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HomeMy WebLinkAboutMINUTES - 04252006 - C.30 CLAIM G• . ,�.0 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: APRIL 25, 2006 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section refere ce are to ) The copy of this document mailed to California Government Codes. D1 you is your notice of the action taken D on your claim by the Board of MAR 17 2006 Supervisors. (Paragraph IV below), Y COUNSEL given Pursuant to Government Code COUNT* A1V1OUNT: ARTC CALIF. Section 913 and 915.4. Please note all $1,816.19 + RENTA "Warnings CLAIMANT: ERIC'a CHO ATTORNEY: UNKNOWN DATE RECEIVED: MARCH 17, 2006 MARCH 17, 2006 ADDRESS: . 1093 LARCH AVENUE BY DELIVERY TO CLERK ON: MORAGA, CA 94556 RECEIVED FROM RISK BY MAIL POSTMARKED: MANAGEMENT FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, e Dated: MARCH 17, 2006 By: Deputy 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantialIIy 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 of act for 15 days (Section 910.8). O Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: �7-i2 ( By: M 6912� Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) O Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unani mous vote of the Supervisors present: (1 This Claim is rejected in full]. ( ) Other: I certify that this is a true Ind correct copy of the Board's Order entered in its minutes for. this date. a Dated: // gJOHN CULLEN, CLERK, By Deputy Clerk WARNING(Gov. code section 9113) T 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 ami now,.and,af all times herein mentioned, have been a citizen of the United States, over age 18, and that today .1 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: dQvv° JOHN CULLEN, CLERK By Deputy Clerk I 0 BOARD OF SUPERVISORS OF CONTRA COSTA COOYp� INSTRUCTIONS TO CLAIMANT :0 A: A. A claim relating to a cause of action for death or for injury to person or to personal property or growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be presented not later than one year after the accrual of the cause of action. (Gov. Code § 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street,Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each. public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. an Raaf!aal■■laaaa■■■■■lalaalaaaalaaaaallaaalla anal■aa/a■aanalmanaa■la ONE la ala ■l RE: Claim By: Reserved for Clerk's filing stamp ERic, cHo ) ) RECEIVED Against the County of Contra Costa or ) MAR 17 2006 District) CLERK BOARD OF SUPERVISORS (Fill in the name) I ) CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ q�Pport of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) S (AM/`11 T CO,\J— �MPL6y e: / 4-9-KrAf6 Lor / /yfi-rZ- /N c 2-. CZ T" GoSTA 3. How did the damage or injury occur? (Give full details;use extra paper if required) 6[ G7 T7r-Enfyrvi) f bVep, L4ivDC-9 ON C4-2 NEXT I-o M/NEED '171, n/�NI OF '�('�L 15RAtel -/' &S A -0 .L�—�/�S W�� Gn/ M y CA/Z 4. at particular ac or omission on the part o county or district o kers, servan s, or employees caused the injury or damage? 7hhd S MAI<►N G, /4- Lo T o T, 5 What are the names of county or district officers, servants, or employees causing the S C,2A TC q�5 damage or injury? i I y, Q O 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 8. Names and addresses of witnesses, doctors, and hospitals: 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT ■ ae,Maeu Mceoam eeeeeccece ■Manama■■■■■■■■■a a a a an MEW MEW■■■ads a a am am Is us■M■■a■■■an a■M■■1 .Gov. Code Sec. 910.2 provides"The claim shall be �) signed by the claimant or by some person on his I)behalf." SEND NOTICES TO: (Attomev) 1 Name and address of Attorney ) (Claimant's Signature) LAX-6-0 4-✓& . M ons eb A C,al 9 StS56 (Address) g7g� w Telephone No. )TeIephone No. ( Zj— ) 37 7 ■sommoo,ss■e,a■sea■a was,Massea,..MMcc a cca c cacccc.Mcc Mcc■a eaaw■,eeecce a a■•scacaa■eae� PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed with the County under the Tort Claims Act, is subject to public disclosure under the California Public Records Act. (Gov. Code, §§ 6500 et seq.) Furthermore, any attachments, addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. ■ cecMMc■Mason"•■own Mento ■MceM a oa■■wain■e■weaM■■M■t■■Mcceouc■■eecnaaac■man momMa,Mel 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 orIofficer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account voucher; or writing, is punishable either by imprisonment in the County jail for a period of not more than one year, by a fine of not exceeding one thousand dollars ($1,000.00), 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 hand fine. QSPRECISION PAINT AND COLLISION Date:3/10/06 Time:3:25:12 PM Pagel oft V Q Date: 3/10/06 03:24 PM Estimate ID: 2829 Estimate Version: 0 Preliminary Profile ID: CONTRA COSTA COUNTY ^ V PRECISION PAINT & COLLISION � 'p 0 1932 ARNOLD INDUSTRIAL PLACE CONCORD,CA 94520 ,i (925)609-6585 Fax: (925)609-9407 D sassed By: Marcos Magdalena Appraised For: CONTRA COSTA COUNTY Condition Code: Good Deductible: i Owner ERIC CHO Address: 2530 ARNOLD DRIVE SUITE 300 MARTINEZ,CA 94553 Telephone: Work Phone: (925)335-8738 Home Phone: (925)335-8789 Mitchell Service: 910751 Description: 1999 Toyota Avalon XL Body Style: 4D Sed Drive Train: 3.01.Inj 6 Cyl4A VIN: 4T1BF18B4XU308371 License: 4EYU887 CA Color: MAROON MET Options: ALUM/ALLOY WHEELS,AIR CONDITIONING,POWER STEERING, POWER WINDOWS POWER DOOR LOCKS,TILT STEERING WHEEL,CRUISE CONTROL,ELECTRIC DEFOGGER AUTOMATIC TRANSMISSION,AM-FM STEREO/CDPLAYER(SINGLE) Line Entry Labor Line Itlem Part Type/ Dollar Labor Item Number Type Operation Descnption Part Number Amount Units 1 001509 BDY REMOVEANSTALL L PARK/MARKER LAMP 0.3 # 2 000219 REF BLEND L FENDER OUTSIDE C 0.9 3 000851 REF REFINISH L FRT DOOR OUTSIDE C 2.1 4 000863 BDY REMOVEANSTALL L FRT BELT MOULDING 0.2 # 5 000865 BDY REMOVEANSTALL L FRT UPR DOOR MOULDING 0.5 # 6 000867 BDY REMOVE/INSTALL L FRT DOOR WINDOW FRAME MLDG 0.2 # 7 000869 BDY REMOVEANSTALL L FRT DOOR MIRROR INC # a 002610 BDY REMOVEANSTALL L FRT DOOR ADHESIVE MOULDING Existing 0.4* 9 000885 BDY REMOVEIINSTALL L FRT DOOR TRIM PANEL INC 10 000911 BDY REMOVEANSTALL L FRT DOOR HANDLE 1.8 # 11 000967 REF REFINISH L REAR DOOR OUTSIDE C 1.6 12 000979 BDY REMOVEANSTALL L REAR BELT MOULDING INC # 13 000981 BDY REMOVEANSTALL L REAR DOOR FRT WINDOW FRAME MLDG 0.4 # 14 001812 BDY REMOVEANSTALL L REAR UPR DOOR MOULDING 0.2 15 002262 BDY REMOVEANSTALL L REAR DOOR ADHESIVE MOULDING Existing 0.4* 16 000999 BDY REMOVEANSTALL L REAR DOOR TRIM PANEL INC 17 001023 BDY REMOVEANSTALL L REAR DOOR HANDLE 1.8 # 18 001070 REF REFINISH ROOF PANEL C 2.5 19 001130 REF BLEND R QUARTER PANEL OUTSIDE C 0.9 20 900500 REF REPAIR ROPE FRONT AND REAR GLASS Existing 0.5* 21 001131 REF REFINISH L QUARTER PANEL OUTSIDE C 1.8 # 22 001177 BDY REMOVEANSTALL ANTENNA 0.5 23 001178 BDY REMOVEANSTALL R QUARTER MUDGUARD 0.2 24 001179 BDY REMOVEANSTALL L QUARTER MUDGUARD 0.2 25 001199 REF BLEND LUGGAGE LID OUTSIDE C 0.9 26 001223 BDY REMOVE/REPLACE LUGGAGE LID ADHESIVE NAMEPLATE 75447-AC010 21.81 0.2 27 001224 BDY REMOVE/REPLACE LUGGAGE LID ADHESIVE NAMEPLATE 75442-AC010 25.46 0.2 28 002395 BDY REMOVE/REPLACE LUGGAGE LID ADHESIVE EMBLEM 75441-05040 20.32 0.2 29 001367 REF REFINISH REAR BUMPER COVER C 2.2 30 001368 BDY REMOVE/INSTALL REAR BUMPER ASSY 1.2 31 AUTO REF ADD'L OPR CLEAR COAT 2.9 32 933003 BDY ' ADD'L OPR TINT COLOR 0.5* 33 AUTO ADD'L COST PAINT/MATERLALS 358.60* 34 AUTO ADD'L COST HAZARDOUS WASTE DISPOSAL 2.00* ESTIMATE RECALL NUMBER: 3/10/0615:24:30 2829 UltraMate is a Trademark of Mitchell International Mitchell Data Version: FEB_06_A Copyright(C)1994-2003 Mitchell International Page 1 of 2 UltraMate Version: 5.0.214 All Rights Reserved @3SPRECISION PAINT AND COLLISION Dale:3/10/06 Time:3:25:12 PM Page 2 of 2 ~ ( O Date: 3/10/06 03:24 PM Estimate ID: 2829 ' Estimate Version: 0 Preliminary Profile 10: CONTRA COSTA COUNTY " -Judgement Item #-Labor Note Applies C- Included in Clear Coat Calc Add'] Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount Body 9.4 45.00 0.00 0.00 423.00 Taxable Parts 67.59 Refinish 16.3 45.00 0.00 0.00 733.50 Parts Adjustments 3.38- Sales Tax 8.250% 5.30 Non-Taxable Labor 1,156.50 Total Replacement Parts Amount 69.51 Labor Summary 25.7 1,156.50 111• Additional Costs Amount IV. Adjustments Amount Taxable Casts 358.60 Customer Responsibility 0.00 Sales Tax 8.250% 29.58 Non-Taxable Costs 2.00 Total Additional Costs 390.18 I. Total Labor: 1,156.50 11. Total Replacement Parts: 69.51 III. Total Additional Costs: 390.18 Gross Total: 1,616.19 IV. Total Adjustments: 0.00 Net Total: 1,616.19 This is a preliminary estimate. Additional changes to the estimate may be required for the actual repair. ESTIMATE RECALL NUMBER: 3/10/0615:24:30 2829 UltraMate is a Trademark of Mitchell International Mitchell Data Version: FEB_06_A Copyright(C)1994-2003 Mitchell International Page 2 of 2 UltraMate Version: 5.0.214 All Rights Reserved s CLAIM �. .BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY t I BOARD ACTION: APRIL 25, 2006 Claim Agai:;ist the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section refere The copy of this document mailed to California Government Codes. you is your notice of the action taken MAR 17 2oo6 on your claim by the Board of Supervisors. (Paragraph IV below), COUNTY COUNSEL given Pursuant to Government Code I MARTINEZ CALIF. Section 913 and 915.4. Please note all AMOUNT: $5,000.00, expected additional out ',Warnings". of pocket cost to' range $5,000.00 CLAIMANT: AND $15,000.00 MORAGA VALLEY SWIM AND TENNIS CLUB ATTORNEY: BY: NILS KJELL DATE RECEIVED: MARCH 17, 2006 UNKNOWN! ADDRESS: P.O. BOX 181 BY DELIVERY TO CLERK ON: MARCH 17, 2006 ORINDA, CA 94563 RECEIVED FROM RISK BY MAIL POSTMARKED: MANAGEMENT FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. MARCH 17, 2006: JOHN CULLEN, Clerk Dated: By: Deputy I1. FROM: County Counsel TO: Clerk of the Board of Supervisors ( his claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 91.0.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). O Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right t i apply for leave to present a late claim (Section 911.3). O Other: I Dated: By: t'Y1�—�A fyt Deputy County Counsel III. FROM: Clerk of the Board J TO: County Counsel (1) County Administrator(2) O Claim was returned as untimely with notice to claimant (Section 911.3). IV. UOARD ORDER: By unani mous vote of the Supervisors present: (t. This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. 0 Dated JOHN CULLEN, CLERK, By Deputy Clerk WAR2,TING (Gov. code section 91 3) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court,action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. e DateJp//0?4 � Z*04 JOHN CULLEN, CLERK By Deputy Clerk i 1 MRR. 15.2026. 10:37AM COMMUNITY DEVELOPMENT . NO.629 P.2 Mor 9a Valley Swim and TennisP.O, Box 181 Club ll Club Orinda, CA 94563 tJ �"r,n s Pj� 2. c�3 I March-1 1, 2006 VIA EMAIL: orindaparksrecanlci.orinda.ca.us; tskinner(fti.orinda.ca.use cityoffices(@ci.oHnda.ca.us Ftan Harvey City of Orinda P.O. Box 2000 MAR 2006 Orinda, CA 94563 Attn: Todd Skinner, Parks Department Attn: Janice Carey, City Engineer VIA U.S. MAIL Contra Costa County Community Development Department 651 Pine Street 4th Floor- North Wing Martinez, CA 94553 Attn: Deputy Director, Catherine Kutsuris VIA FAX: 925-335-1076 ' Gayle B. Uilkema;Supervisor 651 Pine St Rm 108A Martinez, CA 945'53 Re: Damage Resulting from Hillside Runofr To Whom It May Concern: Please be advised that the oraga Valley Swim and Tennis Club ("MVP") property located at 15 Risa Court, Orinda, CA 94563 suffered significant flooding as a result of the substantial rains in December 2005. In particular, several inches of mwd and silt runoff from the City-owned hillside immediately above and behind our property covered the upper tennis courts and walkways and, of greater concern, filled our drains with silt and other debris. This resulted in a cascade of events that threatened additional damage to our facility and to'our neighbors on Risa Court further downhill. We believe at least two items were primary contributors to the extensive runoff and damage to our facility: 1. There is a v-ditch'immediately behind our property on land we understand is entirely or.partially owned by the City of Orinda. The ditch is not regularly maintained by the City, which has allowed debris to collect and limited the effectiveness of the drains when most needed. (As a result of the substantial deposit of silt, the drain will need to be cleared, at a significant expense.) MAR. 15.2000 10:37AM COMMUNITY DEVELOPMENT NO.629 P.3 Gf�ty of 06nda County of Contra Costa Page 2 of 2 2. There have been several sightings 9f cowS,grazing on,the hillside. This.is evidenced by several areas.where grass and other natural ground cover has been eaten away, resulting in enhanced erosion of the hillside. - _. -- --- As a fesult of the runoff from the hillside, our facility has incurred significant out of pocket costs-,and is likely tq continue to inqur additional costs in order to remediate immediate damage and mitigete further damage. Among other things, this includes the cost of sandbags, several hours of hired labor to cant'and position sandbags and seek to clear debris, clearing of several drains (much of which remains to be done), and many hours, and hundreds of gallons of water, cleaning mud off of two sets of tennis courts. As of the date of this letter, I irect out of pocket costs incurred total approximately $5,000, expected additionallout of pocket costs are expected to range between $5,000 and $15,000, and we reserve the right to supplement this letter to reflect additional related costs that are incurred after this date. The type and amount of each cost incurred can be itemized if required. We understand that funds are, or may be, available from the City or County as a result of the substantial damage from the rains. We request reimbursement of the above amounts and, in addition, would appreciate the opportunity to meet with you to,address further action that can and should be teken to prevent this type gf damage in the future. As we are sure.youi appreciate, without the City's active cooperation in prom I ptly , further damage to MVP facilities is inevitable. developing a mitigation plan We look forward to your prompt response. In addition to the move mailing address, you may contact Nils Kjell, President, at;nils c@kjellfamily.00m, Daniel Lantry,Vice President, at danlantry(&sbcglobal.net lor David Marks, Facilities Director, at david.a.marks@com cast.net, Sincerely, Nils Kjell President, Board of Directors Moraga Valley Swim and Tennis Club cc: Board of Directors County of Contra Costa County Administrators Office RECEIVED Risk Management Division 2530 Arnold Drive, Suite 140 MAR 17 2006 Martinez, California 94553 CLERKCONTRA COSTA CO�SORS Phone: 5-1443 Fax 5-1421 March 15,2006 To: Clerk of the Board I. From: Ron Harvey 91-ZA Risk Manager Subject: Moraga Valley Swlim and Tennis Club Please process as a claim the iattached letter dated March 11, 2006 from the Moraga Valley Swim and Tennis Club. If you have any questions feel free to call me at 5-1443. CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY (i BOARD ACTION: APRIL 25, 2006 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Sect The copy of this document mailed to California Government Co lj I D you is your notice of the action taken MAR2) 0 2006 on your claim by the Board of Supervisors. (Paragraph IV below), COUNTY COUNSEL given Pursuant to Government Code MARTINEZ CALIF. Section 913 and 915.4. Please note all AMOUNT: AN AMOUNT WHEREIN 'JURISDICTION WOULD REST IN THE SUPERIOR COURT, UNLIMITED"Warnings". CLAIMANT--JURISDICTION -KEO SIVILAY & KHAM SIVILAY ATTORNEY: STAN CASPER DATE RECEIVED: MARCH 20, 2006 CASPER, MEADOWS, SCHWARTZ ADDRESS: & COOK IBy DELIVERY TO CLERK ON: MARCH 20, 2006 2121 N. CALIFORNIA BLUD. #1020 WALNUT CREEK, CA 94596 MARCH-A7 2006 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors, TO:. County Counsel Attached is a copy of the above-noted claim. MARCH 20, 2006 JOHN CULLEN, r Dated: By: Deputy Il. FROM: County Counsel { TO: Clerk of the Board of Safervisors (/This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply, omply substantially with Sections 910 and 910.2, and we are so I 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: 3`a��� I By: piepu County Counsel III. FROM: Clerk of the Board I TO: County Counsel (1) County Administrator (2) ( } Claim was returned as untimely with notice to claimant (Section 911.3). IV. POARD ORDER: By unanimous vote of the Supervisors present: (tj This Claim is rejected in full. O Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. 0 Dated/AA!// JOHN CULLEN, CLERK, By Deputy Clerk WAMING (Gov. code section 913) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING 1 declare under penalty of perju'ry 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. e Dated: JOHN CULLEN, CLERK By Deputy Clerk BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT i A. A claim relating to a cause of actio for death or for injury to person or to personal property or Bowing crops shall be presented not later than .six months after the accrual of the cause of action. A claim relating to any other cause of action Shall be presented not later thanone year after the accrual of the cause of action. (Gov. Code § 911.2.) i B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. 1 i C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud, See penalty for fraudulent Laims, Penal Code Sec. 72 at the end of this form.' YYOpose."Nod son ove"N s9 Nuove, RE: Claim By: KEO s1vzLAy s K I s1vIT.Ay Reserved for Clerk's filing stamp c/o Stan Casper I ) Casper, Meadows, Schwartz & Cook 2121 N. California Blvd, #I 020 j : RECEIVED Walnut Creek, cA 94596 Against the County of Contra Costa QrK ) MAR 2 0 2006 District) CLERK BOARD Of SUPERVISORS (Fill in the nerve) ) CONTRA COSTA CO. I ) The undersigned claimant hereby makei claim against the County of Contra Costa or the above-named district in the sum 65 EL* and in support of this claim represents as follows:in an amount wherein jurisdiction would=rest`.in':the ssuperior"Court,unlimited Jurisdiction. 1. When did the damage or injury occur? (Give exact date and hour) October 8, 2005 2. Where did the damage or injury occur? (Include city and county) West County Detention Facility., Richmond, CA 3. How did the datnage.or injury occur? (Give full details; use extra paper if required) See Attachment to Claim. 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? See Attachment to Claim S What 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 your) claim resuited? (Give foil extent of injuries or damages claimed. Attach two estimates for auto damage.) Loss of love, comfort, society, companionship, protection, solace, affection, and moral? suport. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Damages are in an amount wherein jurisdiction would rest in the Superior Court Unlimited Jurisdiction. 8. Names and addresses of witnesses)doctors, and hospitals: Unknown at this time. • I 9. List the expendimms you made on account of this accident or injury: I DATE T A AMOUNT I October 2005 Funeral and burial expenses (undetermined at this time) , a s 00 g a a o s a a a a a a a a 0 a It o o a 0 a.a 00.a a•ve•ago Daosass saaannaaa■011.0400 aaaaose man 0200 an Peso go l i Gov, Code Sec. 910.2 provides "The claim shall be signed by the claimant-or by some person on his j behalf" I SEND NOTICES TO: (Attorney) ) ey Name and address ofAttom ) Stan Casper Casper, Meadows, Schwartz Cook laimant's Signature) 2121 N. California Blvd ) Suite 1020 Walnut Creek, CA 94596 (Address) I) I I I Telephone No. 925/947-1147 j Telephone No. .aosa0009aa9a_800aasa0ana•0aaaaa0aagrespaaoaago a@goescase aanDean now Veto loss Dam was alp earl PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed with the County under the Tort Claims Act, is subject to public disclosure under the California Public Records Act. (Gov, Code, §§ 6500 et seg.) Furthermore, any attachments, addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. I as moo Dean coo e11ee3oaogsapa0ssaeaaseavass saa ssosseas so■ase0a*was son aoanaeo Dan a a o pea sant I 1 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 orl officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account voucher, qr writing, is punishable either by imprisonment in the County jail fora period of not more than one year, by a Fine of not exceeding one thousand dollars ($1,000.OD), 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, Claimant: Keo Sivilay,.et al. 'Attachment to Claim I Claimant's Decedent, Som Sivilay (DOB: 08/17/1979) was given access to dangerous instrumentalities with which to do himself harm, as well Provided the opportunity to do himself harm, at a time when employees and agents of the Detention Facility knew, or should have known, that Som Sivilay was in danger of harm, resulting in Som Sivilay's committing suicide at the Detention Facility. 4. At all relevant times while Som Sivilay was an inmate at the Contra Costa County West County Detention Facility, he was so negligently and carelessly confined, assigned, treated, classified, managed, cont dolled, supervised, and cared for so as to proximately result in the injuries and damages above-described. At all relevant times during his commitment to the West County Detention Facility, Claimant's Decedent, Som Sivilay, was examined and treated by healthcare providers who were the agents, servants, and employees of Contra Costa County, and who negligently and carelessly treated, diagnosed, examined, classified, assigned, confined, and otherwise cared for Som Sivilay so as toI proximately result in the injuries and damages to Claimant's Decedent as set forth above. ANDREW C.SCHWARTZ Certified Civil Trial Specialist/ LAW OFFICES OF National Board of Trial Advocacy CASPER,,MEADOWS, SCHWARTZ & COOK TEL: (925)947-1147 STAN CASPER A PROFESSIONAL CORPORATION Certified Civil Trial Specialist/ CALIFORNIA PLAZA FAX: (925)947-1131 National Board of Trial Advocacy 2121 NORTH CALIFORNIA BOULEVARD SUITE 1020 EMAIL: INFO@CMSLAW.COM MICHAEL D.MEADOWS WALNUT CREEK,CALIFORNIA 945967333 LARRY E.COOK RECEIVED THOM SEATON March 17, 2006 MAR 2 0 2006 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. Clerk of the Board of Supervisors County Administration Building 651 Pine Street, Room 1061 Martinez, CA 94553 Re: Claim of Som Sivilay Dear Clerk: Enclosed please find an original and three copies of a Claim Against the County of Contra Costa. In the envelope provided, please return one copy marked "received" for our records. Thank you for your courtesy and cooperation. Sincerely, p_/( Sandra L. Fritts Legal Assistant to Stan Casper /slf Enclosure \ « � \ �_ K # � 7 \ O ) acr eK m _� a 2 J � *la $ # \ k7 S \ k@ \ $\ 0 � \ C) � S «�%IS � 0 q - � 9 � � o .��. CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY (y BOARD ACTION: APRIL 25, 2006 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 a �1 California Government Codes. you is your notice of the action taken MAR 2 4 2006 on your claim by the Board of COUNTY COUNSEL Supervisors. (Paragraph IV below), MARTINEZ CALIF. given Pursuant to Government Code Section 913 and 915.4. Please note all AMOUNT: IN EXCESS OF $251000.00' "Warnings". CLAIMANT: TOMAS A. RODRIGUEZ ATTORNEY: JEFFREY L. KRULL' DATE RECEIVED: MARCH 24 2006 LAW OFFICES OF JEFFREY L. KRULL 24, 2006 ADDRESS: 478 EUCLID AVENUE BY DELIVERY TO CLERK ON: MARCH SAN FRANCISCO, CA 94118 MARCH 23, 2006 BY MAIL POSTMARKED: 1 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN f Dated: MARCH 24, 2006 By: Deputy II. FROM: County Counsel I TO: Clerk of the Board of Supervisors ( his claim complies substantially with Sections 910 and 910.2.. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). O Claim is not timely filed. ThelClerk 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). O Other: If Dated: �"��� �� By: pVl c Deputy County Counsel 1I1. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) O Claim was returned as untimely with notice to claimant (Section 911.3). IV. B ARD ORDER: By unanimous vote of the Supervisors present: (This Claim is rejected in full. O Other: II I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. V Dated:Ar/14_f�10?w JOHN CULLEN, CLERK, BDeputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim.See Government.Code Section 945.6.You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING j 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. DatedIOHN CULLEN, CLERK By zgfADeputy Clerk I r FEP-08-2006 09 53 CCC RISK MRNAGMENT 925 335 1421 P.02 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. A claim relating to a cause of action for death or for injury to person or to personal property or growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be presented not later than one year after the accrual of the cause of action. (Gov. Code § 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street,Martinez,CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each. public entity. E. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form. ■m■■mmmmummmmmmm■mmmmmmmmmmmmmmm man mmmmmummmmmmmmmmmmmmmmumm��mmmmmemmmmm■u RE: Claim By: Reserved for Clerk's filing stamp Tomas A. RodriguezrIECEIVED ) ) Against the County of Contra Costa or ) MAR 2 4 2006 Contra Costa County District) CLERK BOARD OF SUPERVISORS (Fill in the name) ) co;TAA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ in excess of and in support of this claim represents as follows: 0 I. When did the damage.or injury occur? (Give exact date and hour) January 13, 2006 at approx. 3:00 P.M. 2. Where did the damage or inj i occur? (Include city and county) Lefty Gomez Ballfield Complex, Rodeo, CA 3. How did the damage or injury occur? (Give full details; use extra paper if required) Claimant was playing in a play structure at Lefty Gomez Park when a defective play aparatus caused him to fall to the ground resulting in injuries. 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? There were no cones or warning signs around the play area. The failure to maintain the premises in a safe manner is negligence. S What are the names of county or district officers, servants,or employees causing the damage or injury? Contra Costa County FEP,-Oe-2006 09453 CCC RISK MANAGMENT 925 335 1421 P.03 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) Claimant sustained severe pain in right shoulder and lower back 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Medical Treatment- Stills Pending Loss of wages - Still Pending Personal Injury - Inexcessof -$25;000 total amount of claim - In excess of $25,000.00 8. Names and addresses of witnesses, doctors, and hospitals: Doctor's Medical Center at 2000 Vale Road, San Pablo, CA 94806 Dr. Raymond Knapp at 3050 Hilltop Mall Road, Richmond, CA 94806 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT N/A ■aanaaaaf It no era Masa a Mean*ame MEIla lmamelaaaaamn On aal a■■aMM■■ma a■aaa MAMMA*a a as a as a ma{{of .Gov. Code Sec. 910.2 provides"The claim shall be signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney) ) Name and address of Attorney ) i Law Offices of Jeffrey L. Krull ) is Signature) 478 Euclid Avenue ) Jeff y Kr 1, Esq. Attorney for Claimant, - San Francisco, CA 94118 4045 Lamberd Road Tomas A. Rodriguez (Address) r ) E1 Sobrante, CA 94803 Telephone No. (415) - )Telephone No. (510) 758-9508 •■aaa■■a■■taamlaae Of Maamaaaaama IS Ron was ane a asOman aEwa Oran samefmafae■as a am a neefineteal PUBLIC RECORDS NOTICE: Please be advised that this claim form or any claim filed with the County under the Tort Claims Act, is subject to public disclosure under the California Public Records Act. (Gov. Code, §§ 6500 et seq.) Furthermore, any attachments, addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure, a aaaaa.a no aaa a aaesassmfs as Mas■.....a..........................ansa{e■mass Mae m{■am■■sl 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 by imprisonment in the County jail for a period of not more than one year, by a fine of not exceeding one thousand dollars ($1,000.00), 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 imprisomnent and fine. TOTAL P.03 z yy'i 'may/ �'+' ✓ art'Cay/i k:. ,�y � �,) r„ M � oi y ~ r • .3 Y 4 IET �.. 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JC t.,...ar"\ }}e`sY °' y't`.�!n � ' i '�s it�.V'rJ'i+r i\i May"�` 'S•� f.y,i '�"l�+f �' f ll 4r'•13+ L� ' r�(i + 4 fS,� Z`r�'+�. +'�� n M�. � e•7''rpt�w'f`t ,°�` ', s�.-�r"f" r G�'-�\ ;'`_' " '! •''�'.,;�e'f sr �' "'\Y�,y'�C X\tilS . •wys j•7':+ ( P'N k+'r' 1+� t + +..!^ j .r } Y �' + C'� `b �i"� S'Y'�V'� yF�+Y�•�5� �\h�r•Y}\41h...Le�ti�Re x I` '.} �' ��',�+ybiCG��'S�'.+_'.. yr�rrperv�F=kfi,•�p"N yr.!r �:o-dt v37i{'. by {� 3li � `"t + •y v� frt, ta.. . :i eal? .N it s i 7� .L �+.' .s� �"w tl✓ r C .f.. ,7y tF.••c y' '�+ "'� l'tfkllp .s M •.r {:aC 3xkii 'Si r r ?ylX rtZ s.`'� � .,.� r ' r r1 is.' `CfF. 1 r✓5 W v.,a.. .rr 4A-WIT :I,'v`SJ �'aTjf" i�X r'�{.i� .� ':•1,��•��"kr_�!+.+C.rx'r7F as as if�j.✓� sfi�^t, ' rk�y ! !Sr i Y. y- rfy�} �Z'4 I+� + \ r s�;•.G t2 ����,Yj•,. '�r .f(^�•r��y3 P 7'' f r4�'�l Y�.i f77�.,J w+ el}e t+l�'4 rzrlA�•"'rn �' •^ 1'.+i ti� a�d „�'sx $, r,f.} s{i "i�.+l1J �, r, , .1,�� �."y'i,�";'. aYr` j( ;r 1. iv .y M '•^.�,? ys,*s!ro. r � � '1"r 'V�T,�j'ary ✓N'ayyr,i3;•f �t A 9 I?y'.�L+�,�lli�� e »'� S �rrh.. 1 r t d,9, r�T-�'4�i;� t�v}+, "T/S/+ �� %T9`rr�' ` \ f. qyS tiw�� � 4•��1'C'rii.�'. r t •✓ e.k { 4 \�'srfr J iu�Y`�f Yr��rtS�� ��.`.•tri r h r O'!r�' r✓r il'j'r t Y 1 S� �•. .� !�,Jy r� %� r '' \".`-1 i 1�: �y�.•a��Y.J,1'.+.v { ,r ��, �tr I r t i r J •?l ... rw ? "s��;i'�V �t]nr�,v a � s,� M v ,f' i, rG, Ir e ,,�fi,syr ���,,,,,//� C]+ �� V ,f' ,�•i,. ,4 i y 4 'L \. r •. •.��1 iTt'...i'eclfY.r. .�.a ;S.,,u x..sv.{..".� •:s:.Y...i.J. .`tir..., .l..... S.�.i!;. �....... :.v. ,_, �r,+ .. .�:..._ .yt ti 1 I LAW OFFICES OF JEFFREY L. KRULL U CEI V ATTORNEY AT LAW LFC, 478 EUCLID AVENUE ^•r�.IAN FRANCISCO, CALIFORNIA 94118 ?ERVisops CO. JEFFREY L. KRULL TELEPHONE: (415) 387-2446 FAX: (415) 221-1586 March 23, 2006 Clerk of the Board of Supervisors County Administration Building 651 Pine Street Room 106 Martinez, CA 94553 j Re: Your Insured: Contra Costa County Our Client; Tomas A. Rodriguez Date of Accident: January 13, 2006 Location: Lefty Gomez Ballfield Complex, Rodeo, CA. Dear Sir/Madam: Enclosed please find a claim to be filed on behalf of our client Mr. Tomas A. Rodriguez. Please file this claim and return an endorsed filed copy to this office in the envelope enclosed for your convenience. We look forward to reaching a mutually satisfactory resolution of this claim. Thank you for your anticipated courtesy and cooperation in handling this claim. Very truly yours, I The Law Offices of Jeffre . Krull Jeffre 1 JLK Enclosures. i LAW OFFICES OF O JEFFREY L. KRULL ATTORNEY AT LAW 478 EUCLID AVENUE SAN FRANCISCO, CALIFORNIA 94118 JEFFREY L. KRULL TELEPHONE: (415) 387-2445 FAX:(415)221.1586 AUTHORIZATION FOR REPRESENTATION TO WHOM IT MAY CONCERN: I Pursuant to Section 2695 . 2 (c) of the California Code of Regulations, Title 10 , , Chapter 5 , I authorize THE LAW OFFICES OF JEFFREY L. KRULL to handle my automobile claim which occurred on or about This authorization shall be valid for only two years from the below date unless renewed or revoked by the undersigned. Any and all prior authorizations are hereby revoked by the undersigned as of the date of this authorization. f i i DATED : /� f CLIENT ' S NAME DATE OF ACCIDENT AND /OR LOSS / �3 / b CLIENT ' S SIGNATUR - I I I a n� r ©mow .M I ( M 1., 4 �3 e+ }fi . r • 't 4 m � a e \ �• o �3J�o fs w�ou u ZZ ca o 4W ow- Z a CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY (i BOARD ACTION: APRIL 25, 2006 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 California Government Codes. ) you is your notice of the action taken ur claim by the Board of CLAIM AGAINST CONTRA COSTA COUNTY isors. (Paragraph IV below), MAR 2 4 ppp � Pursuant to Government Code AMOUNT: TO BE DETERMINED e ion 913 and 915.4. Please note all COUNTY COUNSE Warnings". CLAIMANT: MARTINEZ CALIF. EDWARD B. FOMINYKH ATTORNEY: UNKNOWN DATE RECEIVED: MARCH 24, 2006 ADDRESS: 6120 SKYLINE DRIVE BY DELIVERY TO CLERK ON: MARCH 24, 2006 EL SOBRANTE, CA 94803 HAND DELIVERED BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. MARCH 24, 2006 JOHN CULLEN, r Dated: By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors I (44--This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to co Imply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). O Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's rig] t to apply for leave to present a late claim (Section 911.3). O Other: Dated: 3- ;2 ?� J By: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) O Claim was returned as untimely with notice to claimant (Section 911.3). I" BOARD ORDER: By unanimous vote of the Supervisors present: (v This Claim is rejected in full. O Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated,4rl�� JOHN CIJLLEN, CLERK, B 9 Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection with this matter. If you wart 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. J Dated:/iOr��OZd� SOL JOHN CULLEN, CLERK By Deputy Clerk I I ` a i BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY xNsTRug,riQNS TO 0,AMOT A. A claim relating to a cause of action for death or for injury to person or to personal property or growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be presented not later than one year after the accrual of the cause of action. (Gov. Code§ 911.2.) B, Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez,CA 94553, C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims,Penal Code See. 72 at the end of this form.' OQ qQ QYp Qq qpq qb aPgbpgqq qQY QP PPPggqOQqOP QppYpPOq OQQgq PQ aQQpq QgQPgq YP PgbbPQ QP Pqi P, RE: Claire By: Reserved for Clerk's filing stamp RECEIVED Against the County of Contra Costa or ) District) MAR 2 4 (Pill in the name) I ) 2 0 06 j CLERK BOARD OF SUPERVISORS 1 CONTRA COSTA CO. The undersigned claimant hereby rziakes claim against the County of Contra Costa or the above-named district in the sum of$+o lz Atkr►hi ret( and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city pd county) 6tzo 5kJ)ine �r;ve, E! Sabrdnk ea/it- 9?!Y43 Cra»f-r�-� Gosf�, L'ou»ftf 3. How did the damage or injury occur? (Give full details; use extra paper if required) 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? I�Fu}q Cu.(+ 3 ex@cs5r*e florcC 5 What are the names of county or district officers,servants,or employees causing the damage or injury? 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two cstimates�for auto darnage.) ynenFa( a.vtcl AADrn" }r�S wines loss I JJ - Mca al Pa 115 7. plow was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 8. Names and addipsses of witnesses, doctors and hoals ,J I)ec+005 Mccl1bal ee-Wer-2, Vain- W. `rMOZZ GLIA, 4)5uxce 4�rIGk-�l20����1,t�r; � s Armricat. Nc&cal &-ston5e- POrh�x 3w29 Nedey'lo Cad , E) `pSMK �a�i� 1 5A&wFi A3uriak - (,izo5kyy�jixt�rlµe E/Sohr4ukCat,���/gp3 9F�Dj 9. ist the expenditures you m¢cde on account of this accident or injury: DATE TIME AMOUN DD0 p0PbpYs00p Dtl pP■099@9Pp9pPtltl tlbtltl0@DDDOpDObPmpmbtl@tl00 gP0P DPop DpbbYYpgtl@•ptlptlPPPPD tlDI } Gov. Code Sec. 910,2 provides"The claim shall be }signed by the claimant or by some person on his behalf." SEND NOTICES T0: (Atto�@Y� 1 � '— Name and address of Attorney (Claimant's Signature) ��2D Sal o/2/= A (Address) Telephone No, ) Telephone No. DtlOno pmpppgp pvpp@@p pDOq ADD qD gD09q@D90D9D 9qD 0909909ODDq 90 @O DDD@0600tl0tlpDtlbbapppDpgp ppl PUBLIC RECORDS NOTICE: Please be advised that this claim form,or any claim filed with the County under the Tort Claims Act, is subject to public disclosure under the California Public Records Act, (Gov, Code, §§ 6500 et seq.) Furthermore, any attachments, addendums, or supplements attached to the claim form, including medical records,are also subject to public disclosure. 96008gtltlbp YY tlpgpppPp•@@pP0@9000 Ptlptl Pgpgq pD btlb Dtl Obgp@@D bgg00 p000tlbbpbPp PpP p.00'a pp0@1 NOTICE: Section 72 of the Penal Code provides, Every person who, with intent to defri ud, presents for allowance or for payment to any state board or officer, or to any county, city, or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account voucher, or writing, is punishable either by imprisonment in the County jail for a period of not more than one year, byla fine of not exceeding one thousand dollars ($1,000.00), 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. home o-t m irl kcnd Sham ' � I / �/ 1 5%5�t"; 5�2cerzc[ /�,�at~ia/2 L�Qti��f �'�f t't>1r��' � ue��l' �� 1'i��'y1Dt�al :5 I rOw �e flye-r -b'eewit�e Z~kra5 1h10Xiet 6arli�in fie.- G ` f' Pi'/1r�me�ou5 �ovrs- I �4u � Q at Ixcn rzyr<ecf on � ar ivea/ a� 29e k9ulic anlone aw &Ote �&rpvka baek out 60Yerei A 441'ju T �1me /z9y rait"1 triC r� t��that' Srs 'r trlcrG c�c �la�ni -b ale tr7 z i'aliCe WutC v am tlorrt �ius�Q &nGt NL ir54I4-iii V i5 m irl�7%eHd exp/ar`rud r cfciLLov jxY I&cle or S/r,wn.e-5,.s /rte /ate va - Pe- �tt7�t �LJ�narvi� d /o rn Al'irl and n�IS`1 7' h.e. ugelers my d,� -WAf 7 z ei�pv 5, k rn.c Pa/tom! rirrr�iYs?o�✓tl� waw rA� � l bud �,��� CloftP/y, w/* At re r 5r�r 4l5� "tn l r c Cl /i�c r? '' c %u j said �vaae ri me IaJ�tr`L t die( kl Ad(ers/aial �A � 5� .5 At ck u�t,/ javlled a� hPollee be/,crm -1),h,�t d o hr er r ra c cd 5Pr nuc /n Z fiICI- Pum nX �dorvn k m y 19rrc..t-5. 7L de?,j,� gem fin veJ f t�r�^tar� &5 foliee baloill pun ivri+ ml arm.5 At hewf n ,( at n�i )TIVA,11 weds Scuu� / rrh 5><orn �1i d 1^� �v�s 4heMy btdZeAM� IrIVclly Q�C� her 5r5k L06 w4yLt6xd Ai5 LrmpkI ac-g runni ower- dC'011i "Alcr wh14L 5 �i� . ahnde ,lamzb -Ku yefpe_r5p aVLA in 'urod fie. de v )��k� me...U� nu } b } u � ccv ailed � �- Wi AVW( O5 p��er �a)t(�e.D{- rCe� arnveJ a 5 well a,5 a n o n2 bOl urce . T was ve507bMO ts(f� . G V 60,C-0414-A, a-j2p ;JD ec( r7 u n6c Us firms s it �- D -�r mdck� 1�( ec��C�red - l lie Svc vat h icvn �uf ave Zac r `s m ec�,`f t�l' LpeLc t •R. _ 2. CLAIM ' BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: APRIL 25, 2006 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 California Government Codes. ) you is your notice of the action taken y� on your claim by the Board of CLAIM AGAINST DEPUTY CUTTITA D WETS D Supervisors. (Paragraph IV below), MAR 2 4 2N, given Pursuant to Government Code AMOUNT: TO BE DETERMINED Section 913 and 915.4. Please note all COUNTY COUNSEL "Warnings". CLAIMANT: EDWARD B. FOMINYKH MARTINEZ CALIF. ATTORNEY: UNKNOWN + DATE RECEIVED: MARCH 24, 2006 i ADDRESS: 6120 SKYLINE DRIVE BY DELIVERY TO CLERK ON: MARCH 24, 2006 EL SOBRANTE, CA ,.94803 j BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. MARCH 24 2006 JOHN CULLEN,mer Dated: ' By: Deputy I1. FROM: County Counsel TO: Clerk of the Board of Supervisors r (V),O'rhis claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). O Other: II Dated: By: Deputy County Counsel LIL FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) O Claim was returned as untimely with notice to claimant (Section 911.3). IN/ BOARD ORDER: By unanimous vote of the Supervisors present: (v) This Claim is rejected in f,11. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. a Dated.4?r//0", %JOHN CULLEN, CLERK, By Deputy Clerk a WARNING (Gov. code section 913) (Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Set-vice 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: �'Q�i JOHN CULLEN, CLERK By Deputy Clerk I BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INS TRUC IONS TO!QAIMANT A. A claim relating to a cause of?laction for death or for injury to person or to personal property or growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be presented not later than one year after the accrual of the cause of action. (Gov. Code § 9:11-2.) 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 I 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 fraud : Julent claims,Penal Code Sec. 72 at the end of this form 5555 oqq @'®050 So SSag50555 ago. ..a 9 a B vosaaaccoucapq ggppq aSbOOGO00asgggq9Y00 maps*as RE; Claim By. Reserved for Clerk's filing stamp RECEIVED Against the County of Contra Costa'or } MAR 2 4 RECD (Fill in th 1 c _ � 1 r District) CLERK BOARD OF SUPERVISORS e named CONTRA COSTA co. ii } The undersigned claimant hereby maalce claim against the County of Contra Costa or the above-named district in the sum of$}a k� t1c}crm l d in support of this claim represents as follows: 1. When did the damage or injiury occur? (Give exact date and hour) Branch , I c >eynber-A5 7101-.,2.— 2. Where did the damage or jury occur? (Include city and county) lold2t� Ski/�n¢ /1 vC, El 5C�bl2mk L41* c/i1 2'3 C'sralya 6 a or 10-s4-d C,oun4v 3• How did the dame injury occur? (D}ive fun details; use extra paper if required) (Sec AH4t 4. What particular act or omiS sion an the part of county or district officers, sezvan , or employees caused the injury or damage? Dcpu+ ' 00t` r _ uted ucdeysi+�t %rcr. W6 if {7 1 -in �e�,505jt 4. ,� r 5 What are the names of county or district officers,servants, or employees causing the damage or injury? o 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimateslfor auto damage.) Mr,��-ttl Ph 5ut( lily ;nJur tva��s "los • <l- ir,•�-y 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 8. Names and addresses of witnesses, doctors,and hospitals: O - DorJor '5 Mec(ll cevrkr-2000 VVr- (lrl Sa<r>t'ablo - Armerie" Mecl;-ce IZEspons� P.o&xI#zy P1ode o Crrt�F. SH Nti Az` fah '- ci2osKyircDrcr -15vbawk�Z7�hcc�a A acialti 6�Zp �7�j(�Y►cD�+Vf 9. List a expendtttues you made on account of this accident or injury: 3 DATE TIME AMOUNT E/ 5obrnN ¢y:?o3 Dog Dooms a a=atom nounOBooaO*•Cb OBtlaaOoa oaaBaa Pmaaoaa aoaaaaaaa C a C Cand BBB B no B a B mommmB awl } Gov. Code Sec. 910.2 provides"The claim shall be signed by the claimant or by some person on his behalf" SEND NOTICES TO: (AttorxteY) ) --�- Name and address of Attorney (Claimant's Signature) (Address) So.bkA /VV E Telephone No. )Telephone No. an a a a moa*pup an Bo ova o a aav Bas,clan a Bo a a a Bona a a a a a a a a a a coo B a a a BBB no as a all an a all t a a a C C Canna, PUBLIC RECORDS NOTICE: Please be advised that this claim form,lor any claim filed with the County under the Tort Claims Act, is subject to public disclosure under the California Public Records Act, (Gov. Code, §§ 6500 et seq.) Furthermore, any attachments,addendums, or supplements attached to the claim form, including medical records,are also subject to public disclosure. BCBa Oaal Ha Baa Bia Baoas Bl@BBBna add eat a aao ago and a a aaaaaaaDaaa Ba an as a as boa o a a a a a a a a a to a al NOTICE: Section 72 of the Penal Code provides.. Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city, or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bili, account voucher, or writing, is punishable either by imprisonment in the County jail for a period of not more than one year, byl a fine of not exceeding one thousand dollars ($1,000.00), 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. 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Wa.•s I � o APPLICATION TO FILE LATE CLAIM BOARD OF SUPERVISOR'S OF CONTRA COSTA COUNTY CALIFORNIA ®� BOARD ACTION Application to File Late Claim ) NOTICE TO APPLICANTRIL 25, 2006 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 Government Code.) given pursuant to Government Code Sections 911.8 and 915.4. Please note the "WARNING"below. Claimant: .CECELIA HOPKINS-CHESTNUT AND ti JAMES CHESTNUT APR U 4 Attorney: R. KENNETH BAUER ���� LAW OFFICES OF R. KENNETH BAUER COUNTYi-. Address: 500 YGNACIO VALLEY ROAD, i'300 MARTINEZ cnLIF` WALNUT CREEK, CA 94596 1 APRIL 04 2006 Amount: • $100,000-00 By delivery to Clerk on: 4 Date Received: APRIL 04, 2006By mail,postmarked on:' RECEIVED FROM COUNTY COUNSEL 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 04, 2006 JOHN CUILLEN Clerk, By: 4i2� DEPUTY II. FROM: County Counsel TO: erk of fheiBoard of Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911.6): (L,4--"'�T`he Board should deny this Applicatio Ii to File Late Claim (Section 911.6). DATED: SILVANO B. MARCHESI, County Counsel, By: DEPUTY III. BOARD ORDER By unanimous vote of Supe"lisori present (Check one only) ( ) This Application is granted (Section 911.6). (V�This Application to File Late Claim i{s denied (Section 911.6). I certify that this a true and correct +copy of the Board's Order entered in its minutes for this date. DATE: -'l "'"'g/ JOHN CUI!LEN, 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 anjcation for leave to present a late claim was denied. You may seek the advice of an attor ley 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 BoardI 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. o I DATED: a"/�•2G, G JOHN CULLEN',Clerk,By: !t— 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 CI ounsel, By: County Administrator,By:. j APPLIICATION TO FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. A claim relating to a cause ofIaction for death or for injury to person or to personal property or growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be presented not later than one year after the accrual of the cause of action. (Gov. Code § 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street,Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors,,rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. now RE: Claim By: Reserved for Clerk's filing stamp .'Cecelia Hopkins-Chestnut and ) JAmac RECEIVED Against the County of Contra Costa or ) APR 0 4 2006 District) CLERK BOARD OF SUPERVISORS (Fill in the name) j CONTRA COSTA co. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ 10 0,o 0 0 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) July 28, 2005 - August 7, 2005 I 2. Where did the damage or injury occur? (Include city and county) I The damage occurred primarily in San Ramon, California. 3. How did the damage or injury occur? (Give full details;use extra paper if required) Ms. Chestnut-Hopkins was negligently directed to apply Edufex to her vagina . for_treatment,, of cervical dysplasia . . 4. What particular act'or omission on the part of county or district ofceis, servants, or employees caused the injury or damage? -i C,,,c; I . The prescription of Edufex for application to mucous membrane.,.- tissues as it is contraindicated. 5 What are the names of coon or district officers, servants, or employees causingahe tY P y.. : , g.... damage or injury? Sunthara Hay, D.O. 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) Second degreee burns to vaginal tissues, urinariy tract infection, swelling and prolonged severe pain, resulting in $25, 000 loss oUJncome. 7. How was the 'amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Estimated loss of^:real estate commissions for 60 'days off work. . 8. Names and addresses of witnesses, doctors, and hospitals: Dr. John Lee, Martine& IiI CA, Dr. Sila Wildfire, Martinez, CA, Dr. Huy Duc Dao, Martinez, CA, JDr. Fred Back, Martinez, CA 9. List the expenditures you made olln account of this accident or injury: DATE TIME AMOUNT $560 .26 - co-pays and +medications I ..Now...Now NEWS man Noon MEN.......MEN Nunes..Kama Mona Nos mom NONE.....Now now...\....saw..1 Gov. Code Sec..910.2 provides"The claim shall be signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney) �l Name and address of Attorney R. Kenneth Bauer, Esq. ) Law Offices of R. Kenneth ) (Claimant's Signature) Bauer 500 Ygnacio Valey 'Rd. , #30041 Seneca Ln. , San Ramon, CA 94583 Walnut Creek, CA 94596 I) (Address) Telephone No. 925-945-7945 I)Telephone No. 925-803-81.82 ................................I......................■..................Nos........l PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed with the County under the Tort Claims Act, is subject to public disclosure.under the California Public Records Act. (Gov. Code, §§ 6500 et seq.) Furthermore, any attachments, addendums,or supplements attached to the claim form, including medical records, are also subject to public disclosure. ......ONE........am.OWN Ram sum..Kum NOON..............NONE noun..MEN.....MEN....now..NEI 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 by imprisonment in the County jail for a period of not more than one year, by a fine of not exceeding one thousand dollars ($1,000.00), 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. M(-c LAW OFFICES OF R. KENNETH BAUER 500 YGNACIO VALLEY ROAD SUITE 300 WALNUT CREEK, CALIFORNIA 94596 (925) 945-7945 FAX(925) 940-9632 March 31, 2006 Monika L. Cooper, Esq. APR 3 2006 Office of the County Counsel COUNTY COUNSEL County of Contra Costa MARTINEZ CALIF. 651 Pine St .;, 9t'' Floor Martinez, CA 94553-1229 Re: Cecelia Hopkins-Chestnut and James Chestnut Dear Ms. Cooper: In response to your recent letter, please be advised that my clients, Ms . Chestnut-Hopkins and Mr. Hopkins hereby apply for leave to present the attached late claim, pursuant to Government Code Section' 911 .4 . The claim was not presented within six months of the accrual of the cause of action because the claimants did not know that Ms'. Chestnut Hopkins was being treated by an employee of Contra Costa County. Sincerely, LAW OFFICES OF R. KENNETH BAUER I R. Kenneth Bauer i RKB: lkb mmc 2'n O 0 f. .1, r n q n0 . oW o .. o ron' o PM 0 to Cj) � 0 Q Q 1� O �t N0 rh nCT (It ,: n R o v C� 0 0 y K : ul r� to '4 1 M1 y, v '