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MINUTES - 05021995 - 1.6
:CLAIM I �P BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA May 2, 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; UnlznoiSection 913 and 915.4. Please note all "WarnI ;cings". 6�11TTLA 0 .. CLAIMANT: Michael Doughty ATTORNEY: � APR Q 1995 Date received COUNTYCOUNSEL ADDRESS: 2941 Estudillo St. #47 BY DELIVERY TO CLERK ON April 5 AIF�T� EZ CALIF. Martinez, CA 94553 BY MAIL POSTMARKED: April 4, 1995 1. FROM. Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. 1. DATED: April 5, 1995 VIL DeputylpR, Clerk i1. FROM: County Counsel TO: Clerk of the Board of Supervisors (This claim complies substantially with Sections 910 and 910.2. { ) This claim FAILS to comply substantially with Sections 910 and 910.2, and,we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Datec: -q— / 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. BOAR: 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: gq �PHIL BATCHELOR, Clerk, B 1"- C , Deputy Clerk WARNING (Gov. code section 913) 5utject 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 de:tare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the Jnitee States, over age 18; and that today I deposited in the Unitet States Postal Service in Martinet, :alifornia, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to '" claimant as shown above. )ate : BY: PHIL BATCHELOR b Deputy Clerk a: County Counsel County Administrator r U Q N 0 NSU N ri C 00 GCLtU � � st co © E � V O t.7 C o N O OD o z � � o 0 MICHAEL DOUGHTY, A MinorC�iNj tv Steven & Donna Doughty, Parents. 2941 Estudillo St. , #47 510 Martinez, CA 94553 BOARD OF COMMISSIONERS --- - -- HOUSING AUTHORITY OF THE COUNTY OF CONTRA COSTA cLERKB�ARoo�suPERVIsoRs NIRA COSTA CO. PUBLIC LIABILITY 1IgDEVIDERO 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 2:00 MEMBER AUTHORITY: Contra Costa DATEFACCIDENT/INCIDENT: 03/21/95 TIME:_AM X PM LOCATION OF ACCIDENT/INCIDENT: 2941 Estudil.lo Street, #47, Martinez, CA 9.4553 NAME: Michael Doughty, A Minor (Steven/Donna Dough t,r�NANT?Y X N_ UNIT 47 TELEPHONE: (510) 372-7471 v DATE OF BIRTH: 09/14/82 SSN: 5 4 5 - 7 3 . - 5 4 7 5 Z Z MARRIED?Y_NX SPOUSE'S NAME: Qa (IF NOT A TENANT: 'ADDRESS: CVs -- -' TELEPHONE: `— EMPLOYER NAME AND a ADDRESS: --/V13 TELEPHONE: FULL DESCRIPTION OF ACCIDENT/INCIDENT: Family turned ceiling fan on in living room. Blade from fan oZ broke loose hitting Michael Doughty in the top of his head Ze Ov p:Z a= EZ UW 09 wV oQ DESCRIBE ANY DAMAGE TO TENANTS UNIT: Blade from ceiling fan in living room broken off. WAS THERE AN INJURY COMPLAINT AT THE TIME OF THE ACCIDENT/INCIDENT? YX N— WAS THE INJURY VISIBLE OR OBVIOUS? Y X N DESCRIBE INJURY,IF ANY: Mi rhaPl Doijghty tuttai ned hump the s i ZP of a gooee Pgg on the top of his head. } cc STATEMENT BY INJURED PARTY: My son has a goose egg on his head from the fan. WAS TREATMENT OR TRANSPORTATION RENDERED OR REQUESTED? YX Njt, IF SO,WHERE AND BY WHOM? Mr. Doughty took son to hospi ttal.. TELEPHONE: IY77'?-- • (2A G�YhC� yie LU FULL NAMES ADDRESSES MTZ. CA• f vrS3 TELEPHONE EMPLOYEE? Roo; w 1. oZ Y_N, Z 2. �� !v Y_N 3 3 m ' N • P 0 p CLAIM PHONED IN T�Ui� ? Y X N_ DATE: J TIME: C3� o�A fA7_AM PM aLU BY WHOM? REPORTED TO: Sharon Jackson. Hsg• Manager IMPORTANT:REPORT MUST BE SIGNED/ LAST MINUTE CHECKLIST DATE OF THIS 0(Ny<N:*_ Claim: 19 _ 1. PHOTOGRAPH ATTACHED? SIGNED: '- '� Phone 1 2. IF NO PHONE,WRITE"NO PHONE" PRINT NAME: S 7 l s 3, IN CASE OF CHILD,GIVE PARENT'S NAMES. HOUSING AUTHORITY ' of the COUNTY OF CONTRA COSTA 3133 Estudillo Street • P.O. Box 2759 • Martinez, California 94553 FAX(510)372-0236 RECEIVED -7 l!a Central administration April 4, 1995 APR 5 19% (510)372-0791 ❑ Development/Modernization CLERK BOARD OF SUPERVISORS (510)372-7308 CONTRA COSTA CO. ❑ Fiscal Acct.&Financial Services Ms. Shirley Casillas (510)372-8134 Deputy Clerk ❑ Housing Management (510)372-0796 Board of Supervisors ❑ Housing Operations Contra Costa County (510)372-7400 651 Pine Street ❑ Purchasing Martinez, Ca 94553 (510)687-2198 ❑ Rental Rehab/Technical (510)372-7391 Re: Incident: March 21, 1995 Claimant: Michael Doughty, A Minor Dear Shirley: Enclosed is a copy of a Public Liability Claim form signed by Steven John Doughty, Sr., father of Michael Doughty, a minor. Please.schedule this claim for review and denial by the Board of Commissioners/Supervisors at your earliest convenience. I would appreciate it if you would let me know the date this claim is scheduled for the Agenda. Should you have any questions, or require any additional information, please contact me. cerely, caueline P.Tillman Administrative Services Officer Enclosure :,. . ..... :'i CLAIM ( (P BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA ' May 2, 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: $5,000.00 Section 913 and 915.4. Please note all OWa=in J CLAIMANT: Anthony L. Butcher APR Q " 1995 ATTORNEY: COUNTY COUNSEL Date received MARTINEZ CALIF. ADDRESS: 44 Heather Dr. BY DELIVERY TO CLERK ON April 4, 1995 San Pablo, CA 94806 BY MAIL POSTMARKED: Hand Delivered 1. FROM,: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. April 4 1995 JJIL BATCHELOR, Clerk DATED: p eputy 11. 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 111. 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. BOA;: 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: 9 9 S PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. Code section 913) Wtject to certain exceptions, you have only six (6) months from the date this notice was personally served or ieposited in the mail to file a court action on this claim. See Government Code Section 945.6. lou may seek the advice of an attorney of your choice in connection with this matter. If you want to consult to attorney, you should do so immediately. AFFIDAVIT OF MAILING de.lare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the inited States, over age 18; 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 ate Claimant as shown above. aged: 4q, 3 BY: PHIL BATCHELOR by Deputy Clerk :C: County Counsel County Administrator C1 Sm " BOARD OF SUPERVISORS OF OOMU OWU OOUNPY INMUCTIONS TO CLAIMANT r 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 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 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. T.^ he m is instE th-a l J �.+ ., talc Claim to �611J.71r iwi c Vtiail c'��ic }'iijbllG'' en-Lity, separate ClalIDS 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. fi • • � � ii i • • * • ! / • f f � � i f i • � f f i � � # � � ! � • 1f 1F � • f • IF � � RE: Claim By ) Reserved for Clerk's filing stamp Z 72U T!s ffZ j RECEIVED (��ga�ist�t�Te_T�FFty of Contra Costa_) T� � District) Fill in name ) C CBOMRACOs ACO S The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and- hour) From 5 :00' p.m on March 9, 1995 through 10:00 p.m on March. 9 , 1995 2. Where did the damage or injury occur? (Include city and county) County Mail - Martinez 3. How did the damage or injury occur? (Give full details; use extra paper if required) See attached sheet 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? See attached sheet w 5. 'What are the names of county or district officers, servants or employees causing the da=age or injury? Officer Battle , Contra Costa County Sheffiff' s Department. . 1 ' 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. $5, 000 . 00 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Claimed for the wrongful detainment of Mr. Butcher on 3/9/95 B. Names and addresses of witnesses, doctors and hospitals. Officer Battle , CCC Sherriffs Dept; Barry Kael, Probation Officer (374-3285) ; Mona Sidhu, Public Defender (374-3233) ; Jeff Wilkins, Social Worker (798-3001) 9. List the expenditures you made on account of this accident or injury: DATE ITE?•1 AMOUNT e � � " � � � � e � * � � � �. � � e � se � � * aeeseeee • e • g • ea * ■ * Gov. code Sec. .,,., ' yiv.2 pi�•r'.de5: "The claim must be signed by the claimant MID NOTICES TO: (� , r."Meylio or by some Rerson on his behalf." Name and Address of Attorney y ,�mc TriY.M's4mri..Y'' "'q9'gGN':iv�N�2i � J 7 lUkTmant l 9 tura Address Telephone No. Telephone No. -<7 s a e B o s e e f • o f e e • a' s s e NOTICE Section 72 of the Penal Code provides: "Every person uho, 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 Sail for a period of not more than one year, by a fine of not exceeding one thousand ($11000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($109000, or by both such imprisonment and fine. II w BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT Continuation from previous page 3 . How did the damage or injury occur? County Police wrongly detained Mr. Butcher on March 9, 1995. He was taken to County Jail for booking and held until a secretary informed the officer that Anthony had served all the sentenced time from a previous offense. The County policeman thought that Mr. Butcher had NOT performed the sentenced work furlough time from a previous crime, even though Mr. Butcher had fully served his sentence by the end of May 1994. In addition, Mr. Butcher had been wrongly detained in West County Detention Center, due to this same mistake and released only 3 days before. 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? Despite Mr. Butcher telling the arresting officer of his mistake, the officer took him to the County Jail and detained him for 5 hours. :CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA May 2, 1995c• 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 . , $500000 Section 913 and 915.4. Please note all r gs-6. Amount: CLAIMANT: ,Anthony L. Butcher APR 0 14' 1995 ATTORNEY: COUNTY COUNSEL Date received MARTINEZCALIF. ADDRESS: 44 Heather Dr. BY DELIVERY TO CLERK ON April 4, 1995 San Pablo, CA 94806 BY MAIL POSTMARKED: Hand Delivered I. FR DM: Clerk of the Board of Supervisors 70: County Counsel Attached is a copy of the above-noted claim, DATED: April 4, 1995 IVIL BATCHELOR. Clerkeputy 11. FROM: County Counsel TO: Clerk of the Board of Supervisors {L-J This claim complies substantially with Sections 910 and 910.2. { ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). { ) Other: Dated: %' - S BY: Deputy County Counsel 11. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). ',V. BOA;.; ORDER: By unanimous vote of the Supervisors present This Claim is rejected in full, ( ) Other: I certify that this is a -true and correct copy of the Board's Order entered in its minutes for this date. Date PHIL BATCHELOR, Clerk, By 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 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 in attorney, you should do so immediately. AFFIDAVIT OF MAILING de-clare under penalty of perjury that I am, now, and at all times herein mentioned. have been a citizen of the Initee States, over age 18; 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. sated: BY: PHIL BATCHELOR byCA., - ODeputy Clerk C: County Counsel County Administrator + Cl.t i.m to: HOARD OF SUPERVISORS OF CONTRA COSTA COUM i =, INSTRUCTIONS TO CLAIMANT � + 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 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. L. i tail �:i5iw is a aii.�t Ywi c iiini� zinc public t'I]i.iiy, separate Cl8ims MUSt De filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. 0 s • * 0 • a e * * f i • • * @ # a 9 0 9 a 0 9 * * 8 a a f 0 * 4 • e * 0 # 8 a RE: Claim By ) Reserved for Clerk's filing stamp A,►T RECEIVE® Am) �air�t the Co'u.�ty of Camra Cos ) a or ) District) CLERK r_OARtOF 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 $ s-, and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) From 6 :00' p.m on February 28, 1995 through 6 :00p.r.on March 6 , 1995 2. Where did the damage or injury. occur? (Include city and county) San Pablo Jail; County Jail; W. County Detention Center; Marshall Creek Detention Center. 3. How did the damage or injury occur? (Give full details; use extra paper if required) Please see attached sheet. �. What particular actor omission on the part of county or district officers, servants or employees caused the injury or damage? Anthony told multiple county correctional officials of this mistake but was held without cause for 7 days until the mistake was recognized. 5. What are the names of county or district officers, servants or employees causing ..,.F . the damage or injury? r Unknown 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. $5, 000 . 00 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Damages are claimed for the wrongful taking of Mr. Butcher's freedom for 7 days . B. Names and addresses of witnesses, doctors and hospitals. Mr. Barry Kael , Probation officer (374-3285) ; Ms . Mona Sidhu, Public defender (374-32.33) ; Jeff Wilkins, Social Worker (798-3001) 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT ,} Gov. Code Stec. 910.2% "The claim must be signed by the claimant SEND NOTICES T0: (A�torney) or by some person on his behalf." Name and Address of.+A�tt�rne>y aimantIs Signature Address Telephone No. Telephone No. 5 � 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 tine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. i I • ' r BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT Continuation from previous page 3 . How did the damage or injury occur? Contra Costa County wrongly detained Anthony for 7 days due to an error. The error was in thinking that Anthony had not performed work furlough hours to which he was sentenced from a previous crime. However, no furlough hours were ever and Anthony complete/ served his sentence in the West County Detention Center by the erid of May .1994. CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA May 2, 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: Roland T. Conwell . ' " UT ATTORNEY: - MAR 3 1 1995 Date received COUNTY COUNSEL ADDRESS: 2744 Sacramento St. #103 BY DELIVERY TO CLERK ON March 31 P 1 9q5 MARTINEZCALIF. San Francisco, CA 94115 BY MAIL POSTMARKED: March 30, 1995 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: March 31, 1995 IV1L BATCHOR, Clerk Deputy Il. FROM: County Counsel TO: Clerk of the Board of Supervisors (LoOr;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: "1 ,�j �,S BY: AOL�� Deputy County Counsel Ill. FROM: Clerk of the Ecarc TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. BOAR� ORDER: By unanimous vote of the Supervisors present (r ) 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 �, , .�fl, , 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. lou may seek the advice of an attorney of your choice in connection with this matter. If you want to consult ir. attorney, you should do so immediately. AFFIDAVIT OF MAILING de:lare under penalty of perjury that I am now, and at all times herein mentioned, have been a citi2en of the lnited States, over age 18; and that today I deposited in the unitee States Postal Service in Martinet, :alifornia, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to :he Claimant As shown above. )aged:_ 9 __ BY: PHIL BATCHELOR by Deputy Clerk :L: County Counsel County Administrator Claim to,:. BOARD OF SUERVISORS OF CMU COSTA COUNPY z INSTRUCTIONS TO CLADWT A. Claims relating to causes of action for death or for injuY7--o person or to per- sonal property or growing crops and which accrue en or before December 319 19879 must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue an or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code $911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Roam 106, County Administration Building, 651 Pine Street, Martinez, CA 94553• C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this To_rm e f • • e e a • • • • • e ;� e s f f a e f e s f e e e • f • f e f f a e e • s • �I f f RE: ClaimBy ) Reserved for Clerk's filing stamp q 'n d � �7 111,1)f ' I ) �."-"-"m,,e� - [CLEI11 ECEIVE® ) Against the County of Contra Costa ) E.RO or ) District) Of SUPERVISORS NTRA 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 $ and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) U OA-Y '1 1 1 ------- wry--r 2. Where did the damage or injury occur? (Include city and county) 5a A R, &_Mc n� Lh�rc(- CCsr(_1 COU117Y 3. How did the damage or injury occur? (Give !till details; use extra paper if required) h-rTGXL- eJ Itri<fr, A rte-----�•--•�-------- ---��w------�arw- 4. What particular act or omission on the part of' county or district officers, servants or employees caused the injury or damage? r^Oi1G (ul ' no ci-11 v �, C�`e.Gl % (�e.�e�r � vie Jas i R , c r �����4�e✓y5 dF FI � � f.�m� I� S"�('`'`�`-t� � t,'Si on r�czb� lrTy ,� err^����I Cav art 6 wr --rf &+ r -Durry (over) 5. 'What are the names of county or district officers, servants or employees causing the damage 'or injury? ( 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. ccu,� T u=� c.ac+ d cl-U-et�t z �,ad b �%;, tiK "aw ltkUtu. ' {ir ►+1 ► � O ori t'ervU--i'IT /�Ct O(x»7- 7hU5 i m(Or'%N6- TAX. Penat 1Ti1e S- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 10 rfa G� W 4-,4 S.$Z 4 5�55 9.5 3 PSN`l-})(c 46co T c 4 cab;['I Ty G 11) A X15. Y2- -F) Z-F)r ic-r, y;C c Y19 5 - .13 3(l A).5- ji�r a, -ro ,-c,,I I;Q b; 1 %�� �> � ,� �-)�9 B. Names and addresses of witnesses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT dZI6JI El), TOY, PC natTY 559 5 -S t,iI15-/9!v iflX L bill,-ry -For 1995 4X.03 :00 ! ! ! ! f ! • ! f lal ! ! R f * ! • ! ! ! ! ! ! ! ! ! ! ! ! ! ! • ! Gov. Code Sec. 910.2 provides: 1 "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or-by some person on his behalf." Name and Address of A't,,itllorneyicycR �; .-I' {• Claimant's Signature) ;Oq`1' a.crcrnen 5T lD Address ,75aA --r'ra►1c►`Sc01 GA . pfd l �� Telephone No. Telephone No. 931- Yy Y 7 . 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 offieer, 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 ($109000, or by both such imprisonment and fine. March 1, 1995 To: County of Contra Costa Office of the District Attorney Family Support Division 50 Douglas Drive Ste 100 Martinez, Ca 94553 Contra Costa Board of Supervisors Re: Case Number 686300 SS#422-76-0865 This is my official notice for payment of$5000.00 in personal damages caused me by the Contra Costa District Attorneys Office, Child Support Division. I am making this request as required by the Small Claims Court. My case is as follows: I presently pay child support,for my son Amin Conwell,through wage'assignment to Alameda County, Case number 303642-A. My case worker is Ms B. A. Dunn, (510)639-3090. I have been paying to Alameda County,at the request of Prince Georges County,Md., since 1988. I am current with my payments and I have no arrears. Around August of 1994 I began receiving notices from Contra Costa County District Attorneys Office regarding child support payments for Amin. I responded properly by calling the offices voice mail at 111-1111. I left several messages at (5 10)313-4200 providing my case number and case worker's name and number in Alameda County. The notices continued to arrive. I mailed a letter to this effect with all the pertinent information to the District Attorneys Office. This was unsuccessful. The District Attorneys Office contacted my employer at the time, Compus Services Corp,to start deducting monies from my wage. The District Attorneys Office was informed that a wage assignment already existed,to Alameda County,and that a new wage assignment was not possible. The Compus employee that spoke with the Contra Costa County representative was Stephanie Burrell,Rockville,Md. I kept trying to make contact with the DA office. In January, 1995,I applied for credit to help finance my upcoming marriage in March, 1995. I was denied credit, 4 times,because of derogatory information filed with TRW by the Contra Costa County District Attorneys Office. This information is false and inaccurate. The actual entry with TRW stated that I was deliquent with a past due amount of $4000. I am attaching copies of my TRW credit report for that time frame. To secure the financing needed for my weeding I had to withdraw(ands from my Merrill Lynch Retirement Account in the amount of$8600.00. This caused me a tax liability for 1995 of$4300.00. I am attaching a copy of this transaction. I finally insisted and spoke with several individuals at the DA office. Finally,I spoke with a Ms. Jordan at (510) 313-4200. She informed me that she would correct my credit report. All this did was to change the fact that I was deliquent to state that I was not deliquent but that I was past due$4000. My credit report with TRW is still reflected this way. I am attaching a copy of my latest TRW credit report. I am requesting two things: 1 -$5000.00 for real damages caused me by the DA office,and 2-my credit with TRW and any other credit reporting agency have removed any information from Contra Costa County. I am alloting 30 days for payment of damages before preceeding to Small Claims Court. I am also alloting 30 days for my credit to be corrected. The date I am requesting resolution is April 3, 1995. As time passes the real damages are accumulating as my credit history is still inaccurately reflected by Contra Costa County. After April 3, 1995, if this issue is not satisfactorily resolved, it may become necessary to take the matter to Civil Court as the amount of damage could very easily exceed$5000. Thank you in your consideration of this matter. Roland T. Conwell 2744 Sacramento St. 4103 San Francisco, Ca. 94115 (415) 931-8447 for contact I 4 � e� � S� �� � �� � �`�- q LI �5 G'� ��i� . � � ■moi This is your TRW consumer identification ID#19 1.9 3716 5 61916 57 number.Please refer to this number when you call or write TRW. ROLAND T CONWELL 103 COMPTON CIR #C SAN RAMON, CA 94583 HOW TO READ THIS REPORT: AN EXPLANATORY ENCLOSURE ACCOMPANIES THIS REPORT. IT DESCRIBES YOUR CREDIT RIGHTS AND OTHER HELPFUL INFORMATION. IF THE ENCLOSURE IS MISSING, OR YOU HAVE QUESTIONS ABOUT THIS REPORT, PLEASE CONTACT THE OFFICE LISTED ON THE LAST PAGE. YOUR CREDIT HISTORY: THIS INFORMATION COMES FROM PUBLIC RECORDS OR ORGANIZATIONS THAT HAVE GRANTED CREDIT TO YOU. AN ASTERISK BY AN ACCOUNT INDICATES THAT THIS ITEM MAY REQUIRE FURTHER REVIEW BY A PROSPECTIVE CREDITOR WHEN CHECKING YOUR CREDIT HISTORY. IF YOU BELIEVE ANY OF THE INFORMATION IS INCORRECT, PLEASE LET US KNOW. FOR YOUR CONVENIENCE, A DISPUTE FORM AND INSTRUCTIONS ARE INCLUDED ON THE LAST PAGE OF THIS REPORT. ITEM ACCOUNT NAME DESCRIPTION STATUS/PAYMENTS 1 BANK CARD CENTER THIS CREDIT CARD ACCOUNT AS OF 01/93 THIS ACCOUNT 4300 SOUTH LOUISE WAS OPENED 05/90 AND HAS IS PAID IN FULL BUT WAS 30 SIOUX FALLS,SD 57106 REVOLVING REPAYMENT TERMS. DAYS PAST DUE IN 11/30/92. BANKING YOU HAVE CONTRACTUAL PAYMENT HISTORY: ACCT # RESPONSIBILITY FOR THIS CCICCCCCCCCC/CC 4610078000081455 ACCOUNT AND ARE PRIMARILY RESPONSIBLE FOR ITS PAYMENT. 2 BENEFICIAL CALIFORNIA THIS SECURED LOAN WAS AS OF 07/90 THIS ACCOUNT 7158 REGIONAL STREET OPENED 02/87 AND HAS 36 IS PAID IN FULL AND ALL DUBLIN,CA 94568 MONTH REPAYMENT TERMS. YOU PAYMENTS HAVE BEEN PAID ON FINANCE HAVE CONTRACTUAL TIME. ACCT # RESPONSIBILITY FOR THIS 28773993296 ACCOUNT AND ARE PRIMARILY RESPONSIBLE FOR ITS PAYMENT. THE ORIGINAL AMOUNT OF THIS ACCOUNT IS $2,700. CONSUMER CREDIT REPORT (CDI) A16VOI 01 20 95 08:21 PAGE 1 ITEM ACCOUNT NAME DESCRIPTION STATUS/PAYMENTS 3 BENEFICIAL CALIFORNIA THIS INSTALLMENT SALES AS OF 09/90 THIS .ACCOUNT 7158 REGIONAL STREET LOAN WAS OPENED 09/85 AND IS PAID IN FULL AND ALL DUBLIN,CA 94568 HAS 60 MONTH REPAYMENT PAYMENTS HAVE BEEN PAID ON FINANCE TERMS. YOU HAVE TIME. ACCT # CONTRACTUAL RESPONSIBILITY 98520097912 FOR THIS ACCOUNT AND ARE PRIMARILY RESPONSIBLE FOR ITS PAYMENT. THE AMOUNT OF THIS ACCOUNT IS $1,200. 4 CARDHOLDER MGMT SERVICES THIS CREDIT CARD ACCOUNT AS OF 05/93 THIS ACCOUNT PO BOX 9201 WAS OPENED 01/92 AND HAS IS PAID IN FULL AND ALL OLD BETHPAGE,NY 11804 REVOLVING REPAYMENT TERMS. PAYMENTS HAVE BEEN PAID ON BANKING YOU HAVE CONTRACTUAL TIME. ACCT RESPONSIBILITY FOR THIS 4071241000028312 ACCOUNT AND ARE PRIMARILY RESPONSIBLE FOR ITS PAYMENT. THE CREDIT LIMIT OF THIS ACCOUNT IS $1,500. 5' CARSON PIRIE SCOTT CO THIS CHARGE ACCOUNT WAS AS OF 02/92 THIS ACCOUNT 101 NORTH WOLF ROAD OPENED 12/85 AND HAS IS CURRENT AND ALL HILLSIDE, IL 60162 REVOLVING REPAYMENT TERMS. PAYMENTS HAVE BEEN PAID ON DEPARTMENT STORES YOU HAVE CONTRACTUAL TIME. YOUR BALANCE AS OF ACCT # RESPONSIBILITY FOR THIS 01/02/95 IS $0. 7723836341 ACCOUNT AND ARE PRIMARILY PAYMENT HISTORY: RESPONSIBLE FOR ITS NNNNNNNNNNNN/NNNNNNNNNNNN PAYMENT. THE CREDIT LIMIT OF THIS ACCOUNT IS $243. 6 COMMERCE COLLECTIONS LTD THIS CREDIT EXTENSION, AS OF 03/90 THIS ACCOUNT 111 LINDBERGH AVE #D REVIEW OR OTHER IS PAID IN FULL BUT WAS LIVERMORE,CA 94550 PERMISSIBLE PURPOSE WAS REFERRED TO A CREDIT i COLLECTION SERVICES OPENED 11/89 AND HAS GRANTOR'S INTERNAL ACCT # UNSPECIFIED REPAYMENT COLLECTION DEPARTMENT, 263413 TERMS. YOU HAVE ATTORNEY, OR COLLECTION CONTRACTUAL RESPONSIBTLITY AGENCY IN 07/01/89. FOR THIS ACCOUNT AND ARE PRIMARILY RESPONSIBLE FOR ITS PAYMENT. THE AMOUNT OF THIS ACCOUNT IS LESS THAN $100. CONSUMER CREDIT REPORT (CDI) 01 20 95 08:21 PAGE 2 � ■moi This is your TRW consumer identification ID# 1919 3 716 5 61916 5 7! number.Please refer to this number when you call or write TRW. ROLANDMPTONNL 103 COCIR #C Q SAN RAMON, CA 94583 ��; ITEM CCO TNU NAMEDESCRIPTION STATUS/PAYMENTS 7 / CONTRA COSTA COUNTY THIS FAMILY SUPPORT AS=OF 11%94T.HIS -ACCOUNT ! t i 40 MUIR ROAD ACCOUNT WAS OPENED 09/94 '60"'ISP'A 5� TRUE. YOUR MARTINEZ,CA 94553 AND HAS UNSPECIFIED `BrA�L�ANCE' AS�O;F lla/3t0/94 IS / GOVERNMENT REPAYMENT TERMS. YOU HAVE $v. 5188;iWITH ACCT # CONTRACTUAL RESPONSIBILITY DUEYOUR SCHEDU,L-ED 7000000068630001 FOR THIS ACCOUNT AND ARE MO'N_THLYrPAYMENT I=S--x$375. PRIMARILY RESPONSIBLE FOR TH;0--Lt1SaT P�AkY�M'ENTaRQPORTED ITS PAYMENT. THE ORIGINAL TO` TRW WAS MADE ONDRAT;. AMOUNT OF THIS ACCOUNT IS UNAVAILABLE =; E— UNSPECIFIED. - UNSPECIFIED. HT'STORY;:, 1 C. 8 CONTRA COSTA COUNTY THIS FAMILY SUPPORT AS OF 11/94 THIS ACCOUNT 40 MUIR ROAD ACCOUNT WAS OPENED 09/94 IS CURRENT AND ALL MARTINEZ,CA 94553 AND HAS UNSPECIFIED PAYMENTS HAVE BEEN PAID ON GOVERNMENT REPAYMENT TERMS. YOU HAVE TIME. YOUR BALANCE AS OF ACCT # CONTRACTUAL RESPONSIBILITY 11/30/94 IS $4,588-1--: 7000000068630002 FOR THIS ACCOUNT AND ARE PAYMENT HISTORY: PRIMARILY RESPONSIBLE FOR CC ITS PAYMENT. THE ORIGINAL AMOUNT OF THIS ACCOUNT IS UNJPEC-iFTED. 9 GCCC/MACYS THIS CHARGE ACCOUNT WAS AS OF 12/94 THIS ACCOUNT P 0 BOX 8122 OPENED 12/93 AND HAS IS CURRENT AND ALL MASON,OH 45040 REVOLVING REPAYMENT TERMS. PAYMENTS HAVE BEEN PAID ON FINANCE YOU HAVE CONTRACTUAL TIME. YOUR BALANCE AS OF ACCT # RESPONSIBILITY FOR THIS 12/24/94 IS $1,031. YOUR CL7C50010622145 ACCOUNT AND ARE PRIMARILY SCHEDULED MONTHLY PAYMENT RESPONSIBLE FOR ITS IS $103. THE LAST PAYMENT PAYMENT. THE CREDIT LIMIT REPORTED TO TRW WAS MADE OF THIS ACCOUNT IS $390. ON 11/10/94. PAYMENT THE HIGH BALANCE OF THIS HISTORY: ACCOUNT IS $1,031. CCCCCCCCCCCC CONSUMER CREDIT REPORT (CDI) A16V01 01 20 95 08:21 PAGE 3 ITEM ACCOUNT NAME DESCRIPTION STATUS/PAYMENTS 10 LEVITZ THIS CHARGE ACCOUNT WAS AS OF 12/92 THIS ACCOUNT P 0 BOX 348 OPENED 07/92 AND HAS IS CURRENT AND ALL BROOMFIELD,CO 80038 REVOLVING REPAYMENT TERMS. PAYMENTS HAVE BEEN PAID ON FINANCE YOU HAVE CONTRACTUAL TIME. YOUR BALANCE AS OF ACCT # RESPONSIBILITY FOR THIS 01/17/95 IS $0. THE LAST CC7755641744820 ACCOUNT AND ARE PRIMARILY PAYMENT REPORTED TO TRW RESPONSIBLE FOR ITS WAS MADE ON 10/31/92. PAYMENT. THE HIGH BALANCE OF THIS ACCOUNT IS $1,540. 11 LINCOLN SERVICE CORP THIS VA REAL ESTATE AS OF 01/94 THIS ACCOUNT 1100 WALNUT MORTGAGE WAS OPENED 01/94 IS CURRENT AND ALL OWENSBORO,KY 42301 AND HAS 30 YEAR. REPAYMENT PAYMENTS HAVE BEEN PAID ON FINANCE TERMS. YOU HAVE TIME. YOUR BALANCE AS OF ACCT # CONTRA lu'Ai, RESPONSIBILITY 12/02/94 IS $127,802. YOUR 2983058443 FOR THIS ACCOUNT AND' ARE SCHEDULED MONTHLY PAYMENT PRIMARILY RESPONSIBLE FOR IS $1,005. THE LAST ITS PAYMENT. THE ORIGINAL PAYMENT REPORTED TO TRW AMOUNT OF THIS ACCOUNT IS WAS MADE ON 11/01/94. $129,500. PAYMENT HISTORY: CCCCCC 12 LORD & TAYLOR THIS CHARGE ACCOUNT WAS AS OF 05/88 THIS ACCOUNT. 424 5TH AVENUE OPENED 07/85 AND HAS IS CURRENT AND ALL NEW YORK,NY 10018 REVOLVING REPAYMENT TERMS. PAYMENTS HAVE BEEN PAID ON CLOTHING YOU HAVE CONTRACTUAL TIME. YOUR BALANCE AS OF ACCT # RESPONSIBILITY FOR THIS 12/31/94 IS $0. THE LAST 24396966 ACCOUNT AND ARE PRIMARILY PAYMENT REPORTED TO TRW RESPONSIBLE FOR ITS WAS MADE ON 06/01/88. PAYMENT. THE HIGH BALANCE PAYMENT HISTORY: OF THIS ACCOUNT IS $171. NNNNNNNNNNNN/NNC 13 MERKSAMER JEWELERS THIS CHARGE ACCOUNT WAS AS OF 12/94 THIS ACCOUNT . 2390 E ORANGEWOOD AVE OPENED 12/93 AND HAS IS CURRENT AND ALL ANAHEIM,CA 92806 REVOLVING REPAYMENT TERMS. PAYMENTS HAVE BEEN PAID ON JEWELRY/CAMERAS YOU HAVE CONTRACTUAL TIME. YOUR BALANCE AS OF ACCT it ESPCNSTBILITV FOR THIS 12/23/94 IS $420. YOUR CC9P70149503012 ACCOUNT AND ARE PRIMARILY SCHEDULED MONTHLY PAYMENT RESPONSIBLE FOR ITS IS $41. THE LAST PAYMENT PAYMENT. THE CREDIT LIMIT REPORTED TO TRW WAS MADE OF THIS ACCOUNT IS $1,500. ON 11/10/94. PAYMENT THE HIGH BALANCE OF THIS HISTORY: ACCOUNT IS $810. CCCCCCCCCCCC CONSUMER CREDIT REPORT (CDI) 01 20 95 08:21 PAGE 4 � ■Mi i f ffv This isY identification ca t � tour TRW consume i n if' io n number.Please refer to this number when .. �, �:9��< you call or write TRW. ROLAND T CONWELL '� lO I y 103 COMPTON CIR #C SAN RAMON, CA 94583 ITEM "�N DESCRIPTION STATUS/PAYMENTS 6 - CONTRA COSTA COUNTY THIS FAMILY SUPPORT -�AS-OF 12/94-THIS:ACCOUN,T 4MU ROAD ACCOUNT WAS OPENED 09/94 ENT- 0ANDALL MARTINEZ,CA 94553 AND HAS UNSPECIFIED PAYMENTS HAVE BEENti, ?,A'ID ON GOVERNMENT REPAYMENT TERMS. YOU HAVETIMEYOUR B' h AS OF ACCT �� CONTRACTUAL RESPONSIBILITY12:/.3ti1�/�9.4IS�4$'4�963. 7000000068630002 FOR THIS ACCOUNT AND ARE ��PAYMEN-T.`HIST PRIMARILY RESPONSIBLE FOR``--���a --CCC ITS PAYMENT. THE ORIGINAL AMOUNT OF THIS ACCOUNT IS UNSPECIFIED. 7 GCCC/MACYS THIS CHARGE ACCOUNT WAS AS OF 01/95 THIS ACCOUNT P 0 BOX 8122 OPENED 12/93 AND HAS IS CURRENT AND ALL MASON,OH 45040 REVOLVING REPAYMENT TERMS. PAYMENTS HAVE BEEN PAID ON FINANCE YOU HAVE CONTRACTUAL TIME. YOUR BALANCE AS OF ACCT # RESPONSIBILITY FOR THIS 01/24/95 IS $946. YOUR CL7C50010622145 ACCOUNT AND ARE PRIMARILY SCHEDULED MONTHLY PAYMENT RESPONSIBLE FOR ITS IS $95. THE LAST PAYMENT PAYMENT. THE CREDIT LIMIT REPORTED TO TRW WAS MADE OF THIS ACCOUNT IS $390. ON 01/14/95. PAYMENT THE HIGH BALANCE OF THIS HISTORY: ACCOUNT IS $1,030. CCCCCCCCCCCC/C 8 LEVITZ THIS CHARGE ACCOUNT WAS AS OF 12/92 THIS ACCOUNT P 0 BOX 348 OPENED; 07/92 AND HAS IS CURRENT AND ALL BROOMFIELD,CO 80038 REVOLVING REPAYMENT TERMS. PAYMENTS HAVE BEEN PAID ON FINANCE YOU HAVE CONTRACTUAL TIME. YOUR BALANCE AS OF ACCT # RESPONSIBILITY FOR THIS 02/07/95 IS $0. THE LAST CC7755641744820 ACCOUNT AND ARE PRIMARILY PAYMENT REPORTED TO TRW RESPONSIBLE FOR ITS WAS MADE ON 10/31/92. PAYMENT. THE HIGH BALANCE OF THIS ACCOUNT IS $19540. CONSUMER CREDIT REPORT (CDF) AlOV02 02 12 95 14:19 PAGE 3 ITEM ACCOUNT NAME DESCRIPTION STATUS/PAYMENTS 9 LINCOLN SERVICE CORP THIS VA REAL ESTATE AS OF 01/95 THIS ACCOUNT 1100 WALNUT MORTGAGE WAS OPENED 01/95 IS CURRENT AND ALL OWENSBORO,KY 42301 AND HAS 30 YEAR REPAYMENT PAYMENTS HAVE BEEN PAID ON FINANCE TERMS. YOU HAVE TIME. YOUR BALANCE AS OF ACCT # CONTRACTUAL RESPONSIBILITY 02/02/95 IS $127,548. YOUR 2983058443 FOR THIS ACCOUNT AND ARE SCHEDULED MONTHLY PAYMENT PRIMARILY RESPONSIBLE FOR IS $1,089. THE LAST ITS PAYMENT. THE ORIGINAL PAYMENT REPORTED TO TRW AMOUNT OF THIS ACCOUNT IS WAS MADE ON 01/01/95. $129,500. PAYMENT HISTORY: CCCCCCCC 10 MERKSAMER JEWELERS THIS CHARGE ACCOUNT WAS AS OF 01/95 THIS ACCOUNT 2390 E ORANGEWOOD AVE OPENED 12/93 AND HAS IS CURRENT AND ALL ANAHEIM,CA 92806 REVOLVING REPAYMENT TERMS. PAYMENTS HAVE BEEN PAID ON JEWELRY/CAMERAS YOU HAVE CONTRACTUAL TIME. YOUR BALANCE AS OF ACCT # RESPONSIBILITY FOR THIS. 01/26/95 IS $379. YOUR CC9P70149503012 ACCOUNT AND ARE PRIMARILY SCHEDULED MONTHLY PAYMENT RESPONSIBLE FOR ITS IS $41. THE LAST PAYMENT PAYMENT. THE CREDIT LIMIT REPORTED TO TRW WAS MADE OF THIS ACCOUNT IS $1,500. ON 01/12/95. PAYMENT THE HIGH BALANCE OF THIS HISTORY: ACCOUNT IS $810. CCCCCCCCCCCC/C 11 MRCSI/WARDS THIS CHARGE ACCOUNT WAS AS OF 07/90 THIS ACCOUNT P 0 BOX 29110 OPENED 07/85 AND HAS IS CURRENT AND ALL MERRIAM,KS 66203 REVOLVING REPAYMENT TERMS. PAYMENTS HAVE BEEN PAID ON DEPARTMENT STORES YOU HAVE CONTRACTUAL TIME. YOUR BALANCE AS OF ACCT # RESPONSIBILITY FOR THIS 02/07/95 IS $0. THE LAST CP9CO3358883141 ACCOUNT AND ARE PRIMARILY PAYMENT REPORTED TO TRW RESPONSIBLE FOR ITS WAS MADE ON 02/01/88. PAYMENT. THE HIGH BALANCE OF THIS ACCOUNT IS $200. 12 NASA FEDERAL CREDIT UN THIS UNSECURED LOAN WAS AS OF 04/90 THIS ACCOUNT 500 PRINCE GEORGES CTR B OPENED 03/89 AND HAS 12 IS PAID IN FULL AND ALL UPPER MARLBORO,MD 20772 MONTH REPAYMENT TERMS. YOU PAYMENTS HAVE BEEN PAID ON FINANCE HAVE CONTRACTUAL TIME. ACCT # RESPONSIBILITY FOR THIS 4086222 ACCOUNT AND ARE PRIMARILY RESPONSIBLE FOR ITS PAYMENT. THE ORIGINAL AMOUNT OF THIS ACCOUNT IS $1,400. CONSUMER CREDIT REPORT (CDF) 02 12 95 14:19 PAGE 4 � ■moi This is your TRW consumer identification ID# 1:9193.7 16 5 61.916 5 7 number.Please refer to this number when you call or write TRW. ROLAND T CONWELL 103 COMPTON CIR #C SAN RAMON, CA 94583 ITEM ACCOUNT NAME DESCRIPTION STATUS/PAYMENTS 14 MRCSI/WARDS THIS CHARGE ACCOUNT WAS AS OF 07/90 THIS ACCOUNT P 0 BOX 29110 OPENED 07/85 AND HAS IS CURRENT AND ALL MERRIAM,KS 66203 REVOLVING REPAYMENT TERMS. PAYMENTS HAVE BEEN PAID ON DEPARTMENT STORES YOU HAVE CONTRACTUAL TIME. YOUR BALANCE AS OF ACCT # RESPONSIBILITY FOR THIS 01/12/95 IS $0. THE LAST CP9CO3358883141 ACCOUNT AND ARE PRIMARILY PAYMENT REPORTED TO TRW RESPONSIBLE FOR ITS WAS MADE ON 02/01/88. PAYMENT. THE HIGH BALANCE OF THIS ACCOUNT IS $200. 15 NASA FEDERAL CREDIT UN THIS UNSECURED LOAN WAS AS OF 04/90 THIS ACCOUNT 500 PRINCE GEORGES CTR B OPENED 03/89 AND HAS 12 IS PAID IN FULL AND ALL UPPER MARLBORO,MD 20772 MONTH REPAYMENT TERMS. YOU PAYMENTS HAVE BEEN PAID ON FINANCE HAVE CONTRACTUAL TIME. ACCT # RESPONSIBILITY FOR THIS 4086222 ACCOUNT AND ARE PRIMARILY RESPONSIBLE FOR ITS PAYMENT. THE ORIGINAL AMOUNT OF THIS ACCOUNT IS $1,400. 16 NASA FEDERAL CREDIT UN THIS UNSECU ED LOAN WAS AS OF 02 J89 TNTS A(rnrTT�T 500 PRINCE GEORGES CTR B OPENED 04/85 AND HAS 24 IS PAID IN FULL BUT WAS UPPER MARLBORO,MD 20772 MONTH REPAYMENT TERMS. YOU 150 DAYS DELINQUENT IN FINANCE HAVE CONTRACTUAL 01/01/89. ACCT # RESPONSIBILITY FOR THIS 4086225 ACCOUNT AND ARE PRIMARILY RESPONSIBLE FOR ITS PAYMENT. THE ORIGINAL AMOUNT OF THIS ACCOUNT IS $3,200. CONSUMER CREDIT REPORT (CDI) A16V01 01 20 95 08:21 PAGE 5 ITEM ACCOUNT NAME DESCRIPTION STATUS/PAYMENTS 17 NO AMERICAN MTG CO THIS VA REAL ESTATE AS OF 01/93 THIS ACCOUNT 3883 AIRWAY DR MORTGAGE WAS OPENED 01/92 IS PAID IN FULL AND ALL SANTA ROSA,CA 95403 AND HAS 30 YEAR REPAYMENT PAYMENTS HAVE BEEN PAID ON REAL ESTATE TERMS. YOU HAVE TIME. PAYMENT HISTORY: ACCT # CONTRACTUAL RESPONSIBILITY -CCCC-CCC 362803154 FOR THIS ACCOUNT AND ARE PRIMARILY RESPONSIBLE FOR ITS PAYMENT. THE ORIGINAL AMOUNT OF THIS ACCOUNT IS $126,562. 18 PATELCO CREDIT UNION THIS AUTO LOAN WAS OPENED AS OF 07/92 THIS ACCOUNT 156 2ND STREET 04/88 AND HAS 63 MONTH IS PAID IN FULL AND ALL SAN FRANCISCO,CA 94105 REPAYMENT TERMS. YOU HAVE PAYMENTS HAVE BEEN PAID ON FINANCE CONTRACTUAL RESPONSIBILITY TIME. ACCT # FOR THIS ACCOUNT AND ARE 9434101 PRIMARILY RESPONSIBLE FOR ITS PAYMENT. THE ORIGINAL AMOUNT OF THIS ACCOUNT IS $17,700. 19 PATELCO CREDIT UNION THIS UNSECURED LOAN WAS AS OF 07/93 THIS ACCOUNT 156 2ND STREET OPENED 06/90 AND HAS 73 IS PAID IN FULL AND ALL SAN FRANCISCO,CA 94105 MONTH REPAYMENT TERMS. YOU PAYMENTS HAVE BEEN PAID ON FINANCE HAVE CONTRACTUAL TIME. ACCT # RESPONSIBILITY FOR THIS 9434102 ACCOUNT AND ARE PRIMARILY RESPONSIBLE FOR ITS PAYMENT. THE ORIGINAL AMOUNT OF THIS ACCOUNT IS $8,500. 20 PATELCO CREDIT UNION THIS AUTO LOAN WAS OPENED AS OF 11/94 THIS ACCOUNT 156 2ND STREET 07/92 AND HAS 48 MONTH IS PAID IN FULL AND ALL SAN FRANCISCO,CA 94105 REPAYMENT TERMS. YOU HAVE PAYMENTS HAVE BEEN PAID ON FINANCE CONTRACTUAL RESPONSIBILITY TIME. PAYMENT HISTORY: ACCT .irk MR THIS ACCOUNT AND ARE CCCCcCCCCCCC/CCCCCCCCCCCC 9434103 PRIMARILY RESPONSIBLE FOR ITS PAYMENT. THE ORIGINAL AMOUNT OF THIS ACCOUNT IS $6,259. CONSUMER CREDIT REPORT (CDI) 01 20 95 08:21 PAGE 6 ■Mi /ZII This is your TRW consumer identification ID 1919 3?1fi 5 61916 5?` number.Please refer to this number when you call or write TRW. ROLAND T CONWELL 103 COMPTON CIR #C SAN RAMON, CA 94583 ITEM ACCOUNT NAME DESCRIPTION STATUS/PAYMENTS 21 PATELCO CREDIT UNION THIS UNSECURED LOAN WAS AS OF 12/94 THIS ACCOUNT 156 2ND STREET OPENED 07/93 AND HAS 60 IS CURRENT AND ALL SAN FRANCISCO,CA 94105 MONTH REPAYMENT TERMS. YOU PAYMENTS HAVE BEEN PAID ON FINANCE HAVE CONTRACTUAL TIME. YOUR BALANCE AS OF ACCT # RESPONSIBILITY FOR THIS 12/31/94 IS $10,734. YOUR 9434104 ACCOUNT AND ARE PRIMARILY SCHEDULED MONTHLY PAYMENT RESPONSIBLE FOR ITS IS $320. THE LAST PAYMENT PAYMENT. THE ORIGINAL REPORTED TO TRW WAS MADE AMOUNT OF THIS ACCOUNT IS ON 12/31/94. PAYMENT $14, 105. HISTORY: CCCCCCCCCCCC/CCCCC 22 PATELCO CREDIT UNION THIS SECURED LOAN WAS AS OF 12/94 THIS ACCOUNT 156 2ND STREET OPENED 10/94 AND HAS 5 IS CURRENT AND ALL SAN FRANCISCO,CA 94105 MONTH REPAYMENT TERMS. YOU PAYMENTS HAVE BEEN PAID ON FINANCE HAVE CONTRACTUAL TIME. YOUR BALANCE AS OF ACCT # RESPONSIBILITY FOR THIS 12/31/94 IS $17,045. YOUR 9434105 ACCOUNT AND ARE PRIMARILY SCHEDULED MONTHLY PAYMENT RESPONSIBLE FOR ITS IS $353. THE LAST PAYMENT PAYMENT. THE ORIGINAL REPORTED TO TRW WAS MADE AMOUNT OF THIS ACCOUNT IS ON 12/03/94. PAYMENT $17,.5'4. HISTORY: CC CONSUMER CREDIT REPORT (CDI) A16V01 01 20 95 08:21 PAGE 7 ITEM ACCOUNT NAME DESCRIPTION STATUS/PAYMENTS 23 PATELCO CREDIT UNION THIS CREDIT CARD ACCOUNT AS OF 12/94 THIS ACCOUNT 156 2ND STREET WAS OPENED 07/92 AND HAS IS CURRENT AND ALL SAN FRANCISCO,CA 94105 REVOLVING REPAYMENT TERMS. PAYMENTS HAVE BEEN PAID ON FINANCE YOU HAVE CONTRACTUAL TIME. YOUR BALANCE AS OF ACCT # RESPONSIBILITY FOR THIS 12/31/94 IS $2,763. YOUR 9434130 ACCOUNT AND ARE PRIMARILY SCHEDULED MONTHLY PAYMENT RESPONSIBLE FOR .ITS IS $139. THE LAST PAYMENT PAYMENT. THE CREDIT LIMIT REPORTED TO TRW WAS MADE OF THIS ACCOUNT IS $3,078. ON 12/25/94. PAYMENT THE HIGH BALANCE OF THIS HISTORY: ACCOUNT IS $3,078. CCCCCCCCCCCC 24 PATELCO CREDIT UNION THIS SECURED LOAN WAS AS OF 07/89 THIS ACCOUNT 156 2ND STREET OPENED 05/89 AND HAS 0 IS PAID IN FULL AND ALL SAN FRANCISCO,CA 94105 MONTH REPAYMENT TERMS. YOU PAYMENTS HAVE BEEN PAID ON FINANCE HAVE CONTRACTUAL TIME. ACCT # RESPONSIBILITY FOR THIS 9434160 ACCOUNT AND ARE PRIMARILY RESPONSIBLE FOR ITS PAYMENT. THE ORIGINAL AMOUNT OF THIS ACCOUNT IS $1,000. 25 PATELCO CREDIT UNION THIS SECURED LOAN WAS AS OF 04/92 THIS ACCOUNT 156 2ND STREET OPENED 04/90 AND HAS 24 IS PAID IN FULL AND ALL SAN FRANCISCO,CA 94105 MONTH REPAYMENT TERMS. YOU PAYMENTS HAVE BEEN PAID ON FINANCE HAVE CONTRACTUAL TIME. ACCT # RESPONSIBILITY FOR THIS 9434161 ACCOUNT AND ARE PRIMARILY RESPONSIBLE FOR ITS PAYMENT. THE ORIGINAL AMOUNT OF THIS ACCOUNT IS $2,000. 26 SUBDIVISION MORTGAGE CO THIS VA REAL ESTATE AS OF 01/94 THIS ACCOUNT 3838 CAMINO DEL RIO NO MORTGAGE WAS OPENED 01/93 IS CURRENT AND ALL SAN DIEGO,CA 921^v8 AND '::��5 30 YElun REPAYMENT PAYMENTS HAVE BEEN PAID ON FINANCE TERMS. YOU HAVE TIME. YOUR BALANCE AS OF ACCT # CONTRACTUAL RESPONSIBILITY 04/30/94 IS $0. THE LAST 3300561 FOR THIS ACCOUNT AND ARE PAYMENT REPORTED TO TRW PRIMARILY RESPONSIBLE FOR WAS MADE ON 04/15/94. ITS PAYMENT. THE ORIGINAL PAYMENT HISTORY: AMOUNT OF THIS ACCOUNT IS CCCCC $129,500. CONSUMER CREDIT REPORT (CDI) 01 20 95 08:21 PAGE 8 ■mss i i?vo This is your TRW consumer identification ID# 1919 371:6 5 61916 5 7 number.Please refer to this number when you call or write TRW. ROLAND T CONWELL 103 COMPTON CIR #C SAN RAMON, CA 94583 ITEM ACCOUNT NAME DESCRIPTION STATUS/PAYMENTS 27 THE BANK OF NEW YORK DE THIS CREDIT CARD ACCOUNT AS OF 09/94 THIS ACCOUNT 200 WHITE CLAY CENTER WAS OPENED 06/94 AND HAS IS REPORTED AS A LOST NEWARK,DE 19711 REVOLVING REPAYMENT TERMS. CREDIT CARD. PAYMENT BANKING YOU HAVE CONTRACTUAL HISTORY: ACCT # RESPONSIBILITY FOR THIS CC 5323501810520888 ACCOUNT AND ARE PRIMARILY RESPONSIBLE FOR ITS PAYMENT. THE ORIGINAL AMOUNT OF THIS ACCOUNT IS $5,000. 28 THE BANK OF NEW YORK DE THIS CREDIT CARD ACCOUNT AS OF 12/94 THIS ACCOUNT 200 WHITE CLAY CENTER WAS OPENED 06/94 AND HAS IS CURRENT AND ALL NEWARK,DE 19711 REVOLVING REPAYMENT TERMS. PAYMENTS HAVE BEEN PAID ON BANKING YOU HAVE CONTRACTUAL TIME. YOUR BALANCE AS OF ACCT # RESPONSIBILITY FOR THIS 12/30/94 IS $4,675. YOUR 5323501819052560 ACCOUNT AND ARE PRIMARILY SCHEDULED MONTHLY PAYMENT RESPONSIBLE FOR 'ITS IS $78. THE LAST PAYMENT PAYMENT. THE ORIGINAL REPORTED TO TRW WAS MADE AMOUNT OF THIS ACCOUNT IS ON 12/27/94. PAYMENT $5,000. HISTORY: CCCCCC YOUR CREDIT HISTORY WAS REVIEWED BY: THE FOLLOWING INQUIRIES ARE REPORTED TO THOSE WHO ASK TO REVIEW YOUR CREDIT HISTORY. ITEM ACCOUNT NAME DATE REMARKS 29 PATELCO CREDIT UNION 12/20/93 INQUIRY MADE FOR CREDIT EXTENSION, REVIEW OR 156 2ND STREET OTHER PERMISSIBLE PURPOSE FOR. UNSPECIFIED SAN FRANCISCO,CA 94105 REPAYMENT TERMS. THE AMOUNT IS UNSPECIFIED. FINANCE CONSUMER CREDIT REPORT (CDI) A16V01 01 20 95 08:21 PAGE 9 ITEM ACCOUNT NAME DATE REMARKS 30 PATELCO CREDIT UNION 10/03/94 INQUIRY MADE FOR CREDIT EXTENSION, REVIEW OR 156 2ND STREET OTHER PERMISSIBLE PURPOSE FOR UNSPECIFIED SAN FRANCISCO,CA 94105 REPAYMENT TERMS. THE AMOUNT IS UNSPECIFIED. FINANCE 31 UNCLE CREDIT UNION 09/27/93 INQUIRY MADE FOR CREDIT EXTENSION, REVIEW OR 2100 LAS POSITAS CT OTHER PERMISSIBLE PURPOSE FOR UNSPECIFIED LIVERMORE,CA 94550 REPAYMENT TERMS. THE AMOUNT IS UNSPECIFIED. FINANQE 32 TRANSCENTRAL MORTGAGE 09/01/93 INQUIRY MADE FOR CREDIT EXTENSION, REVIEW OR 374 WEST RICHMOND OTHER PERMISSIBLE PURPOSE FOR UNSPECIFIED GIDDINGS,TX 78942 REPAYMENT TERMS. THE AMOUNT IS UNSPECIFIED. FINANCE 33 CREDIT REPORTS INC 07/13/93 INQUIRY MADE FOR CREDIT EXTENSION, REVIEW OR 5280 CARROLL CANYON #210 OTHER PERMISSIBLE PURPOSE FOR UNSPECIFIED SAN DIEGO,CA 92121 -REPAYMENT TERMS. THE AMOUNT IS UNSPECIFIED. FINANCE 34 WINNERS CIR RESORT INTL 07/08/93 INQUIRY MADE FOR CREDIT EXTENSION, REVIEW OR P 0 BOX 4068 OTHER PERMISSIBLE PURPOSE FOR UNSPECIFIED CARLSBAD,CA 92008 REPAYMENT TERMS. THE AMOUNT IS UNSPECIFIED. REAL ESTATE 35 PATELCO CREDIT UNION 06/22/93 INQUIRY MADE FOR CREDIT EXTENSION, REVIEW OR 156 2ND STREET OTHER PERMISSIBLE PURPOSE FOR UNSPECIFIED SAN FRANCISCO,CA 94105 REPAYMENT TERMS. THE AMOUNT IS UNSPECIFIED. FINANCE 36 GTE MOBILNET 05/14/94 INQUIRY MADE FOR CREDIT EXTENSION, REVIEW OR P 0 BOX 9065 OTHER PERMISSIBLE PURPOSE FOR UNSPECIFIED PLEASANTON,CA 94588 REPAYMENT TERMS. THE AMOUNT IS UNSPECIFIED. UTILITIES 37 CELLULAR ONE 05/07/94 INQUIRY MADE FOR CREDIT EXTENSION, REVIEW OR 651 GATEWAY PL 15TH FL OTHER ?ERT SSIELF PURPOSE 7Ou UNSPF.CIFIE.D SOUTH SAN FRANCI,CA 94080 REPAYMENT TERMS. THE AMOUNT IS UNSPECIFIED. UTILITIES 38 NORWEST FINANCIAL 04/01/93 INQUIRY MADE FOR CREDIT EXTENSION, REVIEW OR 7815 EVERGREEN WAY #1 OTHER PERMISSIBLE PURPOSE FOR UNSPECIFIED EVERETT,WA 98203 REPAYMENT TERMS. THE AMOUNT IS UNSPECIFIED. FINANCE 39 EMPORIUM CAPWELL 03/08/93 INQUIRY MADE FOR CREDIT EXTENSION, REVIEW OR P 0 BOX 52186 OTHER PERMISSIBLE PURPOSE FOR UNSPECIFIED PHOENIX,AZ 85072 REPAYMENT TERMS. THE AMOUNT IS UNSPECIFIED. DEPARTMENT STORES CONSUMER CREDIT REPORT (CDI) 01 20 95 08:21 PAGE 10 ITEM ACCOUNT NAME DATE REMARKS 45 TRW INFORMATION SERVICES 10/10/94 INQUIRY MADE FOR CONSUMER DISCLOSURE OF YOUR P 0 BOX 2103 CREDIT HISTORY. ALLEN,TX 75002 CREDIT BUREAU # 709314211738164838 46 TRW INFORMATION SERVICES 10/05/94 INQUIRY MADE FOR CONSUMER DISCLOSURE OF YOUR P 0 BOX 2103 CREDIT HISTORY. ALLEN,TX 75002 CREDIT BUREAU # 7093142117381648 47 GCCC/MACYS 10/04/94 INQUIRY MADE FOR REVIEW OF YOUR CREDIT HISTORY P 0 BOX 8122 BY YOUR CREDITOR. MASON,OH 45040 DEPARTMENT STORES 48 TRW INFORMATION SERVICES 10/04/94 INQUIRY MADE FOR CONSUMER DISCLOSURE OF YOUR P 0 BOX 2103 CREDIT HISTORY. ALLEN,TX 75002 CREDIT BUREAU # 9578065655741648 49 TRW INFORMATION SERVICES 10/04/94 INQUIRY MADE FOR CONSUMER DISCLOSURE OF YOUR P 0 BOX 2103 CREDIT HISTORY. ALLEN,TX 75002 CREDIT BUREAU # 8066043471071648 50 UNIVERSITY OF MARYLAND 09/07/94 INQUIRY MADE FOR ADDRESS INFORMATION ONLY. UNIV BLVD AT ADELPHI RD COLLEGE PARK,MD 20742 EDUCATION 51 PATELCO CREDIT UNION 09/02/94 INQUIRY MADE FOR REVIEW OF YOUR CREDIT HISTORY 156 2ND STREET BY YOUR CREDITOR. SAN FRANTCTSCO,CA 94105 FINANCE 52 PATELCO CREDIT UNION 08/05/94 INQUIRY MADE FOR REVIEW OF YOUR CREDIT HISTORY 156 2ND STREET BY YOUR CREDITOR. SAN FRANCISCO,CA 94105 FINANCE 53 SIGNET BANK/VIRGINIA 08/02/94 INQUIRY MADE FOR PRESCREEN PROGRAM. YOUR FILE P 0 BOX 26625 WAS MATCHED AGAINST THIS CREDITOR'S CRITERIA TO RICHMOND,VA 23261 DEVELOP A LIST OF NAMES FOR A CREDIT OFFER OR BANKING SERVICE. CONSUMER CREDIT REPORT (CDI) 01 20 95 08:21 PAGE 12 ■M/ This is your TRW consumer identification ID # 191:9 371 b 5 619'16 5 7 number.Please refer to this number when you call or write TRW. ROLAND T CONWELL 103 COMPTON CIR #C SAN RAMON, CA 94583 ITEM ACCOUNT NAME DATE REMARKS 40 FIRST CARD 01/17/95 INQUIRY MADE FOR CREDIT EXTENSION, REVIEW OR FCC NAIL BK 300 KING ST OTHER PERMISSIBLE PURPOSE FOR UNSPECIFIED WILMINGTON,DE 19801 REPAYMENT TERMS. THE AMOUNT IS UNSPECIFIED. BANKING 41 AMERICAN EXPRESS OPTIMA 01/14/95 INQUIRY MADE FOR CREDIT EXTENSION, REVIEW OR 4315 SOUTH 2700 WEST OTHER PERMISSIBLE PURPOSE FOR UNSPECIFIED SALT LAKE CITY,UT 84184 REPAYMENT TERMS. THE AMOUNT IS UNSPECIFIED. NATL CREDIT CARDS 42 PATELCO CREDIT UNION 01/14/93 INQUIRY MADE FOR CREDIT EXTENSION, REVIEW OR 156 2ND STREET OTHER PERMISSIBLE PURPOSE FOR UNSPECIFIED SAN FRANCISCO,CA 94105 REPAYMENT TERMS. THE AMOUNT IS UNSPECIFIED. FINANCE 43 WACHOVIA BANKCARD SVCS 01/11/95 INQUIRY MADE FOR CREDIT EXTENSION, REVIEW OR 3565 PIEDMONT ROAD MC242 OTHER PERMISSIBLE PURPOSE FOR UNSPECIFIED ATLANTA,GA 30305 REPAYMENT TERMS. THE AMOUNT IS UNSPECIFIED. BANKING THE FOLLOWING INQUIRIES ARE NOT REPORTED TO THOSE WHO ASK TO REVIEW YOUR CREDIT HISTORY. THEY ARE INCLUDED SO THAT YOU HAVE A COMPLETE LIST OF TNQUIRIES. ITEM ACCOUNT NAME DATE REMARKS 44 PUBLISHERS CLEARING HSE 10/28/94 INQUIRY MADE FOR PRESCREEN PROGRAM. YOUR FILE 382 CHANNEL DRIVE WAS MATCHED AGAINST THIS CREDITOR`S CRITERIA TO PORT WASHINGTON,NY 11050 DEVELOP A LIST OF NAMES FOR A CREDIT OFFER OR MAIL ORDER HOUSES SERVICE. CONSUMER CREDIT REPORT (CDI) A16V01 01 20 95 08:21 PAGE 11 ■m/ This is your TRW consumer identification ID# 1919 3716 5 61916 57 number.Please refer to this number when you call or write TRW. ROLAND T CONWELL 103 COMPTON CIR #C SAN RAMON, CA 94583 ITEM ACCOUNT NAME DATE REMARKS 54 PATELCO CREDIT UNION 07/26/94 INQUIRY MADE FOR REVIEW OF YOUR CREDIT HISTORY 156 2ND STREET BY YOUR CREDITOR. SAN FRANCISCO,CA 94105 FINANCE 55 GCCC/MACYS 06/28/94 INQUIRY MADE FOR REVIEW OF YOUR CREDIT HISTORY P 0 BOX 8122 BY YOUR CREDITOR. MASON,OH 45040 DEPARTMENT STORES 56 PATELCO CREDIT UNION 06/08/94 INQUIRY MADE FOR REVIEW OF YOUR CREDIT HISTORY 156 2ND STREET BY YOUR CREDITOR. SAN FRANCISCO,CA 94105 FINANCE 57 SIGNET BANK/VIRGINIA 04/12/94 INQUIRY MADE FOR PRESCREEN PROGRAM. YOUR FILE P 0 BOX 26625 WAS MATCHED AGAINST THIS CREDITOR'S CRITERIA TO RICHMOND,VA 23261 DEVELOP A LIST OF NAMES FOR A CREDIT OFFER OR BANKING SERVICE. PLEASE HELP US HELP YOU: AT TRW WE KNOW HOW IMPORTANT YOUR GOOD CREDIT IS TO YOU. IT'S EQUALLY IMPORTANT TO US THAT OUR INFORMATION BE ACCURATE AND UP TO DATE. LISTED BELOW IS THE INFORMATION YOU GAVE US WHEN YOU ASKED FOR THIS REPORT. IF THIS INFORMATION IS NOT CORRECT, OR YOU DID NOT SUPPLY US WITH YOUR FULL NAME, ADDRESS FOR THE PAST 5 YEARS, SOCIAL SECURITY NUMBER AND YEAR OF BIRTH, THIS REPORT MAY NOT BE COMPLETE. IF THIS INFORMATION IS INCOMPLETE OR NOT ACCURATE, PLEASE LET US KNOW. YOUR NAME ROLAND T CONWELL SOCIAL SECURITY # 422760865 CONSUMER CREDIT REPORT (CDI) A16VOl 01 20 95 08:21 PAGE 13 ADDRESS 103 COMPTON CIR #C SAN RAMON, CA 94583 OTHER ADDRESSES 9200 ALCOSA BLVD YEAR OF BIRTH 1955 SAN RAMON CA 94583 IDENTIFICATION INFORMATION: THE FOLLOWING ADDITIONAL INFORMATION HAS BEEN PROVIDED TO US BY ORGANIZATIONS THAT REPORT INFORMATION TO US. ADDRESS 103 C COMPTON CIR 9200 ALCOSTA BLVD SAN RAMON CA 94583 SAN RAMON CA 94583 REPORTED 01/93 BY A TRW MEMBER REPORTED 02/92 BY A TRW MEMBER EMPLOYERS COMPASS SERVICES LAWRENCELIVERMORELABS FROM 10/1/94 THE NUMBER OF INQUIRIES WITH THIS SOCIAL SECURITY # = 4 Social Security Number You Gave Was Issued: 1968 — 1970 CONSUMER CREDIT REPORT (CDI) 01 20 95 08:21 PAGE 14 i Merrill Lynch Statement of Pierce, Fenner & Smith Inc. Retirement Account Member,Securities Investor Protection Corporation(SIPC) ACCOUNT # F/C # PAGE # SOCIAL SEC. # MLPF& S COST FPO 334 86621 1061 1 422-76-0865 ROLAND T CONWELL IRRA FBO ROLAND T CONWELL STATEMENT PERIOD EIN NUMBER 103 COMPTON CIR # C 01/28/95 TO 02/24/95 00-0000000 SAN RAMON CA 94583-1686 FINANCIAL CONSULTANT ACCOUNT ERIC R CLINE TYPE 94583-1686 (510) 866-2400 IRA ROLLOVER OFFICE SERVING YOUR ACCOUNT 3130 CROW CANYON PL GROUND FL SAN RAMON, CA 94583 ***** ACCOUNT SUMMARY ***** 'PRICED PORTFOL I"0 '- - - D I V I-DEND/I-NTEREST--- -- - - AS OF 02/24/95. . . . $1 .25 THIS STATEMENT. . . . . . . . $8.85CR AS OF 01/27/95. . . . $8,637.71 THIS YEAR . . . . . . . . . . . $17.15CR ***** CONTRIBUTION INFORMATION ***** TAX YEAR 1994 TAX YEAR 1995 ROLLOVER DEPOSITS $8,948.00 $.00 ***** DISTRIBUTION INFORMATION ***** TAX YEAR 1994 TAX YEAR 1995 PREMATURE00 $8 595.31 TAXES WITHHELD 9.00 $1859.53 ***** DAILY ACCOUNT ACTIVITY ***** DATE TRANSACTION DESCRIPTION PRICE AMOUNT 01 28 OPENING BALANCE $.74CR 02 03 CHECK PREMATURE CLOSE OUT $7735.78 CK 3348-01810 ROLAND T CONWELL 02 03 JOURNAL ENTRY 02 03 JOURNAL ENTRY t---FEE I NALXFPREMATURE 02 06 SALE 8645 ML RETIRMT RESERVES $8645.82CR FULL LIQUIDATION 02 06 RECEIVED 8645 ML RETIRMT RESERVES 02 13 JOURNAL ENTRY FED TAX-PREMATURE $.12 02 15 JOURNAL ENTRY REV FED TAX-PREMATURE $.12CR 02 21 JOURNAL ENTRY FED TAX-PREMATURE $.12 02 23 JOURNAL ENTRY REV FED TAX-PREMATURE $.12CR 02 24 CLOSING BALANCE $1.25CR ***** CURRENT PORTFOLIO ***** MONEY ACCOUNT OPENING BALANCE CLOSING BALANCE DIVIDENDS/INTEREST AS OF 01/28 AS OF 02/24 THIS STMT. YEAR TO DATE ML RETIREMENT RESERVES $8,636.97 $.00 $8.85 $17.15 THE ML RETIREMENT RESERVES CURRENT MONTH'S EFFECTIVE YIELD WAS 5.52% YEAR-END PLAN VALUE AS OF 12/30/94: $8,854.17 000002-0000306os END OF STATEMENT FEBRUARY, 1995 Please advise your Financial Consultant immediately of any discrepancies on your statement or if you contemplate changing youraddress.When making Inquiries,please,mention your account numberand Merrill Lynch address all correspondence to the office servicing your account.Please retain this statement foryour tax records.See reverse side for explanation of key terms. CODE 5029R(REV 10-93) Terms and Conditions: It is agreed between Merrill Lynch, Pierce, Fenner&Smith Inc. MLPF&S,as a service,maintains a cumulative record of the amount (MLPF&S)and the client; so designated.by you.But,it is your responsibility to determine and. 1.That all transactions are subject to the constitution,rules,regula- report the appropriate deductible/nondeductible contribution tions,customs,usages,rulings and interpretations of the exchange amount on your Federal Income tax return.The amount of nonde- or market and its clearing house,if any,where the transactions are ductible contributions indicated on your statement may not be executed, and if not executed on any exchange, the National accurate if you now maintain, or have ever maintained an IRA with Association of Securities Dealers,Inc.. another firm or institution as custodian or trustee, if any portion of 2.That unless the.client indicates nonacquiescence in writing,this your IRA is transferred from your account, whether incident to a agreement shall inure to the benefit of the successors of MLPF&S divorce or otherwise,or if you fail to notify MLPF&S of any change by merger,consolidation or otherwise and its assigns,and MLPF&S in the deductible/nondeductible status of your contributions.) is authorized to transfer the account of the client to any such Contribution For 19YY Made In 19YY: IRA/SEP Contributions successors or assigns. made between January 1 and April 15 for the previous tax year. 3.That bonds and preferred stocks,which are callable in part and Basic Plan and 403(b) employer contributions may also be made which we hold for clients (except for those held in custodian after the end of the employer's fiscal year. accounts) are held in bulk segregation, and in the event of a call, 6.Other Deposits and Distributions: the securities to be called will be selected by an automated random Rollover Deposits: Deposits of distributions from another selection in which the probability of a client's holdings being retirement plan such as an IRA, pension, profit sharing or 403(b), selected is proportional to the holdings of all clients of such even if directly transferred. securities held in bulk by us. . Transfers In:Retirement plan assets other than rollover deposits, 4.That MLPF&S shall not be responsible for the destruction or loss received directly from a previous custodian or trustee of your of any securities placed in the custody of a foreign bank,broker or retirement plan account. other custodian,resulting from war,civil commotion,enemy action, Voluntary Distributions: Distributions recorded as a return of governmental acts or other causes beyond the control of the Your voluntary contribution in your Basic Plan account based on depository or MLPF&S. the information furnished to MLPF&S by your Plan Administrator. 5. This statement of account shall be deemed conclusive if not Reportable Distributions: All distributions made from your objected to within ten(10)days. account and paid to you during the year ending December 31 that MLPF&S will report to the Internal Revenue Service as required Other Important Information by law. • MLPF&S trades for its own account as an odd-lot dealer, block Taxes Withheld: Federal and/or state income taxes withheld by MLPF positioner,market maker and/or arbitrageur,and at the time off your distributions made from your account during the year transactions it may have had either long or short positions in such endingg December 31. securities, which may have been partially or completely hedged. Deposits di Income Tax Withheld: Deposits of income tax we h •Trades made up to the statement closing date but which settled holding on distributions from Basic (Keogh Plus) and Retirement ent thereafter will appear on your next statement. Selector accounts. • Bond prices used in this evaluation may be obtained from either Premium Payments: Payments made from your account to fund internal or external sources. an insurance contract and not reported pr taxable distributions. • MLPF&S is a member of the Securities Investor Protection Cor- However,the current cost of life insurance protection is taxable and reportable to the IRS annually. poration (SIPC), which protects each securities customer of its Custodial Fee Charge: Fee charge based on most recent avail- member firms in liquidation for up to $500,000 (including up to able quarter's account valuation.Afinal processing fee will be charged $100,000 in cash). Also, MLPF&S has obtained through a major if the account is closed or transferred and the custodial fee for that insurance company,an additional$9.5 million in securities coverage. year has not been charged.Additional fees may be charged for assets (The$100,000 limit for cash remains.)This coverage protects only that require special custodial services. cash and securities held by us. Money fund shares, although 7,Quarterly Dividend/Interest Recap:Quarterly summary of monthly protected by this coverage, are not covered by any governmental dividends on Merrill Lynch Retirement Reserves Money Fund and insurance agency. Merrill Lynch U.S.A.Government Reserves Money Fund and of mon- Our financial statement is available for your personal inspection at thly interest on the Merrill Lynch Insured Investment Account. our offices,or a copy of it will be mailed upon your written request. 8.Your Portfolio:A summary of your investment portfolio,including • We are not a bank and securities offered by us,unless otherwise priced and unpriced securities and money fund positions as of the indicated,are not backed or guaranteed by any bank nor are they closing statement date. insured by the FDIC. Special note on retirement plan accounts holding annuities: Explanation of Key Terms Insurance contract information is provided by the insurance company 1. Account Type: Type of retirement plan account: IRA, IRRA® that issued the contract.Values for annuitized contracts are shown (individual Retirement Rollover Account),Basics^"(Keogh Plus), on the DecemberstatementtoprovideaccountvaluesasofDecember 31 for federal tax reporting purposes only.A SEP Plus®(SEP/IRA)or 403(b)Retirement Selector®Account(RSA). Contract contracts do 2. EIN Number: No Employer Identification Number (EIN) is not necessarily have available cash values.Coontract provisions can required for an IRA,IRRA,SEP or 403(b).For a Basic Plan,for both be obtained from the issuing insurance company. 9. Current /.Yield: The estimated annual income divided by the employer and employee participants, the number is the nine-digit market value of the security as of the statement closing date. EIN assigned to the employer/plan sponsor by the Internal Revenue 10. Estimated Income: The estimated annual amount you would Service.An employer/plan sponsor should obtain a separate EIN for earn on the security, assuming your current account position and the business covered by the plan from the Internal Revenue Service the current dividend remained constant. by completing the IRS form SS-4. Special Note: If your records differ from this information, please 3.Valuation:Value of the assets in your account for which market notify your Note: If o Consultant i writing with a copy of the state- prices are readily available and any cash balance t of the closing ment noting the discrepancy and, if appropriate, any necessary date r f the statement. Prices for assets that are not publicly traded adjustments will be made. may reflect the initial offering or purchase price and not the current value. Prices shown for interests in limited partnerships and other The Internal Revenue Code prescribes limitations, based on cer- securities for which transactions are effected on the Merrill Lynch tain dollar amounts and percentages of annual earned income or Investor Service may represent: (a)the initial public offering price; compensation governing the maximum amount that may annually (b) the initial public offering price as adjusted for any distributions be deposited as a tax deductible or nondeductible contribution to an of capital made; or (c) a valuation provided by the issuer or its IRA IRRA, BASIC,SEP or 403(b) plan. MLPF&S as Custodian,has agent. Therefore these prices may not represent the investment's ndu to confirm that contributions to your IRA,IRRA,BASIC,SEP o current market value and owners may not be able to realize the or 403Yb)account meet such Internal Revenue Service requirements. prices shown. Please note, that adverse tax consequences may result from any 4.Dividend/Interest:Monthly and year-to-date dividends and interest excess contributions made to your account.If any excess amount is earned on our security positions.yea If our account has been to be withdrawn,yyou must nota our Financial Consultant in writing Y ty P Y in order for MLPF&S to comply with your request.You should consult transferred from another MLPF&S office, refer to your previous your own tax advisor to determine appropriate contributions to your month's statement for complete dividend/interest information. account and their designations. Dividends and interest earned in your retirement plan account are normally not reported to the IRS nor are they taxable until they Explanation of Symbols are distributed.Contact your Financial Consultant if you hold a Limited ** Merrill Lynch maintains a fundamental opinion on this Partnership which may generate Unrelated Business Taxable Income. company. Some mutual funds may withhold taxes on undistributed long term N/A Value not available for purpose ofcompiling this statement. capital gains. Taxes may be withheld on dividends from foreign N/N Non-negotiable securities held registered in your name. securities.Contact your Financial Consultant for further information. N/O CUST Non-negotiable Custodian Registration. 5.Contributions: NOCC Options Clearing Corp. IRA: Total of deductible and nondeductible contributions you NPC Interests in assets not registered in the name of nor held made to your Merrill Lynch IRA, IRRA or SEP/IRA for the tax year by us or our nominees and held by you or registered in indicated. your name with the issuer or its agent.Merrill Lynch,Pierce, Employer: For Basic, SEP Plan or 403(b) participants, the con- Fenner&Smith Inc.does not control or act as custodian tribution for the tax year indicated made to your account by your for these investments. employer.(This does not include Salary Deferral contributions,if any.) RD Bonds are changeable from coupon to registered and vice Salary Deferral:SEP and 403(b)contributions your employer has versa without charge. made to your plan as a result of your election to defer a portion of RG Bonds registered for both principal and interest. your annual compensation. *or[] Please see"Explanation of Key Terms",Item 4. IRA Contributions Designated as Nondeductible:That portion of your IRA contributions you have requested MLPF&S to record as nondeductible for Federal Income tax purposes. (Please note that CODE 5029R BACK(REV 10-93) `hyrnrerrs�ebo I O Q Vf O in 1• /� W O _ N.J' ...o +i W C m Irl J ♦ •: a O O H LO wz¢w 20030 c� -+z ocz wacow E ooacoo mr-ot-�- 10 ozoluz (0IxixJ11 WOCZW ixW=� O � ..� m Oz C� a W cz cz • CU1C' r � 1 UVQQJ cQ�� C� C� 0 'N o N '> m r- 0j5 rD �c°) cYC .. o � C � ? C � c�vcnU > Q a nj �. ca C :3 -X m o M `"o co 0 3, spokes `. i d► Cv rv�n etl - cc co S z! t,red i 'fem W,45 hea SfJYt 4r cen,'ct :£ Zcloci lc� , re- -1 c c t C�� � c, a l January 14, 1995 ROLAND T CONWELL 103 COMPTON CIR APT C SAN RAMON CA 94583 RE: #950111041 DEAR: ROLAND T CONWELL, Thank you for your recent application for a Wachovia credit card. Your application has been carefully considered; however, based upon the reason(s) listed below, we will not be able to approve an account for you at this time. DELIN ME NT CRE�DITy HISTOR LENGTH OF EMPLOYMENT In evaluating your application we obtained information from the consumer reporting agency shown below. You can find out what information is in your file by contacting: TRW CONSUMER ASSISTANCE 660 N CENTRAL EXPRESSWAY ALLEN TX 75002 (800) 682-7654 Sincerely, Credit Department P.O. Box 105336 Atlanta, Ga 30348 (404) 842-3722 The Federal Equal Credit Opportunity Act Prohibits creditors from discriminating against credit appli- cants on the basis of race, color, religion, national origin, sex, marital status, age (providing the applicant has the capacity to enter into a binding contract); because all or part of the applicant's income derives from any public assistance program, or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is: Comptroller of the Currency, Southeastern District, 245 Peachtree Center Avenue, Suite 600, Atlanta, GA 30303. DEL /NA3 L 4 43 Sl Lin r--qPtfl u rLI i M LIO --75 r ! BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA May 2, 1995 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Burd 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 "Narn�i-mgs" CLAIMANT: East Bay Municipal Utility District _ AR e 1 1995 ATTORNEY: Verna P. Bromley COUNTYCOUNSEL Office of General Counsel Date received MARTINEZ CALIF. ADDRESS: 375 Eleventh St. BY DELIVERY TO CLERK ON Mar(,h 11 9 1 QA5 Oakland, CA 94.607=1229 BY MAIL POSTMARKED: Hand Delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: March 31, 1995 JJll 9eputy OR, Clerk Deputy tl I]. FROM: County Counsel TO: Clerk of the Board of Supervisors {vy This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.6). ( ) Claim is not timely filed. The Clerk Should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). { ) Other: Dated: BY: Deputy oZ �► Deputy County Counsel III. FROM: Clerk of the SoarC 70: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOA;: OR-DER: 6y unanimous vote of the Supervisors present (✓) Tnis 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 (1Deputy Clerk WARNING (Gov. code section 913) 6tiett 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 or, now, and at all times herein mentioned, have been a citizen of the Jnited States, over age 18; and that today I deposited in the Unitec States Postal Service in 'lartinez, :aiifornia. postage fully prepaid a certified copy of this Board Order and Notice to Claimant. addressed to the Claimant AS Shown above. BY: PHIL BATCHELOR byi-IDeputy Clerk :L: County Counsel County Administrator Attention: Clerk of the Board of Supervisors RECEIVED County of Contra Costa MAR 3 0 1995 651 Pine Street Martinez, CA 94553-1229 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. Claim for Money or Damages Against Contra Costa County Pursuant to Government Code Section 900 et seq. Pursuant to Government Code section 900 et seq., East Bay Municipal Utility District ("the District") presents the following claim: (a) Name and post office address of the claimant: East Bay Municipal Utility District, 375 Eleventh Street, Oakland, California 94607-4240. (b) Post Office Address To Which the Person Presenting The Claim Desires Notices To Be Sent: Verna P. Bromley, Office of General Counsel, East Bay Municipal Utility District, 375 Eleventh Street, Oakland, California 94607-4240, P. O. Box 24055, Oakland, California 94623- 1055. (c) The Date. Place and Other Circumstances Of The Occurrence Or Transaction Which Gave Rise To The Claim Asserted: On or about March 30, 1995, and in order to obtain a building permit for the construction of the District's Watershed Headquarter Improvements Project located at 500 San Pablo Dam Road, Orinda, California, the County of Contra Costa assessed and the District paid under protest a traffic area of benefit assessment fee in the amount of$18,440.96. Said fee was improperly imposed upon the District, a public agency for the reasons set forth below. (d) General Description Of The Indebtedness. Obligation,_ njury, Damage Or Loss Incurred: On or about March 30, 1995, and in order to obtain a building permit for EBMUD's Watershed Headquarter Improvements Project, 500 San Pablo Dam Road, Orinda, California, the County of Contra Costa assessed and the District paid under protest a traffic area of benefit assessment fee in the amount of$18,440.96. Said fee was and is improperly imposed upon the District, a public agency. The traffic area of benefit assessment fee is an improper special assessment and/or tax from which the District is exempt (San Marcos Water District v. San Marcos Unified School District (1986) 42 Cal.3d 154; Sacramento Municipal Utility District v. County of Sonoma (1991) 235 Cal.App.3d 726). Additionally, the traffic area of benefit assessment fee is not a fee which may be properly imposed upon the District pursuant to Government Code sections 6103, 53091, 66484 or Contra Costa County Ordinance Chapter 913-6. Additionally, there is no reasonable relationship between the traffic area of benefit assessment fee imposed upon the District and the impacts of the District's Project. As set forth in the Negative Declaration for the Project approved by the District's Board of Directors on June 22, 1993 and approved by the Community Development Department of the County of Contra Costa on or about May 31, 1994, there are no significant traffic impacts associated with the Project. As set forth in the County's environmental checklist for the Project, "existing transportation systems or parking facilities will not be significantly impacted by the proposed Project." (Environmental Checklist- page 11). wAmisc\vpb\claimdmg 1 J (e) Name(s)Of The Public Employee(s) Causing The Injury, Damage, Or Loss: The fee was imposed by the County of Contra Costa through its Growth Management and Economic Development Agency, Mr. Val Alexeeff, Director. (f) Amount Claimed: The District has paid the improperly assessed fee in the amount of $18,440.96. Jurisdiction over this claim would rest in Municipal Court. Dated: March 30, 1995 EAST BAY MUNICIPAL UTILITY DISTRICT OFFICE OF GENERAL COUNSEL By— 6&—&—nZ3 Verna P. Bro ey Attorneys for Claimant EAST BAY MUNICIPAL UTILITY DISTRICT wAmisc\vpb\claimdmg 2 4 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA May 2, 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: $52.76 Section 913 and 915.4. Please note all *warnings". CLAIMANT: Dave Hogan ATTORNEY: Date received ADDRESS: 3531 Skylark Dr. BY DELIVERY TO CLERK ON March 31, 1995 Concord, cA 94520 BY MAIL POSTMARKED: March 30, 1995 1. FROM,: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. p DATED: March 31 199 5 B11L BATCHELOR, Clerk 11. FROM: County Counsel TO: Clerk of the Board of Supervisors { L4-*I 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 910.6). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). { ) Other: Dated: _''�— 3 � �� BY: Deputy County Counsel �f 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. BOA;: ORDER: Bj 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: 1995' 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 in attorney, you should do so immediately. AFFIDAVIT OF MAILING 1 de: tihere lere under penalty of perjury that I am now, and at all mes hen mentioned, have been a citi2en of the irlited 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. .,ated: 9 BY: PHIL BATCHELOR by puty Clerk :L: County Counsel County Administrator Clam: to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY . INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for-death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 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 for- RE: Claim By ) Reserved for Clerk's filing stamp R c ) 'E fr Against the County of Contra Costa ) SIF 3 t �A or CLERK BOAk; Jr SUP RS District) GOI�I�` "TACO, > Fill in name ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ ;77 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 2-*3 0 2. Where di Vle damage or injury occur? (Include city and county) 3. How did the damage or injury .occur? (Give full details; use extra paper i required) AW 4. What particular act or omiss' n on the t of county or district officers, servants or employees caused the injury or damage? ;over) �. wnat are the names of county or district officers, servants or employees causing the ca age or in jury? 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) kVC G; $. 'Names and addresses of witnesses, doctors and hospitals. 9. List the exp nditures you made on account of this accident or injury: DATE ITEM- AMOUNT / r re8C�-13—X15.7 6 Irri C) ft phis a,U U Gov. Code Sec. 910:2 provides: - - "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by gqme person on his behalf." Name and Address of Attorney claim= 's si. ure S�cu)��k fir , dress Telephone No. Telephone No. k-/d OIL-55 Cl * * * « * « * « « 1F 3F �F'iF « 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 imprisonrjent and fine. CUSTOMER j� _ swg CBEnmcnaoINVOIC $PER ';uv .OMER P.O..AIUMBER y•` NUMBERr ;,� I lit"Tomic STOIR" E NQ;' ..CUSTOMER N4).•) K C NAME "a s vrs;-+• r .` ..,, 771 a CANT"COSTA=� BLVD 09NCORD,CA 04026. JNE NO.. T.7. TICKET NUMBER C.D O "'-� - / (S1Q). .� lQ ' M may.., y - R %!` f 4i""04 + �+► sT z,P #ADID!'9M E` VEHICLE LICENSE N0. TALE VEHIQE MI A J PA�CAD9ilf ISO**" r'MISCELLANEOUS X CODES YOUR SERVICE ADVIS COURTESY CHECKno `{ FIRESTONEFE B SERVICE C61�ERS NATIONWIDE LIMITED WARRANTY ON VEHICLE INSPECTION AuroMopVE sBACE'IS fORb 1¢lpcajTfjS QR MILES-WHICHEVER COMES FIRST. TIME IN TIME PROMISED ' SEE ATTACHED i = x QUESTED MENDED r ]!E -ow- - LEAVINGWAITING [] C LE UN MBER * Q UT! I_ PRICE ' . p R QN= EXTENSION ART$D .. � 7 t t ' � a� "-a"k n s _ c �V r x wa I "ITk t [ r �R �Iyk yt7J•�]N b ft M.f x OT E�y'�� &v. � 3r� ALL PARTS NEIN UNLESS SPECIFlED'OTHERWISE' d + � �s x ir',� s+� � 'i•t i^ ;�+ d '.s,.a {"C 3 . �'L��-r;.:e �'>�s;. r•c .- � s r '� 4:. ,2',,���u� s->T 't�r�` qTb a � >i � .� s�� - -LE NUMBER ON� * _ UNIT PRICE `;•: :LAf3QppESCRIPji�ly,•', EXTENSION 2 Iy s 39/db93� If vEHi LE Ir�SPECTiON/CQCJRTESY CHECK y� SERVICED BY vUMBER -> x sR ` CERTIFIED BY L909r a � REVISED ES1IMATE REVISED ESTIMATE APPROVAL PFRSON CONTACTED PARTS A OWLEDGF.THAT I HAVE REVIEWED.THIS ESTIMATE Of REPAIR ANgrERVICE YV�7�K ` 4"roy =�ygOR " HON — . TEIEP ENO. AUTHORIZE THE ABOVE WORK TO BE.DONE, INCLUDING THEtgJgICATED PART4,, r '� R,AND PROMISE TO PAY FOk ALL SUCH WORK`I GRANT PEI gtION TO OPERA LATE/Wc - :NCED CAR, TRUCK OR VEHICLE ON STREETS,H GH4iAYS!'4"k Y✓H <IE 0 t s TAX )F INSPECTION AND/OR Try ZING.i UNDERSTANDTHAT AlL C, MS AND RETI <t :TOTAL s T *+. By C OMP NIED BY THIS INVOICE,E. Xb 4 ( TE > NOT EQUEST THE RLTURN Of R LACED PARTS,rf r A tt f FHAVE RECEIVED OOD AND/OR ERVICES AND AGREE TO PAY.AND T t t COMPLY i CAR OLDER_ EEM T WITH'THE ISSUER. CUSTOMEy SIGNATU IER'S SIGNATURE t ! .. r ro READ PORTANT CONSU INFORMATION ON BACK. H q, t - ns ! P i� �d � � 7 60 o ) g CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA May 2, 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: $30,000.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Eleanor M. Kerlinger for Margaret Burbank AT70RNEY: a Date received AR 3 1 T95 ADDRESS: 333:-Abbott Lane BY DELIVERY TO CLERK ON March 31, 1995 C®U;VTYC®UNSEL Alamo, CA 94507 mArl I Nt_-Z CALIF. BY MAIL POSTMARKED: Hand Delivered 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. t� gg DATED: March'31 1995 JJDeputylOR, ClerkJiL It 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: tee— (_VVVuftWJL--S— Dated: / — 3 BYDeputy County Counsel III. FROM: Clerk of the board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BDA; OR-ER: By unanimous vote cf 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-- a PHIL BATCHELOR, Clerk, By� . Deputy Clerk WARNING (Gov, code section 913) iutject to certain exceptions, you have only six (6) months from the date this notice was personally served or iepasited 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 declare under penalty of perjury that I ami now, and at all times herein mentioned, have been a citiZen of the )nited States, over age 18; 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 :ne claimant As shown above. )a-t e t 01s BY: PHIL BATCHELOR by Deputy Clerk L: Lounty Counsel County Administrator v Cla-;- to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Llai= relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553• C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims mist 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 By6�ry �H- � ) Reserved for Clerk's filing stamp ao,vse-,e d,-3ry ,e �o ) _ RECEIVED ��W Against the County of Contra Costa ) ZKOFSUPERWSORS 10 or ) District) CLLOA COSTA CO. n (Fill- in name ) The undersigned claimant hereby..makes claim against the County of Contra Costa or the above-named District in the sum of $ 3© o7TU€ &0 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) �Jo,rry.eni coS71-.11 ��7:/�'/T/�'t�Gty �IF/f`I rJi'��L f�a.��/T�L �i��T/�L-2 C•'� � C oil�1Ty' 3. How did the damage or injury occur? (Give full-details; use extra paper if required) 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? ,cvcr �. wnaL are the na..nes of county or district officers, servants or employees causing the ca:-age or injury? 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 8. Names and addresses of witnesses, doctors and hospitals. ,-I-W Q TA — Owe, � F5LE—J-'T A16,SA/Jo 1 01-1/,0 Loll'----o DL/vim <�,t1C .c�t�/� �- ���� — /7/-1- of/vim <Ad"'X:7- 9. List the expenditures you made on account of this accident or injury: DATE ?,SEM AMOUNT J'AV133M t2 # I7�At� Gov. Code Sec. 910:2 provides: ,N"')ARM- "The claim must be signed by- the claimant SEND NOTICES TO: (Attorney) or by some gerson on his behalf." Name and Address of Attorney Claimant's Signature .=3.3 413 7 7- Address /4_e, Telephone No. Telephone No�io 90-37 — -&-z9-7 6> 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 imprisorunent and fine. �. OLIVE LANE s� Residence C1mb • 4'�w�.t,;r .^tea 1715 OLIVE LANE, ANTIOCH CA 94509 (510) 754278 :x 3ENTAL AMOUNTS INCLUDE- 0 Spacious dining room with table side service 4',t ► Three meats daily with table side service, .,. including special diet items ! Beautician & Barber services ► `Snacks offered twice a day individual climate control 5 ► Weekly housekeeping service _AFL`{:•,. ► 24 hour emergency pull cord at bedside ROOM ACCOMMODATIONS and bathroom 4 INCLUDE: ► 24 hour supervision and security Private bath, clothes closet fire sprinklers, smoke alarms, i Per sonal care assistance, including emergency call system, wall-to-wall carpeting, drapes, k : mei;alio^ monitoringbed, bedside table, lamp,, .easy chair, built-in dresser, y' phone and television outlets, safety grab bars,, and {' ► We 3kly laundry service including personal individual heat and air conditioning. laundry Private and semi-private rooms at Olive lane Residence Club are rented on a month to month basis;there are no ► All bed and bath linens IOuy in fees or extended leases required. A written 30 day t ► All maintenance and utilities, except notice Is required for move out Ail applications for private telephone residency are evaluated on an individual basis in accor- dance with State regulations. f Full social calendar with a wide vane of f p°'Oa tY Private roo s are $ per month and Semi-private act vi es and social events �� o0 rooms are � per month. A completely refundable - R deposit of $100.00 will hold a room of your choice. The SPECIAL FEATURES AND rates are subject to change without notice (current I MENITIES INCLUDE: residents will receive a 30 day written notice). 9/01/92 E► Large congregate living room with color television, fireplace, piano, and game Olive Lane. Residence Club is a licensed residen- tables tial care facility for the elderly. Please call on the J staff if you have any questions or stop by for a tour K :; t► Outdoor patio area for barbecues and -we are always available to assist you. leis.ire time enjoyment State.U c e n s e•#0714 4027 0 ti ,P March,. 31 , 1995 Ori October' 22, 1994,'• my' older sister was a resident in the J Ward at Merrither Memorial Hospital, Martinez, Calif, Her name' is Margaret Burbank. She is 84 years, old, and has been diagnosed as having primary degenerative .dementia, with paranoid features. On the above date, she was shoved by a peer in the hall of the J Ward at Merrithew Memorial Hospital and was, see4to fall to _the floor: The time was 1715, as indicated in the Nursing Notes of her _Hospital. Records. ' Also, in her Hospital Records, under Nursing NOtes,, at time,z 2030,, .she was taken to X ray and, for evaluation by an M.D. Dr. Trapnell, (from Merrithew) in. Medical Progress Notes wrote, " Patient pushed down tonight. now ca-n 't. bear .weight on right hip, . femoral "neck Tract. Patient. refuses. tr.eatmerit.." Margaret has never been married, and had been .living alone. „I decided to 'become her conservator to allow ,.doctor4.s to operate on her fractured hip, since she refused to acknowledge that it- was broken. I became her Temporary Conservator, and gave my permission for her operation which was performed successfully by C ,Aurum• V. Gratch .(Merrithew) on 11 /4/94. "' Margaret was ' later transferred to a skilled nursing facility in Antioch, CA on 1210 A Street. I have since been made her Permanent Conservator: She is now Walking with •the aid. of ,a walker,. .and would do all right in a Board and Care. .facility. Now, she refuses to• leave the, very costly Antioch Convalescent Hospital because she fears she will be 'taken 'some place and pushed dawn. I have contacted the Olive Lane` Residence Club in 'Antioch, and they have met her and said she would fit nicely. Their fee would be within reason. Since Margaret 's stay at 'the Antioch Convalescent Hospital, (Nov.', 1994) , they have charged her, $15, 00. 37 The Administrator at the Olive Lane. Residerice Club says Margaret ,should come willingly, but I can't persuade Margaret to leave. she is senile and connot Abe reasoned with. I feel this situation is a 'result of her accident at Merrithew Memorial :Hospital. Margaret was not charged for. the. cost of her hip openation, . but since she refuses to` leave the Antioch 'Convalescent 'Hospital, I feel the difference in the price of the .two facilities should be paid' by the County. So 'far that difference amounts. to $9, 907. 77. There is no way of knowing .when she "might be persuaded to transfer to" the less expensive residence. Another 5 months ,where she is, would cost another similar amount, and on, 'and 'on. As her Conservator, I would be willing to accept. $30, 000 . to be placed in her Estate Checking' Account for her care at the Antioch . Convalescent Hospital.; If she consents to„ trarisfer, the unused money would returned to the County. Yours truly, ,�EWi4494/' Eleanor Kerlinger, Conservator ' for M. Burbank 333 Abbott Lane, Alamo, CA 9 4 5 0 7 ��G'L� �"� cJ� hv. 88 3 33 c7-7 A/.- 9D-7038/30 3211 RtytDthe Ordrof t'NT'iv✓f� �o r/. /�ast'�r�r'< ! $ G" � ers. Dollars WORLD SAVINGS AND LOAN ASSOCIATION 115 A Alamo Plaza Alamo,CA 945007/ �: 3 2 L i ?0 38 9 :0088 11' 9 3 78 i 48 211' 110000 260000,1' ESTATE OF MARGARET E. BURBANK ELEANOR M. KERLINGER CONSERVATOR 110 510-837-5070 333 ABBOTT LN. I � � 90-7038/30 ALAR , CA 94507 d Xs 3211, Ordff ,vrioc/f o�y'�<�sc�-,rJ'T fav s,� $ o c� Dollars _ WORLD SAVINGS AND LOAN ASSOCIATION 115 A Alamo Plaza Alamo,CA 94507 r �kyt -.-_w i: 321L ?03891:0L10 11' 93 ?8148211' .�'( c oil ESTATE OF MARGARET E. BURBANK ELEANOR M. KERLINGER CONSERVATOR 3.3.7 510-837-5070 333 ABBOTT 1N. 90-7038/30 ALAMO, CA 94507 is 95 3211 Ofdemraf��IL%C f___(rsif/tFs'--a4 1�G{�/T,h�L f $ 3 71� WORLD SAVINGS AND LOAN ASSOCIATION 115 A Alamo Plaza Alamo,CA 94507 Memo 43 2 L 1 ?03891:01 i ? Ill' 93 ?8148 2115 evoo, 07ti' ESTATE OF MARGARET E. BURBANK ELEANOR M. KERLINGER CONSERVATOR 126 510-837-5070 333 ABBOTT LN. -^ 90-7039/30 ALAMO, CA 94507 19 � 3211 Pq tothe Ordefof, �/TrG�cr/ C pi/G' L��'Cc/ f�vS��Tr�� I $ Ti9'�t� Tr�GtlS�isl1� T,�v�- -�r L•d� hrr� �f/� ---"—� Dollars WORLD SAVINGS AND LOAN ASSOCIATION +�+ 115 A Alamo Plaza Ala w,CA 94507 7 Memo 1: 3210038911:01126 11' 9378 148 211' 11`0000 30 2 1 4 41' ESTATE OF MARGARET E. BURBANK ELEANOR M. KERLINGER CONSERVATOR 1 2 9 510-837-5070 333 ABBOTT LN. ? 90-7038/30 ALAMO, CA 94507 r''��dc't l 19 3211 Pgy OO deerro Traci aCx���iP¢s,P�Tl3`� 1 $ 1)oUaIts WORLD SAVAN INDGIS 115A Ab=plaza Alamo,CA 94507 Memo 2 ' //,-` fw 1: 321, 17038940129 11' 93 ?8148 2115 .1110000 34 3 548,1' to 0 o�u aZovo a� p a _ L... 4 r-� t - O�_>L� co t� W CLI CO 0 4 uo �Z O(S�O 0 IMMM WINO k£ L'� IS -y wf3'gr c-Do I E I-4 d oU v) ' EO 9Z 4:+ Z Z ca YA S 9a•��'�T�I! CL C. o Ta CDP a Co c rWOM =v= i 14 _C- T p!; i c Cc ON ui U.. ZLoO _ - c3 O'7)co aCt Cl w-- CLAIM BOARD OF SUPERVISORS OF CONTRA;COSTA COUNTY, CALIFORNIA May 2, 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 knount: Unknown Section 913 and 915.4. Please note ail "Warnings r . CLAIMANT:Kenneth and Tanya Olsen 3 X995 RT70ANE 1':Hinton & Alfert COUNTY COUNSEL 1646 N. California Blvd. , Ste. 600 Date received N➢/4R71IVEZCALIF. ADDRESS: Walnut Creek, CA 94596 BY DELIVERY TO CLERK ON April 3, 1995 BY MAIL POSTMARKED: Hand Delivered I. FROM: Clerk of the Board of Supervisors 70; County Counsel Attached is a copy of the above-noted claim, p gg DATED: ri1 3, 1AC)5 C�ll DeputylOR, Clerk i1. FROM: County Counsel TO: Clerk of the Board of Supervisors (vol' 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 Il. FROM: Clerk of tme Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). V. BOA; ORDER: By unanimous vote of the Superviscrs present W) Tmis Claim is rejected in full. ( ) Other: I certify that this is a Z rue and correct copy of the Board's Order entered in its minutes for this date. _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 leposited in the mail 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 De.lare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the nited States, over age 18; 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: BY: PHIL BATCHELOR by u��. Deputy Clerk 1: County Counsel County Administrator PETER W. ALFERT, SBN 83139 RECEIVED HINTON & ALFERT A Professional Corporation AM 3 1 1646 N. California Blvd., Suite 600 Walnut Creek, CA 94596 CLERK BpAAp OF SUPERVISORS Telephone: (510) 932-6006 COMA CMA Co. Attorneys for Claimants Kenneth Olsen and Tanya Olsen CLAIM AGAINST CONTRA COSTA COUNTY To: County of Contra Costa, Board of Supervisors, 651 Pine Street, Room 106, Martinez, CA 94553 Claimants: Kenneth Olsen and Tanya Olsen Address of c/o Hinton & Alfert, 1646 N. California Blvd., Suite 600, Claimants: Walnut Creek, CA 94596 Claimants c/o Hinton & Alfert Telephone: (510) 932-6006 Date of incident: October 4, 1994 Location of Vasco Road, approximately .7 miles south of Camino Diablo Incident: in an unincorporated area of Contra Costa County Amount of The amount of damages sought by the claimant as of the date of Claim: the presentation of this claim, is sufficient to establish jurisdiction in the Superior Court of the State of California. These damages consist of general and special damages, including, but not limited to, medical expenses, future medical expenses, loss of earnings and earning capacity, interest, and incidental expenses. Known medical special damages totaled $157,439.00 as of March 31, 1995. Wage losses total in excess of $15,470.00. Medical expenses and wage losses are continuing. Nature of Claimant Kenneth Olsen suffered multiple severe Injuries: injuries including extensive fractures of facial bones, a mandibular fracture, a right femur fracture, a right fibular fracture, blunt chest and abdominal trauma, injury to both knees, a fractured toe, a dislocated toe, soft tissue injuries and lacerations. Claimant Tanya Olsen suffered a loss of consortium. Name of Public Public employees, agents, and/or personnel of the County Employees of Contra Costa, presently unidentified, who were involved Responsible: in the construction, maintenance, repair of Vasco Road at and near its intersection with Camino Diablo and the installation, maintenance, repair, phasing and timing of the traffic controls at said intersection. Circumstances Claimants Kenneth Olsen and Tanya Olsen have filed this claim giving rise to as a protective measure due to the fact that a claim for indemnity claim: has been filed against the County of Contra Costa by Buzz Haskins Equipment Company, Inc., A&R Equipment and Steven Renwick, the defendants in a civil action filed by Kenneth Olsen and Tanya Olsen as a result of this incident. This protective claim is being filed to prevent claimants from suffering any loss due to the application of Civil Code Sections 1431, et seq. , also known as Proposition 51. At the time of the incident giving rise to this claim, claimant Kenneth Olsen was driving southbound on Vasco Road at a point approximately .7 miles south of the intersection of Vasco Road and Camino Diablo in an unincorporated area of the County of Contra Costa. Steven Renwick was driving northbound on Vasco Road at that location when he encountered a backup of traffic. Mr. Renwick applied his brakes and veered into the southbound lane where he struck claimant Kenneth Olsen head on. Based upon the claim of Buzz Haskins Equipment Company, Inc., A&R Equipment and Steven Renwick, claimants allege that there are stopping sight distance violations, traffic signal phasing and timing problems with respect to the traffic control 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. Dated: March 31, 1995 HINTON & ALFERT By 4PR NW. A ERT Attorneys for Clai ant CLAI'r'`r BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA May 2, 1995 :lain, 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 :alifornia Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph Iv below), given pursuant to Government Code bwant: $5,000.00 Section 913 and 915.4. Please note all •Warnings". :LAIMANT: Paul Sullivan APR 0 ` 1995 4TTORNEY: COUNTYCOUNSEL Date received ODDRESS: 330 Jennifer Dr. MARTINEZ CALIF. BY DELIVERY TO CLERK ON April 4, 1995 San Pablo, CA 94806 BY MAIL POSTMARKED: Hand Delivered via: Risk Mgmt. f. FROM.: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted claim. p111 BATCHELOR, Clerk ' DATED: April 5 1995 B : Deputy 11. FROM: County Counsel 70: Clerk of the Board of Supervisors (vol This claim com;,lies 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 :f claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Date.: y� ?S BY: Deputy County Counsel 11. FROM: Clerk of the 6:arc TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). V. BOAR: OR:ER: By unanimous vote cf the Supervisors present (V/ This Clairr 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:'YylcQ PHIL BATCHELOR, Clerk, 8y , Deputy Clerk WARNING (Gov. code section 913) iutiett to certain exceptions, you have only six (6) months from the date this notice was personally served or iep:sited in the mail 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 in attorney, you should do so immediately. AFFIDAVIT OF MAILING tie:fare under penalty of perjury that 1 am now, and at all times herein mentioned, have been a citiien of the miter States, over age 1B; and that today I deposited in the unite: States Postal Service in Vartine2, :alifornia, postage fully prepaid a certified! Copy of this Board Order and Notice to Claimant, addressed to ne claimant as shover, above. 'a'•e� c3 BY: PHIL BATCHELOR by Deputy Clerk .. C:unty COJnsel County Administrator Clair: to: - BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY - INSTRUCTIONS TO CLAIMANT A. Clai= relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for-death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed With the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the end of this form RE: Claim By `;;qy` ) Reserved for Clerk's filing stamp RECEIVE® Against the County of Contra Costa ) ) APR 41995 or District) CLERK BOARD OF SUPERVISORS Fill in name CONTRA COSTA CO. . ) - The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ and in support of this claim represents as follows: 1. When did the damage or injury occur? '(Give exact date and hour) l' 9 q 5 2. Where did the damage or injury occur? (Include city and county) ..- ���Cl•-tC�. ��\`1-�...-�.w�� � Sc�����`,�0 (-�C�t\\CC� CCS\�_C-;�L����-` -- 3. How did the damage or injury occur? (Give full details; use extra paper required) \Y� ` G 4. What particular act or omission on the part of count or-4strict officers, servants or employees caused the injury or damage? �. wnat are the names of county or district officers, servants or employees causing ~he dannage or. Injury? 5. What damage or injuries do you claim resulted?- (Give full extent of injuries or damages claimed. Attach two estima es falto e.'ZN� v 7. How was the amount claimed above compu . d? (Include 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 Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by s me person on his behalf." Name and Address of Attorney Claimants Signat e (Address) \:1 ILS Telephone No. Telephone No.� — 1it \2� N O T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of'not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonrsent and fine.