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HomeMy WebLinkAboutMINUTES - 05061997 - C23 I e , ;�-,3 APPLICATION TO FILE LATE CLAIM May 6, 1997 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA BOARD ACTION Application to File Late Claim ) NOTICE TO APPLICANT Against the County, Routing ) The copy of this document mailed to you is your Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to the Board of Supervisors (Paragraph III, below), California Government Code.) ) given pursuant to Government Code Sections 911.8 and 915.4. Please note the "WARNING" below. Claimant: John Bruno & Gayle Wilsone��II��� Attorney: Richard J. Alexander APR 14 1997 Address: 137 Park Place COUNTY MARTINEZ CALIFMARTINEZ . Pt. Richmond, CA 94801 Amount: $10,000.00+ By delivery to Clerk on April 11, 1997 Date Received:April 11, 1997 By mail, postmarked on April 10, 1997 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted Application to File Late Claim. DATED: April 14, 1997 PHIL BATCHELOR, Clerk, BB� Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( //) The Board should grant this Application to File LatyClaim ction 911.6). ( V ) The Board should deny this Application to File Latetion 91 ). DATED: 4 /S I VICTOR WESTMAN, County Counsel, Deputy III. BOARD ORDER By unanimous vote of Supervisorsa erg (Check one only) ( ) This Application is granted (Section 911.6). (�) This Application to File Late Claim is denied (Section 911-.6)0 I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. DATE: MAY 9 9 PHIL BATCHELOR, Clerk, By _ J Deputy WARNM (Gov. Code 1911.8) If you wish to file a court action on this matter, you must first petition the appropriate court for an order relieving you from the provisions of Government Code Section 945.4 (claims presentation requirement). See Government Code Section 946.6. Such petition must be filed with the court within six (6) months from the date your application for leave to present a late claim was denied. You may seek the advise of any attorney of your choice in connection with this matter. If you want to consult an attorney, u should do so immediately. IV. FROM: Clerk of the Board TSO: i County Counsel 2 County Administrator Attached are copies of the above Application. We notifed the applicant of the Boards action on this Application by mailing a copy of this document, and a memo thereof has ben filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. DATED: MA,111� IM PHIL BATCHELOR, Clerk, By Deputy V. FROM: 1 County Counsel 2 County Administrator TO: Clerk of the Board Of Supervisors Received copies of this Application and Board Order. DATED: County Counsel, By County Administrator, By APPLICATION T-10 FILE LATE CLAIM i 1 LAW OFFICES OF RICHARD J. ALEXANDER 2 Ron K. Bochner- 160093 ;' RECEIVED 137 Park Place , 3 Point Richmond, CA 94801 (510) 232-9100 APR I 47 Attorneys for Claimant 'BOARD F 5 'CLER CONT-RA COSTA CO.ISQRS 6 7 8 In the Matter of the 9 Claims of ESTATE OF DELORES APPLICATION FOR LEAVE BRUNO, JOHN BRUNO AND GAIL TO PRESENT LATE CLAIM 10 WILSON (Gov. Code §911.4) 11 against CONTRA COSTA COUNTY, MERRITHEW MEMORIAL HOSPITAL 12 13 TO The Board of Supervisors of Contra Costa County: 14 1. Application is hereby made for leave to present a late 15 claim under Section 911.4 of the Government Code. The claim is 16 founded on a cause of action for personal injury, which accrued on 17 or about August 6, 1996, and for which a claim was not timely 18 presented. For additional circumstances relating to the cause of 19 action, reference is made to the proposed claim attached hereto as 20 Exhibit. A and made a part hereof. 21 2. The reason for the delay in presenting this claim is that 22 the claimants were unaware and uncertain of what claims, if any, 23 they had during all of the period when the claim should have been 24 presented, did not know who or what entities or entity the claims 25 were against as shown by the declaration attached hereto as Exhi.hit 26 I Law Offices of 27 Richard J. Alexander 137 Park Place Point Richmond California 94801 1 Tel (510) 232-9100 1 B and made a part hereof. 2 3. This application is presented within a reasonable time 3 after the accrual of the cause of action, as shown by the 4 declaration attached hereto as Exhibit B and made a part hereof. 5 WHEREFORE, it is respectfully requested that this application 6 be granted and that the attached claim be received and acted on in 7 accordance with Sections 912.4-912.8 of the Government Code. 8 Dated: 9 10 09n Behalf of Claimant 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 I Law Offices of 27 Richard J. Alexander 137 Park Place Point Richmond California 94801 2 Tel (510) 232-9100 Richard J. Alexander Law Offices April 10, 1997 Clerk of the Board of Supervisors SENT VIA CERTIFIED MAIL 651 Pine Street, Room 106 RETURN RECEIPT REQUESTED Martinez, CA 94553 Re: Notice of Intent to Sue and Claim for Damages by Estate of Delores Bruno, John Bruno and Gayle Wilson Dear Board: Pursuant to Code sof Civil Procedure Section 364 and Government Code Sections 910, et seq. , claimants John Bruno and Gayle Wilson hereby notify you that they intend to sue for damages against Contra Costa County and Merrithew Memorial Hospital as follows: 1. Claimant' s address and address where notice is to be sent: Claimant' s address: John Bruno 2622 Downer Avenue Richmond, CA 94804 Gayle Wilson As Above Notices to be sent to: Richard J. Alexander 137 Park Place Pt. Richmond, CA 94801 ( 510) 232-9100 2. Date, place and circumstances of occurrences: In early 1996, Delores Bruno, Merritthew and its employees and agents identified a lesion on Ms. Bruno' s liver that was likely cancerous. However, no more definitive tests were made for several months. On or about July 1, 1996, Delores Bruno presented to the Merritthew Memorial Hospital, where she was convinced to undergo surgery on her liver after Merritthew' s employees determined she could tolerate the surgery. On or about July 22, 1996, the patient was admitted to the operating room. During the surgery, Ms. Bruno lost copious amounts of blood due to a clotting problem which had not been assessed prior to surgery. Post-surgery she was administered excessive fluids; Due to these and other treatments 137 Park Place, Point Richmond, California 94801 (510) 232-9100 Notice and Claim April 10, 1997 Page two of two she received or failed to receive at Merritthew, Ms. Bruno deceased on August 6, 1996. 3. Nature of loss: Ms. Bruno' s death was wrongfully caused by Merritthew and its employees and agents. Merritthew is a county sponsored hospital. Mr. John Bruno, Ms. Bruno' s husband and Ms. Gayle Wilson, her daughter, are entitled to compensation for loss of love, companionship, comfort, society, affection, solace and moral support ( including all detriment they suffered to date of trial and are likely to suffer in the future because of Ms. Bruno' s decease, that is, the value of the benefits they could reasonably expect to receive from the deceased if she had lived) . Mr. Bruno also is entitled to compensation for loss of Ms. Bruno' s consortium. They are also entitled to incidental and other out of pocket costs such as funeral expenses, etc. Separately, both Mr. Bruno and Ms. Wilson have a claim for the infliction of emotional distress, as both were made to witness the suffering Ms. Bruno was wrongfully compelled to endure due to Merritthew and its employee's acts. 4. Name of public employees: Drs. Horacio Asbun, Veda Bhatt, Tremain, Gloria Asuncion, S. Gaskins, Stephen D. Weiss, Pauline Velez, Penney Stringer, Keith White, others. 5. Amount of. damages: Exceeds $10,000.00 and is within the jurisdiction of the Superior Court. Your very truly, Ron K. Bochner RKB/vo 1 LAW OFFICES OF RICHARD J. ALEXANDER 2 Ron K. Bochner - 160093 137 Park Place 3 Point Richmond, CA 94801 (510) 232-9100 4 Attorneys for Claimant 5 6 7 8 In the Matter of the 9 Claims of ESTATE OF DELORES DECLARATION IN SUPPORT OF BRUNO, JOHN BRUNO AND GAIL APPLICATION FOR LEAVE 10 WILSON TO PRESENT LATE CLAIM (Gov. Code §911.4) 11 against CONTRA COSTA COUNTY, ~ MERRITHEW MEMORIAL HOSPITAL 12 13 I, Ron Bochner, declare as follows: 14 1. I am one of the attorneys for claimants in this matter. 15 2. The decendent Delores Bruno, died August 6, 1996. Her death 16 forms the basis of this claim. 17 3. At all times during the pendency period of this claim, 18 claimants were duly diligent in investigating if there had been 19 wrongdoing leading to Ms. Bruno Is death, including, but not limited 20 to, requesting, and paying for, an autopsy, consulting with 21 attorneys, requesting, and paying for, copies of Ms. Bruno' s medical 22 records, and requesting, and paying for, an independent consultant ' s 23 review of Ms. Bruno' s medical records to determine if Ms. Bruno' s 24 death had been wrongfully caused. 25 4. Due to the length of the medical records and to the breadth and 26 Law Offices of 27 Richard J. Alexander 137 Park Place Point Richmond 1 California 94801 Tel (510) 232-9100 1 complexity of the issues involved, the review of the records was not 2 complete until after the 6 months period had passed. 3 5. Under these circumstances, the delay in filing a tort claim was 4 reasonable and there has been no prejudice to the entity' s defense. 5 I declare under penalty of perjury of the laws of the State of 6 California that the above is true. 7 Executed at Pt. Richmond, California this 10th day of April, 8 1997. 9 10 (n-Bo chner 11 On Behalf of Claimants 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Law Offices of E Richard J. Alexander 137 Park Place Point Richmond 2 California 94801 Tel (510) 232-9100 W � v n j S CD (DD N x t( CL CDf n CD o Q O Q� 10 :3: C) (� O (D rt K (DSO N (D t•y En rt- -%j :t' " (D (D Ud 10rt- O W ,p• � r U 0 $U' a E•' w O O O O t+ � M En CD 1'47 MS �q qt(.9 i1 O Nn RRSI ��17 �1 N o CD CO) O cz NLrl -- 4 � J t k f � t7 o 3Dc03'VN NN �obA - oz- v QN Z. 0000 00/ l"1 J D � o m CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA May 6, 1997 Claim Against the County, or District governed by) BOARD ACTION f� 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: Indemnity Claim Section 913 and 915.4. Please note all 1411VIII CLAIMANT: Steve Backes & Cary England dba Designs in Crockett APR 10 1997 ATTORNEY: Peggy Chang, Esq. COUNTY COUNSEL: Charles Alfonzo, Esq. Date received MARTINEZ CALIF. ADDRESS: Buresh, Kaplan, Jang, Feller & BY DELIVERY TO CLERK ON ' Austin 2298 Durant Ave. BY MAIL POSTMARKED: not egible Berkeley, CA 94704 . I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. l DATED: April 10, 1997 cyIL BepuHtyLOR, C1enc�� 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: ld BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: MAY b) /797 PHIL BATCHELOR, Clerk, Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: M���3� 9/ , BY: PHIL BATCHELOR by eputy Clerk CC: County Counsel County Administrator Claim to: BOARD q1PWUPERYISORS OF CONTRA COSTA CO 94 INSTRUCTIONS TO,CE Al?IW 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. Claim 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 Dust be filed with the Clerk of the Board of Supervisors at its .office in Rom 106, Comity Administration Building, 651 Pine Street, Martinez, CA 94553. C. if claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal, Code Sec. 72 at the end of this form. - � RE: Claim By ) Reserved for Clerk's filing stamp STEVE BACKES and CARY ENGLAND dba } ) RECEIVED DESIGNS IN CROCKEI'T, Y. Kl�a_M the C=Yty of Contra Costa APR — 9 WT or- District) CLERK BOARD OF SUKERVISORS Fill In name } CONTRA COSTA CO. The undersiped claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ indemnity claim and in support of this claim represents-as follows: accOrdlng to proof. (Copy of Complaint attached.) 1. When did the damap..or injury occur? (Give exact date and hour) On July 24, 1995, at approximately 11:00 a.m. 2. Where did the damage or injury occur? (Include city and county) On the 1400 block of Pomona Street, Crockett, Contra Costa County. 3. How did the damage or injury occur? (Give flail details; use extra paper if required) Plaintiff allegedly slipped, tripped and fell, severely injuring himself because of the negligent construction of the sidewalk on the 1400 block of Pomona Street. 4. What particular act or omission on the part of county or district officers, servants or.employees caused the injury or damage? Maintenance of the sidewalk. Specifically, a curb was put in the middle of the 1400 block sidewalk. (aver) 5. wnat are the names of county or district officers, servants or employees causing the damage or injury? Public Works Department, Martinez, California. 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Plaintiff, Paul Shaffer, allegedly broke his left wrist and had injury to the left hip andlow back, which resulted in continuing low back/hip pain and difficulty walking. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) To date, there is only $1,797.00 billed by Lamorinda Chiropractic, however, -the charges are unknown at this time for Veterans Adminstration Medical Center, in Martinez and San Francisco, and Merrithew Memorial Hospital and Clinics in Martinez. 8. Names and addresses of witnesses, doctors and hospitals. a. Veterans Administration Medical Center, Martinez, California 94553. 94121, b. Veterans Administrati(?n Medical Center, 4150 Clement Street, San`Francisco, CA c. Merrithew Memorial Hospital and Clinics, 2500 Alhambra Avenue, Martinez, CA `94553,. d. Lamorinda Chiropractic, Brian S. Ike, D.C. , 978 Second St., Ste. 100, Lafayette; FA 94549 9. List the expenditures you made on ao=Mt of this accident or irnjury: DATE ITEM AMOUNT _ To Date - Attorney Fees - $2,925.00 - To Date - Costs - $376.00 � � iFiFiF �FiEik �F .�F � i * � � � N �-iF �.� • Ni � N • � * f � * * f # � * i * * � iF Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or some Person on-.his f." Name and Address of Attorney - Peggy Chang, Esq. [#144364] P Ld' 4aln_ Charles Alfonzo, Esq. {#184164] Claimant s Signatulw Buresh, Kaplan, Jang,. Feller & Austin 2298 Durant Avenue Berkeley, California 94704 Address Attorneys for STEVE BACKES and CARP - ENGLAND dba DESIGNS IN CROCKETT Telephone No. (510) 548-7474 Telephone No. (510) 548-7474 e ♦ eaaaa aaeasaae eee 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)1 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. 12/2496 13- 11 '$510 262 4904 ST FARM-HILLTOP 10 002 3263- 'FNEY OR FfARTY 74-I HOLn T-MOP, A ;C;EMY T£l£PHi, NO.: OURT VSE ONLY PAUL J. STEINER ISBN 411171 415/981-6100 STEINER & STEINER 100 Bush Street, Suite 950 San Francisco, CA 94104 AT70RNEY FOR Plaintiff Insert name of cove.Judicial district or branch court, it any,End post office end sheet address: p ED SUPERIOR COURT, COUNTY OF CONTRA COSTA U Martinez, CA 94553 JUL 2 2 1995 PLAINTIFF. __ slr�tars rsJ.t1 PAUL J. SHAFFER ar DEFENDANT: COUNTY OF CONTRA COSTA; CARY ENGLAND AND STEVE BACKES DBA DESIGNS IN CROCKETT; ALFRED W. MEDCALF; DOES 1,TO 25 COMPLAINT— Personal Injury, Property Damage, Wrongful Deat-71 CASE NUMBER MOTOR VEHICLE [ OTHER (specify): premises Liability Property Damage Wrongful Death C 96 - 03239 © Personal Injury H Other Damages (specify): t. This pleading, including tttsdhments and exhibits, consists of the following number of pages: 2. a. Each plahttiff named above Is a Comptlent adult Fxcept pla-Intitf(name): PER LOCAL RULE 5 THIS a corporation qualified to do business in California CASE I$ SIGNEQ �O an unincorporated entity (describe): DEPS a public entity(describe): a minor [] an adult 0 for whom a guardian or conservator of the estate or a guardian ad teem has been appointed EJ other (specify): 0 other (epee#/).' Except pleintitt(name): a corporation Qualified to do business in California r an unincorporated entity (descri!*): a public entity (describe): a minor [] an adult for whom a guardian or conservator of the estate or a Guardian ad Itlt m has been appointed other (specify): other (specify). b. [� Plaintiff (name): is doing business under the fictitious name of(spectf): end hes complied with the fictitious business name lave$. c. F1 Information about edditionEl plainti"s who are not competent educts is contained in Gompicint- Attachment 2c. .�..• �_ r_.__.. _. _._. .��� .� Y........w, p...Y..it vvvu..c.r �i� �w�v�a.7�J r4 t+ViiGI C�ttl. other (specfW: S. 0 The following paragraphs of this complaint ere alleged on infotmation and belief (specty paragraph numbers): (Continued) �•?�1«° EF.711-? JUP3.1 DEC-24-1996 13=21 510 262 4904 P.02 �•.�....i.i ivcvr tam hpp q.W q Ivy GOP XM Is �„as.,e,,,,eNrpMo•�. CLWLAINT�-- FErsonai injury, Property DP0er r �.�•^�•Y t / Wron tul Death R, art�(1) 9 PQ?tt.t JCfD3,t RU-6 MORT TITLE! CASE fNt11J,8En: SHAFFER V. COUNTY OF CONTRA COSTA, et al . COMPLAINT—Personal Injury, Property Damage, Wrongful Death F.por.ro 3. a.Each defendand named above is a netural person Except defendant(name). 0 Except defendant(name): CONTRA COSTA COUNTY a business organization, form unknown a business organization, form unknown a corporation a corporation [] an unincorporated entity (describe): g an unincorporated Entity (describe). a public entity (describe): [D a public entity (desuitiq: COUNTY other (specify): [3 other (specify): 0 Except defendant(name): Except defendant(name): a business organization, form unknown C] a business organization, form unknown 0 a corporation a corporation © an unincorporated entity(describe): an unincorporated entity (describe): 0 a public entity(describe): ❑ a public entity (describe): 0 other(spec#y`:. l other (specify): b.The true names and capsc$ies of defendants Sued as Does are unknown to plaintiff. C. 0 Information about additional defendants who are not natural persons is contained in Complaint Attachment 3c. d. EJ Defendants who are joined pursuant to Code of Civil Procedure seriion 382a- (names): 4. ® Plaintiff Is required to comply with a claims statute, and a. [3 plaintiff hes complied with appGrxble claims slatutes, or b. Q plalnUft is excused from complying because (specify): 5. This court is the proper court because X at least one defendant now resides in Ks jurisdictional area. Hai the principal place of business of a corpotetion or unincorport:ted association is in this jurisdictional area. I XI iniury to opmon mr dAfmna in nurcr%nsl rvnnnrfir n^,.irrr&A ;.. ?. :.....�:.•:,.�, �.�� I declare under penalty of peju7 under thj&WS of the State (For California lff, marshal. or constable use only) of California that the foregoing Is true and ct. I certify that the folding Is true and correct. Date: Date: SIGNATURE) (StONAruRF) W(a)(9)[Rev.January 1.1981) 3263 DEC-24-1996 13:20 510 262 4904 P.01 12/24/96 13- 12 10510 262 4904 ST FARM-HILLTOP (6 003 • SHORT TITLE: CASE NUMBER: SHAFFER v. COUNTY OF CONTRA COSTA, et al COMPLAINT—Personal Injury, Property Damage, Wrongful Death (Continued) P.o.rMa 7. Q The damages claimed for wrongful death and the relationships of the plaintiff to the deceased are ' listed in Complaint- Attachment 7 as follows: 6. Pietntiff has suffered wage toss loss of use of property hospital and medical expenses general damage property damage loss of earning capacity other damage(specify): PAIN AND SUFFERING 9. Relief sought in this complaint is within the jurisdiction of this court 10. PLAINTIFF PRAYS -, For judgment for costs of svhf for such relief as is fair,just, and equitable;and for ® compensatory oambeesi . [3� (superior Court)according to proof. [� (Municipal and Justice Court) In the amount of S ® other (specify): PREJUDGMENT INTEREST ACCORDING TO PROOF 11. The following causes of action are attached and the statements above apply to each: (Each complaint must Have rine or more causes of action affached) Motor Vehicle General Negligence .. Intentional Tort Products Liability ? Piernises Liability ,] Other ppeciry): PAUL J. STEINER (Type or print name) ignarure of piwntiff or enorney) COMPLAINT-- Personal Injury, Propert a ge, o.�m.. fez�(I)(ward) virongtul Death (Continued) cor/?s.,: • � • 08211.3 JCr09.1 �1-IOAT TITLIr: CASE NUWiBER: SHAFFER v. COUNTY OF CONTRA COS'T'A, et al. FIRST CAUSE OF ACTION—General Negligence Page 4 (number) ATTACPMENT To Q Cc:-.,p:F_int ❑ Cross-Complt:int (Use a separate cause of ac;icn form for each cause of action) GN-t. Plsiraiti (name): PAUL J.- SHAFFER elleget thet detenca {name): COUNTY OF CONTRA COSTA; CARY ENGLAND AND STEVE BACKES URA DESIGNS IN CROCKETT; ALFRED MEDCALF (� Dori 1 to 25 was the legal (prexime,e) cause of dameoes to piainli f. ey the following acts or ornisslons to act, defendant negligently caused ine damage to plainti7 on(date). July 24, 1996 - at(place): 1400 block of Ponoma Street, Crockett, County of Contra Costa, California (descrlpllon of reasons for lisbi7ayl: Defendants, and each of them, negligently maintained, owned, operated, and co4trolled the sidewalk in the 1400 block of Ponoma Street, Crockett[ Contra Costa County, California, proximately -causi plaintiff to slip or trip and fall, serverely injurying himself. t � r foam c Ly eta E'ftL%iV*J:wy 1.'zu CAUSE OF ACTION—General Negligence CCP 425.12 r?nsra ,rccos.i SHORT TITLE: CASE NUMBER; SHAFFER v. COUNTY OF CONTRA COSTA, et' al. SECOND CAUSE OF ACTION--Premises Liability Page s {numbw) ATTACHMENT To M Comaleiru 0 Cross-Complaint (Use a separate cause of eaion form for each cause of action) Prem.L-t. Plaintift(maria): PAUL T. SHAFFER elleges the acts of defendants were itre legal (proximate) cause of damages to plaintiff. On (dare): July 2 4, 1996 plaintiff was injured on the following premises in the following fashion(descripliGn of premises &nd circucistances of injury): Plaintiff was severely injured as a proximate result of defendants, and each of them, negligent operation, maintenance and control of the sidewalk in portions of the 1400 block of Pohoma Street, Crockett, Contra Costa Countyr California. Prem.L-2. Count One—Negligence The defendants who negligently owned, maintained, managed and operated the descdbc4 premise&were(names): COUNTY OF CONTRA COSTA, CARY ENGLANE AND STEVE BACKES DBA DESIGNS IN CROCKETT; ALFRED MEDCALF; and ® Does ` 11 to Prem.L-3. Q Count Two—Mlliul Failure to Worn [Civil Code section M) The defendant owners who willfully or rrwliciov*tailed to ouard or wern against a dangerous condition, use, structure, or activity were (names). [D Does to _ Piaintiff, a reereal;*nal user, was [l an invited Quest Q e paying guest Prem.L-4. ® Count Three.—Dangerous Condition of Public Property The defendants who owned public property on which a dangerous condition existed were (names): COUNTY OF CONTRA COSTA ®toes 9 to 16 t .� a. [� The delendant public entity had E] actual ] constructive notice of the existence of the dangerous condition In sufficlent Oche prior to the injury to have corrected it. b. [ The condition was created by employees of the defendant public entity. Prern.US. a. ® Allegationsut Other Defendants The defendants who the agents and employees of the other defen�and acted within the scope of the agency� (tames): EAG ,EFENDANT AND (X] Does.17to 25 b. The defendants who are liable to plaini'�ts for other reasons and the reasons for their liability are [] described in aaachment Prem.L•5.b [] as follows (names): Caen Rppewtl e� tie _.~ Jv':-r1 Car�cl of Guan�� Row of (5 CAUSE of ACTION—Premises Liability w«s.,z Gfi�3 JGi03.f DEC-24-1996 13=22 510 262 4904 P.03 14Q-4860.1 Rely. 0_449 Prrted:n U.S.A. PROOF OF SERVICE a SUMMONS+ (Use separate proof of service for each person served) 1. 1 served the ;t ~ �1 � fir;-,I a. sum�mons Q complaint 0 amended summons [ amerced complaint s„ r ~. 1•com,pleted and blank Case f]uesfionnaires D,t?ther(Spacl I E gtrdLf�l�tlao�{na�rt,e) tvin [] defendant 0 other(name arrd titre or relationship to person s9rved) d. livery; �D at home 0 at business t date: e. [] by mailing (1) date: (2) place: f .. . .., .� 2. Manner of service(check proper box): a 0 Personal service,By personalty delivering copies.(CCP 415.10) b. [_f Substituted service on corporation. unincorporated association (including partnership).or public entity. By leaving,during usual office hours,copies in the office of the arson served with the person who apparentlywas in charge and thereafter mailing(by first-class mail, postage prepaid copies to the person served at the pace where the copies were left. (CCP 415.20(x)) c. 0 Substituted service on natural person,minor.conservatee,or candidate.By leaving copies at the dwelling house. usual place of abode, or usual place of business of the person served in the presence of a competent member of the household or a person apparently in charge of the office or place of business,et least 18 years of age, who was Informed of the general nature of the papers, and thereafter mailin (b first-class mail,postage prepaid)copsee to person served at the place where the copies were left.(CCP 415.20(b�)(A ttach separate declaration or affidavit stating acts relied onto establish reasonable diligence in firs attempting personal service.) d. 0 Mail and acknowledgment service. By mailing (by first-class mail or airmail,postage prepaid)copies to the person served,together with two copies of the. form of notice and acknowledgment and a return envelope.postage prepaid, addressed to the sendei. (CCP 415.30)(Attach completed acknowledgement of receipt.) e. 0 Certified or registered mail service. By mailing to an address outside California(by first-class mail,postage prepaid, requiring a return receipt)copies to the person served. (CCP 415.40)(Attach signed return receipt or other evidence Of actual delivery to the person served.) f. Q Other(specify code section) Q additional page is attached. 3. The'Notice to the Person Served”(on the summons)was completed as follows(CCP 412.30,415.10,and 474): a. Q as an individual defendant. b. [� as the person sued under the fictitious name of(specify) c. 0 on behalf of(specify): under: M CCP 416.10(corporation) 0 CCP 416.60(minor) Q other. ED CCP 416.20(defunct corporation) Q CCP 416.70(conservatee) 0 CCP 416.40(association or partnership) 0 CGP 416.90(individual) d. by personal delivery on(date). 4. At the time of service I was at least 18 years of age and not a party to this actlon. 5. Fee for service: S 6. Person serving: a. Q California sheriff,marshal,or constable. f. Name. address and telephone number and,if applicable, b. Q Registered California process server. county of registration and number: c. J Employee or independent contractor of a registered California process server. d. (� Not a registered California process server. e. © Exempt from registration under Bus. S Prof.Code 22350(b). PROOF OF SERVICE - - C.C. P. §1013a, 2015 . 5 Backes, et al . , v. Contra Costa County I am employed in Alameda County, California. I am over eighteen (18) years of age and not a party to the with action or proceeding; my business address is 2298 Durant Avenue, Berkeley, California 94704 . On the date entered below, I served a true copy of the attached CLAIM AGAINST THE COUNTY OF CONTRA COSTA, WITH ATTACHMENTS, by placing it, enclosed in a sealed envelope with postage thereon fully prepaid, in the United States mail at Berkeley, California. Said envelope was addressed as hereinafter set forth in this declaration. If more than one addressee appears, this declaration applies to each. Clerk of the Board of Supervisors Room 106, County Administration Building 651 Pine Street Martinez, California 94553 I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct, and that this declaration was executed at Berkeley, California on . April 8 , 1997 . PAMELA J H 7 q � � a � r a . . . .w @R � \ 0 - j / L ?% � Cl) •q @ 0l / roa . \ 4JQ4 - c 0 § # j41 + VO S doge a - 04 �4 . m 0 a § a 0 2 q U ¢ m2 �- ƒ c 7 § \ c � IA Now } . U6 . I � 2 � S � CLAIM C-, , 3 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA May 6, 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 Amount: Unknown Section 913 and 915.4. Please noteiRMAR04- CLAIMANT: Meroe Hamzeh APR 10 1997 ATTORNEY: Steven A. Block, Es COUNTY COUNSEL q• MARTINEZ CALIF. Law Office Of Steven A. Block Date received ADDRESS: 1001 G Street, Ste. 101 BY DELIVERY TO CLERK ON April 9, 1997 Sacramento, cA 95814 BY MAIL POSTMARKED: April 7, 1997 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: April 10, 1997 IVIL DATCUELOR, Clerk`-�jt��.�(��o�oL•� 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: 7 G ��_ 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 (v� 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: bl 17477 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: M�l 3 19/ ' BY: PHIL BATCHELOR b putt' Clerk CC: County Counsel County Administrator I STEVEN A. BLOCK, #84002 LAW OFFICE OF STEVEN A. BLOCK 2 1001 -G- Street, Suite 101 .. Sacramento, CA 95814 '=`' RECEIVED- 3 Telephone: (916) 447-8871 `` G 4 Attorney for Claimant ApR 91997 21 t 5 0 OF SUFERutsdDRS CON TRA COSTA CO. 6 7 In the Matter of the Claim of 8 MEROE HAMZEH, CLAIM FOR PERSONAL 9 INJURIES Claimant, 10 VS. 11 STATE OF CALIFORNIA, CALTRANS, COUNTY 12 OF CONTRA COSTA, CITY OF WALNUT CREEK, 13 Respondents. 14 15 TO THE STATE OF CALIFORNIA, CALTRANS, COUNTY OF CONTRA COSTA, CITY OF WALNUT CREEK: 16 The above claimant hereby makes claim against the STATE OF CALIFORNIA, 17 CALTRANS, THE COUNTY OF CONTRA COSTA, THE CITY OF WALNUT CREEK, 18 in an amount to be determined, and in support of said claim represent as follows: 19 1., Name of Claimant: Meroe Hamzeh. 20 2. Claimant's Address: 4304 Rose Lane, Concord, California, 94518. 21 3. Notices Should Be Sent To: Steven A. Block, Esq., LAW OFFICE OF 22 STEVEN A. BLOCK, 1001 G Street, Suite 101, Sacramento, CA, 95814, (916) 447-8871. 23 4. Description of Subject Incident: On or about September 13, 1996, at 24 approximately 5:03 p.m., Meroe Hamzeh was a passenger in a vehicle driven by Chris Law Offices of 25 STEVEN A. BLOCK Hendryk which was traveling northbound on Interstate 680 at the N. Main Street 1001 G Street,Suite 101 26 Sacramento, CA 95814 overcrossing in the number four lane, when a pedestrian, Gerald Ystrom, jumped from the (916)447-8871 27 N. Main Street bridge striking Mr. Hendryk's vehicle, coming through the windshield and 28 I landing on Ms. Hamzeh in the front passenger seat. As a result of this collision, Meroe 2 Hamzeh suffered injuries, including lacerations, bruises, abrasions, and severe emotional 3 distress. 4 At this location, northbound Interstate 680 is a four lane asphalt roadway. 5 Claimant alleges that the injuries to Meroe Hamzeh was proximately caused by a 6 dangerous condition of public property as a result of the negligent design, construction, 7 configuration and maintenance of N. Main Street bridge. The defects include, but are not 8 limited to, inadequate barricades which allowed pedestrians access to the bridge. Claimants 9 further allege that this public entity had control of said portion of the subject bridge and 10 said bridge and had actual or constructive notice of the dangerous conditions presented. 11 As a direct and proximate result of the dangerous and defective conditions of the 12 public bridge as alleged above, claimant suffered severe and permanent injuries resulting as 13 set forth below. 14 For all the reasons set forth above, at the time of the subject accident, the bridge, 15 and adjacent property at the aforementioned located, constituted a dangerous condition of 16 public property as defined in Government Code §830.8 in that the combination of the 17 above-referenced factors created a trap that would not be recognized by one using the 18 roadway and bridge with due care. 19 5. Names of the Officers or Employees Causing the Damages or Injuries: Such 20 names are unknown to claimant at this time. 21 6. Itemization of Injury: As a result of the dangerous and defective conditions 22 of public property as outlined above, Meroe Hamzeh sustained personal injuries including 23 lacerations, bruises, abrasions, and severe emotional trauma. 24 7. Nature and Extent of Damages: The amount claimed is undetermined at "W Offices of 25 present, but will include all damages arising out of her injuries including past and future STEVEN A. BLOCK 1001 G Street,Suite 101 26 Sacramento, CA 958]4 (916)447-8871 27 28 - 2 - 1 earnings loss, past and future loss of earning capacity, past and future general damages, and 2 compensation for severe emotional distress and injury and psychologic trauma. 3 Claimant requests compensation for all of the aforementioned damages according to 4 proof. 5 8. Service: This claim was caused to be served by first class mail on April 7, 6 1997, on the following parties: 7 STATE OF CALIFORNIA, CALTRANS BOARD OF CONTROL 8 630 K Street, 4th Floor Sacramento, California 9 (personal delivery) 10 CITY OF WALNUT CREEK CITY CLERK/RISK MANAGEMENT 11 P.O. Box 8039 Walnut Creek, CA 94596 12 COUNTY OF CONTRA COSTA 13 CLERK, BOARD OF SUPERVISORS 651 Pine Street 14 Martinez, CA 94553 15 16 DATED: April 7, 1997 LAW OFFICE OF STEVEN A. BLOCK 17 18 By: STEVIRN A. B OCK 19 Attorneys for Claimant 20 21 22 23 24 Law Offices of 25 STEVEN A. BLOCK 1001 G Street,Suite 101 26 Seeramenlo, CA 95814 (916)447-8871 27 28 - 3 - I PROOF OF SERVICE BY MAIL, C.C.P. 1013a. 2015.5 2 I declare that I am an employee in the County of Sacramento, California. I am over the age of eighteen years and not a party to the within cause; my business address is 1001 3 -G- Street, Suite 101, Sacramento, California 95814. On April 7, 1997, I served the within: 4 CLAIM FOR PERSONAL INJURIES 5 6 _X by placing the original or a true copy thereof enclosed in a sealed envelope with postage thereon fully prepaid, for collection and mailing on that date 7 following ordinary business practices, in the United States mail of Sacramento, California, addressed as set forth below. 8 9 by personally delivering, or causing to be delivered, a true copy thereof to the person and at the address(es) set forth below. 10 11 by causing a true copy thereof to be delivered to the party or parties at the address(es) listed below, by and/or through the services of: 12 1. Federal Express 13 2. Facsimile (followed by First Class Mail) 3. Other 14 STATE OF CALIFORNIA, CALTRANS 15 BOARD OF CONTROL 630 K Street, 4th Floor 16 Sacramento, California (personal delivery) 17 CITY OF WALNUT CREEK 18 CITY CLERK/RISK MANAGEMENT P.O. Box 8039 19 Walnut Creek, CA 94596 20 COUNTY OF CONTRA COSTA CLERK, BOARD OF SUPERVISORS 21 651 Pine Street Martinez, CA 94553 22 23 I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct, and that this declaration was executed on April 7, 1997, at 24 Sacramento, California. 1 Law Offices of 25 j J STEVEN A. BLOCK !/ 1001 G Street,Suite 101 26 LORI L. WINDHAM Sacramento, CA 95814 (916)447-8871 27 28 - 4 - _: 1996 / COLLISION REPORT PAGE ( OF& SPECIAL CONDITIOY,S NO JNJ H&R FEL CITY JUDICIAL DISTRICT NUMBER WALNUT CREEK WALNUT CREEK NO KILL 'H&R MISD COUNTY DIST BEAT — �jq�a; CONTRA COSTA 6$2 tars: 0�6U69D1 COLLISION OCCURRED ON: MO DAY YEAR TIME(2400) NCIC l OFFICER I.D. 0 1-680 NIB 09113196 1703 9320 00931 C A MILEPOST INFORMATION: DAY OF WEEK TOW AWAY PHOTOGRAPHS BY: 20 feet N of MP 680 CC 15 .61 FRIDAY NYFS [] NO GOMEZ 9715 N {I AT INTERSECTION WITH: STATE HWY REL HERRINGTON 3 29 OR: 2 0 feet N of N. MAIN ST. - YES [] NO �1NONE PARTY DRIVER'S LICENSE NUMBER STATE I CLASS SAFETY VEH YR MAKE/MODEL/COLOR " LICENSE NUMBER ST., 1 135224464 ICA -C I G 89 FORD 4DR TAURUSNBLACK2MEK341 C DRIVER NAM E(FIRST,MIDDLE,LAST) ] CHRIS JAMES HENDRYK PEDES- STREET ADDRESS OWNER'S NAME [] SAME AS DRIVER 1 TR11 IAN 5489 SILVER SAGE CT. MEHRIAR HAMZEH PA�RKJEDCITYISTATEMP OWNER'S ADDRESS [] SAME AS DRIVER v,rTLlCONCORD CA 94521 4304 ROSE LANE, CONCORD, CA 94518 BICY- SEX HAIR I EYES HEIGHT I WEIGHT BIRTHDATE RACE DISPO OF VEHICLE ON ORDERS OF: W OFFICER [] DRIVER []OTHER CLrj M BLK BRN 5-07 1_7_2 08 j 19 j 78_ 1 US TOWING (510) 754-667, OTHER HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: NONE APPARENT ] .`REFER TO NARRATIVE[ [ (5101 672-9423 (510) 932-3332 CHP USE ONLY DESCRIBE VEHICLE DAMAGE.,. SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER VEHICLE TYPE []UNK []NONE []MINOR NIP 01 4 []MOD.N MAIOR []TOTAL DIR TRV ON STREET OR HIGHWAY SPD LMT PCF ................ N I-680 65 C PARTY DRIVER'S LICENSE NUMBER STATE I CLASS SAFETY VEH YR MAKE/MODEL/COLOR LICENSE NUMBER STAT. 2 U6151149 � CA I C_ j N NONE DRIVER NAM E(FIRST,MIDDLE,LAST) [] GERALD YSTROM PEDES- STREET ADDRESS OWNER'S NAME [] SAME AS DRIVER TR�Py(J 3 CROWN -CT. _ PARKED CITY/STATEMP OWNER'S ADDRESS [] SAME AS DRIVER IT L,WALNUT CREEK CA 94596 I BICLY-- SEX HAIR EYES HEIGHT WEIGHTJ BIRTHDATE RACE DISPDOFVEHICLE ONORDERS OF: [] OFFICER [] DRIVER []OTHER CLf) M BRN BLU 5-10 165 09101150 NfA OTHER HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: NONE APPARENT[] REFER TO NARRATIVE�] [] (510) _944-9768 ( ) NONE CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA VEHICLE TYPE INSURANCE CARRIER POLICY NUNIBER 1 []UNK []NONE []MINOR Is DI�TRVONOST REET OR HIGHWAY SPD LMT PCF 6O []MOD.[]MAJOR []TOTAL.WARD I-680 165 C PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY VEH YR MAKE/hIODEL/COLOR LICENSE NUMBER STATE 3 . . . . . . . . . . . . � DRIVER NAME(FIRST,MIDDLE,LAST) [] PEDFS- STREET ADDRESS OWNER'S NAME [] SAME AS DRIVER TRry PARKED CTTYISTATE/ZIP OWNER'S ADDRESS [] SAME AS DRIVER V Erlf LE BICY- SEX HAIR EYES HEIGHT WEIGHT BIRTHDATE RACE, DISPOOFVEHICLE-ON ORDERS OF: []OFFICER [] DRIVER [)OTHER CLJJ 'OTHER HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: NONE APPARENT[] REFER TO NARRATIVE[] [] CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY,NUMBER VEHICLE TYPE 1 ' []UNK [)NONE []MINOR []MOD.[]MAJOR []TOTAL DIP,TRV ONSTREFT ORHIGHWAY SPD LMT PCF PREPARER'S NAME DISPATCH NOTIFIED REVIEWER'S NAME DA EVIEW D' PASSALAC UA D b 0 9 318 Ya No NIA + TRAFFIC COLLISION CODING PAGE a? of DATE OF ORIGINAL INCIDENT TIME(24M) NCIC NUMBER OFFICER I.D. NUMBER 09 13 — 96 1703 9320 009318 19-131 kDFSCRIPTION ERS NAME/ADDRESS NOTTFi PROPERTY OF DAMAGE DAMAGE SEATING POSITION SAFETY EQUIPMENT EJECTED FROM VEH OCCUPANTS MIC BICYCLE-HELMET I-DRIVER A-NONE IN VEHICLE L-AIR BAG DEPLOYED 0-NOT EJECTED 2 to 6-PASSENGERS B-UNKNOWN M-AIR BAG NOT DEPLOYED DRIVER I-FULLY EJECTED 7-STA.WGN.REAR C-LAP BELT USED N-OTHER V-NO 2-PARTIALLY EJECTED 1 2 3 8-RR.OCC.TRK,OR VAN D-LAP BELT NOT USED P-NOT REQUIRED W-YES 3-UNKNOWN 9.POSITION UNKNOWN E-SHOULDER HARNESS USED 4 5 6 O-OTHER F-SHOULDER HARNESS NOT USED CHILD RESTRAINT PASSENGER G-LAP/SHOULDER HARNESS USED • Q-IN VEHICLE USED X-NO 7 H-LAP/SHOULDER HARNESS NOT USED R-IN VEHICLE NOT USED Y-YES 1-PASSIVE RESTRAINT USED S-IN VEHICLE USE UNKNOWN K-PASSIVE RESTRAINT NOT USED T-IN VEHICLE IMPROPER USE ' U-NONE IN VEHICLE ITEMS MARKED BELOW WHICH ARE FOLLOWED BY AN ASTERISK SHOULD BE EXPLAINED IN THE NARRATIVE PRIMARY COLLISION FACTOR MOVEMENT PRECEDING LIST NUMBER(A')OF PARTY AT FAULT TRAFFIC CONTROL DEVICES 1 2 3 TYPE OF VEHICLE U12 3 1 COLLISION A VC SECTION VIOLATED: CITED A CONTROLS FUNCTIONING A PASSENGER CAR/STN.WGN. A STOPPED B CONTROLS NOT FUNCTIONING*` B PASSENGER CAR W/TRAILER X B PROCEEDING STRAIGHT B OTHER IMPROPER DRIVING* C CONTROLS OBSCURED C MOTORCYCLE/SCOOTER C RAN OFF ROAD X C OTHER THAN DRIVER' X D NO CONTROLS PRESENTIFACTOR D PICKUP OR PANEL TRUCK D MAKING RIGHT TURN D UNKNOWN* TYPE OF COLLISION E PICKUP/PANELTRK.W/TLR. E MAKING LEFT TURN E FELL ASLEEPt' A HEAD-ON F TRUCK OR TRUCK TRACTOR F MAKING U TURN WEATHER(MARK I TO 2 ITEMS) B SIDESWIPE G TRK./TRK.TRACTOR W/PLR. G BACKING X A CLEAR C REAR END H SCHOOL BUS H SLOWING/STOPPING B CLOUDY D BROADSIDE 1 OTHER BUS I PASSING OTHER VEHICLE C RAINING E HIT OBJECT J EMERGENCY VEHICLE J CHANGING LANES D SNOWING' F OVERTURNED K HWY.CONST.EQUIPMENT K PARKING MANEUVER E FOG/VISIBILITY: X G VEHICLE/PEDESTRIAN L BICYCLE L ENTERING TRAFFIC F OTHER': H OTHER*: M OTHER VEHICLE M OTHER UNSAFE TURNING G WIND MOTOR VEHICLE INVOLVED WITH N PEDESTRIAN N XING INTO OPPOSING LANE LIGHTING A NON-COLLISION 0 MOPED 0 PARKED X A DAYLIGHT X B PEDESTRIAN P MERGING OTHER ASSOCIATED FACTOR B DUSK-DAWN C OTHER MOTOR VEHICLE 1 L2L3 MARK 1 T021TEMS Q TRAVELING WRONG WAY C DARK-STREET LIGHTS D MOTOR VEH ON OTHER ROADWAY A VZ SE&ION VIOLATION:CITE X R OTHER': JUMPING DOWN D DARK-NO STREET LIGHTS E PARKED MOTOR VEHICLE E DARK-STREET LIGHTS NOT FUNCTION F TRAIN B VC SECTION VIOLATION:CITE ROADIVAYSURFACE G BICYCLE (I� SOBRIETY-DRUG ICAL JXA RY H ANIMAL: C VC SECTION VIOLATION:CITE f 1 2 3 (MARK 1 TO 2ITEMS) ET X A HAD NOT BEEN DRINKING NOWY-ICY I FIXED OBJECT: E VIS.OBSCURED: B HBD-UNDER INFLUENCE LIPPERY(MUDDY,OTLY.ETC.) F INATTENTION' C HBD-NOT UNDER INFLUENC: 1 OTHER OBJECT: G STOP&GO TRAFFIC D HBD-IMPAIRMENT UNK.' ROADWAY CONDITIONS MARK I TO I ITEMS PEDESTRIAN'S ACTIONS H ENTERING/LEAVING RAMP E UNDER DRUG INFLUENCE' A HOLES,DEEP RUTS' A NO PEDESTRIAN INVOLVED I PREVIOUS COLLISION F IMPAIRMENT-PHYSICAL' B LOOSE MATERL4L ON RDW Y' B CROSSING IN XWALKANERSECTION J UNFAMILIAR WITH ROAD X G IMPAIRMENT NOT KNO«'N C OBSTRUCTION ON ROADWAY' C CROSSING IN XWALK NOT AT K DEFECTIVE VEH.EQUIP.:CITE H NOT APPLICABLE INTERSECTION D CONSTRUCTION-REPAIR ZONE I SLEEPY/FATIGUED E REDUCED ROADWAY WIDTH D CROSSING NOT IN CROSSWALK L UNINVOLVED VEHICLE SPECIAL I FORMATION F FLOODED' X E IN ROAD-INCLUDES SHOULDER X M OTHER': ATTEMPT SUICIDE A HAZARDOUS MATERIAL G OTHER': F NOT IN ROAD X N NONE APPARENT B SEATBELT FAILURE X H Nol,'TIUSUALCONDITIONS G APPROACHINGILEAVINGSCHOOL BUS 0 RUNAWAY VEHICLE SKETCH MISCELLANEOUS rJUREDINN ITNESSES/PASSENGERS PACE .3 OF DATE OF COLLISION TIME(24W) NCIC NUMBER OFFICER I.D. NUMBER • 09 - 13 - 96 1703 9320 009318 9-131 EXTENT OF INJURY ('X' ONE) INJURED WAS ('X' ONE) WITNESS PASSENGER AGE .SEX PARTY SEAT SAFETY EIEC ONLY ONLY FATAL SEVERE OTHER VISIBLE COMPLAINT NUMBER POS. EQUIP. INJURY INJURY INJURY OF PAIN DRIVER PASS. PED. BIKE OTHER 46 M X X 2 N NAME/D.O.B./ADDRESS TELEPHONE GERALD YSTROM 122 09-01-50 H-3 CROWN CT. , WALNUT CREEK, CA, 94596 (510) 944-976 (INJURED ONLY)TRANSPORTED BY: TAKEN T0: �. AMERICAN MEDICAL RESPONSE JOHN MUIR HOSPITAL DESCRIBE INJURIES: . GENERAL BLUNT TRAUMA PRONOUNCED DEAD AT 2030 HRS . VICTIM OF VIOLENT CRIME NOTIFIED Tl7 F I I X I IXI2 3 G 0 NAME/D.O.B./ADDRESS TELEPHONE MEROE HAMEZH 01-21-79 H-4304 ROSE LANE, CONCORD, CA, 94518 (510) 676-802- (510) 932-333: (INJURED ONLY)TRANSOORTED BY: TAKEN TO: AMERICAN MEDICAL RESPONSE JOHN MUIR HOSPITAL DESCRIBE INJURIES: LACERAIONS TO LEFT HAND, COMPLIANT OF PAIN CHEST AREA VICTIM OF VIOLENT CRIME NOTIFIED 1 M NAME/D.O.B./ADDRESS TELEPHONE TROY IWINSKI H-1761 A GEARY RD . , WALNUT CREEK, CA, 94596 (510) 947-384•, (510) 682-592C (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES: J VICTIM OF VIOLENT CRIME NOTIFIED 2 26 M NAME/D.O.B./ADDRESS TELEPHONE DON A SHUMWAY 03-01-70 ..H-1701 PINE ST . , CONCORD, CA, 94520 (510) 827-2567 (INJURED ONLY)TRANSPORTED BY: - TAKEN TO: DESCRIBE INJURIES: ' T VICTIM OF VIOLENT CRIME NOTIFIED 3. T- 131 M NAME/D.O.B./ADDRESS TELEPHONE KERRIE BOYD 10-27-64 H-2127 BARBARA CT. , PITTSBURG, CA, 94565 (510) 432-6807 (510) 838-0134 ()MI)RED ONLY)TRAMPORTED BY: TAKEN TO: DEsrnmE twuRtFS: VICTIM OF VIOLENT CRIME NOTIFIED I PREPAREWS NAME f.DNUMBER MO. DAY YR. REVJEWER'SNAME MO. DAY YR i PASS.ALAC UA, D 009318 09-26-96 {f STATE OF CALIFORNIA •NARRAT VELSUP_PIEM IAL PAGE DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 09/13/96 1703 9320 009318 076U69D1 9, Botts Dots AV A ` /-680 (NIB) FOOT ' ' i PRINTS P-2 INTO WINDSHIELD 9' f 8, 270' (L/F) 261' (UR) ; WEDGE OF N. MAIN NORTH / SOUTH ST. O/C i MEASUREMENTS TO N/ EDGE OF N. MAIN ST, O/C I i i 26AT E/ROADWAY EDGE. ' 16' �+ SHOE i 0 A SHOE r....... i i 82' ASPHALT '79, DIVIDER. i ASPHALT SHOULDER XXi I I I LN ; LN ; LN ; LN r10, 12'0" 120 I 1y 2 p IT p 2 PRLEPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE D PASSALACQUA 009318 09/13/96 STATL OF CALIFORNIA NARRATIVE/SUPPLEMENTAL PAGE ' DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 09/13/96 1703 9320 009318 076U69D1 1 1 FACT 2 2 3 3 4 4 NOTIFICATION: I was dispatched to a call pedestrian,possible suicide on the N. Main St. 5 5 overcrossing at 1701 hours. I responded from I-680 at Treat.Blvd. and arrived on scene at 1703 6 6 hours. As I exited SB I-680 at N. Main St. I observed P-2 on the freeway side of the fence on 7 7 the overcrossing. As I arrived at the scene on the overcrossing I was advised by a W.C.P.D. 8 8 Officer the party (P-2) had jumped onto the freeway.. All times, speeds and measurements in g 9 this investigation are approximate. Measurements were taken by rollmeter, except where 10 10 otherwise indicated. tl 11 ` 2 12 13 SCENE: At the scene of this collision, I-680 NB is a northbound freeway consisting of four 4 14 ' lanes. The roadway is straight and level. The surface is composed primarily of asphalt. See 5 15 diagram. 6 16 7 .17 PARTIES: 18 19 Party# 1Siendrvkl was located at the scene upon my arrival. Parry Hendryk was identified 20 by a valid California driver's license. Hendryk was placed as a party by the following items: 1 21 22 -personal statements 23 - injuries to passengers 24 25 Ford Taurus, Driver# I's vehicle, was located on its wheels as shown on the diagram. 26 V-1 sustained moderate damage to the hood and windshield. 27 28 '29 Party #2 (Ystrom)was located across the front seat of V-1. Party Ystrom could not provide 30 verifiable identification due to his injuries and no identification was found on his person. Doe 31 was placed as a party by my observations and location. 32 33 34 PHYSICAL EVIDENCE: none 35 36 37 STATEMENTS: 38 ,39 Parti' # 1 (Hendryk) related that he had been traveling N/B I-680 in the N-4 In. at approx. 40- 40 45 mph.just driving along when someone comes through the window PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE D PASSALACQUA 009318 09/13/96 APP 01 '97 08=59W FPRHERS INSUWilICE h'f, P.2 ' STATE OF CALIFORM A DATE OF INCIDENT TWE NCICNu&mER OPFICBRLD. NUMBER 09/13/96 1 703 9320 009318 076U69DI 1 2 Witness ftindsh was contacted at the scene during the investigation. Iwinski related that he 3 had been SB I-680 in the S-3 In. 500-600 yds. from the N.Main t, O/C when he saw P-2 4 jump from the OIC and go through the windshield of V-1, 5 6 witness hum vl was contacted at the scene by officer Rohwyr. Shumway related that 7 he had been SIB I-680 a couple of cars behind P-1 when he observed P-2 falling from the 8 overcrossing into V-1 9 10 Witness(Boyd)was contacted at the scene by Officer Rohwer V4 C.P.D.. Boyd related he had 11 seen the same as W-2. 12 I 13 Witness(A.Har+dy#14278)an off duty CI?officer was SB 1-610 and observed P-2 jump 14 ' from the O/C in V-1. Witness Hardy stopped and administered fEst aid to P-2. 15 16 17 �Pfl�l«lYS �t COI�1+C111S 18 19 Party#1 (Hendryk)was traveling N/B I-680 in the N-4 In.at approx.40.45 mph. when his 20 Vehicle(V-1)was struck by F2rty#It2(Ystr om)who was attemptiag to commit suicide by 21 jumping from the N.Main.St.OIC on the NB Ins.of 1-680 22 23 24 CADS& 25 26 P"#2 (Ystrow)caused this collision due to his jumping onto Vehicle#1 in an attempt to 27 commit-suicide. 29 29 30 �J° 31 32 P.U.I.estimated based on statements to be approx.20 feet N. of tl=N/edge of the N. Mob St. 33 OIC within the N-4 In.of 1.680. 34 35 37 38 Intone, ZZ 39 39 FED 0 7 1997 ON SQA} P�1:i3EItI'3I AME J.D.NUMBER DATERE JEWfiR'3 NAME DATE D MSALAAC UA 009318 09/13/96 t r .t t } . d �..t - pW d� Ems" u" nn Q O ) U. cd a' tri i s i SY i } 1 a r f r �