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HomeMy WebLinkAboutMINUTES - 01222008 - C.7 CLAiM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY CbT BOARD ACTION: JANUARY 22, 2008. 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), + DEC N 1; 20ul given Pursuant to Government Code AMOUNT: $2, MILLION COUNTYC: JNS-L Section 913 and 915.4. Please note all CALiF. "Warnings". CLAIMANT: BYRON P. SHIELDS 2007016727 ATTORNEY: AUDREY D. SHIELDS DATE RECEIVED: DECEMBER 24, 2007 ADDRESS: 1970 BROADWAY, SUITE 1250 BY DELIVERY TO CLERK ON: DECEMBER 24, 2007 OAKLAND, CA 94612 and MARTINEZ DETENTION FACILITYBy MAIL POSTMARKED: DECEMBER 21, 2007 901 COURT STREET, C-23 FROM: Clerk 10"t ie oai•d of upervisors TO: County Counsel Attached is a copy of the above-noted claim. LEN, CI Dated: DECEMBER 24, 2007 JOHN CUL By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Sup rvisors (Vy This claire 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 retum 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). O Other: Dated: _-2- -;?-7- y 7 By; Com, Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) O Clairn was returned as untimely with notice to claimant (Section 91 1.3). 1V. BOARD 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. Date •8 CULLEN, CLERK, By eputy Clerk WAR lNG (G . 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 lush to file a court action on this claim.See Government Code Section 945.6.You play 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. *Fo.r Additional Warring See Reverse Side ofTliis Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that i. am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: T d, °�_�OHN CULLEN, CLERK By Deputy Clerk BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY Pa9 e I of 7 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. ...................................................mum.E Emmoo........00. ......E RE: Claim By: Reserved for Clerk's filing stamp BUr�n sh�el� ) RECEIVED Against the County of Contra Costa or ) ULU G 4 tuul District) CLERK BOARD OF SUPERVISCRS 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$ a)OOO�oou•0p and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) fir\ q dao)07,It to Cnn4rn G-S�* (4-rAy 4-o ►heve ?rns rem:�%,N4 f{,_Vv, y'^`; le_'f'E f,,r,K7%0 4in9ec 2. Where did the damage or injury occur? (Include city and county) ,.v►z }y, ak "IDk CZAAr* 5*g , l�erk+�a7, G" �►45S3 �r` 3. How did the damage or injury occur? (Give full details; use extra paper if required) R&5i10 WLE. ow 'I— /) 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? Failure+o ho.�e me +rn�s�ar�oa ba,cv. A-4the Flaks"?" ,� on °l�da�v7- 5 What are the names of county or district officers, servants, or employees causing the damage or injury? CONTPA "&74 CouNZY OEOVT4 SHE,�lFF 'S 0,v4 Me��ce:► �'C3rSbri�p` 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages oSS pf ub(G a� rn ink+e�in9c:r �d claimed. Attach two estimates for auto damage.) Pcfm��end 1 Y P OJt �1 ♦1n�nCJs� (_4 kv�S�n9 1'1� 9r1j+ o� f"y left hand to be Wae►KcrS}hr+ Second�in9cr fcorr. r+�y ��n�\6 W►1`1 r%CAJC C1ase in4v o.Ash' dam``+p Cx�-cntlad pj,\Vie. Nor Cwr,I bore My P►nY.Ze 40 J'YP• on '• Corw���niar 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 0� 0 )Q0?0 W reCpns��rr„t3lve S�►r9ery� c' in optorr�eyr5 -V e:&6 uu ��uJ:� fo. com�e..se.�Yy aarY,��es fog Po.r e.�� Sufferirn� ar�� JS��oOe°o 8. Names and addresses of witnesses,doctors and hospitals: Dr. Sinnoah ^fir cltK ,�vi�lo.� Dc. cd.J ts3, b M 1 ev,�,`_l .1arr�s k..r�cs,lk_ McBcidaNursa F ...4}0.► Nurse oYI and NucfC NJ./ or* a1ti 3MQ a�ed q� �'I1e $Jai, , Ary , iaoa W\,rd Co, 994;-53- 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT 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) 1 Name and address of AttorneyAuA,ay 0. ) `- ` ) 1 (Claimant's Signature) 1970 Zwoe,dw , Sura I�.SO ) ��) �v�r� s�rce-A Oo,k 6,v4) Cc, "1 y�(1� ) (Address) Li (707�SS��O9-oo �� (s��) Gc° I-m;S l rh@SsQr` Jn�y Telephone No. (,51���39—'11yu ) Telephone No. / ■...........\.\.................\....\..\.\..0NONE MEND■■.\\\..0MONSOONS\.rna0ENE.\\\i PUBLIC RECORDS NOTICE: Please be advised that 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 Aci. (Gov. Code, E5 5500 et sen.) Furthermore, any attachments, addendums,or supplements attached to the claim form, including medical records, are also subject to public disclosure. ................■■■\\\\■■■■■■■■■■■■■■■■■■■■■■■■■■..\..■■■■■■■■M-0■■■■■.\.\\■■■\■■■■■■1 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. Page 3 of 7 BCAki ) OF- SUPEkVIS0� OF 9,h COSIP� CZUOS3 TORT G LRZN1 • _ -._�11�rr�eh �y ��rah1�. 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"�. � '! is y �`r, � 7tio-;Y• I�1 z •f � �'j ..� �" v m y 8 0CDC z ° 71 ..� W- 3J n 0 W Z ° 2_ J< CD m w o T Q O Ow 01 }.� a + ,�. v g � ,.�.., � 00 CD _ CD 3 W a � CDCD r o y of 4M v s fl J p `R • T � l ° R. CD M5"- �r S 0 -n o cn m a W , -CD O -01 P ", CD IN M . t` - ; MN Cl) cur tx N ' 47 003 ;ate m 4w. OD CD W > Q t ly C) ,r 3 .- i> CD CD m , Fn ;, � CD p m ... m CD nQa o i m •� Sr CD cn n' O H H H H ® Z M a r r• r r n o m mm m i ❑ ❑ ❑ ❑ ❑ Elm n (D d Irl n v m C m .c O Z a (D m r C� a a a o \ rw n cn tn Ln o C� C 0 m Z w y y z p :k. ..3 R7 Ff ® 70 n n ® m �, V M 0 ° c-' Fri C) i, M a 3 a M In Ry7 m ;r,• �•— w n v Cz n �l Li n rr rr r• r- r• • w w w r r••• RECEIVED DEC 2 4 2007 _ d= C I er k -} �j3oQCLERK BOARD OF SUPERVISORS / r y►S O C S CONTRr,COSTA CO. tM, Gad►s _Lll��� Sf��_�4ini-►S Corre— 5_ZX-Acrice. _ &,V4 race—& rIP _d n --- -- - b�` u--�6c__\Dwr SMO Aha --- -- ---