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MINUTES - 05162000 - C23
CIAIM BOARD-DE SUPER` ISOM OF CONT'Rd OY SIA CQ[TN'I o CAIMMNIA BOARD AC710lIt MAY 16, 2000 Maim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, 1 NOTICE TO CLAIMANT and Board Action. All Section references are to The copy of this document mailed to you is your California Goverment 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 A P R 915.4. Please note all "Warnings". AMOUNT: In Excess of $50,000.00 hRnFMati�2 Gv,L1F� CLAIMANT: Michael Benko individually and as guardian ad litem for Derek Benko ATTORNEY: c/o Dianna L. Albini DATE RECEIVED: April 20, 2000 Lacy Offices of Albini & Cohn ADDRESS: 654 Sacramento St. , 3rd Floor BY DELIVERY TO CLERK ON: _April 20, 20007 San Francisco CA 94111 BY MAIL POSTMARKED: TransMi teal I FROM: Clerk of the Board of Supervisors M. County Counsel Attached is a copy of the above-noted claim. PHIL BAXHELOR. Dated:_ _ April 20, 2000 By: Deputy, w ISI. 1RO? : County Counsel TO: Clerk of the Board of Supervi ors (This claim complies substantially with Sections 914 and 910.2. ) This claim FAILS to comply substantially with Sections 914 and 910.2, and we are so notifying claimant. The Board cannot act for IS 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 911.0. ( ) Other: Dated: 0C) -By. Deputy Deputy County Counsel M. FROM Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). TV BOARD ORDER: By unanimous vote of the Supervisors present: (5. 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: _tWA4r 16 1a PHIL BATCHELOR, Clerk, By `� _ -Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:2L&4 �4� By: PIiIL BATCHELOR BQDeputy Clerk CC: County Counsel County Administrator ;oar suits[o uol sttuopluo agj o; ;oafgns ;ou suot;n o; a[quot[dde suot;s;ttuq 3o sa;n;s;s ate; iapt n s;i[S!j 3ATUM ;t saop jou ;ay stuts[o uol sttuop[so iopun s;ggt.r s;t 30 AAV an[em ;ou saop a;soZ) u-nuoo jo X;unoo ogjL •tute[o .s[notusd lnofi o; a[gsot[dds sosso pus sa;n;s;s ogpzas atp ;[nsuoo •tuts[o atp 3o am;su aqj uo Sutpuadap toluol jo iauogs aq gvw polU oq ;sntu ;!ns gotgtA utg;tM potlad suot;s;ttut[ agZ -Alddu Ssui ;stp spouad suotm!tut[ olmdas otp [[e pus;saapun o; [g[;uassa si not;e;[nsuoo Isla[ pus ant;snst[xa ;ou s[ ;st[ anogs aqL •stuts[o s;ggt'a [!Atj [slapa3 ao `uot;ounfut to sntuspusux ss Bons jopi ogtoads Yoh; soot;os `uot;stnuapuoo aslanut ut soot;os su Bons 10V stuts[o uOl sttuopluo atp o; ;oafgns ;ou ass gotgnt suxts[o o; A[ddu iou saop lutumm stgy ......... ......... ......... ......... ......... ..._-... ........_ _ .. _. ........._.... ......... .......... ....... ......... _........ ......... ......... ......... ......... ......... ......... _ _. _.__ ............ . ........ ......... 017 RECEIVED 1 WILLIAM L.BERG SB#92095 X MICHAEL EDWARD COKE -SB#42757 APR 19 2001 2 LAW 0FEICES'OF WILLIAM L. BERG&ASSOCIATES 1470 Maria Lane, Suite 200 C®RK BOA 5 5F SU �€�VI S CONTRA COSTA CO. Walnut Creek,CA 94596 4 Telephone: (915)943-320 Facsimile: (925)943-1022 y 5 Atto nnm for Claimants 6 Patricia Etridge and John Etridge Patricia Etridge and John Etridge, NOTICE OF CLAIM' 8 Claimants, 10 11 County of Contra Costa,,City of Mama, City of San Ranson,East Bay Municipal Utility District, 12 State of.California Department of T ransgortatioon-CALTRANS, East Bay Regional 13 Park District and DOES 1 to 20, 14 Respondents. 15 16 TO: County of Contra Costa 17 PLEASE TAKE NOTICE of the following claims: 18 Name of Claimants: Patricia Etridge and John Etridge 19 Claimants' Address. 49 Harbor View Drive 20 Richmond, CA 94804-7496 21 Send All Notices To: Law Offices of William L. Berg&Associates 22 1470 Maria Lane, Suite 200 Walnut Creek, CA 94596 23 Date of Accident: 1012211999 24 Place of Accident: Danville Boulevard near Reame Drive,Unincorporated, 25 Contra Costa County. 26 " 4; tries: Multiple abrasions and contusions, brain injury;Loss of Consortium as to plaintiff,John Etridge, only. 3 Circumstances of A cid nt: Claimant, Patricia Etridge, was riding her bicycle in a marked bicycle lane. Cl am nt's'frant fire struck a recessed utility cover Causing claimant to be.thrown 4 over the handle bars and onto thepavement., 5 Jurisdiction: Superior Court, Unlimited Jurisdiction 6 7 8 Dated: April 17, 2000 g W 1I.Li. L. BERG Attorney for Claimants 10 11 12 1 have received the above Notice of Claim on behalf of the respondent(s� Contra Costa. County. l 14 1 Dated: Name: 16 Title: 17 18 1 20 21 22 23 24 25 26 CLAIM AGAINST THE COUNTY OF CONTRA COSTA 1. Claimant: Michael Benko individually and as guardian ad litem for Derek Benko 2. Date of Birth: 8/2960 & 6/19/88 3. Address of Claimant: 2977 Glenside Drive, Concord, California94520 4. Business Phone: C/O Law Offices of Albini & Cohn(415-) 217-5757 5. Date of Incident: 10/31/99 6. Location of Incident:Hillcrest Park children's playground, Grant & Olivera in Concord, California 7. Details of Incident: On or about October 31, 1999 the County of Contra Costa, through its agents and/or employees failed to properly repair, maintain, inspect, manage and/or own the Hillcrest Park children's playground in such a manner so as to cause a dangerous condition to exist on the playground. Said dangerous condition was caused by The County of Contra Costa, its agents and employees failure to properly inspect, repair, maintain, supervise, manage and/or own the Hillcrest Park children's playground so as to create a trap and/or dangerous condition for children using the playground and/or create a false sense of security and safety for the public using the facility. The dangerous condition includes, but is not limited to, Respondents failure to remove debris, trash, used condoms and other paraphernalia from the toddler's playground area. Further, the County of Contra Costa failed to warn the public, including Michael Benko, individually and as guardian ad litem for Derek Benko, of the dangerous condition of the toddler's playground. Negligence of the County of Contra Costa includes but is not limited to the above statements. At all times herein mentioned Michael Benko is the father of Ryan Benko and Derek Benko, Derek Benko is the brother of Ryan Benko. As a direct result of said negligence by the County of Contra Costa, its agents and employees, Michael Benko, individually and as guardian ad litem for Ryan Benko sustained injuries, incurred loss of income and damages by witnessing Ryan Benko's negligent exposure to a used condom in the toddler's playground. 8. Injuries: Emotional Distress, Dillon v. Legg claim for Michael Benko & Derek Benko 9. Economic Damage: Medical and diagnostic studies - approximately $ 200.00 Wage loss due to loss of work—approximately $500.00 10. Total Dollar Amount of the Claim: In excess of $50,000.00. 11. Appropriate Court Jurisdiction: Superior Court of Contra CostaIVED , p Dated: April 17, 200 APR 9. Il 12. Send all Notices d inquiries to: A t)o SUPERVISORS Dianna L. Albini Ct G ilk r, LAW OFFICES OF BINI & COHN 654 SACRAMENTO STREET 3RD FLOOR. SAN FRANCISCO, CA 94111 (415) 217-5757 Telephone (415) 217-5755 Facsimile PROOF OF SERVICE 2 I am a citizen of the United States and an employee in the City and County of San Francisco, State of California. I am over the age of eighteen and not a party to the within action. My business 5 6 address is that of Law Offices of Albini & Cohn, 654 Sacramento St., 3rd Floor, San Francisco, 7 California 94111. 8 On April 17, 2000, 1 caused to be served the following: 9 CLAIM AGAINST THE COUNTY OF CONTRA COSTA 10 11 [X ] U.S. Mail (Certified Return Receipt Requested),by placing an original or true copy there of, enclosed in a sealed envelope with postage thereon fully prepaid, for the collection and mailing on that 12 date following ordinary business practices. I am familiar with the mail collection practices of the law offices of Albini& Cohn, and pursuant to those practices, the envelope would be deposited with the 13 United States Postal Service the same day. 14 15 [ ] Hand Delivery. by causing an original or true copy thereof, enclosed in a sealed envelope to be delivered by hand to the address(es) shown below. 16 [ ] Overnight Delivery: by causing an original or true copy thereof, enclosed in a sealed envelope to 17 be delivered overnight via Express Mail Overnight to the address(es) shown below. 18 [] Facsimile Transmission. by transmitting a true copy thereof by facsimile transmission from 19 facsimile number(415) 21745755 to the address(es) shown below. 20 County of Contra Costa 21 Risk Management Department 22 2530 Arnold Drive, Suite 140 Martinez, CA 94553 23 I declare under penalty of perjury that the foregoing is true and correct. Executed on April 17, 24 25 2000 at San Francisco, CA. 26 27 Faye Stepp on 28 29 CIM () D OF SUP RVISO M OF a&MA QMJA ==, C;1 LUMNIA BOARD AG"flDSt MAY 16, 2000 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 tNs document mailed to you is your California Goverrvmnt Codes. 1 notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), Oven pursuant to Government Code Section 913 and A 915.4, note all "Warnings". AMOUNT: In Fxcess of $50,000.00 %ART� COUNSEL CLAIMANT: Pam Benko, individually and as guardian ad litem for Ryan Benko ATTORNEY: c/o Dianna L. Albini DATE RECEIVED: April 20, 2000 LACI OFFICES OF ALBINI & COHN ADDRESS: 654 SACRAMENTO ST. , 3rd Floor BY DELIVERY TO CLERK ON: April 20, 2000 SAN FRANCISCO CA 94111 BY MAIL POSTMARKED: TranSmi Ltal. L FRONS Clerk of the Board of Supervisors M. County Counsel Attached is a copy of the above-noted claim. PHIL BA LOR, Clerk Dated: April 20. 2000 By: Deputy, 'L FR County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. { ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: ' (, f?U By: L . —Deputy County Counsel EL FROM Clerk of the Board TO: County Counsel (1) County Administrator (2) { ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDE EL By unanimous vote of the Supervisors present: W 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:. � x 1 PHIL BATCHELOR, Clerk, By Jl'1 Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF hLAILING 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: 202' By; PHIL BATCHELOR By Deputy Clerk CC: County Counsel County Administrator 1 �$ 7 CLAIM AGAINST THE COUNTY OF CONTRA COSTA APR 2 0 2000 f 1. Claimant: Pam Benko individually and as guardian ad litem for t` ,;J'7 F r _- 2. Date of Birth: 7/4/65 & 7/10/96 3. Address of Claimant: 2977 Glenside Drive, Concord, California94520 4. Business Phone: C/O Law Offices of Albini & Cohn(415-) 217-5757 5. Date of Incident: 10/31/99 6. Location of Incident:Hillcrest Park children's playground, Grant& Olivera in Concord, California 7. Details of Incident: On or about October'31, 1999 the County of Contra Costa, through its agents and/or employees failed to properly repair,maintain, inspect,manage and/or own the Hillcrest Park children's playground in such a manner so as to cause a dangerous condition to exist on the playground. Said dangerous condition was caused by The County of Contra Costa, its agents and employees failure to properly inspect,repair, maintain, supervise, manage and/or own the Hillcrest Park children's playground so as to create a trap and/or dangerous condition for children using the playground and/or create a false sense of security and safety for the public using the facility. The dangerous condition includes,but is not limited to, Respondents failure to remove debris, trash, used condoms and other paraphernalia from the toddler's playground area. Further, the County of Contra Costa failed to warn the public, including Pam Benko, individually and as guardian ad litem for Ryan Benko, of the dangerous condition of the toddler's playground. At all times herein mentioned, Pam Benko is the mother of Ryan Benko. Negligence of the County of Contra Costa includes but is not limited to the above statements. As a direct result of said negligence by the County of Contra Costa, its agents and employees, Pam Benko, individually and as guardian ad litem for Ryan Benko sustained injuries, incurred loss of income and damages due to Ryan Benko's exposure to a used condom in the toddler's playground. 8. Injuries: Exposure to sexually transmitted diseases, HIV, AIDS,Hepatitis A,B & C, bacteria, virus, etc. 9. Economic Damage: Medical and diagnostic studies - approximately $ 2,000.00 Future diagnostic studies—approximately $2,500.00 Wage loss due to loss of work-approximately $500.00 10. Total Dollar Amount of the Claim: In excess of $50,000.00. 11. Appropriate Court Jurisdiction: Superior Court of Contra Costa 12. Dated: April 17, 2000 13. Send all Notices andInquires to: , Dianna L. Albini LAW OFFICES OF ALBINI & COHN 654 SACRAMENTO STREET 3'FLOOR SAN FRANCISCO, CA 941.11 (415) 217-5757 Telephone (415) 217-5755 Facsimile PROOF OF SERVICE 2 3 1 am a citizen of the United States and an employee in the City and County of San Francisco, 4 5 State of California. I am over the age of eighteen and not a party to the within action. My business 6 address is that of Law Offices of Albini & Cohn, 654 Sacramento St., 3rd Floor, San Francisco, 7 California 94111. 8 On April 17, 2040, 1 caused to be served the fallowing: 9 CLAIM AGAINST THE COUNTY OF CONTRA COSTA 10 11 [X ] U.S. Mail (Certified Return Receipt Requested), by placing an original or true copy there of, enclosed in a sealed envelope with postage thereon fully prepaid, for the collection and mailing on that 12 date following ordinary business practices. I am familiar with the mail collection practices of the law 13 offices of Albini & Cohn, and pursuant to those practices, the envelope would be deposited with the United States Postal Service the same day. 14 15 [ ] Hand Delivery: by causing an original or true copy thereof, enclosed in a sealed envelope to be delivered by hand to the address(es) shown below. 16 [ ] Overnight Delivery: by causing an original or true copy thereof, enclosed in a sealed envelope to 17 be delivered overnight via Express Mail Overnight to the address(es) shown below. 18 [] Facsimile Transmission: by transmitting a true copy thereof by facsimile transmission from 19 facsimile number (415) 217-5755 to the address(es) shown below. 20 County of Contra Costa 21 Risk Management Department. 22 2530 Arnold Drive, Suite 140 Martinez, CA 94553 23 24 I declare under penalty of perjury that the foregoing is true and correct. Executed on April 17, 25 2000 at San Francisco, CA. 26 27 Fay6 Step enson 28 29 ClAIM BC?AFLi) OF S lPFItMQflRfi OF.CQMA =JA Q(}`C1NT'V'o CAT TF`["T'RNTe BOARD Am MAY 16, 2000 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, I NOTICE TO CLAIMANT and Board Action. All Section references are to I The copy of this document mailed to you is your California Goverment Codes. ) notice of the action taken an your ciairn by the Board of Supervisors. (Paragraph IV belov4, Oven pursuant to Government Code Section 913 and 1 915.4. Please note all Wrings". AMOUNT: Nene Stated . _-Y _UNSEL MARTINEZ CALIF. CLAIMANT: Carrie A. Bittle-Hassenzahl ATTORNEY: c/o Thomas R. Woelfel DATE RECEIVED: April 13, 2000 LAW OFFICE OF Thomas R. Woelfel Aril 13 2000 ADDRESS: 4664 Sandmound Blvd. BY DELIVERY TO CLERK ON: P Oakley CA 94561 Transmittal BY MAIL POSTMARKED: L FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BA LOR, Cie Dated: April 13, 2000 By: Deputy. Lv✓ IL FROM County Counsel TO: Clerk of the Board of Supervisors ; This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: "Il '` By: Deputy County Counsel III.. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD'ORDER; By unanimous vote of the Supervisors present: This Claim is rejected in full. Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: 7000 PHIL BATCHELOR, Clerk, By , Deputy Clerk WARNING (Gov. code sectio 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF 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;_ I /; �By; PHIL BATCHELOR By9 _Deputy Clerk CC: County Counsel County Administrator 1 Thomas R. Woelfel, SBN 120358 j LAW OFFICE OF TYLOMAS R. WOELFEL 2 4664 Sandmound Boulevard Oakley, CA 94561 3 (925) 684-2667 4 5 Attorney for Claimant, CARRIE A. BITTLE-HASSENZAHL 6 7 8 CLAIM! OF CARRIE A. BITTLE-HASSENZAHL, 9 Claimant . CLAIM AGAINST CONTRA COSTA COUNTY 10 (Government Code, Section 910) 11 12 13 14 15 TO: CONTRA COSTA COUNTY: 16 Pursuant to California Government Code, section 910, Carrie A. 17 Bittle-Hassenzahl presents a claim to Contra Costa County as 18 follows : 19 The claimant is Carrie A. Bittle-Hassenzahl whose present post 20 office address is 4692 Sandmound Boulevard, Oakley, California 21 94561 . 22 The circumstances giving rise to this claim are : On October 23 16, 1999, claimant was involved in an automobile collision at or 24 near the intersection of East Cypress Road and Bethel Island Road, 25 an unincorporated area within Contra Costs. County, in or about 26 Bethel Island, California. 27 This claimant contends that negligence on the part of Contra 28 Costa County in improperly designing, controlling and/or main- -1- 1 taining the roadway, intersection, the immediate vicinity where the 2 collision occurred, by not providing lighting, reduced speed limit 3 signage, a stop sign, a stop-light controlled intersection, a more 4 gradual roadway turn, underground utility lines with pole removal, 5 movement of poles, guard rails, and/or adequate roadway visibility, 6 created a dangerous condition which substantially contributed to 7 the damages proximately caused to date, and entitles this claimant 8 to monetary damages for her resulting physical and mental damages, 9 and other bodily injuries sustained, all in an amount presently 10 unknown but subject to the jurisdiction of the Superior Court, 11 Unlimited Jurisdiction. 12 This claimant believes that a police report and other reports 13 were prepared by emergency personal but claimant does not presently 14 have copies of them and does not have any information regarding 15 them. 16 All notices or other communications regarding this claim are 17 to be sent to the Law Office of Thomas R. Woelfel, 4664 Sandmound 18 Boulevard, Oakley, California 94561, (925) 684-2667 . 19 DATED: April 10, 2000 20 LAW OFFICE OF THOMAS R. WOELFEL 21 -� 22 By THO S R. WOELFEL 23 Attorney for C3laiffiarit;. CARRIE A. BITTLE-HAS NZAHL 24 25 f j3 26 27 28 -2- CIAIM BOARD OF SLT F'RVT. ORS DE CONTRA COSTA COU=s AL DEN,iA BARD AC11Dllt MAY 16 2000 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), Oven pursuant to Government Code Section 913 and 915.4. Please nate all "Warnings". AMOUNT: $793.71 AP R CLAIMANT: Ronda Cuddeback Coin`�couNSEL MARTRYiEZ,CALIF. ATTORNEY: DATE RECEIVED: April 7, 2000 ADDRESS: 3383 Mildred Lane BY DELIVERY TO CLERIC ON: April 7,_ 2000 Lafayette CA BY MAIL POSTMARKED: Transmittal L FROX- Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BAT .I 'LOR, Clerk Dated:_ _ April 7, 2000 By: Deputy IL PROM: County Counsel TO. Clerk of the Board of Supervisors ( is claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely 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: j '` % By: i}l - Deputy County Counsel M. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV BOARD'ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in full. Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: PHIL BATCHELOR, Clerk, By _S�414" , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. ' For Additional Warning See Reverse Side of This Notice. AlE!F'tDAV1T OF MAEUNG 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: 1 By: PHIL BATCHELOR By / , Deputy Clerk i CC: County Counsel County Administrator PAGE 01 ( P vi Ind 2110 teak St, Concord, CA 94520 (925) 939-2200 FAX (925) -3992 rentaW&9nantfindemoom FAIR 0 7 r (� LCLE;I:?Ka- To..-- hay-on -��nes� C4:�rck, FAX#: ' "' HaD Votes: .. ... J Sending ayes including this coves page. Please call x(926) 939.220- aye of this trans►miesion is unreadable. 04 GE 02 +Gidas to. BARD OF S'[PIRYXSORS OF CONTRA COSTA COUNTY A. CWM5 MIX11108 to causes of acting for deMb or for tNJ*ry to per$" or to pearsosaal prW--J or>Ervwing crops �V;,'U and which accrue on or before December 31, 19V. =a* be is Is I aaId sod leer thsam the 100* day a ter fte C' accroal of the emu at action. Clydrao rcluting to exam of action for death or for injury to pawn or to personal property or mind crops and which accrue on or after January 1, 19lt3,must be presezited not leer els" silt momki aper the accrual of the csanse of action. Claims relating to any other cause of action anise be presented not later than one year aver the accrual of the cause of action. (Govt.Code 191 L2.) IL Claim was be filed with the Clerk of the Roard of Supervitsom at its office in Room 106, County Administration Bull!!%651 Mae Strgeu Martinez,CA 94553. C. If Claim is agaainat a district governed by the Board of Supervisors, rather dtaan the County, the rinse of the District Mould be filled in. D. Xf the claim is against more than one public+entity,separate claims must be filed asgaisaass each public entity. I. Fraud See peas k for fraudulent claims, penal Code Sec.77 at the end of this fares. • A e+e * tt it R '�' • it A tP A * e1 1Y w • et • i wr • • * # # * M • Mr w tr R A M !P r A 1R iM ,t cal 4 ,1 ,t * 11 tr � A • +k A it RE: Chian by ) Reserver!for Clerk's Filing Stamp Against the County of Contra Cry AIR 0 7 2000 � ;y or L District) 6 (Fill is Nasse) The undersigned claimant hereby makes claim against the County of Contra Costa or the abovet amed District its the sum of S fl and in support of this claim represents as follows• a�..4h>r+.••. t,'c ' 41v . 1. Where did the damage or injury occur' �Ct�.r r�+nct i>ir»�r,t Hoau y I'^''��"°�� .1 ............................................. f- � 2. ''Wbere did the da�uage or inO y occur' (tod"t t:ky MA car) ... (�,� ....�.'. u _ ------_ I ----- 3. Sow di�� dams ge or lnjasrT� 'y occur? (CtYs tam a,rwire an scion�jel ttr oq ) 11 7s m" S903L4 'V� r-6+-4440. " i►°.�i5 Q Lrvf.� ��C � CULA's n r a»ra my v'a,t c4itn trvcAf 4 body . ....w............w.s.......r................,.,,.•......... ......*.........•.....•.......vwr..r 4. What particular act or omission on the part of c sty or � district officers. servants, or lo to �Lcca•+u�s�e?d the injury or dausee! c4.'sG ) C 0� T Ile ' . t #A)L p °" ' u. � Z' t o rM s It ct�' 15-o' xy,,ccc-A i:.i`tiris i i;' LI i1J JS 1 it C 1 . 'What am the sames of covwdy or district officer',servaets6 or employees causinS the damage or injury? s Ww dars&M lir injuries do you claim resulted? c cwt kv txwm of Wariw or domavn ckas e#. Anw h two sedmows eor Bq Jay A d . _..... �Q..o 7. How was the , Wmed amou>�1m ated? (locivit 1l�r� wooed Snve or IW prowetive bk j ur or dawmw.) . ..a.ii w.i i i.OW i V.... ..r r a....._w s_r r w s w_..r....... ....... It Nara"and addror wi ommes,doctom and hospitals. Tom.l)cd utc -W �,t t Vn�arnme _ rr . . 9. List the expenditures you a, e►n accooaxt d tbi;accident or injury: JIM AMOL Ger.•.Cock Sec.910.2 pr hides: "The claim most be signed by the claimant SEND NOTICES TO: (Actor ey) or by someperson on his behalf." Name and Address of,A►ttonmy x (Claitaant's Sigruwtum) (Address) kcLa. � �t Telephone No. Telephone No AS .2�3 v ! �kZl NOTICE Soctioa 72 of the Penal Code pi qv "007 persue who.wkb inMent to ddraad.presents for anowswe or for paynno t to any state boaand or otnieer,or to any County.dtq or dish iet bm"or officer,a utborized to allow or pay the same V genuine,any fawn or fruduie bt claim,bill,aueeouNt,Voucher.or wry is punishable either by insprboamest is the county gait for a period of not MOM tirum out Year, by a fine of net exceeding Dare dwmmd dollars (S1.At1ti} or by both web imprwmmcst and floe,or by Imprisommsest in the stmt prisasa, by a fm of so exceeding lee tbommad dollars(S16,000), or by both Web itPris mment and five; ..... ._—+ --- vv t-Y-40 . .:.64 •, - ,._.. Y- •0c.1MMIslts Yrt yy4i1.tK j'14Nrt laKr.1`ftt 34MMM4ES'i3tl4i o Y 0804 Pa0s of Pwser ��j � �(I�I �J CONCORD 1SAFETY CENTER, INC. *A2y017303 I 11301 Detroit Ave. CONCORD, CALIFORNIA 94522 A 2 (510) 682.9459 Fax 682.9483 NA)M fie VMST ' VW ptEr3�STcu No. w,u n� o� t:S'riMATrE VWA try > co. A0JUSTOR REPLACE REPAIR DESCRIMON PARTS LABOR REF ASH SUBLET TOTALS The above is an estimate based on our Inspection and does not cover any additional parts or tabor which may be required atter the TOTAL PARTS . . . . ... . . . . . .. .. . $ �----- work has been started. Occesionaily, wom or damaged parts are TOTAL LABOR. ... . . . ..... . . . . . $ discovered which may not be evident on the first inspection. Because of this, the above prices are not guaranteed. Ouotations TOTAL REFINISH. ..... .. . .. . ...$ on parts and labor are current and sub}ed to change. TOTAL SUBLET...... . ......... $ AUTHORIZATION FOR REPAIR.You are hereby authorized to make the above repairs: TAX. . . ..... . ....... . . ...... . .$ $ SIGNED: DATE; TOTAL.. .. . . . .. . . . .... . . .. .. $ Lou -- t 03/08/2000 at O1:42 PM Job Nul&er: 56548 COric=D cx=#LzR PLymomx, nic. License #:AK--201941 Federal ID #:680418645 WE MEET THE NICEST PEOPLE BY ACCIDENT 2180 DIAMOND 'BLVD. CONCORD, CA 94520 (925) 676-680Ox32 Fax: (925) 676-6972 PVXL1V21 ylAY Z*TnIATE 7 Written by: CARLI ROUNTREE # Adjuster; insured: RONDA CUDDEBACK Claim # Own+a r: RONDAA CUDDEBACK Policy # ,Baas: 2110 OAK ST. Dednntibl+r: CONCORD, CA 94520 Date of Loss: Day: (925)939-2200 Type of Long: Point of Isapwt: 10. Left Front Pil Inspect CONCORD CHRYSLER PLYMOUTH, INC. ausiness: (925)676-68OOx32 Location: 21eO DIAMOND BLVD. CONCORD, CA 94520 Insurance CNA CoeMPmmy: Days to Repair 1998 DODG GRAND CARAVAN 4X2 ES 6-3.8L-FI 4D VAN PH2-SURG Int: 'I XN: 1B4GP54L1WB579960 Lic: 5901166 CA prod Lute: 10/1997 Odlc=nter: Air Conditioning Rear Defogger Tilt Wheel Cruise Control Intermittent Wipers Keyless Entry Dual Mirrors Privacy Glass Clear Coat faint Metallic Paint Power Steering Power Brakes Power Windows Power Locks Power Driver Seat Power Mirrors Anti-Lock Brakes (4) Driver Airbag Passenger Airbag Cloth Seats 7 Passenger Option Aluminum Wheel* -...,.,......---....--,..-----.....,......-------- ---- ----------------------..... --------..- .» NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1# Refn LOWER INNER DR FRAME 0 0.00 0.0 1.0 2# ADD FOR CLEAR COAT 1 0.00 0.0 0.2 3# Algn REALIGN rRR'T DR 0 0.00 0.5 0.0 4 FRONT DOOR S Repl LT Hinge body half upper 1 21.25 0.3 0.3 6 Repl LT Hinge body half lower 1 21.25 0.3 0.3 7 PILLARS, ROCKER i FLOOR 8 Repl IT rront molding w/Decor pkg. 1 111.00 0.3 0.0 9# Refn IT FRT ROCKER MLDG 0 0.00 0.0 1.0 1 c+-.r u�i c�ur i�:ats b ca-o�se- by IiViN I r ircllt► s FAGS 06 03/08/2000 at 01:42 PM Job Number: 56548 pWCL]3CIlIt3►xi.Y zaTIiOAU 1998 DOM GRAND CARAVAN 4X2 E3 6-3.8L-FI 4D VAN PR2-BURG Int: ...-N -_____- - """"_--" O. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT _ 10 -- ..-_`__--ADD-FOR CLEAR COAT 1 0.00 0.0 0.2 111 "TINT COLOR 1 0.00 0.5 0.0 12$ 3ubl HAZARDOUS WASTE DISPOSAL 1 5.00 X 0.0 0.0 13# COVER CAR 1 5.00 0.3 0.0 14# Subl FRT END ALIGNMENT 1 49.55 X 0.0 0.0 ------------------------------ Subtotals > 213.45 2.2 3.0 Parts 158.50 Body Labor 2.2 hrs 9 $ 55.00/hr 121.00 Faint Labor 3.0 hra 8 4 55.00/hr 165.00 Part Supplies 3.0 hro P $ 25.00/hr 75.00 Sublet/Misc. 54.95 ---------------------------------------------------- SUBTOTAL $ 574.45 Sales Tax $ 233.50 Ca 8.2500fi 19.26 GR2AND TOTAL. $ 593.71 ADJUSTMENTS: Deductible 0.00 CUSTOMER PAY $ 0.00 INSURANCE PAY $ 593.71 PARTS PRICES BASED ON STANDARD CATALOGUE, £ PRICE CHANGES WITHOUT NOTICE. SERVICE CHARGES MAY BE ADDED TO SPECIAL. ITEMS NOT AVAILABLE LOCALLY. REPLACED PARTS JUNKED, UNLESS OWNER ASKS RETURN OF PARTS WHEN ORDER IS PLACED. ABOVE ESTIMATE BASED ON THIS INSPECTION. ADDITIONAL PARTS, OR LABOR, MAY BE REQUIRED AFTER THE WORK HAS OPENED UP DAMAGE PREVIOUSLY OBSCURED. Estimate based on MOTOR CRASH ESTIMATING GUIDE. Non-asterisk(+) items are derived from the Guide DR3TE96. Database Date 0/1999. Double asterisk(") items indicate parts supplied by a supplier other than the original equipment manufacturer. Pound sign (0) items indicate manual entries. CAPA items have been certified for fit and finish by the Certified Auto Parts AssoCiaticn. RAGS Part Numbers, Prices and Labor Times are provided from National Auto Glass Specirications, Inc. Pathways - A product of ccc information Services Inc. 2 CLAIM RQA_RD OF fi TP .RVISdM OF CMTRA G't'.?STA COUNTYl C'AT TFORNIA BOAR? AC"1`1011E MAY 16, 2000 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 docurent rneiled to you is your California Government Codes. ) notice of the action taken an your claim by the Board of Supervisors. (Paragraph IV below), Oven pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: Exceeds $10,000.00 CLAIMANT: Reginald Duncan t�iARYi�llt � ATTORNEY: DATE RECEIVED: April 17, 2000 ADDRESS: c/o Margaret Duncan BY DELIVERY TO CLERK ON: _- April 170 200Q 44-A Roy Drive Monroe, 1A 71202 BY MAIL POSTMARKED: - -- Mand-Delivered L FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BATACJELOP, Clerk Dated: April 17, 2000 By: Deputy IL FROM: County Counsel TO. Clerk of the Board of Supervis s ( ""Ibis 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 910.0. ( ) 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: Deputy County Counsel IIL FROM: Clerk of the Board TO; County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV, BOARD CIDER 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:_ :2: PHIL BATCHELOR, Clerk, By , Deputy Cierk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. "For Additional Warning See Reverse Side of This Notice. AFMAVTI' OF MAUJNG 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:-A2 , '� By: PHIL BATCHELOR By Deputy Clerk CC: County Counsel County Administrator CLAIM AGAINST GOVERNMENT ENTITY FOR DAMAGES To the County of Contra Costa, California: W The.Nam Wd J!o ? Address of the t mat: RECEIVED Reginald Duncan C/o Contra Costa County Sheriff s Department CLERK eoARD SU ERVSORS 1000 Ward street CONTRA COSTA CO, Marinez,CA (b) C!D Margaret Duncan 44-A Roy Drive Monroe,LA 71202 (c) IQ the ClAim Am=W: On October 19, 1999 Claimant was approached by Contra Costa County Deputy Sheriffs who shot Claimant with their guns.As a result,.Claimant sustained serious bodily injuries and suffered extreme mental angguish. The Claimant has been detained by the Contra Costa County Sheer s Department since the incident. The substantial famtors and proximate causes of Claimant's serious bodily injuries and extreme mental anguish, include,but are not limited to: The intentional or negligent use of unlawful or excessive force by Contra Costa County Deputy Sheriffs, The intentional or negligent fiffing to property train and supervise the Deputy Sheriffs,who shot the Claimant. The intentional or negligent failure to render proper emergency medical aid or prevented proper emergency medical aid to the Claimant. The intentional or negligent failure to property transport or prevented proper medical emergency transportation for the Claimant.. Intentionally or negligently causing the Claimant to be wrongfully imprisoned. The intentional or negligent failure to render proper medical treatment to the Claimant. (d)QmsW De_Wg ziption ofDamit : The claimant has sustained pain, suffering and the lass of his liberty as a result of the acts aforementioned.. (e) The following public employees who are known to Claimant may have caused the injury, damages, or loss to claimant. Contra Costa Deputy Sheriff Matt Malone Contra Costa Deputy Sheriff Chris Thorsen Contra Costa Deputy Sheriff Duke Mast name) Contra Costa County Sheriff Warren E. Rupf, Other persons employed or contracted by Contra Costa County whose identities are unknown to Claimant at this time. (F)The AMQUUI Claimed: The Claimant claims an estimated amount of injury, loss, or damages which exceeds $10,000.00. Further, Claimant's claim will not be a limited civil case. Dated: April 17,2000 Re d Duncan Claimant CIABI IRQARD OF SLTP .R SMS OF f MIM A MIA CQ=, CAI. EQENTA 1.9 1 B ARD ACTIQIIt MAY 169 '2000 Claim Against the County, or District Governed by the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to 1 The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Y° ` TO pursuent to Government Code Section 913 and 915,4. Please note all "Warnings". AMOUNT: $25,000,000.00 APR f I 21H COUNTY COUNSEL CLAIMANT: CRAIG HYMAN, CAROLYN HYMAN,MBR7ENDA KtEANE, DAVID KEANE, BRANDON HYMAN, a minor, by and through his Guardian ad Litems CRAIG HYMAN and ATTORNEY: BRENDA KEANE, ESTATE OF BRYAN DATE RECEIVED: April 14, 2000 HYMAN, by and through its Administrators ADDRESS: c/o Niall G. Yamane, Esq. BY DELIVERY TO CLERK ON: April 14. 2000 Law Offices of Joseph W. CarciogV„� 601 Brewster Avenue POSTMARKED: HAND-DELIVERED P.O. Box 3369 Redwood City CA 94064 L FROM: Clerk of the Board of Supervisors fi0: County Counsel Attached is a copy of the above-noted claim. PHIL BAT R, Clerk Dated: Aril 14, 2000 By: Deputy,J/ IL FROM County Counsel M. Clerk of the Board of Supervisors ( '- is claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: r Dated:— Deputy County Counsel III. DRUM Clerk of the Board M. County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IVr BOARD ORDER By unanimous vote of the Supervisors present: (�[} This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated PHIL BATCHELOR, Clerk, By , Deputy Clerk WARMING (Gov. code section 913) ` " Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to y�the claimant as shown above. Dated:) l By: PHIL BATCHELOR By J'I Deputy Clerk CC: County Counsel County Administrator 4 Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSMCTIONS T-Q CI,AA�CAS�tT 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 10& 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 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. Ergud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By Reserved for Clerk's filing stamp CRAM HYMAN, CAROLYN HYMAN, BRENDA KEANE, DAVID KEANE, BRANDON HYMAN, a minor, by and l through his Guardian ad Litems CRAM HYM and BRENDA KEANE, ESTATE OF BRYAN HYMAN, by and ) RE El EID tAgainst the County of Contra Costa or ) APR 14 2000 District) (Fill in name) ) CLERK BOARD OF Sl1PERVISORS CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$2 5,000,00C-and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) On October 16, 1999 between 11:30 p.m. and 12.00 a.m. See also Section I of Attachment to Claim. Against the County of Contra Costa for Wrongful Death. 2. Where did the damage or injury occur? (Include city and county) Bethel Island Road, 209 feet Nort N.of East Cypress bad. See also Section I of Attachment to Claim Against the County of Contra Costa for Wrongful Death. 3. How did the damage or injury occur? (Clive full details; use extra�fape�r�f v���i�c�e) and crashed crus to Vehicle operator, deceased Bryan Hyman, lost control dangerous roadway defects and design. See also Sections I and II of Attachment to Claim Against the County of Contta Costa for Wrongful Death. 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? Dangerous roadway defects and design that were caused by, and the responsibility of the County of Contra C osta. See also Sections I and II of Attachment to Claim Against the County of Contra Costa for Wrongful Death. 5. What are the names of county or district officers, servants, or employees causing the damage or injury? Unknown at this time. See also Section III of Attachment to Claim Against the County of Contra Costa for Wrongful Death. 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) Injuries and wrongful death of Bryan Hyman, funeral and burial expenses and medical bills and other cohts(ii�elated to his death. See also Section IV of Attachment to Claim Against the County of Contra Costa for Wrongful Death. 7. f=low was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) These expenses were all reasonably related to the accident,-Injuries aftd- death of Bryan Hyman. Their value is an estimate. All of the bills have not yet been calculated and others may still be identified. 8. Names and addresses of witnesses, doctors, and hospitals. Melissa Cunningham, H - 3158 Stone Road, Bethel Island, CA (925) 684-3330 Carrie Bittle, H - 4694 Sandmont Boulevard, Oakley, CA (925) 684-2100 9. List the expenditures you made on account of this accident or injury. LATE IM ITEM AMORT October, 1999 Funeral & Burial expenses bBr$ �.8bely medical bills and related expenses ****************************************************************************************** ) Gov. Code Sec. 910.2 provides "The claim must be ) signed by the claimant or by some person on his behalf." SEND N TILES TO: Attorn Name and Address of Attorney ) Niall G. Yamane, Esq. Law Offices of Joseph W. Carcione, Jr. ''°% �� 601 Brewster Avenue ) (Claimant's Signature)Niall G. Yamane, Esq P.O. Box 3389 ) Attorney for Claimants Redwood City;, , CA 94064 ) Law Offices of Joseph W. Carcione, Jr. Telephone: (650) 367-6811 ) (Address) Facsi=mile: (650) 367-0367 ) 601 Brewster Avenue, P.C . Box 3389 Redwood City, CA 94064 ) Telephone No. )Telephone No. (650) 367-6811 NoncE Section 72 of the Penal Cotte provides: Every person who,with intent to defraud,presents for allowance or the 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(S 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(S 10,000),or by both such imprisonment and fine. F RE:' Claim by: ) Reserved for Clerk's .Filing Stamp CRAIG HYMAN,CAROLYN HYMAN, ) BRENDA KEANE,DAVID KEANE, ) BRANDON HYMAN, a minor,by and ) through his Guardian ad Litems CRAIG ) HYMAN and BRENDA KEANE, ) ESTATE OF BRYAN HYMAN, by and ) through its Administrators ) Against the County of Contra Costa ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above named District in the sum of$ 25.000,000.00 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact Date and hour) On October 16, 1999 between 11:00 p.m. and 12:00 a.m. See also Section I of Attachment to Claim Against the County of Contra Costa for Wrongful Death. 2. Where did the damage or injury occur? (Include City and County) Bethel Island Road, 209 feet North of East Cypress Road. See also Section I of Attachment to Claim Against the County of Contra Costa for Wrongful Death. 3. Hove did the damage or injury occur? (Give full details; use extra paper if required) Vehicle operator, deceased Bryan Hyman, lost control of the vehicle and crashed due to dangerous roadway defects and design. See also Sections I and II of Attachment to Claim Against the County of Contra Costa for Wrongful Death. 4. What particular act or omission on the part of county or district officers,servants, or employees caused the injury or damage? Dangerous roadway defects and design that were caused by, and the responsibility of, the County of Contra Costa. See also Sections I and II of Attachment to Claim Against the County of Contra Costa for Wrongful Death. 5. What are the names of county or district officers,servants,or employees causing the damage or Injury? Unknown at this time. See also Section III of Attachment to Claim Against the County of Contra Costa for Wrongful Death. 6. What damages or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) Injuries and wrongful death of Bryan Hyman, funeral and burial expenses and medical bills and other costs related to his death. See also Section IV of Attachment to Claim Against the County of Contra Costa for Wrongful Death. 7. How was the amount claimed above computed? (Include the estimated amount of/any prospective injury or damage.) These expenses were all reasonably related to the accident, injuries and death of Bryan Hyman. Their value is an estimate. All of the bills have not yet been calculated and others may still be identified. 8. Name and addresses of witnesses, doctors, and hospitals. Melissa Cunningham, H- 3158 Stone Road,Bethel Island, CA(925) 684-3330 Carrie Bittle, H- 4694 Sandmont Boulevard, Oakley, CA(925) 684-2100 9. List the expenditures you made on accounts of this accident or injury. DATE ITEM AMOUNT October, 1999 Funeral &Burial expenses, $30,000.00 medical bills and related expenses Govt. Code Sec. 910.2 provides "The claim must be signed by the claimant or by some person on his SEND NOTICES TO: ) behalf.,, Niall G. Yamane, Esq. ) - --�- Law Offices of Joseph W. Carcione, Jr. 601 Brewster Avenue ) (Claimant's signature)Niall G. Yamane, Esq P.O. Box 3389 ) Attorney for Claimants Redwood City, CA 94064 } Law Offices of Joseph W. Carcione, Jr. Telephone No.: (650) 367-6811 ) 601 Brewster Avenue, P.O. Box 3389 (Address) Facsimile No.: (650) 367-0367 ) Redwood City. CA 94063 Attorney Representing All Claimants } Telephone No.: (650) 367-6811 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 puishable iether 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." U 1 Niall G. Yamane, Esq. (SBN: 127899) LAW OFFICES OF JOSEPH W. CARCIONE, JR. 2 A Professional Corporation 601 Brewster Avenue 3 P.O. Box 3389 Redwood City, CA 94064 4 Telephone: (650) 367-6811 5 Attorneys for Claimants 6 7 8 9 CRAIG HYMAN, CAROLYN HYMAN, BRENDA KEANE, DAVID KEANE, 10 BRANDON HYMAN, a minor, by and ATTACHMENT TO CLAIM AGAINST through his Guardian ad Litems CRAIG THE COUNTY OF CONTRA COSTA 11 HYMAN and BRENDA KEANE, FOR WRONGFUL DEATH ESTATE OF BRYAN HYMAN, by and 12 through its Administrators 13 Claimants, 14 vs. 15 COUNTY OF CONTRA COSTA, 16 Respondent. I 17 18 TO: COUNTY OF CONTRA COSTA 19 20 Claimants CRAIG HYMAN, CAROLYN HYMAN,BRENDA KEANE,DAVID KEANE, 21 BRANDON HYMAN, a minor,by and through his Guardian ad Litems CRAIG HYMAN and 22 BRENDA KEANE, ESTATE OF BRYAN HYMAN, by and through it Administrators, have not had the opportunity to conduct any discovery or gather information regarding the instant claim other 23 24 than that which they have obtained through their own investigation. The conduct, acts, and 25 omissions described in the instant Claim may not be inclusive of all conduct, acts, omissions which 26 may have caused or contributed to the injuries and wrongful death of Bryan Hyman because of 27 Claimants' need for discovery. Further,many of the allegations set forth in this claim are based on 28information and belief due to the wrongful death of Bryan Hyman in the incident which is the i 1 subject matter of this Claim. Accordingly, Claimants can only supply the information they presently 2 has available to them. 3 4 I. WHEN,WHERE AND HOW DAMAGE AND INJURY OCCURRED. 5 This claire is based on the injuries and wrongful death of Bryan Hyman occurring on or 6 about October 16, 1999,between 11:00 p.m. and 12:00 a.m., as the result of a motor vehicle 7 collision which took place on or about Bethel Island Road, approximately 209 feet Forth of East 8 Cypress Road,in the County of Contra Costa, State of California. (See: Police Report,Exhibit"A" 9 to this claim.) Decedent,Bryan Hyman was the driver of a 1989 Pontiac Firebird and was 10 accompanied by three(3)passengers. 'While operating the Pontiac on this roadway,Bryan Hyman 11 lost control of the vehicle,due to the dangerous defects set forth below, and crashed into a utility 12 pole. See police report for the identity of the specific utility pole. Bryan Hyman and a passenger 13 were injured and killed,two other passengers sustained injury, all because of the roadway defects set 14 1 forth below. 15 Claimants are informed and believe, and thereon allege that the COUNTY OF CONTRA 16 COSTA, and its agents and employees are responsible for Bryan Hyman's injuries and death as 17 alleged in this Claim and the facts and reasons therefor, include the following. 18 19 II. WHAT PARTICULAR ACTSIOMISSIONS BY THE COUNTY OF CONTRA COSTA CAUSED THIS ACCIDENT,INJURIES AND DEATHS. 20 (1) There were defective and dangerous conditions of public property designed, owned, 21 operated,possessed,used,constructed,built,controlled,repaired and maintained by respondent zz COUNTY OF CONTRA COSTA,which existed at the time of this accident which were a 23 proximate and legal cause of decedent's accident,injuries and death. Said defective and dangerous 24 conditions created a reasonably foreseeable risk of the kind of injury and death which decedent 25 Bryan Hyman suffered. Said dangerous conditions included: 26 A. A roadway, at and upon Bethel Island Road, approximately 209 feet North of East 27 Cypress, that possessed dangerous, inadequate, absence of, improper and/or faulty. 28 2 ✓rte' >%:¢? ,%..,,.o:�+ . 1 road design, guard rails, utility pole placement, striping, lights, crash barriers, 2 signage, lane width, shoulder widths,traffic controls, speed controls, roadway 3 elevations, shoulder elevation, debris control, roadway markers, and necessary safety 4 devices, thereby rendering said roadway dangerous and unsafe which created and 5 increased the foreseeable hazard of accidents, injuries and deaths on said roadway. 6 At all times mentioned herein,the respondent COUNTY OF CONTRA COSTA, created 7 said dangerous conditions and knew and/or should have known that the hereinabove-described 8 portion of Bethel Island Road, approximately 209 feet North of East Cypress was extremely 9 hazardous and dangerous, and therefore, said respondent COUNTY OF CONTRA COSTA, should 10 have taken steps to remedy or eliminate such hazards and dangerous conditions. 11 (2) There were defective and dangerous conditions of public property designed, owned, 12 operated,possessed, used, constructed,built, controlled,repaired and maintained by respondent on 13this roadway. COUNTY OF CONTRA COSTA and/or their agents and employees,had actual or 14 constructive notice a sufficient time prior to the Bryan Hyman's accident to have taken measures to 15 remedy and/or protect against there defective and dangerous conditions. The aforesaid defective 16 and dangerous conditions included,but were not limited to: 17 A. A roadway, at and upon Bethel Island Road, approximately 209 feet North of East 18 Cypress,that possessed dangerous, inadequate, absence of, improper and/or faulty 19 road design, guard rails,utility pole placement, striping, lights, crash barriers, 20 signage, lane width, shoulder widths,traffic controls, speed controls,roadway 21 elevations, shoulder elevation, debris control,roadway markers, and necessary safety 22 devices thereby rendering said roadway dangerous and unsafe which created and 23 increased the foreseeable hazard of accidents, injuries and deaths on said roadway. 24 At all times mentioned herein,respondent COUNTY OF CONTRA COSTA and/or its 25 employees had actual or constructive notice of the existence of the hereinabove-described defective 26 and dangerous conditions, and knew or should have known of its dangerous character a sufficient 27 time prior to Bryan Hyman's accident to have taken measures to protect against the dangerous 28 condition. However,respondent COUNTY OF CONTRA COSTA and its employees nevertheless 3 I ' 1 negligently failed to take measures to protect against the aforesaid defective and dangerous 2 conditions. Said dangerous conditions and respondent's negligence associated therewith were a 3 proximate and legal cause of Bryan Hyman's accident and death. 4 (3) The COUNTY OF CONTRA COSTA and its employees and agents proximately and 5 legally caused Bryan Hyman's accident, injuries and death by acts or omissions of said employees 6 occurring within the scope of said employees'employment which were negligent and/or wrongful 7 acts and/or omissions and which created the hereinabove-described dangerous conditions and/or 8 were a proximate cause themselves of the injuries alleged herein. Said negligent and/or wrongful 9 acts and/or omissions created unreasonable risk of injury to persons traveling in motor vehicles on 10 said roadway and included, inter alfa: 11 A. Negligently,carelessly, and unreasonably built, designed, constructed,contracted, 12 erected, located, and/or maintained the subject roadway with dangerous, inadequate, 13 absence of, improper and/or faulty: road design, guard rails, utility pole placement, 14 striping, lights, crash barriers, signage,lane widths, shoulder widths,traffic control, 15 speed controls,roadway elevations, shoulder elevations, debris control,roadway 16 markers, and necessary safety devices thereby rendering said roadway dangerous and 17 unsafe which created and increased the foreseeable hazard of accidents and injuries 18 and deaths,in said roadway. 19 B. Negligently,carelessly, and unreasonably failing to follow the guidelines,policies 20 and procedures set forth by the COUNTY OF CONTRA COSTA and/or any other 21 pertinent public agency, district, and/or entity,in custom and practice, comment, 22 discussion,documents,materials,manuals,brochures and booklets setting forth the 23 procedures and specifications to be followed in building,designing, constructing, 24 contracting, erecting, locating, installing, using, and/or maintaining road design, 25 guard rails,utility pole placement, striping, lights, crash barriers, signage,lane 26 widths, shoulder widths,traffic control, speed controls,roadway elevations, shoulder 27 elevations,debris control,roadway markers, and necessary safety devices for said 28 roadway. 4 1 C. Negligently, carelessly, and unreasonably failing to warn motorists using Bethel 2 Island Road, approximately 209 feet North of Fast Cypress in the COUNTY OF 3 CONTRA COSTA, California, concerning the concealed hazards and traps existing 4 along said roadway,which included the hazards of dangerous, inadequate, absence 5 of, improper and/or faulty road design, guard rails,utility pole placement, striping, 6 lights, crash barriers, signage, lane width, shoulder widths, traffic controls, speed 7 controls,roadway elevations, shoulder elevation, debris control,roadway markers, 8 and necessary safety devices thereby rendering said roadway dangerous and unsafe 9 which created and increased the foreseeable hazard of accidents and injuries and 10 deaths on said roadway. 11 D. Negligently, carelessly, and unreasonably allowed the operation of motor vehicles on 12 said roadway without slowing, stopping, or warning the motorists operating said 13 vehicles, or without repairing,reconstructing, erecting and properly maintaining 14 adequate: road design, guard rails, utility pole placement, striping, lights, crash 15 barriers, signage, lane width, shoulder widths, traffic controls, speed controls, 16 roadway elevations, shoulder elevation, debris control,roadway markers, and 17 necessary safety devices thereby rendering said roadway dangerous and unsafe which 18 created and increased the foreseeable hazard of accidents, injuries and deaths on said 19 roadway. 20 At all times mentioned herein, the respondent COUNTY OF CONTRA COSTA knew 21 and/or should have known that the foregoing negligent, careless and unreasonable acts and 22 omissions described in paragraphs(A)through(D)of paragraph(3)created the foreseeable and 23 known risk of accidents like that which occurred in this case, and thereby proximately and legally 24 caused Bryan Hyman's accident, injuries and death. 25 (4) The COUNTY OF CONTRA COSTA, and/or its employees further proximately and 26 legally caused Bryan Hyman's accident, injuries and death by acts or omissions of said employees 27 occurring within the scope of said employees' employment which were negligent,careless, 28 unreasonable, and or wrongful acts and/or omissions,including, inter glia, failing to provide s 1 necessary and adequate warning signs, signals, lights,barriers, markers, cones,markings or other 2 devices to warn motorists using the subject roadway of hazards and dangerous conditions which 3 constituted a concealed trap for such motorists. Such hazards and dangerous conditions would not 4 be reasonably apparent to, and would not have been anticipated by, a person using due care. 5 Claimants further allege that to the extent there were any signs, signals, lights,barriers,markers, 6 cones,markings or other devices to warn motorists using the subject roadway of said concealed trap, 7 said devices and warnings were inadequate and dangerous. Furthermore, Claimants allege that to 8 the extent there were any signal, light,barrier, markers, cones, signs, markings or other devices to 9 warn motorists using the subject roadway of said concealed trap, said warnings and devices were 10 negligently chosen, used, selected, maintained, and placed as to be ineffective and/or created a 11 dangerous condition. 12 13 III. NAMES OF PUBLIC EMPLOYEES CAUSING INJURY/DAMAGE/LOSS 14 The names of the public employees causing this accident, injuries and death in the herein 15 described circumstances are presently not known to Claimants. 16 17 IV. INJURIES,DEATH,DAMAGES 18 The damage sustained by Claimants, as far as known, and as of the date of presentation of 19 this claim, consist of the injuries and wrongful death of Bryan Hyman, funeral and burial expenses, 20 medical bills and other costs related to his death. 21 The amount claimed, as of the date of presentation of this claim, exceeds $25,000.00. 22 Proper jurisdiction of this claim is with the Superior Court. The claim is based on the injuries, 23 damages, and/or losses resulting from the hereinabove-described accident in an amount according to 24 proof. 25 DATED: April 14, 2000 LAW OFFICES OF JOSEPH W. CARCIONE, JR.,INC. 26 27 NIALL G. YAMANE, ESQ. 28 Attorneys for Claimants 6 C CLArm IIQMW DE SUPERVISM OF CONTRA MSTA COUN vo C_'Ai 1 FORMA BOAT D� ACTION MAY 161, 2000 Crim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV belov4, Oven pursuant to Goverment Code Section 813 and 915.4. Phase note all "Warnings". AMOUNT: $511.00 Al's' t ► �y CLAIMANT: Shilo Lemma ',�pR�; <° t ATTORNEY: DATE RECEIVED: April 17, 2000 ADDRESS: 658 Country Lane BY DELIVERY TO CLERK ON: April 17, 2000 Oakley CA 94561 BY MAIL POSTMARKED: Transmittal L FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. April 17 2000 PHIL BA LOR, Clerk,, Dated: p ' By: Deputy - (� II. FROM; County Counsel M. Clerk of the Board of Supervisors "is claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). { ) Claim is not timely filed. The Clerk should return claim on ground that it was filed Iate 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 11L FROM Clerk of the Board TO. County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDEPL- By unanimous vote of the Supervisors present: This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: PHIL BATCHELOR, Clerk, By , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of Ibis 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: By: PHIL BATCHELOR By Deputy Clerk CC: County Counsel County Administrator FClaim,to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing craps and which accrue on or before December 31, 1987, must be presented not later than the 100`h day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988,must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code§911.2.) B. Claims must be filed with the Clerk of the. Board of Supervisors at its office in Room 106, County Administration Building,651 Pine Street,Martinez,CA 94553. C. If Claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public 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 LI)k .'/ �� ) Reserved for Clerk's Filing Stamp RECEIVED Against the County of Contra Costa APR 17 2000 or CLERK S0,, )6PSUMERVISORS District) C.;JRA COSTA CO. (Fill in Name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above named District in the sum of$ /�` and in support of this claim represents as follows: 7� 1. When did the damage or injury occur? (Give exact Date and Hour) Qel, __ ?...t-1-227 ------------------------------- 2. Where did the damage or injury occur? (Include City and County) --- __ -__---- - -- - - --- -} ._x°4/56-{------------------------ 3. How did the damage or inj y occur? (Give it�n det ;use extra paper ifrequired ,? --------------------------------------- - _-------------- ------------------------- 4. What particular act or omission on the part of county or district officers, servants, or employees caused the jury or damage? (Over) �40 �� COD Yak CLAIM BQARU QF' SUPIERNISMS OF CONJEA CQSTA t YI=s CAT TRIMIA_ BQARD ACS MAY 16, 2000 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 � F1 Board of Supervisors. {Paragraph IV below), given pursuant to Government Code Section 913 and y 915.4. Rowe note all "Warnings". AMOUNT: $196.00 c~ ,> 1 :au,O �i~ZC;ALir= CLAIMANT: Tony Morris ATTORNEY: DATE RECEIVED: April 13, 2000 ADDRESS: c/o San Quentin State Prison BY DELIVERY TO CLERK ON: April 13, 2000 San Quentin CA 94974 BY MAIL POSTMARKED: April 12� 2000 L FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. April 13, 2000 PHIL BATC R, Clerk Dated: By: Deputy IL FROM County Counsel TO: Clerk of the Board of Superviso ( This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.$). { ) 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: �{ j By: D Deputy County Counsel III. FROM: Clerk of the Board TQ County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARDORDEM By unanimous vote of the Supervisors present.- Ibis resent: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:_ )22e 4 14 PHIL BATCHELOR., Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF AfAnING - - 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:2 7 ' By: PHIL BATCHELOR By ''" Deputy Clerk CC: County Counsel County Administrator Claim to BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIIviANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100 ' day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Gov't Code 911.2.) B. Claims must be filed with the Cleric 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. of 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 r' 3 ) RECEIVED Against the County of Contra Costa or ) FAPR 13 2000 District) CLE RK BOARD 0 SUPERVISORS (Fill in name) CONTRACOSTACO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ and in support of this claim represents as follows: 1. When did the damage or injury occur?(Give exact date and hour) ` e C A- :0 2. Where did the damage or injury occur?(Include city and county) e iF., t 3. How did the damage or injury occur?(Give full details;use extra paper if required) -TE !\J e 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? l 5. What are the names of county or district officers, servants, or employees causing the damage or injury? 3 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) — _ 8. blames and addresses of witnesses, doctors, and hospitals. as ��Y'E c1 0•� ��'..� E ..�6•k" t t: �4 � .vr 4 t". � Vw+F A�ti' �,�,d;.. 9. List the expenditures you made on account of this accident or injury. AIy.QI I' Gov. Code Sec. 910.2 provides "The claim must be signed by the claimant or by some person on his behalf." SEND NOTICES TO; tAtt my Name and Address of Attorney ) (Claimant's Signature) �.... kn '� d J •k F (Address) Telephone No. )Telephone No. NOTICE Section 72 of the Venal Code provides: Every person who,with intent to defraud,presents for allowance or the 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(S 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(S 10,000),or by both such imprisonment and fine. RIF- ' 0 `t ` APR 0 3p ► Cl.ERK Hui,,t �U ERMQR QCNIS - _q _ SVM'" • r f�{�1i �N d �1rr # 4� 7E iQ r,-J c : .44 pj- 7E N ""i "To i L C NC STATE OF CALIFORNIA C/ NA.�ttkA' '1VEl It LElU1 N_ AL PAQE $ DATE of INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 10/16/99 2358 9320 014770 10-225 1 STATEMENTS: 2 3 Parfy## IAXymanj was unconscious at the sone and was transported 4 immediately upon ambulance arrival. P-1 was unable to give a statement 5 due to fatal injuries. 6 7 Passenger (Bittlel was contacted by telephone on 10-23-99 at approx. 2000 8 hrs. at her residence. She related that she was seated in the left rear seat of 9 V-1 traveling home with friends eastbound on E. Cypress Rd. P-1 was 10 speeding and he showed them the speedometer reading. The speed 11 indicator was all the way to the end. When V-1 approached the curve, he 12 slowed V-1 down to approx. 50 mph. V-1 proceeded very fast over the 13 roadway warning bumps and P-1 was showing off. It looked like he wanted 14 to see how fast he could make the curve. She estimated V-l's speed to be in 15 excess of 50 mph. They entered the curve and P-1 turned too late. V-1's 16 right tires drifted onto the gravel. V-1 traveled towards the pole and she 17 knew they were going to hit it. V-1 slid to the right and hit the pole. It 18 happened so fast that P-1 was unable to correct V-I's movement. 19 20 Passenger (Cunningham � was contacted by telephone on 10-23-99 at 21 approx. 2030 hrs. at Children's Hospital. She related that she was seated in 22 the right rear of V-1. She and her friends were coming home from 23 "Hollywood Video". When they were on E. Cypress Rd., she thought P-1 24 was driving V-1 too fast. P-1 slowed for the roadway warning bumps, but 25 V-1 was still traveling too fast. P-1 started to turn left and V-I's tires slid to 26 the right. She heard the tires screeching. That was the last detail about the 27 accident she remembered. 28 29 Witness SilivaA was contacted at his residence on 10-22-99, at approx. 2030 30 hrs. Silva related that he saw V-1 from his front window traveling 31 eastbound on East Cypress Rd. He estimated V-I's speed to be 32 approximately 55-60 mph approaching the flashing yellow sign. It's right 33 tires traveled onto the gravel area. V-1 started swerving from side to side 34 and it's brake lights flashed or, and off. V-1 was definitely entering the E DAT D FA LAS 014770 10/16/99 STATE OF CALIFORNIA �i EISUPP DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 10/16/99 2358 9320 014770 10-225 1 curve too fast. There were no other cars in the area. He momentarily lost 2 site of V-1 at the curve because his view was obscured by a trailer in his 3 driveway. V-1 came back into view as it hit the pole. He immediately went 4 to the vehicle. His mother called 911 from home. 5 6 O`I'LIER FACTUAL I FOR AIJON: 7 See vehicle inspection conducted by CHP Officer K.Grimes, #10542. 8 Pages thru I? . 9 10 OPII`�3IOl`vS AND CONCLUSIONS 11 12 SU EYLA RY: 13 V-1 was traveling eastbound on E. Cypress Rd. at a speed approx. 55 mph. 14 P-1 (Hyman) approached the 90 degree, left hand curve to n/b Bethel Island 15 Rd. above the recommended safe speed of 20 mph. flue to V-I's unsafe 16 speed, P-1 failed to negotiate the curve and V-I's right side tires slid off the 17 right roadway edge and onto the graveled shoulder. V-1 traveled out-of- 18 ut-of18 control northbound on Bethel Island Rd. As V-1 swerved from side to side, 19 P-1 attempted to regain control. V-I's right front end struck the utility pole 20 before coming to rest. 21 22 POINT OF IMPACT: 23 The POI (R//F of V-1 vs. Utility Pole) was determined to be 209 feet n/o the 24 s/roadway prolongation line of E/ Cypress Rd. and 11 feet e/o the e/roadway 25 edge of Bethel Island Rd. The POI was determined by physical evidence, 26 vehicle point of rest, and my observations. 27 28 CAUSE: 29 P-1 was the cause of this collision by being in violation of 223 50 V.C. - 30 Traveling at a unsafe speed for conditions. The cause was determined. by 31 statements, physical evidence, vehicle damage, and my observations. 32 33 RECOMMIVIENDATIONS: 34 None, DATE D FALLAS 014770 10/15/99 STATE OF CALIFORNIA v r1A,� t�,RAT11l IUPPLEMEl�1TAL PA ..•:�p DATE OF rNCIDENT TIME NCIC NUMHEIt OfFICEIi I.17. NUMBER. 10/16/99 2358 9320 014770 10-225 1 2 LEGEND 3 4 Vehicle Point of Rest: 5 1. Right Rear tire was located 209 feet n/o the s/roadway prolongation line of E. 6 Cypress Rd. and 9 feet e/o the e/roadway edge of Bethel Island Rd. 7 2. Right Front tire was located 212 feet n/o the s/roadway prolongation line of E. 8 Cypress Rd. and 14 feet e/o the e/roadway edge of Bethel Island Rd. 9 3. 1st Yellow precautionary sign with left arrow located 83 feet n/o the s/roadway 10 prolongation line of E. Cypress Rd. and 11 feet e/o the -,/roadway edge of 1 i Bethel Island Rd. 12 4. 2nd Yellow precautionary sign with left arrow located 45 feet n/o the s/roadway 13 prolongation line of E. Cypress Rd. and 11 feet e/o the e/roadway edge of 14 Bethel Island Rd. 15 5. 3rd Yellow precautionary sign with left arrow located 23 feet n/o the s/roadway 16 prolongation line of E. Cypress Rd. and 11 feet e/o the e/roadway edge of 17 Bethel Island Rd. 18 6. Pt set of Botts dots were located 1150 feet w/o the e/roadway prolongation line 19 of Bethel Island Rd. and were centered within the e/b lane of E. Cypress Rd. 20 This set consisted of four rows of Botts dots. 21 7. Last set of Botts dots were located .285 feet w/o the e/roadway prolongation 22 line of Bethel Island Rd. and were centered within the e/b lane of E. Cypress 23 Rd. This set consisted of three rows of Botts dots. 24 8. Yellow precautionary sign with flashing lights and recommended safe speed 25 was located 644 feet w/o the e/roadway prolongation line of Bethel Island Rd. 26 and 7 feet s/o the s/roadway edge of E. Cypress Rd. DATE D WALLAS 014770 10/16/99 NARRATIVEISUPPL.EMENTAL PAGE DAZE 3PIN NCYC:NUMBER GFFiMKII). NUMBER .., 1011'6199 2358 69320 14770 N 99�-16 Vehicle IMect%n At the request of Officer D. Fallas,*-1.407%y I conducted a vehicle inspection on a 1989 Pontiac Firebird which was involved a solo fatal traffic collision on Bethel Island 0 .Fast Cypress Road on October 16, 1999. On October 27, 1999 at 1130 hours I arrived at American Tow to perform the inspection. Location American Tow 5017 `C' Form Drive Concord, CA 94520 (925) 682-8122 Vehicle 1989 Pontiac, Firebird, 2 door Vin#IG2FS21SOK209096 Cal Plate #2LI805 exp. 6/2000 Odometer, 141,310 miles, 120.0 trip miles Itegistere! 0-4 mer Brenda P. Keane 4600 Regina Court Antioch, CA 94509 NCKWER A M DATE K GRLVHS 010542 1(7/19/99 NARRAiTIVF/SUPPLEMENTAL PAGE ,/ ✓ ,.>;/f ",,.< DME OP!N-C IDE;N7 rIME NC, jMER. pEgIM I.t). `UNMER 104r6/99 2358 09320 14770 99-10-225 General Inspection The involved vehicle was a 1989 Pontiac Firebird 2 door hardtop. This Pontiac is a black rear wheel drive 2 door passenger vehicle with a 2.8 liter 6 cylinder engine and an automatic transmission. The Pontiac also has power assisted disc/drum brakes, and.power assisted steering. There were lap/shoulder safety belts at the two front seating positions. The safety belts are of a continuous web material applied by the person seating in that position. The left and right front shoulder harness/lap belts was latched. The right front safety belt exhibited signs torsional loading. The webbing material had been cut by the fire department to extradite the removal of the driver and right front passenger. The rear safety belts did show conclusive evidence of use or non- use. The exterior of the Pontiac showed total damage consistent with a right side impact.. The damage indicated the Pontiac impacted an object (wooden pole) at about the right front tire and the principle direction of force (PDGF) was diagonal towards the rear of the vehicle and through the center of mass. Contact damage was observed to the right front of the Pontiac beginning at the raid-line of the right front fender and into the right door. Contact damage was also observed to the roof. Induced damage was observed over the remainder of the entire vehicle. The right door and the left and right "A" pillars were cut by the fire department. Brakes Both the front and rear brakes are activated by foot pressure to the master cylinder through the vacuum power assist unit and brake pedal. The pressure applied to the roaster brake cylinder by the brake pedal, pushes hydraulic brake fluid through the brake lines to the rear wheel cylinders and the front brake calipers, thereby activating the brakes. The master cylinder was located on the fire wall in the engine compartment. The composite design master cylinder was properly attached at the front shell of the vacuum power-assist booster. The master cylinder design included a cast aluminum body, primary and secondary piston assemblies with related seals and springs, plastic reservoir, reservoir cap and cap diaphragm seal.. The-fluid delivery lines were properly affixed between the master cylinder and the combination valve. The lines of this location appeared to be free of visible defect or damage. The brake fluid was hark in color and at the full mark in both the front and the rear portions of the reservoir. The brake pedal was depressed. The brake pedal held firm without fade for approximately 2 minutes. The power-assist function is achieved through use of a vacuum booster mounted to the engine compartment bulkhead. The booster unit uses intake manifold vacuum and atmospheric pressure to reduce braking effort. The booster unit was a duel diaphragm, vacuum suspended unit. The booster was composed of front and rear shells, diaphragms, pushrod, and an air valve assembly. Vacuum is delivered to the power-assist booster from a vacuum outlet port located on the engine MIMI'S NAME DATE R MITI 1119= 1AIE GUM ES 010542 117119199 NARRATIVEISUPPLEMENTAL PAGE __ E INCOM NCI '�.uhIBEFt ZTFICER 17, NUMBER 1011'6199 2358 09320 14770 99-10-225 intake manifold. The delivery of manifold vacuum is conveyed through a molded rubber hose and an inline check valve. The front brake calipers were of a single piston floating design. Each caliper was properly affixed to its respective carrier with mounting pins. The mounting pins and anti-rattle springs properly maintained the positioning of brake pads within the caliper assemblies. The steel caliper pistons were in an extended position, with the friction pad linings located in close proximity to the rotor surfaces The brake fluid delivery flex hoses were free of defect as were the rigid brake lines. The front brake pad friction linings were composed of a bonded, semi-metallic material. The friction lining contact surfaces were smooth and displayed indications of full engagement being made between them and the brake rotor surfaces during use. All four of the brake pad friction linings had approximately .39 inch of material remaining. 'The front brake rotors were a vented design. The outboard and inboard contact surfaces of both rotors were smooth and uniform. The rear foundation brakes were duo-serro drum brakes. The self adjusting mechanisms with various brake shoe springs and hardware were properly assembled. Both wheel cylinders were functional and did not displayed any visible signs of leakage. The lines and hoses of the rear foundation brake assemblies were intact and free of defect or damage. The rear brake shoe friction linings were composed of a rivited, semi-metallic material. The brake linings were adjusted in close proximity to the brake drums (proper adjustment). The friction lining contact surfaces were smooth and displayed signs of full engagement being made against the brake drum contact surfaces during use. The two leading brake shoe friction linings had approximately .19 inch of material remaining while the two trailing brake shoe friction linings had approximately .12 of material remaining. The rear brake drums were full-cast designs. No visible imperfections were detected on either drum. The contact surfaces were smooth and displayed a shiny luster from friction lining engagement to them during use. Steering The steering system is controlled by manual input through the steering wheel from the driver. This rotational input is transmitted to the frame mounted steering box through a shaft which extends from the steering wheel through the fire wall to the hydraulic assist steering box. The rotational input into the steering box will cause a movement in the pitman arm which will push or pull on the steering arms, thereby turning the front wheels to either the left of the right. The power steering pump, belt, hoses, and power steering box appeared to be in good working order. The power steering fluid was at the full level. The left and right sides of the steering system showed no previous damage or defects. The remainder steering system showed no signs of prior defects or daniage. The steering system turned the front wheels to the left and right. t -..UMBER DATEA11 K GRafE'S 010542 10119199 r NARRATiVEfSUPPLEMENTAL PAGE /:L DAMITU IN-MUMT TIME N It,..i.JMBER OFFICER I.D. NUMBER '. 10/f649 2358 09320 14770 99-10-225 Tires The tires on this Pontiac Firebird were in good condition. The tires were FUIDDA CARAT ASSURO. The tires were in size 215165815. Three tires displayed a DOT number of PJ5UT`5 97 while the left rear fire displayed a DOT number of PM175FR397 The tire tread depths and air pressures are as follows: Tare_ Tread Depth Air Pressure Right rear .33 inch 36 psi Might front .31 inch 0 psi Left front .33 inch 40 psi Left rear .33 inch 40 psi The right front tire was flat. The outer side wall had sustained an impact during the collision which caused a rupture approximately 3 inches in length at the 10-11 o'clock position Throttle System The Pontiac Firebird was equipped with a 2.8 liter 6 cylinder engine. The induction system was composed of tuned port fuel injection with a cable controlled linkage, throttle return spring, cable controlled cruise control, and an accelerator pedal. The air intake hose was removed from the throttle housing to provide viewing of the throttle plate's positioning. The throttle plate was found established in the closed (idle) position. The control cable connections at the throttle linkage were maintained in their normally routed configuration. The cable ends were properly conjoined at the linkage connection points. The accelerator pedal was depressed. The throttle plate rotated in conjunction with the movement of the accelerator pedal. The throttle plate rotated smoothly, without binding. The throttle rotated from an idle position to a full throttle position and returned. Conclusions After completing a mechanical inspection on the above vehicle, it is my opinion that there were not any prior mechanical defects which would have caused or contributed to this incident. All vehicle body damage noted was a result of this traffic collision. Additionally, it is my opinion that the left and right front shoulder harness/lap belt was in use at the time of this collision_ There was no determination as to the use of the rear safety belts. IT.. A J i .A A K GRIMES 010.542 10119199 NARRATIVEISUPPLEMENTAL, PAGE I LATE of INZOM TM ..ONMERt oFMCM IM, NUNMER 016/99 2358 `09320 1770 9910-225 :fin jurry Assessment BrianCurtis Hyman The assessment of injuries and the mechanism of these injuries was based physical evidence found at the collision scene, and the information obtained from the autopsy performed by the Contra Costa County Coroner's Office. The autopsy was performed by Marr Super MD, Forensic Pathologist, and by Sandy Jagoda, Pathologist Assistant, on 10/18/99 at approximately 1000 hours at the Contra Costa Coroner's Office, 1960 Muir Road, Martinez, CA. Officer Grimes was present during the autopsy. The comer's case number.was 99-1432 On 10/16/99 at approximately 2.358 hours, Brian Curtis Hyman was driving his 1989 Pontiac Firebird eastbound on Cypress Road approaching the left turn to northbound Bethel Island Road. The Pontiac failed to negotiate the left turn in the roadway going off the east side of Bethel Island Road and then impacted a utility pole. Mr. Hyman sustained blunt force trauma to his head during the impact. Mr. Hyman was transported to John Muir Trauma Center where at 1200 hours on 10/1799 he was pronounced dead. In1ur DescriRt The collision produced the following injuries which were identified during the autopsy. 1. Massive skull fracture to the right side of the Petrous 2. Massive hemorrhaging of the brain There was no evidence about the neck, shoulder, chest, abdomen or hips which would indicate the use of a safety belt. Mechanism Of Injury When Mr. Hyman`s vehicle impacted the utility pole, his vehicle underwent a sudden and extreme change of velocity. During the collision sequence the roof of the Firebird was being forced inward. Mr. Hyman impacted the interior of his vehicle causing blunt force trauma.. The cause of death was major blunt force trauma brought on by the sudden and rapid change of velocity at impact. DATE =IEWER'S SAME DATE ?REPARER'S NAME LD,NUMBER L 11 GRIMES 010542 10/1 9199 NARRATIVE/SUPPLEMENTAL PAre ;�'Ip r ;• Ilr1 Lei ;� nul4S� o u. . w 10116/99 2358 09320 14770 -= T` 99-10-22s u. Injury Assessment Sara unniinham The assessment of injuries and the mechanism of those injuries was based physical evidence found at the collision scene, and the information obtained from the autopsy performed by the Contra Costa County Coroner's Office, The autopsy was performed by Marr Super MD, Forensic Pathologist, and by Sandy Jagoda, Pathologist Assistant, on 10/18/99 at approximately 1045 hours at the Contra Costa Coroner's Office, 1960 Muir Road, Martinez, CA. Officer Grimes was present during the autopsy, The corner's case number was 99-1427 On 10/16/99 at approximately 2358 hours, Sara Cunningham was a passenger in a 1989 Pontiac Firebird which was eastbound on Cypress Road approaching the left turn to northbound Bethel Island Road. The Pontiac failed to negotiate the left turn in the roadway ,going off the east side of Bethel Island (toad and then impacted a utility pole. Miss Cunningham was seated in the right front passenger seat and sustained blunt force trauma to her head during the impact. Miss Cunningham was pronounced dead at the collision scene. Injury Description The collision produced the following injuries which were identified during the autopsy. 1. Detached brain stem 2. Hinged skull fracture 3. Lacerated liver 4. Abrasions about the left and right hip, across the pelvis, and on the right shoulder and neck. Indicative of safety belt usage 5. Compound fracture of the right femur 6. Lacerations on the right forehead and chin 7. Abrasions to the left chest area and left outer arm 17-771mr DATEA. A L K GRIME' 010542 10119199 5-ATE CF CAL1FCRNW. NAA� RRATIVEISUPPLEMENTAL � A y MMMM TM --N %'.aero...urr...+s„e...-... ... .. ... 41-r'•sir-. 5r o.l. +Wshr+,.Y.wsw�yT'�fi,Y... ..fiL vLTM 1+.... 10/1'6/99 �> 2358 ._.:_09320 i4770 == ::..99- -225 TMechani Of Iniury When the Firebird impacted the utility pole, it underwent a sudden and extreme change of velocity. Luring the collision sequence the roof of the Firebird was being forced inward tourards the passenger area. 112iss Curmingham impacted the interior of the vehicle causing bluntforce trauma. The cause of death was major blunt force trauma brought on by the sudden and rapid change of velocity at impact. DATE &hVitW&W5 NAME DATE K GAIMES 010542 10/19/99 CIAIM ]BOARD DE.SUPIERVISMS.OF-CMTRA M51A CQ=a CAIfi LIMENIA MAY 16, 2000 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 docur ant mailed to you is your Califorria Government Codes. '17 notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), Oven t pursuant to Government Code Section 813 and 815.4. please note all "Warnings". AMOUNT: $250,000.00, plus $100,000.00 f �TINEZ CALIF, cost of future medical care CLAIMANT: 'Ted Kilano ATTORNEY: Gwillia, lvary, Chiosso, DATE RECEIVED: April 12, 2000 Cavalli & Brewer ADDRESS: A Professional Corporation BY DELIVERY TO CLERK ON: April 12, 2000 P. 0. Box 2079 Oakland. CA 94604-2079 BY MAIL POSTMARKED: . April. 11, 2000 L FRONS Clerk of the Board of Supervisors T'O: County Counsel Attached is a copy of the above-noted claim. PHIL BA= S::t Dated: April 12, 2000 By: Deputy IL 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: Dated: _ i � By: � ���� _ deputy County Counsel III. FRO14- Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV, BOARD ORDER.- By unanimous vote of the Supervisors present: ( This Claim is rejected in full. ( Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: i 0 PHIL BA?CIIELt3R, Clerk, By C4A �, Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of yotir 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 Thir, Notice. AFFIDAVIT OF MA1M73 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. :gated:_ 14 �-3' By: PHIL BATCHELOR By � Deputy Clerk "/.`.1,, CC: County Counsel County Administrator GWILLIAM , ( VARY , CHIOSSO , CAVALLI & BREWER � :' - ATTORNEYS AT LAW J.Gary Gw]Iliam A Professional Corporation Mailing Address Eric H.]vary 1999 Harrison Street,Suite 1600 Post Office Box 2079 James R.Chlosso Oakland,California 94612-3528 Oakland,California 94604-2079 Steven R.Cavalli Phone 510.832.5411 Steven J.Brewer Fax 510.832.1918 Steven A.Reaves Molly C.Harrington Contra Costa Office Phone 925.820.0335 April 11, 2000 RECEf .., APR 12 /wi i Clerk of Board of Contra Costa County Supervisors 651 Pine Street, Room 106 CLERK BOARD OF V+. CONTRACOSh � Martinez, CA 94553 ATTN: Joan RE: Kilano Dear Joan: Enclosed please find an original and a copy of Mr. Ted Kilano's Claim against the County of Contra Costa. Please return a signed/endorsed copy of the claim to our office in the enclosed self-addressed stamped envelope I have provided. Sincerely, GWILLIAM, IVARY, CHICSSO, CAVALLI & BREWER Leni Doyle Legal Secretary to Eric H. Ivary lld Encl. 42144 CLAIM AGAINST THE COUNTY OF CONTRA COSTA A. NAM—E.ADDRESS OF CLATW ANTS: Ted Kilano 641 South Broadway Avenue Bay Point, CA 94565 B. SEND ALL NOTICES TO: Eric H. Ivary Gwilliam, Ivary, Chiosso, Cavalli&Brewer 1999 Harrison Street, Suite 1600 Oakland, CA 94612-3528 C. DATE OF OCCURRENCE. On October 19 and 20, 1999 D. PLACE OF OCCURRENCE: Contra Costa Regional Medical Center 2500 Alhambra Avenue Martinez, CA E. CIRCUMSTANCES OF OCCURREN This is a medical negligence claim by Ted Kilano arising out of defendant's failure to diagnose a retained foreign body in his left eye. On or about October 19, 1999, Mr. Kilano went to the Emergency Room and recounted a history of an injury to his left eye and complained of pain in his left eye. Mr. Kilano was discharged without appropriate tests or examination to rule out a foreign body. The following day, the pain in Mr. Kilano's eye had increased and his vision had deteriorated to the point where he was unable to open his eye. Mr. Kilano returned to the Emergency Department of the Contra Costa Regional Medical Center on October 20, 1999. Again, the foreign object was not diagnosed. On October 21, 1999, Mr. Kilano returned to the Emergency Department of the Contra Costa Regional Medical Center where an x-ray revealed the presence of a"metallic foreign body". As a result of the delay in diagnosis, Mr. Kilano has sustained permanent vision loss in his left eye. Claimant believes the following individuals are or were employees and/or agents of the public entity, and were involved in some aspect of the treatment and care of Mr. Kilano: Frances Chavez, M.D., David J. Su-chow,M.D., D. Scott Schmidt, M.D. F. GENERALDESCRIPTION OF INJURY, DAMAGE OR LOSS INCURRED: As a result of the negligence described above, Ted Kilano is left with a permanent visual loss in his left eye. Additional surgery is pending. G. AMOUNT OF CLAIM AND BASIS OF COMPUTATION SUM CERTAIN): 1W. Kilano claims the maximum recovery allowed under MICRA for non-economic loss, $250,000, and an additional $100,000 for the cost of medical care in the future and a not yet determined amount for loss of earning potential in the future. Dated: April 10 2000 Eric H. Ivary Receipt of a copy of the within claim is hereby acknowledge this day of 2000. 42008 2 - { 1L 44 .�::..xw..:.w.,w,..,Y..<.kv.,...:a2�,> eis�:.�.e, wia...ate*•sx.x....s�;:: rs:Cfrasr u• A PmonmemAL CARPORAT*N 1999 HARRISON STREET.SUMS 10(10 P.O.SM 2079 OAKLAND,CAUFMNIA 94004-2079 TO:r ATTN: Joan Clerk of Board of Contra Costa County Supervisors 651 Pine Street, Roan 106 M),rtinez, CA 94553 C, ClA51 .8=1MAY 15, 2000 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. l notice of the action taken on your claim by the - � Board of Supervisors. {Paragraph IV belovvl, given t pursuant to Government Code Section 913 and r . 815.4. Please nate all "Werrungs" z;. AMOUNT: $4,088.00 �J `'0 0 U N S E L the T iNEZ CAI.11F. CLAIMANT: William J. Klin ATTORNEY: DATE RECEIVED: April. 17, 2000 ADDRESS: 22245 Main Street, #205 BY DELIVERY TO CLERK ON: April 17, 2000,�„� Hayward CA 94541 BY MAIL POSTMARKED: Hand-Delivered L FROM. Clerk of the Board of Supervisors M. County Counsel Attached is a copy of the above-noted claim. PHIL BATCHELOR, Cle Dated: April. 17, 2000 By: Deputy IL FROM County Counsel TO: Clerk of the Board of Supervisors {This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: `"� By: L2n-yl�tDeputy County Counsel 111 PROM 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 0tDER 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 � J X&, Deputy Clerk WARNING (Gov. code section 13) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAIL.NG I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age I8; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: � BY: PML BATCHELOR By Deputy Clerk CC: Co&@gwsel County Administrator ,ia!m 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 IOOh 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 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. 7 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 WILLIAM J . KLUG ) 22245 Main Street , #205 ) RECEIVED HAvward , -fA�94541 ( 510) 5-27-1 -115 Against the County of Contra Costa or ) APR 17 1000 1 District) CLERK BOARD OFF,UPERV SOBS 7 (Fill in name) ) CONTRACOSTACo. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ 4 ,0 S 8 . 0 0 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) December 2 , 1999 at 3 . 57 p .m . 2. Where did the damage or injuCy occur? ('nclude city and county) Contra osta ounty ourt House 725 Court Street Martinez , CA 3. fllow did the damn e o1r r rya c r?5,Fivpe,full dptailsa;u use eytnra pa er if re uireg) n December going Tinto t�re upeior Court Clerks Office . I had the door open and I was holding on to the door handle with my right hand . I saw an asian women in her late 40 ' s through the glass in the door . I was moving aside to let the women come out still holding on to th door handle when the asian women grabbed the other door handel and jd?rked the door closed as I was still holding on to the and unexpected other door hand The sudden p jfprk injure my right arm shA der and back . � ie Asian women that i informed me thedoordthat thoes c°urtm i s- dc�notsiefd ed � er seI f as a court clerk and C� "7. 4. What particular act or omission on the part of county or district officers, servants, or employees caused the t inu ordama e? The Superior Court Clerk Jurked the clerk ' s office door closed asl I was opening the and holding on to the door handle injuring me . S. What are the names of county or district officers, servants, or employees causing the damage or injury? I did not get the clerks name but I could point her out at the court house . ( asian women late 40 ' s 5 ' 1 " tall about 120 lbs ) stated she was a clerk 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) Back strain and lumbar muscle strain and right arm and sholder strain , 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) $647 . 00 medical , medical multiplied by three for pain and suffering ( $1 , 941 . 00 ) , $1 , 500 . 00 lost wages . totaling $4 ,088 . 00 8. Names and addresses of witnesses doctors, and hospitals. den Medical Center , 2003 Castro Valley , CA 94546 Dr . Garriott , 2457 Grove Way , Castro Valley , CA 94546 9. List the expenditures you made on account of this accident or injury. DATE TIME AMOUNT Decer-2 , 1999 9p .m. $259 . 00 Eden Medical Center ER 1/?/2000 ? a .m . $50 . 00 Dr . Garriott Medical � ? 000 ? m 333g p0 Ed n ( X-Ray ) 12/21 O6�b - Present time Host unable to earn 1 ,500 . 00 ast waVees Gov. Code Sec. 910.2 provides "The claim must be signed by the claimant or by some person on his behalf" SEND NOTICES TO: (Attorney Name and Address of Attorney wimam ug4 #11 ) ik/APR 00 (Claiman s Signature) 22WW)n Street #205 Heyward, CA 94541 Telephone No. }Telephone No. ? 1c�2 15 3:Z-- /'3/ NOTICE Section 72 of the Penal Code provides: Every person who,with intent to defraud,presents for allowance or the 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($10,000),or by both such imprisonment and fine. e g oil , z•,aEDEN FOR YOUR CONVENIENCE,WE HONOR alilnr5i;i,niSat,-5+e7 MASTERCARD,&VISA. BILLING DATE 3/27/00 PLEASE CHARGE MY: PATIENT KLUG, WILLIAM J ADMISSION DATE 12/02/99 No. CONTROL NO. 2856550 DISCHARGE DATE 12/02/99 0 MASTERCARD ACCOUNT Y1SA No. ❑ VISA CARD ACCOUNT WILLIAM KLUG CREDIT CARD 1171 COTTER WAY GOOD THRUMO. YR. HAYWARD CA 94541-2102 AMOUNT ENCLOSED OR CHARGED 111�111�11�1�1�11�111111��11�1�111�'��Iilll�ll�lflEllt��f�ll�� PLEASE MAKE CHECKS PAYABLE TO: EDEN MEDICAL CENTER,Fila i 73700,P.O.Box a0000,San Francisco,CA 641W4700 IRS NO.64.2648100 {.:.:.y.:;•.•y . . . . . :k: y 45 45 .....:. y':.�:'ky{:{:.y}:�.;:•. +r.{v.v{.n ::.vi.•:4:::::::.::•. n 1,.+..:..;.a.. ...... ••.•{:..:}}r,n;•;}.y'!..vh.:;•.:..•.::.;. :. •:v,•r''Yv.. .:{}..t•;.:av°v:ihv,k {:{4;{$' $,C�;;.n.$.+v'$,'•'.:.:.r::...:•% .,�{+Sy;:y:.y:.::.:.... •:• ::ay..:4°y:.: :,..�:+'..Y3$•. :.::+.,;cc; ': :xR.:,•a:a:.,.;6?::,%;.+,.:{.y:y.:.pt" :;;$;•,.;+.,{;fi.k.y#,+{•K .h.. .•>...•'•:3,: o:4h t':i:4y'k.✓` 12/08/99 BALANCE FORWARD 259.00 EDEN MEDICAL CENTER Please refer-to the hack of this statement far other important billing infot-mation. 259.005 T,1 l�1� N 1i4L' Et3, KLUG WI LL i AM J 2856550 PHONE: (510) 885.5020 Monday-Friday Important Message 9,00a.m.-3:00p.m. 8 WE HAVE BILLED YOUR INSURANCE. THEY HAVE NEITHER CONFIRMED PHYSICIAN CHARGES ARE BENEFITS NOR MADE PAYMENT. PLEASE ASSIST US IN THIS MATTER. BILLED SEPARATELY EDENVdi t'I,::�,:�,Roadc':�a,�v;ill.y FOR YOUR CONVENIENCE,WE HONOR :O. ..... MASTERCARD,6 VISA. BILLINGDATE 4/01/00 PLEASE CHARGE MY: PATIENT KLUG, WILLIAM J ADMISSION DATE 1/05/00 No. CONTROL NO. 2940290 DISCHARGE DATE 1/05/00 ❑ MASTERCARD ACCOUNT YtSA No. ❑ VISA CARD ACCOUNT WILLIAM KLUG CREDIT CARD 1171 COTTER WAY 0000THRUMO. YR. HAYWARD CA 94541-2102 AMOUNT ENCLOSED OR CHARGED M* L �IIIIIfIIIIIIIIIIIIIIiIIIiII�I�IIIIIIIIIIIIIIIIfIIIIIIIIIIiIfI PLEASE MAKE CHECKS PAYABLE TO: EDEN MEDICAL CENTER,File 73700,P.O.Bax 90000,San Frandsoo,CA 941 DO-3700 IRS NO.94.2946100 :n:. :#a:g�?:............ ....:r. .., .. r.?;.r:•=x:<;':c 60 60 •rr:;•r:rrv:::::.:•r;:.;_.:::::..,_:::.::-•::::.....::.:•:.,:.:o-:;.rrr o-r>r...::•rrrs:.;.:::;;.:.�.;;::..•:::::.,;:.:r:;a•r::•:x<•rr:;•::;•r:•:;•.r;•rsr:•:aa:;:.:;:•::.: `7 1/11/00 ...:.•.•: rte... 1/11/00 BALANCE FORWARD 33$.00 l EDEN MEDICAL CENTER ;A Please refer to the back of this statement for other important billing information, 338.00 ?ATI NTNT1{CL;It3 -- } PHONE: (510) 889-5020 KLUG WILLIAM J 2940290 �I 3 Monday-Friday Important Message 9:00a.m, -3:00p.m. W WE HAVE BILLED YOUR INSURANCE. THEY HAVE NEITHER CONFIRMED PHYSICIAN CHARGES ARE BENEFITS NOR MADE PAYMENT. PLEASE ASSIST US IN THIS MATTER. BILLED SEPARATELY 1.GENERAL DUTY NURSING: The hospital provides only general duty nursing care. Under this system nurses are callear to the bedside of the patient by a signal system. If the patient is in such condition as to need continuous or special duty nursing care, it'is agreed that such must be arranged by the patient, his/her legal representatives, or his/her physicians, and the hospital shall in no way be responsible for failure to provide the same and is hereby released from any and all liability arising from the fact that said patient is not provided with such additional care. 2.TEACHING HOSPITAL: Patient acknowledges that the hospital is a teaching hospital and as such the training of physicians and surgeons, nurses and other health care personnel takes place at the hospital. Patient understands that nurses, physicians and other health care personnel in training may participate in the operation or special diagnostic or therapeutic procedures specified above under a supervising physician or surgeon, and Patient hereby consents thereto. 3.MEDICAL AND SURGICAL CONSENT: The patient is under the control of his/her attending physician(s) and the hospital is not liable for any act or omission in following the instructions of said physicians,and the undersigned consents to any x-ray examination, laboratory procedures, anesthesia, medical or surgical treatment or hospital services rendered the patient under the general and special instructions of the physician. The undersigned recognizes that all doctors of medicine furnishing services to the patient, including the radiologist, pathologist, anesthesiologist and the like, are independent contractors and are not employees or agents of the hospital. 4.RELEASE OF INFORMATION: The hospital and any hospital based physician may disclose all or any part of the patient's record to any person, corporation and/or Eden Medical Center Home Care, if applicable, which is or may be liable under a contract to the hospital or to the patient or to a family member or employer of the patient's for all or part of the hospital's charge, including but not limited to, hospital or medical service companies, insurance companies, workmen's compensation carriers, welfare funds, or the patient's employer. Pursuant to California Civil Code, Section 1798.24(b), the undersigned also authorizes all Federal, State and local governmental agencies, insurance companies, employers, banking institutions, and all others, to release any and all information regarding the patient to the hospital or its agents. This release shall remain in effect for four(4) years, or until revoked by the undersigned. I authorized Eden Medical Center/Laurel Grove Hospital and any hospital based physician to disclose my final diagnosis for billing purposes only obtained in the course of my diagnosis and treatment for alcohol abuse and/or drug abuse. This consent is subject to revocation by the undersigned at any time except to the extent that action has been taken in reliance hereon, and if not earlier revoked shall terminate six months from this date. 5.PERSONAL VALUABLES: It is understood and agreed that the hospital maintains a fireproof safe for the safekeeping of money and valuables.The hospital shall not be liable for the loss or damage to any money,jewelry,documents,or other articles of unusual value and small size, unless placed therein, and shall not be liable for loss or damage to any other personal property, unless deposited with the hospital for safekeeping. The liability of the hospital for loss of any personal property which is deposited with the hospital for safekeeping is limited by statute to five hundred dollars ($500.00), unless a written receipt for a greater amount of currency has been obtained from the hospital by the patient. Si nature)) 8.FINANCIAL AGREEMENT: The undersigned agrees, w ether he)she signs as agent or as patient, that in consideration of the services to be rendered to the patient, he/she hereby individually obligates himself/herself to pay the account of the hospital or any hospital based physician/surgeon/anesthesiologist in accordance with the regular rates and terms of the hospital or hospital base physician. Should the account be referred to any attorney for collection, the undersigned shall pay reasonable attorney's fees and collection expense. All delinquent accounts bear interest at the legal rate. 7.MEDICARE: Patient's Certification,Authorization to Release Information, and Payment Request. I certify that the information given by me in applying for payment under Title XVIII of the Social Security Act is correct. I authorize any holder of medical or other information about me to release to the Social Security Administration or its intermediaries or carriers any information needed for this or a related Medicare claim. I request that payment of authorized benefits be made on my behalf. I hereby assign payment for the unpaid charges of the physician(s) for whom the hospital is authorized to be in connection with its services I understand I am responsible for any health insurance deductibles and 20 percent of the remaining charges. 8JNSURANCE: I hereby assign irrevocable to Eden Medical Center/Laurel Grove Hospital and any hospital based physician/surgeon/anesthesiologist any and all insurance and unemployment compensation disability benefits due me to the full extent of my financial obligation to said hospital or hospital based physician. 9.The taking of still photographs and/or videotapes of medical or surgical procedures/processes, and the use of the same for scientific, educational or research purposes, is approved. THE UNDERSIGNED CERTIFIES THAT HE/SHE HAS READ THE FOREGOING RECEIVED A COPY THEREOF, AND IS THE PATIENT, OR IS DULY AUTHORIZED BY THE PATIENT AS PATIENT'S GENERAL AGENT TO EXECUTE THE ABOVE AND ACCEPT ITS TERMS. If patient is unable to give written or verbal consent to care, or is legally incompetent to give authority, state reason below. AM X19 HOUR PM__- DATE AND TIME OF SIGNING PATIENT WITNESS PATIENT'S AGENT OR REPRESENTATIVE WITNESS RELATIONSHIP TO PATIENT VALUABLES DEPOSITED: YES El NO El EDEN MEDICAL CENTER LAUREL GROVE HOSPITAL 20103 LAKE CHABOT RD. CASTRO VALLEY CALIFORNIA 94546-5367 BUSINESS OFFICE Form#38325(Rev.2199) Eden Medical Center Emergency Department 20103 Lake Chabot Road, Castro Valley, CA 94546 (510) 889-5015 Aftercare Instructions for WILLIAM KLUC, Thursday, December 2 , 1999, 9 : 51 pm IMPORTANT: We have examined and treated you today on an side with your knees bent toward your chest. When you turn emergency basis only. This is not a substitute for, or an in bed, "roll like a log". When you roll over, your effort to provide, complete medical care. In most cases, you shoulders, hips and knees should all move at the same time. must let your doctor check you again. Tell your doctor about DO NOT twist your back. any new or lasting problems. It is impossible to recognize Knees must always be bent, never lie on your stomach. and treat all injuries or illnesses in a single Emergency Lie on your back with a small pillow under you head and Department visit. If you had special tests such as EKG's and 2-3 pillows under your knees (folded blankets in pillow X-rays, we will review them again within 24 hours. We will cases may be used) . call you if there are any new suggestions. After leaving, Lie on either side with your knees curled up toward your you should FOLLOW THE INSTRUCTIONS BELOW. chin. You may use a small pillow under your head. Take all medications as directed. F011ow up with your Your care today was directed by Dr. Ralph D'Amato. Doctor as directed. BACK STRAIN & LUMBAR MUSCLE STRAIN & SCIATICA You were seen to day by the physician assistant Marian Roe. Acute Low Back Strain and/or Sprain is an injury of She has discussed your case with the physician in the either the tendons or ligaments of the lower back. This Emergency Department. results in muscle spasm which usually increases several hours after the injury. Sometimes muscular low back pain OXAPROZIN (Daypro) . can occur without any known injury. saaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa Sciatica is a progression of symptoms due to compression Take this medicine with food in the following dose: 600 mg of the nerves as they exit the spinal column. when this by mouth AS DIRECTED ON YOUR PRESCRIPTION for pain. happens, pain radiates to the buttox area and then down the aaaaaaaaaaaaataaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa+aaaaaaaaaaa legs. Sometimes there is tingling/numbness and weakness in This medicine will control pain and reduce inflammation the legs. Progression of these last two symptoms often (redness and swelling) . Side effects may include: upset requires in-hospital treatment. If you have trouble stomach, heartburn or tiredness. Allergy would show up as: controlling urine or bowel function return to the ER or rash or itching, wheezing or shortness of breath. contact your physician immediately. The steps below are recommended for patients with low Follow these instructions: back pain. Rest enough to reduce your pain. Complete - Take this medicine with food to avoid an upset stomach. bedrest is not generally needed, and may prolong your - Do not take aspirin, ibuprofen, naproxen, or ketoprofen recovery. while taking this medicine. Check over-the-counter medicine labels. Rest on a firm matress and apply heat to your back for - Store this medicine away from heat, moisture or direct several days. If you don't have a firm mattress, ask a light. Lriend (not you) to put a bedboard (a 1/2 to 1 inch thick - If you miss a dose, take it as soon as possible. If it is piece of plywood) between the mattress and the box springs. almost time for your next dose, skip the missed dose. Do You may also try sleeping on a pad or blanket directly on not double the doses. the floor. Call your doctor if you have: DO NOT use a waterbed. It does not support you back in - any sign of allergy. proper alignment. - any new or severe symptoms. ---HEAT or COLD PACKS--- Apply heat OR cold packs to your lower back. For heat you Hydrocodone (Vicodin) may use 1) a hot water bottle wrapped in a moist towel, or This is an strong pain killer used for severe pain. The 2) a moist, warm towel alone. Some patients benefit more drug is actually a combination of hydrocodone (a drug from cold packs rather than hot, similar to narcotics) and acetaminophen. In combination ---FOLLOW THESE INSTRUCTIONS REGARDING YOUR BACK PAIN--- this drug is very useful in controlling pain. It may cause The proper way to get into bed is to sit on the edge of the drowsiness and impaired mental function in some patients. bed first. Then, begin to lie on your side by first resting YOU SHOULD NOT DRIVE OR OPERATE HEAVY MACHINERY WHILE TAKING your elbow, then slowly raising your legs. DO NOT twist THIS DRUG. Occasionally some patients may have dizziness, your legs. Continue to lie down so that you end up on your nausea or vomiting when taking this medication. You should Portions Copyrighted 1986-1959, LOGICARE Corporation, Page 1, continued... Eden Medical Center Emergency Department 20103 Lake Chabot Road, Castro "Valley, CA 94546 (5101) 889--5015 Aftercare Instructions for WILLIAM KLUG, Thursday, December 2, 1999, 9 :51 pm contact you physician immediately if you develop any new or Physician or Nurse unusual symptoms. Like other strong pain relievers, Vicodin often causes some constipation. You can try taking some SEATBELTS. Metamucil (non-prescription) to prevent this problem. There is no doubt that seatbelts save lives. Every day in 00 NOT take Tylenol (acetaminophen) when you are using the Emergency Department we see how people without seatbelts Vicodin. It is okay to use aspirin or ibuprofen. are more severely hurt. we always buckle-upt Please do the same! Children should never sit in front of an AIRBAG. The Take this medication only as directed on the prescription. safest place for a child is the middle of the back seat. THESE ARE YOUR FOLLOW-UP INSTRUCTIONS Call Dr. RANDALL in 5 days it not much better. Call sooner if worsening. You can reach Dr. RANDALL at 886-3138, 20055 Lake Chabot Road, Castro Valley, CA 94546. AS ALWAYS, YOU ARE THE MOST IMPORTANT FACTOR IN YOUR RECOVERY. Please follow the instructions above carefully. Take your medicines as prescribed. Most important, see a doctor again as discussed. If you have problems that we have not discussed, CALL OR VISIT YOUR DOCTOR RIGHT AWAY. If you can't reach your doctor, return to the Emergency Department. * If you had XRays, Labs, or Cultures done during # * your ER visit, have your doctor or clinic call * Eden Hospital (537-1234) to get results. Results * can not be given to you directly over the phone. A great deal of medical information is now available on the INTERNET. If you have access to it, you may try www.EMedicine.com; www.medscape.com; www.DrKoop.com.; or use any search engine to find information! "I understand the instructions above, and discussed in the Emergency Department." My signature on this form allows my records to be faxed or sent from the Emergency Room to my follow up physician. I also understand that release of my records from the medical records department may separately require my addit* 1. authorizing gnature. I1 Lew Patient or Responsible Person Portions Copyrighted 1986-1999, LOGICARE Corporation, Page 2, last page. ATMENT OF CORRECTIONS DISTRIBUTION STATE OF CALIFORNIA ORIG: Inmate (White) PR AND CASH RECEIPTS — ARRIVAL cc: Property File (Canary) Trust Optica (Pink) Central File (Green) INMATE'$ NAME NUMBER CASH PLACED IN INMATE'$ ACCOUNT XOR"S a T C-8201 N/A DISPOSITION CODE: K=KEPT IN POSSESSION (WATCHES,RINGS, AND METALS VALUED LESS THAN E30) M=MAIL O=OONATED S=HELD IN SAFE V= 11 L7 QUANTITY ARTICLES otBA. QUANTITY ARTICLES +Dull'. A#IFTt A CLEB 0119P. BELT SUIT BLOUSE SWEATER ER-S LICENSE CAP TANK TOP YEGLASSES ::COAT UNDERWEAR _ KEYS DRESS HANDKERCHIEF HAT LEGAL PAPERS MEDICAL ID JACKET LETTERS MISC. to NECKTIE/SCARF PHOTOS '---_ MARR. CERT. OVERCOAT PURSE BIRTH CERT. PAJAMAS BILLFOLD SEL.SER'.CAPD PANTS/SLACKS BOOKS SOC. SEC. CARD SHIRT BIBLE RELIGIOUS MEDALS SHOES " DICTIONARY RING SHORTS SUNGLASSES SKIRT WATCH SLIPPERS COIN SOCKS ' CURRENCY STOCKIhtGS CANTEEN DUCAL"._ ` ` DESCRIPTION OF ITEMS ALLEGED 6Y-INMATE TO HAVE A VALUE OVER#$0 DESCRIPTION UCSF ITEMS "TO #E DESTROYED- ARTICLES LISTED AS `MAIL" ABOVE ARE TO BE FORWARDED TO: ADDRESS NAME CITY $TA-TE AND ZIP CODE CLAIM AND RELEASE l relinquish all claim to the articles listed above as "Donated", and hereby ackno*lgd+ge receipt of articles listed as "'Kept in Possession". The above is a correct inventory of per,., - al,property in my possession at the time of admission. SIGNATURE OF INMATE - : DATE I hereby authorize destruction of articles listed above as "To be DQstrvyed",';; SIGNATURE OF INMATE DATE- Wi*NE*SING OFFICER l hereby acknowledge receipt of the articles listed above as "Held in Safe" which was given to me upon my release from the institution. SIGNATURE or INMATE DATE WITNESSING OFFICER CDC-104 (REV. 4177) 8S gem rEFARTMENT OF CORRECTIONS DISTRIBUTION STATE OF CALIFORNIA ORIG: Inmate (White) PROPERTY AND CASH RECEIPTS - ARRIVAL CC: Property File (Canary) Trust Office (Pink) Central File (Green) INMATE'S NAM$. NUMBER CASH PLACED Iht.�1�1�ATE'S ACCOUNT 3. sT C820#3 E // �� DISPOSITION CODE: K=KEPT IN POSSESSION (WATCHES,RINGS, AND METALS VALUED LESS THAN$38) M=MAIL D=DONATED S=HELD IN SAFE V=VAULT QUANTITY ARTICLES 018P. QUANTITY ARTICLES DI$P, QUANTITY ARTICLES DISP. BELT SUIT DENTURES BLOUSE SWEATER DRIVER'S LICENSE CAP TANK TOP EYEGLASSES COAT UNDERWEAR KEYS DRESS HANDKERCHIEF HAT LEGAL PAPERS f' MEDICAL ID JACKET LETTERS misc. ID NECKTIE/SCARF PHOTOS - MARR, CERT. OVERCOAT PURSE BIRTH CERT. PAJAMAS BILLFOLD SEL. SER'. CARD PANTS/SLACKS BOOKS SOC. SEC. CARO SHIRT BIBLE RELIGIOUS MEDALS SHOES DICTIONARY RING SHORTS SUNGLASSES SKI RT WATCH SLIPPERS COIN SOCKS CURRENCY STOCKINGS CANTEEN DUCAT DESCRIPTION OF ITEMS ALLEGED BY INMATE TO HAVE A VALUE OVER $30 - DESCRIPTION OF ITEMS "TO BE DESTROYED'' ARTICLES LISTED AS "MAIL'' ABOVE ARE TO BE FORWARDED TO: ADDRESS NAME t CITY STATE AND ZIP CODE t CLAIM AND RLLEASE t relinquish all claim to the articles listed above as "Donated", and hereby acknowledge receipt of articles listed as"Kept in Possession". The above is a correct inventory of personal property in my possession at the time of admission, SIGNATURE OF INMATE WIT N'EDNG O#FILER O3-1219-0 l hereby authorize destruction of articles listed above as "To be Destroyed". SIGNATURE OF INMATE DATE WITN$ie ING OFFICER " t hereby acknowledge receipt of the articles listed above as "Held in Safe" which was given to me upon my release from the institution. SIGNATURE OF INMATE - BATE WITNESSING OFFICER ' CDC-104 (REV. 4/771 -.-- --- N.�.�1}•.��� R. fry- ,w. St•w^' CD } • CA -- IOU ' Ort �,,ri`tti� tit «t M3 0 fJl y,tF rtw�sti t4rtrtaF s" ClAIM TSO ELID OF SUPER 0gS OF CONTgA COSTA CMJNTY, CALU IENTA 1 l MAY 16, 2000 Claim Againstthe 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 ttis document mailed to you is your California Goverment Codes. l notice of the action taken an your claim by the Board of Supervisors. (Paragraph IV below), given � pursuant to Goverr>Errlent Code Section 813 and U!171 ' 815.4. Please note all "Warnings". AMOUNT: $1,000.00 APR 1 2 200€1 COUNTY COUNSEL CLAIMANT: Micaela Ochoa MARTINEZ CALIF. ATTORNEY: DATE RECEIVED: April 12, 2000 ADDRESS: 854 - 7th St. , #2 BY DELIVERY TO CLERK ON: April 12, 2000 Richmond CA 94801 BY MAIL POSTMARKED: Ap=J II R, 2000 L FRONE Clerk of the Board of Supervisors TO: County Counsel Attached is a ropy of the above-noted claim. PHIL BATCHELOR, Clerl Dated: April 12, 2000 By: Deputy II. FROM: County Counsel TU: Clerk of the Board of Supervisors (-,rhis claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 914.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). { ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Mier: - - --- Dated: By Deputy County Counsel 13L FROM: Clerk of the Board IQ County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD'ORDER.- By unanimous vote of the Supervisors present: {} This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated:�Y t & LQ0 PHIL BATCI3'ELOR, Clerk, By ' j � Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AffID►AVTF OF MAEUNG 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: 222LUI & By: PML BATCHELOR By Deputy Clerk CC: Gutty Counsel County Administrator Claim to: HOARD OF SUP'ERy'ISM OF CO'TRX COSTA COUNTY IIs!' crioNS TO a ADW;T Ae. Claims relating to causes of action for death or for injury to person or to per- stinal property or growing crops and which accrue on or before December 31, 19879 must be presented not later than the 104th 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 5911.2.) H. Claims must be filed with the Clerk of the Board of Supwvisors at its office in Room 105, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is 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 mere than one public entity, separate claims mast be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Ccie Sen. 72 at the and of' this ray. e e e e e e +� e * �t �t �t �t �r e • �t * e �t • e e e e e �t �r e e • e �t �t e e e * s e e +e �r RE: Claim By Reserved for Clerk's filing RECEIVED APR 12 2000 1p—InSE -tFe MuZnEy o -tra Mita ) or CLERK BOARD OF SUpERV15URS CONTRA COSTA CO. District) 7111 in name 5 The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 11 Q 0 and in support of this claim represents as foll.o was 1. When did the damage or injury occur? (Give exact date and hour) R 2. inhere did the damage or "injury occur? (Include city and county) 3. How did the damage or injury occur? (Give full details; use extra paper if required)int..-s becus+.1 a tai b , UU 4. mutat particular act or omission on the part of county or district officers, i servants or eMloyees caused the injury or ? (over) "What are the names_of county or district officers, servants or employees causing the damage or injury? 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimel.. Attach t.w:y estimates ror auto damage. c&-'r C1 kL, . 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. wt4r► s- . .3a k. V;'V 7*� �9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov. Code See. 910.2 providest SEND NOTICES TO: (Attorne ) "Tile claim must be signed by theclaimant Name and Address of Attorney or-by some 2erson on his behalf." J la s Signature 95- 70r' 54- (Address) 4Ad ess, TTelep�hone No. Telephone No. S/t) -.23--x- —7 7 N 0 T I C 9 Sectio 72 of the'Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or orricer, or to ar y couunty, city or district board or officer, authorized to allow or pay the sauce if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county ,fail for a period of not more than one year, by a fine of not exceeding one thousand ($l,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine, Claimtri:� BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY. INSMUCTIQNS TO CLAIMANT /0A A. Claims relating to causes of action for death or for injury to person or to personal property or growin craps and which accrue on or before December 31, 1987, must be presented not later than the 100 'day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Gov't Code 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By Reserved for Clerk's filing stamp y } APR 10 2€l€� Against the County of Contra Costa or } District} (Fill in name) } The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ ,_ and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) -r: 2. Where did the daInage or injury occur? (Include city and county) T' j] 3. How did the damage or injury occur? (Give full details; use extra paper if required) F •r"7,�' , 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? '.i,, {: 0,, q( ` 5. What are the names of county or district officers, servants, or employees causing the damage or injury? { i 0 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) QL r 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) y.. { ': #; 8. Names and addesses of witnesses, doctors, and hospitals.. 9. List the expenditures you made on account of this accident or injury. �^+,+ DATE TIME AMOUNT}' 'yvY yT Y:. Gov. Code Sec. 910.2 provides "The claim must be signed by the claimant or by some person on his behalf." END NOTICES TO: (Attornev Name and Address of Attorney ) ii q F C t ) (Claimant's Signature) D (Address) t.. ,i..aoP Telephone No. " . b. )Telephone No. . �8 :. { t" NOTICE Section 72 of the Penal Code provides: Every person who,with intent to defraud,presents for allowance or the 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. Y\ yl 4 �.s t"S CLAIM BOARD dF SUPERMORS dF CMIRA CCISTA C[H3hTTVo C_ sLEMNie BOARD AnO MAY 16, 2000 Claim Against the County, or District Governed by ► the Board of Supervisors, Routing Endorsements, I NOTICE TO CLAIMANT and Board Action. All Section references are to I N copy of this document rmiled to you is your California Govermnent Codes. ? notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV belovul, given TJ ` C pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: $100,000.00 P 1 iJR' COUNT COUNSEL CLAIMANT: Martin Riley f1 ARTiNEZ CALIF, ATTORNEY: DATE RECEIVED: April 10, 2000 ADDRESS: Martinez Detention Facility BY DELIVERY TO CLERIC ON: _ April 10, 2000 901 Court Street Martinez CA 94553 BY MAIL POSTMARKED: (Transmittal - County Jail) L FROM: Clerk of the Board of Supervisors M. County Counsel Attached is a copy of the above-noted claim. PHIL, BATCHELOR, Cler1 Dated: April 10, 2000 $y: Deputy ,(� �--a IL FROM--County Counsel TO: Clerk of the Board of Supervi ors {' is claim complies substantially with Sections 910 and 910.2. { ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). { ) Claim is not timely 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:_..__ �f`-/G�...1�� � .. By: Deputy County Counsel IIL FROM Clerk of the Board M. County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). I1,, BOARD ORD[[: 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, Clprk, By , Deputy Clerk WARNING (Gov. code section 913) Subject to certain ex a<-ptions, 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 Cod• 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 Seg: Reverse Side of-chis 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 1 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 $y Deputy Clerk CC: County Counsel Count; Administrator W' � iJ ...��<999id�+': �� i.✓. �if. 'i �y[f� '/'�>.� ^' Y^'�i b+: �f�x'�<�� '.' •.. �•, J~•'f,l� t} �{ a!'' S.t:. ..;,� ac"� 3 ,�,:: f,�J' $'�g�•`�u,.. 4�'- � ��u. R'�A.�,� .tr Rr'` A� .. � ��,..Y? ..f. f �« t • oc 4 +! n ,[ 00 }� :.�::,L� 50' �e� J�l „ �d•,y�f/ti, {f4 �>�:. A" ��,,.L �r� V �*"' •}N,:��..._ T''k�/_ Y� ... ice... `�� d .. � a.-,..'1 '�,,. 2 �!'a "{v--dt+''���� 1.+: �'t n,.. ��r i • x A. et �3 N��^ti •�'.• 6F .. � .Yp• y�+ ��'�' � 'M1W W"'r C" "' Y '� .y'� � ���-i �� MiY�: � r�'F 141..�:�'w.._` i a... .y . s t ££ Y �•�c '�� �'�. � � ��ty� k•.-'�..�y>.`' ,< ,�,�,,, s`�'3 ���r_"b.� yi�� ?�� >r>, ?y. ::.F r�'_<.Y _ �'<� .y+a,�,q .�-jk,�" a }r.•i�5:. 4'� iFri+'.�._R S k �i-y:- �'�;k `J'! `� 3,uf -.-J D � r � rsl,V� tF .� /�4'�� •.'A'e.• S 1.�>'4 `'�::. r.:. ( .'^� [�*(/,�.• ,fie"�'' 3 ,,c+ ,t 'P2 /..�".<u`_/.a �.: � 1"..�b°A .. � (+,�-� 2 �:,Sw t± '..n$.r✓' 1�+.'i�+Jf'�'E "H•.�? n �.3b. #�'=>..:.if :.�'! -�� 6 , Ste' 4 `.6 i f in E ? 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FA. �f�..•„, x �„ ts•'� F ,� 3 't�''�� d� n•"?4 ., $�'4� �,,,�'+�i ,t F z. , �' .r. 9 ! ,}'+�' ,,, 1.....n ' t { �'�✓+ a.^''' t if+. .. /4: �vy� � ,,,... ?' ey,.�•:. b.,,,v' b.w `�' '"E, +� y.#. y Y ,ti.. t •. t { .,...� Lc � &r -.. .cam � t.i ��-e ��`l.g?t 'j „q„ ^4 ,',__,�y�.k•.i, f Y Ft+} in k # -. x.. [ ,.s..wk ,,.r§ e...,• '.l f �•h x t ,y,Ct y' - r fa.S 4♦' ! .. LA Sl Al j� ��,r�.,.f �' �r L- MK�.+fi S #.,.,> i.y„ �. '-....`34 4 ��v.& �:S� w. _..•f � � 5._ L g F Y r } v G �Y�"' \;7r �'^3 b �' �: � k Orr� �.,. .,.,.ty' s .. ..� } �. '4•:���7,�i %,�%� }i t�S ^ F r. 3 i„ r •�fi } } y .{ _- - x r f f 'f" k r a A" 1 t 1 1 �," .✓ -.� �� �,�"'�.' _ •nom► i t' All� ,,. r CIArd �O Rib GE SLTPF.R t' M OF CO IRA CUST'A COLT o CALUMNiA BOARD ACTU111t MAY 16, 2000 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, 1 NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this docurent railed to you is your California Government Codes. _ ) notice of the action taken on your claim by the r Board of Supervisors. (Paragraph IV below), Oven pursuant to Governrrient Code Section 913 and 1 3 815.4. Please note all "Warnings". AMOUNT: NONE S'T'ATED COUNSEL CLAIMANT: Christine Bittle Simmons ATTORNEY.. c/o Thomas R. Woelfel BATE RECEIVER: April 13, 2000 SBN 120358 ADDRESS: 'LAW OFFICE OF THOMAS R. WOELFIIgY DELIVERY TO CLERK ON: April 13, 2000 4664 Sandmound Boulevard Oakley CA 94561 BY MAIL POSTMARKED: Transmittal L ]FRO11VL• Clerk of the Board of Supervisors M. County Counsel Attached is a copy of the above-noted claim. Dated: April 13, 2000PHIL BAT OR, Clerk By: Deputy IL FROM County Counsel TO: Clerk of the Board of Supervisors (his 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). ( tJt Other: " Icl t a► E off, t t�7� C/ ` ?r1 Ge L Dated: By: 1 ?,f r4j e_ ,,Deputy County Counsel III. FROK 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 ORDER: By unanimous vote of the Supervisors present: (`9 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-2=�?° PHIL BATCHELOR, Clerk, By , De u Clerk P ty WARNING (Gov. code sectio 913) Subject to certain exceptions, you have only six (b) 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. AFFMAV1T OF AL41 UNG I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: < ' By: PHIL BATCHELOR By ✓ �� Deputy Clerk CC: County Counsel County Administrator LAW OFFYCH OF THOMAS R. W®ELFEL 4664 SANDMOUND BLVD Licensed in: OAKLEY, CA 94561 Walnut Creek Office -California (925) 654-2667 500 Ygnacio valley Road -Hawaii Suite 490 Walnut Creek, CA 94596 (925) 977-4500 April 10, 2000 RECEIVED Contra Costa County Risk Management 2530 Arnold Drive, Suite 1.40 APR 1 3 2000 Martinez, CA 94553 1: CLERK BOARD OF SUPERVISORS Re : Bittle Simmons and Bittle-Hassenzahl a NT AC ST County Date of Loss : October 16, 1999 Dear Risk Management : Enclosed are two (2) Tort Claim forms which are being submitted on behalf of Christine Bittle Simmons and Carrie A. Bittle-Hassenzahl for claims against Contra Costa County for above-referenced loss. Please contact me should you require any additional information. Very truly yours, LAW OFFICE OF THOMAP R. WOELFEL Thomas R.R. Woe-1 Enclosures . Ic 1 Thomas R. Woelfel, SBN 120358 LAW OFFICE OF THOMAS R. WOELFEL 2 4664 Sandmound Boulevard Oakley, CA 94561 0 vIsofts 3 (925) 684-2667 so C0 CLE coc - 4 5 Attorney for Claimant, CHRISTINE BITTLE SIMMONS 6 7 8 CLAIM OF CHRISTINE BITTLE SIMMONS, 9 Claimant . CLAIM AGAINST CONTRA COSTA COUNTY 10 (Government Code, Section 910) 11 12 13 14 15 TO: CONTRA COSTA COUNTY: 16 Pursuant to California Government Code, section 510, Christine 17 Bittle Simmons presents a claim to Contra Costa County as follows : 18 The claimant is Christine Bittle Simmons whose present post 19 office address is 4692 Sandmound Boulevard, Oakley, California 20 94561 . 21 The circumstances giving rise to this claim are : On October 22 16, 1999, claimant' s daughter was involved in an automobile 23 collision at or near the intersection of East Cypress Road and 24 Bethel Island Road, an unincorporated area within Contra Costa 25 County, in or about Bethel Island, California. 26 This claimant contends that negligence on the part of Contra 27 Costa County in improperly designing, controlling and/or main- 28 taming the roadway, intersection, the immediate vicinity where the -1- 1 collision occurred, by not providing lighting, reduced speed limit 2 signage, a stop sign, a stop-light controlled intersection, a more 3 gradual roadway turn, underground utility lines with pole removal, 4 movement of poles, guard rails, and/or adequate roadway visibility, 5 created a dangerous condition which substantially contributed to 6 the damages proximately caused to date, and entitles this claimant 7 to monetary damages for her resulting physical and mental damages, 8 and other bodily injuries sustained, all in an amount presently 9 unknown but subject to the jurisdiction of the Superior Court, 10 Unlimited Jurisdiction. 11 This claimant believes that a police report and other reports 12 were prepared by emergency personal but claimant does not presently 13 have copies of them and does not have any information regarding 14 them. 15 All notices or other communications regarding this claim are 16 to be sent to the Law Office of Thomas R. Woelfel, 4664 Sandmound 17 Boulevard, Oakley, California 94561, (925) 684-2667 . 18 BATED: April 10, 2000 19 LAW OFFICE OF THOMAS R. WOELFEL 20 21 By: r T OMAS R. WOELFEL 22 Attorney for Clai n CHRISTINE BITTLE SIMMONS 23 24 25 26 27 28 -2- APPLICATION TO FILE LATE CLAIM BOARD OF-SUPERVISORS7 CONTRA STA UffYI _CALIFORNIA BOARD ACTION Application to Fila Late Claim ) NOTICE 70 APPLICANT MAY 169 2000 Against the County, Routing ) The copy of this—doomenE mailed to you is your ESndors®ents, and Board Action.) notice of the action taken on your application by (All Section Referwjoes are to ) the Board of Supervisors (Paragraph III, below) California Government Code.) -----) given pursuant to Government Code Sections 911.9 and 915.4. Please note the *WARNING" below. Claimants DENNIS F. GALLAGHER Attorney: c/o Michael J. Farley, Esq. t Law Office of Michael J. Farley `' F Address: 555 University Avenue, #284-West cvi Sacramento CA 95825 MW`.<''j �> : .tF• Amountt $25,000.00 By delivery to Clark on &ri1 6 2000 Date Received: April 6, 2000 By mail, postmarked on April 6, 2000 t --Clark o? EFw RZq-oF Supe sora TOt County SOel Attached is a copy of the above noted Application to File Late Claim. DATED: April 6, 2000 per, BATCHMM, Clerk, By 7 � Deputy : emy naiiil T(W Clark of the o Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911.6). ( ) The Board should deny this Application to File Late Cl (Section 1.6). DATED:, � ` ' VICTOR WES`iKW, County Counsel, By Deputy mous Vo e of supery sora sen (Check one only) ( ) This Application is granted (Section 911.6). (` .�. This Application to File Lata Claim is denied (Section 911.6). I oertify that this is a true and correct copy of the Board's Order entered in its minutes for this date. DATE: 'Y, PHIL BATCHELOR 9 Clerk, ByDeputy WARNING (Gov. Code 1911.8) If you wish to file a count action an this matter, you aunt first petition the appropriate court for an order relieving you from the provisions of Governm nt Code Section 945.4 (claim Presentation requirement). Bee GoverrmMt Code Section 946.6. Such petition suet be filed with the court within six (6) mbnthe from the date your application fon leave to present a late claim was denied. You may seek the advise of any attorney of yaw choice in comwation with this matter. If M want to consult an at should do so Lundiatel . = Clerk : y County AdUnISUIT07 Attached are copies of the above Application. We notifed the applicant of the Board's action on this Application by mailing a copy of this document, and a memo thereof has ben filed and endorsed on the Board's copy of this Claim in aocordanoe with Section "9703. �.lJ Deputy DATED: _PHIL BATCHELOR, Clerk, Byy ^�-' FROM:V. 1 unty Magill 2 53EEy Aftinistrator TO: Clerk or the Boar' of Supervisors Received copies of this Application and Board Order. DATED: County Counsel, By - -- County Administrator, By - -- APPLICATION TO FILE LATE CLAIM I Law Office of Michael J. Farley Michael J. Farley, Esq. (SBN 147584) 2 555 University Avenue, #284-West Sacramento, CA 95825 3 Telephone (916) 920-8576 Fax: (916) 920-7951 4 Attorney for DENNIS F. GALLAGHER 5 6 7 8 STATE BOARD OF CONTROL FOR THE STATE OF CALIFORNIA 9 SACRAMENTO AIR QUALITY MANAGEMENT BOARD 10 11 In re: ) APPLICATION FOR LEAVE TO PRESENT LATE CLAIM AND 12 ) NOTICE OF CLAIM PURSUANT TO GOVERNMENT COME § 910 13 Claim of DENNIS F. GALLAGHER) } 14 ) G.C. § 911.4 V. ) 15 } _ ECS 16 Contra Costa County Sheriff s Department ) 17 � APR 0 6 ZDDO 18 ) cLER ,. C{ 19 20 TO: The State Board of Control and Contra Costa County Sheriff's Department: 21 1. Claimant DENNIS F. GALLAGHER hereby files with the Contra Costa County 22 Sheriff's Department this Application for Leave to File Late Claim and Notice of Claim pursuant 23 to G.C. § 910, which is attached hereto as exhibit A pursuant to G.C. § 911.4. 24 2. The claim of DENNIS GALLAGHER as set forth in the proposed claim attached 25 hereto as exhibit A accrued on or before May 5, 1999, a period within one year from the filing of 26 this application. 27 /II 28 IlI 1 3. Counsel for the applicant has been instructed to file a late claim as indicated on the 2 form attached hereto as Exhibit B. 3 4. The tardy filing of this Application and Notice is due to mistake, inadvertence, surprise, 4 excusable neglect. Moreover, The delay will not prejudice this public entity from a defense to the 5 claim. 6 7 DATE: April 5, 2000 LAW OFFICE OF MICHAEL J. FARLEY 8 }F 9 MICHA 1 F EY, ESQ. 10 Attorney for De is F. Gallagher 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 2 EXHIBIT A NOTICE OF CLAIM " Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY LNSTRUCTIQNIS 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 1001' 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 properry 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 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 filing stamp } DENNIS F. GALLAGHER } Against the County of Contra Costa or ) CONTRA COSTA COUNTY SHERIFF ) District) (Fill in name) ) TSL. .7 pr0� •••�+� �lw: wwwa hereby r�1m� w1..�ws n ainsit the �n.rntt/ of�-rtt 7 Costa or the above-named distr;ct l•lV undersigned claiil ant he eb mnak=- Vlwlla erg • V Vv...alra 4a VGiiaw v � in the sum of$25,000.00 and in support of this claim represents as follows: . 1. When did the damage or injury occur? (Give exact date and hour) MAY 5, 1999 2. Where did the damage or injury occur? (Include city and county) OFFICE OF THE SHERIFF 1980 MUIR ROAD MARTINEZ, CA 94553-4800 3. How did the damage or injury occur? (Give full details; use extra paper if required) SEE ATTACHED LE'T'TER > 4. 'Wh4t particular act or omissio a the part of county or district officers, -vants, or employees causda Me injury or damage? Representatives of the Contra Costa County Sheriff's Office unfairly, unlawfully and unreasonably refused to issue the Claimant herein the appropriate Retirement Badge, fifteen (15) year Service Award and Identification Card. Claimant served a total of fifteen (15) years as a Sheriff Reserve and is entitled to the rights 5. iat aerf'e ill nazi o�county o°c�s ry lofcers, servants, or employees causing the damage or injury? The full list is unknown at this time. However, Sgt. Hank Davis has informed Claimant that his request for appropriate retirement status was denied. 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) Deprivation of benefits following fifteen (15) years of service. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) This, information will be provided. 8. Names and addresses of witnesses, doctors, and hospitals. N/A 9. List the expenditures you made on account of this accident or injury. .DATE TIME AMOUNT ) Gov. Code Sec. 910.2 provides "The claim must be ) signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney) LAW OFFICE OF MICHAEL J. FARM Name and Address of Attorney ) MICHAEL J. FARLEY (SBN147584) ) -^ 555 'UNIVER517Y AVE. , #284 )_ ) �II", :SACRAMTI'O, CA 95825 ' } ATTORNEY FOR CLAIMANT MICHAEL J. FARLEY (Address) SEE ABOVE Telephone No. (916) 920-8576 )Telephone No. (916) 920-8576 NOTICE Section 72 of the Penal Code provides: Every person who, with intent to defraud,presents for allowance or the 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(S 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(510,000), or by both such imprisonment and fine. EXHIBIT B BOARD ACTION ON CLAIM: 12/07/99 CLAIM B©ARn o1= S rp>"ItIM O S OF CONMA tY151A CO=. .Ai t'FQ&) e DECEMBER 7, 1999 Claim Against the County, or District Governed by the Board of Supervisors, Routing Endorsements, 1 NOTICE TO CLAIMANT W 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 belov4, given pursuant to Government Code Section 913 and 915.4. Please nota all *Warnings". AMOUNT: $25,000.00 % (� "} 1999 CLAIMANT': DENNIS GALLAGHER MAR'g"C'rU1"L!:6 ATTORNEY: MICHAEL J. 1:ARLEY (SBN147584) DATE RECEWED: NOVEMBER 2, 1999 ADDRESS: 555 UNIVERSI'1TY AVE., #284 BY DELTVERY TO CLERIC ON: NOVF243ER 2. 1999 SACRAMENI`O CA 94825 BY MAIL POSTMARKED: NOVEMBER 1. 1999 L FROM: Clerk of the Board of Supervisors "!"Ch. County Counsel Attached is a copy of the above-noted claim. PHIL BA &Clerk Dated:__ NOVEMBE�t Z. ]999 $y: Deputy IL pRONL County—Co-unsel TO. Clerk of the Board of Supervis s par-lady ( This claimtcomplies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2,and we are so notifying claimant. The Hoard cannot act for 13 days(Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). do I q9 n er &11 X1Jr /` � L i t _ e- , K 1-e � C-W � :SJJe,mci bt- ✓tea 77 it) e" me- Its ,0el Dated:—//-LI-�+� By: Deputy County Counsel EL FROM Clerk of the Board 7'O: County Counsel(1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3). W. BOARD ORD13b By Unanimous vote of the Supervisors present: tQQ This Claim is rejected in foil. Other: I certify that this is a true and correct copy of the Board's Order oaterod in its minutes for this date. Dated:.Opc&e12h�T,12 PHIL BATCHELOR,Clerk,By Ja6&&Deputy Clerk WARNING(Gov.code section 913) Subject to certain exceptions,you have only six(6)months from the date this notice was personalty served or deposited In the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. if you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side of This Notice. ;MA—W OF MAnJNG I declare under penalty of perjury that 1 am now,and at all times herein mentioned,have been a citizen of the United States,over age 18;and that today I deposited in the United States Postai Service in Martinez,California,postage full, prepaid a certified copy of this Board Order and Notice to Claimant,addressed to the claimant as shown above. Dated-X- By. PHIL$ATCHELOR _Deputy By�t Clerk �J- � i1 k APR' 0 6 2000 LAW(iJ��+'�'ICE p MICHAEL J. FARLEY �° "' t�s �t 3' �„to,'��N,�v. 555 University Avenue, #284-West (916) 920-8576 Sacramento, California 95825 FAX(916) 920-7951 April 5,2000 Via Federal Express Tracking#. 81.8021574372 Clerk of the Board of Supervisors County Admin. Bldg.,Room 106 651 Pine Street Martinez, CA 94553 Re: Gallagher,Dennis Dear Sir or Madam; Enclosed please find an Application for Leave to Present Late Claim and Notice of Claim Pursuant to G.C. § 910 along with attachments and a Proof of Service. Kindly return an endorsed copy to our office in the self-addressed stamped envelope included for your convenience. If you have any questions, please do not hesitate to call. Thank you for your assistance. incerelv xours, MICHAEL J. RLEY MJF:\\\ Gallagher\boardOl ltr 5!X I PROOF OF SERVICE BY MAIL - CCP SECTION 1013a,2015.5 2 I am a citizen of the United States and employed in the County of Sacramento. I am over the age of 18 years of age of eighteen years and not a parry to the within action; my business 3 address is 555 University Avenue, #284-west, Sacramento, CA 95825. 4 On the date listed below, I served the following document: 5 NOTICE OF CLAIM LATE CLAIM,ATTACHMENTS Proof of Service 6 on the parties in said action, by placing a true copy which was produced on paper enclosed in a 7 sealed envelope addressed as follows: 8 (By Mail) : I caused such envelope(s)with postage thereon fully prepaid, to be 9 placed in the United States Mail at Sacramento, California, for delivery to: 10 X (By Federal Express) : I caused such envelope(s), fully prepaid, to be sent 11 via overnight mail by Overnight delivery to the Clerk of the Board of Supervisors,_County Admin. Bldg., Room#106,651 Pine Street, Martinez, CA 12 94553. 13 (By Personal Service) : I caused such envelope(s) to be delivered by hand to the offices of the addressee(s). 14 15 (By FAX) Telecopier: I personally sent to at fax number , a true copy of the above-described document. I verified 16 transmission and called the addressee(s) and verified receipt. Thereafter, I placed a true copy in a sealed envelope with the first class postage affixed and mailed as 17 follows: 18 19 1 certify under penalty of perjury under the laws of the State of California that the 20 foregoing is true and correct. 21 Executed on April 5, 2000, in Sacramento, California. 22 23 24 CHAEU J. FfLEY, ESQ. 25 26 27 28 I Law Office of Michael J. Farley Michael J. Farley, Esq. (SBN 147584) 2 555 University Avenue, #284-West Sacramento, CA 95825 3 Telephone (916) 920-8576 Fax: (916) 920-7951 4 Attorney for DENNIS F. GALLAGHER 5 6 7 8 STATE BOARD OF CONTROL FOR THE STATE OF CALIFORNIA 9 SACRAMENTO AIR QUALITY MANAGEMENT BOARD 10 11 In re: ) APPLICATION FOR LEAVE TO PRESENT LATE CLAIM AND 1? ) NOTICE OF CLAIM PURSUANT TO GOVERNMENT CODE § 910 13 Claim of DENNIS F. GALLAGHER) 14 ) G.C. § 911.4 V. ) 15 } 16 Contra Costa County Sheriff s ) Department ) 17 } 18 ) l 19 20 TO: The State Board of Control and Contra Costa County Sheriff's Department: 21 1. Claimant DENNIS F. GALLAGHER hereby files with the Contra Costa County 22 Sheriff's Department this Application for Leave to File Late Claim and Notice of Claim pursuant 23 to G.C. § 910, which is attached hereto as exhibit A pursuant to G.C. § 911.4. 24 2. The claim of DENNIS GALLAGHER as set forth in the proposed claim attached 25 hereto as exhibit A accrued on or before May 5, 1999, a period within one year from the filing of 26 this application. 27 U/ 28 /lI 1 3. Counsel for the applicant has been instructed to file a late claim as indicated on the 2 form attached hereto as Exhibit B. 3 4. The tardy filing of this Application and Notice is due to mistake, inadvertence, surprise, 4 excusable neglect. Moreover, The delay will not prejudice this public entity from a defense to the 5 claim. 6 7 DATE: April 5, 2000 LAW OFFICE OF MICHAEL J. FARLEY 8 17 } 9 1 MIC J. FAILEY, ESQ. 10 Attorney for DerWis F. Gallagher 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 , �y �j�:',1 2 4 \ 77AN t :v V `". Nom. gyp\ r 77 NN 00 00 _ , '��,. }\U l \.w"• i• l-;,..y \ .-J' \..,.- .rte, �,, 1 s•-� t \� \ � �v N, TO, C2 Ilk IV va �A \ � �' -