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Home My WebLink AboutMINUTES - 03061984 - 1.21 Board Action : C.AII4_ r-� March 6 , 1984 / Bom OB SMMMSOM OF CORM COSTA COWff, CNLMK Rr?IA Claim Against the County, or District ) MMM TO CZAII►4RW governed by the Board of Supervisors, ) The copy s t ma led to you is your Flouting En3orsensnts, and Board ) notice of the action taken on your claim by the Action. All Section references are ) Board of Supervisors (Paragraph IV, below), to California Govezrnnent Codes ) given pursuant to Government Code Section 913 Kenneth Ambrose and 915.4. Please note all 'Warnings'. Claimant: County Counsel Attorney: Alex Friedland Mackey, Rozanski and Friedland JAN 3 0 1984 Address: 738 North First Street Martinet. CA 94553 San Jose , CA 95112 Amount: $11-0009000. By delivery to clerk on Date Received: J-anuary 30, 1984 By mail, postmarked on January 27 , 1984 I. FROM: Clerk of the Board of Supervisors 20: County Counsel Attached is a copy of the above-noted claim. Dated: January 30, 1984 J.R. OtSSON, Clerk, By �I �p�, , q/Lfit�61 Deputy II. FROR: Canty Damsel TO: Clerk of the Board of Supervn.sors (Check only one) ( 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. 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: 'Gc.,li Deputy County Counsel III. FR04: Clerk of the Board TO: (1) County Counsel, (2) County Administrator ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD By unanimous vote of Supervisors present (�) This claim is rejected in full. ( ) Other: I certify that this is a true and correct copy o the Board's Order entered in its min t R fo� tis date. Dated: yti44 J. R. OSSON, Clerk, By , Deputy Clerk SING (Gov. Code Section 913) Subject to certain exceptions, you have only six (6) months from the date of this notice was personally served or deposited in the mail to file a court action an 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. V. Fel: Clerk of the Board 70: (1) County Counsel, (2) Canty Administrator f the above 91aAm We notified the claimant of the Board's action on this claim by mailing a copy of this document, and a memo thereof has been filed and endorsed on the Board's appy of this Claim in accordance with Section 29703. ( ) Awarning gnoof, O[claimant's right to apply for leave to present a late claim was mailed DATED:tgM b R4 J. R. SSON, Clerk, By L-,,d) (se. �U&-A Deputy Clerk cc: County Administrator (1) County Counsel (2) ypp, CLAIM' � I • rA ^ CLAIM TO: BOARD OF SUPERVISORS *O? CONTRA COSTA COUNTY Instructions to Claimant A. Claims relating to causes of action for death or for injury to person or. to personal property or growing crops must be presented not later than the 100th day 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. (Sec. 911. 2, Govt. Code) 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 (or mail to P.O. Box 911, Martinez, .CA) . 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 ent:_ty, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at end of this form. RE: Claim by ) Reserved for Clerk's filing stamps ' KENNETH. AMBROSE RECEIVED ) Against the COUNTY OF CONTRA COSTA) JAN �i ) J. K. OLSSCii: or N A DISTRICT) K OARD F SUPERVISORS Fill in name ) TR A Deputy The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $1,000. 000.00 and in ._support of this claim represents as follows: ------------------------------------------------------------------------ 1. When did the damage or injury occur? (Give exact date and hour) November 1, 1983 - 12: 30 A.M. ------ ----r----------- --- -------------- --------------------------- --- 2. Where did the damage or in-jury occur? (Include city and county) Parking lot of Case Orinda Restaurant, 20 Bryant Way, Orinda, Contra Cost County, California -----�•--------------------------------------------------T--------------- 3. How did the damage or injury occur? (Give full details, use extra sheets if required) See attachment ------------------------------------------------------------------------ 4. What particular act or omission on the part of county or district officers , servants or employees caused the injury or damage? Slamming of claimants head and body against police vehicle and inordinate tightening of handcuffs. 090098 (over) 5. tiiiat are the names of county or district officers, servants or employees causing the damage or injury? Deputy Sheriff Klekare - Contra Costa Sheriff's Department ------------------------------------------------------------------------- 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for .auto damage) Dislocated index finger, sprained middle finger, scratched and bruised wrists and severe laceration above left eye ----------------------------------------------------------------------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) Loss of wages, medical costs and care, permanent mental and physical damage and subsequent costs . 8. Names and addresses of witnesses, doctors and hospitals. - a) -Dr. William C. Lyon, M.D. ,_ Brookvale Medical Center, 2101 Vale Road Suite 200, San Pablo, CA 94806 b) Lafayette Physical Therapy, 895 Moraga Road, Suite 10, Lafayette, CA 94549 ------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: 'DATE, ITEM AMOUNT As of 12/30/83 : Physical theropy $163 .17 Medical Care Not yet available ************************************************************************** Govt. Code Sec. 910.2 provides: "The claim signed by the claimant SEND NOTICES TO: (Attorney) or by some* Oerson on h' behalf. " Name and Address of Attorney ALEX FRIEDLAND1 man ' s Si ature MACKEY, ROZANSKI & FRIEDLAND 2036 A cot Drive 738 North First Street Address San Jose, CA 1511 2 Mozaga; -CA 94556 Telephone No. (408) 288-5500 Telephone No. (415) 682-6883 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, town, city district, ward or village board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is guilty of a felony. " 000099 0 CLAIM BY IQ200ii-i AMBROSE. ATnV1P= 3 Claimant requests that bartender at the Costa Olinda Restaurant call him a cab. Upon this request, the claimant was approached by a man identifying himself as a police officer, J. Hatcher. The claimant asked for identification and was briefly shown some sort of badge and verification card. Claimant was asked by the plain clothes officer to step outside. Upon reaching the parking lot, the two were joined by Sheriffs Deputy Officer Klekare. A conversation ensued in which claimant required officers to inform him of the nature of their interest in him. At that time officer, Klekare reportedly stated "I 've had enough of this shit" and grabbed suspect and slammed him into the side of the police vehicle thereby dislocating the inddx finger and spraining the middle finger of claimant. Officer then proceeded to twist claimants arms behind him and place handcuffs on him. The officer then slammed the claimants head into the body of the police vehicle, causing the claimant to suffer a severe laceration over the left eye. The officer then proceeded to physically throw the claimant, head first into the back seat of the police vehicle. The claimant subse- quently requested that the officer loosen the handcuffs as they were causing injury to his hands and wrists . Upon the request the officer further tightened the handcuffs causing furtherscratching and bruising to the claimants wrists . 000 .00 Board Action : CIAIK March 6, 1984 BOARD OF SQPERVI9= CF CCNPRA STA COMM, CALEPMWM Claim Against the County, or District ) NMICE TO CIADOW governed by the Board of Supervisors, ) The copyof s t ma lea to you is your Routing Endorsements, and Board ) notice of the action taken on your claim by the Action. All Section references are ) Board of Supervisors (Paragraph ID, below), to California Government Codes ) given pursuant to Government Code Section 913 Claimant: East Bay Municipal Utility�"a915.4. 15. 4 Ply note all Narnings". rict Attorney: Boornazian , Jensen & Garthe County Counsel 1504 Franklin Street JAN 3 0 1984 Address: P. O. Box 12925 Oakland , CA 94604 Martinez, CA 94553 Amount: Unspecified By delivery to clerk on Date Reoeived: J an u a ry 3 0, 1984 By mail, postmarked on January 27 , 1984 I. FRCM: Clerk of the Board of Supervisors 70: County Counsel Attached is a copy of the above-noted claim. Dated: January 30, 1984 J.R. CB,SSON, Clerk, By Deputy e en P . Marino II. FROM: County Counsel T0: Clerk of the Board of Supero .ors (Check only ane) (,X) 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. Clerk should return claim an 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: .J: By: ��:�,�,� -� ,,,,F Deputy County Counsel III. FROM: Clerk of the Board TO: (1) County Counsel, (2) County Administrator ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD CRDE[t By unanimous vote of 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: MAR C 1424 J. R. CC,SSCN, Clerk, By ]� , Deputy Clerk WRRCIIMG (Gov. Code Section 913) Subject to certain exoeptions, you have only six (6) months from the date of 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. If you want to consult an attorney, you should do so immediately. V. P": Clerk of the Board 70: (1) County Counsel, (2) County Administrator Attached are copies of the above claim. we notified the claimant of the Board's action on this claim by mailing a copy of this document, and a memo thereof has been filed and endorsed an the Board's copy of this Claim in accordance with Section 29703. ( ) A warning of claimant's right to apply for leave to present a late claim was mailed to claimant. / Clerk, By � J. R. • Deputy Q.S.SCN _ _ De Clerk cc: County Administrator (1) County Counsel (2) 1 CLAIM 1 GPS: 10282 BOORNAZIAN, JENSEN & GARTHE 2 A Professional Corporation 1504 Franklin Street 3 Post Office Box 12925 Oakland, CA 94604 RECEIVED 4 Tel : (415) 834-4350 5 Attorneys for EAST BAY JAPl3o �ggq MUNICIPAL UTILITY DISTRICT 6 J. R. OLSSON CLERK BOARD OF SUPERVISORS 7 B .4CLrONTRA,�OSTA CA. 8 CLAIM FOR DAMAGES INDEMNITY) 9 10 TO: COUNTY OF CONTRA COSTA Board of Supervisors 11 651 Pine Street Martinez, CA 94553 12 13 Claimant, EAST BAY MUNICIPAL UTILITY DISTRICT, hereby makes the following claim for indemnity against the COUNTY OF CONTRA 14 COSTA: 15 1. NAME AND ADDRESS OF CLAIMANT: 16 East Bay Municipal Utility District 17 2130 Adeline Street Oakland, CA 94612 18 19 2. ADDRESS WHERE NOTICES ARE TO BE SENT: Boornazian, Jensen & Garthe 20 1504 Franklin Street Post Office Box 12925 21 Oakland, CA 94604 S 22 3. DATE OF OCCURRENCE: 23 December 19, 1979 24 4. PLACE OF OCCURRENCE: 25 3791 Highland 26 Lafayette, ' California 5. NATURE OF CLAIM: 27 The instant claim is for indemnity only. Claimant East BOORNAZIAN, 28 Bay Municipal Utility District was served with a cross- JENSEN B GARTHE P.O.BOX 12925 1504 FRANKLIN STREET OAKLAND,CALIFORNIA 94604 141518344350 PIER 32 - . P.O.BOX 1119 SAN FRANCISCO,CA 94120 14151 5419000 ' 1 complaint for declaratory relief on December 15 , 1983. Said cross-complaint arises out of a court action 2 entitled Weidman v. Davis, Action No. 240661, venued in the Superior Court of the State of California, in and 3 for the County of Contra Costa. 4 6. DESCRIPTION OF CLAIM: 5 According to the pleadings on file in the matter of F Weidman v. Davis, the Weidmans are claiming that they 6 bought property from defendants Davis that contained defects causing flooding in the Davis home in Lafayette. 7 Davis subsequently cross-complained for declaratory relief against claimant as well as the County of Contra 8 Costa, East Bay Regional Park District and the City of Lafayette. 9 7 . DAMAGE OR INJURY: 10 Unknown. 11 8 . ITEMIZATION OF CLAIM: 12 - Dollar amount is unknown. This claimant seeks indemnity 13 for any monies it is required to pay as a cross- defendant in the Weidman v. Davis matter. 14 DATED: January 26, 1984 BOORNAZIAN, JENSEN & GARTHE 15 16 / 2ZI&I2 17 B /GAYLE P. STARR 18 rtTneys for E.B.M.U.D. 19 20 21 22 23 24 25 26 27 BOORNAZIAN, 28 .JENSEN&GARTHE P.O.BOX 12925 1504 FRANKLIN STREET 3AKLAND,CALIFORNIA 94604 -2- 14151834-4350 nn PIER 32 O i-1 LI�} 10 3 P.O.BOX 7119 SAN FRANCISCO,CA 94120 14151 5419000 Board Action : CC Q�gl March 6 , 1984 . OF SUPERVISORS OF CORI?A COSTA C10Wff t CALIIOFMA Claim Against the County, (r District ) NNICS TO C AD9W governed by the Board of Supervisors, ) The copys t ma led to you is your Routing Endorsements, and Board ) notice of the action taken on your claim by the Action. All Section references are ) Board of Supervisors (Paragraph IV, below), to California Government Doses ) given pursuant to Government Code Section 913 Claimant. Diane Berk and 915.4. Please note all Narningi"6ynty CoUnSel Attorney: Edward T . Nagatoshi FEB 0 3 1984 Address: 1515 Redondo Beach Blvd . , First Floor Martinez, CA 94553 Via Sheriff ' s Office Gardena , CA 90247 ii ��o. �� ebruary 2 , 1984 88843659 Amount: $5 , 000. n'rt�fve�' �airrTefk Date Received: February 2 , 1984 By mail, postmarked on I. FROM: Clerk of the Board of Supervisors 70: County Counsel Attached is a copy of the above-noted claim. Dated: February 2 , 1984 J.R. C[SSON, Clerk, ByP�^ . Deputy L2'1 I e4e n'FSMarino II. FROM: County Counsel T0: Clerk of the Board of Supery cors (Check only ane) (�) 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. 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: a2IJI kV By: Deputy County Counsel III. FROM: Clerk of the Board TO: (1) County Counsel, (2) y Administrator ( ) Claim was returned as untimely with notice to claimant (Section 911.3). W. BOARD By unanimous vote of 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 n is minutesfo this date. Dated: MAR J. R. LESSON, Clerk, By ppm �� , , 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 deposited in the mail.to file a oast action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of yas choice in cormecticn with this matter. If you want to consult an attorney, you should do so immediately. V. FRONT: Clerk of the Board TO: (1) Dainty Counsel, (2) County Administrator Attached are copies of the above claim. We notified the claimant of the Board's action on this claim 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. ( ) A warring of claimant's right to apply for lea 2to present a late claim was mailed to claimant. DATED: MAR 6 3-o4 J. R. CY.SSON, Clerk, By , Deputy Clerk CC: County Administrator (1) County Counsel (2) r CLAIM V j EDWARD T. NAGATOSHI � 1515 W. Redondo Beach Blvd. r 2 First Floor RECEIVED Gardena, CA 90247 3 tel: (213) 538-4525 u..F.EED), ,R t984 4 Attorneyfor Claimant DIANE BERK J. R. OLSSON CLERK BOARD OF SUPERVISORS 5NIRA TA CO. . B C� �. 6 7 8 CLAIM FOR PERSONAL INJURIES AND PROPERTY DAMAGES 9 AGAINST PUBLIC ENTITY 10 In the Matter of DIANE BERK ) CLAIM FOR PERSONAL INJURIES 11 vs. ) AND PROPERTY DAMAGES (Calif. Government Code 12 CONTRA COSTA COUNTY SHERIFF'S ) Section 910) DEPARTMENT ) 13 ) 14 TO THE CONTRA COSTA SHERIFF'S DEPARTMENT. 15 YOU ARE; HEREBY NOTIFIED that DIANE BERK residing at 16 18813 Fellar Ave. in Torrance Calif. 90504 claims compensatory 17 damages from the above listed governmental entity in the amount 18 of $5,000.000 . as of the date of the predentation of this claim. 19 This claim is based on personal injuries sustained by 20 the claimant on or about December 21, 1983 located near the 21 corner of Wilshire Blvd. and Camden in the City of Beverly Hills 22 and involves the same occurrences, transactions and events as 23 those of the claim submitted by ROBERT UCHIDA and filed "recived" 24 by your department on Jan. 23 , 1984. 25 Claimant was a passenger in a vehicle which was law- 26 fully being operated by ROBERT UCHIDA when a vehicle (lic. no: 27 BST025-CA) registered to the CONTRA COSTA SHERIFF'S DEPARTMENT, 28 and operated by an individual whose idenity is unknown to -1 OODiOJ r 1 claimant at present, negligently collied with claimant's vehicle, 2 causing personal injuries to claimant. 3 Claimant believes that the unidentified individual was 4 operating the vehcile .in the course and scope of his employment 5 at the time of the incident, and that the indivddual was employed 6 by the CONTRA COSTA SHERIFF'S DEPARTMENT. 7 All of the above were negligent in their actions , 8 negligent in the hiring of each other, and responsible for the 9 actions of each other. 10 The total amount claimed in compensation for injuries 11 is $40000 .00 . 12 The total amount claimed for property damages is 13 $1000 .00. 14 All notices of other communication with regard to this 15 claim are to be sent to the Law Offices of EDWARD T. NAGATOSHI 16 AT 1515 W. Redondo Beach Blvd. , First Floor, Gardena, CA 90247. i7 DATED: January Al, 1984 18 19 EDWARD T. NAGATOSHI, At to n y for 20 Claimant, DIANE BERK 21 22 23 24 25 26 27 28 -=2- 000106 Board Action : CUUM March 6 , 1984 BOmm OF SDPFmew Qr CONTRA CWTA C omff, C REVOMM Claim Against the Couanty► or District ) "MCC TO C AIIVW governed by the Board of Supervisors► ) The eopys tma lea to You is your Routing Priorsements, and Board ) notice of the action taken on your claim by the Action. All Section references are ) Board of Supervisors (Paragraph IV► below)► to California Goverment Codes ) given pursuant to Gu7vernment Code Section 913 and 915.4. Please note all *Karnin�WWtq Counsel Claimant: James E. - Pollard FEB 0 3 1984 Attorney: Martinet, CA 94553 Address: 111 Quail Hollow Court Hand Delivered b Claimant Martinez , CA . 94553 Y Amount: $114. 50 By delivery to clerk on February 2 , 1984 Date Received: February 2 , 1984 By mail, postmarked on I. F m: Clerk o the Board of Supervisors 70: County Counsel Attached is a copy of the above-noted claim. Dated: February 2, 1984 J.R. OESSON, Clerk, By fCtico Deputy II. FROM: County Cassel TO: Clerk of the Board of Supervisors (Check only one) 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. Clerk should return claim an 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: ? Hy: Deputy County Counsel III. FUN: Clerk of the Board TO: (1) County Counsel, (2) 4ty Administrator ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD By unanimous vote of Supervisors present ( ) This claim is rejected in full. ( ) Other: I certify that this is a true and correct oDW of the Board's Order entered n is mina s f4mr is date. \ , Dated: 6 �a44 J. R. LESSON► Clerk, By e,.,Y 1 l�tGh �, , Deputy Clerk VARQING (Gov. 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 file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of yaw choice in connection with this matter. If you want to consult an attorney, you should do so immediately. V. FROM: Clerk of the Board 70: (1) Canty Counsel, (2) County Administrator Attached are copies of the above claim. We notified the claimant of the Board's action on this claim by mailing a copy of this document, and a maim thereof has been filed and endorsed on the Board's copy of this Claim in accordance with section 29703. ( ) A warning of claimant's right to apply for lea to present a late claim was mailed to claimant. DATID: MNk 619a`� J. R. LESSON, Clerk, By Deputy Clerk► cc: County Administrator (1) County Counsel (2) CLAIM GI.AIM720: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY Instr•.uctions to Claimant A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops must be presented not later than the 100th day 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 *?tion. (Sec. 911. 2 , Govt. Code) 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 (or mail. to P. O. Box 911, Martinez, CA) 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 end of this form. RE: Claim by ) Resery Ts, n stamps v ' FES � ) C. IJo4 Against the COUNTY OF CONTRA COSTA) � ) J. R. Ot5$ON CLERK BOARD OF SUPERVISORS Or DISTRICT) NTRq, o"A Co, �Fi1 in name) ) e - •• Y The undersigned claimant hereby makes claim again s t e County of Contra Costa or the above-named District in the sum of $ and in support of this claim represents as follows: ----\J ---l�T - j--=---------------------------- ------------------ r 1. When did the damage or injury occur? (Give exact date and hour) -----------T---------------- -------------------------------------------- 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage o injury ociur? (Give fu detail use extra sheets if required) 'el � / 4z/ 00(7��,� ---------------------------------------=---------------------------------- 4. What particular act or omission on the part of county or district officers, servants or emplo ees caused the injury or da:uage? 000,108 i Vhat iar lt'he names DoT county or dristtrrirctq Wervant.4; or ti �etctpi oee� jos sing 't'he damage =r 3 /�� r� 11 �'-----r r- (5 . What • amage injuriF);- .clai*mr.resute 3tent---- ve of injuries or <da ges cla meed. Attach t o estimates{Torr uto / damage) xyr rel ' - C 7. How was the .amount claimed abdve computed? (Include the estimated amount of any prospective injury or damage.`) Z-2. ---- ----- ------ --moo-. __ �--- -------- 8. m s - addresses of witnesses d ctors and hospitals. . , List .'the expenditures you made on account of this accident or injury: 1JAT_E ITEM. AMOUNT icy •*iF***'*il**!k**�ti,**flit***tt*hR***st at�t#'�t tk'1t?...�ist*******ik*iF rt***ik it it*#*rtk*tk*fh********* Govt. Code Sec. 910.2 provides : "'The claim signed by the claimant SEND NOTICES TO: . (Attorney) or by some person on his behalf. " Name and Address of Attorney Claimant' s Signature Address Telephone No. Telephone No. 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, town, city district, -ward or village board or officer, authorized to allow .or pay the same if :genuine, any false .or fraudulent claim, bill, account, voucher, or writing, is guilty of .a felony. " `• 'i 0 OQ 9 ' a _ .Mow _ - ORDER NO. I H.BIN HSE DATE TIME I DAY DOC.NO. - THANK YOU FOR 522K O 12/30/83 FRI 17564 A L SHOPPING WARDS SCHEO AISLE I P.BIN I BATCH EMP TERM I DUE DATE 1015 6 1757 1 A I PAT STORE STORE NAME I ORIG I ENT SHTS PIT 1515 PLSNT .HL 101 1 00 TERMS/CREDIT NO. CREDIT APPROVAL AUTHORIZATION I PAGE ASH lOF 1 2841 6692/1515 89239 cCIAL IN5fRLX71ONS/MESSAGE // 420 92 104.97 MPS 9530 2.54 MD9 6.99 ATX THIS PURCHASE IS OrDSE RECD NOTIFIEC BY y. SUBJECT TO THE TERM PHONE CARD AND CONDITIONS OF MY - CREDIT AGREEMENT. . 0 O'�� :i�/I DT-L OR REJECT DATE DF.FUTURE BILL DATE ; t CUSTOMER'S SIGNATURE X NAME AND ADDRESS PHONE NO, PCLLAR09JAMES L 415-2293675 ACCOUNT NUMBER AMOUNT 111 QUAIL HOLLOW MARTINEZ CA 94553 882137694/00000006 DATE TYPE SALE 12/31/83 5 CA 114.50 TTL ; . • KEASE RRESENT THIS SALES CUSTOMER i CHECK IN CASE OF ERROR EXCHANGE OR RETURN COPY f LOC CATALOG NUMBER SEQ.I QUANTITY 1COLORI SIZE I PRICE I WEIGHT TAX TRAN/HDLG i C 42� 9251 68 1 s 42 . 104. 04-12 MOTR YCL JKT TALL Tu,i I i 882 131 b9 s .. Mets 71 Ir' REM PT i - •�� .. ....:„r No `. .,r.. ... . _ 1`Gil.:.:L. �,..l�i Lr�✓IF.:: iJ..:i aa. r 7 r•` ' .'` r.� T-w I IA... I OSE . 104.97 TX .6.99 T/H 2054 TOTAL $114.50IST 04-12 000 , CONTRA COSTA COUNTY DETENTION FACILITY +LJiSil )CLOTHING RECEIPT ' DATE: 01/27184 TIME: 2337 NAME (L,F,M): POLLARD J�E:S�ED1dAkD BOOKING NBR: 13700 -tj rT7 -..--_.__..pOB: 11/06/61 CLQTHING ❑ SHIRT ❑ PANTS ❑ COAT ❑ SHOES ❑ SHORTS `Y. ❑ T SHIRT ❑ SOCKS ❑ HAT ❑ SWEATER ❑ GLOVES ❑ BELT ❑ TIE OTHER t t l INTAKE CLH OFE'TW� INMATE X (SIGNATURE) CLOTHING BOX ASSIGNED: 3 CLOTHING RACK ASSIGNED: RELEASE r% - s` REL OFC: DATE: - ` .RECEIVED ALL CLOTHING INMATE t (S*NATURE) 5*1 y r . 1. Y , 000-1 Board Action : ,- March 6 , 1984 MW cr 3QPERfTISCFZ4 cr CQdPAA ONM Cow", aLIP'mm Claim Against the County, or District ) NNTCE TOO CEADOM governed by the Board of Supervisors, ) The copy Of W8'&6NZX-'ma to you is your Routing Endorsements, and Board ) notice of the action taken on your claim by the Action. All Section references are ) Board of Supervisors (Paragraph IV, below), to California Government Codes ) given pursuant to Government Code Section 913 Claimant. Gordon & Joan Zane and 915.4. Please note all 'Warnings". Attorney: Address: 40 Stratford Road Kensington, CA Amount*. $228. 13 By delivery to clerk on Date Received: - January 31 , 19 8 4 By mail, postmarked on January 30, 1984 I. nom: Clerk 37 the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ,,,�,//� A � ' Dated: January 30, 1984 J.R. CSSSCN, Clerk, By V� �� qty Helen F . Marino II. FTM: County Counsel TO: Clerk of the Board of Super sons (Check only one) y) This claim czmplies 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. 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 Counsel III. FROM: Clerk of the Board TO: (1) County Counsel, (2) County Administrator ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BC)AIM By unanimous vote of 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. � �9 Dated: i� Pad J. R. C SSCN, Clerk, � e-ic.. , Deputy Clerk i4AR*M (Gov. Code Section 913) Subject to certain exceptions, you have only six (6) months from the date of 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 miry 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. V. FROM: Clerk of the Board TO: (1) County Counsel, (2) County Administrator Attached are copies of the above claim. We notified the claimant of the Board's action on this claim by mailing a copy of this document, and a memo thereof has been filed and endorsed an the Board's copy of this Claim in aowrdanoe with Section 29703. ( ) A warning of claimant's right to apply for leave to present a late claim was mailed to claimant, A},, DATED: J. R. CLBSON, Clerk, By �n,,c x a < . Deputy Clerk ^J cc: County Administrator (1) County Counsel (2) 000112 CLAIM i CLAIM TO: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY Instructions =o Claimant A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops must be presented not later than the 100th day 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. (Sec. 911. 2; Govt. Code) 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 (or mail to P.O. Box 911, Martinez, .CA) . 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 end of this form. RE: Claim by ) Reser g stamps TZI AM J 7A ; RE yv sr�� +Tf 0 IC ID I\CA)&ItuCTi!' 0d Against the COUNTY OF CONTRA COSTA) JAIV dpi lyC ) j. . OLSSON or DISTRICT) CLERK D F SUPERVISORS Fill in name) ) 8 .--. ..r............ ..........Deputy The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ and in support of this claim represents as follows: -----------------------------c------------------------------------------ 1. When did the damage or injury occur? (Give exact date and hour) �a � 3 N3 t-52 A ray --------------------------o-r---in-j---ury--occur?--------------(Include---cit---y--and------county) -------- 2. Where did the da/m�age y o .St g fir ------------------------------------------------fu ----:--------------- 3. How did the damage or injury occur? (Give ll details, use extra sheets if required) Guy, )IIS GI�(l ,y,�� 'u� j�l� S�rPh,� � 4!-1' �,r rh ruJr .(lhr uc 124, .o/t yD ,T7 t,11c�./t!rJ�W /�ph� 1wcly`04- �1. /f��:vn6 IL1u/t / } — � e✓ h^. �'V CLE/r/?]ate / er, �':� C �� [� r! /! !�P!✓it i �9 / (P�ll .� �� L✓lr�l t-ed 6%t O Er e l f Pk-!C ------------------------------------------------------------------------ 4. What particular act or omission on the part of county or district officers , servantsor employees caused the injury or damage? // e� ep /rfal 7k«l. 000113 (over) 5. What are the names of county or district officers, servants or employees causing the dam a a or injury? UH 161 140 lrr ------------------------------------------------------------------------- i 6 . What damage or injuries do you claim resulted? (Give full extent of injuries or damage-/s claimed. Attach two estimates for auto o' damage) ! ,4 e zvl iv C 4 ij,,iecl //K c'�k<•�/.,7`/' "1/!J�o ,<<" kr,t c;r /h'•� cGv„t .->ft• /` r� L✓�i . �, 'V7711 ��YfJ�� COeL`�1� / �f 7. How was the amount claimed above mputed7 (Include the estimated amount of any prospective injury 8r damage. ) --------- ! ( ~-aa-r-ee------- ---------�----------------P------------------- 8. Names and addresses of witnesses doctors and hos itals. J 5 d e /'le hi-c t /111 v (,vi�k<��r/<3I / A be �/d�cs(I/G" �frv�f/� L.�l?c i C�JIACFG( to __ __ ____________/_______ _ / _ __ _—_ 9.__Lis__ t the expenditures you made on accoun_t__of___this_____acci___de_nt____or injury____: DATE .`. : , : }i ' ITEM �yAMOUNT fr sj Q ,C,o 3 Govt. Code Sec. 910.2 provides: "The claim signed by the claimant SEND NOTICES TO: (Attorney) or by s me pers.ori on his behalf. " Name and Address of Attorney Ott Cl�iman�zlr/-� Signature �sj2 2 Mr ¢sY,� tz 7 Address Telephone No. rTelephone No. a 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, town, city district, ward or village board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is guilty of a felony. " 000114 _ ,:s rr.atrx.e..:s[rLF§ .31�0 1 •.e/' ` • COMPANY(RENTOR) ' (DPJ CI'EY,NO STA.NO - ��naaRa��:.:plt+•ni r.r ,xr`+t�'^ r y t •,t talpl-f`�y, }r �T5:r r 5f'Jff� EH9 All,n r*in 1 glt}�T'i91+ 'r R/bH IMC�� < ( a. a?y�A� •J?(tJ 30i.IJD t^,1M1..9Ji tS IiOV J I7'rjEPrQ)„'J1.n Dp!; ,MILEAGE DETERMWEO t�% 3. (OD ALTERNATE,FLA TA11A iiM71►: - .BV READING FACTORY - _ F�AAL- , INSTALLEDODONETER - i 7Jy n 4 - t'qF or J i a r (✓10T r- s,r 1S..y,. n� u - AR CKED IN r ,T ?, )iD Sl .1�-t ,,MILES IN )1,)[ G/i( a ,NO ��TY :WILiB RETURNEDJTO,f Ll7 TAy)�5 (88)CfiHECK INCITT " 5Tvky(ON P i !(�RY �...� ")1 ,✓J rT li^a 'fF.l N/� ..^.^) ,l .a-_. aErt, Mfr, -a_OUT.n- r l p (OB)CAR RATE (6Y RESERVED (09) DATE (�) �+ Ofu PREPARED BY COM T BV CAR WILL BE ✓ MILES JL. f I,f';s<.r.A YII✓I ITx'T *J� l .RETURNED BY Al DRIVEN; r'r !, ' _ aF > )•i .s 3- Y,yYyr-vCL.AR MO�DrE�L�,. {{ OWNING CITY i�ly.f�,,E✓%CIG STATi,Tp S*jM LES' D i^t Ci"3� )(: �V1F'-.s..;J`Dv OATu)iyfMErN J k�iYTs� " �"4�' ^kt53i 0'iQ 3(!Rf>rA' t Li'.t+4a lfiQ'Vi,finG'f 2t�1T 3'.5:15 k.!:AIILOWED 'Qui '1"!tn" 'ii;jS A4Mtt>'2c9?''E^{✓ + "s3'A -''' max, �tf07)STATE t (OB)OWNING CITY•N(p ( ARV < (g�p� ( ' 'MILES W _ , r :s CHARGED ,._c i' ( ' FMII3TTF'lli� V1J ) I CAR NALTERNA CARAND DATE +UG (IS)J v OF- O GELID TEpT�ME00T t ,F 1 urrQ �+ 019 SCI .'q'u.0 14SS s � �x�t�;y' Rl�t'!}.• w;a. MILES Ai(Mul:() "i t•t!?t})7" i`7^-r•(jt 'rC -'} ' t t a IN ' ii;91Q -,mil-rT PMIF 9! !'Sk'Y'lA tiOt1.!S�^-it:J,` t ( SIRM "EXTRA';" FOR THIS RATE TO -MILES BEETII DAYS ,'v1 *APPLY:VEHICLE MUST OUT DAYS (q BERETURNED BY.., 50R80N Z AM E R01f6 7. t,r,AP q , e MILESIS J T '32r0r'6 T r' .r' ttd eQ7if)J Tipl .DRIVEN,Y 1,10,L'.J'1r91 :a'?tt I!`. 146:N�,Arl • lfla't- .,�s�;i. .,•.. (tl) .r t - z 1 ALLOWED - fin=nat r<. .-rc� +tl.i r .L (87).BILLING NUMBER.:'+a, .iSb l+U 6$r '1hJt57.1`TS ^^ 14 cJ r4p.{'aIR PER DAY,; DAYS�'.�1+ r .R4+trD 3�r+ J.- S}t$ )(42), ;i - 1 .4`;.i _u•!ti.V.. $ti lr^.6.^.t5 W:.S6� 5_tiilM!l )kY /ire (T5)AUTHORIZATION NO - +' s ^"� (74)CREDIT CARGO C(IEDITTTPI t EEKS @'. tr pQ,'•U L+ C' fr--$�R4lGR' (A§)"i ' - �' , f"i +f+Tas•.. 1'tr�Tli c>:3.. " .+'7T' '-13-!)(1'7 '11".5,:w:i)4 ( E,:)•a -{}i.'lc Ir.:,+:i.),vii. ? �.,s99)�:?(1'11 r f t�. c l .. " (96)RESERVATIO�J.NUMBER (Be(RECAP NO ' PER HOUR HOURS _r ^ dr _t .:.3Jf1 0 1..,'i9. ? (?'0. .�• r 3• .+:w 1 1 i+ r (fiB)YP COMPANYSiIAME(PL EA SE PRVNT)� i ° t!Zi rcl -,y SPEC)AL SPECIALG r r JUt' y .a.. $+') r �r net ierr. .:1_t Se- ° s:. ♦( y JI wilt v, :$ t 1.:? ,-,f (dt:?+lf 't 3y}r•Y �!1°.. U�;$:tn - L (69)RENTER'S(CUSTOMER'S)'NAME(Full).(PLEASE P.RINT)- u,-,J};._Li:.,ri .nJi..e«;is' J,T::- (•I �ICn+.,c;y. �L C.RSr+6�7i 1 (14) r.55UB.TOTALy r O (70).ADDRESS vc r m r o• a s n t. <Ir- t: TE CODE'a•u { L p7) �. 7: F2 ,)v(/, °4 ss T)r t 1.. 1-T't a w L1.,'J o4t .i u,rr i. .L r (r>57s �(QJ1 Tr 3.F 1 .il+r. i F C (Tq CITY - -(72)'STATE --- - `:(Ti)ZIP - - TOTAL TIME AND (A8) i [�R MILEAGEOR'r+?,MINIMUMCHARGEBIRTHDATE. r COMM SOURCE COMM CODE ACOEP S C.D.W. DECLINES INTERG YFEE p9IVER CENSE,730 r t ( - 'y „GOLVS10N DAMA�,�IIAIVEN r•�; �, ♦�>♦'�f!' BY INITIALS CUSTOMER`.ACCEPTS OR. *�i�,.��,�,+• S,•` , tF r - ' DECLINES C.D W A777 RATE SHOWN IN (,? EXPIRATION DATF� - (AREA CODE) +4 0ME.ANO/Ofl.BU51 PHONE AREAS''A:OR 57'SE PARAGRAPH./(o);¢ .H FUEL REPLACEMENT+ x 3 ..}:= ) r I r7 1 'L°„Iti n,L. t '-/' i. ON REVERSE SIDE D:W:APPLICABLE ,r O-TAXABLE ' ONLY IF ACCEPTED. D.WASNOTINSUR-` '® - ^ER MILE � '. RE 'S(CUST ER)NAME ANCE..WHEN,C.DW/:NOT ACCEPTED', K- (5t).. `� ,•j =-t,n -') )I LIABILITY.WILL NOT EXCEED p ry :q:: , t *SU TOTAL UNLESS CONRUCT IS LATE (52) t« ADD FUEL; - I ^JT. TAX �,r + <., STAT ;( P ACCEPTS P A:1 OECLIN DW(PER�AY1�.fi; 53 y .. a 17m a 116 33' 7: ys"'_e is .,.,•,�' .1f. +�' 6 _ +L LOCAL ADDRES5 '"' •� PHONE ND a:. l 9 +pERSONACACCIDF�NT INSURANCE >FUEL REPLACEMENT' (82) @t ejr }.' CUSTOMER ACCEP OR OECUNES P.A;L; •NON.TAXABLE,n,-3i,I - t r` - - AT RATE SHOWN.}FNyI.I+REA U.ACCEPT-.. ® PER MIT F , I HAVE READ THE TERMS AND CONDITI01(S ON BOTIJ SIDES OF THIS RENTAL AGREEMENT ANCE IS•PROOF'QF DOVERAGE UNDER - PAI.(PER DAPI J, (Sq J AND AGREE THERETO.V 1 T - POLICY ISSUED TO LESSOR AS OUTLINED RENTER'S SIGNATUREA - i r r -a.-'7,, - IN SEPARATE DOCUMENT. ++ +__ (Tlfh 11$.3t5rT i2Lr:` J BT ADDITIONAL AUTHORIZED DRIVER - - 378) CASH TYPE OF COUPON ( ( ) rS.;ilr.:C9+t IU1.U'•+'Ic L t 4 r'.r'_ L '•J + ;) ..s+l V.1 J ] iTOTAL'CHARGES° .i l� �., . ru•-T ..n:c.. •.h.s!DYr inn .n. n.:,.? , S (1piORIG DEPOS)T-s,(58)yADDSTSONALL y MISC CREOIT§)� (56)✓Bfii_ L+ ;SEE PAGET(REVERSE610E)ddcf{7TUQ0nJr():z2�(Tnoq?Te)IiTPZt+SG ':s :.eC a Un x r `4 uullt:i 5S 1vtC•:? (TL, + J1. S ADD CITKNO: DATE �.MISC.CHARGES INVOICE SUBJECT TO FINAL AUDIT(SEE PG 1,PARA 4d) MINIMUM RENTAL-ONE DAY,PCUSMILEAGE. t„ ann, 4, ds +.7 lei) iE .7 4 d Mt f u+ N f 3i Lr3 (571 .;INTERCITY FEE AND/OROTHER RATE CHANGES MAI�APPLY IFVEMICLE uNusEo�J,:,+ Le 11.. 9 2(t(T'rN r_� (J�t MET:CHAR6E IS NOT RETURNED TO THE LOCATION ANWOR ON THE DATE AND TIME DEPOSIT•i kSPECIFIED ABO1.VE (SEE PGa PARA 2) r ^m n obT+ n= n (�) 11 CIfSTOMER IS LIABLE FOR ALL PAR,KIING AND TRAFFIC VIOLATIONS '1 GAs Erc f.,,FCf rltt.r t LESB DEPOSIT ,il S_'.uA.u.'. �.... T (SEE.PG.1 PARA68) ; aL Y) .'•'S*'C9 JlP.:'i Or V':6a:rr .�. . r sc,r -1 •`•40TALJ✓Qf r"1 'J V '91 ,Fa fJf)'`°AMOUNTDUF e: LESSOR S INSURANCEVOID IN MEXICO(SEE PG T PARA50) - REFUND •'NO'ROMBURSEMENT WILLfBE�JAADE WITHOUT GAS RECEIP3S v'" r :REFUND RECEIVED EYI-)11+, u t t r ' 1). �+sn r s u f uxrwr i . CHARGE FOR F IELREPLACEMENTAS NOT INCLUDED IN TiMEANDlOR . ],REFUND Per oa cHcrx a aL' to m „ 'M0.EAGEORMINIMUMCHARGE."'NGIh vn J 7 OMM TS Iplt q:r �ittiq)�r_ rr7.iYiirH�A>�<* + } 1 p w r n A10 J1.1.^,3.1tA'+.Oi_,r:E';)i ht.-tTr x(a• '(.i ' �! n 'Yp;,��w.�,t�n�77�"yR'(�2")T.'-,9i.sJ�,n4F_Yv.'J9\,ta?�:,+39Jlyl <9CJ lriti xf.r•1�i(+t�L f(ibv)? SU c��*$5:iJfi!) t.st.rsr�^n.'.7 �lu.Rf iJa✓:`7.!°'sT(EA .. i}' >;l - r1Jf}11:61c+rr tl OU:Cc.r3 t•trJ:f07, _.�i..lrt',ell, , ^' iu :n IF s57�v41 F•J7 tirr�^a�rt,t •*ri a . xrs3 r3�`�`y..yxy...+....+:i+:..eo. r>r++-...� -e..+.....v._,.,.... - ✓ T.q,,,,,. 4,....-.�. `� � ......e 1}e,� 1y:�: RFN,TAt AGREEMENTNO. CUSTOMER REDEIESTS UPGrsnbe _ '10 Ef"fef Sa1sf',R.1n."V EA Folk 480 i �_ f1s(nlats9y'B3Fd1c) :idplsnR4?�mn) rEu�s:+lz t - M "? Y.; - ~_THIS RENTAL AGREEMENT NO,MUST APPEAR LO X IC /awl{iE:lysprtl - -.ON ALL PAYMENTS AND CORRESPONDENCE. . , .�y. _ wwY'sd4TMlf11 ;E9'T/ryAiQYi - PAGE TWO(FRONT SIDE) % a,• t x�(R4$!WHENi'OUR NATIONAL CAR RENTAL CARD HAS BEEN USED v_ r i y+ TOR YOODURR RENTAL YOU WILL BE BILLED FROM AND PAYMENT GOLDENROD , '715HOUID BE MADE TO NATIONAL CAR RENTAL, I Ta Ti`$.'3": ,,.v':� "r1. tOD�iRPA1 AVENUE`_+0.�,,_M!NNEA.P,OLISANW+ .•. ..1,. Lp, aa t j l =Xi..,r4.�.e.. .. >_ c ...tT.F...:�•f''.sa:;-sk�._r..-T..;e.eAA�"c�.a .nu. •. 'FYI"}j��y. `�a+4w4`g�+r�..-,N}rp ul,- 3 \' • i �.• a ._... ,.a. ?er< '� - � ^/ A.' r a y 1 s {/e �n'S b s-.Y ', .o L ,i r n } 'Y ..as tp m r'l ,'�+�,'� r• a A Y� lit }Y .e '+4k e.' 4r, y� r 'a Ort {v Yie§J a-rt�. P' 'arc.{r' r'Pj�a^a.'ty' ln, Y�R ( 7 y tv Mr 'vt.�' ..Ty� r �t'•v c d +4 t4 3 Jt vt.< w n r <. i t•. t hf ,yp ,„ ?..i,. •Y r., d',s.'tt� ht Y?4 ,. r * ,. +' ; .y Yc.1sr a'tyi". 2l" �Xt re,!ra",z" "{_� r t''C :3 y?�h r° fy^t e.^7� s. �.Y 4.+e"! s 'Tr?a ,.r� rte a 5tr / F ,r.J�°i+•w+rn S�fb,rr�. y Wx '4's 1 i tt Reit FS It c1iF l {;6 Z I.. ,�rAI to ir, 1 �.. 'jr e �. 1 m,r•} iJ'\ 1 t C. ♦rL r 3,my5y �.d ` Mlk ' +Na'h4-(F t XSf a :a w v. .+..Y•`.i _ >r'Ot.:rY`. -+ r 'ji'L3 "n" qid; :t.".; i4 •"fry; n?'' t. r ?q B aa„y' 'a a s i'tt cRocxER 1 ( 1 r F F • . jj Jy LE w t t675'ZY '+ r • ,,.y CALIFORMA 94102 19 F .rl,S yy3` Thr4�*� I'iJ� Y>�J'�t•7S51y drYt T^ / I 4 1 f''. /I r � TO THE ORDER• Ur T'1 I'4't DOLLARSc ~it ?�i .•ftyys-m;%>�+tiry ,Lr.S�„s�.� • ' • • K �x� IJOAN t rd/ 40 STRATFORD RD,KENSINGTONF CA 94707 .,.+F ..z. / a*t tuv$ rir ($� .1. z >�rYY y� :'r'R• -n'L Jg A'r^ r � `�" +� �4 �"z W.. � t '�i+iF 4�Xr 3 +. .�.i',r �-;%.�z° rri n A.`i•� ��{%�i'1:'��.4.'t �ca,mA: .,y>' d '� t, -•Iruks �y.�4�4' r}��gy.M"E "�.�� uJ�.�',t?�rt'?'", �.��-'7.r+h��v4"v' 4'�n+'�r3. '�"'��"'� r"�``r�•e�•.T.f �Ad,. :�S3;y,,,I' +i?r,StV ,�i*�is!g?;! .+�.c �� p ":4�.- _ ^.?rir..'r •%kr. .'".o-:*' W t APPLICATIOIT TO FILE LATE CLAIM . BOARD OF SUPERVISOR T. C COSOUPJ'.CY, C.�+,LL�'ORNIA BOARD ACTION Application to File Late ) NOTE TO APPLICANT Claim Against the County, ) The copy of this document mailed to you is your Routing Endorsements, and ) notice of the action taken on your application by Board Action. (All Section ) the Board of Supervisors (paragraph III, below) , references are to California ) given pursuant to Government Code Sections 911.8 Government Code.) ) and 915.4. Please note the "Warning" below. Claimant; Patrick Timothy R o y s t e r County Counsel Attorney: FEB 13 1984 Address: 1 London Court Martinez, CA 94553 C1a-yton , . CA 94517 Amount: $180 . 00 February 13 , 1984 By delivery to Clerk on Date Reoeived: By mail, postmarked on io„ I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted Application to File Late Claim. DATED: F e b r u a r y 13, 19 3 4 R. OISSON, Clerk, By� }'y]AA- j �, Deputy e en arino II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911.6) . The Board should g= this Application to File a Late Claim (Section 911.6) . DATED: JOHN B. CLAUSEN, County Counsel, By, , Deputy III. BOARD ORDER By unanimous vote of Supervisors presenyj (Check one only) ( ) This Application is granted (Section 911.6) . (X ) This Application to File Late Claim is denied (section 911.6) . I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. MAR 6 1984 ` DATED: J. R. QLSSCmi, Clerk, Iiy, p„t . Deputy �e WARNING (Gov't.C. §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 re- quirement) . See Government Code Section 946.6. Such petition must be filed with the court within six (6) months from the date your applica- tion for leave to present a late claim was denied. You may seek the advice of any attorney of your choice in connec- tion 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 Aafiin sa-ator 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. DATEY): MAR 61984 7. R. OLSSON, Clerk, By J �i� . P /],t . Deputy V. FROM; 1 County Counsel, 2 County Administrator TO: Clerk of the Hoard of Supervisors Received copies of this Application and Board Order. DATED: County Counsel, By County Ae31.1n1Gtrator, By 0001,17 APPLICATION TO FILE LATE CLAIM i February 9, 1984 RECEIVED The Board of Supervisors 79�� County Administration Building FEB ) 3? 1984 Box 911 J. R. OLSSON Martinez, CA 94553 CLE K BOARD OF SUPERVISORS CONTR/A� COSTA CO. To: Tom Powers, 1st District Nancy C. Fanden, 2nd District Robert I. Schroder, 3rd District Sunne Wright McPeak, 4th District Tom Torlakson, 5th District Re : Claim Received 1/31/84 by L. Cassaro, Deputy From Patrick T. Royster I am writting in behalf of my son Patrick Timothy Royster, B. D. 9/16/600 because he is presently in a locked psychiatric facility in San Jose, California. I am enclosing Patrick's claim and asking for leave for him to present a late claim (See Section 911.6 of the Government Code). Patrick is receiving no money at this time and his hospital bill is being paid by Medi Cal. He has no way of replacing the clothes that were lost or misplaced while he was serving time in the County Jail in Martinez. The one item I am concerned about is a fairly new jacket that was given to Patrick by myself that Christmas of 1982. He does not have a warm jacket at this time. Would you please look into this matter for myself and Patrick. We would appreciate hearing from you at your earliest convenience. Sincerely, F. N Barbara F. Haselow 1 London Court Clayton, California 94517 Phone: Wk. 682-8000 Ext. 326 Hm. 672-0648 cc: Helen P. Marino, Deputy Clerk _. . - _000118 jJ n 7 CLAIM TO: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY Instructions -o Claimant A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops must be presented not later than the 100th day 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. (Sec. 911. 2 , Govt. Code) 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 (or mail to• P.O. Box 911 , Martinez , CA) • 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 cJlaimMis against more than one public ent '_ty, separate claims must be filed against each public entity. E. Fraud. See penalt_, for fraudulent claims , Penal Code Sec. 72 at end of this form. ************************************************* ** RE: Claim by ) Reservedj»iti}Ls� fl n� amps RY� 'T' �h� _ t7 � ) JAN Against the COUNTY OF CONTRA COSTA) D Cc LZ .......... pur;�:ry 6BR9 or �1!KT% VCS .ouM' t DISTRICT) (Fill in name) ) T The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named 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) -- arc Ck+ 'W 30 Om ------------ 2. Where did t mage or injury occur? -r(Include city and county) 1= trJG _ fl1E r; l tori � kfcc ---------- = $ — -----_ ___ �' 1r2L � _C�I. t ------------ 5. How How did the dangige or injury oc uf? (Give full details, use extra sheets if required) _ {{ nn ,I Lam/ LJril_Ic{�1_'F�Lf4'ssXfoh ��_� .r.� ��_� P. r��Gf'J _ LJL✓J` 4. What particular act or on the part�f county or dist r ct officers , servants or employees caused the injury or damage? 000119 7i1', C atJ01 lC as rn t'er5*:va ,1 �3A'o orf — (over) AMM It 019@O The Board of Supervisors ContraCounty Ciark ^° �`►,�,�,� �,OMicio Cork of tM Board Xo4fy Administration Building Costa Chi f Clark ""'""" t�l,i.l crock P.Q: Box 911 (�� 14%)V2-2371 Martinez, Calitornia 94553 Co urly Ton powers,tst District i Nmry C.Faridsn,2nd District Nobat 1.sebrodor,3rd District suns wriphi tupsak,4tA District Tom Torlskson,Stn District February 2 , 1984 RO: Patrick Timothy Royster 1 London Court Clayton , CA 94517 NOTICE TO CIA 6VW (OT_Late-FllW_c1_a m_) (Government Code Section 911.3) (x) The claim you presented to the Board of Supervisors of Contra Costa dainty, California, as governing body of the x County of Contra Costa and/or District, on January 31 , 1984 is being returned to you herewith because it was not presented within 100 days after the event or occurrence as required by law. (See Sections 901 and 911.2 of the Government Code.) Because the claim was not presented within the time allowed by law, no action was taken on the claim. Your only recourse at this time is to apply without delay to the Board of Supervisors (in its capacity noted above) for leave to present a late claim. (See Sections 911.4 to 912.2, inclusive, and Section 946.6 of the Government Code.) Under some circumstances, leave to present a late claim will be granted. (See Section 911.6 of the Government Code.) You may seek the advice of an attorney of your choice in connection with this matter. If you desire to consult an attor- neyl, you should do so immediately. R R A • t t It TO BE PTLtED IN BY TM C[EM OF THE BOARD ONLY IF APPLICABLE: ( } Since a portion of your claim is not untimely, we are retaining a copy of your claim for Board action on that portion of your claim which is not untimely. J. R WSW, Oounty Clerk By: Deputy Clerk Date: February 2 , 1984 000120 FILE LATE CLAIM M! r BOARD OF SUPERVISORa OF CbNTRA CDSTA court Y, (y1LI_FORNIA BOARD ACTION Application to File Late ) NOTE TO APPLICANT Claim Against the County, ) The copy of this document mail to you is your Routing Endorsements, and ) notice of the action taken on your application by Board Action. (All Section ) the Board of Supervisors (paragraph III, below) , references are to California ) given pursuant to Government Code Sections 911.8 Government Code.) ) and 915.4. Please note the "Warning" below. Claimant: Jodene Tyraven Attorney: David G. Smith Adams: 1440 Broadway, Suite 603 Oakland , CA 94612 Amount: Unspecified Januar 31 1984 By delivery to Clerk on Date Received: Y , By mail, postmarked on anus r , 1984 Certified Mail P24 4177150 I. FROM: Clerk of the Board of Supervisors TO: County Coups Attadied is a Dopy of the above-noted Applicati n to File Late Claim. DATED: J a n u a ry 31 , 19 94 R. OLSSON, Clerk, By �ePutY II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911.6) . (�) The Board shouldShis Application to File a Late Claim (Section 911.6) . !DATED: JOHN B. CLAUSEN, County Counsel, By , Deputy III. BOARD ORDER By unanimous vote of Supervisors present (Check one only) ( ) This Application is granted (Section 911.6) . ( X ) This Application to File Late Claim is denied (Section 911.6) . 11 I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. DATED: MAR 6 M4 J. R. OLSSON, Clerk, By , Deputy WARNING (Gbv't.C. 5911.8) 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 re- quirement) . See Government Code Section 946.6. Such petition must be filed with the court within six (6) months from the date your applica- tion for leave to present a late claim was denied. You may seek the advice of any attorney of your choice in connec- tion 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 espies 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 mesio thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. DATEn: MAR 61084 j. R. OwSON, clerk, ByV Deputy V. FRCM- 1 County Counsel, 2 County Administrator TO: Clerk of the Hoard of Supervisors Received copies of this Application and Board Order. DATED: County Counsel, By County Administrator, By 00021 APPLIC.ATION TO FILE LATE CLAIM DAVID G. SMITH RECEIVED 1 Attorney at Law 2 1440 Broadway, Ste. 603 r Oakland, CA 94612 JAN 3l, iJ84 3 (415 ) 893-3741 J. R. OLSSON CLE BOARD OF SUPERVISORS ONTRA TA CO. 4 B _ .,. 5 IN THE MATTER OF THE PROPOSED APPLICATION FOR LEAVE TO CLAIM OF JODENE TYRAVEN PRESENT LATE CLAIM UNDER 6 AGAINST THE COUNTY OF CONTRA SECTION 911.6 (b) (1) OF COSTA AND THE MARTINEZ THE GOVERNMENT CODE BY 7 COUNTY HOSPITAL / CLAIMANT'S ATTORNEY 8 TO: THE COUNTY OF CONTRA COSTA AND THE MARTINEZ COUNTY HOSPITAL 9 I, DAVID G. SMITH, the undersigned, as counsel 10 on behalf of Jodene Tyraven apply for leave to present 11 a claim pursuant to Government Code Section 911.6 (b) ( 1) . This claim is founded upon a cause of action for 12 personal injuries which resulted from hospital and/or 13 medical malpractice on or about October 1, 1982 through 14 and after June 15, 1983 for which a claim was not 15 presented within the 100-day period provided by Government Code Section 911.2. For additional 16 circumstances relating to the cause of action, reference 17 is made to the proposed claim attached to and 18 incorporated as a part of this application and the accompanying declaration of David G. Smith. 19 20 The reason for this delay in presenting this claim is indicated in the attached declaration. 21 22 I am presenting this application within 23 a reasonable time and within one year after the accrual 24 of this cause of action. 25 WHEREFORE, I respectfully request that my 26 application be granted and that the attached proposed 27 claim be received and acted on in accordance with Government Code Section 911.6(b) (1) , which states 28 000122 _ I that "The board shall grant the application where. . .the failure to present the claim was through mistake, 2 inadvertence, surprise or excusable neglect and the 3 public entity was not prejudiced by the failure to 4 present the claim within the time specified in Section 5 6 Dated: b 7 8 r 9 DAVID G. SMITH 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 00023 r I DAVID G. SMITH Attorney at Law 2 1440 Broadway, Ste. 603 Oakland, CA 94612 3 (415 ) 893-3741 4 5 IN THE MATTER OF THE PROPOSED DECLARATION OF DAVID G. SMITH CLAIM OF JODENE TYRAVEN 6 AGAINST THE COUNTY OF CONTRA COSTA AND THE MARTINEZ COUNTY HOSPITAL 7 8 I, DAVID G. SMITH, DO HEREBY DECLARE: 9 10 That I am an attorney at law duly licensed to 11 practice law in the courts of the State of California and 12 that I am an attorney for the claimant. 13 On or about October 1, 1982, claimant, Jodene 14 Tyraven, had an open reduction and internal fixation of 15 a tibia fibular fracture of the left leg at the Contra Costa County Hospital in Martinez. 16 17 While in the hospital, claimant was advised that 18 the healing process would be very lengthy. 19 From the time of the surgery until now, she has 20 been followed at the Contra Costa County Hospital in 21 Martinez. 22 While she was being followed at the Contra Costa 23 County Hospital in Martinez, numerous x-rays were taken 24 and claimant was never advised that anything was wrong. 25 From the time of ;the initial surgery until now, 26 the valgus deformity in her left leg has become increasingly 27 more severe. 28 Claimant believes that the Contra Costa County 000124 I Hospital was negligent and relies among other things on 2 the doctrine res ipsa loquitur. 3 1 have requested but have not received all records 4 from the Contra Costa County Hospital in Martinez relating 5 to the surgery of October 1, 1982 and the follow-up care which claimant received. Claimant contends that she neither e knew nor should have known that professional negligence 7 has occurred. 8 9 The failure to present this claim was through mistake, inadvertence, surprise or excusable neglect and 10 the County of Contra Costa was not prejudiced. 11 12 I declare under penalty of perjury that the foregoing is true and correct. 13 14 Dated: January 30, 1984 042.,J I DAVID G. SMITH 15 16 17 18 19 20 21 22 23 24 25 26 27 28 000,2 a CLAIM AGAINST THE COUNTY OF CONTRA COSTA AND THE MARTINEZ COUNT 1 HOSPITAL 2 3 4 (a) Name and address of claimant: Ms. Jodene Tyraven 5 534-14th Street Oakland, CA 94612 6 (b) Send all notices to: DAVID G. SMITH 7 Attorney at Law 1440 Broadway, Ste. 603 g Oakland, CA 94612 (415 ) 893-3741 9 10 (c) Date of Occurrence: Unknown at this time. 11 Place of Occurrence: The Contra Costa County Hospital 12 in Martinez. 13 (d) Circumstances of occurrence: Claimant relies on the 14 doctrine of res ipsa loquitur and at this time has no knowledge. 15 (e) General description of injury: Valgus deformity left 16 leg with apparent nonunion. 17 (f ) Amount of claim and basis of computation: Medicals, 18 personal expenses, wage loss according to proof, and general 19 damages. 20 Dated: January 30, 1984 D VID G. SMITH, Attorney for 21 Claimant 22 23 24 25 26 27 28 000 .20