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HomeMy WebLinkAboutMINUTES - 01082008 - C.25 (15) • CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY e • BOARD ACTION: ( 'O8 e� 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 on your claim by the Board of `' `���°' �•' Supervisors. (Paragraph IV below), �n NOV 2 9 2007 given Pursuant to Government Code AMOUNT: $ 1)5C0 , DO D Section 913 and 915.4. Please note all COUNTY COUP' "Warnings". CLAIMANT: t r lofnCSS h4ARTI.NIE?CAt_i''. ATTORNEY: Pe+ff L&rt �r DATE RECEIVED: l U 6�renl b-er 2_q 7�7 ADDRESS: 14ni , Affeyt451AMnee1- BY DELIVERY TO CLERK ON: If�q 04.6 14, CAuF �Ivd, f WaQru,�-Osgk BY MAIL POSTMARKED: Vd- kakd . FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CUL N, Clerk, Dated: mwtw, m zx7 By: Deputy hV_1 UJ OJA,- 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 91. 1.3). O Other: Dated: D By: i / r�� Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. OARD ORDER: By unanimous vote of the Supervisors present: . ( This Claim is rejected in full. O Other: I certify that this is a true and correct copy of the•Board's Order entered in its minutes for this date. Dato OHN CULLEN, CLERK, By01 eputy Clerk WAR ]NG (G . co e section 913) Subject to certain exceptions,you have only six(6) months fitim the date this notice was personally served or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection with this matter. I,f'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 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, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: JOHN CULLEN, CLERK By eputy Clerk I f t This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief' such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be tiled may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act 11/02/2007 12:58 CONTRA COSTA COUNTY CLERK OF THE 4 99323412 NO.852 P02 BOARD OF SUPERVISORSUNS TO CLAIM-�N'f'TA CO UNTY fNSTRUG A. A claim relating to a cause of action for death or for injury to person or to personal property or growing crops small be presented Aotlater t1um six months cause of shall be after esented of la later than onof the �Y az e of action. A claim relating to any other , 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 govermed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is agate more than one public entity, separate claims must be filed against each public entity. B. Fraud, See penalty for fraudulent claims, penal Code Sea. 72 at the end of this form. •sassasssssMss•■rssaasops aprsspsaaassaa.as■pass■asssown owes 8.ss■sssse.s■• ■ss•■s, RE: Claim By: Reserved for Clerk's filing st=P THOMAS BABB RECEIVED Against the County of Contra Costa or ) NOV 2 9 2007 } CLERK BOARD OF SUPERVISORS District) CONTRA COSTA CO. (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$-L500 000.00_ and u1 support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) June 3, 2007 at approximately 6:10 p.m. 2, Where did the damage or injury occur? (Include city sad county) 1 ,192.10 feet south of Cowell Road and Ygnacio Valley Road, Concord, California (Note -- location noted on accident report is in error) 3. How did the damage or injury occur? (Give full details;use extra paPeT lfrequired) See Exhibit A attached hereto 4. What paitieular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? See Exhibit A attached hereto 5 What are the names of county or district officers, servants, or employees causing the damage or injury? Unknown at this time 11/02/2007 12:58 CONTRA COSTA COUNTY CLERK OF THE -� 99323412 NO.852 P03 r6. What damage or Wurics da your claim resulted? (Give full extent of injuries or damages claimed, Attach two estimates for auto damage.) Loss of past earning, loss of future earning capacity, past medical expenses, future medical ex nes (In elude the estimated amount of any .7. Now was the amou�. c�launed above computed. prospective injury or damage.) 8. Names and addresses of witnesses, doctors, and hospitals: John Muir Medical Center, Walnt Creek, CA Michelle Liu, MD, Walnut Creek, CA 9. List the expenditures you made� On account of this accident o� l ury'NT RO See attached ■ss■ego was■■0166sr6rs■■01s■0101■■■■■•■6■■■■■ONE 0r•■■01■ s s■aWas will Gov. Code Sec. 910.2 provides"The claim shall be signed by the claimant or by sante person on his behalf:" SEND N0110E TO (Attorneyl Ct Name and address of Attorney' Claimant's i store) Peter W. Alfert, Esq. Hinton, Alfert & Sumner ) 1646 N. California Blvd. , #600 } (Address) Walnut Creek, CA 94596 } 925-932-6006 } } Telephone No. 925-932-6006 )Tele Phone No. ■sssrNew ss■ss016ssr■sr■son 601■ss•■■016■ones some*mango Mae r■6■age Mrs gownsman s6■■s ■ssr■■r•■l PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed..with the County u§� he e ort 0 et sly) FAct vrth is S'Ubeectty public disclosure under the Califomia Public Records Act. (Gov. Code, attachments, addenduma,or supplements attached to the claim form, including medical records, are also subject to public disclosure. ■■■sr■■■6■ss■■601■■r■.01■■••s■r.■■r01■■sssssr■66■r■■■■s.■r■.■rs■■i■■of,Damage as■EVE.•.•., 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 or district board or officer, authorized to allow or pay the same if genuine, any false or to any county. city, imprisonment in the County jail for a fraudulent claim, bill, account voucher, or writing, is punishable either by period of not Mort than one year, by a xc0edrisannby a�fttie of nol�sxceeding Den tho sand dollars m iimprisonment and fins, or by imprisonment m The P ($10,000), or by both such imprisonment and fine. At all times pertinent herein, Ygnacio Valley Road in the City of Concord, State of California was a four lane, divided highway, with two lanes going generally north and south in the area of the subject incident. On June 3, 2007, at approximately 6:10 p.m., claimant was riding his motorcycle northbound on Ygnacio Valley Road in the City of Concord, County of Contra Costa, State of California in the number one lane (left lane) towards the intersection of Ygnacio Valley Road and Cowell Road, City of Concord, State of California. At that time, claimant's motorcycle was struck on its right side by a 2002 Acura, California license number 5RGS315 owned and operated by Margaret Lim. Ms. Lim's vehicle was traveling northbound in the number two (right) lane of Ygnacio Valley Road, City of Concord, State of California. Claimant alleges on information and belief that a landslide on the hillside on the east side of the northbound lanes of Ygnacio Valley Road caused damage to a section of the roadway on Ygnacio Valley Road. The landslide buckled and deformed the roadway and an approximate 1,000 foot section of the right (number two) eastbound lane of Ygnacio Valley Road was closed. The City of Concord, County of Contra Costa and State of California created a dangerous condition of public property by constructing a lane next to the left (number one) northbound lane of Ygnacio Valley Road and realigning the northbound lanes and placing a cement barrier between the two north and south lanes of travel which was not placed in a consistent, straight manner as it is placed along the travel way throughout this section of Ygnacio Valley Road and juts out toward the travel way at or near the center of the right hand curve in the roadway. Claimant alleges on information and belief as a result of the dangerous condition created by the lane realignment, traffic speed, geometric design of the roadway and other causes due to defendants' conduct, many of the vehicles that travel through this section of roadway inadvertently and unintentionally cross over the center line between the two eastbound lanes . Claimant alleges on information and belief the area where the subject incident occurred was owned, maintained and controlled by the City of Concord, the County of Contra Costa and the State of California. The public property was in a dangerous condition, in that the public entities, by and through their agents, servants, employees and independent contractors, negligently and carelessly designed, constructed, owned, operated, controlled, inspected, maintained, repaired and/or equipped the roadway, its structures and appurtenances, including the shoulder, travel way, road and lane realignment, cement barrier placement and rights-of-way and the area was further improperly signed, improperly aligned, inadequately delineated, striped, marked and signed such that the same was caused and allowed to be, and was, in a dangerous and defective condition. Additionally, the dangerous condition constituted a concealed trap for motorists thereon in that among other things, drivers would inadvertently and unintentionally cross over the center line of the lanes of traffic and endangering other motorists as a result of the improperly signed, improperly aligned, inadequate delineation, striping and markings and other conditions as yet unknown which may have contributed to the dangerous and defective condition of said public property. 1 Claimant alleges on information and belief that the vehicle operated by Margaret Lim at the location of the subject incident was caused to involuntarily.and unintentionally cross over the center line of the lanes due to a due to dangerous conditions including, but not limited to the geometric design of the roadway, the alignment and realignment of the lanes of the roadway of Ygnacio Valley Road at the location of the subject incident. Claimant alleges on information and belief that the City of Concord, the County of Contra Costa and the State of California Department of Transportation all had actual and constructive notice of the dangerous condition of public property at this location of Ygnacio Valley Road as there is a history of landslides in this area. Claimant alleges on information and belief that City of Concord, the County of Contra Costa and the State of California Department of Transportation also negligently failed to take appropriate actions to prevent the landslides from affecting the roadway and further negligently realigned the roadway through the right hand curve including, but not limited to the lane realignment and placement of the cement barriers. Claimant alleges on information and belief that the City of Concord, the County of Contra Costa and the State of California Department of Transportation all had actual and constructive notice of the dangerous condition of public property at the location of Ygnacio Valley Road at or near its intersection with Cowell Road, City of Concord, and specifically at a point including, but not limited to Ygnacio Valley Road at or near 1,192.10 feet of Cowell Road, City of Concord, State of California on or before June 2, 2007. The names of the public employees involved in the design, construction, repair and remediation of the roadway are unknown to claimant at this time. 2 EXHIBIT A 1'04, i:'idCOLUSION REPORT ,0 GHP 555 Page 1 (Rev.7-03) OPI 061 � IL 1 1' VV WJURED CITY 2rL l SPECIAL CONDITIONS UWR MTaRUN Paye 01 FELOW JUDIC/IIALDISTRICT LOCAL REPORTNUMBER VI RUMBER quEO arta❑ CO NTY I � MSDEMEANOR REPORTING DISTRICT mow-_ BEAT O-- '� W2 COLLISION OCCURRED ON ❑ Co�� ,� No DAY YEAR TIME(1400) NCIC N OFFICER I.D. or� MILEPOST INFORMATION Q DAY OF WEEK TOW AWAY PHOTOGRAPHS BY: NONE 0 U FEET/MILES OF M T W T F S O YES ®-.NO AT ERSECTION WI�� T STATE HWY REL OR FEET/MILES OF ©r, , DRIVER'&LI NSE NUMBER ❑YES NO PARTY STATE CLASS glp�G �SAFETY EQUIP. VEH.YEAR Mp,KE/MODEUCOL R 3c� v Y LICENSE NUMBER STATE DRIVER NAME(FIRST,MIDDLE,LA$- }� - ,_ _ (_ OR - OWNER'S NAME I I - PEOES- STREETADDRESS SAME AS DRIVER L�dJ TRIAN J J ❑ I OWNER'S ADDRESS PARKED Cr7TATEMP SAME AS DRIVER VEHICLE ❑ ) I T—1S l�2r 01-1, q�I - DISPOSITION OF VEHICLE ON ORDERS OF: CLIST SEK IWR EYES 1 , HEIGHT 'MIGHT BIRTHDATE �y OFFICER® DRIVER � OTHER OTHER O ❑ ` `"e�.J �V � (� 220 0 ���, E_ PRIOR MECHANICAL DEFECTS: NONE APPARENT HME PHONE BUSINESS PHONE- REFEA TO NARRATIVE ❑ L /--- _ ^ VEHICLE IDENTIFICATION NUMBER: INSURANCE CARRIER 1L111 O VEHICLE TYPE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA POLICY NUMBER DUNK ❑NONE [:]MINOR DIR OF TRAVEL ON STREET OR HIGHWAY - SPEED CI ®MOD. ❑MAJOR ROLL-OVER _ ►11T CA OUL(VA Z - 3 DOT LICECAL-T TCP/PSC M�_�— PARTY DRIVDRIVERS /N�S7E NUMBER TE IC LASS �AIREWG_ ;SAFETY EQUIP. VEH.YEAR MAKE/MODEVCOLOR / M LICENSE NUMBER STATE DRIVER FUME(FIRST,MIDDLE,LAST) - � ,---,----.- -ltCV 2q 2-C---T—L - 1 OWMER'S NAME TRIAN I� PER& STREET ADDRESS �- I V.1 SAME AS DRIVER ❑ N v Li OWNERS ADDRESS PARKED Cl TATE2IP yy VEHICLE AS DRIVER ❑l I DISPOSITION OF VEHICLE ON ORDERS OF: BICY SEX R. EYES HEIGHT WEIGHT ❑OFFICER�,`DRfVER._�:Oi}IER CLIST BIRTHDATE RACE - ❑ < `.IL. � IL (J� �� Per (-C A PRIOR MECHANICAL DEFECTS: OTHER H E PHONE BUSINESS PHONE NONE APPARENT REFER TO NARRATIVE u (-� UfI — VEHICLE IDENTIFICATION NUMBER:I (i—) -�o� VEHICLE TYPE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA IN6URAtJC�y4RIER POLICY NUMBER >'1 DUNK D NONE MINOR 2—ami_ OI ❑MOD. ]M/JOR�ROLL-OVER DIR OF TRAVEL ON STREET OR IG AV - SPEED LIME 2"` ^ CA OOT � I � ��'J � TDPIPBQ PARTY �-T DRIVERS LICENSE NUMBER MCIMX STATE CLA89 AIR BAG ;SAFETY E V EH.YEAR MAKE/WDEUCOLOR 3 LICENSE NUMBER - STATE DRIVER NAME-(F/RS T,MIDDLE,LAS T) _..._-- PEDES- STREET ADDRESS OWNER'S NAME TRIAN SAME AS DRIVER PARKED CITY/STATE/ZI - OWNER'S ADDRESS 1ClF SAME AS DRIVER VEHICLE CONTROLLED D .UMENT DISPOSITION OF VEHICLE ON ORDERS OF: BLIS SEX HAIR EYES Ic RACE OFFICER❑DRIVER OTHER CLIS7 BIRTHDATE 1:1 o DeY Veer _ OTHER HOMEPHONE PRIOR MECHANICAL DEFECTS: NOAPPAREy, 8 SIN S6 NE ^ NE NT REFER TO NARRATNE ❑ Relea `)}/; }a` O 1 VEHr-LE IDENTIFICATION NUMBER: INSURANCE CA /POLICY NUMBER VEHICLE TYPE SCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA 11U K ❑NONE ❑MINOR DI TRAVEL ON STREET OR HIGHWAY SPEED LIMIT ❑MOD. 11 MAJOR❑ROLI-OVER CA DOT PREPARE SN ME -T TCPNSC MCRA( • __ = 7 DISPATCH REVIEWER'S NAME DATE REVIEWED l YES 0 NO 0555 703.frD STATE OF CALIFORNIA TRAFFIC COLLISION CODING - CHP 555 Page 2(Rev. 7-03) OPI 061 Paoc DATE OF COLLISION (MO DAY YEAR) TIME(2400) 7CIC N OFFICER I.D. IJUMBER OWNER'S NAME OWNER'S ADDRESS NOTIFIED PROPERTY YES [:] NO DAMAGE DESCRIPTION OF DAMAGE SEATING POSITION SAFETY EQUIPMENT INATTENTION CODES OCCUPANTS L-AIR BAG DEPLOYED M I C BICYCLE-HELMET A-CELLPHONE HANDHELD f56 A-NONE IN VEHICLE M-AIR BAG NOT DEPLOYED DRIVER PASSENGER B-CELLPHONE HANDSFREE B-UNKNOWN N-OTHER V-NO X-NO C-ELECTRONIC EQUIPMENT C-LAP BELT USED P-NOT REQUIRED W-YES Y-YES D-RADIO/CD D-LAP BELT NOT USED E-SMOKING t-DRIVER E-SHOULDER HARNESS USED F-EATING 2 TO 6-PASSENGERS F-SHOULDER HARNESS NOT USED CHILD RESTRAINT EJECTED FROM VEHICLE G-CHILDREN 7-STATION WAGON REAR G-LAP/SHOULDER HARNESS USED 0-IN VEHICLE USED 0-NOT EJECTED H-ANIMALS 6-REAR OCC.TRK OR VAN H-LAP/SHOULDER HARNESS NOT USED R-IN VEHICLE NOT USED t-FULLY EJECTED I-PERSONAL HYGIENE 9-POSITION UNKNOWN J-PASSIVE RESTRAINT USED S-IN VEHICLE USE UNKNOWN 2-PARTIALLY EJECTED J-READING O-OTHER K-PASSIVE RESTRAINT NOT USED T-IN VEHICLE IMPROPER USE 3-UNKNOWN K-OTHER U-NONE IN VEHICLE ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK(')SHOULD BE EXPLAINED IN THE NARRATIVE, PRIMARY COLLISION FACTOR TRAFFIC CONTROL DEVICESSPECIAL INFORMATION MOVEMENT PRECEDING UST NUMBER N OF PARTY AT FAULT 'I 2 3 1 2 3 COLLISION VC SECTIONNOUTED: CITED A CONTROLS FUNCTIONING YES A HAZARDOUS MATERIAL A STOPPED �- 1'r- 8 CONTROLS NOT FUNCTIONING_ B CELL PHONE HANDHELD IN USE B PROCEEDING STRAIGHT B OTHER IMPROPER DRIVING'. C CONTROLS OBSCURED C CELL PHONE HANDSFREE IN USE I IC RAN OFF ROAD NO CONTROLS PRESENT I FACTOR' D CELL PHONE NOT IN USE I D MAKING RIGHT TURN C OTHER THAN DRIVER' TYPE OF COLLISION E SCHOOL BUS RELATED E MAKING LEFT TURN D UNKNOWN' A HEAD-ON F 75 FT MOTORTRUCK COMBO I I IF MAKING U TURN 13 SIDE SWIPE G 32 FT TRAILER COMBO G BACKING C REAR END H H SLOWING/STOPPING WEATHER MARK T TO 21TEMS D BROADSIDE I I PASSING OTHER VEHICLE _CLEAR E HIT OBJECT I J J CHANGING LANES B CLOUDY F OVERTURNED I I IK K PARKING MANEUVER C RAINING G VEHICLE/PEDESTRIAN I L L ENTERING TRAFFIC D SNOWING H OTHER': I I Im M OTHER UNSAFE TURNING E FOG/VISIBILITY FT N I IN XING INTO OPPOSING LANE F OTHER'. MOTOR VEHICLE INVOLVED WITH O 1 10 PARKED G WIND A NON-COLLISION I IP MERGING LIGHTING B PEDESTRIAN TRAVELING WRONG WAY DAYLIGHT C OTHER MOTOR VEHICLE 1 2 3 OTHER ASSOCIATED FACTOR(S) R OTHER': B DUSK-DAWN D MOTOR VEHICLE ON OTHER ROADWAY (MARK 1 TO 2 ITEMS) C DARK-STREET LIGHTS E PARKED MOTOR VEHICLE A VC SECTION VIOLATION CITEDDYES ----- D DARK-NO STREET LIGHTS F TRAIN ONO E DARK-STREET LIGHTS NOT G BICYCLE B VC SECTION VIDATION CITEo FUNCTIONING' H ANIMAL- ONpS ROADWAY SURFACE Flo C VC SECTION VIOUTION CITED YES 1 2 3 SOBRIETY PHYSICA RUG DRY _ I FIXED OBJECT. ND (MARK I TO 21TEMS) WET D A HAD NOT BEEN DRINKING _ C SNOWY-ICY J OTHER OBJECT:, E VISION OBSCUREMENT: IB HOD-UNDER INFLUENCE D SLIPPERY MUDDY OILY ETC F INATTENTION': IC HBD-NOT UNDER INFLUENCE' ROADWAY CONDITION(S) G STOP&GO TRAFFIC D HBD-IMPAIRMENT UNKNOWN' (MARK I TO 2ITEMS) PEDESTRIAN'S ACTIONS H ENTERING/LEAVING RAMP IE UNDER DRUG INFLUENCE' A HOLES DEEP RUT' A NO PEDESTRIANS INVOLVED - I PREVIOUS COLLISION IF IMPAIRMENT-PHYSICAL' B LOOSE MATERIAL ON ROADWAY' B CROSSING IN CROSSWALK - J UNFAMILIAR WITH ROAD G IMPAIRMENT NOT KNOWN C OBSTRUCTION ON ROADWAY' AT INTERSECTION K DEFECTIVE VEH.EQUIP.: CITED I IH NOTAPPLICABLE _ D CONSTRUCTION-REPAIR ZONE C CROSSING IN CROSSWALK-NOT 0 YES I SLEEPY/FATIGUED' E REDUCED ROADWAY WIDTH AT INTERSECTION ONO F FLOODED' D CROSSING-NOT IN CROSSWALK L UNINVOLVED VEHICLE G OTHER': IE IN ROAD-INCLUDES SHOULDER M OTHER'. NO UNUSUAL CONDITIONS I F NOT IN ROADp NONE APPARENT (' APPROACHING/LEAVING SCHOOL BUS O RUNAWAY VEHICLE SKETCH / MISCELLANEOUS \jIfACATE NORTH 1 1 IZ ,10 OSP 03 79147 INjiRED/-WITNESS /PASSENGERS _.4 HP 555'Pape 3(Rev. 1-031 OPI 061 _ Pes#1� or DATE'OFOLLI Y: ION(MO.'DAAYNUMBER�YEAR) TIME(7400) NCIC M h` OFFICER LQ. , IZLIQi WITNESS PASSENGER EXTENT OF INJURY("X"ONE) INJURED WAS("X"ONE) ' ONLY ONLY AGE SEX PARTY SEAT AIR 'SAF FATAL SEVERE OTHER VISIBLE COMPLAINT NUMBE POS, BAG EQUIP. EJECTED INJURY INJURY INJURY OF PAIN - DRIVER I PASS, PED. BICYCLIST OTHER El Y NAME/D.O.B./ADDRE TELEP! L41) - b (INJURED ONLYTRANSPORTED BY: _ - TA(0_NSO� 2 \\))ll((JJ�` ►�1 u I l2 W�N1�1 C 2l CRIBE INJURIES _ ,J(' 1 0 21 l = - 2A F2 -ia-_�� U L L_ L C L. ;2 -1 O� i✓��'._ H�K�.L vL-T)?-t: ❑VICTIM OF VIOLENT CRIME NOTIFIED ❑# ❑ ❑TE ❑ 101 ❑ I ❑ ❑ ❑ NAME/D.O.B./ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES ❑ ❑ VICTIM OF VIOLENT CRIME NOTIFIED # ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ NAME/D.O.S.I ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES ❑ ❑# El VICTIM OF VIOLENT CRIME NOTIFIED o ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ;NAME l D.O.B./ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES ❑VICTIM OF VIOLENT CRIME NOTIFIED ❑# ❑ ❑ ❑ El ❑ ❑ ❑ D ❑ ❑ NAME/D.O.S./ADDRESS �' TELEPHONE (INJURED ONLY)TRANSPORTED BY: -- TAKEN TO. DESCRIBE INJURIES ❑❑# VICTIM OF VIOLENT CRIME NOTIFIED ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VAME/D.O.B.l ADDRESS 7 TELEPHONE - 1NJURED ONLY)TRANSPORTED BY: TAKEN TO. %SCRIBE INJURIES ❑VICTIM OF VIOLENT CRIME NOTIFIED 'REPARER'S NAME I.D.NUMBER MO. 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'� rT5 .: a & ■ �ty1 11111IN ■ ■ ■ ■ ��© • Jill , STATE OF CALIFORNIA — -- NARRATIVE/SUPPLEMENTAL CHP 556 Rev 7-90 OPI 042 Date of Tine of occurrence NCIC NUMBER OFFICER ID# NUMBER Incident/Occurrence 1810 0704 0431 07-12621 06-03-07 "X"ONE "X"ONE TYPE SUPPLEMENTAL("'APPLICABLE) X Narrative X Collision Report BA Update Fatal it and run update Supplemental Other: Hazardous School Other: materials bus CITY/COUNTY/JUDICIAL DISTRICT REPORTING CITATION NUMBER Concord/Contra Costa/Mt Diablo DIST/BEAT None 05 rY;nacio CATION/SUBJECT STATE HIGHWAY RELATED valley Road/ Cowell road Yes X No Notification: On 06/03/2007, at 1810 Hours, I was dispatched to the intersection of Ygnacio Valley Road near Cowell Road to a motorcycle vs. auto traffic collision with injuries. I arrived at 1815 hours, the following occurred. All measurements in this report.were obtained by vehicle roller tape. Scene: Ygnacio Valley Road is an asphalt roadway oriented approximately north to south. There are two lanes in the northbound direction, and there are two lanes in the southbound direction. The north and southbound lanes are separated by a median which consists of gravel. Cowell Road is an asphalt roadway oriented approximately east to.west. There is one lane in the eastbound and two lanes in the westbound direction. There are also two left turn lanes from eastbound Cowell Road onto northbound Ygnacio valley road, and one right turn lane from eastbound Cowell Road onto westbound Ygnacio Valley Road. Parties: Party 1 was identified with the picture on his California driver's license as Thomas Babb. Party 2 was identified with the picture on her California Driver's license as Margaret Lim. Statements: Party 1 Babb was transported by AMR to John Muir hospital in Walnut Creek. I later contacted Babb via- telephone. Babb said that he was driving in the#1 northbound lane of Ygnacio Valley Road. Babb said all of a sudden, V2 drifted into his lane colliding with his vehicle. Babb said the collision caused him to collide with the cement rail in the center divide of the roadway. The collision with this rail threw Babb off of his motorcycle. Party 2 Lim said that she was driving her vehicle in the#2 northbound lane of Ygnacio Valley Road. Lim said that as she was driving her car, Babb driving his motorcycle, veered into her lane and collided with the rear of her car. Lim said that when she looked into her rear view mirror, she saw Babb already tumbling on the ground. Summary: It is unknown which party, but one of the parties in this collision veered into the other lane. This unsafe lane change caused Babb to lose control of his motorcycle and collide with the rail throwing him off of his motorcycle. PREPARER'S NAME AND I.D.NUMBER DATE: REVIEWER'S NAM DATE M.Switzer#431 06-114007 G. STATE OF CALIFORNIA —� NARRATIVE/SUPPLEMENTAL CHP 556 Rev 7-90 OPI 042 Date of Tine of occurrence NCIC NUMBER OFFICER ID# NUMBER Incident/Occurrence 1810 0704 0431 07-12621 06-03-07 "X"ONE "X"ONE TYPE SUPPLEMENTAL(`X-APPLICABLE) X Narrative X Collision Re ort BA U date Fatal I Hit and run update Supplemental Other. Hazardous School Other: materials bus CITY/COUNTY/JUDICIAL DISTRICT FDS PORTING CITATION NUMBER Concord/Contra Costa/Mt Diablo T/BEAT None LOCATION/SUBJECT STATE HIGHWAY RELATED Ygnacio valley Road/ Cowell road Yes X I No Point of impact: AOI was determined by skid marks from Babb's motorcycle to be, approximately 1,192'.10"west of the west extended curb line of Montecito Drive, and approximately 12'l 0" feet north of the north curb line of Ygnacio Valley Road. Cause: Which party caused this collision cannot be determined because of the lack of any independent witnesses. However, one of the parties in this collision moved their vehicle into the other lane of traffic when it was unsafe to do so, a violation of 21658(x) CVC. Recommendations: None PREPARERS NAME AND I.D.NUMBER DATE: REVIEWER'S NAME DATI M.Switzer#431 06-11-2007 (� EXHIBIT B *****REPORT NOT FINAL UNTIL AUTHENTICATED***** DISCHARGE SUMMARY PATIENT NAME: THOMAS BABB DATE OF ADMISSION: 06/03/2007 DATE OF DISCHARGE: 06/07/2007 DICTATING PHYSICIAN: BRIAN T CHIN, MD DISCHARGE DIAGNOSES: 1. Blunt trauma, status post motorcycle accident. 2. Left subarachnoid hemorrhage. 3. Right VI cranial nerve palsy. 4. Right ankle and foot lacerations. 5. Polycystic kidney disease. 6. Multiple superficial abrasions. 7. Right clavicle fracture. PROCEDURES: Repair of right ankle and foot lacerations. HOSPITAL COURSE: The patient is a 29-year-old man who was involved in a motorcycle accident and sustained the above injuries. He was evaluated by Dr. Adey from neurosurgery for subarachnoid hemorrhage and recommended nonoperative treatment. He was monitored in the Intensive Care Unit overnight and repeat head CT the following morning showed a decrease in the subarachnoid blood. He was evaluated by Dr. Lee from orthopedic surgery who recommended nonoperative treatment of his right clavicle fracture and a sling for comfort for 1-2 weeks followed by gradual reintroduction of range of motion. His right foot and ankle lacerations were repaired primarily in the trauma room. He was evaluated by neuropsychologist and was treated according to the traumatic brain injury protocol. He was evaluated by physical therapy for ambulation. On the day of discharge, he was ambulating with minimal difficulties, pain is well controlled with oral analgesics and he was tolerating a regular diet. DISCHARGE INSTRUCTIONS: Patient was discharged home with unrestricted diet. He was told to ambulate ad lib according to how tie feels. He was instructed to followup with county health for suture removal in 1 week. He was educated about signs of traumatic brain injury and given instructions and signs and Symptoms of when to seek medical attention. He was to follow up with an orthopedic surgeon 2 weeks following discharge. He was given oral analgesics for pain control and a 1-week course of Keflex. ***Edit/Authenticate Report in e-MAPS*** DD:06/07/2007 20:31 DT:06/08/2007 05:27 DOC ID: 231398 Job#: 220343 MR#:0872936 Acct:5555520777 Name:BABB, THOMAS Report: DISCHARGE SUM JOHN MUIR MEDICAL CENTER WALNUT CREEK CAMPUS pg.l 1601 Ygnacio Valley Road Walnut Creek,CA 94598 Authenticated by Brian T. Chin, MD On 06/08/2007 01:28:32 PM 00007 THOMAS BABB D/I: 6-3-07 PROVIDER DATE OF SERVICE AMOUNT Medical: AMR 6-3-07 $1,221.04 PO Box 3429 Modesto, CA 95353 John Muir Medical Center 6-3-07 to 6-7-07 $73,994.15 Walnut Creek, CA 94596 John Muir Physicians 6-3-07 *$160.00 Group PO Box 9017 Walnut Creek, CA 94598 Michelle W. Liu, MD 6-07 through 9-07 *$324.00 1844 San Miguel Drive Suite 303 Walnut Creek, CA 94596 Lost Income: Reva Murphy Associates 6-4-07 through 9-17-07 $25,346.40 * indicates amounts are partial billing only INVOICE ,93AR - American Medical Response _ AMERICAN MEDICARESPONSE WEST TRIP# 401-•77144404- ACCT# 001081121 PATIENT NAME TI OMAS_ M. DADL DATE OF SERVICE 06/03/2.007 ACCOUNT NUMBER': ^^ AMOUNT DUEf ^ti i 0 g INVOICE DATE 0 110/10( THOMAS M. BABB REMIT PAYMENT TO: 58 NATILUS PLACE PITTSBURG, CA 94565 AME%ICAN MEDICAL RESPONSE FILE 73-329 PO I30X 60000 SAN FRANCISCO, CA 94160--3329 PLEASE CHARGE MY: ❑VISA ❑MASTERCARD ❑DISCOVER ❑AMEX ACCOUNT 'i J L�L I L�1 i J 11 _J"H' LJ LJ l.!L_ EXPIRATION DATE _ _. . SIGNATURE PLEASE ENTER AMOUNT PAID: $ PLEASE DETACH AND RETURN THIS PORTION WITH YOUR PAYMENT PATIENT NAME ACCOUNT NO. TRIP NO. INVOICE DATE `1HOMAL A. BABB 001081120-0001 401--77144404-00 09/20/2007 DATE OF SERVICE SERVICE FROM SERVICE TO 06/03-3/2007F YGNACIO VALLEY RD / COWELL AID J�TiPd A4LTI^ :'`EMOr TAL TTOST'ITAL IMPORTANT MESSAGES CODE DESCRIPTION UNITS UNIT CHARGE TOTAL CHARGE A0427 ALS1 EMERGENCY 1 ,095 . 1 1 , 095 . 1E A0425 ALS MILEAGE 20 . 9 125 . 8£ TOTAL CHARGES DUE 1, 221 . 04 CALL RCVD: 18 : 12- DIAGNOSIS : 8 : 12DIAGNOSIS : 9598 SEE REVERSE SIDE FOR INSURANCE INFORMATION T`Eli ,7. An ill: ;7J3 , .,9 Phone Number 1-800-913-9106 Keep this portion for your records. JOHN U I Thank you for selecting John Muir Health for your healthcare H € A t 7 H needs. Quahty patient care and dedication to patient satisfaction John Muir IMFedicat Cerner,Watnut Creek Campus PO Box 39000 are our highest priorities. Department 33370 2v0.o006 1 55555-20777 San Francisco,CA 94139-3370 Our records indicate tt-tat you hawe BWE SHIELD HMO—WG+ as your primary insurance and you do not have a secondary. If this is not correct, please contact our Customer Service Department at the number listed below. THOMAS MICHAEL BABB We have added preventive healthcare and education news on 58 NAUTILUS PL PITTSBURG CA 94565-3519 the back of the statement. We hope to serve you again, if a heatth need arises. Patien!Services Provided Statement Date 06/12/07 DESCRIPTION TOTAL CHARGES Service Date(s) 06/0.3/07-06/07/07 ROOM-BOARD/SEMI $4,950.00 Patient Name THOMAS MICHAEL BABB INTENSIVE CARE/ICU $35,475.00 Account Number 55555-20777 PHARMACY $3,266.25 What we billed to insurance $73,994.15 MED/SUR SUPPLIES $0.00 What's pending with insurance $73,994.15 NON-STERILE/SUPPLY $ 1,126.75 Your payments/adjustments $0.00 STERILE SUPPLY $ 164.00pROSTH/ORTH DEV $0.00 What you owe now $0.00 LABORATORY $20.50 LAB/CHEMISTRY $ 1,466.78 LAB/IMMUNOLOGY $588.02 LAB/HEMATOLOGY $692.75 DX X-RAY $861.00 Please confirm that information is correct. PRIMARY Insurance BLUE SHIELD HMO--MMG+ . Billing questions or changes in insurance coverage? Group/Plan CALC10 (925)947-3336 8:30 am to 4:15 pm weekdays . Written correspondence? ID Number XEHJ03713025 John Muir Health-Attn. Patient Accounts PO Box 39000 SECONDARY No secondary on file. Department 33370 Insurance Please call if incorrect. San Francisco, CA 94139-3370 Group/Plan ID Number Please Note: Your physician will bill separately for their professional services. JMF80102 JOHN MUIR PHYSICIAN NETWORK Questions: 925-952-2828,or e-mail to: PO BOX 9097 jmpn.cbc@johnmuirhealth.com WALNUT CREEK CA 94598 Urgent Care Centers: Walnut Creek 939-4444 Concord 677-0500 San Ramon 866-8050 Brendtwood 308-8111 STATEMENT NUMBER: 52308140 P/C 02 L TEL . 925-435-8916 SHObU AIOCAJI I r;,• PAID HERE Q!t _ _......-____.._.__._.._... 925-952-2828 08/19/2007 288457-5 001 160.00 N=Flr;E PHONE h•.!UP/BC' CLOSING LATE: GUARANTOR NO PAGE_NO. It Paying by Credit Card, THOMAS M BABB JOHN MUIR MEDICAL GROUP See Reverse Side 58 NAUTILUS PL JOHN MUIR PHYSICIAN NETWORK Oa °= PITTSBURG CA 94565 PO BOX 9017 UNITED STATES WALNUT CREEK CA 94598 Iwo C6[ pp pp g@ @@ ryry pp fifi pp oNtoe�oe�e�eloe�Neac�e8eao��oe�e�ooeel�lo�oao�e9s�aoVo��eaeG ��e�eoeloe�e�elelelee�eele��eeoOeleeeeellleee�eeel�leeel0leeel 045970000288457500003390366000016000 CHARGES APPEARING ON THIS STATEMENT ARE NOT INCLUDED ON ANY I IOSPI T AL BILL OR STHTEMEN T .Y: ' -x'' y} ''- i,�3['. sT"'' "d='V 9n �,�. '�,r�J�1�7I _R_-r" 1 �fi�l ..T - __ r �a,.: THOMAS BABB 33-90-36-6 Previous. Patient Balance 071507 160. 00 I PATIENT RESPONSIBLE 160.00 I i ' I i I i i j I 1 r t I � I I i I 1 ' f I t i i f f I I i Statement WHEN CALLING OUR OFFICE,PLEASE INDICATE YOUR ACCOUNT NUMBER: 288457-5 Closing Date: 08/19/2007 oRSTATEMENT NUMBER: 52308140 BALANCE 30 DAYS BALANCE OVER BALANCE OVER BALANCE OVER PATIENT RESPONSIBLE AND UNDER 30 DAY 60 DAYS 90 DAYS NEW BALANCE I 60. 00 160 . 00 Send inquiries to: TAX ID: 68-0360801 JOHN MUIR MEDICAL GROUP JOHN MUIR PHYSICIAN NETWORK PO BOX 9017 WALNUT CREEK CA 94598 STATEMENT OF ACCOUNT MAKE PAYMENTS TO: DATE: 11/06/07 MICHELLE W. LIU, MP 1899 SAN MIGUEL DRIVE, STE #1303 VIALHUT CREEK, CA 99596 WANT TO USE YOUR CREDIT CARP?: (Lae accept Visa and Mastercard) RE PATIENT: THOMAS BABB Card No: ACCT#: 21519 iRequ.ired for all credit card payments) AMOUNT DUE: AMOUNT PAID: THOMAS BABB 50 NAUTILUS PLACE CHECK #: PITTSBURG, CA 99505 :PSS::,::,: nal.r: :ac;.Pfr .:rn.•.:: PLEASE DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE DATE DESCRIPTION CHARGE PAYMENT PAID BY INS DUE PT DUE Balance Forward 207.00 09/04/07 09/09/07 OPHTHALMOLOGICAL SERVICES: MEP 117 .00 Account Balance . . . . . . . (Balance includes pending insurance due . ) Insurance Pending. _ . . . Patient Amount Due This Statement : -------------------- PATIENT BALANCE AGING ------------------ CURRENT 30 60 90 120+ IF YOU HAVE A14Y QUESTIONS, PLEASE CONTACT THE BILLING OFFICE AT (888 , 590-6001 . Patient Name: THOMAS BABB DATE: 11/06/07 Account Number : 21519 Reva Murphy Associates,Inc. Prepared by Ig Work Schedule for Tom Babb SourceDoc based on jobs available and Tom's skillset Chad O'Conners input Job Cost &Billing Detail Date of Injury:06/02/07 Date of Release from Dr.-09/17/07 Prevailing Wage schedules per Period of time not working-06/04/07-09/16/07 lobs. W/E Job Total Prevailing Less Adjusted Gross PR Date # Hrs Wage Medical Hourly Earnings Fringe Wage Rate 6/10/2007 1416 40.0 44.815 (1.73) 43.09 1,723.40 6/17/2007 1416 40.0 44.815 (1.73) 43.09 1,723.40 6/24/2007 1416 40.0 44.815 (1.73) 43.09 1,723.40 7/1/2007 1416 40.0 44.815 (1.73) 43.09 1,723.40 7/8/2007 1416 40.0 44.815 (1.73) 43.091,723.40 7/15/2007 14161 40.0 44.815 (1.73) 43.09 1,723.40 7/22/2007 1416 40.0 44.815 (1.73) 43.09 1,723.40 7/29/2007 1416 40.0 44.815 (1.73) 43.09 1,723.40 8/5/2007 1416 40.0 44.815 (1.73) 43.09 1,723.40 8/12/2007 1416 40.0 44.815 (1.73) 43.09 1,723.40 8/19/2007 1416 40.0 44.815 (1.73) 43.09 1,723.40 8/26/2007 1500 40.0 42.075 (1.73) 40.35 1,613.80 9/2/2007 1500 40.0 42.075 (1.73) 40.35 1,613.80 9/9/2007 1500 40.0 42.075 (1.73) 40.35 1,613.80 9/16/2007 1504 40.0 40.42 (1.73) 38.69 1,547.60 Total Wages 25,346.40 Vl :y 1110/30/20072:37 PMC:\Documents and Settings\jhudson\My Documen ts\PRTimesheets\TomBabbPotentialWageLoss.xlsTomBabbPoten tialW ageLoss.xlsSheet1 EXHIBIT C DIABLO V-TWIN Estimate 3503 PACHECO BLVD In Date: 10/25/2007 MARITNEZ, CA 94553 925-229-5500 Today Date: 10/26/2007 Date Promised 10/25/2007 Estimate For: Unit Name Location BABB,TOM 925-435-8916 Units For This Estimate Service Writer: Year Make Model VIN/Serial No. Color Plate Key Board Miles 2006 ALL CUSTOM V-TWIN 1998 EVO MOTOR VTS11005BTP598206 GRAY 18K3756 10548 Job: CRASH ESTIMATE/VISABLE DAMAGE Job For: 2006 ALL CUSTOM V-TWIN 1998 EVO MOTOR SOFTAIL VTS11005BTP598206 Description STORAGE @ $35.00 PER DAY IF APPLICABLE Parts Part Number Quantity Description Each Price Extension DS305046 1 SOFTAIL LOW KIT CHR 89&99 $124.95 $124.95 1310-0195 1 SHOCKS DRAG SOFTAIL 89-99 $549.95 $549.95 DS-380257 1 6 1/4"FRONTDRAGGER FENDR $21295 $212.95 1027 1 THUNDER HEADER SOFTAIL $564.95 $564.95 42507-89A 1 BRAKE PEDAL MOUNTING PLATE $12895 $128.95 50621-79A 1 FOOTBOARD ASSY $64.95 $64.95 42431-87A 1 FOOT BRAKE SUPPORT $168.95 $16895 50900-72 1 FOOTREST SUPPORT $16.95 $16.95 41745-79 1 MASTER CYLINDER COVER $30.95 $3095 72023-51B 1 STOPLIGHT SWITCH KIT $17.95 $17.95 40957-87B 1 BRAKE LINE, REAR $34.95 $34.95 DS-253320 1 STUD MNT FOOT PEG R.RIB $23-95 $23.95 DS-530632 1 RR KELSEY M/C L87-99 FLST $179.95 $179.95 DS-290791 1 9/16 M/CYL 96-06 S/DISC $122.95 $122.95 DS-224014 1 S/SSTD THROTLE96-00 FXSTS $43.95 $4395 DS-391331 1 4"EXT TANKS 5.2 GAL FXST $419.95 $419.95 0204-0095 1 R. 18X5.5 40 SPK 86-99 $840.95 $840.95 110-14351 1 ME880 180/55ZR18 REAR $223.95 $223.95 2113-0012 1 BATT DRAG SPEC YTX20HL $89.95 $89.95 210281 1 CHUBBY DRAG BAR-NO RISERS $12995 $12995 DS-530603 1 BRAKE PEDAL F/86-99 FLST $42.95 $42.95 1203-0151 1 RAIL BRAKE PEDAL COVER $1595 $15.95 DS-302150 2 DS-NESS STEALTH MIRROR $30.95 $61.90 DS-280475 1 7"HOODED NACELLE BEZEL $323.95 $32395 DS-290585 1 CHR SWTCH HOUSNG'S 96-06 $51.95 $51.95 85-180 1 FRAME,SOFTAIL STYLE-STK-CHROME $770.58 $770.58 DS-273147 1 CHR WIDE LVR SET F/96-06 $26.95 $26.95 Parts Subtotal $5,286.23 Page 1 Job: CRASH ESTIMATENISABLE DAMAGE (Continued) Job For: 2006 ALL CUSTOM V-TWIN 1998 EVO MOTOR SOFTAIL VTS11005BTP598206 Labor Description Job Code Technician Quantity Line Total ESTIMATE AL JULIAN (AL) 3.53 Hours $300.00 R+R FRAME JAK MARTINEZ(JAK) 32 Hours $2,720.00 BARS,INTERNAL WIRING JAK MARTINEZ(JAK) 4 Hours $340.00 Labor Subtotal $3,360.00 Sublet Labor Description Amount PAINT COMPLETE W/FLAMES $4.20000 POWDERCOAT NEW FRAME $30000 RE UPHOLSTER SEAT $125.00 Sublet Labor Subtotal $4,625.00 Recommendations Resolution FRONT FORKS,SWINGARM SUBJECT TO INSP,UNCLEAR OF DAMAGE Job Subtotal $13,271.23 Customer Job Totals Parts $5,28623 Labor $3,360.00 Sublet Labor $4,625.00 Total of Customer Jobs $13,271.23 Estimate Subtotal $13,271.23 Sales Tax $436 11 Repair Order Total $13,707.34 Total Amount Due $13,707.34 Thank You For Your Business! THIS ESTIMATE ONLY GOOD 30 DAYS Page 2