HomeMy WebLinkAboutMINUTES - 04221997 - C16 CLAIM
rr BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA April 22, 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: $800,000.00 Section 913 and 915.4. Please note all "
aw
CLAIMANT: Edward L. Turner
ATTORNEY: APR 0 3 9997
Date received COUNTY COUNSEL
ADDRESS: 901 Court St. BY DELIVERY TO CLERK ON March 28, 1997 MARTINEZ CALIF.
Martinez, CA 94553
BY MAIL POSTMARKED: March 27, 1997
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: April 3, 1997 gglL BATT ffiLOR, Clerk�� �—
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
(x) 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:
e"
Dated: 3 BY: A
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 2 2 1997 PHIL BATCHELOR, Clerk, B�': o 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 4 1997 BY: PHIL BATCHED �� a ty Clerk
CC: County Counsel County Administrator
Cl,,*aim 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.
RE: Claim By _ Reserved for Clerk's filing stamp
)
Against the County of Contra Costa) RECEIVED
or )
District)
MAR 2 81997
(Fill in name) )
CLERK BOARD OF SUPERVISORS
CONTRA COSTA CO.
The undersigned claimant hereby makes claim against the County of
Contra Costa or the above-named District in the sum of $ YO0,O4�10 ®c�
and in support of this claim represents as follows:
1. , When r1i_d the !anaae car in-" nc-r».z? (Give exact date and hour)
i 2. Where did the damage or injury occur? (Include city and county)
C0AAV4,<AP- 60S11f C040J.4d1Z /64®& t�1dli?rjO���f4
3. How did the damage or injury occur. (Give full de ta ls; use extra
paper if required) >®ec?"v D,o//;,f-4_
-e Ole
4. What particular act or omission on the part of county or district
officers, servants or employees caused the . injury or damage?
7 -70
Y411441�le
/�®e i(- 5�� '� `� GCJ��- / v
5. What are the names of county or district offi , ers, servants or
employees causing the damage or injury?
i
6. What damage or injuries do you claim resulted? (Give full extent
of injuries or damages claimed. Attach two estimates for auto n p
damage. )
Axe A'Ork a& ® eve -Polo
3 da
7. How was the amount claimed above computed? (Include the estimated
amount of any prospective injury or damage. )
8. Names qtnd addresses of wit essefs, doctors and hospitals.
Oe
9. List the expenditures you made on account of this accident or
injury.
DATE TIME AMOUNT
/Vaa e- 6, 0r
Gov. Code Sec. 910.2 provides
"The claim must be signed by the
claimant or by some person on his
SEND NOTICES TO: (Attorney) ) behalf. "
Name and Address of Attorney
(ClaimaW is Signature)
Ve / ("Mv�,�er er)
(Address)
� Cly o 5;,V,5 �q
Telephone No. ) Telephone No.
Section 72 of the Penal Code provides:
Every person who, with intent to defraud, presents for allowance
or for payment to any state board or officer, or to any county, city
or district board or officer, authorized to allow or pay the same if
genuine, any false or fraudulent claim, bill, account, voucher, or
writing, is punishable either by imprisonment in the county jail for-
a period of not more than one year, by a fine of not exceeding one
thousand ($1,000) , or by both such imprisonment and fine, or by
imprisonment in the state prison, by a fine of not exceeding ten
thousand dollars ($10, 000, or by both such imprisonment and fine.
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CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA April 22, 1997
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $25,000.00+ Section 913 and 915.4. Pleas(AaaVi
CLAIMANT:George A. and Gloria R. Acevedo, et al APP n 4 1997
ATTORNEY:Thomas C. Nagle COUNTY COUNSEL
Law Offices of Thomas C. Nagle Date received MARTINEZ CALIF.
ADDRESS: 500 Ygnacio Valley Rd. , Ste. 325 BY DELIVERY TO CLERK ON April 3, 1997
Walnut Creek, CA 94596
BY MAIL POSTMARKED: April 1, 1997
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: April 4, 1997 gyIl Bep �HtyLOR. Clerk
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
( This claim complies substantially with Sections 910 and 910.2.
( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying
claimant. The Board cannot act for 15 days.(Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send
warning of claimant's right to apply for leave to present a late claim (Section 911.3).
( ) Other:
Dated: � BY: 4J( t� � 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
VI ) 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 2 2 1997 PHIL BATCHELOR, Clerk, Byvi�-ec� isa —"'. 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 2 4 1997 BY: PHIL BATCHELOR —Deputy Clerk
CC: County Counsel County Administrator
LAW OFFICES OF
THOMAS
101V1I1J �. NAGLE 500 YGNACIO VALLEY ROAD,SUITE 325
WALNUT CREEK,CA_94596
A PROFESSIONAL CORPORATION <510)933
FACSIMILE MILE(510)933-7804
THOMAS C. NAGLE
SHARON M. NAGLE
Apri12, 1997 RECEIVED
t.:
APR '3 MR
CERTIFIED MAIL/ CLERK aOAAb OF SUPERVISORS
CONTRA COSTA CO.
RETURN RECEIPT REQUESTED
Clerk of the Board of Supervisors
Contra Costa County
651 Pine Street
Martinez, CA 94553
Re: Claim of Acevedo v. County of Contra Costa
Dear Clerk:
Enclosed please find a Claim to be filed in the above matter. Please return a date stamped
copy in the enclosed self-addressed envelope.
Thank you for your assistance.
Sincerely,
Jessica Ruffin
Secretary to Thomas C. Nagle
Enclosures
1 THOMAS C. NAGLE (Bar No. 037619)
SHARON M. NAGLE (Bar No. 179124)
2 LAW OFFICE OF THOMAS C. NAGLE
500 Ygnacio Valley Road, Suite 325
3 Walnut Creek, CA 94596
Telephone: (510) 938-2299
4
JEFFREY D. POLISNER (Bar No. 040551)
5 BOLD, POLISNER, MADDOW, NELSON, AND JUDSON
500 Ygnacio Valley Road, Suite 325
6 Walnut Creek, CA 94596
Telephone : (510) 933-7777
7
Attorneys for Claimants
8
9
10 BEFORE THE BOARD OF SUPERVISORS
11 COUNTY OF CONTRA COSTA
12
In re : Claim of ) CLAIM AGAINST PUBLIC
13 ) ENTITY
GEORGE A. and GLORIA R. )
14 ACEVEDO, ET AL. ) RECEIVE®
15 Claimants, )
16 vs . ) APR —31997
)
17 COUNTY OF CONTRA COSTA ) CLERK BOARD OF SUPERVISORS
CONTRA COSTA CO.
18
19 The below stated claimants hereby make claim against the
20 COUNTY OF CONTRA COSTA (hereinafter sometimes referred to as
21
"COUNTY" . ) Pursuant to Government Code section 910, claimants
22
23 make the following representations in support of these claims :
24 (a) The name and post office address of the claimants are as
25 follows:
26
See Exhibit "A" attached hereto. All claimants can be
27
28 1
1 reached in care of the Law Offices of Thomas C. Nagle, 500 Ygnacio
2 Valley Road, Suite 325, Walnut Creek, California, 94596 or Jeffrey
3
D. Polisner, Bold, Polisner, Maddow, Nelson and Judson, 500
4
5 Ygnacio Valley Road, Suite 325, Walnut Creek, California, 94596 .
6 (b) The post office address to which the person presenting
7 the claim desires notices to be sent is as follows:
8
Thomas C. Nagle, Law Offices of Thomas C. Nagle, 500 Ygnacio
9
10 Valley Road, Suite 325, Walnut Creek, California, 94596 ; Jeffrey
11 D. Polisner, Bold, Polisner, Maddow, Nelson and Judson, 500
12 Ygnacio Valley Road, Suite 325, Walnut Creek, California, 94596 .
13
(c) The date, place and other circumstances of the occurrence
14
or transaction which gave rise to the claim asserted are as
15
16 follows :
17 The claimants own, have recently sold, and/or reside at homes
18 located in the City of Pittsburg, in the neighborhoods near the
19
Keller Canyon Landfill . In 1990, the COUNTY issued the Keller
20
21 Canyon Landfill Land Use Permit 2020-89 . Condition of Approval
22 35 . 3 of LUP 2020-89 states in part that, "The landfill operator
23 shall provide funding for the preparation of a property value
24
compensation program study when requested by the County of Contra
25
26 Costa. . . .When a compensation program is adopted by the Board of
27 Supervisors, the landfill developer shall fund it in the manner
28 2
I specified by the Board. "
2 On or about November, 1996, the Board allocated $485, 000 to
3
compensate property owners near the Keller Canyon Landfill for
4
5 declining property values as a result of the Landfill . At a
6 meeting of the Contra Costa County Board of Supervisors ( "the
7 Board" ) on March 18, 1997, the Board unanimously approved a payout
8
program whereby individual homeowners may make claims against this
9
10 fund which will be examined by a claims evaluator.
11 (d) A general description of the indebtedness, obligation,
12 injury, damage or loss incurred so far as it is known at the time
13
of presentation of this claim, is as follows:
14
Condition of approval 35 . 3 of LUP 2020-89 was intended to
15
16 compensate homeowners for declining property values as a result of
17 the Keller Canyon Landfill . As such, claimants, as well as other
18 homeowners in the neighborhoods adjoining the Keller Canyon
19
Landfill, are third party beneficiaries of LUP 2020-89 . The
20
21 COUNTY has breached the condition of approval by allocating an
22 inadequate amount of monies to compensate claimants, and other
23 neighboring homeowners . In so doing, the COUNTY abused its
24
discretion.
25
26 (e) The name or names of the public employee or employees
27 causing the injury, damage, or loss, if known, is as follows:
28 3
1 Unknown to claimant at this time .
2 (f) Amount of claim:
3
The amount claimed pursuant to these claims exceeds twenty-
4
5 five thousand dollars ($25, 000 . 00 . ) Jurisdiction over these
6 claims rests with the Superior Court . Claimants will be seeking
7 attorneys fees through California Code of Civil Procedure Section
8
1021 . 5 in representing these claimants and others who may benefit
9
10 from attorneys' efforts .
11 n /
12 Dated: _ d� 1997 Jeffrey D. Polisner
13 BOLD, POLISNER, MADDOW,
NELSON & JUDSON
14
LAW OFFICE OF THOMAS C. NAGLE
15
16
17 By:
T MAS NAGLE
18 Attorneys for Claimants
19
20
21
22
23
24
25
26
27
28 4
Printed on Recycled Paper
201%Post Consumer Waste
Exhibit"A"
George A. & Gloria R. Acevedo Armando Cardoza
2248 Daffodil Dr. 2211 Santa Maria Dr.
Pittsburg, CA 94565 Pittsburg, CA .94565
Jose Luis Agredano Frank and Kelly Capaldo
2241 Santa Maria Dr. 2227 Carmel Ct.
Pittsburg, CA 94565 'Pittsburg, CA 94565
Frank Aiello Gary & Victoria Carr
1734 Bridgeview St. 22 Mt. Whitney Dr.
Pittsburg, CA Pittsburg, CA 94565
Oscar A. Ardon Mark Condos
(see Daysi Pineda) 2211 Begonia Ct.
Pittsburg, CA 94565
Patrick W. and Cathryn E. Baird
2211 Concord Dr. Ronald L. & Lisa N. Desposito
Pittsburg, CA 94565 2263 Jacqueline Dr.
Pittsburg, CA 94565
Sally and David Bone
2253 Mount Whitney Dr. Nancy J.H. Dion
Pittsburg, CA 94565 2238 Concord Dr.
Pittsburg, CA 94565
Roger Berry
2240 Concord Dr. Lance J. and Maria Dow
Pittsburg, CA 94565 2232 Concord Dr.
Pittsburg, CA 94565
Stefan Burdt
2236 Concord Dr. John and Raegene Edens
Pittsburg, CA 2231 Mt. Whitney Dr.
Pittsburg, CA 94565
James T. Busbee
2113 Sugartree Harry T. & Gail C. Elliott
Pittsburg, CA 94565 1321 West Leland Rd.
Pittsburg, CA 94565
Jeffrey L. Bush
2223 Mt. Whitney Dr. Hector and Raquel Enriquez
Pittsburg, CA 2222 Concord Dr.
Pittsburg, CA 94565
1
Reynato R. & Milagros Evangelista Connie& Barry Grant
2221 Begonia Ct. 2217 Concord Dr.
Pittsburg, CA 94565 Pittsburg, CA 94565
*
*William & Edythe Fairclough Franklin M. & Dorothy Griego
P.O. Box 270 2232 Jacqueline Dr.
Martinez, CA 94553 Pittsburg, CA 94565
Jeffrey & Jane Fischer James F. Hampton
1121 Los Palos Ct. 2240 Westwood Lane
Pittsburg, CA 94565 Pittsburg, CA 94565
H. Dwayne & Anna G. Fisher Frank& Jimmie Hensler
1140 Los Palos Ct. 2214 Mt. Whitney Dr.
Pittsburg, CA 94565 Pittsburg, CA 94565
Louise E. Foreg Robert& Rita Hinde
2218 Concord Dr. 2214 Jacqueline Dr.
Pittsburg, CA 94565 Pittsburg, CA 94565
Kelly Shawn Fraga Madeleine & Leif Holmen
1115 Los Palos Ct. 2239 Concord Dr.
Pittsburg, CA 94565 Pittsburg, CA 94565
Tifton& Julie Gantt Robert L. & Sharon L. Hussey
2228 Santa Maria Dr. 2262 Jacqueline Dr.
Pittsburg, CA 94565 Concord, CA 94565-4470
Peter and Christa Gomm Francisco A. & Ethel A. Jarguin, Jr.
2241 Concord Dr. 2265 Jacqueline Dr.
Pittsburg, CA 94565 Pittsburg, CA 94565
Ricardo & Elsy Y. Gonzalez Larry L. & Carol Jones
1060 Westmont Ct. 2220 Concord Dr.
Pittsburg, CA 94565 Pittsburg, CA 94565
Michael J. Gonsalves **Joe & Brenda Kermode
2243 Jacqueline Dr. 2150 Chestnut Dr.
Pittsburg, CA 94565 Pittsburg, CA 94565
Larry A. & Frances V. Gonzales Scott Leach& Donna Threde
2255 Mt. Whitney Dr. 2226 Jacqueline Dr.
Pittsburg, CA 94565 Pittsburg, CA 94565
2
Antonio & Arminda Loza A. Daysi Pineda& Oscar A. Ardon
51 Maylard St. . 2209 Santa Maria Dr.
Baypoint, CA Pittsburg, CA 94565
Michael P. Lyons Cecilio & Sherry Quintana
2230 Mt. Whitney Dr. 2261 Jacqueline Dr.
Pittsburg, CA 94565 Pittsburg, CA 94565-4470
John& Margery Sue McKee John P. &Anita M. Reudy
2260 Jacqueline Dr. '1142 Los Palos Ct.
Pittsburg, CA 94565 Pittsburg, CA 94565
Andrew E. Miller Keith M. and Sheri A. Robb
2268 Jacqueline Dr. 222 Carmel Court
Pittsburg, CA 94565 Pittsburg, CA 94565
Dan & Jill Millpointer Garth A. & Kelli A. Robershaw
2255 Jacqueline Dr. 2245 Jacqueline Dr.
Pittsburg, CA 94565 Pittsburg, CA 94565
Robert, Paul & Mary Mullen **Mark and Kathy Rusch
2213 Santa Maria Dr. 930 Rockridge Way
Pittsburg, CA 94565 Pittsburg, CA 94565
Guadalupe U. & Sandra Murguia Melvin Sasahara
2225 Daffodil Dr. 2229 Daffodil Dr.
Pittsburg, CA 94565 Pittsburg, CA 94565
Alan S. & Terry E. Park Michael J. & Mary M. Saverio
2269 Mt. Whitney Dr. 2250 Jacqueline Dr.
Pittsburg, CA 94565 Pittsburg, CA 94565
Trace & Michele Parks David M. & Annette Sherman
2205 Santa Maria Drive 2230 Concord Dr.
Pittsburg, CA 94565 Pittsburg, CA 94565
Valerie A. Patton Kenneth L. Swasey
1024 Via Ventio Way 2232 Santa Maria Dr.
Pittsburg, CA 94565 Pittsburg, CA 94565
Ned and Judith Pehrson Adelio & Angelita Tanyag
2250 Concord Dr. 1107 Los Palos Ct.
Pittsburg, CA 94565 Pittsburg, CA 94565-4337
3
Casandra W. & Peter S. Terry
2245 Concord Dr.
Pittsburg, CA 94565
Andrew P. & Teresa L. Thomas
2219 Concord Dr.
Pittsburg, CA 94565
Russell & Karen Thorsted
2261 Mt. Whitney Dr.
Pittsburg, CA 94565
Donna Threde (see Scott Leach)
Patricia A. Townsend
2227 Concord Dr.
Pittsburg, CA 94565
Chuck J. & Laura A. Vaughn
2261 Concord Dr.
Pittsburg, CA 94565
Coy and Martha M. Wilson, Sr.
2257 Mt. Whitney Dr.
Pittsburg, CA 94565
Kevin & Margaret Wise
1148 Los Palos Ct.
Pittsburg, CA 94565
James R. Worley
1117 Los Palos Ct.
Pittsburg, CA 94565
James L. & Maureen E. Wright
2226 Ridgecrest Way
Pittsburg, CA 94565
Note: ** Mailing address different
than property address
4
I PROOF OF SERVICE BY MAIL
[C.C.P. §§1013(a) and 2015.51
2
3 I declare under penalty of perjury under the laws of the State of California that I am over the age
4 of eighteen (18) years, and am not a party to the within action; my business address is Law Offices of
5 Thomas C. Nagle, A Professional Corporation, 500 Ygnacio Valley Road, Suite 325, Walnut Creek,
6 California 94596-3840; telephone number(510) 933-7777.
7 On this date I served the following documents:
8 CLAIM AGAINST PUBLIC ENTITY
9 on the parties or person(s)in this matter by placing a true and correct copy thereof enclosed in a sealed
10 envelope marked Certified Mail, Return Receipt Requested, with the appropriate first class postage
11 thereon fully prepaid in the United States Post Office mail box located in Walnut Creek, California
12 addressed as follows:
13 Clerk of the Board of Supervisors
County of Contra Costa
14 651 Pine Street, Room 106
Martinez, CA 94553
15
Executed in Walnut Creek, California on April 2, 1997.
16
17 �—
sica Ruffin
18
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C. /!G
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA April 22, 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: $500,000.00 Section 913 and 915.4. Please note: ����> -Z
�
Z-11
CLAIMANT: Richard Keith Bosch
PR 0 4 fag,
ATTORNEY: COUNTY COUNSEL
Date received MARTINEZ CALIF.
ADDRESS: 90 Boulder Creek Ct. BY DELIVERY TO CLERK ON April 3, 1997
Danville, CA 94526 AP 1 April 2
BY MAIL POSTMARKED: 1997
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED:�ril 4, 1997 IVIL BATCepuVE OR, Cler���,., --
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: �YG �I BY: /� Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present
(X) This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this date.
Dated: APR 2 2 1997 PHIL BATCHELOR, Clerk, �y-�/�-/�- •� .beputy 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 24 1997 BY: PHIL BATCHELOR eputy Clerk
CC: County Counsel County Administrator
• Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
f 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 D-strict 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: im By Reserved for Clerk's filing stamp
)
F
RECEIVE®
Against the County of Contra Costa) APR - 3 1997
or )
CLERK BOARD OF SUPERVISORS
District) CONTRA COSTA CO.
(Fill in name) )
The undersigned claimant hereby makes claim against the—County of
Contra Costa or the above-named District in the sum of $ SOO, CC>04
and in support of this claim represents as follows:
1. ' }.�: a� . .:y �.i � J' Lj vt. . �'Jr-^yet.' .:.iit1::L llft�,.► tlYxi 11��1Z`�
� Is
- ter(
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)- e � W
4 . What particular act or omission on the part of county or district
fficers, servants or employees caused the injury odamage?
on
��CX*M-(over)
5. What are the names of county or district officers, servants or
employees causing the damage or injury?
6. What damage or injuries do you claim resulted? (Give full extent
of injuries or damages claimed. Attach two estimates for auto
damage. ) �
7. How was the amount claimed above computed? (Include the estimated
amount of any prospective injury or damage. )
{
8. Names and addresses of witnesses, doctors and .hosp'tals.
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 some person on his
SEND NOTICES TO: (Attorney)
Name and Address of Attorney )�
(FC!aimant's Signature)
�Bwmap Caws cr.
(Address)
CA-PLA �p
Telephone No. ) Telephone No
\O Orl%L
NOTICE
Section 72 of the Penal Code provides:
Every person who, with intent to defraud, presents for allowance
or for payment to any state board or officer, or to any county, city
or district board or officer, authorized to allow or pay the same if
genuine, any false or fraudulent -claim, bill, account, voucher, or
writing, is punishable either by imprisonment in the county jail for
a period of not more than one year, by a fine of not exceeding one
thousand ($1, 000) , or by both such imprisonment and fine, or by
imprisonment in the state prison, by a fine of not exceeding ten
thousand dollars ($10,000, or by both such imprisonment and fine.
C
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ir-
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA April 22, 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
Amount: Unknown Section 913 'and 915.4. Please note WEarnings11, _�
CLAIMANT: Rhea D. Chapman APR 0 3 1997
ATTORNEY: MART NEZCALIFL
Date received
ADDRESS: 1360 Springhill Dr. BY DELIVERY TO CLERK ON April 2, 1997
Pittsburg, CA 94565 Hand Delivered via: Risk M t.
BY MAIL POSTMARKED: �
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
PPHHIL Bepu yLOR, Cle
epu y ►�1��
DATED: April 3, 1997 elr:
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
0
0 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: Lill 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.
APR 2 2 1997
Dated: 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 2 4 1997 BY: PHIL BATCHELOR ep ty Clerk
CC: County Counsel County Administrator
Clair- to: BOAM) OF SUPERVISORS OF COMM COSTA COUNTY
INSTRUCTIONS TO CLAI KWr
A. Claims relating to causes of action for death or far injury to Person or to per-
sonal property or g'r'owing cps and slhich 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 uses of action for-death or for inJurY to Person
or to personal property or growiM cps and Mich acorue on or after 4=uary 1,
1988, must be presented not later than six months after the aconin]. 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. On' 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 9k553.
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 Ser. 72 at the end of this
BE: Claim By ) Reserved for Clerk's filling stamp
RECEIVED
Against the County of contra Costa APR - 2 1997
or ) 1Z.:.
CLERK BOARD OF SUPERVISORS
District)
F 1r1 a - CONTRA COSTA CO.
The undersigned claimant hereby makes claim against the County of Contra Costa or
the above-named District in the sum of $ and in support of
this claim represents as follows:
1. When did the damage or injury occur? "(Give exact date and hour)
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)
�1. What particular act or omission on the part of county or district officers,
se^vants or employees caused the injury or damage?
wnat- are the nages of counL_v or district officers, servants or employees causing
the or injury?
5. 'What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. ttach two estimates for auto damage.
v-
vlo L s -F e� -�ro wi 6oV r.+,wt7 hc_-)!L PA-Irl,
Slncle" Zb q
7. How was the amount claimed above computed? (Include the estimated amount of 'any
prospective injury or damage.)
$. ?lames and addresses of witnesses, doctors and hospitals.
9. List the expenditures you made an account of this accident or injury:
DATE ITEM1T 0 J25. ��.
J U <+ .loS"f vim. `-0-� CA.0-,— --�b fa � ��-
t � a'
oe ul�cdt J � V�/tJc �jci ts nn+ a: l bw(n9
-� Gov. Code Sec. 910:2 provides:
"The claim must be signed by the claimant
SQ1D NOTICES 70: (Attbrne )- :•�.; 17or some on his behalf:"
Name and Address of Attorney
Claimant's Signature)
131obn,
A .
Telephone No. Telephone 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, bill,, account, voucher, or writing, is. punishable. eitherby 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
the state prison, by a fine of not exceeding ten thousand dollars ($10.,000, or by
both sz2ch a-rid f-i np.
u��l i l� d,rivin o� ova Cov�c.u��l ,�Ve . J us `�
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3-79
i
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA April 22,- 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
Amount: $112,000.00 Section 913 and 915.4. Please note all ings".
CLAIMANT: Theresa Hamilton and Duane Hamilton APR 0 3 1997
COUNTY COUNSEL
ATTORNEY: c/o Thomas M. Burton (035856) MARTINEZ CALIF. .
Date received
ADDRESS: 5820 Stoneridge Mall Rd. , Ste. 10@Y DELIVERY TO CLERK ON March 28, 1997
Pleasanton, CA 94588 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.
DATED:_April 3. 1997 IaIl BepuHtyLOR, Cleri —�/t-e''�e-`` /'�'�
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: L141fI 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 2 2 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 2 4 1997 BY: PHIL BATCHELOR aR'A--Beputy Clerk
CC: County Counsel County Administrator
Thomas M. Burton (035856) RECEIVE
5820 Stoneridge Mall Road, Suite 100
Pleasanton, CA 94588 78itffi
1W
Telephone: (510) 484-3233Attorne for Claimants CLERK OF SUPERVISORS
Attorney CONTRA COSTA CO.
BOARD OF SUPERVISORS
COUNTY OF CONTRA COSTA
Claim of Theresa Hamilton Gov. Code §§820.21; 911 et. seq.
and Duane Hamilton,
Claimants.
1. Claimant's Names: Theresa Hamilton and Duane Hamilton, 26 Andover
Place; San Ramon, CA 94583.
2. Occurrence: On September 30, 1996, Judi Olivier, a social worker for
the Contra Costa County Social Services Department filed in Contra County
Superior Court two verified petitions containing exaggerated claims of child
abuse against the Claimants arising out the mother's corporal discipline of her
daughter with reference to academic performance; case numbers J96-02218 and
J96-02219.
The Department requested that both minor children in the home be
declared dependent children of the Juvenile Court.
The face of the petitions disclosed no facts even remotely suggesting that
the physical health of the children was ever in substantial danger. Three
1
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA -April 22, 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 Go 15%W111D
Mount: Unknown Section 913 and 915.4. Please note all wings".
CLAIMANT: Terrice Hampton APR 0 3 1997
COUNTY ATTORNEY: MARTINEZ CALIF
Date received
ADDRESS: 1360 Springhill Dr. BY DELIVERY TO CLERK ON April 2, 1997
Pittsburg, 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.
DATED: April 3, 1997 cglL BATCHELOR, Clerk �J �J jLcLc�c�
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: 715,! f-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
(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. l 9
Dated: APR 2 2 1997 PHIL BATCHELOR, Clerk, By-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
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the
United States, over age 18; and that today I deposited in the United States Postal Service in Martinez,
California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to
the claimant as shown above. � c�a'—'
Dated: APR 2 4 1997 BY: PHIL BATCHELOR Deputy Clerk
CC: County Counsel County Administrator
Clain to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A. Claims relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and which accrue on or before December 31, 1987,
must be presented not later .than the 100th dayafter 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.
to T2• t_L.. .s� ! "- - Lt� i Z 4• L.. � �. L...
L. 1.11E cialm Is ag A.,iJN t�1111C�. 1iilGrl V11G lJ1.lUlal: �.ntlb�, separate cialULJ �luJl. uG
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
_ 1
I e�rr' RECEVE®rAPRAgainst the County of Contra Costa )
-21997
or ) `°
CLERK BOARD OF SUPERVISORS
District) CONTRA COSTA CO.
Fill in name )
The undersigned claimant hereby makes claim against the County of Contra Costa or
the above-named District in the sum of $ ✓1 and in support of
this claim represents as follows:
1. When did the damage or injury occur? (Give exact date and hour)
I /�Z(,/9_7 j5.'2
2. Where did the damage or injury occur? (Include city and county)
C
_ �. , omb C`J
3. How did the damage or injury occur? (Give full details; use extra paper if
required)
o
--------------------------- --------------------------------
4. What particular act or omission on the part of county or district officers,
servants or .employees caused the injury or dama e?
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�. What are the names of county or district officers, servants or employees causing '
the damage or injury?
Age,• I5 th
------------------------------------------------------------------------------------
5. What damage or injuries do you claim resulted? (Give full extent of injuries or
damage claimed* Attach two estimates for' auto damage.
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7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.) II r
$. Names and addresses of witnesses, doctors and hospitals.
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9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT I, -
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x/27/97. 1 ��sSedL, Sc,1�.6�C �•�- -fb
112 Ok _
Gov. Code Sec. 910:2 provides:
"The claim must be signed by the claimant
SEND NOTICES TO:. (Attorne ) or by some 2erson on his.behalf."
Name and Address of Attorney
Claimant's ianature
Ad ess
Telephone No. 1 Telephone No. L-7 (31
N 0 T I C E
Section 72 of the Penal Code provides: - -
"Every person who, with intent to defraud, presents for allowance or for
payment to any state board or officer, or to any county, city or district board or
officer, authorized to allow or pay the same if .genuine, any false or fraudulent
claim, bill, account, voucher, or writing, is punishable either by imprisonment in
the county jail for a period of not more than one year, by a fine of not exceeding
one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in
the state prison, by a fine of not exceeding ten thousand .dollars ($10,000, or by
both such imprisonment and fine.
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PLEASE RETURN TO — FOR A
RECHECK IF NOT MUCH BETTER IN THE NEXT DAYS, AND RECHECK AT ONCE F YOU ARE GETTING WORSE;
USE THE EMERGENCY ROOM IF YOUR DOCTOR OR CLINIC IS NOT AVAILABLE. WE ARE OPEN 24 HOURS A DAY.''
❑ The following•are specific instructions.which you should follow:
i
r
EAD INJURY ❑ WOUND CARE(cuts,abrasions,burns etc.)
A. Notify doctor if the following symptoms occur: Keep the dressing or wound clean and dry.
1.Unconsciousness Elevate the wound to help relieve soreness and help speed wound
2.Confusion healing.
-3.Unusual sleepiness
4.Vomiting more than once Use antibiotic ointment daily to wound.
5.Blurred or double vision Despite the greatest care,any wound can be infected. If your wour
6. Increasing dizziness becomes red,swollen,shows pus or red streaks,or feel more sore
r 7.Fever over 1,00°F. instead of less sore as days go by you must report to your doctor
h 8..Inability to move arms or legs ,right away,or'return to emergency room,
9.,Convulsions,fits or seizures
10"Colorless fluid or bleeding from ears or nose. Have sutures removed in days. Recheck if worse
i
4
B.Awaken patient every hours the tr ours after the ❑ SPRAIN&FRACTURE,SEVERE BRUISES
injury to check for these signs and make sure he/she knows their
i name,the date,and where they are: ' 1. Elevate the injured part to lessen swelling.This may be comfortably
done with pillows,blankets-etc.
❑ BACK&NECK INJURY INSTRUCTIONS 2. Ice packs also help prevent swelling,especially during the fist 48 hour.
Place ice in a plastic or rubber bag,with a cloth cover.
1. Use heat or cold on the injured area,whichever seems to help the most. 3. If the part swells or gets cold,blue or numb,or if pain increases
Be careful not to burn yourself. markedly, have it checked promptly by physician.
2. Avoid activity causing pain. 4. If you have an elastic bandage,rewrap it if too tight or loose.Loosen f
30 minutes at least every eight hours.
3. You generally feel worse in 36-48 hours after the injury;then
improvement should definitely begin if you are not aggravating the injury
and are following instructions. If not,contact your doctor. ❑ UTI INSTRUCTIONS
4. If you develop numbness and or weakness in arms or legs after A. Empty your bladder after:
emergency treatme t`notify physician.
j 1.Intercourse(sex) 3.Bicycle riding
I1r 2. Hottub 4. Bubble bath
Physician's Time r, ( Date (�
Signature X I
hereby acknowledge rete t of the instructions indicated above.I understand that I have had emergency treatment and that I may be released before all my medical problems are
known and treated.I will a a1range f r follow-up care as instructed above.
Preprinted Aftercare Instructions Patient or Patient's Represe tative Sign ture
other than above. ❑ YES ❑ NO
1 Sutter Delta Medical Center ;- A11`1F"'T`l%1 j '''`'`"�
3901 LONE TREE WAY • ANTIOCH,CA 94509 i "77 J,Q f� f .t)
EMERGENCY DEPARTMENT COR�'F-S g z L DCi oNSu^
AFTERCARE INSTRUCTIONS
29-005(10/96) WHITE-Chart . ` YELLOW-Patient .
....,.. ,.. a /.:•.. ........ __...._.. ....._ _.. . .. .,f.r t _,.max'._'-``__ •_. � `,, :':'r"
1. NURSING CARE
".This hospital provides only general duty nursing care unless upon orders of the patient's physician the.patient is provided more intensive nursing care. if the patient's'condition is such
as to need the service of a special duty nurse,it is agreed that such must be arranged by the patient or his/her legal representative. The hospital shall in no way be responsible for
failure to provide the same and is hereby released from any and all liability arising from the fact that said patient is not provided with such additional care.
2. MEDICAL AND SURGICAL CONSENT
The undersigned consents to the basic care and procedures which may be performed during this hospitalization or on an out-patient basis. Special treatment or surgical procedures
will be carried out upon the order of the physician and the agreement of the undersigned. Emergency treatment or services,which may include but are not limited to laboratory
procedures,X-ray examinations,medical or surgical treatment,anesthesia,will be rendered to the patient under the general and specific instructions of.the patient's physician or
surgeon.
3. RELEASE OF INFORMATION
To the eident necessary to determine liability for payment and to obtain reimbursement,the hospital may disclose portions of the patient's record,including his/her medical records,to
any person or corporation which is or may be liable,for all or any portion of the hospital charge,Including but not limited to insurance companies,health care service plans or worker's
compensation carriers. To ensure coordination of my medical care,I authorize release of medical information to my primary care physician,and/or referring physician.
4. PERSONAL VALUABLES
It Is understood and agreed that the hospital maintains a safe for the safekeeping of money and valuables,and the hospital shall not be liable for the loss or damage to any money,
jewelry,documents,furs,fur garments or other articles of unusual value and small compass,unless placed therein,and shall not be liable for loss or damage to any other personal
property,unless deposited with the hospital for safekeeping.
5. FINANCIAL AGREEMENT
The undersigned agrees,whether he/she signs as agent or as patient,that in consideration of the services to be rendered to the patient,he/she hereby individually obligates
himself/herself to pay the account of the hospital in accordance with the regular rates and terms of the hospital. Should the account be referred to an attorney for collection,the
undersigned shall pay actual attorney's fees and collection expense. All delinquent accounts shall bear interest at the legal rate. At my option,I may choose the Hospital's"Preferred
Payment Plan"and make payments of the amounts owed in monthly installments. "Preferred Payment Plan accounts are subject to a finance charge and will be opened upon receipt
of the first monthly payment underlhe terms of the Plan. An account disclosure describing the terms and conditions of the"Preferred Payment Plan"is available on request and is
included on the reverse side of the hospital's billing statement. I will also receive a statement of billing rights under the Fair Credit Billing Act. I understand that If payments not made
as and'when due,the unpaid balance may be assigned for collection. I agree to pay all collection costs,court costs,and reasonable attorneys'fees incurred in the enforcement of this
obligation.-
S. ASSIGNMENT OF-INSURANCE BENEFITS
The undersigned authonzas;,whether he/she signs as agent oras patient,direct payment to the hospital of any insurance benefits otherwise payable to the undersigned for the care
rendered at a rate not to exceed,thei regular charges. It agreed that payment to the hospital,pursuant to this authorization,by an insurance company shall discharge said insurance
company of any and all obligations under a policy to the extent of such payment. It is understood by the undersigned that he/she is financially responsible for charges not covered by
this agreement. �.
7. AUTHORIZATION FOR RELEASE OF.MEDICAL INFORMATION
STATE LAW PROVIDES THAT UPON AN INQUIRY AS TO THE PRESENCE OR GENERAL CONDITION.OF THE PATIENT,DELTA MEMORIAL HOSPITAL MAY,UNLESS- '
OTHERWISE REQUESTED BY THE PATIENT,NEXT OF KIN,OR PROVIDER OF HEALTH CARE,RELEASE AT ITS DISCRETION NONE,PART OR ALL OF THE FOLLOWING
INFORMATION: THE PATIENTS NAME,ADDRESS,AGE AND SEX,•REASON FOR ADMISSION,GENERAL NATURE OF INJURIES,OR THE GENERAL CONDITION.OF THE
PATIENT.
STATUS OF ADVANCED DIRECTIVE
1. Information Source:(circle one) Patient Spouse Other(who)
2. Does patient have Advanced Directive? ❑ Yes ❑ No
If yes:Is copy in record? ❑Yes ❑ No No(patient Instructed to provide)
3. Policy/Brochure given? ❑ Yes ❑ No(reason why not)
4. Info received/recorded by:Admitting Registrar
Nursing
5. Advanced Directive rescinded by patient: Date revoked Date changed
The undersigned certifies that he/she has read the foregoing,receiving a copy thereof,and is the patient,or is duly authorized by the patient as patient's general agent to execute the
above and accept its terms.
Patient/Paren ardian(Itothpr than parent indicate relationship). Financial Responsibility Agreement by Person Other than the Patient,or the Patient's
l / Legal Representative:I agree to accept financial responsibility for services rendered
to the patient and to accept the terms of the Financial Agreement,assignment of
Insurance Benefits.
Date l' Tim
Wit ess I _ ' Financially Responsible Party
Sutter Delta Medical Center
3901 LONE TREE WAY- ANTIOCH,CA 94509
CONDITIONS OF::
ADMISSION /•REGISTRATION
29-547(10/96) WHITE Chart YELLOW PatienUGuarantor PINK'Business Office
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CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA April 22, 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 "j)
Amount: Unknown Section 913 and 915.4. Please note Atrnings :7
CLAIMANT: Cydnie R. Mixon APR 0 3 9997
COUNTY COUNSEL
ATTORNEY:
MARTINEZ CALIF.
Date received
ADDRESS: 1360 Springhill Dr. BY DELIVERY TO CLERK ON April 2, 1997
Pittsburg, CA 94565 Hand Delivered via: Risk M t.
BY MAIL POSTMARKED: �
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim. ppHH BB
DATED: April 3, 1997 B1�IL DepuyLOR, Clerk�� ,��
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
This claim complies substantially with Sections 910 and 910.2.
( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying
claimant. The,Board cannot act for 15 days.(Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send
warning of claimant's right to apply for leave to present a late claim (Section 911.3).
( ) Other:
Dated: / BY:_4& 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 2 2 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 27iis 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 24 1997 BY: PHIL BATCHELOR � C4
puty Clerk
CC: County Counsel County Administrator
Clair- to: BOAR) OF MPERVISORS OF COMM C05TA COUNTY
INS'TRUMONS TO CLADiANT
A. Clziss relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and %Wch accrue on or before December 31, 1987,
must be presented not later than the 100th day ager the accrual of the cause of
action. Claims relating to causes of aetSoa for-death or for injury to Parson
• of: to Personal pz-aPa"ty or growing crops and rich 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 ID6, County Administration Building, 651 Pine Street, Martinez, .CA 9k553.
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 Sea-. 72 at the end of this
fc v.
R£: Claim By ) Reserved for Clerk's filing stamp
RECEIVED
Against the County of Contra Costa APR -2 1997
or ) I 1. 9-16 Irk
District) CLERK BOARD OF SUPERVISORS
FM inr ) CONTRA COSTA CO.
7be undersigned claimant hereby makes claim aga#st the County of Contra Costa or
the above District in the sum of $ and in support of
this claim represents as .folloaws:
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)
/l
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?
c
-5_ Wnat are the names of counLv or district officers, servants or employees causing
the d3:_.ae or i7i- j1:7T.?
5. {hat damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage.
brier vr�s a�l-c-� "n C:en � �ac�k- s� sk-e
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7. Hoa was the amount claimed above ted? the estimated auaunt %of �an �
computed? (Include y �,r
prospective injury or damage.) - yy�
3. Names and addresses of witnesses, doctors and hospitals.
9. List the expenditures you made on account of this accident or injury--
DATE
njury:DATE ITEM` AMOUNT
�n/a s o�- f� soh �� i n lam- �ZJA+e,
hoJj-
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Gov. Code Sec. 910:2 provides:
"The claim must be signed by the claimant
SEND NOTICES TO: (Attorne ) or by some his behalf."
Name and Address of Attorney -Y1, l � LM�I)
'
Cla t's Signature)
yo� rk K, .
d
04;,
Telephone No. Telephone 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, bill; account, voucher, or writing, is punishable eitherby.imprisonment in.
the county jail for a period of not more than one year, by a fine of not exceeding. .
one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in
the state prison, by a fine of not exceeding ten thousand dollars ($10.,000, or by'
both such i-riso-unjent and fine.
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CLAIM
" BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA April 22, 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: $2,000,000.00 Section 913 and 915.4. Please note all •Warnings"
CLAIMANT: Evelyn Sabah jKlEcMal mm)
ATTORNEY: Goldman & Goldman APR n 4 1gg7
Attorneys At Law Date received COUNTY COUNSEL
ADDRESS: Eric Goldman BY DELIVERY TO CLERK ON April 4, 1997 MARTINEZ CALIF.
2124 Los Angeles Ave. p 1 ril 3
Berkeley, CA 94707 BY MAIL POSTMARKED: A 997
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: April 4, 1997 �aIL �ep�HtyLOR, Cler �� _� —
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
V\, This claim complies substantially with Sections 910 and 910.2.
( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying
claimant. The Board cannot act for 15 days.(Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send
warning of claimant's right to apply for leave to present a late claim (Section 911.3).
( ) Other:
Dated: yf�Y A? BY: Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the 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 2 2 1997 PHIL BATCHELOR, Clerk, �LJ— �. 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. l
Dated: PR 2 4 199 BY: PHIL BATCHELOR ���✓ Deputy Clerk
CC: County Counsel County Administrator
GOLDMAN F3 GOLDMAN
ATTORNEYS AT LAW `�"�"`•M+--„.�,,,,��R
2124 LOS ANGELES AVENUE RECEIVED
BERKELEY, CALIFORNIA 94707 fff
(510) 527-8880
d
S.
CLERK BOARD OF S cpEp,
CONTRALfI 4�t,opS
CoS'rA Co.
April 3, 1997
Clerk, Board of Supervisors of Contra Costa County
651 Pine Street, Room 106
Martinez, CA 94553
Re.- CLAIM AGAINST COUNTY [MERRITHEW MEMORIAL HOSPITAL]
LORRE, HENDERSON, M.D. . DOES 1-100.
(and 90 day notice of intent to sued
This office represents Evelyn Sabah. You are hereby notified that Ms. Sabah
claims damages from the county in the amount of $2,000,000.00.
This claim is based on the medical malpractice and negligent treatment received
by Ms. Sabah at Merrithew Hospital. Ms.,Sabah was'und&the”negligent care and.
treat"meat"of Lorre Hen derson,. M.D. until October`29; 1996, when-Dr. Henderson was
sick and a`replacement,surgeon reviewed her case and begari appropriate,:referraIs and
treatment. Negligent acts by Dr. Henderson and Does include;'butiare.not limited to,
negligence in surgery,.diagnosis and treatment. Negligence against the hospital
includes the negligent, inadequate, hiring, support and supervision of surgeons,
assisting surgeons, physicians, nurse practitioners and nurses and the inadequate
maintenance of staffing and equipment levels.
Unknown to Ms. Sabah, Dr. Henderson performed negligent surgery on Ms.
Sabah in June of 1996. Ms. Sabah suffered complications including but not limited to
"- -'aches -3f+nr tl�:e s!Irnery Dr, Henderson affirmatively misrepresented to Ms.
JCVGrc ]lir to:,i civi:�.:.i u:w: a_.
Sabah that the complications were not caused by the surgery. Other staff and Does
negligently diagnosed and treated her. Ms. Sabah continued as a patient at Merrithew.
Ms. Sabah did not learn the true facts until after Dr. Henderson went out on an injury
leave and Ms. Sabah was seen on or about October 29, 1996, by a replacement
surgeon, Dr. Thomas White, who referred her to U.C. Davis for surgical repairs of a
spinal fluid leak and other problems which had been caused and aggravated by
malpractice by Dr. Henderson during his surgery and follow up.
As°a result of the malpractice, claimant has suffered several reconstructive
surgeries;-paralysis,:;insertion of steel plate, tong rehabilitation,'loss of senses; pain
suffering;.emotional.distress;, and .will continue to suffer`add itional injuries according;to
proof. Damages include medical injury and disability; economic value�of.services,
attendant care, incidental expenses, medical expenses, and general damages and all
other compensatory damages.
This letter is also 90 day notice of intent to sue for medical malpractice. (CCP
364.) All notices or other communications should be sent to the undersigned.
YO rs ery uly,
Eric Goldman
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APPLICATION TO FILE LATE CLAIM April22, 1997
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
BOARD ACTION
Application to File Late Claim ) NOTICE TO APPLICANT
Against the County, Routing ) The copy of this document mailed to you is your
Endorsements, and Board Aetaon.) notice of the action taken on your application by
(All Section References are to ) the Board of Supervisors (Paragraph III, below),
California Government Code.) ) given pursuant to Government Code Sections 911.8 and
915.4. Please note the "WARNING"
Claimant: John Snavely APR 0 71997
Attorney: COUNTY COUNSEL
MARTINEZ CALIF.
Address: P.O. Box 1708
El Cerrito, CA 94530
Amount: Unknown By delivery to Clerk on April 4, 1997
Date Received: April 4, 1997 By mail, postmarked on Hand Delivered
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above noted Application to File Late Claim.
DATED:April 7, 1997 PHIL BATCHELOR, Clerk, By�j1-env Deputy
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
( ) The Board should grant this Application to File Late Claim (Section 911.6).
( The Board should deny this Application to File Late Claim (Section 911.6).
DATED: qj'7 7 VICTOR WFSTMAN, County Counsel, By -1 W Deputy
III. BOARD ORDER By unanimous vote of Supervisors present
(Check one only)
( ) This Application is granted (Section 911.6).
This Application to Fjle Late Claim is denied (Section 911.6).
I certify that this is a true and correct copy of the Board's Order entered in its
minutes for this date.
DATE: APR 2 2 1997 PHIL BATCHELOR, Clerk, ate-' Deputy
WARNING (Gov. Code 5911.8)
If you wish to file a oourt action on this matter, you must first petition the
appropriate court for an order relieving you from the provisions of Government Code
Section 945.4 (claims presentation requirement). See Government Code Section 946.6. Such
petition must be tiled with the court within six (6) months from the date your application
for leave to present a late claim was denied.
You may seek the advise of any attorney of your choice in oonnection with this
matter. It you want to consult an attorney, u should do so immediately.
IV. FROM: Clerk of the Board TO: 1 County Counsel 2 County Adninistrator
Attached are copies of the above Application. We notifed the applicant of the
Board's action on this Application by mailing a copy of this document, and a memo thereof
has ben filed and endorsed on the Board's copy of this Claim in accordance with Section
29703.
DATED: APR 2 4 1997 PHIL BATCHELOR, Clerk,"," Deputy
V. FROM: 1 County Counsel 2 County Administrator TO: Clerk of the Board
of Supervisors
Received copies of this Application and Board Order.
DATED: County Counsel, By
County Administrator, By
APPLICATION TO FILE LATE CLAIM
1 In the Matter of the )
Claim of John Snavely ) APPLICATION FOR LEAVE TO
2 against County of Contra ) PRESENT LATE CLAIM
3
Costa ) [Gov. Code 911. 4 ]
�
4
5 To the County of Contra Costa
6 1. Application is hereby made for leave to present a late claim
under Section 911. 4 of the Government Code. The Claim is founded
7
8 on causes of action which accrued on April 5, 1996 and continuing
9 until April 11, 1996, and for which a claim was not timely
10 presented. For additional circumstances relating to the cause of
action, reference is made to the proposed claim attached hereto as
11
Exhibit 1 and made a part hereof.
12
2 . The reason for the delay in presenting this claim is , the
13
mistake and/or excusable neglect of the claimant, as is more
14
particularly shown in the declaration of John Snavely, which is
15
attached as Exhibit 2 and made a part hereof.
16
3 . This application is presented within a reasonable time after
17
the accrual of the cause of action, as shown by the declaration of
18
John Snavely attached hereto as Exhibit 2 and made a part hereof.
19
20
WHEREFORE , it is respectfully requested that this application be
21
granted and that the attached claim be received and acted on in
22
accordance with sections 912 . 4-912 . 8 Of the government code.
23
24
25 Dated: April 4 , 1997 1;44�
JOHN SNAVELY
REC
27
28 A
CLERK OARD OF SUPERVISORS
CONTRA COSTA CO.
Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
XNSTRUCTIONS 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 bepresented 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.
RE: Claim By Reserved for Clerk's filing stamp
John SNavey John Snavely )
Against the County of Contra Costa)
or )
District)
(Fill in name) )
The undersigned claimant hereby makes claim against the County of
Contra Costa or the above-named District in the sum of
and in support of this claim represents as follows:
1. When did the damage or injury occur? (Give exact date and hour)
4/8/97 to 4/12/97 inclusive
2. Where did the damage or injury occur? (Include city and county)
In the county records and administrations buildings gnd in the
Martinez Detention facility, and in Richmond and transport from Richmon
3 . How did the damage or injury occur? (Give full detailp; use eXtKa
paper if required) False arrest and imprisonment by Richmond Police
officers and county sheriffs , plus an attempt by other county
employees to suppress a restraining order obtained by John snavely .
4 . What particular act or omission on the part of county or district
officers, servants or employees caused the injury or damae?
Clerks claimed that my file was lost or unavailbble w9en I came
toet a copy of it after the originals were stolen from me by
Ric9mond Police Offieer WAshington. I was incarcerated on the pretext
of assault with a deadly we on in order to drive me from my home, and
the officer who released me QF�1 it; he sugge trd Pat I should "respect
police officers in the future . or words t tia e ect. (over)
I was let go in the middle of the night , purposely .
t7xAAo, 1
-5;_ What are the names of county or district officers, servants or
employees causing the damage or injury?
Names unknown at this time, although I believe I have a record of
one clerk ' s name, which I cannot locate .at this time .
6. What damage or injuries do you claim resulted? (Give full extent
of injuries or damages claimed. Attach two estimates for auto
damage. ) Emotional dress , loss of income, false imprisonment ,
$45 to get back to my car in Richmond .
7. How was the amount claimed above computed? (Include the estimated
amount of any prospective injury or damage. )
It wawsdetermined by consulting with legal consel .
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
4/8/97 to 5/15/97 approximately $1500 .00
exact amount to be determined .
AAAAAAAAAAAAAAAAAAAAAAAl4AAAItAttAA�RAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
Gov. Code Sec. 910.2 provides
"The claim must be signed by the
claimant or by some person on his
SEND NOTICES TO: (Attorney) behalf. "
Name and Address of Attorney )
(Cla�imant's Signature)
Cl 174
(Address)
Cl
Telephone No. ) Telephone No. tUG '�`r'7-23
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAArIrAAA94AAAAAAAAAAAbAAAAAAAAAAAAAAAA
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.
DECLARATION OF JOHN SNAVELY
1 I, John Snavely, declare:
2 1. 1 am the claimant in the above-entitled matter and
3 can testify as to the- events and circumstances of this claim.
4 2 . Soon after I was released from jail, I contacted
5 several attorneys about this matter. Not one of them cautioned me
6 that I must file a claim within six months of the incident. One
7 of them, whose name I believe was Lauer, said nothing when I said,
8 "we have a year to do this, " during a discussion over filing suit.
9 I believe now that I was still in a very agitated and upset
10 state at the time I spoke with her and I may not have made things
11 as clear as I could, although at the time I thought her silence
12 meant that she agreed.
13 3 . Soon after that I spoke to an attorney named Michael
14 Roman in Berkeley; Mr. Roman seemed very busy and said I should
15 forget about filing anything in the city of Richmond, because its
16 attorneys fought so hard that even if you won the expenses would
17 leave very little left.
18 4 . I filed a complaint for violation of my civil rights
19 by the' Richmond police with the Federal Bureau of Investigation.
20 One reason I waited for a long time is that I expected they would
21 contact me with helpful information or at least tell me the results
22 of their investigation. To this day I have heard nothing from
23 them.
24 5. I spoke with another attorney several times in March,
25 1997 , a Robert Schock. He was interested in another case involving
26 me, but said that this incident was a "can of worms, " and that he
27 EXHIBIT 2
28
was not sure about the statute of limitations. He said this on one
1 or two occasions and earlier this week, I discovered that the
2 regular time for filing is within six months. None of the
3 attorneys ever specifically told me that.
4 6 . I do not believe that the County of Contra Costa
5 would be prejudiced by this delay.
6
7 I declare under penalty of perjury that the statements in the
8 above declaration are true of my own knowledge.
9
10
11 Dated: April 4 , 1997
JOHN SNAVELY
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