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HomeMy WebLinkAboutMINUTES - 06121990 - 1.14 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 JUNE 12, 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: $120.00 Section 913 and 9.15.4. Please note all "Warnings". CLAIMANT: SADLER, Linda K. ATTORNEY: Date received ADDRESS: 2700 O'Harte Road BY DELIVERY TO CLERK ON May 15, 1990 (via transmittal) San Pablo, CA 94806 BY MAILPOSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County- Counsel Attached is a copy of the above-noted claim., pp}� gg DATED: May 18, 1990 B�jIL DeputyLOR, C1 rk II. FROM: County Counsel TO: Clerk of the Board of pervisors (I► ) 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 lateclaim (Section 911.3). ( ) Other: Dated: r 21 .1 SO BY: _ -Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1)` County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). ` IV. BOARD ORDER: By- unanimous vote of the Supervisors present (.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. pt Dated: JUN 1"2 1990 PHIL BATCHELOR, Clerk, By Deputy- Clerk WARNING (Gov. code seion 3') 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: JUN 1 2 1 BY: PHIL BATCHELOR.by _Deputy Clerk CC: County Counsel -County Administrator Clain. to: BOARD OF SUPERVISORS OF CONTRA COSTA (AUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to pers�)� 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. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By ) Reserved for Clerk's filing stamp j ITEJ 111 VEI- I Against the County of Contra Costa ) or, ) MAY 1 5 1990 District PH;(RiVi'C ROR CLERK P!Q,/kPP OF SUPERVISOR"a I Fill in name ) _ .,k EOSTA Co. The undersigned claimant hereby makes claim against t . County of Contra .Costa or the above-named District in the sum of $ 1,Rp,00 and in support of this claim represents as follows: - ---------- 1. When did the damage or injury occur? (Give exact date and hour) ----- _ �' .X90--------------------------------------------------------------- 2. - Where did the damage or injury occur? (Include city and county) ---- --- - -- __fit ----------------------------------------- 3. How did the damage or injury occur? (Give full details; use extra paper 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) 5. What are the names of county or district officers„ or pausing' := the .damage or in-Jury? --------------------�-- ---- 5. What damage or injuries do you claim resulted? (,�ilz R i; . e -L- c-f fL>>=,jmr3es or damages claimed. Attach two estimates for auto d -&., ---------------------------------------------�r_�_ ---- 7. How was the unt claimed above computed? (Incic.l�- the, ez 1.m ed- am=t of any prospective injury or damage.) 7-ora, AcA.Pi dm`s APO 4417t',� 141,50 .Ss'7;0,X 8. ` Names and addresses of witnesses, doctors and hospla3a . 9. List the expenditures you made on account of this a= dt*n4.- C—Ir irrr : DATE ITEM A ?i ' Gov. Code Sec. X10.2 Tidt "The claim must Te aig;yed'1 by tt-e� at,'?ai7.'m3L1t; SEND NOTICES TO: (Attornev) or by some perszmi on e s beha ,`'..-"i /Name//��and Address of Aytt�,orney d CZa1. L' r� :.IYK ',�1. �•E'a6�f%off' �E������r, 106 sg s�.a� ;- •�is �r1lD . D .�.Q i'�o.�� Telephone No Telephone No&.. f2 N 0 TIC E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents ftr- aMew& �tm fC r payment to any state board or officer, or to any count,, c +.ly; =- cff--,tr 1mt ?Dane ar officer, authorized to allow or pay the same if genuine,: ary/ fo,a& ear° IIsudialent " claim, bill, account, voucher, or writing, is punishable:; ed1th6-- b-F. i4rii-Mt in the county jail for a period of not more than one year, b�7 a), JannF, or Tom; ceding one thousand ($1,000), or by both such imprisonment and ,,, cr - mrr-dsm=nent in the state prison, by a 'fine of not exceeding ten thousm, dbM.-mss (;, �,�Q „ mm by both such imprisonment and fine. - 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 JUNE 12, 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: $100.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: PUTT, Jim and Judy ATTORNEY: Date received ADDRESS: 2215 Cypress Pt. BY DELIVERY TO CLERK ON May 18, 1990 Byron, CA 94514 BY MAIL POSTMARKED: May 17, 1990 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. May 18, 1990. EaDATED: IL BATCHELOR, 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: ..S 1'21/go BY: I S_ Deputy County Counsel III. FROM:. , Clerk of the Board TO: County Counsel (1) County Adminis rator (2) ( ) Claim was returned as untimely with notice.to claimant (Section 911.3). IV. BOARD ORDBy. 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-. n Dated: JUN 1.2 1990 PHIL BATCHELOR, Clerk; By Deputy Clerk WARNING (Gov. code sec 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. JUN 1,2 199 Dated: BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator NOTICE OF INSUFFICIENCY AND/OR NON=ACCEPTANCE OF CLAIM TO: 'm and Judy Putt 221 ress Pt. Byron, 4514 Re: Claim of JIM AND JUDY PUTT 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) , the claim 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, County ounsel Q��- S, /) - By: Deputy Co y Counsel Cr CERTIFICATE OF SERVICE BY MAIL C._C.P. _SS 1012, 1013a, 2015 .5; Evid. C. S§ 641, 664) i 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 thisfday deposited in the U.S. Mail at Martinez/Concord, Contra Colsta County, California. I certify under penalty of perjury that the foregoing is true and correct. Dated: at Martinez, California. cc: Clerk of the Board of Supervisors (ori final) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOV.C.§§ 910, 910 . 2, 920 .4, 910 . 8) 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, 19879 must ,be presented not later,..than ,the 100th day after the accrual of._the cause of action.-. Claims relating ....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.) ._ •c. _ . B. Claims must be filed with the Clerk of the Board of Super`visors'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 .fiiied in. D. If the claim is against more than one public entity, separate claims must be filed against 'each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this ..,form': . ,-.. _:. . . .. . �_e. . . _. . �. _... . .... .. .. " RE.: Claim By ) Reserved for Clerk's filing, stamp- ­ RECEIVED ED Against the County of ,Contra Costa . ) MAY 1 8'1090 .> or v ) .. y r . -- PHIL BATCHELOR �' , l C1E2K 80 D OP;SUPERVISORS District) cosTA co. Ey —dill inn e ) The undersigned claimant hereby makes claim agnst the ounty of Contra Costa or the above-named District in the sum of $ - and in support of this claim represents-as -follows: ----------------------------------------------------------------------- --- --- 1. Wh n did the damage or injury occur? (Give !exact w d hour) a 2. Where did the damage or injury occur? (Include city and county) --------- --`�------- -`t -- LO - --------- -- ------------ 3. How did the amage or injure ? e 11 details; use extra aper 7 required) y � 4.,e V7& ------------------ -------------- ------------------------------------------------ 4. - What'particular .act or omission °on the'part 'of. county.pr.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 in jur �p - = ----- =`-` =-U- --1 -- ---- ------- ------ ------ --- �------- 5: What damage or.-injuries" do you claim" resulted ''(Give" full extent. of injuries or damages claimed. Attach' two estimates for ;auto damage. ----�-- --- ------------------' ---- --------------��---------------------- ------- 7. How-was the amount claimed above computed? (Include the estimated amount of`any prospective injury. or damage.) 8. Names anaddresses of itne'sses, tdoctors and hos ital"snJ 41 a! - ? . 9. List the. expenditures you made on .account-of. this accident. or injury: DATE , .iTEMj AMOUNT Gov.. Code- Sec. 910.2 provides: r "The claim must be signed' by the claimant SEND NOTICES TO: v(Attorney) ryI orb some,. erson on his behalf." Name and Address_.of:_Attor,.ney imant's,Signature a ' Add s Telephone No. Telephone `�. No. �/�-- 3 �`- oo oz 6 3757 N 0 T I C E Section 12 'of. t1he Penai Code provides: w "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 aper od 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. A. R. S. American Retrofit Systems Lic. No. 463520 P.O. Box 325 I BYRON, CALIFORNIA 94514 (415) 634-5823 CUSTOMER'S ORDER NO. PHONE DATE 19 NAME ADDRESS n c v er, -gam 'CASH . a.C OA ,a „CHAR6E ON ACCTS MDSE RE'�O 'Q mss. r_ ; r x - G�2 L�._..... .... _.._......:_.....:06 ........_ ..2L7rti . r I ..... I__._....._..... � I ...........a......_. . L...._........_. TAX I SOLD BY RECEIVED BY .. TOTAL j �` All claims and returned goods MUST be accompanied by this bill. 28549-hank`You ,,,,u,,609 n Inc.,Groton,Mas.01471. - ro 0346 N O 0-4 co } QaO . WN1` moo° mog toz `fit i.Iy CLAIM d 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 JUNE 12, 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: $450.00 Section 913 and 915.4. Please note all, "Warnings". CLAIMANT: IMPARATO, Gregory D. ATTORNEY: Date received ADDRESS: 1441 Whitecliff Way BY DELIVERY TO CLERK ON May 18, 1990 (via Risk Mgmt) Walnut"Creek, CA 94596 BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: -County Counsel Attached is, a copy of the above-noted claim. DATED May 18, 1990.1 EVIL BATTCHELOR, 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: �.3 e BY: P 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. BOARDORDEBy 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. p1 q Dated: JUN 1 2 1990 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code sects 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: JUN 12 1990 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator .y NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM T0: Greg D. Imparato 1441 Whi cliff Way Walnut Cree CA 94596 Re: Claim of GREGORY D. IMPARATO 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) , the claim 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. x 6 . The claim is not signed by the claimant or by some person on his behalf . 7 . Other: VICTO"WEST7 nsel By: Deputy C my Counsel CERTIFICATE OF SERVICE BY MAIL C.C.P. 99 1012, 1013a, 2015 .5; Evid. C. S9 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: l a , at Martinez, California. cc: Clerk of the Board of Supervisors (or inal) � Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOV.C.§§ 910, 910 . 2, 920 .4, 910 .8) CONTRA COSTA COUNTY PERSONNEL DEPARTMENT-SAFETY DIVISION PERSONAL PROPERTY LOSS OR DAMAGE PROCEDURE. This bulletin sets forth policies and procedures regarding personal property loss or damage reporting. It is an addendum to County Administrator Bulletin 313.1. I. Personal Property Loss or Damage Procedure A. All requests must be filed on Form AK130. Supply is available from the Personnel Department, Safety Division. B. The department head or designated representative is responsible for adherence of the claim as outlined in Administrative Bulletin 313.1. II. Amount of Reimbursement Reimbursement for items lost or damaged beyond repair will be subject to the following conditions: A. A flat depreciation rate of 10% will be used on all articles.over one year except contact lenses and eyeglasses. (see item D-E for coverage) . B. When private insurance covers the claim loss, the County will only pay the difference. C. Cash loss will be .paid up to a maximum of $25.00. D. Contact lenses will automatically be assumed to be covered under an employee's private insurance and reimbursement will be for half of the lense cost. When claims are being submitted for lenses, the employee must also: 1. Provide a statement by their medical doctor or optician of the total cost of the lense replacement. AND 2. Provide a statement that new lenses were the same as lenses lost or damaged.: (ie: if lenses were hard lenses, cost to replace will be for hard lenses) 3. Lense reimbursement will not cover eye examination or prescription change. E. Eyeglasses will be covered for repair to frames, replacement of broken lenses and frames only. The cost of re-examination .and new prescription changes will not be covered. Reimbursement will be for the total cost of loss or damages but no more than the original cost. Additional copies of this procedure may be obtained from the Personnel Department, Safety Division, AK 130.1 5/83 SAFETY DIVISION PERSONAL PROPERTY REIMBURSEMENT CLAIM TO BE COMPLETED BY CLAIMANT: Claimant's Name: Gr eeO Date: Address: ILI"I li-)�� ° ��1 � w Department: i Describe the manner in which the loss or damage occurred (,p lAfaA YIDAAA ount of Loss Claim $ 6/ ' RECEIVEiount to repair damaged property vett Ah-- attach invoice & actual repair) $ MAY /k•�S- G.y,., riginal purchase price of article(s) aa // PHIL BATCKLOR attach sales slip on same) $ /V,4 CL IC BOARD Of SUPERVISORS SA _ By Ll °' ere purchased: Date purchased: 312G/�D. Do you carry private insurance coverage for property loss or damage to your personal property? Yes No _ If yes, have you contacted your insurance agent for reimbursement? Yes No ><' If yes, how much did your insurance reimburse you for the claim? $ If no, why did the company reject your claim? TO BE COMPLETED BY WITNESS Roo s Signature Date Confirming statement by witness to .incident: Witness' Name (Print) Signature of Witness TO BE COMPLETED BY IMMEDIATE-SUPERVISOR Confirming statement by immediate supervisor: Supervisor's Name (Print)- Signature of Immediate Supervisor TO BE COMPLETED BY DEPARTMENT HEAD OR DESIGNATED REPRESENTATIVE: I recommend approval of this claim because said claim meets the criteria for reim- bursement provided by -Administrative Bulletin 9313.1, as follows: (P'Mase-:"°MtY-r.'� ` items 1-4 under Administrative Bulletin 9313. 1. ) ' I recommend rejection of this claim because said claim -does not. meet the criteria for reimbursement ,provided by Administrative Bulletin 9313. 1, as follows: (Please refer to items 1-4 under Administrative Bulletin 9313.1. ) Signature of Department Head or Designated Representative HAVE YOU CHECKED TO BE SURE 1. Damaged property is attached to ,this claim. If not, ..please explain. onus 2. This form has been completely answered. Cost 3. County demand form and Board Order, Aineeded, is attached. Pi � AK130 6/83 :77el7t PEMS P.L 7E No.: EMPLOYEE TRAVEL DEMAND ON THE TREASURY OF THE COUNTY OF CONTRA COSTA (FOR REIMBURSEMENT OF EMPLOYEE EXPENSES) CLAIM MONTH: (PRINT) LAST NAME , INITIALS IMPORTANT SEE INSTRUCTIONS ON REVERSE SIDE M0. YR. TRAVEL BY-PRIVATE AUTO ITEMS OF EXPENSE DATE FROM, TO MILES DATE AMOUNT TOTAL ITEMS OF EXPENSE The undersigned under the penalty of perjury states: That this claim and the items as therein set out are true and correct; that no part thereof has been heretofore paid,and that the amount therein is justly due, and that the some is presented within one year after the Inst item thereof has accrued. MADE BY EMPLOYEE SIGNATURE DATE APPROVED BY TOTAL MILES SUPERVISORS SIGNATURE DATE MILEAGE DISTRIBUTION RECEIVED, ACCEPTED and EXPENDITURE AUTHORIZED ORGN. TASK OPT ACTIVITY IN-LIEU REGULAR MILES MILES SIGNED DEPARTMENT HEAD OR AUTHORIZED DEPUTY DATE EXPENSE DISTRIBUTION DATE DESCRIPTION ORGN ACCOUNT AMOUNT TASK OPT ACTIVITY 2 OTHER TRAVEL 2303 2 I 2 ' 2 , (M8154 REV. 9/82) , INSTRUCTIONS TO CLAIMANTS' All claims against Contra Costa County must be itemized, giving dates and character of expenses incurred. Receipts are required for lodging, public transportation (other than local), registration fees, and items bought for others, such as meals and incidentals. Purchases for others must be identified according to person or party and relationship to county business. Travel by private auto -- indicate from where, to where, and return. Only actual miles. driven in the course of duties are to be claimed. If more than one trip to the same location is made in one day, the number of trips must be specified so the number of miles will not appear exaggerated. Miles under a Travel Request approved' by the County Administrator specifying a certain rate per mile must be separated from other miles and entered under '11n-lieu Miles" on the demand. Items of Expense - claims for meals. must specify the location or occasion. When a meal allowance is claimed .for overtime worked, the explanation should be '"meal allowance-overtime worked" and the number of hours. The verification statement on this form must be signed by the claimant. Each claim is to be approved by the Department Head or an authorized deputy of the Department. Head before filing with the County Auditor-. Controller for allowance. For further information, 'refer to Administrative. Information Memo No. 9.3 and your Departmental Manual. County Auditor-Controller Finance Building Martinez, California, 010nora Co sta COV011, VED AP 1990 Klee 4z ent . ♦ Counsel •I� CLAIM county BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA 1990 M AY Claim Against the County, or District governed by) OARD 0 X53 the .Board of Supervisors, Routing Endorsements,, ) NOTICE TO CLAIMANTS l 9 0 and" Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $150,000.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: DUNN, Peggy 105.0 Oak Street ATTORNEY: Martinez, CA 94553 Date received .ADDRESS: Paralegal/Legal Assistant Services BY DELIVERY TO CLERK ON May 8, 1990 (hand delivered) P.O. Box<:766, Court Station Martinez, CA 9455.3-0766 BY MAIL POSTMARKED: 1. FROM: Clerk of the Board of Supervisors TO: County ,Counsel Attached is a.copy of the above-noted claim. PpHHIL BATCHELOR, Clerk DATED: May 8, 1990 BY: Deputy II. FROM: County'Counsel TO: Clerk of the Board of Supervisors —(y ) 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: _ ..J 9 G BY: f < \� S Deputy County Counsel Ti 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 OR 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:D DIN 1 2 1990 PHIL BATCHELOR, Clerk, ByDeputy Clerk WARNING CGov. code se -h/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: JUN 12 I990 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator I Peggy Dunn 1050 Oak Street 2 Martinez, CA.. 9.4553 (415) 370-0588 ►oC 3 MAY Claimant, in propria persona. PHIL BATCHELOR 4CLERK L •.RD Of SUP[:VISORS 2A COSTA CO. 4 D-- 6 -6 7 8 BEFORE THE BOARD OF. SUPERVISORS 9 COUNTY OF CONTRA. COSTA . 10 11 In. Re: ) Claim No. 12 Claim of PEGGY DUNN, Claimant, ) CLAIM 13 Against the COUNTY. OF CONTRA ) COSTA, Merrithew Memorial Hospital, ) [Gov't. Code § 911. 2] 14 DOE Doctorsl` 25, inclusive. ) 15 .. 16 17 The undersigned claimant hereby.,makes a claim, against.the County of Contra 18 Costa and Merrithew Memorial Hospital (aka "County Hospital", formerly 19 known as Contra Costa County Hospital) , DOE Doctors 1 - 25,' inclusive, in 20 the sum of $150, 00'0.'00. . ., r F. 21 In support.of this claim, claimant represents: 22 1. ) Date of Injury.: ..-The-injuries ° occurred: 23 a.) first in . 1982 (or 1983) . * when claimant had an ectopic 24 pregnancy in her left fallopiani.,tube-,,and was treated at Merrithew Memorial 25 Hospital for removal of same; after removal of the ectopic pregnancy: 26 * Dr. Graham's records list the first ectopic pregnancy in 1982; Mt. 27 Diablo Medical Center's records list it in 1983; Dr. Graham's .records list the second ectopic pregnancy in 1983; Mt. 28 Diablo Medical Center's records list. it in 1984; the correct answer lies in claimant's medical records at Merrithew Memorial Hospital. Claim against Contra Costa County - page 1 . mss- 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 JUNE 12, 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: $500.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: WESLEY, Colinda ATTORNEY: Date received ADDRESS: 52 Alvarado Avenue BY DELIVERY JO CLERK ON May 18, 1990 Pittsburg, CA 94565 BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: May 18, 1990 EVIL BAATTCHELOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of SOITervisors 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: y: BY: I J ' 21 Deputy County Counsel Dated: 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 OR R: 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: . JUN 9 2 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: UN 12 199U BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator BOARD OF SUPERVISORS , CONTRA COSTA COUNTY , CALIFORNIA AFFIDAVIT OF MAILING In the Matter of ) Claim of Colinda Wesley ) ) ) I declare Linder 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 iX kki((X1XcoPy of the Board Order certified on June 12 11:990 and previously mailed to the below listed claimant on June 12 , 1990 . to the following ; Colinda Wesley 52 Alvarado Avenue Pittsburg, CA 94565 I declare under penalty of perjury that the foregoing is true and correct. Dated June 18 , 1990 at Martinez , California . Ann Cervelli , Deputy Clerk 3 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 JUNE 12, 1 99 0 and Board Action. All Section references.are to. ) The copy of this document mailed to you is your notice of Cali-fornia Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph, IV below), given pursuant to Government Code Amount: $500.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: WESLEY, Colinda ATTORNEY: Date received ADDRESS: ' 52 Alvarado Avenue BY DELIVERY TO CLERK ON May 18, 1990 Pittsburg, CA 94565 BY..'MAIL POSTMARKED: I. FROM; Clerk of the Board of.Supervisors TO:. County Counsel Attached is a copy of the above=noted claim. pH • gg DATED: May 18, '1990 �aIL DeputyLOR, Clerk II. FROM: County Counsel TO: Clerk of the Board .of S011ervisors 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 GBY: I J i Deputy County Counsel V III. 'FROM: Clerk of the Board -TO: County Counsel (1) County. Admim strator (2) (._ Y Claim was returned as untimely with notice to claimant (Section 911.3).. IV. BOARD OR R By unanimous vote of the Supervisors present ( ) This Claim is rejected. i'n 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: JUN 1 2 199f HIL 'BATCHELOR, Clerk, 8y , 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 i.n 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 la's shown above. . Dated: JUN 12 •`�9nn JtJ BY: PHIL BATCHELOR by Deputy Clerk CC.: County Counsel County Administrator --46_5 coe�4�_ 0-040 On �L `�- w tit C� RECEIVED M AY 1 8 1990 VHII SATCHEICR ! Ci.ERK BOAR F SUPeRVISORS COSTAE CO- PROPERTY/CLOTI-LING RECEIPT I 1• CONTRA COSTA,-COUNTY CQTY REC. �JO.^K � � �.' j ka Elul L..}} ( ! HACK MCF ! DATE: ;- —I�—jI -- �: MCDF TIME: —. _- - ----- —---- ; rH [iox —� _WFC BOOKING NBR:`-1; ) _ ( =:> >,—� \ -- `OTHER --- i .;�r�ti4�r�i -•`.'�^ �i F��vv°i� "{�,s'�"���a �,�i� �c�`;�iri�4k1^n ,' �* �*�c� � N' ��� r'_��, ("'ASH: �r h ❑ SHIRT/BLOUSE ❑ DRESS ElGOAT/JACKET IIE/SCP.R1= ❑ 4iORTS/PANTIES ❑ JEWELRY,---. j ❑ SOCKS/NYLONS ❑].SWEATER/SWT. St'tIRT V'JATCIt {. i ! I .>'{ r C. ❑ BELIE, M,"PAN'TS/S1G,IFiT4�•.,,.�, --- -------- -------------- , ❑*"•T S' MY/ „�_❑ WALLET [] HAT/PURSE ❑1KFYS I 10 K1\114 ? �`; :ii ❑?GI-ASSES ❑ OTHER ry -- ----- — — I BKG OFC•r'4'� ;��',' .d: ? Iii-L?. -----}, — � , IN SIGNATURE � L+Fa as' 7t`-' -n d •rot. (�gy`g�` '� r„Ja 4`�,a". i } "tm ��'.. '.. I. I havo 4 re nide I all rl f nn 1,3y.. DATE: sonal ;property and clothing. I RE L OF C:--------- - - X .3 TAII�i;i BOARD OF SUPERVISOI-',�,' C)J' "NIP" lnstrncti.rri­s toa, pjiaf��-L. rc; A. Claims relating to-causes of acticTi fz:.-,r -CO' person or to personal property or x(,.`JS­t 1- ,.resented not later than the 100'th day afte.- the ti--ie cz,:Lse of action. Claims relating to any cihE-T.- Of -bc:tjon must be presented not later than o n e v e a r,�"al 1 tz. i tb;-f', a c c a:,,a a 1, c,,1 t�.,a cause of action. (Sec. 911. 2 , Govt. Cc3ej B. Claims must be- f-iled with the Clea-} r>f tbe. L-o-ard of Supervisors at its office in Room 106 , Couy,L); 651. Pine Street, Martinez , California 948-53 , C. If claim is against a district gc.-,7eT-nECi b­., -Eiie., Boald or '.;uoe-rvisors , rather. than the County, the name of the DJLst:r.i:c.t _qhc:,ja Lj. hE 'ilied `n. D.' If the claim is against more than one claims must be filed against each. public 'ent.-itj*_ E. Fraud. See penalty for frauduler.,.t c-laims,, P&,n_-3. Cc-,Jc' Sec., 72 at end O-f t1lis form. RE: Claim by ) P:a.served for .111Lla stamps RECEIVEIJI Against* the. COUNTY OF CONTRA COS`1z;k MAY 18 1990 PHIL BATCHELOR or DISTRICT) CLERK OARD OF SUPERVISORS C COSTA CO. (Fill in name) Dellu� L7 The undersigned claimant hereby makes the I Ci_-j=t t,,,, of Contra Costa or the above-named District in t3-y-e :soar iDf- 600," and in Support Of this 'claim 'represenits •-as' f.v1LcTws-z ------------- 1. When did the damage or injury occ-.,=? ('G i.-VE! E" act cRitE .a.P6 hour) 2. b Where dhe damag or inju il '/1_Cv1"-q co 100 __V----------------- 3. How did the damage or injury occur? =(Giire f-,,oll (5et:.ad.3s-1, u.se ej:tra 7 sheets if required) O&A kk&71 In ffSo ', &nl rAL ai0AeS ,0L^CJ / /4(&t.4 PCtb 611115 CAJR:5 -,T C"y 0i t4t� lny= tip_ "il l� 0/-- &LA- Aa-d 174JO 0-'*,,64-� lqL 74e P41 &-,o- �Z< - S, Av 4 . What particular act or omission 013, b-, district Off , :)r employees c officers , servants Z 6� � r^ t1Ju c,� �o e �p sGU j2,11L3 _Ss 14,Lf-d MAJ h_e, s4-k6 . Lover) b JL cczt,/4,- o--( �-Act-1 U� .:k ''p GENERAL ACKNOWLEDGMENT State of California On this the 1 5tWay of May 1g 90,before me, SS. County Of ContraCosta SUSAN J. ROBERTS the undersigned Notary Public,personally appeared COLINDA.WESLEY OFFICIAL SEAL ❑ personally known tome SUSAN I ROBERTS �proved to me on the basis of satisfactory evidence v ry NOTARY PUBLIC—CALIFOP,NIA COWRA COSTA COUi4TY to be the person(s)whose name(s) is subscribed to the My commission expires May 13,1991 within instrument,and acknowledged that she executed it. WITNESS y hand and official seal. Notarys Signature M /Commission expires May 13; FORM G.A. HOPKINS LEGAL FORMS,2328 FRUITVALE AVE.,OAKLAND,CALIF. . PHONE(415)532.1972 ,', �_• zat. ar.e..the._names of county or district of_`icers , servants or employees:: causing the damage or injury? ` _ o rn �ssr Ul5 l - ---- 6 . -OTIat �d_am-a-ge-or injuries do you claim resulted?r (Give full extent of injuries or damages claimed. Attach two estimates for auto damage) -------------------------------- 7 . How was the amo nt claimed above computed? (Include the estimated amount of any rospective injury or damage. ) �24n� r,-s� Qne.. O(z(oz, y F5. Na3Tl-S and aGC�r SSeS-of wltnes.pc;s , Q-c�orS and 11-3,3 itals .^- -_ _------ 2� 3� s-�µ Q �C fq c'e 'Yh h�A b46-516-123 Sq 4-eA-C4 06/t, n 2 e2 . 9Yv26 ------------------------------------------------------------------------- j.. 9 . is the expenditures you made on account of this accident or injury : s DATE ITEM 1-MOUNT c�� 1�� lQ�� mss P�ln�j von _02> t Govt. Code Sec. 910 . 2 provides : "The claim signed by the claimant SEND NOTICES TO: (Attorney) or by some aerson on his bei7al.f. ' ie and Address of Attorney Cl/ Claimant ' Signature �Jddre�s $a Telephone No. - Telephone No. NOTICE Section 72 of the Penal Code provides : "Every person who, with intert to defraud, presents for allowance or for payment to any state, board or officer , or to any county, town, city ,j district, ward or village board or officer, authorized to allow or pay the same if genuine , any false or fraudulent claim, bill , account , voucher, �� or writing , is guilty of a felony. " Iq . .. 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 . JUNE 19, 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: Unspecified' Section 913 and 915.4. Please note all "Warnings CLAIMANT: WTLLIS, Rufus Charles ATTORNEY: James T. Reilly Attorney at Law Date received ADDRESS: BY DELIVERY TO CLERK ON May 18; 1990 (hand delivered) 239 Miller Avenue Mill Valley, CA 9.4941 'BY MAIL POSTMARKED: _ 1. FROM: Clerk of the Board of Supervisors TO County Counsel Attached is a copy of the above-noted claim. DATED: May 21, 1990 ppNNIL ATCHELOR, Clerk -B.Y: 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: �1 �tG BY: ) ' Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV: BOARZThi By unanimous vote of the Supervisors present ( 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. q p(1. Dated: J UN 1 2 1990 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code se ti 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: JUN 12 1990 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator JAMES T. REILLY N.11AY 1 3 1990 Attorney at LawLEM 130 239 Miller Avenue CON;TRG. Mill Valley, California 94941 415-383-5080 Fax: 415-383-7665 May 17, 1990 'NALORiGiff CLAIM FOR DAMAGES AGAINST THE COUNTY OF CONTRA COSTA and THE CONTRA COSTA COUNTY SHERIFF'S DEPARTMENT (Government Code Sections 910, 911.2 and 915) To: Board of Supervisors, County of Contra Costa 651 Pine Street Martinez, California 94553 The following claim for damages is hereby presented on behalf of claimant RUFUS CHARLES WILLIS. 1. Name and Address of Claimant: RUFUS CHARLES WILLIS c/o JAMES T. REILLY, Attorney at Law 239 Miller Avenue Mill Valley, California 94941 (Please Note: for security reasons related to his testimony as an informant in the case of People v. Johnson, Masters and Woodard, Marin County Superior Court Case No. 10467, Mr. ' Willis is presently being housed in a confidential location. It is therefore necessary for all contact regarding this claim to be directed to my office address. ) 2. Send Notices to Counsel for Claimant: JAMES T. REILLY, Attorney at Law 239 Miller Avenue Mill Valley, California 94941 Telephone: 415-383-5080 No man has greater courage, honor and integrity than he who forthrightly accepts responsibility for his actions, regardless of the consequences. © 1985,JAMES T.REILLY Claim of RUFUS CHARLES WILLIS for Damages against the County of Contra Costa and the Contra Costa County Sheriff's Department (Government Code Sections 910, 911.2 and 915) May 17, 1990 Page 2 3. Dates of Occurrence on which claim is based: November 18, 1989 to approximately December 11, 1989 4. Place of Occurrence on which claim is based: Contra Costa County Jail 5. Names of Public Employees Causing the Injury, Damage or Loss: The names of the individuals .responsible for claimant's injuries are not known to claimant. His injuries were caused by a slip and fall in the shower of the Contra Costa County Jail at Martinez, which resulted from apparent failure on the part of Contra Costa County Sheriff's Department personnel to properly repair and maintain the shower stall. Claimant was also repeatedly denied proper medical attention and treatment by the jail medical staff. - On one occasion, a written "Sick Call Request" was returned to him unsigned by a nurse known to him as "JUDY", who indicated that he would "just have to learn to live with" the pain he was experiencing in his back. 6. Circumstances Giving Rise to the Claim for Damages: On November 18, 1989, at approximately 7:00 p.m. , Claimant was released from his assigned cell (D-2-B) for an hour of "free time" . He immediately went from his cell to the shower room. As he stepped into the shower room, he slipped and fell on his back. Claim of RUFUS CHARLES WILLIS for Damages against the County of Contra Costa and the Contra Costa County Sheriff's Department (Government Code Sections 910, 911.2 and 915) May 17, 1990 Page 3 After falling, he noticed that the outer shower room floor was covered with water, that the shower was spraying water out onto the outer shower floor and that the door to the shower would not shut properly because it was broken. When he discovered that he could not get up, he requested assistance from another inmate (DANIEL RODRIGUES) , who summoned officers and nurses. At this time, Mr. WILLIS$ back was in con- siderable pain and he could not move. He was also feeling numb- ness in his legs. Trustee inmates (believed by claimant to have been JOE PULIDO and PAUL EDWARD WHITE) were then detailed to turn off the shower and clean up the area. About 20 minutes later, claimant was placed on a piece of plywood and a stretcher. He was then taken by ambulance .to Merrithew Memorial Hospital. After his return from the hospital, Mr. WILLIS continued to suffer from back pain and numbness in his legs. On at least four occasions he submitted "Sick Call Requests" , asking for medical treatment. In each case, his request was ignored or denied. On December 22 , 1989, Mr. WILLIS was transported from the Contra Costa County Jail to a confidential housing location. 7. Description of Injury, Damage or Loss: As a result of these injuries, Mr. WILLIS suffered from back pain, numbness of his legs and headaches, which continued for more than thirty (30) days after the incident in which he was injured. Claim of RUFUS CHARLES WILLIS for Damages against the County of Contra Costa and the Contra Costa County Sheriff's Department (Government Code Sections 910, 911.2 and 915) May 17; 1990 Page 4 S. Amount of Claim: In accordance with. California Government Code section 910, sub-division (f) , claimant states that the amount of his claim exceeds $10,000, and he therefore does not include in this claim a specific amount of damages. Furthermore, he states that the amount of his claim does not exceed $25,000 and that it is therefore within the jurisdiction of the Municipal Court. Submitted on behalf of claimant RUFUS CHARLES WILLIS by counsel: Date: May 17, 1990 T. REILLY, Attorney at w Counsel or RUFUS CHARLES WILLIS Wi11CoCo.910TortClaim