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HomeMy WebLinkAboutMINUTES - 05091995 - 1.13 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA May 9, 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: $55,000.00 Section 913 and 915.4. Please note all •Warnings". CLAIMANT: Booker t. Carloss ATTORNEY: Date received ADDRESS: 2830 Magnolia Street BY DELIVERY TO CLERK ON April 6, 1995 Oakland, CA 94608 BY MAIL POSTMARKED: April 5, 1995 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. 10 � J IL gATCHEIOR, Clerk DATED: April 6399 B : Deputy 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: 'Y r�- LI s 8Y: Deputy County Counsel 111. FROM: Clerk of the board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). Iv. 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 9 PHIL BATCHELOR, Clerk. B . Deputy Clerk WARNING (Gov. code section 913) Sutject to certain exceptions. you have only six (6) months from the date this notice was personally served or deprsited in the mail to file a court action on this claim. See Government Code Section 945.6. rou may seek the advice of an attorney of your choice in connection with this matter. If you want to consult in attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the Jnited States, over age 18; and that today I deposited in the Unitee States Postal Service in Martinez. :alifornia, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to Che claimant as Showa above. )ated: �I Ll _ BY: PHIL BATCHELOR by Deputy Clerk :L: County Counsel County Administrator Vs .� TIZ- tzlrj oAK { C N, JSN ... /h: y, L ` e 'IVTW . N t�1 00M Ii�4 C05 T /i CNIO Ty ;i 2930 AA A61ia 5t RECEIVED +' �Q l� ��lod APR s tss� ✓ CLERK 8 D OF COSUP ERV/SORS } ACfRq COSTA CO. vc� : M A.VC 2q, (q 5 - ��G, SS, pvo. E lbj,ee'-66 )(Je,; Grbick &la C6(AR4L SG errff s LA-.+�L be 6vk MCA1 cG� 2R IRgS, c6o",+Va cbsfa CoUo i l`e/t . 5_ 1'�S Y�Srb/e- �c cavlspor�tti 5 I rCoUt '5 c,v l ucln b -f plspdrt, 6111,D_ AAJ ualc40le- I llecpj s- Ied AaSke "old &d �k I al wo(L pr6d(Ac� e-fC, s e wAt'y\ ohek. TkIS � >� wb(k I Ud' �6r~. 1 /ZVO 3)?YfS 0 vVtl�r rf 5 � IVt�mse- Cri/o\a aqd ci u l rcSe�rCk wortk 1-�OQ�.0 o Uctt'WA All airv\, omo. 14K� .- 113* ftkce� 5-606 � lgg5 U.pot, Ptfctse 5e d Gcl�lJedytn�,-K4 PY recetp°- 4 ' A5 O�Qldv d S C-D J J f32 /-� CD a . C� CONFIDENTIAL COUNTY COUNSEL' S OFFICE CONTRA COSTA COUNTY MARTINEZ, CALIFORNIA MEMORANDUM Date: April 6, 1995 TO: Deputy Clerk of the Board Shirley Casillas FROM: Victor J. Westman, County Counsel By: Brandon Baum, Deputy County Counsel RE: Booker T. Carloss Please treat this letter as a new claim. 1 r APR 0 6 T95 C �VOR,,AajCOUNSEL / CALIF. W,,A &44-sp( , P J 0 Ai Iron 0651c b c�vt Du t� AdvAivit5ttlOt 10tH I 5Da Fez Cid qi y5- Dear eaDepcA(fmW+ �OS 1031 C( 01 E { �11(tyjl(I1 Ou r- Yt P rt i V work Vr6dt& ark q k c LSSO(' hvt� tt . �- hcao e, c,��rn I fed a C�a c rz-, a r 600 . t j Disk kon 100-11ptkf Seruices ( 415) $q ZS.Sa .. Cu fpt C)�- �,trtSL�✓GInC� J-Ll\d�c tJ P?;-fof"kx(e- Co m rK s �f, Sfafe� far nd� �a Iry Ire (Soo) X43 q'os 3 �I COA+rCk COSH N A Beardo" Supervis6l:s burs , ep trtlen-f^ c4- �Lo bt 11 0 1 Sl C? V6 -65-q I UlAtyAr� Tpx-s(Arn in ce- Co mpo I NO 7�5 -zq36 (WP16 6V6 �� c vie. �I�I�- ave: De��� h�e R if QSk i w'PO- e_ TILe- 0lnDuvTf- , C ICLIwMP f tS �6� k Si`vtc�eJQ� ? . {{$.S. bj6+- t S - 1. OJ C � d bur IIec CL J COOL k Pr ti c, Ttoed ,, IIrl o(,ei f !v�i(PN 5�l lCt uC)I'OC� Coity fo covvf0a Csta at m this ule w0 kirn drn t�Sf /��+r��e �e ect� m �c�� W nJfw ket let- U e VA cov&;C-F w all - (oe (veoc, '[T/l Seri-{'s !>Pctv-fmen+ rocw k�a L)e- pvt twpa df p�ers qvi a r�,c(es-R\ f�e. bis o rv. -1�t�e r�e ►'tOTI d �!'/'Pc�rorlS SeQ oLc.k lej ?.A,w4 D� f ec.e i'Pt C4 -t��s Itfiver- m frLse% . (6,s �} 0 :?- Foo 33 wlpsf)q5�325 B(6c)�Plr- 131 od N MCL leu 04, wAIRS Qa IP- of no+ a l v4. Lx rk o o e(7 lis c cj s { f I 1 i I I I I AWADED , 3 =CLAJM BOARD OF SUPERVISORS `UF CONTRA COSTA COUNTY, CALIFORNIA May. 9, 1995 Claim Against the County, or District governed by) BOAR_ D 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: $7,681.43 Section 913 and 915.4. Please note all "Warnings" AT CLAIMANT:Paul Nara ' ATTORNEY: APR 12 1995 Date received COUNTYCOUNSEL ADDRESS: 143 Doris Dr. BY DELIVERY TO CLERK ON April 12, 1 TINEZ CALIF. Pleasant Hill;, CA 94523 BY MAIL POSTMARKED: April 11. 1995 1. FRDM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. 9 DATED: April 12, 1995 IVIL BATCHELOR, Clerk 11. FROM: County Counsel 70: 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 $oart TO: County Counsel (1) County Administrator (2) { ) Claim was returned as untimely with notice to claimant (Section 931.3). IV. BOA;: ORDER: Bj unanimous vote of the SuDerviscrs 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. q C� Doted: 1 ! PHIL BATCHELOR, Clerk, By \ ad . 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. row 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-.lore 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 :he claimant As Shown above. " BY: PHIL BATCHELOR b . )ate.,:_ 9s�_ y _ puty Clerk :L: County Counsel County Administrator G� i ic7 t. a ` t���p6q } } l { 7 � LCIER[KBOAR VED April :L 1, 1995 19% UPERVOSORS Dear Clerk of the Board of Supervisors, ta Co. The following is a revised letter originally sent to Teri Rie of the Public Works Department. It has been revised according to instructions received from Brandon Baum (See enclosed copy). I regret this revision has not been done in a timely manner. I currently do not live at the address to which the Notice of Insufficiency was delivered. I did not receive it from Nancy Hara (the resident at that address) until after the 15 day deadline had passed. Please re-enter my claim. I would also like to add that the County as stated in the following letter waited approximately 5 months before completing the repairs to my property. Also enclosed is a letter from the Countra Costa Flood Control verifying that my drain was disconnected during construction of the storm drain. So please have a little compassion and re-enter my claim. Tanlc You, P ul :Kara 143 Doris Dr. Pleasant Hill, CA 94523 Hm 798-7996 Wk 210-6842 April 11, 1995 Teri Rie Engineering Staff Public Works Dept 255 Glacier Dr. Martinez, CA 04553 RE: Flooding at 1145 Palm Ave., Martinez, CA 94553 Dear Teri: Enclosed is a bill listing damages incurred due to flooding of our property on Palm Ave. The flooding which caused the majority of the damage occurred on November 6, 1994. We feel the flooding was a direct result of the construction of a new storm drain system that the County was installing in front of our home. I I was concerned in September, right after construction had been completed in front of our home, that there may have been damage to our drain pipe. So I ran a snake through the pipe and found it have indeed been plugged. I informed you in September (I can't recall the exact date) of the problem and you said that the contractor, V & M Construction, would attach our drain to the new storm drain system. At that time you informed me that the crew was working feverishly to complete the storm drain project so that they might not get to us for a week or so. I told you I was concerned that the work be completed before the rainy season began. The rains began in early November which was almost two months after the damage to the drain pipe had been incurred. Most of our property damage occurred on November 6 when 1 foot of water accumulated in our garage because of the damaged drain. during this time we obtained a sump pump to continue draining the garage. On November 7th we spoke to you on.the telephone, and also notified you of this problem via FAX. You assured us that the problem would be remedied. The unusually heavy rains continued over the next 2 & 1/2 months and despite our continued communication with you and the construction company, no effort was made to repair our drain pipe. When the:word was finally done in early January, you told us that you had found that our garage flooded because our drain pipe had either been broken or disconnected from a sewer line during September construction. The broken or disconnected drain pipe was covered up and we were never informed. Because the flooding was a direct result of your construction activity, we feel we are entitled to financial renumeration for damages incurred. Copies of all past correspondence and photos showing damages can be forwarded to you upon request. Sincerely yours, qct-,j Paul Hara cc:Supervisor Jeff Smith FLOOD DAMAGE AT 1145 PALM AVENUE 3 oak 8x10 frames $42.00 1 Conair hot roller set 37.00 1 Black& Decker 1/2 inch drill Model #7254 120volt 50.00 1 Craftsman circular saw#315.10902 58.00 1 Black& Decker 2 speed jigsaw#7514 40.00 1 Black& Decker electric planer#76963 60.00 1 Vidal Sassoon Curling Iron VS101 17.00 1 "Super Bright" timing light 35.00 1 set video distribution catalogs & notes for video projects; replacement value 700.00 various keepsake Christmas ornaments 70.00 2 11x14 oak framed photos 100.00 4 Historical xerox reproductions "Welcome to Topaz" 50 pages 10.00 2 FBW Halogen Lamps 71.44 5 Books titled "What to expect when you're expecting", "Bad Place", "The Client" & 54.99 "Jurrassic Park"(2). 4 Linen Napkins 12.00 1 Kodak slide stack loader 80.00 1 50meter Climbing Rope 180.00 8 pairs of summer shoes 160.00 1 used pair of climbing shoes 80.00 1 Wind Trainer&misc. bicycling items 200.00 various desk& office supplies 50.00 various theatrical make up supplies 100.00 garden hose 22.00 sump pump rental 40.00 portable air conditioner unit 120.00 144 files of photography business negatives: 109 Individual Portraits Sessions: 218 rolls of film, processing &proofs x $14.00 3,052.00 10 Family Portraits Sessions: 60 rolls of film, processing &proofs x $14.00 840.00 25 Senior Portrait Sessions: 100 rolls of film, processing &proofs x $14.00 1,400.00 GRAND TOTAL OF DAMAGES FROM FLOODING. . . . . . . . . . . . . . . . $7,681.43 RECEIVED APR 1 2 1995 CLERK BOARD OF CONTRA COSTA cp,lSf1R5 Letter From C.C. Flood Control verifying that Drain was disconnected during County construction of storm drain. • e�`''OO&T+ Contra Costa County J.Michael Waltord _pit FLOOD CONTROL ex officio Chief Engineer Milton F.Kubicek,Deputy Chief & Water ConservationDistrict 255 Glacier Drive,Martinez,CA 945 53-4 897 •,�� ►sp* Telephone:(510)313-2000 FAX:(510)313-2333 February 24, 1995 Mr. Mike Dedmon V&M Construction P.O. Box 3075 Our File: DA 40A Storm Drain Antioch, CA 94531 Project No. 7565-6D8571-93 Dear Mr. Dedmon: Enclosed is a letter from Paul Hara requesting reimbursement for property damage occurring as a result of a disconnected garage drain at 1145 Palm Avenue. This garage drain and our newly installed storm drains were excavated on January 12, 1995, and it was verified that this drain was disconnected during the Line B5 storm drain installation. Section 7-1.11 and Section 7-1.12 of the State Standard Specifications and Section 3-1.08 of the Project Special Provisions address the issue of property damage. We are forwarding this claim to you and your insurance carrier for handling. If you have any questions or need additional information, please contact Teri Rie at 313-2255. Very truly yours, Joseph P. Murphy Assistant Public Works Director Construction Division JPM\sd:u g:\const\C0RRES\DA40-M0 l.t2 Enclosure cc: P.Pagra Sawyer,District 2 Risk Management - ., Paul'and Nancy.-Hiri` 1145 Palm Ave. Martinez,CA 94553 Powers and Company 2130 Professional Drive,#230 Roseville,CA 95661 RECEIVELD;-] APR 12 M LL CLEI BOARD OF SUPERVISORS CONTRA COSTA CO, E Letter of Denial due to non correction of items mentioned in the Letter of insufficiency RECEIVED APR 1 2 1996 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. Letter of Insufficiency OFFICE OF COUNTY COUNSEL DEPUTIES. ••-��' CONTRA COSTA COUNTY PHILLIP S. ALTHOFF SHARON L. ANDERSON BRANDON D. BAUM COUNTY ADMINISTRATION BUILDING ANDREA W. CASSIDY VICKIE L. DAWES P.O. BOX 69 MARKE S. ESTIS VICTOR J.WESTMAN MARTINEZ, CALIFORNIA MICHAEL D. FARR COUNTY COUNSEL 94553-0116 LILLIAN T. FUJII DENNIS C. GRAVES SILVANO B.MARCHESI TELEPHONE (510) 646-2041 GREGORY C. HARVEY ARTHUR W.WALENTA,JR. FAX (510) 646-1078 KEVIN T. KERR ASStSTANTS EDWARD V. LANE, JR. MARY ANN M. MASON PAUL R. MUNIZ March 9 , 1995 VALERIE J. RANCHE DAVID F. SCHMIDT DIANA J. SILVER VICTORIA T. WILLIAMS NOTICE OF INSUFFICIENCY RECEIVE® AND/OR NON-ACCEPTANCE OF CLAIM II TO: Paul Hara APR 12 .1995 1145 Palm Avenue CLERK BOARD OF SUPERVISORS Martinez, CA CONTRA COSTA CO. RE: CLAIM OF: Paul Hara Please Take Notice as Follows : The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code Section 910 and 910 .2, or is otherwise insufficient for the reasons checked below: [] 1 . The claim fails to state the name and post office address of the claimant. I] 2 . The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [X] 3 . The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [] 4 . The claim fails to state the name (s) of the public employee (s) Causing the injury, damage, or loss, if known. [] 5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10, 000) . If the claim totals less than ten thousand dollars ($10, 000) , the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10, 000) , the claim fails to state whether jurisdiction over the claim would rest in municipal or-superior court. [] 6 . The claim is not signed by the claimant or by some person on is behalf. [X] 7 . Other: Your letter to Teri Rie demanding compensation for damages must, by law, be treated as a claim against the County treasury under the Government Tort Claims Act. As such, it must comply with certain technical requirements before the Board of Supervisors may consider payment of the claim. One of those requirements is that you must specify, to the extent possible, the exact date upon which the injury occurred. Your letter is somewhat vague on the dates and actually does not refer to any specific year. Although one might infer that the year was 1994, the Tort Claims Act specifies that the date must be included in the claim. Please take a moment to correct this deficiency and resubmit the claim. VICTOR J. WESTMAN, County Counsel Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013a, 2015.5; Evidence Code §§ 641, 664) I declare that my business address is the County Counsel's Office of Contra Costa County, 651 Pine street, Martinez, California 94553; I am a citizen of the United States, over 18 years of age, employed in Contra Costa County, and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non-acceptance of Claim by placing it in an envelope addressed as shown above, sealed and postage fully prepaid thereon, and thereafter was, deposited this day in the U.S. Mail at Martinez, California. I certify under penalty of perjury that the foregoing is true and correct. Dated: Marchl�, 1995 at Martinez, California. S Cc: Clerk of the Board of Supervisors (original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOVT. CODE §§ 910, 910.2, 920.4, 910.8) CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA April 4 , 1995 laim Against the County, or District governed by) BOARD ACTION he Board of Supervisors„ Routing Endorsements, ) NOTICE TO CLAIMANT nd 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 mount: $7, 681 .43 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Paul Hara ATTORNEY: Date received ADDRESS: 1145 Palm Ave. BY DELIVERY TO CLERK ON March 9 . 1995 Martinez , CA 94553 BY MAIL POSTMARKED: Hand Delivered via : Risk Mgmt. I. FROM: Clerk of the Board of Supervisors TO: County Counsel — Attached is a copy of the above-noted claim, gg DATED: Marsh A 1445 ��ll DeputyLOR. Clerk 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. ( his 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: DateCount, Cc 111. FROM: Clerk of tre Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARDS ORDER: By unanimous vote of the Supervisors present ( d) 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 S PHIL BATCHELOR, Clerk, Byk Deputy Clerk WARNING (Gov. code section 913) Subiect to certain exceptions, you have only six (6) months from thP. date ?his nnti�e w?!s personallv served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING 1 declare under penalty of perjury that I am now, and at all times hereir, mention>ea, have b2en• s ^" ^^ w° 'nited States, over age 18; and that today l deposited in the United States P)s-Crl Se,vice in Martinr.;,, alifornia, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, aadriwed to le claimant as shown above. sled: BY: PHIL BATCHELOR by r;,4,��puty Clerk .. County Counsel County Administrator BOARD OF SUPERVISORS OF CONTRA C6STA COUNTY, CALIFORNIA May 9, 1995 :lain Against the County,, or District governed by) BOAR_. D 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 kuunt: $100.18 Section 913 and 915.4. Please note all aWarninps". .LAIMANT: v, Tommy Walker. 4 4TTDRNEY: hp�O Z COON`NSZCp0 FL Date received 4DDRfSS: P.O. Box J—,4174 MAS BY DELIVFRr TO CLERK ON April 7, 1995 San Quentin State Prison Hand Delivered San Quentin, CA 94974 BY MAIL POSTMARKED: I. FRD!!: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: April 7. 1295 JJIL 1eputy R. Clerk il. FRO!!: County Counsel TO: Clerk of the Board of Supervisors ( his claim complies substantially with Sections 910 and 910.1. ( ) This claim FAII.S 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 nct timely filed. The Clerk should return claim on ground that it was filed late and send warning cf cla'imant's right to apply for leave to present a late claim (Section 911.3). Date:: ? BY: _ Deputy County Counsel JJ. FRDM: Clerk of the E:uc 70: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). V. BOARDS OR:ER: By unanim:us vote cf the Superviscrs present (✓) Tnis Clair 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 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 $ep.siteC 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 platter. If you want to consult in attorney, you shoulC do so immediately. AFFIDAVIT OF MAILING ve:lare under penalty of perjury that I ar, now, and at all times herein Mentioned, have been a citizen of the MiteC States, over age 18: and that today l deposited in the Unite: States Postal Service in Martinet, :alifornia, postage fully prepaid a Certified copy of this Board Order and Notice to Claimant, addressed to ne tlairrart as shown above. a'e= 995- BY: PHIL BATCHELOR by Deputy Clerk LL�inty Co4n.sel County Administrator K< - Cn' 'hS 3. el Y o IS,lo . ; ti i V 3 State of California Department of Corrections INMATE/PAROLEE APPEALS SCREENING FORM NAME: NUMBER 7 SQP LOG No: (OTHER LOG NO) ISSUE: AREA OF ORIGIN: HOUSING U14IT S w 3 6 NOTE YOUR APPEAL IS BEING RETURNED TO YOU FOR THE FOLLOWING REASON(S): The action or decision being appealed is not within the jurisdiction of the Department. a. BPT Issue, file BPT 1040 form&submit to C&PR b. Other, see comments 2. You have submitted a duplicate appeal on the same issue. Check one: Your first appeal was screened out on for Your appeal is currently under review at the level. ECE1 Your first appeal has been completed at the level. 4" APR 95 3.You are appealing an action not yet taken. CLERK BOAR OF SUPERVISORS_ 7 �� 4.You may not submit an appeal on behalf of another inmate. COST CO. 5. You have not adequately completed the Inmate/Parolee Form (CDC 602) or attached the proper documents. CDC-11`i Hearing Officer's or Disciplinary Committee Results. Supplemental Reports to CDC-115. CDC-115A with I.E./D.A. info. CDC-128B1 Hearing Notif. CDC-839/840 Class/Reclass Score Sheet CDC-128G ICC/UCC Clas. Corn. CDC-128G Init. Cias. Com. CDC-128G CSR Endorsement Chrono Lab Results Sheet CDC-114D Lock Up Order CDC-1030 Confidential Disclosure CDC-7219 Medical Report Legal Status Summary CDC-128C Medical Chrono Board of Control Claim Form (attached) Property Inventory Slip Receipts- Qtr. Pkg. Inventory Slip CDC-143 Property Transfer Slip Cell Search Slip You have failed to complete Section Sign& Date Section Other: -- V 6.There has been too great a time lapse between when the action or decision occurred and when you filed your appeal. 7.This°issfle has been appealed under the assigned SQP Appeal Log No. Per DOM section 54100.10.1, a copy of the reviewer's response: Is attached Will be forwarded to you upon completion 8. Abuse of the Appeal Procedure. See Comments. Comments: 1J. IE cE�� C -I1, Appeals Coordinator Date This screening action may not be appealed unless you allege that the above reason is inaccurate. In such case, please return this form to the Appeals Coordinator with the necessary information. PERMANENT APPEAL ATTACHEMENT-DO NOT REMOVE. CDC-695 (REVISED 2/95) STATE OF CALIFORNIA DEPARTMENT OF CORRECTIONS n ti , 'INMATE/PARIDLEE Location: Institution/Parole Region Log No. Category APPEAL FORM ' t CGC sot(12/67) 2. 2. You may appeal any policy,action or decision which has a significant adverse affect upon you.With the exception of Serious CDC 115s,classification committee actions,and classification and staff representative decisions,you must first informallyseek relief through discussion with the appropriate staff member,,who will sign your form and state what action was taken. If you are not then satisfied,you may send your appeal with all the supporting documents and not mope than one additional page of comments to the Appeals Coordinator within 15 days of the action taken.No reprisals will be taken for using the appeals.pnocedure responsibly. NAME- NUMBER ASSIGNMENT UNIT/ROOM NUMBER 1 o M nn �c�O ke ���%�= 51 36 A. Describe Problem: /va.rn C� tcY z-;. ,n� t1zP r ,5 t t e! imrk�• n, � `��h �_ ' e ,a...4.it�t`t�_ •Nr'.ii`� e, 1�C,4fit>;J14 .r.�.:,r_ �;t��`k:�: C�a r.�:�_ �.�c;a �.�t/"v� ...+z�:t7:��_. 'ts a.,:v+:?.. .tJ�eeP Clea?,�=.11�..`J.-�s�e .an�...�'.-��. �Vpryn b Lp htj' �? f JI�A,x�.. i ";! -i"3. .T,S� iC4.",+`�`�"l ..ti'..+^. ,:ti' r!' J�... i,•.-'?r e.?: 4' ;1' ' .Xn',.':!8�" ._ri`C i'C,trli� `„�.b.n.i .?,'�;i`.:iZ$.'.tx��1 - 'iy.:h"' �4�iai 8} � i. "�!a=1 A� 1 �' .n�.. R •y I,u�`r .�Ir� ;.'tr � .x ��11yy r CSy1 4hdl.Y—.S/1, /�2'S CP !./-�, pRr�,� 1iyre� °.1'7<.b�3+`,1;9� .L.YV! A".'.� If you need more space,attach one additional sheet. B. Action Requested: h n t,zxf: * • 4��t }�. Fl4,3t:"� s ?f.. Lis n,�yrTn,1' i 1h (� 7tsues kJ., 0 v 1 1t CY V ,A .Q�k,. /.$:A�l"L�.^. "_`.f��.sr�'b1�'" �.�*�`�'1�1;.,'rit�..�:�.., '�.?y G"t u'�,.a;�.:5�. ;��,'t:.� ;�°u...�,'. ' �>,. ..:,".`"i��F9A>Tt�%3��h Y, :,,�. '9�1,.41c� �� .:i:✓. Inmate/Parolee Signature: Date Submitted: 0- '-,)J 1 C. INFORMAL LEVEL(Date Received: ) Staff Response: Staff Signature: Date Returned to Inmate: D. FORMAL LEVEL If you are dissatisfied,explain below,attach supporting documents(Completed CDC 115,Investigator's Report,Classification chrono,CDC 128,etc.)and submit to the Institution/Parole Region Appeals Coordinator for processing within 15 days of receipt of response. Signature: Date Submitted: Note:Property/Funds appeals must be accompanied by a completed CDC Appeal Number: Board of Control form BC-1 E,Inmate Claim 3 z� top !J ( f 1. I f _ ' INMATE/PAROLEE APPEALS SCREENING FORM NAME:_. �-��-- NUMBER SOP LOG No: .14 (OTHER LOG NO) ISSUE: AREA OF ORIGIN: HOUSING U14IT �> W 36 NOTE YOUR APPEAL IS BEING RETURNED TO YOU FOR THE FOLLOWING REASON(S): The action or decision being appealed is not within the jurisdiction of the De rtment. a. BPT Issue,file BPT 1040 form&submit to C&PRb. Other, see comments 2. You have submitted a duplicate appeal on the same issue. Check one: Your first appeal was screened out on for [CLE :, F_1VED ",r Your appeal is currently under review at the level.Your first appeal has been completed at the level. "APR _ 71995 3.You are appealing an action not yet taken. `4. You ma not submit an a RK BQAR DF gUPEftV150RS y appeal on behalf of another inmate. CONT~A COSTA CO. 5. You have not adequately completed the Inmate/Parolee Form (CDC 602) or attached the proper documents. CDC-115 Hearing Officer's or Disciplinary Committee Results. Supplemental Reports to CDC-115. CDC-115A with I.E./D.A. info. CDC-128131 Hearing Notif. CDC-839/840 Class/Reclass Score Sheet CDC-128G ICC/UCC Clas. Com. CDC-128G Init. Clas. Com. CDC-128G CSR Endorsement Chrono Lab Results Sheet CDC-114D Lock Up Order CDC-1030 Confidential Disclosure CDC-7219 Medical Report Legal Status Summary CDC-128C Medical Chrono Board of Control Claim Form (attached) Property Inventory Slip Receipts:__Qtr. Pkg. Inventory Slip CDC-143 Property Transfer Slip Cell Search Slip You have failed to complete Section Sign&Date Section Other: 6.There has been too great a time lapse between when the action or decision occurred and when you filed your appeal. 7.Thisissue has been appealed under the assigned SOP Appeal Log No. Per DOM section 54100.10.1, a copy of the reviewer's response: Is attached Will be forwarded to you upon completion 8. Abuse of the Appeal Procedure. See Comments. Comments: 75 14 C4.4 Lo J. IE CE�� C -II, Appeals Coordinator Date This screening action may not be appealed unless you allege that the above reason is inaccurate. In such case, please return this form to the Appeals Coordinator with the necessary information. PERMANENT APPEAL ATTACHEMENT-DO NOT REMOVE. CDC-695 (REVISED 2/95) 1 14 y - . ,� ,.-. ,. �...��� � � ✓rte � . 7 ilii - - '•as _ �o .. _ V--max AIW ._ r. ." . - _- A a wft x011 fM�Avc- � n 0� 8. Action Rs uw i f ,._ - - o,m_ t:. INFORMAL LEVEL(Data Received. j f _.Stsff ` -. .. :: .. .'r, _: . �.�. . '.' ^z e�-w..:T.�'.'� --_- � - .._.:z�_��� ..g:'•^�-s_riT'!:�2 -v -"a. �.sa.,:,_ - _ - O. FORMAL LEVEL th Drou aay wed,e�loinbalow.abch.ylvortil�soowa.ros{oot11p1.e.dcoc116,+ .. eors�port,Llr+idRor�oiie+lnawcaClia..Me. aa% submit to e Regon Appleds Ooadlnlferibr pioeesele�w IlHn 1D drys a1 no t of nspense -� •-. -. .yY.- :. �� _. _ . .gyp _ .s•�^• - ' - .;;.. - _ .+ -uf• '-.. _ :` - ;'r EFS' -� �t+'�'r�T.-r-r--s. � - N�.PrOpMty/FYnd6eppads RIWt bs ea�ompenled Lire00111p1/led .,, } _ -' - Board of Control form SC-tE,borate palm My name is Tommy Walker I turned myself in on 03-10-95 to Martinez Superior Court Department #13. I had One Hundred & Eighteen cents in my pocket. Five twenty dollar bills & eighteen cents in coins, one dime, one nickel & tree pennies. The jailer place my money is a plastic bag. I signed a property slip to confirm the correct amount of money that I had so it will go on my books. They gave me my receipt. Ok I filled out a commisary slip on 03-15-95 the items that I ordered came up to be $63.57. But I never received mypackage because they told me to roll up my' things to go to WCDF on 03-16-95. On 03-20-95 I was transferred to San Quentin State Prison. I would like for your office to verify the truth of what`I have wrote & correct this wrong doing. Your immediate attention in this matter is bery deeply appreciated, as I need the rest of my money as that I may supply myself with necessary hygiene supplies etc. q S! 3- 7- a . C-4 ,G JL •.4 i y ' 3 mss/ -S t a d 00 1 V CL Oil M 3 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA / Ma 9 lqq 5 Claim Against the County, or District governed by) BRRD ) N 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 Cosies. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $50,000.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Antoinette Henry ATTORNEY: APR 9 1 ygs Date received COUNTY COUNSEL ADDRESS: 946 9th Street BY DELIVERY TO CLERK ON April 11, 1995 MARTINEZ CALIF. Richmond, CA 94801 BY MAIL POSTMARKED: Airborne Express 1. FROM: Clerk of the Board of Supervisors . TO: County Counsel Attached is a copy of the above-noted claim. Ap Blril 11 1995 PpHHIL BATCHELOR, Clerk DATED: : Deputy Il. J_AJ'A IL!r �A-4 A 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: �l _ 1 ! / S BY: Deputy County Counsel III. FROM: Clerk of the: Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Superviscrs present This Claim is rejected in full. ( ) Other: I certify that this is a -true and correct copy of the Board's Order entered in its minutes for this date. Dated: 19c),5' PHIL BATCHELOR, Clerk, By� Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States., over age 38; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: ()9_� BY: PHIL BATCHELOR b LAgLge)Deputy Clerk LL: .County Counsel County Administrator C=a tc= BOARD OF "RMERVISORS OF CONTRA COSTA COtJNPY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury.-to person.or to per- sonal property or -growing crops and which-accrue on or before December 31,1987, . must be presented 'not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue.on or. after January. 1, 1988, must: be presented not later than six months after the accrual of the -cause of action,. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt.-.Code 5911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 1.06, 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 b,6-- i 1 ed e=iled against each public entity. . - E. Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the end of this RE: Claim By ) Reserved for Clerk's filing stamp ANTOINETTE HENRY CEIV-- Against the County of Contra Cosh ) 11995 or ) _ District) CLERK BOARD OF SUPERVISORS Fill in name ) CONTRA COSTA CO. The. undersigned claimant hereby makes claim .against the...Co)inty of Contra Costa -or the above-named District in the sum of $ in excess of and in support of this claim represents as follows: $50,000 1. When did the damage or injury occur?--"(Give exact date and hour) OCTOBER 18, 1994, approximately 9:00p.m. 2. Where did the damage or injury occur? (Include city and county) On Highway 4, on the way from Martinez to Richmond, .in Contra Costa County. .1. How did the damage or injury occur? (Give full details; use extra paper if required) See attached addendum "A" 4. What particular actor omission on the part of county or district officers, servants or, employees caused the injury or damage? See attached addendum"A" 5. wnat are t.ne names of county or district officers, servants or employees causing . thec - =ge or In jt:ry? Doe sheriff driver of the bus, employee of the County of Contra Costa. County of Contra Costa County Department responsible for the maintainance of Bus. No.6602 Counteremployees responsible for superyison_of tl}&_rrLa;nt, ;j;p �r P � , 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. See attached exhibit "A"_ 7. How was the amount claimed,above computed? (Include the estimated amount of any prospective injury or damage.) See attached exhibit "A" S. Names and addresses of witnesses, doctors and hospitals. Driverrof the bus; other prisoners on :the bus, discovery continuing. Claimaht._is presently treating with Dr. Schnake and. Dr. Floyd Giles, She has treated at the Richmond Health Center. 9. List the expenditures you made on account. of this accident or injury: Dr TE ITEM AMOUNT Discovery and investigation continuing Gov. Code. Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES TD:':.�(Attorne ) _ or some person on his behalf." Name and Address of Attorney c ANTOINETTE HENRY CLAIMANT _946 9th Street (Claimant's Signature Richmond, CA 94801 946 9th Street Address). Richmond, CA 94801 Telephone No. Telephone No. 510-215-9714 NOTIC-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 �=h i1riso u}ent and fine. ADDENDUM "A" TO CLAIM OF ANTOINETTE HENRY 3 . Claimant was being transported by bus from Richmond Muni Court after sentencing for failure to pay outstanding traffic tickets. She was handcuffed to another persn in the front seat of the bus inside of a cage. As the bus pulled out, the driver began pumping and stomping on the brakes in an attempt to stop the bus. The driver was unable to stop the bus and subsequently rearended a truck. 4. The County failed to inspect and have a preventive maintainance program for the brakes of the bus that would have kept the bus brakes in a safe condition. The bus driver being aware of the condition of the brakes failed to warn and/or inform the County mechanics. of said condition. The County mechanics failed to properly repair, maintain and/or replace the brakes of the bus. 6. As a result of the accident claimant injuried her mouth, neck, back and shoulder. Claimant is presently treating for her back, neck and shoulder. LEWIS & LEWIS ATTORNEYS AT LAW A Professional Corporation MARVIN K.LEWIS 595 MARKET STREET,SUITE 2700 SAN FRANCISCO,CALIFORNIA 94105 TELEPHONE(415)777-8888 April 10, 1995 Clerk of the Board of Supervisors Room 106 County .Administration Building 651 Pine Street Martinez, CA 94553 Re: Antoinette Henry v. County of Contra Costa Dear Clerk: Please file the enclosed claim and return a conformed copy for Ms. Henry's records. Thank you for your cooperation in this matter. Sincerely, L urz s Legal Assistant cc: Antoinette Henry �. t r� M m+l � ■ en r9 rI� it it a�� a 0 CEI I` v�ti W W Asa _ � z � Gi ❑ � I O O i o z O E > y w a z sN I y w �o CL ol cc CL G' wwII��pp �� W o z _ ¢ _ LLI } MCC U W � �J O� Q Z W Q (_) ' r/ ¢� a ❑ W C3 W I pm a ; in W O ' ¢ Uw Pw calx .❑ �'� Z V = �W JU Q� Z ^¢ cy Z 0 4L Mo m M a s °"� Q = = n W 1 0 ® ❑ ❑ °° ❑ �` N Liu 1 Z ....� O V Ca P 04 trI _jra P• o � " v ri _ p6` __ m W it > ucr m� O • a M a^ n�-a tdn Uo o coui w , O C7� T E--i O ~ {~/1 0 w » . W N N c.� o p M z i 0, H N N f q, oc rA LU Z o fat !n OtaLn co LL o40 wv O r. LL. LU 4a 4o W M Ln E low > v► � � 'a ol � v O ; O� r0 ... C W p M Imx c N N .o :: =' X v c N '' ro v H D ep C u o. cx Cr HN ° E a, v+ arao 3 16" ri 3 Ham Z- w W >, O W :4, aW 2' O t u W W E r _ N O E W W C u C E W o � u d � W o 7 i X Z Id i C1 X E ` W C — U Q Z O O m ° N 0. '° v 'x °' o ° 3 �a a W F- 6i O v E Lu E .im C 0 a, oaa > ate, ° y Ge 41 '410 CLAIM + 1.) S BOARD OF SUPERVISOKS OF CbNTRA COSTA COUNTY, CALIFORNIA May 9, 1995 Claim Against the County, or District governed by) BOAR_ D 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 ' nrlAmount: $50,000.00+ Section 913 and 915.4. Please note all "War ngs,5$T 'rim �R 0 6 19995 Ya CLAIMANT: Jean Smith ATTORNEY: David J. Vary Dam COUNTY COUNSEL Date received MARTINEZ CALIF ADDRESS: 444 Market Street BY DELIVERY TO CLERK ON April 5, 1995 San Francisc:o, CA 94111 BY MAIL POSTMARKED: Hand-Delivered 1. FRDt0.: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim, ppH gg DATED: April 6, 1995 B�jll DeputylOR, Clerk Cr 11. FROM: County Counsel 70: Clerk of the Board of Supervisors ( his claim complies substantially with Sections 910 and 910.2. { ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.6). ( ) 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: 1- 12 — / L5-, BY: Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOA;: ORDER: By unanimous vote of the Superviscrs present (✓) This 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. Dated ji PHI.L BATCHELOR, Clerk, B .Deputy Clerk 1-d 42 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. 1'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 1 declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the inited States, over age 16; and that today I deposited in the United! States Postal Service in Martinet, :alifornia, postage fully prepaid a Certified copy of this Board Order and Notice to Claimant, addressed to the claimant as Shown above. )eted: 9 BY: PHIL BATCHELOR bIAII'Deputy Clerk :C: County Counsel County Administrator 1 David J. Van Dam, Esq. SB#: 39445 Welti_n & Van Dam 2 444 Market Street Suite 930 3 San Francisco, CA 94111 Telephone: (415) 433-4500 4 - RECEIVE® 5 Attorneys for Claimant JEAN SMITH FNR. 5 6 CLERK BOARD OF SUPERVISORS 7 CONTRA COSTA CO. 8 9 JEAN SMITH, CLAIM FOR PERSONAL INJURY (Government Code §910) 10 Claimant;, 11 v• 12 COUNTY OF CONTRA COSTA, 13 Respondents. 14 TO THE BOARD OF SUPERVISORS OF THE COUNTY OF CONTRA COSTA: 15 YOU ARE HEREBY NOTIFIED that Jean Smith whose address is 2865 16 LaSalle Avenue, Concord, California claims damages from the County 17 of Contra Costa in the amount, computed as of the date of 18 presentation of this claim of $50,000.00 plus special damages 19 according to proof, 20 '.Chis claim is based upon an accident which caused personal 21 injury to Jean Smith on October 6, 1994 in 'Concord, California on the 22 premises of George Miller Center East, 3020 Grant, Concord, 23 California under the following circumstances: : 24 Defendant, acting by and through its agents and employees, 25 allowed a dangerous and defective condition of public property to 26 exist on the premises of the George Miller Center. East in the form of -1- 1 a concrete sidewalk, a portion of which was substantially elevated 2 above the surrounding sidewalk to the point where it constituted a 3 hazard to persons lawfully using the premises. 4 Claimant is informed, and believes that the premises at 3020 5 Grant: commonly known as George Miller Center East were owned, 6 controlled, operated and maintained by the. Public Health Services 7 and/or the Office of Education of the County of Contra Costa. 8 The names of the public employees. responsible for the care, 9 maintenance and creation of the dangerous and defective condition of 10 the public property causing injury to the claimant are unknown. 11 Injuries sustained by claimant Jean Smith include a fracture of 12 the collar bone together with contusions and abrasions and a sprained 13 hip 14 The amount claimed, as of the date of presentation of this 15 claim, is computed as follows: 16 Damages incurred to date: 17 Expenses ;for medical care in and unknown amount. 18 General damages for pain, suffering, loss of enjoyment of life 19 and the like: $50,000.00 20 'total amount . claimed as of., the date of presentation of this 21 claim: $50,000.00 plus special damages in an amount as yet .22 unknown. 23 Jurisdiction over this claim will rest in Contra Costa County 24 Superior Court. 25 All notices or other communications with regard to this claim 26 shall be sent to David J. Van Dam of the law firm of Weltin & -2- i 1 Van Dam, 444 Market Street, San Francisco, California 94111 2 telephone number (415) 433-4500, facsimile number (415) 956-9752. 3 DATEI3: April 5, 1995 WELTIN & VAN DAM 4 5 By. / D J. Van Dam 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 i -3- i . CLA�M 1 . 13 BOARD OF SUPERVISORS OF CONT. A COSTA COUNTY, CALIFORNIA May 9, 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 :alifornia Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below). given pursuant to Government Code %mount: $300;000.00 + Section 913 and 915.4. Please note all "Warnings". :LAIMANT:Jesse And Jovita Sandoval n 0 4TTDRNEYaMichael A. Kelly APR 10 15 Date received COUNTY COUNSEL 4DDRESS: 650 California, 30th Floor BY DELIVERY TO CLERK ON_ AAlIr 1 71 1 gqMARTINEZ CALIF. San Francisco, CA 94108 BY MAIL POSTMARKED: April 6, 1995 f. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim, gg DATED: April 10, 1995 Bpp Vll BATCHELOR, Clerkva odd i1. FROM: County Counsel 70: Clerk of the Board of Supervisors { t**<T.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: �— Jr' 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. BDA;,, ORDER: By unanimous vote of the Supervisors present ( ✓) Itis 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, ByA Deputy Clerk WARNING (Gov. code section 913) iutiect 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 Zezlare 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 Unitee States Postal Service in Martinez, :alifornia, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to Ae claimant as shown above. iatec!: MBY: PHIL BATCHELOR b Deputy Clerk L: County Counsel County Administrator CLAIM AGAINST MERRITHEW MEMORIAL HOSPITAL CLAIMAN`.r'S NAMES: Jesse Sandoval and Jovita Sandoval AMOUNT OF CLAIM: $800,000 „ - CLAIMANT'S ADDRESS: 1372 Babel Lane �F �F�V E® Concord, CA 94518 ADDRESS TO WHICH NOTICE ARE TO BE SENT: APR 995 Michael A. Kelly, Esq. CLERK nPdTA�OS SUPERVISORS Walkup, Melodia, Kelly & Echeverria 650 California, 30th Floor San Francisco, CA 94108 415/981•-7210 DATE OF NEGLIGENT CONDUCT: October 27, 1994 and thereafter. LOCATION OF ACCIDENT: Merrithew Memorial Hospital & Medical Center 2500 Alhambra Ave. Martinez, CA 94553 HOW DID INCIDENT OCCUR: On and after October 27, Jesse Sandoval sought medical care at the Merrithew Memorial Hospital Medical Center :Emergency Room. On and after said date Merrithew Memorial Hospital and its agents and employees negligently examined, diagnosed, treated, advised and prescribed a course of care for Jesse Sandoval. Respondent emergency room physicians and nurses failed and omitted to properly diagnose, treat and hospitalize claimant as an inpatient on and after October 27th. Diagnosis, treatment and instructions on October 28th were also substandard and caused additional injury. DESCRIBE INJURY OR DAMAGE: Mr. Sandoval suffered the permanent loss of his penis. Mrs. Sandoval has sustained (and continues to sustain) all elements of consortium loss. NAME OF PUBLIC EMPLOYEE OR EMPLOYEES CAUSING INJURY OR DAMAGE, IF KNOWN: Claimants review of the medical records reveals the following employees causing injury or damage: (1) Gerte Males, M.D. (precise spelling uncertain) ; (2) D.P. Meehan, R.N. ; (3) Jewel Brown; (4) B.J. Seuneud, R.N. (precise spelling uncertain) ; (5) the physician providing treatment on October 28, 1994 whose signature is illegible on the Emergency Department Physician Assessment Form; (6) R. E. Keck, R.N. (precise spelling uncertain) ; and (7) the physician who provided care on 10/28/94 t whose signature is illegible on the Discharge Instruction Form dated 110/28/94. ITEMIZA'T'ION OF CLAIM: General Damages: a) Jesse Sandoval $250, 000 b) Jovita Sandoval $250, 000 Special Damages: $300, 000 Signed on behalf of Claimants: DATED: .April� , 1995 Is'W Z�f' Michael A. Kel WALKUP, MELO , & ECHEVERRIA possible\sandoval\claim , Law Offices of PAUL V.MELODIA WALKUP, MELODIA, KELLY & EmEVERRIA CYNTHIA F.NEWTON DANIEL 1.KELLY ERIK BRUNKAL JOHN ECHEVERRIA A Professional Corporation MICHAEL J.RECUPERO RONALD H.WECHT 650 CALIFORNIA STREET, 30TH FLOOR,SAN FRANCISCO,CALIFORNIA 94108 MICHAEL A.KELLY TELEPHONE(415)981-7210 FACSIMILE(415)391-6965 OF COUNSEL KEVIN L.DOMECUS JOHN D.LINK JEFFREY P.HOLL WESLEY SOKOLOSKY,M.D.,J.D. DANIEL DELCOSSO RICHARD H.SCHOENBERGER BRUCE WALKUP (1914-1994) March 29, 1995 RICHARD B.GOETHALS,JR. (1950-1994) RECEIVE® Via Certified Mail WR 7 W5 Clerk Board of Supervisors Con1tra Costa County CLERK®N�RARD�OS A CQ�SORS 651 Pine Street Martinez, CA Re: Jesse Sandoval Dear Sir or Madam: Enclosed herewith please find the original and one copy of Claim for Damages in the above referenced matter. Please acknowledge receipt on the enclosed copy and return to us in the envelope provided. Thank you for your anticipated cooperation. Very my yours, 6 MI EL A. KE4-- MAK:mkp Enclosure possible\sandoval\supervis.ol t- p � a �.. . a N c,� -r1 • co n N � � c � V cr1 to � O a3 N • O D �+ - A • © OU ANN • T4 � LO � W H ' • H • � W 4 z o � Uv o v � z U pG o o p 0 o = H d a W W a �n W Q O 4 .1 v LLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA May 9, 1995 lain. Against the County, or District governed by) BOARD ACTION he Board of Supervisors. Routing Endorsements. ) NOTICE TO CLAIMANT nd 6oard 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 mount: $250,000.00 + Section 913 and 915.4. Please note all OW LAIMANT: Jesus Sandoval and Jovita Sandoval _ . APR a 7 1995 TTDRNE Y: Jonathan Brand, Esq. COUNTY COUNSEL Date received MARTINEZCAUF. DDRESS: 1800 Sutter Street, Ste. 350 BY DELIVERY TO CLERK ON April 7, 1995 Concord, CA 94520 BY MAIL POSTMARKED: Hand Delivered FROG'-: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. Bdpp IL ATCHELOR. Clerk DATED: ri 1 7 1 QA, : Deputy I. FROm: ounty Counsel 10: Clerk of the Board of Supervisors { This claim, complies substantially with Sections 910 and 910.2. ( ) This Clair, 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). ( ) Claire 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: Date.: -7 -ac, BY: Deputy County Counsel 11. FROM: Clerk of the baro 70: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). ►. BG��� OR:ER: 6j unanimous vote of the Supervisors present (✓) Itis Cl,airr 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:_ 0 7-PHIL BATCHELOR. Clerk, By Deputy Clerk WARNING (Gov. colt section 913) utje:t to certain exceptions. you have only six (6) months from the date this notice was personally served or rpcsited in the wA it to file a court action on this claim. See Government Code Section 945.6. Du may seek the advice of an attorney of your choice in connection with this matter. If you want to consult attorney, you should de so immediately. AFFIDAVIT OF MAILING declare under penalty of perjury that I em now, and at all times herein mentioned. have been a citizen of the )itet States, over age IS; and that today I deposited in the Unite: States Postal Service in "A rtinez, 0 ifornia, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to claimar; as show, above. ate:: ,� BY: PHIL BATCHELOR b � Deputy Clerk .. Loamy Coinsel County Administrator RECEIVE® d. owivwe& 1 APR 71995 Jonathan Brand,, 'Esq. 2 LAW OFFICES OF JONATHAN BRAND CLERK BOARD OF SUPERVISORS 1800 Sutter Street, Suite 350 CONTRA COSTA CO. 3 Concord, CA 94520 (510) 602 2770 4 Attorney for Claimant 5 JESUS SANDOVAL, and 6 JOVITA SANDOVAL 7 Claimants, CLAIM FOR. DAMAGES FOR PERSONAL INJURIES 8 (Government Code Section 910) (Civil Code Sections 377.60, 9 377.30) 10 vs. 11 MERRITHEW MEMORIAL HOSPITAL AND CLINICS, CONTRA COSTA COUNTY 12 HEALTH SERVICES, and Does 1 through 50, 13 Respondents. 14 / 15 YOU ARE HEREBY NOTIFIED THAT JESUS'AND JOVITA SANDOVAL, whose 16 address is 1372 Babel Lane, Concord, CA 94518 claim damages from the 17 above named defendants in an amount within the jurisdiction of the 18 Superior Court. 19 PLACE AND DATE OF OCCURRENCE: 20 MERRITHEW MEMORIAL HOSPITAL. Mr. SANDOVAL was seen on and 21 after October 27, 1994. 22 CIRCUMSTANCES OF OCCURRENCE: 23 On or about October 27, 1994 Mr. SANDOVAL presented to 24 MERRITHEW MEMORIAL HOSPITAL for treatment. He was complaining of a sore 25 on his penis, fever and pain. He had ,been told to go to the hospital by 26 ALAN TOBIAS, M.D. and had been seen the week prior at SUN VALLEY URGENT 27 28 CARE for the same complaints. He was treated in the emergency room and 1 sf 1 sent home. -The attending physician was Geeta Malik. The next day -Mr. 2 SANDOVAL returned to MERRITHEW MEMORIAL HOSPITAL and was admitted 3 overnight for surgery to relieve the tight phimosis. He is sent home the 4 next day. The attending physician was. Walter Carr. Mr. SANDOVAL was 5 again admitted on or about November 31 1994. At all times herein 6 mentioned the physicians and staff at MERRITHEW MEMORIAL HOSPITAL were 7 medically negligent in the manner in which they treated and diagnosed 8 Mr. SANDOVAL. Specifically, Mr. SANDOVAL should have been admitted to 9 the hospital on October 27, 1994 and received IV antibiotics and an 10 immediate circumcision. 11 DESCRIPTION OF DAMAGE OR LOSS: 12 As a result of the negligence Mr. SANDOVAL was forced to 13 submit to an amputation of his penis. 14 DAMAGES INCURRED TO DATE: 15 The amount claimed as of the date of the presentation 16 of this claim is computed as follows: 17 AS TO MR. SANDOVAL: 18 1. General damages - in an amount in excess of 19 $250,000.00; 20 2. Medical expenses to date - in an amount estimated to 21 be in excess of $50, 000. 00; 22 3. Future medical expenses - - in an amount estimated to 23 be in excess of $250, 000.00; 24 4. Lost income and earning capacity - in an amount 25 estimated to be in excess of $250,000.00 26 Total damages at this time for MR. SANDOVAL estimated to be . 27 in excess of $800,000.00 and within the jurisdiction of the Superior 28 Court. 2 1 AS TO MRS. SANDOVAL: 2 1. General damages for loss of consortium in excess of 3 $250,000.00. 4 Total damages at this time for Mrs. SANDOVAL estimated to be 5 6 in excess of $250,000.00. 7 SEND NOTICES TO: 8 JONATHAN BRAND, Esq. 9 LAW OFFICES OF JONATHAN BRAND 1800 Sutter Street, Suite 350 10 Concord, CA 94520 11 Dated: 0 . Z14 12 _ LiL_ -��! BY JO HAN BRAND, Esq. 13 torney for Claimants 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 3