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MINUTES - 06242003 - C.14
CLAIM / BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY -/ BOARD ACTION: JUNE 24, 2003' Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given r Pursuant to Government Code Section 913 and s 915.4. Please note all"Warnings". AMOUNT: UNKNOWN CLAIMANT: JESSICA SACKS ATTORNEY: DAVID G. SMITH DATE RECEIVED: MAY 21 , 2003 ADDRESS: 2201 BROADWAY, SUITE 807 BY DELIVERY TO CLERK.ON: MAY 21, 2003 OAKLAND, CA 94612 BY MAIL POSTMARKED: HAND DELIVERED B RISK MANAGEMENT FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEET Dated: MAY 21 , 2003 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supe cors ( ) This claim complies substantially with Sections 910 and 910.2. (4his 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: V � 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 ODDER: By unanimous vote of the Supervisors present: (x� This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JUKE 24.L_2003 JOHN SWEETEN, CLERK., By l , Deputy Clerk WARNING(Gov. code sectio 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your lchoice in connection with this matter. If you want to consult an attorney, you should do so immediately. `For Additional Warning See Reverse Side of This Notice. ' AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned,have been a citizen of the United States, over age '18; and that today I deposited in the United States Postal Service in Martinez, California,postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: JOHN SWEETEN, CLERK.By Deputy Clerk OFFICE OF4HE COUNTY COUNSEL '-� "�,� SILVANo B.MARCHESI r t q COUNTY COUNSEL COUNTY OF CONTRA COSTA Administration Building 651 Pine Street, 9" SHARON L. Aar;sov'Floor r; $; °3 + Martinez, California 94553-1229 1° x '�„--� �` CHIEF ASSISTANT 'tai GRIC.RA RVEY (925) 335-1800 VALERIE J. RANCHE (925) 645-1078 (fax) ASSISTANTS V "`fZy NOTICE OF INSUFFICIENCY ANI)/OR NON-ACCEPTANCE OF CLAIM: TO: DAVID G. SMITH Attorney at Law 2201 Broadway, Suite 807 Oakland, CA 94612 RE: CLAIM OF: JESSICA SACKS Please Take Notice as Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code Section 910 and 910.2, or is otherwise insufficient for the reasons checked below: [ ] 1. The claim fails to state the name and post office address of the claimant. [ ] 2. The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [X 13. The claim fails to state the date,place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [X 14. The claim fails to state the names) of the public employee(s) causing the injury, damage, or loss, if known. [ ] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000). If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount claimed as of the date of presentation,the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. [ ] 6. The claim is not signed by the claimant or by some person on his or her behalf. Page 1 David G. Smith, Esq. Re: Claim of Jessie Sacks Page Two [ ] 7. You are required to submit your claim on the proper form,which is enclosed.. Please resubmit your claim on the enclosed form, including all the required information. Gov. Code, § 910.4. Please be aware that you have only a limited period of time in which to file an amended claim. See Gov. Code, § 9101.6. [X] S. Other: Your claim does not identify any involvement of Contra Costa County SILVANO B.MARCHESI COUNTY COUNSEL By: 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 fine 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 Mon-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: at Martinez,California. cc: Clerk of the Board of Supervisors(original) Risk Management (NOTICE OIC INSUFFICIENCY OF CLAIM:GOVT.CODE§§910,910.2,920.4,910.8) Page 2 1 CLAIM AGAINST 2 CONTRA COSTA COUNTY-ANIMAL SERVICES 3 � t� 2z 4 rc ?dpi (a) Name and address of claimant: Jessica SacksNO� 5 3119 The Alameda +° t Concord, CA 94519 6 (925) 686-1455 7 (b) Send all notices to: DAVID G. SMITH 8 Attorney at Law 2201 Broadway, Suite 807 9 Oakland, CA 94612 (510) 893-3741 10 11 (c) Date of occurrence: 12/3/02 12 Place of occurrence: 3119 The Alameda, Concord, Contra Costa, CA 13 (d) Circumstances of occurrence: Ms. Sacks witnessed her mother being attacked by 14 their dog,which had recently been adopted. 15 (e) General description of injury: Emotional distress from witnessing her mother being 16 attacked by dog. 17 (f) Amount of claim: Unknown at this time. 18 19 Dated: May 15, 2003 Lk 20 i 21 MVTD G. SMITH, Esq. Attorney for Claimant, 22 Jessica Sacks 23 Receipt of a copy of the within claim is hereby acknowledged this day of 24 251 by 26 27 28 CLAIM f BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY j BOARD ACTION: JUNE 24, 2003 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action, All Section references are to } The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given { Pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". E A AMOUNT: UNKNOWN � A''£` CLAIMANT. DEBORAH SACKS ATTORNEY: DAVID G. SMITH DATE RECEIVED: MAY 21 , 2043 ADDRESS: 2201 BROADWAY, SUITE 807 BY DELIVERY TO CLERK ON: MAY 21, 2003 oakland, on 94612 BY MAIL POSTMARKED: HAND DELIVERED BY RISK MANAGEMENT FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEETEN, e Dated: MAY 2l . 2003 By: Deputy II. FROM: County Counsel TO. Clerk of the Board of Supervisor ( ) This claim complies substantially with Sections 910 and 910.2. (t4-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 914.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: _ f 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: fix) This Claire is rejected in full. ( } Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JUNE 24, 2403 JOHN SWEETEN, CLERK,, By , Deputy Clerk WARNING(Gov. code sect` n 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. *Fear Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned,have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California,postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: JUNE 25, 2403 JOHN SWEETEN, CLERK By Deputy Clerk OFFICE OF THE COUNTY COUNSEL ; SILVANo B. MARCHES] COUNTY OF CONTRA COSTA COUNTY COUNSEL Administration Building #,� d 1 651 Ping Street, 911i00r i —o" SHARON L. ANDERSON CHIEF AssiSTANT Martinez, California 94553-1229 cl GREGORY C. HARVEY (925) 335'1800 {1gti'- o 4 C`�: '� l''jh �' VALERIE J. RANCHE (925) 646-1078 (fax) e ° 3! '3 ' � ASSISTANTs NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: DAVID G. SMITH Attorney at Law 2201 Broadway, Suite 807 Oakland, CA 94612 RE: CLAIM OF: DEBORAH SACKS Please Take Notice as Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code Section 910 and 910.2, or is otherwise insufficient for the reasons checked below: [ ] 1. The claim fails to state the name and post office address of the claimant. [ ] 2. The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [X 13. The claim fails to state the date,place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [X] 4. The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or loss, if known. [ ] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000). If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. [ ] 6. The claim is not signed by the claimant or by some person on his or her behalf. Page 1 David G. Smith, Esq. Re: Claim of Deborah Sacks Page Two [ ] 7. You are required to submit your claim on the proper form, which is enclosed. Please resubmit your claim on the enclosed form, including all the required information. Gov. Code, § 910.4. Please be aware that you have only a limited period of time in which to file an amended claim. See Gov. Code, § 910.6. [X] 8. Other: Your claim does not identify any involvement of Contra Costa County SILVANO B. MARCHESI COUNTY COUNSEL By. Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (C.C.P.§§ 1412, 1013a,2615.5;Evidence Code§§ 641,664) 1 declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California 94553;I am a citizen of the United States,over 18 years of age,employed in Contra Costa County,and not a party to this action. I served a true copy of this Notice of insufficiency and/or Non-acceptance of Claim by placing it in an envelope addressed as shown above,sealed and postage fully prepaid thereon,and thereafter was,deposited this day in the U.S.Mail at Martinez,California. I certify under penalty of perjury that the foregoing is true and correct. Dated: .. t` at Martinez,California. t J. cc: Clerk of the Board of Supervisors(original) Tisk Management (NOTICE OF INSUFFICIENCY OF CLAIM.GOVT.CODE$§910,910.2,920.4,910.8) Page 2 1 CLAIM AGAINST 2 CONTRA COSTA COUNTY-ANIMAL SERVICES 4 }' (a) Name and address of claimant: Deborah Sacks 2003 5 3119 The Alameda ,.: Concord, CA 94519 6 (925) 686-1455 ` 7 (b) Send all notices to: DAVID G. SMITH 8 Attorney at Law 2201 Broadway, Suite 807 9 Oakland, CA 94612 (510) 893-3741 10 11 (c) bate of occurrence: 12/3/02 12 Place of occurrence: 3119 The Alameda, Concord, Contra Costa, CA 13 (d) Circumstances of occurrence: Ms. Sacks was attacked in her home by her recently 14 adopted and unprovoked dog. 15 (e) General description of injury: Both hands and right arm. 16 17 (f) Amount of claim: Unknown at this time. 18i t 191 Dated: May 15, 2003 20 DAVID G. ITH, Esq. 21 Attorney for Claimant, Deborah Sacks 22 Receipt of a copy of the within claim is hereby acknowledged this day of 23 24 i 25 by 26 i 27 28 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY " BOARD ACTION: JUNE '241 2003 Claim Against the County, or District Governed by } the Board of Supervisors, Routing Endorsements, } NOTICE TO CLAIMANT and Board Action. All Section The copy of this document mailed to you is your California Government Codes. - , . ' . ' £ notice of the action taken on your claim by the ,; R Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please nate all "Warnings". AMOUNT: EXCESS OF $25 ,000. CLAIMANT: RIZZA HERRERA AND WINSTON HERRERA ESTA'T'E OF CHRISTOPHER HERRERA, DECEASED ATTORNEY: THOMAS E. SOKAT, ESQ. BATE RECEIVED: MAY 211 2003 ADDRESS: LAW OFFICE OF THOMAS E. SOKATBY DELIVERY TO CLERK ON: MAY 21 , 2003 383 DIABLO ROAD, SUITE 100 DANVILLE, CA 94526 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Beard of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. 3©I-IIN SWEE E T erk Dated: MAY 212 2003 By: Deputy IL FROM: County Counsel TO: Clerk of the Board of Supervisors (,.�This claim complies substantially with Sections 910 and 910.2. ( } This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( } Claim is not timely fled. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( } Other: .Dated: By: � �� ;,:.��. f � Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel(1) County Administrator(2) ( } Claim was returned as untimely with notice to claimant(Section 911.3). IV, BOARD ORDER: By unanimous vote of the Supervisors present: (X) This Claim is rejected in full. ( } Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. .Bated: JUTE 241 2003 JOHN SWEETEN, CLERK., By , Deputy Clerk WARNING (Gov. code s ction 913) Subject to certain exceptions, you have only six (6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States,over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: JUNE 25, 2003 } SWEETEN, CLERK By Deputy Clerk Clairiu to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY A- Claims relating to causes of action for death or for injury to person or to personal property or growing craps and which accrue on or before December 31, 1987,Ynust be presented not later than the 10&day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing craps and which accrue on or after January 1, 1988,must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be preserved not later than one year after the accrual of the+cause of action. (Gov't Code 911.2_) B. Claims must be filed with the Cleric of the Board of Supervisors at its office in Room 106, County Administration Building,651 Pine Street,Martinez,CA 94553. C. If claim is against a district governed by the Board of Supervisors,rather than the County,the name of the District should be filled in. D. Uthe claim is against more than one public entity, separate claims roust be filed against each public entity. E. Ems. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form. ikk#rkk��slrsE+R#k+k4+k#tt#Kkfyfkit►tkitkw*'#iki4*##iilffkiiFd!#k*Mk#Mrilk+idt#+R#1.R+K�Y#ttl*#+ki#lMi#+►*###*i*+�Y RE: Claim By Reserved for Clerk's filing stamp Rizza Herrera and'-wingtbn.Herrera Estate of Christopher Herrera, Deceased � RECEIVED�------•---�-� Against the County of Contra Costa orMAY } .District) CL�S�c Rn �., (Fill tri name) A'0 0 SUS RVtSCR8 The undersigned claimant hereby makes claims against the County of Contra Costa or the above-named district in the sum of and in support of this claim represents as follows: rn excess of $25,000. See Government Code Section 910 (f) . 1. When did the damage or injury occur?(Give exact date and hour) December 1, 2002,.at approximately 3:4:5 a.m. , was the time of death. The decedent was treated between 2:40 p.m. and 4:05 p.m. on ll-30-02. 2. Where did the damage or injury occur?(Include city and county) Decedent was treated at Contra Costa Regional. Medical Center, 2500 Alhambra Avenue, Martinez, CA and died at home at 3484 Willow Pass Road, Apt. 5, Concord, CA. Both locations are in Contra Costa County. 3. How did the damage or injury occur?Give full details;use extra p i#`required) Rizza Herrera. and Winston Herrera are the parents of decedent Christopher Herrera. On November 30, 2002, Christopher Herrera, who was two years old, had an asthma attack and was taken by his parents to the emergency room at Contra Costa Regional Medical Center. Christopher Herrera was admitted, examined, treated and released at approximately 4:00 p.m. At approximately 3.45 a.m. on December. 1, 2002, Christopher Herrera went into respiratory and cardiac arrest and died. a 4. What particular act or emission on the part of county or district officers, servants, or employees caused the iniury or darna e? The county,its employees,servants,employees and or agents were negligent with regard to the treatment provided to Christopher Herrera,including but not limited to,the following negligent acts or omissions: failing to adequately monitor decedent,prematurely discharging decedent,failing to adequately review decedent's medical records and negligently prescribing medications to decedent. S. What are the names of county or district officers, servants,or employees causing the damage or injury? Christopher Farnitano, M.D. In addition, there may be others whose i.denities are unknown at this time. 6. What damage or injuries do you claim resulted?(Give hall extent of injuries or damages claimed. Attach two estimates for auto damage.) The negligence referred to herin above caused the death of Christopher Herrera. Plaintiff's. damages exceed $25,000 (See Government: Code Section 910 (f) . How was the amount claimed above computed?(include the estimated amount of any prospective injury or damage.) Claimants' damages exceed $25,000. See Government: Cade Section 910 M. S. Names and addresses of witnesses, doctors, and hospitals. Rizza and Winston Herrera,3484 Willow Pass road,Apt. 5,Concord,CA Christopher Famitano,M.D.,2500 Alhambra Ave.,Martinez,CA Contra Costa County Regional Medical Center,2500 Alhambra Ave.,Martinez,CA. See attached sheet. . List the expenditures you matte on account of this-accident or injury. but of pocket: none at this time. IE IME AN4 � t .�+tw***+�«*.r..r*:+r�r��*w*�«*��s*****�*«��*r�*�w�**t.�**#*�t:s**�*�.*.tit«*.*r.*�.�t*��*r.w *****•�**� Gov. Code See. 910.2 provides"The claim trust be signed by the claimant or by some person on his behalf.,, .SES. '1OTICES 7 C} ( ttornev Name and Address of Attorney } Thomas E. Sokat, Esq. ) Law Office of 'Thomas E. Sokat } Or-) Q�Cnc&� Aila 383 Diablo Road, Sutie 100 ) (Claimant's Signature) Danville, CA 94526 383 Diablo Road, Suite 100 (Addrm) ) Danville, CA 94526 (925) 831--0568 ) 925 831-0568 Telefahone No. )'Telephone No. ( ) *��«.**•*�����:*�«�*+sus*t�s��������*:•����*�:�s*.«*���«««**s�***����*�:�►«�s���►��*��►�:�r*�e���► NoncE Section 72 of the Peal Code provides. Every person who,with iatrrit to defraorl,puts for*Bowa=or the payment to any sttatt board or officer,or to any county.city,or district board car officer,armed to alicnv or pay the saint if genuine,any false or ftaudulent ckLm,bill,acxo=t, voucher,or wridn&is punishabh:tilbtr by i p6sc ninent in the counlyjall for a period of not more Ow we year,by a fine of not eaweeding cane tho (S 1,0001 or by bats sacb haprisoome tt and fine,or by imptisoament in the stats prisonby a ftne of not exceeding ten tbousand dollars(S10,000),or by both such imprisonment and fmc. Continuation of Response to#8 American Medical Response Gary Giusti VonSargent 801 10`h Street,4"h Floor Modesto, CA 95354 Mt. Diablo Medical Center 2544 East Street Concord, CA 4520 Arnold 3osselson, M.D. Forensic Pathologist Office of Coroner, Contra Costa County 1964 Muir Road, Martinez, CA 94553 Gary Davis Forensic Toxicologist Forensic Services Division Office of the Sheriff, Contra Costa County National Medical Services 1604 Harbor Bay Parkway, Suite 150 Alameda, CA 94502 Officer Sansen Concord Police Department 1350 Galindo Concord,CA 94520 Contra Costa County Fire Department Maurice Howell Mike Eglite Denny Clemens All Employees of Contra Costa Regional Medical Center, 2500 Alhambra Avenue, Martinez, CA, who provided medical or nursing care to Christopher Herrera on 11-30- 02. LAW OFFICE OF THOMAS E. SOKAT TELEPHONE: (925)648-2075 4115 BLACKIiAWK PLAZA CIRCLE,SUITE 100 E-MAIL:TSOKAT@AOL.COM FACSDA E: (925)648-2076 DANVILL,E,CA 94506 WWW.CCCBA.ORG/TSOKAT November 18, 2003 , Board of Supervisors of Contra Costa County Room 106 r - . 1 County Administration Building ��a d 651 Pine Street ,� � 40 Martinez, CA 94553 s -U Re: Christopher Herrera, deceased ' Date of Treatment: 11-30-02 Date of Death: 12-1-02 Notice of Intention to Commence Legal Action To The Honorable Board of Supervisors of Contra Costa County: This law firm represents the family of Christopher Herrera, deceased, who was treated at the Contra Costa County Regional Medical Center Emergency Department by Dr. Christopher Farnitano, an Emergency Department physician on duty at the time, and others, during the afternoon November 30, 2002. Christopher, aged two, died at approximately 3:00 a.m. on December 1, 2002 as a result of substandard treatment which Contra Costa County Regional Medical Center and Dr. Farnitano provided to him on November 30. The Herrera family has directed that I commence a legal action against The 'County of Contra Costa and any other responsible parties in order to recover all damages that they are entitled to recover under the laws of the State of California for the wrongful death of Christopher Herrera. My clients previously filed a notice of claim against Contra Costa County on May 21, 2003, which was denied by the Board on June 24, 2003. A copy of the claim and the County's denial of the claim are attached. If you have any questions please do not hesitate to contact me. Very truly yours, Thomas E. Sokat cc: Medical Board of California Central Complaint Unit 1426 Howe Avenue, Suite 54 Sacramento, CA 95825 Crim lir: BEIM OF SUPERVISORS OF CONTRA COSTA COUNTY A. Clairns relating to causes of action fbr 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 1 oLt'f`day after the accrual of the rause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing cops and which amme 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 affcr the accrual of'the cause of action. (Gov't Code 911.2.-) B. Claims attest be filed with the Clerk of the Board of Superwrisors at its office in Room 105,County Administration Building,551 Pine Street,Martinez,CA 94553. C. If claim is against a district governed by the Berard of Supervisors,rather than the County,the name of the District should be fitted in. D. If the claire is against more than one public entity,separate claims must be filed against each public entity. £. fes- Sec penalty for fraudulent claims, Petal Code Sec. 72 at the end of this farm: s*s*,�s*:,cwt+��sartrt«r**�t*«sr*ss+�x*s*r.�*«�e**+r+r*vis s*s�r+�,►.+�,►****«s*sw+r�r*�*s**+r*+r*r*«s*«*«t**« RE: Claim By Resented for Clerk's filing stamp Rizza Herrera and Winston.Herrera F0RECEIVE-D ,: Estate ofChristopher Herrera, Deceased Against the County of Contra Costa orDistri D3 (pill in name) CLERK BOARD OF SUPERVISORS CONTRA COTTA C{3, The undersigned claimant hereby makes claim against the County ofCorttra Costa Or the above named district in the sunt of 3 and in support of this claim represents as follows: in excess of $25,0100. Bee Government Code Section 31.0 (f) . I- When diel the:damage:or injury oar?(Give enact daft and hour) December 1, 2002,- at: approximately 3:45 a.m. , was the time of death. The decedent was treated between 2:40 p.m. and 4:015 p.m. on 11-30-02. 2. Where did the damage or injury occur?(Include city and cmuty) Decedent was treated at Contra Costa Regional Medical Center, 2500 Alhambra Avenue, Martinez, CA and died at home at 3484 Willow Pass Read, Apt.-.5, Concord, CA. Both locations are in Contra Costa County. 3. How did the damage or injury occur?(Clive flitl drfails use extra Pam.rfr�u� irred) Rizza Herrera and Winston Herrera are the parents of decedent Christopher Herrera. On November 301, 2002, Christopher Herrera, who was two years old, had an asthma attack and was taken by his parents to the emergency room at Centra Costa Regional Medical Center. Christopher Herrera was admitted, examined, -treated and released at approximately 4:00 p.m. At approximately 3:45 a.m. on December 1, 2002, Christopher Herrera went into respiratory and cardiac arrest and died. 4, *hat particular act or omission can the past of county or district officers, semnts.or employees caused the iniurlt ter damaRe? The county,its employees,servants,employees and or agents were negligent with regard to the treatment provided to Christopher Herrera,including but not limited to,the following negligent acts or ornissions: failing to adequately monitor decedeat,prematurely discharging decedent,failing to adequately review decedent's medical records and negligently prescribing medications to decedent. S. What are the names of county or district officers,servants,or employees causing the damage or injury? Christopher Farni.tano, M.D. In addition, there may be Gathers whose idenities are unknown at this time. f. What damage or injuries do you claim resulted?(Give full extern of injuries or damages claimed, Attach tuvt estimates for aunt damage.) The negligence referred to herin above caused the death of Christopher Herrera.. Plaintiff's damages exceed $25,000 {See Government Cade Section 910 (f) . 7. How was the amount clamed above computed?(include the estimated amount of any prospective injury or damage.) Claimants' damages exceed $25,000. See Government Code Section 910 (f) . S. Names and addresses of witnesses,doctors,and hospitals. Rizza and Winston Herrera,3484 Willow Pass Road,.Apt.5,Concord,CA Christopher Farn taro,M.D.,25001Alhambra Ave.,Martinez,CA Contra Costa County Regional Medical Center,2500 Alhambra Ave.,Martinez,CA. See attached sheet. 9. List the'expenditures you trade on account of this accident or injury, but of packet none at this time. DAM Ifta AMOUNT F *+l*##!#M#+Mt#aR+�«##+t+F+h+)t¢#'F##k«###k#+M1#kt#s#+tklClkr#ke###F«r####«kik#:f#+f#t►k#t#*#tKF+irk+R+l#kk##kk+Fk# Gov. Code Sec.910.2 provides"The claim must be } signed by the claimant or by some person oA his behalf„ SEM MOM 10, fAtt ev Name and Address of Attorney � Thomas E. 5okat, Esq. Law 0lffice of Thomas E. Sokat } 4t- At�� 383 Diablo Road, Sutie 1010 (Claimant's Signature) Danville, CA 94526 383 Diablo Road, Suite 100 } (Address) } Danville, CA 94526 Telephone T3c�. (925) 831--01568 j Telephone No. (925) 831-0568 NMCE Section 72 of the Penal Code provides: Every person who.with#aatcot to dem pmsevu for allowance or alae pkat to any state board or officer,or to any may.city,or dot rier board or officer,autlwra i*wd to allow or pay the wow if SM%drte,any false at fraudulent claim,bill,sc mat, vo be r.nt wrft m&is pwAsMble either by bVdsonment in the cotusly Jall Rw a peniod of not mom Om tact year,by a fire of not exceeftg one twoued($1,03131,or by boM uscts h%*fiwnmwt aryl fur,or by irvrisomeut in die state prison,by a fine of not exceeding eding teas dow;and'461bm($10.000).cor by both vadh issspctsowriew and Am. Continuation of Reponse to#8 American Medical Response Gary Giusti 'ion Sargent 801 10"' Street,4'Floor Modesto,CA 95354 Mt. Diable Medical Center 2540 East Street Concord, CA 4520 Arnold Josselson,M.D. Forensic Pathologist Office of Coroner,Contra Costa County 1960 Muir Road, Martinez,CA 94553 Gary Davis Forensic Toxicologist Forensic Services Division Office of the Sheriff,Contra.Costa County National Medical Services 1600 Harbor Bay Parkway, Suite 150 Alameda., CA 94502 Officer Sansen Concord Police Department 1350 Galindo Concord, CA 94520 Contra Costa County.Fire Department Maurice Howell Mike Eglite Denny Clemens All Employees of Contra Costa Regional Medical Center, 2500 Alhambra Avenue, Martinez, CA, who provided medical or nursing care to Christopher Herrera on 11-30- 02. CLAIM BgA.RD OF SUPERUSORS OF CONTRA COSTA COUNTY 17 BOARD ACTION: JUNE 24, 200 Claim Against the County, or District governed by ) the Board of Supervisors,Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action, All Section reference ri (n,,I�t r ,� The copy of this document mailed to you is your California Government Codes. ttT , �< notice of the action taken on your claim by the �° Board of Supervisors. (Paragraph IV below), give ° "` Pursuant to Government Code Section 913 and Cu t: t°�'>.4>-€ 915.4. Please nate all"Warnings". A iT 1,.!114-;.!�'AI.4 F" AMOUNT: EXCESS OF $25,000. CLAIMANT: RIZZA HERRERA AND WINSTON HERRERA ESTATE OF CHRISTOPHER HERRERA, DECEASED ATTORNEY: "THOMAS E. SOKAT, ESQ. DATE RECEIVED: MAY 21, 2003 ADDRESS: LAW OFFICE OF THOMAS E. SOKATBY DELIVERY TO CLERK.ON: MAY 21,___2003 383 DIABLO ROAD, SUITE 100 DA MLLE, CA 94526 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEE E erk Dated: MAY 21, 2003 By: Deputy 11. FROM: County Counsel. TO: Clerk of the Board of Supervisors 0 This claim complies substantially with Sections 910 and X10.2. ( ) 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 912.3), { ) Other: Dated: �" 0-3 By: f Deputy County Cbunse 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: (K) This Claim;is rejected in W. ( ) Other: I certify that this is a true and correct copy of the Board's Carder entered in its minutes for this date. 11-7 /C'1 c U u t0 C31 z uj LLA ,., LO cc - LLJ ,� to Da < G N -2Eti- ' m0 p O O to ci1LL' UtD i u CA d' aE� � A CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY • BOARD ACTION: JUNE 24, 2003 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and x 915.4. Please note all "Warnings". i AMOUNT: $8 , 909 -00 CLAIMANT. ANN BARBER ATTORNEY: UNKNOWN DATE RECEIVED: MAY 21. , 2003 ADDRESS: 231 CAMPBELL LANE BY DELIVERY TO CLERK.ON: MAY 21 , 2003 PLEASANT HILL, CA 94523 BY MAIL POSTMARKED: MAY 20, 2003 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEETEN 1 Dated: MAY 21 , 2003 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors {phis claim complies substantially with Sections 910 and 914.2. ( ) 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: jr By: LL11olui 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: JUNE 241 2003 JOHN SWEETEN, CLERK, By , Deputy Clerk WARNING(Gov. code s tion 913) Subject to certain exceptions, you have only six (6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned,have been a citizen of the United States, over age 18 and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: JUNE 25, 2003 JOHN SWEETEN, CLERK.By Deputy Clerk t 231 Campbell Large i r Pleasant Hill CA 94523 (925)938-297 MAY 2 1 �J cL fire 8O.ARD OF 4 May 20,2003 To wham it may concern, My two children and I had the misfortune of the creek behind our house overflowing into our home on the 16t'of December 2442. There was very heavy rain that night and we were notified by the Pleasant hill Police at 3;40 a.m.in the morning that the creek had over flowed the banks and was beginning to enter our home. We began to sand bag all entrances to the house but there was not enough time.The entire down stairs flooded about six inches.Enclosed are pictures taken during the flood. I had to have all the carpet and linoleum removed and machines brought in the dry the walls. I had the floors replaced with linoleum for fear of future flooding. As a home owner on Campbell Lane,I routinely remove debris from the creek,I have removed a car battery,bamboo branches shopping carts and rubbish of different kinds. There was nothing I could do that night to prevent the creek from over flowing and I understand that there is a plan In the future to fix this problem. I met with Flood Control Division Advanced Planner,Kevin Emigh and William Bailey, Engineer Technician on May 12th 2043. They showed me maps the indicate that Flood Control is responsible for the creek by my home. Please call me with any questions and thank you for your time. Sincerely, Claim to: BOARD OF SUP{{ERVrrI*�SOR//S��x,���QF C�ONTRA�/{�OS. CMM M A. Clams relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of.action for-death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. G. 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 } Resery d k's filing stamp NAYJ10O3 theCounty of Contra Costaor } District) (Fill in name - . ) The undersigned claimant hereby makes claim against the bounty of Contra Costa or the above-named District in the sum of $ '� ` - and in support of this claim represents as follows: 1. When 'lid the damage or injury occur? (Give exact date and hour) 4r.a6" "Z..f •�y. �.✓ Jam✓ _���� r ! D �=Y t_..s m . _fir LL �_ LLL����� .-may✓ (C rrr®+.rwi.r...r—wrrrsrr.irwrrr 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give full, details; use extra paper if required) cw 4. What particular act or emission on the part of county or district officers, - servants or .employees caused. the.injury or damage? 7. wnat are the names of county or district officers, servants or employees causing the damage or injury? 6 What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach twoestimates for auto damage. f , / M >.✓ate_. -r'" r- ` %t 7. Hoc was the amount claimed above computed? (Include the estimated amount of any prospective in or damage.) : Wil¢ r 10 �. Names an ad ddress witnesses, doctors and hospitals. s' g. List the expenditures you made on account of this accidentAor injury: DATE ITEM AMOUNT- fl�i� �yam.? �a !�,'.,ly''���,t`.,. 4. �z°`,.'"�'Z�d�°�� �,�7�{�`..C%'T •`-`�,.'� i ,r�_i s _ -. Gov,�t {�A-��{��trM���tq�t �t {�w{ � �tyy�t� y�t� Code Seca 810.2 pi ov1des: "The claim must be signed by the claimant SEND NOTICES T0: (Attorney or some n on his-.behalf " Name and Address of Attorney C1 -i 1t's Signature Ad ess e-SI Telephone No. Telephone No. ✓, r' * * NOTICE Section 72 of the Penal Code provides: " "Every person who, with intent to defraud, presents for allowance or for - payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either byofmnntsex eedin (X3n the county jail-for a period of not more than one-year, by one thousand ($1, 0), or by both such imprisonment and fine-,or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. -�ampfle�i Mtn. ViewCrty earpeterja f2ar ` Cl •.�anftta te Clara ,y.tFET•v+NYL�LOryRS•�AFWYOpG FLvCR$ � ✓da!IS .RAMIC'ILE•LAtMNATE%V,-CC.AREA FUGS R t_M. Dublin Leandro Craig Kelly, Senior Design Consultant San Francisco 2691 Monument Boulevard iiiovato Concord,California 94520 s Concord tai., 315-676-3124 •fax: 925-676-3064 � .. Antioch voice mail:800-729-1331 ext. 244 Salinas email: ckeily@carpeteria.com NAi� . .�� .�...v IRST) , 'Na1NE(LAST) (FIRST) . AD SS q ADD SS C] it STAVE CITY ST'AT'E COD 0MEE TONE WORK PHONE ZIP CODE HOME PHONE WORK PHONE 6-1 .w r ; iv. ,r. -�%..c u,. . b.r, .. .. � .«w,4`�iva x. �'P .rv'L�.+rfv.l _ - '' 6dr�'ihu !s'�',ta,r.- .Sr'T,�' A'� •_ } t 1� °Tr✓ /t 4 . } r 4- REMARKS: + 77 r5.. VUMMEllc L'GtiDfTpN} 73 CN R(S SIGNATURE(S), URE(S). THE EA LISTEDWOOM _ ,.Y' -.,...,.r+",",•••° OADEFt AND 00NDrNM SEE REVERSE FOR IMPORTANT NOTICES AND ADDITIONAL TERMS. CUSTOMER Premier Meaning Systems P. d. Box 3216 Martinez, CA 94553 877-334-7847 Invoice date: 01/13/2003 Job Address Insurance Information Ann Barber 231 Campbell Lane Pleasant Hill, CA 94523 ;Vw,0t&or Cleaning Systems Job Rate: 12/06/02 Cleaning & Restoration FREE (877) 334-7847 Deon Fouche senior Restorer Cell.(415)747-2059 Po.Box 3216 Martinez,CA 94553 Original Recap of Services Emergency Water Damage Restoration $ 3209.00 Total $3 209.00 Item # Item description Unit Measure Price Cost I Emergency response 1 170.00 170.00 2 Remove and reset furniture 3 hr 28.00 84.00 3 Extract carpet 400 sf 0A5 180.00 4 Extract pad 400 sf 0.45 180.00 5 Extract other flooring 200 sf 0,45 90.00 6 Disengage carpet 400 sf 0,38 152.00 7 Remove wet pad 400 sf 0.50 200.00 8 Remove wet carpet 400 sf 0.50 200.00 9 General prep 2 hr 42.00 84.00 10 Apply anti microbial deodorizer 800 sf 0.22 176.00 11 Dehumidifier 4 units x 4 days 16 days 94.00 1504.00 12 Dump load I loads 85.00 85.00 13 Monitor equipment 2 ea 52.00 104,00 Total $ 3209.00 Prices as per"The Blue Book of Cleaning, Reconstruction and Repair cosV—2002 fjR iV B�V L3 a., i y }{ j } , A vF y awe {6 4 �2 nd. ! �1 y: { 0 k4l, s r t } `is '3 yfv n k>. { ; Ile v 5 r < 5 w: { t f: S s & ' All w i CLAIM /' BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: JUNE 24, 003 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and r ^ - f 915.4. Please note all "Warnings". AMOUNT: $7 , 165 . 13 > s CLAIMANT: CLARK J. DAWSOrI ,;s; ) ATTORNEY: UNKNOWN DATE RECEIVED: MAY 23. 2003 ADDRESS: 3205 C.AMBY ROAD ` BY DELIVERY TO CLERK ON: MAY 23 , 2003 ANTIOCH, CA 94509 BY MAIL POSTMARKED: MAY 219 2003 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEE�E erk Dated: MAY 23, 2003 By: Deputy �" II. FROM: County Counsel TO: Clerk of the Board of Supervisors { } This claim complies substantially with Sections 910 and 910.2. (4.)``This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant, The Board cannot act for 15 days(Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). { ) Other: Dated: `� �' °` By: Deputy County Counsel 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. JUNE 24 2003 Dated: JOHN SWEETEN, CLERK_ , By , Deputy Clerk WARNING(Gov. code sectio 913) Subject to certain exceptions, you have only six (6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: JUNE 25, 2003 JOHN SWEETEN, CLERK.By Deputy Clerk `~� OFFICE OF THE COUNTY COUNSEL °��.A� SiLVANO B.MARCHE53 COUNTY OF CONTRA COSTA � ��.��, COUNTY COUNSEL Administration Building tl SHARON L.ANDERSON 651 Fine Strut, 9", Floorf' o" CHEF AssisTANr Martinez, California 94553-1229 p d b i i z GREGORY C.HARVEY (825) 335-1800 `1 C�; 'u 1`y`l' - 4` VALERIE J. RANCHE (925) 646-1078 (fax) t� IJ�" ;< AsswAws s' NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Clark J. Dawson 3205 Camby Road Antioch, CA 94509 RE: CLAIM OF: CLARK..J. DAWSON 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: [ 0. The claim fails to state the name and post office address of the claimant. [ ] 2. The claim fails to state the past office address to which the person presenting the claim desires notices to be sent. [x] 3. The claim fails to state the date,place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [ ] 4. The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or loss, if known. [ ] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000). If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. [ ] 6. The claim is not signed by the claimant or by some person on his or her behalf. Page l Clam J. Dawson Re: Claim Page Two 7. You are required to submit your claim on the proper form,which is enclosed. Please resubmit your claim on the enclosed form, including all the required information. Gov. Code, § 910.4. Please be aware that you have only a limited period of time in which to file an amended claim.. See Gov. Code, § 910.6. [ 18. Other: SILVA O B. MARCHER COUNTY COUNSEL Monilia L. Cooper Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013a,2015.5,Evidence Code§§641,664) 1 declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California 94553;1 am a citizen of the United.States,over 18 years of age,employed in Contra Costa County,and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non-acceptance of Claim by placing it in an envelope addressed as shown above,sealed and postage fully prepaid thereon,and thereafter was,deposited this day in the U.S.Mail at Martinez,California. I certify under penalty of perjury that the foregoing is true and correct. t Dated: V-' at Martinez,California. r ,fi p t cc: Clerk of the Board of Supervisors(original) Risk Management Page 2 Claim to: BOARD Ur SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death 'or for injury; to person or to :per_ sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later- than tine 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., grow ng 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 presen ed not later than one year after the accrual of the cause of action. (Govt: Code §911.2.) B. Clam must be filed with the Clerk of the Board of Supervisors at' its office in Room 1.016, County Administration Building, 651 Pine Streets Martinez,>C� 94558. r C. If claim is against a district governed by,the Board of Supervisors, rather than toe County, the name of the District should be filled in. D. If the claim is against more than: one public entity, separate clairs must be filed aszainst each public entity. . Fraud. See penalty for fraudulent.claims, Penal.. Code Seo.; 72 at the end of this form. RE: Clain By Reserved for Clerk's filing stamp } f , > RECEIVED Against the County cif Contra. cosh > � Y 1003 orA District} Fill xm name ) The undersigned claimant hereby makes claim against the County of Contr Costa or, the above-named District in the sum of $ <. z and in support of this claim represents as .follows: 1. When did the damage or injury occur? (Give exact date and :hoar) y B. 'Where did the damage or injury occur? (Include city and county) 33 How dad the damage or injury occur? (Give full details;''use extra paper if required) s a equ red) 'KK ; f , "' `'�'''`3 ,F ;. b�.+yw; d✓ s3f/ .^v" ^�"d' y.'6.'f "'',�,"3 Bf''d/�./*r.J - "'"L<rl 4. What partic ar act or omission' on thePar"t of county or district officers, the. sets cr.�loyees caused, the.in ury, or•. damage• rn.& , ( �. wnat are tris names of county or district officers, servants or employees causing' the damage or injury? . What damage or injuries do you claim resulted? {Giver full extent of .injuries or damages claimed. Attach two estimat;s for auto damage- ; ~_0 ' ?• How was the anxsunt claimed above computed? {Include the estima ed amount of any a prospective injury or damage.) � � 9 r .� amf�.^7�andWaddressas of witnesses, doctors and hospitals. � r__r_,.�........._._��.. the expenditures you ede on account of this accident or injury g. List BATE ITEM � A�'��7L�i i'f �t +� Gov. Gude Sec. 910:2 Prov as: the' claimant "The claim MIs be signed by ; 1 Sr'4Nn NOTICES TO: (Attorney) or br some erson onhis.behalf.n Name and Address of Attorney Gla. t s `Sgmatur Address Telephone No. Telephone No. # N CIT I CE ` Section 72 of the i'ena.l Code provides; `! ++ person who, with intent to defraud, presents for allowance or ;for Every pe- county, city or district board cr payment to any state board or officer, or to any false or fraudulent officer, authorized to allow or pay thesameis � Y b1e e ythe,. by !=Pri.sa:isnent in claim, bill, account, voucher, or writing, a fine of` not exceeding the county ail for a period c�P' not more than torte year'� by one thousand 01,400}, or by both such i�prisoz�tent and firie;`�t7r' by f.mprsc�nr�nt :.:� ing ten thousand the state prison, by a fine of not exceeddollars ($10,000, or by both such impr isonnt and fine. ......» ............................ __ Sportsmen Yacht Club f Incorporated 1931 3301 Wilbur Avenue, Antioch, CA P.O. Box 518, Antioch, CA 94509-0051 (510) 753-1444 ,to contra costa County Directors'.` Sportsmen Yacht Club has been negotiating with Contra Costa County officials the past several months. regarding the defective storm drain which runs from K-Mart parking lot,under our roadway at Sportsmens Y.C.and on to the San Joaquin River. The county officials had MSI run a camera from Wilbur avenue to the river to access the damage.Joe Yee has the 3 tapes showing the damage and has agreed with Greg Cunnington to install a flapper gate at the river.Joe and Greg have also agreed to repair the many blown out areas in the pipeline.These repairs will make the pipeline round enough so they can then run a liner inside the existing pipeline for a final repair.The worst area showing on the tape is directly in front of the vessel Eddie Drew and has contributed to the collapse of 100' sea wall. Joe Yee has agreed to pay for the sheet piling and Sportsmen Y.C. agrees to have it installed. Sportsmen also agrees that the county will not have to dredge the effected area or have any other responsibility created by this leak.Enclosed is the bid from sheet piling distributor for the total cost of$7007.72.The installation of the sea wall will also require 100' of 4x6 timbers to support the wall at the top. Lawes hardware sells the beams for$17.44 each in 12' lengths.$17.49 x 9 lengths=$157.41 This brings the total cost to the county$7007.72+$157.41=$7165.13 1 can be reached on my cell phone at(925)354-1226 Thank you in advance . Clark J.Dawson Sportsmen Y.C. Cc:Lonnie Gibson-Commodore Dave Selvy-Vice Commodore Darlene Dawson-Rear Commodore Chuck Carroll-Secretary PAUL RACINE DISTRIBUTOR LTD. Paul Racine Distributor Ltd. 2515 Clipper Lame Phone (707) 263-0586 Lakeport, California (95453) Fax (707) 262.0586 E-mail: domeport@jps.net jps,net QUOTE NAME Jim Dobson ADDRESS CITY Cell 925-354-1226 PHONE 925-757-2255 Fax DELIVER TO (LOCATION) QUANTITY UNIT DESCRIPTION UNIT COST AMOUNT 18030 30 Ft CL-45001 C-Loc Sheet Piling 3,63 $ 6,534.00 $ - $ APPROXIMATE SHIPPING GATE SUS TOTAL $ 6,534.00 LABOR SALES TAX $ 473.72 DELIVERY AMOUNT $ - INSTALLAT€ON AMOUNT OTHER LABOR AMOUNT TOTAL $ 7,007.72 NO REFUNDS AMOUNT PAID ALL SALES FINAL AMOUNT DUE $ 7,007.72 THIS PRICE IS GOOD FOR 15 DAYS date Nonce Is to aN parsons,firm,aria entities 0Xter1CM;'credit to,tontratt+r,q y0t,or he'!"m)fIalms a.)ewst this:onfra[tuei b s,ness a5s4Uat en'r its trustee,ma: they must bok WO,to tns tends,propsrty,and Mot assts of PALM,RA4tNE 0 STR81 i(DR LTC a t,-a-HE C C>,_h:FAQ:T4,R�AIZ SUP'_Lr�W; -Aide for payment or for S453er 5@tit6f Etc tta m,Ceb2,j dgttt@ t(d@tr@C�).sward,or ath9r}bitgao0n wrilCh f wr} B£Affie p?yaGi@ h@rauc3er TPe L 9i @s.?k,;ilt5.d;;6 t5.@;;<r fKa%6 h4}v"8r4 ars nGi parsortaty tlebtS wrian dda m��dth PA!! RAONE NSTR18UTOR LTG dib a.THE DOCK FACTORVANC S'PF'L'(1_-O iPAN prnpernes r r bus+ness rr atters,or for any inn of obii1pton rssutt+no therefrom,or for any typo or class of ttaim f 5sy ry > ,3 yy t �Cp Y. ccs kn r)