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Home My WebLink AboutMINUTES - 05121987 - 1.15 .tom CLAIM. / BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT May 12 , 1987 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Unspecified Section 913 and 915.4. Please note all �I�r11iBas, nSel CLAIMANT: D014ALD HAROLD CLARK ET AL (i ut�`y Law Offices of Bowles & Verna APR,2 7 1987 ATTORNEY: 2121 N. California Blvd. #875 Walnut Creek, CA 94796 Date received Martinez, CA 94553 ADDRESS: BY DELIVERY TO CLERK ON April 17 , 1987 BY MAIL POSTMARKED: April 16 , 1987 I. FROM: Clerk of the Board of Supervisors TO: lCounty Counsel Attached is a copy of the above-noted claim. April 23 , 1937 ppHHIL ATCHELOR, Clerk1�� DATED: p BY: Deputy L. Hall II. FROM: County Counsel TO: Clerk of the Board of Supervisors (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. The Clerk. should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: �/��u �. J; / ? BY: �-��-" �• �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. BOARD ORDER: By unanimous vote of the Supervisors present X) 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. p Dated: MAY 12 1987 PHIL BATCHELOR, Clerk, By 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 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. 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 asshownabove. Dated: MAY 1 3 1987 BY: PHIL BATCHELOR by De ut Clerk � y CC: County Counsel County Administrator 1 CLAIM AGAINST THE COUNTY OF CONTRA COSTA Donald Harold Clark, Shirley Lee Kerr, Lloyd Kennedy and Pauline Kennedy c/o Law Offices of Bowles & Verna present a claim for damages against the County of Contra Costa, for costs of defense, indemnification from any liability in conjunction with that matter entitled Adams v. Clark, Contra Costa Superior Court Action No. 293644, as well as for general and special damages according ,to proof. CLAIMANTS " ADDRESS; Law Offices of Bowles & Verna 2121 N. California Blvd. , Suite 875 Walnut Creek, CA 94596 DATE OF OCCURRENCE: August 27, 1986 PLACE OF OCCURRENCE: Danville, California SAID CLAIM ARISES FROM THE FOLLOWING CIRCUMSTANCES: On or about February ll, 1987, Donald Clark, Shirley Lee Kerr, Lloyd Kennedy and Pauline Kennedy were served with a summons and complaint which alleged wrongful death in conjunction with the death of Shannon Adams, seeking damages for wrongful death by reason of 'a collision occurring between the vehicle being driven by Donald Clark and the decedent. The complaint alleges negligent operation of the vehicle as well as deficiencies in the main- tenance, design and construction of the subject roadway. A cross- complaint ,and this claim seek indemnification of this matter. NATURE AND EXTENT OF DAMAGES: Because of the negligence of the County of Contra Costa involved in the design, construction or maintenance of the subject roadway, Donald Clark's, Shirley Lee Kerr's, Lloyd Kennedy's and Pauline Kennedy's conduct was secondary and passive, without active fault. Thus, the County of Contra Costa is obliged not only to indemnify and defend Donald Clark, Shirley Lee Kerr, Lloyd Kennedy and Pauline Kennedy, but also to reimburse them and hold them harmless for any judgment, settlement, legal expenses and fees. Donald Clark, Shirley Lee Kerr, Lloyd Kennedy and Pauline Kennedy hereby tender the defense of this action to the County of Contra Costa. Dated: April 16, 1987 LAW OFFICES OF B/OWLES & VERNA r 64). By: RECEIVED RIC D T. BOWLES APR 1987 �, L<m CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT jig 12 , 1987 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Unspecified Section 913 and 915.4. Please note all "Warnings". CLAIMANT: CITY OF SAN RAMON County Counsel 2222 Camino Ramon APR,2 7 1987 ATTORNEY: San Ramon, CA 94583 (�/� q Date received A ril 16 a 1��' CC BY - 94553 ADDRESS: BY DELIVERY TO CLERK ON P BY MAIL POSTMARKED: no envelope 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: April 23 , 1987 Jy1L BAATCtELOR, Clerk P y L. Hall 1I. 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 911.3). ( ) Other: Dated: ? BY: � ��—� �l�_l�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. BOARD ORDER: By unanimous vote of the Supervisors present X) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board' Order entered in its minutes for this date. MAY 12 1987 Dated: PHIL BATCHELOR, Clerk, By 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 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. 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: MAY 13 1987 BY: PHIL BATCHELOR byW/��LZ_C�Deputy Clerk CC: County Counsel County Administrator r Sheriff-,Coroner V Tv Richard K.Rainey Contra Costa CountyCounty Counsel SHERIFF-CORONER Warren E. Rupf P.O. Box 391 Assistant Sheriff Martinez. California 94553-0039 APR,111987 Gerald T.Mitosinka (415) 372- Assistant Sheriff Martinez, CA 94553 To: Joe Tonda, Risk Manager Date: April 13, 1987 Safety & Benefits From: Gerald Mitosinka, Asst. . Sheriff subject: Public Liability Claim By: Lt. Lyle Shores, Admin. Div. San Ramon #87-018 Claimant: Greathouse In anticipation of you requesting further information on the above entitled case I am forwarding the below listed attachments for your review: 1. One copy of San Ramon Police Department' s report # 87-018 concerning this incident. 2. One copy of Misdemeanor complaint. LS:mr CC: file 1987 AN EQUAL OPPORTUNITY EMPLOYER MEMO mun DATE: April 10, 1987 TO: ores, Lieutenant F• essional Standards and Resources i FROM: J.L.✓ )Gackowski, Lieutenant an Ramon Police Services SUBJECT: Claim - Greathouse, M.R. CF#S87-018 Please find attached: - San Ramon claim #005.87, received 4-6-87 and attachments - CF#S87-018 This claim was received by the city on Monday, April 6, 1987. The city will deny the claim and coordinate with Risk Management. It should be noted that the original drunk driving complaint against Greathouse has been amended to include resisting arrest and battery on a peace officer. cc: G. Ford, Captain Date: April 6 , 1987 TO: City Attorney, City Manager, Asst . to City Manager Police Services FR: CITY CLERK Attached is the following: Claim No. 005 .87 Claimant Michael R. Greathouse c/o Leslie R. Karlstrom-Krebs 2258 Third St . , Livermore, CA 94550 Date Received: April 6 , 1987 NOTE: Appropriate department (dept. which is named in claim) to conduct an initial investigation and report to City Attorney and Assistant to City Manager within 15 calendar days from the date of this notice. /csn/claimfor s - 1 - RECEIVED APR 0 G 1987 CLAIM AGAINST THE CITY OF SAN RAMON (For Damages to Persons or Personal PropertlAY OF SAN RAMON Maim No. 005.87 A claim must be filed with the City Clerk of the City of San Ramon, 2222 Camino Ramon, San Ramon, California within 100 days after the incident or event causing the loss or damage occurred. Name of Claimant Michael R. Oreathouse - --- Address c/o Law Offices of Leslie R. Karlstrom-Krebs, 2258 Third St . 1 Livermore , UA 94550 Send Notices regarding this claim to the above address . (415) 449-9093 Time and Date of Incident Approx 2 :00 am on January 1., 1987 Place (specific location) Pine Valley/Davona Drive , San Ramon, CA Circumstances (specify the act or omission upon which you base this claim in as much detail, to include a copy of any police report) Claimant was stopped for aneged speeding and subsequently arrested for alleged driving under the influence. During arrest of claimant , several police officers of herein CiTY assauited and useexcessive f-unz on claimant , causing claimant ' s nose to be broken and resultant serious damage to claimant ' s nose cartilage . On January 20 , 1987 , claimant was tormerly charg!d witn violarton 523152 (a) & (b) , driving rinfluence , however , no mention is made of an alleged Penal code 5148 violation by claimant , the all-e-ged Ju3`tification by herein CITY officers for said nights police brutality . Name(s) of Public Employee(s) causing injury, damage or loss, if known Officer Hansen Nash and DOES I through V CLAIM AGAINST THE CITY OF SAN RAMON (For Damages to Persons or Personal Property) Claim No. 005.87 Page 2 Loss Description (Describe injury, property damage or loss. If if there were no injuries, state "No Injuries") Serious physical injury and emotional distress Said injury has nPrPq-,jrit-Pd and continues to necessitate , medical treatment and claimant is scheduled to undergo surgery for said injury later this year at an P.;t;mated cost of $3 , 500-00.- {See enclosed medical records) . Claimant currently suffers serious nasal breathing difficulties and pounding in hi -q t-.qr<; And head. and has to date incurred a $500 .00 wage loss due to absence at work. Damages Claimed: 5000.00 medical Amount claimed as of this date $ ,nn nn wnggn loss Estimated amount of future expenses $ unknown Total amount claimed $ unascertained Witnesses, Hospitals, Doctors, etc. Barbara Greathouse and other witnesses currently unascertained ; medical doctor-Zev M. Kahn , M.D. Additional Information (Any additional information that you feel may be helpful in evaluating your claim) Date: March 31 , 19 87. Claimant's Signature LESLIE SIAIIE R. KAR41STROM-KREBS ATTORNEY FOR MICHAEL GREATHOUSE MUNICIPAL COURT OF Ct .,.FORNIA COUNTY OF CONTRA COSTA WALNUT allrm C JUDICIAL DISTRICT DA# 561223 No. ra0;9"4.t; - THE PEOPLE OF THE STATE OF CALIFORNIA ag BASO ,ve-s COMPLAINT demeano)iT ,k T-w�- 2. 23152(a) C.V.C. V. C�45N 2. 23152(b) C.V.C MICHAEL RORY GREATHOUSE, Ve6endant The undersigned states, on information and belief, that the above-named defendant did, in this Judicial District, commit a misdemeanor, namely, a violation of Section 23152(a) of the CALIFOMIA VEHICLE CODE (DUI Alcohol and/or Drugs) , in that th; defendant- on or about January 1, 1987 , did wilfully and unlawfully drive a vehicle while under the influence of an alcoholic beverage and under the combined influence of alcoholic beverage and a drug. COUNT TWO 'the undersigned further states that the said defendant did, in this Judicial District, commit a misdemeanor, namely, a violation of Section 23152(b) of the CALIFORNIA VEHICLE CODE (Driving at .10 or Above) , in that the defendant on or about January 1, 1987, , did wilfully and unlawfully drive a vehicle while having 0.10 percent or more by weight of alcohol in the defendant's blood. Complainant requests that defendant be dealt with according to law. I dectaiLe undeA penaZty o6 peAju)Ly that the 6ougoing is ttue and connect. Dated January 15, 19817 at Concotd, Cafi6oAmZa. FILED BY J. WALLIS CCMPLAINANT SO DEPUTY DISTRICT ATTORNE, DA 231(0)1/82 BRUCE C. MILLS /mea CONTRA COSTA COUNTY HEALTH SERVICES DEPT. EMERGENCY ROOM RECORD Patient Name(Last. First,Middle) 7tcom Number Patient's Maiden Name CHART SOURCE VISIT G'ti►-_A7i ):I^E MICHAEL 3 6 '40 4"54•:04_%:.i 02 -O'Clr11 Local Address(space/apt) City State Zip Telephone Acriv I Oate Time How LIU6,1_IN Ci-C7 JA CIJ0)L[N, CA 41'" 2:3'Z4[7-:rr: 01/01/C:r 0=:••_i 1711 Cate of Birth Age Emergency Contact Name Telephone F.C. Pt.Type Med Serv. 1 f.i�7/'Jsf i.+ t:F,F� :l^-.i:.R t:F:E(1?}iflt! E: :(il E F./R � CIFIC INSTRUCTIONS(If Checked) VOMITING AND DIARRHEA: These problems can usually be HEAD INJURY: The patient should be observed closely during the treated by discontinuing all solid foods and cloudy liquids.For the next 24 hours.Check every hour or two to make sure patient can be first 24 hours give clear fluids like flat 7-Up or ginger ale,Kool-Aid, aroused. Any of the following should be reported immediately.Per- clear fruit juices, Gator Aide, diluted bouillon or consomme,etc. sistent severe headache, nausea, repeated vomiting, excessive sleepi- Frequent small feedings such as 1 tbs.(1 tsp.for infants) every 10 ness, difficulty arousing patient,slurred speech,unusual irritability minutes are best. Popsicles and jello are usually welcome. Once or other abnormal behavior, weakness, partial paralysis, numbness, these are well tolerated, advance the diet to easily digested foods unequal pupils, leakage of fluids from nose or ears, convulsions or such as applesauce, bananas, crackers, rice, rice cereal, dry toast, any other symptom of concern. boiled or broiled white chicken meat.Carefully reintroduce infants to diluted formula. Gradually resume a normal diet,but avoid fatty were given a tetanus booster shot today. It is foods, leafy vegetables, fried foods, prunes, peas and plums for a help prevent to .. . If it was your firs , ou while. Repeated or severe vomiting,especially in children,or vom- should see your doctor about comp Izatlons. In any iting blood deserve early medical attention. case, we recommend you write today's date on the back of your drivers license,or someplace else where it will be available for future COLDS/FLU: Colds and flu are usually caused by viruses and are reference. This injection also boosts your immunity to diptheria. therefore resistant to antibiotics such as penicillin. Your symptoms may include sore throat, headache,muscle aches,stomach cramps, ECASTS: Allow a plaster cast 24-36 hours to harden. Keep limb nausea, vomiting and diarrhea. Usually such illnesses get better by elevated and dry. If parts of your limb become cold,blue,numb or themselves in a few days. If you are not better in that time,if you unexpectedly painful, you should return right away. Do not put develop fever or swollen glands, or if you become unexpectedly sharp instruments inside the cast, even if it itches. You must be worse, contact your doctor or return here. The most important checked in 24 hours. things you can do are take in plenty of liquids and to get plenty of rest. Discomfort from sore throat may be reduced by gargling with WOUNDS: Keep your wound as clean and dry as possible. Change diluted salt water (1/2 tsp per 8 oz. glass) or by using various your bandage when and if your doctor recommends it. Watch for lozenges,mouth washes or sprays. Fever,swollen nodes,and pus on signs of infection (pus, unusual redness, increased pain or warmth, the tonsils can be caused by bacterial infections. If the doctor red streaks, swelling of lymph nodes or fever). Return in case of suspects such an infection, a culture may be taken. You can call infection, bleeding, numbness or decreased ability to move the 372.4239 for results in 2 days. affected part of your body. Keep your appointment. BRONCHITIS: Inflammation of the tubes in your lungs can be 0 MIDDLE EAR INFECTIONS: Otitis media is an infection of the caused by infection or other irritation. Get adequate rest.8 ounces middle ear. It can be painful and can cause fever. It should not cause of fluid per hour (for an adult) will help keep secretions loose so serious complications as long as it is treated adequately. Be sure to that you can cough them up. A vaporizer or sitting in a steamy dive or take medicine as directed and for as long as directed.Return bathroom may also help. If you smoke, stop it. Follow any other if symptoms do not improve after 36-48 hours or if they get worse instructions from your doctor. Return if you have blood in your at any time. Be rechecked in clinic at end of treatment even if well. sputum, fever, chest pain, shortness of breath or other symptoms of concern. The care you have received has been rendered on an emergency basis only. You may be released from the Emergency Room before all your medical problems are known or treated. Be sure you understand all instructions given to you. Do not hesitate to ask questions. IF YOU FEEL THAT YOUR RECOVERY IS NOT PROCEEDING AS EXPECTED, OR IF YOUR CONDITION WORSENS UNEXPECTEDLY, YOU SHOULD RETURN HERE OR CONTACT YOUR REGULAR PHYSICIAN. APPOINTMENTS — We have clinics in Richmond, Pittsburg, Brentwood and (for Health Plan members only) Concord. Appointment desks are open weekdays between 8 AM and 4 PM (later in some locations). Be sure to tell the clerk that you were referred by the Emergency Room. RICHMOND 231-3021 MARTINEZ FAMILY PRACTICE CLINIC 372.4376 PITTSBURG 439-4070 MARTINEZ SPECIALTY CLINICS 372-0279• BRENTWOOD 634.1102 CONCORD 671501 *Martinez Specialty Clinic appointments can also be made in person by taking this slip of paper to the appointment desk in the Outpatient Department at the south Fnd of the lobby. MEDICINES—We can only prescribe enough medicine to last you until you are to be checked in clinic. Refills of your medicines(especially ones you take regularly) should come from your clink doctor. Unused medicines should be discarded. Pharmacy hours are from 8 AM to 9 PM on weekdays and from 8 AM to 4:30 PM on weekends and holidays.When the Pharmacy is closed,we can dispense small amounts of some medicines.The balance of your prescription'can be picked up from our pharmacy the next time it is open. If you live in Concord and belong to the Health Plan,arrangements can be made for the balance of your prescription to be sent to the clinic on Willow Pass Road. SCREENING NURSE — The Screening Nurse is available most days from 8 AM to 11 PM —Telephone 372-4239. You can call for selected test results and for medical information (but be aware that it is not possible to diagnose or treat over the telephone), TEST RESULTS —Tests may have been ordered to assist in your care. X-rays and EKG's interpreted by the Emergency Department physician will be reviewed later for a more definite interpretation.Your doctor may instruct you to call the Screening Nurse for results at a later time. PATIENT INSTRUCTIONS DISABILITY Will be able to return to work or school on: O i ¢ Restrictions 1 Was visit an emergency by Medl-Cal standards? YESQ•-•NO DATE: �PM 1 have read and understand these instructions MD. TIME:PHYSICIAN'S SIGNATURE PATIENT'S SIGNATURE PATIEh T 1. r M N LO to 0 0 O to .- of .N- m m w Q .�. W < w !� LL V to N C R Q M M M M M M m m m f rte' a 44 w 4964 �Q{� h ♦ aN } - a h M C p I � V LI M Q @ L"1 K N O a 0 o M .., C ¢ w wsmo � tD C tmo alalm �'v N F Q> c c t @ y F u n d =, O 0 @ Q ' .,J i U • o t° u WI cNv Q a N �2m O c = C C st c ; c LL m > a 3 o y a c > p c c._ E o a .� • 0 i >- > > o —� _« o J a 0 �' •>< a c o > ca <d QI QZm Q x " m Et1 : a ° m2 Zw m � N i S.r o o > w > c E 0 m c � @ >U m q ! � Z O w �. � Z @c M p � y � m eo 0 f\\1 F L o > o c c c a a Q a U 4 tj U Z p o o tt > m o a a Z > E O E j. E > ? 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Q F =10000000 NMto0mM to N > jz `m c < A r ON NQ 00 p 0t0to0W0 0 z „ >NoOmto000 I.'1 t0 to N G7 Ul ul tt1 ( = Q �+ � p Ld rn00at00000 N N N pt N NN • vIU ¢ ma+cnalrn rna�rncroma @ j Zr j� u n • > I >LI y _ » # w us LU • O M Y C W ¢ 1 Q a m C@Qi m ^ m at Q Q W o w a C O m ,m � �+ E E .0-6 t 1c @ uIu ° WEat W Q tu3 @r s~ » •na Eo 1. m >>m Q a z E = n � 0 � s 2 C d F ; awrw m m ma+ masm a o Cam r a@ q = m ¢ ¢ y » > CL > WWW EEEEEEz Q a M'- @ � cE � `- = � ra � u � rx .X c c Z 3 .1 '' u 9 2a .'7 2.2 C'D a u ur '_ X._ �t � � 3@@ E C " x C r 3 ,'_' u Q: _@ @ a r w O O 5`t 3 3 3 3 > 3 F" C C N ODUQOQZQQ dggQli z W \ 1W `@ x O > 4 a 3 u @ Q G u 1 z Z \\ .!N U W LL }- U to i ►' W Q Q ¢ 0 Q �Q W W CI W 10 to n y m a1 0 N M Q Z I-uN a r M V at to n m asci N Q M v ui 10 n >Q❑ ❑❑aa�o❑a❑❑❑❑ o N» z r r rrrrr C a` 0 r QmQ .. � ¢ oa ❑ ❑ cU ❑ o❑ ❑ ❑ cyocaa ❑ *lot$ '1i,"Iv4WYN3"SNI'SW3ISAS'I'lam103 •4fsl WMOd(`—•'� L 'rs•n wt 03A.." {rJ + nador Valley Medical Clinic Billy Davis, M.D.032818 �. t.." 7667 Annador Valley Blvd. r Edmund Kemprud, M.D. G028372 pAT. NO: / Dublin, California 94568 ASSIGNMENT AND RELEASE:I hereby assign my insurance benefits 1I 3 l be pad directly to the undersigned physioian and 1 am financially nwPoe► DATE: (415) 828-9211 sibla for noncovered services.I also authorize the physkAen to release Fed.I.D.#68.0094836 any information required to process this claim. Greathouse Michael = LAST FIRST SIOGULL.SECURITY No, GATE TREATMENT RV$ AMT. TREATMENT RVS AMT. - TREATMENT RY AMT. _ INITIAL OFFICE VISITS INJECTIONS X-RAY IREISTABUSHED Visit,Brief 90000 IntraMuSCular/SUDCUtaneous Medications 140 Skull Ltd-70250 141 Comp. 70260 Visit,Limited 90010 60 Thera unit injections —9-07-30-7- 142 Chest 2 Views 71020 Visit.Intermed, 90015 61 Celestone_oc 62 Ketzol.,_.CC 99070 143 C-Spine.Ltd-72040 tat Comp. 72050 Visit.Comp. 90020 63 1 Phenergan_mg 64 Adrenalin cc 99070 145 Thoracic Spine 72070 qure Visit Charge146L•S Soine,Ltd=72100 147 Com . 72110 STABUSHED PATIENT OFFICE VISITS 65 99070 /' 148 5lnuses•Ltd-70210,l 149 Comp. 70220 '1 Visit,Minimal 90030 150 Rbs-R L-111 157 Bilat.Visit,Brief 90040 66 99070 152 Shouider-730.70 103 QavK* 73000Visit,Limited 90050 1 Intravenous Madicanon 154 Elbow-73080 155 Foreum 73090 4 Orrice Visit.Intermed, 900601 67 Therapeutic Injection 90749 156 Wrist 73110 tq Office Visit.Ext. 90070 1 157 Hano-73130 158 1 Finger 73140 11 Office Visit.Como. 90080 1 68 99070 159 Hip-73510 164 Pelvis 72170 EXAMINATIONS _. _ 161 Knoe--73570 162 1 TiblFib 73590 12 Periodic 13 Pre•Employment 90088 69 99070 363 1 Ankle-73610 164 Foot 738.'30 14 Insurance 15 OMV 18 GYN 90088 1 MEDICATIONS 165 1 Cakaneoua-73650 168 Toe 73660 17 School 17 Sports) 90488 t9 Detention Time 99040 70 99070 167 20 LABORATORY SIMPLE LACERATIONS 71 168 f Strap Screen 87081 21 'Suture Sclp.Nk.,Extrem,Tmk., 169 1 GC Screen 870701 Ex.Gen. ern. 1200_ 72 170 1 Unnalysis-dip 11711 Comp. 81000 22 'Suture Fc.,Era.,Eytas.,Nose, I IMMUNIZATIONS 172 Hemoglobin 85014 Lips,Mes.,Mbrs. cm. 1201-1 73 1 D.T. 174 1 DPT 75 TT 907201 173 Stool Occult Blood 89205 23 78 1 MMR 907231 174 Wet Preo 87210 INTERMEDIATE LACERATIONS 77 1 Polio 907201 175 KOH Prep 87205 24 `Suture Sctp.,Trunk, 78 Rubella 907211 176 Potassium 84132 Exrem. cm. 1203_ 79 PPO 865801 177 Glucose 82962 25 'Sutura NK..Hnas.,Ft., 80 influenza 90720 178 Cholesterol 82465 Ex.Gen. em. 1204_ 81 Gama Globulin 907201 179 Triglycerides 84475 26 'Suture Fc„Eylds,Nose,Lps., 82 180 Sad. emanon Rate 85650 Mcs.Mors. cm. 1205_ SUPPLIES 181 Unite Pregnancy 82496 2T 83 Cast Removal 99070 182 Mono Spot 86006 84 CasUSotint Matenal•Lignt❑ 990710 183 Gram Stain 87205 ON/APPLICATION OF CASTS OR SPLINTS 85 Plaster Splint__•W_'L 99070) 384 CBC wlditt 85033 86 CastShoe 87 1 Fx shoe 990701 185 1 Coronary Risk 1 849491 28 88 1 Crutches 990701 186 Executive If Panel 80119 89 1 Cervical collar 990701 187 1 SMAC 25 Panel 80118 29 90 1 Shoulder Immobilizer 940701 188 1 PAP Smear 15390 SURGICAL PROCEDURES 91 SPLINTS:Clavicle 1 990701 189 1 Thyroid Profile 1 842511 30 1 Anoscopy 40260 1 92 Finger,Extensr0 Cage 990701 190 Premarital VDRL,Female 865921 31 1 Biopsy,Exciswnal tttf70 93 Knee 44 Kneeoand 990701 741 Premarital VDRL,Male 192 Rtn. 865921 32 More Lesions 11101 95 Wrist 99070 193 1 Serum Pregnancy 82998 33 Burn Deondement 16024 1 96 Ankle 47 Geto Cast 99074 194 Urine Orug Screen 34 1 Abrasion Deondement 11040 1 98 1 Lumbar Support qW701 195 Mast Allergy Testing 796,197,198,199 35 Cerumen Removal 69210 99 Rib Belt 990701 200 C+S 241 Urine 87086 36 160 Abcess 10060 104 Tennis Elbow Band 990701 202 Specimen Drawing Fee 99018 37 Removal Foreign Body—Eye 20520 101 Elastic Bandage inch 99070 203 36 SkirvS.O. 10120 102 Cradle Sting 990701 204 oumas Lan 39 Intranasal 30300 103 Woum Prep.Sm 1 104 1 Large 99070 i 40 Paronycnistorrychis 10100 105 1 Suture Tray 99070 1 MISCELLANEOUS PROCEDURES 41 Ned Removal 11730 306 Extra Suture Packs 99070 206 Audiomerry 92551 42 Nan Hematoma 10140 347 Suture Removal Tray toe 1 a 0 Tray f 990701 247 Pulmonary Function 94001 43 InjJAsp.Mir JoinuSursa 20610 109 DressingaSm 110 Mee. 111 I Large 1 990701 208 1 Med•Neb Treatment 94699 44 InjJAsp.Minor Joint/Bursa 20605 112 1 Ointments 99070 f 209 1 EKG S Interpretation 93000 45 1 Inj,Trigger Paints/Tendon 20550 113 Xylocama 990701 210 EKG Monitor Tracing 6 Interp, 46 Intephalangeal Jnt Disloc,MR 26770 114 irrigating Lens 99070 P21323 EKG Stress Test 93015 47 Shoultler Dislocation,MR 23fi54 115 Oxygen Supplies 44470 Physical 7heraDy 47000 48 Racial Head Subluxation.MR 24640 116 .IV Solution Cc 990701Physical Therapy 97050 49 1 Epistaxis,Anterior 30900 ill i.V.S-.01106 118 Vctutrol 49474 214 Physical Therapy" 97200 SL Gasvrc Intubation 89130 119 Monitor Cable 990701 215 Fitness Evaluahon/Conference S1 Cathetenzatron,Bladder 53670 1 120 Foley Catheter 1121 IMinicath 490701 216 Coronary Risk EvaluationtConf. 52 Hemorrhoid,External 46324 1 122 Eye Tray 123 I Eye Parch 990701 217 Conference min 9903_ 53 Cryotherapy 17340 i 124 Optno Burr 990701 218 Special Repoli 99080 54 Venipuncture.I.Y. 36410 125 instrument Tray 990701 219 55 CondylomaralPadophyllm - - 46900 126 Pendrd Bit 99070 ROTES: No WorklSChooVPE lot Days 56 Fee Increase-Debridement 28 12] Cryotherapy Supplies 99074 Return to WorklSchoot on 57 Fee Increase Surg.Revision 22 129 Tm1a Out A.M. p.m 58 Return Visit Date: Time: DIAGNOSIS RECD BY: TOTAL TODAY'S FEE ,. 0 c H OLD BALANCE RECALL 0 CA'Co. TOTAL DUE ❑ CHECK AMT.RECD.TODAY SIGNATURE TV" Dare 0 NEW BALANCE INSURANCE INSTRUCTIONS:Attach this copy to your insurance claim form after you have completed your part of the form. Mail directly to your Insurance Company. ' Billy Davis' M.D. C32816 nador Valley Medical Clinic ( �`t 7667 Amador Valley Blvd. Edmund Kemprud, M.D.G02B372 PAT. NO: Dublin, California 94568 ASSIGNMENT AND RELEASE:I hereby assign my inauranee benefits 1%CJ I S 7be paid directly to the undersigned phyid san and I am financially reWn- ; DATE: (415) 828-9211 sible for noneovered services.I also authorize the physician to release Fed.I.O.e68.00948J6 any information re0uired to Process this claim. CREATHOUSE M1C11A L : LAST FIRST SOCIAL SECURITY NO. DATE TREATMENT AVS I AMT. TREATMENT I RV$ I AMT. TREATMENT I RVS I AMT INITIAL OFFICE VISITS INJECTIONS X-RAY 1 Office Visit,Brief 90000 Intramuscuiar/Su_bcutaneous Medications 140 1 Skull Ltd-70250 141 Comp. 70260 2 Office visit,Limned 90010 ti0 Therapeutic Injections 90730 142 41s:2 Views 71020 3 Office Visit,Intermed. 90075 67 Ca+estone_cc 62 Kefzol_cc 99070 tai e,Ltd-72040 1M Comp: 72050 4 Office Visit.Comp. 90020 63 Phenergan prig 6a Adrenalin cc 99070 10.5 ic Spore 72070 5 Procedure Visit Charge •58 146 ine.Ltd-72100 147 Comp. 72110 ESTABLISHED PATIENT OFFICE VISITS 65 99070 148 1 Sinuses-ltd-70210 149 Comp. 70220 6 Office Visit,Minimal. 90030 1 150 Ribs-R L-71100 151 Bilat. 71200 7 Office Visit.Brief , 90040 1 66 99070 152 Shouter-73030 153 Cavae 73000 8 Office Visit,Limned90050 Intravenous Medication 154 Elbow-73080 155 Fommm 73090 9 Office Visit.Intermed. 90060 - 67 Therapeutic Injection 90749 - 156 Wrist 73110 10 Office Visit,EM. 90070 157 Hand-73130 158 Finger 73140 11 Office Visit,Comp. 90080 68 99070 159 Nip-73510 160 Pelvo 72170 EXAMINATIONS 161 Knee-73570 162 TiWFib 73590 12 Periople 13 Prs-Employment 90068 69 99070 763 Ankis-73610 tW Foot 736'10 a -- 14 Insurance 15 DMV 18 GYN 90088 MEDICATIONS 765 Calcaneous-73650 168 Toe 73660 17 school 17 Sport 90086 _ 19 Detention rime 99040 70 991170 167 LABORATORY SIMPLE LACERATIONS 71 168 Strep Screen 87081 21 'Suture Sclp.Nk.,Extrem.Tmk., - - 169 1 GC Screen 87070 Ex.Gen. cm. 1200— 72 170 1 Unnaysm-oio 171 Comp. 810001 22 'Suture Fc.,Ers.,Eyids..Nose, IMMUNIZATIONS 1175KO�H emoglobin 85014 Ups.Mes.,Mbrs. em. 1201— 73 D.T. 74 DP7 75 TT 90720 Occult 81000 892051 - 23 76 MMR 907231 rep 87210 INTERMEDIATE LACERATIONS 77 Polio 90720 Prep 8720524 -Suture Sclp.,Trunk• 78 1 Ruoeda 90721 otassium 84132 Extrem. cm. 1203— 79 PPD 66580 177 1 Glucose 82962 25 'Suture Nk.,Hnds.,FL, 80 1 Influenza 907201 178 Cholmerol 824651 Ex.Gen, cm. 1204— 1 81 1 Gama Globulin 90720 179.Tnglycendes 84475 26 'Suture Fc.,Eylos.Nose,Lps., 82 1 5-5-1 socimentation Rate 85650 Mcs.Mbrs. t:m. 1205— SUPPLIES 181 1 Urine Pregnancy 82996 27 iia 1 Cast Removal 990701 182 1 Moro Spot 86006 84 1 Cast/Solmt Matenal-Light 0 990701 163 Gram Stain 87205 REDUCTION/APPLICATION OF CASTS OR SPLINTS 85 Plaster Splint W L 990701 184 CBC wrdiff 85031 86 1 Cast Shoe 187 1 Fx shoe 99070 185 Coronary Risk 1 84999 28 88 1 Crutenes - 990701 186 1 Executive If Panel 80119 89 1 Cervical Collar - 990701 187 1 SMAC 25 Panel 801181 29 90 1 Shouicer Immobilizer 990701 188 PAP Smear 38155.901 SURGICAL PROCEDURES 91 SPLINTS:Clavicle 99070 189 Thyroid Profile 1 84251 30 Anoscopy x0260 92 I Forger,Extension/Cage 1 990701 190 1 Premarital VDRL Female 86592 31 1 Biopsy,Excisional11100 93 1 Knee 1941 Kneeband 99070 191 Premarital VDRL Mal 192 Rtn. 865921 32 More Lesions 11107 95 1 Wrist - 990701 193 Serum Pregnancy 82998 33 1 Burn Debridement 16020 96 1 AMKIa 97 J Geld Cast 990701 194 Urine Drug Screen 34 Abrasion Oeondement 11040 98 1 Lumbar Support 99070 195 Mast Allergy Testing 196,197,198.199 35 Cerumen Removal 69210 99 1 Rib Beit 990701 200 C+S 201 1 Urine 87086 36 11&0 Abcess 10060 100 1 Tennis Elbow Band 990701 202 Specimen Drawing Fee 99018 37 1 Removal Foreign Body—Eye 20520 101 1 Elastic Bandage inch 99070 203 38 Skin/S.O. 10120 702 1 Cradle Sling 99070 204 ow.aetao 39 1 Intranasai 30300 103 Wound Prep,Sm 1 104 Large 99070 40 J Perdnycma/Onychia 10100 105 1 Suture Tray 99070 MISCELLANEOUS PROCEDURES 41 Nail Removal 11730 106 1 Extra Suture Packs 99070 206 Audiometry M47 42 Nul Hematoma 10140 I 107 Sutura Removal Trav Toe +a D my 990701 207 Pulmonary FunctionBursa 20670 7C9 I Oressings•Sm not M.4. 111 Wqe 99070 208 Med•Neo Treatment44 InI.1Asp.Minor JointlBursa 20605 112 1 Ointments 990701 209 EKG B Interoretation1 45 Inl.Trigger Points/Tendon 20550 113 1 Xylocame 99070 210 1 EKG Monitor Tracing 6 LM46 Inleonalangeal Jnt Disioc,MR 26770 11a Irrigating Lens 99070 211 EKG Stress Testq Shoulder Dislocation,MR 23650 tt5 Oxygen Supplies 99070 212 Physical Therapy1 48 Radial Head Subluxation,MR 246401 116 1 IV Solution c cc 99070 213 Physical Thereby 97050 • 49 1 Epistaxis.Anterior 30900 117 1 I.V.Supplies 1 118 1 Volutrol 990701 214 Physical Therapy 97200 5o Gastric Intubation 89130 119 1 Monitor Cable 99070 215 Fitness EvaluatiorvCbnference 51 Catheterization.Bladder 53670 120 1 Foley Catneter 121 Minicam 990707- 216 Coronary Risk EvaluationwCdnf. 52 Hemorrhoid.External 46320 122 1 Eye Tray 1 123 1 Eye Patcn 990701 217 Conference min 9903_ 53 Cryotherapy 17340 124 1 Optno Burr 990701 218 I Special Report 99080 54 Venipuncture,I.V. 36410 125 1 Instrument Tray 99070 219 • 55 CondylomalarPodoohydin 46900 726 Penonl Bit 990701 NOTES: No WorfuScnooUPE for nays 56 Fee Increase-Osbridement •28 127 1 Cryotnerapy Supplies 990701 Return to Work/School on 571 Fee Increase-Surg.Revision 22 729 Time Out A.M. p.m, 58I Return Visit Oats: Time: DIAGNOSIS RECD BY: TOTAL TODAY'S FEE O CASH OLD BALANCE —rf RECALL 0 CR.CO. TOTAL DUE 0 CHECK AMT.RECD.TODAY SIGNATURE ' 7 , Typ. oat. a NEW BALANCE INSURANCE INSTRUCTIONS:Attach this copy to your insurance claim form after you have completed your part of the form. Mail directly to your Insurance Company. 6 o ;ry m w c CD �f a _, c n. LU a } c �o CO ; 0)5> W �t + m UT Obi t0 .O to Q m m c S1 `.. `o -y 9 E > o 4 o _ E ; ECF ; a Edo d O x t uj i-., ci -- .1 _ r�-•• _ y O E E o o z m t° CD z to to } a� ¢ c Em Q 4 }G V Q ❑ ❑ ❑ 3 PROOF OF SERVICE BY MAIL State of California , County of Alameda I am a citizen of the United States and a Resident of the County aforesaid ; I am over the age of eighteen years and not a party to the within entitled action; my business address is 2258 Third Street , Livermore , California. T On April 1 , 1987 —, I served the within CLAIM (GREATHOUSE vs. CITY OF SAN RAMON) to the City - Clerk on the Parties in said action , by placing a true copy thereof certified mail enclosed in a sealed envelope with postage thereon fully prepaid , in the United States mail at Livermore , California , addressed as follows : City Clerk of San Ramon 2222 Camino Ramon San Ramon, CA I declare , under penalty of perjury , that the foregoing is true and correct . Executed on April 1 , 1987 at Livermore , California ., Lynda Adams ' tale File No. - rges Date .` NaM-o(Last.First.Middle) Citation INTOXICATED DRIVER REPORT N Residence Address -.: City Residence Phone CONTRA COSTA COUNTY SHERIFFS DEPARTMENT Business Address City Business Phone CITY O Location of Arrest Time of Arrest Driver's Lie.If State license Status CAI - Sex Hair Eyes Height Weight Date of Birth Date/Time Booked Social Security p Date&Time Occ Location Code Date/Timm DDL Req.Sent Method Sent ,:. •�•� �Z-Z�p. '. ? , • , ;+ STT OMail QPhone , VEHICLE INFORMATION j Vehicle License Number •,i• _ State Year of Vehicle Make Body Type __ -. - Color ..Y .� 1981 _ yy:v Registered Owner Same as Driver x�� R/ Address - ❑Same as river ^ r Stored Name of Garage/Released to , ress .. r.. ❑Yes FIELD SOBRIETY TEST Was Subject's Vehhile Involved in an Collision R port Number Heel to Too/Walking Lias Test QL Foot O R.Foot Accident? ! 2 3 f.}S 6•t gq yT„ N ; Yes No Q' Administ r ? Yes ❑Nc Breath:Or r of Alcoholic Beverage ( �. Strong Moderate Weak � Glasses;Lenses Eyes - ... �q �� ❑Yes No 46 K 1Z•�S C� J�1/��/I,/ . Speech ,. ., ,. .• .�.:: .'.,. -. . g765 �rD Z- I k Ilk Clothing Worn/Condition and Description T• t�,ct t,eT S V f Si-l�-"'�LtO ��r►1 'F� L-r. t Balance: - 3d 1 "TLI�/►�. 1 r Other: 4� A&J- �ff) Describe Test Location,Surface.Weather and Lighting V�b�t Gtr LIT'S• t IMPLIED C NSENT 23187 V.C. 1. YOU ARE REQUIRED BY STATE LAW TO SUBMIT TO A CHEMICAL TEST TO DETERMINE THE ALCOHOL AND DRUG CONTENT OF YOUR BLOOD. X YOU HAVE A CHOICE OF WHETHER THE TEST IS TO BE OF YOUR BLOOD.BREATH OR URINE • WHEN APPLICABLE:SINCE MEDICAL TREATMENT IS NEEDED.YOUR CHOICE OFATEST ISLIMITED Tp• THESE ARE THE ONLY TESTS AVAILABLE AT: - TESTIS) NAME BRIEFLY EXPLAIN NEED FOR MEDICAL TREATMENT: I IF YOU REFUSE TO SUBMIT TO.OR FAIL TO COMPLETE A TEST.YOUR DRIVING PRIVILEGE WILL BE SUSPENDED 6 MONTHS.OR REVOKED FOR 2 OR 3 YEARS.A 2-YEAR REVOCATION WILL RESULT IF YOU HAVE BEEN CONVICTED WITHIN THE LAST 3 YEARS OF DRIVING UNDER THE INFLUENCE INCLUDING SUCH A CHARGE REDUCED TO RECKLESS DRIVING. 4 A3-YEAR REVOCATION WILLRESULTIFYOUHADMORETHANONEOFTHESECONVICTIONSWITHINTHELAST5YEARS.REFUSALORFAILURETOCOMPLETEATESTMAYBE USED AGAINST YOU IN COURT.REFUSAL OR FAILURE TO COMPLETER TEST WILL ALSO RESULT IN A FINE ANO IMPRISONMENT IF THIS ARREST RESULTS INA CONVICTION OF RIVING UNDER THE INFLUENCE. SOL DO N07 HAVE THE RIGHT TO TALK TO AN ATTORNEY OR HAVE AN ATTORNEY PRESENT BEFORE STATING WHETHER YOU WILL SUBMIT TO'A TEST.BEFORE DECIDING WHICH TEST TO TAKE OR DURING THE TEST. G. IF YOU CANNOT COMPLETE THE TEST YOU CHOOSE YOU MUST SUBMIT TO AND COMPLETE A REMAINING TEST. THE ABOVE STATEMENT WAS READ TO THE ARRESTEE BY: I.D. TIME TIME I.D.OF SAMPLE RESULTS.IF AVAILABLE fSPOSITION OF.SAMP I]BLOOD BREATH URINE •� �� DL 367 COMPLETED REFUSED �•�.�/��3` • � • I f� �� DRUG ADMONITION .. Q ATTACHED(OL 367A)ON WHEREEST CONDUCTED ME N TITLE OF GIVING T�� • REV.1.•66 MAIITINQ PRWNTING A, THE'BREATH TESTING EQUIPMENT DOES NOT RW-4 ANY BREATH SAMPLE FOR LATER JWALYS(S BY YOU OR A§jWINC ELSE T IF YOU WANA SAMPLE RETAINED.YOU MAY PFff CA BLOOD OR URINE SAMPLE THAT WILL BE RETAINED AT4F OST TO YOU.IF YOU DO SO,THE SLOOO OR URINE SAMPLE MAY BE'TESTED FOR ALCOHOLIC OR Oft-CONTENT BY EITHER PARTY IN A CRIMINAL PROSECUTION. ?OFFICER TIME READ LOCATION y.�f. (:.. ADMONITION OF RIGHTS 1.YOU HAVE THE RIGHT TO REMAIN SILENT. 9.YOU HAVE THE RIGHT TO TALK TO A LAWYER A,IF YOU CANNOT AFFORD TO HIRE A LAWYER• "_.• �',.ANYTHING YOU SAY CAN AND WILL BE USED AND HAVE HIM PRESENT WITH YOU WHILE YOU ONE WILL BE APPOINTED TO REPRESENT YOU AGAINST YOU IN A COURT OF LAW ARE BEING QUESTIONED. - BEFORE QUESTIONING.IF YOU WISH ONE THE ABOVE STATEMENT WAS READ TO THE ARRESTEE BY. ,y � DO YOU UNDERSTAND EACH OF THESE RIGHTS I HAVE HAVING THESE RIGHTS IN MIND.DO YOU WISH TO SUBJECT'S WAIVER STATEMENT *q EXPLAINED TO YOU? _ TALK TO US NOWT YES NO YES NO INTERROGATION #�A•' 00 YOU SCRIBEOW OF ANYTHING MECHANICALLY WRONG WITH YOUR VEHICLE? ARE YOU SICK OR INJURED?DESCRIBE ,`�L .... - a..{, ❑YES ❑NO 'D YES .❑NO ARE YOU DIABETIC OR EPILEPTIC? 00 YOU TAKE INSULIN?(PILLS OR DO YOU HAVE ANY PHYSICAL DEFECTS? DESCRIBE !��•:�,�;. INJECTION) ❑YES ❑NO ❑YES ❑NO - :❑YES to NO ..• •._ WHEN DID YOU LAST$LEEP HOW LONG? WHEN DID YOU LAST EAT( . DESCRIBE WERE YOU DRIVING THE VEHICLE? IF NO WHO? WHERE DID YOU START DRIVING? WHERE WERE YOU GOING? :i ❑YES ❑NO [�NM - "?t' WHERE ARE YOU NOW? WHAT HAVE YOU BEEN DRINKING? - FK}W MUCH? TIME STARTED TIME STOPPED WHERE WERE YOU DRINKING? DO YOU FEEL THE EFFECTS OF THE DRINKS? DESCRIBE ❑cl YES ❑NO ARE YOU UNDER CARE OF DOCTO IF VES,NAME 6 ADDRESS OR DENTIST? ❑YES ❑NO -HAVE YOU TAKEN ANY MEDICINE fF YES.WHAT HOW MUCH? TIME OF{,AST DOSAGE OR DRUGS? Q YES ❑ NO DO YOU FEEL THE EFFECTS OF THE DRUGS? DESCRIBE .. WITNESS AGE SEX NAME PASSENGER Q VICTIM ADDRESS R BUS cl ❑ Q u t tc iG Am YL ice"" - �-"'��a► � � s ESTIff OFFICER{NAME&RA;wO 1.01140 SUP RVISOR(NAME&RANK) DATE i REM m SMI maL i_ �� ' • a — � ►. � as �� f� �. � _ � � L� ��a� � _._.,__.. �� •��-= �.:.• �� •L = � � ... � - to �._ saw •� �s�.1�! � � ��I► + +-_.�1��. L►1'-� In wi:4-lin IVA Uzi W� :Z+� _.a.�.�� .-�� i•�� t ��+_ fie �s•.i' i.�i r►�� ice►—�rai�� ==_�—� --i �� ..._. G! � rli�� ti� i ` w � ice= S. _- '�� ► �t1 r�I I► � � 4 .. 1�1. 1► .r ++� E a Man OEM —..�+�+.-"!C /iZ%I.MR �� Ste•► *aa��► i�.�,s:iL �i �!�� r � MINK Ink tM �►. w �'" iii��'�� Z�+�► 4.� ~`a► •a —e �t�`.. � �'• ; .��.'-+ti 711► / �+.. '� �i: �.+��'�►_ ':ri +" -- ,�.�'�jii"-a �a� _�i�` �: i�aJ+,. �. ♦ � w'' moi►. R-:4My ■ ■ '�� _ L. •�- .r t� i��t �• ■raa z_ •• :ate��i�� IL L' �!��•�� t� =� � • � �a��. rt•• •� � Int �� ice. ��r�• .� �lIv-.�_�- I � � r+ -� ' s MIR-OW OM 4 b."40'. � �� ' �_ r� ��a� - V + � •jam- Mix T14. IL t,V • mm� • • • + L �� .i► s_ fi�� _ Lam. �. �.�...�� MW AM _. ► 0 Rp F wz, OL a ��- ♦ i .VRA ■may_ v_�._L I R-4 W-2 m6m s ►:t ■ ■ =� L •. . m 440 a Sm �- r a as �t�a l Z� i��"t.�►• �� _ ISL aZ ZS WA lip"IT Wm i � � r� L1� � �� a.��r_ Vis►__ � `►r• �-__ <Ai� ' '� �� 1�'l � �► �� _ _ fir.• �► -�1 ��- moi_:.�1 �-A"' /� ',�. �'�- L �1� L �►� Lam_ _�..�- � -"taa nr low, i BEAT OCCURRED '7 2 FORM C FCase No. 180 Crttna%Classtttcatton 181.Detail Code 1 182. Detail CodD�_3 ) 183.8 Cont. Suvv• kame IL FMI 1 BS.Data Ong.Apt. 186.Date-Tuna187.Gnd Coda S �•1-8� 1.1.87 )7•[-LA - 189. Suspect Name (Lt FM) C, 74.F 1Eg, /++OPrt11Tr DESI'�IPTION(Intpa nded.tlecwe.ed Found.Lost.Stole.1 ham No.Arae.Ouattth Brand/MateiManuhctuns MOON N-~.So"N~-M"conanaow Oesenaton.Loen.o- ssnantaae-Valu-r.InCiudetotal loss--USTINFOLLVNNGORDER alCoMriC-f.holes 81Jet.etry.C)Ctott+wtp.Furs 01Ven¢IesE!Office Eauetr-entF)Mdo.TVLM.G)FwasattsM1Mt1WaftesGoods 11 eo",i-swe ne-I It L"ifecs III M.sC C) 22 1- 8-7 �..��,: o N- Mix lZ s S. 1 '��;�. Lc M I& •o ,: .-. < .:.• .....e Lie F Ivey.; � .... � Gt CA Ic �1 It Vc, e r 1=e e e rA V C V ► V6 Ar jj �1}IA" ")A 1144 .e a c ve 'ce A "Ye-MaL.3c, \� \ t I N A C M A 1.1�.' �G ht G c, 1= 't G -c N%-< t.. S O t N 14 ♦ 11' .` �C e c } F, A ! t �< O wt•vct L'i pk,S Q '7t.,eame- F+N t'. cYAc1: i. ;r1< b'1V< !I 11• ►7 w)CI L +� e i de J61\' h,tw -tic XIOLLS C. C,.t 7K NOG a Kt CCM t �•t/y� ►Ij c + 1. w S -o ►M Licit r- e 7.)T Also � C IG h tc EV it e Aa ''eS6 N. e 190•Dis:ribution_a at_oa l O SR Y !_Coraner_wrcotics_in.estigat ion_Juv. 191.Aeoomng Deo 1Pr�np Z•E-to a 1 3,Disposition Intelligence�ice_C:�olsint O{c._FOS Patrol GP. Press Sa:, ot'+er Go • N A►�` �l��'q 194.A�p roving Suotr IPnntl )195-Emp a 196.Date 97.Page SGT- M. ILG - a3 CONTRA COSTA COUNTY SHERIFF-CORONER'S DEPARTMENT -- P. 0. Box 391, Martinez, CA 94553-0039 -- (CA0070000) Rev 5/86 BEAT OCCURRED--:2 2 FORM C 179 Case Fde No 180 C, Son;.181. De ail Code I 182. Detail Code 2 I8?• Co t.\` 8 Sup; `Jrtvl►t F�t.ANee 231 . t 8a Vtcnm Neme IL FM) 185 Dau Ong.Rpt. 186 Dale•Time Thts Apt. 187.Gnd Code -V •S. -181 1-1-87 33D 11-]-C. L� 168. Suspect Yece (L, FTS) C-1 eA� hOL.Sc .. M1G� G, 169. PNOPf.Rrf 69•►NO►ERTY DESL41nT10N)tmttou-d*d Neco.,eea.Found.Lost.Stotetl Item No.Iuhcie.Ownttts.Snna'MridMsnvhcwns Monet MWmbW.Semi Nutneet,Moceiteneew Desctsetton.Leceteet' •t gsint"usaM.vaiuv.Include tow Lose.•UST IN FOLLW NG ORDER aI Cwmntti.Notes!)Jewettl'.C1CID~g_Fwm DI vantCW E)0l5u Eovtenwlt F)Raeo.TYs.ec.GI FtweMne M)MoreeneLe Goods n Co-s.,-vo,s Items Jt Lwestoe►[!tlA.fc -; o L k tt 1- .. tee 5 C, r c A KEF<40 C>LA_ t 1S�rl��t0 s+s: Q �u Ct i i.6 :.. < - �► -1 IO 1 5' C-1 C \-t is { rA�iaN = h Yc h i 1-e ht tt . S - C T C i ,.` .T 1� .:.. \ 1a! K!. �'C C••J G C t\AA t }1LG Vt1-tle�e G e� :+ �e t }ewe }e� }�.A� ��,e C: L bN -Y� r'. .� w 1:.t L� J dA��cl \� 24- e I, t 512.2 d S- C r {1S 6I. io C. M t#A t2 I,LIC`t N tl 1iz¢ � 1bC12 T 1`h p moo, �[ e IC1 �` dtOe �G ► �1 N >a C3-;7:.Ge� A � o %r <sart S' C t 1a6 Sc 1..D S let Qe �ti)�•lO 1uL\I\;me, AN. V1 O T Ur f, �1 e►I 7= h r S- Ci I.e } GS If AN -t I Fo. Ft< "Jossc c A, V A,I-, d C 7e. Ivc.A 1-ISCM+ Uri. �1A„Se ,.,Q A N d <� 12 S C-i a ck a }o S�e 6 k� o + his Ve !„c"IiJvo C e a ' C' r• S. 190•Distribution8 CE_CA_L^o$a g Coroner_Narcotics_Investigation__-JU.'. 191-Report,mg Deo IpnMt! E�-p a 193.Disposition Intelligence Vice_Ct-1olaint Dfc._�DB 192• Patrol Cap. eress_$ta:.__"Otter C 11 14.Avotovtng Suov ^tnti i 1g5,ET..o..a 196.Date 97.Pao� 5{ T. X. IL CONTRA COSTA COUNTY SHERIFF-CORONER'S DEPARTMENT -- P. 0. Box 391. Martinez, CA 94553-0039 -- (CA0070000) Rev 5186 A BEAT OCCURRED 7 2 FORM C , 179 Case Fels No. ISO..CtimeJCiassohes'twtn 1 181.Detail Code 1 182. Detail Code 2 183.8 Coat. �o1 sJ`��Vt` KK�Qt. hC i tlts Supp. 184 Vrctam Name(t.FM) t 83.Date Ong.Rpt. 186.Dau.True Tho Rpt. 187.Gnd Code �.U•S. -t 033b t1-7-e- -L4 1 ee. PRO►E111T1 DESCIPUMON(impounded.Rocov"o,found.Lo" Sto+eni hem No..Anwie.Ok mm",8tendtM8telM.nuhctw*$Mo661 NUFF16W.Sm-4 Nvi*Oer.Moceetan+w.0escnpt.en,tarAboo erne.:utero,v.tw.bCtuas told Low-USTsN FOLUMNG ORDER Al Cunenot.Not*$8)Je.•err.C)CW~jn Fum.01 vetncin E)ORice Eow~s n Rwm.T/s.etc.Gl Fwaamns M)Nauee/w Goods h Co,,s--*b,e Nen%Jt L"stocr V M..¢ c c ty i >s c► �=r.c c> �-� s eHf h �t C e �1ISsrt � ►M L 1 1 CAr Lta ti. �►� cJ - C-11 r C s�b� F+• C.� � bfs N * S . LQ r S� e r : ' S �1 Ike o F - st f•r. `�_ S - G.cf3 m,S-e ` Q AC r-Zl a t „ �. u - C It A 1J.n C t' k s� iy 1� AN 14,e yr w 'Stv AtL P4 S It Fad M elPal e1»s t c G z -v C lr fSc N S iw. rJ C t ep t:. S t K tr �t N td � O `tw.r Pq I JWASicc � "� 'St 1r .-. 2 �e c� =' 't ti ti- 4 r 1= - }� b C ' 1 rt.{ tc y ...-. c e It%s A *• ha r. o ►- P - 1-1 A rr V .4.e jq11 t ! R r?t► >w i�t �' es' Tf O{. 1 't 7Yi1^ 4K., C.it 1, ►N t' 189.0istritwtion6 O 0E O 0A O t 0 0 osit0 v 490•Reporting Deo iPnnti 191.Emp a 192.Disposition Corona,C Reporting Ramotics a Investigations O F.0.8. C;. 7 Y 1�t�414 Intelligence O Vice Q Complaint Officer 193.Aoprovong Suov 111trano 11%.Etnp a 195.Due 196. Page Other SGT. CONTRA COSTA CfliINTY CNFRTFF_rnRnNFR'S nFPARTMFNT -- P. n_ Rnx 341. Martine?. CA 94553-0039 ►• (CAnn7nnnny s? Test Subjec Model 5000 , . INTOXILYZER BREATH TEST Operator . ' :L i • x - Dat a I PRECAUTIONARY CHECK LIST FOR INTOXILYZER Wait at least 15 minutes prior to collection of the breath sample, during which time the -subject must not have ingested alcohol beverages or other fluids nor regurgitated, ....rrs J 9 9 vomited, eaten or smoked or used a mouth spray and has been under constant observation. itial that 15 minute waiting period was observed .4'. - { ✓ 1. Press red "POWER" button to turn instrument on. READYING ✓ 2. Wait until digital display is scrolling and "PUSH BUTTON' 'THE is flashing on screen. INSTRUMENT 3. Press green "START TEST" button. «, - , • 4. , Insert test card face up and top first. FIRST ✓ 5. Insert a new disposable mouthpiece into breath tube. - BREATH 6. Have subject blow when screen displays "PLEASE BLOW INTO MOUTHPIECE UNTIL TONE STOPS" or flashes "PLEASE BLOW." Do not remove mouthpiece. SECOND / 7. Wait until instrument has completed automatic air blank BREATH and screen displays "PLEASE BLOW INTO MOUTHPIECE UNTIL : SAMPLE TONE STOPS" or flashes "PLEASE BLOW." ✓ 8. Have subject blow using same mouthpiece. ,LEAVING ✓ 9. Remove test record when it is ejected from the printer. � w J THE 7�7— 10. Complete information in log book and on test record. INSTRUMENT - 11. Press "POWER" button to turn off instrument . =' 7- 12. -Send cardboard section of test card to the laboratory (or depository) ,designated in lace desi de p g p y) , give subject First paper = copy, and forward one copy to District Attorney's Office. Please make sure subject 's name is legible. • CL-153 s. t T � JI Y .7 yi,�_at„n�•e 1ti tr 1 SC.1' .•1 1 v`1 r4 L , i ♦r � . 'cue>;, s -` [.r♦ �, �• r� tr r - .` '` • i{:�. r.;-arrtr'3F d � s (ta•+r r �'” _ 'f- t � v., � r. L i -..�v _. r,� • �',ri �.�,kN. �•f,��7s}H,I' �' � -x• � t l .'t ' _ { 1� �'{ 'ic r 4�•c Q"r��s.�i 4 i {jyf4zt -` -t 4., Ara - .�4tl ren t iT •(r(r - r�.ra L• � j C .1 1 q v �.I• �l �1� SY+ _• r r• SUBJECT +tom_ rlll' •� �'�i _f` NSTRUMENT NSTR MMENT LOCATION _ � OBSERVATION TIME: ij START - OPERATOR OPERATOR NO. r OPERATORS AGENCY REMARKS. - L i FOR INSTRUMENT ACCURACY ?' a DETERMINATION Am - OPERATOR INITIALS SIMULATOR TEMP SOLUTION NO. DISTRICT ATTORNEY'S COPY f.scx' 'h � N, ti0t}-�r'/�'�'a—S�Y7'y�9�C^" I �+Vy4�"'•'� S a .•F '1 T M -•' •�=� wts 'N 24 1473'•"�' / "•i.�e's^I`l 3 V�f f 4 •�w. .i'e fµ�T -!}•LY y.�i,,y.,..}.. r�Y''s-t"4: -r.r�Yft`s.'�l'��:-k;. 'St.J yt�� yy M� �• .:'T..- CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT May, 12, 1987 and Roard Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant toAQvenf; Code ounsel Amount: $500, 000 . 00 Section 913 and 915.4. Please note all "Warniflgs�. CLAIMANT: AUSTIN M. SAUNDERS APR,2 7 1987 c/o Pieter K. Williams Martinez ATTORNEY: Attorney At Law , CA 94553 1901 Railroad Avenue Date received ADDRESS: Pittsburg, CA 94565 BY DELIVERY TO CLERK ON April 14, 1987 hand del . BY MAIL POSTMARKED: no envelope I. FROM: Clerk of_ the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim.; A ril 23 1987 pH IL BATCHELOR, Clerk DATED: P BY: Deputy L. Hall I1. 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 911.3). i ( ) Other: i Dated: C !' �-� f� T BY.�n c �/l"� -u- -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. BOARD ORDER: B unanimous vote of the Supervisors resent i Y P P (,Y) 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: MAY 1 2 1987 PHIL BATCHELOR, Clerk, By 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 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. 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: .MAY 13 1987 BY: PHIL BATCHELOR by /_W_X__�Deputy Clerk CC: County Counsel County Administrator PIETER K. WILLIAMS ATTORNEY AT LAW 1901 RAILROAD AVENUE P.O.BOX 1577 RECEIVED PITTSBURG,CALIFORNIA 94565-0157 (415)432-6456 APR 14 1981 April 7 , 1987 eA�soN � T 'o CLAIM AGAINST PUBLIC ENTITY (Government Code Section 910) TO THE COUNTY OF CONTRA COSTA, STATE OF CALIFORNIA: I'. AUSTIN M. SAUNDERS hereby makes a claim for personal injuries against the above-named as follows : 1. The name and post office address of the claimant is AUSTIN M. SAUNDERS 125 North Broadway, Apt. 31 Pittsburg, CA 94565 2 . The Post office address to which the person presenting the claim desires notices to be sent : PIETER K. WILLIAMS Attorney at Law 1901 Railroad Avenue P .O. Box 1577 Pittsburg, California 94565 3. The date, place and other circumstances of the occurrence or transaction which give rise to the claim asserted: On January 9 , 1987 , Claimant was arrested in the City of Pleasant Hill , California. While in the custody of Officer Curtis White and Reserve Officer J. Jonopulos used excessive force and there- by battered and assaulted claimant requiring medical treatment including stitches. 'Some or all of said misconduct occurred while claimant was within the confines of the Sheriff' s Detention Facility in Martinez , California, and while claimant was at Merrithew Memorial Hospital, Martinez , California, , Claim Against Public Entity April 7 , 1987 Page Two 4. The name or names of the public employee of employees causing the injury, damage or loss , if known : Unknown 5 . The amount claimed as of the date of the presentation of this claim, is as follows : AUSTIN M. SAUNDERS -- $500 , 000. 00 (FIVE HUNDRED THOUSAND DOLLARS) The computation of the amount claimed .is based upon the type and severity of .the injury, including all general and special damages proximately caused thereby. Dated: April 7 , 1987 /" 4 2 27-11-*- 6 AUSTIN M. SAUNDERS, Claimant PIETER K. WILLIAMS Attorney for Claimant CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA £laim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT May 12, 1 $7 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. } the action taken on your claim by the Board of Supervisors —" (Paragraph IV below), given pursuant to Government Code Amount: $166 . 89 Section 913 and 915.4. Please note all "W&PPAWY Counsel CLAIMANT: F .B. HA.GaIAN APR,2 7 1987 7 Rolph Park Drive /► ATTORNEY: Crockett, CA 94525 Martinez, Ci/1 94553 Date received ADDRESS: BY DELIVERY TO CLERK ON April 16 , 1987 BY MAIL POSTMARKED: April 15 , 1937 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: April 23 , 1987 gy1L BATCHELOR, Clerk eputy L. Hall 11. FROM: County Counsel TO: Clerk of the Board of Supervisors { 4 This claim complies substantially with Sections 910 and 910.2. { } This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). { } Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: /� ✓ `�' Dated (�- -�'�-��, �- f � � ,� BY:�",-�~1ti-'JL-�t-C.'c�"Cr.-s�"`rL.-C..�-�eputy County Counsel I11. 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. BOARD ORDER: By unanimous vote of the Supervisors present XThis 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. p Dated: MAY 12 1981 PHIL BATCHELOR, Clerk,-By 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 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. 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. y P Y Dated: / /� MAY 13 1981 BY: PHIL BATCHELOR b i'�-�--� ut Clerk CC: County Counsel County Administrator CLAIM TQ: BOARD OF SUPERVISORS OF CONTRA COSTA CUUNT, Instructions to Claimant Return original application to Clerk of the Board 651 Pine St., Room.106 Martinez, CA 94553 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 , California 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 end of tFiis form. RE: Claim by )Reserved for C1 ;,�, g stamps RECEIVED ) Against the COUNTY OF CONTRA COSTA) apR 7 or DISTRICT) (Fill in name ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ l(p6. gal and in support of this claim represents as follows: �. Wien did-the damage or��n3ury occur? Give exact date an�l�iourf �:- i�Tfiere $i� (Fie damage or �n3ury occur? ?Include city and countyS �� 1317 G ap 6~s R m C 6G ET-"- Cc Atr'F A &,W 5T'A- C t3 v n(TY 3: �How�did�the damage+orlinjury occur?s`(Give"tull�cetails;�use extra`. sheets if required) -FR wxt r- D Q®2, L.o c Jzr W i jq >v w f "r) FM04-YE 8 0�z o tC E A( To GA-1 tj F-" rttvr SAWOM nl'A k>c oft c s A,L D ��.-.r:�s.r�.r�r.=s ai:i:��r�as�-�.� T��if�_��..-��.w��ir��r.��.s��.�. 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? (over) I S. -What' are the names of county or district officers, servants or' { employees causin the damage or injury? Z) t-f F R t F F' 5 E Pr E ,,�. tz NN L L $Y O r r( c a ,.. 6. What-damage or-injuries do-you-claim-resulted? !(Give full-extent of injuries or damages claimed. Attach two estimates for auto damage) -SE E. 3 A OOV E q 13E'-(n4U 7.- How was-the amount claimed-above-computed?_ (Include the estimated- - amount of any prospective injury or damage. ) ,Ar-TUAL. CvST5 8 --------------- . Names and addresses of witnesses, doctors and hospitals -z--� -------- ---------------------------------------------- . Lister u made on account of this accident or injury. V ' '! ITEM AMOUNT , . 4 oo e- l 5.t Z 41 I 2-W7 0.0 0 0 05'r'^t T ,e► s W,4LL PtA-1evrtt tG �Y L~,B.E-I- + nd, -- t1t dG vs.r- Govt. Code Sec. 910.2 provides : "The claim signed by the claimant SEND NOTICES TO: (Attorney) or b some person on his behalf. " Name and Address of Attorney Claimant S{gnature ac.P14 �3 DR/ Vic Addr ss Telephone No. Telephone No. 7 1?-7— NOTICE Section 72 of the Penal Code provides: "Every person who, 'with intent to defraud., presents for allowance or for payment to any state board or officer, ' or to any county, town, city district, ward or village board or officer, authorized to allow or pay the same if genuinet any false or fraudulent claim, bill, account, voucher, or writing, is guilty of a felony. " r _;, �:t�, 3^ bra s 's ; s a•r„S L 22{f � �,� � +�+�� .� �� L i� � r �, r S � Vis ,.''`�T,,*•P' w ,� '� b�� `�l`.a� �,IL �^ g � u '� � '3• -:.�r�. °�� `��" `�y�"-3 y".*v.��"_�,�,ax `t�yrE �;j�� r} r ��, P -011 ,' ' S>< aW� ^` P"-.4'F: ' ;cy,. Ta"x # {'... .�4`+.z •.$=' '7` t;r� .ek� s" S`<' s ., w ^rs. a �:. r ��F ' ,'�' ,�. '�> } � '.' p",%' �aez�,C.� �*�k, it •, ,.�wd,`�'u`R,m r Z� S i...x...;a� f�,F.�+ '�T..',_K"��.,,.r_ 4 rr.,"a' x ..y eaves,,, r -ts a,,,,. - w..r'i' •� .x,y�Yx.. .,� sa 7 a'."4fb f' .r„ ,.gr'F X: 'S-mss.-# • ,� �j., '' ' � St'�1l.CRJs��dttE�``d03�Ad1�:��$E M1Vla��1`�'1�IV �� _ :�- �'� � ,`� •-•+n:�'+ 1� _ � - �'i" :: y�'�s,d �'��,��a�`^�wT"e�.,w.`c�. .�3k��' :1� '�'.n w°3a�,�' �.:.�3�""�i-tn��rr'n� r � r.11 �'.y„�..� s ►^� :v-+ jw� �Y��y F'� � f'. 'r:s" x fig" =r v:r�•+T,t �: ��•J...,'f ......j `"{/1 r'J 1' � .� r7w ro A z"' PWQ "' J s n ra s �. -..SL .�++^ a+'Pr''.r,k. ..�.$n. ra �+� �E•.$p.� �e'�- - k u, � � f +'rY i _ ....� 4 i .J rF 77 f.I� f /�4'h Y4ra b .�i�, °� C a .,F�. L 1 ♦a a#G� +"fr'� 9y^L ; .� .�t3'°2 3` "' �, yvx'��'' Z'^' e y.�i�"..�, JAS sO 7 F 9� ��' " ' \ 'Ss` -s iso. 3 s L ,• `W fin, v _ ; � t L OEM cc i �- a Am.As a. 0 C i r t ` CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION r the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT May 12, 1987 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the BoArd of Supervisors 10 000 000 . 00 (Paragraph IV below), given pursuant tov4�(eri�@�8) Amount: Section 913 and 915.4. Please note all Aya�,nt�g ' 19 8 7 DAVID P. VINES tt''ttCC CLAIMANT:C/o Charles E. Merrill, Esq. 177 Front Street #L Martinez, CA 94553 ATTORNEY:Danville , CA 94526 Date received April 13, 1987 hand del . ADDRESS: BY DELIVERY TO CLERK ON p BY MAIL POSTMARKED: no envelope I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: April 13 , 1987 PpHHIL BATCHELOR, Clerk BY: Deputy Gt L. Hall I1. 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 911.3). ( ) Other: Dated: 1 / yLI BY: `'`_ .i/. c L�lc ,t_L!—fJ' eputy 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. BOARD ORDER: By unanimous vote of the Supervisors present ( ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: MAY 1 2 1987 PHIL BATCHELOR, Clerk, By �. Deputy Clerk P Y 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 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. 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: -MAY 1 3 1987 BY: PHIL BATCHELOR by De ut Clerk p y e k CC: County Counsel County Administrator 1 CHARLES E. MERRILL , Esq. 177 Front Street 2 Suite L ^ �t� Danville, CA 94526 C 1� 3 Tele : 415 837 0777 4 MARC S. MAZER , Esq. �; APR /\319:877 3010 Shattuck Ave t 5 Berkeley , CA 94705 Tele : 415 843 5300 6 7 Attorneys for Claimant 8 In the Matter of the Claim of ) ) . 9 DAVID P. VINES, ) CLAIM AGAINST GOVERNMENT 10 ) ENTITY PURSUANT TO Claimant , ) GOVERNMENT CODE 9I0 11 vs . ) COUNTY OF CONTRA COSTA, MERRITHEW ) 12 MEMORIAL HOSPITAL , AND DOES ) 13 1 through 50, inclusive . ) 14 Respondant ) 15 DAVID P. VINES, by and through his attorney , MARC S . 16 MAZER , states the following claim aginst the COUNTY OF CONTRA 17 COSTA, MERRITHEW MEMORIAL HOSPITAL , and DOES 1 through 50, 18 inclusive, pursuant to § 910 of the California Government Code : 19 1. The name and post office address of DAVID P. .VINES , 20 claimant , is as follows : 21 David P. Vines 22 c/o CHARLES E . MERRILL, Esq. 177 Front Street 23 Suite L Danville , CA 94526 24 2 . Claimant requests that all notices and other 25 correspondence be sent to claimant at the following address : 26 c/o CHARLES E. MERRILL , Esq. try 177 Front Street Suite L 28 Danville, California 94526 1 3 . On or about January 2 , 1987, at Merriethew Memorial 2 Hospital in the County of Contra Costa , california ,. claimant 3 received personal injuries under the following circumstances : 4 Claimant was admitted to Merrithew Memorial Hospital to 5 have repaired a skull fracture through elevation of said 6 fracture and enclosure of a forehead laceration . 'The' claimant 7 was admitted to surgery whereby his depressed skull fracture was v 8 elevated and the forehead laceration was closed. 9 10 While claimant was in surgery skull fracture elevated and 11 the laceration closed the claimant was unconscious and under 12 care of an anesthesiologist . During the course of the 13 operation, the oxygen to claimant was negligently terminated for 14 a period of five to fifteen minutes . As a result of failing to 15 receive adequate oxygen for said period of time, the plaintiff 16 suffered brain damage and physical injury . The brain damage 17 and/or inury was proximately caused by the failure to supply 18 oxygen for a period of five to fifteen minutes while claimant 19 was undergoing surgery . 20 21 The failure to supply pp y ox ygen to the claimant while under 22 the care of the County of Contra Costa , Merrithew Memorial 23 Hospital , Physician Cavvett , Physician Gross , Physician 24 Vukalcic , and other agents and employees of the County of Contra 25 Costa currently unknown to claimant , . and Does 1 through 50 , 26 inclusive, were negligent and their wrongful acts , acting in the 27 course and scope of their employment , caused claimant to be 28 without oxygen for a period of five to fifteen -2- j 1 minutes while undergoing surgery. while at Merrithew Memorial 2 Hospital . 3 4 5. So far as is known to CHARLES E. MERRILL, and to 5 claimant, DAVID P . VINES , claimant has incurred damages in the 6 amount of $10, 000 000. 00 due to the following injuries : 7 Claimant was without oxygen or received little or no 8 oxygen for a period of five to fifteen minutes which produced 9 death and deterioration to claimant ' s brain . It is believed 10 that said injuries will be permanant . The full nature and 11 extent of claimant ' s injuries are not finally ascertained at 12 this time . 13 14 Claimant was not made aware of these aforesaid 15 circumstances and the damages set forth above until on or about 16 January 6 , 1987. 17 18 6. The names of the public employees or agents causing 19 the injuries herein described are not yet known; said persons 20 are therefore designated as Does 1 through 50. 21 22 7. At time of presentation of this claim, RICHARD P . 23 VINES , claims damages in the amount of $10 ,000, 000, including 24 approximately $9 ,500 ,000 due to prospective injuries and damage, 25 computed on the basis of the following : 26 Present damages : $100 ,000 27 Future loss of earings : $3 , 000 ,000 28 Pain, suffering , mental anguish and psychological trauma : $5,000, 000 -3- 1 Future medical expense: $1 ,500,000 2 3 Claimant is still under medical care and the full extent of his 4 injuries are not presently known although said injuries appear 5 to be improving. 6 7 8 9 10 Dated : April 7 , 1987 11 f 12 RCZE &A-t-torAne/ 13 Iflaimant 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 -4- ` CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the 3oard of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT Mav 12 , 1987 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. } the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $150. 00 Section 913 and 915.4. Please note allftw"sCounSe CLAIMANT: JOHN L. SERTICH APRT x.187 72 Camino Sobrante ATTORNEY: Orinda, CA 94563 Martinez, CA 9451-53 Date received ADDRESS: BY DELIVERY TO CLERK ON March 31 , 1987 applic. to file late claim grante BY MAIL POSTMARKED: no envelope I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: April 13, 1987 PpHHIL BATCHELOR, Clerk BY: Deputy / L. Hall r II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. (X) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The' Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: r c- J /g / BY: 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. BOARD ORDER: By unanimous vote of the Supervisors present Y�) 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. MAY 12 19$7 . Dated: PHIL BATCHELOR, Clerk, By , 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 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. 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. MAY 13 1987 Dated: BY: PHIL BATCHELOR by eputy Clerk CC: County Counsel County Administrator t t _'L•: :Lm r1`J x BOARD OF SUPERVISORS OF CONTRA CCWX krFoWyapplication to: Instructions to Claimantp`erk of the Board M rtinez,Califomia94553 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, California 94553. C. If claim is against a district governed by th Supervisors, rather than the County, the name of the Dist c ' lled in. D. If the claim is against more than one publi en*� VA , sep� c ims must be filed against each public entity. . E. .Fraud. See penalty for fraudulent claims, a c. 72 t end o this form. RE: Claim by )Reser v g stamps RE 'hrt�nC.`A `14563 Against the COUNTY OF CONTRA COSTA) F 1987 or DISTRICT) 'tc'S' � ..... crs s (Filln name ) . The undersigned claimant hereby makes claim against the Coun y of Contra Costa or the above-named District in the sum of $ 1,5�p •00 and in support of this claim represents as follows: �. When-ala-th-edPdamage-or//-injury occur? Give-exac/tt-d�a`%t/�e /�nd hourf r'd (}Gij �'r t b Tk' v�raw no T"t l�'CY ea,'t�Pr 1 P +tu " VA/`''.5 ,, C +�-x4.,d ao po r1 el a- Mwapr S' ,gip_ �u _ a_vg eDu_ _nnoMP �--- _ 17_RE-e a i3-the da_.-n_age- or sn3ury occ �? -tZncl'ude city �h� couZty�---- '12 CCcrn e.'o so hood e 1 �r Q r l`n A co 04,-Q -Icw 3. Now did the damage or in3ury occur? (Give iuiS details, use extra sheets if required) jD e4,t we `!d a '4"•Ct a r`H �V 4. What particular act or omission on-the part of county or district officers, servants or employees caused the injury or damage? (over) 5. . What are the names of county or district officers, servants or* . employees causing the damage or injury? � LL 00 . QTQ'C�i`ut �P.pr� -_--_-__� _- ___--'t-s_-:-------------s------------- r- --_ - --------- 6. What damage or xn�urses do you claim resulted? Give full extent of injuries. or damages claimed. Attach two estimates for auto damage) __________________________________________________________________ __ _ 7. How-was the amount claimed above computed? (Include the estimated - amount of any prospectivenjury or damage. ) r '�4C-1-� 6 i I krbN^- C oti•tea t�o .- , __---- 11`�i- i esse- --of-----witnesses------,--doctors----------and--hospitals.---------------------- 8. ft LO tt �1 expenditures you made on account of this accident or injury: DATE ITEM AMOUNT 49 E2ffafrs.. t So «6a 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 7.2 of the Penal Code provides: "Every person who, with intent to defraud, presents for all-owance 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. " :. AMENDED -CLAIM BOARD OF'SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA ;"lim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT May 12 , 1987 and Bgard Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to GoverntO tCliy Counsel Amount: Unspecified Section 913 and 915.4. Please note all "Warnings . CLAIMANT: DOLORES J. GONZALES APR,2 7 1987 c/o Susan Jeffries Martinez, CA 94553 ATTORNEY: Groff, Fortner & Johnson 3105 Lone Tree Way #D Date received April 17, 1987 ADDRESS: Antioch, CA 94509 BY DELIVERY TO CLERK ON BY MAIL POSTMARKED: April 15 , 1987 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. �bIL gATCHELOR, Clerk- C� DATED: April 23 , 1987 : Deputy L. Hall II. FROM: County Counsea TO: Clerk of the Board of Supervisors - �) Thisilclaim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 7 BY: �`- �- County Counsel L 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. BOARD ORDER: By unanimous vote of the Supervisors present fi6 ( /y� This Claim4is 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. MAY 12 1987 PHIL BATCHELOR Clerk B '� /� Deputy Clerk Dated: y L.�' P y 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 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. 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: MAY 13 1987 BY: PHIL BATCHELOR by / / eputy Clerk CC: County Counsel County Administrator LAW OFFICES OF + GROff, fORTnE R & JOH nson LONE TREE PROFESSIONAL CENTER RICHARD P. GROFF 3105 LONE TREE WAY,SUITE 0 STANLEY W. FORTNER ` CURTIS L.JOHNSON AO11oCH, CALMORNO 94509 '(4151'757-6686 County Counsel April 14, 1987 A P R ,i. 6 1987 Martinez, CA 94553 Clerk of the Board of Supervisors Victor J. Westman County Counsel iw P.O. Box 69 1g8't Martinez, CA 94553-0116 ppR I Re: claim of Dolores J. Gonzales our File No. 7896 Dear Sir or Madam: Our firm recently submitted a claim, on behalf of Dolores J. Gonzales, to your office. On April 9, 1987, we were notified that Ms. Gonzales' claim was insufficient and/or non-acceptable for the following reasons: 1) "The claim fails to state the circumstances of the occurrence or transaction which gave rise to the claim asserted. (See #7) ". 2) "The claim fails to state what act or omission on the part of Contra Costa County or its employees gave rise to the claim asserted. " We request that you reconsider your "Notice of Insufficiency and/or Non-acceptance of claim" for the following reasons: The claim, five pages in length, fully states the circumstances of the occurrence which gave rise to the claim asserted. The claim states, in part: "I was processed at the Martinez jail, including a humiliating body search, photographing and finger- printing. " Furthermore, the claim asserts the act or omission on the part of Contra Costa County where it states: . . . county employees knew, or should have known, that I was not drunk as I displayed no observable signs such as I witnessed displayed by other detainees. " Clerk of the Board of Supervisors • Re: claim of Dolores J. Gonzales April 14, 1987 Page 2 In short, the County is charged with false arrest, assault and battery and failure to exercise due care. Should you choose not to reconsider rescinding your April 9, 1987 notice requiring expenditure of funds on the part of my client to have the court order same, we are providing you with notice that we will pursue costs and attorney fees. As you know, the California Government Code requires "substantial compliance" with the Governmental Tort Claims filing require- ments. A fair reading of Ms. Gonzales' .five page claim can not result in any finding other than "substantial compliance. " Please advise. Very truly yours, GROFF & JOHNSON SUSAN M. JEFFRIES SMJ:jm cc: Jo Gonzales APPLICATION TO FILE LATE CLAIM _HOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIPMIA RDARD ACTION Application to File Late Claim ) NOTICE 70 APPLICANT May 12 , 1987 Against the County, Routing } The copy of this document mailed to you is your Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to the Board of Supervisors (Paragraph III, below), California Government Code.) } given pursuant to Government Code Sections 911.6 and 915.4. Please note the "WARNING" below. Claimant: JUDITH GUSTAFSON County Counsel c/o Sharon Green APR,2 7 1987 Attorney: 722 Montgomery St, #35 Address; San Francisco, CA 94111 Martinez, CA 94553 Amount: Unspecified By delivery to Clerk on April 14, 1987 Date Received: April 14, 1987 By mail, postmarked on April 13, 1987 I. FROM; Clerk of the Board of Supervisors 70: County Counsel Attached is a copy of the above noted Application to File Late Claim. DATED: Ap r i 1 23, 1987 PHIL BATCHELOR, Clerk, By Deputy Hall 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 deny this Application to File Late Claim (Section 9 1.6). DATED: eu CTOR WESTMAN, County Counsel, �-� �I � III. BDAJff ORDER By unanimous vote of Supervisors present (Check one only) E } This Application is granted (Section 911.6). (}( } 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. DATE: MAY 1. 2 1987 PHIL BATCHELOR, Clerk, By Deputy WARNING (Gov. Code (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 Govermmtent Cade Section 945.4 (claims presentation requirement). See Government Code Section 946.6. Such Petition must be filed With the Court Within six (6) months from the date your application for leave to present a late claim Was denied. You may seek the advise of any attorney of your choice in oonnection with this matter. It ym want to consult an attorne should do so immediately. IV. FROM: Uerk of the Board TO: 1 County Counsel 2 County A s or Attached are copies of the above Application. We notifed the applicant of the Board's action on this Application by mailing a copy of this document, and a memo thereof has ben filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. DATED: MAY 13 1987 PHIL BATCHELOR, Clerk, By YXZDeputy V. FROM: 1 County Counsel 2 County Administrator TO: Clerk of the Board Received copies of this Application and Board Order. of Supervisors DATED: County Counsel, By County Administrator, By . APPLICATION TO FILE LATE CLAIM !' SHARON GREEN INC. LAWYERS 722 MONTGOMERY STREET,SUITE 35 i SAN FRANCISCO,CALIFORNIA 94111 I (415)398-2434 i April 10 , 1987 �Y�i 1qp � R X1987 The Board of Supervisors County Administration Building P.O. Box 911 Martinez, CA 94553 Dear Board of Supervisors; This letter is our application for leave to file a late , claim on ; behalf of Mrs. Judith Gustafson. i On April 21 , 1986 Mrs. Gustafson was the victim of a false arrest , false imprisonment , assault and battery, intentional infliction of emotional distress , negligent infliction of emotional distress and related torts arising out of an incident in Danville. A copy of the police report related to this incident is attached as Exhibit 1. A claim was filed with the City of Danville on July 17, 1986, attached as Exhibit 2. The City of Danville rejected' the claim on August 4, 1986 , see attached Exhibit 3. The City concedes that the claim was timely filed, see Exhibit 4. When the City rejected the claim, Mrs. Gustafson learned for the first time that the law enforcement officers were employed by the County , and that the claim should be presented to the County. Immediately a claim was filed with the county on August 4, 1986 . It was rejected by the county as untimely, see attached Exhibit 5. Under these circumstances we believe that the County is improperly asserting that the claim was untimely, and we seek leave tolfile a late claim based on the foregoing facts. i Very truly yours, SHARON GREEN SG/et Encl i I i' j i �� .\ �4 � • 1 4� �, e 1 �, ,E �XxZgZZ 1 �� '�, ,� 4 t ,4 11 ��. �` �� 1 '� �� r FORM A •+a itt O...• S tinuahC^ VUUm of $usoett o Vii last fest F rmr .r� 7 Face NPI A;e c -� � • ' �, B 9 Oc[UCAItOn WO•�Hour; to t< T•'e$,oPnce. lies$ 13 HomePrsnne is Victim SActlwtyPriorTaOUrfmgOtlenSe E"nC•tovmPrr Scnoc -peciort Pace be. .4j. 't h"�rn"-'Vn^"r ly �•L'Q 2� UCCUDtIhO^ l WO'% HOur! 0 ip -92 as � 7-nc, Arr•oge jn+� 70 y �lV �-c D••nno 21 Emc .menl'Y..•'.� l.3oe i.eta'+t _ic.. .orti- e . ` '1 A, ..� r - :%a. Dale «•metrc,�:,••eoGa. t?aI, 'rir -:ecor•e•1 = Oav Case 7tmeWr.ae.; 3" '�.70 ':eatr.e• - -- a t ON -� -� �SU 1A10 -a r-16 o v. A+:e ••er: �as�e ) •ton a Emdr.vmenf bc^ _T57- 7,„,a• 3t°. 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G eT• 47 Cr-•nc L ,,,, evt•sx•: C: :• ':sat,.e•onc••r C' 3,e,rnr(..._ C 9 Ga'sal, G Un. P.,.a t. G 9 ter.-tottt,on of G Js S..sm.t Ar ec G ,. '7 fie!_. -'s casn G 76 Sit.,C••Po..a• c•-r' •t.. C .. C - O'n•' I P•,r� ❑ t; $e•etr.r,n loot G at eoutrd-Gah`aeo V.tl- Ct_ L..; :x•.- c..: 7+,v... • L 3 c._„_ i❑ •i Tn�.O•,y Tv�&ir•rot - G 7! tJsra Ga...anc ti..•r I C pR...E, v Ci ';Ga*>t$*Ca•: Er L,j • a.--y. .yrs' C : „r.C)n,r Monet I G 79 Ptace,P.ccerh�n C _=-t.c . r t- ` Ta: �G !3 `•.^t. Jnr. 1 lk -” :1_ C ,£ 5,,• tra airs C 3C P c:t:C.,Cie'••; t ! r•—• 5"ty—a•.r C �^^ Tee S C Ugrt v.c!•• s Na^ L,,,. .. .. I •7.. r5 ..^ t"..• ... v•n.(.e A.a 7!410 (U�''''!! 3: iN 1.r{I.a VrCtim 27" I r C Fe-o.r A.ntt'ir {L: 33 U++u a.,a:'J"ft•"t a ee L ffr YYt t i N Lv - SATL _ a 1"" )I Vr- AM•N a ', i~ S� � i ��va tit 1 t.•tWNLIU Sl uta Ie fieD r. ; ,... Pr,� . .E�_ ,,j� E✓7�L1 a5 ADJIC'v.n :t Ctr r$b f•r• E.TiC•vrte h0 c . it AQ. ip . CE' ` C::I...[ STATISTICS -VICE Ccc�, , _CCAc CT+-f= :a Pa 1 c' CONTRA CCSTA COUNTY SHERtCi•CORONER S OEPARTMENT _ P 0 80. 391. Martinus.CA 94SS3 — (CA007e000l PATROL C FORKS fNVESTIGATION )Ole 56 ONTINY PLEMENT C STATEMEN''IV (I-ek ocation Coce.Loca!lor e2 Sun—No 1.0.,kcsstnt3 Fefs".L 63 0 0 8- 64 Race 0!� i,�% ill' cicl- - r— -. (4 Wr 71.AKA 2 .sloe AM-st RtM 7:1 Home PhoPhone %flA Sus.nes%F-?--cne L'Xrll Let LWZI.LF__-1 x2o-L� ad- E,.7-,;,ov-en: Sncc: ;6 Occupazio- s L,:qr,N:) 7e soc--ng N: C,.f N- A10S 79 SuSLPctNc 60 DOB 81.Race $2.Sex 83 Age 84 Ht 05,Wt Ige Ha;! 167 Efts I L 66 A#,.4 E? Resicence Accfess 90 Home F1 one 91 92 Emcioyneni,Sc-,cc, 93 occucation 9-Driver 5 License No 95 N_1•C.:f N, iy:El z r--A:$;S'fLE 98 FA-_";A; HAl:; 59 COMPLEXtON IG) GEN Ar-r-NCE ICI, DEMEAN-0= sr-E=.:- I C 2 i 2 S-Sos:, 1 2 SvSPE_�, 1 2 SurCIE:7 1 2 S-,S=E:' 2 2 S.;!:- 2 U.- C a u,. 0 0 u-- 13_Z, :u-- c u 0 El 0 u C 0 a.t 1 Al-c i.31 0 C-1 Ar-, E_ 0 1 Ce., rZ�D I A.C, C C I ACCI-I C_ v i—se rj Cc:a, C: 2 6,0'eto f r 2 Ir.11 8-r D 0 2 2 0., D 2 AV" !-C G ?011- -,I ��E) 3 S,s-. Q G 3 P,,kla,c,.. 3 r-,c-,ev 0 Cl 3 0 souse 0 C 3 ca'3- M G 3 mi't it _-CLC: C: - .ct, _ C-: r 0 0 FA C: 0 r Ix, t C Z C 1: C s G: Cok.-c 0 C' C C: 0 L Z C: 1: 17 r F C r, C 0 0 0 C C 0 S E4(-s 0 C. s 0,cc, Q a tj,,us.s!So Q 0 a Owes, r r Z cca's. Z I C!0 V-o,e vs;C.,,v, F U C3 9'K.,G. ❑ M, 9 Vical, 6- gas.. W;, CJ 10 C!-e! 0 0- m F! 5: -.CC 9 C 0 ll C', 0 -.s c--,- 0El !1 0!"v 0 0 f2 Lt"."IC 0 0 11 C L-3 r C C 0 t.. 1 0 7 12 Cr,:, 4 b , -ri,"ar4s jewe,ry Scam tronc.ex j C)4 Fur �,_s e Giasse! Tatto I 1'5 Venice - sear. :!ane. Mocet,C--'C' L.censc N�; Cr.7,e- icent:*fn; C!%ataC*.e!lslfCt Susciev = V,cttm AL -TIF—Aocress ;F,C i 106 Rec.sterea O�,�e, 1:9 WnZ"as Ir.e Ke:S I IC LoCal;orl of Vel.:cle 111.Re;pase--t. 112 C::rc:*,.-^, I A Race Sex AC. "14 F; tcen:e C71NIS IST, ATZ e --i E IIE Cc.o_-A: Cr 6 ty'r F.a s .ER PesA----,ess -oei�e 7 E 12, 126 012VIc,v Hc,_-ts =6:ia:C, p M S 114L THS 7 Vt- �aun V, CE Ac, li? 13Q Accro n Wer� ,Cr,— 1, E .1Irp,ov.. 0 Su e,-set jpf:,f, E-1010y*e P43 131 G Sacs t an CSI •Ez V CFzME'F CRI',I-: P Z cEr C:' -4E r CONTRA COSTA COUNTY SHERIFF-CORONER'S DEPARTMENT VO Soit 391.Martinet,Co.24553 JCAG070(-0G1 ` FORM C N14"A Rik t3al% CASE F+LE A J 13B pAr.GATEJ/`,�I A �NTINUATION 9SUp'IEMENT'"D�TATEMENT t1&A Ia2 Location coat 143 LOCAIto oIoccurrenceS SUSPECT +45000 146 Eiuo►Inq No".' ,G'le No ' f ��. 147 Nu'^b'• SrrN Nun'n►• 4.ttelra-&&A Cww"ol'G^ . o^OofRTti OESCA+PTIOM Iln Dower) FKO..'.f itwn9 lC7r tIM.^111M w0 AnKY Ouan'.Iv Br.^d tt.'.Y.n IaCWrM"A" .IC /.rt. LOCat,o'r.'nF.I..M Ya,u. IKlue.rel. aCY- LIST IHiOIIOWING OpGEA •ICu'r.nC.NorMB/J.�.Iry C iCMrn•n0 furl C'V.n.CI.tE 10.1-WET11G 1 I. w 1..ou..r•o o Goof.1 r Contv'n.e•.n.,nt J 1 l•.MIOC.• 1 Y,u 148 149, to SE4u. ISI 8oaw0 ua.E ^o +5i r.,�DEI.NAYS l OTr ARITICLE NAME I NuvBE°S Yawur4CTuoFQ NCCEi NL.-Ar S unISCELLANE0U5 DESCRIPTION VALUE O _• , 1 1 s s SaV � o -.T14 SH. O sr CVM8 FO ' U S ,T A22a_b &.2- rn TWO CE. TEl act t 0 VZTH-Cvt-• --- d E 0 0 nAr SHE-_ UA Sf(L SVW15� 7D LAA-L- _(2 14 F_ F-+eOA4--f hOO S To a/vOICIr 3 . t1 �• R J�?QT14 1400le A/ 0 66r &VU% V C S� V,� dna 'T" i"}{ -55 PeDCr•. q['e' ry•+Pr:nll E�Me'C.ee'4' 196 ACOr Cv,nq SL0ef VISCf•IPf41n E-CIOvel hC '': li 1:^S,'C� 6: ALu'+ '" d i.Su =1.+ =A �C =R 1 Calti':C_ '. CF ..cg v Gr.I•.lE'•. e T-CT CS —v:CE -cF'> CC1ai 1E0 PA'�_L rrv:r•,c .F —Fo_cE_-v __NaF,:G' C _.Ty _... Cy�rv•_alh' I •�e •acv• r �5� "A: �CT• _- ? C�44C J E CONTRA CCSTA COUNTY SNFRIFF•CORONER'S DEPARTMENT — P O Bot 391 M4rtlnev CA 94$53 — (CA0070000, i FORM C k. Cg11aE 7 T7 Gn5E Il • 139 OAY.PATE 119 CONTiNt}ATiON t16UE'PIEµfNT O STATEh1ENT 14t T!►� T-W 1sZ LocallonCoot 147 Locxh atOccLr+rcnct S 1�'� SVECT +s5 D O.8 146 alwa+t+gNo rGutnlo . 147. P"ovt T"Y OESC+1+sTIGN i+a*ao,n.en R+eow+w! sov.a los+ Sle—.11fo-No Art1{1t Ou.n+ae. grinOrM.a*+►A..utx+wyuen.+N+r,w S.n.+Nwr. +Y+.se +I• s+lawI.., 1 Lora I mo+a wvr oq•.n �D1uo IK+uu+lo's'I,6 I UST 1N I CL L OWING C AOE A A ICurrtrxv tweIH91jo-oo G 1C+pManq iu+1 OIVMKMfE IO+hct Eeu 1f+Pr.e+O +{{,�1i+aw *#—A-+�+�+"o'Q Geom I i Can.unYDN afM*i I iav fm.R 11A+fc 1 ts4 tS3 t5 IS2 1S3 tSs OTr APTICLE NAME Nuve e+MN CiNC v « 4cEE tiu AEps MISCELLANEOUS OESCAlPT10N VALUE sarm 1-.omo S � To sooerra-L IS I"A P-%0A I it 0- ,/L ' r- !9tvs-(---- 6usT-nr-so*,A.1 S a CA P_ IS 7-mr/) - &g "ant ALL c. CA0 E�AT- I rac c4aLs RAMI SN8 t GvactL r-coh, O?cr- T14 F- ale 6USM62 155 Fier) ' S +tv-tPa!nt; E!'IG'Cv!t Y,: f5. A^L'Cv+nS.;,pt+�'3"'^.Arrbt! Ernwovee Na - GSCOS•+,on •te A, u+' ue 30r GM ;A CO CR CP1A+f= ' [t:•iec5', C-.l+c5 + a +60 PA-PCL _rEcsC'a5 E __PRCvEGTy _NAC 0T1C'S —STA'1 TI —VICE S CS �v Ci'.A°_AINT CEP+-"v — SC•CCA% ._C'+ r'.= °sr F,Fy� J pl CJNTPA COSTA CCIINTT SHEPIFF•COgCNMS DEPAPTMENT.�.P O. got 191, Mft1mN.Cat,0553 — (CA00700001 CASE F L #'�n - U16 Y,:0j OIC �KA COSTA, CALIFORNIA RICHARD KC,cr`RA P .,, SHERIFF-CORONER 1 A.M. DATE HOilR P.N.. I , 'the under ne.d, under p alty of er ' ry, herebv declare that I arrested O� 0 on the charge of and that I requested that a peace o ricer take this defendant intc custody. I hereby agree to appear in the Office of the District Attorney t:. sian a formal complaint, five business days after the date of this incident. 1. That I will appear and testify in court on any day or days that this charge is set for hearing. i 2. That should the County of Contra Costa, its officers, agents, employees, or any peace officer be sues' or subject to suit because of the arrest made by rE, I shall forever hold said County of Contra Costa, its officers, agents, employees, or any peace officer free, clear, and harmless anc'defend thee, in sEi action. Location: 3024 Parkside Drive, Concord, California, or Room 220, County Building, 100-37th Street, Richmond, California , Business Hours Citizen's Signature �t Residence Address Residence Phone 1 Business Addres Deb Business Phone Office toT Officer n PF r7 Rev. 2/85 i i RELEASE AND PROMISE TO APPEAR FROM CONTRA COSTA COUNTY D T ITI ,J�ACILITY (Penal Code Section 853) �.• �a 1 The People of the State of California vs: ) Booking No. • 9Q 1 '777� In consideration of being released from custody, I hereby agree: I. That I will appear at the 1�9LWalnut Creek Municipal Court located at 640 Ygnacio Valley Road, Walnut Creek 0 Bay Municipal Court located at 100 - 37th Street, Richmond [� Mt. Diablo Municipal Court located at 1950 Parkside Drive, Concord Mt. Diablo Municipal Court located at 1010 Ward Street, Martinez CJ Delta Municipal Court located at 45 Civic Avenue, Pittsburg [_] Other i DATE TIME on the charge of violating Section(s) of the California Penal/Vehicle Code. 2. That if I fail to 'appear and am apprehended outside the State of California, I waive extradition. 3. I understand that any court or magistrate of competent jurisdiction may revoke this order of release- and either return me to custody or require that I give bail or other assurance for ray appearance. a. I further,understand that if I fail to appear when required to do so that I may be charged with the additional crime of a misdemeanor under Section 1320A of the California Penal Code. Date: + �� I r-,o Defendant /< Address City & Phonel._: i�.r.�V I t ►=— "/.�► ':hite to Booking el low to Complaint Deputy ?ink to Defendant Rev. 4/83 i j ',1 i �` 4 �.� �{ ' r c :t �XKIgIZ 2 ,. �� ',� t ', ,, ` _: :.. ,F t '; E [RECEI,VED 1 W. PATRICK RESENO ATTOMMY AT LAW AUG 1986 O 177 Front Street 2 Danville, CA 94526 3415/837-8257 ,pp„ty .. 4 Attorney for claimant 5 b Claim of JUDITH B. GUSTAFSON ) 7 ) CLAIM FOR PERSONAL !, vs. ) INJURIES (SECTION 910 OF THE C;ITY OF DANVILLE ) GOVERNMENT CODE) TO THE CITY OF DANVILLE: YOU ARE HEREBY NOTIFIED THAT JUDITH GUSTAFSON? whose address is 1925 Parkmont Drive, Danville, California, i 13 II } claims damages from the City of Danville in an amount not 14 I yet fully determined , but computed as of the date of 15 ;; I i presentation of this claim, at the sum of $50,000.00. L.6 This claim is based on personal injuiry sustained by claimant on or about April 21 , 1986, in the vicinity of ;f 367 Diablo Road, Danville, California, under the following :a a circumstances: Claimant was arreste8 by Danville Police while eating dinner with her children at the restaurant commonly known as Bob ' s Big Boy in Danville , California. Claimant was arrested and charged with defrauding an innkeeper and transported to the County Jail where she was �) temporarily incarcerated. ) ! The name of the public employees causing the 26 1 injuries to claimant are contained in a report No. D86-9665, I f 1 i i 1tiled and reported by Deputy A. Burt and witnessed by Deputy 2 Corona, and Officer J. Rain. 3 The injuries sustained by claimant, as far as I 4 i known as of the date of presentation of this claim, consist 5 of mental and emotional distress, violation of clai'mant ' s 6 civil rights, wrongful arrest and imprisonment necessitating 7 psychiatric evaluation and consultation and medical a I treatment and care. 9 � The amount claimed, as of the date of presentation 10 I of this claim, is $50,000.00. 11 All notices or other communications with regard to 12 this claim should be sent to claimant at 177 Front Street, 13 Danville, California, 94526 , to the offices of W. Patrick 14 Resen, Attorney at Law. 15 DATED: July d , 1986. 16 17 18 j W. PATRICK RESEN Attorney for Claimant i? 20 '1 22 I i 23 24 25 c 26 2 i i 1 1 PROOF OF PERSONAL SERVICEr I DECLARE THAT: � I I I am. a resident of Contra Costa County, State of Cal It twi Over .1 eighteen (18) years of age, and not a party to this actio My . business address is 177 Front Street, Suite L, Danville, California 94526. On 17 July 1986 , I served Claim for Personal Inju-ries (section 910 of the Government Code) to the Office of the Administrator, City of Danville, 510 LaGonda Way, i } Danville, California. s I declare under penalty .of perjury that the foregoing is true 11 and correct, and that this declaration was executed at Danville, 12 :. California on the 17th of July 1986, 13 14 Barbara Felix 15 t6 I 17 I 18 f; 19 i 20 21 , 22 ; 23 24 ! 25 t 26 } i 27 28 J i V i 1 `a 1�\ s t SoIBI"f 3 .ti ^p {t,, '� r fr �• �Sk C+ ��f ��i;. v 1 «• 4� tlflrNw•, ':_� ..i {:2q�,kW'�i�rl�'}1�r sy, V5 }' ' 6. 4 7;' E. .• + } i y+ui b': 1! tl:. 4 JIW o ' � ;°{• 4 y < ': •n +i a i' r•r 1.+s � 1 �y ,a f f tJL aa:� �, ti s�, ' • .iJ >I ♦t r?' 1 Y' •� ' x K L� r .}•�l�t. � �� ( � � � 1' 't1- :. :�. � ;�,�t 7��t♦��w' i ,� � a M 3 i' c � �"^ �`. ° Ii'11�i r � � f t.� i,.,i h, � ��'>J ,. rC •�� }�Jf y/�'•t• ;If Yt�, 1 �J�t^� y Y.r lty'l 2�y�y `} 1�t� t,1b k�H'7� � �it '{� w ; �i tL 6„} �+A i �-'J #'i',fZ•x' iJ,� f` t ,r � a � C ♦ 2 ' � ry. }/ty��t,� �t t � ra.�•S2 5,�r -. tr•LFk �� W1+7r.f ...`p'� la +•4 t t� �# } i �` , �� f� ' dot vj ow f 11 t�i 5t ; r1 e '' ��t�f ! � d`st � ' d '`.• ! 1+'�y�461��5�a�Tyi'� � � r r'.� 1 s 11 � ¢ ( *� ,f f1; ,Itf .,t: t f, 1S. .'j �." T\T �l a Yi .t• i'7t� Yt � 71 .. � i �.' i .J..� ,r � ; .';rr ♦ a t 's yf�� A � n � �. i . r a . �+ ..q.r' ' 4 ' ADMINISTRA'1�IVg' BTAI+'F REPORT r r p i TO: Ka or and Cit Counoii :Y, Au et 4 1986 Y t Y Y..' 9u :SUBJECT- :, Rejectidn of :claim by'audith 8. �ustafson - r This report recommends rejection of i claim by the above claimant; r BACKGROUND The City received a claim wising from an arrest by the Danville Police Department. ' RECOMMENDATION It :is recommended that the-,�.tbove claim be ..rejected and referred ;y . to 'Contra Costa County. r. COST IMPACT None j Prepared by: Tom Hanson Administrative Services Officer V _ 4 i ',` �� , �� `\ t ', `'� �'k �S �� ,t EXxIB�� ,� Y ,1 t i 1 �� , �1 ,,, ,Y . �� ,� a October 29, 1986 Ms. vicki ;Finucane Contra Costa County Counsel P. o. Box !69 Martinez, California 94553 Re: Gustafson vs. City of Danville I' Dear Ms. Finucane: The referenced claim was submitted to us in a timely fashion. The Danville City Council rejected this claim at their meeting of August ` 4, 1986. i Sincerely. Tom Ha on Administrative Services officer cc: W. Patrick Resen, Attorney at Law,,, Contra Costa County Risk Management Authority Charles Williams, City Attorney, Danville i I 1 i 1 i (418) 82o-6337 510 La Gonda Way Danville, California 94526 I 1 � h � w � `, �ijt a �\, ,y �� ` V ,� ,1 1��, �� ,, �, .. 1 ,` �l 1 i� t `Y �, ,\ 1 e` ,i i i V y rhe Board of Supervisors C^1O,�,r��ra ;panty Aft"Ire0on Building Costa sent y mrt�1»`� .p.Box 9,., WAY it 1•rlitMt,calllornis NS53 \ 40 �,w l•grMw.Dr OWi y.i.•"M AMM 4'prwr M trww,M prusi �' I 70tJudith B. Gustafson I c/o 14. Patrick Resen Attorney At Law 177 Front Street Danville, CA 94526 YMCE 70 C NDVM OT Lte ilial CUN) (government coda section 911.3) U) the claim you presented to the Board of supervisors of Contra Costs Canty, California, as "rnlnq body of the X County of contra cotta and/or District, be Au u� a 7f 4 WLly____ is being returned to t you event with cc Docs-we tt res noE—pre—sen�dthln 100 days after the went see ocewrenoe as rewired by Low. (Bee sections 901 and 911.2 of the Government Code.) Because the claim was not presented within the time aLtawe by Um, w action we taken on the claim. Tour only recourse at this time is to apply without delay to the Board of supervisors (!n its capacity noted above) tar lwve to present a late claim. (Boo settlors 911.6 to 912.2, J Inclusive, and section $46.6 of the Government code.) birder tome cirwestar,oes, leave to present a late Ghia will be pronted. on section 911.6 of the Goverment Coat.) Tou my seek the advice of an attorney of your choice In connection with this setter. It you desire to oonsult or attor- mey, you should do so immediately. k So MM 1N tut W CLIM ar In IMM OW it ARUCI ZI i since a portion at your claim is ret untimely, ware retaining a acpy of your claim tcc board action an that gertim of your calm whloh Is not untimely. t,khow,pn1 d do DOW of Wtnvinas eN Cawlpi Adsimi,Umw R"Ut Y Mark—�— Dets, August 21, 1986