HomeMy WebLinkAboutMINUTES - 07172001 - C.21 cap
CLAP1'I
HOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNLA
BOARD AC710July 17, 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. I notice of the action taken on your claim by the
Board of Supervisors. (Paragraph IU below), given
pursuant to Government Code Section 913 and
915.4. Please note all "Warnings".
AMOUNT: $250,000
CLAIMANT: Karina Martinez
ATTORNEY: John E. Gonzales DATE RECEIVED: June 5, 2001
ADDRESS: 1035 Carleton St. BY DELIVERY TO CLERK ON: June 5, 2001
Berkeley, CA 94710
BY MAIL POSTMARKED:
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JO E Clerk
Dated: June 5, 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: GJ��� 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).
�V. BOARD ORDER: By unanimous vote of the Supervisors present:
l.�)( 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 Deputy Clerk
i
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.DiG
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 th claimant as shown above.
Dated. By: JOHN SWEETEN, CLERK By V Deputy Clerk
l
y
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 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
KARINA MARTINEZ )
RECEIVED
Against the County of Contra Costa or CONTRA COST1 JUN 0 5 2001
REGIONAL MEDICAL CENTER, MERRITHEW )
HOSPITAL and DOES 1 - 20, inclub�igffict) 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$ 250,000.0%nd in support of this claim represents as follows:
1. When did the damage or injury occur?(Give exact date and hour)
December 5, 2000 .
2. Where did the damage or injury occur?(Include city and county)
Merrithew Memorial Hospital (Contra Costa Regional Medical Center) ,
County of Contra Costa, Martinez, California (hereinafter, "Medical Provider"
3. How did the damage or injury occur?(Give full details;use extra paper if required)
See enclosed Notice of Intention to Sue.
Y i
4. What particular act or omission on the part of county or district officers, servants, or employees caused the
injury or damage?
See enclosed Notice of Intention to Sue.
5. What are the names of county or district officers, servants, or employees causing the damage or injury?
Unknown medical provider(s) which Claimant believes is an employee or
are employees of Contra Costa County and Medical Provider.
6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach
two estimates for auto damage.)
See enclosed Notice of Intention to Sue.
7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or
damage.)
See enclosed Notice of Intention to Sue.
8. Names and addresses of witnesses, doctors, and hospitals.
Unknown medical provider(s) at Contra Costa Regional Medical Center
(Merrithew Memorial Hospital) , Emergency Department, 2500 Alhambra Avenue,
9. List the expenditures you made on account of this accident or injury. Martinez , California
DATE TIME AMOUNT
Investigation is underway and Claimant reserves the right to amend this
Claim.
******************************************************************************************
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 )
John E. Gonzales-Madrid 1)
DURAN, GONZALES, OCHOA & TAFOYA, LLP
1035 Carleton Street ) flaimant's Signature)
Berkeley, California 94710-2638 )
(510) 540-1046 ) As Vttorney (on left)
FAX: (510) 540-1036 ) (Address)
Attorney of Claimant )
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 JOHN E. GONZALES-MADRID
DURAN, GONZALES, OCHOA & TAFOYA, LLP
2 1035 Carleton Street
Berkeley, California 94549-3800
3 (510) 540-1046 . FAX (510) 540-1036
4 Attorney for Claimant/Plaintiff
KARINA MARTINEZ
5
6
7
8 SUPERIOR COURT OF CALIFORNIA, COUNTY OF CONTRA COSTA
9
10
11
12 KARINA MARTINEZ, )
No. TBD
13 Plaintiff/Claimant, )
NOTICE OF INTENTION
14 vs. } TO SUE
15 COUNTY OF CONTRA COSTA, MERRITHEW ) CCP § 364 (a)
MEMORIAL HOSPITAL; and DOES 1 )
16 through 20, inclusive, )
17 Defendants/Respondents. )
18
19 TO: COUNTY OF CONTRA COSTA, MERRITHEW MEMORIAL HOSPITAL;
20 BE HEREBY NOTICED, pursuant to CCP § 364 (a) , that Claimant
21 KARINA MARTINEZ intends to sue COUNTY OF CONTRA COSTA, CONTRA
22 COSTA REGIONAL MEDICAL CENTER, MERRITHEW MEMORIAL HOSPITAL (herein-
23 after, "Health Care Provider") and other unknown medical providers
24 for shock, fright and emotional distress under Dillon v. Legg
25 (1968) 68 C2d 728, 730, 69 CR 72, 74 caused by perceiving the
26 personal injuries inflicted by Health Care Provider on JOSE
27 TRINIDAD RUVALCAVA, patient of defendants and grandfather of
28 Claimant .
1 Legal Bases of Claim:
2 The legal bases of the claim are :
3 Actions and omissions of Health Care Provider constituting
4 medical malpractice (professional negligence) in the care of JOSE
5 TRINIDAD RUVALCAVA, specifically, an employee of Health Care Pro-
6 vider dropped a metal plate of some kind on the left foot of
7 Claimant while he was being treated at Merrithew Memorial Hospital
8 on December 5, 2000 and while Claimant was perceiving such inci-
9 dent . Such action and omission of Health Care Provider was a
10 deficiency in the standard of care to provide a safe environment
11 within which diagnosis, treatment and recovery was to be carried
12 out . Such action was contrary to hospital patient care protocol .
13 Such action and omission of Health Care Provider was a breach of
14 the hospital ' s professional duty to provide a safe condition by
15 permitting an unsafe condition to exist . See Murillo v. Good
16 Samaritan Hospital (1979, 4th Dis. ) 99 Cal. App. 3d 50, 160 Cal .
17 Rptr. 33) . Other actions and omissions of Health Care Provider
18 which breached the standard of care (as hereinafter defined)
19 includes, but is not limited to: failure of defendants to properly
20 train and/or supervise employees of defendants and other agents
21 (hereinafter, "agents" ) to assure that the standard of care (as
22 hereinafter defined) , was met . Health Care Provider, and each of
23 them, did not use the care and skill ordinarily used by health care
24 providers practicing in their respective fields and in the same or
25 similar locality and under similar circumstances (hereinafter,
26 "standard of care" ) . Defendants are vicariously liable for the
27 actions and omissions of agents which fell below the standard of
28 care .
2
1 Types of losses :
2 As a result of the negligence of Health Care Providers,
3 Claimant lost the use of his left foot which became infected and
4 developed gangrene. Such foot may have to be amputated.
5 The type of losses sustained to Claimant as a result of the
6 malpractice of Health Care Providers, which proximately caused the
7 physical injury of JOSE TRINIDAD RUVALCAVA, is :
8 (a) Emotional shock, fright and emotional distress .
9 (b) Anxiety, worry, ordeal .
10 (c) Horror.
11 Because discovery is continuing in this matter Claimant re-
12 tains the right to amend any information or assertion of her in
13 this notice.
14 Dated: June 4, 2001 .
15
JOHN NZALES-MADRID
16 Atto ey for Plaintiff
JOS TRINIDAD RUBALCAVA
17
18
19
20
21
22
23
24
25
26
27
28
3
1 JOHN E. GONZALES-MADRID, Bar No. 139455
TAFOYA & GONZALES-MADRID, LLP
2 1849 Willow Pass Road, Suite 301
Concord, California 94520-2524
3 (925) 676-4746; Facsimile : (925) 676-4705 RECEIVED
4 Attorney for Claimants
JOSE TRINIDAD RUVALCABA, PATRICIA SEP 2 8 2001
5 REYNOSA DE RUVALCABA and KARINA
MARTINEZ CLERK BOARD OF SUPERVISORS
6 CONTRA COSTA CO.
7
BOARD OF SUPERVISORS, COUNTY OF CONTRA COSTA
8
9
10
11 Claims of )
No. To Be Designated
12 JOSE TRINIDAD RUVALCAVA, )
PATRICIA REYNOSO DE RUVALCABA ) NOTICE OF CHANGE OF ADDRESS
13 and KARINA MARTINEZ, ) AND TELEPHONE NUMBER OF THE
THE ATTORNEY OF CLAIMANTS
14 Claiamnts. ) JOSE TRINIDAD RUVALCABA,
PATRICIA REYNOSO DE RUVALCABA
15 ) and KARINA MARTINEZ
16
TO THE BOARD OF SUPERVISORS, CONTRA COSTA COUNTY:
17
NOTICE IS HEREBY GIVEN that the address and telephone number
18
of JOHN E. GONZALES-MADRID, TAFOYA & GONZALES-MADRID, LLP, the
19
attorneys of Claimants JOSE TRINIDAD RUVALCABA, PATRICIA REYNOSO DE
20
RUVALCABA and KARINA MARTINEZ, are:
21
TAFOYA & GONZALES-MADRID, LLP
22 1849 Willow Pass Road, Suite 301
Concord, California 94520-2524 94520-2524
23 (925) 676-4746 FAX: (925) 676-4705 .
24 Dated: September 27, 2001 .
25 JOHN . fNZALES-MADRID,
Attor eyf Claimants
26 JOSE RIDAD RUVALCABA,
PATRICIA REYNOSO DE RUVALCABA
27 and KARINA MARTINEZ
28 RUV-CA. 01
1
1 DECLARATION OF SERVICE
2 I, the undersigned, declare according to Code of Civil Pro-
3 cedure H 1013 and 1985 .3 that :
4 I am, and was at the time of the service hereinafter men-
s tioned, at least 18 years of age, employed in the County of Contra
6 Costa, and not a party of this action. My business address is 1849
7 Willow Pass Road, Suite 301, Concord, California 94520-2524 . On
8 September 28, 2001, I served the within NOTICE OF CHANGE OF ADDRESS
9 AND TELEPHONE NUMBER OF THE ATTORNEY JOSE RUVALCABA, PATRICIA
10 REYNOSO DE RUVALCABA and KARINA MARTINEZ (Re: Claims of Jose
11 Trinidad Ruvalcava, Patricia Reynoso de Ruvalcaba and Karina
12 Martinez, Board of Supervisors, Contra Costa County) , on the person
13 [hereinafter termed "recipient"] whose name and address follow:
14 Clerk
Board of Supervisors
15 Contra Costa County
651 Pine Street, Room 106
16 Martinez, California 94553-1293 . _
17 Service was accomplished by:
18 X depositing a copy of the attached papers in the United States
mail in Concord, California, enclosed in a sealed envelope,
19 with postage fully prepaid, addressed to recipient at the
above address .
20
X personally delivering a copy of the attached papers to the
21 recipient at the above-indicated address .
22 leaving a copy of the attached papers with the clerk or per-
son in charge of recipient ' s office (address above) .
23
transmitting via facsimile a copy of the attached papers to
24 the recipient at the above-referenced FAX number.
25 Executed on September 28, 2001 at Concord, California. I
declare under penalty of perjury that the foregoing is true and
26 correct .
27
DECLARANT
28
2
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
BOARD ACT1ou July 17, 2001
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
Board of Supervisors. (Paragraph IV below), given
pursuant to Government Code Section 913 and
915.4. Please note all "Warnings".
AMOUNT: $250,000
CLAIMANT: Jose Trinidad Ruvalcava
ATTORNEY: John E. Gonzales DATE RECEIVED: June 5, 2001
ADDRESS: 1035 Carleton St BY DELIVERY TO CLERK ON: June 5, 2001
Berkeley, CA 94710
BY MAIL POSTMARKED:
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOI WEETEN. Clerk
Dated: .Tuna 5� ,001 : Deputy .
IL FROM: County Counsel TO: Clerk of the Board of Supervisors
( This claim complies substantially with Sections 910 and 910.2.
( ) This claim FA1LS 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:
Dated: , �' By: —fi4rDeputy County Counsel
M. FRONVL Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present:
( This Claim is rejected in full.
( Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date.
Dated. 1,171 2)01 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 MAII G
I declare under penalty of perjury.that I am now, and at all times herein mentioned, have been a citizen of the United
States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully
prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above.
Dated: ). By; JOEIII SWEiTEN, 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
Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A. Claims relating to causes of action for death or for injury to person or to personal property or growing
crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day
after the accrual of the cause of action. Claims relating to causes of action for death or for injury to
person or to personal property or growing crops and which accrue on or after January 1, 1988, must be
presented not later than six months after the accrual of the cause of action. Claims relating to any other
cause of action must be presented not later than one year after the accrual of the cause of action.
(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
JOSE TRINIDAD RUVALCAVA* RECEIVED
Against the County of Contra Costa or CONTRA COSTA) JUN 0 5 2001
REGIONAL MEDICAL CENTER, MERRITHEWee )
HOSPITAL and DOES 1 - 20, inc lus Visirict) CLERK BOARD OF SUPERVISORS
1l
(Fill in name) )
*Medical Record #7832223 CONTRA COSTA CO.
�
The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district
in the sum of S 250,000.0(dnd in support of this claim represents as follows:
1. When did the damage or injury occur? (Give exact date and hour)
December 5, 2000.
2. Where did the damage or injury occur?(Include city and county)
Merrithew Memorial Hospital (Contra Costa Regional Medical Center) ,
County of Contra Costa, Martinez, California (hereinafter, "Medical Provider"
3. How did the damage or injury occur?(Give full details;use extra paper if required)
See enclosed Notice of Intention to Sue.
v
4. What particular act or omission on the part of county or district officers, servants, or employees caused the
injury or damage?
See enclosed Notice of Intention to Sue.
5. What are the names of county or district officers, servants, or employees causing the damage or injury?
Unknown medical provider(s) which Claimant believes is an employee or
are employees of Contra Costa County and Medical Provider.
6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach
two estimates for auto damage.)
See enclosed Notice. of Intention to Sue.
7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or
damage.)
See enclosed Notice of Intention to Sue.
8_ Names and addresses of witnesses, doctors, and hospitals.
Unknown medical provider (s) at Contra Costa Regional Medical Center
(Merrithew Memorial Hospital) , Emergency Department, 2500 Alhambra Avenue,
9. List the expenditures you made on account of this accident or injury. Martinez , California
DATE TIME AMOUNT
Investigation is underway and Claimant reserves the right to amend this
Claim.
******************************************************************************************
) 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 )
John E. Gonzales-Madrid )
DURAN, GONZALES, OCHOA & TAFOYA, LL1�
1035 Carleton Street ) (Claimant's Signature)
Berkeley, California 94710-2638 )
(510) 540-1046 ) A att rney (on left)
FAX: (510) 540-1036 ) (Address)
Attorney of Claimant )
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($1,000),or by both such imprisonment and fine,or by imprisonment in the state prison,by a fine of not
exceeding ten thousand dollars(S 10,000),or by both such imprisonment and fine.
I JOHN E. GONZALES-MADRID, Bar No. 139455
DURAN, GONZALES, OCHOA & TAFOYA, L.L.P.
2 1035 Carleton Street
Berkeley, California 94710-2638
3 (510) 540-1046; Facsimile : (510) 540-1036
4 Attorney for Claimant/Plaintiff
JOSE TRINIDAD RUVALCABA
5
6
7
8 SUPERIOR COURT OF CALIFORNIA, COUNTY OF CONTRA COSTA
9
10
11 JOSE TRINIDAD RUVALCAVA, )
No. TBD
12 Plaintiff/Claimant, )
NOTICE OF INTENTION
13 vs. ) TO SUE
14 COUNTY OF CONTRA COSTA, MERRITHEW ) CCP § 364 (a)
MEMORIAL HOSPITAL; and DOES 1 )
15 through 20, inclusive, )
16 Defendants/Respondents. )
)
17
18 TO: COUNTY OF CONTRA COSTA, MERRITHEW MEMORIAL HOSPITAL;
19 BE HEREBY NOTICED, pursuant to CCP § 364 (a) , that Claimant
20 JOSE TRINIDAD RUVALCAVA intends to sue COUNTY OF CONTRA COSTA,
21 CONTRA COSTA REGIONAL MEDICAL CENTER, MERRITHEW MEMORIAL HOSPITAL
22 (hereinafter, "Health Care Provider") and other unknown medical
23 providers for professional negligence which proximately caused the
24 personal injuries of JOSE TRINIDAD RUVALCAVA, patient of
25 defendants .
26 Legal Bases of Claim:
27 The legal bases of the claim are:
28 Actions and omissions of Health Care Provider constituting
1 medical malpractice (professional negligence) in the care of JOSE
2 TRINIDAD RUVALCAVA, specifically, an employee of Health Care
3 Provider dropped a metal plate of some kind on the left foot of
4 Claimant while he was being treated at Merrithew Memorial Hospital
5 on December 5, 2000 . Such action and omission of Health Care
6 Provider was a deficiency in the standard of care to provide a safe
7 environment within which diagnosis, treatment and recovery was to
8 be carried out . Such action was contrary to hospital patient care
9 protocol . Such action and omission of Health Care Provider was a
10 breach of the hospital ' s professional duty to provide a safe
11 condition by permitting an unsafe condition to exist . See Murillo
12 v. Good Samaritan Hospital (1979, 4th Dis. ) 99 Cal. App. 3d 50 , 160
13 Cal . Rptr. 33) Other actions and omissions of Health Care
14 Provider which breached the standard of care (as hereinafter
15 defined) includes, but is not limited to: failure of defendants to
16 properly train and/or supervise employees of defendants and other
17 agents (hereinafter, "agents") to assure that the standard of care
18 (as hereinafter defined) , was met . Health Care Provider, and each
19 of them, did not use the care and skill ordinarily used by health
20 care providers practicing in their respective fields and in the
21 same or similar locality and under similar circumstances (here-
22 inafter, "standard of care") . Defendants are vicariously liable
23 for the actions and omissions of agents which fell below the stan-
24 dard of care .
25 Types of losses :
26 As a result of the negligence of Health Care Providers,
27 Claimant lost the use of his left foot which became infected and
28 developed gangrene. Such foot may have to be amputated.
2
1 The type of losses sustained to Claimant as a result of the
2 malpractice of Health Care Providers, which proximately caused the
3 physical injury of JOSE TRINIDAD RUVALCAVA, is :
4 (a) Loss of left foot .
5 (b) Special damages, including past and future hospital and
6 other health care facility expenses, medical expenses (of physi-
7 cians, surgeons, podiatrists, therapists, other medical practi-
8 tioners) , medical diagnostic expenses, drugs and medications,
9 prostheses and other aids to function, modification of vehicle and
10 dwellings, travel expenses related to medical treatment .
11 (c) Pain, suffering and emotional distress.
12 (d) General damages, including impairment of quality of life.
13 in his "golden years, " including a catastrophic impact on his self
14 esteem and feelings of self worth and value to his large extended
15 family.
16 Because discovery is continuing in this matter Claimant re-
17 tains the right to amend any information or assertion of his in
18 this notice.
19 Dated: June 4, 2001 .
20
JO N G ZALES-MADRID
21 A rney for Plaintiff
J TRINIDAD RUBALCAVA
22
23
24
25
26
27
28
3
1 JOHN E. GONZALES-MADRID, Bar No. 139455
TAFOYA & GONZALES-MADRID, LLP
2 1849 Willow Pass Road, Suite 301
Concord, California 94520-2524
3 (925) 676-4746; Facsimile : (925) 676-4705
4 Attorney for Claimant RECEIVED
JOSE TRINIDAD RUVALCABA
5 SEP 2 8 2001
6
CLERK BOARD OF SUPERVISORS
7 CONTRA COSTA CO.
8
BOARD OF SUPERVISORS, COUNTY OF CONTRA COSTA
9
10
11
12
Claim of )
13 ) No. To Be Designated
JOSE TRINIDAD RUVALCAVA, )
14 ) NOTICE OF CORRECTION OF
Claimant . ) NAME OF JOSE TRINIDAD
15 ) RUVALCABA, CLAIMANT
)
16
NOTICE IS HEREBY GIVEN that the full and correct legal name of
17
JOSE TRINIDAD RUVALCAVA, who filed a Claim on June 5, 2001 which
18
was rejected by the Board of Supervisors on July 17, 2001, is JOSE
19
TRINIDAD RUVALCABA. Any Complaint filed by this Claimant will be
20
filed under the name of JOSE TRINIDAD RUVALCABA and not under JOSE
21
TRINIDAD RUVALCAVA. Such persons are one and the same person.
22
Dated: September 27, 2001 .
23
JOHN 41 #OtZAIES-MADRID,
24 Attorlpy o Claimant
JOSE INIDAD RUVALCABA
25
26
27
28 RUV-CORR. 02
1
1 DECLARATION OF SERVICE
2 I, the undersigned, declare according to Code of Civil Pro-
3 cedure H 1013 and 1985 .3 that :
4 I am, and was at the time of the service hereinafter men-
s tioned, at least 18 years of age, employed in the County of Contra
6 Costa, and not a party of this action. My business address is 1849
7 Willow Pass Road, Suite 301, Concord, California 94520-2524 . On
8 September 28, 2001, I served the within NOTICE OF CORRECTION OF
9 NAME OF JOSE TRINIDAD RUVALCABA. CLAIMANT (re : Claim of Jose
10 Trinidad Ruvalcava, Board of Supervisors, Contra Costa County) , on
11 the person [hereinafter termed "recipient"] whose name and address
12 follow:
13 Clerk
Board of Supervisors
14 Contra Costa County
651 Pine Street, Room 106
15 Martinez, California 94553-1293 .
16 Service was accomplished by:
17 X depositing a copy of the attached papers in the United States
mail in Concord, California, enclosed in a sealed envelope,
18 with postage fully prepaid, addressed to recipient at the
above address .
19
X personally delivering a copy of the attached papers to the
20 recipient at the above-indicated address .
21 leaving a copy of the attached papers with the clerk or per-
son in charge of recipient ' s office (address above) .
22
transmitting via facsimile a copy of the attached papers to
23 the recipient at the above-referenced FAX number.
24 Executed on September 28, 2001 at Concord, California. I
declare under penalty of perjury that the foregoing is true and
25 correct .
26
DECLARANT
27
28
2
CLALVI
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY. ALTFO N A
BOARD ACTION July 17, 2001
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. ) 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: $250,000
CLAIMANT: Rosa Reynoso De Ruvalcava
ATTORNEY: John E. Gonzales DATE RECEIVED: June 5, 2001
ADDRESS: 1035 Carleton St BY DELIVERY TO CLERK ONJune 5, 2001
Berkeley, CA 94710
BY MAIL POSTMARKED:
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOH�1EETEN, le.k
d
Dated: June 5, 2001 By: Deputy_ �
d
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).
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:
Dated: �`C ��� 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).
1Y. BOARD ORDER: By unanimous vote of the Supervisors present:
('I.)-. 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 mikazeputy
fhis date.
Dated: ,awl JOHN SWEETEN Clerk, By 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
prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above.
Dated: By: JOHN SWEETEN, CLERK 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 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 100h 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
ROSA REYNOSO DE RUVALCAVA )
RRECEIVEDAgainst the County of Contra Costa or CONTRA COSTA) 001REGIONAL MEDICAL CENTER, MERRITHEWCLERKERVISORSHOSPITAL and DOES 1 - 20, inclubHfict) 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$ 250,000.0%nd in support of this claim represents as follows:
1. When did the damage or injury occur?(Give exact date and hour)
December 5, 2000.
2. Where did the damage or injury occur?(Include city and county)
Merrithew Memorial Hospital (Contra Costa Regional Medical Center) ,
County of Contra Costa, Martinez, California (hereinafter, "Medical Provider'
3. How did the damage or injury occur?(Give full details;use extra paper if required)
See enclosed Notice of Intention to Sue.
4. What particular act or omission on the part,of county or district officers, servants, or employees caused the
injury or damage?
See enclosed Notice of Intention to Sue.
5. What are the names of county or district officers, servants, or employees causing the damage or injury?
Unknown medical provider(s) which Claimant believes is an employee or
are employees of Contra Costa County and Medical Provider.
6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach
two estimates for auto damage.)
See enclosed Notice of Intention to Sue.
7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or
damage.)
See enclosed Notice of Intention to Sue.
8. Names and addresses of witnesses, doctors, and hospitals.
Unknown medical provider(s) at Contra Costa Regional Medical Center
(Merrithew Memorial Hospital) , Emergency Department, 2500 Alhambra Avenue,
9. List the expenditures you made on account of this accident or injury. Martinez, California
DATE TME AMOUNT
Investigation is underway and Claimant reserves the right to amend this
Claim.
******************************************************************************************
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 )
John E. Gonzales-Madrid )
DURAN, GONZALES, OCHOA & TAFOYA, LL)
1035 Carleton Street ) Z
asSignature)
Berkeley, California 94710-2638 )(510) 540-1046 ) A atey (on left)
FAX: (510) 540-1036 ) (Address)
Attorney of Claimant )
)
)
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($1,000),or by both such imprisonment and fine,or by imprisonment in the state prison,by a fine of not
exceeding ten thousand dollars(S 10,000),or by both such imprisonment and fine.
1 JOHN E. GONZALES-MADRID
DURAN, GONZALES, OCHOA & TAFOYA, LLP
2 1035 Carleton Street
Berkeley, California 94549-3800
3 (510) 540-1046 . FAX (510) 540-1036
4 Attorney for Claimant/Plaintiff
ROSA REYNOSO DE RUVALCABA
5
6
7
8 SUPERIOR COURT OF CALIFORNIA, COUNTY OF CONTRA COSTA
9
10
11 ROSA REYNOSO DE RUVALCAVA, )
No. TBD
12 Plaintiff/Claimant, )
NOTICE OF INTENTION
13 vs. ) TO SUE
14 COUNTY OF CONTRA COSTA, MERRITHEW ) CCP § 364 (a)
MEMORIAL HOSPITAL; and DOES 1 )
15 through 20, inclusive, )
16 Defendants/Respondents. )
17
18 TO: COUNTY OF CONTRA COSTA, MERRITHEW MEMORIAL HOSPITAL;
19 BE HEREBY NOTICED, pursuant to CCP § 364 (a) , that Claimant
20 ROSA REYNOSO DE RUVALCAVA intends to sue COUNTY OF CONTRA COSTA,
21 CONTRA COSTA REGIONAL MEDICAL CENTER, MERRITHEW MEMORIAL HOSPITAL
22 (hereinafter, "Health Care Provider") and other unknown medical
23 providers for professional negligence which proximately caused the
24 personal injuries of her husband, JOSE TRINIDAD RUVALCAVA, patient
25 of defendants .
26 Legal Bases of Claim:
27 The legal bases of the claim are:
28 Loss of consortium based on the actions and omissions of
1 Health Care Provider constituting medical malpractice (professional
2 negligence) in the care of JOSE TRINIDAD RUVALCAVA, specifically,
3 an employee of Health Care Provider dropped a metal plate of some
4 kind on the left foot of Claimant while he was being treated at
5 Merrithew Memorial Hospital on December 5, 2000 . Such action and
6 omission of Health Care Provider was a deficiency in the standard
7 of care to provide a safe environment within which diagnosis,
8 treatment and recovery was to be carried out . Such action was
9 contrary to hospital patient care protocol . Such action and
10 omission of Health Care Provider was a breach of the hospital ' s
11 professional duty to provide a safe condition by permitting an
12 unsafe condition to exist . See Murillo v. Good Samaritan Hospital
13 (1979, 4th Dis. ) 99 Cal . App. 3d 50, 160 Cal . Rptr. 33) Other
14 actions and omissions of Health Care Provider which breached the
15 standard of care (as hereinafter defined) includes, but is not
16 limited to: failure of defendants to properly train and/or
17 supervise employees of defendants and other agents (hereinafter,
18 "agents" ) to assure that the standard of care (as hereinafter
19 defined) , was met . Health Care Provider, and each of them, did not
20 use the care and skill ordinarily used by health care providers
21 practicing in their respective fields and in the same or similar
22 locality and under similar circumstances (hereinafter, "standard of
23 care" ) . Defendants are vicariously liable for the actions and
24 omissions of agents which fell below the standard of care.
25 Types of losses :
26 As a result of the negligence of Health Care Providers,
27 Claimant lost consortium due to the loss of her husband' s use of
28 his left foot which became infected and developed gangrene. Such
2
1 foot may have to be amputated.
2 The type of losses sustained to Claimant as a result of the
3 malpractice of Health Care Providers, which proximately caused the
4 physical injury of JOSE TRINIDAD RUVALCAVA, is :
5 (a) Loss of love, companionship, affection, society, solace
6 and comfort of JOSE TRINIDAD RUVALCAVA;
7 (b) Loss of conjugal fellowship;
8 (c) Interruption of future plans and planning;
9 (d) Loss of moral support;
10 (e) Need to provide additional care to JOSE TRINIDAD
11 RUVALCAVA.
12 (f) Impairment of quality of life in Claimant ' s "golden
13 years. "
14 Because discovery is continuing in this matter Claimant re-
15 tains the right to amend any information or assertion of his in
16 this notice.
17 Dated: June 4 , 2001.
18
Jq4q EGONZALES-MADRID
19 orn y for Plaintiff
O E T INIDAD RUBALCAVA
20
21
22
23
24
25
26
27
28
3
1 JOHN E. GONZALES-MADRID, Bar No. 139455
TAFOYA & GONZALES-MADRID, LLP
2 1849 Willow Pass Road, Suite 301
Concord, California 94520-2524
3 (925) 676-4746; Facsimile: (925)- 676-4705
RECEIVED
4 Attorney for Claimant
5 PATRICIA REYNOSO de RUVALCABA SEP 2 82001
6 CLERK BOARD OF SUPERVISORS
CONTRA COSTA CO.
7
8
BOARD OF SUPERVISORS, COUNTY OF CONTRA COSTA
9
10
11
12
Claim of )
13 ) No. To Be Designated
ROSA REYNOSO DE RWALCAVA, )
14 ) NOTICE OF CORRECTION OF
Claimant . ) NAME OF SPOUSE OF JOSE
15 ) TRINIDAD RUVALCABA,
CLAIMANT
16 )
17 NOTICE IS HEREBY GIVEN that the full and correct legal name of
18 ROSA REYNOSO DE RWALCAVA, who was identified as the spouse of
19 Claimant JOSE TRINIDAD RWALCAVA (sic) in her Claim filed on June
20 5, 2001 and rejected by the Board of Supervisors on July 17, 2001,
21 is PATRICIA REYNOSO DE RUVALCABA. Any Complaint filed by this
22 Claimant will be filed under the name of PATRICIA REYNOSO DE
23 RUVALCABA and not under ROSA REYNOSO DE RUVALCAVA. Such persons
24 are one and the same person.
25 Dated: September 27, 2001 .
26 JOHNE ZALES-MADRID,
Attor f Claimant
27 PATRI A EYNOSO DE RUVALCABA
281 RUV-CORR. 01
1
1 DECLARATION OF SERVICE
2 I, the undersigned, declare according to Code of Civil Pro-
3 cedure §§ 1013 and 1985 .3 that :
4 I am, and was at the time of the service hereinafter men-
s tioned, at least 18 years of age, employed in the County of Contra
6 Costa, and not a party of this action. My business address is 1849
7 Willow Pass Road, Suite 301, Concord, California 94520-2524 . On
8 September 28, 2001, I served the within NOTICE OF CORRECTION OF
9 NAME OF SPOUSE OF JOSE TRINIDAD RUVALCABA, CLAIMANT (re : Claim of
10 Rosa Reynoso de Ruvalcava, Board of Supervisors, Contra Costa
11 County) , on the person [hereinafter termed "recipient',) whose name
12 and address follow:
13 Clerk
Board of Supervisors
14 Contra Costa County
651 Pine Street, Room 106
15 Martinez, California 94553-1293 .
16 Service was accomplished by:
17 X depositing a copy of the attached papers in the United States
mail in Concord, California, enclosed in a sealed envelope,
18 with postage fully prepaid, addressed to recipient at the
above address.
19
X personally delivering a copy of the attached papers to the
20 recipient at the above-indicated address.
21 leaving a copy of the attached papers with the clerk or per-
son in charge of recipient ' s office (address above) .
22
transmitting via facsimile a copy of the attached papers to
23 the recipient at the above-referenced FAX number.
24 Executed on September 28, 2001 at Concord, California. I
declare under penalty of perjury that the foregoing is true and
25 correct .
26
DECLARANT
27
28
2
CLArni
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY CALIFORNIA
BOARD ACTION: July 17, 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 I t�I The copy of this document mailed to you is your
California Government Codes. � l notice of the action taken on your claim by the
Board of Supervisors. (Paragraph IV below}, given
JUN 2 0 2001 pursuant to Government Code Section 913 and
915.4. Please note all "Warnings".
COUNTY COUNSEL
AMOUNT: Moneak Yates MARTINEZ,CALIF.
CLAIMANT: $1000
ATTORNEY: None DATE RECEIVED:June 19,2001
ADDRESS: 525 Verde Ave BY DELIVERY TO CLERK ON: June 19,. 2001
Richmond, CA 94801
BY MAIL POSTMARKED: May 19, 2001
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JQ S[ ETEN, C er<
Dated: June 19, 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).
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:
Dated: By: B Deputy County Counsel
III. FROM Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present:
( This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date,
Dated. a(� 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 NIAILING
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.
Datecl--Sj� By: JOHN SWE-TEN, CLERK By I 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 statutesand
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 CLA PLANT
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 thanthe:1`00" 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 relatin;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:=..)
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 944-53.
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 file' against each public entity.
E. Fraud. See penalty for fraudulent claims. Penal Code Sec. is at the end of this form:
RE: Claim by ) Reserved for Clerk's Filing Stamp
RECEIVED
Against the County_ of'Contra Costa
or . JUN 1 9 2001
>' 91� 1 r CLERK BOARD OF SUPERVISORS
Mcn eiftl \N 0,'�f7 District) CONTRACOSTgCO
1 I .
(Fill in Mame)
The undersigned claims t hereby makes claim against the County of Contra Costa or the above named
District in the sum of S 4=-' and in support of this claim represents as follows:
1. When did the damage or inju; . occur? (Give ecaa Date and Hour)
.
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3. How did the damage or injure occur:' (Give full details.use esm paper if required)
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CLABI
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, 'CA 1EORNLA
BOARD AC110N: July 17, 2001
Claim Against the County, or District Governed by I
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. i notice of the action taken on your claim by the
Board of Supervisors. (Paragraph IU below), given
JUN 2 0 2001 pursuant to Government Code Section 913 and
915.4. Please note all "Warnings".
AMOUNT: $2451.66 G."--i: ; .,_,iSEL
MARTINEZ,CALIF.
CLAIMANT: Valerie J. Ranche
ATTORNEY: None DATE RECEIVED: June 15, 2001
ADDRESS: 651 Pine St 8 Flr BY DELIVERY TO CLERK ON: June 15, 2001
Martinez, Ca 94553
BY MAIL POSTMARKED:
I. FRO)IL Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOMEN, Jerk
Dated: June 19, 2001 By: Deputy
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
(L,�Y"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: 5-0 By: Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present:
(� This Claim is rejected in full.
( ) Other:
I certif that this is a true and correct copy of the Board's Order entered in its minutes for this date.
Dated: JJOHN SWEETEN . Clerk, By , G' , 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
kX repai a certified copy of this Board Order and Notice to Claimant addressed to the claimant as shown above.
\d: By: JOHN SWEETEN, CLERK By &4I 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
r
• ti
Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A Claims relating to causes of action for death or for injury to person or to personal property or growing crops
and which accrue on or before December 31, 1987, must be presented not later than the 100`h day after the
accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to
personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later
than six months after the accrual of the cause of action. Claims relating to any other cause of action must be
presented not later than one year after the accrual of the-cause of action. (Govt. Code §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
s�;--T6r,-X9-t Co L`L-� `LIOSE/ ) RECEIVED
Against the County of Contra Costa
JUN 1'5 2001
or
CLERK BOARD OF SUPERVISORS
CONTRA COSTA CO.
District)
(Fill in Name)
The undersigned claimant hereby makes claim against the County of Contra Costa or the above named
District in the sum of$o2'y� d in support of this claim represents as follows:
1. When did the damage or injury occur? (Give exact Date and Hour)
----�-----`D/-- - "�-� -------------e -- ------- ---------------------------
2. Where did the damage or injury occur? (include City and(::oounty)
---
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?
(Over)
v ,
-aug pue lumuesudmt Bans
qloq .iq ao `(000`oiS) s-ellop puesnogl ual'autpaaaxa lou;o aug a Sq luosud ales am ut luamuosudmt .iq..to•,aug
pue im muosudmt gans qloq :iq io 1( 000;IS ) saellop puesnoq;auo 2utpaa3xa lou 3o aug a Aq °jeaA auo ueq; aaom
IOU;o pouad a io; ltef.iiunoa aq; ui luamuosudim Sq.iaq;ta algegstund si tui;um io '.[aganoA';unoaae 'lliq•lumla
lualnpnrl;.co rile;.Cue °aumua,D.lt awes ay;.ied .io n+olle of pazuoglne 'iaagjo xo p-moq laulsip ao Alta .Clunoa :Cue
of ao laaag;o ao p.Ieoq ams:iur of luaiuAed xo;ao aauumolle lo;s;uasaid�pneJ;ap of jualul g;l b-oq.++uos zad:Csan3„
:sap�+oid apoJ leuad ay;}o ZL uotlaaS
� JI .LO N
// z Q oh auoydalaZ _ / c [.' �qK auoydala i _
ry
�o(ssavr)-Ipp
T00G,0
Al
(a.[nleualS s,lu tell)
".Jjegaq siq uo uos and amos.iq io. Giawoud) :OZ SaDI.L014 (Ngs
iuruuela aq;Aq V�a"R aq lsnui[utela aq L,,
I ::sapl.+oid Z-0I6 'aaS-,)POJ -AOD
14101 v 3lva
:.Clnful to luaptaae stgl;o lunoaae uo apem non saln;tpuadxa aql lst'I 6
.•sleltdsoq pup.°siolaop�sassault.N jo sassalppe pue samrK •g
-------------------------------------------------------------------------------------
(•aaewep io.ilnfui aAilaadso-id.Cue{o iunouie pa[eutgsa atnapntaul) ;palndmoa lunome pamiela aAoge aql se.N.Nog -L
-------------------------- ---
---
��,cv�c� �"v sad-,o�e� �,�-s� �r��c o '�'''V
acs', -0 1�U � D C-' �, `�'�1 S��1 a .��o
IA l �.
.[oj saleu[gsa oAy iPeud- -pauneia sa`ueu[ep to saunfui}o puma wu aAib) Zpallns;u ul!ela noA jop ssaun fu[10 sagemep legb -9
------------------------------------------r`a 7Y7��-- V1 '11���,7 J ---
;,A.�nfut.to aoemep ay;�utsnea saaeol�a to°s;ue.uas°siaa�o lau;stp to:+;unoa;o saureu aq;a.ie 1egM 'S
Attachment to claim form filed by Valerie J. Ranche
3. On June 14, 2001 at approximately 8:00 a.m., I entered the newly formatted parking lot
behind 651 Pine Street. The entrance at Escobar was narrowed by two cyclone fences,
each coming in at a different angle to the narrow entrance. I pulled to the right to avoid the
left side of the cyclone fence and found myself too far from the scanner. Joanie, who was
monitoring the new entrance, waved in front of the scanner raising the barricade. She
waved me ahead. I thanked her, pulled slowly ahead, and crushed the casing of my front
right sideview mirror and damaged the front right side of my car below the mirror.
4. The entrance had a design defect and visual trap. The left side of the cyclone fence led
the driver to pull to the right. The right side of the cyclone fence was angled outward from
the entrance giving the impression of more room than actually existed on the right side.
When waved through by Joanie, I did not realize that insufficient space existed on the
right side.
Please note that at all times, county personnel Joanie, Davida, and Sharon Hyme-
Offord were pleasant and courteous.
06/15/2001 at 02:46 PM Job Number:
21975
MARTINEZ AUTO BODY SHOP
Federal ID #:942574428
615 ALHAMBRA AVE
MARTINEZ, CA 94553
(925)228-3689 Fax: (925)372-6546
PRELIMINARY ESTIlNATE
Written by: KELLY SHAVER #
Adjuster:
Insured: VALERIE RANCHE Claim #
Owner: VALERIE RANCHE Policy #
Address: 866 NORTHBALE RD Deductible:
OAKLAND, CA 94610 Date of Loss:
Day: (925)335-1829 Type of Loss:
Day: (925)335-1829 Point of Impact: 2. Right Front Pil
Inspect MARTINEZ AUTO BODY SHOP Business: (925)228-3689
Location: 615 ALHAMBRA AVE
MARTINEZ, CA 94553
Insurance
Company: Days to Repair
1990 EAGL TALON 4-2.OL-FI 3D WHITE Int:TAN
VIN: 4E3CS44R4LE058409 Lic: 2SCW387 CA Prod Date: Odometer:
Air Conditioning Rear Defogger Tilt Wheel
Intermittent Wipers Tinted Glass Body Side Moldings
Dual Mirrors Clear Coat Paint Power Steering
Power Brakes Power Windows Power Locks
Power Mirrors AM Radio FM Radio
Stereo Cassette Search/Seek
4 Wheel Disc Brakes Cloth Seats Hiback Bucket Seats
Recline/Lounge Seats
-------------------------------------------------------------------------------
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
-------------------------------------------------------------------------------
1 FENDER
2 Repl RT Fender 1 207.00 3.0 2.2
3 Add for Clear Coat 0.9
4 Add for Edging 0.5
5 Repl RT Molding upper 1 26.25 0.3 0.3
6 Repl RT Splash shield front 2WD 1 24.00 0.5
7 DOOR
1
06/15/2001 at 02:46 PM Job Number:
21975
PRELIMINARY ESTIMATE
1990 EAGL TALON 4-2.OL-FI 3D WHITE Int:TAN
-------------------------------------------------------------------------------
NO. . OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
-------------------------------------------------------------------------------
8 Repl RT Outer panel 1 225.00 4.5 2.2
9 Overlap Major Adj . Panel -0.4
10 Add for Clear Coat 0.4
11 Add for power units 0.4
12 Add for Edging 0.5
13 Add for Inside 0.5
14* Rpr RT Door shell 0.5 Incl.
15 Repl RT Molding body side center 1 89.35 0.3 0.3
16 Add for Clear Coat 0.1
17 Repl RT Molding at belt 1 49.45 0.3
18 Repl RT Mirror electric 1 175.00 Incl.
19 R&I RT Glass Jeep, Eagle 0.5
20 HOOD
21 Blnd Hood 1.6
22 FRONT LAMPS
23 R&I RT Side marker lamp Incl.
24 FRONT BUMPER
25 R&I R&I bumper assy 1.0
26# Repl COVER CAR 1 5.00 T 0.1
27# Repl CORROSION PROTECTION 1 5.00 T 0.3
28# Subl HAZ WASTE DISP. EPA#984908202 1 5.00 X
29# Rpr TINT FOR BLENDABLE MATCH 0.5
30# Rpr TEAR DOWN REQUIRED
31# ADDITIONAL DAMAGE POSSIBLE 1
-------------------------------------------------------------------------------
Subtotals ==> 811.05 12.2 9.1
-------------------------------------------------------------------------------
Estimate Notes:
NO TIME TO BLEND INTO THE RIGHT QUARTER PANEL DUE TO PRIOR DAMAGE.
Parts 796.05
Body Labor 12.2 hrs @ $ 62.00/hr 756.40
Paint Labor 9.1 hrs @ $ 62.00/hr 564.20
Paint Supplies 9.1 hrs @ $ 26.00/hr 236.60
Sublet/Misc. 15.00
----------------------------------------------------
SUBTOTAL $ 2368.25
Sales Tax $ 1042.65 @ 8.0000% 83.41
2
06/15/2001 at 02:46 PM Job Number:
21975
PRELIMINARY ESTIMATE
1990 EAGL TALON 4-2.OL-FI 3D WHITE Int:TAN
----------------------------------------------------
GRAND TOTAL $ 2451.66
ADJUSTMENTS:
Deductible 0.00
----------------------------------------------------
CUSTOMER PAY $ 0.00
INSURANCE PAY $ 2451.66
THIS ESTIMATE MAY BE SUBJECT TO APPLICABLE DEDUCTIBLE. UNDER CALIFORNIA
CODE OF REGULATIONS, TITLE 10, CHAPTER R, SUBCHAPTER 8, SECTION 2695.8.D.2.C,
YOU ARE ADVISED, THAT YOU HAVE THE RIGHT TO HAVE ANY. REPAIR FACILITY OF YOUR
CHOICE TO DO THE REPAIRS TO YOUR VEHICLE. HOWEVER, YOUR INSURANCE COMPANY CAN
REASONABLY ADJUST ANY WRITTEN ESTIMATES PREPARED BY THE REPAIR SHOP OF YOUR
CHOICE. IF YOU CHOOSE TO USE AS REPAIR FACILITY SUGGESTED BY YOUR INSURANCE
COMPANY, THEY WILL GUARANTEE THE DAMAGED VEHICLE TO BE RESTORED TO ITS PRE-LOSS
CONDITION AT NO COST TO YOU OTHER THAN AS STATED IN THE POLICY (I.E. POLICY
LIMITS OR DEDUCTIBLE OR ALLOWABLE DEPRECIATION.
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from
the Guide DE3XS90 Database Date 4/2001 and the parts selected are OEM-parts manufactured by the
vehicles Original Equipment Manufacturer. Asterisk (*) or Double Asterisk (**) indicates that the
parts and/or labor information provided by MOTOR may have been modified or may have come from an
alternate data source. Non-Original Equipment Manufacturer aftermarket parts are described as AM
or Qual Repl Parts. Used parts are described as LKQ, Qual Recy Parts, RCY, or USED. Reconditioned
parts are described as Recon. Recored parts are described as Recore. NAGS Part Numbers and Prices
are provided from National Auto Glass Specifications, Inc. Pound sign (#) items indicate manual
entries.
Pathways - A product of CCC Information Services Inc.
3
CI_,ALM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALEORNLA
BOARD ACTIOU July 17, 2001
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
Board of Supervisors. (Paragraph IV below), given
�T'su'vL,D0 pursuant to Government Code Section 913 and
S
915.4. Please note all "Warnings".
AMOUNT: Unknown
JUS 10 2001
cou ZINEZ�A�FL
CLAIMANT: Eugene Chang MAR
ATTORNEY: None DATE RECEIVED:June 14, 4001
ADDUSS: 2718 Fulton St. BY DELIVERY TO CLERK ON: June 14, 2001
Berkeley, Ca 94705
BY MAIL POSTMARKED:
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
J EN C
Dated: June 15, 2001 By: Deputy u
H. FROM: County Counsel TO: Clerk of the Board of Supervisors
(c_-r 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).
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:
Dated: ..��—�� By: A' 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 certi v that this is a true and correct copy of the Board's Order a ered in its minutes or this date.
Dated: I �� JOHN SWEETEN Clerk, By au 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 MAMING
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: . �� � r By: JOHN SWE;'I'EN, 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
Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
c
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 I00th 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 ( 1 C_ff/q)(j� Reserved for Clerk's filing stamp
)
RECEIVED
)
Against the County of Contra Costa or ) JUN 14 2001
CLERK BOARD OF SUPERVISORS
V14X S��fi�rm 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$ i -KA-#L w i and in support of this claim represents as follows:
1. When did the damage or injury occur?(Give exact date and hour)
T___ a -Pe,- is; 2"0 , 3, PAf
2. Where did the damage or injury occur?(Include city and county)
o col�sa , ,C X707,
3. How did the damage or injury occur?(Give full details;use extra paper if required)r"
4. What particular act or omission on the part of county or district officers, servants, or employees caused the
injury damage?
tn, �LCd�G G( fT ch -
5. What are the names of county or district officers, servants, or employees causini,,the damage or injury?
r Ck A' n,
6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach
two estimates for auto damage.) A-
7. How was the amount claimed above computed?(Include the estimated amount of any prospective injury or
damage.) , �� C�v-k ca Q
J
h
max . s�ql S,
8. Names and addresses of witnesses, doctors, and hospitals.
9. List the expenditures you made on account of this accident or injury.
DATE TEAE 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 )
0-u 6rF-x &-Y4 N 6r- )
7-7 I �' FU-L-TO/X S T, ) (Claimant's Sign ture)
�
� g 7Ps - �uCTa� �;.
(Address)
3 FF Kz (-:E-%, 0
Telephone No.- Sr/ J-4 -tS 34J— ___)Telephone No. 4.<-1 0) S 0 - -ti 3> -S-
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.
RECEIVED
To: Board of Supervisors CLAIM JUN 14 2001
Of Contra Costa Count CLERK BOARD OFSUPERVISORS
Y CONTRA COSTA CO.
651 Pine Street
Martinez, CA 94553
Eugene Chang
2718 Fulton Street
Berkeley, CA 94705
June 12, 2001
I, Eugene Chang, the claimant residing at 2718 Fulton Street,
Berkeley, CA 94705 on June 12, 2001 make the claim to the Board of
Supervisors of Contra Costa County at 651 Pine Street, Martinez, CA
94553 against Kensington Police Department at 217 Arlington
Avenue, Kensington, CA 94707-1401.
The incidence occurred on December 15, 2000, at 101 Colusa
Avenue, EI Cerrito, CA 94707. Kensington Police Department was
called. The matter is continuous. My claim exceeds ten thousand
dollars ($10,000). No dollar amount is included here. It is a none-
limited civil case.
My mother Stella Chang wished to have her body to be stored in a cryonics
facility so as for her to be revived in the future to live again. She had
designated me as her agent to carry out her wish for cryonics for her. She
died on November 5, 2000. Later, her body was moved to the morgue in
Sunset View Mortuary. On December 15, 2000, when I was arranging
cryonics for my mother, my other sibling Betty Huck came from Los
Angeles area. She and the Mortuary had no right to bury my mother over
my objection. On that day, I called the Police to prevent the wrongful burial.
I told Officer H. Khan, # K 15, that Huck and the Mortuary had no legal right
to bury my mother over my objection, that they were wrong to do that. The
Police went to the Mortuary and Cemetery but failed to stopped Huck and
the Mortuary from wrongfully burying my mother. As a result, my mother is
wrongfully prevented from her body to be preserved in a cryonics facility
and her being revived in the future to live again. I have suffered extreme
mental anguish, as a result of the damage and injury to my mother's body.
At Berkeley, California !�Z�6A4,�
On June 12, 2001 Eug6ne Chang
CLAIM
BOARD OF SUPERVISORS OF CON 4 COSTCOUNTY, CALIFORNIA
BOARD ACTION: July 17, 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
JUN 12 2001 915.4. Please note all "Warnings".
AMOUNT: $330.00 Ongoing COUNTY COUNSEL
MARTINEZ,CALIF.
CLAIMANT: Patsy Joyce Everette
ATTORNEY: clone DATE RECEIVED: June 11, 2001
ADDRESS: 1199 Court Ln. BY DELIVERY TO CLERK ON: June 11, 2001
Concord, CA 94518
BY MAIL POSTMARKED:
I. FROM Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN WE N, Clerk
Dated: Juen 12, 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).
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:
rN
Dated: ( By:_ Deputy County Counsel
III. FROM Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present:
This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy of the Board's Order entered in this date.
Dated: I JOHN SWEETEi9 Clerk, By41491: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.
AFFIDAVrr OF]AIAII,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
/tfo the claimant as shown above.
Dated: I�, xT� 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 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.
Ft-y '
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 propem•.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 ors owing 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 944-53.
C. If Claim is acainst 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 a_ainst each public entity.
E. Fraud. See penalty for fraudulent claims. Penal Code Sec. i'- at the end of this form.
RE: Claim by. ) Reserved for Clerk's Filing Stamp
)
.-AVED
Against the County of Contra Costa JUN 1 .1 2001,
Or CLERK BOARD OF SUPERVISORS !rSo�
CONTRA COSTA CO.
District)
(Fill in Name)
The undersigned claimant herebv mal.?es-claim against the County of Contra Costa or the above named
_
District in the sum of 5�3�- 2
-�,00 and'in support of this claim represents as follows:
1. When iiia the d iilage or lnlnri' OCCllr' Give exact Date and Hour)
top/ ,_f_ JO -- ----------------------------------
------------
2. Where did the damage or injury occur? (Include Ciro•and Councv)
- - --� �e�grctJc,+ - 90 U ,r� iu1:U, .-------------- -9_ -
3. How did the damage or injury occur? (Give full details;use extra paper if required
-----------------------------------------------------------
4. What particular act or omission on the pan of county or district officers, sen-ants, or employees caused the
injury or damage?
(Over)
-aug par luaiuuositdmi q;)ns
gloq .iq 10 `( 000`oTS) sirflop pursnogi uai'uipaaaxa lou jo aug r Sq `uostad aims aql ut w2muosudu t Sq 10.aug
pur mamuosudmj gons gloq .iq 10 •( oOo�IS ) strrtop pursnogl auo oulpaaoza lou jo aug p :{q `lma auo urge a1ouI
IOU jo pouad r ioj guf hunoo aql uz wouluosudml .iq taglta algrgsiund sl tupp.►s to �saganon.�iunoaar ljj!q turup
luafnpne.ij to asjrj.ius`auinua;jr awrs ayl .ird 10 .aojjr of pazuoglnr`ta:)Wo to plroq..I:)ulslp 10.-i3[�,•.iluno7 .wr.
o1 10 `tangjo to ptroq aims::iur of lu;;w ird.uoj to.aaurmorfr 1oj sluasatd�pnz ipp o11uami ql!,b'oq.A uostad .i-tan3,,
:! :sappwid apo:).jquad ayl.jo.;,;, uo!loaS
10 -K
oti auoydajal -ohauogdaial
(ssatPP')
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L I BRARY I NJURY
Saturday, Apr!1 21 , 2001 , 1 ;50 prn
Concord Library, Contra Costa County
2900 Salvio St. Concord, CA #94519
3. According to the Contra Costa Times, two inches of rain fell the
previous day. Although the parking lot and sidewalk were dry, the Library
foyer inside entranceway mat was saturated.
Entering Concord Library, I walked on this squishy gray mat. My
left foot, (wearing a Rockport shoe) skidded, leaving a
'measured 3 foot", wet, skid mark. Trying to regain my balance, I
twisted sharply to the right, wrenched left hip and twisted my
spine, while trying not to fall.
When I deposited video tapes on the counter, the tall, blonde-haired lady in
a purple dress and black sweater was alerted that I'd slipped and almost
fell. "Please mop the floor before someone falls," I pleaded. Later, I
noticed her carrying a mop to wipe foyer wet foot prints where others had
walked. Her name was Linda 1.1.
While perusing library books, the Reference Desk Librarian, Chris located
me and said she'd have to make out an accident report. She was about 5' 2",
Oriental and wore a maroon blouse and black jumper. She insisted the
floor was dry and I responded, " It isn't where patrons have walked." I
suggested she measure my skid mark which I'd guessed one to two feet
long, incorrectly. She did. It measured the ruler's length.
After I left her office, I noticed an Oriental balding man in a grey shirt and
dark gray pants removing a heavy, rain drenched mat with great effort.
Staff mopped the entranceway again, His name was Tyrone.
6. Wrenching and twisting resulted in left and right hip inflammation by
late afternoon. Frozen peas were placed beneath left hip sacrocilic area;
frozen corn kernels were placed beneath right hip sacrociliac area while I
watched T.V. A heating pad was used alternating ice treatment throughout
the evening. Took a Naproxen before bed. Sleepless night due to extreme
discomfort.
Sunday-April 22, 2001 : Placed right heel on ground exiting chair, after
eating breakfast. Pain radiated down right leg. Swollen gristley nodule
above and agonizing pain felt in right hip area. Cried out in anguish.
Removing refrigerator items resulted in lacerating, shooting pain again.
Used the hot tub from 9;00-9:30 am. spine feels twisted, L-5 and L-4 out
of alignment. Iced areas from 8:00 to 9;00, 1 1 :30-12:00, 1 :00 to 3:00 while
- - - reading paper- and watching-T.V. --
1�
•� .1
- _ _- 6 tv - w i•..
.� i
' - 1 � .. � -
' .. 1
- _. ._ �•
PAGE TWO
Sunday-April 22, 2001: Left ankle sore, pain down left leg, hurts to sit.
Left hip inflammed, above hip left gristley nodule protruding. 8:00 pm I
climbed on dining room table where shoulders, upper and lower back areas
and hips were vibrated. My husband commented that my "hips were stiff
and not moving". It hurts to turn turn head, I feel like I pulled a muscle
beneath right rib cage.l just hurt all over. Took a Percocet. I'm a Grandma
for the second time, Ariel Oliver de la Campa-8 lbs. 12 oz. was born at
5:30 pm, San Francisco's Kaiser Hospital. Wish I were able to see him.
Monday-April 23, 2001 : Miserable night. I need to see my Chiropractor
and am fearful of a pinched nerve. Called and asked to speak with Maureen
Kilmurray, Concord Head Librarian. She'd sent report to Risk Management
and said it may take several weeks to hear from them. I reported my
worsening symptoms and said I need to seek medical help. I waited all day
Monday but she never called giving me permission.
Monday-April 23, 2001 : Icy feet, little bladder control, radiating pain
left leg. Suspect first right rib is out of alignment. Hurts to sit or turn
head. Little flexibility. Used hot tub 2: 15-3;00 pm. Took a Percocet 4:00
pm and laid on ice pack 4:30-5:00 pm. Feels like bones are rubbing together
L-5 and L-4 and that spine is twisted. I waited all day for a Library call
regarding seeking treatment which is a necesssity,
Accompanied elderly friend needing 33 stitches, to Mt. Diablo Emergency
Room 6:30 pm. Sat sideways, slouched in waiting room chairs or stood in
agony, entire 5 hours. Friend brought a Percocet and jacket at 10: 15 pm.
Applied icepacks to shoulders and hips from 1 1 :30 to 12:00 pm, once home,
Tuesday-April 24. 2001 : Called and told Concord Librarian and It was
imperative to seek medical treatment. I could not and will not wait any
longer for permission from risk management, Unable to sit,my husband
drove to Dr. Kneebone's office.
Only slept 4 hours. Ache and hurt so badly, I feel like a truck ran over me,
Both hips are swollen, sharp pains are radiating down left leg. Fearful of a
pinched nerve if I wait. Wanted desperately to visit my new grandchild at
Kaiser, San Francisco but physically unable to drive. Hurts to sit, to turn
head or bend sideways. Spine feels twisted and I am crying. Took a Percoet
about 2:00. Alternating ice and heat therapy; hot tub emersion.
Weddesday-April 25, 2001 : Called Concord Library and related
seriousness of seeking medical care. No response from Risk Management.
.. __ .. r .. _ .. _ .I�.� ._ ..
_ _ 1
• ' • _ -
1. _ � _ _
PAGE THREE
Awakened with sharp shooting pains down left leg and left hip region. Took
a Naproxen at 12:30 pm and 3:00 pm, I am limping on my right side. Hot tub
was 106 degrees and therapeutic jets aren't helping. I AM MISERABLE.
God bless Dr. Bill Kneebone! ---Relief at last. I waited too long, Risk
Management has not called. Called the Central Library information desk
informing I would not be volunteering as a Heritage Collection Docent for
my husband (Dr'.s appointment) because of my injuries.
Pelvic bones were twisted and right leg 2 inches shorter than left. L-5,
L-4 and L-3 and first right rib were out of alignment. He adjusted my left
ankle, neck, shoulders and sacrocilia areas----everything. I really hurt
everywhere now, Iced left and right hip areas 4:00-5:00 pm while
watching Oprah. Took a Percoet at 7:00 pm and Elavil at 8:00.
Thursday- Apr11 26, 2001 :
Good night's sleep and improvement. I'm not limping and spine doesn't feel
twisted. Still have muscle spasms and it hurts to turn head. Just ache all
over. DC appointment at 2:00 pm. Right ankle, right foot, and first right rib
adjusted along with mid-thoracic, and neck areas to stabilize. Iced areas,
while watching TV all evening, One Percocet 7:00 pm., ache everywhere.
Friday-April 27. 2001 :
Sleepess night, read, watched Dr. Laura and finally slept between 3 and
6:00 am. YUKI Dragging all day Spine feels twisted and L-5 is out of
adjustment again as it hurts to sit. Right hip is kiunking. Alternated heat
and ice. I am weary and tired of pain; one Percocet at 7 pm.
April 28th, 29th, 30th-Continued with ice and heat treatments. Little
flexibility bending torso and turning neck, Left and right hip regions still
inflammed. Using one Percocet daily. No response from Risk Management,
May 3-May 9th UDC Convention, Washington and Oregon visit,
Thursday,, May 10th: "B/C Therapy" -therapeutic massage from Christine
to loosen muscle spasms and joints prior to a DC appointment.
May 21 st and May 24th, 2001 : Necessary Chiropractic Appointments.
May 18, 2001 : Risk Management, Central Library (Penny Bailey) called
regarding my April 21 , 2001 Concord Library injury.
r _ _ _
.. - - .� ..
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County Administrator Contra
Risk Management
Costa
County Aamimsrauor Sunc:nG
Ma Pine Street.rr cor County
Martme�•Cal fc( i
n ?�
Liability Claims ;415)j46-11:z-
Safety :414) 546--,2C3
vocational Renab litat:cr. 51 546_;2-
Workers'CD censa;,. 51 ..a5- S26
•�.,rwse!L
C NScNT FOR THE R--TEASE
rF MEDICAL TN"70E-"IAT_Ni
au-'.nor 7e
cnvLder c. ea- =_'1 Care '
t0 d;SclOSe to t_`le bearer, who represents --1-le Coun`- 1 0. C'vntra
Costa - R=sk Management Div=sion and/or desigratedceov service,
all medical infor-mation necessary_ to substantiate a claim
initiated by me.
herebv consent and =guest that tl:e- Beare: be per =_ted
examine and obtain copies of all hospital and medical records
of every sort and kLnd, interview doctors aPid other attendants
regardi::g all matters 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 herebv acknowledge that i have received a copy of this Consent
for Release of Medical Information. it is understood that a
photostat of this authorization is as valid as the original.
Date: f 2 a Signed:
Address :
awe
C.^.P_Ser'Tat^.r or Guardian)
: Date o_ _air
social -Sec''Xi.t✓ Nc 5.3a:fig-9 .Sro
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JAI
-.W H7 ITRA COSTA COUNTY CALIFORNIA
:z.WI
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BOARD ACT10N:July-l7, 2001
TWzo° — NOTICE TO CLAIMANT
€„ }EQZ = The copy of this document mailed to you is your
1," H notice of the action taken on your claim by the
�y Y�Hrnloi Board of Supervisors. (Paragraph IV below), given
zz-rNux pursuant to Government Code Section 913 and
915.4. Please note all "Warnings".
.P3
r.
•� `* i RECEIVED: June 7, 2001
tr:
IELIVERY TO CLERK ON: June 7, 2001
AIL POSTMARKED:
v)
0: County Counsel
I
1
;TEN, Clerk
i
2
supervisors
W
:nd 910.2. _
o
Ins 910 and 910.2, and we are so notifying claimant. The
aim on ground that it was filed late and send warning of
aim(Section 911.3).
Dated: &—I/,Q/ By: -'! eputy 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).
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: n 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
)repaid a certified copy of this Board Order and Notice to Claimant, )addressed to the claimant as shown above.
0ated:l I a�� By: JOHN SWEETEN, CLERK By r 1/Jl, jj � 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 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 100h 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
)
RECEIVED
Against the County of Contra Costa or )
JUN 0 7'2001
District)
BOAD OF
(Fill in name) ) CLERK CONTRA COSTACO.ISORS
The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district
in the sum of.$ 3 DO a and in support of this claim represents as follows:
1. When did the damage or injury occur? (Give exact date and hour)
� 2- g,od
2. Where did the damage or injury occur? (Include city and county)
Conco2 CaA,7P * aSTA
3. How did the damage or injury occur?(Give full details; use extra paper if required)
tvh t(-ea s'ToP 1X14 -)-A may` Geos p re';"1.5 0- -4-r t�
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J"/Q .e," th-e y'e o d "'I" %'� F? Ford' r,► uS7,9 n 6
Cotes. 5 � Xleo sive e:�7de 74ayes
4. What particular act or omission on the part of county or district officers, servants, or employees caused the
injuryor damage? o �k C �a'i wJ� 4ae P,Pl G/1ni s
S'/Dw a�-Wh 6-2 Sof+
5. What are the names of county or district officers, servants, or employees causing the damage or injury?
Jo � n P,-*,rIGk k/ PO — Go,, 4,-o Cos 7-,A F/2F
6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach
two estimates or auto d agee)y �o e,- �C �„�y1� 1Pr10 b/P,-, s
keys, Dry �ic�' � � ,..,( O
Sd°0
7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or
damage.) �c,.a�egP -�a Aiz- LV
JnJKr�S
8. Names and addresses of witnesses, doctors, and hospitals.
P.e5rre 61-0aJ11 3305- SII-IWO Cir. �-� o<-
r
9. List the expenditures you made on account of this accident or injury.
DATE TIME AMOUNT
19-PI'
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 )
(Claimant's Signature)
/.
(Address)
Telephone No. )Telephone No. 7d 7 �y
NOTICE
Section 72 of the Penal Code provides:
Every person who,with intent to defraud,presents for allowance or the payment to any state board or officer,or to any
county,city,or district board or officer,authorized to allow or pay the same if genuine,any false or fraudulent claim,bill,account,
voucher,or writing,is punishable either by imprisonment in the county jail for a period of not more than one year,by a fine of not
exceeding one thousand($1,000),or by both such imprisonment and fine,or by imprisonment in the state prison,by a fine of not
exceeding ten thousand dollars($10,000),or by both such imprisonment and fine.
. . CONCORD POLICE DEPARTMENT 14 DEC ?H. 14 29
CJP�C 4t: aI N� fj NUMBER MIT&RUN TRAFFIC COLLISION REPORT
R --/��- ��7\ INJURED FELONY n
�75Z� C� —Z� ❑ CR No. �`�
SPECIAL VENT ES NUMB HIT&RUN COUNTY 1 Z DATE & TIME REPORTED PAGE
CJTY -.L CK R ALL
e OTHER KI D ISD
❑ Contra Costa �Z L� �— ` t
OF
JG ASSIF IC ATION DATE & TIME OCCURREDNC IC NO. OFFICER
%I-?- C. � L�� 0704
Oc JPRIMARY STREET ISPFED DAY OF WEEK TOW AWAY 9TATE
/ HWY PHOTOS
Z / - LIMIT REL
O1\ ^V\ S MT W T NOS 1 )YES ( )YES
R
U AT INTERSECTION WITH (SECONDARY STREET)ET) $PEED ID SV PP
LIMIT
J OR: FEET/MIL43 N S E W OF
L�'t < s- ❑
DRV ER S L�9No.�QbQq STATE CLASS r
Y R. ` :MAKE/M(�^�'• LICENSE NO, STATE
P PED NAME (FIRST,MIGOLH•LAST) t -
R V
PKD STREET ADDRESS OWNER'S NAME AME AS DRIVER
EH
y BIKE CITY/STATE/ZIP OWNER'S ADDRESS SAME AS DRIVER
OTHR SEX HAIR EY S HGNT WGHT BIRTHDATE R�\ DISPOSITION OF VEHICLE ON ORDERS OF: ( )OFF—R JQ}�AIVHR
M=. CAY YHAR ( JOTMfiR
HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: Ne w PwgeNT ( JR HP Hw TO NAR RwTIVQ
T D BY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED
INSURANCE, CARRIER
POLICY NUMBER IUNK ( )NONE )MINOR
Q+3L )MAJOR )TOTAL
OIIR..OF IHWAY
P`C`F .ICC '
P C H P
f )
D ORI ER SLICENSE NO. STATE Ct�CLASSSAFETY VEH.YR LOR
//Q MAKE/ /C LICENSE NO. STATE
�]
=UIP. . t DEL
PED ,\\ FIRST;MIOOLE.4A ST) Z� l ��
A
PK STREET ADDRESS
V ' ME J9AME AS DRIVER
IREH GK::A
.�
TDI. STATE/ZIP
OWNER'S ADDRESS ME AS DRIVER
Q21 e
2 OTHR SEX HAIR IFY�-F5\ HG HT W^G�HT BIRTHDATE JRACE DISPOSITION OF♦VEHICLE ON ORDERS OF: ( JOPPICeR "1111VHR
\r4O —C• Y ��`V�Z��� ( JOTRHR
HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS:" NE APPARENT ( JRHP6RTONwRRATIVH
l ) — _ TOWED BY DESCRIBE V HICLE DAMAGE SHADE AIRREDAAMAGED
INSURANCE CARRIER POL{CY.NUUM-BER 1� IUNK I )NONE kI-.+M1NOR
)MOD ( )MAJOR I )TOTAL
DIR.OFON EET OR HIGHWAY PCF ICC ( J
RAVEL
PUC J J
�1.� :� CHP
D RVR DRIVER'S LICENSE NO. STATE CLASS SAFETY VEH,YR. MAKE/MODEL/COLOR LICENSE NO. STATE
EQUIP,
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PED NAME JP IR ST,MIDDLE,LAST).P tN1ENT
A
PKD STREET ADDRESS OWNER'S DiVYII�NCO ' ,El) AS CRIV�$y��T
R VEH �C�A,-// liliTllJJ111�T/�1 j�
y BIKE CITY/STATE/ZIP OWNER'S ADDRESS SAME 4S DRIVER/
3 � s � ' .
FTI
HAIR EYES HGHTWGHT BIRTDADATEYBARRACE DISPOSITIONeg§ C�O - )or PICC E PHONE BUSINESS PHONE PRIOR MEC CAL DEFECTS' JNORH APPARHRT ( .JR MPHR TO NARRATIYH
) ( ) TOWED BY DESCRIBE VEHICLE DAMAGE SHADEAI AREA:EDAAMAGE
INSURANCE CARRIER POLICY NUMBER )UNK ( )NONE ( )MINOR -
)MOO ( )MAJOR ( )TOTAL
DIR.OF C,.V STREET OR HIGHWAY PCF fCC ( J
T PUC ( J
CHP
RE.OIT
!N 1 BEAT DATE & TIME REPORT WRITTEN SUPERY{SO APPROV{NG
cv-:R-1 N 97
CONCORD POLICE DEPARTMENT 1
TRAFFIC COLLISION CODING
PAGE
O..T=LLIe7
.EA T(T�_L� NCIC N 0704R ✓ �� Nil 3 \ �W
OWNER'S NAME(ADDRESS NOTIFIED
PROPERTY ( )YES ( )NO
DAMAGE DESCRIPTION OF DAMAGE
SEATING POSITION OCCUPANTS: SAFETY EQUIPMENT MIC BICYCLE EJECTED FROM VEH.
_ 1-Driver L-Air Bag Deployed 0-Not Ejected
2 to 6-Passengers A-None in Vehicle M Air Bag Not Deployed HELMET 1-Fully Ejected
7-Station Wagon Rear B-Unknown N-Other DRIVER 2-Partially Ejected
Lap s .
8-RR.Occ.Truck or Van C•LBelt Used P-Not Required V-No Unknown
9-Position Unknown W-Yes
D-Lap Belt Not Used CHILD RESTRAINT
1 2 3 0-Other E-Shoulder Harness Used
F-Shoulder Harness Not Used Q=In Vehicle Used PASSENGER
456 G-Lap/Shoulder Harness Used R-In Vehicle Not Used No
7 H-Lap/Shoulder Harness Not Used S-In Vehicle Used Unknown Y.Yes
J_Passive Restraint Used T-In Vehicle Improper Use
K-Passive Restraint Not Used U-None In Vehicle
ITEMS MARKED BELOW WHICH ARE FOLLOWED BY AN ASTERISK(')SHOULD BE EXPLAINED IN THE NARRATIVE.
PRIMARY COLLISION FACTORTRAFFIC CONTROL DEVICES 2 S TYPE OP YEHICLE 2 3 MOVEMENT PROCEDING
LIST NO. (#) OF PARTY AT FAULT COLLISION
VC e ti n Violated: Cited: A Controls Functioning A Passenger Car/Station Wagon A Stopped
( )Yes )No B Controls Not Functioning' B Passenger Car With Trailer 6 Proceeding Straight
# B Other Improper Driving-k C Controls Obscured C Motorcycle/Scooter C Ran Off Road
D No Controls Present/Factor• D Pickup or Panel Truck D Making Right Turn
C Other Than Driver'
TYPE OF COLLISION E Pickup/Panel Trk.W/Trailer E Making Left Turn
D Unknown' A Head-On F Truck or Truck Tractor F Making U Turn
# E Fell Asleep'
B Sideswipe G Truck/Trk.Tractor W/Trailer IG Backfin
W THER (MARK I TO 2 ITEMS) Rear End H School Bus I 1H Slowing/Stopping
A Clear D Broadside I Other Bus I Passing Other Vehicle
B Cloudy E Hit Object J Emergency Vehicle J Changing Lanes
C Raining F Overturned K Hwy.Const,Equipment K Parking Maneuver
D Snowing G Vehicle Pedestrian L Bicycle L Entering Traffic
E Fog/Visibility Ft, H Other': IM Other Vehicle M Other Unsafe Turning
F Other*: MOTOR VEHICLE INVOLVED WITH N Pedestrian N Xing into Opposing Lane
G Wind A Non-Collision O Moped O Parked
�
LIG"TI'+c B Pedestrian IP Mer in
FDOark
ht C Other Motor Vehicle Q TravelingWrongWay
•Dawn D Motor Veh..on Other Roadw OTHER ASSOCIATED FACTOR R Other':-Street Li htsE: Barked Motoc Vehicle (MARK 1 TO 2 ITEMS)
-No Street Lights F Train A VC Section Violation:
YesCited:
No
E Dark.Street Lights Not G Bicycle
Functioning* H Animal: SJ B VC Section Violation Cited: SOBRIeTY DRUG
Yes No PHYSICAL
ROADWAY SURFACE MARK 1 TO 2 ITEMS
A D I Fixed Object: C VC Section ViolatioYe9CiteNo A Had Not Been Drinking
B Wet J Other Object: B HBD-Under Influence
C Snowy.IcyE Vision Obscurement C HBD-Not Under Influence'
D Slippery (muddy,oily,etc.) F Inattention' D HBD Impairment Unknown'
ROADWAY CONDITIONS PEDESTRPAN'S ACTION G Stop&GoTraffic E Under Dru Influence'
(MARK I TO 2 ITEMS) F Impairment-Physical*
A No Pedestrian Involved H Entering/Leaving Ramp
A Holes Deep Ruts' Crossing in Crosswalk 1 Previous Collision G Impairment Not Known
8 Loose Material on Roadway• B.at Intersection J Unfamiliar with Road HNot Applicable
C Obstruction on Roadway' C Crossing in Crosswalk-Not K Defective Veh.Equip.: Cited: I Sleepy/Fatigued
D Construction.Repair Zone at Intersection Yes No SPECIAL INFORMATION
E Reduced Roadway Width D Crossing-Not in Crosswalk IL Uninvolved Vehicle: A Hazardous Material
F Flooded* E In Road-Includes Shoulder TT M Other': la Fire Involved'
Other•: F Not in Road IN None Apparent C Tire Defect/Failure
H No Unusual Conditions G A roach/Lea School Bus O Runaway Vehicle
SKETCH:
MISCELLANEOUS*
ryo1C
OgTK
-Zq0
do - t
CP-20.2 JUN 27
CONCORD POLICE DEPARTMENT
DIAGRAM LEGEND
Page
DATE OF COLLISION TIME(2400) NCIC NUMBER OFFICER 1.0. OR NO. e
MO. �20AY "j YROO 0704 \�Z�
VEHICLE POINTS OF REST(POR)
VEH...N WHEEL- FT. DIR' T. .`.. 1ST r REFERENCIE POINT).",, F.T.`•. 'DIR .��'f 2ND REFERENCE POINT.'- -2;C-, 3 '
i,
,
L��-7 _I \• �\ \� \k \\ ♦e if
t e\
--T3•3 "
PEDESTRIAN POINT OF LANDING/REST
PED.p -HD.lFT - FT. -OIR .1ST REFERENCE POINT FT- -DIR : k 2ND REFERENCE POINT}•:
PHYSICAL EVIDENCE
REM X - - DESCRIPTION
PHYSICAL EVIDENCE LOCATION.
r
REM A 'FT'. •I DIR: +"� M 15T.REFERENCE POINT ! ``� { _ FT- .DIR � _.*'+ -2ND REFERENCE POINT
REPORTING FFIC BEAT DATE d TIME REPORT WRITTEN SUPERVISOR APPROVING
CP-!9•1 MAY 95
CONCORD POLICE DEPARTMENT
TRAFFIC COLLISION CODING -
DD �G` ) y�1 /�^E�� PAGE
noAT
\ COwYLI N YEw T�A —L NCIG N O7O4R N`U`J
OWNER S NAMEJADDRESS NOTIFIED
PROPERTY
( YES )NO
DAMAGE DESCRIPTION OF DAMAGE
SEATING POSITION OCCUPANTS: SAFETY EQUIPMENT MIC BICYCLE- EJECTED FROM VEH.
1-Driver L-Air Bag Deployed 0-Not Ejected
0 2 to 6-Passengers A-None in Vehicle M Air Bag Not Deployed HELMET
B-Unknown 7-Fully Ejected
7-Station Wagon Rear N-Other DRIVER 2-partially Ejected
C•Lap Belt Used 1
8•RR.Occ.Truck or Van P-Not Required V-No 3-Unknown
9 Position Unknown D-Lap Belt Not Used W-Yes
1 2 3 E-Shoulder Harness Used CHILD RESTRAINT
0-Other F-Shoulder Harness Not Used Q-In Vehicle Used PASSENGER
4 S 6 G•Lap/Shoulder Harness Used R-In Vehicle Not Used X-No
7 H•Lap/Shoulder Harness Not Used S-In Vehicle Used Unknown Y-Yes
J-Passive Restraint Used T-In Vehicle Improper Use
K-Passive Restraint Not Used U-None In Vehicle
ITEMS MARKED BELOW WHICH ARE FOLLOWED BY AN ASTERISK I-)SHOULD BE EXPLAINED IN TNF-NARRATIVE-
PRIMARY COLLISION FACTOR 1 2 3 TYPE VEHICLE 1 2 3 MOVEMENT PROCEDING
LIST NO. (x) OF PARTY AT FAULT TRAFFIC CONTROL DEVICES COLLISION
VC e ti n Violated: Ci ed: A Controls FunctioningA Pdssenger Car/Station Wagon A Stopped
\ k ( )Yes )NO B Controls Not Functioning' B Passenger Car With Trailer B Proceeding Straight
* B Other Improper Driving' C Controls Obscured C Motorcycle/Scooter IC Ran Off Road
C Other Than Driver' D No Controls Present/Factor' O Pickup or Panel Truck ID,Making Right Turn
TYPE OF COLLISION E Pickup/Panel Trk.W/Trailer E Makin Left Turn
D Unknown'
* E Fell Asleep' A Head-On F Truck or Truck Tractor F Making U Turn
B Sideswipe G Truck/Trk.Tractor W/Trailer G Backing
S"THER (MARK I TO 2 ITEMS) gRear End IH School Bus H Slowin /Stoppin
A Clear D Broadside I Other Bus I Passing Other.Vehicle
B Cloudy E Hit Object J Emergency Vehicle J Changing Lanes
C Raining F Overturned K Hwy.Const. Equipment IK Parking Maneuver
D Snowing G Vehicle Pedestrian L Bicycle I L Entering Traffic
E Fog/Visibility Ft. H Other': IM Other Vehicle IM Other Unsafe Turning
F OtherMOTOR VEHICLE INVOLVED WITH N Pedestrian N Xinginto Opposing Lane
•:
G Wind A Non-Collision 10 Moped 0 Parked
LIGHTING B Pedestrian P- Merging
-711'A Daylight C Other Motor Vehicle 0 Traveling Wrong Way
B Dusk-Dawn D Motor Veh..on Other RoadwayOTHER ASSOCIATED FACTOR R Other':
E.Parked Mo;or Vehicle . (MARK I TO z ITEMS)
C Dark-Street Lights A VC Section Violation: Cited:
D Dark•No Street Lights F Train e�y; >.„
G Bicycle Yes No
E !]ark•Street Lights Not
Functioning' H Animal: '<` B VC Section Violation Cited: SO PIETY DRUG
Yes NO PHYSICAL
ROAOWAY SURFACE MARK 1 TO 2 ITEMS
A D 1 Fixed Object: C VC Section ViolatioYesCiteNo A Had Not Been Drinking
B WetJ Other Object: i' O B HBD-Under Influence
C Snowy•Icy E Vision Obscurement C HBD-Not Under Influence'
D Slippery (muddy,oily,etc.) F Inattention* D HBD'-Impairment Unknown'
ROADWAY CONDITIONS PEDESTRNaN'S ACTION G Stop&Go Traffic E Under Drug Influence'
(MARK 1 TO z ITEMS( H Entering/ g F Impairment-Physical*
A No Pedestrian Involved g/Leavin Ramp G Impairment Not Known
A Holes Dee Ruts' B Crossing in Crosswalk I Previous Collision H Not i lict No
B Loose Material on Roadway' at Intersection J Unfamiliar with Road
ble
C Obstruction on Roadway• C Crossing in Crosswalk-Not K Defective Veh.Equip.: Cited: I Slee /Fati ued
D Construction-Repair Zone at Intersection Yes No SPECIAL INFORMATION
E Reduced Roadway Width D Crossing-Not in Crosswalk L Uninvolved Vehicle A Hazardous Material
F Flooded" E In Road-Includes Shoulder M Other*: B Fire Involved'
Other': F Not in Road N None Apparent C Tire Defect/Failure
H No Unusual Conditions I LG A roach/Leaving School Bus 10 Runaway Vehicle
SKETCH: I MISCELLANEOUS:
ROgTa _
-Zq�
Az -
I I
CONCORD POLICE DEPARTMENT
INJURED/WITNESSES/PASSENGERS
PAGE
Dew F 15}pty lC'� TIM( y .CIC UMSER
B07OA
11\\
EXTENT OF INJURY ("X"ONE) Y INJURED WAS("X"ONE)
NLY AGE
Wong ss NCER PAR ry PEAT swPery eJ¢c Teo
__T
BE% PwTAL SEVERE OTHER VISIBLE COMPLAINT DRIVER LASS EO BICYCLIST OTHER NUMBER O5. EOUIP.
INJURY INJURY URY PPLAIN
�RETELEPHONE
TRANSPORTED BY (INJURED ONLY): TAKEN TO:
DESCRIBE INJURIES
❑ VICTIM OF VIOLENT CRIME NOTIFIED
ll
D ` A����j TELEPHONE
--c-t, .
TRANSPORTED BY (INJURED ONLY): N TAKEN TO:
DESCRIBE INJURIES k
❑ VICTIM OF VIOLENT CRIME NOTIFIED
❑ a ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ � I C
AME D.O.B. ADDRESS TELEPHONE
a S!�—�,S— t
TRANSPORTED BY (INJURED ONLY): TAKEN TO:
DE?CRIBE
VICTIM OF VIOLENT CRIME NOTIFIED
❑.t.. X13 ❑ ❑ ❑ ❑ ❑ ❑ ❑ a ❑ 2
ADDRESS TELEPHONE
C�j Q
TR NSPORTED BY (INJURED ONLY): TAK EN TO:
DESCRIBE INJURIES
❑ VICTIM OF VIOLENT CRIME NOTIFIED
�� ❑ ❑ ❑ ❑
❑(tel EJ 07 ❑ ❑ 2 � C
..D'C.B. A `J\� c.�-� �� � • TELE
om"\ O
TFIANSPORTED BY (INJURE ONLY): TAKEN TO:
DESCRIBE INJURIES
❑ VICTIM OF VIOLENT CRIME NOTIFIED
NAME 0,11 B, ADDRESSTELEPHONE
TRANSPORTED BY INJURED ONLY): TAKEN TO:
DESCRIBE INJURIES
A
❑ VICTIM OF VIOLENT CRIME Nt9 in
q
rRORT F CER BE T DATE ANO TIME R RT WRITTEN SUPERVISOR APPROVING TYPIST DATE AND TIME REPO R'.I�
r
PAGE FcR #
NG DATE ANO 71101E REPORT TYPED
'ORTING OFFICER BEAT DATE AND TIME REPORT WRITTEN SVPE RVISOR APPROVITYPIST
PAGE c # T' �`\2�
.FACTS:
At 1147 hrs, I was dispatched to an auto collision, with reported injuries, on
Concord Bl at Grant St. The collision was involving a Fire Engine that was
responding to an emergency call.
I responded from Concord Av and Bonifacio St, and arrived at 1150 hrs.
Both VI) and V2) were located.at their respective PORs. Dl) was standing
outside of V 1). His passenger was being treated by paramedics, from AMR,
who were on scene.
All measurements were obtained via `Lidar' unit number L4.
SCENE:
Both Concord B1 and Grant St are smooth, flat, asphalt roadways. The
intersection is controlled by a complete set of traffic signals. The signals
were checked, and found to be functioning properly.
Concord B1 is a 3 lane one way roadway, running NV/B. Grant St is a 2-way
roadway, running north and southbound.
Refer to diagram on page #10 for additional information
VEMCLES A.ND INVOLVED PARTIES.
D1) Identified as Vega via a valid CDL.
,See page 41 -
D2) Identified as Kipp via a valid CDL
Seepage 41
REP RTI ( R� 1116 DA AN EP RITTEN SUPERY7SOR APPA I G TYPIST DATE AND TIME REPORT TYPED
;. ROO - R
PAGE ICR#
REPORTING OFFICER BEAT DATE AND TIME REPORT WRITTEN SUPERVISOR APPROVING TYPIST DATE AND TIME REPORT TYPED
PAGE CR
VEHICLES AND INVOLVED PARTIES: con't
V 1) sustained moderate body (sheet metal) damage to the R/R quarter panel.
There was no apparent damage to the frame or rear axle assembly. V1)
was found to be derivable. At D 1)'s request, VI) was towed from the
scene.
V2) sustained minor scraps along the right side of the front bumper.
PHYSICAL EVIDENCE:
.Side scuff located at AOI from the R/R tire of V1).
Photos of the overall intersection, and damage to both V 1) and V2) taken by
CSI Hinermann. refer to her supplemental report.
INJURIES:
D 1) Vega complained of pain to his back.
Pass 1) Brown complained of pain to her head and neck.
Both were evaluated by paramedics at the scene, and chose to not be
transported, by ambulance, to the hospital..
STATEMENTS:
DI) Vega said he was traveling NB on Grant St, south of Concord Bl, in the
#3 through traffic lane.
RE RTI F R I IL17 DAT NDTIREPORT Vi RITTEN SUPERVISO APPROVING TYPIST I DATE AND TIME REPORT TYPED
PAGE CR#
REPORTING OFFICER BEAT DATE AND TIME REPORT WRITTEN SUPERVISOR APPROVING TYPIST DATE AND TIME REPORTTYPED
PAGE S C R# <2:D
STATEMENTS: con't
As he approached Concord B1, D1) Vega saw the signal light.for N/B traffic
was green. D1) Vega started to proceed into the intersection, when he heard
a siren, and saw V2) approaching the intersection on W/B Concord Bl. Dl)
said he `jumped on it' (accelerated rapidly) in an attempt to clear out of the
intersection for V2), instead of stopping. D 1) Vega added he did not think he
could stop in time for V2).
As he accelerated into the intersection IFO V2), the R/R of V 1) was
impacted by V2). The force of the impact spun V2) `around'. V2) came to
rest facing S/B between the traffic lanes, on Grant St, north of Concord B1.
When asked, Dl) Vega said he first noticed V2) when he was `about 5 feet'
into the intersection. He did not hear any sirens until he actually saw V2)
approaching. Dl) Vega estimated his speed prior to entering the intersection
at "normal speed about 25 MPH"
J
D2) Kipp, is the Senior Firefighter assigned to Confire Station 8. He was
driving V2) W/B on Concord'Bi;east-of Grant St, with V2)'s overhead red
lights and electronic siren activated. He was responding as a second unit to a
non-related auto collision, with injuries and disentanglement, on Concord
Av. (Refer to Confire master number 51595)
-D2) Ki.p•wasytra-ve-l:ng WB-4n!tile #.24ane at about 25-30NISPH.As he
approached the intersection of Grant St, he noticed the signal light for WB
traffic was red. D2) Kipp slowed to `about 10-.151VIPH' and began chegking
for cross traffic. D2) Kipp first looked to his right. He did not see any S/B
traffic on Grant St approaching. D2) Kipp then looked to his left, and saw
traffic was stopped in both the left turn lanes on N/B Grant St, at Concord
Bl. D2) was still slowing, when he saw V 1) suddenly enter the intersection
-from NB Grant St.
D2) braked hard, but..he was unable.to.avoid colliding into the R/R quarter
panel of V1). D2) Estimated the speed of V2) at `about 40 MPH' as it
entered the intersection.
REPO RTIN I 1.8 T DAT ND� E f20RT�(JRITTEN SUPERVISOR APPROVING TYPIST DATE AND TIME REPORT TYPED
PAGE ICR#
REPORTING OFFICER BEAT DATE AND TIME REPORT WRITTEN SUPERVISOR APPROVING TYPIST DATE AND TIME REPORT TYPED
PAG E C R#C�C�_f�(�Z�
STATEMENTS: con't
W1) Long said he had just turned onto W/B Concord Bl, from SB Colfax
St. (Which is 1 block east of Grant St)
W 1) Long merged into the #I WB lane, when he heard a siren approaching
him. W 1) Long immediately pulled to the south curb line of Concord Bl, and
came to a stop. WI) Long saw V2) pass by him with its emergency red
lights on, and its siren `blaring.' W1) Long commented, "It was loud....
Real loud"
WI) Long looked away as V2) passed by him. When he looked forward, he
saw V2) impacting VI) in the R/R quarter panel. He watched as VI) `spun
around' .and out of the intersection. W1) Long did not see V 1) enter the
intersection, nor could he estimate V1)'s speed. W1) Long could not
estimate the speed of V2) either.
Pass 1) Brown was riding in the R/F seat of V 1). She is D 1) Vega's
girlfriend.
Pass 1) Brown said they were traveling N/B on Grant St, south of Concord
Bl. She could not say how fast they were going, but said, "We were not
going fast." Pass 1) Brown did not see or hear V2) approaching. She said her
window was rolled up, and.she was talking to Dl) Vega abou# her bracelet,
and-how the latch worked.Passl)•IBrown was looking atiher bracelet at the
time. Just as they began to cross over Concord Bl, Pass I) Brown looked up
and saw ".A big fire truck.right outside my window." The next thing Pass.l)
knew, VI) was spinning.
Passl).Brown did not notice V1) suddenly accelerate, nor did she recall ever
hearing a siren.
Pass2)Nieland was the Capitan assigned to Confire Station 8. He was riding
in the R/F seat of V2). -
Pass2) Nieland said that V2) was slowing to "about 15 MPI" as it
approached Grant St, while traveling WB on Concord B1 in the #2 lane._
REPORTI F �`��
BIF 4 DATEA TI Gti .PLr WRITTEN SUPERVISOY),IPPRO�IIN�� TYPIST DATE AND TIME REPORT TYPED
PAGE ICR#
REPORTING OFFICER BEAT DATE AND TIME REPORT WRITTEN SUPERVISOR APPROVING TYPIST DATE AND TIME REPORT TYPED
PAGE
STA TEMENTS: con't
Nieland said all the emergency equipment was on, and the siren was
functioning.
Pass2) saw VI) suddenly enter the intersection of Concord B1 and Grant St,
from N/B Grant. He estimated V 1)'s speed at "40-45 MPH"
Pass2) yelled at D2) Kipp to stop, but 132) Kipp was "already on the brakes."
Pass2) watched as V2) collided into VI) as VI) crossed IFO them.
Pass3) Roy was the fire fighter assigned to Confire Station 8. He was riding
in right rear seat of V2), which faces to the rear of V2). Pass3) Roy did not
witness the collision. Pass3) Roy did say that V2) was traveling "Pretty
slow" when he felt the impact.
OPLNIONS AND CONCLUSIONS: con't
This collision occurred when D1) Vega failed to yield the right of way to an
emergency vehicle approaching the intersection.
D1) Vega first noticed V2) after entering the intersection by 5 feet. If D1)
was traveling at the speed limit, D1) should have attempted to stop, or turn
in order to yeld to V2), not accelerate through the intersection.
S.inoe:V 1:);.sus.tai.iled.,rel-ativ.el.y:amunor.overalldarnage,.the.:.collision..gppear-e.d
to be a low speed impact on the part of V2).
AREA OF IMPACT.•
Determined by post impact scuff left by the RIR tire of V1).
Approximately 29.8 feet south, of the north curb line of Concord Bl; and
approximately 40.5 feet east, of the west curb line of Grant St.
REPO IN ^ '� B�AJ DATE AN 6(E PO jiT gJRITTEN SUPERVISO�P PROVING TYPIST DATE AND TIME REPORT TYPED
I
PAGE FCR#
REPORTING OFFICER SEAT DATE AND TIME REPORT WRITTEN SUPERVISOR APPROVING TYPIST DATE AND TIME REPORT TYPED
PAGE FCROOZ
3 � 112�
RECOMMENDATIONS:
None
RE RTI BYDATE ANP E�T WRITTI N SUPERVIS P VING�f TYPIST DATE AND TIME REPORT TYPED
I
PAGE ICR#
REPORTING OFFICER BEAT DATE ANOTIME REPORT WRITTEN SUPERVISOR APPROVING TYPIST DATE ANDTIME REPORT TYPED
• CONCORD POLICE DEPARTMENT �1
FACTUAL DIAGRAM Page
DATE OF COLLISION TIME(2400`) NCIG NUMBER r0ff�ICER I.D. CR NO
Mo.
DAY v4/\/ t �\ 0704 0C)
All measurements are approximate and not to scale unless stated (scale=
..
.. �.. ... ..,. ....:.' '....; : .IND ......
KATE';
NORTH
i
C�,
ll
I
I I
. .
• s
Y!
.. ... .: r.. :.. -
t
_
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..... .'.. ... . ...... -
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..:._.
0 A6VN �R l O.DI i�f YR. REVIEWER'S N�yf'E ,rJ j) LI (/I MO. DAY YR.
CONCORD POLICE DEPARTMENT
DIAGRAM LEGEND l
Page Cl
DATE OF COLLISION TIME(2400) NCIC NUMBER OFFICER I.D. CR NO.
MO. �Z DAY � YRC 0704 r ` `� f`_ 7CCD
VEHICLE POINTS OF REST(POR)
VEH..d WHEEL.: FT.- DIR - -1ST REFERENCE,POINT.- - FT. DIR - -.2ND REFERENCE POINT
L�2z \\ t\ \l l\ \t ac lC
t CV7 q33 t\
PEDESTRIAN POINT.OF LANDING/REST
DIR 1ST REFERENCE POINT - : FT DIR _ 2ND REFERENCE POINT
PED k -HDJFT .FL .. ...... . - - .! - ...
PHYSICAL EVIDENCE
ITEM X - -.,.. ' - .. DESCRIPTION,'
PHYSICAL EVIDENCE LOCATION
REM f --FL. DIR.. „, IST REFERENCE POINT.'•.- �-• - FT. DIRE '2ND REFERENCE.POINT -
REPORTING FFIC BEAT DATE&TIME REPORT WRITTEN SUPERVISOR APPROVING
95
CP-J9.1 MAY / .
C-al
CLAIM
BOARD OF SUJPERV35RS OF C01s'1RA COSTA COUNTY, CAUEQPUNLA
BOARD ACTION: July 17, 2001
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
RP(?;12IrW Board of Supervisors. (Paragraph IV below), given
pursuant to Government Code Section 913 and
JUN 0 0 2009 915.4. Please note all "Warnings".
AMOUNT: $5,000 COUNTY COUNSEL
MARTINEZ CALIF.
CLAIMAIN'T: Andres Vega
ATTORNEY: None DATE RECEIVED: June 7, 2001
ADDRESS: 143 San Simeal BY DELIVERY TO CLERK ON: June 7, 2001
Vallejo, CA 94591
BY MAIL POSTMARKED:
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN STEN, Cler},
Dated: June 7. 2001 By: Deputy Q
H. FROM County Counsel TO: Clerk of the Board of Supervisors
{1.4 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).
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:
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).
TV. BOARD ORDER: By unanimous vote of the Supervisors present:
( This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date.
Dated: I �� JOHN SWEETEN Clerk, By2..��!"'1 i`�-T'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 MALUNG
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 clai antt as shown above.
Dated: By: JOHN SWa=, CLERK By OtJh ueputy 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 CLAIMANT
A. Claims relating to causes of action for death or for injury to person or to personal property or growing
crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day
after the accrual of the cause of action. Claims relating to causes of action for death or for injury to
person or to personal property or growing crops and which accrue on or after January 1, 1988, must be
presented not later than six months after the accrual of the cause of action. Claims relating to any other
cause of action must be presented not later than one year after the accrual of the cause of action.
(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
JJ r ) )
T RECEIVED
Against the County of Contra Costa or ) JUN 0..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$ a:. up;-.# cf t'. is ^lain^.represents as follows:
1. When did the damage or injury occur? (Give exact date and hour)
.lz-P- a0
2. Where did the damage or injury occur? (Include city and county)
C0,1 CO 9-0 &7C47--T, Cos rl-9L
3. How did the damage or injury occur?(Give full details;use extra paper if required)
-7 -H a4 c.e-j c S 7re--e• a
COS A 'FYZ r QQ.P�& r_T+�� �� n -� �/Q Pq M P-�
I S
4. What particular act or omission on the part of county or district officers, servants, or employees caused the
injury or damage? L, �s
CO—It-5-P Lt.K 5 a.! P Olt(
5. What are the names f county or district officers, servants, or employees causing the damage or inj ry?
J 0 n �a�rc�
e r pp CcC h2 pPo;
6. What damage or injuries do you claim°r�sulted? (Give full extent o 'injuries or amages'clatmed. Attach
two estimates for auto damage.) 1 J A QF c
7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or
damage.) n J u e (r- s
8. Names and addresses of witnesses, doctors, and hospitals. n
3 Q.11- �`
9. List the expenditures you made on account of this accident or injury.
DATE TIlVIE AMOUNT
` ctvl �
******************************************************************************************
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 )
Claimant's Signature-T-1
(Address)
Telephone No. )Telephone No. Zo71
NOTICE
Section 72 of the Penal Code provides:
Every person who,with intent to defraud,presents for allowance or the payment to any state board or officer,or to any
county,city,or district board or officer,authorized to allow or pay the same if genuine,any false or fraudulent claim,bill,account,
voucher,or writing,is punishable either by imprisonment in the county jail for a period of not more than one year,by a fine of not
exceeding one thousand($1,000),or by both such imprisonment and fine,or by imprisonment in the state prison,by a fine of not
exceeding ten thousand dollars($10,000),or by both such imprisonment and fine.
��
t
• . ., _ -..
• ... .S. 5.�...__ _ ,
i
._ _ �� � -
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
BOARD ACTIONt July 17, 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
1&NC9EHI 7KQ pursuant to Government Code Section 913 and
915.4. Please note all "Warnings".
JUN 052001
AMOUNT: $13, 000
COUNTY COUNSEL �
CLAIMANT: James Dowdy MARTINEZ CALIF.
^. .
ATTORNEY: None DATE RECEIVED: June 1, 2001 �.
ADDRESS: 1001 #C Wilbur Ave BY DELIVERY TO CLERK ON: June 1, 2001
Antioch, CA 94509
BY MAIL POSTMARKED: Play 31, 2001
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JMWE Dated: June 4, 2001 By: Deputy1!
H, FROM County Counsel TO: Clerk of the Board of Supervisors
( ) This claim complies substantially with Sections 910 and 910.2.
(V)�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: //Lp'G � ��6' i�"- Deputy County Counsel
III. FROM Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present:
This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy of the Board's Order a tered in its tnut s for this date.
JOIN 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 MAIIdI`'G
I declare under penalty of perjury that I am now, and at all times herein mentioned,have been a citizen of the United
States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully
prepaid I certified copy of/this Board Order and Notice to Claimant ddressed to A.4e clai ant as shown above.
Dated: I�r ��I By: JOIN 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 P
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1
DEPUTIES:
SILVANO B.MARCHESI
COUNTY COUNSEL 5 E j JANICPHILLIP .AME OFF
� ��----�- . . U JANICE L.AMENTA
NORA G.BARLOW
SHARON L.ANDERSON ==rr B.REBECCA BYRNES
o,''. =-? ? � ANDREAW.CASSIDY
t�
ASSISTANT COUNTY COUNSEL CONTRA COSTA;QU,NTY MON IKAL.COOPER
¢ - `c�, `1 VICKIEL.DAWES
GREGORY C.HARVEY OFFICE-OFT-HE-9 OUP OUNSEL MARKES.ESTIS
ASSISTANT COUNTY COUNSEL I I. . .0`=, ==-.- I I LILLIANT.FUJII
InCONT =MINISTRATION:BUILDIN��� JANET L.HOLMES
nv-
~ �+ ~
DENNIS C.GRAVES �65�1WINEWREETs9.t , -O,OKEVIN T KERR�R
BERNARD L.KNAPP
SENIOR FINANCIAL COUNSEL MARTI NEZ;-'.CAL'IFORNIA�94553`-1229 EDWARD V.LANE.JR.
�' BEATRICE LIU
GAYLE MUGGLI 4.0, MARY ANN MASON
OFFICE MANAGER �US�� - '� PAUL R.MUMZ
A nn�iX VALERIE J.RANCHE
PHONE (925) 335-1800 NOTICE OF'HVSEFMCIENCY DAVID F S R M DG
DAVID F.SCHMIDT
FAX (925) 646-1078 AND�OR DIANAJ.SILVER
JACOUELINE Y.WOODS
NON-ACCEPTANCE OF CLAIM PAMELAJ.ZAID
TO: James Dowdy
1001 Wilbur Avenue, #C
Antioch, CA 94509
RE: CLAIM OF: James Dowdy
Please Take Notice as Follows:
The claim you presented against the County of Contra Costa or District governed by the Board of
Supervisors fails to comply substantially with the requirements of California Government Code Section
910 and 910.2, or is otherwise insufficient for the reasons checked below:
I.
I. The claim fails to state the name and post office address of the claimant.
I: ] 2. The claim fails to state the post office address to which the person presenting the claim desires
notices to be sent.
LXX] 3. The claim fails to state the date, place or other circumstances of the occurrence or transaction
which gave rise to the claire asserted.
[XX] 4. The claim fails to state the naine(s) of the public einployee(s) causing the injury, damage, or
loss, if known.
IXX] 5. The clainn flails to state whether the arnount clauned exceeds ten thousand dollars ($10,000).
If the claunn totals less than ten thousand dollars ($10,000), tine claim fails to state tine amount
claimed as of the date of presentation, the estimated amount of any prospective injury, damage
or loss so far as known, or the basis of computation of the amount claimed. If the arnownt
claimed exceeds ten thousand dollars ($10,000), the clairmfails to state whether jurisdiction
over the claim would rest in municipal or superior court.
[ 16. The claim is not signed by the claimant or by some person on his or her behalf.
[
17. Other:
Page 1
SILVANO B. MARCHESI
COUNTY COUNSEL
By:��
Deputy County Counsel
CERTIFICATE OF SERVICE BY MAIL
(C.C.P. §§ 1012, 1013a,2015.5;Evidence Code§§641,664)
I declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California
94553;1 am 2t citizen of the United States,over 18 years of age,employed in Contra Costa County,and not a party to this action. I
served a true copy of this Notice of hisufficiency and/or Non-acceptance of Claim by placing it in an envelope addressed as shown
above,scaled 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.
Dated: June 4,2001,at Martinez,California.
ce: Clerk of the Board of Supervisors(original)
Risk Management
(NOTICE OF INSUFFICIENCY OF CLAIM:GOVT.CODE§§910,910.2,920.4,910.8)
Page 2
05/20/01 SUN 22:33 FAX 825 427 8345 Bay Point Family Support @004
RECEIVED
TORT CLAIM{ AND REQUEST FOR RELIEF JUN 0:.1 2001
CONTRA COSTA C:'OUNTY BOARD OF SUPERVIS
CLERK BOARD OF SUPERVISORS
CONTRA COSTA CO.
CLAIMANT Filing Date:
4G
Address
9
DECLARATION
The aformentioned party het-eby requests and relies upon .and allocation of
relocation funds in the base 9111ount of$13,000.80 that will be used to reestablish
residency in a proper and suitahle location.
It is further requested that Contra Costa County Board of Supervisors determine
the entities of which appropriai.e ownership and responsibilities rests, and that arty
responsible parties be duly noti-led of the tenants intent forthwith.
I hereby attest to the fact that I
1. Am the legal and contractutl tenant of this address.
2. Am not currently a party hx any litigation in respect to this property.
3. Am a legal and registered citizen of the United States.
4. Am not the Legal Owner [in whole or in part] of this property or it's adjoining
parcels.
5. Will use the money allocatefl for the purpose of obtaining an alternate residence.
The claiv4 is hereby submitte_1 and filed in the County of Contra Costa on this
day of May,2001.
/s/ —y
Claimant - <, _�V�tness
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
BOARD ACTIO July 17, 2001
Claim Against the County, or District Governed by 1
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. 1 notice of the action taken on your claim by the
Board of Supervisors. (Paragraph 1V below), given
RF_GE=11W[EM pursuant to Government Code Section 913 and
��JJ 915.4. Please note all "Warnings".
AMOUNT: $13, 000 JUN 0 5 2009
COUNTY COUNSEL
CLAIMANT: Carlos Martinez MARTINEZ CALIF.
ATTORNEY: None DATE RECEIVED: June 1, 2001
ADDRESS: 1001 #B Wilbur Ave BY DELIVERY TO CLERK ON: June 1, 2001
Antioch, CA 94509
BY MAIL POSTMARKED: May 31, 2001
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
J00 ETEN, &Irrk
Dated: June 4, 2001 By: Deputy
IV
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: 62— By: L_41V", ' 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:
r\' This Claim is rejected in full.
( ) Other:
I certi that this is a true and correct copy of the Board's Order entered in its minutes for this date.
Dated: 1 a�I JOHN SWEETEN Clerk, By , Deputy Clerk
WARNING (Gov, code section 91.3)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited
in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an
attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so
immediately. *For Additional Warning See Reverse Side of This Notice.
AFFIDAVIT OF 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 laimant as shown above.
DateBy: 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 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 TortClaims Act.
4
SILVANO B.MARCHESI DEPUTIES:
PHILLIP S.ALTHOFF
COUNTY COUNSEL SE__L JANICE L.AMENTA
NORA G.?� _ B.REBECCA LOW
SHARON L. ANDERSON
�7 F_- -4.\� ANDREAW.CASSIDY
YRNES
ASSISTANT COUNTY COUNSEL CONTRA COSTA v�O:U,NTY MONIKAL.COOPER
- \, `\ VICKIE L.DAWES
GREGORY HARVEY OFFICE�In.00OFUNTTH�ADEM_INCISTORAUTIONfJ:BTUYILyDI C'O�lUNSEL SARKE S. S
ASISTANTTCOUNTY CILANTFUJII
„jI
JANETL.HOLMES
DENNIS C.GRAVES 651 RIN&STFiEET 9.tIi FL-OO i KEVINTKERR
`�'� �= ''+ "'�� ' I BERNARD L.KNAPP
SENIOR FINANCIAL COUNSEL MARTINEZ CALIFORNIA�945``1229 EDWARD V.LANE.JR.
GAYLE MUGGLI _ BEATRICE LIU
MARY ANN MASON
OFFICE MANAGER C'�. �/ �C�
�_ � , PAUL R.MUNIZ
`Srl %entity` VALERIE J.RANCHE
PHONE (925) 335-1800 NOTICE OF IIVSL=TFFTCIENCY STEVEN P.RETTIG
DAVID F.SCHMIDTHMIDT
FAX (925) 646-1078, AND/QR DIANAJ.SILVER
JACQUELINE Y.WOODS
NON-ACCEPTANCE OF CLAIM FAMELAJ.ZAID
TO: Carlos Martinez
1001 Wilbur Avenue, #B
Antioch, CA 94509
RE: CLAIM OF: Carlos Martinez
Please Take Notice as Follows:
The claim you presented against the County of Contra Costa or District governed by the Board of
Supervisors fails to comply substantially with the requirements of California Government Code Section
910.and 910.2, or is otherwise insufficient for the reasons checked below:
]
I. The claim fails to state the name and post office address of the clainnant.
[ ] 2. The claim fails to state the post office address to which the person presenting the claim desires
notices to be sent.
[XX] 3. The claim fails to state the date, place or other circumstances of the occurrence or transaction
which gave rise to the claim asserted.
I.XX.I 4. The claim fails to state the name(s) of the public ennployee(s) causing the injury, damage, or
loss, if known.
[XX] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000).
If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount
claimed as of the date of presentation, the estimated amount of ally prospective injury, damage
or loss so far as known, or the basis of computation of the amount claimed. If the amount
claimed exceeds ten thousand dollars ($10,000), the claim fails to state whether jurisdiction
over the claim would rest in municipal or superior court.
[ ] 6. The claim is not signed by the claimant or by some person on his or her behalf.
] 7. Other:
Page 1
SILVANO B. MARCHESI
COUNTY COUNSEL
:
BY 6?ZG
Deputy County Counsel
CERTIFICATE OF SERVICE BY MAIL
(C.C.P. §§ 1012, 1013x,2015.5;Evidence Code§§641,664)
I declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California
94553;1 am a citizen of the United States,over 18 years of age,employed in Contra Costa County,and not a party to this action. I
served a true copy of this Notice of Insufficiency and/or Non-acceptance of Claim by placing it in an envelope addressed as shown
above,sealed and postage fully prepaid thereon,and thereafter was,deposited this day in the U.S. Mail at Martinez,California.
I certify under penalty of perjury that the foregoing is true and correct.
Dated: June (l%2001,at Martinez.,California.
1
cc: Clerk of the Board of Supervisors(original)
Risk Management
(NOTICE OF EN SUFFICIENCY OF CLAIM:GOVT.CODE§§910,910.2,920.4,910.8)
Page 2
05/20/01 ...SUN 22:34 FAX 925 427 8345 Bay Point Family Support 9006
i ►
TORT CLAIM AND REQUEST FOR RE IEFRECEIVED
CONTRA COSTA COUNTY BOARD OF SUPI R VIsUICS
JUN 0:.12001
CLERK BOARD OF SUPERVISORS
/ CONTRA COSTA CO
CA91-0-5 /�0,4g7e7l
CL IMANT Filing Date-
AddresslV 4
-7v5—r 9
DECLARATION
The aformentioned party hehzby requests and relies upon and allocation of
relocation funds in the base an'tount of $13,000.00 that will be used to reestablish
residency in a proper and suitahle location.
It is further requested that Coutra Costa County Board of Supervisors determine
the entities of which appropriate ownership and responsibilities rests, and that any
responsible parties be duly notified of the tenants intent forthwith.
I hereby attest to the fact that I:
1. Am the legal and contractual tenant of this address.
2. Am not currently a party in=any litigation in respect to this property.
3. Am a legal and registered citizen of the United States.
4. Am not the Legal Owner [ixs whole or in part] of this property or it's adjoining
parcels.
5. Will use the money allocated for the purpose of obtaining an alternate residence.
The clainj is hereby submitteO and filed in the County of Contra Costa on this
day of May,2001.
A
Claim nt Witne
R °s a✓ N e Z.
CLABI
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY CALIFORNIA
BOARD AC-n0July 17, 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. 1 notice of the action taken on your claim by the
Board of Supervisors. (Paragraph IV below), given
pursuant to Government Code Section 913 and
915.4. Please note all "Warnings".
0 5 X009
AMOUNT: $13,000 COUNTY COUNSEL
CLAIMANT: Joseph Martinez MARTINEZ CALIF.
ATTORNEY: None DATE RECEIVED: June 1, 2001
ADDRESS: 1001 #A Wilbur Ave BY DELIVERY TO CLERK ON: June 1, 2001
Antioch, CA 94509
BY MAIL POSTMARKED: May 31, 2001
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JO SWE EN, Clerk
Dated: JhmP 4, 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: 6-5-,o By: �I�L�1' 6Deputy 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).
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 ent red i it/s�/mi uses W, eputy
his date.
Dated. ' ��, JOHN SWEE'T'EN Clerk, By 11� 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 MAH U G
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United
States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully
prepaid a certified copy of this Board Order and Notice to Claimant, addressed tote claimant as shown above.
JOHN SWEETEN CLERK
Dated: � By: � 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.
SILVANO B.MARCHESI DEPUTIES:
PHILLIP S.ALTHOFF
COUNTY COUNSEL S __L JANICE L.AMENTA
NORA G.BARLOW
SHARON L. ANDERSON -\ + B.REBECCA BYRNES
a.%-?Y ���� ;�- ANDREA W.CASSIDY
ASSISTANT COUNTY COUNSEL CONTRA COSTA71
' OIJ,N 1 Y MONIKAL.COOPER
F VICKIE L.DAWES
GREGORY C.HARVEY OFF ICE•O:F_THE-COUNTY ^OUNSEL MARKES.ESTIS
ASSISTANT COUNTY COUNSELIII. r. . == LILLIANT.FUJII�C`0irm-V ADMINISTRATIONBUILDING, JANET L.HOLMES
DENNIS C.GRAVES 651,PI- TREET" th FLOOR' KEVIN IKERR
._ BERNARD L.KNAPP
SENIOR FINANCIAL COUNSEL MAR TINEZ',._CALIFORNIA 94563-1'229 EDWARD V.LANE.JR.
BEATRICE LIU
GAYLE MUGGLI , \ - �y
����'' MARY ANN MASON
OFFICE MANAGER �_ _-c�^� C PAUL R.MUNIZ
ra ri�i)1d L VALERIEJ.RANCHE
PHONE (925) 335-1800 NOTICE OLIN=SITFFIC.IENCY DAVID F SIDT
HM
FAX (925) 646-1078 DANAJ.SILVERIDT
AND/OR JACQUELINE Y.WOODS
NON-ACCEPTANCE OF CLAIM PAMELAJ.ZAID
TO: Joseph Martinez
1001 Wilbur Avenue, #A
Antioch, CA 94509
RE: CLAIM OF: Joseph Martinez
Please Take Notice as Follows:
The claim you presented against the County of Contra Costa or District governed by the Board of
Supervisors fails to comply substantially with the requirements of California Goveniment Code Section
910 and 910.2, or is otherwise insufficient for the reasons checked below:
[ ]
I. The claim fails to state the name and post office address of the claimant.
] 2. The claim fails to state the post office address to which the person presenting the claim desires
notices to be sent.
XX] 3. The claim fails to state the date, place or other circumstances of the occurrence or transaction
which gave rise to the claim asserted.
[XX:j 4. The claim fails to state the nauie(s) of the public employee(s) causing the injury, damage, or
loss, if known.
[XX] 5. The claiin fails to state whether the aTnount claiined exceeds ten thousand dollars ($10,000).
If the'claiun totals less than ten thousand dollars ($10,000), the clai n fails to state the amount
claimed as of the date of presentation, the estimated amount of any prospective injury, damage
or loss so far as known, or the basis of computation of the amount clai ned. If the amount
claimed exceeds ten thousand dollars ($10,000), the claim fails to state whether jurisdiction
over the claim would rest in municipal or superior court.
[ ] 6. The claim is not signed by the claiinant or by some person on his or her behalf.
[ ] 7. Other:
Page 1
SILVANO B. MARCHESI
COUNTY COUNSEL
By:
Deputy County Counsel
CERTIFICATE OF SERVICE BY MAIL
(C.C.P. §§ 1012, 1013a,2015.5;Evidence Code§§641,664)
I declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California
94553;I am a citizen of the United States,over 18y ears of age,employed in Contra Costa County,and not a party to this action. I
served a true copy of this Notice of Insufficiency and/or Non-acceptance of Claim by placing it in tin envelope addressed as shown
above,scaled and postage fully prepaid thereon,and thereafter was,deposited this day in the U.S.Mail at Martinez,California.
I certify under penalty of'perjury that the foregoing is true and correct.
Dated: June 2001,at Martinez,California.
J
cc: Clerk of the Board of Supervisors(original)
Rist:Management
(NOTICE OP INSUFFICIENCY OF CLAIM:GOVT.CODE$§910,910.2,920.4,910.8)
Page 2
05/20/01 SUN 22:33 FAX 925 427 8345 Bay Point Family Support
Rh 003
RECEIVED
TORT CLA1N.AND REQUEST FOR RELIEF UN 0:.1 2001
CONTRA COSTA C=OUNTY BOARD OF SUPERVIS K BOARD OF SUPERVISORS
CONTRA COSTA CO.
CLAMIANT Filing Date:
Address
� t90 i AA-
DECLARATION
The aformentioned party heaeby requests and relies upon and allocation of
relocation funds in the base 02ount of$13,000.00 that will be used to reestablish
residency in a proper and suitable location.
It is further requested that Centra Costa County Board of Supervisors determine
the entities of which appropriatte ownership and responsibilities rests, and that any
responsible parties be duly notiried of the tenants intent forthwith.
I hereby attest to the fact that 4
1. Am the legal and contractuHl tenant of this address.
2. Am not,currently a party in any litigation in respect to this property.
1 Am a legal and registered c;tizen of the United States.
4. Am not the Legal Owner IM whole or in part] of this property or it's adjoining
parcels.
5. Will use the money allocatd for the purpose of obtaining an alternate residence.
The claim is hereby submitted and filed in the Co ty of Contra Costs on this
A day of May,2001.
O KO24
Cl:aim a
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY CALIFORNIA
BOARD A00July 1-3, 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. 1 notice of the action taken on your claim by the
Board of Supervisors. (Paragraph IV below), given
pursuant to Government Code Section 913 and
MAY 3i 2001 915.4. Please note all "Warnings".
AMOUNT: $10,000 COUNTY COUNSEL
MARTINEZ CALIF.
CLAIMANT: Peter Martorano
ATTORNEY: None DATE RECEIVED: May 31, 2001
ADDRESS: P.O. Box 15456 BY DELIVERY TO CLERK ON: May 31, 2001
Beverly Hills, CA 90209
BY MAIL POSTMARKED:
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOINS EN, Jerk
Dated: Y 31, 2001 By: Deputy
II. FRO 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: �,7-'3By: ����epu�tyCounty Counsel
M. FRONZ Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present:
This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date.
Date n JOHN SWEETEN Clerk, B� , Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date tills 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
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
prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the. claimant as shown above.
Dated: u 1 �� By; JOHN SWEETEN, CLERK By 1 Deputy Clerk
11
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.
RECEIVED
CLAIM FOR DAMAGES AGAINST MAY. 3 12001
THE COUNTY OF CONTRA COSTA
CLERK BOARD OF SUPERVISORS
TO: The Clerk of the Board of Supervisors CONTRA COSTA CO.
County Administration Building
651 Pine Street, Room 106
Martinez, CA 94553
The following claim for damages is hereby made by Peter Martorano, against you, and
each of you, the particulars of the claim being as follows:
A. NAME AND ADDRESS OF CLAIMANT:
Peter Martorano
P.O. Box 15456
Beverly Hills, CA 90209
(510) 453-4830
B. ADDRESS TO WHICH NOTICES ARE TO BE SENT:
Peter Martorano
P.O. Box 15456
Beverly Hills, CA 90209
C. DATE, PLACE AND OTHER CIRCUMSTANCES
WHICH GIVE RISE TO THE CLAIM:
On December 6, 2000, at approximately 9:15 a.m., Scott Cook was driving a 1997
Jeep Cherokee, bearing California license plate number 3VVT512, in a generally
northbound direction on Frontage Road in the City of Emeryville, County of
Alameda. At said time and place, Scott Cook caused the Jeep Cherokee to strike
and collide a vehicle bearing California license plate number 4KQV359, which
was being operated by claimant Peter Martorano.
At the time of the accident, Scott Cook identified the insurance carrier of the
aforementioned Jeep Cherokee as Contra Costa County Risk Management. It is
believed that Scott Cook was an employee of Contra Costa County at the time of
the accident.
At all times herein mentioned, Contra Costa County and its employees negligently
and carelessly operated, maintained, owned, entrusted, serviced and controlled the
above-referenced Jeep Cherokee so as to cause it to collide with the vehicle being
operated by claimant Peter Martorano. At all times herein mentioned, Scott Cook
made an unsafe turning movement in front of claimant's vehicle.
As a result of the accident, claimant sustained injuries to his back, neck, chest and
right side extremities.
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D. DESCRIPTION OF INJURIES AND DAMAGES:
Claimant Peter Martorano suffered injuries to his neck, back, chest, right arm and
right leg, and other injuries currently undiagnosed.
As a result of his injuries, claimant has incurred expenses for medical care and
treatment and related costs and expenses required in the care and treatment of said
injuries, and claimant's damage in this respect is presently unascertained as said
services are continuing. To date, claimant has treated with Dr. Richard Richman
located in Alameda, California.
Furthermore, as a result of the accident, claimant has been at times unable to
follow his regular employment, to his special damage in a presently unascertained
sum as said loss is not yet final.
In addition, claimant has been generally damaged in a sum in excess of the
jurisdictional minimum of the Superior Court of the State of California.
E. EMPLOYEES CAUSING INJURY AND DAMAGES:
Other than Scott Cook, the identities of the employees of the public entity
responsible for the accident are presently unknown to claimants.
F. AMOUNT OF CLAIM:
The amount of this claim exceeds $10,000. Jurisdiction rests with the Superior
Court of the County of Alameda.
DATED: May 30, 2001
PETER MA TORANO
Claimant
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