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HomeMy WebLinkAboutMINUTES - 03231999 - C16 Y CLAIM EMNIA } Ae March 23, 1999 Claim Against the County, or District Governed by � the Board of Supervisors, flouting Endorsements, NOTICE TO CLAIMANT and Board Action. Al! Section references art The ropy of tNs document mailed to you is your California Goverifvrient Codes. 11 ry, notice of the action talon on your claim by the "'. " lard-of Supemsors. (Pi4vaph IV below), given pursuant to Govenent Code Section 913 and 915.4, Please note l "Warnings". I`, Aw iNEEZ}AL F AMOUNT: In excess of $10,000.00 CLAIMANT: Greta Banks, Armndria Banks, and Troylin Lavon Banks ATTORNEY: DATE RECEIVED: February 24, 1999 ADDRESS: 4445 Pali Lane BY DELIVERY TO CLERIC ON: February 24, 1999 Oakley, CA 94561 BY MAIL POSTMARKED: Interoffice L FROft Clerk of the Board of Supervisors M County Counsel Attached is a copy of the above-noted claim. PHIL BATCI LOR, Clerk Dated: February 25, 1999B v: Deputy , ✓ z IL FROn- County Counsel TO: Clerk of the Board of Supervisor {Q This claim complies substantially with Sections 910 and 910.2. { ) This claire FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.0, ( 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). { ) tither: Dated: " By: ���ty County Counsel .: D1 FROM, Clerk of the Board T`ti. Ciu 4 Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD GIRDER: By unanimous vote of the Supervisors present: (NA 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. Bated: PHIL BATCHELOR, Clerk, By , Deputy Clerk -- WARNING (Gov, code section 13) ..� 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 ?v B G 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: . . By: PHIL BATCHELOR By Deputy Clerk CC. County Counsel County Administrator A ''ME1 CLALM � Bb .!QSQRS OF C0_1XTRA COSTA COL'IIVILALOM,1A BOARD 00 March 2 , 1999 Claim Against the County, or District Governed by the Board of Supervisors, Routing Endorsements, } NOTICE TO CLAIMANT and Board Action. All Section references are to 1 The copy of this document mailed to you is your California Government Codes. } notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given !� pursuant to Government Code Section 913 and 915.4. Please noteall "Warnings". AMOUNT: $4,403.15 CLAIMANT: Casey A. Pratt ATTORNEY: c/o Mercury Insurance DATE RECEIVED: February 26, 1999 ADDRESS: P. G. Box 13768 BY DELIVERY TO CLERK ON: FebruaLy. 26, 1999 Sacramento, C.A. 95853 BY MAIL POSTMARKED: Interoffice Mail L FROINE Clerk of the Board of Supervisors TO- County Counsel Attached is a copy of the above-noted claim. PHIL BAT M I, e Dated: March 12, 1999 By: Deputy IL, FROM: County Counsel TO: Clerk of the Board of Supervis rs ( This claim complies substantially with Sections 910 and 910.2. This claim FAILS to comply substantially with Sections 9I0 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.$). ( ) 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: .47 IY Dated: ' L ? By: f �, �""' Deputy County Counsel V HL 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. BOA 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: °tom 2,.59 PHIL, BATCHELOR, Clerk, By , Deputy Clerk WARNING (Gov. code section 13) 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 NJAILLNG 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: By: PHIL BATCHELOR By eputy Clerk CC: County Counsel County Administrator CLA '_�►I B DARD OF SUP MSORS OF CONNIRA C[STA i Y 1.12"i s !CAI 71A BOARD AOC?l t Aril 6, 1999 Claim Against the County, or District Governed by the Beard 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 California Government Codes. ) 4 notice of the action taken on your claim by the 4 Board of Supervisors. (Paragraph IV belovO, given t pursuant to Government Code Section 913 and 915.4. Please note all 'Warnings". AMOUNT: $4,403.15 ���� tAA?o1 � . CLAIMANT: Casey A. Pratt ATTORNEY: c/o ML ercury Insurance ISA'`E RECEIVED: February Zia, 1999 ADDRESS: P. C. Box 13768 BY DELIVERY TO CLERK ON: February 26, 1999 Sacramento, CA 95853 BY MAIL POSTMARKED: Interoffice Mil L FROM: Clerk of the .Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PML BAT HELOR, Clem Dated: Ylarch 1, 1999 By: Deputy. r 11 FROM: County Counsel TO: Clerk of the Board of Supervis` s ('41 This claim complies substantially with Sections 910 and 910.2. { This claim PAILS 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 claire 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: CYL 91T � ,: Dated: Deputy County Counsel +�f r III. FROM Clerk of the Board TO: &unty 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: 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. AFF.Q?AVIT 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: By: PHIL BATCHELOR By Deputy Clerk CC: County Counsel County Administrator w 'TOk J.WESTMAN DEPUTIES- �✓l�I `" Y COUNSELPtidLL11 S.ALTHOF= JANICE L.AMENTA B.REBECCA BYRNES SILVANO B.VIARCHESI CONTRA COSTA,COUNTY ANDREA COOPEIRY ASSISTANT cOL TY ou vsEL AWES OFFICE OF THE COUNTY' COUNSELMARKE S.°SS S A, ON L.ANDERSON LILLIAN T1�.FARR C(l NTY ADMINISTRATION BUILDING DENN c C.CRAVES AssisTANT COUNTY COUNSEL 661 PINE STREET,9th FLOOR JANET L.}iCLMES MARTINEZ,CALIFORN A 9465.1-1229 KEVIN T.KERri GREGORY C.HARVEY BERNARD!.KNAPP ASSISTANT COUNTY COUNSEL EDWARD v.LAME.JR. VARY ANN MASON IZ GAYLE MUGGLI PAUL R. NOR PHILIP J..NORCAARJ OFFICE MANAGER VALERIE J.RANCHE DAVID P.SCHMID T DIANA J.SILVER PHONE(925;335-1800 T -OF-INSUFFICIENCY y �r�7� 7��7 (� BARBARA N.SUTUFPE FAX(925)646-1078 NOTICE OF INSUFFICIENC I JACQUELINE Y.WOODS ANDZOR NON-ACCEPTANCE OF CLAIM TO: Mercury Insurance Group P.O. Box 13768 Sacramento, CA 95853-3758 RE: CLAIM OF: Insured Casey Pratt 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. ] 3. The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. []4. The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or loss, if known. [XX ]5. The claire 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 claire fails to state whether jurisdiction over the claim would rest in municipal or superior court. [XX] 6. The claim is not signed by the claimant or by some person on his behalf Page 1 [X-XI 7. Other: Please submit claim form and two repair estimates. VICTOR J. WESTMAN, County Counsel By: aunty Coups l CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013x,2015.5;Evidence Code§§641,664) 1 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 Unites: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: February 23, 1999 at Martinez,California. cc: Clerk of the Boa asupervisors(original) Risk Management NOTICE OF INSUFFICIENCY OF CLAIM:GOVT.CODE§§9=0,910.2,920.4,910.8) H:\GROUPS\TORT\CASES\FORMS\RIS,CMGMT\INSUFFIC.WPD Page 2 CLAM BOARD-OF, OF SLTYJM EBA CQUA CQUins CALiF(3RNiA BOARD ACT1Q11E March .23, 1999 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, NOTICE TO CLAIMANT and Board Action. All Section references are to } The copy of this document railed to you is your California Government Codes. 1 notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV blow), given pursuant to Government Code Section 913 and a )' 915.4. Please note all "Warnings". r"- Z AMOUNT: Unspecified eqs CLAIMANT: Casey Pratt W4 Fi11NE Z 0ALiF ATTORNEY: c/o Mercury Insurance Group DATE RECEIVED: February 19, 1999 ADDRESS: P. 0. Box 13768 BY DELIVERY TO CLERK ONT: February 19, 1999 Sacramento, CA 95853-3768 BY MAIL POSTMARKED: February 16, 1999 E FROIVE• Clem of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BATfELOR, Clerk Bated: February 22, 1999 By: Deputyz F r/ IE FROM: County Counsel TO: Clerk of the Board of Supervisors { ) This claim complies substantially with Sections 910 and 910.2. (V) 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:_ !t ___Deputy County Counsel Ill FRC7nM Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 311.3). IV. BOARD ORDEPt: 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: _.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 MAILIiiG I declare under penalty of penury 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:, - By: PHIL BATCHELOR By Deputy Clerk CC: County Counsel County Administrator Claire to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing craps and which accrue on or before December 31, 1987, must be presented not later than the 100' day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt.Code§911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building,651 Pine Street,Martinez,CA 94553. C. If Claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be rifled in. D. H the claim is against more than one public entity,separate claims must be filed against each public entity. E. Fraud. See penalty for fraudu!enz claims, Pcraf Cade Sec. 72 at the end of this foram. RE: Claim by j Reserved for Clerk's Filing Stamp Against the County of Contra Costa or District) (Fill in Name) The undersigned claimant hereby snakes claim against the County of Contra Costa or the above named District in the sunt of S '-E'�0,f t and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact gate and Hour) _ --------------------- --'-___--------___-,.----_____--_--__-__ 2. Where did the damage or injury occur? (include City and County) _____ ✓.________ -`- "_ ----------- ., - --� _ ___--�--�-�-�--��------------- 3. How did the damage or injury occur? �(Give full details,use extra paper if regyir3ed) �,. a f�°'o` �_.r i�-�. _,3 A�,%'�g`C..i�-%;r```,� � "r � s-�',,.', 'o.�'f t..Z:a•4.m.' �!�_�"7 r'�`..%�. ' ___ ._ -� '__'_a'C: L .�_ i-tr.`s __ �>_���------------ ®__r-- ��£ L � 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage:' Pit C ' r (Over) 5. What are the names of county or district officers,servants,or employees causing the damage or injury? -------------------------------------------- 5. What d is ii far Uri S d�H' if xair ! 51 1tE{l"r+(Give full extent of injuries or damages claimed. Attach two estimates for auto dam4i� via ie ..m....-..--__..®-------------------.-_-----_------_---------- 7. How was the above claimed amount computed? (include the estimated amount of any prospective injury or damage.} ------------------------------------------------------------------------------------- h. Names and addresses of witnesses,doctors,and hospitals. ----------------------------------- __E______--____----_--__--___ ---------------- 9. List the expenditures you made on account of this accident or injury: BATE ITEM AMOUNT f{ � a � � attc � sarstat � seak � rtirieltiprt * ktrst $k � � � � as � * st ,tte � # ikrka4 �r � laatskYe * � � te �c � � s4ia * � Gov. Code Sec.910.2 provides: "Tile claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf." Name and Address of Attorney N ti Claimant's Signature; : — ' 3 (Address) Telephone No. Telephone No. NOTICE Section 72 of the Penal Code provides: "Every person who,with intent to defraud,presents for allowance or for payment to any state board or officer,or to any county,city or district board or officer,authorized to allow or pay the same if genuine,any false or fraudulent claim, bill, account,voucher,or writing,is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand dollars ($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 ($10,000), or by both such imprisonment and fine. 02/12/1999 02:27 PM BODY SHOP NAME: AU'TOXCELLEINCE INC DATE ASSIGNED: 42/04/1999 BRANCH: 14 UNIT: LOSS DESCRIPTION: C-68 NO: I CAR NO.: I INS DRIVING N.B.ON BOLINGER CANYON RD WHEN A COUNTY WORKER IN CO. TRUCK PULLED CLAIM NUMBER: SNO00985-90 OFF SHOULDER INTO LANE AND 01 HIT HIM. IVSD: WILLIAM J.PRATT INS SAID IT WAS ON A BLIND CURVE DESCRIPTION OF DAMAGE: ADJ.NAME: 1367 CHRIS WALLER RIGHT FRONT HOOD&SIDE PANELS ADJ. PHONE: (916)861-3861 Fit 17 1999 EXISTING DAMAGE: DATE OF LOSS: 02/02/1999 DATE RPTD TO CO: 02/03/1999 p15PATOKER SPECIAL EQUIPMENT: MEIVED VEH. DESC: 1995 HONDA CIVIC EX VELI. LIC. PLATE:VIN: 2HGEJ1228SH51000 FEB 16 1999 DRIVEABLE:YES �° ASSIGNMENT TYPE: REGU , TTICLE OWNER: 5, . � DED/LIMIT TAR OL$LISI 500.00 ,�� PRATT, WILLIAM J ACTUAL COST $ 12000.00320 TOPEKA PLACE i 19991 STATED VALUE $ �` DANVILLE CA 94526 (925)831-0902 (408)467-5633 '.4TCHE.' RENTAL CAR COV: YES CALL AT: RENTAL CAR LIMIT: $20 PER DAY 30 DAYS 924 831 0902 VEHICLE LOCATION: AGENT: 4176 POLICY NUMBER: AP03185029 RESIDENCE DATE CAR ADDED: 05/13/1998 DRAFT/COVERAGE CODE: DANVILLE CA 94526 :: COMPANY CODE: MIC (925) 831-0902 w COVERAGE STATUS: SPECIAL INSTRUCTIONS: COVERAGE CONFIRMED t EST. GIVEN TO OWNER: YES CAMS CLOSING REPORT LOW BLUE BOOK DATE RECEIVED: 02/04/1999 ESTIMATE $ 4417.76 (with mileage adjustment)$ 13150.00 DATE CONTACTED: 02/06/1999 DEDUCTIBLE $ 500.00 NUMBER OF PHOTOS: 5 DATE INSPECTED: 02/06/1999 BETTERMENT $ CLOSING DATE: DAYS TO REPAIR: 10 ALLOWANCE $ CLOSING TYPE: MERCURY PAYABLE $ 3917.76 TOTAL REPAIR COST$ 4417.76 REPAIRABLE LOSS INSURED PAYABLE $ 500.00 SUPPLEMENT SEQ DATE SUPPLEMENT BETTERIMENT ALLOWANCE MERCURY INSURED . NO.OY ADD'L BAYS CLOSING SUPL.TO NO: INSPECTED AMOUNT$ $ $ PAYABLE$ PAYABLE$ PHOTOS TO REPAIR TYPE OWNER SHOP COMMENTS: Date: 02112199 02:26 PM Estimate ID: 2432 Supplement. 1 (F) Profile ID: MERCURY BOSTROM'S AUTOXCELLENCE 2700 HOOPER DRIVE SAN RAMON,CA 94583 (510)831-1778 Fax: (510)831-8472 Damage Assessed By: DANA PLEECE Supplemented By: FRANKIE QUADRATO Condition Code: Good Deductible: UNKNOWN Insured: CASEY PRATT Address: 320 TOPEKA PLACE DANVILLE,CA 94526 Mitchell Service: 913130 Description: 1995 Honda Civic EX Vehicle Production Date: 10194 Body Style: 2D Cpe Drive Train: 1.61-InJ 4 Cyl 4A VIN: 2HGEJ1228SH510006 License: 4BZV430 CA Mileage: 46,468 OEMIALT: O Search Code: B94583 Color: BLACK Line Entry Labor Line Item Part Type/ Dollar Labor CEG Item Number Type Operation Description Part Number Amount Units Unit 1 AUTO BOY OVERHAUL FRT COVER ASSY 2,O 2.0 2 301680 BOY REMOVEIREPLACE FRT BUMPER COVER 71101-SRO-AOOZZ 175.57 INC 2.OT 3 AUTO REF REFINISH FRT BUMPER COVER 1.9 1.9 4 301780 BOY REMOVE/REPLACE FRT BUMPER HONEYCOMB REINF 71170-SR3-AOI 64.20 INC 2.OT 5 300011 BDY REMOVEIREPLACE FRT BUMPER REINFORCEMENT 71130-SR3-AO2ZZ 128.50 0.3 # 0.3T 6 301850 BDY REMOVE/REPLACE FRT BUMPER SPOILER 71110-SR3-000 80.33 INC 0.3T 7 AUTO REF REFINISH FRT SPOILER 0.8 0.8 8 302390 BDY REMOVEIREPLACE R HILAMP ASSEMBLY 33100-SR3-A01 93.20 0.3 # 1.3T 9 AUTO BDY CHECKIADJUST HEADLAMPS 0.4 0.4 10 302790 BDY REMOVEIREPLACE R SIGNALIMKR LAMP ASSEMBLY 33300-SR3-A02 29.47 INC # 0.2T 11 303110 BDY REMOVEIREPLACE HOOD PANEL 60100-SR3-00OZZ 250.05 1.0 1.0T 12 AUTO REF REFINISH HOOD OUTSIDE 3.0 10 13 AUTO REF REFINISH HOOD UNDERSIDE 1.5 1.5 14 303130 BOY REMOVE/REPLACE HOOD EMBLEM 75700-SR3-000 12.43 INC 0.2T 15 305020 BDY REMOVEIREPLACE L FENDER PANEL 60261-SR3-AOOZZ 207.48 2.0 # 2.0T 16 AUTO REF REFINISH L FENDER OUTSIDE 1.9 2.3 17 AUTO REF REFINISH L FENDER EDGE 0.5 0.5 18 305090 BDY REMOVE/REPLACE R FENDER MOULDING 75301-SR3-AO1 8.03 0.2 0.2 T 19 305100 BDY REMOVE/REPLACE L FENDER MOULDING 75321-SR3-A01 7.63 INC 0.2T 20 900500 BOY* REMOVEIREPLACE COVER CAR "*Quaff Rep[Part 10.00* 0.0* T 21 900500 BDY* REPAIR COLOR SAND AND BUFF.3 PER PNL.MAX 1.5 Existing 0.9* 22 900500 BDY* REMOVE/REPLACE FLEX ADDITIVE **Qual Repi Part 8.00* 0.0* T 23 900500 MCH* ADO'L LABOR OP FRONT WHEEL ALIGHNMENT Sublet 65.00* 0.0* 24 900500 BDY* REMOVEIINSTALL DOOR COMPONENTS FOR REFINISH Existing 1.5* 25 900500 BDY* REMOVEIREPLACE YOKAHAMA TIRE 185XSOX14 AVID H4 Qua€Rep#Part 135.00'* 0.0* T S1 26 BETTERMENT-P YOKAHAMA TIRE 18SX60XI4 AVID H4%10.00"' 13.50 T 27 300028 BDY REMOVE/REPLACE UPR FRONT BODY TIE BAR -S 04602-SR3-GOOZZ 81.40 2.0 2.OT 28 AUTO REF REFINISH UPPER TIE BAR 0.5 0.5 29 305620 BOY REMOVEIREPLACE R FRONT BODY RADIATOR SIDE PANEL -S 04601-SR3-AO0ZZ 71.85 2.2 2.5T 30 AUTO REF REFINISH R RADIATOR SIDE PANEL 0.5 0.5 ESTIMATE RECALL NUMBER: 2109/9909:24:15 2432 UltraMate Is a Trademark of Mitchell international Mitchell Data Version: JAN_99-A Copyright(C)1994-1997 Mitchell International Page 1 of 2 All Rights Reserved Date: 02/12199 02:26 PM Estimate ID: 2432 Supplement: 1 (F) Profile ID: MERCURY 31 300027 BOY REMOVEIREPLACE R FRONT BODY FRONT APRON PANEL 60611-SRO-AOOZZ 75.00 2.0 # 3.0T 32 300050 BOY REMOVEIREPLACE R UPR FRONT BODY APRON REINF -S 60614-SRO-AOOZZ 37.37 2.0 2.0T 33 300035 BOY REMOVEIREPLACE R FRONT BODY SIDEMEMBER -S 60810-SRO-902ZZ 363,48 5.5 # 8.0T 34 AUTO REF REFINISH R SIDEMEMBER 1.0 1.0 35 320470 BDY REPAIR R FRT DOOR SHELL Existing 0.5*# 3.5 36 AUTO REF REFINISH R FRT DOOR OUTSIDE 2.0 2.2 37 320960 BOY REMOVE/REPLACE R FRT DOOR ADHESIVE MOULDING 75302-SR3-AO1 47.57 0.0* 0.2T 38 325900 BOY REMOVEIINSTALL R ROOF SIDE MOULDING 0.3 0.3 39 326170 REF* REPAIR R ROOF RAIL Existing 0.0* 40 933002 REF ADD`L OPR CLEAR COAT 2.5* 41 AUTO ADD'L COST PAINT/MATERIALS 338.10* T * a Judgement Item #-Labor Note Applies Add'I Labor Sublet 1. tabor Subtotals Units Rate Amount Amount Totals If. Part Replacement Summary Amount Body 23.1 52.00 0.00 0.00 1,201.20 Taxable Parts 1,886.56 Refinish 16.1 52.00 0.00 0.00 837.20 Parts Adjustments 86.68- Mechanical 0.0 52.00 0.00 65.00 65.00 Sales Tax @ 8.250%fl 148.49 Non-Taxable Labor 2,103.40 Total Replacement Parts Amount 1,948.37 Labor Summary 39.2 2,103,40 Ill. Additional Costs Amount IV. Adjustments Amount Taxable Costs 338,10 Betterment 14.61- Sales Tax @ 8.250% 27.89 Customer Responsibility 14.61- Total Additional Costs 365.99 1. Total Labor: 2,103.40 If. Total Replacement Parts: 1,948.37 III. Total Additional Costs: 365.99 Gross Total: 4,417.76 IV. Total Adjustments: 14.61:1 Net Total: 4,403.15.._ Less Original Net Total: 4,542.56 Net Supplement Amount: 139.41- 51: FRANKIE QUADRATO 139.41- ESTIMATE RECALL NUMBER: 2/09/99 09:24:15 2432 UltraMate is a Trademark of Mitchell International Mitchell Data Version: JAN, 99_A Copyright(C)1994-1997 Mitchell International Page 2 of 2 All Rights Reserved TRAFf IC COLLIS-1-ON REPORT .SPECIA1,Q'ONOf'?'tY)N..S No);N? H R"EL CITY it'DWIAI,DISTRICT NUMBER I 0 [ I UNINCORPORATED WALNUT CREEK NO KILL H&R MISD COUNTY DIST BEAM 2-09 ) C} CONTRA CQSTA, 0 ? c-Stars: OBHDIZXL t COLLISION zX'CttRREDC)N:oMO DAY YEAR TIME(24(ll)) NCIC N OFFICER S.D. {) : BOLT. .NGER CANYON RD. S/B 02 102 L99 1600 9390 1, 0148811 A P r DAY OF WEEK TOW AWAY .PHOTOGRAPHS BY: 3 3 MiLFi�JST INFCIRMA'.9tIN; TUESDAY YES PQ NO C) N I; AT INTERSECTION WITH: STATE HWY REL `s OR: l . 4 m I S o f CROW CANYON RD. YES Ivo NONE ' PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY VEH YR MAKEIMODEL/COLOR LICENSE NUMBER STATE 1 B8234411 CA C C 95 HIONDA CIVIC BLACK, . . 4BZV430 CA DRIVER;NAME(FIRS'T,MIDDLE,LAST3 • • . • • . • • • y CASE}" ADAM PRATT I OWNER'S NAME sA:'fE As DRIVER � PEDES- !STREET ADDRESS 320 TOPEKA PL. OWNER'S ADDRESS SAME AS DRIVER I t PARKED CITY/STATEJZIP V£rfL DANVILLE CA 94526 DISPO OF VEHICLE ON ORDERS OF. OFFICER n DRIVER (]OTHER BILCY- SEX HAIR :# £YES HEIGHT WEIGHT BIRTHDATE RACE DRIVEN AWAY BLrl tN f BI#L —( 1130 ? 08"1 2 ? 2 PRIOR MECHANICAL DEFECTS. NONE APPARENT Ps REFER TO NARRATIVE OTHER 6 HOME PHONE BUSINESS PHONE VEHICLE I[3ENTIF3CATION NUMBER: E (9 2 5) 8:3 1—0 902 NONE CHP USE ONLY DESCRIBE VE141CLF DAMAGE SHADE IN DAMAGED AREA ? • INSURANCE CARRIER POLICY NUMBER i V EHiCLE TYPE L'NK ��NONE ��MINOR MERCURY AP 0 3 18 5 0 2 9 j 01 MOD. MAJOR ��ROLL-OVER � ..ri1Y DIR TRV I ON STREET OR HIGHWAY SPEED LIMIT CA DOT N I BOLLINGER CANYON 45 CAL.T TCPJPSC MC/MX PARTY k DRIVER'S LICENSE NUMBER SLATE CLASS SAFETY VELI YR MAKE'MODELJCOLOR WCENSE NUMBER STATE IS0309570 CA A C 95 �GMCe /U W:�ITE . . . . . . . IE 005440_ CA DRIVER'NAME{FIRST.MIDDLE.LAST} PQ RODNEY TAYLOR. HOLLAND OWNER'S NAME �� SAME AS DRIVER PEDES- STREET ADDRESS COUNTY, CONTRA COSTA TRt� I 1 355 W' L OWCREFK LN. OWNER'S ADDRESS SAME AS DRIVER PARKED CITYJSTATE/ZIP 2467 WATER. BIRD WAY, VEII L;MI As TTt NE`Z CA 94 553 DiSPOOFVEHICLE ONORDERS OF: � � OFFECER �Ji DRIVER �]OTHER BICY :SEX I HAIR EYES HEIGHT WEIGH"I' BIRTHDATE RACE DRIVEN AWAY rL M BRN CR i 6-00 1 .8 v 2 ,G 4 8 ? j PRIOR MECHANICAL DEFECTS: NONE APPARENT REFER TO NARRATIVE 4 OTHER (HOME PHONE BUSINESS PHONE ?VEHICLE IDENTIFICATION NUMBER: 0 2,.1" 3 2 2 8^-3 3 9 2 (9 2 5) 313-''7 0 41 ? CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE!N DAMAGED AREA VEHICLE TYPE INSURANCE CARRIER POLICY NUMBER UNK NONE MINOR CONTI-A COSTA COUNTY SELF iNSUREL} 22 [J MoD.� ]MAJOR ( �ROLL-OVER DIR TRV ON STREET OR HIGHWAY SPEED LIMIT CA DOT ' S 30 .1LINGER CANYON 45 1 CAL-T TCPJPSC _ Mc/Mx 'PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY 11 VEH R MAKE/MODELiCOLOR LICENSE NUMBER STATE 3 •CHRISWA L R. DRIVER NANIEiFIRS'T.MEDDLE,LAST' OWNER'S NAME SAME `W Ek WA PEDES- STREET ADDRESS VE TR�AN I OWNER'S ADDRESS SAME AS D VE :PARKED?C;TYiSTATEJZiP VE L ,�••� D'+SPO OF VEHICLE ON ORDERS OF: � � OFF;CER f i DRIVER � JOT14FR :aICY- SEX HAIR EYES HEIGHT i WEIGHT BI H:q tEAIM RACE ( I t PRIOR MECHANICAL DEFECTS: NONE APPARENT REFER TO NARRAT;VE OTHER HOME PHONE G. NESS PHONE 'VEHICLE IDENTI#^ICATiON NUMBER: � j CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA VEHICLE TYPE INSURANCE CARRIER [C NUMBER \1\Ii,,H (.\I.IH)4Nl,\ I'f 1I FIC" COLLISION CODING _ I,A,;E .l of It !)A ,1,3 ,)kt(;INAI.SNCIDEN'F i�it.I33_'itMb N W NUMBER --- CWFH'ER I.D. N1;Mi1E'R 02 02 - 99 1500 9390 1 014881 ' 2-09 ;OWN€IRS NAMEIADDRESS - -- - NOTIFIED t i I'ROf'FR'TY I DESCRIPTION OF-DAMAGE OAMAOE ! SEATING POSITION i OC'C'UPANTS SAFETY EQUIPMENT EJECTED FROM VE14 hilt'HIC'YCL€S-HF,i.MET t 3- DRIVER ,t-NONE IN VEHICLE L-AIR SAG DEPLOYED U-NOT EIECTED to 6-PASSENGERS B-UNKNOWN M-AIR BAC;NOT DEPLOYED 'RIVER ?•FULLY EIECTED 7-STA.WON,REAR C-LAP BELT USED N-OTHER V-NO PARTIALLY EJECTED I 3 8-RR.OCC.TRK,OR VAN D-LAP BELT NOT USED P•NOT REQUIRED W.YES 3-UNKNOWN i 4-POSITION UNKNOWN E-SHOULDER HARNESS USED 5 6 0-OTHER F-SHOULDER HARNESS NOT USED CHILD RESTRAINT PASSENGER e G-LAP/SHOULDER HARNESS USED Q-IN VEHICLE USED X-NO I 7 I H-LAP/SHOULDER HARNESS NOT USED R-IN VEHICLE NOT USED Y-YES ' `—PASSIVE RESTRAINT USED S-IN VEHICLE USE UNKNOWN i i K-PASSIVE RESTRAINT NOT USED T-IN VEHICLE IMPROPER USE U-NONE IN VEHICLE i , ITEMS MARKED BELOW WHICH ARE FOLLOWED BY AN ASTERISK t*)SHOULD BE EXPLAINED IN THE NARRATIVE PRIMARY COLLISION FACTOR MOVEMENT PRECEDING LIST NUMBER IX)OF PARTY AT FAULT TRAFFIC CONTROL DEVICES i TYPE OF VEHICLE COLLISION - 11112113 � 1 2 3 A VC SEC VIOLATED: CITED ! A CONTROLS FUNCTIONING A PASSENGER CAR/STN.WGN. A STOPPED T 1J A j ZIC" NO 3 S CONTROLS NOT FUNCTIONING* B PASSENGER CAR W/TRAILER X 3 B PROCEEDING STRAIGHT B OTHER IMPROPER DRIVING i C CONTROLS OBSCURED 1C MOTORCYCLE/SCOOTER C RAN OFF ROAD C OTHER THAN DRIVER* �!X D NO CONTROLS PRESENT/FACTORI !D PICKUP OR PANEL TRUCK i D MAKING RIGHT TURN .w D UNKNOWN* !E PICKUP/PANEL TRK.W/TLR. E MAKING LEFT TURN E FELL ASLEEP* j TYPE OF COLLISION F TRUCK OR TRUCK TRACTOR F MAKING U TURN y !A HEAD-ON ? G TRK./TRK.TRACTOR W/CLR. ? i G BACKING i WEATHER(MARK i TO ITEMS) 'B SIDESWIPE H SCHOOL BUS 1 j H SLOWING/STOPPING ?X ;A CLEAR C REAR END i I OTHER BUS i i PASSING OTHER VEHICLE B CLOUDY D BROADSIDE ! I EMERGENCY VEHICLE ! ! i CHANGING LANES 1C RA?NTNG E HIT OBJECT E K HWY.CONST.EQUIPMENT # K PARKING MANEUVER ! IID SNOWING F OVERTURNED i L BICYCLE X i L ENTERING TRAFFIC j E FOG/VISMILITY: G VEHICLE/PEDESTRIAN M OTHER VEHICLE M OTHER UNSAFE TURNING F OTHER*: i H OTHER*: i N PEDESTRIAN !N XING INTO OPPOSING LANE —O WIND ( MOTOR VEHICLE INVOLVED WITH I O MOPED :0 PARKED W LIGHTING ! A NON-COLLISION 1P MERGING A DAYLIGHT B PEDESTRIAN !4 OTHER ASSOCIATED FACTOR Q TRAVELING WRONG WAY B DUSK-DAWN X C OTHER MOTOR VEHICLE 1 ' 3 1 MARK I TO ITEMS- ! R OTHER*: C DARK-STREET LIGHTS ! D MOTOR VER ON OTHER ROADWAY I A VC SECTION VIOLATION:CITE D DARK-NO STREET LIGHTS ? ;E PARKED MOTOR VEHICLE i 7 i E DARK-STREET LIGHTS NCYT FUNCTION !F TRAIN e B VC SECTION VIOLATION:CITE Ii ROADWAY SURFACE !G BICYCLE 1 SOBRIETY-DRUG PHYSICAL X ?A DRY i I H ANIMAL: C VC SECTION VIOLATION:CITE i 3 (MARK O ITEMS) i B WE, 1 3I x X, A HAD NOT BEEN DRINKING 'C 5NOWv.ICYI FiXEDORIECT: ! 1 E VIS.OBSCURED: i ! n e a _I II HHD-UNDER!NFLUENCE I 1D SLIPPERY(MUDDY,OILY,E- !I F INATTENTION* 1C HBD-NOT UNDER:NFLUENCE ROADWAY CONDITION'S t ; OTHER OBJECT: _ G STOP&GO TRAFFIC j D HBD-IMPAIRMENT UNK.- 1 <+ - - -.--- MARK I TO 2ITEMS i PEDESTRIAN'S ACTIONS i H ENTERING/LEAVING RAM? i I E UNDER DRUG INFLUENCE* r-a A HOLES,DEEP RUTS,. X A NO PEDESTRIAN INVOLVED i I PREVIOUS COLLISION !F IMPAIRMENT-PHYSICAL' B LOOSE MATERIAL ON RDWY* ! B CROSSING IN XWALKIINTERSECTION E E ) UNFAMILIAR WITH ROAD I G IMPAIRMENT NOT KNOWN C OBSTRUC:'TION ON ROADWAY` ! C CROSSING IN XWALK NOT AT i ,K DEFECTIVE VEH.EQUIP.:CITE H NOT APPLICABLE -...- -- INTERSECTION D CONSTRUCTION-REPAIR ZONE E ! I SLEEPY/FATIGUED E REDUCED ROADWAY WIDTH D CROSSING NOT IN CROSSWALK I L UNINVOLVED VEHICLE SPECIAL INFORMATION F F:_OODED* E IN ROAD-INCLUDES SHOULDER i M OTHER°: ! A HAZARDOUS MATERIAL _- G OTHER*: ; _ 1 F NOT?N ROAD X X i N NONE APPARENT ? _ B SEATBEL?'FAILURW X H NOUNLSSUALCONDITR)NS I, iG - APPROACHING--/-L-EAVINGSCHQOL,8US iO RUNAWAY VEHICLE SKETCH ALL R ;MISCELLAN EO }US i CL AiM ri' C I r i � — SI.\FL OF CALIf`tWMA INJURED/WITNESSES/PASSENGERS M DA Tt OF C`QLLWON T;ME(24W! Nf'IC NUMBER OFFICER I.D. NUMBER . 02 99 1600 9390 014881 2-09.02 II EXTENT OF INJURY('X' ©NE) INJURER WAS ('X' ONE) WITNLSS PASSENGER A(;E SEX - - - - PARTY SEAT SAFETY�EIEC`fED� ONLY i ONLY I FATAL € SEVERE OTHER VISIBLE COMPLAIN! NUMBER JOS. EC}FIEP, INJURY E INJURY INJURY OF PAIN DRIVER PASS. PED. !BIKE OTHER ; i i E X ! 17 F i 3 :NAME/D.O.B./ADDRESS TELEPHONE SARAH MICHELLE MtOR.RISON 01-23-82 H-1976 SAINT CECRCE RD. , DANVILLE, CP,, 94526 (925) 735-8558 ;(INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES: 3 3 3 VICTIM OF VIOLENT CRIME NOTJFIED NAM E/D.O.BJADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES: E VICTIM OF VIOLENT CRIME NOT#FIED t i NAME/D.O.B./ADDRESS TELEPHONE 3 s I !(INJURED ONLY)TRANSPORTED BY: TAKEN TO: f 3DESCR?3E INJURIES: t VICTIM OF VIOLENT CRIME NOTIFIED 3 !NAME/D.O.B./ADDRESS TELEPHONE ;(INJUR-MYONLY)TRANSPOR'T'ED BY: TAKEN TO: iDESCRIBE INJURIES: VICTIM OF VIOLENT CRIME NOTIFIED f i i r ;NAME/D.O.S./ADDRESS TELEPHONE i t i t ( t (?NJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES: VICTIM OF VIOLENT CRIME NOTIFIED PREPAREWS NAME 1.0 NUMBER MO. DAY YR. ;REVIEWER'S NAMEM(). DAY YR. WALLING rr 01., 02-02-991 STATE OF CALIFORNIA ENTAL pacie (SAFE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 02/02/99 1600 9390 014881 2-09 N SKETCH W E (Not To Scale) S BOLLINGER CANYON RD CROW CANYON RD. Double Yellow !tines V-2 V-? I Solid Whig Line Solid White Line Road Edge � Road Edge Dirt Shoulder ---gy. �/ �/ -� Dirt Shoulder PREPARER"S NAME E.D.NUMBER DATE REVIEWER'S NAME DATE M WALLING 014881 02/02/99 STAVE OF CAUFORNIA �RRATi1 EIDE 1PPL1=Al1EN_TAL _ Page " cif €}A€L OF€NC€DENT TIME NCIC NUMBER OFFICER C.D. NUMBER 02/02/99 1600 9390 014881 2-09 1 NOTIFICATION: 2 3 1 was dispatched to a property only collision call at 1629 hours. I responded from. S/B Camino 4 Tassajara S/of Highland Rd. and arrived at the scene of the collision at approximately 1652 5 hours. All measurements, times and speeds are approximate. All measurements were taken by 6 estimation. 7 8 STATEMENTS; 9 10 Party #I (Pratt): related to me at the collision scene that he was driving his vehicle (Honda) NIB I 1 Bollinger Canyon Rd. at approximately 45-50 MPH. Party#1 stated as he,;,,as driving around a 12 right hand curve in the road, when he observed a white P/U coming toward him in his lane. P-1 13 stated he applied his brakes in an attempt to stop before colliding with the P/LT. P-1 stated he 14 was unable to stop before the front right area of his vehicle collided with the front middle 15 bumper of the P/U. 116 17 Party #2 (Holland): related to me at the collision scene that he was driving his vehicle (GMC) 18 S/B Bollinger Canyon Rd. P-2 stated he was stopped on the left shoulder of S/B Bollinger 19 Canyon Rd. when he entered the N/B lane at approximately 5 MPH en-route to the S/B lane. P-2 20 stated he was in the NB lane when he observed a black vehicle traveling N/B come around a 21 curve directly in front of him.. P-2 stated he applied his brakes and stopped in the N/B lane and 22 watched as the black vehicle skidded into the front of his P/U. 24 25 SUMMARY 26 27 Party 91 Pratt was driving V-1 N/B Bollinger Canyon Rd. at approximately 45-50 MPH. Party 28 #2 Holland was driving V-2 S/B Bollinger Canyon Rd. in the N/B lane at approximately 5 MPH. 29 Party #2 Holland entered the N/B lane at a curve in the road. Party 41 Pratt carne around the 30 curve and observed V-2 directly in front of him in the NB lane. P-1 applied his brakes in an 31 attempt to step, and left approximately 103' of locked wheel skid makes in the roadway. The 31 skid marks were completely within the NB lane. The front right of V-1 collided with the front 33 middle bumper area.of V-2. V-1 sustained major damage to the front bumper, fender and light 34 assembly. V-2 sustained minor damage consisting of dents and scratches to the front bumper 35 area. 36 37 38 39 40 -PREPARER'S NAME I.D. NUMBER DATE REVIEWER'S NAME DATE M WALLING 01488: 02/02/99 STATE OF CALIFORNIA tlNAaj34j j1 E1SUPPLgMENTAL Paas cif DATE OF INCIDENT TIME NCIC NUMBER C7FFICER I.D. NUMBER 02/02/99 1640 9394 014881 2-09 1 AREA OF VMPACT (AO1)o 3 The A01 was determined by statements, physical evidence and damage to the involved vehicles. 4 5 AOI #1 m 1.4 miles N/of the north roadway edge prolongation of W/B Craw Canyon Rd. and 6' 6 W/of the east roadway edge ofN/B Bollinger Canyon Rd. 7 8 9 CAUSE: 10 1 i Party 92 (Holland) caused this collision by driving on the left side of the roadway at a curve, 12 creating a hazard. The cause was established by statements, physical evidence and damage to the 13 involved vehicles. REPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE M WALLING 014881 02/02/99 „� SAN RAMON- CA 94583 Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100'x' day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (govt. Code§911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building,651 Pine Street,Martinez,CA 94553. C. If Claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity,separate claims must be filed against each public entity. F. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RF: Claim by ) Reserved for Clerk's Filing Stamp Y If 4o � Against the County of Contra Costa ii or District) (Fill in Name) .------...,. The undersigned claimant hereby makes claim against the County of Contra Costa or the above named District in the sunt.of S and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact Date and.Hour L -- K: , ----------------------- _ --_-..---_-----____-------__---_--__--_------_-- __-_-- 2. Where slid the damage or injury occur? ;Include city and County) - 3. How did the damage or injury occur? (Gfiat t details;use extra paper If required)_____________________®___ -----------------------------------------------------------------'-� = ,fd€ a -_ 4. What particular act or omission on the part of county or district officers, servants, or employeesiAused the injury or damage? , s (Over) rl:0;,CAI,It ORN£A TRAI•I'IC COLLISION REPORT SI I t#A,i()ND!T(ONS No IN) H kR FEL CITY );°DICIAL DISTRWT NUMBER 0 ( j tj- INCORPORATED WALNUT CREEK No KILL H&R MISO COUNTY LAST BEAT 2-09 0 1 CCNTRA COSTA x.10 C*Sears: 08HDl4XL t'OLLISION(WCURREDON: MO DAY YEAR T£MEO400) NCIC a OFFICER I.D. (t BOLLTNGER CANYON RD. S/B 102102199 1600 19390 x}14881 t' ---- A 1 MILEPOST INF.}RMATIC)N: DAY OF WEEK TOW AWAY 'PHOTOGRAPHS BY: T £ TU'ESDAY st I YES Pq NO O N I; AT INTERSECTION WITH: STATE HWY REL OR: 1 . 4 mile (s) S of CROW _CANYON RD. DO YES f I NO 14 NONE :PARTY I DRIVER'S LICENSE NUMBER STATE CLASS SAFETY vEH YR MAKElMODEEL/C'OLOR LICENSE NUMBER STATE' 1 ; B8234411 CA C C 95 HONDA CIVTC BLACK 4BZV430 CA DRIVER NAME(FIRS—,,MIDDLE.LAST) _ Ebk CASEY ADAM PRATT ;OWNER'S NAME SAME AS DRIVER 9 PEDES- STREET ADDRESS {v TITR Kt� S 320 TOPEKA PL. OWNER'S ADDRESS #a: SAME AS DRIVER PARKED E CITY/STATE/Z±P VEk L DANV T LLE CA 9 4 5 2 6 DISPO OF VEHICLE ON ORDERS OF: [ J � � OFFICER IQ DRIVER � OTHER BICY-- SEX I HAIR I EYES s HEIGHT WEI�O _ BIRTHDATE RACE DRIVEN AWAY € CLISI M BItN BLU 5"0 9 1 V 812 9 1 82 PRIOR MECPANICAL DEFEM: NONE APPARENT PQ REFER TO NARRATIVE i OTHER t HOME PHONE BUSINESS P14ONE VEHICLE IDENTIFICATION NUMBER: 1 (9 2 5) 831-0902 t ) NONE CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER VEHICLE TYPE !�I UNK ��NONE L I MINOR � MERCURY AP 0 318 5 0 2 9 1 01 � f[�MOD. MAJOR []ROLL-OVER ( I DIR T RV ON STREET OR HIGHWAY SPEED LIMIT CA DOT ( ..... 1 N BOLLINGER CANYON 45 CAL-T TCP/PSC MC/Mx WARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY VEH YR MAKE.'MODELICOLOR LICENSE NUMBER STAT E 2 S0309570 CA A C 95y CMC P/U, WHILE �E 005440 CA1 DRIVER NAME(FIRST.MIDDLE,LAS") y p ROD EY TAYLOR HOLLAND OWNER'S NAME �� SAME AS DRIVER 1 PEDES- STREET ADDRESS COUNTY, CONTRA COSTA t S TR#A i 355 W I LLOWCREEK LN. OWNER'S ADDRESS J SAME AS DRIVER PARKED C.iTYISTATE/ZIP 2467 WATER BIRD WAY, 7 / VE{tj MARTINEZ CA 94553 DISPOOFVEHICLE ONORDERS OF: OFFICER DRIVER ]OTHER s J(� I4Y- :SEX HAIR EYES HE'GHT WEIGHT $IRT?DATE RACE DRIVEN AWAY CL s ! M BRN C N 6—0 0 18 5 1 0 2 2 4 PRIOR MECHANICAL DEFECTS: NONE APPARENT REFER TO NARRATIVE OTHER HOME P40NE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER: // I t 9 c2.5) 228-3392 (9 2 5) 313-7041 CHP USE ONLY ! DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA f VEHICLE TYPE INSURANCE CARRIER POLICY NUMBER UNK NONE i MINOR I ? C'o:1'rA COSTA COUNTY SELF INSURED 22 MOD.� �MAJOR � �ROLL-OVER 1 DSR TRY I ON STREET OR HIC,IiWAY SPEED LIMIT CA DC77' S s BOLLINC.ER CANYON 45 CAL-T TCP/PSC MC/MX PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFE 3 Y i VEH YR — MAKE/'MODEL/COLOR LICENSE NUMBER STATE 3 i . . . . . . . . . , . .CHRIS SNA LE . . . . . . . . DRIVER 7 NAME(F!RST.MIDDLE.LAS,, J OWNER'S NAME SAME q§Y' PEDES- STREET ADDRESS locig TR;F OWNER'S ADDRESS SAME AS DtVER I PARKED ..ITYIST'ATEIZIP [ t "O"�L LAIMS S DISPO OFVEHICLE t)N ORDERS OF: OFFICER I i DRIVER � �:}THFR i B - SEX =liAlll EYES HEIGHT W'EIGHTI BI HC4tEM iV! RACE PRIOR MECHANICAL DEFECTS: NONE APPARENT REFER TO NARRAT'rYE -- OTHER HOME P40NE .;NESS PHONE VEHICLE!DcNTIFICAT±<)N NUkIBER: I� 3 ! CHP USE ONLY 1 DESCRIBE,VEHICLE DAMAGE SHADE IN DAMAGED AREA VEHICLE TYPE • p iNS11RANC'E CARRIER a` *IPLIC'!NUMBER 't J t I UNK [ J NONE f j MINOR t w € If I MOD.f 1 MA,OR f l ROLL-OVER � I 11)IR`rRV1 ON.,TRFETI)R.HIGHWAY SPEED LIME T CA DOT I CAL=1 TCP/?SC MClMX I'Rf_PARER'S NAM±i DISPATCH NOTIFIED REY S NAME DATER VIEW !WALLING, M 0.1 4 8 8 1. i Yea No N/A �eT /���y ---(�(� �e 0 9390 C1�488 -- i 0 i L t1I•'1I. it INAL;NN+ JS NT F"ifr�i(Ni%)) I NC'IC NUMBER CSf+wER I.D NUMBtU^q VG 99 j y r � 1 ) G 09 0WNE S NAME/ADDRESS f NOTIFIED PROPERTY i t j!DESCRH°TFON OF DAMAGE DAMAGE tE is SEATING POSITION SAFETY EQUIPMENT EJECTED FROM VEH tx'CtrPnNTS bIlC'IsIC'YC'LI:-HELMET -DRIVER A-NONE IN VEHICLE L,AIR BAG DEPLOYED C-NOT EJECTED _2:o 6-PASSENGERS B-UNKNOWN M-AIR BAG NOT DEPLOYED DRIVER 1-FULLY EJECTED 7-STA, -STA.WON.REAR j C-LAP BELT USED N-OTHER V-No 2-?ARTIALLY EJECTED 12 3 S-RR.Of C.TRK,OR VAN D-LAP BELT NOT USED P-NOT REQUIRED W-YES 3-6NKNOWN V-POSITION UNKNOWN I E-SHOULDER HARNESS USED 5 6 1 C)-OTHER i -S14OULDER HARNESS NOT USED CHILD RESTRAINT PASSENGER 0-LAP/SHOULDER HARNESS USED Q-IN VEHICLE USED X-NO 7 H-LAP/SHOULDER HARNESS NOT USED R-IN VEHICLE NOT USED Y-YES PASSIVE RESTRAINT USED S-IN VEHICLE USE UNKNOWN c K-PASSIVE RESTRAINT NOT USED T-IN VEHICLE IMPROPER USE U-NONE IN VEHICLE Cf EMS MARKED BELOW WHICH ARE FOLLOWED BY AN ASTERISK_ -)SHOULD BE EXPLAINED 3N THE NARRATIVE PRIMARY COLLISION FACTOR MOVEMENT PRECEDING LIST NUMBER 01 OF PARTY AT FAULT i TRAFFIC CONTROL DEVICES y 2 3 TYPE OF VEHICLE E COLLISION A VC SECTION VIOLATED: CITED g i A CONTROLS FUNC 10NING A PASSENGER CAR/STN.WON. t A STOPPED t T ! NO r B CONTROLS NC7C FUNCTIONING* ! B PASSENGER CAR W;TRAILER i X B PROCEEDING STRAIGHT RAGHT B OTHER IMPROPER DRIVING C CONTROLS OBSCURED C MOTORCYCLE 1 SCOOTER i C RAN OFF ROAD C OTHEPTHAN DR3VER* X D NO CONTROLSPRESENTIFACTOR D PICKUP ORPANELTRUCK D MAKING RIG14T TURN D UNKNOWN* ° E PICKUP/PAN£LTRK.WtTLR. E E MAKING LEFT TURN E FELL ASLEEP* TYPE OF COLLISION F TRUCK OR TRUCK TRACTOR I F MAKING U TURN i_ A HEAD-ON G TRK,/TRK,TRACTOR W(%R. 0 BACKING WEATHER(MARK I TO21TEMS) B SIDESWIPE H SCHOOL BUS I H SLOWING/STOPPING A CLEAR C REAR END I OTHER BUS i PASSING OTHER VEHICLE B CLOUDY D BROADSIDE ( t J EMERGENCY VEHICLE t J CHANGING LANES E ; C RAINING E :IIT OBJECT � E K HWY.CONST.EQUIPMENT lK PARKING MANEUVER D SNOWING F OVERTURNED L BICYCLE j X IL ENTEPINGT.RAFFIC E FOG/VISIBILITY: G VEHICLE I PEDESTRIAN M OTHER VEHICLE t M OTHER UNSAFE TURNING �F OTHER*: H OTHER*: N PEDESTRIAN N XING INTO OPPOSING LANE E G WIND ! MOTOR VEHICLE INVOLVED WITH 0 MOPED O PARKED I LIGWnNG A NON-COLLISION P MERGING A DAYLIGHT B PEDESTRIAN j I ! OTHER ASSOCIATED FACTOR is ! Q TRAVELING WRONG WAY B DUSK DAWN X C OTHER MOTOR VEHICLE J- 's 2 i 3 MARK I TO 2 ITEMS E R OTHER': C DARK-STREET LIGHTS D MOTOR VEH ON OTHER ROADWAY !A VC SECTION VIOLATION:CITE D DARK-NO STREET LIGHTS ;: E PARKED MOTOR VEHICLE I ;E DAR_SC-STREET LIGHTS NOT FUNCTION F TRAIN B VC SECTION VIOLATION:CITE ^� -- i ROADWAY SURFACE i G BIC YC E ; SOBRIETY-DRUG PHYSICAL X A DRY H ANIMAL: I C VC SECTION VIOLATION:CITE( 1 Z 3 ;MARK I TO2ITE MS)_ B WET Ix A HAD NOT BEEN DRINKING C SNOWY-ICY 1 FIXED OBJECT: E VIS,OBSCURED: 1B HBD-UNDER INFLUENCE 'r D SLIPPERY{tehUDDY.4iLY.E'C.) F INATTENTION' IC HBA D—NOT UNDER INFLUENCE E; _ ;J OTHER OBJECT: G STOP do GO TRAFFIC D HBD-IMPAIRMENT`UNK.' i ✓ROADWAY CONDITIONS I __------------------+ MARK I TO 2 ITEMS i PEDESTRIAN'S ACTIONSH ENTERING 1 LEAYENG RAMP E UNDER DRUG INFLUENCE* A HOLES,DEEP RUTS* -�� X 'A NO PEDESTRIAN INVOLVED�s 1�' E 1 PREVIOUS CO LWON F IMPAIRMENT-PHYSICAL* B LOOSE MATERIAL ON RDWY* B CROSSING 1N XWALKANTERSECTION I, j ! iJ UNFAMILIAR WITH ROAD E G IMPAIRMENT NOT KNOWN E C OBSTRUCTION ON ROADWAY* C CROSSING IN XWALK NOT AT K DEFECTIVE VEH,EQUIP.:CITE j ! H NOT APPLICABLE INTERSECTION D CONSTRUCTION-REPAIR ZONE E j S SLEEPY/FATIGUED $ i E REDUCED ROADWAY WIDTH ? J CROSSING NOT!N CROSSWALK L UN?NVOLVED VEHICLE SPECIAL INFORMATION E F FLOODED* i ?E IN ROAD,INCLUDES SHOULDER ) M OTHER*: A HAZARDOUS MATERIAL G OTHER*: — ! F NOT IN ROAD X X N NONE APPARENT B SEATBELT FAILURE X HNO UNUSUAL CONDiT;ONS G APPROACHING/LEAVING SCHOOL BUS, O RUNAWAY VEHICLE SKETCH A—L L E P7 !MISCELLANEOUS i CLAt'IUI �..__,.. CII i ti I'_i!'E OF CALIFORNIA INJURED/BVI`INESSESIPA.S►.SENGE'RS UA OF<'C LLESI<}N TIME( 4(K)Y [NCICNUMIIER OFFICER t.D. NUMBER02 — 99 , 1600 9390 a 014881 209 S'r EXTENT OF INJURY('X' ONE) INJURED WAS ('X' [INE} ' WITNLSS PASSEN4ER ma, 3 SEX PARTY tiEA" :SAFETY EJECTED ONLY ONLY FATAL SEVERE OTHER VISIBLE COMPLAINT � NUMBER NIS, EQUIP. ! Q lNJFiRY INJtfRY INJURY OF PAdNDRIVER PASS. PED. BIKE t OTHER 1 3 G NAME/D.O.B./ADDRESS TELEPHONE SARAH MICHELLE MORRISON 01-23-82 H-1976 SAINT GEORGE RD. , DANVI SLE, CA, 94526 {928} 735-8558 (INIGRFD ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES: f VICTIM OF VIOLENT CRIME NOTIFIED f ' t NAME/D.O.B.IADDRESS TELEPHONE i {INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES: t I VICTIM OF VIOLENT CRIME NOTIFIED 9 C NAME/D.O.B.IADDRESS TELEPHONE i :(INJURED ONLY)TRANSPORTED BY: TAKEN TO: i i 2DESCRIBE INJURIES: VICTIM OF VIOLENT CRIME NOTIFIED I. INAME/D.O.B./ADDRESS TELEPHONE i = s i (?NJUREWNLY)TRANSPORTED BY: TAKEN TO: yt DESCRIBE INJURIES: 3 VICTIM OF VIOLENT CRIME NOTIFIED 9 I f = {NAME/D.O.B./ADDRESS TELEPHONE 7 i (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES: VICTIM OF VIOLENT CRIME NOTIFIED PREPARER'S NAME — — I LD NUMBERMO. DAY YR. REVIEWER'S NAME MO. DAY YR, WALLING M 0-4881 02902-99 ' STATE OF CALIFORNIA ENTAL �f DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 02/02/99 1600 9390 014881 2-09 N SKETCH W E (Nast To Scale) BOLLINGER CANYON FAD CROW CANYON RD. I Double Yellow Lines V-2 i V_, Sold White Line Solid White Line Road Edge Road Edge Dirt shoulder # lie 0/0 �-- Dirt Shoulder Dirt Should 12'0" ;2'0" 1 U T PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE M WALLING 014881 02/02/99 STATE OF CALIFORNIA J Ca ..".ATC or INCIDENT of- TIME NCIC NUMBER OFFICER E.D. NUMBFR 02/02/99 t 640 93901 014881 2-09 1 NOTIFICATION: 2 3 € was dispatched to a property only collision call at 1629 hours. I responded from SIB Camino 4 Tassajara S/of Highland Rd. and arrived at the scene of the collision at approximately 1652 5 hours. All measurements, times and speeds are approximate. All measurements were taken by 6 estimation. 7 (� 'gyp!.{yam 8 STATEII�� E •'TS: 9 10 Party 41 (Pratt3. related to me at the collision scene that he was driving his vehicle (Honda)N/B 11 Bollinger Canyon Rd. at approximately 45-50 MPH. Party#1 stated as he was driving around.a 12 right hand curve in the road,when he observed a white PCU corning toward him in his large. P-1 13 stated he applied his brakes in an attempt to stop before colliding with the P'U. P-1 stated he 14 was unable to stop before the front right area of his vehicle collided with the front middle 15 bumper of the P/Li. 16 17 Party #2 (Holland): related to me at the collision scene that he was driving his vehicle (GMQ 18 S/B Bollinger Canyon Rd. P-2 stated he was stopped on the left shoulder of S/B Bollinger 19 Canyon Rd. when he entered the N/B lame at approximately 5 MPH en-route to the SIB lane. P-2 20 stated he was in the N/B lame when he observed a black vehicle traveling N/B come around a 21- curve directly in front of him. P-2 stated he applied his brakes and stopped in the NB lane and 22 watched as the black vehicle skidded into the front of his P/J. 23 24 25 SUMMARY: 26 27 Party#1 Pratt was driving V-1 N/B Bollinger Canyon Rd. at approximately 4.5-50 MPH. Party 28 #2 Holland was driving V-2 S/B Bollinger Canyon Rd. in the N/B lane at approximately 5 MPH. 29 Party#2 Holland entered the N/B lane at a curve in the road. Party #1 Pratt came around the 30 curve and observers Vat directly in front of him in the NB lane. P-I applied his brakes in an 31 attempt to stop, and left approximately 103' of locked wheel skid makes in the roadway. The 31 skid marks were completely within the NIB lane. The front right of V-I collided with the front 33 middle bumper area of V-2. V-I sustained major damage to the front bumper, fender and light 34 assembly. V-2 sustained minor damage consisting of dents and scratches to the front bumper 35 area. 36 37 38 39 40 PREPAREWS NAME I.D.NUMBER DATE REVIEWER'S NAME DATE M WALLING 014881 42/42/99 ST ATE OF CALIFORNIA DATE OF 1'NCICDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 02/02/99 , 1600 9390 014881 2-09 1 AREA OF IMPACT (AOI). 3 The A01 was determined by statements, physical evidence and damage to the involved vehicles. 4 5 AOI ##1 - 1.4 miles N/of the north roadway edge prolongation of W/B Crow Canyon Rd. and 6' 6 W/of the east roadway edge of N/B Bollinger Canyon Rd. 7 8 9 CAUSE: 10 I l Party##2 (Holland) caused this collision by driving on the left side of the roadway at a curve, 12 creating a hazard. The cause was established by statements,physical evidence and damage to the 13 involved vehicles. PREPARER'S NAME LD.NUMBER DATE REVIEWER'S NAME DATE M WALLING 014881 02/02/99 Office of the County Counsel Contra Cosh County 651 Pine Street, 9th Floor _. icsne; 335-1800 Martinez, CA 94553 fax: 646-1078 E t5 � Date: February 24, 1999 To: Ann Cervel#i, Clerk of the Board From: Victor J. Westman, County Counsel - y: Gregory C. Harvey, Assistant County Counsel Sub, : Claim of Creta Banks Please handle the attached claim which was apparently served in error on the Risk Management Department in error in the normal course. H:64A,COOP\GROUPS1TORnCRSES1FORMSW.SMOWV -M-STNO.WPD CONFIDENTIAL ATTORNEY CLIENT COMMUNICATION WALKUP, MELODIA, KELLY & ECHEVERRIA 650 California Street, 26``}' Floor San.Francisco, CA 94108 (415) 981-7210 Attorneys for Claimants CLAIM FOR DAMAGES AGAINST THE COUNTY OF CONTRA COSTA TO: COUNTY OF CONTRA COSTA Risk Management 2530 Arnold Drive, Suite 140 Martinez, CA 94533 The following claim for damages is hereby made by and on behalf of Greta Banks, Amandria Banks, a minor,by and through her Guardian ad Litem, Greta Banks, Troylin Lavon Banks, a minor, by and through his Guardian ad Litem, Greta Banks, against you, and each of you, the particulars of the claim being as follows: A. NAME AND ADDRESS OF CLAIMANTS: Greta Banks Amandria Banks Troylin Lavon Banks 4445 Fall Lane Oakley, CA 94561 B. ADDRESS TO WHICH NOTICES ARE TO BE SENT: Richard H. Schoenberger Walkup, Melodia, Kelly & Echeverria 650 California Street, 26th Floor San Francisco, CA 94108 C. DATE, PLACE AND OTHER CIRCUMSTANCES WHICH GIVE RISE TO THE CLAIM: The accident which is the subject of this claim occurred on or about August 27, 1998 in the early evening hours at a certain property known as 1938 Taylor Road, a floating pontoon-type dock with five berths. Said property is located on Bethel Island in the County of Contra Costa. Page 2 At all times herein mentioned, the property known as 1938 Taylor Road, including the floating pontoon-type dock with five berths was owned, operated, maintained, controlled, supervised, repaired,planned, designed and inspected by the County of Contra Costa, including but not limited to the power transmission lines and power sources at 1938 Taylor Road, as well as all electrical lines, out lines, outlets and wiring at 1938 Taylor Road,Bethel Island, County of Contra Costa. The County of Contra Costa negligently and carelessly planned, designed, constructed, supervised the construction of, operated,maintained,repaired, supervised, controlled, owned, operated and inspected the conductors, outlets, distribution system parts and component parts of said electrical lines, outlets and wirings and power transmission lines and power sources at 1938 Taylor Road, Bethel Island, County of Contra Costa, State of California. Other dangerous conditions at the site included open/unprotected conductors, outlets that were not weather proofed, distribution system parts which were missing,broken and damaged components, control devices higher than six foot, six inches above the working surface and a lack of clear working space about equipment. As a direct and proximate result of said negligence and carelessness and of the dangerous, defective, deceptive condition of said property, Lavon Banks,who was swimming on and near the aforementioned property,was electrocuted and suffered fatal injuries. The County had notice and knowledge of said dangerous, defective, deceptive condition of said electrical equipment for a sufficient period of time prior to the accident hereinabove described to have taken measurements against the condition,but the defendants, and each of them, carelessly and negligently failed to properly and adequately warn users of said condition, carelessly and negligently failed to provide adequate supervision and inspection of said property and negligently failed to provide adequate and proper safety devices and/or insulation around said hazards. Said dangerous, defective and deceptive condition of said property was created by negligence and careless conduct of employees and agents of the County of Contra Costa, while acting within the course and scope of their employment and agency and said dangerous, defective and deceptive condition was actually and constructively known to exist by employees and agents of the County of Contra Costa prior to the date of this accident. Page 3 D. DESCRIPTION OF INJURIES AND DAMAGES: As a direct and proximate result of the matters above and hereinafter set forth, claimants have been permanently deprived of the care, comfort, love, companionship, society, services, affection, instruction, advice, training, guidance, protection, counsel, support(both economic and non-economic) and contributions of their husband and father, all to their damage according to proof and in an amount in excess of the jurisdictional limits of this court. In addition, claimants have incurred certain funeral and burial expenses, the exact amount of which is presently unascertained,but said amount will be inserted herein by amendment when the same is finally determined. E. EMPLOYEES CAUSING INJURY AND DAMAGES: Claimants do not know at the present time the names of the agents, servants and employees of the County of Contra costa who contributed to said injury and damages. F. AMOUNT CLAIMED: Claimants claim damages in excess of$10,000. The appropriate court of jurisdiction is San Francisco or Contra Costa County. WALKUP, MELODIA, KELLY & ECHEVERRIA DATED: February 23, 1999 RICHAR)H. SCHOENBERGER Attorney fClaimants o . v CIAIM WMD Arm ?arc 23, 1999 Claim Against the County, or District Governed by # ° the Board of Si4ervisors, Routing Endorsements, ) F1 >. NOTICE TO CLAIMANT and Board Action. All Section references are to z.. x. the copy of tWs dot ment mailed to you is your Califorria Government Codes. "-N �'` otice of the action'taken on your claim by the Board of Supervisors. (Paragraph 1V below), given pursuant to Government Ocie Section 913 anti 815.4. pease noteall "Warnings". AMOUNT: T Excess of $25,000.00 Superior Court Jurisdictional limit, according to proof. CLAIMANT: Kefali Hailu ATTORNEY: Paul D. Hiles DATE RECEIVED: February 24, 1999 .Attorney at Law ADDRESS: Schwartz, Silber & Hiles BY DELIVERY TO CLERK ON: February 24, 1999 540 Lennon Lane, Ste. 250 Walnut Creek, CA 94598 BY MAIL, POSTMARKED: Hand-deI i vexed L FRONL Clerk of the Board of Supervisors M County Counsel Attached is a copy of the above-noted claim. PHIL BATCHELOR, Clerk Dated:— February 24, 1999 By: Deputy ` , , D. FROM: County Counsel TO: Clerk of the Board of Supervisor QThis 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 clays (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 °fight to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated:_ Zb By: Deputy County Counsel s _ s , III. 1FROn- Clerk of the Board TO: G��tity 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:&- ' PHIL BATCHELOR, Clerk, By ` , Deputy Clerk WARNING (Gov. code sectio 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 145.6. 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 AIAILLNG 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&k&llx c2 ,'—M9By: PHIL BATCHELOR By Deputy Clerk CC: County Counsel County Administrator Paul D. Hiles, Esq. SCHWARTZ, SILBER & HILES 540 Lennon Lane, Suite 250 Walnut Creek, CA 94598 RECE Telephone: (925) 932-4314 U Attorney for Claimant 4 IlOwn A4 CO"A CO to . CLAIM AGAINST CONTRA COSTA COUNTY The undersigned hereby presents the following claim against Contra Costa County, 651 Pine Street, Martinez, California. Name of Claimant: Kefali Hailu Address and telephone number of Claimants 188 Peppertree Way, Pittsburg, California 94565, telephone number (925', 439- 7438 Send Notices to: Schwartz, Silber & Hiles 540 Lennon Lane, Suite 250 Walnut Creek, CA 94598 Date of the Accident: August 27, 1998 Place of the Accident: At the intersection of Golf Club Road and Stubbs Road in the City of Pleasant dill, Contra Costa, County, Calmfornza General Description of the Accidents Claimant, while crossing Golf Club Road at the uncontrolled intersection with Stubbs Road, was struck by a. motor vehicle proceeding westbound on Golf Club Road, sustaining severe personal injuries. Act or Omission on the part of Public Employees that Resulted in the Creation of a Dangerous Condition Causing Claimant' s Injuries: Failure to provide a safe access to and from the parking lets adjacent to Golf Club Road to persons attending classes at Diablo Valley College, knowing that large volumes of students would be attempting to cross this intersection in conflict with vehicular traffic. Names, if known, of any Public Employees Causing the Injury or Loss: Uncertain at this time, but claimant reserves the right to assert the correct nares of the public employees involved, when ascertained. Names and Address of Witnesses: Man Wingate, 3280 Withers Avenue, Lafayette, California 94549; Stacy Squires, 1441 Creekside give, Walnut Creek, California; Ivy Mettner, 3725 A Northwood give, Concord., California; Anthony Loera, 900 Roanoche Drive, Martinez, California; Phomas Greenlaw, 2740 Waltrip Lane, Concord, California. Names and Address of Doctors and Hospitals Where Treated: John Muir Medica' Center, 1601 Ignacio Valley Ewan, Walnut Creek, California 94598; Kaiser Hospital Walnut Creek, 1,425 S . Main Street, Walnut Creek, California 94596; Raiser Hospital Martinez, 200 Muir Road, Martinez, CA 94553 ; Kaiser Hospital Antioch, 3400 Delta Fair Blvd. , Antioch, CA 94509; Cardiology .Associates, 1515 Yanacio Valley Road, Suite J, Walnut Creek, California. 94598; Dr. John Gunderson, Centers for 0ccupat4onal Medicine, 223 . Galaxy Court, Concord, California 94520 . General Description of the injuries and Damages Suffered: Multiple fractures including but not limited to, left hip fracture, left femur fracture, ligament tears of right knee, concussion, internal bleeding, and other possible Injuries which will be more fully documented at a later date. Total Amount Claimed: Total damages are unknown at this time, however, they include, but are not limited to, general damages for pain, suffering and disfigurement, past medical expenses known to be in excess of $60, 000 and continuing, future medical expenses in an amount unknown to claimant, as well as damages for lost income and loss of future earning capacity according to proof, all to claimant ' s damage in an amount in excess of the minimum jurisdictional limit of the Superior Court, i.e. , in excess of $25, 000, according to proof . Description of Property Damage: Damage to clothing in an amount according to proof. This is not a claim for indemnity. Is DATED: February 23, 1999 'AUL D. LES Attorney for Claimant CLAIM BOARD QE SUEMSMS QE CMIRA, COSMxA {1RD ACTtt t March 23, 1999 Claim Against the County, or District Governed by } the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to The copy of tlis document railed to you is your California Government Codes. } notice of the action taken on your claim by the Board of Supervisors. (Paragraph 1V below), given pursuant to Government Code Section 913 and 915.4. Please noteall "Warnings". AMOUNT:. $150,175.00 MARCLAIMA'3T: Walter L. Laniel s`€ A , ATTORNEY: DATE RECEIVED: February 24, 1999 ADDRESS: #4 Simo Street BY DELIVERY TO CLERK ON.- February 24, 1999 Alamo, CA 94507 BY MAIL POSTMARKED: Interoffice A. FRONt Clerk of the Board of Supervisors TQ: County Counsel Attached is a copy of the above-noted claim. PHIL BAS OR, Clerk Dated: February 25, 1999 By: Deputy ` p IL FROIN1 County Counsel TO: Clerk of the Board of Supervi rs This claire 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: A ounty Counsel s 301 FROM Clerk of the Board 70. o ty Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with noti a 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: ;43. PML BATCBELOR, Clerk, By 96m, Deputy Clerk WARNING (Gov. code section 13) 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: Nf� By: PHIL BATCHELOR By QDeputy Clerk CC: County Counsel County Administrator Office of the County Counsel to Contra Costa County 651 Pine Street, 9th door Phone: 335-1800 Martinez, CA 94553 Pax: 646-1078 FEB 4 ®ata: February 23, 1999 To: Ken Torre, Executive Officer of the Contra Costa Superior Court From: Victor J. Westman, County Counsel by: Gregory C. Harvey, Assistant County Counsel.. Sub}: Materials and claim of Walter Laniel This will reply to your memorandum to Mary Ann Mason dated February 16, 1999. By copy of this letter, I will refer the materials received from Mr. Lanielto the Clerk of the Board of Supervisors to be treated as a formal claim and send a copy of the materials to Risk Management for their investigation and follow up. cc: Ann Cervelli, Clerk of the Board Ron Harvey, Assistant Risk Manager Bcc: Ann Cervelli — Please treat the documents attached to Ken Torre's Memo as a claim. Thanks. H:IGROUPS\TORTICAS=S\FORMSIk4EMO MEM-STND.WPO CONFIDENTIAL ATTORNEY CLIENT COMMUNICATION QCff SUPERIOR COURT OF CALIFORNIA County of Contra Costa 649 Merin Street, Room 108 - Martinez, California 94653 DATE; February 15, 1999 t� TO: Ma n Mason FROM: Ken Torre, Executive Officer SUBJECT: Citation I ern forwarding the attached correspondence for your review. Please contact.rrie after your review with questions that you will have. Thank you, Olt 'o )f4. s/l.,fi"� ,�#{ 3, v.a•.;..m" t, 't'"' t aff� as F 'jF` 7777 'e,` ,,x a �(�";� "alb n 7� f ,�,�.•§.�i' t �`�"" ;. ,a,,.,a"""�i.a�«'li..,..k lw^•�...z'..,,...;;.....f ,^7�'�.X.�l+�i.=,: ^""^�,:�.,�.�.;.t...s... w .:.':�-..,..Q.:.��r.�;�v. ,a,,,F��•��3 a at T-fi�,,i s� 0.1"_.`' ",� '""�'`mi it�'�"+"„' _ ✓'3Me�" ""' _'. #7�s�"`, }�8 .'s3irt� ;. ��#�'�T`4�ke, ►��j zF.4�>iJ WON;#1=t•T" ,*#,3',rs telt+r���x-ITL: .e,��'X�; '"T"��`tr��"•• - -"� °r:l� '§�+�71`�`�'�?'€z � k r�d.T F�,�7T V.. 7 7- -rt .,.,.+'.xF. �n•YT`.�.nx^2 T>xFS,gnT' 9F�+*n i�vn- _ � =J � �, €F:. .a fi ••,�,,,n.,;''��z�rvsa^c..^,^�,.. x z..h.,a�f3.7' ....���:A a ?acts .i t� ` ?r z`. «• 14 1 r a a "F '7lt `r`, �'zt ` .r i!ti -i-^x J■i t_- �Vit. r • � w ,r ry ■ +sem WALNUT CIRIEK DANTILLE ,IUD DIST. WAD=- CREEK CA. 94596--tin LAD ML.-.LA.NIE WALT.ER lW,',SVW STREET Air CA 94507 I A•IM-,HONESTIJAW. ABn TAX ,FAYING' CITIZEN CE.:fiHEST .',UNITED' N N}:Tf�;:'UNIT`E`D STATES. CF .AMERICA: . Aft SICK A14I3.;TIR�'I7. ,'itt' IVAID-TAX-BURDENS CO1 AW HCRASSiENT "AND` , OEESSARVA$M� Ems' A l } Y FELLOW CITIZENS o f �'�`� �£. �� y y]1yf �� q�P 1 yyyy■Y} M yI yW � KM 'S ASS THE r. a . AT :CYEEA3I� ''THELTCu' `CASEA#�3 DESIS7I FROM � tS T�SaAItY �iA aS } : A? 7 S iSE 0� �4JHICH::.T Y :SIRE +AMOm; �H S `T"O.lRECIEl THE CCI I TIMI C` WHICH^`'I A-K'DEIAANt?I FRDM YOU SERV NDS Ili LkE AlqD WrrHOt,M ONE HUMPED AND F.IFT�'DOLLARS $150' GO-,- malle � %M�C.LQSED A�7RES3 AND CITTIMI'l 1" THIS STkTE AND COU=o ?IQa5.0 '^^ -- t � . 17..DG `)dj S M ., LAN-ML LA tR?WA[ n C �+ tis �n Asa A Ail• I=EIY ( HE #.� 1J ST.7% .�ES C A i•L^RLi ICA syl(1 T2My . Z �"l�L+�r�r2°�-..Y�.T nom'..� j 's''f+>7�', u '�-LT �� �tL���s eritY '.`1,i� ?..1, 'B.' I:bE v,AT� •a."l i11:". .Lm. Y.4..frTFl-7vm.E �"�LJ��.uF�.s ,..�J, r1'\' `�TS MS TiE S:L CNS .; "a L CCL 20TE`D MCNf 'f TISE-P �Y `IE �CL-Mv a m 0 1 t F.� i 1i"''' T'' 1�'P LJ 't'`• �}+ ?std!-' r. .,+r +a VT?' rA ry J V"^::�'T': t' " a.-_®.,.4C' 5=1 d.. 3-. � WHITE, 1M, 3LM o . Ly -:PER�"�"t:i: �E4 c �^-t'S.; TO 3c • _o r3 i 7 9 TONIGHT, ON THIS I AT AP. 01,00 HRS AS I WALKED IN TOEN WALNUr' CREEX ALL ALONE AND FCR NZ AEPARENZ RESASON WAS FOLLCWD BE AND Fat NCS ftasw AFFARE {WAS gUESTIONED RT AR POLICE OFFICER-$ WAS ILIE;ALL'S DETAIMI) WAS ILLEGAL =LOATED BIE Hl I SIiCAIL SEAMS Cr M`i PERSON FOR NO APEKHENZ'REASON AND WAS INSULTED, AILD SUaJECTED TO, P ICAL ABUSE BY,TIM P C� LICE CFFTCER, WHIIX "IWC#. 01MIR OFFICERS LOOM ON. THE POLICE: OFFICER BEIIG UP=S BECAUSE THAT'.. DID tC' r HAVE.,,AXD DRI MRS-Lis CENSE IN MY WALT .'a DIED Mr WA= OUr_ CF MY` HAND IN AND AM,< ESSIVE AND V'IOLENr• ATTACHED TO M AXSTS : ' ANi? LEA' R Y CP2D� , ' 41 -r' `" .+5, c.,4 "Aa , 7r: .xrw i" y .x•-S .n .a".:�. ie` T-." "F'' cY HAT P 'fRWARD TOWARDS TIS OFFICER� I: AT THIS TIS AND D ULStRIN�" fiHIS y R . rEI�TZRL'' I ICTDE I AIT "tom COMPMURE AM -DEFE:MM Vj, SES THROUGH i+T.CO .. ;. ' NSTI'IUIONAE RIS FREEDOM CF SlEECFJ. I STATED THAT THE CF IUER AND CFFMER s HAD NC1. PR O&ALBLE CAUSE 79 HAVE STOPPED ME TC BEGIN WITS ACC msED M CF JIAT WALKI= OF WHA r DENSER. THE CFEMERS DIDIM HAVE A1�'HIM ELSE T(Y Do C CHER THAN T O-AIEML' TC7' HUP=LkTE ME THE TAX PAYER AIM PROVIDERS CF' THEIR PAS e"HF.C:" , AFTERS AID UMC~ESARIL)t LENGTHY:' PERIM CF TIM Cp HICK I- WAS s� SUWE=M TG MM Pl€YSZC'AL ABUSE AND ABUSIVE AND SLANEROUS QUESTIONS CONC:E ERKING MY CHARACTEH', AND THR.EATENI= TO`TAM ME TO ,TAIL FOR NO REASOHi FIrAL'P eRCf T FS 'AIT TICKET. FM AND CFFENS+' THAT' DID ID ITOr ACCUR AND AL"00 1� TO LEAVE, `FEP OFFICER WHom CITE? .''+ , wHEx t ASND TCR THEIR BUSINESS CARDS FM LnTE'R M.-TI NTIFICAT'WX DENIED IS THEIR BUSINES CARDS AND I`NSULTE'D �E FcR eSll7_ z w cR T T_R BUSINESS CARDS, IN WHAT I C'AN AONLY ASSUME dAS AN ATT�,'IVTT TC ti 12E TIE IDEI TIES FROM M, FCR STATING THAT IdAS AM GOIM TO rLiz AND SU?"_' :AGAIMS THEPF l C FCR THEIR ILLEGAL .tfffl UNLAWFUL DMkINM M, AM SEARCH CP DZ' SAYIT' C_4 MY PERSON, THE 07MER• ALSO STOOD TOO CLOSE TO rE Ai) SPDXE TO f�"Q in .ijM M7M;� THAT L COULD LNLr DESCRI IBL+ kS AM ACT CT HOMOSEXUALITT CIT .4FICH T DINT 3ELM* CH PARTAKE INrR.�TIff v�ONSTITUONAL RIG-HTS ` an ClzfRLY `ICLi'�D :�s, 1 ::t'�. !A M `O Q�BE5 �". CYTlc}}x��iT�.:a t�L7:�1YY:t�,D AND �F CR ✓t ISC IP`Lti(A.R ACTION 'j O �±� TAM '?C;:.F 7ST 7'-7.,S* THESE OFFICERS COMM M— 3) AND OFFENCE AGAMT AICD LAW AB-IDM CITIZEN OF THE EqUIT11ANT Iy. yy, OPIITOX' TO AND BREAKIMAND INTERI: ly AM BUSINESS WjrK I3rENTIOR' TO STEAD FROM THE PROPERM THESE TEREE OFFICERS AM' I CLEARLY STATED SO TO THEIR FACE, WERE ATTEM IM TO RE (TIflME ME INTO AND pH.YSICA'LLY: DEFEINSM, FCxSTURE AND TO DEFEND MY' SELF AGAINST THEN BY, ,., PHWMA STREN=H., IN CARDER FOR THEIR J USDIFICATION FOR WANMNG: TO TARE NE TO JAIL F-'CR'NO-A sPABEjM RESON CMM THAN TO JUSTE,,KXLL Tlfa, TGT.ALL tIXER'(RESSIONAL. BEHAVJjM AND TML TRSU TO AND RflMB'I TAX wHOX FR-SES THEM 12 T "' , 3 ,FI1;1Ai�G►IAI, 1.'Yf+� IHI Ti ADD a A� T 7G AND Ti FIND.; $�UiRDEMOM :Bi 1�D CR' TEIEII; yA OF, RES TFC r L s LA.RIE, WALTER' AN CI,fiI EII CF THS' UNITED STATES CF I WAS DETAMIED FCR AEX ONE KOM AND THIRTY MMRES i.ND S'UBJECTEDi TO THEIR ABUSE MY TIVE IS TALT ED AT ABX AM.. $1 0c,.00F AN HCM ALS I DElikM : CST° RESIEMMIT, To BE COMPENSATED FM T11-2ILL 214L, DETAIN&Nr CF M. T11NE AND FCR n IMTRUCTroK IN T LAW T O TSS FCLME Ct+'FIOEr�B '?iHC : nT TIE SdivE+� TIiZ WERE, TIU-! .�_„ IMM My' Fr,RWON T/dIs IT'PI .p,. F iAK /�tt !�' klm "IUSTl S!� TI.,T AM MUIFLY 3.cl)=T FM ,3� ABUSE t1 5 .00' aI�z`3 I IZE DA iiAP S"�+�TEs?A a Ht7�tI?R _,DTOLD• rI�:ASL MA?4E C Stiy"X rjUT' To MY" VA ME AND IAIL ';IT TI EN CF A MYEFRYCA v� LANIEL WALTER L COURTESY,NOTICE 4 SIMO ST ALAMO CA 94607-1055 BRING THIS NOTICE WHEN APPEARING - OR WITH RETURN PAYMENT DOCKET: W 644731-2 1 Cite. 30683325-6 Issued: 02/14/98 � W. Driv.Lic.: N6008730 CA DOB: 05/11/69 Veh.Lic.: CA Location: N MAIN/LA LASSIE "' You have been.dted.401th the following_violations: CVC 21955 -CROSS BETWEEN INTRSC { Clear this dit'.0 n on or before the due da#e of 03/17!98 by doing O o e follom g V ,, .. 2} A �peac In court at 8 iS'AM any Tuesday thmugh'friday except,holidays. lows - Ceck In at.the Clerks Office,; ; # NOTICE: You are not eligible for traffic school because this Is not a moving traffic citation. l i listed above au will be s Ell BAIL, ; SE SUSPENSIO REST f ASSESS erre collec ion agency. WALNUT CREEK/DANVILLE 9U0 DIST W 644731-2 1 PES BOX 5128 WALNUT CREEK CA 94596-1128 ai I Qom, tkk 54,9 , `t�s. 4 8802 1� , WALTER Awi`e'at GA" 94'567' t, 24 APR, -q. CUSTOMER'S ORDER NO. DEFT'. I DATEi NAME: HU=IIBkL G,GlM WALNIZ CREEK ADDRESS: 640;=MC IO, )/ALLEY R" +--STY,S`T"ATEP ZIP WALXW Cmxs CA� 94596, .. SOLD BY.. COD. Ck4ARCE ON ACCT. Elm. PAID OUT iF�F iFif r r r r 56'060-0OCID�g ROW a CREC CFi MMT ORDER Fly nLEGAAL,�'A wX: AM FMICAL.ABUSE CF le � PERBONj ANDC E PAZ Ull ME 70 TES SKIS Orr SKME i BPe { Q& HUNDRED AM F r INZ&HEST WILL BE =IPLIE QUA6RULX UNTIL PAYLM@Nr I RECEIV 20n AM 98, .r Ii IF it9F KEEP THIS COPY FOR YOUR REC^Rf]S � b rjP 1 i i MUNICIPAL COURT OF CALIFORNIA, COUNTY OF CONTRA COSTA WALNUT CREEK/DANVILLE .JUDICIAL DISTRICT 640 YGNACIO VALLEY ROAD, WALNUT CREEK, CA 94596 510-646-6572 } i THE PEOPLE OF THE STATE OF CALIFORNIA, DATE: 03/24/98 VS. i WALTER L. LANIEL DOCKET: W 644131-2 01 4 SIMO ST CITATION: 30 683325-5 ALAMO, CA 94507 NOTICE OF RETURNED CITATION/BAIL REQUEST WE ARE RETURNING,YOUR COURTESY NOTICE RECEIVED IN THIS OFFICE ON MARCH 23, 1998. IN RESPONSE TO YOUR LETTER, THE BAIL IN THIS MATTER IS $ 55.00 WHICH IS DUE ON OR BEFORE APRIL 17, 1998. IF YOU DO NOT PAY BAIL ON OR BEFORE THAT DUE DATE, YOU MUST APPEAR IN COURT BY CHECKING IN AT THE CLERK'S OFFICE AT 8:00 AM ANY TUESDAY THROUGH FRIDAY, ON OR BEFORE THE ABOVE DUE DATE. IF YOU FAIL TO CLEAR THIS CITATION BY THE DATE LISTED ABOVE YOU WILL BE SUBJECT TO INCREASED BAIL, DRIVER'S LICENSE SUSPENSION, ARREST AND/OR IMPOSITION OF A CIVIL ASSESSMENT UP TO $250.00 ANIS YOUR CASE REFERRED TO A COLLECTION AGENCY. PLEASE RETURN THIS FORM WITH YOUR REPLY. DO NOT SEND CASH. d a d i KEN TORRE CLERK OF THE COURTS BY: P BONNICI DEPUTY CLERK FORM: NORC',;. CLAE BAS. Q s11P.F.MtL RS of ANTRA TY* CAUFURNIA . BOARD ACTS March 23, 1999 Claim Against the County, or District Governed by } the Board of Supervisors, Routing Endorsements, NOTICE TO CLAIMANT and Board Action. All 'Section references are to } The copy of this document railed to you is your California Government Codes. I notice of the action taken on your claim by the Beard of Supervisors. (Paragraph IV below), given r 'x x pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: $500,000.00 CLAIMkNTT:M ria Lavin and Alfonso All )RNBY:Lw,7 Offices o'I Bruce O. Fagel DATE RECEIVED: February 24, 1999 445 So. Beverly give, Ste. 200 ADDRESS: Beverly Hills, OA 90212 BY DELIVERY TO CLERK ON: February 24, 1999 BY MAIL POSTMARKED: February 22, 1999 L Fi OIN1 Clerk of the Board of Supervisors Ta: County Counsel Attached is a copy of the above noted claim. PHIL B CHELOR, Clerk Dated: February 24, 1999 By: Deputy 12 II. FRONL- County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 914 and 910.2. ( ) This claire PAILS to comply substantially with Sections 910 and 914.2, 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). (/fhj(�� Usher. 1 I g -1k JEA rL _�� - . Dated: �By: Deputy County Counsel El FROft Clerk of the Board 1yC): ty Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). Its. BOARD ORDEE : 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: r "`41L , Z PHIL BATCHELOR, Clerk, By j,,-� , Deputy Clerk WARMING (Gov. code secti 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. AFFMAVIT OF MAIL G - 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: By: PHIL BATCHELOR By Deputy Clerk CC: County Counsel County .Administrator LAW OFFICES OF BRUCE. G. PAGEL Bruise G. Pagel, Esquire #103674 2 . 448 South Beverly Drive, Suite 200 # 3 Beverly 'Bills, CA 9021.E(31.0) 277-1288 (310) 277-0835 FAX r 4 # 5 ' Attorney for Plaintiff(s) 6 i1 7 i 8 CLAIM FCR DA14AGES AND PERSONAL INJURIES I 9 'i MARIA LAVIN and ALFONSO LAVIN, ) CLAIM FOR. DAMAGES FOR 10 # ) PERSONAL INJURIES Plaintiffs, } 11 # ) GOVERNMENT CODE VS. ) SECTION 310 12 : ) COUNTY CSP CONTRA COSTA a ) 13s subdivision of the State of ) California, dba as Merrithew ) 14 Memorial Hospital & Health Centers and Contra Costa ) 151. Regional Medical Center; and ) Richmond Health Center and ) 16 . DOES 1 through 50, inclusive, ) ) 17 Defendants----------- 18 :11 18 ;} i( TO THE COUNTY OF CONTRA COSTA, a subdivision of the State of 19 E California, doing business as Merrithew Memorial Hospital and Health 20 ! Centers and Contra Costa Regional Medical Center, and Richmond Health 21H 1 Center, and. to each of the above named entitles, individuals and 22 health care providers: 23 j! You are, hereby notified that MARIA LAVIN and ALFONSO LAVIN, i 24 .1 251 whose addresses are in care of their Attorney, Bruce G. Fagel, 445 South Beverly Drive, Beverly Hills, California., 90212 , claim damages i 26 1 I# from the above-mentioned entities and individuals in the amount, 271 28 i computed as of the date of the presentation of this claim in the I !! amount of $500,000. 00. # j3 1jl The claim is based on personal injuries of MARIA LAVIN due to � 2 ';; negligence on or about August 25, 1998, when defendants negligently 3 caused bodily injury to her, specifically causing the fetal demise i3 4of her unborn infant. 51i As a result of this negligence of the above named entities, 6 if physicians, medical staff and personnel of COUNTY OF CONTRA COSTA 71; whose names are presently unknown, MARIA LAVIN and ALFONSO LAVIN have jexperienced severe emotional distress. i 9 This claim is also based on failure to inform, lack, of informed j 10 ,,, consent, failure to warn and failure to adequately select the medical 11 staff and other employees, as well as to adequately review their � s 12 competence � � com etence and negligent failure to maintain, operate and manage the 13 premises and equipment at said. hospital. 1414i As a result of the fetal. demise, Claimants claim damages for f 15 '1 their infant's death and the loss of his comfort, support, society, 16 (` love, companionship, solace, moral support, affection, physical 17 assistance, and financial support and services, and funeral and last 18 ii medical and incidental expenses. 191 'WHEREFORE, Claimants claims damages against the respondents as 20 follows: 21 MA gI LAVIN: 22 ` General Damages: $250, 000. 00 1 I 23 Economic Damages: Presently unknown. 24 'r Funeral Expenses: Presently unknown. 251 Last Medical Expenses: Presently unknown. 26 ! ALFONSO LAPIN: 27General. damages: $250,000.00 C 28 'l Economic Damages: Presently unknown. IE i Funeral Expenses: Presently unknown. Y+ ti 2H Last Medical. Expenses: Presently unknown. 3I All notices or other communications with regard to this claim 4 should be sent to the claimants in care of their attorney. is 51� DATED: February 22, 1999 LAW OFFICES OF BRUCE G. PAGEL # 61 7 t 8i BY: '< I BRUCE G. L Attorney for Plaintiff(s) f ltd i(( 111 12 , 131 I $ k I 1.4 4 f 1 17 1.8 1.9 i 20 21 ;1 .f f+ 22 ' 23 1 24 251 27 ; 28 �f li -3- i i� I pp' p IIt PROOF OF SERVICE STATE OF CALIFORNIA } } 4 ;i COUNTY OF LOS ANGELES } 5 I am employed in the County of Los Angeles. I am over the age of eighteen years and not a party to the within action. My 'p business address is 445 South Beverly Drive, Suite 200, Beverly 7 1 Hills, California 90212 . i $ On February 22, 1999, I served the foregoing documents j described as CLAIM FOR DAMAGES AND PERSONAL INJURY, on the interested parties by placing a true and correct copy thereof 10 enclosed in a sealed envelope addressed as follows: �p See Attached Service List [x] (LIPS OVERNIGHT) . 1.2 [x) I deposited such envelope in the mail at Beverly Hills, 13 California. The envelope was mailed with postage thereon I fully prepaid. As follows: I am "readily familiar" with the 1411 firm's practice of collection and processing correspondence j for mailing. Under that practice it would be deposited with 1SP the U.S. Postal Service on that same day with postage thereon 16 fully prepaid at Beverly Hills, California in the ordinary I; course of business. I am aware that on motion of the party ;G served, service is presumed invalid if postal cancellation 17 ; date or postage meter date is more than one day after date of # ` 18 deposit for mailing in affidavit. �I ;! [ I delivered such envelope by hand to the offices of the 19addressee. 20 x (STATE) Y [ � ( A E} I declare under penalty of penury under the lags of p the State of California. that the above is true and correct. � 21 [ (FEDERAL) I declare that I am employed in the office of a 22 member of the bar of this court at whose direction the service was made. 23i Executed on February 22, 1999, at Beverly Hills, California. 24 ; 2 p r 26 E; �. f � an anchez 27 F; 28 i f� f i! S E E `4T I C E L I S T R 2 ; COUNTY CE CONTRA COSTA Board of Supervisors � 3 651 Pine Street, 1st Floor Martinez, CA 94553 4H MERRITHEW MEMORIAL HOSPITAL & HEALTH CENTERS j 5 ATTN: Risk Manager 2500 Alhambra. Avenue 6 ., Martinez, CA 94553 7 (" CONTRA COSTA REGIONAL MEDICAL CENTER S 1! ATTN: Risk Manager 2500 Alhambra Avenue 4 Martinez, CA 94553 RICHMOND MEDICAL CENTER 1011 ATTN: Administrator 111 100 38th Street Richmond, CA 121 13 13 f 14 ' 15 ' 16 X171,I IS r 20 f 21 � f 22 .1 23 24 ;i 25 2 6 ("} 27 28 i i e1 i C/, . CIAIM B IABD AGwi C1 t March. 23, 1999 Claim Against the County, or District Governed by ) the, Board of Supervisors, Routing Endorsements, NOTICE TO CLAIMANT and Lard Action. All Section references are to The copy of tNs document moiled to you is your California Govermmnt Codes. notice of the actio taken on your claim by the Board of Supervisors. (Paragraph IV below), liven pursuant to Govem mnt Cade Section 913 and 915,4. PIS rete all -Warnings". A. 1131'?�rT: See Clam r CLAIMANT: Maria Lavin and Alfonso Lavin AT'TORNTY: Law Offices of Bruce G. Fagel BATE RECEIVER. February 23, 1999 Bruce G. Fagel., Esq ADDRESS- 445 Sc. Beverly lir. , Ste. 200 BY DELIVERY TO CLERK. C3N. February 23, 1999 Beverly :ills, CA 90321.2 BY MAIL POSTMARKED: I February 22, 1999 (LYE'S Next Jay) L FRONS Clerk of the Board of Supervisors TO. County Counsel Attacked is a copy of the above-noted claim.. PHIL BAT LC3R, Clerk Dated:— February 23, 1999 —By: Deputy '- — IL FRONT± County Counsel M Clerk of the Board of Supervisfdrs (� This claire complies substantially with Sections 910 and 910.2. ( ) This claim TAILS 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). ( } Claire 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: 6 � Dated. � By: �-h�tt'l�"Yt �Deputy County Counsel III. IFRO1.4- Clerk of the Board TO- County Counsel (1) County Administrator (2) ( ) Claire was returned as untimely with notice to claimant (Section 911.3). IV. BOARD 01 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: `LPHIL BATCHELOR, Clerk, By s , Deputy Clerk 3� 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. Ste 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 IIIAII.ING 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 alcove. Bated: By: PHIL BATCHELOR By - ' !9puty Clerk CC: County Counsel County Administrator 1 'i LAN OFFICES OF BRUCE C. PAGEL E Bruce G. Pagel, Esquire #103574 2 ! 44'5 South Beverly Drive, Suite 200 E Bevo rly Hills# CA 90212 (310) 277-3288 (310) 277-0835 PAX i 4 # 5 i Attorney for Plaintiff(s) I' 7 E 8 iE CLAIM FOR DAMAGES AND PERSONAL INaURIES 91 MARIA LAVIN and ALFONSO LAVIN, ) CLAIM FOR DAMAGES FOR 10 1 } PERSONAL INJURIES } Plaintiffs, } ! } GOVERNMENT CODE 11 �, { VS. } SECTION 910 12 l } " ' COUNTY OF CONTRA COSTA, a } 13 subdivision of the Stag. of } California, dba as Merrithew } 14 Memorial Hospital & Health } Centers and Contra Costa } 15 ? Regional Medical. Center; and } (` Richmond Health Center and ) 1 16 } DOES 1 through 50, inclusive, } I 17 Defendants. } ------------------------------ 1,.8 � }1 TO THE COUNTY OF CONTRA COSTA, a subdivision of the State of 19 I California, doing business as Merrithew Memorial Hospital and Health 201 1 Centers and Centra Costa. Regional Medical Center, and Richmond Health 21 ! Center, and to each of the above named entities, individuals and 22 (' health care providers.- s 2 244 .1 You are hereby notified that MARIA LAVIN and ALPONSO LAVIN, i whose addresses are in care of their Attorney, Bruce G. Fagel, 445 25 . South Beverly Drive, Beverly Hills, California, 9021.2, claim damages 26 11 1 from the above-mentioned entities and individuals in the amount, 27 ' computed as of the date of the presentation of this claim in the 28 1 amount of $500, 000.00. i� The Maim is based on personal injuries of MARIA LAVIN due to 21 : negligence on or about August 25, 1998, when defendants negligently 3 caused bodily injury to her, specifically causing the fetal demise i 4 of her unborn infant. 5 As a result of thi f� f f Funeral Expenses: Presently unknown. 2 ! Last Medical Expenses: Presently unknown. 31 All notices or ether communications with regard to this claim , 41 should be sent to the claimants in care of their attorney. 5 DATED: February 22, 1999 LAw OFFICES OF BRUCE G. PAGEL 6l 7 BY: j BRUCE C. FL` 9 ! Attorney' ftit Plaintiff(s) { 10 12 'I .t 13 14 � K 3.5 16 : 171 I 18 19 i 2011 I 3 211 22 I � 23 , 1i 24I 251 26 2 7 i' 28 a i -3- i i` i PROOF F SERVICE 3i STATE OF CALIFORNIA ! ss. C 4 :1 COUNTY OF LOS ANGELES ) i� I an employed in the County of Los Angeles, I am over the age 61 of eighteen years and not a party to the within action. my business address is. 445 South Beverly Drive, Suite 200, Beverly 7 Hills, California 90212. 8 On February 22 , 1999, I served the foregoing documents i described as CLAIM FOR DAMAGES ANIS PERSONAL INJURY, on the 9 ! interested parties by placing a true and correct copy thereof 10i i enclosed in a sealed envelope addressed as follows: { ( See Attached Service List 11 ` X12 : [x] (UPS OVERNIGHT) . .I [x] I deposited such envelope in the mail at Beverly Hills, V13 '� California. The envelope was railed with postage thereon fully prepaid. As follows: I am "readily familiar" with the 14i firm's practice of collection and processing correspondence for, mailing. Under that practice it would be deposited with 15 the U.S. Postal Service on that same day with postage thereon 4 16 fully prepaid at Beverly Hills, California in the ordinary course of business. I am aware that on motion of the party served, service is presumed invalid if postal cancellation 17 �J date or postage meter date is more than one day after date of 18 deposit for mailing in affidavit. [ ] I delivered such envelope by hand to the offices of the 19 ° addressee. i � 20 [x] (STATE) I declare under penalty of perjury under the laws of 1 the State of California that the above is true and correct. 21 22 � [ (FEDERAL) I declare that I am employed in the office of a member of the bar of this court at whose direction the service was made. 23 ' ;i Executed on February 22, 1999, at Beverly Hills, California. 241 25 r ;' OCL 0 26 j Diana Sa 27 ;' I� 281 #� I 't� �1 _ i? S E R V I C E L I S T COUNTY €3F CONTRA Ct)S`I'A F Board of Supervi ® ; , snX CD c ro ro �• . C7 CA ch U3 .4 � S N It A � • fir.-r�,.r` � go MCIlz v t ' 4 ` i ►V y P co MIA . ''! tt G t5 res g � 1; • �s,� �> } �'►` . � � � rri }� a,fit! ry y {,k v > } C u it i £ 1 4 . A. a f}i•, rN zv "a'i' r C, CLAM B0D� March 23, 1999 Claim Against the County, or District Governed by the Burd of &pervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to The copy of this docuwvnt railed to you is your California Govermlent Codes. notice of the action taken on your claim by the . > Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and FEBCN-IN �„sLL.� " qq 91 .4, pease note all "`earnings". 4.s AlOUNT: $150,000.00 N-IN 'If EZCALiF CLAIMANT: Christopher David Owens ATTORNEY: John Diaz Coker DATE RECEIVED: February 17, 1999 Attorney at Law February 17, 1999 ADDRESS: 525 Marina Blvd. BY DELIVERY TO CLERK ON: Pittsburg, CA 94565 February 16, 1999 BY MAIL POSTMARKED: L FI7ONE Clerk of the Board of Supervisors M County Counsel Attached is a copy of the above-noted claim. PHIL BA HELOR, Clerk Bated: February 18, 1999 By: Deputy Vii_ ` IL FROM: County Counsel TO: Clerk of the Board of Supervisors This claire complies substantially with Sections 910 and 910.2. ( ) This claire FAILS to comply substantially with Sections 510 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). Claire is not timely filed. The Clerk should return claire 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: Ila! Dated: " By: Deputy County Counsel ML FROM: Clerk of the Board M my Counsel (1) County Administrator (2) ` ( ) Claim was returned as untimely with nice to claimant (Section 511.3). 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:P PHIL BATCHELOR, Clerk, By Deputy Clerk.. WARNING (Gov. code sectio 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 545.6. 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. A'FFIDA'VIT OF AIAELING I declare under penalty of penury 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. By: y _._ I�ated: X ` � B PHIL BATCHELOR B � I?eputy Clerk CC: County Counsel County Administrator JOHN DMZ COKER � ATTORNEY--AE30GADO K Of Counsel A. ARACELI RAMIREZ RHONDA WILSON RICE Clerk, Board of Supervisors County of Contra Costa 65! Pine Street Martinez, CA 94553 February 16, 1999 RE: Claim of Christopher David Owens Dear Clerk, Please file the enclosed original Claim and return the also enclosed copy of such claim., marked with your receipt stamp, to our office in the envelope provided. Thank you for your help and courtesy. Sincerely, 41- 'Al Secretary TIC Enclosures 525 FARINA BOULEVARD PITTSBURG, CALIFORNIA 94565 (325)432-7373 CLAIM AGAINST THE COUNTY OF CONTRA COSTA CHRISTOPHER. DAVID OWENS presents a claim for damages against the County of CONTRA COSTA, and its agents and employees, including the Sheriff and the administrators of the 1) . county detention facilities and 2? . the county shooting or rifle or target range located near the Marsh Creek Detention Facility. Mailing Address of Claimant : 3491. Halifax Drive Concord, California 94519 Temporary Residence Address of Claimant : 3411 Olivera Rd. Apt . 16, Concord California, 94519 Address to Which Notices are to be Sent John Diaz Coker, Attorney at Law 525 Marina Boulevard, Pittsburg, California, 94565 Parties ResL-onsiblen Claimant does not know the names of the responsible parties who are the persons within the administration of the County Shooting Range and of the County Detention Facilities including, but not limited to, those at the marsh Creek Detention Facility. Date, Place and Circumstances of Occurrence : On September 1, 1998 claimant was an inmate at Contra Costa County' s Marsh Creek Detention Facility operated by the Office of the Sheriff of the County of Contra Costa. On that date he was struck by a stray b=allet or other projectile that came from the .L Sheriff' s shooting range. The projectile struck claimant in the face causing damage to the bones immediately above and below his left eye and grazing his left eye, and hitting him with such force that it caused his body to twist and fold over, driving his head onto the ground and causing him damage to his back and neck. For some time previous to this incident stray bullets and other projectiles, apparently connected with the shooting activity at the nearby Sheriff' s shooting range, would enter the inhabited portions of the Marsh Creek Retention Facility, posing a danger to those inmates confined to the Retention Facility as well as to other persons on the property. More than five persons have been so struck with such projectiles before the incident involving claimant . Many such projectiles have been found within the detention facility and ether nearby areas indicating that bullets landing in these areas outside the shooting range is a frequent occurrence. The Sheriff has made little, none, or insufficient effort to abate the danger thus posed to inmates and others near the shooting range. Respite Claimant' s repeated requests to be taken to receive adequate medical attention to his injuries, the personnel at the detention facility delayed in affording claimant adequate medical care and adequate opportunity for medical diagnosis of his resulting condition. As examples, but not a complete listing, of this lack of adequate medical care are the following items : ) . The prescribed medications which were to be taken every two hours after seeing the doctor were not even given to claimant for at least 24 hours . The pain medication was delayed 48 hours . 2 Claimant was not housed in the medical module of the Main Detention Facility, but instead was housed on the floor of another module of the detention facility for 72 hours after the incident, and later housed on an upper bunk, when lower bunks were available, for the next five days after the time on the floor. Despite claimant' s fear of being returned to the Marsh Creek Facility, he was processed to return to the Facility where he had been shot, and given other housing arrangements which were uncomfortable and unduly restrictive. Claimant had been told by one doctor he had seen at the County Hospital that if a certain symptom developed that he should return for medical attention immediately. When that symptom, light flashes, occurred and claimant reuuested to be returned to the doctor and explained the reason, he was informed that he would have to be satisfied with the medical attention available in the jail and no action was taken by the jail staff for about thirty days . When a family member complained to the Sheriff' s office about the lack of medical attention claimant was receiving, she was told by an employee of the Sheriff' s office the crimes for which claimant was in jail and told that Claimant was lucky to receive any medical treatment at all . In=uries suffered: In addition to the above described trauma and denial of medical treatment, claimant has suffered the following injuries : Pains to his back and neck, blurred vision, headaches, tooth pain, loss of color perception, internal bleeding in the left eye, anxiety about his future health and vision, caused by the blow and by the lack of medical attention to his injury. At this time 3 claimant does not know how many of these symptoms will be of long duration or permanent . Amount of Claim and basis of computation: Claimant has little idea of the amount that his injury will cost him in medical treatment and loss of earring ability and does not know at this time how much pain and suffering will flow from this injury. As a claim must set forth an amount, Claimant, for lack of sufficient information, estimates damages at $150, 000 . 00 . Damages are computed on the basis of the cost of treatment, loss of income potential, and the value of the pain and suffering that will be endured. Dated: February 12, 1999 . J/ JohW Diaz Co e ` Atta y f= Chr r David Daens 4 CLAM BOARD OF SUPER ORS OF BVI A CQS'TA QQ!=. CAT,U'C3M A .o ARb A06 March 23, 1999 Claim Against the County, or District Governed by } the Bard of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to The copy of this doemnent railed to you is your California Government Codes. ; notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given � pursuant to Governrmnt t Section 913 and 1 915.4. Tease roteall "Warnings". AMOUNT: Approximately $2,200.00 CLAIMANT: ?gruel Peixoto ATTORNEY: BATE RECEIVED: February 19, 1999 ADDRESS: 551 E. Cyprus Road BY DELIVERY TO CLERK ON: February 19, 1999 Oakley, CA 94561 BY MAIL POSTMARKED. Interoffice L FRONL Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BATC R, Clerk Dated: Fehrr ary 22, 1999 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claire 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: Bated: 1 By: Deputy County Counsel { ffi FROM- Clerk of the Board TO; e6unty Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDEF 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: PHIL BATCHELOR, Clerk, By 49A,,) , 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 NlAHJNG 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. Bated: By: PHIL BATCHELOR By Deputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100'' day after the accrual of the cause of action. Claims relating to causes of action for death or for Injury to person or to personal property or growing crops and which accrue on or after January 1, 1988,must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt.Code§911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building,651 Pine Street,Martinez,CA 94553. C. If Claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity,separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claims by ) Reserved for Clerk's Filing Stamp Against the County of Contra Costa or N ifs r '.—_ i, � District .._�...(Fill in Name) The undersigned claimant hereby makes claim against the County of Contra Costly or the above named District in the sum of S and in support of this claim represents as follows. 1. When did the damage or injury occur? (Give exact Date and Hour) -------------------------------------------- 2. -- - ----------- 2. Where did the damage or injury occur? (Include City and County) _ - __-- - ---Ttz --_ 3. How did the damage or injury occur? (Give full details;use extra paper if required) 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? (Cher) 5. What are the names of county or district officers,servants,or employees causing the damage or injury? ---------------------------------------------------------------- 6. What damages or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) ------------------------------------------------------------------------------------- 7. How was the above claimed amount computed? (include the estimated amount of any prospective injury or damage.) ---------------------------------------------------- S. Names and addresses of witnesses,doctors,and hospitals. 9. List the expenditures you made on account of this accident or injury: ;DA'I'S ITEM AMOUNT taieisatiat # #I; * skate is at attlk * * * a at is * akatxis 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 a C461,"� (Claimant's Signature) (Address) Telephone No. Telephone?tiok 9 S 6 2, S—" ¢ a er * at * a * R * n a * ata * e z} a * s u * at at a to * x a * x tt * tt at * a ar st 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 dollars ($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. PROPOSAL and CONTRACT Slate h° TOe. Dear sir: propose to furnish all materials and performs all labor necessary to complete the following: All of the above work to be completed in a substar3ti i and workmanlike manner according to standard practices for the suns of � - y 4 c��.�- � �.o� � Dollars t� Progress payments to be made . �„ " �,..�-�,..<-' �•�»,.�. `�- � �,..,�.- �. �`:� as the work progresses to the value of - per cent f ?of ail work completed. The entire amount of contract+.o be paid within r"'' �,,,.� _ days after completion. Any alteration or deviation from the above specifications involving extra cost of material or labor will only be executed upon written orders for same,and will become an extra charge over the sum mentioned m this contract, All agreements must be made in writing. Name and Registration Number of any salesperson who Respectfully submitted, solicited or negotiated this contract- By le Martie No. •- Contractors are required by lam to be licer}seds and regulated by the Contractor's Mate License Tee one � _y. Board. Any questions concerning a contractor arra fr Slate � � Y Contractor's s gate License No. be referred to the registrar of the board whose address is; You, the beer, may cancel this transaction at Contractor's Mate License Board, any time prior to midnight of the third business day 1020 N Street, after the slate of this transaction, Sacramento,California 95814 ACCEPTANCE You are hereby authorized to furnish all materials and labor required to complete the work mentioned in the above proposal,for which agree to pay the amount mentioned in said proposal, and according to the terms thereof. ACCEPTED Date� , 19 NOTICE TO OWNER i Under the Mechanics' Lien Law, any contractor, anent or a modification thereof, its the- office of the county i s' subcontractor, laborer, materialrnan or other person who recorder of the county where the property is situated and helps to improve your property and is not paid for his labor, requiring that a contractor's payment bond be recorded in € services or material, has a right to enforce his claim such office, said bond shall be in an amount not less than against your property. fifty percent (50%) of the contract price and shall, in addition to any conditions for the performance of the i Under"the lana, you may protect yourself against such contract, be conditioned for the payment in full of the E claims by filirsg, before commencing such work of claims of all persons furnishing labor services,equipment im rovement,an original contract for the work of improve- or materials for the work described in said contract. in Pads—At CC-UTE UTY sine Form No.55-037—CAL!F.—Rev.3/79 Spires Bound-Cucote—Farm No.50-250—CALIF. Cont, Lic. No. 266161 Phone: (925) 228-5242 4 Come Court Fax: (925)228-5243 Z4 Martinez, CA 94553 PLANING SEM SLICE 24 Hour Service DATE: 19 99 Serving Centra Costa County Sincs 1965 TO: JOB NAME: R .EEIXQTa SAME 5SI — CyE8FS.a ROAD OAKLEY CALIF-ORRIk 945§1 WE PROPOSE TO FURNISH ALL MATERIALS AND PERFORM ALL LABOR NECESSARY TO COMPLETE THE FOLLOWING ERNIPS WILL COM1 OUT UNCOVER AND Plied: SEPTIC JAX"Ks RESUILU SEPTIC AND BACK 1711-1, S�FPIIC . ALL OF THE ABOVE WORK TO BE COM- PLETED IN A SUBSTANTIAL AND WORK- MANLIKE MANNER FOR THE SUM OF: 2,140.00 TEL : PAYMENT N FULL TO BEEMADEUPON COMPLETION OF JOB. IF Na-11PAIDWITHIN 30 DAYS AFTER THE #3ArE OF STATEMENT A F;!NANCE CHARGE WILL BE ADDD TO YOUR ACCOUNT SUCH FINANCE CHARGE IS COMPUTED BY A PERIODIC RATE OF 1 1/2%PER MONTH WHICH 1 AN ANNUAL RATE OF 18%APPUED TO THE PREVIOUS BALANCE AFTER DEDUCTING CURRENT PAYMENTS AND/OR CREDITS. COtiDITtONSs it is unders#odd ort,;sg'dais r,ut rq v:?f not be held ilahle for any Ross,drrnr*ge or delays occosioned by fire,strikes,or material stolen after delivery upon premisas,'lockouts,acts of God or the public enemy,accidents,bcycotts,Material sno loges,disturbed tabor conditions,delayed delivery of n:arer:a:s from Seller's suppliers,fo;'m moioro',,.r„er art weoth-'fronds: freight embargos,causes incident to-60nol emergancies,war,a-other causes beyond reasonable control of Seib,whether of like or different character,or other causes beyond his control.Prices quoted in this contract ere base upon present pr'ces crud upon condition that the proposal will be accepted within,thirty clays.Also general conditions which are standard for specio3 y contractors in the construction industry,Not responsible for?owns,trees,flowers,fences,etc. NOTICE TO CV NIRS Contractors are required by law to be licensed and naguiated by the Contractors'Shame License Board.Any questions concerning a contractor may be referred to the registrar of the board whose address is: Confroftmr State License Board,1020 N Street Sacramento,California 95814 Under the Machanias'Llan Law,any contractor,subcontractor,libber,mater eiraan,or thereof,in the office cf the county recorder of the county where the property-is situated arra other person who heips to IMprove yolo property and is not paid for his labor,services or mate- reCeiring that a contractors payment bond be reowdsd;n such office.Said frond snail be it an ria!,has a right to entorca hta claim,against your property. amount not less than'My percent(501%)of the contract price and shelf,in addition to any condi- `Under the law,you may protect yoursef x art such alai;<s be filing,before cornmenc! .'..g t ons for the pe:?Crma,roe of the Contract,cordstionad for the payment in'uit of the clams of alt such wori<or fmprovwnem an origtnw contract,for the work at improvement or rnodi4cation persons fumrsning labor,services,equipment or. serials for work descr,t ed In said contract. Any alteration or deviation from the above specifications involving extra cost of material or labor will only be executed upon w 'tten orders for same, arid wall become an extra charge over the surra mentioned in this contract. All agreements crust be madevin y rk.. BY: S ACCEPTED LICENSE NO 266161 DATE ao Olocl • i , 0r c ' 00 ( i r rrn r r a i4l 0 00 exit, . 0 i� �� p C i iif ` � 0 w , . CLAIM BQARD OF SUPEMSt712S OF CONIRA TA COLIXTYs CAIHMNU. March 2 . 1999' BOARD AC'�011� - Claim Against the County, or District Governed by l the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to The copy of this docurment mailed to you is your California Government Codes, l Notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and 915.4. Please noteall "Wernings". AMOUNT: $280.17 00U} "y C 0 JVA CLAIMANT: Melanie Sears ATTORNEY: DATE RECEIVED: February 18, 1999 ADDRESS: 9C SU_W4 t Csrcle BY DELIVERY TO CL,ERI ON: February 18, 1999 Walnut Creek, CA 94596 February 17 1999 BY MAIL POSTMARKED: y L FROINE Clerk of the Board of Supervisors M County Counsel Attached is a copy of the above-noted claim. PHIL BA LOR, Clerk Bated: _ Febniar + 1992 By: Deputy, °e IL FRO1Vi: County Counsel TO: Clerk of the Board of Supervi rs ) This claim complies substantially with Sections 910 and 910.2. ) This claire FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 91{1.8). ( ) 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: Q o� m� By:. :k2y4putt' County Counsel 2. r III. FRONt Clerk of the Board TO.11-6unty 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: ? 09 PHIL BATCHELOR, Clerk, By � Deputy Clerk . , u WARNING (Gov. code section 13) 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 MAIi.,riG 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: s " By: PHIL BATCHELOR By t Deputy Clerk CC: County Counsel, County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for Beath or for injury to person or to personal property or growing crops and which accrue on or before December 31, 2987, must be presented not tater than the 100"' 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 mast be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building,651 Pine Street,Martinez,CA 94553. C. If Claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity,separate claims must be filed against each public entity. F. Fraud. See penalty for fraudulent claims, Petal Code see. 72 at the end of this form. RF: Claim by ) Reserved for Clerk's Filing Stamp MEG Against the County of Contra Costa or DAw�§±t�DOr--s € x District) (Fill in Name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above named District in the sum of S<`. `'','. , . and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact Date and Hour) _ ___: __ _____-a_______w____oe.__________________..___________..______________ 2. Where did the damage or injury occur? (Include city and County) F _____________ ----------------- -------------------------- -_ .________._____ 3. How did the damage or injury occur?o. (Give full details;use extra paper if required) } 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? _ (Over) 5. What are the names of county or district officers,servants,or employees causing the damage or injury? --------------------------------------------------------------------------------------- 6. What damages or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) s e-m m..-«-r r r a r r r r r r s e e-..a-e----e-a..-a R r--s-s s®m u s e s---a--e e-e w e s----..a m e e-a z a m m m e r- 7. How was the above maimed amount computed' (include the estimated amount of any prospective injury or damage. ------------------------------------------------------------------------------------- S. Names and addresses of witnesses,doctors,and hospitals. ------------------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT ie 4P sesta4a s4lss� �r * � � �; * * � * atR # ste# * gkie * it � ieieiratfklai: do ieyt :kst * � � k �t ts � * S �a � ieisst 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) (Address) Telephone No. Telephone No. NOTICE Section 72 of the Penal Code provides: "Every person who,with intent to defraud,presents for allowance or for payment to any state board or officer,or to any county,city or district board or officer,authorized to allow or pay the same if genuine,any false or fraudulent claims, 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 dollars ( $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. DAMAGE 3v`EI•+ORT SEARS 02/12/99 at 16:37 D. R. 15071-1204359 ASIGSG58 Est: j. BROADWAY Al.fTO .2:#;.ski. r 2198 N. MAIN STREET WALNUT L;; CA 94596{a5 9 'i 5) 944-102'/ Owner: MELANIE SEARS Day Phones (925) 256-0960. ..... €.. .. d i e s.>r. r. 1851 TRINITY RINtiY AVE 0108 Other r er P h : WALNUT CREEK CA 94596 ;: t }+ L1 . e f N/A .... ..... Insurance Co. ,-. Phone�� 91 HOND CIVIC DX 4D BED LT BLUE 4-1. 5L-F:1: V:#.n;. ,1.11°:ET ftr4':"iMS0;:.4f6 4 Licenses 2WF .`II:1,;1'..5 Cf. I`s'od Ddn#.e:. 0/ 0 Odometer.. ;! Automatic transmission Power steering Power brake,-., Tinted Body side moldings Yis%X.I. #}:Y;#. ''f' ::; Rear defogger Tilt wheel n.Tt.1;_'1••`,et seats tsa Recline/lounge seats Clear goat paint, Metallic is pa:E,,''t, ---------------------------------------------------------------------------------- PAR'T' 5,: <. DESCRIPTION OF DAMAGEDAMAGEQ QTY COST LABORLABORPAINT sr11.BC s::.ts"s., O ---------------------------------------------------------------------------------- :I. REAR BUMPER O/1'O/H Rear Bumper 1 0. 00 .,, 5 0. 3 Repl Cover sedan DX 1 127. 68 incl 0. 0 rpt Rep! Upper .eam sedan .I. 43. 62 6 Inc! 0. 0 UUARTER PANEL 6 R e 3 I Rear `.:•i I'Y:f,is.I.£:£ 1 7. 15 .. .1.5 0. 0 � 0 < 0 0 a 10 VISUAL ESTIMATE ON ✓ 1 0,. 00 0. 0 c1'v ----------------------------------------------------------------------------------- au . o! < i e ==M> 178. 45 > l 0. 0 (( « r DAMAGE REPORT OR/12/99 9tf k t 16037 D. % 15071-1204359 £.,4 ... AJ168658 Est: J. HOWSE BROADWAY AUTO BODY 7/ t.:`4..yy�,,.``�;�ttS:y3' H.CREEK,M i��. tt STREET t [ (925) 944-1027 Parts 17 S. Body Labor 1. 5 units @ $58. 00 87n00 ------------------------------------------- T a X on TOTAL. { 126. 45 at % 2500% 4. ref: GRAND t" .. $ 280. 1 7 !NSURANCE PAYS $ 280. 17 N 0 T E MUST BE IN OUR SHOP BY �:00 A. M. 00 THE DAY OF YOUR AVFIOI iTMENT TO INSURE DELIVERY AS BCHEtUffl...................... ALL PARTS PRICES ARE SUBJECT TO INCREASE BW'ED ON ACTUAL IK' ICE FROM THE DEALER...THIS ESTIMATE ONLY CGVERS THE. AROVE LISTED RORK.AMY HIDDEN CAMASES WILL BE AN ADDITIONAL CHARGE. Yu% 0LL BE NOTIFIED CE ANY ADDITIONAL CAM96E BEFORE REPAIRS ARE. COM.PLETED.., N C T E Esti*a'te based cn MOTOR CRASH ESTIMATING OUIDE. Non-asteriib(*4 items are derived f:oi§ t�e 3u:de 104405. Database Bata _ r99 Douk'ae asterisi(**) iters i�ldicate part supplied by a wpplier other than ting original equ:Apaeint eaiwfacturer. CAPA itells have been certified frsr fit and fKAh by he Certified Auto Parrs Association. NAGS Part Numbers, Prices and Labor limes are provideY from National Autos Class Specifications, Inc. E East - A product of CCC information Servicer Inc-. c i ; s` �1.�.� �.^..-..•.----a5�sy.-�!.:.�„r*5,*�+..;^,r.'•:rr-�-.,:::rrwarr-� .��......__ _:.,.�,,.,.y.:- {✓`+ dam,i` Ll 0 G .. �l o e _ �,.. � -°.. �� � � 'tom' �► � � CLAS BQARD OF SITYJMS 0E CONIRA COSTA CQUina CALIEDR_NiA 14arch 23, 1999 Claim Against the County, or District Governed by FEB the Board of Supervisors, Routing Endorsements, } OUN HNt NOTICE TO CLAIMANT and Board Action. All Section references are to The copy of this document railed to you is your California Gowriment Codes. } Mice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and 915.4. pease note all "Warnings". AMOUNT: $308.51 t2 CLAIMANT: David P. Yuen ATTORNEY: DATE RECEIVED: February 18, 1999 ADDRESS: 3272 Greenhills Dr. BY DELIVERY TO CLERK ON: February 18, 1999 Lafayette, CA 94549 Interoffice MAIL POSTMARKED: L FROT E Clerk of the Board of Supervisors TU: County Counsel Attached is a copy of the above-noted claire. PHIL BATC LO C14s, Dated: February 18, 1999 By: Deputy f IL FtUM: County Counsel TO: Clerk of the Board of Supervise s } 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). ( Claire 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: `.. s t Dated:_ r<` y uty County Counsel �. . EI FROM Clerk of the Board M Coi 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 Claire 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: PHIL BATCHELOR, Clerk, By , Deputy Clerk WARNING (Gov. code sectio 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 Cade 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 MAI NG 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 Carder and Notice to Claimant, addressed to the claimant as shown above. Dated: By; PHIL BA CCI-IELOR By puty Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 1000' 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 he presented not later than one year after the accrual of the cause of action. (Govt. Code§911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building,651 Pine Street,Martinez,CA 94553. C. If Claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity,separate claims must be filed against each public entity. F. Fraud. See penalty for fraudulent claims, 'penal Cod--Sec. 72 at the end of this form. RL: Claim by ) Reserved for Clerk's Filing Stamp Av Against the County of Contra Costa E or District) - zv (Fill in Name) The undersigned claimant her by snakes claim against the County of Contra Costa or the above named District in the stem of$ u,` �'5'1 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact Date and Hour) .,_i_ — _°gym_____---------b -..t._ _eI-L ___________________________d_______......-m®m 2. Where did the damage or injury occur? (inciude City and County) --------------------------i� ` �� #os_oa' oo � isr" _ ��.a_€ail €w -?S ¢s �-- faei 3. How did the damage or injury occur? (Give fluii details,uae extra paper if required) ..,k ._..(i sa .';' .c; is'.. _.#.s > ,. t ..¢. � YC.xsa..r' fie +a.,foS Yogi t'f >u'"}ti;`�.f�.. �. �f z/{.� � -ti�� rk c i �a^�'"3 t e>��a €�{` �k r a a '.# ; ;v ✓ frEs�4 }.i.L b 3g ;uq i3 bs� 9 £5 i w Gs`!V r #stlw., oa «4_`4: Er2ar_s___e--_a.._..a___a_a____----mm—_a___--___mma_—m_--®__e_------ 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? (Over) S. What are the names of county or district officers,servants,or employees causing the damage or injury? ------------------------------------------------------------------------------------- 6. What damages or injuries do you claim resulted? (Give fail extent of injuries or damages claimed, Attach two estimates for auto damage.) r A-Y Dftfv1o�&C;,) 6,sYv-4D P-EJ-1 (Z F A,I ----------------------------------------------------------------------------------- 7. How was the above claimed amount computed? (include the estimated amount of any prospective injury or damage. 6,iE s -'.14 N �5 5 ------------------------------------------------------------------------------------- S. Names and addresses of witnesses,doctors,aad fiostfkaI& ------------------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM A M 0 UN'T L--4- a Gov. Code See- 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 ClaimanVg Signature) if fl C11 I 14,SN Address Telephone No. Telephone No.-k 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 dollars ( $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. ; S� lCmdl ±UG Sy�G Lo »o= EUGENE PCMG '-6263 DATE: Q-1117 COMMMWT9 LETTY PALM§ 1,23 � EAK �R§ g92:2i 1.. +r � {•. S a?t��r ":ter •Sx c "';�'_.,z % t £sem° Ila e 3 .ufa ?� h w ^sCC4u t2 NE.II An ounl Fl n mu n Fay a.,�.a of Ba:<nce lnch;.,e this naacnoer n your c eck Enclosed e p a r r Pay..,..,Due and any comspondence, ,:h`�+.�aiSv.GX2• �:4?�.�ti:a; 'aA A/.L.iLf�/:5 q o l 2PSao.is �^ e E __.__...d,._..._.._.....,..w.DON'T LEAVEYOURACCOUNT L'NPRGTEC",ED,F_f. 3e`€3FlEYt?Ev'tdfEsSS3EldfFE3i3574i§G �7i4i3648 i ENROLL TODAY IN FIRST CARD GUARD. SIMPLY COMPLETE THE ENCLOSED COUPON FIRST CARD 7 f AND RETURN IT WITH YOUR PAYMENT« K0. 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TOT, ARGKES, f 306.5: PA MEA G: @ K CARD sS .St w ; MILEAGEPLUSH RST tate Nirunkun New Account Number Amount FICARIYa Nlnsrridlm Payment Due Balance Lnciude uas nn $i1CT on yo::r cheer Enc Ned Payment DCe a ara any correspondence 02fI0/S8 53.00 � 2r58�.I5 � $ . DTON},,''Tga LEAVE ACCOUNT -aUNPROTECTED, dll3fi($i$kF] I3FfF9 $3[1if$!$18 $$$flliE$33di idf d (-tI 34 f AN 2 N1.i OTICE ENROLS, TODAY IN FIRST CARD GUARD. SIMPLY COMPLETE THE ENCLOSED COUPON CARR r AND RETURN IT WSSit YOUR PAYMENT. P.O- 5CX 5930 CAROL STREAM, TL 016276006002004 001016 60197-5930 DAVID P YUEN GEORGIA W YUEN 32.72 GREENHIL LS DR yy f$ ff ## III }! CA 94549-2I(4a0 1 1It$]$!$fIIII}I[IIS]$II$ItItittil�ill fill,I$III$$8gI1141!!(1]1 4673675429203000 35811505300 De ach pay:ne:t Stub are return_with check payable to:First Cara. Tars acaosr e Postir.� Reference Nercha.�tt Name or Transaction!�escripdon �C?rd,New r�urchases Fees,�Payments& C ae ? ;.}ate i � ;Ty.� Advarkces�z pebats g Credits 12/21 0818100559L29 CREDIT - MICHAELS STORES, INC. 494 V 5.40 12/26 1.2/26 08584e01468L29 T E STATIONERS CONCORD CA V 22:57 12/21 12/25 0872403763LZ9 MARKS CARDS 45 PLEASANT HILL CA V �.<x*,129� 12/30 12130 0813602846A01 THE MEWS NEARHOUSE #2154 PLEASANT HILL CA V ,,--- ------ --- rnw.srnssn t'6 V AS.Cs£s E