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HomeMy WebLinkAboutMINUTES - 03111997 - C17 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA March 11, 1997 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 I"MV111) CLAIMANT: Andrew Everson FEB 13 1997 ATTORNEY: COUNTY COUNSEL Date received MARTINEZ CALIF. ADDRESS: Martin J. & Lucille Everson BY DELIVERY TO CLERK ON February 12, 1997 17 Hunters Terrace Danville, CA 94506 BY MAIL POSTMARKED: Hand Delivered via: Risk Mgmt. I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. 88 DATED: February 13, 1997 Jy1L RATCVELOR, Clerkepu ��� -- 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: , 9 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. q Dated: MAR 11 1997 PHIL BATCHELOR, Clerk, By a-042 , 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. MAR 13 1987U �dp-- Deputy Clerk Dated: BY: PHIL BATCHELOR b CC: County Counsel County Administrator 1 MARTIN J. EVERSON 17 Hunters Terrace 2 Danville, CA 94506 (510) 943-6383 3 Father of Claimant 4 5 6 7 8 9 10 Claim of ANDREW EVERSON 11 vs . CLAIM FOR PERSONAL INJURIES (SECTION 910 12 SAN RAMON VALLEY UNIFIED SCHOOL OF THE GOVERNMENT CODE) DISTRICT, CONTRA COSTA COUNTY 13 OFFICE OF EDUCATION, CONTRA COSTA SELPA, TOWN OF DANVILLE, 14 DANVILLE POLICE DEPARTMENT, MR. DUFF DANILOVICH (Principal of 15 Los Cerros Middle School/ RE IVED Employee of San Ramon Valley _. 16 Unified School District) , `� > ELIZABETH ANDERSON (Teacher/ 121997 17 Employee Contra Costa County , office of Education) , GERI CLERK 80ARD OF SUP RVlSORS 18 MURPHY (Program Administrator/ TSA COSTA CO. Contra Costa County Office of 19 Education) , and JEFFREY HEBEL (Police Officer/Employee 20 Danville Police Department) . 21 / 22 TO: SAN RAMON VALLEY UNIFIED SCHOOL DISTRICT, CONTRA COSTA COUNTY OFFICE OF EDUCATION, CONTRA COSTA SELPA, and TOWN OF DANVILLE/ 23 DANVILLE POLICE DEPARTMENT 24 YOU ARE HEREBY NOTIFIED that Andrew Everson, whose address. is 25 17 Hunters Terrace, Danville, California 94506, claims damages 26 from each and every one of the individuals and entities identified 27 above in the total amount of $25, 000 . The undersigned is the 28 father of Andrew Everson, and I make this claim on his behalf . 1 This claim is brought against SAN RAMON VALLEY UNIFIED SCHOOL 2 DISTRICT, the CONTRA COSTA COUNTY OFFICE OF EDUCATION, the CONTRA 3 COSTA SELPA, the TOWN OF DANVILLE and DANVILLE POLICE DEPARTMENT, 4 MR. DUFF DANILOVICH (Principal of Los Cerros Middle School/ 5 Employee of San Ramon Valley Unified School District) , ELIZABETH 6 ANDERSON (Teacher/Employee Contra Costa County Office of 7 Education) , GERI MURPHY (Program Administrator/Contra Costa County 8 office of Education) , and JEFFREY HEBEL (Police Officer/Employee 9 Danville Police Department) . 10 This claim is based upon physical and emotional injuries 11 sustained by Andrew Everson on November 22, 1996, while a student 12 in his Special Education classroom at Los Cerros Middle School . 13 Attached hereto as Exhibit "All is a detailed statement of the 14 incident of November 22, 1996, and background information related 15 to the events leading up to the incident. 16 This claim involves the wrongful application of a W&I 5150 17 commitment of Andrew Everson to a locked psychiatric facility in 18 violation of his civil rights pursuant to 42 U.S .C. §1983 , et 19 sea. ; Section 504 of the Rehabilitation Act, 29 U.S.C. §794, et 20 sea. and Title II of the Americans with Disabilities Act, 41 21 U. S.C. §12101 . This claim also involves the false imprisonment 22 of Andrew Everson and further involves the unlawful application 23 of restraints in violation of those provisions of California law 24 relating to behavioral interventions for special education 25 students (Education Code §56520, et seg. and Code of Regulations 26 [CCR] §3001, et seg. /Hughes Bills Statutes). . Further, this claim 27 is based upon fraudulent alterations and additions to the school 28 records of Andrew Everson made subsequent to the events of 2 . 1 November 22 , 1996 by Teacher Elizabeth Anderson and Program 2 Administrator Geri Murphy. 3 As a result of the negligent and unlawful conduct of the 4 individuals and entities identified above, Andrew Everson suffered 5 physical and emotional injury as a result of being placed in four- 6 point leather restraints and delivered to a locked psychiatric 7 unit. In addition, on, Andrew Everson, as of this date, has not 8 returned to school because the classroom environment poses a 9 danger to him. The special damages incurred to date for medical, 10 hospital care, as well as psychological and academic, evaluations, 11 total $2, 250 . 00 . Claimant will seek general, special and punitive 12 damages . , The total amount claimed as of the date of presentation 13 of this claim is $25, 000 . 14 Jurisdiction over the claim would rest in the Contra Costa 15 County Superior Court and/or in Federal District Court . 16 . All notices or other communications with regard to this claim 17 should be sent to: Martin J. Everson and Lucille Everson, parents 18 of Andrew Everson. The notices or other communications should be 19 sent to the following address: 17 Hunters Terrace, Danville, 20 California 94506; (510) 943-6383 . 21 ' 22 DATED: February 7, 1997 23 24 25 26 Martin J. i'verson, 27 Father of Claimant 28 3 1 EXHIBIT "All 2 BACKGROUND INFORMATION 3 Andrew Everson is a fourteen-year old boy who has been 4 diagnosed with Down Syndrome and anoxic brain damage. He is 5 severely mentally retarded. His current overall level of 6 functioning is approximately that of a three-year old. His 7 speech is extremely limited and his articulation is so poor that 8 he is not understandable to those who do not know him well . He 9 is a pleasant and Personable individual; although he has 10 behavior problems consistent with that of a three-year old 11 child. 12 Andrew was born on September 12, 1982 . He was found to be 13 in congestive heart failure at birth and suffered lung damage 14 from meconium aspiration. He was diagnosed with four separate 15 cardiovascular abnormalities involving a large hole between the 16 atriums of his heart (atrial septal defect) , a hole between the 17 ventricles (ventricular septal defect) , a vascular ring causing 18 compression of his trachea, and a patent ductus arteriosus . He 19 was hospitalized at Children' s Hospital in Oakland on five 20 occasions prior to undergoing open heart and thoracic surgeries 21 at 10 months of age which were performed as life-saving 22 measures . Physically, Andrew has done well since that time; 23 although he has been diagnosed with brain damage as a result of 24 the traumatic problems at birth and the subsequent cardiac and 25 respiratory problems experienced during his first year of life . 26 Andrew has, at all times, resided at home with his mother, 27 Lucille, his father, Martin, a sister Diana (18 years old and a 28 student at UC Berkeley) , and sister Cynthia (12 years old and a 1 six grade student) . Andrew has, for years, been well managed at 2 home. His favorite activities involve shooting basketballs, 3 playing Nintendo, watching movies he selects, looking at picture 4 books and listening to music. Andrew has not for many years 5 exhibited behavior problems at home. 6 7 SCHOOL HISTORY BACKGROUND 8 Andrew has been a client of the San Ramon Valley Unified 9 School District since 1986 . 10 Andrew has always required an intensive, highly-structured 11 program in order to learn. The San Ramon Valley Unified School 12 District, in the past and currently, has not provided him with 13 that type of a' program with the result that his level of 14 functioning is far below what his cognitive capabilities would 15 otherwise allow. 16 During the 1987/88 school year, Andrew contracted an E coli 17 bacterial infection in his, ear which was caused by the presence 18 of fecal material in his classroom. At the time, Andrew was 19 enrolled in a special day class run by the County located at 20 Vista Grande Primary School in Danville . The classroom 21 conditions were unsanitary because although most. of the children 22 were not toilet trained, there was no toilet and no running 23 water in the classroom. Complaints to the Program Administrator 24 about the unsanitary condition of the classroom by Andrew' s 25 parents and by the County Occupational Therapist, Nancy McGhee, 26 were ignored. After Andrew was diagnosed with the E coli 27 infection, the Contra Costa County Heath Services Department 28 shut the classroom down and it was subsequently moved to a 2 1 location where a toilet and running water were available . 2 Andrew has since been diagnosed to have some permanent hearing 3 loss in the affected ear, which injury could have been avoided 4 had the program administrators followed through on the 5 complaints. 6 The California State Department of Education has 7 investigated on two occasions the special day classes run by the 8 County in which Andrew was previously enrolled. The complaints 9 made by his parents during the 1987/88 school year and again 10 during the 1991/92 school year involved failure to implement 11 Andrew' s IEP. The state compliance reports on both occasions 12 found that required IEP services were not being provided to 13 Andrew and that the school district and County were out of 14 compliance with his plan. During both school years, Andrew was 15 placed in County-run programs with too many students and 16 inadequate staffing. 17 18 EVENTS: LEADING UP TO NOVEMBER 22, 1996 INCIDENT 19 On November 22, 1996, Andrew engaged in disruptive behavior 20 in the classroom which was mishandled by the teacher and 21 principal . At the. request of the principal, Andrew was taken 22 into custody by a police officer on a W&:I 5150 72-hour detention 23 on the basis that he was mentally ill and was a danger to 24 others . Andrew was placed in four-point leather restraints 25 (bound by ankles and wrists) and was delivered to the locked 26 psychiatric unit at the County Hospital where he was promptly 27 released to his mother after an evaluating psychiatrist found no 28 evidence of mental illness or mental disorder, and found no 3 1 , evidence that he was a threat to anyone . In fact, Andrew did 2 not have a mental disorder when he was taken into custody and 3 has never been diagnosed as being mentally ill; but rather, he 4 was exhibiting reactive behavior of the type which would be 5 expected by a three-year old, consistent with his mental 6 retardation. 7 During the two-and-a-half months of the school year prior to 8 the incident, more and more disabled students were added to the 9 Los Cerros Special Day Class. On November 22, 1996, there were 10 15 students with severe developmental disabilities placed in the 11 classroom, including at least one wheelchair bound student with 12 a severe physical disability. There was one teacher (Elizabeth 13 Anderson) and three aides . During the first two months of the 14 school year, there were only two aides in the classroom. one of 15 the aides was Amanda Savage, who supposedly was hired as 16 Andrew' s one-to-one aide. The classroom became a "dumping 17 ground" with so many students .that virtually no individual 18 teaching instruction took place . The classroom teacher had the 19 - responsibility to carry out the IEP plans of 15 students in 20 addition to attending IEP meetings, parent conferences, and 21 other teaching duties . She repeatedly ended the class day early 22 by putting the students on the school bus as soon as it arrived; 23 sometimes ending the school day 30 minutes early. The classroom 24 turned into essentially a "baby sitting" operation where Andrew 25 was neglected and ignored by his teacher and aide and his IEP 26 was not implemented. 27 On November 22, 1996, after Andrew was transported in 28 restraints to the locked psychiatric unit of the County 4 1 Hospital, Elizabeth Anderson gave the following statement to the 2 investigating police officer which he included in his police 3 report : 4 "Everson' s behavior has deteriorated dramatically over the past months. He has thrown things around the 5 classroom on numerous occasions. Due to his size and physical outbursts, Anderson cannot control Everson' s 6 behavior. " 7 Prior to calling the Police Department, the school 8 principal, Mr. Danilovich, attempted to reach Andrew' s mother at 9 home and his father at work. Mr. Danilovich wanted Andrew off 10 campus and it was only after he determined that his parents were 11 unavailable to pick him up that he decided to call the police to 12 have Andrew forcibly removed. 13 In fact, Andrew was placed in restraints and taken to a 14 locked psychiatric unit at the County Hospital because the 15 principal wanted him off campus and his parents were not 16 immediately available to pick him up. Less drastic measures; 17 such as taking Andrew to the Principal ' s Office for the 18 remaining 30 minutes of the school day could have been 19 undertaken; but were not . 20 When Andrew was placed in restraints for transportation, he 21 was noted to be calm. The Fire Department report states the 22 following: 23 "On arrival, we were directed to the classroom where we found two adult males restraining the patient on the 24 floor of the classroom. At this time, the patient was acting very aggressively. . . . She [Elizabeth Anderson] 25 stated that over the last couple of weeks, he had been exhibiting increasing aggressive behavior. . . . When 26 Danville police arrived on scene he wrote a 5150 hold on the student and we prepared the student for 27 transport. At this point Andrew had calmed down considerably and during the transport to Merrithew, he 28 exhibited no aggressive tendency. " 5 1 Upon arrival at the psychiatric unit of the Hospital, the 2 Initial Mental Health Status Evaluation states that Andrew was 3 "calm, relaxed, alert, cooperative and friendly" and that his 4 affect and mood were appropriate. He was not found to have a 5 mental disorder and he was released to his mother who told the 6 evaluating psychiatrist : 7 "Mother reports with proper supervision patient does not act out with such severity. . . . Patient 's current 8 behavior has been unremarkable . . . . Mother feels quite safe bringing patient home stating patient has never 9 "acted out like this at home, only in low supervised settings. " 10 11 The Police Report of the incident does not indicate that 12 Andrew' s aide was in any way involved with attempting to control 13 him in the classroom. In addition, neither the aide nor anyone 14 else from the school went with him to the psychiatric hospital; 15 rather, he was left with total strangers in restraints to be 16 delivered to a locked facility. 17 After the incident, Andrew was suspended from school for two 18 days . The Suspension Notice stated in part : "Andrew pushed 19 'i teacher to floor and urinated on her. " Andrew does not have the 20 mental capacity to urinate on anyone and Program Administrator, 21 Geri Murphy' s description is a mischaracterization. Rather, 22 Andrew had wet his pants because he was, afraid. 23 After the November 22, 1996 incident, Elizabeth Anderson 24 backdated a "Behavior Intervention Referral Information" form in 25 which she falsely wrote that she had called Andrew' s mother 26 about an alleged earlier incident and that Mrs . Everson "laughed 27 and called it teenage behavior. " The alleged telephone call to 28 Andrew's mother never occurred and her note is a fabrication in 6 1 which she attempts to wrongly shift the blame for Andrew' s 2 classroom behavior to his mother in an attempt to cover up her 3 failure to implement the Behavioral Intervention Plan. 4 Additional fraudulent alterations and additions were made to 5 Andrew' s school records after the incident . These additions and 6 alterations were made by the teacher and by a program 7 administrator with intent to deceive as part of an effort to 8 cover up the failure of the teacher to comply with the SELPA 9 guidelines and with the Hughes Bill requirements (Evidence Code 10 §56520, et al . ; CCR §3001, et al . ) for reporting and implement- 11 ing behavioral intervention plans. The failure to comply with 12 these guidelines for implementing Andrew' s Behavioral Inter- 13 vention Plan directly led to the events of November 22, 1996 . 14 The Contra Costa County Office of Education, the Contra 15 Costa SELPA, and the San Ramon Valley Unified School District 16 are aware of prior complaints made concerning classroom teacher, 17 Elizabeth Anderson, to the effect that she neglects and 18 "targets" for expulsion the lower functioning and more difficult 19 students in her special education class . Prior complaints made 20 about her to program administrators have been ignored. 21 Although Andrew Everson is severely mentally retarded,. he 22 has the same right as other citizens of this Country to be 23 treated with respect and dignity. He has the right to receive a 24 public education in a non-threatening environment . In this 25 instance, those members of society who were most intimately 26 charged with the responsibility of caring for him totally failed 27 their obligations and discriminated against him because of his 28 disability. 7 1 PROOF OF SERVICE BY MAIL - C.C.P. S§1013 (a) , 2015.5 2 1 declare under penalty of perjury that : 3 1 am a citizen of the United States and am employed in the 4 County of Contra Costa. I am over the age. of eighteen years and 5 not a party to the within action. My business address is 1676 6 North California Boulevard, Suite 500, Walnut Creek, California 7 94596-4183 . On February 7, 1997, 1 served ' by certified mail, 8 return receipt requested, the within CLAIM FORPERSONALINJURIES 9 (SECTION 910 OF THE GOVERNMENT CODE) on the parties in this action 10 by placing a true copy thereof, enclosed in a sealed envelope with 11 postage thereon fully prepaid, in the United States mail at Walnut 12 Creek, California, addressed as follows : 13 San Ramon Valley Unified School District Business Services 14 699 Old Orchard Drive Danville, CA 94526 15 Contra Costa County Office of Education 16 77 Santa Barbara Road Pleasant Hill, CA 94523 17 Contra Costa SELPA 18 2520 Stanwell Drive, Suite 270 Concord, CA 94520 19 Town of Danville 20 Danville Police Department 510 La Gonda Way 21 Danville, CA 94526 22 23 24 25 26 Executed on February 7, 1997, at Walnut Creek, California. 27 28 Arletta E. Runyon 2 C. 17 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA March 11, 1997 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 maile4Lto 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 Goverment Code Amount: $2,000,000.00 Section 913 and 915.4. Please note all M"1711M' CLAIMANT: Steve & Janet Felt FEB 11 1997 ATTORNEY: Mark A. McLaughlin, Esq. COUNTY COUNSEL . Date received MARTINEZ CALIF. ADDRESS: 2211 "A" Street BY DELIVERY TO CLERK ON February 7, 1997 Antioch, CA 94509 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. CpIL Q Bg HLO DATED: February 111,1997 Deputy .. Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, andae are so notifying claimant. The Board cannot act for 15 days.(Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: a� /i 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 (X) 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. MAR 111997 Dated: PHIL BATCHELOR, Clerk, B�j-�� acu__ 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. MAR 13 1991 �—a —� Deputy Clerk Gated: BY: PHIL BATCHELOR CC: County Counsel County Administrator \j aim to: BOARD OF SUPERVISORS OF CONTRA COSTA COU INSTRUCTIONS TO CLAIMANT Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, . Penal Code Sec. 72 at the end of this form. RE: Claim By Reserved for Clerk's filing stamp STEVE FELT & JANET FELT RECEIVED. Parents of Tammy Elaine Felt (Deceased) xy_e� Against the County of Contra Costa or FEB 7 1997 Q District) CLERK BOARD OF�UPERV�ISORS (Fill in name) CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 2,000,000.00 and in support of this claim represents as follows: ---------------------------------------------------------------------------- 1. When did the damage or injury occur? (Give exact date and hour) 8-08-96, 5:15 p.m. - 6:30 p. I---------------------------------------------------- 2. Where did the damage or injury occur? (Include city and county) ____Camino-Diablo Road, 280 feet East of Marsh Creek _Pyl2n., California 3. How did the damage or injury occur? (Give full details; use extra paper if required) Claimants' child was involved in a serious auto accident which seriously injured the child and due to errors by County Emergency Services Dispatcher, an ambulance was not timely or properly dispatched to transport child to hospital which resulted in death of child. ------------------------------------------------------------------------------------ 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? Failure to follow Emergency Services Dispatch .protocol re ambulance following serious auto accident resulting in failure to have ambulance transport injured,person to hospital in timely manner resulting in death. '(over) • • 5. What are the names of county or district officers, servants or employees causing the damage or injury? Unknown ------------------------------------------------------------------------------------ 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Death of claimants' child. ------------------------------------------------------------------------------------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) ----$2,000,000-00 for wrongful _death _ 8. Names and addresses of witnesses, doctors and hospitals. The CHP Report is attached hereto and incorporated herein by reference. American Medical Response, P. O. Box 7423, San Francisco, CA 94120-7423. Delta Memorial Hospital, 3901 Lone Tree Way, Antioch, CA 94509 ----------I -------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT 8/96 Funeral. expense & medical bills $20,000.00 est. aw _ ` t T Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO ' -(Attornev) '" or' by some person on his behalf." Name and Address of,-'Attorney Mark A. McLaughlin, Esq. 2211 "A" Street Atty. for (Claimant's Signa , e Antioch, CA ,94509 2211 "A" r Address Antioch, CA 94509 Telephone No. (510) 754-2622 Telephone No. 510 754-2622 N O T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000) , or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. ,TATE OF CALIFORNIA Q TR216F'FIC COLLISION REPORT PAGE OF -t SPECIAL CONDITIONS NO[NJ H&R FEL CITY JUDICIAL DISTRICT NUMBER FATAL 0 [ ] UNINC. DELTA MUNI g- q79 C-- NO KILL H&P MISD COUNTY DIST BEAT _ 2 CONTRA COSTA 661 C*Stars: OARN6881 COLLISION OCCURRED ON: MO DAY YEAR TIME(2400) NCIC/ OFFICER I.D. G L CAMINO DIABLO RD 08108196 1715 9390 013955 c A MILEPOST INFORMATION: DAY OF WEEK TOW AWAY PHOTOGRAPHS BY: THURSDAY [X]YES [] NO 12 EXPOSURES N [] AT INTERSECTION WITH: STATE HWY REL CHP - 5166 M OR: 2 8 0 feet E of MARSH CREEK RD YES Pq NO NONE PARTY DRIVER'S LICENSE NUMBER STATE I CLASS SAFETY VEH YR MAKEIMODEIJCOLOR LICENSE NUMBER STATE 1 B3822543 , ICA C H 92 TOYT 4 RUNNER WHITE WNDMSTR CA DRIVER NAME(FIRST.MIDDLE.LAST) P] SCOTT WILLIAM CHAPMAN PEDES- STREET ADDRESS OWNER'S NAME [ SAME AS DRIVER ff 403.8 BOULDER DR WILLIAM CHAPMAN PARKED CITY/STATE/ZIP OWNER'S ADDRESS [] SAME AS DRIVER lErTll ANTIOCH 94509 4038 BOULDER DR, ANTIOCH, CA 94509 CL� SEX HAIR I EYES HEIGHT NEIGHT BIRTHDATE RACE DISPO OF VEHICLE ON ORDERS OF: K] OFFICER [] DRIVER []OTHER M 13RN ERN 5-08 190 02 22 77 B AND J TOWING (510) 757-3100 OTHER HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: NONE APPARENT p] REFER TO NARRATIVE(] [ (510) 754-3595 ( ) NONE CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA [ INSURANCE CARRIER POLICY NUMBER VEHICLE TYPE ]UNK []NONE []MINOR UNKNOWN 01 I []MOD.P]MAJOR []TOTAL iiuun..... DIR TRV ON STREET OR HIGHWAY SPD LMT PCF .............................. E CAMINO DIABLO RD 55 21460 ( VC IPARTY1 DRIVER'S LICENSE NUMBER STATE I CLASS SAFETY VEH YR MAKE/MODEIJCOLOR LICENSE NUMBER STATE . 2 JA1725S92 � CA C G 78 CHEV. P/U. . . . . . . . .YEL 1K41390 . .CA . . . . . . . . . . . . . . . . . . . . . . DRIVER NAM E(FIRST,M IDDLE,LAST) P] JIMMY LEE BABB PEDES- STREET ADDRESS OWNER'S NAME P] SAME AS DRIVER TRff 16711 MARSH CREEK RD SPACE #71 PARKEDEDCITY/STATE/ZIP OWNER'S ADDRESS SAME AS DRIVER VErTL CLAYTON CA 94517 BICY- SEXHAIR EYES HEIGHT WEIGHT BIRTHDATE RACE DISPO OF VEHICLE ON ORDERS OF: [] OFFICER K] DRIVER []OTHER C`fj M IBLN BLU 5-10 195 04104 71 DRIVEN AWAY OTHER HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: NONE APPARENT p] REFER TO NARRATIVE[] [] (510) 757-4383 (7 0 7) 746-8028 CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA [ INSURANCE CARRIER POLICY NUMBER VEHICLE TYPE ]UNK []NONE �]MINOR NONE 22 []MOD.[]MAJOR []TOTAL DIR TRV I ON STREET OR HIGHWAY SPD LMT PCF E CAMINO DIABLO RD 155 PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY VEH YR MAKE/MODEL/COLOR LICENSE NUMBER STATE 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DRIVER NAME(FIRST,MIDDLE,LAS-n [] 1 PEDES- STREET ADDRESS OWNER'S NAME [] SAME AS DRIVER TR ff PARKED CITY/STATE/ZIP OWNER'S ADDRESS ['] SAME AS DRIVER VE rT BICY- SEXHAIR EYES HEIGHT WEIGHT BIRTHDATE RACE DISPO OF VEHICLE ON ORDERS OF: [] OFFICER [ DRIVER []OTHER CLM OTHER HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: NONE APPARENT[] REFER TO NARRATIVE[] [ ]. CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER VEHICLE TYPE lfjMODjjMAJOR []TOTAAL DIR TRV ON STREET OR HIGHWAY -. SPD LMT PCF I PREPARER'S NAME DISPATCH NOTIFIED REVIEWER'S NAME AT REVIEWED OBRIEN D 013955 M Y. No N/A � �4 ""� STATE OF CALIFGRNIA ' TR kYkTC COLLISION CODING rAce of 1 DATE OF ORIGINALINCIDENTTIME(2400) NCIC NUMBER OFFICER I.D. NUMBER Q C-8 - U8 - 96 1715 9390 1 013955 10ARN6881 <6v OWNERS NAME/ADDRESS NOTIFIED PROPERTY DAYTON S I LVA/219 9 9 MARSH CREEK RD, BYRON CA '(510) 643-28611 YES DESCRIPTION OF DAMAGE DAMAGEDESCRIPTION WIRE FENCE - 16 FT AND 2 POSTS - SEATING POSITION SAFETY EQUIPMENT EJECTED FROM VEH OCCUPANTS M/C BICYCLE-HELMET I-DRIVER A-NONE IN VEHICLE L-AIR BAG DEPLOYED 0-NOT EJECTED 2 to 6'PASSENGERS B-UNKNOWN M-AIR BAG NOT DEPLOYED DRIVER I-FULLY EJECTED 7.STA.WGN.REAR C-LAP BELT USED N-OTHER V-NO 2-PARTIALLY EJECTED l 2 3 S-RR.OCC.TRK.OR VAN D-LAP BELT NOT USED P-NOT REQUIRED W-YES 3-UNKNOWN 9-POSITION UNKNOWN E-SHOULDER HARNESS USED 4 5 6 0-OTHER F-SHOULDER HARNESS NOT USED CHILD RESTRAINT PASSENGER G-LAP/SHOULDER HARNESS USED Q-IN VEHICLE USED X-NO 7 H-LAP/SHOULDER HARNESS NOT USED R-IN VEHICLE NOT USED Y-YES J.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 WHICH ARE FOLLOWED BY AN ASTERISK(9 SHOULD BE EXPLAINED IN THE NARRATIVE PRIMARY COLLISION FACTOR MOVEMENT PRECEDING LIST NUMBER(#)OF PARTY AT FAULT TRAFFIC CONTROL DEVICES 1111213 TYPE OF vEHICLE 1 2 3 COLLISION A VC SECTION VIOLATED: CITED A CONTROLS FUNCTIONING A PASSENGER CAR/STN.WGN. I A STOPPED 1 21460 (a) VC NO B CONTROLS NOT FUNCTIONING* B PASSENGER CAR W/TRAILER X 8 PROCEEDING STRAIGHT B OTHER IMPROPER DRIVING* C CONTROLS OBSCURED C MOTORCYCLE/SCOOTER C RAN OFF ROAD C OTHER THAN DRIVER* X D NO CONTROLS PRESENT/FACTOR D PICKUP OR PANEL TRUCK D MAKING RIGHT TURN D UNKNOWN` TYPE OF COLLISION E PICKUP/PANEL TRK.W/TLR. E MAKING LEFT TURN E FELL ASLEEP' A HEAD-ON - F TRUCK OR TRUCK TRACTOR F MAKING U TURN WEATHER(MARK 1 TO 2 ITEMS) X B SIDESWIPE G TRK./TRK.TRACTOR W/I'LR. G BACKING X A CLEAR C REAR END H SCHOOL BUS H SLOWING/STOPPING B CLOUDY D BROADSIDE I OTHER BUS X I PASSING OTHER VEHICLE C RAINING E HIT OBJECT I EMERGENCY VEHICLE 1 CHANGING LANES D SNOWING F OVERTURNED K HWY.CONST.EQUIPMENT K PARKING MANEUVER E FOG/VISIBILITY: G VEHICLE/PEDESTRIAN L BICYCLE L ENTERING TRAFFIC F OTHER': H OTHER': M OTHER VEHICLE M OTHER UNSAFE TURNING G WIND MOTOR VEHICLE INVOLVED WITH I N PEDESTRIAN N XING INTO OPPOSING LANE LIGHTING A NON-COLLISION 1 10 MOPED O PARKED X A DAYLIGHT B PEDESTRIAN _ P MERGING B DUSK-DAWN X C,OTHER MOTOR VEHICLE 1 2 3 �HMARK II TO ITEMS IATED �OR Q TRAVELING WRONG WAY C DARK-STREET LIGHTS I D MOTOR VEH ON OTHER ROADWAY A VC SECTION VIOLATION:CITE R OTHER':• D DARK-NO STREET LIGHTS E PARKED MOTOR VEHICLE E DARK-STREET LIGHTS NOT FUNCTION F TRAIN B VC SECTION VIOLATION:CITE ROADWAY SURFACE G BICYCLE SOBRIETY-DRUG PHYSICAL X A DRY H ANIMAL: C VC SECTION VIOLATION:CITE nl 273 (MARK I TO 2 ITEMS) B WET X A HAD NOT BEEN DRINKING C SNOWY-ICY I FIXED OBJECT: E VIS.OBSCURED: B HBD-UNDER INFLUENCE D SLIPPERY(MUDDY.OILY.ETC.) F INATTENTION' C HBD-NOT UNDER INFLUENCE ROADWAY CONDITIONS 1 OTHER OBJECT: G STOP&GO TRAFFIC D HBD-IMPAIRMENT UNK.' MARK 1 TO 2 ITEMS PEDESTRIAN'S ACTIONS H ENTERING/LEAVING RAMP E UNDER DRUG INFLUENCE' A HOLES,DEEP RUTS- X A NO PEDESTRIAN INVOLVED I PREVIOUS COLLISION F IMPAIRMENT-PHYSICAL' B LOOSE MATERIAL ON RDWY' B CROSSING IN XWALK/INTERSECTION J UNFAMILIAR WITH ROAD X G IMPAIRMENT NOT KNOWN C OBSTRUCTION ON ROADWAY' C CROSSING IN XWALK NOT AT K DEFECTIVE VEH.EQUIP.:CITE H NOT APPLICABLE D CONSTRUCTiCONSTRUCTION-REPAIR ZONE I TERSECTION I SLEEPY/FATIGUED E REDUCED ROADWAY WIDTH D CROSSING NOT IN CROSSWALK L UNINVOLVED VEHICLE SPECIAL INFORMATION F FLOODED' E IN ROAD-INCLUDES SHOULDER M OTHER*: A HAZARDOUS MATERIAL G OTHER*: F NOT IN ROAD X X N NONE APPARENT B SEATBELT FAILURE X HNO UNUSUAL CONDITIONS G APPROACHING/LEAVING SCHOOL BUS 1 O RUNAWAY VEHICLE SKETCH MISCELLANEOUS 1 STATE OF CALIFORN'(A INJURED/` rrNESSES/PASSENGERS • PAGE oP 1 DATE OF COLLISION TIME(2400) NCIC NUMBER OFFICER I.D. NUMBER G8 — 08 — 96 1715 9390 013955 OARN6881 $ $ EXTENT OF INJURY('X' ONE) INJURED WAS ('X' ONE) WliNESS PASSENGER 'AGE SEX PARTY SEAT SAFETY EJECTED ONLY ONLY FATAL SEVERE OTHER VISIBLE COMPLAINT NUMBER POS: EQUIP. INJURY INJURY INJURY OF PAIN DRIVER PASS. PED. BIKE OTHER 19M X X 1 1 H 1 NAME/D.O.B./ADDRESS TELEPHONE SCOTT WILLIAM. CHAPMAN 02-22-77 H-4038 BOULDER DR, ANTIOCH, , 94509 (510), 754-3595 (INJURED ONLY)TRANSPORTED BY: TAKEN TO: AMR PARAMEDICS DELTA MEMORIAL HOSPITAL DESCRIBE INJURIES: CAUSE OF DEATH PER CONTRA COSTA CORONER' S OFFICE — BLUNT TRAUMA TO THE CHEST AND ABDOMEN VICTIM OF VIOLENT CRIME NOTIFIED 17 IF I X I I I I IX I I I I 1 1 3 1 H 1 NAME/D.O.B./ADDRESS TELEPHONE TAMMY ELAINE FELT 03-04-79 H-1030 CLAUDIA CT #30, ANTIOCH, CA, 94509 (510) 756-7705 (INJURED ONLY)TRANSPORTED BY: TAKEN TO: AMR PARAMEDICS DELTA MEMORIAL HOSPITAL DESCRIBE INJURIES: CAUSE OF DEATH PER CONTA COSTA CORONER' S OFFICE — BLUNT TRAUMA TO THE HEAD r I VICTIM OF VIOLENT CRIME NOTIFIED X 118 IM I I I I I I I I 1 1 2 1 3 1 G T 0 NAME/D.O.B.IADDRESS TELEPHONE ADAM DALE KERR 11-28-77 H-16711 MARSH CREEK RD SPACE #90 , CLAYTON, CA, 94517 (510) 754-4584 (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES: VICTIM OF VIOLENT CRIME NOTIFIED NAME/D.O.B./ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES: VICTIM OF VIOLENT CRIME NOTIFIED T-T I I I 1 .1 1 ' 1 1 1= NAME/D.O.B./ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES: VICTIM OF VIOLENT CRIME NOTIFIED PREPARER'S NAME LD NUMBER MO. DAY YR.. REVIEWER'S NAME MO. DAY YR. OBRIEN D 013955 08-18-96 STATE OF CALIFORNIA • • NMRATIVE/SUPPLEMENTAL PAGE 1 DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 08/08/96 1715 9390 013955 OARN6881 Sketch 10 Camino 15' 10' 10'0,415'-* W/B EJB Diablo .0 Asphalt Roadway 10 10 To E/B Marsh Creek D r t � 2 i� S h i� 0 U To W/B d Marsh e Creek r Dirt Area Drawn By 10' 10' D.Beringer 11398 PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE D OBRIEN 013955 08/08/96 STATE OF CALIFORNIA NAPRATIVF/SUPP1 EMENTAL PAGE DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER o 08/08/96 1715 9390 013955 OARN6881 " Factual Camino 15' 10' 10' 15' "�" W/B E/B4--25'. 25 ® 5" Gougemark 4 28, Diabl.o jA n\ :4 ,.+ ,Ills) © Blood in roadway 4pIA ..1• I . C9_ —► {� © 4" Gougemark 8' O8" Gougemark 47' O Gougemark from rim Debris (� D5' Q e' OGougemark from rim 23' W © 8' Scrapemarks lo 17 O 60' Skidmark (I}— 026' Gougemark To E/B Marsh Creek 35' Skidmark D 45' CK 11' Scrapemark i r t' t Gougemark S 1 from Bumper ' h a' L) o 10' ' u I To W/B 290' to Marsh 10' Marsh Asphalt a Creek / Creek Roadway r Dirt Area Drawn By 10' 10' D.Beringer 11398 PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE D OBRIEN 013955 08/08/96 STATE OF CALIFORNIA NARRATIVE/SUPPLEMENTAL PAGE DATE OF INCIDENT TIME NCIC NUMBER OFFICER LD. NUMBER J 08/08/96 1715 9390 013955 OARN6881 c� 1 FACTS: 2 3 NOTIFICATION: I was dispatched to a call of an injury traffic collision, with an ambulance 4 responding at 1718 hours. I responded from I-580 EB east of North Flynn and arrived on 5 scene at 1740 hours. All times, speeds and measurements in this investigation are approximate. 6 Measurements were taken by rollmeter, except where otherwise indicated. 7 8 SCENE: At the scene of this collision, Camino Diablo Rd is a eastbound/westbound rural 9 roadway consisting of two lanes. The roadway is straight and level. The surface is composed 10 primarily of asphalt. The posted speed limit is 55 mph. See diagram. 11 12 PARTIES: 13 14 Party# 1 (Chapman)was located in the EB lane of Camino Diablo Rd. Party Chapman was 15 identified by the Contra Costa County Coroner's office. Chapman was placed as a party by the 16 following items: 17 18 - personal statements 19 - injuries " 20 21 Tovt 4-Runner;Driver# 1's vehicle. was located on its wheels as shown on the diagram. 22 V-1 sustained total damage 360.degrees. 23 24 Party# 2 (Babb)was located on the right shoulder of Camino Diablo Rd EB. Party Babb was 25 identified by a valid California driver's license. Babb was placed as a party by the following 26 items: 27 28 - personal statements 29 - being registered owner 30 - being in possession of the vehicle's keys 31 32 Chev Pickin, Driver# 2's vehicle, was located on its wheels, on the right shoulder of Camino 33 Diablo Rd. EB. V-2 was moved prior to CHP arrival. 34 V-2 sustained minor damage to the left front fender, left front running light lens, left front head 35 light frame, and the to the left front bumper. 36 - 37 PHYSICAL EVIDENCE: See factual diagram. 38 39 40 PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE . D OBRIEN 013955 08/08/96 0 • STATE OF CALIFORNIA NARRATIVE/SUPPLEMENTAL PAGE DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 08/08/96 1715 9390 013955 OARN6881 3 1 STATEMENTS: 3 Driver# 1 (Chapman) related that he was trying to pass another vehicle and they would not let 4 him. 5 6 Driver#2 (Babb) related that he was driving Camino Diablo Rd EB at approximately 40 to 7 45 mph. D-2 observed a white vehicle (V-1/Toyt) passing him on the left. As D-2 observed 8 V-1, V-1 struck the left front side of V-2 (Chev). D-2 applied the brakes and stopped in the 9 EB lane. D-2 observed V-1 turn side-ways and roll. Two people were ejected as V-1 rolled. 10 D-2 and his passenger(Kerr) exited the vehicle and went to see what they could do to help the 11 two people who were ejected from V-1. 12 D-2 related that he did not see or hear V-1(Toyt) at any time prior to the collision. 13 D-2 related that he had just washed V-2 and was driving V-2 to the old Vasco Rd to air dry the 14 vehicle, and then he would return home. At the time of the collision, D-2 was talking to his 15 passenger, Adam Kerr, about what work they were going to do on V-2 when they got home. 16 17 Passenger 91 elt), due to her injuries, was unable to give a statement. 18 19 Passenger 92 (Kerr)was contacted on the right shoulder of Camino Diablo Rd WB. Kerr 20 related that D-2(Babb) was driving Camino Diablo Rd. EB at an unknown speed. P-2 21 observed a white vehicle (V-1/Toyt) passing them on the left. As P-2 observed V-1, V-1 struck 22 the left front side of V-2(Chev). P-2 observed V-1 roll in front of V-2. P-2 observed two 23 people get ejected from V-1. 0-2 stopped the vehicle in the EB lane. Both D-2 and P-2 exited 24 the vehicle to see what they could do to help the two people that were ejected. 25 26 Additional Information: 27 28 Patricia C. McLeod stopped at the accident scene,just seconds after it occurred. McLeod was a 29 trauma nurse, who provided emergency care for Driver#I(Chapman) and Passenger 91(Felt). 30 As McLeod attended to P-1, she observed D-1 waking up. McLeod then asked D-1 for his 31 name, date of birth, where he was from,his passenger's name and what happened in the 32 collision. D-1 related to McLeod that he was trying to pass another car and they would not let 33 him pass. 34 Patricia C. McLeod 35 2413 Santa Cruz Ct. 36 Byron CA 94514 37 (hm) 510 516-7522 (wk) 510 246-7564 38 39 40 PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE D OBRIEN 013955 08/08/96 STATE OF CALIFORNIA • • NARRATIVE/SUPPLEMENTAL PAGE DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 08/08/96 1715 9390 013955 OARN6881 g T S 1 On 8-12-96, I spoke to William Chapman(father of D-1) in regards to D-I's state of mind and 2 his destination. Mr. Chapman related that D-1 and P-1 were driving to Mr. Chapman's office 3 to pick up a trailer and Mr. Chapman. D-I's travel originated from his home, then to P-I's 4 home, and the to Mr. Chapman's office. D-1 was excited because they were packing to go on a 5 hunting trip that weekend. D-1 had no time schedule. 6 7 OPINIONS AND CONCLUSIONS 8 9 SUMMARY: Driver#1 (Chapman)was driving EB Camino Diablo Rd, at approximately 55 10 mph. Driver#2 (Babb) was driving EB Camino Diablo Rd, at approximately 45 mph, in front 11 of D-1. D-1 began to pass V-2 (Chev), crossing over the solid double yellow lines to do so. 12 For an unknown reason as V-2 passed V-1, the two vehicles struck each other, somewhere near 13 the center of the roadway near the solid double yellow lines. 14 After the collision, D-2 applied the brakes and stopped in the EB lane of Camino Diablo Rd. 15 V-1 continued out of control, rolling several times. As V-1 rolled, both D-1 (Chapman) and P- 16 1 (Felt) were ejected onto the EB lane of Camino Diablo Rd. 17 V-1 came to rest, on its wheels, south of the south road edge of Camino Diablo Rd. 18 19 V-1 (Toys) sustained total damage 360 degrees. 20 V-2 (Chev) sustained minor damage to the left front fender, bumper, running light lens, and the 21 head light frame. 22 D-1 (Chapman) sustained fatal injuries. Contra Costa County Coroner's case number- 23 96-1140. 24 P-1 (Felt) sustained fatal injuries. Contra Costa County Coroner's case number- 96-1139. 25 D-2 (Babb) claimed no injuries. 26. P-2 (Kerr) claimed no injuries. 27 28 AREA OF IMPACT: The AOI was established by the physical evidence, the statements, and 29 the vehicle damage. 30 The AOI was approximately 280 ft east of the east road edge prolongation of Marsh Creek Rd. 31 and in the area of a 3ft radius from the center divide (solid double yellow lines) of Camino 32 Diablo Rd. 33 34 35 36 37 38 39 40 PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE D OBRIEN 013955 08/08/96 STATE OF CALIFORNIA NAiZRATiVE/SUPPLEMENTAL PAGE DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 08/08/96 1715 9390 013955 OARN6881 1 CAUSE: The cause was determined by the physical evidence, the statements, and the vehicle 2 damage. 3 Driver 91 (Chapman) caused this collision by passing V-2(Chev) to the left of solid double 4 yellow lines, a violation of section 21460(a) VC. 5 6 RECOMMENDATIONS 7 8 None. 9 10 ADDITIONAL INFORMATION: 11 12 Officer Brian Land, MALT, assisted in the examination of the physical evidence and of the 13 vehicle damage, to determine the cause of this collision and the area of impact. 14 15 16 17 18 19 20 21 22 23 24 25 L6 27 28 29 30 31 PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE D OBRIEN 013955 08/08/96 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA March 11,1997 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 mailelkto 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 G Amount: $3,925.00 Section 913 and 915.4. Please note all " CLAIMANT: The Hertz Corporation, FEB 1 1 1997 ATTORNEY: COUNTY COUNSEL Date received MARTINEZ CALIF.. ADDRESS: P.O. Box 721 BY DELIVERY TO CLERK ON February 11, 1997 Park Ridge, NJ 07656 Hand Delivered via: Risk M t. BY MAIL POSTMARKED: � I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. Ik� , DATED• February 11, 1997 JVIL DeputyLOR, Clerk_ /_ aZ;t , II. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (X) 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: MAR 111997 PHIL BATCHELOR, Clerk, By�it-e��Laoa-o6er , 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: MAR 13 1997 BY: PHIL BATCHELOR b a � Deputy Clerk CC: County Counsel County Administrator 1 • 1 � The Hertz Corporation L P.O. Box 721 - Park Ridge, New Jersey 07656 February 3 , 1997 CONTRA COSTA COUNTY 1801 SHELL AVENUE MARTINEZ, CA 94553 RECEIVED Our File #: 05-96-22583-0-BI FEB 1 1 1997 Date of Loss: 12-03-96 Place of Accident: WALNUT CREEK CLERK BOARD OF SUPE SORS CONTRA COSTA CO. Driver of your vehicle: CATHERINE MARY BUTLER Dear Sir/Madam: Our investigation of this matter indicates that our vehicle was damaged as a result of your negligence. Please furnish us with the name, address and policy number of your insurance carrier, unless you intend to settle this claim without resort to insurance coverage. If you choose not to refer this matter to your insurer, we hereby make claim against you in the amount of $3, 925 .00, which includes $248 . 85 for Loss of Use of the damaged vehicle and towing and storage charges of $ . 00, if applicable. Please forward to us payment in the full amount of $3 , 925 . 00 . Please make your check payable to ' The Hertz Corporation" , refer to our file number, and forward payment in the enclosed envelope. If necessary, we may be able to work out suitable payment terms . Very truly yours, ELISE SHAMANSKY Claims Examiner (201) 307-2589 Enclosures T2A/BI Hertz rents Fords and other fine cars STAT[Of eUWOM" TRAFFIC SMULSM REPORT utiaAL COM MNS r wuN LTTT dH{fOME EMTAK T xvowrNwsAA IL45(G)Pc r UWAWVT CA CC.SO CAsa C G S D ASS/S r mmsaax NT&*Jm ooutsx raposT m UNTOCT sur 424 0.0,irm VA OLUwlQN OOCLxA0 ON ENE, MAY TW TMIE/am) "=# OPEICSA t O. Q MILEIOfTEdOAYATgN _••••+•,••_•••.__. _«•�.,•�••.••_••••_ Orr O"1iR TOLE AWAY EF. S TFS &t Q1P j AT wnpwwlm ww STATE"WY xK. sIKYLIrs YttJMH)"Anal STAT[ CLAM sJl'!TT TtAA lEAOs�lG0.6R Nix -An i C �F}RD CRO. . . . .. . . . .w gr. .me- tAAltq E40S170_ ,CA Mae. 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ONLY)TRANE►ORM srs - TAKU TO: DOME wuRU ❑•7C71Y Of NOIOR CMA""wo ILA101 D.O.a f ADDREN TILLH,OM[ Puma*K,4 TRMMPOATEO•r: TAKEN TO: C430"a"Jupwo ' ❑wcrro►Y►otertarrT►crwo ❑# Lla _� ❑ a a O.O.E.I AGOROE - TaE►/K+Nt PLU"D ONLY)TRA49PORM EY; TAKm To: . 069CAM HJL"to ❑vbcm of NOLENT Mil NOTr1m r ❑ ❑ IIIrIr ao.a/ADDRsss nun,ow V,44 lD ONLY)TRANWORTm NY: TAKEN TO: oncRJa ttJUNun I] YK7fYa�atrcwae[NonRm rAOMU1IN141I ID NWY[R Ma OAT R[YrrllRIRAW Yo DAY XQ CHP 55 oy 3( w.7-07)OPI 042 87 4J07/ STATE Ot•'CAL FORNIA NARRATIVE/SUPPLEMENTAL clip W6(Rev 7-90)opt oat Page 3 PATE OF MODENTMOURRENCE TIME MOM NCI-Nt>lMEA OFFCER LD.k%MER NW"R 931.0 $999 'r ONE •X'ONE TYPE SUPPLEMENTAL r)r APPCC.40W (,g Normdve ❑CaBston report Q BA update ❑fatal ❑Hit and tun update Q supplements! 9)ottwr, ❑Ham*us that dWs Cl Wx>ci bus 0 outer: CnYiCOUHTY/AA)"L DISTRICT AEPOATM tASTRICU$EAT -rtATC?N NUhtSER UXATOW6UBJECT STATE HCULMAY RELATED ❑Yes ❑No 2 Z Aftwx 229-1 "VMS. Wit AAAIV61'b ! T 3. S. A%. kikox., Tia"s PwAk&sm 1S► AS :iR►S ANb We2ST 6. t T 0a Wt 4/L 7, Sov b AJI�tZS. t;,�t a ^ $ t.& W" 9. 41 10. 11.11 1 ° b C AfiRo4 rS w 12 D W 13 • 14 .10WIN MO COM •J 15. TO TUC ILIr. A--ft D t—'CLork. sarg 10tivimAwi +16. t-'r. 4iAD O t 17. 19. *1 C't t b WAS &a- 20. . r20, '1•C? t>t Tu N17 21. aL V xK " 6qgdr %VMPAM, 22. 23 r Aa IT& 24. u T kr 2S. +A e A t HOST 001: COMPACtaJ 26. bjN b oPt 27. X29. TWSo u 4Ub. 4R. 28. 'N► i 1�.. . ' 30. 8A&W V b S t!c+r 31. N 1% PWARE"NAME AND 6D.MUMMER DATE P4 EvtE We G NAME nr r r Use previous,editions until depleted. �^ 90 srs.s STATE OF CALL ORNA r NARRATIMSUPPLEMENTAL CHP 566(Rey 7.60)ON 042 Pape .X OATS Cr NCS TUE Rom MGG N fiiScR OFF3CER LO.NUWSER MLIMBEA 3 iSZ.O 'Jr ONE 'X'ONE TYPE SUPPLEMENTAL rJr APPt t_WW (�Narrative O Coasion repw O SA v*W O Fatal O Nk and run update O Supplemental IM Outer. O Hazerdout matarisis O Sthooi bvs O Other. MYrCOlFt7YtJ OC AL DISTRICT REPORT NO OISTRICTA3EAT CtTATKA NUM13ER LOCATIOri'SMM STATE H4HWAY MATED O Yea ONO t. Z V b PbLLQLJfAJ4 2. M t t.. +AT t 3. 4. '� rc l ws��t'c + �._) .ttUJIM LTANW AA Ar DAIS QcaAl A4b WAS U NZ l W l a 10. Vt Wk�,_ W9&[3;.rt:, &N-A.4bWA &I Md3j UMzWA Y Y 11. ti 13. d to "wtBD 14. ��` t• 15. 16. t S C4411SIIAGG A.N b 17. A; & c..r GOJAr r4rJ& 18. fiR V-3 ICTIOPI W UrT 19. `to b1 w 14 IMM iziS h6oft jc%r 21. V S AT' 22. T N 23. WAS, d V- 25. GStQ V I26 2T. - vl TCD r a uta 'C1Wct� w.t,S b � � 28 t.%q %R2r4ak %j kkts. bm%tig:LiAyY 2LO c.T, W L-de OCAAD 29. JQBs tC t m b t d S. 30. D vT%ZS, 0-3 IWCD P—A 'r r M b STA2Imb 31. Loow cb A"uu4. amp GL booJ Wil b w tJA IFVWR8 NAt4 ANO LQ NUMNA DATE FCVWWER'3 K WE GATE �O V�,I Cs �$ t2•y-Z 1r Use previous ed46ons until depleted. 90 r,N,y; STATE OFCAU FOAMA NARRATIVE/SUPPLEMENTAL .Cts 558(Rev 7-90)OPl 042 Page $' DATE OF MEWNT/OCCURFENOE TUE 12T9 NCIC NUYSE R OFGICEA l.D.NUMBER NUNSEA I1-3 '96 1 Zi i ,S; xONE •7C ONE TYPESUPPLEWEMALIWAPPMABLF} Z NN M6ve 0 CONSW report ❑8A update Draw 01 Mt and run update i t�Supplemental ([Ai Other: ❑Hazardous materials ❑School bus 0 Other. 4 Cr1'VCOU NTYI.1OmL4L DISTRICT AMRT*4 bSTAfCT/BEAT CRATgN NW3ER LWATiI?tOi BJECr+ STATE WOiMAY ABATED ❑Yes ONO I. R66 IQ$ PC" COVJCr A.PJb t N V- 2 %,Wb 3. vLt, v 4. C1 tAa W#-JAl .T�l s1 e.� JD SIA&WIM TA&Ljr,%4!Ci cKQEb S. OUT OF 'M ' bgwgwos D b w f 6 W'*UW b t. ll1Eg t Sit t wJt.S. t -Cm b -11i W rffNT +d/a b.1` Aw 9 0 t111A VAAb 1r F4L0QAtL.* �Ow b v 0 1: 10. eXr WWMj We Tkatielb AROwdb. S 3 IT 1 a SrUhg 11. `r v Wgr 12. % ' t G f tn GA A.W b *14W.0, VOIR * y'>ri SIr 13 C,4K ttJ uxuaOT lv.%T 14. Wri CARR, a. V- 15. 0014 1b Ovr DE CQM—."W(. 1. T 16Nl,,� �416" b %jmQtm mog. L 4004 17. tt t k. 'r 4 18, u�J 19. 20. P toe at . P-44 bdt CAMNI-I 21, 04.1AJkbS nitxbjD ►3 22., OR . v C c 23. ?.IT F~OsL 24. 25. 26. 27. 14SIO W" 1LAh!,bW4c,, = 28. 29. 30. 31. PP&AFEWS NAME AND W*" 0.N 11" DATE REVEWERS NrutE DATE .YOvr-jG X89 9 Use previous edWons ung depleted. ���- 9067541 1 � 1 N i ? r w waOu � > . 0 N L1! b a Im co uj w o a. see AIM Q a F- 9 ul e a CO VCL O mw Jg m w w 900 W LL a STATE OF CAUFORNIA CHP556- Supplemental Legend Page • DATE OF OROMI NCOM TW CUM M=MAMM OFFEM Lo. PACE -7 12M196 2221 9320 8999 Subject 245 PC-INCIDENT(CONTRA COSTA SHERIFF DEPT.) 1 FACTUAL DIAGRAM LEGEND: 2 3 4 POI #1 (V-1 VERSUS V-2) LOCATED APPROX. 14 FT. E/O THE WEST 5 ROADWAY EDGE OF PEBBLE CT. AND 79 FT. NIO THE NORTH 6 PROLONGATION LINE OF PEBBLE DRIVE. 7 9 POI #2 (V-1 VERSUS V-3) LOCATED APPROX. 8 FT . E/O THE WEST 9 ROADWAY EDGE OF PEBBLE CT. AND 63 FT. NIO THE NORTH lo PROLONGATION LINE OF PEBBLE DRIVE . 11 12 13 POINTS OF REST: 14 15 (V-1) R/F TIRE- LOCATED APPROX. 65 FT. EAST OF THE EAST 16 PROLONGATION LINE OF PEBBLE CT. AND 1 FT. SIO THE SOUTH 17 ROADWAY EDGE OF PEBBLE DR. 16 19 RIR TIRE- LOCATED APPROX. 64 FT. EAST OF THE EAST 20 PROLONGATION LINE OF PEBBLE CT. AND 11 FT. SIO THE SOUTH 21 ROADWAY EDGE OF PEBBLE DR. 22 23 L/F TIRE- LOCATED APPROX. 59 FT. EAST OF THE EAST 24 PROLONGATION LINE OF PEBBLE CT. AND EVEN WITH THE SOUTH 2s ROADWAY EDGE OF PEBBLE DR. 26 27 28 (V-2) R/F -TIRE- MOVED PRIOR TO CHP ARRIVAL. LOCATED APPROX. 29 1 FT. NIO THE NORTH PROLOGATION LINE OF PEBBLE DR. AND 10 30 FT. E/O THE WEST ROADWAY EDGE OF PEBBLE CT . 31 32 R/R TIRE- LOCATED APPROX. 7 FT . NIO THE NORTH 33 PROLONGATION LINE OF PEBBLE DR. AND 4 FT. E/O THE WEST 34 ROADWAY EDGE OF PEBBLE CT . 35 36 37 WA—R—UrS NAME M W-443ER DAT6S ttMtE TE Officer Johnson 13849 12/03/96 STATE OF CALIFORNIA CHP556- Supplemental Legend Page CATE OF OWN&NGDEW TAE a4m NGC NUMBER OFFOM M PAGE 12/03196 - 2221 9320 8999 Subject: 245 PC-INCIDENT(CONTRA COSTA SHERIFF DEPT.) 1 POINTS OF REST:—CONTINUED- 2 3 (V-2) -CONTINUED- L/F TIRE- LOCATED APPROX. 6 FT. NIO THE 4 NORTH PROLONGATION LINE OF PEBBLE DR. AND 4 FT. E/O THE s WEST ROADWAY EDGE OF PEBBLE CT. 6 7 e (V-3) R/F TIRE- LOCATED APPROX. 35 FT. NORTH OF THE NORTH 9 PROLONGATION LINE OF PEBBLE DR. AND 3 FT . EAST OF THE WEST la ROADWAY EDGE OF PEBBLE CT. 11 12 R/R TIRE- LOCATED APPROX. 43 FT. NORTH OF THE NORTH 13 PROLONGATION LINE OF PEBBLE DR. AND 1 FT. EAST OF THE WEST 14 ROADWAY EDGE OF PEBBLE CT. 15 16 L/F TIRE- LOCATED APPROX, 34 FT. NORTH OF THE NORTH 17 PROLONGATION LINE OF PEBBLE DR. AND 8 FT. EAST OF THE WEST 18 ROADWAY EDGE OF PEBBLE CT . 19 20 21 22 23 24 25 26 27 2s 29 30 31 32 33 VREPAWn RAWOATV RE%&Wf3TS WMX GATE Officer Johnson 13849 12103196 UP whul lei Mal as m o^*� �N N."EmIisaVAMT . ,. ���� -gyp• ///���r � - s■� u0��i��f���!l�lit►7��E 3�--=��r�� F,.T I-X. . EWA '! Cm=per above appraisal 1� ♦ �i. �� ions on the Revers— unless signed by a. ..- �1► iThe Hertz Corporation • DateOut UNIT NO. : DATE: 7 MILES : " ) STORED AT: MILLBRAE, CA VDA # . APPRAISER: R DG OR SPURGEON PICTURES: SIGNATURE: I E 3REP895 t -BEQUEST TO PLACE AN ITEM ON THE BOARD OF SUPERVISORS' AGENDA O AQ1 Use-ft ftm forPJenninp.Hearkw) TO: CLERK OF THE SOARD OF SUPERVISORS #ROM: Irene Prado �- STAFF MEMBER TO CONTACT FOR ADDITIONAL 141 ORMA7=: #41 me a Teiephone Number) REQUESTED BOARD AGENDA DATE: March 11, 1997 IS THERE A CRITICAL DEADLINE FOR BOARD ACTION AND, IF SD, WHAT IfIT: RO .2-YES March 11, 1997 .jOffi W� PATI« THIS IS A NOTICED HEARING:X IYO TES SUGGESTED AGENDA LANGUAGE: D*-*claims of Canadari'American Oil Company; J. Cannon;' W. & M. Chaman; •L. Dabney; A. Everson; S: & J. Felt; C. Fontenot; • The Hertz Corporation; F. --House; B. Tye; Western StatesPetroleum Association; and H. Willett. - THIS ITEM BELONGS IN THE FOLLOWING CATEGORY(Ch 9_ ck One): (See attached for further definition of catep d") - x CONSENT: No dISCUSBION no speakers. no opposition. _—PRESENTATION -Brief: ,l,ress than In baits, --PRESENTATION-Low. Mwe than five mimes. Estimated amount of gme - -- - of Person maidrtp preser�etionj _ _ _ -:SHORT DISCUSSION:Less_than dive minSes. - _: .."_ - __ DELIBERATION: horger than five minutes. - - --- --- - -Emoted amount d time -- - - - -- -_- -- . -- CLAIM BOARD OF SUPERVISORS OF CONTRA.COSTA COUNTY, CALIFORNIA March 11, 1997 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 not % W'71 CLAIMANT: Canadian American Oil Company FEB 14 1997 ATTORNEY: David J. Friedenberg COUNTY COUNSEL 2171 Junipero Serra Blvd. , Ste.620Date received MARTINEZ CALIF. ADDRESS: Daly City, CA 94104 BY DELIVERY TO CLERK ON February 13, 1997 BY MAIL POSTMARKED: February 12, 1997 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: February 14, 1997 Jdil �epu-cylOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). (/Y Other: CUarO Com, 7t �- Vos L/ C eke Dated: BY: Depu Count Counsel 1/0 flc4a 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 (X) 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. 4 l Dated: MAR 111997 PHIL BATCHELOR, Clerk, 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: MAR 13 1997 BY: PHIL BATCHELOR b�js e�we� Deputy Clerk CC: County Counsel County Administrator CLAM AGAINST THE "COUNTY OF GDNTRA CO 3TA RECEIVED .: (Please Print or Type) FEB 13 1007 Claimant's Name : cANApTAN AMRRT( AN OTT, COMPANY I -_ . — CLERK BOARD OF SUP01VISORS Claimant' s Address : 444 Divisadero Street . CONTRA rQqTA f'f) San Francisco CA Zip: 94117 Phone(415) 755-6622 Amount of Claim: $ CLAIM FOR INDEMNITY -Re: TEXACO v. CAN AM OIL CO. , Contra Costa County, etal U.S. Dist. Ct #�96-4051 Address to which notices and correspondence are to be sent i erent than above) : DAVID J. FRIEDENBERG 2171 Junipero Serra Bl Suite 620 Daly City CA _ Zip : 94014 Date of Incident: 1973 - 1999 Location of Incident: 3599 Mt. Diablo' Blvd. , Lafayette CA How did it occur: Alleged pollution and soil contamination from Petroleum products leaking from storage tanks and lines Describe damage or loss : Allp(;;-rl janlliition and soil cQntamination Name of Public Employee(si ) causing injury or damage , if known (if unknown so state) : UNKNOWN Itemization of claim (List items totaling amount set forth above) : UNKNOWN AT THIS TIME Total $ I declare under penalty of perjury that the foregoing is -true and correct. Dated at Dalv City California,,–on 21 _,19897 DAVID J. FRIEDENBERG Attorney for Canadian American Oil Co Signat dre of C191mant V N OtA � PA PA tA VIA 0 �'• sa H Y�' V• � v1 V d : ro H • V o d °� � '� °�,' � '� �'to : r��•� Ate'� Q � �v c •�+ w `�a o..*d fid' Q� N Y^ � N J O `p �•Z 4 N p3 Q Dorno Z oQ� LO N O e i i f s t ✓~•, l r J i �— t CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA March 11, 1997 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 maileoLto 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: $1,370.00 Section 913 and 915.4. Please note Rpowtvigg) CLAIMANT: Jocelyn Cannon FEB 14 1997 ATTORNEY: COUNTY COUNSEL Date received MARTINEZ CALIF. ADDRESS: 545 Parker Ave. , Apt. 10 BY DELIVERY TO CLERK ON February 14, 1997 Rodeo, CA 94572 Hand Delivered via: Risk. M t. BY MAIL POSTMARKED: � I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. GATED: February 14, 1997 JAIL �TTCHtyLOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors (�) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 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 (X) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Q Dated: MAR 111997 PHIL BATCHELOR, Clerk, BY'/1- jS—a -' 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 7hi.s 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: MAR 13 1997 BY: PHIL BATCHELOR b �jt�-+ 1�_aa6a—' Deputy Clerk CC: County Counsel County Administrator c2A = to; BOtM OF MPERVZ=TS OF CWM COSZA CU Wry IfiSfRUC IOXS TO CLAD!NT A- Clzx=s relating to causes of action far dea`h or for injury to person or to per_ soaal property or growing crops and rich accrue on or before Decw� 31, 1987, Must be meted rYw-{ later than the l000�t.`h day ,after �ythe �accrual y�}of th+e cause of aCticn• C°31 IMS relating o causesof aCtica fo eath o fc injury to person ' Cr to per—conal proper''-y 4r 8rouin8 crops and %&1ch accrue on or after Jaznrary 1, 19889 II xst be presented not later than six =nths after the accrual of the came of action. Claims relating to any other c of action mast be presented not later than cn-- year z4fter the =rual of the cause of.action. (Govt. Code S911-2.) Claim rest be filed idth the Cleit of Me B=rd of SMXwVi.='s at its office In IC6, Caunty Administration Building, 651 Pine Street, Harti =, Ca 94553. �=. If.claim 3s•asaixasb a district governed by the Board of SupP,xwisors, rather than tie C.ountp4' the name of the District should be filled in- D. If the claim is against m=re tl-nn one public entity, separate clams must be filed 2gainst each public entity. S Fraud- See penalty for fraudulent claims, Penal,Code Ser. 72 at the end of this � t# tf � tFi4G4f �➢flFdFltlEitfiflStF <t4CE {t {lgSt iE # �F # lilt # fF �FL4lFQ' i4iElEtEtElElE i£t Maim By ) Reserved for Clerk's filing stamp J o Ce(y to C, P-K o V1 } RECEIVED } 0 AGains't the County of Contra Costa or ) 181407 District) CLERK BOARD OF SUPERVISORS F its name } CONTRA COSTA CO. tm dersig eUI=nt ha^eby sakes claim against the County of Contra Costa or the above-named District in the -urn of7'O.Co �- 2� in support of this claim represents as follows:. t`.a X YeA�-�.7"<!Q t - :.. t:hea did the d3sage or injury occur? -(Give exact date and hour) �'7 30 Pit . Xnmvdial the dm—'Fre cr W=7 c=u-? (Inaude city and county) ?"/L,, AT-e- cD9a,,,, 21,4 Ave- '1R'C&0 3. Hou did the damage or injury occur? (Give Rall. details; use extra paper if ^ rewired) W L f ti f `u 7�t i tI� JF'GT l v�1 G � l3 14. teat particular act or ocaission on the part of county or district officers, se.^vants or emPlo//yees caused the in j`-y or damage? c ur,X�J/91 t 5. .+nat; are .»e n;-,,*ves tri:' county or district officers. Servants or employees causir4g �. Vbat damage or. injuries do y 03211, resulted? (Give t1�1�. exteat of 1x uties Cr ,damages claimed. Attach two estimates for auto damage. 'I_ flowcams the 2cm=t diasmed above coapaztect? (Iz:dbOe the estimated ano=t 'of arty prospective injury or damage.) 3. !lames and addresses of witnesses, doctors and hospitals. Po �e� 9. List the ependitures you made on accauut of this accident or injury: DATE ITEF. AM'aNT ¢ tf tt tE et tE 2F df 2f tf iE tf iE IE iE-4E #:it SF iir !E iE !E if 0 0 0 fE !E if iE a a 0 Gov- Code Sec. 910:2 provides: . 1 qbe claim must be signed by the claimant KMC£S W.- (Attorney) or by some on his behalf." Name and Address of Attorney C xfm-ant's Signature Address_ Tel ephnne No. Telephone No ,5 711- 3&j Z # a K tf 0 tE iE iE if tE w Z x * * tb NOTICE Section 72 of the Penal Code provides: "Every person vft, ,with intent to defraud, presents for allowance or for Palr=-It 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 clalm, bill; account, vouc`ner, or mri,ting, is punishable either by iwprisonment in the county jail for a period of not more than one year, by a fine of not exeeedLng one thousand ($3,000), or by both such impri3onment and fine, or by imprisonment in' the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both st!oh 1^Yr<s `zrr,�^t a--d fine. tl_ Ijiff Servlce Ad or: P . Z c3 ►� J v ,� a w N o�► Customer # ,- DE$CRIPTION PARTS LABOR ( TOTAL VAL ( I I I Y Ir,dt L,1-4I -43q 1 1I i V- f elsw- rcea, I ( dot. I I c 1'' U& S i W i I I I I 3 4� I I w I f i f Fluids I Tax I Grand Total CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA March 11, 1997 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 maileoLto 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: $2,000,000.00 Section 913 and 915.4. Please note a $�flilt) CLAIMANT: William & Mary Chapman FEB 1 1 1997 ATTORNEY: Mark A. McLaughlin, Esq. COUNTY COUNSEL 2211 "A" Street Date received MARTINEZ CALIF. ADDRESS: Antioch, CA 94509 BY DELIVERY TO CLERK ON February 7, 1997 BY MAIL POSTMARKED: Hand Delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED•February 11, 1997 BAIL BAATTCUELOR, C1erk�� II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. (/\) This claim FAILS to comply substantially with Sections 910 and 910.2, and -we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: BY: c 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 (X) 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: MAR 1997 PHIL BATCHELOR, Clerk. B� ,e-a 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. MAR 13 1997 Dated: BY: PHIL BATCHELOR b" � Deputy Clerk CC: County Counsel County Administrator �`Q aim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code .§911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for. fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By Reserved for Clerk's filing stamp WILLIAM CHAPMAN & MARY CHAPMAN RECEIVED Parents of Scott William Chapman (Deceased) L Against the County of Contra Costa —7 W7 or FO A-1 District) _80ARD OF SUPERVISORS CLERK CONTRA COSIA CO (Fill in name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 2,000,000.00 and in support of this claim represents as follows: ------------------------------------------------------------------------------------- 1. When did the damage or injury occur? (Give exact date and hour) 8-08-96, 5:15 p.m. - 6:30 p.m. --------------------------------------------------- 2. Where did the damage or injury occur? (Include city and county) ----Camino-Diablo-Road., 280 feet East of Marsh CreekRoad_Pyl2n., California 3. How did the damage or injury occur? (Give full details; use extra paper if required) Claimants' child was involved in a serious auto accident which seriously injured the child and due to errors by County Emergency Services Dispatcher, an ambulance was not timely or properly dispatched to transport child to hospital which resulted in death of child. ----------------------------------------------------------------------------------- 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? Failure to follow Emergency Services Dispatch protocol re ambulance following serious auto accident resulting in failure to have ambulance transport injured person to hospital in timely manner resulting in death. (over) 5. What are the names of county or district officers, servants or employees causing the damage or injury? Unknown ------------------------------------------------------------------------------------ 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Death of claimants! child. --------------T How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) $2,000,000.00 for wron&ful death -------------------------------- ----------- 8. Names and addresses of witnesses, doctors and hospitals. The CHP Report is .attached hereto and incorporated herein by reference. American Medical Response, P. 0. box 7423, San Francisco, CA 94120-7423 Delta Memorial Hospital, 3901 Lone Tree Way, Antioch,. CA 94509 ---------- ------------------------------- List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT 8/96 Funeral-expense & medical bills $20,000.00 est. ,$ Gov. Code Sec. 910.2 provides: _ "The claim must be signed by the claimant SEND NOTICES or' (At;t�rney)7� „� ' orb some person on his behalf." Name and Address of�Att6rney°: w D,- Mark A. McLaughlin, Esq. - 2211 "A" Street Atty. for (Claimant's Signature Antioch, CA 94509 2211 "A" r Address Antioch, .CA 94509 Telephone No. (510) 754-2622 Telephone No. (510) 754-2622 * * * N O T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher,, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000) , or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. I ,TATE OF CALIFORNIA f TRAFFIC C'OLLI:SION REPORT • PAGE 1 OF SPECIAL CONDITIONS NO INJ H&R FEL CITY JUDICIAL DISTRICT NUMBER FATALE O [ ] UNINC. DELTA MUNI NO KILL H&R MISD COUNTY DIST BEAT 2 CONTRA COSTA 661 C-stars: OARN6881 COLLISION OCCURRED ON: MO DAY YEAR TIME(24M) NCIC OFFICER I.D. L CAMINO DIABLO RD 08 08 96 1715 9390 013955 c A MILEPOST INFORMATION: DAY OF WEEK TOW AWAY PHOTOGRAPHS BY: I THURSDAY Pq YES [] NO 12 EXPOSURES N [] AT INTERSECTION WITH: STATE-HWY REL CHP - 5166 In OR: 280 ieet E o' MARSH CREEK RD YES Pq NO NONE PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY VEH YR - MAKE/MODEL/COLOR LICENSE NUMBER STATE 1 B3822543 ICA C H 92 TOYT 4 RUNNER WHITE WNDMSTR CA DRIVER NAM E(FIRST.M IDDLE.LAST) Pq SCOTT WILLIAM CFAPMAN PEDES- STREET ADDRESS OWNER'S NAME [ SAME AS DRIVER T rT 4038 BOULDER DR WILLIAM CHAPMAN PARKED CITY/STATE/ZIP OWNER'S ADDRESS [] SAME AS DRIVER VEr ANTIOCH 94509 4038 BOULDER DR, ANTIOCH, CA 94509 B(ClY- SEX HAIR EYES HEIGHT WEIGHT BIRTHDATE RACE DISPOOF VEHICLE ON ORDERS OF: P] OFFICER [] DRIVER []OTHER CLm M BRN BRN 5-08 190 02122177 B AND J TOWING (510) 75773100 OT`HE�R HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: NONE APPARENT REFER TO NARRATIVE[] [ ] (510) 754-3595 ( ) NONE CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER VEHICLE TYPE []UNK []NONE []MINOR UNKNOWN 01 I []MOD.Pq MAJOR [ ]TOTAL ',;;;;;•,;',�, DIR TRV I ON STREET OR HIGHWAY SPD LMT PCF .............................. E CAMINO DIABLO RD ISS 21460 (a)VC PARTY DRIVER'S LICENSE NUMBER STATE I CLASSSAFELY VEH YR MAKE/MODEL/COLOR LICENSE NUMBER STATE 2 A1725592 CA C G 78 CHEV P/U YEL 1K41390 CA DRIVER NAME(FIRST,M(DDLE.LAST) �] JIMMY LEE BABE PEDES- STREET ADDRESSOWNER'S NAME V] SAME AS DRIVER TR[A{J 16711 MARSH CREEK RD SPACE #71 PA .KJEDCITY/STATE/ZIP OWNER'S ADDRESS ] SAME AS DRIVER VErTLI CLAYTON CA 94517 BICY- SEX HAIR I EYES HEIGHT BIRTHDATE RACE D[SPOOF VEHICLE ON ORDERS OF: [] OFFICER K] DRIVER []OTHER CLn M 12LN BLU 5-10 WEIGHT 195 04 04 71 DRIVEN AWAY OTHER HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: NONE APPARENT K] REFER TO NARRATIVE[] [] (510) 757-4383 (7 0 7) 746-8028 CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER VEHICLE TYPE []UNK []NONE �]MINOR NONE 22 I []MOD.[]MAJOR []TOTAL ... DIR TRV I ON STREET OR HIGHWAY FSPD LMT PCF E CAMINO DIABLO RD 5 PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY VEH YR MAKE/MODEL/COLOR LICENSE NUMBER STATE 3 l . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . DRIVER NAME(FIRST,MIDDLE,LAST) I PEDES- STREET ADDRESS - OWNER'S NAME [] SAME AS DRIVER TRff PARKED CITY/STATE/ZIP OWNER'S ADDRESS [] SAME AS DRIVER VE rt BICY- SEX HAIR EYES HEIGHT I WEIGHT BIRTHDATE RACE DISPO OF VEHICLE ON ORDERS OF: [] OFFICER [] DRIVER []OTHER CLn OTHER HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: NONE APPARENT[] REFER TO NARRATIVE[] [] CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER VEHICLE TYPE []UNK []NONE []MINOR []MOD.[]MAJOR []TOTAL � DIR TRV ON STREET OR HIGHWAY -. SPD LMT PCF f PREPARER'S NAME DISPATCH NOTIFIED REVIEWER'S NAME / ATE REVIEWED 4 OBRIEN D 013955M YLNo STATE OF CALIFORNIA . TRAFFIC COLLISION CODING PAGE OF DATE OF ORIGINAL INCIDENTTIME(2400) NCIC NUMBER OFFICER I.D. NUMBER 16 7 C-8 - U8 - 96 1715 9390 013955 OARN6881 OWNERS NAME/ADDRESS NOTIFIED PROPERTY DAYTON S I LVA/219 9 9 MARSH CREEK RD, BYRON CA (510) 643-28G11 YES DESCRIPTION OF DAMAGE DAMAGE BARBED WIRE FENCE - 16 FT AND 2 POSTS SEATING POSITION SAFETY EQUIPMENT EJECTED FROM VEH OCCUPANTS MIC BICYCLE-HELMET 1-DRIVER A-NONE IN VEHICLE L-AIR BAG DEPLOYED 0-NOT EJECTED 2 to 6'PASSENGERS 8-UNKNOWN M-AIR BAG NOT DEPLOYED DRIVER I-FULLY EJECTED 7-STA.WGN.REAR C-LAP BELT USED N OTHER V-NO 2-PARTIALLY EJECTED 1 2 3 8-RR.OCC.TRK.OR VAN D-LAP BELT NOT USED P-NOT REQUIRED W-YES 3-UNKNOWN 9-POSITION UNKNOWN E-SHOULDER HARNESS USED 4 5 6 0-OTHER F-SHOULDER HARNESS NOT USED CHILD RESTRAINT PASSENGER G-LAP/SHOULDER HARNESS USED Q-IN VEHICLE USED X-NO 7 H-LAP/SHOULDER HARNESS NOT USED R-IN VEHICLE NOT USED Y-YES 1-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 WHICH ARE FOLLOWED BY AN ASTERISK(-)SHOULD BE EXPLAINED IN THE NARRATIVE PRIMARY COLLISION FACTOR MOVEMENT PRECEDING LIST NUMBER(P)OF PARTY AT FAULT I TRAFFIC CONTROL DEVICES 1 2 3 TYPE OF VEHICLE 1 2 3 COLLISION A VC SECTION VIOLATED: CITED A CONTROLS FUNCTIONING A PASSENGER CAR/STN.WON. A STOPPED 1 21460 (a) VC NO B CONTROLS NOT FUNCTIONING' B PASSENGER CAR W/TRAILER X B PROCEEDING STRAIGHT B OTHER IMPROPER DRIVING' C CONTROLS OBSCURED C MOTORCYCLE/SCOOTER C RAN OFF ROAD C OTHER THAN DRIVER' X D NO CONTROLS PRESENT/FACTOR D PICKUP OR PANEL TRUCK D MAKING RIGHT TURN D UNKNOWN' TYPE OF COLLISION E PICKUP/PANEL TRK.W/TLR. E MAKING LEFT TURN E FELL ASLEEP' A HEAD-ON F TRUCK OR TRUCK TRACTOR F MAKING U TURN WEATHER(MARK I TO2ITEMS) X B SIDESWIPE G TRK./TRK.TRACTOR W/TLR. G BACKING X A CLEAR C REAR END H SCHOOL BUS H SLOWING/STOPPING B CLOUDY D BROADSIDE - I OTHER BUS X I PASSING OTHER VEHICLE C RAINING E HIT OBJECT J EMERGENCY VEHICLE 1 CHANGING LANES D SNOWING F OVERTURNED K HWY.CONST.EQUIPMENT K PARKING MANEUVER E FOG/VISIBILITY: G VEHICLE/PEDESTRIAN L BICYCLE L ENTERING TRAFFIC H F OTHER`: OTHER`: M OTHER VEHICLE MOTHER UNSAFE TURNING G WIND MOTOR VEHICLE INVOLVED WITH N PEDESTRIAN N XING INTO OPPOSING LANE LIGHTING A NON-COLLISION 0 MOPED 0 PARKED X A DAYLIGHT B PEDESTRIAN P MERGING OTHEIATED FA B DUSK-DAWN X C OTHER MOTOR VEHICLE 11213 .MARK II ASSOTO 2 ITEMSCTOR Q TRAVELING WRONG WAY C DARK-STREET LIGHTS D MOTOR VEH ON OTHER ROADWAY A VC SECTION VIOLATION:CITE R OTHER': D DARK-NO STREET LIGHTS E PARKED MOTOR VEHICLE E DARK-STREET LIGHTS NOT FUNCTION F TRAIN B VC SECTION VIOLATION:CITE ROADWAY SURFACE G BICYCLE SOBRIETY-DRUG PHYSICAL X A DRY H ANIMAL: C VC SECTION VIOLATION:CITE 1 1 1213 (MARK 1 TO 21TEMS) B WET XA HAD NOT BEEN DRINKING C SNOWY-ICY I FIXED OBJECT: E VIS.OBSCURED: B HBD-UNDER INFLUENCE D SLIPPERY(MUDDY.OILY.ETC.) F INATTENTION' C HBD-NOT UNDER INFLUENCE I OTHER OBJECT: G STOP&GO TRAFFIC D HBD-IMPAIRMENT UNK.' ROADWAY CONDITIONS MARK 1 TO 2ITEMS PEDESTRIAN'S ACTIONS H ENTERING/LEAVING RAMP E UNDER DRUG INFLUENCE` A HOLES,DEEP RUTS' X A NO PEDESTRIAN INVOLVED i PREVIOUS COLLISION F IMPAIRMENT-PHYSICAL' B LOOSE MATERIAL ON RDWY' B CROSSING IN XWALK/INTERSECTION 1 UNFAMILIAR WITH ROAD X G IMPAIRMENT NOT KNOWN C OBSTRUCTION ON ROADWAY* C CROSSING-IN XWALK NOT AT K DEFECTIVE VEH.EQUIP.:CITE H NOT APPLICABLE INTERSECTION 4 1 D CONSTRUCTION-REPAIR ZONE I I SLEEPY/FATIGUED E REDUCED ROADWAY WIDTH D CROSSING NOT IN CROSSWALK L UNINVOLVED VEHICLE SPECIAL INFORMATION F FLOODED' E IN ROAD-INCLUDES SHOULDER MOTHER': A HAZARDOUS MATERIAL G OTHER': F NOT IN ROAD X X N NONE APPARENT B SEATBELT FAILURE X H NO UNUSUAL CONDITIONS G APPROACHING/LEAVING SCHOOL BUS O RUNAWAY VEHICLE SKETCH MISCELLANEOUS STATE OF CALIFORNIA 9 INJURED/WITN�e,SSES/PASSENGERS • • PAGE OF 1 DATE OF COLLISION TIME(2400) NCIC NUMBER OFFICER I.D. NUMBER G8 — 08 — 96 1715 9390 013955 OARN6881 $ EXTENT OF INJURY ('X' ONE) INJURED WAS ('X' ONE) WITNESSPASSENGER AGE SEX PARTY SEAT SAFETY EJECTED ONLY ONLY FATAL SEVERE OTHER VISIBLE COMPLAINT NUMBER POS. EQUIP. INJURY INJURY INJURY OF PAIN DRIVER PASS. PED. BIKE OTHER 19 M X X 1 1 H 1 NAME/D.O.B./ADDRESS TELEPHONE SCOTT WILLIAM CHAPMAN 02-22-77 H-4038 BOULDER DR, ANTIOCH, 94509 (510) 754-3595 (INJURED ONLY)TRANSPORTED BY: TAKEN TO: AMR PARAMEDICS DELTA MEMORIAL HOSPITAL DESCRIBE INJURIES: CAUSE OF DEATH PER CONTRA COSTA CORONER' S OFFICE — .BLUNT TRAUMA TO THE CHEST AND ABDOMEN r I VICTIM OF VIOLENT CRIME NOTIFIED 17 FT X I I IX I I 1 1 1 3 1 H 1 NAME/D.O.B./ADDRESS TELEPHONE TAMMY ELAINE FELT .03-04-79 H-1030 CLAUDIA CT #30 , ANTIOCH, CA, 94509 (510) 756-7705 (INJURED ONLY)TRANSPORTED BY: TAKEN TO: AMR PARAMEDICS DELTA MEMORIAL HOSPITAL DESCRIBEINJURIES: CAUSE OF DEATH PER CONTA COSTA CORONER' S OFFICE — BLUNT TRAUMA TO THE HEAD r I VICTIM OF VIOLENT CRIME NOTIFIED -] X 118 Im 2 3 G 0 NAME/D.O.B./ADDRESS - TELEPHONE . ADAM DALE KERR 11-28-77 H-16711 MARSH CREEK RD SPACE #90 , CLAYTON, CA, 94517 (510) 754-4584 (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES: VICTIM OF VIOLENT CRIME NOTIFIED I I Ti NAME/D.O.B./ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES: VICTIM OF VIOLENT CRIME NOTIFIED T_ NAME/D.O.B./ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO: - DESCRIBE INJURIES: VICTIM OF VIOLENT CRIME NOTIFIED PREPARER'S NAME LD NUMBER MO. DAY YR.. IREVIFWER'SNAME MO. DAY YR. OBRIEN D 013955 08-18-96 STATE OF CALIFORNIA • • . NMRATIVE/SUPPLEMENTAL PA ,F y DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 08/08/96 1715 9390 013955 OARN6881 Sketch Camino 15' 10' 1 010 415'-* W/B EIB Diablo Asphalt Roadway 40 10 To E/B Marsh Creek D r t i S h 0 U To W/B d Marsh ' e Creek r Dirt Area Drawn By 10' 10' D.Beringer 11398 PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE D OBRIEN 013955 08/08/96 STATE OF CALIFORNIA NAPRATIVE/SUPPLEMENTAL PACE DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER O 08/08/96 1715 9390 013955 OARN6881 " Factual Camino W/B EJB 25' O 5" Gougemark Diablo (� 4; '�1yd" ji a11," +3a' ►IIiI► OB Blood in roadway „7 ,lr►, , , ,ala (9_ —'P9' © 4" Gougemark a' (� OD 8" Gougemark 47' UE: Gougemark from rim Debris (� DS no, (T)Gougemarkfrom rim 10 23' (( © 8' Scrapemarks 17' O 60' Skidmark (I}-- O26' Gougemark To EJB Marsh Creek O 35' Skidmark D 45' a r C11' Scrapemark � t Gougemark ( S from Bumper h a' 0 10, ,,, u I To W/B 290' to d Marsh 10' Marsh Asphalt Creek / Creek Roadway r r Dirt Area Drawn By 10' 10' D.Beringer 11398 PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE D OBRIEN 013955 08/08/96 STATE OF CALIFORNIA NARRATIVE/SUPPLEMENTAL PAGE DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 08/08/96 1715 9390 013955 OARN6881 1 FACTS: 2 3 NOTIFICATION: I was dispatched to a call of an injury traffic collision, with an ambulance 4 responding at 1718 hours. I responded from I-580 EB east of North Flynn and arrived on 5 scene at 1740 hours. All times, speeds and measurements in this investigation are approximate. 6 Measurements were taken by rollmeter, except where otherwise indicated. 7 8 SCENE: At the scene of this collision, Camino Diablo Rd is a eastbound/westbound rural 9 roadway consisting of two lanes. The roadway is straight and level. The surface is composed 10 primarily of asphalt. The posted speed limit is 55 mph. See diagram. 11 12 PARTIES: 13 14 Party# 1 (Chapman) was located in the EB lane of Camino Diablo Rd. Party Chapman was 15 identified by the Contra Costa County Coroner's office. Chapman was placed as a parry by the 16 following items: 17 18 -personal statements 19 - injuries 20 21 Tovt 4-Runner;Driver# 1's vehicle, was located on its wheels as shown on the diagram. 22 V-1 sustained total damage 360 degrees. 23 24 Party# 2 (Babb)was located on the right shoulder of Camino Diablo Rd EB. Parry Babb was 25 identified by a valid California.driver's license. Babb was placed as a party by the following 26 items: 27 28 -personal statements 29 - being registered owner 30 - being in possession of the vehicle's keys 31 32 Chev Pickup, Driver# 2's vehicle, was located on its wheels, on the right shoulder of Camino 33 Diablo Rd. EB. V-2 was moved prior to CHP arrival. 34 V-2 sustained minor damage to the left front fender, left front running light lens, left front head' 35 light frame, and the to the left front bumper. 36 37 PHYSICAL EVIDENCE: See factual diagram. 38 39 40 PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE D OBRIEN 013955 08/08/96 STATE OF CALIFORNIA NARRATIVE/SUPPLEMENTAL PAGE DATE OF NCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 08/08/96 1715 9390 013955 OARN6881 3 1 STATEMENTS: 2 3 Driver# 1 (Chapman)related that he was trying to pass another vehicle and they would not let 4 him. 5 6 Driver#2 (Babb)related that he was driving Camino Diablo Rd EB at approximately 40 to 7 45 mph. D-2 observed a white vehicle (V-1/Toyt) passing him on the left. As D-2 observed 8 V-1, V-1 struck the left front side of V-2 (Chev). D-2 applied the brakes and stopped in the 9 EB lane. D-2 observed V-1 turn side-ways and roll. Two people were ejected as V-1 rolled. 10 D-2 and his passenger(Kerr) exited the vehicle and went to see what they could do to help the 11 two people who were ejected from V-1. 12 D-2 related that he did not see or hear V-1(Toyt) at any time prior to the collision. 13 D-2 related that he had just washed V-2 and was driving V-2 to the old Vasco Rd to air dry the 14 vehicle, and then he would return home. At the time of the collision, D-2 was talking to his 15 passenger,Adam Kerr, about what work they were going to do on V-2 when they got home. 16 17 Passenger#1 elt), due to her injuries, was unable to give a statement. 18 19 Passenger#2 (Kerr)was contacted on the right shoulder of Camino Diablo Rd WB. Kerr 20 related that D-2(Babb) was driving Camino Diablo Rd. EB at an unknown speed. P-2 21 observed a white vehicle (V-1/Toyt) passing them on the left. As P-2 observed V-1, V-1 struck 22 the left front side of V-2(Chev). P-2 observed V-1 roll in front of V-2. P-2 observed two 23 people get ejected from V-1. D-2 stopped the vehicle in the EB lane. Both D-2 and P-2 excited 24 the vehicle to see what they could do.to help the two people that were ejected. 25 26 Additional Information: 27 28 Patricia C. McLeod stopped at the accident scene,just seconds after it occurred. McLeod was a 29 trauma nurse, who provided emergency care for Driver#1(Chapman) and Passenger#1(Felt). 30 As McLeod attended to P-1, she observed D-1 waking up. McLeod then asked D-1 for his 31 name, date of birth, where he was from, his passenger's name and what happened in the 32 collision. D-1 related to McLeod that he was trying to pass another car and they would not let 33 him pass. 34 Patricia C. McLeod 35 2413 Santa Cruz Ct. 36 Byron CA 94514 37 (hm) 510 516-7522 (wk) 510 246-7564 38 39 40 PREPAkER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE D OBRIEN 013955 08/08/96 STATE OF CALIFORNIA • • NARRATIVE/SUPPLEMENTAL PA E DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER f 08/08/96 1715 9390 013955 OARN6881 g T 3 1 On 8-12-96, I spoke to William Chapman (father of D-1) in regards to D-I's state of mind and 2 his destination. Nir. Chapman related that D-1 and P-1 were driving to Mr. Chapman's office 3 to pick up a trailer and Mr. Chapman. D-I's travel originated from his home,then to P-I's 4 home, and the to Mr. Chapman's office. D-1 was excited because they were packing to go on a 5 hunting trip that weekend. D-1 had no time schedule. 6 7 OPINIONS AND CONCLUSIONS 8 9 SUMMARY: Driver 91 (Chapman) was driving EB Camino Diablo Rd, at approximately 55 10 mph. Driver 42 (Babb) was driving EB Camino Diablo Rd, at approximately 45 mph, in front 11 of D-1. D-1 began to pass V-2 (Chev), crossing over the solid double yellow lines to do so. 12 For an unknown reason as V-2 passed V-1, the two vehicles struck each other, somewhere near I3 the center of the roadway near the solid double yellow lines. 14 After the collision, D-2 applied the brakes and stopped in the EB lane of Camino Diablo Rd. 15 V-1 continued out of control, rolling several times. As V-1 rolled, both D-I (Chapman) and P- 16 1 (Felt) were ejected onto the EB lane of Camino Diablo Rd. 17 V-1 came to rest, on its wheels, south of the south road edge of Camino Diablo Rd. 18 19 V-1 (Toyt) sustained total damage 360 degrees. 20 V-2 (Chev) sustained minor damage to the left front fender, bumper, running light lens, and the 21 head light frame. 22 D-1 (Chapman) sustained fatal injuries. Contra Costa County Coroner's case number- 23 96-1140. 24 P-1 (Felt) sustained fatal injuries. Contra Costa County Coroner's case number- 96-1139. 25 D-2 (Babb) claimed no injuries. 26 P-2 (Kerr) claimed no injuries. 27 28 AREA OF IMP ACT: The AOI was established by the physical evidence, the statements, and 29 the vehicle damaze. 30 The AOI was approximately 280 ft east of the east road edge prolongation of Marsh Creek Rd. 31 and in the area of a aft radius from the center divide (solid double yellow lines) of Camino 32 Diablo Rd. 33 34 35 36 37 38 39 40 PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE D OBRIEN 013955 08/08/96 STATE OF CALIFORNIA NA-ZSATIVE/SUPPLEMENTAL PACE DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 08/08/96 1715 9390 013955 OARN6881 � 1AC USE: The cause was determined by the physical evidence, the statements, and the vehicle 2 damage. 3 Driver 41 (Chapman) caused this collision by passing V-2(Chev) to the left of solid double 4 yellow lines, a violation of section 21460(a) VC. 5 6 RECOMMENDATIONS 7 8 None. 9 10 ADDITIONAL INFORMATION: 11 12 Officer Brian Land, MAIT, assisted in the examination of the physical evidence and of the 13 vehicle damage, to determine the cause of this collision and the area of impact. 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE D OBRIEN 013955 08/08/96 r CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA March 11, 1997 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 maile4Lto you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant t r Amount: $10,000.00+ Section 913 and 915.4. Please note al I s� � CLAIMANT: Laquetta A. Dabney FEB 11. 1997 ATTORNEY: James B. Chanin, Julie M. Houk COUNTY COUNSEL Law Offices of James B. Chanin Date received MARTINEZ CALIF. ADDRESS: 3050 Shattuck Ave. BY DELIVERY TO CLERK ON February 10, 1997 Berkeley, CA 95705 b eruar F2, 1997 BY MAIL POSTMARKED: 5' I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. GATED: February 11, 1997 t�IL �ep�tyLOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days.(Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: �lJ�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 ( X) 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: MAR 11 1997 PHIL BATCHELOR, Clerk, B � — Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months frau 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. c/ Dated: MAR 13 1997 BY: PHIL BATCHELOR by\L e ms La-, _Deputy Clerk CC: County Counsel County Administrator LAW OFFICES OF JAMES B. CHANIN 3050 SHATTUCK AVENUE BERKELEY,CALIFORNIA 94705 (510)848-452 FAX(510)848-5819 00, RECEIVED s.. JAMES B.CHANIN xr. 1-CD 10 1997 JULIE M.HOUK '` February 7 , 1997 CLERK BOARD OF SUP FMSORS VIA CERTIFIED MAIL/RRR COPITRACOSTACO- Clerk of the Contra Costa County Board of Supervisors 651 Pine Street Martinez , CA. 94553 Re: Our Client: LaQuetta A. Dabney Subject: Tort Claim Dear Madam/Sir: Enclosed please find the original and one copy of the Tort Claim "this office is submitting to the County of Contra Costa on behalf of our client, LaQuetta A. Dabney. Please return the enclosed copy of the Tort Claim to our office in the enclosed self-addressed, stamped envelope showing the date it was received in your office . Thank you for your attention in this matter. Very truly yours , LAW OFFICES OF JAMES B. CHANIN B LlE M. HOUK Enclosures . ORIGINAL JAMES B. CHANIN (SBN# 76043 ) RE 'EIVED JULIE M. HOUK (SBN# 114968 ) Law Offices of James B. Chanin 3050 Shattuck Avenue FM 101997 Berkeley, California 94705 510/848-4752 CLERK BOARD OF SUP RV{SORS COfVTRA COSTA CO. Attorneys for Claimant CLAIM AGAINST THE COUNTY OF CONTRA COSTA LAQUETTA A. DABNEY, ) Claimant, ) TORT CLAIM VS . ) COUNTY OF CONTRA COSTA, CLAIMANT'S NAME: LAQUETTA A. DABNEY CLAIMANT'S ADDRESS: 4811 Appian Way, Bldg. #4, Apt. 2 El Sobrante, CA. 94803 CLAIMANT'S TELEPHONE NUMBER: ( 510 ) 223-2149 .ADDRESS TO WHICH NOTICES ARE TO BE SENT: JAMES B. CHANIN, JULIE M. HOUK, LAW OFFICES OF JAMES B. CHANIN, 3050 SHATTUCK AVENUE, BERKELEY, CALIFORNIA 95705 . DATE OF THE INCIDENT: On or about August 27 , 1996 , the Claimant was terminated from her employment as an Experienced Level Clerk at the Richmond Health Center Medical Record Department by her supervisor, Michele Kimmel . On or about October 9 , 1996 , the Claimant' s request for reinstatement to this position was denied by the Contra Costa County Director of Human Resources . Discovery continuing. LOCATION OF ACCIDENT OR INCIDENT: Claimant' s termination was from the Richmond Health Center facility, located at 100 - 38th Street, Richmond, CA. Discovery continuing. 1 HOW DID THE ACCIDENT OR INCIDENT OCCUR: On or about August 27 , 1996 , the Claimant was terminated from her employment as an Experienced Level Clerk at the Richmond Health Center Medical Record Department by her supervisor, Michele Kimmel . On or about October 9 , 1996 , the Claimant' s request for reinstatement to this position was denied by the Contra Costa County Director of Human Resources . The Claimant was terminated .from her employment by her supervisor, Michele Kimmel, due to her physical disability, i .e,. , multiple sclerosis. Claimant was told by Ms . Kimmel that she was "too slow" and that she could not be assigned to a slower desk because she had to keep another worker there who was being accommodated for an injury. Ms . Kimmel did not make any reasonable accommodation for the Claimant' s physical disability, even though the Claimant put the County on full notice of her disability in writing prior to being hired to work for the County at the Richmond Health Center. When Ms . Kimmel complained to the Claimant that she was "too slow, the Claimant advised Ms . Kimmel that she was unable to' move faster because of her physical disability. Ms . Kimmel demanded that the Claimant submit proof of her physical disability to Ms . Kimmel from her treating physician. Pursuant to Ms . Kimmel' s demand for proof of her physical disability, the Claimant submitted a letter from her physician to Ms . Kimmel dated August 6 , 1996 , concerning her medical condition. Ms . Kimmel informed the Claimant that this letter was insufficient and demanded additional information from the Claimant' s physician ,be submitted. Ms . Kimmel then gave the Claimant a form for her physician to complete. On or about August 23, 1996 , the Claimant submitted the form completed by her physician to Ms . Kimmel ' s office . On or about August 27 , 1996 , Ms . Kimmel terminated the Claimant from her employment at the Richmond Health Center. The Claimant' s efforts to obtain reinstatement to her position have been unsuccessful to date. Claimant was terminated from her position with the County of. Contra Costa in violation of public policy due to her physical disability. Even though the Claimant advised the County prior to hiring her to work in the medical records division at the Richmond Health Center of her physical disability, no attempt was made to make any reasonable accommodation for the Claimant's physical disability. 2 Claimant's termination was thenratified by the Director of Human Resources for the County of Contra Costa on or about October 9 , 1996 . Claimant is informed and believes and thereon alleges that this incident was the result of customs , policies and practices of the County of Contra Costa in failing to make reasonable or appropriate accommodation for persons with physical disabilities , such as the Claimant. Claimant is further informed . and believes and thereon alleges that this incident was the result of customs, policies, and practices of the County of Contra Costa which encourages , authorizes or condones discrimination against individuals having physical disabilities . Claimant is informed and believes and thereon alleges that the acts and/or omissions of Michele Kimmel as alleged herein were _ intentional, malicious, oppressive and/or were done with a conscious or reckless disregard for the Claimant' s rights . Discovery continuing. DESCRIBE INJURY OR DAMAGE: Pain, suffering, emotional distress , lost wages, damage to career, other damages to be ascertained, attorneys ' fees, punitive damages and costs . Claimant may recover damages under theories of liability which include, but are not limited to, California FEHA, 42 U.S .C . Section 1983 , American with Disabilities Act, violation of public policy; negligence, infliction of emotional distress, slander, libel, misrepresentation, fraud, ratification, custom, policy and practice, and other theories of liability to be ascertained. Discovery continuing . NAME OF PUBLIC EMPLOYEE(S) BELIEVED TO HAVE CAUSED INJURY OR DAMAGE: Michele Kimmel, DOES 1-100 . Discovery continuing, DEMAND FOR PRESERVATION OF EVIDENCE: Claimant does hereby demand that the COUNTY OF CONTRA COSTA, including its employees, agents , servants and/or attorneys, maintain and preserve all evidence, documents and tangible materials which is and/or may be relevant to the subject matter of this Claim during the pendency of this matter, including until the completion of any and all civil litigation and appeals arising from the events which are the 3 subject matter of this Claim. AMOUNT OF CLAIM: Claim is in excess of $10, 0.00 . 00 . Jurisdiction is in the Superior Court of the State of California for the County of Contra Costa County and/or United .States District Court for the Northern District of California . DATED: February 7 , 1997 LAW OFFICES OF JAMES B CHANIN B �1 ' J �IE M. HOUK torneys for Claimant(s ) 4 1 PROOF OF SERVICE BY MAIL 2 I am a citizen of the United States and employed in the 3 County of Alameda, California . I am over the age of 18 years 4 and . not a party to this action. My business address is the LAW 5 OFFICES OF JAMES B. CHANIN, 3050 Shattuck Avenue, Berkeley, CA 6 94705 . 7 On the date set forth below, I caused the within 8 TORT CLAIM 9 to be served by placing a true copy thereof enclosed in a .10 sealed envelope, with postage thereon . fully prepaid for 11 delivery via Certified Mail/Return Receipt requested, in the 12 United States Post Office mail at Berkeley, California, 13 addressed as follows : 14 Clerk of the Contra Costa County Board of Supervisors 15 651 Pine Street Martinez, CA. 94553 16 I certify under penalty of perjury that the foregoing is 17 true and correct. 18 Executed on February 7 , 1997 , at Berkeley, California. 19 20 J IE M. HOUK 21 22 23 24 25 26 27 28 mw x� mo �D C/) a >c oxn f D< > o z CA -c • • f • F Lr. :3 • : ,; Al CV L-j LLJLU r s A� (Jt'O I- Ln I n r �l (D ru rt ft ti LU r• ro n x � N• a (D Z O N (D CJ t•h O Ef) w rt nrtrt �D" • (D (D CJ rt O � G cn rt Ln K w O h O Fh En G an r a c 0 • -y f'' - a '' ` •I j�. s•r r. ., • r. • c s a CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA March 11, 1997 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 mailek 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 C2 Amount: $10,000.00+ Section 913 and 915.4. Please note all " CLAIMANT: Claudia Fontenot FEB 0 6 1997 COUNTY COUNSEL ATTORNEY: Stanley J. Bell, Esquire MARTINEZ CALIF. Law Offices of Stanley J. Bell Date received February 6, 1997 ADDRESS: Two Transamerica Center BY DELIVERY TO CLERK ON 505 Sansome St. , 18th Flr. February 5, 1997 San Francisco, CA 94111 BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED:February 6, 1997 Jdll �eputy�' Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors 061,-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: f� BY: �� Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (�) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: MAR 11 1997 PHIL BATCHELOR, Clerk, B ,mac Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personalty 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: MAR 13 1997 BY: PHIL BATCHELOR Q Deputy Clerk CC: County Counsel County Administrator 1 CLAIM FOR DAMAGES FOR PERSONAL INJURIES 2 TO: MERRITHEW MEMORIAL HOSPITAL 2500 Alhambra Avenue 3 Martinez, CA 94553-3156 _ ' RECEIVE® 4 BOARD OF SUPERVISORS COUNTY OF CONTRA COSTA FEB — 61997 5 651 Pine Street Martinez, California 94553 CLERK BOARD OF SUP RVISORS 6 CONTRA COSTA CO. JOHN C. KOFOED, M.D. 7 2450 Martin Road Fairfield, CA 94533 8 PLEASE TAKE NOTICE that the undersigned hereby serves and makes 9 demand upon you for the cause and amounts set forth in the following claim: a 10 w Claimant's Name and Address: as 11 CLAUDIA FONTENOT w 8 12 2726 Downer Avenue Richmond, CA 94804 .. o -s 4" -- 13 U Claimant's Mailing Address to which Notices are to be Sent: 14 Stanley J. Bell, Esquire Vlaoue - w° a 15 LAW OFFICES OF STANLEY J. BELL w d Two Transamerica Center Qo IH c tn rA 16 505 Sansome St., 18th Floor 3 San Francisco, California 94111 a 17 Amount of Claim: 18 Special damages and expenses proximately caused by the occurrence 19 described below and general damages are in excess of the jurisdictional minimum of 20 the Superior Court. 21 Date and Place of Occurrence giving rise to the Claim Asserted: 22 On or about the 8th of August, 1996 and continuing, at Merrithew Memorial 23 Hospital in the City of Martinez, County of Contra Costa, State of California. 24 Description of Occurrence: 25 That on or about the aforementioned date and for some time prior thereto, 26 claimant consulted the above-named public entities, by and through their agents for the. 27 purpose of obtaining diagnosis and treatment for her right leg condition, and said public 28 entities undertook and agreed to diagnose claimant's condition and to care for and treat 1 her and to do all of the things necessary and proper in connection therewith; that said 2 public entities, and each of them, thereafter entered into such care and treatment 3 individually and by and through their agents and employees. 4 That from August 8, 1996 and continuing, said public entities, and each of them, 5 so negligently and carelessly examined claimant and diagnosed or failed to diagnose 6 claimant's condition and so negligently and carelessly treated and operated on claimant 7 by the use of instrumentalities, medicines and procedures, the exact nature of which is 8 unknown to claimant, and which instrumentalities, medicines and procedures were 9 under the sole and exclusive control and custody of said public entities, and each of 10 them, that claimant was caused to and did, suffer severe personal injuries. a 11 DATED: February 5 , 1997 w° $ 12 LAW OFFICES OF STANLEY J. B- e-g .e-g 13 Cn u a;; C0 U f7r C � „ � � 14 By: STA LL 15 Attorney or Claimant E 16 eH o � � a 17 18 19 20 21 22 23 24 25 26 27 28 2 1 RE: Claim of CLAUDIA FONTENOT 2 PROOF OF SERVICE BY MAIL - C.C.P. Sections 1013a, 2015.5 3 I, the undersigned, hereby declare that I am a citizen of the United States, over 4 the age of eighteen years, and not a party to the within action. I am employed by the 5 LAW OFFICES OF STANLEY J. BELL. My business address is 505 Sansome St., 18th 6 Floor, San Francisco, California 94111. 1 served a true copy of CLAIM FOR DAMAGES FOR PERSONAL INJURIES by mail, by placing the same in an envelope, sealing, fully 7 prepaying postage thereon and depositing said envelope in the U.S. Mail at San 8 Francisco, California on February 5, 1957 9 MERRITHEW MEMORIAL HOSPITAL 10 2500 Alhambra Avenue w Martinez, CA 94553-3156 as 11 ti BOARD OF SUPERVISORS w a 8 12 COUNTY OF CONTRA COSTA "' 651 Pine Street 13 Martinez, California 94553 14 JOHN C. KOFOED, M.D. w F� N e 2450 Martin Road w 15 Fairfield, CA 94533 �o �9 16 a17 1 declare under penalty of perjury that the foregoing is true and correct. 18 Executed in San Francisco, California on February 5, 1997 19 20 21 Karen D. Haym n 22 23 24 25 26 27 28 3 i Jat$�,� .>"�.�� r F. .;.��....''`� vtt r^�?'t.� � ¢r�»'S.SS'N- -'��r�"-G' "..+�"`� ! S'� •".�r,"�3w3.t:.'� 6 "� ,�«'k- T r x ❑ o F k _ • 111 "� +•d• L k 'J 5 - � n • • a • CD �s �6 0 r � � m � •'^� k� o F ter•- '� ��rr - - � - RM �■ L J � � � m Wit+.. '"� tO m • • Y ., V �0 a m x CD r xs � c c _C C k'`t1 r yy� S n E s z S 6 h 2 6 S H 3 = Addressee Co '' '" 2' � 9 " PY �\ �' Al ��A, '4.1- rt'•` - ria^ t+* .a ,ki °i— +.. ��«.. y*}�,x. -� s', ." �°x'.,• "r�5z���� �„t, �"�'�'�as '�"? - l�f c:•i � /�a��: � ��- x i� 1^"A 4'Ne_fr mom'F'� Y•JTxy.,}S+- 6+ tv at ext �,.� nett'� �• .-^� ..j I �=` r n t t` c" �.,,:i.' r !: N T t tsft�' VIM a �Qfi r 'atu. Ply i i.c�•�.i•3.a E rt�,�,�TM3�k S ,.�y. S:f ,.. ��•�y +'""t- I .�' c a. $ .- .fi•-:,s ,r.. i - -K. ,� _y' 1 ..mak= ��k� ���� rn Vl 1'.1: �•,,. 'O �� �.� `� �.� `[„rpt r ,�#�' � iS�•4 � `f q `c *&zM t 7 ''� ' a; n��4.e-• ���£ � ,y."3cc���,q� ����'' � ��. i"�.� _ �"'�-x}n`� �`�'ac'�. � � l�l �: rn Gw r ve y.�.. r - sg�.�+�rt3a.. ".�''e ��a`�r�" vlf` ^�#�.. k' r"' '�� �. '�`; • Y h' � ti CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA March 11, 1997 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 maile4Lto 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: $332.73 Section 913 and 915.4. Please note all-*STE,— CLAIMANT: Florence House FEB 0 6 1997 ATTORNEY: Date received �M�pUg7INEZCALIF. ADDRESS: 2585 Montgomery Ave. BY DELIVERY TO CLERK ON February 6, 1�9'�/ Concord, CA 94519 February 4 1997 BY MAIL POSTMARKED: n' I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED:February 6, 1997 CIL �p�zyLOR, Cleric,� "' 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: _ C� ' BY: eputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (X.) This Claim is rejected in full. ( ) Other: I certify that this is &.true and correct copy of the Board's Order entered in its minutes for this date. Dated: MAR 111997 PHIL BATCHELOR, Clerk, Byi""""` tea — 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: MAR 13 1997 BY: PHIL BATCHELOR by� ��- Deputy Clerk CC: County Counsel County Administrator chic to: H3AP•D OF SUPERVISORS OF CONTRA COSTA CW= IRSTRUCTIouS pro CLAIMW A. Clzi=s relating to causes of action for death or for injury to Person or to per somal Property or growing crops and which accrue on or before December 319 1987, must be presented not later than the 100th day after the accrual of the cause of action. Clai relating to causes of action for-death or for inJUry to per-%a • or to Personal Property or Sroming orcps and tett ch accrue on or atter Ja=iary l,, 19W9 must be Presented not later than site months after the accrual of the cause of action. Claims relating to airy other cause of action must be presented not later than we year after the accrual of the cause of action. (Govt. Code 5911.2.) B. Clmust be filed with the Cleric of the Hoard of Supervisors at its office 1n Room 106, Ooaurtty Administration Building, 651 Pine Street, Martinez, CA 94553• C. If claim is-against a district governed by the Hoard 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 BE: Claim By ) Reserved for Clerk's filling stamp FLORENCE HOUSEFRE '" t the County of Contra Costa or }District) My ORSF' in rz She undersigned claimant hereby brakes claim against the County of Contra Costa or the above--zram�,�! District in the sum of 3 3 2.7 3 and in support of this claim represents as fonaws: 1. 14= did the damage or injury occur? "(Give exact date and hour) 01/25/97 7:00r)m 2. Where did the damage. or injury occur? (Include city arid.county) CONCORD/PLEASANT HILL- CONTRA:°COsTTASCOUNTY 3. How did the damage or.injury occur? (Give full details; use extra paper if reOuired) I HIT A LARGE POT HOLE IN THE RIGHT HAND LANE ON CONCORD AVENUE-JUST BEFORE THE CONCORD SUNVALT.EY FORD DEALERSHIP.. . 4. What particular act or omission on the part: of county or district officers, servants or employees caused the injury or damage? WHEN I CALLED THE .POLICE TO REPORT THE POT HOLE & PROBLEM THEY SAID THEY HAD RECEIVED FOUR CALLS ALREADY & WERE SENDING SOMEONE OUT_ I'M SURE Jkly DAMAGE WOUT.D NOT HAVE OCCTTRED IF SOMEONE HAD RESPONDED SOONER SCE T WAS THE FIFTH VEHICT.E & THEN THREE ADDITIONAL CARS AFTER ME. :�„�,.-j �. wnat are me Hanes of county or district officers, servants or employees causing the da:_-.age Or ir.jurT? CONTRA COSTA COUNTY OR WHOM EVER IS RESPONSIBLE FOR ROAD REPAIRS. 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto daarage. TWO TIRES ON RIGHT SIDE_ HAD TO BE REPLACED AND FRONT END ALIGNMENT. I AM NOT CLATMING THIS AGAINST MY INSURANCE AS MY DEDUCTABLE IS $500.00. 7. Hou was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) WORK DONE BY BIG O TIRES WHERE I HAD MY CAR TOWED AND T.EFT OVERNIGHT. DUE TO THE FACT IT TS MY ONLY VEHICLE I::'HAD THE WORK DONE THE NEXT DAY. $. :lames and addresses of witnesses, doctors arA hospitals. ENCLOSED IS A LIST OF 3 OF THE 8 PEOPLE WHO ALSO HAD TIRE DAMAGE_ 9. List the expenditures you made an account of this accident or injury: DfiT£ IT£N: AMOWT 04¢2.6.97_ 2 NEW TIRES ALIGNMENT $332-73'. V �C Gov. Code Sec. 910:2 provides: aloe claim must be signed by the claimant SEND NOTICES T0: '(Attorne ) or bysome RM= on his n Name and Address of Attorney Claimant�s Si tore 2585 MONTGOMERY AVE.- Address. CONCORD, CA 94519 Telephone No. Telephone No. (510)827-9629 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 ($10,000, or by" both s,ch and f ne. SUMMARY OF OCCURRENCE ON 01-25-97: I was driving down Concord Avenue toward Concord, when I hit a large pot hole on far right lane just before Sunvalley Ford Dealership. The Damage sustained was 2 flat tires on right side which has to be replaced and the front end needed alignment. I was the WIh person to hit this pot hole and while I walked to a pay phone to call the police and AAA Insurance to get a tow, there were three other cars who had tire damage from the same pot hole. I have enclosed the names of three of the people who also suffered tire damage and can verify that I in fact did incur tire damage from this dangerous pot hole. FLORENCE HOUSE (510)827-9629 INFORMATION FROM ADDITIONAL PERSONS WHOM RECEIVED DAMAGE FROM LARGE POT HOLE ON 01/25/97: JEAN MICKENS 517 AVALON WAY SUISUN, CA 94585 (707)122-4698 MARIAN ASAN 780 OAK GROVE RD#C111 CONCORD, CA 94518 (510)798-8851 LIC#3CKD240 CARICE HUYS 332 WEST J STREET BENICIA, CA 94510 (707)746-7688 LIC#3SUB443 '92 TOYOTA 4 I .. } i i$i„Rt,t. t o a t + !I v,I1 , , �, . n a u: c 1 5 Ii t r14a a I I I t' i = '3.1 . 3r' t71G {1 7II�C�. #I17 , 1 r ate < 5st ;f fs .Ia, �' r ANNO�TIAWES� ,, 1 ,t1;44U 'A l CONCORD AVS i � ,- y , ;: e; �! c 7i s?t� 1 ,t {+ _ ( :,a r r�( a n511, �A(Ii BF+ i,; t i1jii . .i 5)3 tit. i Vt: T ! E y t �w k xy `t F t C1NC:CIRU. . CA 9 520 1.E f�A±s#CAD05304tIUS .. P -i +7 r'' iI. - i 1 I.t. •,`iv'�iit.'t, I ,d.. 1 ” r ' t,11 , y r ijs t°� 'T J, S +_ , a b R b + c rd sf v 6 x`' ;{li} I ACCOUNT ��wE h: iH PHONE a�n,�°g a £r 'r'+x ce,�I Y REFERENCE 4 ifs taItI r , x r u 10),i lox t't 1!' a: t `�CI a? r J t I'- { u s -3 J i 1 t- t, ¢�}jA' ? .,# t s, ; i y r Y,}#£ f ;Y.� 7 f>� x ,} 11 lturl49ale4 sygrt L 1'1 1t.i<�. :I .Ytt.rt,},a .Lyx pt- F.ii. /. f !t! �C7S1. }T {r NOIl5� FLDRANEEj, i ,. ! 'p 1 f r,s, i w �"i€ s N, s -- ,{ , W PHONE) t dzf� C iz �I� ,�ATE�lT�ME a{ddr e .`8 6 _ t� t y r6 r I l . f t 111'i v 'SR5,',ma aTGu"y AVE ? q �;. s tl ', c L - i RE A E.N k,: VIN.NO + x s e t f a s1i h r ! t t sty jxe r r, } d r s tt l £ WC..FS NO ,r F r , 1, 11 � C041 UNGOAQ, CA QA519 s Ir : , I, 1RI 1, 4 P *'ma�yy rls ° f it"' S. kF /�.5..' �rlrr F.i 4� rF ,f'r ctiri £1t tt r3 r `},- + •(i.71' .1 9�i r h s, v ;`i 't#�. S _ .r'I" ,r }P• z ,[ LI E E TAG NO NEXT INSP DATES rj t BAR;NO ;i h, I x�",1+t' ; r, r i= E: 1 3 "#. k',,, i.5� ? 4 'i t F'; E € t i f y k —11" y �� t s a '�d• fit '"r' i. $ •P -,a 7 i. ° ���t w�I sui i�? " I u� inter t{ #'�€'l s V:Ii•1' i 1 N MAXIMA",. : Y Lf�7� f ,.. f. F' (F x". }f r . `s 5�r7 t 7 s}rY 1 t PROMISE DATE/TIME MILEAGE q rte" e S t _'z WRITTEN BY p 1 r s t a ,f ,,s4 rr=�ALL PARTS NEW UNLESS�� . p yt �.. ..# �a ;tr'8«``F z,. I ,%N11 }T fY 1.7 -sfr x£ I°.. 1 + 't } #.';7 L„�-4x f}.r :5. f.y 1 S x 5 r ti. .A �r"' K BE t 1 ,. i k "9 d { M l lJ� Y��� § ;N, , .,�� OTHERWISE,,SPECIF�ED ' �s �:• t ; ,,!;,, d' �a?r;? �t >t4 r � a� a n:< ! * r' �,i 1 : , s ,W3v,R. 5� €. T;5&:&s Ys£arr:r �;_ + TI,' i • • • •• 4 Gy.x.,"ri4� ? !uf s "R` 13d ;an q d{ ::•,�f s t'P L .:,r r„ ...' > i s;. '' .t.,:, x ::-�1 l 1,.:,.ita i,r 2 at i 1.., sw:#-'; 1 f"-`. :} - yt .:i.'.. p >t; ,r*{',�c.}'(;P :'v° w.,``as P �.+x $,,Z •.Y 's" # n .t t! d d f'Er .. +e+ £n r 7{ �, :,},4f� �a F_" :a� r q ��r"Q I h'x� :".�..L i.. 4 d... r hEgg 7! 519 f".�$ x I"",. , l r� d 5yk d. .:1 H t;r' I i #'B "h}y. f i f �" Yy Y- 1, C; 9v° k y, -.g R GINAL,.Iwo « :: <:r.f aM.,F<.x t Iits,,;. t f#...3'. 1 s t P agar ? a T r .5 .F �.. eeS* x pw It; r�,�r�Ffi'.4�'�r ktn',•4 !'�`�({i "'''.(4Ir,t}q�..,I. Y € � ?ii k ,-, g T_- ,e b>tf.,, £I _, I.::. I ' ,a,:r 5 1'�t , ,;.rr�,���}'f':s� c-�;_ c t 5 ta` t'r . 'n k{ 1 4t i i,. ,� :„ a r 'xr y, .i '3 F? � f" gyp. rfir REVISEDfI °ry 7 i". t`t s r S +i(f ) t r ? € k i + ). S},; '.t r ky € w gt ,I f. yud r r ;REVISEDh2 ..g'4rwefi^ n uw zn,.,., r i.y `g r , ,t;.,,y f a xtC ifiF +� ,� ,� t s§:, v n 8 -J,", r k'1,`acknowle"d esnot(ee and oral a royal of ari`increaseun,'tha onginal estimated rine} ,i' !a " W,.i i `," Ir p sy y ' % � f r,s 'Ai'ti'... t t c a a, l 3 Ys Q.'C PP a p.. x Y�, +r"' I ks d3"rs, tv11�'-.a x t�.k > 'fi a.to(..�A.; a I� ,L tk <$5 N{a 5 5 t < :r i St a tx 3 n 3 s +>_Yta ',e 7a �P a<4 t 7.�5 , L i Cr" ,. I R a �5+ •.}wl Fi'i r;t f a, .r'st w t hz,zt'L€£ pit` :>? `i -z d S } g , , t gr's"sv �+�..�rS�k's a:i, w. ;lai'6 4 r? p`-.r iy` y .# a s r Ast7w. �I ?F/1..f r 11 " I i °� PARTS.. OTH�'RS F LABOR A s ,1,.rk €. 15 .+irr s- y S If•t S fi F' r! 0 • • • •i • • 0 • ..5,�S!ki eta s y �I }^°v E b y ;i .,hi !'. f ,ti=j .x. rv,,,4 4 i '11 r s 5 G I+�> ' �.' F z .tz.,,t 1,(^a y PF� .r° 3 ' 'i I 1 . lt.>< x'�k"'IXs�i+ df<y 1" tsr r �. I., ssP sitl� 5t{ d q v �t y r ��r I a f CHEC.!' TIRES f j {5�y' {.F as "z1 'x I .i>.t I � 53Y a+=:„vr�t� :i f�'it ,. # s, r,'S A }'i kIT k 27 tf, 3 fk s 1. o "�Z �� t� > , i It,�.. klx T� 4"+s 3 t_til' (SSS '� ! i �3af Ift rk 1 a i p (.k ��� ;' 36 '.O 2 S/d5RI5 EURO H%P t , {I 124 U ;� : 234 48J�l r, f `� f ly ,.t �� ,M , s s� �# j ,F-iiI ` BIG O'PACKA(,E; '°t I t�;IS ° i� :�� ” I ��� II 1 I ,% � � �. . 1414 4 , f fRCE �MOUNTIN6 .f �` ° 1 <'�/ 1", �: , `t`t ) � s# i s J 1 _ r x< + FREE LIFETIHG�GOMPIITEH��BALHNIE i�i a ' hN S . �, -FREE RUBBER VALVE SfiEti _ , s,a# r'rt� est ; t4 s d t} :! k , t k FREE FLAT AEPAIR5 ,FI ' ' �t 1 fa ,: FL`' 7 -.y:a ern - I , ffiE� ROTATIONIEVERYrj50OQ HILESIVa ` : el 4 "ts , :y- VII t e is, f$ , t y < rl i ` `, 2 EN1. VIRtII9EP;IAL NARBE FLR Tint 3 d r �. 'fl+c I�, ,q r i . 0 'i 4ij,. 1 �'AL''IONMENT' FOUR 3HEE 5' �s ;b4 953, ,il. , P. LftNGER TIfi NGAR�ENEGk,+ IR 5 1 4 !' rix � + s 3 ­il }11 ri'1 r:�..a: f; ,FRE'�5UR; RE.6UI,ARI YE I ' ?41k. ?� L —, ?sa a� �_f � '9E APPRECIATE YGUR'6USIkESS` f :, t I �� r1. q1:111 I "l t �` `"f a . , 1.I 11,�,!,,ix' I",, i f} HA4'E A:GREAT'OA1 r r 1,6 ;, , „, apt Jt �. 3 r ntxh,�I`t•e , S t �tt ¢iu ? , r �sy s s t { a ,+� s r` r 1 4 5 7t I 1 ; r� v,,, e c _ t� r tI I y r t� i }. . , F 3- I Ir- t 4f 1 E 3 ! P 1 i 3'r,� 5 1 t I 11, ,' ; } �2 f rfb tom,lEt� 5k +..J v«i P T;'1 ! f 1 t� »..f SrFPk SY I' �. > � .h v. 1 A 5 S 5Jr n V C s d+ f t" i. w€ d F ��. c.� ! ?ry �Sdr y}4 j'd ^ '?f.f�T}J pn ypt>5. s ( i t �:' kfr s .1 , eT f F re*.t cix p, t n ' vg,1: t �,r. C r r s 3 _ firt'w k } .r S vp5z, 5 E t '<5 f S+"4'a 3r+ g , e v r 5 F }i,` t� '' .f { I _ �4a 1 , ' fit '� r'w1 is ,,,.. ,, ;�. r it' e; '.a ^Y ,. k 4 }I L. s ,I > s q f + ,;t �F:. 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I,.,,, F-�tix t:... � f4n,....,,,.Sd, { �Y1 )311 ,P; (. ! . y: 1.11 } VEHICLE y"' • ' I GRANT BIG O TIRES,ItPERMISSION TO OPERATE t4E.VEHICLE i ; 9t t 4 i J LF AF PARTS f {i 7',, z , ,.,:HEREIN DESCRIBED FOR THE PURPOSE OF TESTING,INSPECTING } .G,w ,J'� 11 INCLUDES REMOV�:L OF WHEELS AND DRUMS FOR THE PURPOSE,t t 3 !mL t .`O"( i # :-3 ) - : ,ahX g - d S i, t ii '"OFINSPECTING THE BRAKES,SERVICING,OR DELIVERY ERY:I RELEASE 'tl ,3}�" uH}$. :t s a• ,LABOR ay »t I ,BIG.0 TIRES FROM RESPONSIBILITY}FOR LOSS-OR DAMAGE TO ,.•�.# y `,>, 11 I s� „3I1.e ds r ) ' ' {: 7 :rt nr,,''. .`VEHICLE'OR CONTENTS'THEREIN;IN CASE OF;FIRE,THEFT ORr I>• c r LR t3,.r t RR r' s t r' 1 •,OTHER 1' ?t '£ s t x { '(,Yts,t" 1=OTHER CAUSE BEYOND_.BIG O,TIRE'S CONTROL I AUTHORIZE THE d}�t't'}'�,(a t; - a t ,{�„•f. ,,t} 1 x Y,yjs'I) + s: .4 x ° .z- 5 q }j;�:e s . `REPAIR AND SERVICE WO ISTED ON THIS INVOICE.TO BE "I - % -SUBLET r i'.I I,il "" �.:tPERFORMED FOR,THErA 'SHOWN t1 i 0 `?` tr dt i t,l s .i��.. ., c $PAR O-i , s i•, ..i. ,i i t k.ICY eaR I#s. i T r 2 't t g, FS SUBTOTAL S f - s,_ ,y , ' a '� �"SSSN,L 4 C , . I t 3 r s.F, b c t+, a s z i c - r TAX i ," 1 E}C � . ..,�, ;�� _. i s r.�`df s ,,: i I ta'I , 1 Y r. stcNATUR _' TOTAL f 3 ,'''17:•. ri; CAS AMOU T „CHECK AMOUNT CHECK NO C.C.AMOUNT C.C.TYPE C.C.APPROVAL TYPE ON ACCOUNT ;r .00 P .00 00 00'; 1. YOU IK ___ _[___.._-..�.�..____.�_._w__._-_.1___ .�__._v__._-..._--__..__...___.__.._� __.. - ___ __- '1 ;1 '1 t i1 �4 ci 1 t dm Vs Z'�tcs� �U 1 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA MARCH 11, 1997 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 maileoLto 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 � ode Amount: Within Jurisdiction of Section 913 and 915.4. Please note a11��in s Superior Court CLAIMANT: Betty Tye FEB 13 1997 ATTORNEY: Dean Shotwell, Esq. COUNTY ART NEZ�CALIF� Law Offices of DeanShotwell Date received ADDRESS: 2600 Kitty Hawk Rd. , Ste. 107 BY DELIVERY TO CLERK ON February 13, 1997 Livermore, CA 94550 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: February 13, 1997 JVIL BepuHHtyLOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors j>4 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: I l BY: xv 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 (�1 ) 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: MAR 11 1997 PHIL BATCHELOR, Clerk, hR-� j ate, , 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: MAR 13 1997 BY: PHIL BATCHELORIkX Deputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. ****************************************************************************** RE: Claim By Reserved for Clerk's filing stamp BETTY TYE ) RECEIVED Against the County of Contra Costa ) em ' 3 OTor ) CLERK BOA OF SUPERVISORS CONTRA COSTA COUNTY District) CONTRA COSTA CO. (Fill in name) ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above- named District in the sum of$ within jurisdiction of Superior Court and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) August 20, 1996, approximately 3:00 p.m. 2. Where did the damage or injury occur? (Include city and county) 2000 Block Sand Point Road,Byron , California 3. How did the damage or injury occur? (Give full details; use extra paper if required) See Attached 4. What particular act or emission on the part of county or district officers, servants, or employees caused the injury or damage? The County of Contra Costa, its servants or employees, having previous knowledge or notice of a dangerous or defective condition existing on Sand Point Road, Byron, California, and having authority to remedy such condition, failed or neglected for a reasonable time thereafter to remedy the situation or take steps reasonably necessary to protect the public. 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.) ��'P.P. AttnrhPcl 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Not Applicable 8. Names and addresses of witnesses, doctors, and hospitals. See Attached 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT See Attached. Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant Name and Address of Attorney '&0 ACT �p DEAN SHOTWELL, ESQ. (Signature of Attorney for Claimant) Law Offices of Dean Shotwell 2600 Kitty Hawk Road, Suite 107 BETTY TYE Livermore, CA 94550 (Claimant) 2046 Sand Point Road Livermore, CA 94550 (Address) Telephone No. 510-606-6107 Telephone No. 510-513-0571 ****************************************************************************** ATTACHMENT TO CLAIM OF BETTY TYE QUESTION NUMBERS: 3,6,8, and 9 #3. On August 20, 1996, approximately 3:00 p.m., Betty Tye was riding a bicycle on a public street known as Sand Point Road, in the City of Byron, State of California. As she was riding, Mrs. Tye struck a pothole in the roadway, approximately four inches in depth, and covered by standing water. Mrs. Tye was thrown from her bicycle, landing on the asphalt with tremendous force. Mrs. Tye was transported to Sutter Delta Memorial Hospital by ambulance. #6. Massive contusions to the face and torso, chronic headaches, soft tissue injuries to the neck and back, and inflammation of vertebrae in the neck. #8. Bert Tye Sutter Delta Memorial Hospital 2046 Sand Point Road 3901 Lone Tree Way Byron, CA 94514 Antioch, CA 94509 M. Jane Nishio, M.D. Walnut Creek Radiology 2200 Grant, Suite 102 Box 3796 Concord, CA 94520 Antioch, CA 94531-3796 Roger Vigil, M.D. Mathew Voksinich, M.D. 1601 Cummins Drive, #D 1601 Cummins Drive, #D Modesto, CA 95358-6403 Modesto, CA 95358-6403 #9. Date: Item: Amount: 8/20/96 AMR Ambulance $820.10 8/20/96 Dr. Vigil $128.00 8/20/96 Sutter Delta $428.97 8/20/96 Walnut Creek Radiology $24.26 8/20/96 Dr. Nishio $242.00 8/29/96 Sutter Delta $978.00 8/29/96 Dr. Vuksinich $161.00 8/29/96 Walnut Creek Radiology $121.01 9/03/96 Dr. Nishio $75.00 9/20/96 Sutter Delta $63.60 9/24/96 Sutter Delta $134.62 9/27/96 Sutter Delta $134.62 10/7/96 Sutter Delta $134.62 10/24/96 Sutter Delta $348.14 10/24/96 Sutter Delta $75.00 10/24/96 Walnut Creek Radiology $47.76 ***Additional billing not available at this time. I will forward upon receipt. 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." C. r � CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA March 11, 1997 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 maileoLto 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 CLAIMANT: Western States Petroleum Association FEB 0 6 1997 ATTORNEY: McClintock, Weston, Benshoof,Rochefort, Rubalcava & MacCuish LLP COUNTY COUNSEL. Attorneys At Law Date received MARTINEZ CALIF. ADDRESS: 444 South Flower St. , 43rd Flr. BY DELIVERY TO CLERK ON February 5, 1997 Los Angeles, CA 90071-2901 11 t BY MAIL POSTMARKED: February 3, 1997 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED:February 6, 1997 IVIL BAATTCUELOR, Clerkeputy 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: 8LiZ7 7 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 (X) 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: MAR 11 1997 PHIL BATCHELOR, Clerk, By /� "�J�jS -��— 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: MAR 13 1997 BY: PHIL BATCHELOR b�_ r* Q¢ beputy Clerk CC: County Counsel County Administrator MCCLINTOCK WESTON BENSHOOF I ROCHEFORT RECEIVED RUBALCAVA MACCUISH FEB - 51997 ATTORNEYS AT L A W CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. February 3 , 1997 County of Contra Costa 651 Pine Street Martinez, California 94553 Board of Supervisors for the County of Contra Costa 651 Pine Street Martinez, California 94553 Re : Western States Petroleum Association v. County of Contra Cost, Board of Supervisors for the County of Contra Costa Dear County of Contra Costa and Board of Supervisors for the City of Contra Costa: Please take notice that Western States Petroleum Association intends to commence action against the County of Contra Costa and Board of Supervisors for the City of Contra Costa regarding the County' s adoption of Ordinance 92-20 on December 30 , 1996 and determination that the Ordinance was categorically exempt from the California Environmental Quality Act . This notice is provided pursuant to Public Resources Code Section 21167 . 5 . Very truly yours, Av/ Joon-Soo Kim McCLINTOCK, WESTON, BENSHOOF, ROCHEFORT, RUBALCAVA & MacCUISH LLP JSK:dsy 178483 444 South Flower Street Los Angeles Telephone Facsimile Forty Third Floor California 90071 213 623 2322 213 623 0824 (PROOF OF SERVICE - 1013a, 2015 . 5 C.C. P. ) STATE OF CALIFORNIA ] ss . COUNTY OF LOS ANGELES ] I am employed in the County of Los Angeles, State of California. I am over the age of 18 and not a party to the within action; my business address is 444 South Flower Street, Forty Third Floor, Los Angeles, California 90071 . On February 3 , 1997, I served the foregoing document (s) described as NOTICE OF COMMENCEMENT OF ACTION on the interested parties in this action by placing a true copy thereof enclosed in a sealed envelope addressed as follows : JCounty of Contra Costa Board of Supervisors for the 651 Pine Street County of Contra Costa Martinez, California 94553 651 Pine Street Martinez, California 94553 X I placed such envelope with postage thereon fully prepaid in the United States mail at Los Angeles, California. x 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 Los Angeles, 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 . I sent such document (s) by Federal Express/UPS Air. I sent such document (s) by telecopy. _ I delivered such envelope by hand to the offices of the addressees . x I declare under penalty of perjury under the laws of the State of California that the above is true and correct . Ge I declare that I am employed in the office of a member of the bar of this court at whose direction the service was made . Executed on February, 1997, at Los Angeles, California. Diana S . Yi 179483 COPY 1 GREGORY R. McCLINTOCK (State Bar No. 043987) EDWARD J. CASEY (State Bar No. 119571) 2 JOON-SOO KIM (State Bar No. 167160) McCLINTOCK, WESTON, BENSHOOF, 3 ROCHEFORT, RUBALCAVA & MacCUISH LLP 444 South Flower Street, Forty Third Floor 4 Los Angeles, California 90071-2901 Telephone : (213) 623-2322 5 Attorneys for Plaintiff and Petitioner 6 WESTERN STATES PETROLEUM ASSOCIATION 7 8 SUPERIOR COURT OF THE STATE OF CALIFORNIA 9 FOR THE COUNTY OF CONTRA COSTA 10 11 WESTERN STATES PETROLEUM ) Case No . ASSOCIATION, ) 12 ) NOTICE OF COMMENCEMENT Petitioner and ) OF ACTION 13 Plaintiff, ) 14 V. ) 15 COUNTY OF CONTRA COSTA; BOARD OF RECEIVED SUPERVISORS OF CONTRA COSTA ) 16 COUNTY; and Does 1-25, ) FEB - 51997 17 Respondents and ) Defendants . ) CLERK BOARD OF SUPERVISORS 18 ) CONTRA COSTA CO. 19 20 21 As required by California Public Resources Code Section 22 21167 . 5, Western States Petroleum Association has notified the 23 County of Contra Costa, the Board of Supervisors for the County of 24 Contra Costa and the Attorney General of this action. Attached as 25 Exhibits A and B are true and correct copies of letters dated 26 February 3 , 1997, confirming notice to both the County of Contra 27 28 1 NOTICE OF COMMENCEMENT OF ACTION 178500 1 Cost, the Board of Supervisors for the County of Contra Costa and 2 the Attorney General . 3 4 DATED: February q 1997 GREGORY R. McCLINTOCK EDWARD J. CASEY 5 JOON-SOO KIM McCLINTOCK, WESTON, BENSHOOF, 6 ROCHEFORT, RUBALCAVA & MacCUISH LLP 7 8 ioor�-SoOl Kim 9 Attorneys for Plaintiff and Respondent 10 WESTERN STATES PETROLEUM ASSOCIATION 11 12 13 14 15 16 17 18 19 20 21. 22 23 24 25 26 27 28 2 NOTICE OF COMMENCEMENT OF ACTION 178500 1 (PROOF OF SERVICE - 1013a, 2015 . 5 C. C. P. ) 2 STATE OF CALIFORNIA ] ss . 3 County OF LOS ANGELES 4 I am employed in the County of Los Angeles, State of California. I am over the age of 18 and not a party to the within 5 action; my business address is 444 South Flower Street, Forty Third Floor, Los Angeles, California 90071 . 6 On February 3 , 1997, I served the foregoing document (s) 7 described as NOTICE OF COMMENCEMENT OF ACTION on the interested parties in this action by placing a true copy thereof enclosed in a 8 sealed envelope addressed as follows : 9 County of Contra Costa Board of Supervisors for the 10 651 Pine Street County of Contra Costa Martinez, California 94553 651 Pine Street 11 Martinez, California 94553 12 x I placed such envelope with postage thereon fully prepaid in the United States mail at Los Angeles, California. 13 x I am "readily familiar" with the firm' s practice of collection 14 and processing correspondence for mailing. Under that practice, it would be deposited with U. S. postal service on that same day with 15 postage thereon fully prepaid at Los Angeles, California in the ordinary course of business . I am aware that on .motion of the party 16 served, service is presumed invalid if postal cancellation date or postage meter date is more than one day after date of deposit for 17 mailing in affidavit . 18 I sent such document (s) by Federal Express/UPS Air. 19 I sent such document (s) by telecopy. 20 I delivered such envelope by hand to the offices of the addressees . 21 x I declare under penalty of perjury under the laws of the State 22 of California that the above is true and correct . 23 rZ, I declare that I am employed in the office of a member of the bar of this court at whose direction the service was made. 24 Executed on February 97 at Los Angeles, California. 25 26 27 Diana S . Yi 28 3 NOTICE OF COMMENCEMENT OF ACTION 178500 r s EXHIBIT A MCCLINTOCKI WESTON BENSHOOF I ROCHEFORT RUBALCAVA I MACCUISH ATTORNEYS AT L A W February 3 , 1997 County of Contra Costa 651 Pine Street Martinez, California 94553 Board of Supervisors for the County of Contra Costa 651 Pine Street Martinez, California 94553 Re : Western States Petroleum Association v. County of Contra Cost, Board of Supervisors for the County of Contra Costa Dear County of Contra Costa and Board of Supervisors for the City of Contra Costa: Please take notice that Western States Petroleum Association intends to commence action against the County of Contra Costa and Board of Supervisors for the City of Contra Costa regarding the County' s adoption of Ordinance 92-20 on December 30, 1996 and determination that the Ordinance was categorically exempt from the California Environmental Quality Act . This notice is provided pursuant to Public Resources Code Section 21167 . 5 . Very truly yours, Joon-Soo Kim McCLINTOCK, WESTON, BENSHOOF, ROCHEFORT, RUBALCAVA & MacCUISH LLP JSK:dsy 178483 444 South Flower Street Los Angeles Telephone Facsimile Forty Third Floor California 90071 213 623 2322 213 623 0824 7 (PROOF OF SERVICE - 1013a, 2015 . 5 C.C.P. ) STATE OF CALIFORNIA ] ] ss . COUNTY OF LOS ANGELES ] I am employed in the County of Los Angeles, State of California. I am over the age of 18 and not a party to the within action; my business address is 444 South Flower Street, Forty Third Floor, Los Angeles, California 90071 . On February 3, 1997, I served the foregoing document (s) described as NOTICE OF COMMENCEMENT OF ACTION on the interested parties in this action by placing a true copy thereof enclosed in a sealed envelope addressed as follows : County of Contra Costa Board of Supervisors for the 651 Pine Street County of Contra Costa Martinez, California 94553 651 Pine Street Martinez, California 94553 X I placed such envelope with postage thereon fully prepaid in the United States mail at Los Angeles, California. x 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 Los Angeles, 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 . I sent such document (s) by Federal Express/UPS Air. I sent such document (s) by telecopy. _ I delivered such envelope by hand to the offices of the addressees . X I declare under penalty of perjury under the laws of the State. of California that the above is true and correct . GZ— I declare that I am employed in the office of a member of the bar of this court at whose direction the service was made . Executed on February, 1997, at Los Angeles, California. 't Diana S. Yi 178483 EXHIBIT B MCCLINTOCK WESTON BENSHOOF I ROCHEFORT RUBALCAVA I MACCUISH ATTORNEYS AT LAW February 3 , 1997 The Honorable Daniel E. Lungren Attorney General Office of the Attorney General 1515 11K11 Street Suite No. 511 Sacramento, California 95814 Re : Re : Western States Petroleum Association v. County of Contra Cost, Board of Supervisors for the County of Contra Costa Dear Mr. Attorney General : Please take notice that Western States Petroleum Association intends to commence action against the County of Contra Costa and Board of Supervisors for the City of Contra Costa regarding the County' s adoption. of Ordinance 92-20 on December 30, 1996 and determination that the Ordinance was categorically exempt from the California Environmental Quality Act . This notice is provided pursuant to Public Resources Code Section 21167 . 5 . Pursuant to Section 21167 . 7 of the California Public Resources Code, Western States Petroleum Association will furnish a copy of its petition for writ of mandate and complaint challenging the County' s actions with respect to the Ordinance. If you should have any questions or comments regarding this action, please do not hesitate to call . Very truly yours, Joon-Soo Kim McCLINTOCK, WESTON, BENSHOOF, ROCHEFORT, RUBALCAVA & MacCUISH LLP JSK:dsy Enclosure 178491 444 South Flower Street Los Angeles Telephone Facsimile Forty Third Floor California 90071 213 623 2322 213 623 0824 (PROOF OF SERVICE 1013a, 2015.5 C.C.P. ) STATE OF CALIFORNIA Iss . COUNTY OF LOS ANGELES I I am employed in the County of Los Angeles, State of California. I am over the age of 18 and not a party to the within action; my business address is 444 South Flower Street, Forty Third Floor, Los Angeles, California 90071. On February 3, 19971 1 served the foregoing documents) described as NOTICE OF COMMENCEMENT OF ACTION on the interested parties in this action by placing a true copy thereof enclosed in a sealed envelope addressed as follows : The Honorable Daniel E. Lungren Attorney General Office of the Attorney General 1515 "KII Street, Suite No. 511 Sacramento, California 95814 x I placed such envelope with postage thereon fully prepaid in the United States mail at Los Angeles, California. x 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 Los Angeles, 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. — I sent such document (s) by Federal Express/UPS Air. — I sent such document (s) by telecopy. — I delivered such envelope by hand to the offices of the addressees . x I declare under penalty of perjury under the laws of the State of California that the above is true and correct . I declare that I am employed in the office of a member of the bar of this court at whose direction the service was made. Executed on February , 1997, at Los Angeles, California. Diana S. Yi 178491 1 (PROOF OF SERVICE - 1013a, 2015 . 5 C.C. P. ) 2 STATE OF CALIFORNIA ] ] ss . 3 County OF LOS ANGELES ] 4 I am employed in the County of Los Angeles, State of California. I am over the age of 18 and not a party to the within 5 action; my business address is 444 South Flower Street, Forty Third Floor, Los Angeles, California 90071. 6 On February 3 , 1997, I served the . foregoing document (s) 7 described as NOTICE OF COMMENCEMENT OF ACTION on the interested parties in this action by placing a true copy thereof enclosed in a 8 sealed envelope addressed as follows : 9 SEE ATTACHED SERVICE LIST 10 x I placed such envelope with postage thereon fully prepaid in 11 the United States mail at Los Angeles, California. 12 x I am "readily familiar" with the firm' s practice of collection and processing correspondence for mailing. Under that practice, it- 13 would be deposited with U.S. postal service on that same day with postage thereon fully prepaid at Los Angeles, California in the 14 ordinary course of business . I am aware that on motion of the party served, service is presumed invalid if postal cancellation date or 15 postage meter date is more than one day after date of deposit for mailing in affidavit . 16 I sent such document (s) by Federal Express/UPS Air. 17 I sent such document (s) by telecopy. 18 I delivered such envelope by hand to the offices of the 19 addressees . 20 x I declare under penalty of perjury under the laws of the State of California that the above is true and correct . 21 I declare that I am employed in the office of a member of the 22 bar of this court at whose direction the service was made . 23 Executed on February__ ,!1997 at Los Angeles, California. i 24 25 Diana S . Yi / f ' 26 27 28 3 NOTICE OF COMMENCEMENT OF ACTION 178500 1 WESTERN STATES PETROLEUM ASSOCIATIONV. COUNTY OF CONTRA COSTA; 2 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY 3 SERVICE LIST 4 r 5 /County of Contra Costa 651 Pine Street 6 Martinez, California 94553 7 Board of Supervisors for the 8 County of Contra Costa 651 Pine Street 9 Martinez, California 94553 10 The Honorable Daniel E. Lungren 11 Attorney General Office of the Attorney General 12 1515 "K" Street Suite No. 511 13 Sacramento, California 95814 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 4 NOTICE OF COMMENCEMENT OF ACTION 178500 c� a+ ON � cd °v N �v 0vAv o � w v � d o r v w �, rNi s } i 0 0 m d N a Q. ova a N N� o v 10, d O O _ v � v 0 �A 3 a o on Ntd Uig MCCLINTOCK I WESTON BENSHOOF I ROCHEFORT RUBALCAVA I MACCUISH ATTORNEYS AT LAW E � RECEIVED February 3 , 1997 FEB - 5 1997 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. County of Contra Costa 651 Pine Street Martinez, California 94553 Board of Supervisors for the - County of Contra Costa 651 Pine Street Martinez, California 94553 Re : Western States Petroleum Association v. County of Contra Cost, Board of Supervisors for the County of Contra Costa Dear County of Contra Costa and Board of Supervisors for the City of Contra Costa: Please take notice that Western States Petroleum Association intends to commence action against the County of Contra Costa and Board of Supervisors for the City of Contra Costa regarding the County' s adoption of Ordinance 92-20 on December 3,0, 1996 and determination that the Ordinance was categorically exempt from the California Environmental Quality Act . This notice is provided pursuant to Public Resources Code Section 21167 . 5 . Very truly yours, Joon-Soo Kim McCLINTOCK, WESTON, BENSHOOF, ROCHEFORT, RUBALCAVA & MacCUISH LLP JSK:dsy 178483 444 South Flower Street Los Angeles Telephone Facsimile Forty Third Floor California 90071 213 623 2322 213 623 0824 (PROOF OF SERVICE - 1013a, 2015 . 5 C. C. P. ) STATE OF CALIFORNIA ] ] ss . COUNTY OF LOS ANGELES ] I am employed in the County of Los Angeles, State of California. I am over the age of 18 and not a party to the within action; my business address is 444 South Flower Street, Forty Third Floor, Los Angeles, California 90071 . On February 3 , 1997, I served the foregoing document (s) described as NOTICE OF COMMENCEMENT OF ACTION on the interested parties in this action by placing a true copy thereof enclosed in a sealed envelope addressed as follows : County of Contra Costa Board of Supervisors for the 651 Pine Street County of Contra Costa Martinez, California 94553 651 Pine Street Martinez, California 94553 X I placed such envelope with postage thereon fully prepaid in the United States mail at Los Angeles, California. X 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 Los Angeles, 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 . I sent such document (s) by Federal Express/UPS Air. I sent such document (s) by telecopy. _ I delivered such envelope by hand to the offices of the addressees . X I declare under penalty of perjury under the laws of the State of California that the above is true and correct . _ I declare that I am employed in the office of a member of the bar of this court at whose direction the service was made . Executed on February 3 , 1997, at Los Angeles, California. Diana S . Yi 178483 �1 o ON .,A rA 't o t 4 . l r V _ COPY 1 GREGORY R. McCLINTOCK (State Bar No. 043987) EDWARD J. CASEY (State Bar No. 119571) 2 JOON-SOO KIM (State Bar No. 167160) McCLINTOCK, WESTON, BENSHOOF, 3 ROCHEFORT, RUBALCAVA & MacCUISH LLP 444 South Flower Street, Forty Third Floor 4 Los Angeles, California 90071-2901 Telephone : (213) 623-2322 5 Attorneys for Plaintiff and Petitioner 6 WESTERN STATES PETROLEUM ASSOCIATION 7 8 SUPERIOR COURT OF THE STATE OF CALIFORNIA 9 FOR THE COUNTY OF CONTRA COSTA 10 11 WESTERN STATES PETROLEUM ) Case No. ASSOCIATION, ) 12 . ) NOTICE OF COMMENCEMENT Petitioner and ) OF ACTION 13 Plaintiff, ) 14 V. ) e� RECEIVED 15 COUNTY OF CONTRA COSTA; BOARD OF ) SUPERVISORS OF CONTRA COSTA ) 16 COUNTY; and Does 1-25, ) FEB - 51997 17 Respondents and ) CLERK BOARD OF SUPERVISORS Defendants . ) CONTRA COSTA CO. 18 ) 19 20 21 As required by California Public Resources Code Section 22 21167 . 5, Western States Petroleum Association has notified the 23 County of Contra Costa, the Board of Supervisors for' the County of 24 Contra Costa and the Attorney General of this action. Attached as 25 Exhibits A and B are true and correct copies of letters dated 26 February 3 , 1997, confirming notice to both the County of Contra 27 28 1 NOTICE OF COMMENCEMENT OF ACTION 178500 1 Cost, the Board of Supervisors for the County of Contra Costa and 2 the Attorney General . 3 4 DATED: February q 1997 GREGORY R. McCLINTOCK EDWARD J. CASEY 5 JOON-SOO KIM McCLINTOCK, WESTON, BENSHOOF, 6 ROCHEFORT, RUBALCAVA & MacCUISH LLP 7 8 Joor�-Soov Kim 9 Attorneys for Plaintiff and Respondent 10 WESTERN STATES PETROLEUM ASSOCIATION 11 12 13 14 15 16 17 18 19 20 21. 22 23 24 25 26. 27 28 2 NOTICE OF COMMENCEMENT OF ACTION 178500 1 (PROOF OF SERVICE - 1013a, 2015 . 5 C. C. P. ) 2 STATE OF CALIFORNIA ] ] ss . 3 County OF LOS ANGELES ] 4 I am employed in the County of Los Angeles, State of California. I am over the age of 18 and not a party to the within 5 action; my business address is 444 South Flower Street, Forty Third Floor, Los Angeles, California 90071 . 6 On February 3 , 1997, I served the foregoing document (s) 7 described as NOTICE OF COMMENCEMENT OF ACTION on the interested parties in this action by placing a true copy thereof enclosed in a 8 sealed envelope addressed as follows : 9 County of Contra Costa Board of Supervisors for the 10 651 Pine Street County of Contra Costa Martinez, California 94553 651 Pine Street 11 Martinez , California 94553 12 x I placed such envelope with postage thereon fully prepaid in the United States mail at Los Angeles, California. 13 x I am. "readily familiar" with the firm' s practice of collection 14 and processing correspondence for mailing. Under that practice, it would be deposited with U.S . postal service on that same day with 15 postage thereon fully prepaid at Los Angeles, California in the ordinary course of business. I am aware that on motion of the party 16 served, service is presumed invalid if postal cancellation date or postage meter date is more than one day after date of deposit for 17 mailing in affidavit . 18 I sent such document (s) by Federal Express/UPS Air. 19 I sent such document (s) by telecopy. 20 I delivered such envelope by hand to the offices of the addressees . 21 x I declare under penalty of perjury under the laws of the State 22 of California that the above is true and correct . 23 IZ- , I declare that I am employed in the office of a member of the bar of this court at whose direction the service was made . 24 Executed on February 97 at Los Angeles, California. 25 26 27 Diana S. Yi 28 3 NOTICE OF COMMENCEMENT OF ACTION 178500 EXHIBIT A MCCLINTOCKI WESTON BENSHOOF I ROCHEFORT RUBALCAVA I MACCUISH ATTORNEYS AT LAW February 3 , 1997 County of Contra Costa 651 Pine Street Martinez, California 94553 Board of Supervisors for the County of Contra Costa 651 Pine Street Martinez, California 94553 Re : Western States Petroleum Association v. County of Contra Cost, Board of Supervisors for the County of Contra Costa Dear County of Contra Costa and Board of Supervisors for the City of Contra Costa: Please take notice that Western States Petroleum Association intends to commence action against the County of Contra . Costa and Board of Supervisors for the City of Contra Costa regarding the County' s adoption of Ordinance 92-20 on December 30, 1996 and determination that the Ordinance was categorically exempt from the California Environmental Quality Act. This notice is provided pursuant. to Public Resources Code Section 21167 . 5 . Very truly yours, Joon-Soo Kim McCLINTOCK, WESTON, BENSHOOF, ROCHEFORT, RUBALCAVA & MacCUISH LLP JSK:dsy 1715483 444 South Flower Street Los Angeles Telephone Facsimile Forty Third Floor California 90071 213 623 2322 213 623 0824 -,A (PROOF OF SERVICE - 1013a, 2015 .5 C.C. P. ) STATE OF CALIFORNIA ] ] ss . COUNTY OF LOS ANGELES ] I am employed in the County of Los Angeles, State of California. I am over the age of 18 and not a party to the within action; my business address is 444 South Flower Street, Forty Third Floor, Los Angeles, California 90071 . On February 3, 1997, I served the foregoing document (s) described as NOTICE OF COMMENCEMENT OF ACTION on the interested parties in this action by placing a true copy thereof enclosed in a sealed envelope addressed as follows : County of Contra Costa Board of Supervisors for the 651 Pine Street County of Contra Costa Martinez, California 94553 651 Pine Street Martinez, California 94553 x I placed such envelope with postage thereon fully prepaid in the United States mail at Los Angeles, California. x 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 Los Angeles, 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 . I sent such document (s) by Federal Express/UPS Air. I sent such document (s) by telecopy. _ I delivered such envelope by hand to the offices of the addressees. x I declare under penalty of perjury under the laws of the State of California that the above is true and correct . G� I declare that I am employed in the office of a member of the bar of this court at whose direction the service was made. Executed on February, 1997, at Los Angeles, California. Diana S. Yi 178483 EXHIBIT A 4 n MCCLINTOCK WESTON BENSHOOF I ROCHEFORT RUBALCAVA I MACCUISH ATTORNEYS AT LAW February 3 , 1997 The Honorable Daniel E. Lungren Attorney General Office of the Attorney General 1515 "K" Street Suite No. 511 Sacramento, California 95814 Re : Re : Western States Petroleum Association v. County of Contra Cost, Board of Supervisors for the County of Contra Costa Dear Mr. Attorney General : Please take notice that Western States Petroleum Association intends to commence action against the County of Contra Costa and Board of Supervisors for the City of Contra Costa regarding the County' s adoption of Ordinance 92-20 on December 30, 1996 and determination that the Ordinance was categorically exempt from the California Environmental Quality Act . This notice is provided pursuant to Public Resources Code Section 21167 . 5 . Pursuant to Section . 21167 . 7 of the California Public Resources Code, Western States Petroleum Association will furnish a copy of its petition for writ of mandate and complaint challenging the County' s actions with respect to the Ordinance . If you should have any questions or comments regarding this action, please do not hesitate to call . Very truly yours, Joon-Soo Kim McCLINTOCK, WESTON, BENSHOOF, ROCHEFORT, RUBALCAVA & MacCUISH LLP JSK:dsy Enclosure 178491 444 South Flower Street Los Angeles Telephone Facsimile Forty Third Floor California 90071 213 623 2322 213 623 0824 (PROOF OF SERVICE 1013a, 2015 . 5 C.C.P. ) STATE OF CALIFORNIA Iss . COUNTY OF LOS ANGELES I I am employed in the County of Los Angeles, State of California. I am over the age of 18 and not a party to the within action; my business address is 444 South Flower Street, Forty Third Floor, Los Angeles, California 90071 . On February 3, 19971 1 served the foregoing document (s) described as NOTICE OF COMMENCEMENT OF ACTION on the interested parties in this action by placing a true copy thereof enclosed in a sealed envelope addressed as follows : The Honorable Daniel E. Lungren Attorney General Office of the Attorney General 1515 "KII Street, Suite No. 511 Sacramento, California 95814 x I placed such envelope with postage thereon fully prepaid in the United States mail at Los Angeles, California. x 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 Los Angeles, 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. — I sent such document (s) by Federal Express/UPS Air. — I sent such document (s) by telecopy. — I delivered such envelope by hand to the offices of the "addressees. x I declare under penalty of perjury under the laws of the State of California that the above is true and correct . I declare that I am employed in the office of a member of the bar of this court at whose direction the service was made. Executed on February 1997, at Los Angeles, California. Diana S. Yi 178491 1 (PROOF OF SERVICE - 1013a, 2015 . 5 C.C. P. ). 2 STATE OF CALIFORNIA ] ] ss . 3 County OF LOS ANGELES ] 4 I am employed in the County of Los Angeles, State of California. I am over the age of 18 and not a party to the within 5 action; my business address is 444 South Flower Street, Forty Third Floor, Los Angeles, California 90071 . 6 On February 3 , 1997, I served the foregoing document (s) 7 described as NOTICE OF COMMENCEMENT OF ACTION on the interested parties in this action by placing a true copy thereof enclosed in a 8 sealed envelope addressed as follows : 9 SEE ATTACHED SERVICE LIST 10 x I placed such envelope with postage thereon fully prepaid in 11 the United States mail at Los Angeles, California. 12 x I am "readily familiar" with the firm' s practice of collection and processing correspondence for mailing. Under that practice, it 13 would be deposited with U.S. postal service on that same day with postage thereon fully prepaid at Los Angeles, California in the 14 ordinary course of business . I am aware that on motion of the party served, service is presumed invalid if postal cancellation date or 15 postage meter date is more than one day after date of deposit for mailing in affidavit . 16 I sent such document (s) by Federal Express/UPS Air. 17 I sent such document (s) by telecopy. 18 I delivered such envelope by hand to the offices of the 19 addressees . 20 x I declare under penalty of perjury under the laws of the State of California that the above is true and correct . 21 D` _ I declare that I am employed in the office of a member of the 22 bar of this court at whose direction the service was made . 23 Executed on February. , `;1997 at Los Angeles, California. i6I 24 25 Diana S . Yi / 26 27 28 3 NOTICE OF COMMENCEMENT OF ACTION 178500 1 WESTERN STATES PETROLEUM ASSOCIATION v. COUNTY OF CONTRA COSTA; 2 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY 3 SERVICE LIST 4 5 County of Contra Costa 651 Pine Street 6 Martinez, California 94553 7 �noard of Supervisors for the 8 County of Contra Costa 651 Pine Street 9 Martinez, California 94553 10 The Honorable Daniel E. Lungren 11 Attorney General Office of the Attorney General 12 1515 "K" Street Suite No. 511 13 Sacramento, California 95814 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 4 NOTICE OF COMMENCEMENT OF ACTION 178500 1 ill i i `2f O O P a - a U OLn c m w Ln N U ¢ 4-I d 0 xO o 0 U — O 3 O U — co �4 F z ¢ y � 4 ° a x a v � � � " w �:) r� rz oz 4 LW 0 N N 3: a O N >1 rl LL zs4-) a -H L �4 4-) 00Ln ( a J CLAIM 01 . 0 BOARD .OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA March 11, 1997 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 maileoLto 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 Gnmen ��� Amount: $250,000.00 Section 913 and 915.4. Please note all . F CLAIMANT: Harry Daniel Willett FEB 1 1 1997 ATTORNEY: COUNTY COUNSEL Date received MARTINEZ CALIF. ADDRESS: 901 Court St. BY DELIVERY TO CLERK ON February 7, 1997 Martinez, CA 94553 BY MAIL POSTMARKED: February 6, 1997 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: February 11, 1997 saIL Bep�HtyLOR, C1erk--�.., � 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: // /ff 7��- d� Dated: ������� BY: 4Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) (x) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (A 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: MAR 111997 PHIL BATCHELOR, Clerk, B �� �QoCe-- , 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. ( q Dated: MAR 13 1997 BY: PHIL BATCHELORDy�/�o�' Deputy Clerk CC: County Counsel County Administrator TO: Harry Daniel Willett 901 Court Street Martinez, California 94553 NOTICE TO CLAIMANT (Of Late-Filed Claim) (Government Code Section 911 .3) The claim you presented to the Board of Supervisors of Contra Costa County, California, as governing body of the County of Contra Costa on February 7, 1997 has been reviewed by County Counsel and is being returned to you herewith because : XX Your claim for an injury to person or personal property which arose on or after January 1, 1988 was not presented within six months of the event or occurrence as required by law. (See Government Code sections 901 and 911 .2) Because the claim was not presented within the time allowed by law, no action will be taken on the claim for any injuries peior to August 7, 1996 . Your only recourse at this time for any injuries prior to August 7, 1996 is to apply without delay for leave to present a late claim. (See Government Code sections 911 .4 to 912 .2 and 946 . 6) Under some circumstances leave to present a late claim will be granted. (See Government Code section 911 . 6) You may seek the advice of an attorney of your choice in connection with this matter. If you desire to consult an attorney, you should do so immediately. PHIL BATCHELOR, Clerk of the Board of Supervisors and County Administrator By:�.� / 2 Deputy Clerk Dated: Enclosure NOTICE OF LATE CLAIM Page 1 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 copy of the above Notice to Claimant (of Late Submitted Claim) , addressed to the claimant as shown above. Dat& By Phil Batchelor b � D'e'puty Clerk NOTICE OF LATE CLAIM Page 2 - claim 'to:'Lo: HOARD OF SU MMES OF XNMA MST'A CO 'Ty I?1VTnMONS M M ADWIT 1. Claims relating to causes of action for death or for injury to person or to per- &onal property or growing crops and which accrue on or before December 31, 1987, oust be presented not later than the 100th day after the aeerval 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.) S. Maim must be filed with the Clerk of the board of 3upervis= at its office in ,Roam 106, C unty Administraticn building, 651 Pine Street, Martinez, Ch 94553• C. If Chin is against a district governedbythe Board of supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By ) Reserved for Clerk's 11e*1 .. nst the C6,Lm-tF'ofContra- Costa ) or. ) CLERKCONTRA.OARD O OSTA CO 150RS District) F in name ) The undersigned claimant Hereby makes claiminst the q%mty of Contra Costa or the above-named District in the sum of - 1 C7 d and in support of this claim represents as follows: 1. When did the damage or injury occur? {G ve exact date and hour) R. [Mere did the damQirar injury occur? (Include city. and +a=ty) c C4 G G 3. How, did the damage oreinjury occur? (Give de ls= u, paper red) ;0 .'*\e . 4-v -f 4. What particular act or omission on the part of county or di ict officers, or loyess Caused the i ury or damage? ,� ,svvwts � /'nze _ (over) 5. Wiat are the names of county dais ict officer servants or loyees causing the damage or injury? J. q 6. What damage er injuries do you claim resulted? (Give Sall extent f�injuries yq,,,, es claimed. Atte two nest tes for auto e. rn ; �. 7. Hou Was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 8. names and addmspepof W'i �es# doeto a� ho �►�►� q 9• List the expenditures you made on account of this accident or injury: D_ I_ A_ Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant MID NMMS T0: (Attorney) or by .some person on his be-half." 'ame and Address of Attorney qLA, u j" ,..,(,Claimant's iorture � � � (Address) Telephone No. Telepnane No. i ! i ! NOTICE Sectim 72 of the Penal Code provides: *Every person Who, with intent to defraud, presents for allowance or for payment to any state board or offices, or to any county, city or district board or officer, authorized to allow or pay the acme 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 ;*ear, 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 ($1090009 or by Doth such i=prisonment and fine. � Q rri ZD # Dv o CO) 111 �C n m 11"1 Oc ka —04 ,[c (Aj 73 fn CD #C� 0 Qto�113, -!1y����w��