HomeMy WebLinkAboutMINUTES - 04151997 - C17 CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA April 15, 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 G�1S�
Mount: $10,000.00 Section 913 and 915.4. Please note all s'
CLAIMANT: Mary Armstead MAR 7 0 1997
ATTORNEY: COUNTY COUNSEL
Date received MARTINEZ CALIF.
ADDRESS: 2301 Willow Pass Rd. BY DELIVERY TO CLERK ON March 18, 1997
Bay Point, CA 94565
BY MAIL POSTMARKED: Hand Delivered via: Risk MgTnt.
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: March 20 , 1997 ef11L BATTCVELDR, 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: ,�� BY: Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel (1) County Admin' trator (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: APR 15 1997 PHIL BATCHELOR, Clerk, ��
,t–a-car--' , 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 show above. �—
Dated: APR 17 1997 BY: PHIL BATCHELOR Deputy Clerk
CC: County Counsel County Administrator
Ron Harvey
Clan to: BO OF MPERVISORS OF CONTRA COSM COUNTY BAR
Nq,--y ,ono Sf insrRncr m 1'o aAmw 1 -88 1997
A. Claiss relating to causes of action for death or for injury to Person or to Per-
sonal.
ersonai property or growing crops and cdnich accrue on or before December 31, 19871
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 Perseu
• or to permnal property or grawlM Fops and %&Ich accrue ca or after Jatntatyr 1,
1988, must be presented not later than six months after the aorraual 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 taut be filed xith the Clett of the Board of SwWV1 Era 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 ml=t be
filed against each public entity.
E. Fraud. See penalty for fraudulent claims, Penal.Code Ser. 72 at the end of this
! E• E i E E E E E E E ! E ! E E E f E E ! � E E 1E E E E E E E E E f E E E E E E E E E
RE: Claim By ) Reserved for Clerk's filing stamp
RECEIVED
MAR 1 81997
Against the CoaMy of Contra Costa :4) yh
or )
CLERK BOARD Of SUPERVISORS
District) CONTRA COSTA CO.
(Fillin wame
The undersigned claimant hereby makes claim against the County of Contra Costa or
the above-named District in the sum of $ 0 00 0 and in support of
this claim represents as foUaws:
1. 'fxs: did heda—,-e or injur;+ 000="? '(Give exact date and hour)
2. Where did tfm damage or injury occur? (Mnalude city and county)
3. How did the damage or injury occur? (Give full details; use extra paper If
required)
PnKILe Ja ef' 5 s }S etc .e�;n C, � ('Ain
4. What particular act or omission on the part of county or d str' t offi rs,
servants or employees caused the injury or damage? CSR.p Vel k i J�c�r t Q
CXr \ v)�I C A
��/� I Cps rrI 0���-1 1��6'✓�-� �� ��V��Z �h�ti� r�-.� rC 1�h\�r_ � J
5. wnat are 'lye nares of country or district officers, servants or employees causing
five d3:3oe or injC7)•? � �1 \ �PWv\ M,t� • WY\d �.P . 1.r.r ¢i� � n�avv LI�U'�W M .�.
5. {What damage or injuries do you claim resulted? (Give Hill extent of injuries or
damages . Attach two estimates fo auto damage. W RS
rwJr�hu . Unnee eSRtL • A nv l WUe moi• JY1 r-� o � �1
,�(,,�, `.YGOy,
7. HbiY wa§ am�au:t�c7aimed above computed? ( .Include the estimated amaunt of any
prospecWye injury or damage.) \1 AL N , YR
"-�
Sct wad \Sw h� �As�r 1 a = h \So Pg�VN
�e�� A
�Iy1�� ' 1tiyy�v\,s�\ \ h
!RAme-s acyl addresses of v t,,,[neess--
IJtc1 � �fJ a�� i �,v,��o�•� �S �t j to �9 9ct�rc
hecr4nn
yN,1\ aa-1 C 11ow�4s y c,n�Q qhs
a 9 Z'S �s
9. List the expenditures you made on aocouat of this accident or injury:
DATE ITEM �, Ali A1tWT
300
E i if IF ! if M IE f !E aF ♦F * * IE fF R � -* 1F.f f If If E E ! i * 1F ! f f f � lF �IF ! rt
Gov. Code Sec. 910:2 provides:
"The claim must be signed by the claimant
SEM NOITCWS T0: (Atto_rne ) or by some personon his behalf."
Name and Address of Attorney
'Acla isSignature
�,?
Address- 9q s(.S
Telephone No. Telephone No
s a * e aE !FT I W
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,�eh L risonre and fine-
\, 3
J, z vk-, L
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA April 15, 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 G���
Mount: $10,000.00 Section 913 and 915.4. Please note all
CLAIMANT: Mary Armstead MAR 7 0 1997
ATTORNEY: COUNTY COUNSEL
MARTINEZ CALIF.
Date received
ADDRESS: 2301 Willow Pass Rd. BY DELIVERY TO CLERK ON March 18, 1997
Bay Point, CA 94565
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.
March 2p , 1997 [pHHIL BATCVIELOR, Clerk
DATED: BY: OeDu Y.
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: 2 BY: Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel (1) County Admin' trator (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 refected 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: APR 15 1997 PHIL BATCHELOR, Clerk, iy. Deputy Clerk
YARNING (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 anvil 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
1 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: APR 17 1997 BY: PHIL BATCHELOR b�= Deputy Clerk
CC: County Counsel County Administrator
CLAIM
BOARD OF SUPERVISORS OF CONTRA C111A COUNTY, CALIFORNIA
April 15, 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: $10,000 + Section 913 and 915.4. Please note ailPawa y
CLAIMANT: William Belenis JJjj}
MAR 2 9 1997
ATTORNEY: Stanley J Bell COUNTY COUNSEL
Ttvo Transamerica Center Date received MARTINEZ cALIF.
ADDRESS: 505 Sansone St. , 18th Floor BY DELIVERY TO CLERK ON March 26 1997
San Francisco, CA 94111
BY MAIL POSTMARKED: Cert. Mail March 25, 1997
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED;— March 26, 1997 Id?L epu IyLOR, Clerk
I1. FROM: County Counsel TO: Clerk of the Board of Supervisors (J J
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 tate claim (Section 911.3).
( ) Other:
Dated: BY: 4LZizi�,�ffl 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.AD 1,
Dated: APR 15 1997 PHIL BATCHELOR, Clerk, By /5 /��. 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 ail 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.
APR 17Dated: BY: PHIL BATCHELOR by_� Deputy Clerk
CC: County Counsel County Administrator
1 CLAIM FOR DAMAGES FOR PERSONAL INJURIES
2 TO: STATE BOARD OF CONTROL
STATE OF CALIFORNIA
3 630 K Street, 4"' Floor
Sacramento, California 95814
4
CITY COUNCIL
5 CITY OF CONCORD RECEi'T-,
1950 Parkside Drive ----_---
6 Concord, California 94519
7 CITY COUNCIL MAR 2 6 199-1
CITY OF WALNUT CREEK CLERK BOARD OF S! '.
8 1666 North Main CONTRA
Walnut Creek, California 94596 — --
9
BOARD OF SUPERVISORS
10 COUNTY OF CONTRA COSTA
a 651 Pine
11 Martinez, California 94553
w a�ag 12 CONTRA COSTA COUNTY TRANSPORTATION AUTHORITY
s 1340 Treat Boulevard, Suite 150
13 Walnut Creek, California 94596
o " 14 PLEASE TAKE NOTICE that the undersigned hereby serves and makes demand
a 15 upon you for the cause and amounts set forth in the following claim:
�e� F
c 16 Claimant's Name and Address:
a 17 WILLIAM BELENIS
409 Santa Fe Avenue
18 Point Richmond, California 94801
19 Claimant's Mailing Address to which Notices are to be Sent:
20 Stanley J. Bell, Esquire
LAW OFFICES OF STANLEY J. BELL
21 Two Transamerica Center
505 Sansome Street, 18th Floor
22 San Francisco, California 94111
23 Amount of Claim:
24 Special damages and expenses proximately caused by the occurrence
25 described below and general damages are in excess of the jurisdictional minimum of
26 the Superior Court.
27 Date and Place of Occurrence giving rise to the Claim asserted:
28 On or about the 14th of November, 1996, at the construction of a new freeway
1 onramp to Highway 24 at Concord Avenue, City of Concord, County of Contra Costa,
2 State of California.
3 Description of Occurrence:
4 That at said time and place, as aforesaid, said public entities, and each of them,
5 negligently and carelessly owned, possessed, operated, constructed, inspected,
6 maintained, contracted, subcontracted, supervised, controlled and had a right to
7 control, engineered, designed, performed and planned construction work and supplied
8 workers and materials for the job site and premises referred to herein and further in that
9 they permitted large, open trenches and holes to exist and remain in the area where
a 10 claimant and others were working without adequate safety rails, guards, barricades or
a
m 11 other safety or warning devices, thereby creating a risk of injury to workers working on
8
ar;F 8E 12 said job site; and further in that they negligently and carelessly failed to coordinate the
w
e 13 work being conducted on said job site in a safe and proper manner; and further in that
U
w I'A 1•' 14 the defendants and each of them caused and allowed the work area in and around
a
uk 1 15 where claimant and others were working, to be in a dangerous condition in that the
0<��F 16 work areas were strewn with construction material and debris, thereby precluding safe
a17 access to and from work areas and thereby creating a risk of injury to workers working
18 on said job site; and further there was inadequate lighting or illumination to perform the
19 aforesaid work; that in all respects, the aforementioned conditions created a trap to
20 claimant; and further that said public entities, and each of them, had.actual or
21 constructive knowledge of the unsafe conditions, as aforesaid, and failed to remedy
22 said conditions, having a reasonable opportunity to do so; that said public entities, and
23 each of them, further failed to have pre-job safety conferences and further failed to
24 request any precautions in the written contract between the parties; that in all respects
25 the aforesaid conditions created a dangerous and defective condition of public
26 property; that as a direct and legal-result of the negligence and carelessness of said
27 public entities, and each of them, as aforesaid, and as a further direct and legal result
28
2
1 of the dangerous and defective condition of public property, as aforesaid, while
2 claimant was walking preparing to move a crane, he was caused to fall into an open
3 and unguarded trench, thereby causing him to sustain severe personal injuries.
4 DATED: March 25 1997
5 LAW OFFICES.OF STANLEY J. BELL
6
7 By: /
TANIZEY J. BELL
8 Atto eys for Claimant
9
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1 RE: Claim of WILLIAM BELENIS
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
LAW OFFICES OF STANLEY J. BELL. My business address is 505 Sansome St., 18th
5 Floor, San Francisco, California 94111. 1 served a true copy of the CLAIM FOR
6 DAMAGES FOR PERSONAL INJURIES by mail, by placing the same in an envelope,
7 sealing, fully prepaying postage thereon and depositing said envelope in the U.S. Mail
at San Francisco, California on March 25 , 1997.
8
9 STATE BOARD OF CONTROL
STATE OF CALIFORNIA
10 630 K Street, 4' Floor
w Sacramento, California 95814
ca 11
�a CITY COUNSEL
12 CITY OF CONCORD
1950 Parkside Drive
13 Concord, California 94519
14 CITY COUNSEL
uAlle CITY OF WALNUT CREEK
15 1666 North Main
aF 16 Walnut Creek, California 94596
BOARD OF SUPERVISORS
e 17 COUNTY OF CONTRA COSTA
651 Pine
18 Martinez, California 94553
19 CONTRA COSTA COUNTY TRANSPORTATION AUTHORITY
1340 Treat Boulevard, Suite 150
20 Walnut Creek, California 94596
21
I declare under penalty of perjury that the foregoing is true and correct.
22 Executed in San Francisco, California on March 25 1997.
23
24
25
26 KarenD. ay�, an
27
28
4
NOTICE OF INSUFFICIENCY
AND/OR
NON-ACCEPTANCE OF CLAIM
TO: Anne Bransford
18 Citadel Ct.
Pleasant Hill, CA 94523
RE: CLAIM OF: ANNE BRANSFORD
Please Take Notice as Follows:
The claims you presented against the County of Contra Costa, Contra Costa County Wide Landscape
District, Contra Costa County Wide Landscape District, Zone 22 or District governed by the Board of
Supervisors fails to comply substantially with the requirements of California Government Code Section
910 and 910.2, or is otherwise insufficient for the reasons checked below:
[ ]
I. The claim fails to state the name and post office address of the claimant.
[ ] 2. The claim fails to state the post office address to which the person presenting the claim
desires notices to be sent.
[X ] 3. The claim fails to state the date,place or other circumstances of the occurrence or
transaction which gave rise to the claim asserted.
[xa 4. The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or
loss, if known.
k] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000).
If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount
claimed as of the date of presentation, the estimated amount of any prospective injury,
damage or loss so far as known, or the basis of computation of the amount claimed. If the
amount claimed exceeds ten thousand dollars ($10,000), the claim fails to state whether
jurisdiction over the claim would rest in municipal or superior court.
[ ] 6. The claim is not signed by the claimant or by some person on his behalf.
[X] 7. Other: The claim fails to describe any duty or obligation of the public entity and any action
giving rise to the claim.
VICTOR J. WESTMAN, County Counsel
ByAA
Deputy County Counsel
Page 1
CERTIFICATE OF SERVICE BY MAIL
(C.C.P. §§ 1012, 1013a,2015.5;Evidence Code§§ 641,664)
I declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California
94553; I am a citizen of the United States,over 18 years of age,employed in Contra Costa County,and not a party to this action. I
served a true copy of this Notice of Insufficiency and/or Non-acceptance of Claim by placing it in an envelope addressed as shown
above,sealed and postage fully prepaid thereon,and thereafter was,deposited this day in the U.S.Mail at Martinez,California.
I certify under penalty of perjury that the foregoing is true and correct.
Dated: March 26, 1997 at Martinez,California.
cc: Clerk of the Board of Supervisors(original)
Risk Management
(NOTICE OF INSUFFICIENCY OF CLAIM:GOVT.CODE§§910,910.2,920.4,910.8)
Page 2
NOTICE OF INSUFFICIENCY
AND/OR
NON-ACCEPTANCE OF CLAIM
TO: Anne Bransford
18 Citadel Ct.
Pleasant Hill, CA 94523
RE: CLAIM OF: Anne Bransford
Please Take Notice as Follows:
The claim you presented against the County of Contra Costa or District governed by the Board of
Supervisors fails to comply substantially with the requirements of California Government Code Section
910 and 910.2, or is otherwise insufficient for the reasons checked below:
[ ] 1. The claim fails to state the name and post office address of the claimant.
[ ] 2. The claim fails to state the post office address to which the person presenting the claim
desires notices to be sent.
[x] 3. The claim fails to state the date, place or other circumstances of the occurrence or
transaction which gave rise to the claim asserted.
[x] 4. The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or
loss, if known.
[x] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000).
If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount
claimed as of the date of presentation, the estimated amount of any prospective injury,
damage or loss so far as known, or the basis of computation of the amount claimed. If the
amount claimed exceeds ten thousand dollars ($10,000), the claim fails to state whether
jurisdiction over the claim would rest in municipal or superior court.
[ ] 6. The claim is not signed by the claimant or by some person on his behalf.
[x] 7. Other: Your claim should provide any and all information on its face. Do not refer to other
documents in other locations.
VICTOR J. WESTMAN, County Counsel
By: &Atc d
Deputy County Counsel
Page 1
CERTIFICATE OF SERVICE BY MAIL
(C.C.P. §§ 1012, 1013a,2015.5;Evidence Code§§641,664)
I declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California
94553;I am a citizen of the United States,over 18 years of age,employed in Contra Costa County,and not a party to this action. I
served a true copy of this Notice of Insufficiency and/or Non-acceptance of Claim by placing it in an envelope addressed as shown
above,sealed and postage fully prepaid thereon,and thereafter was,deposited this day in the U.S.Mail at Martinez,California.
I certify under penalty of perjury that the foregoing is true and correct.
Dated: April 1, 1997 at Martinez,California.
cc: Clerk of the Board of Supervisors(original)
Risk Management
(NOTICE OF INSUFFICIENCY OF CLAIM:GOVT.CODE§§910,910.2,920.4,910.8)
Page 2
c ./7
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA April 15, 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 note alIrsm v +l) -
CLAIMANT: Anne Bransford �7So"
18 Citadel Ct. MAR 2 6 1997
ATTORNEY: Pleasant Hill, CA 94523
Date received COUNTY
ADDRESS: BY DELIVERY TO CLERK ON March 25, 19
BY MAIL POSTMARKED: Cert. Mail March 24, 1997
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: March 26, 1997 JpIL BepUIyLOR. Clerk
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
( ) This claim complies substantially with Sections 910 and 910.2.
(x) 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: k 7/ / ( BY: �!N Deputy County Counsel
II1. 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: APR 15 1957 PHIL BATCHELOR, Clerk, B __� j —. 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
1 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: APR 17 19917 BY: PHIL BATCHELOR b�+ / Gr—deputy Clerk
CC: County Counsel County Administrator
NU 3 a97
NOTI E Y a t'
AND/OR
NON-ACCEPTANCE OF CLAIM
TO: Anne Bransford
18 Citadel Ct,
Pleasant Hill, CA 94523
RE: CLAIM OF: ANNE BRANSFORD
Please Take Notice as Follows.
The claims you presented against the County of Contra Costa, Contra Costa County Wide Landscape
District, Contra Costa County Wide Landscape District, Zone 22 of District governed by the Board of
Supervisors fails to comply substantially with the requirements of California Government Code Sec-tion
910 and 910.2, or is otherwise insufficient for the reasons checked below:
( j L The claim fail, to state the name and post office address of the claimant.
[
) 2- The claim (ails to state the post office address to which the peason presenting the c,laun
desires notices to be sent.
(X ] 3, The clams fails to state the date, place or other circunsstances of the occurrence or
tran action which gave rise to the cl im asserted,
E'rtrs arae X2.2 <- ,/,
x14. The clains fails to state the name(s) of the public employee(s) causing the injury, damage, or
loss, if known. G<� C4� r��G'' .� 7
[x j S. Ac claim fait's to state whether a amou wed exceeds ten thousand dollars (S 10,000).
If the claim totals less than ten thousand dollars($10,000), the claim fails to slate the amount
claimed as of the date of presentation, the estimated amount of any prospective injury,
damage or toss so far as known, or the basis of computation of the amount claimed. If the
amount claimed exceeds ten thousand dollars($10,000), the claim fails to
state whether
jut i. diction over the claim would rest in municipal or superior cpurt.
( j 6. The claim is not signed by the claimant or by some person on his behalf.
? (Xj 7. Other: The claim fails to describe any duty or obligation of the public entity and any action
giving rise to the q lain.
VICTOR J. WESTMAN, County Counsel
r2 GX t t9'S r ! C�2
Dapnty County Counsel —
a
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. (Gov't Code 911. 2 . )
u 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
)
--C 96 -VSon7 / j7�5e 6' a� � ��
Against the County/ of Contra Costa RECEIVED
Ot�T
�!2ue" .�'�pT'strict) MAR 2 5 1997
(Fill in name) )
CLERK BOARD OF SUPERVISORS
CONTRA COS t�CO. t _
The undersigned claimant hereby makes claim ayaiu y
Contra Costa or the above-named District in the sum ofy $_ g1
and in support of this claim represents as follows:
;
?It19^. did, the d.at�ac;e ^r ,Z 31Ty n•-r.�ir` (Give ex;R t, H:ltA and hnur)
2 . Where did the damage or injury occur? (Include city and county)
3 . How did the damage or injury occur? (Give full details; use extra
paper if required)
4_. What particular act or omission on the part of county or district
officers, servants or employees caused the injury or damage?
(over)
5 What are the names of county or district Officers, servants or
employees causing the damage or injury?
-Ial�uk' '�
6, W damage Qrr da damagesdo claim
ed..ou Atta h two eestimates for lauto
ent
of injuria
damage. ) /V~p�cz� r,
f
? . How was the amou-- n- t claimed above co�mpudte ge(}nclude-the mated
amount of any prospective injury
—.—-- --- doctors and hospitals.
8.Names______and addresses of
_wyittnesses� � �(/
t c'�le eta r
j . Lis- t the expenditures r� 'y°ll made on account of this accident or -!
injury• DATE MINE OU T
7 Gov. Code Sec. 910. 2 provides
} "The claim must be signed by the
} claimant or by some person on his
$END NOTICESTObehalf. " —
Name and Address of Attorney }
(Claimant's Signature)
} (Address)
Telephone No. } Telephone No. S/U
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.
M
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CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA April 15, 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
Mount: $8,620.00 Section 913 and 915.4. Please note a11;Wasp; m'����
CLAIMANT: Ronda Burnett tI1L1S�N1I1�1I��.•��ffsa��
Map 7 1 1997
ATTORNEY:
Date received COUNTY COUNSEL
ADDRESS: 9422 West Lane BY DELIVERY TO CLERK ON March 20, 1997 MARTINEZ CALIF.
Stockton, CA 95210
BY MAIL POSTMARKED: March 19, 1997
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim. Bg HH
DATED: March 21, 1997 BgIL OeputyLOR , Cierl)�_� _,� �Qo��--
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
This claim complies substantially with Sections 910 and 910.2.
( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying
claimant. The Board cannot act for 15 days (Section 910.8).
( } Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send
warning of claimant's right to apply for leave to present a late claim (Section 911.3).
( ) Other:
Dated: 3/a l-[ / BY: ,�50 � 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: APR 15 1997 PHIL BATCHELOR, Clerk,by✓ a06D , 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 asshownabove.
Dated: APR 17 1997 BY: PHIL BATCHELOR v 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. (Gov't 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.
U. it the claim is against more enan one puullc 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 "rials Forxba.
Nst�•+ta�.�,tar�ust•n.eoaac,:^�a,�,,�.aa�ucc;�••t*r►rrrtrt*,k•***rrttrr*•**�*•rr•**�•tr•
RE: Claim By Reserved for Clerk's filing stamp
Against the County of Contra Costa)
RECEIVED
or )
> MAR 2 0 ►997
District)
(Fill in name) )
CLERK BOARD OF S'JF'_iVSORS
CO�dTPA.
The undersigned claimant hereby makes claim against the County of
Contra Costa or the above-named District in the sum of $
and in support of this claim represents as follows:
1. When did the damage or injury occur? (Give exact Cdate and hour)
l0, - )Jr- Rl� C0fAVV(E (-Ci�tL `l`7_`� J " � C LYI`�� c��1>�fj(j
2 . Where did the damage or injury occur? (Include city and county)
3 . How did the damage or injury occur? (Give full details; use extra
paper if required) ;,)qt, 5 e ppe,d {dor q f'f f c e ttc,r5 irl<cwa
-I_-SSCW-
4. What particular act or omission on the part of county or district
officers, s�/ervants or employees caused
-- the injury or damage?
LnCcnn� a EK5f.xnCc 5+gfQ_"ztiFS Lk) k
(over)
5. What are the names of county or district officers, servants or
employees causing the damageL or injury?
CCrz t CeS+G ✓l�zl C-' 1\,'i
6. What damage or injuries do you claim resulted. (Give full extent
of injuries or damages claimed. Attach two estimates for auto
damage. ) Lr 65 4 5,ion. �� 1-0 ¢
l"Z S �3,` An c—o �nrs- i'e-u f , eat c-n
7. How was the amount claimed above computed? (Include the estimated
amount of any prospective injury or damage. ) It L. qg COMppu I
my
8. Names and addresses of witnesses, doctors and hospitals.
9. List the expenditures you made on account of this accident or
injury.
DATE TIME AMOUNT
####***#**####**#**################**####**#********#*######*******
Gov. Code Sec. 910. 2 provides
"The claim must be signed by the
claimant or by some person on his
SEND NOTICES_TO: 1Attorney) I_ behalf."_
Name and Address of Attorney ) �C p� 43u-f _
y(Claimant's Signature)
)
9z1 � u ls-f
(Address)
CA- 9 5--), 16
Telephone No. ) Telephone No. .) 6�
UnTICE
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.
f �
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CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
April 15, 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 JjLv nnen odeTin
fs�
Mount: $50,000 + Section 913 and 915.4. Please note i a �VMM.
CLAIMANT: Christopher Cole MAR 2 6 1997
ATTORNEY: Law Offices of Freeman & Freeman MART YCOUNSECAUFL
Valerie A. McGuire Date received
ADDRESS: 350 E Street, Third Floor BY DELIVERY TO CLERK ON March 26, 1997
Santa Rosa, CA 95404
BY MAIL POSTMARKED:Express Mail March 24, 1997
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: March 26, 1997 CIL BepUiyLOR, Clerk
11. FROM: County Counsel TO: Clerk of the Board of Supervisors ��` a_Yd16L
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: If 7 BY: Deputy County Counsel
111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present
(�) This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this date.
Dated: APR 15 1997 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: APR 17 1997 BY: PHIL BATCHELOR Deputy Clerk
CC: County Counsel County Administrator
CLAIM AGAINST THE COUNTY OF CONTRA RECEIVED
COSTA "
(Government Code Section 910. et seq. ) I
L,:LERK601V300FSUPERVW0RSJ
2 61997
1. Name and post office address of claimant:
Christopher Cole 801 Pacific C0S ACO.
Petaluma, CA 94954
Daytime Phone: (415) 435-7963 Evening Phone: Same
2. Post office address to which the person presenting the
claim desires notices to be sent: (If not filled in,
notices will be sent to address provided in No. 1 above)
LAW OFFICES OF FREEMAN & FREEMAN
Valerie A. McGuire, Esq.
350 E Street, Third Floor
Santa Rosa, California 95404
(707) 575-7141
3. Date and time of day of the incident which gives rise to
the claim:
October 13, 1996
Approximately 3:00 a.m.
4. Location of the incident: California State Highway 580,
Richmond Toll Bridge, Contra Costa
County, California
5. Describe what happened: Negligent traffic control and/or
maintenance of toll bridge contributed to this vehicle accident
that resulted in a cement boulder being thrown over the overpass
landing on the vehicle Christopher Cole was a passenger of, the
cement went through his windshield, striking the driver of the
vehicle, Mr. Cole's brother, in the mouth rendering him
unconscious .
6. General description of the injury (damage or loss)
incurred, insofar as is presently known:
Christopher Cole suffered severe emotional stress due to the
fact his brother, William Cole, lost consciousness and Christopher
was forced to manage the vehicle from the passenger's seat.
7. Naze(s) and department of the public employee(s) causing
the injury (damage or loss) , if known.
To be determined
8. Amount claimed as of the date of presentation of the
claim, including the estimated amount of any prospective
injury, damage or loss insofar as can be presently
calculated, together with the basis of computation of the
amount claimed.
Damages Incurred to Date Estimated Future Damages
Hospital Bills . . . .$to be det. Hospital Bills . . .$unknown
Doctor Bills. . . . . .$to be det. Doctor Bills Due. $unknown
Lost Wages . . . . . . . . $to be det. Lost Wages . . . . . . . $unknown
Other special damages Other special damages
(Please specify) . . $ $
General Damages . . . $10,000 . 00 General Damages. .$10,000 . 00
TOTAL DAMAGES TO DATE: $20,000.00
Total amount claimed as of date of presentation of this
claim:
In excess of $50,000.00
Date: March 21, 1997
Valerie A. McGuire, Esq.
Attorney for Claimant
PROOF OF SERVICE
CCP 1013a, 2015.5
I, the undersigned, declare as follows:
I am employed in the County of Sonoma, State of
California; I am over the age of eighteen years and not a party to
the within entitled action; my business address is: Law Offices of
Freeman & Freeman, 350 E Street, Third Floor, Santa Rosa,
California 95404 .
On the date indicated below I served a true copy of the
following document(s) :
CLAIM AGAINST THE COUNTY OF CONTRA COSTA
on the parties named below, addressed as follows:
Contra Costa County
County Clerk
P.O. Box 911
Martinez, CA 94553
(X) BY MAIL: I placed said documents in a sealed envelope, with
postage thereon fully prepaid for first class mail, for
collection and mailing at Santa Rosa, California, following
ordinary business practices. I am readily familiar with the
practice of Law Offices of Freeman & Freeman for the
processing of correspondence, said practice being that in the
ordinary course of business, correspondence is deposited with
the United States Postal Service the same day as it is placed
for processing.
( ) BY PERSONAL SERVICE: I caused each such envelope to be
delivered by hand to the addressee noted above.
( ) BY FACSIMILE: I caused the said document to be transmitted
by facsimile machine to the number indicated after the address
noted above.
I declare under penalty of perjury under the laws of the
State of California that the foregoing is true and correct.
Executed on March 24, 1997, at Santa Rosa, California.
SHANNON L. DORMAN
Offices also located in:
San Rafael, CA
415.459-6141
Petaluma, CA
Freeman & Freeman
707.763-7191
Law Offices Lower Lake, CA
350 E Street,Third Floor 707.262-0845
Santa Rosa,CA 95404
707.575-7141 Napa,
707.254-897979
March 24, 1997 Ukiah, CA
707.463-3763
Vallejo, CA
707.552-2026
Contra Costa County
County Clerk
P.O. Box 911
Martinez, CA 94553
RE: Chris Cole vs. County of Contra Costa
Enclosure: ORIGINAL AND FOUR COPIES OF THE CLAIM AND THE PROOF OF
SERVICE
Dear Court Clerk:
Enclosed is a check in the amount of:
XXX Please file originals and return filed-received copy
Please record
Please submit for Judge's signature as soon as possible
For issuance:
XXX Return envelope enclosed
Other:
Thanking you in advance for your anticipated cooperation.
Very truly yours,
FREEMAN & FREEMAN
Shannon L. Dorman
Legal Assistant
Enclosures
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�IIIIIIIIIIIIIIIII�IIIU�IIII INTIIIIIIIIIII Alll III III
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CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
April 15, 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: $50,000 + Section 913 and 915.4. Please note all
CLAIMANT: William Cole
MAR 2 6 1997
ATIORNEY: Law Offices of Freeman & Freeman OOUNTY OLIUNSEL
Valerie A McGuire Date received MARTINEZOALIF.
ADDRESS: 350 E Street, Third Floor BY DELIVERY TO CLERK ON March 26, 1997
Santa Rosa, CA 95404
BY MAIL POSTMARKED: Express Mail March 24, 1997
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
IL
DATED: March 26, 1997 `pATCELOR, Clerk
; �epu
11. FROM: County Counsel TO: Clerk of the Board of Supervisors
�) This claim complies substantially with Sections 910 and 910.2.
( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying
claimant. The Board cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send
warning of claimant's right to apply for leave to present a late claim (Section 911.3).
( ) Other:
Dated: 7 / Z 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.
APR 15 1997
Dated: PHIL BATCHELOR, Clerk;B�_Z ,lr��u---� 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 mil 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
l as shown above.
Dated: APR 17 1997 BY: PHIL BATCHELOR �� �Deputy Clerk
CC: County Counsel County Administrator
CLAIM AGAINST THE COUNTY OF CONTRA COSTA
RECEIVED
(Government Code Section 910. et seq. ) 6 '" 9,7
1. Name and postoffice address of claimant: F SUPERVISORS
COSTA CO.
William Cole
801 Pacific
Petaluma, CA 94954
Daytime Phone: (415) 435-7963 Evening Phone: Same
2. Post office address to which the person presenting the
claim desires notices to be sent: (If not filled in,
notices will be sent to address provided in No. 1 above)
LAW OFFICES OF FREEMAN & FREEMAN
Valerie A. McGuire, Esq.
350 E Street, Third Floor
Santa Rosa, California 95404
(707) 575-7141
3. Date and time of day of the incident which gives rise to
the claim:
October 13, 1996
Approximately 3:00 a.m.
4. Location of the incident: California State Highway 580,
Richmond Toll Bridge, Contra Costa
County, California
5. Describe what happened: Negligent traffic control and/or
maintenance of toll bridge contributed to this vehicle accident
that resulted in a cement boulder being thrown over the overpass
landing on William Cole's vehicle windshield, the cement went
through his windshield, striking Mr. Cole in the mouth rendering
him unconscious .
6. General description of the injury (damage or loss)
incurred, insofar as is presently known:
William Cole suffered multiple traumatic injuries resulting
from the vehicle accident. He suffered loss of his front teeth,
a concussion, swollen upper lip, jaw, and head.
7. Naze(s) and department of the public employee(s) causing
the injury (damage or loss) , if known.
To be determined
8. Amount claimed as of the date of presentation of the
claim, including the estimated amount of any prospective
injury, damage or loss insofar as can be presently
calculated, together with the basis of computation of the
amount claimed.
Damages Incurred to Date Estimated Future Damages
Hospital Bills . . . .$ 3,559 .65 Hospital Bills . . .$unknown
Doctor Bills. . . . . .$ 4,381. 11 Doctor Bills Due.$unknown
Lost Wages . . . . . . . . $ to be det. Lost Wages . . . . . . . $unknown
Other special damages Other special damages
(Please specify) . . $ $
General Damages. . . $10,000 . 00 General Damages . .$10,000 . 00
TOTAL DAMAGES TO DATE: $27,940.76
Total amount claimed as of date of presentation of this
claim:
In excess of $50,000 . 00
Date: March 21, 1997
Valerie A. McGuire, Esq.
Attorney for Claimant
PROOF OF SERVICE
CCP 1013a, 2015.5
I, the undersigned, declare as follows:
I am employed in the County of Sonoma, State of
California; I am over the age of eighteen years and not a party to
the within entitled action; my business address is: Law Offices of
Freeman & Freeman, 350 E Street, Third Floor, Santa Rosa,
California 95404 .
On the date indicated below I served a true copy of the
following document(s) :
CLAIM AGAINST THE COUNTY OF CONTRA COSTA
on the parties named below, addressed as follows:
Contra Costa County
County Clerk
P.O. Box 911
Martinez, CA 94553
(X) BY MAIL: I placed said documents in a sealed envelope, with
postage thereon fully prepaid for first class mail, for
collection and mailing at Santa Rosa, California, following
ordinary business practices. I am readily familiar with the
practice of Law Offices of Freeman & Freeman for the
processing of correspondence, said practice being that in the
ordinary course of business, correspondence is deposited with
the United States Postal Service the same day as it is placed
for processing.
( ) BY PERSONAL SERVICE: I caused each such envelope to be
delivered by hand to the addressee noted above.
( ) BY FACSIMILE: I caused the said document to be transmitted
by facsimile machine to the number indicated after the address
noted above.
I declare under penalty of perjury under the laws of the
State of California that the foregoing is true and correct.
Executed on March 24, 1997, at Santa Rosa, California.
njv; n t w
SHANNON L. DORMAN
Offices also located in:
San Rafael, CA
415.459-6141
Petaluma, CA
707.763-7191
Freeman & Freeman
Law Offices
Lower Lake, CA
707.262-0845
350 E Street,Third Floor
Santa Rosa,CA 95404 Napa, CA
707.575-7141 707.254-8979
March 24, 1997 Ukiah, CA
707.463-3763
Vallejo, CA
707.552-2026
Contra Costa County
County Clerk
P.O. Box 911
Martinez, CA 94553
RE: William Cole vs. County of Contra Costa
Enclosure: ORIGINAL AND FOUR COPIES OF THE CLAIM AND THE PROOF OF
SERVICE
Dear Court Clerk:
Enclosed is a check in the amount of:
XXX Please file originals and return filed-received copy
Please record
Please submit for Judge's signature as soon as possible
For issuance:
XXX Return envelope enclosed
Other:
Thanking you in advance for your anticipated cooperation.
Very truly yours,
FREEMAN 6 FREEMAN
Sh GNI VLU n ( / - l 7(, -
Shannon L. Dorman
Legal Assistant
Enclosures
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s s n 4 i i s '1 b E h C H Addressee Copy 11311,
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY CALIFORNIA April 15, 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 Governpn igdg�
Amount: $100,000.00 Section 913 and 915.4. Please note all W M `
CLAIMANT: Rehana N. Curtis APR 0 1 1997
ATTORNEY: David L. Crump MARTINC COUNSEL Attorney At Law Date received
ADDRESS: 4745 University Way Ave. NE BY DELIVERY TO CLERK ON March 31, 1997
Seattle, WA 98105-4412
BY MAIL POSTMARKED: March 28, 1997
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
iqIL ATC E
DATED:_ April 1, 1997 : �epuy LOR, Clerk
v -
1I. 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: Y11 /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
XThis 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: APR 15 1997 PHIL BATCHELOR, Clerk, By� . Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the
United States, over age 18; and that today I deposited in the United States Postal Service in Martinez,
California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to
the claimant as shown above.
Dated: APR 17 1997 BY: PHIL BATCHELOR b eputy Clerk
CC: County Counsel County Administrator
ORIGINAL
Claic to: BOARD OF SUPERVISORS OF CONTRA COSM COUNTY
INSTRUCTIONS 'lO CLAD4W
A. Clam 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 presorted 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 grouting M'qm and which socrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not
later than one year after the accrual of the cause of action. (Govt. Code 5911.2.)
B. Claim mist be filed with the Clerk of the Board of Supervisors at its office in
Room 106, County Administration Building, 651 Piste 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
ro•'�.+.
� f /f i 1f 1E f f N 1t k # 1F • ! !F * � ! * R M fF * 1F ■ It fF 1F ! M A ! iF IF � ■ 1f ! t nE � �
R£: Claim By ) Reserved for Clerk'scling stamp
RECEIVEo7
3 11991'
Against the County of Contra Costa
or ) CLERK BOARD
CONTRA ODS A CO 1SJORS
District)
(Fillin nac )
Zine undersigned claimant hereby makes claim against the County of Contra Costa or
the above-named District in the sum of $ 00, D o 0 . °O and in support of
this claim represents as follv.ts:
1. When did the damage or injury, occur? (Give exact date and hour)
----
2. Where did the damage or injury occur? (Include city and county)
3. How did the damage or injury occur.? (Give full details; use extra paper if
required)
59-C ODeA16✓wl - Arf-Tr#V, - -----
L. What particular act or omission on the part of county or district officers,
servants or employees caused the injury or damage?
sec A e:c/bVW1 - +7f'.fz.f
5. wnat are the nanies of comry or district officers, servants or employees causing
the da -:ae or injury?
.SE6 A-aiAE�3✓./t. ..a-TYAz.�-�
5. Mhat damage or injuries do you Claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage.
As ex48L/W . krY e ems .
7. How was the amount claimed above computed? (Include the estimated amount of any
Prospective injury or damage.)
.fcE MJ�jr��vYr't - 77'sr-tai
$. Names and addresses of witnesses, doctors and hospitals.
-5e-z-
9.
EE9. List the expenditures you made on account of this accident or injury:
DAI"r ITEM AMOUNT
5e7- .979az-66 W-In - .srY4 r v
Gov. Code Sec. 910:2 provides:
"The cl.a must be signed by the claimant
S M NMCE5 TO: (Attorney) or on his behalf."
Name and Address of Attorney
David L_ CrumpC
Aftor�rey At Tarr laimant Signature _
4745 University Way Ave. NE 5Cor11,4- �sR,
Seattle, Washington 98105-4412 (Address)
Llwlowr-' -Y f LSA �58�
Teslephone Na. zo6 SL tVia* * *Telephone* * * e *No
*'
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, bills- account, voucher, or writing, is punishable either by imprisonment In
the county jail for a period of not more than one year, by a fine of not exceeding
one thousand ($1,000), or by both such Imprisonment and fine, or by imprisonment in'
the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by
both _ h imrisoire^ and finc,.
ORIGINAL
Addendum to Claim By Rehana N. Curtis
1. The damages and injuries occurred at approximately 2030 hours(8:30 p.m.) on
Saturday, October 12, 1996.
2. The damages and injuries occurred at the approximate confluence of eastbound SR-24
and northbound I-680, in Walnut Creek, Contra Costa County, California.
3. The damages and injuries are believed to have occurred when a county animal control
vehicle being driven negligently and at an excessive speed by county employee Scott
M. Carney, lost control on the bending curve, causing a trailer being towed by said
vehicle to swing out and collide with the vehicle being driven by Rehana N. Curtis.
The force of the collision caused Rehana N. Curtis to lose control of her vehicle,
smashing into the barrier wall and sustaining severe injuries thereby.
4. The driver of the county owned animal control vehicle negligently operated the vehicle
as set forth in item number above, by traveling at an excessive speed, too fast for the
conditions, and too fast for the load which the vehicle was pulling, causing, among
other things, the vehicle or its trailer to enter another lane improperly. The county is
responsible for the negligent acts and omissions of its employee on an agency theory.
5. Scott Michael Carney is the name of the county employee who caused the damages
and injuries to Rehana N. Curtis.
6. The following damages and injuries resulted from the negligence of the county
employee:
a. total loss of the automobile driven by Rehana N. Curtis;
b. severe past and future emotional pain and suffering as a result of personal
injuries in an as yet undetermined amount;
c. wage losses in an as yet undetermined amount;
d. past medical expenses in an as yet undetermined amount;
e. future medical expenses in an as yet undetermined amount;
7. The above damages have been computed by summation from billings and receipts
where known; otherwise said damages are so indicated where not presently known
with certainty.
Addendum to Claim by Rehana N. Curtis- 1
8. Names and addresses of witnesses, doctors and hospitals are as follows:
a. witnesses:
so
1. Rehana N. Curtis - 4849 Scotia Dr., Union City, CA 94587; ( ) 429-
9967; �o
2. Scott M. Carney- 1516 Berrellesa St., #13, Martinez, CA 94553; (S)
229-4965;
3. CHP Officer A. Farrar#9950,
4. CHP Officer McAdams(# unknown);
5. Others: there have been no eye-witnesses to the collision yet identified.
b. doctors:
1. American Medical Response, P.O. Box 7423, San Francisco, CA
94120-7423;
2. Jacob Epstein, MD -trauma physician c/o P.O. Box 30187, Walnut
Creek, CA 94598; (510) 947-5288;
3. Arthur J. Garry, Jr., MD - trauma physician c/o P.O. Box 30187,
Walnut Creek, CA 94598; (510) 947-5288;
4. Robert Clark, MD - trauma physician c/o P.O. Box 30187, Walnut
Creek, CA 94598; (510) 947-5288,
5. Steve Sorinson, MD - trauma physician c/o P.O. Box 30187, Walnut
Creek, CA 94598; (510) 947-5288.
c. hospitals:
1. John Muir Medical Center, 1601 Ygnacio Valley Road, Walnut creek,
CA 94598-3194; (510) 947-3336;
2. Kaiser Hospital, Hayward, CA.
9. Expenditures made to date on account of the damages and injuries, where known with
certainty, are as follows:
a. American Medical Response - Ambulance Services - $778.79;
b. John Muir Trauma Physicians - emergency room - $9,855.50;
c. John Muir Medical Center- hospital services - $29,009.10;
d. Kaiser Hospital - hospital services - amounts not presently known;
e. Dr. Matsuoka- head and neck surgeon - amounts not presently known;
f. Physical therapy services while in hospital - amounts not presently known;
g. Dr. Richard Floria - follow up treatment - amounts not presently known; and
h. Automobile - total loss - approximate valuation= $14,164.00.
Addendum to Claim by Rehana N. Curtis-2
This Addendum to Claim By Rehana N. Curtis consists of three type-written pages
and is submitted as an attachment to and incorporates the claim of Rehana N. Curtis
against the County of Contra Costa this ;,(,o day of March, 1997.
Rehana N. Curtis
4849 Scotia Drive
Union City, CA 94587
(510) 429-9967 Home
(510) 572-1425 Work
Addendum to Claim by Rehana N. Curtis-3
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CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA April 15, 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
Mount: $5,000.00 Section 913 and 915.4. Please note all
,2(a;py ����
CLAIMANT: James E. Marshall IILLF��tta3
ATTORNEY: MAR 2 0 1997
Date received COUNTY COUNSEL
ADDRESS: 3838 Clayton Rd. , 1901 BY DELIVERY TO CLERK ON March 19, 1997ki T
Concord, CA 94521 Hand Delivered
BY MAIL POSTMARKED:
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim, q
DATED: March 20, 1997 6gIL 6eputyLOR, Clerk'����, „ Q —
11. FROM: County Counsel TO: Clerk of the Board of Supervisors
(h7 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. "d / 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: APR 15 1997 PHIL BATCHELOR, Clerkputy 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 3his Notice.
AFFIDAVIT OF MAILING
1 declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the
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: APR 17 1997 BY: PHIL BATCHELOReputy 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. (Gov't 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.
aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa
RE: Claim By Resn=Ki
Clark's f ling stamp
James E. Marshall
Against the County of Contra Costa)
or )
District) ISORSI(Fill in name) ) .
)
The undersigned claimant hereby makes claim against the County of
Contra Costa or the above-named District in the sum of $50gq
and in support of this claim represents as follows:
1. When did the damage or injury occur? (Give exact date and hour)
February 26 , 1997
2. where did the damage or injury occur? (Include city and county)
Martinez, Contra Costa County
3 . How did the damage or injury occur? (Give full details; use extra
paper if required) On February 26 I was released on my own
recognizance by a judge in Superior Court in Martinez . I was taken
back to Martinez County Jail and held. I told deputies there that
4. What particular act or omission on the part of county or district
officers, servants or employees caused the injury or damage?
They failed to process or enter into the cf .ter the order for my
release.
(over)
5. What are the names of county or district officers, servants or
employees causing the damage or injury?
I don't know who was actually responsible.Everyone involved was
an emFleTee eF tie eat�nt�
6. What damage or injuries do you claim resulted? (Give full extent
of injuries or damages claimed. Attach two estimates for auto
damage. )
Lost wages in the amount of $4616 .
7. How was the amount claimed above computed? (Include the estimated
amount of any prospective injury or damage. )
11 days 8 hours per day at &7 . 00 per hour = $616
2 shows on 2 weekends at $1000 per show = $4000
8. Names and addresses of witnesses, doctors and hospitals.
Melissa Bellamy 3838 Clayton Rd. #901 Concord, Ca. 94521
9. List the expenditures you made on account of this accident or
injury.
DATE TIME AMOUNT
•*eesssessssa+r**r**s*ttr*a��rr+tr�**►�r,►,t*****festa*�,t**r*rre***aar*r
Gov. Code Sec. 910. 2 provides
"The claim must be signed by the
cl ant or by some person on his
SEND NOTICES O: (Attorney) behAlf. 11
Name and Address of Attorney
f3838
(Claimant's Signature)
Clayton Rd. #901 r,,,,,,,,,.,j Ca
(Address)
Telephone No. ) Telephone No. ( 510 ) 676-8018
eeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeseessseseeeeeeeseaeesseeesseeseeee
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.
ATTACHMENT 1
3. (con' t) I had been released . They told me that it wasn' t on
the computer. I was subsequently transferred to West County Jail
and held until March 12 , 1997 . At that time they told me that
they had finally recieved my paperwork, showing that I should
have been released on February 26 . I was told that a "bureaucratic
snare" had caused the problem.
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA April 15, 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: $100,000.00 Section 913 and 915.4. Please note al1iAp �
CLAIMANT: Minnie F. Marzilli
ATTORNEY: MAR 2 1 1997
Date received March 21 1997M FiT y COUNLIFL
ADDRESS: 28 Cedar Lane BY DELIVERY TO CLERK ON
Orinda, CA 94563
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.
IL gATCHELOR, Clerk
DATED: March 21, 1997 : Deputy
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
This claim complies substantially with Sections 910 and 910.2.
( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying
claimant. The Board cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send
warning of claimant's right to apply for leave to present a late claim (Section 911.3).
( ) Other:
Dated: a� / 7 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
(y
) 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: APR 15 1997 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: APR 17 1997 BY: PHIL BATCHELOR b� Deputy Clerk
CC: County Counsel County Administrator
RECEIVED
MAR 2 1 �9R
CLERK BOARD OF SUPERVISORS
CONTRA COSTA CO.
CLAIM AGAINST THE COUNTY OF CONTRA COSTA AND THE CONTRA
COSTA COUNTY FLOOD CONTROL AND WATER CONSERVATION DISTRICT
(Government Code $$ 910, 910 .2)
Claimant' s Name: MINNIE F. MARZILLI
Claimant' s Address : 28 Cedar Lane
Orinda, California 94563
Name and address of person to whom notices regarding this
claim should be sent : To Claimant at above address .
Date of accident or occurrence: January 1, 1997
Place of accident or occurrence : 28 Cedar Lane, Orinda, CA
(Claimant' s residence)
General Description of accident or occurrence : On January
1, 1997, a landslide occurred at the side yard adjacent to
the walkway leading to the front door of Claimant' s
residence . The slide was a direct and proximate result of
the negligent, improper and wrongful design, location,
maintenance and repair by the County of Contra Costa and the
Contra Costa County Flood Control and water Conservation
District of storm drains and sewers and related facilities
and easements which caused storm water to be diverted on to
Claimant' s property, saturating soil and causing the
substantial landslide and damage to Claimant' s residence and
property, as shown in the attached photographs .
Names, if know, of public employees causing the injury or
loss : Not known at this time .
Names and addresses of witnesses:
1 . Minnie F. Marzilli 28 Cedar Lane, Orinda, CA 94563
(telephone: 510/254-3629)
2 . Dan Marzilli 28 Cedar Lane, Orinda, CA 94563
(telephone: 510/254-3629)
1
3 . Mr. and Mrs . Stu Maiden Arden Lane, Orinda, CA 94563
4 . Mary McConville Arden Lane, Orinda, CA 94563
General Description of the loss, injury or damage suffered:
Claimant has sustained damages estimated at $60, 000 to
$75 , 000 for repair of the hillside (including retaining
wall, soil replacement, irrigation and landscaping) and
repair of damage to home, walkways and driveway. In
addition, Claimant has sustained loss of time, emotional
distress, sleeplessness, and anxiety as a result of the
conduct of the governmental entities .
Total amount claimed: $100, 000
I, the undersigned, declare under penalty of perjury that I
have read the foregoing claim for damages and know the
contents thereof; that the same is true of my own knowledge
and belief, save and except as to those matters wherein
stated on information and belief, and as to them, I believe
them to be true.
� f
DATED: February _, 1997
MINNIE F. MARZILLI
Received by County of Contra Costa this day of
1997 .
Signature of County Clerk
2
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA April 15, 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: $10.95 Section 913 and 915.4. Please note all -WRPwt3ud[E2D
CLAIMANT: Richard C. McBurnie APR 0 1 1997
ATTORNEY: COUNTY COUNSEL
Date received MARTINEZ CALIF.
ADDRESS: 812 Matedera Circle BY DELIVERY TO CLERK ON April 1, 1997
Danville, CA 94526
BY MAIL POSTMARKED: Hand Delivered via: Risk Mgmt.
I. FROM. Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: April 1, 1997 'qIL ATCiiELOR, Cler: �eputy
11. FROM: County Counsel TO: Clerk of the Board of Supervisors
This claim complies substantially with Sections 910 and 910.2.
( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying
claimant. The Board cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send
warning of claimant's right to apply for leave to present a late claim (Section 911.3).
( ) Other:
Dated: BY: Deputy County Counsel
111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present
( /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: APR 15 1997 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: APR 17 1997 BY: PHIL BATCHELOR 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 per-
sonal 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. Claims relating to causes of action for.death or for injury to person
or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not
later than one year after the accrual of the cause of action. (Govt. Code 5911.2.)
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in
Room 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.
* * * * * * * * * * * IF * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
BE: Claim By ) Reserved for Clerk's filing stamp
Richard l` _ Mr Burnie ) RECEIVED
)
wrd OL
Against the County of Contra Costa > APR 1997'.Y/
or )
District) CLERK BOARD OF SUPERVISORS
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 $ i o . 9 5 and in support of
this claim represents as follows:
1. When did the damage or injury occur? (Give exact date and hour) ~�
March 26 , 1997 , approx. 11 :45 A.M.
2. Where did the damage or injury occur? (Include city and county)
Hwy. 680 South at Walnut Creek Flyover
3. How did the damage or injury occur? (Give full details; use extra paper if
required)
Coutny Vehicle # 5626 de-accellerating going down ramp and was spewing
diesel fuel from exhaust , vehicle towing open trailer . Claimant vehicle
covered with diesel fuel mist .
------------------------------------
4. What particular act or omission on the part of county or district officers,
servants or employees caused the injury or damage?
Malfunstion or lack of vehicle maintenance .
(over)
5. What are the names of county or district officers, servants or employees causing
the damage or injury?
Not known, vehicles in question did not stop.
6. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage.
No injuries, .
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
Car wash receipt .
---------------------------- ----
6. Names and addresses of witnesses, doctors and hospitals.
Subject claimant only.
9. List the expenditures you made on account of this accident or injury- w
DATE ITEM AMOUNT
3/27/97 Car wash $10 . 95
Gov. Code Sec. 910:2 provides:
"The claim must be signed by the claimant
SEND NOTICES TO: (Attorney) or by some person on his behalf."
Name and Address of Attorney
-"�Z laimant's Signature
812 Matadera Circle-Danville CA 99526
Address
3/28/97 -
Telephone No. Telephone No. 51 82 - 9
# # # # # # # # # # # # # # # # # #
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.
ST�TF iRPM
State Farm Insurance Companies
INSURRN<F
North Coast Regional Office
April 21, 1997 6400 State Farm Drive
Rohnert Park, CA 94926-0001
Contra Costa County Administrator
Board of Supervisors RECEIVED
County Administration Building
651 Pine Street, Room 106
Martinez, CA 94553-1293 APR 2 81997
CLERK BOARD OF SUPERVISORS
CONTRA COSTA CO.
RE: Our Insured Mary Diaz
Our Claim Number 05-6620-646
Date of Loss 1/10/97
Amount of Loss $5, 675.81
Dear Sirs:
I am in receipt of your correspondence dated April 15, 1997 . I
have been notified that my claim has been rejected in full.
Please advise the specific reasons why this claim was rejected.
I have been advised by ARB, Inc. , that they are not responsible
for this loss for which State Farm has presented a claim. Per
their letter of April 7, 1997, copy enclosed, they were not
responsible for the hole which caused damage to our insured's
vehicle.
It seems there is a question as to who is responsible for this
hole in the ground. ARB, Inc. , has stated that their work
location was 1, 000 feet from the pot hole area.
I am once again directed to your department for collections on
this matter.
Please respond to my request for the specific reason your
department has denied my claim.
If you have any questions, please feel free to call. I will
await a response to this request.
Sincerely,
Eric Gius
Claim Representative - ROAC
State Farm Mutual Automobile Insurance Company
(707) 588-6470
EG:bb 052/0421011
HOME OFFICESBLOOMINGTON, ILLINOIS 61710-0001
14409 PARAMOUNT BLVD. R R PHONE (310)630-5601
PARAMOUNT. CA 90723 INC. FAX (310)601-4601
9%GINEERS- ON SI'RUC TOR s
April 7, 1997 ROAC
APR 10 697
Contra Costa County INCOMING
651 Pine Street 6th Floor
Martinez, California 94553-1229
Attn: Julie Aumock, Claims Adjustor
RE: Claimant State Farm Mutual Auto Insurance Company
Claim Number: 05-6620-646
DOI January 10, 1997
Dear Ms. Aumock:
I am in receipt of your notice of an insufficient hole covering at the above captioned location.
Your claim has been fully investigated. The "hole" was found to be a manhole cover surrounded by
a sunken ditch due to flooding in the area. Cal Trans had placed barricades and cones to warn
drivers of the pot holes caused from the flooding. Also, it was noted, that Contra Costa County
had recently paved the area.
ARB is not responsible for the damages to Mary Diaz's car. Our work location was 1000' from of
the pothole area. In addition, our construction work was performed on the opposite side of the
street.
If you have any questions regarding the foregoing please do not hesitate to call me at 562-601-4490.
Yours truly,
Carla J. Routt
Claims Administrator
cc: State Farm Insurance Companies
9AKERSFIELD.CALIFORNIA • PARAMOUNT CALIFORNIA • FONTANA,CALIFORNIA • O1TTSEURG.CALIFORNIA
'ULSA.OKLAHOMA - SCUTH AMERICA QUITO, ECUADOR
ROAC —
, CLAIM
APR 18 1997 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA April 15, 1997
Claim-Against t41CD"t a 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: $5,645.81 Section 913 and 915.4. Please note ailAM cr—$11Vgfh1
CLAIMANT: State Farm Insurance Companies MAR 2 0 1997
Insured: Mary S. Diaz
ATTORNEY: Claim No. : *05-6620-646 COUNTYCOUNSEL
Date received MARTINEZ CALIF.
ADDRESS: 6400 State Farm Dr. BY DELIVERY TO CLERK ON March 19, 1997
Rohnert Park, CA 94626
BY MAIL POSTMARKED: Mand Delivered via: Risk Mg}nt.
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: March 20, 1997 IVIL NTTCVELOR, Cler�t�9
1I. 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 Bard 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: /Aa /dz� 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: APR 151997 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 aentioned, have been a Citizen of the
United States, over age 18: and that today I deposited in the United States Pastal 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: APR 17 1997 BY: PHIL BATCHELORjDuty Clerk
CC: County Counsel County Administrator �'�" —
C / 7
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA April 15, 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
Mount: $5,645.81 Section 913 and 915.4. Please note all i�i( IINJgiT11
CLAIMANT: State Farm Insurance Companies J MAR 2 0 1997
Insured: Mary S. Diaz
ATTORNEY: Claim No. : *05-6620-646 COUNTY COUNSEL
Date received MARTINEZCALIF.
ADDRESS: 6400 State Farm Dr. BY DELIVERY TO CLERK ON March 19, 1997
Rohnert Park, CA 94626 Hand Delivered via: Risk M t.
BY MAIL POSTMARKED: l�
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: March 20, 1997 6yIL BAATCVELOR, Cleepur�9
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
0-01 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: � 'ol� / _ BY: Deputy County Counsel
111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present
(�) This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this date.
Dated: APR 15 1997 PHIL BATCHELOR, Clerk, *)L� 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:
APR 17 1997 BY: PHIL BATCHELOR \J �— 6puty Clerk
CC: County Counsel County Administrator
State Farm Insurance Companies
INf U0.ANCf
GJ
"ar*y North Coast Office
March 11, 1997 6400 State Farm Drive
�pR 1$ Aggl Rohnert Park,California 94926-0001
Countra Costa County
651 Pine St
Martinez, CA 94533
****IMPORTANT****
PLEASE WRITE OUR
CLAIM NUMBER* ON
YOUR REPLY OR PAYMENT
THANK YOU
RE: Claim Number: *05-6620-646
Date of Loss: January 10, 1997
Our Insured: Mary S. Diaz
Dear Sirs:
State Farm Mutual Automobile Insurance Company on behalf of
Subrogee, Mary S. Diaz hereby makes claim for $5645. 81 and makes
the following statements in support of claim:
1. Notices concerning this claim should be sent to:
State Farm Insurance Companies
6400 State Farm Drive
Rohnert Park, CA 94626
2 . The date of accident occurring on January 10, 1997 at
Waterfront Road Martinez CA
3 . The circumstances giving rise to this claim are as
follows:
Our vehicle hit unmarked hole in the road, causing
damage.
4 . The injuries reported consisted of None reported.
5. Our total claim is as follows:
Company's Net Payment $5179 . 77
Insured's Deductible Interest $466. 04
Total Property Damage $5645. 81
HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001
sr�rF FaF ss
State Farm Insurance Companies
Countra Costa County NSUY�NCF
Page 2
March 11, 1997
North Coast Office
6400 State Farm Drive
Rohnert Park,California 94926-0001
NOTICE:
This form is to provide notice of our claim for damages in
accordance with the day statute. If this form is not acceptable
for compliance with the statute, please rush the necessary form
to my attention for proper filing.
State Farm Mutual Automobile Insurance
Dated: MAR I 11997 By:
Employee ame
Employee Tit t
A�` /-- ,�,f('r-6 /
Employee Phone Number
Enc: Supporting Documents
cc: Russell 6798
09
HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001
Clair to: BOAFM OF SUPERYL M OF CMUICOSTA OOUNTY
INSTRUCTIONS TO t3.AI}WU
A. Claiss relating to causes of actions for death or for injury to person or to per
sonal PrOpertY or growing crops and vhieh accrue on or before December 31, 1987,
must be presented not later than the 100th day after the acmIual of the cause of
act,ion. Claims relating to causes of action for-death or for Injury to person
or to Personal property or King crops and *61ch accrue on or after January 1,
19W: must be presented not later than sin months after the accrual of the cause
Of action. Claims relating to any other cause of actions mast 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 SupavL-ars at its office In
Room 3016, County Administration Building, 6% 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 Seo. 72 at the end of this
Tor-W.
ct �rcrcrct +tcrinrsrsr +r +rsttt * +t +rest +t � +� crxn� ctnrAunstu � rtss � nt +s � cs � ct
BE: Claim By ) Reserved for Clerk's filing stamp
RECEIVED
Against the County of Contra Costa r�r
or ) 1 gaff
District) CLE! KSQARD OF SU M
MU gas nameCONTRA COSTA CO
The undersigned claimant hereby makes claim against the County of Contra Costa or
the above-named District in the sum of $ 5645.81 and in support of
this claim represents as follows:
1. When did the damage cr injury occur? -(Give exact date and hour)
1-10-97 5:00 pm
2.. Where did the damage or injury ower? (Include city and cuxnty)
Waterfornt Road, Martinez CA Contra Costa
3. How did the damage or injury occur? (Give fuU details; use extra paper if
rewired) Vehicle drove over metal plate covering a hole in the road. Vehicle tire dropped
into the hole and caused vehicle damage:
4. What particular act or omission on the part of county or distri�tEoSrs,
se^vants or employees caused the injury ar damage? EO.
Insufficiant hole covering.
IAN 2 9 1997
wnat are the nal-nes of county or di
theor injury?
strict officers, servants or employees causing
da wbe
Cal Trans?
Contra Costa County Roads Dept.
5. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two est=imates for auto damage.
See estimate
7. How was the amount claimed above Computed? (Include the estimated amount �of any
prospective injury or damage.)
See estimate
$.
Names and addresses of witnesses, doctors and hospitals.
No witnesses
9. List the expendittses you made on account of this accident or injury:
DAZE ITEM NM0M
See draft copies
*' . Gov. Code Sec. 910:2 provides:
SM NOTICES T0: (At "Tbe claim must be signed by the claimant
-� . –eta some person ars his behalf."
Name and Address of Attornflys
Claimant's Signature
State Farm Insurance Companies
REGIONAL OFFICE AUTO CLAIMS
Address. b4UU Statearm Drive
Rohnert Park, CA 94926
Telephone No. I Telephone No. 707-533-6470
* * * * * * * * * * * * * * *
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
paymnt 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 sv-h i.—,.riso-usen-- and rine.
° • — Rental Agreement 0425417 — 2312
o ae 1225 SONOMA BLVD '' Description Rate Amount
VALLEJO CA 94590-6954 Q
15 DAYS @ 29.99 449.85
CAL.-VLF 11 .40
SALES TAX% 7.25 32.61
Bill To:
+v M'"-'EMERYVa ME"RY'+ mn-ar
STATE FARMILLE
ATTN: GLUEGE»CHRISTINA•
2000 POWELL ST., SUITE 100
EMERYVILLE CA 94608
INFORMATIONRENTAL ROAD
Date Out Date In
1/13/97 1/27/97 MAR Q 3 07
Renter Home Phone G
S 's MARY SILVEIRA DIAZ 707-746-0705 INCOMI�
Address Office Phone
..�..; 1436 LANDAHL CT
City State Zip R t=<-E
BENICIA CA 94510
Driver License State Expires -
N0451528 CA 7/28/97 FE 4 ?�q%
DOB
7/28/53 EMERV.,:..,
Additional Driver TOTAL CHARGES 493.86
Name LESS AMOUNT RECEIVED 253.86
SPOUSE W/VALID LIC
Age Driver License State Expires
25 Amount Due • • • • • • • • • • • • • • • • ' 240.00
IMPORTANT
Color License No. aim #/Po 'cy #/P.O. # Billing Inquiries Call INFORMATION
Tax ID #
SILVER 3MBD706 6620646
Model Unit # ured 707-554-8200 36-3041733
96 TAUR W11183 DI Billing Information
Date of Loss Type of Loss $16.00/DAY NO SALES TAX
1/10/97 INSURED
Type of Car Repair Shop
TOWED-- -� 7"'1i�1.i YUC] C:o"' CY1 l� •- �- %1:>fl : a
m
OVER 2800 OFFICES IN THE U.S. AND CANADA o
AND ONLY ONE NUMBER TO CALL
1-800-RENT-A-CAR `
a ■ • a a a • • ■ ■ a • ■ • ■ ■ ■ ■ ■ ■ ■ • • ■ ■ e • ■ ■ •
?lease Return T^is P^rtion with Remlittance Amount Due • • • • • • • • • • • • • • • , 240.00
Remit to:
Paid by:
ENTERPRISE RENT A CAR STATE FARM-EMERYVILLE
ATTN: ACCTS RECEIVABLE ATTN: GLUEGE•CHRISTINA-
PO BOX 5666 2000 POWELL ST., SUITE 100
CONCORD CA 94524 EMERYVILLE CA 94608
Customer# Rental Agreement Amount GPBR
01/28 STF2305 D425417 240.00 2312
STATE FARM INSURANCE COMPANIES � 11-35112
FARM MUTUAL AUTIONGSILE LMSURANCE LOMRANY
r COAST OFFICE RONNERT PARK,CAWFORNIA Lim. 04642
BER POLICY NUMBER CAR NO. DATE OF LOSS AGENT
-644 111198 9115-i09A 01-�10-97 .619E
A2s MARY S IV
Usti 11.SJV
wTie NIERPRISE Frg 274 W11
.OF 225 SthCMA ALWO
LLEJC CA 9096"6954 "
Ult
� It E — RENTAL 06IM®UR58N8NI
TO cus" K � asnIm COPY
WDWN NOT NEGOTIABLE
FILE CC
CLAIM NO 05-6620-646 POLICY NO V098-905-05A LOSS DATE 01/10/97 DRAFT NO 1 02 351830 J
PAYEE DATE 01/21/97
QIABLO CHRYSLER PLYMOUTH FOR THE ACCT. OF MARY DIAZ AMOUNT $*******56 . 00
ee180 DIAMOND BLVD
CONCORD CA 94520-5704
COVERAGE
TIN 05-942776470 COLLISION (LOMV)
' 400-3 556.00
REMARKS TOW BILL REIMBURSEMENT
I
I
CREATED BY Beverly HALEY
STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY 1 02 351830 J
NORTH COAST OFFICE BANK OF AMERICA NT 8 SA 11-35/1210
ROHNERT PARK, CA CUSTOMER SERVICE AMERICAS 1233 DATE 01/21/97
A Pleas Hill Auto 02-103 CONCORD, CA
COVERAGE
COLLISION (LOMV)
'CLAIM TIO 05-6620-646 POLICY NO V098-905-05A -CLAIM UNIT 168. 400-3 $56.00
LOSS BATE 01/10/97
INSURED DIAZ, MARY
FIFTY-SIX AND 00/100 DOLLARS i 6!a k*tY:#
G.DG
Pay to the
Order of: DIABLO CHRYSLER PLYMOUTH FOR THE ACCT. OF MARY DIAZ
2180 DIAMOND BLVD TIN 05-942776470
CONCORD CA' 94520-5704
AUTH BHALE
APPROVED BY
CLAIM NO 05-6620-646 POLICY NO V098-905-05A_°'. LOSS DATE 01/10/97 DRAFT NO 1 02 351659 J
PAYEE
DATE 01/17/97
14R
36 LANDAHL&CTIABLO CHRYSLER PLYMOUTH AMOUNT $****4 , 879 . 77
BENICIA CA 94510-2577
COVERAGE
TIN 05-942776470 COLLISION (LOMV)
400-1 84,879.77
REMARKS
L—
CREATED BY Beverly HALEY
STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY 1 02 351659 J
NORTH COAST OFFICE BANK OF AMERICA NT 8 SA 11-35/1210
ROHNERT PARK, CA CUSTOMER SERVICE AMERICAS 1233 DATE 01/17/97
Pleas Hill Auto 02-103 CONCORD, CA
COVERAGE
COLLISION (LOMV)
CLAIM NO 05-6620-646 POLICY NO V098-905-05A CLAIM UNIT 168 400-1 $4,879.77
LOSS DATE 01/10/97
INSURED DIAZ, MARY
**x*****+***+*******************x**x*+EXACTLY FOUR THOUSAND EIGHT HUNDRED SEVENTY-NINE AND 77/100 DOLLARS * **'��$� •�7::
Pay to the
Order of.. MARY S DIAZ E DIABLO CHRYSLER PLYMOUTH
1436 LANDAHL CT TIN 05-942776470
BENICIA CA 94510-2577
AUTH BHALE
APPROVED BY
- - -- - - - —11- ... . ...., JVJ—V JH LUSS DATE U1/10/97 DRAFT NO 1 02 690398
PAYEt MARY S DIAZ DATE 02/07/97
1436 LANDAHL CT AMOUNT $*******20, 0.
BENICIA CA 94510-2577
TIN COVERAGE
RENTAL REIMBURSEMENT
REMARKS 2 DAYS LOSS OF USE 501-3 $20.00
CREATED BY Christina R Ransom-Gluege
E STATE FARM MUTUALAUTOMOBILE INSURANCE COMPANY
NORTH COAST OFFICE BANK OF AMERICA NT 8 SA 11.35/12101 02 690398 J
r ROHNERT PARK, CA CUSTOMER SERVICE AMERICAS 1233DATE 02 Emeryville 02-209 CONCORD, CA /07/97
COVERAGE
CLAIM NO 05-6620-646 POLICY NO V098-905-05A CLAIM UNIT 168 RE �REIM50R53MENT $20.00
LOSS DATE 01/10/97
INSURED DIAZ, MARY
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxEXACTLY TWENTY AND ODIlb%LLARS 41 doth�4�:k:�ftk
Pay to the
Order of. MARY S DIAZ
1436 LANDAHL CT
BENICIA CA 94510-2577 TIN
AUTH C
APPROVED BY
CLAIM NO 05-6620-646 POLICY NO V098-905-05A LOSS DATE 01/10/97 DRAFT NO 1 02 690394 J
PAYEE DATE 02/07/97
MARY S DIAZ
1436 LANDAHL CT AMOUNT $******224 . 00
BENICIA CA 94510-2577
COVERAGE
TIN RENTAL REIMBURSEMENT501-3 $224.00
REMARKS 14 DAYS AT $16 PER DAY.
i
I
CREATED BY Christina R Ransom-Gluege
STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY 1 02 690394 J
NORTH COAST OFFICE BANK OF AMERICA NT & SA 11-35/1210
�`• '• ROHNERT PARK, CA CUSTOMER SERVICE AMERICAS 1233 DATE 02/07/97
Emeryvi LLe 02-209 CONCORD, CA
COVERAGE
RENTAL REIMBURSEMENT
CLAIM NO 05-6620-646 POLICY NO V098-905-05A CLAIM UNIT 168 501-3 $224.00
LOSS DATE 01/10/97
INSURED DIAZ, MARY
fro :
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx:xxxxxwxxxxxxrxxxxxxexxxEXACTLY TWO HUNDRED TWENTY-FOUR AND 00/100 DOLLARS .�kxt A�iB 9Fik fi����.AP
Pay to the
Order of MARY S DIAZ
1436 LANDAHL CT
BENICIA CA 94510-2577 TIN
AUTH C
APPROVED BY
Enterprise ERAC-4E REV.1095
C;
rent
-a-car
Mr1 �111F' TI. l:H- •(H1F
EPd7rc,F•FrgF FENT-A-CAF CC"iF'AP:'Y OF =A^! :31,A- 6: tf,F TH t„Alit
:ALEPIEIr,P 122-5 SOMOt°:: FLY-E, 74-24)61 6:0%`IF-� !'Vtl— =T;-L�E
T, IjA L1 c i - c• .O(.-h_o_ _ I T'S -�>
YEAR RENTAL SOURCE/ I. e
rr TYPE T C I F�]�! tiCl, D,42-24!
YEAR O RENTER MILES O --
�Y UIiH=` '=:Lvc IF'P' PAJ CHr:�'Sc
START CHARGES IF DIFFERENT' ADDRESS HOMEPHONE
CITY STATE P OFFICE PHONE
1�_ _ O
ORIGINAL VEHICLE _
COLOR LICENSE NO, LOCAL ADDRESS OTHER PHONE
T
i_'.!CC {h1 F{11^Iih cl
MAKE ECAP A DRIVER'S LICENSE STATE E%PIPES , HOURS O
DOB HEIGHT WEIGHT EYES HAIR ---0it
MILE- IN
AGE OUT .... _ _ ✓ ._. _
SOCIAL SECURITY as EMPLOYER
DRIVEN
I '� BILL ❑ COMPANY _ _
CONDITION AGREED TO TO -j —
X t
x ADDRESS
777
CITY STATE 21P — --�T `
DV
ATTIC 1 — -PHONE Ti—EXT.
u '
RENTER ACCEPTS ”- ENTER REMER PEOUESTS DAMAGE WAIVER(OWl 4t RENTER
DAMAGE �" 'i Dur FEE SHOWN Iry ADJOINING COLUtINWP
_ _
RESPONSIBIIITY' X REVERSE.THIS IS NOT INSURANCE. X
P RENTER DECLINES 'RENTER RENTER REOOESTS PERSONAL A CIDFT RENTER
PERSONAL f-3 ".` ANCE Ival AT DAILY FEE sNG.vA m A _ -
;-F DDT, E Ya , % 'h % e/. % F ACCIDENT INSU IhP CMUMN AND'AS READ INE PoUCY CIPl :X::::
-
r: RENTER DECL NES TER RENTED PEWESTS CPTKKiPL SVPPLEMSAI RENTER
j
IN 4, IV 3-_;1/E 5/-/J/_je F O AL SUP0.EMENFAf 1� {`1j LAILTY PROTECTION AtEt AT DAILY RATE _ -
T 1 71
L G PROTECT SLPI X :I^1I IXUMN SEE RE ERSE X
IAUDI TIONAL DRIVER'- ONE PERMITTED WITHOUT ENTERPRISES APPROVAL.
'
Ir _iR�PL E Nf I � I"URRI E 1 msaA,sei Dny ww r _
AGE LICENSE NO.
DG ` STATE EXP.
COLOR LICENSE NO. -Who is under my control and O'BEti n ID drive Me ronMO WNdmcb for me and A my belull. I vn mar ordiDle
1
or Their s,WNI&They're cirms, and for wrlurq Mrtne uN cAnd'llonr Of this agreement. L
MAKE ECARA - �y �II `' 1 _
X RENTER 11' F�.I -� �� ENTERPRISE'S REP
MILE- IN PERMISSION GRMT�D FOR VEHICLt TO LEAVE THE STATE.
AGE OUT YES �A`IO STATES Y AUNDIBY SE'S REP
TOTAL CHARGES
DRIVEN
CONDITION AGRE NO GASOLINE REFUND
-I DAY MINIMUMX ACKNOWLEDGMENT OF TERMS AND CONDITIONS
� B�ENTER y- 'HAVE READ AND AGREE TO THE TENNIS ELOW IS CONSIDERED TO HAVE BEEN
DEPOSITS
E CREDIT CARD%OUCHER A14D I AUTHORIZE
V
`}
•
- : '
REFUNDS
DATE
g XJDREP EPL� 1 A
X
I WILL OATERNIM 0�0 AMOUNT PD BY TYPE DATE PO AUTH• CLOSED BY
F OUT E T/e T/• a/e 1A 5A e/i E/e F PEIDflN f _ IDEP. 4,
U 1T•-. _
CAR BY
L IN -G. T/e T/a D/e th % DA T/e F -EXT. ADDTL _ PAID CASH CHECK CR.CARD
T TO DEP. BY
_ EXT. ADDTL - RECEIPT FOR CASH REFUND
TO DEP.
EXT. ADDTL _ - DATE AMOUNT
TO DEP. 1 ) 1 BY REX
EXT. ADDTL CLAIM INFORMATION
TO DEP.
ADDITIONAL INFORMATION: POL.OR
CL d1tC'
I - 'INSD�t.IC
_ _ _ LOSS
-'�•" �liil'i E, __ _ _IC DATE --. MEET_ACCIgfMT_
PHONE NAME
C7 7 1.._
f SHOP
IR REPA
-� IR P
RENTER RESPONSIBLE FOR AND =1 SH H.e
AUTHORIZES CHARGES TO THEIR t, --
CREDIT CARD FOR TRAFFIC '\ TYPE CAR
VIOLATIONS
CUSTOMER COPY - ADDITIONAL STIPULATIONS ON. ERSE
:L_
PAGE 1 of
Wran oe.uvo(wr. ..
FrAG(:OILl51OU REPORT-Property Dama o only
Srtau eoWm(aRs YT{RYI b�':smKr!b x�wRv c
ru �
eo,..n RsronYo xrn,cr A46
urwsRY �y/
xcwusnow T[Y( unc /CL
owta,aaf 7
AT M{RtitIR1NMlR L.d�
S
WM 7 T IPrAWAY RAn✓YWI,Y4Y,Ui
ntr.YL33 °" S W T
PARTY [RS us[Rv sR ❑`'ss ❑Ro ❑r{R
1 eswn [A(xn sour.
wr {cRRrr.Y (.cwT! rWORs,RRru RECORD ONLY NOT SUBSTANTIATE:
OR INVESTIGATED BY CEP
t0. St t � aTTJ[rAn(nr/
IR rsR hR}MD YMsu C
0.
0 — l REPORT TAKEN AT
WCTG1[ pR TRA [t OR fTw{t}pR MGRWAT �_I—
CONTRA }COSTA CEP
oT"A snYR uARtiuoD4iCaLOR ucaa{YYxtR 5801 BLUM RD
PARrYZ oroviR3uctRs{uurstA .rAn CW[ SKxS'((pb/. MARTINEZ, CA 94553
VMtR Nf(AR .Y0044 LAfTI IMgll(NLY{iR �� �
DATE:
! ' t��
na RssT AanRssx mri3ran(ar
/K Y6R 3{It S,R}RgAT[ CNtR311 p{,CTpyx{((
rc4i pR.TRAT{l ORxfR[npYnyry,At �,s{o�, NEEDS FOLLOW-UP
orRSR [w TR rAKt�YwuicauY ucwa{R4WI{11 STAn vol nri FOLLOW-UP COMPLETE,
:Tx. RTT. R.o AG{ xt3 RAu{
.:3 ❑ ❑ AooR{ss r,oRt Ku[RSR SARs.
❑ ❑ A4i sac Rau{ aoaRau rroRt Y.Yu
/um
PROP. appRiy
4YYNEA oAK.a[o rWonwsT
REVIEW AND ANSWER ALL OF THE FOLLOWING QUESTIONS (THAT APPLY) .
PLEASE PRINT LEGIBLY.
1 . Date of collision: Time of collision: .. 30AM ore
Z . Today's date :
3 . If there has been a lapse of 3 days or more between the date
of this collision and today' s date, please explain.
1A 011 n(I VVIP
_ T
k L1c aj
SWlcou'nn
Rtit w r-d the
4 . WhWy were you in. I JA cth
S . What city were you in or near?_
Report #
Page 3
18 . Did the weather contribute to this collision? If so how?
19 . What were you doing just prior to the collision? (example-
looking to my Left to make a lane change; trying to ick up
a cigarette that I dropped; tuning my radio; etc. ) 'L sa1.J
a n6—WP
�9rCS tial r61 LJ �S rg rt'O -CIC u�4�C 51ti p��1P �v T i
fa.<bwv�(��
-(`r �� sine,• � ' �- ' �
20 . How did this collision occur? (Be specific, include as much
detail as possible)
NZ
c�
3 p
r t\ � ,r 0 n .
V
(use additional sheets if necessary)
Report #k
Page 4
21. What happened after the collision? '1
L
JA- h & �" '
22 . Did you sp ak with the other driver? If so, what was said?
r, .rte
1 r til e
23 . If not, did you attempt to stop the driver to get his/her
attention? (Explain)
24 . Describe the other driver: (sex, race, height, weight,
build, color of hair, facial hair, scars, tatoos, etc. )
25. Describe the other vehicle : (year, make, model, color,
license, identifying marks, etc. )
Report #
Page 5
26. Shade in damage. Your vehicle. Other vehicle.
IF YOUR VEHICLE WAS DAMAGED BY OR STRUCK AN OBJECT, COMPLETE
THE FOLLOWING:
27. Can you identify the object? (Example-golf ball size rock,
tire tread, small metal object, etc.•)
28 . Did the object fall from or was it kicked up by a vehicle?
z
29 . Did you actually see the object come off of the vehicle, or
Slid you see the object come from the area of the vehicle?
4
30 . Do you think the other driver was aware of the fact that
something had fallen from his/her vehicle? (Explain why you
think the driver had knowledge)
I ' orf
Report #
Page 6
31. If you feel that you have any other pertinent information
please explain.
NAME: (PLEASE PRINT)_jO(lt-O LJI-a
ADDRESS: �l +r;�l (�
DAY TIME PHONE NUMBERIZQJ -7 !44 — Q 7 O I YAm i 7�^ Otl� t
HOME PHONE NUMBER _(707) a ~ 0 ?C)
SIGNATURE:- N�OAJJ 4j } DATE e 1
File #10164-0009814 El
G ... 1. w ;; _V! i. ?4M F !A'MI
-- I;i : �:: r , . I.' '�+ ' .:::. ' 1i 11 . 1 '-!tltl•: ', :", .�i f'�f7F'
;, 005—yovnO 64601
µn0,21 S. "DI " Policy #
K `+'1�MAT CA 9415 Lit 05 .17 Date of Lass: 1110197 at 5:00
vti^ n1" i_.a t ., . C'Gi_ ._IiYiCN
74q.0700-- rik UV impact : ; r. FRONT
0
-
WIRMOND W11
d; t7Ttlt1 C'f! dr 4,_,e prase #k94-2776470
F _
.� ('' Yin icN(dFI1r VY.i�/G rti4'.S-' :- Jri jot=, ET4�.F.1-'..,d t�:-.I� h- .Sl=""+- �.
L+/!.:.�{: :.`h. :ftv �'•A: -'f? :-i ilo! . . 0/0 Mi leader 39669
1..0r: Y.;',rs7�.1,1trli_ie. cfta
i i ll AKPN ) rower- brakes
wipprs
rags _-uwwol .. ". i.v :.r. :_,', r!; ,Y wavnenger airbag
PORI'
Y A. 11; iii"c+-lial-,i'" i:I'r COST i..(11=tC;1=`. PAINT iH18C
0. 00
n : i is .i 443. 00 .i_nuil 0. 0
pf G1- L,t; md ! W , Qt pskn n; Ar hj 1 12. 00 Incl 0. 0
r•.a111 (notr6r,'W ur,KPI iower 320. 00 3. 8 0. 0
`* R£r 'Ili. r nr [ 5. 85 ITtCI
I7
New whe 1. L9 Fi . f " , a ie iLhel` 1. 14. 50 1ncIHK1!,.T ` 1 V EE)
4-11 s_ olumn asy wit ;. ' `, i. 460. 00 2. 3 0. 0
177. 50 0. 0 AR 2 3 1997
EMERYVILE B.C.
#101 -94-0009814 Et
Cl R F1 I 11,111Ftel
c n'-1 g✓,r-4 FV I P-$wz
V ON G R F;-N/M F T 6
L-FI
I ABOR PAINT m 1 C-3c,
4'l, 0 0. 0 X 658. 01
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d 7. 5-0 Inc] 0. 0
I. 7-. 4)0 0. 31 0. 0
RO lit 7 :,USPUN-S -IN
o m 00 4. 5 0. 0
1, UP] Ci os,,m em b e r bolt 4 11 . 00 Incl 0. 0
1 73. 50 Incl 0. 0
RT "I CT� 3:-it) .. 5. 00
0 1 Tl e 1 0. 0
8. L)'- Incl Q . Ot
- ---------------------------------------
304t). rBO 21. 2 0. 0 708. 01
RECEIVED
JAN 2 3 1997
EMERYWLLE S.C.
File #10184-0009614 E 1
_1...}'.:y- a= 3=f C16 R M :± 8-J F- l._! E2 C-k i\t C. }_=_ GCl m F-1 r-1 h.{ I E_C—a
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3046. 80
,53. 0a 11:='3. 60
FiUB ;r(i;; $ 4878. 41
80 at 8. 2 S00't• 251. 36
---- __
i:k1`.:"t" � i� RFF'EtIRS $ 5129. 77
r�?Ihi i1`i TY�i'.IVT`.i C
Crndrtr�i. 's. 131.:• -25a. a0
Rl T
Nf:1 i;,( F i-'jC r=i:1`- -IT RS s 4879.7 7
e
nTE _VIEWED &J 5 - ES?INET; REcI D SY EST,sRTaR��._
aLf.EMENTS REMPE -'RIOR AKPG'' L r.Y A STATE An. RE-'Ri:SENTGTIVE.
;te*ate based or N4TOR CRASri EST:"AT?tiG GUU9: Non-asterisk'+i iteas a"e der•ivea fro* the &ade DR3TE%. Database Date 11!%
oz'iblp a5tv15kk *; 7 o'.6 pat a'..,'.Ci:a2 uv a s4Cz,i ier' other than "e original eQu;F9eit vanufacturer.
CRFA ,te*s iave veer, certifies for 4i: sr:i finish by t o Ce,tified Auto Parts Association.
ElEst - A product of ;:CC info*stir,; SeeS;ws Irc.
�1T'OnJO{ c�,fverj s 56 . U aC77w -13�� C�
� rpD
�� rS 5.77
c,1 e - n7- �l`I3S'7 7
4
AMER TOW,INC. dba
-AAIERICA11,TOW S
• -. �`f,
(510) 682-8122
A"
5017•C FORM DRIVE,CONCORD,CA 44520
AGCOUWNO. i)rH+1� f 4�.-.,-1 C SIG . DATE ,a_
NAME '.
ADDRESS
CITY STATE
AA1.
TOW REQUESTED BY r"" 1 t ('. TIME P.M
MAKE (�f�,,.,I.tcL t• r.T.. dJ- � . YEAR + S" uc.No. 3Ntt�17�
CALOR 'r C V, V.LN.NO.
DRIVER GASH .OA. GE ON F R r'
TOW FROW❑ REARM DOLLY❑; WHEELLIFT❑ CARRIERy� *5 f gk ~
x
FROM: L..�(( .LL CF �_t ylt ClA
TO: 1-Y•a+.1< Cl..rT�l4• I'-t�< Qkt' }
s
2ND TOW
r
f!f
Toy H
x
TOTAL 1.tl
ADVANCE CHCS. <r -
STORAGE: .FROM:
SR D TOLL DEL GAS REt AFTER H ,p_ $
TIRE CHANGE DEAD BATTERY
RELEASE OF T
PERSONAL PROPERTY PHONE NO.
SERVICE
SG
NOT RESPONSIBL'- FOR ANY
RECEIVED BY nr
DAMAGE '
ALL CLAIMS MUST BE ACCOMPANIED
S.
• s � h i
R.O. P.O. +
EXPRATK7N DrAyTE T MEMSERSHIPNO.ORDRMERSMNa.,. -
,9125 i 24'HOUR SERVICE CUSTOMER COPY
Y �.
uhoi,,),7 Fj I jt P
r 6 I-If I1 II I,1i11llllf2,
olC I Y r'j
P1 J ;I INY H I 1 4 5.
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MOP ftW l') 4titfI
it
6 1-ANOAHL C T
FN C 0, 1 Y at F., 0 1A
-"-.:4 1 v o F L_,>> C01 t- f q I ON
Ot hp 7 07 1 :4n 0?0,)- Point Of Impact : 12 F RON r
0
F .aid
R:.rl_air MAR.() IHRYGDII=4 PINMOITH
I i t y 2180 01AMCIND PLVD
C.ONrOPn, FA q 451 2O Ltcenau 4()4-2 /7(-.47k1
5jlj V1)Y(jl1FP 4Y 1 .3ri VAN GRf FN/tWT 6-3, .31_-FT
k e
11,1-1- 4 - 141 ipi I I -
lo i-,h in I t
o I Pnor-r m
P 1 01 1 ON 0 i)cvi�11,1- T 1Y,1 1 N L,:3;.
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1 if:} I Il f r11rtS 14 1 0. t1L1 M. 0 0 zO. 00
In wt-1 I vi 0
on 0 i;P
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1 . r19UIl I t11 Cj J6 W0 7• -41 til, it 0. 0
2 1997
JAN 2
EMERYVILLE S.C.
r., 01 1 to f-0009 81 l Ft.
tt 0'. .91
0 i tR! 4111 V Ikt R f x IIF44-l-1 MF 1 £,- j;
14 L I-D T I ON Ir UPOI(IO (j I'' O f kttll' r,IZIINI
W t NW,14 T
I OFT, G,1. � I—HR Y =31 J" R t 1 11 t,ort 1 0. 041 0. 0 0. 0 < i- 53. 01
ON iji Ov.-)
1 p I A r o 1 0 1 J i!I P T E P I:,L A b!"'. ill 0 kII
F,Roti r Na t ON
Ho in I Fr6 foo m 1,) :3`). 0x,7 4. "1 0. QN
Pep] Cro 5 a ill e in her bin 1 1, 4 11 . 00 Incl 0. 0
PQPI Peinforcement t 73. 50 Incl 0. 0
RepI PT ( nk-4,,v, entrI arm 1. 10"). 00 Tm-1 0. 0
Pep [ P-1 I .owor cntrI arm bushing rpa I fl. 95 1 nc. L 41. 0
Sltbt ota 1 3046. !10 -'I
% 0. 0
PI n :
F C C I M V V I
Fil"VIA tZ Pt I.,it) 1.111 "ot"r. t l'i
Fart 5 046. 80
o f.-..%: o lAll 11; 1 1 . 6 0
S+_tb l et lrr I 1 708. 01
,3UPTO F01 T 487fA. 41
7',9x on $ :304i;, 8 0 8. D:500,.4
TOTAI. f-,*(')ciT OF PEPAIFO-i t 5 1 e?9. 77
NT5,-
oc"I
N[-'-I' CFIFj-F FIF RFPPMC; *1 4);79. 77
IWITE fVVIEWED gy wESTIMATE REVEWD BY ESTIMTOR
Vtiai.E*NTS RElki
' WOO L'1 8f A STATE P M WnK SENTAT 1 ljE.
�- l.RE PRIOR 6 '
^a;ed nn MOTOR CW, EMMATNG MCC ItOU are loeivod f,im hp Guido LIR;TEy6. Ditinisp nate 11P4.
-it- rA;-t SVOplied by i -or,,plipr other' th.ir lriqoml un if4[t rpr.
'--XA it,u hP,,q cprtifi.ed fIr `jt and `inch b, ;I,e Certified �Ajjt,
4 oI%nd,,j,-t if FfT, hf.lrvatlo^ fnr.
0 1
f_.i yA 97 1 V;I f 0
41 1
I Ol ill j I I
1-1 0 0 0111
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J+ hi le DT ive I b I e Isla
v Pl-Art".
F T n o n
L aiRY.,I En 1TAL E M4.1 I P I I I (A INF ORD, 0-i
i; Alla t; ., 7
ol I
fI
T':
otl
0 10 1L
lI-) Ir-.DTOCR
TCH Estimating Supiv. Review
to r Signature
DIM
e, ./ 7
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA April 15, 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 Gove [93)
Mount: $5,000.00 Section 913 and 915.4. Please note all •Nars" II�
CLAIMANT: Wesley James Swartz MAR 2 8 1,997
COUNTY COUNSEL
ATTORNEY: MARTINEZ CALIF.
Date received
ADDRESS: PO Box 143 BY DELIVERY TO CLERK ON March 27, 1997
Concord, CA 94522-0143
BY MAIL POSTMARKED: March 26, 1997
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: March 28, 1997 IVIL BATTCepuVELDR, Clerk 1�
11. FROM: County Counsel TO: Clerk of the Board of Supervisors
(�) This claim complies substantially with Sections 910 and 910.2.
( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying
claimant. The Board cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send
warning of claimant's right to apply for leave to present a late claim (Section 911.3).
( ) Other:
Dated: 31947 BY: � � "�" Deputy County Counsel
II1. 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: APR 15 1997 PHIL BATCHELOR, Clerk, B . IDaputy Clerk
YARNING (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.
7
Dated: APR 17 1997 BY: PHIL BATCHELOR Lem t�A-�uty 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 rieath 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. (Gov't Code 911.2 . )
B. Claims must be filed with the Clerk of the Board of Supervisors at its
office in Room 106, County Administration 5aildiug, 651 Pine Street,
Martinez, CA 94553 .
C. If claim is against a district i;overned 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, P*: ial Code Sec. 72 at the
end of this form.
RE: Claim By Reseived for Clerk's filing stamp
C..
Against the County of Contra Costa)
9r-- > FMAR 7 1997
Dict)
CLERK BOARD OF SUPEFv r;;
(F 11-4a i�,ame) ) CONTRA COSTA i-c. .
The undersigned claimant hereby makes claim against the _County 9f
Contra Costa or the above-named District in the sum of $ E'G
and in support of this claim represents as follows:
1. When did the damage or injury occur? (Give exact date and hour)
F6
1. . Where did t�e damage or ip3ury occur? (Inq�lude city and county)
_AJ1�
3. How did the damage (fir inqry c�c ;ur? (Give full detailsX use extra
paper if required) l�e�t� 1 �k 'F� l�7/Fit � G' �'FFE.I) l��r� IICIN
(t C�IIT — �7T+�1 `i"t t't F- Q Pc _
4. What particular act or omission on the part of county or district
officer servants or emplo,Yees a sed the injury or damage.
tvLb �CFV71 TKAT `�ffEV� CUFiS -Q , F fGi�GN7—
(over)
5. What ara the names of county or district officers, servants or
employees causing he damage or iM 7
IA' � kti - -L tC / t{C c'j
O�Q ;t
-rlfe- Ajko , fC> �)ATr a) f ' C) Tc, A-(o
5. :ghat damage or injuries do you claim resulted? (Give full extent
of injuries or damages claimed. Attach two estimates for auto
damage. ) %�4� c-,ti /—C-7T- /'} til� Ac),g6xk�'C c A) Ze—7- q), vb
7. How was the -amount claimed above computed? (Include the estimated
amount of a.iy p ospective injury or damage. )
PAI /0 it FFc_ �Ati'CE Pe)X me We, -r-fl
S. Names and addresses of witnesses, doctors and hospitals.
9. List the expenditures you made on account of this accident or
injury.
DATE TIME AMOUNT
Gov. Code Sec. 910. 2 provides
' The claim muse. -)e signed by *.':e
Claimant or by some person on his
SEND NOTICES TO: (Attorney) behalf. " _
Name and Address of Attorney )
( i 's Sig ure)
> C� tt o X Iq 3
(Address)
)
CJvf c"61u
Telephone No._ ) Telephone No. _
Not.
Section 72 of the Penal Coca provides:
Every person who, with i;-.tent to defraud, presents for allowanc.=_
or for payment te: any state board ,-r officer, or to any county, city
or district board or officer, authorized to allow or pay the same if
genuine, any false or frauOulent claim, bill, account, voucher, or
writing, is punishable either by imprisonment in the county jail for
R period of not more than one year, by a fine of not exceeding one
khousand ($1,000) , or by bot'i 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.
MAURICE MOYAL MAURICE MOYAL WARREN SIEGEL
Ph.D.(Accounting) A Professional Law Corporation CA State Bar 464605
Admitted to Dist. MOYAL BUILDING
of Columbia Bar 1899 CLAYTON ROAD,SUITE 100
CONCORD,CALIFORNIA 94520-2541
D.C.Bar 9370624 Tel: (510)686-0200
CA State Bar 9052648 Fax: (5 10)686.0204
Colonel,U.S.A.(Ret)
i
MAR 2 7 1997
CLER CONTRRD OF SUP
A COS A CO�SORS
March 26, 1997
Clerk of the Board of Supervisors
Contra Costa County
County Administration Bldg. , Room 106
651 Pine Street
Martinez , CA 94553
Re: Wesley James Swartz
Dear Clerk:
Enclosed please find a claim from Mr. Wesley James Swartz .
Please return a copy with your clerk' s filing stamp. A stamped,
self-addressed envelope is provided.
Thank you for your courtesy and cooperation.
Very truly yours,
MAURICE MOYAL
A PROFESSIONAL LAW CORPORATION
MAURICE MOYAL ce,
MM/lp
Enclosures
cc: Wesley James Swartz
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