HomeMy WebLinkAboutMINUTES - 06061995 - 1.25 CLAIM
BOARD OF SUPERVISORS OF,CONTRA COSTA COUNTY, CALIFORNIA ` -
dune F, 1995
Llaim 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 tion 913 and 915.4. Please note all "Warnings".
CLAIMANT: Jacquiline Valentine
ATTORNEY: Hayes and Mitchell MAY - 8 1995
COUNTYCOUNSEIb
MARTINEZ CALIF. ate received
ADDRESS: 1944 Embarcadero BY DELIVERY TO CLERK ON May 8, 1995
Oakland, CA 94606
BY MAIL POSTMARKED: May 5, 1995
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: May 8, 1995 PpHHIL BATCHELOR, Clerk
BY: Deputy
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
( his claim complies substantially with Sections 910 and 910.2.
( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying
claimant. The Board cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send
warning of claimant's right to apply for leave to present a late claim (Section 911.3).
( ) Other:
Dated: r _c7 !,>,— BY: Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present
(") This Claim is rejected in full .
( ) Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this date.
Gated: PHIL BATCHELOR, Clerk, By Deputy Clerktia� C .
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This 'notice.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the
United States, over age 18; and that today I deposited in the United States Postal Service in Martinez,
California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to
the claimant as Shown above.
Dated: ` BY: PHIL BATCHELOR byf eputy Clerk
J �Jj A A
CC: County Counsel County Administrator
�C� ® RECIPIENT'S COPY „� 4 � � AnHd cEL 449753 6503
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ti
HAYES AND MITCHELL
ATTORNEYS AND COUNSELORS AT LAW
May 5, 1995
, Shirley Casillas, Secretary
Board of Supervisors
County of Contra Costa
651 Pine Street
Room 106
Martinez CA 94553 Via FedX Delivery
Re: Valentine v. Contra Costa Health Plan, et al.
Dear Ms. Casillas:
Enclosed please find an original and copies of that
Governmental Claim pertaining to the above-captioned matter.
Please endorse a copy as received by the Board and return it
in the enclosed envelope.
Thank you for your courtesies in this matter.
Yo rs very truly,
i
RA . ''HAYES
en osures
cc: Client
1944 EMBARCADERO, OAKLAND, CALIFORNIA 94606-5213
TELEPHONE (510) 261-8188 • FACSIMILE (510) 261-8190
1 DEBRA' A. HAYES (113141)
Hayes and Mitchell ��'�; "RECEIVED
2 Attorneys at Law
1944 Embarcadero
3 Oakland, California 94606 [MAY 81995
(510) 261-8188
4 CLERK ROA9D OF S J-ER ISOR5
Attorneys for Claimant 0 !1 A COS- ,ev0
6 GOVERNMENTAL CLAIM FOR DAMAGES AGAINST
7 THE COUNTY OF CONTRA COSTA
[Government Code, Sec. 910, et seq. ]
8
TO: Shirley Casillas, Secretary
9 Board of Supervisors
County of Contra Costa
10 651 Pine Street
Room 106
11 Martinez California 94553
12 CLAIMANT'S NAME: Jacquiline Valentine -
13 CLAIMANT' S ADDRESS: 102 Chelsea Hills Drive
Benecia, California
14
ADDRESS TO WHICH Hayes and Mitchell
15 NOTICES ARE TO BE SENT: 1944 Embarcadero
Oakland, California 94606
16
DATE OF ACCRUAL OF CLAIM: December 15, 1994
17
AMOUNT: Not Stated; see, Govt. Code
18 Sec. 910(f)
19 OTHER CIRCUMSTANCES RELATING
TO ACCRUAL OF CLAIM: See Attachment hereto
20
NAME OF PUBLIC EMPLOYEE(S)
21 CAUSING INJURY: MILT CAMHI, per Attachment
22
ITEMIZATION OF DAMAGES: Contract/Tort; Jurisdiction
23 over the claim would rest
24 in the Superior Court
DATED: May 5, 1995 Hayes an itchell
25 Attorney t L
26 y:
AYES
ATTACHMENT to Governmental Claim of Jacquiline valentine
1
2 1. Claimant made application, pursuant to
3 advertisement for the position, about November, 1993, and was
4 hired to begin work about January 15, 1994, as a Triage Manager
5 for the CONTRA COSTA HEALTH PLAN, a Division of CONTRA COSTA
6 HEALTH SERVICES. Among claimants duties were to supervise all
7 triage nursing personnel in two counties, Contra Costa and
8 Solano. Claimant was hired under a written employment agreement
9 for the first year's service. In November, 1994,. claimant was
10 given a new contract to continue her position through November,
11 1995.
12 2 . On or about December 15, 1994, claimant was
13 terminated from her position without good cause in breach of
14 her employment agreement.
15 3 . Claimant worked directly for the CONTRA COSTA
16 HEALTH PLAN, under Executive Director MILT CAMHI. Beginning in
17 June, 1994, claimant approached CAMHI about an increase in her
18 salary after an outstanding three month review, claimant's
19 mandatory overtime for which she was denied compensation and
20 the requirement that she remain "on call" at all times,
21 including nights and weekends. At this time, with only claimant
22 and CAMHI present in the latter's office, he became verbally
23 and physically enraged at claimant's request and blocked
24 claimant's exit when she tried to escape from his office.
25 4 . On or about July 39, 1994, claimant again
26 approached CAMHI about her raise in light of those factors
outlined above (mandatory uncompensated overtime and being
Attachment to Governmental Claim of JACQUILINE VALENTINE
2
1 perpetually on-call) , and was heatedly told by him in response
2 that she was "emotionally disturbed" as a result of certain
3 instances of domestic violence claimant had endured at the hand
4 of her former husband.
5 5. On another two or three occasions, CAMHI again
6 reproached claimant about her physical abuse at the hand of her
7 former husband at those times that she made further application
8 for a raise in salary due to the number of hours she was
9 required to work and the fact she was on-call seven days a
10 Week, 24-hours a day.
11 6. At all times, claimant rejected CAMHI ' s
12 statements that her request for raise was a result of being the
13 victim of physical abuse by her former husband.
14 7. In retaliation for rejecting CAMHI 's misconduct
15 in using plaintiff's spousal abuse to avoid her legitimate
16 claim for a raise, claimant was demoted from the position for
17 which she was hired and her contract renewed to a lower
18 position of Advice Nurse Manager.
19 8. In further retaliation for claimant's rejection
20 of that harassment by CAMHI as set forth above, claimant was
21 terminated for not responding to a request for overtime work .
22 which was not part of claimant's job description.
23 WHEREFORE, Claimant prays, as to her non-statutory
24 causes of action:
25 1. That rate of pay consummate with her contracts of
26 employment, within the jurisdiction of the Superior Court,
exclusive of interest;
Attachment to Governmental Claim of JACQUILINE VALENTINE
3
1 2. Damages for emotional distress as a consequence
2 of sexual harassment, defamation in being terminated not for
3 cause and interference with her contract with CONTRA COSTA
4 HEALTH PLAN, within the jurisdictional limits of the Superior
5 Court;
6 3 . Such other relief as the Board deems proper in
7 the premises.
8 Dated: May 5, 1995. HAYES & MI C ELL
9
7
10 B
RA 'HAYES
11 At rneys or Claimant
ENTINE
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
Attachment to Governmental Claim of JACQUILINE VALENTINE
4
CLAIM I , a-5-
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA June. 6,"1995
Claim Against the County, or District governed by) J 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: $259.70 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: Robert J. hrrol
ATTORNEY:
Date received
ADDRESS: 1310 Alma Ave. , W1O9 BY DELIVERY TO CLERK ON May 5, 1995
Walnut Creek, cA 94596
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. ppHH gg
DATED: May 5, 1995 BYIL DeputyLOR, Clerk
II. FROM:: County Counsel TO: Clerk of the Board of Supervisors
( Lej 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 / w BY: a XDeputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present
(✓RD) 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: .l�UAII (, , 199,j PHIL BATCHELOR, Clerk, By Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court \action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the
United States, over age 18; and that today I deposited in the United States Postal Service in Martinez,
California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to
the claimant as shown above.
Dated: BY: PHIL BATCHELOR by y Clerk
CC: County Counsel County Administrator
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Clai- to: BOAP.D OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A. Clai.s relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and which accrue on or before December 31, 1987,
must be presented not later than the 100th day after the accrual of the cause of
action. Claims relating to causes of action for death or for injury to person
or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not
later than one year after the accrual of the cause of action. (Govt. Code §911.2.)
B. Claims must be filed with the Clerk of the Board of.Supervisors at its office in
Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553.
C. If claim is against a district governed by the Board of Supervisors, rather than
the County, the name of the District should be filled in.
D. If the claim is against more than one public entity, separate claims must be
filed against each public entity.
E. Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the end of this
form.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
BE: Claim By ) Reserved for Clerk's filing stamp
�� •J- -��rY� RECEIVE® '
)
i
Against the County of Contra Costa ) rj
or )
District) CLERK BOARD OF SUPERVISORS
CONTRA COSTA CO.
Fill in name
The undersigned claimant hereby makes claim st he County of Contra Costa or
the above-named District in the sum of $ and in support of
this claim represents as follows:
l. When did the damage or injury occur? (Give exact date and hour)
//0
"0 k 0 14
2. Where did a damage or injury occ ? Include city and co ty)
p �
o Cir
3. How did the damage or inury ur? (Giv'e' full details; use ex ra paper if
required) 41 61b
��/'a�-� su/�i• .� �rn1�u Cu�'�YJ Ir;m
4. What particular act or omission on the part of county or district officers,
servants or employees caused the injury or damage?
44A
e
�. wnat are the napes of county or district officers, servants or employees causing
the ta-m-age or injury`s
5. What damn e or injuries do you claim resulted? (Give full extent of injuries or
damages , laimed. Attach two estimates for auto damage. ��
7. How 4s the amount claimed above computed? (Include the estimated amount of any
prospIective injury or damage.)
� 4
8.4. es and addresses of witnesses, doctors and hospital
ent �An9. ist the expenditures you made on account of thiacridjury:
DATE ITEM AMOUNT , ►
70
Gov. Code Sec. 910:2 provides:
"The claim must be signed by the claimant
SEND NOTICES TO: (Attorney or by some perspn on hisbehalf."
Name and Address of Attorney
(C,r.a*,kmnts Signature
AVO Wma
Address)
is u G C
Telephone No. Telephone No. 6a) 13
�40 SIP.
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 i,.risonment and fine.
3
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ARROL, FtOE(EF;T RF VEH: .'9 ,SATURN Sr 2DFi
1,31iJ ALMA AVE LICENSE: ,..3JBM783
WALNUIT: 1
`CREEK--:: CA ;94590 MILEAGE: 0 '38;75
H: (510).933A038 W: (510 )988=4152 K
VIN/STOCK:
.
ACCOUNT#. NEW FO#:,
.:QTY. STOCK NUMBER DESCRIPTION EACH ADD ON/FET EXTENSION ,
1 .( SPEC I AL: PR I ME 25i i GOLD CENTER' GP 225.00i 225.C10'
1 i RVS RUBBER VALVE STEM 9. .97 1. .n.�7
1 .t LAD ACCI.I—DALANCEor .OC 12.00
1 .( L 1102 t'1OUK`dT AFTER MARKET ALLOYS WWF 2.CSC 2.()Cz
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Total Parts 226.97 Gabor lu.4U
A B C D ObO W I TOTAL PARTS AND LABOR c,,r
WAO
SAVE OLD TIRES O O B O Cast ______z Check = 155.70-Pard 1 = SALES TAX `1 E?
.. and 2 = arge = Coupon • 259.7C
STI TED COSTSg� �41
REISED ESTIMATEADDI qNA %
' a+..'. „xr.�rc ,. +wc€a" �..,cxra, '.bn _..r; s, •+Y' .-. :/, ',J , t :'<,5v,.r., .,.,: r t.�x+a�°a+rte; .:,s. ::sy.ur. ":sc:-..a 0'u,t� ,er1' e t. e3a, «�;
I hereby authorize the repair'work to be done alo cessa enals.Wheel Works and its
employees ma 'o operate vehicle for'u' ses of testin ,inspection or deliver at m risk.An PARTS LABOR NOTAL
Y P P � 9 P Y Y
express mechanics lien is acknowledged.on above vehicle to secure a amount of repairs hereto.It is
also understood that Wheel.Works will not be held respo ble for ss r damage to vehi or articles AUTHORIZED BY IN PERSON C3 -BY PHONE O`
left;in vehicle in case`of fire,theft or any of .r s be el rks control.ALL TS AND ,
MERCHANDISE ARE NEW UNLESS N (R_ R MA U SED).,
R RN PARTS ❑ DATE TIME CALLED BY
PHONE NUMBER
SIGNAT E ISCARD PARTS L3I acknowledge notice and oral approval of an
the original.estimated price..::
z CLAIM I -a--1>
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA June 6, 1;395
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: $25,000.00 + Section 913 and 915.4. Please note all ar Vfflm
Send Notices to Claimant & Lawyer
CLAIMANT: Elliott and Shelley Fineman 68 Stratford Road MAY
Kensington, CA 94707
ATTORNEY: Laura Hillenbrand, Esq. COUNTY COUNSEL
Rust Armenis & Schwartz Date received
MARTINEZ CALIF.
ADDRESS: 350 California St. , Ste. 1900 BY DELIVERY TO CLERK ON May 2, 1995
San Francisco, CA 94104
BY MAIL POSTMARKED: June 6, 1995
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: May 2, 1995 PpHHIL BATCHELOR, Clerk
BY: Deputy
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
(� This claim complies substantially with Sections 910 and 910.2.
( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying
claimant. The Board cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send
warning of claimant's right to apply for leave to present a late claim (Section 911.3).
( ) Other:
Dated: — 3_ 15 BY: Deputy County Counsel
111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present
(✓) This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this date.
Dated: Q� LpTJ Cj957 PHIL BATCHELOR, Clerk, B 9 Q Deputy Clerk-
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the
United States, over age 18; and that today I deposited in the United States Postal Service in Martinez,
California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to
the claimant as shown above.
Dated: 9 s BY: PHIL BATCHELOR b Deputy Clerk
CC: County Counsel County Administrator
RE: Claim by Elliott L. Fineman and Shelley B. Walpert Fineman
Against the CnuntV of Contra CnAta
The undersigned Claimants hereby make claim against the County of
Contra Costa in the sum exceeding $25,000 and in support of the
claim represents as follows:
1. The existence of damages were .discovered through the inspection
of Rogers Pacific Geotechnical Engineering Firm in December 1994.
2. The Damage occurred at 68 Stratford Road and properties directly
adjacent thereto particularly 4 Marchant Gardens and 72 Stratford
Road.
3. The damage occurred through the act or omission on the part of
county officers servants or employees as is outlined in attachment
"A" hereto and incorporated by reference.
4. The names of the county or district officers servants or
employees are unknown, except as indicated in attachment "A"
hereto.
5. The damages and injuries that we claim resulted as is outlined
in attachment "A" hereto.
6. The amount of the claim was determined as is outlined in
attachment "A" hereto.
7. Names and addresses of witnesses are as is outlined in
attachment "A" hereto.
8. Expenditures made in respect to this damage is as is outlined
in attachment "A" hereto.
Please send notices to
Elliott L. Fineman
68 Stratford Road
Kensington, California 94707
with Copy to
RECEIVED-1
Laura Hillenbrand, Esq.
Rust Armenis & Schwartz, MAY - 2 1995350 California Street , Suite 1900
San Francisco, California 4104
CLERK BOARD Of SUPERVISORS
CONTRA COSTA CO.
Claima 's Sig ature Date April 27, 1995
Shelley B. Walpert-Fineman
CA Vama t' Signature Date April 27, 1995
Elliott L. Fineman
Attachment "A"
To Claim by Elliott L. Fineman and Shelley B. Walpert-Fineman
Against the County of Contra Costa
Claimants Elliott L. Fineman and Shelley B. Walpert-Fineman
represent the following in support of this claim:
1. Claimants' address is 68 Stratford Road Kensington Contra Costa
County California (Claimants' Property) . They own and reside at the
house located at that address and have done so at all times
relevant to this claim.
2. This claim is based upon damage to Claimants' Property that
first was discovered on Claimant's Property in December 1994 and
is continuing thereafter under the following circumstances.
3. Contra Costa County (The County) negligently and improperly
approved, consulted planned designed constructed improved,
remodeled, controlled and or maintained a drop inlet structure and
drainage pipe system connected thereto. The drainage pipe system is
buried in the ground on the Claimants' Property. The drop inlet
structure is located in part below the sidewalk on the eastern
boundary of the Claimants' Property and is within the easement
granted to The County for the purpose of sidewalks.
4. The Claimants believe that the drop inlet structure and the
drainage pipe system are part of The County's drainage and Flood
control program and are owned and or controlled by the County
pursuant to its drainage and flood control responsibilities. The
County has a mandatory duty to potentially affected persons,
including Claimants, to properly design and construct the drop
inlet structure and drainage pipe system to adequately process
water and debris generated by rains and to conduct proper
maintenance and repairs as needed. Said duty includes where
necessary the retention of engineers and other professionals. The
County has negligently failed to fulfill this duty.
In May June and July of 1994 The County rebuilt Stratford Road.
Prior to the commencement of construction, Claimant Elliott L.
Fineman notified County Engineer Brian Balbas and met with him at
Claimants Property. Claimant Elliott L. Fineman informed Mr Balbas
of persistent problems of accumulation of debris and gravel in the
drainage pipe and notified Mr. Balbas of the condition of the drop
inlet located on the west side of Stratford Road which allows
debris and gravel to be swept into the drainage pipe on the south
boundary of Claimants' property. Claimant Elliott L. Fineman
notified Mr. Balbas that in Claimant's belief and opinion, the
design and performance of the drop inlet on the east and west
sides of Stratford. Road were at that time defective because they
failed to exclude such gravel and debris. Claimant Elliott L.
Fineman indicated to Mr. Balbas that plans for the reconstruction
of Stratford Road included the replacement of a drainage pipe under
Stratford road, running in an east west direction which collects
i r
Attachment "A"
To Claim by Elliott L.. Fineman and Shelley B. Walpert-Fineman
Against the County of Contra Costa
water from the drop inlet on the east side of Stratford Road and
directs it into the drop inlet box located on the west side of
Stratford road. Claimant Elliott L. Fineman indicated that in his
belief the County had an opportunity to replace the two above
mentioned drop inlets at the same time the pipe connecting the
two was to be replaced.
Despite having been put on notice in May or June 1994, The County
breached its duty to Claimants by failing to retain engineers and
other professionals to further examine the design of the drop
inlets and in failing to in fact redesign the drop inlets as part
of the reconstruction of Stratford Road.
As a proximate cause of this breach of duty to Claimants,
amounting to negligence, Claimants' Property has been damaged as
herein alleged. This damage has resulted form the following
circumstances:
The County through its agent Brian Balbas was put on notice of
the existence of a defective condition of design and performance
of the above-mentioned drop inlets. As a result of the
inadequate design construction and or maintenance of the drop
inlet structure, sediment and debris commonly brought by heavy
rains are routinely permitted to enter the drainage pipe system
and thus block the pipes. When this occurs, water pressure in
the drainage pipe system weakens the integrity of the drainage
pipe system and creates gaps therein. Water leaking through
these gaps caries away the soil surrounding the pipe further
weakening the pipe, eroding the support of the pipe and further
weakening the joints thereof. During downpours, because the
drainage pipe receives collected waters originating from blocks
up hill of Claimants' property large volumes of water flow
through the drainage pipe on Claimant's property. In December
1994, the existence of a large gap several feet in length and
width was first discovered in the drainage pipe approximately 10
feet from the western boundary of Claimants' Property. Surface
flooding subsequently erupted through this gap in January and
March 1995 causing further enlargement of the gap and causing the
loss of several cubic yards of soil from Claimant's property and
causing additional loss of support of the drainage pipe which
exits for the County's benefit and is situated on Claimants'
property.
It was also discovered at the same time in January 1995 that a
retaining wall situated at the south boundary of Claimants'
property has been undermined by water escaping from the drainage
pipe adjacent thereto.
Attachment "A"
To Claim by Elliott L. Fineman and Shelley B. Walpert-Fineman
Against the County of Contra Costa
Water flowing from this separation has further damaged Claimant's
Property by causing Claimants to lose the use of Claimants yard.
Monetary damage to Claimants also includes claims filed and
potential claims which may be filed against Claimants by the
owners of properties adjacent to Claimants' Property particularly
4 Marchant Gardens and 72 Stratford Road. Monetary damage to
Claimants also includes costs of consultations and other
professional services including legal services incurred or .yet to
be incurred.
3 . Claimants will sustain further damage if the defective,
improperly designed constructed and or maintained drop inlet
structures and drainage pipe system are not corrected. The
injury, damage and loss expected to be incurred by Claimants in
the future includes further injury damage and loss to Calimants'
Property and structures thereon caused by continuing and further
flooding of Claimant's property and flooding of adjacent
properties and the defense by Claimants' of claims brought or
which may be brought in the future against Claimant by the owner
or owners of adjacent properties including 4, Marchant Gardens and
72 Stratford Road.
4. The damage which is the subject of this claim was first
discovered by Claimants in December 1994.
5. Claimants have not yet obtained a final estimate of the dollar
amount of damage sustained to date but such damages exceed,
$10,000 and continue to increase with further rains. Jurisdiction
of the claim will rest in Superior Court. The total of
Claimants expenditures to date have not been determined but can
be obtained an provided upon request.
6. The damages mentioned above are the direct result of The
County's negligence in improperly approving, planning,
designing, constructing, improving, remodeling, controlled and/
or maintaining a drop inlet structure and drainage pipe system
connected thereto. As a result of the County's negligent acts
and omissions the legal theories of recovery asserted against
the County include, but are not limited to, the following:
A. Inverse Condemnation;
B. Negligence;
C. Professional negligence;
D. Trespass; and
E. Private nuisance.
t
7. Witnesses to the facts represented herein are know to include
the following:
a. Dorothy Nixon and Ron Nixon
4 Marchant Gardens
Kensington, California
b. Alan Kropp, G.E.
Alan Kropp & Associates, Inc.
2140 Shattuck Avenue
Berkeley, California
C. Elliott L. Fineman
68 Stratford Road
Kensington, California
d. Roger's Pacific Geotechnical Engineers
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CLAIM /",S-
BOARD
, a$-
BOARD OF SUPE=-VISOR:C OF CONTRA COSTA COUNTY, CALIFORNIA f
June-6, 19951
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:TOm Luke
H-00944
ATTORNEY:
Date received
ADDRESS: Folsom State Prison BY DELIVERY TO CLERK ON IIay 5, 1995
P.O. Box 715071
Respesa, CA 95671-5071 BY MAIL POSTMARKED: Band Delivered via: Sheriffs Dept.
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: —yo��.. S 9 9 S gtIL �ep�tyLOR, Clerk
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
( ) This claim complies substantially with Sections 910 and 910.2.
( ✓This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying
claimant. The Board cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send
warning of claimant's right to apply for leave to present a late claim (Section 911.3).
( ) Other:
Dated: J� Jr_ / S! BY: / JA��_ eputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present
(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: S PHIL BATCHELOR, Clerk, By Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This -Notice.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the
United States, over age 18; and that today I deposited in the United States Postal Service in Martinez,
California, postage fully prepaid a certif'ed copy of this Board Order and Notice to Claimant, addressed to
the claimant as shown above.
Dated: s BY: PHIL BATCHELOR by (2A4,.eJ&,)Deputy Clerk
CC: County Counsel County Administrator
OFFICE OF COUNTY COUNSEL DEPUTIES:
CONTRA COSTA COUNTY PHILLIP S. ALTHOFF
SHARON L. ANDERSON
BRANDON D. BAUM
COUNTY ADMINISTRATION BUILDING ANDREA W. CAS S I DY
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
ASSISTANTS EDWARD V. LANE, JR.
MARY ANN M. MASON
PAUL R. MUNIZ
May 5, 1995 VALERIE J. RANCHE
DAVID F. SCHMIDT
DIANA J. SILVER
VICTORIA T. WILLIAMS
NOTICE OF INSUFFICIENCY
AND/OR
NON-ACCEPTANCE OF CLAIM
TO: Tom Luke
H-00944
Folsom State Prison
P.O.B. 715071
Represa, CA 95671-5071
RE: CLAIM OF: Tom Luke
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:
[x] 1 . The claim fails to state the name and post office address of
the claimant.
[x] 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.
[x] 4 . The claim fails to state the name (s) of the public employee (s)
causing the injury, damage, or loss, if known.
[x] 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.
[x] 6 . The claim is not signed by the claimant or by some person on
is behalf .
[] 7 . Other:
VICTOR J. WESTMAN, County Counsel
By:
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: May -t, 1995 at Martinez, California.
a
t
cc: Clerk of the Board of Supervisors (original)
Risk Management
(NOTICE OF INSUFFICIENCY OF CLAIM: GOVT. CODE §§ 910, 910.2, 920.4, 910.8)
RECEIVE®
• � � MAY -
5 10
>- - CLERK BOARD OF SUPERVISC
J. y CONTRA COSTA CO.
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CLAIM
BOARD OF SUPERVISORS OF. CONTRA COSTA COUNTY, CALIFORNIA June 6, x995 `
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: $25,000.00-._ Section 913 and 915.4. Please rote all
I
"Warnings".
CLAIMANT: Steve Morris Idle
ATTORNEY: A. Araceli Ramirez ,Film
��� 12 1995
Date received 0UNTYCOUNSEL
ADDRESS: 525 Marina Blvd. BY DELIVERY TO CLERK ON May 12, 199 ARTINEZ CALIF.
Pittsburg, CA 94565
BY MAIL POSTMARKED: May 11, 1995
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim, pH ,
DATED: May 12, 1995 BYIL BATCHELOR, Clerk
eputy LJ ..A
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
( This claim complies substantially with Sections 910 and 910.2.
( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying
claimant. The Board cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send
warning of claimant's right to apply for leave to present a late claim (Section 911.3).
( ) Other:
Dated: (� BY: Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present
This Claim is rejected in full .
(� ) Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this date.
Dated: S PHIL BATCHELOR, Clerk, By Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately. * For Additional darning See Reverse Side Of This Notice.
AFFIDAVIT OF MAILING
—l—declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the
United States, over age 18; and that today I deposited in the United States Postal Service in Martinez,
California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to
the claimant as shown above.
Dated: ILAAJ__ )� BY: PHIL BATCHELOR by eputy Clerk
CC: County Counsel County .Administrator
RECEIVED
MAY 1 2 1995
C
LERK BOARD OF SUPERVISORS
CONTRA COSTA CO.
CLAIM AGAINST COUNTY OF CONTRA COSTA AND ITS AGENTS AND EMPLOYEES
AND
THE CITY OF PITTSBURG AND ITS AGENTS AND EMPLOYEES
Steve Morris hereby presents a claim for damages against the
County of Contra Costa and its agents and employees and the City
of Pittsburg and its agents and employees.
ADDRESS OF CLAIMANT: Steve Morris
163 Lois Avenue
Pittsburg, CA 94565
ADDRESS TO WHICH NOTICES SHOULD BE SENT:
Steve Morris
C/O: Coker & Ramirez
525 Marina Boulevard
Pittsburg, CA 94565
DATE, PLACE AND CIRCUMSTANCES OF OCCURRENCE:
On November 16, 1994 Claimant was arrested by officers of .
the City of Pittsburg Police Department, ostensibly pursuant to
an outstanding no-bail arrest warrant. He was taken to the
Pittsburg jail, was booked and photographed, and remained there
until later that day when he was taken to the Martinez Detention
Facility.
Claimant is informed and believes that there was, in fact,
no valid arrest warrant. The warrant on which Claimant was
arrested was in fact an old juvenile warrant, which was to have
been removed from the system by Claimant' s Probation Officer, Jim
Heiser. Mr. Heiser failed to remove this old warrant from the
system, despite the fact that it had been discharged as part of
Claimant's old juvenile charges.
Claimant was forced to stay in the Martinez Detention
Facility the remainder of November 16, 1994 and at some point on
November 17, 1994, was transferred to the West County Detention
Facility. He was scheduled to appear in court on November 17,
1994, and although brought from West County to Martinez to wait
in the "bullpen, " never saw the judge. He was returned to the
West County facility, where he remained in custody until December
1, 1994.
Despite repeated questions of why he was there and what
happened , to the rule that he should be brought before a
magistrate within 72. hours, he was told "it doesn't matter. "
Once Claimant was released and questioned his probation
officer about the incident, Mr. Heiser attempted to discourage
Claimant from seeking the advice of an attorney.
��uJ1,
- - -�
U—il
PARTIES RESPONSIBLE: Jim Heiser, of the Contra Costa County
Probation Department; County of Contra Costa and unknown agents
and employees of the County of Contra Costa; the City of
Pittsburg, and agents and employees of the City of Pittsburg.
AMOUNT OF CLAIM: $25, 000. 00
GENERAL DESCRIPTION OF INJURIES AND BASIS OF COMPUTATION OF
DAMAGES:
Compensatory damages are based upon the deprivation of
constitutionally protected rights suffered by Claimant as a
result of the false arrest, detention and incarceration. In
addition, Claimant was in custody for an approximate total of
sixteen (16) days without being brought before a magistrate as
required by laza. Further, Claimant suffered emotional distress
and was severely traumatized by the experience, as he had done
nothing wrong. As a result of this wrongful arrest and improper
incarceration, he was forced to drop a college course he had
started, and had to start the course over with an unnecessary
delay.
Dated: May 11, 1995
A. ARACELIREZ
Attorney for Claim t
Steve Morris
COKER & RAMIREZ
ATTORNEYS-ABOGADOS
JOHN DIAZ COKER
A. ARACELI RAMIREZ
RHONDA WILSON RICE
RECEIVE®
Clerk, Board of Supervisors F' —
Contra Costa County r MAY 1 2 1995
651 Pine Street
Martinez, CA 94553
CLERK BOARD OF SUPERVISORS
CONTRA COSTA CO.
May 11, 1995
RE: Claim of Steve Morris
Dear Clerk,
Please find enclosed the original and a copy of a Claim
presented on behalf of Mr. Steve Morris against the County of
Contra Costa. Kindly retain the original and return the copy
marked with your received stamp to our office in the envelope
provided.
Thank you for your help and courtesy.
Sincerely,
Secret;-.i
me
Enclosures
525 MARINA BOULEVARD PITTSBURG, CALIFORNIA 94565 (510) 432-7373
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CLAIM
r BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA -
\June 6-,-_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: $86.90 o Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: Suzanne Moss MAY - 8 1995
ATTORNEY: COUNTY COUNSEL
MAMMEZCALIF. Date received
ADDRESS: 234 Stanford Ave. BY DELIVERY TO CLERK ON May 8, 1995
Kensington, CA 94708
BY MAIL POSTMARKED: May 5, 1995
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: Play 8, 1995 gy1L BATCHELOR, Clerk ,
eputy
oll
II. FROM: County Counsel TO: Clerk of the Boardof Supervisors
( his claim complies substantially with Sections 910 and 910.2.
( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying
claimant. The Board cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send
warning of claimant's right to apply for leave to present a late claim (Section 911.3).
( ) Other:
Dated: —[ — BY: Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present
This Claim is rejected in full .
( ) Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this date.
Dated: 9S PHIL BATCHELOR, Clerk, B, 1 ,dDeputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This ?notice.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the
United States, over age 18; and that today I deposited in the United States Postal Service in Martinez,
California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to
the claimant as shown above.
Dated:_90 �9 oI BY: PHIL BATCHELOR byOAAxO,,.)eputy Clerk
CC: County Counsel County Administrator
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Cia to: BOAP,D OF SJPERVISORS OF CONTRA COSTA COUIM
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
RE E-
Against the County of Contra Costa ) MAY - 8 1995
or )
District) FCLERK BOARD GE 5UPERViSJF;S
Fill in name ) k CONTRA COSTA CO. - -The undersigned claimant hereby makes claim against the County of Contra Costa or
the above-named District in the sum of $ ':9(c) .10 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
OY� � �P �11n��_�.l Y� �►r� d7� � C��.11�(�YL T1��, �ir� ��.lns�_h_
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 offices, V"
r
servants or employees caused the injury or damage?
irn Vow Cu& c��Sc�SSl Cms in �� QJb li C.
�. wnat are the names of county or district officers, servants or employees causing
the ca:--_ge or Injury?
?,w- azj 4- #�f -
5. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage..
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
$. Names and addresses of witnesses, doctors and hospitals.
b �, )b-
co N-�t -
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
l-� ate
Ct
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Gov. Code Sec. 910:2 provides:
"The claim must be signed by the claimant
SEND NOTICES TO: (Attorney) or b some person on his behalf."
Name and Address of Attorney A�hN,
1 is Signature
a3 n &
(Address)
Telephone No. Telephone No. S So f S " 2�2
s
N O T I C E
Section 72 of the Penal Code provides:
"Every person who, with intent to defraud, presents for allowance or for
payment to any state board or officer, or to any county, city or district board or
officer, authorized to allow or pay the .same if genuine, any false or fraudulent
claim, bill, account, voucher, or writing, is punishable either by imprisonment in
the county jail for a period of not more than one year, by a fine of not exceeding
one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in
the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by
both such imprisonment and fine.
CUSTOMER COPY
f:
9BILINS STW
NEW 5;` 695 SOUTH VAN NESS AVENUE
USE SAN FRANCISCO, CA 94110
WTIRES
HEELS (415> 558-9121
HUB CAPS
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BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
' s J me 6, 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 I t i tatid15.:4. Please note all "Warnings".
CLAIMANT: Elaine Sian ttb� �p11
MAY 2 2 1995
ATTORNEY: COUNTY COUNSEL.
DPOR69-Z OALIF.
ADDRESS: 2501 MacAuthur Ave. BY DELIVERY TO CLERK ON May 19, 1995
San Pablo, CA 94806
BY MAIL POSTMARKED: Hand Delivered via: C. Counsel
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: May 19, 1995 PpHHIL BATCHELOR, Clerk % C.A�4�BY: Deputy ShAd-o,
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
(1/)--This claim complies substantially with Sections 910 and 910.2.
( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying
claimant. The Board cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send
warning of claimant's right to apply for leave to present a late claim (Section 911.3).
( ) Other:
Dated: BY: Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( } Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the 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 _ �C1S�PHIL BATCHELOR, Clerk, By a�rQQ�e ) Deputy Clerk
—�-7- WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the
United States, over age 18; and that today I deposited in the United States Postal Service in Martinez,
California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to
the claimant as shown above.
Dated:— 19C?5 BY: PHIL BATCHELOR by h„ CJA,&A— Deputy Clerk
CC: County Counsel County Administrator
Clain BOARD OF SUPERVISOR&,OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A. Clais-s relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and which Accrue on or before December 31, 1987,
must be presented not later than the 100th day after the accrual of the cause of
action. Claims relating to causes of action for.death or for injury to person
or to Personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not
later than one year after the accrual of the cause of action. (Govt. Code §911.2.)
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in
Boom 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 ro-ne of the District should be filled in.
D. If the claim is against more than one public entity, separate claims must be
filed against each public entity.
E. Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the end of this
f or::.
RE': Claim By Reserved for Clerk's filing stamp
Against the County of Contra Costa
or
District)
(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 damageorinjury occur? '(Give exact date a-rid hour)
2. Where did the damage or injury occur? (Include city and county)
3. How did the damage oriAJ y occur? (give details; use extra Dar>er if .
rrequi 0 S It t6__0 OAe a A
�;
44� V�
IL, ,
CAU,0t 74U Clk
4. What particular act or omission on the part of county or district officers,
servants or employees caused the injury or damage?
�. what are �ne names of county or district offKcers, servants or employees causing
'he tamage 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.
su,
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
$. Names and addresses of witnesses, doctors and hospitals. _
ilii, C'.�aua:� , �T,�P_ /�I o• -a!�-o ���'` G� �'�L``�� X07
0 St QST C.9 V/�
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 some pol8on on his behalf."
Name and Address of Attorney
aimant's Signature)
Address.
1.2
Telephone No. Telephone No6g��,IT 1WN T
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 impriso.-Lment and fine.
1
#3 I was on the corner stop light of Pennsylvania and Harbour Way going
to Westbound 580 when suddenly I felt a loud collision behind me.
My right leg quickly pressed the brake so hard that I did not want to be
in the middle of the intersection to get hit by both sides of the traffic.
After the responding to the collision, I looked up on my rear view
mirror and saw this white male on white Ford Pickup Truck had just
rear ended my new 2.5 month Bronco. I got off my vehicle and went
toward the back and saw the damage that this man did to my truck. I
saw his expression, he looked down and shook his head. The way I
saw where his truck struck the back right side seemed that he needed to
make a left on Harbour Way but not cautiously looking that I was in
front of him and the light was red. We decided to moved both our
vehicles away from the traffic and pulled over by the Alaska gas
station and exchange information.
After the incident, I used the telephone by the gas station and called
my husband and then called my office and informed them that
accident and will not be able to go to work. I came home after the
scene, went inside the house, bend down slightly toward the end table
to reach for the camera and suddenly heard a popped behind my back.
I knew then that I needed to see my personal doctor. I called my doctor
and scheduled to see him today, then I called my chiropractor and told
him that I need to see him first thing Friday morning.
I was having difficulty getting into my Bronco but with the help of my
husband I finally got in. He had to fixed the passenger seat so I could
not feel the pain and assisted me inside the doctor's office. I told Dr.
Stephens that I was rear ended this morning on the way to work. I told
him that I felt a popped on my lower back as reaching the camera and I
couldn't sit and stand right. He gave me two prescriptions,
cylcobenzarine and toradol for pain killers. When I had to get up, I had
to bend down like an old lady. Mark Rizzuto had hit me hard. My left
lower back began to hurt severely. I could not sit or stand straight.
Then three months after the accident my right side was hurting
extremely bad. I kept complaining to Dr. Heslip (chiropractor) that my
pain would not stop and it was bothering me at work. I would stress
out about my lower back constantly in pain and then I would get severe
headaches that I end up staying home and could barely get up because I
felt the head was going to explode anytime. On January 19, 1995, I
saw Dr. Lee (he's also with Dr. Stephens office) for a visit and
complained about the severe headaches I have been feeling and he
prescribed me an antibiotic and put me for medical illness for two days.
This accident have caused me pain and suffering and I prayed to God
that it didn't put me on disability permanently. It is just unfortunate
that Dr. Heslip had to put me on a temporary disability because I
wanted to go recover and he has helped me through this ordeal
physically and emotionally. This incident has also caused me
financially because I had to go on temporary disability. I had to work
from 40 hrs a week to 20 hrs.
I want be compensated for the wages I loss and the suffering that I
have endured during this accident.
#6 I have enclosed Dr. Heslip's statement and photo damage that Mark
Rizzuto has caused to my vehicle. I have provided on #3 questions
the pain I have endured.
#7 I claimed for at least $30,000. This amount does not include the wages,
the doctor's bill, and the mileage I have provided on Question #9.
Sheetl (2)
EXPENSES FOR ELAINE STAN
Date I= Aumru mile= AMQ=
11/11/94 Parking on street @ $.75 per $ 3.00 20 miles @ $.29 $ 5.80
1/2 hr ( arked @2hrs)
11/14/94 Parked@ I hr $ 1.50 20 miles @ $.29 $5.80
11/16/94 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
11/18/94 Parked 0 1.5hr $ 0.75 20 miles @ $.29 $5.80
11/21/94 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
11/23/94 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
11/28/94 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
11/30/94 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
12/2/94 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
12/5/94 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
12/9/94 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
12/13/94 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
12/16/94 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
12/19/94 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
1 2/21/94 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
12/23/94 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
12/27/94 Parked @ 1.5hr $ 0.75 20 miles 9 $.29 $5.80
12/28/94 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
1 /3/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
1 /6/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
1 /9/95 Parked @ 1.5hr $ 0.75 20 miles Ca) $.29 $5.80
1/13/95 Parked @ 1.5hr $ 0.75 20 miles Ca) $.29 $5.80
1/18/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
1/20/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
1/25/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
1/27/95 Parked @ 1.5hr $ 0.75 20 miles P $.29 $5.80
1 /30/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
2/1 /95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
2/3/95 Parked @ 1.5hr $ 0.75 20 miles Ca-) $.29 $5.80
2/7/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
2/8/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
2/13/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
2/15/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
2/17/95 Parked 9 1.5hr $ 0.75 20 miles @ $.29 $5.80
2/21/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
2/22/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
2/24/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
2/27/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
3/1 /95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
3/3195 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
3/6/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
3/8/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
Page 1
�
,
� .
8hagM Q8
. . . .
, ^
. .
Sheets (2)
Date Item Amount Date
11/7-11/20 Sick da - $11.54 per hr 24 hrs $ 276.96 11/10/94
11/21 -12/4 Holida used as sick da - 16 hrs $ 184.64
Vacation used as sick da - 5.5 hrs $ 63.47 1/19/95
12/19-1/1 Holiday used as sick da - 24 hrs $ 296.96
Other used as sick da - 8 hrs $ 92.32
1/2-1/15 Holida used as sick da - 8 hrs $ 92.32
1/16-1/29 Sick da - 32 hrs $ 369.28
Holida used as sick da - 8 hrs $ 92.32
1/30-2/12 Sick da - 4 hrs $ 46.16
2/13-2/26 Sick da - 4 hrs $ 46.16
Holiday used as sick da - 4 hrs $ 46.16
Loss of 40 hrs due to temp. disab. $ 461 .60
2/27-3/12 Vacation used as sick da - 4 hrs $ 46.16
Loss of 40 hrs due to temp. disab. $ 461 .60
3/13-3/26 Sick da - 4 hrs $ 46.16
Loss of 40 hrs due to temp. disab. $ 461 .60
3/27-4/9 Loss of 36 hrs due to temp. disab. $ 415.44
4/10-4/14 Sick da - 4 hrs $ 46.16
Loss of 16 hrs due to temp. disab. $ 184.64
Total $ 3,730.11
Page 3
• Sheets (2)
Item Amount
Visit to Dr. Stephens $ 5.00
Prescriptions $ 10.00
Visit to Dr. Stephens $ 5.00
Prescription $ 10.00
Total $ 30.00
Page
o
May 11, 1995
�Ay 12 1995
COUNTY COUNSEL
Mr. Victor J. Westman MARTINEZ CALIF.
Deputy County Counsel
Contra Costa County
P.O. Box 69
Martinez, California 94553-0116 RECEIVED
Re: Claim #IA 1151 J MY 18 sffi
D/Loss: November 10, 1994 VLA ;
CLERK BOARD OF S ERVISORS
CONTRA COSTA CO.
Dear Mr. Westman:
Attached to this letter is an amended copy of the original form that I had sent
to your liability office recently. I am providing you with the information that
was stated on your letter dated May 9, 1995. I have spoken with Julie Aumock
and had instructed me to mail the claim form to your office again.
Thank you for your assistance in this matter.
Sincerely,
a�
Elaine C. Sian
2501 MacArthur Avenue
San Pablo, California 94806
(510)235-6740
OFFICE OF COUNTY COUNSEL DEPUTIES:
CONTRA COSTA COUNTY PHILLIP S. ALTHOFF
SHARON L. ANDERSON
"T 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
ASSISTANTS EDWARD V. LANE, JR.
MARY ANN M. MASON
PAUL R. MUNIZ
May 9 , 1995 VALERIE J. RANCHE
DAVID F. SCHMIDT
DIANA J. SILVER
VICTORIA T. WILLIAMS
NOTICE OF INSUFFICIENCY
AND/OR
NON-ACCEPTANCE OF CLAIM
TO: Elaine Sian
2501 MacArthur Blvd.
San Pablo, CA 94806
RE: CLAIM OF: Elaine Sian
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:
(x] 1 . The claim fails to state the name and post office address of
the claimant.
(x] 2 . The claim fails to state the post office address to which the
person presenting the claim desires notices to be sent.
[] 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.
[x] 6 . The claim is not signed by the claimant or by some person on
is behalf .
[] 7 . Other:
VICTOR J. WESTMAN, County Counsel
By:
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: May 9, 1995 at Martinez, California.
. 1
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 Oi' CONTRA COSTA COUNTY, CALIFORNIA 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 ►ngDJj� Section 913 and 915.4. Please note all "Warnings".
CLAIMANT:Elaine Sian +ate
MAY - 8 1995'
ATTORNEY: COUNTY COUNSEL
MARTINEZ CALIF. Date received
ADDRESS: 2501 MacAuthru Ave. BY DELIVERY TO CLERK ON May 8, 1995
Dan Pablo, CA 94806
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,
DATED: May 8, 1995 JAIL BATCHELOR, Clerk
eputy
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
( ) Tjyrs claim complies substantially with Sections 910 and 910.2.
( iJ
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: f BY: Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present
( ) This Claim is rejected in full .
( ) Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this date.
Dated: PHIL BATCHELOR, Clerk, By Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section .945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately. * For Additional darning See Reverse Side Of This Notice.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the
United States, over age 18; and that today I deposited in the United States Postal Service in Martinez,
California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to
the claimant as shown above.
Dated: BY: PHIL BATCHELOR by Deputy Clerk
CC: County Counsel County Administrator
OFFICE OF COUNTY COUNSEL DEPUTIES:
g-r' 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
ASSISTANTS EDWARD V. LANE, JR.
MARY ANN M. MASON
PAUL R. MU&IZ
May 9 , 1995 VALERIE J. RANCHE
DAVID F. SCHMIDT
DIANA J. SILVER
VICTORIA T. WILLIAMS
NOTICE OF INSUFFICIENCY
AND/OR
NON-ACCEPTANCE OF CLAIM
TO: Elaine Sian
2501 MacArthur Blvd.
San Pablo, CA 94806
RE: CLAIM OF: Elaine Sian
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:
[x] 1 . The claim fails to state the name and post office address of
the claimant.
[x] 2 . The claim fails to state the post office address to which the
person presenting the claim desires notices to be sent.
[] 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.
[x] 6 . The claim is not signed by the claimant or by some person on
is behalf .
[] 7 . Other:
VICTOR J. WESTMAN, County Counsel
By:
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: May 9, 1995 at Martinez, California.
CC: Clerk of the Board of Supervisors (original)
Risk Management
(NOTICE OF INSUFFICIENCY OF CLAIM: GOVT. CODE §§ 910, 910.2, 920.4, 910.8)
Cla BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A. Cla4ms relating to causes�, I L 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, 1987i
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,
19881 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 =3t be filed with the Clerk of the Board of Supervisors at its office in
BOOM 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
RE: Claim By Reserved for Clerk's filing stamp
RECEIVED
-d
Against the County of Contra Costa
MAY 8 1995
or
vta-. 9&4- rn A
District) CLERK BOARD OF S ERVISORS
(Pill in name) CONViA 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)
Nwtm-&A /b, oqv, 1—"d' �a
2. Where did the damage or injury occur? (Include city and county)
3. How did the damage ori fury occur? (Give
details; use extra paver if
requi 0/'l. /WS.
6&CA- 4VV- -OW CC- a-AIAL V1
4. What particular act or omission on the part of county or district officers,
servants or employees caused the injury or daniage?
0 V,1-
�. wnat are the names of county or district officers, servants or employees causing
the oJam-age or Injury?
SOC-&
5. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage.
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
$. Names and addresses of witnesses, doctors and hospitals. _
a1-IrO �TO�C Gf� � c X07
d 664dkSf QS T C.4- Olyl'&Y
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: (Attorne ) or by some person on his behalf."
Name and Address of Attorney
Claimant's Signature
Address.
Telephone No. Telephone No.
* * * * x
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 ga
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 - a
the state prison, by a fine of not ,exceeding ten thousand dollars ($10,000, or�.by ,
both such imprisonnm. nt and fine. �
#3 I was on the corner stop light of Pennsylvania and Harbour Way going
to Westbound 580 when suddenly I felt a loud collision behind me.
My right leg quickly pressed the brake so hard that I did not want to be
in the middle of the intersection to get hit by both sides of the traffic.
After the responding to the collision, I looked up on my rear view
mirror and saw this white male on white Ford Pickup Truck had just
rear ended my new 2.5 month Bronco. I got off my vehicle and went
toward the back and saw the damage that this man did to my truck. I
saw his expression, he looked down and shook his head. The way I
saw where his truck struck the back right side seemed that he needed to
make a left on Harbour Way but not cautiously looking that I was in
front of him and the light was red. We decided to moved both our
vehicles away from the traffic and pulled over by the Alaska gas
station and exchange information.
After the incident, I used the telephone by the gas station and called
my husband and then called my office and informed them that
accident and will not be able to go to work. I came home after the
scene, went inside the house, bend down slightly toward the end table
to reach for the camera and suddenly heard a popped behind my back.
I knew then that I needed to see my personal doctor. I called my doctor
and scheduled to see him today, then I called my chiropractor and told
him that I need to see him first thing Friday morning.
I was having difficulty getting into my Bronco but with the help of my
husband I finally got in. He had to fixed the passenger seat so I could
not feel the pain and assisted me inside the doctor's office. I told Dr.
Stephens that I was rear ended this morning on the way to work. I told
him that I felt a popped on my lower back as reaching the camera and I
couldn't sit and stand right. He gave me two prescriptions,
cylcobenzarine and toradol for pain killers. When I had to get up, I had
to bend down like an old lady. Mark Rizzuto had hit me hard. My left
lower back began to hurt severely. I could not sit or stand straight.
Then three months after the accident my right side was hurting
extremely bad. I kept complaining to Dr. Heslip (chiropractor) that my
pain would not stop and it was bothering me at work. I would stress
out about my lower back constantly in pain and then I would get severe
headaches that I end up staying home and could barely get up because I
felt the head was going to explode anytime. On January 19, 1995, I
saw Dr. Lee (he's also with Dr. Stephens office) for a visit and
complained about the severe headaches I have been feeling and he
prescribed me an antibiotic and put me for medical illness for two days.
This accident have caused me pain and suffering and I prayed to God
that it didn't put me on disability permanently. It is just unfortunate
that Dr. Heslip had to put me on a temporary disability because I
wanted to go recover and he has helped me through this ordeal
physically and emotionally. This incident has also caused me
financially because I had to go on temporary disability. I had to work
from 40 hrs a week to 20 hrs.
I want be compensated for the wages I loss and the suffering that I
have endured during this accident.
#6 I have enclosed Dr. Heslip's statement and photo damage that Mark
Rizzuto has caused to my vehicle. I have provided on #3 questions
the pain I have endured.
#7 I claimed for at least $30,000. This amount does not include the wages,
the doctor's bill, and the mileage I have provided on Question #9.
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Mark A. Heslip, D.C. S T A T E M E N T
100 Bush St. #1900
San Francisco, CA 94104 04-28-95
(415)989-7200
BALANCE: $ 3673 . 00
ACCOUNT NUMBER: 1000 - 3182
Elaine Sian ACC. LAST PMT:
2501 MacAuthur Ave. INS BILLED:
San Pablo CA 94806 LAST CHG: 01-27-95
Date Description Code Charge Credit Adjust Balance
11-11-94 COMPREHENSIVE EXAM/T 99204 125. 00 0. 00 0. 00 125. 00
11-11-94 CRYOTHERAPY 97010 10. 00 0. 00 0. 00 135.00
11-11-94 XRAY LMBOSCRL COMPLE 72120 111. 00 0.00 0. 00 246.00
11-11-94 LUMBOSACRAL SUPPORT 99070 56. 00 0. 00 0. 00 302 . 00
11-14-94 LIMITED EXAM/TX 99213 40. 00 0. 00 0. 00 342. 00
11-14-94 ULTRASOUND 97128 25. 00 0. 00 0. 00 367. 00
11-14-94 CRYOTHERAPY 97010 10. 00 0. 00 0. 00 377.00
11-16-94 LIMITED EXAM/TX 99213 40. 00 0. 00 0. 00 417. 00
11-16-94 ULTRASOUND 97128 25. 00 0. 00 0. 00 442. 00
11-18-94 LIMITED EXAM/TX 99213 40.00 0. 00 0. 00 482. 00
11-18-94 ULTRASOUND 97128 25. 00 0. 00 0. 00 507.00
11-21-94 LIMITED EXAM/TX 99213 40.00 0. 00 0. 00 547. 00
11-21-94 ULTRASOUND 97128 25. 00 0. 00 0. 00 572. 00
11-23-94 LIMITED EXAM/TX 99213 40. 00 0. 00 0. 00 612. 00
11-23-94 ULTRASOUND 97128 25. 00 0. 00 0.00 637.00
11-28-94 LIMITED EXAM/TX 99213 40. 00 0. 00 0. 00 677. 00
11-28-94 ULTRASOUND 97128 25. 00 0. 00 0. 00 702. 00
11-30-94 LIMITED EXAM/TX 99213 40. 00 0. 00 0. 00 742. 00
11-30-94 ULTRASOUND 97128 25. 00 0. 00 0. 00 767-.00
12-02-94 LIMITED EXAM/TX 99213 40. 00 0. 00 0. 00 807. 00
12-02-94 ULTRASOUND 97128 25. 00 0. 00 0. 00 832 . 00
12-05-94 LIMITED EXAM/TX 99213 40. 00 0. 00 0. 00 872 . 00
12-05-94 ULTRASOUND 97128 25. 00 0. 00 0. 00 897.00
12-09-94 LIMITED EXAM/TX 99213 40.00 0. 00 0. 00 937. 00
12-09-94 ULTRASOUND 97128 25. 00 0. 00 0. 00 962 .00
12-13-94 LIMITED EXAM/TX 99213 40. 00 0. 00 0. 00 1002. 00
12-13-94 ULTRASOUND 97128 25. 00 0. 00 0. 00 1027. 00
12-16-94 LIMITED EXAM/TX 99213 40. 00 0. 00 0. 00 1067. 00
12-16-94 ULTRASOUND 97128 25. 00 0. 00 0. 00 1092 . 00
12-19-94 LIMITED EXAM/TX 99213 40. 00 0. 00 0. 00 1132 .00
12-19-94 ULTRASOUND 97128 25. 00 0. 00 0. 00 1157. 00
12-21-94 LIMITED EXAM/TX 99213 40. 00 0. 00 0. 00 1197.00
12-21-94 ULTRASOUND 97128 25. 00 0. 00 0. 00 1222. 00
12-23-94 LIMITED EXAM/TX 99213 40. 00 0. 00 0. 00 1262 .00
12-23-94 ULTRASOUND 97128 25. 00 0. 00 0. 00 1287.00
12-27-94 LIMITED EXAM/TX 99213 40. 00 0. 00 0. 00 1327. 00
12-27-94 ULTRASOUND 97128 25. 00 0. 00 0. 00 1352 .00
12-28-94 LIMITED EXAM/TX 99213 40. 00 0. 00 0. 00 1392. 00
12-28-94 ULTRASOUND 97128 25. 00 0. 00 0. 00 1417. 00
01-03-95 INTERMEDIATE EXAM/TX 99203 75. 00 0. 00 0. 00 1492. 00
Continued. . .
F,
01-03-95 ULTRASOUND 97128 25. 00 0.00 0.00 1517.00
01-06-95 LIMITED EXAM/TX 992.13 42.00 0.00 0. 00 1559.00
01-0j-95 LIMITED EXAM/TX 99213 42 . 00 0.00 0.00 1601.00
01-09-95 ULTRASOUND 97128 25. 00 0. 00 0. 00 1626.00
01-13-95 ULTRASOUND 97128 25. 00 0.00 0. 00 1651. 00
01-13-95 LIMITED EXAM/TX 99213 42 . 00 0. 00 0. 00 1693. 00
01-18-95 LIMITED EXAM/TX 99213 42 .00 0.00 0.00 1735.00
01-18-95 ULTRASOUND 97128 25.00 0. 00 0. 00 1760.00
01-20-95 LIMITED EXAM/TX 99213 42. 00 0.00 0.00 1802.00
01-20-95 ULTRASOUND 97128 25.00 0. 00 0.00 1827.00
01-25-95 LIMITED EXAM/TX 99213 42 .00 0.00 0. 00 1869.00
01-25-95 ULTRASOUND 97128 25. 00 0. 00 0. 00 1894 .00
01-27-95 LIMITED EXAM/TX 99213 42 . 00 0. 00 0. 00 1936. 00
01-27-95 ULTRASOUND 97128 25. 00 0. 00 0. 00 1961. 00
01-30-95 LIMITED EXAM/TX 99213 42 .00 0. 00 0.00 2003 .00
01-30-95 ULTRASOUND 97128 25.00 0.00 0.00 2028.00
01-30-95 THERAPUTIC EXERCISES 97110 31.00 0. 00 0.00 2059.00
02-01-95 LIMITED EXAM/TX 99213 42 . 00 0.00 0.00 2101.00
02-01-95 ULTRASOUND 97128 25.00 0.00 0. 00 2126.00
02-03-95 LIMITED EXAM/TX 99213 42. 00 0. 00 0. 00 2168.00
02-03-95 ULTRASOUND 97128 25. 00 0. 00 0. 00 2193 .00
02-07-95 LIMITED EXAM/TX 99213 42 . 00 0. 00 0. 00 2235.00
02-07-95 ULTRASOUND 97128 25. 00 0.00 0.00 2260.00
02-08-95 LIMITED EXAM/TX 99213 42 .00 0.00 0.00 2302.00
02-13-95 LIMITED EXAM/TX 99213 42.00 0.00 0.00 2344.00
02-13-95 ULTRASOUND 97128 25.00 0. 00 0.00 2369.00
02-15-95 LIMITED EXAM/TX 99213 42. 00 0. 00 0.00 2411.00
02-15-95 ULTRASOUND 97128 25. 00 0. 00 0. 00 2436.00
02-17-95 LIMITED EXAM/TX 99213 42 . 00 0. 00 0. 00 2478.00
02-17-95 ULTRASOUND 97128 25. 00 0. 00 0. 00 2503 .00
02-21-95 LIMITED EXAM/TX 99213 42 .00 0.00 0.00 2545.00
02-21-95 ULTRASOUND 97128 25.00 0.00 0.00 2570.00
02-22-95 LIMITED EXAM/TX 99213 42.00 0. 00 0.00 2612.00
02-24-95 LIMITED EXAM/TX 99213 42.00 0.00 0.00 2654.00
02-24-95 ULTRASOUND 97128 25. 00 0.00 0. 00 2679.00
02-27-95 INTERMEDIATE EXAM/TX 99203 75. 00 0.00 0.00 2754 .00
02-27-95 ULTRASOUND 97128 25. 00 0. 00 0. 00 2779.00
03-01-95 LIMITED EXAM/TX 99213 42 . 00 0. 00 0. 00 2821.00
03-01-95 ULTRASOUND 97128 25.00 0.00 0. 00 2846.00
03-03-95 LIMITED EXAM/TX 99213 42 . 00 0. 00 0.00 2888.00
Continued. . .
03-03-95 ULTRASOUND 97128 25. 00 0. 00 0. 00 2913 . 00
03-06-95 LIMITED EXAM/TX 992 .3 42 . 00 0. 00 0. 00 2955.00
Q3-06-95 ULTRASOUND 97128 25. 00 0. 00 0. 00 2980. 00
03-08-95 LIMITED EXAM/TX 99213 42 . 00 0. 00 0. 00 3022 . 00
03-08-95 ULTRASOUND 97128 25. 00 0. 00 0. 00 3047. 00
03-10-95 LIMITED EXAM/TX 99213 42 . 00 0. 00 0. 00 3089. 00
03-10-95 ULTRASOUND 97128 25. 00 0. 00 0. 00 3114 .00
03-13-95 LIMITED EXAM/TX 99213 42 . 00 0. 00 0. 00 3156.00
03-13-95 ULTRASOUND 97128 25. 00 0. 00 0. 00 3181. 00
03-15-95 LIMITED EXAM/TX 99213 42 . 00 0. 00 0. 00 3223. 00
03-15-95 ULTRASOUND 97128 25. 00 0. 00 0. 00 3248. 00
03-18-95 LIMITED EXAM/TX 99213 42 . 00 0. 00 0.00 3290.00
03-18-95 ULTRASOUND 97128 25. 00 0. 00 0. 00 3315. 00
03-20-95 LIMITED EXAM/TX 99213 42 . 00 0. 00 0. 00 3357.00
03-20-95 ULTRASOUND 97128 25. 00 0. 00 0. 00 3382 . 00
03-22-95 LIMITED EXAM/TX 99213 42 . 00 0. 00 0. 00 3424 . 00
03-22-95 ULTRASOUND 97128 25. 00 0. 00 0. 00 3449. 00
03-27-95 LIMITED EXAM/TX 99213 42 . 00 0. 00 0. 00 3491. 00
03-27-95 ULTRASOUND 97128 25. 00 0. 00 0. 00 3516. 00
03-31-95 LIMITED EXAM/TX 99213 42 . 00 0. 00 0. 00 3558. 00
03-31-95 ULTRASOUND 97128 25. 00 0. 00 0. 00 3583. 00
04-03-95 INTERMEDIATE EXAM/TX 99214 65. 00 0. 00 0. 00 3648. 00
04-03-95 ULTRASOUND 97128 25. 00 0. 00 0. 00 3673. 00
For proper credit, please enclose this portion with your payment.
Elaine Sian BALANCE: $ 3673 . 00
2501 MacAuthur Ave.
San Pablo CA 94806 AMOUNT ENCLOSED:
Please fill in blank.
DATE DUE:
Brian Heslip, D.C. THANK YOU.
Mark Heslip D.C.
100 Bush St. #1900 ACCOUNT NUMBER: 1000-3182
San Francisco, CA 94104
415-989-7200
1'
Sheetl (2)
EXPENSES FOR ELAINE SIAN
Date Jit Amount Mueaw Amount
11/11/94 Parkin on street @ $.75 per $ 3.00 20 miles @ $.29 $ 5.80
1/2 hr (parked @2hrs
11/14/94 Parked @ 1 h r $ 1.50 20 miles @ $.29 $5.80
11/16/94 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
11/18/94 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
11/21 /94 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
11/23/94 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
11/28/94 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
11/30/94 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
12/2/94 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
12/5/94 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
12/9/94 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
12/13/94 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
12/16/94 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
12/19/94 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
12/21 /94 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
12/23/94 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
12/27/94 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
12/28/94 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
1 /3/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
1 /6/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
1 /9/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
1 /13/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
1 /18/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
1 /20/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
1 /25/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
1 /27/95 Parked @ 1.5hr $ 0.75 1 20 miles @ $.29 $5.80
1/30/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
2/1 /95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
2/3/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
2/7/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
2/8/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
2/13/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
2/15/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
2/17/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
2/21 /95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
2/22/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
2/24/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
2/27/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
3/1 /95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
3/3/95 Parked @ 1°.5hr $ 0.75 20 miles @ $.29 $5.80
3/6/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
3/8/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
Page 1
t
Sheetl (2)
3/10/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
3/13/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
3/15/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
3/18/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
3/20/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
3/22/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
3/27/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
3/31 /95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
4/3/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
4/7/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
4/19/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
4/21 /95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
4/26/95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
5/1 /95 Parked @ 1.5hr $ 0.75 20 miles @ $.29 $5.80
Total $ 45.00 $319.00
Parkin $ 45.00
Mileage $ 319.00
Loss of wages $ 3,730.11
Dr's visit/ rescri tion $ 30.00
Grand Total $ 4,124.11
Page 2
Sheets (2)
Date Item Amount Date
11/7-11/20 Sick da - $11.54 per hr 24 hrs $ 276.96 11/10/94
11/21 -12/4 Holiday used as sick da - 16 hrs $ 184.64
Vacation used as sick da - 5.5 hrs $ 63.47 1 /19/95
12/19-1/1 Holiday used as sick da - 24 hrs $ 296.96
Other used as sick da - 8 hrs $ 92.32
1 /2-1/15 Holida used as sick da - 8 hrs $ 92.32
1/16-1/29 Sick da - 32 hrs $ 369.28
Holiday used as sick da - 8 hrs $ 92.32
1/30-2/12 Sick da - 4 hrs $ 46.16
2/13-2/26 Sick da - 4 hrs $ 46.16
Holida used as sick da - 4 hrs $ 46.16
Loss of 40 hrs due to temp. disab. $ 461 .60
2/27-3/12 Vacation used as sick da - 4 hrs $ 46.16
Loss of 40 hrs due to temp. disab. $ 461 .60
3/13-3/26 Sick da - 4 hrs $ 46.16
Loss of 40 hrs due to temp. disab. $ 461 .60
3/27-4/9 Loss of 36 hrs due to temp. disab. $ 415.44
4/10-4/14 Sick da - 4 hrs $ 46.16
Loss of 16 hrs due to temp. disab. $ 184.64
Total $ 3,730.11
Page 3
Sheets (2)
Item Amount
Visit to Dr. Stephens $ 5.00
Prescriptions $ 10.00
Visit to Dr. Stephens $ 5.00
Prescription $ 10.00
Total $ 30.00
Page
CALIFORNIA COLLEGE OF PODIATRIC MEDICINE
12/ 19/94 'TH'RU X01 /01 /95 DATE : 01 /06/95 224285
u07895 SIAN , ELAINE 0460- - -8216 549-71 -4286
- - EARNINGS-------- > HOURS RATE CURRENT YTD
REGULAR-SALARY 923 . 20 48 . 00 GROSS . . . . . : 923 . 20 923 . 20
HOLIDAN . 00 24 . 00 ��(o .9� FIT . . . . . . . : 101 . 56 101 . 56
OTHER . 00 8 . 00 �2 FICA . . . . . . 57 . 24 57 . 24
MHI . 13 . 39 13 . 39
3/ Cj Ld SIT . . . . . . . . 12 . 98 12 . 98
7� l SDI . . . . . . . . 9 . 23 9 . 23
< -DEDUCTIONS-- >
PARKING 9 . 24 9 . 24
< -- - --NET----- > 719 . 56 719 . 56
FEDERAL STATUS : M-00/00 000
STATE STATUS . : M-00/00 000 CA/CA
VACATION AVAILABLE : 43 . 78 ( HOURS )
CALIFORNIA COLLEGE OF PODIATRIC MEDICINE
11 /21 /94 THRU 12/04/ 94 DATE : 12/09/94 223902
007C95 SIAN . ELAINE 0460- - -8216 549-71 -4286
< - - - -
EARNINGS------ - - > HOURS RATE CURRENT YTD
REGULAR -SALARY 923 . 20 42 . 50 GROSS 923 . 20 12 , 321 . 84
REGULAR-HOURLY 00 16 . 00 FIT . . . . . . . . 101 . 85 1 , 335 . 43
HOLIDAN 00 16 . 00 - ! ?'' " FICA . . . . . . . 57 . 23 763 . 95
VACATIuN 00 5 50 -"' MHI . . . . . . . 13 . 39 178 . 67
- SIT . . . . . . . . 13 . 01 172 . 28
SDI . . . . . . . . 12 . 00 160 . 18
< -DEDUCTIONS-- >
PARKING 9 . 24 73 . 92
<-- ---NET----- > 716 . 48 9 , 637 . 41
FEUERAL STATUS M-00/00 000
STATE STATUS M-00/00 000 CA/CA
VACATION AVAILABLE 37 62 (HOURS )
( SaInOH) 70 ' 07 : 318VIIVAV NOI1V3VA
VD/VO 000 00/00-W : ' ' Sf11V1S 31VIS
000 00/00-W : Sf11V1S lVH303d
£6 ' 026 ` 8 L7 ' 9LL < -----13N----- >
89 ' '19 V2 ' 6 9NIAHVd
< --$NOI1jf1030- >
9L ' 87L 00 ' 2 [ IDS
1-2 ' 6SL 10 ' £ l 1IS
82 ' 59L 6£ ' £ l .. ' • .. ' IHW
ZL ' 90L 7Z ' LS " VOId
85 ' 2£2 ` [ 58 ' L0L 00 ' 72 00 ' AD IS
'79 ' 96£ LL 02 926 SSOaJ 00 ' 95 OZ ' £Z6 AHV1VS-ZlVln93V
01A iN3blNnO 31Vl� smnOH < ---- - - --S9NINNV3 - - - -
98Z7- LL-6V5 9L28- - -0970 3NIV13 ' NVIS 569100
17LGEEZ 76/£2/ LL : 31VU 76/OZ/ LL nWH1 76/LO/ LL
3NI31a3W OIa1Vla0d dO 3931103 VINkIOdIIdO
CALIFORNIA COLLEGE OF PODIATRIC MEDICINE
02/ 13/95 THRU 02/26/95 DATE : 03/03/95 225112
00 ?895' SIAN . ELAINE 0460 -8216 549-71 -4286
-
EARNINGS- ------ - > HOURS RATE CURRENT YTD
REuULAR -HOURLY 377 . 94 32 . 75 11 . 5400 GROSS . . . . . : 470 . 26 3 , 721 . 66
SICK 3� 46 . 16 4 . 00 11 . 5400 FIT . . . . . . 33 . 62 373 . 65
HOLIDAY Lr2 '6 `46 . 16 4 . 00 11 . 5400 FICA . . . . . 29 . 15 230 . 74
MHI . . . . . . . 6 . 81 53 . 96
SIT . . . . . . . . 3 . 92 47 . 02
SDI . . . . . . . : 4 . 71 37 . 22
�
� 5 �6 / �� < -DEDUCTIONS-- >
T ( PARKING 9 . 24 46 . 20
< -
--- -NET----- > 382 . 81 2 , 932 . 87
FEDERAL STATUS ' M-00/00 000
STATE STATUS . . : M-00/00 000 CA/CA
\ ACAT10N AVAILABLE : 53 . 80 (HOURS )
CALIFORNIA COLLEGE OF PODIATRIC MEDICINE
224678
01 / 16/95 THRU 01 / 29/95 DATE : 02/03/95
007895 SIAN , ELAINE 0460- - -8216 549-71 -4286
< - -- -- - - EARNINGS-- -- ---- > HOURS RATE CURRENT YTD
REGULAR-SALARY 923 . 20 40 . 00 3&9,2�- GROSS . . . . . . 923 . 20 2 , 769 . 60
SICK . 00 32 . 00 FIT . . . . . . . . 101 . 56 304 . 68
HOLIDAY . 00 8 . 00 x•2.3 2 FICA . . . . . . . 57 . 24 171 . 72
(/- MHI . . . . . . . . 13 . 39 40 . 16
7 SIT . . 12 . 98 38 . 94
SDI . . . . . . . : 9 . 24 27 . 70
< -DEDUCTIONS-- >
PARKING 9 . 24 27 . 72
< -
-- --NET----- > 719 . 55 2 , 158 . 68
FEDERAL STATUS : M-00/00 000
STATE STATUS . . : M-00/00 000 CA/CA
VACATION AVAILABLE : 49 . 94 (HOURS )
CALIFORNIA COLLEGE OF PODIATRIC MEDICINE
01 /02/95 THRU 01 / 15/95 DATE : 01 /20/ 95
224476.
007895 SIAN , ELAINE 0460- - -8216 549-71 -4286
< - - - -- - - EARNINGS-------- > HOURS RATE CURRENT YTD
REGULAR-SALARY 923 . 20 72 . 00 GROSS . . . . . . 923 . 20 1 , 846 . 40
HOLIDAY 'J` ,;��_ ''; . 00 8 . 00 �1�� 3� FIT . . . . . . . 101 . 56 203 . 12
Jar FICA . . . . . . . 57 . 24 114 . 48
MHI . . . . . . . 13 . 38 26 . 77
SIT . . . . . . . . 12 . 98 25 . 96
SDI . . . . . . . . 9 . 23 18 . 46
< - DEDUCTIONS-- >
PARKING 9 . 24 18 . 48
< -
----NET----- > 719 . 57 1 , 439 . 13
FEDERAL STATUS : M-00/00 000
STATE STATUS . . : M-00/00 000 CA/ CA
VACATION AVAILABLE : 46 . 86 (HOURS )
CALIFORNIA COLLEGE OF PODIATRIC MEDICINE
02/27/95 THRU 03/ 12/95 DATE : 03/ 17/95 225409
007895 SIAN ELAINE 0460- - -8216 549-71 -4286
<- - - . - - EARNINGS---- - - - - > HOURS RATE CURRENT YTD
REGULAR -HOURLY 415 44 36 . 00 11 . 5400 GROSS . . . . 461 . 60 4 , 183 . 26
VACATION 7. .? 46 16 4 . 00 11 . 5400 FIT . . 32 . 32 405 . 97
�. -'r i _'•< I FICA . . . . . . 28 . 62 259 . 36
MHI . . . . . . . 6 . 70 60 . 66
SIT . . . . . . . ; 3 . 75 50 . 77
SDI . . . . . . . : 4 . 61 41 . 83
(b� Y < -DEDUCTIONS-- >
PARKING 9 . 24 55 . 44
< -----NET----- > 376 . 36 3 , 309 . 23
FEDERAL STATUS . M-00/00 000
STATE STATUS . . ; M-00/00 000 CA/CA
VACATION AVAILABLE51 . 73 (HOURS )
03/ 13/95 THRU 03/26/95 DATE : 03/31 /951
007895 SIAN , ELAINE 0460- - -8216 549-71 -42861
< - - - - - - -EARNINGS------ -- > HOURS RATE CURRENT YTD
REGULAR-HOURLY 415 . 44 36 . 00 11 . 5400 GROSS . . ;... . : 461 . 60 4 , 644 . 86
SICK 46 . 16 4 . 00 11 . 5400 FIT . . . . . . 32 . 32 438 . 29
FICA . . . . . . : 28 . 62 287 . 98
MHI . . . . . . . 6 . 69 67 . 35
SIT . . . . . . . : 3 . 75 54 . 52
SDI . . . . . . . : 4 . 62 46 . 45
< -DEDUCTIONS-- >
PARKING 9 . 24 64 . 68
< - ----NET----- > 376 . 36 3 , 685 . 59
FEDERAL STATUS : M-00/00 000
STATE STATUS . : M-00/00 000 CA/ CA
VACATION AVAILABLE : -53 :bb (HOURS )
CALIFORNIA COLLEGE OF PODIATRIC MEDICINE
03/27/95 THRU 04/09/95 DATE : 04/ 14/95 225810
007895 SIAN , ELAINE 0460- - -8216 549-71 -4286
<-- --- - -EARNINGS-------- > HOURS RATE CURRENT YTD
REGULAR-HOURLY 415 . 44 36 . 00 11 . 5400 GROSS . . . . . . 415 . 44 5 , 060 . 30
_ FIT . . . . . . . . 25 . 39 463 . 68
FICA . . . . . . 25 . 76 313 . 74
MHI . . . . . . . 6 . 02 73 . 37
SIT . . . . . . . : 3 . 22 57 . 74
SDI . . . . . . . : 4 . 15 50 . 60
< -DEDUCTIONS-- > '
PARKING 9 . 24 73 . 92
< -----NET----- > 341 . 66 4 , 027 . 25
FEDERAL STATUS : M-00/00 000
STATE STATUS . . : M-00/00 000 CA/CA
VACATION AVAILABLE : 55 . 59 (HOURS )
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CLAIM
BOARD OF SUPERVISORS OF CONTRA' COSTA COUNTY, CALIFORNIA -
June 6, 1995
. a5
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: $ 89.00 Section 913 and 915.4. Please note all ® ar INl�
CLAIMANT: Ray Swindell ,'MIRY
MAY 12 1995
ATTORNEY: COUNTY COUNSEL
Date received MARTINEZ CAUF.
ADDRESS: 3220 May School Road BY DELIVERY TO CLERK ON May 12, 1995
Livermore, CA 94550
BY MAIL POSTMARKED: May 10, 1995
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: May 12, 1995 PpHHIL BATCHELOR, Clerk .
BY: D putt' ffadJ_
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
(This claim complies substantially with Sections 910 and 910.2.
( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying
claimant. The Board cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send
warning of claimant's right to apply for leave to present a late claim (Section 911.3).
( ) Other:
Dated: ✓ ��a—�( 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: PHIL BATCHELOR, Clerk, ByA16A, QQAA � Deputy Clerk IA
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This -Notice.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the
United States, over age 18; and that today I deposited in the United States Postal Service in Martinez,
California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to
the claimant as shown above.
Dated: 9 CRs BY: PHIL BATCHELOR b eputy Clerk
CC: County Counsel County Administrator
z
,f
a
y � r
dy �
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v
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. Cade 5911.2.)
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in
Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553.
C. If claim is against a district governed by the Board of Supervisors, rather than
the County, the name of the District should be filled in.
D. If the claim is against more than one public entity, separate claims must be
filed against each public entity.
E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this
for=
� 1F lt �Fy�f
R£: Claim By ) Reserved for Clerk's filing stamp
�F
Against the County of Contra Costa
or )
District) FBOARD OFSUP
QA�jFill in name ) 2EPACOSS
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)
.` m ZI-c-Pt, 3 - 1 s' go
2. Where did the damage or injury occur? (Include city and county)
f
•1 �� �� � �� �'h�Q.-c G.U-�- !� Gam' �-���-cam- �2
3. H did the damage or injury occur? (Give fufi 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?
• s
5. wnat; are the na--Pes of county or district officers, servants or employees causing
the _`azage or in jury?
5. Wh�tdiamnale, or injuries do you claim resulted? (Give full extent of injuries or
dimed. Attach two estimates for auto damage.
7. How was the amount claimed above computed? (Include the estimated amount_ of any
prospective injury or damage.) '
$. Nales and addresses of witnesses, doctors and hospitals.
r
9• List the expenditures you Ade on account of t is accident or injury:
DATE ITEM AMOUNT �f �a
3
Gov. Code Sec. 910:2 provides:
"The claim must be signed by the claimant
SEND NOTIC� 'Q� or by some person on his behalf."
Name and Ad'dr'ess ibff'—ttorney "
?Claimant's Signature
.3 jlI a-4--p Ii
Addres
- - e,_ - -
Telephone No. Telephone No.
N 0 T I C E
Section 72 of the Penal Code provides:
"Every person who, with intent to defraud, presents for allowance or for
payment to any state board or officer, or to any county, city or district board or
officer, authorized to allow or pay the same if genuine, any false or fraudulent
claim, bill, account, voucher, or writing, is punishable either by imprisonment in
the county jail for a period of not more than one year, by a fine of not exceeding
one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in
the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by
both such imprisonment and fine.
EWE
T1k;ECENTER PRICING
� THIS PORTION TE1 BE CC?MPLETEE}BY MEi+ABER. ,
rleName A Lf 611
Addressy„2 20 � 4_ 3 C U Cy L'
Ci ty .� f 1 fr` `1� Q r State [ Zip
Phone 3 Z Membership#
Make of Vehicle Model Year- -
Vehicle License # Color [tet
THTS PORTION TtJJ BE COMPL>r t'ED$Y TIRE SALES PERSON:
SUP PRINT
AMOUNT 2 (Must be accompanied by
Date
-/ QTY ITEM# DESCRIPTION PER TIRE register receipt to be valid.)
Tire Mfg. /001L11 f 1 Auto and Light Truck/ Van
Type X qr-�- r 6850 Lifetime balance and rotation-
r,7 �� \ auto, light truck and and van-
Size /Lf per wheel on same wheel $7.00
Salesperson 6841 Rim swap/seasonal exchange $5.00
Recomm ded air pressure 6857 _ Motorhome&Dual Wheels:
_
By Appt. Only --9- 469078197
Front Rear0.
..
(16.5"aril smatter) $�,P.?0 1575514 75.99
D.O.T.#'s covered under 7$215
lifetime balance &rotate 5439 California State Disposal Fee $�E Hpp 00
arIcLBoad Hazard. 6350
Battery Installation BOLA C 7.00E
Battery installation-with exchange ChbW ESPOSAL .00
5439
Road Hazard Warranty BALs C =`E
89.51 TOTAL
Included for original purchaser of 3597 2727 4.27PM
passenger and light truck tires.
See reverse for details.
THIS PORTION.TO BE:COMPLETEQ BY
Ti - 1
SHQP . warehouse Name/#
_.
Time In (me ou r r Work Time � 7 Warehouse X doing work If other than above
WORK TO B --ition
L/F �
_ r
None
one !
J Best to Sparr: �
S.'atiCJ u;ri F;:T1iC
II _ J Customer keeps tire(s)
I have read the above conaiuvu-,..
"V')Z'r:Upn:' i `n J Carry in rims Consent. )
ft 1 dont Ba ince On
Spare raque FT.L �] n