The URL can be used to link to this page

Home My WebLink AboutMINUTES - 07182000 - C24-C25 TO: BOARD OF SUPERVISORS PROM: Phil Batchelor, County Administrator t 1 Uot I DATE: July 18, 2000C 0 Z-03i t d °�.. SUBJECT: Final Settlement of Claim n t Linda Sanousi vs. Contra Costa County UOU WCAB No. WCK 0038576 SPECIFIC REQUEST(S)OR RECOMMENDATION(S)S BACKGROUND AND JUSTIFICATION RECOMMENDATION: Receive this report concerning the final settlement of Linda Sanousi and authorize payment from the Workers' Compensation Trust fund in the amount of$20,000. BACKGROUNDIREASONS FOR RECOMMENDATION: William R. Jones, defense counsel for the County, has advised the County Administrator that within authorization an agreement has been reached settling the workers' compensation claim of Linda Sanousi vs. Contra Costa County. This Board's June 27, 2000 closed session vote was: Supervisors Gerber, Uilkema, Calnciamilla, DeSaulnier, and Gioia, yes. This action is taken so that terms of this final settlement and the earlier June 27, 2000 closed session vote of this Board authorizing its negotiated settlement are known publicly. CONTINUED ON ATTACHMENT: YES SIGNATURE: ,o''RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE i ''APPROVE OTHER SIGNATURES: ACTION OF BOA ON .DULY 18, 2000 APPROVED AS RECOMMENDED X OTHER € VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS 1S A TRUE AND CORRECT COPY OF AN ACTION TAKEN AND ENTERED ON THE MINUTES OF THE BOARD X UNANIMOUS (ABSENT OF SUPERVISORS ON THE DATE SHOWN, AYES: NOES: ABSENT: ABSTAIN: ATTESTED JULY 13, 2000 PHIL BATCHELOR,CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR Contact: Tony Schleder—335-9411 cc: CAO Risk Management Auditor-Controller BY DEPUTY CLAIM RD QE SUPER-NI QRS QE CONTRA MSTA CQ=--CALEFQRN1A J AIQ-..AM JULY 15, 2000 Pairn Against the County, or District Governed by } the Board of Spervisors, Routing Endorsements, } NOTICE TO CLAIMANT and Board Action. All Section references are to } The copy of this doccu rent meiled 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 815.4. Please note all "Warnings". AMOUNT: $2,317.21 CLAIMANT: Traci Beitzell ATTORNEY: N/A DATE RECEIVED: MAY 25, 2000 ADDRESS: 259 BEEC- TJT DRIVE BY DELIVERY TO CLERK ON: MAY 25, 2000 HERCULES CA 94547 BY MAIL POSTMARKED: MAY-24, -20001 L FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL CHELOR, CIC Dated: JUNE 9, 2000 By: Deputy IL FRONT County Counsel TO: Clerk of the Board of Supe ors Otis claim complies substantially with Sections 910 and 910.2. } This claim FAILS to complysubstantially 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: Deputy County Counsel L FROM Clerk of the Board TO: County Counsel (1) County Administrator (2) } Claim was returned as untimely with notice to claimant (Section 911.3). . BOARD ORDEP-P- By unanimous vote of the Supervisors present: Ibis Claim is rejected in full. i 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 4 , Deputy Clerk WARNING (Gov. code section 913) ect to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited e mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an ney of your choice in connection with this matter. If you want to consult an attorney, you should do so Jistely. 'For ,Additional 'Warning See Reverse Side of This Notice. AFFIDAMM OF N A.nJNO are under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United , over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully d a certified copy of this Berard Order and Notice to Claimant, addressed to the claimant as shown above. } � By: PHIL BATCHELOR By 25L—Adeputy Clerk aunty Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100`x' day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988,must he 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 ) Reserved for Clerk'.s Filing Stamp Traci Beitzell } E Against the County of Contra Costa } zo,0 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$ 2 ,317 •21 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact Date and Hour) 3/16/2000 @ 5 .4 5 pm ------------------------------------------------------------------------------------- 2. Where did the damage or injury occur? (Includ%City and County) San Pablo Dam Rd. ", Richmond Ca. cross street Tri Lane 3. How did the damage or injury occur? (Give fun details;use extra paper if required) Driving on San Pablo Dam Road towards El Sobrante car hit a very large and deep pot hole which was unavoidable and not sFe in distance and was also Xi filled with water from the current rain. i t' ICS ., t -------------------------------------------------i�`�. _ 1 } _ $14 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? The county did not monitor the roadway conditions in a timely mariner and correct this damage of the roadway. This is a public roadway and used daily. It took. 2 weeks after my accident for the pothole to be filled. (Over) vo -------------- is v: i xott c r t t—A Hi V -rp-sf SERVICE RVI Sg + ;nt y tw CENTER t'' wf o , EaVEw CHRYSLER, PLYMOUTH, Dw, J __+< t ? OND 01 . Zn R .., .v. Y!�[�i�R:nc x:d#•�;�;<?G•?k�A:Yt iii,�t•#X�'74 x��ne yid•�•�4?4 x:fir:G��r p .'{•.f k.�'.t.t•,t i" . 1:*.' •�.� ,? ��:_ � . . CtJBTCrAER N6. ADWSOR CAR NCS. - NV E AT V- ., 44213 �yyEL y L,ENy1Nt,r `2- : ! - . j1iUU jECS12900 3e L-6}C�EN9 N0.�e iLwidit. CORK`rL - ACT 'f.��.•.,. i 6..6.i..i is �s�iw°'2 S-t, �•� LA£..}'.mi _ -- �c .YEA 7wa , tbLt. ...>: - - - OELiVERY DA DELMAY WN - -! X_'9 r.IkACA t�!lU �$�.... �_,. ?�'��.if'T�`�'��LER/ EBt't.ING tL X1 - t .: VEMJ ICY.—No.- ss 55 MEMO MEER N. . mi N UTI 5 LCs !"f:-3 .b 5 to N 0 V...t` _0 6 1=i'�i 5 �: - CAV ftEBftfENC vFtCSf ;; _.susfNEes P'.MtSNE t acknowledge 701ca and oral approyato?an incr easy in the ortgirtaf estirttdted ortca. M02 44342 . . ` _ .-...._...._.....__., - — ..- ia5.�(y��2 y t 13 fF s� _ .�_ TECH(S) .L .4 82 k�°.) CUSMINI {p€_� NOISEES: Ti{1*�Y A*/�gPOT 'OLE 4B{O�t��.i(fy'{,;A Uti.pK 3 Lf0 _xAx HEARD A .^y��G4INaI.!'S�b�; f'f O.i.a�!EESPEC ALLY ��sE-i°f 7S F�52,-54O. 9 F W�`EF.=<„°L RIM BEN� a`? '�f I NG CK - OAK- K PART9QQWQT TWP RIGHT WHEELS BENT. �7�0—A REPLACED.�STEEERING RACK RIGHT WHEELS, PERFORMED 110 Q277 A3& . :QEAUMa. 22001,, � " L § I ysi_ is yEA P ?00104. 90.6-40 w • CRE K AND REPORT 1iOWLIN. G NOISE FROM STEERING WHEN TURN06. ?JNRAG RERNIRTfRE JOHE ON, JOB ESTIMA CUSTOMER: t�ER Bf ACKNOWLEDGES RECEIVINGORIGINAL ESTIMATE OF 185.00 QTAX) �� 1 yrPPRO y��i .{PjED�1t R'.CE}�..�S°3�3#w.D ESTIMATE E J :;�fi4'.�§{ y) OF '�'.�8172REPLACETS �"1 �.' TA��'j[ qX) ON )00127100 AT .f _,nr Please tat! usWout Or Service and PartS Depah%entS TOTAL LAROR. . . . 5820o'-' My Service Advisor listen8d and Understand my fit???d":i� F _ UB t r Y 0 YES ( ) N ( ) F O . -: 61%t My vehicle ss ready at =gt ?3 . time. 1110 CAu. ! JE ( No \ ! TOTAL MISC f _ Jt0.0f1 called $ �d vta C32h[je p �a, edi . � ir. .. . . . zx,6, repairs and } h . Our Parti-Depariment had the necessary parts for the fairs 04 yburvehicllw in stock. ES NO s 3 i uL1 r i[i..w"e341i#'e on e r'+�t 1�al '%rile' Factory >roibo:,,tt my rac'rvic experience :if sent a Customer Satisfaction Survey. i N 11C J< i Wheat Steed Chrysler-Plymouth Jeep 2404 N.Main Street BAR#AA-170632 � WALNUT CREEK,CA 54596 U.S.EPA ID#CAD 98241 4153 5825)997.5080 Date: 03/27/00 12:59 P.M. Estimate ID: 05-4469-91301 Estimate Version: 0 Committed Profile ID: CUSTOMIZED STATE FARM INSURANCE 333 Civic DR Pleasant Hill ,CA 94523 (925) 680-4107 Damage Assessed By: RON BURK Appraised For: CLAIM PROCESSOR TEAM 4 (800) 440-6175 Type of Loss: Collision Date of Loss: 03/16/00 Deductible: 500.00 Claim Number: 05-4469-91301 Insured: TRACI BEITZELL Address: 259 OEECHNUT 0R HERCULES, CA 94547-1123 Telephone: Work Phone: (925) 935-3500 Home Phone: (510) 245-0538 Mitchell Service: 912528 Description: 1997 Chrysler Sebring LXi Body Style: 20 Coe Drive Train: 2.5L Inj 6 Cyl AO VIN: 4C3AU52NOVE062963 License: 3TO8904 CA Mileage: 44,339 OEM/ALT: A Search Code: B1MM Color: BLACK Options: Alloy Wheels, Air Conditioning, Power Steering, Power Brakes, Power Windows, Power Door Looks, Tilt Steering Wheel, Electric Defogger, AM-FM Stereo Cassette, Automatic Transmission, Center Console, 2-Door. Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation Description Part Number Amount Units 1 201785 MCH* REMOVE/REPLACc WHEEL MR761495 344.40* INC* 2 RT/FRT OEM 17" ALLOY 3 201785 MCH* REMOVE/REPLACE WHEEL MR761495 344.40* INC* 4 RT/RR OEM 1711 ALLOY 5 900500 MCN* REPAIR FOUR WHEEL ALIGNMENT Sublet INC* 1.8* 6 200441 MCH REMOVE/REPLACE STEERING GEAR ASSEMBLY -M M8910690 907.20* 3.7* 7 900500 MCH* REPAIR MOUNT AND BALANCE TIRES W/STEMS Sublet 30.00* INC* 8 900500 MCN* REPAIR DEALERSHIP CHECK OUT TIME COMPLETE Existing 1.0* 9 900500 MCH* REMOVE/REPLACE P/S FLUID New 6.50* INC* * - Judgement Item ESTIMATE RECALL NUMBER: 03/27/00 12:59:47 05-4469-91301 UltraMate is a Trademark of Mitchell International Mitchell Data Version: MAR_00—A Copyright (C) 1994,1999 Mitchell International Page 1 of 2 All Rights Reserved Date: 03/27/00 12:59 P.M. Estimate ID: 05-4469-91301 Estimate Version: 0 Committed Profile 10: CUSTOMIZED Add'l Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount Mechanical 6.5 85.00 0.00 30.00 582.50 Taxable Parts 1,602.50 Sales Tax @ 8.250% 132.21 Nan-Taxable Labor 582.50 Total Replacement Parts Amount 1,734.71 Labor Summary 6.5 582.50 III. Additional Costs Amount IV. Adjustments Amount Taxable Costs 0.00 Insurance Deductible 500.00- Total Additional Costs 0.00 Customer Responsibility 500.00- I. Total Labor: 582.50 11. Total Replacement Parts: 1,734.71 III. Total Additional Costs: 0.00 Gross Total: 2,317.21 IV. Total Adjustments 500.00- Net Total: 1,817.21 Point(s) of Impact 14 UNKNOWN (P) Inspection Site: SHOP Inspection Date: 03/27/00 Body Shop: BODY SHOP=N/A REPAIRS TO THIS VEHICLE MAY REQUIRE SPECIFIC WELDING EQUIPMENT AS RECOMMENDED BY THE MANUFACTURER REINSPECTION FAX HOTLINE FOR BODY SHOPS ONLY 925-680-4165 ESTIMATE RECALL NUMBER: 03/27/00 12:59:47 05-4469-91301 UltraMate is a Trademark of Mitchell International Mitchell Data Version: MAR 00_A Copyright (C) 1994,1999 Mitchell International Page 2 of 2 All Rights Reserved --�- :} k 4 F �� { j _�y T �� V" f �f v s "r�i /� r�+� � ,� � � ;, r� � � � �� .. '� `� -�. ~- � � 1 .. `�p.. � :� :� CLAIM { Al2�,}T OE SUPERVISORS OF CON'T'RA OSTA COUNlYs CALIFORNIA_ $gip An JULY 18, 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), given pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: $1,000,000.00 CLAIMANT: TIA BLAND ATTORNEY: C/O FRANK M. Ennix, Esq. DATE RECEIVED: JUNE 19, 20010 ADDRESS: 3300 Telegraph Avenue BY DELIVERY TO CLERK ON: JUNE 19, 2000 Oakland CA 94609 BY MAIL POSTMARKED: JUNE 19, 2000 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BATCHELOR, Clerk Dated: JUNE 19, 2000 By: Deputy Qyty H. FROn- County Counsel TO: Clerk of the Board of Sb6pervisors { his claim complies substantially with Sections 910 and 910.2. ( ) This claim PAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). { ) Claim is not timely filed. The Clerk should return 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 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: +C) 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: Jt PML BATCHELOR, Clerk, By _* /,�, Deputy Clerk n� gilt 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. *Por Additional Warning See Reverse Side of This Notice. AF`IDAVIT OF MA.ILMG I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: By: PHIL BATCHELOR By eputy Clerk CC: County Counsel County Administrator Law Offices of €' FRANK M. ENNIX ....i 4. wY Frank M. Ennix 3300 Telegraph Avenue In Reply Refer Attorney At Law Oakland, California 94609 to File No. (510)654-5527 June 16, 2000 1 (925)335-1913 - Facsimile Sent Via Express Mail Clerk of The Board of Supervisors County Administration Building„ Room 106 925) 335-1900- Telel2 one 651 Pine Street Martinez, CA 94553 Re: Tia Bland Dear Sir or Madame: Enclosed please find the original and a copy of our claim against Contra Costa County on behalf of Ms. Tia Bland. Please return an endorsed copy to our office in the self-addressed envelope we have enclosed for your convenience. Sincerely, LAW OFFICES OF FRANK M. ENNIX Carolyn Sil s-S , Senior aralegal CLSS: ps Attachment Claim to: BOARD t'lV SUPERVISORS OF CON'T'RA COSTA CQUNW �UC`I�ftiYS �t��t�Ai�l? A. Claims relating to causes of action for death or for*IM to person or to PamI&I PrOPcrtY Or growing crops 2nd which accrue an or before December 31, 1987, must be pMseRW not later*40 &a 11i8`r` day dler the accrual of the cause of a ctiom Clafms mating to causes of action for death or for fns to perm-air to peel property or growing craps and which accrue on or after Unary 1,L'i88,roam be prevented not Is ter thin six mondts a!'ter the accrual of the cause of action. Clam rdating to any other cvAu of action,must be presented not later than one year after the accrual of the cause of acid..(GoYL Code§91 la) B. Claims ,canon be filed with the Clerk of the Board of Supervisors.at its office in Room l.06, county Administration BuBdhm 631 Pint Street,Martine:,CA 9533 C. U Claim is against it district gdve rned by the Board of Supervisors, rather than *e County, the name of the District should he tilled ire. D. If the claim is ag iust more than one public entity,separaft claims must be Sled against each public entity. E. l?raud. See penalty for fraudulent claims, Penal Code Sec.72 at the end of this form. Illi: Claim-by ? Resrarvettfor Ci ew$ stamp T1A BLAND _ -- Against the County of Contra Coda s, or in'1i"u) Tlx: on&xsig d claimant hereby makes cls against the County of Contin Costar or the abovie named District in the sone of$1 1 99 _a 0 Oand in support of this claim represents as follows: (one million) 1. "Wben did the damage or injury occur? (ca"enact Doo wee now) December 20, 1999. . ....a... .----------- -----.......:».-.._-----..............__-_----------------------------------- i, 'Where did the damage or injury occur" (ind &tray wed Caunry) 1 759 Beau Rivage, SanPabloAvenue, CA' 94806 .... » - a + __ .__ .____.___ � ..�_. _.. 3. Hear did the damage or Injury oceui" cry tnB dsrafkC;nue extra y:err ttrey, ) Claimant was attacked and beaten by the officers of the Contra Costa County Sheriff' s Department. d. ' pardwcular act or+omisAo n ou the part of county ordistrict of'Bcem sor dnPloyeea c*nse d the injury or dam*W— Same as number 3 . Claimaint sustained injuries as a result. of a beating by officers of the Sheriff' s Department. (Over) S. What are the names of qty or~ct officeM servants,or etnp1ayees emsing the dmaw or hj1W Centra Costa County Sheriff' s Department officers s. What damages or in 1wr es do you claim remkod7 -(civs M 03 mt of Jaknim or dwmtgw ddms& A#mit two WGROUS for 400 A=0*016) Claimant sustained severe brusies, abrasions, sprains and strains and soft tissue damage to her body and members. She also suffered from emotional and physical trauma. one million dollars in damages. ------------------------------------------------------------------------------------- z. Hoa was the above claimed amount computed'! (Indwu r*.,d tzd an o mm of*vprospectv_ yr Exact figures are unavailable at this time. This above amount is an estimate of the damages claimant suffered. 1 . Contra Consta County Medical Ctr ' 2500 Alhambra Ave, Martinez94553 8. Names and addresses of wittwsses,daetors,and hospitals. .( 510) 798-5999 2. Kelly Lynch, 5900 Rose Arbor Road, San Pablo, -CA 94806 3. Karen Bland, Raul Bland, Sr. & Paul Bland, Jr. - 9280 Coral Road, Oakland, CA 94603 - No telephone i_ 4. Ralph Peterson, p.M.D. , _ 10520 MacArthur Byrd, ,Oak�_CA x494605._. .51 0) 9. .List the expenditureat you amde on account of this accident or injury. 562-7467 DATET Ai" '- Unknown at this time : � syr # # # # a4 # * # wt �r-ir .k.* ► +4 'A r at t '� �r ;tr..t ir..r +r. ••..►. 4 +r x '�.tt rSxtB ...x xS '�.ik :l � ": * # � * � .e • Gov.Code Sec 910.1 pmvidek "The d4n nos be signed by the clamant g VN'D 1407aCM TO: (A ttar arty) or&y Wake pftlom on bis bthaff_ N ame and.Address of Attorney � FRANK M. ENNIX, ESQ.' (40459) 3300 Telegraph Avenue Oakland, CA 94609 (�tsst�re) Karen Bland, mother and legal guardian o_L_T_jA RLAmrS rAjAAWT (Add ) 9280 Coral Road, Oakland, CA 94603 TeicphoneNo. Telepbanc No. No te1ephQne • t xt * # * * * * * * # # # # * # ak # # # ! * at # # Y st i # yt X * * * * ik * * * * * * 1k 1k # # * * * * * # it * * r . ,a a NOTICE Section 72 of the Penal Code provides: "Every person who,with intent to defraud,prregents for allowance or f+dr payumt to any state board or officer,or to any county,city or dlsb*t board or of'fieer,amthorbed to ad" or pay the same if genuine,any fain or iran&flent ciaiim,bili,account,voucher,or writiar,Is punithabic either by tmprisonment in the co"jail for a period of not more thin one year, by a fine of not exceeding one thousand doltars (S1,0{l0),or by both sartch imprisottmant and t1ne,or by iupr*wn est in the state prion,by a fine of not exceeding ten thousand dotfars( S10,000), or by both such imprisonment and flfne . s t t t t TA moo ItA 04 Ir 00 Qft opi to t s.+ 11I1�1� �- is'"r�� i i � -ids► �� ' t � , w t . t _ t � t t 1 1 1 t CIATM 8Q"D OF SUPERNISM OF CON3:RA CMIA Q2Uh=, CAIURNiA .-13D�'D AA00 JULY18, 2000 Claim Against the County, or District Governed by the Beard of Supervisors, Routing Endorsements, NOTICE TO CLAIMANT and Board Action. All Section references are to The copy of this dDemnent mailed to you is your California Government Codes. notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given pursuant to Government Cotte Section 913 and 915.4. base note all *Warnings". AMOUNT: $1©4.00 CLAIMANT: ,TEFF BURROR ATTORNEY: DATE RECEIVED: JUNE 8, 2000 ADDRESS: 2243 SPRING LAKE DRIVE BY DELIVERY TO CLERK ON: 1ZIF 8 -2C?0o MARTINEZ CA 94553 BY MAIL POSTMARKED: (BY JBANSMT_T_TAL) L FROM: Clerk of the Board of Supervisors 'TCI: County Counsel Attached is a copy of the above-noted claim. PHIL BAT W� I Clerk Dated JUNE 9, 2000 By: Deputy M II. FROM: County Counsel TO. Clerk of the Board of Supervisors ( � sl}tis claim complies substantially with Sections 910 and 910.2. ( ) This claire FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: `/ By:moi �zf M__._Deputy County Counsel IM FROM: Clerk of the Board lr . County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). TV. BOARD ORDlE IL 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! Q PHIL BATCHELOR, Clerk, By 0' Deli!� puty 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. DAVIT 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 4� By: PHIL BATCHELOR By l/v r 1 pity Clerk tl CC: County Counsel County Administrator SHARON HYMES-OFFO€ D Claim : BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY JUN 6 2000 INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100`" day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988,must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code§911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building,651 Pine Street,Martinez,CA 94553. C. If Claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity,separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec.72 at the end of this form. RE: Claim by ) Reserved for Clerk's Filing Stamp D Against the County of Contra Costa or CLERK a n 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$ CI and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact Date and Hour) ftl 2-000 2. Where cid the damn a or injury occur? (Include City and County) VIE— /---------------------------------------- 3. Dow did the damage or injury occur? (Give full detail,;use extra paper if required) ;J ;'�< .:' dj.' '. fl-t$'0. �'""`r,rt n'};iflfm?�,r'��`t:. ' G .., d -✓�:- ''f ,�`lifi,:, '`�%''� ,.£,. »' >„r,"., ------------------------------------- �1a -.- -_--------------------------- 4. What particular act or omission on the part of county or'diy§i j cers, servants, or employees caused the injury or damage? 13 Y ;s £, (Over) 5. What are the names of county or district officers,servants,or employees causing the damage or injury? OHM------------------------------------ -------------------------------------- -� 6. What damages or injuries do you Claim resulted. (Give fail extent a s or damages claimed. Attach two estimates for auto damage.) , ..S A lzxl 7. How was the above-claimed amount Computed? (Include the estimated amount of any prospective injury or damage.) ------------------------------------------------------------------------------------- 8. dames and addresses of witnesses,doctors,and hospitals. �4A ------------------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov. Code See.910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf.." Name and Address of Attorney aimant's Signature) (A d�ress) jiprn✓ j i Telephone No. Te,ephoi,e No. 44 NOTICE Section 72 of the Penal Code provides: "Every person who,with intent to defraud,presents for allowance or for payment to any state board or officer,or to any county,city or district board or officer,authorized to allow or pay the same if genuine,any false or fraudulent claim, bili, account,voucher, or writing,is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand dollars ($1,000 ), or by both such imprisonment and fine,or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000), or by both such imprisonment and fine. CIAIM BARD ACTIN JULY 18, 20100 Claim Against the County, or. District Governed by � the Board of Supervisors, Routing Endorsements, NOTICE TO CLAIMANT and Board Action. All Section references are to The copy of this document railed to you is your California Goverment Codes. } notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), Oven { pursuant to Government Code Section 913 and 995.4. Please note all "Warnings". AMC3ISNNONE STATED T: j t°$ CLAIMANT: Liliana Garcia ATTORNEY: DATE RECEIVED: JUNE 9, 2000 ADDRESS: 43694 Bryant Street BY DELIVERY TO CLERK, ON: JUNE 9, 20300 Fremont CA 94539 Hand.-Delivered: BY MAIL PCtSTMAR.IELI: L FRC>M: Clerk of the Board of Supervisors TO. County Counsel Attached is a copy of the above-noted claim. PHIL BAT�C. l✓LOR, Cler Dated: .Tune 12, 2000 By: DePut`Y_.__. � ,• I1L FROn. County Counsel TO. Clerk of the Board of Supervisbfs { } .This claim complies substantially with Sections 910 and 910.2. C;,,-Otis 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 fled. 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: e ,.� �4 By; --' - w . : , ,, f Deputy County Counsel 1XL FROM Clerk of the Board M. County Counsel (I) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 11v BOARD ORDIIL By unanimous vote of the Supervisors present: t 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: PML 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 il=ediately. *For Additional Warning See 'Reverse Side of This Notice. DAVIT OF MAtUNG ". 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 ropy of this Board Carder and Notice to Claimant, addressed to the claimant as shown above. Dated: By: PHIL BATCHELOR By m / �,geputy Clerk CC: County Counsel County Administrator VICTOR J.WESTMAN DEPUTIES; PHILLIPS S.ALTHOFF JANIMENTA COUNTY COUNSEL NORAEL.ARLOW NORA G.BARLCW B.REBECCABYRNES ANDREA W.CASSIDY SILVANO B.MARCHES! CONTRA COSTA COUNTY MONIKAL.COOPER CH IEF ASSISTANT COUNTY COUNSEL VICKIE L.DAWSS OFFICE OF THE COUNTY]"CO UNSEL MICHAEL MESTIS CHAEL D.FARR SHARON L.ANDERSON COUNT I ADMINISTRA-MON BUILOING LiLLIANT.FUJII N ASSISTANT COUNTY COUNSEL ��i P1NE�fRE=T,' th FLOOR JANETL.HOLMES MARTINEZ,CALIFOfit1%X'9%4 98-1229 KEVIN T.KERR GREGORY C.HARVEY BERNARD L.KNAPP EDWARD V.LANE,JR. ASSISTANT COUNTY COUNSEL BEATRICE LIU MARY ANN MASON PAUL R.MUPIIZ GAYLE MUGGLI VALERIE J.RANCHi OFFICE MANAGER STEVEN NOTICE OF INSUFFICIENCY DAVID SC F.SCHMETTIIG DT DIANA J.SILVER PHONE(926)335-1800 AND/OR JACOUELINE Y.WOODS FAX(925)6ee-1078 — NON-ACCEPTANCE OF CLAIM TO: Liliana Garcia 43694 Bryant St. Fremont, CA 94539 Please Take Notice as Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code Section 910 and 910.2, or is otherwise insufficient for the reasons checked below: [ 1. The claim.fails to state the name and post office address of the claimant. ] 2. The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [ ) 3. The claim fails to state the date,place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [ ] 4. The claim fails to state the name(s)of the public employee(s) causing the injury, damage, or loss, if known. [ X ] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000). If the claim totals less than ten thousand dollars($10,000), the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars($10,000),the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. [ 16. The claim is not signed by the claimant or by some person on his or her behalf. Page 1 [X 7. Other: The above information can be provided in a letter referencing your original claim. VICTOR J. WESTMAN COUNTY COUNSEL By: Deputy County Counsel CERTIFICATE OF SERVICE EY MAIL (C.C.P. §§ 1012, 1013a,2015.5;Evidence Code§§ 641,664) 1 declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California 94553;1 am a citizen of the United States,over 18 years of age,employed in Contra Costa County,and not a party to this action. I served a true copy of this Notice of insufficiency and/or Nan-acceptance of Claim by placing it in an envelope addressed as shown above,sealed and postage fully prepaid thereon,and thereafter was,deposited this day in the U.S.Mail at Martinez,California. I certify under penalty ofpetury that the foregoing is true and correct. Dated: June 13,2000,at Martinez,California. cc: Clerk of the Board of Supervisors(original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM:GOVT.CODE§§910,510.2,920.4,910.8) Page 2 SHARON RYMES-OFFORD Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY JUN 6 2000 +TSTRUCTIONS TO CLAIMANT A; `Claims relating to causes of action for death or for injury to person or to personal pro0i °#eIVaw!u1_IC ods and which accrue on or be€ore December 31, 198"7, mast be presented not later than the 100' day after the accrual of the cause of action. Claims relating to causes of auction for death or for injury to person L ar to personal property or g=rowing 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 m, County Administration Building,651 Pine Street,Martinez,CA 94553. C. 1f 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. 1f the claim is against more than one public entity,separate claims must be filed A,,-Ainst each public entity. F. EEM&. See penalty for fraudulent claims, Penal Code Sec.72 at the end of this form. RE: Claim by ) Reserved for Clerk's Filing Stamp — - Against the County of Contra Costa or CLERK B , 3 co u os R (Fill in Name) The undersigned claimant hereby snakes claim against the County of Contra Costa or the above named District in the sucn of and in support of this claim represents as follows: 1. When did the damage or injury occur; (Give exact date and TTuur) 4; rZa 2. Where did the damage or injury occur? t xndude City imd county) � • -_ AW-0 �-.------- -°--`-�- --_- - ------_---- 3. Row acid the dammage or in juryoccu (Give nail details.,We catru pnperr 4f raquirtl) 4,. �What particular act or oteivsion on the parts/of county or district officers, servants, or employees caused the injury or damage? (Over) TJ r;u'rn•nr nmraa On •,arsr PROM : MARTINEZ CONCRETE PHONE NO. 510 467 1406 .dun. 08 2000 10:03AM P1 5. 'What are the.names of county or district officers,servants,or employees cawing the damage or injury? 6 74— �. What damages or itjurtes do you u'laim resulted? (Give tx#�att a1'iidnrics or dal)aXes c1=imed. Atacii twl�estimdtq far �. t'—,� �I�" `,•� �'.. -��'-,fir 7. How was the above ci�►imctl amonvft computed? (t,rivae c a"am wit of any prosprettve injury or dawsp-) 8. Names and addresses of witnesses,doctors,and hospital& _ 61W� 6, 1*il -� - c Cep 1 $i ----------------- - - -------- ----------- 9. List the expenditures you made on account of this accident r injury-' ,/ G ruel ltd u.brw.f rn �, Gov.Code Sec.910.2 provides: '! e ' "The claim must be signed by the claimmt SENT]NOTICES TO: (Attorney) or.by some persons on bis behalf." Name and Address of Attorney CI ' IS tuna#tire Address) A. Telephone No. Telephone No. r . NOTICE Section 72 of the Penal Code proxides: -Every per,wn who,with intent to def'riLud,presents for altawance or for Payment to any stxte hoard or ofl5cer,or to any county, city or district board or a ffiiceir,authorized to allow or pay the same it genuine,any false or fraudulent claim,bill, acct,voucher,or wri6A&is p131tisbAble either by Imprisonment in til$GQltllty J40 fot a period of not more than one year, by a rMe of not exceeding one thousand dollars (51,004),or by both such imprisonment and fine;,or by imprisonment its the state prison,by a rine of not exceeding ten thousand dollars ($10,400), or by froth such imprisonment and fine. FROM MARTINEZ CONCRETE PHONE NO. : 510 467 1406 ,jun. 08 2000 10:05AM P1 County Administrator Contra t4isk Management Division Costa 2530 Arnold Drive,Butte 140County LiabNuiitY bet (925)335-144.0 Martinez.Catifornia 94653 Fax number {925)335 1420 April 3, 2000 ` Liliana Garcia. 43694 Bryant Street Fremont, CA 94539 Sent Certified bail RE: Claimant Lil;aaa Garcia Insured: Contra +Costa. County D/Accident: 12/13/1999 Claim No.: 43786 Dear Ms. Garcia: Unfortunately I have not been able to reach you by telephone to respond to your inquiry. R.ochat& Smith is the only appraisal service that we use, If you let them know the location of your vehicle they can inspect it anywhere and it will not require your presence. If you chose not to use them you may go though your own insurance carrier and they will send a demand to us for the cost of the repairs and your deductible. The other option you have is to get two estimates for the damage to your vehicle caused in the above captioned accident. We will review the estimates and sena you a check. In my last letter of February 24, 2000 I provided you with some incorrect information, The statute date for your claim will run on,Tune 13, 2000, You,have until this date to officially fie r--ur claim agair:t the County of'Contra CC5t0.. I have again onclosod a clai 1 form,th at should be presented before that time to protect the statute. I apologize for the mistake in my previous tetter. Should you have any questions please do not hesitate to contact the undersigned. 1 look forward to hearing from you soon. Sincerely, Sharon Hymes-Afford, � '' Liability Claims Adjuster , Ce- y747 CLAIM BOARD O SIT ERVI ORS OF CONTRA COSTA COUNn CALIFOMIA C WMID AC11 JULY 1S, _20W. 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 lY below), given pursuant to Government Bode Section 913 and r t 915.4. Please note all "Warnings". AMOUNT. $5,740.00 CLAIMANT: MARK AND STACEY KEMPE ATTORNEY: DATE RECEIVED: JUNE 21, 2000 ADDRESS: 1769 TERESA LANE BY DELIVERY TO CLERK ON: .TUNE 2112000 OAKLEY CA 94561-1631 BY MAIL POSTMARKED: TRANSMTTI'AL I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BATCHELOR, Clerk Dated: NNE 21, 2000 By: Deputy .-"' xg�� 41 10, H. FROA— County Counsel TO: Clerk of the Board of upervisors { "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: u2 _ 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 GIRDER- By unanimous vote of the Supervisors present: {`•0�' This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: PHIL BATCHELOR, Clerk, By eputy 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. AFFMAVIT 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: 7`0 By: PHIL BATCHELOR By f�i t/` eputy Clerk CC: County Counsel County Administrator State Farm Insurance Companies North Coast Office June 15 , 2000 6400 State Farm Drive Rohnert Park,California 94926-0001 Cc County-Risk Management 2530 Arnold Drive, Ste 140 Martinez, CA 94553 MEW -. RE : Claim Number: 05-M191-324 Date of Loss : March 1, 2000 JUN 2 1 LUuu Our Insured: Mark Kempe Stacey Kempe Amount of Loss : $5, 740 . 00 CLERK BOARD RA C ORS CONT Dear Claim Representative: We are writing to you with reference to a loss sustained by our insured. Our investigation indicates that you are responsible for this loss . By virtue of our payment, we are entitled to recover from the responsible party. If you have liability insurance, please refer this letter to your insurance company and inform us of your insurer' s name, their address, and your policy number. If you do not have insurance, please respond to us in regard to your position in this matter. Please call our office or use the enclosed self-addressed envelope for your response . Sincerely, r Susan Nilson Claim Specialist State Farm General Insurance Company (707) 588-6073 Fax (707) 588-4019 Enclosure : Return envelope PS : Our insured sustained damage to their sewer line as a result of your agency filling in "sink hole" with concrete . Loca- tion of incident was directly above sewer line - due to weight-collapsed and caused damage to same . SHARON j/}t fir O JUN 2 0 2000 HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001 CLAIM NO 05-M191-324 POLICY NO 57-L85642-6 LOSS DATE 3/01/2000 PAYMENT NO 1 02 235183 Coverage Description. Amount COL/Lin $'' ` MATE 5/30/2000 Nan-Classified Building Damage $5,240.00 43l00.1I 1 AMOUNT $5,240.00 TIN ENTERED BY BAUER, PATRICIA 11UTHORIZED BY CARR, MARCELLA R PHONE (925) 779-2964 AIR .REMARKS STATE FARM GENERAL INSURANCE COMPANY 1 02 235 .83 a NORTH COAST OFFICE BANK OF AMERICA, N.A. 64-1278/611 5/30/2000 ROHNERT PARK, CA CUSTOMER CONNECTION ANTIOCH 02-124 L626 ATLANTA DEKALB CNTY, GA INSURED KEMPE, MARK CLAIM NI S 694449 "324 Loss DATE 3/01/2000 F � 1 ACT, � IVE THkND TWO 3NDRiFRTY AND 00!100 DOLLARS **** S, 240 ,00 Pav to the MARK KEMPE & STA Y M# E 8e IRST ORTGAGE CORPORATION ITS SUCCESSORS CJtcter off. AND/OR AS9L � ' 769 TE�2ESl LN _$ D AT E SENT OAKLEY CA 94561-16 1 MAY 0 2000 A TIOCH EIRE CLAIMS APPROVED BY FROM : ,ROTO ROOTER PNCJNE NO. 92579elB52 Mag. 24 20M 02:10PM P1 9303100 798•-2122 7S8.8100 439-9100 75"S" #9,$Mi��a 4, 46� 1 C7 n CALIFORNIA 94520 PROPOSAL AND CONTRACT TOv attn:. t,!ARCELLA JOB NAME. STATR 'FARM INSURMCE 1901 W 10th ST 1769 -OAKU .Y ' 1 - K .'IT Gt ICS� 'l.Lf?2 liiL3'S W /'S,f�Cli?li.pi JV"`�Sf'C.(.7i 1.Ji[lR ASI�!!'S ="S`�'!4 'RL4w `Sw Ft'•iZ �Vf ;. LL ,�-�/•4 4`• • v LAS•'yCky�MA. . T"ER±AL-`."Xr, �i Z S ITS. pAymlm MM UPW OMTL .TION 01` JCB. ALL Or Tf1! ASOYE WORK TO BE COW PLUID IN A 6i#WANTIAL AND WORK- Q 5,740.Cit? MANUKI@ MAh NF£ $U►A C**..�D .PAYMS W W FULL TO ISR MADE UPON CO Wn")ON OF JO&IF NOT PAD IN FMI.VAYKN 30 DAY$AFTEit DATE Or STAUMEW A P NANCE CMARGE'WILL BE Api,I;D TCS YOUR ACCOUN'G SUCH RNAW 9 CNARGI 15 COMPU"TiliD 8Y A PERIONC RATE OF 1'. %PLR MONTH WHICH IS AN AM WUAL Rt ATR OP 14%APPLM•T6 THE PRS 16\L W-E AMA DEDUCTING CURRENT PAYMENTS ANDS/09 CREDITS CONDITIONS, It to rnd!arstswd and agree]tfsat we*hail not ba haW Snbta for any W&damom at daksfrs cocemkoed by fire,strAwr,or n oicrla7.Mian offer delivery upon p n"nj%w jodwAs,ace$of 004 or&pubfte w m+y,acc dwflN boycotts,nwnwinl 4%orkgft,d7 IuA*d k*bor roratkm*defoyed•tW wry of rmoteikik from$eilar's supplier*,looms rr4o el irklo w+t vnpoovr,fAaod%k4* amborrpea<au*es'incident to notfexwai arttargrtnclas sur,or*+or couses#5aaywrd iha ntwAnoib control of SOW,whatiter of take or&f6ertni d,arwom of oftwY cauYea beyond iris eonttoL Prices gwited in+A Compact ura b;o Won Wfts*rt prices and upon eon hhdn#fust the prapaSal 41 ba actwptsd within thirty days,Also gwwx l cond?Hm4 which ane standord for jp66My eontrrattows in the con*trutrioh industry;Nor respuoetsibka for kswns,tmcs,flowers,fences,etc. NCMicli TO O WN*R contrartofs now fwgolkod by tow to be licensed and ragplated by elrw'Contrvaciera' Stases Lieansa boned. Asir alw scions concorni" a Contrbetof wftY'bei nefoira al to tii+r naiistrow 0,4 tko 6oarif,rf+asw'a+ddrwts 13* Contew Stars'fsaibrR Llaaasmo hoard, 1020 N Stiwwt Seearw»aenta.Callkwnla 959144 'Ungar Iha Medsa*�i6,tum taw,arty ems.subron+octoi,fabarci,matarkalnxm or'ri moditoeton thataof,in Sha of xt of ttae cewniy racordtr of ttey county whvr e},o or other pe+son ,Aw firs to improves ybw property and is not paid for hb lobar.sw-kms property to situosad and requiring that a oontrac ar'*oriytti Mj bard be eKo+t+4dd In,crit+. ar maw of,h",2 right to anfonoa lila ebim 000&nst your property, *HkOm Said band Aa to*in ars onwta°tt nest Seas era,ftfry paretnt(.50%j of`tir3 ow*tuct 1"do thin 14pa, yam rnoy proted yourself ocicwnst Such Clams by fs`iLrp,Want p ko and shots,in addition to any conditions for Mw parforymn a of she son,sac+,))i connetu;ieg w6-+ork or knpraavamertt,ort ur4nol contest for M,c work of improwemant contlititned far the paym,wM in f%A of the Ck*m of o1 oersona 4u.mh"ng igbor.smvkai, owip"ant or rnatcrksls for Sha work desCrikiied rt toil oont oict Any alteration or deviation from the above specifications involving extra cast of rnat erial or labor will c>wt€y be exacLtted ` upon written or,4*nt for same, and will become on extra CF arge ,Neel the sunt rnentiorted in this contract AN allrearrents must be made in wri#ttmg.. Su"TIED BYaf'GlYiaisi. � 's'' M AC•QEP.TED LICENSE NO 38 9 DAT9 _... _. !` 070'"' _ _.yG`.A?s�r e .vr'co,C.C:lfornia 94520 FAX 9251 798-185,2 0 R.'jWalnut Creek.Lafayette,Orinds,Danville,San Ramon (925)939-3100 . yygA AMAIN CLEM114;f ELECTRICALLY Concord.Pleasant Hill,Martinez (925)798.2122 •SEPTIC TANKS PUMPED,ALSO INSTALLED Pittsburg,West Pittsburg (925)439-9100 •SEWSRS,STORM A YARD DRAINS NOTALLED Pinole.Hercules,Rodeo,Crockett (510)785-8100 RADIO DISPATCHED SERVICE Antioch,Oakley,Brentwood,Discovery Bay (925)754.8865 RECEIVED MAY 19 2000 STATE FARM INSURANCE ANTIOCH CLAIMS Invoice No. E-1007-00 1901 W 10TH ST Work Order: 061587 ANTIOCH CA 94509 Date of Job 05/16/00 1 Service at : 1769 TERESA LN 05-M191324 SERVICEMAN: JOSE 1 . 00 HOURS AT $95 . 75 PER HOUR CLEANING SEWER LINE 95 . 75 1 . 50 HOURS TV MINI CAMERA AT $185 . 00 PER HOUR (1 1/2 HR MIN 277 . 50 CLEANED CLOGGED SEWER WITH CABLE, ABLE TO GET LINE OPEN BUT NOT ABLE TO GET PAST 4 FT FROM C/O. ALSO T/V'D SEWER FROM C/O IN FRONT YARD, NOT ABLE TO SEE CLEAR, WATER STANDING IN PIPE. FOUND NO ROOTS IN THE LINE. POSSIBLE CAUSE OF BREAK IN PIPE, GARAGE SUNK DOWN AND CRUSHED SEWER PIPE CLAIM #05-M191-324 SUBTOTAL 373 . 25 CALLED IN BY: MARCELLA 6�5-7860 TAL 373 .25 a If and paid by 10th of month following date as indicated above a service ch r of 1 112% per month will be charged or overdue accounts, which is 18% annually in-case suit be You PROMPT SERVICE recommended to enforce payment of any sum due under said invoice, purchaser agrees to LIKE [ Rtt„ MPT pay reasonable attomey fees to be fixed by court. WE PAYMENT Please use back for any comments. - _ ..... ......... ......... ......._.._.... ........... ........... ......... ...................... ._ ..._ _ _ {}`may �7 License e#323839 PLUMBERS Invoice Due Upon Presentation G42 (Save this invoice for your guarantee) Fed 1.D. #94-1585617 Mason Circle TEAMS:NET CASH Concord, CA 94520 Fax(925) 798-1852 Walnut Creek 939-3100 Pittsburg 439-9100 Concord 798-2122 Pinole 758-8100 Danville 838-6400 Antioch 754-8866 Brentwood 634-1108 Customer Name Phgne No. Date 7- U- :W;,l _." t '1 �4 '.! '� EJ` 't��j f- •- / i Y,,.;. "_j f`r� �} $filing Address JsSb Address ^{� r �i ` f t Cir C 1_ r rC Gr ' 11 Gash Cl Check# 11 Purchase Order# Ci Charge Credit Card Cl AuthJRelease# a (Job Description 1 St Man Charge ---------- _. . _ _..._ ,.____... ....... Hourly[date _ f. 2nd Man � = t -�- Hourly Rate A. y r 1 Cause 16f S oppage: 7a"7Z2 Materials: Mateffals Total Equipment Total Equipment: Drain Care \ Products Total Tax Drain Care Products: . ____ _ __ Guarantee: l It l€1 IV V Vl Vlll 1X X Recommended Service: Service Technician Time In Time Out Price Quoted: 71autlorize the perfomance Curs mat`s Sl r',s re ommended service -Inglals It not paid by the 10th of the manta following date as indicated above,a service dwp of 1.1/2%per n oft will be on overdue accourrts,which Is 18%annuals .in case suit be oorntnenced to erre payment of arty sum due under said invoke,purchasOr a90004 to pay reasonable aftmW fees m be fixed by oaxt. i L--W-e would-appreciate your calling us in the event of further drainage problemsii For dishonored checks,per civil code 1719,shall not be less than$100.00 and a maximum of$15003.00. CUSTOMER COPY CLAIM BOARS OF SlipER aSOI2 OF CONTRA COSTA COUNTY, CALEEORNIA BOARD _AOOIt JUIX 1 , 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 ¢i = Board of Supervisors. (Paragraph IV below}, given pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: $499.99 c^ `"s 4 NS�„ ate,<s tNtFZ C Aw"tis CLAIMANT: SONYA S. KOLINSKY ATTORNEY: DATE RECEIVED: JUNE 20, 2000 ADDRESS: 125 SAN JOAQUIN COURT BY DELIVERY TO CLERK ON: JUNE 20, 2000 BAY POINT CA 94565 BY MAIL POSTMARKED: HAND-DELIVERED I. FRONE Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BATCHELOR, Clerk Dated: JUNE 21, 2000 By: Deputy f H. FRO-14- County Counsel TO: Clerk of the Board ofSupervisors { 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). ( Wither: did C f?6 fVir Dated: .21p 6 By: . , � r Deputy County Counsel .III. FROA- 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. 'k_)7-"PHIL�� PHIL BATCHELOR, Clerk, By � 'L� � ' , 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 NIA�G I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:_QBy: PHIL BATCHELOR By eputy Clerk 61 V CC: County Counsel County Administrator "Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY I INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100'h day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988,must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code§911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building,651 Pine Street,Martinez,CA 94553. C. If Claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public 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 ro ) t=om � 1 �� RECEIVED Against the County of Contra Costa - JUN 2 0 MOO or CLEW 90AR6 OF (PERVISOFIS CONTRA COSTA CO. District} (Fill in Name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above named District in the sum of S and in support of this claim represents as follows: �`� 'F ` `5 I M .t " e sv i f,Ci wt"e 1. When did the damage or injury occur. (Give exact Date and Hour) ��+ ��4�� lo , "- 2. 'Where did the damage or injury occur? (include City and County) vj -�- ------e-.--------:�------------------- 3 -i- 3. How did the damage o injury occur? (Give foil details;use extra paper if required) Y ` s? A,c'i- ej 4. What particular act or omission on the part of county or district officers, servants, or employees cause the injury or damage? £ LEs akma- 0 " - �, ( (Over) S j � f'S S' -"tr' 5. What are the names of county or district officers,servants,or employees causing the damage or injury? r 6. What damages or injuries do you claim resulted? (Give fall extent of Injuries or Jumages claimed. Attach two estimates for auto damage.) 1 7.� How was the aboveclaimedamount computed? (Include the estimated amount of any prospective injury or damage 7 CL f:"tc 't. . ------------------ 3 �..._ �wi �yC 4 � �1 �7� �f. 8. Names and addresses of witnesses,doctors,and hospitals. 4. -+- {- A' `�w` a $ f _ - 9, List the expenditures you made on account of thWaccident or injury: _ Q' { DATE ITEM AMOUNT it 4e ie # # �& is 9k aY 7s do �k ik * # �Y � 3c 3r sR st #� 3k is �c # is de rc 7t is tY � 8t ak Yc is Yt � 7s it iF 7k �'"ie * Yt..at' it !r=it. is R 3i 3c Gov. Code Sec.910.2 provides: "The claim trust be signed by the claimant SEND NOTICES TO; (Attorney) or by some person on his behalf." Name and Address of Attorney ' A °**} �` (Claimant's(Clat"s Signature (Address} Telephone No. Telephone No. NOTICE Section 72 of the Penal Code provides: "Every person who,with intent to defraud,presents for allowance or for payment to any state board or officer,or to any county, city or district hoard or officer,authorized to allow or pay the same if genuine,any false or fraudulent claim, bill, account,voucher,or writing,is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand dollars ($1,000), or by both such imprisonment and fine,or by imprisonment in the state prison,by a fine of not exceeding ten thousand dollars ($10,000), or by both sz ch imprisonment and fine. CLALMBOARR OF 511PEMSORS-OF-CONTRA COSTA-COUNTY, ti ry BOARD ACT10JULY 8, 20100 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ? NOTICE TO CLAIMANT and Board Action. All Section references are to } The copy of this document mailed to you is your California Government Codes. } notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given 7,(ZU3aW pursuant to Government Code Section 913 and 915.4. Please note all "Warnings" AMOUNT: $178.37 JUN 1 2004 CLAIMANT: �COUNSEL GAUP, CLEMENT LIN ATTORNEY: DATE RECEIVED: JUNE 14, 2000 ADDRESS: 265 CAMELBACK RD, #106 BY DELIVERY TO CLERK ON: JUNE 14, 2000 PLEASANT HILL CA 94523 BY MAIL POSTMARKED: TRANSMITTAL I. FRONL- Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BATCHELOR, Clerk Dated: JUNE 16, 2000 By: Deputy. H. FROM: County Counsel TO: Clerk of the Board of pervisors (This claim complies substantially with Sections 910 and 910.2. ( ) This claim PAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Beard 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: J � Dated: l='C` By: �`�( ( - t�r 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: rr2W4X- PHIL BATCHELOR, Clerk, By ' Deputy Clerk V 41 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 NI ARLIiG 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: t '7.aO�By: PHIL BATCHELOR By eputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (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 fine Street,Martinez,CA 94553. C. If Claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the 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 Wye n' , L Ron Harvey Against the County of Contra Costa N 14 7000 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) ----------- -- , : _ _ __------------------------- 2. Where did the damage or injury occur? (include City and County) On Cone or� CW Ave. Tt� uLawt b'& -dee+, be-foye h+'t -le 'un c tads) ---P-1---C'ott!A.--- gncor_4----4ve:__�-?fe stt LL-ki - _G2Atia__Cos'fq 3. How did the damage or injury occur? (Give full details;use extra paper if required) Co(4 t t y� item was b� _ c eef hole 'P\ . -`he mi d at 1e of e _ Z <ircve at ct6w t 3o rqh c-d 2 _-thou.g 'It lues i0t, ek vf dt e� __01�_�t _1--41M.__fas-C,__�Y__ e---k -_ _-_pt---Acit--)*,rf=-------- -_ 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? 11 wtIs It rcxlm' . `doe skoa1A ��4et� n to dmf '�i VQrS ��rt�t' Q#' d 5 )o i Ifo l e D'r CT1 a CbA 4 i f Ion f $h e "roa Over) 9S rod, . 5. What are the names of county or district officers,servants,or employees causing the damage or injury? couh -- --------- -------------- - -----------------------------------------------------w & What damages or injuries do you claim resulted' (Give{toll extent of injuries or damages claimed. Attach two estimates for y�aut(o,damage, �q'y rim >-.S}0-a �+ _ WlCeei_ClyUi?� _' ________ 7. How was the above claimed amount computed? (Include the estimated amount of any prospective injury or damage.) ------------------------------------------------------------------------------------- 8. Names and addresses of witnesses,doctors,and hospitals. ------------------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT ? ft�0 ntkv tlrp, t,r.-�b Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf." Name and Address of Attorney (Claimant's Signature) MmeI o 6 P . ,V (Address} CA , X1.3 Telephone No. p ( p p Tele hone No. 91 NOTICE Section 72 of the Penal Code provides: "Every person who,with intent to defraud,presents for allowance or for payment to any state board or officer,or to any county, city or district board or officer,authorized to allow or pay the sante if genuine,any false or fraudulent claim,bill, account,voucher,or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand dollars ($1,000),or by both such imprisonment and fine,or by imprisonment in the state prison,by a fine of not exceeding ten thousand dollars ($10,000), or by both such imprisonment and fine. SAM'S CLUB4 02/15/00 17:40 3227 6612 018 _ 325 i MEMBER 21 SS5311362 ELS TING LIN 822626 185/65 ADV+ 4919 card T 157611 REC YC.FE'E 0,25 N 5 TIRE SERVICE 100 N TAX 1 8,250 1 4,12 TOTAL 61 ,36 DEBIT TEND S106 CHANGE DUE 0100 EFT DEBIT PAY" FROM PRIMARY ACCOUNT ; 2530 . 61,36 TOTAL. PURCHASE REF 4 004705047057 NETWURK ID, 000.3 FSI PR CODE 512457 02/15. 00 17:41 .17 4 ITEMS SOLD 3 4 TCt 3119 7626 7486 7184 518 SAVE AT S A M, 'S CLUB- 02/15/00 17.41;23 _..... ....... ._. _.. _........ ......... ......._. .11.11 ....._... ...... ........ ....... .. ......... ......... ....................... IMPOTtTANT DOCUMENT 326074 aj�2/BA=Ry INSTALLATION WORK ORDER /NO LIFETIME TIRE SERVICE PACKAGE PURCHASER'S FORM /NO BASIC LIMITED WARRANTY INFORMATION 1 hereby authorize the repair work below to be done along with the necessary material,and hereby grant you and/or your partner permission to operate the car or truck herein described on streets,highways or elsewhere for the purpose of testing and/or inspection.An express mechanic's lien is hereby acknowledged on above car or truck to secure the amount of repairs thereto. SAM'S CLUB IS NOT RESPONSIBLE FOR LOSS OR DAMAGE TO CARS OR ARTICLES LEFT IN CARS IN SAYE THIS CASE OF FIRE, THEFT OR ANY OTHER CAUSE BEYOND OUR CONTROL. DAMAGE TO VEHICLES DOCUMENTI r INCLUDING LOST HUBCAPS MUST BE REPORTED TO THE CLUB WITHIN 72 HOURS OF SERVICE. CLUB#: t tviBER SIGNATURE MEMBERSHIPNUMBER / NAME ~}—tin Lam.t t CITY ATE ZIP COVE K `745 ATE ODOMETER YEAR AKI AND MODEL COLOR LICENSE/STATE OF LICENSE ov atk 4 MEMBER ARRIVAL TIME SERVICE COMPLETED TIME WORK/HOME PHONE Ty DESCRIPTION NOTE:All 16"or 16.5"tires must be approved by TMA i I TIRE supervisor. SIZE SWC# y' BATTERY SPECIALL INFORMATION GROUP SWC# BALANCE YES NO ROTATION YES NO LEASED BY KEEP OLD TIRES YES NO KEEP OLD BATTERY YES NO BEST TO SPARE YES NO E TIRE INFLAI� � LUG TORQUE RECOMMENDED TIRE PRESSURE: FRONT: REAR: F "PSI F FTLB R PSI R WAW WIL Out LiF R/F STOM RIMS/LOCKING HUBCAP$ Yes No { YESNO f ULM ATTENTI II'YOU HAVE AL RIMS,HAVE YOUR LUG NUTS RET RQUE BETWEEN 25 AND 50 MILES. Member Initials DOT No: DISCLAIMER SAFETY CHECKLIST Tire#l: Predamaged or loose fitting wheel covers tug nuts tightened Tire#2: Predamaged or rusted lug nuts �ecured hubcap(same condition) E'fire#3: Predamaged or rusty wheels ` Wheels balanced w/receipt I Tire#4: Predamaged or corroded cables l Recorded damage to vehicle Predamaged or corroded tray/hold down Battery cable ends secured € Battery hold down.secured MEMBER MUST INITIAL DATE OF ROTATION ODOMETER READING CLUB NUMBER CLUB SIGNATURE PSI check ALL,CLAIMS AND RETURNED GOODS MUST BE ACCOMPANIED BY TINS DOCUMENT.ail DAY GUARANTEE ON BALANCE. SWC-403 Rev.2-98 SAKE THIS DOCUMENT!! MEMBER COPY ilk, j 141 MIND n 4, TERMI, r � y t OE 1 NE BhY �Y £ Mel 4,o r, l file r, tzStte i-,-,11,5 i;+}()p WHEEL. WORKS .� ' ,,w+i I! e ..t..£ .. Ex#.`"� •�i 1 " f, .,...5.�"., ..,i x �l.i.{2tit .,.:?....,+�. a: YOU 5htf3ULCi KtJC3W As a Wheel Works customer,you have.a choice of whether or not any work will be performed on your vehicle.it is important to us that we.provide the necessary Information so that you are able to make informed decislons.Therefore,we have itemized the parts and services by the toll categories. 3: It1MME0IATE ATTENTION 00EVENTIVE MAINTENANCE IMPROVED PEI FORMANCe You may need these Items due to: These are optional items These are optional Items • Cam v + Address a customer requester convenience(stiffen ride,enhance • Component no longer performs intended purpose Comply maintenance recommendations by the vehicle's • Component does not meet a design specification(regardless original equipment manufacturer(OEM) performance,eliminate noise,etc.) performance) • Comply with recommendations by the tire manufacturer + Although many aftermarket manufacturers claim improved of • component a is missing • component is close to the end of Its useful life{lust above the performance over the original equipment manufacturer,we can oni! discard specifications;or weak,etc.) rely upon their testing results,and cannot confirm their claims of performance. QTY STOCK NUMBER DESCRIPTION PARTS LABOR/OTHER EXTENSION T 4— �A ;r� ;4':�tk..�* n :',-r ,3�..+,'h; �. �:s. t?-• , it :€ _ .,_.,.»..-. ( .}F 44 F 3 1. .+w .^.. X.,. i( ..RA ,4 vt ..Ir. 6 ,(. 5 k MSS .'�'•�',.:'4; f f- f,":. �+. ., .'_. 1 J 0,0 A M C E? 0 CAUTION.It your c>}r has aftermarket alloy,mag or aluminum wheels,you must re-torque the lug nuts on each wheal after 20 mMMes,atter this Installation. SAYE M 0 T`ES Wheel Works will provide this service fres of charge.By signing below,I acknowledge Ilia as notice that i must re-torque a8 the vehicles lug nuts after ❑ 20 miles after this Instollelfon,and the Impot#ance of rs•torquing the lug nuts. i # s4 :. u4'i. 3 $*t °m' TOTAL(ARTS AND LABOR ESTIMATED COSTS .) SALES Ax I hereby authorize the repair work to be done along E IC .r with the necessary matenals.Wheal Works and its 'Cush = • i i employees may operate above vehicle for purposes of testing,inspection or delivery at my risk.An express medtanfc'slien lsacknowledged on,above tilt � STitIYtA G � �=1110NA vehicle to secure the amount of repairs thereto.it is {f ? also understood that Wheel Warks will not be held I acknowledge th2t the itemized parts and services responsible for or loss or damage to vehicle or articlas PARTS LABOR TOTAL performed on my vehicie are the items that l left In vehicle in case of fire,theft or any other authorized,I agree to pay the amount shown an cause beyond Wheel Works control,ALL PARTS IN PERSON ❑ BY LONE El this invoice, and I acknowledge taking possession AND MERCHANDISE ARE NEW UNLESS NOTED. AUTHORIZED BY of my vehicle. (R,(EMANUFACTURE0,U-USED). E3 FiETURt4 PARTS ©DiscARD PAkTs DATE TIME _ GALLED BY -_ PHONE NUMBER sad—1 n„al of 9.5 TOYOTA 2100 N. BROADWAY "I love "whatyou do or m . �' f WALNUT CREEK, CA 94596 �. (i)TOYOTA (925) 933-7912 �J BAR#A0005283 US EPA ID#CAD 882017477 41 RECOMME=NDE=D$ERVICES OPFRA11ON OPERATION DESCRIPTION MO/Ml TOTAL OPERATIONOPERATION• r, SERVICE}{ISTORY DATE REPAIR ORUR MILEAGE ADVISO R I ECHNICIAN TYPE OPERATIONOPERATION CtEkRiPTION' : r° i ✓ ` 1951 t' . 6 3 "" i LOID C )0TQZEXLQBE xPRIE$8 LUDE 09/07/`9 204295 20127 377 ;L.tg c 36'raz ODY TRIM TNTAEXT. 01/02/99 203395 111 9 IS ri4S 199 14 3 'roz 3ODY TRIM INTA C T , 08/04/99 1,99184 3.914 703 L«L~ 'I' ) E EXLU XPRESS LUDE 913242a ,;, 2 . iLEGF'FRS0N NO. 939 XONTR N AN WILE TO CONSUMER:PLEASE RE CX"IM1R6 TiNIF WARRANTY INFORMATION ON BACK. VEHICLE YEAR 1 MAKE/MODEL PRODUCTION DATE STOCK NO. LICENSE NO. R,O.NO. % w CLEMENT @@ qq±±ppyy{��rrg y��gg CUSTOMER NO. Cp4'0V3 DELIVERY DATE DELIVERY MILES ;SELLINCaDEALERNO. 8,0.DATE CLA:EENT I..'IN 6 _'i"'A A f £`v£. l� 3"°1 3 i�A"'�r. 2K' g SERVICE CONTRACT CONTRACT NO. EXPIRATION DATE EXPIRATION MILES ADVISOR h 265 CAME[- RD APT 106 TOYOTA (531'r a '°31 1,the ragistered owner,:authorize int 1;pertarm the repairs and.fumish the necessary materials and sublet repairs.I understand Any:coatdiju4tad heretofore.Is so estimate 'HAT NO. rV only.Your empiayeas may opergta!!ha vehicle for.inepeGtlon,'teating and dellvsry at my risk.You wAl not tie rasponsibla for loss or risen§ga to vehicle or articles left In: ,..,y vehicle.1 agree to pay reasonabls aic[ege on vehfola lett more.than 48 Bourg shot notification that repairs are completed,I AGREE THAT YOU HAVE AN EXPRESS}1EN �s HILL, iy� ON THE DESCRIBED VEHICLE FQH THE GHARG€S FOR PARTS ANC LABOR FURNISHED UNDER THIS REPAIR Of3pER INGL,UGINQTHOSE FROM ANY PRIOR MILEAGE ,'. f P i i A$4 CA ; ' REPAIR......... THE VEHtGttE.IF t FAIL TO PAY SUCH CHARGES,1 AGREE THAT THE VEHICLE MAY BE HELD UNTIL'SUCH'CHAHGES ARE PAID.IN THE, '�}�I��6,d' p EVENT OF LEGAL ACTIN COLLBCT A Y 9UE;1 AGREE TO PAY COST OF COLLECTION AND FEPOLUD3 ASONABLE ATTORNEY FEES: ¢» BUSINESS PHONE' f TRANS. .PRINTED DATE/TIME PROMISED PRIORITY . rlI—I R'S ACKNOWLEDGEMENT ;O t STIMATE +TAX, AIR COND. APPOINTMENT t) a r?B''1 d�r � D() �$( ;ag}' OPRIf WHOAUTCH. PHONE DATE TIME AMOUNT BY NEW TOTAL � A4,LPAf1TSREMOVED �—t f: +TAX .TURBO ©, YES pr'rRll I�f S i "W,@ ARDED tJ SAVE UNLESS INSTRUCTED +TAX +e—� SPECIFIED OTHER- OTHERWISE' RRIOR El DISCARD Wt6 . TO REPAIRS x LABORJOB • i. dP as t Y a rant i f4'd sa, 4' ; s i' f&rz`"� -s."`.,s n w F x c„ t1 t � VI$ ! AD OR _93`d 751 X, xef .� r rV, FOR YOUf ."CCtNVEN1EICE TERMS:STRICTLY CASH CHECK %i5a ti t a, ', ,x �,. s OR APPROVED CREDIT CARDS £ L, �'F r '.� 3 s tz t+.. r e. }z $ � WE HQNORrTHE FOLLOWING t� x� . �^s � CREDIT CARDS: �s. "1 rt "t a t srir "� r'f r:. 1 : t to ir!: ' �t ° 't s_. �. MASTERCARD VISA. AMERICAN EXPRESS DISCOVER 1 .. � ,r. {h�I+rI.✓T,�,'i{Mh ��.«a sav �f. 04 0-9 V V firS ,l� h , �,i! " rknaJ f"' 111 4 .d � ,�., .' < :'N,', ykk� 2�,'" S y?tt 4Y' eti„ a rr t, �,.. r �, w1 ° yy� x, t� .� PLEASE ASK US E°C7R OUR a p, Lj "CURRENT COUPON SPECIALS" .rr 1 d o { r �,�, t ��T �.. :x-� rel y :✓ s 4;ti s r sr '' rn I ns T "a^,t :.*� J'z§txs C�r xi i5 -ra eft'o" 1z 3 0. ;lx, ALL CARS MUST BE PICKED UP DURING SERVICE DEPT. HOURS, 21 �, r< SERVICE DEPT.HOURS '� „ , 6-00 AM TO MIDNIGHT MON-FR1 id,., "J""t*r C41sr£ K a u ; t � � 7:00 AM TO 5:00 PM SATURDAY r , ;; �� ` ' (EXPRESS'LUBE ONLY OPEN SUN 9:00�AM TO 5:00 PM) x , - [ x: THAM YOU FOR!RINGING i' :'YOUR VEHICLE TO US FOR SERVICE WHEN CALLING ABOUT YOUR VEHICLE ar PLEASE REFER TO THE REPAIR ORDER NUMBER AS INDICATED ON TOP OF FORM. "By law,.you may chooseanother facility to perform any needed repairs or adjustments which the Smdg.Check teat Indicates ars necessary." 7` Used motor oiiand used anti-freeze are aregulated Hazardous Waste.Your used motor oil and used antifreeze are being legally transported,siored and 1 reprocessed. ALL TO PARTS AND ACCESSORIES AND LABOR ARE WARRANTED FOR 72,000 MILES OR it i MONTHS,WHICHEV€R.OCCURS'FIRST.THIS WARRANTY IS IN LIEU OF ANYOTHER'EX• PRESS OR`IMPLMD WARRANTIES. . t TOYOTA WALNUT CREEK WALNUT CREEK,CA 94596 BAR# US EPA ID# PAGE E: 1 >ti2,.2616 (925)933-7912 A8006283 CAD 982017477,;,; •4' �'S R .s esu � � '"' r —�" ✓ � � i �---.. 5 rt- L rt, m � y� CLAIM BOARD QE SUPE SMS OF CNTRA Q)STA t 02M,,CAf HISTA l 1AliD AC'fl�l' JULY 18, 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 railed to you is your California Government Codes. } notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and 915.4. Pose note all Wnings". AMOUNT: UNDETERMINED CLAIMANT: FAUL MALTZER AND MANE OBHIMA ATTORNEY: DATE RECEIVED: JUNE 9, 2000 ADDRESS: 2 GLORIETTA COURT BY DELIVERY TO CLERK ON: JUNE 91 2004 ORINDA CA 94563 NAND-DELIVERED BY FAIL POSTMARKED.* L FROK Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BATC OR, Clerk Dated: .T1iNE 12._2004__-- By: Deputy i �✓ 3L FROM: County Counsel M. Clerk of the Board of Supervise { ) This claim complies substantially with Sections 910 and 910.2. ( is 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: +e% uty County Counsel IM FROK Clerk of the Board Tb: 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: 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 maircr. If you want to consult an attorney, you should do so immediately. "For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAIILIiritG I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the united States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: r By: PHIL BATCHELOR ByQMn_� pDeputy Clerk CC:: County Counsel County Administrator VICTOR J.WIESTMAN DEPUTES: PHILLIPCOUNTY COUNSEL ANICE SAME NAP NORA G.BARLOW B.REBECCA BYRNES SILVANO B.MARCHESI CONTRA COSTA COUNTY ANDREA MONIKA L..COOPER COOPER CH IEF ASSISTANT COUNTY COUNSEL. VICKIE L.DAWES OFFICE OF THE COUNTY.COUNSEL MARKES.ESTIS SHARON L.ANDERSON MICHAELTFUJIIRR CQUI�TY AptvltNISTRATIt7N gU1LpINS', LILLIAN 7.PUJII VES ASSISTANT COUNTY COUNSEL 651 FINE STREET 91h FLOOR JA N T L.HOLMES JANET L.HQLMES GREGORY C.HARVEY MARTINEZ, CALIFOAN1A1 45$3-1229 KEVIN T.KERR BERNARDL.KNAPP ASSISTANT COUNTY COUNSEL EDWARD V.LANE,JR. BEATRICE LIU MARY ANN MASON GAYLE MUGGLI PAUL R.MUNIZ VALERIE J.RANCHE OFFICE MANAGER NOTICE OF INSUFFICIENCY STEVEN F.S HMIDT DAVID F.SCHMfDT ILVER PHONE(925)335-1800 AND/OR JACQUELDIANA J. INE Y.WOODS FAX(925)646-1078 NON-ACCEPTANCE OF CLAIM TO: Paul Maltzer Diane Oshima 2 Glorietta Ct. Orinda, CA 94563 Please Take Notice as Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code Section 910 and 910.2, or is otherwise insufficient for the reasons checked below: [ ] I. The claim fails to state the name and post office address of the claimant. [ ] 2. The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [ ] 3. The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [ ] 4. The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or loss, if known. [X ] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000). If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10,000), the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. [ ] 6. The claim is not signed by the claimant or by some person on his or her behalf. Page I June 7, 2000 Ron ROMY JUN 0 -4 20 Mr. Ron Harvey Contra Costa County Risk Management 2530 Arnold Drive, Suite 140 Martinez, CA 94553 Re: 2 Glorietta Court, Orinda Dear Mr. Harvey: We own a home in Orinda, which was damaged in February due to flooding as a result of an underground San Pablo Creek culvert section which became obstructed. We have filed a claim for our damages with the City of Orinda and we have been working with Mr. Tony Allenza of your office regarding that claim. We have recently been advised that we should also file a claim with the Contra Costa County Public Works Department, in the event that the county may share in the responsibility for repairing the damage to our home, or in fixing the culvert. I had spoken with you on the telephone about a week ago regarding this matter and you advised me to send the enclosed material to you. Please let me know if there is any further information that you need, or whether there is any further action that we need to take with regard to this claim for damages. Thank you for your assistance in this matter. Sincerely, Paul Maltzer 2 Glorietta Court RE EIVED Orinda, CA 94563 (925) 254-9514 - home (415) 558-6391 - work tFRK c�pstTRS Enclosures s Coxa£. STA�o. cc - Mr. Bill Lindsay Paul Maltzer&Diane Oshima 2 Glorietta Court, Orinda CA 94563 June 6, 2000 Mr. Bill Lindsay City Manager City of Orinda 14 Alterinda Way Orinda, CA 94563 RE: Supplemental Claim for 2 Glorietta Court Dear Bill: Thank you for your letter of May 19, 2000. We agree that there are serious issues that will need to be resolved in order to replace the failing San Pablo Creek culvert section, which serves the interests of the entire Orinda community. As stated in our letter to you dated May 7, 2000, we want to continue working cooperatively with the City to develop acceptable interim and long-term repairs. This will likely involve access and construction on our property, as well as on our neighbors' properties. Accordingly, this letter supplements our City claim, initially filed for damages suffered from the Feburary 13, 2000 flood, to reflect the possible additional compensation for the replacement of the damaged culvert on our property. We have attached a copy of our "Notice of Claim Against the City of Orinda, California", marked where we are inserting additional claim information, described below: INSERT A (to "General description of the accident or occurrence"): Repair and/or replacement of the San Pablo Creek culvert to restore storm water drainage, which may require excavation and construction on our property,as determined to date. INSERT B (to"General description of the loss, injury or damage suffered"): Major excavation and/or construction necessary to repair or replace damaged culvert section(s) may result in one of more of the following: a)major damage and/or loss of mature and sacred trees;b) soil compaction; c) site clearing to create construction lay- down area and access;d) structural and non-structural damage to house and garage);e) damages to landscaping; f) loss of use. Regarding the section of the claim farm dealing with specified damage expenses, at this time there are no construction or other estimates for repairing or replacing the culvert, as you know. We would like to take the opportunity to acknowledge and thank you for authorizing Tony Allenza to promptly issue checks covering our immediate flood clean.-up expenses. We also want to inform you that we have decided to proceed with the construction repairs to our playroom and bathroom. In March, we submitted two construction bids to Tony, and plan on contacting our preferred contractor,Fjellbo and Son, to schedule the job. Please let us know if the above supplemental claim information is acceptable in this form, or if you have any further questions. Thank you for your continued attention to this matter. Sincerely, Paul �PDiane Oshima 254-9514 (H), Paul at work: (415) 558-6391; Diane at work: (415)274-0553 cc: Tony Allenza, Contra Costa Risk.Management Agency NOTICE OF CLAIM AGAINST THE CITY OF ORIND,44 CALIFORNIA (Government Code Sections 910,910.2) RETURN TO: City Clerk City of Orinda 14 Altarinda Road Orinda,CA 94563 Claimant's Name: lest first Claimant's Address. 4*1 ."- number street .A5 Is-4-591 Zt 2. - h8rde pho6e number I.Work phone number fax ntfinber Name and address of person to wham notices regarding this claim should be sent(if different than the name and address provided above: tone toy� Date of the accident or occurrence: Place of accident or occurrence: ' Cross-streets,if applicable: General description of the accident or occurrence(attach additional pages if more space is needed): J r ' L& Names, if known,of any public employees causing the injury or loss: 1. 3. 2. 4. Names and addresses of witnesses: name address, phone 3. 4. continue on other side of this orf;you m=complete both sides and then,sign this forts Names and addresses of doctors who treated and hospitals where injured were treated(if applicable): name address phone AD 3. _ 4. � General description of the loss,injury or age suffered: r �--, /`��y K 4, r Total amount claimed(in dollars): $ The basis of computing the total amount claimed is follows: Damages incurred to date: Medical expenses: $ Loss ofearnings: Special damages for- a. b. $ C. $ d. $ (attach copies of documenu which substantiate these amounts,if available) I/We, the undersigned,declare under penalty ofpedury that We have read the foregoing claim for damages and know the contents thereof;that the same is true of my/our own knowledge and belief, save and except as to those matters wherein stated on information and belief,and as to them,We believe'it to be trine. DATED: si nt�ttun of c SW re of clai RECEIVED in the City Clerk's office this�day of ,20 signattnre of City"Clerk or official city representativrece`ving this claim FOR CLAIMS RELATED TO INJURY TO PERSON OR ERS KAL, PROPERTY, THIS FORM MUST BE FILED WITH THE CITY OF ORINDA WITHIN SIX MONTHS FROM THE ACCRUAL OF THE CTASE OF ACTION. A CLAIM RELATED TO ANY CATTIER CAUSE OF ACTION SHALL BE PRESENTED NO LATER. THAN ONE YEAR. AFTER.ACCRUAL OF THE CAUSE OF ACTION. February 28, 2000 Bill Lindsay City General Manager Orinda City Office 14 Alterinda Road Orinda, CA 94563 RF: Storm Patrol Response Claim Form: 2 Glorietta Court Dear Mr. Lindsay: We are submitting the City's Storm Patrol Response Form, documenting our losses resulting from the flood that occurred on February 13`h. With the operations now underway to clear the San Pablo Creek culvert, and temporary pump system in place to carry backed-up waters through a hose line to the creek, we are now able to focus on specifying the damage and repairs needed to return our home to normal. The enclosed Response Farm is an initial statement of the damage. We will submit further information and details to you as soon as we receive them. We would appreciate and request a response from you as to the process and timetable for receiving reimbursement for the cast of repairs. As reflected in the letter from the Glorietta neighborhood, dated February 24", the City made major mistakes in responding to this disaster. Given the circumstances, we believe it is in everyone'sbest interests to ensure that you and your staff guarantee a quick and expeditious response to all the flood claims filed by property owners impacted by the San Pablo Creek culvert blockage. If you have any questions, or need further information, please contact us. Thank you for your prompt response. Sincerely, Diane Oshima and Paul Mezer � 2 Glorietta Court Orinda, CA 254-9514(home) (415) 274-0553 (Diane at work) (415) 558-6391 (Paul at work) cc: Allan Tabor, Orinda City Council STORM PATROL RESPONSE FORM Da Time: AM <i!4� Name: ` Address: Home Phone: AM Work Phone: 77 t Other: Slide Flooding ,li' Culvert Storm gain Tree Down Nearest Crass Street: (try to get this sine some streets sound the same, i.e. La Cresta La Cuesta) Description & Location of Problem: it0i Low is 4f M .00 'anz� Pep K5 VL 4 UMP mad LI { Wild &WU � Y • r Crew Dispatcher,': February 24, 2000 Members, Orinda City Council City Offices Orinda Way Orinda, CA 94563 RE: Floods on Glorietta Boulevard Dear City Council Members: As the residents of Glorietta Court and Boulevard, this letter is to convey our general outrage over the City's mishandling of the flood emergency that occurred on February 13`x', compounded by its inability to realize and reluctance to deal with a serious problem for its residents. But first, we would like to make one exception and express our deep appreciation and regard to Councilman Alan Tabor for his prompt assistance. Mr. Tabor has been the one ray of hope and lone City representative to show human understanding, leadership, civic responsibility, and plain common sense in helping us to get City staff to respond to this disaster. Perhaps it is apparent only to Mr. Tabor the extreme attitude of denial and appalling lack of responsiveness displayed by the City staff, particularly Acting Public Works Director Andrew Gaber, and thus the substantial liability to which the City has been exposed. In the interests of not only explaining our sorry experience (so far), but also to alert you, our elected leaders, of the need to take whatever actions are necessary to ensure that the City is run efficiently and professionally, we present the following chronology of events: Sunday, February 13th: Flooding occurs at 6.00 p.m., damaging houses and/or property at 111 Glorietta Blvd., owned by,Sara Harkness; 2 Glorietta Ct., owned by Paul Maltzer and Diane Oshima; 115 Glorietta Blvd., owned by Howard and Carol Riback; 6 Glorietta Ct., owned by Jefferson and Seanna Allen; 10 Glorietta Ct., owned by Charles Vitt and Theresa Reynolds; and 16 Glorietta Ct., owned by Giampiero and Elizabeth Kirpatrick, Fire Department responds to 911 call from resident Sara Harkness, as her house floods. KTVU and KGO TV are on the scene with live coverage of the flooding of the Harkness, Maltzerl0shima and Riback homes. In contrast, the City s response does not occur until 11:00 p.m., and is limited to sweeping debris off the storm drain grates while residual flood waters continue to flow over Glorietta Blvd into Sara's house. Later that night, neighbors fill and stack sandbags to try and protect,Sara's home from further flooding. Monday, February 14t°: Diane Dshima, the VittlReynolds, Sara Harkness take the day off from work to clean up the flood mess, aided by neighbors and friends. Diane and Sara hire a restoration company to begin repairs to their homes. Glorietta neighbors leave several messages for Acting Public Works Director Andrew Gaber and City Manager Bill Lindsay, and get no call back until after 3:00 p.m., at which time Mr. Gaber states that by the end of the week he will try to get a roto-rooter-type company with a video scan to investigate the San Pablo Creek culvert. Theresa Reynolds calls Councilwoman Joyce Hawkins demanding a response from the City, which results in a visit by Mr. Gaber and City Engineer Mark Lowery to inspect the area, and Orinda City Council February 24,2000;page 2 of 5 meet with the neighbors. They estimate that the culvert is perhaps 80%clogged, but do not conduct any work to further investigate or mitigate the problem because they do not have proof that the culvert is the City's responsibility to maintain. Meanwhile, Carol Riback receives a return phone call from Councilwoman Laura Abrams and is informed that the City does not take action in an emergency for fear that it will be sued for their actions. Tuesday, February 15th: Paul and Sara consult with an attorney and civil engineer to analyze the emergency and assess options for seeking relief. Theresa Reynolds conveys information she received from Joyce Hawkins indicating that the City is under the impression that the culvert is privately owned and therefore not a City responsibility. Ironically, at the same time, Mark Lowery and his crew are replacing a privately-owned, smaller culvert along Glorietta Court that had been ruptured for a number of years. The over,flow from that minor culvert contributed to the flooding of the Riback home because the San Pablo Creek culvert flood overwhelmed the storm drain system. Had the San Pablo Creek flood not occurred, the overflow from the minor culvert would have traveled into the storm drains, as it has in past winters, including the 1998 E'1 Nino season. Wednesday, February 16t": Paul misses work to deal with flood damage and goes to the County Recorder and Public Works off ace. His simple research produces Country records documenting that the culvert was built by the County to arrest erosion of Moraga Way, and that the County was responsible for all repairs, maintenance and operational requirements. Upon its incorporation, the City of Orinda inherited the culvert, its construction drawings and all repair and maintenance obligations. In the meantime,friends, including soccer teammates of Sara's daughter, build a more substantial wall of sandbags around Sara's house, with no help from the City. In fact, Mark Lowery (on-site to repair the minor culvert described above)demonstrates the City's insensitivity by asking Sara why the neighbors are bothering to sandbag her home. Thursday, February 17th` Paul educates the City's engineers that the culvert is indeed their responsibility, and leaves a copy of his records research at the house, which is picked up by Mark Lowery. .Friday, February 1'8t°: Andrew Gaber informs Paul Maltzer and Howard Riback that the City has inspected the culvert and found it free of obstructions throughout, despite his statements on Monday. He cannot account for why the flooding occurred, other than to theorize that there was a temporary blockage that ultimately was washed away. Paul asks for documentation of the inspection, which to date we still have not received. Diane and Sara find out from their-respective insurance companies that none of the damages suffered will be covered by their policies. Saturday, February 19th: Friends and neighbors, with special tribute to Ron Gherlone, spend the entire day helping to clear out more of Sara's flood damaged furniture and belongings, and carry out major yard clean up, sandbagging and reorganizing to create an alternate channel for future flood waters to flow, away from her house. City assistance is completely non-existent. Sunday, February 20th: With storm clouds threatening, Glorietta's hero, Giampiero Kirkpatrick, and Paul climb down into the culvert and find that it is completely blocked with rock Orinda City Council February 24,2000;page 3 of 5 and mud(see attached photos), contrary to the City engineers'declarations. Coincidentally, neighbors read that morning's Contra Costa Times article quoting Mr. Caber's unfounded and irresponsible assertions that the culvert is clear(see attached article). In the article, Mr. Gaber also asserts that the minor culvert(see 211.5 discussion above), had it not been clogged, would perhaps have averted the flood by relieving the back-up from the San Pablo Creek culvert. However, this is impossible, because those two culverts are entirely separate systems. In response to the new information regarding the clogged San Pablo Creek culvert, residents call the emergency public works number to alert them of the imminent danger of more flooding. Residents also start calling City Council members Sunday evening, including Alan Tabor. Mr. Gaber calls Diane and Paul and informs them that repairs to the culvert cannot begin until after April 3e, citing the need to obtain permits from State and regional agencies before the City can proceed. Apparently in response to a neighbor's call to Councilwoman Joyce Hawkins, Mr. Gaber supposedly assigns his staff to carry out flood preventive measures to tide the neighborhood over until Tuesday, when the City is open after the holiday. However, when public works staff show up at 2 Glorietta Court, they indicate that in fact Mr. Gaber has not authorized them to do anything other than "monitor the situation", and that sandbagging would not occur until it is raining. Paul informs the staff that the flood waters rise very quickly–the culvert backed up and flooded on.February l?within 45 minutes— and therefore they should not wait until it's raining before they act. After being admonished by neighbors for their unacceptable response, the staff brings back 30-40 sandbags and lays them at the foot of Paul and Diane's driveway. This has the opposite effect from protecting their property, instead obstructing the flow of anyfloodwaters loodwaters exiting the area (see attached photos). Monday, February 21": City Manager Bill Lindsay, Councilman Tabor and Sarge Littlehale meet with Raul and other neighbors to discuss the situation. With appropriate prodding by Mr. Tabor, Mr. Lindsay changes his initial suggestion to have the neighbors call Diamond K to deliver sand to do more sandbagging,finally offering City assistance on Tuesday to temporarily protect against further flooding until the culvert is cleared. It is assumed at this time that clearing the culvert itself couldprobably not be done until the spring or summer. The possible courses of action considered are 1)pump and/or channel flood waters through a trench on the Maltzer/Oshima property; and 2)forth the dike built around Sara Harkness'house with more sandbags. Tuesday, February 22,d: City public works crew consult with Paul to install two pumps and a hose to carry backed up water from the culvert to a storm drain along Glorietta Blvd., powered by a,generator. They also indicate that in fact, work on the long-term solution of clearing the culvert will start on Wednesday. The City also assigns staff to conduct a 24 hour watch, to ensure the temporary system remains operational and adequately handles any flooding situation. At 9:00 p.m., while the rain pours, neighbors notice that there is no water flawing through the hose, and that the culvert has backed up to a depth of more than fr`ve feet in the Vitt/Reynolds rear yard(10 Glorietta Ct.), rising more than afoot every ten minutes. The City's 24 hour watch staff is nowhere to be found. The neighbors estimate that the creek will crest and flood again in about 10-15 minutes. Orinda City Council February 24,2000;page 4 of 5 The neighbors notify the sheriffs elce of the emergency. Superman Giampiero swims into the flood waters near the vertical shaft leading to the culvert. Together with Paul, the two risk life and limb as they proceed to clear and reposition the submerged pumps until they are working again, narrowly averting a replay ofFebruary 13`h. Meanwhile, other neighbors take more sandbags to Sara's house at 111 Glorietta Blvd., and save seven chickens and two ducks. The City's public works staff show up just in time to hold up a flashlight to illuminate the area where Giampiero and Paul are finishing the work of hoisting the 300 pounds of pumps and hoses out of the muck at the bottom of the culvert 10 feet below ground, and 17 feet below the water level. When the water recedes at around midnight, Giampiero and Paul turn off one of the pumps to keep it from burning out, because the City's staff is not around to do it. Wednesday, February 23"d: Mark Lowery and Bill Lindsay apologize for this latest fiasco. We hear from Mark that Eddy, the public works nightwatch staff,shunned his duties and has been fired for repairing his car at the City's offices that night, instead of being on Glorietta Court monitoring the pumps. We are also informed that the emptying of the culvert itself must wait until the City obtains the necessary equipment. City public works staff returns to make adjustments to the pumps to hopefully make them function reliably in the next storm. We still await the promised additional sandbagging at Sara Harkness'house. This entire episode has wreaked havoc on the neighborhood, disrupting all of our lives. Unfortunately, we have no choice but to continue to closely monitor the City's response. To say that the City showed gross negligence and incompetence during the events of this past week and a half is less than an understatement. Our faith in this City's ability to constructively deal with problems has been seriously shaken. If the City government was able to show a fraction of the dedication, cooperative effort, and community spirit of the Glorietta neighbors and other Orindans who rolled up their sleeves and took decisive action, we would be able to sleep soundly through the rainy nights, or even perhaps go out for dinner and a movie without worry. In particular, we want you to be aware of the extreme emotional distress that Sara Harkness and her daughters, Liz and Val, currently suffer as a direct result of this latest emergency. Sara has not returned to work since February 13th, and is now on medical stress leave. They have now endured four flooding events, a fallen oak tree, and unmitigated loss of privacy and increased noise and glare from a series of utility and construction projects by the City and other public agencies immediately adjacent to their home. As friends and neighbors, we have done everything we can to help them get back on their feet. But the City's sensitivity and assistance has been woefully inadequate. In recounting that tense night of February 22"d, we now fully realize and resent the hazardous conditions and threat of serious personal injury(or worse)to which Giampiero and Paul were exposed, because the City was not there for us. Unlike the City, their instincts were to act and do what was necessary. We are very thankful for their bravery and that they were not harmed. _.. .. _. Orinda City Council February 24,2000;page 5 of 5 We are assured by City staff that the culvert repairs are forthcoming, and are happy to finally see the first steps toward that end. Perhaps our horrible experience is an exception to the way the City usually handles itself in life-threatening situations. But forgive us for being skeptical, for if even a portion of the energy and effort the City expended in avoidance, denial, and buck-passing in dealing with this situation had instead been directed towards taking action, this letter would never have been written. As our elected officials, it is your duty to ensure that the conduct we have described above is never tolerated or repeated. We await the City Council's response to our concerns which are relevant to all the people who live and work in Orindal. Sincerely, r X0 a�4L ll lvr� Y cc: Bill Lindsay Andrew Gaber Additional Signators to letter to the Orinda City Council from the neighbors of Glorietta Court and Boulevard, dated February 24, 2000. doubts the Pavilion will change much irg vosirut ain�, wager uuw, if and when the company takes over On Wednesday morning,workers its management from Concord. Bund silt in the 36-inch-diameter Negotiations are under way be- outfall at the lower end, he said. tween the city and the promoter, Gaber said a former public works di- which has long been the Pavilion's rector told him the city has never had a flooding problem involving the cul- vert. even though its outfall "has Orinda been that full"of silt for years. A 12-inch-diameter underground 5�.CtM culvert an Glorietta Court was ti3ockag Gaber said. Without that . blockage,he said,the pipe probably crews ima '""� r' /� could have handled more of the , ( ! sturmwater that backed up from the 2JL110 cuse bigger culvert, � Gaber quoted residents as saying ,� CoiAra Costa County installed the Of .960. portion of the culvert around i8o"�l. He was uncertain who owns or is responsible for that stretch,he said. 00 Some residents Still Nor dues Gaber know who owns believe a.clogged culvert and or installed the culvert's lower por- tion,he said.It might have been built ole city are responsible for iii the 1940s or 1960s. damage on Feb. 13 The city's policy is to take re- f sponsibility for maintenance of the By Andy 3okelson section under Glorietta Boulevard TIMES STAFFw7tnM and its adjoining right of way, in- cluding the outfall,he said. OIZINLDA a-Whatever clogged an underground culvert Feb. 13, trig- "I believe it's the city's responsi- gering a flash flood on two streets, : bility to maintain the culvert," said apparently washed through before Sara Harkness, whose home and maintenance workers later inspected yard on Glorietta Boulevard sit by the pipe, says a city official. the outfall and had extensive flood damage. "There doesn't appear to be any- thing clogging it"now,said Andrew Theresa Tetra Court whose back (Taber, acting public works director. yard gr Glorietta Court(loaded Feb. 13, agreed. "My own view is the Some residents say the city bears weight of the evidence certainly leans esponsibility for the culvert and the toward the city being responsible." Feb. 13 flooding, which damaged a handful of homes on two streets and Easements were granted to the drowned four chickens in a back "furry by property owners in 1360 "far a pipe and for maintenance of yard. that pipe,"she said. The flooding during a rainstorm lasted more than three hours. "It appears as though (the culvert behind her home)was put in for the Something—perhaps tree limbs, county,and it would revert to the city crush or old wood—apparently got when the city incorporated, as I un- caught in the pipe during the storm, derstand it," Reynolds said. Gaber said..Up to 6 feet of stormwa- ter backed up into low-lying back The city and neighbors will dis- yards on Glorietta Court and then Wuss what needs to be done, Gaber cascaded down to Glorietta Boule- said. yard. --�When work= checked the 6�1 ,ndy Johelson rovers Larncorinda. n �r' inc"li-teter upper end of the cul- him aL 92.3-943-8379 or ,.»,„ L ,in a C LUj:Un wa r fIfw, On Wednesday morning,workers found silt in the 36-inch-diameter outfall at the lower end, he said. Gaber said a former public works di- rector told him the city has never had a flooding problem involving the cul- vert. even though its outfall "has been that full" of silt for vears. CLAIM L BUA tp of uPERVISORS OF CC?NTRA COSTAatT1�T's CART A .. �. ACTI oa JULN' 18, 2000 Claim Against the County, or District Governed by } the Board of Supervisors, Routing Endorsements, y NOTICE TO CLAIMANT and Board Action. All Section references are to The copy of this document mailed to you is your California Goverrrnent Odes. } notice of the action taken on your dairn by the Board of Supervisors. (Paragraph IV below), given purw ant to Government Code Section 913 and 915.4. Flom note all "Warnings". AMOUNT: IN EXCESS OF $25,000.00 CLAIMANT: SINA SHARAREH s v. ATTORNEY: c/o LISA RADCLIFFE DATE RECEIVED: JUNE 12, 2000 Attorney at Lacy ,TUNE 12 2000 ADDRESS: 920 Country Club Drive, StelB BY DELIVERY TO CLERIC ON: Moraga CA 94556 BY MAIL POSTMARKED: HAND-DELIVERED L FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PML BACl k Dated: JUNE 12, 2000 By: Deputy ".",.' �' '— ,. -04— IL FRONT County Counsel TO: Clerk of the Board of Superviso s (s , Thus claim complies substantially with Sections 910 and 910.2. { } This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.$). ( ) 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: ,r Dated: f " By Deputy County Counsel M. FROM Clerk of the Board TIO: County Counsel (1) County Administrator (2) ( } Claim was returned as untimely with notice to claimant (Section 911.3). IY, BOARD CRDM— 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 fire a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this :matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. DAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Bated: By: PHIL BATCHELOR By puty Clerk IF CC: County Counsel County Administrator RECEIVED CLAIM PRESENTED TO THE CITY OF WALNUT CREED, THE CITY OF PLEASANT HILL, THE CITY OF JUN 12 ZOOO LAFAYETTE, THE CITY OF PIT-BBURG, and RVISORS THE COUNTY OF CONTRA COSTA,CALIFORNIA N BOARD�C©STACO. 1. Claimant's Marne: SIVA SHARAREH 4 Address: % Lisa Radcliffe Attorney at Law 920 Country Club Drive, Suite 1B Moraga, CA 94556 Tel: (925) 376-2325 2. When did the damage or injury occur? .December 24, 1999, at approximately 3:30 a.m. 3. At which location did the damage or injury occur? Police report Broadway Parking Garage #99-031809 1231 S. Main Street Walnut Creek,CA 4. (a) What happened, and why is each of the municipal entities responsible? Prier to the date of the incident giving rise the claim made herein, Lt. Schultz, an officer in the employe of the Walnut Creek Police Department recruited the Claimant herein for service to the Contra Costa County anti-crime multitask force. Claimant slid thereafter engage in such activities as were assigned to him by the said officer, without further training and/or qualifications. In doing such act, the said Lt. Schultz did act as the agent as and for each of the members of the said task force. Also prior to the date of the incident giving rise to the claim herein, Claimant teamed that a threat had been made on his life by a person (Matt Anderson, later killed by Walnut Creek police). This information was conveyed to the officers in the task force. Claimant was then requested to follow through on the desire of the members of the task force to gain information for them of suspected illegal activites taking place in and about the said parking garage. The said officers abandoned him, and allowed him to be "set up" to be shot by firearms in the possession of the said Matt Anderson. In being "set up", the Claimant did go the Broadway Plaza Garage as instructed, where he was told by one Jeffrey Todd Price, presently under suspicion of involvement in the attempted murder of Claimant, along with an accomplice, one Erin Ortman, both such persons presently being in custody for their involvement in the incident giving rise to the claim made herein to go to a certain place in the garage to be seen by someone. Claimant had -previously reported to the officers that he was a marked man. Claimant was allowed to walk into a trap where one Matt Anderson was lying in wait for him. The said Matt Anderson did then and there assault the Claimant with deadly force, wounding I him by shooting turn in the neck. Claimant was specifically on a mission for the Walnut Creek Police and the joint task force when such injury occurred, in accordance with Sec. 3356 of the :Labor Code of the State of California. In accordance with the rights and privileges granted to Claimant therein, and the responsibility imposed upon law enforcement, Claimant made a claim against the City of Walnut Creek for benefits provided for therein. The said City of Walnut Creek did deny liability for such benefits thereunder, forcing the filing of this claim for liability and damages under the common law of the State of California:, for injury and damages caused by the negligence and violation of the civil rights of the Claimant of each of the municipalities involved herein in the anti-crime task force. 5. What damage or injury occurred? Claimant received lite threatening gun shot injuries to his person, causing severe physical, emotional and mental injury. He was caused to be hospitalized for a time, all to his economic damage, and did receive severe permanent injury to his person. In addition, he did receive permanent injury physically and emotionally all to an amount in excess of the minimum jurisdiction of the Superior Court of the State of California. 6. Claim amount? The amount claimed is in excess of$25,000, being the minimum amount of a claim within the jurisdiction of the Superior Court of the State of California, being both for temporary and permanent disability in a claimed amount commensurate with such injury and damages as is reasonable under the circumstances and as is usually granted in the jurisdiction where any further action will be filed. 7. How did you arrive at the amount claimed? The amount of the claim arrived at was by referring to the amount usually allowed in personal injury claims of the severity which occurred in the incident giving rise to this claim in the jurisdiction wherein the injury and damages occurred. Medical damages directly incurred to date, as a direct and proximate cause of the injury have been in excess of$110,000.00. Loss of wages have been incurred in an unknown, but substantial, amount. Grievous physical, mental and emotional injury was incurred and continues to accrue as a direct and proximate result of the injury received by the Claimant as a direct and proximate result of the injury and damages. 8. I declare under penalty of perjury under the laws of the State of California that the inf imation herein contained is true and correct, and that this,, siec4Imtion was executed on �,,2000 at �' , CA. Signature of Claimant or Representative 2 9. Official Notices and Correspondence: Name and city: Lisa I Radcliffe, SBN 150011 Richard Hellesto, SBN 61471 George W. Kilbourne, SBN 23381 Attorneys for Claimant Address: 920 Country Club Drive, Suite 1B Moraga, CA 94556 TelMhone: (925) 376-2325 3 CIAM SOA naF SUPERVISMS 01 N c0_S1 UNTY, ORNIA OAR[l ACTIQ�E JULY 18, 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 l The copy of this document mailed to you is your California Government Codes. :f notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 613 and 915.4. Please note all "Warnings". AMOUNT: $60,000.00 M,AR TiN_;-Z CALIF, CLAIMANT: JAMES STRICKl, ,Nl7 ATTORNEY: C/o THOMAS P CREERTY DATE RECEIVED: JUNE 21, 2000 Attorney at Law ADDRESS: 917 Las Juntas Street BY DELIVERY TO CLERK ON: iINF?1 .,, 2000 Martinez CA 94553 BY MAIL POSTMARKED: TT INF. 91 9000 1. FROM; Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BATCHELOR, Clerk Dated: Timm 21 _ 7QDD _By: Deputy QeVIVI-11 2a�w�� 47 H. FROM• County Counsel TO: Clerk of the Board of S ervisors (v`j 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: 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: t 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 N[AELING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: 'a,0 By: PHIL BATCHELOR By Deputy Clerk CC: County Counsel County Administrator 1 THOMAS P. GREERTY (SBN 085616) ��Ir�� Attorney at Law Y 2 917 Las Juntas Street Martinez, CA 94553 JUN 2 1 ZQoo 3 (925)370-8400 Fax: (925)370-0778 CLERK B OF SupEr 4 C(71A CTA Ct3. Attorney for JAMES STRICKLAND 5 6 BEFORE THE BOARD OF SUPERVISORS 7 CONTRA COSTA COUNTY, CALIFORNIA 8 9 Claim By: JAMES STRICKLAND 10 Against: CONTRA COSTA COUNTY CALIFORNIA 11 12 The undersigned claimant hereby makes chum against the COUNTY OF CONTRA COSTA in the QJ< wQ.y;01 0's,r,m 13 approximate sum of$60,000.00 and in support of this claim represents the following: W—J(0 ZN ll p— y-cm X 14 1. WHEN DID THE DAMAGE OCCUR? 0 15 Sunday, January 23, 2000 at 12:18 p.m. C) 6 } ; 16 2. WHERE DID THE DAMAGE OCCUR? Lo N 17 The intersection of Willow Pass Road and Evora Road in the unincorporated area of Contra Costa County 18 3. HOW DID THE DAMAGE OCCUR? 19 Claimant was waiting at a red light westbound on Evora, at its intersection with Willow Pass Road and, 20 when his light turned green, Claimant proceeded slowly (10 mph)into the intersection, westbound on Evora, and 21 was almost through the intersection when a CONTRA COSTA COUNTY Sheriff's vehicle, driven by Deputy 22 Sheriff David Hartman, without lights or siren, ran the red light for southbound Willow Pass Road and violent 23 struck Claimant's vehicle, causing his injuries. 24 4. WHAT PARTICULAR ACT OR OMISSION ON THE PART OF COUNTY OR DISTRICT 25 OFFICERS, SERVANTS, OR EMPLOYEES CAUSED THE INJURY OR DAMAGE? 26 Contra Costa County Deputy Sheriff David Hartman caused this motor vehicle accident by running a red 27 light. 28 1 1 5. WHAT ARE THE NAMES OF COUNTY OR DISTRICT OFFICERS, SERVANTS, OR 2 EMPLOYEES CAUSING THE DAMAGE OR INJURY? 3 DEPUTY DAVID HARTMAN. 4 6. WHAT DAMAGES OR INJURIES DO YOU CLAIM RESULTED? 5 Property Damage: $2,316.00. Claimant has already been paid by Contra,Costa County. 6 Personal Injury: Cervical and lower back injury. Claimant is in constant pain and is suffering in his back 7 and neck which forces him to take medication and physical therapy. Damages are estimated to be over$30,000.00. 8 7. HOW WAS THE ABOVE CLAIM COMPUTED? 9 Medical bills and lost wages. 10 8. NAMES AND ADDRESSES OF WITNESSES, DOCTORS, AND HOSPITALS. 1.1 MT. DIABLO MEDICAL CENTER KAISER PERMANENTE n MEDICAL RECORDS MED-LEGAL RECORDS DEPARTMENT 0 12 P.O. Box 4110 1425 S. Main Street C? Concord, CA 94524 Walnut Creek, CA 94596 u1d„arN LU i '-Em Witnesses: Other than those witnesses listed in the California Highway Patrol Traffic Collision Report, c�a ,x c . Z n o • none known to Claimant. WW `s0J "0 15 T ° 9. LIST ALL EXPENDITURES YOU MADE ON ACCOUNT OF THIS ACCIDENT OR INJURY: M16 N DATE ITEM AMOUNT °S 17 As of yet, specifics are undetermined. 18 19 SEND NOTICE TO: THOMAS P. GREERTY 20 Attorney at Law 917 Las Juntas Street 21 Martinez, CA 94553 925 370-$ 22 �' , 28 <ES W. STAICkLAND THOMAS P. GREERTYff 24 'Claimant Attorney for Claimant 25 26 27 28 2 �/+'''�'�'�� g ,. irl.1111l�1 iBoAgp oF STP�ORS OF CMTR.A COSTA [Yt=o AL O2NI _BQABD ACMI^ JULY 18 2000 Cairn A,gai€�,st the County, or District Governed by ) the Gerd of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of ttis doewent rmiled to you is your California Government Codas. } notice of the action taken on your claim by the Board of Supervisors. (Paragraph lii below), given pursuant to Government Code Section 913 and 915.4. Please Mote all "Warnings". AMOUNT: NONE STATED CLAIMANT: THYSSEN-DOVER ELEVATOR CORPORATION ATTORNEY: c/o Gregory P. Lombardi DATE RECEIVED: JUNE 9 2000 Taylor & Gutierrez LLP ADDRESS: 90 New Montgomery St. Ste 905 BY DELIVERY TO CLERK ON: JME 9, 200 San Francisco CA94,105 BY MAIL POSTMARKED: HAND-DELIVERED L FROM: Clerk of the Board of Supervisors TI> County Counsel Attached is a copy of the above-noted claim. PHIL BA C1R, Clq Dated: JUNE 92 2000 By: Deputy IL FROM: County Counsel TO: Clerk of the Berard of Supe ors (.�.)"Ihis 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 1$ 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: x� �J Dated: Deputy County Counsel 13L FROM Clerk of the Board M. County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDEEL By unanimous vote of the Supervisors present: 11 This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: �,P O PHIL BATCHELOR, Clerk, By lS�""' 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 �.onsult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Noti-.e. DAVIT OF MAUING 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 Gam- 5 - -Deputy Clerk CC: County Counsel County Administrator TAYLOR & GUTIERREZ LLP .Attorneys at Law 90 New Montgomery Street, Suite 905 San Francisco, CA 94105 Telephone (415) 541-9800 • Facsimile (415) 541-8690 June 8, 2000 LE13 EI D Via Overnight Courier 5 2000 Clerk of the Board of Supervisors p57A CpvlSORS Contra Costa County County Administration Bldg., Room 106 651 Pine Street Martinez, CA 94553 Re: Governmental claim against the County of Contra Costa Related matter: Anthony Hines v. Thyssen Elevator Company Contra Costa County Superior Court, Case No. C00-00712 Our File: Thyssen/Hines (106.020) Dear Clerk: Thyssen-Dover Elevator Corporation presents the enclosed governmental claim against the County of Contra Costa. Please file the claim and return a filed-endorsed copy in the prepaid envelope provided. Thank you. Very truly yours, TAYLOR & GUTIERREZ, LLP g . Lo ar GPL/mca Enclosure x:A06\020\county-06.Wpd JUN-07-2000 14:26 CONTRA CCSTA CTY R I SK MGT Claim to. BOARD OF SUPERVISORS OF CONTRA COSTA COUN. W I;S=M0_MS_Tia CIvAIMAN3 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, crust be presented not later than the 10e day atter the accrual of the cause of action. Claims relating to causes of action for death or for injury. to person.or to per3onal property or growing crops and which accrete on or after January 1, 088,must be presented not later than six months after the accrual of the cause of action. Claims relating to any other t;ause of action roust be presented not later than one year after the accrual of the rause of action. (Govt,.Cotte§911.7.� B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Resort 106, County Administration Building,651 Pine Street,Martinez,CA 34553. , C. If Claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be frilled lin. D. If the claim is against more than one public entity,separate claims must be filed against each public entity. E. Fraud. See penalty forfraudulent claims, Penal Code Set.72 at the end of this form RE: Claim by 3 Reserved for Clerk's r". Thyssen-lover Elevator Corporation '0 :' a;w SVO' IAIV`dd l :it5 ,. Against the County of Contra Costa f Ur t71t l~r.. ' � , District) .. (Fitt 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) See Attached. 2. 'Where slid the damage or injury occur? ),xad county) ........................................ (L-tdudc cui_____ ____________................._____________ __ See Attached. ...........................................................,..,...._.,,._.». 3. How did the damage or injury occur? (etre tial loon.:me antra paper itroquired) See Attached. ............................................................... _..__-__________--_ 4. What.particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? See Attached. _. RECEIVED „. av b ,SUN-07-2000 14:26 CONTRA COSTA CTY RISK MGT P.02/03 Claim to: B6.,AD OF SVPER'VIS©RS OF CONTRA COSTA COUNTY INST1t17CT1UNS TQ CI.MMANT 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, 1387, 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 wbicb accrue an or after January 1, 1988,must be presented not later than Sia;months after the accrual of the came 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 i.i against a district governed by the Board of Superviaors, rather than the County, the name of the District should be filled in. D. 11 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 Cotte Sec. 72 at the end of this farm. RE: Claim by ) Reserved for Cleric's Filing Stamp Thyssen—Dover Elevator Corporation ) } Against the County of Contra Costa or District) (Fill in Nalene) The undersigned claimant hereby makes claim against the County of Contra Costa or the above named District in the sum of S and in support of this claim represents as follows: 1. When did the damage or injury occur.? (C vc exact Date and Hour) See Attached. 2. 'Where did the damage or injury occur? (inrluda City and County) See Attached. 3. Dow did the damage or injury occur? (Ciro fa detaiw.use esus paper if required) See Attached. ------------------------------------------------------------------------------------- 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage'! See Attached. (Over) JUN--07-2000 14:26 CONTRA COSTA CTY R19< MOT P.03/03 S. 'What are the names of coi. or district officers,servants,or employees ca :g the damage or injury? See Attached. --------------------------------Yif-------------- 6. What damages or injuries do you claim resulted? ((rive M extent otiAiurivs or damages claimed. Attach two estimutos for auto damage.) See Attached. -------------------------------------------------------------------------------------- ,7. How was the above claimed amount computed? (include the estimated amount of any prespecliv,e injw7 or damage.) See Attached. 8. Names-and addresses of witnesses,doctors,and hospitals. See Attached. ------------------------------------------------------------------------------------- 9. .List the expenditures you made on account of this accident or injury: xa.'•rF rr 1 tC� wr See Attached. * x �rx ,e �ex ,e * ,� rese �ek �e * * ae * * �rx * * * x * * x * x * * * * xxxxx ,exte :axx rtx � x * * ,a * �t Gov.Cods:Sec.910.2 provides: "The claim must he signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf." Name and Address of Attorney Gregory P. Lombardi ._ .— Taylor &Gutierrez LLP 90 New Montgomery St. , Ste. 905 ( an#'s Signa re) Gregory P. Lombardi San Francisco, CA 94105 Taylor & Gutierrez LLP (Address 90 New Montgomery St. , Ste. 905, San Francisco, CA Telephone No. 415/541-9800 Telephone No. 415/541-9800 94105-4504 �F * x ,yak ,tlfe * # xxxdrfx9a # * # * # art * xx * xxxx * stir * * # xxxnaa � * * xxxxx ,e * * die NOTICE Section 72 of the Penal Code provides; "Every person who,with intent to defraud,presents for allowance or for payment to any state board or officer,or to any county, city or district board or officer,authorized to allow or pay the same if genuine,any false or fraudulent claim,mill, account,voucher,or writing,is punishable either by imprisonment In the county jail for a period of not more than one year, by a fine of not exceeding one thousand dollars ($1,000),or by both such imprisonment and fine,or by imprisonment in the state prison,by a fine of not exceeding ten thousand dollars ($10,000), or by both such imprisonment and fine. Attachment to Claim of Thyssen-Dover Elevator Corporation In March 1998, Thyssen-Dover Elevator Corporation and Contra Costa County entered into a contract in which Thyssen agreed to service the elevator equipment at Merrithew Memorial Hospital, 2504 Alhambra Avenue, Martinez, CA, a facility owned and operated by Contra Costa County. Laura Lockwood, Director of Capital Facilities &Debt Management, signed the contract on behalf of the County. A copy of the contract is attached as Exhibit A. Under the contract, the County agreed to defend and indemnify Thyssen from claims arising out of the elevator equipment's use. Specifically, the County agreed to: indemnify, defend, save harmless, and insure [Thyssen] as an additional insured on [the County's] policies, against all claims, demands, and liability for damages, including attorney's fees and costs, or death or bodily injury to persons or for injury to property arising out of or connected with the use of the elevator. However, this indemnity will not extend to any loss, damage, or expense arising out of the sale negligence or wilful misconduct of[Thyssen] or its employees while at the [County's] site. (Contract, Terms and Conditions, para. 3.) On February 29, 2000, Anthony Hines, an employee at Merrithew, filed a complaint for damages against Thyssen in Contra Costa County Superior Court. A copy of the complaint is attached as Exhibit B. Hines alleges that he became stuck in an elevator at the hospital on March 11, 1999, and that he suffered injury as a result. Thyssen was served with the summons and complaint on March 7, 2000. (Note: this is the second complaint Hines has filed against Thyssen and the second claim Thyssen has made against the County as a result. The County acted on the prior claim on March 21, 2000.) Hines reported the incident to his supervisor at the hospital, Barbara L. Hughey. He has visited and/or treated with the following healthcare providers: • Sigal Medical Group 1223 Solano Ave., Albany, CA 94706. • Carlton W. Purviance, Ph.D. 190 Hospital Drive, Vallejo, CA 94589. • Eduardo Abdala, M.D. 1040 Colusa St., Vallejo, CA 94590. • Knudson Chiropractic 521 Capitol, Vallejo, CA. He claims medical expenses, wage loss, and pain and suffering in an undetermined amount. Attachment to Claim of Thyssen-Dover Elevator Corporation X:\I06\020\claim-02-attach.wpd Page 1 of 2 Under the contract, the county is obligated to defend and indemnify Thyssen from the Hines complaint including payment of any judgment or settlement in Hines' favor and payment of Thyssen's attorney's fees and costs, incurred both in the defense of Hines' claim and in pursuit of indemnity from the County. Alternatively, the County is liable to Thyssen on an equitable-indemnity theory. Attachment to Claim of Thyssen-Dover Elevator Corporation X:\106\020\claim-02-attach.wpd Page 2 of 2 a EXHIBIT A MAF 2 .'99 12: t 8P i r Y ThC `. ` i '1tATC R CORPORATION JVTENANCE AGREEMENT ELEVATOR MAI CONTRA COSTA COUNTY 7.500 ALHAMBRA AVENUE MARTINEZ, CA (Mete na#terPurchaser) Cctntmcf Proposed by: TH`(SSEN ELMATOR CORPORA-noN tHettainalter C pang) THYSSEN ELEVATOR CORPORATION 1660 FACTOR AVENUE SAN LE4NORC, CA 94577 Agrees to service the elevator equipment described herein on the following terms and conditions, in Purchaser's building located at MERRIT'NE;W MEMORIAL HOSPITAL 2500 ALHAMBRA AVENUE MARTINEZ, CA aQtL1PfiWNT DESCRIPTION ." TYRE +QUAti"fi'tY MANXJM� ELEV.10 L+1Nti1tlGS/0Pe41NC-- GEARED SIX(6) USEC 515 IL I URC�ASER'S RESI'aONS#Sii.1T1ES Pxntsesswn or r owoi of the,equ onent that rarttain ax dusivoty yoxtts as cwne:r, lessee, possessor or rxottudian. • Your ti sootssbay Includes. W is ftot i&nimd to. W4ducting or wa ir4 pesseNem in the proper use of the etc ttlptoertt, taken tete cgtrapmard out of setwir e w herr It becofftes unsafe or opera"*in a manner that height Cause Injury to a user, promoy trepofto taus arty accidents or zy rsattditn which may need attention and maintainkv surveillance of the equipment fat such purposes. •" You will provide us unresWcfe d access to 3trs egchprnettt. and s safe workplace for our employees. :. • You will keep the pits and the machift Loons clear and free of ter and trash and not perm'd them to be used for storage; and provide supply power of pnaw vatage and free at aberrations. • You ag e:e that you will(tot permit others tomake char4e s,>adfustrrmts, tests. additions, repair$or teptacenwnts to the equipment. " « You will ensure:that mat5tine rooms are ptget yventltated, and humidity and ternperatura controlled In the 55 •80#Degrees Fa"nheit tartge mandated brth+s±RKM 17.1 Handbook. RECEIVED MAk 91998 TmnsemE vmg Copuovuvom MAIN`?deft'#l"CE AG#£SfENT MTEXCXkDf.`t PAG-61 tt RiiFl l!#�LtIMtSSPtxft EXHIBIT—A MAR 23 '99 1 2:i SF"t CbLA ANY` SCOPE OF WORK Undetr thitG'contract the Company will maintain the elevator equipment herein described on the following terms and c onditksns: Thee bompany wilt use skilled, trained personnel, supervised and directly employed by us and use reasonable cares to see that the equipment is maintained as set forth herein.,'The Company will regularly and •systomat#calty examine, adjust, lubricate, and if conditions warrant, unless specifically excluded under the exdtisions paragraph. repair or replace the, Machine:Including worm, gear, thrust bearings. drive sheave, sheave shaft bearings, brake coil, brake Unings wind components. Pump Unit including pump, V-belts, strainers. sifewers, springs and gaskets.. Matz rt-kxducling mcitor windings. bearings, totaling eiemeat. commutators. txushas and brush holders. Motor ionerstor.Including windings. bearings, rotating element, commutators. brushes and brush holders. Jack Unit:inelucttng plunger, guide bearirng, packing and packing gland. Controller:#nd6ding.rejays, re:sistoms, contacts. coils. leans, transformers, fuses„ timing devices and solid . raanrnport __ Vaty :Including relief valve, pilot, lowering. leveling and oheddng valves: or any of the parrs thereof. DispatcNng Equipment Including relays, resistors. ccntacs, cork, leads, fuses, transformers, firming devices. and solid state components. 9+elsctor:Including tkd cal or n*chank2i drive components. cans, contacts, relays, resistors, leads, transfom em.and solid state components, Governor Including sheave, beariras. shafts., c ordads and rovemor jaws. Car.Including power doctr operator, door protective devices, car door hangers; car door contact, load weighing equipment, car safety devices, car guide shoes. and subfiooring. Naistwa'y Including defledor sheave. secondary sheaves, buffers, govemor tension assesrblies,guide rafts, limit switches, compensating sheave assemblies, compensating chain of cables. traveling cables. hoistway ale ri actaine morn wiring, hoWway door Interlocks, horstway door hangers and gbs and auxiliary closer. Acce"cary Equipment:including all acrossory elevator equipment instaited prior to commencement of this -contract unless excepted in the exc4mons pamgtagh. Fixtures.r:car and hall button stations, master Indicator writmi panels, all signal fixtures includiN contacts, ' buttons. kety switches arnd lodes. Lamps and sockets will be rep[aced during regular examinations only, or wtii otherwise be subject to separate billing. Furnish lubricants.Compounded to specifications and setected to give tee t*st performance. Furnish and Maintain-hydraulic fluid at proper operating level. Wrs ropas:w ill be renewed as often as necessary to maintain an adequate factor of safety and equalize the tension on no ho#stirng ropes. ER-ORATIONS- The lc ORATIONs:Tho,itesrrns tlstOd on the schedule below show considerable wear and wig have to be replaced In the near future. To pr*xvidei,you watt the muimu n service from UW"itexrrs, the Company is accepting them in their present condition W th the Understanding riding that you agree to poly, in4ldcRios to ttte base arraotutt of this proposal, an extra price at the t1n*'uses Items 4itod are first replaced. The d 9*tsar tfutr fe placamentw#ll be determined by prorating this total cost "of reptarlitg dee individual hearxs. You art►tc part'for ttszt portion of the rde of tate Rem used prior to the state of this COAtruld And tete Comp*ny agrees to M for aw portion used during the time:of aria CMAMC. S'CNEL?M F PAMTO SE PRUI MD Noy HQURS OF SERVICE AN wrnrtcaiwtif be performed dttr{nq the regular working MUM of the regular y ork#tsg days of the elevator trade, unless offlW d spooned below The Corsrp24Y Win proirldtr aaterrgency minor adjustment call bed*service: ttsvartor Malrrtonarnce(FM) . L3irrltt+g,te ttiar wwarttlrtg hours of the regular wts kkV days only. Caft2cks outside therse hours will be bitted at our regular rates in addition to the ltd base price. EElevator.Maintenance Time Differll tidal(PMTD) © . Ut'Overtime callbacks, we wt"ll<absorb U*worked hours at straight time rates and you will be charged f6r the overtime-fiftMitlm Portion Ont , at our regular billing rates. • �ntrar Marrrterrtaneae with Cs�lbscttcn{FNt�`1 '} ,.On a 24 tthur; 7 stays a week basis, ww will absorb the premium expense. . MAR 23 '99 12:19PM FMTD-518 TESTS Ts company shad not as a part of this agreernent be required to make tests as set forth in the edition of Arnerk an Rational Standard Safety Coda for.Etevatom and Escalators(ANSI,17 t)In effect at the time this agreement Ls entered into. SPggAL PRQ'VISIQNS This a►grectmerst. after acceptance,is agreed as being entered into, and service shad corrvnence on October 2x4,1997 and continue until teniiinated at the end of the first SPX(6)years after the cormnxtocemrit data,.as.- CQffrR CT PAYMENTS Are due►monthly In a3vancx at ,ronhtinCMeLo ZERO - IS 0.00 .._)pax month. ACCEIsTANCE •Thhs proposal, when accepted by you. irectuding the terms and the exclusion on page four(A)hereof and approved by at Company o", shall constitute the contract between us, and aH prior representations or agreerrsents not incorporated herein are superseded. This agreement, if not property execzAed and returned to us in sixty(60)days from the date submitted is void. proposed for. THYSSEN ELEVATO 0 A4=pted CONTRA COSTA COUNTY Leger Kama of Address: 2WO Alhambra Avenue By DEBRA►WIL.SQN Martinez.CA 94553 Trice BUSINESS-MANAGER Date Submitted March 5,1"s Accepted for THYSSEl1 ELEVATOR COO. py tRl�! rarJKrd/rCkSltl lft w..,.......�. By.�... ».. ne....... .......... 7r'f3a ._. trr~- JL+1'rt"" Time ;t;A t� •+� Cad tri ELO MAIUM"CE ACRLeEMEN PAGE MPR 23 '99 12:EOrM � W �.' FMTD-518 r TERMS AND CONDITIONS` The:Company'shall not be hell responsible or gable tot any WS, damage. detisniar, of Cetay awsrd by aecacideists stitices. tochrsLft Itle, hoods. acts of cyst or milliary iuthotittes, or by insuffectort or not or by any othef cause which is beyorul its trasonabie OontM. in tib"ent*haul the Company be table vkadoutsf r ke CDniect-niaf daehtivQes at torr proposal of haGrwcous waste aWeriais. ilia tEnitae a{labiilty an the Ccirspany otlrau than that speatic Fy rr anticne d herein is irrtcttded. the Company strati hat be daftly fax any envitanrraenbtfeccte3gieaS reponr g, testing, Clasnithg, or rehabirdation dictated by any agency or party for any rehasors if such action isrmquireed, the Company shalt be fully rene».tcd by the Purchaser. puts haaeea equipment is is any trthet etreratarnedtattiicai equrp+tvrFnt is sutaject b wear and tear. deteaiora stat and m Amcdon throuo use. abuse. wear, oontaaninsban and ottler forcer beyond the Control of Compaty, VWk this agreement is des tad to teduce It*WaW and ptolong the useful tete of such equipment, Company mattes no repre setuation Stat such equipment rrti not beak dawn or uraatfutsrrtott and Purctsaser shall fhoid any harmless from arty surd event or atc*xdarislog therefrom The Pumiuser will Indemnify. dalwid, save hanzdess and nmsure Caneparty at an additional Insured CM Pis pokaw against at chinas. demands, and amity f«damages. Irrcftt V attcurley s tees and least%, tot deadt ax bodty injury to persam or fpr hVU1Y to pwidy aifsksp out of or connected with the use of Chet elevator, Har sever, this khdetnt*T w*riot txtead to any lase, darnag s nor expense milisarg aur of the sole negtigenne or wipfut mtsc w4uctof Company orb empfcyees whist the Purrhasees sate. At any tteie the Cornpany`s stinricrtnstln is StrA thg the*OpnOM thlt Crxttipitrty I$asserting nosSesUM and CxArot sleuth over 4're spe iic component tong seed at"9fi:trh moment and possession and c*rtfel c9ft tatwinder of the eaptipment shalt tun iii with The PwVtaser. Thee Company" not be responsible for any saraton Out mgt asawr that cannot be revealed by OrOrmy aisual irtspaationz while Company is at Putciasa%side. In the event the PutLtlaset fails to give Osie Company i r adhde verbal and oon�nning wdtttn notim wAW wren ty four Items Of arty aceiderAt alteration or change affecting flvtl rgtilpftrent facts to kssn ediatty diswrttiflUt uses of the teyuiprnent k a h ar unpts w to be ' t+atdty; Ger fails to trtairxain s urveiltatrest of It*equipment in order baa detect f7*j operab k t*n Purser will be held restsonsba for any :.anti all damages. khjury and labaity as a mu*of said taiture. `fih s notkct taquira rAnt is b oe suscdy canstru d and any ba rte sa eornpty *Ih Oft regykernent will serve to hold the Purthaset and it's ittsum stable ror any and at daunages or injuries wM dr tut therdwm. ln_ttie event Company gives Purchaser no&*of. «Purctsase r faAs fo tetra ttnyr tstsstfe cdxvditions raarected 'r nY itmtF lave no Aot W Obligation to petdxm under sfvs ccontrad and such failure to c mW sten be deanred a n utenal breaCt of Cris coot=by to the event of Sate, tease or cutter ttansfa at than a evatots er cOter e4ul desrrafyed itefete> C(Cee W noses it wtridh they ate •locale d, Or a ctsaru t in Itte paY 4 party. the Pumhasex agrees to see owl sue:!%trartskme of ahemate payment party is mark wrene of alis coft*1 and assumes arW agrees to be bound fry the terms heteo(fox ft balers of the omlract term"stxb Ya trxhs toff as lutein provided, of ouheerMse be Sable for Isle Aril unpaid balance due for the une#w terra of She crantnct; provided however; that in .say w)dY cases the Company may;n its sots discstetion tannate Otte above comas wsilh arny r tcl+sumessor at"time upors IPO)days advance notate In writing. The contraOt twice is a unit amount fox Ore entim conaaet period subject to interest and escw4bon a*twments. teas"'paymwts arra"for Pumas es axwenw ce. fn ft eve nt of treactt of this aarrrratt, including the fa4ure by purcttasrr to pelt tic prttz tNtteo due. the Carp"mzV at ft tT!kA decxara ahs"TIS due or to be becomA due under els acemact ler the unexpred term of slava Cpat=anmediatety due arra paw and Purcthaeser awes that the umparry is Cist%2rged from any Austen otligati nt to persona. Any n"ft an snail blear teme st at the max4MM rate allowed by taw. Interest wheal not paid shaft Oompcund where permimsd by taw. In.Va event legal or OdW 360A is kura ted by the Company To collect any money due it under m s cwaaC or damages fes as bmaclt. it strati be ettt'tied to mcxw;a thud pe ty ctstteratotr e>xJenxeS. attorneys tees and tests incurred by it with iWefcit in o:*ncton wtt h such acdran wttiet w or not sta>rsut is tged of crs+xCucted err rice evert cf ah aGual or attagesd+3e{sua bf trxrtpsnY. Purctarser OW give Company a tan day w6ftn nonce and if Catspatty fatda to cute or aornmitnon sow to euro wWm urch prxlod. Pur-112sar may, upon an adci anal three dryx rvriat rr tso0ue, tirtttiirsaite<but agteemeret. 04put is will be tesctved to the maximum extent possible by good Will negoUfttL tf a dispute is not sell, t'hcn arty contruversy of claim arising out otor taWng to Ous cor&=€hat be settead kh aocarfty=with the Commercial Aifli4'ow totes of Ott American Arbitration Assodstion, sad judgrmrd upon Rte award may be ar tarW in tiny mut hr#kV ju�on thereat. tet cater of . moretary dfsp(Aes. tr*patties start eu#h make their"best arra Apar talkers and thrr l ibfttar{s)"eine 64W orw er the ateh6f W ere orb M wfthaut prritalion. The nen-pteYwAng parry slsad nay Ota Arbitrawls)fees. 0uri g tNe peerdrrVCy o{surth dipxAe. Purctwier will OW Camp"any undisputed sutras Or if same be in dis xme such masranable value as would n«maOy be rtb#trura bee so Use vwk and the tlrw!'traitle Of the work;n along the ct WjWd atrotmb it ft+e dispute is PAW in Company's favor. if flue daiputed amount(j)are root so dackltad W Company'favor; than Cortpany sthalt remit back to Purchaser any tbtass= paid. lel#4 event the Purt haset`s aocaptanc:a is in fans ft-m of a purcrase onset or tutu hand of dcorumem the prvAsiorrs„ le n and cCeaOi I at this&Agreement shaa 9"n in ft tvft of oaralim . • EXCl.1; tONB The tbtbwksp manse tars not inciuxfed to ntis erxWw trairttskft. m4nlsrhing;, nomwig or neestam Tw of any compoesrehts of VW etevalob heti, its Ro«s, floor . srAa, hu�aiis, ca'ttrq e�-: list txxstvtay eftdcarturas, eAaexs, fiatrtes and ares«otter patians cd` ew Batt Subject to ptab6c abase: hy*v%TftqMftM msii thV*au C V* t.atipft prolac:Wn"ftM rsOfsmartslt of any 00iUft. *JWVOM*tubela and assodatat t can ea eland for rob f iminabom teatimes for errtwStncy tighiing, clay Paw"tfnits or mnpeeteftfs tnatattetd of conneded fol a meigargy aWTdby PWAW tom: mall rale POWN fists, bf*tkars and teeer$1 1g t *01 or obsows equipment wtifeh is no kutq+atr mgAadY avaubir#fxuuoft nomwatuppty sourca L if Ute otfgi w wpor d was — ' AG(ftttrt+fftdaaruid'aar lnsfariad by C«etpany, of was PVAW by PsuRdrsser ouch as.puttvsd&TAsd b,;sheath attcsrrtty,intewrxn or taUsar sysWgrk tiny prraW*mt with design, mabulaf>at workmanship,ant spedaty es;ckSded ftd m emwage under this SwtWast.. if the `etetuatfcea am etw4w wi#h a rownatrs cm it fawn,usew not be teeznaerss ie hof the rrhaGnbafsarhraa«funiskt+t tq to tete amoi's waftheat dtatectotstilansors f3paiea ex tenev►ats t:tr ohhfas;wry were t ahthef bran otomy shells anpty 1a tearultrsit and the Ccrrrparny strut tstd0e ragarir sd u traria adIUSIments. repairs,or reMewirts hauled by reason of negfigerve on the part est cttufs, misuse of Ute+kqui r&nt, aartyittatstehtntat Gonditiotts indtrdirrg t+ayisge:ex by mason of any outer cause fxeyond Use Caerpanys,=r*oc to the event tests ase rrtquitbd by WAtracL Pun2taser undtttswift Itmt lose gest tmposa upon Che ee4uorort graatet strahu trims ems arising dors normal Wiataititxt.`i'iiefetfM it is agreed that Sri mating Vxb lists, the Company shaff trot be held Table tax leakage, bss, damlge, k*MY or de*ucbm of pentons or property, snooept Oma.of#0 C mparry, because of aha fpr the adon or faitrre of any d t)+eartete+nrxal, It repeirs ars naeestsaey betfofe br anent%Ot h 10 MW Oodtt«Wbrmancsr ser*wwAwit. such wok shall tact eoasidaetd a+aen rtxtra to this aaont V4 and paYabte aa$is senesce exdec."dart Company Is not obOgated 10 kaW tom u xUadunern on tm etahraW. Bites>nerr or aftrent Ettsts of do other tititigs not fates'%V g ssr+exr4at reyutadotas in eflea an to torte WS CMUVu was first&Clad kft wheMe r or exit nvriommencled of Obeeled toy kwmattltst'OW;%;wies at by gove!mm r"atatl+ajWs, nor snake any mptacah Wta carte parts of a sL!fferesrt designs untess agreed W separaaely In writing• TNYSSai EmwmR CoppopAn om MAINTENANCE AGREEMENT' PA464 EXHIBIT B 3 i - i s t7gR F dR PAATY wtTHOUT ATTORNEY(NAM. TELEPh FOR COURT USE ONLY JOHN' C. SMITH, . JR. (SB# 047157) 415) 861-1886 2-17!1 qua LAW OFFICES OF JOHN C. SMITH, JR.. 1390 Market Street, Shite 310 San Francisca,. CA 94102 _ )� ATTRNEY FOR(MANSE): Insert name of court,Judicial district or branch court„if any,and post Office and street address: SUPERIOR COURT OF THE STATE OF CALIFORNIA COUNTY OF CONTRA COSTA-UNLIMITED CIVIL JURISDICTION 0: 725 Court Street, The Courthouse Martinez, CA 94553--1233 PLAINTIFF: �"Y mh ANTHONY HINES DEFENDANT: THYSSEN ELEVATOR COMPANY and DOES 1 TO i 0 CASE NUMBER: I COMPLAINT—Personal Injury, Property Damage, Wrongful Death fi Q MOTOR VEHICLE BOTHER(specify): ! =Property Damage Q Wrongful Death 00 -0€ tt 1 �' =Personal injury Q Other Damages(specify): 1. This pleading,including-attachments and exhibits,consists of the following number of pages: _4. 2. a. Each plaintiff named above is a competent adult Q Except plaintiff(Harm): PER LOCAL RULE 5 THIS M corporation qualified to do business in California CASE (S ASSjCyE Q 0 a unincorporated entity(describe): DEPT 4, =a public entity(describe): Q a minor an adult Q for whom a guardian or conservator of the estate or a guardian ad liter has been appointed Q other(specify): [�other(specify): Except plaintiff Mame): E3 corporation qualified to do business in California . Man unincorporated entity(describe). Qa'public entity('describe). Ma minor Q an adult Q for whom a guardian or selvator of the estate or a guardian ad l#em has been appointed Q other(specify): Q other(specify): b. Q Plaintiff(name)- is doing business under the fictitious name of(specify): and has complied with the fictitious business name laws. c. Q Information about additional pkdndff's who are not competent adults is shown in Complaint— Attachment 2c. (Continued) Form Approved by the Judlo corer of C*Hgn a COMPLA04T--Persanal injury,Property Damage„ EKecthm January 1.1982 ' } . Ruse 982.1(1) bM1131� �� CCA 425.12 C--87 SHORT TITLE.: MINES vs. THYSSEN caseu�.sBas�: i t I COMPLAINT-•-Personal Injury, Property Damage, Wrongful Death Page two 3_ a. Each defendant named above is a natural person Except defendant(name): Except defendant(name): Thyssen Elevator Co. JIM a business organization,form unknown a business organization, form unknown ]a corporation ( a corporation (� an unincorporated entity(describe): an unincorporated entity(describe): a public entity(describe): a pubiic entity(describe): other(specify): other(specify): Q Except defendant(name): L.Except ceferrcant(narre): 77 a business organization, form unknown =a business organization, form unKnown: a corporation =a corperavon an unincorporated entity(rescribe): �v an uninC rpW.'ated e t'.t'J c�?SCribe%: a public entity(describe): a public an ii'/'vesc':ve;: other(specify): other specifvl b. The true names and capacities of defendants sued as Does are unknown to piaintiff. c. �— Information about additional defenrants who are not natural persons is contained in Complaint— Attachment 3c. d. `t Defendants who are joined pursuant to Code of Civil Procedure section 382 are(r.ames): 4. r-1 plaintiff is required to comply with a claims statute, and a. [ plaintiff has complied with applicable claims statutes.or b. plaintiff is excused from complying because(specify): 5. This court is the prosper court because M at least one defendant now resides in its jurisdictional area. the principal place of business of a corporation or unincorporated association is in its jurisdictional area. injury to person or damage to personal property occurred in its jurisdictional area. other(specify): 5. The foltowing paragraphs of this complaint are alleged on information and belief(specify paragraph numbers): (Continued) Page rars SHOR: Tl'I,,E: CASE NUMSFR: H?"NES vs. THYSSEN COMPLAINT—Personal Injury, Property Damage,Wrongful Death(Continued) Page three 7. The damages claimed for wrongful death and the relationships of plaintiff to the deceased are j�listed in Complaint-Attachment 7 [ as fellows: 8. Plaintiff has suffered wage loss toss of use of property { hospital and medical expenses =general damage [�property damage (doss of earning capacity ( other damage(specify) 9. Relief sought in this complaint is within the jurisdiction of this court. 10. PLAIN T ll=a= PRAYS =or judgment for costs of stilt: for such relief as is fair,just, and equitable: and for compensatory damages (Superior Court)according to proof. 1(Municipal and Justice Court) in the amount of other(specify): 11. The following causes of action are attached and the statements above apply to each: (t=ech complaint must have one or more causes of action attached.) ( Motor Vehicle General Negligence CD Intentional Tort €Products Liability Premises Liability r Other(specify): JOHN C.- SMITH r J . _ _ _ . . . . _ (Type or print name) (si;"Atura o plaintiff or atwmey) COMPLAINT—Personal Injury,Property Damage, Page three Rule 482.1(1)(cont'd) Wrongful Death(Continued) C�^v 425.12 �_87 il- tc 3 71TLE: j CASE Nu.ASSR, HIKES vs. THYSSEN (i t 1 FIRS`` CAUSE OF ACTION—Products Liability Page �numbtgr) ATI TACHMEN f TO TRComplaint Cross-Ct'Zmolaint (Use a separate :aura of action form for each cause of action.) Raintiff(nar e): Anthony Hines S Prod-L-1. On or about(date): 3/9/99 plaintiff was injured by the following product: Thyssen Elevator and elevator system. Prod.L-2. each of the defancants knew the product would be ,urcnased ar'd used without inspectsors for detects. The prwdwG. was {:$teCtiV€3 Wt`;er; , Ieft the Control of eacn@fanC.,+afit. The orocuct 3 the titTka 0f injtir^., was being .�' usec , :he ;Fanner intencec by tine defendants. used 'tn w r;anner t."sai 'was reascna.�`y fcreseeabble Iv defendants as inv 'Ying nn ami^ C n-ja not 1 Ci 4 3iv5.... 4G"' 4e4k r reacily apparent. ACequate warnings of the danger were not giver;. p rod._-3. P!ai-tiff was purchaser--f the rCdt Ct. user:f t`te Nrcd.ct. bystanaer to the ,,SC 07e roduc ctr,.er 1(s4o .Cify): �t +lN7F=-1_z iNUL7RY `AIRS THE '_SGAL ✓nifYln RE-SuL 7 C= .., ,7,LL::VV1!NG: Count Ome-Stric: liability of zhe following defendants wnc a. ^,arufacturec or asser bled the product Thvssen C.eS---- -- - - C y �l b. designed and manufactured C,-c.'1pcinent parts supp'.ied tC u'e rnanufac Liar(fiarnes): `;`hvssen Coes 1 - - 10 1(7 c. said the product to the public(ramex,. Thyssen L3oes �. to . Prod.L-3. C=Count Two—Negligence of the following defendants who owed a cuty to plaintiff(names: Thyssen Mones to�. Prod.L.-8. Count Three- Breach of warranty by the fallowing defendants(names): Does to - a. ; who breached an implied warranty b. who breached an express warranty which was written: =oral Prod.L-7. = The defendants who are liable to plaintiffs for other reasons and the reasons for the liability ,are risted in Attachment--Prod.L-7 = as follows: bursa AzWovoo Lty Me Judlow council of Ca ffl*ria n Aute 982 6i 'saz CAUSE OF ACTION—Products Uability ccs 425.,2 a SUPERIOR COURT COUNTY OF CONTRA COSTA MARTINEZ, CA 94553 HINES VS. THYSSES EVEVATOR CO. � r NOTICE OF CASE MANAGEMENT CONFERENCE CIVMS`L'00-030712 1. NOTICE: THE CASE MANAGEMENT CONFERENCE HAS BEEN SCHEDULED FOR: DATE: 07/18/00 DEPT: 15 TIME: 8:30 THIS FORM, A COPY Cr THE NOTICE TO PLAINTIFFS, THE ADR INFORMATION+ SHEET, A BLANK CASE MANAGEMENT CONFERENCE QUESTIONNAIRE, AND A BLANK STIPULATION FORM ARE TO BE SERVED ON OPPOSING PARTIES. ALL PARTIES SERVED WITH SUMMONS AND COMPLAINT/ AND THEIR ATTORNEY OF RECORD MUST APPEAR. � . You may stipulate to an earlier Case Management Conference. wy all parties agree to an early Case Management Conference, Tease contact the Court Clerk's Office at (5251646--2960 fol- assignment- of an earlier date. 3 . You must be familiar with the case and be fully prepared to par- ticipate effectively In "'t-he Case Management Conference and to discuss the suitability of this case for the EASE Program, private mediation, bind.ting or non-binding arbitration{ and/or use of a Special Master. 4 . At any Case Management Conference the court may make pretrial orders including the following: a. an order establishing a discovery schedule b. an order referring the case to arbitration c. an order transferring the case to limited Jurisdiction d. an order dismissing fictitious defendants e. an order scheduling exchange of expert witness information f. an order setting subsequent conference and the trial date g. an order consolidating cases t h. an order severing trial of cross-complaints or bifurcating issues 1 _v, i. an ruder determining when demurrers and motions will be filed SANCTIONS If you do not file the Case Management Conference Questionnaire or attend the Case Management Conference or participate effectively in the. Conference, the court may impose sanctions (including dismissal of thy, case and payment, of money) . CLERK OF THE SUPERIOR COURTS OF CONTRA COSTA COUNT-k ,..., I declare under penalty of perjury that I am not a arty to this action, and that I delivered car mailed a copy o thi notice to the person representing the plaintiff/cross-�compla*na:nt. Dated: 02/29/00► M.OLSO e uty Clerk r dm9!'Id 60 i?d5 ��rr OUd f A311UA UNSWUH1 I IES '000s-vC C-009 AVH03 W •V3AOltl*•MMM CY tLt Ct%' ON -S Ln rrrr�!� } Pyo ..�,.�«c�,ay..,..l..r» eanec.s'r__.` •.^.t�.S W -»s.> -. "n'• '`�.,s...:SSss:''�^,?4.8Laow.-€:,,,•i c,.w..�ik.,. ....».�&�..,sn.<,.rsc . .,. .. ._ ...,. � .. ., ... CI AIM BOARD OF SUPERVI, M5 t`)F mN'1'RA cusTA t`YN;T'=TT"Y. CALHWYi1A BOARD ACng JULY 18, 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 Goverrment Codes. y notice of the action taken on your claim by the Board of Supervisors. (Paragraph 1V below), given ° . 3 t pursuant to Gcrvemment Code Section 913 and '- 915.4. Please note all "Warnings". AMOUNT: L1one Stated CLAIMANT: Derek G. Westfall ATTORNEY: DATE RECEIVED: June 13, 2400 ADDRESS: 2206 Overlook Drive BY DELIVERY TO CLERK ON: June 13, 2000 Walnut Creek CA 94596 Hand-Delivered 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 HELOR, Clerk Dated:_i_,I hint-_14. 3000 By: Deputy, ..� r', -? IL FRONT: County Counsel TO. Clerk of the Board of Supervi ors { ) This claim complies substantially with Sections 910 and 910.2. { r�J`fiis claim TAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 930.8). { ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: , _ - By:� �' - ,,Deputy County Counsel 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 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 slate. Dated: PHIL BATCHELOR, Clerk, By ' -X , Deputy Clerk !l 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 NSAIMG I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: ,r r By: PHIL BATCHELOR By �Z�^` - put, Clerk CC: County Counsel County Administrator __. VICTOR J.WESTMAN DEPUTIES: PHILLIPS.ALTHOFF COUNTY COUNSEL JANICE L.AMENTA NORA G.BARLOW B.REBECCA BYRNES S9LVAN0 B.MARCHESI ANDREA W.CASSIDY CONTRA COSTA COUNTY MONtKAL.COOPER CH iEF ASSISTANT COUNTY COUNSEL VICKIE L.DAWES OFFICE OF THE COUM` YCOUNSEL. MARKES.ESTIS SHARON L.ANDERSON MICHAELTFUJIIRR COUtVTY AIJPyiI NlSTRA't"ION BUILDING: LILLIAN T FUJII ASSISTANT COUNTY COUNSEL 6551 P!,NE STREET 9thPLOOR DENNISC.GRAVES JANET L.HOLMES GREGORY C.HARVEY MARTINEZ, CALIF{}ii�i1A. 053,4229 KEVINTKERR BERNARD L.KNAPP ASSISTANT COUNTY COUNSEL EDWARD V.LANE,JR. BEATRICE LIU MARY ANN MASON GAYLE MUGGLI PAUL R.MUNIZ VALERIE J.RANCHE OFFICE MANAGER STEVEN P.RETTIG NOTICE OF INSUFFICIENCY DAVID F.SCHMIDT PHONE(925)335-1800 JDACOUEL NEY WOODS FAX(925)646-1078 AND/OR NON-ACCEPTANCE OF CLAIM TO: Derek Westfall 2206 Overlook Drive Walnut Creek, CA 94596 Please Take Notice as Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code Section 910 and 910.2, or is otherwise insufficient for the reasons checked below: [ ] I. The claim fails to state the name and post office address of the claimant. [ ] 2. The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [x] 3. The claim fails to state the date, (please provide a year)place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [ ] 4. The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or loss, if known. [x] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000). If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10,000), the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. [ ] 6. The claim is not signed by the claimant or by some person on his or her behalf. [x] 7. Information may be included in a letter referencing your original claim. Page 1 VICTOR J. WESTMAN COUNTY COUNSEL BY: �' i Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013a,2015.5;Evidence Code§§ 641,664) 1 declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California 94553;1 am a citizen of the United States,over 18 years of age,employed in Contra Costa County,and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non-acceptance of Claim by placing it in an envelope addressed as shown above,sealed and postage fully prepaid thereon,and thereafter was,deposited this day in the U.S.Mail at Martinez,California. I certify under penalty of pet ury that the foregoing is true and correct. Dated: June 15,2000,at Martinez,California. cc: Clerk of the Board of Supervisors(original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM:GOVT.COBE§§910,910.2,920.4,910.8) Page 2 _. "Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CL 'T 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 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. -Fm-d. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form. RE: Claim By Reserved for Clerk's filing stamp s - 1 :EIVED JUN 2000Against the County of Contra Costa orJo GOVT AS P R ISt?F1a District) (Fill in name) ) The undersigned claimant hereby makes claim against the County of Centra 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) 2. Where did the damage or injury occur?(Include city and county) f .�. - i ' 3. How did the damage or injury# occur?(Give full details; use extra paper if required) ,.F 3 _'C c.'' 'i t -L...' i'c•`� t.'_:. ''3 .L -•g'a°": f`f i'f G:.-„�, s•'�:'.+t''E�. -"..r��_C: e •C* vd '�''"�s�_iv �'. � �-`_. ``.:+.� f �'y k Y.7� �:�: o ��.,} .} 5¢�.=o",.f':-S�i a✓.."7r&:.. "tom C. it;�wt s`' �'�. w4• ! v'• Ste" .. t 4. Mharparticular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? C_e "Ykc—n "'0' '<n 5. 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 claimed. Attach two estimates for auto damage.) ob <-4 ">A-1- ai 1 ky 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 8. Names and addresses of witnesses, doctors, and hospitals. 9. List the expenditures you made on account of this accident or injury. DATE. T AMS' Gov. Code Sec. 910.2 provides"The claim must be signed by the claimant or by some person on his behalf SEND NOJICES TO: orney Name and Address of Attorney (ClaimaiVs Signature) (Address) A 'y Telephone No. Telephone No. I/D N0110E Section 72 of the Penal Code pro-vides: 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*1 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. ClAIM x IA –NAMAO .JULY 18, 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 ttlis docurrent mailed to you is your California Government Codes. } notice of the action taken on your Bairn by the Board of Supervisors. (Paragraph IV below), liven pursuant to Goverment Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: $1,125.74 f CLAIMANT:3: a3i3t'"lE1J.N WORRALL+ ATTORNEY: DALE RECEIVED: JUNE 8, 2000 ADDRESS: 2872 LYON CIRCLE BY DELIVERY TO CLERK. ON: -UN 8, 2000 CONCORD CA 94528 BY MAIL POSTMARKED: , JUNE 7 002 QO L FROM Clerk of the Board of Supervisors TO. County Counsel Attached is a copy of the above-noted claim. PIIL B LOR, Clerk Bated: JUNE 9, 2000 By: Deputy -- IL ]SRC A- County Counsel TtY Clerk of the Board of Supervi rs (11.y-?tis 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 fled. The Clerk should return claim on ground that it was filed late and send earning of claimant's right to apply for leave to present a late claim (Section 911.3). ( } Other: r Dated: % '/ `"" %C,' By:..J2144 t ,�; n� .0eputy County Counsel IML DRUM Clerk of the Board 't'U: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). Na BOARD 0EFL- 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 ,,.a 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 deposite in the mail to file a court action on this claire. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so inunedistely. "For Additional Warning See Reverse Side of This Notice. AFFTBAVIT OF MAUJ N`G I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage full; prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Bated: y: PSL BATCHELOR By � Depury Clerk —()CC: County Counsel County Administrator } 555 I w tt .........._... __ _ .._._. ._ �'; _.... ---p-.... ffLg,..._.-....._ �.__ �..- �'c�. ,._ ��e'�,.. � �,,.� �;>.,,,✓�.� ,^,cwt, s *+..t..� . ...... r.:.. .�� ... _t'=k.��,:lK MAE- 3'k!t!.., �e l� a 5 tS. J J0 i ..._. ...._. ...... ,.' :.2$„ ` �'..... i y .; .: TYi,.. �X'wc.k .. ..-/'c. .. �%iC;° £ f<%•va'yad.a- -y.. a All .... ... .. ..-- ------------------ p' f f ss .......... . ........ ..... S i il.,.i.`s ._..."y~k':'b1'x'' rc?.i i,f ,_ .,�.._....itka ,._. .<.. K.�,?k. .�'...... ;t?. .%. m:.b•':.....,�.. ,. ............... Ai FWeAS S ,�`..c� ?"�:.:.. k i fir' ,'�a'' c�.•#...Y "'b-� 3 '?�a.sd.'e/y�...,.� ' ,/. �sx,�..<..�4..�4:.s �.Y�x�'"aJ.. ,-�.:,�i,��f.;.::f�t €:'�5.:�.,�,. � ��.�,l:C.?'&�i'fi�'r.�,t.�..,.. .... ... Ws '........ _ k'b,.°"�is§.. s}.;:•..yw 'r •`'''ct',a F ...:•c�,..tl...�...J, w..�', t_s 6M:� c,'s:._vi1`f31, . ,.:rk.ti_. .�._i/k ��'3...:..... ......... { € ..n 5 _--� 3rn;f...: ,{.A� # �, " '.� `,''- � c..� #,•..�3.,>,,.,.;. �''i t: {1 �{ f s t"° !� ,� 3t•-k n?irsr- - j:�•`..✓�''d-'�tta .�... �'.'t%i 3w�'a..;.,g a, '...-.... ":`��:... u�'��'3..�w fir:..3-...� S..C:'. ':k�'3�y � �,.�,� f. ..F:vs i` /'.5: � .................. t .. ,kS'- r:.f- >• gS.... 'c ..#.. ''..f_>.?i - ^t 'f.•.,i�p�" `NS. .¢':r 5. Sft .... y? ' _......... .. S. F" . • , vita=`,s .v.._.__.__ _.._........ ..........._ . _ _ __ _.-.._-. ....._.. _, ._....... ._..._. g i q s E P tl _"''_' t- Zd� •^� �I .;'e..,°� #.�r �,n -9F';..z.'l ''1'h �f✓'.._.. f'•��^�,1.'f'i 4.':'w..�- f...�s{sf ,...,� �.� .. ' 4 k l 1 ry ' ar.{ �„i.. �•...... ..f.. 4?"�,�.>.$`�. � ^?'. ..�kn4•°�.SSE &'$`�'�rf'.. t•, r �'� 1 .E r.:�.#,,�.� ;Xer�.G,lf�� .�y'_.. ..�e:5�:.£��.2", i�} .....`�` ,ir?:h„"s'Lr'�.."'•f��...t.��.�..... ;�.3.C'b.... s'4.."'�......�.}r:.�,i. .'�`,},...... feJ '#"t-Tw'RS-k"s �-��'4��i''".�,` ............. ... .... ........ .. :....... ............ �...��t�w`^^",....__.. i'...�.::�,�.;�i/s,...;.��.+t,.p'�;.....:�;ys:��.....�;:Yc..�. .r..-.,. �g�..yY1.i"��"+�-r`�f�'s �.•�.s;.� �'�...�...} Y'.�.. -'t€ ......,... Ilk., ,tt _ ,t,J �• r 1� 5 z�a zy APPLICATION TO FILE LATE CLAIM HOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA JULY 18II 2000 BOARD ACTION Application to File Late Claim ) NOTICE TO APPLICANT Against the County, Routing ) The copy of this documenE Filled to you is your Endorsements, and Hoard Action.) notice of the action taken on your application by (All Section References are to the Bard of Supervisors (Paragraph III, below), California Government Code.) ) given pursuant to Government Code Sections 911.8 and 918.4. Please note the "WAMMM" below. Claimant: TIARA BELL (A Minor) ° t Attorneys c/o Robert G. Schock Law Office of Robert G. Schock Address: 1970 Broadway Suite 1200 :> k Oakland CA 94612 Amount: $5,000,000.00 By delivery to Clerk on JUNE 20, 2000 Date Received: JUNE 20, 2000 By mail, postmarked on Unreadable I. FROM: Clerk of the Board of Supervisors TCIs Covmty Cousel Attached is a Copy of the above noted Application to File Late Claim. DATEDt_ JUNE 21, 2000 PHIL BATCHELOR, Clerk, By � �� » �Deputy I. FROM: County Counsel 10 Clerk of ttse' $Card of Supervisors The Board should grant this Application to File Late Claim (Section 911.6). { ) The Board should deny this Application to File Late Claim (Section 911.6). DATED: WESTMAN: County Counsel B3 `- � ' ty II. BO RUER By mous vo e of Supervisors present (Check one only) Q44 This Application is granted (Section 911.5). { } This Application to File Late Claim is denied (Section 911.6). I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. DATE: PRIL BATCfiELOR, Clerk, By • Deputy WAR= (Gov. Code 1911.$) If you wish to file a Court action on this matter, you must first petition the appropriate Court for an order relieving you from the provisions of Government Code Section 945.4 (Claims presentation requirement). :lee Govetrr Mt Code Section 946.6. Such Petition must be filed with the Court within six (6) months From the date your application for leave to present a late claim was denied. You may seek the advise of any attorney of yow Choice in connection with this matter. If you want to Consult an attorne should do so immediatel . V. : Ter o t : 1 County ouwie County Achini s rator 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 Boardts copy of this Claim in accordance with Section 29703. DATED: s— RM BATCHELOR, Clerk, By c"„� Defy V. FROM: T-5 County Counsel County Administrator 70: Clerk of the Hoar Received Copies of this Application and Hoard Order. of Supervisors DATED: County Counsel, By County Administrator, By APPLICATION TO FILE LATE CLAIM APPLICATION TO FILE LATE CLAIM BOARD OF SUP VISORS OF CONTRA COSTA OD NTY�___CALIFORNIA - BOARD ACTION Application to File Late Claim ) NOTICE TO APPLICANT JULY 18 2000 Against the County, Routing ) The copy of this-73-Sument mailed to you is your Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to the Burd of Supervisors (Paragraph 1119 below), California Government Code.) ) given pursuant to Govenvent Code Sections 911.8 and 915.34. Please note the: "WARNING" below. Claimants JEREMY MANSKER Attorneys c/o LAW OFFICES OF THOMAS STEVEN WROBEL Address: 1255 POST STREET, SUITE 850 Amounts SAN FRANCISCO CA 94109 By delivery to Clerk on JUNE 12, 2000 Date Received: JUNE 12, 2000 By mail, postmarked on JUNE 10, 2000 I. s fferk of the Boar o Supe :ors TOs County Counsel Attached is a copy of the above noted Application to File Late Claim. JUNE 15 2000 > �µ DATED: r PHIL BAZ'CHELAR, Clerk, BY � �`�-�..� � ',: Deputy t 1. FROM: County Counsel : Clerk of the d o Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911.6). ( '�,Y'The Beard should deny this Application to File sate Claim (Section 511.6). DATII7s VICTOR Ir S'I W, County Counsel, By`� y�� .- ��3 �_ Deputy ORDER EY mous vo e o Supervisors presen (Check one only) ( ) This Application is granted (Section 911.6). ( This Application to File Lute Claim is denied (Section 911.6). 1 certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. DATES t �PHIL BATCHELOR, Clark, ------,�- Deputy WARNM (Gov. Code 1911.8) If you wish to file a court action on this mutter, you must first petition the appropriate court for an order relieving you frim the provisions of Government Code Section 9345.34 (claims presentation requitramt). See Government Coda Section 9346.6. Such petition must be filed with the court within six (6) months from the date your application for leave to present a late claim was denied. You may seek the advise of any attorney of your choice in oorrneotion with this matter. if M want to consult an attorneyou should do so 1="&atel . FROM: , . , y County or, 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 accordance with Section '9703. DATED: 'AVOPHIL JkTCHELOR, Clerk, ByDeputy Y. PRE 1 ty el County Adminis actor !Us Clark Bf EFS Boar of Supervisors ReceiYed copies of this Application and Board Order. DATEDs County Counsel, By County Administrator, By APPLICATION M FILE LATE CLAIM CLkB1 BOARD DE SUPERNISORS OF Q0,N A COSTA C01, , !C [EYIRNTA �l AGT10 JULY 18, 2000 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsernents, .._. ` rte NOTICE TO CLAIMANT and Board Action. All Section references are to ) d C The copy of this document rnailed to you is your California Goverment Codes.'`, tai " notice of the action taken on your claim by the i Board of Supervisors. (Paragraph IV below), Oven 4 , r �' `i I pursuant to Government Code Section 813 and y 815.4. Please note all *Warnings". AMOUNT: SOWN � /�� le-l"- ' CLAIMANT: JEREMY MANSKER Sfir' ATTORNEY: c/o LAW OFFICES OF DA RECEIVED: June 12, 2000 STEVEN WROBEL `� ADDRESS: Cathedral Hill Office l� ilding$Y DELIVERY TO CLERK ON: ATINF 1-2-0-- 2000 1255 Post Street CA 94199 ,.TUNE 10, 2000 BY MAIL POSTMARKED. �x Y L FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted 'i \ PHIL BA OR, Clerk Dated: JUNE 12,r 000 By: putt' IL FROM County Counsel TO: Clerk of the Board hf Supervisors ( } This claim complies substantially with Sections 9IO�and 910.2. ( } This claim FAILS to comply substantially with Sectios 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 action 911.3). ( ) Cather: Dated: By: 14 Deputy County Counsel III. FROM Clerk of the Board TOi County Counsel (1) my Administrator (2) ( } Claim was returned as untimely with notice to claimant (Section 911. }. a 5 TV. BOARD ORDEEt By unanimous vote of the Supervisors present:\ ( ) This Claim is rejected in full. { } Other: I certify that this is a true and corrin copy of the .Board's Order +entere 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 not 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 a may, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF bL431I IG I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Carder and Notice to Claimant, addressed to the claimant as shown above. Dated: By: PHIL BATCHELOR By Deputy Clerk CC: County Counsel ty n's ar LA W OFFICES OF THOMAS STEVEN WROBEL. _ Cathedral Hill office Building 1255 Post Street, Suite 850 z�U a x ,: x`.0000 San Francisca, California 94119 (415)474-9700 Ext. 108 Fax(415) 923-1359 tswrobel�,7a aol.com Tune 7, 2000 CER'T'IFTET)MAIL ---RETURN RECEIPT RE( UESTF-D Clerk of the Board of Supervisors 651 fine Street, 1't Floor Martinez, CA 94553 Re: :sov �""^` t c`l ,rr► f teremv MWsker Dear Sir/Madam: Enclosed please find the governmental claim of Jeremy Mansker. once you have reviewed the claim, please contact me to discuss settlement. Very truly yours, 44r THOMAS S. WROBE,L TSW/mc enclosures cc: Jeremy Manske" i 1 THOMAS S. WROBEL(SB#189389) LAW OFFICE OF THOMAS S. WROBEL N 12 2 1255 Post Street, Suite 850 San Francisco, California 94109 3 Telephone: 415/474-9700 u 4 Facsimile: 415/923-1359 5 Attorney for Plaintiff, James Oakes 6 7 COUNTY OF CONTRA COSTA 8 CASE NO: 9 JEREMY MANSKER, WRITTEN APPLICATION/FOR LEAVE 10 Claimant, TO PRESENT GOVERNMENT CLAIM 11 FOR MEDICAL MALPRACTICE VS. 12 pursuant to Government Code Sec. 911.4 CONTRA COSTA REGIONAL MEDICAL 13 CENTER 14 Defendant. 15 16 1. JEREMY MANSKER (hereinafter referred to as the `Claimant") hereby makes 17 written application for leave to present claim pursuant to Government Cade Sections 911.4 and 18 910. 19 2. Said application and attached claim are presented within a reasonable time before 20 one year after the accrual of the cause of action. 3. Said cause of action is detailed within the attached claim accrued on or after June 21 29, 1999. 22 4. Presentation of the attached claim was delayed due to the inadvertence of the 23 claimant, 24 5. The inadvertence of the claimant is due to his lack of medical expertise and 25 understanding of the nature of a medical malpractice claim. 2 Written Application for Leave to Present Claim 1 6. The claimant's treating doctors also informed the claimant that his misaligned 2 right tibia would not pose a problem. Mr. Mansker delayed obtaining a second opinion about 3 his injury due to the assurances of his initial treating physicians. 4 7. When claimant discovered a loss of function in his right leg and ankle, claimant 5 sought out a second medical opinion. b 8. In January 2000, claimant was told he would need corrective surgery. 9, The Contra Costa Medical Center will not be prejudiced in its defense of the 7 claim by the failure to present the claim within the time specified in Section 911.2, since 8 claimant's damages are memorialized by written records. 9 to Dated: June 20 0 LAW OFFICES OF THOMAS S. WROBEL 11 12 By Thomas S. Wrobel 13 Attorney for Plaintiff' 14 15 16 17 18 19 20 21 22 23 24 25 3 Written Application for Leave to Present Claim 1 Proof of Service 2 1 am a citizen of the United States and employed in the County of San Francisco. I am over 3 the age of eighteen(18)years and not a party to the within action. 4 On June 066 I served the WRITTEN APPLICATION FOR LEAVE T4 5 PRESENT GOVERNMENT CLAIM FOR MEDICAL MALPRACTICE, on the Contra Costa Regional Medical Center by: s X (MAIL) by placing a true copy thereof enclosed in a sealed envelope(s) with postage thereon fully prepaid in the United States mail at San Francisco, California addressed pursuant to the attached Service List. 8 (PERSONAL SERVICE) by placing a true copy thereof enclosed in a sealed envelope(s), and caused such envelope(s) to be delivered by band addressed 10 pursuant to the Address Service List below or attached. 11 (FACSIMILE TRANSMITTAL)by faxing a true copy thereof as Follows: 12 NAME FAX NO. TIME 13 My business address is: 14 1255 Post Street, Suite 850, SF, CA 941.31 15 1, Thomas Wrobel, declare under penalty of perjury under the laws of the State of California 16 that the foregoing is true and correct. 17 r i r Signed -� , 18 1g ADDRESS SERVICE LIST: Centra Costa Regional Medical Center 20 2500 Alhambra Avenue Martinez, CA 94553 21 (925) 370-5000 22 23 24 25 4 Written Application for Leave to Present Claim I THOMAS S. WR.OBEL(SB4189389) LAW OFFICE OF THOMAS S.WROI3EL 2 1255 Post Street, Suite 850 San Francisco, California 94109 Telephone: 415/474-9700 4 Facsimile: 415/923-1359 5 Attorney for Plaintiff, James Oakes b 7 COUNTY OF CONTRA COSTA s CASE NO: 9 JEREMY MANSKER, GOVERNMENT CLAIM FOR 10 Claimant, MEDICAL MALPRACTICE 11 VS. 12 CONTRA COSTA REGIONAL MEDICAL 13 CENTER 14 Defendant. 15 16 GOVERNMENT CLAIM FOR MEDICAL MALPRACTICE 17 1. JEREMY MANSKER (hereinafter referred to as the "Claimant") hereby makes 14 claim against the Contra Costa Regional Medical Center, as more particularly set forth below. 19 2. Claimant's name and address are as follows: Jeremy Mansker, c/o Thomas S. 20 tiVrobel, 1255 post Street, Ste. 850, San Francisco, CA 94109. 3. All notices concerning this claim shall be sent to the Claimant at the above 21 address and any telephone contact directed to the Claimant shall be through the above telephone 22 number of the Law Offices of Thomas S. Wrobel. 23 4. The date of the incident was on or about June 29, 1999 through the present date. 24 S. The location of the incident was the Contra Costa Regional Medical Center, 25 2540 Alhambra Avenue, Martinez, California, in Contra.Costa County, 2 Govemment claim 1 6. On June 29, 1999, Claimant was in a motorcycle accident that resulted in a 2 broken right tibia. Due to his injuries, he was rushed to the Contra Costa Regional Medical 3 Center Emergency room for treatment. 4 T Upon completion of an examination and x-rays, he was placed in a splint and 5 was told to return in two days to put his leg into a cast. Claimant went through 7 or 8 casts 6 before he was finally taken out of his final cast on or about August 20, 1999. Claimant, over time, noticed a loss of function in his right leg and ankle. When the claimant consulted with his 7 treating physician, Dr. Jason Appel, the doctor told him not to worry about his leg — that it 8 would be fine. 9 8, On or about January 2000, Claimant presented to another orthopedic for a second 10 opinion. The second doctor told him his bone had not heated properly and that it would need 11 corrective surgery. As a result of this future surgery, Claimant will need to be off of work for 12 approximately 3 months and will again have to undergo physical therapy. 13 9. Although the Claimant is still investigating the nature and the extent of the 14 liability of the Contra Costa Regional Medical Center, at this time it appears that the doctor(s) at 15 Contra Costa Regional Medical Center knew or, in the exercise of reasonable diligence, should 16 have known, of the existence of the Claimant's condition, and were further negligent in the 17 manner in which they repaired Claimant's leg and then told him it had healed properly, 18 10. At this time, it is unclear whether there exist further legal and/or factual bases 19 establishing the hospital's liability and the Claimant does not waive the right to assert such contentions as and when he learns of them. 20 11. As a result of the negligence of the Contra Costa Regional Medical Center and 21 its agents and/or employees, Claimant suffered injuries and damages to his health, strength and 22 activity, nervous system, and income. 23 12. A general description of the injuries and damages incurred by the Claimant, so 24 far as they are now known, are as follows: 25 a) Misaligned and improperly heated right tibia; 3 Govemmcm,Claim I b) Pain and suffering; 2 c) Emotional distress, 3 d) Loss of function in his right leg and ankle; 4 e) Future lost wages; and 5 f) Future medical expenses. 6 14. The name or names of the public employees causing said injuries, damages and losses are presently unknown. s 15. The amount claimed as of the presentation of this claim is for a sum in excess of the minimum jurisdictional limits of the Superior Court of the State of California, Unlimited 9 Jurisdiction. 10 16. The basis of computation of the amount claimed as of the presentation of this 11 claim is the damage and losses suffered by the Claimant as a result of the acts and omissions of 12 the Contra Costa Regional Medical Center. 13 14 .7. Dated: Tune 000 LAW OFFICES OF THOMAS S. WItOBEL 15 16 By Thomas S. Wrobel 17 Attorney for Plaintiff 18 19 20 21 22 23 24 25 4 Goverment Claim 1 Proof of Service 2 1 am a citizen of the United Mates and employed in the County of San Francisco. I am over 3 the age of eighteen(18)years and not a party to the within action. 4 On June 7"',�000 I served the Governmental Claim for.Damages of Jeremy Mankser, on 5 the Contra.Costa Regional Medical Center by: 6 X_ (MAIL) by placing a true copy thereof enclosed in a sealed envelope(s) with postage thereon fully prepaid in the United States mail at San Francisco, California 7 addressed pursuant to the attached Service List. 8 (PERSONAL, SERVICE) by placing a true copy thereof enclosed in a sealed envelope(s), and caused such envelope(s) to be delivered by hand addressed pursuant to the Address Service List below or attached. 10 (FACSIMILE TRANSMITTAL)by faxing a true copy thereof as Follows: 11 NAME FAX NO. TIME 12 13 My business address is: 1255 Post Street, Suite 854, SF, CA 94131 14 1, Thomas Wrobel, declare under penalty of perjury under the laws of the'State of California 15 that the foregoing is true and correct. 16 17 Signe 18 ADDRESS SERVICE LIST: 19 Contra Costa Regional Medical Center 2500 Alhambra Avenue 20 Martinez, CA 94553 (925) 374-5000 21 22 23 24 25 5 Gove ment Claim JPI vtr, Y 4 t ` t1 �N Y rlV ri 4 t� tp 0 tai" s r i y