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Home My WebLink AboutMINUTES - 04111995 - 1.11 r CLAIM ' BOARD OF SUPERVISORS OF CONTRA COSTit COUNTY, CALIFORNIA April 11, 1995 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: Unknown Section 913 and 915.4. Please note all "Warnings". p F Sm CLAIMANT:M ck Robinson , ATTORNEY: 'AAR 1 2 1995 Date received COUNTYCOUNISSE. ADDRESS: 2047—C Arnold Way BY DELIVERY TO CLERK ON March 22, 19"RTINEZCALIF. Concur&., CA 945207 BY MAIL POSTMARKED: Hand l)al i varArl via- Pi.-* 4=t- 1. bt1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ��IL ATCHELOR, Clerk DATED: March 22. 1995 : �eputy 31. FROM: County Counsel TO: Clerk of the Board of Supervisors (4 This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying Claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). { ) Other: Dated: 3—Z3 �`� s BY: � Deputy County Counsel 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 Superviscrs present W) 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: ,5'_ PHIL BATCHELOR, Clerk, By r 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 wait to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately, AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 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. Dated: BY: PHIL BATCHELOR b Deputy Clerk CC: County Counsel County Administrator Ciai- 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: Cl m ) Reserved for Clerk's filing stamp �ECFNED ) Against the County of Contra Costa ) I 221995 or ) -; -r vim,•. RL k District) CLERK BOARD OF SU ERVISORS Fill in name ) CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ and in support of this claim represents as follows: 1. When did the damage or injuryoccurs (Give exact date and hour) 01,�K MARCH q, I 2. Where did the daidage or ink occur? (Include city and county) - SEP12n 21alklgul-90A)a 3• How did the damage or injury occur? (Give full details; bse extra paper if required) --PSI 1r) 0- 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or dama&e? iN E , I ; LLY 1 5. wnat are the names of county or district officers, servants or employees causing 'he -Jamage or injury? 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto NEE -V--- - r -E(2A/ k 7. How was the amount claimed abovecomp ted? (Inc de 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 AMOUNT t { 7W - GovCode Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) - ;.or by,,,pWe perigon onAis Wmlf." Name and Address of Attorney oor,�W C aimari 's Si ture 7 qq ddress. J Telephone No. Telephone No. s * * 1 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 ($10,000, or by both such impriso.runent and fine. o Go Q V U � a jv---A a m ` N i� p '71 \ 0 �,., �n.,k •��G y cam+ LO N. O r O O G� r. N �s N N V O 4 G N } m CLAN BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA April 11, 1995 Claim-Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Unknown Section 913 and 915.4. Please note all "Warnings". CLAIMANT:Mack Robinson � ��` ATTORNEY: Date received COUNTYCOUN$C-L ADDRESS: 2047—C Arnold Way BY DELIVERY TO CLERK ON March 22, 19"rTINEZCALIF. Concord., CA 94520 BY MAIL POSTMARKED: lianrl T)P1 i vprarl vin- Ri ek Mb t_ 1. FROM: Clerk of the Board of Supervisors �� 10:wCounty Counsel Attached is a copy of the above-noted claim. ��IL BATCHELOR, Clerk DATED: March 22. 1995 _ : eputy 11. FROG!: County Counsel TO: Clerk of the Board of Supervisors (7)' 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: eputy County Counsel ill. FROM: Clerk of the Board 70; 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.& true and correct copy of the Board's Order entered in its minutes for this date. Dated: PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. Code section 913) iubject to certain exceptions, you have only six (6) months from the date this notice was personally served or ieposited in the mil to file a court action on this claim. See Government Code Section 945.6. 'ou may seek the advice of an attorney of your choice in connection with this matter. If you want to consult n attorney, you should do so immediately. AFFIDAVIT OF MAILING declare under penalty of perjury that 1 am now, and At all times herein meati;one `hay.e'been a citizen of the inited States, over age 18; and that today I deposited in the United States .stat Service, in 'Uri,inez, :alifornia, postage fully prepaid a rtified copy of this Board Order and Pcticr to Claiment, addressed to he cla;man• AS W, aVed / /99 - ntec: BY: PHIL BATCHELOR b Depaty-Clerk C: County Counsel County Administrator I - I ' M NZ ai.t6 _ �? v K s - o Za a °O o - �j�bo 0 6 G'd O O BOJ d rr 't � W V M 1 O U V /� 0N V N 4 '.0 OLL1C � m° YV t o cc mco Gl 2 ._ Cr 6 CT 2-7- CC Un LU L�n CL .c: t E U CX. Lt.J �y W v j } � ¢ .a a c WOOS 0 0ca MU `c Cbk,I M BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA April 11, 1995 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) N071,6E 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: $25,000.00 Section 913 and 915.4. Please note all "Warni.ngs�ti u CLAIMANT: Jennalind Armstrong a MAR 1 1995 ATTORNEY: Isam C. Khoury, Esq. COUNTY COUNSEL Date received MARTINEZ CALIF. ADDRESS: 605 C Street, Ste. 200 BY DELIVERY TO CLERK ON March 15. 1995 San Diego, CA 92101 BY MAIL POSTMARKED: March 13, 1995 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: March 15, 1995 ILIL EePutylOR, Clerk I1. FROM: County Counsel TO: Clerk of the Board of Supervisors ( his claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). { ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: ?J "/�` S BY Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. BOARD ORDER: By unanimous vote of the Supervisors present (✓] This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: /Q�PHIL BATCHELOR, Clerk, By , Deputy Clerk ""' WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter, if you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING 7 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. Dated:_ PHIL BATCHELOR b. fQ% : —, Bd,,/Deputy Clerk CC: County Counsel County Administrator ,fit ��'� •�� .�°� �. LO«.! a- U r rn Ul Ul U � L tr �o Q. ca 1f r © � 4 n �� Wf Cla: , tb: BOARDF 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 cropslland 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 JENNALIND ARMSTRONG ) RECEIVE® Against the County of Contra Costa ) ; ' 5 1995 or . ) CLERK BOARD Of SUPERVISORS District) II 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 $ 25,000 .00 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) October 1.9, 1994 at 12:25 p.m. 2. Where did the damage or injury occur? (Include city and county) ii Intersection of Concord Boulevard and Parkside Drive, in the City of Concord, County of Contra Costa, State of California 3• How did the damage or injury occur? (Give full details; use extra paper if required) - At said time and place, Claimant" JENNALIND ARMSTRONG was a passenger in a vehicle which was struck by a bus driven by Robert Frederick Dunham. The_sub-iect bus was owned by the` Central Contra C'cs, „`�r ,it_Alltbority. 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury„ or damage? The County of Contra Costa negligently, carelessly and recklessly own, manage, maintain, control, driveland operate the subject vehicle in such a manner causing it to collide with Claimant' s vehicle. SEE ATTACHED CONCORD POLICE DEPARTMENT TRAFFIC COLLISION REPORT ;cvc^) D. wnat are the names of county or district officers, servants or employees causing the damage or injure? Central Contra Costa Transit Authority / Robert Frederick Dunham— ----------------------------- 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Serious contusion to left breast with considerable residual hematoma; Contusion sprain to left chest neck and back ____ 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Medical specials to date $3,700 .00 (approx. ) 8. -Names and=.addresses of witnesses, doctors and hospitals. - Mt. Diablo Hospital; Mt. Diablo Emergency Physicians; Diablo Valley Radiology; Sharp Cabrillo Hospital; E&L Physical Therapy; Norman Kane, M.D. Elizabeth S. Saarni, M.D. Witness names and addresses are listed on the attached Concord Police 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov. Code Sec. 910:2 vides: "The claim be s ed the claimant SEND NOTICES TO: (Attorney) o b some a on on is if." Name and Address of Attorney Isam C. Khoury, Esq. COHELAN & KHOURYC aimant's Signa e 605 C 'Street, Suite 200 Isam C. Khoury, Esq. San Diego, CA 92101 (619 ) 239-8148 Address Telephone No. Telephone No. :t :t :t * :tit 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 impriso.rv,�ent and fine. S a `�j� oct 1 19941,, _ 26 OCT �1 1 5 CONCORD POLICE DEPARTMENT SPECIAL CONDITIONS NUMBERMIT&RU TRAFFIC COLLISION REPORT R INJUED FE•,ONY CR No. SPECIAL VEHICLES NUMBER -9-IT&RUN COUNTY 1 Z JDATE Q TIME REPORTED PAGE ciTr vo LlcK oTNcw w KILLED MIsD [MICR OTNK ❑ Contra Costa .. ...._ .-, '/1 : ,9 `9y �d 2,, OF s. CLASSIFICATION GV/ DATE s, TIME OCCURRED NCIC NO. OFFICER A�'r= — — /o l9 yy i.2.?� 070E OCCURRED ON: PRIMARY STREET - SPEED DAY OF WBBK TOW AWAY STATE MWY PHOTOS Z - LIMIT T F REL S M T S IN bQNo"O* O No r[s U AT INTERSECTION WITH �ARKS�tF _DA (SECONDARY STREET) SPEED - ID fUPP - LIMIT J ❑ OR: FEET/MILES N f a W OF - a5 ❑ DRVR DRIVERS LICENSE NO. STATE CLASS SAFETY VEM.YR. MAKE/MOOEL/COLOR LICENSE NO, STATE J P PRO NAMB rlgsT,MlooLc,LAST) • • • A PKD STREET ADDRESS OWNER'S NAM[ `' R VEH ( )SAME AS DRIVER T I VC C�VTRAL. �?12,q y BIKE CITY/STATE/ZIP OWNERS ADDRESS ( ') SAMfiAS D01VER C, /y q OTNR SEX HAIR EYES MONT WORT ■IRTI DATE RAGE DISPOSITION OF VEHICLE ON ORDERS OF: ( )orvwKR OwrvcR MIO. DAY YKAw 1 rnAj / ( )oTNKw HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: ( )MONK APPARKMT ( )RtrtR.TO MAXRAYIVK TOWED by Dfi{CRIB[ VEHICLE DAMAGE {MADE IN DAMAGED INSURANCE CARRIER _ POLICY NUMBER IYNK I )MONK ( MINOR AREA: l�tAyFLow�, ca..-clsnct• S S / , IMOD ( )MAJOR )TOTAL DIR.OF ON STR LET OR HIGHWAY PCF ` IGC , TRAVEL 7_ .1 Q� /�\ - �� Imo. 2-160(C `.7 VC CHP DRVR DRIVERS LICENSE NO. STATE 1CLASS ISAPETY VEM.YR. MAKE/MODAL/COLOR LICENSE NO. STATE EQUIP. PRO NAME (wIR KT,M1o0 Lt,LAST) P A PKD STREET ADDRESS OWNER'S NAM[ SAME AS DRIVER R VEH i T BIKE CITY/STATE/Z IF OWNERS ADDRESS -AME AS DRIVER Y 2 OTHR SEX "AIR ares HGMT WONT BIRTHDATE RACE DISPOSITION OF VEHICLE ON ORDERS OF: ( )orrlctw {.JIDRIVtw _ MO. OAY : YEAR •( )OTNKR - (� GR 5v2 / = HOME PHONE BUfINEss PHONE PRIOR MECHANICAL DEFECTS: ( )MONK Av►AftKNT i )RKFKRTO NwggwTiVK TONED BY DESCRIBE VEHICLE DAMAGE SHACK AREAIMAG tD INSURANCE CARRIER POLICY NUMBER IUNK )NONE ( )MINOR !I MAJOR ( )TOTAL DIR.OF ON STREET OR HIGHWAY PCF ICC ( ) TRAVEL }� PUC ( ) u- ?_,-, 1` CHP' DRVR DRIVER f LICENSE NO. STATE CLASP ISAPETY " VE .YR. E D O r LICENSE NO. STATE EQUIP. PPED NAME (FIRKT,MIDOLK,'LAST) - • • • • • • . • • • • • • • • • • • • • • • • • • • • • • • • A THEREP .REP ..RT NOT TO DE uSCOPIED, D PLICATED PKD STREET ADDRESS 1 IJ ,�C,'S,iLI l TO �'!\�OT _I\�"�7[-71V M AGENCY R VEH ( 11 ii 1JJ I v �' wR Iv T 01: J 7 S L BIKE CITY/STATE/ZIP _LO •GiM -' S OTHR SEX MAIN J[YES IMONT JWGHT I ■IRTMOATE RAIRK 'DISPOSITION'OF' EgICL@ O Rf OF: MO. DAY : YEAR I to MOMS PEON[ BYSINEfE PHONE PRIOR ME L DEFECTS: ( MC Avvw iNwwMTIVt ( l ( 1 By SQRTBE 9CNI L wM cl'C IN DAMAGE INSURANCE CARRIER POLICY NUMBER r IUNK )NONE )MINOR AREA: R�.. ;rds Eu�cau rr IC r,• , .d ;-i, 112, )TOTAL OIR.OF TRAVEON STREET OR HIGHWAY PCF ICG ( ) L PUC ( ) CMP REPORTING OFFICER BEAT JDATE & TIME REPORT WRITTEN SU �SON APPROVING � - ��'`- �i 1 C�• lei CP-23-1 JUN s7 u CONCORD POLICE DEPARTMENT TRAFFIC COLLISION CODING PAGE DATE OF CO1.1-11 TIME � (2t00) "CIC NUM{$�6,R - - OFFICER"N.D. NYM$ER MP. + PAY 1 YiAR -V O�'^ �`+/� t OWNERS NAME/ADORESS NOTIFIED PROPERTY YEs NO DAMAGE DE&CRIPTION.OF DAMAGE SEATING POSITION . ., SAFETY EGUIPMEN,T EJECTED FROM VEH. OCCUPANTS: M/C BICYCLE- 1 DriverL•Air Bag Deployed, 0-Not Ejected 2 to 6•Passengers A-None in Vehicle K Air.Bag Not Deployed HELMET 1-Fully Ejected g Unknown 7-Station Wagon Rear N-Other DRIVER 2-Partially Ejected 8-RR.Occ.Truck or Van C-Lap Belt Used P•Not Required V-No�Yes 3-Unknown, D-Lap Belt Not Used - 1 2 3 $-Position Unknown CHILD RESTRAINT E-Shoulder Harness Used Q-Other. PASSENGER F-Shoulder Harness Not Used G•In Vehicle Used , 456 G-Lap/Shoulder Harness Used R-in Vehicle Not Used X•No 7 H-Lap/Shoulder Harness Not Used S-In Vehicle Used Unknown Y-Yes . J-Passive Restraint Used T-In Vehicle Improper Use K•Passive Restraint Not Used U-None In Vehicle ITEMS MARKED BELOW WHICH ARE FOLLOWED BY AN ASTERISK'(•)SHOULD BE EXPLAINED IN THE NARRATIVE. PRIMARY COLLISION FACTOR TRAFFIC CONTROL DEVICE& .1 1213 TYPE OF VEHICLE 1 2 '3{ MOVEMENT PROCEOINO LIST NO. (*) OF PARTY AT FAULT COLLISION tt .A_.V.0 eectian V.ioiatedt_..Ci eO-;-„,_.A:Contrals-Functionin Y. __.A Passenger Car/Ste i n W on Stopped ],( ( )Yes O)NO g Controls Not Funcuonin • B Passenger Car With Trailer X IB Proceeding Straight w B Other Improper Driving- C Controls Obscured C Motorcycle/Scooter IC Ran Off Road D No Controls Present/Factor' D Pickup or Panel Truck ID Making Right Turn C Other Than Driver* TYPE OF COLLISION IE Pickup/Panel Trk.W/Trailer JE Making Left Turn D Unknown* A Head-On F Truck or Truck Tractor IF Making U Turn E Feli Asleepg Sideswipe G Truck/Trk.Tractor W/Trailer IG Backing WEATHER (MARK 1 TO 2 ITEMS C Rear End H Schaal Bus IH Slowing/Stopping A Clear D Broadside 1 Other Bus I Passing Other Vehicle B Cloudy E Hit Object J Emergency Vehicle J Chanaina Lanes C Raining F Overturned K Hwy.Const,Equipment K Parkin Maneuver D Rain&SnowingGE hicle Pedestrian L Bicycle L EnteringTraffic Hher•: M Other Vehicle M Other Unsafe Turnin E F /Visibilit Ft. MOTOR VEHICLE INVOLVED WITH N Pedestrian N Xing into Opposing Lane F Other*: A Non-Collision O Moped O Parked G Wind LIGHTINGB Pedestrian P Merging A Daylight C Other Motor Vehicle G Traveling Wrong Way B Dusk Dawn D Motor Veh.on Other RoadwayOTHER ASSOCIATED FACTOR R Other*: E Parked Motor Vehicle (MARK I TO 2 ITEMS) C park-Street Lights A VC Section Violation: Cited: F Train D Dark-Na Street Lights Ye N E park-Street Lights Not G Bicycle 9 B VC Section Violation fated: 90 111 DRUG Functioning* H Animal: Y N PHYSICAL ROADWAY SURFACEC VC SQCtIOR V101atlOn CILBd: MARK I.TO 2 ITEMS rDSlip I Fixed Object: A Had Not Been Drinking Yes No B HBO-Under Influence J Other Object'. _... . -IcyE Vision Obscurement C HBp-Not Under Influence er (muddy,of etc. F Inattention* D HBD-Impairment Unknown' ROADWAY CONDITIONS PEDESTRIAN'S ACTION . . G Stop$t GO Traffic E Under pru Influence* (MARK-I TO,2-ITEMs)-- - - H Entering/ Ramp F Impairment-Ph sisal” A No Pedestrian Involved A Holes Deep Ruts Crossing in Crosswalk I Previous Collision G Impairment Not Known B Loose Material on Roadway* B at Intersection J Unfamiliar with Road H Not Applicable C Obstruction on RoadwayC Crossing in Crosswalk-Not K Defective Veh.Equip.: Cited:. I Slee Fati ued D Construction-Repair Zane at Intersection Yes N SPECIAL INFORMATION E Reduced Roadway Width D Crossin -Not in Crosswalk L Uninvolved Vehicle A Hazardous Material F F looded JE In Road-Includes Shoulder M Other*: B Fire Involved- 0 Other*: IF Not in Road N Nona Apparent I I I C Tire Defect/Failure H No Unusual Conditions G Approach/Leaving School Bus O-Runaway Vehicle SKETCH: MISCELLANEOUS: , f.ICLSQCS ice. V-� NORTH l CP-28-2 JUN 67 "' l`� CONCORD POLICE DEPARTMENT INJU RED/WITN ESSES/PASSENG E,RS PAG[ DATE OF COLLISION TIM[ 240t� NCIC NUMBER OFFICER I.D. NUMBER ,. I c�- Iii 4�( 2 0704 d �3 4 - .? EXTENT OF INJURY("X"ONE) INJURED WAS("X"ONE) WIT" Sf{ FAG Samoan AOS fix. PARTY {SAT jSAFXrV SJSCTS D, ONLY ONLY FATAL f[VSRS OTNSR Vltl■LS COM PLAINT DRIVSR ►Atf. PSD. SICYCLIfT OTNtR NYMSSR POt. SOYIP, INJYRV INJURY INJURY OP PAIN - ❑ : � ❑ a : ❑ . ❑ o. ❑ ❑ _ NAM[ D.O.B. ADDRESS - TEL[FHONIK .. TRANSPORTED BY IMJURED ONLY - - - - TAKEN TO: DESCRIBE INJURIES ❑ VICTIM OF VIOLENT CRIME NOTIFIED EAG / o ❑ ❑ cl ❑ ❑ ❑ ❑ ❑ ❑ NAME O.O.C. - ADDRESS TELEPHONE N -s as TRANSPORTED BY (INJURED ONLY)* TAKEN TO: - DESCRIBE INJURIES ❑ VICTIM OF VIOLENT CRIME NOTIFIED m=? a ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ NAM[ D.O.B. - ADDRESS -#1 CjQj TELEPHONE TRANSPORTED BY (INJURED ONLY): .. TAKEN TO: DESCRIBE INJURIES ., - .. .. ❑ VICTIM OF VIOLENT CRIME NOTIFIED ❑ ❑ ❑ ❑ ❑ ❑ ❑ 101 ❑ I ❑ I ❑ NAME D.O.B. ADDRESS TELEPHONE TRANSPORTED By (INJURED ONLY): TAKEN TO: DESCRIBE INJURIES Cl VICTIM OP VIOLENT CRIME NOTIFIED ❑ ❑ I ED 1 ❑ ❑ 1 D 1 ❑ ❑ ❑ E-T ❑ NAME O.O.B. ADDRESS TELEPHONE TRANSPORTED BY INJURED ONLY): TAKEN TO: DESCRIBE INJURIES ❑ VICTIM OF VIOLENT CRIME NOTIFIED NAME D.O.B. ADDRESS - TELEPHONE TRANSPORTED BY IINJURZO ONLYT-' TAKEN TO: DESCRIBE INJURIES ❑ VICTIM OF VIOLENT CRIME NOTIFIED REPORTING OFFICER BEAT DAT[AND TIME R[FORT MRITT[N SYSOR APPROVING TYPIST DATE AND TIME REPORT TYPED Pfi CP-19-1 JUN 67 CONCORD POLICE DEPARTMENT FACTUAL DIAGRAM u PAO[ OAT[O`P`COLLISION ��]] TIM[ ii00 NCIC NUMBER OFFICE" I.D. NYMQO[11 ll� 0704 *A J-il - l ALL MEASUREMENT[AR[APPROXIMATE AND NOT TO:CAL[IJNLEsi'LTAT[D(fCALC- -I z S PT Rosi ; . 1 �IvloV� A�T.� Mti tn1�RxVn►.1 : . .. . � ' _ - FRo/St" LY.FT 'TYRs✓: t �� - /woeCiw[._. .2-2- FT' gzb tom! r-MoCa . aF- OP. 24.zi.. F-r E-oF- w LDYiff of A v FT S of 19 fT. LJ of E ®GE car L/R -rmR`. 1 f� s eaF 1`sEtiG7- cbV Cotic&R i t%L. 't V-I ' 1 _.. WL A` lop Atff sme BWv i :.:....� : :_ DRAWN■V -- I.D.NUMBER IND. DAY T". "[VI[IMER •NAME MO. DAA' ♦R. v338 r TRAFFIC COLLISION 94-26648 PAGE-5 FACTS: NOTIFICATION• _. .. On 10-19-94 at about 1227 hours, I was dispatched to investigate a possible injury traffic 'dollision, at the intersection of Concord B1, and Parkside Dr. I responded from Willow Pass Rd. and Parkside Dr. All times and measurements are approximate. SUMMARY: (P-1) Robert . Dunham, a driver for Central Contra Costa Transit Authority, said he was E/B on Concord B1. approaching Parkside Dr. , where he slowed down to turn left. Dunham said he saw a vehicle approaching at a high rate of speed, W/B on Concord Bl. approaching Parkside Dr. Dunham..believed. he-had, enough-time.-to turn_ left,--N/B .-__ . onto Parkside Dr. Dunham turned, and in doing so, collided with the approaching Honda Accord. (P-2) Jessie Halligan, said she was driving W/B on Concord B1 . approaching Parkside Dr. Halligan said the County Connection van turned left onto Parkside Dr. right infront of her. Halligan swerved to the right, and broad sided the County Connection Van. At the time of the collision, Dunham was transporting Marcy Belcher, who hit her chest on the seat infront of her. Belcher was transported to Mt. Diablo Hospital via AMR, where she was treated for minor injuries, and later released. STATEMENTS: (W-1) Colleen Nye, said she was stopped S/B on Parkside Dr. at Concord Bl . Nye saw Dunham traveling E/B on Concord B1 . and turn N/B onto Parkside Dr. infront of make a left turn infront of Halligan, who was W/B on Concord B1. approaching Parkside Dr. (W-2) Nicole Phillips, said she was at the mentioned intersection and saw Dunham turn left onto Parkside Dr. from Concord B1 . and noticed Halligan approaching in the opposite direction, W/B on Concord Bl. Phillips,--said -she heard a--loud collision and noticed that both Dunham and Halligan had collided. POINT OF IMPACT: The POI is determined to be approximately twenty feet west of a prolongation of the east edge of Parkside Dr. and approximately three feet south of a prolongation of the north edge of Concord B1. CAUSE: Dunham caused this collision by being in violation of 21801 (a) CVC- Failure to yield to oncoming traffic prior to turning. RECOMMENDATIONS• I recommend that Dunham be issued a citation for 21801 (a) CVC. PEREZ/#0338 BEAT 4 10-19-94/1500 SUPERVISOR C;a i r CLAIM t 1, BOARD OF SUPERVISORS OF •CONTRA�.COSTA COUNTY, CALIFORNIA April 11, 1995 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: Unknown Section 913 and 915.4. Please note alt "Warnings-', , 4, ^.1 Y= CLAIMANT: Belinda Birdsong ATTORNEY: Steven H. Herman ` COUNTY Date received nfiFaFtTINEZCr`LIF. ADDRESS: Pier 35, 2nd Floor, West Gate BY DELIVERY TO CLERK ON March 15, 1995 San Francisco, CA 94133 BY MAIL POSTMARKED: Hand Del i-,Tararl 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim, DATED: March 15. 1995 gy1L �epuiyLOR, Clerk 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 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 3" ILe — �iBY: 4Deputy County Counsel 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). 1V. BOARD ORDER: By unanimous vote of the Superviscrs 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�2 .p� , 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 on attorney, you should do so immediately, AFFIDAVIT OF MAILING I declare under penalty of perjury that 1 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: is J 9_ 9� BY: PHIL BATCHELOR by eputy Clerk CC: County Counsel County Administrator 1 STEVEN H. HERMAN Bar No. 57287RECEIVED LAW OFFICES OF STEVEN H. HERMANJQ 2 Pier 35, 2nd Floor, West Gate San Francisco, CA 94133 r15R 1995 3 Tel: (415) 982-6800 CLERK BOARD OF SUPERVISORS 4 Attorneys for Claimant I CONTRA COSTA CO. Belinda Birdsong 5 6 BEFORE THE BOARD OF SUPERVISORS OF THE 7 COUNTY OF CONTRA COSTA 8 9 IN THE MATTER OF THE CLAIM OF ) 10 ) BELINDA BIRDSONG, ) 11 ) AGAINST ) 12 ) THE COUNTY OF CONTRA COSTA ) 13 ) 14 15 Pursuant to section 910 of the Government Code, claimant 16 BELINDA BIRDSONG presents the following claim against the COUNTY 17 OF CONTRA COSTA: 18 1. Claimant's post office address is c/o Steven H. Herman, 19 Law Offices of Steven H. Herman, Pier 35, 2nd Floor, West Gate, 20 San Francisco, California 94133 . 21 2 . The COUNTY OF CONTRA COSTA should send all notices 22 regarding this claim to Steven H. Herman, Law Offices of Steven 23 H. Herman, Pier 35, 2nd Floor, West Gate, San Francisco, 24 California 94133 . 25 3 . On or about September 16, 1994, in front of 1736 San 26 Pablo Avenue, City of Pinole, County of Contra Costa, State of 27 California, claimant was walking down the sidewalk when she 28 stepped into a hole in the pavement and tripped and fell to the 1 ground. COUNTY OF CONTRA COSTA knew, or should have known, of 2 the dangerous condition of said public property. - 3 4 . As of the date of this claim, claimant has incurred the 4 following injury, damage and loss: claimant suffered significant 5 and severe injuries to her knee and injuries to her body, health, 6 strength and activities, and extreme general shock and injury to 7 her nervous system and person, the exact nature and extent of 8 which is unknown at this time. 9 5. The name or names of the public employee or employees 10 causing claimant's injury are unknown at this time. 11 6. Jurisdiction over this claim rests in the Superior 12 Court. 13 Dated: March 14, 1995 14 15 LAW OFFICES Oi EVEN H. HERMAN 16 17 By / Steven erman 18 Att me for Claimant 19 20 21 22 23 24 25 26 27 28 �CluAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY CALIFORNIA April 11, 1995 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: Unknown Section 913 and 915.4. Please note all "Warnings I �i�tVIT� jig CLAIMANT: Buzz Haskins Equipment Co. , Inc. : A & R Equipment, and Steven Renwick MAR 2 0 1995 ATTORNEY: Andresen and James COUNTY Cou�sE c/o William P. Schneider Date received � 7'INEZCAUtF. ADDRESS: 425 Market St. , Ste. 900 BY DELIVERY TO CLERK ON March 17, 1995 P.O. Box 193731 San Francisco, CA 94119-3731 BY MAIL POSTMARKED: March 16, 1995 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. gg DATED: March 17, 1995 Jq1L DeputyLOR, Cler 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: -2.0 g,s� BY: puty County Counsel 311. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (V) This Claim is rejected in full. ( ) Other: I certify that this is a -true and correct copy of the Board's Order entered in its minutes for this date. Dated:�J4g&j _ 1 9 9 PHIL BATCHELOR, Clerk, By r Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned$ have been a citizen of the United States, over age 18; and that today I deposited in'the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. )9 9`5� BY: PHIL BATCHELOR byPA�A�Deputy Clerk CC: County Counsel County Administrator CLAIM AGAINST GOVERNMENTAL ENTITY FOR INDEMNITY AND APPORTIONMENT To: County of Contra Costa Board of Supervisors 651 Pine Street, Room 106 Martinez, CA 94553 Name of Claimants BUZZ HASKINS EQUIPMENT COMPANY, INC. , A & R EQUIPMENT, AND STEVEN RENWICK Mailing Address of Claimants RECEIVED s c/o WILLIAM P. SCHNEIDER z,,. RECEIVE® Andresen and James 425 Market St . , Ste. 900 ' 71995 PO Box 193731 San Francisco, CA 94119-3731 CLERK BOARD OF SUPERVISORS Claimants' Telephone CONTRA COSTA CO. c/o Andresen and James (415) 541-0920 Identity of Person to Whom correspondence Should be Sent WILLIAM P. SCHNEIDER Andresen and James 425 Market St . , Ste . 900 PO Box 193731 San Francisco, CA 94119-3731 Facts Upon Which Claim is Made On October 4 , 1994 at approximately 4 : 15 p .m. , claimant Steven Renwick was northbound on Vasco Road at a point approximately 0 . 7 . miles south of the intersection of Vasco Road and Camino Diablo. Rounding a curve, Mr. Renwick encountered a backup of traffic . When he realized that he could not stop in time , Mr . -Renwick elected to steer into the lane of opposing traffic, which appeared clear to him, rather than plow into the car ahead. Unfortunately, plaintiff Kenneth Olsen was driving in the opposite direction and a collision ensued. A copy of the Traffic Collision Report is attached. Mr. Olsen suffered serious injuries . He has brought a lawsuit against the claimants . Kenneth Olsen' s wife, Tanya, had brought a cause of action for the loss of consortium. A copy of plaintiffs' complaint is attached. Claimants claim that they are entitled to equitable indemnity and apportionment of fault from and with respect to the County of Contra Costa, which owned and maintained the roadway on which the accident happened. Claimants alleged that there are stopping sight distance violations, traffic signal phasing and timing problems with respect to those signals at the intersection of Vasco Road and Camino Diablo, lack of appropriate signage, and road alignment and shoulder inadequacies . These conditions contributed to the occurrence of this accident and it is on this basis that claimants present this claim. Discovery and investigation are continuing. Date Claimants were Served with Plaintiff' s Summons and Complaint December 8, 1994 Name of Plaintiffs in the Underlying Case KENNETH MITCHELL OLSEN AND TANYA OLSEN, TRAFFIC COLLISION REPORT. Identity of Court CONTRA COSTA COUNTY SUPERIOR COURT Attachments COMPLAINT OF KENNETH MITCHELL OLSEN, AND TANYA OLSEN AND THE TRAFFIC COLLISION REPORT. Dated: March 1995 ANDRESEN AND JAMES By: --•. WILLIAM P. SCHNEIDER Attorneys for Defendants BUZZ HASKINS EQUIPMENT COMPANY, INC. , A & R EQUIPMENT, AND STEVE RENWICK PETER W. ALFERT, State Bar No. 83139 HINTON & ALFERT 2 A Professional Corporation 1646 North California Boulevard, Suite 600 3 Walnut Creek, California 94596 Telephone: (510) 932-6006 4 Attorneys for P-laintiffs 43 5 6 7 3 IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA 9 IN AND FOR THE COUNTY OF CONTRA COSTA 10 KENNETH MITCHELL OLSEN 11 and TANYA OLSEN, NO. C 9 4 12 Plaintiffs, 13 VS . COMPLAINT FOR DAMAGES (Personal Injury) 14 BUZZ HASKINS EQUIPMENT CO. , INC. , A & R EQUIPMENT CO. , STEVEN VERN 15 RENWICK, and DOES 1 through 10, "011 CE: TOCP` Rutt 51 Inclusive 11 !'..7 16 Defendants. 17 18 Plaintiffs KENNETH MITCHELL OLSEN and TANYA OLSEN complain 19 and allege against defendants, and each of them, as follows: 20 FIRST CAUSE OF ACTION (Negligence) 21 1. The true names or capacities, whether individual, 22 corporate, associate or otherwise, of defendants DOES 1 through 23 10, inclusive, and/or the factual basis of liability against said 24 defendants, are unknown to plaintiffs at this time, who, 25 therefore, sue said defendants by such fictitious names, and when 26 the true names and capacities of said defendants, or facts 27 rendering said defendants liable, have been ascertained, 28 1 plaintiffs will amend this complaint accordingly. Plaintiffs are 2 informed and believe and thereon allege that each defendant 3 designated herein as a DOE is responsible, negligently or in some 4 other actionable manner, for the events and happenings 5 hereinafter referred to and caused injuries and damages 6 proximately thereby to plaintiffs, as hereinafter alleged, either 7 through said defendants ' own negligent conduct or through the 8 conduct of their agents, servants or employees, or due to the 9 ownership, lease or sale of the instrumentality causing the 10 injury, or in some other manner. 11 2 . Plaintiffs are informed and believe and thereon allege 12 that, at all ,times mentioned herein, defendants, and each of 13 them, were the agents, servants, employees or joint venturers of 14 their co-defendants, and that in doing the acts herein alleged 15 they were acting within the scope, course and authority' of said 16 agency, employment or joint venture. Each and every defendant, 17 as aforesaid, when acting as a principal, was negligent in the 18 selection and hiring of each and every other defendant as an 19 agent, servant, employee or joint venturer. 20 3 . At all times herein mentioned, defendant BUZZ HASKINS 21 EQUIPMENT CO. , INC. was and is a California corporation -duly 22 organized and existing under and by virtue of law and statute. 23 4 . At all times herein mentioned, defendant A & R 24 EQUIPMENT CO. was and is authorized to do business in the State 25 of California; the true business structure and status of said 26 defendant is unknown to plaintiffs, and plaintiffs pray leave to 27 amend in that respect when the status and structure of said 28 defendant is finally determined. 2 1 5 . At all times herein mentioned, Vasco Road, at a point 2 thereon approximately .7 mile south of Camino Diablo, was a 3 public street and highway in an unincorporated area of the County 4 of Contra Costa , State of California. 5 6 . On or about October 4 , 1994 , plaintiff KENNETH MITCHELL 6 OLSEN was operating his motor vehicle along and upon Vasco Road, 7 at a point thereon approximately . 7 mile south of Camino Diablo, 8 in said county and state. At said time and place, the 9 defendants, and each of them, so carelessly and negligently 10 owned, entrusted, operated, maintained and controlled their motor 11 vehicle, along and upon Vasco Road, in said county and state, as 12 to cause -their motor vehicle to hit, strike and collide with the 13 motor vehicle being operated by plaintiff KENNETH MITCHELL OLSEN, 14 thereby causing plaintiffs to suffer the damages and injuries as 15 hereinafter alleged. 16 7 . As a direct and proximate result of the aforesaid 17 conduct of the defendants, and each of them, plaintiff KENNETH 18 MITCHELL OLSEN has suffered and continues to suffer permanent 19 injuries to his person, body, and health, including but not 20 limited to severe injuries to the muscles, bones, tissues and 21 nerves, and has been caused great mental and physical anguish, 22 all to his general damage in a sum in excess of the 23 jurisdictional minimum of this court. 24 8 . As a direct and proximate result of the conduct of the 25 defendants, and each of them, as hereinafter alleged, plaintiff 26 KENNETH MITCHELL OLSEN was compelled to and did employ the 27 services of hospitals, surgeons, physicians, nurses, and the 28 like, to care for and treat plaintiff, and did :incur medical, 3 1 hospital and professional and incidental expenses, and plaintiff 2 is informed and believes and thereon alleges that by reason of 3 said injuries he will necessarily incur additional like expenses 4 for an indefinite period of time in the future, all according to 5 proof at the time of trial . 6 9 . As a direct and proximate result of the aforesaid 7 conduct of the defendants, and each of them, plaintiff KENNETH 8 MITCHELL OLSEN was prevented from attending to his usual 9 occupations, and plaintiff is informed and believes and thereon 10 alleges that he will thereby be prevented from attending to his 11 usual occupation for a period of time in the future and thereby 12 will also sustain loss of earning capacity, in addition to loss 13 of earnings, past, present, and future, all according to proof at 14 the time of trial. 15 10 . Plaintiffs have sustained a loss of interest on the 16 value of all damages from the date they were incurred to the 17 present, and said loss will continue into the future. 18 WHEREFORE, plaintiffs pray judgment against defendants, and 19 each of them, as hereinafter set forth: 20 SECOND CAUSE OF ACTION (Loss of Consortium) 21 ' As and for a second, separate and additional cause of 22 action, plaintiff TANYA OLSEN complains of defendants, and each 23 of them, and alleges as follows : 24 11 . Plaintiff TANYA OLSEN realleges and incorporates herein 25 by reference each and every allegation contained in the First 26 Cause of Action, inclusive. 27 12 . Plaintiff TANYA OLSEN is and, at all times herein 23 4 1 mentioned, was the lawful wife of plaintiff KENNETH MITCHELL 2 OLSEN. 3 13 . By reason of the premises, plaintiff TANYA OLSEN has 4 suffered loss of support, services, love, companionship, 5 affection, society and other elements of consortium, all to her 6 general damage in an amount in excess of the jurisdictional 7 minimum of this court. 8 WHEREFORE, plaintiffs pray judgment against defendants, and 9 each of them, as follows: 10 1 . For general damages in excess of the jurisdictional 11 minimum of this court, according to proof; 12 2 . For damages for medical and related expenses, according 13 to proof; 14 3 . For damages for loss of earning capacity and loss of 15 earnings, according to proof; 16 4 . For damages for plaintiffs ' other economic losses, 17 according to proof; 18 5 . For interest on general and special damages, as 19 permitted by law; 20 6 . For plaintiffs ' costs of suit incurred herein; and 21 7 . For such other and further relief as the court- deems 22 just and proper. 23 Dated: December 7 , 1994 ,\ 24 HINTOtL-- ALFERT A Profession \ Co oration 25 1 / 26 13 , PETE A R 27 Attorneys for laintiffs 28 5 SUMMONS (CITACION JUDICIAL) FOR COURT Us(UN(I j NOTICE TO DEFENDANT: (Aviso a Acusado) I BUZZ HASKINS EQUIPPIENT CO . , INC . , A & R EQUIPMENT CO . , STEVEN VERN RENWICK, and DOES 1 through 10 , Inclusive , YOU ARE BEING SUED BY PLAINTIFF: (A Ud. le esta demandando) KENNETIi MITCHELL OLSEN and TANYA OLSEN, You have 30 CALENDAR DAYS after this sum- Despues de que le entreguen esta citation judicial Listed mons is served on you to file a typewritten re- fiene tin plazo de 30 DIAS CALENDARIOS para presentar sponse at this court. una respuesta escrita a maquina en esta torte. A letter or phone call will not protect you; your Una Carta o una Ilamada felefonica no le ofreceri typewritten response must be in proper legal proteccirin, su respuesta escrita a maquina tiene que form if you wmaTt the court to rear your case. cumpfli,r cern las formalidades legates ipnopiadas ii Listed ff you do not f e your response-on time,you may qu1em 4te V °Ort`escuche a' "SOI lose the case, and your wages,.money and pro- Si Listed no presenta su respuesta a tiempo, puede perder perty may be takEn without further warning from el vaso, y le pueden quitar su salario,su dinero y ofras cocas the court. de su propiedad sin aviso adicional por parte de la torte. There are other legal requirements. You may Existen otros requisitos legales. Puede que Listed quiera want to call an attorney right away. If you do not llamar a un abogado inmediatamente. Si no conoce a un know an attorney,you may call an attorney refer- abogado, puede llamar a un servicio de referencia de ral service or a legal aid office (listed in the phone abogados o a una olicina de ayuda legal(vea el direclorio book). telefonico). CASE NUMBER. (NurtKro dr/C.so) The name and address of the court is: (E/nombre y direcci6n de la torte es) I 4 ,f3 5 43 7 � SUPERIOR COURT OF CALIFORNIA, COUNTY OF CONTRA COSTA A `P STRU TADORFSs 725 Court Street uAtt-fat;ADDRESS P. 0. Box 911 CrTyAlto Zip CODE MaTtineZ, California 94353 The name, address, and telephone number of plaintiff's anomey,-or plaintiff without an attorney, is: (EI nombre, la direcci6n y el numero de releiono def abogado del demandante, o del demandan(e que no (fiene abogado. e+) PETER W. ALFERT, State Bar No . 83139. HINTON & ALFERT_, A Professional Corporation 1646 North California Boulevard, Suite 600 Walnut Creek, California 94596 ` Telephone : (510) 932-6006 7 i`?'J=! STEPHEN L. WEIR DATE: Clerk, by t( ('4.�2 �I(`) i • Deaut� (Fechjl (Acn(anol IDrlcg.+do ISFALf XMiCE TO THE PERSON SERVED: You are served 1. as an individual defendant. 2. as the person sued under the fictitious name of (specify): 3. 0 on behalf of (specity): Buzz Haskins Equipment Co . , Inc . under: FX-] CCP 416.10 (corporation) CCP 416.60 (minor) OCCP 416.20 (defunct corporation) CCP 416.70 (conservatee) CCP 416.40 (association or partnership) O CCP 416.90 (individual) 0 other: 4. Q by personal delivery on (date): Foam Aaooled by Rule 982 (S" reverse for Proof of Service) Jud'cuf council of cahfomis 9821.1191 Ifl— Jar 'Y 1, 19841 C20 I QM 1-84 SUMMONS ccP 412 20 1 O P O 1 4. 9 4 - O -� O — �2..5 -i- CRD 266 1 C, , G7AKLANL7 Tran w T AF1r' "OLLISIONREP RT • 'Wem i.*1006"W" rm __. wAa1s.+.arfyk-r ►YO,IW wr.e ...I. - � Num mml .a„aat oa.,li.t..t ma "T v"A ""(nt r to ti it Ilt�{MeTw.9tMM1tOR iAr9 ■titV TWAINAT p"Wre"Apod tt1 3 M W T F S M..t ClowI A41MA g r...1■.t■.t.w Jiffirs nam NI'IA40MI'WaL.. a~A 07 Mlpjcs A G•(fir is -- - - MA trt%&"uctrrat MOSS& _ _ [tar[ icA" taAt14r tuft "",mesa, atA An 1 G [12 7qa 'torso u r, tltl ru rrtrt+Arrt.titivt.sa.rt - . F ,o . ' . 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(qtwwCK00TRUCKTRA AjX0 aMTAUOK TR ma R Wr TELILID HEMSN Kim "Weei,tW ft p m No r IT 11Q aKOAD01oa Or"m bus !A V[lit G"AR _ T 0 a al+E)MOEMCT rE(i4 11AWNC Yar. l /P1DYT�AM ■4-1.4iOTM[FOG I VIIIUUTY R, MOTOR V[NCL[IMYOIY 1YI1M TIIIAM IRTO QpVQw"Q wit 0tH •t Nam-CaLumew mmia 10PARK&B wiwq 1i9tlTRAM1p t1 O OTMIR YDTe11Y1114CLA fKAViy�O WR WAY CATUOMT MOTen VE 6W OrW%X RO40MAI OTMKR ASIOGIATIO FACT0401 4R•1 13 00K.caw" PARR[D Y lieu 1 Z 3 I bm trr lastrlll/I ._ DAKII•tTR 0 .1aV 1 dIRt.YOtfaaITUOMt _SrOrOltme DA1IR• TRKIT UGHTS MOT.ACADW1 P PYMcnolRMa A T■ M1pIRa WjAeskv ( lVQ44GTMMLATMI i 1 2 2 "MICA; Mer 4 — r■ (MARK 1 7011 IMI1. iQ_ rOwr•ICT — J n 1 .- .. •_. IMO NOT Nw 10 aUMIRT(.YUasV'elty.ITa) Vral6M eiaEURi YiIIT I ItY TT4rtwR•1 Mte.so?UN641 ITR—Yaw aOAeWAr00MO1ReMIS) ETOP Mltt•IY► M MKWO) (NARK 1 TO I ITEMS) PaOaiTINAWS INVOLKI) 0 TAAF130 *oaR aRYO IAPLVIMa No►119111 TAIAA IxydLymm [M YMO I WYIaM R1YP P NotEI,CEEB Put, Oo Cm SM IN CAOSSWALN ►A[Y104� WilOwLbM . IMra)11 Ilo :trOvrK tIAATIMALoNR6ADWA 13 ATIw 111c'na" jWOMWARVOW1613 CASLI VC nO■Ow ROADTTAI• NOT A►IyAYIQU te ro OaC�SEfH01MeROrWALX,M07 1 •1 �~ KaaP11PAf1atl Ge1Ts1 G1tOM.Ri1AlRwt A?IMTEAaanttes _ aIDVC[D ROADWA ahA -j4t1W GAGSAWALK UwtR.owtrp VitApLa jAmAm99QWI11MAIWAf. F Rom• Dv '1 "O r 0640 Ka,a A• ■ Me VMUil1AL 40MOIT70•a1 IQ RYRAWAT V4WLJ via .A VAI du kA .�. IR1•P1 ,��d9trs ..:.1.`Di�.�ii�ty, 7/Idr''s rte - _ �.C.fjrrtr r1UYSAlIR 444uMl90 M116691%L �,�..CQIttaM ��}-•Core( �� slog ... Oak P.D. ..LOth �>G)/7J► A!AMtrfo 01AQao alma4 iMIA its a O'kaki, 1 16v i-A I OPI ads � J O - CRD ZSS 1 C OAKLAND PO4 PrATR e+cYnVAfe4 1N RED I WITNg§§gS1 PASSENGERS caTworeeO:ey •4 Arts•r S wi.a,u.■ QO erre;C3o�� wrist Q — r wn+oe ►aOtpiart EXTENT OF INJURY( "X" ONE INJURED WAS ( "X" ONE rlATv !uT +rm Nf 1 "a tit - ra■i f ao.a f arr iii .-O rat ►. ■M■ rM< •[a � T nMwe/t h0a ■Sa1. 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U. 1 �. � •� :Ji U .- i.•� � CFif726ta' i C Ot1KLr\ND u5 FACTUAL DIAGRAM ` • '-� rad t as T4 a• a4♦NUa■ •u■ l.•. c hU4 wYeeas op" Atte ..a. - -visata __ .._.._-. L t UretMt T11 fAt /e O IMA7t A140 NOT..TO 1CA64t Ur1Li911 tTATXU I/CALL s r* etwT :SrtL.ea . ' ® I �T Af►r.t4�T SNt.AR ® r��a wwT cna� urge. � �-!cr•Aydwl.T 3KwR iMi _. (g� 3 rr r3111T Stites _ r . = S AOwV PAcy iJGATt�rJ Oft CA F't+f3C A A�ti.O ��h �� wlaewY �G� o� �ASCv Ap : EIQOw-e CUM o%, \AS& RO �..� vlrN POW% Lip -Sul Mr • :s Fr 1 y Y•l ; j0. 14t4 fr " " 7 FT t ,• LIC 3 i ! i* r �r 6tGtti'+�NG _ PiiYs1dakL M\V/ N� Q 491 FT WAL too 4 1M L2L St.tt4S... STr•+ftT 3lY f,,Kr StpF© ANO. = Fr wk IT Fr wfoo ® . ® Z FT OIl4M t�4� .ICOR NAiQk` Cr SlaF (D At.& zh Pr fti: _ s,�.ar 3QtG ter 914" ® AN& 3 FT tJe'-® - ® St er TMti.,- oft,t �A�:R Fu�ti, 41arc � 0R4 W-teJ G L/►ti b �. 4rE1lAt t AWft N Pr arloi: sretim- _ G�iAAOQAtt� _. txtt►�tW1e0 Mils . . 7 M i 1.s�r• _ !i ease" 11111 ee. saw Tt. ■t• 404019 0•rse. — ._. . r0. •a-t •�. �Eb4GQs Io3d" /D -S CHP SSS-081.4 IAer 11.991 Opt 042 ■ _.1 s, �S' � .. /� ire>.• �� a • r� `r .r �J v ..r.._ • • .:-r7-pjJMAW - a A .J U-0661- Ta.3 � � L r: 1 M - ► 1 i a �� • ►' �� " !.' art ... � I 1 0. 1 4. 04 0 4 F d CPD DCG 1 CF' ELAND F 0 ^r EIS ne.r,+ ,u..r.aff•v,wcrsa grrf:tKtp, w Q's'R ras t rr....s..� _ oh.#%Mve IA4Jt, WAIWOUMATf r . cl#QP0uusmf& _ w ar Oy T rlb ri S N4 Te ►'t" .. 18 1LA i= - T ► A R . t n r+j lmJ to J•Z. �til� AMA i.� ok t Yir._ a+ Q r OTS 1gR F4C,-tuAMT4eo - r , ri Ily ?' F vAzT w4 " 61417 - - 47rs, z� T 706 e.4< to ok l . � ' Wr�wrrafr�A ltfrr • M ttlif I O. 14. 94 04 O " F1"1 - CRD 266 1 C , OAKLAND FOS TAV wil -9hor 7- l NTA - ISM- '� 176,1,5- c"? I -Y M trans /Rlarr KI' tt.t1 4 \ ® WAII "A ® COUJUM open Q MURfarlt O tarty a M•fa,b U/O•f1 QtrRlYtffl+w QMtR C] fMtA1C4JtWtpw C3 e„dygm oMtff✓•, G I /� 1 �► t f ftCIT _ IITATM 4 _ rte w0 FA Cr O =ACT A L PJ ro (w, r� tAt o 8. 11 _ Ix- 14. I'14. C—: TWA-r— - ou&P4r - 1 t SAA�' ,,,lr r yy► IBE66tJ 70 7n; 21. Srr , t= ;:ri : o �- f� U! I= YC i.J !' ai r� -444 VVJ T off?+ til = t1itJ i O _, l AL1 .. 70 r o oLAP `i &_' _cl u t,' ,pj 29. GL- 1v 1r4"r r f¢ !tl 1 = 29, f — 131. 7 32. . CHP all _. am t ay. ",-P-WA-MMM s*-PMW M Atl N D R EMENTA DOI off t+R! u sm I y�y c • - �> 1 t.s' 9'0 ' logo � -- _ 7 rot+ •ru Cr wrMH1M y0LLltt'4MtFO�► _ ❑ YVMp01 13 rats wiirruaGO2 , 0 ta•urcx+n. El o1wt71 - Q r.suoer.wraa+u �•••7 , i lCJ�40lltA � OT11P1 I&OW01r�r a tiMCi� d ru a Oar _ FFA At Kt MO 24 VAU 71,1' '-f ." / r 'M Mr1 is r V�= F*► rT n '�" v,1 '7ti1�= 1G` rA u r ' ' L -► + � "r v t / ""F Ir` _ SI-AlrSomn M op to. c t4 Tic, !T - JG=' }r.,o tit" t�;•o i'x 14. tT K el Al r .� ✓ a " o..c}_ is, !rJ r A — t 1 4 Litz Of= S - 1 � std-zo NPH S !1 r QO O ' t ► - r�,ST T ,. S y�to - 21. -7.l t t rQv� (T -n4 tai d tAf- 25, s!> t ! 1 " ems"' CA - V t{.{.. ULj*s4 " dU 2+l, 30, 4 - 32, !Y. O 4 O 4 C, F Dd v C'R'D m.c- 1 C A O A Z:L A-24.0 P 1 -0 - " L Polly 10- 93R Ioza• hum= rv. Pool _ ® kM1ilTM, ® aOWtbr+MPOW MVA.R ❑ v.ea& �tTtlVrurvaR 0 turKlNrrK El ar+,ltt a ,MtM..�.V.il�aN ter. OfYtR u , wt � - G/tuT A wALs L4 biti 3. 14 " k CAA 2t �' r T 1 4 ■L J 1 TA (q I a 1Lt e I NAM 714 - �� n . • � I ♦ 74 � IJP- 10 10. 13, T 100 A._._ w Mo 4 • Ert * t7ts A► ?t,a. tfit& c. Y*:k _. I --- y P L 18. 3'ibA M . 1iT";:,::t 19. (Wits Q 4 Jaih -MPO "i!AE d4 4. VOW 1. V-1 AS' J-2. wMrS uS.1 22. '' a �'T� GL on.1 eL 710 T' ea 25, 4'1 vi J•'Z u a r Aa . 28. AnorJ Ott I-A,pIC r - �i to 29. - VA CO AQP flyS. eq OH4,�VGti� FymrzzrJGvt— AFJ% �rAT81� -r ]1 - 1 ay. -e IJ41 ..--......... tr uet� OCT 1 3 1994 . _ �pAKLpND " CRD 266 1 C} tAL r T Q G! rox 3 � Ilk 0• t"'i rtisuit%$Gaft (�{ wYMUM fir+ (� +WI� Wl1A/N �raas.N1� �roN" i❑' frJr/t,twtMTAI � �R11 V ,weo11 iMitA u JV AA L - Mi Pi 1 045 -1 • dO ewl 10 3 + r furl �+ tw • Tarte t v . ! L - tit l,T _ t u � �• 1 0 M 1p a oo i. Tc z oto � is r { ■ uLAS 3't, r rA��' �w Law Offices of 'ANDRE,SEN AND JAMES Richard E.Andresen 42Not a Partnership 5 MARKET ST STE 900 SACRAMENTO OFFICE Justin D.James PO BOX 193731 Gwendolyn Davis SAN FRANCISCO CA 94119-3731 Karen K.Fettig Roger B.Eliassen (415)541-0920 Theresa L.Heptner Geoffrey Gaidos FAX (415)541-5229 Paul D.LeVeque Cindy Helfand Robert N.Paige Ronald P.Luttringer Michael E.Todd H.Renton Rolph Lorna A.Voboril Helen Santana William P.Schneider 1860 HOWE AVE STE 400 R. Lynn Smith SACRAMENTO CA 95825-1073 Patricia A.Strickland (916)568-3230 Georganne Wood FAX (916)568-3215 RECEIVE® O`,' March 16, 1995 PMI 7 1995 COUNTY OF CONTRA COSTA BOARD OF SUPERVISORS CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. 651 PINE STREET ROOM 106 MARTINEZ, CA 94553 Re : Case : OLSEN V. HASKINS, ET AL. Action: CONTRA COSTA SUPERIOR COURT ACTION NO. : C94-05376 To COUNTY OF CONTRA COSTA BOARD OF SUPERVISORS : Please refer to the instructions below marked with an "X" . [X] We enclose CLAIM AGAINST GOVERNMENTAL ENTITY FOR INDEMNITY AND APPORTIONMENT in the above case . Please file the original and return the file-marked copies in the envelope provided herein. Thank you for your prompt attention to the above matter. Very truly yours, ANDRESEN AND JAMES Ka by Hein, cretary to William P. Schneider Enclosures ra q^� / fn F a C7 Ny. U ID NO LL LLJ 73 ac LLI LLQ -- -'df`` � �`� m �� ¢� ❑ o W _ � rrrrr4 .s'y o c y E ui N ? O m 4 p Z cw} a r= �. �, 4)i- t, ami�.� N a N ' a T ii Kuaa � W ❑❑Om <� QXo' min � Q ° o"m 10 {1^I ! o y o > ro'—C a� .E O j c- } d O d CL cou m o/'j -U N ,O N N cD M CV N Z W S S y. ro Z, =C - 1 m 3s 1 W '".X i0 41 'C7 fJ E m � n „ m L { r »3 u w a� E' a �j Q > > ` m "+ - " =30 t @ C3 h .moi a o 04».XEOmn cl MCC E ^ CY2 m w n O w c cr% _ a> M L w Q .o' `''` m z 2• ax Q=.>- O N ~ c:: (D Q1 rri as INEq•.:, N �� W O .�- N W ik #k 3 u ¢... x.6 3 2.aPi^i m �€ 8 lt7 ip -C ] a> X. O. Y Z tr oma,¢ ou,¢A ' - G 'CJ N 0) C r0 '�"'W 5. r�p+O- W :A Q q j .,`s O .Y- ; W L .0�uj' L ,D..p 0" UC D 4 O U `•�C ca'a y 4 a rn C u- m m m N �fy q, m��4,•�IS � _� `� � N fl�r �"' '_'T w ❑a a $ � w i� v J � C lL Z' ©� '''a O t!Oft * 1 t`. 1 `�+ ❑ tee.�e ti �' 1 i' `� o . °c `u q 9 tom` d r° X 0 Lam.'a,C W Lu a _ to -alk 4 yy1 4 4 5 2 >o r" � � •O '� ��l q-L1 C O Z Q ¢2 U �'S1d 8,.'1- 1 ` o z S U Z z y r4a Da z_ -Q t0 Lw o.= 4Na W Q --� i 4 4+ ❑ ❑; ❑❑ &❑❑ a) C 70c o 0 m C 00 p vruits t ' i C -a ►, 4'd 1 y`"•. t' W a `"w'cl '�" td4 i W ° gg ❑❑❑❑❑ k❑❑ ❑ C� .j t ? n tx QE Ta a Z 2ti,...w. Ci . x oa xpro o pEc.�� , El � ❑❑C�❑❑ I ❑ogymg ❑ g� Z ,L iV ..--`,in tU = o. 88 C Ec m' z m �fP� m - 'yd O � s O iz� < 1 I � Q _p N C r-• d� C C L A:l!a BOARD OF SUPERVISORS OF CONTRA COSTA'COUNTY, CALIFORNIA April 11, 1995 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: $100,000.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Susan Neal ATTORNEY: Arne J. Nelson, Esq. MAR 14 1995 595 Market St. , Ste. 1350 Date received COUNTY C%0UNBEL ADDRESS: San Francisco, CA 94165' BY DELIVERY TO CLERK ON March 14. 1995 "'AR;:;;e_ _ BY MAIL POSTMARKED: Fed Ex March 13, 1995 1. FROM: Clerk of the Board of Supervisors 70: County Counsel Attached is a copy of the above-noted claim. DATED: March 14, 1995 gall BATCHELOR. Clerk . 11. FROM: unty Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. { ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). { ) Other: Dated: _ S BY: Deputy County Counsel 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 Superviscrs 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: BATCHELOR, Clerk, Byall Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant MS shown above. Dated:_ BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator -FEB-15-1995 15:34 FROM CCC RISK MANAGEMENT TO 514152270122 P,01i02 Clair.. to: BOAP.D OF SUPERVISORS'OF CONTRA COSTA COUM = INSTRUCTIONS TO CLAD 0T A. Clai..-s relating to causes of action for death or for injury to person or to per- sonal property or growing crops and shich accrue on or before December 31, 1987, =st be presented not Yater than the 100th day after the accrual. of the cause of aCtion. Claims relating to causes of action for.death or for ic,jury to person or to personal property or growing crops and uriich 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 mumt be filed with the Clerk of the Board of supervisors ,at its office in Room 106, County Administration Building, 651 Pim Street, marti,nez, CA 94553. C. If claim is against a district governed by the Board of Supervit ors, 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 ffl2L'. RE: Claim By } Reserved for Clerk's fixing stamp } SUSAN NEAL SAA RECEIVED Again the County of Contra Costa ) '' or ) 141995 District) CLERK BOAR OF ' 'PERVISORS Fl in name CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-wed District in the am of $ 100,000-00 _ and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) SEPTEMBER 19, 1994 AT APPF40DCMTELY 2:00 P.M. 2. 11h" did the d=ga or injury occur? (Include city and county) PUBLIC�jzIDE WA Z LOCATED ADJACENT TO CCAYRON ROAD AT TIS CONOORD BERT STATION POSES, IN Q:)oom, CALIKiNIA. ...... ..,,+._.._ 3. Now did the damage or injury occur? (Give full details; use extra paper if required) SEE ATPAACEMERr #1 4. What particular act or emission on the part of county or district officers, servants or employees caused the injury or damage? SEE ATTACRvH P #2 lcvr_^} FEB-15-1995 15:35 FROM CCC RISK MANAGEMENT TO 914152270122 P.02i02 5. wnat are -ne names o1' county or district officers, servants or employees causing the damage or Injury,? 5. What damage or injuries do you claim resulted? (Give fill exte•it of injuries or damages claimed. Attach two estimates for auto damage. SEE ATTACHMENT #3 ?• Now was the amount claimed above oomputed? (Include the estimal.ed amount of any prospective injury or damage.) SEE ATTACHMENT #4 9. Names and addresses of witnesses, doctors and hospitals. C. :'1;ROEMr SPENCER, D.D.S. - 2903 SALVIO ST. , CONCORD, CA 94519 RAISER (MARTINEZ) 1O(M - 200 MUIR ROAD, MARTINEZ, CA 94553 9• . List the expenditures you made on acw mt of this accident or injury: DATE ITEM AMOM SEE ATTACHMENT #4 � i i A � R # ! iF .� ii M M !F 1F * � � -� M.• � � # M � � � * � A ! � � • • • * * A • rF Gov. Code.Sec.. 910:2 provide:*,.:rby= t signed by the claimantSEND NOTICES T0: (Attorne ) on his behalf." Name and Address of Attorney ARNE J. NE SON, ESQ. t s Signature 595 MARBLY ', SUITE 1350 37 2 WILIAW PASS ROAD, #2 SAN FRANCISCO, CA 94105 Ad (Address) CA 94519 Telephone No. (415) 227-0300 Telephone No. easeire • 0 9 V I Isrrre • sf ace * 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 sunh Imprisonrpent and fine. 1 TOTAL P.02 DESCRIPTION OF OCCURRENCE: Claimant was walking along a concrete sidewalk adjacent to Clayton Road, near the intersection of Clayton Road and Oakland Road, in the city of Concord, Contra Costa County, leading from the Concord BART Station to the BART Station parking lot, when she tripped as a result of the toe of her shoe striking the raised concrete edge of what appears to be an electrical vault mounted in the sidewalk and covered by metal doors. Said raised concrete edge is approximately one inch to one and one-half inches in height, irregular and at the time of this incident was partially obscured by leaves, gravel and other debris. Claimant fell face forwards onto and over the steel doors of the above-described electrical vault. Claimant attempted to break her fall with her hands against the steel doors, but her hands slid across this relatively smooth metal surface and the left side of her face struck the concrete sidewalk on the far side of the electrical vault. ATTACHMENT 11 NATURE OF INJURY. LOSS OR DAMAGE RESULTING FROM THE INCIDENT: When Claimant's face struck the concrete, this impact pushed her (lower) dental bridgework back into her mouth. This trauma killed the two teeth adjoining the bridgework. The loss of these two teeth now requires Claimant to wear a partial denture plate in place of the bridgework. Claimant further chipped an upper front tooth, has undergone one root canal (at tooth 110) , and has had two teeth removed (nos. 8 and 9) . Claimant sustained facial trauma and severe bruising. Claimant is currently scheduled to have three posts placed in her jaw (at teeth nos. 8,9 and 10) , to undergo two additional root canals (at teeth nos. 8 and 9) and to have three additional crowns placed. Other injuries currently unknown. ATTACHMENT #Z CAUSE OF INJURY. OR DAMAGE: The raised one inch to one and one-half inch, irregular concrete edge of the electrical vault, which edge was partially obscured by debris, located within the above-descrj.bed sidewalk. Said raised edge within the sidewalk created a trap and/or hazard for Claimant and other foreseeable non-negligent users of said sidewalk. ATTACHMENT #3 AMOUNT CLAIMED AS OF DATE OF PRESENTATION OF CLAIM i ESTIMATED AMOUNT OF FUTURE CLAIM Current out-of-pocket dental expenses, for exam, x-rays, root canal tooth 110, two teeth extractions, temporary plate, two porcelain crowns, permanent lower partial plate: approximately $4,481.00. Current medical (non-dental) expenses: approximately $500.00. Loss of earnings for four days disability from legal secretarial position: approximately $1,000.00. Estimate of future dental expenses to be incurred within six (6) months, including posts at teeth nos. 8, 9, 10, root canals at teeth 8 and 9, crowns at teeth nos. 8,9, 10: approximately $3,450.00. Estimate of future lifetime dental expenses for maintenance, routine examination and replacement of the dental repairs necessitated by this subject incident: approximately $IS,000.00. ATTACHMENT *4 't SEI � � LAW OFFICES OF ARNE J. NELSON 03AI303 S95 MARKET STREET SUITE 1350 FACSIMILE SAN FRANCISCO, CALIFORNIA 94105 (415) 227-0122 (415) 227-0300 March 11, 1995 BY FEDERAL EXPRESS DELIVERY Board of Supervisors Room 106, County Administration Building 651 Pine St. Martinez, CA 94553 Attn: Clerk Re: Susan Neal Our File: C397.306 Dear Clerk: Enclosed is an original and one copy of a "Notice of Claim against Contra Cosat County. " Please file the original and return a filed endorsed copy to this office in the enclosed envelope. Thank you for your attention to this matter. Very truly ours, F ES O J. NELSON A e J. Nels n AJN/cc 306\CL Encl: A cc = i N m (FJ N N UO s a1`2:3 z O UM W 1y r� Am- N E 'w7 .4f v t y1.",4, W d m W m puy LI NwoAllLLI o tl] 12, ,-t 1 n 1 �I �� p, t(3o, # o .� i O N O E o V N m5 2 i� Gl d m : E to !� A7 i o f Z v ¢ D m m� CR E p�yyy 1 1//}��a ;� N tna !U - W ❑OOcn v ac X o 0� V }N CO fU O 4 7� � { W W � �r id ; � W�� m 7n' nN ❑E �a C',} iN x o❑ I7 tj > �¢ :{' t- 1U iW IU m 1 m mcg � o d Y i. .Z O W X ¢ _ r. 4r E 10 ILLCA ~' ¢ gQ ❑ ❑ ' 40 v '£ v P 1 }F o ❑ m ;ca a 1 i 4 it cc Cr N >o zy \p J' i g 2 w 3w v� Q?= mz=_3 -c., br. 8 "O 0):B ,wx..m{�'� tf} c"5 ¢ m tgi o w o ow o UA ElC .O N zQa A 4a 3 =w ' r ooh rn LL W, p -Q.. ❑ ❑ ❑ Q❑ ❑❑ LL L'i w vatr'� i Ir r cam `r 1 a k-) ul i El ❑❑El $❑❑ ❑ iiiiii� a !1 ,mom , O."T 'v O m I 41 E o _ as I-- m y 2. p j ��yR O m C v3Efr F, V a o o 'Q .n > z 2-' `:..3 -o c a t- r-. '- cica oQ ti W- x W=" n"- t m 7 r'" a « } a 'm tir a-r ❑ a ❑❑❑Q❑ zQEB ❑§rd a. o Z= E - t o E .LL iU (tn 1 x ` 0 QUO v '0 m L N N > w b 'm 3 CD �_ -° o c a (n c 2 .8 ° in"i r G Q,� m _ r = o Q > = i+ Q t m@ N ` Q -o C Cc 9 w a _ _0 W CVS ® pjO � E °' v 'dCm " C� @ N L Cf3 7 e C c �'S �1 m m !Y 2 N w Q � x r ro a° w v Q = o W b QN w !—"1 '� mJLU m U °L L aGi � tF+ 'Q� CLAIM _ BOARD OF SUPERVISORS OF CON`G'A COS)A COUNTY, CALIFORNIA April 11, 1995 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: Unknown Section 913 and 915.4. Please note all "Warnin " CLAIMANT: Linda Ortega, Anna Duprat, Robert Duprat and I , win ATTORNEY: James D. Burnette, Jr. - MAR 2 2 1995 Thomas P. Greerty Date received COUNTYCOUNSEL ADDRESS: 706 Ferry Street BY DELIVERY TO CLERK ON March 22, 1995 MARTINEZCAUF. Martinez, CA 94553 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. ppHH g DATED: March 22, 1995 8rll DeputyLOR, Clerk - -/ (!4 , Il. FROM: County Counsel TO: Clerk of the Board of Supervisors { ) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: BY: - — Deputy County Counsel Ill. 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 Superviscrs present (vl' 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: 41A / PHIL BATCHELOR, Clerk, By. !/t Po A t11A 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 Bn attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that 1 am now, and at all times herein mentioned, have been a citizen of the Jnited States, over age 18; and that today l 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. )ated: BY: PHIL BATCHELOR by eputy Clerk :C: County Counsel County Administrator Claim`"tCi i E ` 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- 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:r '"Claims' relating'to causes of action o for death 'or'for-injury"to*`pers6n'` or to personal property or growing crops and which accrue on``or,after�ianuary"l, 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 §9ll•2••) rt`41 X4;;1 'tcuilelmi' r ' s:• r`Y. ;? ;S � 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 See. 72 at the end of this W. RE: Claim By LINDA ORTEGA,"f ANNA } Reserved for Clerk's filing stamp DUPRAT, ROBERT DUPRAT and JAMES D. ) RECEIVED BUR�IFT ,�,�•. ...ga ns. the County of ContraCosta W 2 2- 1995 or, CLERK BOARD OF SUPERVISORS District) " 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 $ 1Tnr3pfprm;TSpa and in support of this claim represents as follows: :._....:. ------__----_-__ ---------- 1. When did the damage or injury occur? (Give exact date and hour) September 23, 1994 (date of injury) and November 12, 1994; (date of death) . 2. Where did the damage or injury occur? (Include city and county)'Alhambra valley Road, one mile west of Bear Creek Road, in unincorporated Contra Costa County (9/23/94) and Doctor's Hospital, Pinole, Contra Costa County (11/12/94) -----------------__ ---------___ ..__ ___ _.„_... __.._...__- ---M__.._- dam 3. How did the age or injury occur? (Give full details-"use extra paper it .Q' ::' required) JAMES D. BURNEITE, son of LINDA ORTEGA and father of,ANNA, DUPRAT. ROBERT DUPRAT,.and JAMES D BURNETTE JR. , ,was ,killed� in a motorcycle accident on a: Count maim,,, taineclurider Ythe'supervision and control'of CONTRA COSTA COUNTY- ------- OUNTY. y. `. -__-_--�-�r_.w-.._rl-uwi�,�O:,it 4. Wtiat particular aet'or omission on the part of county or district officers, '� ,:: ' {¢ srvanta'or`emloyees caused the injury+ or damage? JAMES D` B �was killed° as a resu `t1ofu th', ai urea of CONTRA COSTA CONTY't6 properly notify; warn, signal,t°or other- wise give, notice of a raised curb on the County road, to-wit; Alhambra Val"ley`Rriacl`° orie=t mile west of Bear Creek Road, in unincorporated--Contra Costa County. (over) " . 5. What 'are the names of>county. or distr{ict dffieers, .servants;,or employees causing u " the.•damage or injury? unknown' at;.this�-time: N.Y44i44r4ti-44NN44N44N4—N444.sN4N--N4N4N-444444MN4—N44N—S44- 6. What�,damage or injuries do you claim resulted? (Give full extent of injuries„qr $mages claimed. Attach two estimates for auto damage.Claimants' .injuries. include u are' not ,limited to, the death of JAMES. ,D. BURNETI'E and .the, loss of his support, '' love”ci onsideration, help and familial relationship. ��r��-�-4�--MM-4N444-4NN444NN4wN4444 NN4NN4N-4--N4N4-4-4444— �. . How was the amount claimed above computed? (Include the estimated amount of any ,prospective injury or.damage.) undetermined ----=-=-w_N_44N--------+----------- _..4---------------------------------------- 8. . Names and addresses of witnesses, doctors and hospitals. Staffry,tk"DOCTORS' HOSPITAL, PINOLE, CA. Law enforcement and medical personnel at scene of accident. —N---4:N4444-4-4--N-------------------------------N------------------N4444NN-44 9. List,�the,expenditures you made on account of this accident or injury: ATE ITEM AMOUNT Unknown at this time. Gov. Code See. 910.2 provides: J '_ "The claim must be signed by the claimant SEND NOTICES TOs (Attorney orb so son on his behalf." Name and Address of Attorney L THOMASP. GR=TY Clai t' Signa Attorney'„fat ,Law Attorney for, Claimants 706 Ferry 'Street 706 Ferry Street, Martinez CA 94553,;% ; r.� Martinez, CA 94553 Address Telephone,No. 510-370-8400 Telephone No. 510-370-8400 NOTICE Seoticri.,?2 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 eounty�'3ail fora period of not more than one year, by a fine of not.exceeding one .thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,0001 or by both such imprisonment and fine. t r CLAIM BOARD OF SUPERVISORS OF GONTRA.;905TA COUNTY, CALIFORNIA April 11, 1995 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 1V below), given pursuant to Government Code Amount: Unknown Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Johnny Alexander Sanchez, A MinorILI ` } ATTORNEY: Date received ADDRESS: 226 Summerfield Dr. BY DELIVERY TO CLERK ON March 14, 995 COUNTY COUNSEL MAN 6ItlGS vnbrr . Bay Point, CA 94565 via: Housing BY MAIL POSTMARKED: g Authority I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: March 15, 1995 ��IL �ep�tyLOR, Clerk 11. FROM: County Counsel 70: Clerk of the Board of Supervisors (✓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: 3 �� — �7 BY: Deputy County Counsel Ill. 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:Af 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 Rn attorney, you should do so immediately. AFFIDAVIT OF MAILING I derlare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the ,lnited States, over age 16; and that today I deposited in the United States Postal Service in Martinez, ,alifornia, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to Che claimant as shown above. )ated: BY: PHIL BATCHELOR byeputy Clerk :C: County Counsel County Administrator CCarlHARMA Warren & Company Johnny Alexander Sanchez, A Minor California Housing Authority Risk Management Agency226 SUmmerf i el d Dr. Bay Point; CA 94565 HOUSING AUTHORITY OF THE COUNTY OF CONTRA COSTA PUBLIC LIABILITY ACCIDENT/INCIDENT NOTICE SUBMIT VIA MAIL OR FACSIMILE TO: 1.CARL WARREN&CO.,ATTN.:LOU FREIHEIT,CENTRE POINTE,165 LENNON LANE,STE 101,WALNUT CREEK,CA 94598 (800)998-4763 • FAX(510)938-6648 2.ARMTECH,INC.,6939 SUNRISE BLVD.,STE 201,CITRUS HEIGHTS,CA 95610 • 916-726-8324 • FAX 916-726-6558 MEMBER AUTHORITY: Hsg. Auth.of C.C. Co. DATE OF ACCIDENT/INCIDENT: TIME: AM PM LOCATION OF ACCIDENT/INCIDENT: Housing Office NAME: Johnny Alexander Sanchez TENANT?Y N X UNIT TELEPHONE: 510-458-1568 a DATE OF BIRTH: 9/18/7 9 SSN: 5 6 4 - 6 3 - 8 0 2 5 coQ MARRIED?Y N x SPOUSE'S NAME: aa IF NOT A TENANT: o_j ADDRESS: 226 Summerfield Dr. , Bay Point, CA 94565 TELEPHONE: 510-458-1568 MAR 1 4 199 EMPLOYER NAME AND ADDRESS: Daily Ledger 1650 Cavallo Rd, Antioch, CA 94509 z; - ISORS TELEPHONE: 510-757-2525 Ct;nNT:¢�COSTA CO. FULL DESCRIPTION OF I was turning around from my bike and then my bike slip side ways and ACCIDENT/INCIDENT: ow landed on miq side of my right. I had knocked the wind out of me, but then I got o o it back. My legs started to hurt a lot. I couldn't move them or else it started to PK hurt a lot. Uw U)O U p U a DESCRIBE ANY DAMAGE TO TENANTS UNIT: n/a WAS THERE AN INJURY COMPLAINT AT THE TIME OF THE ACCIDENT/INCIDENT? Y X NWAS _ DESCRIBE IIINJURY, IFJURY IBLE ANYORfB el1S fr'umm my-t1ke on my side and I couldn't really feel my legs but at the end they started to hurt a lot. cc Z STATEMENT BY INJURED PARTY: WAS TREATMENT OR TRANSPORTATION RENDERED OR REQUESTED? Y X N__Al gle,%+;,1 : 1Ji.Li�,76lq t1;1c7.x IF SO,WHERE AND BY WHOM?4a/yf. Di41lo /�OS/!• �iq �in�iu�9�nC TELEPHONE: 6 j_0 n LU FULL NAMES ADDRESSES TELEPHONE EMPLOYEE? LU 1' YN— 2. Y 3 3. YN w�_ 0O CLAIM PHON O ASSOCIATED? Y— _ DATE: I E: _ —AM PM MW Cr BY ? 1M IMPORTANT:REPORT MUST BE SIGNED! LAST MINUTE CHECKLIST DATE OF S REP T — 19 1. PHOTOGRAPH ATTACHED? SIGNED2. IF NO PHONE,WRITE"NO PHONE" PRINT NA E: 3. IN CASE OF CHILD,GIVE PARENT'S NAMES. SEND ORIGINAL IMMEDIATELY TO CARL WARREN&CO. 1 st COPY TO ARMTECH;2nd COPY FOR MEMBER CLAIM �• `�� BOARD OF SUPERVISORS OF CONTRA_COSTA�COUNTY, CALIFORNIA April 11, 1995 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: Unknown Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Nakia Smith ' ( ATTORNEY: _96 dl 9 "9''` Date received ADDRESS: BY DELIVERY TO CLERK ON March 14, 1995 OOUNTYCOUNsEL 95 W. Grove Avenue 4437 ..... Richmond, CA 94801 BY MAIL POSTMARKED: via- An11:cin2; Aiit_ h_ n=it�T 3. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. pH gg DATED: March 15, 1995 Buil DeputylOR, Clerk 33. 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: /k —`3.� BY: Deputy County Counsel 311. 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 Superviscrs present W1 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: y�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. rou may seek the advice of an attorney of your choice in connection with this matter. If you want to consult in attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under Penalty of perjury that I Am now, and at all times herein mentioned, have been a citizen of the Jnited States, over age 16; and that today I deposited in'the United States Postal Service in Martinez, :alifornia, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to :he claimant as shown above. )ated: l�'Q 9.r, BY: PHIL BATCHELOR by y put Clerk (1 6"027 :C: County Counsel County Administrator CHARMA Carl Warren & Company California Housing Authority Risk Management Agency Ms. ,Na ki d .Smith 95 W. Grove Avenue, #437 HOUSING AUTHORITY OF THE COUNTY Richmond, CA 94801 OF CONTRA COSTA PUBLIC LIABILITY ACCIDENT/INCIDENT NOTICE SUBMIT VIA MAIL OR FACSIMILE TO: 1.CARL WARREN&CO.,ATTN.:LOU FREIHEIT,CENTRE POINTE,165 LENNON LANE,STE 101,WALNUT CREEK,CA 94598 (800)998-4763 • FAX(510)938-6648 2.ARMTECH,INC.,6939 SUNRISE BLVD.,STE 201,CITRUS HEIGHTS,CA 95610 • 916-726-8324 • FAX 916-726-6558 MEMBER AUTHORITY: Housing Authority of C.C.C. DATEOFACCIDENT/INCIDENT:__7-22-95 TIME: XX AM—PM LOCATION OF ACCIDENT/INCIDENT: 95 W. Grove Avenue. , Richmond Ca 94801 NAME: Nakia Smith TENANT?Y X N UNIT 437 TELEPHONE: 412-9957-message o DATE OF BIRTH: 11-28-74 SSN: 5 4 6 _ 4 1 _ 1 4 7 zz MARRIED?Y N XXSPOUSE'S NAME: F IV F aQIF NOT A TENANT: v_j ADDRESS: TELEPHONE: I9Q EMPLOYER NAME AND ADDRESS: CLERK BOARD OF St I VISORS TELEPHONE: CONTf'.A COSTA CO. FULL DESCRIPTION OF ACCIDENaT/INCIDENT: z - >EE , ow a� �, hktt W UC h `` a DESCRIBE ANY DAMAGE TO TENANTS UNIT 6 t 4 / I 1 WAS THERE AN INJURY COMPLAINT AT THE TIME OF THE ACCIDENT/INCIDENT? Y V N WAS THE INJURY VISIBLE OOBVIO ? Y N — DESCRIBE INJURY, IF ANY: Out S --- c� z STATEMENT BY INJUREDARTY: 3 ll \S (-J )I WAS TREATME T O RANSPORTATION RE DERED OR REQUESTED? Y N (�' IF SO,WHERE AND BY WHOMk. (-b .�1. TELEPHONE 90) w I FULL NAMES ► ADDRESSES TELEPHONE" EMPLOYEE 1. d nn��)or I/v(l knn�?n I�.YI�nb(A)1J Y_N z t= 2. Y N 4J 3: 0 3. Y N Cd _ CLAIM PHONED IN TO ASSOCIATED? Y—N DATE: TIME: —AM, PM v _ . BY WHOM? Terry Moore REPORTED TO: Linda- Russo ' IMP!B�TArrN��T*:�REPQRT MUST BE SIGNED! LAST MINUTE CHECKLIST DATE OF THS PORT:- �}�os0� -I 19 1. PHOTOGRAPH ATTACHED? SIGNED: TITLE: 2. IF NO PHONE,WRITE"NO PHONE" PRINT NAME: 1 3. IN CASE OF CHILD,GIVE PARENT'S NAMES. SEND ORIGINAL IMMEDIATELY TO CARL WARREN&CO. 1st COPY TO ARMTECH;2nd COPY FOR MEMBER RECEIVED ZL`,P 1 * 199 . CLAIM, � ' - -` / • ' BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA April 11 , 1995 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: $4,826.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Stanislaw Sliwak , `� � ATTORNEY: y' 7:+ ) Date received COUNTYCJLINOCRL ADDRESS: 1743 Carriel Dr. , #7 BY DELIVERY TO CLERK ON March 15, 19,954TINEZCALIF. Walnut Creek, CA 94596 BY MAIL POSTMARKED: March.1.14,".1995 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: March 15, ]()()5 gqIL �ep�tyLOR, Clerk 11. FROM: County Counsel TO: Clerk of the Board of Supervisors (L,.KThis 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 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 Superviscrs present W-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. Dated: 19 9S PHIL BATCHELOR, Clerk, By Deputy Clerk If WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the Claimant as shown above. Dated: BY: PHIL BATCHELOR byPeputy Clerk CC: County Counsel County Administrator Claim 'W: BOARD OF SQPERYISORS OF CCRWPRA.LWTA COM= INSTRDCTIONS TO a Angor A. Claims relating to causes of action for death or for injury --o person or to per- sonal property or growing crops and which accrue on or before December 319 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 1911.2.) 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. 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 3 orm. f f 0 • f ! ! • f f • • f f f • i f i • f ! f i ! f f f 4 f f f • • f RE: Claim By ; Reserved for Clerk's filing stamp SLA-w SLIW&K, ) RECEIVE® aair-sthe County of Contra Costa ) or ) MAR 151995 District) CLERK SOARD OF SUPERVISORS Fill in name ) CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of =� 826 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) :FF-C9r2wA-P,Y 2 t q S 2. Where did the damage or injury occur? (Include city and county) M P(P-Tl N E Z- 3. How did the damage or injury occur? (Give full details; use extra paper if required) wRdNGFLJ-LL. .ZN► � C TTIoI✓ op s�4lE 3NlaMF hX IZEFG�n/� y3 Lt L >` t!Y I /V 6- 4. 4. What particular act or omission on the part of county or district offioers, servants or employees caused the injury or damage? nJF-&LI GE70 e- E bP EMPLO I(EEs OF Z). A , L(( Stt-PPO R-7- 'QIVtrloK) 5. What are the names of county or district officers, servants or employees causing . the damage or injury? 51 CSV ke ( 13 I-( S .1-7 , 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. s $2 64/000 t'- •v►-►,: v-e d.�vwa y e.r. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) f-eO( _. �cn� gip,9 7-' B. Names and addresses of Witnesses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMD= Gov. Cade Sec. 310.2 providts: "The claim must be signed by the claimant SO NOTICES TO: (Attorney) or bY some person on his behalf." Name and Address of Attorney Claimant's Signature) 17't 3 CV/-rmti&- W 7 Address Telephone No. Telephone No.(5io� 0/2 - z 757 # * • f # fIr # # # # # # # f # • # 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. Date:03/15/95 From: Stanislaw Sliwak 1743 Carmel Dr#7 Walnut Creek, Ca 94956 Attachment to Claim against Contra Costa County D.A Family Support Division According to Court Order dated 04/19/94,I'm obligated to pay child Support, Case 565317. In April of 1994 my case was transferred to Amador County,where mother of my child lives. In the next 3 months I received requests for payments from Your D.A.Family Support office. In June of 941 made the last payment to your office,and sent a letter to Amador County D�A and Your D.A. office that the next payment I will make to Amador Count D.A. office,which I did. (Exhibit A) Since July of 94, 1 make payments to Amador County D.A.Family Support Office. On 11/19/94 D.A.Family Support in Martinez sent me Child Support warning notice,that I'm 2 months behind my payments and will intercept my Income Tax refund. (Exhibit B) I reply to this notice on 11/28/94. (Exhibit C) In response,D.A. in Martinez notified me that they will send the money to Amador County, ignoring the fact that I had no arrears. (Exhibit D) In my letter dared 12/07/94 I expressed my concern,aslung again to reverse the order. (Exbibit E) Finally on 02/26/95 D.A. Family Support in Martinez,wrongfully intercepted my Income Tax refund by levying. (Exhibit F) Also,1 would like to point on the fact that last year D.A. in Martinez intercepted my Income Tax refund and blamed the I.R.S. for their mistake. (Exhibit G) Sincerely /Stanislaw Sliwak / A) Date: 06/13/94 From: Stanislaw Sliwak 1743 Carmel Dr #7 Walnut Creek, Ca 94596 To: District Attorney Family Support Division 708 Court Street, Suite 102 Jackson, California 95642 D.A. Case No. : 94-CI-6285 Re.: Child Support payment Recently I received an order of Child Support obligations from your Office. I understand that my case has been transferred from Contra Costa County in Martinez to your District. I contacted the case worker in your office by telephone and she said that I need to send the payment directly to your office, without any request from your office. For several years I was making promptly payment to D.A. Office in Martinez by due date which was the 20th of each month. (Acc 565317 ) On 6/9/94 I received another request from D.A. in Martinez. My records are in Martinez and I will make payments to D.A. in Martinez on their request . A note was attached to the monthly statement that if I don ' t pay to D.A. in Martinez, they will issue an order assigning a portion of my wages. The D.A. in Martinez, by a mistake intercepted my income tax return in the amount of $58.00, which is shown in the balance 1st of month column. Later the amount was returned to me, but the record has not been corrected. (See attached copy of the monthly statement , the note, letter sent to me after mistakenly intercepted taxes, and copy of my check sent to D.A. in Martinez) . I do not want D.A. in Martinez to contact my employer . My payments are on time every month. Please contact D.A. Office in Martinez to stop sending me these requests, so I can start making payments to your office. Sincerely / Stanislaw Sliwak / cc: D.A. in Martinez Attachments: copy of monthly statement copy of the note and my check copy of the letter after income tax interception return copy of income tax refund offset notufication r m IF VG 12- CCQ� �r m� � 'I- ea� C ea N N > O as m� ca $ E >. Rl,mCy L L� � mE OE m O= C _ mmgcz 4) m2� m•� 3� E m�V_O 2�ui �� oU . o_ N ,,� r• ` ENE► :°mw react °o 1=030 fn >, � cac vF- � = am E(XD N O .- ci � U) 0W a E. ogL � uj 0 .5 > cc's a ) mmomenti c ,no J ixC a c) 'Now -x- CRt4�ea�«mm a)— (D m eno .Qm t �o �� EN � � o � � m m� E g v cm3z�'� I L11- t v E ; �� o' c-0 uj � c3go� �r > c8 "m c� - _ co - e= r 22 m �� o >.12 C. = � N •• 2 s r W " ..._�- to ; O G r m ~ co f N mom. m O ��rj - CL O � Z c m >.m o z �, -L r-Y m Z 1� LL R C m e 0t a0 ;0 m mNeoc� o go � � � U3 , N >.. .. w Z > M1 i}^dlaN 3 ' p ea cc C m w O Z U OCL t C tA� m _ x g Q yp r � �� Ec '-'o c � �•p e= =r W 8 QU - � o� obi d � c c - 3 3 Eaa Keri N c > m3 � N8a Cc 0t m r=�mcm�' �i� �.o° C7om= >jai O _ _ r�W+ _m 3 m J ~r C N 2.00 N•3 "' E r4S m m o 21 E CL 0-5 �_ o 11 N ea � c6 w mom m �� co �, e= 65cn_L mt o 0 � m 090 mQ � a 0 O cc 4) LL Q O 00 0 p'a :3 .0 Q - ------ -- — -- - - -- = NNN m0 --- -- N eagNLO 9'a Q tV w a'0 E r m c o Y `oa.2 09 m t LL m ~ Em >,2 oto oto � c E 0Lm 0r a c �- m 0LL� 0 ,r� m >,T4= > >1 m �+ 2 Cc N Q.= cn 1.1 W Ili m•� to m m v+ Q p� M4 1� p•L O -- - r. uh- � ir1R1 mo >. fl- 8>> �� tCL6 J fg04 O ? � 'o 10 7mCQ ~ mco � N a uxa © � `� g3gm � a: r �� z ..� � 0. 0 4c 9. mg OOHtaW r"'4n m2 r �J au �. u J O" -g-o a +•� �•c 0 !•� O O N 040 Z u 0 iL K1 i v o0 $ � n o m•$ 0 m N°g z f.M .-1 at 0% i i Date: 11/28/94 From: Stanislaw Sliwak 1743 Carmel Dr #7 Walnut Creek, Ca 94596 To: District Attorney Family Support Division 50 Douglas Drive ste 100 Martinez, California 94553 D.A. Case No. : 565317 Re: Child Support warning notice Recently I received Child Support Warning Notice from your office. The same notice I received last year from your Office. It was sent by mistake, which you corrected after you intercepted my money. I received the intercepted amount, after my intervention, on 04/05/93. You blamed the IRS for your mistake. (See attachment. ) This year you made even worse mistake, my case is not in your DA. My case has been transferred from Contra Costa County to DA in Jackson, California. If you intercept my income tax refund, I will have to take legal action asking for damages due to your wrongful levy and harassment. I suggest you to fix your computer programs or procedures. If you need help: maybe I can assist you. Another problem is to contact you by phone. You ask to leave name, .case number and phone number, and your worker will return a call within FIVE working days. If I miss your -call, I have to wait for another 5 days. Is this the correct way of doing business? Sincerely Stanislaw Sliwak Attachments: copy of the letter after income tax interception return copy cf income tax refund offset notification _ Office of District Attorney Contra Gary T. Yancey, District Attorney Costa - ."� FamilySupport Division PP 50 Douglas Drive County,.. Y,, Gayle Elaine Graham, Director Martinez,California 94553 Osr'4 COUN'� Senior Deputy District Attorney FAX:(510)313-4221 Phone:(510)313-4200 (510)313- /3d1f y Date TO: SUBJECT: `b- MES b—MES AGE a_ %/ -2s �l /LZ-1- Cilr�1. SIGNED L REPLY DATE SIGNED FS-88 (Rev. 9/91) Date: 12/07/94 From: Stanislaw Sliwak 1743 Carmel Dr #7 Walnut Creek, Ca 94596 To: District Attorney Family Support Division 50 Douglas Drive Ste 100 Martinez, California 94553 D.A. Case No. : 565317 y i Re: Child Support warning notice In response to my letter dated 11/28/94 questioning the validity of interception of my income f-Av rAfiinrl r_pi c ed t-hT? , 1.,�. � .. at you w! " SCTlt the money to Amador County. When your Office handled my case, I did not have any arrears. I was making my payments on time. Since you have transferred my case to Amador County, I continue to make promptly payment to District Attorney in Jackson, Ca. I DO NOT HAVE ANY ARREARS. I have to ask this question: SINCE I DO NOT HAVE ANY ARREARS, WHY DO YOU INTERCEPT MY :MONEY? Please reverse your order to intercept my Income Tax refund. I will not ask you to reverse the order again. Sincerely .S��v�,G�,,, -�Cc.•w a.� / Stanislaw Sliwak / Attachment: copy of your reply to my letter from 11/2$/94 iz L�? �L/tet �2�-C��-t� Tc',.-�"e�LC� �'%'�✓ L��"'1`/ Zo 'Ile 7 l /�,, STATE OF CALIFORNIA FRANCHISE TAX BOARD P.O.BOX 9»2867 NOTICE DATE : 02/26/95 -:•' �'\ SACRAMENTO,CALIFORNIA 94267-0041 TAX YEAR 1994 56375-7323 STANISLAW A SLIWAK TAXPAYER SSAN : 563-75-7323 1743 CARMEL DR #7 NOTICE NUMBER : 95-19067889 WALNUT CREEK CA 94596 THE ORGANIZATION(S) LISTED BELOW INDICATED YOU OWE THEM MONEY. THEY HAVE REQUESTED, UNDER CALIFORNIA LAW, THAT YOUR TAX YEAR CREDIT BE REDUCED AND THAT THE MONEY BE SENT TO THEM . STATE DEPT OF SOCIAL SERVICE EC STANISLAW A SLIWAK MIS 9-011 744 P STREET SACRAMENTO CA 95814-2450 916 657-3657 S 826 . 00 YOUR REFUND WAS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1 ,25' . 20 TOTAL AMOUNT OFFSET. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S 826 . 00 BALANCE TO BE REFUNDED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . S 424 .20 PLEASE NOTE THAT WE CANNOT REVERSE THIS ACTION . YOUR QUESTIONS CAN ONLY BE ANSWERED BY CONTACTING THE LISTED ORGANIZATION. J 1 9 0 —> G 0 4. LP x r. 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