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Home My WebLink AboutMINUTES - 05251993 - 1.21 REGE� II CLAIM n�1a 2 1993 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against th2OV ;District governed by) BOARD ACTION the Board of Sup visors, Routing Endorsements, ) NOTICE TO CLAIMANT May 25 , 1993 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: $2060 .00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Gary Allan Bacome ATTORNEY: Date received ADDRESS: 317 San Marcus Drive BY DELIVERY TO CLERK ON April 27, 1993 Vallejo CA 94590 BY MAIL POSTMARKED: Hanrl d P I i-,TPrt-d I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: April 29 , 1993 PpHHIL BATCHELOR, Clerk BY: Deputy I1. FROM- County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Gated: L / S3 BY: 4 Deputy County Counsel { J I11. FROM: Clerk of the Board TO: County Counsel (1) County Administr or (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: MAY 2 5 1993 PHIL BATCHELOR, Clerk, . Deputy Clerk MARNING (Gov, code se 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. *For additional warnina See reverse side of this notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez. California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: MAY 2 5 1993 BY: PHIL BATCHELOR Deputy Clerk CC: County Counsel County Administrator This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort C1 a ir,:s Act . Clam to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claiss 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 must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 12 at the end of this form. RE: Claim By Y Reserved for.Clerk's filing stamp 6A IN Aum RECEIVED 3 )-41 Against the County of Contra Costa ) or ) District) CLERK OFSt1PERVISORS Fill in name ) 7A CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ Op6, a 7�L 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) 3. How did the damage or injury occur? (Give Hill details; use extra paper if required) ---------------------------------- ----------------------------------------------- 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? �R (over) D. gnat are the names of county or district officers, servants or employees causing Lie daman ge or injury? ---- �Ij�-------------------------------------------------------------------------- 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. 5_FA fL P_ DGS NOT OFEe-4 i 1 l _D2 I N ez 5( bE -n kE -Ptt5HG-D 841 i W7) Fe_'.iLC� .0 U. FI?�1ME bGt)T � P,c�� 61(_UMC ;s TIU5 . PACK 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) e-z5-J& ta>(-e_, -Pron1 bcX c e-[UQ i r t5 2 buA l s ; �e0�fA �}6 bL Mbye_ 0 n c� the j, bey�� r� �rc:c2�5 fie ---------------r---------------a--___-M____wM__- ---------N--- ------- ----- $. Nares and addresses of witnesses, doctors and hospitals. iP/4uL- _1bMAs, 6cLjc>EN 111c)-l-eL I?vn 137 1 V'AL&—so .JUC-fily -DiLLAPb, GoLvON NNy MOTGL 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT 412,33 TD f e�t�t 2 r O 1 �"�'e�.k �G a. © 0 _ ill C:'.. d . f 3 ' To u3i :,4 j { r � ML �l AW Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES--1TOs"-,-(Attor.ne ) or by some person on his behalf." Name and Addness :of °Attorney Q �7 Cl mant's Signature 3► Ct,iS (Address) U I I ego q 4-59D 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. OAT&OF,COLLISIOW TIME (8010) NCIC Humana OFFICUR I.D. HUMMER PAOR -74 .. .............r-.- OAT -MM, Sr k.v %V*W"JYTArR I t2. G KW., P? 5', PM rlAJ Mov G;b -4yeo4lLru; q Aj h 9X n7' r Al' IWIT 77AzE z N7. JN7. QA/ �Mj h6w 4W JJZ f2L L WN, :•.1Y: c7s El tt re4ME . .... .A t,),b Awl", :.w C iez -iiWom ,z- I .........- ;~'''`,.'.: .:.5A .5�-A A 3Z V lz�XV 111 nP It re -13 N S WA�,Je SSG ANUT.11ai Un AAM I W 4CA'Zil t:L al L_, 9 1 M36*0 Mi !r3LLTy_ 4364 44- i8. • _1W.-Hi L.T-J�, —4 jo. 4T 'Zn7�61 cn3i?_ 34L 6c,"'cv, MM • 23. t..y =43LU1141 OURC R 40MU i,; y T,y"Ail A.UDE. M:ll P�Tl 7. -Ul'.A"'1 3,A? I M, P-ORPAIRMIR'S HANK SAV Va.='S MA a MUNNUM ...... '70' STATE OF CAUFORIIA 2rA*i Axc A+J.,� <O R.V:7:`.+:U n. 3^!'J:!.::.!11' }';1•::,R'.-3,f:T TRAFFIC COLLISION REPORT-Property Damage Only ; _" ';'• JSPEOA I: MTE .,.REPORTWO DISTIECTOR, ell A/�� AV OWWF. '..,,:r :.! TOMwwwrr ?;"'i::i;•.STATE NORWAT RB.ATED:,S Y-Tr•1N .LIC06ERATE SAFETY SOUP. •Y'.< �S,.i`"%•. a .:� !s " IScii�iiioeD �`__t:A�T`"—". _. ... .,. .. .,.. .S`;`.�'..;: P7101R IEEIDER_"_ �� - .�5:^s: �.,. v:4, :aq�-s•.' �'.s �� ,'-%t:.� i•;':::_�. �,c`'•=:�i`t;;. ,t., .,s..:Y�)"i;::.ERICA Y PED.'--RREADDRESS 1•' IRA .',i•n :Pi:; ...:. ��`�'''"• _ MC YEN SlE EIRiNDAIE URAIiI. CARRIEII POLICY YIR{EEa' FMI t442 12 1 nereu a vEL awstaErroaxoeaF – _ -..— EEo OTHER ra, YAIK/ ICOlp1 'y'• ;1 •�.A. -tICEHBE IEYEER'- TE VEK TYPE �,.moi:' .•�, - ':.� �i• s"1''' �: '.`� EpeEL `r :,1� '� =:-`:]!•:`ice ;s \ '.\:Ir`.:` e•:.:--}""�3• :�'T'=� _ PARTY DRIVER'S LJCEIISE NLIYEEa - RATE CLASS SAFiTr,EOUP. 'SIMDE'. '+¢r _. �+: DAIt�OtD S�YY`.• 'i.�' :,�` � :�S: w A: -� - DRIVER IIAIIi FIRST.YD LAST .PHONE - •- :'::• h .l' ( DLR .. "- .,. -.. ;.;.:::f..• <:'4 ::'Yi.;��.:...::a�: .......::...:i':,.:':L taly '�•,,�� i ,F""e��• 4+� PEDa ADDIIEO �..� ATE .':�' '.'3 k�i—..�:�.�.••��..�.�'rr Si• •+'�.`':":,.- .:��+.^-�..�....T,—�'.`:'' `-ew�'.'.._:� _ 'w q. F. _ 'y[ •7"' �� ti • .. .. - '..,... .. ... ".G q - PKVEH EEX. M�`• s. ....:i _. .:'�..:, -.Fs+..''d�_r' T EETINDATE' NSYRANCE GIIIIIEII. NIaIEEa ''°.':$ �:`d''^ i�i;e• i�'=;',-:t::'�"'=?, 4 _ i�..... .�v .•a „. :''. -.F- .b' ��::YC-i i•'?4. [�ir:[,••,, •3 t.l.e', .iy.,V y !�•i, ..- - w'� '��'nt s, :'!�'.£��?.:" w:CSK... SL Ti+-t�..ry.d'.w�.' •-r:u ��'.�('Jt:; y�.s":o,' _ :. �_r _ erctE awTRwvn aN oaIEo1II�Ar :::,._,.. svEEa ;. ;en, a .. .... .. �...•.... .._r..:....'.:':,� y .. .,il... <'.('�rr.:�4'J•: :yQ�il.hl,•:rF.^ .�.�:<, .5 - a ELL ra EMEEIEiDMICOMR moi: :.� -LICENSE IRRISEa••• ATE VEY;TIIE. �PAAT><:% ^.,ice • '' :'iz.�.:•+:'�'x;F!' ?�,`#;•. ... ... -t:.,. 5::.: +.,. :-M: :.n: iip....y R:@,e:xy,.y,)�aH n.tis 175::.,f:•.Y:'SL''-.$-.$ YIR. RIO. AM SEE- - - _ADaTEEt - :.�;^ .:s y;i'.;_ ,,,`",T, ._ ......... ,.. �+ :'F:Y �•�'''� ..4 _ ,:�: _:•? :�� '�PMONE NIEYIER'' ''� '•"P .EO:'•` `> �+ (@ i�v. •:.•�P'.''• pity }.1� 'l`j}1. -�v3 ..n a•;',V• }-e r: I� Crg. }•�.�. �'fl�. �r;,S ` .Ra:�cf2'k.�JIe•'�_ ....c 4..., �i�l�S�'.�4� „!''il9i:�?F-is;' _ '•%',�':��.ld.•.7!"" `''l�:i-1+k\: x :i+'i�ii•'%:E_'��+'xr._::ti`-,�"r��t' S �..K. AM SE>R NAYS. .. - -AOOREp. - .,`,.:,r Ri?;:?.._.`y:P.PMONE =,F.r:<.• - :cx4 i.,1. +tr`.:�NRV ND:�t �ar- Ell :• i::a• z. , .PROP... .•.... _...:;"t�;.......:.'.'=- - `''1.i� '�'f11''ti'' -- _ - e• � OWNEW1 E w.. ((••qq�(( ` yT ..« .. r.. .. .:•,..,:.. .... .:.yr ':1:."• -tcr..,.' h•6.:7,- nJ, x..,`�?fi�kC'1<'£:::'r ... .. ........:..... - :•j:� - r{i-,!..' �'r'f yftn,": - - - .xfq...i.i- ' PRIMARYCOLIISHM FACTOR. ; ;...:,:: `"$ 'YGVEIEJI[FBECEOIIIG __ !� TRAFFIC CQNTROLD `-F` y+r>'TYPEOF i :r r` i `•• IMPORTANT— READ CAREFtJL.LY 7. - _ .... _ .. ..'C:� ' �..i,•':1'�]'sem . r, Keep this report. This. is your record of this. accident. To comply with Cal ifornia::Vehicle . 20002 (duty where property damaged), you must either: _ a. Give the owner or person in charge of such property the name and address'of:the driver and owner of the vehicle; or in the absence of the owner, W. b. Leave a written notice in a conspicuous place on .the,other vehicle: damaged property;;giving':the name and address of the driver and.owner of the vehicle involved and a statement of the circumstances This information is necessary for the completion'-of your state SR-1 Form, Report of Traffic Accident, and your insurance report. VEHICLE CODE SECTION 16000 The driver of a vehicles involved in an accident resulting-in damage to the property of any ONE party in excess of the amount stated in VC Section 16000 or in the injury or death of any person_ MUST submit a'SR-1 Form-to the California Department of Motor Vehicles within 10 days. Note: Failure to comply may result in suspension of your driver's license.... . Form SR-1 may be obtained from the Department of Motor Vehicles, the California Highway Patrol, any:police ' ' station, motor vehicle club, or insurance agent. - If city or state property is damaged, you will be contacted regarding possible liability. CHP SSS-03(REV11-0E)OP1042 Estimate ID: 152 Preliminary Profile ID: R 6 R R 6 R BodyWorks 1132 Benecia Road Vallejo CA 94591 (707) 552-5750 Damage Assessed By: PAM BARTNECK Insured: GARY BACOME Cm N) Mitchell Service: 913509 Description: 1986 DODGE 4WN@1=R 4DR HATCHBACK VIN: 1B3BZ18A8GD119B08 License: 2YEM653 CA Color: SILVER Line Entry Labor Line Item Part Type/ Dollar Labor CEG Item Number Type Operation Description Part Number Amount Unit Unit 1 313280 MECH REMOVE/REPLACE L LWR FRT SUSP CONTROL ARM ASSY -M 4322155 130.00 INCL 1.5T 2 314770 MECH REMOVE/REPLACE FRONT STRG LOCK HOUSING -M 4147001 34.00 1.1 1.1T 3 314780 MECH REMOVE/REPLACE FRONT STRG IGNITION SWITCH -M 5209891 30.00 0.6 0.6T 4 314790 MECH REMOVE/REPLACE FRONT STRG CYLINDER_W/KEYS---_., -M 5207203 29.00 0.8 0.8T 5 900500 BODY *ADD'L LABOR OPR AXLE AND LEFT STRUT OPEN ITEMS SUBLET 6 900500 MECH *ADD'L LABOR OPRIMAY BE ADDITIONAL DAMAGE b COSTS SUBLET 7 900500 MECH *ADD'L LABOR OPRiONCE REPAIRS ARE STARTED r SUBLET 8 900500 FRAME*ADD'L LABOR OPR"FRAME MAY NEED STRAIGHTENING AFiR EXISTING 9 900500 FRAME*ADD'L LABOR OPR-�MEASUREMENT- POSSIB_L_E A_D_D_'L_COST I EXISTING 10 900500 MECH *ALIGN ALIGN SUSPENSION SUBLET 49.95* 11 315720 MECH REMOVE/REPLACE FRT FRAME SUSPENSION XMEMBER -M 4322244 640.00 4.5 4.5T 12 933006 FRAME ADD'L LABOR OPR FRAME/RACK SET UP - 2.5* * Judgement Item I. Labor Subtotals Units Rate Totals II. Part Replacement Summary Amount Frame 2.5 48.00 120.00 Taxable Parts 8633.00 Mechanical 7.0 48,00 336.00 Sales .Tax @ 7.259 62.57 Labor Subtotal 456.00 Non-Taxable Parts 49.95 Labor Summary Totals 9.5 456.00 Total Replacement Parts Amount: 975.52 III. Additional Costs Amount I. Total Labor: 456.00 Total Additional Costs: 0.00 II. Total Replacement Parts: 975.52 III. Total Additional Costs: 0.00 Gross Total: 1,431.52 Customer Allowance: 0.00 Customer Responsibility: 0.00 Net Total: 1,431.52 This is a preliminary estimate; additional changes to the estimate may be required for the actual repair. Vehicle Description has been manually entered. y i i ESTIMATE RECALL NUMBER: 00/00/00 00:00:00 152 Mitchell Data Version: APR 93 Copyright (C) 1990, Mitchell International Page 1 of 1 All Rights Reserved HUGGIN'S TOW & $15.00 Fee On AUTO TRANSPORT PHONE Qp>--;lv-7:� Returned Checks � a (S - DATY TIME REQUESTED BY 41 3 5-.'6D,a(aL97 LOCATION OF VEHICLE 317 5-m) /�11-1,126fu S MILEAGE SERVICE TIME EXTRA PERSON FINISH FINISH FINISH START START START TOTAL TOTAL TOTAL Y R -FiMAKEIMODEUCOLOR SERIAL NO. REGISTRATION NO. DRIVER ADDRESS START E] LOCKOUT FLAT TIRE Ej DOLLY BATTERY ❑ WET f-] . GAS ❑ FLAT TOW BRAKES FLOODED F-� WRECK HOIST TWO F] TOWED TO REMARKS MILEAGE CHG. TOWING CHG. LABOR CHG. STORAGE CHG. .,I GFI ICI 'S 9rfGVltTL04V � TOTAL � I� (AUTHORIZED SIGNATURE) 223 road service . NCB o. HUGGIN'S TOW & $15.00 Fee On AUTO TRANSPORT PHONE RM Returned Checks 4nlm s Ntal�- n 1 7DATE TIME REQUESTED BY 4 2 I3 1 & Z/,gy, A LOCATION OF VEHICLE MILEAGE SERVICE TIME EXTRA PERSON FINISH FINISH FINISH START START START TOTAL TOTAL TOTAL YEAR MAKEIMODEUCOLORSERIAL NO. v6 TS NO. DRIVER ADDRESS f 31 ee 11) START LOCK OUT FLAT TIRE Ej DOLLYZ BATTERY F-1 WET F� GAS E] FLAT TOW BRAKES FLOODED WRECK HOIST TWO TOWED TO 'PL-5/DEN C REMARKS MILEAGE CHG. TOWING CHG. LABOR CHG. STORAGE CHG. (TECH ICIA SSIGNATURE�J•` TOTAL 26I OD (AUTHORIZED SIGNATURE) 043 road service NCR ev ~- _ A � » 4 � , �. i`Y i4 e J y� � � :'' '�4. Y 4 rte•= i"«v„ri � +� � � tZ::4`C��p��*i gi,. `" ;fix d"�, r' � ',� x 'S ', � c c."� i .-. Y 4aia�y � „q.. '�,� .i �dArp S �a y�k�, � ,�cV �+, t 1 :t r �t��1 �� . fi1J S-�{yy, �� Z� �., '�.�.f�: Y� 1 s ��1 `,�•t ♦� � � '�. .r � • RECEIVED -�1 Z. CLAIM MAY 0 4 1993 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA COUNTY aOUNM Claim-Against the County, or District governed by) BOARD Wgbk'7o CALIF, the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT MAY 25, 1993 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: $46,036.25 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: CONTI MATERIALS SERVICES, INC. (#760—A-473025) ATTORNEY: The Maryland Insurance Group National Recovery Center Date received ADDRESS: P.O. Box 17116 BY DELIVERY TO CLERK ON April 22, 1993 Baltimore, MD 21203-7116 BY MAIL POSTMARKED: April 21, 1993 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. pH gg DATED: May 4, 1993 81'IL Depuiy OR, Clerk 01 II. FROM: County Counsel TO: Clerk of the Board of Supe isors ( ✓f 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: leyeLt 1993 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. Dated: MAY 2 5 1993 PHIL BATCHELOR, Clerk, s Deputy Clerk WARNING (Gov, code se ' n 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately, *For additional warning see reverse side of this notice. 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 1B; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: MAY 2 5 1993 BY: PHIL BATCHELOR b Deputy Clerk CC: County Counsel County Administrator This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. The d Insurance Group Claude Lewis,CPCU National Recovery Center Manager 3910 Keswick Road,Suite#135 P.O.Box 17116 Baltimore,Maryland zI203-7116 410-366-I000 April 20, 1993 Fax:410-554-58z6 RLzk'r"r -b�,�!�D Clerk of the Board of Supervisors County Administration Building 651 Pine Street, Room 106 APR 2 21993 Martinez, CA 94553 CLERK BOARD OF SUPERVISOR$ CONTRA COSTA CO. RE: OUR CLAIM #: 760-A-473025 OUR INSURED: Conti Materials Services, Inc. D.O.L. : 11-13-92 TOTAL DAMAGES: $46, 036.25 Dear Sir/Madam: Enclosed, please find a completed proof of claim, as well as supporting documentation relative to the above captioned loss. Please acknowledge receipt of this correspondence by contacting me at 410-554-5816 so we may discuss liability in this matter. I look forward to hearing from you. Sincerely, Stephen H. Chiurazzi Subrogation Specialist SHC/emr Enclosure 411.SC Maryland Casualn.Company Assuranre Cumpan}'of America Marland Lloyds Northern hlsunlOCC Cumpa-of New York National Srandard Insurance Company M.a'.Iand Insurance Con,pany Maine Bonding an l(:asualty Cnugiana Valiant Insurance Cumpan, Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT' A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for-death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code 5911.2.) 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 CONTI MATERIAL SERVICES INC , } RECEIVED C/O MARYLAND CASUALTY INS . CO. ) - Against the County of Contra Costa ) APR 2 2 1993 or ) District) CLERK BOARD OF SUPERVISORS CONTRA 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 of $ 46,036.25 and in support of this claim represents as follows: ---------------------------..��--------------------------------------------------- 1. When did the damage or injury occur? (Give exact date and hour) NOVEMBER 13, 1993 2 : 45 P. M. ----------- ------------------------ ------------- 2. Where did the damage or injury occur? (Include city and county) CA.MINO DIABLO RD . , . 9 MILES EAST OF VASCORD . 3• How did the damage or injury occur? (Give full details; use extra paper if required) GRAVEL TRUCK AND TRAILER OVERTURNED ONTO ITS RIGHT SIDE WHILE TRYING TO RE-ENTER THE RAODWAY FROM THE SHOULDER . 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? FAILED TO MAINTAIN AND/OR REPAIR THE EDGE OF THE ROADWAY AND SHOULDER TO ESTABLISHED STANDARDS AND GUIDELINES . (over) 7. W naL are the names of county or district officers, servants or employees causing the da*aage or injury? CONTRA COSTA COUNTY PUBLIC WORKS DEPT. , ROAD MAINTENANCE DIV . , SPECIFIC PERSONS UNKNOWN TO US . ------------------------------------------------------------------------------------ 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. SEE ENCLOSED DOCUMENTATION -------------------------------------- ------------------------------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) SEE ENCLOSED DOCUMENTAT-ION -------------------------------------- --M--M--N-----•--------M---------------- 8. Names and addresses of witnesses, doctors and hospitals. STEVEN A. BROCK JEANETTE ENGLAND 14660 S . HWY. 99 P. O. BOX 188 MANTECA, CA 95336 BYRON, CA 94514 209 467-0626 510 634-5068 ---•----------------------------------------- M-- --------------------------- 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 Stephen H. Chiurazzi, Subrogation Specialist, as Subrogee of Conti Materials Services Claimant's Signature National Recovery Center x 17116, B o e MD .21203-7116 Address Telephone No. I Telephone No. (410) - 554-5816 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. me OF CALIPORNLA {. ` I. F`AFFIC COLLISION REPORT ,ADE � GP -7 ECIALCONDIRONs NUMBER WT4RUN CITY _ UDICIALDISTRICT LOCAL R[PORTNwBER INJURED FELONY utj UELTN'\ NUMBER NITA RUN COUNTY REPORTING 0181 CT BUT I 3 KILLED MI30. /// -ren % O ® C-o ti k 2A CoJT11 Wo t COLLISION OCCURRED ON WL DAY YEAR TIME(awi) NCIC SOFFICER 10- Z CAMI,"o DIA3cA 2D lk 131`$2. !x4'4 1396 17- z:q MILEPOST INFORMATION DAY OF WEEK TOW AWAY PHOTOGRAPHS BY: F . u FEET/MILES OF S KT W ®r[B [:]No AT INTERSECTION WITH STAT[HYVr REL p ®OR' • 1 PlR/MILES E OF VN5CC7 ILII ❑YXV ®NO ®NONE ARTY oRIVERTM LICENs[NUMBLR STATE CLASS SAFETY VSK YEAR YA.J MODEL/COLOR Nt Li LtLICENSINUMBER STATE 1 c39055 3 CAA d7 �E16lkT/3,� SMP/ QA0 3H98,3o, ca )RIVER NAYS(FIRST.MIDDLE.LAST) - 4 114 0 SmvE►J 87 F-e-uEAAOF- lwtkT 1 u(3Z14 0 CA PEDES STRIM ADORERS OWNIR'B NAYS 1:1 SAME AS ONVER p CONST ► '...RATEO 'AAKEDCITY/STATE/DP OWNER'S ADOA " ❑BAYS AS DRIVER ECI[II ClKA _rE_CA % C4 ^�535L Pb bosc 3oZl4 8 ►.� C'& 9 SZ(1% BK)Y- SEX HAIR I EYES NfTOIfT WEROHT ORTHOATE RACE DISPOSITION OPVEHICLSON ORDERS OF. OFFICER oWVER ❑OTHER MO.CLIST 8 . DAY YEAR Zpg 4 b�Ra `-1 l 6 { ❑ M tD2N 0J3 -1 o 1°10 0 8 2� : 6� IPELZ q' fir, OTHER MOMS PHONE BUSINESS PHONE �� 'q�� _Q RIOR MECHANICAL DEFECTS: NONE ARMMENT® R[,4R TO NARAAnV E 13 (ZOO -Z51 ZV CHP USE ONLY DESCWBEVEHICLE DAMAGE SHADE IN DAMAGED AAEA INSURANCE CARRIER POLICY NUMBER VEHICLE TYPE 1 ,KVLAr-3o LcT111 933 405, ZS ; 3 1 OL6 YA.L011 AL DIROP JONSTMETORNI.HWAY SPEED PCFICCI.AVEQ ' CL t&slea �IA�Xo S LIMIT CHPO TARTY DRYvER'suCENSENUMBER STATE CLA$B 3AFET/ VSK YEAR MAKE 1 ODLL/COLOR LICENSENUMBER $TATE 2 [QUIP. ok.. �4oN10�- ltorL � DOWER NAME 1 FIRST,WOOLS.LAST) ® 2000 Z PEDES STREET ADDRESS OWNER?NAME ❑SAME AS DRIVER IRAN .. . . . PARKED CITY ISTATE/ILP OWNER'S ADDRESS ❑SAME AS DRIVER IEHICLE ..... .- cl SICY. SEXHNR [MLS HMGIR WttOHT WRTMDATI RACE DISPOSITION OF V..ON..S.OP: ❑OFFICER �DRIV[R []OTHER. COST DAY YEAR . FLED 5car'-J_ OTHER HOME PHONE BUSINESS PHONE r 1PN011 MECHANICAL DEFECTS: NOW APPARENT® R[RR TO NARRATIVE❑ ❑ ( , .Lf^J� \ / V N Y_ - CIV USE ONLY DESCRIBE VEHICLE DAMAGE .. SHADE N DAMAO[D MEA ..V[HICLt TrM . INSYRAlK :. ❑UMC. ®NONE ❑MINOR -... ... .. ECARRIEA ►O .... __. .. .. YCYNNUMBER. . ac pMMD0. pYA.1011 pTOTAL . ... DIOL OF ION STREET OR HIGHWAY PCF K7 .. SPEED C Q zCisI V. Puco M CAM�3o 0(Agw20 LIMIT IS CHPo )ARTY ORIvER'B LICENSE NUM BER STATE CLASS SAFETY ML YEAR MAKE/YOOELICOLOR LJCL45INUMBER STATE DRIVER NAME I FIRST.MIDDLE.LAST) .. .. -.. •. PEDES- STREET ADDRESS OWNER'S NAY[TRIAM []SAME AS ORN[R . a 'ARKEO CITY/STAT[/LP OWNERS ADORES$ ❑SAME AS DRIVER bMCLE . cl SICY. SQ HAIR . RI EYES MEIGHfT WEIGHT BIRTHDAYS RACE OISPOSON OF VEHICLE ON ORDERS OR ❑OiRCSR_ ❑DRIVER [:]OTHER CUSS Y0. DAY . rEM .- ) OTHER Nokia PHONE BLIsNLii PHONE PRIOR MECHANICAL DEMCTS: NCNS APPARENT❑ R[F[R To NMUTATRVE❑ ❑ (. ,. -.i CHIP USE ONLY DESCIIBS VEHICLE DAMAGE SHADE IN DAMAGED MEA NSURANC.E CARRILR POLICY NUMB" vtNKX[TY►E . _ . LINK. 0NONE YYI011 i .• � _~: pYDO. pYAdOR pTDTAL qll OP ON srRam OR HIGHWAY SPEED IC/ ICC Q , TRAVEL p'EE PUC❑ cHP13 EPAARE.R'S,NAME _ l DISPATCH NOTIFIED IREVIEWERSNAME T[REVIEWED _fib�A I'V (22v; r3YES M NO 1%WA NP 555 PAGE T (Raw T$B) OPI 042 88 48667 'ATEOFCAUFORMA •RAFFIC COLLISION CODING �C T;�NQV. 2 0 199 „ACE Z ATE OF COLLISION ( Q T�1E(2400) NCIc NUMBER OFmcam L a _ NW�EII O. I1 DAY L YEAR 1Z- '�� 935 ,� OWNER'S NAME!ADDRESS NOTIFIED PROPERTY ` ©YES []NO DAMAGE JOESWUPTIONOFOAMAGa SEATING POSITION SAFETY EQUIPMENT EJECTED FROM VEHICLE OCCUPANTSti L-AIR BAG DEPLOYED M/C BICYCLE_HELMET ` A-NONE IN VEHICLE — M-AIR BAG NOT DEPLOYED DRIVER 11-NOT EJECTED B-UNKNOWN N-OTHER 11:FULLY EJECTED C-LAP BELT USED P-NOT REQUIRED W NO 2PARTIALLY EJECTED I-DRIVER D-LAP BELT NOT USED -71 W-YES 3-UNKNOWN 1 2 3 2 TO 5-PASSENGERS E•SHOULDER HARNESS USED PASSENGER 4 5 6 T•STATION WAGON REAR F-SHOULDER HARNESS NOT USED CHILD RESTRAINT X•NO 8-REAR OCC,TRK.OR VAN G-LAP/SHOULDER HARNESS USED Q-IN VEHICLE USED Y.YES 9-POSITION UNKNOWN H-LAP/SHOULDER HARNESS NOT USED R-IN VEHICLE NOT USED 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(•)SHOULD BE EXPLAINED IN THE NARRATIVE PRIMARY COLUSION FACTOR LISTCONTROL DEVICES 2 $ TYPE OF VEHICLE 2 3 MOVEMENT PRECEDING UST NUMBER (N) OF PARTY AT FAULT COWSION I AVC SECTION VIOLATED: GT D ACONTROLS FUNCTIONING APASSENGEA CAR/STATION WAGON ASTOPPED B CONTROLS NOT FUNCTIONING• BPASSENGER CAR W/TRAILER B PROCEEDING STRAIGHT I B OTHER IMPROPER DRIVING•: CONTROLS OBSCURED C MOTORCYCLE/SCOOTER RAN OFF ROAD D NO CONTROLS PRESENT/FACTOR• D PICKUP OR PANEL TRUCK D MAKING RIGHT TURN C OTHER THAN DRIVER• TYPE OF COLLISION E PICKUP/PANEL TRUCK W/TRAILER E MAKING LEFT TURN D UNKNOWN• AHEAD-ON F TRUCK OR TRUCK TRACTOR F MAKING U TURN I E SLE B SIDESWIPE GTRUCK/TRUCK TRACTOR W/TRLR BACKING REAR END ITSCHOOLBUS H SLOWING/STOPPING WEATHER( MARK I TO 21TEMS) D BROADSIDE I OTHER BUS 1 PASSING OTHER VEHICLE ACLEAR E HT OBJECT I Ij EMERGENCY VEHICLE •j CHANGING LANES B CLOUDY F OVERTURNED ((HIGHWAY CONST.EQUIPMENT ((PARKING MANEUVER C RAINING VEHICLE/PEDESTRIAN L BICYCLE L ENTERING TRAFFIC D SNOWING --.•- OTHER•: MOTHER VEHICLE OTHER UNSAFE TURNING E FOG/VISIBILITY FT. MOTOR VEHICLE INVOLVED WITH N PEDESTRIAN XING INTO OPPOSING LANE F OTHER•: ANON-COLLISION MOPED PARKED G WIND PEDESTRIAN P MERGING UGHTING OTHER MOTOR VEHICLE TRAVELING WRONG WAY A DAYUGHT OTHER•: D MOTOR VEHICLE ON OTHER ROADWAY OTHER ASSOCIATED FACTOIi(S) B DUSK-DAWN E PARKED MOTOR VEHICLE 2 3 (MARK 1 TO I ITEMS) C DARK-STREET LIGHTS FTRAIN Av"EcTw""OLATJON: crrtD D DARK-NO STREET LIGHTS BICYCLE �Ya �� DARK.STREET LIGHTS NOT ANIMAL: B vc stmoN Ylou - FUNCTIONING• H Z l 6SL3C a SOBRIETY-DRUG % ROADWAY SURFACE FIXED OBJECT: CVCS1CT10NvIOPATwm: gTEp 2 3 PHYSICAL A DRY 1 QYtt (MARK 1 TO 21TEi1S) B WET OTHER OBJECT: 13� HAD NOT BEEN DRINKING C SNOWY.ICY J D D SLIPPERY(MUDDY,OILY,ETC.) EVISION OBSCUREMENT: B HOD•UNDER INFLUENCE F INAON OBSC •. HBO-NOT UNDER INFLUENCE. HOD-IMPAIRMENT UNKNOWN ROADWAY CONDITION(S) G STOP&GO TRAFFIC (MARK 1 TO 21TEMS) PEDESTRIANS INVOLVED E UNDER DRUG INFLUENCE' A NO PEDESTRIAN INVOLVED H ENTERING/LEAVING RAMP F IMPAIRMENT-PHYSICAL A HOLES,DEEP RUT• CROSSING IN CROSSWALK PREVIOUS COLLISION" IMPAIRMENT NOT KNOWN UNFAMILIAR WITH ROAD- B LOOSE MATERIAL ON ROADWAY• B AT INTERSECTION (( NOT APPLICABLE DEFECTIVEVEA EQUIP.:_-arta„ C OBSTRUCTION ON ROADWAY• CROSSING IN CROSSWALK-NOTArts I SLEEPY/FATIGUED D CONSTRUCTION-REPAIR ZONE AT INTERSECTION UNC SPECIAL INFORMATION E REDUCED ROADWAY WIDTH D CROSSING-NOT IN CROSSWALK L UNINVOLVED VEHICLE AHAZARDOUS MATERIAL FLOODED• IN -INCLUDES SHOULDER OTHER G OTHER•: jF NOT IN ROADNONE APPARENT H NO UNUSUAL CONDITIONS APPROACHING/LEAVING SCHOOL BUS 0 RUNAWAY VEHICLE KETCH Im MISCELLANEOUS JNDt:ATt NORM _.`;, :71-:T(..F,-..."'49;:4300 `c 1 15i91 . . .. .. J._Hdgfrs ... —Dist..AffiY• : County Juvenile ._Caltrans . Coron = Oc k P.D. t0ther ��j Vabcn czm � ,� 1 {� •.10.[e 7•r:C n, 0•.,•aA•/`DI ISA! NJURED / WITNESSES / PASSE1"aERS PAGE 3 DATE.F COLLISION TIME(2400) NCIC NUMBER OFFICER I.D. NUMBER I t- ►'� =Sz 1y�S ' .. g 40 1222 EXTENT OF INJURY ( "X" ONE) INJURED WAS ( "X" ONE)WITNESS PASSENGER ONLY ONLY AGE SEX NUMBER POS. EQUIP. EJECTED FATAL SEVERE OTHERINJURY IBLE COMPLAINT DRIVER PASS. PED. BICYCLIST OTHER INJURY INJURY IILIURY OF PAIN J tt rr ❑ z� 'tom ❑ ❑ (DRESS ^,❑ ❑ ❑ n❑A ❑ ❑ ❑ N3EGJ. w&\\ E E,N6LAJ.NO1 (0- 1-1- foal `a .ox 1 \WN cA uSI TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO: '1 DESCRIBE INJURIES VICTIM OF VIOLENT CRIME NOTIFIED NAME i O.O.L I ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES VICTIM OF VIOLENT CRIME NOTIFIED ❑# ❑ ❑ L ol ❑ I ❑ 111 1 ❑ lo I ❑ I ❑ NAME I D.O.B./ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES VICTIM OF VIOLENT CRIME NOTIFIED El ❑ ❑ ❑ ❑ El [I El ❑ [1 1:1 NAME I O.O.B.I ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES VICTIM OF VIOLENT CRIME NOTIFIED Ctt ❑ ❑ ❑ 1 ❑ I ❑ I ❑ I ❑ 1 ❑ 1-❑ NAME i O.O.B.I ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES VICTIM OF VIOLENT CRIME NOTIFIED ❑� ❑ ❑ ❑ ❑ El 1:1 El 0 .1 NAME IO.O.L/ADDRESS TELEPHONE QN.VRED ONLY)TRANSPORTED BY: TAKEN TO: OESCRI BE INJURIES 11 VICTIMOFVICLENTCRIMENOTIFIED P £PAAER'S NAME� I.D.NUMBER MO. DAY YEAR REVIEWERS NAME MO. DAY- :HP 555-Page 3(Rev.7-87) OPI 042 a7 43637 r'Hlr i UAL UIFi1 MIAIVI PAGE DATE,OI CO'LLI$ION TIMI 00) NCIC NUMRER DF"CE NV MRER ' MO. 1 • DAV VR. 1� il, 1�� \ZZ•`� ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED (SCALE -- INDICATE .. _. .-NORTH .. n� ` .. .......... .. x I o x• d I u f t ..... ...... ..._ .. ( -- . _........ _ IL 1 LL o � 1 - --------------- --- -----.._ DRAWN or I.D.NUMRER MD. DAY VR• REVIEWERS NAME MO. DAV YR. 11".119 �Q,✓ r, a 9 a z5 i i�-5 z CHP 555—Page 4 (Rev 11.85) OPI 042 ARA I' ElSUPPLEMENTAL ` PAGE ITE OF NCIDEHT'C�RENCE Z TIME�;WOi1 ' NCIC T4 o OFFI R-LI NUMBER . 'ONE WONE "l TYPE SSUPPLEMENTAL(W APPLICAM4 ' NARRATIVE ® COLLISION REPORT ❑ BA UPDATE ❑ FATAL ❑ HIT&RUN UPDATE SUPPLEMENTAL ❑ OTHER ❑ HAZARDOUS MATERIALS ❑ SCHOOLBUS OTHER TY/COUNTY IJUOICAL DISTRICTREPORTING DISTRICT/BEAT CITATION NUMBER )CATION/SUBJECT STATE HIGHWAY RELATED YES NO NOTt Fac- cow 2. 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POLICY ECA:1. :1..1.'�,.3..5 6 5 :l(},..q 1. 9:.,,. TO -..l().....0 All "'r,._.3..::L3�Z ta.1~!(.M..,:,�:�!;_ ��J;;..��Af�R fl iii c �l.is(]' 1_(] '. :.:.� CLAIM 760—A 4: ...tr.:...., I.l/tl 11—0.3 92 RPT T 17 C D : 1:i.--1.f3 9.,._...'n C;7.V:Y':=�0 44 c.,., ! 3 (::Fl! (;Cl I:l E ..0() , r:, COi--•! (:11:-1:- 760 ::3ACRAi'1EN'T'(:l t11:1,,l `d,,l05eJ. ;31'V 4,J()�:;1 (�L.0 .',#�.'T .r0.�¢:'::''';: :.' :.. ,,AMT 0000000(} :.. PRODUCER R 0::''0;:';:1::.5.1. t:3ttr::;RF`ii"11:::NTO Vtll...l...EY :I: ISL:IN � •f7 Ll.;'FWXf' -Qn()0()f3:l.r�?. ' ',',1=:;:3'T' I:IAM • 700(} ; 1 INSUREDC(:lN•T:i: MATERIALS SERVICES P , 0 ,4BOX ..;3004ca h7UC:�Cf(��! ;(::Fl �J'i ?:1.;3 ACCD ..,. .. .. :t:Y 1.1 FORCED (.l I.. I.. 0 I" ROAD '. IV - =,..'. -:r;;;-•-..r LOCATION 1.3'r I<(.l NCA0, SIll. i` DRIVER NO NAME STEVE 1:3 Id Cl f.:I< CLAIMANT ,.7 (.'.,.Y SFX -T:Y.I L31... �..:I.I'! I'tl._,.7 �.T'"/R ';�;...I'I.) -.1_[1,.7,.7"- ;RES.�,"0/�3��''I:.;'T' .�:T (]QAM.T. r ' • ...J it-• V``l5tj:,c'(rArt'-i.ti ,'SI,:;i _ r CON1I L„lN::5l 2 ).} ,. .I. (.r..lI...I... .._� .()(}�!.0.}0 ..-.::.x.0.;3�;�:.#3,1 7.,:.,q:a�LL'�O:S.f-__:17 : `+'<13#:3 ��< ;_ kill ,, r :5',' MOOL �Y �:r. �:rY :,:'2�t:a•; (+�I'i]' TAN : L I,MI (f:5 Ci:i,I, PER I'I::,RS 10 . 1:31• PER 0.(.(. :_' ;-:.0. la.D.: N1,,12..:..(](..(',r, (, M131: P.l:R .F51::R,13 () ...f51:::1t...:n(.(... () .(:liil,U.?::0FR,;;FI.Cc:' '; ::p,;:;L7L-..CJ ;i``(tC'Cl (.C.IL_L.: : .. ... .r..: ... .:r 'i nY .) I I I....I.(..t•1131...1... I._N I.l(.11.•..Y1...M1...N t S:... :..-::; .-:..-::. .... ,,...,. ., '�-;;.:.;.,'�.,,':.-:4-,:, .:. ':r+,�:r-.'�:r-.:.,..�•:. .:,.,.;,,Nr,:,:r.��:�:.: �.,....>,'',:;�::`T'(:1W&l._f1[3 ON P.I:I ,: - All 4 �.:s�^,++�;.:f':..4 1 h:jl4..r•,��r 'r st:• ` •. :Y .. ... ... .,.....:::,,. - ....: �-, ..=a . ,_,::: _ ,I. I n(,;I.,, 1. N! NI.,,XT 1 n(:rI::. RI::.::-RElI.N,.7 ;;;::OR-, a1:1.1:3S _i]RFO �ii�r;:;,r,:>,Mht:-:T,I AN#:i'. W'SPACI::':..,'TX(::#:3 INI:5 low ,' .. �Y, .'Y• ,.,j��: alt.. _ ::1..,::.�^,., . 't . .: ..rl+._ ,'C' •IW..:1:'A''r: .U:^'irk`.•. ��1;::;.:,�t.. .. ON gmay no most qqq W Aspic. WHO i •r - '-�' Vii`: :;1.,'!i,t, .�. ,:�,Jk.�;r„-'�:,t-i•:� , 'ice,:'.+<t .mi:;..- :.. ... .. ............ ..: r. .:0..,.:r .., n..lp� t'3�;;': �rtt,� <•.,1:.. ,,'.s:.: ,rt.::�:,.:�:�,. R: ...:s.:r ..' vin DAMAGE&EVALUATION APPRAISING OF AUTOMOBILES.TRUCKS.HEAVY EQUIPMENT,FARM MACHINERY&BOATS T H O M A S =A##Tai of SEzv&,z P.O. BOX 1038 • CITRUS HEIGHTS.CA 9561 1 (91 6) 969-1606 9 FAX(91 6) 726-7942 December 8 , 1992 Mr . Doug Dean Maryland Casualty P. O. Box 15252 Sacramento , CA. 95851 RE : CLAIM NO : 760 A 473025 INSURED : CONTI MATERIALS OUR FILE : S92012038 D/L : 11- 13-92 Dear �Mr . Dean: This will ac.knowled ;eOrec:eipt of the above referenced loss on -�Nc)v . 18 , 1992 . We contacted Delta. Truck Center in Stockton, where this tractor was towed and the insured, where the trailer was located, and then inspected the tractor and trailer on Nov . 20 , 1.992 . IDENTIFHATION - Tractor ..................................................................................................................................... MAKE : Freigtliner YEAR : 1987 VIN : SFVNYBY93HP310641 LI';ENSE : 3h98306 M:I.LEAGE : 406 , 972 EQUIPMENT NO: 44 Cummins tiTCC 300 Mr . Doug Dean December 8 , 1992 Page -2- ' IDENTIFICATION - Continued .........................................................................._.........._....._.._..............._......._............................... MAIN TRANS : 1160 9 Speed REAR END: SQ100 SUSPENSION: Spring NO. OF AXLES : 3 CONSTRUCTION: Steel frame ATTACHMENTS : Power steering , Air conditioning Trailer MAKE : Fruehauf YEAR: 1987 MODEL: Transfer LICENSE : LUB2140 VIN: 3U02323H1000108 Enclosed are four pages of photos showing this tractor and trailer at the time of our inspection . We understand this loss occured when the truck and trailer swerved to miss a car, leaving the roadway, going into and thru a ditch , and then rolled over in a field. The major portion of the damage is to the right side . The truck would require replacement of the front bumper, entire cab assembly, about 50% of the box mounted behind the truck and numerous items mounted on the right side . The hood assembly could be repaired. Repair of the trailer would require rebuilding the trailer assembly, replacing a section of the main frame rails and almost completely replacing the box assembly. Also , there is damage to the rear of the trailer , including the crossmember plate where the license plate and lights mount , and tires and wheels . Mr . Doug Dean December 8 , 1992 Page -3- We have a repair cost of $33 , 198 . 26 , and a repair cost on the trailer of $16 , 091 . 40 , for a total repair cost of $49 , 289 . 66 , plus there is a good possibility of hidden damage . In our opinion the tractor and trailer are constructive total losses . We obtained salvage bids on this equipment . The high bidder is Rux Oneto at $5 , 600. 00 on the tractor and $500 . 00 on the trailer . His phone number is 209-223-0436 , his car phone is 916-761-4872 . Enclosed are ads listing comparable trucks and trailers for sale , which we used to establish the value on this truck and trailer at $50 , 000 . 00 . We trust we have covered all areas to your satisfaction. Should you have questions , please contact our office . Yours truly, THOMAS APPRAISAL SERVICE Tommy Thoma TT : jt Encl . SUFFIX O1 RJTOMOBILE STATEMENT OF LOSS CLAIM NO�(�P`113�ZS OAL OSS EALUATIONY POLICY NO. TTLV ELS 1��33eS �` "`�� CLAIM OFFICE S1A�7o AND SALVAGE INFORMATION LINE CODE INSD CLMT A SHOP ESTIMATE A R AGREED PRICE TOTAL DATE RECEIVED T A DIFFERENCE DEDUCTIBLE - DATE INSPECTED L DEPRECIATION NET LOSS DATE CLOSED L DAYS TO REPAIR TYPE OF LOSS 0 S S1 Comments T 1. YEAR MAKE MODEL �`i4f-1 �" J ��"�" 2. SERIAL NO. SF1/N B0 3VAp 0 r 3. MILEAGE "�Olo1°l`12 4. ENGINE 4 - 6 - 8 - GASDIESE 5. SALVAGE POOL A 6. TIRES 32nds REMAINING LF LR RF RR SPARE L L MARKET VALUATIONS IF NECESSARY 0 BOOKS USED S SOURCE COST S BASE PRICE 1 AIR CONDITIONING CRUISE CONTROL AM FM TAPE STEREO aob pct 5 -2� LESS DEDUCTIBLE - � NET LOSS TILT WHEEL SALVAGE DISP. CODE SALE PRICE TRANSMISSION REAR DEFOGGER FIRST TOW 2nd TOW 3 ?cif.ao P.S. FIRST STORAGE $ per day = P.B. 2ND STORAGE $ per day = POOL CHARGE _ OTHER CHARGES - SPECIFY = TOTAL EXPENSES �1i�56 CHECK WHEN COMPLETED AVERAGE OF BOOKSSTOLEN AUTO FILE ❑ NATB SALVAGE ❑ LESS OLD DAMAGE — 20008 TOTAL LOSS NATB STOLEN ❑ LESS TIRES RECONDITIONING — TAX & TITLE + Appraiser ACV Y�,6ss�. T - J SETTLEMENT AMOUNT ` Y0�6Stis? c7't � ��- p� � -7 Claim Representative Date Comments V"`AV" 'o° <JA.� v o b�•75 � � Ow � - 3��Ss`6�S .� �u r! 56ov)= —3�,0�.Z� 20657 Ed. 10-84 FII F • �11ALLCn!!-!nT R 71 IWE AR 0 LABOR MAIIESRIAL DETAILS OF REPAIR AND REPLACEMENTS IN MRS. WIM WAN tip oh ILI w,pilf—W ........................ Thpnias Apprai(".7.1 Service Date P.O. Box 1038 * Citrus Heights. California 95611 Co. Claun No.74 QA47,3_0a 5 (916)q69.1606 0 (9115)726-2211 BILLING Our File No. C/o &d�az a ASSURED CLAIMANT MAKE YEAR MODEL BODY STYLE I.D.NO. LICENSE NO. MILEAGE A -7 HPQ / 06Y_7_ � ALLOWED PARTS OR RE- LABOR SUBLET PAIRE-R PLACE DETAILS OF REPAIR AND REPLACEMENTS IN HRS. MATERIAL VD A,, as Of b la d 9, 6 0a 4a 0 V UV 2 1 /010 '7-AD- 00 3 4Z\ 5 A 6 5, 7 F'o 6 0 8 9 '2 :3 B A '5 :6 Labor D6 For 8 less deductible S or"o FIRM theundersigned names to complete and Net Parts reairs as listed to above vehicle including all towing 019 0 and starnste charces. ADDRESS Tax % A Supplement for additional damairt must be author• lzed by Appraiser prior to completion at Repairs. BY Sublet Adv.Charges APi#RAISER ...... ....................................................... 33 -C THIS IS NOT A REPAiR AUTHORI UAON GRAND TOTAL S OR GUARANTEE OF PAYMENT Authorization must be obtained from owner of vehicle. SI9FFIX �� .AUTOMOBILE STATEMENT OF LOSS CLAIM NO. ��AL�1301s •POLI& NO. E 1�19�'�bs (',.;' TOTAL LOSS EVALUATION y-i CLAIM OFFICE AND SALVAGE INFORMATION LINE CODE INSD - CLMT A SHOP ESTIMATE A T AGREED PRICE TOTAL DATE RECEIVED T A DIFFERENCE DEDUCTIBLE - DATE INSPECTED L DEPRECIATION NET LOSS DATE CLOSED L DAYS TO REPAIR TYPE OF LOSS O S S1 Comments T 1. YEAR MAKE MODEL 2. SERIAL NO. 3 ucl 2.-31 1 acs. �a T 3. MILEAGE 4. ENGINE 4 - 6 - 8 - GAS - DIESEL 5. SALVAGE POOL T A 6. TIRES 32nds REMAINING LF LR RF RR SPARE L MARKET VALUATIONS IF NECESSARY o BOOKS USED S `Z SOURCE COST S BASE PRICE AIR CONDITIONING CRUISE CONTROL AM FM TAPE STEREO LESS DEDUCTIBLE - 100 •Db NET LOSS I-)1441•f TILT WHEEL SALVAGE DISP. CODEya`2 SALE PRICE 50a•ao TRANSMISSION REAR DEFOGGER FIRST TOW 2nd TOW 51S-a� P.S. FIRST STORAGE $ per day = P.B. 2ND STORAGE $ per day - POOL CHARGE _ OTHER CHARGES - SPECIFY - TOTAL EXPENSES CHECK WHEN COMPLETED AVERAGE OF BOOKS nLa STOLEN AUTO FILE ❑ NATB SALVAGE ❑ LESS OLD DAMAGE - 20008 TOTAL LOSS (� NATB STOLEN ❑ LESS TIRES RECONDITIONING - TAX & TITLE + ��-1 N Appraiser ACV l-3`l�f�•5� I J SETTLEMENT AMOUNT l�y`�Z �v j 0, Claim Representative Date Comments ------------� 20657 Ed. 10-84 FILE PFAr F PJAW OR WE 9 ff PARTS OR DETAILS OF REPAIR AND REPLACEMENTS MATERIAL Irmo I I 1W WON MIAMI go rim 11.m_ MMI mo owl VAN% iWom I ME2,� i�i��r 11;imillill ..11111 4 WWWW • - i>bbuC Y.b Ks l;Cbbo !rr 111 ":3 >> a r i k3 a x � 0400 i u {�' 7 o a. Ln G(}1 oo � a ka§S 1 u s�� th �'S N 2 I APP 2 1993 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA COON Il ..DUNS& . MARTINEZ. CAU1% Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT May 25 , 1993 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $350,000.00 Section 913 and 915.4. Please note all "warnings". CLAIMANT: George Cowen and Barbara Cowen ATTORNEY: Wald, Freedman, Chapman & Bendes A Professional Corporation Date received ADDRESS: 1999 Harrison Street BY DELIVERY TO CLERK ON April 22 . 1993 Suite 1900 Oakland CA 94612 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. PPHHIL BATCHELOR, Clerk DATED: April 29 , 1993 BT: Deputy I1. FROM: County Counsel TO: Clerk of the Board of Supervisors (VI 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: O Dated: Z g 093_ 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. Dated: MAY 2 5 1993 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, *For additional warnina see reverse side of this notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: MAY 2 5 1993 BY: PHIL BATCHELOR by, Deputy Clerk CC: County Counsel County Administrator This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. RECEIVED APR 2 21993 s 3:a/� fC . CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. In the Matter of the Claim of: ) GEORGE COWEN and BARBARA COWEN ) -vs- ) CLAIM AGAINST CONTRA COSTA COUNTY FLOOD CONTRA COSTA COUNTY FLOOD ) CONTROL AND WATER CONTROL AND WATER CONSERVATION ) CONSERVATION DISTRICT ) DISTRICT, GOVERNMENT CODE SECTION 910 GEORGE COWEN and BARBARA COWEN hereby present this Claim to the CONTRA COSTA COUNTY FLOOD CONTROL AND WATER CONSERVATION DISTRICT pursuant to Section 910 of the California Government Code: 1. The name and post office address of Claimants is: GEORGE COWEN and BARBARA COWEN 1475 Westridge Avenue Danville, California 94526 2 . The address to which all notices are to be sent is as follows: GEORGE COWEN and BARBARA COWEN c/o WALD, FREEDMAN, CHAPMAN & BENDES A Professional Corporation 1999 Harrison Street, Suite 1900 Oakland, California 94612 3 . Claimants are informed and believe that said CONTRA COSTA COUNTY FLOOD CONTROL AND WATER CONSERVATION DISTRICT through its subsidiary agencies, designed, and permitted to be built, constructed, installed, controlled, and at all times herein 1 relevant was responsible for the maintenance of that certain flood diversion creek, ditch and channel upon the real property adjoining the real property of Claimants and upon the property of Claimants which real property of Claimants ' is commonly known and described as 1047 Westridge Avenue, Danville, California. 4 . Claimants are informed and believe that on or about January 13 , 1993 , and continuing thereafter said CONTRA COSTA COUNTY FLOOD CONTROL AND WATER CONSERVATION DISTRICT so negligently and carelessly maintained and managed said drainage system so that the same was caused to flood and inundate the property of Claimants ' residential and real property and improvements thereon, and thereby causing personal injuries and consequential damages. 5. At the time of presentation of this Claim, Claimants claim damages in the sum of Three Hundred Fifty Thousand Dollars ($350, 000. 00) , said sum being the sum necessary to repair said property and to compensate Claimants for the loss of value thereof and other damages herein mentioned as a result of the negligent and careless acts and omissions by the said CONTRA COSTA COUNTY FLOOD CONTROL AND WATER CONSERVATION DISTRICT. DATED: April 22 , 1993 WALD, FREEDMAN, CI MAN & BENDES A Professional CorpTration By -- OBERT B. FREEPRAN ttorneys for d1aimants 2 RECEIVE® a APR 2 21993 I CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. In the Matter of the Claim of: ) GEORGE COWEN and BARBARA COWEN ) -vs- ) CLAIM AGAINST CONTRA COSTA COUNTY, CONTRA COSTA COUNTY ) GOVERNMENT CODE SECTION 910 GEORGE COWEN and BARBARA COWEN hereby present this Claim to the COUNTY OF CONTRA COSTA pursuant to Section 910 of the California Government Code: 1. The name and post office address of Claimants is: GEORGE COWEN and BARBARA COWEN 1475 Westridge Avenue Danville, California 94526 2 . The address to which all notices are to be sent is as follows: GEORGE COWEN and BARBARA COWEN c/o WALD, FREEDMAN, CHAPMAN & BENDES A Professional Corporation 1999 Harrison Street, Suite 1900 Oakland, California 94612 3 . Claimants are informed and believe that said COUNTY OF CONTRA COSTA through its subsidiary agencies, including but not limited to the DEPARTMENT OF PUBLIC WORKS, and the CONTRA COSTA COUNTY FLOOD CONTROL AND WATER CONSERVATION DISTRICT, designed, and permitted to be built, constructed, installed, controlled, and at all times herein relevant was responsible for the maintenance 1 of that certain flood diversion creek, ditch and channel upon the real property adjoining the real property of Claimants and upon the property of Claimants which real property of Claimants' is commonly known and described as 1047 Westridge Avenue, Danville, California. 4 . Claimants are informed and believe that on or about January 13 , 1993 , and continuing thereafter said CONTRA COSTA COUNTY so negligently and carelessly maintained and managed said drainage system so that the same was caused to flood and inundate the property of Claimants' residential and real property and improvements thereon, and thereby causing personal injuries and consequential damages. 5. At the time of presentation of this Claim, Claimants claim damages in the sum of Three Hundred Fifty Thousand Dollars ($350, 000. 00) , said sum being the sum necessary to repair said property and to compensate Claimants for the loss of value thereof and other damages herein mentioned as a result of the negligent and careless acts and omissions by the said COUNTY OF CONTRA COSTA. DATED: April 22 , 1993 WALD, FREEDMAN, CHAPMAN & BENDES A Professional Corpo ion `\ OBERT B. FREEDMA Attorneys for Claimants 2 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT May 25 , 1993 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: $1 , 294 .03 ,�9p''� Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Joanie Dybach Q9 ATTORNEY: N Date received ADDRESS: 5219 Mary ue Circle BY DELIVERY TO CLERK ON April 20, 1993 Concord CA 94521 BY MAIL POSTMARKED: Hand delivered 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim, ppHH gg DATED: April 29 , 1993 BYIL DepuLyLOR, Clerk ' I1. FROM: County Counsel TO: Clerk of the Board of Supervisors (t/) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: y Dated: L.l Zy /f�3 BY: y-u Deputy County Counsel 11I. FROM: Clerk of the Board TO: County Counsel (1) County Admin strator (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: MAY 2 5 1993 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. *For additional warning See reverse side of this notice. 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, j California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: MAY 2 5 1993 BY: PHIL BATCHELOR y Deputy Clerk CC: County Counsel County Administrator This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. " aim tc: KA:,O OF SUPERVISORS OF COMRA COSTA COMM 'KS"AJCTIONS ''TMJ CLAIMANT �+. Clai:-z relating to aiuo s of action for death or forl:n�ury to -rson or to per- al property or griwing 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_accr-dal 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. Clair.s must be filed with the Clerk of the Board of Supervisors at its office in Roca 1Qfi, County Adainistra-ion 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 claics =ast be filed against ea4h public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. "2 at the en of this for--. RB: Claim By j Reserved for Clerk's filing stamp O RECEI�f�� Against the County of Contra Costa ) or ) APR 2 0 1993 Fill in name District; �CLERK8 ARD OF.SUPERMSOAS CONTRA COSTA_ The undersigned claimant hereby makes claim against the County of mantra Costa or the above—named District in the sum of $ 1.'1c�t_A,_LL and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 2. Wherk did the damaga or ir�ary occur? (Include city and cvant ) 3. How did thedda.::age cA injury occur? (Give full details; use extra p3p%r if required)--y \.vzsm �\\v�� v` „��'c C\n c V� • .`� �\s - A�`.n�� w�a�c a�c�r ��rnn�z�\�s j �. � :� � \cam \ate •��c ��v\s� s�q \v'Nn �Zo tae par4a�.p .r—� r . '-F Ly os.r. , servants or e.rloyees caused the in�u.ry cr damage? - - �`t. -�V.� aC'ca t�vcZ•�� vtv,.s\�.�xaU�J Nl-v�noy� arC� 7& \l=+�!\�t.. �K� • �� ' ILC. C�J.S\p -��lvV�b\V\5 �'U\W�C\CS K\ Jz c�- aie �w'aA\ca�S ,�yvi L `ni�13� ne �� es o.��scoun:.y or district officers, servan s cr employees e a-7-3ge cr :r,jury? 5. What damage or injuries do you claim resulted? (Give full extent of injuries or �= damages claimed. Attach two estimates for auto damage. �� N- -V s -,- �� cay� o,ti.�w�bac ��Ws\x�\a\,\ — �� 7. How was the amount claimed above o=puted? (Include the estimated amount of any Prospective injury or damage.) -R Noc,� $. Names and addresses of witnesses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury: DA„r ITr..M AMOUNT - 1-�y 93 ,`�.�c u\�, s vs cv�Sv�. a\\9Mvvc,•,.� �y� X11,9� 9 X13 aNIA U q �a�• Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICM Z0: :,-.:(Attorney) or erron on his .half." Name and Address of;.Attorney laimant-s Signature �Adoress Telephone No. Telephone No. e 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 i=risonment in the county jail for a period of not more than one year, by a fine of not exceef'ing one thousand ($1,000) , or by both such imprisonment and fine, or by imprison_�nt in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or 5y both such Imprisorimnt and fine. 5-7546PT.3 R /� Oa►waMAl011GR®ITCARDS A -"-CUSTOMER R �.i - 0O111RGEfSTTE.CIIEDISCARD G INVOICE R yALESPERSI* CUSTOMER P.O.NUMBER 3653-028347 Nu b' MARK MORRIS TIRES HOME PHONE NO. .• CUSTOMER NUMBER C MANE j �\J1 PC K 570 CONTRA COSTA BLVD T ADDRESS,.r . tt,. a. PLEASANT HILL. CA 94549 BUSINESS PHONE NO. T.T. KET TICNUMBER I C.D. 0 - - --.�(� i� .. �• - (415) 686-0586 . M CITY TE ZI _ BAR IF AG096169 0Q . VEHICLE MAKE {YEAR ';11.11; ,.. - . E VEHICLE LI NO. a STATE VEHICLE MI TO. .C C'2.APPR. _ .. _ 1. MISCELLANEOUS CODES SERVICE REQUESTED .ter _. ::, ... .. .: .. _ OR RECOMMENDED YOUR SERVICE ADVISOR TIME IN TIME PROMISED ARTICLE NUMBER Ek, Ory. UNIT PRICE PARTS DESCRIPTION' EXTENSION a I r1i e4 � :o - Vis; - s= F= - MggT�RCA S1 to-k CAP _ N4I , ALL PARTS NEW UNLESS SPECIFIED OTHERWISE t-, it 't^;+5. z-..Y,..y2a:�•.�u. 'ate xxn;;n�Irrw�r:n a"• f.•cs;. L?+ ,!• Y•9or�-tl TC3tAt:'PQ1RT5;TIRES•IUVD;O+�>tTERft ;. :vrc.z;�, F:. ARTICLE NUMBER. QTY. UNIT PRICE^ - LABOR DESCRIPTION EXTENSION 46930 1 00 100 COURTESY CHECK N/C J^ I 1 V, We appreciate your patronage. Please REGISTRATION NUMBER !':J..:+•y,.,.'r-. ,.. :z:T';.,- i'.�5'i"i�l�.Tl ,1.fjW; h `.i'`'a I: L .'I't ." - !{'tj;•U I•4;v°.1�. g ,,.....,.. contact us if we can be of further service. .. .,;'�.,jS`.I. -..,'.- ,•��J.d.....ki._� 'A.V%, ��q!•�"1• f6r ]..4._ 096169 R'F REVISED ESTIMATE REVISED ESTIMATE APPROVAL PERSON PARTS CONTACTED h�• I ACKNOWLEDGE THAT I HAVE REVIEWED THIS ESTIMATE OF REPAIR AND SERVICE WORK. TELEPHONE N0. 1 HEREBY.AUTHORIZE THE ABOVE WORK TO BE DONE, INCLUDING THE INDICATED PARTS LABOR AND LABOR,AND PROMISE TO PAY FOR ALL SUCH WORK.I GRANT PERMISSION TO OPERATE THE REFERENCED CAR,TRUCK OR VEHICLE ON STREETS,HIGHWAYS OR ELSEWHERE FOR THE DATf�iIME TAX PURPOSE OF INSPECTION AND/OR TESTING.I UNDERSTAND THAT ALL CLAIMS AND RETURNS MUST BE ACCOMPANIED BY THIS INVOICE. BY L DO NOT REQ UES THE RN OF REPLACED PARTS. 'ESTI., TE. s' !� - THE SERVICES YOU RE UESTED HAVE BEEN PRO ERAr LY. CUSr S SIGNATURE PERFORMED BY THE FOLLOWING MASTER RE TO EOPL . 11 MERCHANDISEY: SERVICED h CERTIFIED .. - BY �'" BY CUSTOMER SIG A RF t• sewn EatoApTAIJT PAWCIIIVeo 1.11!^0AAAT11nIkR 0%I►R n&~ i i VISAa "The Used Auto Parts People'' CONCORD AUTO DISMANTLERS 2211 ARNOLD INDUSTRIAL HWY. P.O.BOX386 ' COM*ORD CALIFORNIA 94522 (415)685-7700 CUSTOMER'S ORDER NO. DATE NAME ADDRESS 1 ' i 1 CITY STATE PHONE (0y I CASH C. .D. CHARGE ON ACCT. MDSE.RETD. I PND OUT CREDIT AW. i i ' I SEE REVERSE SIDE FOR CONDITIONS OF SALE - ON.: 1 I i i 1 7 1t-Aj l 1 T V 1 .e s x :'.•y :.'y:r �:. ❑ V IMASTERCARD`M1?( } ' CASH ' ❑ CHECK SUB TOTAL -----� FwN0�t'-*,ERVE EXCHANGED OR RETURNED WITHOUT THIS INVOICE THE RIGHT TO REPLACE DEFECTIVE PARTS. TAX All mechanical parts are guaranteed for 100 days from TOTAL 310gF 0 date of purchase.There Is no guarantee for labor to install ' or remove. DEPOSIT AMOUNT X BALANCE RECEIVED BY DUE 7333D ADLER TIRE & AUTOMOTIVE -- WORK SHEET -- Date: C�\ Time: Name Phone P.O.# Car D IR ic.# � �U Mileage Tires 'e DOT# ��L. �� c�.S,e lls..) Ay , ` V ►��I1G Balance: 4—Front—Rear Tire Repair: RF LF RR LR lignment- Front—4 Wheel Brakes: Front Rear Disc. Drum Type Turn Rotors Turn Drums Calipers Shock—Struts: Front Rear I Comments: � C tm c ` _ Ion s jr I �,T I Cost:$ Check All Vehicles Air Tires Rec Align Front Brakes% Rear Brakes% Wheel Covers Missing: RF LF RR LR Rims Secured Before Lowering Car . " G JJ V• ar .�1 T a. .. i 1621 ^h :.On - .t. T :gel .:r m ly .33 CD c 2 D Z o a IL O" C-. La plmam< 1 0 03 ;z v a m .. � m m Z OOm��' oW2, ; 3xO 8�nDm o c�gm�3mm,rmg'�my° {�� i1CD oN m zru � cOgO �$vy � � =r»am ° O pvym � . �zn� � o � am CDa� .D �1 �sr C. D-�=m°D m Ln m ■1 m� m< mom ° 3 A O '"` m mmA oma 0 > C �.. N maaom� � w � \ T S " CO �. Uri s D MO O qK4 -im 3 .-� 6N' CD M�m� mffa 0 ym $ZCD > mo 5 rQ yr Zpn � Ca CD g� o Dz-1=� $Cxm M 1 N > v L71 m OpOOc m »'R gpo c O 0 rZCy •o n 'm_z�m �ptmnm � N tD. `� �' O Dtn(A n � y �Cor `` O (nCD •� o a co- Om�O w.o ci 3 Z W Mcn ID CO a m z �oOgOomZ Ul ca MC m Qa 0 H tn —c n \ W 0 T ' m n '< s w mOmi3c ao IQ. 1x11 \ _ N W� co W N %T - y y (0 --4 m V T r T r yD > C c 1 O O > D to > _ 10 = m\ m ID D o - O -4 O m G t7 y 1 m D y C D m r r D N o O O D a o Q m `o m .. ol - C oW z "a. 9 v D 1 D 1:. PHYSICAL DAMAGE REPORT 5077 NAME ,/✓ / DATE / G ADDRESS / CITY /r � ZIP YEAR MAKE-e57e57 G T MODEL G`e HOME PHONE ... �� ! WORK PHONE HOW DID YOU FIND OUT ABOU S? L J YELLOW PAGES ❑ DRIVE BY U REFERRAL ❑ OTHER,WHAT 0 REPEAT CUSTOMER D BUSINESS ASSOC.WHOM? INSURANCE CO. APPRAISER APPRAISER'S PHONE CLAIM NO. VIN# / � � � � PRO.DATE DESCRIPTION OF DAMAGE0. QQ� 2 - 3 It /i 'ir/ a --- 5 41 IVI- 8 cI IV /L a% �Bif 10 Ile 11 13 1a00' TEE,¢r:lr/� GLE0. 15 J7 _ 16 17 18 19 20 21 22 23 2a 25 j26 27 P8 C '29 TOTAL ► mom:. I hereby authorize the above work and acknowledge receipt of copy. 120 PARTS PRICE ` HRS. $ SIGNED X DATE 102,:=BODY.'LABO '' .-.:'HRSc s• zf 104:::.:FRAME LABOR .: :HRS '' $ '.103' PAINT LABOR. HRS.@:,;::::; '. $'•: -At o Aut ;01-:.AAECH:LABOR':` :`HRS :. .. .........:-.. 140. � 175 SUPPLIES 23 130 SUBLET $ i `. t•;s r'.,. �� i'•:.• ,, 134 TOWING $ "WE SPECIA ''tiEi` E CTION" 1225 Parkside Drive Walnu %9 ' � (510)934-5424 (510)934-9777 850 TAX $ } TOTAL $.> L c n_..-,.,,r•+:^.'i:%'-•i�;. :;'=kv a'':;::S '2Y%":a tr: :^L:°.' :r' 25.�:z,_Y�, ''�.+: `b1:''ni�:� � c c CD 1.pCl O ac c x O D 1� O - O o O :r O O o �'- m n ,3�3cc�j rn 33 1- > Z m 0 n aW ` O-n 17 i m m°EL o s�2�Qz�-_ C •1 a oa `m Z.. a D �' om T< p��oom$°'°m y . a B T �m O m ' m r. nca_ g a $_ C zM O cS" z c3p-o ,^ m 3 »�cp' $ opm��$ < C $ �. a t� at�mE� c3$$� < 2 g - 0 aa a m -i 2=2<`°�m 'g sem' n r N $'o o aoo $ r M sM3� N p G o� m$$$o3s$t�mo' m m N S m j n m:$m'sSgm&mm�o 0 m M g g -A 0,-s g z n $ :a m A m3mo°am<�t3� v M Qr 8 a t$ ao��_?�e°sZo ��o �1 D 3 r ;K c- - 2 L7 -n m O n W D m o(7 mz-r� °a:$S1 o D D _g.��mmm_�� Cf fgcm O O cro0 �t(9 wr� - D '2 DG) D z �'g$5 O O� r r Ox �z Z Or V - t m N fl°r n (5 MM m O m�om -Di �m m -� m - n S O (n 1CD _o m D - m m O z - - D m - Z 2 3 m - m con mO Z. O \/ Z m$ m O 7 m O g Z�yj f/1 n In @ 1y O n ZZ ZC Z cmc m Z O " co on a -_� Fn o v o y p m D cls O m r n m CD '� 3 N �/� m O s�. Z' r o) O r od CD rrH m m m0 g m 17 06 O D !...... .._....._. S 31 M "a ? m� Z N "'I mmAll s o ((J�1 so �f° D 4� .O �, o woD r o mm5 a (n _ - .. z z co x oo m m mo �� co D 1" T_ o > 8 wk 4�b cn X r. j i m F or-W ;ov A V m }' �:. C a09 «m (n ;Za so< CDP w = p G) Ro W m Z N_ 3 A. S ❑ m m N mD O a < x M i.i m _m O rr� n gm CZ m S10 9m q C) p a z El m m Z < m ;P� v v m m m - x x 'v m El D _ =m m m m m <O . c Sv z a o m �n O n 3 D o z a r .. m -.._. - ... ... m 9 • C a a _ y INVENTORY TIME r • 3 OPURPOSE ONLY .. c L;8 N N N N N 9 NN N N + + + + ii+ + tp Q� V 0 N A W N D c T O . f0 -" V 0 -- H . W N O 8 co V W N A W N + O + Z Coo co-A Dm2 amr cnom wom c ZW. C ro DS x(� Twm (dam m MmD nnN o(l) D �co 1y nim() M,-- roC:O <V77 co*p T0. conn r,nr D ZcoT mco mzm mZC)<xr<p Z yD Z O D .m cox' P<Z Oor Z rim r1< 2-i2 71r xD DO <XS rrx DZx D()m mxm I2 pxx <cc CD m-m roD rooa ro0x niDm nipL) 3 rom o r N n a' -0G) Ooc G) Ej. ro m,n Omm :ice m m-t (n2m -i�D 2-x r• ro amro 1D rma m. az aZ<D2i Mn 1r- 3 .m m. r 2 zo �g m-4- r W MWI; aD. mm� z ms coq 1a() moz rz. « oma mz.�nz mpm m (nD R° (A <- G)i m-Z .x x Or Zn pm.t D"2 1 5 z-m �D7C m rZ -( mC7C a O coG)m m' ZrC) 9L) coT.G7 r IP D Z D. Dm 71m -. �Zm a n �C Z x C 0 mmg n7Z Zn con m 3m m 1) . (� T. . m m N < G7 a 0... �. 2 �� M i D m m D (n W om m -4 D ,m N m O 2:1 (� { Z -f (n y, n > m m .-Di .r= n m MW (p N N N N N N N N + + + + + Z _ Z — A - O t° OD V W N W N 0 t0 co J co (n A W N + + co co v co co A co N _..... _....._._....9s:._. —.._...... ....- -- --- - - --- - - ... S:•.,. CLAIM N!AY u 41993 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA COUNTY COUNSEL MARiINM CNN, Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT MAY 25, 1993 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: HUGHES, Barbara ATTORNEY: Allan M. Tabor, Esq. Ryan and Tabor Date received ADDRESS: 11 Embarcadero West.. Ste. 130 BY DELIVERY TO CLERK ON April 29. 1993 Oakland, CA 94607 certified BY MAIL POSTMARKED: April 28, 1993 I. FROM: Clerk of the Board of Supervisors 70: County Counsel Attached is a copy of the above-noted claim, pp BB DATED: May 4, 1993 BIL DepuLyLOR, Cler II. FROM: County Counsel TO: Clerk of the Board of ervisors ( ) 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: L_o MaboNos oS?,Trk% Ncrk— o,-D,06D CO PJ-rF_.0L.1�Eb O2 n,_re# i cD Y Cotzn9iY Bp C'ONT"ieot (20S7-/4 Dated: �i.., �l l Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 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: MAY 2 5 1993 PHIL BATCHELOR, Clerk, y Deputy Clerk WARNING (Gov. code se 13) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately, *For additional warning see reverse side of this notice. 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 16; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. MAY 2 5 1993 Dated: BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator . s This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. t.,• Z t NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Allan M. Tabor, Esq. Ryan and Tabor 11 Embarcadero West, Suite 130 Oakland, CA 94607 RE: CLAIM OF: Barbara Hughes 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: [ J 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. [xx] 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. [ J 6 . The claim is not signed by the claimant or by some person on his behalf. [xx] 7 . Other: The claim identifies negligence committed at Los Medanos Hospital . The County of Contra Costa does not own, operate, control or otherwise have responsibility for Los Medanos Hospital . That facility is owned operated and controled by a totally separate public entity. You are referred to the roster of public entities on file with the County Clerk for the name and address of the appropriate public entity for Los Medanos Hospital. VICTOR JJ1 WESTMAN, County Counsel ,ff By: e' Dy Co my C61nsel Page 1 16 1 CERTIFICATE OF SERVICE BY MAIL (C.C.P. SS 1012, 1013a, 2015.5; Evidence Code SS 641, 664) I declare that my business address is the County Counsel's Office of Contra Costa County, 651 Pine Street, Martinez, California 94553; 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 addressed as shown above, sealed and postage fully prepaid thereon, and thereafter was, deposited this day in the U.S. Mail at Martinez, California. I certify under penalty of perjury that the foregoing is true and correct. Dated: May 5, 1993 at Martinez, California. cc: Clerk of the Board of Supervisors (original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOVT. CODE SS 910, 910.2, 920.4, 910.8) Page 2 I RYAN & TAB OR ALLAN M. TABOR 2 STATE BAR NO. 52846 11 Embarcadero West, Suite 130 3 Oakland, CA 94607 Telephone ( 510) 444-5350 4 Attorneys for Claimant 5 6 7 8 CL AI M 9 10 BAFBARA H[BHES, .,..: - -- --.ter.• , 11 Claimant 12 VS. �I 4 APR 291993 13 LOS MEDANOS HOSPITAL AND COUNTY OF CONTRA COSTA' � Ri(gOARD OF SUPERVISORS', 14 CONTRA COSTA CO. _ 15 Respondents. 16 A. Barbara Hughes lives in Castro Valley , California. 17 B . Notices in this matter are to be sent to Ryan & Tabor , 18 11 Embarcadero West, Suite 130 , Oakland, CA 94607 . 19 D. On or about April 5 , 1991 , claimant' s mother Alma Louise 20 Michelson was a patient in Los Medanos Hospital in Pittsburg . 21 Due the negligent care and treatment of said patient , said 22 patient died as a result of defendant' s negligent care. 23 D. Injuries: Death . 24 E . Damages with respect to this claim. The jurisdiction 25 rests properly in the Superior Court and exceeds $25 ,000 .00 . 26 F, Names of public employees responsible are unknown at the 27 present time . 28 G . Barbara Hughes is the daughter of. decedent Alma Louise RYAN&TABOR ATTORNEYS AT LAW PORTOBELLO SQUARE 1 11 EMBARCADERO WEST,SUITE 130 OAKLAND,CA 94607 (510)444-5350 I Michelson and hereby claims damages for the loss of- care , comfort 2 and society of her mother . 3 H . On November 23 , 1 992 , Barbara Hughes first became 4 alerted to the fact that there may be a claim for medical 5 malpractice . 6 DATED: April 23 , 1993 RYAN OR 7 BY 8 L M. TABOR 9 10 11 1.2 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 RYAN&TABOR ATTORNEYS AT LAW PORTOBELLO SQUARE 11 EMBARCADEROWEST,SUITE 130 2 OANLAND,CA 94607 (510)444.5350 1 PROOF OF SERVaCE BY MAIL (CCP SECTION 1013 (A) , 2015.5) 2 I am a citizen of the United States and am employed in the 3 4 County of Alameda , California. I am over the age of eighteen 5 yearq and not a party to the within action ; my business address is 11 Embarcadero West, Suite 130 , Oakland, California 94607 . 6 On April 23 , 1993 , I served the within CLAIM in said action 7 8 by placing a true copy thereof enclosed in a sealed envelope with 9 postage thereon fully prepaid , in a United States Postal service mail box at Oakland , California addressed as follows : 10 CE RTI FI E D MAIL 11 RETURN RECEIPT REQUESTED 12 LOS MEDANOS HOSPITAL 2311 Loveridge Road 13 Pittsburg, CA 94565 14 CERTIFIED MAIL RETURN RECEIPT REQUESTED 15 Contra Costa County 16 Board of Supervisors 651 Pine Street, Room 106 17 Martinez , CA 94553 18 I declare under penalty of perjury that the above is true and 19 correct. Executed on the above date at and , California. 20 21 AL tAR M. TABOR 22 23 24 25 26 27 8 RYAN&TABOR ATTORNEYSAT LAW PORTOBELLO SQUARE . 1 EMBARCADERO WEST,SUITE 130 OAKLAND,CA 94607 3 (510)444.5350 r W � LnON := EA U u � -•: VA Pa sb W U �= N to O tU N ;_ p U W a o o U) srl C� ®i u J FlY 1'1.9 n .a, w / CD °W 412 ir- Y O D d'Szma'� 7a. CC 0 d°a4 _ cc W • CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorserr:ZLIts, ) NOTICE TO CLAIMANT y and Board Action. All Section refer to The copy of this document mailed to you5 your 'notice of California Government Codes. R .,,n,l ) the action taken on your claim by the Board of Supervisors `J %7;F%# (Paragraph IV below), given pursuant to Government Code Amount: $800 ,000 AQ Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Krystal R. Johnso>, a Minor c/o Charles E. Johnson ATTORNEY: Van Blois & Knowles Date received ADDRESS: One Kaiser Plaza, Suite 2245 BY DELIVERY TO CLERK ON April 27 , 1993 Oakland CA 94612 BY MAIL POSTMARKED: Hand delivered 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. eH 8g DATED: April 29 , 1993 B1IL DepuiyLOR, Clerk ' 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( il) 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 /1IV 11I. 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. BOARDD ORDER: By unanimous vote of the Supervisors present ( ►�) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: MAY 2 5 1993 PHIL BATCHELOR, Clerk, By , Deputy Clerk WARNING (Gov. code sec on 913) Subject to certain exceptions. you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For additional warnina see reverse side of this notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: MAY 2 5 19,93 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator b 7' This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. 1 VAN BLOIS & KNOWLES One Kaiser Plaza, Suite 2245 2 Oakland, CA 94612 RECEIVED (510) 444-1906 3 Attornevs for Claimant APR 2 7 998 4 � CLERK BOARD OF SUPERVISORS 5 CONTRA COSTA CO. 6 7 8 IN THE MATTER OF THE CLAIM 9 OF KRYSTAL R. JOHNSON, a minor 10 against CLAIM 11 COUNTY OF CONTRA COSTA 12 / 13 TO : COUTNTY OF CONTRA COSTA 14 Krystal R . Johnson, a minor, by and through her father, 15 Charles E . Johnson, hereby makes claim against the above-named 16 public entity for the sum of eight hundred thousand dollars I 17 ($800 , 000) , and makes the following statements in support of the 18 claim: 19 A. NAME AND POST OFFICE ADDRESS OF CLAIMANT : 20 Krystal R. Johnson c/o Charles E . Johnson 21 1.1780 San Pablo Avenue El Cerrito, CA 94530 22 B . POST OFFICE ADDRESS TO WHICH NOTICES CONCERNING THE CLAIM 23 ARE TO BE SENT: 24 Van Blois & Knowles One Kaiser Plaza, Suite 2245 25 Oakland, CA 94612 26 / / 1 C. DATE, TIME AND PLACE OF THE OCCURRENCE OR TRANSACTION 2 GIVING RISE TO THIS CLAIM: 3 The events giving rise to this claim occurred on or about 4 October 28 , 1992 , on the premises formerly known as Belding 5 Elementary School , at 18th Street and Lincoln, in the City of 6 Richmond, County of Contra Costa, State of California . 7 D. CIRCUMSTANCES GIVING RISE TO THE CLAIM : 8 The circumstances giving rise to this claim are as follows : 9 On or about October 28 , 1992 , and for some time prior thereto, 10 the aforementioned premises, and the appurtenances thereon, were, 11 directly, and by and through its agents, servants, independent 12 contractors, lessees, and/or tenants, owned, possessed, managed, 13 maintained and controlled by the above-named public entity. 14 On said date , and for some time prior thereto, said premises 15 had been and were being used for the purpose of a Head Start 16 program in which small children, including claimant were enrolled 17 and did participate . 18 On or about October 28 , 1992 , and for some time prior thereto, 19 the above-named public entity, directly, and by and through its 20 agents, servants, employees, independent contractors , lessees 21 and/or tenants, so negligently and caret-essly designed, 22 constructed, owned, operated, controlled, managed, maintained, 23 repaired, equipped, and failed to modify the aforementioned 24 premises, and the appurtenances thereon, including but not limited 25 to a certain playground apparatus located thereon,. . such that the 26 same was and were caused and allowed to be, and was and were, in a. 2 1 dangerous and defective condition, constituting a concealed trap 2 and hazard for those, namely small children, who would be using 3 said premises and said playground apparatus, in that, among other 4 things : said playground apparatus failed to have adequate and 5 sufficient safety devices and failed to have adequate and I 6 sufficient energy absorbing devices, and further was improperly 7 sized for the foreseeable age and physical capacities of the 8 children who would be using same, thereby creating a serious and 9 foreseeable hazard of falling from said playground apparatus with 10 serious injury as the likely result . Other conditions as yet 11 unknown may have contributed to the dangerous and defective 12 character of said public property and claimant will pray leave to 13 assert same as they become known . By reason of the foregoing, said 14 public property was in a dangerous and defective condition, 15 constituting a concealed trap for the foreseeable users thereof, 16 including small children, and creating a substantial risk of harm 17 to persons using same with due care in a manner in which it was 18 reasonably foreseeable said public property would be used. Said 19 public entity was further negligent and careless in that , by and 20 through its agents, servants, employees, independent contractors, 21 lessees and/or tenants, it knew, or in the exercise of ordinary 22 care should have known, of the dangerous condition of said public 23 property, and of the risk of injury created thereby, and 24 nevertheless failed to provide adequate and sufficient warning of 25 the hazard, and failed to remedy said condition, although having a 26 reasonable opportunity to do so. 3 1 Said public entity, directly, and by and through is agents, 2 servants , employees , independent contractors, lessees and/or 3 tenants, was further negligent and careless in failing to 4 adequately and sufficiently supervise, or see to it that others 5 adequately and sufficiently supervised, the activities of the 6 children on said premises and said playground apparatus, by reason 7 whereof , children, including claimant , who were not of sufficient 8 size and strength to use said playground apparatus without 9 endangering themselves, were nevertheless permitted to use same at 10 great risk to themselves and others . 11 As a direct and proximate result of the negligence and 12 carelessness of said public entity, and the dangerous and defective 13 condition of public property, as aforesaid, at the time and place 14 hereinabove set forth, the claimant , while lawfully in and upon 15 said playground apparatus, was caused to fall from same to the 16 ground below, as a direct and proximate result of which claimant 17 was caused to sustain severe personal injuries and damages . 18 E . NAMES OF PUBLIC EMPLOYEES CAUSING INJURY, DAMAGE OR LOSS : 19 The names of the public employees causing claimant' s injuries 20 and damages are unknown at this time . 21 F . ITEMIZATION OF CLAIM AS OF DATE OF PRESENTATION: 22 The amount of the claim as of the date of its presentation is 23 the sum of eight hundred thousand dollars ($800 , 000) . The basis of 24 computation of this amount is as follows : 25 26 4 1 Expenses incurred by and on behalf of. claimant for the services of health care 2 practitioners and facilities to care for and treat claimant' s injuries both to date 3 and in the future, in an amount presently unknown, but estimated to be 4 the approximate sum of : . . . . . . . . . . . . . . . $50, 000 . 00 5 Damage to claimant ' s earnings and earning capacity both to date and 6 in the future, in an amount presently unknown, but estimated to be the 7 approximate sum of : . . . . . . . . . . . . . . . . . $250 , 000 . 00 8 General damages in the sum of : . . . . . . . . . . . $500 , 000 . 00 9 Total : . . . . . . . . . . . . . . . . . . . . . . . $800 , 000 . 00 10 VAN BLOIS & KN97LES 11 12 Dated: April 26 , 1993 by: .` �� 13Yli R: `Lew1s Van Blois Attorneys for Claimant 14 r 15 16 17 18 19 20 21 22 23 24 25 26. 5 CLAIM • BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA V' y•y Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT May 25 , 1993 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 LV (Paragraph IV below), given pursuant to Government Code Amount: $561 .00 Section 913 and 915.4. Please note all "Warnings". g3 CLAIMANT: John Ledesma C ATTORNEY: Date received ADDRESS: 77 West Leland Road BY DELIVERY TO CLERK ON April 22 , 1993 Pittsburg CA 94565 BY MAIL POSTMARKED: Hand delivered 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim, ppHH gg DATED: April 29 , 1993 B7Il DeputyLOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( t� 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: O? y��3 BY: (�, Deputy County Counsel 11I. 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. BOARDD 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. Dated: MAY 2 5 1993 PHIL BATCHELOR, Clerk, 8y Deputy Clerk WARNING (Gov. code secti 3) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For additional warnina see reverse side of this notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: MAY 2 5 1993 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Clains Act. claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Clair^s 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 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 ) Reserve for C erk!- filing stampQ RECEN . Against the County of Contra Costa ) APR 2 L 19993 or ) District) CLERK BOARD OF SUPERVISORS Fill in nine CONTRA COSTA 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: - -----------------------a_.._.. --------------------------------------------------- 1. When did the damage or injury occur? (Give exact date and hour) Z/_/, J-D 015�49 2. Where did the damage or injury occur? (Include city and county) 7211 3. How did the damage or injury occur? (Give full details; use extra paper if required) __��-------------------.. d 14. What particular act or omission-on the part of county o district officers, servants or employees caused the injury or damage? 12e 191z- (over) r t 5. wnat are the names of cowity or district officers, servants or employees causing the damnnge or injury? -----------:__-� 2 J-0--- ------------ 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? (InHude the estimated amount of any prospective injury or damage.) ------------ $. Names and addresses of witnesses, doctors and hospitals. 9. List the expenditures you made on 'account of this accident or injury: DATE ITEM r AMOUNT' Gov. Code Sec. 910.2 provides: "The cla ?must be signed by the claimant SEND NOTICES TO: • (Attorne )`: or bme rson M his behalf." Name and Address of' Attorrne-y Claimant's Signature A ess Telephone No. Telephone No. -'0"e 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 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. ' ~ I T E M I Z E D S T A T E M E N -T CLAIM NO: ADJUSTER: EMPLOYER: N/A -------------------------- ____________________________------------------ PATIENT: BIRTHDAY: INSURED: John Ledesma 1181 PI 06-24-32 77 W. Leland Rd. SEX: M I . D. # Pittsburg CA 94565 RELATIONSHIP: GROUP: _________________________________------ --------------- __________ OTHER INSURANCE: WORK INJURY: NO ZNSUREDS ADDRESS: AUTO ACCIDENTh NO ---------- _____________________--- --- _____________ RELEASE OF INFORMATION: ON FILE ASSIGNMENT OF BENEFITS: ON FILE _______________________________________________________________ ILLNESS/ACC. DATE: FIRST TREATMENT: ________________________________________________________________________________ DIAGNOSIS: 723. 2 Cervical Syndrome 729. 1 Cervical Mylagia 723. 1 Cervicalgia 729. 2 Cranial Neuralgia Headache Syndrome 710. 4 Cervical Polymyo sitis 847. 0 Cervical Whiplash-Type Injury Sprain/Strain ________________________________________________________________________________ DATE DESCRIPTION PROC CODE AMOUNT 03-18-93 Init Inter Hx/E 90015 65.00 03-18-93 A-P&Lat FS x-ray 72010 116. 00 03-18-93 Calcium/Relaxant 99070 10. 00 03-18-93 Office visit 90050 32. 00 03-18-93 OV/Modality 97200-52 23. 00 04-06-93 Office visit 90050 32. 00 04-06-93 OV/Modality 97200-52 23. 00 04-08-93 Office visit 90050 32. 00 04-08-93 OV/Modality 97200-52 23. 00 04-13-93 Office visit 90050 32. 00 04-13-93 OV/Modality 97200-52 23. 00 04-15-93 Office visit 90050 32. 00 04-15-93 OV/Modality 97200-52 23. 00 04-17-93 Office visit 90050 32. 00 04-17-93 OV/Modality 97200-52 23. 00 TOTAL 521 . 00 ___________________ ________ID___No____ _ ____________ D 04 22 9 _pl�yer John Quesada, D. C. / -2915987 3715 Railroad Avenue Suite B Social Sec No Pittsburg, CA 94565 N/A** (415)439-7323 ` A r-t 4 -~- —� ..i h M cn Ku Er CP it IL w to to a a 1.j U a co P4 4ZZ6 j tit `` �, .�`, �• ': :G•' 'J _. r� -.. .� 4w ±� _ �{ y REc:�i"�•: /,�� APS 291993 CLAIM B couNll ,pUBQ@RD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA MARTINEZ. C-AL10a Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT May2 5 , 1993 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: $510,000.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: George Victor Sutherland ATTORNEY: Date received ADDRESS: 1378 Redwood Street BY DELIVERY TO CLERK ON April 21 , 1993 Pittsburg 94565 BY MAIL POSTMARKED: Hand delivered 1, FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. EV BATCHELOR. Clerk DATED: April 29 , 1993 BT: Deputy b 1I. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. ( V1 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: ` (� ��o�.�u� �lsi�. �. -Z I - �� CO .�c _� VV i Gcerm�.n� (�ca�aSQ ��ro-2 I-9.�. c_LVIA.av-t rk To F,ca S Dated: „,,;I 2q B ��w-�-y Deputy County Counsel J 11I. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: MAY 2 5 1993 PHIL BATCHELOR, Clerk, By 11� . 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. *For additional warning see reverse side of this notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez. California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: MAY 2 5 1993 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Clains Act . • NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: GEORGE VICTOR SUTHERLAND 1378 Redwood Street Pittsburg, CA 94565 RE: CLAIM OF: GEORGE VICTOR SUTHERLAND 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. [ J 2 . The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [ }� J 3. The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [ ] 4 . The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or loss, if known. [ �( ] 5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000) . If the claim totals less than ten thousand dollars ($10,000) , the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10,000) , the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. [ ] 6 . The claim is not signed by the claimant or by some person on his behalf. [XX] 7 . Other: The claim filed 4/21/93 is insufficient. The Board has denied the claim of 10/21/92 . The claimant has six months from denial of 10/21/92 claim to file suit. VICTOR J. STMAN, County Counsel By: Deputy ounty ounsel CERTIFICATE OF SERVICE BY MAIL (C.C.P. SS 1012, 1013a, 2015.5; Evidence Code §S 641, 664) I declare that my business address is the County Counsel's Office of Contra Costa County, 651 Pine Street, Martinez, California 94553; 1 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 addressed as shown above, sealed and postage fully prepaid thereon, and thereafter was, deposited this day in the U.S. Mail at Martinez, California. I certify under penalty of perjury that the foregoing is true and correct. Dated: May 3, 1993 at Martinez, California. cc: Clerk of the Board of Supervisors (original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOVT. CODE SS 910, 910.2, 920.4, 910.8) ,I Claim-to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 1069 County Administration Building, 651 Pine Street, Martinez, CA 94553. I 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 orm. - RE: Claim By ) Reserved for Clerk's filing stamp ' � 'iowz, 's t, RECEIVED ) Against the County of Contra Costa ) OCT 2 ' M • or ) • A/�D CLERK BOARD OF SUPERVISORS `� F 8t CONTRA COSTA CO. Fill in ame) ) . The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ �'"��p p D, and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) :)Ltw e. 31 )q S 2- £sT TJ►,-;e. .; Soo -!o-n c P.✓i — Sea-h..e.Q Lto. Cc-.) -0- a; 8 a S h ti b - .J 2. Where did-the damage •or injury occur? (Include city and county) ?o &tz, Ma-,,n o re�,_ -Q ,? sP `�-� ern b (a�,, �e C'' �: 9.-o d/o q - Re�,a,c.��. ��w w►�T.te �/icy/9 2. - c�� w�.a n,�P�'aa�t-� c�K� ��..e.. ------_---------------------- ---_ ---_--- ----------------------- 3. How did the damage or injury occur? (Give full details; use extra paper if required) 1r) i4o C111 4. What particular act or omission on the part of county or district officers, servants or employees .caused the injury or damage? W[ c� �OQP 4Ga c-e_�/00 Q 41 ,- 4d a. •auT3 pue quamuosTadmT Bons ggoq Sq jo 100010T$) ejpTTop puesnogq uaq SuTpaaoxa qou 3o auTi: a Aq 'uosTud ag2gs aqq UT quamuosTjdmT Aq JO '9u'T3 PUB guaMUOSTJad -c Bons ggoq Aq JO '.(000`x$) PuESriogg auo BuTpaaoxa qou 3o auT3 a Aq 'JU9A auo uegq',GJOM -40U-10 Poj.zad:e..:uD3 TTe-C ;Aqunoo .aqq UT quamuosiadmT Aq J9ggT9 aTgegsTund sT 'BuTgTJM JO '.zagonon 'qun000e 'TTTq 'mTETo quaTnpneu3 ao asTe3 ALM 'auTnues 3T awes aqq Aed so MoTTe og. pazTjoggne 'J90T33o ao p.moq g0TJ'46Tp ,ro 4To lAqunoo Aue oq ao 'J;DOT33o JO p.zeoq agegs AUe oq guamked JOJ JO aouemOTTe JOJ squasaid 'pne.z3ap oq quaquT ggTM 'oqM uosiad Ajan3a :sapTnoid..apo0 .T.euad .bg4...3o :ZL uo goaS a0I10N Af Z-�oN auogdaTay 'ON auogdaTay quewt Aauaoggy 3o ssaappy pue ameN. u'3Tega sTq uo uosiad autos S4 ao (AauJoa.IV) :01 S30Iy0N (N3S quE[uTeTo arlq ,fq pauBTs aq gsnm mreTo agy,, :sapTno,zd Z'0t6 •0aS apo0 •no0 iNnOWV W3yI SIV(l :A.MCui Jo quapTooe Gjq 3o qun000e uo apm noA sa.angTpuadxa aqq gstq •6 _��j-a' -�� - �T��-moo''{75-777-7'-7-jn j �r r 7` oE' �oco�.*nnC -rro a!*Tz'•S •Q i F dao vii . .w�•}v ii: .,.. 7 t.. �.. r Lei ..._ y' o 04-0 0/,9,4 CaBemep jo A mCuT anTgoadsoid Aue 3o 4unoum pagemTgse aqq apnToul) Lpagndmoo anoge P9mTeTo qunome aqq sem MOH 'L ------------------------------------------------------------•------------------------- 7, �f` a ( �� •a P ogno gTgsa ars�oF'ggTl '-PaozTeTo saSemep ao saijnCuT 3o guagxa TTn3 anTO) LpagTnsai mTeTo noA op saT.mCuT so a emep gegM •g ' , -----------------------------------------------T-----�- -------- jo v Lf►CuT jo 9Bu aqg SuTsneo saaAOTdM9 JO sgUeAJas 's.zaoT33o goT.zgsTp so Aqunoo 3o sameu aqq am IuM .S Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one'year after the accrual of the cause of action. (Govt. Code 5911.2.) 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 filin stamp > RECEN ) ,S Against the County of Contra Costa ) �R 2 1993 , or • _ �� AnJA 'i' gpO c SUPERVISORS Fill in e ) OKCOON?RA COSTA CO. 9 The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 6'1O10066--,10 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) -—-—---------—--------- 2. --- - --------------- 2. Where did the damage or injury occur? (Include city and county) 3• How did the damage or injury occur? (Give full details; use extra paper if required) 4. What particular act or omission on the part of county or district officers, ~- servants or employees caused the injury or damage? (over) V- 5. What are the names of county or district officers, servants or employees causing "• the damage or injury? -------------------------------------------------------------I----------------------- 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.) -------------------------------------------------------------I------------------------ 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: n "The claim must be sig��ed by'the claimant SEND NOTICES TO: (at;'corney) or � some person on s beha " Name and Address of Attorney / . ' laimant's .,•ignature ^ ddrTU Telephone No. Telephone No. V V I V I * 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 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 Endorse s, ) NOTICE TO CLAIMANT May 25 , 1993 and Board Action. All Section refer 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: $250, 183 . 00 �`QQ, �' Section 913 and 915.4. Please note all "Warnings". BNFL CLAIMANT: John Charles Will i+gTns ATTORNEY: The Law Firm of Richard Scheuler Date received ADDRESS: P. O. Box 8548 BY DELIVERY TO CLERK ON April 19 , 1993 Red Bluff CA 96080 BY MAIL POSTMARKED: April 15 , 1993' I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. �aIL gATCHELOR, Clerk Q _ • DATED: April 29 , 1993 : 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 910.6). ( ) 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: ' y y3 BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Admihistrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD 0 DER: By unanimous vote of the Supervisors present ( ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: MAY 2 5 1993 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. *For additional warnina see reverse side of this notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: MAY 2 5 1993 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction,, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. • Claim.to: BOARD OF SUPERVISORS OF CONTRA COSTA OOUNTY IIETRUCTIONS 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 Mich accrue on or before December 31, 19871, 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 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 John Charles Williams ) RECEIVED gainst the County of Contra Costa ) APR 1 91993 or ) CLERK BOARD OF gupFRVtSORS District) corvTRa CO co. Fill in name ) , The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 250 ,183 - 00 and in support of this claim represents as follows: I. When did the damage or injury occur? (Give exact date and hour) December 24 ,. 1992 at 8: 30 p.m. 2. Where did the damage or injury occur? (Include city and county) Chico, Butte County, California .:& Martinez, Contra Costa County, .CA 3. How did the damage or injury occur? (Give full details; use extra paper if required) See Attached �rwww_wwww_ww_w_ 4: What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? See Attached (over) �v 5. What are the names of county or district officers, servants or employees causing .. the damage or injury? The Chief of Probation, Contra Costa County, and his subordinates in the Probation Department having cognizance of my case in that department, the names of whom are presently unknown. -------------••----------------------- 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. False imprisonment over a six day period from December 24 through December 29 , 1992 . --------- ------------- 7. How was the amount claimed above computed? (Include the estimated amount of .any prospective injury or damage.) See attached. 8. Names and addresses of witnesses, doctors and hospitals. Arresting officer, City of Chico . Police Department. Booking & custodial officers , City of Chico Police Department and Butte County Sheriff' s Department. Chief of Probation, Contra Costa County and subordinates having _�cogri �sl �_4 �LY_�s1�e_3.A.thy.sae& e -------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT 12-24-92 Towing and Storage $ 150 .00 12-29-92 Transportation to Chico 33. 00 12-24-92 False imprisonment 250 , 183 . 00 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 Thomas J. Hilligan (Claimant's Signature Law Firm of Richard ScheulerU--- .O. The Law Firm of Richard Scheuler P.O. Box 8548 Box 8548 Red Bluff, CA 96080 Address Red Bluff, CA 96080 Telephone No. 916-5294791 Telephone No. 916-529-4791 * * * * * * * * * * * * * * TFF * * 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)9 or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($1090009 or by .... both such imprisonment and fine. Attachment to claim to Board of Superviors of Contra Costa County 3. I was arrested on the above date by an officer to the Chico Police Department pursuant to a warrant issued by the Municipal Court, County of Contra Costa, Mt. Diablo Judicial District. That warrant was issued on February 26, 1992, in case No. 110647-5, People v. John Charles Williams, allegedly for my failure to appear in that court on that date. Following that arrest I was booked and jailed in the Butte County Jail until December 28, 1992 when I was taken under custody to the Contra Costa County Jail in Martinez. On December 29, 1992, while still in custody, I was brought before the Municipal Court Judge who had issued the warrant for my arrest, Judge J. D. Hatzenbuhler, who, after reviewing the record in my case, ordered my release. A review of my case, Contra Costa County Municipal Court Case No. 110647-5, will indicate that as a result of a violation of Vehicle Code Section 23152a and a subsequent conviction for that offense, I was placed on summary probation for three years commencing March 21, 1988. In January, 1992 I was arrested for another DUI offense in Tehama County, California, and in February, 1992 I was convicted of that offense. In late January, 1992, apparently as a result of my arrest in Tehama County, I was notified that I was ordered to appear in the Contra Costa County Municipal Court in Case No. 110647-5. A copy of that notice is attached as Attachment A. Upon receiving such notice I both called and wrote the Court informing it that I believed that I was no longer on probation when my difficulties arose in Tehama County. Judge Hatzenbuhler acknowledged the existence in the court's file of my phone call and my letter to the Court in my appearance before him on December 29, 1992. The judge observed that I was not on probation after March 21, 1991 and therefore should not have been ordered to appear based on any alleged violations of probation occurring in 1992, and further that a warrant for my arrest should not have been issued based upon my non- appearance before him. 4. There was an apparent failure on the part of officers of the Contra Costa County Probation Department in determining that I was in a probationary status beyond March 21, 1991, and further in alleging to the Municipal Court that I had purportedly violated that probation during 1992. Page 1 of attachments 7. a. Towing and storage of my motor vehicle as the result of my arrest on 12/24/92 in Chico, CA: $150.00 b. Public transportation fare from Martinez, CA to Chico, CA on 12/29/92: $33.00. c. General damages for: Arrest warrant outstanding from 1/26/92 to 12/24/92. False imprisonment from 12/24/92 to 12/29/92, including Christmas. $250,000.00 Page 2 of attachments j Space Below use of Court Clerk Only JOHN CHARLES WILLIAMS P.O. BOX 161 MINERAL, CA 96063 P4 MUNICIPAL COURT OF CALIFORNIA,. COUNTY OF CONTRA COSTA MT. DIABLO JUDICIAL DISTRICT PEOPLE OF THE STATE Plaintiffs) vS• CASE NUMBER 110647-5 � s ORDER TO SHOW CAUSE FOR 014N CHARLES WILLIAMS PROBATION Defendants) VIOLATION �i (Abbreviated Title) TO: THE' ABOVE-NAMED DEFENDANT IT APPEARING TO THE COURT that you have been charged wi th rVC 11 5 (A) in Red Bluff Judicial District. xxxR� xxsxx (date) NOW, THEREFORE, YOU ARE HEREBY ORDERED AND DIRECTED to appear in this court at j2970 Willow Pass Road, Concord, Ca. 1950 Parkside Drive, Concord, Ca. II 1010 Ward Street, Martinez, Ca. on at a . 00 . gM. , to show cause why you should (date) (time) not be punished for contempt in disobeying the mandate of this Court. A BENCH WARRANT WILL BE ISSUED FOR FAILURE TO APPEAR. Dated 2/5/92 - Judge of the Municipal Court J.D. HATZENBT`'."' R JDH:km 238-2M-4/89 1 PROOF OF SERVICE BY MAIL - CCP 1013a(3) 2 I declare that: 3 I am employed in the County of Tehama, State of California. I am over the 4 age of 18 and not a party to the within action. My business address is 437 5 Washington Street, P.O. Box 8548, Red Bluff, California 96080. 6 On April 15, , 1993, I served the within Claim by John Charles 7 Williams against the Contra Costa County. 8 9 on the deferidant in the said cause, by placing a 10 true copy (copies) thereof in a sealed envelope(s) with postage thereon 11 fully prepaid addressed as follows: 12 Clerk of the Board of Supervisors Room 106 13 County Administration Building 651 Pine Street 14 Martinez, CA 94553 15 16 17 18 and placing it (them) for collection and mailing on that same date following 19 the ordinary business practices of The Law Firm of Richard Scheuler, at its place of business, located at 437 Washington Street, Red Bluff, California 20 96080. I am readily familiar with the business practices of The Law Firm 21 of Richard Scheuler for collection and processing of correspondence and documents for mailing with the United States Postal Service. Pursuant to 22 said practices the envelope(s) would be deposited with the United States 23 Postal Services that same day in the ordinary course of business. 24 I declare under penalty of perjury under the laws of the State of California and the United States of America that the foregoing is true and correct, and 2' that this declaration was executed on April 15, 1993, at Red 26 Bluff, California. 27 �� 28 Babette L. Fries TAW FIRM OF RICHARD SCH&ER ATTORNEYS AT LAW RICHARD SCHEULER 437 WASHINGTON STREET THOM1ZAS J. HILLIGAN P.O. BOX 8548 RED BLUFF, CA 96080 (916) 529-4791 RECEIVED April 26, 1993 APR 2 71993 i C.(.2-R€<BOARD OF StiPERRVISORS j 1A M3`rA CO. Board of Supervisors County Administration Building 651 Pine Street, Room 106 Martinez, California 94553 Re: John Charles Williams Gentlemen: This letter is to confirm that the Board has received a claim from this office on behalf of Mr. Williams against the County of Contra Costa. This was confirmed by my secretary on this date in a telephone conversation with Shirley, a clerk of the Board of Supervisors. Sincerely, l Thomas J. Pinn TH/rlb �cq N ro u �i y1 W z Lr) O O Ln-r1 fit+ r p ~~ tti O G>aEn ,j N U +° a-)LH r' �^ •1 Q) 0 ::S tn t.+ ID a•`�4 CP N Q O ..^'•'A, .r aw m A C)+ a MMM�((�441 Q a z � *nn 1 W M A��, • J ryt � Z Hl7 ►M+ N z +� H N A u ; � ¢ 7 APPLICATION TO FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA BOARD ACTION Application to File Late Claim ) NOTICE TO APPLICANT May 25 , 1993 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: Porscha Rogers , a Minor Attorney: Law Offices of Timothy M. Hamilton One Daniel _Burnham C_o_urt Address: Suite 391C San Francisco CA- 9-4109-5460 Amount: $10,000 By delivery to Clerk on April 26 , 1993 Date Received: April 26 , 1993 By mail, postmarked on April 22 . 1993 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: April 29 , 1993_ PHIL BATCHELOR, Clerk, By Deputy II.� FROM: County Counsel TO: Clerk of the Board of Supervisors (V) The Board should grant this Application to File Late Claim (Section 911.6). ( ) The Board should deny this Application to File Late Cla (Section 911.6). DATED: Al 3 o tVICTOR WESTMAN, County Counsel, Deputy III. BOARD ORDER By unanimous vote of Supervisors present (Check one only) ( Vf 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: PHIL BATCHELOR, Clerk, By Deputy WARNING (Gov. Code §911.8) If you wish to file a court action on this matter, you must first petition the appropriate court for an order relieving you from the provisions of 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. IP you want to consult an attorney, u should do so immediately. IV. FROM: Clerk of the Board TO: 1 County Counsel 2 County Administrator Attached are copies of the above Application. "Ne noti ed tie 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: S-j-S-17.E PHIL BATCHELOR, Clerk, By Deputy V. FROM: (15 County Counsel 2 County Admi rator TO: Clerk of the Board of Supervisors Received copies of this Application and Board Order. DATED: - County Counsel, By County Administrator, By APPLICATION TO FILE LATE CLAIM 1 TIMOTHY M. HAMILTON #90270 One Daniel Burnham Court, Suite 391C 2 San Francisco, California 94109-5460 RECEIVED (415) 394-9965 3 Attorney for Claimant AR 2 6 M 4 PORSCHA ROGERS, a Minor CLERK BOARD OF SUPER I-50 5 CONTRA COSTA 6 7 In the Matter of the Claim of ) PORSCHA ROGERS, a Minor, ) 8 ) APPLICATION FOR PERMISSION TO Against ) PRESENT LATE CLAIM 9 ) CONTRA COSTA COUNTY. ) 10 ) 11 ) 12 ) 13 TO: CONTRA COSTA COUNTY and THE CONTRA COSTA COUNTY BOARD OF SUPERVISORS: 14 15 Application is hereby made for permission to present the 16 attached claim after expiration of the time limit provided in 17 Government Code §911.2. 18 (1) As stated in the attached claim, claimant's cause of action 19 accrued on or about April 24, 1992. 20 (2) The time for presentation of such claim under Government 21 Code §911.2 expired on or about October 24, 1992. 22 (3) The reasons for failure to present such claim within the 23 time provided in Government Code §911.2 is as follows: 24 Porscha Rogers is a minor. I am informed and believe that she 25 was born June 11, 1981. Porscha was involved in an auto versus 26 pedestrian accident on April 24, 1992, in which she sustained a 27 broken left ankle and left tibia, as well as internal head injuries. 28 -1- 1 She was hospitalized for approximately two months following the 2 accident. I was retained by Porscha Rogers' mother, Sharon Rogers, 3 on March 15, 1993 . The delay in filing a claim and making this 4 application for permission to present a late claim is not 5 attributable to Porscha Rogers, who is a 6-grader and is suffering 6 from brain injury resultant to the above-mentioned accident. 7 Attached as Exhibit 1 is the proposed claim. 8 I declare under penalty of perjury that the foregoing is true 9 and correct. 10 Executed this 22nd Day of April 1993 . 11 12 13 14 TIMOTHY M. HAMILTON 15 Attorney for Claimant PORSCHA ROGERS, a Minor 16 17 18 19 �0 21 22 23 24 25 26 27 28 -2- 1 PROOF OF SERVICE 2 I am over 18 years of age and not a party to the within 3 action. I am a resident of and employed in the City and County of 4 San Francisco and my business address is One Daniel Burnham Court, 5 Suite 391-C, San Francisco, CA 94109. 6 On the date shown below, I served a true copy of: 7 APPLICATION FOR PERMISSION TO PRESENT LATE CLAIM 8 9 on the parties listed below: 10 The Clerk of the Board of Supervisors Board of Supervisors for Contra Costa County 11 351 Pine Street, Room 106 Martinez, CA 94553 12 13 by placing true copy(ies) in postage-prepaid sealed envelope(s) and 14 by depositing the envelope(s) in a United States mailbox at 15 San Francisco, California. 16 I declare under penalty of perjury under the laws of the State 17 of California that the foregoing is true and correct. 18 Executed at San Francisco, California on April 22, 1993. 19 201 C- 21 21 Catherine E. Singels 22 23 24 25 26 27 28 -3- (010/13 3©arj 1 TIMOTHY M. HAMILTON #90270 One Daniel Burnham Court, Suite 391C 4 � 2 San Francisco, California 94109-5460 (415) 394-9965 3 Attorney for Claimant 4 PORSCHA ROGERS, a Minor 5 6 7 In the Matter of the Claim of ) PORSCHA ROGERS, a Minor, ) 8 ) CLAIM FOR PERSONAL INJURIES (Gov.Code §910) 9 Against ) 10 ) CONTRA COSTA COUNTY. ) 11 ) 12 ) 13 ) 14 TO: THE CLERK, CONTRA COSTA COUNTY BOARD OF SUPERVISORS: 15 You are hereby notified that PORSCHA ROGERS, a Minor, claims 16 damages from Contra Costa County in an amount that exceeds $10, 000. 17 Jurisdiction rests in the Superior Court. 18 1. The name and post office address of the claimant: 19 PORSCHA ROGERS, a Minor 202634 Lowell Street Richmond, CA 94804 21 22 2 . Address to which Claimant wishes notice to be sent: 23 The Law Offices of Timothy M. Hamilton One Daniel Burnham Court, Suite 391C 24 San Francisco, CA 94109-5460 (415) 394-9965 25 3 . The date, place and circumstances of the occurrence giving rise 26 to the claim asserted: 27 On April 24, 1992, at approximately 3:30 p.m. , PORSCHA ROGERS, 28 a Minor, was riding her bicycle south on 28th Street near Rheem -1- I Avenue in the City of Richmond. She was struck by an automobile 2 traveling west-bound on Rheem Avenue. Claimant alleges that the 3 County of Contra Costa dangerously, improperly, negligently, 4 recklessly, or consciously designed, controlled, serviced, repaired, 5 monitored, modified and/or maintained Rheem Avenue and 28th Street 6 in the City of Richmond and the intersection of Rheem Avenue and 28th 7 Street in the City of Richmond at or near the location of the 8 accident and its environs, including, but not limited to, the curbs, 9 shoulders, center lanes, landscaping situated thereon, located at or to near the intersection, and among other things, said public entity it failed to maintain, service, repair, modify, or otherwise control 12 said location despite increased traffic patterns and numerous 13 accidents which occurred at said location since its design and 14 construction. Further, despite the knowledge of said public entity 15 of the traffic volume on said roadways and of the danger to school 16 students in the neighborhood, the vehicular speeding, the accident 17 frequency, etc. , the above-designated public entity failed to post 18 warning signs and/or safe speed limit signs for the traffic thereon, 19 failed to install adequate controls and/or failed to take other 20 reasonable, adequate or necessary measures or precautions to prevent 21 speeding and/or to slow traffic traveling on said roadways to a safe 22 speed under all the circumstances. Moreover, said location and 23 intersection was inadequately designed, monitored, modified, 24 repaired, serviced, signed and/or controlled, in view of the nature 25 of the neighborhood, the close proximity of the public school, the 26 topography of the roadways, the uncontrolled, unrestricted approaches 27 to the intersection, the known speeding and the high traffic volume. 28 Additionally, said public entity failed to give adequate warning of -2- 1 the presence and location of school children and other pedestrians, 2 thereby contributing to the dangerous situation at that heavily 3 traveled intersection in the City of Richmond. The above-mentioned 4 government entity failed to warn members of the general public, 5 including claimant, of each and every factor set forth herein and of 6 the dangerous, unsafe and concealed condition, which constituted a 7 trap to members of the general public, including claimant. As a 8 direct and proximate result of the combination of all the factors set 9 forth herein, said public entity created and perpetuated the 10 dangerous and unsafe condition at said intersection and its environs 11 which resulted in the severe personal injuries of claimant PORSCHA 12 ROGERS, a Minor. 13 14 4 . The general description of injury, damage or loss: 15 As a result of this accident, PORSCHA ROGERS, a Minor, has 16 sustained severe fractures to her left ankle and left tibia. She 17 also suffered closed head injuries and remained hospitalized for 18 approximately two months. She has permanent, irreversible injury to 19 her body, including, but not limited to, her left lower extremity and 2p her brain. Porscha will require ongoing medical care, therapy, 21 treatment, etc. and will be deprived of earning capacity as she 22 matures into an adult. She has also suffered great pain, anxiety, 23 discomfort, etc. 24 25 5. The name or names of the public employees causing the injury, 26 damage, if known: 27 Claimant does not currently know the names of any such public 28 employees. -3- 1 2 Dated: April 22, 1993 THE LAW OFFICES OF TIMOTHY M. HAMILTON 3 4 5 By: TIMOTHY M. HAMILTON 6 Attorney for Claimant PORSCHA ROGERS, a Minor. 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 -4- 1 PROOF OF SERVICE 2 I am over 18 years of age and not a party to the within 3 action. I am a resident of and employed in the City and County of 4 San Francisco and my business address is One Daniel Burnham Court, 5 Suite 391-C, San Francisco, CA 94109. 6 On the date shown below, I served a true copy of: 7 CLAIM AGAINST PUBLIC ENTITY 8 9 on the parties listed below: 10 The Clerk of the Board of Supervisors Board of Supervisors for Contra Costa County 11 351 Pine Street, Room 106 Martinez, CA 94553 12 13 by placing true copy(ies) in postage-prepaid sealed envelope(s) and 14 by depositing the envelope(s) in a United States mailbox at 15 San Francisco, California. 16 I declare under penalty of perjury under the laws of the State 17 of California that the foregoing is true and correct. 18 Executed at San Francisco, California on April 22, 1993 . 19 0 k_ 20 �--� Catherine E. Singels 21 22 23 24 25 26 27 28 -3- » -- 0 0 `a 0 lu-, 0 oy N 0 �y -t00 cn ri � ca H UJ cj a y � 63 ¢CY-1uj . Z d U� LG N x o ' o ` G w O � CONFIDENTIAL COUNTY COUNSEL'S OFFICE CONTRA COSTA COUNTY MARTINEZ, CALIFORNIA MEMORANDUM Date: April 30, 1993 To: Jeanne Maglio, Clerk of the Board of Supervisors FROM: Victor J. Westman, County Counsel By: Gregory C. Harvey, Deputy County Counsel RE: Porscha Rogers, a minor Petition to File a late claim This late claim is filed on behalf of a minor, a ten year old girl, injured on a City Street in Richmond. I have discussed this case with Risk Management and :victor Westman. Filing by mail was effective two days prior to the end of the one year period, April 22, 1993 . Under Government Code Section 946 . 6 (c) (2 ) , should the County deny the petition for a late claim, the Superior Court would have a mandatory duty to grant relief to the plaintiff from the requirements of the claims filing statute. Rather than force the minor whose petition to file a late claim is within one year to make a motion which the Court is required to grant and which we cannot ethically oppose, I have spoken with Risk Management and County Counsel and both. join me in recommending that the petition to ''file a late claim in this case be accepted. Following acceptance of the petition, the claim can then be denied. We therefore request that the matter be placed on the agenda as follows : "Grant petition to file a late claim and deny claim, of Porscha Rogers, a minor. " cc: Victor Westman Joseph Tonda Ron Harvey