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MINUTES - 04061999 - C32
CLAINT D__0F SU EMS013S QE CUSIRA COSTA COUNTY* CALMDRLIA RWD ACTT April 6, 1999 Claim Against the County, or district Governed by } the Board of Supervisors, Routing )indorsements, ) 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 g Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and { , 915.4. Tease note all "Warnings". MAR AMOUNT: AMOUNT. rts2 L CLAIMANT: Greg Valentino ATTORNEY: DATE RECEIVED: February 26, 1999 ADDRESS: 200 MacDonald Avenue BY DELIVERY TO CLERK ON: February 26, 1999 Rlcrn:�ond., CA interoffice BY MAIL P{3S7MARIC.ED: L FROM: Cleric of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BATC LOR, Clerk Dated: March 1, 1999 By: Deputy - -r IL FROM: County Counsel TO: Clerk of the Board of Supervi 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 claim (Section 911.3). ( ) Other: ff � t Dated: By: '!!��Ie� Deputy County Counsel III. FROM- Clerk of the BoardTO: C my Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with n ce 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: `,d PFUL 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 NIA.IiX4G I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: By: PHIL BATCHELOR By eputy Clerk CC: County Counsel County Administrator DEPUTIES: VICTOR J.WESTMAN PHILLIP S.A,7HOFF jAN!CE L.AMENTA COUNTY COUNSEL NORA G.BARLOW ANDREA W.CASSIDY SiLVANO B.MARCHES! N40NIKA L.COOPER CONTRA COSTA COUNTY VICKIE L.DAWES OPIEF ASSiSTANT COUNTY COUNSEL MARKS S-FSTIS OFFICE OF THE COUNTY COUNSEL MICHAEL L).FAR. ;LILUAN SHARON L.ANDERSON COU14TY ADMINISTRATION BUILDING DENNIT FUJI1 S C.GRAVES ASS!STAN'T COUNTY COUNSEL 651 PINE STREET, 9th FLOOR JANET L.HOI-NIES KEVIN T L.MARTINEZ, CALIFORNIA 94653-1229 BERNARD L.KNAPP GREGORY C.HARVEY EDWARD V.LANE,JR. ASS!STANT COUNTY COUNSEL BEATRICE LIU MARY ANN MASON PAUL P.MUNIZ GAYLE MUGGLI VALERIE J.RANCHE OFFICE MANAGER STEVEN P RET TIG DAV!D F.SCHM;6T DIANA J.SILVER PHONE(925,335-1800 BARBARA N.SLIT U FFE FAX(925)646-1078 JACQUELINE Y.WOODS NOTICE OF INSUMEFICIENC AND/ NON. -ACCEPTANC QF CLAIM TO: Greg Valentino 200 MacDonald Avenue Richmond,, CA RE: CLAIM OF: Greg Valentino Please Take--Notice as Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code Section 910 and 9 10 2, or is otherwise insufficient for the reasons checked below: I- The claim fails to state the name and post office address of the claimant. 2. The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [X ] 3. The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. 4. The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or loss, if known. 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000). If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10,000), the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. 6. The claim is not signed by the claimant or by some person on his behalf. Pacfe 1 [X 7. Other: The claim fails to describe any duty or obligation of the public entity and any action giving rise to the claim. VICTO J:NEST- IN, County Counsel By: Deputy County Counsel t C� 2TIFI+CT� F OF JER IC_F BY (C.C.S'. §§ 10---2, 101.3 a,2015.5;Evidence Code§§641,664) I declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California 94553;i am a citizen of the United States,over 1€3 years of age,employed in Contra Costa County,and not a party to this action. I served a fxae copy of this Notice of Insufficiency and/or Non-acceptance of Claim by placing it in an envelope addressed as sho,vr: above,sealed and postage fully prepaid thereon,and thereafter was,deposited this day in the U.S.Mail at Martinez,California. I certify under penalty of penury that the foregoing is true and correct. Dated: March 2, 1999,at Martinez,California. cc: Clerk of the Board of Supervisors(original) Risk Management (INGI'ICE,OF INSUITICIENCY OF CLAIM:GOVT.CODE§§910,910.2,920.4,910.8) Page 2 C1 iso d 8(}M OF S MtVTXRS OF CC NnA CMA COMTY Y°R0�'TI-QNS TO� 'T A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue an or before December 31, 1987: must be presented not later then the 100th day after the aceru 3 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, 3988, must be presented not later than six months after the accrual of the cause of actio. Claims relating to any other cause of action must be presented not hater than one year after the accrues) of the cause of actio. (Govt. Cade 5911.2.) B. Claims must be filed with the Clank of the Board of Supervisors at its office in Room 1.06, County Administration Building, 651 Fine Street, HbrtinezCA 94553. C. If claim is against a district governed by the Board of Supervisors, rather thin the County, the name of the District should be filled in. D. Ir the claim is against more than one public entity, separate claims must be filed against each public entity. B. Fraud. See penalty for fraudulent claims, Penal Code Seo. 72 at the end of this REa Claim By Reserved for Clerk's filing stamp gainst the County of MHER dta ) or ) - ri district) n The undersigned claimant hereby mattes claim against the County of Contra Costa or the above-named District in the sum? of this claim represents as follows: -- and .in support of I. When did the damage or injury occur? (Give exact date and hour) iWw•sirwndee Laii+rr.r S .+'Y ,: { .b .:: i'. ;" y.= } - f C.:,:_j 2. Where did the damage or injury occur? (Include city and county) 3. iioW did the damage Or injury occur? (Give full details; required) use extra paper if �, .. ��wbin c.rL L ..._ •'.'. .';�y,i L .`�., _ F}? �, f.r S f yt 'C ,n, t...t . What particular act or omission on the part of oounty or district officers, servants or employees caused the injury or ? F d r e a.e (over) . `What are the names of county or district officers, servants or employees cuing the damage or injury? 3�, t t 5 t , '.,- �•` rim+rra..r---------..mrrm®.r r,m.r..wr.wrrwr.r+r.r+rm�.awrr.r �' +�araw.sa�w+rir..r+rru "fi 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. de by 5:, w,�+r�+�.+.sr�ri.rrirrs+f+rr ••• �ri�rafr4� �ir�'r«"�ni"a' < 7. How was the amount claimedW�`above txxnputed? (Include the estimated amount of any n 3 prospective injury or damage.) r Q f.,y ,�,.„t.,err+ra.a.r+..www...ri.L�i.wrMrr.war'r�aTGr.+w�row.��+...►�+ir'rw� . $. Names and addresses of witnesses, doctore and nospiia.Ls � r > s - .} -+ I!",!i . .rsr.a.r.ar+n � ' --------- .rm+rrr+rrrriar.m.r<r s.wfr�+a►+:w.wr.iirr. rrr+.:'�rrwt+r 9. List the expenditures you made on account of this accident or injury: DATE MM AMOM.® ,.Mf>,,,=/' 's�f��," � `�- R.,,J v.. W _ •v. .A '� a ': itti. `:`„�l = � i. ..' a„ Gov. Code ,Sec. 910.2 provides: s nThe claim must be signed by the claimant SEND NoTi S T0: (Attorney) or same. r, on on his : half." and Address of Attarney f r l d a mane S 51 n ti s -'F ' Odd t., b.., s oTelephone No. TelephoneNo. a ilp ewe NOTICE Section 72 of the Penal. Code provides: "Every person who, with intent to defraud, preseents'ffor allowancey or or foboard or payment to any state board or officer, or to any county, officers authorized to allow or pay the same if genuine, any false or fraudulent claim, claim, bill, account, voucher, or writing, is punishable either of exceeding the county jail for a period of not more than one year, imprisonment in one thousand ($1,000), or by both such imprisonment and fine, or by imp the state prison, by a fine of not exceeding ten thousand dollars ($1000009 or by both such imprisonment and tine. {r o> , CLAIM. BOARD QE S IER IS+Q F COI�`t'RA COSTA CY�I1'��TYYx CALdiFC3I2NiA BORD_. kptiil 6, 1999 Claim Against the County, or District Governed by } NOTICE TO CLAIMANT the Board of Supervisors, Routing Endorsements, } and Board Action. All Section references are to The copy of this document mailed to you is your California Government Cones. 1 notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and > 915.4. Please note all "Warnings". 5 00000 s.0 _T f En: AMOUNT: , . y :kR.TiN:ZCA,L, '. CLAIMANT: Jamecas Keti Farr ATTORNEY: DATE RECEIVED: March 5, 1999 ADDRESS: Martinez Dentention Facility BY DELIVERY TO CLERK ON: -March 5, 1999 Jamecas Farr A-CO-31 BY MAIL POSTMARKED: March 4, 1999 901 Court. Street Martinez, CA 94553 L FROTNE Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BAT,C LOR, Cler� A Dated: March 8, 1999 By. Deputy '- II, FRO1Nt- County Counsel TO: Clerk of the Board of Supervisors N°) This F-.laim 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: - —Deputy County Counsel { III. FROM: Clerk of the Board TO: nty Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). ;lV. BOARD ORDER.. By unanimous vote of the Supervisors present: This Claire is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code sectio 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government 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. AF11DAVIT OF MA.IMG I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: By: PHIL BATCHELOR By Deputy Clerk : County Counsel County Administrator Maim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY A. Claims relating to causes of action for death or for injury to person or to personal, property or growing craps and which accrue on or before December 31, 1587, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing craps 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. (Gov't 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. f -'aim 13 against a district governed by the hoard 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 and of this form. RE: Claim By Reserved for Clerk's filing stamp ai r"c jrSig ' ) �.. } RECEIVE.:-.- Against the County of Contra Costa) Y# or ) fir ', # o CAel District} y, e; QAADOFStfPE �> (Fill in name) } CONTRA COS ._.,,...... The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ten m►•nrl in st prort of this claim im represse nt s as follows: 1. when did the damage or injury occur? (Give exact date and hour) � �`" �s t•� g� ;�,• �: . 5{..' ,.tom✓,{ :�,� : f f,• 2. where did thejdamage or` injury occur? (Include City and county) -J-t2;A . %.-I ifool 3. How did the damage or injury occur? (Give full details, ute extra paper if required) 140 iAL,e I Jet 0 ad, Ly!C b Sul' 4. What particular act or omission ori the part of dounty or district officers, servants or employees caused the injury or damage? T ,j�y�f, 'fi'�v CS C..�.a ) ,+''.,�( y-j. � a/.,., sx'X ,� �"f ;4�,!`2• „�,a. i,r t �)) /�IESjyev -. ./.,: t w j , .. .: :, ,•:: �f :' '_ j -,fir '�.•-� ,f�f!.? �� ."�*,>_ £? �„£'�r. !•t.`! AJ f. i ,� �`� �� �``;� :>fi- r,"s {over} 5. What are the names of county or district officers, servants or employees causing the damage or injury? 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. ) 4�t 1,611 c e �' A y t t at S" Jtr t2 dr 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) 8. Names and addresses of witnesses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury. TM AM0_ } Gov. Code Sec. 910.2 provides } "The claim must be signed by the } claimant or by some person on his SEND MQTJCES TO; (Attorney) " Name and Andress of Attorney } } (Claimant's Signature) } (Address) } 'e Telephone No. } Telephone No. NOTICE Section 72 of the Penal Code provides: Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($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. � .,... ...r.. � `�.. � �- a� C �.�_ .� r:, �,�. y: � "'"� � � `��� `.— _`" � � ���~ , � _ � � ��. i _f �- £ � k f .,.; 4 � r'� �� � y �� _ �.. {M4, 4 � .. ,m �. .,,� S.: ''� t `'�� t w- Kwt .' .� - -.- r ^� � � � � .,�' ' l�, i � �� } � il � '� '� . �� ,, �'�' �, '. �" r; `� � � r, ;�; I r �� � � :, n t,� � _ � ,... i �, 's ! � � ,.� „ � • s _ �� � Y� f CLAM BOARD ACS April. b 1999 Maim 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. 4 notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV belov+rl, given pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: $350,000 CLAIMANT: Robert Adieiber t Gray ATTORNEY: DATE RECEIVED: March 5, 1999 ADDRESS: 3470 Golden Gate ly�ay BY DELIVERY TO CLERK ON: March 5, 1999 Lafayette, GA 94549 BY MAIL POSTMARKED: Hand-delivered ivered L FROWN- Clerk, of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BA nLO& Clerk Dated: March 8, 1999 By: Deputy TI. FRt31M: County Counsel TO: Clerk of the Board of Supervi rs XThis 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 910.0. ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: { By: s Deputy County Counsel 2�/ IM FTiC31t1 Clerk of the Board Tunty Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with no lice 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 elate. Dated:_ PHIL BATCHELOR, Clerk, By , Deputy Clerk WARNING (Gov. code sectio 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 915.6. 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 MAIIX. G I declare under penalty of perjury that I ani 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: en 1 By: PHIL BATCHELOR. By puty Clerk CC: Count-,., Counsel County Administrator C1aia to® BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INST RCTIO*(8 TO CLAIM= 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 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Gov't Code 911.2. ) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 1.06, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. B. Er_aqd, See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. i<ie�titikiter+kit�e���r�r�r#�k�A##,kir�t##rad+k#+�#+��ir*�rik��irik*tr�t4M�ir�t�tl��t��i���Y#ate*�t�tiks�lw+k�#rk,�+l��k�e RB: Claim By Reserved for Clerk's filing stamp ROBERT ADIELBERT GRAY } ) Against the County of Contra Costa) } or } District) Ic 0P 15058s (Fill in name) ) C NTRA COSTA CO _J1. The ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 350 ,000 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) September 9 , 1998 at 9 : 00 p.m. - 10: 00 p.m. 2. Where did the damage or injury occur? (Include city and county) 3470 Golden Gate Way, Lafayette, CA, Contra Costa County 3. Row did the damage or injury occur? (Give full details, use extra paper if required) SEE ATTACHED 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? SEE ATTACHED (over) 5. What are the names of county or district officers, servants or employees causing the damage or injury? Contra Costa County Sheriff' s Dept. ; Lafayette Police Dept. ,' Officer N. Mullnix and Officer E. Gibbons; Lafayette Police Dept. Sergeant M. Fisher. 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage-) Physical injuries to hand and wrist; broken ribs, closed; abrasions and head injury. General damages include pain, discomfort and emotional distress. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) Estimate. 8. Names and addresses of witnesses, doctors and hospitals. Same as item 5 above. 9. List the expenditures you made on account of this accident or injury.PATUX =MME AMPgNT 9/10/98 Bail (premium) $1 ,500 Kaiser/Walnut Creek Less than $500 Cost of Defense - Not fixed at this ti,-r..e. Gov. Code See. 910.2 provides "The claim must be signed by the claimant or by sQfie person on his SEND NOTICES TO*,--- (Attgrmney) I behalf." Name and Address of Attorney 41mn 'gignature} 3470 Golden Gate Way (Address) Lafayette, CA 94549 (925) 284-4852 Telephone No. Telephone No. NOTICE Section 72 of the Penal Code provides: Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($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. Claims of ROBERT ADIELBERT GRAS'' Attachment 3. On September 9, 1999 at approximately 9:33 p. . Lafayette police officers responded to a dispatch call concerning an audible alarm emanating from 3470 Golden Gate Way in Lafayette. Mr. Robert Gray was in his business, Lafayette Motors, awaiting the arrival of the police. When the police arrived, they acted unreasonably and used excessive force resulting in physical injuries to Mr. Gray, 4. Officers acted unreasonably when responding to a dispatch call to Mr. Gray's business. The Lafayette Police Department failed to call Mr. Gray to notify him that police officers were outside of his business. When the officer's entered the building, they failed to identify themselves and they ignored Mr. Gray's identification of himself as the business owner and treated him like a suspect. Despite the fact that Mr. Gray owned and operated the business and was lawfully on the premises and in lawful possession of a firearm on his own private property,the officers pulled their guns and wrestled Mr.Gray to the ground and arrested him acting unreasonable and using unnecessary force. Office of the County Counsel Contra Costa County 651 Pine Street, 9th Floor Phone: (925) 335-1800 Martinez, CA 94553 Pax: (925) 646-1078 Date: March 22, 1999 To: Joan Staley Office of the Clerk of the Board From: Victor J. Westman, County Counsel By: Janet L. Holmes, Deputy County Re: Claim of Robert Adielbert Gray Scheduled foriBoard Action April 6, 1999 ,loan: Thank you for forwarding the new copy of the Gray claim identified above. Reviewing this copy of the claim, and the earlier copy that was also scheduled for Board action on April 6, 1999, they appear to be identical (copy attached). Only one copy of the claim should therefore be forwarded to the Board. The new forwarding memo dues not need to be forwarded to the Board. If you have any questions, you may call me at 5-1823. ii;�S�OU�StiC}RTU2ESfi�t{3St�QREES\cab-Da22.wp6 ' of'. CLAM BOARD OF SU' MSORS + CON COSTA CQ=, CALH'ORMA BOARD D April 6, 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. .�u. 4 3 notice of the action taken on your claim by the . x Board of Supervisors. (Paragraph IV below), given s pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: AI7I7roX:�Pit� $500.00te� $500.00 CLAIMANT: Tami C. Hoover ATTORNEY: DATE RECEIVED: March 10, 1999 ADDRESS: 3889 Crow Can-yon Rood BY DELIVERY TO CLERK ON: March 10, 1999 San Ramon, CA 94583 BY MAIL POSTMARKED: Interoffice L FRONC Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. 4 ut Dated: -march 1©, 1999 By: DepHIL BATC LOUR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Superviso ` This claim complies substantially with Sections 910 and 910.2. ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ) Other: Dated: z° c � ,: By: f .� Deputy County Counsel i TIL FROM Clerk of the Board TO: Cdunty 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: 0 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: i PML BATCHELOR, Clerk, By r'_� , 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 trail 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: a By: PHIL BATCHELOR B ,� Deputy Clerk CC County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100'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 0911.2.) B. Claims must be Bled with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building,651 Pine Street,Martinez,CA 94553. C. If Claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D, If the claim is against more than one public entity,separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim by ) Reserved'-for Clerk's piling Stamp Against the County of Contra Costa or District) (Pill in Name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above named District in the surra of$ b and in support of this claim represents as follows: 1. When did the daerage or in jury occur? (Give exact D tte Rnd Tlenr . f ° Qq J €rA ----------------------------------------------------------------------- 2. Where did the damage or injury occur? (include City and County) k } 4 Y k I, (a— siw'�G,—, `.n.+'hd f � , .`<< eee-e --__mAe_eo-- mad�. ft-6,-0 S+ ✓. 4 aY..r�+a. ms: S_e___-.._..___-.._r_-_..�__--_-..e......___o____-_a_-_-.._-_______________ 3. How did the damage or injury occur? 4 Give full details,use extra paper If required e �q ) ,F' q {E`er'+ j'F,Y��p/q 3g } t 5 t ' s� Li -------------------- 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? b an f (Over) S. What are the names of county or district officers,servants,or employees causing the damage or injury? -------------------------------------------------------------------------------------- 6. What damages or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) i ne, rear b U f 42X 7, How was the above claimed amount computed? (include the estimated amount of any prospective injury or damage.) 8. dames and addresses of witnesses,doctors,and hospitals. ------------------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT hop f5 i 5D 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 4Ei (Claimant's Signature) . O .s' s (Address r) lei el— Telephone No. Telephone No. NOTICE .0N _ Section 72 of the Penal Code provides: "Every person who,with intent to defraud,presents for allowance or for paymput4o agy sW.hoard 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 imprisonnient inthe coukit.T.1# 0 for a period of not more than one year, by a fine of not exceeding one thousand dollars ( 5I,fff16 or.by`botfi'suth 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. CIAIM kpril 611999 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 docdrmnt mailed to you is your California Government Codes. l notice of the action taken on your claim by the Board of Supervisors. (Paragraph 111 mow), given pursuant to Government Code Section 913 and g'� 915.4. Please note all "Warnings". MAR s AMOUNT: $10,000-00 ccj,,qtg,COUNSEL CLAIMANT: Patricia men. ATTORNEY: DATE RECEIVED: Febntary 26, 1999 ADDRESS: 110 Pacific St. , #186 BY DELIVERY TO CLERIC ON: February 26, 1999 San Francisco, CA 34111 BY MAIL POSTMARKED: Interoffice L F.RO.NE Clerk of the Board of Supervisors TSD: County Counsel Attached is a copy of the above-noted claire. PHIL B,�X LOR, Clerk Dated: March 1, 1999 By: Deputy r II. FRONVL County Counsel Ta. Clerk of the Board of Supervis&s ( This claim complies substantially with Sections 910 and 910.2. ( This claire PAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 310.8). ( ) Claire is not timely filed. The Clerk should return claire on ground that it was filed late and send warning of claimant°s right to apply for leave to present a late claim (Section 911.3). ( ) Cather: Dated; fl' iAill114B ., i ,Z1Y1, �� Deputy County Counsel DL FROM— Clerk of the Board M. County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). TV. BOARD ORDM— By unanimous vote of the Supervisors present: 4 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: � M2 9 PML BATCHELOR, Clerk, By ; Deputy Clerk WARNING (Gov. code sectioir 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. *.Por 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. Bated: . By: PHIL BATCHELOR By putt' Clerk CC: County Counsel County Admiristrator Contra Costa County phone.335-18()0 °pf#ice of the County Counsel Fax:rggo-j 07 8 Street, 9th Floor 651 Pine CA 84553 Martinez, February 1999 26, Ann Cerqell't , �x : Counsel County Counsel Motor J. West Garvey, Assistant County _... Fro by: Gregory C Subs. Claim of Patricia t_arnben Please treat the attached letter as a Claim. Thanks C4t4fIf3ENTtAL A-F'CflRN f-y CLtF—t'T COMMUNICATION X2/05/1999 15:44 4156617215 Al PHOTO PAGE 02 February 5, 1499 Phil Batchelor County Administrator County of Contra Costa 651 fine St. Martit=,CA 94.553 Dear Mr.Batchelor: As the former secretary of Wendel Brunner,M.D., Director of Public Health for Contra Costa County,I hereby inforrtt you that I am filing a claim against Contra Costa County for unlawful dismissal,due to I. Racial discrimination 2. Whistle-blowing I was asked by TAC Staffing in mid-January to take over the post of secretary to Dr.Brunner on,a next-day basis,as the previously assigned temporary had quit unexpectedly.('[here wood reason for this.) At no time during the next 3 weeks was I told by Dr.Brunner or by my agency that my performance was anything less than satisfactory in any respect;in fact,I understand my performance was described by Dr. Brunner as"mature","competent",and"professional". However,on arriving at work this morning (Friday,February 5)I received a phone call from TAC,the excuse given to the agency being that a permanent replacement had been hired. This was not,of course,the reason,as the permanent replacement(Jan Millar)was already scheduled to begin work on February 16. The underlying motive was that I was aware of the relationship existing between Paul Kraintz.Dr.Brunner's assistant,and his secretary,a contract employee from Volt,Joanna Penzuela. Joanna had been a close personal friend of Amelia,Dr.Brunner's previous secretary,and was Intensely hostile to any replacement. (This was why Margaret,the previous temp,quit.) On the morning after I began,Joanna informed me,in a furious rage,that I was not to answer her phone or Maul's,as they both received numerous personal calls.(This was fine with me.) `That Friday,January 22,she spent the day making numerous personal phone calls in both English and Spanish,then asked Dr.Brunner for overture Friday night and Saturday,including a building pass. I pointed out to him the true situation. Needless to say,Joanna continued her rudeness and hostility,which I did my best to ignore. She spent every possible minute on the phone,fending off creditors and begging for money from friends. (Some of these calls were tong-distance to Now Fork,) On Friday,January 29th,at approximately 2.00 P.M.,Paul Kraintz,her direct supervisor,asked her to drive him to his house to assist him with"pemnal problems". She accepted and they left together. As per request,I ignored their phones,but did tell several people who came looking for hire that they had left together. I thought about informing Dr.Brunner of the situation,but decided not to-after all,I would only be there for another two weeks,so why bother? It-was easier just to let it slide,and the same for Paul's loud remarks about how much he disliked Germans-the more so as I was not sure whether these were intended for Dr. Brunner,his direct supervisor,or for myself.as I was carrying a German novel to read during my tong commute.(The book in question,Jenchen Gebert,is not a Nazi tract,but a novel about Jewish life in 19th-Century Berlin,by a left-wing Jewish author,Georg Hermann,who was killed In the Holocaust.) 15:44 4156617235 Al PHOTO PAGE 03 On Thursday,February 4,Dr.Brunner Was out of the office,and I spent most of the day preparing a series of Walt charts for Tracy Rattray in CW&PP. This was not really my job,of course,but I didn't have anything else to do,and Tracy had boon very pleased with an earlier set I had done for her, These charts included numerous statements about the need for diversity and inclusion in hiring,set in targe 55 point font. This was therefore a clear,official statement of'the county's value system. During the late afternoon, Dr.Brunner returned to the office,and Paul remarked to him that Joanna had gotten a new job and would be leaving. My response was"Boy,everybody's leaving around here.,aren't they?" referring to Dr. Brunner's own campaign for a job with the Gray Davis administration_ I then casually said to Joanna, "Where ase you going?" She was very upset by this casual question and refltscd to answer. I shrugged my shoulders and said"I guess you're right-being Hispanic is what gets you a job around here,ian't it?" She responded that she didn't like my attitude,and I promptly shot back that I didn't like hers,and if she didn't like being insulted,she should keep quiet herself. The conversation ended at this point. I waited until Dr. Brunner had gotten an urgent message from Art Chen,setting up an appointment for that everting with Grantland Johnson,the new head of the California Health and Human Services Agency,in San Francisco, regarding his potential new job in Sacramento.of which I assume you are well aware,and then left myself. Cruder these circumstances,I think it is clear that neither the fust excuse given to the agency,tete hiring of a new person,nor the second,that I had made a racist remark,is accurate. On the contrary,my remark was morely a restatement of official county policy,which I had just spent the afternoon typing. Rather,my dismissal was a direct result of Paul Kratitttz`s dislike of Germans,and of his fest that I would reveal his relationship with Joanna-a fear which he himself brought to fulfillment,since,I had already decided to keep quiet about It. I thercforo respectfully request from the County of Contra Costa the followitig L_ A letter of apology,specifically acknowledging that my job performance was acceptable, and that I was dismissed unfairly. 2. Payment for the 6 days remaining on my contract. This can be made to myself of TAC. 3. S 10,(D4}E},0{'l,as recompense for personal pain and suffering,and the damage done to my reputation with TAC. I await your response. Respectfully, 0 " Pat Lamken I 10 Pacific St.,#186 San Francisco,CA 94111 (415)759-9M f CLAM BOARD OF SLTIMSQRS QE COTR C( M CE3UfiiTY,� RNA BOARD ACT'II April 6, 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 Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: Exceeds the Jurisdictional Miniamt m for the Superior Court of California CLAIMANT: Mori ue C. Martin ATTORNEY: Bruce E. Krell f}ATE RECEIVED: March 8, 1999 Law Offices of Bruce E. 'Krell ADDRESS: A professional Corporations BY DELIVERY TO CLERK ON: March 8, 1999 345 Grove Street. Sans Francisco, CA 94102 BY MAIL POSTMARKED: Interoffice L FRONT: Clerk of the Board of Supervisors TO. County Counsel Attached is a copy of the above-noted claim. PHIL BAS, LOR, Clerk Dated: Y.rch 8, 1999 By: Deputy II. FR.ONL County Counsel TO: Clerk of the Board of Supervis I s ( This claim complies substantially with Sections 910 and 910.2. Y } This claim PAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Beard cannot act for 15 days (Section 910.0, ( } Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: ��� s f > � 3VOot-z2 / R } g {{ f 9} LM } Dated: By: Deputy County Counsel III. FRONL Clerk of the Board Talounty Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD OF2I?M— 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: ✓ 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 actions 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. AF IDAVff OF Ni ILLNI 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 7. € By: PHIL BATCHELOR By 1 . Deputy Clerk CC: County Counsel County Administrator i- March 3, 1999 County of Contra Costa Clerk of the Board PO Box 911 Martinez, CA 94553 Re: Monique C. Martin, Date of Accident: 9/20/98 Greetings: Enclosed you will find an original claim form with several copies as well as a stamped, self- addressed envelope. Please acknowledge one copy of the claim and return it to me in the envelope provided. Thank you in advance for your kind assistance in this matter. Very truly yours, Te1ISE GARON Legal Assistant to Bruce E. Krell Enclosures CALIFORMAXORT-CLAIM A APV T C UNlY OF CO MA COS'T'A Claimant's name: MONIQUE CELOCIA MARTIlV Send All Notices to the following address: LAW OFFICES OF BRUCE E. KRELL, INC. 345 Grove Street San Francisco, CA 94102 Date of Incident: September 20, 1998 Location of Incident: SR 24 eastbound 320 feet west of Boulevard Way Basis of Clain: Failure to timely and sufficiently clear previous motor vehicle accident, failure to properly notice drivers of ongoing construction, failure to remedy a dangerous roadway Injury and Damage Incurred: Claimant suffered injuries to her head, neck, back and ribs. Name of Public Employee(s) causing Injury or Damage: County employees in charge of maintaining highway Jurisdiction: Damages to Claimant exceed the jurisdictional minimum for the Superior Court of California. Bated: March 2, 1999 4 F- B e CE E. LAV OFFICES OF BRUCE E. KRELL Attorneys for Claimant LENA HAW-1- TON L� N S V J) rnm 47 tr + �°� • s}t � C Ln ear ��L�Ott r� At- CLAIM T 7M_C0S1A,_C0_UM1 1A T April 6, 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 Board of Supervisors. (paragraph IV below), given pursuant to Government Code Section 913 and 915.4. please note all "Warnings". AMOUNT: Uxi cif3.ed CLAIMA'N'T: Kevin J. -Metcalfe $ 't ATTORNEY: c/o Wausau Insurance Companies DATE RECEIVED: March 4, 1999 5959 S. Mooney Blvd. ADDRESS: Visalia, CA 93277-9329 BY DELIVERY TO CLERK ON: March 4, 1999 BY MAIL POSTMARKED: Interoffice L PRONE Clerk of the Beard of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BATCHELOR, Clerk Dated: March 4, 1999 By: Deputy r II. FROM: County Counsel TO: Clerk of the Board of Supervi 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.$). Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). { ) Other: Dated: y: uty County Counsel 11L FROI : 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 ORDM- By unanimous vote of the Supervisors present: LA 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: _ 9mY PHIL BATCHELOR, Clerk, By4 puty Clerk WA RIMING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF M.AnRgG 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�" 7 Pt�7 By: PHIL BATCHELOR. By Deputy Clerk CC: County Counsel County Administrator Wausau Insurance Companies } Rec _ February 19, 1999 PUBLIC WORKS DEPARTMENT CONTRA COSTA COUNTY 225 GLACIER DR MARTINEZ CA 94553 Claimant: Kevin J Metcalfe Claim Numbers M27-054061 Lw07 Accident Dates December 31, 1998 Insured Names Kinder Morgan C P Inc This letter is to put you on notice of a pending claim. Kevin U Metcalfe was involved in a traffic accident with our insured at the intersection of Solano way and Imhoff in the unincorporated area of Contra Costa County. we are in the process of settling the matter with Mr. Metcalfe and we will be looking to you for contribution based on the timing sequence of the traffic signal located at this intersection. Our investigation indicates that the timing of the traffic signal played a major part in this accident. Please forward this letter to the appropriate department and/or person(s) so that they may respond to us in writing within the next 20 days. Please accept this letter as out notice of intent to subrogate against you in this matter. If you need any additional. information, you may contact me at (559) 730-4653 between 7:00A°�! and 3 s30PM, PST. Lana D Willis SENIOR CLAIM .EXAMINER F2-LWC7 EMPLOYERS INSURANCE OF WAUSAU A Mutual Company 5959 S. MOONEY BLVD r VISALIA CA 93277-9329 a (559) 730-4000 MAILING ADDRESS: PO BOX 5056 w VISALIA CA 93278-5056 FAX (559) 730-4500 STA:EOF-ALIP ORNIR TRAMC COLLISION PORT SPECIAL CONDITIONS S NO INJ H"FEL CITY JUDICIAL DISTRICT NUMBER ,/ I UNINC MT. DIMLO 2 6lo > NO KILL H&A MISD COUNTY Dt3T BEAT` 12-438 +w �' CONTRA COSTA 4 2 C*St r �! x R. 083SCOBs C OLLISION OCCURRED ON: MO DAY YEAR TIME('rAC3lOy NCIC t I OFFICER I.D. _ Q SCLtANO WAY 12 31 98 0700 19320-1014392. ..- C F i MMEPOST INFORMATION: DAY OF WEEK TOWAWAY PHOTOGRAPHS BY: t THURSDAY YEs No O60 i �N Pq AT INTERSECTION WITH: STATE HWY REL OR: IMHOFF YES NODQ NONE PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETYVEH YR MAKEIMODELYCOLOR LICENSE'NUMBER STATE 1 03905895 ICA C G 96CHEV.P-LT.WHITE. . . . . . 5J7772D . .CA I. . . . . . . DRIVER�NAMS(PIRST,MtDDLE.LAS'T) LYNN SMITH STADE OWNER'S NAME SAME AS DRIVER PEDES- STREET ADDRESS SANTA FE PAC PIPELINE 3-937 TWIN OAKS OWNER"S ADDRESS [] SAME AS DRIVER PARKED CrrY/STATFMP 1550 S OLANO WAY, CONCORD, CA 94520 VI" LE NAPA CA 94558 DISPO OF VEHICLE ON ORDERS OF: OFFICER Pq DRIVER OTHER BICY- 'SEX HAIR EYES HEIGHT` WEIG#it BIRTHDATTI RACE DRIVEN AWAY CL M SRN BLU' 6-00 2 0 0 07123158 PRIOR MECHANICAL DEFECTS: NONE APPARENT-.E REFER TO NARRATIVE OTHER HOME PHONE BUSINESS PRONE VEHICLE IDENTIFICATION NUMBER, t yy [ l 7 0 7) 258-1636 (9 2 5/ 682-0232 CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA iNSCIRASCE CARRIER POLICY NUMBER VI H1CLE TYPE j UNK NONE MINOR NATION M I ON FIRE CA 565-5253 2 2 � []MGD. MAJOR Rt rLL ovu �► DIR TRV I ON STREET OR HIGHWAY SPEED LIMIT CA DOT N SOLANO WAY 35 CAL-T TCPJPSC MC/MX IPARTY DRIVER'S LICENSE NUMBER STATE C°,ASS SAFETY VEHYR MAK&MODEL/COLOR LICENSE NUMBER STATE 2 W 87 LEMONY) 16 sp-vED oRANGR ' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � DRIVER NAME(FIRST,MIDDLE.LAST) KEVIN JAIMES METCALFE OWNER'SNAME I] SAME AS DRIVER, PEDES- STREET ADDREM TRrf 1, 292 OAKTUS OWNER'S ADDRESS tQ SAME AS DRIVER PARKED CPTYlsTATIP 3 VE L PLEASANT HILL CA 94523 DISPO OF VEHICLE ON ORDERS OF; K.j OFFICER DRIVER OTHER SICY• S5x HAIR EYES HEIGHT WEIGHT BtRTfiDATs RACE TOSCO SECURITY M BRN Btt I _ .7 0 04 ; 0 ! PRIOR MECILLNICAL DEFECTS; NONE APPARENT REFER TO NARRATIVE It OTHER HOME PHONE BUSINESSPHONS VEHICLE IDENTIFICATION NUMBER: (9 2 5) 939-6662 — (9 2 5) 372-3132 CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER VEHICLE TYPE �j TrNx �]NONE []MINOR NA 04 MOD. MAJOR ROLL-OVER °y DIR TRV a ON STREET OR HIGHWAY SPmuMrr CA DCVI' E IM"40_FF 35 CAL-T TCPAW MC/MX PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY VEFI YR MAKEJMODELJCOLOR LICENSH NUMBER STATE 3 DRIVER:NAME(FIRST,MIDDLE,LAST) OWNT WS NAME SAME AS DRIVER I PEDES- STREET ADDRESS y.R f OWNER'S ADDRESS ] SAME AS DRIVER PARKED CrrYJSTATEIZ P VE DISPO OF VEHICLE ON ORDERS OF: OFFICER j DRIVER ]OTHER BICY- 5EX HAIR I EYES HEIGHT WEIGHT BIRTHDATE RACE C PRIOR MECHANICAL DEFECTS: NONE APPARENT REFER TO 14ARRATIV8 OTHER HOME PHONE BUSINESS PHONE VEHICLE IDEM TMCA_TION NUMBER: CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED ARBA I INSURANCE CARRIER POLICY NUMBER VEHICLE TYPE �]UNK t]NONE ]MINOR MOD.i I MAJOR f jROLwL'-OVtTR DIR TRV"ON STREET OR HIGHWAY SPEED LIMIT' CA DOT CAL-T TCPIPSC MC,Mx PREPARER'S NAME. DISPATCH NOTIFIED REVIEWERNAME DTE ARROY0 R 014392111ya DqNorl NIA I STATE OF CALIFORNIA "' LA IC COLLISION CODING CAM2 op .DATE OF ORIGINAL INCIDENT TIMEI2400J NCIC NUMBER OFFICER I.D. NUMBER 12 3 0700934 ?4392 12x438 OWNERS NAMEJADDRFM NOTIPMO # PROPERTY DESCRIPTION OF DAMAGE DAMAGE OCCUPANTS M1C BICYCLE-HELMET' SEATING POSITION SAFETY EQUIPMENT EJECTED FROM VEH DRIVER A-,NONE IN VEHICLE L-AIR BAG DEPLOYED 0-NOT EJECTED 2 to 6-PASSENGERS B-UNKNOWN M-AER SAO NOT DEPLOYED DRIVER I-PULLY EJECTED 7:STA,WON.REAR C-LAP BELT USED N-OTHER V-NO 2-PARTIALLY EJECTED 1 2 3 ! 8•RR.OCC.TRK.OR VAN D-LAP BELT NOT USED P-NOT REQUIRED W-YES 3-UNKNOWN 4-POSITION UNKNOWN E-SHOULDER HARNESS USED b 3 6 0-OTHER F-SHOULDER HARNESS NOT USED CHILD RESTRAINT PASSENGER # G-LAPISHOULDER HARNESS USED Q-IN VEHICLE USED X-NO 7 H-LAPISHOULDER HARNESS NOT USED R-IN VEHICLE NOT USED Y-YES J-PASSIVE RESTRAINT USED S-IN VEHICLE USE UNKNOWN K-PASSIVE RETMINT NOT USED T-IN VEHICLE IMPROPER USE U-NONE IN VEHICLE T ITEMS MARKED BELOW WHICH ARE FOLLOWED BY AN ASTERISK M SHOULD BE EXPLAINED IN THE NARRATIVE t PRIMARY COLLISION FACTOR MOVEMENT PICYL'm LIST NUMBER GA OF PARTY AT FAULT TRAMC CONTROL DEVICES � �. � � � TYPE OF VEMCL$M � � �,i 3 CdLLMON CONTROLS 2NG7IONING A PASSENGER CARtSTN.WON. A STOPPED 21451 (a)VC NOtB CONTROLS NOT FUNCTIONING* B PASSENGER CAR W/TRAILER X X B PROCEEDING STRAIGHT B OTHER IMPROPER DRIVING C CONTROLS OBSCURED i C MOTORCYCLE I SCOOTER C RAN OPF ROAD C OTHER THAN DRIVER* D NO CONTROLS PRESENTIFACTOR D PICKUP OR PANEL TRUCK D MAKING RIGHT TURN D UNKNOWN* E PICKUPIPANEL'TRK.WIT'LR. jE MAKINGLUTTURN E FELL ASLEEP* TYPE OF COLLISION F TRUCK OR T RUCK TRACTOR P MAKING U TURN R i A HEAD-ON G TRK.fTRK.TRACTOR W)TU. s G BACKING WEATTIBA MARK 2 TO 2 T II i£M!$ B SIDESWIPE H SCHOOL BUS T # H SLOWING ISTOPPING A CLEAR #C REAR END I OTHER BUS # I PASSING OTHER VEHICLE X 8 CLOUDY X D BROADSIDE 11 EMERGENCY VEHICLE J CHANGING LANES C RAINING E HIT CIIJEC T' K HWY.CONST.EQUIPMENT I K PARKING MANEUVER' D SNOWING F OVERTURNED L BICYCLE t L ENTERING TRAFFIC ..�._®.,.....may ,�...��„. E FOG/VISIBILITY: j G VEHICLE I PEDESTRIAN j M OTHER VEHICLE M OTHER UNSAFE TURNING F OTHER*: H OTHER* N, i N PEDESTRIAN N XING INTO i7PPOSING LAIC G WIND moTOR VEEI#ICL$TINVOLVED WTTIi O MOPED -L4--O PARKED LIIGInINGi A NON P MERGING A DAYLIGHT B PE•�R^�iiii4s� DE,STRIAN �y dI1RRK ASSOCIATED FACTOR i Q TRAVELING WRONG WAY X B DUSK-DAWN #C OTHER MOTOR VEHICLE 1 3 MAI TO2ITEMS R OTHER-! C DARK•STREET LIGHTS D MOTOR VER ON OTHER ROADWAY A VC SECTION VIOLATION:COTE D DARK-NO STREETLIGHTS E PARKED MOTOR VEHICLE E DARK-STREW;LIGHTS NOT FUNCTION F TRAIN B VC SECTION VIOLATION.CITE I ROADWAY SURFACE X G BICYCLE SOBRIETY-DRUG A DRY H ANIMAL: C VC SECTION VIOLATION:CITE i 3 1 (MARK I' . X B WET X X A HAD NOT BERN DIIIMCING C SNOWY-ICY I Fmglx D OBJECT. E VIS,OBSCURED: B HBD-UNDER INFLUENCE D SLIPPERY UDDY OILY,ETC. F 3NATT ELATION* C HBD-NOT UNDER INFLUENCE ROADWAY CONDITIONS I OTHER OBJECT: G STOP&GO TRAFFIC i D HBO-IMPAIRAiENT UNK.' MAltTC T TO 3 ITEMS PEDES`FRIAN`S ACTIOPJS H ENTERING I LEAVING RAMP E UNDER DRUG INFLUENCE' A HOLES,DEEP RUTS- j A NO PEDESTRIAN INVOLVED I PREVIOUS COLLISION F IMPAIRMENT.PHYSICAL' B LOOSE MATERIAL ON RDWY- 8 CROSSING IN XWALKJINTERSECTION 11 UNFAMILIAR WITH ROAD IRMENT NOT KNOWN C OBSTRUCTION ON ROADWAY* C CROSSING IN XWALK NOT AT K DEFECTIVE VEH.EQUIP.:CITE ¢H NOT APPLICABLE D CONSTRUCTION-REPAIR ZONE INT'ERSECT'ION i SLEEPY I PATIGUED E REDUCED ROADWAY WIDTH D CROSSING NOT IN CROSSWALK L UNINVOLVED VEHICLE SPECIAL UQMORIyfATIOiN F FLOODED- E IN ROAD-INCLUDES SHOULDER M OTHER*: A HAZARDOUS MATERIAL G OTHER*: F NOT IN ROAD_ X .Xi"N NONE APPARENT B SEATBELT PASLURE X i H NO UNUSUAL CONDITIONS Q APPROACHINGILEAVING SCHOOL,BU O RUNAWAY VEM E .SKETCH -MISCELLANEOUS "e------4-4.;x 7}ti STA,M OF C ALI$ORNIA JETRED/WI NE,.. S GAS rAc . DAT$OF COLLISION' TIME040NCIC NUMBER NUMBER .2. 3 98 0700 - 9320 014392 12-438 EXTENT OF IN3�I3RY 'X' ONB Mum WAS "X' ON WITNESS PASSENGER AGE SEX PARTY SEAT SAFETY $I8C'i7ID ONLY ONLY E FATAL SEVERS 10THimvtsmLs COMPLAM NUMBER POS. squiF. E WJURY INJURY 0UURY OF PAIN DRIVER FASB. FH#. SPKS OTHER I i «� 31�g �„/ r� y �7 7 3"S x x eG .L ►Y „ NA#EM.O.SdADDRESS TKIPHONB KEVIN JAMES METCALFE 04-20-8I. Rm292 CAKVUE, PLEASANT MILL, CA, 94523 (925) 939-6662 ' (925) 372-3132 (INJURED ONLY)TRANSPORTED BY: TAKEN TO: AMR JOHN MUIR MEDICAL CENTER, WALNUT CRK DESCRIBE INJURIES: BROKEN LEFT CLAVICAL, LACERATIONS TO HEAD AND LEFT SIDE OF DEFT LEC AND LEFT ARM. f lvwmoFvmuwrcmuswmnw, NASfE�3.0,$.fADDRESS TELEPHONE f(INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES: VICTIM OF VIOLENT CRIME NOTIFIED 9 S _ NAMEID.O.BJTELEPHONE ADDRESS � ONJURED1 ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES: E VICTIM OF vlOt..ENT CREME NOTA 3 's NAMEID.O.$.rADDRESs :'$L$PHONB (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE MURIBS: VICTIM OP vw 8Nr CR)M$NOTIFY NA1+4E D.O.B.fADDRESS TELEPHONE 6 i(INJURED ONLY)TRANSPORTED BY: TAKENTO. DESCRIBE IWJRIBS. VICTIM OF VJOI.BNr am Narww PREPARER'S NAME LO NUMBER MO. DAY YR. RBVIEVVBR`s NAME MO. DAY YR. ARROYOR 014.39 I —3I-98 s 0 two .AT. .. .couws$aft [tsut €SA**l I"Cfc w4 Y.ti I"' iCrJI t.0. »uY.d9F V.. .aT I Y». fl Ott �l3j�s 14�3�t� i`3-'�3� yy SCALE) �xiw� p.ALL MCASUPICMCNYS AMC AiyPRO.X#MAYC x4440 tt0T TO SCAL€UNLCSS STATCO(%CALL ;(y+T.�, • t( y ewCiC ATS wQRtM v SIR)P, HFF � *l wa t i LA Nt e W-4 tA 5 C tai ; ti4 e i� AN WAY Sll.ta arw C[Y O.b,wVY.CR Y1;. aar ri. ■Y viE M'Y 1b'4 wAwC YO. efwv vw. 26 CHP 555_Pgge 4 (Rev H.85)OP!042 FACTUAL DIAGRAM *A4W 99.wrte av Caste+aa. rrrt (7ii6E Mete >+ura►Rw •a•'�retw t,0. +rear:lt■ �.�.. . a,. 31 ��. ck$ oloo T51 1 " + 1 '3$ ALL MEASUREMENTS Ale% APPROXIMATE AND NOT TO SCALE UNLESS STATES(SCALE -ro SCALP') x e t` ;� 2.1 ire !le i IMHOF r OhafC A4e F 11R. e a'# *k ws e SaAEa� e ( r v �� � ''i'1 t,R�'1' E21Es}►�" E.AO1 43e We 1i4 YS` ?De AY v SCAA"tet* 0)AQ .S C#j A4AbWA'l awAwAt aY �r.�iy9,yr Vtr�i+yltw j ro. awr ♦w. �wawt;wa w'i tags � ra. Yw♦ rw. CHP 556—Page 4 (Rev$1.851 OP!042 STATE OF CALIFORNIA G tRATIMFJ L P MSN A - I�� DATE OF INCIDEN r TIME NCIC NUMBER OFFICER I.D. NUMBER 12/31/98 0700 9320 014392 12-438 1 FACTS: 2 3 NOTIFICATION: I was dispatched to a call of an injury traffic collision,with an 4 ambulance responding at 0705 hours. I responded from Contra Costa Blvd. at Golf Rd. 5 and arrived on scene at 0710 hours. All times, speeds and measurements in this 6 investigation are approximate. Measurements were taken by rollmeter, except where 7 otherwise indicated. 8 9 SCENE: At the scene of this collision, Solano Way is a northbound/southbound 10 unincorporated city street consisting of two northbound lanes with one left turn lane and 11 one right turn lane and two southbound lanes. It intersects with Imhoff 3Xt to the west 12 and with Arnold Industrial Way to the east. Both roadways are straight and level. The 13 surface is composed primarily of asphalt. See diagram. 14 15 PARTIES: 16 17 Pa # 1 (STARE)was located standing next to V-1. Party STADE was identified by a 18 valid California driver's license. STARE was placed as a party by the following items. 19 20 -personal statements 21 22 CHEVROLET PICK=LUP,V-1,was moved to the northeast curb of Solano Way and 23 Arnold Industrial Way by STADE. V=1 sustained no visible damage. 24 25 Party#-2 0, TCALFEI was located lying on the roadway being attended to by 26 paramedics. Party METCALFE was identified by a valid California driver's license. 27 METCALFE was placed as a party by the following items: 28 29 4 personal statements 30 31 LEMC)ND 16-Speed Bicycle,V=2,was moved from its point of rest by paramedics. It 32 was located lying on the roadway next to METCALFE. It sustained moderate damage. It 33 was released to Tosco Security personnel for safe keeping. 34 35 PHYSICAL EVIDENCE:. There were some scrape marks on the roadway left by V=2 36 indicating the area of impact. 37 38 39 40 PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE R.ARROYO 014392 12/31/98 at STATE OF CALIFORNIA °1►i liClhYl1/Ct�CE tI �1 I*11It; itiTAi _-. PAGE DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 12/31/98 0700 9320 014392 12-438 1 STAIE—MENTS: 2 3 Parti# I STAKE)related that he was driving V-1 northbound on Solana, Way 4 approaching the intersection of Imhoff*Pst./Arnold industrial Way. He was in the#2 lane 5 at approximately 15 mph. The traffic signal lights changed from red to green, so he 6 proceeded forward. He suddenly saw METCALFE on the bicycle ride out in front of 7 him. He applied his brakes and swerved to the right to avoid METCALFE. They 8 collided. METCALFE fell down and away from the pick-up track's left front comer. 9 10 Panty##2 MI Tf ALFE)was contacted in the Emergency Room at John M. uir Hospital 11 in Walnut Creek. He related that he was riding his bicycle eastbound on Imhoff DI, He 12 was stopped in the#1 lane for a red traffic signal light at the intersection of Solano Way. 13 He was waiting for a car to come by and trigger the signal light to change. A big rig 14 truck came up to make a right turn onto southbound Solano Way. The big rig triggered 15 the signal light to change from red to green. He started forward into the intersection. As 16 he was going through,he saw that the light changed from green to yellow to red just 17 about the time he was crossing into the northbound lanes of Solano Way. Then he saw 18 the white pick-up truck coming towards him. He tried to duck and lay his bicycle down 19 to the left to avoid the pick-up truck,but they collided. 20 21 22 OPIMONS-AND CONCLUSIONS 23 24 Si MI T)IARYa STARE was driving V-1 northbound on Solano Way, in the#2 lane, at an 25 unknown rate of speed, approaching the intersection of Imhoff'7A./Arnold Industrial 26 Way. METCALFE was riding V-2 eastbound on Imhoff Rd., in the#1 lane, and stopped 27 at the intersection of Solano Way for a red traffic signal light. The traffic signal light 28 changed from red to green for METCALFE, and he proceeded forward into the 29 intersection. Halfway through the intersection,the light turned red for METCALFE and 30 green for approaching STA 7E. STAKE failed to see METCLAFE legally crossing the 31 intersection and failed to yield. As a result, STARE struck METCALFE. 32 33 AREA OF IMPACT: The area of impact was determined to be approximately 24 feet 34 north of the south curb prolongation of Arnold Industrial Way, and 10 feet west of the 35 east curb prolongation of Solano Way. 36 37 CAUSE: STAKE was at fault for violation of section 21451 (a)VC -Failure to yield. 38 39 The Summary,AOI, and Cause were based on Party statements. 40 PREPARER'S NAME I.D.NIUMBER DATE REVIEWER'SNAME DATE R ARROYO 014392 12/31/98 t ATE OF CALIFORNIA ateRRAINFJS 1pP1_C�i INTAL as DATE OF INCIDENT 'TIME No NUMBER OFFICER I.D. NUMBER 12/31/98 0700 9320 014392 12438 1 REQQ � IQM 2 3 bions. PREPARER'S NAME I.D.NUMBER DATE RE'VIE%WER'S NAMH DATE R ARRC7YO 014392 12/31/98 DEPUTIES: VICT00 J.WESTMAN PHILLIP S.ALTHOFF JANI COUNT Y COUNSEL NORORAA' L.AMENIA G.BARLOW B.REBECCA BYRNES ILVANO S.MARCHESI ANDREA .COOPW. R DY S MONIKA L.COOPER CONTRA COSTA COUNTY VICKIE L.DAWES CH!EF ASSISTANT COUNTY COUNSEL MARKE S.ESTIS OFFICE OF THE COUNTY COUNSEL MICHAEL D.FARR SHARON L.ANDERSON COUNTI ALMINESTRATION BUELDiNG i ILLIAN T.FUJII Ass sTANT COUNTY COUNSEL 651 PINE STREET, 9th FLOOR �NET HLLM GRAVES MARTINEZ, CALIFORNIA 94553-122.9 KEViNT.KERR GREGORY C.HARVEY BERNARD L.KNAPP ASSISTANT COUNTY COUNSELEDWARD V.LANE,JR. BEATRICE LIU MARY ANN MASON GAYLE MiJGG�I PAUL R.MUf17 VALERIE J.RANCHE CFFECE MANAGER STEVEN P.RETTiG DAVID F.SCHMID; DIANA J.SILVER PHONE(920)335-1800 BARBARA N.SUTLIFFE FAX(925)646-1078 JACQUELINE Y.WOODS NOTICE OF INSUFFICIENCY ANIS/OR NON-ACCEPTANCE_OF CLAIM TO: Wausau Insurance Companies Attention: Lana D. Willis P.O. Box 5656 Visalia, CA 93278-5056 RE: CLAIM OF: Your Insured Kinder Morgan G P Inc. Claim Number M27-054061 DOL: December 31, 1998 Please Take Notice as Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code Section 910 and 910.2, or is otherwise insufficient for the reasons checked below: [X] 1. The claim fails to state the name and post office address of the claimant. [ ] 2. The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [X] 3. The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [X] 4. The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or loss, if known. [X]5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000), If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10,000), the claim fails to state whether Page 1 jurisdiction Over the claim would rest in municipal or superior court. [ 6. The claim is not signed by the claimant or by some person on his behalf L X] 7. Other: The claim fails to describe any duty or obligation of the public entity and any action giving rise to the claim. VICTOR J. WESTMAN, County Counsel By. W 7 eiuty C ty Co nse CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013a,2015.5;Evidence Code§§641,664) I declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California 94553;1 am a citizen of the United States,over 18 years of age,employed in Contra Costa County,and nota spaz'ty to this action. I served a true copy of this Notice of hisuffioiency and/or Non-acceptance of Claim,by placing it in an envelope addressed as shown above,sealed and postage Dally prepaid thereon,and thereafter was,deposited this day in the U.S.Mail at Martinez,California. I certify under penalty of perjury that the foregoing is true and correct. i:ated: March 5, 1999,at Martinez,California. f cc: Clerk of the Board of S anervisors(original) Risk Management ,NOTICE OF ASUPTICMI NICY OF CLAW.-:GOVT.CODE§§910,910.2,923.4,910.8) Page 2 CIABI I Rp ClFLIPER�rIO OF Clot"t` t� CCf A mTTV CAL,I �ORl`w'LA BOARD AOM April 6, 1999 Crim Against the County, or District Governed by ) the Bard of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document n-ailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given .� pursuant to Government Code Section 913 and <y�- 915.4. Please note all "Warnings". :. 3. .AMOUNT: Unspecified CLAIMANT: Francisco Ramirez ATTORNEY: DATE RECEIVED: March 5, 1999 ADDRESS: 824 El Pueblo Avenue BY DELIVERY TO CLERK. ON.: March 5, 1399 Pittsburg, CA 94565 M.D.F. , Room Hi BY MAIL POSTMARKED: March 4, 1999 L FRONL• Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BATGLOR, Clerk Dated: March S, 1999 By: Deputy It. FRONL- 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: Date ` ' ' % By: ? s �puty County Counsel III. FRONT: Clerk of the Board TO:? Co my Counsel (1) County Administrator (2) ( ) Claire was returned as untimely with n6tide to claimant (Section 911.3). IV. BOARD ORDER. By unanimous vote of the Supervisors present: This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated:_ PHIL BATCHELOR, Clerk, By eputy Clerk WARNING (Gov. code section 9 3) 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 NLAILING 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 B Deputy Clerk CC: County Counsel County Administrator _.......................................................................................... _ ......................................................................... xIV ) } T— MAP }` NOTICE of CLAIM AGAINST THE COUNTY ©F CONTRA C© TA` (Government> code. ss ,920; 91.0.2) sx€ C1A�RR© Su � ' 0#S p#kT RA COSTS CO. Return to: Coun_ tyClerk's Office 651 Line Sheet Martinez, CA 94553 Phone Number: CLAIMANTNAME: C -- CLAIMANT'S ADDRESS: u . umbe Street City state zip, Code NAME AND.'ADDRESS: OF PERSON-:TO?WHOM N6TICES` RE ARDING THIS. CLAIM SHOULD` BE SENT (if differertt than'above) �1 . . ..: DATE OF- THE, ACCIDENT OR OCCURENCE PLACE OF THE ACCIDEi°T OR OCCURENCE: GENERAL.D .THE..ACCIDENT OR..C)CCUREICE; (attach additional pages if more =space i% needed': L .w. JW 'NAMES, HNOWNr AWR Ar LOA OF > IY `PUHLIC EMP Y'EE�CA THE INKY �R' LOSS: NAMES AND ADDRESS OF :WITNESSES: NAME ADDRESS TELEPHONEKS ' 2 ` NAME AND ADDRESS OF DOCTORS; HOSPITALS WHERE' TREATED; NAME ADDRESS TELEPHONE 2 . GENERAL DESCRIPTIO OF THE LOSS, JURY 'OR DAM AGE SUFF FRED: Lii x e rc ACS.�c��:�"� -.4 U AMOUNT 'CLAIMED: " . BASIS OF .,COMPUTING THE TOTAL AMOUNT CLAIMED IS AS FOLLOWS: Damages incurred to" date:. medical Z, $ Lass of Earnings: $ . Special damages '--for: (Attach``"cop es . f available) . the undersigned] declare:under penalty. of perjury that I/we have the foregoing, claim.:fcr.:'damages and AhoW. the "contents :t'hereof; 'that same is .true .c►f my our`own `knowledge_.ai d "belief,' save and :except -,as , :hose matters wherein:"stated ,on information and belief, and as to n, Ijwe believe -it0. be true..' J D'* I .w► gnature of <Cla rkant(s) { <J et County C3 erk`�s Offic yed :ae this -day �f , 1998 .fi gnature' _ r r icicskak7k*tk�r�k7k9ft7kio7kak7k7k**iso****9t 7ktkik7k**7k Ar 7k71t�cakisiktkit9r7kak7kak�kik�#lk##tic ii*���'*�7klcBe 7ktFc*#� Z CLAIMS. BELATED TO INJURY TO PERSON' 4R PERSONAL yPROPERTY-, THIS FORM FROM`THE >T BE FILED.':WITH. THE �Co Cc ,,County WITHIN 18 Q:.Days ..; .RUAL .OF THE CAUSE OF ACTION." A CLAIM -RELATED TO .ANY OTHER CAUSB; QF FI02i .`SHALL BE ;PRESENTED .NO LATER THAN ONE, YEAR AFTER ACCRUAL dF'.THE �► TSE OF ACTION. .: r .t CIP 6 ,1a 4 Y1 S r 4` U, s k F