER': E IN ROAD-INGLUDES SHOULDER M OTHER-:
X H NO UNUSUAL CONDITIONS F NOT IN ROAD X N NONE APPARENT
0 APPROACHING/LEAVING SCHOOL BUS 0 RUNAWAY VEHICLE
SKETCH MISCELLANEOUS
TYPE COLL:G
INDICATE NORTH SPECIAL COND:NONE
Y( PCF:22350 CVc
CASE STATUS:CLOSED
CLOSED BY:P253
COPIES TO: ?5, '{ p
INDF-XED BY,.
08;L'7/2007 06:39 92593^'786 DIRITO BROS PAGE 06
STATE OF CALIFORNIA
INJURED/WITNESSES/PASSENGERS Page 3 of 4
CHP 555 CARS R2QR 3 Rev 1-03 OPI 061
DAYS Of COLLISION(MO. DAY YEAR) TIME(2-1) NC
# OFFICER I.Q. NUMBER
7/12/2007 0854 0712 P253 07-16213
wiTNESS aASSENCER EXTENT OE INJURY(')'ONE) INJURED WAS{'X'ONE) PARTY $EAT ALR SAFETY EJECTEO
AGE SEX NUMBER POS. 9AG EQVIP.
ONLY ONLY FATAL SEVERE OTHER VISIBLE GOMPUINT
ORfvEa PASS. PEO. BICYCLIST OTHER
INJURY INJURY INJURY OF PAIN
* x ❑ ❑ ❑ 1 1 L G 0
TELEPHONE
NAME/0.0.6.1 ADDRESS
RICARDO GONZALEZ (10/02/1978) 1980 MUIR ROAD MARTINEZ CA 94553
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
NA NA
DESCRIBE INJURIES: LACERATIONTO SCALP.
VICTIM OF VIOLENT CRIME NOTIFIED
NAME IOA.O,fADDRESS TELEPHONE
(INJURED ONLY)TRANSPORTED BY: _ TAKEN TO; w�
DESCRIBE INJURIES:
VICTIM OF VIOLENT CRIME NOTIFIED
# o ❑ 0 0 o L ❑ ❑ ❑ T-7
NAME/D.O.B./ADDRESS TELEPHONE
(INJURED ONLY)TRANSPORTED BY; TAKEN TO:
DESCRIBE INJURIES:
VICTIM OF VIOLENT CRIME NOTIFIED
NAME I D,O.B./ADDRESS TELEPHONE
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
DESCRIBE INJURIES:
VICTIM OF VIOLBNT CRIME NQ(IFIED
NAME!D.O.B./ADDRESS TELEPHONE
(INJURED ONLY)TRANSPORTED SY: TAKEN TO:
DESCRIBE INJURIES;
VICTIM OF VIOLENT CRIME NOTIFIED
❑# ❑ o ❑ o ❑ ❑ ❑ I=]
❑
NAME/D.0.6.!ADDRESS TELEPHONE
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
DESCRIBE INJURIES:
V OF VIOLENT CRIME NOTIFIEP
PREPARER'S NAME I.D.NUMBER MO. DAY YEAR REVIEWER'S NAME MO. DAY YEAR
K.M,HARMAN P253 7/12/2007
08'7/2007 06:39 92593^' 786 DIRITO BROS PAGE 07
STATE OF CALIFORNIA,
NARRATIVEISUPPLEMENTAL PAGE 4 OF 4
DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER
07/12/2007 0856 0712 P253 07-16213
1 NOTIFICATION: On 7-12-07 at about 0900 hours I was dispatched to a minor injury two-vehicle
2 collision on Pine Street West of North Broadway. I responded from Ygnacio Valley Road and Oak
3 Grove Road and arrived on scene at 0908 hours. Officer Leonard and Sgt. Cashion were already
4 on scene_ Both involved vehicles were parked at the south curb of eastbound fine Street west of
5 North Broadway_ Driver#2 was identified with a valid California driver's license. Driver#1 was
6 verbally identified. He had a valid California driver's license.
7
8 SUMMARY, Priori collision 5=,dflvers UveFddtivirig bast bh-Fine STr-��6fwes UT ,Nfbrth
9 Broadway. Driver#2 stopped because he thought a pedestrian to his left was going to cross the
10 street. Driver#1 was driving a Sheriffs Patrol Car. He looked down at his computer and did not
11 realize that Vehicle #2 had stopped. Driver#1 applied his brakes, but could not stop in time.
12 Vehicle#1 rear-ended stopped Vehicle #2.
13
14 CAUSE: Driver#1 caused the collision by driving an unsafe speed for conditions, looking down at
15 the computer with stopped traffic ahead, 22350 CVC.
16
17 DISPOSITION: Case Closed.
PREPARED BY NUMBER �DATE R�/1 'S NAME 0 iK. M. HARMAN �*�J.D,
253 2/2007 111 f4 `
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f" 07000038352 James Cuneo 1210612007 Medical status and POA
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0700004248E Fularxe Data intake: General Case
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07000043084 Payments Slioteped... urned to Karser?
0700009318E ate Check Y Status ayee Name Reserve Category Amount 80ing... from Dr.Snider been receivec
07000043381 09118J20D7 16999 Paid OCCP PHYSICIANS MED A55 Medical 157.03
07000043430 Send 4etter...
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07000043730 Andrew shank 12/07/2007 If the EE has not returned to the cin¢set an
07000093783 Paula Londrurn 1211112007 Med status?
Y' 07000093898 Saul Garoa 12/1912007 Clam review
III + U 07000043938 Jose Perez 12J10J2007 1 left an initial contact vcml for Elsa Mendoza
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