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Home My WebLink AboutMINUTES - 03131990 - 1.1 (2) a: 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 March 13, 1990 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: $49.59 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: BROWN, Judith ATTORNEY: - Date received ADDRESS: 818 E. 20th ;#B BY DELIVERY TO CLERK ON February 14, 1990 Oakland, CA 94610 BY MAIL POSTMARKED: February 12, 1990 1. FROM: Clerk of the Board of Supervisors T0: County. Counsel Attached is a copy of the above-noted claim. pH DATED:. February 16, 1990 JV Beputt ATCHELOR, Clerk 11. FROM: County Counsel TO: Clerk of the Board of Supervisors � ) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 2-,/ BY: I =A Deputy County Counsel U \P 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 ( 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: NAR 13 1°0 PHII 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 1 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: MAR 1 4 1990 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator w r CLAIM TO: BOARD OF SUPERVISORS OF CONTRA C rNyapplication to: Instructions to ClaimantC!erk of the Board P.O.Box 911 Martinez,Califomia 84553 A. Claims relating to causes of action for death or for injuryto 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 Distript should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims , Penal Code Sec. 72 at end of —this form. RE: Claim b ) Reserved for Cler&L'g_,gJ1ing stamps ECS Again st the COUNTY OF CONTRA .COSTA) FEB 14 1990 i��L ISTRICT) M!t°ATfHELC or F i 1 i n name ) cte�K OFsoaao �sup r:=v soles C CGT�.CO. t The undersigned claimant hereby makes claim again. the County of Contra Costa or the above-named District in the sum of $ A59 and in support of this claim represents as follows: ---------- --- - ----------- _ y- -- --- - ------ i. When did the damage or" �in_ 'ur- occur?------ Giv-e-exact date and hour]---- 7-3 ( 99a t)&S daAl �Z rJ&9, -------- ------- W�iere aid .the-a Fagge or injury occur? {Include city---and county)- -- ------------- 3. How did the damage-.or injury occur? (Give u11 details , use extra sheets if.'required) -----------------r_-_-__-.�-.�-_--T---- .------------- r-- �k-_.. 4. What particular act or omission on the part of count T . y .nor district officers, servantsor employees caused the injury or damage? (over) r t 5. What are the names of county or district officers, Bervants or �employees causing the damage or in j extent____- 6. What damage or injuries do you claim resulted? Give full of injuries of damages claimed. - Attach two estimates for auto damage) -------------------------------------------------- 7. How was the amount claimed above computed? - (Include the estimated amount of any .prospective injury or damage. ) L _ _ _ _ _ 8. Names and addresses of witness s, doctors an hospitals. 3. is the expenditures you made on account of this accident or injury: ITEM AMOUNT I 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 , . _ 1 nature dr s 1 Telephone No. Telephone Nc 4 — t***a��r**,t**�f**rt*��**,t��+,t��*,��t*��r*rt,�**. 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, sward or village board or officer', authorized to allow or pay the same if genuine , any false or fraudulent. clai.m, bill , account, voucher, or writing, is guilty of, a felony. " PROPERTY/CLOTHINGRECEIPT COC. "RA COSTA COUNTY (',41EC. N0. 65309 RACK# DATE: 12-2 i U CMDFt TIME: MC I PROP BOX' W,FC NAME: ' �<.:�. *..1 : L ; WCJC" - :ttN BOOKING NBR: OTHER CASH:, $ o 7. 1, SHIRT/BLOUSE ❑ DRESS ❑ COAT/JACKET) ❑ TIE/SCARF I ❑ SHORTS/PAN'TIES JEWELRY I ❑ SOCKS/NYLONS t ❑ SWEATER/SWT.SHIRTWATCH ❑ BELT �fT7 ❑ 'ANTS/SKIRT ' ❑ SHOES/BOOTS ❑ T-SHIRT/BRA - ❑ WALLET ❑ HAT/PURSE L�j KEYS ❑ KNIFE _ ED GLASSES OTHERi1:_ :l E BKG OFC: I I INMATE SIGNATURE iwin i iI have received all of my per- DATE:_ sonal property and clothing. RELOF-C: X INMATE SIGNATURE P ' 1` �J � ti C7 N +1 t. �g t O 0 Cyt Y� 1 V r0 4 ". �O O y v �� 11 1 ` 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 March 13, 1990 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: $130.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: DOCKIES, Robert L. ATTORNEY: Date received ADDRESS: 597 7th Street BY DELIVERY TO CLERK ON February 15, 1990 (hand delivered) Richmond, CA 94.804 BY MAIL POSTMARKED: 1. FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. February 16 1990 PpHHIL BATCHELOR, Clerk DATED: Y BY: Deputy 11. FROM: County Counsel TO: Clerk of the Board of Supervisors r ) 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: 2/�� /9(� By lax ZQAJ n 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 Superviscrs present (V 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: M�'R �, 1990 PHIL BATCHELOR, Clerk, By Deputy Clerk Af err,, WARNING (Gov. code sec"—on/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: MAR 14 1990 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator �t♦ CLAIP�I TO: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY Instructions to Claimant A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Sec. 911. 2, Govt. Code) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106 , County Administration Building, 651 Pine Street, Martinez , 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 this form. RE: Claim by ) Reserved for Clerk, ' ling stamps SIV Against the COUNTY OF CONTRACOSTA) FEB 1519 51990 PAL WCHU01 or DISTRICT) rk g(jA00 OF 5 +isOQs C co (Fill in name) ) co►�j . e The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ and in support of this claim represents as follows : ------------------------------------------------------------------------ 1. When did the damage or injury occur? (Give exact date and hour) 2. Wh re id the damage or injury occur? (Include city and county) -4(371 -------------------------------------------------- Howth damage or injury occur? (Give full details, use extra sheets if required) -vL --�- --------------------------------- -- --- --- 4 . What-p�afticular act--or--o-mission 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? -�----- -- - ----- ---- - - --- 6. What damage or injuries do you claim resulted? (Give full extent OT injuries or damages claimed. Attach two estimates for auto damage) 7 " Ho was he amount .claimed above computed? I d Ho p ( nclu e the estimated amount f .any prospective .injury. or .damage.) p �� - �--------------------- -------- -------- ------------- :8. Names and addresses of witnesses, doctors and hos .itals..= — --. -- i --------- -------- i --- --- ij --- List .the -expendtures .you.made ..on account of ths accident or nury: :::DATE ITEM AMOUNT } f Govt. "-Code S.e'C" '.'91'0::2 :pr.ov des "The claim si:9 ned b "the claimant Y } SEND NOTICES TO: (Attorney') or by".some• per ,on "on s his :behalf ::Name ::.and 'Address of Attorney laimant:s Signature SS'7 7 'Ad'dress Telephone .N.o. '-Telephone No.. LL/��02 3S &/ �s� *.*•*'*.*'�'!c.*'*'�'�'''k.*'*':�t*:��l`***.i:*'*.*'a'*'*'k.li*"k:**'.*�A'''k:*ic:�l'�1`*:*,*:*�'�"A'*'R.*'*..lf'*i.�,**.'A',*'*.�:�1'**I{ la**'k:�A':�1'*.* NOTICE Section 7-2 .-.of "the .Penal Code .provides: "'_'E"very .person .who, :with ::.intent :-t:o ddfraud., ;;Presents,-:f.or ,-al.lowance 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, bil-1, account, voucher, or .writing, .is guilty .of 'a felony. » , 4 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION a the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT March 13, 1990 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: $350,000.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: LONDONIO, Jeannie County counsel FF L B i ,2 1990 ATTORNEY: Law Offices of �p. Bruce G. Fagel Date received Martinez, GA 465, ADDRESS: 445 So. Beverly Dr. , Suite 200 BY DELIVERY TO CLERK ON February 6, 1990 Beverly Hills, CA 90212 BY MAIL POSTMARKED: February 5, 1990 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. gqDATED: February 8, 1990 IL BATCHELOR, Clerk : Deputy II. 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: 2 l2 J (� B; 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 ORD By unanimous vote of the Superviscrs 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:-AR 13 1,990 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code sect 13) 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: MAR 1 4 1990 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator NOTICE OF INSUFFICIENCY AND/OR k NON-ACCEPTANCE OF CLAIM TO: Law Offices of Bruce G. Fagel 445 So. Beverly Dr. , Suite 200 Beverly Hills, CA 90212 Re: Claim of JEANNIE LONDONIO Please Take Notice As Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code section 910 and 910 . 2, or is otherwise insufficient for the reasons checked below: 1 . The claim fails to state the name and post office address of the claimant. 2. The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. x 3 . The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. 4 . The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or loss, if known. 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000) . If the claim totals less than ten thousand dollars ($10,000) , theiclaim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10,000) , the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. 6 . The claim is not signed by the claimant or by some person on his behalf . 7 . Other: VICTOR J. WESTMAN,, C my Counsel /`D . I�D By: f Deputy Co Counsel CERTIFICATE OF SERVICE BY MAIt C.C.P. §§ 1012, 1013a, 2015 .5; Evid. C. §S 641 , 664) My business address is the County Counsel's office of Contra Costa County, Co. Admin. Bldg. , P.O. Box 69, Martinez, California, 94553, and I am a citizen of the United States, over 18 years of age, employed in Contra Costa County, and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non Acceptance of Claim by placing it in an envelope(s) addressed as shown above (which is/are place(s) having delivery service by U.S. Mail) , which envelope(s) was then sealed and postage fully prepaid thereon, and thereafter was, on this day deposited in the U.S. Mail at Martinez/Concord, Contra Costa County, California. I certify under penalty of perjury that the foregoing is true and correct. Dated: °��\ �D , at Martinez, California. cc: Clerk of the Board of Supervisors ( iginal) : , Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOV.C.§§ 910, 910 . 2, 920.4, 910 .8) I 1 LAW OFFICES OF BRUCE G. FAGEL 445 South Beverly Drive, Suite 200 217 Beverly Hills, California 90212 j 3 (213) 277-1288 4 Attorneys for Claimant F E B 61990 C CLERK BO!'J.D'0F 5l.1r"EP"SU"5 C6 .......... CUS71 CU. .. !. Deur i 6 7 CLAIM FOR DAMAGES AND PERSONAL INJURIES JU S i 8 I i I 9 i 10 JEANNIE LONDONIO, ) CLAIM FOR DAMAGES AND PERSONAL INJURIES 11 Claimant, ) GOVERNMENT CODE §910 12 ) vs. ) 13 14 COUNTY OF CONTRA COSTA and ) MERRITHEW MEMORIAL HOSPITAL; ) 15 DOES 1 to 50, Inclusive. ) 16 ) Respondents. ) l 17 18 ) 19 TO: THE COUNTY OF CONTRA COSTA, a political subdivision of the State of California and I 20 MERRITHEW MEMORIAL `J.OSPITAL, a public entity, owned and operated by the COUNTY OF 21 CONTRA COSTA: 22 You are hereby notified that JEANNIE LONDONIO, whose address is in care of her Attorney, 23 Bruce G. Fagel, 445 South Beverly Drive, Beverly Hills, California, 90212, claims damages from the 24 above-mentioned entities and individuals in the amount, computed as of the date of the presentation 25 of this claim of $350,000. 26 The Claim is based on the wrongful death of her daughter SABRINA ANN LONDONIO born July 27 29, 1989 at said hospital. The child died August 26, 1989 at Oakland Children's Hospital. i 2$ The child died from negligence from the care and treatment rendered by physicians, nurses and 1 f ' i j1 other employees of the above named county and hospital to the child and the child's mother, whose 2 names are unknown at present. Said Claim is also based on the negligence of the hospital in 3 selecting and periodically reviewing the competence of its medical staff and other hospital 4 employees and failure to obtain knowledgeable informed consent. The names of the public employees causing the child's injuries and her death are unknown to 5 Claimants at this time, although according to present information they are nurses, physicians and 6 other medical personnel employed by said hospital. 7 The damages to Claimants consist of the death of her child, including the loss of love, 8 companionship, comfort, affection, society, solace and moral support, as well as the loss of financial 9 support during the Claimant's and her daughter's common life expectancy. Also claimed as 10 damages are the last medical expenses and funeral expenses for the deceased child. 11 General Damages and Pecuniary Damages: 350,000. 12 Medical Expenses: Unknown. 13 Funeral Expenses: Unknown. 14 All Notices or other communications with regard to this claim should be sent to the claimants in 15 care of her attorney. Dated: February 5, 1990 16 LAW OFFICES OF BRUCE FAGEL 17 18 By Bruce G. Fagel, .D., 0 19 20 i 21 22 23 i 24 25 26 .27 28 /wootlwarl/pov910/ /rPaM/D9(/ 2 02/05/90 i 1 PROOF OF SERVICE BY MAIL 2 STATE OF CALIFORNIA, COUNTY OF LOS ANGELES 3 I am a resident of the county aforesaid. I am over the age of eighteen years and not a party to 4 the within action. 5 My business address is 445 South Beverly Drive, Suite 200 Beverly Hills, California 90212. 6 On February 5, 1990, 1 served the within Claim for Damages on the interested parties in said i 7 action, by placing true copies thereof enclosed in sealed envelopes with postage thereon fully paid, i 8 and also by Registered Mail, in the United States mail at Beverly Hills, California, addressed as 9 follows: Clerk of the Board 10 Contra Costa County Board of Supervisor 651 Pine Street 11 Martinez, California 94553 12 13 1 declare under penalty of perjury under the laws of the State of California, that the foregoing is true 14 and correct. I 15 Executed on February 5, 1990, at Beverly Hills, California 16 18 19 20 21 22 23 24 25 26 27 i 28 /wootlwarr)/gov910/ /i'ga/g5/bgf/ 3 02/05/91 I i 2 � ¥i • ¢ \Cato W '® @ ~ � J � �$ & ca I m -ct m 4 'p ® � 0 %A4 o . , r / U U2 � � « I, . �/ / \ \ ® ® co !�� 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 March 13, 1990 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: $222.02 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: NELSON, Gary ATTORNEY: J Date received ADDRESS: c/o 5340 Lawton Avenue BY DELIVERY TO CLERK ON February 9, 1990 (via Clerk's)CD Oakland, CA 94618 BY MAIL POSTMARKED: February 5, 1990 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim, ppHH gg DATED: February 16, 1990 BYIL DeputyLOR, Clerk II. 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: 2 2 G BY: 1 ` " 'l Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel -0) 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 ( k This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy o.f the Board's Order entered in its minutes for this date. Dated: MAR 1 .1 199(1 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code sect' n 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: MAR 14 1990 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator ;A Tn.• BOARD OF SUPERVISORS OF CONTRA COTeAuZRYiWgl application t0. Instructions to Claimant Clerk of the Board P.O.Box 911 A. Claims relating to causes of action for death or forninDurynto4533 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 this form. RE: Claim by ) Reser ng stamps Ag &F-g OeLSONJ RECEIVEI� 00 53gO LOTW K. 0AXL01, ,ek,%j8 � 1990 V+ T C�k,S FEB 9 Against the COUNTY OF CONTRA COSTA) PHIL BATCHELOR or Akkit k DISTRICT) 6 CLERKBOARDOOSTACo50 (Fill in name) ) . The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in . the sum of $ , `�o� _ and in support of this claim represents as follows : ------------------------------------------------------------------------ 1. When did the damage or injury occur? (Give exact date and hour) ------------------------------------------------------------------------ 2. Where did the damage or injury occur? (Include city and county) 'AQ�� ---- ------------ --------------------------------------------- 3. How did the damage or injury occur? (Give full details , use extra sheets if required) -----------=--------------------------------------------------------- 4 --- . What particular act or omission on the , part of county or district officers , servants or employees caused the injury or damage? (over) INCIDENT REPORT CONTRA COSTA COUNTY SHERIFF'S DEPARTMENT s INCIDENT INCIDENT: LOW p/1.Sp( . FACILITY: V�,r- REPORT #: 9O - ��. DATE/TIME 1/3/cj0 DATE/TIME C�3/qo LOCATION: OCCURRED: 1 REPORTED: I INMATE: /14 i �Z BOOKING #: 9 j-)ZOUSING ASSIGNMENT: Last Firsy Middle WITNESS(ES) -- LIST -- Name - Address If an inmate, give booking #: SYNOPSIS: NEt%MQ1,A I AJ& (!!7!0 G4&. NARRATIVE: rcZ.�p�J is CC ,�� kfcr- C'i6-t...t_� /V CTT- _see ACTION TAKEN/RECOMMENDED: 1101 RE RTI G EM OY E # SUPERVISOR # ATI NS DIRECTOR # O.D. ROUTING INSTRUCTIONS: White to Facility Manager - Yellow to Booking File - Goldenrod to Inmate By: Pink to Lineup Board Page one of Rev. 3/85 LJ .l53Q_ .._ CONTRA. 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CHARGF3 — CHG COI)E. SFCTI()il NARK/DKT L3AL1- AR { APRFST RPT TYPE N1ht- - -- -- ----- — N01-'isFk A rl,I�) ( A G Y .411MPFR P.LI_ Cn1 PC /at)n. t SSiR3-1 lll0 1) 20 COUP =- - i),p A F F---------- T.1 `l E= -- -- CIri,%►ITFtjTS rl;r)E SFC TIO 4 ,vARR/DKT f=T ;JF CT DPT SFNTENC•F RELLASF TYPE NA R ---_ ----- ----— -- D.1 U n"_h F l A''" FATE_ D A T E RE I-. CO2 PC !t7n A915n3-5 7 103013Q 2199 PC ti 71; COUpT ()PT 7 DAIF : TI"• E Safi I',OL�S -+F*i.-#kk*****kk**#**********A•k#***1e*** k*#k*****'�'*************#************* ti/E rUIIF 5FCTION WARRANT HAIL DT F_HR U PUTT LST DT TY ' 'R - -- -- ---------- ----- NIJNAbF11_ IjIN1--- 9ThTII5 SEIN!T ()F. RFL kL rirtt HSS 11390 0938F 1000t) .On F T ti- — - --- -------- ---- - --- --------------------------- ---------- ------------------ - HOLD AGF'iC Y : I-AKE CO S/0 APPEAR Iia (HIS CJIIiVTY (8?1pC ) ADVISED: Y t2Fid11F TF1)• N tv-nFlR/1n11 -C_±+.tC CO�toFTFf) riY :_ RELEASE----- ---------- --- --- --- OFFICFR•---- --- - IVTAKF - - - - 851 .5 A')JTSFU: Y COMPLETED: Y OFCLI'lEn : o IN;gATF :________-_N---- PRE1100K oY : =11766 BOOK `1Y : r10805 DHD1i) HY ' FINGFRPRTNTEr) fly : a qq r . fQCONTRA COSTA DETENTION FACILITY • �� '� `CLOTHING RECEIPT ? t DATE Ail TIME {y a FACILITY 7 4 - NAME (L w D.O B 4'�I..� ki: BOOKING NBR t • . • n S�SKIRT _- OAT/JACKET <', ;,I p OE BOOTS PANTIES ��. .� - .IRT/BRA KS YLONS 3 `�`� d1 q3 . HAT/PURSE * , _ r # 3 ATER/SWT SHIRT Y DRESS i. OTHER I #� _ "! � �'�z E `��•�,�s fir. a•. £ .S `s •� Y t 13 BKGOFC � . , ow v ^ 1 p E�h INMATE SIGNATURE �z r W - DATE �. I HAVE RECEIVED L y r • D A EIVE L OF M REL OFC: Q, L CLOTHING 1 . , F' INMATE SIGNATURE "` _ -s - gg -tom "' 1 ,T ' $, A s.� ' 7t. }Ry +w`'S-� �,�. 1 -�• ��'i ir��""r.!'+ - � _ - t �'�T r �^i1;'��5a�� 'id �t`3��-. `'s�v- :i s:"'"•+-T- e / .,��. ea w� j i 1 t I i - � -3°S 1 �' 1 �' �-^.gyp _ u a C:� w c.� W INd 1• X1.1 == ,.. yG.. 1ST fl �K� 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 March 13, 1990 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: Undetermined Section 913 and 915.4. Please note all "Warnings" COUJAY CLAIMANT: O'CONNOR, Betty ATTORNEY: R. Kenneth Bauer Belzer, Jackl, Katzen, Hulchliy, Date received Martinez A7O,;` ,P, ADDRESS: Muray & Balamuth BY DELIVERY TO CLERK ON February 9, 1990 2033 No. Main St. , Suite 700 Walnut Creek, CA 94596 BY MAIL POSTMARKED: February 8, 1990 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. Februar 9 1990 QQHHIL BATCHELOR, Clerk DATED: Y 8Y: Deputy 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: AA, Dated: BY: ) _ /J&� � A 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 Superviscrs present (k1rThis Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy o.f the Board's Order entered in its minutes for this date. Dated: MAR 13 1990 PHIL BATCHELOR, Clerk, By ,L,� _ 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: MAR 14 1990 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY " INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months 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. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 1069 County Administration Building, 651 Pine Street, Martinez, CA 94553• C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must ue filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By ) Reserved for Clerk's filing stamp Betty O'Connor � RECEIVED�i 1 Against the County of Contra Costa ) F E B 9 1990 or 1) / PHIL BATCHELOR District) CLERCO ARD FSUPCOSORS Fill in name ) 8 ............ A TADe The undersigned claimant hereby makes claim against the Co of Contra Costa or the above-named District in the sum of $ 50, 000. 00 plus and in support of this claim represents as follows:. ------------------------------------------------------------------------------------- 1. When did the damage or injury occur? (Give exact date and hour) On and after September 12 , 1989 -------------------; Where did the damage or injury occur? (Include city and county) Occurred at Merrithew Memorial Hospital ------------------------------------------------------------------------------------ 3. How did the damage or injury occur? (Give full details; use extra paper if required) .-Claimant received negligent medical treatment for broken wrists, in that the right wrist was not reset as needed, and the splints were improperly removed from both wrists and replaced by improper casts. ------------------------------------------------------------------------------------ 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? Claimant' s right wrist was not reset as needed. Claimant' s splints were improperly removed and replaced by improper casts. (over) 5. What are the names of county or district officers, servants or employees causing the damage or injury? Dr. Beck and Dr. Gross -------------------7-7-------------------------------------------------------------- 6. What damage or injuries .do you .claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Malformed right and left wrists; partial loss of use of digits on both hands; resulting surgery and bone graft; pain. --------------------------------------------------------------------------------------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) . Adding medical expenses incurred, estimated future medical expenses, estimated lost wages and compensation for pain and suffering. ------------------------------------------------------------------------------------- R. Names and addresses of.witnesses, doctors and hospitals. Dr. Beck, Dr. Gross and Dr. Nottingham, Merrithew Memorial Hospital, and Dr. George Sutherland, 2230 Gladstone Drive, Pittsburg, California. --------------------- -------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Medical- --expenses - and ,.lost wages incurred as a result of the complained of act`s.�drid'-Fomiss iones`have not yet been calculated. Gov. Code Sec. 910.2 provides: a "The claim must be signed by the claimant �,:, , a . SEND NOTICES T0: "{Attor. .�.ney.; )'� or by some person ori bis b alf." Name and Address`of`"Attorney R. Kenneth Bauer Claimant s ignature Belzer, Jackl, Katzen, Hulchiy Murray & Balamuth 2033 No. Plain St. , Ste. 700 Address Walnut Creek, CA 94596 Telephone No. (415) 932-8500 I Telephone No. * �t N 0 T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. #########YXM I LL. Q N Ru 1 O O OQ N a o ult - > � prd 134•H cn w O -O M -_ b 4-) u1 p (0 Lf) fa P Od-) 4-) rn W to N •rl O N z p FC 4 •rt d-) U +-) F! U. rd 4-I O N O N >1-H C: 9 4J P4 � ] r� O ►n td U U a Its a a as 0 W - R W W � V N Q N Q x W O[ U � O a >o O W H r� X Z Y T Odu "COuu W W z Nil : ~ 3 ul Lr- W imp . Vu a m a w N a w LAW OFFICES OF BELZER, JACKL, KATZEN, HULCHIY, MURRAY & BALAMUTH THE PERI EXECUTIVE CENTRE 2033 N.MAIN STREET,SUITE 700 V.JAMES JACKL WALNUT CREEK,CALIFORNIA 94596 TELEPHONE(415)932.8500 ROBERT A.BELZER LINDA R.KATZEN TELEFAX:(415)932.1961 NICHOLAS P.HULCHIY WILLIAM J.MURRAY WM.BARRY BALAMUTH CHRISTOPHER J.JOY March 1, 1990 GLENN H.WECHSLER ESTHER HERRERA R.KENNETH BAUER � � � BRENT K.NOMORA MURA 4 GREGORY A.MILLER MAR 21990 PHIL ?ATCHELCR CLFRK.COARD OF SUPERVISOR; Clerk of the Board of Supervisors c -ACO De ur , Room 106 , County Administration Bldg . 651 Pine Street Martinez , CA 94553 Re : Betty O 'Connor Dear Clerk : Enclosed please find a copy of the claim of Betty O'Connor which was previously forwarded to you by this office via first class mail. The enclosed is a duplicate ,of that claim and is being sent to you by certified mail. Thank you. Very truly yours, BELZER, JACKL, KATZEN, HULCHIY , MURRAY &� �BALAMUTH Catherine Irvine, Secretary Enclosure 0 i 5. What are the names of county or district officers, servants or employees causing the damage or injury? Dr. Beck and Dr. Gross -------------------------------------------------- What damage or injuries .do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Malformed right and left wrists; partial loss of use of digits on both hands; resulting surgery and bone graft; pain. _M.__________________________________________________________________________________ 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injuryor damage.) . Adding medicaexpenses incurred, estimated future medical expenses, estimated lost wages and compensation for pain and suffering. ------------------------------------------------------------------------------------ 8. Names and addresses of witnesses, doctors and hospitals. Dr. Beck, Dr. Gross and Dr. Nottingham, Merrithew Memorial Hospital, and Dr. George Sutherland, 2230 Gladstone Drive, Pittsburg, California. _—_____________________________________________________________________________.a___ 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Medical expenses and lost wades incurred as a result of the complained of acts and omissions have not yet been calculated. Gov. Code Sec. 910.2 provides.- "The rovides:"The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some person on bis alf." Name and Address of Attorney R. Kenneth Bauer Claimants ignature Belzer, Jackl, Katzen, Hulchiy Murray & Balamuth 2033 No. Main St. , Ste. 700 Address Walnut Creek, CA 94596 Telephone No. (415) 932-8500 E Telephone No. NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either ,by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by.a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. tS5�p5'tP � � P t O ik a.bra cn (CD N p C p ��{ ,-A 43 �a 01- � c r a a0J': C-1 U .,�, �2 � �daY2 O � g � u i„['1 � wpmaJ 04 r r 1 /. /p 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 ;March 13, 1990 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: $4,687.52 Section 913 and 915.4. Please note all °Warnings". CLAIMANT: SAECHAO, Yoon Choy and Manh Fuey ATTORNEY: California State Automobile Assoc. Date received P.O. Box 7 ADDRESS: San Pablo, CA 94806 BY DELIVERY TO CLERK ON February 15, 1990 (via Risk Mgmt.) BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. QQHH gg DATED: February 16, 1990 JV DepuLyLOR, Clerk II. 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: I'' Deputy County Counsel -r III. FROM: Clerk of the Board TO: County Counsel (1) County Admini rator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present Wf*�This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: MAR 13 1990 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: MAR 1 4 1994 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator JULIE AU1r:?'K ,Claim For Damages �EB 15 1990 In accordance with Section 910 of the California Government Code,this is to formally place you on notice of our subrogated claim for the loss described below. oUity Dat : 19� ' 151990 �� California Claim is hereby made and filed against the ----I - i�l /) ,/ /Y /I follows: Insured/Claimant's: Ugaz a �, ARO-74 AK California State A omobil A sociati n nter-Insurance Bureau Address of Claimant: G4 / �� (Send notices to this address) L. � (`J"�'�/ Reference File Date of Occurrence: Place of Occurrence: U Nature and Items Making up said Amount: Name of Public Employee(s) r causing said Damage(if known): Metails: t 1E 1) FEB 1T 1990 CAr State Automobil As cia n Ina' c Bur u PHU SATCMEIOil CLERK AREO OFOSUPERVISORS s B •.ev.11-87) <��,. assignment of claim and "�� subrogation agreement In nside atio o the pa ent the undersigned of esum of ❑ a sum estimated to b �•I� i Dollars, being the full amount of losand damage insured against under an automobile insurance policy, number l 373 l issued to the undersigned by the CALIFORNIA STATE AUTOMOBILE ASSOCIATION -36INTE -INSURANCE BUREAU, loss and damage having occurred on or about the ay of ' 19 , the said undersigned hereby assigns and transfers to said Bureau Csaid clai (n the above amount ,plus additional claim for damage resultiinggfrototal m said accident, not covered under said policy of i surance, in the ount of$ , constituting`b El a total estimated claim /-/ in the amount of 6—_, Said Bureau is hereby subrogated in place and stead to the extent of the a v amount of the said total claim and is hereby authorized and empowered to sue, compromise or settle in name or other- wise to the extent of said total claim for loss and damage, and to endorse in my name any check made payable to me therefor, and collect and receive any money payable thereby. The undersigned covenants that ha��not released or discharged any such claim or demand a ( st a such party or parties and that ill furnish to said Bureau any and all papers and information in possession, necessary for the proper prosecution of such claim. Dated a this day of 19 WITNESS F1433 (.REV.7-77) � f California State Automobile Association Inter-Insurance Bureau 02234176 s DATE OF LOSS CLAIM INSURED'S NAME - t••73 JUATE t e 7 -IJ ..!I""!P CHAIO Y! 11,} . �:r��.l'{ - i!..}'--1.CT--r✓�' POLICY—TYPE• IND OF LOSS -SUFFIX _ JCLAIMANTS N..ME PAY rn-i l7 1 aN w' % 40 o D.O. ADJUSTER NO, IN PAYMENT OF to I .►. - Through O D Security Pacific National Bank 11-4 r'`r(� - ^ 4 �. T f i(� r -•C'-• "" �' �}c .t _ Sen Francisco Main Office$0512. 1210 2 3 t One Francisco eroMai Center !i PAY - San Francisco.CA 94111 - _v) M } 1 rn - .. Sn to M mm r` to n TO - i - �- � C r r I �_,'1- AUTHORIZED SIGNATURE THE ORDER �'t�,l.!..F• ._1�:., �::r.. �.;,xFC .,r; - . ., . NOT NEGQTI-ABLE OF D.O. COPY California State Automobile Association Inter-Insurance Bureau 02243-8992 O/O 02,2 DATE OF LOSS CLAIM �t^ INSURElD''StN1AME \- { �[ �UATE^ t� r� _1 ci�� 1C "_. 1 I tit i I,.}:t -�L ..!T',,r ..l�1 NI C, 7.11orrl? L,r'.'J0 ii 1JC? 0 --..i'._. i. In POLICY—TYPE KING OF LOSS SUFFIX CLAIMANT'$NAME PAY Z'i OS I I l � Ar.. r'F�rCi, YC�C�LJ, C11�_1'r` st4, �Ct`. 1.�r Mo D.O. ADJUSTER N0. IN PAYMENT OF: Through 11-4 O.T security Pacific Neff onot Bank r•• San Francisco Mein Othce$0512 1210 ; s �' 161. 14 ACTUAL C 11,_.,r� 'Y I.„_.U? One Embercadoro Censer C San Francisco.CA 94111 m PAY . - .1 I r..rt.i..:' -F :: S';1 X FIU1'vr.fREI) r:v11!E tom,!1.::;1. KM c. l 1,;, s I- iT M 9 Mo In I rn r q f E TO f��.�L" I Ifil'+II"7 1 ��,ITT` r�P i:::=�•I'•i F't 1-' AUTHORIZED SIGNATURE - ORDER 6 yy DIE) ._ � #:. q �l�t!'$`�.i�BGbTi�A-BLE . OF R1LH1%_1IJjUl CA Cj' `'a-01 D.O. COPY r k F FIAT, 00 )i•at.v.#+:�•h a+J+.#i#+:h"N k***#i*w!Y yi #i it*,f###i#t.•t##E#i##+�#i#E�#r�E��##i•Vii-#(•Vii'##i•tot M y*1 N#i'*1*1�,•#•N•1ti#{tt#t .;. �{ t:`Cli='f�h7•: :i �t:�t:Jl' r•ai�iCE SAL�l�IBY POOLS . LOT* A 902 69 � �K -282 5TH STREET li'SURANCE -SI.L LIN :.VAL_L_E,.1Ci, CA 94590 TN!'OIC:C= ROW. . L..Z *, f0i...644-•:•4468 :.i!C,' '09/,gT' DATE RECEIVED. -. iD i)6/89: � .........._.__'_..............._.._...._.. ._..._-.-._..___.___..__ti_.__.__ __._____—_. ____...__._ C::i:l M f'A i'd'r'. .":, . . SPA—CA. STATE Fit_►TO ASSOC .C A L..L_E::I?, x ADJUSTER. . . . ,JAMIE:: HOL:.I...AND I'N URE::D. . RACCHAf_!, YOCiN 40/04/89 #i PHONE. . . . . . . 40-233-8800 OWNER„ . . . .SAME �. I:{O O CITY. . . > .:A id P(1 I:•I_C: to{._A 3:i`S,r. . . ,:6 I'7 1 r,.. BOO F`HONE . 41.5...'2 ,;,...SL BOO SEQ/UNI t:. 0/101S g VL:::L'fICCE::. . .05 BLUE.: DODGE is /VISTA L..IC . . C;A—IMVJ007 >+: I:)OMAGE:: . .. R/SDE: VINO. .. . .JI.3LrG49I?QF Z80 7 6"i +: Ff'':[:lM. . I:;A'Y' AREA FRAME TO. . C i if'ART SERVICE 'r:ARD VF1L.I..E JO 22% MARKET AUE. 282 5TH STREET 44-4468 #�#+:#i#i•#r:)}:#k#+:,#i•h:#+:h:•h:-h:#f§+:•�:#t•#+:#i••>i•#+:•#+:#+:#i•#Fi#i#t)+:•N:#i-#+:•)4 i{-k#i.,`z'.:�•#+:#(1+:#t•#i•#+:#+:#•i+#F 7t••h:#+:�n:t•}.�.:#+i)i..h:-U:3+:)+:#+:�a:•7+:-#+:at i+:#i-•ii•�P:•h:#�:'�:#i#(•i+:#+:•)[•N:#t.�..yi. ITEM )}. CHARGES AND RECEIPTS -r: : :L 1.,)/ ->`r/09 i Etr::,p-1<;;`('ORT, t:;l-IARGE O E'Ci(:iL Q ;20 #+: 2 10/09/09 I-'...O f.. I N G SERVICE HARGC_ 41. .. () #c TOTAL AM06NT DUE— $82.40 +: MAKE CHECKS PAYABLE T C't C C i I'i"t F:i' INSURANCE SALVAGE POOLE #+:•ri:#+:#i..j;.#k)+:#��#+;#i#G�ii#+:•A:•#,;�ii�#+i#+:#+:)+r i�:#+;#+:#t.p:.)+:#+:#;.•k#i 3+:•?+i#+:•N:•h:#i•9i�+:•#+}#i-#:#i•u#+:•li#+;#t##+:#i•�N:#;#i#+:#i-#(u:•k•u:•�:#k#r..a:Ni#i•tt•#i•#+:)f.•#i#i•�:.#f-)i•#i•#i-#i�#i-�: • s 4 ..9!A, �r¢5t l - � ,,...-�bv�•,.t�r a.n�� .. .n. �_ti-o �.. . .. .. ". � ....»., i.., ..� f. -. v ..._ ; ,tee_•v �. .4�. . r . 1% <*>—P roof of loss ctaimNo.06-T73733-3 . receipt and release Policy No. Data Policy Exp;rea T73733-3 9-24-90 According to the terms and conditions of the Policy of Insurance identified above, the California State Automobile Association Inter-Insurance Bureau (Bureau) insured SAECHAO,YOON,CHOY against loss to the automobile, described in said Policy as follows: MakeYear Body Type Engine Number ' DODGE ` 1985 , 4D WAG ` JB3BG49DOFZ803768 A loss cauped by COLLISION occurred on they 30TH day of AUGUST ' 1989 about the hour 1:30 P. m. the particulars of which are as follows:ON THE DATE AND TIME INDICATED MY VEHICLE WAS DAMAGED UNDER THE CIRCUMSTANCES CONTAINED IN MY LOSS REPORT. CLAIM IS HEREBY MADE FOR THE ACTUAL CASH VALUE OF THE VEHICLE AS INDICATED BELOW. The vehicle will be retained by: bureau ❑ Insured The loss described was not caused intentionally or otherwise by the design, procurement,or fraud of the Insured, nor by any agent or aro., other person acting for or on behalf of the insured. There is no other insurance in force as to this loss. There is no lien, conditional sale contract, bailment lease, or other interest in the described automobile except: Loss/Damage Less Amount of Deductible Other Deductions Amount Claimed Due by the Insured $ 4,605.12 I$ �$ I$ 4,605.12 In consideration of the payment of FOUR THOUSAND SIX HUNDRED FIVE & 12/00 ($ 4,605.12 ) the Insured hereby assigns,transfers and sets over to the Bureau any and all claims or causes of action of whatsoever kind and nature which the Insured now has,or may hereafter have,against any person or persons as the result of the occurrence and loss as described above,to the extent of the payment above made;the Insured agrees that the Bureau may enforce the same in such manner as shall be necessary or appropriate for the use and benefit of the Bureau,either in its own name or in the name of the Insured;that the Insured will furnish such papers, information,or evidence as shall be within the Insured's possession or control for the purpose of enforcing such claim, demand, or cause of action; and The Insured understands and agrees that the furnishing of this form or the preparation thereof by any adjuster or agent of the Bureau is not a waiver of any rights of the said Bureau. 12/00 The insured acknowledges receipt of the sum of FOUR THOUSAND SIX HUNDRED FIVE & ($ 4,605.12 ) and hereby releases and discharges the Bureau from any and all liability whatsoever for any claim under Policy No. T73733-3 for the loss or damage described above and further acknowledges receipt of said amount in full satis- faction for all such claims or demands. The Insured acknowledges receipt of the sum,of FOUR THOUSAND SIX HUNDRED FIVE & 12/00 $ 4,605.12 Paid under his direction as follows: To SAECHAO MANH FEUY the sum of $ 4,605.12 To the sum of $ To the sum of $ *IMPORTANT—READ OTHER SIDE BEFORE SIGNING• } - INSURED DATEL'I ' �� t9�LI J INSURED WITNESS: .Rapti IRer.5-BB) ^ - 1, UnGi1 "+.r;♦ CALIFORNIA STATE AUTOMOBILE ASSOCIATION S I� / J POLICY N0. ?!E9ISTRATION r.A. NAME OF R�FfstSTERED OWNER r- ` `° PATE OF,LOSS NAME AND ADDRESS OF LEGAL OWNER LIfENSE If jATE EXP.)DATE _..VEHICLE I}}J►. r, � j �x t,. \`VEHICLE DESCRIPTION VEHICLE CONDITION ItKE TYE7R - MiL E VALID RATING E EXCELLENT/VERY GOOD/GOOD/FAIR/POOR M DEL .� t BOOY STYLE, BOF1Y' PAINT' INT�RIOR' MEGJHANICAL' 4 EDITION . DOORS TIRES RF 2/ %WORN LF /32 %WORN COLOR RR %WORN LR /32 %WORN INTERIOR: +±a`.4-_C - EXTERIOR: SPARE /32 %WORN ❑SPACE SAVER TYPE SPECIAL PAINT PRIOR.DAMAGE:'t ._ .,, ,r, D METALIC D TWO-TONE ❑OTHER(DESCRIBE) ENGINE CYLINDERS E f r jj d-GAS D DIESEL CJ ROTARY 2 3 4` SIZ 5 6 B 12 RANSMISSION -` ) I AMOUNT AUTO ❑5-SP ❑4-SP [13-SP ❑OTHER - - `� $ F s OAUIPMENT KELLY FLUE BOOK ~~ POWER EQUIPMENT SEATS RADIO WHEELS ROOF OPTIONS ITEM ADD OR DEDUCT WHOLESALE RETAIL 13 Air Gand 0 Power ❑AM ❑Mags ❑Vinyl 7777 A Pwr Brakes 'U Bucket ZD AMIFM D Alum ❑Sun Man Pwr Steering ❑Bench AM/FM Stereo ❑Spoke D Sun Else D Pwr Windows D Split b AM/FM Tape ❑Wire ❑T Top 0 Pwr Locks O Leather ❑Tape Only 0 Wire Cap ❑Other(describe) C1Cruise Cntrl ❑Vinyl ❑Factory CB ❑Sport I.QTHER ❑Till Wheel ❑Cloth ❑CB ❑Rallye RW Oe(og O Remote Mirror Velour ❑Dix Sound Other(describe)` L.i Digital Inst ❑Pwr Antennas ❑Other(describe) O Digital AM/FM ❑Keyless Entry ❑Other(describe) ❑Tinted Glass SPECIAL EGUIPMENTICOMMENTS + MILEAGE:ADD Op DEDUCT TOTAL /"r}'.V @ w,.K�....,i.. VEHICLE CURREAT Sf*TUS i f't"tet a AUTO LOCATED 4 / DAILYRATE CHARGES T TE APPRpX"VFiL�IE OF VEHICLE IS BUREAU TO WQ YES HAS VEHICLE BEEN ORD YES L N0. DATEARDERED KEYS YES PINK 8 REG. OU YES RETAIN VEHICLE? U NO EKED TO STORAGE YARD? 0 NO /.O J y ATTACHED? D NO ATTACHED? ❑NO INSURED'$ LIST PROPERTY IN VEHICLE IF DATE INSURED WAS ADVISED ITEMS ARE MISSINGISTRIPPED FROM PROPERTY ANY,ON INSPECTION REPORT TO REMOVE PROPERTY: VEHICLE(LIST ON INSPECTION SHEET) SIDS FROM 1}f :; I ` / cf.: „) 2) �i�Z i• t �NY� i r 3} L AMOUNT: $ (.; r .Si• �� r t� C� v E :.DEALER QUOTES (USUALLY 3-IF NONE ON HAND,WHAT PRICE WOULD VEHICLE BRING?) ❑RECONDITIONED ❑AS IS(PRICE BELOW) NAME OF DEALER SALESMAN ON HAND ASKING PRICE SELLING PRICE REMARKS-IF ON HAND,MILEAGE 3) SETTLEMENT VEHICLE E �. .G05F--_--"---._..._.� LOAN NO.---„-,..--______ ET PAYOFF__,-GOOD UNTIL--'000TED BY-- 0 NEW 0 USED j DA1 MW/ 7; ENDERED S7I:EM * D a 15�- 4:7.L-1 ACCEPTED ACTUAL CASH VALUE SETTLEMENT / r� /r.- 4` LESS DATE REVI E Y,SYP OR TE rf K ADJUSTMENTS a '/ NET-ACY = l NET f��' f) / f APPROVED BY DGM. SETTLEMENT S /4 �'�'/ a` USE TAX-ACV = 9t i` .s/” APPROVED BY DCM OR SUPERVISOR DATE COMPROMISED SETTLEMENT ' (INCL TAX LICENSE) t DMV LICENSE _ r' � / REPRE$ENTAT)VE ,t', j, D. _ DATE, TOTAL S F1439(Rev.t-BBI %' Fr.Y,,"rN POCECSIN- SALVAGE STATE Of CALMOftaA- 3 TRAFFIC,COLLISION REPORT PAGE of t SPECIAL CONDITIONS NUMSER WT RUN Or" iUONXAL STRKT LOCALREPORTMRRi£R j 4 NJUAILD FELONY _ i / + NUMBER NRA RUN CoLoot. REPOIRINO Do.POC, SEAT ��- KILLED "SO. C-O'Aj-ron os LUIRfOFL,OCCURREO ON i w l f� ..e 1`-S;:�'• MO. I DAY + Y A Twa CNON) NGC S OFFICER L D. o W_ L-11 .L-�fJ --- �'-'�=--------_--.%"_lii "POST NFOTIMATIONl — it� DAY Of MEEK TOW AWAY TOORA►NS by: . t- a NINO U PEETIwt." of SMT F S ❑YEt QAT OITERSECTIdt W}TH STATE NW REL. DOR: PEETI WLEs of C ❑YEt t NONE PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY VEN,YEAR IMODEL I COLOR ENSENUYSER STATE i77, . . . . . . . . . . . DRIVER NAME(FIRST,WDOLE,LAST) t j? ❑ .r- of IV /�Y f.0—lr . .. PEDES- STREET ADDRESS oYFNER3 NAYS ❑BAWE At ORNAR TRIAN PAAKEO CITY I STATE ZIP OWNER'S ADORE" ❑SAY[At DRNER VEHICLE {ICY. SEX I twR EYES "EJOHTWEIO BIRTHDAYS, RAC[ DISPOSMONOFVEMCLEONOROERSOf: ❑OFFICER [)DRIVER ❑OTHER YEAR 'co I EP `s ), Dfc = 0 W OTNEA HOME PHONE - BUSINESS PHONE (� 1 �Jt ,r^�� NOR YECNANKAL pLKCTi: �NONE APPARENT❑ REFEA TO NARRATIVE❑ ❑ \ 31 5-531w, {L��If) ��"�j, G+1 �+ CHP USE ONLY DESCISS£VEHICLE DAYAOE &MADE IN OAYAGEO AREA - I VEHICLE TYPE INSU ECARRIER POLICY NUMBER ❑LNK. ❑NONE ❑WHOR . 1 = MOO. MAJOR DTAL gR.Of ONSTRESTORMGHWAY SPEED PCF ICC[ AVEL uWT go w�,. ►LIC❑ ' G! "✓ CNP❑ PARTY DRIVER'S UC ENS&NUMBER ^y STATE CLAD SAFETY VEK YEAR MAK£1 YODEL I COLOR tNSENUMBER STATE '� � !�� Sour. � �` . L ` . .� -f �'r.,�?}'j . . (A v?"30 . DRIVER NAME(FIRST,WOOLS,LAST) Ing MAO 1� P DES- TR ADDRESS OWNER7 NAYS �SAAfE AS DRIVER 7'NAN 1\ � %� rte" ❑ S1 _ 1 �17 TZ Lr PARKED CIT%;, TE I ZIP i OWN£RTi ADOAtSS E AS ONVAR VEHICLE INCY. X "AIR EYES "EAGHT WEIGHT YOCUST =RI DADYEA ATTI R RACE DISPoStnONOFY[FBCLEONOROERSOF: - ❑OFFICER DRIVER ❑OTHER SE OTHER HOME PHONE BUSINESS P`HON[ PRIOR MECHANICAL DEFECTS: NONE APP ARENTa. - REPEA TO NARRATIVE❑ ❑ ( CHP USE ONLY DESCRIBE VEHICLE OAMAOE SHADE W DAMAGED AREA INSURANCE CARRIER - POLICY NUMBER VINCIIITYPt ❑ Tp{' _ INK, ❑NON[ =/'�(WNOA _ ❑MOp. MAJOR 13'`TOTAL WR. ONSTREET OR iWttWAY SPEED PCF R:C❑ UYR CIHJCPO •LE PARTY DRI ER'S LICENSE NUMBER STATE CLASS SAFETY VEK YEAR NODE I cJZLR a ENS& UMBER STATE EoVIP. LVJ�� DRIVER NAME(RAST,WOOLS,LAST) 5� ` 1:1 V)I. ov PEDES- STREETADDRESS - R'S NAME SAY ASDRIVER Ta S� PARKED CITY I STATE IZIP OWN ADDRESS SAYE • A VENICLE - (f"/ ❑ ciaTC A / BICY- SEX I NAIR EYES "&IGHT WEEGHT MO SI p�+ATEI YEAR f " SP oNOFV LE oR6£RSOf; ❑OFFICER ❑DRIVER. ❑ THEA OUST I 1 _ r Om£a HOME PHONE iuBl"ESS PHONE PRIOR YE NIAl $DEfEtTt. E AP►AR R£FERTO NAARATIVE❑ ❑ ( ( } Ic 1YV. CH USE ONLY EHICLE OAMAOE SHADE N DAMAGED AAEA Y[ CLE TMP[ INSURANCE CARRIER POLICY NUMBER ❑UFBL C3NDNE ❑MINOR _ .❑MOO. ❑MAJOR ❑TOTAL pIR Of ON STREET OR MOHWAY optLIMIT ICC TRAVEL I ED PUC❑ CNP❑ PAEPAAER'S HAMS DISPATCH NOTIFIED REVIEWER'S NAME GATE REYiEwEp ❑YE$ Cl NQ cr IIA �GT. W. GIBISIG 31198 CHP bis PAGE -8111)(Row 1JI$j OP!DA2 se .ncnt .. STAT[O F CAUFORNIA - - 1"IRAFFIC COLLISION CODING FADE 7� DATE OF CO SIGN - -� �- TIME(]A00) NGC NUMBER_ OFFICER 1.D -7 NUMBER MO.' DA�7C YEAR'S .A LJ ��=G7 \ L-�• ' "� OWNER'S NAME ADDRESS / NOTIFIED PROPER7V [DYES F]NO DAMAGE DESCRIFnON OF DAMAGE SEATING POSITION SAFETY EQUIPMENT EJECTED FROM VEHICLE OCCUPANTS L-AIRBAG DEPLOYED Y/C RICYCLF-HEI MET A-NONE IN VEHICLE M-AIR BAG NOT DEPLOYED 0-NOT EJECTED B-UNKNOWN N-OTHER DRIVER 1-PARTILLY EJECTED C-LAP BELT USED P•NOT REQUIRED V-NO 2-PARTIALLY EJECTED L451-DRIVER D-LAP BELT NOT USED W-YES 3-UNKNOWN E-SHOULDER HARNESS USED 2T09-PASSENGERS ppggE�� 7-STATION WAGON REAR F-SHOULDER HARNESS NOT USED CHILD RESTRAINT G-LAP/SHOULDER HARNESS USED O-IN VEHICLE USED X-NO 9•REAR OCC.TRK.OR VAN Y-YES 9-POSITION UNKNOWN H-LAP/SHOULDER HARNESS NOT USED R•IN'VEHICLENOTUSED0•OTHER J-PASSIVE RESTRAINT USED S-IN VEHICLE USE UNKNOWN K-PASSIVE RESTRAINT NOT USED T-IN VEHICLE IMPROPER USE U-NONE IN VEHICLE ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK(•)SHOULD BE EXPLAINED IN THE NARRATIVE PRIMARY COLLISION FACTOR TRAFFIC CONTROL DEVICES 2 3 TYPE OF VEHICLE I 2 3 MOVEMENT PRECEDING LIST NUMBER (N) OF PARTY AT FAULT COLLISION r AVC SECTION VIOLATED: ciao CONTROLS FUNCTIONING APASSENGER CAR/STATION WACON RYES ASTOPPED NO B CONTROLS NOT FUNCTIONING 0 BOTHER IMPROPER DRIVING•: CONTROLS OBSCURED B PASSENGER CAR W/TRAILER ;( B PROCEEDING STRAIGHT C MOTORCYCLE/SCOOTER C RAN OFF ROAD D NO CONTROLS PRESENT/FACTOR• D PICKUP OR PANEL TRUCK D MAKING RIGHT TURN C OTHER THAN DRIVER' TYPE OF COLLISION E PICKUP/PANEL TRUCK W/TRAILER E MAKING LEFT TURN D UNKNOWN• A_HF AD-ON F TRUCK OR TRUCK TRACTOR F MAKING U TURN B.IE FELL ASLEEP B SIDESWIPE I IGTRUCK/TRUCK TRACTOR W1 TRLR, G BACKING C REAR END I IHSCHOOL BUS 9SLOWING/STOPPING WEATHER( MARK t TO 21TEMS) 0 BROADSIDE I OTHER BUS I PASSING OTHER VEHICLE ACLEAR E HIT OBJECT J EMERGENCY VEHICLE J CHANGING LANES B CLOUDY F OVERTURNED KHIGHWAY CONST.EQUIPMENT K PARKING MANEUVER C RAINING G VEHICLE I PEDESTRIAN L BICYCLE L ENTERING TRAFFIC D SNO\WING IH OTHER': MOTHER VEHICLE MOTHER UNSAFE TURNING E FOG/VISIBILITY FT. MOTOR VEHICLE INVOLVED WITH N PEDESTRIAN N XING INTO OPPOSING LANE F OTHER': ANON-COLLISION MOPED PARKED IGWIND B PEDESTRIAN P MERGING LIGHTING OTHER MOTOR VEHICLE TRAVELING V/RONG'NAY I/ A DAYLIGHT D MOTOR VEHICLE ON OTHER ROADWAY OTHER ASSOCIATED FACTOR(S) R OTHER*: B DUSK-DAWN E PARKED MOTOR VEHICLE 2 3 (MARK 1 TO 21TEMS) IC DARK-STREET LIGHTS F TRAIN Avc SECTION VIOLATION: CITED IDDARK-NO STREET LIGHTS BICYCLE Oy EDARK-STREETUGHTSNOT RHINAL: BvcBI_-vaL."ON: CITED FUNCTIONING• H ❑YEs ROACWAY SURFACE FIXED OBJECT: ❑No SOBRIETY•DRUG IA DAY I Cvcs[cnoNvaunoN: CITED 2 3 PHYSICAL ❑YEy (MARK 1 TO 21TEMS) B WET OTHER OBJECT: ❑� HAD N07 BEEN DRINKING C srlowv-ICY D D SLIPPERY(MUDDY,OILY,ETC.) EVISION OBSCUREMENT: B HBD-UNDER INFLUENCE F INATTENTK)N•: HBD-NOT UNDER INFLUENCE' ROADWAY CONDITION(S) D HBO•IMPAIRMENT UNKNOWN PEDESTRIAN'S INVOLVED G STOP 6 GO TRAFFIC (MARK 1 TO 2 ITEMS) H ENTERING/LEAVING RAMP E UNDER DRUG INFLUENCE' NO PEDESTRIAN INVOLVED PREVIOUS COLLISION F IMPAIRMENT-PHYSICAL A HOLES,DEEP RUT CROSSING IN CROSSWALK i IMPAIRMENT NOT KNOWN B LOOSE MATERIAL ON ROADWAY• B AT INTERSECTION UNFAMILIAR WITH ROAD H NOT APPLICABLE C OBSTRUCTION ON ROADWAY• CROSSING IN CROSSWALK-NOT K DEFECTIVE VER EQUIP.: �D ❑YEs I I SLEEPY/FATIGUED ID CONSTRUCTION-REPAIR ZONE AT INTERSECTION ❑IIIc SPECIAL INFORMATIC14 IE REDUCED ROADWAY WIDTH D CROSSING-NOT IN CROSSWALK L UNINVOLVED VEHICLE AHAZARDOUS MATERIAL F FLOODED• IN ROAD-INCLUDES SHOULDER M OTHER-: G OTHER•: I IF NOT INROAD NNONE APPARENT FT H NO UNUSUAL CONDITIONS APPROACHING!LEAVING SCHOOL BUS O RUNAWAY VEHICLE KETCH ( i r MISCELLANEOUS I __•% t`�. INDICATE NORTH �.,, CHP 555 PAGE 2; Rav I-&a)OPI 042 - STATE OF CALIFORNA INJUREC,MITNESSES / PASSENGERS ' >~ '" ('„ PAGE < DATE OF l ON y� TIME(2400( 71C�/,/-I IILJ U ul h OFRCER 1.0 (O� NUMBE � 1 L C' EXTENT OF INJURY ("X" ONE ) INJURED WAS("X"ONE) r WITNESS PASSENGER PARTY SEAT SAFETY ONLY ONLY AGE SEX FATAL SEVERE OTHER VISIBLE COMPLAINT NUMBER POS. EOUIP. EJECTED INJURY INJURY INJURY OF PAIN DRIVER PASS. PED. BICYCLIST OTHER ❑tt '❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ NAME/D. . ADDRESS y.�, TELEPHONE (INJURED ONLY)TRANSP ED BY: TAKEN TO: A—ec-p Ii \ DESCRIBE INJURIES VICTIM OF VIOLENT CRIME NOTIFIED ❑# ❑ ❑ ❑ ❑ ❑ 1010101 ❑ 1111 NAME I D.O.B.I ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES ' r VICTIM OF VIOLENT CRIME NOTIFIED NAME I D.O.B.I ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES I ^.,fit• VICTIM OF VIOLENT C ME NOTIFIED NAME I D.O.B.I ADDRESS - TELEPHONE - ONJUREO ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES VICTIM OF VIOLENT CRIME NOTIFIED NAME I D.O.B.I ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: - TAKEN TO: DESCRIBE INJURIES VICTIM OF VIOLENT CRIME NOTIFIED ❑# ❑ ❑ ❑ ❑ 10101170 ❑ NAME ID.D.S./ADDRESS - TELEPHONE ONJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES VICTIM OF VIOLENT CPSME NOTIREO PREPARER'S NAME I.D.NUMBER MO. DAY YEAR REVIEW.' NA MO. DAY YEA �,� o -� ,� > a U. GIB _ CHP 555-Page 3(Rev.7-87)OPI 442 87 43637 lugw TIVE'ISUPPLEMENTAL r .• '.:� DAT OFo TIME(2400) NCC NUMBER OFFCERLD NUMBER PAGE to 1 13 'X ONE' WOKE it TYPE SUPPLEMENTAL rJr APPLICABLE) - - NARRATIVE , COLLISION REPORT ��I ❑ BA UPDATE ❑ FATAL ❑ NIT i RUN UPDATE ❑ SUPPLEMENTAL ❑ OTHER / ❑ HAZARDOUS MATERIALS ❑ SCMOOLBUS - ❑ OTHER CIT' UNTY/JUOICALDISTRICT REPORTING DISTRICT BEAT OTATION NUMBER o LOCATION/SU •ECT - STATEHIGHWAYREIAT YES NO if C CALAA 1 1 2. 4. 1 j li - w. 'vv 5. 6. 7. .. a ..r-- 8. h-- ao 10. - L� 11. 0 CAL c& E:,: 12. 13. Li CJ LA- 1 6 14. 15. 16. 17. 18. 19. L7 (T C — 20. 21. 22. 23. P1 — < / / WC 24. i 26. 27. 29. - 30. 31. 32. PREPARER'SNAME LD-NUMBER MONTH/DAY/YEAR REVIEWER'SNAME AU O n/ I CHP 55 Rev.7-87) OP 42 u••p.wws•a•onsunne•p«w 87 45312 i CLAIM O 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 March 13, 1990 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: Undetermined Section 913 and 915.4. Please note all "We..0ijr20y. counni CLAIMANT: SAFEWAY STORES, (INC. FEB � r, 19,90(Adams, Hackett, Logan, Riley� Walker, Williams) A�� ATTORNEY: r 'tl �z,,::GA;s ° '5,53 Jolie Krakauer Date received ADDRESS: Martin, Ryan and Andrada BY DELIVERY TO CLERK ON February .7, 1990 (hand delivered) Ordway Building, Suite 2275 One Kaiser Plaza BY MAIL POSTMARKED: Oakland, CA 94612 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the��above-noted claim. DATED: February 9, 1990 JVIL DeputyLOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Sup visors �► ) 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: 2 J (2 190 BY: f _ /JL'L n 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 (kef This Claim is rejected in full. ( ) Other: I certify that this is altrue and correct copy of the Board's Order entered in its minutes for this date. 1 Dated: MAR 1 3 1990 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code sec ion 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: MAR 1.4 1990 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator MARTIN, RYAN & ANDRADA RECEIVED A Professional Corporation Ordway Building, Suite 2275 %� C.,�l�e�� One Kaiser Plaza FEB 71990 Oakland, CA 94612 (415) 763-6510 PHIL BATCHELOR CLERK BOARD Of SUPERVIS RS ONTRA OST O Attorneys for Claimant B ° °' SAFEWAY STORES, INC. CLAIM AGAINST CONTRA COSTA COUNTY HEALTH DEPARTMENT TO: CLERK OF THE BOARD OF SUPERVISORS , 651 Pine Street, Room 106, Martinez, CA 94553: SAFEWAY STORES , INC. , hereby makes a claim against the CONTRA COSTA COUNTY HEALTH DEPARTMENT and makes the following statement in support thereof: 1. Claimant' s post office address is: SAFEWAY STORES , INC. , 201 - 4th Street, Oakland, California 94607 . 2. Notices concerning the claim should be sent to Gerald P. Martin, Jr. , Martin, Ryan & Andrada, One Kaiser Plaza, Suite 2275, Oakland, CA 94612. 3. The date and place of the occurrence giving rise to this claim are as follows: On or about August 10, 1989 SAFEWAY STORES , INC. was served with a complaint captioned Ernestine Adams, et al. v. Safeway Stores, Inc. Case No. 653448-2) . The action was filed in the Superior Court of California, County of Alameda. On or about August 10, 1989 SAFEWAY STORES, INC. was served with a complaint captioned Arthur Hackett, et al. v. Safeway Stores, Inc. Case No. 653478-3) . The action was filed in the Superior Court of California, County of Alameda. _1_ J On or about August 16, 1989 SAFEWAY STORES, INC. was served with a complaint captioned Glynis Logan, et al. v. Safeway Stores, Inc. Case No. 653460-4) . The action was filed in the Superior Court of California, County of Alameda. On or about August 10, 1989 SAFEWAY STORES , INC. was served with a complaint captioned Roshanda Riley, et al. v. Safeway Stores, Inc. Case No. 653838-7) . The action was filed in the Superior Court of California, County of Alameda. On or about August 8, 1989 SAFEWAY STORES , INC. was served with a complaint captioned Moses R. Walker v. Safeway Stores, Inc. Case No. 096027) . The action was filed in the Municipal Court of California, County of Contra Costa, Bay Judicial District. On or about August 10, 1989 SAFEWAY STORES , INC. was served with a complaint captioned Jacob Williams, et al. V. Safeway Stores, Inc. Case No. 653430-3) . The action was filed in the Superior Court of California, County of Alameda. 4. The circumstances giving rise to liability are as follows: SAFEWAY STORES , INC. , owned and operated a distribution center warehouse at 2900 Hoffman Boulevard, City of Richmond, County of Contra Costa, State of California. On July 11, 1988 , there was a fire in the warehouse. The fire burned for a number of days. The above-described lawsuits involve claims by plaintiffs for personal injury and property damage as a result of exposure to smoke from the July 11, 1988 fire at the Safeway distribution center warehouse in Richmond, California. Among other allegations, plaintiffs contend that the fire should have been extinguished immediately and that plaintiffs should have been evacuated. Safeway contends that the Contra Costa County Health Department was responsible for monitoring the air quality in the area of the fixe, advising community residents with regard to air quality, evacuating the area if necessary, rendering advice to the Richmond Fire Department regarding the necessity for extinguishing the fire, and for issuing any health advisories necessitated by the fire. The Contra Costa County Health Department was also responsible for monitoring the presence of toxins, if any, and rendering health advisories, if any such advisories were necessary. As a result of the Contra Costa -2- County Health Department' s failure to properly manage the Safeway fire and its aftermath, claimant contends that it is entitled to indemnity for the damages sought in the above-described complaints. 5. General Description of Injury, Damage or Loss Incurred: Claimant is entitled to equitable or partial indemnity from the Contra Costa County Health Department pursuant to Greyhound Lines, Inc. , v. County of Santa Clara (1986) 187 Cal.App. 3d 480. The indemnity to which claimant is entitled extends not only to the complaints set forth above, but to any subsequent complaints or cross-complaints brought against claimant based on the above-described occurrences. 6. Jurisdiction over this claim would rest in Superior Court. 7 . The names of the public employees causing claimant ' s damages are unknown. 8 . The amount of the claim and the basis for its computation have yet to be determined. DATED: ,C�� MARTIN, RYAN & ANDRADA A Professional Corporation n By 1� . JOLIE KRAKAUER -3- CLAIM BOARDI, 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 March 13 1990 and Board Action. All Section references are to The copy of this document mailed to you is your Aotice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Undetermined Section 913 and 915.4. Please note all "Warnings". CLAIMANT: SAFEWAY STORES, INC. (Farmers Insurance Exchange) ATTORNEY: Jolie Krakauer, Esq, r Martin, Ryan and Andrada Date received ADDRESS: Ordway Building, Suite 2275 BY DELIVERY TO CLERK ON February 16, 1990 One Kaiser Plaza Oakland, CA 94612 BY MAIL POSTMARKED: February 15, 1990Federal Express I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. February 16 1990 JVIL BATCHELOR, Clerk DATED: Y eputy II. FROM: County Counsel TO: Clerk of the Board of upervisors � ) 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: IC 190 BY: I JIB 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 (m, This Claim is rejected in full. ( ) Other: I certify that .this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: MAR 13 1990.0 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: MAR 14 1990 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator • LAW OFFICES OF MARTIN, RYAN & ANDRADA GERALD P. MARTIN,JR. A PROFESSIONAL CORPORATION 1FJA JOSEPH D. RYAN J. RANDALL ANDRADA ORDWAY BUILDING,SUITE 2275 OAKLAND,CALIFORNIA 94612 "IVE"D JOLIE KRAKAUER ONE KAISER PLAZA JILL J. LIFTER REklrl I KEITH 1.CHRESTION50N ANN HARDING BATTIN TELEPHONE::(415)763-6510 STEPHEN F. RILEY FAX:(415)763-3921 FEB 16 1990 GLENN GOULD f0: 26 a . ky, P41t BATCMELOR CLERK BOARD If SUPLjtVjS0jS W'-=0NT.t=0-, P NX February 15, 1990 FEDERAL EXPRESS MAIL TRANSMITTAL MEMO TO: Clerk of the Board of Supervisors 651 Pine Street, Room 106 Martinez, CA 94551 SUBJECT: SAFEWAY FIRE Farmers Insurance Exchange v. Safeway Stores, Inc. Our File No: S 831 ENCLOSURES: Original and a copy of a claim against Contra Costa County Health Department and a return envelope. I REQUESTED ACTION: Please stamp the copy received and return the copy to this office in the envelope provided. YOUR COURTESY IS APPRECIATED Yours very truly MARTIN, RYAN & ANDRADA By: Nancy Faro*e6h, Secretary to JOLIE KR*LX)JER RECEIVED MARTIN, RYAN & ANDRADA FEB 1031990 A Professional Corporation Ordway Building, Suite 2275 PH!LBATCHELOR CLERK BOARDOf JUPERVISORS One Kaiser Plaza B // ONTRACO TA O. D Oakland, CA 94612 L7 (415) 763-6510 Attorneys for Claimant SAFEWAY STORES, INC. CLAIM AGAINST CONTRA COSTA COUNTY HEALTH DEPARTMENT TO: CLERK OF THE BOARD OF SUPERVISORS , 651 Pine Street, Room 106, Martinez, CA 94553: SAFEWAY STORES, INC. , hereby makes a claim against the CONTRA COSTA COUNTY HEALTH DEPARTMENT and makes the following statement in support thereof: 1. Claimant' s post office address is: SAFEWAY STORES , INC. , 201 —4th Street, Oakland, California 94607. 2. Notices concerning the claim should be sent to Gerald P. Martin, Jr. , Martin, Ryan & Andrada, One Kaiser Plaza, Suite 2275, Oakland, CA 94612. 3. The date and place of the occurrence giving rise to this claim are as follows: On or about August 16, 1989 SAFEWAY STORES, INC. was served with a complaint captioned Farmers Insurance Exchange v. Safeway Stores, Inc. (Case No. 096177) . The action was filed in the Municipal Court of California, County of Contra Costa, Bay Judicial District. 4. The circumstances. giving rise to liability are .as follows: -1- SAFEWAY STORES, INC. , owned and operated a distribution center warehouse at 2900 Hoffman Boulevard, City of Richmond, County of Contra Costa, State of California. On July 11, 1988, there was a fire in the warehouse. The fire burned for a number of days. The above-described lawsuits involve claims by plaintiffs for personal injury and property damage as a result of exposure to smoke from the July 11, 1988 fire at the Safeway distribution center warehouse in Richmond, California. Among other allegations, plaintiffs contend that the fire should have been extinguished immediately and that plaintiffs should have been evacuated. Safeway contends that the Contra Costa County Health Department was responsible for monitoring the air quality in the area of the fire, advising community residents with regard to air quality, evacuating the area if necessary, rendering advice to the Richmond Fire Department regarding the necessity for extinguishing the fire, and for issuing any health advisories necessitated by the fire. The Contra Costa County Health Department was also responsible for monitoring the presence of toxins, if any, and rendering health advisories, if any such advisories were necessary. As a result of the Contra Costa County Health Department' s failure to properly manage the Safeway fire and its aftermath, claimant contends . that it is entitled to indemnity for the damages sought in the above-described complaints. 5. General Description of Injury, Damage or Loss Incurred: Claimant is entitled to equitable or partial indemnity from the Contra Costa County Health Department pursuant to Greyhound Lines, Inc. , v. County of Santa Clara (1986) 187 Cal.App. 3d 480. The indemnity to which claimant is entitled extends not only to the complaints set forth above, but to any subsequent complaints or cross-complaints brought against claimant based on the above-described occurrences. 6. Jurisdiction over this claim would rest in Superior Court. 7. The names of the public employees causing claimant ' s damages are unknown. -2- s 8 . The amount of the claim and the basis for its computation have yet to be determined. DATED: 3 )6 CIU MARTIN, RYAN & ANDRADA A Professional Corporation n ;� l By �( JOL E KRA AU 'R -3- PROOF OF SERVICE BY MAIL - C.C.P. §§1013a, 2015. 5 I , NANCY FARDANESH, certify that I am over the age of 18 years and not a party to the within action; that my business address is One Kaiser Plaza, Suite 2275, Oakland, California; and that on this date I placed a true copy of the foregoing document (s) entitled: CLAIM AGAINST CONTRA COSTA COUNTY HEALTH DEPARTMENT on the parties in this action by placing a true copy thereof in a sealed envelope addressed as follows: Clerk of the Board of Supervisors 651 Pine Street, Room 106 Martinez, CA 94553 XX (By Overnight Courier) I caused each envelope, with postage fully prepaid, to be sent by Federal Express -. (By Mail) I caused each envelope with postage fully prepaid to be placed for collection and mailing following the ordinary business practices of Martin, Ryan & Andrada. (By Hand) I caused each envelope to be delivered by hand to the offices listed above. (By Telecopy) I caused each document to be sent by Automatic Telecopier to the following number : as indicated above I declare under penalty of perjury that the foregoing is true and correct. Executed on Is '� , at akland, Ca ifornia. NANCY F ANESH -4- CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION th`e Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT March 13, 1990 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: $625.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: SAMPLE, Donna ATTORNEY: Date received ADDRESS: 1225 Mariposa Street BY DELIVERY TO CLERK ON February 12, 1990 Rodeo, CA 94752 BY MAIL POSTMARKED: February 9, 1990 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PpHHIL BATCHELOR, Clerk DATED: Febraury 16, 1990 BY: Deputy . IT II. �FROM: County Counsel TO: Clerk of the Board of S isors (� ) 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: 2� IS 9(I BY: I _ J 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 ORD 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: MAR 13 1990 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. 1 '4 Dated: MAR 1990 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months 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. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553• C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name °'of the District should be filled in. D. lI the claim 13 agd1I15ti LIIUT`C 1.11dL1 011C Puuttt; Gll�1Ly", :iya "ovc filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code See. 72 at the end of this form. RE: Claim By ) Reserved for Clerk's filing stamp ) RECEIVED' Against the County of Contra Costa ) F E B 12 1990 or ) PHIL BATCHELOR CLERK BOAFSUP SUPERVISORS District) RA e Fill in name ) e The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District 'in the sum of $ AA _S_. ° and in support of this claim represents as 'follows: / ---------------------------------------------fe A1. When_ did the damage or injury occur? (Givxact to and hour) (, ` ' 2. Where did the damage or injury occur? (Include city and county) T --- ------ ----------------------------------------- ------ VU 3. How did the damage or injury occur. (Give full details; use extra per if required) �iy✓►� l�G �,� � - 4. What particular act or omission on the part of county or district officers, servants or employeescaused the injury or damage? (over) 5. What are the names of county or district officers, servants or employees causing the damage or injury? claim resulted? Give full extent of injuries or 4p- 6. What damage or inJuries .do you . ( J ,p- �. damages claimed. Attach two estimates for auto damage. C��""` � o' 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) o alavz-n -------------------------- --------------------------- - 8. Names and addresses of witnesses, doctors and hospitals. ------------------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE .. _<.ITEM AMOUNT Gov. Code Sec. 910.2 provides: 1 f. The claim must be signed by the claimant SEND NOTICES..T0: ,, (Attorney_).,,.. orb_y some person on his behalf." Name and Address of Attorney Claimant's Signature t Address •� S Z Telephone No. Telephone No. �2 NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state •prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. {�� H, �� ,, �� s3,� � � `�� 3�. � sx t• s; :e 'Nv0 ,� 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 March 13, 1990 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: $500::000.00 Section 913 and 915.4. Please note all "vftthitp.counsel CLAIMANT: SHERMAN, Connie and Jeff FEQ ATTORNEY: Law Offices of Bruce G. Fagel Date received ADDRESS: 445 So. Beverly Dr. , Suite 200 BY DELIVERY TO CLERK ON g February 6, 1990 Beverly Hills, CA 90212 BY MAIL POSTMARKED: February 5, 1990 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: February 9, 1990 JAIL BAATTCHELOR, Clerk II. 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: 11190 BY: 0 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). 1V. BOARDD ORDER: By unanimous vote of the Superviscrs present (lam) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: MAR 13 1990 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: MAR 14 1990 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator 1 LAW OFFICES OF BRUCE G. FAGEL 1 445 South Beverly Drive, Suite 200i �/'` �7�e� p: 2 Beverly Hills, California 90212 F 11 '� (213) 277-1288 3 FEB 1990 Attorneys for Claimants 4 SUP FHl B)AM-;ELOR CLERK BOARD Or ERVISORS C T' COSTA CC. 2 -DepuX 5 6 i CLAIM FOR DAMAGES AND PERSONAL INJURIES 8 9 10 CONNIE SHERMAN and JEFF SHERMAN ) CLAIM FOR DAMAGES AND PERSONAL INJURIES 11 Claimants, ) GOVERNMENT CODE §910 12 vs. j 13 14 COUNTY OF CONTRA COSTA and ) MERRITHEW MEMORIAL HOSPITAL; ) 15 DOES 1 to 50, Inclusive. ) i ) 16 ) j Respondents. ) i 17 ) I ) 18 > 19 TO: THE COUNTY OF CONTRA COSTA, a political subdivision of the State of California and 20 MERRITHEW MEMORIAL HOSPITAL, a public entity, owned and operated by the COUNTY OF 21 CONTRA COSTA: 22 You are hereby notified that CONNIE SHERMAN and JEFF SHERMAN, whose addresses are in 23 care of their Attorney, Bruce G. Fagel, 445 South Beverly Drive, Beverly Hills, California, 90212, claim 24 damages from the above-mentioned entities and individuals in the amount, computed as of the date 25 of the presentation of this claim of$500,000. The Claim is based on the wrongful death of their daughter AMANDA BETH SHERMAN born 26 27 November 5, 1989 at said hospital. The child died November 8, 1989 at Oakland Children's Hospital. The child died from negligence from the care and treatment rendered by physicians, nurses and 28 1 i s � i 1 other employees of the above named county and hospital to the child and the child's mother, whose 2 names are unknown at present. Said Claim is also based on the negligence of the hospital in 3 selecting and periodically reviewing the competence of its medical staff and other hospital 4 employees and failure to obtain knowledgeable informed consent. The names of the public employees causing the child's injuries and his death are unknown to 5 Claimants at this time, although according to present information they are nurses, physicians and 6 other medical personnel employed by said hospital. 7 The damages to Claimants consist of the death of their child, including the loss of love, 8 companionship, comfort, affection, society, solace and moral support, as well as the loss of financial I 9 support during the Claimant's and their daughter's common life expectancy. Also claimed as 10 damages are the last medical expenses and funeral expenses for the deceased child. 11 General Damages and Pecuniary Damages: 300,000. j 12 Medical Expenses: Unknown. 13 Funeral Expenses: Unknown. The Claim is also based on personal injuries and damages sustained by CONNIE SHERMAN 14 15 during the,negligent labor and delivery of her child who also suffered severe emotional distress. Her 16 damages also include her own medical expenses, past and future and loss of earnings and earning capacity. 17 General Damages: 100,000. 18 Special Damages: Unknown at this time. 19 The Claim is also based on damages to JEFF SHERMAN for the loss of consortium and services I 20 of his wife CONNIE.SHERMAN. 21 General Damages $100,000. I 22 Special Damages Unknown. 23 All Notices or other communications with regard to this claim should be sent to the claimants in 24 care of their attorney. 25 Dated: February,5, 1990 LAW OFFICES OF BRUCE FAGEL 26 27 Luce G. Fa ,'M. ., J.D. 28 2 I , Y I � i 1 I 2 PROOF OF SERVICE BY MAIL 3 STATE OF CALIFORNIA, COUNTY OF LOS ANGELES 4 I am a resident of the county aforesaid. I am over the age of eighteen years and not a party to j the within action. i 5 My business address is 445 South Beverly Drive, Suite 200 Beverly Hills, California 90212. 6 On February 5, 1990, 1 served the within Claim for Damages on the interested parties in said 7 action, by placing true copies thereof enclosed in sealed envelopes with postage thereon fully paid, .8 and also by Registered Mail, in the United States mail at Beverly Hills, California, addressed as 9 follows: 10 Clerk of the Board j Contra Costa County Board of Supervisor 11 651 Pine Street Martinez, California 94553 12 13 I declare under penalty of perjury under the laws of the State of California, that the foregoing is true 14 and correct. i 15 Executed on February 5, 1990, at Beverly Hills, California 16 17 18 19 20 21 22 23 24 j 25 26 I 27 28 /wooRwartl/gov910/ 02//0505//90go29f/ 3 0 1 r- N cn to aN r 0 N N .,A o A N � s C .a �o ,fl a 0 1 Y lJ' ti tJt t/� VCIA r APPLICATION TO FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA BOARD ACTION Application to File Late Claim ) NOTICE TO APPLICANT March 13, 1990 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 911.8 and 915.4. Please note the "WARNING" below. Claimant: WILSON, Clarence COunty COunsel Attorney: .- FEB 2 Z 1990 Martinez, CA 04553 Address: 516 O'Farrell Street, #427 San Francisco, CA 94102 y February 16, 1990 Amount: By deliver to Clerk on y Date Received: By mail, postmarked on February 15, 1990 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted Application to File Late Claim. DATED: February 16, 1990 PHIL BATCHELOR,- Clerk, By Deputy II. FROM: County Counsel 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 laim (Section 911.6). DATED: 2 21 VICTOR WESTMAN, County Counsel, By� S Deputy III. BOARD ORDER By unanimous vote of Supervisors pres t (Check one only) ( )/ 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: MAR 13 1990 PHIL BATCHELOR, Clerk, By Deputy WARNING (Gov. Code 5911.8) If you wish to file a court action on this matter, you must first petition the appropriate court for an order relieving you from the provisions of Government Code Section 945.4 (claims presentation 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 connection with this matter. If you want to consult an attorney, u should do so immediately. IV. FROM: Clerk of the Board TO: 1 County Counsel 2 County Administrator 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: MAR 14- 1990 PHIL BATCHELOR, Clerk, By Deputy V. FROM: 1 County Counsel 2 County Admin rator TO: Clerk of the Board of Supervisors Received copies of this Application and Board Order. DATED: __ .: ' county Counsel, By County Administrator, By APPLICATION TO FILE LATE CLAIM I CLARENCE WILSON DECEIVED 51.6 Ofarrell Street 427 2 San rancisco California 941.02 FEB 1 s (41.5 ) 441-9594 1990 3 In Pro Per PHIL BATCHELOR CLERK BOARD Of SUPERVISORS 4 co s.A o. Deputy 5 6 7 CLAIPi OF ) R'BQUEST FOR LEAVE TO PRESENT. A LATE CLAIM. 8 CLA?ENCE WILS 0i1: ) (Pursuant . to Government 9 vs, ) Code Section 91.1 . 6) to CO'TNTY Or CONTRA COSTA ) 11 ) 12 TO BOARD 0 ' SUPERVISO. , CONTRA COST? COJt:TY, OR COJNIY MANAGER. �jq f-r- 13 Claimant CLARENCE WILSO.\i, request leave to a. late claim 14 in pursuant to Section 911 . 6 of Governirlent Code ection 15 911 . 6. Claimant, CLARENCE NILSON claims that he wasp-,t aware 16 of the County clerk,s involvement in the fraud until after 17 repeated request to review case number 094420. 18 When Claimant first tent back to County building, or 19 1-'.ay 21, 1989,. the forms exihbi.ts , and � t,;ere not in the file; 20 only exi-!ilK,i.ts Cand D were in the file tocorrespond with the 21 master register. Claimant was not aware of exibhits A and B 22 until January of 1990 when he went to check on another matter 23 regarding case number 094420. 24 when Claimant -went to the County Clerk, s office on 25 January 5, 1990, exibhit A and B were in the file. Claimant 26 Then file a claim with the county for damages suffered. 27 ' 28 1 In Pro Per -1- t r IIT I CLARENCE WILSON RECEIVED 516 Ofarrell Street t=427,2 144_11� 2 San Francisco California 94102 -c 1990 (415 ) 441-9594 � ,a� x,11 3 In Pro Per CATCKU01 SERB BOARD Of U►f€MK CONTRA to CO• 4 a p� 5 6 7 CLAIM OF CLAIM FOR MONEY AND PERSONAL INJURY DAMAGES 8 CLARENCE WILSON (Government Code Sections 9 vs . 905 ) 10 COUNTY OF CONTRA COSTA / 11 0: THE COUNTY MANAGER AND':/ OR CLERK OF THE COUNTY OF CONTRA 12 OSTA. 13 YOU ARE HEREBY NOTIFIED that CLARENCE WILSON, whose 14 address is 516 Ofarrell Street x#427, San Francisco California 15 D4102, claims damages from the County Of CONTRA COSTA in the 16 aggregate, amount, computed as of the date of presentation 17 f this claim. 18 This claim is based upon negligence and fraud on part of 19 7lerks for the COUNTY OF CONTRA COSTA, regarding an eviction 20 of Claimant by Store Owners on or about April 27, 1989. 21 Claimant claims that the notice of trial was mailed to 22 the wrong address, 733 E1 , Portal Center, by County Clerk 23 :IM PERICOLI, on March 31, 1989. Trial was held on April 11, 24 L989 and a judgment in favor of the property owners was 25 ssued by the Court. 26 On April 12, 1989, a Notice Of Judgment was mailed to 27 he correct address of 644 El Portal Center persumablly by 28 he same COUNTY CLERK. -1- 1 The 733 El Portal Center address was a mistake on 2 complaint # 094420 that was made first by the property owners 3 who later amended. the complaint to the right address of 644 4 El Portal Center, and then by Claimant,s attorney who got 5 the address of 733 E1 Portal Center from property owners 6 first complaint. 7 At all times mention herein, the COUNTY CLERKS were 8 acting within the course and scope of their employment with 9 the COUNTY OF CONTRA COSTA, and should have checked for the 10 right address . It is their respnsibility and obligation to 11 make sure that all of the respondants receive all Court doc- 12 uments as required by law. 13 The amendment to the complaint by the property owners 14 contained the right address that was approved by the court 15 and should have taken precedence over the original complaint. 16 The County Clerk .was improperly trained by the COUNTY OF 17 CONTRA COSTA, therefore COUNTY and COUNTY CLERKS are liable 18 for damages to the Claimant because of their negligence and 19 fraud. 20 The names of otheragents and employees of the COUNTY OF 21 CONTRA COSTA, who were responsible in some manner for the 22 negligence and fraud are presently unknown. 23 As a proximate result of the above negligence and fraud, 24 Claimant has suffered economic loss,severe intentional emo- 25 tion distress and severe negligence emotional distress . 26 The aggregate amount claimed, as of the presentation 27 bf these claims, is computed as follows: 28 -2- 1 LOSS of wages $ 50, 000. 00 2 General Damages $ 1, 000, 000. 00 3 Total $1, 050, 000. 00 4 5 All notices or other communication with regard to this 6 claim should be sent to Claimant at 516 Ofarrell Street 7 #427, San Francisco California 94102. 8 9 10 Dates a2i j 11 IN PROPRIA PERS ON IA 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 —3- 28 w , 1 t w 1l J rfr 1-4r .e22Is tr y6uite 145 �tticr Ca94022 . .:................ ..._< 4"9 I-'fi 6 7 t s i jr _.�r� a Pers<1 ,:. A iG14ALG li�Ktiff n 1 opria Pe ona B'3 / -77 }t� OF, COI3Tkr. ..."" `i�,`"'P ey CALIPQRNIA '"8 COUNTY OF CONTRA COSTA, STATE OF CALIFORNIA plaintiff ) ) Case K,. 04W..t, NO. 094420 Amendment #1 fig a .,.n5'��"101s• .n;rof , ) } Exparte tit dba PoNal^Eeauty ) Request to Amend Complaint Ct- }, - 93 De�,encants ) 14 that L�a9 5iL3 �� ..�.=:b• �� f,{;t;t:.y'i !C t5 Viiiinquests to amend complaint due to clerical error. 11C.Ii(} {'-i"�R�'•iEllYtt . LC' C}:3Tro=Sr'w L 8t`:S? ?S t- t3� Einla*f U �i{' k2ATi lb I• Sul lts�?.. 133 F3 ��.»7! T. _ C'ez+t� IT t'c, 644 F'1. Portal Celit'e"' 17 The original complaint listed the address of the property as 18 733 E1 Portal Center II due to a clerical error. The real 19 property is located at 644 El Portal Center II, in the City of , t kr^ 20 San Pab%`,4Cou1S�nty of Contra Costa, State of California. 0,19 21 ---- DATED:_ - DATED February 24, 198 9 jcwar OF 25 ' • Mr Plaintiff in Pa Per 20 1 l MUNICIPAL COURT OF CALIFORNIA, COUNTYONTRA CO0 BAY JUDICIAL DISTRI T L E D 100 37th Street BAY MUNICIPAL COURT No. . 094420 =. Doputy 9. Barbara J. DetrickMy dba E1 PortaV-Beauty Supply MEMOR NDUM TO SET CASE FOR TRIAL Doris Wilson 7 Clarence Wilson (Abbreviated Title) De(eadsot(s) t Nature of case (state fully) Unlawful Detainer, Nonpayment ofain't Amount t 6. 905. 24 Is cross-complaint filed ? No Is Jury demanded ? no (Yes or No) (Yes or No) Time necessary for trial 1 Hour Is reporter requested? No (Estimate carefully) Is this case entitled to legal preference in setting? Unlawful Detainer CCP 1179a (If Yes, state reasons, giving code sections) List dates NOT acceptable to you April 15 thru April 21 The names, addresses and telephone numbers of the attorneys for the parties or of parties appearing in person are : For Plaintiff For Defendant For Barbara J. Detrick Doris & Clarence Wilson dba El Portal Beauty Supply 101 First Stree, Suite 145 644 E1 Portal Center II Los. Altos, Ca. 94022 San Pablo, Ca. 94806 The case is at issue and 1 hereby request that it be set or trial. Dal ed � (NOTE: Must signed by attorney requesting setting.) DECLARATION OF SERVICE BY MAIL (C.C.P. 1013A (1). 2(115.5) My 1511 aint 61; address is 101 First Street Suite 145, Los Altos, Ca. 94022 (builnesa/reeldence) I am. and was,at the time the herein mentioned mailing took place. a citizen of the United States. (esP ed/eel ent) in the County where said mailing occurred, over the age of eighteen years and not a party to the above entitled cause. on March 24. 1989 I served the foregoing document by depositing a copy ILITof. I'losed in separate. sealed envelo with t(h�4 postage thereon fully prepaid. in the United States mail box at +�s Alto s County of Santa Mara . California. each of which envelopes was addressed respectively as follow* �oR r z � C�cR�evCE e(�..Gs o.✓ V41 �, #4047-A�. (74,V ►-gam, Dr 1 declare undcrpenilty of periury that the foregoi g is trueend correct. :ecuted bn Ma.rch 24. 1989 � at 1 Giifomla. (Place) \ Ts i nelur loran t) n The above-entitled case has been set for trial on !� at' M. Jury/Court/Pre By I Barbara J. Detrick ` 101 First Street, Suite 145 2 Los Altos, Ca. 94022 F ! L. ED 3 415-493-1167 BAY MUNICIPAL COURT 4 Plaintiff in Propria Persona MAR - 8 1989 5 3 Robert K. Gordon, Cleric 6 8y Deputy 8 COUNTY OF CONTRA COSTA, STATE--OF_CA NIA 9 Barbara J. !Detrick, ) 10 Plaintiff ) vs. ^ ) NO. 094420 Amendment #1 11 Doris Wilson ) Clarence Wilson ) Exparte 12 dba E1 Portal Beauty ) Request to Amend Complaint Supply`' ) 13 Defendants ) 14 ) 15 Plaintiff requests to amend complaint due to clerical error. 16 I. 17 The original complaint listed the address of the property as 18 733 E1 Portal Center II due to a clerical error.. The real 19 property is located at 644 El Portal Center II, in the City of 20 San Pablo; County of Contra Costa, State of California. 21 22 23 DATED; February 24, 1989 24 - 25 ---� 26 27 Plaintiff in o Per 28 4!, bTSTU.VTjj TU bxobLTS b6}•cvua $! } n IT2-183-1T(?.1 i s roe vT4oa' cg ' aquss TOT LTIE-P 24:71-66-' 2flT4--E Td2 I 1 aat0ais14z: 0* °nGZ:T.Tcy, I 101 First Street, Suite 145 2 Los Altos, Ca. 94022 415-493-1167 3 4 Plaintiff in Propria Persona 5 6 7 8 COUNTY OF CONTRA COSTA, STATE OF CALIFORNIA 9. Barbara J. Detrick, ) 10 Plaintiff ) Vs. ) Case No. 094420 11 Doris Wilson ) Clarence Wilson ) ORDER GRANTING EXPARTE 12 dba E1 Portal Beauty ) Supply ) 13 Defendants ) 14 ) 15 It is hereby ordered that 'Plaintiff 's Exparte, Request to 16 Amend Complaint, to change the address of Unlawful Detainer and 17 Summons from 733 E1 Portal Center II to 644 E1 Portal Center II. 18 19 20 !pR o4 21 DATED: ,19 001A CIS 22 A i 23 j rt 24 �y 25 JUDGE OF AL COURT tf 26 27 28 c , cc ru N j CiLio '09,-00 o �y7 ° Lo 00 C� N H b7 00 o cn00 �c 00 °• E t" L4 x ON •00 n A IP rn c! Q{ n rn v rt H H• O O CO v � O z '� ►~- 'd rt 00 (D a y r trn r', re w0 �. rt -4. vi O 60 nct � o y (D o - o r• z x a IH. t2i tIj _ n r I.A. r+, W a tri Z @ Q. H o Ki r (D y 1- to m bb v o j"'' n ui �• (D Cd C ~ y n I- Q K D b . ISI � n r- ID rn $ v C , m r* ' �n H. ,/ �! D m Li m Q %V' �_ N n1 a Ln cnD 00 m Ob M w �A C "n CD mO ]i v ° o Ln 3 o D ? v' -Dc Ln cc l7 w < r D No v CD a /�/^� n r V/ 00 .w% m w ^� t .a. N ' iv m n -� Q 1O °° `D N C7 -4 N4 Z � -< b � 3 d (n E Q a 00 H rn Q S N n O cit o 0 n Z Z N• _'� o n I arI-'r, p 0 f�J F 0 z O '' D A • 7� S0 O f1 A n m OZ Z O N. i p a BARBARA J. DEI'RICK CIARENCE WILSON _ _.-_ 141 First Street Suite 145 733 El Portal Center IT Los Altos, CA '94422 San PAW, 94806 MUNICIPAL COURT OF CALIFORNIA, CO. BAY JUDICIAL DISTRICT 100 - 37th Street, Richmond, CA 91805 BARBARA J. DETRICK Plaintiff(s) No. 94420 vs NOTICE OF hITRIAL AND TRIAL CLARENCE WILSON Defen ants► To each party or to the attorney(s) of record for each party herein: Notice is given that the above entitled action has been set for court trial on April 11, 19$9 at 8:30 a•m. , in'this court, at 100 - 337th, Richmond, CA 44805. (Check the Court Calendar in the hallway outside of room 202 for the Courtroot that will bear this matter.( THIS IS THE ONLY NOTICE OF TRIAL THAT IS REQUIRED TO BE GIVEN. (Rule 509b CRC) Pretrial stateaents must,be filed one week before pretrial hearing is beard. Pursuant to CCP 631, jury fees are to be posted 25 days prior to the trial date, unless jury is for an Unlawful Detainer action, then fees must be posted 5 days prior to the trial date. If fees are not posted by the required date, then the jury is automatically waived. First day jury fees are Nctice is given that the pretrial hearing has been ordered set on at SRR OF HE--011-CIPAr COU DATED MARCH 31, 19$9 Deputy Clerk KIM PERICOLI CLERKS CERTIFICATE OF SE CE BY MAIL (CCP 1012a(3) ) 1, Clerk of the above naaed court, do certify tat I as not a party to this action; a on the date shown below I served the foregoing document by depositing a true copy thereof, 'enclosed in a separate, sealed envelope, with the postage thereon fully prepaid, in the United St_tes mail at Richmond, CA, each of which envelopes was addressed respectively to the peiscns and addresses shover atove said document. Ricbnand, California CLERK-O?TNE-MUNICIPAL CQURT Dated By Deputy Clerk MARCH 31, 79$9 KIM PERICOLI � , NOTICE OF bT971)�T�� 7v b�obl7s bs..2ove >• ...,Piii,;` ✓ � D s Ij roe bT4:oe ` Gs ' x4055 TOT ETI" 2�166�` �nT�6 T42 1 "LLWl&:"Z: 0 - T1or:ITC;: 101 First Street, Suite 145 / 2 Los Altos, Ca. 94022 415-493-1167 3 1+ 4 4 Plaintiff in Propria Persona 5 6 7 8 COUNTY OF CONTRA COSTA, STATE OF CALIFORNIA 9 ) Barbara J. Detrick, 10 Plaintiff ) Vs, ) Case No. 094420 11 Doris Wilson ) Clarence Wilson ) ORDER GRANTING EXPARTE 12 dba E1 Portal Beauty ) Supply ) 13 Defendants ) 14 ) 15 It is hereby ordered that Plaintiff 's Exparte, Request to 16 Amend Complaint, to change the address of Unlawful Detainer and 17 Summons from 733 E1 Portal Center II to 644 E1 Portal Center II. 18 19-2./- 2( 0/2` DATED ,19 r 22 23 �1 _ � J 24 JUDGE OF AL COURT 25 �•... .F 26 27 28 ID g ytilelppt Coal aa� � 1 Clarence Wilson 2871 Loyola Ave 2 Richmond Ca. 94906 e ) 3 Defendant In Pro Per 4 5 6 Municipal Court Of California County Of Contra Costa 7 Bay Judicial District 8 9 Barbara J. Detrict, Plaintiff, Case NO. 094420 10 11 vs ) Motion To Vacate Jugdement ) 12 Clarence Wilson , et al. , 13 Defendant 14 15 16 Defendant States as Follow, 17 1, 0 18 Plaintiff stilted in her original compl*Ant that my address 19 is 733 E1 Portal Center The complaint was dated February 16; 20 1989. 21 2. 22 The Complaint was answered on february 27, 1989 by a evict- 23 ion legal center,which got the adress off of the complaint 24 the plaintiff entered on february 16 1989. 25 3. 26 Plaintiff then amended the complaint on March 1, 1989 27 to state the right address after the complaint was answered 28 on february 27, 1989. 1 4. 2 Plaintiff knew or should have known the right address of my 3 place of business. plaintiff knew I was going to hire an 4 attorney to help my case. 5 $► 5. 7 I was never served a notice of trial by the court because 8 it was delivered at 733 E1 Jjortal center not my correct 9 adress of 644 el portal center. 10 11 12 Dated april 30 1989 13 14 Defendent in Pro Per 15 16 17 18 19 20 21 - 22 23 24 25 26 27 28 r 4 eD t ��J