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MINUTES - 05031994 - 1.22
CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA MAY 3.9 1994 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $ 2, 500,000. 00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: FALCON, Lydia, FALCON, Joelda, FALCON, Apol6h a and FALCON, Joey; by and through' their Guardian Ad Litem Lydia Falcon ATTOaNEY: Nicholas Wagner 1111 -W. Herndon Ave . , Ste 317Date received ADDRESS: Fresno, CA 93720 BY DELIVERY TO CLERK ON April 18, 1994 D MAIL POSTMARKED: April 14, 1994 APR 18 9994 Cetified Mail P 027862 578 I. FROM: Clerk of the Board of Supep6 COUNSELTO: County Counsel Attached is a copy of the ab%W#*Z ✓4UKm, ppHH gg DATED: 0 AALg' )Q 9 ! Bl IL DeputyLOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ✓) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). c ( ) 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: c�L Dated: 9 9`{ BY: ep, Deputy County Counsel Ur 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: PHIL BATCHELOR, Clerk, By NJ, 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. ////n����/n� Dated: BY: PHIL BATCHELOR by�'Ei.o -Q00 c�Deputy Clerk CC: County Counsel County Administrator Claim *to: BOARD OF SUPERVISORS OF CONTRA COSTA CQUIU'i'Y INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented. not later. than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury.to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553• C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. 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 Nicholas .Wagner } for Lydia Falcon, Joelda Fa]con, .AApni a Falcon, and Joey Falcon"; by and through their Against tbt County of Contra Costa Guardian Ad Litem Lydia Falcon or District} =ipport " Fill in name } The undersigned claimant hereby makes claim against the County of FJW the above-named District in the sum of $ 2,500,000.00 and this claim represents as follows: cLRK sOANo OF _J SUPERVISORS w"tint 1. When did the damage or injury occur? (Give exact date and hour} A. November 2, 1993, at 7:42 a.m. 2. Where did the damage or injury occur? (Include city and county) T-Westbound E1 Portel Drive/Westb , _Pablo City, 3. How a occur? (Give full details; use extra paper if required) Claimants husband and father was killed while he was apprehended by police officers employed by the California Highway Patrol , and the City of Richmond Police Department. 4. What particular act or omission on the part of county or district officers,_ servants or employees caused the injury or damage? _Police officers used excessive and inappropriate force in apprehending Mr. Falcon causing his his death. (over) 5. What are the names of cour15Fbi2,distriqt officers, servants or employees causing the damage or injury? ,_� .L'Aknown at this time. 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Loss of support, society, services, buriel expenses-, consortium, companionship, love, affection, loss of financial support. $2,500,000.00 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Please -see the items listed in number six. 8. Names and addresses of witnesses doctors and hospitals. Brookside Hospital Dr. Richard Luca '(Pathologist) 20000 Vale Road WITNESSES San Pablo, CA 94806 T=I.;Mi les Nelson Desormier Dennis McPartland KPnj Sc j:2 IL_ ---------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT N K N OA AT THIS' TIME A Gov. Code Sec. 910.2 provides: "The claim must be Migned -by the claimant SEND NOTICES TO: (Attorney) or by samep)4h his behalf." Name and Address of Attorney Nicholas Wagner k(j2lai' aht tb Signature) 1111 W. Herndon Avenue, Suite 317 SAME Fresno, CA 93720 (Address) (209) 449-1800 Telephone No. Telephone No T I T NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill , account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($ltOOO)l or by both such imprisonment and fine, or by imprisonment iry the state prison, by a fine of not exceeding ten thousand dollars ($100000, or by both such imprisonment and fine. LAW OFFICES OF NICHOLAS WAGNER THE ATRIUM BUILDING 1111 EAST HERNDON AVENUE,SUITE 317 FRESNO,CALIFORNIA 93720 Telephone(209)449-1800 Fax#(209)436-8900 April 14, 1994 RECEIVED `APR S 81994 CERTIFIED RETURN RECEIP^1 CLERK EOARD OF I-SWIE VISORS Clerk of the Board of Supervisors C01`1' `vY `y" Room 106, County Administration Building 651 Pine Street Martinez, California 94553 Re: Falcon ENCLOSED YOU WILL FIND: Original and three copies of Claim. For your information and review. In accordance with your request. Please call the office upon receipt. Please review, sign and return. Please file and return a conformed copy. Please review the deposition transcript noting any necessary changes on a separate sheet of paper. Thank you for your attention to this matter. Should you have any questions please do not hesitate to call. Sincerely, LAW OFFICES OF NICHOLAS WAGNER Robyn L. Eads _. Secretary to NICHOLAS WAGNER NW/rle Enclosure ` tS� ���•r�rJ } .r+ LP A,1 c ( A--) r U) cfi rJ' g� ro (3) y VS. -tom }k © Ln © �c", d � nV c� W N h `Z d d O x W x ' d U Z W LAW OFFICES OF NICHOLAS WAGNER THE ATRIUM BUILDING 1111 EAST HERNDON AVENUE,SUITE 317 FRESNO,CALIFORNIA 93720 RECEIVE® Telephone(209)449-1800 NOV _ µ 1994 Fax#(209)436-8900 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. November 2 , 1994 Michael D. Meadows Casper, Meadows & Schwartz 2121 North California Bouelvard Suite 1020 Walnut Creek, California 94596 RE: Lydia Falcon Dear Mr. Meadows: Please let this letter serve as notice that the Law Offices of Nicholas Wagner hereby files and claims a lien against any proceeds that plaintiff, Lydia Falcon, receives in the above-referenced case. As you know Lydia Falcon, and the Law Offices of Nicholas Wagner entered into a contingency fee agreement whereby our office agreed to represent plaintiff and provide legal services and advance all costs on behalf of Lydia Falcon. On or about May 9, 1994 plaintiff, Lydia Falcon discharged this office as her legal counsel. Therefore, we are entitled to recover attorneys fees in the amount of one-third of her total recovery as set forth in the contingency. fee agreement and $65 .99 as costs (specified below) which have been incurred in the prosecution of this case: Record Fees - $ 40.50 Copies - $ 7 .00 Long Distance - $ 10.75 Postage - $ 7 .74 Total - $ 65.99 Y M. Meadows November 2 , 1994 Page two Please send me a copy of the complaint as soon as possible. Thank you for your attention to this matter. Should you have any questions please do not hesitate to call. Very truly yours, LAW OFFI ES OF NICHOLAS -AG NICHOLAS WAGNER NW/rc cc: State of California/State Board of Control Contra Costa County Pre red Works, Inc. for the City of Richmond erk of the Board of Supervisors/Martinez, California to � Ql!L��t�'A N Sa is v O ' d, .4J � rn O p 6 U 41 U 41 cn n w 44 W 34 4-J er r-t O Ln t� 4'1 t t�'t ftp F h M W N ..e O ui rn OUl) 44 Q u go d o J4 cA 2 a O a p U °xW z F- L) H fi W M CLERK OF THE BOARD Inter - Office Memo To: Brandon Baum, Deputy County Counsel From: Shirley Casillas, Deputy Clerk Clerk of the Board of Supervisors Date: November 4, 1994 Subject: Claim of Lydia Falcon ---------------------------------------- ---------------------------------------- Per our conversation I am forwarding the letter from Lydia Falcons ' former lawyer. sc CLAIM + • ate' BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA MAY 3, 1994 Claim Avainst the County, or District governed by) BOARD ACTION the lb&?rd of.avpervisors, Routing Endorsements, } NOTICE TO CLAIMANT and Board Action. All Section references are to The copy of this document mailed to you is Your notice of California Gcvernhent Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code wrraunt: Unknown Section 913 and 915.4. Please note all •ilarnings". ' CLAIMANT: Whittenbur Todd M-. � APR 0 7 1994 ATTORNEY: Stanley J. Bell Esq. Law Offices of StanleyJ. Bell Date received COUNTYCO VSEL, BY DELIVERY TO CLERK a'!._A,�_ 'TtAUF ADDRESS: Two Transamerica Center T 505 Sansome St. , 18th Floor BY MAIL POSTMARKED: April 5, 1994 San Francisco, CA 94111 Certified Mail 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. IL ATCNELOR, Clerk -- �� DATED, Q ,.. 94J; ��: �tputy� .11. FROM: County Counsel TO: Clerk of the Board of Supervisors (v 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 1S days (Section 910.0. ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( } Other Dated: S � BY: Deputy County Counsel -0 A 911. 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 RDER: By unanimous vote of the Supervisors present 1 ) 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. Data 9 PHIL BATCHELOR, Clerk. By Q_ � . Deputy Clerk WARNING (Gov. code section 913) object to certain exceptions, you Rave only sic (6) months from the date this notice was personally served or ,eposited in the mail to file a court action on this claim. Sea Government Code Section 945.6. ou Way seek the advice of an attorney of your choice in connection With this utter. if you want to consult n attorney, you should do so imediately. *For additional warning see reverse side of this notice. AFFIDAVIT Of MAILING declare under penalty of perjury that I am now, and at all tines herein ventioned, have been a citizen of the nited States, over age 18; and that today I deposited in the unitedUtes stal Service in Martinez, slifornia, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to he Claimant As shown above. Keg: ] , BY: PHIL BATCHELOR by � �Q�h Deputy Clerk A .: County Counsel County Administrator I CLAIM FOR DAMAGES FOR PERSONAL INJURIES 2 TO: BOARD OF SUPERVISORS COUNTY OF CONTRA COSTA 3 651 Pine CENED Martinez, California 94553 R , "I 'i 4 COUNTY OF CONTRA COSTA APR _ 6 1 5 PUBLIC WORKS DEPARTMENT 255 Glacier Drive 6 Martinez, California 94553 FCLEBC�P,RD OF�UF+ERVIS®RS corvTzi cosTACO. 7 COUNTY OF CONTRA COSTA PUBLIC WORKS MAINTENANCE OFFICE 8 2475 Waterbird Way Martinez, California 94553 9 PLEASE TAKE NOTICE that the undersigned hereby serves and makes demand a 10 upon you for the cause and amounts set forth in the following claim: A o 0 11 Claimant's name and address: 12 TODD M. WHITTENBURG H 13 1392 Rolling Hill Way Martinez,.California 94553 w��us Claimant's mailing address to which notices are to be sent: 15 Stanleyy.J. Bell,, ,Esquire 16 LAW OFFICES:OF STANLEY S. BELL`; Two Transamerica Center . a 17 505 Sansome'St., "'8th Floor San Francisco, California 94111 18 Amount of Claim: 19 Special damages and expenses proximately caused by the occurrence 20 described below and general damages are in excess of the jurisdictional minimum of 21 the Superior Court. 22 Date and Place of Occurrence giving rise to the Claim asserted: 23 On or about the 19th day of October, 1993 and continuing to November 20, 24 1993, at the traffic bridge on Waterford Road, west of its intersection wtih Solano Way, 25 City ofMartinez, County of`Contra Costa; State of California. 26 Description of Occurrence: 27 That on or about the aforementioned date and for some time prior thereto, the 28 w 1 above-named public entities, by and through their agents, servants and employees, 2 negligently and carelessly owned, possessed, operated, constructed, inspected, 3 maintained, contracted, subcontracted, supervised, controlled and had a right to 4 control, coordinated, engineered, designed, performed and planned repaving work and 5 supplied men and materials to the job site referred to herein in that they faiiled to 6 provide claimant and others with adequate and sufficient respirators, clothing and/or 7 any other safety device, appliance or appurtenance, thereby creating a risk of injury to 8 men working on said job site, and further in that said public entities failed to warn 9 claimant and other workers of said dangerous condition, when they knew, or in the a 10 exercise of ordinary care should have known that there were unsafe levels of lead in w ti e� 11 and around said job site; that in all respects the above conditions created a trap; that w 'n 12 said public entities had actual or constructive knowledge of the unsafe conditions, as 13 aforesaid; that said public entities and others failed to remedy said conditions, having a o a 0 14 reasonable opportunity to do so; that as direct and legal result of the negligence and U k �; 15 carelessness of said public entities, and each of them, and as a further direct and legal Fido F wo .2 16 result of the dangerous and defective condition of public property, as aforesaid, while 3 a 17 claimant was working on said job site, he was caused to be exposed to toxious and 18 noxious substances, thereby causing him to sustain severe personal injuries. Plaintiff 19 discovered the toxic exposure on or about December 6, 1993. 20 DATED: April `�' , 1994. r. 21 LAW OF� S OF ` L BELL 22 23 ' E 24 torneys for Claimant 25 26 27 28 r 1 RE: Claim of TODD M. WHITTENBURG ACTION NO. 2 3 PROOF OF SERVICE BY MAIL - CCP Sections 1013a 2015.5 4 I, the undersigned, hereby declare that I am a citizen of the United States, over 5 the age of eighteen years, and not a party to the within action. I am employed by the LAW OFFICES OF STANLEY J. BELL. My business address is 505 Sansome St., 18th 6 Floor, San Francisco, California 94111. 1 served a true copy of the CLAIM FOR 7 DAMAGES FOR PERSONAL INJURIES by mail, by placing the same in an envelope, 8 sealing, fully prepaying postage thereon and depositing said envelope in the U.S. Mail at San Francisco, California on April 5 , 1994. 9 10 BOARD OF SUPERVISORS COUNTY OF CONTRA COSTA 11 651 Pine Martinez, California 94553 12 g�' a COUNTY OF CONTRA COSTA 13 PUBLIC WORKS DEPARTMENT w o255 Glacier Drive 5.0 H 14 Martinez, California 94553 Wo U 15 COUNTY OF CONTRA COSTA ee F PUBLIC WORKS MAINTENANCE OFFICE o 16 2475 Waterbird Way Martinez, California 94553 17 18 19 20 21 22 23 declare under penalty of perjury that the foregoing is true and correct. 24 Executed in San Francisco, California on April 5 , 1994. 25 26 27 --(�C��' A 28 Donna L. Kotake :z A,(I w 00 u a r _ M Ln `. ... Ln Q H O •,4 O U r� H FG p > 44 P4 O rd �:) U U to W >i •ri fes" tf" -n a z 4-) !�a �D r--1 �4 ®- OOLn (o ru ru le:� IT fu L1. a Z LU � sZ w U ° 15 F- ° U {-: a U �' x W < � WWLLJ WB z Oz z F u Z n i WRITE-IT!, - DON'T SAV IT! 74380 M 10, ©s ff// CONTRA COSTA COUNTY Q,� TO g I-Jf� I IL.�t�i�-Im�'1 1 ]u 1 I e DATE ! I V rI t U FROM? SUBJECT3L CIA eck�l vr►e cj SIGNED PLEASE REPLY HERE TO DATE SIGNED INSTRUCTIONS - FILL IN TOP PORTION, REMOVE DUPLICATE (YELLOW) AND FORWARD REMAINING PARTS.TO REPLY,FILL IN LOWER PORTION, RETAIN TRIPLICATE(PINK)AND RETURN ORIGINAL. FORM M103 1 �f.Alii" FOR DAMAGES FOR PERSONAL INJURIES 2 TO: BOARD OF SUPERVISORS COUNTY OF CONTRA COSTA 3 651 Pine Martinez, California 94553ED . 4 ; COUNTY OF CONTRA COSTA 5 PUBLIC WORKS DEPARTMENT OR —13 1994 255 Glacier Drive 6 Martinez, California 94553 CLERK sops SUPERVISORS 7 COUNTY OF CONTRA COSTA CONT'-"!;' cOSTA ONT'"OSTA CO PUBLIC WORKS MAINTENANCE OFFICE 8 2475 Waterbird Way Mariinez, California 94553 9 PLEASE TAKE NOTICE that the undersigned hereby serves and makes demand a 10 upon you for the cause and amounts set forth in the following claim: 11 fl Claimant's name and address: 12 TODD M. WHITTENBURG 13 1392 Rolling Hill Way w° al Martinez, California 94553 oh g 14 W Claimant's mailing address to which notices-are.to be sent: 15 E Stanley J. Bell, Esquire o 16 LAW OFFICES OF STANLEY J. BELL Two Transamerica Center a 17 505 Sansome St., 18th Floor San Francisco, California 94111 18 Amount of Claim: 19 Special damages and expenses proximately caused by the occurrence 20 described below and general damages are in excess of the jurisdictional minimum.of 21 the Superior Court. 22 Date and Place of Occurrence giving rise to the Claim asserted: 23 On or about the 19th day of October, 1993 and continuing to November 20, 24 1993, at-the traffic bridge ori.Waterford Road, west of its intersection wtih Solano Way, 25 City of Martinez, County. bf'Cantra Costa;:State�,of California. 26 Descriptign of ccurre ce: 27 "; That on or about the aforementioned date and for some time prior thereto, the 28 R 1 above-named public entities, by and through their agents, servants and employees, 2 negligently and carelessly owned, possessed, operated, constructed, inspected, 3 maintained, contracted, subcontracted, supervised, controlled and hada right to 4 control, coordinated, engineered, designed, performed and planned repaving work and 5 supplied men and materials to the job site referred to herein in that they faiiled to 6 provide claimant and others with adequate and sufficient respirators, clothing and/or 7 any other safety device, appliance or appurtenance, thereby creating a risk of injury to 8 men working on said job site, and further in that said public entities failed to warn 9 claimant and other workers of said dangerous condition, when they knew, or in the a 10 exercise of ordinary care should have known that there were unsafe levels of lead in w 11 and around said job site; that in all respects the above conditions created a trap; that 12 said public entities had actual or constructive knowledge of the unsafe conditions, as h3 aforesaid; that said public entities and others failed to remedy said conditions, having a 1 e q 14 reasonable opportunity to do so; that as direct and legal result of the negligence and v 15 carelessness of said public entities, and each of them, and as a further direct and legal 0 16 result of the dangerous and defective condition of public property, as aforesaid, while 3 a 17 claimant was working on said job site, he was caused to be exposed to toxious and 18 noxious substances, thereby causing him to sustain severe personal injuries. Plaintiff 19 discovered the toxic exposure on or about December 6, 1993. 20 DATED: April `� , 1994. 21 LAW OFF12�:S OF f L BELL 22 ; r` 23 $;WLEY LL 24 Attorneys for Claimant 25 f.'. 26 27 28 I RE: Claim of TODD M. WHITTENBURG ACTION NO. 2 3 PROOF OF SERVICE By MAIL - C.C.P. Sections 1013a. 2015.5 4 1, the undersigned, hereby declare that I am a citizen of the United States, over 5 the age of eighteen years, and not a party to the within action. I am employed by the LAW OFFICES OF STANLEY J. BELL. My business address is 505 Sansome St., 18th 6 Floor, San Francisco, California 94111. 1 served a true copy of the CLAIM FOR 7 DAMAGES FOR PERSONAL INJURIES by mail, by placing the same in an envelope, 8 sealing, fully prepaying postage thereon and depositing said envelope in the U.S. Mail at San Francisco, California on April 1994. 9 10 BOARD OF SUPERVISORS COUNTY OF CONTRA COSTA 11 651 Pine Martinez, California 94553 wear 12 11 COUNTY OF CONTRA COSTA 13 PUBLIC WORKS DEPARTMENT w 255 Glacier Drive 14 Martinez, California 94553 U 15 COUNTY OF CONTRA COSTA E4 F PUBLIC WORKS MAINTENANCE OFFICE 0 16 2475 Waterbird Way Martinez, California 94553 17 18 19 20 21 22 23 1 declare under penalty of perjury that the foregoing is true and correct. 24 Executed in San Francisco, California on April 1994. 25 26 27 28 Donna L. Kotake ��l r � t � -s :C ltif .0 Fll 7 'M CD .. \\\� d r NUN •� ,.:, O p. ',A 'VA rA pN � V O O N S d Y 6 - G Q �y. PUBLIC WORKS DEPARTMENT CONTRA COSTA,COUNTY DATE: April 12, 1994 TO: Jean Maglio, Chief Clerk, Clerk of the Board's Office FROM: S. Clifford Hansen, Deputyc Works Director, Administrative Services SUBJECT: Claim/Whittenburg D* The attached Claim for Damages was received through the U. S. Mail at our offices on Waterbird Way. We have been advised that County Counsel and Risk Management have already received a copy of this claim. SCH:drg c:wh1t1en.t4 RECEIVED Attachment cc: County Counsel APR 3199x. Risk Management CLERK ARD OF SUt7EC VISORS R COI'iTI':^.COSif-,CO. 1 CLAIM FOR DAMAGES FOR PERSONAL INJURIES 2 TO: BOARD OF SUPERVISORS COUNTY OF CONTRA COSTA 3 651 Pine Martinez, California 94553 4 COUNTY OF CONTRA COSTA 5 PUBLIC WORKS DEPARTMENT 255 Glacier Drive 6 Martinez, California 94553 7 COUNTY OF CONTRA COSTA PUBLIC WORKS MAINTENANCE OFFICE 8 2475 Waterbird Way Martinez, California 94553 PLEASE TAKE NOTICE that the undersigned hereby serves and makes demand 10 upon you for the cause and amounts set forth in the following claim: 11 Claimant's name and address: 12 TODD M. WHITTENBURG 13 1392 Rolling Hill Wa Martinez, California &553 14 C'laimant's mailing address to which notices are to be sent: 15 Stanley J. Bell, Esquire 16 LAW OFFICES OF STANLEY J. BELL Two Transamerica Center 17 505 Sansome St., 18th Floor San Francisco, California 94111 18 Amount of Claim: 19 Special damages and expenses proximately caused by the occurrence 20 described below and general damages are in excess of the jurisdictional minimum of 21 the Superior Court. 22 Date and Place of Occurrence giving rise to the Claim asserted: 23 On or about the 19th day of October, 1993 and continuing to November 20, 24 1 - 1993, at the traffic bridge on Waterford Road, west of its intersection wtih Solano Way, 25 City of Martinez, County of Contra Costa, State of California. 16 Description of Occurrence: 27 That on or about the aforementioned date and for some time prior thereto, the 28 I above-named public entities, by and through their agents, servants and employees, 2 negligently and carelessly owned, possessed, operated, constructed, inspected, 3 maintained, contracted, subcontracted, supervised, controlled and had a right to 4 control, coordinated, engineered, designed, performed and planned repaving work and 5 supplied men and materials to the job site referred to herein in that they faiiled to 6 provide claimant and others with adequate and sufficient respirators, clothing and/or 7 any other safety device, appliance or appurtenance, thereby creating a risk of injury to 8 men working on said job site, and further in that said public entities failed to warn 9 claimant and other workers of said dangerous condition, when they knew, or in the a 10 exercise of ordinary care should have known that there were unsafe levels of lead in w 1 i and around said job site; that in all respects the above conditions created a trap; that all tin e $ 12 said public entities had actual or constructive knowledge of the unsafe conditions, as L�•�rl Zen H U, 13 aforesaid; that said public entities and others failed to remedy said conditions, having a 14 reasonable opportunity to do so; that as direct and legal result of the negligence and v 215 carelessness of said public entities, and each of them, and as a further direct and legal O 16 result of the dangerous and defective condition of public property, as aforesaid, while 3 a 17 claimant was working on said job site, he was caused to be exposed to toxious and 18 noxious substances, thereby causing him to sustain severe personal injuries. Plaintiff 19 discovered the toxic exposure on or about December 6, 1993. 20 DATED: April 1994. 21 LAW OFFiep OF L BELL 22 23 B 24 tor neys for Claimant 25 26 27 28 L 1 RE: Claim of TODD M. WHITTENBURG ACTION NO. 2 3 PROOF OF SERVICE BY MAIL - C.C.P. Sections 1013a. 2015.5 4 I, the undersigned, hereby declare that I am a citizen of the United States, over 5 the age of eighteen years, and not a party to the within action. I am employed by the LAW OFFICES OF STANLEY J. BELL. My business address is 505 Sansome St., 18th 6 Floor, San Francisco, California 94111. 1 served a true copy of the CLAIM FOR 7 DAMAGES FOR PERSONAL INJURIES by mail, by placing the same in an envelope, 8 sealing, fully prepaying postage thereon and depositing said envelope in the U.S. Mail 9 at San Francisco, California on April F 1994. *a 10 BOARD OF SUPERVISORS m COUNTY OF CONTRA COSTA ., 11 651 Pine y o gQ$ Martinez, California 94553 12 . COUNTY OF CONTRA COSTA A- 13 PUBLIC WORKS DEPARTMENT W a 255 Glacier Drive 5.5 d 14 Martinez, California 94553 X8. 0 v 15 COUNTY OF CONTRA COSTA d o N PUBLIC WORKS MAINTENANCE OFFICE o 16 2475 Waterbird Way eMartinez, California 94553 ,.� 17 18 19 20 21 22 23 I declare under penalty of perjury that the foregoing is true and correct. 24 Executed in San Francisco, California on April 5 , 1994. 25 26 27 28 Donna L Fo-take CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA MAY 3, 1994 Claim Against, the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 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: $251000.00 Section 913 and 915.4. las Wal ngs". CLAIMANT: SUTHERLAND, George �� APR 19 1994 ATTORNEY: Anthony Guy Ashe COUAfiTYCOUNSEL Attorney - Abogado Date received MART1NEZCAUF. ADDRESS: 525 Marina Boulevard BY DELIVERY TO CLERK ON Agril 19 , 1994 Pittsburg, CA 94565 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. gglL �eT�tELOR, Clerk DATED: P II. FROM: County Counsel TO: Clerk of the Board of Supervisors (l�) 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: q 9 BY: Deputy County Counsel i I1I. 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 (X 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: PHIL BATCHELOR, Clerk, By C,� 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: _ BY: PHIL BATCHELOR by QQ� J Deputy Clerk CC: County Counsel County Administrator RECEIVE 1 ANTHONY GUY ASHE "APR 191994. Attorney - Abogado 2 525 Marina Boulevard l0;IOC4.M . Pittsburg, CA 94565 CLERK BOARD OF SUPERVISORS 3 Tel: (510) 432-7373 CONTRA COSTA CO. 4 Attorney for Plaintiff 5 IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA 6 IN AND FOR THE COUNTY OF CONTRA COSTA 7 GEORGE SUTHERLAND CLAIM FOR DAMAGES 8 Plaintiff 9 VS. 10 COUNTY OF CONTRA COSTA, 11 et al. , 12 Defendants. 13 Plaintiff GEORGE SUTHERLAND claims damages for the personal, 14 physical injury to him from the battery which occurred 10/26/93 in 15 the DEPARTMENT OF SOCIAL SERVICES, 4545 Delta Fair Boulevard, 16 Antioch, County of Contra Costa, California in the amount of 17 TWENTY-FIVE THOUSAND DOLLARS ($25,000.00) . He can be reached 18 through the office of his attorney whose address is listed above. 19 STATEMENT OF FACTS 20 On Tuesday October 26, 1993, officers of the Contra Costa 21 Department of Social Services battered Mr. Sutherland. (Please see 22 the attached statement of Alicia Prouty, Exhibit A) The officers 23 then wrote fictitious reports to cover-up their errors. (see 24 attached Police report, Exhibit B) Mr. Sutherland is currently 25 being prosecuted for the alleged battery in Delta Municipal Court 26 Case # 88060-9 (two counts of misdemeanor battery, Penal Code 27 section 242) . 28 v 1 ARGUMENT 2 Battery and intentional infliction of emotional distress 3 (I.I.E.D. ) are the intentional torts which will be alleged in a 4 complaint for lawsuit if this case can not be amicably settled out 5 of court. 6 Battery: Battery is any intentional, unlawful and harmful 7 [or offensive] contact by one person with the person of another. 8 The intent necessary to constitute battery is not an intent to 9 cause harm, but an intent to do the act which causes the harm. 10 BAJI 7.51. 11 I.I.E.D. : A plaintiff is entitled to recover damages for 12 severe emotional distress if a proximate cause of such emotional 13 distress was the outrageous unprivileged conduct of the defendant 14 done with either the intent to cause emotional distress or with 15 reckless disregard of the probability of causing such emotional 16 distress. BAJI 12.70 17 It is well settled that an employer is liable for the acts of 18 an employee who commits an intentional tort while working within 19 the scope of his employment. Thus Contra Costa County would be 20 liable for the intentional wrongful conduct of a security guard who 21 batters an individual and follows the battery with false criminal 22 allegations (while Contra Costa County might not be liable for a 23 social worker man who commits similar acts) . 24 N.I.E.D. A plaintiff is entitled to recover damages for 25 severe emotional distress if a proximate cause of such serious 26 emotional distress was the negligent conduct of the defendant. 27 BAJI 12.80. 28 Exemplary Damages: Plaintiff may be entitled to damages 1 against defendant for the sake of example, or by way of punishment, 2 if the trier of fact finds oppression, fraud or malice in the 3 conduct upon which liability is founded. 4 Contra Costa County may be liable for punitive damages in the 5 case of due to the vicious manner in which my client was attacked, 6 as well as, the false statements made by Contra Costa County 7 employees to hide their culpability. 8 INJURIES/MEDICAL TREATMENT 9 Mr. Sutherland immediately complained of pain in his wrist and 10 back. He went to Merrithew Memorial Hospital's Pittsburg clinic on 11 November 1, 1993. He was treated with medication and released. 12 (records attached as Exhibit C) 13 The pain in his wrist and back have decreased, but he still 14 has pain. 15 MEDICAL SPECIALS 16 Medical expenses incurred by Mr. Sutherland as a result of the 17 wrongful conduct described above are not yet available. 18 PAIN AND SUFFERING 19 Immediately following the assault, Mr. Sutherland was in shock 20 and in pain. He was unable to walk erect for quite some time. 21 But for the negligent and intentional wrongful acts of Contra 22 Costa County employees, Mr. Sutherland would have been spared the 23 entire ordeal and a great deal of pain and embarrassment. As just 24 and reasonable compensation for this pain and suffering and the 25 embarrassment and indignities occasioned by your employees, Mr. 26 Sutherland demands the amount of $25,000.00. 27 CONCLUSION 28 In this case, your employee has committed both negligent and 1 intentional torts on the person of my client. Independent 2 witnesses place Contra Costa security personnel in the aggressor's 3 position, with my client acting legally at all times. 4 Based on all the above, Mr. Sutherland is prepared to accept 5 the sum of $25,000.00 in full settlement of his claims against 6 Contra Costa County. 7 8 5incerel , 9 10 A thony Guy As e, Esq. 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 ------------------------------------------------------------------------ - Client: George Sutherland Worker: Alicia Prouty C4BD ------------------------------------------------------------------------ RECORD OF 10/26/93 INCIDENT i George Sutherland had come to an appointment we had scheduled in order to complete his Hearing forms. He was very upset over his denial, and what he considered being abandoned by everyone who said they would help him with his ssa/ssi claim. He. was loud to the point of yelling, cursing, and crying at the same time. I spoke to him in a calm voice trying to get his attention focused on completing the application. However, he responded to each sentence by continuiing to be loud. I was in no way threatened or felt threatened, as client was just venting his anger at the system-- albeit too loudly. Two security guards opened the door of the interviewing booth, and approached client in a domineering stance, getting very close to him. One security guard yelled at client to "KEEP IT DOWN. DO YOU HEAR ME, ANSWER ME. " Client looked up at the guard and said nothing. The guard again yelled, "DO YOU HEAR ME?" Client at that time responded, "I hear you. I know where you're coming from. I know your authority. " The next thing I knew it, both guards immediately jumped to both sides of him, forcing Mr. Sutherland's hands behind his back so hard that he was pushed down violently against the desk. Client's body, from the waist to his head was pushed down against the desk. At that point, Mr. Sutherland started fighting back. I immediately left the booth to avoid getting smashed between the desk and the wall partition. I was hesitant to leave because I believed that the security guards were unnecessarily attacking Mr. Sutherland. Mr. Sutherland is very ill, both physically and mentally, as well as suicidal, and I was afraid he would be injured. I was very upset emotionally and outraged, as I believe that this violent incident did not have to occur. I believe that the security guards provoked this incident. They should not have approached Mr. Sutherland with a domineering, aggressive attitude. They could have . avoided this incident, and the ensuing injuries to both themselves and to Mr. Sutherland, by using a little tact. You cannot approach an angry person with aggressiveness, and not expect a confrontation. IPA 5 Name Yate die tt E I of 2 ' CONTRA COSTA COUNTY PUBLIC SERVICE REPORT FORM t.CASE NO. Cf 3-ol•(t� 2 CODE SECTION 3.CRIME 4.CLASSIFICATION S.REPORT ARE 9 'tl 148 Zyo zti2 ►S (eo2 -aktmel as e��z �LsTS ASS 6 DATE AND TIME OCCURRED-DAY 7.DATE 8 TIME REPORTED 8.LOCATION OF OCCURRENCE 10-ve•a'S t3 So F44.15 -roc )0• .q3 I 1 qe5 Atpctoc.)r SarAAt-SEQv,rc 9.VICTIM'S NAME-LAST,FIRST,MIDDLE(FIRM IF BUSINESS) 10.RESIDENCE ADDRESS 11.RES.PHONE WA%Imo,"-r A•A me0i 12.00CUPATION I&RACE-SEX 114.AGE 115.DOB 1&BUSINESS ADDRESS(SCHOOL IF JUVENILE) 17.BUS.PHONE Pyo 1 45-45" PeLc'h r*%Q 704-0-75 V-VICTIM W-WITNESS P=PARENT RO=POLICE OFFICER 18.Check if mor Continuation 19.NAME-LAST,FIRST,MIDDLE 20.CODE 21.RESIDENCE ADDRESS 22 RES.PHONE Q Tt►� 23.OCCUPATION 124.RACE-SEX 25.AGE 26.DOB 27.B[USINE(SSSA�ADORESS(SCHOOL IF JUVENILE) �r/��.�� 2&BBU&PHONQE I 291 NAME-LAST.FIRST,MIDDLE ' 7. 30.CODE 31.RESIDENCE ADDRESS 32 RES PHONE 33.OCCUPATION 34.RACE-SIX 35.AGE 36.DOB - 37.BUSINESS ADDRESS(SCHOOL IF JUVENILE) 3&BUS.PHONE METHOD OF OPERATION_ Describe characteristics of premises and area where offense occurted' C S'r IA3?'E•Qvie" Akckr $oo?7f 22 Describe brfeRy how offense was commraod sbfr h90-1r 1350 114CS "S k%)`W'. 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'�' 7 _''.'. CONTRA COSTA,COUNTY -HEALTH `SERVICES MOP 43 �.38$ _PITT'. ,- �---- _, 5 MERRI;fHEW MEMORIAL' HOSPITAL r AND CLINIC � > SUTHERLAND" dGEORGE > PITTSBURG HEALTH .CENTER H 2/09/1944 510 432-6039 }�••��; x,w OUTPATIENT NOTES a T z7.T'T 9aR ,lowt R . HD � 2 ' Date atient ;.ID: Page 112 1/ r . . t x w ea f .y i y l�r• 4 r: � wKe. l-PHC (Side • 2) (I1-86) t 4 M n , .� •CONTRA COSTA COUNT-Y HEALTH SERVICESSg Y, a{i; , .;, } rr st °>t 3 t$z.z ,.k• r a r a a: MERRITHEW MEMORIAL HOSPITAL AND PITTSBURG HEALTH CENTERS r�. s�,��r � t OUTPATIENT NOTES Uate � � ao- Patient` ID t Page Jr htxy�'�S y �.�fl^-ds t y � h41 fflrindm- ,;�'f 1 t 1 t tJotice Ck U _ �4 t: 1 2overbook Chary 4Rv- „ Provider Letter' tCer' e1,[� Patient cailc;ci by providir`[ ryer❑ ------- -- r ;,t ^*, y �'•k p T{ - _ 's it z�. �� z t s,s N -.�'"s� � �•'ss y n�a� �.�r��,p r���,p :u. � _�t i !�r x• v sr t�` r:v` ''k- ,�i 0 -fit s V t i�� r 5 i o z� R V 9 Lj iC. •r fi �Y t C 3x35 F+rf,y d U ,Z6..' I IF �F t b b r L. : y .✓ Y r x tr t � =d uta• tt tii+. t 51 MA -86� MERRITHEW MEMORIAL HOSPITAL AND CLINICS MARTINEZ SPECIALTY CLINIC January 4, 1994 SUTHERLAND, GEORGE 36-74-18-1 ROGER BARROW, M. D . PROBLEM: Followup visit. SUBJECTIVE: The patient generall y continues to feel that he is ` being totally ignored by all health care systems, Social Security, Disability, the Fire Department where he tried to obtain work, 'and' anything else he can think of. He seems to have lost hope that he will ever be able to work again. He continues �z to see Dr. Brenner on a regular basis as his psychiatrist and z` takes Prozac 40 mg daily. He says ,the Prozac helps and he is hopeful that during the upcoming Social Security determinations that he will be considered disabled. s4, tY His diabetes, he says, seems "OK. " However, he does not check his sugars are recommended and continues to take 25 units of NPH ,f insulin a day. He .denies hypoglycemic �ymptoms. His chronic lung disease causes mild cough and exertional dyspnea, he states , but has been stable. His low `back continues to be uncomfortable although he says he was greatly helped by the pain medicine and "Soma so that he could. sleep better. ' He requests more Soma which helps the back spasms at night so he is able to sleep better. OBJECTIVE: This is a depressed-appearing, overweight man who is �4F cooperative today. . Lungs are clear. Cardiovascular: Regular rate and rhythm without murmur. Abdomen soft, flat, nontender, without organomegaly. His low back reveals diffuse hyperesthesia to light touch but not apparent focal deep tenderness. He does seem to' have somewhat increased paraspinous muscle tone in the r asitting position. He moves about fairly easily and without a lot of difficulty. Neurologic: Within normal limits. Pulmonary function tests in July 2992 were done at Martinez and a verbal report says that ' they revealed mild restrictive pulmonary disease with some mild improvement with bronchodilators. 4a ASSESSMENT: 1. Chronic back pain of thirteen years duration with recent � 3a ! exacerbation. 2 . Diabetes of uncertain control. 3. Hypertension, controlled adequately with a blood pressure of 128/90. Depression, curre,ntly under psychiatric care. 5. Mild chronic restrictive lung disease from cigarette smoking i $c which he quit in 1990. Jv V &f: R :re's 17 '2 r n "CIONTRA COSTA COUNTY HE ALT H',SERVICE S "4� g -the rlou�d C.�eOr j MERRITHEW MEMORIAL HOSPITAL'kAND:CLINIC Sy r =r' PITTSBURG HEALTH CENTER �"," z r f }� k OUTPATIENT NOTES;; Dates ' ` ' Patient ID Page ;r UR ='D•i f L •�'{^ t Mkt '�a ° � si,`�G"J i4 > n a �' a _ ... , , BROKEN A - .. PRN Send Rea t. Notice zh t Reappt. 1-2 vvks:as overbook Chart Ck.❑ ProvidersLetter'Certified 11llail❑ Regular Mail❑ Patient called b ovider Other r f hx s axf a� YP ❑ ❑ 1W 1. j 34f U { Ch 5�t a� if cn} i 3 f �a s c,:ma .' t. i s s x , y� a b > Y�t):"it"y ���` ���� t +akz+d•t c'� it �1., f d:,ta ,�., (r a f�`kr "� fµs °'+�. � ' - ��,,�:;yaks t - � IRA V j f 7.•.} U F 4 i 4tf{'fir° " f MR 1-PIC (11 8t ) (Side"1) i u3 x n.. 1r. s,'*...v.... ,.,5`t...`,..r�,ez'". r„ ..Y-Y,.?s wm,t.'✓:t``�..!�`::.., .r .3.c�x MERRITHEW MEMORIAL HOSPITAL AND CLINICS u:. y: MARTINEZ SPECIALTY CLINIC " '.January 4, 1994 PAGE TWO f 4L s�xf SUTHERLAND. GEORGE 36-74-18-1 ROGER BARROW, M. D. t; PLAN: Health care maintenance: I recommended influenza vaccine and pneumococcal vaccine. However, he refuses bath saying he doesn't like to be "poked. " =,+r. 2. He will continue his current medications including insulin 25 units of NPH daily. Proventil and Azmacort inhalers. Prozac 40 mg daily, Procardia 10 mg t. i . d. , r, a." { 3.' He is again instructed to bring all medications to clinic next time since he continues .,to forget them and I am not sure I know all the medications he is on. 4. Refilled Soma, #30 and Proventil inhaler. `. 5. Erythromycin 250 mg q. i. d. p. r.n. colds or bronchitis . ` 6, Electrolytes, CBC, hemoglobin Ale, VDRL. It should be noted that his borderline high potassium last time was noted and ItWO he was instructed .to decrease his° frequent consumption of bananas and other fruits which he has done . {?5,; 7. I will send A letter at 'his request to his social worker ti!P-li . regarding his Request for Doctor' s" Information Regarding >t Social Security Disability. Please see that dictated letter. Fr 8. Return to clinic in four to six weeks. He was instructed to bring all his medications with him. y } RB:KC D:01/04/94 T:01/06/94 ROGER BARROW, M. D. 1�'t }aryl�i !t4i1 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA MAY 3 , 1994 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 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 , 500. 00 ection 913 and 915.4. Please note all "Warnings". CLAIMANT: Pacific Bell APR 18 1994 ATTORNEY: COUNTY COUNSEL MAAT04rzZCALIF Date received ADDRESS: Attn: M.R. Gylock BY DELIVERY TO CLERK ON April 14 , 1994 401 lennon Lane,Room 208 M Walnut Crek, CA 94598 BY MAIL POSTMARKED: April 13, 1994 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PPH gg DATED: G.4o .., ( �9 BIL DeputyLOR, Clerk /D 00� II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( V� This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 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: 199 PHIL BATCHELOR, Clerk, By. � �a a Q�m J 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. r Dated: L BY: PHIL BATCHELOR by �, La.,.Q eputy Clerk CC: County Counsel County Administrator NN 051 C:J' b Nd5 -- ` v m i r V Q 6 4 C 6� Q O U- Q V 1. y m U r� Z N 7 a j O a v f FCONTA...., 7STA Claim Against Contra Costa County 9 Pacific Bell presents a claim for damages against the County of Contra Costa as provided in Government Code Section 900 et seq. Claimant's Address Pacific Bell Claims Attention M. R. Gylock 401 Lennon Lane, Room 208M Walnut Creek, CA 94598 Date of Occurrence: 3/13/94 Location: 10 feet west of North East Comer of Beaver Ln &Beaver Court, Byron Circumstances Causing Claim: Delta Diablo Sanitary District under contract to County Damaged a telephone facility while repairing a water leak. Their employee, Roger Burchay, was using a backhoe to excavate for the leak when he hit our cable. Description of Damage: One 100 pair communications cable Amount of Claim: $ 1,500.00 Note: This is an estimated amount. When the final bill is complete it will be forwarded to your office. Date of Claim: April 11, 1994 Pacific Bell Case No.: N460122 Michael Gylock Area Claims Manager Claim Against Contra Costa County Pacific Bell presents a claim for damages against the County of Contra Costa as provided in Government Code Section 900 et seg. Claimant's Address Pacific Bell Claims Attention M. R. Gylock 401 Lennon Lane, Room 208M Walnut Creek,GA 94.598 Date of Occurrence: 3/13/94 Location: 10 feet west of North East Comer of Beaver Ln&Beaver Court, Byron Circumstances Causing Claim: Delta Diablo Sanitary District under contrail to County Damaged a telephone facility while repairing a water leak Their employee, Roger Burchay,was using a backhoe to excavate for the leak when he hit our cable. Description of Damage: One 100 pair communications cable Amount of Claim: $ 1,500.00 Note: This is an estimated amount. When the final bill is complete it will be forwarded to your office. Date of Claim: April 11, 1994 Pacific Bell Case No.: N460122 -414 Michael Gylock Area Claims Manager Claim Against Contra Costa County Pacific Bell presents a claim for damages against the County of Contra Costa as provided in Government Code Section 900 et seq. Claimant's Address Pacific Bell Claims Attention M. R. Gylock 401 Lennon Lane, Room 208M Walnut Creek, CA 94598 Date of Occurrence: 3/13/94 Location: 10 feet west of North East Comer of Beaver Ln&Beaver Court, Byron Circumstances Causing Claim: Delta Diablo Sanitary District under contrail to County Damaged a telephone facility while repairing a water leak Their employee, Roger Burchay, was using a backhoe to excavate for the leak when he hit our cable. Description of Damage: One 100 pair communications cable Amount of Claim: $ 1,500.00 Note: This is an estimated amount. When the final bill is complete it will be forwarded to your office. Date of Claim: April 11, 1994 Pacific Bell Case No.: N460122 Michael Gylock Area Claims Manager Corporate Claims PACIFIC BELL® 401 Lennon Lane,Room 208M tM Walnut Creek,California 94598 A Pacific Telesis Company (510)977-2171 April 11, 1994 Case No.: N460122 County of Contra Costa, Board of Supervisors 651 Pine Street Martinez, CA 94553 Ladies/Gentlemen: We are sending you the attached claim notice pursuant to Section 910 of the California Government Code. In order to be assured that you have received this claim, I would like you to sign and return an enclosed acknowledgment of receipt form. Please fill out the form and return it in the stamped addressed envelope. Thank you for your cooperation. If you have any questions, please call me on (510)977-2171. Very truly yours, Mich I ock Area Claims Manager attachments CLAIM , a. BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA MAY 3 1994 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $5 .0 0j� j j� 6ec�on 913 and 915.4. Please note all "Warnings". CLAIMANT: CORREIA, Denise M. APR 18 1994 �A ATTORNEY: COUNTY COUNSEL. ss MARTINEZCAUFDate received ADDRESS: 247 Btily R8aad, 94 b5#53 BY DELIVERY TO CLERK ON April 18, 1994 Pitts uu BY MAIL POSTMARKED: Hand Delivered via : Risk Mgmt . I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the "'above-noted claim, pp�I gg DATED: /gTg�7` Bl�il DeputyLOR, Clerk (� ,���e1• o�� II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: ly BY: L- Deputy County Counsel cf 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present i ( This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: 3 Q PHIL BATCHELOR, Clerk, By �, C w ,��4 Q . a Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *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:�24-.4 ! 1 S C1 BY: PHIL BATCHELOR by e ,QD J Deputy Clerk CC: County Counsel County Administrator Clair: to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of 'aetion 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 The 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: lClaim By ) Reserved for Clerk's filing stamp . " REAV Against the County of Contra Costa ) 18 199 or ) District) CLERK BOARD OF SUPERVISORS Fill in name ) CON TFio".COSTA CO. 4 The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) /�pie.i � lc� �� I� /� rou..nd / /.• �� r4 . /rl. 2. Where did the damage or injury occur? (Include city and county) A h%.n-)CL lr6 At!e-o 1,on�rA. _CoJ' l-a__G._Oun 3e' How did the•dama a or injury occur? Give full details; use extrpaper if 8 j Y ( � required) r4er'e wad a, ca.f in Y'Ae Pa-r- r-r'4�/ fo /A ¢or-n�r in 7Ae �'/rte r oorsi Y'Aa,l waJ Je:nq ac/e/oi-edo /.. wa.f /aakin� .ai.� tie ccLf ntr� 74a ii �h'� ic� /oo%eG� a /o f /i/<e �y mi r f/,r7q caf.� 4AyAew tAere VV 4-,f a. 9i1-/ ,V/aVI*n +•vi//, C-i- �Jein_q adeplid a ii `!waJ Sfickin hiJ y7a.wJ oui o�' /•Ae c�_ge_JR.S / fv f ^q_-f ea�.,Ll�_f!'S-1=:fL�� /D e�e[ _1LLF.� L�1.ey-L_.1F.P �.5/_u J1�� ed a n,� 4. What particular act or omission on the part of county or district officers,'°oi��`r servants or employees caused the injury or damage? / 7`ie e �/ola �/NeJ fAeRe were in Co^�ic+/e.a/e a .,ot r--aa�a oc Dti C✓wfwcLJd CoCkaJh.' Aa�0oe,,eJluck —e /h 4 r oer,t w/t/, a.fOcG� /� peo/o/e ani Jaio( ' "7-�i.! ref why y/Ok A�ci+ ri� S/iC/c Yok 'P,`nje-rJ �'n "e ease 7 /11 7-A,-jrwaJ ) '4^11 14r /ady wAe ,4'/e4f .�,y/ c/ re�oer/ l,nel a cA%P &n her JAeuldepr errn der/ rr>e wArrr 7010 an -Aa 9ei LL fe_y'r,.�_r .rL y 5. wnat are the names of county or district officers, servants or employees causing damage amage or in jury? �i» n o .tar e o f�+P i n Q iri p J� u An IS/V /e wa%f /o /d -1A /Aelf S«./oert�iJor o!' /{nirr,a / eor„4-rol khowf 74XPir narriPJ, 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) ----------------------- ------------ $. Names and addresses of witnesses, doctors and hospitals. Co /lPen O'near/ Cr;,r le .2y7 §ai ley Road, r/V V S li f 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT �/ • / �a,�,c(•J• �+o /a red- j, h�e. re i J A _ eatd. N,Wrjw�f C/iniC Save Me . 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 Claimantls Signature syr �ai�P � da� J �S3 Address Telephone No. Telephone No. a J a f •'J i f N O T I C E /r,Q-//e,,• N / �c�oe f�a� ever� on� f'PCiryPd a. /e..�J Section 72 of the Penal Code provides: on 079 e : Ile f 7/�ip K�oe r vI✓or ��'d. ' fi i d 10,4 / "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 imprisonr,�ent and fine. _ \ DATE bL� S NAME PNEUMO COCCAL III • • • . • Oar TETANUSIDIPHTHERIA (enter wldate) INFLUENZA (eater widate) HEPATITIS B (enter w/-d--a--tee) OTHER iSpeeify wrdatel 1 1 Contra Costa County Public Health Immunization Assistance Program CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA MAY 311994 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 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: $3 , 120.00 Section 913 and 915.4. Pleaselot/ g CLAIMANT: COBB, Michael Dewey and COBB, Renee Marie APR 19 1994 ATTORNEY: COUNTY COUNSEL Date received MARTINEZ CALIF. ADDRESS: 2924 Clearland Circle BY DELIVERY TO CLERK ON Anril 19 , 1994 Bay Point, CA 94565 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: �� B!: Deputy �J II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( Vf 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: I 19 9 y 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. Date PHIL BATCHELOR, Clerk, By.�_ ,� f1 aoJ 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. l Dated: BY: PHIL BATCHELOR by �� a�Jl1l� Deputy Clerk CC: County Counsel County Administrator Cia;-- BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for.death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. 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 f orm RE: Claim By } Reserved for Clerk's filin stamp ie+AAr:�-L Dom{ 0056 -A�4i) ) RECEIVED - �NCG MA-M- Co&f ) Against the County of Contra Costa ) or } [APR 19 1994 AN!M/k{— (2V ICES 1 -E� District) CLE UPERVISORS Fill in name ) CONTRA COSTA CO. MND DELIVERED The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $, , 12Q ..OD 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) ,Z'q;--fC L-F--A4?LAt4-h (2(B2CE-, E"pc),rim,C A 9`151p5,. O a UTtzA (0.5 -- --Q-TY 3. How did the damage or injur occur? (Give full details; use extra paper if required) " EE � +� 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage?. Qt I � 13�A KiETP-g1-VAW 1W rr4+ -rt'+-E,bF- C-DSTA 010U )-t �-���,t�1_. S�V►c-�S ���-��r�-t�-N�� }�--� SN-� rl�cs� � ��Er tiv�R'5 S-n U- DM +►Ep,, W 1-►1CA WAS Aly c):F:- - 1-3 o s ao►c.E w�Ntxu.c e s v �e>+�er� S�-= -tTW S OA�b- N o rbc )l.f.ns-r �i��-y G R�rR✓� �- �. �. wnat are the names of county or district officers, servants or employees causing .he damage or injury? OC)f TA COLkoTy - 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.-TO A14 A+,AtMAJ CDi � 7. How was the amount claimed.above computed? (Include the estimated amount of any prospective injury or damage.)C©---,T 07- �bcb--XSoD,oo , vU-�it-L-<� SsW.6-0 1Q !2S 120-Do , moot .1,5CDO-Uo, 34i5 w►s5 -� )PA(,,- IADcuu-b eas7 4 N uJ bolo !,T Le--AST ..------------M______ $. Names and addresses of witnesses, doctors and hospitals. MtkR4 f\N1,A L-N. 3fky t 01 tiT_ C."\ -1-4E 0C0-U-fQ(sK21'-, DP -A-cbcK-) e0oE Aprs • �'RoK- 025 �FoPcIGT �3,w L0A,4T -1-4r\,),Pt.nD;f5t0 SrPt-VF- th-PakZ'�. ;7-rZo u-c _w_------_.._-_..r______�___M___ 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT 7 LALs Tv- Vis,- o, W Gov. Code Sec. 910:2 provides: "The claim must bl,, signed by the claimant SEND NOTICES TO: (Attorney) a persn his bet lf." Name and Address of Attorney Claimant's Signature Address Telephone No. Telephone * * * * wit T NOTICE Section 72 of the Penal Code provides: - "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to.allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. C-) -_Z/�51 LyvIL-L-1 E� t+t_CJo trl� t�1 T�r�o � -TO f1kO�2 _471��►�� '_t _ vL��T CP t�T l� cK-Qi21'�_. — 11�1w�— Ott3CRn akOLeTi��- l�l.l��l3E_C° 1 _ SID �QT r�_s_►1� �.v��� l.:c�ui�_� t-l-t t_+'�(Z1-4�t� ������-�4t. L Ae. -s'A'(� • OID b L'UCC, I t=- 5+VE7_t•Mch Zj tea ��k UAd _�_�_i Adu o cwto, DcR_ I l._l__ O� IDl LEI 1A�fl1�� 5yQL-0—E i 9 cl _� -�- �bU_f�S�t�,a`To_���N Nom- -1.1-F�vE � 5�--� � • i, —LO ct�4 H �''OL PET LICENSE APPLIqATION SERVICE» ,� NT . _ L CERTIFICATION O'F.RABIES VACCINATION' J� sox-t ; � PLEASE CHECK BOXES NEXT TO SeLECTED FEES. �' MAIITiNE?,CAb63 � ' ; �•= xs FEE SCHEDULE. MaKE crlECKs PAYABLE TO COUNTY TREASURER . ; /EyAE N411DYOE LOS artHl THE.aoilMAnoN•aEq,es?So.escDw, ` a, °:' RF' kTf*Ayr :� #)it-::_-4-:YR' 'TAS pOBECT AS NECESSARY) 6 A NEW RABICS NATIQN.I$ IE .OUIRI HAVE YOUR VETERINARIAN QOMP{,ETE THE CERTIFl-• +CATION PORTION OF THIS FORM. SIGN THE APPLICATION IN THE ` e YR* . NRS ' 'SEE-BACK PAGE fMCE PRM)M TNEN MAIL-THE WWrE.AND PINKCOPIES: .` R Fa c REfG'IAAR .. SPECIAL ' RTN p01/1 PAYIEIR. ,S USTED.ABOVE YOUR VA1:4 DOGLCENSE 'NO FEE W1ED UcENNSE OLtR1tICATE(PINK COPY)AND NEW ID TAC WILL BE $14;00 $28.00 $38.00 •tICEN$E .. . WIED TO YOU N APPROXIMATELY-3-4 WEEKS. ' � D -ENTER SPECIAL L SPAYED ORLICENSPENALTY S ECODE ax P YOU WVE NY OLESTION9NEITEREDC5DOG UGENSE EcLffi70'' :� 1A /e ?. $1Q00 : ' OWNER CERTFCATIOItICERT (SEE BACK PAGE)FY THAT THE STATEMENTS ARE TRUE AND IHAVERECEIVED A COPY OF CONTRA COSTA COUNTY ORDINANCE CODE ARTICLE 416-4.4(RESTRAINT)INCLUD04G SECTION 416.4402(ANIMAL AT LARGE 416.4A04.(ABANDONMENT).gND,416.4 406(PROHIBITION). M(TED ON. CPTX)MAL YOUR COPY OF THIS FORM) .' R .. GTLCENSE .. 14410' 'S26O !^Z " ..._ :,..'.... .-. 4'..:. �:ti.:.. I^F'�;i!w ^s:: B'TRAST ).GNED: DATE 'CR�DTF CAT LICENSE I{-�J TOT , LEGAL REbc1 Hr1RI GOF3i :.. UNDER '••AV,AB2 OR �LEY DOG 'PLEASE 6if7E7AT•Tp'iAt PEESPAID: i'NAME FIRST NBES N S (PLEASE PROM - - _ _ _ ,. .LAST .;' .._ _ ." - r " T INFORMATION . DOG 2924 CLcARLA,NO CIR - I ME CAT NT WILLIE - .. (P1lINABER,, LSTREET) -i:(SUFFIX)' ... , ..(APT.) - OWNERS - -=.. - - PLEASE SELECT DOMINANT`BR EED"CODE AND.OESCRIPTION FROM CHART ON . .. .. - - VERSE SIDE OF THIS AT*NFORM,ANDfNTIER Ip SPACES BELOW. P t.`f TSBIIG CA .94565 ;:. .�WXID `C3$ , BULL'_. R:RYER .(CITY) r (STATE) BREEO .. (?I% {CODE) - (DOMR~BREED DESCRIPTION) $SB !�i3'17- = �PHATE -. i39 $�2$8. ..,. - StfF .. _... ..pONE :.,..� ' QsPAYEO ORPHONE CHECK BOX IF IF PET RESIDES AT AN ADDRESS affERENT ADDRESS-PIR 'OR MAILING'ADDRESS'IS A (COLOR), AGE(VR�IO) (SEX) Iv6ncrc�T��EaDnrsEOl !AhRURAG gOl1TE-aa n.L' .STxAox EN'15fTOEiIGE_�1OpR15¢eE�Qw;Foa.Dya,(rs,)F,LBDREss ��..iWTE SNw!� -B+ DVLa. ONLY.SEE BOTTOM LEFY SEOTU.OF TH(S rtbRM' - � �. ... _. '- - IDENTIFICATIONOR .. INUMBER). 4STREET) {APT.) .. - DATA (OPTXQNAL) AL ANIMAL : - .. . .. RESIDENCE..;. .. - _DATE PET ACQUIRED - DATE PET.ENTERED.COUNTY ADDRESS - - - - - IF WITHIN 30 DAYS .. . (CITY) '_ (STATE) - .(ZIP) - IF WITHIN 30 DAYS 1q j LOA 4.L.. � RABIES CERTIFICATE L� wITR ICR W VETERINARIAN,HAVE VACCINATED THIS :. .r . )) 2) (3 4) 6 61 7) (8 RAj3ES YAC EXPIRES (05 19 .. - �. CENT O LEP 4I' P QIP..•.;' 'OTHER u L I CF fvSE DELINQUENT AFTER -VACCINE PRODUCT rrAND LOT NUMBER.USED. ��ee 07131/91TYPE f -RAS 3 TRIMl1NE TRI-RAB ®RENEWAL 05/31/91 .,89: 042706BIO : - .LOT. Lor.. xOT. PREVIOUS LICENSE 1 PREVIOUS LICENSE YEARMUMBEA - ' EXPIRATION'DATE 'RAB-VAC 3 2 EN.PURALL R RARAB . ,PET YIOVED - .LOT w. LOT s LOT r a PET .. - DECEASED DATE 04JT OF COUNTY DATE F"MILR E 3 DURARAB 3 OTHER ^ 'LOT• "LOT• 4 NAME LOT a TRANSFER R : -�N. �(+f Z_4/Qr .EXPIFE.S • :. y SHIP NAME FIRST .MIDDLE -IAST ..'VETEAINARIAMS .'i_w NAME. NEW ADDRESS NUMBER STREET SUFFIX APT. .. .. .•. ,,y i. . A� OWNER'S HOSPITAL VAI I F NAME OR YyFTcRI16A1F! Hpdi* � CHANGE OF CITY blATE nP SD ss 17$0-XGNACIO YAtLEY RDAD ADDRESS CM,STATE. , : ..:.:-QZ2•G 9A ......ZIP . PHONE NUMBER - ALTERNATE PHONE NUMBER ' OWNER COPY-SUBMIT TO ANIMAL'SERVICES FOR PET LICENSE �v NEAR IAN • � ,. /�. -_:¢ j �n. ,z t �: .� ` e�A ._....T,.� ,. � _. i ) �. _. UNITY ) l CONTRA COS r.+ PARTMENT gg ANIMAL S�`RYlCES { 4849 Imhoff PI. _ _ 651 Pin le Shores r. S Martinez, CA /� Pinol , CA 94553 94564 �.646-299 P 4-3966 i Datk f , Time: f } To: OEA ll=-r Address:s ✓�l�1 �7�C�Z1 ' Off ice rp � attempted contact regarding: Name(Print) FSS ❑ Requested service; please reschedule. 4 ❑ Information about the problem you reported. ❑ Allegation your pet isn't properly controlled. ❑ Investigation of a reported bite or scratch. ❑ Your current Dog_ License number(s). # ! g� ❑ 4nimai Services may have your Dog(s) impounded at /'the location circled above. It will be held days ( for you to reclaim. If not reclaimed within the time in- i, dicated, it may be sold or disposed of. V Call circled telephone number as soon as possible. # Other:L � 1- 2—' .;,YJ� I&")r.vcZ�" Normally,stray unlicensed dogs are held 72 hours.Please f telephone the circled number preferably between 8 a.m. and 8 p.m. Monday through Saturday. The center Is `; open from 10 a.m. to 5 p.m. Monday through Saturday (except holidays). ADT#818 REV.8/88 SM poor Card � t C 2 _ CLAIM i , �- — BOARD Of SUPERVISORS OF CONTRA COSTA COUNTY. CALIFORNIA May 3, 1994 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document nailed to you is your notice of California 6ovtrnn+tnt Codts. ) the action taken on your claimby the tBoard ofSupervisors (Paragraph IV below), p Pu #mount: $250,000.00 Section 913 and 915.8. PI-Me 9s"• ' CLAIMANT: BURNETT, Kim Harold APR 0 4' 1994 COUNTY COUNSEL ATTORNEY: Date received M'AATINEZCALIF. ADDRESS: 901 Court. St. BY DELIVERY TO CLERK ON April .6, 1994 Martinez, CA 94553 BY MAIL POSTMARKED: via: interoffice mail 1. FROM: Clerk of the $card of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JVIL JepuiELOR• Clerk DATED: �I�,,._-7 4 1.9`3.x{- X_�1 .11. FROM: County Counsel 10: Clerk of the Board of Supervisors (1 } This Clain Complies substantially with Sections 910 and 910.3. i ) This claim TAILS to comply substantially with Sections 910 and 910.3, and we are so notifying Claimant. The $card cannot act for 1S days (Section 910.$). ( ) 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: A-=; I T q BY: � Deputy County Counsel 111. FROM: Clerk of the board TO: County Counsel (1) County AdNinistwor (2) i ! Claim was returned as untimely with notice to Claimant (Section 911.3). 1Y. BOARD ORDER: $y unanimous vote of the Supervisors present this claim is rejected in full. Other: 1 • - � - I ■ 11 lid I certify that this is a true and Cornct Copy of the board's Order entered in its minutes for this data. bated: PHIL BATCHELOR, Clerk, ly .,,0,�p, .a���,� Oeputx Clerk MARKING (goy. Code section 913) subject to certain exceptions, you !save 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. fou may seek the Advice of an attorney of your choice in connection pith this viatter. 1f you want to consult M Attorney, you should do so immediately. *For additional warning see reverse side of this notice. AFFIDAVIT OF MAILING C declare under penalty of perjury that I am now, and at all titles herein mentioned, have been a citizen of the Jnited States, over aye 18; and that today I deposited in the United tatts sial Service in Martinet. W ifornia, postage fully prepaid a certified Copy of this Board Order and Notice to ClAlmant, addressed to the claiAi nt as shown above. r 914 BY: PHIL BATCHELOR byJ . beauty clerk :C: County Counsel County Administrator - RECEIVED APR 6 1994 w iL �5x" - _`C - an- --cam - - ck—z�— N-o VA-p __�._��___t'��-��L _ --��_._�es�.�•res_Vie.:-�:c�__,��c�,w�c_t -��---�------- ��� 4 _ .- r - -------_- ---_-- .J o � Ua �� r. v -31 �� � a �