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MINUTES - 03021999 - C12
CI ALM. $CHA T OF SUPFRNSOR.S OF (M RA COSIA MIDiTys CAI-1FORNIA RWD ®11I !4.rch 2, 1999 Claim Against the County, or District Governed by ) the Beard of Supervisors, Routing Endorsements, l NOTICE TO CLAIMANT and Board Action. All Section references are to The copy of this document mailed to you is your California Government Codes. { , 2- notice of tlx: action taken on your claim by the . ' Board of Supervisors. (Paragraph IV below), givers pursuant to Government Code Section 913 and Ai Bei` 915.4. Please note all "Warnings". AMOUNT: Jurisdiction of Superior Coy tloARTWt%z under Section 91.0 (f) CLAIMANT: Gordon N. Ball, Inc. ATTORNEY: Paul A. Aherne, Esq. DATE RECEIVED: January 26, 1999 Simpson, Aherne & Garrity January 26, 1999 ADDRESS: 1900 So. ?lorfol.k Street, X6260 BY DELIVERY TO CLERK. ON: San 1,1ateo, cA 94403 January 22, 1999 BY MAIL POSTMARKED: L FRflM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL B LOR., Clerk Dated: January 27, 1999 By: Deputy IL FR0/1I: County Counsel TO: Clerk of the Board of Supervisors (;�} This claire complies substantially with Sections 910 and 910.2. ( This claim BAILS 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: Dated: By: �` Deputy County Counsel IM FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). TV. BOARD ORDER. By unanimous vote of the Supervisors present: (vf 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. 11 Dated:w " PHIL BATCHELOR, Clerk, By y E , 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 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: By: PHIL BATCHELOR BDeputy Clerk CC: County Counsel County Administrator Simpso-.N, Ai-iEnNE & AFtF�ITY PROFESSIONAL CORPORATION ATTORNEYS AT LAW THE ATRIUM 1900 SOUTH NORFOLK, SUITE 260 PAUL A. AHERNE SAN MATEO, CALIFORNIA 94403-1151 SAN FRANCISCO OFFICE PAUL V. SIMRSON TELEPHONE (650) 358-5990 ONE EMBARCADERO CENTER RONALD F. GARRITY SUITE 2440 LAURA E. !NNES FACSIMILE (650) 356-6991 SAN FRANCISCO, CA 94:11-3713 A. ROBERT ROSIN WWW.SAGLAW.COM 14151 679-2829 JANETTE G. LEONIDOL7 t ".,"z'A 36 i-s3s.! ._67e-2830 ANNE C. STROMBERG s LEIGH ANN ALDERMAN e ^- KIMBLE R. COOK ^1 OF COUNSEL GORDON J. FINE January 2 1 2 , 99 l W-tLL.3AM A. R03Ls".,r5 KATHLEEN A. FOLEY - - KELLY FRANCIS ,..,. PAMELA A. LEWIS PETER V. SHACKTER VIA CERTIFIED MAIL RETURN RECEIPT REQUESTED Clerk of the County Board of Supervisors 725 Court Street Martinez, CA 94553 Rea Gordon N. Ball, Inc. - County of Contra Costa - Fish Ranch Road Slide Repairs, Project No. 0672-686345-98 Dear Sir/Madam,: Enclosed please find the Claim of Gordon N. Ball, Inc . against the County of Centra Costa in connection with the above- referenced project . Please acknowledge receipt of this Claim by returning to us a conformed copy of the Claim. We have enclosed a self- addressed, stamped envelope for your convenience . All communications regarding this claim should be directed to Paul Aherne at this office . Should you require any further information, please notify us at your earliest convenience . `hank you for your attention to this matter. Very truly yours, Linda M. Rivera. Legal Assistant to Paul A. Aherne : 1.mr Enclosures cc : Public works Department 15551.1/ 200353_1 CLAIM OF GORDON N. BALL, INC. AGAINST THE COUNTY OF CONTRA COSTA ITS CONSULTANTS AND THEIR EMPLOYEES (Government Code Sections 905 and 910, et seq. ) (1) Name and address of claimants (a) Claimant : Gordon N. Ball, Inc. 333 Camille Avenue Alamo, CA 94507 (b) Persnns to whom notices may be sent Paul A. Aherne, Esq. Simpson, Aherne & Garrity 1900 So. Norfolk Street ##260 San Mateo, CA 94403 Attorneys for Claimant (2) Date, x>lace and circ=atances of claim, general description of damages and losses as known at this time: This claim arises from the work of improvement project entitled "Fish Ranch Road Slide Repairs, Project No. 0672-686346- 934; (the "Project") , owned by the County of Contra. Costa (the "County") . Claimant Gordon N. Ball, Inc . ( "Ball") was the prime contractor to the County for the construction of a two soldier- pile tieback retaining wall with embankment grading, pavement replacement, fencing and erosion control, in the Orinda area, for work to be performed on the grounds of the County, completed in December of 1998 . Due to circumstances entirely beyond its responsibility or control, Ball experienced substantial additional costs to complete its contract. The primary causes of the increased costs include : the County' s failure to provide adequate plans and specifications essential to Ball' s efficient performance of the contract, site and work conditions were substandard, were not in accordance with the industry standards and materially different than those indicated by the County in the contract documents, the County' s failure to pay Ball for directed extra work in accordance with the payment provisions of the contract; and the County' s failure to pay for authorized chance orders. Although the County acknowledged monies due to Ball, it failed and refused to make payment to Ball of undisputed amounts due in an attempt to gain negotiating leverage. The County was aware that extra work was delaying the Project, but did not process requests for extension of time or extend the schedule and held Ball to the original schedule exposing Ball to liquidated damages in an attempt to gain negotiating leverage. Damages sustained by Claimant include, but are not limited to, contract balance, agreed extra work, delay damages, and interest . In addition to that amount, the conduct of the County has caused Ball to incur significant other financial damages, including, 'Loss of other opportunities . The foregoing list is provided by way of example, and is not exhaustive. As a result of these and other events, Ball experienced significant delays in performing its work, as well as substantial additional costs . Because Claimant has not fully completed its investigation of its claim nor has it had access to all information and documents in the possession of the public agency, Claimant reserves the right to amend, supplement and modify this claim. This claim is submitted without prejudice to submitting further claims for additional damages accruing or new claims in connection with the project . (3) Names of ompl2yees and Dersons causing damages : With a full reservation of rights to supplement this list, the following individuals are known to have been involved: 1 . Joseph P. Murphy, Associate Civil Engineer, Construction Division 2 . Frank Navarro, Resident Engineer, Construction Division 3 . William B . Nugent, Associate Civil Engineer, Construction Division (4) Amount of clai Jurisdiction of the claim will rest with the Superior Court under Section 910 (f) of the Government Code . Damages will exceed the jurisdictional minimum amount for that Court; accordingly, a precise statement of the amount of damages is not legally permitted. (5) Signature: GORDON N. PALL, !NC. By > IX � o � R r o` 4014 � z n ; 3 ia i t 0 • 4 041 An N Sv tv Cn C3 r s t to ! + Ln Ut t! W � O ID + 0C- 40 04 ice . OOC Y a 41 0 0 _ " . , CIALM Ce 130MUMM ?arch 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 The copy of this document railed to you is your 'FY California Goverment Codes ti k # notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given k pursuant to Government Code Section 913 and 915.4. Please noteall "Warnings". AMOUNT: $15,000.00 CLAIMANT. Deahanna Nicole Dixon ATTORNEY: DATE RECEIVED: February 1, 1999 ADDRESS: 777 Loughbrough Dr. , #108 BY DELIVERY TO CLERK ON: February 1, 1999 .Merced, CA 9 €3485 BY MAIL POSTMARKED: Transndttal L FROM: Clerk of the Board of Supervisors M County Counsel Attached is a copy of the above-noted claim. PHIL BATCHELOR, Clerk Dated: February 1, 1999 By: Deputy II. FIptOM: County Counsel TO: Clerk of the Boars' of Supervisors J claim complies substantially with Sections 910 and 910.2. ( } This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: - _ BY: `1-� Deputy County Counsel M. FR0114- Clerk of the Board TO; County Counsel (1) County Administrator (2) ( ) Claim was :returned as untimely with notice to claimant (Section 911.3). IV. ,.BOARD ORDER By unanimous vote of the Supervisors present: ( This Claim is rejected in full. ( ) Other:_ I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. mated: PEEL BATCHELOR, Clerk, By , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (5) 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.iDAVIT OF 1YI4.II 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 Order and Notice to Claimant, addresser) to the claimant as shown above. Dated,M41tBy: PHIL BATCHELOR By _ ljeputy Clerk CC: County Counsel County Administrator Clair..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'h 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�ejntity,sept arate claims the be filed against each public entity. Z. Fraud. S-C a PkLnu k s�J€'fr a'uduI$°nt�L`lalms, Penal C:.°&See.. 72 at the end of this forrn. Af Yf •lt 96 31C $t $6 fi 'k dk 8$ qa # $4 $5 !Q 7F 7k 9t fi * fi 7C 8c # 1t 7r aY 5t is fr R !! 1e dt � * eF !$ 7t tt it $8 k 7R �t 7k a! k !e at # Yk 'k �$ RE: Claire by } Reserved for Clerk's Filing Stamp P5 Against the County of Contra Costa or District) (Fill in Name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above named District in the sura of S and in support of this claim represents as follows: 1. When did the damage or in* occur' (Give exact Date and hour) w ° ✓ 2. Where slid t e dam ge or injuAll s ~_ occur? (Include City and County) Ar T 5 d n i"Z °e.c� rF°}i :5'� rwtalf Eb`�/w a �9r a a.y _ �a 3. How did the damage or injury ogccgur�'� �(Give ryuii details,use Xtra p� r iti f 0 p A'}F. �g ..".i9+'i.y�Y:�L'ai� 's ` ,,, sx 'v`'p ,.. ��t%,,s 3�' ✓ .�-'�'`z.r`'-b..�- f) X.L._ S 'r µ 3. t.6 d'-z+c�ti..' F { y. d/•(ryfia1 �y ..,,,.y- ,+ -.f° �''" ',�.``1r.`.; ;, f.,,s3¢', `i�A' ''Y'�"6,i °. i ✓-tS $` k - >"': Fr' > a' "'' { .. 'eCf``",.+,o/ 2 c 'ACLU. --------------------- 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? r� ' . --ay f C ,$,f5 , .. Ic 6 ac— �" }r, -i ';`"/'{�' '`l. ,...d �i'` ,f ate • ff_o+'f • €�.;'grst.6d `� .5 ✓; '-''Z`'` -� . P �,r�, 'se'oy dt rte ..; ,i kow lal ,% (Over 5. What are the n4mes of county or,,,district officers,servants,or employees causing the damage or injury? -, € . ------------------------------------------------------------------------------------- 6. What damages or injuries do you claim resulte 'f;(Give full eNtent of mjuries or•d �cia d. Attach two a ates fu luta damage ) r € s l P VI bad 60 4tu/ 'd q ------------------------------------------------------------------------------------- 7. How was the above claimed amount computed` (include the estimate amount of any prospective injury or damage.J Aw ulgk/ Names and Wddi.v 'YVsY.+2Y1Y Y'4�T;Lf 3iIVcY.V-+?1 atli6��<-M1Vti�litiiYai4 ,,`� r�$�.. 'F}y� 3ptc a,r+�-, 44 g �,. /�+ �,r C.a.L�,,s { .4'��.." A` `�Y,: $ L✓� 11Q `6"°i,+C.�.a _,._.. -----------------------------------------------ad------------------------------ 9. -..__..-_..-_ ___..__-_.._..__..__ 9a List the expenditures you trade on account of this accident or injury. TATE ITEM AMOUNT " ell. Gov. Code Sec.910.2 provides: "The claire trust be signed by the claimant SENT? NOTICES TO., (Attorney) or by some person on his behalf." Name and Address of Attorney -� (Claimant's Signature) 12 (Address)l., leg N0. Telephone No. Telephone N , rte 17,,E v —7 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 sande 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 f1me,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. SMANNA DIXON Department of Emergemy services 901 Nevin Avenue Rornond,CalifaiRnia Telephone:307-1555 JMPrRFNT AREA The Department of Emergency Servicesrenders care to patients requiring'immedia#e medical attention. In some cases, further evaluation or treatment will be necessary:These instructions are to help you obtain any further care whichis advised by the physician treating you in the Emergency department. Unless a specific appointment is noted below, it is responsibility to,make arrangements for any additional care. if the-condition for which:you were treated worsens ' r ` unexpected problems develop, please contact this department or your regular doctor irnfnediatety. 1. 0 No further appointment advised at fts,ttme..Pleese.read`rtote above. u.. 2. [ 1 An appointment has been scheduled for you in the Clinic h on 3. Please call for an appointment in the following clinic*soon as possible.You should be screen in about da (,_1 Medical Clinic . . .. . 387.1555 Ear, Nose&'Throat'.. . . . . . . . . . . . 3t37�15 ( . Pediatric Clinic 3D7-15431:1" i� l erntatofogy Clinic. . ;#171 b L] (same day). . . . . . . 307-15 C'1 Allergy Ctinic. 3€37=15 6 EI Surgical Clinic. . . . . . . . 307-1550 FLJ Psychiatry Clinic. 3 7 1591 U OBfGyn Clinic. . . . . . . . . 307-1588 J A.D.A.P. CLINIC . 3137-#531 � (same day). . . .. . . . . 307-1$68 0 Urgent Care'Clinic 307-1555 [. Orthopedic Clinic . . 307-1534 Occupational Medicine. . 3074560 F Eye Clinic . . . . . ... . . . . . . . . . . . . . . 307-1538 4. f_i A priority appointment has been made for you at the'"':"', Ciinic.They will be calling you within the next few days;however,if you do not hear from thgrn within a week please call the number circleii above 5. L! Please contact your regular physician, Dr. for follow-up care. f3. (._} To obtain a personal physician` ll orae of the nutter lir; i~ a r tine ppo t#rlent to gat a €t lrt 1: 307-1565 7. i Please return to the Emergency departrnent in days. Bring this slip with you, 8. 'CiSstruct#ons regarding - are pnMed.onthe laa €oft his formforyour.informatlon. Please read thea,to refresh your memory 6n ruing your treatment and 1119111661orks given.to you, g. C_ l You may call the Richmond Health Clinic(374-3021}for follow-up treatment fear this p+roi Eern. 10. ] Please call the Emergency Department'advice nurse between 7 pm and 9 pM*.20,7AM.td.learrfth0 resutts of your z; X-Rays or tab tests. 11. (_ t,the un�ders gged,acknowlr pt Of a copy of these instructions together with any of the special instruct",noted. _5M A119 A I s yr^' ✓� DATE � PREPARED BYENT PT ASS DAY iNITNESS' 04692(REV.8 94) DMTPMWM: WH11E_CHARt CANARY-PATIENT Vomiting Diarrhea Give clear liquids only- Sips, 1/2 ounce to 1 ounce 1. Clear liquids: 7-Up, ginger ale, tea, diluted apple only at a time until vomiting has stopped for 6 to 6 juice, Jell-Q, hours,tl-en slowly increase amounts as desired.The 2, Solids: Yogurt (goad), soft boiled carrots (gond), more you give at a time, the more likely it is to come crackers, toast (no butter), rice or rice cereal, up. apple,banana,a little lean broiled meat if diarrhea Give: Ginger ale, 7-Up, bouillon soup, Jell-O, Coca- is not too bad. Cola tea, popsicles, apple juice. Give what tete child 3. Ramen noddles with broth. seems to take best,he or she knows what is upsetting. 4. Mashed potatoes. 1. (HEAD INJURY''INSTRUCTION Your(child, husband, wife, friend) has just suffered a heed injury. At present,,there is no evidence of any permanent damage. Sometimes, however, symptomsdevelop late. You should watch for the following and call'or return to the Emergency Room if any of these occur, 1. Change in size of pupils, particularly'if one is larger than the other. 2. Double vision or blurred vision. 3. Convulsions, fits or seizures (jerking or spells), 4. Unusual drowsiness or sleepiness - a child in particular may be drowsy and want to sleep after a head injury. You should make sure that you can awaken him easily at such times and also be certain to wake hire every 2 or 3 hours during the night to see that he is easily arousable, ki 5, Continued nausea or forceful or repeated vomiting. 6: Weakness of arms or legs or unsteadiness in walking or crawling. Sad headache or, in infants, increased irritability or furious crying. Infants - bulging of the soft area of the head, SUTURE REMOVAL Tease phone tomorrow (or Monday if on the weekend) and arrange appointment to return tosurgery clinic in days to have your stitches removed. Replace bandage if it gets wet or dirty, Incision may be left;uncovered after second day unless doctor says differently, if signs of infection (pus, heat, redness, swelling or intensive pain) appear, return at once. FEVER. 1, Fever helps the body defend against germs and viruses. 2. Fever over 102'or accompanied by aching can be treated with aspirin or acetaminophen-one grain(65 milligrams, mgm) per year of age up to 14 grains maximum, given every 4 hours. Don't use if vomiting or stomach pain; don't use if the child won't drink. 3, Dress children with``fever lightly. If fever is over 104" or causes delirium, sponge dr bathe with tepid (lukewarm) wate'r. Do not use alcohol. 4, Barely, small children have seizures with fever; they stiffen, muscles jerk, and eyes roll back. Don't panic, lay child on right side:and cool off with tepid water sponges. It usually lasts a few minutes, Drive in carefully for a medical checkup as soon as the seizure stops. Such seizures occur in one out of 200 to 300 children. k l CAST PRECAUTIONS Don't: Dox; 1. Get your cast Diet. 1. Follow your doctor's instructions carefully. .: Remove:padding. . Exercise as directed by your doctor. 3. Insert anyt hing under your cast. 3, Elevate your cast above the level of the heart, if you have 4. Alter or trim your cast, any difficulty with swelling. 5. Drill or punch hales in your cast, 4, Call the clinic if: 5. Remove your cast. A. The cast becomes too snug or tight. drip tape of any kind on your cast. 8, The cast becomes loose, broken or cracked. retains moisture and wi11 soften C. The fingers or toes below the cast become painful, numb, your,cast,) or difficult or impossible to move. D. The fingers or toes below the cast become discolored. E, The cast causes painful rubbing or pressure beneath it. F. You develop localized pain under your cast, particularly if the pain feels like a rock or burning under the cast. ............................ ............................. .......... 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E i i E?: C e E?: i% ISM jig y {' y ' 4 dump } l{ r ji "., MAN �\ r oi- INN ON }r r 'In � Y x € t R'xr,'r'rr n: '' I CLAIM RQAU OF SUL'FF nSORS OF CONTRA COSTA CD,= CALL TFD ItNiA BOARD March 2, 2999 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 mailed to you is your California Government Codes. 1. � , Lp- notice of the action taken on your claim by the .> � Mb Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and k ` 915.4. Please note all "Warnings". C AMOUNT: $276.53 A NEZ < CLAIMANT: Elaine Garcia ATTORNEY: DATE RECEIVED: February 4, 1999 ADDRESS: 4270 Silver 1I leadow Ct. BY DELIVERY TO CLERK ON: February 4, 1999 Danville, CA 94506 BY MAIL POSTMARKED: Transmittal L FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BA�TgHEELOR, Clerk Dated: February 4, 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). ( ) 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: ��..�' b Dated: _�- By: ''�7 r Deputy County Counsel 7 TIL FROM- Clerk of the Beard TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: (-,I- 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:ftk� ' 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 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 MARXiG 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 CIaimant, addressed to the claimant as shown above. Dated6dtf By: PML BATCHELOR B 2joefr Deputy Clerk CC: County Counsel County Administrator 02/02/99 16: 12 Z 15107365245 KIP GARCIA P.01 Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNT INSIR_VCT-1QNS TO CLAIMANT A. Claims Mating to cau of action for death or for injury to person or to personal ptro ty or growing crops and which accrue on r before December 31, 1987, must be presented not later than the 100", day after the accrual of the cause action. Claims relating to causes of action for death or for injury to person or to personal property or wing crops and which accrue on or after January 1, 1988, must be presented not later than six months after he accrual of the cause of action. Claims relating to any other cause of action must be presented)not later tha a 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 Rom 106, County Administration Builth g,651 Pine Street,Martinez,CA 94553. C. If Claim is against a C istrict governed by the Board of Supervisors, rather than the County, the name of the District should be r1liv i in. D. If the claim is against i tore than one public entity,separate claims must be filed against each public entity. L. 1"r u . 'ace penult),to,fraudulent claims, Penal Code Sec.72 at the end of this form. wwwwwrrwww �tww wxereae ,ewww +xrrww �rwzewwwww * wwwww * �cwww ,� rrw �evtwtr �rwww RP: Claim by ) Deserved for Clerk's Filing Stamp . ppyy S Y Against the Cc unty of Contra Costa or a' District} (Fill in Name) The undersigned claimai t hereby makes claim against the County of Contra Costa or the above named District in the sum of S I and in support of this claim represents as follows: 1. When died the damage 4 r injury occur? Give exact Date and flour) _._._V............... ..........,..__......_....___............._.._........._........_ 2. Where did the damage r in jury occur°? (include city and county) 0L4 __..._ . ... ........ _ ..................... ..C . res.. ``. 0 .. 3. Row di t:he damage o injury occur? (Give fait details;use extra pager If required)\ QbU,+1 _�\r--Q— C, ' -\A, vim.% c,, 4. paillcuiar act o omission on the hart of county or distri 02/02/99 16117 2 151073€5246 KIP CRRCIR P.03 5. What an!the names of county or district officers,servants,or employees causing,the damage or injury" _ d. W hat damages or inju fres do you claim resulted? (Give full extent of injuries or damages eiahned.sAttach t"a estimates for auto dornase.) .. 7. How was the above claimed amount computed+ (Include the e>rtimated atnaun.of R4 prospeetivr injury or dwnasr.) C>t~ ............................................................. Names and addresses witnesses,doctors,and hospitals. 9. I.,ist the expenditures yi M made on account of this accident or injury° i A-0— PM * �z �t �: ae * � rr �t �t � ,are * >« * ,aa �ta � rta �rse �rkasars * * a * a ,s * �ts� � t� ,sa � * (terse * � re ,ttete Gov.Cotte Sec.910.2 provides: "The claire must be signed by the claimant SEND NOTICES TO: (Att rney) or by some person on his behalf." Name and Address of Attoicy (Claimant's n fare) (Address} T'- Telephone No. Telephone No.9as— NOTICE Section 72 of rise Penal Cod4 provides: "Every person who,with iril nt to defraud,presents for allowance or for payment to any state board or officer,or to any county,city or district pard or officer,authorized to allow or pay the same if genuine,any false or fraudulent claim,bill, account,vouch° or writing,is punishable either by imprisonment in the county jail for a period of not more than one year,by a f'i a 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 fin CONT I NUE FROM PREVIOUS PRGE 001 t UA0 WR 0 SO 0 A/F MOTE 0 }ager Qu to Tera C;ARCIAs ..A1NE E►t p l.c:)ycm ft.. 14 142.70 MAIER MEADOW (NIT IoANVIL1.1E, CA 94506 QTY Part 4 DescTiption Price F.E.T. Total 1.Be £p_0NW UP PR0GRSV GOLD WHEEL#2i0 14XV 159.99 0.00 1519.99 1.01 QP--ONT UP BGSTN 185/6014814 lIP41 TIRE 82.99 0.00 82.99 1.09 LABOR-MTC MTC MOOT AND DISMOUNT W/BALANCE 12.00 0.00 12.00 1.00 SCRAP TIRE SCRAP-FEE TIRE DISPOSAL. FEE 1.50 0.00 1.59 6 ADDIT10 AL AUTHOVIZED I AGREE TO PAY REASONABLE STORAGE ON VEHICLE LEFT MORE THAN 48 HOURS AFTER PHONE NO, ISATE CALLED NOTIMATION THAT REPAIRS ARE COMPLETED.YOLI WILL.NOT W HELD AE8PON E FOR MY- SY LOSS OR DAW GE TO VEHICLE OR ARMLES LEFT 3N CASE OF FIRE,THEFT,ACCIDENT ANY AIYTHORCYED BY ApLZ NEw 7aTAt OTHER CAUSE BEYOND YOUR CONTROL. WOVA AUTHOFMD I GRANT♦3iel O 72RES PERMISSION TO OPERATE THE VEHIOLE HEREIN DEW^SED FO PURP E OF TESTtNC{ 1NSPECTtfita NOILUM REMOVAL OF WNSELS AND F'Olt THE IF DATE CALLED INSPtCTIND'4 iRAi{ES SER i)ti DELIVERY#RELEASE 104 o IRT €S FR6M pESPON819iLITv FOR TIME $Y i LOSS OR DAMADE T6 YtHN;k,.EV�fNffi T#!#REIN.3N CASE OF FfHE,THEFT OR OTHER CAUSE iY ADD- NEV't T$TAt 'iYp�E ERW04'XORME6 sCONTROL( THE A.MitO WT AWN BELOW. ANCISERVICE WORK LISTED ON 73{38 INVOICE AMOUNT StONATURE z::u::st:nsz zrza nszrzz:V _.,F:rs:r:.. .,... tet:;t:aSEaYCs:::isia:::t::::: :;sE ` CEi�► Etaiilf##z1aClf3s6'#F1 ?fE us:::c :ss:stin ssniusst::;ssz r.: Quote good foy, 30 Alays! t'>, :r. 4 CONT I N?!E PROMI ( REV I OUS PAGE 002 Sd[4[[�`e[[GifG[Gi:i[:4K:b L::uii l:ft GS a'r'w i:::S:e�6e:i' ::GF{l .Gvf r:�.:isif:r'�::ii:A:bG:[NAtfi[ff.il:::{:iliw«.i•e.wayi:r[w�1+9[[�S�iYYM:}TNMhh•YMTNhV•MV44►ytr[�Yt•b�•1✓k••wr.Ly�wi•iS'W�•K.1¢:GS{yWjti�1[Gyl.n Griv wvr sr..o.r.w.. isr .G crit Gf iDuo+,e good for E30 t ays r � Sales Tax 0 a.2509 Cie.0,450 Tatal MAJOR ETA CSS SHOCKS STRUTS ALIGNMENT SUSPENSION 02/02/99 16: 15 Z 15107365246 KIP UARCIP P.02 .`fir, ne F61aY r •f47d,RP law ALAMEDA PLEASANTON DUBLIN WALNUT CREEK 661 Aaarine Vteage Pkwy,4215 Roeawood Dr, W28 Dougherty Rd. 1231 S.Matt St.RyNck r+�► Alameda,CA 94509 Pleasanton,CA 945M Dublin,CA 6450 Walnut Cresk,CA 64395 TIRE (StCr) ,> 9pC (3t0)73i»9443 ($ID)653,971ID ('sIV)A'S4&V j l AUTOCENTERS 1IVERMORE 3420PLESlmrky 34)0CASCa VALLEY SAN Ran All A 1465 First St. 3420 S anby Blvd. 3450 Castro Valley Bind, ?131 San Raman Valley Blvd. Livermore,CA 94550 Pleasanton.CA 96566 Castro Valley,CA 94548 San Plamon,CA 94583 (St0)4434XV 15 10)49R400 (310)ee&8500 (510) •t td0 ESTIMATE 01 REPAIRS AS LISTED ICOR PARTS AND LABOR--VERBAL AGREEMENTS NOT BINDING -- FREE ESTIMATES OWNE DATE PHONE YEAR—MAKE MODFL MILEAG E LICENSE NO. 0 DESCRIPTION OF SERVICE TOTAL a � 14 "f y - ' iI'rlY�l q r�i`` Ftt •' ,' -r 17 E „» PRICE IS FIRM F041 30 DAYS--AF1 ER 36 DAYS PRICE MUST BE RECONFIRMED. SALES TAX �■�' ALL SERVICE BACKED BY NAT ONWIDE WARRANTY(ASK FOR COPY) TOTAL NO THIS ESTIMATE DEFINES TWO DIF RENT CLASSIFICATION OF SERVICE/REPAIRS AS FOLLOWS AEOWRED SERVI, E.(A)PARTS 1 10 LONGER PERFORM INTENDED FUNCTION(B)PARTS DO NOI MFE=T DESIGN STANDARDS(C)PART)S MISSING(E))OERVICEIPART tEQUIRED FOR SAFE OPERATION OF VEHICLE-, MAINTENANCE,,(it)BASED ON M SAGE AND/OR ACE:OF VEHICLE,PARTS ARE Ci.OSE TO THE END OF THEIR USEFUL LIFE.(I.E.RUBSER PARTS CRACKED, SWOLLF,4 OR FATIGUED. ,(B) COMIPLY WA IH MAIN T'NANCE RECOMMENDED BY NEW CAFi MANUFAwTURER. (C) ADDRES4: A CVSTOty F lS REEDS, CONVENIENCE UFA REQUEST (I.E. ENHANCE PERFORMANCE., E LIMiNATE NOISE:, LTC.). t;. (D)TECHNICIAN RECOMME-t DATION BASED CIN SUBSTANI-A IAL AN()INFORMED EXPERIENCE, F YOU HAVE ANY OUESTIONS,I LEASE CALL rr Ci,AM ROA C)lii SUPEMS ► QE a&TRA_ OS A CQL %1M.CAIXEDT2NIA BOARp ACn01 March 2 1999 Crim Against the County, or District Governed by the Board of Supervisors, Routing Endorsements, 3 NOTICE TO CLAIMANT and Board Action. All Section references are to The copy of taus document railed to you is your California Govern hent Codes. l notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below, even .- pursuant to Goverrnt Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: $2,000.00 WARIViNEZ CAUF- CLAIMANT: George Morgans ATTORNEY: DATE RECEIVED: February 4, 1999 ADDRESS: 511 Captain's Court BY DELIVERY TO CLERIC. ON: February 4, 1999 Bay Point, GA 94565 BY MAIL POSTMARKED: Interoffice Mail L FROM L, Clerk of the Board of Supervisors TOt County Counsel Attached is a copy of the above-noted claim. PHIL BATCHELOR, Clerk Dated: February 5, 1999 B Deputy fF r IL FOM: County Counsel TO: Clerk of the Board of Supervis' rs ( 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). { } 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: Dated: - �_ By: L222ff2� Deputy County Counsel IIL FROM: Clerk of the Board TO. County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDS By unanimous vote of the Supervisors present: (&4" 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: � s 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 hIARX'iG I declare under penalty of perjury that I ate 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: 4,e— iL111-2 By: PHIL BATCHELOR By c L ' puty Clerk CC: County Counsea County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS,TO!C AL Claims relating to causes of action for death or for injury to person or to personal prop" or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 10e 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 94551 C. U Claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity,separate claims must be filed against each public entity. E. fraud. See penalty for fraudulent claims, Penal Code See. 72 at the end of this form. RE: Claim by Reserved for Clerk's Filing Stamp Against the County of Contra Costa or District (Fill in Name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above named District in the sum of and in support of this claim represents as follows: . el I ----------- 1. When did the damage or injury occur? (Give exact Date and Hour) T-4 4, --------------------- -------------------------------------------- ------- -------- 2. Where did the damage or injury occur? (Include City and County) 4- Z7-S All ? - -------------------------------- --------------------------------- ------------ ------ 3. How did the damage or injury occur? (Give run details;use extra paper If required) - P-S Y4 �,z e e� + 4-k f YV:C o"m ------------------------------------------------------------------------------------- 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? r. �A "v (Over) S. What are the names of county or district officers,servants,or employees causing the damage or injury? eo. ckr # .".fc 6. What damages or injuries do you claire resulted? (Give full extent of injuries or damages chimed. Attach two estimates for� auto damage.} /` _ t ✓ a € s r 4 c Z- #1. s'+ Po g'Y f...c.. J 7. How was the above claimed amount computed? (include the estimated amount of any prospective injury or damage.) 67 d 5. m o e o v w-r r e s-e m m r e a a w-e w r w d r s r w s-m-a u r-r--r e--r r-s r-e w-e r--r--e v e n e e v-w a w+s e r-r r+r..--e 8, Names and addresses of witnesses,doctors,and hospitals. 0' t: 9. List the expenditures you made on account of this accident or injury: DATE ITEM. AMOUNT t,.r y e .• t} +„ S ,1v tixr _._ f..fit 4`ss,v 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 Si tore) ry f+nh r (AddressAi } 4. J Telephone No. Telephone No C i NOTICE .• r }:'x, .. �:�'-o-Si' � " :sw`� � , �•,:'E."Wiz' Section 72 of the Penal Cotte 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 fare 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 finc. Date: 09/29199 02:34 PM Estimate ID. 11126 Preliminary Profile ID: Standard Profile AIM'S AUTO BODY, INC, 1705 Somersvillo goad Antioch,CA 94509 (925)754-7600 Fax: (925)754-3614 BAR # AH 134092 FED # 94-2227228 Damage Assessed By: JAMES MALTBIE Condition Code: Good Deductible: UNKNOWN Insured: GEORGE MORGAN Address: 511 CAPTAINS COURT BAY POINT,CA 94565 Telephone: Home Phone(925)709-0601 Mitchell Service: 915489 Description: 1988 Chevrolet Pickup 01500 Body Style: 2D Pkup 6'Bed 117"WS Drive Train: 5.71-Inj 8 Cyl 2WD VIN: 1GCDC14KOJ i1467q License: 3502539 CA Mileage: 150,351 OEM/ALT: O Search Code: None Color: RED Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation Description Part Number Amount Units 1 500820 BOY REMOVEIREPLACE FRT BUMPER FACE BAR 15574111 GM PART 999.00 1.4 #° 2 500940 BDY REMOVEIREPLACE FRT BUMPER IMPACT STRIP ORDER FROM DEALER 44.50 INC # 3 500325 BOY REMOVE/REPLACE GRILLE 16615110 GM PART 271.00 0.4 # 4 500694 BOY REMOVE/REPLACE GRILLE FILLER PANEL ORDER FROM DEALER 33.75 INC # 5 AUTO REF REFINISH CTR FILLER C 0.8 6 500695 BOY REMOVE/REPLACE R GRILLE PANEL EXTENSION ORDER FROM DEALER 19.10 0.2 # 7 AUTO REF REFINISH R FILLER C 0.4 8 503260 BOY REMOVEIREPLACE R LWR MARKER LAMP ASSEMBLY 6975196 GM PART 6.90 INC # 9 512370 BOY REPAIR R FENDER PANEL Existing 1.5*# 10 AUTO REF REFINISH R FENDER OUTSIDE C 2.6 11 512790 BOY REMOVE/REPLACE R FENDER WHEEL OPENING MLOG 15546444 GM PART 96.05 0.2 12 514540 BOY REMOVEIREPLACE WHEEL 12325649 GM PART 349.00 0.3 13 514600 BOY REMOVE/REPLACE WHEEL HUB CAP 15551491 GM PART 38.76 14 900500 BOY* ADO'L LABOR OP MOUNT&BALANCE Sublet 16.00* 0.0* 15 900500 BOY* REMOVE/REPLACE TAPE STRIPES **Qual Rep#Part 7.50* 0.3* 16 515040 MCH ALIGN FRONT SUSPENSION -M 1.9 17 AUTO REF ADD'L OPR CLEAR COAT 1.3* 18 933003 REF ADD'L OPR TINT COLOR 0.5* 19 933018 REF ADD'L OPR MASK FOR OVERSPRAY 0.4* 20 AUTO ADD'L COST FAINT/MATERIALS 128.80 21 AUTO ADD'L COST HAZARDOUS WASTE DISPOSAL 5.00 ESTIMATE RECALL NUMBER: 1/2919914:31;37 11126 UltraMste Is a Trademark of Mitchell International Mitchell Data Version: JAN-99_A Copyright(C)1994=1997 Mitchell International Page 4 of 3 All Rights Reserved Date, 01129199 02:31 PM Estimate ID: 11126 Preliminary Profile ID: Standard Profile Judgement Item #-Labor Note Applies C-Included In Clear Coat Calc Add'l Labor Sublet 1. Labor Subtotals Units Rate Amount Amount Totals IL Part Replacement Summary Amount Body 43 -i-20-0 --600 - 15 23--Bg 6-0 Taxable Parts 985.56 — - Refinish 6.0 52.00 0.00 0.00 312.00 Sales Tax @ 8.250% 81.31 Mechanical 1.9 62.00 0.00 0.00 98.80 Total Replacement Parts Amount 1,066.86 Non-Taxable Labor 649.40 Labor Summary 12.2 649.40 III. Additional Costs Amount IV. Adjustments Amount Taxable Costs 128.80 Customer Responsibility 0.00 Sales Tax @ 8.250% 10.63 Non-Taxable Costs 6.00 Total Additional Costs 144.43 1. Total Labor: 649.40 11. Total Replacement Parts, 1,066.86 Ill. Total Additional Costs. 144.43 Gross Total. 1,860.69 IV, Total Adjustments: 0.00 Not Total: 1,860.69 THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. AM WARRANTIES APPLICA13LE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR DISTRIBUTOR OF THE PARTS, RATHER THAN BY THE ORIGINAL MANUFACTURER OF YOUR VEHICLE. This Is apreliminary estimate. Additional channes to the estimate may be required for the actual repair. Point(s)of impact I Right Front Corner(P) ESTIMATE RECALL NUMBER: 1/2919914:31:37 11126 UltraMate is a Trademark of Mitchell International Mitchell Data Version. JA"9_A Copyright(C)1994-1997 Mitchell International Page 2 of 3 All Rights Reserved Date: 01129/99 02:31 PM Estimate ID: 11120 Preliminary Profile ID: Standard Profile AUTHORIZED AND ACCEPTED: You are hereby authorized to make the above specified repairs. I understand that payment in full will be due upon release of vehicle, including additional supplemental damage charges, and hereby grant you and\or your employees, permission to operate the car, truck or vehicle herein described on street, highways or elsewhere for the purpose of testing and/or inspection. An expressed mechanic's lein is hereby acknowledged on above car, truck or vehicle equal to the amount of repairs thereto. You will not be responsible for loss or damage to vehicle or articles left in vehicle in case of fire, theft, accident or any other cause beyond your control. ALL OLD PARTS REMVED FROM VEHICLE WILL BE DISPOSED OF UNLESS OTHERWISE SPECIFIED. ******* NO CREDIT CARDS ACCEPTED **REPAIR ORDER**authorized by date ESTIMATE RECALL NUMBER; 1129199 14:31:37 11126 UltraMate Is a Trademark of Mitchell International Mitchell Data Version: JAN_9!R_A Copyright(C)1994-1997 Mitchell International Page 3 of 3 All Rights Reserved DAMAGI REPORT MORGAN 02/01/99 at 09 : 21 D.R. 52369-5000110 AL1 75322 Est : M. CALVILLO 11 poll IE 1?1—.-N-"L-,)F-� y"Ijip<5 13CAIA!, 14 1�jk IE ?411y' 2180-A MARKET ST CONCORD, CA 94320- (925) 687-3117 Owner ; GEORGE MORGAN Day Phone: (925) 709-0601- Address : 511 CAPTAINS COURT Other Ph: ( - - BAY POINT CA 94565 Deductible: $ N/A insurance Co. z Phone - Claim No. : Adj . -. 88 CREV CIO 4X2 FLEES SIDE 2D SHORT RED 8-5 . 7L-Fl Vin; IGCDC14KOjZ314674 License: 3SO2539 CA Prod Date : 0/ 0 Odometer : Power steering Power brakes Dual mirrors Clear coat paint --------------------------------------------------------------------------------- PART NO, OP. DESCRIPTION OF DAMAGE QTY COST LABOR PAINT MISC FROG a' BUMPER 2 O/H Front Bumper I V00 1 . 6 VO 3 Repl Fc br chrm w/o ar int k w/impct 1 199 , 00 Inc! VO 4 Rep l Impct sty'p w/o shah_ ts pkg. brgh 1 44 . 50 incl 0 . 0 5 Rep! Cntr flir w/o grivnt his w/o 1 33 � 75 V3 04 6 Add for Clear Coat I VOO 0 . 0 V2 7 Rep! RT Otr flir w/o gr11 vnt hls i 19 . io 0 . 3 O 3 8 Add for Clear Coat i 0 , 00 VO Vi 9 GRILLE 10 Rep! Grille w/o WT package chrome i 271 . 00 V8 0 . 0 ii FRONT LAMPS 12 Repl RT Sd mrkr imp Chvrit lwr 1 6 . 90 incl 0 . -0 13 FENDER 14* Repr RT Fender I V00 ns 2 . 6� i5i Overlap Minor Panel 1 0 01,0 0 . 05 --0 . 2 V Add for Clear Coat i 0 .00 00 V10 17 .ep1_ RT Wheel :sprig midg chrome 1 iV05 0 . 3 VO 0 WHEELS 19* Rep! RT/Front Wheel Type 1 15x7 1 349 . 00 0 . 3 VO 20 Rep! RT/Front Hub cap Chevrolet 1 3875 0 . 0 0 , 0 21* STRIPES 1 0 . 00 0. 0 0 . 0 T 0 . 00) 22* AL I GNMENT 1 0 . 00 —00 0 . 0 -------------------------------------------------------------------------------- Subtotals 978 . 05 6 . 1 4 . 0 18 . 00 Page : DAMAGE RZF`ORT MORGAN 02/01/99 at 09 : 21 D.R. 52369-0)v��0�1 0 AL175322 Est : M. 5o 11141 !Q11171 "a 1117. 2180-A MARKET ST CONCORD, CA 94320- (925) 4320-925; 6e'7µ-3 1 µ7 Parts 97kos Body Labor 6 . 1 units @ $52 , 00 317 . 20 Paint Labor 4 . 8 units @ $52 , 00 2 4 . 6 # Paint/Materials 4 ,8 units @ $22 , 00 105 . 60 Sublet/Misc 000 --------------------------------------------- SUBTOTAL 166& 45 Tax on $ 110V65 at 8 . 2500% 9V89 --------------------------------------------- GRAND TOTAL $ 1759 . 34 -------------------------------------------- INSURANCE PAYS $ 1759 . 34 THIS `STI-ltF IS BASED ON THE LOWEST POSSIBLE COST CONS!STEN-,.' ..�� r.I,G 17K ANDD, As SINr, � fvr„A?A\ F,-H� � IT— S N01' COVERED V ES -st.Y':?T vIR A'y H-10-EN ��1tQ',.- ,'U D fiN TEABO',, t WILL BE AN ACJ'l._('iNAL L- B to based !Crl01 t CPU CH STIIIA-I „ G"UHIDE: Non ahe _sv �) `tms am edved3 fmpa G de R'1C & ase } t G8 .z��tt�:� ;��, :. .t, us v n,r5 1 _.i,P�% .e :ru_�t„ Jas�.s��,: �wy'����5� d�., i�j �v' Dr{13 e �.Aer+'.v"*) 3. ms a.nj'Late .F �v suppllie3 '"y a syupp.lier other than he Lr}. _ a f t d+ to .,i, CATA, _,.,,L:S have been certified ;or fit a_.,, ?I.,:.�n by thke Certified Auto Pearcy Association a NAGSPart imbzrs, .r?�V� �P; .�3�: ta_s"� �"e �'?J?��v `€a� a•atAoxa. A-..-to Ci a5s Spec if n _nic. EZEst - A product of vL„ Wf}o;-manen services inn, Page; 2 CIAIM BOARD OF SUPS MS RS OF CONNIRA QQSTA CQ12M , CAi:1!1 Y`1fRMA BOARD ACT[011 Marc 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 The copy of this docent railed to you is your California Government Codes. l notice of the actiontaken on your claim by the Board of Supervisors. (Paragraph 1V below), given m pursuant to Government Code Section 913 and 0 915.4, pease rote all "Warnings". $26,000.00 AMOUNT: �� > CLAIMANT. ;edroza 1'09T vNI AUF ATTORNI EY: DATE RECEIVED: February 4, 1999 ADDRESS: 553 -- 19th St. BY DELIVERY TO CLERK. ON: February 4, 1999 Richmond, CA 94801 BY MAIL POSTMARKED: and-delivered L FROft- Clerk of the Board of Supervisors M. County Counsel Attached is a copy of the above-noted claim. PHIL BATCHELOR, Clem Dated: February 5, 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). 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). ( ) Cather: Dated: (?Ny: Deputy County Counsel f IIIc DRONE° 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 ORDEEL By unanimous vote of the Supervisors present: ( This Claim is rejected in full. { ) Cather: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: lf 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 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 NIAELLvG 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 � Nputy Clerk CC: County Coursel 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 he presented not later than the 100'h 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 grooving 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. 4 RE: Claim by ) Reserved for Clerk's Filing Stamp 5 � ) EV Against the County of Contra Costa or 4 District '. (Fill in Name) �,gTRA C 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) s 3 s ------------t : a;.�'�.._`�� j al----- i..��j_ ,1fJ#�—'..Qm,.mmmo_oo......'��d_�o..,.r�.r_�_.,�aoo___ 2. Where did the damage or injury occur? (include City and County) 3. Hose did the damage or injury occur? (Give fun details:use extra paper if required) { •, '/ivt y S ,{.` i f`. 'S i ,i. 'r t�..i.., ,'` f.;, fi"`- 5j....i. ` i. '�l;,��#- ------------------------------------------------------------------------------------- 5 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? c ✓ •.,JS J i"'0 t = t f t 5 - ='^ .. 2 e�+ ��if y S � -5.: Sf'as O:�sl✓{ \�+� /�....,� 7 4 a..� .a. .>..{ y, l: - ... F� I s Y��-52•��t:. 4.�D-2y...s �/�`''� ;5.;.,:� !. f°? ��� ��F it iy•' (Over) 5. What are the names of county or district officers,servants,or employees causing;the damage or injury? f hh 6. What damages or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) �', _ "0e '`4iuf'd i 3�,+4`✓7�. Y1 i �} •i" }� t 3 ,fir ew Si ------------------------------------------------------------------------------------ 7. How was the above claimed amount computed? (Include the estimated amount of any prospective injury or damage.) k - ------------------------------------------------------------------------------------w 8. Names and^ addresses of witnesses,doctors, end hospitals. } ? 5 5$`5 4 'v F •� 5 1 .J %L.. L� LS :➢.�,3 S�`J XM1i 1 .fit f. 4F'"Y 9. Dist the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT 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 ( lai is Signa�slre) (Address) Telephone No. Telephone N� NOTICE action 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. CLAIM BQAED SITUMSORS C} CONTRA COSTA_ IT M' CALIEDMIA BOARD A OS March 2, 199 Crim 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 mailed to you is your California Government Codes. I notice of the action taken on your claim by the ,N* ° a. Board of Supervisors. (Paragraphs IV below), given �4�� v .y � ¢,: pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: $2,545-89 CLAIMANT:Wilton M. Pollard ATTOKNatEY: DATE RECEIVED: February 1, 1999 ADDRESS: 3575 Mendenhall Ct. BY DELIVERY TO CLERK ON: February 1. 1999 P—leasanton, CA 94588 BY MAIL POSTMARKED: Transmittal L PRONE Clerk of the Board of Supervisors TO. County Counsel Attached is a copy of the above-noted claire. PHIL BAT HELOR, Clerk Dated: February 1, 1999 By: Deputy II. FRONE County Counsel TO: Clerk of the Board of Supervisors ( 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: r 0 � �On t� ;2! /� 1s'O ---f44� t ` Dated: - `x} By: Deputy County Counsel III. FRON1 Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Crder entered in its minutes for this date. Dated: is f PHIL BATCHELOR, Clerk, By , Deputy Clerk WARMING (Gov. code secti n 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. DAVIT OF N 41LLN. 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: a , , j By: PHIL BATCHELOR By Deputy Clerk CC: County Counsel County Administrator Claim ter. BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Cl ms 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'h 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 Iater 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 roust be fled with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building,651 Fine Street,Martinez,CA 94553. C. If CUim 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:Cly by } Reserved for Clerk's Filing Stamp v a a �a Against the County of Contra Costa 2 S or } District) M" .,e (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,2 5 S' and in support of this claim represents as follows: 1. VAwn did the damage or injury occur? (Give exact Date and Hoar; ----- _--- -------------------------------------------------- 2. —-/9----`---_--- --- !��'------------------ 2. Wberedid the damage or in ury occur? (Include City and county; /� / �+ /tAr"1't/ 6V44*4} `"e r&,sj,,j-t; +C d P.r 9„5-0x' J�iw S6�Jk1A /Cat i, AL., / �►.���a� f�rr�+�t�d� co 3. How did the damage or injury�occur? (cave full details;use extra paper if required 2 J f t' / Ilv"wg er(� gst f• M1� OT iCd IeR. G/L� t ltYi2f+I1 /d/�7t +i 1L � i'� ✓moi,`'+ 1 Ot44-,.,, 9l-140 N-L opt r&1yAJwrQ )0. ivien AVL #CA 'r.X/04cfZcf fir ems ta+�Z.a(�+aal �s"a.a�i Of j«rrQ,J`.ar" J:"d. i"�S� /`a c:rco �'s�carf da.sl SkAX&II / let,U -}+iG�E1--------------------------7� �t wttd¢ ";A /°�c��+`+ a�.�_JY_ 1�2��_tvl(Gt/J�-j,-, ri'-rC1 f-Wa _____ 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injrnT or damage? (Over) 5. What are the names of county or district officers,servants,or employees causing the damage or injury? C-S «__ Go�t � 7 ut ___ a.� trr� t1t _� -_ u�'_ `ir.� « l` __ �v_st « „_..,_____.«__-___-._ a5 What damages or injuries do you claim resulted? (Give hill extent of injuries or damages claimed. Attach two estimates for auto damage.) jJj�`�� �� �t �+ �jr w4et; ! a`yn� t+fit t Al f`r� r/t a�/r W� e t / iv e-Jtp SZ z,- ah'+!6<) <tA fL�b4srri♦t�/t a TA � 7 e!/E� O 5 jeS� ! P i 1P fTt ir.i l� )di /aK f$ Cly A�GAl�,f /1 S,-ja W tt!t L !a+►►A.,i SLA i� r da h I/16 aj. r s.�S ) . / �t a. or.-0#•i yyr e%r`a lad+g,art -----------------------------------------V & ai+"t,1. ^.�. k *'t� �2. t^ $, t�'ii'_------------------------------------------- sage. ,.! _6, /f -,/4 d/4 A t t-"If i «v «�i >--..---«®m '. How was the above claimed amount computed? (Include the estimated amount of any prospective injury or damage.j S at.ta. &j J;f.-" a, I J"'f f O+ A A.I'>#-t f 4/e a I'- 8. _Names and addresses of witnesses,doctors,and hospitals / 8,r v p•�t v el tr e+ ri�y 1k&':t 4 a SJ 425 �►tr 1` 1+ ii Iv' .f� �°e f',*t A d I` ?'�4 . ire 1' 0a.. r�* l i ;s *. ct tars'-�, t"Lf f 4 44 1a J t'4 c{ ,t 0 __«______------------------------------------------------------ 9. ______«____«___«____«_«____«______ _.._«__________«__9. List the expenditures you made on account of this accident or injury. I FEN AIMQUN T ee3 a t 9 i1+e�,la�+ fcv.> ;er4L�S 35'S� x a,Z 0 Z 9aC"da' p_„Ct Cl'?" �fCy�«r,7,l�+g/ ��,.,, 83 r s (A) MIS TISr���dst'te��axf 3f`€ ►v/t a�tL b / ` a sar4 ,x �e * aa� * ae , at *'Daae * a� �aa� a * * a� a �a * *t '*` tea * apt Gov.Cade 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.E S" 7� 3t 0 a # * a a at 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 alloy 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 (810,000), or by both such imprisonment and fine. +,+ e ) l a /a tf/ r u G r'3 ri O /`i i+✓dE S+ L �j Ee Sr�' /fit o d r t�i`•2 ?t r S +c t-B r t G u +lt a s •t fs !r 'S I /L� A a 6t.oh&j m:. 001 ca a� y r`v t s ii rS f 4e I-1'r r.1-s/t 4-X-4- /* -X-4`i "CL.-C, r d d Are- et,tt/7 ,/` �pc� r t` is i' �` 'S l`v cp " kw �,r�.,�� t,!z., , ��; f !✓a..f � o� d�+��".,ter e.� �'si � f�a .�„ P C ? a 'i -Jeo ec a5 �t Ei L fitG°'..( I ;13/7 I/!+G k1`A AISX fLtJ^ GthlZ.rGGt/ fq 47 T J'Jc ; 4org b A A e f t r^R t-e. OL +f V IC f lt GT � e- - r t4 f�. f�G.t a " ! d�!` S st b t c.•+ y r cr 1F 4s v e E' n G !o.[e / 35 ' 4/1) r,'.r f J 2 S� �g f L a f '�` e' •.� ACURA OF PL.E,,,Ap�SANTON 4341 Rosewood Drive SHEET NO OF S E€TS PLEASANTON,CA 94566 (925)463-4700 ESTIMATE OF REPAIRS E - ADDRESS --- DATE -__---- MAKE OF CARYEAR 1 TYPE 7 LICENSE NUMBER tMtL€AGE 1MOT OR NO t SERIAL NO y( iNSUPED BY IAr)JUSTEP INSPECTORERtONE 3+aOME BUSINESS _-- - —`--__ [)ESCRIPTION OF REPAIRS AND REPLACEMENTS PARTS LABOR PAINT TOTAL NUMBER AMOUNT AMOUNT AMOUNT AMOUNT i I I i f LA t P at i i ! I s E i i t i t i i t ! j s i E E t t i E 1 i TOTAL The above is an est+mate based on our inspection and does not cover any c addir:o at parts or tabor which may be required after the work has been TAX E opened up occaslonaiiy after the work has started worn Or damaged tarts +J are discovered whsch are no; evident On the first inspection Because of this TOTAL C ESTIMATE the above prices are not guaranteed and are for immediate acceptance only w.ywa..w.Y.Wl' c70Q - res*,ty»X—r-3wtss u ..II S►�:c57�M 70i 1 :G c"t > . > a v: !tf C —Z � tart to . dr , 3 to � -w n � ii > 3� n x fill 0 ' � rn to to !� 00 �Y H rm r M cz a t>- 9 4� M ' , 4A GA Im A m l M W ri Z ca It it 0 --Fz Un }>s y ry14 { ,� x cr) z MIC'HEUN" . BF vodrih" INVOICE ALay Tin &Bun EPA*CAL000072981c 777 .DUIVXJOJ31 0 Conft aisl 4 BAR#AJ36777Fi 1688 PIKER ROAD, SANTA ROSA, CALIFORNIA 95403 \ o (707) 544-3420 + (800) 300.6696 INVOICE DATE COST.NO. ORDER NO. PAGE INVOICE No. 'Fires• Brakes •Al W.heels America Invoice 33445 Western Avenue DATE INVOICE# Union City, CA 94587 �- 1213198 1715 SILL TO CASH SALE (Milton Pollard I 925-848-3604 i - P.O. NO7 � TERMS REP SHIP VIA----i=YOUR ROITAG# Due Upon Re.,. 1 Walk IN --------------- -r- DESCRIPTION RATE � AMOUNT i ITEM !20O WHEEL REMANUFACTURE 1 83,00 89.00 300 Wheel Remanufacture Supplies 1 10;00 1O.00T AFT AFTERMARKET WHEEL 1 0.00 O.00T 'thank you 0.00 O.00T WE THANK YOU FOR YOUR BUSINESS It Sales Tax 8.25°h 0.83 I � i I I 1 I Total $99.83 WE SELL. REPRODUCTION HEADL.,AMPSITAIL LAMPS t� .:•. BAXIERS k. .' air a 6770 SANTA RFTA ROAD PLEASANTON CA. 04566 (510) 734-6730 J Y t Ohk #9200-1 12%04/96 16:38 sf`> Check Subtotal 16.98 0.00 Tax rf f Tax Check Total 16.98 J i{ y k tF Tendered: f•if 16.98 VISA .'. M POLLARD ; , t$ ACCT; 4128003330877654 f < . . EXP. GATE: 11%99 ..t n . AUTN. CODE: 374052 y � a{ A t Y.... *RESERVE YOUR HOLIDAY PIE NOW!!! � fief . *DECEMBER FEATURE IS CANDY CANE PIE .. •<....;,r. r ,t *WERE YOU SERVED PROMPTLY? (YES) (NO) * *DID YOU ENJOY YOUR MEAL? (YES) (NO) * *DID YOU ENJOY YOUR VISIT? (YES) (NO) * CLAIM BOARD QE StJ`�I SOS ()F O�ITRA CQ5TA CC}[.T1V`no CALJEQRNTA D0 O ACTI®Iil Yiarch 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 } The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the P-x;3 Board of Supervisors. (Paragraph IV below), given v. pursuant to Government Code Section 913 and HE'0. 0 !"1 515.4. Please note all "Warnings". AMOUNT: $26,000.00OUtN�=Y Fr k<NZ" CLAIMANT: Patricia 1114arcelina Reyes ATTORNEY: DATE RECEIVED: February 4, 1999 ADDRESS: 553 — 19th Street BY DELIVERY TO CLERK ON: February 4 1999 Richmond, CA 94801 BY MAIL POSTMARKED: Hand--delivered L FItO.Ni t- Clerk of the Beard of Supervisors TO: County Counsel Attached is a copy of the above-noted claire. PHIL BAT LOR, Clerk Dated: February 5, 1999 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisd { This claim complies substantially with Sections 910 and 910.2. ( This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: d a ' Dated: y: Deputy County Counsel r III. FRO?& Clerk of the Board `11'O: taunty 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. t6r P1iIL BATCHELOR, Clerk, By , Deputy Clerk W1UL�'ING (Gov. code section 13) m 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. AFMAVIT OF AlAnM 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 � � `���' �7eputy Clerk M County Counsel Co=y Administrator claim to: BOARD OF SUPk#VISORS OF CONTRA COSTA COUNTY INS'T'RUCTIONS 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 loot' 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 1€6, County Administration Building,651 Pine Street,Martinez,CA 94553. C. If Claim is against a district governed by the Board of Supervisors, rather titan the County, the name of the District should be filled in. D. If the claim is against more than one public entity,separate claims must be filed against each public entity. E. Fraud, See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim by } Reserved for Clerk's Filing Stamp " E . Against the County of Contra Costa or ta; District) A � (Fill in Name) The undersigned claimant�hereby makes claim against the County of Contra Costa or the above named .District in the sum of$ and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact nate and Hour) ---------------------------------------- 2. ______..._m_m...__________________________ 2. Where did fhe damage or injury occur? (Include city and County) _ = r s a -�___ _______®_ e�_'_`_' _ '_ ra______a__________ __________________ __ 3. How did the damage or in jury occur? (Give full details;use extra paper if required) J ------------------------------------------------------------------------------------- 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? M girw ?p,} {Over) 5. What are the names of county or district officers,servants,or employees causing the damage or injury? moa ___._. -----_ ®_.._.. --- 6. What damages or injuries do you claim resulted? (Give fun extent of injuries or damages claimed. Attach two estimates for auto damage ) SS:, "';i" � �ar°,b 3� •t'+, �a" „� #@ ti- �,+'rr %#• 7r a . How was the above claimed amount computed? (include the estimated amount of any prospective injury or damage.) re -------------------------------------------------------------------------------------- 8. Names and addresses of witnesses,doctors,and hospitals. f € x uL (g ce ` if - I �S fit�} f�..��"�r > v)��f,;. v e��<Rtc✓S 2�. sa' ��i�.;w a�, `�,.. � ^'�,''"�� n i'\�I +�£i.a .i s�•�"N d� ..Yr _..__o..w_-..--------..--__..r-rw--..®r-..------:_---.._r_..---_--a-_r__..-..a 9. List the expenditures you made on account of this accident or injury. (SATE ITEM A..MOUNT asa * aaaa * tvtiaaararxta * a * 'aikrh * a°ae ata * at * aatr Gov. Code Sec.410.211provides. "The claim must be signed by the.ciainiant SEND NOTICES TO: (Attorney) � or by some person on his behalf" Name and Address of Attorney ,1.;x3 " Claim ail 's 5ignature} w � s (Address} Nhone Telephone No. Telephone do 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 salve 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 fide 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 5r,rb imprisonment and fine. CI A.L 1 $OAR2)—QE SUPEMCMS OF CONIRA TA C'0Y�TV CAL Tlk'(')RN1A BOARD AM #arch 2, 1999 Claim Against the County, or District Governed by the Board of Supervisors, Routing Endorsements, ? NOTICE TO CLAIMANT and Board Actio. All Sectio references are to The copy of this 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 a pursuant to Government Code Section 913 and ,. 915.4, Tease noteall "Warnings" AMOINNT: $1,000,000.00 F E B fl :w> CLAIMANT.Vernon W. bodes °i'.'' �t���}}�� ATTORNEY: DATE RECEIVED: February 2, 1999 ADDRESS: lest County Detention Facility BY DELIVERY TO CLERK ON: February2, 1999 5535 Giant Highway Richmond, CA 94806 BY MAIL POSTMARKED: Unreadable L FROTNE Clerk of the Board of Supervisors M County Counsel Attached is a copy of the above-noted claim. PHIL BATC OR, Clerk z Dated: .February. 2, 1999 By: Deputy '�<.r >%;,F r 11. FRO-14- County Counsel 1`0: Clerk of the Board of Supervis rs ( tThis claim complies substantially with Sections 910 and 910.2. ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: By: Deputy County Counsel III. FROM- Clerk of the Board TO. County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. BOARD ORI}ER: 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 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 K41L 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 Order and Notice to Claimant, addressed to the claimant as shown above. Dated: v'eC4 By: PHIL BATCHELOR By puty Clerk CC: County Counsel County Administrator NOTICE OF CLAIM AGAINST THE COUNTY-OF CONTRA CO TA. (Government-Cods-ss 910 9 Lo.Z) Return to; C6untyClezk's suffice 651 Pine SEree£ Martinez, CA 9455 _.. Phone Number: CLAMNT FAME. ;` f. CLAIMANTS ADDR:SS: 21 Er r4TE 'r ! , . ( #ANT 8,16ti WA Number Street City State Zip 'Cade NAME ADPL}-ADDRESS' OF PERSON :10-.WHOM, NOTICES REGARDING THIS CLAIMSHOULD' BE SENT if different than ".Above) ;.. TP, ., ,w #Y DATE OF THE ACCIDENT OR:*OCCUREN'CEt . PLACE OF TRE ACC,1bB-NT Q OCCU'RENCE:.. GENERAL DESCRIPTION OF .THE.ACCIDENT C}Fi ,UCCURE�FCE (attach additional pages more space is needed) : n NAME � IF XXOWN f `'6F `ANY''L?UBL�IC p�MPL�YEES `CAU SANG THE INJURY t3R Lt3S5 r - NAMES AND ADDRESS 'O ..WITNESSES NAME ADDRESS TELEPHONE NAME AND ADDRESS OF DOCTORS; HOSPITALS WHERE TREATED: 13 NAME ,ADDRESS TELEPHONE GENERAL DESCRIPTION OF .'THE LOSS; INJURY OR DAMGAGE SUFFERED#- . "" TOTAL AMOUNT CLAIMED ' J � THE BASIS OF COMPUTING THE TOTAL AMOUNT CLAIMED IS AS FOLLOWS: Damages incurred to date: Medical Expenses: $ Lass of Earnings: $ Special damages for: " s1 LI Gam` C J' 8LUP-ED p�0 HAS 8LAct� M-F(f4; }��0 ; 5 - (Attach copies if available) I/We, the undersigned, declare under penalty of perjury that I/we have read the foregoing claim for damages and }snow the contents thereof, that the same is true of my/our own knowledge and belief, save and except as to those matters wherein stated on information and belief, and as to them, I/we believe it .to be true. DATED: signature of Claimant(s) Received in the City Clerk's Office this day of s 19918 S gnature FOR CLAIMS RELATED TO INJURY TO PERSON OR PERSONAL PROPERTY, THIS FORM ITUST BE FILED WITH THE CITY OF PITTSSURG WITHIN SIX MONTHS FROM THE ACCRUAL OF THE CAUSE OF ACTION. A CLAIM RELATED TO ANY OTHER CAUSE OF ACTION SHALL BE PRESENTED NO LATER THAN ONE YEAR AFTER ACCRUAL OF THE CAUSE OF ACTION. .................................. ......................................... ............................................ ...... . .............................................. .. .. ................. .. ..... . _ ...... ............. . ........................ ................................... .................................. WEST COUNTY DETENTION FACILITY ASSAULT ON VER_NON R®DES ON AUGUST 13,1998 IN MODULE 7-A DOCUMENTATION OF INCIDENT AND MEDICAL EXAMINATION. To Whom It May Concern: I Vernon W. Rodes declare as follows: I have personal knowledge of the facts contained herein and, if called to testify, I could and would testify to the following facts. On August 13, 1998 at 11:00 a.m., I returned to my module for computer class break. I went to my room to get my cup so I could make a cup of coffee. This particular day (Thursday) was module clean up day. Everyone in the module except the clean up crew was suppose to be locked down in the rooms. The water dispenser was located on a table by room #12. The water dispenser is normally located at the food servery. I walked to the water dispenser and filled my cup with water. I looked inside of the water dispenser and noticed that it only had a cup or so of water left in it. Normally, I always refill the dispenser when it is low on water. This particular time I did not refill it. I noticed a module worker opening his room. (Mike Humphrey) and I wanted to ask him for a packet of sugar. As I started to walk towards the module workers room # 1. A man named Kenneth Griffin was walking up to the water dispenser to get some water. Griffin was not on the clean up crew! I told Mr. Griffin that he might want to get some more water for the dispenser. As I was asking the module worker for the sugar Mr. Griffin started calling me a good for nothing lazy mother f----ker! He said you lazy son of a bitch why didn't you refill the machine! I turned from talking to the module worker and said hang on a minute and I will refill it. Mr. Griffin walked by me standing at Room #1 as he was heading for the utility closet with a large hard plastic water picture in his hand. He was still calling me names and cussing at me. I ignored him. I did not even look at him as he walked by me. After I received my sugar, I started walking towards my room # 62. About fifteen feet away from room # 1 Mr. Griffin was still continuing to call me names and cussing at me from the door of the utility closet. I said you rude f—ker there is no reason to call ane names and continued to my room. -2- As I was walking away, I heard him say what did you say. And I Just mored him. When I got to the top of the two steps in the center of the module, I started to turn because I could hear what sounded like feet running behind me. Before I could turn around, I was hit in the back of the head by something very hard. As I turned around, I could see that it was Mr. Griffin, as I turned around he hit me in the lower Jaw and chest with something very hard again. After that, he started swinging wildly at me. He had beaten me almost to the ground when I started to protect myself. When I reached a standing position he hit me once again in the right eye and face with something very hard. I was dizzy and blood was running from my face to the floor. My hands were on my knees so I could keep my balance. I was trying to locate Griffin because I was afraid that if he hit me again in the head that he would knock me unconscious. When I could see him is when I noticed that he had a hard plastic water picture in his hand. I do not remember what hand he held the water picture in. All I could think about was getting away from Griffin so he did not hit me again. I knew the Deputies were in there programs room so I stumbled with my hands on my knees to the food servery counter hoping that the Deputies would see me from there. After reaching the food counter Thank God, Deputy Sims could see me. He was standing in the programs room. Seconds later Deputy Amin rushed out the door towards me. Deputy Amin asked me what happened. I said that guy hit me with a water picture and I pointed towards Griffin. Amin said what guy, again I pointed towards Crim who was walking away from us towards room#4. Amin said I have had problems with him before and yelled Mr. Griffin come here. Griffin did not respond to the Deputy. Again Deputy Amin yelled Mr. Griffin come here. Griffen still did not respond to the Deputy. Again, the Deputy yelled for Griffin to come here. Deputy Arvin then asked rine if I could walk to my room. I said yes Sir and went to my room. Once inside my room I used some napkins to stop the bleeding from my eye and cheek where it was cut. The cut was approximately two inches long from the corner of my eye to my ear. My left ear and right lower chin was bleeding also. I was spiting blood. Within approximately five minutes, Deputy Bryant was at my room asking how I was doing. I said not so well. He asked if I could walk to medical. I said yes that I think I can. He said come on lets go. -3- 4n the way to medical Deputy Bryant asked what happened. I briefly explained to him what happened. He asked if I had the opportunity to return blows to Mr. Griffen. I said I did not think so. I was rasing my hands to keep from being hit. Deputy Bryant asked if I wanted to press charges. I said that I was afraid to because I did not want to be beaten up by the inmates for doing so. I told him that I would like to talk to a Sergeant about it. When I arrived, medical a male nurse named Anthony treated me. He asked me what happened and I briefly explained to him what had occurred. He said. that I was going to need stitches on the cut next to my eye and that I would probably go to Martinez to get them. I said fine. Another nurse in the room said that Lir. James R.ael would be arriving the office soon. She said that the doctor could take care of my stitches right here in this office. She also said that building four had called and the other party involved in the fight wanted medical attention for his hand. She said that she was going to take care of him and left the room. The male nurse cleaned and applied a disinfectant to the cut next to my right eye, the cent'.and right side cuts on my nose, my right forearm cut, the cut on my left ear, the cut on the back left side of my neck, and the cut on my right lower jaw, He asked if I had pain anywhere else. I said that I was sore all over my body. A Sergeant Hisey came into the room. He asked if I wanted to press charges. I told him that I was concerned about other inmates giving me a hard time or wanting to beat me if I did so. -He told me that he needed a victim to proceed with the filing of the charges. I explained to the sergeant that I did not provoke the man that did this to me, and what he did to me was wrong. The sergeant said that he understood however, he needed a victim to proceed with charges against the man that assaulted me. i said all right sergeant I will do whatever is necessary to press charges. The sergeant said Mr. Rodes I am going to send you to building four for a few days and then back to building 7-A. I said thank you sir. Hold me that a Deputy would be in to make a report on the incident. I said fine sergeant and thank you again. When Dr Rael arrived,he walked up to me, bent over in front of me, looked at the five little butterfly bandages holding the cut next to any eye closed, and, said that's fine. He said that I did not need stitches on the cut and started to walk away. I could not believe that he was leaving. He did not appear to be concerned about my well being at all? As the doctor was walking away, the nurse Anthony asked if he could give me some painkiller. The doctor said fine. The nurse said Ibuprofen and the doctor said yes -4- and left the room. I was given twelve 600-mg Ibuprofen pills. I was instructed to take four pills per day for three days. The nurse then handed me an ice pack to hold on the cut next to my eye. Deputy Amin then carne into the room. He informed me that he was going to make a report on the incident and then escort me to building four. Deputy Amin then made a list of the cuts on my head and arms. He asked how many times that Mr. Griffin hit me. I said eight times or more that I was not sure on the count over eight. He asked me if I was hurt anywhere else? 10_'said that my neck, jaw, chest, left arra, and eye hurt. I said that my vision in my' Reye was blurry and that there were specks in my vision. I told him that the right side of my face was numb. He asked if there was anything else bothering me. I said not that I notice at this time. The nurse took away my ice pack after ten minutes of using it. Deputy Amin then escorted me to building four. Once inside of building four Deputy Amin instructed me to wait for hire in the programs room so we could make the report. After making the report, I was instructed to go to cell # 17. It was 11:20 a.m. I could hear Mr. Griffin hollering from cell # 23 that if I pressed charges on him that he was going to do the same to me. The guy in the cell with me said that is the guy that hit me hollering out there. I slept the rest of the day of Thursday. That evening my eye was totally swollen closed. My jaw was so sore that it was difficult to open my mouth to eat. The right side of my face was numb. The side of my neck was sore. My right hip was giving me pain in certain positions of movement. There was pain in my left shoulder armpit joint area. When my right eye would move it made a crackling sound. When I opened my eyelid with my fingers, I noticed that the white part of my eye was totally red and my vision was blurry with black specks in any vision. My nose was plugged up and could not breathe through it. When I would blow my nose, I was getting blood out of it. My left shoulder was sore and hart when I moved it. I was spiting blood. 8/14/98 Friday I stayed in bed all day. I could hardly move I was so sore. 8/15/98 Saturday morning at breakfast(8:30 a.m.) I asked the Deputy on duty if I could use the telephone to call the medical office. He said go make the call. I called the medical office and told the lady that my head was pounding. I also informed her of all the other places that were bothering me. I informed her of the eight inch in diameter black and blue spot on my left shoulder. The nurse said that i would be ok and th."Kh I was old and it would take a long time to heal. I asked for more pain pills and she said she would get back to me. She never did get back to me with any concern about anything that I had mentioned to her. It was clear to me that I was on my own to deal with the pain: and heal. The Deputies asked more about the condition I was in than the so called doctor did. Saturday afternoon I was told to roll up my stuff that I was beim moved back to building 7-A. I asked the Deputy if one of the module workers could help me move my things to bldg. # 7-A and he said yes. Module worker # 1 helped me make the move. When I arrived building 7-A I was instructed to move into cell#31 with another inmate. At approximately 10:30 p.m., Saturday night I asked Deputy Garlin If anyone was going to take pictures of my face and cuts. He said for my personal documentation. I said yes. He said that he would get back to me. At 11:00 p. . Deputy Garlin called me to his station and told me that the sergeant said that there was no film for their camera. I said fine. At 11:30 p.m. Deputy Garlin called me to his station again. He informed me that the sergeant had called him back and said that he was rounding up some film for the camera. He said that he would call me when they were ready to take the photos. On 8/16/98 at 12:30 a.m. I was called from my room to the Deputy station. Deputy Anderson had arrived with a camera. I was conducted into the program room and Deputy Anderson took four photos of my face. Two from the front, and two from the side. Deputy Anderson documented each photo on a form that he had brought with him to the module. Deputy Ramireze and Deputy Marlin witnessed the photos taken of my face. On 8/18/98, I asked Deputy Amin if I needed to sign anything to proceed with filling charges on Griffin, He said that he would get them and get back to me. During lunchtime Deputy Amin presented me with some papers and said to read them and then sign them if I wanted to do so. I read the document and noticed that it stated that by signing it I was not going to pursue the filling of the charges on Mr. Griffin. I walked up to Deputy Amin and before I could say anything, he said now you realize that by signing those papers that you are stating that you do not want to press charges. I said yes sir I noticed that when I read the document. I said that I wanted to press charges not give up the right to do so. He said oh, excuse me Mr. Rodes I misunderstood you when you asked. He then tore up the documents and threw them in the trash. I asked Deputy Amin how much time I had to proceed with pressing charges on Griffin. He said that the DA had twelve months to do so. I said that I thought that we had a certain amount of hours to do it and that is why I had asked him. He said no that it was months and not hours. He said that I needed to contact an attorney about it. I said thank you Sir. -6- On 8/24/98 8:30 a.m. I called the medical office and informed there that I was experiencing pain in my hip, and getting bad headaches. The lady asked if there was anything else bothering me. I said yes that I still had blurred vision and black specks in any right eye vision. I also informed her about my face being numb on the right side. I informed her that I was eating six to eight aspirin at a time to relieve the pain. She said that it sounded like I needed a trip to Martinez to see the doctor. I said whatever it takes please do it. On 8/26/98, I was informed that I had a medical visit scheduled for that day at 1:30 p.m. at West County Detention Facility. When I arrived the medical office, a male nurse named Anthony took my temperature and vital signs. He is the same nurse that dressed my cuts on the day of the incident. He also weighed me and I weighed 187 pounds. I was conducted to an examination room. A person I assumed to be a doctor started asking me what was bothering me. I later found out that his name was Dr. Pizzo. He inspected my eye, ears, nose, and asked me if it hurt here or there as he touched me in those places on my head and face. The locations on the right side of my face that he touched I said yes I asked if something was in my eye and he said no. I asked why my face was numb. He explained about the two main nerve cords on my face and said that the feeling may come back in time, or if damaged by the cut on my face that it may never come back to normal. I asked why the pain was in my hip and he told me that a nerve may have been pinched somehow during the fight or a mussel was pulled. He told me that he was going to give me pain pills for two weeks. He said that I could pick them up tomorrow at 1:30 p.m. He said that he wanted to see me for another examination in three weeks. I said thank you Doc and left the room. On 8/27/98, I picked up my pain pills at the medical office. There were forty-two 600-mg Ibuprofen pills in the container. I have been taking the pills daily and I feel much better. Before I close this statement, I would like to mention that I had never had conversation with Mr. Griffin or any previous problem of any kind with him. Other inmates in the module informed me that he was having problems with a girlfriend that he was writing in the jail at the time of the incident. -7- I was informed that other inn 4tes were making fun of him because this woman was a "crack-head and would do anything for the drug". Inmate's black and white alike informed me that Griffin was always making racial comments and talking about slapping whitey around. There were inmates on the module clean up crew that witnessed the incident when it took place that morning. Other inmates watched from their cells. However, none of these people want to be involved with the incident in anyway. I swear under penalty of perjury under the laws of the state of California that the foregoing declaration is true. Executed this i y .._ . slay of � , 1998 in Contra Costa County, California P Vernon W. Rodes SS{ Y C { .Y 00 l ( �s 0 C T 0 ' _ _ t r ` N s s } .W y—. '+"'' � �. ,�•.. � .r,.n, � ,ate.. -�, �-. --�, � �+ 01 00 '— r04 tit Ro � `} f CLAM BQARD DE S1ffJMSQRS QE CU'Y'TRA. STA CC}t.Tri'T"Y. CALIII;'OMiA BOMB AO ylareh 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 ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claire by the Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: $485.58 CC;- ~ sLN EL_ CLAIMANT: Kitt. ScInwitters ATTORNEY: DATE RECEIVED: January 27, 1999 ADDRESS: 920 Oak Street BY DELIVERY TO CLERK ON: January 27, 1999 Clayton, CA 94517 BY MAIL POSTMARKED: Transmittal L F.fROIK: Clem of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claire. PHIL B HELOR, Clerk January:anuary 28, 1999 By: Deputy 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 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( } Claims 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: '� � t Deputy County Counsel III. I'MOR- Clerk of the Board M County Counsel (1) County Administrator (2) ( ) Claire was returned as untimely with notice to claimant (Section 911.3). IV. ARD 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 Carder entered in its minutes for this date. Dated: PHIL BATCHELOR, Clerk, By 4j6Z4f, , 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 Sectior. 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. *Por Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF NL4B-J!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. Bated: °" y: PHIL BATCHELOR By 4-Deputy Clerk 71 CC: County Counsel County Administrator January 25, 1999 -rAp Contra Costa County Risk Management 651 Rine Street Six Floor Martinez, CA 94553 Re: Damage Claim To Whom It May Concern: On December 11 , 1998, 1 incurred damage to my personal vehicle while traveling on Treat Blvd, between Cherry and Sheppard Lanes, I immediately contacted Walnut Creep (City Attorney's Office) advising them of the damage, They forwarded claim papers to my residence. 1 had the damage to my vehicle repaired, photographed and submitted the claim immediately to Walnut Creek. I recently had the claim returned to me. I was notified by Risk Management, Phil Steffen, the roadway where the damage occurred was County jurisdiction. He advised me to submit the claim to your office. I requested my documentation back from them in order to provide the same information to your office, Walnut Creek (City Attorney's Office) maintained the original copies and photographs I submitted, however did provide me with photocopies which are attached. Please review my letter submitted to Walnut Creek for details of the incident. As you will see I am only seeking a fair and equitable reimbursement. I recently travelled down Treat Blvd and found the pot hole had been repaired. I thank you in advance if your agency took care of this hazard. Please contact me should you have any additional questions. Sincerely, hittF Schwitters 920 Oak. Street Clayton, CA 94517 (925)779-6964 work (92'5)673-3344 home A MUNICIPAL RISK MANAGEMENT INSURANCE AUTHORITY 19 : BAPS MIGUEL DRIVE - SUI'T'E 200 m WALNUT CREEK,CA94596-5332 (925;943-1100 FAX(925)946-4-83 January 15, 1999 Kitt Schwitters 920 Oak Street Clayton, CA 94:17 RE: CLAIMANT: Kitt Schwitters CLAIM NO.: 1008524 OUR PRINCIPAL.. City of Walnut Creek DATE OF INCIDENT, 12/11198 Gear IVIS. Schwitters: Per our discussion, attached you will find the original claim, photos, and estimate that you sent to us, I suggest that you direct your claim to the County for further handling. Very truly yours, Phil Steffen Liability Claims Adjuster PSBsep Attachment RECYCLED PAPER a CLAM PRESENTED TO T . CITY OF WALNUT CREEK R r Please read the instructions on the tzack before corn lain . �, ' 4 (PLEASE PRII'�' "} t . .sc u t vt"-1` 5 DE( " 1 Claimant's Address: PAO Oa& SME-a-7- CITY CLERKcc: , CA City, State, Zip: 64/7`01!, 7�9 G. &LNUT CREEK, Day Phone: (-Y,�Sj &73-3344 Eve Phone: (?A,$) JV-334 City Claim# !Month: tmber- Day:11vdalYear: 1948 Time: am. X'z P.M. 3. At which to a 'on damage or ir:iu- ? � 7-re 8i vd be fit -4, sha--d A&A eT /ra' the 4.3 141 CIO C ;..& s Lei . Mat is Jh ,City r irk? a. deldvtr? an 7reeg;t cornets i°�vtr7 de,-eel-ion ap4es,'- /i br lr , ler ewe, *.;3 eCcr� .tF side. CA + .c To-d a- � r�l� �z'arn��� �� 'th44 .scrt.t rte' t0 rem 5. What damicy occurred? or ioccurred? t7r-n 41)d� of 7h t7,�,tr,-L /n �{G I,c2L: 'rg� tsei � Y«it ' c 4tGlt[rt ,,fe1rL PI�fCL 4YYi /V veiea „L im � C'raG "t { 6. Claire:amount (on:y if less than $10,000): of If the amount exceeds $10,000, please check the court of appropriate jurisdiction: _ Municipal Court (claims up to$25,000) Superior Court(claims over$25,0001 7. How did you arrive at the amount claimed?Please attach documentation. �'r�cz ��t �`�t�#-�i � �'�'-� r,- St��E �:t}Y�l;�'r:,�s� �- ,'�:1�:�rr��-.:� t �'c>.t-�-• �t%�- t'tt�n�� I. 8. 1 declare under penalty of perjury under the laws of the Mate of California that the following information is true and correct,and that this declaration was executed on I91—f at - : .�._ CA. �Signa!ure of Claimant or Representative's Signature 9. ( � cia '�Icces and orresondence l represertcd by an insurance company or an attorney,please provide the information requested below. Name and Capacity: (PLEASE PRINT) Address: City, State,Zip: Daytime Telephone: { } Pvenin `fele hone: ( ) December 15, 1998 City Of Walnut Creek Tom Hauss, City Attorney PQ Box 8089 Wainut Creek, CA 945961 Be: Damage Claim Gear Sir, On December 11, 1998, at approximately 3:30 P,K, 1 was traveling in my personal vehicle, on Treat Blvd, between Cherry and Sheppard Lanes in the number three lane. My left front tire hit a large pot hole in the roadway, causing me to swerve slightly before regaining control of my vehicle. I pulled to the side of the roadway and observed damage to the tire, which was now bulging. My alloy rirn received minor damage in the way of scratches. I immediately telephoned your office and spoke to your secretary, requesting a claire fora and advising her of the damage and the existing pot hole. I was able to drive my vehicle to my Clayton hone where the tire basically gave way. On December 12, 1993, 1 returned to the area to photograph the street and surrounding area, focusing on the pot hale. This hole was able to accommodate my entire tire and was approximately 10-12" deep. I also took photos of my vehicle, pre-existing tires and condition as well as the damaged tire. (see attached photos) ;deedless to say, I was forced to replace the tire. Due to the fact, I had 23,000 miles on my vehicle, it was recommended through Volvo, i replace all four tires at the same time to rnaa!nLa,n handling and safety capabil:t:es. Prior Lea thisnc�dent, I had low-profile Michelin tires, which. are rather expensive to replace. I was able to replace all four tires at a more reasonable cost by staying away from this brand and profile. 1 was also given a wonderful discount on the tires at the time of purchase. As I wouid not expect the City of Walnut Creek to incur the total cost of replacement, I am asking consideration for a fair and equitable reimbursement. I have enclosed a copy of the invoice from Americana Tires, where i purchased the new tires. Reasonably speaking, I would have replaced the tires I had on the vehicle, around 35-40,000 miles. Therefore, by splitting the total cost in half, I feel would be fair and equitable. Please consider my clam; for your review. Should you have any questions or concerns, please contact me. Sincerely, Kitt B. Sch Twitters 920 {yak Street Clayton, CA 94517 i I" .nq ag irc { L t CLERK X i '5757941,, 575794 SATE 1�-1 11999, 4; 13 PM Tit Gtl, `77'�41 SCHW TTERS,KI T T CAN 08 1 2402 SAN .JOSE DRIVE SOLD c c0 CC K ST STORE# TRAN STORE ADDRESS TO i s ';`" l N iGA 94E,i g AN T I OCH CIA 94509-0000 SALESPERSON 925-706- 575 DL: N454455c C90E Cc N DESCRIPTION x Pi'7-'TZ 5 r:'sa - 16 89Y ' OV'.0i"AN"A X3'30 21-.e=iCK 0.,')Ga :360.071 80017 1 4 CERTIFICATES 11.75j 47.00 8007 _ 4 STA77 REQUIRED RED E 4vtI RDNIMFNTAI— FEc 0014 1 4 LIFETIME COMPUTER SPIN BALANCE 11.00 44.00 1 4 RUBBER VALt�E lb.00 dam 00; ; 36..36 z-511 YOL VO 85 1 TAX; W3.158 #UNITS: 4 ACC i Al 2,1505-71 .1.Il: ::�390 AUTHif 00 i G F 01— :..} .. CHECK. 485.52 WORK ORDER LIMITED WARRANTY REPAIR � LIFETIME WQRKsMANSHIP/MATERIRL.S ROTATION � L�m REBALANCE FREE REPLACEMENT ENT ROAD HAZARD AIRCHE K `-A ERR 13 0600 MILEAGE WARRANTY RETURN TIRES AR MILEAGE, ,. t CHANGE SNOWS } S 1 � ���a �1 l s?:}tJ✓ CUSTOMER. �—�- � RET#GHTEN LUG NUTS AFTER 25 MILES '`ustorrat signature � ^ardho;dar ckrowiedgaa raceip4 0l goods andlor services in the 'INITIALS amount . aha Total.pawn hereon and agrees to perfarm the 0mgm%ns sat,girth in the CardhafdaYs agsasma,i with the Issuer. N4 � W f � F Y t� taut d r A � qF � f f;f 6 4 r x y { Inut OTA, a.•fryY'.� `f>wk, 6 a;hr ,- 4 ' Y '�^$ > ;•f 5 {S. Y+X C. •xc� � JxiYC'Ty �t h y fiW �} x ,, ANY}y�'+T`''��c�e �, ��:i:'e'$h'v'�f'.�,. '•4. Y h F.-�xi.• > „eF4 4+ OM .. - N A Z,k E r t 7 3G d'�\Ng✓h..3 f..'X" A 'c J - ,t•-" 1 fi'�d� '� ly y,,y+k�+4 X.%i '� '. 'i" + -• - •x �''�`.w` "t."r.4 1, t'"a�T �`�'''`Yy£w'••a—"''.st, � a ,�. `"» a_ t _. .% Y.,,y y{._. A '"'�` +.'qfY'�'>u y�#Y?.� ""��ro`,•r ,{ � ..'c`$'s�..,H ti y,•,e, .a 'r :>�Aa` t''��'lqr-' f 1 } F � j e y } f +, y +� if I'-Jff �✓ M lir � f lot 4P X l f� t :r..,.. } �i ff�, 9R04'Y�SUOP}N 4 Sf< M / 6 �p f J' ; .; f ,r :r wraueae�w+occ.�,,, ' �fi2aF.$tP,�,f w T 5� {{ p v. s di i } Y � CZAIIVJI R. ?�RD OF SUEERUSORS OF CD.Ni 4 TSTA C 12ilL CAIJZQRNIA B D ACTIO rch 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 emailed to you is your California Government Codes, ) notice of the action taken on your claim by the Vl Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and Ary RR 815.4. Please note all "Warnings". 0 99 i V! k„ AMOUNT: $1,800.00 CLAIMA'N'T: Jo='canna Turley ATTORNEY: DATE RECEIVED: January 25, 1999 ADDRESS: 2604 Silvercrest BY DELIVERY TO CLERK ON: January 25-, 19-92-- Pinole, 5, _1999- _Pinole, 0A 94564 BY MAIL POSTMARKED: Jantza.ry,22. 1999 L FROM- Clerk of the Board of Supervisors M County Counsel Attached is a copy of the above-noted claim. PHIL BA7,CHELOR, Clerk , Dated: January 25, 1999 By: Deputy ,rte .� -etr IL FROM: County Counsel TO: Clerk of the Board of Supervi rs (This claim complies substantially with Sections 9103 and 910.2. ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant, The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: By: Deputy County Counsel U FRO',4 Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). W. OARD C7RDFIL- By unanimous vote of the Supervisors present: ( j 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. Bate PHIL BATCHELOR, Clerk, By , Deputy Clerk WARNTING (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. AFFMA` I'r OF NIkILL 1G 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 to the United States Postal Service to 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 Cl.alr. for BOkRD OF SUPERVISORS OF C093A COSTA CCIt Y INSTRUCTIONS TO C£.ADIAty" AQ Clai relating to ruses of action for death or for injury 'o per son cr to per- so^ l property or grow .ng crops and which accrue ren or before D ember 3i, X87 must be presented not later t,Ian the 100th day after the accrual of the cause of action. Claims relating to carries of action fear.death, or for injury to person or to personal property or growing crops and which ague on or after .unary 1, 1988, must be presented not later than six months after the accrual sof 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 S. Claims mast be filed with the Clerk of the Board of Supervisors at its .of'f'ice in Rom 1.06, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. f claim is against a district goverr.ned by the Board of Superviaors, rather than the County, the name of the District should be fill in. B. if the claim is against more than one public entity, separate claims must be filled against each p=ublic ezntity. E., Fraud. :. See penalty for fraudulent. claims, Penal Code Sec. 72 at the end of b,h s form. y y, ye yy yyg y y g yYy y yyY ( yy Yy yy, y{j, y lL y y YL y REa Claim By Reserved for Clerk's filing stamp ~ z ox t a ..... t Against the City 7F Conga Costa or } BOARD OF SUPE C3R Districts �O T�CO, ., : Till in nam ' :e undersigned claimant hereby makes clams ag `rst the County of Contra, Costa or the above-named District in the s= of $ end in support of this claim represents as follows: l.. When did the rime or injury occur? (Give exact date and hour) E .1 57 2. Where did the dal6ge or injury occur? (Include city and county) , ... £.✓.vim ,s,.{ ;,. w. L, .+,&" ...+ ✓w- 'i..3.. � „F9.. * s .+�.+� P .✓ '{;,,fi:'ufL Y-�:.savw 6r ! ! • draw did the damage or injury occur? (Give full deta s` use ext �r } � � rrequire d . �: M, _v"s.;, :.�2., .,gr, -.+?.s3.:;srt ,d r e 1 d �s r z> Lr 3>x a fie- r £' w Wha Particular act or omission on the part of county or district of'ficers, {< stents or employees caused the in jur►yr or.damage? "'�.. sG C k:--/. c a- w• t'p'''r ,r' v"� r r' *`. X '>• ^trill 'a�.^�L'".`, yam. Z5L 7- f gra'{ t "z.:.• r. s (over) ft. F'€� * %" ' �a wnat are the yes of county or district officers, servants or employees causing the damge W injury' .� What damage or injuries do you claire resulted? (Give full extent of injuries or damages claimed. Attach tW estimates f auto 7. Now .s the amount claimed above computed? (Include the estimated mount of any perspective in jury or damage.) ZZ 9" t CZ ®-Arid MnA Mddr4-_ssos of witnesses, doc:'to-s and !iospi to ls. d¢ + ., List the expe.ditures you made on ac to of this accident or n;u. `2 ITEM, i,rG' s . '��-�!&� ::YS'3.••.aY � .. •--�� mom°. � 3'*'� ,�?° Gov. Code Sec. 91G.2 pfrov.ides: "The claim =st be signed, by the c:l. ir�t° SEND NOTICES TO: (Attorney) or by some cerscsr. on his.L>ehalf." Name and Address of Attorney flaimart's Signature, -.1 Telephone No. Telephone No .f' € wilt it a� 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 ary 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.f'or a period of not more than one•3 `# by a fine of not exceeding one thousand ($1,000), or by both sum 'imprisoMen"t and fine,•or'by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,0000 or by. j both such imprisonment and fine. -a GS 00000 O O -1 'V "v O � = O %W W N N L71 j � Tn n -t Un N.) c � � o O •LLn .11 M :2 N 0 10 m N C7 LEt81 D mx pTp d'15T3 0h> N �C,. -t Om0m n c S trt7s �7� 0 0CI3t � �s xin C -< �-i � rr. r- 0 00 N W m ' m :3 C LL` ry m n r7 r C RT 'r5 --s p0CY �esm nr cr < r. 3 v n wX 0 r' -+C r T7 w -i m -c ti •-i r 'x m > m Mo h 1OG � C77c3 m rtmra rma00 N� x r # 0 m O 9 -4 ,r hr -t v+m o 11 N -e C7 �m > 0 go N V 10 10d G7 N W W < tNi�. Cal M -d 0 Ln W Vit..a -L-5 t 7 Cx W O r- < < 10 NJ N m N cc A t�"T 'o 0 03 ..,j r m vs to 0 C:) - Nc O N n 0 10 � o m L-4 'o c `- w co'o 0 y r m n rNv m 0 c)C)) co M Lq Ln Ln Ln � s n s � <T > 10 LA � a u; 03 to Cry to.,m -a0-•C,'0= © 03y c �N c�C> 3CA .r0v7W;o > OLit O0n0 NriNun Wm cn —t (r, oNtnOsk m > zw, es > a0 � ? n m cl N r- n W r m m m M = z �, o D-e 0 > Om 06 W C7 m < -< m .. n --Im `p z �arc�nr� n o A y to -a -t r -t0 m o m > �. L,4 re st C tort V! �F fi7 7 © O Ln m N ca W 0 O O 0 O O cJ N + `C yJ ND Nruru P13 — V WV CC W W 44 4m O W N-� ,a C O C*C 10 Ln C x W°qs �5 h: W W co+`j tt3 Q �_7kj O B C3 V DIATE 12/01/98 __.--u_-m.._..._--..v__•._________ __---------------------A COUNIT TRANSACTION SUMMARY-_.__-..._-__..___W_-..-__.._-___..___.._..____.__-.____..__-___- PRACTICE WICE: e' RKELEY ORTHOPAEDIC MEDICAL GROUP. IN 25 ORIN'DA WAY, STE 100 CRINDA. CA USA 9456.-- r-45-253-9182 ACCOUNT NER: 243386 FINANCIAL CLASS 8s AtRiMG W GUARANTOR: PATIENT; INSURANCE: `-LIPLEY, JCHA NA C 01, TURLET: jCHANNA C INS 1s UNITED HEALTHCARE/;ALTA BATES ,{•, Sr RCREST SS#x 566-52-1 (-; CLAINa 562-50-6 038 PINOLr CA ISSN 94564 26,`)4 SILYERCRES$ PINCLE, CA USA 9,4564 Puff., H: H: e 51 22-'-- `r940 (( w T✓PE BE ',�T v CC1)E DE sr.r^:.lp ,sit 1, � i r,r" All'! IU i!" � �t"W. _n! t'rit �}"s�il"� 1,...ir ti.•�`i.,'t;, z_ d e�1� i.�lt� i.+.r+s r3 z�i�ak BALANCE _=�sw .. t!+ ... v 01 c4..: 4r101r7-v.f i.:.vt'L ii t . _ .. , `.?1502f S:7:0 525 20 A - :3'),'��+1";3"` 1 N i PMMT ad:'P ! 4 1 —0 4011) L• 105 z .. :7i 9'?:•a.i i.wlhS *'i OFF VISIT LGvs;._ {i .. ?'i -�r, i .;.){'i r t�1 i l l t _ 1600 PERSONAL �.t'4i�t..t 1 2 1 +i{0. 1�I 11 ;? EST. r>1PKEM 1 m ., f'=r,.. r •'. 7,;i,+20 r 01CT %W i d � 1 -�,.,'•.F I z 00 2112!F L8._#'S. A i 11y':rt.':. 1 i�-_j Ct- p �,:� cp m _gu' 7`t T DOCTORS: 6'�.s'.,.�'.i�Y 7AA IT: .rye o MD SUBSET AMM0, M0, Nj'13111JES71' TOTAL cuppZE-N7 30 DAG 60 DAys To ENS No DNS to DAG SUBSET TOTAL AS INN. $,Cts, $-oo $,0,i $, i,. $,r:«7 ---.;:,(; , —...__—..__.—__..._.._�....�_ _. ,r4.,a.t � , �__,..._....__...._..,._....___.___.__..__.._�_..._«.__.._....�.�...._.�...—._e...... C:_. .�t`,�'�..� c.i.:. ewe. .. _I rL;'`, :. �' fti.C.I 1 is rr�"*`Il,:`i?•i 1 ,-r '+ „ .,.-.. •ATF ":a` fl :'1C; r: r 'rT It r.!iC r tr ieF,ns 9;'r r r t^ r.>ar `=r i ." t)� i�i i�.�tte s-tJi•C `'r. :.l "sbCI� .:�U.: L}i�l� i..(.rL rlt+:a4�N, �a,:.�:'�S.t.. `UG L�rtsa;f"_?L:S FU L AC NG, ;..T1d�,�L SJ n;NT TOM r+}*}:C`9 CO )1,) L.'<;) 1.),1`) Nf__Jl+,iT �'r�•..:_ ^'47 ,;1.`-;; `mo i, d:,.. PA w;iaC.NI!J 'o-aWDJti5:.IPB I:: ,,=..1 Yr ESTI• i I}�1L�i'�i"1'� :`w} }i,) y r,Yn r. XV s 1 00 Ln LA06 �- E r 0 �- Lai i. Ln - f i K 0 a'0 ; � +� jy( n 40 le } 3 SSS ,i q RCC'S�C'�SC.PA'*FTJ.'^.5�Ti:^_i:' •3:•Zv:�:4 ,...pn.'"r�-,'^__.....__ y...:.., g n .. � 8 ! > ifp■� :mow✓ '.i a wd S t CIJAIM BOARD OF SUP .MSO135 OF CONTRA COSTA COUNM C``AI ORNIA BOARD ACT1011 ', 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 The copy of this document mailed to you is your California Government Codes. ' a of the taken pour claim }ythe �ad Surviso . (ParagrahlUbelow, given pursuant to Government Code Section 913 and 915.4. Please node all "Warnings" V �kM0UNT: Jurisdiction of the Superior C t CLAIMANT': Catherine Wildermuth ATTORNEY: Donald S. Edgar, Esq. DATE RECEIVED: February 3, 1999 50 Old Courthouse Sq. , Ste. 610 ADDRESS: Santa Rosa, CA 95404 BY DELIVERY TO CLERK. ON: Februa-ry 3, 1999 BY MAIL POSTMARKED: February 2, 1999 L FROM: Clem of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PML BAT LOB, Clerk Dated: FebruaEX 3, 1999 By: Deputy IL FROM: County Counsel TO: Clerk of the Board of Supervis rs ( is claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910,.8). ( ) Claim is not timely Bled. 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: a Dated: '` ' By:mi Deputy County Counsel 13L FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IVOAR1J OItIIERs 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. g /qff 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 fhis Notice. A.FF UDAVIT OF NIAUXiG 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: PML BATCHELOR By _ Deputy Clerk CC: County Counsel County Administrator RECD{ 1 Donald S. Edgar Esc SBN-139324 � THE LAW OFFICE OF DONALD S. EDGAR 2 503 Old Courthouse Square, Suite 610 Santa Rosa CA 45404 _ 3 707 54�-3200 �707� 578-3040 (facsimile) . .��000��..-.. ,... .. 5 Attorneys for Claimant CATHERINE WILDERMUTH 6 7 TO: COUNTY OF CONTRA COSTA Clerk Board of Supervisors 8 651 Pine Street, 1 Floor 9 + Martinez, CA 44553 10 1 . CLAIMANT'S NAME: CATHERINE WILDERMUTH 4830 Hilltop Drive 11 El Sobrante, CA 44803 12 c/o THE LAW OFFICE OF DONALD S. EDGAR 50 Old Courthouse Square, Suite 610 13 Santa Rosa, CA 95404 14 2. ADDRESS TO WHICH NOTICES ARE TO BE SENT: 15 Donald S. Edgar, Es THE LAW OFFICE OF DONALD S. EDGAR 16 50 Old Courthouse Square, Suite 610 17 Santa Rosa, CA 95404 18 3. DATE OF OCCURRENCE: October 20, 1448 19 4. LOCATION OF OCCURRENCE: 20 Contra Costa County Regional Medical Center 2 5003 Alhambra Avenue 21 Martinez, CA 94553 22 5. NATURE OF OCCURRENCE: 23 The legal basis for the claim is that Contra Costa County Regional Medical Center and Dr. Jennifer Siegel improperly and negligently rendered treatment and care to 24 Catherine Wildermuth by inter glia, improperlyprescribing fenfluramine and/or phentermine, failing to adequately examine Ms.Wildermuth before or during the course of 25 treatment, and failing to properly diagnose Ms. Wildermuth. 26 b. ITEMIZATION OF INJURIES AND DAMAGES: 27 The claim is in an amount that will place it within the jurisdiction of the Superior Court, 28 - 1e I Claimant sustained damage to her cardiopulmonary system, including but not limited to contracting Primary Pulmonary Hypertension, damage to her mitral and tri- 2 cuspid heart valves from the consurn tion of"Fen-Phen" diet drugs prescribed by )ennifer 3 Siegel, M.U., with the Contra Costa Iteg oral Medical Center. 4 7. NAMES AND DEPARTMENT 4P THE PUBLIC EMPLOYEES CAUSING THE [OSS, IF KNOWN:5 )ennifer Siegel M.U. 6 Contra Costa keglonal Medical Center 2500 Alhambra Avenue 7 Martinez, CA 8 DATED: February 2, 1999 THE LAW OFFIC DONALD-S. EDGAR 9 011�0 0-0 By 10 Donald S. EdgarEsq. II Attorneys for Claimant 12 13 14 15 16 17 \\server\cases\phenfen\c€€ents\wildermuth\county:;!aim 18 19 20 21 22 23 24 25 26 27 28 - 2 - I PROOF OF SERVICE 2 STATE OF CALIFORNIA, COUNTY OF SONOMA 3 I am employed in the County of Sonoma, State of California. I am over the age of 18 and not a party to the within action- my business address 4 is 50 Old Courthouse Square, Suite 610, Santa Rosa 611 ornia 95404.. On the date below indicated, I served the foregoing document described as: 5 6 NOTICE OF GOVT. CLAIM 77 by lacing the true copies thereof enclosed in sealed envelopes 8 addressed as stated on the attached mailing list: 9 COUNTY OF CONTRA COSTA 10 Clerk Board of Supervisors 651 Fine Street, 11 Floor 11 Martinez, CA 94553 12 13 X BY MAIL 14 15 X;; I caused such envelope to be deposited inthe mail at Santa Rasa, U California 95404. The envelope was mailed with postage 16 thereon fully prepaid. 17 I am "readily familiar" with our firm's practice of collection and 18 processing correspondence for mailing. It is deposited with the U.S. postal service on that same day in the ordinary course of business. 19 Executed on February 2, 1999, at Santa Rosa, California. 20 21 � I declare under penalty of perjury under the laws of the State of California that the above is true and correct. 22 Shannah Maszk 23 Type or PrintName' Signature 24 25 26 27 28 . 3 _ CLAIM BOARD QF M _ O QE CDN SIA COUNICys CALMORNIA B�__ARDD A�C11March 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 The copy of this document mailed to you is your California Government Codes. T :K� ry notice of the action taken on your claim by the 21 "' �,Z Board of Supervisors. (Paragraph 1V below), even pursuant to Government Code Section 913 and ," 915.4. Please note all "Warnings". AMOUNT: Approximately $10,250.00 GIIAU � CLAIMANT: Pamela Witt and California Casualty Management Company ATTOR'N'EY: Leslie Prince. DATE RECEIVED: January 27, 1999 Attorney at Law ADDRESS: La-v7 Offices of Russo & Prince BY DELIVERY TO CLERK ON: Tia rZr 7,� 1999 740 Texas Street, Ste. 202 Fairfield, CA 94553--5508 BY MAIL POSTMARKED: L FRROI♦I: Clerk of the Beard of Supervisors M. County Counsel Attached is a copy of the above-noted claire. PHIL BAIPELOR,Cleric Bated: January 28, 1999 By: Deputy r 11. FROM: County Counsel TO: Clerk of the Board of Supervis rs �,,rThis 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 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ) Other: Dated: By: (-4/ f Deputy County Counsel e M. FROIN-1 Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV.,,BOARD ORDER. By unanimous vote of the Supervisors present: ( This 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:YWZPHIL 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 claire. 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 I4IAHJNG 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:Y'I,tk � 11 /1 By: PHIL BATCHELOR By � putt' Clerk d CC: County Counsel County Administrator —Paw OfficEl of,::.-RUISO & _(PTInCE Brenda Rosso Woolsey 740 Texas Strut, Suite 202, Fairfield, CA 94533-5508 Leslie Prince,Attorney Attorney Telephone: (707)427-5777 facsimile: (707)427-1233 (Formerly'Leslie soroch) CLAIM AGAINST PUBLIC ENTITY A'; '✓ ' hl'nn e TO: COUNTY OF CO?�TRA COSTA Claimants: California Casualty Management Company 1650 Telstar Drive Colorado Springs, Colorado 80949-9700 (719) 532-8000 and Pamela Witt 34 Canyon Dr. Port Costa, CA 94569 (510) 787-3376 Address for notices: c/o Leslie Prince,Law Offices ofRusso&Prince, 740 Texas Street, Suite 202, Fairfield, California 94533, telephone number(707)427-6777. Date.place and circumstances of incident: On August 5, 1998, an elm tree located across the street from Pamela Witt's house fell over, causing damage to Ms. Witt's house and personal property, and to her car which was parked in front of her house. The County of Contra Costa owned the tree and/or was otherwise responsible for maintaining the tree in a safe condition and failed to do so. Description of injury: Pamela Witt sustained property damage to her house, personal property and her car. Ms. Witt had car insurance and homeowner's insurance with California Casualty Management Company. California Casualty Management Company made payments to Ms. Witt for some of the damages, pursuant to the applicable insurance policies. Ms. Witt seeks reimbursement of her out-of-pocket damages, and California Casualty Management Company seeks reimbursemnet of the amounts it paid to Ms. Witt towards the damages. Public entities/employees causing injury: County of Contra Costa, and its employees whose names are unknown at this time. 1 Amount of Damages: Approximately $4,250 for damage to Pamela Witt's car, and approximately $6,000 for the damage to Ms. Witt's home and personal property, for a total of approximately $10,250. Jurisdiction would rest in the municipal court. Date: 2- qC7 LAW OFFICES OF RUSSO & PRINCE By: LV91AE PRINCE, Attorney at Law, on behalf of Claimants PAMELA WITT and CALIFORNIA. CASUALTY MANAGEMENT CO. 2