HomeMy WebLinkAboutMINUTES - 04081997 - C12-C16 C.12
TO: BOARD OF SUPERVISORS, AS THE GOVERNING BOARD OF CONTRA COSTA COUNTY
FLOOD CONTROL AND WATER CONSERVATION DISTRICT
FROM: J. MICHAEL WALFORD, CHIEF ENGINEER
DATE:
SUBJECT: APPROVING A REIMBURSEMENT AGREEMENT BETWEEN THE FLOOD CONTROL
DISTRICT AND MCBAIL COMPANY FOR SUBDIVISIONS 6109, 6454 and 6621 IN
DRAINAGE AREA 56.
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
I. Recommended Action:
Approve a reimbursement agreement in the amount of$ 264,889.09 between the Flood Control District
(DISTRICT) and McBail Company (DEVELOPER) and authorize the Chair of the Board to execute the
agreement on behalf of the District.
II. Financial Impact:
Future drainage fees will be obligated to payment of the reimbursement.
III. Reasons for Recommendations and Back round:
The Developer has been required to construct drainage area improvements at a cost which exceeds the
amount of drainage fees required to be paid by the developer under the terms of the drainage area fee
ordinance. The Developer is entitled to a partial reimbursement of the excess costs as provided for in the
drainage area credit and reimbursement policy.
IV. Consequences of Ne¢ative Action:
Non approval of the agreement would be inconsistent with the adopted Credit and Reimbursement Policy.
Continued on Attachment: SIGNATURE: //[ ,(A YI,�,itn
_RECOMMENDATION OF COUNTY ADMINISTRATOR
_RECOMMENDATION OF BOARD COMMITTEE
APPROVE OTHER
SIGNATURE(S):
ACTION OF BOARD ON )���7 APPROVED AS RECOMMENDED OTHER
VOTE OF SUPERVISORS
UNANIMOUS(ABSENT )
AYES: NOES:
ABSENT: ABSTAIN:
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Orig.Div: Public Works(FCE)
1 ftueEY tatNy tlW thle IS•tme and cwrect Dopy d
c: County Administrator 2 ectbn taken and entered on the minutee of the
Community Development Board of 8upervkM o 1 tllq,da �.nown.
Building Inspection AT7E87EC: X55 7
County Counsel of Supwviwm and my Flr:ninistrer
County Assessor
tor
County Treasurer-Tax Collector
County Auditor-Controller y
Chief Engineer
CONTRA COSTA COUNTY
FLOOD CONTROL AND WATER CONSERVATION DISTRICT
REIMBURSEMENT AGREEMENT
1. PARTIES. Effective i , the Contra Costa County Flood
Control and Water Conservation District, (hereinafter called "DISTRICT"), and McBail
Company, A General Partnership, (hereinafter called "DEVELOPER"), mutually agree as
follows:
2. INTRODUCTION.
A. DEVELOPER has subdivided the property designated as Subdivisions 6109, 6454
and 6621 within Drainage Area 56. Said development is within the jurisdiction of the
City of Antioch (hereinafter called "AGENCY"). To satisfy AGENCY's conditions
of approval for said development, DEVELOPER installed a portion of the drainage
facilities shown on the adopted Drainage Plan for Drainage Area 56.
B. The cost to install these facilities exceeded the amount of drainage fees required by
the drainage fee ordinance for said drainage area, Ordinance No. 85-52.
C. DISTRICT has adopted a Drainage Area Credit and Reimbursement Policy for said
drainage area.
D. Since DISTRICT has an effective Drainage Plan and a Drainage Area Credit and
Reimbursement Policy for said drainage area, DEVELOPER has requested that the
DISTRICT enter into this agreement with DEVELOPER, pursuant to said policy.
3. TERMS. DISTRICT shall reimburse DEVELOPER for eligible costs exceeding the amount
of fees required by said ordinance, in accordance with the terms of this agreement and the
DISTRICT's above-mentioned Drainage Plan and the Drainage Area Credit and
Reimbursement Policy for said drainage area, which policy is attached as Exhibit "A" and
made a part hereof by this reference.
4. ELIGIBLE COSTS. The drainage facilities, right-of-way, and other items eligible for
reimbursement and their estimated costs are outlined on Exhibit "B", attached hereto and
incorporated herein by this reference.
5. DEDICATION OF EASEMENTS. Easements containing the drainage facilities covered by
this agreement shall be offered for dedication to AGENCY.
6. CONFORMANCE TO PLANS AND SPECIFICATIONS. The drainage facilities covered
by this agreement shall be installed in conformance with the plans and specifications prepared
by DEVELOPER and approved by AGENCY. DISTRICT shall be under no obligation to
perform under this agreement unless the drainage facilities are accepted as complete by
AGENCY.
7. HOLD HARMLESS. DEVELOPER shall defend, indemnify, save and hold DISTRICT, its
governing body, officers, agents and employees absolutely free, clear, and harmless from any
claims, actions, or costs arising from any property and/or rights acquisition which may be
necessary hereunder, or arising from any and all damage to property, injury to persons,
including death, or any other type of liability arising as a result of DEVELOPER's installation
of the drainage facilities required by the conditions of approval for said development.
8. NON-RESPONSIBILITY OF DISTRICT. The installation of drainage facilities covered by
this agreement is the sole responsibility of DEVELOPER, except for the normal inspection
provided by the AGENCY. DISTRICT assumes no responsibility whatsoever for construction
procedures and methods utilized by DEVELOPER in constructing the drainage facilities.
9. PAYMENT. Payment terms are set forth in Exhibit "A", except that the first payment shall
not be made until DEVELOPER submits to DISTRICT acceptable evidence that
DEVELOPER has paid for the installation of the drainage facilities covered by this
agreement.
I ,
10. TERMINATION. This agreement shall remain in effect either(1)for 40 quarters as provided
in Section V.B. of Exhibit "A", or(2)until DEVELOPER has been reimbursed for the total
eligible reimbursement amount, whichever first occurs. Non-submittal of the acceptable
evidence of payment required by Section 9 shall not result in an extension of the termination
date.
11. NO OTHER RECOURSE AGAINST DISTRICT.
A. This agreement constitutes the total statement of rights between DISTRICT and
DEVELOPER concerning payment or reimbursement for costs of installing the
drainage facilities exceeding the required drainage fees.
B. If, after the expiration of the 40 quarters described in Section V.B. of Exhibit "A",
DEVELOPER has not received the total reimbursement amount, DEVELOPER shall
have no right to further reimbursement by DISTRICT from any drainage fees
thereafter collected by the DISTRICT, or from any other source of DISTRICT
funding.
CONTRA COSTA COUNTY FLOOD CONTROL DEVELOPER*
AND WATER CONSERVATION DISTRICT
McBail Company
Chair of the Board of Supervisors,as governing body of B
the Contra Costa County Flood Control and Water
Conservation District And By
i
ATTEST: (t C)"_� s' /�/9� *Corporations rewire two signatures, one by the
President or Vice si nt,and one by the Secretary or
Phil Batchelor, Clerk of the Board of Supervisors and Treasurer. Signatures by DEVELOPER must be
County
Administrator notarized.
BYehg.e .
Deputy Crk
Recommended for Approval:
J.Michael Walford
Chief Engineer
By %A&42V&eWjNW
Approved as to Form:
Victor J.Westman
Coour
By �:0' .
_ c
Depu .
i It fi
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Exhibit"A"-Drainage Area Credit and Reimbursement Policy
Exhibit"B" -Calculation of Reimbursement Amount
Note to Developer: For corporations,the contract must be signed by two officers. The first signature must be that of the
chairman of the board,president or vice-president;the second signature must be that of the secretary,assistant secretary,
chieffinancial officer or assistant treasurer. (Civ.Code,Sec. 1190 and Corps. Code,Sec. 313.)The acknowledgment below
must be signed by a Notary Public.
CERTIFICATE OF ACKNOWLEDGMENT
tate of California )
ss.
County of
On the date written below e, the undersigned Notary Public, ally appeared the
persons ove for Developer, personally known to me (or proved to me onsus of
x'/21
STATE OF CALIFORNIA )
S.S.
COUNTY OF CONTRA COSTA )
On this 6th day of March, 1997, before me, SUE WICKENS, a Notary Public in and for
said state, personally appeared MICHAEL R. GALLAGHER, personally known to me to
be the person whose name is subscribed to the within instrument and acknowledged to
me that he executed the same in his authorized capacity, and that by his signature on the
instrument the person, or the entity upon behalf of which the person acted, executed the
instrument.
WITNESS my hand and official seal. may{
' '. ') SUE
. SUE WICKENS r
�J $.6141y
Commission#1122000 rz
Sue Wickens 1Notary Public—California a
Contra Costa County
My commission expires 1/26/2001 Comm.ExpiresJan26,2001
satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument
and acknowledged:atu
e/she/they executed the same in his/her/their a ericapacity(ies),
and that by his/heon the instrument the per or the entity upon behalf of
which the person( ecuted th trument.WITNESS my haal s
Dated:
[Notary's Seal]
Notary Public
C/z
EXHI}3IT "A"
DRAINAGE AREA t1?IDIT AND POT ICY
Adopted Tune, 1989
The following policy adopter by the Board of Supervisors, as the governing ley
of the Contra Costa County Flood control and Water C.'onsarvation District, .shall
be used to determine credits and reimbursements as provided for in various
Drainage Area Fee Ordinances.
I_ DEFIIVIT'.CONS-
1_ Drainage Area Plan. The engineering plan which shows and lits the
size, length, and location of drainage facilities adopted for a
Drainage Area.
2. Drainage Area Fee Ordinances. An ordinance adopted for a Drainage
Area specifying the drainage fee necessary to omplete construction of
the planned facilities.
3. Drainage Area Fee Obligation_ The drainage fee due on a development as
determined ftp the Drainage Area Fee Ordinance.
4. Eligible Costs. The cost of installing drainage facilities which are
past of the Drainage Area Plan.
S. In-tract Drainage Faci1"it es. Drainage facilities required within the
I imits of the development.
6. off tract Drainage Facilities. Drainage facilities required outside
the limits of the development.
7. Credit. TAben a Drainage Fee ordinance allows construction of drainage
facilities in lieu of the payment of drainage fees, the eligible
construction costs may be applied as a credit against the drainage area
fee obligation.
8. P4imbursement. Payment to the developer for the eligible cost of
installing drainage ar."ra facilities in excess of the drainage area fee
obligation.
Ir. installation of drainage facilities required as a cvndition of
property development can be very costly, arra in many cases benefits other
properties within the watershed. A Drainage Fee Ordinance spreads the costs
of the drainage facilities to all of the benefitting properties and ensures,
through a system of fees, grits, arra reimbursements, equitable financial
participation.
on.
The drainage fee ordinances creates a fee obligation on all properties
within the Drairoge Area. The ordinance bees oc7e_*ative tmon a request to
1
develop or improve a parcel of land. The drainage area fee obligation is
limited to the fee due and is payable either in the form of cash or the
installation of a portion of the drainage facilities shown on the adopted
drainage area plan.
when a condition of development requires the construction of drainage
facilities with a cost in excess of the drainage fee obligation inposed by
the fee ordinance, a portion of the excess cost may be eligible for
reimbursement.
Eligible costs. A portion of the cost to install drainage facilities shown
an the adopted drainage area plan may be eligible for credit against the
required drainage fees and for reimbursement of costs in excess of the
drainage fee obligation. Credit or reimbursement shall be limited to the
following eligible costs:
1_ Actual in-tract and off-tract construction costs plus a fixed amount of
7 percent of the in-tract construction cost and 14 percent of the off-
tract c=istxur-tion cost for allowance of misoellaneous developer's
costs, including contract preparation, engineering, bondJj-q, etc-
Construction costs do not include utility relocations or , the
acquisition of rights of way.
2- Actual public agency project inspection fees for only those drainage
area facilities shown an the adopted drainage plan.
3- Actual utility relocation costs.
4. Actual off-tract right of way acquisition costs needed for the
installation of drainage area facilities, provided the developer does
riot have a beneficial interest in the off-tract property.
The determination of construction costs will be based on at least three
independent bids. The developer shall submit said bids to the District for
review and concu:rrence. Upon District concurrence with the bids, the lowest
bid shall be the basis for determination of the credit and reimbursement
amount.
TheDistrict reserves the right to reject the developer's bids or any other
proposed value of said eligible costs and to calculate said costs and the
fixed mar)� using then current prices.
Ifthe developer elects to install a More costly drainage system than shown
on the adopted drainage area plan, the District reserves the right to
calculate said eligible costs using the then current prices for only the
facilities shown on the adopted plan.
IV. Credit. The developer may apply as a credit toward the drainage fee
obligation the eligible coststo construct drainage area facilities.
2
V- Reimburseirent.
A. le7here the amount of said eligible costs exceed the drainage fee due,
the developer, upon entering into a reimbirsem-ant agreement with the
District, shall be eligible for a percentage reimbursement an the
amount of the eligible costs determined by Section 1=. above, in
e-Nness of the drainage fee due as follows-
Off-tract work: 100% (one Hundred Percent)
On-tract work : 501 (Fifty Percent)
Prior to the application of the above percentages, the eligible costs
in excess of the drainage fee due shall be prorated between off-tract
work and on-tract work in the same proportion as the total eligible
costs for off-tract work and on-tract work are to the total eligible
costs.
B- The reimbursement shall be subject to the following limitations*
1. shall be paid only from drainage fees collected
pursuant to a Drainage Fee Ornance-
2- If more than one reimbursement agreement is in effect in a
Drainage Area, the reimbursement payment to each agreement shall
be based on the ratio of each agreement's original amount to the
total original amount of all outstanding reimbursement agreements.
3., The District reserves the right to utilize not more than So
percent of the drainage fees collected annually, on a fiscal year
basis, for the purpose of ma)axig reimbursement payments.
4- Reinhn-sement payments shall be made. quarterly, except that,
during any quarter the District reserves the right not to rake
said payments if the amount of available funds to be di--Jxzsed is
less than $5,000.
5. Reimburseny-mt agreements shall remain in effect for 40 quarters.
The first quarter shall be the one following the quarter in which
the first reimbursement payment is made- Any outstmding balance
owed at the end of the 40 quarters shall be waived by the
developer-
6. Reimbursement agreements executed prior to a government loan
shall share with the gave=ent loan and other
agreement(s) the payments calculated in paragraph B.2 above-
7. Reimbursement agreement(s) executed su rent to a government
loan(s) shall have payments "calculated" using the pro-rata basis
of paragraph B.2. above- However, in order to accelerate
repayment of the government loan(s) , the "calculated" payment
shall be applied to repayment of the goverment loan(s) , rather
than be distur-sed to the subsequent reimburs ent aqreaTent(s)
3
Upon full repayment of the government loans) : reimburserrv--nt
payments shall commence to the subsequent reinbursement
agreement(s) . the forty quarter time limit for a subsequent
reimbursement agrnt shall not start until the date the first
payment is made to the remIx -cement agre=ent.
VS. A&plicability: Upon adopti-on by a drainage area, this policy shall be the
basis for all subsequent reimbursement agreements in that drainage area.
This policy Win not alter any reimbursement- agreement exaOlted pursuant to
a different policy.
RSC:s1
UA:Reimpolc
Manil8, 1990
4
Exhibit "B" /2
Calculation of Reimbursement Amount
Drainage Area: 56
Development: Subdivision 6109, 6454, and 6621
Developer: McBail Company
3200 Danville Boulevard, Suite 200
P.O. Box 1056
Alamo, CA 94507
Assessor's Parcel: 051-323-001, 051-170-031
Subdivision 6621 Drainage Area 56 Fees
Lot Area # of Lots Fee Total
4,000 - 4,999 SF Lot C $1,465 $1,465
5,000 - 5,999 5 1,525 7,625
6,000- 6,999 9 1,590 14,310
7,000 - 7,999 1 1,650 1,650
8,000 - 9,999 3 1,735 5,205
Total 18
Drainage Fees Due $30,255
Subdivision 6109 Drainage Area 56 Fees'.
Lot Area # of Lots Fee Total
4,000 - 4,999 SF 3 $1,465 $4,395
5,000 - 5,999 4 1,525 6,100
6,000- 6,999 4 1,590 6,360
7,000 - 7,999 3 1,650 4,950
8,000 - 9,999 2 1,735 3,470
Total 16
Drainage Fees Due $25,275
Subdivision 6454 Drainage,Area 56 Fees '.
Lot Area # of Lots Fee Total
4,000 - 4,999 SF 16 $1,465 23,440
51000 - 5,999 13 1,525 19,825
6,000- 6,999 2 1,590 3,180
8,000 - 9,999 4 1,735 6,940
Total 35
Drainage Fees Due $53,385
1
Eligible Construction Costs:
Off-Tract Work
Description QuantitY Unit Cost Total
Earthwork 36,300 CY $2.20 $79,860.00
Concrete Inlet Headwall 1 EA $33,616.20 $33,616.20
Outlet Structure 1 EA $20,150.00 $20,150.00
84" RCP w/cutoff walls 440 LF $236.50 $104,060.00
Rip-Rap 3,260 SF $5.90 $19,234.00
Filter Fabric 605 SY $1.85 $1,119.25
54" RCP CL III 50 LF $112.00 $5,600.00
Type A Headwall 1 EA $3,200.00 $3,200.00
72" Chain link fencing 720 LF $11.65 $8,388.00
Hydroseeding 149,000 SF $0.03 $4,470.00
Finish Grade for low flow 1 LS $3,400.00 $3,400.00
16' Double swing gates 3 EA $925.00 $2,775.00
Finish Grade for Channel 1 LS $6,768.00 $6,768.00
AB 2,400 SF $0.97 $2,328.00
LLandscaping 1 LS $16,965.80 $16,965.80
Sub-Total $311,934.25
Engineering (14%) 43,670.80
Eligible City Inspection Fee 17,537.04
Permits 662.00
Off-Tract Total $373,804.09
Total Eligible Costs $373,804.09
Drainage Area Fees $108.915.00
$264,889.09
Off-Tract Reimbursement @ 100% $264,889.09
TOTAL REIMBURSEMENT $264,889.09
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C-13
TO: BOARD OF SUPERVISORS
FROM: J. MICHAEL WALFORD, PUBLIC WORKS DIRECTOR
DATE: APRIL 8, 1997
SUBJECT: APPLICATION TO CALTRANS -DIVISION OF AERONAUTICS FOR A LOAN TO PROVIDE
A MODULAR GENERAL AVIATION TERMINAL BUILDING AT THE BYRON AIRPORT
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
I. Recommended Action:
APPROVE and AUTHORIZE the Public Works Director to SUBMIT, on behalf of the County, an
application to Caltrans - Department of Aeronautics for a loan to purchase and install a modular General
Aviation Terminal building at the Byron Airport.
II. Financial Impact:
The amount of the loan with Caltrans will be $200,000. Annual principle and interest payments will be
approximately $20,000. The annual loan payments will be deducted from the Airport Enterprise Fund.
III. Reasons for Recommendations and Background:
The Byron Airport is in need of a General Aviation Terminal building. The new building would provide
office space for Airport staff, and general meeting and flight planning areas for users of the Airport.
IV. Consequences of Negative Action:
Alternate financing for a General Aviation Terminal building for the Byron Airport will have to be found,
or the building will not be purchased.
Continued on Attachment: SIGNATURE: Cl I P
_RECOMMENDATION OF COUNTY ADMINISTRATOR _RECOMMENDATION OF BOARD COMMITTEE
APPROVE OTHER
SIGNATURE(S):
ACTION OF BOARD ON LLa : C APPROVED AS RECOMMENDED_OTHER
VOTE OF SUPERVISORS
/UNANIVOUS(ABSENT )
}OYES: NOES:
ABSENT: ABSTAIN:
HEW:DRA
c:97-4BO8a.wpd
1 ttanEy car"that this Is s true and correctcopy of
Orig Div:Aitports(Dick Awenius 6-5722) an action taken and entered on the m!nutes of Bra
cc, County Administrator Board of saPan•iao ` .�vT 9 y
Works Director PHIL 7 '
PHIL BAHELOR,Ga:':-! ., and
Public Works Accounting Bupervlson;and Countyedmimstrator
Auditor/Controller ' �
Aviation Advisory Committee(via A/P)
Federal Aviation Administration(via A/P)
Caltrans-Division of Aeronautics(via A/P)
P
`STATE CaF CALIFORNIA -DEPARTMENT OF TRANSPORTATION / J
AIRPORT DEVELOPMENT LOAN - APPLICATION
DOA-0013 (216)
PLEASE PRINT OR TYPE AND COMPLETE ALL ITEMS
PART I. AIRPORT INFORMATION
PUSUC ENTITY AIRPORT NAME PERMIT NO.
Contra Costa County Bvron Airport
CON rAC r-N-AMI TITLE
Dick R. Awenius Airports Lease Manager
BUSINESS ADDRESS i aU51NE55 PHONE
550 Sally Ride Drive, Concord, CA 94520 '(510) 646-5722
PART 11. PROJECT INFORMATION
TOTAL STATE
PROTECT DESCRIPTION COST LOAN OTHER(Wecliy)
Purchase and installation of a 24' X 60' modular $200,000 ! $200,000
General Aviation Terminal.
� I
i
I
PART III. ADDITIONAL DOCUMENTS
Pursuant to Public Utilities Code Section 21602 and the California Airport Loan Regulations,please submit the following documents with this application:
• Local government approval(resolution or minute order) authorizing the application.
• Documentation evidencing full compliance with CECA and State EIR Guidelines:
- State Clearinghouse No. SCH or Categorical Exemption Gass No. le
• Project Feasibility: (1) engineering feasibility;(2)economic justification;(3)financial feasibility.
PART IV. AUTHORIZATION
AUTHORIZED OFFICIALS SIGNATURE TITLE
Public Works Director
PRINT NAME DATE
J. Michael Walford 4/1/97
SEND COMPLETED APPLICATION AND ALL REQUIRED DOCUMENTS TO:
CALIFORNIA DEPARTMENT OF TRANSPORTATION
AERONAUTICS PROGRAM - MS #40
P. O. BOX 942873
SACRAMENTO, CA 94273-0001
DOA%1U 13
C./4
TO: BOARD OF SUPERVISORS
FROM: J. MICHAEL WALFORD,PUBLIC WORKS DIRECTOR
DATE: APRIL 8, 1997
SUBJECT: APPLICATION TO CALTRANS - DIVISION OF AERONAUTICS FOR A LOAN TO
CONSTRUCT T-HANGARS AT THE BYRON AIRPORT
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
I. Recommended Action:
APPROVE and AUTHORIZE the Public Works Director to SUBMIT, on behalf of the County, an
application to Caltrans - Division of Aeronautics, for a loan to construct T-Hangars at the Byron Airport.
II. Financial Imoact:
The loan with Caltrans will be approximately $680,000. Annual principle and interest payments will be
approximately $70,000. The annual loan payments will be deducted from the Airport Enterprise Fund.
III. Reasons for Recommendations andBackground:
There is demand at the Byron Airport for 27 additional T-Hangars. Revenue from the rental of the T-
Hangars is expected to offset the annual cost of the loan payments.
IV. ConsCquences of Negative Action:
Additional T-Hangars at the Byron Airport will not be constructed.
Continued on Attachment:_. SIGNATURE: Cj
_RECOMMENDATION OF COUNTY ADMINISTRATOR _RECOMMENDATION OF BOARD COMMITTEE
—APPROVE _OTHER
SIGNATURE(S):
ACTIONF L APPROVED AS RECOMMENDED OTHER
1p
VOTE OF SUPERVISORS
UNANIMOUS(ABSENT )
AYES: NOES:
ABSENT: ABSTAIN:
HEW:DRA
c:97-4/BO8.wpd 1 eweM ow""M me,is•eve am cane oopy d
on aodon t1ken and entered on lea minutes at me
Of
Orig Div:Aitports(Dick Awenius 6-5722) Ivey J CJr .
cc: County Administrator E�PHI TCHELOR,C:=r's" twerd
Public Works Director z
leer'and c kdMinnuator
Public Works Accounting rA M 1 0"
Auditor/Controller
Aviation Advisory Committee(via A/P)
Federal Aviation Administration(via A/P)
Caltrans-Division of Aeronautics(via A/P)
STATE OF CALIFORNIA-DEPARTMENT OF TRANSPORTATION
REVENUE GENERATING LOAN - APPLICATION
DOA-0020 (Rev.2195)
PLEASE PRINT OR TYPE AND COMPLETE ALL ITEMS
PART 1. AIRPORT INFORMATION
PUBLIC ENTITY AIRPORT NAME PERMIT NO.
�
Contra Costa County
Z5&T9 NAM TIT
Dick R. Awen` s Airports Lease Manager
BUSINESS ADDRESS - BUSINESS PHONE
550 Sally Ride Drive (510)646-5722
PART IL PROJECT INFORMATION
PROIECTOESCRIPTION TOTAL STATE
i LOAN OTHER(MentYy)
Construction of a 27 bay T-Hangar building $680,000 $680,000
PART ill. ADDITIONAL DOCUMENTS
Pursuant to Public utilities Go cle ection and the California Airport Loan Regulations,please sul5mit the o owingocuments wl Is app Icauon:
• Local government approval(resolution or minute order) authorizing the application.
• Documentation evidencing full compliance with CEOA and State EIR Guidelines:
- State Clearinghouse No.SCH 88082020 or Categorical Exemption Class Na.
• Project Feasibility: (1) engineering feasibility;(2)economic justification;(3)financial feasibility.
Layout plan showing project location(s)and dimensions.
PART IV. AUTHORIZATION
PRINT NAAC TITLE
J. Michael Walfo d Public Works Director
AUTHORIZED OFFICIAL'S SIGNATURE DATE
4/1/97
SEND COMPLETED APPLICATION AND ALL REQUIRED DOCUMENTS TO:
CALIFORNIA DEPARTMENT OF TRANSPORTATION
AERONAUTICS PROGRAM-MS#40
P. 0. BOX 942873
SACRAMENTO, CA 94273-0001
DOA 914= �—
C. 15
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA April g, 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 sty
Mount: $3,000,000.00 Section 913 and 915.4. Please note Vaaw rjl R, o
CLAIMANT: Gerald Lee Anderson J MAR n 4 1997
ATTORNEY: COUNTY COUNSEL p
Date received RTINEZCALIF.
ADDRESS: 2 Gem Avenue BY DELIVERY TO CLERK ON March 4 199/
Los Gatos, CA 95032
BY MAIL POSTMARKED: March 3, 1997
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: March 4. 1997 CIL BePuIyLOR, Clerk� ``�� C�����
r
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: 3/✓ ! 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
(X) This Claim is rejected in full.
( ) Other:
1 certify that this is a true and correct copy of the Board's Order entered in its minutes for
this date.
Dated: APR O 8 1997 PHIL BATCHELOR, Clerk, Bjt � �/f 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
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 10 1997 BY: PHIL BATCHELOR � ca�"� Deputy Clerk
�T
CC: County Counsel County Administrator
RECEIVED 'I
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P
=trF.`BOARD OF SUPERVISORS
._.._-ON T RA COSTA CO.
February 24, 1997
Board of Supervisors
Contra Costa County
651 Pme Street
Martinez, CA 94553
10 W-HON1 11 MAY CONCERN:
l am writing this letter to your office in regards to a civil law suit I need to the against Contra
Costa County Jail Facility and the City of Martinez.
They arrested me and improperly housed me in their Detention, although they were warned and
told about my physical disorders. 1 suffer from epileptic seizures, grand mal. 1 also have asthma,
which 1 have had since birth.
Jail personnel placed me on the second floor in a two-man locked down tacility. They put me on
the top bunk, from which 1 tell to the floor and hurt my left temple and my lower back. I still
have scars plus witnesses names that saw and heard the procedure that 1 went through.
Now l would like to ask you and your office to represent me in this civil law suit against Contra
Costa County Jail Facility and the City of Martinez. I hank you.
Sincerely,
Gerald Lee Anderson
NOTICE OF CLAIM AGAINST THE eiTy-OF-Pf-&1&6i�, C
(Government Code ss 910, 910. 2) EIVE D
Return to: _Q W
Clerk' s Office MA
City o it urg
2020 Rai d Avenue CLERK BGA RD OF J�,
Post ice B 1518
P� sbu .a. Califo is 9456 Phone Number:
CLAIMANT NAME: G .r-- A AL,n l S 4z n/.Q r-
CLAIMANT'S ADDRESS: � � yy
Number Street
d 5 6o9Td .5 CA /%/ F i Cl 5-17 ;3 R7
City State Zip Code
NAME AND ADDRESS OF PERSON TO WHOM NOTICES REGARDING THIS CLAM SHOULD BE
SENT (if different than above) :�n A/ 7-&A /'.,c rs C,� ✓�y pt Ute /
DATE OF THE ACCIDENT OR OCCURENCE:
PLACE OF THE ACCIDENT OR OCCURENCE: rj V Z.02.0aS �--a Co LV-ry
GENERAL DESCRIPTION OF THE ACCIDENT OR OCCURENCE (attach additional pages
if more space is needed) : 1 tie B-
� �)
L3i3cA k7he -I h^ve /K Ll ,�edicn � r Vie / .n.v vv17/A /�/ajo�, ve'd
NAMES, IF KNOWN, OF ANY PUBLIC EMPLOYEES CAUSING THE INJURY OR IrOSS :
W,/V S 0,1
A J � NJ 11D�
NAMES AND ADDRESS OF WITNESSES:
NAME ADDRESS / [ / TELEPHONE
1. RAN K ) S'4"4r4Lr acr, !�" //Tur /�/ Q- U�/� �� ��/ . 6 � �5�� � �,
2 . ;JARRk /fir,IiZXors X36:--C ti7anF a/y, Pl�A � 9� h �r/`F
NAME AND ADDRESS OF DOCTORS, HOSPITALS WHERE TREATED:
NAME ADDRESS TELEPHONE
,1• t L tirIti e Co ti
2 .
GENERAL DESCRIPTION OF 'THE LOSS, INJURY OR DAMGAGE SUFFERED: 19
5"
n C
f'Its
/ r
6 c > >
TOTAL AMOUNT CLAIMED
Q
THE BASIS OF COMPUTING THE TOTAL AMOUNT CLAIMED IS AS FOLLOWS :
Damages incurred to date:
Medical Expenses: $
Loss of Earnings: $
Special damages for:
t)RAIA6,? r
A-Iiy� Lax( BCid
(Attach copies if available)
I/We, the undersigned, declare under penalty of perjury that I/we have
read the foregoing claim for damages and know the contents thereof; that
the same is true of my/our own knowledge and belief, save and except as
to those matters wherein stated on information and belief, and as to
them, I/we believe it to be true.
DATED:
Signature of Claimant(s)
(- dZg ��Cif� XP-0 3,;
Received in the City Clerk' s Office this day of , 199 '..
Signature
FOR CLAIMS RELATED TO INJURY TO PERSON OR PERSONAL PROPERTY, THIS FORM
MUST BE FILED WITH THE CITY OF PITTSBURG WITHIN SIX MONTHS FROM THE
ACCRUAL OF THE CAUSE OF ACTION. A CLAIM RELATED TO ANY OTHER CAUSE OF
ACTIOiv SHALL BE PRESENTED NO LATER TITAN ONE YEAR AFTER ACCRUAL OF THE
CAUSE OF ACTION.
P 325 849 950 p �
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CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA April 8, 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: UnknMn Section 913 and 915.4. Please note ay $d11fm
CLAIMANT: Bushra Begum '+' _ �J
M nR n 4 1997
ATTORNEY:
COUNTY COUNSEL
3818 Camino andres Date received MARTINEZ CALIF.
ADDRESS: BY DELIVERY TO CLERK ON March 4 1997
Bay Point, CA 94565
BY MAIL POSTMARKED: January 27, 1997
Hand Delivered via: Risk Mgmt.
1. FROM: Clerk of the Board of Supervisors 70: County Counsel
Attached is a copy of the above-noted claim.
DATED: March 4, 1997 cglL RAATTCVELOR, Clerkepu
Y.
II. FROM: County Counsel TO: Clerk of the Board of Supervisors L�
(� 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`5. 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.
APP " "
Dated: PHIL BATCHELOR, Clerk, By /C 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.
APR 10 1997
Dated: BY: PHIL BATCHELOR by--o Deputy Clerk
CC: County Counsel County Administrator
Julie Aiimnrk
FEB 25 1997
Memorandum Ron Harvey
OFFICE OF COUNTY COUNSEL
11"e) �-
DATE: February 19, 1997
TO: Jeanne Maglio, Clerk of the Board of Supervisors
Attn: Shirley Castillo
FROM: VICTOR J. WESTMAN, COUNTY COUNSEL i n
By: Gregory C. Harvey, Deputy County Counsel
RE: Claim of Bushra Begum Against Contra Costa County
Redevelopment Agency
RECEIVED
Attached are documents to be treated as a claim. R+ -�
MAR ?COSTA
CLERK BOARVISORS
CONTR .
CONFIDENTIAL ATTORNEY CLIENT DOCUMENT 1
COUNTY COUNSEL'S OFFICE
CONTRA COSTA COUNTY
MARTINEZ,CALIFORNIA
Date: February 6, 1997 CONFIDENTIAL
To: Greg Harvey, Deputy County Counsel
From: Sharon L. Anderson, Deputy County
Re: CLAIM OF BUSHRA BEGUM AGAINST CONTRA COSTA COUNTY
REDEVELOPMENT AGENCY
When Vic gave me the attached claim, he suggested that, if Jim Kennedy agreed, this should
be processed through the Board as a formal claim. I spoke to Jim on this date and he agreed that it
should be processed as a claim. I told Jim that I would ask you to have someone handle this as a claim
and process it through the Board's agenda in the usual manner. I have the various loan documents if
you need them. Thank you.
SLA:la
CC. Jim Kennedy
CONTRA COSTA COUNTY REDEVELOPMENT AGENCY f E B
COUNT"COUNSEL
MARTINEZ CALIF.
DATE: February 5, 1997
TO: Sharon Anderson Deputy County Counsel
FROM: Jim Ke Deputy Director - Redevelopment
SUBJECT: January 1997 Claim of Bushra Begum
Enclosed is a copy of a letter received by this office on January 28, 1997 requesting a warranty from
the Agency relative to certain alleged deficiencies in a property purchased by the above party. As
background, I offer the following.
In 1993 the Redevelopment Agency established a second mortgage program to assist first time
homebuyers in the purchase of homes within the Oakley and Bay Point communities. The funds
utilized were bond proceeds secured by Redevelopment Agency tax increments from the Oakley and
Bay Point project areas. The Agency had no contractual relationship with a builder in the conduct
of this program. The Agency did have operating agreements with a mortgage lender. The First Time
Homebuyer Program is generally described on the attached public information brochure. Copies of
other lending agreements are available upon request.
The above party purchased a home using financing that included the Agency's second mortgage
assistance. The transaction closed in April of 1996. To document the assistance, the above
referenced borrower was required to execute a Promissory Note, a Deed of Trust, and Security
Agreement, and a Resale Restriction Agreement and Option to Purchase. Copies of those documents
are attached.
This is to request your guidance on responding to the above claim. To the best of my knowledge,
this claim was not filed with the builder-Anchor Drive Associates. I underscore that the Agency had
no contractual relationship with Anchor Drive Associates, or any other builder. The assistance was
provided directly to homebuyers purchasing homes of their selection within the community.
JK:lh
Attachments
cc Kelly Calhoun
File F5.9(cx12)
ua25/anderson.mem
97 JAN 28 PM 4: ej
F
--- CEIVED
yl
MAR - 4 r f
January 16, 1997
¢CLERK BOF VW SUPER ISOR_%'
r0',.RA CoSTA_c0.,,_ ,
Contra Costa County Redevelopment Agency
651 Pine Street
Martinez, CA. 94553
Gentlemen:
Re: 3818 Camino Andres
Bay Point, CA. 94565
This letter is to inform you that the above property which I purchased April 4, 1996, has water
approximately 6 inches deep under the house.
Unless this problem is immediately corrected I will contact my attorney to rescind the purchase
agreement and seek damages.
I want a ten(10)year written warranty from the date of the correction to assure me that the problem
has indeed been corrected. This warranty must be signed by the Contra Costa County Redevelopment
Agency officer and also signed by Anchor Drive Associates with personal guarantee signed by the
principals.
Sincerely,
13ok2k v
Bushra Begum /
3818 Camino Andres
Bay Point, CA. 94565
cc Norwest Mortgage
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CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA April 8, 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 IL
rrGeoo��vrrerrrnCmeenrYt�e Code 1�
Amount: $175,000.00 Section 913 and 915.4. Please note all 1�X rgY--. V
CLAIMANT: Glenda Ellyn Edwards u MAR 0 A 1997
ATTORNEY: John C. Ferry COUNTY COUNSEL
P.O. Box 23646 Date received MARTINEZCALIF.
ADDRESS: 200 Gregory Lane, Ste. B-2 BY DELIVERY TO CLERK ON March 5, 1997
Pleasant Hill, CA 94523-0646
BY MAIL POSTMARKED: March 4, 1997
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
March 6, 1997 HIL BATCVIELOR, Clerk
DATED BppY: Depu y
II. FROM:
County Counsel TO: Clerk of the Board of Supervisors
(U1 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: �Y`` / 4,-,, ota A4t� ��'e
tA4,<,
X(
Dated: BY: /L 447- 'c,C Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present
(X) This Claim is rejected in full.
( )
Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this date.
Dated: APR 0 8 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 10 1997 BY: PHIL BATCHELOR b� V� Deputy Clerk
CC: County Counsel County Administrator
Claim to: BOARD OF SQPER71SORS OF CONTRA COSTA COUNPY
INSTRDCTIONS TO M ADWT
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, 19871
must be presented rot 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 4911.2.)
B. Claims must be filed xith the Clerk of the Board of Supervisors at its office in
Room 106, County Administration Building, 651 Pine Street, !lartinsz, CA 94553•
C. If claim is against a district governed by the Board of Supervisors, rather than
the County, the r>ame 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 and of this
TO—M.
f f f f ! ! ! i ■ f i f f f i ! i f f ! i i f f i f ! f f f f f f f f f i f f f ! f f
RE: Claim By 1 y ; Reserved for Clerk's filing stamp
REC.,
Against the County of Contra eta )
or ) MAR F
District) CLERK BGn pop SUPERVIS
(Fill in name ) Coh'rnACosi—
Slee undersigned claimant hereby makes claim against the County of Contra Costa or
the above-named District in the aum 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)
-4-v %A
3. How did the damage or inju6 occur? Give full detailsf use extra paper if
required) I p
4. t ioular act or omission c6 the part of county or district Ufioerst
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?
���wb� 9v\�p--
6. What damage injuries do you Claim resulte (Give full e t of Wurriie orF� bel,
damages claimed. Attach two estimates for auto damage.
7. Now was the amount claimed above oacputed7 (2r6lude the estiilated amount of any
prospective injury or damage.)
S. !tames and addresses of ktTWSM, doatoA and hospitals. 1 i
9. Lik the expendituresvyou made on account of this acccciiddent or injury: - 1
DATE M
rarararrrrasaraaaraaararraraaaararasarraaa
Gov. Code Sec. 910.2 provides:
by the
SMNMCFS T0: (Attorney) or some claim �soneonih sdb-half.^claimant
ame and Address of Attorney
laiman�s Signature)
_.
o� A
Telephone No&/=�4- IWC) i Telephone N C..7 2
a ! a f r r aT r a a r a r r r f a a
NOTICE
Section 72 of the Penal Cade providest
°Leery person who, with intent to defraud, presents for allowance or for
papmcnt to any state board or officer, or to any oounty, city Cr district board or
officer, authorized to allow or pay the an if genuine, any false or fraudulent
claim, bill, account, voucher, our writing, is punishable either by imprisonment in
the county jail for a period of not mare 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 8, 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: $5,000.00+ Section 913 and 915.4. Please note all • in%gV r TS
CLAIMANT: Nancy Farren MAR 17 1997
COUNTY ATTORNEY: Gail S. Greenwood
MART NEZ CALIF
Law Offices of B. Palmer Riedel Date received
ADDRESS: 2700 Ygnacio Valley Rd. , Ste. 130 BY DELIVERY TO CLERK ON March 14, 1997
Walnut Creek, CA 94598-3455
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.
IL gAT ffiLOR, Cle���
DATED: March 17, 1997 : Depu y
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
foy(If This claim complies substantially with Sections 910 and 910.2.
( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying
claimant. The Board cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send
warning of claimant's right to apply for leave to present a late claim (Section 911.3).
( ) Other:
Dated: 9 /6 7 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
(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 0 8 1997 PHIL BATCHELOR, Clerk, 8� � ��d� . 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"
Dated: APR 10 1997 BY: PHIL BATCHELOR by`�j— Deputy Clerk
CC: County Counsel County Administrator T
Julie Aumnck
0/��errithew
��emorial MAR 1419-97
� 4&d
AND HEALTH CENTERS
March 13, 1997
To: Contra Costa County Counsel
From: William Walker, MD, Health Services Director
Re: Nancy Farren
Please note that a §364 Notice of Intent to Commence Action regarding the above-named patient
was mailed to Dr. Allen Casebolt who is currently on sick leave. Copies are attached.
cc: Ron Harvey
enc.
RECEIVED
MAR p14nn 1919T
CLE 9 80ARD OF SUPERVISORS
CONTRA COSTA CO.
CONTRA COSTA COUNTY --
Y'
February 24, 1997
VIA CERTIFIED MAIL
Allen Casebolt,M.D.
MERRITBEW MEMORIAL HOSPITAL
2500 Alhambra Avenue
Martinez, CA 94533
Re: Our Client: Nancy Farren
SS#: 563-46-9038
Date of Birth: 4/20135
Date Of Injury: 2/27/96
Dear Dr. Casebolt:
This letter shall serve as notice in accordance with Section 364 of the California
Code of Civil Procedure that Nancy Farren will file a lawsuit against you resulting
from her personal injury on February 27, 1996. The legal basis of this action will be the
negligent failure to properly treat and perform surgery on Ms. Farren's left ring finger.
Ms. Farren will allege that you failed to perform the proper surgery which caused her
to lose mobility of the finger and require further surgeries, as well as further physical
therapy and medical treatment for an indefinite period. Ms. Farren will allege medical
expenses which have not yet been ascertained(because a third surgery will minimally
be necessary), but which are anticipated to be in excess of$5,000. Ms. Farren will also
allege pain and suffering and emotional damages.
Very truly yours,
LAW OFFICES OF B. PALMER EI:
GAIL.S. GREENWOOD
cc: Nancy Farren
LAW OFFICES OF
B. Palmer Riedel
2700 Ygnacio Valley Road •Suite 130• Walnut Creek,California 94598-3455 - (510)934-4111
FAX It(510)934-4628 • 1).0.13ox 1043 • Lafayette,Califomia 94549-1043
1
DECLARATION OF SERVICE VIA U.S. MAIL
2
3 I, the undersigned DECLARE:
4 I am a citizen of the United States, over 18 years of age, and not a party
5 to the within entitled action; I am employed at and my business address is 2700
6 Ygnacio Valley Road, Suite 130, City of Walnut Creek, County of Contra Costa, State
7 of California; on this date I served the within:
s
9 = LETTER DATED FEBRUARY 24, 1997
10
on the parties in said action by placing a true copy thereof enclosed in a sealed
11
envelope with postage fully prepaid and depositing same in the United States mail at
12
Walnut Creek, California, addressed as follows:
13
Allen Casebolt, M.D.
14 MERRITHEW MEMORIAL HOSPITAL
2500 Alhambra Avenue
15 Martinez, CA 94533
16 I declare under penalty of perjury that the foregoing is true and correct,
17 and that this Declaration is executed at Walnut Creek, California on February 24,
11997.
199 �
20 RRI MOTINEZ
21
22
23
24
25
26
C . Is
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA April 8, 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: $10,000.00 Section 913 and 915.4. Please note all 0
"TrMIM7111
CLAIMANT: Brenda J. Gardner UUDV'"' ��UUJJ
MAR 17 1997
ATTORNEY: COUNTY COUNSEL
Date received MARTINEZCALIF.
ADDRESS: 147-4th Street BY DELIVERY TO CLERK ON March 14, 1997
Richmond, CA 94801
BY MMarch 13
AIL POSTMARKED: 1997
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
PPHHIL ATLHHELOR, Clerk�� o e�
DATED:March 17, 1997 BT: �eputy
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
This claim complies substantially with Sections 910 and 910.2.
( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying
claimant. The Board cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send
warning of claimant's right to apply for leave to present a late claim (Section 911.3).
( ) Other:
Dated: H d "/ BY:� ( 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
(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. o o
Dated: APR O 8 1906' PHIL BATCHELOR, Clerk, BBj-�/S�� 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 10 1997 BY: PHIL BATCHELOR o� Deputy Clerk
CC. County Counsel County Administrator
Claic :o: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY U ��
INSTRUCTIONS TO CLAIMANT
A. Claiss relating to causes of action for death or for injury to person or to per-
sonal Property or growing crops and which accrue on or before December 31, 1987,
must be presented not later than the 100th day after the accrual of the cause of
action. Claims relating to causes of action fa•-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 accMml of the cause
of action. Claims relating to any other cause of action must be presented not
later than arm: 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 Sapervisors at its office in
Room I.06, 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
for--.
RRRRRRR � MRR ! fE 1flRRRRRRRRRRRRRRRRRRRRRARRR /F 1FR
RE: Claim By 1 ) Reserved for Clerk's filing stamp
RECL:
Against the County of Contra Costa
or ) MAR Q
District) CLPRK BOARD OF SUPERVISORS
(Fill in name - ) CONTRA COSTA CO.
The undersigned claimant hereby makes aim�8ain t theOgounty of Contra Costa or
the above-named District in the sum of $ U C� . 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)
�D � {� .
3• How did the damagd or injury Ioc ur? (G'ye full Beta' use extrar f
required) �n � YV��h'�1
4. What particular act or omission on thJ part of county or district office,
�servants or employees caused the injury or damage. J
n� CL✓-�
j. what are the na.•ues of county or district officers, servants e loyees ca i t�t
tsyo ua _be or inju �.? J ^ (�/ „ V 1�7 ( J�1 L.- LI t f
aaa L
u _L�4__ _
5. Khat damage or injuries do you claim resulted? (Give full e)( o in uri
damages claimed. Attach two a t�cates for auto damage,
/ . I U9 S
7. How was the amount above computed? (InobAde the estimated amount o any c-
rospective injury or damage.) �y C - C��
AA /vA
�yL �4L Urnt.-+,1 �--E--
$ Names and addresses of 1�esses oCtors spiiais. y t
.� tt-� u�c�
9. List the expenditures you made on ao=mt of this acoident or injury:
DATE ITEM AMIW
God. Code Sec. 910:2 provides:
The claim must be i ed by the claimant
SEND' CES T0: (Atto.^ne } some is behalf."
Name and Address of Attorney
/ l - N –(Claimant's `ignatu —
(Address)
NO. 3__ Z �b Telephone No. t
V1,,P_V 754 - P-7 (,
NOTICE �{ �J (Ar
Section 72 of the Penal Code provides: Z
1 T
"Every person who, with intent to defraud, pre Lts f lowanci o for �d I ,
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 ., '] iu-;r;so-uxr and fine-
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CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA April 8, 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: $1,000.00 Section 913 and 915.4. Please not }�.��T
IDCLAIMANT: Annie Perkins—Jeffries JJ��+
MAR 13 1997
ATTORNEY:
Date received COUNTY COUNSEL
MARTINEZ CALIF.
ADDRESS: 112 Adele Dr. BY DELIVERY TO CLERK ON March 11, 1997
Vallejo, CA 94589
BY MAIL POSTMARKED: Hand Delivered via: Risk MPmt.
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim. p11 HH q�
DATED: March 13, 1997 IVIL BeputyLOR, Clerk/' �J/ vlo
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
(4 This claim complies substantially with Sections 910 and 910.2.
( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying
claimant. The Board cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send
warning of claimant's right to apply for leave to present a late claim (Section 911.3).
( ) Other:
Dated: 3 '��J / BY:L
/r Deputy County Counsel
I11. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
1V. 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 0 8 1997 PHIL BATCHELOR, Clerk, BLA `�' , ` 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 10 1997 BY: PHIL BATCHELOR b ".��a-__e_�DeputY Clerk
CC: County Counsel County Administrator
Cion
Claic to: BOAPM of SJPERVMRS OF CONM COSTA C(XKU VAR It 1997
lA'SMUMONS TO CLAI}fW
A. Clam relating to causes of action for death or for injury to person or to per_
sonal property or growing crops and mbich 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 Pew Property or growing crops and %lhich accrue on or after January 1,
198$, 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 §913..2.)
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in
Room 106, Camty, Administration Building: 651 Pine ,street. Martinez, CA 94553.
C. If claim is against a district governed by the Beard 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
for.-.
RRR R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R IF R R R R R R R
R£: Claim By l 7 Reserved for Clerk's filing stamp
RECEIVED
Against the County of Contra{ Costa } a f d Cu µ
or } MAR I. 11997
District} pKBpApoapSupEgvtsaFls
(Finin name) } NIRA COSTACO
The undersigned claimant hereby makes claim against the County of Contra Costa or
the above-named District in the sum of $ 61r-�and in support of
this claim represents as folla•m:
1. When did damage or injury occur? (Give exact date and hour)
r
2. Where jdid / damage or` injury occur?{ (Include jcity and County)
r{ / 3
L i i F t f�LJ Z» (; t.. i i
3. How did the damage or injury occur? (Give full details; use extra paper if l
rewired)
t�7jg
4. What particular act or omission on�ibe part of county or district officers,
servants or employees caused the injury or damage?
�G
r, >r -
5. wnat are tne names or county or district officers, servants or employees causing
t'� da:-;-ge 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 %as the amount claimed above ted? (include the estimated amOunt of any
prospective injury or damage CL tit -YLIX6r L
21,
S. Names and addresse 0 o"
,T witnesses d -tors and hospitals.
Z'
- t,
List the expenditures you made on account of this accident or injury=
DATE 1TEN AVOJNT
Al t, �
JA,
w
God. Code Sec. 910;2 provides:
"The claim must be signed by the claimant
SEND NOTICES TO: (Attorney) or'W some on 's behalf
Nam and Address of Attorney
(Claitant's Signature)
A_ddxvss)
7e
Telephone No, Telephone No� C
r
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 ($10,000, or by
both :5=h and f-ine,
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{�� tl: Uig ;�-�t�•r''.i C.i Y �,)Jil�'�..y'��'� ( U,�1�1�1'...C`��
c.-�.�l��,i,L��I' l'�"� �I✓`�'�;7 �r'1.�'.J �kZ,ti� (12Tt,c.c�w,� ��.;;�-�,-.- aCP_-,�
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ESTMATE FOR THREE TIRES AND RIMS.
RIM # nCOST FOR THREE
TIRES # ` l��JL � Q COST FOR THREE
CHROME LUG NUTS �3 X 1 .0 1(S�' S ) C I �j• O� )
CHROME VALVE STEMS 3 �C "� C� �•°l
TAX I`�
INSTALLATION 3 �2- -9 � (37 -c)4)
TOTAL
ESTMATE FOR THREE TIRES AND RIMS.
RIM # COST FOR THREE
I
TIRES # I g550 •R15 COST FOR THREE X � -qq t 1 -7
CHROME LUG NUTS �� "4 1 .
CHROME VALVE STEMS
J LA- b --L,+� �L � vG !
TAX 3 E , / 4
INSTALLATION 4" �$ -)
TOTAL ��
CLAIM PRESENTED TO THE CITY OF SAN PABLO 4for Filing Stamp
' Please read the instructions on the back before com letin .
1. Claimant's Name: (PLEASE PRIN ) n�I e �'� (—l� � PrO�C�"i��,r�Z`�
Claimant's Address: cc:
A
City, State, Zip: CA 1 l O C ct4 52)
Day Phone: Gve Phone.—(I JL City Claim#
2. When did the damage or iniuty occur?
Month:: Day:a� Year: 19a Time: a.m.7 /
3. At which location �d the dama e ort occur? Police Report#
4. What happened and why is the City responsible?
a ---
4,, wZl
N e and positio of respo ible City Employee(s), if known:
b,
5. What damage or injury occurred? % Gu�J L�'C,
6. Claim amount (only if less than $10,000) 4t \O� CU
If the amount exceeds $10,000, please check (J) the court of appropriate jurisdiction:
Municipal Court (claims up to $25,000)_Superior Court (claims over $25,000)
7. How did you arrive at the amount claimed? Please attach documentation.
8. I declare under penalty of perjury under the laws of the State of f iftomia that the following informa9ntrue
and c ct and t thi declaration was executed on �—T t
at CA. ` I
Signature of Claimant or Rk&senqWs Signature
9. Official Notices and Cortes ondence
represent y an insurance company or eo attomey, please provide the information requested below.
Name and Capacity: (PLEASE PRINT)
Address:
City, State, Zip:
Davtime Telephone: ( Evening Telephone:
CCN I R. Cl)S \ ct)t, N I �-
(L MUNICIPAL RISK MANAGEMENT INSURANCE AUTHORITY
Ptl1 S:AA V11c( " (1KIl'F WITT 2011 N% VI.AtT( R1 1:K, C,A Q4,I)i
February 24, 1997 >fit)043_1100 • 1:AX 10)Q4n_A IS
Ms. Annie Jeffries
112 Adele Drive
Vallejo, Ca 94589
RE: CLAIMANT: Annie Jeffries
CLAIIVI NO.: 1007535
OUR PRINCIPAL: City of San Pablo
DATE OF INCIDENT: 1/23197
Dear Ms. Jeffries:
In follow-up to the letter I sent to you returning your photographs, as I explained to you,
the area where your vehicle was damaged is in Contra Costa County, and not in the
City Limits of San Pablo.
As a result, under separate cover, you will be receiving a Notice of Rejection of your
claim from the City of San Pablo.
If you have any further questions, or if I can be of any further assistance to you, please
call.
Sincerely yours, -
ZI,�,
Will Venski
Liability Claims Adjuster
WV/pm
c: Ms. Charlotte Maggard, City of San Pablo
ILIO
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA April @, 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 ��,v'
Amount: $25,000.00+ Section 913 and 915.4. Please note all
CLAIMANT: Michael Marcus, a minor c/o Charles & Minie Marcus MAR n 4 1997
AT70RNEY: Jacoby & Meyers COUNTY COUNSEL
Dona E. Cohn, Esq. Date received MARTINEZCALIF.
ADDRESS: 100 California St. , Ste. 700 BY DELIVERY TO CLERK ON March 4. 1997
San Francisco, CA 94111
BY MAIL POSTMARKED: March 3. 1997
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim. P 4
DATED: March 4, 1997 cf�IL 9epuyLOR, Clem
i
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
(Xj 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 9//1,,1''.3).
Other: o //w bIFC�( GlJ (A `.s'✓x,
Dated: ��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.
Dated: APR O 8 1997 PHIL BATCHELOR, Clerk, B ''/� a°�� Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only Six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the
United States, over age 18; and that today I deposited in the United States Postal Service in Martinez.
California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to
the claimant as shown above.
Dated: APR 10 1997 BY: PHIL BATCHELOR b� / Deputy Clerk
CC. County Counsel County Administrator
F E g ._ I S - 9 3 T H U S : 2 !5 C O N T R A COSTA Co . RISK MGT R . @ 2
Clair. to: BARD OF SUPERVISORS OF CON'T'RA COSTA COt,^,7Y
INSTRUCTIONS M CI.AMN-r
A. Claics relating to causes of action for death or for injury to parson or to per-
sonal property or growing crops and which accrue on or Wore December 31, 1937 ,
must be presented not later than the 100th day after the accrual of the cause of
action. Claims relating to causes of action for.death or for injury to person
or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not
later..than one year after the accrual of the cause of action. (Govt. Code §911.2.)
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in
Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553.
C. If claim is against a district governed by the Burd of Supervisors, rather than
the County, the raze of the District should be filled in.
D. If the claim is agairst 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.
# # # # # # # # # # I # # # # # # # # # # # # # # -# # # # # # # # # # # # # # # # # #
RE: Claim By } Reserved for Clerk's filing stamp
)
Michael Marcus, a minor _ }
c/o Charles '& Minie Marcus ) RECEIVED
Against the County of Contra Costa }
or ) MAR —4 l9gl
District)
(Fill in name ) CLERK 60ARD OF S1JPEP`
- -
CONTRA
The undersigned, claimant hereby makes claim against the County of Contra Costa or
the above-named District in the sum of $e cess of $25 , 000 and in support of
this claim represents as follows:
1. When did the damage or injury occur? (Give exact date and hour)
December 5,1996 at approximately 7-9 a.m. _
..�.. � +��....�� ��..,� �...��..�w..��..��....�►.r �...»w�..«..mow
2, Wnere did the damage or injury occur? (Include city and county)
Laidlaw Transit Bus Yard, 436 Parr Boulevard, Richmond, Contra Coster Co.
3. How did the damage or injury occur? (Give full details; use extra paper if
required)
see attached
4.�N%at particular act~or omission on the part of county ordistrictoff� cers, ~
servants or e^ployees caused the injury or damage?
see attached
;ovc�)
Claimant fell asleep on the school bus and did not get off at his
school stop. The driver drove the bus to the school yard and
vacated the bus without checking the entire bus. Claimant was left
on the bus and woke up alone, in a panic. He was forced to crawl
out a window and fall to the ground. He walked out of the Laidlaw
Transit bus yard and was picked up on the street by a stranger who
drove him to the police station. West Contra Costa Unified School
District and Contra Costa County did negligently manage, hire,
operate, maintain, and supervise its transit service and are
directly and proximately responsible for all of claimant's
injuries.
r t_ � •- i � — y -� THU 9 : 2 .6 CONT Rra COSI- A CO . R I SK MGT P . O3
5. what are the na.-jes of county or district officers, servants or employees causing
the darage or injury?
Sheila, Laidlaw Transit bus driver
5. - -
What damage or injuries doyou claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage.
Including but not limited to abrasions, contusions to face, emotional trauma
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
D>, cove s Contin Inq _ __-+—~_
$. Names and addresses of witnesses, doctors and hospitals.
Kaiser Permanente
901 Nevin Avenue
Richmond, CA 94801
9. List the expenditures you made on account of this accidentorinjury:
DATE ITEM AMOt N i
Discovery is continuing.
A # # # # # i # # �f.M # # i � ! i # i # M # #' # # # ! # # # M #
,,Gov. Code Sec. 914.2 provid
011ie claimgne byi he claimant
SEND NOTICES TO: (Attorney) or soros on hi f.*
eme and Address of Attorney
Jacoby & Meyers
Dona E. Cohn, Esq. - :, siera $ignaLLt�
100 California St. , Ste 700 Attorney for Claimant
San Francisco, CA 94111a b & M 10California St,
A ess
Ste 7.00- • I -"
San Francisco, ' CA 94111
Telephone No. 415-399-8951 Telephone No. n/a
N0TIC8
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 (31014401 or by
both such imprisonment and fine.
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CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY CALIFORNIA April 8, 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 toS',w`�,
Amount: $10,000.00+ Section 913 and 915.4. Please note all ings..
CLAIMANT: Joseph C. Nichelini, d.b.a. Nichelini General Engineering MAR 0 4 1997
COUNTY COUNSEL
ATTORNEY:
Stephen P. McGee, Esq. MARTINEZCALIF.
Law Office of STephen P. McGee Date received
ADDRESS: 862 Sir Francis Drake Blvd. , #2748Y DELIVERY TO CLERK ON March 4, 1997
San Anselmo, CA 94960
BY MAIL POSTMARKED: February 27, 1997
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: March 4, 1997 JyjL BAATTCVELOR, Clerepuk�f�
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
PCf 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: y / BY: x 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 08 1997 PHIL BATCHELOR, Clerk'. 4-- J� peputy 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 1 0 1997 BY: PHIL BATCHELOR '1by� � QaLo Deputy Clerk
CC: County Counsel County Administrator �'-
Rk r-1`lED
Law Office of _
STEPHEN P. McGEE F2,A�'
_ i< !997
Mailing Address: CLERK =RViSORS
862 Sir Francis Drake Blvd., No. 274 co, Telephone: (415) 256-2855
San Anselmo, California 94960 Facsimile: (415) 256-2852
February 27, 1997
BY CERTIFIED MAIL - RETURN RECEIPT REQUESTED
Board of Supervisors Building Inspection Department
Contra Costa County Contra Costa County
Clerk to the Supervisors 651 Pine St., 3'Floor,North Wing
651 Pine Street Martinez, Ca 94533-1295
Martinez, CA 94533-1295
Contra Costa County J. Michael Walford,Director
Department of Public Works Contra Costa County
Grading Division Public Works Department
651 Pine St., 3d Floor,North Wing 255 Glacier Drive
Martinez, CA 94553-1295 Martinez, CA 94553-4897
Contra Costa County Mr. Harvey E. Bragdon, Director
Public Works Department Community Development Dept.
Construction Division Contra Costa County
255 GIacer Drive 651 Pine Street,North Wing
Martinez, CA 94553-4897 Martinez, CA 94553-1295
Mr. Richard Lierly
Contra Costa County
Public Works Department
Engineering Services Division
255 Glacier Drive
Martinez, CA 94553-4897
Re: Project: Hillcrest Heights, Tract 7582
Claimant: Nichelim General Engineering
Issue: Improvement Security Bonds/Security
NOTICE PURSUANT TO GOVERNMENT CODE SEC. 66499.7
To Whom It May Concern:
The accompanying Notice is being provided at this date in order to eliminate any future
questions as to the timeliness of the claim. However,by filing this claim it is not to be suggested
that all of the pertinent facts have been developed and/or understood by the claimant. Therefore,
the claimant will be most interested and willing to consult with appropriate individuals and to
Law Office of
STEPHEN P. McGEE
February 27, 1997
Page 2
review available files in an effort to determine the underlying facts and possible explanations for
the issues of concern to the claimant.
Furthermore,the claimant is most interested in the response from various County officials
relating to our letter of February 18, 1997.
Very truly yours,
LAW OFFICE OF STEPHEN P. McGEE
e he . McGee
SPM/ed
Attachment
cc: Office of the County Counsel
Contra Costa County
651 Pine Street, 9'h Floor
Martinez, CA 94553
L0SPhM646\04\L-P W DEPT.doc
I Stephih'P;McQee (Bar#079508)
Law Office of Stephen P. McGee
2 862 Sir Francis Drake Blvd.,#274
San Anselmo, California 94960
3 Telephone: (415)256-2855
Facsimile: (415) 256-2852
4
Attorneys for: Joseph C. Nichelini doing business as
5 and licensed as Nichelini General Engineering
6
7 Claim of
8
JOSEPH C. NICHELIM, d.b.a.NICHELINI CLAIM AGAINST PUBLIC ENTITY
9 GENERAL ENGINEERING PURSUANT TO GOVERNMENT
CODE SECTIONS 905 AND 910
10 Claimant,
11 vs.
12 COUNTY OF CONTRA COSTA
13
14
15 TO: County of Contra Costa and/or Board of Supervisors of Contra Costa County care of the Clerk to
16 the Supervisors, Contra Costa County Building Inspection Department; Contra Costa County,
17 Department of Public Works Grading Division; Contra Costa County, Department of Public Works
18 Construction Division; J. Michael Watford, Director, Contra Costa County Public Works Department;
19 Mr. Harvey E. Bragdon, Director, Contra Costa County Community Development Dept.; Mr. Richard
20 Lierly, Contra Costa County, Public Works Department, Engineering Services Division; and Office of
21 the County Counsel, Contra Costa County
22
23 JOSEPH C.NICHELINI, individually and doing business as and licensed as NICHELINI
24 GENERAL ENGINEERING ("NGE")hereby makes claim against the COUNTY OF CONTRA
25 COSTA and/or the entities thereof named above for the sum set forth hereinbelow and makes the
26 following statements in support of the claim:
27
28
-1-
1 1. The name and mailing address of Claimant: Claimant Joseph C. Nichelini, doing
2 business as, and licensed as NICHELINI GENERAL ENGINEERING has a mailing address of Post
3 Office Box 5156,Napa, California 94581.
4 2. Official Notices and Correspondence: Notices concerning this claim should be sent to
5 Stephen P. McGee, Esq., Law Office of Stephen P. McGee, 862 Sir Francis Drake Blvd., #274, San
6 Anselmo, California 94960.
7 3. Dollar amount and basis of claim: As set forth herein,NGE is seeking the recovery of the
8 principal sum of$535,421.29 plus interest thereon at the maximum rate provided for by law, from
9 during or about September 1996, plus all other relief provided for under the applicable contract and/or
10 by law. NGE's claim as of the date of this claim is in an amount that would place it within the
11 jurisdiction of the Contra Costa Superior Court.
12
13 The claim is based on damages, breach of a statutory duty and/or negligence by the County of
14 Contra Costa, and/or its entities thereof, due to the failure of the County, and/or its entities thereof, to
15 require and/or obtain a sufficient amount of security through the Improvement Security Bond for
16 Subdivision Agreement dated April 24, 1996, or other forms of security required to be provided under
17 the terms of California Government Code Section Sections 66499 et seq.
18 4. The date, place and circumstances giving rise to this claim are as follows:
19
NGE is informed and believes and thereon alleges that the County of Contra Costa and Cerrito
20
Development, Inc. ("CERRITO") entered into a written Agreement for Subdivision Improvements
21
("Subdivision Agreement") on or about May 7, 1996.
22
23 NGE is informed and believes and thereon alleges that the Subdivision Agreement was or
24 should have been executed pursuant to the provisions of the California Government Code pertaining to
25 the Subdivision Map Act of the State of California.
26 The Subdivision Agreement required security for the faithful performance of the Subdivision
27 Agreement and security for payment to any contractor, his subcontractors and to persons renting
28
-2-
I equipment or furnishing labor or materials to them for the improvement required under the Subdivision
2 Agreement.
3 NGE is informed and believes and thereon alleges that CERRITO executed an Improvement
4 Security Bond for Subdivision Agreement("Bond") on April 24, 1996.
5 NGE is informed and believes and thereon alleges that said Bond is in an insufficient amount
6 and/or related security has not been required and/or obtained by the applicable governmental entity in
7 accordance with applicable Government Code provisions.
8
9 NGE on or about May 1994, entered into a written contract with CERRITO. Between July 1994
10 and October 1996, written and/or oral revisions thereto were made and NGE famished all required labor,
11 materials, services, and equipment, all of which was used, consumed and/or contributed towards the
12 work of improvement in the real property commonly known as Hillcrest Heights, Subdivision No. 7582.
13 NGE has not been paid all due it. Initially, the recovery of this money is being sought through, not by
14 way of limitation, a mechanic lien recorded by NGE on February 4, 1997, and a Notice to Surety and
15 Bond Principal on Payment Bond dated January 24, 1997.
16 Damage will be subject to full specification and itemization by NGE when it is determined that
17 the amounts due and owing to NGE for the provision of labor, materials, equipment and supplies to that
18 certain real property situate in the County of Contra Costa, State of California, located at and commonly
19 known as (i) Hillcrest Heights, and/or (ii) Subdivision No. 7582, Hillcrest Heights, cannot be recovered
20 under the Improvement Security Bond for Subdivision Agreement dated April 24, 1996, because, not by
21 way of limitatin, of the insufficient amounts of said security and/or cannot be recovered due to the
22 unavailability of such security as is to be required by the governing public body under the applicable
23 provisions of the California Government Code and Sections 66499 et. Seq.
24
5. NGE does not have specific information or belief as to the identity of any one individual
25
with the County of Contra Costa responsible for the insufficiency of the Bond and/or the unavailability
26
of any other form of security required under the terms and provisions of the California Government
27
Code.
28
-3-
1 6. It is unclear whether NGE is required to comply with the claims procedure at this date but
2 the claim is provided to avoid the lapse of any rights and/or interests through the passage of time.
3 7. NGE hereby reserves the right to modify and/or amend this Claim.
4
5
6 Dated: February 27, 1996
7 /
8 JO ICHEL individually
9 aPM doing business as and licensed as
NICHELINI GENERAL ENGINEERING
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
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CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
April 8, 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 nogRaMaW413
CLAIMANT: Allen Abrantes 1 MAR 0 4 1997
ATTORNEY: John A. Pettis COUNTY COUNSEL
1830 Pacheco Blvd. Date received MARTINEZCALIF.
ADDRESS: P.O. Box 1689 BY DELIVERY TO CLERK ON March 4, 1997
Martinez, CA 94553
BY MAIL POSTMARKED: Hand Delivered via: Risk MQmt.
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: March 4, 1997 JYIL ATCgqELOR, Clerk
BY: �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
clang-t. Th: Board cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send
warning of claimant's right to apply for leave to present a late claim (Section 911.3).
( ) Other:
Dated: �j�S/� BY: �(i/J/�/J(a ®/ Gr%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
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 0 8 19917
PHIL BATCHELOR, Clerk, B� 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 10 1997 BY: PHIL BATCHELOR b� Deputy Clerk
CC: County Counsel County Administrator
NOTICE OF INSUFFICIENCY
AND/OR
NON-ACCEPTANCE OF CLAIM
TO: John Pettis
P.O. Box 1689
Pacheco, CA 94553
RE: CLAIM OF: Allen Abrantes
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.
[XXX] 3. The claim fails to state the date, place or other circumstances of the occurrence or
transaction which gave rise to the claim asserted.
[XXX] 4. The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or
loss, if known.
[XXX 15. 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.
[@@] 7. Other:
VICTOR J. WESTMAN, County Counsel
By: d
Deputy County Cou sel
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 5, 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
JU!ie Aumock
MAR 0 4 7997
JOHN A. PETTIS 8 ASSOCIATES
PROFESSIONAL LAW CORPORATION
February 25, 1997
Julie Aumock RECEIVED_
Contra Costa County Risk Management
651 Pine Street W -,�49`97
Martinez, CA 94553 . 7�� AZt
CLERK BOARD OF SUPER SORS
CO.
Re: Your Insured: Chief Allen Little CONTRA COSTA
Date of Loss: February 14, 1997
Our Client: Allen Abrantes
Dear Ms. Aumock:
Please be advised that this office represents the above client in connection with injuries
sustained in the above accident in which your insured was involved.
We are hereby making a claim for damages on behalf of our client and we also wish to
inform you that we have a lien for attorney's fees and costs on our client's cause of action
and any recovery thereunder.
Please send us a letter confirming coverage in this matter and setting forth the applicable
policy limits, and direct all future correspondence to this office.
We will inform you when we have the medical and specials information together and are in
a position to discuss settlement of this case.
In the meantime, we hereby request that you send us copies of any statements made by our
client to you or your principals and also advise us of the names and addresses of any
witnesses known to you or your principals.
If our client has previously signed any authorizations allowing the release of medical or
other privileged information to your company, they are hereby revoked by this letter.
Thank you for your courtesy and cooperation.
Very truly yours,
JOHN A. PETTIS
JAP: rkc
Enclosure
cc: Allen Abrantes
1830 PACHECO BOULEVARD, P. 0. BOX 1689 MARTINEZ, CALIFORNIA 94553 •15101 229-0900
JOHN A. PETTIS a ASSOCIATES
PROFESSIONAL LAW CORPORATION
DESIGNATION OF ATTORNEY
TO HANDLE INSURANCE CLAIM RECEIVED
MAR - 4199T
CLERK BOARD OF SUPERVISORS
To: Contra Costa Count Risk Mann ment CONTRA COSTA CO.
Re: Claim Number:
Date of Loss: February 14 , 1997
Pursuant to Section 2695.2 (c) of the California Code of Regulations, Title
10, Chapter 5, I hearby designate JOHN A. PETTIS & ASSOCIATES
PROFESSIONAL LAW CORPORATION as my attorneys, to handle my
personal injury claim under the above-captioned loss.
A photostatic copy of this designation shall be constructed as effective and
valid as the original.
Signed:
Printed Name: r-, ' X'3"e"Q :tFZS'
Dated: o"— F 7
1830 PACHECO BOULEVARD, P. O. BOX 1689 - MARTINEZ,CALIFORNIA 94553 -l510) 229-0900
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C . 15
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA April 8, 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. 1 the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $10,000.00+ Section 913 and 915.4. Please note all aT 411dM3)
CLAIMANT: Eric shueler MAR 0 6 1997
ATTORNEY: COUNTY COUNSEL
Date received MARTINEZ CALIF.
ADDRESS: 151 El Dorado Rd. BY DELIVERY TO CLERK ON March 5, 1997
Walnut Creek, CA 94595
BY MAIL POSTMARKED: March 4, 1997
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: March 6, 1997 IVIL BeATTCVELDR, Clerk
Y.
Il. FROM: County Counsel TO: Clerk of the Board of Supervisors
This claim complies substantially with Sections 910 and 910.2.
( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying
claimant. The Board cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send
warning of claimant's right to apply for leave to present a late claim (Section 911.3).
( ) Other:
Dated: //� BY: Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present r
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 0 8 1997 PHIL BATCHELOR, Clerk, Bye /i i±.2� 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 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 10 1997 BY: PHIL BATCHELOR Deputy Clerk
CC: County Counsel County Administrator
FEB-26-1997 10:47 P.02/03
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 31, 1987,
Must be presented not later than the 100th day after the accrual of the cause of
action. Claims relating to causes of action for-death or for injury to person
or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not
later than one year after the accrual of the cause of action. (Govt. Code §911.2.)
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in
Room 1061 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 See. 72 at the end of this
o
#
RE! Claim By ) Reserved for Clerk's filing stamp
Frs_ - &t,UP,ler RECEIVED
Against the County of Contra Costa ) [MAR — 5 °`'z
or )
--
District) CLER ?`.�` „pERVH ORS
(Fill in name )
The undersigned claimant hereby makes claim against the County of Contra Costa or
the above-named District In the sum otA, and is�sWpoo Ifo
this claim represents as follows: C141is witi,� *"a
1. When did the damage or injury occur? (Give exact date and hour)
2. Where di/d� the damage or injury occur? (Include city and county)
L^jjsCL_idk
3. Hoyt did the damage or injury occur? (Give full details; use extra paper if
required) z was rid �5 bicycle o TSe� Cr«k Raced wtic�
Z 5+�-kcK u., u+�e�cr, r��e., efll�v4sp F.a l+ raed aid Y�,e cd�cr e`febridSC-,
�AiwSv.� mC 'f0 'F4�I GnA Sk 65in,n ;-. —9c3 .
4. What particular act or omission on the part of county or district officers,
servants or employees caused the injury or damage? _1kc-
(over)
FEB 26 '97 10:46 PAGE.02
FEB-26-1997 10:48 P.03iO3
5. what are the names of county or district officers, servants or employees causing
the damage or injury? Un Knoun .
6. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage. S,f «-d
enjC6. ri 5ht el becs� rr`ynt Knpe r;rytir g;J, e�F rnc1 bed
vr.e«.ov.J (dSS . -T�.e b;�,y�It wfa. G.,.d clet= �✓�c- cl�o
4�.9^tiec�ti�• .�Ja1� i:. .[ ��1. � ,.,,i c�„�� 1 �a�St��ia�_ .._
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
o(- C .t5 w i� fihc , aui b d:�wE o�
bC �'�C Sia Ptfi6r COtn,�f. . ,
S. Names and addresses of witnesses, doctors and hospitals.
m/n,� H"1-4 , v4aln< A- Cveek. /moi tN �7rce�slo�Je t Jof..7 IYIC CG.IIery
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOM -
# rrrr # # # # .# # # # # : rr # -# r.rrrrr # # ■ # # # rrrrrr # rrr #
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 /
_ (Claimant's Signature
vJalrwF (A .�.
Ad ess
qLfSTS
Telephone No. - I L4 o Telephone No. � a 1 9�f4 - 0 8� 3
# # # rr # # # # # # # # # # +� # #
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.
TOTAL P.03
FEB 26 '97 10:46 PAGE.03
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TO: BOARD OF SUPERVISORS Contra
�.,.
Phil Batchelor, County Administrator Z ) '
FROM: �I Costa
County
DATE: April 8, 1997
SUBJECT: Final Settlement of Claim -
Sarah Austin vs . Contra Costa County
Claim No. IM 1907-R
SPECIFIC REOUEST(S)OR RECOMMENDATION(S)8 BACKGROUND AND JUSTIFICATION
RECOMMENDATION:
Receive this report concerning subject final settlement and payment in the
amount of $100,000 from the Medical Liability Trust Fund.
REASONS FOR RECOMMENDATION/BACKGROUND:
Joseph J. Tonda, Risk Manager for the County, has advised the County
Administrator that within authorization an agreement has been reached
settling the medical liability claim of Sarah Austin vs . Contra Costa
County.
This Board' s March 18, 1997 closed session vote was : Supervisors Rogers,
Uilkema, Gerber, DeSaulnier and Canciamilla, yes .
This action is being taken so that terms of this final settlement and the
earlier March 18, 1997 closed session vote of this Board authorizing its
negotiated settlement are known publicly.
CONTINUED ONATTACHMENT: _YES SIGNATURE: , \
_RECOMMENDATION OF COUNTY ADMINISTRATOR _RECOMMENDATION OF BOA MMITT E
APPROVE —OTHER
SIGNATURES:
ACTION OF BOARD ON 997 APPROVED AS RECOMMENDED — OTHER _
VOTE OF SUPERVISORS
I HEREBY CERTIFY THAT THIS IS A TRUE
X UNANIMOUS(ABSENT ) AND CORRECT COPY OF AN ACTION TAKEN
AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD
ASSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN.
Contact: Ron Harvey 335-1443 ( [� $ / 9"
CC: CAO Risk Management ATTESTED—T/
Auditor-Controller PHIL BAT HELOR.CLERK OF THE BOARD OF
Health Services Director SUPERVISORS AND COUNTY ADMINISTRATOR
DEPUTY
M382 (70/88)