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HomeMy WebLinkAboutMINUTES - 01132009 - C.09 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: JANUARY 13, 2009 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. D you is your notice of the action taken on your claim by the Board of DEC 12 2008 Supervisors. (Paragraph IV below), given Pursuant to Government Code COUNTY COUNSEL Section 913 and 915.4. Please note all AMOUNT: UNKNOWN MARTINEZ CALIF. "Warnings". CLAIMANT: STEPHANIE M. ROYAL ATTORNEY: ALBIE JACHIMOWICZ DATE RECEIVED:. DECEMBER 12, 2008 HINKLE, JACHIMOWICZ, POINTER, ADDRESS: AND EMANUEL BY DELIVERY TO CLERK ON; DECEMBER 12, 2008 2007 WEST HERDING STREET, STE. 100' SAN JOSE, CA 95128 BY MAIL POSTMARKED: DECEMBER 11, .2008 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DECEMBER 12 08 DAVID TWA, Cle Dated: 20By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Su rvisors (✓r`I'his 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). O Other: Dated: J— 5 0 '7 By�� 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). OARD ORDER: By unanimous vote of the Supervisors present: �j 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. DatID TWA, CLERK, By Deputy Clerk WARNING(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 maif 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. Dat AVID TWA, CLERK, By, eputy Clerk This warning doesno�t apply to claims which are not subject to th�talifornia�Tort;.Claims Act such as actions in inverse condemnation, actions for specifuc relief such as mandamus or injunction, or Federal Civil Rights..claims. The above list is not exhaustive:andIegal consultation is essential to understand all the separate.limitations periods that may apply. The limitations period within which suit must be filed 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 = �-poi ts`rights under California Tort Claims Act nor does`at waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act y� BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT i r 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. i D. If the claim is against more than one public entity, separate claims must be filed against each k public entity. E. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form. j i RE: Claim By: Reserved for Clerk's filing stamp ) 2 2ooa I Against the County of Contra Costa or ) DEC iN EST CIT District) Cl=F`BOARD CON"(FPA COyIA CO. ill in the name) ) i The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named j district in the sum of$ and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 12JLdv 26Os approxiw ely 9sp,�, 2. Where did the damage or injury occur? (Include city and county) 1yl �6Y►f-t'71 C05tA COxvvi-� 3. How did the damage or injury occur? (Give full details; use extra paper if required) r-C f Cr tb a farhzd svit'C't 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? habrd Lv16 i-D Polio Rgm-f ,, Pd- s Driver N-&,& sp :c4 ��hsafe specd� 5 What are the names of county or district officers, servants, or employees causing the damage or injury? C�lon`�v � . Colockw � 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) _ vch I a<.� :I'►'1 oQT.i dGUt"c J v 1'ir4wand fb..ss"ier roar 5 td o a f to-*- �sec 09h;Kate) Chani& 51g&4ld<-r, back, 9lu.hzou_,s pain; Whiplash! haA in) r� 7. How was the amount claimed above computed? (Include the estimated amount of any i prospective injury or damage.) V< bodLj SKOP a,VtAcka(rushyo epee -cs pLrsar : exAvn� -crn�s �� ERS doG¢ay visit', azul p"51a� l I'Yte�-zcPy APp�t " 3 8. Names and addresses of witnesses, doctors, and hospitals: Ste lm 51'►GGt 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT a6;oC�o.o0 ACCOROIX fo Pleoof' a ammaamau ms a■mooson&soon aa..■osmosesam&a mea•■m&m&••mm■amua Basso a Nona ams nm a a sous I Gov. Code Sec. 910.2 provides"The claim shall be i signed by the claimant or by some person on his. behalf' SEND NOTICES TO: (Attorney) ) Name and address of Attorney ) i (Claimant's SiAIMM at Law tore) 200 SW Heddin Street.Suite Ift j 40640 InnoValr Dr. *-x41103 So jose' A 951 ) (Address) (408)246-3508 ) ALBIE.iACHIMOWICZ,ESQ ) SCX lin'[ t�lfiv 95K3 ) Telephone No. )Telephone No. mono■■am■ssgas memo■■ma■samom&am anammmmm••esasmasnmmmsr mmmmmamsmsn seams■■■own■■mammmms 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 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. mommoommonss makes Now mmm■■omammommmmmassm mm sassamomm&mm■mossmasm vasoamommman■ ■we a moves 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. Supplement to Claim Repekft 3. How did the damage or injury occur? On Saturday, 12 July 2008, 1 was driving my vehicle—Grey/Blue 2007 Nissan Altima Hybrid— on I-80 W/B. Just east of Barrett Ave, l merged into the#1 lane at 60-65 MPH. Within about 10 seconds, the traffic in front of me began to slow and I applied the brakes of my car to slow down to approximately 45-50 MPH. I then felt the Westcat Bus behind me hit the rear of my car, pushing my body forward and backward, and also crashing my head into the headrest. The collision pushed my car forward and also forced it to slightly spin to the right. The bus then hit me a second time at my rear passenger side before eventually coming to a stop with the tail-end of my car slightly raised in the air. Before the Richmond Police arrived, the bus reversed slightly and placed my car back on the ground. I was still in the car when the Richmond police officer arrived on scene. I did not remove myself from the car until I was taken to the ambulance. 8. Names and addresses of witnesses, doctors, and hospitals. Eric James Bostick Berenice Nava 2401 A Waterman Blvd. Ste. P.O. Box 40446 206 San Francisco, CA 94170 Fairfield, CA 94534 Delza Ramolete Bao Ngo 47 Glenwood 2140 Highland Dr. Hercules, CA 94547 San Pablo, CA 94806 Dale T. Sanchez Tiffany Silvers 2001 Forest Run 151 Bluebird Ct. Hercules, CA 94547 Hercules, CA 94547 Fernando D. Lucas Phillip Junior Rose 1608 Swallow Way 727 Florida Ave. Hercules, CA 94547 Richmond, CA 94804 Dr. Robert Tang, MD Deallo Onasis Pearce 1020 291h Street 121 Brighton Dr. Sutter Medical Group Sutter Square, Ste. Hercules, CA 94547 360 Sacramento, CA 95816 Justin Leland Lucas 2066 Lewis St. Teresa Wooden, PT Hercules, CA 94547 1014 North Market, Ste. 120 Sacramento, CA 95834. Enrique Gonzalez Marquez P.O. Box 40446 Alta Bates Summit Medical Center San Francisco, CA 94170 2450 Ashby Ave. Berkeley, CA 94705 ,� tt Gs G, �. u Cl VA WNN* +' V © '1A 0 VA C3 0 ©in 4 y � J