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HomeMy WebLinkAboutMINUTES - 06231992 - 1.26 CLAIM <<. , BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA `fUN 05 1992 COUIV7 y Claim';A@ainst the County, or District governed by) BOARD ACTI0NMART/1VZP?►VFEL the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT June 23, 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: $525.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: HANSEN, Linda (Mother of Jeremy Dews) ATTORNEY: Date received June 2, 1992 ADDRESS: 3852 I'llmwood Drive BY DELIVERY TO CLERK ON Concord, CA 94521-2661 May 29, 1992 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 'o DATED: June 5, 1992 BY: Deputy 00 J-4. II. FROM: County Counsel. TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. �.I ) 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). i ( ) 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: �J, A Deputy County Counsel 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 (V This Claim is rejected in full. ( ) Other: I certify that this is'a true and correct copy of the Board's Order entered in its minutes for this date. 0 Dated: JUN 2 3 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 prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: JUN 2 3 199—2 BY: PHIL BATCHELOR b 011 A., Nz, Deputy Clerk CC: County Counsel County Administrator ;i NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Linda Hansen 3852 Plamwood Drive Concord, CA 94521 Re: Claim of Jeremy Dews , Please Take Notice As Follows : The claim you presented against the County of Contra Costa or District governed by theBoard 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. 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. XX 6 . The claim is not signed by the claimant or by some person on his behalf . 7 . Other: VICTOR J. WES- , County Counsel �)a By. D J , Deputy CPunty'Counsqj CERTIFICATE OF SERVICE BY MAIL; C.C.P. 59 1012, 1013a, 2015. 5; Evid. C. 96 641 , 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 : June 8, 1992 at Martinez Californi . cc: Clerk of the Board cf Supervisors iginal) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOV.C.§§ 910, 910. 2, 920.41 910. 8) E 7 • w Claib to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY ' INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual •of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue.on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relatin& to any other cause of action..must be presented not later than one year after the accrual of.the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553• C. If claim is against a district governed ,by the Board of Supervisors, rather than the County, the name of .the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By ) Reserved for Clerk's filing stamp z Against the County ContrdCosta ) JUN 2 1992 or ) CLERK BOARD FF -- District) CONT A COs p CO�SORS Fill .;in name ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 5? 5eO� and in support of this claim represents as follows: ------------------------------------------------------------------------------------- 1. When did the damage or' injury occur? (Give exact date and hour) 5 - - -- 2. Where did the damage or injury occur? (Include city an county) ntno LU L 3. How did the damage or injury -cur?, (Give full details; use extra paper if required) zttq ---------------------------- V A.-------------------------------------------------- 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damag ';e--e.r S\rl u a ave ker1 ,e k� s a�-T1-� CQY ) s01k)j .CLW ee-r) )yy, �und�c� -3ea ( t mQo� ��,,.�.ei ' .v CX"+N t n-\?w\ 4- Qr < Y t- ' lU G.L_' 1517'1 n ri►v► 1 f(IYOL l� 5. What are the names of county or district officers, servants or employees causing the damage or injury? -Tor, b je—b b ------------------------------------------------------------------------------------ 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed: Attach two estimates for auto damage. 1, tort de c� �l�Q n _ � as 5�� Y lac�.r,r fl ,rd�- --- L m 1 ' $ im4aoc�. --------------- _ tssLap. ------------------- 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 41 Jq a, WLO f TbTe lock. Oaaas&b 4130 5Ji s)q a. ao .- &p e--s ace. 00 5C ra 19 a Trar)3r)n�ssl ibo,C3� X 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 Signature Address Telephone No. Telephone No. N O T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents ,for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill-, account, voucher, or writing, is punishable either by imprisonment in the countyjail 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. Y J ti� w a`s svr1� ot 'v ye ut � sx-yv ,'�s eC.,- 1-e- s � CO&N),Yn Dl( A fie\, � n rl �r�SV► C 0A- , Ck� Woo �1c\)c ' 1 Ln cC, (\/ 11 V � O v CN �- W O = v 0 0 o a a E U II Z0 v N c n. o 1 J N r- IN � U Y I r- CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT June 23, 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: $5,000.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: MORRIS, Bonny Ray ATTORNEY: Paul J. Mansdorf Attorney at Law Date received ADDRESS: 3150 Hilltop Mall Road BY DELIVERY TO CLERK ON June 4, 1992 Suite 50 Richmond, CA 94806 BY MAIL POSTMARKED: June 3, 1992 CERT P 987 308 587 I. FROM: Clerk of the Board of Supervisors TO: 'County Counsel Attached is a copy of the above-noted claim. DATED: June 5, 1992 PpHHIL BATCHELOR, Clerk o BY: DeputyAAA- At A 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: h ��� BY: � -�,�, � �- Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( This Claim is rejected in full. ( ) Other: I certify that .this is a true and correct copy of the Board's Order entered in its minutes for this date. 0 Dated: JUN 2 3 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 prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. 0 Dated: JUN 2 3 1992 BY: PHIL BATCHELOR by a Deputy Clerk CC: County Counsel County Administrator R RECEIVED ECEIVED PAUL MANSDORF JUN 4 1992 Attorney at Law J 0 P v1st 2 3150 Hilltop Mall Road CLERK RS RK BOARD OF SUPERVISORS Suite 50 CONTRA COSTA Co. 3 Richmond, CA .. 94806 (510) 970-7650 4 Attorney for Claimant 5 BONNY RAY MORRIS 6 CLAIM AGAINST- COUNTY OF CONTRA COSTA, A. PUBLIC ENTITY 7 1) Name and address of Claimant: Bonny Ray Morris 8 West County Detention Facility 5555 Giant Hwy. Richmond, CA 94806 9 2) Send all notices to: PAUL J. MANSDORF, Attorney at Law, 10 3150 Hilltop Mall Rd. , Suite 50, Richmond, CA 94806 11 3) Date of occurrence: December 13 , 1991 Place of Occurrence: Highway 4 between Martinez and Bay 12 Municipal': Court aboard a county jail transport bus 4) CircumstAhces of Occurrence: County bus swerved toward right 13 to avoid coliliision, into the embankment. Although liability for incident itself appears to rest with another party, the design of 14 the bus seats and lack of seat belts caused injuries to claimant. Claimant, seated in a smooth metal seat without a seatbelt, slid 15 down betweenseats and was pinned. Due to restraints upon his body, he was unable to break the impact. His head hit the metal 16 cage. 5) General Description of Injury: Claimant suffered injuries to 17 his back and head, suffering headaches, and mental and emotional 18 distress and ,:general damages. 6) Amount of claim and basis for computation: Claimant claims 19 five thousand dollars ($5, 000. 00) for medical expenses and pain and suffering and loss of income. 20 Dated: ' June 3 , 1992 21 22 PAUL J. MANSDORF Attorney for Claimant 23 24 25 26 Paul J.Mansdorf ATTORNEY AT LAW Richmond,California (415)970-7650 • j;) i�-�� cam IIS }j�Irn N Rf - 4 i-1 O r� O U -n a W tll H J �4 M 34 4.1 ao • � w :3 U 4-) H U) U) Ly 44 H 44 O N N E-{ o r. (1) a burl U +-) r� s4 Q O O in rd H 9 N Ln c 0 m N a m Ir o_ 90896 VO'QNOWHO18 .OS 311nS-avoa llVW dOl-1-11H 09LE•2l31N3O WWOO dOl'1-11H MV-1 1V A3NaO-UV'daoasNdw -r lndd RECEIVO * CLAIM JUN 1 1 1992 f.� BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA COUr"TY COUNSEI 1 nom„r7 rn.-I F.! Claim Against the County, or District governed by) BOARD CTI'ON the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT June 23, 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: Exceeding $500,000.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: OLIAZADEH, Vida ATTORNEY: Gary P. Snyder Kully & Snyder Date received ADDRESS: 1111 Civic Drive, Suite 1.45 BY DELIVERY TO CLERK ON June 8, 1992 Walnut Creek, CA 94596 June 5, 1992 BY MAIL POSTMARKED: CERT P 387 385 402 I. FROM: Clerk of the Board of Supervisors TO: County .Counsel Attached is a copy of the above-noted claim. Pp June 11, 1992. HHIL BATCHELOR, Clerk 01a DATED: BY: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors � ) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: G /tr. 92— BY: 1 . >, r J r Deputy County Counsel T 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: JUN 2 3 IM PHIL BATCHELOR, Clerk, By 20., 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 perjurythat I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United.States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: JUN 2 3 1992 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator REcGEIVEDx NOTICE OF CLAIM JUN 81992 1. Name of Claimant: Vida Oliazadeh CLERKBOARpOFSUPERVISORS 1220 Contra Costa Blvd. CONTRA COSTA CO. Concord, CA 94520 2 . Nature of Claim: Contamination with dirty needle at Merrithew Memorial Hospital, Martinez, on February 27, 1992, resulting in possible exposure to hepatitis and/or HIV. 3. Witnesses to incident: Claimant Vida Oliazadeh Laboratory technician Pat Sincery Dr. Basch 4 . Amount of �claim: exceeding $500, 000 if contamination with hepatitis or HIV from this dirty needle develops. 5 . Direct inquiries to: Gary P. Snyder Kully & Snyder 1111 Civic Dr. , Suite 145 Walnut Creek, CA 94596 Dated: June 5, 1992 KULLY & SNYDER BY GARY P. SNYDER Attorney for Claimant Ali ilt 1 1` ti N M 01 � U MA NN O , M 0 u) u, cn � r a 0 kA Q o � oaW 4L ,JNU U ate ? a a 3 AIMENDED !' � CLAIM :'• BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA C'aim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT June 23, 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: $50,000.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: HOLDEN, Wilfred and Ruth/CNA ATTORNEY: CNA Christine Hoyt Date received ADDRESS: Claim Specialist BY DELIVERY TO CLERK ON June 3, 1992 Continental Casualty Company P.O. Box 7430 BY MAIL POSTMARKED: June 1, 1992 San Francisco, CA 94120 7430 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim..EY IL June , 1992 BYIL BATCHELOR, ClerkeputX_ 40M 44AA0 o FROM: County Counsel TO: Clerk of the Board of Supervisors \�I /& ZX44 This claim complies substantially with Sections 910 and 910.2. ( ) T dclaim 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: G Z BY: I✓ SA Deputy County Counsel v 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. 0 OL Dated: JUN 2 3 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 prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: JUN 2 3 1992 BY: PHIL BATCHELOR by 01a Deputy Clerk CC: County Counsel County Administrator CNA PO Box 7430 San Francisco CA 94120 7430 D I Pr The Public Defender's Office 11 IN 31992 May 28, 1992 200-37th Street Richmond CA 94530 "RANCH 0 F F t';L' DEFENDER Claim No: 13-434175 T8 CONTRA Insured: Wilfred & Ruth Holden Date of Loss: 12/16/91 Amount of Loss: $50,000 Type of Loss: Fire To Whom It May Concern: In response to the attached notice, the following information may be of some assistance. This fire took place on 12/16/91 at the Public Defender's Office located at 200-37th Street, Richmond CA. The fire was caused by an employee who inadvertently left the coffee-maker on. Should you have any further questions, please do not hesitate to call at the number noted below. Very truly yours, Christine Hoyt or Claim Specialist ECEIVED Continental Casualty Company (415) 872-5641 31992 C125B28.518/2346 IcLOLM180—ARD OFSUPERVISORS loc—o—wMARS CONTRA COSTA CO. CNATranscontinental Technical Services, Inc. For All the Commitments You Make* NOTICE OF INSUFFICIENCY ANDLOR CLAIM TC: Wilfred & Ruth Holden P.O. Box 7430 94120-7430 San Francisco, CA. Re: Claim of Wilfred & Ruth Holden D Please Take Notice AS Follows : The claim you presented against the County to substantially of Contra Costa or District governed by the Board of Supervisors fails with the requirements of California Government Code section 910 and r the reasons checked below: se insufficient fo 910 . 2, or is otherwise 1 . The claim fails to state the name and postoffice address Of , the claimant. 9 post office address to which 2 . The claim fails to state the the person presenting the claim desires notices to be sent. XX3 - The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. public 4 . The claim fails to state the name(s ) of the p if known , employees) causing the injury, damage, or loss , 5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ( $10, 000 ) . If the claim totals less than ten thousand dollars ($10,000) , the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ( $10,000) , the claim fails to state whether jurisdiction Over the claim would rest in municipal or superior court. —6 . The claim is not signed by the claimant or by some person on his behalf . -7 . Other: VICTOR J. WESTMAN, Cb my Counsel By: Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL C.C .P. SS 1012, 1013a, 2015 . 5; Evid. C. §5 641, 6641 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) , twhich 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 fora;oin is true and correct. Dated : May 4. 1992 at Martinez,, California,,.. cc; : Clerk of the Board cf Supervisors (9!�qinal) Fisk Man-agement INXICE OF: INSUFFICIENCY OF CLAIM: GOV.C.§§ 910, 910 . 21 920. 41 910- 8) YYYiY YK \ 'Fl J `4n ;b A Yom.. { \ 1 h ` O d U V dW � x iCd d 2 k � w �W� FO-) -ccucn Q Cam ZQ-C. _ OWE CW.- LA- Ls- 40 7 r iJUI�1 1 1. 199,2 APPLICATION TO FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COMM, CALIFORNIA cousin couNs=i mAf"30ARY-ACTION Application to File Late Claim ) NOTICE TO APPLICANT 'lune 23, 1992 Against the County, Routing ) The copy of this document mailed to you is your Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to ) the Board of Supervisors (Paragraph III, below), California Government Code.) ) given pursuant to Government Code Sections 911.8 and 915.4. Please note the "WARNING" below. Claimant: CAPPS, Gerald Attorney: David E. Smith Wilcoxen, Callahan, Montgomery, & Harbison Address: 2114 K Street Sacramento, CA 95816 Amount: $250,000.00 By delivery to Clerk on June 8, 1992 Date Received: By mail, postmarked on June 5, 1992 I.' FROM: Clerk of the Board of Supervisors TO: County Counsel . Attached is a copy of the above noted Application to File Late Claim. DATED: June 11, 1992 PHIL BATCHELOR, Clerk, By Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911.6). The Board should deny this Application to File Late Claim ( tion 1.6'). j 1 � DATED. I2 VICTOR WESTMAN, County Counsel, By �D�eputy III. BOARD ORDER By unanimous vote of Supervisors present VV (Check one only) ( ) This Application is granted (Section 911 .6). (� This Application to File Late Claim is denied (Section 911.6). I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. 0 DATE: JUN 2 3 1992 PHIL BATCHELOR, Clerk, By a Deputy WARNING (Gov. Code §911.8) If you wish to file a court action on this matter, you must first petition the appropriate court for an order relieving you from the provisions of Government Code Section 945.4 (claims presentation requirement). See Government Code Section 946.6. Such petition must be filed with the court within six (6) months from the date your application for leave to present a late claim was denied. You may seek the advise of any attorney of your choice in connection with this matter. If you want to consult an attorney, u should do so immediatel . IV. FROM: Clerk of the Board T0: 1 County Counsel 2 County Administrator Attached are copies of the above Application. We notifed the applicant of the Board's action on this Application by mailing a copy of this document, and a memo thereof has ben filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. DATED: JUN 2 � i�iM1 PHIL BATCHELOR, Clerk, By--(] 01 1 A,. Deputy V. FROM: 1 County Counsel 2 County Administrator TO: Clerk of the Board of Supervisors Received copies of this Application and Board Order. DATED: JUN 2 3 1992 County Counsel, By, - County Administrator, By APPLICATION TO FILE LATE CLAIM 1 WILCOXEN, CALLAHAN, MONTGOMERY & HARBISON DAVID E. SMITH, State Bar No. 72703 2 2114 K Street Sacramento, California 95816 3 Telephone: (916) 442-2777 4 Attorneys for Claimant, RECEIVE® GERALD CAPPS 5 JUN 81992 6 9 CLERK BOARD OF SUPERVISOR 7 CONTRA COSTA C0• 8 IN THE MATTER OF THE CLAIM OF: 9 10 GERALD CAPPS, } APPLICATION FOR LEAVE TO PRESENT 11 } LATE CLAIM Claimant, } 12 } [Gov. Code, § 911.2 et seq. ] -vs- } 13 } COUNTY OF CONTRA COSTA, } 14 } Respondent. } 15 } 16 17 TO: COUNTY OF CONTRA COSTA, STATE OF CALIFORNIA, 18 Board of Supervisors 19 651 Pine Street, Suite 106 Martinez, CA 94553 . 20 21 22 GERALD CAPPS, through his attorneys, hereby present this application for leave to present late claim to the COUNTY OF CONTRA 23 24 COSTA, pursuant to the California Government Code 9911.2 et seq. , as follows: 25 1. Application is hereby made for leave to present a late claim 26 under Government Code §911. 2 , et seq. This claim is founded on a 27 cause of action for personal injuries, which occurred on or about 28 UW DUCES a WILOO.KEN,CALLAHAN MONTGOMERY& HARBISON 211,N STREET SACKA EW0.G WW a 1 1 August 25, 1991, and for which a claim was not timely presented. For 2 additional circumstances relating to the cause of action, reference 3 is made to the proposed claim attached hereto as Exhibit A, and made 4 a part hereof. 5 2. The reason for the delay in presenting this claim is 6 mistake, inadvertence, surprise and excusable neglect of the 7 attorneys for claimant, as is more particularly shown in the 8 Affidavit of David E. Smith, attached hereto as Exhibit B, and made 9 a part hereof. 10 3 . The COUNTY OF CONTRA COSTA has not been prejudiced by the it failure to timely file a government tort claim, as they have been on 12 notice of the accident of August 25, 1991, together with 13 approximately 22 fatalities along the same roadway since 1986. 14 4 . This application is presented within a reasonable time after 15 the accrual of the cause of action, as shown by the Affidavit of 16 David E. Smith. 17 WHEREFORE, it is respectfully requested that this application 18 be granted and that the attached claim be received and acted upon in 19 accordance with Government Code §§906, 910, 910.2, 910.4, 915 and 20 915. 2 . (^ 21 Dated: 22 WILCOXEN, CALLAHAN, MONTGOMERY & HARBISON 23 24 B 25 D ID E. SMITH Attorneys for Claimant 26 G:\cases\h\10946.des\app.hay 27 28 LAW OFFICES OF VALCOXEN.CA IAHAN MONTGOMERY& HARBISON T 1.K STWE1 AE SACRAMQ CA®IB 2 • • • �xh�B� t A 1 WILCOXEN, CALLAHAN, MONTGOMERY & HARBISON GARY B. CALLAHAN, State Bar No. 047543-2 2 2114 K Street Sacramento, California 95816 3 Telephone: (916) 442-2777 4 Attorneys for Claimant, GERALD CAPPS 5 6 7 8 IN THE MATTER OF THE CLAIM OF: 9 10 GERALD CAPPS, } GOVERNMENT CLAIM FOR PERSONAL 11 } INJURIES; NOTICE OF CLAIM NOT Claimant, } TIMELY FILED 12 } -vs- } [Gov. Code, §§ 906, 910, 13 } 910. 2, 910.4, 911. 2 , 911.4, COUNTY OF CONTRA COSTA, } 911. 6, 915, 915. 2] 14 } Respondent. } 15 } 16 TO: COUNTY OF CONTRA COSTA, STATE OF CALIFORNIA, 17 Board of Supervisors 651 Pine Street, Suite 106 18 Martinez, CA 94553 . 19 YOU ARE HEREBY NOTIFIED that GERALD CAPPS, through his 20 attorneys, Wilcoxen, Callahan, Montgomery & Harbison, hereby presents 21 this claim to the COUNTY OF CONTRA COSTA pursuant to Government Code 22 §§ 906, 910, 910. 2 , 910.4 , 911. 2, 911.4, 911. 6, 915, and 915.2 . 23 Claimant is GERALD CAPPS, whose address is 20955 S. Manteca 24 Road, Manteca, CA 95336. The address to which GERALD CAPPS desires 25 notice of this claim to be sent is: 26 David E. Smith, Esq. Wilcoxen, Callahan, Montgomery & Harbison 27 2114 K Street Sacramento, California 95816 28 (916) 442-2777 UW OFFICES OF AILCOXEN,CALIAHAN MONTGOMERY R HARBISON 211 i K SKEET SACR&ACNTO.CA fl 8 1 1 This claim is based on personal injuries sustained by Claimant 2 on or about August 25, 1991, in the vicinity of State Route 4 and 3 Discovery Bay Boulevard in the County of Contra Costa under the 4 following circumstances. 5 On August 25, 1991, GERALD CAPPS was driving his 1986 Oldsmobile 6 Delta 88 proceeding eastbound on State Route 4 in the eastbound left 7 turn lane preparatory to turning north on Discovery Bay Boulevard in 8 the County of Contra Costa when, as a proximate result of a dangerous 9 and defective condition of the said intersection of State Route 4 and 10 Discovery Bay Boulevard in the County of Contra Costa, the vehicle it in which Claimant was driving collided with a 1985 Honda Prelude 12 bearing California license plate number 1MQE953 , then and there being 13 operated by JOEY ESQUIVEL RUIZ of 991 Estates Drive, Brentwood, 14 California 94513 , proximately thereby causing personal injuries and 15 damages necessitating the employment of medical care professionals 16 to treat said injuries, both physical and mental, proximately further 17 thereby causing loss of earnings and earning capacity. 18 The subject accident was investigated by the California Highway 19 Patrol. The results of their investigation are set forth in the 20 State of California Traffic Collision Report, Local Report Number 8- 21 294, attached hereto as Exhibit A and incorporated herein, which 22 investigation is set forth in the report which consists of ten pages. 23 Claimant' s claim is hereby presented to the COUNTY OF CONTRA 24 COSTA in that the COUNTY OF CONTRA COSTA had a mandatory duty to 25 provide safe roadways. The Claimant is informed and believes that 26 Discovery Bay Boulevard was in a dangerous and defective condition 27 in that on Claimant's information and belief, based upon material 28 provided by the California Highway Patrol, there had been some UW CFF CES GF WI LOOXEN,CALLAHAN MONTGOMERY& HARBISON 8 14 K STFEET SACAA.WNT0,CA '¢ 5 2 1 22 fatalities in the general vicinity of Discovery Bay Boulevard and 2 State Route 4 between June 8, 1986, and August 10, 1991. 3 The claim is further presented pursuant to the provisions of 4 Government Code section 830, in that the intersection herein was a 5 dangerous condition creating a substantial risk of injury when the 6 property and the adjacent property along Discovery Bay Boulevard were 7 being used by Claimant herein with due care in a manner which was 8 reasonably foreseeable to the COUNTY OF CONTRA COSTA. 9 This claim is also presented pursuant to the provisions of 10 Government Code sections 835 and 835. 2 , in that the roadway was 11 dangerous and known to be dangerous because of the prior accidents, 12 both fatal and nonfatal, known to the COUNTY OF CONTRA COSTA through 13 their statutorily mandated traffic accident and injury surveillance 14 programs. 15 So far as it is known to Claimant at the date of filing this 16 claim, he has incurred damages in the amount of $250, 000, 17 representing damages for pain and suffering, medical expenses 18 incurred to date, future medical expenses, loss of earnings, and loss 19 of earning capacity. 20 Claimant is ignorant of the name(s) of the public employee or 21 employees responsible for the. acts and omissions herein specified. 22 At the time of presentation of this claim, Claimant claims 23 damages in the amount of $250, 000, as hereinabove set forth. 24 DATED: ��� , 1992 WILCOXEN, CALLAHAN, MONTGOMERY & HARBISON 25 26 By DAVID E. SMITH 27 Attorneys for Claimant 28 UW OFFICES OF WILCOXEN,CAL.LAHAN MONTGOMERY& HARBISON r 14 N WKE7 FAC aCX d�a 3 • • �xhi�i t A STATE AALJ1p/Y1A Tryfia=le COLLISION REPOR PROS IOP (� SPICAAL CONOIT)ONS "w"CR MITRAL« cTrr .3301" .DN117ICT AEPOATNWSEA SLAxoda o Nu st% )SEE AW COLMT ARJOATE•O DISTINCT "AT IDLLRD w A /Lo\C404. G ����J// (�•,,,, 1 C �a err L.IrOAM OCCURRED ON Yn DAT YEAR TWt(26=) 00=00=/ of,.L Q n __ 1 �_1r�_ __?_' _--__ ------------- ZS; 41 C. 35 3Z© 0S' WUTPOST NAA)RYATION �_____ DAt O/Trill( TOW AWAY TOGA"Ha AT- 4 L L f, .,_. DA T W T F S ®TEs []NO QU MAT SfTIRs[G7TOPI WITH STATE HArr REL, son: ..s3 rvrr,"k+.9 L OP j 1 L.'VV� Ley /-"� ®Tp aN0 ®HOAR PARTY owvERSLACENaENWaER sTAa CWt SAfSTY YEK TRAA MAX[! !COLOR ENSENWaRR STA: 1 A L/ 793 LL DRIVER NAME(AAST.WDO".LST)) ►[OIs STREET ADO"" OVW*Lxs PAM[ VSAM[AS OAMSR TA,AN ❑ PAAKIO CTTY; ATS►7)► _ OMNS"ADORS" nSAMRY pAvtA SICy S" NWA ITS* WRROFTT 'rA"DA,DATE rRAi1 AACS o1SPOMTOM OP YElSCLI OP ORDERS Oi! PICEAI MVIR QOTHER ir 7 70 OTHER /10•fL PNY,?PA[ SUi4i[SS PNONS ' ♦SOA M[CHAMCAL DIFICTE: NOW APPAA ANT® REFER TO NAAAATIYE ❑ ( •�� 61 5 y zz l-5— UAL Y[xcu TY// DRseasE[YRHICLI DAMAD[ Ag[w DAMAGED AREA INSUAAvCR CARRIER POUCY NWSER �On OMA,AOR OIA.OF ONETREETORHIONWAT $pitoPCs r ❑Q TRAVIfSEL UMIIf/�-uiri T �t�� icr PARTY ONV RA's UCENsR NUMSER STATE CUSS $AFCTT VEK►RAA MALE 1 MOO"i EASE NIAyER STATE aAVEA N(1Y[()%RsT,ASDOL[.LAST) • . ■ Ly�rN L am. ..�t Al g4v PSORS TR[ST ADORE" OWN[R1 NAME SAYE AS ONVEA MAN ❑ � � /�rJ '�� /x/21 rJ� J�A� .� PARXIOCETT I STATI!ZW OWNUT's ADDRESS 13❑ SAW[AS OAIYIA VEHICLE ��� liM `L O Q CO K. Ar , b ! /1� rcT. SRR NWA [Iia PElaxr WwQ#(T BIRTHDATE RAei O1SPOr'T}OMOFVINC1AONOROEASOF: ❑orPIcEA ®oNVEA (30TWEA OUST Mo. ; oAr YE►AI ❑ kNi / LLY2--> OTHER NOYS PHON[ SLAMA[M PADRES M004 MICPAMCAL 09FICTS: NON[A"AASWT� ASFSATO PAAR.rnE O ❑ (2.0 9) g5 2 to 3 S ( ) L"-- V O k4 O i "SCA1sR VENiCLR OMABE SNADI N DAMADEO AAEA IkSUAANCR CAANER POUCT N&MBLA �_ t ; ❑IMG. ONOh[ OYIN6R • ,.�/J ` ®YOQ ❑MA.AOR aTOTAL DER.OP ON STREIT OR HIGHWAY *Pilo ►CP ice C3TRAVEL _ 4 / UYfr Puco /{ �.....-.. CNP❑ PARTY ONYIws UCENSE NWsEA STATS CLASS SAFETY VSK TIAA MAXRtMOOELICOLOA, iNSE NWAEA STATE 3 low. CANER NAME(ARST,MIOOLS,LUT) • • • • • ` • • • • • . . . . . . . • . PIDIS. STREET ADDRESS OWNS"NAME ❑SAY[AS OPAYEA cl PARKED CATV A STATE I SIP OWNER'S ADDRESS � SAMXAXO VEA V EMICLI SICT. SER I NWA EYES MEK)HT "WONT U06r OAT YEAR RAGE OISPOrTON OP Vow-LE ON OAOIRS OP: OfRCEA QORIYEA C]OTHIA CUNTOTHER /HOME PHONE ., UBJNf"PHONE P4COR MECHAMCAL OEFECTV: NONE AFP ENT❑ REFER TO NAARATIYE❑ ❑ \ / ( ) CMF USE ONLT OESCAISE VEN! OAM i SHADE Of DAMAGED AREA INSURANCE C.AANEA POLICY NWSEA YEMCLETY►I. QIAMIC ❑HOAR MINOR TRAVEL I PUC❑ CMP P•f PAAEA'3.fA E DIS?AFf,:u N/)TIGRC?' ay�'`jM�*'�'�yAAt GATE R[VIfwED YES fZtftit C MP SSS PAGE T (R•v 148, vA".uc1 -•. ._. ._- - .. .. .. ti' �.�r�VItW/V1rYr TRAFFIC COLLISION CODINr 0Ai►#CO�USgN t TYl(��fA. MIOC MWRA L +•err•••, ..—... YO. 0�� �tAR •••� OWN[AlY N41[/ADOIL[[{ PHOPERTY �•• ❑Y[s ry OALiAGE acscrrlsoN of aa++acu (.... SEATING POSITION SAFETY EQUIPMENTM/ �Y <� EJECTED FROM VEHIC. OCCUPANTS L•AIR BAG DEPLOYED 0-NOT EJECTED A,NONE IN VEHKCLE N-AIR SAG NOT DEPLOYED DRIVER' I-FULLY EJECTED B-UNKNOWN N-OTHNOT R V-1410 2-PARTIALLY EJECTED C-LAP 8NOT Ei7 USED P- EOKARED W,YES 3•UNKNOW N f-DRIVER D-LAP BELT NOT USED 1 Z 3 2 TO 6-PASSENGERS E-S14OULDER HARNESS USED PASSENGER r} rj 6 7-STATION WAGON AFAR F-SHOULDER HARNESS NOT USED CHILD R,5TRAINT X•NO 8-REAR OCC.TRK.OR VAN C+'LAP I SHOULDER HARNESS USED O-IN VEHICLE USED 4-POSITION UNKNOWN H'LAP/SHOU LDER HARNESS NOT USED R-IN VEHICLE NOT USED Y,YES 7 0•OTHER J•PASSIVE RESTRAINT USED S-IN VEHICLE USE UNKNOWN K-PASSIVE RESTRAINT NOT USED T-IN VEHICLE IMPROPER USE U-NONE IN VEHICLE ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK I')SHOULD SE EXPLAINED IN THE NARRATIVE PRIMARY COLLISION FACTOR MOVEMENT PRECEDING UST NUMBER (I)OF PARTY AT FAULT TRAFFIC CONTROL DEIAOES 1 2 3 TYPE OF VEiiCLE 1 2 3 COLLISION A vC SECTION VIOLATED: O JO ACoNTAOLS FUNCTIONING APASSENGER CAR/STATION WACO% AsToPPED - -•` "A vc— No $CONTROLS NOT FUNCT1oNNG' EW&SUNGEA CAR W/TRAILER $PROCEEDING STRAIGHT I $OTHER]MPROP DRIYINO': CONTROLS OBSCURED MOTORCYCLl:ISCOOTEA C RAN OFF ROAD Q No CONTROLS PRESENT i FACTOR' OR PANEL TRUCK Q MAKING RIGHT TURN C OTHER THAN DRIVER• TYPE OF COLLISION E PICKUPI PA–gMJRUCX W/TRAILER I I IE MAKING LEFT TURN_ Q UNKNOWN' HEA 0-ON F TRUCK OR TR TRACTOR F MAKING U TURN JErc $SIDESWIPE GTRUCK/TRIC RACTOR W/TALA. BACKINGREAR ENO SC S SLOWING/STOPPINGEATHER( MARK I TO 2ITEMS I Q 8RCAOS40F I O BUS I PASSING OTHER VEHICLE CLEAR E HIT OBJECT T_qERGENCY VEHICLE �J CHANGING LANES CLOUDY F OVERTURNED K HG IPMENTK PARKING MANEUVER RAINING VEHICLE t PEOESTRIAN LBICYCLE ENTERING TRAFFIC . SNOWING OTHER': OTHER VEHICLE OTHER UNSAFE TURNING FOG t visialLTY FT. MOTOR VEHICLE INVOLVED WITH N PEDESTRIAN KING INTO OPPOSING LANE F OTHER•: ANON-Co( Som MOPED PARKED G WINO �� yK101i PEDESTRIAN P MERGING LIGHTING OTHER MOTOR VEHICLE TRAVELING WRONG WAY ADAYLIGHT . Q MOTOR VEHICLE ON OTHER ROADWAY OTHER ASSOCIATED FACTOR(S) OTHER,: B DUSK-DAWN E PARKED MOTOR VEHICLE 1 2 ' (MARK I TO 2ITEMS) CDARK-STREETLIGHTS TRAIN AYc woUn anv Q DARK•NO STREET LIGHTS BICYCLE O�� I jy Oyu HO C� V�-r" (/No DARK-STREET LIGHTS NOT ANIMAL: $we[[cm,YK/uTiON: pna 1 FUNCTION NG• [QYa ROADWAY SURFACE FIXED OBJECT: ❑� SOBRIETY-DRUG ADAY I resE u arta 1 2 3 PtiYstCAL ` Gw (MARK I TO 21TEMS) C WET J OTHER OOJEGT: HAO NOT BEEN DRINKING sNowr.Icr Q SLIPPERY(MUDDY,OILY,ETC,) VISION OBSCUREMENT: $HOD-UNDER iNFLUENCE F tNATTFNTDON•: MOD_NOT UNDER INFLUENCE ROADWAY CONDITION(S) G STOP 100 TRAFFIC MOO•IMPAIRIENT UNKNOWN' (MARK i TO2ITEMS) PEDESTRIANS INVOLVED E UNDER DRUG INFLUENCE' ?�B NO PEDESTRIAN INVOLVED H ENTERING/LEAVING RAMP A HOLES,DEEP RUT• I PREVIOUS COLLISION F IMPAIRMENT- PHYSICAL' CROSSIHG IN CROSSWALK IMPAIRMENT NOT KNOWN B LOOSE MATERIAL ON ROADWAY' ATINTERSECTION INFECTIVE WITH ROAD C OBSTRUCTION ON ROADWAY• K DEFECTIVE VEH £OUIP,: Cid EO IH NOT API FATIG E CROSSING]N CROSSWALK-NOT QYn j SLEEPY/FATIGUED j Q CONSTRUCTION-REPAIR ZONE AT INTERSECTION LI►a SPECIAL INFORMATION E REDUCED ROADWAY WIDTH ID GROSSING•NOT IN CROSSWALK L UNINVOLVED VEHICLE AHAZARDOUS iUTERIAL FLOODED E IN ROAD-INCLUDES SMOULDER M OTHER' IG OTHER•: NOT IN ROAD NONE APPARENT H NO UNUSUAL CONDITIONS APPAOACHING/LEAVING SCHOOL BUS Q RUNAWAY VEHICLE SKETCH _ti•• I - /�� �. MISCELLANEOUS HO DOT -- - wICAnNOM CR CRN! - ------ DA PDI/SO _CT C)THER 14 d �3 _ ST- G'vr1 i f CHP 535 PAGE 2( R*r 1.i[j OPI 042 ' � CATI Of COLLISION of" NUMBER VATNESS PASSENGER AGE US EXTENT OF INJURY "X"ONE) INJURED WAS("X" ONE) AR1`Y UAT SAFETY gjacrab ONLY ONLY HL"21A POS. 104AP. it"-4860 OhLYY TRANSPORTED BY: TAKEN TO: OISCRISE INJURIES C3VICTIM OF IAOLVrr CRIME NOTIFIED PQUA*0 ONLY)TRANSPORTED BY: IF TAKEN TO. AJURCO ONLY)TRANSPORTED By: TAKEN TO. ESCA186 INJURIES VICTIM�F VIOLENT CRJAAE NOTIFIED PhOmf 4JUAW ONLY)TRANSPORTED BY: TAKEN TO. VICTIMOFVIOLEWCAIMENOTIFIED WUAF.0 OMY)TRANSPORTED BY. TAKEN TO: ` _---- _—__BY: TAKEN TO: — ClVIC14109VOLENTCRUENOTIMED DAY TE IP 555-Page 3(Rev.7-87) QF1 042 al 43037 ' •TATE O• CAL1/OwNIA • FACTUAL-DIAGRAM � DA7a Or CQO LLI aION Tlr[ (���OI NCIC wu r.�f/Tw� Or/ICar ..0, wyYaaw ,, ?,09c � AL SU REMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED (SCALE Orp INOICATa V Q.T. G 4 F . Y-L � p J7/r7 p SFr auolW c rr��cln�LS JAZaLl 11WA OwAMN OY ll.'s. NV rYCw I YO. OAY Yw, iY[VIaW\MSS NAr� I YO. DAY Yw. 9-8-9/ _ CHP 555—Page 4 (Rev 11.85) OPI 042 kX9 A'jNEISUPPLEMENTAL PAGE wrcoP +to�Nes � TiYE�2A0q NGCNUMeER DP•cERLD. 2 NN1tl�EJ1 .XO1{ .rc" TYPE SUPP"WENTALMAPMJOA" INAPRATra C40UJ31ON ❑ 8A UPOATE PATAL ❑ Mi RUN UPOATE F { SUPPLEMENTAL OTKM ❑ 442ARL1OIAMATMALS ❑ 3CMOOLaU3 D OTHUt CITY=UNTYIAJDCAL DIST AIGT REPORTING OWA S18EAT CITATION NUM8ER LOCATION/SUBJECT STATE NGNWAY RELATED YES ND 1. • 2. 3. 4. C 10. 11. 1� 12. diarL llTG7 12 14. L 15. on ' 16. 17. ri I ,9. 20. 21. 7 -zni I 22. 23. A1 a. 25. / 26. •Lt CLQ "I 27. 28. a. 29. 30. 31. +� f. 32. PREPARERS NNIS I.O.NUMMR TNI Y/YEA REVIEW ERS NAME M N/wY EAR CNP$56(Rev.7-87)OP1 042 88 48641 ��� ''.u.ca0� +� irl• .S i :.rtL- �.+1J.Li �...�r[!.�1 � �..,L i • �Ir/ ,��-1.i. s..r�' .i�r�..lr i '" • .Y•E'� ..s La • /sir G/ .rt...l .: s, APF AV 4 1L-A md ,� �►i!/ %�[... i.r�'/ fir. TATE • UPCAtiIA - lV,aATtVE(SUPPLEMENTi,L. PAGE OA{E Or IN IDENTtOCCuAENCE TME{2Ki04 MGCMU OFFICERED. MUySr� t • 'X ONE 'X'CME TYPE SUPFLEYEMTALfX APPUGAYq ® MAAAATIVE COLUMN REPO$gr a SAUPDATE a FATAL ❑ MTAPIUMUPOATE ❑ SUPPLEMENTAL ❑ OTMEFL ❑ MAZAAD04A MATEMALS a SOMOOL SUS ❑ OTHER CITY!0OUNTY/4VOGAL CISTRGT REPORTING DtSTPjCt l BEAT OTATION NUMSEA LOCATION!SU&FC: STA:E wGe+riAY AE'J.7=-, YES N; lot) ZZ 2. 3. 4. 5. 6. 7. — CA-Aolt, ' L ZAJ 9. 10. 11. 12. 1 ti 14. ~ 15. _ x 16. 17. 18. Z ' 19. �' 20, ti 21. 22. i" 7 23. z 24. �r•�' �� . 25. � 26. 27. 28. 29. ✓' "� 30, 31. 32. /o L. -- PAEPARERSNAME 11.0.NUMBER MONTMt DAY!YEAR IEWER ME YONTMIOAYlYEAA i CHP 556(Rev.7.87) OPI 042 88 4864 RA►W%E/SUPPLEMENTAL OA,TEOFINCSOENTIOGCURENGTiME12AM MGIC MU R OFFIT �N.IMSER r •X ONE 'X ONE TYPE SUPF6EMENTALrXAYFLIG" ® NARRATIvE COLL41ON REPORT ❑ SA UPOATE cl FATAL ❑ NR i RUN UPDATE ❑ SUPPLEMENTAL D OTHER _ ❑ MZWZ04A MATERIALS a SCHOOL" ❑ OTHER- CITY/ THERCITY/COON TY/,=iCAL OiSTRICT Al POALNG DISTRICT I BEAT QlATONNuMBER 6OCATgNiSU61ECT STATE W(J1WAY RELATED YES L7NO 2. 3. a. ��,,,' s. 7. e. flt 9. 10. 11, 12. 13. 1 A. -- 15. 1!J 16. Ll 0 m ? 1.* > ul /A x,. 17. Z.•� ,�t..c 18. 20. u 21. 22. 23. r t j j •'* G" 4. 25. ? 26. 27. ' 4 28. "- } 29. 30. � - 31. �2 PREPARERSNAME I.D.NUMBER NTH/pAT1YEAR REVIEWERSNAME MONTNJOAY/YEAR CHP 556(Rev.7.67)OPI 042 85 48641 tAi ATiVEJSUPPLEMENTAL •AOE DATE BLF/+�j�ij tOCCURfNCII / %4(2Aoo� NGG NUM R G/FiGEptO. NUMBEA _ ;? -row. 'x"ONE TYPE PPI,EMENTK(')C AYPtX tg,l� NAARATIVE ® COLLli10N AF.PCIAT a BA UPDATE ❑ FATAL ❑ }rT AAUN UPDATE DiU?otEMEMK Q OTHER a MAZAAWkS MATOUAL3 Q sCNOOLAGi a OTHER CITY 1CCUNTY/JUO"LDIST RICT REPWINGDGTRICT/6EA7 OTATIONNUMSER LOCATION I SUBJECT S7 A:E n�Gt+wAY AE;,+7 ED YES r7.1 NG 1. 3. 4. 1 i S. 4' ? 7. 8. 9. - 10. 11. 12. MQZ, ' 13. _j /. r __ / LU n 14. 16. 17. 20. 21. 22. G� 1 23. 24, _W*' 50 25. _ 26. i t 27. 28. 29. 30. r- 31. PREPARER 5 NAME 1.B.NUMBER MJNi 1,QA /YEAR REYlEWEA'SNAME MONTMIOAY/YEAR CHP 556(Rev.7.87) OPI 042 88 48641 IATIF ARATIVE/SUPPLEMENTAL •AGE OATEO NCS EMT/ URENCN=NU CiftGEA D. MUItlEf4 �� 15P/ zo *v ONE 'X'ONE TYPE SUPKIMEMTALCX'APKX..4" NARRATIVE ® COU151OM AEPORT El -SA UPDATE FATAL ❑ MT i RUN UPDATE ❑ SUPPLEMENTAL OTHER: Q MAZAROO144WATEPIA43 Q SCNOOLBUS OTNEIL CITY!COUNTY 11UOCAL DISTRICT REPORTING OISTFYCT/BEAT OTATIONNUiABER LOCATION/SUBJECT ST A T E NG»W AY RE LAT ED cl YES NO 17 3 _ 4. 5. 6. 7. 8. r C L1 10. 11. y j 12. 13. 14. 15. : r:6 LmgS 0 16 La 16. 17. 18. 19. -...' F--P7 20. 21. 22. Q iG' j Out V- 23— Y` p 24. 25. 26. 27 ` 28. I wr 29. 30. 31. 32. PREPARERS NAME I.D.NUM/B�ER 1,UNtN.DArI YEAR REVIEW ERS NAPE MOM»e0Ar1rEAR CHP 556(Rev.7.27) OPi 042 u«p..a...uw» 88 48641 • • �X�f1�blt. AFFIDAVIT I, DAVID E. SMITH, declare the following: 1. I am an attorney with the law firm of Wilcoxen, Callahan, Montgomery & Harbison, attorneys for claimant, GERALD CAPPS, herein. 2 . Our first contact with Claimant was on February 24, 1992. 3 . On February 25, 1992 a Government Claim for Personal Injuries was presented to the State of California for injuries received by Claimant pursuant to a August 25, 1991 automobile accident on State Route 4 at Discovery Bay Boulevard. At that time, the attorneys for Claimant were ignorant as to the ownership of Discovery Bay Boulevard. 4 . On February 25, 1992 the attorneys for Claimant enlisted the services of an investigator to determine ownership of Discovery Bay Boulevard. On May 13, 1992 our firm received a written report from Pacific Legal Investigations, Inc. Pacific Legal Investigations, Inc. identified the true and correct owner of the property as the COUNTY OF CONTRA COSTA, not the STATE OF CALIFORNIA. I declare under penalty of perjury that the foregoing is true and correct and if called to testify could competently testify thereto. Dated this day of 1992 , at Sacramento, California. DAVID E. SMITH 1 1. APPLICATION TO FILE LATE CLAIM JUN 1992 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA COUNTY coUNsE-1 mABO'ARD"ACTION Application to File Late Claim ) NOTICE TO APPLICANT June 23, 1992 Against the County, Routing ) The copy of this document mailed to you is your Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to ) the Board of Supervisors (Paragraph III, below), California Government Code.) ) given pursuant to Government Code Sections 911.8 and 915.4. Please note the "WARNING" below. Claimant: HAYWORTH, Kristen Attorney: David E. Smith, Esq. Wilcoxen, Callahan, Montgomery & Harbison Address: 2114 K Street Sacramento, CA 95816 Amount: $250,000.00 By delivery to Clerk on June 8, 1992 Date Received: By mail, postmarked on June 5, 1992 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted ApplicationFile6 LteClaim. DATED: June 11, 1992 PHIL BATCHELOR, Clerk, By Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911.6). The Board should deny this Application to File Late Claim (Secti 911.6). DATED: C/12. VICTOR WESTMAN, County Counsel, Byl� _ . S Deputy III. BOARD ORDER By unanimous vote of Supervisors present (Check one only) ( ) This Application is granted (Section 911.6). ( This Application to File Late Claim is denied (Section 911 .6). I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. DATE: JUN 192 PHIL BATCHELOR, Clerk, ByJaDeputy WARNING (Gov. Code §911.8) If you wish to file a court action on this matter, you must first petition the appropriate court for an order relieving you from the provisions of Government Code Section 945.4 (claims presentation requirement). See Government Code Section 946.6. Such petition must be filed with the court Within six (6) months from the date your application for leave to present a late claim was denied. You may seek the advise of any attorney of your choice in connection with this matter. If you want to consult an attorney, u should do so immediately. IV. FROM: Clerk of the Board T0: 1 County Counsel 2 County Administrator Attached are copies of the above Application. We notifed the applicant of the Boards action on this Application by mailing a copy of this document, and a memo thereof has ben filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. DATED: JUN 2 3 1992 PHIL BATCHELOR, Clerk, By d Deputy V. FROM: 1 County Counsel 2 County Administrator TO: Clerk of the Board of Supervisors Received copies of this Application and Board Order. DATED: County Counsel, By County Administrator, By APPLICATION TO FILE LATE CLAIM • WILCOXEN , CALLAHAN , A LAW COORPOORATIORATIO GARYANS N MONTGOMERY & HARBISON JOSEEPHPH FF..I-IHAA RBISON,III PATRICK L-}IINRICIISEN ATTORNEYS AT LAW JOHN P.MCCARTHY 2114 K STREET JOANNE M.MERRY RICHARD F.MILLS SACRAMENTO, CALIFORNIA 95816 IAMBS R MONTGOMERY (916) 442-2777 SusAN T.PATRONIK FAX (916) 442-4118 DAVID E.SMmI DANIEL E.WILCOXEN• A LAW CORPORATION June 5, 1992 'CERTIFIED SPECIALISTS IN CIVIL TRIAL ADVOCACY BY THE NATIONAL BOARD OF TRIAL ADVOCACY CERTIFIED MAIL/RRR RECEIVED Board of Supervisors 8192 651 Pine Street, Suite 106 JUN Martinez, CA 94553 CLERK BOARD OF SUPERVISORS Re: Gerald Capps v. CONTRA COSTA CO. County of Contra Costa Kristen Hayworth v. County of Contra Costa Claim Number: G264748 Greetings: Enclosed please find the following: 1. Application for Leave to Present Late Claim plus two copies presented on behalf of Gerald Capps; 2 . Application for Leave to Present Late Claim plus two copies presented on behalf of Kristen Hayworth. Please return to this office the enclosed copy of each Application indicating that you have received same. Thank you for your prompt attention to this matter. If you have any questions, please do not hesitate to contact this office. Very truly yours, DEBORAH GOODRUM, Paralegal DDG:deb Enclosures G:\CASES\H\10946.DES\GOVCLAIM.LTR 1 WILCOSEN, CALLAHAN, MONTGOMERY 6 HARBISON DAVID E. SMITH, State Bar No. 72703 2 2114 K Street Sacramento, California 95816 3 Telephone: (916) 442-2777 4 Attorneys for Claimant, RECEIVED KRISTEN HAYWORTH a- ---- 5 JUN 8 1992 6 CLERK BOARD OF SUPERVISORS 7 CONTRA COSTA CO. 8 IN THE MATTER OF THE CLAIM OF: 9 10 KRISTEN HAYWORTH, } APPLICATION FOR LEAVE TO PRESENT 11 } LATE CLAIM Claimant, } 12 } [Gov. Code, § 911.2 et seq. ] -vs- } 13 } COUNTY OF CONTRA COSTA, } 14 } Respondent. } 15 } 16 17 TO: COUNTY OF CONTRA COSTA, STATE OF CALIFORNIA; 18 Board of Supervisors 19 651 Pine Street, Suite 106 Martinez, CA 94553 . 20 21 22 KRISTEN HAYWORTH, through her attorneys, hereby present this application for leave to present late claim to the COUNTY OF CONTRA 23 24 COSTA, pursuant to the California Government Code §911.2 et seq. , as follows: 25 26 1. Application is hereby made for leave to present a late claim under Government Code §911.2, et seq. This claim is founded on a 27 cause of action for personal injuries, which occurred on or about 28 UW OFFICES OF WILCOXEN,CALLAHAN MONTGOMERY& HARBISON 2114 N STWEf SACFAWNTO,CA 9WO 1 1 August 25, 1991, and for which a claim was not timely presented. For 2 additional circumstances relating to the cause of action, reference 3 is made to the proposed claim attached hereto as Exhibit A, and made 4 a part hereof. 5 2 . The reason for the delay in presenting this claim is 6 mistake, inadvertence, surprise and excusable neglect of the 7 attorneys for claimant, as is more particularly shown in the 8 Affidavit of David E. Smith, attached hereto as Exhibit B, and made 9 a part hereof. 10 3 . The COUNTY OF CONTRA COSTA has not been prejudiced by the 11 failure to timely file a government tort claim, as they have been on 12 notice of the accident of August 25, 1991, together with 13 approximately 22 fatalities along the same roadway since 1986. 14 4 . This application is presented within a reasonable time after 15 the accrual of the cause of action, as shown by the Affidavit of 16 David E. Smith. 17 WHEREFORE, it is respectfully requested that this application 18 be granted and that the attached claim be received and acted upon in 19 accordance with Government Code §§906, 910, 910.2, 910.4, 915 and 20 915. 2 . u 21 Dated: 22 WILCOXEN, CALLAHAN, MONTGOMERY & HARBISON 23 24 By: 25 D"IE. TH Attorneys for Claimant 26 G:\cases\h\10946.des\app.hay 27 28 UW OFFICES OF WILCOxEN,CALIAHAN MONTGOMERY& HARBISON 7114 K STFEET SACIN 1110,CA B 1 1 2 • • • �xhiBit A 1 WILCOBEN, CALLAHAN, MONTGOMERY & HARBISON GARY B. CALLAHAN, State Bar No. 047543-2 2 2114 K Street Sacramento, California 95816 3 Telephone: (916) 442-2777 4 Attorneys for Claimant, KRISTEN HAYWORTH 5 6 7 8 IN THE MATTER OF THE CLAIM OF: 9 10 KRISTEN HAYWORTH, } GOVERNMENT CLAIM FOR PERSONAL 11 } INJURIES; NOTICE OF CLAIM NOT Claimant, } TIMELY FILED 12 } -vs- } (Gov. Code, §§ 906, 910, 13 } 910. 2, 910.4, 911. 2 , 911.4, COUNTY OF CONTRA COSTA, } 911. 6, 915, 915.2] 14 } Respondent. } 15 } 16 TO: COUNTY OF CONTRA COSTA, STATE OF CALIFORNIA, 17 Board of Supervisors 651 Pine Street, Suite 106 18 Martinez, CA 94553 . 19 YOU ARE HEREBY NOTIFIED that KRISTEN HAYWORTH, through her 20 attorneys, Wilcoxen, Callahan, Montgomery & Harbison, hereby presents 21 this claim to the COUNTY OF CONTRA COSTA pursuant to Government Code 22 §§ 906, 910, 910. 2, 910.4, 911.2, 911. 4, 911. 6, 915, and 915.2. 23 Claimant is KRISTEN HAYWORTH, whose address is 1730 Surfside 24 Place, Byron, California 94514. The address to which KRISTEN 25 HAYWORTH desires notice of this claim to be sent is: 26 David E. Smith, Esq. Wilcoxen, Callahan, Montgomery & Harbison 27 2114 K Street Sacramento, California 95816 28 (916) 442-2777 UW OFFICES OF WILCOXEN,CA LAHAN MONTGOMERY& HARBISON 2114 K STREET S�CRN.ENTa G 9W8 1 1 This claim is based on personal injuries sustained by Claimant 2 on or about August 25, 1991, in the vicinity of State Route 4 and 3 Discovery Bay Boulevard in the County of Contra Costa under the 4 following circumstances. 5 On August 25, 1991, KRISTEN HAYWORTH was a passenger in a 1986 6 Oldsmobile Delta 88 proceeding eastbound on State Route 4 in the 7 eastbound left turn lane preparatory to turning north on Discovery 8 Bay Boulevard in the County of Contra Costa when, as a proximate 9 result of a dangerous and defective condition of the said 10 intersection of State Route 4 and Discovery Bay Boulevard in the 11 County of Contra Costa, the vehicle in which Claimant was a passenger 12 collided with a 1985 Honda Prelude bearing California license plate 13 number 1MQE953 , then and there being operated by JOEY ESQUIVEL RUIZ 14 of 991 Estates Drive, Brentwood, California 94513, proximately 15 thereby causing personal injuries and damages necessitating the 16 employment of medical care professionals to treat said injuries, both 17 physical and mental, proximately further thereby causing loss of 18 earnings and earning capacity. 19 The subject accident was investigated by the California Highway 20 Patrol. The results of their investigation are set forth in the 21 State of California Traffic Collision Report, Local Report Number 8- 22 294, attached hereto as Exhibit A and incorporated herein, which 23 investigation is set forth in the report which consists of ten pages. 24 Claimant's claim is hereby presented . to the COUNTY OF CONTRA 25 COSTA in that the COUNTY OF CONTRA COSTA had a mandatory duty to 26 provide safe roadways. The Claimant is informed and believes that 27 Discovery Bay Boulevard was in a dangerous and defective condition 28 in that on Claimant's information and belief, based upon material UW OFFICES lF WII.COXEN,CAUAHAN MONTGOMERY& HARBISON 2114 N STRE SACRAWNTaCA p$IB 2 1 provided by the California Highway Patrol, there had been some 2 22 fatalities in the general vicinity of Discovery Bay Boulevard and 3 State Route 4 between June 8, 1986, and August 10, 1991. 4 The claim is further presented pursuant to the provisions of 5 Government Code section 830, in that the intersection herein was a 6 dangerous condition creating a substantial risk of injury when the 7 property and the adjacent property along Discovery Bay Boulevard were 8 being used by Claimant herein with due care in a manner which was 9 reasonably foreseeable to the COUNTY OF CONTRA COSTA. 10 This claim is also presented pursuant to the provisions of 11 Government Code sections 835 and 835.2, in that the roadway was 12 dangerous and known to be dangerous because of the prior accidents, 13 both fatal and nonfatal, known to the COUNTY OF CONTRA COSTA through 14 their statutorily mandated traffic accident and injury surveillance 15 programs. 16 So far as it is known to Claimant at the date of filing this 17 claim, she has incurred damages in the amount of $250, 000, 18 representing damages for pain and suffering, medical expenses 19 incurred to date, future medical expenses, loss of earnings, and loss 20 of earning capacity. 21 Claimant is ignorant of the name(s) of the public employee or 22 employees responsible for the acts and omissions herein specified. 23 At the time of presentation of this claim, Claimant claims 24 damages in the amount of $250, 000, as hereinabove set forth. 25 DATED: ��.�- �'1 , 1992 WILCOXEN, CALLAHAN, MONTGOMERY ARBISON 26 27 By D ID E. SMITH 28 Attorneys for Claimant UW OFFLES OF WILOOXENCAUARAN MONTGOMERY& HARBISON m 1•K SKEET SACRUENTO.OA 95M 3 • • �xh�B� t A RAT{ ALJPOMM TFIC COLLISION REPOR'L PAD. iKRKeaNarnolw n"R7Rio PMiLEoaY'R a a1acRAL OKTrwcT i(1/E�tORTNWM'A//� (/,,,�/► �r�. MAKER NRB RUN COUNTY REPOMT7m ORTRKT SEAT DOLLANOM OCCURRED ON 11O, DAY V AA UK(am) M=8 orm"A l A _ 1 2S; 91 dd35- 1320 G MILEPOST INPORIA"mm r l DAY OP WE" TOW AWAY HOTOGRAPIIs SV: I.- yt6 < j,() t l T W T.F S ®,n Noll (I FE P I LAW OJ ❑Ar INTEREEc'TIDN MEIN j STATE NW,nL. �OR: PEETJYR!!V U OPL 00 //�" ova ❑No ®NONE PARTY WSVE"LICENSE mums" *TATE CLASS SAFETY VEA TEM YAK*t t COLOR LRE NtA/SEA ETAT Gly 3 LG C.9 � P W 3C UZE 53 . DRIVER NAYS(AMT.MIDDLE,LAST) ■ L.942 Ul VLA- PEOE*. STREET ADDRESS. OV104"*NAME .'�*A11i AS OMIER TRIM(. ❑ r PARKSo CITY f ATS/Zw _ _ OWNWS ADDRESS .SAY*AS OMVEA 4141 SK,. SEK KNA + Y� RACE anwoulwH OP YEMCE ON OAEE OPirACER ❑anon ❑ lg;lspo Ea . ? R an sT I. itI Cwt OTHER NOPE PNOIIE ,,�r SUsk%m P`FWNS AOR MECHANICAL OEP*CTM NN*OAPPARLNT E REFEA TO NARRATIVi❑ ❑ . C -51 6 15 Y ,Zzq-5" ( / _ ��� Cw USE ONLY DESCIESEYENWAA DAMAGE SHADE It DAMAGED AREA +'r YLKLEtTPE INSURANCE CARNIA Poucy NUMBER 1 y &00. ❑YA.IDR []MALOm or ON STRKST OR HONWAT sPSEo PCP ICC O TAAYEL CcNP13 PARTY OMVLA's UCLRLNUMSLR 4STATE, CLASS SAFETY YEK YEAR ENi*NUBEA *TATE 2 URKtxi .? . . DRIYLA M((WE(ART.WOOLS,LAST) PEOiS. STREET ADDRESS OWNERSAYS NSAYE M DOWNi ❑ 41/ :5-1 PARKED CETT ISTATSI M OWNEA7 A88Ris.,<,, ❑SAYE AS DOVER YEoi Ysi�1 lb dD� = b W 0 BICT- SRDM I HAIR E,p MOOT wL'IaRt �. M OAS TS I rEAn R1ACL DisFos naw OF YLECLE ON ORDLRS OF. ❑Of*cam 0ORMEII ❑OTNLA `�j 'Z� ' : 3 ccz -- *Than NOPE PHONE BUS"S4 PHOIK � \ PR1011 MECHANICAL OaftCTS: 110Nt APPARtNT ASRA TO NARIM►Mi❑ ❑ 9, g �.. " / �1L,._ CIM us&ONLY DtstlSSt YENICLR DAMADE SNARL Mt DAYAO/D AREA YSwcLE TTPI INSURANCL CMAkA POMMCY NUMBLA ❑ j , UNK. N0R1E YINOtt ._. ®MOO. ❑MAJOR ❑TOTAL - OIA OP ON STREET OA NWA, 'PEED PCP IOC❑ TRAY" _ L U. PUC❑ CNP❑ PARTY ORIYEAS LIG D+sa NUMt aA STATE CLASS S"ITY VEK YLAA YAKS tMOCKLI COLOR LICIN91 NUMBER *TATE 3 DANSE" NAME(ARST.POOLE.LAST) PEDES, STREET ADORERS Oww"m MAYS ❑SAYE AS DAIYER THAN ❑ PARKED CITY i STATE I TIP OWNER'S ADDRESS SAME AS COVER YEwcLE s7CY. SEX I NMR EYa* NNUGM I wooNT SIRTNDATS FACE DISPOMAON of VENICLA ON ORDERS Of: OfflCER ❑COVER ❑OTNER CUST Y0. . DAY 'fun ❑ OTNLR NOME►NONE L91NEss PHONE POOR YECMAISCAL DEFECTS: NONE— ENT❑ REFLRTONARAATWE❑ ❑ vim CLE St,t. OESCABE VEHICLE DAY E SNARE W DAMAGED AREA INSURANCE CAIIISEA POUCY NUMBER LAK. ❑NONE MINOR TRAVEL u W t Put❑ /� CNP( / P4FPARER'3 NA y, DISPATCu#p'YTIC6'1lDA TE REVIEWED c YES {� u^ ? CHP ESS PAGE T (Rev MBS t tw twi w' . .. ' TRAFFICA COLLISION CODIN • . A' ►Rot OATi: #.COLIaMON�••"• TWA(( "o. ki'K mossax L Mtn .� ZIT-1.AM OWI ft"a/AODMiii Mawpw PROPERTY DAILAGE aiiclrPTKiN OF DANA" SEATING POSITION SAFETY EQUIPMENT EJECTED FROM VEHIC. �,C,sJcrcL_c.t�l._L.cT OCCUPANTS L-AIR BAG DEPLOYED 0-NOT EJECTED l A.NOME IM VEHICLE M-AIR SAG NOT DEPLOYED DRIVER I-FULLY EJECTED a: UNKNOWN N-OTHER V.NO 2-PARTIALLY EJECTED C-LAP BELT USED P-NOT REOUIRED W-YES 3-UNKNOWN 1•DRIVER D-LAP BELT NOT USED = 2 `; 2 To S-PASSENGERS E-SHOULDER HARNESS USED PASSENGER 4 S 6 T-STATION WAGON REAR F-SHOULDER HARNESS NOT USED CHILD REST BeIIQ X•No I-REAR OCC.TRK OR VAN G-LAP/SHOULDER HARNESS USED G-IN VEHICLE USED Y-YES i-POSITION UNKNOWN N.LAP I SHOULDER HARNESS NOT USED R•IN VEHICLE NOT USED 0.OTHER -PASSIVE RESTRAINT USED S-IN VEHICLE USE UNKNOWN 7 K-PASSIVE RESTRAINT NOT USED T•IN VEHICLE IMPROPER USE U-NONE IN VEHICLE ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK(')SHOULD BE EXPLAINED IN THE NARRATIVE. PRIMARY COLLISION FACTOR CONTROL DEYK:EJI T •� IMCKUP TYPE OF VEHICLE 1 2 MOVEMENT PRECEDING LIST NUMBER(0)OF PARTY AT FAULT COLLISION . I VC SECTION VIOLATED: a s CONTROLS FUNCTIO IMO PASSENGER CAR/STATION WAGON ASTOPPED' "• - vc— Ho CONTROLS NOT FUNCTIONING• NIGER CAR W/TRAILER B PROCEEDING STRAIGHT i $OTHER IMPROPERDRIVING': CONTROLS OBSCURED MOTORCYCLE(SCOOTER RAN OFF ROAD D NO CONTROLS PRESENT I FACTOR` OR PANEL TRUCK D MAKING RIGHT TURN C OTHER THAN DRIVER• TYPE OF COLLISION I PA UCK W I TRAILER E MAKING LEFT TURN D UNKNOWN• HEAD-ON F TRUCK OR Tq TRACTOR MAKING U TURN I E B SIDESWIPE TRUCK 1 TRUC RACTOR W/TRLR. BACKING REAR END SC S SLOVANG/STOPPING WEATHER MARK l TO 21TEMS) D BROADSIDE O BUS I PASSING OTHER VEHICLE IA CLEAR E HIT OBJECT ERGENCY VEHICLE J CHANGING LANES CLOUDY F OVERTURNED K HIG PMENT E(PARKING MANEUVER RAINING VEHICLE/PEDESTRIAN L BICYCLE ENTERINO TRAFFIC SNOWING OTHER': OTHER VEHICLE OTHER UNSAFE TURNING fOG/visimLITY FT. MOTOR VEHICLE INVOLVED WITH N PEDESTRIAN XING INTO OPPOSING LANE OTHER': ANON-COLLI810N MOPED PARKED WIND S- NdJ3 PEDESTRIAN MERGING LIGHTING OTHER MOTOR VEHICLE TRAVELING WRONG WAY DAYLIGHT D MOTOR VEHICLE ON OTHER ROADWAY OTHER ASSOCIATED FACTOR(S) OTHER' OUSK-DAWN E PARKED MOTOR VEHICLE 1 2 " (MARK 1 TO ITEMS) DARK-STREETUGHTS TRAIN A c noLA crTia r ovu DARK-NO STREET tiGNTB BICYCLE G►Ire•'-.,��✓ V z. _ SNo DARK-STREET LIGHTS NOT ANIMAL: Vc WPM vwuawN: �o 1 FUNCTIONING` Ova ROADWAY SURFACE SOBRIETY-DRUG FIXED OBJECT: uno 2 S PHYSICAL DRY I cVa (MARK 1 To 2ITEMS) B WET OTHER OBJECT: ONO HAD NOT BEEN DRINKING SNOWY-ICY J D D SLIPPERY(MUDDY.OILY,ETC.) VISION OSSCUREMENr: B HBO-UNDER INFLUENCE F INATTENTION': HBD•NOT UNDER INFLUENCE ROADWAY CONDITIONS) J G STOP i OD TRAFFIC HOD-IMPAIRMENT UNKNOWN (MARK i T02 ITEMS) PEDESTRIANS INVOLVED H ENTERING/LEAVING RAMP UNDER DRUG INFLUENCE A NO PEDESTRIAN INVOLVED F IMPAIRMENT-PHYSICAL" A HOLES.DEEP RUT` PREVIOUS COLLISION CROSSING IN CROSSWALK IMPAIRMENT NOT KNOWNJ 7�_ j B LOOSE MATERIAL ON ROADWAY• JIB AT IMERSECTIOM UNFAMIUAR WITH ROAD K DEFECTIVE VEK EOUIP.: CMD NOT APPLICABLE C OBSTRUCTION ON ROADWAY- CROSSING IN CROSSWALK-NOT ❑TA : I SLEEPY I FATIGUED D CONSTRUCTION.REPAIR ZONE AT INTERSECTION O"o SPECIAL INFORMATION E REDUCED ROADWAY WIDTH D CROSSING-NOT IN CROSSWALK L UNINVOLVED VEHICLE AHAZARDOUS MATERIAL FLOODED• IN ROAD-INCLUDES SHOULDER OTHER IG OTHER F MOT INROAD NONE APPARENT H NO UNUSUAL CONDITIONS IG APPROACHING/LEAVING SCHOOL BUS I I 1 10RUNAWAY VEHICLE SKETCH - MISCELLANEOUS iaeATt<NOQIN . .HO DOT CR CRNR u/ ,�..,sc :C' - d Les�rv,e� _,__DA PD,/SO CHP SSS PAGE 2( R&V Iii)OPI 042 BTATE OVALIFORNI," IN,WREb I WITNESSES / PASSE, ERS PACE 3 DATE OF OOLUSIO L0. NWEER oL MRTNRB PAssNER A09 SEE EXTENT OF INJURY "X"ONE} INJURED WAS{"X"ONE) PAM sEA7 SAF'E'TY EJECTED ONLY MILT FATAL SEVERE OTHER VISIBLE COMPLAINT NUMBER POI. MAP. MVRY MUURV INJURY OF PAIN DRIVER PA'S[' K0. BICYCUff OTHER ❑u ■ Zorn ❑ ❑ ❑ ❑ 1010 ❑ ❑ ❑ NAM[/D.O.L l PONE - TELEPMON[ (W,I JREO QNLYY TRANSPORTED SY: TAKEN TO: DESCRIBE MUURIEs 0 VICTIM OF VIOLENTCRIME NOTIFIED ❑ ■ rs- 1:1 . 0 ❑ ❑ ❑ ❑ ❑ ❑ ❑ � x.. NAME IIXO.L/AODRW TELEPMONE MwVAID QKT)TRANBPORTED BY: TAKEN TO: a D[sCRIBE Pimm LJ VICTIM OF VIOLENT CRIME NOTIFIED HAMA. OAS.I ADDREBE T[L[PMONE ON+ R[D OP1LY)TRANSPORTED BY: TAKEN TO:. DESCRB[MuuRIEs ❑ VICTIM OF VIOLENT CRIME NOTIFIED ❑ 1 Zl ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1 '1 NAME 10.O.B.I ADDRESSTELEPMONE 7,06 ONAURED ONLY)TRANSPORTED SY: TAKEN TO. 0[sCRIBEM WAlfii VICTIM OF VIOLENT CRIME NOTIFIED ❑* ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ NAME/O.O.S./ADORES" TELEPHONE (MATURED ONLY)TRANSPORTED ST: TAKEN TO: DESCRIBE MUURIES . VICTIM OF VIOLENT CRIME NOTIRE0 ❑ ❑ ❑ ❑ ❑ ❑ o ❑ ❑ ❑ ❑ NAME/AAL!ADDR W - TELEPHONE SFLIURED ONLV)TRANSPORTED BY: TAKEN TO: DESCRIBE MIduRIEs i t •J..0-�.�• V�CnW OV VIOLENT CRIME HOTIRED PREPARE R'S NA f.0.NlAl4FR MO. !!'AA 41vIEwERs NAMf. MO, DAY YE♦ /S �r r B7 a3tl37 ,HP 555•Page 3(Rev.7.87)ON 042 •rwra o• twL1•a1.NrA . FACTUAL DIAGRAM •ACa< �-,/ • ' 9AT9 O♦ COLL1640« T1M{ is.**) Ncic NVN09. D•e•t[F(JJ.a. «uN11t AL SUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED(SCALE K or t- Y-I /+ r«alcwri {/ YOI.TN V G Cour crr4L cv—ac;C YZ � O /71#r $000" C7 4wexorm a� 15-fr t�rcnccJrst cfruL G Lt�tf/Itr CA4-N K uk Lx ' �'u'1xwuL Ltv� O1.AWNmy � (�.0. NV1+XlN � MO. Off• •A. }rLVI[WlN�S NAMI � MO. DAV VA. _'7 L CHP 555—Page 4 (Rev II.85)OPI 042 �_ tr1�rLg�r�I� i/� � � � els ,� • WAWA I!wIll r.. � If.0 "--� !!Iffl Iii /L:iii�a _lel .i� �.�yZito 1l �. .:. i'�— i�_ .;moi-�' � L<< • FA AC AWAA �_1 /B 1� RAPAAWNE/SUPPLEMENTAL •• OATf:OF frt/OCCURENCE TwE(2Ao4 ffGCNUIlE QPFfCEALD. NfNAaLlI 'I�Ot+E 'A'ONE TYPEiUvq.EyEMUIt.CXUWt7GAB�A . ®'NARRArW ® 00{3Ja1DNREVORT D SAUPDATE ❑ FATAL Q Nf &FWIIUPDATE supPLEMENTAL D QTNEft E] NATAW00US MATOVALS 0 W-MOLSM Q mot C4TV=UNTV/JUOICAL01STF4GT ...iii REPOATINi DISTRICT I WAY CITATION NUMBER LOCATION/SUBJECT STATE wGOWAY RELATED YES NO 2. 3. 4. curp' � y 5 V •• L; 7. f 8. 9. 10. 11. 12. 13 14. 15. Plot ? LI 16. 17. 18. -r �r 19. 20. 21. 22. L,.S 'z 23. 4. 25. 26. iy 27. 28. Z02 29. 30. 31. 32. PREpANAME I.Q.NUMBER MONTH/DAY/NEAR ReVI ERS NAME MONTH/OAY/YEAR RUM HP 558(Rev.7.87)OP1042 °""°' '"MiOip 1d 88 48641 W, a// it..r L r t IM • .,r4V./'l/ � tri t/ it l_ � f". ♦ lri.:r l..i_ II '1tri• -., I-0 99 OWG. r� .,�C�- r1: l _ ,.,rc it� � ��� :alts L"'.�r �:,�•► _rd/ �+► L.+rI .�yL f%/Marl I r � M /�.r r _ ..�.. /Cyr-%rr � ur__ .. !C.►,L�,t. �t.j.-�• • JW� f t .1 Gf .i ' 'rL« - TWIN. 'SIC / "F A 1 wow rl Lr ..11l !rl ti.t l l +L_„Gy� � +rr i � � 1.,,;.� .s..�rr+ lam✓ .sem urto - �:. .:���► f� �^Y� _ FA r ..� ��ri-ice • • �X�1►blt, 4' AFFIDAVIT I, DAVID E. SMITH, declare the following: 1. I am an attorney with the law firm of Wilcoxen, Callahan, Montgomery & Harbison, attorneys for claimant, KRISTEN HAYWORTH, herein. 2. Our first contact with Claimant was on February 24, 1992. 3. On February 25, 1992 a Government Claim for Personal Injuries was presented to the State of California for injuries received by Claimant pursuant to a August 25, 1991 automobile accident on State Route 4 at Discovery Bay Boulevard. At that time, the attorneys for Claimant were ignorant as to the ownership of Discovery Bay Boulevard. 4. On February 25, 1992 the attorneys for Claimant enlisted the services of an investigator to determine ownership of Discovery Bay Boulevard. On May 13 , 1992 our firm received a written report from Pacific Legal Investigations, Inc. Pacific Legal Investigations, Inc. identified the true and correct owner of the property as the COUNTY OF CONTRA COSTA, not the STATE OF CALIFORNIA. I declare under penalty of perjury that the foregoing is true and correct and if called to testify could competently testify thereto. Dated this S day of 1992, at Sacramento, California. VI E. SMITH ... .. �= _—----- --.. -- i .. . . i. . . . : ' . .. ... . . ;.: :,. . . .:. .. : .: - - ... .. .. ... . .'; ,.i . . 1 t'r .. ... - 1 .. .. 'x> . .. .. ..:> . . �t - :it1•:: .. :., :o... ..:.. .. . ..'. 3' :;: •3 .. ii ` ::' :'r' - . a:..P-..... .:'�L1. .. ..v., . .5't':.a •:¢.. . .sr . .. •, ..I�. off{..'. :C'. : .. :: ,. . - _ - :+1. ,` : I . .. ic: 2l''i�: •17'�' :'., - .. ,' :.... .. .�I. .Re';'::. +L:- .t I., .,.ill .. ,,.[.,. .1�a. f '• ..: .. }y, r it lt�'r '~�- F`A!:: '.. , . ll' a. :.. Vii.'. .. ... ._n ,.. 4. - .. ,: r;.:.. .. , 1. .. .. . . ... . , . ..,: . 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I: f :'i I.:r..; .. .-•�..� F`..m :::i SUPERVISORS '{ k: •,rx, '�.�`.;::•:. :,:...;,;t:.r„�; - 1.IBOARD OF SUP ,�,,,� tits;,._'” ,;: 106 TRRF"T S U ITE :. 6 5 1 P LIVE S :;,. 1 �tt/��(7/�L�7�3TINEZ CA 94553 1 ,,. t..:•;�'.�;';,;:;%,:"e' .-. -.- - -:11-;Gyr42'v%t• miry.-'-ply. •1�•_Yi`r_ L-`.1 l�"tF,',:'-_ _ : . .. 'Iwe j,i . ... ��'.�i: _ '.1 1. .. ,...,, - .t...f - I:.,. Via] ,'I .i w.Y .:,' - : ": �_ — . .;+ rte_'-• i "1.: 1. , t ..,..,,. .1', ':irk ':7`:u:�. : .. -1 .r .,, ,.•h1+ I. ... ...... -: tiL r :.s:. r' y..;. r-. :.y.i•r:.'. ::". - Gat.. �:F a n. ,_ _ .t, : •l ,,.v....,. .].. .• - til.. - GG v;!A,* dd C �'34� ;.r i -PJ!4 •41'1• - - hr:', f:x, is r. Iff 'r } r ,., t.. L t.. .' { :::,-..,.... , .:..I. ,.0 ,..,. -- .:.:.,r ..ir ft +.i r ;,~r.. Int' ="Yk. p ..�.. ..,.... ! ;i.3,. /*..".. fid`,' :'c' :j�.1,.; •„i>I`n. 1 :AGi�' :�v� 'tl, t, �q :G�.r di.' :a3'- �,y�. >E C. 'If r[i, y, G 3YS .'a:i:e 4. ,F - J,. 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'. rel,. .. .. : .....:.,; 1�. ry(: . ..., , ,. } ,;,,..,.::; iC. .: "f' I, . {, .: ,. .....:I i. e:,,.::.,,. :r JUN 11. 1992 APPLICATION TO FILE LATE CLAIM COUNTY COUNSEL BOARD OF SUPERVISORS OF CONTRA COSTA COMM, CALIFORNIA Rnar.INE-7 m-w. BOARD ACTION Application to File Late Claim ) NOTICE TO APPLICANT June 23, 1992 Against the County, Routing ) The copy of this document mailed to you is your Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to ) the Board of Supervisors (Paragraph III, below), California Government Code.) ) given pursuant to Government Code Sections 911.8 and 915.4. Please note the "WARNING" below. Claimant: NAGEL, Charles Parry Attorney: Address: 3116 Flannery Road San Pablo, CA 94806 Amount: $500.00 By delivery to Clerk on June 8, 1992 Date Received: By mail, postmarked on no envelope I. FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above noted Application to ile Claim. DATED: June 10, 1992 PHIL BATCHELOR, Clerk, By Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911.6). The Board should deny this Application to File Late Claim (Secttl, n 911.6). DATED: JL VICTOR WESTMAN, County Counsel, By� -> Deputy III. BOARD ORDER By unanimous vote of Supervisors present (Check one only) ( ) This Application is granted (Section 911.6). ( A This Application to File Late Claim is denied (Section 911.6). I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. DATE: JUN 2 3 1992 PHIL BATCHELOR, Clerk, By 01 09 ; Deputy A:ii _ - ---•- WARNING (Gov. Code 5911.8) If you Wish to file a court action on this matter, you must first petition the appropriate court for an order relieving you Prem the provisions of Government Code Section 945.4 (claims presentation requirement). See Government Code Section 946.6. Such petition must be filed With the court Within six (6) months Pram the date your application for leave to present a late claim was denied. You may seek the advise of any attorney of your choice in connection with this matter. If .you want to consult an attorney, u should do so immediatel . IV. FROM: Clerk of the Board T0: 1 County Counsel 2 County Administrator Attached are copies of the above Application. We notifed the applicant of the Board's action on this Application by mailing a copy of this document, and a memo thereof has ben filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. ( L(V :DATED: .LUN 2 3 1992 PHIL BATCHELOR, Clerk, By a Deputy •- i i i V. FROM: 1 County Counsel 2 County Administrator TO: Clerk of the Board of Supervisors Received copies of this Application and Board Order. DATED: -Obunty Counsel, By County Administrator, By APPLICATION TO FILE LATE CLAIM RECEIVED k JUN 81992 CLERK BOARD OF SUPERVISORS 1 _. . CONTRA%C-STA(:'O ZJZaA- t6 5,L+ 1)elkt, . - 41A-0- atq- -ems . � . . �� . .��.m.�,y�._a-�.�.e<� :.tea -�l�.a. .�.c,cs. �,L. Phil Batchelor The Board of Supervisors Contra Clerk of the Board X :. and County Act,^f6istration Building Costa County Administrator 8$f,Pine:St, Room (415)646-2371 106 County Martinez, California 94553 Tom Powem,1st District Nancy C.Fohdom 2nd District A~L Sehrodw.3rd District Suncor Wright NePask,4th District Tom ToAaksm 5th DiMd ' F"•' .Lars :o oma. June 4, 1992 Charles Perry Nagel 3116 Flannery Road San Pablo, CA 94806 NOTICE TO CLAIMANT (Of Late-Filed Claim) The claim you presented to the Board of Supervisors of Contra Costa County, California as governing board of the County of Contra Costa and/or District, on May 28, 1992 has been reviewed by County Counsel and is being returned to you herewith because: X Your claim for an injury to person or personal property which arose on or before December 31, 1987 was not presented within 100 days after the event or occurrence as required by law. (See Government Code Sections 901 and 911.2. ) Your claim for an injury to person or personal property which arose on or after January 1, 1988 was not presented within six months of the event or occurrence as required by law. (See Government code Sections 901 and 911.2. ) Your claim relating to a cause of action other than injury to person, personal property or growing crops was not presented within one year after the event or occurrences as required by law. (See Government Code Sections 901 and 911.2. ) Because the claim was not presented within the time allowed by law, no action was taken on the claim. - Your only recourse at this time is to apply without delay for leave to present a late claim. (See Government Code Sections 911.4 to 912.2 and 946.6. ) Under some circumstances leave to present a late claim will be granted. (See Government Code Section 911.6. ) You may seek the advice of an attorney of your choice in connection with this matter. If you desire to consult an attorney, you should do so imm.edistely. PHIL BATCHELOR, Clerk of the Board of Supervisors and County Administrator By: Deputy Clerk 5. What arethenames of county or district officers, servants or employees causing .he damage or ini;IT'? 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. r SiPf2-1aq'�)2 �o�tEc,�roles rn -----------_---_--__�- ---------------------- ------ ------------------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) ,AY»o0p�Ji WAt 1�3� kJEb —Qgbvr, 6:[» Cb) � ��7'aV1S �Nb ab"-) e��fLeL4, 6%FY IJbT- Abk)L AJ)1-Q- AN y MD IZ(S '")NNAeYbn 8. Names and addresses of witnesses, doctors and hospitals. Jh o ��r DerI -------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITr :.ti:.. ..,.:: AMOUNT � Sl {� �f {E {•t fF iE i� {f # {f .$ fit iF�{� �E {� iF {E}'# 5, # # Sf $E iF f} bF # # 6F # {} {¢ fF $ # {� i# � i? # # 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 ignat BH► u aA u Address Telephone No. j Telephone No. b Z2Y -3 9 �' N 0 T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is 'punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and .fine, or,by imprisonment in, the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. -. ,_Claim to: BOARD OF SUPERVISORS OF COMA OOSTA 00= IH`S'TRIIMONS TO CLAIMANT _ A. Clai.t relating to causes of action for death or for injury to person or t6,-,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 mwe than ore 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 Torm. RE: Claim By ) Rerve V7k1sJiling stamp CEIVE ) Against the County of Contra Costa > 2 8 1992 or ) RD OF SUPERVISORS District) RA COSTA CO. Fill in name ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum ofQd, °a and in support of this claim represents as follows: � $� -. FT _ -Z $.<R y l 1. When did the damage or injury occur? (Give exact date and hour) C � -7 S`2 lel 2. Where did the damage or injury occur? (Include city and county) �- 1 te'Z AAj,&j op V �A r� 1���1b C°� k�4 C �� T2.4 (d S7-,4 3. How did the damage or injury occur? (Give full details; use extra paper if N required) 1�0 M�)(/A R 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? ` , Y.n [VAS L)s7rD .d.5 57_e cL e)o�1 Ate► b h A s )2>ecokJ jO v x.L e D c a,62 Cad vTo/L .�� �^ est' a�,� �; 2e � s bn �R,r�s `Deer AkTtCl_� , ASD LbAS NDZ- l�T�hN�d q 6LC,ki erz, (over) RECEIVED APPLICATION TO FILE LATE CLAIM JUN 11. 1992 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Counm� rounr�F mMARD�AC''ION Application to File Late Claim ) NOTICE TO APPLICANT June 23, 1992 Against the County, Routing ) The copy of this document mailed tc you is your Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to ) the Board of Supervisors (Paragraph III, below), California Government Code.) ) given pursuant to Government Code Sections 911 .8 and 915.4. Please note the "WARNING" below. Claimant: NAGEL, Charles Parry Attorney: Address: 3116 Flannery Road San Pablo, CA 94806 Amount: $1,100.00 By delivery to Clerk on June 8, 1992 Date Received: June 8, 1992 By mail, postmarked on no envelope I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted Applicati to F Late L' Deputy DATED: June 11, 1992 PHIL BATCHELOR, Clerk, By II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911.6). �N ) The Board should deny this Application to File Late Claim (Se •on 911.6). DATED: G��2 'q2 VICTOR WESTMAN, County Counsel, By ILj) • 5• 4 Deputy III. BOARD ORDER By unanimous vote of Supervisors present (Check one only) ( ) This Application is granted (Section 911.6). (Vf This Application to File Late Claim is denied (Section 911 .6). I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. DATE: JUN 2 3 1992 PHIL BATCHELOR, Clerk, By D Deputy WARNING (Gov. Code 5911.8) If you wish to file a court action on this matter, you must first petition the appropriate court for an order relieving you from the provisions of Government Code Section 945.4 (claims presentation requirement). See Government Code Section 946.6. Such petition must be filed with the court within six (6) months from the date your application for leave to present a late claim was denied. You may seek the advise of any attorney of your choice in connection with this matter. If you want to consult an attorney, u should do so immediatel . IV. FROM: Clerk of the Board T0: 1 County Counsel 2 County Administrator Attached are copies of the above Application. We notifed the applicant of the Board's action on this Application by mailing a copy of this document, and a memo thereof has ben filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. DATED: JUN 2 3 1992 PHIL BATCHELOR, Clerk, By Deputy t:+o V. FROM: 1 County Counsel 2 County Administrator TO: Clerk of the Board of Supervisors Received copies of this Application and Board Order. DATED: County Counsel, By County Administrator, By APPLICATION TO FILE LATE CLAIM RECEIVED loe JUN 81992 i CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. ': J b 4 Ua _ _ �i-a�--. ..c�.at.r�•�, crk. _.C�� � 7S-2g8�/ - �- � r ..Ar _ 4 � Batchel The.Board of Supervisors Contra Ce'rkl fthe Bo d • and .County Administration Building Costa County �(4 5)6"-237ator 651'Pine St, Room 106 County Martinez, California 94553 Tom Powers,tst District Haney C.Fandan.2nd District Ilobart I.Schroder,3rd District Surma Wright KePask 4th District Tom Torlskmm 5th District June 4, 1992 Charles PA rry Nagel 3116 Flannery Road San Pablo, CA 94806 NOTICE TO CLAIMANT (Of Late-Filed Claim) The claim you presented to the Board of Supervisors of Contra Costa County, California as governing board of the County of Contra Costa and/or District, on May 28, 1992 has been reviewed by County Counsel and is being returned to you herewith because: X Your claim for an injury to person or personal property which arose on or before December 31, 1987 was not presented within 100 days after the event or occurrence as required by iaw. (See Government Code Sections 901 and 911.2. ) Your claim for an injury to person or personal property which arose on or after January 1, 1988 was not presented within six months of the event or occurrence as required by law. (See Government code Sections 901 and 911.2. ) Your claim relating to a cause of action other than injury to person,. personal property or growing crops was not presented within one year after the event or occurrences as required by law. (See Government Code Sections 901 and 911.2. ) Because the claim was not presented within the time allowed by law, no action was taken on the claim. Your only recourse at this time is to apply without delay for leave to present a late claim. (See Government Code Sections 911.4 to 912.2 and 946.6.) Under some circumstances leave to present a late claim will be granted. (See Government Code Section 911.6.) You may seek the advice of an attorney of vour choice in connection with this matter. If you desire to consult an attorney, you should do so immediately. PHIL BATCHELOR, Clerk of the Board of Supervisors and County Administrator By:• Deputy Clerk Claim to: BOARD OF SUPERVISORS OF CDNTRA COSTA COUNTY IPdS"T C TI CKS TO CLA AiANT A, Claims relating to causes of action for death or for injury to person or to per sonal property 'or growing crops and iihich accrue on or before'December 31, 1987, must be presented not later than the 1017th 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 latex than one ,year.after .the accrtal 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 Ro= 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..aczainst more than one public entity, separate claims must be filed agaiiist each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this orm. RE: Claim By ) erve for Clerk' filing stamp ) RECEIVED Against the County of Contra Costa ) MAY 2 81992 or ) District) CLERK BOARD OF SUPERVISORS Fill in name ) CONTRA COSTA CO. The undersigned clairent hereby makes claim against the County of Contra Costa or the above-named Distri ct in,the sum of $ and in support of this claim represents as follows: W:- 7F - ZS !6zl 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) 3 l 1 6 )-,ANN6=RY Pei UfaP �C,kGo (fe. Co >!n Ccs i 3. How did the damage or injury occur? (Give full details; use extra Raper if required) /I 13URt )Aa Lr Ot P6 CJS A\ '► d 4. That particular act or omission on the part .of county or district officers, servants or employees caused the injury or damage? PCS 11 neo( C 4rC - o -C Co Y»,b& raGZ 6.15?' -CIA s A P2►y,s )D,6 9 h Q w. -Cr, Dep,- AS a e C 60e a D 7-)<4. t-v p s At 67 (over) 5.. What athe names of county or district officers, servants or employees causing. ., ' re the damage or inju:;? C • Shen- : ?�ep, �vvigJ41-2y A—) ------------------------------------------------------ 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. D.AmA9 , �6Ss 649 )9ll A-1 'i3 cAL-m3d2 AL�rb-Y_s.-r;e P)a76.4— 5 PA)a) 4'-' )7 p 1�l e---------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Y"6Lv^ cess 3 c5 JtAiN,�FO 4-/20 Y," �LjAj �aGL ��a.s AIJP �_---- ----------- 8. Names and addresses of witnesses, doctors and hospitals. cc -- ---------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT fir.t i Gov. Code Sec. 910.2 provides: The claim must be signed by the claimant . tr SEND NOTICES TO: (Attorney)' - or by some person on his behalf." Name and Address of Attorney Claimant I s LSignatunel Address • �1�iL �m��b '�� �:/��j� ��%/1Jh �b'.'�TA LDUroii' Telephone No. Telephone No.j��- 72 N 0 T I C E Section 72 of the Penal Code provides: "Every person who,- with intent to defraud, presents for allowance- or for payment to any state board or officer, or to any county, city or district board or officer, authorized "to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a, fine of not exceeding ten thousand dollars ($10,000, or �by both such imprisonment and fine.