Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
MINUTES - 03261996 - C12
CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA ` t March 26 _:1996 '. Claim Against the County, or District governed by) BOARD ACTI0q 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 Gove��ii� Amount: $5,592.79 Section 913 and 915.4. Please note a 1fings" "OD CLAIMANT: Monica Holmes FEB 7 9 1996 ATTORNEY: COUNTY COUNSEL Date received MARTINEZ CAUF. ADDRESS: 1844 Giarameta St #652 BY DELIVERY TO CLERK ON February 28, 1996 Richmond CA 94806 BY MAIL POSTMARKED: February 27, 1996 via: Housing Authority I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. February 29 1996 PpHHIL BATCHELOR, Clerk DATED: y 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: 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:. M&" o210 , /991, PHIL BATCHELOR, Clerk, By ull,.,h., ��a ��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:-m.11L BY: PHIL BATCHELOR b Deputy Clerk CC: County Counsel County Administrator BOARD OF COMMISSIONERS OF THE HOUSING AUTHORITY OF THE COUNTY OF CONTRA COSTA Claim *to: BOARD OF SUPERVISORS OF 0MRA COSTA COUNTY 4' INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code 5911.2.) B. Clam 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 oublic entity. E. Fraud. See penalty for fraudulent claims, Penal Code See. 72 at the end of this form. * * * * * * * * * * * * * * * * * * * * * * *. * * * * * * * * * * f * * * * * * * * * RE: Claim By ) Reserved for Clerk's filing stamp MONICA HOLMES RECEIVED Inst the County of Contra Costa ) FEB 2 8 W6 or ) HOUSING AUTHORITY OF THE COUNTY Fi BOARD OFSUPERVISORS OF CONTRA COSTA District) COMACOSTACO. Fill in name ) - The undersigned claimant hereby makes clamsagainst th 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) — JaltaLAJ _.4 R - L10 ln L _J ___y_ Luz� 2. Where did the damage or injury occur? (Include city and county) Adz 3. How did .the damageorinjury occur? (Give full �edr"6 details; use extra paper if required) �v 7b��e 4. What particular act or omission on the t of county or district o f s servants or employees caused the injury or damage?1b (over) i 5; What are the names of county or district officers, servants or employees causing ^4 the damage or injury? I/ 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damagesclaimed. Attach two estimates for auto damage. D Ll.�J. . �� 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) -Le�" 140&1 4e Gt w mV U��� 8. Names and addresses of witnesses, doctors and hospitals. 9. List the expenditures you ma a on account of this. ccident or ink -: DATE ITEM AMOUNT ow Gov. Code Sec. 910.2 provides: "The claim must be signed by a claimant SEND NOTICES TO: (Attorney) or by some so his beha f." Name and Address of Attorney Mz� Cla t's .Signature Address Taliai holxi No • * * f * * * * * * * *V –i i-1 -W V aT-W 0 # NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent '- claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($19000), 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. 66120000, a o 4 l 1 � 1 P�. P N r s a� p vy cj V � n Q y0 � a� d � yr o 41 v� 0 0 2• CLAIM �F BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA March 26, 1996 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: $993.19 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Shari Alexander IR1091RIIW1110 ATTORNE'i MAR p 7 1996 Date received COUNTY COUNSEL ADDRESS: 120 Northstar Drive BY DELIVERY TO CLERK ON March 6, 19TINEZCALIF. Pittsburg, CA 94565 BY MAIL POSTMARKED: March 5, 1996 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. IL BATCHELOR, Clerk DATED: March 7, 1996 ��: �eputyJZa II. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantia.11y 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: ?5 1 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 (f) 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:WQ,_, eco. Jqq(,, 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:�14,,,AQ, 'J-7— ���2-- BY: PHIL BATCHELOR bkJ1,d PC 0 Deputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SJPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAMW 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 5911.2.) B. Claim must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 551 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the end of this f o-z. RE: Claim By ) Reserved for Clerk's filing stamp h i alexancLer" ) Y RE CEIVED a � - Against e Cgonty of Contra Costa or ) Ke D pp District) ��801lS Fill in name) ) The Undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ _ �`l �!ef and in support of Unis claim represents as follows: 0 eS?- �bP T7xio-Tt= Real E!Ve _ 1. When did the damage or injury occur? "(Give exact date and hour) bt..t.dl 2. Where did t . damage or injury occur? (Include city and county) 102 _20MI-La- LL_,�r, 3• How did the d ge or injury occur? (Give full details; use extra paper if required) o +h co q h\ -�-e 06ILS + dUL5i ,► Quer' o� t-h rC cc c� r-a_�e cr, !2 a 4. What particular act or omission on the part of county or district officers, servants or employees, caused the injury or damage? �o(- nye 4D Fc.)—Qa ov,e,(� lie e0 ck -�or LA)ar- n ry . fie. ` 3 0 s U erg c0 rte�Du �. Wnat are the najes of county or district officers, servants or employees causing the damage or Injury? 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. z-, 7. Now was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) $. Names and addresses of Witnesses, doctors and hospitals. ,�Ohr� 1(2 K 6LV1 $o IQ 0 12--Hn f-O-a- D L V-5 L � 9. List the expAditures you made on account of qhis accident or injury: pC�Ss � DATE ITEM AMOUNT tt z Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SM NOTICES TO:_—(AR�^ne j- or by some person on his behalf." Name and Address of Attorney (Claimant'sSignature) Address. 42 Telephone No. Telephone No. ✓ �� %— O b f NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for Payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both zuch i-risonmen- and fine. - ' STORE: 162 WINDSHIELDS DATE: 03/01/96 . ANTIOCH, CA - 162 TIME: 06 :28PM 3670 DELTA FAIR BLVD � . ANTIOCH, CA 94509 QUOTE (510) 777-9600 , **************************************** OWNER: SHARI/90 ACURA LEGEND QUOTE NO. : 000281 162 CASH SALES - ANTIOCH REQ DATE : 03/01/96 3670 DELTA FAIR BLVD CUST # : 84170 ANTIOCH, CA 94509 - ^ 510-777-9600 /�-- **************************************** MAKE: ACURA MODEL: LEGEND L, LS YEAR: 1990 PART DESCRIPTION QTY QTY AMT NO ORD SHIPPED � Windshield 1 1 .489. 75 UAROR - 3. 5 3. 5 45. 00 UKIT 1 1 5. 95 ***TOTAL*** PARTS $489. 75 LABOR $45. 00 KIT $5. 95 SALES TAX $40. 89 GROSS TOTAL $581. 59 Customer Sipnature: =============== INET TOTAL > > > QUOTE ONLY. NOT VALID FOR MORE THAN 30 DAYS FROM DATE OF REQUEST < < < DAMAGE REPORT ALEXANDER 02/29/96 at 13 : 37 D.R. 26379-0001947 AB076560 Est : Not On File. (AMERICANAUTIO BODY REPAIR AND PAINT **CALL 510-432-9910*** 105 BLISS AVENUE PITTSBURG, CA 94565-4937 (510) 432-9936-FAX Owner: SHERI ALEXANDER Day Phone: ( ) 674-2267- Address : 120 NORTHSTAR DR Other Ph: ( ) 427-0604- PITTSBURG CA 94565 Deductible: $ N/A Insurance Co. : Phone: Claim No. : Adj . . 90 ACUR LEGEND LS 4D SED WHITE 6-2 . 7L-FI Vin: JH4KA4674LC015846 License: Prod Date: 10/89 Odometer: 0 Automatic transmission Power steering Power brakes Power windows Power locks Power driver seat Power passenger seat Power antenna Power mirrors Tinted glass Body side moldings Dual mirrors Air conditioning Rear defogger Tilt wheel Cruise control Climate control Theft deter/alarm Anti-lock brakes (4) Driver airbag 4 wheel disc brakes Electric glass sunroof Leather seats Bucket seats Recline/lounge seats Alloy wheels Clear coat paint -------------------------------------------------------------------------------- REPR/ PART NO. REPL DESCRIPTION OF DAMAGE QTY COST LABOR PAINT MISC -------------------------------------------------------------------------------- 1 HOOD 2 Refin Hood 4 door 1 3 . 0 3 Add for Clear Coat 1 1 . 2 4 FRONT DOOR 5* Refin LT Mrrr rmt cntrl w/o htd 1 0 . 8 6* Refin COLOR TINT 1 0 . 5 7* Refin COVER CAR 1 T 5 . 00 ._.._8* Refin COLOR SAND & POLISH 1 1 . 0 9 --_-_\ 10 11 WINDSHIELD 12 Repl Glass NAGS 4 door 1 811 .25 4 . 0 13 Repl Reveal molding upper 4 door 1 33 . 18 Incl 14 Repl LT Reveal molding side 4 door 1 54 . 66 Incl 15 Repl RT Reveal molding side 4 door 1 54 . 66 Incl 16 Repl Reveal molding lower 4 door 1 81 .44 Incl 17* Repl TINT 1 T 50 . 00 Subtotals =__> C035 . 191:9 4 .5 6 . 0 55 . 00 Page: 1 b C7 � GOMEZ BROS. .ESTIMATE CUSTOM PAINT AND AUTO BODY • �� OF REPAIRS 2160 Piedmont Way, Pittsburg, CA 94565 Phone (510) 39-180 _f 7 NAME 3 ADDRESS - 7( r PHONE NO. 6�! 6 c) r y ' MAKE' YEAR ?OSTYLE&{�.�/`//7SERIAL#,T�d//Ei4�6�'''!L!°D/ ! LIC.#J�We7:T_a4/_ DATE ae,`29`K INSURANCE CO. ADJUSTER CLAIM # ESTIMA". -o-- .ONT OF CAR RIGHT SIDE .. BUMPER FENDER FENDER Bumper Brkt. "F ender Skirt Fender Skirt Bumper Guard ,: Fender Ext. ',: Fender Ext. Bumper Reinf. Fender Mldg. Fender Mldg. Bumper Pad W. O. Mldg. W. 0. Mldg. Gravel Shield Cowl Cowl Valance Headlamp Headlamp Headlamp Door Headlamp Door HEADER PANEL Sealed Beam Sealed Beam Grille Park. Light Park. Light Grille Mldg. Side Mark. Lamp Side Mark. Lamp Grille Brkt. 71 Vert. Supt. DOOR,,FRONT DOOR, FRONT Door Hinge Door Hinge Door Reinf. Door Reinf. CORE SUPT. Door Mldg. Door Midg. Radiator Door Handle Door Handle Rad. Shroud Door, Glass Door, Glass Rad. Hoses Anti-Freeze ;`, DOOR, REAR „ DOOR, REAR Fan Blade Door Mldg. Door Mldg. Fan Belt Center Post Center Post Fan Clutch /C. Rocker Panel Rocker Panel ya Rocker Mldg. Rocker Mldg. / a; A.C. CONDENSOR QUAR. PANEL QUAR. PANEL Recharge A.C. Quar. Ext. Quar. Ext. Air Cond. Line Quar. Wheel Hse. Quar. Wheel Hse. Dog Leg Dog Leg Quar. Mldg. Quar. Midg. HOOD Wheel, Open Midg. Wheel, Open Midg. Hood Hinge Fender, Rear Fender, Rear Hood Midg. Tail Lamp Tail Lamp Hood Latch Side Mark, Lamp Side Mark, Lamp Ornament REAR OF CARMISC. ITEMS g Name Plate Bumper Top Bumper Brkt. Antenna Bumper Reinf. Battery SPINDLE Bumper Guard Gas Tank Wheel Bumper Pad Frame Tire %Worn Body Panel Cross Member Hub Cap Gravel Shield Motor Mts. Up. Cont.Arm Floor Undercoat Up. Cont. Shaft Towing & Storage , Low. Cont. Arm TRUNK LID Refinish As Nec. J�` Low. Cont. Shaft Trunk Lid Mldg. RECAPITULATION Wheel Align Trunk Hinge Trunk Lock 5.- CO _ Labor His. $4S6;, $ frlf� ®V WINDSHIELD Lic. Light Parts $ _ Adhesive Kit Back-up Lamp Moulding Tax Open Items Material $. 60, Q If the customer wishes to claim used and/or damaged parts, please check this box ❑ I hereby authorize the repair work listed to be done along with the necessary parts and materials.My car will be driven by your employees Sublet $ to make required tests at my risk.An express mechanics lien is hereby acknowledged on above car or truck to secure the amount of repairs thereto.I hereby waive the Statute of Limitations and if any action on this account requires employment of an attorney I agree to pay 11/2% interest per month which is an annual percentage rate of 18%from date,reasonable attorney's fees and court costs.Storage.will be charged 48 hours after repairs are completed.Not responsible for loss or damage to cars or articles left in cars in case of fire,theft,accident or any other cause beyond our control. TOTAL $ Authorized by X Deductable $ DAMAGE REPORT ALEXANDER 02/29/,96 at 13 :34 D.R. 26379-0001947 AB076560 Est : Not On File. AMERICAN AUTO BODY REPAIR AND PAINT ***CALL 510-432-9910*** 105 BLISS AVENUE PITTSBURG, CA 94565-4937 (510) 432-9936-FAX Parts 0 . 00 Labor 0 . 5 units @ $48 . 00 24 . 00 Paint 6 . 0 units @ $48 . 00 288 . 00 Paint/Materials 6•. 0 units @ $22 . 00 132 . 00 Sublet/Misc 5 . 00 -------------------------------------------- SUBTOTAL $ 449 . 00 Tax on $ 137 . 00 at 8 . 25000-o 11 . 30 -------------------------------------------- GRAND TOTAL $ 460 . 30 ------------------------------------- ------- LA INSURANCE PAYS ` $ 460 . 30 THIS IS AN ESTIMATE ONLY BASED ON OUR VISUAL INSPECTION***********POSSIBLE FURTHER DAMAGE MAY BE EVIDENT AFTER DISMANTLING********** PARTS PRICES SUBJECT TO INVOICE-REPAIRS FULLY GUARANTEED "QUALITY WITHOUT COMPROMISE" FED.# 94-2638040 EPA.# CAD981383250 Estimate based on MOTOR CRASH ESTIMATING GUIDE. Non-asterisk(*) items are derived from the Guide IRT4800. Database Date 12/95 Double asterisk(**) items indicate part supplied by a supplier other than the original equipment manufacturer. CAPA items have been certified for fit and finish by the Certified Auto Parts Association. EZEst - A product of CCC Information Services Inc. Page: 2 DAMAGE REPORT �t, ALEXANDER 02/29/96 at 13 :34 , ,/'" a, 6 D.R. 26379-0001947 AB076560 Est : Not On File. AMERICAN AUTO BODY REPAIR AND PAINT ***CALL 510-432-9910*** 105 BLISS AVENUE PITTSBURG, CA 94565-4937 (510) 432-9936-FAX Owner: SHERI ALEXANDER Day Phone: ( ) 674-2267- Address : 120 NORTHSTAR DR Other Ph: ( ) 427-0604- PITTSBURG CA 94565 Deductible: $ N/A Insurance Co. : Phone: Claim No. : Adj . : 90 ACUR LEGEND LS 4D SED WHITE 6-2 . 7L-FI Vin: JH4KA4674LC015846 License: Prod Date: 10/89 Odometer: ,,,- 0 i Automatic transmission Power steering Power brakes x Power windows Power locks Power driver seat Power passenger seat Power antenna Power mirrors Tinted glass Body side moldings Dual mirrors Air conditioning Rear defogger Tilt wheel Cruise control Climate control Theft deter/alarm Anti-lock brakes (4) Driver airbag 4 wheel disc brakes Electric glass sunroof Leather seats Bucket seats Recline/lounge seats Alloy wheels Clear coat paint -------------------------------------------------------------------------------- REPR/ PART NO. REPL DESCRIPTION OF DAMAGE QTY COST LABOR PAINT MISC -------------------------------------------------------------------------------- 1 HOOD 2 Refin Hood 4 door 1 3 . 0 3 Add for Clear Coat 1 1 .2 4' FRONT DOOR 5* Refin LT Mrrr rmt cntrl w/o htd 1 0 . 8 6* Refin COLOR TINT 1 0 .5 7* Refin COVER CAR 1 T 5 . 00 8* Refin COLOR SAND & POLISH 1 1 . 0 -------------------------------------------------------------------------------- Subtotals =__> 0 . 00 0 . 5 6 . 0 5 . 00 Page: 1 Pol z u rj i i v� 3 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA ,..March 26; 1996-• Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. A11 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 "War ' g s��II� CLAIMANT: George Bonds [ ATTORNEY: 4AR 0 4 1996 Date received COUNTY COUNSEL ADDRESS: 4170 Arthur Road BY DELIVERY TO CLERK ON March 1, 1996 MARTINEZ CAUF. Martinez, CA 94553 BY MAIL POSTMARKED: Hand Delivered 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: March 4, 1996 PpHHIL BATCHELOR, Clerk BY: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors (vf This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 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)1?aA,eJ, 9-6,199 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 warnina see reverse side of this notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:�2012A Qom_ ,.;LF f 9 BY: PHIL BATCHELOR by NJ A Deputy Clerk CC: County Counsel County Administrator RECEIVED Iii LAIM AGAINST THE COUNTY OF CQNTRA SUPERVISORSOF George Bonds presents a claim for damages against the A CO. County of Contra Costa in the sum of forty-five thousand dollars ($45,000.00) . (� CLAIMANT'S ADDRESS: Mr. George Bonds 4170 Arthur Road Martinez , CA 94553 0510) 229-3089 DATE OF OCCURRENCE: SEPTEMBER 5, 1995 , PLACE OF OCCURRENCE: Richmond Municipal Court CIRCUMSTANCES OF OCCURRENCE: I was struck in the foot due to the actions of County employee C. Turner, badge number 40614 . Officer Turner was having an argument with another officer as he was removing handcuffs and chains from inmates who were being transported for court appearances . He intentionally and/or negligently dropped the chain and handcuff onto my foot. I fell to the ground in pain and was unable to stand. I was given ice to put on the area. I was not provided with adequate follow-up medical care. NATURE OF INJURY: Persistent pain and swelling of the foot, reduced mobility and continuing discomfort. WITNESSES: Claimant; Officer C. Turner; Officer David Hanson; Inmate Carl Johnson; Inmate Charles Stone; Inmate Aaron Cooper; Inmate James Bredford; Inmate Todd Wilson; West County Detention Facility nursing staff; IN Dated: 2/28/96 Ge rge Bonds FACILIW FECOURT SERVICES DIVISION BAY LTA IABLO INCIDENT REPORT o MT. ERIOR ❑ SUPERIOR ❑ WALNUT CREEK ��IG�17� ,z✓L/ INCIDENT,,e�.t,A ��4�L� '""'° _ REPORT# MDF# LOCATION161t(41 ' & A&A( DATE/TIME 0?-,0S— I DATE/TIME OCCURED 08 Y-Q REPORTED_d' �Q SUBJECT.� �^r O - 1��}1�... �i._ w DOB do? 1 Z Z I L13 SEX [ ADDRESS QST + T 4 4D/�T i N j t ! }�.�C.�Lt IF INMATE BK# S2/Seo 3 Z HOME PHONE A)1A BUSINESS -SA-14 -L AKC "444 44 BUS PHONE WITNESS 1YA e `yN P_-4ViD D ✓z51 _62 DOB " SEX 4W El ADDRESS loS'� I , -s 7, , /�► FL 2— C�- IF INMATE BK# /V/��. HOME PHONE AWA BUSINESS .9,!br., -!'¢�� UE BUS PHONE SYNOPSIS Vf ^3 W WU CUA J I IV d4C. :75Ad.4-los oAJ Tom- 1 OF t� lc"R16 �r �rr.r iri�rrrr.. NARRATIVE t4jX4 r U AICc� ,� T�l. NS,?�x�"r .e''7o c/'�V�-c.yx". �.�- %J�?�c�4-c' 7dT" c..t.a, �--- C`4 . 4 -L+►.v� "T LE- 1nJryt�� rp 5a�L.L. t f (A2tAct+ P € C �,.a &A.3.0 OgXL&A L) ACTION TAKEN RECOMMENDED _ D Or . 4e 4 t- G u roc- c 4 I'v'-k-' " rpi3 REPORTING DEPUTY SUPERVISOR REVIEWED BY DISTRIBUTION: DIV COMMANDER CT SER LT FACILITY SGT ✓ MpF MCDF WCDF OTHER PAGE�OF Z �., I . CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA March 26, 1996, 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: $10,000.00 + Section 913 and 915.4. Please note all "Warnings". CLAIMANT: I.R.S.C. Inc. RIEZZavill) ATTORNEY: Gary R Steinberg FEB 7 9 1996 4675 MacArthur Ct Ste 1590 Date received COUNTY COUNSEL ADDRESS: Newport Beach CA 92660 BY DELIVERY TO CLERK ON February 28MAIMN6ZCALIF. BY MAIL POSTMARKED: via: County Counsel I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. February 29 1996 PpHHIL BATCHELOR, Clerk GATED: y 61': Deputy I1. FROM: County Counsel TO: Clerk of the Board of Supervisors (v")"' This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: C 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:.'Mo�,,J, oZ�o.�99� 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 warnina see reverse side of this notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: 8Y: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator I LAW OFFICES OF GARY R. STEINBERG 4675 MacArthur Court, Suite 1590 2 Newport Beach, CA 92660 Attorney Bar No. 62899 (714) 556-5353 4 Attorney for Claimant, I.R.S.C. Inc. FEB -2 5 6 CLAIM OF I.R.S.C. INC. , A CAL 8 9 9 10 11 I.R.S.C. INC. , a California ) corporation ) CLAIM FOR MONEY OR DAMAGES 12 ) (Government Code §905) Claimant, ) 13 ) 14 Against: MUNICIPAL COURT FOR ) THE BAY JUDICIAL DISTRICT, ) RECEIVE® 15 MUNICIPAL COURT FOR THE WALNUT ) CREEK JUDICIAL DISTRICT, 16 MUNICIPAL COURT FOR THE DELTA ) FEB 2 8 1996 DISTRICT, AND MUNICIPAL COURT ) 17 FOR THE MT. DIABLO DISTRICT, ) CLERK-BOARD SUPERVISORS AND THE COUNTY OF CONTRA COSTA ) CONTRA COSTA CO. 18 ) 19 ) 20 21 To: Municipal Court for the Bay Judicial District, Municipal 22 Court for the Walnut Creek Judicial District, Municipal Court for 23 the Delta District, and Municipal Court for the Mt. Diablo District, 24 and the County of Contra Costa. 25 1 . The name and address of the Claimant, I.R.S.C. Inc. , is 26 as follows: 27. I.R.S.C. Inc. 3777 North Harbor Boulevard 28 Fullerton, CA 92635 c:\lit\irsC\claim �, rY 1 2 . This Claim is being made pursuant to Government Code 5905 2 & §910 and Gary R. Steinberg is acting as agent on behalf of 3 I.R.S.C. Inc. for purposes of presenting this instant Claim. The 4 post office address to which Gary R. Steinberg presenting the Claim 5 desires notices to be sent is as follows: 6 Law Offices of Gary R. Steinberg 7 4675 MacArthur Court, Suite 1590 Newport Beach, CA 92660 8 9 3 . The date, place and other circumstances of the occurrence 10 or transaction which gave rise to the Claim asserted is stated 11 herein below: 12 A. That on or about November 1, 1994 the Claimant, 13 through its manager, David R. Michaels, executed that 14 certain Contract identified as the Agreement for Copies 15 of Filing Information, a true, identical copy of which is 16 attached hereto and incorporated by reference into this 17 Claim as Exhibit "A" . The Agreement for Copies of Filing 18 Information shall herein after be referred to as the 19 "Contract" . The Contract provided for data and other 20 information in the possession of the Contra Costa County 21 Municipal Courts or the Data Processing Service 22 Department to provide upon the terms and conditions as 23 stated in said Contract for criminal filings, civil 24 filings, small claim filings and traffic filings to the 25 Claimant upon payment of certain costs as described in 26 the Contract. The Claimant has paid all costs required 27 of Claimant pursuant to the Contract. The local public 28 entities to which this Claim is being made did c:\lit\irac\claim 2 1 unilaterally and without cause breach the Contract by 2 failing and refusing to provide Claimant with the data, 3 information and records to which the local public 4 entities are obligated to provide such information, data 5 and records pursuant to the Contract. The Claimant was 6 informed on January 25, 1996 by Kathy Parker, Court 7 Operations Supervisor, that as of January 25, 1996 the 8 local public entities to which this Claim is being filed 9 with had suspended the sale of the data, information and 10 records to which the local public entities were obligated 11 to provide such information to I.R.S.C. Inc. under the 12 Contract. A true, identical copy of the letter of 13 January 25, 1996 to I.R.S.C. Inc. is attached hereto and 14 incorporated by reference herein as Exhibit "B" . Prior 15 to January 25, 1996 the Claimant had paid all costs 16 required under the Contract. The Claimant made timely 17 payment on January 3, 1996 . A true, identical copy of 18 the cover letter enclosing the costs pursuant to the 19 Contract is attached hereto and incorporated by reference 20 herein as Exhibit "C" . 21 4 . The general description of the damage or loss incurred so 22 far as it may be known at the time of presentation of this Claim is 23 as follows: 24 A. The Claimant is a reseller of data and 25 information and the Claimant has been damaged by the 26 breach of the Contract by the local public entities for 27 their failure to provide the information pursuant to the 28 Contract. The Claimant has incurred damages arising from c:\lit\irsc\claim 3 1 the failure of the local public entities to deliver the 2 data and information required under the Contract so that 3 the Claimant may utilize such data and information for 4 the sale of its services to its customers. Further, the 5 Claimant contends that it has a state statutory and both 6 a state and U.S. Constitutional right to be provided the 7 data and information described in the Contract. 8 5 . The name or names of a public employee or employees 9 causing the injury, damage or loss, if known, are as follows: 10 A. Stephen L. Weir, County Clerk of Contra Costa 11 County. 12 B. Kathy Parker, Court Operations Supervisor of 13 the Contra Costa County. 14 C. Such other counsel of the Contra Costa County 15 as referred ,to in Kathy Parker' s letter of January 25, 16 1996, which such public employees are unknown to 17 Claimant. 18 6 . Jurisdiction over this Claim would rest in the Superior 19 Court. 20 21 22 Dated: February 14, 1996 23 24 By: - 25 ry R. S54inberg q. Attorney or the Claimant, I.R.S.C. Inc. 26 27 28 4 c:\1it\irsc\c1aim AGREEMENT FOR COPIES OF FILING INFORMATION Effective , 19_, the County of Contra Costa (hereafter "County" and '_4, .P2.S.C. _-Xi-K. (hereafter "User" ) mutually agree and promise follows . 1. Definitions: A. Initial filing information, initial filing data or data means copies of the following non-confidential records which are in possession of the Contra Costa County Municipal Courts or Data Processing Services Departments: Document Description Estimated Costs 1. Criminal Filing 2 . Civil Filing 3 . Small Claim Filing 4 . Traffic Filing * Estimated cost will be provided if desired, otherwise, user shall pay the actual cost when billed. B. User understands and agrees that, in addition to the above- listed, any records which are related to the initial filing function and are obtained by User during the aforenoted fiscal year will be provided under the terms and conditions of this Agreement. C. "Records" means papers, files, microfiche, computer readable disks, tapes, cards, or any other reproducible media, upon which information related 'to the initial filing function is contained. D. "County" means the County of Contra Costa and any of its authorized departments, agencies, officials , managers, employees and agents. 2 . Payment of Costs; Furnishings of Records Subject to the below stated terms and conditions , User hereby agrees to pay the aforestated amounts which User agrees are to cover County' s actual costs of assembling and copying the aforestated filing information, including any computer programming associated therewith, and County agrees to provide said filing information to User at such time as County, at its convenience, can obtain the copies of said information for User. An estimate of the total amount shall be paid to the Department possessing the documents before any documents are copied. If the estimate exceeds the cost incurred to assemble and copy the data, including any programming required therefore, the balance will be refunded. If the estimate is not sufficient to cover the cost incurred to assemble and copy the data, including any programming required therefore, User will pay the balance before the copies are released to User. The parties understand and agree that County is not selling the filing information but rather only recovering its costs of assembling and copying the information, including the cost of any programming associated therewith, so that User is able to obtain copies of County's filing information without monetary consideration beyond the aforestated agreed actual costs of assembling and copying the information, including any programming associated therewith. User understands and agrees that this Agreement is not for sale of.. goods and is not subject to the provisions of the California Commercial Code or any other law pertaining to sales of goods . 3 . COUNTY'S DISCLOSURE AND DISCLAIIMR; WARNING TO. USER; USER'S WAIVER. USER UNDERSTANDS AND AGREES THAT ANY COMPUTER PROGRAMMING IS DONE BY COUNTY AS A COURTESY TO USER TO ALLOW FILING INFORMATION DATA TO BE COPIED IN THE FORM DESIRED BY USER, RATHER THAN THE FORM MAINTAINED BY COUNTY, AND USER FURTHER UNDERSTANDS AND AGREES: A. THAT THE FILING INFORMATION DATA IS COPIED OR DERIVED FROM RECORDS MAINTAINED BY COUNTY FOR COUNTY USE AND THAT THE USER'S USE OF SUCH DATA 1S COMPLETELY INCIDENTAL TO THE PURPOSE OF COUNTY USE FOR WHICH THE DATA HAS BEEN MAINTAINED. B. THAT THE DATA HAS NOT BEEN DEVELOPED WITH THE INTENT OF USE OR BENEFIT TO ANYONE OTHER THAN COUNTY AND HAS NOT BEEN MAINTAINED IN A MANNER INTENDED TO BE USEABLE, ACCURATE OR BENEFICIAL FOR USER' S USE. C. THAT IT IS QUITE POSSIBLE THAT ERRORS AND OMISSIONS HAVE OCCURRED IN ANY PROGRAMMING DONE BY COUNTY TO PROVIDE THE DATA IN THE FORM DESIRED BY USER, AND USER FURTHER UNDERSTANDS AND AGREES THAT IT IS HIGHLY PROBABLE THAT ERRORS AND OMISSIONS WILL OCCUR IN ANY RECORD KEEPING PROCESS, ESPECIALLY WHEN LARGE NUMBERS OF RECORDS ARE DEVELOPED AND MAINTAINED; NOTWITHSTANDING, USER AGREES TO TAKE THE RECORDS "AS IS" , FULLY EXPECTING THAT THERE MAY WELL BE ERRORS AND OMISSIONS IN THE DATA OBTAINED FROM COUNTY. D. THAT COUNTY MAKES ABSOLUTELY NO WARRANTY WHATSOEVER, WHETHER EXPRESSED OR IMPLIED, AS TO THE ACCURACY, THOROUGHNESS, VALUE, 'QUALITY, VALIDITY, MERCHANTABILITY, SUITABILITY, CONDITION, OR FITNESS FOR A PARTICULAR PURPOSE OF THE DATA AND ANY PROGRAMMING USED TO OBTAIN THE DATA IN THE FORM DESIRED BY USER, NOR AS TO WHETHER THE DATA IS UP-TO-DATE, COMPLETE OR BASED UPON ACCURATE OR MEANINGFUL FACT. E. THAT USER HEREBY FOREVER WAIVES ANY AND ALL RIGHTS, CLAIMS, CAUSES OF ACTION OR OTHER RECOURSE THAT IT MIGHT OTHERWISE HAVE AGAINST COUNTY FOR ANY INJURY OR DAMAGE OF ANY„ TYPE, WHETHER DIRECT, INDIRECT, INCIDENTAL, CONSEQUENTIAL OR OTHERWISE, RESULTING 2 - FROM ANY ERROR OR OMISSION IN SUCH DATA OR IN ANY PROGRAMMING USED TO OBTAIN THE DATA IN THE FORM DESIRED BY USER, OR IN ANY MANNER ARISING OUT OF OR RELATED TO THIS AGREEMENT OR THE DATA PROVIDED HEREUNDER. 4 . Third Party Use of Data; User's Indemnification A. User agrees that it will provide no copy (or partial copy) of any filing information data to any other entity, business or individual without 1) disclosing that the copy (or partial copy) of the data is obtained from Contra Costa records and 2 ) including a complete copy of Paragraph 3 of this agreement with the copy (or partial copy) of the record. B. User hereby agrees to defend, save, hold harmless and indemnify County and its officers, employees and agents, against claims by anyone for any loss, injury, damage, risk, cause of action, or liability of any type ( including legal fees) occurring to User or any other person, relating to or arising out of the subject matter of this Agreement, or which may be alleged to have been caused, either directly or indirectly, by the acts, conduct, omissions, negligence or lack of good faith of County, its officers, agents or employees in any way related to or arising out of the subject matter of this Agreement. 5 . Defenses of County User understands and agrees that this is the entire agreement for the use of filing information and that nothing that may be stated or done by any County employee, agent or official shall be deemed to waive or toll any statute of limitations, waive any defense or in any way stop the County from asserting any and all defenses provided by law or this Agreement. 6 . Signatures User by N / ame Title Date who represents he has full authority to enter into this agreement on behalf of User by virtue of 1) the Articles of Incorporation, by-laws or a resolution of the Board of Directors , 2 ) the partnership agreement or approval of all general partners, 3) approval of the proprietor or owner, or 4 ) approval of the governing board of the city, county, district or agency. f- Clerk'sofficeStephen L. Weir Contra ► /y County Clerk 103 court House Costa Ex-Officio Clerk of the Superior Court P.O. Box 911 1.1 Col 1nty Martinez, California 94553-0091 (510) 646-2950 T- O: .4TH.COUri'� January 25, 1996 To whom it may concern, Effective immediately, the Contra Costa County Clerk will suspend the sales of the Contra Costa County Criminal Index. This decision is based on the recommendation of the Contra Costa County Counsel and is pending the resolution of a Southern California case regarding the sale of indices disclosing charges, as do ours. To receive notice of a change of status, please fill out the form below and return it to: Contra Costa County Clerk Attention: Kathy Parker Post Office Box 911 Martinez CA 94553 Very truly yours, STEPHEN L. WEIR County Clerk Kat y Parler Court Operations Supervisor --------------------------------------------------------------- Please provide notification of status change for the sale of the Contra Costa County Criminal Index to: Company Name: Company Address: Telephone number: information Resource Service Company`9 January 3, 1996 Contra Costa County Clerk Research Department Attn: Kathy Parker P0Box 911 Martinez CA 94553 Re: Contra Costa Superior Criminal Index on Magnetic Tape Dear Ms. Parker: Please find enclosed our company check#8862 in the amount of $125.00 for the purchase of the Contra Costa Superior Criminal update Index on magnetic tape for the preceding month. We would like the information at 6250 bpi and in ASCII or EBCDIC. Thank you again for your time and consideration in this matter. If you should have any question regarding the above, please do not hesitate to call 800-640-4772 Est 317. Sincerelv. Vera Budack 16-21)1220 I. R. S. C., INC. 8862 8 6 2 3777 N.HARBOR BLVD. FULLERTON,CA 92635 THIS CHECK VOID 60 DAYS FROM ISSUANCE (714)526-8485 C ` t �+ 4Y THE �..T u m j 2 f My �s !. r DOLLARS TO THE ORDER OF DATE((�, CHECK NO. CHECK AMOUNT %09 1 t IZS FIRST INTERSTATE BANK of California r 280 SOUTH STATE COLLEGE BLVD, NP PO.BOX 280 BREA,CA 92621-0280 t i 11'0013136 2 1: 1 2 2000 2 L131: 3 13 ? 2 5 28 111' L L VERIFICATION STATE OF CALIFORNIA, COUNTY OF I have read the foregoing and know its contents. Q CHECK APPLICABLE PARAGRAPHS I am a party to this action. The matters stated in the foregoing document are true of my own knowledge except as to those matters which are stated on information and belief,and as to those matters I believe them to be true. O I am F7 an Officer = a partner D a of a party to this action, and am authorized to make this verification for and on its behalf, and I make this verification for that reason. 0 I am informed and believe and on that ground allege that the matters stated in the foregoing document are ,true. 0 The matters stated in the foregoing document are true of my own knowledge except as to those matters which are stated on information and belief,and as to those matters I believe them to be true. I am one of the attorneys for , a party to this action. Such party is absent from the county of aforesaid where such attorneys have their offices,and I make this verification for and on behalf of that party for that reason. I am informed and believe and on that ground allege that .the matters stated in the foregoing document are true. Executed on , 19_,at California. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Type or Print Name Signature PROOF OF SERVICE 1013a(3)CCP Revised 5/1/88 STATE OF CALIFORNIA, COUNTY OF Orange I am employed in the county of Orange State of California. I am over the age of 18 and not a party to the within action;my business address is: 4675 MacArthur Court, Suite 1590, Newport Beach, CA 92660 On February 16 , 19 96 . I served the foregoing document described as Claim for Money or Damages on all parties in this action ® by placing the true copies thereof enclosed in sealed envelopes addressed as stated on the attached mailing list: by placing= the original= a true copy thereof enclosed in sealed envelopes addressed as follows: ®BY MAIL ®*I deposited such envelope in the mail at Newport Beach ,California. The envelope was mailed with postage thereon fully prepaid. ®As follows: I am"readily familiar"with the firm's practice of collection and processing correspondence for mailing. Under that practice it would be deposited with U.S. postal service on that same day with postage thereon fully prepaid at Newport Beach California in the ordinary course of business. I am aware that on motion of the party served,service is presumed invalid if postal cancellation date or postage meter date is more than one day after date of deposit for mailing in affidavit. Executed onFebruary 16 . 19 96 .atNewport Beach California. 0 ='(BY PERSONAL SERVICE) I delivered such envelope by hand to the offices of the addressee. Executed on , 19 .at .California. ®(State) I declare under penalty of perjury under the laws of the State of California that the above is true and correct. (Federal) I declare that I am employed in the office of a member of the bar of this rt at whose direction the service was made. Gary R. Steinberg Type or Print Name SI Ure *(BY MAIL/NATXU.1 E MUST BE OF PERSON DEPOSIT[ ENVELOPE IN MAIL SL OR BAG) **(FOR PERSONAL SERVICE SIGNATURE MUST BE TH OF MESSENGER) MAILING LIST Stephen L. Weir, County Clerk Contra Costa County 103 Courthouse P.O. Box 911 Martinez, CA 94553-0091 Kathy Parker Court Operations Supervisor 103 Courthouse P.O. Box 911 Martinez, CA 94553-0091 Clerk of the Bay Municipal Court District Contra Costa County Municipal Court 100 37th Street, Rm. 185 Richmond, CA 94805 Clerk of the Delta Municipal Court District Contra Costa County Municipal Court 45 Civic Avenue P.O. Box 431 Pittsburg, CA 94565 Clerk of the Mt. Diablo Municipal Court District Contra Costa County Municipal Court 1950 Parkside Concorde, CA 94519 Clerk of the Walnut Creek Danville Judicial District Contra Costa County Municipal Court P.O. Box 5128 Walnut Creek, CA 94596 GARY R. STEINBERG .ATTORNEY AT LAW 467S MACARTHUR COURT r SUITE 1590 NEWPORT BEACII, CALIFORNIA 9224360 TELEPHONE (714) 5S6-5353 FACSIMILE (714) 851-2810 February 16, 1996 Stephen L. Weir, County Clerk Contra Costa County RECEIVED 103 Courthouse P.O. Box 911 FEB 2 $ 1996 Martinez, CA 94553-0091 CLERK BOARD OF SUPERVISORS Kathy Parker ColvTh�, Court Operations Supervisor 103 Courthouse P.O. Box 911 M rtinez, CA 94553-0091 Clerk of the Bay Municipal Court District Contra Costa County Municipal Court 100 37th Street, Rm. 185 Richmond, CA 94805 Clerk of the Delta Municipal Court District Contra Costa County Municipal Court 45 Civic Avenue P.O. Box 431 Pittsburg, CA 94565 Clerk of the Mt. Diablo Municipal Court District Contra Costa County Municipal Court 1950 Parkside Concorde, CA 94519 Clerk of the Walnut Creek Danville Judicial District Contra Costa County Municipal Court P.O. Box 5128 Walnut Creek, CA 94506 Re: Claim for Money or Damages Pursuant to Government Code §905 February 16, 1996 Page 2 Gentlemen: Please find enclosed a Claim of I.R.S.C. Inc. pursuant to California Government Code §905. Very truly y Z ary R. Stei erg, Esq. GRS:lm Encl. cc: Jack Reed calitiirsciweirAtr VICTOR J. WESTMAN CONTRA COSTA COUNTY COUNSEL TO P.O. BOX 69, CO. ADMIN. BLDG., MARTINEZ, CA 94553 (� v J DATE Z -\IQSUBJECT �✓�� \.J r QR S. A CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA March 26, 1996 Maim 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 toVigs". fmaw Amount: $10, 000.00 + Section 913 and 915.4. Please note all CLAIMANT: Cory Nichols MAR p 4 1996 COUNSE ATTORNEY: MAR r1NEZ CALIF. Date received ADDRESS: 1470 Maria Lane, #300 BY DELIVERY TO CLERK ON February 29, 1996 Walnut Creek, CA 94596 BY MAIL POSTMARKED: Hand Delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PpHHIL BATCHELOR, Clerk DATED: March 4, 1996 BY: Deputy , II. FROM: County Counsel TO: Clerk of the Board of Supervisors (t/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: / — 1 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:W,,, 36 _ (9%, 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 warnina see reverse side of this notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:-W.,,), aZ, BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator M l ` 1 . 2 Cory Nichols, IN PRO PER 1470 Maria Lane, #300 3 Walnut Creek, CA 94596 4 CLAIM AGAINST A PUBLIC ENTITY 5 In the Matter of the Claim of: 6 CORY NICHOLS, ECENED Claimant, 29 0 8 vs . FMSORr 9 CONTRA COSTA COUNTY SHERIFF' S COSTA CO' DEPARTMENT. 10 11 12 To: County of Contra Costa Sheriff' s Department . 13 Cory Nichols hereby makes claim against the County of Contra 14 Costa for damages as the result of his wrongful arrest and 15 incarceration. Cory Nichols makes the following statements in 16 support of his claim: 17 1 . Claimant' s address for the receipt of mail is 1470 Maria 18 Lane, Suite 300, Walnut Creek, CA 94596 . 19 2 . Notices concerning the claim should be sent to the above 20 address . 21 .3 . The date and place of the occurrence giving rise to this 22 claim is on or about August 29, 1995 at 10 Via La Cumbre Court, 23 Lafayette, CA in Contra Costa County. 24 4 . The circumstances giving rise to this claim are as 25 follows : 26 Cory Nichols was arrested at the above address without 27 probable cause and with no basis in law for his arrest . He was 28 1 ' w� ' 1 2 incarcerated as a result of that arrest and deprived of his freedom 3 of movement by imprisonment . 4 5 . Claimant' s injuries are loss of freedom of movement and 5 emotional and physical injuries according to proof but in an amount 6 in excess of $10, 000 . 00 7 6 . The names of the public employees causing the claimant' s 8 injuries are believed to be Sheriff' s Deputy McLaughlin and another 9 deputy, whose name is unknown. 10 7 . My claim as of the date of this claim is $10, 000 . 00 or 11 more according to proof based upon my loss of freedom and the 12 emotional trauma I experienced. My claim will be based upon proof 13 in an amount to be proved later. If the claim can be settled 14 without the involvement of .an attorney, the claim will be closed within the jurisdiction of the Municipal Court . If an attorney is 15 required to represent me, the claim may exceed the jurisdiction of 16 17 the Municipal Court . 18 Dated: February 29, 1996 19 0�, 20 CORY NIC ,OLS 21 22 23 24 25 26 27 28 2 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA March 26, 1996: 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: $10,000.00 + Section 913 and 915.4. Please note all Ilk r CLAIMANT: David Pinckert ((�� MAR 0 4 1996 ATTORNEY: Date received COUNTY COUNSEL ADDRESS: 2306 Pacheco Steet BY DELIVERY TO CLERK ON March 1, 1996 MARTINEZ CALIF. Concord CA 94520 BY MAIL POSTMARKED: February 29, 1996 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim, ppHH gg DATED: March 4, 1996 BYIL BATCHELOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors (✓f This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( Other: Dated: - —L —S} Ce BY: r 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—M&,,.1 /q 94PHIL BATCHELOR, Clerk, By 3JJ"A_L,1 Deputy Clerk WARNING (Gov, code section 913) Subject to certain exceptions, you have only six- (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For additional warnina see reverse side of this notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Y Dated�a„,,, a -g 1 9 9 (e BY: PHIL BATCHELOR by Deputy Clerk J 4L CC: County Counsel County Administrator - =; RECEIVED MAR - 1 0,196 DAVID PINCKERT CLERK BOARD OF SUPERVISORS 2306 Pacheco Street CONTRA COSTA CO. Concord, CA 94520 February 26, 1996 Contra Costa County Board of Supervisors 651 Pine Street, Suite 106 Martinez, CA 94553-3152 i Attention: Clerk of the Board of Supervisors NOTICE OF CLAIM AGAINST CONTRA COSTA COUNTY This claim is presented by David Pinckert for actions of the Contra Costa County Mental Health Clinic at Concord sometime in 1995. Claimant has no way of knowing the exact time of these.actions. This claim is timely because_ the claimant learned of these actions only within the last six months. The claimant, David Pinckert, resides at 2306 Pacheco Street, Concord, California, 94520. All correspondence concerning this claim should be sent to the claimant at that address. In violation of Welfare and Institution's Code Section 5328 and other sections of California law, the County Mental Health Depgrtrnent wrongfully released to the Concord Police Department and/or the Contra Costa County District Attorney's Office privileged, private and confidential information from the claimant's records at the Mental Health Clinic. This release was made without written authorization from the claimant and without an order of the Court requiring said release. As a result of the release of these records, the claimant was wrongfully arrested and incarcerated for six months, during which time the plaintiff was subjected to physical beatings, .deprivation of medication for a preexisting seizure disorder, humiliation and embarrassment. As a result of this incarceration, the claimant lost the businesses which he operated, all to his great_financial detriment. Further, as a result.of the release of his records, the claimant was required to 'stand trial for a crime he did not commit, resulting I i Contra Costa County Board of Supervisors February 26, 1996 Page 2 in great emotional stress, fear, anxiety, anguish, embarrassment and humiliation to claimant. The amount of the claimant's claim exceeds $10,000.00 and jurisdiction rests with the Superior Court. Very truly yours, a/Lr DAVID PINCKERT - � } - �4 - y : 2 . � E 0tn . . ® K � . . ba CD \ > } a tok § n \ w / 0 r ? . . Ln ( CD \\\ . ( | , \ \ � °» . . . . . . \ . . . . . . . . . : :: : . } CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA MARCH 26, 1996 , 4 . Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $2,000.00 Section 913 and 915.4. Please note all CLAIMANT: CARLTON ROSS MAR Q 5 1996 ATTORNEY: DCOUNTY COUNSEL Date received RTINEZ CALIF. ADDRESS: 72 RIVERVIEW DRIVE BY DELIVERY TO CLERK ON MARCH 4, 1996 PITTSBURG CA 94565 BY MAIL POSTMARKED: NOT LEDGIBLE I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. QQHHIL BATCHELOR, Clerk DATED: MARCH 5, 1996 8Y: 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: (101 �J (p BY: ,�L�-- 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:Djn,a, , 19'7(, 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 warnino 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:=Qx" I:Vg ���9 BY: PHIL BATCHELOR b _ Deputy Clerk CC: County Counsel County Administrator Claim *to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT r� 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, 19879 must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue 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 actio 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, aeparate cla!as must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, 'Penal Code Sec. 72 at the end of this form. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 0! * * * * * * RE: Claim By ) Reserved for Clerk's filing stamp ) RECEIVED Against the County of Contra Costa or ) District) NtRa► T SOBS Fill in raw) ) 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) 2. Where tile! `Uie daiwaga. or injury civ'G=lir r %'Tholudo, eziu 6.'okxcaty) CJ3�4eA CV�A Q-0U'4,+ 3. How did the a or injury occur? (Give full details; use extra paper if 1 required). 7t ,�S) f\` QG YY\� r>4 4,5 q Lb ( 2 �1�c� cam.. ��� A- 16� -�h6r.� �� S S CSS rm �� w 8 r �?tii5 ��•►•, cz� bG aw tri, ro 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? 1510 ' ec2�2,d� �1`' t�'Co�� ' )6r r�455�., (over) 5. What are the names of county or district officers, servants or employees causing the damage or injury? 6. 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.) 4-o iL YrG �'�6 Arnim % 8. Names and addresses of witnesses, doctors and hospitals. .A_MM__M_M M__N_t1_MN�_MM�MN�M�MM_.1_MN.M_�M_ 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT as * ee � eefe * * * ecce * ace * eeeeeee * e * efefee * eee Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf." Name and Address of Attorney S Claimantis Signature Address 0 Telephone NO(.3 3 �. Telephone No.s/o ��31 NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for Payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in, the county Jail for a period of not more than one year, by a fine of not exceeding one thousand ( 1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. E _ cls affLk �Pj cite,6 S'�'p f M6- 1—:Aku-0 o o 0 "96-7CIS-MAZA (ZA fRick A 4+h K�.A 4 Ax C� kik cl ..m..._.... _,...__ `-.._..:°a....eLL/:!f �'�L�'(%'-- t_�C✓--'�-,�"''�i'G✓t�-l/-'-L:O'"�=^.—`.��e�;,�.�.��,wf/_"'��Q_____.,.._._�«�.., yk f _•'�a:.,-�------- ... —�_��...,_._._ ___...........r..�__._._.....�..--..w.,.._.._,.,..,_,� ._.,,.,....».,�,.�,...�....,...�.w.,..,. `"yo- ti N j b o 13S 1 J p � 0 G s L•Y�e, 7 CLAIM BOARb OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA , March 26, .1 996 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: $945.02 Section 913 and 915.4. Please note5 . "►� CLAIMANT: USAA Casualty Insurance Company FEB 7 9 1996 Belia McIntire - Claim Specialist ATTORNEY: 3676758-7101-6-606 COUNTY COUNSEL Date received MARTINEZCAUF- ADDRESS: PO Box 15506 BY DELIVERY TO CLERK ON February 28, 1996 Sacramento Ca 95852 BY MAIL POSTMARKED: via:'. Risk Mgmt. I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. r PpHHIL BATCHELOR, Clerk DATED: February 29, 1996 BY: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors (V/ This claim complies substantially with Sections 910 and 910.2. ( ) This claim'FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 2,12,21'1 U 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: -MA,,,cL 96 PHIL BATCHELOR, Clerk, By �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 warnina see reverse side of this notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: `rn oL Q 19 1 �2 BY: PHIL BATCHELOR by eputy Clerk CC: County Counsel County Administrator usaa USAA CASUALTY INSURANCE COMPANY P.O. Box 15506 Sacramento, CA 95 5 RECEIVE CONTRA COSTA RISK MANAGEMENT 651 PINE ST 6TH FLOOR 8 MARTINEZ CA 94553 RS February 14, 1996 Policyholder: Ingrid J. Fawell Reference Number: 3676758,-7101-6 -606 Date Of Loss : November 18, 1995 Loss Location: Clayton, California Your Driver: Steve Rodrick Dear Julie Ammock: Enclosed you will find a claim presented on behalf of USAA and our policyholder. We have paid our insured $945 . 02 which includes our insureds paid $500 . 00 deductible. Please include our policyholder' s name and reference number when submitting payment or correspondence so that we may make proper identification. If you have any questions regarding this matter, please call . Sincerely, Belia McIntire Claims Subrogation Specialist USAA Western Regional Office Phone: (800) 531-8222 Ext. 46459 Fax Phone: 916 285 2268 F 3676758 - 6 - CA - 11/18/95 - 606 - 82 - G583 tla i ro: BOAM) OF SUPERVISORS OF CONTRA COSTA COUNTY C • J Y INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for-death or for injury to person or to personal property or growing crops and which accrue on .or_after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must-6e 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 £orz. R£: Claim By ) Reserved for Clerk's filing stamp USAA INSURANCE- / INGRID J. FAWELL RECEIVED Against the County of Contra Costa ) FEB 2 8 or ) CLERK BOARD OF SUPERVISORS District) CONTRA COSTA CO. om Fill in n . ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $945.02***************2nd in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) NOVEMBER 18, 19951- 8:30 PM 2. Where did the damage or injury occur? (Include city and county) 1200 MARSH CREEK ROAD CLAYT N y CA 3. How did the damage or injury occur? (Give full details; use extra paper if required) THE 194 CHEVY TRUCK WAS PARKED/UNOCCUPIED IN SHAWN FAWELL PARKING LOT WHEN STRUCK BY POLICE VEHICLE VAN. IMPACTED THR RIGHT QUARTER PANEL OF `94 CHEVY TRUCK. 4. What particular act or omission on the part of county or district oai--rs, servants or employees caused the injury or damage? COUNTY EMPLOYEE WAS DRIVING POLICE VAN. �. wnaL are the namaes oi- county or district officers, servants or employees causing the ,d3 age or injury' STEVE RODRICK 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. RIGHT REAR QUARTER PANEL TO THE '94 CHEVY. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) SUPPORTED BY OWN INSURANCE CARRIER APPRAISAL. 6. Names and addresses of witnesses, doctors and hospitals. N/A 9. List the expenditures you made on account of this accident or injury: DAT£ ITEM. AMOUNT 1/24/96 COLLISION COST $445.02 2/08/96 COLLISION DEDUCTIBLE $500.00 Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or some on is 1 r Name and Address of Attorney USAA IN CIALIST Claimant's Signature vv P.O. BOX 15506 Address. SACRAMENTO, CA 95852 Telephone No. Telephone No. 916-921-9060 � * T W W if NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for Payment to any state board or officer, or to any county, city or district board or Officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such impriS went and fine. P AGE i U.S A.A 14ESIFER!'-4 REGIONAL OFFICE P ,04 BOX 15506i SACRAMENTO; CA 958S2—i506 (800) 50-8222 CD LOG NO 0003?62 DATE 02/06/bt: CLAIM# 000000oi2 POLICY# 00413S38s COMPANY USAP! CLAIM REP 01104/00026 INSURED iLT DAVID W GUTHRIE CLAIMANT NONE LOSS DATE 01117196 TYPE OF LOSS COLLIDRV SUPPLEMENT IN SP DATE 1/i9/96 i-Ol'--ATION Ell 01/iT/'rat 10:00A.mi APPRAISER MICHAEL jGREGORY C'C-.iMP AN)" U-SAA ADDRESS P.Q BOX 62123.-D CITY STATE ORANGEVALE PHONE (9i6l630-134i ZIP 55662 SHOP Ham:VES BROTHERS COLLISION' REPATTN OF STEVE FURMAN ADDRESS 1800 20TH STREET PHONE (916)4S6-336S CITY STATE Sq5BqMENTO CA LICENSE # ZIP IS i4 REG. # 68-0168303 NAME iLT DAVID W GUT"RIE WORK PHONE ADDRESS 7S14 SALTfir; SEA WAY CITY STATE SACRAMENTO CA ZIP 95831-3786 PHONE (916)422-6403 LICU 3CBW376 CA VIN JH4DA9389PS000080 ENG/CALOR MET. GREEN MILEAGE 60716 CONDITION GOOD ACCTING CTL# 00i E=NEW PART EC=GUALITY REPLACEMENT PART EU=SALVPGE PART EP=GUALITY REPLACEMENT PART P=CHECK I=REPAIR/ALIGN/SUBLE'r L=REFINISH N=ADDNL LABOR .OPERATION TE=PART/PART IAL REPLACE ET=LABOR/PARTIAL REPLACE !T=LABOR/PARTIAL REPAIR AA=APPEARANCE ALLOWANCE RP=RELATED PRIOR DAMAGE UP=UNRELATED PRIOR DAMAGE P.0. 2 WITH 3 DAYS OF REPAIR TIMEj 1993 ACU eft INTEGRA LS 2 DOOR HATCHBACK Si4128/D OPTNS BfBNDUX OPTIONS: ELEC REMOTE CONTROL MIRRORS POWER WINDOWS REAR SPOILER MOONROOF AIR CONDITIONING OP GDE MC DESCRIPTION PRICE Aj% HOURS R %i-c: COVERiFRONT BUMPER QUALITY REPL. PART i 62: 0-.,% J. L 018 COVER&RONT BIMPER REFINISH 2.8 :+ . E oio SPOILERiLOWEnj ROA T 71ilOSK7010 71.13 C . 0-- ACURA INTEGRA LS 2 DOOR HATCHBACK PAGE 2 CD LOG NO 0003T68 DATE 02/06/T6 OP GDE MC DESCRIPTION MFG. PART lf,104 PRICE Aj% HOURS Pk L oio SPOILE&LOWER FRONT REFINISH 5 i+ N 973 HEADLAMPS AIM ADDTL LABOR Si 5 1 E 054 LAMP' jSIDE MARKER RT 33800SK7ACi 62,72 .2 J. I iC,!+ FENDER)FRONT RT REPAIR/ALIGN w5*i L 104 FENDER&RONT RT REFINISH 2. 3 91- E 132 HLD&FENDER SIDE R/R R & 1 2 j. E i10 GUARD&ENDER MUD RT R & 1 12 -1. i- M'1 i CLEAR COAT REFINISH is.7s* 115*1* N Mis COLOR TINT ADDTL LABOR .5*i N M17 COVER CAR EXFERIOR ADDTL LABOR 3.004� . i i I M60 HAZARDOUS WOPTE REMOVAL SUBLET 200* 4- 0 ITEMS FINAL CALCULATIONS # ENTRIES GROSS PARTS 13%85 OTHER PARTS PAINT MATERIAL 140,00- PARTS TOTAL 596`60 TAX ON PARTS VRATERIAL Q 7,750% 46.24 LABOR RATE REPLACE HRS REPAIR HRS i-SHEET METAL 48n00 s. i 2S6 369.6-0, 2-MECH:ELEC 48.0t---- B-FRAME 48,0-%r.� 4-REFINISH 48.00 S.6 268.80 S-PAINT MATERIAL 2sloru LABOR TOTAL 6i2,40 TAX ON LABOR e lojo% SUBLET REPAIRS 2.50. TONING & STORAGE GROSS TOTAL 0283.74 LESS: DEDUCTIBLE WAIVED, NET TOTAL 0283.74 LESS: ORIGINAL NET TOTAL 1016.43- NET SUPPLEMENT TOTAL 167. 3i PX1:YY/00/00/00/00 SEARCH AREA: SACRAMENTO GEOCODE: 9615i DEVICE 057885-006 ADP AUDAPOINT U Sl LOG 0003968 DATE 02/06/96 22: 29:06 R2.5 CD 01/96 COPYRIF.HT: 1995 AUTOMATIC DA70PROCESSINi.5 THIS IS NOT A REPAIR AUTHORIZATION. OWNER MUST AUTHORIZE REPAIR% PLEASE GIVE THIS REPAIR ESTIMATE TO YOUR GARAGEMAN4 NO SUPPLEMENTS WITHOUT PRIOR APPROVALa SUPPLEMENTS WILL NOT BE CONSIDERED WITHOUT COPIES OF ALL PARTS INVOICESz CALIFORNIA LAW PROVIDES THAT YOU HAVE THE RIGHT TO SELECT THE REPAIR FACILITY OF YOUR CHOICEI THIS:.i...: E..:! 1.Mf••iTH!✓!.« BEEN PREPARED BASED ON•} i}"i f:: USE SE {t?i-• CRASH PARTS rLif`}"?....5.i:.i S"i• SO_F _r OTHER-ErTHAN THE `!..s � k _T_FE^ wrYOURiMOTOR i O- V: i _ f : ANY WARRANTIES •i.;!— APPLICABLE TO THESE REqJPCEMENT PARTS AREFrwiDEEi' THE MANUFACTURER O e -o CD LOG NO 0003962 DATE 02/06/9---, DISTRIBUTOR rF THE E P _ f RATHER - Hes " } j BY . ORIGINAL. MANUFACTURER -" ACj L: " O: VEH •• •i°_...i t'l PAGE PXN LOCATE REPORT QUALITY REPLACEMENT PARTS INCLUDED IN THIS APPRAISAL ARE AVAILABLE FRO*!---. SUPPLIERS SHOWN ON THE PARTS EXCHANIGE (FIX! LOCATE REPORTTHE ONLY DUALTT''i'' REPLACEMENT PARTS SUBjECT TO CAPA CERTIFICATION WE BUMPER COVERS, HEADEi''. PANEL& AND NON-STRUCTURAL SHEET METAL PARTS. USA? REQUIRES THE USE OF CAX-'! CERTIFIED PARTS FOR ANY REPLACEPT&T PART SUBJECT TO CAPA CERTIFICATION, SUDSTITUTED FOR 0 is GUIDE SUPPLIE!:`-, R L R NO. PART DESCRIPTION! PKIT NfUMBEN'.. Oi2 )COVERXRONT BUMPER ACITGf2q0::' 7ii0lSK7&80ZZ C RR W. A INSERTED PX PRICE IS BASED ON! PRICE QUOTED BY 7HIS SUPPLIEF''. ORG ORIGIN CODE : C il E 1 H :KIST CLS CLASSIFICATION' CODE : R RECONDITIONED PARIF C CAPA CERTIFTgp,PART WOTED BY LISTED SUPPLIE-..--:--. SRC SOURCE CODE : i !Gi NAL 3 ORIGINAL EOUIPMENT MANUFACTURER WEM) PART SPL. CODE SUPPLIER/ADDRESS lD/CIT`i` ST ZIP TELEPHONE Oi CAPITAL PLTNG REMAN P A.'W 14 S WK) 372-330]-,- i045 TRIANGLE COURT, #8 WEST SACRAMENTO CA 9E60E: ---------------------------------------------------------------------------------- OnTE 02/06/96 22 : 33 : 23 ANCAPOINT SEOUENCE 4Q0G...T6-.E SEARCH AREA : SACRAMENTO GEOCODE: 9615i U Si LOG 0GO3968 DATE 02/06/96 22 : 29 : 06 R2.5 CD Ot/0, COPYRIGHT; WRE AUTOMATIC DATA PROCESSING MEFF# : 444 ImageMate Page : 2 Claim# : 000000006 Name : FAWELL C y 2 : 3 : 4 : .z ^�-ram°. � � wr Y; ;����,� ;���"��'��` ,i ��yyY1,66 11�,CC���Vt�R ., M•���.`3 Cr C� `. �`�� � ff EC+ERtiL hjflTfha�c+�f{ e of t 3r k • � CH�.V R�:� oc,� a z,.:zr „�i 6 6:. x....,.. �'�� j�`�+A�e¢'•}"��� .C°+�ZE"'� R P1fi t 1 f,. � 5 : 6 : s a777777 s `.p 7 µ k 33t%.saa 1-7 v.yp.javA ^ PAGE 1 MIKE 'S AUTO BODY ' 2001 FREMONT STREET CONCORD , CA 94520 (510) 686-1739 CD LOG NO 0002113 DA [E O1/11/96 SHOP CONI ACI ROH EWING lNIii P UAlL O1/11/96 ' OWNER INGRID J FAWELL ADDRESS 2219 NAVARRO CT ` CITY CTATL ANl�IOC|� CA ` ||OHL P(0N| 77 (�10) U �O57 ZIP 9450� -5O23 � WORK P|0N[ ( ' )OOO 'OOOO ' CLAIH000000006 POLICYS 003676738 INSURI-ED INGRID J FAWELL C|AIH REP 01104/00027 LOSS DAT[ 11/18/93 CiAIHANT ' � TYPE OF LOSS COLL/DRP ' ' . .� INS CO USAA �� r� CONTACT LIC# K1 1-11'626 ~ ' ° VIN 2G.CLC19Z3R'1211303 DODY COLOR T[AL MIL[AG[ 22312 CONDITION [XCL ACC7 'NG C7L4� 001 [=NLW PART [C '[COMOMY PART LUSALVAGE PART [P=C[L PX R[PURT P-Ci|LCK I' m. PAI�/ALIGN/CUDL[T LRFFINISH N.-ADDN 'L LABOR OPERADON TE:PART/PART IAL REPLACE ET=�AUUR,/PAR7 IAL R[ PLAC[ ll �LABUR/PARl IAL R�PAI R AA' AF'PLARANCE ALLOUANCE ' RP--RELATED PRIOR DAMAGE UP :UNQF|.ATED PRIOR DAMAGE -k.-:USER VNTERED VALUE *A*+*w*��,*�*A*-A A**���-k**A***A-A*��k A A*/A*��-A*-A A**A*-A *�-A A*-A*A*A-A A**�** R-01/11/96�C01/11/96�I '01/10/96�S '01/12/96 '4 DAYS TO REPAIR DAMAGE IS TO RT BUD SIDL Al REAR . RFST OF V�KICLE IN EXCi CONDITION . ****-k* �A- k A-****A-**A-****k A- -k-k k******************* 1.994 CHR--V 1/2TON 8 FT EX\ LNDLU CAB TRK U0243C/B OP7NS U/3140DPGRTSC OPTIONS : [�O -STAG[ � [X[[RIOR SURFAC[S DUMP[R STRIPS lINTE U GLAGS POWL.R DOOR LOCKS POWER WINDOWS REAR BUMPER TILT STEERING WHEEL AIR CONDITIONING CALIFORNIA EMISSIONS CRUISE CONTROL OP 0 D E MC D[CC�IPTIUN M} G . PARI NO . P�lCL AJ% ||OUi".0 R I 493 "AN 1:L ' D[DSID[ RT R[PAIR/ALIGN 7 . 5"1 L 498 07 PAN[L ' DLDCID[ �*i K[r-lKlS|| 11 . O 4 [ 424 MLDG , DEDSIDEPNL LWR R 15607256 OM PART 25 . 75 . 3 1 [ 40,el MLDG , DLDCID[ PN/ LUk 17.1 R, 1,56 161.20 GM PAp7 21 . 55 . 3 1 E 1133 13 HLDG , DEDSIDE WHL OPNG RT R & I * � . 3 1 E 534 TAIiLAMP ASSFHDLT R R & l * . 3 1 — E 433 BUHPFR , RFAR STFP R & I . CHEV- 1/2TON 8 Fl EXTENDED CAB IRK PAGL 2 _ CD LOG NO 00021113 DAT[ 01/11/96 . 9 ITEMS MC MESSAGE 09 INCLUDES 0 . 6 HOURS MAJOR PANEL TWO-STAGE ALLOWANCE FINAL CALCULATIONS & ENTRIES GROSS PARTS 47 . 30 ADJUS7H[N7S DISCC)UN| @ 10 . 00X 4 . 73- O [|i[R PARTS 5 . 00 PAINl MATERIAL ` 86 . 40 PARTS TOTAL.. 133 . 97 � TAX ON PARIS & MkTLRlAL @ 8 . 2b0% 11 . 05 LABOR RATE REPLACE HRS REPAIR HRS 1' C||[ [ | MLTAL 50 . 00 2 . 7 0 . 5 360 . 00 2-MECH/ELEC 50 . 00 - 3-FRAME 50 . 00 4-REFINISH ' 50 . 00 4 . 8 ' 240 . 00 .� 5-PAINT MATERIA� / 18 . 00 . LABOR TOTAL 800 . 00 TAX ON LABOR @ .000% SUBLET REPAIRS TOWING STORAGE ' GROSS TOTAL 943 . 02 LESS : DEDUCTIBiE 300 . 00- NET TOTAL 443. 02 ADP S<0PLINK U0310 ES LOG 0002113 DAT[ 01/11/96 15 ; 59 ; 50 R4 . 2 CD 12/95 ' PXN : YY/OO/OO/OO/OO CUK : 02/00/00/00 COPYRIGHT , 1996 AUTOMATIC DATA PROCESSING 1 .3 HOURS WERE ADDED TO lHlS ESlIMAl [ BASED ON ADP 'S TUU' SlAGE REFINISH FORMULA : 20% OF RLFINI3|| |0URS , AF (ER OVERLAP , PLUS 0 . 6 HOURS FOR THE FIRST MAJOR PAN[L ' WHERE NOTED . - ---------- '--- '------------ '------ '------------------------------------------- ` - "RAFf=1C COLLlS'CN REPORT DEC - b CKP 555 PAGE I (Rev 240 OPI 042 92 PAGE NUMtR HIra DISTRICT LOCALRAMIRTNUMER NJUIL[D FEW u Su c rzncr� p cXWA Co.S.O. � MIT RRN RzuITT M"""a OBTRICT [EAT ) 1 - 2.449 1 _ 2.449 rYtA L03114 324 COLLISION OCCURRED,° YM DAY YEAR TWAE(31401 = I�(nP�,o7�t'A¢Jc, [ or 12oo��ilryus►J 8e$ �( 1) i►8 i 9S Z..-)30 9-37.� 7193 0 --------------rLEro[r NIOIRYATIOM r [K----- _ �- DATOwaTOW AWAY PHOTOGRAPHS BY: v BEET,KRIIL of S M T W T S OTEs ®"D 0 �AT sfT[RSECTION MORN /r n STATE NWT REL. .: mss" MNWIMILES S of ►�/ldrzsla roH lam- 10'. ®Ho PART DRIV UCW$[NWBGI STATE cuss SAFETY VEHL YEAR ImoonI COLOR 1 LICENSE NUMBER RATE 1 N1 l S! 'L4.o CA- c NG7A 11C-�,�. =0 Li^W___ /�IJ-r Q 3 4.z,oa. . .CA DRIVER NAY[(IHRSr.Moo".LAR) ® �Tyc 1 {.1 Ar)1c .A' ►Eoti STRIM ADDRESS OWN&"MAY[ pS,AYE AS DRIVER TRIAN PARKED r /BTAT[ 7yOWNERB ADDRESS � LI"As OWILX VIIHICLII ❑ CuK,�TaA.. Ci �i4Si1 I So►SU.sw 4.pus Mor n,4 I✓Z,64, OCT. $EY LwRT aYo MOOIfT W60HT► ORRNOAT[ RACE CWPOMFTW"OF VEHICLE ON ORDERS O► cr"WaR ®DRIVER QOTNER Q M TIMA Baa s---) 1 LS 3 L T t 59 �.,r�1Gr 5c u OTHER HOME PONE Bu4L%m PROM[ PRIOR MECHAHICIA OERC'YO MOMS APPARENT® REFER TO NARRATIVE ❑ ) S I v� �c4(o-S'7� CHIP �&T FEE VEHICLE DAMAGE $MADE N DAMAGED MEA NSUR NCE CAR ER POLICY ML$&sER aNONE ©&KNOB llAt� Z Z QYAJOR TOTAL O0.OF ON somm FMSHIB�V onto Kr DOT O , CA O ICC O rue O , 12916 �A1LluR.Lr,�r 31.1/A ► 7 PARTY DIIVtR'$YCtM[M1YS[N STATE CLAM SAFETY VOL YEAR MAK[/MOLICENSE MUWu RATE Sour. 2 qa CLIaV � w-S)DEL/COLOR -ti.u_m. k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DRIVER t(RIIIST,MaDLE,LAST PIDIM ADDRESS OWNERS NAME SAME AS DRIVER o 1 PARKED CITY/STATE/MPADORER SAYE AS DRIVER VEHICLE . 12000 M.41:.S1i U G4S►'7 ICY. SEX I MMR EVU NEIGHT WoonT ORTHDAT[ .. RACS DISPOSITION OF VEHICLE ON ORDERS OP: ❑OFRCIR ❑ORIVER UTMER n , GUST Y0. ! OAT .' ;a. q •v 0 ❑ OTHER HOME PHONE sWR1[M PHOAI[ PRIOR MECHANICAL DEFECTS: NON[APPARENT REM TO NARRATIVE❑ ❑ ( ) , C 34P Ust ONLY DESCRIBE VEHICLE DAMAGE SHADE N DAMAGED AREA VEHICLE TYPE 0- 0--40— INSURANCE CARRIERPOLICYRRRRBtR a" ! ®YDD. ❑MAJOR 0—AL DIL OF ON BSIMS'SIMIMMIRF on" PCF DOT O C O ICC O TRAVEL G-r NA aju R.u. Lor ` A r4 o N cc PARTY DRrvER$ucws[NLMRsED STATE CUES SAFETY VtHL YEAR MAK!I NODIKU COLOR f, E mosiR ETATF 3 EOUM. , owvER wwc lRR$1.roDLE.LARI owNa"NAME $AYE AS DRIVER TRIAN RIAN TRStT ADDRESS ❑ i✓ s�, ❑ l PARKED CITY/STATE I L► OWNERS ADDRESS aSAME AS DN R' VEHICLE OCY• SEX I IWR EYES MERCHT EIGHT ORTHOATE RACE DISPOSITION OF VEHICLE ON OADEM Of: QOF CER ❑DRIVER ❑OTHER COST YO. ! DAY . YEAR ❑ ! . OTHER HOPE PHONE sUSNEM PHONE PRIOR YECHANCAL DEFECTS: APPARENT a REM TO NARRATIVE O ❑ ( , ( " , CHP USE owl Omm"V$ISCL DAI&AGt SHADE N DAMAGED AREA KE INBURM' CARRIER POLICY NWVDSCLE TYPE SER 0- 04, QAINOR •'•A:." Dn1 or ION STM= "REO PC ORH , IOlRM11. F ' TRAVEL LEVY DOT D CA D lee O O P MPATCH NOTIFED AnuWERs MIME _ - DATE REVIEWED Q �. 1(S.o/��•?/O. 7I QYE! O NO so WA TRAFFIC COLLISION CODING aa I +s< - 2 DATE OR COLLISION /�_ TSI[(3100) MGIC M0q�0[� to L 0 NW S[R t ►/O. , DAY Y[AN �1� 1• ZO �}► dz OWNER'S NAM[!ADDR[SS NOWNOTIFlED PROPERTY o— o"o DAMAGE. oacwnlou o�oAsuo[ SEATING POSITION`'.. SAFETY EQUIPMENT EJECTED FROM VEHICLE r OCCUPANTS L-AM ABAG DEPLOYED KLG BICYCLE.NE_uct A-NONE IN VEHICLE M-AIR BAG NOT DEPLOYED 0-NOT EJECTED -` 8-UNKNOWN N-OTHER DRIVER 2•FULLY EJECTED C-LAP BELT USED P-NOT REOUIRED V-NO 2.PARTIALLY EJECTED W-YE8 3-UNKNOWN 1.DRIVER D-LAP BELT NOT USED 1 2 3 2 TO 6.PASSENGERS E-SHOULDER HARNESS USED PASSENGER 4 5 6 T STATION WAGON REAR F-SHOULDER HARNESS NOT USED CHILD RESTRAINT X-NO 11•REAR OCC.TRK.OR VAN G-LAP/SHOULDER HARNESS USED O-IN VEHICLE USED Y-YES 9-POSITION UNKNOWN H-LAP/SHOULDER HARNESS NOT USED R-IN VEHICLE NOT USED 7 0-OTHER -PASSIVE RESTRAINT USED S-IN VEHICLE USE UNKNOWN K.PASSIVE RESTRAINT NOT USED T-IN VEHICLE IMPROPER USE U-NONE IN VEHICLE ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK(•)SHOULD BE EXPLAINED IN THE NARRATIVE PRIMARY COLLISION FACTOR TRAFFIC CONTROL DEVICES Z 3 PE OF VEHICLE Z 3 MOVEMENT PRECEDING UST NUMBER (r) OF PARTY AT FAULT COLLISION r q VC SECTION VIOLATED: cBD,. ACGNTROLS FUNCTIONING APAS$ENG CAR/STATION WAGON gSTOPPED ONO B CONTROLS NOT FUNCTIONING• B PASSENGER AR W/TRAILER B PROCEEDING STRAIGHT r B OTHER IMPROPER DRIVING•: CONTROLS OBSCURED MOTORCY J SCOOTER RAN OFF ROAD I IMPRaP�. PJA tJu.JG D NO CONTROLS PRESENT/FACTOR• D PICKUP OR TRUCK MAKING RIGHT TURN C OTHER THAN DRIVER• - TYPE OF COLLISION PICKUP/PA TRUCK W/TRAILER MAKING LEFT TURN D UNKNOWN• HEAD-ON F TRUCK ORT TRACTOR MAKING U TURN r E SIDESWIPE i TRUCK/TREK TRACTOR W/TRLR )( ]OTHER CKING REAR END SCHOOL BUS OWING/STOPPING WEATHER( MARK 110 21TEMS) X D BROADSIDE OTHER BUS SSING OTHER VEHICLE V_lACLEAR E HIT OBJECT 1J EMERGE VEHICLE ANGING LANES B CLOUDY OVERTURNED KHIGHWAY NST.EOWPMENT PARKING MANEUVER C RAINING VEHICLE/PEDESTRIAN L BICYCL TERING TRAFFIC SNOWING OTHER.: OTHER ENCLE HER UNSAFE TURNING E FOG/VISIBILITY FT. MOTOR VEHICLE INVOLVED WITH PED WAN G INTO OPPOSING LANE F OTHER.: ANON-COLLISION MOPE �( RKED _GWIND PEDF.STRAN RGING LIGHTING OTHER MOTOR VEHICLE AVELING WRONG WAY 1ADAYLIGHT MOTOR VEHICLE ON OTHER ROADWAY OTHER ASSOCIATED FACTOR(S) ': B DUSK•DAWN PARKED MOTOR VEHICLE Z 3 (MUM t TO 2"on) C DARK-STREET LIGHTS TRAIN Ave VIOLA pip yu D DARK-NO STREET LIGHTS BICYCLE ONO DARK-STREET LIGHTS NOT ANIMAL: B VC SECTION VIOLATION: crrE0 FUNCTIONING• Ors ROADWAY SURFACEPHYSICAL SOBRIETY X A DRY I FIXED OBJECT: CVCUCnQkVWLATM: Q $ (MARK 1 TO:nun) B WET OTHER OBJECT: OND NAD NOT BEEN DRINKING SNOWY-ICY D CE D SLIPPERY(MUDDY.OILY,ETC. ON► VISIOBSCUREMENT: HBD-UNDER LU HBO NOT UNDER OER ININ FLUENCE INATTENTION•: HBO-IMPAIRMENT UNKNOWN' ROADWAY CONOITMON(Si PEDESTRIANS INVOLVED STOP&GO TRAFfIC UNDER DRUG WFLuEWE (MARK 11 TO 21TEMS) H ENTERING/LEAVING RAMP A NO PEDESTRIAN INVOLVED PREVIOUS Ca1NSKM 0 IMPAIRMENT-PHYSICAL- HOLES.DEEP RUT• CROSSING IN CROSSWALK IMPAIRMENT NOT KNOWN UNFAMILIAR WITH ROAD B LOOSE MATERIAL ON ROADWAY• ID AT INf'ERSECTKON NOT APPLICABLE OBSTRUCTION ON ROADWAY• DEFECTIVE VEK EOWp P.: Rp CROSSING IN CROSSWALK-NOT OYp J lLEEP1l/FATKBIED D CONSTRUCTION•REPAIR ZONE AT INTERSECTION 13- SPECUI.INFORMATION E REDUCED ROADWAY WIDTH CROSSING-NOT IN CROSSWALK I IL UNINVOLVED VEHICLE ANAZARDOUS MATERIAL FLOODED• IN ROAD-INCLUDES SHOULDER OTHER•: IG OTHER•: NOT IN ROAD X' NONE APPARENT X IH NO UNUSUAL CONDITIONS IG APPROACHING/LEAVING SCHOOL BUS I I 1 10 RUNAWAY VEHICLE SKE CN 4 �-)(�dL.•ut TR� O U•I -�f rorcan NeRnL :.'C.'T i " �CR CRNR v-z CJ IZow M4=a — 19C CHIP 1 C ZiMk Ra. G'o.Ce.S-dowow . rrvs+uN ceLzs�c. — DA ' PD S Dir.T6�I t11o/J•GACJt� - - _ CT OTHER Toho....rKocsN CNP"A AGE 2( RIO 11.611) OE2 OATC 0I COLLISIONNCIC NUMOCR OIIICCn I.D. NVMCCw YO. OAv 19, •w. q5 x:030 932.0 93 //•Zf�� ALL MEASUREhWS ARE APPROXIMATE AND NOT TO SCALE UIWS STATED (SCALE C 1 I /► IMDICATU 000 RD- MOOT" EmfLb jEE PRaKIN(r LDT SHERl FFS DETENTION Fbcl l.i r A v—'P vNINV01 4ED rew•r1� to log of i 90 Iol v—1 1 � 10' 4 ' 3 lo' 10� 9' 9' oMArM eT I.D.MYrw[w ro. owT Tw, wave's MO. owT •w. co}'y CHP 555—Page 4(Aev 11.85)OP1 042 S"ATE CF CALIFORNIA NARRATIVE/SUPPLEMENTAL CHP 556(Rev 7-90)OPI 042Page 4 DATE eF INCIDENVOCCURRENCE TIME(24NCIC NUMBER OFFICER I.D.NUM3W NUMBER 32.v 1 Z )r ONE -X'ONE TYPE SUPPLEMENTAL r'X-APPLICABLE) .® Narrative Q Collision report ❑BA update C)Fatal ElHit and run update El Supplemental ❑Other: ❑Hazardous materials ❑School bus ❑Other: CITY/COUNTY/JUDI r DISTRICT / REPORTING DISTRICT/BEAT CITATION NUMBER ! uN,,�. / 3 zo/4o 2r I LOCATIONtOW00WSTATE HIGHWAY RELATED L./VI PLv��,E+PA24.�..x.�r [?1 Z�co lti4Lm5►�� .,[tJrryTaw�; rvvaww Gt. a. (L ❑Yes 14e]No i r 2. nl On(4 A-m0&� 1� -}�� (I�1GC.IDIc1�lT -/JD 1 s.1JLt1Llt� J 2��a CALJ... Lo A9pZADoL 3. 223�t1�2S. ParlbLo'C �..ti 52G1 �..,� tv�� c Q.a R 22tc]t�3 otJ 4. Srrc1�L. G ao➢rLnK 23yS1ilxs. s. Sri 6. i ICIJ: rC1 T'A&-" 1�:11 46-R� es 1•4 PA69S 43. �s,oJ oG 17. L?/vt PLz!!r=ts Paakj^L L--w'r" (-2 1ZftL42SJ CJZAZ GQe •. NAQS14 hCINk 8 ► t�Tr._ni n arJ f^AC.�L.I zy G t��ro N _ 9. iki AAAJ ^n LAT 15 r-EAr/L_L-Wt6L. WIR2TIFIGI/3L LICe4-7-11416 10. 1 rd G Stora LLS. 11. �G ��•rrYL�ts : _ i 12. 13. W&=A n.mac_ [fN->)n 0 N-b : -1 r 14. I�L_ii 2.; ?QycciwtcntT 7R.�. i 1s. y-I • 17. PnAort:. Ta 1-Lr A-aZI0A4-.1_9E UE�. 1S W--PIcrMtS, /..I rIew �►d��ch.,.�� 18. o^J PA& 43 ,„1 -I ILE- PaS1 nc.4 .xAS 4.3LLND u Pori M'i \ 119. L1�J_ LS 4-L(� LA I PPrb -,.i I A .5 PAIL= '� �v&C /h 0 LA 32±- 0 AJ - -A ze-Ae-CI'Z.T. S,9 C_ ) 20. Ido DArnA&► -m r)1 ,-- verA. ort T7L,,- S-PARS n/tn- , lJ.aA3rsvG.--,c- 7-1Z RJn�t of 21. rtl,c- 4PzA,&r T)R,r- ala& -rt.l,2.rpt. P4/NT G 14 PS a^) iQ4,u v-- . 22. AaPass�.�,r--^!S. � 41 [r>LI T&T', �*.. -r-1J.E li Gr�Nno,J �G 1L/1� a•.>t� l 23. i tit-sT)L tem ILM 5 L L �/P LU AW-Ifs CA 24. -2 , D 25. DEP,G 1 n l 1� L71.4(a1`A-,%A c�N T AGIZ iT 3. ?AtJcA=-t 1 ail iQ Ltnl-OCGuPI�) 126. �I G r.I A tt-'� 15-1-ALL. T7�-G TTnaT- aF -n1G G.,c1.1 r 10A3. 127. '50S rA/nhC4--� Mot). 0A-►Mom !-ZM_. AANw=- Ai-ex-4 s , 128. 14_$l CA.t_.. (ryt flZ^XeS 29. P30 NE. 30. 1 r�IJ\1Cl 6= 31. PREe _ANQ I.D.NUMBER / DATE REVIEWERS NAME OATS W I c,So,.>t.--r c. '1 Qts 1 Use previous editions until depleted. , STATE OF CALIFORNIA , NARRATIVE/SUPPLEMENTAL CHP 556(Rev 7-90)OPI 042 Page 5 DATE-OF INCIDEAVOCCURRENCE TIME(2400) NCIC NUMBER OFFICER I.D.NUMBER NUMBER //'� � 11. X3-4 11.330 G- 32o I )q3 'X'ONE 'X'ONE TYPE SUPPLEMENTAL r)rAPPLACABIE) Q Narrative ®'Collision report ❑BA update ❑Fatal ❑Hit and run update ❑Supplemental ❑Other: ❑Hazardous materials ❑School bus ❑Other: CITY/COUNTY/JUDICTI/S�RICT ^ REPORTING DISTRICT/BEATCITATION NUMBER U N1, / L.ON?1/uL%M/AT.LlsA4L--1b 3 zzlQC7Z LOCATION/9b*1W SM 1 s XaF STATE HIGHWAY.RELATED CL. EntPlc7 to z P•4atvNGLor E IZom OU Su&4-�- •. Ay-C N MAJILS►1 U& V- 2-b• ❑Yes No i t.�TATG/YK�rli$c 2. C�4kI CS- 3. ici-7-4 rEmo 7-AJ4r 4,- ..aAT AAcic.r.4G \)-I , -rAZiN` rra A1JOID ++M 1-U T-Kk. PAJdC,=-I�, 4. o r,1 14-t S Q;r. ILS t/J 1'?s.NTI c na Ls-4s To G LLQ -t- T1 .P U rstJL.-I 5 TZO P, Ar►C rYw k E 5. A n3 Po1N r -r"R J. W141--14 Il£ lSaAk-r=M 11E Frits 114-r- i rr PAGr ` 6.�A/JICNS � LdNLt-USIciVS 7. ?4VfAT aP- IM PACT- 8. ACT8. ES?'AMUSa=CI, 2-:1 V-2 a,�T. f�Cl-lS10�.1 dLG, .e D•�� 1N Tl�t� tG1fNDi_d�1� 9. 17ArtL�.etiG Lir 1=' 1-2=c= /17,ML.S►� ert��-amt� •, ��op`rz.a�. . S.n� S�oF /1'14-t_sIJ C'tt=z gra . 110. A r*0 /a-ap210-e- 1 W�o F r7�. G. Ebl� D f T7i E O.ti.2lu NG Ld>- 11. ArLrZanu�: ' 12. U-( L-wA5 Tr•ACaNG 1N 1-14 . PAJZJ"- Lar L-aJ- tJ I,lt.*( Be AP4 t.4CL- 13. SA-v,-.ve. LAP tri A Now-nLtij Z)IP-tMn.a_ )N 11ts ATTL,tpr T-b /kaon A P-LL 14. -rtt.te.r-ftRkIMS�1. .1 ,-5.-- l.J. S'1.h6C 0 4-1M , 1 L&41 ,,.,istUeMLr aTLCA-.. aLm? b, T-Alm i 15. SP4R.G 1 VLF I a.aJvr=-t a,-& 7)m'GG REgjL. of U-I -�O I N PAr-r Q I T-4 T114-- RA Qr2. 16. PrA a Z o F L7-Z, L,311►c it ,j,4 S L.L-�.su_z P4-U Lc..�--b_ Fac,N L; I . 117. \ 1 / L_A-USE.: LA r4 Sn•f-- &,4ckj NG P tA re r a F 1 18. LA #1 l S. PIL r21 C1c_ 19. -Caw rm tG N DA T7cra S 20. AICa�. 21. 22. 23. i 24. 25. 26. 27. 28. 29. 30. 31. PREP NA UAE LD.NUMBER / DATE REVIEWERS NAME DATE�� •1`.L.J�LSOA311. 19.9 Use previous editions until depleted. 90 57541 AUT AOBILE ACCIDENT AND U .3 REPORTMw ' Member Name USA umber L/R Number Date of Loss Company v ® Ingrid J. Falwell 3676758 6 11-18-95 CIC }a, ADDRESS(STREET,CITY,S ATE AND ZIP CODE) PHONE NUMBER(AREA CODE) U0 2- 15(6 79, - �l C= PERMANENT HOME(LEGAL)ADDRESS(STREET,CITY,STATE AND ZIP ODE) PHONE NUMBER(AREA CODE) YEAR� MAKE �H�V BODY JE P(V IMILEAGE(r�tad MOTOR/SERIAL NO. LICENSE NUMBER(YEAR,STAT V NAME OF REGISTERED OWNER(LAST,FIRST,MIDDLE INITIAL) YOUDDR ESTIMATE OF DAMAGE A Sc-*,/ OA- (JoMO F*wELL $ / Od Ix PARTS DAMA�ED AND EXTENT /� WHERE MAY CAR BE SEEN? v RT. l'�e-k2 �o�QuZ-1-c PAW E L Mkkjr_ S AI O rdi CA n>0LIENHOLDER NAME AND ADDRESSPQ Q,:�,y_ (0 b LIENHOLDER ACCOUNT NUMBER d Fr✓�, co-EO tT V Nt s N ��22l 19! -10 IF YOU WERE USING HIRED OR' YEAR AND MAKE LICENSE NUMBER( EAR,STATE,NO.) BORROWED CAR,GIVE FOLLOWING: - REGISTERED OWNER(FULL NAME,ADDRESS) COMPANY CARRYING INSURANCE(NAME,ADDRESS,POLICY#) v NAME(LAST,FIRST,AND MIDDLE INITIAL) AGE OCCUPATION PHONE NUMBER(AREA CODE) a HOME: a V CCL w • ' •_cA O BUSINESS: � ; ADDRESS(STREET,CITY,STATE AND ZIP CODE) f✓ !OC C�+Al E D RELATIONSHIP TO DID YOU AUTHORIZE DRIVER WAS DRIVER WEARING POLICYHOLDER TO USE YOUR AUTOMOBILE? SEAT BELT? C° ❑ YES ❑ NO ❑ YES ❑ NO 0 V TIME AND DATE OF ACCIDENT OR LOSSLOCATION OF ACCIDENT OR LOSS(STREET,CITY OR COUNTY,AND STATE) u r, E°°sIt IVvv g� 2vg� Has Lvov /';SN c,2K Rn G�A7tbr'i cA 7 / NAME OF OWNER(LAST,FIRST,MIDDLE INITIAL) E ADDRESS(STREET,CITY,STATE AND ZIP CODE)��� rV�1 PHONE NUMBER Lu 12000 tmogt c�<< /��� CA s•6YG- 57-6 Q NAME/�OF DRIVER(LAST,FIRST,MIDDLE INITIAL) AGE ADDRESS(STREET,CITY,STATE AND ZIP CODE) ��h Y� HONE NUMBER z aOC)�IC T VG CDEPuTY� 34 po SN G2K let? 9YS1 r' t:- 700 � MAKE OF OTHER CAR MODE I IYEAj LIC SE NUMBER(Y�EO�ATE,NUMBER) VE�4 S"Cr,�s YOUR ESTIMATE OF DAMAGE jZ WHERE tId T-EEN' JPARTS DAMAGED AND EXTENT F OTHER PARTY'S INSURANCE AGENT/COMPANV(a E A ADDRESS) ° GnvfiTy' 15 S&LF y�_wiee7 EMPLOYEE �'3(. La;t - MkRSK ck%C KEY: V P`U (Ppll eo CA LABEL STREET,SHOW TRAFFIC yNOctyPttS�, 1pET� tONC`u� t Ct./1'('1� ' CONTROLS,SHOW CARS(NUMBER W YOUR CAR#1,OTHER CAR#2), Q -Flop INDICATE DIRECTIONS Q ' N W O Q Ir G a �111rr+:S EXPLAIN FULLY MANNER IN WHICH ACCIDENT OCCURRE / d W rn Ow f E° A ' �z W D W(,� C(� IF COMPREHENSIVE CLAIM,FURNISH FOLLOWING TIRE MILEAGE AGE OF CONVERTIBLE TOP,SEAT COVERS,BATTERY,ETC, a INFORMATION ON ITEMS INVOLVED IN LOSS. IF NOT ORIGINAL EQUIPMENT,GIVE COST. IF REQUIRED,HAS STATE MOTOR VEHICLE.ACCIDENT REPORT BEEN FILED? ❑ YES ❑ NO IMPORTANT!!Insurance coverage cannot be verified to the State for you,unless we have your accident report. CONTINUED ON BACK LA001-1094 CA- D-7101 -5 -1104 /27 NAME AND ADDRESS HOME PHONE RELATION TO DRIVER MARITAL STATUJJ1 WAS PASSENGER/CHILD AGE BUSINESS PHONE ❑ MARRIED SINGLE RESTRAINT IN USE? ❑YES ❑NO NJURED? IF YES,NATURE AND EXTENT OF INJURIES El YES El No Iy� WHERE TAKEN(IF KNOWN) Z 8Y WHOM(IF KNOWN) . " qQ 41 NAME AND ADDRESS HOME PHONE VO RELATION TO DRIVER MARITAL STATUS WAS PASSENGER/CHILD AGE BUSINESS PHONE Q ❑ MARRIED ❑ SINGLE IRESTRAINT IN USE? ❑YES ❑NO to ZsINJURED? IF YES,NATURE AND EXTENT OF INJURIES Q` ❑ YES ❑ NO V= ERE TAKEN(IF KNOWN) BY V(HOM(IF KNOWN; Wo =-NAME AND ADDRESS HOME PHONE 1- C RELATION TO DRIVER MARITAL STATUS WAS PASSENGER/CHILD AGE BUSINESS PHONE ❑.MARRIED ❑ SINGLE RESTRAINT IN USE? ❑YES ❑NO INJURED? IF YES,NATURE AND EXTENT OF INJURIES BY WHOM(IF KNOWN) ❑ YES ❑ NO ERE TAKEN(IF KNOWN) NAME AND ADDRESS ' HOME PHONE Z i A d RELATION TO DRIVE. WASP SENGLRlCHILD CL URSDS °•^,E L:USiN.PS PHONE O` RESTRAINT IN USE? ❑YES ❑NO ❑ YES ❑ NO UO NAME AND ADDRESS , HOME PHONE Zw RELATION TO DRIVER WAS PASSENGERICHILD INJURED? AGE BUSINESS PHONE Q` RESTRAINT IN USE? ❑YES ❑NO El El V NAME AND ADDRESS HOME PHONE Z no RELATION TO DRIVER WAS PASSENGER/CHILD INJURED? AGE BUSINESS PHONE RESTRAINT IN USE? ❑YES ❑NO ❑ YES 11NO ' NAME11 C Irve / u�� ADD�ES ` HOME PHONE 7 !J J ✓! �i VWHERE• WITNESS AT TWIE OF ACCIDENT? BUSINESS PHONE AG S 6Vd of V4,v 1e GyL 706 U) NAME ADDRESS HOME PHONE HV Z0 AGE WHERE WAS WITNESS AT TIME OF ACCIDENT? BUSINESS PHONE rjF- NAME ADDRESS HOME PHONE ' m = E WHERE WAS WITNESS AT TIME OF ACCIDENT? BUSINESS PHONE YOUR TRAVEL DIRECTION YOUR SPEED LENGTH OF YOUR SKID MARKS OTHER PARTY TRAVEL DIRECTION OTHER PARTY SPEED LENGTH OF OTHER PARTY SKID MARKS COMPLETE IF WHICH CAR WAS OTHER CAR WHERE WAS OTHER WHERE WAS YOUR CAR INTERSECTION ENTERED FIRST? COMING FROM CAR WHEN YOU WHEN YOU FIRST SAW COLLISION ❑YOURS ❑OTHER ❑RIGHT ❑LEFT I FIRST SAW IT? OTHER CAR? Q DESIGNATE THE NUMBER OF TRAFFIC LANES WHAT WAS EXACT POINT OF FIRST IMPACT WHAT WAS EXACT POINT OF FIRST IMPACT ON r ON YOUR CAR? OTHER CAR? GYOUR DIRECTION OTHER ..i IN YGUR OPINION,R:10 WAS AT FAULT AND WHY? JARE YOU MAKING CLAIM IS OTHER PARTY Q AGAINST OTHER PARTY? AGAINST YOU? V ❑YES ❑ NO ❑YES ❑NO CL STATEMENT MADE BY YOU ABOUT ACCIDENT STATEMENT MADE BY OTHER PARTY ABOUT ACCIDENT H DID POLICE APPEAR AT WAS POLICE REPORT LAW VIOLATIONS BY YOU LAW VIOLATIONS BY OTHER PARTY SCENE OF ACCIDENT? WRITTEN? ❑YES ❑ NO ❑YES ❑NO POLICE CHARGES AGAINST YOU POLICE CHARGES AGAINST OTHER PARTY CALIFORNIA Statutes,Section 1879.2(a) states:"For your protection California law requires the following to appear on this form. Ag person ' Who knowingly presents a false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison.' ' DATE OF THIS REPORT SiA OF DRIVER OF P LICYHOLDER'S CAR (IF AVAILABLE) SIGNATUA OF POLI YHOLDER (IF AVAILABLE) AFFIDAVIT OF PAYMENT BY USAA C I l I certify that I have examined the C* file of the below referenced insured Othat payment checks were issued as fuliows: USDA Insured: •USAA Number ZU/ Q Claim Number: 5" e� Date of Loss:- 1. oss:1. Applicable Coverage: Check Numb r: � heck Date: ? Amoun of Bank: G� . Payee: Z. Applicable Coverage: Check Nu r he Date: Amo ck: a� OA� Bank: O Payee: • 3. Applicable Co erage: Check Num er: Check Date: Amount of Check: Bank: Payee: CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA March 26, 1996 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: $10, 000.00 + Section 913 and 915.4. Please note all "War (rV1181V11]) CLAIMANT: Robert- Merritt '` MAR 0 4 1996 ATTORNEY: Richard B Vaught, Esq. WtiNTYg0UNSEL 111 N. Market St. , #332 Date received MARTINE:ZCAUK ADDRESS: San Jose, CA 95113 BY DELIVERY TO CLERK ON March 1, 1996 BY MAIL POSTMARKED: February 29, 1996 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. March 4 1996 EVIL BATCHELOR, Clerk Y DATED: eputy 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 (!,-,tAA;-✓ 1 s ti.a e 4;6- d-c�2� a� Dated: — `/ -1j (p BYDeputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARDD 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:. W&j,L, /' & 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 b Deputy Clerk CC: County Counsel County Administrator NOTICE OF CLAIM TO PUBLIC ENTITY TO: ADMINISTRATOR OF THE BOARD OF SUPERVISORS RISK MANAGEMENT RECEIVED HIGHLAND GENERAL HOSPITAL 1411 E. 31st Street Oakland, CA 94602 [MAR - 11996 RON HARVEY CLERK 130AR C�F S 0-ERVISORS MERRITHEW MEMORIAL HOSPITAL COi TP,,-a-QSTA CO. C/O RISK MANAGEMENT 651 Pine Street Martinez, CA 94553 Pursuant to Government Code Section 910, claimant hereby presents his claim for medical malpractice as follows: CLAIMANTS NAME AND ADDRESS: Robert Merritt 1837 Church Street Oakland, CA 94621 ADDRESS TO WHICH NOTICES ARE TO BE SENT: Richard B. Vaught, Esq. 111 N. Market St. , #332 San Jose, CA 95113 (408) 297-5060 CIRCUMSTANCES OF THE OCCURRENCE: On or about September 1994, and thereafter, the claimant was examined at MERRITHEW MEMORIAL HOSPITAL with complaints of pain upon urination and in the area of his left femur. Claimant was diagnosed as having a urinary tract infection and was prescribed antibiotics. On or about March 1995, and therafter, the claimant was examined at HIGHLAND GENERAL HOSPITAL with complaints of severe pain during urination and more pronounced "bone" pain. Once again, claimant was given a prescription for an antibiotic. On or about October 1, 1995, claimant was again seen at HIGHLAND GENERAL HOSPITAL with complaints of excruciating pain and spasms rendering him unable to straighten out his torso and unable to keep his balance on his left leg. At this time, claimant was advised that he was in Stage D (fourth stage) of prostate cancer. The discovery date of this medical malpractice is approximately October 18, 1995 and the six (6) month statute of limitations date within which to file a claim against a government entity is April 18, 1996. The hospitals and their staff, so carelessly and negligently diagnosed, treated, prescribed, and monitored or failed to monitor, claimant, which negligence and carelessness resulted in claimant not receiving proper treatment for prostate cancer until he was in Stage D (fourth stage) . DESCRIPTION OF INJURY OR DAMAGE SO FAR AS KNOWN AT THIS TIME: As a result of the respondents' negligence and carelessness claimant has a shortened life expectancy due to the extent of the cancer and not receiving proper medical treatment in a timely manner. NAME OF THE PUBLIC EMPLOYEE RESPONSIBLE: The names of the employees are unknown at this time, but include members of the medical staff and nursing staff who participated in claimant's treatment from September 1994 to October 1, 1995. Such names are known by, or available to, the public entity against whom this claim is made. AMOUNT OF CLAIM: General damages in an amount in excess of the minimum jurisdiction of the Superior Court, in addition to special damages according to proof. Dated: February 29, 1996 LAW OFFICES OF ARNOLD LAUB By G!� RICHARDB. VAUG T Attorney for C Mimant 1 PROOF OF SERVICE BY MAIL 2 I am a citizen of the United States and employed in the City 3 of San Jose, County of Santa Clara. I am over the age of 18 years 4 and not a party to the within action. My business address is 111 5 N. Market St. , #332 , San Jose, CA 95113 ; that on February LI, 1996 6 I served a copy of the attached NOTICE OF CLAIM TO PUBLIC ENTITY 7 by placing a true and correct copy in an envelope addressed to: 8 ADMINISTRATOR OF THE BOARD OF SUPERVISORS 9 RISK MANAGEMENT HIGHLAND GENERAL HOSPITAL 10 1411 E. 31st Street Oakland, CA 94602 11 RON HARVEY 12 MERRITHEW MEMORIAL HOSPITAL C/O RISK MANAGEMENT 13 651 Pine Street Martinez, CA 94553 14 which envelope was then sealed and placed for collection, mailing 15 and deposit on the above date with postage thereon fully prepaid, 16 in the United States Postal Service following ordinary business 17 practices. 18 I am readily familiar with the practice of this office for 19 collection and processing of correspondence for mailing with the 20 United States Postal Service; this correspondence would be 21 deposited with the United States Postal Service on the above date 22 in the ordinary course of business. 23 I declare under penalty of perjury that the foregoing is true 24 and correct. Executed on February 7-'( , 1996 at San Jose, CA. 25 r^' 26 Le icia Renteria t Ali v m �f a _ E C3cr a Ln C iv .1] iri W �i► N P4 p� W140 m 1 Naw -H xa0 W a to W ` � w CO W � ~ U �. fill I CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA March 26, 1996 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: $133,626.00 Section 913 and 915.4. Please note a11u� CLAIMANT: Mount Diablo Corporation c/o V. A. Garbesi MAR 0 8 1996 ATTORNEY: Date received COUNTY IECCNSEL ADDRESS: 1701 Geary Road BY DELIVERY TO CLERK ON March 7, 19 Walnut Creek CA 94596 BY MAIL POSTMARKED: March 6 1996 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: March 8, 1996 ppHHIL BgATCHELORepu , Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors (1r 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 L 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: �,�� z�,fq9/n 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: aa /17941 BY: PHIL BATCHELOR b Deputy Clerk CC: County Counsel County Administrator Claim 'to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY � ' 1 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, 19879, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue 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 riled against ellen puuiiis entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By ) Reserved for Clerk's fling-�t�np RECEIVES l O rea & y'¢.f " - low 'Cid - - ) h�� Against the County of Contra Costaor V ) ,Czo ��o`L zre)! ) 0"KONTRA►COSTA Co. ORS /<fa der' C'ox-,seDistrict) Fill in name ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ /,33, (0�,(��-- and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) Cam c,��• ah o.-.7 �h z r�L�/ /Jro 'c G L` moo. 7SZU- 13��Z-43 2. Where did the damage or injury occur? (Include city and county) s "`.3 sa n. �a trioti (f Y,e .177S_2 3. How did the damage or injury occur? (Give full details; use extra paper if required) z� S l cc r�'ee �v h. �-.,c c,,n f erg f�,' r i'i� r �i �-o z i��. e a 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? o7-7 (over) 5. What are the names of colmty or district'officers, servants or employees causing the damage or injury? ✓C oter►r�,Cee , m�4`� �r - f/��' Cow Z,,, J�'Z�rr�z' r /'ySSiS�4AL� /�2)e CJOY�s S. khat damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. � 0/33, 696 -to - L5-Ce /=r/e 4,'n lnouyt &,a6 /G, 2,,n Ett,, Z • Aro I'ec Z Wo, 7�Z 0- 6 ,B T2Z2 - 5'3 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 4,1Z�� a t iY,cG�C/ea 8. Names and addresses of witnesses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT � Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: "Uttorne )' or by some persmmbla behalf." Name and Address of Attorney / j 4i ClgLjmant's Signature Address 7o /') Telephone No. Telephone No. S/D - Z S r v 7 go NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000)9 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. qty � . 0 � � �... � Q � � m d �' h � � o F p � 0 . 'b�C � � �►` tD �„ A o C`> �... � a � 6� � o � � � � � � �� � � � V1 _ �V � ,t�.; � � � � �: p � � .� --. .:1 `V QQ �. n � ' t �' �, �t `� ,. . .. r � } �w r� � } ..� � �� � ��� l � IL CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA ; MARCH 26, 1996; Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $30,000.00 Section 913 and 915.4. Please notel�, mda"As.TIM CLAIMANT: WAGGS & WHISKERS MAR 0 5 1996 ATTORNEY: COUNTY COUNSEL Date received MARTINEZ CALIF. ADDRESS: 435 VALLEY VIEW ROAD BY DELIVERY TO CLERK ON MARCH 4, 1996 EL SOBRANTE CA 94803 BY MAIL POSTMARKED: MARCH 1, 1996 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: MARCH 5, 1996 JYIL �eputyLOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors tv/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 I11. 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:�,��A ?,fv , f T96 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 warnino see reverse side of this notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. r Dated: n,.,O, ;1_2 BY: PHIL BATCHELOR by—�� Deputy Clerk CC: County Counsel County Administrator WARD OF .SUPERVISORS OF CONTRA COSTA COUNTY Yn;ITUCI'IONS 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, 1 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 105, 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 na.;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=. 0 * * 0 * * * * 0 to * * * * a * * * 0 M * * * Q * a * * 0 * * * * a * * m * * a * a RE: Claim By ) Reserved for Clerk's filing stamp Waaas & Whiskers ) 435;.Valley View rd El Sob. - ) RECEIVED Against the County of Contra Costa ) or ) MAR - 4 19% Contra Costa County District) Fill in ranee ) CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. The Undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 30 , 0Q0 . 0Q a.�d in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) August. 1995- Febuary 1996 2. Where did the damage or injury occur? (Include city and county) 435 .Valley View rd . E-1 Sobrante California 94803 3. How did the damage or injury occur? (Give full details; use extra paper if required) Road closed . No acess provided . Layed off 6 employees . 4. What particular act or omission on the part of county or district officers, se.^vants or employees caused the injury or damage? Closed road wtiat are tine names of COUnLV or district officers, servants or employees causing the -da:--age or injury? Public works ------ full ex 6. What damage or injuries do you claim resulted? (Give tent of injuries or damages claimed. Attach two estimates for auto damage. Loss of income, six. employees layed off . 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Last years income . 6. 'Names and addresses of witnesses, doctors and hospitals. Bob. Sullivan Dick & Susan McCloskey Al Kirkman -3730 SPablo Dam rd 5751 Olinda rd . El Sobrante San a 4969 Santa Rita rd . (510) 223-9531 El Sobrante( 510) 223-5778 El Sobrante -,- --.wk. 223-9695 hm. 235-2039 9. List the expenditures you made on account of this accident or injury: DATE I TE V. AMOUNT` *See attached la . a Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney)_ or b some Person On his bQalf-W-- Name and Address of Attorney aJ t's ignature EI! Sbbran' te California 94803 TelephoneNo. 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 cne yearn 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 irz-prisonj-)ent and fine. .%QafG� Mo -< CisnC� 4p.p X p► � i , n 0) mo � '� rt w �+- ct x }d+•� 0 w � N 0 ct 1 i-+ ct N rn ca O ct w n � n V.• ct , w o . vi O A t<< CP •W Lo � f �rh N cn t d . .Y! 3 ( J IT a AMENDED C L A I M BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA March 26, 1996 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 ralifornia Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant twzq) ar Amount: Section 913 and 915.4. Please note al nings". CLAIMANT: Ralph Williams MAR 18 1996 COUNTY COUNSEL ATTORNEY: Neal Kuvara MARTINEZ CALIF. Date received ADDRESS: p0 Box 150150 BY DELIVERY TO CLERK ON March 18, 1996 San Rafael, CA 94915-0150 BY MAIL POSTMARKED: March 159 1996 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached i5 a copy of the above-noted claim. ppHHIL ATCHELOR, Clerk DATED: March 18, 1996 Bl: 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: Ce 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 4 a(,, l R94 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:. �T�g /n BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA March 26, 1996 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 CLAIMANT: �. Ralph Williams MAR 0 g 1996 ATTORNEY: Neal Kuvara COUNTY COUNSEL PO Box 150150 Date received MARTINEZ CALIF. ADDRESS: San Rafael CA 94915-0150 BY DELIVERY TO CLERK ON March 6, 1996 BY MAIL POSTMARKED: Transmittal from County Clerk I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: March 8, 1996 PpHHIL BATCHELOR, Clerk ~ Bl : Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( (/KThis claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: / � � BY: Deputy County Counsel 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: 1 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 warnina see reverse side of this notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator 1 NEAL KUVARA, ESQ. State Bar No . 48141 _ KUVARA & COHEN RECEIVED 2 Post Office Box 150150 San Rafael, CA 94915-0150 3 (415) 456-5900 MAR _ 6 i996 4 CLERK B0ARD OF UPERV6S0RS CON�'F;�COSTA CO. 5 Attorneys for Claimant 6 7 CLAIM FOR PERSONAL INJURY In Re: Claim of RALPH WILLIAMS, AGAINST PUBLIC ENTITY 8 Against Town of OAKLEY 9 10 TO: TOWN OF OAKLEY 11 Claimant, RALPH WILLIAMS, 220 W. Ruby Street, Oakley, Ca, 12 presents a claim for damages. The following statements are made in 13 reference to this claim: 14 15 1 . Notices concerning this claim should be sent to NEAL 16 KUVARA, KUVARA & COHEN, Post Office Box 150150, San Rafael, CA 17 94915-0150 . 18 2. The occurrence giving rise to this claim took place on or 19 about January 19, 1996, at or near O'Hara Street, Oakley, Ca. The 20 circumstances of the occurrence are as follows : 21 3. The accident occurred at approximately 7 : 30 p.m. Mr. 22 Williams was walking down O'Hara Street and tripped over a 23 protruding cement slab of sidewalk. The area immediately 24 surrounding the sidewalk was dark, with no streetlights. Mr. 25 Williams suffered severe scrapes to his hands and left harm, as 26 well as extensive damage to his left shoulder. The area immediately 27 surrounding the sidwalk was unlit, and there were no warning signs 28 or markers to alert Mr. williams of the impending hazard. 1 4 . The injuries, damage and loss for which this claim is 2 made, so far as now known, consist of: Severe scrapes and bruising 3 to Mr. Williams left hand, pain and swelling of the left shoulder 4 area, infection of the left hand necessitating pain killers and 5 antibiotics; loss of work time to seek treatment. The ultimate 6 extent of injury and loss is unknown at this time. 7 5. It is believed that the amount of the claim exceeds 8 $25, 000. Jurisdiction over the claim would rest in Superior Court. 9 10 DATED: KUVARA & COHEN LAW FIRM 11 12 13 By NEAL KUVARA 14 Attorney for Claimant 15 16 17 18 19 20 21 22 23 24 25 26 27 28 KUVAFiA EiCOHEN L�.w r Attorneys: Courthouse Square B San Francisco: Neal Kuvara 1000 Fourth Street (415)922-5522 Lawrence M. Cohen Suite 700 �!{� p. ikalnut Creek: William Donnelly L 510)839-0400 Of Counsel: P.O. Box 150150 Paul R. Martin San Rafael,California 94915-0150 STEPHEN HEN t by S-.0 ;,QTY CLERK San Jose: 879 (415)456-5900 CO IT 1 C ica-1114 rfY (408 Oakland: SY—�71„, ..___ (510)839-0400 Sacramento: (916)446-1242 March 1, 1996 Stockton: (209)465-0313 Santa Rosa: (707)571-0405 RECEIVE® FAX: (415)456-1482 Town of Oakley c/o Contra Costa County MAR 6'1996 P.O. Box 911 Martinez, Ca 94553 CLERK BOARD OF SUPERNflSORS CONTRA COS''A!_'C�� - RE : Our Client: Ralph Williams Date of Accident: 1/19/96 Location: O'Hara Street Dear: Sir/Madam: Enclosed please find the original and a copy of our client' s CLAIM FOR PERSONAL INJURY AGAINST PUBLIC ENTITY. Please return a copy marked "Received. . . (with date) " or your procedural equivalent in the enclosed self-addressed stamped envelope for our records. Please direct any questions or correspondence regarding this claim to the undersigned. Thank you for your courtesy and cooperation in this matter. Very truly yours, KUVARA & COHEN LAW FIRM Kevin Martin, . for NEAL KUVARA .!J Attorney,. at Law Extension 500 ' f 1 S 1 O ri O a rr • CZ � a th a '0 Nx o �-o w W , O M .- UI n � s ,f RECEIVED KUVARA Ei COHEN LAW FIRM MAR 18 Q% Attorneys: Courthouse Square Neal Kuvara 1000 Fourth Street �11 ArCreet—: J Nft Lawrence M. Cohen Suite 700 Walnut 'William Donnelly (510)839-0400 Of Counsel: P.O. Box 150150 Paul R. Martin San Rafael,California 94915-0150 /� t /� San Jose: (415)456-5900 (`�- I/ (408)446-5879 Oakland: (510)839-0400 Sacramento: (916)446-1242 March 15, 1996 Stockton: (209)465-0313 Santa Rosa: (707)571-0405 FAX: (415)456-1482 RE : Our Client: Ralph Williams Date of Accident: 1/19/96 Location: O'Hara Street at Acme County Clerk: Enclosed please find an updated claim for personal injury of Mr. Ralph Williams, with a more definitive address and location of the accident. I have also included some pictures of the accident scene for your consideration. Please contact me with any further questions . '1; G14 Kevin Martin, for NEAL KUVARA Attorney at Law Extension 500 NK: km Enclosures s I 1 NEAL KUVARA, ESQ. State Bar No. 48141 KUVARA & COHEN 2 Post Office Box 150150 =RECEIVED San Rafael, CA 94915-0150 3 (415) 456-5900 Y 4 a W 18 5 CLERK Attorneys for Claimant .CONTRAARD�COSTACp_SQRS 6 7 CLAIM FOR PERSONAL INJURY In Re: Claim of RALPH WILLIAMS, AGAINST PUBLIC ENTITY 8 Against Town of OAKLEY 9 10 TO: TOWN OF OAKLEY 11 Claimant, RALPH WILLIAMS, 220 W. Ruby Street, Oakley, Ca, 12 presents a claim for damages. The following statements are made in 13 reference to this claim: 14 15 1 . Notices concerning this claim should be sent to NEAL 16 KUVARA, KUVARA & COHEN, Post Office Box 150150, San Rafael, CA 17 94915-0150. 18 2 . The occurrence giving rise to this claim took place on or 19 about January 19, 1996, at or near O'Hara Street, Oakley, Ca. The 20 circumstances of the occurrence are as follows : 21 3. The accident occurred at approximately 7 : 30 p.m. Mr. 22 Williams was walking down O'Hara Street and tripped over a 23 protruding cement slab of sidewalk. The accident occurred at the 24 corner of O'Hara and Acme streets, near the county buildings . The 25 area immediately surrounding the sidewalk was dark, with no 26 streetlights. Mr. Williams suffered severe scrapes to his hands 27 and left harm, as well as extensive damage to his left shoulder. 28 The area immediately surrounding the sidewalk was unlit, and there 1 were no warning signs or markers to alert Mr. Williams of the 2 impending hazard. 3 4 . The injuries, damage and loss for which this claim is 4 made, so far as now known, consist of: Severe scrapes and bruising 5 to Mr. Williams left hand, pain and swelling of the left shoulder 6 area, infection of the left hand necessitating pain killers and 7 antibiotics; loss of work time to seek treatment. The ultimate 8 extent of injury and loss is unknown at this time. 9 5. It is believed that the amount of the claim exceeds 10 $25, 000. Jurisdiction over the claim would rest in Superior Court. 11 12 DATED: S,/ KUVARA & COHEN LAW FIRM 13 14 15 By NEAL KUVARA 16 Attorney for Claimant 17 18 19 20 21 22 23 24 25 26 27 28 �. ; �� k } / � ,5� .� .. '.l ;KS �`� 11 ��� � - y=�- II I° � �� .,� .. ✓k. � 'a � H ......;ray��1 _ ��.,: ���"� ,����� }� ��� . sir ��F�'r�r�✓. A{..�5>&Yi,.y±C'-s.:.# ... .. .�q 3' A e_ t - �}�,�..s�y�"'�E� �. �'. � .fit 1� ,�` � � `�� ice' [ J 7 d r-� '"r � e ��,y� �.. p * o �r �,.r„.f . �*�` tye+- tet.. �A.[ 4 �. -� t� t fl �� ,. � t ��, 3'-.�caY�, Ym ��.y•'� n tS �g�'. y� ,� i ,w .,�,�� g iy � �. r �Y.�ry�*"a...,n a$` � w.c�".`"us e �^,,'S.f'�� � .gym `� s� ''' � 6+�§��'t�'�' .�'� i� `ta � . � � ��Y�"� ,�,� x '�"� � °� � �" kyr,. ��Y�'���. �� ' "axe%t�•�+� �. � � �" �'.. `�. � '� ti � i v l i l xa 44 ra+rp yA. . .,yw}yam .yrs `yG�' •Sis,.• orf -Y� �/► 1 r .:, .mss�,. ., Zqy .:..�.. U.a 4`��X� • �YtO, r O � �SOO -110 0) 02 � ct C � 0Z 0 c D. C C (D (Dcm 00 0 Z i 0) Ln 0 0 " �- a 0 rt 0 Pi N. ro rt 04 (D 0 N _- � 9cn 0 rt N• G ti "z 't7 k.; (D N• (D %0 rt rt NQ�ST, Ln (n L' o ct- 0 _ w0 0 0ell ttr ::� tits F+ � -,�•c�,. v i a