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HomeMy WebLinkAboutMINUTES - 06192001 - C.10 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY CAU ORNIA BOARD AnoN: June 19, 2001 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 [� ��91igII�' L9� Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and MAY 16 2001 915.4. Please note all "Warnings". AMOUNT: $6682.89 COUNTY COUNSEL MARTINEZ CALIF. CLAIMANT: State Farm Ins. ATTORNEY: None DATE RECEIVED: May 16, 2001 ADDRESS: P.O. Box 6403 BY DELIVERY TO CLERK ON: May 16, 2001 Ronert Park, CA 94927-6403 BY MAIL POSTMARKED: May 15, 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JO� WEETEN, Clerk Dated: May 16, 2001 By: Deputy `! - IL FROM: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: By: 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 certif that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated. JOHN SWEETEN 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. AFFIDAVIT OF MAIIdNG I declare under penalty of perjury that 1 am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaidcertified copy of this Board Order and Notice to Claimant, addressed t the claimant as shown above. Dated: d By: JOHN SWEE=, CLERK By /Deputy Clerk Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT C• A. Claims relating to causes of action for death or for injury to person or to personal property 4or 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 Pine Street,Martinez,CA 94553. C. U Claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D.• 1f the claim is against more than one public entity,separate claims must be riled against each public entity. G. Fraud. See penalty for fraudulent claims. Penal Code Sec.72 at the end of this form. w • a >< * w n * *'w * x * • ,r * . a n n * a �.• * a a >< �e s a w it a a n a arra * ■ a a # • a n w RE: Claim by ) Reserved for Clerk's Filing Stamp S � Q.4t �trm I;�I :tk b5 -44 (,p t a 31 RECEIV` Against the County of Contra Costa AY • or M r CLERK BOARD OF SUPERVISORS District) CONTRA COSTA 00. (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 660,$9 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact Date aad Hour) 3 - aL4 -9J 3 :. 15 Pm ---------•---------------------------------------------------------------------------- 2. Where did the damage or injury occur? (Inctude City and County)+ Z C�tr c&t� ��. O- r4v+,r" ------------------------------------------------------------------------------------- 3. How did the damage or injury occur? (Give full details;use extra paper if required) - Owr (A.YiVl,r ran rtd 2iGL t CI Y'if 0c.,r t✓1SK ►'gyp( J (.�. C �f • CCccc57rt (:!�L2it'�� �u-✓►�Gc� r�i,VI.Gl- 1 F'h,U..r:L S ...... ..... � -------------------------------------------------------------------- ---- -------- 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? V 1 ole fl un "0 a 1 (A) v L re-r o ,4 (Over) • ` 5. ,What are the names of county or district officers,servants,or employees causing the damage or injury? �'ct n3613 n ac, Q m ra- ------------------------------------------------------------------------------------- 6. What damages or injuries do you claim resulted? (Give PoIl extent of injuries or damages claimed. Attach two estimates for ado damage) r�n+-e. OL - .2 e a-i a c,t-,e d Q.S-f r Vn a_t-t ------------------------------------------------------------------------------------- 7. How was the above claimed amount computed? (Include the estimated amount of any prospective Injury or damage.) COIi;S[on t tow : 5 8 '5l- (a Dec1�c-frb(z (ux+'�ed) _ ( oo•oo --2-- �----------------------------------------- S. Names and addresses of witnesses;doctors,and hospitals. --------------------------------- 9. .List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT • * R R * * a R * * R R R * R R a a a a ai* * * * * * R * * * a k a R R * * a a R * * R R R * * * R R R * R R R 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 AftormT CIz4,i m; f-,,re Ag-+e r 4& ro? S�Sura n r� laimant's Signature..): . 4P (Address) c Y9�2 -7 yy 3 Telephone No. Telephone No. 80o y yO 7 7 * a * * * * * * * * a * R a * * * * * A a * * a * R * * * * * R * R ! * * * R a a R R R * * * * * a a * R a NOTICE Section 72 of the Penal Code provides: I "Every person who,with intent to defraud,presents for allowance or for payment to any state board or officer,or to any county,city or district board or officer,authorized to allow or pay the same if genuine,any false or fraudulent claim,bill,account,voucher,or writing,;is punishable either by imprisonment in the county jail for a period of not • more than one year, by a fine of not exceeding one thousand dollars ($1,000),or by both such imprisonment and fine,or by imprisonment in the state prison,by a fine of not exceeding ten thousand dollars(S10,000), or by both such imprisonment and fine. • Enterprise Rental Agreement 0692797 - 2322 rent-a-car � Aw; 12492 SAN PABLO AVE ascription Rate Amount aaaa� RICHMOND CA 94805-1914 12 DAYS @ 36.99 443.88 VLF 2.4 � SALES TAX% 8.00 35.51 Bin To: 5V emara.emeteeem.t.nartram �tC���t. i STATE FARM-RICHMOND (HILLTOP) ATTN: HARRIS-THOMAS 4965- 2920 9652920 HILLTOP MALL RD RICHMOND CA 94806 cc ..._ _. 1•11L►-TO?"I RENTAL SIC �J INFORMATION Date Out Date In N4 4/12/01 4/23!01 I I I�!IIl Renter Home Phone 1` H�IH�IIHIIIHII�I JUANI7A MORRIS 510-234-3361 HI11�11111 �IIryI„III►I�IIII111HIIII11111H1�� II Addressff' IIIlllllll O ice Phone 2121 VALE RD APT 304 415-436-8292 03-4613-231 RB City State Zip SAN PABLO CA 94806-3881 Driver License State Expires U0129375 CA 1/23/03 DOB 1/23/59 Additional Driver TOTAL CHARGES 481.79 Name ESS AMOUNT RECEIVED Qµ11 0� POCkLf 1411.79 NO OTHER DRIVER PERMITTED Age Driver License State Expires . 00- 340.C . AMOUNT DUE•• • •••• •• - -- • RENTAL VEHICLES CLAIM INFORMATION IMPORTANT INFORMATION Color License No. Claim #/Policy #/P.O. # WHITE 4JRL201 054613231 Billing Inquiries Call Fed Tax ID # Model Unit # Insured 510-234-6100 36-3041733 00 CAMR XW4231 MORRIS• JUANITA• Billing Information Date of Loss Type of Loss 3/24/01 INSURED Typo of Car Repair shop i F k You or Choosing Enterprise NI55300 ZX EASTERN AUTO Thg Etp •se VISIT US AT OUR WEB SITE WWW.ENTERPRISE-COM Please Return This Portion with Remittance AMOUNT DUE• • ••• ••• •--• •• , 340.00 Remit to: ' Paid by: ENTERPRISE RENT A CAR ATTN: ACCTS RECEIVABLE STATE FARM-RICHMOND (HILLTOP) P.O. BOX 1528 ATTN: HARRIS-THOMAS 4965• NOVATO CA 94948-3147 2920 HILLTOP MALL RD RICHMOND CA 94806 Customer# Rental Agreement Amount GPBR 04/27 STF2322 D692797 340.00 2322 i * STATE REQUIRED DAILY TAX EQUAL 1/365TH OF THE RENTED VEHICLE'S ANNUAL LICENSE FEE IN 05:34PM , 5/01/01 ENTERPRISE RENT-A-CAR COMPANY OF SAN FRANCISCO RENTAL AGREEMENT OUT 05,:06PM 4/27/01 12492 SAN PABLO AVE 510-234-6100 D693086 RICHMOND CA 94805-1914 2322 PAGE 1 OF 1 24-HOUR DAY RENTAL TYPE O SOURCE WEEKEND- 999 UNIT 1 RENTER SUMMARY OF CHARGES UNIT # XW5967 JUANITA MORRIS LIC# 4KGG767 2121 VALE RD APT 304 MILES MODEL CAMR SAN PABLO CA 94806-3881 NO CHARGE COLOR WHITE LOCAL: 1 150 MI FREE/DA IN 28681 (H) 510-234-3361 (W) 415-436-8292 OUT 28551 (0) 510-234-3361 4 DAYS Q 24.99 99.96 DR. LICENSE U0129375 STATE CA EXPIRE 1/23/03 * VLF 1.12 DOB 1/23/59 HT15 2 WT 120 EYES BRN HAIR BRN S.S.# EMPLOYER HUD OFFICE I I BILL TO N CUSTI # I I i I j SALES TAXA 8.00 8.00 ADDITIONAL DRIVER NO OTHER DRIVER- PERMITTED I I I CLAIM INFO PERMISSION TO LEAVE STATE POL/CLAIM/PO# YES NO X TOTAL CHARGES 109.08 INSURED CUSTOMER SIGNATURE ON FILE DEPOSITS 109.08 PAYMENT INFORMATION REFUND LOSS DATE AMOUNT PD.BYiTYPE DATE AUTH THEFT ACCIDENT 109.08 MC SALE 5/01/01 023060 TYPE CAR SHOP PHONE NAME OPENED BY #4608J MARCELL A LLOYD CLOSED TICKET PAYMENT INFO CLOSED BY #7945N MICHAEL JAMES I 0 . Pv �+ I ...•... _ RBZ0006Z date : 05-14-01 page: 1 ...... rete....i r�e '>'�u t e L�ata I STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY AUTO PAYMENTS BY COL clr3umt policy number 05 <' 4 .[Z3 .-2'31' DO07 -3 08 -05F named insured date of loss MORR= S , .TUAN=TA O 3 —2 4 —0 1 COL 4 O O C denotes consolidated payment P denotes previous data COL: 400 indemnity: 5, 931 . 12 dir rcov: 0 . 00 expense: 0 . 00 payment number payee I amount status COL pay code reporting party 102874015) EASTERN AUTO BODY 5, 831 . 12 OIS 400 1 Named Insu 102873590J JUANITA MORRIS 100 . 00 PAID 400 1 2 Named Insu C O L 5 0 1 C denotes consolidated payment P denotes previous data I COL: 501 indemnity: 500 . 00 dir rcov: 0 . 00 expense: 0 . 00 payment number payee amount status COL pay code reporting party 102212304) ENTERPRISE RENT-A- 340 . 00 O/S 501 1 Named Insu 02616827) JUANITA MORRIS 160 . 00 PAID 501 2 Named Insu t1 '7 Las s �� i i i I i I I I i 7.., l z N, State Farm Insurance ComIA pany ► . I1 CAR RENTAL AND TRAVEL EXPENSE-COVERAGE Rl- You have this coverage if"R1"appears in the"Coverage's" space on the declarations page I) 1 ► .j 1. Car Rental Expense We will: II A. repay you u to S16 perday when you rent a car from a car rental a enc or ara e:OR \ PYY P P Y Y g Y g g [ er''da5; if "oudo notrent`a car:wli'ile Due to a loss t your car which would be payable under coverage D,F or G. `I 1 This applies during alperiod starting: V I A. when your car cannot run due t the loss:or E B. if your car can run,when you leave it at the shop for agreed repairs: and ending: `►. A. when it has been repaired or replaced,or I I' B. (1)when we offer to pay for the loss,if your car is repairable,or `I I (2)five days after we offer to pay for the loss,if: nl r\' (a) your car was stolen and not recovered,or r (b) weldeclare it a total loss, nl. which comes first C I V lig Vi 0 P04041 F c c �c �c c �•- �c � c �� i Date: 04/30/01 09:14 A.M. Estimate ID: 05-4613-23101 Estimate Version: 1 Supplement: 1(P) 04/30/01 09:14: Profile ID: CUSTOMIZED i State Farm Insurance Damage Assessed By: Michael Greth Appraised For: CLAIM REP TEAM 4 (800) 440-6175 Supplemented By: Joe Lombardo Type of Loss: Collision Date of Loss: 03/24/01 Deductible: 250.00 Claim Number: 05-4613-23101 I Insured: JUANITA MORRIS Address: 2121 VALE RD APT 304 SAN PABLO, CA 94806-3881 Telephone: Work Phone: (415) 436-8292 Home Phone: (510) 234-3361 Mitchell Service: 912776 Description: 1990 Nissan 300ZX GS Vehicle Production Date: 12/89 Body Style: 2D Cpe Drive Train: 3.OL Inj 6 Cyt 4A VIN: JNlRZ26AXLX009540 License: 3GST241 CA Mileage: 127,503 OEM/ALT: A Search Code: B1MM Color: BLUE Options: Alloy Wheels, Air Conditioning! Power Steering, Power Brakes, Power Windows, Power Door Locks, Power Seats, Tilt Steering Wheel, Cruise Control, Electric Defogger, AM-FM Stereo, Compact Disc Player, Leather Seats, T-Top Roof, Automatic Overdrive, Center Console, Rear Gate Wiper, Trip Counter, Power Remote Mirror, i Disc Brakes, Power Antenna, 2-Door Hatchback, Fuel Injection. Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation Descriptions Part Number Amount Units 1 900500 FRM REPAIR FRAME/UNIBODY REPAIR AND SETUP Sublet 168.00 2 201070 REF REFINISH FRT BUMPER COVER C 3.0* 3 900500.BDY* ADD'L LABOR OP FLEX / ADHESION PROMOTER New 5.00* INC* 4 201090 BDY OVERHAUL FRT COVER ASSY 3.0 # 5 201180 BDY REMOVE/REPLACE FRT BUMPER COVER 62022-30P28 550.00* INCL # 6 BODY KIT, QUOTED BY CAR BOY 7 201470 BDY REMOVE/REPLACE FRT BUMPER SPACER 62090-30P00 56.75 INCL 8 201530 BDY REMOVE/REPLACE FRT BUMPER REINFORCEMENT 62030-45P00 299.58 INCL 9 201560 BDY REMOVE/REPLACE FRT OTR BUMPER RETAINER 62050-45POO 55.41 INCL 10 201600 BDY REMOVE/REPLACE R FRT BUMPER IMPACT ABSORBER 62210-30P00 108.44 0.2 # 11 201610 BDY REMOVE/REPLACE L FRT BUMPER IMPACT ABSORBER 62211-30P00 108.44 0.2 # 12 201840 BDY REMOVE/INSTALL R H/LAMP ASSEMBLY Existing 0.3*# 13 AUTO BDY CHECK/ADJUST HEADLAMPS 0.4 S1 14 201870 BDY REMOVE/REPLACE L H/LAMP ASSEMBLY B6060-30P00 313.30 0.4 # 15 202550 BDY REMOVE/REPLACE L FOG LAMP 'ASSEMBLY 86155-30P00 88.14 INCL # 16 202770 REF BLEND HOOD OUTSIDE C 1.1 17 202820 BDY ALIGN HOOD ASSY 1 0.2*# 18 202980 BDY REMOVE/REPLACE HOOD PRIMARY LATCH 65601-30P0l 48.26 0.4 ESTIMATE RECALL NUMBER: 04/18/01 12:54:16 :05-4613-23101 UltraMate is a Trademark of Mitchell International Mitchell Data Version: APR_01_A Copyright (C) 1994,1999 Mitchell International Page 1 of 5 Ultramate Version: 4.7.006 All Rights Reserved I i Date: 04/30/01 09:14 A.M. Estimate ID: 05-4613-23101 Estimate Version: 1 Supplement: 1(P) 04/30/01 09:14: Profile ID: CUSTOMIZED I I 19 203140 BOY REMOVE/REPLACE CTR HOOD FINISHER 62310-30P11 109.96 INCL # 20 AUTO REF REFINISH CTR FINISH PANEL C 1.9 21 203180 BDY REMOVE/REPLACE FRT HOOD SEAL 62370-30POO 9.29 INCL # 22 203210 BDY REMOVE/REPLACE HOOD FRONT MOULDING SUPPORT 62340-30POO 27.86 INCL # 23 203450 BDY REMOVE/INSTALL COOLING RADIIATOR Existing 1.8* 24 204480 MCH REMOVE/INSTALL AIR COND CONDENSER -M Existing 1.9*# 25 AUTO MCH REMOVE/REPLACE EVACUATE & RECHARGE A/C -M 1.4 26 936000 ADDIL COST FREON & OIL , 40.00* 27 936003 ADDIL COST COOLANT I 5.00* S1 28 205380 BDY REMOVE/INSTALL R FENDER ASSY 1.0 # S1 29 900500 BDY* REMOVE/REPLACE RESTORE CORROSION PROTECTION New 10.00* 0.5* S1 30 205390 BDY REMOVE/INSTALL L FENDER ASSY 1.0 # S1 31 205420 BDY REPAIR R FENDER PANEL Existing 2.5*# 32 AUTO REF REFINISH R FENDER OUTSIDE C 2.5 S1 33 205430 BDY REPAIR L FENDER PANEL Existing 2.5*# 34 AUTO REF REFINISH L FENDER OUTSIDE C 2.3 35 206210 REF REFINISH RADIATOR SUPPORT COMPLETE 1.0* 36 206350 BDY REMOVE/REPLACE UPR FRONT BODY TIE BAR -S 62510-3OP60 95.21 1.0 S1 37 206430 BDY REMOVE/REPLACE R FRONT BODY BAFFLE -S 62502-30P70 79.01 3.0 # S1 38 200142 BDY REMOVE/REPLACE L FRONT BODY BAFFLE -S 62503-3OP70 79.01 3.0 # 39 2D6510 BDY REMOVE/REPLACE FRONT BODY VERTICAL SUPPORT 62552-30POO 35.87 0.2 S1 40 213770 MCH REMOVE/REPLACE AIR CLEANER ASSEMBLY -M 16500-30POO 101.14 0.7 # 41 220300 REF BLEND R FRT DOOR OUTSIDE C 1.0 42 220310 REF BLEND L FRT DOOR OUTSIDE C 1.0 43 220732 BDY REMOVE/INSTALL R FRT REAR VIEW MIRROR 0.2 # 44 220740 BDY REMOVE/INSTALL L FRT REAR VIEW MIRROR 0.2 # 45 220748 BDY REMOVE/INSTALL R FRT BELT MLDG 0.3 46 220756 BDY REMOVE/INSTALL L FRT BELT MLDG 0.3 47 200033 BDY REMOVE/INSTALL R FRT DOOR TRIM PANEL INCL 48 200034 BDY REMOVE/INSTALL L FRT DOOR TRIM PANEL INCL 49 200039 BDY REMOVE/INSTALL R FRT DOOR HANDLE 1.7 # 50 900500 BDY* REMOVE/INSTALL LT ROCKER MLDG Existing 0.5* 51 REF REFINISH/REPAIR LT ROCKER MLDG 0.5* 52 900500 BDY* REMOVE/INSTALL RT ROCKER MLDG Existing 0.5* 53 REF REFINISH/REPAIR RT ROCKER MLDG 0.5* 54 200040 BDY REMOVE/INSTALL L FRT DOOR HANDLE 1.7 # 55 231460 MCH ALIGN FOUR WHEEL -M 1.4 56 900500 BDY* ADDIL LABOR OP PAINT OVERSPRAY COVER New 5.00* INC* 57 936001 ADDIL COST TOWING 85.00* 58 936008 ADDIL COST PAINT/MATERIALS 420.00* 59 936012 ADDIL COST HAZARDOUS WASTE DISPOSAL 3.00* 60 AUTO REF ADDIL OPR CLEAR COAT 1 3.2 61 933003 BDY* ADDIL OPR TINT COLOR 1` 0.5* 62 933017 BDY* ADDIL OPR COLOR SAND & BUFF 2.0* I * Judgement Item # Labor Note Applies C Included in Clear Coat Calc I ESTIMATE RECALL NUMBER: 04/18/01 12:54:16 105-4613-23101 UltraMate is a Trademark of Mitchell International Mitchell Data Version: APR_01_A Copyright (C) 1994,1999 Mitchell International Page 2 of 5 ULtramate Version: 4.7.006 All Rights Reserved i i Date: 04/30/01 09:14 A.M. ' Estimate ID: 05-4613-23101 Estimate Version: 1 Supplement: 1(P) 04/30/01 09:14: Profile ID: CUSTOMIZED I Remarks 4-18-01 M. GRETH - A TEAR DOWN IS RECOMMENDED. I I i I I I i i I I I I I i I i i I I I I i ESTIMATE RECALL NUMBER: 04/18/01 12:54:16 05-4613-23101 UltraMate is a Trademark of Mitchell International Mitchell Data Version: APR_01_A Copyright (C) 1994,1999 Mitchell International Page 3 of 5 Ultramate Version: 4.7.006 All Rights Reserved I I i II I • Date: 04/30/01 09:14 A.M. Estimate ID: 05-4613-23101 Estimate Version: 1 Supplement: 1(P) 04/30/01 09:14: Profile ID: CUSTOMIZED Add'l Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount Body 29.5 56.00 0.00 0.00 1,652.00 Taxable Parts 2,185.67 Refinish 18.0 56.00 0.00 0.00 1,008.00 Sales Tax a 8.000% 174.85 Frame 0.0 56.00 0.00 168.00 168.00 Mechanical 5.4 56.00 0.00 0.'00 302.40 Total Replacement Parts Amount 2,360.52 I Non-Taxable Labor 3,130.40 Labor Summary 52.9 3,130.40 III. Additional Costs Amount IV. Adjustments Amount Taxable Costs 465.00 Insurance Deductible 250.00- Sales Tax a 8.000% 37.20 Customer Responsibility 250.00- Non-Taxable Costs 88.00 I Total Additional Costs 590.20 I. Total Labor: 3,130.40 II. Total Replacement Parts: 2,360.52 III. Total Additional Costs: 590.20 Gross Total: 6,081.12 1 IV. Total Adjustments 250.00- Net Total: 5,831.12 Less Original Net Total: 5,221.58 Net Supplement Amount: 609.54 S1: Joe Lombardo 609.54 I Point(s) of Impact 12 FRONT CENTER (P) i Inspection Site: EASTERN A/B Inspection Date: 04/18/2001 I I Body Shop: EASTERN AUTO BODY Address: 1223 MILLER AVENUE OAKLAND, CA 94601 Telephone: (510) 532-0808 Fax phone: (510) 532-3314 ESTIMATE RECALL NUMBER: 04/18/01 12:54:16 OS-4613-23101 iULtraMate is a Trademark of Mitchell International Mitchell Data Version: APR_01_A 1 Copyright (C) 1994,1999 Mitchell International Page 4 of 5 ULtramate Version: 4.7.006 All Rights Reserved Date: 04/30/01 09:14 A.M. Estimate ID: 05-4613-23101 Estimate Version: 1 Supplement: 1(P) 04/30/01 09:14: Profile ID: CUSTOMIZED REPAIRS TO THIS VEHICLE MAY REQUIRE SPECIFIC WELDING EQUIPMENT AS RECOMMENDED BY THE MANUFACTURER REINSPECTION FAX HOTLINE FOR BODY SHOPS ONLY 925-680-4165 I I I i I I I i I I I I i i i i ESTIMATE RECALL NUMBER: 04/18/01 12:54:16 05-4613-23101 UltraMate is a Trademark of Mitchell International Mitchell Data Version: APR_01_A Copyright (C) 1994,1999 Mitchell International Page 5 of 5 ULtramate Version: 4.7.006 All Rights Reserved I t� '1 ����" ��"`r,r� �� � _ ii� �=ter-•=��"' rf _ +- c .,, wh �_a,J�• KMrk ;7I it . � -.5,��.y'+-'�� L. >Y r -, �'i, 1 ff i... r I t_ may) 7 .` 4#`�,. �{• � .,.'I: ^ ( ' i �i III '� ._;•` i rr.,�,_, :'� t;: ;;_. - - {- Rte: :�,• . ,' j ` _ r At, 4 �'4� ,v F�. ? �'���LFA � ` ``,�,�-"'` --_1 t \ � ` � �{v.�"/"-�•?1�si . F { '. 1, F 4 IF T�,, � Y�`-. •, .4 -.� , ; e 1F .s y�"",""".�'�.. { , 4 •••ilii•, } a Itk. a � •fir f `�.;�j�'' t.' -sem:,, - ) I�:: rw •sL��° I��`.. l 'P,rF, � .I, ,� '11111 f ;', r `x g.#s"?• Y r". b '{U .•: �.— ,�� :I f �``t� �� 'fel' ..�'� "tn a �n� � I' � �,I I �� 111• ,._:�`�:, i.. I 05/01/01 TUE 12:91 FAX + OIG Audit SF [A002 ® Emir 1151 EAST Hp1SDALE BLVD. FOSTER CRY,CA 94404 • ATTN:nDIIqRECT+OR,EIIR��S I t. coT rrxacr uI s - - an , ,{1eA r MEMVi WA• OUNTNAME I1DDP,ESS U t VA MEMBFRSHIPACEOUNTHUMHBL •� _��� DfPfFrA OV1TE - SIGNATURE ,Yi •. N� p{11 Club' rticwnrs.to Provide the hbgi� �^RT9c*•cI Qouil 4eriric'a Ywr.comrticnt; cod- '( AMOUNT COLLECTED FROM MEMBER 5199 rymWrdi9Nfha rim o o.hm rvWved would be l oppi c ltl '.• a[.t-900-NAC 4736 E.' YEAR MAKE •MOpEt i- ms's `1 esn' ` T` NEY11(a,F/$TOCK NUM86L j VINt" S_ SCRATCHIiD V DAWC-ED M•_�,MiMN!, B—BROKEN .. k INDICATE E7Q T 1 DAMAGE BY P A(3A10 IN THE APPROMUTE DESCRIPTION v ' �. .,....- IFR r `LOCAnO_I OF VEHICLE I r• 1GNATUflE f Tow DESTINATION YFI.111 RECEP/ED Br k- r-i Tgp4(TIF7n x r� rs a4 � bE - IOQfOUT T.r r.Forav E` o7 EXMA MAN END END COMPLETE07.' 1•' ✓ COMPLETED . START _ START ARRIVED TOTAL TOTAL TOTAL r TOTAL LES5ZONE _ (LESS) b (LESS( 30 _ . CHARGEABLE MILES CHARGEABLE MILES CHARGEABLETIME f CHARGEABLE TIME C N :1.; •:..r. {;; .FiFECW .st.. .IAL r FLAT/ZONE TOW MILES AFTER 5 FLAT �( (� •3 MILES TO - SPECIAL SERWCE NIGHT OTHER SERVICE(DESCRIBE) TOTAL r""011. (INDICATETTM-9 AM/PM _ "'aye;. rR7B Y•fr+ _.� ` DOLIJES DpVEUNE � '� ADMW FEF i:.. x TIME GRAND TOTAL .x MAN j .� MEMBEFFS CdPYI"s..: STATE OF CALIFORNIA ' r TRAFFIC COLLISION.'REPORT '�� vi CHP 555 CARS Page 1 (Rev 8198)OP1,042 P"o I or'liscI t IAL CONDRIONS CITY AIGICNL DISTRICT LOW REPORT NUMBER UN,DUTY EMERGENCY VEHICLE .AMD 'U— COURTESYREPORT I f PINOLE BAY SUPERIOR NA.A44A mm w&RW HOA COUNTY REPORTING DISTRICT BEAT 0 rll CONTRA COSTA 901 COLLISION OCCURRED Ok MO DAY 04" NGC R OFFICER I.O. Z FITZGERALD DRIVE(E(B) 03/24R001 1520 9320 15026 MILEPOST NFUPMATM DAY Of WEEK TOW AWAY PHOTOGRAPHS BY: rx f NOUS U SAT'URDAYF YEA NO i I O 7r IIRERSECTKNN WITH: STATE HWY REL DR: 1-80(EB)OFF RAMP TO FITZGERALD DRIVE -- `'E6 lxI- F'MTY GRIYER'a LtGENSE NUMBER STATE CIAsa SAFETY VEH.YEAR MAKE I MODEL I COLOR LICENSE NUMBER ISTAT9 EGUP FORD CRN VIC WHT I C6137355 CA C L 99 ------------------- 1021078 ---- CA DRIVER NAAEffIRST.MOM.E.LAST) ON G --- ------ XI SANJAY NAAN RAMRAKHA CWNEWS MAW r__.'SAME AS DRIVER TR�A1/} STREET ADORE&& _ CONTRA COSTA COUNTY R 555 GIANT HIGHWAY x SAME AS DRIVER now CITY I STATE/ZIP VEHICLE nRICHMOND CA 94806 Dmpmrr GN OF V9mms ON ORDERS OF: -- ❑wFICtR QDi+rveR =;LI'f/ER war— r� 'w" HFNGNT WCIIONT WMCC%TE PAM CCMTl7NE�TIAI TOWING-(925�80i726MR DrrM BLK IBE;: 5-07 170 01/30/1970 O PWOR MECK CEPECTs 7x ---- 71 REFER TO NARRATIVE OTHER HOMEPHONE BUSIESS PHONE IRHICtE IOOYrPICATIDM 11l1teF.R: (510)2624205 CHP US!OlayIO—lSCRISE VEHICLE DAMAGE SHADE N DAMAGED AREA NffiDIANCE CARRIER POLICY NIXON VEHICLE TYPE I t_JUNIC ED—OIE N 7MOR SELF-INSURED 48 _ iX iiAA�oR - aaLoVER CA DOT E FITZGERALD DRIVE 30 CAL.T TCPWW MCAD ZE Allw DRIVE"Uemu(AMBER STATE CLAss SAFETY VEIL YEAR MAKE/MODELICOLOR LICENSE STATE 2 U0129375 CA C G 90 ISS 300ZX BLU CA DRMER NAAEpTRBT,MIDDLE.Wn ---- ------------------- ---------- ----- XJUANITA T.MORRIS OVOOM MARIE Y BAMt AS DRIVER TRIC U n 2121 VALE RD. 11304 DRIERS ADDRESS n&AME AS DRIVER CITY STATE I EIP �= Fq SAN PABLO CA 94806 OISPOSRKIN OF vEMCLE ON ORDERS OF: uOFFICER ]DRIVER 10THER MCY- sex HAIR EYES tEIOHR "RmNT &&ATNDATE PACE CIVIC CENTER AUTO-(510)223-2273 GLIST W DST Yw PRIOR MECHANICAL DEFECTS �NO/E APP. F BRN BRN i-02 120 0123/1959 ix I "-�REFER roHAwuTrvE OTHER HOMPMONE ouswa&S PHONE VEHICLE IDENTIFICATION NUMOM n (510)234-3361 (415)136-8292 uv w!ONLY DESCRIBE VEHICLE DAMAGE GRAM N DAMAGED AREA INSURANCE CARRIER POLICY NUMBER VEHICLE TYPE — 'um -"am 1 7MrA m STATE FARM 7308 A23 05F 01 �X'jMoo MA" RG RM-OVER NR OF TRAVEL ON STREET OR W10111Y SPEED LIMIT CA DOT E 1-80 OFF RAMP 65 CAL•T TcP4-SC MfADI PARTY DRIVOM LICENSE NUMBER STATE CL11SS SNEw VEH.YEAR MAKE/MODEL/COLOR LICENSE NIARYR STATE 3 DRIVER NAMEpWaT,WOOLS LAST) ----- -- ------------------- ---------- -------- OVAIER•s NAME -:SAW As DRIVER TRW( STREEr AOOReSS _ �i ONNERS ADDRESS {SAME AS DRIVER PARKED CITYISTATE/71P 1 VEHICLE OISPOSRION OF VEMCLE CN ORDERS OF: I-_OFFICERIOIBVER i THER L� GIST ae11 HIAW EYES IElDlfr VCEIONT IAD BS 0"Te Ys RAGE . PNIOR MECHANICAL OEFEM I NONE APP. ,---PURR TO NARRATIVE ' I OTHER NOME PHONE BUaUESSPHOME VEHICLE IDEIRGTCATION NUMBER! CHP USE ONLYDESCRIBE VEHICLE DAMAGE SHAM N DAMAGED AREA NSURANC!CARRIER POLICY AA MBER VEHICLE TYPE HUMC ❑NONH ARMOR M00 MAJOR ROLL-OVER EI iDIR OF TRAVEL ON STREET OR WGHIRRY SPEED LIMIT CA DOT I W-T TCRPSC MCJWC PIWARIR'S NAME OWATCHNOTPIEO AME DATE RENEVAD S.BOUYEA 15029 IVES ND I x;wA S AL 8 STATE OF CALIFORNIA TRAFFJC COLLISION CODING . CHP 555 CARS Paget(8Pte /98)OPI 042 9 03!24/2001 1520 9320 15028 3 �j�0 PROPERTY 7AWRIE" 77 ES NO DAMAGEoBSu+n>TION or ou+Aae SEATING POSITION SAFETY EQUIPMENT EJ ICLE OCCUPANTS MIC BICYCLE-HELMET - l-AIR BAG DEPLOYED 0- NOT EJECTED A-NONE IN VEHICLE M-AIR BAG NOT DEPLOYED I•FULLY EJECTED B-UNKNOWN N-OTHER DRIVER 2-PARTIALLY EJECTED ] Z 3 I-DRIVER C:LAP BELT USED P-NOT REQUIRED V-NO 3.UNKNOWN 0-LAP BELT NOT USED W-YES 4 5 6 2 TO B-PASSENGERS E-SHOULDER HARNESS USED CHILD RESTRAINT 7-STA.WGN REAR F-SHOULDER HARNESS NOT USED 11--m VER CrElowo PASSENGER B-RR.OCC TRK OR VAN G-LAPISHOULDER HARNESS USED R-IN VEHICLE NOT USED X-ND 7 9-POSITION UNKNOWN H-LAP/SHOULDER HARNESS NOT USED S-W VEHICLE USE UNKNOWN Y-YES C-OTHER J-PASSIVE RESTRAINT USED T-IN VEHICLE IMPROPER USE K-PASSIVE RESTRAINT NOT USED U.NONE IN VEHICLE ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK 1')SHOULD BE EXPLAINED IN THE NARRATIVE. PRIMARY—LUMON FACTOR LIST NUMBER(9)OF PARTY AT FAULT TRAFFIC CONTROL DEVICES 1 2 3 TYPE OF VEHICLE ] 2 3 1 COLLISION 1 A YC ittll°tl Ymurm. "rg2 !-_�/ES X A CONTROLS FUNCTIONING A PASSENGER CAR I STATK)N IMAGO JA STOPPED 21453(A) ;pp CONTROLS NOT FUNCTIONING* PASSENGER CAR WI TRAILER X X lb PROCEEDING STRAIGHT B OTHER IMPROPER DRIVING. CONTROLS OBSCURED MOTORCYCLE I SCOOTER IC RAN OFF ROAD R• NO CONTROLS PRESENT FACTOPICKUP OR PANEL TRUCK D MAILING RIGHT TURN OTHER TWIN DRIVER' Type Of COLL151ION ft PICKUP/PANEL TRUCK W/TRA(LER Ir MAKING LEFT TURN UNKNOWN- JA MEAD.ON TRUCK OR TRUCK TRACTOR IF MAKING U TURN FELL ASLEEP' 113 SIDE SWIPE u TRUCK I TRUCK TRACTOR W/TRLR. JU BACKING REAR END I IN SCHOOL BUS SLOWING/STOPPING X U BROADSIDE OTHER BUS 11 PASSING OTHER VEHICLE CLEAR E HIT OBJECT EMERGENCY VEHICLE JJ CHANGING LANES X 0 CLOUDY F OVERTURNED K HIGHWAY CONST.EQUIPMENT PARICINO MANEUVER IN X RAING VEHICLE/PEDESTRIAN BICYCLE ENTERING TRAFFIC SNOWING OTHER` OTHER VEHICLE OTHER UNSAFE TURNING FOG I VIS180.TTY FT. N PEDESTRIAN IN XING INTO OPPOSING LANE OTHER" MOTOR VEIOCIE INVOLVED WITH MOPED 10 PARKED W MND NON-COLLISION IF MERGING PEDESTRIAN 0 TRAVELING WRONG WAY )( A DAYLIGHT M OTHER MOTOR VEHICLE OTHER ASSOCIATED FACTORS OTHER': DUSK-DAM MOTOR VEHICLE ON OTHER ROADWAY 1 2 3 (MARK I TO ITEMS) DARK-STREET LIGHTS E PARKED MOTOR VEHICLEX A W8=10—MAIM CUM DARK-NO STREET LIGHTS TRAIN 21807 ;No E DARK-STREET LIGHTS NOT 0 BICYCLE X IX B �e wwcrmM "g' YES IM FUNCTIONING* H ANAL: 22350 x ND SOBRIETY•DRUG C "CUCM1N"M a-- Yes 1 2 3 PHYSICAL DRY I FIXED OBJECT, !No (MARK I TO 2ITEMS) WET D X X1 I HAD NOT BEEN ORWKING SNOWY-ICY J OTHER OBJECT: VISION 08SCUREMENT: 1 113 HOD-UNDER INFLUENCE INATTENTION: MBD-NOT UNDER INFLUENCE' ROADWAY CONDITION(S) GSTOP a GO TRAFFIC D HOD-IMPAIRMENT UNKNOWN' (MARK I TO 2 ITEMS) Tr ENTERING I LEAVING RAMP UNDER DRUG INFLUENCE' HOLES,DEEP RUT' XIA NO PEDESTRIANS INVOLVED PREVIOUS COLLISION IMPAIRMENT-PHYSICAL' LOOSE MATERIAL ON ROADWAY' B CROSSING IN CROSSWALK J UNFAMILIAR WITH ROAD IMPAIRMENT NOT KNOWN OBSTRUCTION ON ROADWAY• AT INTERSECTION K DEFECTIVE VEH.EQUIP.: CRED NOT APPLICABLE CONSTRUCTION-REPAIR ZONE C CROSSING IN CROSSWALK-NOT I Its SLEEPY/FATIGUED REDUCED ROADWAY WIDTH AT INTERSECTION H wo FLOODED- CROSSING-NOT IN CROSSWALK L UNINVOLVED VEHICLE I I JA HAZARDOUS MATERIAL OTHER' r IN ROAD.INCLUDES SHOULDER V OTHER': X I PI NO UNUSUAL CONDITIONS IT NOT IN ROAD N NONE APPARENT APPROACHING/LEAVING SCHOOL BUS RUNAWAYVEHICLE SKETCH MISCELLANEOUS _-1�r/-.+TW DOT- . MOICATE NORTH 1 �CR CRNR 19C 'CNP _DA PD/SO CT OTHER STATE Of C��ALIFORNIA WJURSD I WITNESSES?PASSENGERS pop 3« CHP 555 CARS Page 3 Rev 8J98 OPI 042 Ml k:M COLL1510M(Mo. DAY NLN 1 03/24/2001 1520 9320 15028 3-30 0 WITEsa PA2891412 R arm e!x EXTENT OF INJURY('X'ONE) INJURED WAS('X'ONE) PARTY SAT �� � *MYONLr FATAL SEVERE OTIER VMftg COMPLAINT mAmm POS. EOWP. INRIRY "Illy SLAIRY OF PAW DNIVEA PASS. Pm, BICLYCLIST OT¢R ❑ ❑ 31 M ❑ ❑ 0 ❑ ❑ ❑ ❑ I 1 L 0 NAME/O.O.B.I ADDRESS TELEPHONE SANJAY NAAN RANRAKHA (01/30/1970) 555 GIANT HIGHWAY,RICHMOND,CA 94806 (510)2624205 (INJURED ONLY)TRANSPORTED BY: TAKEN TO: AMR AMBULANCE BROOKSIDE SAN PABLO DESCRIBE INJURIES: COMPLAINT OF PAIN TO NECK AND BACK VICTMI OF VIOLENT CRIME NOTIFIEO D 17 M ❑ ❑ ❑ ❑ _; ;_ I ,i 2 1 3 1 G 1 0 1WRM.O.B.I ADDRF53 TELEPHONE GEORGE MORRIS 02/15/1984 2121 VALE RD. #304,SAN PABLO,CA 94806 (510)234-3361 (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES: ❑ VICTIM OF VIOLENT CRIME NOTIFIED x❑le 1 ❑ 34 1 MI 1L� LJ U ❑ ❑ ❑ ❑ ❑ NAME I D.O.B./ADDRESS TELEPHONE MERLE HAGMAN 03/13/1967) 12 BAY HARBOR COURT,RICHMOND,CA 94804 510)558-2283 (INJURED ONLY)TRANSPORTED BY: TAKEN TO DESCRIBE INJURIES: VICTIM OF VIOLENTCRIMME NOT6¢D ❑� ❑ ❑ ❑ ❑ ❑ L� ❑ !J iJF7 I NAME I D.O.S.I ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO DESCRIBE INJURIES: (� VICTRA OF VIOLENT CRIME NOTIFIED ❑ El ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ NAME/O.O.B./ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: TARN TO: DESCRIBE INJURIES: =m OF VIOLENT CRLNE NOTIFIED El El ED D NAME 10.0.8.I ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES: VICTIM OF VIOLENT CRIME NOTIFIED PREPARER'S NAME I.D.NUMBERM0. DAY YEAR REVIEVVER'S NAME MO. DAr YEAR S.BOUYEA 15028 03,242001 MIX OF rALPFrM IA ' FACTLIAL•DIAGRAM CNP W Page 4(Rer 8-97) OPI 042 N d •rMT.v cLlu"IOD cmr re* 'ro*12•001 •rrxe 'vnd��a !race• - p LH 0 /3 o 9 3 i o ��a Z 3-3�a ALL MUSURtIA MM All!A/MOJtMM AMD MDT TO WMA MA"STAMD leCMA• rc. ! Nam r Poi � 1>. �� 2 3' � I • cE��� CCF a � I LE G�� V P t. &2-tCJ 61 Z1V L;,-I FN D C,vAR o (?A=L. I E• �4AC'�rL L:CsN� ;� ti. Yc��a.r LAOSS rrgR+ca,`S. rluPI K1 o M/r[R MO Mr rwe P"PAW IUD DAV vw ----------------� .__._—...._— --- OSa oY lean STArl Of CAUfCM1NM FACTUAL DIAGRAM GHP%&!' =4(Rev 0-97) OR 042 lrMIn CVccLLaKMiNo yH rt") row'i2aa01 MC+t� .OfI�fJR�O soomI 03 Ill Ol 1,�Za �J3La SoZg 3-�pa ALL MMASYII WWM AMR Aftl*W TV AMO MOT TO*CAL[VUEU STATSO(SCAN. n I MrMR11 Fu MG r I I� I • v••pw�l LMFi+T I P (L 2t 2 3, SAD (,El s) Ll a LEcx tz I = V A- SoLs D •.,a z�r L rw E Fs.��6 G/�a�-L) � ' W 8 90L=O YC4--j LZ je r--- Z40ttzj wu=—%r 4-:..+E _ D GvAaO RA-rL E, TQAC'C'TC �C:s1; �• C��.3 r � W-� w t Est '�- r' G,-jAaO (?4sc_ 5 5 yi �PWPAM er 10 mans W plr 17AA perAmn MAW CLQ OAT YGA _._ p4a 19 7l9n STATE OF CALIFORNIA &RRATIVEI3UPPLEMENTAI __ oaaE L ,DATE OF INCIDENT TIME NCIC NUMBER OFFICER F.D. NUMBER 03-24-01 1520 9320 15028 3-300 Physical Evidence Legend: Points Of Rest: Vehicle#1 (L/F tire)was located at the east edge of Fitzgerald Drive(w/b)and approximately 12 feet south of the south edge of Fitzgerald Drive(e/b). Vehicle#1 (L/R tire)was located at the east edge of Fitzgerald Drive(w/b)and approximately 3 feet south of the south edge of Fitzgerald Drive(e/b). Vehicle#2 (L/R tire)was located approximately 25 feet south of the.south roadway edge of Fitzgerald Drive(w/b)and approximately 21 feet west of the east edge of Fitzgerald Drive(w/b) . Vehicle#2 (L/F tire)was located approximately 14 feet south of the south roadway edge of Fitzgerald_ Drive(wfb)and approximately 20 feet west of the east edge of Fitzgerald Drive(w/b). PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE S BOUYEA 15028 03-24-01 STATE OF CALIFORNIA NAIFtRATIVE/SUPPLEMENTAL Page 7 .DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 03-24-01 1520 9320 15028 3-300 Facts: Notification: While on routine patrol in the unincorporated Town of EI Sobrante, l copied via scanner of a collision involving a Contra Costa County Sheriff Department patrol vehicle, EB I-80 on the Richmond Parkway off ramp at approximately 1520 hrs. 1 advised CHP dispatch that I was enroute to assist the Oakland Highway Patrol Office with this investigation and I arrived at the scene at approximately 1533 hrs. CHP was requested to investigate this collision at the request of the Contra Costa Sheriff.Department and the Pinole Police Department. Oakland CHP was unavailable to respond so I handled the investigation to the conclusion. All-times speeds and measurements are approximations. All measurements were taken by visual estimation,roll meter,and pacing. There were no injuries observed or claimed at the scene by party 42.Party#1 was transported to the hospital by American Medical Response Paramedics.All parties were located seated in their vehicles upon my arrival to the scene. All vehicles were located at their final points of rest. Scene: Roadway Description: Fitzgerald Drive at the scene of this collision intersects the I-80(e/b)off ramp.:J11e intersection is level and is constructed primarily of asphalt. The intersection is a City of Pinole maintained roadway. The intersection is controlled by overhanging signal lights. Richmond Parkway(e/b);tums into Fitzgerald Drive at the west roadway edge of this intersection. When traveling east on Richmond Parkway approaching this intersection,a driver has a clear and unobstructed view of the I-80(e/b)off ramp to his/her right. When traveling on the I-80(e/b) off ramp a driver has a clear and unobstructed view of Fitzgerald Drive to the his/her-left. See factual diagram for further details. Whether: At the time of this collision the weather conditions were cloudy with light rain. Parties:- Party#1 (P-1) (Ranu-akha) was located at the seated in V-1's driver's seat. P-1 was identified by California drivers license. P-1 was determined to be the driver of V-1 based upon his location,and his statements. Vehicle#1 (V-1)(Ford) was located at its point of rest upon CHP arrival. V-1 had no prior mechanical defects or damage. V-1 sustained minor left tire/rim damage and moderate right rear collision damage as a result of this collision. Party 42(P-2)(Morris) was located at the scene seated in V-2's driver's seat. P-2 was identified by a California drivers license. P-2 was determined to be the driver of V-2 based on location,and her statements. PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE S BOUYEA 15028 03-24-01 STATE OF CALIFORNIA ' NARRATIVEISUPPLEI)AENTAL ,DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 03-24-01 1520 9320 15028 3-300 Vehicle#2 (V-2)(Hiss)was at its point of rest upon CHP arrival. V-2 had no prior mechanical defects or damage. V-2 front end damage as a result of this collision. Physical evidence: Relative damage to V-1 and V-2. Statements: Party#1 (P-1)(Ramrakha) related in essence that he traveling Code 3 (lights and siren)(e/b)on Richmond Parkway in the E-1 lane at a speed of approximately 25-30 mph. P-I said he was slowing for the intersection. P-1 stated that he didn't know what color the light was but assumed that it was red since P-2 did not stop. P-1 related that he slowed to approximately 15-20 mph,and then proceeded through the intersection at approximately 30 mph. P-1 said he did not stop prior to proceeding through the intersection. P-I said after the collision he exited V-1 and asked P-2 if she was OK,P-2 replied that she was"shaken". Party#2(P-2)(Morris)related in essence that she.was traveling on the I-80 off ramp approaching the intersection of Richmond Parkway in the E-1 lane at a speed of approximately.15-20 mph. P-2 said the light was green and that it had been green since it came into view. P-2 said she could hear a siren but did not see the lights until it was too late. P-2 related P-1 proceeded through.the his red light and when she saw him do this she applied V-2's brakes. P-2 said V-2 slid into V-1 prior:to her even turning V-i to the left.. Witness#1 (Hagmann)related in essence that he was driving w/b on Fitzgerald Drive stopped for the red light at the intersection of I-80. Wit-I said he could hear V-1's siren and then saw V-I's lights. Wit-1 said V-1 was traveling at approximately 30 mph when it approached the intersection. Wit-I related that when V-1 proceeded through the red light,P-2 did not stop, V-2 and broadside the Sheriff vehicle. Wit- I said V-2 was traveling at approximately 20 mph when she approached the intersection and it looked like she was going slow enough to have.been able to stop in time. Opinions and Conclusions: Summary: V-1 was driving code 3 (red lights and siren)on Richmond Parkway approaching the I-80(e/b)off ramp at a stated speed of approximately 30 mph. (E/13)Richmond Parkway traffic had a red light at the I-80 off ramp. V-2 was I-80(e/b)on the Richmond Parkway off ramp in the E-1 (left turn lane)approaching the intersection of Fitzgerald Drive at a stated speed of 15 mph. The 1-80(e/b)traffic light was green. P-I failed to clear the intersection prior to proceeding through the red light and continued into the intersection at a stated speed of 15-20 mph.. P-2 failed to slow when she first heard V-1`s siren. When P-2 saw V-I's over head lights she applied V-2's brakes but due to the wet roadway and her speed, V-2 failed to stop prior to colliding with V-1. The front end of V-2 collided with the right rear quarter panel of V-1. All vehicles were at their points of rest upon my arrival to the scene. PREPAREWS NAME I.D.NUMBER DATE REVIEWER'S NAME DATE S BOUYEA 15028 03-24-01 STAVE OF CALIFORNIA • N�►RRATIVE/SUPPLEMENTAL Mae �r JDATE OF INCIDENT TIME NCICNUMBER OFFICER I.D. NUMBER 03-24-01 1520 9320 15028 3-300 Point of Impact(POI): POI#1 (V-2 vs V-1 )was located approximately 10 feet north of the north roadway edge of I-80(e/b) off ramp and approximately 48 feet east of the west roadway edge of Fitzgerald Drive. POI#2(V-1 vs concrete curb) was located at the east edge of Fitzgerald Drive (w/b)and approximately 32 feet south of the south edge of Fitzgerald Drive(w/b). Cause: P-1 (Ramrakha)is at fault in this collision and in violation of 21453 (a)vc(failure to stop for a red light). 21453 (a)vc requires the driver of a motor vehicle to stop for a red light at the limit line.A driver of an emergency vehicle may proceed through the red Iight after having first"cleared"the intersection prior to proceeding and after ensuring that all other motor vehicles have yield to the emergency vehicles red light and siren. An associated factor for P-I in this collision is 21807 vc(failure to clear an intersection) states in part that section 21806 vc shall not operate to relieve the driver of an authorized emergency vehicle from the duty•to drive with due regard for the safety of all persons and property. An associated factor in this collision for P-2 is being in violation of 22350 vc(unsafe speed) 22350 vc states in part that the driver of a motor vehicle shall not drive that vehicle without due regard.for weather,traffic,and roadway conditions. Both of the involved parties had a clear and unobstructed.view of each opposing . direction of travel and should have been able to take notice of each other,thus.avoiding a collision. The POI and cause was determined by statements of the involved parties,my observations,witness statements and physical evidence. Recommendations: None. PREPAREWS NAME I.D.NUMBER DATE REVIEWER'S NAME DATE S BOUYEA 15028 03-24-01 I •' STATE FARM ..., State Farm Insurance Companies INSURANCES May 14, 2001 North Coast/6400 State Farm Dr. P.O.Box 6403 Rohnert Park,CA 94927-6403 Clerk of the Board of Supervisors Room 106, County Administration Building 651 Pine Street FAY Martinez, CA 94553 01 CERTIFIED MAIL Re: Claim Number: 05-4613-231 Date of Loss: March 24, 2001 Dear Board of Supervisors: State Farm Mutual Automobile Insurance Company, on behalf of Subrogee, Juanita Morris hereby makes a claim for$6682.89 and makes the following statements in support of claims: 1. Notice concerning this claim should be sent to: State Farm Insurance Companies PO Box 6403 Rohnert Park, CA 94927-6403 The date of the accident occurred on March 24, 2001 at 3:15 PM, Fitzgerald Drive off ramp in Pinole, Contra Costa Co, CA. The circumstances giving rise to this claim are as follows: Your Driver, Sanjay Naan Ralnrakha, driving a 1999 Ford, Crown Victoria, license number#1021078, ran a red light and collided into our insured's vehicle, causing property damage. 2. The injuries reported consisted of neck and back pain with Juanita Morris. 3. Our total claim is as follows: Company's Net Payment $6431.12 Insured Deductible/interest $251.77 Total Property Damage $6682.89 HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001 STATE FARM _ . State Farm Insurance Companies &401401 INSUQANCEL North Coast/6400 State Farm Dr. P.O.Box 6403 Page 2, 05-4613-231 Rohnert Park,CA 94927-6403 NOTICE: This form is provided notice of our claim for damages in accordance with the 120-day statute. If this form is not acceptable for compliance with the statute, please rush the necessary form to my attention for proper filing. State Farm Mutual Automobile Insurance Company Dated: May 14, 2001 Employee Name Suzanne Little Employee Title Claim Expediter Employee Phone Number 800-440-6177,Ext. 7 Sincerely, Suzan e Little Claim Expediter 800 440 6177 Ext. 7 State Farm Mutual Automobile Insurance Company SL Enclosure: Supporting document Claim form �(A-Ppl + HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001 7000 1670 0005 9840 3749gpy ggOG._ 4J PBP EYEA roaaoga U.S.POSYAGIE o JJC70 1. r ,I f , f I I I i I i ' I i 1 • may',%�7 a�i e !r a .. "77 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY CALIFORNIA BOARD ACT1011 .lune 19, 2001 Claim Against the County, or District Governed by 1 ) the Board of Supervisors, Routing Endorsements, I ) 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 651AUWpursuant to Government Code Section 913 and � M 915.4. Please note all "Warnings". AMOUNT: In Excess of $500,000 NAY 14 2001 COUNTY COUNSEL CLAIMANT: Sophie Chao MARTINEZCALIF. I ATTORNEY: Marlene P. Getchell I DATE RECEIVED: May 11, 2002 ADDRESS: 790 Mission Ave i BY DELIVERY TO CLERK ON: May 11, 2001 San Rafael, CA 94901 1 BY MAIL POSTMARKED: May 10, 2001 I I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. i J0 EN k Dated: May 11, 2001By: Deputy, i II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( his claim complies substantially with Sections 910 and 910.2. I ( ) 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: I i Dated: 0/ 0 I By: Deputy County Counsel I 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). i IV. BOARD ORDER: By unanimous vote of the Supervisors present: (L� This Claim is rejected in full. j (\) Other: i I certi that this is a true and correct copy of the Board's Order entered in its minut s for this date. Date JOHN SWEETELq 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 MAIIdNG 1 declare under penalty of perjury that 1 am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claiman addressed to the claunant as shown above. Dated.11 A AQ 06 1 By: JOHN SW=.LrN, CLERK By eputy Clerk This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. i I . I Marlene P. Getchell Attorney at Law i RECEIVE 790 Mission Avenue San Rafael, CA 94901 (SBN 72187) MAY 1 1 2001 Telephone Number: (415)457-8830 Facsimile Number: (415) 459-1384 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. Attorney for Claimants i Clayton John Bartholomew and Sophie Chao I i i i CLAIM AGAINST A MUNICIPAL ENTITY CONTRA COSTA REGIONAL MEDICAL CENTER GOVERNMENT CODE SECTION 9.11.2 i 1. Name/Address of Claimant:I Sophie Chao 281 Fernwood Drive Moraga, CA 94556 i 2. Name/Address for Service of Notice, etc.: Marlene P. Getchell Law Offices of Marlene P. Getchell 790 Mission Avenue San Rafael, CA 94901 3. Date, Location and Description of Incident: i On December 14, 2000 at Contra Costa Regional Medical Center, Contra Costa County, Martinez, California, Claimant Sophie Chao suffered emotional distress when her son, Cash William Bartholomew, received personal injuries and then died as a result of the intentional acts and/or negligence of Contra Costa Regional Medical Center, its employees, staff and agents, all of who are directly responsible for the personal injuries and death of Cash William Bartholomew and causing emotional distress to Claimant Sophie Chao. Contra Costa Regional Medical Center, its employees and agents intentionally or negligently failed to exercise the proper degree of knowledge and skill in caring for Sophie Chao and Cash William Bartholomew, and failed to provide adequate care, supervision and protection for Sophie Chao and Cash William Bartholomew, thereby causing the death of their son Cash William Bartholomew and the emotional trauma to Claimant Sophie Chao at the time of the injury to Cash William Bartholomew. i 4. General Description of the Indebtedness,Obligation,Injury,Damage orLoss Incurred Medical expenses of Sophie Chao, unknown at this time. Punitive damages according to proof. Loss of earnings of Sophie Chao, unknown at this time. The Claimant continues to suffer emotional distress as a result of the above described incident. I 1 ' PROOF OF SERVICE 2 i 3 I am a citizen of !the United States and employed in the County of Marin; I am over the age. of eighteen years and not a party to 4 the within action; mybusiness address is 790 Mission Avenue, San Rafael, California 94901. 5 I On May 10, 2001, jI served the following document(s) : 6 i Claim Against A Municipal Entity by Claimant Sophie Chao 7 Claim Against A Municipal Entity by Claimants Clayton John Bartholomew and Sophie Chao 8 i Addressed as follows: 9 1 Certified Mail/Return Receipt Requested 10 Clerk of the Board of Supervisors 651 Pine Street, First Floor 11 Martinez , California) 94553 12 Certified Mail/Return Receipt Requested Frank Puglisi, Jr. 13 Executive Direcotr Hospital and HealthlCenters Division 14 2500 Alhambra Avenue Martinez, California 94553 15 XX By depositing a true copy thereof in the United States 16 mail at San Rafael, California, in a sealed envelope, with first-class postage thereon fully prepaid. 17 By depositing a true copy thereof in the United States 18 mail at 'San Rafael, California, in a sealed envelope, with Express Mail postage thereon fully prepaid. 19 I By delivering true copy thereof , at San Rafael , 20 Californlia, to a driver authorized by Federal Express to receive ldocuments in an envelope designated by the 21 express service carrier, with delivery fees provided for. i 22 By facsimile transmission to 23 By personally delivering a true copy thereof at the addresslset forth above. 24 i I declare under penalty of perjury under the laws of the State 25 of California that the foregoing is true and correct. I 26 1 Dated: May 10, 2001 27 MARLENE P. GETCHELL 28 I I i 5. Names of Public Employees or Employees Causing the Injury, Damage or Loss, If Known. At the time of the incident, Sophie Chao was a patient at Contra Costa Regional Medical Center. The names of public employees or employees causing the injury, damage or loss, are unknown at this time and have yet to be identified. 6. Extent of Claim: Claimant's is within the jurisdictional limits of the Superior Court and is in excess of $500,000. Claimant's claim is not a limitei civil case. DATED: A �P,, ETC&� M Attorney for Claimant Sophie Chao I I I f y I ` f I, Y. L �r. � 1 f� n �f. sy �' 7 ti r-1 O Ein c O co .� CD S c7 0 w f *`�7f1fla.t!g 9 1 ►y c ! r . 0 AMENDED CLAIM BOARD OF SUPERVISORSI OF CONTRA COSTA COUNTY CALUORNIA BOARD ACTION: June 19, 2001 I Claim Against the County, or District Governed by 1 the Board of Supervisors, Routing Endorsements, 1 NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. I notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given (9311V pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". MAY 10 2001 AMOUNT: Unknown COUNTY CLAIMANT: Cipriano Diaz—Renteria MART NEZ CALIF• I ATTORNEY: Frank J. Christy DATE RECEIVED: May 8, 2001 ADDRESS: P.O. Box 4899 BY DELIVERY TO CLERK ON: May 8, 2001 Petaluma, CA 94955 BY MAIL POSTMARKED: 1. FROM: Clerk of the Board of Supervisors ; TO: County Counsel Attached is a copy of the above-noted claim. S ETE rk 2001 Dated: May 16, By: Deputy I 11. FROM: County Counsel TO: Clerk of the Board of Supervisors par ct � ' ( plies sullf�stantially with Sections 910 and 910.2. vKThis claim com I ( ) 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 91 i 0.8). ( ) 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: TI�Z_p0i-IL7oi75 01 U/ e%irn �Lr1o,--7"D 41eUe/qjbe,� e,__�-000_ ,�ot ca-7�i�, � �% LG�c C%i� �G�d• Coote.�,� 9/1.4/�9�2.Z) Dated: Jr—-' 7 Qr By: Deputy County Counsel I T— I 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). i IV. BOARD ORDER: By unanimous vote of the Supervisors present: (A,) This Claim is rejected in full. ( ) Other: i I certifthat this is a true and correct)copy of the Board's Order entered 'n its minutes for this date. Dated: , JOHN SWEETEN . Clerk, B eA2��Be yputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. `For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am tiow, and at all times herein mentioned, have been a citizen of the United hates, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid certified copy of this Board Order and Notice to Claima , addressed to the c imant as shown above. Dated: WVUL �0 6DI By: JOHN SWEiTEN, CLERK By eputy Clerk i i, I I! This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. i The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. i �I j i i i I I I I i i i i �I I i i AMENDED CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY CA ORIVLA I BOARD ACTION: June 19, 2001 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. j ) 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: Unknown CLAIMANT: Cipriano Diaz—Renteria i ATTORNEY: Frank J. Christy DATE RECEIVED: May 8, 2001 ADDRESS; P.O. Box 4899 i BY DELIVERY TO CLERK ON: May 8, 2001 Petaluma, CA 94955 BY MAIL POSTMARKED: i i I. FRONL- Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. �JoRl St} ETE rk %3,, Dated: May 16, 2001 By: Deput i 11. FRONL County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. { ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk sholuld 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: I I Dated: ByJ Deputy County Counsel i 11. FROM Clerk of the Board TO: County Counsel (1) County Administrator (2) Claim was returned as untimely with notice to claimant (Section 911.3). i V. BOARD ORDER: By unanimous vlote of the Supervisors present: This Claim is rejected in full. Other: I I certify that this is a true and correct icopy of the Board's Order entered in its minutes for this date. Dated: JOHN SWEETEN Clerk, By Deputy Clerk i WARNING (Gov. code section 913) ubject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited t the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an :torney of your choice in connection with this matter. If you want to consult an attorney, you should do so nmediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United sates, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully •epaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. ated: By: JOHN SWEETEN, CLERK By Deputy Clerk I I, I I I I� This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to uriderstand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. i I i I I ii I i i I II i I I I I I� it I I I II . I I i CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY CALIFORNIA BOARD ACTIO At June 19, 2001 i Claim Against the County, or District Governed�by I the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are;to ) The copy of this document mailed to you is your California Government Codes. I notice of the action taken on your claim by the 61 II� Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". MAY 10 2001 AMOUNT: Unknown COUNTY COUNSEL MARTINEZ CALIF. CLAIMANT: Cipriano Diaz—Renteria ATTORNEY: Frank J. Christy DATE RECEIVED: May 8, 2001 ADDRESS: p.0. Box 4899 BY DELIVERY TO CLERK ON: May 8, 2001 Petaluma, CA 94955 BY MAIL POSTMARKED: I I I I. FROM: Clerk of the Board of Supervisors j TO: County Counsel Attached is a copy of the above-noted claim. JOhN SWEETEN, Clerk Dated: May 9, 2001 By: Deputy 4 � --o II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). I ( ) Other: i i i i �✓�� / Dated: .� � By: �l f ' Deputy County Counsel I i ID. FROM Clerk of the Board TO: County Counsel (1) County Administrator (2) Claim was returned as untimely with notice to claimant(Section 911.3). i IV. BOARD ORDER: By unanimousvote of the Supervisors present: ( ) This Claim is rejected in full. ( ) Other: i I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. I Dated: JOEIIV SWEETEN Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six(6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See;Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a ccertified copy of this Board Order sand Notice to Claimant, dressed to t clai ant as shown above. Dated.-/W 5� 1 By: JOHN SWEETEN, CLERK By eputy Clerk - J �I • �I II This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. �I i i i The Board of Super v ors j Contra John Sweeten Clerk of the Board and County Administration Buildingi Costa County Administrator 651 Pine Street,Room 106 JJ (925)335-1900 Martinez,California 94553-1293 County r John Gioia,1st District JV Gayle B.Uilkema,2nd District Donna Gerber,3rd District Mark DeSaulnier,4th DistrictI< Federal D.Glover,5th District TO: Cipriano Diaz-Renteria c/o Frank J. Christy Jr., Esq. P.O. Box 4899 Petaluma,CA 94955 I I I jNOTICE TO CLAIMANT (Of Late-Filed Claim) (Government Code Section 911.3) i The claim you presented tolthe Board of Supervisors of Contra Costa County, California, as governing body of the County of Contra Costa on May 8, 2001, has been reviewed by County Counsel and lis being returned to you herewith because: X Your claim for an injury to person or personal property was not presented within six months of the event or occurrence as required by law. (See Government Code sections 901 and 911.2) I — Your claim relating to a cause of action other than injury to person, personal property or growing crops was not presented within one year after the event or occurrence as required by law. (See Governmint Code sections 901 and 911.2) Because the claim was not presented within the time allowed by law, no action was taken on the claim. Your only recourse at this time is to apply without delay for leave to present a late claim. (See Government Code sections 911.4 to 912.2 and 946.6) Under some circumstances leave to present a late claim will be granted. (See Government Code section 911.6) I I i I I I i I I I I I I i i I Cipriano Diaz-Renteria j c/o Frank J. Christy Jr., Esq. Re: Claim Page Two I I I I I I I You may seek the advice of an attorney of your choice in connection with this matter. If you desire to consult an attorney,you should do so immediately. Date: a6Of I JOHN SWEETEN,Clerk of the Board of Supervisors and County Administrator I I I I By: I eputy erk I Enclosure I i I I Affidavit of Mailing I I declare under penalty of perjurylthat 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 copy of the above NOTICE TO CLAIMANT(OF LATE -FILED CLAIM), addressed to the claimant as shown above. i I Date: /It aD01 D uty Clerk I 1AT0RPRISK-MG F\CLA1MSILATE1Diaz Renteria.wpd I I I I I I I I Office of the County Counsel Contra Costa County 651 Pine Street, 9th Floor Phone: 335-1800 Martinez, CA 94553 Fax: 646-1078 ENCLOSURE MEMORANDUM RECEIVED MAY 0-.8 2001 CLERK BOARD OF SUPERVISORS Date: May 8, 2001 CONTRA COSTA CO. To: Ann Cervelli, Chief Clerk Clerk of the Board of Supervisors From: Silvano B. Marchesi, County Counsel by: Bernard L. Knapp , Deputy County Counsel Subj: Claim of Cipriano Diaz-Renteria Please process the attached Statutory Claim Against Public Entity of Cipriano Diaz-Renteria, which was served on the Office of the Sheriff on May 1, 2001 and received by our office on May 7, 2001. Thank you. cc: Risk Management Lt. Dale Varady, Office of the Sheriff lATORTBOSUaz-Rentena claim memo.wpd 4 LAW OFFICES OF FRANK J. CHRISTY, JR. Of Counsel I . Facsimile Jeanine F.Gisvold Mailing Address: P.O. Box 4899 (707)762-3538 Petaluma, CA 94955 Also admitted in (707) 773-2714 Virginia and Washington, D. C. April 26, 2001 Contra Costa County Sheriff's Department Administration Office 651 Pine Street, 7"' Floor Martinez, CA 94553 Re: Cipriano Diaz-Rentena v. Contra Costa County(Sheriff's Department) New Claim Dear Sir or Madam: Enclosed please find an Original and 1 copy of Cipriano Diaz-Renteria's Statutory Claim Against Public Entity. Please return a file-endorsed copy of the Claim to us in the envelope provided. Should you have any questions regarding the enclosed Claim, please contact Mr. Christy. Very truly yours, Donna C. Kamahele Assistant to Frank J. Christy,Jr. Enclosures I i i i i i I FRANK J. CHRISTY,JR.! SBN 119615 LAW OFFICES OF FRANK J. CHRISTY, JR. 2 Mailing Address: P.O. Box 4899 Petaluma, CA 94955 3 Telephone: (707) 773-2714 Facsimile: (707) 762-3538; 4 I Attorneys for Claimant 5 6 7 8 I 9 10 CIPRIANO DIAZ-RENTERIA, ) STATUTORY CLAIM AGAINST 11 ) PUBLIC ENTITY Claimant, ) 12 vs. ) 13 ) CONTRA COSTA COUNTY, ) 14 ) 15 Respondent. ) I ) 16 ) 17 TO: CONTRA COSTA COUNTY(SHERIFF'S DEPARTMENT) 18 Claimant Cipriano Diaz-Renteria hereby makes claim against CONTRA COSTA 19 20 COUNTY (SHEFIFF'S DEPARTMENT) and makes the following statements in support of the claim: 21 22 NAME AND ADDRESS OF CLAIMANT 23 Claimant is Cipriano Diaz-Renteria, care of Frank J. Christy, Jr., Law Offices of Frank J. I 24 Christy, Jr., P.O. Box 4899,Petaluma, CA 94955, Telephone: (707) 773-2714. 25 PERSON TO WHOM NOTICES SHOULD BE SENT 26 Notices concerning the claim should be sent to Claimant's attorney of record Frank J. I 27 Christy, Jr. at: 28 JJl I i I Claim i 1 i i 1 Frank J. Christy,Jr. Law Offices of Frank J. Christy,Jr. 2 i P.O. Box 4899 Petaluma, CA 94955 3 � (707) 773-2714 4 j DATE AND TIME OF INJURY 5 The date and time of the occurrence giving rise to this claim are: October 27, 2000 and I 6 continuing thereafter. 7 i LOCATION OF OCCURRENCE 8 Contra Costa County Jail, Martinez, California. i 9 URCUMSTANCES OF OCCURRENCE 10 The circumstances giving rise to this claim are as follows: On October 27, 2000, at 11 approximately 6:33 p.m.,IClaimant Cipriano Diaz-Renteria was pulled over on 7`h Street in 12 Richmond, California and cited by Officer Roderick, Badge No. 267, of the City of Richmond i 13 police Department for a traffic violation. 14 � After Officer Roderick issued the aforementioned citation, he informed Claimant that he 15 i was placing him under arrest because of outstanding warrants in San Mateo and Marin County. 16 Claimant was informed that the warrants were for one Cipriano Diaz— not Cipriano Diaz- 17 Renteria. Claimant thereafter informed Officer Roderick that he name was Cipriano Diaz- 18 ' Renteria and that he wasi not aware of any outstanding warrants. Claimant also advised Officer 19 Roderick that he had recently been issued a new California Drivers License on October 20, 20 2000, and that he wouldjnot have been issued the license—which Officer Roderick had in his 21 possession—if he had outstanding warrants. Finally, the name on the Traffic Citation issued by 22 Officer Roderick was Cipriano Diaz-Renteria. 23 Despite the foregoing, Officer Roderick arrested Claimant and took him to the 24 Richmond Police DepaAment Jail. Thereafter, Claimant was transferred to the Contra Costa 25 County Jail during the evening of October 27, 2000,without any effort by the Richmond Police 26 Department to determine whether Claimant was in fact the person for whom the warrants had 27 been issued. 28 i i Claim 2 i i I I I Claimant was booked into the Contra Costa County Jail on October 27, 2000,without I 2 any effort by Sheriff Department Personnel to determine whether Claimant was in fact the 3 person for whom the warrants had been issued. Claimant was detained at the Contra Costa 4 County Jail until October,131, 2000, at which time he.was transferred to the San Mateo County I 5 Jail. During his detention in the Contra Costa County Jail, Claimant and his pregnant wife— 6 Damarys—repeatedly advised Sheriff Department personnel that Claimant was not Cipriano I 7 Diaz and that if they wouI Id compare fingerprints or photographs of the two, they could confirm 8 that they were detaining the wrong person. Claimant's requests—as well as those of his wife- 9 were ignored by Sheriff Department personnel. 10 On October 31,2000, Claimant was booked into the San Mateo County Jail in Redwood I 11 City, California. Claimant was arraigned on or about November 2, 2000, in San Mateo County 12 Superior Court in the action entitled People v. Cipriano Diaz, Case No. NM 247-539A. At the 13 hearing, Claimant advised the Court that he was not Cipriano Diaz and that if his fingerprints or 14 photographs were compared with that of Cipriano Diaz they would confirm that he was not the 15 proper defendant. The Court thereafter Ordered the case continued until December 20, 2000, 16 and the release of Claimant on his own recognizance. The matter was subsequently continued i 17 until January 2001, and on January 2, 2001, Claimant returned to the San Mateo County I 18 Superior Court and at thIIat time Case No. NM 247-539A was dismissed in the interest of justice 19 since the person in the Court(Claimant)was not the right defendant. i 20 DESCRIPTION OF DAMAGES 21 This claim is for general damages, special damages, violation of constitutional rights, 22 emotional distress, loss iof income, loss of earning capacity, punitive damages, attorneys' fees, 23 and costs of suit arising'from placing Claimant in false light, false arrest, false imprisonment, 24 malicious prosecution, violation of Claimant's constitutional rights, and otherwise. 25 IDENTITY OF PUBLIC EMPLOYEES CAUSING INJURY 26 1 The identity of the public employee(s) causing Claimant's injuries are presently 27 unknown. 28 Claim 3 i I I I AMOUNT OF CLAIM 2 As of this date, the claim is in an amount within the jurisdiction of the Contra Costa i 3 County Superior Court(Unlimited Jurisdiction). The claim.is based upon an amount to be 4 proven later. 5 IDENTITY OF WITNESSES I Witnesses include claimant, his wife—Damarys Diaz-Renteria. The identity of other 7 witnesses is presently unknown. 8 COURT OF APPROPRIATE JURISDICTION 9 The California CI urt of appropriate jurisdiction over this claim is the Superior Court for 10 the County of Contra Costa. 11 The Federal CouIt of appropriate jurisdiction over this claim is the United States District 12 I 13 Court,Northern Districtlof California. 14 15 Dated: April 25, 2001 i LAW OFFICES OF FRANK J. CHRISTY, JR. I 16 ,\ 17 18 Frank . Christy,Jr. 19 Attorney r Claimant � 20 i 21 22 i I 23 24 25 I 26 I i 27 28 i Claim j 4 I I I FRANK J. CHRISTY,JR., SBN 119615 LAW OFFICES OF FRANK J. CHRISTY, JR. 2 Mailing Address: P.O. Box 4899 Petaluma, CA 94955 3 Telephone: (707) 773-2714 Facsimile: (707) 762-3538 4 Attorneys for Claimant 5 6 7 8 9 10 CIPRIANO DIAZ-RENTERIA, ) STATUTORY CLAIA4 AGAINST 11 ) PUBLIC ENTITY Claimant, ) 12 ) vs. ) 13 ) CONTRA COSTA COUNTY, ) 14 ) 15 Respondent. 16 ) 17 TO: CONTRA COSTA COUNTY (SHERIFF'S DEPARTMENT) 18 19 Claimant Cipriano Diaz-Renteria hereby makes claim against CONTRA COSTA 20 COUNTY(SHEFIFF'S DEPARTMENT) and makes the following statements in support of the 21 claim: 22 NAME AND ADDRESS OF CLAIMANT 23 Claimant is Cipriano Diaz-Renteria, care of Frank J. Christy,Jr., Law Offices of Frank J. 24 Christy, Jr., P.O. Box 4899, Petaluma, CA 94955,Telephone: (707) 773-2714. 25 PERSON TO WHOM NOTICES SHOULD BE SENT 26 Notices concerning the claim should be sent to Claimant's attorney of record Frank J. 27 Christy, Jr. at: 28 Claim 1 I Frank J. Christy,Jr. Law Offices of Frank J. Christy, Jr. 2 P.O. Box 4899 Petaluma, CA 94955 3 (707) 773-2714 4 DATE AND TIME OF INJURY 5 The date and time of the occurrence giving rise to this claim are: October 27, 2000 and 6 continuing thereafter. 7 LOCATION OF OCCURRENCE 8 Contra Costa County Jail, Martinez, California. 9 CIRCUMSTANCES OF OCCURRENCE 10 The circumstances giving rise to this claim are as follows: On October 27, 2000, at 11 approximately 6:33 p.m., Claimant Cipriano Diaz-Renteria was pulled over on 7`h Street in 12 Richmond, California and cited by Officer Roderick, Badge No. 267, of the City of Richmond 13 Police Department for a traffic violation. 14 After Officer Roderick issued the aforementioned citation, he informed Claimant that he 15 was placing him under arrest because of outstanding warrants in San Mateo and Marin County. 16 Claimant was informed that the warrants were for one Cipriano Diaz—not Cipriano Diaz- 17 Renteria. Claimant thereafter informed Officer Roderick that he name was Cipriano Diaz- 18 Renteria and that he was riot aware of any outstanding warrants. Claimant also advised Officer 19 Roderick that he had recently been issued a new California Drivers License on October 20, 20 2000, and that he would not have been issued the license—which Officer Roderick had in his 21 possession—if he had outstanding warrants. Finally, the name on the Traffic Citation issued by 22 Officer Roderick was Cipriano Diaz-Renteria. 23 Despite the foregoing, Officer Roderick arrested Claimant and took him to the 24 Richmond Police Department Jail. Thereafter, Claimant was transferred to the Contra Costa 25 County Jail during the evening of October 27, 2000, without any effort by the Richmond Police 26 Department to determine whether Claimant was in fact the person for whom the warrants had 27 been issued. 28 Claim 2 I Claimant was booked into the Contra Costa County Jail on October 27, 2000, without 2 any effort by Sheriff Department Personnel to determine whether Claimant was in fact the 3 person for whom the warrants had been issued. Claimant was detained at the Contra Costa 4 County Jail until October 31, 2000, at which time he was transferred to the San Mateo County 5 Jail. During his detention in the Contra Costa County Jail, Claimant and his pregnant wife— 6 Damarys —repeatedly advised Sheriff Department personnel that Claimant was not Cipriano 7 Diaz and that if they would compare fingerprints or photographs of the two, they could confirm 8 that they were detaining the wrong person. Claimant's requests—as well as those of his wife - 9 were ignored by Sheriff Department personnel. 10 On October 31, 2000, Claimant was booked into the San Mateo County Jail in Redwood 11 City, California. Claimant was arraigned on or about November 2, 2000, in San Mateo County 12 Superior Court in the action entitled People v. Cipriano Diaz, Case No. NM 247-539A. At the 13 hearing, Claimant advised the Court that he was not Cipriano Diaz and that if his fingerprints or 14 photographs were compared with that of Cipriano Diaz they would confirm that he was not the 15 proper defendant. The Court thereafter Ordered the case continued until December 20, 2000, 16 and the release of Claimant on his own recognizance. The matter was subsequently continued 17 until January 2001, and on January 2, 2001, Claimant returned to the San Mateo County 18 Superior Court and at that time Case No. NM 247-539A was dismissed in the interest of justice 19 since the person in the Court(Claimant)was not the right defendant. 20 DESCRIPTION OF DAMAGES 21 This claim is for general damages, special damages, violation of constitutional rights, 22 emotional distress, loss of income, loss of earning capacity, punitive damages, attorneys' fees, 23 and costs of suit arising from placing Claimant in false light, false arrest, false imprisonment, 24 malicious prosecution, violation of Claimant's constitutional rights, and otherwise. 25 IDENTITY OF PUBLIC EMPLOYEES CAUSING INJURY 26 The identity of the public employee(s)causing Claimant's injuries are presently 27 unknown. 28 Claim 3 I AMOUNT OF CLAIM 2 As of this date, the claim is in an amount within the jurisdiction of the Contra Costa 3 County Superior Court(Unlimited Jurisdiction). The claim is based upon an amount to be 4 proven later. 5 IDENTITY OF WITNESSES 6 Witnesses include claimant, his wife—Damarys Diaz-Renteria. The identity of other 7 witnesses is presently unknown. 8 COURT OF APPROPRIATE JURISDICTION 9 The California Court of appropriate jurisdiction over this claim is the Superior Court for 10 the County of Contra Costa. 11 12 The Federal Court of appropriate jurisdiction over this claim is the United States District 13 Court,Northern District of California. 14 15 Dated: April 25, 2001 LAW OFFICES OF FRANK J. CHRISTY, JR. 16 17 V 18 � FrN. risty, Jr. r Claimant 19 20 21 22 23 24 25 26 27 28 Claim 4 SILVAf►,�J B.MARCHESI I DEPUTIES: PHILLIPS.ALTHOFF v OUNTY COUNSEL I $E__ L JANICE L.AMENTA SHARON L.ANDERSON a , ;� ° -:;:.--`�� ANDREAB. W.CA BYRNES IOY CONTRA COSTMCOUNTY ASSISTANT COUNTY COUNSEL MONIKA L.COOPER //"./•, -r-� y5. �` VICKIE L.DAWES GREGORY C.HARVEY OFFICE.OF._THE COUNTWCOUNSEL MARKES ESTIS I - --�'•� '' ASSISTANT COUNTY COUNSEL ( of' .,.�''-=-�. .� I: LILLIANTFUJII P tCOuN4-TY.-_ADMIN ISTRATIGN BU I LDING`�� JANET L.HOLMES DENNIS C.GRAVES �6511PINE';STREET``§,�h-FkLOOR KEVINTKERR t"" —� 1-=��{ ICY-+/' I�rBERNARD L.KNAPP SENIOR FINANCIAL COUNSEL MARTINEZ;CALIFORNI .5 229 EDWARD V.LANE.JR. BEATRICE LIU GAYLEMUGGLI = - ,'~ MARYANNMASON OFFICE MANAGER `� � �' �� PAUL R.MUIJIZ PAUL R. PHONE (925) 335-1800 coUN STEVEN P.RETTIG DAVID F.SCHMIDT FAX (925)646-1078 NOTICE OF UNTIMELMESS JACOU LINE R JACQUELINE Y.WOODS I PAMELA J.ZAID AS TO A PORTION OF THE CLAIM TO: Frank J. Christy, Jr. Law Offices of Frank J. Christy, Jr. PO Box 4899 Petaluma, CA 94955. RE: CLAIM OF: Cipriano Diaz-Renteria I Please Take Notice as Follows: In regards to the claim you submitted on May 8, 2001, on behalf of Cipriano Diaz-Renteria, portions of the claim are timely and portions are untimely. The portions of the claim prior to November 8, 2000 that you presented against the County of Contra Costa governed by the Board of Supervisors fail to comply substantially with the requi-etilents of California Government Code Sections 901 and 911.2, because they were not presented within six months after the event or occurrence as provided by law. Because the portions of the claim prior to November 8, 2000 were not presented within the tune allowed by law, no action was taken On those p6rtlons of your clan. The claim was forwarded to the Board for action only on the timely portions of the claims. The only recourse at this tune is to apply without delay to the County of Contra Costa governed by the Board of Supervisors for leave to present a late claim as to the claims which are untimely. See Sections 911.4 to 912.2, inclusive, and Section 946.6 of the Government Code. Under some circumstances, leave to present a late claim will be granted. See Section 911.6 of the Goveninient Code. SILVANO B. MARCHESI COUNTY COUNSEL I By: Monika L. Cooper Deputy County Counsel I I I i Page 1 i I I yr i I CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013x,2015.5,Evidence Code§§641,664) I declare that tiny business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California 94553;1 am It citizen of the United States,over 18 yew's of ace,employed in Contra Costa County,and not a party to this action. I served a true copy of this NOTICE OF UNTE\4ELINESS AS TO A PORTION OF THE 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 perjury that the foregoing is true and correct. Executed in Martinez,California. Dated: May��j ,2001 I I J� i I cc: Clerk of the Board of Supervisors(original) Risk Management I I I I I I I I I I I I I I I I I I i i I i I I I I I I I I Page 2 GIC f AMENDED CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA BOARD ACT OU June 19, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, 1 NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this 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 MAY 15 2001 915.4. Please note all "Warnings". COUNTY AMOUNT: Unknown MARTWEZOUNSCALIFL CLAIMANT: Smith Cunningham/ ElworIthy Brothers ATTORNEY: Leonard J. Cook I DATE RECEIVED: May 14, 2001 ADDRESS: 1999 Harrison St 112070 BY DELIVERY TO CLERK ON: May 14, 2001 Oakland, CA 94612 BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisols TO: County Counsel Attached is a copy of the above-noted claim. JOI�1 ETEId, �CI k Dated: May 15, 2001 By: Deputy 11. FROM: County Counsel TO: Clerk of'the Board of Supervisors (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: i OQ Dated: _J %CO'O� B ;_� .:' Deputy County Counsel I 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). I IV. BOARD ORDER: By unanimous vote of the Supervisors present: /) This Claim is rejected in full. Other: I certift this is a true and correct) thacopy of the Board's Order tered in its minutes for this date. Dated: N/0"/ JOHN SWEETEN Clerk, By &A&kputy Clerk WARNING (Gov, code section 913) Subject to certain exceptions, you have only six(6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid certified copy of this Board Order and Notice to Claiman addressed to the clai ant as shown above. Dated: �(� o By. JOHN SWEETEN, CLERK By eputy Clerk � 1 This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. I i i i I i i I i CLABI BOARD OF SUPERV7SnRS OF CONTRA COSTA COUNTY, CA TFORN A BOARD ACTION: June 19, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, I NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. notice of the action taken on your claim by the LED Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and MAY 10 2009 915.4. Please note all "Warnings". Unknown COUNTY COUNSEL AMOUNT: MAR INEZCALIF. CLAIMANT: Smith Cunningham & Elworthy Brothers ATTORNEY: Leonard J. Cook Esq. DATE RECEIVED: May 9, 2001 ADDRESS: 1999 Harrison St. #2070 BY DELIVERY TO CLERK ON: May 9, 2001 Oakland, CA 94612 BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisorsi TO: County Counsel Attached is a copy of the above-noted claim. JOHN SIZETEI , rk Dated: May 9, 2001 By: Deputy /(1 11. FROM County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Elections 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 990.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: By: Deputy County Counsel III. FROM Clerk of the Board TO: jCounty Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). I 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: JOHN( SWEETEN Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order ind Notice to Claimant, addressed to the claimant as shown above. Dated: By: JOHN SWE'�`PEN, CLERK By Deputy Clerk This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. i II it I I i Al Clain?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 10&day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Gov't Code 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street,Martinez, CA 94553. C. If claim is against a district go lerned 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. i 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 Smith Cunningham and ) RECEIVED Elworthy Brothers ) Against the County of Contra Costa or ) MAY 0 9 2001 CLERK BOARD OF SUPERVISORS District) CONTRA COSTA CO. (Fill in name) ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ and in support of this claim represents as.follows: Undetermined. 1. When did the damage or injury occur?(Give exact date and hour) January 20, 2000 11805 hours 2. Where did the damage or injury occur?(Include city and county) Unincorporated area of Contra Costa County. 3. How did the damage or injury occur?(Give full details;use extra paper if required) County Animal Control Officer was attempting to control a young cow. The cow jumped a fence and caused a traffic accident , which is the subject of a lawsuit asjreflected in the attached complaint . Claimant has had to retain legal counsel and respond to the complaint . The conduct of the Animal.-Control Officer is the cause of the injuries of plaintiff Sylvia Burgess . i I I r, 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? Animal Control Officer was negligent in the manner in which he attempted to control thi young cow. 5. What are the names of county or district officers, servants, or employees causing the damage or injury? Scott Carney 6. What damage or injuries do you claim resulted?(Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) Claimants have been suedby plaintiff Sylvia Burgess. 7. How was the amount claimed above computed?(Include the estimated amount of any prospective injury or damage.) To be determined. Claimants have had to retain an attorney to represent them in lawsuit. 8. Names and addresses of witnesses, doctors, and hospitals. See attached State of California Traffic Collision Report No. 1-253. 9. List the expenditures you made on account of this accident or injury. DATE TDyIE AMOUNT To be determined Gov. Code Sec. 910.2 provides"The claim must be signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney Name and Address of Attorney ) Leonard J. Cook, Esq. ) BABBITS & WALTER 1999 Harrison Street , #2070 ) (Clai�,r nt'sSignature) Oakland, CA 94612 ) Attorney for Claimants ) (Address) (510) 587-1603 ) Telephone No. i )Telephone No. NOTICE Section 72 of the Penal Code provides: I 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 countyjail for a period of not more than one year,by a fine of not exceeding one thousand(S 1,000),or by both such imprisonment and fine,or by imprisonment in the state prison,by a fine of not exceeding ten thousand dollars($10,000),or by both such imprisonment and fine. i AMENDED CLAIM BOA OF JPERVISORS OF CONTRA COSTA COUNTY, CALIFORNLA BOARD AC110N: June 19, 2001 i 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: Unknown CLAIMANT: Smith Cunningham/ Elworthy Brothers ATTORNEY: Leonard J. Cook DATE RECEIVED: May 14, 2001 ADDRESS: 1999 Harrison St #2070 BY DELIVERY TO CLERK ON: May 14, 2001 Oakland, CA 94612 BY MAIL POSTMARKED: I I I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. i JOHNETEN, CI k Dated: May 15, 2001 By: Deputy. i H. FROM County Counsel TO: Clerk of the Board of Supervisors i ( ) This claim complies substantially with Sections 910 and 910.2. I ( ) 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 9110.8). ( ) 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: Byi: 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 I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JOHNi SWEETELI Clerk, By Deputy Clerk WARNING(Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. `For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order a!I nd Notice to Claimant, addressed to the claimant as shown above. Dated: By; JOHN SWEETEN, CLERK By Deputy Clerk i i This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction,or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. I� Claim to: uomw of swravISORs of CONTRA com CouNTY i� IN TO CL AIMATIT 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 orlbefore December 31,1987,must be presented not later than the 1006 day after the accrual ofthe 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 rause 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 9112.) B. Claims must be filed whh the Clair of the Board of Supervisors at its offict 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 fiaudulent claims,Penal Code Sec.72 at the and of this form. sssasssssssssssswsswssswsrwswsswwwsswrww•sswwswwwwwwrs•sssssssww++wrrrsarrsrwsrwwrw+sww++ RE: Claim By Reserved for Clerk's filing stamp Smith Cunningham and ) � RECEIVED Elworthy Brothers ) Against the County of Cornra Costa or ) MAY p 9 2001 80MV OF sUFERVMoR6 District) A oo. (hill in name) ; The undersigned claimarrt hereby msl es 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: Undetermined. 1. When did the damage or injury otxatt't(Give exact date and hour) January 20, 20001805 hours 2. Where did the damage or injury (irulude city and county) Unincorporated area of Contra Costa County. - 1 3. How did the damage or injury occur?(Give full details;use extra paper if required) County Animal Control Officer was attempting to control a young cow. The Cow jumped a fence and caused a traffic accident, which is the subject of a lawsuit as reflected in the attached complaint. Claimant has had to retain legal Counsel and respond to the complaint. The conduct of the Anima]].Control Officer is the cause of the injuries of alaint:iff• Sylvia Rureress. I I l l a` 4. What particular ad or omission on the part of county or district officers.servants,or 4-Ployees caused the injury or damage? Animal Control Officer was negligent in the manner in which he attempted to control the young cow. 5. What are the names of county or district officers,servants,or employees causing the damage or injury? Scott Carney 6. What damage or irdufles do you claim resulted?(Give fall extent of injuries or damages claimed.Attach two estimates for auto damage.) Claimants have been suld by plaintiff Sylvia Burgess. i 7. How was the amount claimed above computed?(Include the estimated amount of any prospective injury or d=nap.) I To be determined. Claimants have had to retain an-attorney to represent them in lawsuit. S. Names and addresses of witnesses,doctors,aid hospitals_ See attached State of California Traffic Collision Report No. 1-253. 9. List the expenditures you made on account of this eaddent or injury. DATE TME A14rov1vT To be determined trrtrttttt*ttttttt*ttt*tttatts**ttt*tttiitsriiirrrttttr*t*tttttrrr•*err*�atatraisisertrrttr Gov.Code Sec.910.2 provides"The claim must be signed by the claimant of by some person on his behalf." SEND NOTICES TO: (Attorney Name and Address of Attorney ) Leonard J. Cook, Esq. ) BABBITS it WALTER 1999- Harrison Street, #2070 } (Qai Ys Signature) Oakland, CA 94612 ) Attorney for Claimants } (Address) ) Telephone No. (520) 587-1603 Telephone No. iiifiiiittiiitititiiiiiitittitt{•tttftiiifittttttttiiiiititrritiiiiititttttrrritrti�ii•*i♦ NOTICE Sec4w 72 of the Penal C,aie pivMca: Every Person wbo,with ituart to defraud,presents for auaas=or the payment to any state board at officer,or to any Maty,city,ordistria board or offioar,wtboriud to allow or pay the sari e'genuine,any false or bauduknt claim,bal,aconna, voucher,or writing,is pwdshable eitba by imprisonment in the county iail for a period of not nota than one year,by a fine of not extaemng one tlwusand($1,000),or by both mcb tmprisauuent and fmr,or by imprisonment in the stare prison,by a fine of not ezoecding tat thousand dollars(!20.000),ar by both sigh imprinmmm and fiat. i .may' w Irl .a1�1M.aM.W Aammoy 11 A, AOa /yrs]MIAO W.MM oumfy sav Im rig _ low Q /-�?c7-aD / 8U7SVA `7�5 zo A r �Mue.r.MaM.aIeII GAYaMGII ,OWMAtl. .IIYIVMM.1.er KMM! reffnM,,m of I $ N T W(D S QTES M No AT RIe1RCT10111MIR RIATC WW ML 6,:J IZ YM jiqwol LCBM6Ml.IMII RAA UAQ6 WRY RAR IMImuma/O*m M4T.IM6RMAB9i OTAI! 2 �(n Iq - MMR e+l�+aY�41AYq ,�3•,oQ�� vn� �. 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I I v GVJrJl I—" rK —v w"-I CK DIU Doe UU--u I U 17CJJJJ171J Y•.Ub/10 �n �'a.•0... 7 �fool�OU, alis i—wi ,�• ..,.�■a EX1TEwr OR 11tRtY'(-W OW) MJUMD WAS("X"ONE 1. ,may o.. u■eno a4, N � V"U" .■Ian1 IW. .mR o�wc■ '■.■IM ML R■1Pl craa..r■o..o■ , Q,,„�,_ �/�2 h./�. 1, I 1_.. 0�/�C� �l�IC4C�-�_ rrro�onr .■13.:1.6 ` L ' /IM A AA-1 WC Co- I ly Q Q "'Mom, IM11�-H G'u n!1.f �7-�Hr f'1 .moan 1'-F"�.Tm.r. ����aa t`On.� CYIfL��lS WOOL,Ti,�q.�• . w■a■wws g MCTW M.103.11►tl11Y!1tl7Y1[D 13 0 11 10101010 ❑ :m 3lan.wuwom■1■r. T.■c�,m ■�ilutlnr. ,. . ❑nce3lxmeio:raw�cwmm ❑ El I cl ❑ T!3■►■0w m aM3q T.�MI1.,■■w: TA90i e: ■■[KlYlbp I ❑+naw ervgllelcaw«■+1n1■ r I5 E3 ❑ :ao.a/11■o■fT■ I riYMIdR waan,wawrtmw: r�xan.w we...wis ❑.rcnrorvnurrarononrlon i as w1 I T■.p11.c I ❑.�....d.r.a1.1...+�. 59 �p0 i A42 R smz I I i m i a-r cwa ao a.� roc rn v u.��i r=rt .moo r uwo i .�.�..a-aa�a.� r.o ri ars FACTUAL DIAORAM .�,. u !`�,i..` E._a;; 34-1451-f m aw.mg"wwiMMVS ARE APPM4WWAAT6 ANO 140T TO ICAM Wwum"AV=%*CALK w 10.x: wrr.r M,.www. ■w. wwv r. wavnrww•w«wws -ww.��.• +w• emus ss. I i I I 1805 liars. ID#6212 N�_�-.9320 -PA Date: 1-20-00 Tom.. . ._ Report#1= �' NOTWICA"ON• Received loose c i ow call from dispatcher at app: x. 1805 hrs, response was from S.R,4 and Hillcrest Ave.Dispatcher advised of a non-injury collision at approx. 1815 hrs, involving a cow.responding from Buchanan Rd.and Loveridge Rd.arrived at the collision scene at approx. 1820 hrs.where report was taken from both Parties. Scene: Kirker Pass Rd.at the collision scene is a northbound/southbound roadway consisting of two lanes in each direction with a center divider consisting of a concrete w 11.The roadway is straight and on a slight down bill for northbod traffic. Parti#2 (Ssnehwas located at the collision scene,Party admitted to driving Veh.#1 and was identified by a valid California drivers license. eh was moved prior to CHP arrival,vehicle had right front end damage and was driven from the scene. Party#2(Burp-essl was located at the collision scene,Party admitted to driving Veh.#2 land was identified by a valid California drivers license. Ve .# was mov prior to CHP arrival,vehicle had left front and s - damage and was driven from the scene. Skiidmarks and Debris: None. Pronerty Damage:There was a black cow that was killed due to the collision.The cow had a brand and cut ear markings that were observed by witness Cunningham. Officer M.Harvey#6212 I I I Date: 1--2.0-00 T n. 1805 hrs. M#6212� NL,,,.,,t 9320 Page#,67 Report#1-253 STATEMENTS: Party#1(Sanchs4 Related that he was northbound on Kirker Pass Rd.at approx.60 mph in the#1 lane in traffic when a black cow jumped over the center divider wall.Party said that the cow jumped directly in his path and he could not avoid hitting it_ Pa -y urease)Related that she was northbound on Kirker Pass Rd.at approx.50 mph in the#1 lane in traffic behind Veh.#I.Party said she saw Veh.#1 hit the cow and that the cow went down on it's front knees.Partysaid that she could not avoid the cow*Ie to traffic and that her vehicle struck it. Witness Mr.Cu I ningbam related the cut ears on the cow looked like Mr.Elsworthy's stock but he could not see a brand. Witness Mrs, gha m was contacted on 1-21-00 at approx. 0900 hrs.and she related that Mr.Cunningham said the cow indeed belonged to Mr.Elsworthy that there was a brand on it and the ear cuts were the same as the Elsworthy cattle. OPE UD"&CONCI USIONS: • i Party#1 (Sanchez)was northbound on Kirker Pass Rd.at approx. 55 . mph in the#1 lane in traffic when a black cow jumped over the center" divider wall directly in his path.Party#2(Burgess)was northbound on Kirker Pass Rd.at approx.55 mph in the#1 lane in traffic behind Veh.#1.Party#1 could not avoid hitting the cow and after his vehicle struck the cow and he drove past it the cow went down on it's front knees.Party#2 could not avoid the cow either and her vehicle also struck the cow killing it. The cow was turnled over to witness S.Cunningham the night of the collision because the Animal Services Officer would not be able to pick it up until the following day.The cows ownership had to be Officer M.Harvey#h212 i I I I i h. Dafe; 1-20-00 T,.��! 1$di-�lis. ID#6212 N�„ ..c r.:. 9320..,-w.:�eg'a: ,. Report f4k . determined bef it could be disposed of After ownership was determined the cow was left with S.Cunningham. Cause:of collision was the cow being at large and jumping the center divider wall in front of Veh.#1 and alternately being struck by Veh.#2. Point Of Impact:was based on statements,and point of rest of the cow.Point of Impact was the northbound#1 lane of Kicker pass Rd. approx 1200' south of the intersection of Nortonville Rd. . I 1?.�CONII�NDATIONS: - None. Officer M.Harvey#6212 *w TnTAI P.OrF 1 r i MAY 16 2001 10:31 FR BABBIT:S AND WALTER 510 587 0056 TO 19256461078 P.01i01 i BABBITS and WALTER 1999 HARRISON STREET, SUITE 2070 OAKLAND, CA 94612 1 Telephone: (510)587-1600 Fax: (5 10) 587_0056 FAX COVER SHEET i RECIPIENT'S FAX NUMBER: i(925)646-1078 DATE: May 16, 2001 I TO: MONICA COOPER, ESQ. FROM: LEONARD J.COOK, ESQ. RE: SYLVIA BURGESS vs.SMITH CUNNINGHAM,et al. Contra Costa County Superior Court Action No:C01-00234 DOCUMENTS FAXED: Complaint of Sylvia Burgess and Summons/Gross-Complaint of Smith Cunningham and Herbert Elworthy vs.Contra Costa County,et al. NUMBER OF PAGES: COVER PLUS____11_ MESSAGE: Ms.Cooper,per your telecon with Mr.Cook,attached please find above documents. On May 1, 2001, Leonard J. Cook, counsel for Messrs. Cunningham and Elworthy accepted service of the Complaint on behalf of Smith Cunningh9m and Herbert Elwodhy (erroneously sued as Elworthy Brothers) . I �t����t�t������ ...r......................... ttt�tttt�t�t ■�����������■ If you have problems receiving any of the following pages,please call our regular office telephone number: (510) 587-1600. The information contained in this transmission is attorney-client privileged and confidential. It is intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient,the reader is hereby notified that any consideration,dissemination,or duplication of this communication is strictly prohibited. I If you have received this communication in error,please return this transmission to us at the above address by mail or immediately notify us by telephone. Thank you. I ** TOTAL PAGE.01 ** MAY 16 2001 09:09 FR BABSITS AND WALTER 510 587 0056 TO 19256461078 P.02i12 MAY 15 2001 10:39 FR GABSITS RNV UHLI=K z4v Dtf( edzo lu t7c�s_a, cc, .vim• . sYLVZA BURGESS vs. SMITH SUMMONS A$ 1'0 "CROSS-COMPLAftIT" CUNNINGNAM, et al. (CfTACIONJUD1ClAL,) CROSS-DEFENDANTS roeeolrelr6f:oWr NOTICE TO L':656MAIMT: (Aviso a Aeusado) ru 00W FreO a�lfi eoefir CONTRA COSTA COUNTY, and NOES 1 to 20, i I � I YOU ARE BEING SUED BY Obe1dA MF: C1LOSS-COMPLAINANT (A Udle estd demandando) SMITH CUNNINGKAM and HERBERT ELWORTHY, You have 30 CALENDAR DAYS after this sum- 000pais do quo/o onrroguen as*Cflaeidn judicial wfed mans is served on you to Ale a typewritten re- Ilene un pram do 30 DIAS CALENDARIOS para presenter sponsc at this court i una rospuema escrits a mAgWna an eats collo. A letter or phone call will not protect you; yodr Una calfs o una lfamada rolofdnloa no la afroeor4 typewritten response must be in pro Der legal proroccibn; su rospuosta escr/ro a miqulne Jena quo form R you want the court to hear your case. curnplir con bs forfro idadas/spa/es aproplsdos of usfed If you do not Ale your response on time, you may vFrierre quo to cello odeurho su ease. lose the case, and your wages, money and pro- 5/used no oreson/i su respuesta a gompo,0"do Forder perry may be taken without further warning from elcase.y/opusdertqu/tarausabrio,sudineroyefrase*ass the Court do au propieded a/n av/se adleiansl pot pail*ds la corfe. There are other legal requirements. You may Exfsren aims mquisiros lsgalos. Puede quo usrod quiors want to call an attorney right away. If you do not llama►a un obogado inmed/afamente, Si no con000 a un know an attorney, you may call an attorney refer- abSdado, ptlsds /121n2r a un servicio ds referencia do ral sorvice or a legal aid efflaw(Fisted in the phone abagados o a una ofrcins de oyuda legal(vee a/dirocrorio book), tele/dnlao, e►sG01-0023q -0 Ei(NUMrsO�rCnfol The Warne and aodrs or the tours lig (E/Hombre y dhecri0n do la cone ss) � ':0 01-0 0 2 3 9 CONTRA COSTA COUNTY SUPERIOR COURT Unlimited Civil Jurisdiction Complaint filed 1/19/0: 725 Court Street Martinet, CA 94553 Cross-Complainant The name,address,and telephone num5er of pplailliN wpaomer,or plaef6 mldhout an attorney,is: (El nombre. la diraccidn y al nvm*ry de felftno der abogado del demandante. o del demandanre quo no Dene obogado, 6s) Leonard J. Cook, esq. i (510) 587-1600 (510) 567-0056 Leonard 3. Cook, SBN 063971 BABSITS 6 WALTER 1999 Harrison Street, !Suite 2070 Oakland, CA 99012 *ATE; I;i 77W P+rT-' �., MAY 15 2001 �:;:;C;- Clerk,by KRI; h1/,�iE.RrQA(+! Deputy v f ecnol ; ..VF Ct':t:J� (001WRool ~ Ist3pu NOTICE TO THE PERSON SERVED: You are served 1. as an Individual defondant. M 2.C as Fh1 person sued under the fictitious name of(spociy)' J3.[Jon Dehaft or(sperlw O under: C CCP 416.10(corporsbn) r CCP 416.00(minor) [J CCP 416.20(defunct corporation) CCP 416.70(conservatee) [`I CCP 416.40(associetien or penhership) C CCP<f6.P0(indjviduaq 1.•. _.___ . C other: a. by personal deilyery an(date): Cwm aseper antis wi IZell reyUtu for Weer 03crrrecl c2p417,7v "dl.-d C.-4.1 c,v.,,,.. NZOM Re. SUMMONS �yoal i w+ TQTA,_ PADE.OZ -4 20'd 9S00L8S0TST !Ol 02GL8z2526 --- --- -- ^c dd 07:91 T00Z St .ktw I MAY 16 2001 09:10 FR BABBITS AND WALTER 510 587 0056 TO 19256461078 P.03i12 ** L0'30tid 1diOi ** Mm' 15 2001 1039 FR E4981 TS AND LFRLTER alb :,!f/ iob_nb its r.vivt,.: I i 1 Leonard J.Cook(SBN 063977) a BABBITS& WALTER rt Attorneys at Lew 1999 Harrison Street, Suite 2070 ] Oakiand, California 94612 Telephone: (5 10) 537-'1603 1yOUI bS►1Y I S A l0� 5 2 4 Facsimile: (510) 587- 056 GaAl ti. '•_. ._.aACNlE Attorney for Defendants and Cross-Complainants s SMITKCUNNINGHAM1 and IMUERTRLWORMY �:— erroneously sued herein as ELWORTHY BROTfMPS 1MOM813SUED 7 I 8 j o SUPERIOR COURT OF THE STATE OF CALIFORNIA COUNTY OF CONTRA COSTA—UNLLNIITED CIVIL 1G I 11 I 11 SYLVIA BURGESS, I ) Case No. COI-00234 13 Plaintiff. ) CROSS-COMPLAINT BY FAX 14 vs, ) I ) is SMITH CUNNINGHAM,' DOE ONE ) 16 TIiMOUGH DOE FIVE, individually and ) d.b.a.ELWORTHY BRO,TFMRS, and DOES ) 11 SIX THROUGH DOE FIFTY. INCLUSIVE, ? I ) is Defendants. ) 1s I ) SMITH CUNNINGHAM, and HERBERT 20 ELWORTHY, 21 t.� Cross-Complainant, ) �. 22 ) vs, ) 'J 23 i ) Z9 CONTRA COSTA COUNTY. and MOES 1 -- ) 20. ) Q is Cross-Defendants. ) 26 ) ,G 27 o a' Each Cross-Complainants allege: O o 20 CROSS-COMPLAINT n.. .y- inn. .n•s. g I P 597 0@56 PAGE,?% £0 5500LB50ZSTi01 02LL8Z25526 Hf it:9l i60z 91 kew MAY 16 2001 09:10 FR BABBITS AND WALTER 510 587 0056 TO 19256461078 P.04i12 I I I 1 1. Cross-Complainai is are informed and believe and thereon allege that at all times z herein mentioned each of the Cross-Defendants was the agent and employee of each of the 3 9 remaining Cross-Defendants and was acting within the course and scope of said agency and 5 employment. 6 2. All further references to "Cross-Complainants" include by such reference"cross- 7 complainants, and each of them' "; all further references to "cross-defendant" include by such 8 reference "cross-defendants, and each of them." 9 I to 3. Cross-Complainants do not know the true names of those cross-defendants sued as it MOES 1 through MOES 20, inclusive. Cross-complainants are informed and believes and I 12 thereon alleges that those Cross-defendants are in some way liable and responsible for the events 13 referred to in this Cross-complaint and such caused damage to Cross-complainants. Cross- ly � complainants will amend this Cross-complaint to insert the correct names and capacities of those 15 � 16 Cross-defendants when such are discovered. 17 4. Cross-complainants incorporate here by reference the complaint on file herein, 18 solely for purposes of reference and without admitting any of its allegations. Cross-complainant 19 incorporate by reference all other pleadings in this action which seek affirmative relief, but does 20 not adopt as true or correct any of the allegations of those pleadings. 21 zz 5. If the allegations of the complaint are true, cross-defendants were negligent, and 23 this negligence proximately and/or legally caused the injuries and damages alleged in the 24 complaint. ! 25 6. That the negligence of cross-defendants was primary and active, and the negligence 26 27 of cross-complainants, if any, was only secondary and passive in nature. 28 I 2 CROSS-COMPLAINT I i i MAY 16 2001 09:10 FR BABBITS AND WALTER 510 587 0056 TO 19256461078 P.05i12 ! 1 7. Cross-complainants are informed and believes and thereon alleges that in the event 2 any parry to this action should establish any liability on the part of Cross-complainants, which 3 liability is expressly denied, Cross-complainants may be obligated to pay sums representing a 9 1 5 proportion or percentage of fault not Cross-complaint's own, but that of Cross-defendants, other i 6 patties to this action and third 'persons not parties to this action. Therefore, Cross-complainants request an adjudication and determination of the respective proportions or percentages of fault, if 8 1 any, on Cross-complainants' part and on the part of the Cross-defendants, and of all other parties 9 to this action so as to apportion age the award to reflect the percentof fault of Cross-complainant 10 1 11 (if any), Cross-defendants and!of a]I other parties to this action, named or unnamed in the I 12 pleadings of this action. 13 8. A determination of the respective proportion or percentage of fault, if any, of the 14 Cross-complainants and the Cross-defendants, other parties to this action and third persons not 15 16 parties to this action is necessary to protect the rights of the Cross-complainants. 17 9. In equity, cross-complainant is entitled to complete indemnity from cross- 18 defendants for the amount of any judgment returned on the complaint and for the amount of any I 19 settlement made with plaintiff, together with costs and attorney's fees incurred by cross- 20 1 21 complainants in the defense of the complaint and in the prosecution of this cross-complaint. � 22 An actual controversy has arisen, as illustrated by cross-complainants' contention I 23 in this matter. Cross-defendant disputes these contentions, and contends that cross-complainants 24 is entitled only to partial indemnity, or to no indemnity at all. 25 j WHEREFORE, cross-complainants demand judgments against cross-defendants for: 26 I 27 28 3 CROSS-COMPLAINT I I MAY 16 2001 09:10 FR BABBIT:S AND WALTER 510 587 0056 TO 19256461078 P.06/12 1. A separate declar a' tion of the respective proportions or percentages of fault if any, i of the cross-complainants and of the cross-defendants, other parties to this action, and third 3 4 persons not parties to this actio I n; 5 1 A declaration of the rights and duties of the parties, 6 3. Indemnity and contribution for the amount of any judgment obtained by, or 1 7 settlement made with, plaintiff(s), 4. Costs and attorney's fees incurred in the defense of the complaint and in the 9 1 prosecution of this cross-complaint;and 10 P 11 5, All other proper i'relief 12 13 DATED- May 2001 BABBITS& WALTER 14 15 By: 16 Leonard 1. Cog- Attorney foreefendants 17 is 19 20 21 22 23 24 25 26 2 4 CROSS-COMPLAINT MAY 16 2001 09:11 FR BABBITS AND WALTER 510 587 0056 TO 19256461078 P.O?/12 . I I I 1 PROOF OF SERVICE I 2 RE: Sylvia Burgess vs. Smith Cunningham,et al. 3 Contra Costa County Superior Court Action No: COI-40234 a ^-Y I hereby declare under penalty of perjury pursuant to the laws of the State of California s I that I am a citizen of the United States,over the age of 18 years, and not a party to the within 6 action. My business address is;1999 Harrison Street, Suite 2070, Oakland, California 94612. I 7 am readily familiar with the business practice for collection and processing of correspondence 9 ' for mailing with the United States Postal Service. On the date set forth below, I served the 9 following' 10 ' SUMMONS, CROSS-COMPLAINT 11 12 VILA MAIL By placing a true copy thereof enclosed in a sealed envelope, postage prepaid, in the United States mail 13 XXX at Oakland,California, 14 VIA FACSIMILE By faxing a true copy thereof to the facsimile is number of the recipient listed below. 16 VIA HAND- I By causing to be delivered, a true copy thereof to the 17 recipient(s)listed below. DELIVERY i 16 19 addressed as follows: 20 j ames J. O'Donnell, Esq. Attorney for Plaintiff SYLVIA BURGESS z1 'Donnell & Smith Phone: (925) 934-6092 22 776 Ygnacio Valley Road, Ste. 200 alnut Creek, CA 94598 23 24 I onica Cooper, Esq. Attorney for Contra Costa County 25 eputy County Counsel Phone: (925) 335-1862 ontra Costa County Fax: (925)646-1078 z6 551 Pine Street, 90'Floor 27 artinez, CA 94553 26 2 SUMMONS,CROSS-COMPLAINT TO CONTRA COSTA COUNTY I I MAY 16 2001 09:11 FR BABBITS AND WALTER 510 587 0056 TO 19256461078 P.08/12 1 I declare under penalty of perjury that the foregoing is true and correct 2 DATED: May (P , 2001 fVe-0, ryl 3 Ellen M, Gilmore 4 5 b 7 9 9 I 10 11 12 13 , 14 15 16 17 18 19 20 21 22 I 23 24 2$ 26 27 20 3 SUMMONS,CROSS-COMPLAINT TO CONTRA COSTA COUNTY i i f MAY 16 2001 09:11 FR BABBITS AND WALTER 510 587 0056 TO 19256461078 P.09z12 ; -JON-18-2081 0'0 :50 PM ODONNELL SMITH — - 1 SUMMONS (CITACION JUDICIAL) Post cou81rL4ron4y NOTICE TO DEFENDANT: (Aviso a Acusedo) SMITH CUNNINGHAM,DOE ONE THROUGH DOE FIVE, invidvidually and d.b.a. ELWORTHY BXOT7•MRS;and DOE SIX THROUGH DOE FIFTY, INCLUSIVE, YOU ARE BEING SUED BY PLAINTIFF: (A Ud. le es« demendando) SYLVIA BURGESS You have 30 CALENDAR DAYS after this sum- Despu6a de que to antrequen eats cltac/bn Judicial usfed mons Is served on you to file a typewritten re• time un plaza de 90 DIAS CALENDAR/09 para presenter eponae at this court. Una mspuesta escrlla a Rrbqulna an ears calls. A letter or phone call will not protect you; your Una cafft a Una Hamada telaMn/ca no le offeoer7 typewritten response must be In proper legal pmteoell3n; ou reapuasta eacr)ts a m8qu/no Bene que form If you want the court to hear your came. cumphr can las formalldades legates apmpladas st uttad Ii you do not Ills your response on time, you may quid"qua/a Corte eocuehe au eoao. lose the case, and your wages, money and pre- s/usted no preaenta su mspuasta s Nampo, pugdo pardar perty may be taken without further warning from e/ease,y la puaden qu/tarau sa/srlo,au dlnaro y sues cosec the court. de au propledad stn avise adlclone/porporte de is conte. There are other legal requirements. You may Existop otrva requlalfoe legales. Puedo sue usfed qulero went to Call an attorney right away. If you do not llemor a un abogodo /nmedletamente, S/ no Conoco a un know an attorney,you may call an attorney rarer. abogodo, puede 11amor a un sWvlc)o do rol'onancla de nal sofYlce or a legal aid office(Ilated In the phone obogados o a una otfclna de eyudo legal Ives el dlrecforio book). felaftSnlco). _ amara � o Tyre name and address of the court is.(E/nombre y dlrecc/dn de to come es) Superior Court of California, County of Contra Costa, '. 725'Court Street P.O. Box 911 Martinez A 94553 nae,ab rese, and telephone number of plelnt(fro aaerney,or ptainliff VAhaut an attorney,W (Einorrlore,la dfrecc/bn yet numero do t9i0feno del abogodo del demandants, o del demandante quo no flene abogado os) JAWS 1. O'DOI NELL, ESQ. (Bar# 120940) O'DONNEU&S&fITH Phone No. (925)935-1707 1776 Ygnado Vallcy Road, SWtc 200 Fax No. (925) 934-6,092 tR RE DAtE: �.I4< 1 $ 7f1 s LI.Pc@(L ,9PURr , Deputy (Faoha). I I -- ` (Actuarfa !Ooleyaao) .ISEALI NOTICE�TOTME PERSON SERY9D:You are orvad as in Individual defendant 2. Q al:the penton Feed under the HotRlau6 home of(apedAl), 3, h....l an behalf of(speelly).- under: CCP 419.10 (eo(por600n) CCP 416.90(minor) Q CCP 419.20(defunct corporation) CCP 410.70(eanse"tee) Q CCP 416.40(association or partnership) CCP 415 9D(individual) Q other: 4. by personal delivery on(dare): Porm Adopled by Rule 9e2 (Sae rower"for Proof of servioa) 2)() 4t l496 (e1JRy Jewry 1,981 SUMMONS CCP 412.90 Jr4itin(l.'n�n,-il A', fnr flernaa " TAN 19 2001 15:55 9259346092 PAGE.03 MAY 16 2001 09:11 FR BABBITS AND WALTER 510 587 0056 TO 19256461078 P.10/12 1 James J. ODonnell SUN 120940 O-DONNELL& AbUTR l 2 1776 Ygnaeio Val*Road, Suite 200 Walnut Creek,California 94398 3 Tel: 925 935-1707 200I JnN i 9 A 10' 4 `$ Fax: (9253934 -6092 5 Attorneys for Plaintiffs 6 a IN THE SUPERIOR COURT OF THE STATS OF CALIFORNIA 9 IN AND FOR THE COUNTY OF CONTRA COSTA 10 UNLIMITED JURISDICTION PER COCAS RULE 5 THIS CASE IS ASSIGN0 TO i l SYLVIA BURGESS 12 Plaintiff, ) ) 13 1 vs, ) No: 14 SMITH CUNNINGHAM, DOE ONE ) THROUGH DOE FIVE, individually 2nd } COMPLAINT FOR DAMAGES 15 d.b.a. ELWORTHY BROTHERS, and DOE ) 16 SIX THROUGH DOE FIFTY, INCLUSIVE, FAX 17 Defendants, ) ) 18 19 20 Plaintiff SYLVIA BURGESS complains of defendants SMITH CUNNINGHAM, DOE ONE 21 THROUGH FTVE, individually and d.b.a. ELWORTHY BROTHERS, and DOE SIX THROUGH 72 DOE FIFTY, INCLUSIVE: 23 1. Defendants DOE ONE through DOE FIFTY,inclusive, are sued herein under fictitious Q 24 names because their true names and capacities,whether individual,associate,corporate or governmental, 25 are not now known to plaintiffs;that plaintiffs are infortned and b4cve and upon such information and —," 26 belief allege that each of said defendants is negligent or responsible in some manner for the events and 27 happenings herein alleged,and that said defendants negligently acted or failed to act in one or more of EJ ,1 28 1 JAN 1Q 2001 15156 52S9346092 PAGE.04 MAY 16 2001 09:12 FR BABBITS AND WALTER 510 587 0056 TO 19256461078 P.11/12 1 said occupations or businesses and that such negligence proximately caused the injuries and damages 2 hereinafter set forth,that plaintiff's are uncertain as to the manner or function of such defendants, and 3 plaintiffs pray leave to amend this Complaint to insert therein the true names, capacities, functions, 4 occupations and businesses of said defendants when the same are ascertained. 5 2. Plaintiff is informed and believes that at all times and places mentioned herein,each of the 6 defendants was the agent,servant and employee of each other remaining defendants, and was at all times 7 and places mentioned here acting within the scope and purpose of the agency, service and employment. 8 3. At all times mentioned herein, defendants SMITH CUNNINGHAM, DOE ONE 9 THROUGH DOE FIVE, individually and d.b.a. ELWORTHY BROTHERS, and DOE SIX 10 THROUGH DOE FIFTY owned,managed,controlled and/or supervised cattle on property adjoining 11 Kirker Pass Road in unincorporated Contra Costa County, and/or owned,managed,controlled and/or 12 supervised property adjoining said Kirker Pass Road. 13 4. On January 20,2000,plaintiff SYLVIA BURGESS was lawfully operating a 2000 Dodge 14 Dakota automobile on Kirker Pass Road in unincorporated Contra Costa County. 15 S. At said time and place, said defendants, and each of them, carelessly and negligently 16 owned, managed, controlled and/or supervised cattle on property adjoining Kirker Pass Road in 17 unincorporated Contra Costa County and/or owned, managed, controlled and/or supervised property 18 adjoining said Kirker Pass Road so as to cause said automobile driven by Plaintiff to collide with a stray 19 cow,all of which directly and proximately caused plaintiff to sustain the injuries and damages hereinafter 20 set forth. 21 6. As a direct and proximate result of said carelessness, negligence, acts, omissions and 22 conduct of the defendants,and each of them,plaintiff received certain and severe injuries, including,but 23 not limited to,neurologic and orthopedic injuries,resulting in impairment of mental and bodily function; 24 and she has suffered and will continue to suffer great physical pain and mental suffering,and she has beer 25 impaired in her mental and physical capacity,all of which will result in certain permanent disability to saic 26 plaintiff, all to her general damage in an amount in excess of the jurisdictional limits of this court. 27 7. As a direct and proxhnate result of said negligence, acts,omissions and conduct of th( 28 2 4 MAY 16 2001 09:12 FR BABBITS AND WALTER 510 587 0056 TO 19256461078 P.12i12 1 defendants, and each of them, and of said injuries caused to plaintiff, plaintiff was required to and did 2 incur expenses for services of hospitals, doctors,and other medical care and treatment in an amount not 3 now known to plaintiff and plaintiff is informed and believes and upon such information and belief alleges 4 that she will incur additional expenses in the future in an amount not now known to her,and plaintiff will 5 ask leave of this Court to set forth the exact amount thereof when the same are ascertained. 6 S. As a further direct and proximate result of said negligence,acts,omissions and conduct 7 of defendants, and each of them, and of said injuries to plaintiff, plaintiff was prevented from attending 8 to her usual activities and occupation, and plaintiff is informed and believes and upon such information 9 and belief alleges that she will be prevented from attending to her usual activities and occupations in the 10 future,all to plaintiffs damage in an amount not now known to her, and plaintiff will ask leave of Court 11 to amend her pleadings to set forth the exact amount thereof when the same are ascertained. 12 9. As a further direct and proximate result of said negligence, acts, omissions and conduct 13 of defendants, and each of them, plaintiff suffered damage to, loss of value and loss of use of her 14 property, including but not limited to damage to, loss of value and loss of use of her vehicle, all to 15 plaintiffs' damage in an amount not now known to her, and plaintiff will ask leave of Court to amend her 16 pleadings to set forth the exact amount thereof when the same is ascertained. 17 WHEREFORE,plaintiff prays for judgment against the defendants,and each of them, as follows: 18 1. For general damages; 19 2. For special damages according to proof; 20 3. For costs of suit herein, 21 4. For prejudgment interest;and 22 5. For such other and further relief as the Court may deem proper. 23 24 Dated: January 18, 2000 ODONNELL& SMI 25 . .14 26 By 1` James J 0 D nne 27 Attorndys for laintiff 28 3 ** TOTAL PAGE.12 ** j C. fo CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA I BOARD ACT1oN June 19, 2001 I Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, f NOTICE TO CLAIMANT and Board Action. All Section references are to I) 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 MAY 9 5 2009 915.4. Please note all "Warnings". ' AMOUNT: $450.00 couNTY COUNSEL MARTINEZ CALIF. CLAIMANT: Shannon C. Staiger I ATTORNEY: None DATE RECEIVED: May 14, 2001 ADDRESS: 1725 Buckeye Dr. ! BY DELIVERY TO CLERK ON: May 14, 2001 West Sacto, CA 95691 BY MAIL POSTMARKED: ray 10, 2001 i I. FROINE• Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. J,0 Clerk I Dated: May 14, 2001 By: Deputy H. FROM: County Counsel TO: Clerk of the Board of Supervisors ( his claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially;with Sections 910 and 910.2, and we are'so notifying claimant. The Board cannot act for 15 days (Section 91018). I ( ) 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). I ( ) Other: Dated: �✓ Ey:l Deputy County Counsel M. FROM Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV, BOARD ORDER: By unanimous vote of the Supervisors present: W) This Claim is rejected in full. (� Other: i I I cert if that this is a true and correct copy of the Board's Order entered in its minutes f r this date. Dated: �u U JOHN SWEETEN Clerk, By' 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. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepai a certified copy of this Board Orden and Notice to Claima , addressed tot clai ant as shown above. Date "- b XV By: JOIN SWEETEN, CLERK By puty Clerk This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in :inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. I I i I I i i I f i 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 ;rowing crops and which accrue on or before December,31, 1987, must be presented not later than the 100x'' day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person onto personal property ore owing crops and which accrue on or after January 1. 1988, must be presented not later than sii months after the accrual of the cause of action. Claims relating to any other cause of action must be presented riot laier 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 StreeLlMartinez. 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. j D. U the claim is a;ainst more than one public entity.separate claims must be filed against each public entity. F. Fr-md. .See penalty for fraudulent claims. Penal Code Sec. 7'_ at the end of this form. i i RE. Claim b.' Reserved r E® 1726 MAY 1 42001 A;ainst the County of Contra Costa �SUPBRV ' or i i i I District) (Fill in Name) I i The undersigned claimant herebv 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 dama;e or injure occur" f Give exact Date and Hour) �v"----------------------------- rL '_. Where did the dama_e or m•lun•occur? (Include Cityand County•) ------------------------ 3. How did the damage or injury occur^ (Give full details:use ex=paper if required} &d/ S� i 7L . I I/ s/f sr, � � �e �T ® "Al l�,� ----- -------------- 4. What particular act or omission on the part of county or district officers, sen-ants, or employees caused the injury or damage? i - (Over) I aug par wauiuosudu3i gins gloq .{q to `( 000`oTS ) siriioP pursnogi aai'ulpaaaxa 1oa;o aug r .{q `uosud ams aqi w wauiuosudmr Sq io .aug par iaamuosudmi Bans gpoq .iq io •( 000-IS ) slriiop pursnogj auo oufpaa:)xa IOU 10 aug r :iq `ura& auo argi auouz ioa;o pouad r xoj i!rf.,4unoa;)q1 ui wamuosudmi .Cq iaglta aigrgs?und si tunum so '.taganOA =iunoaar !lliq mmia luainpnr.l;to asir;.iue �auinua'.li amrs aqi .ird to .tiolir of pazuoglnr °ia:)Wo.fo psroq nuisip to .iiia i.uunoa..iur 01.10 `iaogjo.10 plroq xrls :iur, of ivam:ird Ioj to aourmoiir lo;sluasaad•pnrs;ap of luaiol gii&-oq.++ uossad .isan3„ :sap�%Oid apo isua i aql.}o Z: aolloas 3 J .110 1-i X X X X X X X X X X X X X X X X X �/• X M X X X X i4 X X X X X X X a: X X X X X y: X X X X X X X X X X X X X X X +� SC�✓� �� �Ji/ auogdaiaZ •04 auogdaial,' ( sso.Ippv s,lurmiriJ ) ialuoUF.io ssalPPF pur. auirx - ..'3ir'yaq tiq oo uossad amos .iq to t.:i;;-low ), :O L S3JLL0±� Q43S �I iurlurrp agi..q padfis aq isnlu mlrp aql„ :S;)PI AOJ(i —016 -3;)(3ape' '.'09 X X X 'X' "X is X k. is Y Y it *.W. I I ' I �I l�.lU4Ct' I13.LI 3.LtQ I 1I :.i-fnfui to wappm, supjo junoaar ao aprm no C gi imipuadxa;)q1 isrj '6 �I -------------------- ----------------------------------------- --=:--------------------- � I -- •siriidsag pur •s�oiaop=sa;sauu.n jo cassalpp^.'pu.. same -g ..` •_ I II • II (•aoeutrp jo.unfit aA!=odsoid.iue to mnoutr paiemoso atp apnpul? ;paindmoa iunomr paunria anogr aql sr,a.aog _ ----------------------•--------------------------------------- - ------------------ i _._ ': :. .'. ..+,. : .... .. :.'. •.. . ,..�aveurep one so}S;nINU asa o,4 IRentr.'paurtrp sao:eutrp to saunfut,jo ivaixa my a&!t) palinsal ru!-g3,iloA•Op saunfui'lo salni'bau,_1rq,b .9 ----------------- -- -- �I ZSsnfuf so aarmrp age ouisnea saaeoidma so tsjar.uas�ssa3Wo jauzsip io.Ciunoa;o samru zip alr irq,b s li i it APR-23-01 11 :28 GSM P. 01 ilk I; CHUM AUTO GLASS .,. 27'11.48 Soc, San►a Cruz;-C1 9500-2 c F,3 1.) 475-132 �2 1 ;J t e7 s, I Tee i/,,1./s, I +7 7 + , e,7S �, lC''E.E�.�c�•-n-C� •� ��!� r �LC.rc.?•E../ ys'.li cy 3.5! u x. T: .�.3 i i I I I i i 04/30/01 MON 11:05 FAX 4088421713 GARLIC CITY GLASS Fih 001 I . I I $ GARLIC CITY. GLASS Q 00073 04/30/2001 showroom: 381 First St. PO Box 732 Gilroy, CA 95021 STA0202 WI (408) 842-1666 FAX# (408) 842-1713 TO 13ENJ FED ID# 77-0571321 I i SHANNON STAIGER I i i Hm877-890-0202 Wk - - 1999 FORD TAURUS 4 DOOR SEDAN I / / 877-890-0202 - 1 DW01218GBYN Windshield (slr contr) 40x63 605.80 260.49 260.49 Labor (flat rate) 60.00 2.0 Urethane, Dam, Primer 18.00 18 .00 18.00 I I i I I i I I I I I I I I i TOTAL LABOR (NON-TAXABLE) 60.00 SUBTOTAL 338.49 i CA SALES 22.28 1 I TOTAL 360.77 BALANCE 360.77 I I i ,ba_r><non Staiger r'o L -'°ELL Smart AutoGlass [smartone@smartautoglass.com] Sem— Wednesday, May 09, 2001 9:10 AM ,. To: SHANNON.STAIGER@HELLODIRECT.COM Subject: Glass Quote I I > No Claim = ON >'Contact FuIlName = SHANN'�N S'fQIG:ER��;::;,:::::� >Contact 1NorkFhone =800-846-0777 X8640 > o tact HomeFhone= 916-375-1655 ;.;;R,, > Contact_FAX =877-890-0202 > Contact Email = SHANNO.N.SpTAIGER_• HELLO,�DI�REC�;C-OM > >•make = F�ORD i >'body style =4 DOOR SEDAN�� I ' > Problem_Windshield crac =on ' > S1 = I HAVE A SCRAPE ON THE WINiD`SHiIELM-,A CR%AfCK`, &A`VERY LAR@E��CRAKSPANNiIN;GTHE`WINDSHIEL�®r.; I NEED AN E?STI-MATE FOF:.AN OEM WINDSHIELD REPLACEMENT,.t. >----------------------------------------------- 1 >Thank you for your inquiry of 5/08''20'01. Our quote is as follows (Quo alid.or30days;) > > 1. x`39 4f7 TintediShaded w ndshlefdsinsfiallation newmoldingandtax_incuded. > >This pricing is for original`equipment quality glass, which comes with a` > life ime guarantee on product defects and workmanship, Pl I si odhi e"f ee Mip } repair for 2s long as you own this vehicle° Please call toll-free 888/452-7779(Northern California Only)for an appointment in one of our shops or mobileservice to your home or office. Thank you again for contacting SMART AutoGlass. > l > If you are not in our service area and would like to be connected to a quality shop in your area, please call 800-774-7011 or go to www.ppgprostars.com <http://www.ppgprostars.com>This is the PPG-Prostars locator service. (Please note that the quoted price above is good at our stores in Northern California only). > You may want to check your insurance comprehensive coverage. We can billyour insurance directly. ;>An auto glass chip, no larger than the size of a quarter and not in the • driver's line of vision (the area covered by the windshield wipers)may be > repairable. The cost of an in shop repair is $49.9.5 and mobile service is > S69.95. 7 i 7 7 � 7 � 7 7 I I I i l I San Jos 3A 3 1'3;8-i e 7 (30'. -- APR-23-01 10 :33 AM 1`1 P- 02 r- -- .__......._._..._...._..._. .....-- ...... ..... January 25, 199 Subject Cornment on Closecut Techniqule,. i This technique does not meet Original Equipment specifications. - 'w`; 2. It leads to mixing of chemicals, sorn;e of which may be incompatible. it provides the replacement windshield with a bed of cured urethane having the form (shape) of the previous windshield - which may be very different - thus contributing to stress and ultimately breakage of the replaced windshield. 1 ' Closecutting puts the replacement windshield too high to the body and the old adhesive may cause interference with moldings. Consequently, when the windshield is being pushed down into the adhesive (decking), installation breaks i may occur. S. Urethane cure and shrinkage is not consistent at different thicknesses, therefore, ' an uneven cut may place the glass into tension/stress resulting in breakage of the windshield i 6. When a cutout is being done on a windshield, the possibility exists of slicing the old adhesive several times at varying; depths thus resulting in leaks and little or no adhesion in these areas. This compromises the structural integrity of some I vehicles and possibly windshield retention. .f:..'� 1 7. Some forms of this procedure may reduce "land' area for fresh adhesives and thereby may lead to inadequate iadhesive surface area. Again, this can compromise structural integrity as well as proper function of the windshield as a deployment device for the airbag. ;6There may be rust on the pinch;weld area under the original urethane that may r..;. lead to leaking and loss of structural integrity in some vehicles. 0 9. Ciosecutting does not allow verificatior, that a previous installation was performed k ` using proper materials or methods. Cahite Technical Group - I i HP(JR1-23-01 10 _31 AM P_ 01 p 1`111 arant Giass Ccrnp y -- n r AUTO GL_Ass CLEAR VIEWS January 2001 New Winter 2001 NAGS Calculators — . Just a reminder that Mygrant Glass Company is using the new Winter 2001 NAGS Calculator that was effective Monday, January 8, 2001,. GM Service Bulletin November 2000 — This GM Ser Ace Bulletin 'No: 00-08-48-003 Date: November, 2000 Subject: Elimination of Short Method (Short Cut Method) for Stationary Glass Replacement " '" Models: 2001 Passen er �,C;ars and Trucks X g "Effective immediately: GEneral Motors will no longer recommend the Short Method (which is often referred to as the Short' Cut Method) forlstationary glass replacement. The Extended Method (which is often referred to as the Full Cut Method) will be the only procedure recommended. ,F• General Motors had recommended the Short Method or Short Cut Method for approximately the last 35 years. In recent years, modifications or variations to the intended process have been applied that compromised the quality of the repair process. In short, what was originally intended years ago is not how it is 2pplied today. _— This policy change will result ire a number of actions Y' including: IY .7 'C r 7N r r G., 1 v� ►:a `Q 1i. 1'a � � 5 , rr -rr e o u C to CLAIM BOARD OF SUPERVISORS �OF CONTRA COSTA COUNTY, CALIFORNIA BOARD ACTIO .JUNE 19, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to 1 The copy of this document mailed to you is your California Government Codes. ► notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: $282.67 MAY I 200� COUNTY COUNSEL CLAIMANT: Andrew Mason MARTINEZ CALIF. ATTORNEY: None DATE RECEIVED: May 21, 2001 ADDRESS: 7279 Newcastle In BY DELIVERY TO CLERK ON: May 21, 2001 Dublin, CA 94568 BY MAIL POSTMARKED: May 18, 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JO WEETEN, Cl Dated: May 21, 2001 By: Deputy H. FROM County Counsel TO: Clerk of the Board of Supervisors ( 0"'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: 5 - 7- 1—of By: eputy County Counsel T 46 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). BOARD ORDER: By unanimous vote of the ';Supervisors present: This Claim is rejected in full. ( Other: I cern i y that this is a true and correct copy of the. Board's Order entered in its minutes for this date. Dated. <AM JOHN SWEETEIV Clerk, Byl__�J,4x", , 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. AFE DAVIT OF AIAAILING 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 prepai a certified copy of this Board Order and Notice to Claimant addressed to the claimant as shown above. JOHN SWEETEN CLERK Dated: ( By: � By eputy Clerk i This warning does not apply to claims which are not subject to the California ,Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. i i Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAUVIANT 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 Decernb;er 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 orb owing crops and;wbich accrue on or after January 1, 1988, must be presented not later than siz 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 accrdal 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 ibis form. RE: Claim by ) Reserved for Clerk's Filing Stamp ) RECEIVES Against the County of Contra Costa MAY 2 1 2001 or ' CLERK BOARD OF District) CONTRA C0.1716, (Fill in Name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above named District in the sum of Stand in support of this claim represents as follows: 1. When did the damage or injury occur:' (Give exact Date and Hour) of �D�' 3o P�"I' --------------------------=---------------------------------------------------------- 2. Where did the damage or injury occur:' (Include City and Couniv) 25 -----------------�------------------`- - r-------------- --------------- -- --- --- --- - - 3. How did the damage or injury occur:' (�Gi/ve full details;use extra gaper if i• yuired) --------- -- ---------------------------=----------------------------------------------- 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or„damage''_ All-(/!o! 71W-1,0-- (Over) i I -jug pule uuawuosudwt gans gloq:iq.io `( 000`olS) sar.Ilop pursnogi ual Quipaaaxa jou jo aug L, Sq `uosud aulels aql ui luawuosiidwi Aq io`aug pale luawuosiadwt gans gloq Aq io `( 00()4jS ) saullop puusnogl auo oulpaaan iou jo aug p .iq `imi auo uugj ;mow lou jo pouad u Ioj l!lef Aluno3 aql ui luawuosudwi Aq aagila alglegslund sl` uili1.\1 10 �iagano:%, `lunoaap `ll!q `iumlo lualnpnu_lj io aslle;Sule `awnuao 3E awns aqi .ked io .tiollu of pazl.ioginr `ia3!jjo io papoq lauislp io il!a I.ijunO3 Aug Iof.io 41aag3o.io p,poq awls Auu of luawApd ioj io a:)upntojjr.ioj sluasaid�pnr i;ap of lualul gj!mL`oqm, uosaad .:Liana„ :sapl.,Lo id apo3 1puad aqi jo ZL uollaaS 3 � I10N Nj auogdalal -osj auogdalaL (isa.ippv) � � 2 ( a.inlru;is s;)upwncl .CauaoiiV.lo ssa.iPPV.pule awlel[ 7-. Ipgaij'sl I.4i) uosiad awos:iq io (Aauloii6) OL S3JILO�i QI�(35 wvturpj�a_gj,_A 'pau„is_,(I;sniu tumla. l,, :saP'no.ui Z•0I6 'gas aPOD •.w- 1 ; M =F M M M M M M M,.M�M M. M,•.M M�M.'M MIM 'M M M M M M M M M M M M M M M M M M M -F M M M M M M M M M M M M M M. M M .L4:10Nv Wall 1-LtQ J :-{anful io ivapiaale sigl jo iunoaau uo aplew noA sa inuipuadza aql isiZ -6 -----------------------------------------------------------------.-------------------- -slp.;idsoq pule 4sioiaop 4sassauu:ll,Io sassa.ipple pup sawp�4 -8 ------------------------------------------------------------------------------------- T (•a'oewrp.io.Cinfm inl�aadso td.Cue So�unowe pa�c�ugsa a apn�auI) palndwoa iuno le pawiulo anogp aql sp.y.t+og ('aae►uep P1 no .iof saletugsa oAq gaeud pauaep saieiuep ro-saunfut{o �uaixa mi;ani0) Lpai(nsw wIrIJ ROA op tial InCIIi-IO sa2Y.4pp ileg�Vj 9 17 4.Unful.io a2ruirp aql'Ouisnra saaeoldwa io`slur.uas`s iaaWo la, isip io x4unoi jo sawru aql a.ile ulegM S . Brl�I �ilRES� NO I:} REFUNDS"ON DEPOSITS;,;,; : ( OR SPECIALORDERS: " .I( , ., NATIONAL CUSTOMER SERVICE' A.%,`J. DUl 1...:1:1 1 k+I...vD PHONE#600 321-2446 cnxi CUSTOMER MUST PRESENT COPY'.... • � � OF INVOICE FOR ANY WARRANTY, , 43 .1.1'1\.'(:1:1.(:.`(:?�� .I......:3,:3r..�(c11.-, {••'i:tl:l4::::�:I. )r )c .1(• :I. I'I Irl (:i T. (::. I::: 7( Y. i(. ::ic)J.c1 'C•(:) ;310.1:1 'V;c Irlf)f:yr:)I�I,, (111X)1:1:::IBJ vc.fl-1 ;; ':)C, f�l(:;(. RA ;. .. I-'II:::W (:;l��lt:i fl...l::: I...I''I '� I...:{.i::;� ..:il.Jl••I::i:l.::i:`:i CY) 1) ;:`:;C.',8 lYl:i.:l. r, :1. J„ 0t':3QJI/0 ':) F:l 1111 i_�f)�5,...•r::,:ti r�):} D: .X•r' .I.�)n A1'�1 E792 + F,.Flf-1 11):: CAL0000,4 2 G Slsm. meth Fart II QTY DcscT:iptioll Parts Labor FET Total ................_......................_1111.._......................_............................................_.....;.........._.................... ......................................................... .......... ........ 1111.. . . 32 TIMIURLST 1..00 MICHELIN 21514011? PILOT S1.10110, 245.99 0.00 0.00 245.99 32 EINT 1.00 E14V. TAX FOR TIRES 0.0(1 1.00 0.00 1.00 . 32 PruKDJ. 1.00 PACKAGE DELUXE TIRE itiSTALI_ 010-1 15.00 0.00 15.00 THIS PACZAGE INCLUDES: C'RI!1141i_ HOUNT & DISMOIJNT x +� LIFETIME COMPUTER SPIN PkANCE RUBBER VALVE ^Tt.hl PRORATED WARNRITY FOR MATERIALS'& DEFECTS mL IFETIME: RUTATIOt(S 32 DISPT 1.00 DISFnJSAL FEE FOR TIRES 0.E0, 1.00 .0.� :.A.00 ................ _.._...._.............._............_.._......_.........._................_..: ........................................................................................................................................................................................................................................................................................_.._........_....._._.. M.. ,. ,. Cl. .1<.:>I1 C 1.1 c...I. C.'Ii�a'rc{(: r::<a•rd f�"a- r'.�a ,. J:): I...t:x 1:1(:. r ,. 17 00 . (::L1c•)c:•I. 8!:: Ali.2C.):I. (:3(. bA-,c)-tial :: I ACKNOWLEDGE NOTICE AND ORAL APPROVAL OF ANY INCREASE IN THE ORIGINAL ESTIMATED PRICE: X TERMS: (NET 10th PROX. UNLESS OTHERWISE SPECIFIED) PAST DUE CHARGE IS COMPUTED BY A i "PERIODIC RATE"OF 1.5%'.PER MONTH ON UNPAID BALANCE WHICH IS AN ANNUAL PERCENTAGE RATE TERMS ACKNOWLEDGED 8 RECEIVED BY OF 18%.IF NECESSARY TO INSTITUTE LEGAL ACTION TO ENFORCE COLLECTION OF THE AMOUNT DUE ,, . ,•, , UNDER THIS INVOICE,BUYER AGREES TO PAY ALL NECESSARY COSTS AND ATTORNEY'S FEES. /�++/�/X /� /�T ITC /� /■/rl/T "' w 'rlyntTn fA/LJCCI t� 00A VC0` `M! �I -V\ \ ■ QI IT\ AI I(-IV II/IFIV I T I 11RRS: .4. r !,.;;•i'l�Fi.:.r•;t:;?7�?{i.'",r.+. Limited Warran�or�Bi O&Fulda Brand Tires condition may reSult.:(till O will check Ilse tut;nuts on.new,'customtarmag-.wliOels L•,very Big U I rand ti irc hearnl,�the Ri,g O uante•tail[\sena(nuutber aiul not rnarkerl' I free of char;gc and[3iq O assumes no resl,onsihilily'Cot dama�c or'In,ury`11, 1couW purchased ad. i Ifi O'I'ires SlirU,i.twarronla.l;Iti tins( Iaillln (Ille fu defects occur if crlslooler fails to hnve the Ili,,nils clit-ck'ed ns reconnueitdcil. in wurhnrniship fir nralcrials anr.l aLainst read hazard d;unal�c fir failnrr.for the life ' �`'...� :''i��""': r if Ir rn'i:;iunl tread(fl.twit lit:%;t;?ltd"ul;tit'inch of rr.nclinin.�u!adl.Alit sorb lire IIIG U L1611TED DRAKE 1VA12n,iNTY: Ih:II Iwcutta:s rtnscrviccnhic(11.11 i11!4 Ow pr"rtod sprrilir..I ldilrliow. d k;n'. a yc;•r• 2 }'nor orvr brat;. Itor:;and dist hr:Ikc earls arc tw:n-ranlcd ht•lily O-I'ires fur ntllcnl;r wt,;n'. IYi:arrir,.lonlhr.li'nn101111isin\,!,iccwillhc�rl,:,irrdlu'rrpinralfrecolrllal'4 nrlinn:I,criod::prrilild.n1111(:fn•nt•..IIllisill%lire,which cv,:rconn•Slirst.Ifntidrulgr a( ;my ItiL 0:fires Store. fort Inav he ch;1locil till iw;I;IIlaliun anti :on .e:Idrs lax. ,.r Linn:is nil•..111cra�i:a:spl:.:ilir1lInI Ihr•Irnnt oI�Illisincnirr..;I!).00umile/!)nfonlll. Shinld a suitable replacentcnl lift not hr Lw:Iil;Ihlr.in a rr:Iynn,l C ldttir.IIIc(11 Win:11 t%-Ijow is I toile;:lust policw is in ell%cl.If dill inti Ibis perind any of the lc/9 I s11ocS plirrhasC price, inclntlill Sidcs lax will hr rl:ftnldal. Alice Ihr Irce rcpkicenwilt nil%or dl.r hrakU d:=. herunn rlrlrOif it worn nal. naw beakl spurs rrrld/or pciiod.alt all,mnlicc will hc.t;it'I:11 a :Ii.Isl file plilc11asc pricf.fila rr•I-:.tcr.Incltl tire. I'4 h:l"I'(I up(nI IIIc dile it the ori:,irr,Il brad:It IIIc little od its d;aua�r of Idifnrc. it uul disr p;IdS will he inslalic-d upon till.plcS,:III;II un of Y.mr illvnirc Io allr Ifig I:)Tier . ' full• ,rowirlim: hr:.hc:;,-l0,1-vAlhualt•Ilnr:j!.I,.�rlhrhml:rshu,:::nod/nrrllsr•hralo. I sprcitird nn (lit'fnna of 1111' int•nirr: Iln�n n I %c:u'\vnrr.Inlw will ;il.Itiv. '' I pad>'.l'lw hrad:I;vht s;iII,l;oI (kl ;r brlkc p:ils will he cunsidcrrd %wr,rn )ill wild( Willi Ihr pill-Ortse of Yoln (iii•() Iirand•lire:nal the Illstaldaliun p;.IdI agc wall will the"hoes'or pads'nlillinnnn IIIiI.:kncsS ds ICs"Ihalt nulnul:n Inlet's gpccificatot lios rcrr:irc: -. I III: if nn urn n(1facLla uI S spr:.-iIw;IIi"IIs alt :IJ,plicahbr. 111% ntdninotm lliicklless o1 Lilt rima:Mw kcpflirs !.thrill'-•Rt,-In(IanCinrl l.defifli Mirotions I 1 Kt211ds ol'mi incl .,I • I ALL OTHER BRANDS NOT LISTED ABOVE: What is not covered in .our Limil.cd (Brake Warranty: ICYrrY ncu• lin-lii� 0 '1 if(: purchaScd al N• U Tires Slow i:< will-la If apainS Thr \vnrranlw do"s If,.![ cl.w,•I an% addildonad Isles ter kIb(.n' to np-11adc Life hr;dw hlilurc Lilt('In cICIC(IS in r worhnanisilip onlalcriat lot-the life of IIIc aril;incl hcn'I. sv,ucln I.,current I,•dcrol arn.l!..r::Talc Saf(:Ic <1:nlLl:nils.YOU IIIIISI auLhorize Ihr: Am- snrlt Iirr which l.tit:; nndwr Ihr• IVI'III" it IIIis warr;Init' jl lr:ttn tri 2i:S'l.nd" nlItis,( t tiler, Ir:r!••<La Ib( •:nIi11 In;Ihr s\::u:n1 to ifs I.rnper.,p,•rnliull.or:it von do an inrdt III rcnlnillin}'I.rr;nd)Will))';rrpl;n:C(I.II cllrr.:nl r.:Tail 111RX.inclwlinL I .IC.'I'.. I . less;ot;Ildowanre IiY. p r dr ,criati,(it ban sed,.II wcr. M.A. win will I(:1AINr IIrnI-insII111.11. n.nl-n':nr;Inlctl brike S11ucs plod/or disc bell(! palls. 'Ibis n•:Irranic i:: r:vl P., b.: rl.ns11'11cd as it QINIMIUcr; IIINI %.OU u"ill'ncecr Set'eral srr%icI parka cs art n%;Iilablc \%illi the pin(h:Isr of wnln'In(nI BigO. cnprrirncl !,;':.Iirr Innhllan:: r\I,IIs,. nl.:gr,.•I. nrcidrols. anrd nnusnal or sevr.I"_, IT"SOge. .,I- Pnddn Tilts. these packogcs arc sulci sepitmWl•. as hulii•;IwIl un Ifo• I dliwin! cr.,n(Iilions: coil aIl(-.•r:=.:It- ;,I ..:l with I:r:.Iriln!syslrnl. II is rcronoorlidi'd Irlail of This immure. (here arc Inter pa11ka.gcs: 1I Ihcn•ftnr. Ilial con 11;r%(• wont br;Ilan:(swsnan •jw.:kr.l evert•5.U(IO olilus aI coni w:m,esl I'w U Tht:.s `torr•. Irl..: ,If O n'i,:. I:rokes 1,:(miring rrpl;wenwill and/or 1. Tutsi,:I'rn•Irrnp: ittcludi-s rubber cnf%(.slcnls..:otnputcr haliolccl slamlar(I I r!•I):Iir dill. IV acctdr,nl iI tNhtr ramal(.. 11101. w;nitlalisnt. abilsc or nrglcH nic ntvunlinR. perch_;cxtttlticd hoot Ilti>?tcarrnnlc. 2. Oc-buc Parkupe - all ii.I:nfs in Basic pack;3gc pills Prcc Idol rcpnirs N Pres Rntaliolea. Ilimitntion of Conseyuenlial and (nridental Danra.Qes: I"i;Ihilih under limilt.'d %%ori:ollc i= lintilcd III Ibc rcplaa'nlcni knits and (:(,St.,; fit I rentiluo f acka(le-all itcllc: do I)OUXU pad:;I_c plLIS 3 wear I'ro-Vill"d IZo;ILI illslallnlioll of Illest. palls :it the ML! 11 'fills Sion- prneiding hrslkv srrcire. Tilt, littz;n-d Warran(y down if, 2/a2rf(.IS ill an inch of rctooinuft lia•a(.I ft. I:rr.r re-h;Ihun lilt-4. mlrrau(%dw..,Inv r(t%rr runsc(plcnUal nr inrirlUnlal danchls.flicludilw hill nul lirnilcil Io. loss 01'fisc. iuwill:,.ch;l1gr_s or 11:I11sporlalioll cIl;tig,:s. Sonic:stales do not albnv Ill•t,:tclusion ur IiniWiliutl of inridellhil or col lsc(Illei[Hill USED TIRE WARRANTY: d;trawl i_S.so(II!SC IIIIIiI;11inIC:Ulaw n.Il :Teel%.This\\:Irranlw pro\,idcs specific k,�al I':wI rw used lire pn]cllased al Iiia(>'1'ires S1irt,is\carr;ill(I.I,!!nils( I;Iilnrt,due III an!I Ihcre nl:.t he.,Ill.r ri011s thol ttr.:c%:n.w h,iol slaw lo st;Ilr. dcfects in a'inanyttn rlullip .Ir Llgri:11 liar .S ;(O(IM . r\ray SlICII lilt Wilichlhs n lilndrr . tilt,pants"(This hillin"I will ail(% will hr r..:placcd:Il .:Inrcnl Il:hail pril:c.ili dudin!. P.I:.T.. Icss;rat allowanrc fir drprucii1lion b;lscd..tl \%mar. IwARNINGl/ IVE141 DRARES!! "11,111'C;II lt:iS bl:etl I'r.:lillr:td %\Cilli Pitilli oil lir;1kc l"illill•-F. \'Ill art)ralltiolwd agaillyl WARRANTYADJUSTMENT C1IARGES: nnhinLr rapid of srw.•rr hmkr opplw;llions Inmic,li:110\':Illr,r installing nc\w hr;ldtc For any' lire rrplacc(.1 nndcr\t-arrnnl% it is flu:owner's rest:.Lnisibililt'(n pay;ippli- Knill}*. A nr\c set of rrliln:d I'm1kc.•Aloilld bU uc;nnl siolilm,Io:I nu\w cnginc 111;11 coble faxes and/of,governnu.]lial lues as"(.It as dealer servii-c:;sllr.h:is Innllnlillq. j hay hccn ut'crllatdc(I.Sino,til,.:sit,lac.:of the bl:dte Iillin:-and possihlw the drill hidanrin!".and road haz:u'd worr:udics whin applicable.u'Itic11 you nuf%;nuhorizc. surnpface has hr:cn niacltined nna Ihonnd. IIIc brakes will ralnirc Scaling beton: ;Inerlin,Severe SI•.:py.rApPly I:cur hralics ino dcr;drh-for the Iil:s!.:,OO utiles. Aliv But O Til.-"Stoic will honor Ihcsc Iiolifed\carmillics and plm idr;I(inniparlblU priced rclAacrttfend lire. or if (rill leliln(I ill the originrll purc11;isU priC(: 1;111 bC ALIGNMENT WARRANTY G MONTHS. 0,000 MILES LIMITED WARRAN'rY suhstintdcd al our discretion.TIv;ul wc;n is pro-laird un Ili.:basis that Ilic Iirr,u-cild is worn down to 2,i32nds of(.fit hich IPoutinin,g Ir,:arf t1rom",(4:1)(11 or Tri ircadwear indicalors(m tires rnnaillilu!1111:111 lin-flit'O,g PLddn I.4ran,f Twos.TVI rcplar'rIocfll j FRUNT END&SUSPENSION PARTS_ Cost is dc(Crminc(I ba nntllipivin"' Ihr cto-rcnl SIILL!"sIc(I list prier of Ilic I( tart II.:I Ironl !:ltd/sIlsln•nsinll parr list("] on 111% limit ill Ibis Illwnll C Mid insI:IIICII h% utcut (irc by (he perccnlagU of Head used and adding P.E.'I. and slate taxes. I aIII lunUlinnhCUMIS"o11'Iilurcufmadcii:Ils.wurkutanship. . r•,\c:Ir for Thi:perbnl(n nrlc:Il:r:;frt•eillcrl fill lilt-,f'rool of ibis dnwoicr f 12 ttunllllS All Tires Purchased_Front Authorized Big O Tires Stores: I or I2.00O Inilcs it lrui spccilwd nn Ow Iron) of 111is inwoircl. ❑ n(:%Y pal't tied) he General Cunditluns 8:DelhOlions: I h.Irnished. If I:lurm ,his period tilt earls hI-roaa• rlr.Icclive or worn\oral. new Proof of I't.nehnse Rcrltlur(I - I.tig U's Iinliletl twarranlics fill tires pur'I:hased hoin w;I11:ntlyd parrs will be inslolled ill•orl prrsrnlaliun III Your iln•olcr" to;illy ituillo- all alllhnrizr(I Itil!UTh"S 1iurc.will lit-h...norc(1 al all\,Big()Tiles Storc.jl'hc I;tiled Iizrd _,C ISi )'I'dres S(urr\%till:I Ironend nd dep:urluenl. uilhoul.charge lin'the pill-Is. Iirr nluSi. be rcluroc.d to :I IJill 1)Tires Slone. This warl'ollh Is nil II':IIISICrable. 'IIIis willranlw dors nut cower :n l% a,.dd11ivlit l purls Io res(orc the from Wilt rat II applies to of h!in;Il Ili fC11nsr:l •nth'. Por will ranlw. Iirr owl ices IIitISI lcndrsuspensi..nt swsl-,Ili Io I:L11'1'CI11 t•:dcraI sit Irl\ slifnWit'(1s.Il von du not alllhorizn I)rcScnt Their sales involr.C. I.hc a(ILIRinnll word(. %oil •.will rccrkv non-iltslnlird. non-warnolicd palls. Proper 'lire Repair - All lireS ttrtlSI be rrpaircl.l in ucUurdnnc.c. villa Iii O'S appropriate 'hire Rg:,1ir Polir.t•. An improprx i(-pair tl,ics ttn1 cimstilnle oli This a'arrallry is n!t lu he cOnsli-11rtl;Is:I,glinmillce That YOII will levo experlenr.: a(Ijl.tslablc conditiun.'I Iles Ilial fail as the res1111 of;111 ilnpPtI.I I repair nI V V.NLlii1Cd flow curl/stlsln'nsi"It problunis. Abu"c. oc ler(, a(ritk:nls and unusual or sc\,crc floor will-r,ull'v. i Ilri"Jo)!VOIKIIIIIAIs caul ;vlw(:'S0%:III�ccI worn'Irottl cod/sllspcosioll syslrnt. lit"O Road Ilaz;n'd failure• -The Icrttl "HON11 Ildzartl Pailurc: in%l:idcs 11011-IYpairilbkt Tires rrconnlnnrls IIIaI con li:nc clot li'unl rntl/Suspcnsiun Syslcnt r11rcttU(I Rupairl hie Til,(, - A lur Ili, brellil:Incl Sdnlilar injuries. 1 . fifes SIorC. SCI' Pmol I•:nd. SuSIWIlsion. 12c1)airablc'fir(: - A puncitn'c or prnctrlli.nt Inn( In Cxcrcd :'�"at its willi•sI point I )!:r'iotli.:nth' IL wrn.ir n!::n',::;I ISi� i;) ' will be rcpaircLl its spccili(:(I nn(Icr lii•�l.Y"'hire IZcp:Iir I'nlir\.. ShorhS;SUnts r-;cnta':II O)Ildt(km, lit-low. Lifc ul"1'read-lAtc ul'I'rcad"mcaos down it,2/32nds 0t alt inch of rcnrtitfit ",Ircad 011 :III Tires, ai which point Ihr tires arc cunSidCl'Cd twurn uul :.Intl nu klmIII:r SIIOCKS/STRUTS&STRUT CARTRIDGES-1.1IIITED WARRANTY: twarrantccl. liil O Tires shocks. Mill lllwlrzon slrul se;lIc.I IUIifs and Strut rariridle"shall hr l.intilitl.ioll of Cunsoluculi;I1 U:Itn;]L<c - the abovc warrollies cin nil cover \%>n'ranlcd foil,EI" Ion(,":Is wol.l utwn IVC t'Cltdcics I.nt IMFIS and 12 owidlis oil klhor. cmise(Iucllliill dnntage and anw Iiiihilin•is hilliled to rrpnirirrg nr replacini4 Ulu Lire N,_5 O Tiers air slloek.c shall Ile warrntlCLi 101' 12 11)011111"trout Ibc finir,of purrlta.s,: mit Biq U Tiles Store in at r c[, d;lll(e nilh 111%Icrttis s,-I forth:Ihl,crn. !, p:n'Is ant(lat)tw.11,01c air shuelis.Shucks.M;wl'hcisu11 strut sc;dcd unit or slrnl Exclusions fruin Ntarrantw - ThuSC.UICS wltiUli I)Ccouic LulScrwice;.Iblc (1110 (o cartridge cease to funcliun hrcause of;t Glilurr,of niolrri;tis.workninnship or wear ❑rodent, lilt:. then. chain d;unagc. vandalism, racing, improper h;ihowc of flu-ilw[Ile pcfiud specified. il.will bre.replaced bw an:lir Shock.shock. MacNivi-sun ali,gnnicnl(uncwen fir irrl:.lular\Ve;u'I lack(1101'improper'rotalion.improper lcpnir. sit nl scaler( unit. or sh I11 rnrlridgc (.I rLlu:Il or superiL,r yuitlilw. II I3i.1_' O"fires ny)rupUr inllatiun pressure,rcp;Iirahlc puncnn'cs•uwrt'Ioadin .wclticic ubsu ncliun ;md'sdmilar (wpus of dnnia,gr fir nhusc ;if,; exr.lnded dronf w;t1r:uuw. Uz(,tic. ill installed il_ the new fill( will be inslallc(I as per Ow :IhOve surfed twarr:lnlY. Sce twcather crocking Isllpcilieial cracking)twi!1 nu( be covered I,w \%arranly alter lit,: Pro111 N11d.Snsptnsion.Sllnclts/SnliIs Gcocial Conditions ISclow. }•Ctrs Iion),Ihe(Tilde of pin-clulse.A(if(,-is nal adjuslnhlc fur problcnis of apiwar.lncc ahcr file firs( 1011,0l ucadwear.A lire is not ;:011.1.10:1111C fin'It-]('disllubnl,Irc aper Alignment, Front End,Suspension.Shocks/Struts Gcncral Conditions: file first 2/32nds of an inch ul Irea(Itvear.Any'implied warranty of nu:rcluAilabilitc Ullliw(ion of f::.oIIS,-iplettlial "I'1111:11-le - The :Ihove warranlw docs nil cower Lit.hitless fora pariwilla pnrposc. if applicable. is hilliletl to the duralkiii of this run:-cl.IrlC ll-Ull d;unal;c. MILI illy' IiabilitY• is limited In repafrinL or replacing r.xpress warrant Y. LnSS ill fifne. incon%cnicncc, loss of fisc of,vehicle. ;]fill ol11r:l. Ibc' purl al it lirenscd Hig U rcl:Iil store in accordance with the Ir"flus set ill(idcn(al fir cunsequelilial(lavages arc not covered In.this warralm.l'lle:111ovr" lin'Ih:Ibuvc.Sonic SlalUs OL)nal:111,1wthe exclusion Ill,liniitolinn oflncldenlal w;n'ranlics du not dicer cnns((Illcntiad danuo-ics and anw Itability is tillIiI cd lu mpairin or rcplacin the rirr ill :I hid i)Tires tifore in necordnnct will\ Ili(:lcrnts In'cunscylicit(ial (I:un:.:hrs. Sn these. liotikilions nt:w nol ;fill)[\• to yon. This scl lolill nhuwe. Si1n (lit w c states .l?lot ;Illofile n cm-losioor linila11 il lliul illci(Ic11lal I w:nranlwvitt .spc(.ffic lcl!al ritihls. nild coil Ina\,also havc other rights or ct)lISe(pirnlial d;umlgcs or hillilafton in how lent;an inipliud twnrruuw Iasis.so whirl) w;II_v I'rLnn slue 1'.sial\..'file shocdt 19: :311,111 warrailly described;Ibovc Ihcsc rxclusionS fir IiniitalionS nuiv no(app[\'.This warran(y•provides Specilt(-Ic.qal only applies It,shoat ab.surbc,rs ilISLalled fill privately(-u)vncrl vchlcicS. rioli s,itnd there TIM be other rt lilts. which Vary'from stave to slate. General Warranty:' All parts and/nr labor will have a 40 day Caul.ton rc1!ardinlf wlu:cls: Ln1; flus pill (-at liew ctfstunis or 11mg whr:el's could OI'4,000 mile\wa.rli nty. ywl)ICI1C VCT C011111IS III:SI.'U IIIeSS OUICA-WISL' broil".loose during the first 1001101c .1 illiving. It the hig nllls art nol cilecRed for Il!!hlness aper Ila:tin;I 25 mile"of dri%Int!and :rain at 100 Miles. :nt ylnsalc Spiucilicd obuvc. . i 02. CLAEq BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNLA BOARD ACT10(� June 11%, 2001 Claim Against the County, or District Governed by j the Board of Supervisors, Routing Endorsements, I NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. 1 notice of the action taken on your claim by the dlld�L3Nlltit/W Board of Supervisors. (Paragraph IV below), given 13SNnQO AIN n ob pursuant to Government Code Section 913 and luut [ s ASW 915.4. Please note all "Warnings". AMOUNT: $5000 CLAIMANT: Lisbett Delvalle ATTORNEY: None DATE RECEIVED: May 7, 2001 ADDRESS: 560 Sunnyview Dr 4404 BY DELIVERY TO CLERK ON: May 7, 2001 pinole, CA 94564 BY MAIL POSTMARKED: May 4, 2001 I. FROM. Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. I N, rk Dated: May 7, 2001 By: Deput H. FROM County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. i ( ) 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), I ( ) 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: i —g— pl Dated: By: __(v Deputy County Counsel i 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). i BOARD ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in full. Any Other: I certify that this is a true and correct copy of the Board's OrderAgtered in its minutes for this date. Dated JOHN SWEETEN Clerk, By , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepai a certified copy of this Board Order and Notice to Claimant addressed to the cl 'mant as shown above. n�,� JOHN SWEETEN, CLERK Dated: �� Oq v By: By' eputy Clerk r i This warning does not apply to claims .which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. I I . I I I I I I I I I • I . i • i Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injure to person or to personal propem? orb owing crops and which accrue on or before December131, 1987, must be presented not later than the 1001' day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or bowing 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 an}. other cause of action must be presented not later than one year after the'accrual of the cause of action. (Govt. Code §911.2. ) I B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Buildin„651 Pine Street. Martinez. CA 9453. I C. If Claim is against a district governed bytheBoard of Supervisors, rather than the County, the name of the District should be filled in. i D. If the claim is against more than one public entity.separate claims must be filed against each public entity. I E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the cnd oft;is form. I I RE: Claim by ) Reserved for Clerk's Filing Stamp ba bfa�i I)P-14L I-ze 11 I � Against the Count of Contra Costa - _ 1 or 1 I District) (Fill in Name) I The undersigned claimant hereby makes Iclaim against the County of Contra Costa or the above named District in the sum of S-50 0616D ind int support of this claim represents as follows: - i 1. When did the damage or in jury occur? !Give exact Date and Hour i --------------- --- - ------ ------------- -- ------ ------ 2. here did the damage or in jury occur? (include City and Count 3. How did the damage orinlun_• occur? (IGive ftW details; use extra paper if required j (gyp Wky- , pc.,) ci �� D'5�c wc,�,� t�14- t4 s ., 0-(,,u sy h, rnh 414 11 01 ------------------------------------------------------------------------------------- 4. What particular act or omission on the.part of county or district officers, sen-ants, or employees caused the injury or damage? Co t� I C(Over) I I -aug par ivamuosrldmi yens gloq eq 10 °( 000`013 ) slrllop pursnogi nal Uutpaaaxa lou jo aug r Sq `uosud ams aqi ut luauiuosudmi .-q 10 `aug pur luamuosudmi Bans gioq ::q 10 `( 0004iS ) smllop pursnogi auo outpaaaxa ion 3o aug r Sq `arae auo urge atom ion jo pouad r 1o; Itrf iiunoa aqi ui ivamuosudmt .{q laglta algrgstund st `2ut}u.&1O `saganon 'iunoaar jpq •mrrla ivafnpnrll 10 asle3 .sue -aurnuao';t awes aqi erd 10 molir of pazuoginr °1aaWo 10 preoq 13ulsip 10 :uta `eiunoa eue of 10`1aag;o 10 pluoq ams :iur of ivamnrd 10;10 aaur.aollr 1o;sivasald`pnel;ap of maim grim 4ogn+ uoslad n.rana„ :sapinold apo lruad aqi;o ZL aoii:)aS 3JI10 —ill Q ori auoydalal •oh auoydalal 7Ob6 A�) Y aV3 (ssalppv) (alnirutrS s,lurwrr J ) iaruouy;o ssalpPV Pur aum?q ;, }p gaq sig uo uoslad awos.iq io (.�aulou�) :OI S3JI LOh QI�i3S iurwirp aqi.:q pauLis aq isnur wtrlo aql,, :sapi.iold Z'016 -aaS aPOD •.sof IN.l04N:c Wall alv(l :.unfui 10 ivapiaar sigi;o iunoaar no aprur noe samuipuadxa aqi isi-I 6 ------j,:-------- -- ------------ - wo 3 �, sli�ds y u. •sloioo sassauir.�,jo vassal pr pur. .a g } 1 �'`1 __ ��, ' Liar►_ 1of l . .a :-�- - ---y ,�� � --�a:�i� - ---- ---r--- -�-�-- ---- - (•a2ewep.jo.unfu!anu3ad old.sue o iunome pairwgsa aqi ap cul) paindtuoa iunomr pauiirla anogr aqi sum .vog Dq ( a9eutep ohne aoi saieumsa o&4 ipu-u + -patum:)saoemrp so saunfu!jo ivaoa ffnj amf) pallnsal MMID noA op saunfui 10 sanrurrp iegtA -9 �elnfui so aormrp agi onisnra saaeoldma so`siar•�1as°slaag}o iauisip so eiuno�;o samra aqi a1r irgM 'S U��{y County Administrator Contra Risk Management Costa County Aoministration jU;imng 651 nStreet. 0tn ='oo : Count y Martinez. ,=,al�rorn�:� ?:.j;,; Liability Claims 115) 016-1'55 Safety -!IS) 016 l - 20 Vocational aetlao ;at cn ,1i5i le5 Workers Ccmoensat n CONSENT FOR THE RELEASE C7 MEDr^aL INFOP_T1A '_CN authorize Mame o ?a _e^ti ( Prov_cerc eaCara , to dLscicse to the bearer, who represents ,.':,e County of Contra Costa - Risk Management Division andior designated, copy service , all medical information necessary to substantiate a claim init_ated by me. hereby consent and request that the bearer 'ce perm--e— examine erm ieexamine and obtain copies of all hospital and medical records of every sort and }find, interview doctors and Other attendants regarding all :clatters relating to examination, diagnosis, care and treatment of myself . I understand that this Consent for the Release of Medical Information will remain valid unless cancelled by me. I hereby acknowledge that I have. received a copy cif- this Consent for Re-ease of Medical Information. it is understood that a photostat of this authorization is as valid as the original. . Date : y 2 Signed: Q Address : Ik) G C' GIU '166 ( Cons,?_--va z,,D r or Guarcian) Date of Birth: � to Soc=d� 5ecur_t_r No IJc%A_1 4AAr1-55 5 60 -fin ��Du V-) 11v v IPw Pfno1e u BAY AREA CREDIT SERVICE 2185 The Alameda, San Jose, CA 95126-1109 7 PLEASE PAY ! : Q ! + ' 2001 CHG.: r0 .00 1 it CREDITOR AMERICAN MEDICAL RESPONSE INTERIEST TOTAL ► i 40116.4. LINDA, i• vw SAN' LO LO 4: 1 • 1128 III oil 1$1111111 III-sil MIS 11"11.111 Is.1.1d fie i PLEASE DETACH AND RETURN UPPER PORTION OF STATEMENT WITH PAYMENT AIR F CREDIT BUREAU i + i IF YOUR i i PAID IN FULL WITHIN 7 DAYS, ANY UNPAID ORUNREPORTEDAY BE LISTED AS AN •A COLLECTION ON i • CREDITIBUREAU OR CALL US TOLL AT t•! X11 SINCERELY BAY AREA CREDIT SERVICE x�gr Balance $ 525 .43 Account 3407164 MAT0029�64100 Phone 408-248-5570 4K.s},tp"_ ,cs t5 i t a C n:Y s F2 pyy`��pi J�,p {y�j �r'•}�''��{ � � �-"�(ur}dg .; ri;y;�,{�� .��1 tr�i 4°��'y�t�,r,r,Q J'�J�.�.1� �eri�'��`S'�"'"�'r}�j����U�`{�� $� e• :�Yt�,c� ^µ .S� '�'"'.m '"�dr-1az'i.\'Sc,'a.�Y4�jt.i�"a'�'�rw;E�'lsc�3Ar•Y.a'i�_.n.�f,�c�,t�'�.�. a�., � Drs.Medical Ctr.-San Pablo P.O. BOX 2517 Account Information Santa Ana, CA 92707-0517 Ntfmt NW Oat cal ELIZABETH DELVALLE 004671376 Ac+:+xwl qni tt Mr��.Vet 00145343134 61 709 ER Accmnt Ral.nce January 17, 2001 689.30 Mmlt Wte 11/26/2000 F"111 ty 00145343134 GAR Drs.Medical Ctr.-San Pablo Gu+ranter 11111111111111111111111111111111111111111111111111111111111111111iI111I11111111 ELIZABETH DELVALLE ELIZABETH DELVALLE 333 LINDA 800/346-0775 SAN PABLO, CA 94806 Para asistencia en espanol,sirvase Ilamar a!numero!dcntificado. ; :''"` due« . :><>« >'.'>>: «:: <>. ;<:> Thisas a remihd�r that yaut.payl ent snow ::..: ;.... ;:..... ::>:..<;:.;::: :« ......... ...... Phrase rernil your payment off 6 account balance; A::�tdAin irnvela�pe has been.enclosed t10' yatar tv 'ir<<: « > <: ���< ::«:':< «:> < �«�; � < ::>t:::> -`:«:><< < fi < .»>: .« << ::;:: ..< Tz:: jci :: It ou; refer>tv> a :wlth: csur llsa :It asterCard<:>Dlscaver ior;Amenean;E ress;card;:, leas::::... ... t l ti. return l i bbltbtj ; otti6n'6 a is letter> .. ; . .. .' :::< >: : . :;. con .ete a e... h .. I�. . . . ..... .. I� del.....ot er' r�ia.............rietits ave .&hi is e w .wl : x e .0. a� meet m u l to ieae « : >< Uns_ . _ _ . . . _..+ ,: .; e. p..GY.Ya._ P..y ou off; .no lot _t a _t. ys f o� a,th.:....at off s letter..._.. :... . ....... __,:.._::_ ._ .. _ .... .. .. ... .. . _._. . .. ._. . . .. . . . ..... .. :..:.......... 1. a ment h s alr:ead ' been:: xiitde« . as :d re ard: 1 .. . . .. a e O. .. . th s nonce: : . :li;i:iisi::ii:'iij::':i:;:::::r;: <>;>:::;::::.:.:: ;::::: ::::::>::;;:;;>; .: ............I:; :;;::;; :z::;.::;:<.<;:;>. We would"lke;to tliaril.j!au'#cr your cc€ .et thin and #off tte.ci vi'tunt to he:<of;seree.:: P pp . y .. . If.you should have ally questions, please contact us at the plane number<pl lntetl above PLEASE DETACH THIS PORTION AND RETURN IT WITH YOUR PAYMENT. To pay by credit card, please complete this section EXPIRATION DATE VISA MASTERCARD MONTH YEAR Amount to Charge 177771 IJU LL >< > <>« C;JAMEX E[ DISCOVER CARD NUMBER(ALL DIGITS PLEASE) Print cardholder's name: CLQ .. Cardholder's signature: —-- -- Please include your account number on your check or money order,payable to: Drs.Medical Ctr.-San Pablo Account Number..... 004671376 Responsible Party... ELIZABETH DELVALLE Drs .Medical Ctr.-San Pablo Patient Name.......... ELIZABETH DELVALLE Po Box 31001-0169 Account Balance..... 689.30 Pasadena, Ca 91110 Payment Amount MECFR04 Please make sure the above address shows in the window of the envelope provided. 0910169 004671376 000068930 9 ER ' CA EMER PHYS*DMC SAN PABLO CMP' TAX ID# BILLING OFFICE PHONE 1601 CUMMINS DR. , STE. D-38 94-3273404 1(800)664-7660 MODESTO CA 95358-6403 ACCOUNT NUMBER DATE OFSTAI'EMENT 38-08-04671376 02/23/01 Address Service Requested PATIENT'S NAME DELVALLE ELIZABETH I I LOCATION OF SERVICE I 03843-1 CEP *DMC SAN PABLO CAMPUS (209) 557-1264 ELIZABETH DELVALLE SAN PABLO CA 94806 333 LINIDA SAN PABLO CA 94806 I I DATE POS DIAGNOSIS DESCRIPTION OF SERVICES AMOUNT 11/26/00 23 ** 99283 LEVEL 3 EMERGENCY, PHYS CHA 135.00 ** 7242, 8469, E8121 1 11/26/00 23 7242 99052 NIGHT (10:00 P.M. - 8:00 A. 15.00 02/22/01 999913 INSURANCE CARRIER PAYMENT 135.00- i I I i I I ' I I I EMPLOYER INJURY DATE jADMISSION DATE DISCHARGE DATE CHIRON CORP 11/26/00 I 15.00 I I I it I REFERRING DOCTOR CARSON; DESMOND M.D. ATTENDING DOCTOR CARSON, DESMOND M.D. . ......... ..................... ELIZABETH DELVALLE 333 L I N I DA ACCOUNT NUMBER STATEMENT DATE SAN PABLO CA 94806 38-08-04671376 02/23/01 I j PRIMARY POLICY # SECONDARY POLICY# 9368663 i MAKE CHECK PAYABLE.TO: SEF:REVERSE SIDE FOR AN EXTLANATION OF THIS BILL CEP *DMC SAN PABLO CAMPUS I CA EMER PHYS*DMC SAN PABLO •CMP 1601 CUMMINS DR. , STE. D-38 MODESTO CA 95358-6403 15.00 I I � V ' V 2 _ - `7v - C i-o CLABI BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA BOARD AC11011t June 19, 2001 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 I 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: $755.84: MAY O 7 2001 COUNTY COUNSEL CLAIMANT: Dorothy Warner MARTINEZ CALIF. ATTORNEY: None DATE RECEIVED: May 8, 2001 ADDRESS: 2124 Alfred George Ct BY DELIVERY TO CLERK ON: May 8, 2001 Tracy, CA 95376 BY MAIL POSTMARKED: May 4, 2001 i I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOEIi1 SWEETEN, Cler Dated: May 8, 2001 By: Deputy. II. FROM County Counsel TO: Clerk of the Board of Supervisors (✓I ✓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: 5 ` 6'—0` By:��4 !;r,0,"A___Deputy County Counsel M. FROM Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). TV. BOARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. ( ) Other: I certi that this is a true and correct copy of the Board's Order ntered in its minutes for this date. Dated: �l . l JOHN SWEETEN . 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. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully )repaid a certified �copy of this Board Order and Notice to Claima addressed to a cl mant as shown above. Dated: Dd o , By: JOHN SWEETEN, CLERK 13 kL6eputy Clerk I This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. I I I 0 I I i i i I I I I I I I r Claim k: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100`h day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must.be presented not later than six' months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2. ) B. Claims must be filed with the Clerk' of the Board of Supervisors at its office in Room 106, County Administration Building,651 Pine Street,Martinez, CA 94553. C. If Claim is against a district ooverned;bv 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 RECEIVED Against the Countv of Contra'Costa MAY 'O;8 2001 or . . CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. District) (Fill in Name) The undersigned claima t here vmakes claim against the County of Contra Costa or the above named District in the sum of S ;. o�,`'4'and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact Date and Hour) -'---= °-----i--------------------------------------- 2. Where did the damage or injury occur? (Include City and County) Tis sckr VA, 3. How did the damage or injury occur? (Give full details:use extra paper if required) 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury--or damage? 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Ai© OI I .313 01 I AIM "N011u'SISI 38 t:-9,1 fl'� _J_CJIJL :__�_iLk�fed _C ,J(_;�:,'_3I SaItld38 HiIh 033308d 01 NOI1NBOH1n8 83WOISn3 -------------------------------- -3t, Y11 S398U M3N NO N0I103iOC id 08V VH (1H 8 >30a 3OI:id mo-1yno 1f1O7d %i�l� 01 3df1 -qq s�:f:?��T�il:i�>CI o v;18 Iz ........ 00'06x', 00, 00'661 11485348"9-59 983 a59i11i0S/Wd lU51 3NI1 3SIIX3/aal SIM NO11dI83530 Aib 39 3,101 ING08d H331 WS1S .....-.--...................................._._..----------------------..,................-----------.._._...__._._.,,.,----._..... -- -- ....... .......------._.....- " f_,N0I13fI?•11t.-3NI 90001 10 2 100001bL[ JiSnO Ji 907 N 1Nf10JJN _.....................-...... --._....._._-.- l x2''7 6 9 C.) ---KOICYNI .J .3 jN1 Tl 3�1r,r; . .I Iliw �::i - tfli.;li I'•!T d_L.�1•IiJ�ICi " _:-0JV-J N?:.Jf"I..L:3':i V;;1 :;I.Lt+..LS",3SNT-1 Wti I-Ily �0 1�;=i( iI3}3 - -3w11 r_ •3 `j 1)'iwV11: FROM :, BILLINGS CHEVROLET PHONE NO. : 408 473 9995 Apr. 18 2001 09:10AM P1 AV)R 18, 2001 COUNTER SATES Store 01 PARTS01 PORT 15 2525 MAKE GM PART#(S) - - m— LN# QOH BIN DETAIL PACK LIST TRADE COST CORE SRC _ `------- -------- -------- -------- --- 1 450MEW WHEEL-16X 5.803 OD C 1 480.50 qmmmmw eammew 0.00 PRICES CALCULATED FROM MASTER MCS I F114 s 7'sqy (A=ADD) (Bn=BRCH) (C=CONT) (Ln=LOC) (On=ORDRS) (Pn=PG#) (P=PRNT) (LS=LOST) (TAB) APR-18-2001 09:02 408 473 9995 P.001 04/18/2001 WED 10:18 FAX Z001 0 4 -1 r.•-2 G:0.3. P R I: c E_ lJ U 1- E P A G E 1 i49 : ?6 P,i01 AMLRIC''A 'i I IRE COP1PANY - CfiN 18 650-980-9611 3 ' LJ. Et- (:011110 . FAL. I+101JP11-ATN VIEW, CA 940,10--+1000 NA i6 E: : WARNER ,.30E PHONE : I-RANCODE : 1 At7D :L`;5 : 9:3 CHE.VY CAMARO 51_�ilh : b c u v P-11)IJN-1 A 1 N V.CELJ ti i A. I c : CA L7:P : 940411 LANNY ---------------------------------------------------..------------------------------------------------------------------------------------ CODE CC QTY SIZE DESCRIPTION F.E.T PRICE ANOUNT ....-------------------------------------------------------------------------------••------------------------------------------------------ 30146 1 1 P245150ZR-16 LENT GOODYEAR EAGLE 6S-C BCS 0.00 161.00 161.00 80015 1 1 STATE REQUIRED ENVIRONMENTAL FEE 0.00 1.00 1.00 80229 1 1 WASTE TIRE DISPOSA;. FEE 0.00 2.00 2.08 80299 1 1 90 DAY GUARANTEE COMPUTER SPIN BALANCE 0.00 13.99 13.99 30141 1 1 P245(50ZR-16 RIGHT GOODYEAR EAGLE GS-C BCS 0.00 161.00 161.00 8C075 1 1 STATE REQUIREO ENVIRONMENTAL FEE 0.05 1.00 1.00 50224 1 1 WASTE TIRE DISPOSAL EEE 0.00 2.00 2.00 8x299 1 1 90 DAY GUARANTEE COMPUTER SPIN BALANCE 0.00 13.99 13.99 80003 1 2 SHIPPING 6 HANDLIN!i - 0.00 10.00 20.00 80146 1 2 RUBBER VALVE 0.00 2.15 5.50 TAX: 29.08 TOT AI: 422.55 FItC_l:: CU : TOMER I'I_A1' RLPA:IR A04D R0'rA'r;I0N Ilii.s C1 s good fc.)r• 3 1 dciyE. I Hi1hJl` 'r:JtJ F1)Ft :,ttOP1�:[,IvG AiIE R LG 1 :IRE C0i11�ANY (Salesperson's Signature) APR-19-2001 09:2E3 P.001 m�G,Ou.Ls .�pq M�zGn 30. 200111 .23am y.;i March 30, 2001, 11 :22am mvc-003s.jpg �as iiN err .y ''/j .. .. _ • • ��..'..// f � =tx"k�' L 'rte"•��yar,, {".:. [.i Am ,Ni ^r 7 - eP ` e I • � o I _ i i I I —'— .•-'':::'S' tib"_ .:.'7 yxy�u > ml J fl '- -�;•� .�:.`y`ti(: MM : •�`..'T l•.A •ala:-.-- - lypi' 4�?�' . :�, `:YLy�Yt:.:•'�ti•�.X.'1�:�..� ..�: � � �� ..1,�Y: '..;4,�i»� .n;�sti��'y`'X•:�,;/. Fn,f', 'ti.:•lgr�rFt'.: r_G"ti:NS:lA.::: .ri''Ye ,:.�!�_' `fir;.-:.i's3��'-:::s:.:.;:�.,. .rY 'ki;��'•� '.:i": c..;'.;•"e7�::it' :. .. .. - '<-.:�'.:•ec.:.:r.:.s�.:�:EG.`'.'�.ri*''•i•; '..:4.� ,,;:a's'1'_ - .,3ire�t:,.ri ti":tii,�rs^ .:z.. k.. }i - F.t. 1 i bdC• s700-CAU IU12SZTT 'TOOZ '0E u�z2Y1 r . y i r 7 ,f �y 3 ' vsh �MSi�I ` N L \ 7L, �i r 1,A r 8 J 2 Q Q ii. ANW L.<� CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA BOARD ACT10June 19, 2001 Claim Against the County, or District Governed by 1 the Board of Supervisors, Routing Endorsements, 1 NOTICE TO CLAIMANT and Board Action. All Section references are to 1 The copy of this document mailed to you is your California Government Codes. notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and MAY 14 2001 915.4. Please note all "Warnings". AMOUNT: In Excess of $500,000 COUNTY COUNSEL MARTINEZ CALIF. CLAIMANT: Clayton Bartholomew ATTORNEY: Marlene P. Getchell DATE RECEIVED: May 11, 2001 ADDRESS: 790 Mission Ave. BY DELIVERY TO CLERK ON: May 11, 2001 San Rafael, CA 94901 BY MAIL POSTMARKED: May 10, 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted`.claim. JO WEETEN C IK Dated: May 11, 2001 By: Deputy. H. FROM: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: .S'! By: Deputy County Counsel 111. 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: (k) This Claim is rejected in full. ( ) Other: I certif that this is a true and correct copy of the'. Board's Order entered in its min tes for this date. Dated. I JOHN SWEETEiV 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. AFFIDAVIT 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: 4 1 By: JOHN SWEETEN, CLERK By Deputy Clerk This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The Count}, of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. Marlene P. Getchell Attorney at Law RECEIVED 790 Mission Avenue San Rafael, CA 94901 (SBN 72187) MAY 1 1 2001 Telephone Number: (415) 457-8830 Facsimile Number: (415) 459-13.84 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. Attorney for Claimants Clayton John Bartholomew and Sophie Chao CLAIM AGAINST A MUNICIPAL ENTITY CONTRA COSTA REGIONAL MEDICAL CENTER GOVERNMENT CODE SECTION 911.2 1. Name/Address of Claimant: Clayton John Bartholomew 1006 North Main Eureka, Kansas 67045 Sophie Chao 281 Fernwood Drive Moraga, CA 94556 2. Name/Address for Service of Notice, etc.: Marlene P. Getchell Law Offices of Marlene P. Getchell 790 Mission Avenue San Rafael, CA 94901 3. Date, Location and Description of Incident: On December 14, 2000 at Contra Costa Regional Medical Center, Contra Costa County, Martinez, California, Cash William Bartholomew,the child of Claimants Clayton John Bartholomew and Sophie Chao, died as a result of the intentional acts and/or negligence of Contra Costa Regional Medical Center, its employees, staff and agents, all of who are directly responsible for the death of Cash William Bartholomew. Contra Costa Regional Medical Center, its employees and agents intentionally or negligently failed to exercise the proper degree of knowledge and skill in caring for Sophie Chao and Cash William Bartholomew, and failed to provide adequate care, supervision and protection for Cash William Bartholomew and Claimants Clayton John Bartholomew and Sophie Chao, thereby causing the death of their son Cash William Bartholomew. Claimants were given specific assurances by the Contra Costa Regional Medical Center, its employees and agents that their child would be safe while under the direction, supervision and care of Contra Costa Regional Medical Center. The Contra Costa Regional Medical Center,its employees and its agents failed to provide adequate care, supervision and direction of claimants' child or follow through on their assurance of safety from a known danger. Despite the foregoing affirmative representations to Claimants,the District,its employees and its agents took no action to follow through on their assurances or to safeguard Claimants or their son. As a result, each Claimant named herein has been injured and the Claimants' son has died. 4. General Description of the Indebtedness,Obligation,Injury,Damage or Loss Incurred Medical expenses of Sophie Chao, unknown at this time. Medical expenses of Cash William Bartholomew to date of his death,unknown at this time. Punitive damages according to proof. Loss of earnings of Sophie Chao, unknown at this time. The Claimants continue to suffer emotional distress as a result of the above described incident. 5. Names of Public Employees or Employees Causing the Injury, Damage or Loss, If Known. At the time of the incident,.Sophie Chao and Cash William Bartholomew were patients at Contra Costa Regional Medical Center. The names of public employees or employees causing the injury, damage or loss, are unknown at this time and have yet to be identified. 6. Extent of Claim: The claim of each of the Claimants is within the jurisdictional limits of the Superior Court. Each Claimant claims an.amount in excess of$500,000. Each claim is not a limited civil case. DATED: . () 6 MARLENE W ETCHELL Attorney for Claimants 1 PROOF OF SERVICE 2 3 I am a citizen of the United States and employed in the County of Marin; I am over the age of eighteen years and not a party to 4 the within action; my business address is 790 Mission Avenue, San Rafael, California 94901. 5 On May 10, 2001, I served the following document(s) : 6 Claim Against A Municipal Entity by Claimant Sophie Chao 7 Claim Against A Municipal Entity by Claimants Clayton John Bartholomew and Sophie Chao 8 Addressed as follows: 9 Certified Mail/Return Receipt Requested 10 Clerk of the Board of Supervisors 651 Pine Street, First Floor 11 Martinez, California 94553 12 Certified Mail/Return Receipt Requested Frank Puglisi, Jr. 13 Executive Direcotr Hospital and Health Centers Division 14 2500 Alhambra Avenue Martinez , California 94553 15 XX By depositing a true copy thereof in the United States 16 mail at San Rafael, California, in a sealed envelope, with first-class postage thereon fully prepaid. 17 By depositing a true copy thereof in the United States 18 mail at San Rafael, California, in a sealed envelope, with Express Mail postage thereon fully prepaid. 19 By delivering true copy thereof , at San Rafael , 20 California, to a driver authorized by Federal Express to receive documents in an envelope designated by the 21 express service carrier, with delivery fees provided for. 22 By facsimile transmission to 23 By personally delivering a true copy thereof at the address set forth above. 24 I declare under penalty of perjury under the laws of the State 25 of California that the foregoing is true and correct. 26 Dated: May 10, 2001 27 MARLENE P. GETCHELL 28 LAW OFFICES OF MARLENE P. GETCHELL 790 Mission Avenue SAN RAFAEL, CA 94901 (4 15) 457-8830 LETTER OF TRANSMITTAL May 10, 2001 Certified Mail/Return Receipt Requested Clerk of the Board of Supervisors 651 Pine Street, First Floor Martinez, California 94553 Re: Claim Against Municipal Entity Claimants: Clayton John Bartholomew and Sophie Chao Dear Sir/Madame: Enclosed please find: Claim Against A Municipal Entity by Claimant Sophie Chao Claim Against A Municipal Entity by Claimants Clayton John Bartholomew and Sophie Chao ( ) For Signature and Return ( ) Per Your Request ( ) For Signature and Forwarding ( ) Per Our Conversation as noted below ( ) Approved ( ) For Review and Comment ( ) Approved as noted ( ) For Correction ( ) Disapproved ( ) For Recordation ( ) For Your Files ( ) For Payment ( ) See Remarks Below ( ) For Court Filing and Return ( ) Other of Endorsed Stamped Copy in envelope provided. REMARKS: Please file stamp receipt on enclosed page 1 of each claim and return in the enclosed envelope. Thank you for your assistance in this matter. Very truly yours, Marlene P. Getch 11 Enclosure c: \wp51\letters\trans2 c ,a s CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA BOARD ACT1011t June 19, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, 1 NOTICE TO CLAIMANT and Board Action. All Section references are to I 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 i � 2009 915.4. Please note all "Warnings". AMOUNT: $120,000 COON-y COUNSEL MARTINEZ CALIF. CLAIMANT: Rodney K Windsor Jr #2000026172 ATTORNEY: None DATE RECEIVED: May 17, 2001 ADDRESS: MDF D—C-1 BY DELIVERY TO CLERK ON: May 17, 2001 901 Court St. Martinez, . CA 94553 BY MAIL POSTMARKED: May 15, 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JO WEETEN, ler Dated: May 17, 2001 By: Deputy. II. FROM County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections' 910 and 910.2. ( ) This claim FAILS to comply substantially with ,Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: �r By: 'Deputy County Counsel III. FROM Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the, Supervisors present: (X) This Claim is rejected in full. ( ) Other: I certify, that this is a true and correct copy of the Board's Order e ed in its min es for this date. Dated:/ JOHN SWEETEI�1 Clerk, By e�ty 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 MAII.ING 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 certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: CZ By: JOIN SWEETEN, CLERK By Deputy Clerk This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. Claim to: BOARD, OF SUPERVLSO,S 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` day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause*of action. (Gov't Code 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By Reserved for Clerk's filing stamp oh nw1 VI m� A o1®60oa(aa RECEIVED Against the County of Contra Costa or ) MAY 1:7 2001 District) CLERK BOARD OF SUPERVISORS (Fill in name) ) CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ /660' and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) cy 3 30 P ►'h 2. Where did the damage or injury occur? (Include city and county) cc, 3. How did the damage or injury occur? (Give full details; use extra paper if required) l� 7'hI5 rn-E4c.Jil( tic brau36 - ' n vS his!' <�bar* Ce�rY; bcn►n5 � k.-r-9- OL,no4 r cbl�,a. f COGeo'DaS on /2uSeV9I83 4. What particular act'or omission on the part of ceunty or district officers, servants, or employees caused the injury or damage? �XCQJITI VU CC.P_ / 1-arra-3S/o�tl�` 5. What are the names of county or district officers, servants, or employees causing the damage or injury? f�0 � F', co��4 y oa- cznc}► cS ►jolt'►('f (ZJP �'v, r C por cz�l- 5vPjz�ior) r.Iu(,e 40 +roti rN 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) � i 1 Q P Fo �� 13�� ' n I vx`t Q QcQ iUIeck (3aa , -` (-Qc.�,Cgwe1-eV\ G-,f\ 16'r U�sA�� a (3 (��•� �y� �c . t^��l x��n ✓i o 1�ylo-w 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) vv�_ LAJ a r / flu-�v t .a (ri.�o� ► c� 8. Names and addresses of witnesses, doctors, and hospitals. 9. List the expenditures you made on account of this accident or injury. DATE TIlvffi AMOUNT Gov. Code Sec. 910.2 provides "The claim must be signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney Name and Address of Attorney X y i X+rilkva(tf laimant's Signature) K44" amt® &'° Cep tivur oc, 45 53 � (Address) Tgs53 ►/11 C'r ► rLcZ C-0. � �► Telephone No. Telephone No. ****************************************************************************************** NOTICE Section 72 of the Penal Code provides: Every person who,with intent to defraud,presents for allowance or the payment to any state board or officer,or to any county,city, or district board or officer,authorized to allow or pay the same if genuine,any false or fraudulent claim,bill,account, voucher,or writing, is punishable either by imprisonment in the'county jail for a period of not more than one year,by a fine of not exceeding one thousand(S 1,000),or by both such imprisonment and fine,or by imprisonment in the state prison,by a fine of not' exceeding ten thousand dollars($10,000),or by both such imprisonment and fine. ��, �� .�.�� '`=�''+ 1 �. t ; � j�,;, _.. 1 ��.:.' 4 , 1 �1 ,. � � � ,e �. �, -74 ---Cao+r �F ------- 01 _dM- --- 93 i;- — -- � spo�.s��l�s) - - - - - ------- --- '_n-1 pct.r I/ L Ii 4, —fie v 3ACiAj-I:)-57- 4-Lz-4Zn _n -exr III I- 61-w-,Zm" -CLC-JI q 3jL G(CL ohon �d o�. �u!1 i S �►Y1�.,��)—p.F Pf�.�I�J�1—�-1'A � r�.Rr-4�/U� �' 1 i✓_9.1s� 17 o F ey"o 1 , /Vo ft C i , o M'C i als ► - 4),Z-0- ns Co ryl-r n-f lop )o --- �. -- ---shit►FE.s__._.( �u _�S_—C_C�� --- --�_�'.-----Ccs.�b.e..ll.._...._0.�_�..._..__G�_►_��_��.__o..�C�xCszs.Sl_��Q._._ el - . _ $�' 13 r_�.�_Ii-��--U,P.O'.,.�Z. --CLfIZ_�.►Z--,--��nQ.�.,(,t).�S'o.r_.� � ��.no.C1-�y)----- /Dl---�--- o�c��r',_1.___�.�.th_aoo.�.—��_�3o._P_�._.i..n_f�.�Ac�_.►._�z----- a ►�h�a��---------- �a iii • p �3 _ CQ��c�Com�I'/t-*�-�--c,,� �.����c�-R.ti•4.--�--�<.u-��_v`a--■--f��,--��cl.-----•-...._.. win — 'J�.2_c ►s_Q�cl�S�ctr`� �_s._ h.a a nv�'11�a,r_dL -- - — �_E�o l7 -,�v_u._C_s..L._toar_\/- - �.�_c����c.�lz�_Uz_L-1.� waw-.�_h_�.�.�1:c.v_�L-�c�hQ•��d fh_.�b�� --- �.. c.�..�.�.._.—.--- a c� J R—_��o-c._.�o�c�.__moo--- '�"f_�►.ck_,. .C��'tc��.�.n�-�?--�..�--�-.C..—.----- aa_._.�_----1,�._in��.Sor __._��a..��.c�_�f Fd.r�-._c.{ cox_3._Ln►_R���-.5.__.su�,.1.•z_cz�-s...--------.ay -----------._�__ _'�r. _a_ ._�adtis�-��c._ _I_v��a�_►z.�.^�--so�-1�� .� ---�u_�._._v.t.,cQ.��._�►.►� ..... ------__�._...---..._..Ci�1C� ....cU U..�`,-�,`t.f�.�...�,.._C..)r�.�'1....Yi�l�. �C►1 owVLL��...�� .I�JGS (�f�4�/r.0 U S�.�/ �.YI.j.U�'.�U ,. . i4y -�f._.. .�SJ.(..� 1 rv, r r.� ---.............. -..._............ 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'- /� .-T'A� _ ._._.. . ._ _;^r .t* �%f 7.s f .+'r:• is r-� v4 A j � ' .'f,.i a• L? ! `C _ Y !./ i�%� �'Z. f? l.t '7 t: �: "��t:_:�j � r�J.•y �'• ,�i��".�:`Y /Y: i:�•'. '. C' X. La(I ijc"7 P,if ztc 47 7 7 I. y!�'�>r`�!;1(/.///�r{��f` !,�%a��. _ �pJ�r�'::1 .~q.!'-r''`` 'f`�E� /f � !� �:`/'� •�J s 's'"' �- r 5/ l� .�,�rl C-' t'�.J"�. f^'.----�•�i''l.` � 'r� "i�� s'•l.,f, - I i ,'C .�J. �S"�.,'�i� .r '` ` .���1� 1' f � .l .i C C IL.'`a/ e� f+i" ��g.:��f::%'T- rte.'= �• ` d�r��rr�• i �{ t%'f n :, .r ,�� .��J' �'� � •-ice- r��� ^�t 'f�f?P:-�' ��r�'�_:::` r, � Yi- ,� i�r �.•�.�+Y'-`a-3•,���+=-ir •r• r `�. J�•' :4r 'fir r�J 1� %,�� f � �•+::�'� r`". .��,�l:d �'. 4':�� ai 7 �' �iF�� ��' /�' %��':�''� =���$°'�,{ � �L`;�,t,,.:� ..- :-"�. /ha r�''. :`«` rs!�s.'•<�! f"�•_` .•''cif fJ��"!i . jw � iy !i T'� � YP•i .'r� / _ b�r7. � .c�'`� '! r \ � sr:: r '-+'+ � - f i7 �1; .f`tf •�'��'t '�,n ',civ+`=�i � Y•'�s'� •d '�� ����� �Mi��r ".." i; �a:� • 'i?`- "��' y� ,� a. f � �•- i- -!:-'�• ,�".. ..s'i'r 'A...- _ .�• '.� i' ':3_ -19 Lj 'tom "4r �' �f' � <' S * �.. .. +r' 3".!4 J'� * t':J i f'..17 7'f�f,•�' %/ :� %i t��' './! ■�l/�� �� i•7i'!! '�'F'�f fl�f. �r.1'% .�J?.7d1' .7"7--T "�f 7 d'/!:df? `;i r i m + C �•'..� r 7'/Y?� j'l'. Il T i r C"�'77 .i✓�S �~ `` :t✓' !.3' i el. 'FYr 4• j_ I��.+�f�� i�=' � 'T O Fr .:.T j•. r `.� '�,; t}•.,-.'._: {�...,.Y I - 'Y�FY'E: `�'!,rte' .�.. :.� r•:I .+�.i••,,�:.. � 2` � � i'1'• �..-,' L'�'•'r �i�:�5.•��.:1 `.:.�.ry'. - - IX i t eft ��' -•'jJ- 1 !4� 1 l `J I iy- L ' 114 is a 40 C� o F' a - 6�`I r -- 4 4 y � I____ Lcitcutii of Luttirzl 1;i15tzi Wffirr of tltr ii.Nlirriff Warren E. Rupf snean i March 30, 2001 Mr. Gary Mosbarger Martinez County Detention Facility 1000 Ward Street Martinez, CA 94806 Dear Mr. Mosbarger: I have been advised of your Citizen's Complaint that on March 3, 2001, employees of this department used unnecessary force against you. Additionally,you alleged that an inmate death was caused by staff at the Martinez Detention Facility on November 19, 1999. The Office of the Sheriff will always investigate a citizen's complaints and concerns so that we may improve our level of service to the community and its'citizens. The Internal Affairs Unit of the Sheriff's Office will be reviewing these matters and initiating an investigation if appropriate. At the conclusion of this review,you will be notified as to the findings. Sincerely, WARR VE RUPF, SH RIFF L-T CL By: Lieutenant Dale v4rady Professional Standards &Resources c �s Ccs • a yv`o.A'o�S Co c...��a.l n LS- (.�� `t ^ �3o Q r c►F Post Office Box 391• Martinez, California 94553-0039 (925) 335-1500 • a �' C7� LQ �._ :A st 1 AN 4 ti } C� CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA BOARD ACTIO June 19, 2001 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 RIECM11 Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and MAY f 7 2001 915.4. Please note all "Warnings". AMOUNT: $50,000 COUNTYcouNSEL MARTINEZ CALIF. CLAIMANT: Elizabeth Stevens ATTORNEY: Michael J. Recupero DATE RECEIVED: May 17, 2001 ADDRESS: 650 California St 26th Flr BY DELIVERY TO CLERK ON: May 17, 2001 San Francisco, CA 94108 BY MAIL POSTMARKED: May 16, 2001 I I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JO1vTEEiT Jerk Dated: May_ 17, 2001 By: Deputy .i I H. FROM: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should returnclaim 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: I Deputy County Counsel I M. FROINZ 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 I certif that this is a true and correct copy of the Board's Order entered in its minute for this date. Dated: 0Dl JOHN SWEETEli 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 i f This Notice. AFF 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 cl imant as shown above. Dated: 6 By: JOHN SWEETEN, CLERK By'z� b Deputy Clerk This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult thespecific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. CLAIM FOR DAMAGES AGAINST CONTRA COSTA COUNTY MERPITI4EW MEMORIAL HOSPITAL AND CONTRA COSTA REGIONAL MEDICAL CENTER TO: CONTRA COSTA COUNTY BOARD OF SUPERVISORS 651 Pine Street DECEIVED Martinez, CA 94553 MERRITHEW MEMORIAL HOSPITAL I 2500 Alhambra Avenue CLLARD OF SUPERVISORS Martinez, CA 94553 CONTRA COSTA Co. CONTRA COSTA REGIONAL MEDICAL CENTER 2500 Alhambra Avenue Martinez, CA 94553 The following claim is hereby';made by and on behalf of Elizabeth Stevens against Contra Costa County, Contra Costa Regional Medical Center and Merrithew Memorial Hospital. A. NAME AND POST OFFICE ADDRESS OF CLAIMANT Elizabeth Stevens, Social Secur=ity No. 550-92-4437 c/o Todd and Jenny Goodspee& 3671 Edmonton Way Concord, CA 94520 B. ADDRESSES TO WHICH NOTICES ARE TO BE SENT Elizabeth Stevens c/o Todd and Jenny Goodspeed 3671 Edmonton Way Concord, CA 94520 Michael J. Recupero Walkup, Melodia, Kelly& Echeverria 650 California Street, 26°i Floor San Francisco, CA 94108 C. DATE, PLACE AND OTHER 'CIRCUMSTANCES WHICH GIVE RISE TO THIS CLAIM The incident which gives rise to this claim occurred following claimant's admission to the hospital on or about November 28, 2000 at Contra Costa Regional Medical Center and Merrithew Memorial Hospital. The claimant Elizabeth Stevens was admitted to the hospital with complaints of nausea and vomiting and underwent abdominal surgery. Thereafter, her care was managed by physicians and nurses who were acting as employees or agents for the County of Contra Costa, Contra Costa Regional Medical Center, and Claim for Damages Page 2 Merrithew Memorial Hospital. At all times mentioned herein and on or about December 4, 2000, the respondents, and each of them, failed to timely diagnose,treat and care for Ms. Stevens's health condition, including the vascular obstruction to her lower extremities. During this period of time there were significant irregularities, signs and symptoms which were not appreciated or acted upon in a timely manner. Said actions were negligent and resulted in bilateral above-the-knee amputations of claimant's legs, and other injuries. The treatment rendered to claimant Stevens herein during her stay at Contra Costa Regional Medical Center and Merrithew Memorial Hospital was negligent and such negligence legally caused her to sustain injuries as hereinafter described. D. DESCRI.PTION OF INJURIES AND DAMAGES: The claimant suffered bilateral above the knee amputation to her lower extremities as well as other injuries presently undiagnosed. E. ECONOMIC LOSSES: Claimant has sustained and will sustain medical and attendant care costs for care and treatment of her injuries. Future medical and care costs are currently unknown and will be provided when obtained. Plaintiff has sustained a past and present loss of earnings and earning capacity. F. EMPLOYEES CAUSING INJURY AND DAMAGE The name of the particular employees of said public entity responsible for the occurrence herein described are unknown to claimants at this time. G. AMOUNTS CLAIMED: Plaintiff will claim the entirety of her economic and noneconomic damages available to her pursuant to the proof at the time of trial. Damages for the claimant exceed $50,000, the minimal jurisdictional limits of the Superior Court. DATED: May 16, 2001 WALKUP, MELODIA, KELLY & ECHEVERRIA By: �6m� MICHAE J. RECUPERO Attorneys for Plaintiffs PROOF OF SERVICE (CCP 1013a, 2015.5) I am over the age of eighteen years and not a party to the within action; my business address is and I am employed at Walkup, Melodia, Kelly & Echeverria, 650 California Street, San Francisco, California 94108. On the date below I served the following document(s), the original of which was/were produced on paper purchased as recycled, in accordance with Rules of Court §201(d): CLAIM FOR DAMAGES AGAINST CONTRA COSTA COUNTY, MERRITHEW MEMORIAL HOSPITAL AND CONTRA COSTA REGIONAL MEDICAL CENTER to: Contra Costa County Board of Supervisors 651 Pine Street Martinez, CA 94553 Merrithew Memorial Hospital 2500 Alhambra Avenue Martinez, CA 94553 Contra Costa Regional Medical Center 2500 Alhambra Avenue Martinez, CA 94553 ® BY CERTIFIED MAIL. I caused such envelope with postage thereon fully prepaid to be placed in the United States mail at San Francisco, California. 1 declare under penalty of perjury that the foregoing is true and correct. Executed on May 16, 2001, at San Francisco, California. Shiloh Leza PROOF OF SERVICE x � x � t� J fd tJ NCD0 �� p • 0 p '1 C, �,....... (31 C3 w N Ln LL, � . D vv � 9 11K1,i con � '.aa'h'11aCQa 1 i 1 O N `d, N Z, N m o d O o a� Q @ C6 pV V G c? tV�CCn c N (L m _ 9 7 �Y l d O o m CC 7, N U '= *' O o-<1' T U Sl N 6' O Ci- .- r CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA BOARD A0011t June 19, 2001 i Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ! ) NOTICE TO CLAIMANT and Board Action. All Section references are to 1 The copy of this document mailed to you is your California Government Codes. I notice of the action taken on your claim by the I&IET'lEavl[EM Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and MAY 17 2009 915.4. Please note all "Warnings". COUNTY COUNSEL AMOUNT: Unknown MARTINEZ CALIF. i CLAIMANT: John T. Wadsworth ATTORNEY: Steven Henderson DATE RECEIVED: May 17, 2001 i ADDRESS: 3024 Railroad Avenue i BY DELIVERY TO CLERK ON: May 17, 2001 Pittsburg, CA 94565 1 i BY MAIL POSTMARKED: May 16, 2001 i i I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. SWEET N, ; X C er Dated: May 17, 2001 By: Deputy , H. FROM County Counsel TO: Clerk of the Board of Supervisors i ( 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). i ( ) Other: i /� Dated: �— f'� � 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: iv) This Claim is rejected in full. ( � Other: i I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JOIN SWEETEN Clerk, By4abttg�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 .vant to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. i AFMAVTr 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 clamant as shown above. Dated: 6 Q� By; JOHN SWEETEN, CLERK By eputy Clerk This warning does not apply to claims which are not subject to the California Tort Claims Act such,as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. 1 STEVEN H. HENDERSON - SB #88620 2 JILL STERN-HENDERSON - SB #148172 Attorneys - Abogados RECEIVED 3 3024 Railroad Avenue 4 Pittsburg, California 94565 MAY 17- 2001 (925) 427-1771 5 FAX: (925) 427-42$2 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. 6 Attorneys for Claimant 7 8 In the Matter of the Claim of: 9 10 JOHN T. WADSWORTH, 11 Claimant, 12 Vs. 13 CONTRA COSTA COUNTY HEALTH CLAIM FOR DAMAGES 14 SERVICES DEPARTMENT,:,CONTRA COSTA COUNTY, DARYL I': SMITH, 15 M.D., THOMAS E. WHITE, M.D., DR. CORCORAN, DR. KWOK, DOES 1 16 through 25, and DOE CORPORATIONS 17 1 through 25, inclusive, 18 Respondents. 19 20 I. 21 JOHN T. WADSWORTH hereby presents this claim to CONTRA COSTA 22 COUNTY HEALTH SERVICES DEPARTMENT, CONTRA COSTA COUNTY, DARYL I. 23 SMITH, M.D., THOMAS E. WHITE, M.D., DR. CORCORAN, DR. KWOK, DOES 1 24 through 25 and DOE CORPORATIONS 1 through 25, inclusive, pursuant to Government 25 26 Code §910, et seq. 27 28 1 Wadsworth Claim ' II. 2 The name and post office address of Claimant is: 3 4 John T. Wadsworth 3036 N. Francisco', 5 Antioch, CA 94509 6 III. 7 The post office address to which Claimant desires notice to this claim to be sent is 8 as follows: 9 Law Office of Steven H. Henderson 10 3024 Railroad Avenue 11 Pittsburg, CA 94565 12 IV. 13 At all times herein mentioned, the CONTRA COSTA COUNTY HEALTH 14 SERVICES DEPARTMENT,,CONTRA COSTA COUNTY were public entities and at all 15 times herein mentioned defendants DARYL I. SMITH, M.D., THOMAS E. WHITE, M.D., 16 DR. CORCORAN, DR. KWOK, and DOES 1 through 10, were employees and/or agents 17 18 of the above-named public entities and were acting in the course and scope of their 19 employment and/or agency. 20 V. 21 On or about December.1, 2000, and at all times thereafter, at the CONTRA 22 COSTA COUNTY REGIONAL MEDICAL CENTER, defendants, and each of them, 23 24 caused injury to Claimant JOHN T. WADSWORTH as the result of negligent medical 25 treatment, including, the negligent insertion of the endotracheal tube and/or mouth gag 26 and negligent diagnosis of the source and cause of bleeding after Claimant's tonsils 27 were removed. 28 2 Wadsworth Claim VI. 2 , Amongst other negligent acts, defendants, and each of them, rendered negligent 3 4 medical treatment, care, and diagnosis, relating to surgery and all care and treatment 5 administered before, during, and after Claimant's surgery. 6 VII. 7 At all times herein mentioned, the defendants negligently failed to provide proper 8 and reasonable medical care to Claimant JOHN T. WADSWORTH. 9 VIII. 10 11 As a result of the aforementioned negligence of defendants, and each of them, 12 Claimant has suffered great emotional damage, physical damage, and loss of earnings, 13 medical bills, general damages and special damages. The amount of these damages 1 has not yet been ascertained, due to the severity of Claimant's injuries. 15 IX. 16 17 Therefore, Claimant JOHN T. WADSWORTH seeks relief for the damages he 18 sustained as a result of the negligent failure of defendants, and each of them, to properly .19 provide proper medical treatment to Claimant JOHN T. WADSWORTH. 20 21 22 Dated: May/ , 2001 23 EN H. HENDERSON 24 Attorneys for Claimant 25 26 27 28 3 Wadsworth Claim 1 PROOF OF SERVICE 2 I am employed in the County of Contra Costa, California. I am over the 3 4 age of eighteen (18) years and not a party to the within cause. My business 5 address is: 3024 Railroad Avenue, Pittsburg, CA 94565. 6 On the date shown below, a copy of the attached document(s): 7 CLAIM FOR DAMAGES',was served on the interested parties in this 8 action by placing a true copy thereof in a sealed envelope, addressed as 9 10 follows: ' 11 Clerk of the Board of Supervisors 651 Pine Street 12 Martinez, CA 94553 13 [ ] (BY PERSONAL SERVI(;E) By causing each such envelope to be 14 delivered by hand, as addressed, with instructions that it be personally served. 15 [ X ] (BY MAIL) By placing said envelope, with postage thereon fully prepaid for 16 first-class mail, for collection and mailing at my place of business following 17 ordinary business practice. I am readily familiar with the ordinary business practice for collection and processing of mail. In the ordinary course of 18 business, mail is deposited with the United States Postal Service on the same day as it is placed for collection. 19 20 [ ] (BY FACSIMILE) By,causing said documents to be transmitted by facsimile machine to the number indicated after each address listed. 21 [ ] (BY OVERNIGHT COURIER) By causing said document(s) to be delivered 22 by overnight courier to the addressee(s) noted above. 23 I declare under penalty of perjury under the laws of the United States that 24 the foregoing is true and correct. 25 Executed May 16, 2001, at Pittsburg, California. 26 27 28 BARBARA COATES v v� CD N CD tT CN tU 7� m o ,.- � � a c0 w U) c n N G�GriLf. ��`il�lZ- .J"ci�xia�.-C�c�asuic .9-f/S65 May 16, 2001 Clerk of the Board of Supervisors 651 Pine Street Martinez, CA 94553 Re: _Wadsworth v. Contra Costa County, et al. Claim for Damages Dear Sir or Madam: Enclosed please find an original;and one copy of the Claim for Damages in the above- referenced case. Please stamp the copy with your received stamp and return it to this office in the envelope provided. If you have any questions regarding this matter, please do not hesitate to call. Very truly yours, Barbara Coates Legal Assistant Encls. CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA BOARD ACT1011k June 19, 2001 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 I 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". ilff 17 2001 AMOUNT: $25, . 000 COUNTY COUNSEL CLAIMANT: Abraham Dumanon MARTINEZ CALIF. ATTORNEY: Scott L. Woodall DATE RECEIVED: May 17, 2001 ADDRESS: 2340 Santa Rita Rd #5 BY DELIVERY TO CLERK ON: May 17, 2001 Pleasanton, CA 94566 BY MAIL POSTMARKED: May16, 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JO E C erk Dated: May 17, 2001 By: Deputy'. H. FROM: County Counsel TO: Clerk of the',Board of Supervisors ( his claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.:8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: S! �$''D( 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: ( ) 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 minute for this date. Dated: Q0 JOHN SWEETEN 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. AFFIDAVIT OF MAEUNG 1 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 prepaidn certified copy of this Board Order and Notice to ClaimanE_ iQ;;;Zuty shown above. Dated: O ��' By: JOHN SWEETEN, CLERK By Clerk This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. I ►��-qw Office of Scott L. Woodall 234 0 Santa Rita Road, Suite 5 Phone: (925)600-01 1 1 Pleasanton,California 94566 Fax: (925)600-0003 RECEIVED January 12, 2001 MAY 1-7 2001 CERTIFIED RETURN RECEIPT REQUESTED CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. Alameda-Contra Costa Transit District 1600 Franklin Street Oakland, California 94612 Cleric, Board of Supervisors County of Alameda Administration Building 1221 Oak Street, Room 536 Oakland, California 94612 Clerk, Board of Supervisors County of Contra Costa 651 Pine Street, Room 106 Martinez, California 94553 Re: GOVERNEMNT CLAIM FOR MONETARY DAMAGES.RESULTING FROM PROPERTY DAMAGES AND PERSONAL INJURIES Client : Abra{:am Dunranon Date of Loss: 12106/00 Greetings: Please consider this correspondence a "Notice of Government Claim" pursuant to the California Government Code. The addresses of my client is 40183 Leslie Street, Fremont, California 94538. Please direct all communications directly to this office. May 14, 2061 Page 2 I. FACTUAL SUMMARY On December 6, 2000, at approximately 10:00 a.m., my client, traveling in his white 1993 Nissan pick.-up, California license plate number 4V81.434, was struck from behind by AC Transit Bus #2605 on line #29. �The accident occurred on Mowry Avenue, near Blacow, in the city of Fremont. My client was making a right turn onto a private driveway and was struck from behind. IL LIABILITY My client is informed and believes the bus driver, T. Brar #30896, and the Aiameda- Contra Costa Transit District, the Cowity of Alameda, and the County of Contra Costa are directly and vicariously liable',for the negligent operation of a AC Transit bus because the driver, during the court and.',scope of his employment, violated California Vehicle Code, sections 22350 and 21703'. Further, Alameda-Contra Costa Transit District, the County of Alameda, and the County of Contra Costa are directly and vicariously liable for my client's injuries because they negligently trained and supervised the drivel- of the bus. SUMMARY OF INJURIES AND DAMAGES Soon after the collision, my client sought treatment for his injuries. My client was treated for injuries to his head, neck, back, shoulder, arm; leg, and foot pain and/or injuries. As a result of the collision Mr. Dumanon has incurred property damage, including loss of use damages, and wage loss. Please consider my client's claim for property damage, personal injuries, pain and suffering, wage loss, medical. expenses, loss of use of property, general damages, shock, anxiety and injury to his nervous system, attorney fees, loss of consortium, and any other loss which may become known in the future as a result of the above-described automobile accident. The extent of my client's economic damages, as well as non-economic damages, is not yet known. What is certain is my client's damages will be in excess of$25,000.00, which is the jurisdictional minimum of the Superior Court of the State of California. May 14, 2001 Page 3 Accordingly, I expect that you will respond as required by law. T look forward to working with you in an effort to bring about a',fair and equitable settlement. Sincerely, Scott L. Woodall S L W/rn k to CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNLA BOARD ACT10tlt June 19, 2001 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 31211V[E Board of Supervisors. (Paragraph IU below), given pursuant to Government Code Section 913 and MAY 1 5 2001 915.4. Please note all "Warnings". AMOUNT: $1844.59 COUNTY COUNSEL ,MARTINEZ CALIF. CLAIMANT: Sean C. Pressler ATTORNEY: None may 14 2001 DATE RECEIVED: Y ADDRESS: 3234 Northampton Ct. BY DELIVERY TO CLERK ON: May 14, 2001 Pleasanton, CA 94588 BY MAIL POSTMARKED: May 11, 2001 I. FROM: Clerk of the Board of Supervisors, TO: County Counsel Attached is a copy of the above-noted claim. JOHN ETEN, le Dated: May 14, 2001 By: Deputy, II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.') ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: �'J� By: L-002Deputy 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: 00 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. JOHN SWEETEN Dated: 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 NIAEUNG 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 certified copy of this Board Order and Notice to Claimant, addressed to the cl imant as shown above. v� O (� JOHN SWELTEN CLERK Dated: ��- �l r � �� By: � B} � Deputy Clerk This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAS ANT 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 ore owing crops and which accrue on or after January1, 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. ( Goat. 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 94-4-53. 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 entit,% E. Fr:md. CPQ ner.alt•for fraud»ient claims. Penal Code Sec. 72 at the end of this form. RE: Claim by . ) Reserved for ClerWs'Filing Stamp RECEIVED Against the Count of Contra Costa MAY 14 2001 or CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. • District ) (Fill in Name) The undersigned claimant hereby makes claim,against the Count• of Contra Costa or the above named District in the sum of S 10 -S and in support of this claim represents as follows: 1. When-.did the damage`or-iglu'ry occur!. GINe enact Date and,Hour - Zn171 ----- ---- - 1 - -'`�------------'---`--------------------- 2. Where did the damage or injury occur? (Include Cin•and County) _���CO__�IGDt)!✓1 _ j�►�/-- �V��--8��2'0�-_��----=---------------------------- 3. How did the damage Or injury occur. (Give full details use este paper if required;i gia FF-1a, DR-o?'PC-_ L.&V-4,6 er-�JP_0-4-M OPQ t_.,6-.o o�9-- A CV-V S'5 ,4,4t, ., 170 -L - C , ------------------------------------------------------------------------------------- 4. What particular act.or omission on the part. of count•. or,district officers, servants, or employees`caused the injury or damage? ". . _ �1126F1&M-re Z SIAA-m D '5i5e-rra4J OF �DOF E UC A^31> IT S(t D vFr- (Over) j I -jug paE luauiuosiidmi gars gloq Sq so `( 000`01s ) ssrllop'pursnogl qal'.uipaa:)xa lou jo aug r .{q 'uosud ams aql nt lumuosudun .Cq .io `aug paE laauruosuduri q:)ns gloq .iq -jo •( 000•is ) S1Ellop pursnogl aao ouipaaaxa 1oa jo aag E :+q 'jm,e auo,.Uugl a ioui 1oa,Io pouad u lo3.11ef,.iianoa agl.ai luaiuuosuduzl .iq iaglia algEgsiund st `nullWA:to •iaganon •1lInoJJr `lllq 'tu?Eia,,. lualnpnuij to aslrl .i UE •auinuau j! awles aql .icd to .jiollr of pazuoglnr `.ia:)Wo so p.[Eoq laulsip 1o: %,Llunoa .iuE of so°iaag;o to psroq alrls .iuu 01 luaui,ird lol io aaur.+nollg io;sluas;ud �.pnuijap of lualu► gli& ogee uosrad.iian3„ :sap�io.id apoD lquad agl..jo Zi, ao[IaaS 3JI10N �t�6 •ori auogdalaZ .auogdalal, l almra;:i slur.ulirlJ ) . catuou'p SSalppv pur mwkE lrgaq.slq.uo` uossad os .iq to (.iawouv) :oi s3 uo_O- Q_�;3s luruiirlJ aql.iq paa ►s aq lsnru Lump aql,, f :s.aPi.iotd nI� -aas ;)POD -.'&of) � X X Y X X 'X X � X �f � �c :F X at {c �C Y l' L X � � �f � � � � � X � � � X X � %�.� X Y Y X � �C X X � X �.X•� �.:i � :.ijnful.io luaplOaE sigljo.luno-joE no aprui noxi sairaipuadsa aql lsi'I 6 ---------------------------------------------------- -- ------ 3�� �� �� 8 �+ •�sd oil, Qb+��'� rworwlvp tf5 OlArW tw 1—&o sleldsoq`par. ssalabp' sassauli.+n'Jo sassa�ppr'pa^'Saul^ti g' - ------------ ------- --- ----------- --------------------------------------------------- Ave(-.4 5-. /V1 (•aoeutep to Zinfur anwadsold.sue jo iunomc pamwusa ay7 apnj�uj? Lpalnduioo iunoiIIr paiuirla a,,oyE aql SE." .11Ug , ,. V�,•.'�...,e+:/�N� , 'Q��,(I'�SCN.1rJ r GG1O�.1V"�GJ��bQ` '��Q��.../ - loj salau[psa OAQ Ipcuv 'pau[[ep saoeutep.to sarsnfui jo.waixa nnj anis) .Lpallnsa.i mrriz no i op sa[srifui'Io iauEixILp:lEgA '9 ---�i------�-'--`A--------------.6---- --- • �i r.--_ ;l_ - ;.._i_ F r•:..s'•�•',.:'. .._--- ;,:ilnfIIt so aaEIIirp agl UIIIsnE� saaeoldIIta so`slareras•S.ia•JI},}0 1Julslp 10.�lIIn0��0 SaII1EII aql alE lEq� 'y - I 05/011 21 0_. at 03: ._7 PM oi:� I93 B & S HACIENDA AUTO BODY License # :AG161460 Federal ID = : 9424640(:7 i Quality isn't expensive it's priceless 3687 OLD SANTP. RITA RD #7 I PLEASANTON, CA 94588 I (925) 847-8789 Fax: (925) 847-0804 I PRELIMINARY ESTIMATE I rplritten by: ROBERT SANCHEZ # Adjuster: I nsured: Snawn Pressler Claim # Owner : Shawn Pressler Policy # F.ddress 3234 North Hampton Deductible: Pleasanton, CA 94588 Date of Loss : %5) 989-6447 1Type of Loss : Point. of Impact: i Ir:spe;:t B & S HACIENDA AUTO BODY Business: ;c;;_!-, ;� ci Location: 3687 OLD SANTP, RITA RD #7 PLEASANTON, CA 94588 i I r:s.-,rar. :e i ('oncar.y Days to R.epji.i i 1985 VW JETTA 4-1AL-FI 4D1 SED green Int: I'.v: ri',iV;Gv.O"_68F'v!7�i 9.139 Lica: Prod Date: C: ::. :ter: Rear De;o ger ( Intermittent Wipers Tinted Body Side ?-loicii!:gs I Dual Mirrors Clear Coa; int Power Bra:4res iCloth Seats Bucket SeE.t :: RecLir.e;"Lounge Seats --------------------------------------------- -......--- ---------- NO. OP. DESCRIPTION QTY EXT. l.'FI _:1 FAINT 1 FRONTIBUMPER 0/119 bumper asst' GRILLE R&I Grille 5 HOOD i � 1 , , 115/03/2:101 at 03: 1-7 PM �:ol> P•] - - -932 PRELIMINARY ESTIMATE 1985 VW1 ETTA 4-1. 8L-FI 4D SED green Int : -------- ------- -----------I-------------------------------- -- -- [d0. OP. DESCRIPTION QTY EXT. Pt:_CE -,P.:-: �. PAIi1T c-i Rpr Fl: -)d2. ! dd for Clear Coat 1 . FENDER Rpr LT Fender' 2 . . Overlap Major Adj . Panel -0. 4 Add for Clear Coat 0. "s Repl LT Body side mldg base 1 13. -11. 13 R&I LT Wheel opng mldg izi Repl Emblem GLI COWL & WINDSHIELD 1.6 Blnd Cow' panel 0. 6 i7 R&I RT -viper arm w/o turbo diesel i R&I LT Wiper arm w/o turbo diesel FRONT1DOOR Blnd LT Cuter. panel 1 . .1 Rep-1 L1' Body side mldg base 1 '76. 4( _. 'D Kepi LT Window ,molding upper 1 25 . 8`: R&_ Li Window molding lower 1 .'.� R&= LT Mirror ,remote control Rep.L ar cover ' 1 5. 0(: c :.lor tint 1 Rpr ::.l.:;r sand & polish ''"azardous waste 1 3. C(. ---------- ------------------ Subtotals =_> ].30. :)( 7 . 9 ,Parts 122 . 20 Body Labor 13. 3 hrs ( 6( . . Paint Labor 7 . 9 hrs (' S :':':r. Paint Supplies 7. 9 hrs / nr 19 . 50 Body Supplies 8. 4 hrs (9 2 . ;�-ir. 17 . 64 Sublet/Misc. � . 00 --------------------------------- ---------- -- ,SUBTOTAL -------------------------------- -...-- - -,SUBTOTAL $ i61- . 35 , 2 i i i 9T PRELIMINARY ESTIMATE 1985 VW' JETTA 4-]. .8L-FI 4D SED green Int : Sales Tar, $ 337 . 1-:4 i:t 0. 26. 99 -------------------------------------------- - - ------------ GRAND TOTAL $ 164= . 33 ADJUSTMENTS: Deductible 0.00 --------------------------------- - -- --- - CUSTOMER ------------------- - .. ..- -CUSTOMER PAY INSURANCE PAY S 1644 . 33 ii. :reek is q:.laranteeci for 1 year. We warranty wor'rmanst:ip nl::: :i l.rlt . 2' Life t:_::le guarartt.ee on our, Stage Paint and 5 (five) Year!: or, Stage ra1nL . 1 A'_1 sublet repair_s are warranteed for 1 year, wheel. :;i :: :: .-: :ts have a 3C ;:fay :larranty. 4 ) Damage! due to improper care or act of 1 'Void uarantee. EPA # 000000184 . .L._:ce.pte•-_? by Date rearMake Model to begi.rl repairs ::aged on WTC:R ':RASH ESTIMATING GUIDE. Unless otherwise noted a.. ) is •n.•: th ;.,..::.il': F,I::P.91'09 Ii,y1.;,1>as=: Da*.e 1/'001. and the parts selected are: OEM--pa !.:; :tc:::. .:in(,- ! by ::h.? i i. al Ecle .lnrcnt: 14anufacturer. Asterisk: (') or Double Astezisi es that :'he t.:. '•.:. .czho[ ;r -: ,ivation p ov.tded by MOTOR may Have been moclif.i.ec.l , me.; _O;:r_ Non-Or:.icli.n:+). Equ3.pment Manufacturer afterrnark:et l.x:ci a: A:7 ;uai F.•.p1. P<,rts. Gsr-rl parts are described as LKQ, Qual Recy Parts, V,C' of 0:'•':'. ,econdj.1,iO11e6 i Recored parts are described as P.ecor.e. NA( P-:r;. :>•: :; and P: _r:es ::r.•s (?r::': icle•.:1 front 1jr11Acir<jl. Auto G.I.ass Specifications, Inc. Pound s.idr. ;ili il :•u. :I: .:,te mania- entries. ..,,riiways P. p*.odu%:t. of CCC rnf.ormati.on Services In, . 3 INVOICE ELITE AUTO GLASS P.O. Box 2806 San.i Ramon,.CA 94583 Z (925.) 820-3208 Fax (925) 820-3401 Bill To: i Insured- Phone: Phone:/ Policy: -77 Cim #: AthNer: P.O.#/Ref: Loss Loc: Loss Date/Cause: Miles Yea[/Make M'6:40il .:': ge V Y 11 so 6e1�cli, D.Number.' -)"6 T'r no; VMA64. 16 11 Labor' CUSTOMER SIGNATURE Release and authorization to pay other than insured or claimant. Parts Sub-Total The glass has been replaced to my complete satisfaction and I authorize the Labor Sub-Total to pay direct to Elite Auto Glass the full amount due me under the terns of my policy covering the said Law and I understand for any reason my insurance company does Sub-Total not pay this claim I will be responsible for payment o I f same. Sales Tax INSURED In-Store: _7 L J 0"I / Address: t- City: Windshield Repair Possible? Yes Nov JA o7t Customer Initials: Accepted Declined Cmt: 0) CL cn C3 C3 al Tz N CD 0 0 Q) o Q) 0 ru CD :3 0 Ln (D .0 !- w U) �o 0 (00 0 (D 3 vo W 0 0) er rA \ N N Q y `y N N 'O � O• � yN Ji ✓ � U Y m h. y a � cP cP a N � 3 N 9 d'6 ° E ✓ � �0..� •o ��� ro u V 0 ((,� m � p"r3 Z"0, j, I I I I I • y 1 I 1 D I ,p , \• I O oA �• I - .� LA o �. I � I I i