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HomeMy WebLinkAboutMINUTES - 06111996 - C28 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA June 11, 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: Unknown Section 913 and 915.4. Please note all °Warnings% CLAIMANT: Theresa Castillo ATTORNEY. David G. Smith MAY 2 2 1996 Attorney at Law Date received OUNSSL ADDRESS: 2201 Broadway, Ste. 815 BY DELIVERY TO CLERK ON May A2MOCAUF. Oakland, CA 94612 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: May 22, 1996 IVIL BAATTCepuYELOR, Clerk V 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: AZ�/ g l� BY: Deputy County Counsel l ' IV III. FROM: Clerk of the Board TO: County Counsel (1)- County Adm' A trator (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: JUN PHIL BATCHELOR, Clerk, By f . 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,sNh12 aboyt. Dated: o�V BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator RECEIVE® EMAY2 1 1996 1 CLAIM AGAINST COUNTY OF CONTRA COST CLERK BOARD OF SCONTRA COSTTAA CCO. SOBS 2 O. (a) Name and address of claimant: Theresa Castillo 3 1641 Santa Clara St. Richmond CA 94804 4 (510) 524-3652 5 (b) Send all notices to: DAVID G. SMITH Attorney at Law 6 2201 Broadway, Suite 815 Oakland, CA 94612 7 (510) 893-3741 8 (c) Date of occurrence: December 22, 1995. 9 Place of occurrence: Carlson Boulevard at Huntington, City of Richmond, County of Contra Costa. 10 (d) Circumstances of occurrence: Defendant, COUNTY OF CONTRA 11 COSTA Animal Control vehicle being driven by RANDELL L. GERKE, made unsafe left turn colliding w/Plaintiff. 12 (e) General description of injury: Neck, chest, elbow, arm numb 13 hands. 14 (f) Amount of claim: Medical expenses; personal expenses, wage loss according to proof, and general damages according to 15 proof. 16 Dated: May 20, 1996 17 DAVID M TH, Esq. 18 Attorney for Claimant, 19 Theresa Castillo 20 Receipt of a copy of the within claim is hereby acknowledged this day of 21 COUNTY OF CONTRA COSTA 22 23 by 24 25 26 27 28 IV. CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Jurie 11, 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 p %]b ur .4 e Amount: Within the jurisdiction of the Section 913 'and 915.4. Please OWzrmn Superior court MAY 2 4 1996 CLAIMANT: Rick Pene ra COUNTY COUNSEL ATTORNEY: Thomas G. Lewcallyn MARTINEZ CALIF. - Date received ADDRESS: 2030 Franklin St. , Fifth Floor BY DELIVERY TO CLERK ON May 23, 1996 Oakland, CA 94612 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, gg DATED:_ May 24, 1996 IVIL DepuLyLOR, Clerk II. FROM: County Counsel 70: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: N., 06 BY; Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Admin' gator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARDS 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. JUN11 1996 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 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: JUN 12 199 BY: PHIL BATCHELOR byB.' 0.. Deputy Clerk CC: County Counsel County Administrator 1 THOMAS G.LEWELLYN STATE BAR#111733RECD 2030 FRANKLIN STREET FIFTH FLOOR 2 OAKLAND,CA 94612 �� 510-444-7530 NCLERKCBOA AY 2 31996 3 4 Attorney for Claimant OF SUPERVISORSNTRA COSTA CO. 5 6 7 8 9 10 RICK PENEYRA, CLAIM FOR DAMAGES 11 Claimant, (Government Code Sections 905 and 910) 12 vs. 13 CONTRA COSTA COUNTY, 14 Respondent. 15 16 TO: CONTRA COSTA COUNTY 17 Clerk of the Board of Supervisors 18 651 Pine Street Room 106 19 Martinez,CA 94553 20 21 Claimant, RICK PENEYRA presents his claim for damages for personal injuries and property 22 damage pursuant to Government Code Sections 905 and 910 as follows: 23 24 A. NAME AND ADDRESS OF CLAIMANT: 25 Rick Peneyra 26 335 Falcato Drive 27 Milpitas,CA 95035 28 1 1 B. ADDRESS OF PERSON TO WHOM NOTICES ARE TO BE SENT: 2 Thomas G. Lewellyn, Esq. 3 2030 Franklin Street Fifth Floor 4 Oakland,CA 94612 5 C. DATE,PLACE AND CIRCUMSTANCES OF THE OCCURRENCE: 6 On November 26, 1995,claimant Rick Peneyra, was an inmate at the Main 7 Detention facility located at 1000 Ward St.,Martinez,CA. On the evening on November 26, 8 1995, claimant developed severe pain in his neck and shoulder and developed numbness in the 9 shoulders and arms. Thereafter,he was unable to move his arms and legs. He told a deputy in 10 charge that he was having these medical problems and he asked for medical help. Although the 11 deputy knew claimant required medical care he failed to summon medical help. No medical 12 assistance was provided until approximately 7:00 a.m., November 27, 1995, when the 13 morning nurse came on duty. Thereafter,claimant was brought to the Merrithew Memorial 14 Hospital in Martinez. As a proximate result of the failure to provide medical care when it was 15 reasonably apparent that it was needed,plaintiff sustained permanent and disabling injuries. 16 D. DESCRIPTION OF INJURY OR DAMAGE SO FAR AS KNOWN AT THIS 17 TIME: 18 Anterior spinal artery infarction;permanent,partial paralysis;medical bills past 19 and future; wage loss and loss of earning capacity. 20 E. NAME OF THE PUBLIC EMPLOYEES RESPONSIBLE: 21 Unknown at this time. 22 F. AMOUNT OF CLAIM AND BASIS FOR COMPUTATION: 23 An amount within the jurisdiction of the Superior Court of the State of 24 California. 25 26 Date: May 21, 1996 f 27 THOMAS G.LEWELLYN 28 Attorney for CLAIMANT 2 CLAIM .a- i BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA June 11.,. 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: $200,000.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Roderick S. Jones Ty.Z33VIII) ATTORNEY: Ian M. Cooper MAY 2 2 1996 Lew Offices of Johnb E. Hill Date received �(� COUNSEL ADDRESS: 8105 Edgewater Dr. , Ste 100 BY DELIVERY TO CLERK ON �O 6INEZCAM Oakland CA 94521 ����—y BY MAIL POSTMARKED: Mav 17, 1996 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. Ma 22 1996 pH I1. ATCHELOR, Clerk DATED: Y +- 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: BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Adminis rator (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: UN 111996 PHIL BATCHELOR, Clerk, 8 A. 2� y�dQ�, 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: JUN 12 199 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator IN THE MATTER OF THE CLAIM OF ) RODERICK S.JONES ) AGAINST THE COUNTY OF CONTRA ) COSTA and DOES 1-50 ) Claimant, Roderick S. Jones, hereby makes claim against The County of Contra Costa in the sum of $200,000 and in support of this claim represents as follows: 1 . When did the injury or damage occur? November 20, 1995 at or about 7:15 am RECEIVED 2. Where did the damage or injury occur? MAY 2 0 1996 CLERK BOARD OF SUPERVISORS Contra Costa County Jail in Martinez, California. Lco�r�A cosrA co. 3. How did the damage or injury occur? While being escorted from his cell, sheriff's deputies used such force to upon claimant so as to fracture claimant's wrist and causing Roderick S. Jones to suffer serious and permanent injuries. 4. What particular act or omission on the part of the County of Contra Costa, its servants, or employees caused the injury or damage? The County of Contra Costa so negligently hired, trained, supervised their officers and deputies, and an individual deputy so intentionally, recklessly and carelessly used unreasonable and excessive force against claimant so as to cause the injuries laid out in this claim. 5. What are the names of the public employees causing the damage or injury? Unknown to claimant at this time. 6. What damage or injuries do you claim resulted? Claimant 'Roderick S. Jones sustained a fracture to his wrist other injuries including physical and mental pain and suffering as a result of the incident on November 20, 1995. 7. How was the amount of the claim computed? The exact amount of claimant's special damages, medical care and subsequent medical treatment are not presently known. Claimant's claim exceeds the jurisdictional limits of the Municipal Court. 8. Names and addresses of witnesses, doctors and health care providers: Witnesses include myself, the two deputies who were transporting me, and Willard Thomas, an inmate, CDC # D12583. 9. Name, social security number, birth-date, and address of claimant: Roderick S. Jones; SS# unknown ; DOB unknown; c/o Law Offices of John E. Hill, 8105 Edgewater Drive, Suite 100, Oakland CA, 94621 , telephone (510) 729- 6330. 10. Send notices to: Ian M. Cooper Law Offices of John E. Hill, 8105 Edgewater Drive, Suite 100, Oakland CA, 94621 Dated: _� riwtz SignoW by or on be alf of Claimant IAN M. COOPER C . 1 PROOF OF SERVICE 2 3 I, Barbara Graves, do hereby declare and state: 4 I am employed in the County of Alameda, California. I am over the age of 18 years and not 5 a party to the within action. My business address is 8105 Edgewater Drive, Suite 100, Oakland, 6 California 94621. 7 On May 16, 1996, I served the within: CLAIM BY RODERICK JONES AGAINST THE 8 COUNTY OF CONTRA COSTA on the parties in this action, by placing a true copy thereof in a 9 sealed envelope, and each envelope addressed as follows: 10 SEE ATTACHED LIST 11 X (By Mail) I caused each such envelope, with postage thereon fully prepaid, to be placed in the United States mail at San Francisco, California. 12 (By Personal Service) I caused each such envelope to be delivered by hand to the 13 offices of each addressee above. 14 (Telecopier) I caused each such document to be delivered by telecopier to the offices of each addressee above. 15 (Federal Express Mail) I caused each such document to be delivered by hand to the 16 offices of each addressee by Federal Express, over night service. 17 I declare under penalty of perjury that the foregoing is true and correct. Executed 18 19 on �'/�' � , at Oakland, California. 20 21 22 23 BARBARA GRAVES 24 25 26 27 28 C. �S CLERK OF THE BOARD OF SUPERVISORS ROOM 106, COUNTY ADMINISTRATION BUILDING 651 PINE STREET MARTINEZ, CA 94553 U tir _ 0 W M V} � N k G W Q � G Gs. W 3 a LA OFFICES OF f OHN E. HILL John E.Hal ATTORNEYS AT LAW SNFRANCISCO OFFICE Daniel A.Stenson 30 Hotaling Place Barbara J.Coffey First Floor James E.Keller 8105 Edgewater Drive San Francisco,California 94111 Michael P.Guta Suite 100 (415)398-2434 Telephone Mary-Lou Williams Ian M.Cooper Oakland,California 94621 (415)392-2809 Facsimile Dylan R.Lawrence (510)729-6330 Telephone John L.Corey (510)729-6333 Facsimile OF COUNSEL a"` Melvin M.Belli � r'. MAY 1 o 1996 f` k May 17, 1996 CLE 1(BOARp OF CONTRA COST PC S A CO. ORS CLERK OF THE BOARD OF SUPERVISORS ROOM 106, COUNTY ADMINISTRATION BUILDING 651 PINE STREET MARTINEZ, CA 94553 Dear Clerk: Enclosed please find two copies of Roderick Jones' claim. Please return an endorsed copy in the self addressed, stamped envelope provided. Thank for your assistance. Ve truly yours Ian M. Cooper Enclosures: CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA June 11, 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: $639,000.00 Section 913 and 915.4. Please note all "Warnings", CLAIMANT: Oskar and Gunvor Sundstrom ���°►��� � ATTORNEY: James I Fisher, Esq. MAY 2 2 1996 David P Lanferrnan, Esq. Date received ADDRESS: Lanferman, Fisher & Hashimoto BY DELIVERY TO CLERK ON Ma; 20, 1996�UNTYCOUNBEL 3100 Mowry Ave. , Ste. 300 Fremont, CA 94538-1509 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. ��il DepuLyLOR, Clerk DATED: May 22, 1996 14 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: 4 Dated: BY: Deputy County Counsel I1I. 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. [JUN 11 1996 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 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: JUN 12 1996 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator �.AID ra Lv: MAY ,L 6 1996 q{ CLERKOON BOARD OF STA COtMSOFt5 CLAIM AGAINST PUBLIC ENTITY [Govt Code §§ 905, 505.2, 910, 910.21 TO: WEST COUNTY WASTEWATER DISTRICT[OF CONTRA COSTA COUNTY] Claimants OSKAR AND GUNVOR SUNDSTROM hereby make claim against THE COUNTY OF CONTRA COSTA and the CONTRA COSTA COUNTY PUBLIC WORKS DEPARTMENT, and make the following statements in support of the claim: 1. The Claimant's post office address is: OSKAR and GUNVOR SUNDSTROM 5316 Sobrante Avenue El Sobrante, California 94803 2. All notices or other communications with regard to this claim should be sent to the Attorneys for the Claimant as follows: James 1. Fisher, Esq. David P. Lanferman, Esq. LANFERMAN, FISHER & HASHIMOTO 3100 Mowry Avenue, Suite 300 Fremont, California 94538-1509 Telephone: (510) 494-5500 3. The date and place of the occurrence giving rise to this claim are: The flooding of sewage and release of contaminants and resulting damages and losses inflicted on Claimants at their residence located at 5316 Sobrante Avenue, El Sobrante, California, occurring on February 5, 1996, arising out of the public entities' public works project, and continuing thereafter. 4. The circumstances giving rise to this claim are as follow: On or about February 5, 1996, Claimants are informed that the above-named public entities, and their contractors, planned, designed, engineered, contracted for, constructed, or partially constructed improvements to the public sewer line adjacent to Claimants' property. The public entities and their contractors performed such work in a negligent and careless manner, causing a blockage of the public sewer main, directly resulting in the flooding CLAIM AINST PUB I ENTITY Page SUNDSTROM/WEST COUNTY WASTEWATER DISTRICT[OF CONTRA COSTA COUNTY] f.\client\sundstro\pub l i c.c 14 960520/]]47 and contamination of Claimants' residence at 5316 Sobrante Avenue, El Sobrante, California, with thousands of gallons of raw sewage, and highly contaminated sewage waste, causing damage to Claimants and to Claimants' real and personal property. 5. Claimants' injuries include, without limitation, damages to real property, damages to personal property, costs for repair and restoration of Claimants' property, ongoing and continuing loss of use and enjoyment of property, severe emotional distress, medical injury and impairment of health,medical expenses,increased living expenses, lost earnings and other related damage, loss, and expense. The claim as of the date of this claim is in an amount that would place it within the jurisdiction of the Superior Court. The claim is based upon injury, loss and/or damage which is currently susceptible only of estimate, in an amount to be proved later. The current estimate of this claim includes the following: a. Clean up, repair and restoration of the Sundstrom residence: $70,000 b. Alternate lodging for the Sundstroms due to contamination of their property: $20,000 C. Loss of personal property: $ 5,000 d. Medical expenses: $15,000 e. Utility bills during clean up, repair of the premises: $ 2,500 f. Travel expenses caused by Claimants' forced relocation: $ 2,000 g. Diminution in value of or "stigma" attached to Sundstrom residence: $25,000 h. Physical and emotional injury and distress to Gunvor Sundstrom $250,000 i. Physical and emotional injury and distress to Oskar Sundstrom $250,000 $639,000 CLAIM AGAINST P ENTITY Page SUNDSTROM/WEST COUNTY WASTEWATER DISTRICT[OF CONTRA COSTA COUNTY] f.\c 1 f ent\sundstro\pub1 ic.c14 960520/1147 6. The names of the public employees causing the Claimants' injuries are presently unknown. Joe Carone Construction contracted with the above-named public entity to perform improvements on the public sewer line adjacent to Claimants' residence. Dated: May 20, 1996 LANFERMAN, FISHER & HASHIMOTO By: rUNVOR FISHER. f Claimants OSKAR and SUNDSTROM IMAGAINST P I ENTITY Page SUNDSTROM/WEST COUNTY WASTEWATER DISTRICT[OF CONTRA COSTA COUNTY] f:\client\sundstro\pub I i c.cl4 960520/]]47 1 PROOF OF SERVICE Personal Service 2 I declare under penalty that I am a citizen of the United 3 States and am employed in the County of Alameda. I am over the age 4 of eighteen years and not a party to the within action. My business 5 address is 38849 Logan Drive, Fremont, California. 6 On May 20, 1996, I served the foregoing document (s) described 7 as : 8 CLAIM AGAINST PUBLIC ENTITY 9 [Govt. Code H 905, 505 .2, 910, 910 .21 To: West County Wastwater District [Contra Costa County] 10 by personally serving the following party at the following 11 address : 12 13 Board of Directors West County Wastewater District 14 2910 Hilltop Drive Richmond, CA 94806-1974 15 [Phone: (510) 222-67001 16 17 Executed on May 20, 1996 , Fremont, California. I declare 18 under penalty of perjury under the laws of the State of California 19 that the foregoing is true and correct . 20 21 22 By: FREMONT EXPRE S COURIER SERVICE 23 . 24 �/,,7, 25 26 27 28 -1- CLAIM C : a a BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA June 11, 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 Amount: Unknown Section 913 and 915.4. Please no rm"`ngs' CLAIMANT: Denise Tejan MAY 2 8 1996 ATTORNEY: COUNTY COUNSEL Anthony Guy Ashe MARTINEZ CAM Attorney at Law Date received ADDRESS: 525 Marina Blvd. BY DELIVERY TO CLERK ON May. 22, 1996 Pittsburg, CA 94565 Hand Delivered BY MAIL POSTMARKED: 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim; ��IL gATCHELOR, Clerk DATED: May 28, 1996 : Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ✓1 This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). i ( ) Claim is not timely filed. The Clerk should return claim on ground that itwasfiled late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: �f Dated: A/4, 1— G/ BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Adminis ator (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: JUN n 41996 PHIL BATCHELOR, Clerk, 6y 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. JUN 10 Dated: 12 BY: PHIL BATCHELOR by erP�A O-W ���, Q Q��Oeputy Clerk CC: County Counsel County Administrator c;.aim '.o: BOARD OF SUPERVISORS OF CONTRA C=A oOUNrY INSTRUCTIONS To CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- conal property or growing crops and which accrue on or before December 31, 19870 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, mustbe presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code 5911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553• C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in.. D. If the claim is against more than ane public entity, separate claims must be filed agaiist each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this 'form. RE: Claim By ) Reserved for Clerk's filing stamp ,��8� ►� ®� ) RECEIVE® Against the County of Contra Costa ) or 2 2 1996 I ) District) CLERK BOARD O CONTFt�COs A CO. t�Ov (Fill in: name)) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) w~ 3. How did the age or injury occur? (Give full-details;details; use extra paper if req red) (-Aa G 3`( W1t9Noojfi �T' T � `�/�� T- A V S CE At N�+� �zS ��J A/Y 001�2T <FA 2k S� -w w 4. What particular act or omission on the part of county or district officers, servantsemployees caused the injury or damage? D+0 P —5EIN6-E, -&9 C,,H--T Y ("TA01-ce (over) 5., .�What are the names of county or district officers, servants or employees qausing rO ' the damage or ink Sd C� L j)C) �3c V-T" S k s c 6. What damage or injuries do you claim resulted? (Give full extent of injur es or s claimed. A c _ _ 0 h two estimates for auto e. A v h, 9 A V A 7AS (TVAgED F -0fA 'PC'tl-F-7ND J3PCK0) W,5 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.)T'N_T5 t"NC' F'PP5r CJ-A:vM F-r4-E& B. Names andddres s of witnesse , doctors and hospitals. 5 FA u H�j�KO" mT .DzA 94-0 t P6 P-:=T,4C. �C( NTLL-TS I-OL, A P116-V hFt� n r 1--Aci 4 r© Fa�.TrK5 A -- 13 V-A 9 6,N T t4. �5 TAT rz s 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT N 0 OCAT 0 OF POC? GT-r EM DeN SE's D LAC- To T"EE &C--nrEP.O'S j 61 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 Atto y _ -Awr 4 0/v 6-a AZ5 A IT061 E'&I AT P A U. ) VA t!D Claimants Si ure �5 m A ezN 150a �C- CA 264LAO Telephone No. 510 - q3 a•- ~13 -1a Telephone No. effsef • • • • a • fe • yea 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. 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