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HomeMy WebLinkAboutMINUTES - 03101992 - 1.1 (2) CLAIM Rt%;EIVED BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA F E B 14 1992 r Iq i,.Against the County, or District governed by) BOARD O N the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT March 10,%4ft J SQ GtLlf. 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: $2,000,000.00 Section 913•and 915.4. Please note all "Warnings". CLAIMANT_Ys,ANCHEL., Veronica ATTORNEY: Date received ADDRESS: 628 Alabama Street BY DELIVERY TO CLERK ON February 12, 1992 Vallejo, CA .94590 BY MAIL POSTMARKED: Hand delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ��IL' gATCHELOR, Clerk d DATED: February 13, 1992 : Deputy I 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 clai,mant's.right to apply for leave to present a late claim (Section 911.3). ( ). Other: Dated: 2192 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 ( his 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. t9 Dated: MAR 10 1992 PHIL BATCHELOR, Clerk, By ODeputy 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 0 1992 BY: PHIL BATCHELOR b 01 "Deputy Clerk CC- County Counsel County Administrator CLAIM FOR DAMAGES TO: The Clerk of the Board of Supervisors Contra Costa County 651 Pine Street Martinez, CA 94553 NAME OF CLAIMANTS: Veronica Sanchez 628 Alabama Street Vallejo, CA 94590 ADDRESS TO WHICH NOTICES SHOULD BE SENT: Veronica Sanchez 628 Alabama Street Vallejo, CA 94590 CLAIM PRESENTATION DEADLINE: February 13 , 1992 NATURE OF CLAIM: Claimant is a 26 year old female who delivered a child on August 5, 1991, at Merrithew Memorial Hospital. The delivery was performed by Judy Rubin, M.D. , an employee of Merrithew Memorial Hospital. On August 13, 1991, claimant learned that some placenta had not been delivered. Claimant underwent a D&C (dilation and curettage) on August 14, 1991. Since that time, claimant has continued to experience pain and vaginal spotting. INJURY CLAIMED: Pain and vaginal spotting and possible other damage, the full extent of which is not known at this time. DAMAGES CLAIMED: Lost income, medical bills and general damages. EMPLOYEES RESPONSIBLE FOR EVENTS: The names of each of the clerical and/or nursing staff employees who are responsible for these events are currently unknown to claimant. Dr. J. Rubin is one of the physicians who is responsible for this action. Claimant does not know the names of the other physicians who are involved at this time. AMOUNT OF CLAIM: $2, 000, 000. 00 Veronica Sanchez CERTIFIED: RETURN RECEIPT REQUESTED ECEIV.ED EFBI192R CONTRA COSTA CO. SORS 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 10, 1992 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 me;Board�of�Supervisors (Paragraph JV below), given pursuant to Government Code Amount: $2415.85 Section 913 .and 915.4. Please nofta 1 "W r " CLAIMANT: BLANC, Brian QQUNTY COUNSEL MARTINEZ, CALIF. ATTORNEY: Date received ADDRESS: 754 Navaronne"W4y BY DELIVERY TO CLERK ON February 11, 1992 Concord, CA 94518 BY MAIL POSTMARKED: Via Risk Management I. FROM: Clerk of the Board of Supervisors TO: -County Counsel Attached is a copy of the above-noted claim. DATED: February 11, 1992 PpHHIL ATCHELOR, Clerk BY: Deputy _ Oif 4L4'V 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: I1 Z 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 (tom 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..._- OL Dated: MAR 10 1992 PHIL BATCHELOR, Clerk,. By a 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 No LOL,.Deputy aimant, addressed to the claimant as shown above. (-I Dated: MAR 10 1992 BY: PHIL BATCHELOR by 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 causesTof 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.Supervisor& 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., 7Y 7i X :4 ii c R R- .:A N ..• if R n if. .F R if 7f X. 7f 7f F R. 7f 1{' . RE: Claim By ) Reserved for erlts i ing •stamp �,:�►� I�►.�c� � RECEIVE � Against the County of Contra Costa N or ) FEO l 1 1992 District). CLERK BOARD OF SUPERVISORS (Fill in name) ) "CONTRA COSTA CO. The undersigned claimant hereby makes claim.,aaainst the County of Contra Costa or the above-named District in the sum of $ and in support of this claim represents as follows: —N--N—_ N--------N— 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did .ehe damage or 'injury occur? ,=(Include, city-and county) 3. How did the damage or injury occur? (Give.full'"details; ;use .extra paper .11f required) 1N1� 6►� i 5. What are the names of county or district officers, servants or employees causing the damage or injury? G�sAN � fy a� SS Tf �L , C'oa1z � 5. What damage. or injuries .do you claim resulted? (Give full extent of injuries or damages claimed: Attach two estimates for auto damage 1 o Y• f� �a ��i� ���d q� . 5� �rsff�� u�Mt�� c�as • {-�t�J • �r , t��l�Fs,wt-�-�.ls %45 . � N----------------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective .injury ore.) 6L ! . c sa r.�•9,J �o aQ r -tl+ $. - Names and addresses of witnesses, doctors and hospitals. -------------------------------------------- .-NN----------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov. Code Sec. 910:2 provides: �m "The claim must be signed by the claimant SEND NOTICES JTO-.,, � tcrne ).,.;331-, orb some person on his behalf." Name and Address Cof.�At-to"rney..---'-—.i lai is Signature Address Telephone No. Telephone No. NOTICE Section 72 of the Penal ,Code provides: "Every person who, with intent to defraud, presents for allowance or -for payment to any state board or officer, or to any county, 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—M0,000, or by both such imprisonment and fine. SPRINGS & �BERTINO COLLISION CENTER (415) 935-8870 754 NAVARONNE WAY 1982 VOLKSWAGEN CONCORD SCIROCCO SILVER ' CCA. 94518 VLICENSEo_ 2YUC006 N ' U ( } 356-692 4 E V IN No. o WVWCA0538CK013410 S T ( ) - EXT: HPR.DATE- 10/81 U POLICY No. O ( } - EXT. I PT.CODE- R CLAIM No. MREFERRED BY: PREY OUST �TM.CODE- A INSIDE ADJ. a EESTrMATQR d KEN REYNOLDS. EBD STYLE COUPE N OUTSIDE ADJ. -. RINDEPENDENT MILEAGE: 125520 E DEDUCTIBLE INS. CONTACTi P.O. No: DATE OF LOSS: ! ! ADJUSTER . UNIT No: PHONE No. of } CLAIM No. EXT. EXT: 01 VISUAL DAMAGE • REPORT • The elements of data used to calculate this estimate were obtained from a Mitchell International Barcode Database. Calculations of the estimate are performed by a computer program created by Akzo Coatings Inc. (C) 1990 Mitchell International, Inc. 1 M REMOVE/REPLACE COVER FRT BUMPER 231.65 1.3 1.5 2' M REMOVE/REPLACE LENS k HOUSING, PARK/SIGNAL 73. 15 0.3 LAMP L 3 M REMOVE/REPLACE FRAME H/LAMP L 110.65 0.5 4 M -CHECK/ADJUST HEADLAMP'S ADJUST 0. 5 5 STRAIGHTEN RADIATOR SUPPORT 2.0 6 FRAME TIME SET-UP 2. 0 7 FRAME TIME PULL AND SQUARE f 3. 5 8 M REMOVE/REPLACE FILLER PANEL, FRT BUMPER L 72.30 0.3 0. 5 9 REPAIR HOOD t 1.0 2.9 10 M REMOVE/REPLACE PANEL FENDER-L 36`°45 2.3 _ 2.8 11 M REMOVE/REPLACE PROTELT MOULDING, FRT FENDER 18.65 0.2. R 12 R & I GROUND EFFECTS L/F 1.0 1.5 13 ADDITIONAL TIME ALLOTTED FOR 2 STAGE PAINT 2.5 14 MATCH PAINT 0.5 15 COLOR AND POLISH. 0.5 16 BLEND ADJACENT PANELS 1.0 17 R AND I PARTS FOR PAINTING. 5.0 `' 18 CAR BAG PROTECT FROM OVERSPRAY 5.00 0.4 19 HAZARDOUS WASTE REMOVAL 5.00 20 MISCELLANEOUS BODY MATERIALS (AUTO) 0.00 21 PAINT MATERIALS =57.40 M=Mitchell (*)=Estimator5 Judgement TOTALS 0 868.85 62.401 5.00 1.19.9 14. 1 0.0 BAR AA 158262 ESTIMATE PRINGS T SIR ,"RA PAINT/MISC 262.40 SUBLET 00 SINCEBEl�TINO BODY LABOR 748.80 @t52.001961 FRAME PAINT LABOR 733.20 @$52.OO MECH LABOR .00 $5;r 0 COLLISION CENTS TOW 00 .00 :A (415) 935-8870 DETAIL TAX 93.33 FAX (415) 935-1333 DEDUCTIBLE 1413 CARLBACK AVENUE i. INS. PAYS OUST. PAYS WALNUT CREEK, CA 94596 ^s*tet- I hereby authorize the above repair work to be done along with the necessary material. I agree that you are not responsible for loss or damage to vehicle or articles left in the vehicle in case of fire,theft or any other cause beyond your control or for any delays caused by unavailability of parts or delays in parts shipments by the supplier or transporter. I hereby grant you and/or your employees permission to operate the above vehicle on streets, highways or elsewhere for the purpose of testing and/or inspection. An express mechanic's lien is hereby acknowledged on the above vehicle to secure the amount of repairs thereto, and I further agree to pay reasonable attorneys',fees and court costs in the event of legal action is necessary to enforce this contract. acknowledge that the total estimate of repairs includes all parts, labor, handling and diagnosis and agree that, if closer analysis finds that additional repairs are necessary,I will be contacted for authorization if the amount I must pay will be increased. Revised EST. Time Date Phone OWD By Accepted By Date POWER OF ATTORNEY: For consideration of repairs made to this vehicle, I hereby grant my POWER OF ATTORNEY to sign or endorse any checks and/or drafts made payable to me,and any release'thereto,as settlement for my claim for damage to this automobile. Authorized by X Date Received by Date UM tstimate Report - 7635 NAME DATE BUS.PHONE ADDRESS +' STATE �" �'-r ZIP PHONE RES. �� -'��/� YEAR MAKE ��J��M�EL� I.D.NO. ' PAINT CODE PROD.DATE TRIM MILEAGE LICENSE NO. INS.CO. CLAIM NO. R.O.NO. ADJUSTER PHONE Deductible/Betterment pair P ace • 0 • • :• • 2 ! 8: - a J� -3 4 4 y { �' 5 �C -of—, fi?c'��K d � /o 6 X, I.,-/— c-7z- 'z' L 7 V v 8 9 10 2 v �f 1 1 chi O 12 13 14 `� ® 1 15 16 Q 17 18 19 20 21 22 9 23 71 24 25 26 27 28 29 301 1 WRITTEN BY TOTALS I hereby authorize t above work and acknowledge receipt of copy. Signed X P. 0. NO. n�� • PARTS Prices subject to invoice $ d L A B 0 R �• rs. @ $� t,P$ C> BRAN ER @ S LOA N E Shop Supplies $ (` PAINT hrs. @ S $ MOTORS, I N C. Paint Supplies $ A5EN,�� Towing/Storage $_ 1840 No. Main St. Sublet/Miscellaneous $ WALNUT CREEK, CAL. 94596 va SUB TOTAL $ Phone 934-8224 Direct Line 934-8575 ` TAX $ TOTAL ESTIMATE $ 885-07633 NORICK OKLAHOMA CITY 10 27 CONCORD POLICE DEPARTMENT SPECIAL CONSIITIONS NUMBER HIT&RUN TRAFFIC COLLISION REPORT INJURED FELONY ov e7n,!51, 4-71 0 ❑ Fc g No. 7 2;— 7,;t 7 frL VEHICLES NUMBER HIT&RUN COUNTY I 2 DATE & TIME REPORTED PAGE CITY POLICE OCV ALL KILLED MISD E�E,j)• OT KER ❑ Contra Costa / g 9Z /753 / of ,� CLASSIFICATION �C DATE & TIME OCCURREDNCIC NO. OFFICER 1.0. NO. /•P� c�iv6in/t' V.s. f�"�.�.�Eo �9c>,ra. / g q2 /7�3 0704 29/ OCCURRED ON: PRIMARY STREET SPEED DAY OF WEEK TOW AWAY STATE HEY PHOTOS LIMIT R °-° ,S.9r✓ //yJEO �� �'.S S M T W®F S ( Noi ( )Noi Ives C AT INTERSECTION WITH (SECONDARY STREET) SPEED ID SUPP .J ® OR: —5z (9p MILES N 8 E W OF T �/ LIMt� ❑ DRVR DRIVER'S LICENSE NO, I STATE CLASS J.,, SAFETY VEH.YR. MAKE/MODEL/COLOR LICENSE NO. STATE �7X/ CdoS�SJ�T' G%9 4 . . . . P PEP NAME (FIRST,MIDDLE.LAST) A LIS: e-1-L iN�9 13c�A CFd (J.v/rte /L7 PKD STREET ADDRESS OWNER'S NAME ( )SAME AS DRIVER R VEH T 2gSSE�-r Esc G�o�vsoci�.sjr�o .�i�PF Z�i�sre��JJ" y BIKE CITY/STATE/ZIP OWNER'S ADDRESS ( SAME AS DRIVER �oivco.e� CA o1�SZ0 OTHR SEX HAIR J�HGHT WGHT 31RTHDATE RACE DISPOSITION OF VEHICLE ON ORDERS OF: ( )OFFICER. DRIVER . DAAAV • YEAR /� '� /�` //� /y� / j�tI �/o // `s 63 ev �/Vf.� /e' ell -% -[iIVG• .` )DTNER HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: h4%ONE APPARENT I )REFER TO NARRATIVE ( ) ( �7o) 9-?0- {�O TOWED BY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED �/ r+ AREA: INSURANCE CARRIER POLICY NUMBER )UNK )NONE MINOR r• FI G: I IMOD ( )MAJOR ( )TOTAL DIR.OF ON STREET OR HIGHWAY PCF ICC ' TRAVEL ��'J ��/ �yPUC S �� /i'I f/FY f/ 22—/0 7 CHP ( I DRVR DRIVER'S LICENSE NO. STATE CLASS SAFETY VEH.YR, MAKE/MODEL/COLOR LICENSE NO. STATE EOUIP. PED NAME (FIRST,MIDDLE,LAST) .2 A PKV STREET ADDRESS OWNER'S NAME ( )SAME AS DRIVER R VEH T BIKE CITY/STATE/ZIP OWNER'S ADDRESS ( )SAME AS DRIVER v 2 OTHR SEX HAIR EYES 111GHT JWGHT I BIRTHDATE RACE DISPOSITION OF VEHICLE".ON ORDERS OF: )OFFICER (.)DRIVER MO. DAY YEAR OTHER HOME PHONE //�� BUSINESS PHONE PRIOR MECHANICAL DEFE CTS: VINONE APPARENT ( IREFERTONMMTIVE (�4) ?L�L� iQ�2 ( ) TOWED BY DESCRIBE VEHICLE DAMAGE SHADEAREDAMAGED INSURANCE CARRIER POLICYNUMBER �"� 'f; r.J )UNK ( )NONE ( )MINOR fXjMOD )MAJOR ( )TOTAL —SI' DIR.OF I ON STREET OR HIGHWAY PCF..:_, ICC TRAVEL ' "•r� • •:`i v i i_. ;r i• 14,44". (,;)_J. DRVR DRIVER 5 LICENSE NO. STAVE' IC LA¢S SAFF-T-Y.y 'H.YR. 1 M ML�AA/O DCR 4�.0 R tt i i P� LICENSE NO. STATE v,,. t /•„.<�: :y r fir. . . . . . . . . . . . . . . . PED NAME (FIRST,MIDDLE,LAST) 1 hiI1�Et"(i A a : PKO STREET ADDRESS OW R'8 NAME SAME AS DRIV ER R VEH � Y BIKE CITY-/STATE/ZIP �l OWNER'S ADDR�$S A P S D IVER 3 OTHR SEX HAIR EYES HGHT WGHT B IR�p•,•S^�1d•�A(1ZlJ 0 s(�[� DISPOSITION OF VEHICLE ON ORDERS OF-: ( )OFFICER ( )DRIVER. MO. I yVi1C6i TIJ wp (CII ( )OTH[R HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: ( )NONE APPARENT ( )R[FeR TO NARRATIVE ( TOWED( ) TOWED BY DESCRIBE VEHICLE DAMAGE SPADE IN DAMAGED AREA: INSURANCE CARRIER POLICY NUMBER )UNK )NONE ' )MINOR )MOD ( )MAJOR )TOTAL , DIR.OF ON STREET OR HIGHWAY PCF ICC ( I TRAVEL PUC ( ) CHP REPORTING OFFICER BEAT DATE & TIME REPORT WRITTEN ISUPERVISORAP,'ROVING 7W te� /- S- �i 'Z �0 2 3 CP-25-1 JUN 87 " CONCORD POLICE DEPARTMENT _...._. _.- .... TRAFFIC COLLISION CODING ., • PAGE DATE OF.COLLISION 9 TIME (240.00)) ,w( NCIC NUMBER OFFICER IVAJ NUMBER 9 MO. / -" 9 YEAR / / /4rM 0�/04 Zi I / I ♦ �/ OWNER'S NAME/ADDRESS NOTIFIED: PROPERTY ( YES ( NO DAMAGE DESCRIPTION OF DAMAGE SEATING POSITION OCCUPANTS: M/C BICYCLE=SAFETY EQUIPMENT EJECTED FROM VEH. _ 1 -Driver A-None in Vehicle HELMET L-Air Bag Deployed 0-Not Ejected B-Unknown 2 to 6-Passengers M-Air Bag Not Deployed 1-Fully Ejected 7-Station Wagon Rear N-Other DRIVER 2-Partially Ejected C-Lap Belt Used 8-RFIquired V-No 3=Unknown 9-Position Unknown D-Lap Belt Not Used W-Yes 230 Harness Used CHILD RESTRAINT 0-Other F-Shoulder Harness Not Used Q-In Vehicle Used PASSENGER i 4 5 6 G-Lap/Shoulder Harness Used R-In Vehicle Not Used X.No 7 H-Lap/Shoulder Harness Not Used S-In Vehicle Used Unknown Y.Yes J-Passive Restraint Used T-In Vehicle Improper Use K-Passive Restraint Not Used U-None In Vehicle ITEMS MARKED BELOW WHICH ARE FOLLOWED BY'AN ASTERISK (•)SHOULD BE EXPLAINED IN THE NARRATIVE, PRIMARY COLLISION FACTOR TRAFFIC CONTROL DEVICES 1 2 $ TYPE OFVEHICLE 1 2 $ MOVEMENT PROCEDING LIST NO. (*) OF PARTY AT FAULT COLLISION z A VC Section Violated: Cited: A Controls Functioning A Passenger Car/Station Wagon A Stopped 22/07 ( )Yes XNo B Controls Not Functioning* B Passenger Car With Trailer B Proceeding Straight it z B Other Improper Driving` C Controls Obscured 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 I D Unknown" E Pickup/Pane!Trk.W/Trailer E Makin Left Turn E Fell Asleep* A Head-On F Truck or Truck Tractor F Makin U Turn B Sideswipe G Truck/Trk.Tractor W/Trailer G Backing { WEATHER (MARK 1 TO 2 ITEMS) C Rear End H School Bus H Slowing/Stopping A Clear D Broadside I Other Bus I Passing Other Vehicle B Cloudy E Hit Object X I J Emergency Vehicle J Changing Lanes C Raining F Overturned K Hwy.Const.Equipment K Parking Maneuver D Snowing G Vehicle Pedestrian L Bicycle L Entering Traffic E Fog/Visibility Ft H Other M Other Vehicle IM Other Unsafe Turnip MOTOR VEHICLE INVOLVED WITH N Pedestrian N Xin into Opposing Lane { F Other`: G Wind A Non-Collision O Moped O Parked { LIGHTING B Pedestrian P Merging { A Daylight C Other Motor Vehicle Q Traveling Wrong Way B Dusk Dawn D Motor Veh,on Other RoadwayOTHER ASSOCIATED FACTOR R Other C Dark-Street Lights E Parked Motor Vehicle (MARK 1 TO 2 ITEMS) D Dark-No Street Lights F Train A VC Section Violation: Cited: E Dark-Street Lights Not G Bicycle Yes No Functionin H Animal: B VC Section Violation Cited: soBRlErr DRUG g" Yes No PHYSICAL ROADWAY SURFACEMARK 1 TO 2ITEMS A Dr I Fixed Object: CVC Section ViolatioYe$CiteNo A Had Not Been Drinkin H f 6 BD- n Influe en Under u e We c B t J Other Object: C Snow -Icy E Vision Obscurement C HBD-Not Under Influence` D Sli er (muddy,oily,etc.) F Inattention* I ID HBD-Impairment Unknown* ROADWAY CONDITIONS PEDESTRIAN'S ACTION G Stop&Go Traffic E Under Drug Influence* (MARK I TO 2 ITEMS) F Impairment-Physical* A No Pedestrian Involved H Entering/Leaving Ramp A Holes Deep Ruts` Crossing in Crosswalk i Previous Collision G !m airment Not Known B Loose Material on Roadwa B at Intersection J Unfamiliar with Road H Not Applicable C Obstruction on Roadway' C Crossing in.Crosswalk-Not K Defective Veh. Equip.: Cited: I Sleepy/Fatigued D Construction-Repair Zone at Intersection Yes No SPECIAL INFORMATION E Reduced Roadway Width D Crossing-Not in Crosswalk L Uninvolved Vehicle A Hazardous Material F FloodedE In Road-Includes Shoulder X IM Other': 1B Fire Involved' G Other': IF Not in RoadN None Apparent I IC Tire Defect/Failure H No Unusual Conditions' IG Approach/Leaving School Bus O Runaway Vehicle SKETCH: MISCELLANEOUS: INDIC NORTH v, TiPF�9T BG V2 z�P CP-28-2 JUN 67 CONCORD POLICE DEPARTMENT • _ FACTUAL DIAGRAM PAGE �o - S ATE OF,COLLISION9 �j ITIMCJI&oo) NCIC NUMBE-Rl f�,� - OFFICER I.D. NUMBER 9�j ^'� io. / Div vw. 9 / /� 0704 271 / G — /¢7 ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS TATED (SCALE • - . e9epxaxr.»Ast' INmcA lF i°J9C�0 /Z'—/Z T"�z �d rzil�Iz NowT 1 ! i - I /0 1, • Z� ;V, �. 14 Ile ( I I � 1 DRAWN BY I.D. NUMBER MO. DAY YR. REVIEWER NAME MO. DAY YR. ) 77126— \ 2Clr /_ c!_CJ JUN.7 PAGE /- 9- p2 19r- '09!30 tiT /7S'3 //o u 09r t <SCE�✓ �sr" F,.rT o.� .9 �m�N � G'.P � 9,2- 7�S' .� G✓.4r ,BC.9NC +4�/JC-7j /7j�' ?�i9r' c� Gf�' �/.CE' E�J6/i✓c �.5'/ .SG✓/f'�' /S S��E: /.�rrt;�s'�zT/O�✓ Oi �S".9.c/ �S//JJt �e /S�i✓U T.�797" O.� 7�' SCE�t/E .cO.P Fc/.�ry� ,�J�.�ii��7©•✓. �E�GGE �� Z>f/i».��"�'• • ?�t� /•P� /N� �9 rSC Tz''f✓E Go�J6 /N ;P a' /6 T �-�•A T/.Pty C C f3 G6IC.f0- 7n> r rG�E rd � r9r..�.y cam".' Ei�//f �Z yi�Q �9 1�7vT �'">"E7✓,�/ 6 .�o� �tT / o DF �'�e-" G��-"'T' �yEEL 7a Tic ,c.Po✓1!T 7�7C IAJ SES 'O l� 6 77 77�a" /i✓ �9CC/46W,7 Gkl SCE�/c �/o Tti.P�/c'Z� .�/6•�fy S/� �clrD .4.✓ <S/�7 �✓ doloe .SPORT OFFICE.1 J JBR�� AND TIME REPORT WRITTEN BUP RVISOR APPROVING TYPIST DATE AND TIME REPORT TYPED J a-100A SEP 84 - - "'• PAG E' O,c .S [CR 7 7l 72 = c;;,Ve- V . au.-9s let 14/o fit' iP/6♦}f 7a �i9�•� o97- �� ac E.Y / .5-�&txe 771��"' Grr�-►' I�iPO T O.�' (/Eric �2. S /O c�/i Z GJ•�3 .9.P.Et=b ./5y�1/O C/ f3't' O ��viotiU' /�,v C'p�yC'GccsipNf', �G7Z- � � .2� �9.s �� GEFT fi?G r OF l/c�'iGGG' ��• ' .�'!�C/�t/E OF 77?E7s�T �C ♦,/O /�F'ri�iT �� E�9�ST OF 7�f GJEST Sy S//yl�Z7i✓ T I�4T /mac%�iSC/.Pt�7� GJ/Q.S CoGG ON Nr/ G / //I/ T♦�i'SZedil.6r 4 �� F ♦ CC / �/D 6 .eair! O / T.Pr�3r Z •9T Seollew -5' uGGe' TJy�z' ,e/ f2.4e� i� ,Po�vr r.3/� l,�eS•9L.� f�flc?.��� !/rte/GGA'_ T'- �o cc�s�ov wgs �'.9r�f�� 6 ��= G/^.tS�'� 7z.�.�.vi�v ♦r�o Jr.7�/c;y✓r C ,i�%tN�N?70 J /C,ONE< REP ZSR BEAT JOATE=ND TIME �REPORT TEN SUPERVISOR APPROVING TYPIST DATE AND TIME REPORT TYPED CP-100A SEP �� 3 9 2 CLAIM RECEIVED J►�0" BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA A 1 4 1992 Claim Against the County, or District governed by) BOA D CT N the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT Marc NSR and Board Action. All Section references are to ) The copy of this document mailed to you is N &t�SIFbf California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $1,955.78 Section 913 and 915.4. Please note all "Warnings". CLAIMANT:!'•BIRO, Richard ATTORNEY: Date received ADDRESS: 1160. Folsom Street BY DELIVERY TO CLERK ON February 14, 1992 San Francisco, CA 94103 BY MAIL POSTMARKED: Nand delivered via Risk Management I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. IL gATCHELOR, Clerk O DATED: February 14, 1992 ��: Deputy avv,a.4 411 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: 11 J9 - BY: i S Deputy County Counsel , I . 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 (L- ) 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 1 n JQ§ 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 o 199 BY: PHIL BATCHELOR by 0, Deputy Clerk CC: County Counsel County Administrator Claim• tq: 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.Distriet•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 ) Res e ved f C rcIs filin tamp R CEI Against the County of Contra Costa ) FB 1 Q 1992 or.. ) . CIEf" BOARD OF SUPERVISORS District) . CONTRA COSTA co. Fill in name ) . ._ The undersigned claimant-'herebymakes claim airs the County of Contra Costa or the above-named District in the sum of $ _�,.5 7 a and in support of this claim represents-as-follows: ------------------------=N..N-.N.M.�N-------------------------------------------- 1. When did the damage, or injury occur? (Give exact date and hour) -.r-L.4 -....----M----------------- 2. Where did the,damage or injury occur? <(Include city and county) Co 1�'x /yyy///�T���H.r D z. �A �/ ,/� A✓) 0- ---- - M--N----rM--� --- 3. 'iiow did the damage or injury occur? (Give full details; use extra paper if tea', /oma required) l�1�1 Tev �•// p�[��:pvr� .. !` 7�J�� �a�:: ��- roc .o rr� �ok.�uL p/.�r� Ao.t,�, O --- ----- ---- --------------------------------r-r--------------- 4. What particular, act. or omission- on-the part of; county or district officers, servants or employees caused the-;injury or damage? f��G./ Akj ho � (over) 5. Wnat are the names of county or district officers, servants or employees causing the damage or injury? ------------------------------------------------------------------- 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.) ^a.lei .... --- - --- 8. Names and addresses of witnesses, doctors and hospitals. /ems Pira' ^1.41 A.Z , f.► ,X: .tc jt o ------ - - ----------------- ----- -------------------------------------------- 9. List the- expenditures you made on account of this accident or injury: DATE ITEM AMOUNT , 7f if 7f A 7f 7f R if .if 7f 1* *,R \ Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES TO:'-*(Attorne :)�)_ or by some person on,his_ behalf." Name and Address of Attorney (Claimant's Signature Address . . rA Telephone No: r Telephone No. 4:.*. * �t WO T IC E Section 12 •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, ($10,000, or by both such imprisonment and fine. J f: IMPERIAL AUTO PAINTING ESTIMATE AND 3'135 - 24th Street San Francisco, CA 94110 REPAIR ORDER Phone (415) 285-456 6 `2 / ® 0200 (415) 285-4797r SHEET NO. OF / SHEETS . — Car Owner f'Gr� Business Phone Date CITY Address Hepbone Est.No. Repair Insurance Co. f'/'(� o � Order No. I.D. Retain Customer Initial Adjuster Parts ^ Y MAK M E S EDOMETE e troy S ® DESCRIPTIONOF • OR LABO �® / tE7G`� •CSG 171 i— _ / l. r io/f 5e Ri s o %n .� lee 7Z /iii v— -- f IMPERIAL AUTO P INTI CHECK 41 oq 0101_ J O 0�yy HR/S.OF LABOR Q$ PER R.$ / l$ / 5,2 � p PARTS The above estimate is based on our inspection and does not cover additional parts or labor which' ` may'be required after the work has started.Worn or damaged parts,not evident on first inspection, ESTIMATE AMOUNT$ �p PAINT / may be discovered and you will be contacted for authorization for additional work. Parts prices 'MATERIALS - subject to change without notice.This estimate is good for days. - Revised Estimate$ BODY 'MATERIALS $........ .........insurance Deductible Estimator..................................._.......................... Customer'sUO.K.By . ACKNOWLEDGEMENT:Ihave read and understand the above estimate and authorize repair service �a SUBLET be performed, including sublet work and acknowledge receipt of this estimate. An express Time Date Called B WIIOm rr^^ mechanic's lien is hereby acknowledged on above car,truck,or vehicle to secure the amount of y �f/ TAX repairs thereto. ADVANCE THIS WORK AUTHORIZED BY DATE Deposit$ CHARGES TOTAL WORK ACCEPTED BY: - DATE Chgs.if not Repaired$ ©I/D/E/A inc.•Caldwell,ID 83605•CALL TOLL FREE 1-800-635-9261 *CODE N-NEW U-USED R-REBUILT ���� Item No.228809.1158 �/_ U t _'K______________ _____,___ _--__.-_-___ ____-___ ______ _____-___ _---___-_-_.___ _____�____ - _------________._ _ C FAX COVER.SHEET 4 sPectaL / INSTRUCTIONS COPY TO: Date/ 2 — Log No. ,, O Confidential ' Time: • S1 Number of Pages: O Urgent, (Including cover sheet) 0 Please reply TO: ), For your information Mr./Ms. oo/� 4v,;' 1 , r� MESSAGE: Of: Elr e d FAX#: / Mr,/Ms:' Address: FAX#` + If not received correctly, please call: PI-W.0 in U.S A.•: AAVORY 1588 REOPOfR YC.g2y3 - --•-------------'-------------------------------------------- --`--- ----------`----f-'--F^`------------------ P 0i D 2 x747367 xD � � NAME J r' ✓4�i V �/�`+.-- -- -- RTE -----�-- ' --- -.-�... .---.. . .� t._ � A CD vii w ADDRESS .v � CITY ST Z!P -'rp PHONE �Ge / J _ YEA MAK / I - -- L-�1/�.� / —._.—..._ - - O r a C7 r m ID NUMBER _ COLOR PROD.DATE �Q r 6 i•— k cc CD TRIM MILEAGE UG N0. INS.CO ^- m CD CD ADJUSTER LIC NO PHONE FILE NO. CLAIM NO r - - �- IFT.11 T , i jli tt I -i. �.. �G c• y`i-.� ^ a y, �iR 1r '_.i S a'�.- � >,' �. ��3.. u�..`g-'xla 5.1 � �, a y' 's�^•`l,a m l�. .� 1� r vl IS -I'Ivi [ r' f ° I;.I i I9 •� ro o �_I t i- � I ��� I I + ► r i � IT I f _ so o n x -o ris c c �' < e ^I.v I`° cC+e r � I I � � vi 1:7 oI� c nc} Znn = ilk :;I ? I�1E�`K V > > > o a C 1 I ul MaI � _ C _ + _ I i m a 4 3 = I I y 8 ? = i•.°'i u I} �S n K 1- w4 ID VC C ic I o.IV . i 3 _ _ 1 I Z _ F 3 0Q i', rn 2 l7 �1 "+ y$' C pp St — !T'7 r Gy w ?i 5 r z m u=w �. ",' ti •'I+i ^ L. I x� I ; , ;D !, .. @ _ I( O ('J �. i t •3jr in .die i j_ , 1 ti 11- LW It EEL— g',1968 UD/EIA inc. For.n No. 1009 I'DIE/A inc.,one VDIEJA Way,Caidwell,10 83605.99930?-CALL TOLL FREE 1-800-635.8281 r DACE COPY r` ,r 1 i dz9 a z w. G x w ry t iVNI � 1 k Y �+ F•'�.w., i C � � �q'� � �3" �7'^`s 4f 3�tf.��;`��°xr� ��Pc,"��3 � � is �SsY+t''. a� a t�'G�, z.�` •m''w`tn�.i r+� s d `0 t ,m� k as � x ,} T '` h Cox s a y '. a 4' p z r p i tv'" � 4*' �•-.wR W t :Sx<..rr ' "rd' >' k h S }➢ Taos• Y t f y` ^.. e a iv4i vt y a ^ �' .J o i -14 dyi' S,.t t { a o� 74 b,� E n CLAIM //0 A BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Clai*�Ag3inst the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT March 10, 1992 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: FIELDS, Betty RECEIVE® ATTORNEY: FEB 111992 _ Philip C : Gallagher Date received MichaelC .. Scranton ADDRESS: BY DELIVERY TO CLERK ON FebfqVt1VV4oL74sEL1992 A Professional Corporation F, 1200 Concord Avenue "Suite 26-0. by Concord, CA 94520 MAIL POSTMARKED: February 6, 1992 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim, ppHH Bg DATED: February 10. 1992 BYjI DepuLyLOR, Clerk ° C,)AW 01 AU II. FROM: County Counsel TO: Clerk of the Board of Supervisors �__N:J ) This claim complies substantially with Sections 910 and 910.2. ( l ) 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 11 9 2 BY: }. Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administfator (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: MAR 1 0 19-92 PHIL BATCHELOR, Clerk, By a , 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 1 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 Not'ce to Claimant, addressed to the claimant as shown abpve. Dated: MAR 1 0 .1992 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator • a I PHILIP C . GALLAGHER, Esq. p MICHAEL C . SCRANTON �.' RECEIVE® 2 A Professional Corporation 1200 Concord Avenue , Suite 260 1992 3 Concord , CA 94520 FEB — 7 ( 510 ) 682-7777 4 CLERK BOARD OF SUPERV CONTRA COSTA CO. 5 Attorney for Claimant BETTY FIELDS 6 7 8 CLAIM AGAINST PUBLIC ENTITY 9 10 In the Matter of the Claim of ) C'LAIM FOR DAMAGES } (Govt . Code Section 11 BETTY FIELDS ) '910 et . seq) 12 Against ) 13 COUNTY OF CONTRA COSTA ) 14 1 . I , PHILIP C . GALLAGHER, the undersigned, present this 15 claim for damages as a person acting on behalf of the claimant . 16 2 . I desire notice relative to this matter to be sent to my 17 following business address : 1200 Concord Avenue , Suite 260 , 18 Concord, CA 94520 . 19 3 . The name and address of claimant are : BETTY FIELDS , 20 3505 Gateway Road, Space 27-M, Bethel Island , California 94511 . 21 4 . The date and place of the occurrence that gave rise to 22 this claim are as follows : August 10 , 1991 at approximately 2 : 10 23 a.m. on State Route 4 , 1100 feet East of Byron Highway, in an 24 unincorporated area of Contra Costa County, California. 25 5 . The circumstances of the occurrence which gave rise to 26 the claim are : James Lee Fields , Jr. , deceased, son of claimant 27 BETTY FIELDS , was a passenger in a motor vehicle which crossed 28 1 the center line on Highway 4 , striking another vehicle head-on, 2 ejecting him from the vehicle , causing his death. Claimant BETTY 3 FIELDS contends that the County of Contra Costa through its 4 employees and agents , negligently and carelessly owned, 5 possessed, leased, operated , maintained, designed, constructed, 6 repaired, equipped, controlled , engineered , graded and banked 7 State Route Highway 4 at and/or near where the fatal collision 8 occurred. 9 Further, claimant BETTY FIELDS, contends that the 10 County of Contra .Costa by and through its employees and agents , 11 failed to properly select , train and supervise its employees and 12 agents . 13 6 . A general description of claimant ' s injuries , damages 14 and losses incurred so far as is now known are as follows : 15 Claimant BETTY FIELDS is the surviving mother of James Lee 16 Fields , Jr. , age 18 at the time of his death, deceased, and as a 17 result from the motor vehicle accident described above , claimant 18 BETTY FIELDS sustained damages for funeral and burial expenses , 19 medical expenses , loss of care , comfort , society, love , affection 20 and fu.ture support . 21 7 . If known, the name( s ) of the public employee( s ) causing 22 said injuries , damages and losses is/are : Unknown at this time . 23 8 . The amount claimed as of the date of presentation of 24 this claim consists of general damages and special damages 25 relative to claimant ' s injuries and property damage and loss of 26 use of same in amounts unknown at this time but in the aggregate 27 not less than $100 , 000 . 00 and exceeding the jurisdiction of the 28 Municipal Court of the State of California. Claimant reserves 2 1 the right to insert said amounts when same are ascertained. 2 3 MICHAEL C. SCRANTON 4 A ofessional Corpor ion 5 6 DATED: February 6 , 1992 by: C AN C,1 PH LIP GALLAGHER, lAttorney 7 for Claimant , BETTYUIELDS 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 3 1 PROOF OF SERVICE BY MAIL ( C. C.P. 1013A, 2015 . 5 ) 2 3 STATE OF CALIFORNIA 4 COUNTY OF CONTRA COSTA 5 6 I am a citizen of the United States and a resident of the 7 County of Contra Costa. I am over the age of eighteen years and 8 not a party to the within above entitled action. My business 9 address is 1200 Concord Avenue , Suite 260 , Concord, California 10 94520 . On February 6 , 1992 I served the within CLAIM FOR DAMAGES 11 on the parties in said action, by placing a true copy thereof 12 enclosed in a sealed envelope with postage thereon fully prepaid, 13 in the United States mail in Concord, California, addressed as 14 follows : 15 16 Clerk, Board of Supervisors County of Contra Costa 17 651 Pine Street Martinez , CA 94553 18 19 I , TINA WILDER, certify ( or declare) , under penalty of 20 perjury that the foregoing is true and correct . 21 Executed on February 6 , 1992 at Concord, California. 22 23 TINA WILDER 24 25 26 27 28 4 0 00 o m .o G. N� O O r `p�.o n N @ O .err tpo 47 ri Y cIr Qi, '0 r 4 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 10, 1992 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". ftECEIVED CLAIMANT: FUNG, Don C . FEB 1 1 1992 ATTORNEY: Law Offices of Meisel & Sherman- Date received COUNTY COUNSEL ADDRESS: 456 Montgomery Street BY DELIVERY TO CLERK ON FebMRJVF' TWF' 1992 18th Floor BY MAIL POSTMARKED: From Risk Management San Francisco, CA 94104 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim, gg DATED: February 10 , 1992 ��rt DepuLyLOR, Clerk t 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: 210 12- BY: IJy L, Deputy County Counsel — I III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: MAR i n _PHIL BATCHELOR, Clerk. B 444 04 . 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 Not'ce to Claimant, addressed to the claimant as shown gabove. Dated: MAR 10 19gg BY: PHIL BATCHELOR by 7z'. Deputy Clerk CC: County Counsel County Administrator 4 , LAW OFFICES OF MEISEL & SHERMAN 456 MONTGOMERY STREET, 18TH FLOOR SAN FRANCISCO, CALIFORNIA 94104-1251 (415) 788-2035 FACSIMILE RE FILE NO: (415)39&4366 February 3 , 1992 BIC-4599-1AW Ron HarvoY � �� � 0 FEB 0 ,1992 Board of. Supervisors County of Contra uosza r:anage::crt 651 lain. Street., 6th floor Martinez, CA 94553 Re: FLING v. City of Walnut Creek & . County of Contra Costa Dear Sir/Madam: Enclosed please find two signed originals of Claim Against the City of Walnut Creek, County of Contra Costa. Please return a conformed copy via the self-addressed, stamped envelope enclosed herewith. Thank you for your assistance in this matter. Should you have any questions, please contact me. Very truly yours, An W4nnq Para gal AW:gv 4599.clm Enclosures: Claim forms (2 for Oakland, 2 for Alameda) SASE (2) R CEIV D FEB 1 01992 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. DON C. FUNG, CLAIM AGAINST CITY OF WALNUT CREEK, COUNTY OF CONTRA COSTA _ Claimant(s) , ZFEB IVE® VS. f CITY OF WALNUT CREEK; COUNTY 1992 OF CONTRA COSTA; and DOES 1-25, public entities andCLESUPERVISORS their employees. STA CO. CLAIMANT'S SOCIAL SECURITY NO: 566-69-1618 CLAIMANT'S ADDRESS: 2324 San Bruno Avenue, San Francisco, 94134 TELEPHONE: (Home) 467-3079 (Work) 467-9492 ADDRESS TO WHICH NOTICES ARE TO BE SENT, IF DIFFERENT FROM ABOVE: Law Offices of Meisel & Sherman, 456 Montgomery Street, 18th Floor, San Francisco, CA 94104 DATE OF ACCIDENT: November 23, 1991 TIME: 10: 00 a.m. LOCATION OF ACCIDENT: N. Broadway & Lincoln Avenue, Walnut Creek DIRECTION PUBLIC VEHICLE WAS TRAVELING? HOW DID THE ACCIDENT OCCUR? Claimant was standing in the back of his van when a W.C.F.D. fire truck, license plate E202891, struck him. INJURY OR DAMAGE CLAIMED: Including, but not limited to, left thigh, neck and back injuries. NAME AND/OR I.D. NUMBER OF PUBLIC EMPLOYEE(s) INVOLVED: Fire truck, 88 duplex .(red) , license plate E202891 (CA) NAMES (s) OF 1. Derrell E. Hoschover TEL. NOS. 930-5500 EYEWITNESS(es) : 2 . Jeffrey L. Bright (209) 772-9703 3 . CLAIM AGAINST CITY OF WALNUT CREEK, COUNTY OF CONTRA COSTA Page 2 ADDRESS(es) OF 1. 4657 Revina Lane, Concord, CA EYEWITNESS(es) : 2. 4473 Hartvickson Lane, Valley Springs, CA 3. Damages include, but are not limited to loss of earnings and capacity to earn, medical and hospital bills, past, present and future, and pain and suffering, emotional trauma and general damages. Information provided herein is based. on that which is available to claimant as of the date of the presentation of this claim. Damages are sought in an undetermined amount, pursuant to Califor- nia Government Code Section 910, and said damages are in excess of the minimum jurisdiction of the Superior Court of the State of California. I DECLARE, UNDER PENALTY OF PERJURY, THAT/ ABO IS TRUE AND CORRECT. Signed by or on behalf of claimant: Andfew\jl. Me' , Attorney for Claimant 4599.clm CLAIM RECEIVED BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA •r� FEB 14 1992 C1a4yr Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT March 10 f and Board Action. All Section references are to ) The copy of this document mailed to you is your noticefof California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $40,000,000.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT:HEMMINGWAY, Ann Marie ATTORNEY: Date received February 13, 1992 ADDRESS: 7488 Bedford Court BY DELIVERY TO CLERK ON Dublin, CA 94568 Hand delivered BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PpHHIL BATCHELOR, Clerk DATED: _Fehruary '14, 1992 BY: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors `(J ) 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 S /. 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 ORDER: By unanimous vote of the Supervisors present i (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 ate._Dated: MAR PHIL'BATCHELOR, Clerk, By o 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 asshown a[b]ove. RJ4444 Dated: """"" 1 O 1992 BY: PHIL BATCHELOR by 0Oeputy Clerk w , CC: County Counsel County Administrator a-aim to: BOARD OF SUPERVISORS OF CONTRA 00.S'PA OOUM RMRUCTIONS 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. If the claim is against more than one public entity, separate claims mast 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 ) Reser v d for Cl k's fi ing stamp DECEIVE® Against the County of Contra Costa ) or ) FEB 1 3 1992 District) CLERK BOARD OF SUPERVISORS Fill .in name ) CONTRA COSTA CO. a.4- The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ Q ppb, pa 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) N 3. How did the damage or injury occur? ive full de a 1s; usextra paper if required) �"udl c�C t 1�v� t�r�2 S o Y\_S ,%r e lei-5('_rv�'2'5 Dr,ess G-mv �1 iT�l u. What particular act or omission on the part of county or district officers, servants or employees- caused the injury or damage? cC - `�- ��d Ll �rZ►a NTED D E� k- (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 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 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:. "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf." Name and Address of Attorney Claimant's 'gnatur Address `Telephone No. Telephone No.S:2 n c9 t�- ` 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. 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 10, 1992 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:GLASGOW, Kurt ATTORNEY: Date received ADDRESS:8368 Brentwood Boulevard BY DELIVERY TO CLERK ON February 7, 1992 Brentwood, CA ,94513 BY MAIL POSTMARKED: Hand delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: February 10, 1992 PPHHIL BATCHELOR, Clerk BY: Deputy 04 &,AZ:�� 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: ' ,. - �• 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. 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: MAR 10 1992 PHIL BATCHELOR, Clerk, By d , 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 Q �gg� BY: PHIL BATCHELOR by �\ eputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT Ak*laims relating to causes of action for death or for in to person or to r- ��`Y pe Pe scnal 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 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 5911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Roam 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 Tom. * iF IF iF It 1t 11 * iF OF IF * * N * • 1I * N * 11 A IF * * * * * * * * N A i iF RE: Claim By ; Reserved for Clerkl3ptiling stamp KURT GI.ASM14 �> RECEIVED Against the unty of Contra Costa ) !---D 7 1992 orXKX ) District) CLERK OF SUPERVISORS Fill n name coNCOSTA Co. 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: %,Vlithin the jurisdiction of. the Superior Court 1. When did the damage or injury occur? (Give exact date and hour) On or about September 10, 1991 -NNNMN FNM-N--r-NNM-N--NMN-NN 2. Where did the damage or injury occur? (Include city and oounty) Contra Costa County Jail, Martinez, California . 3. How did the damage or injury occur? (Give full details; use extra paper if required) While incarcerated at Contra Costa County, Jail, conTwncing August 21,' 1991, Claimant was assaulted, beaten, and abused by two other inmates which assault and abuse took place on or about September 10, 1991. NNMN�MNN MMN 4. What particular act or emission on the part of county or district officers, servants or employees caused the injury or damage? Negligently supervised and/or failed to supervise inmates in order to prevent assualt, battery, and abuse. (over) 5. What are the' names of county or district officers,. servants or employees causing the damage or injury? Unknown at this time. -------------- -------- ------------ 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages.claimed. Attach two estimates for auto damage. Plaintiff was beaten, battered and abused, and was emotionally and physically distressed and physically beaten and sexually abused. ----------------------------------- ------------ 7. How was the amount claimed above computed? (Include the estimated amount of any prospective. injury or damage.) Amount unknown at this time. ------------ ---•------------------------------------------------------------------- 8. Names and addresses of witnesses, doctors and hospitals. Unknown at this time. ------------------------------------------------------------------------------------ 9. List the expenditures you made on account of this accident or injury: DATE ITEM' AMOUNT Unknown at this 't'i e0 Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant C,RkMi SEND NOTICES TO:__�(At_torne_ F�F orb some person on his behalf." of Name and Address Attorney `s t- Claimant's gnature loci Address Telephone No. Telephone No. NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, 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. CLAIM ";i •� 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 10, 1992 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: PERCY, Stephanie RECEIVED ATTORNEY: none specified FEB 1 1 1992 Date received ADDRESS: none specified BY DELIVERY TO CLERK ON Febr> F��� '7.992 BY MAIL POSTMARKED: From County .Counsel I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. February 10 1992 PQHHIL BATCHELOR, Clerk DATED: Y BY: Deputy (L40 I1. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: `11 BY: �- Deputy County Counsel J( 0 NIJ III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: MAR 10 1992 PHIL BATCHELOR, Clerk, By--iJ 1AAjVP,0j 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 0 1992 BY: PHIL BATCHELOR by b Deputy Clerk CC: County Counsel County Administrator NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Stephanie Percy No address available Re: Claim of Stephanie Percy 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. 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. XX 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. WEST , County Counsel 2� �L BY Deputy C my Counsel CERTIFICATE OF SERVICE BY MAIL; C.C.P. SS 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: , at Martinez, California. cc: Clerk of the Board cf Supervisors (original ) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOV.C.§§ 910, 910. 2, 920. 4, 910 . 8 ) d �o a om � fvHb h� O r R CB O .m d ZNo� � tm �a � U N N a � d a Stephanie Percy SERVICE ADVICE FORM Office of Clerk of the Board Notice of Intent to Commence Action REw1rn (Name of Action) FEB ", 1992 (Court) )UNSEL (Number) �AR(SNEZ, CALIF, 1) Service was made by:' Personal Service [ ] Name of Server: Mail [ X ] Did you sign acknowledgment and return it to Plaintiff's Attorney? Yes [ ] No [ X] 2) Date of Service 2/6/92 Time of Service P.m. 3) Were you served as an individual? Yes [ ] No [ X] 4) Were you served as an official of the County? Yes [ ] No [ X] 5) Was service made on the Clerk of the Board? Yes [ X] No [ ] 6) ' If service was made in person, then please give ,the name of the person who received service: Name Title Deputy Clerk Department Clerk of the Board Office Address 651 Pine St. , Rm. 106, Martinez INSTRUCTIONS: The Summons and Complaint (and other legal documents) should be referred immediately to County Counsel. TO: COUNTY COUNSEL Received the. documentation pertinent to the above referenced Action this 6th day of February , 1992. RECEIVED S errithew � RECEIVED emorial FEB 6192 FEB 04 1992 44 O�pD4QIL CLERK BOARD OF SUPERVISORS COUNTY COUNSEL CONTRA COSTA CO. MARTINEZ, CALIF. AND CLINICS TO: Office of County Counsel DATE: February 3, 1992 Contra Costa County FROM: Mark Finucane / a4k 7.�� RE: NOTICE OF INTENT TO Health Servicesirector / COMMENCE ACTION Stephanie Percy Record #521582--7 Claim IM 91--022 R Enclosed is a Notice of Intent to Commence Action regarding the above patient. This was received by the Richmond Health Center on January 31, 1992. A claim was filed on December 17, 1991. SP Enclosure cc: Risk Management Department SE Contra Costa County •A S�•9 COUNTY G A-301A (3/87) NOTICE OF INTENTION TO COMMENCE ACTION AND CLAIM AGAINST RICHMOND HEALTH CENTER RECEIVED IP iiF TO: RICHMOND HEALTH CENTER 61992 38th Street and Bissell Ave. FB Richmond, CA 94805 SUPERVISORS CONTRA COSTA CO. Claimant STEPHANIE PERCY gave birth to her daughter on August 1, 1991 at BROOKSIDE HOSPITAL. EBONY DIVINE HONEYCUTT, born August 1, 1991, died on August 2 , 1991 at CHILDREN'S HOSPITAL in Oakland, California. Prior to the delivery of EBONY DIVINE HONEYCUTT, STEPHANIE PERCY was operated on at BROOKSIDE HOSPITAL by COLLIN MBANUGO, M.D. for the removal of her appendix. She was released on June 14, 1991, and placed on Terbutaline. She continued her treatment for prenatal care at the RICHMOND HEALTH CENTER and there were numerous references by STEPHANIE PERCY to the decreased fetal activity of EBONY DIVINE HONEYCUTT. STEPHANIE PERCY's pregnancy continued until full term with no intervention. The due date was July 27, 1991. STEPHANIE PERCY went into labor on August 1, 1991 at approximately 2 : 00 a.m. She was admitted to BROOKSIDE HOSPITAL at 3 : 30 a.m. and placed in the maternity ward at 5: 00 a.m. At 7: 30 a.m. it was determined that something had gone wrong and DARYL MURDOCH, M.D. ultimately delivered EBONY DIVINE HONEYCUTT at 7 :55 a.m. Shortly after delivery, a crew from CHILDREN'S HOSPITAL arrived at BROOKSIDE HOSPITAL and took EBONY DIVINE HONEYCUTT to 1 CHILDREN'S HOSPITAL where she was treated until her death at 11: 05 a.m. on August 2 , 1991. The death of EBONY DIVINE HONEYCUTT has caused claimant emotional distress, damages for loss of companionship and general damages, as well as loss of income, loss of earning capacity, further medical expenses, and other damages according to proof which are within the jurisdiction of the superior court. NOTICE IS FURTHER GIVEN that 90 days after receipt of this notice an action will be brought for the recovery of monetary damages resulting from the injuries and death and occurrences described above. I certify under penalty of perjury that the foregoing is true and correct and that this verification is executed in the City and County of San Francisco, State of California, this day of January, 1992 . STEPHANIE CY R�PEw�® CENSER �p►N 3 � 1992 EjCN� NEpI�N c��®S EU 3g�&8�sse11�5 E� R►chmand,CA ��� u wu 2 CLAIM j BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA FEB 1 1992 Clair.-'Against the County, or District governed by) BOARD A COUNSR the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT March 10 p99lff• "411. 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: RODRIGUES, Chris ATTORNEY: Date received February ADDRESS: PO, BOX 484 BY DELIVERY TO CLERK ON Fey 14, 1992 Byron, CA 94514 BY MAIL POSTMARKED: Hand delivered via Risk .Management I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of' the above-noted claim. February 14, 1992 EVIL BATCHELOR, Clerk DATED: BY: Deputy I�FR` �La OM: 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 SJft 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. Dated: MAR 10 1992 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 prepaida certified copy of'this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: MAR 10 192 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel . County Administrator Clarim, 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' 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 ) Rese ved for Clerk's filing stamp C E El , Against- the County of Contra 'Costa or ) FEB . 141992. Ile-Roaf\ '211' District) . CLERK BOARD OF SUPERVISORS Fill in e ) CQ! RA CO The undersigned•claimant hereby makes claim al st tl County of-Contra Costa or the above-named District in the sum of $ �; ,I � �•� 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) CA 3. How did the damage,'elr injury.pccur? (Give full details; use extra paper if required) CONTRA Co STA Co. K8Ad.'hr�-Te0< a,7� s7,-t�1 .c/4-,;1 W11,ti� 4. What,_particular act-,or omission on the part of county or district officers, servants or employees caused the •injury or-damage? 9O�ly V (over) 5. what are the names of county' or district officers, servants or employees causing the damage or injury? 115 igi A-CLE- To LA \J� 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.) X21_U51 --------.�� --------------------=---------------------- $. -Nines-and addresses of witnesses P doctors-and- hos itals: - - - ---- iC'- ----------------------------------N--N------------------------ N----- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT * . * C-* Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES�,IRQ t(Attar ie:)� � s orb some pecsonon his behalf." Name and Address.ntifAtt° iejiw ,w�� ' - Q-e-j cIEd i s Si ture C, Address Telephone No., Telephone No.,^ s/ eo l a * T-F-F-T-1 W I W V. N I I V 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' punishableeither '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 imprisontent in the state' prison, by 'a fine of not exceeding ten thousand..dollars .($10,D00,: or by both such imprisonment and-fine. W-11 G. RNE-4 SONS 230.Chestnut Street JOB WORK ORDER Brentwood, California 94513 DATE OF ORDER (415) 634-5609 CUSTOMER'S ORDER NO. PRONE STARTING DATE BILL T4 / ORDER TAKEN BV ADDRESS E) DAY WORK — O CONTRACT CIT ❑ EXTRA JOB NAME AIQD LOCATION DESCRIPTION OF WORK 777ONE- e , tib .y I itL/ TOTAL MATERIALS TOTAL LABOR TAX /L,• O' DATE COMPLETED WORK ORDERED By TOTAL AMOUNT S 1:2-ZZ 1 hereby acknowledge the satisfactory completion of the above described work. ❑No one home ❑Total amount due C] Total to for above work or be mailedsled when lob finished signature TERMS 30 DAYS Any portion of the previous balance remaining unoaid_3n_d�.r�-�' . r I-- - it:...__,r_� — = INVOICE N f N 0 -Ni O n. 1 m r c c v En m 3 Q, O A O N inv p7�p17•� 1-0 vZQ� M wig!* z n 4mA m m 3 N N n (n Ln I 2 { m m m 1 m v z 0 o ° m b m m � m m 1 © A Q�7 m N � O CLAIM ~✓/�C� BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Cla�mykoainsf the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT March 10, 1992 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: See estimates Section 913 and 915.4. Please note all "Warnings". CLAIMANT: SCHRECKENGOST, James John t� ATTORNEY: Date received ADDRESS: 2957 McKenzie Drive BY DELIVERY TO CLERK ON February 11, 1992 Richmond, CA 94806BY MAIL POSTMARKED: Via Risk Management I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PH Bg DATED: February 11. 1992 BYIL DeputyLOR, Clerk c 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 91.1.3).. ( ) Other: Dated: 2-1 (( 51— BY: I, .Q;, , ' ���. Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Admi strator (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: 'MAR 1 1992 PHIL BATCHELOR, Clerk, By 9 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 10 1992 BY: PHIL BATCHELOR by a Deputy Clerk CC: County Counsel County Administrator Clai�tn 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- sona-1 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 andwhich 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 ats 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 ) Re erve or le k's filingstamp AJAJ R CEI Er Y. Against the County of Contra Costa ) F8 11992 :or-, ) District) CLERK BOARD OF SUPERVISORS Fill in name ) CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum, of $ 5.£z:`: F5+3mcL+f_ and in support of this claim represents as.follows: ----------------�N_�_ . . ____---- 1. When did the damage._or injury occur? (Give exact date and hour) ----------- 2. Where did the damage7'dr injury occur? (Include.,city and county) ...CC? i 5. What are the names of county or district officers, servants or employees causing the damage or injury? -- ------------------------- What 'damage or injuries do -you-claim resulted? , (Give.full extent.,of injuries or damages claimed. Attach two estimates for auto damage. 1 ii__ ------------6-f . How was the amount claimed above computed? Include the es imated amount of an 7 uted?p ( Y prospective injury or damage.) $. ztnes and addresses of witnesses, doctdrs and hos itals. ___________N-----------------___-N--NN---------------_N--- _-_----- 9. List the expenditures you made on account of this accident or'injury: DATE ITEM AMOUNT - ...�..7 a ,. ao q wy R 7f 7f if R Gov. Code Sec. 910.2 provides: The claim must be signed by the claimant un SEND NOTICES T0: (Attorne ) , , N or-bsome person on his behalf." Name and Address of Attorney aimant's Signature) 57`Mc_KE r\z;F_ Address . Telephone No-, Telephone No ��� � � ` �',a * 1 . * W. N-0TICE . Section 72 of the Perial 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 fora 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 ($10,000, or by , vr''" both such imprisonment and fine. r NI� r Y --O far r Kf-d Alam U h�w� , l-�� avv\ foYN1 Y\/\Y f�g ;�tc�fi;dry 4 1 'J t ar� - C(�vh �iiG�• �`L �h � �foeF� O-f �5. �1cV\ v\, <nr-1,' S0 c�I IY -.F- n }� f� e. o� f6C)+- 6ct�-E-c,1n ;,� ,,., fr{ 5h 1y �Da, qt-,E d u I4 Contra Costa County i, RECEIVED FEB 141992 ` Risk Management VbW Dimap Quotation 062499 DATES/�/ NAME —C-1 e c k Gam_ YEA"�MAKE1 YM—C MODEL P—(—^ ADDRESS LICENSE NO.�� L� MILEAGE CITY STATE ZIP VIN NO. H.PHONE _ W.PHONE PROD.DATE BODY CODE PAINT TRIM INS.CO. ADDRESS DATE OF LOSS CLAIM NO. ADJUSTER PHONE LIC.NO. FILE NO. D.D. LINE RE- RE- DETAILS'_OF REPAIR PARTS INDEX LABOR HOURS NO. PAIR PLACE R=Repair S=Straighten A=Aftermarket N=New PI PARTS SUBLET/MISC. R/C=Recycle/Rechrome/Recore U=Used R Rebuilt BODY PAINT FRAME MECH 1 , 2 - 3 4 5 ck 6 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 OLD PARTS WILL BE DISCARDED UNLESS OTHERWISE INSTRUCTED TOTALS 0.1 /�cx� SOMETIMES AFTER THE WORK HAS BEEN STARTED,ADDITIONALLY DAMAGED OR WORN PARTS ARE DISCOVERED hrs.(ral�L WHICH WERE NOT EVIDENT ON FIRST INSPECTION.THIS DAMAGE REPORT DOES NOT COVER OR INCLUDE ANY ADDI- L BODY TIONAL PARTS OR LABOR WHICH MAY BE REQUIRED.ALL PARTS PRICES ARE SUBJECT TO INVOICE. A ' .p B ' PAINT - hrs.la I hereby authorize the above work and acknowledge receipt of copy. I O FRAME hrs.@ Signed X Date R MECH hrs.@ PARTS Prices subject to invoice I .SUBLET/MISCELLANEOUS . � Paint Suppli��hrs.pa "� — Uri I.C) Body Supplies—hrs.@ Towing/Storage no, EPA/Waste Disposal Charge - AS y. SUB TOTAL ;. .............. TAX_%on$ WRITTEN Y � TOTAL tt ©1988 I! /Atinc. Form No.1169R I/D/E/A inc.,One I/D/E/A Way,Caldwell,ID 83605-6900-.CALL TOLL FREE 1-800-635-9261 7680 STE WART'S BODY SHOP "INC. Make - �� SERVICING THE BAY AREA SINCE 1944 Ins. By 12540 San Pablo Avenue between Clinton &Solano _ Richmond,CA 94805 Reg.7491 Phone:235-3515 Clgim #, D/L Serial # .:. �� ! , ✓ Miiea e — TO Dat Lic. No. Phone: Res +42 � i a Phone; Bus. e P - l� Replace Repair NEW BMW=W i F 1 IN as a � m6, r � z LAB HRS. The above named insured is to pay: a ° L °,P TS $ insurance deductible PAINT $ depreciation The'above is an estimate based on�our SUBLET �O inspection and does not cover any additional 5 ES A AUTHORIZE STEWART'S BODY SHOP parts or-labor`which may be required after the TO REPAIR ABOVE SAID VEHICLE AS work has been opened up. Occasionally after Advance Chgs. i•, ITEMIZED PER THIS ESTIMATE:: work has started, worn or damaged part are Y discovered, which are not evident,en,4hemr-4= ,, TptAL inspection. Because of this the above prices are; not guaranteed, and are for immediate..ac_cep--•-, LESS tante only. X NET TOTAL DATE.. _ iviS�E J SpeediplyC MCPS%Patented 40) CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA .e RR AA� Claim] lgainst the County, or District governed by) BOAAD ACTI�tJ� 1992 the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT March 1JbuNW$bUNM and Board Action. All Section references are to ) The copy of this document mailed to you is N%tWFof California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: 1,000,000.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: SHAW, Valerie A. aka Verlon W. Hubbard ATTORNEY: Date received February 14, 1992 ADDRESS: P.O. BOX 2781 BY DELIVERY TO CLERK ON Richmond, CA 94801 BY MAIL POSTMARKED: Hand delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy.of the above-noted claim. February 14, 1992 PpHHIL ATCHELOR, Clerk DATED: Y BY: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors �(J ) 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: Z 1 1 1 � BY: -� AqJ A Deputy County Counsel U \1 U, III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (✓This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: MAR 10 1992 PHIL BATCHELOR, Clerk, BDeputy 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 0 �gg2 BY: PHIL BATCHELOR by leputy Clerk CC: County Counsel County Administrator J , Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY MRSTRUCTIONS TO CLAIMANT 11 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 theuaccrual 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 mast 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 To-r—M. RE: Claim By ) Reserved for C1 rk's fili stamp �33Pk.caj RECEIVE® Against the County of Contra Costa ) or FEB 1 4 1992 ) District) CLERK BOARD OF SUPERVISORS Fill in name ) CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ �., c>c>c>4 b o ca-oo and in support of this claim represents as follows: p� ,n�,�}5 c�� �sA cp 2 coo�ogic� eav�S�liv�x ��-.sa.Es:. _�� --------------- 1. When did the damage or injury occur? (Give exact date and hour) 4 �� CYtwc�� cac,�s ccc 4-t �Em Qt 2. Where did the damage or injury occur? (Include city and county) VzR �C�� ne 17 L 3. How did the damage or injury occur? (Give Hall details; use extra paper if required) vv--/v C�, 3�� `t��q-�4c� <<-c I}-1-ff 40YLQAE,may K v-F- R�`r_ � r11�(�tc��co-� 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? 2�Tb prs o� Mz- Z 'c�K�l� —Ll��C- _ _ (over) `l Qlly� n� 5 CZfR lc-Et c)Tc NAY QI-IK r! nra RM�� �f m� S iii..._L-s k-k-h cx-_N=k 7 _ .i* •_few 5. What are the names of county or district officers, servants or employees causing the damage or injury? T7-�� 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claime„d.� Attach tw�or estimates' for auto damage. 4) 7.��'io "'I s the� ela m above compute ?(Include th esti�matedaamount of any prospective injury or damage.) ---------------------------------------------------------------------------=--------- 8. Names and addresses of witnesses, doctors and hospitals. T3-� o3 Sven b� P<<;v0PsKot-�J ---------------------------------------------------------------------------- ------- 9. List the expenditures you made on account of this accident or injury: DATE .' ITEM AMOUNT L MRV- —�is i'KFUtZmI�'i�O�C ���-- U`�lC�es KC-r, �� �,—� nYA-rc::V£ to t0 V.W W4.4_I* '* rt � � Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND br b some person on his ehalf." Name and Address of Attorney Claimant's Signature Address in�orc c p Telephone No.. ( Telephone No. NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or .officer, .or to any county, 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., December 2 , 1991 Dr. Tenki S. Tenduf-La Medical Director West County Richmond Health Center 38th & Bissell Richmond , CA 94805-2276 / Dear Dr . Tenduf-La : From the beginning of my treatment at the Richmond Health Center, I have had appointments cancelled without notice, been told I had no appointment when showing up for one I had been given, had my prescription refill scratched out by the pharmacist and after he did so he gave me my bottle of med}gi.ne back and told me I had no refills left and to call. the advice nurse for a new one . I was told by you that 1 had not seen' Dr . Duir in over a year when in flint; 1 had pr'oof to the contrary . 1 liavu been informed by yousr!.lf and Dr. . Duir in a very rude manner that I did not have a tFiyroid pr.oblom rind need riot take any medication for one inspite of a letter 1 presented to Dr. Duir in person from Kaiser Nuclear Medicine a letter signed by Dr . Navarro indicating I did and needed to take medicine everyday . Dr. Duir refused to give me a prescriptionfor thyroxine and said she would only do so if I signed a statement saying I knew the medication was not necessary even, though she had previously given me a prescription for thyroxine and was aware that as a patient I was in no position to make such a medical determination. I was told by Dr. Duir that my receiving prescription for my medication was contingent .upon my signing the aforementioned statement which further stated I would never seek treatment at the Richmond Health Center again if I missed an appointment which at that time was more than two months away. Again I ask you, was Dr. Navarro (Kaiser) and Dr. Shenoy (Kaiser) wrong in indicating I had a thyroid problem? Were you right in telling me I did not need to take thyroxine medication and Dr. Duir correct in refusing me medication unless I signed a statement indicating I needed no medication? After continual harrassment each time I came in for an appointment or called for one, I am afraid that my health may be seriously jepodized by seeking health care at a facility were you personally told me almost no one there wanted to treat_ me although I have done nothing or said nothing that should evoke this inhumane response. VALERIE AW aka VERLON HUBBARD P. S . My health is currently in physical and emotional crisis as a direct result of yourself, Dr. Duir and inappropriate health care provision by the Richmond Health Center.