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MINUTES - 05252004 - C18
CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: MAY 25, 2004 Claire Against the County, or District Governed by ) the Beard of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to } The copy of this docurment mailed to you is your California Government Codes, } notice of the action taker,on your claim by the Board of Supervisors. (p'aragr'aph IV below), give l ursua�at to Gove,m hent Code Section 9 a 3 and 915.4. Please note all "Warnings". AMOUNT: $249.00 CLAIMANT: STANLEY R. 'ZI?'�,MIIAI ATTOILNEY: UNIKINOTON DATE RECEIVED: APRIL 20, 2004 ADDRESS. 6363 CHRISTIE .AVENUE #2517 BY DELIVERY TO (-LER ON: APRIL 20, 2004 EERYVILLE, CA 94605 BY MAIL POSTMARKED: APRIL 19, 2004 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. APRIL 20 2004 JOHN'SWEET Dated: By: Deputy II. FROM: County Counsel.. TO: Clerk of the Board of Supervisors (y 1",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 9113.8). ( } 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: ..: ¢ ff Deputy County Couns( Ill, FROM: Clerk of the Board TO: County Counsel(1) County Administrator (2) ( } Claim was returned as untimely with notice to claimant(Section 9:1,3). IV. BOARD ORDER. By unanimous vote of the Supervisors present: ( ' This Claim is rejected in full. ( } Other: 4 I certify that this is a true and correct'copy of the Board's Order entered in its minutes for this date. Dated: JOHN SWEETEN, CLERK, By , Deputy Clerk WARNT�G(Gov. code sec ion 913) Subject to certain exceptions,you have only six(6) months from the date this notice eras personally served or depositez in the mail to file a court action on this claire, see Government Code Section 945.6. You may seep 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 deposite 'in the United States Postal Service in Martinez, California, postage fully Prepaid a certified copy of this Board Carder and Notice to Claimant, addressed to the claimant as shown above. Dated J011N SWEETEN, CLERK By Deputy Clerk Claim to; BOARD OF SUPERVISORS OF CON-MA COSTA INSTRUCTIONS TO CLAD-VM a 0 2004 ULEE� A. Claims relating to cau3es of action for death or for injur sonal property or growing crops and which accrue on or before Deco must be presented not later than the 100th day after the accrual of the ' f action. Claims relating to causes of action for.death or for injury to person or to personal property or growing drops and which accrue on or after January 1, 1938, must be presented not later than six months after the accrual of the cause of action. Clams 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 §9x1,2.) B. Maims must be filed with the Clerk of the Board of Supervisors at its office in Room 106? Cot:nty Administration Building, 65! Pine Street, Martinez, CA 94553. C 1, claim is against a district governed by the Board of Supe^visors, rather 'than e f +.,; s fi e*d in the C{:,u��ty', the u o� the Dist-.L pct should D. Tf the claim is against more than one public entity, separate claims must be Hied against each: public entity. B. ' Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the end of this form. Claim By *TIj � � ,�,����'�� Deserved for C1erk's filing stamp ' .i 3 - Against the County of Contra Costa � or District) The undersi ,rias are the names of county or district officers, servants or employees causing the damage or in jury? A �r ileP,9ie?°M 4W /10 K ' A 5< What damage or injuries do you claim resulted? Give full extent of injuries or damages cla ed. Attach two aimates for auto damage. 6 ro v r 7. How was the amount claimed above computed? (include the estimated amount of any prospective injury or damage.) Names and addresses of witnesses, doctors and hospitals. C � 9. List the expenditures you made on account of this accident or injury DATE ITEM AMOUNT Gov. Code Sec. 910:2 provides. "71he claim must be signed by the claima=nt SEND NOTICES TO: (Attorney) or bypome person on his. bel^alf.� Name and Address of Attorney Clal.Lrant''s Signature' A4�d-e,s i 64 -.4 Telephone No. telephone Na. N O T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allv,,rance 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 sane if .genuine, any false or fraudulent claim, bill, account, voucher, or uniting, 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 ($l,OE 0), or by both such imprisonment and fire; or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment- and fine. ........................................._... .............................. ............................................................................................... ... ......... _ ... ......... ......... ......... ......... ............. _ .. ......... ......... ......... ............___ ..... ......... ......... ......... .........-_ ............................................................................................. .................................................................................. U Lu LIJ el X cl CLAIM n BOARD OF SUPERVISORS OF CONTRA COSTA COUNT'' BOARD ACTION: .Y 25, 2004 Claire 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), giver - pursuant to Government Code Section 913 and 915.4. Please note all"Warnings". AMOUNT: $250,000-00 CLALMANT: Roy T . PI LPS ATTORNEY: CHARLA R. DUKE DATE RECEIVED: APRIL 20, 2004 ADDRESS: 0N" LAKESIDE DRIVE #203 BY DELIVERY TO (.LERK ON: APRIL 20, 2004 OAKIAVD, CA 94612 BY MAIL POSTMARKED: APRIL 19, 2004 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. Dated: APRIL 20, 2004 JOHN SWE T Clerk By: Deputy IT, FROM: County Counsel.. TO: Clerk of the Board of Supervisors (#)'This claim complies substantially with Sections 914 and 910.2. x ( ) This Claire FAILS to comply substantially with Sections 914 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 yarning of claimant's right to apply for leave to present a late claim (Section 911,3). Other: .Dated: By: % �� <�� _� f Deputy County Couns� ;.IT, FROM: Clerk of the Beard TO: County Counsel (1) County Administrator (2) ( ) Claire was returned as untimely with notice to claimant (Section. 911.3). IV. OARD 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 Beard's Order entered in its minutes for this date. Dated: JOHN SWEETEN, CLERK, By — , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you hove only six(6) months from the date this notice was personally served or deposite in the mail to file a court action on this claim, See Government Code Section 945.5. 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 deposite ,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 „ COUNTY OF CONTRA COS A�`�4�` C1.�A1:1'V�AG i. B S:t �HE h.4 WED (i'urmau t to Govca7jmcjrt Code Setiflun 910,et seq.) r� CLA TWANTn SPR 2 0 200 ° ? t C RC OF SUPrfj%, S!"S Name 1. 3 x ✓ I'l:tlrre( Cis SfiCO§TAEO. Address r (include City,State&Zip,Code) PERSON TO WHOM ANS'NOTICES CONCERNING CLATIM SIIOUL.1)BE SENT: (Include City,State," Zip Code) r, Wu..FN DID 11`HF,F)AMAGL OR INJURY OCCUR? Datt; TicTle arty�� n� (State exact month,date&year) AT WHICH LOCATION DID THE DAMAGE ORINJURY OCCtTM z v WHAT HA.PPE'NT TD ANIND WHY IS THE .'RESPONSIBLE?(Attach additional sltccU,if needed) �,>.f'� *E i��' ..:'per r�. :•`�.� .✓..��;' � R.z.x a/ .� ;?`. g--�a„a �s 2:2•;<._, e`i.�.: y�'`^!!�� ���•�” tt i>�', �"st Yt y�,.t c �'4�*?�k'�'a i � �..�� �: �� 21L �3"`4� • WjjA.T DAMAGE OR INJURY OCCURRED?(Attach additional shcets,'i€needed) �.b"�i*.. i ',Y i. '``�s t'• e`k- s „•, t 4.F4°:�i i a s q?.. .a'a��O•L .. o} .''.t vliW'''1 •'vJ +..:`.s 'tLT W5> 4 -F':�v; r/'"' . t,l,Al i AOITiVT: $ I.T. W D 1 V 0 U AId.RIVE ATTIIE AMOUNT CLAIMED? tcf'1.`t4P :f`'S'9 �n.i t. ,S-..+... S 9.;•✓ .iifJ tr s Vis':." r 2'ri' ice''. <:`.a ' i. n :✓".s .iv•.. ,f y ;f JZ, i..,,,... •':s':�.. t t e'i ?.' - ,�. ._ .�. s \• ddb Y i:£ 0 'c�?a,tii•� Y r'%� 5+.�.,�.r.+' '`...� `.. i�ka'v � ; �` 4° �^-'-- °Zvi-- A! DAM OU s s % � "��✓✓� ''' ,signature of Cla-imatit ar°�cr in acting on hi, fielarrTf PROOF OF SERVICE -BY MAIL I am a resident of the County of Alameda, I am over the age of eighteen (11,8) and not a party to the action. On this date, I served the following document: Claim Against the County ol."Contra Costa by placing in the U.S. Mail a true and correct copy of the document In a sealed envelope, with postale-pre-paid, addressed to: Clerk of the Board of Supervisors County of Contra Costa 651 Pine Street, Room 106 Martinez, California 94553 Executed on April 19, 2004 at Oakland, California, I declare under penalty of perjury under the lwNs of the State of California that the forep-oina,is true and correct. JA Nancy G. Pill;p`s La-v Clerk Phelps THE LAY OFFICE OF CHARLA R. DUKE ATTORNEYATLAW I'Lakeside Drive .'Suite 203 Oakland, California. 94612 (510) 839-5453 Fax (510) 893-4228 April a 9 2:00 APP 02904 b Fit OAR U Clerk off.the Board of Super-84sors County of Contra Cost 6S I Pine Street. Room 106 aftneCalifornia94553 RE: CLAM OUR CL,IENf: ROY PHELPS DATE OF NJURY: 11-11-03 Dear Sir or Marl n. Please fired enclosed the cl lr<of Roy Phelps,our client. Please oariffb i the enclosed cpy of'the clann and retLim It tos in the,enclosed self= stomped addressed errmlojve, Very truly yours, D. XTb r hea L,aw;<CIerk s� 13 UJ 9 LL LL o 0 tf3-'�c CLAIM g BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: MAY 251 2004 Claim Against the County, or District Governed by ) the Beard of Supervisors,Routing Endorsements, NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this 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), give: Pursuant to Government Code Section 913 and >915.4. Please note all"Wanungs". AMOUNT: $15,000,00 CLAIMANT: CAROLYN CA.TALANO ATTORNEY: UNKNOWN DATE RECEIVED: APRIL 21, 2004 ADDRESS: 10049 FOXBORO CIRCLE BY DELIVERY TO C-LERK ON: APRIL 21, 2004 SAN RAmON, CA 94583 BY MAIL POSTMARKED: APRIL 22.1_ 2004 PROM: Clerk of the.Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWE T ��lerk Dated: APRIL 21, 2004 By: Deputy II. MOM: County Counsel.. TO: Clerk of the Board of Supervisors t s. phis claim complies substantially with Sections 914 and 910.2. { ) This Claim PAILS to comply substantially with Sections 910 and 914.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was sled late and seed warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( } Other: `� N :: -it `' ...-'"S ... P C Dated: B Deputy County Cour: 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, OARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. ; ) Other: , I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: . JOHN'SWEETEN, CLEF., By _ , .Deputy Clerk IV WARNING (Gov. code section 913) Subject to certain exceptions, you have only six(6) montlhs from tie date this notice was personally served or depositec in the mail to file a court action on this claire. See Government Code Section 945.6, You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. ' For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I arra now, and at all times herein mentioned, have been a citizen of the'United States, over age 18; and that today I depositec,,in the Ignited 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 RECEIVED-w APR21W, s o=C Claim ta. BOARD OF su OF t}tr'i".�A, A, � ��� K{�(tr�y�13 }spy ri � "y�{r'�}}''�}�j*T �/��'�}�'�{`+'� TO CLAIMANT .�...n.•.,o"2.TPiS Fein� ��5 S j:.M-........... 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 the 100th day after the accrual sof the ease oil' action. Claims relating to causes of action for-death or for injury to person or to personal property or moving crops and which accrae on or after January 1, 1.988, rust 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 the year atter the aParsal of the cause of action. (Gov't. Code §911.2.) B. Claims must be .filen with the Clerk of the Board of Supervissors 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 tame of the District should be filled in. D. If the claim is against more than one public entity, separate clai=- must be f iled against each public entity. E. * Fraud. .see pena'l'ty for fraudulent claims, Penal., Code Sec. 72 at the end of this Hg: Claim By Rese-rved for Clerk°s filing stamp 7Tairust the county or Contra, Costa } or, } .District) 1 in The undersigned claimant hereby,makes claim against the County of Contra Costa or the above-named District in the sum of ` "� and in support of this claim represents•as follows: "� � f • L eYwii.Yl��`YMas 1. When did the *_or injury occw? (Give enact date and hour) 2. Here #d the eor in,ury occur' (Include city and county) .�to> .. ' s t'�t� � f ,✓ .SSG' .�'�� '�"`�t°� . r! J t �t,y✓ x"".f=- d ' , of m "'y+L. c- } r t" m t a / J°,.G� e r r 7 ',�; ^T; 'y .. � ✓ t F, 3. How did the damage cr injury occur? (Give full details; use extra paper if required) l y i• '� �d ' t'f�'",'� `/`r�. FL.',� 3°t > �"'.+`^ "°fry'ff`, �''/ ls'��� � °`��....»�t'r`'✓ �`�✓'_...�.� 7 'rf'� ,G,. what particular act or omission on the part of county or diatrict officers, s ervants cr ployees caused.the injury or dagga? s ! 20'd `d-0 Wnat are tn$ nares of county or district officers, servants or employees causing the damage or injLu-y? 5, What damage or injuries do you claim resulted? (Give full 'extent'cif injuries or damages cued. Attach two estimates for auto damage. 7. How was the mount clam abovecomputed? (Include the estimated amount of any prospective injury or damage.) L_! B. ..e,........�..w.�.r�.m..�.......,.......R. .�....r.�w." w+� .w�..,ti..s+rs.,.re...,....ww ?games and addresses of wi tnesSs, doctors and tospit2l.s. '',r1 A"' f' jF7 ...�pe.•' J t✓' P '''� t• �.,,{' `r 1 I 1�f•`�^.°'�A,.'r p Tom' 4. List the expenditures es you made on account of this accident. or in jlm-j: DATE ITM AMOUNT T g • � 9F �r i4 � � � #E .jF �F iF iF !F � � !t �h-# 9�.� !F 4F !F � ffi �•� # !E � � IE � � !F �F iF it �,,iF � Matt'`. Code Set:. '9103.2 provide s: 'iTYie claim must be signed by the claimant SEND NOTICES z (Attc3rne or by some I his. ." affie and Address of Attorney r (CItima *!t s, Signature F F A&Iress !",•. ,tdx-..- ,t-�"' /'i' J "' .,•'mow Jr_, Telephone Pito. Telephone No. N0TICE Section 72 of the, Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for paymentto any state board or officer, or to any county, city or district board or offlcer, authorized to allow or pay the same if.genuine, any false or fraudulent claim, bill,, account, vouchear, or writing, is punishable either by imprisoizaent in the county Jail.•f'or a period of neat more than one-year, by a fine of not exceeding one thousand ($1,0 00). or by'both such' imgrisorkwnt and fine;-'ori by impriso=oent in the state prison, by a fine of not exceeding ten thousand.dollars ($10,.000, or by. bath such imprisonment and fine. 20✓20°d zt7_� 1;22 Szs sN3WSUNt�W XS 18 :::)v 00:',T i7OOE-eo--Ndu Carolyn Catalano 14063 Foxboro Circle San Ramon, CA 94583 (325) 829-8466 April 20,2004 Clerk of the Board of Supervisors Room 106 County Administration Building 659 Pine Street Martinez, CA 94553 Gentlemen: On Monday, April 5, 2604 at 12:36 p.m. I was walking on Camino Tassajara on the east side of the street south of Blackhawk Road, north of Blackhawk Plaza Circle with my co-worker, Diane Enea. While walking ! tripped on the temporary wood cover that was covering the construction on the sidewalk. As I fell to the ground, I used my left wrist to break my fall. As a result, I broke my left wrist in several places. I have enclosed photographs to illustrate the condition of the sidewalk. I am writing this letter to state a claim for compensation from Contra Costa County for its negligent maintenance of the public sidewalk, which caused this injury. My damages are as follows: I have missed two days of work so far. I have an appointment scheduled in one week and there will be more doctor visits ' until I am healed. My doctor is located in Lafayette. My doctor said I must keep my wrist in a portable cast for approximately 6 weeks. I have enclosed my medical records for your review. i am employed as an Administrative Assistant for a local builder. My duties include daily correspondence and other tasks that require me to use the computer. This injury has greatly limited the day-today tasks I am able to do since I must use the computer with one hand. I live alone and do not have anyone to help me. Thus, I also cannot perform daily tasks at home that are essential to my personal and household activities. I have suffered extreme pain. I have been terribly inconvenienced and hurt by this injury. My claim at this time is $15,000 for expenses, time off work and pain and suffering. This amount is determined by the fact that I hope to be healed in 6 weeks time. Should that change or should there be complications to my injury,the amount of my claim will be increased. Please do not hesitate to contact me if you have any questions or concerns. Sincerely, Carolyn Catalano CC:bc Enclosures AMADOR VALLEY 9258287112 p. 3 AMador Valley Medical Clinic NKA Allergies: Patient No: 4 6 3 9 3 .1867 Amedor Valley Blvd.. A ril 6 , 2004 � '�ubllrr, Cellfrsrnle 94588 Caste; # eels: , Rx:Crv?A► Me RPh arlmacy (510) 828-9211 4 }, 6 �� i !,..ATA LaAlti O, �C)LYN NAME j Last First Initial x Age riot v Phones ADDRESS 10069FOXBORO �1R SA�3 1��C3Z� CA 9458 (925.).648-;5636X fFtX FRED.COMET. SIT STAND WALK. 'MuvE FWRD RACK WNRr, COM TO EASE Work PhonePhoneOCCAR.INT SM SIGNS I�+E019AT—ION1'f EA'�RI ENT rA O An EIR �L R#odulers WEUL ! { OR C:LNeck # u R LOppor Rack OR I.Mld 84ck s p p i � s �R L Law H4tlt I # C]R M L Rattotk + V vssl At27ty Rvdl4rlsm to ATM13R OL Fi risru iROL (CP ONCT81C2ThC3#IDili C11YUv.� ThigkEIR134 Call.-URDL FOOT ORDL E0}113-9) SY4ikt�kfd X_ fll�m; [ISp. Stab Ex_xl3 $irEtan EX.oxld Ostrongtk E"d; C-1cos.—Xld >i ,m1a O.B. CI,S. 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E9L8.3t8i0$.OlE$D6.4 �" "3 $Ro=c+IPNeumsiS08 4$O.Of41St.017t1tt.0$ Gault t4, no iso,toad,asel,nsrafs 81iNif$RN2fik1Ptg2 $4I.1D1541,271864 NL$0,vsa16 Etlt, edmEXe ! SJraMfTNdnxlEPend« 733.3f725,Sf725.32 RovIels NL tests,pfa= no mass,kemroldsfhet;a i LA0fCI1DLl75la?5f01t2 4741272/2601250.1 Hours: NL tram,parr,sons.OTR's"- j iEL#af+fADae«1PJSt t685.$l2$9.3t38$.8 �" ✓iElvwll CkP4lxil:6TRnlCDST 797S.b17R71.62f78S.$9 a SPiiVitt EXAM ., . CONd*lBLoptte«tSTY 372.301373.0f$73.tS CrmARR1Si6NEMfKER#t« 518.1/372.721370.1 f Carvlul Rom OsfiEa-Lumbar RHI, C'(4sk21C.8Rsiffibre C 73$.215401610.1 N fir Ptlf,. x pain DDDtMIG ut 722.81758.051274.6 IFlex #5o i OEbydriel0lulaess/RA 2.78.117$4.41774 EKc 70 6 DERMaIt-Catct!MDNtSEB 622.91112.31610 ETdystattelV.LAByYlmrlt« 3$1.851386.36 c R. 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STRessfPANc/Mum 308.S1300.011307.48 fes g2klgid woo seeks ORINWISYRdrIWALg 406.9107SX721.1 Splint Elovatloe UTIfUR#Uir-1VA$la* 6091687,81558.1 fgjl_ow_.--W.prn Sllavimmab. P.T .. twk ' wArls/11MAJACat CM 1111ON108.I Re=tktc dlwk Nest Masuge/RON Pro MULT. M=AND FOOD ALLERGIES � CiftfRTC It wall Admu-Cir Lgds ItaIU.S.tmam T CAUSE ACUTE CHRONIC EXACERBATION II not Imptmd.� - d EXEC-11 Rest AT LT CERV, T€tOR.LJM& INFECTED 91 tare 7S oat better—$ SN INE Ci3 Cralcus # fN;R NO WRST VILOR TOE fT ANK KNE €d Kemprud,M.$.19111y Davis,M.D. Rosen PAP 6C?018tn. C3CISIAAt APR-20-2004 TUE 08;50 AM DR ?FFFFINGF / CALDWELL FAX NO. 9252841505 P. G1 I i LAND L. PFEFFINGE MR f 'LAFA.'YETTE OffICE. ADDRES D r v HGF PHONE � �' CELL WORK 4. _ REFERRING I .D, IBX f EMPLOYER/ADDRESS INDUSTRIAL CARRIER CL.AIM# ADDRESS ADJ DOI SSN DOB REASON i APR lhe e n 4/5/04 while walking and used her hand to break heir fall. As a result,she sustained a fracture of the carpal bane,which,is non'displaced. 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L04 �. .LjYi�C•• it?:{ •: v 9 b. al 4 ::;h :r ' Y :'..... w . .. ._ :h;• .. 4. 4/8/2004 X. 9.38. 4 .: ::......::. ... - > l Y an t C v. y^ r x. .v 4/8/200 . ......... 9.39.03 A ! w .. r ) f f ..... ............. fFF F k �i rFJF f �F j ...: rn?vt. •r .. ?r' F F F F F � f �i '.r. f u?: .:- � § . . � ©° . . .�. . . . . . .� . . .. . . . . ..r . . ..... . ■ k $ $ � s S 9 le LO Sit r 0 E AV CLAIM U, BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION:MAY 25. 2004 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.Governrnent Codes. ) notice of the action taker's on your claire by t.1-ke Board of Supervisors. (Paragraph iV below;, give Pursuant to Government Code Section 913 and 915.4. please note all "Warnings". A.MO'U' T: $75,000.00 CLAIMANT: JUDY CROUCH ATTORNEY: R. NIGH LAS t-3ANEY, ESQ• DATE RECEIVED: APRIL 23, 2004 ADDRESS: 943 FIRST SHEET, BY DELIVERY TO C_JrIERK ON:APRIL 23, 2004 BENECIA, CA 94510 BY MAIL POSTMARKED: HAND DELIVERED FROM: Cleric of the Board of Supervisors TO., County Counsel Attached is a copy of the above-noted claim. JOAN SWEETS Y Dated: APRIL 26, 2044 By: Deputy 11, QOM: County Counsel, TO: Clerk of tete Board of Supervi rs { Y`This claire complies substantially with Sections 910 and 910.2, 4 { ) This Claim FAILS to comply substantially with Sections 910 and 9`x 0.2, and we are so notifying claimant, The Board cannot act for 15 days (Section 910.8), { ) Claim is not timely Teti. The Clerk should return claire 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; � '' �� �° �� B � �'�'� ����� � y: Deputy Count Counse III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) { ) Claire was returned as untimely with notice to claimant (Section 911.3). V. OARD ORDER:. By unanimous vote of the Supervisors present: { This Claim is rejected in full, { ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated. JOHN SWEETEN, CLERK, By � , Deputy Clerk WARNING (Gov, code se ion 913) Subject to certain exceptions, you have only six (6) nionths from the date this notice was personally served or deposited in the mail to file a court action on this claire, See Government Code Section 945,6. You may seek the advice of an attorney of your choice in connection with this matter, If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty ofperjury 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 depo,sited.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 Clea Claire to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTR JQTlQ��S TO CLQ 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 Cather cause of action trust be presented not later than one year after the accrual of the cause of action. (Gov't Code 911.2.). B. Claims roust be filed with the Clerk of the Board of Supervisors at its office-in Room 106, County Administration Building, 651 fine Street,Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors,rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims roust be fled against each public entity. . B. Er—au d. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this fours. RE: Claire By Reserved for Clerk's filing stamp JUDY CROUCH � RECEIVED Against the County of Contra Costa or EAP3. --_ 2004 District) 1CLER;BOARD of d�PERVISO�M (Fill in name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sura of S-7 5,0 00.0 Land in support of this claire represents as follows: 1. When did the damage or injury occur?(Give exact date and hour) November 10, 2003, approximately 5: 00 p.m. 2. Where did the damage or injury occur?(Include city and county) on the sidewalk outside the Contra Costa Cinema, 555 Center Avenue, Martinez, Contra Cost. County, California. 3. How did the damage or injury occur?(Give full details;use extra paper if required) Claimant parked her vehicle in the handicapped parking space near the Contra Costa Cinema. While walking toward the theater, claimant tripped and fell over a broken and raised portion of sidewalk. 4. 'What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? Failed to maintain sidewalk in a safe condition. 5. ghat are the names of county or district officers, servants, or employees causing the damage or injury? ;Unknown at this time. 6. What damage or injuries do you claim resulted?(Give full extent 'of injuries or damages claimed. Attach two estimates for auto damage.) Claimant sustained injuries to her shoulder, arm and wrist. Shoulder was fractured. Claimant .also suffered facial abrasions. 7e How was the amount claimed above.computed?(Include the estimated amount of any prospective injury or damage.) Special damages, including medical bills, amounting to $25, 000 .00. General damages, including pain and suffering, $50, 000. 00. 8. Names and-addresses of witnesses, doctors, and hospitals. Witnesses to accident include claim.ant!s grandchildren, Davie, Mattie and Michael Towers, address 210 Midway Drive, Martinez, CA. Claimant was seen at County hospital in Martinez, and Dr. William Johnson. 9. List the expenditures you made on account of this accident or injury. ?ATE_ I AIviCL3NT } Gov. Code Sec. 910.2 provides"The claim must be signed by the claimant or by some person on his behalf." SEND NQTICES T(3: (Attorney Name and Address of Attorney ) f R. NICHOLAS BANL'Y BBQ. A' ° L ATTORNEY AT LAW (d ima 's Signature) J 903 First Street Benicia, CA 94510 903 First Street (Address) Benicia, CA 94510 Telephone No.. ( 7 0�1 746-1800 }Telephone No. ( 7 0 7) 746-1800 ?NOTICE Section 72 of the Penal Code p-m ides: 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,author wd to allow or pay the same if genuine,any false or ftaudulent claim,bili.account, voucher,or writing,is punishable tither by imprisonment in the county jail for a period of not mors than one year,by a fine of not exceeding one thousand(S 1.000),or by berth 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 fire. APPLICATION TO FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTRA COS'T'A COUNTY, CALIFORNIA BOARD ACTION MAY 25, 2004 Application to File Late Claim NOTICE TO APPLICANT Against the County, Routing The copy of this document mailed to you is your Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to ) the Board of Supervisors (Paragraph 111, below), California Government Code. 1 given pursuant to Government Code Sections 911.8 and 915.4. Please note the"WARNING"below. Claimant: CORLETTA JUSTICE Attorney: HIMATIEIA T. ROBERTS, ESQ Address: 576 10th STREET, 0AKT_k1\113, CA 94607 Amount: $5,000,000. By delivery to Clerk on: APRIL 26, 2004 Date Received: APRIL 26, 2004 By mail,postmarked on: HAND DELIVERED I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted Application to File Late Claim. DATED: APRIL 26, 2004JOHN SWEETEN,Clerk,By: 4 DEPUTY II. FROM: County Counsel TO. Clerk of thei,Boa d of Supervisors The Board should grant this Application to File Late Claim (Section 911.6). ( ) The Board should deny this Application to File Late Claim (Section 911.6). DATED: x SILVANO B.MARCHESI,County Counsel,By: DEPUTY III. BOARD ORDER By unanimous vote of Supervisors present (Check one only) ( This Application is granted (Section 911.6). ( ) This Application to File Late Claim is denied (Section 911.6). 1 certify that this a true and correct copy of the Board's Order entered in Its minutes for this date. DATE: JOAN SWEETEN,Clerk, By: ,' DEPUTY WARNING(Gov. Code §911.8) If you wish to file a court action on this matter,you must first petition the appropriate court for an order relieving you from the provisions of Government Code Section 945.4(claims presentation requirement). See Government Code Section 946.6. Such petition must be filed with the court within six(6) months from the date your application for leave to present a late claim was denied. You may seep 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. IV. FROM: Clerk of the Board TO: (1) County Counsel (2)County Administrator Attached are copies of the above Application. We notified the applicant of the Board's action on this Application by mailing a copy of this document, and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. DATED: JOHN SWEETEN, Clerk,By: DEPUTY V. FROM: (1) County Counsel (2) County Administrator TO: Clerk of the Board of Supervisors Received copies of this Application and Board Order. DATED: _ County Counsel,By: County Administrator,By: APPLICATION TO FILE LATE CLAIM 04/21/2004 -3:44 CONTRA COSTA COUNTY CLERK OF THE 915100634'?26 NO.319 Poo /i Claim to. BOARD OF SUMMSORS OF CONTRA COSTA COUNTY NS TO A. Claims relating to causes of action for death or for injury to person or to parwnal prop"or growitr}g crops and which accrue on or before Dezember 31, 1957, trnust 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, 1955, rust be presented.r of later than six months after the accrual of the amuse ofactlon. Claims relating to any other ruse of action must be presented not later than one year after the accrual of the cause of action. (CxoVt Cade 911.2.). B. Claims must be filed with the Clark of the Board of Supervisors at its oifsec in Room 106, County Administration Building, 651 Fine Street,Martinea, CA 94553. C. If Claim is against a district govemed by the Board of Supervisors,rather than the County, the name of the District should be fillet[in. D_ lfthe claim is agairtst more than one public entity, separate claims roust be filed against each public entity. E. Er-&p-d, See penalty for fraudulent plaints,Penal Code Sec. 72 at the end of this form_ *���ao�t+c+t�dr,r+�����t�.,�rr�tr#,r*��t+�i�i#��+rrsw**rM�+MF�•��+b#�#+�a3��#+�+w�!+��xr.*+�r.s��.s ����t�dt� RE: Claim By Reserved for Clark's filing stamp } RECEIVED Against the County of Con"Costa or � APR 2 6 2004 Fill in name) ) Cl��6 SAD F 8�.P q' ;4 r, �± tSY:u � C . The undersigned claimant�Feby makes claim against the County of Contras Costa or the abcsve-named district in the sum of S and in support of this claim represents as follows: I. When did the damage or injury occur?(Give exact date and hour) Q,14_ 2. Where did the damage or rtrrJury occur?(Iriclude city and coutity) x 3- How did the damage or injury occur?(Clive fUll details,use wra paper ifrequ red) 17 f 3 04/21/2004 13-44 CONTRA RA COSTA COUNTY CLERK OF THE 4 915107634728 N-0.319 P02 4. What particular actor ornission on the part of county or district officers, servants, of employees cause4 the injury or damage? , �"- " x k y.^:�^fit r , Y .� ..^� ,,3...r,,»� t�-"r-f fis� „�.F�:.s„�s�r''~�_b..�� ' j`� a, •,� fes` ,d'� S. What are the namesof county or district officers, servants, or employees causing the damage or injury? g wr Z,»•'ry /w+'� L;'G" � \.i.+ti'�h31- }'Y aw;:r� Fe'ED'S / ,°JAY e.✓f'% �� J`T� "` �✓Jr� {'L/""'C..;�'iY. $)' 4.t..'3. �~ '�.� /X � � y" j.if .fi/ y ;hs/ �+ �� •I 9 fi.s l✓ y✓L} S "44.r.'`} / �C,�t..�i+ 's.^'',-C-t�.bstiZ<,M' JF.'V ek-fv m"A14 --On, C What damage:or injuries do you claim resulted'(Give full extent o�uries or damages claimed, Anach tWo+urates for auto damage,) e 7. How was the amount claimed above computed?(Include the estimated amount ofany prospective injury or damage. 9. Names ani addresses of witnesses doctors, and hospitals 9. List the expenditures you made on account of this accident or injury, DA"#';l iw.r'�n�l'✓�' ?3�5;-�-'Z.-x-�-� ,L.b,F�.�e.'fro•�'...��,..•''�r'R^"fh.�.`"Y.'S.��d Gov. Code See, 910.2 provides"The claim must be: C A ) signed by the claimant or by some person on his behalf." SVQNQP_Name and Address of Attorney) �$e_� .{�,;+.t�ti*'*'t�`�`L`^'ma<o„-> `{ `f'�.�'`�' "..rs,�... iw �✓p fiaS.S_.} .»- .��•'r.«,w�-'' i...�.. �. d (Claimant's Signature) c� r � y / tF (Address) Telephoneg 'f Telephone No. ***�tstra�e�rrrwras*ws�►�s**s;tMc.+��s��c*s�rx�s�*+�*+R*i�s�wrs�rr�*ss***Y�*�1+tt���ra+s��4**+�sr���r�+e+e�s�►�#�%+6 NOME Section 72 oftbt lel Codo prvvid= Every petsotz wbo,witb irntew to deftud,pmmu for IDOW&Uft or the payment to any state board or of ca.or to any 0AMy city,or district board or officer,autborzed to allow or pay the$am if getaiite,any b1se or budWent clam,bA acwwk vouches or rwriant is putisMble Mber by imprismmom its tbe.waro jail for a pmiod c f not mom tbw cat year.by a Am of not cx=Cft9 one thousand ES l,0MJ or by both such impdsoument wo fine,or by imprisonment in the stats prim,by a fine oftot ex=*diAg ten tbcnmd dollars(S 10,00oX or by both such im;paisonmvt and fioe� Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY REC Application To File Late Claim Against Public Entity ED # APR 2 6 200 In the Matter of the Application for Permission To File Late Claim of Corlet L € c „.CC, ' A r iSORS vs. County of Contra.Costa, Contra Costa Medical Center 1. Corletta.Justice, hereby applies to the Board of Supervisors of Contra Costa County for leave to present a claim against said County, pursuant to Section 911.4 of the California Government Code. 2. The cause of action of Corletta Justice a minor, as set forth in her proposed claire attached hereto, accrued on 27`x', April 2003, a period within one year from the filing of this application. 3. Corletta Justice's reason for the delay in presenting her claim against the County of Contra Costa, Contra Costa Medical Center is as follows: She was at all times herein a minor suffering from acute and disabling psychiatric problems due to being subject of statutory rape at Contra Costa Medical Center. Dated: April 26 2004 x HIAWATHA T. ROBERTS. ESQ. Attorney for Claimant, Corletta Justice APPLICATION TO FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY CALIFORTNIA a LIOARD ACTION MAY 25, 2004 Application to Pile Late Claim.. ) NOTICE TO APPLICANT Against the County, Routing ) The copy of this document mailed to you,is your Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to } the Board of Supervisors (Paragraph III,below), California Govemment Code.) ) given pursuant to Government Code Sections 911.8 and 915.4. Please note the"WARNING"below. Claimant; YOL4-NDA JUSTICE Attorney: III9WATr1A T. ROBERTS. ESQ - Address: 576 10th STREET OAKLAND, CA 94607 Amount: $1,000,000. By delivery to Clerk on: APRIL 26, 2004 By s Date Received: APRIL 26, 2004 B mail postmarked on. HAND DELIVERED I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted Application to File Late Claim, 200, DATED: APRIL 26iOHN SWEETEN, Clerk,By: DEPUTY II. FROM: County Counsel TO. CIZ of theiBoar of Supervisors The Board should grant this Application to File Late Claim Section 911.6 ! ( The Board should deny this Application to File late Claim (Section 911.6). DATED. 7�` `` SIL`VANO B.MARCHESI,County Counsel,Byg�' - _ DEPUTY III. BOARD ORDER, By unanimous vote of Supervisors prdent (Check one only) ( This Application is granted (Section 911.6). ( This Application to File Late Claim is denied(Section 911.6). 1 certify that this a true and correct copy of the Board's Order entered in its minutes for this date. DATE: JOHN SWEETEN,Clerk,By: DEPUTY WARNING (Gov. Code §911.8) If you wish to file a court action on this matter,you must first petition the appropriate court for an order relieving you from the provisions of Government Code Section 945.4 (claims presentation requirement). See Government Code Section 946.6. Such petition must be filed with the court within six(6) months from the date your apRj cation for leave to present a late claim was denied. 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. IV. FROM: Clerk of the Board TO: (1)County Counsel (2) County Administrator Attached are copies of the above Application. We notified the applicant of the Board's action on this Application by mailing a copy of this document, and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. DATED; X4, af-eAe JOHN SWEETEN,Clerk.,By. ' s DEPUTY V. FRO . (1)County Counsel (2)County Administrator TO: Cferk of the Board of Supervisors Received copies of this Application and Board.Order. DATED; County Counsel,By: 5 County Administrator,By: APPLICATION TO FILE LATE CLAIM ut-I'fellIeW04 1,x.44 CONTRA COSTA COUNTY CLERK OF THE 4 915107634728 NG.319 901 a Claim to: BOARD OF gMZRVISORS OF CONTRA COSTA COUNTY I� ;"t 3CIJQN5 Q cLAmate 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 cc before December 31, 1987, must be presented not later than the I OO h day after the amoral ofthe 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, 1999, must be presented not later than six months alter 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 rause of actions. (Gov't Code 911.2.). R. Claims roust be filed with they Clerk ofthe Board of Supervisors at its office in Room 106, County Administration Building, 651.Fine Street,Martinet, 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. Ifthe claim is against more tharn one public entity, separate claims rust be filed against each public entity E. Fjjyj, See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this fours. ##,�###i#its#s#t�#rk#isr#t+tlM##�S;t+�###�#ttii+M#�#t+►*1�rFi�i##,i#k+M##4#4+�l�r�gtr+ldks+t�+e+iew#�rsit+ta RE: Claim By Reserved for Clark's filing stamp gar st the Cony of Contra Costa orRECEI E, ('ill in name) ,C i P 2 Z004. 41JI-E K BOAS)OF SL C�h A.`USI C(q The undersigned claimant .hereby mattes claim against the County iii Contra&star or the Aboves-reamed district in thc sum of S s and in support of this claim represents as follows: 1. When did the damage or injury occur?(Give exact date and hour) . There did the da a est injury o r7 �` S I (Include City W county} C �'`'� .3. How did the damage or injury occur?(Give full details; use extra paper if required) .'` W" / Ek t � }X te.,, - t i-�;ati:.- ,:�..,�..(.L...s a>'-;." ?"�...2='� j..,�f f � ,' I"7 l/ ' ��✓. .-y.,G �.'y �-avN a T k-Lr-rrr€ ur" 1 Hft a 91 b 1 O?63472e NO,319 002 r 4. 1�hat particular acct or on on the pan of county or district officers,, servants, or employees caused the injury or damage? ����� � ��> � �� �� �s� �3 ;�yrw�h.�.�� fi< y S. What are the names of county or district officers, t4rvants,or eatiployees c using the damage or injury? '.. ,£.,4t •'d.��r�' S,..� �'vt �s�A1� -s'"%,�%�'a+'�•i.✓r...s�. Y �+ '"ti.Y �''`� 5'�r ,�.�""' 't...�•" /¢ rr�„ er 't., -" 3-'�f..>-_� .,•�ndy`, y;,es,-✓-'c.;�i'. 6: What damage or injuries do you claim resulted?(Give full extent of injuries or damages claimed. ch tWo estimates for auto darnage.) } ��/ 6ai y � �{+,. # � .�` '.�'1 J�.'f`s''3e �'`E � f�1P�.:4-✓3-�'"'7,ir#' a��''•-�°�':�,�Lf� � �'^�`6.� �"'�s.,a-.f.:`-e+£---,, blow was the amount claimed above computed?(Include the estimated amount of any prospective injury or damage ` 4ti2 .eir/'1+.6' �r{Yyfe'.+R1�.ii�•"i.^/lG :..n✓'ry f�� e" bt i); C^Ci .`"�.w. 9 6 9[+ S. Maines and addresses ofwitnessea, doctors, and hospitals. ` i y. ' l 9. List the expenditures you made on account of this accident or injury, T'lY�if���a°9���TVT`��Tal iT��'��i��F�*�*����9'F����T��!������lf�T����T���7T������*��f Y`►����*TiV��T } Gori. Code Sec, 910.2 provides"The claim recast be signed by the claimant or by some person on his behalf." Id0110E O: (Attcsrnev '1 - Name and Address of Attorney r ti .....t x i• +✓ .:e.f x f� .j i4> �_. J.)` `[ C= 7A`� :>"'•'^��'• ..!.,.c.+$ ,:s��P'.�'- ✓s 4.?,.«,c�'��r...-yF,.,.r � f •£:'"E (Claimant's Signature) 61 } y ))(( i �� Lr.7 ti. � �C { t.+`} 5...�-."0. �S..e�_e'�....: .. { �.P.Y� .F.x--aS.m1�`��A•ZZ.> b. k else .z:. .� e� f . plCStte 1'46Q, � Telephone Nmu- rfaa�*aarfd"81!'far$U!Ir!ilFir7E�i!aMaFiilati+ltll!alt�latitiltlt!>B�trR�>I#+ilal;�f'a~�t�iri>fii!a�t��+ark'eft#+Haat#r!!p#��'9#1�YFfca�!#i�+MalrF+ftsi�iaratll� NOME arm 72 of the pMt Code provides: Every person wbo,with intent to defraud,tents for altar or the payn=t to any state board or c ira,or 10 any u aty.city,or district board or officer.authorized to avow or pry the sarin,:if ge vine,any bUe or tart dWesat claim.ba aaa~ar 4 voucher,or writing.is fishable eith ar by imprtranmem in 1ho aroay}all for at period at not mora than one year,by is Am of not exceeding one thousaad ttl,000).at by both such impriseurn"d aW fzt,or by Unpr sonment in the arcate prison,by a fim of-not exceeding ter thaQmd daltarrs(S l0,0WJ,at by both sach impristrttar ebt wJ tine, Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA CO ECE1 1) I A PP 2 6 2004 Application To File Late Claim Against Public Entity L ARD OF qL, -I ,AQOS� C, In the--Matter of the Application for Permission To File Late Claim of Yolando Justice, a Minor, vs. County of Contra Costa, Contra Costa Medical Center 1. Yolando Justice, hereby applies to the Board of Supervisors of Contra Costa County for leave to present a claim against said County, pursuant to Section 911.4 of the California Government Code. 1 The cause of action of Yolando Justice a minor, as set forth in her proposed claim attached hereto, accrued on 27', April 2003, a period within one year from the filing of this application. 3. Yolando Justice's reason for the delay in presenting her claim against the County of Contra Costa, Contra Costa Medical Center is as follows: She was at all times herein a minor suffering from acute and disabling psychiatric problems due to being subject of statutory rape at Contra Costa Medical Center. Dated: April 26, 2004 HIAWATHA T.ROBERTS. ESQ. Attorney for Claimant, Yolando Justice A�1END - CLAIM BOARD OF UPERVISORS OF CONTRA COSTA'COUNTYMaq , ` BOARD ACTION: X04 Claire Against the County, or.District Governed by } the Beard of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this 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), giv Pursuant to Government Code Section 913 and 915.4. Please note,all"Warnings", AMOLNT: $399.00 CLAIMANT. STANLEY R. Z1�I AN ATTOR' EY; UNKNOt ' DATE RECEIVED: APRIL 27, 2004 ADDRESS: 6363 CHRISTI AVENUE #251.7 BY DELIVERY TO (ALERK ON:APRIL 27, 2004 R4lRYVILLE, CA 94608 BY MAIL POSTMARKED: 'APRIL 26, 2004 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim, JOHN SWE lark :gated: APRIL 27, 2004 By: Deputy II, VR.OM: County Counsel, TO: Clerk of the Board of Supervisors (tis claim complies substantially with Sections 910 and 910.2, ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notAying claimant. The Board cannot act for 15 days (Section 91 t1.8), ( } 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 Couns TIL 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: ( This Claim is rejected in full. ( ) Other° I certify that this is a true and correct copy of thec Board's Order entered in its minutes for this date, Dated: JOHN SWEETEN, CLERK, By d , Deputy Clerk WARNING(Gov. code sedion 91 ) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposite in the mail to file a court action on this claire. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional darning See Reverse Side of This Notice, AFFIDAVIT OF M.A.ILING 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 deposite4,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 3 3 t C:,lalm to BOARD OF SUPERVISORS QP COMM COSTA CC :Y AV,I2�S'"UC`r TONS *M C..A�skN7 u � � ( Am Claim relating is causes of action for death or for injury to Pers� conal property or gmwing crops and which accrue ora or before December 31, must be presented not later th&n the 100th day after the accrual of the cause of action. Cla.iL= relating to causes of action for .death or for injury to person or to pe-1-coral property or growing crops and �hicn accrue on or after January �. 1988, must be preseanted not later than six months after the accrual of the cause of action. Claim relatirg to any other cause of action must be presented not later than one year after the accrw,aal of the cause of action. (Coat. Code §91.1.2.) Ba Claims must be filed with the Clerk of the Board of Supervisor at .its Office in Boom Bo106, County Adrministr°a.tion Buileing, 651 Pine Street, K- rtinez, CA 94553. C. if claim is agains�- a oistrilcw governed by the �%.rd of Supervisors, rather than the arOLL':ty,, he r,2 ue of the District sho, °d be s i ll e'ul ir?. D. If the claim is against more than one public entity, separate clams must be filed against each public entity, E. " Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. BB Claim By if ti%.t Reserved for Clerk's` filing stamp Apirast the County of Contis Cosmo � or DistricA. ts P i,l in r� The undersigned claimant hereby des clan snot tine Co my of Contra Costa or the above—named District in the sure of $ , � ca and in s',upport of this claim represents as foli ws: 1. hien did the da=aga or in,;u:ap oc»u.�"? wive exact date and hour) 2a dere did the die or injury cur? (Include city mond county) 3. How.did the damage,or injury occur' (Give fall, details; use extra paper if required) /�f 7 e} r -i� > � ��r��. �► f� �" � � 7 i�¢ =r� " -5'I`" ,���t�r tt . ' Ctrl ' ?L'd° ..�`,r .�✓. �"s B= y, �Vii`t'��Qt�``�`"t"?'+C:.v � ,�d ,�lr'Dh3 l'�`'d4' a�`-}%p 17C �t' C3 M+ �. L�1 !'" �3C?i d" �'`s``«�'�'),�'s�l C-1`k t l'"l d� ! j r' ✓� Cr d irf rJ 1C'Ce/ d" r � G'3Tt` 1df5/� LA/ llit'(i°:.� 4. What particular act or omission on the part of county or district officers, servants or .employees caused t {{ �yy f the in-1u.^yr° damage? se e? S ce r,, �'q t1,>t14 rm e Y r' ��"�.�t Wrat are tre nates of counry or district officers, 9 vanes or em=ployees causing the doge or in: ury? ' yn ! fy ', �P,4te rt'Aow 1 I /10 � c:A: r -ii What doge or 17QJILLries do you claim resulted? (Give full extent of in Juries or damages claimed. Attach two eAtimatles for auto damage. 7. How was the amount claimed above computed. (Include the estimated amount of any prospective in-ltx:-y or damage.) m ?dames and addresses of witnesses, doctors and hospitals. i3 (o F�fG- `'re e L e- 1114 - 'f � CA C ` 3� ga List the expenditures you made on accotrit of this accident or injury; DA=E " ' �� f Cosi. Code Sec. X10;2 provides: "The claim must be signer by the. claimant Sri NOTICES °O': (Attorney) or by ome verso;: on his behalf." Name and Address of Attorney Claiz2-rit's Signature � t P V-0 (Ad m"ess% telephone No. '" lephona No. �t N 0 1 C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, press:.-its for allowance or for payment to any state boa-d or officer, or to any county, city or district board or offieer, authorized to allow or pay the Sarre if genuine, any, .false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment. in the county ,fail for a period of not more than one year, by a fine of not exceeding one thousand ($2.,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 imprisorroent and fine. George Beesley 136 Fig Tree Lane #3A Martinez, Ca 94553 Work done at 177 Front street Supplies for suite K . �` 1. Door = $107.00 2. Door Drill hardware = $29.00 3. Paint = $25.00 4. G.F.I. outlet = $18.00 5. Plate cover = $1.00 6. Junction box cover = $2.00 7. New door locks = $60.00 8. door hinges $ 25.00 9. Junction box = $3.00 10. screws = $3.00 Suite K Total = $273.00 Labor = $150.00 Total = $423.00 h s r( 3 r� law C`i --, € trema F ^: �LL, 0j, <4 6 4