HomeMy WebLinkAboutMINUTES - 04271999 - C14 7
CIAI
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Claim to: BOARD OF SUPERVISORS OF CON'T'RA COSTA COT �
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, 2987, must be presented not later than the 100u' 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. Cade§911.2.)
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 146, County
Administration Building,651 fine 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 claire is against more than one public entity,separate claims must be filed against each public entity.
E. Fraud. Ser penalty for fraudulent claims, Feiial Code Stx. '72 at the eat!of this farm.
RE; Claim by } Reserved for Clerk's Filing Stamp
}
Against the County of Contra Costa IVED
or [MAR=1119909V
z
s
District g JERK 80AR3 GE Stl'E I!$60"�
(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. ld,0, dO and in support of this claim represents as follows:
1. When did the damage or injury occur? (Give exact tete and Hour)
___---- _ ---_________________________________________________
2. Where did the damage or injury occur? (include City and County)
_- -
3. How did the damage or injury occur? (Give lull details;use extra paper if rrtluired> ___ __________
_____________________________________________________________________________________
4. What particular act or omission on the part of county or district officers, servants, or employees caused the
injury or damage?
(Over)
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CLAIM �
BOARD OF SUF, MSC}RS OF Ct7 IELA CC}STA COUXMCATIA
HWDL ACTT April 27, 1999
Claim Against the County, or district Govetned by 3
the Board of Supervisors, Routing Endorsements, NOTICE TO CLAIMANT
arld Board Action. All Section references are to } The copy of this document mailed to you is your
California Goverwrient Codes. } tiotice of the action taken on your claim by the
t yrs 7 Board of Supervisors. (Paragraph IV below), given
pursuant to Goverment Code Section 913 and
M t- 915.4. Please note all "Warnings".
AMOUNT: $860.24 °<ViN "A
~- Am
CLAIMANT: Pamela Hulse
ATTORNEY: DATE RECEIVED: March 26, 1999
ADDRESS: 1861.6 Walnut Read BY DELIVERY TO CLERK ON: March 26. 1999
Castro Valley, CA 94546
BY MAIL POSTMARKED: March25, 1999
L FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
PHIL BkT- BELOR, Cler
Dated: March 26, 1999 By: Deputy
IL FROM: County Counsel TO: Clerk of the Board of Superv` ors
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 claire (Section 311.3).
( ) Other:
A I s _
s By: j `rtsS Deputy County Counsel
Bated: '/
fy
III. FROM- Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claire was returned as untimely with notice to claimant (Section 911.3). x.
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 Carder entered in its minutes for this date.
bated: �� 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 snail 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 MAIMG
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: R By: PAIL BATCHELOR BDeputy Clerk
CC: County Coursel County Administrator
Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRI CTIONS 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 Claire is against a district governed by the Board of Supervisors, rather than the County, the name of the
District should be filled in.
D. If the claim is against more than one public entity,separate claims must be filed against each public entity.
E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form.
RE•. Claim by ) Reserved for Clerk's Filing Stamp
ti U—IL
:..,
Against the County of Contra Costa
or _
District
(Fill
(Fill in Name)
The undersigned clairnan hereby makes claire against the County of Contra Costa or the above named
District in the sura of$ and in support of this claim represents as follows:
1. When did the damage or injury occur:' (Give exact Date and Hour)
di
_______e__ °_____. _ _- _ _� _a______.__ m _____________________..__
2. Where did the damage or injury occur? (Include City and County)
C on ca rda o, C,4 S
3. How did the damage or injury occur? (Give full details;use extra pager if required)
#� 9 0 f e, rip q2. s
4. 'What particular act or omission on e part of county or district officers, servants, or employees caused the
injury or damage?
9*%"� hoad hM,,t W+4A^
t S tpfll
W .. � � gi+"e AA Axfver i
�� j
S. What are the names of county or district officers,servants,or employees causing the damage or injury?
(AnKnown
t5 _What damages or injuries do you claim resulted' (Give full extent of injuries or damages claimed. Attach two estimates for
auto damage.) a
(A4 ho kX)
____ ` __________ _______ _____-____ --- -..______f _ ______________
i. How was the above claimed amount computed: (Include the estimated amount of any prospective injury or damage.}
ca 5 4. oft rtf le- fl'�.Y (0i t � x
Y t. W YN4�t
-------------------------------------------------------------------------------------
8e Names and addresses of witnesses,doctors,and hospitals.
y,s
in
9. List the expenditures you made on account of this accident or injury:
LATE 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
(Cla` ant's Signature}
a �
(Address)
C
Telephone No. Telephone ilio.
NOTICE
Section 72 of the Penal Code provides:
"Every person who,with intent to defraud,presents for allowance or for payment to any state board or officer,or to
any county,city or district board or officer,authorized to allow or pay the same if genuine,any false or fraudulent
claim, bill, mount,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.
FROM EH,011E HO. 40 941 K-25 'Z2 1939' 1x2:45f'M P1
87
MAIN STREET PAINT & BODY SHOP
�.�cerse �#:�#. 155791
"QUALITY AT A MODERATE PRICE"
e-mail mainbody@aol.cry :
312 SOUTH MAIN STREET, #5
MILFITfiS, CA 95035-6821
(408)942-8220 x'ax: ',408) 942-0325
PRELIMINARY ESTIMATE
Wr1tter. by: LUPE ORTIZ, Jig
Adjuster;
Insured: Pam Hulse claim
Owner: Pam Hulse Policy #
Address: Deductible:
Date of Loss:
Feat; (510)247-0808 Tym of Loss:
Paint of Impact*
In"ct
Location:
insvran e
Company: Days to Repair
99 DODO BR2500 4X2 QUAD CAB 8-5.9L-•FI 4D SHORT Int:
VIN: '.B 7XC23?2XJ536880 Lic: Prod Data: Odometer:
Inte-rmittent Wipers Dual Mirrors Power Steering
Power Brakes Ait l-Lock Brakes (2) Driver Airbag
Passenger Airbag Split Bench: Seats Rear Step BL.iper
-------------------------------------------------------------------------------
Nth. OP. DESCRIPTION QTY EXT. PRICE LS'0OR PAINT
-------------------------------------------------------------------------------
1 WINDSHIELD
2 Rept Windshield NAGS 1 668.80 2.1
3* Repl Adhesive kid 1 25.00
-------------------------------------------------------------------------------
Subtotals - 693.80 2.1 0.O
1
PROM PHONE NO. 4O8 942 0223 MP.R. 22 1999 12:4GPM P2
03/22/1999 at. 1108 YAM "tib "-uaber:
26798
PRELIMINAPY ESTIMATE
99 DODO 882500 02 QUAD W I5-SAL-FI 4D SHORT Int:
Parts 693.80
Body Labor 2. 1 hrs @ A 52.0 /hr 109.20
----------------------------------------------------
SUBTOTAL $ 803.00
Sales Tax $ 693.80' @ 8,2500% 57.24
----------------------------------------------------
GRAND TOTAL $ 860.24
ADWSTMENTsS
Deductible 0.00
----------------------------------------------------
CUSTOMER PAY $ 0.00
INSU'RAWT ?AY $ 860.24
Estimate based on MOTOR C8.?SH SST 'A"=:0 G11 0. t or-aster i.sk(0) items ars derived f:om the Guide
OR3TA94. na4abase nate 2099. louble Merik!"I items indicate pa`-` 2;pplied lied 07 a SUPAis
other than the original equipment manufacturer. Poun, sign 1 ) Ltems _d Cavy manual entries.
CAtA items have been certified for !it and iini5h by the Certified Auto tarts Association. .'AGM
Part Numbers, Prices and Labor Tunes are provided from National Auto 11ass Specifications, Inc.
pathways 1': product o.. Information Jer vi'v4r+J W,
';,-2':—1999 i }: i 2P i FROM BABY CITIES:-- GLAS„; SIF-1 S.3C.'' 7919 9 P r>
# �+r,t��€C31'E � 151286
WV_ts1as8
H4'ARDING GLASS #151 HARDING GM IWt5T'RIE6 1151
FORMERLY BAY CITIES GLASS No. BOX 8"7
24784 MISSION BLVD RWA CITY, NO 641WO7
HAYWARD, CA 94544
PHONE~. {800) 358-4444
ACCOUNT:: 151000 LEDGER: i 51 e00
AAM HULSE WORK: 51Z 247 0800
INVOICED BYs
Po#
1 DW 1)1 76 UBN WINDSHIELD �y x,88. X 0 394. 55�/s�{ 394. 59{
1 LABOR LABOR (AUTO) 40. 00 40. 00
1 URETHANE S I SLA 220 URETHANE 19. 00 19. lio
KIT
1 Z5275017 MOULDING (REVEAL) 35. 84 35. 84
AUTOMOBILE gM�INFORMATION 4k�9. 4�2
YEAR 4 89 40. 81.
MAKE DODGE
MODEL PICKUP, 1500, 250el 37.OE
STYLE : 4 DOOR QUAD CAB
VEH ID 526. 51
LIC #
NATE
HOME # MILES
WORK # 510 247 0808 UNIT #
FSO # CITY CDr
CAR LOC: 526. 5:
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CLAIM
�Q A BI�t April 27, 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 docurrent mailed to you is your
California Govemment Codes. ) notice of the action taken on your claim by the
Board of Supervisors. (Paragraph 1V below), given
"I pursuant to Government Code Section 913 and
.,._ 915.4. Please note all "Warnings".
q
Exceeds $50,000.00
AMOUNT:
3
Elizabeth Saxton Individual' _
CLAIMANT: as Guardian of Aaryah Saxton-Inas, a minor
ATTORNEY: Devin L. Domecus DATE RECEIVED: March 26, 1999
Walkup, Melodia. Kelly & Echeverria
ADDRESS: 6503 California Street, 26th FIRM DELIVERY TO CLERK ON: Marr h 26, 199()
San. Francisco, CA 943.038
BY MAIL Pf)STMAI2I ED: March 25, 1999—
L FROI&- Clerk of the Board of Supervisors TCt: County Counsel
Attached is a copy of the above-noted claim.
PHIL BHELOIZ, Clerk '
Dated:— Larch 29, 1999 By: Deputy ... �
lit. FROItI� County Counsel TO: Clerk of the Board of Supervi ' rs
0�%) This claim complies substantially with Sections 910 and 910.2.
( ) This claire FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The
Board cannot act for 15 clays (Section 91€3.8).
( ) 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 claire (Section 911.3).
) Other:
Dated:— /� : : By: ; G : : e < F uty County Counsel
s
III. FROM: Clerk of the Board 7E0,-.:C4unty Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 311.3).
IV. BOARD ORDEP_ By unanimous vote of the Supervisors present:
(7q- 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 elate.
Dated: '41 PHIL BATCHELOR, Clerk, By , Deputy Clerk
47
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. *Por Additional Warning See Reverse Side of This Notice.
AFFIDAVIT OF NIAILLNIG
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 shoxxm above.
Dated: By: PHIL BATCHELOR By '� Deputy Clerk
CC; County Counsel County Administrator
WALKUP,MELODIA,KELLY &ECHEV'ERR.IA
650 California St., 26th Floor
San Francisco,CA 94108
Telephone: 415-981-7210
BOA O OF Super w �
Attorneys for Claimants ' CO
s<
CLAIM FOR DAMAGES AGAINST
CONTRA COSTA COUNTY
MERRITHEW MEMORIAL HOSPITAL AND
CONTRA COSTA REGIONAL MEDICAL CENTER.
TO: CONTRA COSTA COUINTY BOARD OF SUPERVISORS
651 Pine Street
Martinez, CA 94553
MERRITHEW MEMORIAL HOSPITAL
2500 Alhambra Avenue
Martinez,CA 94553
CONTRA COSTA REGIONAL MEDICAL CENTER
2500 Alhambra Avenue
Martinez,CA 94553
The following claim is hereby made by and on behalf of Elizabeth Saxton, Individually and
as Guardian of Aaryyah Saxton-Lucas, a minor, against Contra Costa County and Merrithew
Memorial Hospital.
A. NAME AND POST OFFICE ADDRESS OF CLAIMANT
Elizabeth Saxton
2800 Gentrytown Dr.,#17
Antioch, CA 94509
Aaryah Saxton-Lucas
2800 Gentrytown Dr.,#17
Antioch,CA 94509
B. ADDRESS TO WHICH NOTICES ARE TO BE SENT
Kevin L. Domecus
Walkup,Melodia, Kelly&Echevenia
650 California Street, 26th Floor
San Francisco, CA 94108
Claim for Damages
Page 2
C. DATE, PLACE, AND OTHER CIRCUMSTANCES WHICH GIVE RISE TO THIS
CLAIM
The incident which gives rise to this claim occurred on or about September 25, 1998, at the
Contra Costa Regional Medical Center and Merrithew Memorial Hospital. The claimant
Elizabeth Saxton was admitted to the hospital for the birth of her child. Her care was
managed by physicians and nurses who were employees of the County of Contra Costa, the
Contra Costa Regional Medical Center, and Merrithew Memorial Hospital. Due to a delay
in the labor and delivery process, there were significant fetal heart tone irregularities which
were not appreciated or acted upon, resulting in significant perinatal hypoxia and ischemic.
The entirety of Elizabeth Saxton's medical treatment after her admission was negligent, and
resulted in the injuries to Aaryah Saxton-Lucas, as hereinafter described.
D. DESCRIPTION OF INJURIES AND DAMAGES:
The claimant Elizabeth Saxton suffered severe emotional distress as a result of the injuries
to her child. The claimant, Aaryah Saxton-Lucas, a minor, suffered severe hypoxic and
ischemic brain damage as a result of the delayed delivery.
E. ECONOMIC LOSSES:
The medical bills and other economic losses are unascertained at present.
F EMPLOYEES CAUSING INJURY AND DAMAGE
The name of the particular employees of said public entity responsible of the occurrence
herein described are unknown to claimants at this time. The claimant believes that a Dr.
David Pilcher may have been involved in her care during the labor and delivery.
G. AMOUNTS CLAIMED:
Damages for all claimants exceed $50,000, and the appropriate court of jurisdiction is the
Superior Court, County of Contra Costa.
DATED: WALKUP,MELODIA,KELLY&ECHEVERRIA
By.-
KEVIN L. DOME
Attorneys for Claimants
Law Offices of a
PAUL V.MELODIA @/a/A K YlE�.P9 1CLt" DI q � KELLY
E d LY & qy CHH yE-�RI q� CYNTHIA F.NEWTON
DANIEL J.KELLY 91 �,edl b./.+f 3.i 6.l'.�,9iL'°!l 8e ,P.,+ $� @� $®.£�}.G'.�. MICHAEL J.RfrCUPERO
JOHN FCHEVERRIA A Professional Corporation DOUGLAS S.SAELTZER
RONALD H.WECHT 650 CALIFORNIA STREET,26TH FLOOR, SAN FRANCISCO, CALIFORNIA 94108-2702 KHALDOUN A.SAGHDADI
MICHAEL A.KEi LY TF LE?HONE(41,5)981-7210 FACSIMILE(415)391-6965 DORIS CHENG
KEVIN L.COMECUS
JEFFREY?;ROLL ... i�- ..
RE CEJ V OF COUNSEL
DANIEL L)Eit'CtSS3 JOHN D. LINK
RICHARD H.SCHOENBERGER WES'EY SOKOLOSKY,M.D.,J.D.
March 25, 1999 ' ,N
BRUCE WALKUP
(1914_1994)
RICHARD B.GOET4ALS,JR.
.. (7950-1994)
Certified Mail
Contra Costa County Board of Supervisors
651 pine Street
Martinez, CA 94553
Ree Claim of Elizabeth Saxton and Aaryah Saxton-Lucas
Dear Sir or Madam:
Enclosed please find the original and one copy of the Claim for Damages in the
above-referenced matter.
We would appreciate your acknowledging receipt of the Claim by returning a date
stamped copy in the envelope provided.
Thank you for your cooperation.
Very truly yours, f
Jana Whitson, Secretary to
"'KEVIN L. DOMECUS
KLD\jw
Enclosures
i
APPLICATION TO FILE LATE CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA aYMM CALIFORNIA
April �, 1999
BOARD ACTION
Application to File Late Clain NOTICE TO APPLICANT
Against the County, Routing } The copy of thia7333GWE maiTe3 to you is your
Endorsements, and Hoard Action.) notice of the action taken on your application by
(All Section References are to } the Hoard of Supervisors (Paragraph III, below),
California Goverment Code.) } given pursuant to Goverment Code Sections 911.8 and
915.4. Please note the "WAFNING'r" below.
Claimants Donnell Young
Attorneys
Donnell Young AT-046278-8
Address: Atascadero State HOSDital
P. 0. Sox 7001. March 29 1999
Amount: Atascadero, CA 93423-7001 By delivery to Clerk on 9
Date Received.- March 29, 1399 By mail, postmarked on March 25, 1999
I ' Clerk of he Hoard of Supervisors 16t unty Counsel'
Attached is a copy of the above noted Application to Pile Late Claim.
DATED: March 30, 1999_ _PHIL BATCHELOR, Clerk, By � � �� f: Deputy
IZ. Fes: County Counsel lot Clerk of the and of Supervisors
The Board should grant this Application to File Later Claim (Section 911.6).
( The Board should deny this Application to File Late Claim (Section 91 6).
DATED: 64OR MTKAN, County Counsel, By y
BOARD ORDER By ursan moans vo e of Supervisoft present
(Check one only)
{ This Application is granted (Section 911.6).
�3 This Application to File Late Claim is denied (Section 911.6).
certify that this is a true and correct copy of the Board's Order entered in its
minutes for this date.
DATE: . PHIL BATCHELOR, Cleric, Bye Deputy
WARitswM (Gov. Coder J911.8)
if you wish to file a ovum action on this matter, you must first petition the
appropriate court for an order relieving you from the provisions of Goverment Code
Section 945.4 (claims presentation t). See Government Code ';Section 946.6. Such
petition must be filed with the count within six (5) month from the date your application
for leave to present a late claim was denied.
You map seek the advise of any attorney of your cahoios in commotion with this
math. If M want to oonsult an attorney 7W should do so immediately.
V : Clark of Me County COUnSil M County Administrat6e
Attached are oopi+es of the above Application. We notifed the applicant of the
Board's action on this Application by mailing a dopy of this document, and a memo thereof
has ben filed and endorsed on the Hoard's dopy of this Claim in accordance with Section
29703.
DATED: : Po KUL HATCHELOR, Clerk, ��By— DeputyD
V. �1 County Counsel ' Gusty Adminis for To-. Clerk of the Board
of Supervisors
Reoeived copies of this Application and Board Order.
BATED: County Counsel, By
County Administraator, Hy
APPLICATION TO FILE LATE CLAIM
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