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HomeMy WebLinkAboutMINUTES - 03072007 - C.26 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: MARCH 06 , 2007 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. g� ).-,--,,;2. you is your notice of the action taken �` a• ; .;; on your claim by the Board of JAN 3 © € Supervisor s. (Paragraph IV below), 0007 C" given Pursuant to Government Code AMOUNT: $30 ,000 . 00++ COUNTY( ;11°1 pEL Section 913 and 915.4. Please note all MARTINEZ CAL.iF. "Warnings". CLAIMANT: JAMES H. DISNEY ATTORNEY: JAMES H. DISNEY DATE RECEIVED: JANUARY 30 , 2007 JAMES H. DISNEY ADDRESS: 3325 CLAYTON ROAD BY DELIVERY TO CLERK ON: JANUARY 30, 2007 CONCORD, CA 94519 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of tlae Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JANUARY 30 , 2007 JOHN CULLEN, r Dated: By: Deputy 1.1. FROM: County Counsel TO: Clerk of the Board of Supervisors ( -JAl'iis claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: /- 07 By: Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911-3). IV. QOARD 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,A1,Z.'aA,; ! WORN CULLEN, CLERK, By Deputy Clerk_ WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6) rnontlas from the date this notice was personally served or deposited in the in ail to file a court action on this claim.See Government Code Section 935.6.You may seek the advice of an attorney of'your choice in connection wide this matter. If you want to consult an attorney,you should do so immediately. *For Addidorlal Warning See Reverse Side ol7his Notice. AFFIDAVIT OF MAILING declare under penalty of perjury that .l. ani now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in (Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated��704 -/ .p7' JOHN CULLEN, CLERK By Deputy Clerk 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. RE: Claim By: Reserved for Clerk's filing stamp JAMES H. DISNEY ) RECEIVED JAN 3 0 2007 Against the County of Contra Costa or ) County of Contra Costa, Deputy ) CLERK BOARD Of SUPERVISORS Sheriff Justin Gregory, CONTRA COSTA CO. (Fill in the name) ) Deputy SheriffNeil Black (Detention) , Doe 1-Doe 10 The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ 3 0, 0 0 0 ++ and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) September 29, 2006, and f61lowing; continuing 2. Where did the damage or injury occur? (Include city and county) Arrested b_v Deputy Sheriff Justin Gregory on September 29, 2006 outside Bray Courthouse without legal justification; incarcerated 3. How did the damage or injury occur? (Give full details; use extra paper if required) County Jail. Arrest without probable cause,' without arrest warrant, or restraining order, or other lawful process. 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? Peace officer may only arrest without a warrant upon probable cause, when acting within his duty as an officer. See Penal Code 9g 836, 834 , 841 , 849 , et al c� 5 What are the names of county or district officers, servants, or employees causing the damage or injury? Deputy Sheriff Justin Gregory, Deputy Sheriff Neil Black (Detention) ; Conspiracy with°others, names currently �y unascertained. See 06-8472 CCC S0; and other 0RMCI INAL �� : 06-5653 CCC S0; and other - ' --TA-Iliat--damage-::or=-injune-s do--your-claim-resulted?..., (Give_ftill.-extent--of injuries .or dam.agies claimed. Attach two estimates for auto damage.) Injuries to body, strains, sprains, Penetration of skin causing blood flow, bruises, Loss of time and income therefrom,. Mental anquish, pain & suffering, travel expense, etc. 7. How was the 'amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Estimated. Damages are continuing and on—going and may exceed the amount estimated in the space above 5 -1. An arrest complaint was declined by Deputy DA; no criminal proceedings. 8. Names and addresses of witnesses,doctors, and hospitals: Deputy Sheriff Justin Gregory; Neil Black (who describes falsely) Attending medical technician at Jail, others 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT currently unascertained;.'.in-l.full Bail With Alladin Bail Bonds $315 ; on Sept. 30 , about 1 : 30 a.m. a wommosommum Room Sam am soon boom 0 a a a No somsms ) Gov. Code Sec. 910.2 provides"The claim shall bc-- ) signed by the.claimant or by some person on his behalf SEND NOTICES'TO: (Attomev) ) Name and address of Attorney k U(Claimant's Signature) JAMES H. DISNEY 3436 Tanager Circle, Concord, CA 94520 3325 Clayton Road (Address) Concord, CA 94519 Telephone: 925-687-7100 Telephone No. 925-687-7100 Telephone No. 686-1315 a 00 a 0 0 0 0 a a 0 a a a 0 a a a U a a a 0 5 a a 0 0 a a a a a a a a a 0 a a a a a 0 0 a 0 a a a a a 0 a a a a a 5 a 2 8 a a a a 2 0 a a a 0 a 0 a 0 a a 0 a a a 0 1 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 ass mammon an 00 a Room a a was 9 so avow game on onson Rona 0 sams wassmom samomossm mass a man;am a a a owns I 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 Count-v )all for a ID 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. CLAiN1 �� :P BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: MARCH 06 , 2007 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT aTd B-Tard;Ac ion,)All Section references.are to. copy The co of this document mailed to Cairfornia,,Goernment Codes. ) you is your notice of the action taken FEB p 2 on your claim by the Board of Supervisors. (Paragraph 1V below), COUNTYCOUN EL THE AMOUNT CLAIMED EXCEEDS THE given Pursuant to Government Code MARTINEZ CALIF LIMIT PROVIDED IN SECTION 910 Section 913 and 915.4. Please note all AMOUNT: (f) OF THE GOVERNMENT CODE "Warnings". . CLAIMANT: JESUS HECTOR SALAZAR CHIQUETE ATTORNEY: ARNOLD CAS ILLAS , Esq . DATE RECEIVED: FEBRUARY 01 , 2007 3500 W. BEVERLY BLVD. FEBRUARY O1 2007 ADDRESS: MONTEBELLO, CA 906 BY DELIVERY TO CLERK ON: BY MAIL POSTMARKED: JANUARY 29 , 2007 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. FEBRUARY 02 , 2007 JOHN CULLEN, Dated: By: Deputy Z�fp� 11. FROM: County Counsel TO: Clerk of the Board of Supervisors 09 ( J,-Triis 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: Dated: By: Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). VOARD 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/%,VM aeAfJ9HN CULLEN, CLERK, ByAff_��__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 widr 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 1 am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:� M&WAOHN CULLEN, CLERK By eputy Clerk -UUfql Y I-LtMK Ur- BOARD OF SUPERVISORS OF CONTRA COSTA40OUNTY 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 shat I 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 Supervisqrs at its office in Room 106, County Administration Building. 651 Pine Street, N.4artinez, 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. 0 M 0 a 4 2 a W a 6 9 a&& a 0 0 N a 0 0 a a 0 a 0.a a a.a 0 0 0-a 0 a V 0 0 as a a W a N as RE: Claim By: Reserved for Clerk's filing stamp Jesus 'Hector salazar�..Chiaup_t-r, Against the County of Contra Costa or District) o RKB 2001 (Fill in the name) C OP'IS" CO& The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum.of S see attch. and in support of this claiiii represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) See Attachment. 2. Where did the damage or injury occur? (Include city Euid county) See Attachment. 3. How did the damage or injury occur? (Give full details; use extra paper if required) See Attachment. 4. V3.11t particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? See Attachment. 5 What are the names Of COUMV Or district officers. servams, or employees causing the damage or injury'7' See Attachment. JJfd I r �_Ltter•, lir I I f 6. W12.t damage or injuries do your claim resulted? (Crive full extent of injuries or damages claimed. Attach two estimates for auto damage.) See Attachment, 7. IIow was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) See Attachment. 8. Names and addresses of witnesses, doctors, and hospitals: See Attachment. 9. List the expenditures you made on account of this accident or injury: DATE TIivIE AMOUNT See Attachment. eeao*Goes■11ssomtosol,aaW000meaGeseGe00Neves been e■.*nae.e*nsen8reg114o■114aamso.ee0ie@1191 Gov.Code Sec. 910.2 provides "The claim shall be - -- - -_-)signed by the claimant or : some person on his ------- belualf." - -- SC-ND NOTICES TO: (Attorrteyl ) /w Name and address of Attorney ) Arnoldo Casillas, Esq. ) (Cl mans gnatture) 3500 W. Beverly Blvd. ) Montebello, CA 906Q2 ) 35 } dre ontebello, CA 90602 ) ) (323 ), 725-0917 ) Telephone IVo. (323 ) 725-0917 Telephone No. rood mass $41010's's a mooned Goosl11*es Good aeeoss**d*esse*lesioeee neo a edomosoQ PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed w.itli the County under the Tort Claims Act, is subject to public disclosure undar the California Public Records Act. (Gov. Code, §5 6500 et seq.) Furthermore, any attachments: addendums, or supplements attached to the claim form, including medical records,are also subject to public disclosure. ■omelegs§11840*goose 0meows aaad11rrpoeeaGbr*boabseaene*10eaa hobo■aa■aeaGeaeegsrseassoof NOTICE: Section 72 of the Pend Code provides. Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer,or to any count), city, or district board or officer, authorized to allow or pray the same if genuine, any false or Fraudulent claim, bill, account voucher, or N riling, is punishable either by imprisonment in the County jail for a period of not Irlore than one year, by a Time of not exceeding one thousand dollars ($1,000.00), or by both such intprisomnent and Fine, or by imprisonment iii the staie prison, by a fine of not exceeding tent thousand dollars ($10,000),or by both such imprisonmentand Fine. I GREGORY W. MORENO, ESQ.,SBN 57844 ARNOLDO CASILLAS, ESQ., SBN 158519 2 MORENO, BECERRA & CASILLAS A Professional Law Corporation 3 3500 West Beverly Boulevard Montebello, CA 90640-1541 4 Telephone: (323) 725-0917 Facsimile: (323) 725-0350 5 6 Attorneys for Claimant JESUS HECTOR SALAZAR CHIQUETE 7 8 Attorneys for Claimant ) CLAIM FOR MONEY DAMAGES 9 JESUS HECTOR SALAZAR CHIQUETE ) [Gov. Code Section 900, Et. Seq.] 10 Claimant, ) 11 V. ) 12 CONTRA COSTA COUNTY, ) 13 Respondent. ) 14 To the Clerk of the Board of Supervisors of County of Contra Costa: THE 15 UNDERSIGNED HEREBY SUBMITS TO THE PRESENTLY IDENTIFIED PUBLIC 16 ENTITY THE FOLLOWING WRITTEN CLAIM FOR MONEY DAMAGES: 17 1. Name of Claimant: JESUS HECTOR SALAZAR CHIQUETE 18 2. Name and mailing address of the person to whom notice of action on this claim is to 19 be sent: 20 JESUS HECTOR SALAZAR CHIQUETE 21 c/o ARNOLDO CASILLAS, Esq. MORENO, BECERRA & CASILLAS 22 3500 West Beverly Boulevard Montebello, California 90640 23 3. Date and location where injury sustained: 24 August 14, 2006 on Vasco Road in Contra Costa County. 25 4. A general description of the injury incurred: 26 On August 14, 2006, Claimant's father Francisco Javier Salazar was a passenger in a 27 vehicle traveling northbound on Vasco Road in the northbound lane. Rosa Osbourne was 28 1 JESUS HECTOR SALAZAR CHIQUETE' S CLAIM FOR MONEY DAMAGES I traveling southbound when the vehicle Claimant's father was traveling in crossed over the double 2 yellow lines into the southbound lane of traffic. The vehicle Decedent was a passenger in 3 collided head on with the vehicle in which Rosa Osbourne was driving. Claimant's father 4 suffered blunt force injuries and died at the scene. 5 5. Total amount claimed for physical injuries, future medical care, lost wages, and 6 earning capacity, and past, present and future physical and psychological pain and 7 suffering: 8 The amount claimed exceeds the limit provided in section 910 (f) of the Government 9 Code. This claim will be an unlimited civil case. 10 6. Name of hospitals/physicians: 11 To be determined. 12 7. How injury or damage occurred/basis for liability: 13 The death of claimant's father was caused by the injuries he sustained as a result of the 14 collision of the two respective vehicles. Basis for liability is Wrongful Death and corresponding 15 damages, including, but not limited to, loss of future financial support, loss of love, comfort, 16 solace, care, consortium. 17 The present responding public entity owned, designed, maintained, and/or controlled the 18 roadway(Vasco Road) that is the subject of the present claim. 19 This claimant contends generally that at the above place and time there was a dangerous 20 and defective condition of public property pursuant to Government Code Section 835 (a) and (b), 21 and other potentially applicable Government Code provisions, in that the subject roadway was 22 improperly and negligently designed, constructed, owned, transferred, maintained, and operated 23 in that it failed to contain a median barrier or other device(s) which would have prevented the 24 subject vehicular crash; was improperly banked, graded, or curved; provided inadequate line of 25 sight; the elevation, speed, and structural standards were improper; the road and shoulders were 26 not an adequate width; the road failed to contain proper delineation, including, but not limited to, 27 vertical delineators, and also failed to contain proper pavement markers, stripping, signage, 28 reflectors and median and shoulder rumble strips or barriers; the speed limit was improperly 2 JESUS HECTOR SALAZAR CHIQUETE' S CLAIM FOR MONEY DAMAGES I selected and implemented; many crashes had occurred at this area of the roadway; traffic volume 2 exceeded the capacity of the road at the time the road was designed and constructed and at the 3 time of the subject crash; the area of the road where the subject crash occurred contained an 4 improperly located and excessively long second lane for high-speed passing-by southbound 5 traffic without protection for northbound traffic. This public entity unreasonably delayed 6 installing delineators and rumble strips until after the subject crash; Vasco Road was added to 7 the Interregional Road System (ERRS) and was eligible for funding from the State of California 8 for road improvernents. In addition, claimant is informed and believes that Vasco Road has been 9 designated a California Safety Corridor, and increased safety should have been promoted. This 10 public entity had both actual and constructive notice of the hazardous and dangerous and 11 defective condition of the roadway for a sufficient time prior to the subject crash to have 12 prudently acted upon and corrected the roadway in the area of the subject crash. This public 13 entity and its employees were generally negligent and caused damages as set forth in this claim. 14 - The present responding public entity unreasonably allowed this hazardous and dangerous 15 and defective condition to exist by failing to take action to implement changes needed to 16 maintain the safety of said roadway. Moreover, prior to the subject crash, the present responding 17 public entity knew, or should have known, of the necessary changes needed to maintain the 18 safety of said roadway, such as the implementation of median rumble strips and/or median 19 barriers. The present responding public entity had sufficient time prior to the subject crash to 20 implement such necessary and needed changes,but failed to act reasonably to implement them. 21 The present responding public entity also failed to properly investigate, survey, record, 22 document, monitor, patrol, enforce and report traffic conditions, traffic speeds and traffic 23 violations on said roadway. 24 The present responding public entity was fully aware, or should have been fully aware, of 25 the dangerous condition of said roadway. Over a period of many years prior to the subject crash, 26 a significant number of vehicular crashes occurred at or very near to the area of roadway where 27 this crash occurred so as to place the present responding public entity on notice that there was a 28 need for median barriers to prevent cross median movement by vehicles. 3 JESUS HECTOR SALAZAR CHIQUETE' S CLAIM FOR MONEY DAMAGES I Furthermore, the present public entity negligently or intentionally failed to provide any 2 reasonable warnings, signage, notices, or announcements regarding the collision hazards posed 3 by the above-described dangerous condition. 4 Claimant has not completed his/her investigation and expressly reserves the right to make 5 additional amendments to this claim and/or pleading as the law permits. 6 8. Other pertinent information: 7 NONE 8 9. Name of the presently known employees, agents, or representatives, whose acts or 9 omission caused claimant's injuries: 10 None known to claimant at this time. 11 10. Known addresses of district officers, employee, or agents causing claimant's 12 injuries: 13 None known to claimants at this time. 14 ALL NOTICES OR OTHER COMMUNICATIONS REGARDING THIS CLAIM 15 SHOULD BE SENT TO CLAIMANT AT: 16 JESUS HECTOR SALAZAR CHIQUETE c/o ARNOLDO CASILLAS, ESQ. 17 MORENO, BECERRA& CASILLAS 3500 West Beverly Boulevard 18 Montebello, CA 90640 PH: (323) 725-0917 19 FX: (323) 725-0350 20 MORENO, BEC. RRA CA 1✓'AS 21 22 ' Dated: January 2 j , 2007 By: 23 AANOLOO CA,9&LM, SQ. GREGORY W. MOREN , ESQ. 24 Attorney for Claimant JESUS HECTOR SALAZAR CHIQUETE 25 26 27 28 4 JESUS HECTOR SALAZAR CHIQUETE' S CLAIM FOR MONEY DAMAGES I PROOF OF SERVICE 2 STATE OF CALIFORNIA ) ss 3 COUNTY OF LOS ANGELES ) 4 I am employed in the County of Los Angeles,State of California.I am over the age of 18 and not a party to the within action; my business address is 3500 West Beverly Boulevard,Montebello, 5 California 90640-1541. 6 On January , 2007, I served, in the manner indicated below, the foregoing document described as CLAIM FOR MONEY DAMAGES on the interested parties in this action 7 by placing the true copies thereof enclosed in sealed envelopes addressed as follows: 8 Clerk of the Board of Supervisors Contra Costa County Administration Building RETURN RECEIPT REQUESTED 9 Room 106 651 Pine Street 10 Martinez, CA 94553 11 X BY CERTIFIED MAIL RETURN RECEIPT REQUESTED: I caused such envelopes to be deposited in the United States mail at Montebello, California, with postage thereon fully 12 prepaid. I am readily familiar with the firm's practice of collection and processing correspondence for mailing. It is deposited with the United States Postal Service each day 13 and that practice was followed in the ordinary course of business for the service herein attested to (C.C.P. § 1013(a)(3)). 14 I declare under penalty of perjury under the laws of the State of California that the foregoing 15 is true and correct. 16 Executed on January 1 2007, at Montebello, California. 17 18 Steven Ibarra 19 20 21 22 23 24 25 26 27 28 5 JESUS HECTOR SALAZAR CHIQUETE' S CLAIM FOR MONEY DAMAGES t } G dQ n, o cc o vu CC is Co YV Vit,=W .�a�Ak�111 �_,i+c +'� •--+ ..-. CD 19, ���� t• �U tt3 cid G v y O U �A Vr.. 1 C� w.� r U � IA .s �* 3 U 3 q c t ,M ' coo O '1 LO C( Q 6 r .40 W y',� gid• rh°�'rr,Ut�� `°` � � �` Cd 0 U CA y s cl �d o U%o CC, (� N O j 1 M CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY b/Z BOARD ACTION: MARCH 06 , 2007. Claim Against the County, or District Governed by ) the Board of Supervisors; Routing Endorsements, ) NOTICE TO CLAIMANT 0�a�nd?B;�oaFd`AciE n. All Section references are to j The copy of this document mailed to Cati 9PEB forniaGovernmenes.t Cod you is your notice ofthe action taken G 2 2007 on your claim by the Board of Supervisors. (Paragraph IV below), COUNTY COUNSEL THE AMOUNT CLAIMED EXCEEDS THE given Pursuant to Government Code MARTINEZ CALIF. LIMIT PROVIDED IN SECTION 910 AMOUNT: Section 913 and 915.4. Please note all (f) OF THE GOVERNMENT CODE "Warnings". CLAIMANT: ESTATE OF FRANCISCO. JAVIER SALAZAR ATTORNEY: ARNOLD CAS ILLAS , Esq• DATE RECEIVED: FEBRUARY 01 , 2007 3500 W. BEVERLY BLVD. ADDRESS: MONTEBELLO, CA 906@: BY DELIVERY TO CLERK ON: FEBRUARY 01 , 2007 SFO BY MAIL POSTMARKED: JANUARY 29, 2007 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. FEBRUARY 02 , 2007 JOHN.CULLEN, C Dated: By: Deputy iI. FROM: County Counsel TO: Clerk of the Board of Sup rvisors ( 4, 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). ( ) Other: Dated: S 6S7 By: _Deputy County Counsel 1.11. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV.BOARD ORDER: By unanimous vote of the Supervisors present: (� This Claim is rejected in full. ( ) Other: I certify that this is a true and coirect copy of the Board's Order entered in its minutes for this date. Dated/;I�,76/ ;X00hO1­1N CULLEN, CLERK, By r .. Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6) months firoin 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 attomey of your choice in connection widr 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 1. am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in N.1.artinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Datedh/ yd`J 10;;-p -&e,7 JOHN CULLEN, CLERK By Deputy Clerk t_LtMJ,, ur- 1 r7 BOARD OF SUPERVISORS OF CONTRA COSTAOOUNTY 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 mint be riled with the Clerk of the Board of Supervis,qrs at its office in Room 106, County Administration Building: 651 Pine Street, Martinez, CA 04553, 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. 0606604 a not a Now RE: Claim By: Reserved for Clerk's filing stamp Estate of Francisco Javier ,;aia7ar_ Rec - ell/ D Against the County of Contra Costa or _J FEB 0 . . 1 Z007 District) ARr)C CLERK BO0 SUPERVISORS (Fill in the name) S co. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of S Pee attch, and in support of this claim represents as-follows: 1. When did the darnage or injury occur? (Give exact date and hour) See Attachment. 2. Where did the damage or injury occur? (Include city and county) See Attachment, 3. How did the damage or injury occur? (Give full details; use extra paper if required) See Attachment, 4. Wl)at particular act or omission on the part of county or district officers, servants, or employees caused the injury or darnaae? See Attachment, 5 What are the names of county or district officers, servants, or ernployees causing the darnagc or injury" See Attachment. '-UN I I H (-UU[I I y, !-Ltt"'K Ut- I mt � :Vj. -- -------- r 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) See Attachment. 7. How was the ramount claimed above computed? (Include the estimated amowit of any prospective injury or damage.) See Attachment. 8. Names and addresses of witnesses, doctors, and hospitals: .S6e Attachment. 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT See Attachment. 0-Dome&$$ Gov.Code Sec. 910.2 provides"The claim shall be ')-gigned-by-the-clainiant-pr-b-, - e p�qsqn_on his behalf." SC-ND NOTICES TO:- (AttorneyJ ) Name and address of Attorney Arnoldo Casillas, Esq Cf 'mnt"sSWawre) 3500 W. Beverly Blvd. * Montebello, CA 90602 3500 w lap;;FQ:p4 tAddre"AF----W6-nt.ebello, CA 90602 Telephone No. (323 ). 725-091 7 Telephone No. (323 ) 725-0917 a 09 a a 0 a a a 0 5 a a 01*08409 swap.4.9096984 a goo 08604 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, §5 6500 et seq.) Furthermore, any attachments, addendurns,or supplements attached to the claim form, including medical records,are also subject to public disclosure. NOTICE: Section 72 of rhe Penal Code prol-lides. 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, mithorized to allow or pav the same if genuine, any false or Fraudulent claim, bill, account voucher, or writiq, is punishable either by imprisonment iii the County jail for a period of not more than one year, by a fine of iiot.exceeding one thousand dollars (51,000.00), or by both such imprisonment and fine, or by imprisonment in the staie prison, by a fine of not, e.<ceediniz ten thousand dollars ($10,000),or by both such imprisonment and fine. 1 GREGORY W. MORENO, ESQ.,SBN 57844 ARNOLDO CASILLAS, ESQ., SBN 158519 2 MORENO, BECERRA & CASILLAS A Professional Law Corporation 3 3500 West Beverly Boulevard Montebello, CA 90640-1541 4 Telephone: (323) 725-0917 Facsimile: (323) 725-0350 5 6 Attorneys for Claimant ESTATE OF FRANCISCO JAVIER SALAZAR 7 8 Attorneys for Claimant ) CLAIM FOR MONEY DAMAGES 9 ESTATE OF FRANCISCO JAVIER SALAZAR) [Gov. Code Section 900, Et. Seq.] 10 Claimant, ) 11 V. ) 12 CONTRA COSTA COUNTY, ) 13 Respondent. ) 14 To the Clerk of the Board of Supervisors of County of Contra Costa: THE 15 UNDERSIGNED HEREBY SUBMITS TO THE PRESENTLY IDENTIFIED PUBLIC 16 ENTITY THE FOLLOWING WRITTEN CLAIM FOR MONEY DAMAGES: 17 1. Name of Claimant: ESTATE OF FRANCISCO JAVIER SALAZAR 18 2. Name and mailing address of the person to whom notice of action on this claim is to 19 be sent: 20 ESTATE OF FRANCISCO JAVIER SALAZAR 21 c/o GREGORY W. MORENO MORENO, BECERRA& CASILLAS 22 3500 West Beverly Boulevard Montebello, California 90640 23 3. Date and location where injury sustained: 24 August 14, 2006 on Vasco Road in Contra Costa County. 25 4. A general description of the injury incurred: 26 On August 14, 2006, Claimant Francisco Javier Salazar was a passenger in a vehicle 27 traveling northbound on Vasco Road in the northbound lane. Rosa Osbourne was traveling 28 1 ESTATE OF FRANCISCO JAVIER SALAZAR' S CLAIM FOR MONEY DAMAGES 1 southbound when the vehicle Claimant Francisco Javier Salazar was traveling in crossed over the 2 double yellow lines into the southbound lane of traffic. The vehicle Decedent was a passenger in 3 collided head on with the vehicle in which Rosa Osbourne was driving. Claimant suffered blunt 4 force injuries and died at the scene. 5 5. Total amount claimed for physical injuries, future medical care, lost wages, and 6 earning capacity, and past, present and future physical and psychological pain and 7 suffering: 8 The amount claimed exceeds the limit provided in section 910 (f) of the Government 9 Code. This claim will be an unlimited civil case. 10 6. Name of hospitals/physicians: 11 To be determined. 12 7. How injury or damage occurred/basis for liability: 13 The death of claimant was caused by the injuries he sustained as a result of the collision 14 of the two respective vehicles. 15 The present responding public entity owned, designed, maintained, and/or controlled the 16 roadway(Vasco Road) that is the subject of the present claim. 17 This claimant contends generally that at the above place and time there was a dangerous 18 and defective condition of public property pursuant to Government Code Section 835 (a) and (b), 1.9 and other potentially applicable Government Code provisions, in that the subject roadway was 20 improperly and negligently designed, constructed, owned, transferred, maintained, and operated 21 in that it failed to contain a median barrier or other device(s) which would have prevented the 22 subject vehicular crash; was improperly banked, graded, or curved; provided inadequate line of 23 sight; the elevation, speed, and structural standards were improper; the road and shoulders were 24 not an adequate width; the road failed to contain proper delineation, including, but not limited to, 25 vertical delineators, and also failed to contain proper pavement markers, stripping, signage, 26 reflectors and median and shoulder rumble strips or barriers; the speed limit was improperly 27 selected and implemented; many crashes had occurred at this area of the roadway; traffic volume 28 exceeded the capacity of the road at the time the road was designed and constructed and at the 2 ESTATE OF FRANCISCO JAVIER SALAZAR' S CLAIM FOR MONEY DAMAGES 1 tune of the subject crash; the area of the road where the subject crash occurred contained an 2 improperly located and excessively long second lane for high-speed passing-by southbound 3 traffic without protection for northbound traffic. This public entity unreasonably delayed 4 installing delineators and rumble strips until after the subject crash; Vasco Road was added to 5 the Interregional Road System (IRRS) and was eligible for funding from the State of California 6 for road improvements. In addition, claimant is informed and believes that Vasco Road has been 7 designated a California Safety Corridor, and increased safety should have been promoted. This 8 public entity had both actual and constructive notice of the hazardous and dangerous and 9 defective condition of the roadway for a sufficient time prior to the subject crash to have 10 prudently acted upon and corrected the roadway in the area of the subject crash. This public 11 entity and its employees were generally negligent and caused damages as set forth in this claim. 12 The present responding public entity unreasonably allowed this hazardous and dangerous 13 and defective condition to exist by failing to take action to implement changes needed to 14 maintain the safety of said roadway. Moreover, prior to the subject crash, the present responding 15 public entity knew, or should have known, of the necessary changes needed to maintain the 16 safety of said roadway, such as the implementation of median nimble strips and/or median 17 barriers. The present responding public entity had sufficient time prior to the subject crash to 18 implement such necessary and needed changes,but failed to act reasonably to implement them. 19 The present responding public entity also failed to properly investigate, survey, record, 20 document, monitor, patrol, enforce and report traffic conditions, traffic speeds and traffic 21 violations on said roadway. 22 The present responding public entity was fully aware, or should have been fully aware, of 23 the dangerous condition of said roadway. Over a period of many years prior to the subject crash, 24 a significant number of vehicular crashes occurred at or very near to the area of roadway where 25 this crash occurred so as to place the present responding public entity on notice that there was a 26 need for median barriers to prevent cross median movement by vehicles. 27 Furthermore, the present public entity negligently or intentionally failed to provide any 28 reasonable warnings, signage, notices, or announcements regarding the collision hazards posed 3 ESTATE OF FRANCISCO JAVIER SALAZAR'S CLAIM FOR MONEY DAMAGES I by the above-described dangerous condition. 2 Claimant has not completed his/her investigation and expressly reserves the right to make 3 additional amendments to this claim and/or pleading as the law permits. 4 8. Other pertinent information: 5 NONE 6 9. Name of the presently known employees, agents, or representatives, whose acts or 7 omission caused claimant's injuries: 8 None known to claimant at this time. 9 10. Known addresses of district officers, employee, or agents causing claimant's 10 injuries: 11 None known to claimants at this time. 12 ALL NOTICES OR OTHER COMMUNICATIONS REGARDING THIS CLAIM 13 SHOULD BE SENT TO CLAIMANT AT: 14 ESTATE OF FRANCISCO JAVIER SALAZAR c/o ARNOLDO CASILLAS, ESQ. 15 MORENO, BECERRA, GUERRERO & CASILLAS 3500 West Beverly Boulevard 16 Montebello, CA 90640 PH: (323) 725-0917 17 FX: (323) 725-0350 18 MORENO, BECERRA & S LAS 19 20 Dated: January .2e? , 2007 By: 21XRNTOLDO SIL ASttgQ. GREGORY W. MORENO, ESQ. 22 Attorney for Claimant -73ESTATE OF FRAN CISCO JAVIER SALAZAR 4 24 25 2 6 4 2 7 4 28 4 ESTATE OF FRANCISCO JAVIER SALAZAR' S CLAIM FOR MONEY DAMAGES 1 PROOF OF SERVICE 2 STATE OF CALIFORNIA ) ss 3 COUNTY OF LOS ANGELES ) 4 I am employed in the County of Los Angeles,State of California. I am over the age of 18 and not a party to the within action; my business address is 3500 West Beverly Boulevard,Montebello, 5 California 90640-1541. 6 On January , 2007, 1 served, in the manner indicated below, the foregoing document described as CLAIM FOR MONEY DAMAGES on the interested parties in this action 7 by placing the true copies thereof enclosed in sealed envelopes addressed as follows: 8 Clerk of the Board of Supervisors Contra Costa County Administration Building RETURN RECEIPT REQUESTED 9 Room 106 651 Pine Street 10 Martinez, CA 94553 11 X BY CERTIFIED MAIL RETURN RECEIPT REQUESTED: I caused such envelopes to be deposited in the United States mail at Montebello, California, with postage thereon fully 12 prepaid. I am readily familiar with the firm's practice of collection and processing correspondence for mailing. It is deposited with the United States Postal Service each day 13 and that practice was followed in the ordinary course of business for the service herein attested to (C.C.P. § 1013(a)(3)). 14 I declare under penalty of perjury under the laws of the State of California that the foregoing 15 is true and correct. 16 Executed on January Lq , 2007, at Montebello, California. 17 18 i r Steven a 19 20 �14 2 h 4 23 24 25 26 27 28 5 ESTATE OF FRANCISCO JAVIER SALAZAR' S CLAIM FOR MONEY DAMAGES lu r t�.�ix% vi it �O s. (n O } �:. ;.. ": t 67 0 �U cr �+y�4 t� Q U 0 F7A a Ir ' Ir mommsmom— ma �y 4 ® . � - Q EJ +ramal LO >� ru N. tr Q J r a CL '7 rr d `710 d i iw* co U. ED Ul IV OAO U � 0 U 0 U r Ln 1� (� C3 :r Ln ZI N ~� C3 <t a d c oa3x � N ami z cc ' o CLAIIC , BOARD OF SUPERVi.SORS OF CONTRA COSTA COUNTY BOARD ACTION: MARCH 06 , 20.07 Claim Against the County, or District Governed by ) the Boai•d of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and •-oard{Action. All Section references are to 1;, X0 1,. l n,1 ) The copy of this document mailed to al�foi<n�a,God ernment Codes. ) you is your notice of the action taken �( FEB U 2 2007 on your claim by the Board of Supervisors. (Paragraph IV below), COUNTY COUNSEL THE AMOUNT CLAIMED EXCEEDS THE given Pursuant to Government Code ldP.RTIRz CALIF. LIMIT PROVIDED IN SECTION 910 Section 913 and 915.4. Please note all AMOUNT: (f) OF THE GOVERNMENT CODE "Warnings". CLAIMANT: HASLY ALEJANDRA SALAZAR CHIQUETE ATTORNEY: ARNOLD CAS ILLAS , Esq - DATE RECEIVED: FEBRUARY 01 , 2007 3500 W. BEVERLY BLVD. ADDRESS: MONTEBELLO, CA 906©2 BY DELIVERY TO CLERK ON: FEBRUARY 01 , 2007 1 BY MAIL POSTMARKED: JANUARY 29 , 2007 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. FEBRUARY 02 , 2007 JOHN CULLENlk4t�� Dated: By: Deputy II. FROM.: County Counsel TO: Clerk of the Board of Supervisors his claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: a" S —O� By: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. ( ) Other: I certify that this is a true and con-ect copy of the Board's Order entered in its minutes for this date. Dated:/t'7'i�r m o2d0 HN CUL.LEN, CLERK, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection wide this matter. If you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side ofThis 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 claima�i.f as shown above. Dated:/ya ''��� °'?'�� JOHN CULLEN, CLERK ByDeputy Clerk H t-IJUNI T Ur- I BOARD OF SUPERVISORS OF CONTRA COSAOUNTY INSTRUCTIONS TO CLADJANT 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 Supervisqrs at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 4553. C. If claim is against a district governed by the Board of Supervisors, rather than die 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. $go a meows 08901990sesm W.00.0 a..**.00*660**Nosed 00 at RE: Claim By: Reserved for Clerk's filing stamp Hasly Alejandra Salazar Chiquete RECEIVED Against the County of Contra Costa or FEB 0 1 2007 District) CLERK BOARD OF SUPERVISORS (Fill in the naive) CONTRACOSTACO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum,of.S pee aitch. and in support of this claim represents as-follows: 1. When did the damage or iniury occur? (Give exact date and hour) See Attachment. 2. Where did the damage or injury occur? (Include city mid county) See Attachment. I How did the damage or injury occur? (Give full details-, use extra paper if required) See Attachment. 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? See Attachment. 5 What are the names Of COLMIN! or district officers, servants, or employees causing the damage or injury? See Attachment. !_UN I h'.H (_UUf'j I y ut­ iJ�DU NU. 6. V&?,t damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) See Attachment. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) .-See Attachment. 8. Names and addresses of witnesses,doctors, and hospitals. See Attachment. 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT See Attachment. ) Gov.Code See. 910.2 provides "The claim shall be )signed by the claimt o behalf." in y" me pqLsqn_on his SEND NOTICES TO: (Attornexi--) Name and address of Attorney 7 Y LA Arnoldo Casillas, Esq v(daima,It i 1pignat-ure) 3500 W. Beverly Blvd. ' Montebello, CA 90602 3500 w Montebel die10, CA 90602 Telephone No. Telephone(323) 725.-0917 NO. (323 ) 725-0917 to a as awas e e e e e 0 e e e e e e mean*peones.s ON ovasysesswas VON s.e.90*9948 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, 55 6500 et seq.) Furthermore, any astachirients, addandurns,or supplements attached to the claim form, including medical records,are also stibject to public disclosure. a 8 a avows me saw$Nebo evolossev*8 soon per own 0 owes# NOTICE: Suction 72 of the Penal Code proiides. Every PCTSOn 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 rnore than one year, by i fine of not exceeding one thousand dollars (IS1,000.00), or by both stich imprisonment Find fine, or by irnprisonireilt in the state prison, by a fine of nor exceeding ten thousand dollars ($1 U,000), or by both such imprisonment and fine. 1 GREGORY W. MORENO, ESQ.,SBN 57844 ARNOLDO CASILLAS, ESQ., SBN 158519 2 MORENO, BECERRA & CASILLAS A Professional Law Corporation 3 3500 West Beverly Boulevard Montebello, CA 90640-1541 4 Telephone: (323) 725-0917 Facsimile: (323) 725-0350 5 6 Attorneys for Claimant HASLY ALEJANDRA SALAZAR CHIQUETE 7 8 Attorneys for Claimant ) CLAIM FOR MONEY DAMAGES 9 HASLY ALEJANDRA SALAZAR CHIQUETE ) [Gov. Code Section 900, Et. Seq.] 10 Claimant, ) 11 V. ) 12 CONTRA COSTA COUNTY, ) 13 Respondent. ) 14 To the Clerk of the Board of Supervisors of County of Contra Costa: THE 15 UNDERSIGNED HEREBY SUBMITS TO THE PRESENTLY IDENTIFIED PUBLIC 16 ENTITY THE FOLLOWING WRITTEN CLAIM FOR MONEY DAMAGES: 17 1. Name of Claimant: HASLY ALEJANDRA SALAZAR CHIQUETE 18 2. Name and mailing address of the person to whom notice of action on this claim is to 19 be sent: 20 HASLY ALEJANDRA SALAZAR CHIQUETE 21 c/o ARNOLDO CASILLAS, Esq. MORENO, BECERRA & CASILLAS 22 3500 West Beverly Boulevard Montebello, California 90640 23 3. Date and location where injury sustained: 24 August 14, 2006 on Vasco Road in Contra Costa County. 25 4. A general description of the injury incurred: 26 On August 14, 2006, Claimant's father Francisco Javier Salazar was a passenger in a 27 vehicle traveling northbound on Vasco Road in the northbound lane. Rosa Osboume was 28 HASLY ALEJANDRA SALAZAR CHIQUETE' S CLAIM FOR MONEY DAMAGES I traveling southbound when the vehicle Claimant's father was traveling in crossed over the double 2 yellow lines into the southbound lane of traffic. The vehicle Decedent was a passenger in 3 collided head on with the vehicle in which Rosa Osboume was driving. Claimant's father 4 suffered blunt force injuries and died at the scene. 5 5. Total amount claimed for physical injuries, future medical care, lost wages, and 6 earning capacity, and past, present and future physical and psychological pain and 7 suffering: 8 The amount claimed exceeds the limit provided in section 910 (f) of the Government 9 Code. This claim will be an unlimited civil case. 10 6. Name of hospitals/physicians: 11 To be determined. 12 7. How injury or damage occurred/basis for liability: 13 The death of claimant's father was caused by the injuries he sustained as a result of the 14 collision of the two respective vehicles. Basis for liability is Wrongful Death and corresponding 15 damages, including, but not limited to, loss of future financial support, loss of love, comfort, 16 solace, care, consortium. 17 The present responding public entity owned, designed, maintained, and/or controlled the 18 roadway(Vasco Road) that is the subject of the present claim. 19 This claimant contends generally that at the above place and time there was a dangerous 20 and defective condition of public property pursuant to Government Code Section 835 (a) and (b), 21 and other potentially applicable Government Code provisions, in that the subject roadway was 22 improperly and negligently designed, constructed, owned, transferred, maintained, and operated 23 in that it failed to contain a median barrier or other device(s) which would have prevented the 24 subject vehicular crash; was improperly banked, graded, or curved; provided inadequate line of 25 sight; the elevation, speed, and structural standards were improper; the road and shoulders were 26 not an adequate width; the road failed to contain proper delineation, including, but not limited to, 27 vertical delineators, and also failed to contain proper pavement markers, stripping, signage, 28 reflectors and median and shoulder rumble strips or barriers; the speed limit was improperly 2 HASLY ALEJANDRA SALAZAR CHIQUETE' S CLAIM FOR MONEY DAMAGES I selected and implemented; many crashes had occurred at this area of the roadway; traffic volume 2 exceeded the capacity of the road at the time the road was designed and constructed and at the 3 time of the subject crash; the area of the road where the subject crash occurred contained an 4 improperly located and excessively long second lane for high-speed passing-by southbound 5 traffic without protection for northbound traffic. This public entity unreasonably delayed 6 installing delineators and nimble strips until after the subject crash; Vasco Road was added to 7 the Interregional Road System (1RRS) and was eligible for funding from the State of California 8 for road improvements. In addition, claimant is informed and believes that Vasco Road has been 9 designated a California Safety Corridor, and increased safety should have been promoted. This 10 public entity had both actual and constructive notice of the hazardous and dangerous and 11 defective condition of the roadway for a sufficient time prior to the subject crash to have 12 prudently acted upon and corrected the roadway in the area of the subject crash. This public 13 entity and its employees were generally negligent and caused damages as set forth in this claim. 14 The present responding public entity unreasonably allowed this hazardous and dangerous 15 and defective condition to exist by failing to take action to implement changes needed to 16 maintain the safety of said roadway. Moreover, prior to the subject crash, the present responding 17 public entity knew, or should have known, of the necessary changes needed to maintain the 18 safety of said roadway, such as the implementation of median rumble strips and/or median 19 barriers. The present responding public entity had sufficient time prior to the subject crash to 20 implement such necessary and needed changes, but failed to act reasonably to implement them. 21 The present responding public entity also failed to properly investigate, survey, record, 22 document, monitor, patrol, enforce and report traffic conditions, traffic speeds and traffic 23 violations on said roadway. 24 The present responding public entity was fully aware, or should have been fully aware, of 25 the dangerous condition of said roadway. Over a period of many years prior to the subject crash, 26 a significant number of vehicular crashes occurred at or very near to the area of roadway where 27 this crash occurred so as to place the present responding public entity on notice that there was a 28 need for median barriers to prevent cross median movement by vehicles. 3 HASLY ALEJANDRA SALAZAR CHIQUETE' S CLAIM FOR MONEY DAMAGES 1 Furthermore, the present public entity negligently or intentionally failed to provide any 2 reasonable warnings, signage, notices, or announcements regarding the collision hazards posed 3 by the above-described dangerous condition. 4 Claimant has not completed his/her investigation and expressly reserves the right to make 5 additional amendments to this claim and/or pleading as the law permits. 6 8. Other pertinent information: 7 NONE 8 9. Name of the presently known employees, agents, or representatives, whose acts or 9 omission caused claimant's injuries: 10 None known to claimant at this time. 11 10. Known addresses of district officers, employee, or agents causing claimant's 12 injuries: 13 None known to claimants at this time. 14 ALL NOTICES OR OTHER COMMUNICATIONS REGARDING THIS CLAIM 15 SHOULD BE SENT TO CLAIMANT AT: 16 HASLY ALEJANDRA SALAZAR CHIQUETE c/o ARNOLDO CASILLAS, ESQ. 17 MORENO, BECERRA, GUERRERO & CASILLAS 3500 West Beverly Boulevard 18 Montebello, CA 90640 PH: (323) 725-0917 19 FX: (323) 725-0350 20 MORENO, BE RRA , SIL A 21 22 Dated: January ?q , 2007 By: 23 OLDO C/ASILLAS,IESQ. GREGORY W. MORENO, ESQ. 24 Attorney for Claimant HASLY ALEJANDRA SALAZAR CHIQUETE 25 26 27 28 4 HASLY ALEJANDRA SALAZAR CHIQUETE' S CLAIM FOR MONEY DAMAGES 1 PROOF OF SERVICE 2 STATE OF CALIFORNIA ) ss 3 COUNTY OF LOS ANGELES ) 4 I am employed in the County of Los Angeles,State of California.I am over the age of 18 and not a party to the within action; my business address is 3500 West Beverly Boulevard,Montebello, 5 California 90640-1541. 6 On January , 2007, I served, in the manner indicated below, the foregoing document described as CLAIM FOR MONEY DAMAGES on the interested parties in this action 7 by placing the true copies thereof enclosed in sealed envelopes addressed as follows: 8 Clerk of the Board of Supervisors Contra Costa County Administration Building RETURN RECEIPT REQUESTED 9 Room 106 651 Pine Street 10 Martinez, CA 94553 11 X BY CERTIFIED MAIL RETURN RECEIPT REQUESTED: I caused such envelopes to be deposited in the United States mail at Montebello, California, with postage thereon fully 12 prepaid. I am readily familiar with the firm's practice of collection and processing correspondence for mailing. It is deposited with the United States Postal Service each day 13 and that practice was followed in the ordinary course of business for the service herein attested to (C.C.P. S 1013(a)(3)). 14 I declare under penalty of perjury under the laws of the State of California that the foregoing 15 is true and correct. 16 Executed on January 1 , 2007, at Montebello, California. 17 18 Steven lbarra 19 20 21 22 23 24 25 26 27 28 5 HASLY ALEJANDRA SALAZAR CHIQUETE' S CLAIM FOR MONEY DAMAGES 7^ - (� q . , a y O .e 165 o Ln . do ci- 0 U ° G V <n: m ET Ir-- §: m Ln 4 L ru C3 ^1 J i� J J Li: Yn � O O LO 0 Jv O r C4 0 M o c s�yOVIAQ, +" Al ��y o C3 �a 0 v �o m s Ca s f 0 a9y " G G W �G i� CLA.f ..1 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: MARCH 06 , 20.07 Claim Against the County, or District Governed by ) the B ai•d-,dT pervisors, Routing Endorsements, ) NOTICE TO CLAIMANT annd�Br�y �' o TAldtionkV, . All Section references are to ) The copy of this document mailed to `�Clifo�rnia Go�ve�nment Codes. ) you is your notice of the action taken �4, on your claim by the Board of 0�� �O 1ASS, Supervisors. (Pai agt aph IV below), G Mgr_ THE AMOUNT CLAIMED EXCEEDS THE given Pursuant to Government Code SAA AMOUNT: LIMIT PROVIDED . IN SECTION 910 Section 913 and 915.4. Please note all (f) OF THE GOVERNMENT CODE "Warnings". CLAIMANT: FRANCISCO JAVIER SALAZAR CHIQUETE ATTORNEY: ARNOLD CAS ILLAS , Esq - DATE RECEIVED: FEBRUARY 01 , 2007 3500 W. BEVERLY BLVD. FEBRUARY Ol 2007 ADDRESS: MONTEBELLO, CA 906 BY DELIVERY TO CLERK ON: yo BY MAIL POSTMARKED: JANUARY 29 , 2007 FROM: Clerk of the Board of Supervisors TO:. County Counsel Attached is a copy of the above-noted claim. FEBRUARY 02 , 2007 JOHN CULLEN, Dated: By: Deputy II. FROM.: County Counsel TO: Clerk of the Board of S ervisors ( ' his claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2; and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 91. 1.3). O Other: Dated: " D- By: rn C eP6V11__Deputy County Counsel i.II. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. PARD ORDER: By unanimous vote of the Supervisors present: (vrThis 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:/�-�YM '00,.-&$-OkHN CUL.LEN, CLERK, By 14 Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6) ninths from the date this notice was personally served or deposited in the nliail to file a court action on this clahn.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection wide this matter. Ifyou want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side ofTliis Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that i am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. �/ Dated: ,YVA d7. QZ&10?'JOHN CULLEN, CLERK By Deputy Clerk H t-Uurj IT '-LtzKK ur- I rit DLJ BOARD OF SUPERVISORS OF CONTRA COSTA06UNTY INSTRUCTIONS TO CLAJMANT 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 or action. (Gov. Code § 911.2.) B. Claims must be filed with the Clerk of the Board of Supervis.qrs at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 04'553. 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. F 0 0 8 a 0 9 a 0 4 a 0 a A 0 9 a a 0"a a N 0 0 a a 0 9 a a a a a a a so a ON out a a 0 0 a W-a a a a 0 a 0 0 a 0 0 W 8 a.0 a 0 so a a a 3 x at RE-: Claim By: Reserved for Clerk's filing stamp Francisco JaMi-er ehiqtI-L. RECEIVED Against the County of Contra Costa or FEB .0 12007 CLERK BO, VISORS F7,' � ''PER (Fill in the name) CON.� The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of S Poe attch, and in support of this claim.represents as follows: I. When did the da-mage or injury occur? (Give exact date and hour) See Attachment. 2. Where did the damage or injury occur? (Include city and county) See Attachment. 3. How did the damage or injury occur? (Give full details; use extra paper if required) See Attachment. 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? See Attachment, 5 What are the names of county or district officers, servants, or employees causing the damage or iajury^ See Attachment. t-UN I (-1JU141 r !-Lth'pt. ut- r-4U. C. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attack two estimates for auto damage.) See Attachment 7. How, was the amount claimed above computed? (Include the estimated amount of any prospective initiry or damage.) See Attachment. 8. Names and addresses of witnesses, doctors, and hospitals: Site Attachment. 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT See Attachment. News 4141414111 a so I IV 0 No 0 a-04 OR a 104111 sees 41.10 No a awe 0 am.0 6 a of ass New 4 No ONO a a a a NJ Gov.Code See. 910.2 provides "The claim shall be ')-signed-by-the claimant orb. — me-person on his., SEND NOTICES TO. (Attorney) l behalf-" Name and address of Attorney Arnoldo Casillas, Esq. -r--rC-Ign—iant'4!%nature) 3500 W. Beverly Blvd. Montebello, CA 90602 3500 ZAadre0sA)rCE----M-0ntebello, CA 90602 Telephone No. (3231 725-0917 Telephone No. (323 ) 725-0917 0 a 16 a as 9 a a Vegas as so 0 a a as 0 somas a waves I staywasys a"a 0.a 0 0 a 0 go a a 0 goo go 5 09 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 undar the California Public Records Act, (Gov. Code, 55 6500 et seq.) Furtliet-more, any attachments; addandums, or supplements attached to the claim forth, including medical records,are also subject to public disclosure. 119111949111111211111 we 010,41 0 eggs pas 0400 64169 a NOTICE: Section 72 of the Penal Code provides. Every person W11D, With intent to defraud, presents for allowance or for payment to any state board or officer,or to any count), city, or district board or officer, authorized to allow or pay the sarn.- if genuine, any false or .Frauclulent claim, bill, account voucher, or xvi-ItIng, 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 ill the stale prison. by a.fine of not exceeding tan thousand dollars ($1 U,000),or by boil)such imprisonment and Fine. I GREGORY W. MORENO, ESQ.,SBN 57844 ARNOLDO CASILLAS, ESQ., SBN 158519 2 MORENO, BECERRA & CASILLAS A Professional Law Corporation 3 3500 West Beverly Boulevard Montebello, CA 90640-1541 4 Telephone: (323) 725-0917 Facsimile: (323) 725-0350 5 6 Attorneys for Claimant FRANCISCO JAVIER SALAZAR CHIQUETE 7 8 Attorneys for Claimant ) CLAIM FOR MONEY DAMAGES 9 FRANCISCO JAVIER SALAZAR CHIQUETE ) [Gov. Code Section 900, Et. Seq.] 10 Claimant, ) 11 V. ) 12 CONTRA COSTA COUNTY, ) 13 Respondent. ) 14 To the Clerk of the Board of Supervisors of County of Contra Costa: THE 15 UNDERSIGNED HEREBY SUBMITS TO THE PRESENTLY IDENTIFIED PUBLIC 16 ENTITY THE FOLLOWING WRITTEN CLAIM FOR MONEY DAMAGES: 17 1. Name of Claimant: FRANCISCO JAVIER SALAZAR CHIQUETE 18 2. Name and mailing address of the person to whom notice of action on this claim is to 19 be sent: 20 FRANCISCO JAVIER SALAZAR CHIQUETE 21 c/o ARNOLDO CASILLAS, Esq. MORENO, BECERRA & CASILLAS 22 3500 West Beverly Boulevard ]Montebello, California 90640 23 3. Date and location where injury sustained: 24 August 14, 2006 on Vasco Road in Contra Costa County. 25 4. A general description of the injury incurred: 26 On August 14, 2006, Claimant's father Francisco Javier Salazar was a passenger in a 27 vehicle traveling northbound on Vasco Road in the northbound lane. Rosa Osboume was 28 1 FRANCISCO JAVIER SALAZAR CHIQUETE' S CLAIM FOR MONEY DAMAGES I traveling southbound when the vehicle Claimant's father was traveling in crossed over the double 2 yellow lines into the southbound lane of traffic. The vehicle Decedent was a passenger in 3 collided head on with the vehicle in which Rosa Osbourne was driving. Claimant's father 4 suffered blunt force injuries and died at the scene. 5 5. Total amount claimed for physical injuries, future medical care, lost wages, and 6 earning capacity, and past, present and future physical and psychological pain and 7 suffering: 8 The amount claimed exceeds the limit provided in section 910 (0 of the Government 9 Code. This claim will be an unlimited civil case. 10 6. Name of hospitals/physicians: 11 To be determined. 12 7. How injury or damage occurred/basis for liability: 13 The death of claimant's father was caused by the injuries he sustained as a result of the 14 collision of the two respective vehicles. Basis for liability is Wrongful Death and corresponding 15 damages, including, but not limited to, loss of future financial support, loss of love, comfort, 16 solace, care, consortium. 17 The present responding public entity owned, designed, maintained, and/or controlled the 18 roadway(Vasco Road) that is the subject of the present claim. 19 This claimant contends generally that at the above place and time there was a dangerous 20 and defective condition of public property pursuant to Government Code Section 835 (a) and (b), 21 and other potentially applicable Government Code provisions, in that the subject roadway was 22 improperly and negligently designed, constructed, owned, transferred, maintained, and operated 23 in that it failed to contain a median barrier or other device(s) which would have prevented the 24 subject vehicular crash; was improperly banked, graded, or curved; provided inadequate line of 25 sight; the elevation, speed, and structural standards were improper; the road and shoulders were 26 not an adequate width; the road failed to contain proper delineation, including, but not limited to, 27 vertical delineators, and also failed to contain proper pavement markers, stripping, signage, 28 reflectors and median and shoulder rumble strips or barriers; the speed limit was improperly 2 FRANCISCO JAVIER SALAZAR CHIQUETE' S CLAIM FOR MONEY DAMAGES I selected and implemented; many crashes had occurred at this area of the roadway; traffic volume 2 exceeded the capacity of the road at the time the road was designed and constructed and at the 3 time of the subject crash; the area of the road where the subject crash occurred contained an 4 improperly located and excessively long second lane for high-speed passing-by southbound 5 traffic without protection for northbound traffic. This public entity unreasonably delayed 6 installing delineators and rumble strips until after the subject crash; Vasco Road was added to 7 the Interregional Road System (IRKS) and was eligible for funding from the State of California 8 for road improvements. In addition, claimant is informed and believes that Vasco Road has been 9 designated a California Safety Corridor, and increased safety should have been promoted. This 10 public entity had both actual and constructive notice of the hazardous and dangerous and 11 defective condition of the roadway for a sufficient time prior to the subject crash to have 12 prudently acted upon and corrected the roadway in the area of the subject crash. This public 13 entity and its employees were generally negligent and caused damages as set forth in this claim. 14 The present responding public entity unreasonably allowed this hazardous and dangerous 15 and defective condition to exist by failing to take action to implement changes needed to 16 maintain the safety of said roadway. Moreover, prior to the subject crash, the present responding 17 public entity knew, or should have known, of the necessary changes needed to maintain the 18 safety of said roadway, such as the implementation of median rumble strips and/or median 19 barriers. The present responding public entity had sufficient time prior to the subject crash to 20 implement such necessary and needed changes, but failed to act reasonably to implement them. 21 The present responding public entity also failed to properly investigate, survey, record, 22 document, monitor, patrol, enforce and report traffic conditions, traffic speeds and traffic 23 violations on said roadway. 24 The present responding public entity was fully aware, or should have been fully aware, of 25 the dangerous condition of said roadway. Over a period of many years prior to the subject crash, 26 a significant number of vehicular crashes occurred at or very near to the area of roadway where 27 this crash occurred so as to place the present responding public entity on notice that there was a 28 need for median barriers to prevent cross median movement by vehicles. 3 FRANCISCO JAVIER SALAZAR CHIQUETE' S CLAIM FOR MONEY DAMAGES I Furthermore, the present public entity negligently or intentionally failed to provide any 2 reasonable warnings, signage, notices, or announcements regarding the collision hazards posed 3 by the above-described dangerous condition. 4 Claimant has not completed his/her investigation and expressly reserves the right to make 5 additional amendments to this claim and/or pleading as the law permits. 6 8. Other pertinent information: 7 NONE 8 9. Name of the presently known employees, agents, or representatives, whose acts or 9 omission caused claimant's injuries: 10 None known to claimant at this time. 11 10. Known addresses. of district officers, employee, or agents causing claimant's 12 injuries: 13 None known to claimants at this time. 14 ALL NOTICES OR OTHER COMMUNICATIONS REGARDING THIS CLAIM 15 SHOULD BE SENT TO CLAIMANT AT: 16 FRANCISCO JAVIER SALAZAR CHIQUETE c/o ARNOLDO CASILLAS, ESQ. 17 MORENO, BECERRA & CASILLAS 3500 West Beverly Boulevard 18 Montebello, CA 90640 PH: (323) 725-0917 19 FX: (323) 725-0350 20 MORENO, BECERRA & CASILLAS 21 22 Dated: January 7- , 2007 By: 23 —ARNOLDfO VASILLA , ESQ. GREGORY W. MORE O, ESQ. 24 Attorney for Claimant FRANCISCO JAVIER SALAZAR CHIQUETE 25 26 27 28 4 FRANCISCO JAVIER SALAZAR CHIQUETE' S CLAIM FOR MONEY DAMAGES • • 1 PROOF OF SERVICE 2 STATE OF CALIFORNIA ) ss 3 COUNTY OF LOS ANGELES ) 4 I am employed in the County of Los Angeles,State of California.I air over the age of 18 and not a party to the within action; my business address is 3500 West Beverly Boulevard, Montebello, 5 California 90640-1541. 6 On January , 2007, I served, in the manner indicated below, the foregoing document described as CLAIM FOR MONEY DAMAGES on the interested parties in this action 7 by placing the true copies thereof enclosed in sealed envelopes addressed as follows: 8 Clerk of the Board of Supervisors Contra Costa County Administration Building RETURN RECEIPT REQUESTED 9 Room 106 651 Pine Street 10 Martinez, CA 94553 11 X BY CERTIFIED MAIL RETURN RECEIPT REQUESTED: I caused such envelopes to be deposited in the United States mail at Montebello, California, with postage thereon fully 12 prepaid. I am readily familiar with the firm's practice of collection and processing correspondence for mailing. It is deposited with the United States Postal Service each day 13 and that practice was followed in the ordinary course of business for the service herein attested to (C.C.P. § 1013(a)(3)). 14 I declare under penalty of perjury under the laws of the State of California that the foregoing 15 is true and correct. 16 Executed on January , 2007, at Montebello, California. 17 18 Steven Ibarra 19 20 21 22 23 24 25 26 27 28 5 FRANCISCO JAVIER SALAZAR CHIQUETE' S CLAIM FOR MONEY DAMAGES .a Fri Y .��_� ,�' .•ice-�. c o y .n O arcLU O Ln �h r-4u o u LUY. Q a cr. tm 4 _ O a3 U � d 0 U 4 0 U # z n Ir ---—-- p— �sscsama fil O ED ci Q a un n.j o 0 r- cr Q r } m „ > 012 ° 3 C: O ,�I t'�1 G Or CDO GCS O V r m N D 4 r Q a � o U�p U c V N 60*1� L Q ' G CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY � BOARD ACTION: MARCH 06 , 2007 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board A 'on. All Section references are to The co of this document mailed to �ahi,f©npra;.Gou rnment Codes. 1� ) you is your notice of the action taken ® I on your claim by the Board of Supervisors. (Paragraph IV below), THE AMOUNT PROVIDEDIDEXCEEDS THE given Pursuant to Goverment Code COUNSEL LIMITINSECTION910 GOU�TYA�d � f OF THE GOVERNMENT CODE Section 913 and 915.4. Please note all pVIART'► ( "Warnings". CLAIMANT: MARIA DEL CARMEN CHIQUETE ATTORNEY: ARNOLD CAS ILLAS , Esq - DATE RECEIVED: FEBRUARY 01 , 2007 3500 W. BEVERLY BLVD. ADDRESS: MONTEBELLO, CA 906N BY DELIVERY TO CLERK ON: FEBRUARY 01 , 2007 'YO BY MAIL POSTMARKED: JANUARY 29 , 2007 FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. FEBRUARY 02 , 2007 JOHN CULLEN, le• Dated: By: Deputy 11. FROM.: County Counsel TO: Clerk of the Board of Supe►•vison•s (J�iis 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 Clei•k 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). ( ) Otlner: Dated: 5--0 -7 By: y i / Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). I`.V. OARD ORDER: By unanimous vote of the Supervisors present: (V This Claim is rejected in full. ( ) Other-: I certify that this is a true and con-ect copy of the Board's Order entered in its minutes for this date. Dated/%rV,4 %p;P& 4,;�O11N CUL.LEN, CLERK, By' _Deputy Clerk WARNi.NG (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 widn this matter. If you want to consult an attorney,you should do so immediately. *For Additional Wanting See Reverse Side of'This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that li. am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United. States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. . Dated:/*>66 o ,e^9,"';.JOHN CULLEN, CLERK By.. Deputy C1,,• _UN f1"H (_U:=,1Fi t_Uljrqj y Ur_ Imt BOARD OF SUPERVISORS OF CONTRA COST*OUNTY 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 CTOPS shall be presented not later than six months a-Fier 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 Supervis,Qrs at its Office in Room 106, County Administration Biiilding, 651 Pine Street, Martinez, CA 4553. 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. we"avows feet It"I'llas 01$&sea gun at RE: Claim By: Reserved for Clerk's filing stamp Mariaa -Del Carmen chi ire triRECEIVED R D Against the County of Contra Costa or FEB .0 1 2007 CLERK BOARD OF StjpERVISORS rn EUPEn DISORS -District) CON A COSTA Co. (Fill in the narne) The undersigned clairnant hereby makes claim against the County of Contra Costa or the above-named district in the sun,of S see attch, and in support of this claim.represents as-follows: 1. When did the damage or injury occur? (Give exact date and hour) See Attachment. 2Where did the damage or injury occur? (Include city and county) See Attachment. 7. How did the damage or injury occur? (Give full details; use extra paper if required) See Attachment. 4. V)at particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? See Attachment, 5 Wliat are the name,; of county or district office- s, servants,'or employees causing the dmage or injury? See Attachment. -IJ:D 1 H (-UUF41 f l-LtltK lit- v4u. 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) See Attachment. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) See Attachment. 8. Names and addresses of witnesses, doctors, and hospitals. See Attachment. 9. List the expenditures you made on account of this accident or injury- DATF TIME AMOUNT See Attachment. Waosseveyal of 9 10 9 00 so 9 Sao 040-04.0swas**.gone me*0 a a 00 me 0 we Be$ Gov. Code Sec. 910.2 provides "The claim shall be .-.-----Ygigned-by-the-cla-iniant-or some person on his behalf." SC-ND NOTICES TO:-(Attorney) Name and address of Attorney Arnoldo Casillas, Esq dairnan(s lignature) 3500 W. Beverly Blvd. * Montebello, CA 90602 3500 tAddreosird- Montebello, CA 90602 (3231 725-09 7 (323 ) 725— Telephone No. Telephone No. 0917 11 of soll Be s 50111116soolls .0.86#00. 9 ads Wasof 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, 55 6500 et seq.) Furthermore, any attac.hinents, addendurns, or supplements attached to the claim form, including medical r.-cords,are also subject to public disclosure. Rooms 0 490911.4090$Von$*Vegas$move QW&M rovowas fuse# NOTICE: Secirion 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 counq,, city, or district board or officer, authorized to allow or pay the same if genuine, any false or Fraudulent claim, bill, account voucher, or writit)g, is ptinishable either by imprisonment in the County jail for a period of riot more than one year, by a fine of not exceeding one thousand dollars ($1,000.00), or by both Stich 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 imprigunment and fine. I GREGORY W. MORENO, ESQ.,SBN 57844 ARNOLDO CASILLAS, ESQ., SBN 158519 2 MORENO,BECERRA & CASILLAS A Professional Law Corporation 3 3500 West Beverly Boulevard Montebello, CA 90640-1541 4 Telephone: (323) 725-0917 Facsimile: (323) 725-0350 5 6 Attorneys for Claimant MARIA DEL CARMEN CHIQUETE 7 8 Attorneys for Claimant ) CLAIM FOR MONEY DAMAGES 9 MARIA DEL CARMEN CHIQUETE ) [Gov. Code Section 900, Et. Seq.] 10 Claimant, ) 11 V. ) 12 CONTRA COSTA COUNTY, ) 13 Respondent. ) 14 To the Clerk of the Board of Supervisors of County of Contra Costa: THE 15 UNDERSIGNED HEREBY SUBMITS TO THE PRESENTLY IDENTIFIED PUBLIC 16 ENTITY THE FOLLOWING WRITTEN CLAIM FOR MONEY DAMAGES: 17 1. Name of Claimant: MARIA DEL CARMEN CHIQUETE 18 2. Name and mailing address of the person to whom notice of action on this claim is to 19 be sent: 20 MARIA DEL CARMEN CHIQUETE 21 c/o ARNOLDO CASILLAS, Esq. MORENO, BECERRA & CASILLAS 22 3500 West Beverly Boulevard Montebello, California 90640 23 3. Date and location where injury sustained: 24 August 14, 2006 on Vasco Road in Contra Costa County. 25 4. A general description of the injury incurred: 26 On August 14, 2006, Claimant's husband Francisco Javier Salazar was a passenger in a 27 vehicle traveling northbound on Vasco Road in the northbound lane. Rosa Osboume was 28 1 MARIA DEL CARMEN CHIQUETE' S CLAIM FOR MONEY DAMAGES I traveling southbound when the vehicle Claimant's husband was traveling in crossed over the 2 double yellow lines into the southbound lane of traffic. The vehicle Decedent was a passenger in 3 collided head on with the vehicle in which Rosa Osbourne was driving. Claimant's husband 4 suffered blunt force injuries and died at the scene. 5 5. Total amount claimed for physical injuries, future medical care, lost wages, and 6 earning capacity, and past, present and future.physical and psychological pain and 7 suffering: 8 The amount claimed exceeds the limit provided in section 910 (f) of the Government 9 Code. This claim will be an unlimited civil case. 10 6. Name of hospitals/physicians: 11 To be determined. 12 7. How injury or damage occurred/basis for liability: 13 The death of claimant's husband was caused by the injuries he sustained as a result of the 14 collision of the two respective vehicles. Basis for liability is Wrongful Death and corresponding 15 damages, including, but not limited to, loss of future financial support, loss of love, comfort, 16 solace, care,consortium. 17 The present responding public entity owned, designed,maintained, and/or controlled the 18 roadway(Vasco Road) that is the subject of the present claim. 19 This claimant contends generally that at the above place and time there was a dangerous 20 and defective condition of public property pursuant to Government Code Section 835 (a) and (b), 21 and other potentially applicable Government Code provisions, in that the subject roadway was 22 improperly and negligently designed, constructed, owned, transferred, maintained, and operated 23 in that it failed to contain a median barrier or other device(s) which would have prevented the 24 subject vehicular crash; was improperly banked, graded, or curved; provided inadequate line of 25 sight; the elevation, speed, and structural standards were improper; the road and shoulders were 26 not an adequate width; the road failed to contain proper delineation, including, but not limited to, 27 vertical delineators, and also failed to contain proper pavement markers, stripping, signage, 28 reflectors and median and shoulder rumble strips or barriers; the speed limit was improperly 2 MARIA DEL CARMEN CHIQUETE' S CLAIM FOR MONEY DAMAGES I selected and implemented; many crashes had occurred at this area of the roadway; traffic volume 2 exceeded the capacity of the road at the time the road was designed and constructed and at the 3 time of the subject crash; the area of the road where the subject crash occurred contained an 4 improperly located and excessively long second lane for high-speed passing-by southbound 5 traffic without protection for northbound traffic. This public entity unreasonably delayed 6 installing delineators and rumble strips until after the subject crash; Vasco Road was added to 7 the Interregional Road System (IRKS) and was eligible for funding from the State of California 8 for road improvements. In addition, claimant is informed and believes that Vasco Road has been 9 designated a California Safety Corridor, and increased safety should have been promoted. This 10 public entity had both actual and constructive notice of the hazardous and dangerous and 11 defective condition of the roadway for a sufficient time prior to the subject crash to have 12 prudently acted upon and corrected the roadway in the area of the subject crash. This public 13 entity and its employees were generally negligent and caused damages as set forth in this claim. 14 The present responding public entity unreasonably allowed this hazardous and dangerous 15 and defective condition to exist by failing to take action to implement changes needed to 16 maintain the safety of said roadway. Moreover, prior to the subject crash, the present responding 17 public entity knew, or should have known, of the necessary changes needed to maintain the 18 safety of said roadway, such as the implementation of median rumble strips and/or median 19 barriers. The present responding public entity had sufficient time prior to the subject crash to 20 implement such necessary and needed changes, but failed to act reasonably to implement them. 21 The present responding public entity also failed to properly investigate, survey, record, 22 document, monitor, patrol, enforce and report traffic conditions, traffic speeds and traffic 23 violations on said roadway. 24 The present responding public entity was fully aware, or should have been fully aware, of 25 the dangerous condition of said roadway. Over a period of many years prior to the subject crash, 26 a significant number of vehicular crashes occurred at or very near to the area of roadway where 27 this crash occurred so as to place the present responding public entity on notice that there was a 28 need for median barriers to prevent cross median movement by vehicles. 3 MARIA DEL CARMEN CHIQUETE'S CLAIM FOR MONEY DAMAGES I Furthermore, the present public entity negligently or intentionally failed to provide any 2 reasonable warnings, signage, notices, or announcements regarding the collision hazards posed 3 by the above-described dangerous condition. 4 Claimant has not completed his/her investigation and expressly reserves the right to make 5 additional amendments to this claim and/or pleading as the law permits. 6 8. Other pertinent information: 7 NONE 8 9. Name of the presently known employees, agents, or representatives, whose acts or 9 omission caused claimant's injuries: 10 None known to claimant at this time. 11 10. Known addresses of district officers, employee, or agents causing claimant's 12 injuries: 13 None known to claimants at this time. 14 ALL NOTICES OR OTHER COMMUNICATIONS REGARDING THIS CLAIM 15 SHOULD BE SENT TO CLAIMANT AT: 16 MARIA DEL CARMEN CHIQUETE c/o ARNOLDO CASILLAS, ESQ. 17 MORENO, BECERRA, GUERRERO & CASILLAS 3500 West Beverly Boulevard 18 Montebello, CA 90640 PH: (323) 725-0917 19 FX: (323) 725-0350 20 MORENOMRR & AS 21 22 Dated: January �9 , 2007 By: 23 ARNOLDO SESQ. GREGORY W. MORENO, ESQ. 24 Attorney for Claimant MARIA DEL CARMEN CHIQUETE 25 26 27 28 4 MARIA DEL CARMEN CHIQUETE' S CLAIM FOR MONEY DAMAGES I PROOF OF SERVICE 2 STATE OF CALIFORNIA ) ss 3 COUNTY OF LOS ANGELES ) 4 I am employed in the County of Los Angeles, State of California.I am over the age of 18 and not a party to the within action; my business address is 3500 West Beverly Boulevard,Montebello, 5 California 90640-1541. 6 On January , 2007, 1 served, in the manner indicated below, the foregoing document described as CLAIM FOR MONEY DAMAGES on the interested parties in this action 7 by placing the true copies thereof enclosed in sealed envelopes addressed as follows: 8 Clerk of the Board of Supervisors Contra Costa County Administration Building RETURN RECEIPT REQUESTED 9 Room 106 651 Pine Street 10 Martinez, CA 94553 11 X BY CERTIFIED MAIL RETURN RECEIPT REQUESTED: I caused such envelopes to be deposited in the United States mail at Montebello, California, with postage thereon fully 12 prepaid. I am readily familiar with the firm's practice of collection and processing correspondence for mailing. It is deposited with the United States Postal Service each day 13 and that practice was followed in the ordinary course of business for the service herein attested to (C.C.P. § 1013(a)(3)). 14 I declare under penalty of perjury under the laws of the State of California that the foregoing 15 is true and correct. 16 Executed on January ?i°� , 2007, at Montebello, California. 17 18 Steven Ibarra 19 20 21 22 23 24 25 26 27 28 5 MARIA DEL CARMEN CHIQUETE' S CLAIM FOR MONEY DAMAGES :., ' O O c---Clio Ci) �' I:ri SNLIJ O f i r ���`i j �i✓' N cs }`�F1ti j CO LL 1 W 'v 4 ..ti CN 0 4 Ii n O O ell OQQ a �,• dye U 0 U 0 U a- ..n E" o- r- M o _ c3 Ln ru O I i 0 0 a d :J ' u c z: w G {• �Y I• CIS 4-1 ��p�0 d 12 0 U os 0 U ay Ir Y'G a Ln cl w.� �E n� CC cl i6 } �i2<li -.t T .r ..J j it A CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: MARCH 06 , 20.07 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT a►hd�BoaidActho►h. All Section references are to �- 1�1' t" � The copy of this document mailed to Califo►nia7Government Codes. you is your notice of the action taken i N F E B O 2 2007 on your claim by the Board of Supervisors. (Paragraph IV below), COUNTY EZ CALF l_ THE AMOUNT CLAIMED EXCEEDS THE given Pursuant to Government Code ��IARTl1t���Ai_ii=. LIMIT PROVIDED IN SECTION 910 Section 913 and 915.4. Please note all AMOUNT: (f) OF THE GOVERNMENT CODE "Warnings". . CLAIMANT: ESTATE OF MANUEL SAC LOPEZ ATTORNEY: ARNOLD CAS ILLAS , Esq- DATE RECEIVED: FEBRUARY 017 2007 3500 W. BEVERLY BLVD. FEBRUARY Ol 2007 ADDRESS: MONTEBELLO, CA 906W- BY DELIVERY TO CLERK ON: 310 BY MAIL POSTMARKED: JANUARY 29 , 2007 FROM: Clerk of tlhe Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. FEBRUARY 02 , 2007 JOHN CULLEN, e►- Dated: By: Deputy I.I. FROM.: County Counsel TO: Clerk of the Board of Su e►•visors ( This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). O Other: Dated: a_5✓�� By: CQ6 y_c-- Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Adrninistrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. ,ROARD 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:/ lAreA 4G J0-4IN CULLEN, CLERK, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6) months frown 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. Date&' Q rX A? 4&0?JOHN CULLEN, CLERK By Deputy Clerk t-Uri I KHU-xz 1 Fi k-u-jr i f k_LtMr, 1jr- I r1M JIU. LOU BOARD OF SUPERVISORS OF CONTRA COST*OUNTY INSTRUCTIONS TO CLAQ11LAN 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 a-Fier 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 Supervisqrs at its office in Room 106,. County Administration Building, 651 Pine Street,Martinez, CA 04'553. 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 It the end of this form. Ross 0*pew a*""gas 66465 RE: Claim By: Reserved.for Clerk's filing stamp Estate of Manuel Sac FEB 0 Against the County of Contra Costa or 2007 CLERK BOARD C)r S District) . .... CONTRA COS ERVISORS _rA Co. (Fill in the name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum,of S pee at�tch, and in support of this claim represents as-follows: I When did the damage or irkiary occur? (Give exact date and hour) See Attachment. .16- )Where did the damage or injury occur? (Include city and county) See Attachment. 3. How did the damage or injury occur? (Give full details;use extra paper if required) See Attachment, 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or clarnage? See Attachment. 5 What are the name,,(31 COL111tV or district officers, servants, or employees causing the damage or injury? See Attachment. UJI411".H 1-1J:=11H (-UUrq1y Ur Imt Hu. WU_, E. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) See Attachment. 7, I-low was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) See Attachment. 8. Names and addresses of witnesses, doctors, and hospitals: See Attachment. 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT See Attachment. a vNevessm mango If*$&**0 *WOOD@ Do*us Mee wee.sommewoo to aaa reaaea 0 as 0 moo am PRO Gov.Code Sec. 910.2 provides"The claim shall be signed by the claimant or. some person onhis behalf" SEND NOTICES TO: (Attorney)_____j .Name and address of Attorney Arnoldo Casillas, Esq. -7 '(Cl 'matt�Yrlvignature) 3500 W. Beverly Blvd. Montebello 3500 , CA 90602 *-tXFdre5siya----Mo—li-tebell(), CA 90602 (3231 725-0917 (323 ) 725-0917 Telephone No. Telephone No. 0 0 0 1 a 0 B a a I a a 9 a a a a a a 0 a a a a a V a 0 a 0 0 go Ouse$goes P sea masof 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 Calirornin Public Records Act. (Gov. Code, 55 6500 et seq.) Furthermore, any attachments, addendurns, or supplements attached to the claim form, including medical records,are also subject to public disclosure. a/0 googol 1111640016*90 0*sees 1-4*&ISO one 0.611.01 was*@ ***so*a a 0 a e r O a 4 a r e e r e a a sign I was dome**sea NOTICE: Seciion 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 witing, is punishable eitha by imprisonment in the CountN,jail for a period of not more than one year, by i fine of not exceeding one thousand dollii-s or by both such imprisonment and Fine, or by imprisonment in the stale prison, by a fine of not exceeding ten thousand dollars ($10,000),or by both such irripri ponnnent tInd fille. I GREGORY W. MORENO, ESQ.,SBN 57844 ARNOLDO CASILLAS, ESQ., SBN 158519 2 MORENO, BECERRA & CASILLAS A Professional Law Corporation 3 3500 West Beverly Boulevard Montebello, CA 90640-1541 4 Telephone: (323) 725-0917 Facsimile: (323) 725-0350 5 6 Attorneys for Claimant ESTATE OF MANUEL SAC LOPEZ 7 8 Attorneys for Claimant ) CLAIM FOR MONEY DAMAGES 9 ESTATE OF MANUEL SAC LOPEZ ) [Gov. Code Section 900, Et. Seq.] 10 Claimant, ) 11 V. ) 12 CONTRA COSTA COUNTY, ) 13 Respondent. ) 14 To the Clerk of the Board of Supervisors of County of Contra Costa: THE 15 UNDERSIGNED HEREBY SUBMITS TO THE PRESENTLY IDENTIFIED PUBLIC 16 ENTITY THE FOLLOWING WRITTEN CLAIM FOR MONEY DAMAGES: 17 1. Name of Claimant: ESTATE OF MANUEL SAC LOPEZ 18 2. Name and mailing address of the person to whom notice of action on this claim is to 19 be sent: 20 ESTATE OF MANUEL SAC LOPEZ 21 c/o GREGORY W. MORENO MORENO, BECERRA& CASILLAS 22 3500 West Beverly Boulevard Montebello, California 90640 23 3. Date and location where injury sustained: 24 August 14, 2006 on Vasco Road in Contra Costa County. 25 4. A general description of the injury incurred: 26 On August 14, 2006, Claimant Manuel Sac Lopez was a passenger in a vehicle traveling 27 northbound on Vasco Road in the northbound lane. Rosa Osbourne was traveling southbound 28 1 ESTATE OF MANUEL SAC LOPEZ' S CLAIM FOR MONEY DAMAGES I when the vehicle Claimant Manuel Sac Lopez was traveling in crossed over the double yellow 2 lines into the southbound lane of traffic. The vehicle Decedent was a passenger in collided head 3 on with the vehicle in which Rosa Osbourne was driving. Claimant suffered blunt force injuries 4 and died at the scene. 5 5. Total amount claimed for physical injuries, future medical care, lost wages, and 6 earning capacity, and past, present and future physical and psychological pain and 7 suffering: 8 The amount claimed exceeds the limit provided in section 910 (f) of the Government 9 Code. This claim will be an unlimited civil case. 10 6. Name of hospitals/physicians: 11 To be determined. 12 7. How injury or damage occurred/basis for liability: 13 The death of claimant was caused by the injuries he sustained as a result of the collision 14 of the two respective vehicles. 15 The present responding public entity owned, designed, maintained, and/or controlled the 16 roadway(Vasco Road) that is the subject of the present claim. 17 This claimant contends generally that at the above place and time there was a dangerous 18 and defective condition of public property pursuant to Government Code Section 835 (a) and (b), 19 and other potentially applicable Government Code provisions, in that the subject roadway was 20 improperly and negligently designed, constructed, owned, transferred, maintained, and operated 21 in that it failed to contain a median barrier or other device(s) which would have prevented the 22 subject vehicular crash; was improperly banked, graded, or curved; provided inadequate line of 23 sight; the elevation, speed, and structural standards were improper; the road and shoulders were 24 not an adequate width; the road failed to contain proper delineation, including, but not limited to, 25 vertical delineators, and also failed to contain proper pavement markers, stripping, signage, 26 reflectors and median and shoulder rumble strips or barriers; the speed limit was improperly 27 selected and implemented; many crashes had occurred at this area of the roadway; traffic volume 28 exceeded the capacity of the road at the time the road was designed and constructed and at time 2 ESTATE OF MANUEL SAC LOPEZ' S CLAIM FOR MONEY DAMAGES I time of the subject crash; the area of the road where the subject crash occurred contained an 2 improperly located and excessively long second lane for high-speed passing-by southbound 3 traffic without protection for northbound traffic. This public entity unreasonably delayed 4 installing delineators and rumble strips until after the subject crash; Vasco Road was added to 5 the Interregional Road System (IRRS) and was eligible for funding from the State of California 6 for road improvements. In addition, claimant is informed and believes that Vasco Road has been 7 designated a California Safety Corridor, and increased safety should have been promoted. This 8 public entity had both actual and constructive notice of the hazardous and dangerous and 9 defective condition of the roadway for a sufficient time prior to the subject crash to have 10 prudently acted upon and corrected the roadway in the area of the subject crash. This public 11 entity and its employees were generally negligent and caused damages as set forth in this claim. 12 The present responding public entity unreasonably allowed this hazardous and dangerous 13 and defective condition to exist by failing to take action to implement changes needed to 14 maintain the safety of said roadway. Moreover, prior to the subject crash, the present responding 15 public entity knew, or should have known, of the necessary changes needed to maintain the 16 safety of said roadway, such as the implementation of median rumble strips and/or median 17 barriers. The present responding public entity had sufficient time prior to the subject crash to 18 implement such necessary and needed changes, but failed to act reasonably to implement them. 19 The present responding public entity also failed to properly investigate, survey, record, 20 document, monitor, patrol, enforce and report traffic conditions, traffic speeds and traffic 21 violations on said roadway. 22 The present responding public entity was fully aware, or should have been fully aware, of 23 the dangerous condition of said roadway. Over a period of many years prior to the subject crash, 24 a significant number of vehicular crashes occurred at or very near to the area of roadway where 25 this crash occurred so as to place the present responding public entity on notice that there was a 26 need for median barriers to prevent cross median movement by vehicles. 27 Furthermore, the present public entity negligently or intentionally failed to provide any 28 reasonable warnings, signage, notices, or announcements regarding the collision hazards posed 3 ESTATE OF MANUEL SAC LOPEZ' S CLAIM FOR MONEY DAMAGES I by the above-described dangerous condition. 2 Claimant has not completed his/her investigation and expressly reserves the right to make 3 additional amendments to this claim and/or pleading as the law permits. 4 8. Other pertinent information: 5 NONE 6 9. Name of the presently known employees, agents, or representatives, whose acts or 7 omission caused claimant's injuries: 8 None known to claimant at this time. 9 10. Known addresses of district officers, employee, or agents causing claimant's 10 injuries: 11 None known to claimants at this time. 12 ALL NOTICES OR OTHER COMMUNICATIONS REGARDING THIS CLAIM 13 SHOULD BE SENT TO CLAIMANT AT: 14 ESTATE OF MANUEL SAC LOPEZ c/o ARNOLDO CASILLAS, ESQ. 15 MORENO, BECERRA, GUERRERO & CASILLAS 3500 West Beverly Boulevard 16 Montebello, CA 90640 PH: (323) 725-0917 17 FX: (323) 725-0350 18 MORENO, BECERRA & CA AS 19 20 ' Dated: January , 2007 By: 21 g CA 1LLA Q. GREGORY W. MOREN , ESQ. 22 Attorney for Claimant ESTATE OF MANUEL SAC LOPEZ 23 24 25 26 27 28 4 ESTATE OF MANUEL SAC LOPEZ' S CLAIM FOR MONEY DAMAGES I PROOF OF SERVICE 2 STATE OF CALIFORNIA ) ss 3 COUNTY OF LOS ANGELES ) 4 I am employed in the County of Los Angeles,State of California.I am over the age of 18 and not a party to the within action; my business address is 3500 West Beverly Boulevard, Montebello, 5 California 90640-1541. 6 On January 2007, I served, in the manner indicated below, the foregoing document described as CLAIM FOR MONEY DAMAGES on the interested parties in this action 7 by placing the true copies thereof enclosed in sealed envelopes addressed as follows: 8 Clerk of the Board of Supervisors Contra Costa County Administration Building RETURN RECEIPT REQUESTED 9 Room 106 651 Pine Street 10 Martinez, CA 94553 11 X BY CERTIFIED MAIL RETURN RECEIPT REQUESTED: I caused such envelopes to be deposited in the United States mail at Montebello, California, with postage thereon fully 12 prepaid. I am readily familiar with the firm's practice of collection and processing correspondence for mailing. It is deposited with the United States Postal Service each day 13 and that practice was followed in the ordinary course of business for the service herein attested to (C.C.P. § 1013(a)(3)). 14 1 declare under penalty of perjury under the laws of the State of California that the foregoing 15 is true and correct. 16 Executed on January , 2007, at Montebello, California. 17 18 ----.. Steven Ibarra 19 20 21 22 23 24 25 26 27 28 5 ESTATE OF MANUEL SAC LOPEZ' S CLAIM FOR MONEY DAMAGES k •y'`Fy7�C�0.. ¢��S�w�.9"ice �y� (� LU CC 0 .f •9 ,tbS t+ O LU LAJ 4: cs a3 an O U rLI c;3 O . V � CT' m n a o i � w3 v w U- N 3 tib Com• ' �,, Q�W 6n�opJp0� J e C-i FQ- rte+ N CT qtr :l C7 (4 NO o o U-0 �tYiLt� o Q y l cif','•'+ .'1�5 r cc co00 ¢z N LU L.J cid 0 U ca U cr' m �_... a Ln d o 41 c� U J v, Z CG O CLAINI BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: MARCH 06 , .2007 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT /pyan,d17l oaidrAZ.ttion. All Section references are to ) The copy of this document mailed to l �Ca}i forn.ia�Government Codes. ' l , l you is your notice of the action taken �. F E B G 42 2007 on your claim by the Board of Supervisors. (Paragraph IV below), COUNTY COUNSEL THE AMOUNT CLAIMED EXCEEDS THE given Pursuant to Government Code KIARTINEZ C.kLiF. LIMIT PROVIDED IN SECTION 910 AMOUNT: Section 913 and 915.4. Please note all (f) OF THE GOVERNMENT CODE "Warnings". CLAIMANT: LORENZO SAC LOPEZ ATTORNEY: ARNOLD CAS ILLAS , Esq . DATE RECEIVED: FEBRUARY 01 , 2007 3500 W. BEVERLY BLVD. FEBRUARY O1 2007 ADDRESS: MONTEBELLO, CA 9060 BY DELIVERY TO CLERK ON: �b BY MAIL POSTMARKED: JANUARY 29 , 2007 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claire. FEBRUARY 02 , .2007 JOHN CULLEN, rk Dated: By: Deputy Il. FROM: County Counsel TO: Clerk of the Board of Sup rvisors 04--l"his claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). O Other: Dated: a 0-7 By: Deputy County Counsel Ill. 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. PO.ARD ORDER: By unanimous vote of the Supervisors present: (v' This Claim is rejected in full. ( ) Other: I certify that this is a true and coi7-ect copy of the Board's Order entered in its minutes for this date. Dated:/:4r&4 m4� *& N CULLEN, CLERK, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6) nrontlrs 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 widr this matter. {f'you want to consult an attorney,you should do so immediately. *For Additional Warring 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 Nliartinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated/ >>V6 o,7 o&O-0i. JOHN CULLEN, CLERK BY Deputy Clerk �� p Y t-UFA I KH I H INC BOARD OF SUPERVISORS OF CONTRA COSTA OUNTY 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 a-Fier 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 or action. (Gov. Code § 9) 1.2.) B. Claims must be filed with the Clerk of the Board of Supervisqrs at its office in Room 106, County Administration Building,, 651 Pine Street, Martinez, CA 9.4.5 1 53. C. If claim is against a district governed by the Board of Supervisors. rather than the County, the name of the District should be filled in. D' If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code See. 72 at the end of this form. go message$ 0.0600 as 0868011m at RE-: Claim By: Reserved for Clerks filing stamp Lorenzo Sac Lbpe-7. RE FIVE Against the County of Contra Costa or FEB _4 1 2007 -District) CLERK BOARD OF SUPERVISORS (Fill in the name) M. TA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of S pee attch, and in support of this claim.represents as-follows: 1. When did the dianage or injury occur? (Give exact date and hour) See Attachment. 1 Wliere did the damage or injury occur? (Include city and county) See Attachment, 3. How did the damage or injury occur? (Give full details; use extra paper if required) See Attachment, 4. What particular act or omission on the pan of county or district officers, servants, or employees caused the injury or damage? See Attachment. 5 What are the names Of C01.111tV or district officers, servants, or employees causing the damage or injury? See Attachment. I H l_UUfj If !_Ltt"K Ur- I tit v4U.U4:D 6. What damage or injuries do your 'Claim resulted? (rive full extent of injuries or damages claimed. Attach two estimates for auto damage.) See Attachment. 7. I-low was the amount claimed above computed? (Include the estimated arnowit of any prospective injury or damage.) See Attachment, 8. Names and addresses of witnesses, doctors, and hospitals: See Attachment, 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT See Attachment. 0 5***asp a 8*9 ass$as@ 0 meow a 0 0 a-do was a me WOOD a Doom awe 0 0 a a-**age**a ass of a am as.0 a-ago a a ass# Gov.Code See. 910.2 provides "The claim shall be )-signed-by-the claimant or by me-person on his behalf SC-ND NOTICES T0: (At!orney) ) Name and address of Attorney , Arnoldo Casinas, Esq (Claidiatit's g ture) 3500 W. Beverly Blvd. ' Montebello, CA 90602 3500 ZAJdrec1A)rCt_- Montebello, CA 90602 (323) 725-0917 (323 ) 725—o917 Telephone No. Telephone No. 0 0 9 a a a&9 8 awe at*a am a am a awe a a 0 am goo a**gas Nola a V a awe m a a a 9 0 dead awes*seem 4 of a 0 a a V see 0 a a a a 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 and the California Public Records Act. (Gov. Code, §5 6500 et seq.) Furthermore, any attachments, addandurns,or supplements attached to the claim form, including medical records,are also subject to public disclosure. a possmassupso 0 was pas 4.949#*&Dog add pas owe a ease I NOTICE: Section 72 of the Penal Code provides. Every PCTS011 Who, With intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city, or eliSITict board or officer, authorized to allow or pay the same if genuine, any false or Fraudulent claim, bill, account voucher, or writing, is pimishable either by imprisonment in the County jail for a period of not snore than one year, by a fine of not exceeding one thousand dollars ($1,000.00), or by both such Mil.irisonment at)d fine, or by imprisonment in the staie prison, by a fine of not exceeding t.-ii thousand dollars ($10,000), or by both such imprizonment and fine. I GREGORY W. MORENO, ESQ.,SBN 57844 ARNOLDO CASILLAS, ESQ., SBN 158519 2 MORENO, BECERRA & CASILLAS A Professional Law Corporation 3 3500 West Beverly Boulevard Montebello, CA 90640-1541 4 Telephone: (323) 725-0917 Facsimile: (323) 725-0350 5 6 Attorneys for Claimant LORENZO SAC LOPEZ 7 8 Attorneys for Claimant ) CLAIM FOR MONEY DAMAGES 9 LORENZO SAC LOPEZ ) [Gov. Code Section 900, Et. Seq.] 10 Claimant, ) 11 V. ) 12 CONTRA COSTA COUNTY, ) 13 Respondent. ) 14 To the Clerk of the Board of Supervisors of County of Contra Costa: THE 15 UNDERSIGNED HEREBY SUBMITS TO THE PRESENTLY IDENTIFIED PUBLIC 16 ENTITY THE FOLLOWING WRITTEN CLAIM FOR MONEY DAMAGES: 17 1. Name of Claimant: LORENZO SAC LOPEZ 18 2. Name and mailing address of the person to whom notice of action on this claim is to 19 be sent: 20 LORENZO SAC LOPEZ 21 c/o ARNOLDO CASILLAS MORENO, BECERRA & CASILLAS 22 3500 West Beverly Boulevard Montebello, California 90640 23 3. Date and location where injury sustained: 24 August 14, 2006 on Vasco Road in Contra Costa County. 25 4. A general description of the injury incurred: 26 On August 14, 2006, Claimant's brother Manuel Sac Lopez was a passenger in a vehicle 27 traveling northbound on Vasco Road in the northbound lane. Rosa Osbourne was traveling 28 1 LORENZO SAC LOPEZ' S CLAIM FOR MONEY DAMAGES I southbound when the vehicle Claimant's brother was traveling in crossed over the double yellow 2 lines into the southbound lane of traffic. The vehicle Decedent was a passenger in collided head 3 on with the vehicle in which Rosa Osboume was driving. Claimant's brother suffered blunt 4 force injuries and died at the scene. 5 5. Total amount claimed for physical injuries, future medical care, lost wages, and 6 earning capacity, and past, present and future physical and psychological pain and 7 suffering: 8 The amount claimed exceeds the limit provided in section 910 (f) of the Government 9 Code. This claim will be an unlimited civil case. 10 6. Name of hospitals/physicians: 11 To be determined. 12 7. How injury or damage occurred/basis for liability: 13 The death of claimant's brother was caused by the injuries he sustained as a result of the 14 collision of the two respective vehicles. Basis for liability is wrongful death and the 15 corresponding damages pertaining to the heir of decedent including, but not limited to, loss of 16 future financial support, loss of love, comfort, solace, care. 17 The present responding public entity owned, designed, maintained, and/or controlled the 18 roadway(Vasco Road) that is the subject of the present claim. 19 This claimant contends generally that at the above place and time there was a dangerous 20 and defective condition of public property pursuant to Government Code Section 835 (a) and (b), 21 and other potentially applicable Government Code provisions, in that the subject roadway was 22 improperly and negligently designed, constructed, owned, transferred, maintained, and operated 23 in that it failed to contain a median barrier or other device(s)which would have prevented the 24 subject vehicular crash; was improperly banked, graded, or curved; provided inadequate line of 25 sight; the elevation, speed, and structural standards were improper; the road and shoulders were 26 not an adequate width; the road failed to contain proper delineation, including, but not limited to, 27 vertical delineators, and also failed to contain proper pavement markers, stripping, signage, 28 reflectors and median and shoulder rumble strips or barriers; the speed limit was improperly 2 LORENZO SAC LOPEZ'S CLAIM FOR MONEY DAMAGES • 1 selected and implemented; many crashes had occurred at this area of the roadway; traffic volume 2 exceeded the capacity of the road at the time the road was designed and constructed and at the 3 time of the subject crash; the area of the road where the subject crash occurred contained an 4 improperly located and excessively long second lane for high-speed passing-by southbound 5 traffic without protection for northbound traffic. This public entity unreasonably delayed 6 installing delineators and rumble strips until after the subject crash; Vasco Road was added to 7 the Interregional Road System (MRS) and was eligible for funding from the State of California 8 for road improvements. In addition, claimant is informed and believes that Vasco Road has been 9 designated a California Safety Corridor, and increased safety should have been promoted. This 10 public entity had both actual and constructive notice of the hazardous and dangerous and 11 defective condition of the roadway for a sufficient time prior to the subject crash to have 12 prudently acted upon and corrected the roadway in the area of the subject crash. This public 13 entity and its employees were generally negligent and caused damages as set forth in this claim. 14 The present responding public entity unreasonably allowed this hazardous and dangerous 15 and defective condition to exist by failing to take action to implement changes needed to 16 maintain the safety of said roadway. Moreover, prior to the subject crash, the present responding 17 public entity knew, or should have known, of the necessary changes needed to maintain the 18 safety of said roadway, such as the implementation of median nimble strips and/or median 19 barriers. The present responding public entity had sufficient time prior to the subject crash to 20 implement such necessary and needed changes, but failed to act reasonably to implement them. 21 The present responding public entity also failed to properly investigate, survey, record, 22 document, monitor, patrol, enforce and report traffic conditions, traffic speeds and traffic 23 violations on said roadway. 24 The present responding public entity was fully aware, or should have been fully aware, of 25 the dangerous condition of said roadway. Over a period of many years prior to the subject crash, 26 a significant number of vehicular crashes occurred at or very near to the area of roadway where 27 this crash occurred so as to place the present responding public entity on notice that there was a 28 need for median barriers to prevent cross median movement by vehicles. 3 LORENZO SAC LOPEZ' S CLAIM FOR MONEY DAMAGES I Furthermore, the present public entity negligently or intentionally failed to provide any 2 reasonable warnings, signage, notices, or announcements regarding the collision hazards posed 3 by the above-described dangerous condition. 4 Claimant has not completed his/her investigation and expressly reserves the right to make 5 additional amendments to this claim and/or pleading as the law permits. 6 8. Other pertinent information: 7 NONE 8 9. Name of the presently known employees, agents, or representatives, whose acts or 9 omission caused claimant's injuries: 10 None known to claimant at this time. 11 10. Known addresses of district officers, employee, or agents causing claimant's 12 injuries: 13 None known to claimants at this time. 14 ALL NOTICES OR OTHER COMMUNICATIONS REGARDING THIS CLAIM 15 SHOULD BE SENT TO CLAIMANT AT: 16 LORENZO SAC LOPEZ c/o ARNOLDO CASILLAS, ESQ. 17 MORENO, BECERRA & CASILLAS 3500 West Beverly Boulevard 18 Montebello, CA 90640 PH: (323) 725-0917 19 FX: (323) 725-0350 20 MORENO, BECERRA & C LLAS 21 22 Dated: January 2007 By: 23 RNO O AS1LLAV, ESQ. GREGORY W. MORENO, ESQ. 24 Attorney for Claimant LORENZO SAC LOPEZ 25 26 27 28 4 LORENZO SAC LOPEZ'S CLAIM FOR MONEY DAMAGES I PROOF OF SERVICE 2 STATE OF CALIFORNIA ) ss 3 COUNTY OF LOS ANGELES ) 4 1 am employed in the County of Los Angeles,State of California.I am over the age of 18 and not a party to the within action; my business address is 3500 West Beverly Boulevard,Montebello, 5 California 90640-1541. 6 On January , 2007, I served, in the manner indicated below, the foregoing document described as CLAIM FOR MONEY DAMAGES on the interested parties in this action 7 by placing the true copies thereof enclosed in sealed envelopes addressed as follows: 8 Clerk of the Board of Supervisors Contra Costa County Administration Building RETURN RECEIPT REQUESTED 9 Room 106 651 Pine Street 10 Martinez, CA 94553 11 X BY CERTIFIED MAIL RETURN RECEIPT REQUESTED: I caused such envelopes to be deposited in the United States mail at Montebello, California, with postage thereon fully 12 prepaid. I am readily familiar with the firm's practice of collection and processing correspondence for mailing. It is deposited with the United States Postal Service each day 13 and that practice was followed in the ordinary course of business for the service herein attested to (C.C.P. § 1013(a)(3)). 14 I declare under penalty of perjury under the laws of the State of California that the foregoing 15 is true and correct. 16 Executed on January 2007, at Montebello, California. 17 18 - Steven Ibarra 19 20 21 22 23 24 25 26 27 28 5 LORENZO SAC LOPEZ' S CLAIM FOR MONEY DAMAGES s � � U o� 00ell, 0 d d� Q 4- a . Q 03 cz p c3 4- O U.4- Eli 1 ON $f G1T�•"�' L M1ED ,. o v� Lrl fu !_5" - C3 7 J J �- 7 Q M 1 N CD Fes-o NCO ' uj C CA, 1a: CiJ N Q N �LL s 'F' o A c� C3 cn X�4.111 all 0 U C3 �. r Rom -n -n a- Q- ® m • o C3 s.n nj M I� N { i I �o _ icy ;Q �U d �v 14 sY CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: MARCH 06 , 2007. Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and,B.oaAd L ton. All Section references are to The co of this document mailed to (gCalifornia:Go�ve►-nment Codes. ) copy 'FEB �� �;1 you is your notice of the action taken ,; on.your claim.by the,Board of 0 2 2007 Supervisors.'(Paragraph IV below), COUNTY COUNSELTHE AMOUNT CLAIMED EXCEEDS THE given Pursuant to Government Code k4ARTIN1 ! F LIMIT PROVIDED IN SECTION 910 Section 913 and 915.4. Please note all Kffi T: (f) OF THE GOVERNMENT CODE "Warnings". CLAIMANT: JOSE SAC LOPEZ. :. ATTORNEY: ARNOLD CAS ILLAS , Esq - DATE RECEIVED: FEBRUARY 01 , 2007 3500 W. BEVERLY BLVD. FEBRUARY O1 2007 ADDRESS: MONTEBELLO, CA 9069,2 BY DELIVERY TO CLERK ON: 4�6 BY MAIL POSTMARKED: JANUARY 29 , 2007 FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. FEBRUARY 02 , 2007 JOHN CULLEN, l Dated: By: Deputy 11. FROM.: County Counsel TO: Clerk of the Board of Supervisors ( is 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: Dated: �� Jam' By: 11 C Q-g4,,�_- Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. ARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its.minutes for this date. Dated/.;"� a -0;06HN CULLEN, CLERK, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6) months fi-om the date this notice was personally served or deposited in the nuail 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 Additiaial War nirwb See Reverse Side of'Tliis Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury,that i am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: h °�i°�'� JOHN CULLEN, CLERK By Deputy Clerk �� iz: t-UM I H U-Jurll ur- BOARD OF SUPERVISORS OF CONTRA COSTA _0UNTY 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 ofaction. (Gov. Code § 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisip at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 04553. C. If claim is against a district governed by the Board of Supervisors. rather t1mn 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. ppo§"sell own *alga @now RE: Claim By: Reserved for Clerk's filing stamp Jose Sac Lopez 'FC EIV "'FCEIV a"D 0 IE Ti Against the County of Contra Costa or EFES 01 Zoo OF 8.. 11 CLARK RK BOARD District) cotq-rp CO (Fill in the naive) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sunt of S see aitch, and in SLIPPOrt of this claim,represents as followi: 1. When did the damage or injury occur? (Give exact date and hour) See Attachment, 2. Where did the damage or injury occur? (Include city aiid county) See Attachment. 3. How did the damage or injury occur? (Give full details.; use extra paper if required) See Attachment. 4. Mat particular act or omission on the pan of coumy or district officers, servants, or employees caused the injury or damage? See Attachment. S What are the names OCCOL111tV or district officers, servants, oi- employees causing the damage or injury? see Attachment. -U,3 I H UJUfq I t-Lthfi ut- r 4U. 6What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) See Attachment. 7. I-low was the amount claimed above computed? (Include the estimated amount of any prospective ir�lttry or damage.) See Attachment, 8. Names and addresses of witnesses, doctors, and hospitals: Ste Attachment, 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT See Attachment. Gov.Code Sec. 910.2 provides "The claim shall be signed-by-the clairnant-o-r-0", ome person on his behalf SEND NOTICES TO: (AttoMey) �4 Name and address of Attorney 1/ Arrioldo Casillas, Esq. rbnatit's Sigr6ture) 3500 W. Beverly Blvd. Montebello, CA 90602 3500 W_ tAddl-psircl- Montebello, CA 90602 (323) 725-0977 (323 ) 72 Telephone No. -- Telephone NO. 5-0917 young go"as* 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, 55 6500 et seq.) Furthermore, any attachments, addendums, or supplements attached to the claim form, including medical records, are also subject W public disclosure. 9 a 201411009W8401 9*09 a 0 as 6109"Ress *`Son 0 0$*SOON NOTICE: Section 72 of the Penal Code provides. Every person who, with intent to defraud, presents for allowance or for payinent to any state board or officer, or to any count)-, city, or district board or officer, authorized to allow or pay the same if genuine, any false of, fraudulent claim, bill, account voucher, or ivritiiig, is pilnisliable either by imprisonment ill the County jail for a period of riot more than one year, by a fine of not exceeding one thousand dollms 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 imprigonnnentand fine. I GREGORY W. MORENO, ESQ.,SBN 57844 ARNOLDO CASILLAS, ESQ., SBN 158519 2 MORENO, BECERRA & CASILLAS A Professional Law Corporation 3 3500 West Beverly Boulevard Montebello, CA 90640-1541 4 Telephone: (323) 725-0917 Facsimile: (323) 725-0350 5 6 Attorneys for Claimant JOSE SAC LOPEZ 7 8 Attorneys for Claimant ) CLAIM FOR MONEY DAMAGES 9 JOSE SAC LOPEZ ) [Gov. Code Section 900, Et. Seq.] 10 Claimant, ) 11 V. ) 12 CONTRA COSTA COUNTY, ) 13 Respondent. ) 14 To the Clerk of the Board of Supervisors of County of Contra Costa: THE 15 UNDERSIGNED HEREBY SUBMITS TO THE PRESENTLY IDENTIFIED PUBLIC 16 ENTITY THE FOLLOWING WRITTEN CLAIM FOR MONEY DAMAGES: 17 1. Name of Claimant: JOSE SAC LOPEZ 18 2. Name and mailing address of the person to whom notice of action on this claim is to 19 be sent: 20 JOSE SAC LOPEZ 21 c/o ARNOLDO CASILLAS MORENO, BECERRA & CASILLAS 22 3500 West Beverly Boulevard Montebello, California 90640 23 3. Date and location where injury sustained: 24 August 14, 2006 on Vasco Road in Contra Costa County. 25 4. A general description of the injury incurred: 26 On August 14, 2006, Claimant's brother Manuel Sac Lopez was a passenger in a vehicle 27 traveling northbound on Vasco Road in the northbound lane. Rosa Osboume was traveling 28 1 JOSE SAC LOPEZ' S CLAIM FOR MONEY DAMAGES I southbound when the vehicle Claimant's brother was traveling in crossed over the double yellow 2 lines into the southbound lane of traffic. The vehicle Decedent was a passenger in collided head 3 on with the vehicle in which Rosa Osbourne was driving. Claimant's brother suffered blunt 4 force injuries and died at the scene. 5 5. Total amount claimed for physical injuries, future medical care, lost wages, and 6 earning capacity, and past, present and future physical and psychological pain and 7 suffering: 8 The amount claimed exceeds the limit provided in section 910 (f) of the Government 9 Code. This claim will be an unlimited civil case. 1.0 6. Name of hospitals/physicians: 11 To be determined. 12 7. How injury or damage occurred/basis for liability: 13 The death of claimant's brother was caused by the injuries he sustained as a result of the 14 collision of the two respective vehicles. Basis for liability is wrongful death and the 15 corresponding damages pertaining to the heir of decedent including, but not limited to, loss of 16 future financial support, loss of love, comfort, solace, care. 17 The present responding public entity owned, designed,maintained, and/or controlled the 18 roadway(Vasco Road) that is the subject of the present claim. 19 This claimant contends generally that at the above place and time there was a dangerous 20 and defective condition of public property pursuant to Government Code Section 835 (a) and (b), 21 and other potentially applicable Government Code provisions, in that the subject roadway was 22 improperly and negligently designed, constructed, owned, transferred, maintained, and operated 23 in that it failed to contain a median barrier or other device(s) which would have prevented the 24 subject vehicular crash; was improperly banked, graded, or curved; provided inadequate line of 25 sight; the elevation, speed, and structural standards were improper; the road and shoulders were 26 not an adequate width; the road failed to contain proper delineation, including, but not limited to, 27 vertical delineators, and also failed to contain proper pavement markers, stripping, signage, 28 reflectors and median and shoulder rumble strips or barriers; the speed limit was improperly 2 JOSE SAC LOPEZ' S CLAIM FOR MONEY DAMAGES I selected and implemented; many crashes had occurred at this area of the roadway; traffic volume 2 exceeded the capacity of the road at the time the road was designed and constructed and at the 3 time of the subject crash; the area of the road where the subject crash occurred contained an 4 improperly located and excessively long second lane for high-speed passing-by southbound 5 traffic without protection for northbound traffic. This public entity unreasonably delayed 6 installing delineators and rumble strips until after the subject crash; Vasco Road was added to 7 the Interregional Road System (IRKS) and was eligible for funding from the State of California 8 for road improvements. In addition, claimant is informed and believes that Vasco Road has been 9 designated a California Safety Corridor, and increased safety should have been promoted. This 10 public entity had both actual and constructive notice of the hazardous and dangerous and 11 defective condition of the roadway for a sufficient time prior to the subject crash to have 12 prudently acted upon and corrected the roadway in the area of the subject crash. This public 13 entity and its employees were generally negligent and caused damages as set forth in this claim. 14 The present responding public entity unreasonably allowed this hazardous and dangerous 15 and defective condition to exist by failing to take action to implement changes needed to 16 maintain the safety of said roadway. Moreover, prior to the subject crash, the present responding 17 public entity knew, or should have known, of the necessary changes needed to maintain the 18 safety of said roadway, such as the implementation of median rumble strips and/or median 19 barriers. The present responding public entity had sufficient time prior to the subject crash to 20 implement such necessary and needed changes, but failed to act reasonably to implement them. 21 The present responding public entity also failed to properly investigate, survey, record, 22 document, monitor, patrol, enforce and report traffic conditions, traffic speeds and traffic 23 violations on said roadway. 24 The present responding public entity was fully aware, or should have been fully aware, of 25 the dangerous condition of said roadway. Over a period of many years prior to the subject crash, 26 a significant number of vehicular crashes occurred at or very near to the area of roadway where 27 this crash occurred so as to place the present responding public entity on notice that there was a 28 need for median barriers to prevent cross median movement by vehicles. 3 JOSE SAC LOPEZ' S CLAIM FOR MONEY DAMAGES I Furthermore, the present public entity negligently or intentionally failed to provide any 2 reasonable warnings, signage, notices, or announcements regarding the collision hazards posed 3 by the above-described dangerous condition. 4 Claimant has not completed his/her investigation and expressly reserves the right to make 5 additional amendments to this claim and/or pleading as the law permits. 6 8. Other pertinent information: 7 NONE 8 9. Name of the presently known employees, agents, or representatives, whose acts or 9 omission caused claimant's injuries: 10 None known to claimant at this time. 11 10. Known addresses of district officers, employee, or agents causing claimant's 12 injuries: 13 None known to claimants at this time. 14 ALL NOTICES OR OTHER COMMUNICATIONS REGARDING THIS CLAIM 15 SHOULD BE SENT TO CLAIMANT AT: 16 JOSE SAC LOPEZ c/o ARNOLDO CASILLAS, ESQ. 17 MORENO, BECERRA & CASILLAS 3500 West Beverly Boulevard 18 Montebello, CA 90640 PH: (323) 725-0917 19 FX: (323) 725-0350 20 MORENO, BECERRA & LLAS 21 22 Dated: January �L, 2007 By: 23 OL O ASIL AS ESQ. GREGORY W. MORENO, ESQ. 24 Attorney for Claimant JOSE SAC LOPEZ 25 26 27 28 4 JOSE SAC LOPEZ'S CLAIM FOR MONEY DAMAGES 1 PROOF OF SERVICE 2 STATE OF CALIFORNIA ) ss 3 COUNTY OF LOS ANGELES ) 4 I am employed in the County of Los Angeles,State of California.I am over the age of 18 and not a party to the within action; my business address is 3500 West Beverly Boulevard,Montebello, 5 California 90640-1541. 6 On January , 2007, I served, in the manner indicated below, the foregoing document described as CLAIM FOR MONEY DAMAGES on the interested parties in this action 7 by placing the true copies thereof enclosed in sealed envelopes addressed as follows: 8 Clerk of the Board of Supervisors Contra Costa County Administration Building RETURN RECEIPT REQUESTED 9 Room 106 651 Pine Street 10 Martinez, CA 94553 11 X BY CERTIFIED MAIL RETURN RECEIPT REQUESTED: I caused such envelopes to be deposited in the United States mail at Montebello, California, with postage thereon fully 12 prepaid. I am readily familiar with the firm's practice of collection and processing correspondence for mailing. It is deposited with the United States Postal Service each day 13 and that practice was followed in the ordinary course of business for the service herein attested to (C.C.P. § 1013(a)(3)). 14 I declare under penalty of perjury under the laws of the State of California that the foregoing 15 is true and correct. 16 Executed on January , 2007, at Montebello, California. 17 18 Steven Ibarra 19 20 21 22 23 24 25 26 27 28 5 JOSE SAC LOPEZ' S CLAIM FOR MONEY DAMAGES O Ln CJ -r7 .....mum -n E-a-M-8--m-REM Ir O to > 00 00 CD cn — 6 Gq 3 z � r �J i C .: C C ru U-1 C O r 0 r w w -0 --- 03 w C7 O A� n O � O m -' o CD „l X N y b c r r_7 CD C,0 a _� 6 P-A CD CD V 4 3c • - >O 0 5� p Z � yFi W O CLAIM BOARD OF SUPCRVi.SORS OF CONTRA COSTA COUNTY C . 24 BOARD ACTION: MARCH 06 , 2007 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endor-sernents, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to California Government Codes. t)� -� you is your notice of the action taken r =" �_=;-` on your claim by the Board of FEF 020007C. Supervisors. (Paragraph IV below), given Pursuant to Government Code COUNTY Ci.COUNSEL'- Section 913 and 915.4. Please note all AMOUNT: $250 .00 a IART 1",Ezz rA..i:: "Warnings". CLAIMANT: CATHY S . KORA ATTORNEY: UNKNOWN DATE RECEIVED: FEBRUARY 02 , 207 ADDRESS: 410 NORTH CIVIC DRIVE BY DELIVERY TO CLERK ON: FEBRUARY 02 , 2007 #301 WALNUT CREEK, CA 94596 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Super-visor-s TO: County Counsel Attached is a copy of the above-rioted claim. JOHN CULLEN, 1 Dated: FEBRUARY 02 , 2007 By: Deputy 11 FROM.: County Counsel TO: Clerk of the Board of S pervisors I- H I-Tills claim cornplies.substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we ar-e so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claire is not timely filed. The Clerk should r-etul-n claim on gl•ound 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: Dated: - 5- U 7 By: /"'0 Cil e�� Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. ,ROARD ORDER: By unanimous vote of the Supervisors present: ( This Claire 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//441'44 10 !L,&t� HN CULLEN, CLERK, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6) rrrorrths 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 widr, this matter. If you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side of'11is Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:/%x'44 mfr 4?AWP' JOHN CULLEN, CLERK By _Deputy Clerk `2/12/200G, 11:44 CONTRA COSTA COUNTY CLERK OF THE 4 914153565855 NO.856 901 BOARD 00 WYERVISORS OF CONTRA COSTA COUNTY INST&UCTIONS TO CLAMAW—, 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 inorift after the acenal 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 Administiation Building,651 Pine Street,Martinez,CA 945 53 C. If claim is against a district governed by the Board of Supervisors, rather than the Cowity,,the name of the District should be filled in. D. If the claim is against more then 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, RE: Claim By: Reserved for Clerk's filing stamp REC h FEB Against the County of Contra Costa or q 2 2007 CLEfitKCo. BOAIVRD o District) DON..Rq C F OSSUPERVISORS (Fill'-in the name) 7"A The undersigned claimant hereby mg �<es claim against the County of Contra, Costa or the above-earned district in the sum of$ 2-5-'o6 J/ end in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 2. Where dirt the damage or injury occur? (Include city and.county) ax- � {"-r k-QK ,two 3. How did the damage or injtn-y occur? (Give MI details; use extra paper if required �oA_q -c, V'C� -A 0-A'�-'�CA r 0-0 W CAW-, VA'r%� N C.) 0'" y (-�Wc S CrN C- es 4. Wt particular.`act or omission on the part of county ojr�di"strict officers, servants, or employ caused the injury or damage? 'CVP. OL c� s� z,- * � 'I'" - - Nrl -'r 6 5 What are the names of county or district officers,servants,or employees causing the damage or injury? -, • �\._.J C�h--�'' C�.�.�rr'1 ��CQ5 �o�-�'v� R S S r,r�� t,�h�--tX�n�.���'sY"� 1 c�.0-, � � � - 1 11 C � ` �� 5 h�`�t�,, r-o b �� �.�,.>o.�, c�(r+,�..���q��,ur�^c�..r,...it,-1 �..Q s � kt-...�.(.� `Vl t:!� �,Y �'S` �`S„Q � k'�..YY1 � Y'l a � �l.�4�l_�-r - �t„�d C�»k �.Lk"Y\ate. c�-Jkr�... �(�1 C9-�C�i .,�•>e.x-Q.., �.��./11� .{�e-� --2ra�.-�, 5���-- � h1-vi c�c��Y�. a 12/12/2006 11:44 CONTRA COSTA COUNTY CLERK OF THE 914153585855 NO.856 902 (. What darna,ge of injuries do yoiir claim. resulted? (Give full extent of injuries or damages elahmed. Attach two estimates for auto damage.) ' 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) C.��.js eu�.X'� s�1. � 5 �-� h�des �r o� `-l.\� ty .C�► iC.'Or.�� 8. Names and addresses of witnesses, doctors,and hospitals' 33'-4 Z) \k S c 'w mb 4 a b am v,f\- rc-A S,-,6,r%4 Q -A— c�4k\CL ��0.r\t 3►.,ft-� 'N.G;�!1 C�pr. �`l01 � Gr"G.9-\��C.�. 9. t�c. ¢gn 33►� i� S CL, a isk tide expeitoitures you mage on account o f is accident or injury: DATE TYME AMOUNT 25 c7. ) Gov. Code Sec.910.2 provides"The claim shall be )signed by the claimant or by some person on his behalf SEND NOTICES TO; (Attomev)_ Dame and address of Attorney ) Claimant's Signature) } (Address) Telephone No. )Telephone No.cA'?-S ■■■■r■■r••N■■■■•■■e■■r■■■.ora■■■•■■■■..•■■■■■■■w•■■••■■•■■r■■•■■•■■■■•■■r■r�•■■.■■■■� I'C1BLIC RECORDS NOTICE: Please be advised that this claim form, or any claim tiled 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, addend.ums, or supplements attached to the claim fonia, including medical records,are also subject to public disclosure. ■•■■■■sr■■■■•■■■•■■•••■■r■■■r■•■■•r■■■rr•■■■•�■a■rM■r•■■■■•••■rr■■■■■■a■■■•rr■.r■weer NOTICE: Section 72 of the Penal Code provides: Every person.who, with intent to defraud, presents for a]lowance or for payment to any state board or officer, or to any county, city, or district board or offtoer, aWioiized to allow or pay the same if genuine, any false or fraudulent claim, bill, ACCOMIt 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 thousmid dollars ($1,000.00), or by both such imprisonment and fine, or by.imprisonment in the state prison, by a (tine of not exceeding ten thousand dollars ($10,000), or by both such imprisonment and fine. r CLAiM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY • 02 BOARD ACTION: MARCH 06 , 2007 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. R (gzn, F) you is your notice of the action taken q I on your claim by the Board of �) Supervisors. (Paragraph IV below), FEB 0 2 2007 given Pursuant to Government Code AMOUNT: $469 . 81 COUNTY COUNSEL Section 913 and 915.4. Please note all t AARTINEZ CALIF. "Warnings". CLAIMANT: JEANINE ELIZABETH BATES ATTORNEY: UNKNOWN DATE RECEIVED: FEBRUARY 02 , 2007 ADDRESS: 426 TERES ITA BLVD. , SAN FRANCISCO.., CA 9412Y DELIVERY TO CLERK ON: FEBRUARY 02 , 2007 . BY MAIL POSTMARKED: POSTMARK UNKNOWN FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. FEBRUARY 02 , 2007 JOHN CULLEN, e' Dated: By: Deputy 11. FROM: County Counsel TO: Clerk of the Board of S ervisors ( ),�Ilislaim 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: Dated: By: eputy County Counsel III. FROM:: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. J3OARD ORDER: By unanimous vote of the Supervisors present: ( This Clairn is rejected in full. O Other: I certify that this is a true and con-ect copy of the Board's Order entered in its minutes for this date. Dated: Q.>IZ6 aG oZN CULLEN, CLERK, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6) months from the date this notice was personally served or deposited in the nuail 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 wide this matter. if you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side ofThis Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that i. ani now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:!%X0,094-07 JOFIN CULLEN, CLERK ByAe� Deputy Clerk BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT 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.) 3. Claims must be filed with the Cleric of the Board of Supervisors at its office in Room. 106, County Adnwiistration Building, 651 Pine Street,Martinez,CA 94SS3. If claim is against a district governed by the Board of Supervisors, rather than the County, the -naive of the District should be filled in. 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. Eaaa aEaaaEE EaEEER as a MEN 6*Runs 9aaaEaCaeEE!■EEa EaE E MIR None aCEEEEERKE an EEEaEEE EEaI RE: Claim By: Reserved for Clerk's filing stamp RECEIVED Against the County of Contra Costa or ) FEB 0 2 2007 District) CLERK BOARD Or SUPERVISORS (Fill.in the name) ) CONTF AC-5STACO. The undersigned claimant hereby makes claim against the Counq of Contra Costa or the above-named district in the sum of$_ 46L cg 1 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) �a n 2-O -1 "i 0 C> c) 12 a C7 2. Where did the damage or injury occur? (Include city and county) C.O—4-� c9� San :J?a+a 10 'Ony-L tZQJ �-c-2 fl�'�eJ►tiz CA-, iN`y-,� qp (2 ka 6 l0 S- I I How did the damage or injury occur? (Give fun 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? --the- c;i-t-aacc, atze �� Gd cel t -,S-r -.c�u-��-R- A'1-1L w► �111�'lto�. i S 0 U-c p- 'Z ..cam. s �n�! A.ctn S'2tpPi 1 tJ G.- A b- ALc �o bd S�J� S What are the names of county or district officers,servants, or employees causing the damage or injury? ri 11 Cf 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. -Attach two estimates for auto damage.) l'Vl J mak. is c 2�ct� �. k'�r+� 15 }, - W gs -:r- 7. s �- 1N b e. t qc LLbe— P lc,n ,f2 4-0 6►�.y e,. 471 1—�. �-�- 7. How was the amount claimed above computed? (Include the 'estnna ed''amount of any C-ke-el— Pros ective injury yor damage..) �1 �,� lc�:P�;� L- � �r f� 6Zeel a Ce,-l. jZ.... V1 .3U u, L.m C/V c t-t - i-a 8. Names and addresses of witnesses,doctors, and hospital f1e0.3e. "--a- 90t,vc�, � o - FGn hOrr-Z 4 ra h C-(a i*P, GuG Z< E-f va 9. List the expenditures you made on account oft saccident or injury: DATE TR\JE AMOUNT t [■ annual Ron Rolm t[[[[enoun[ Itn■■t[■af[fiffi[f[[[■f[[[[[■■[[f[Mass ffffifitt[[[t[f[titEof .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 ) (Claimant's Signature) L4 J (Address) Telephone No. )Telephone No. /5 L/5 a �/so ■t■[■■■Essex KENN[■[■■■■[■■ ■ Know KNEREEMNINERINK[[t[[t t f t f■[f ago■■■t[■f■man■was Russ SUN■1 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 at seq.) Furthermore, any attachments,addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. ■ none MEN Evans NEW ago[on..[ Is [f[[[f t f f■t f f f■[[t[f[[[[[[[[■[[[[t t[Wages Know[air[SEEN f[[f 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 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 imprisorunmt and fine. Question: 3 I was riding my bike on San Pablo Dam Rd towards Castro Ranch Rd when I hit the crack shown in the pictures. The cracks were not visible because there was a pack of cyclists ahead of me and two directly in front of me in a single file. We were peddling about 20 miles an hour down the road. The riders in front me shifted to avoid the crack at the same time I couldn't react and my front wheel went directly in the crack blowing out my tire, then bounced me in the middle of the road skidding on my rims. I managed to stay upright and didn't get hit by a car therefore I did not sustaining any bodily injuries. However my front fork was cracked, wheel bent and tire blew out. 1/2512007 3:48:47 PM MIKE'S BIKES of SAN FRANCISCO 1233 Howard St. San Francisco,CA 94103 (4 15)241-BIKE (888)696-BIKE www MikesBikes.com Ref SO#: Receipt#: 32017 10-5/2007 Store: 005A Assoc: Zack S Cashier: Zack S Bill To: Jeanine Bates 426 Teresita Blvd. San Francisco CA 94127 ITEM# DCS QTY PRICE .XTPRICE -- —...- — — ----------- 22352 BIK 1 ,808.00 2,808.00 07 Ruby Pro RED 51 8192 WHL -1 300.00 (300.00) / 07 ROVAL PAVE SL Giz =i_00 r. 3796 LBR 1 20.00 20.00 HBAR INSTALL 8069 WHL 1 733.00 733.00 �/�.I t h�eL<. ]�r�- 07 KSYRIUM ES M10 SHI '=ix 36't' %��- r 1 4 Unit(s) Subtotal: 3,261.00 Z'a-12 ex s � � 8.500 %Tax: 275.49 Qy� S IYtzs 10 RECEIPT TOTAL: 3,536.49 Tend: 3.536.49 CrCard: 3,536.49 VISIMC No Refunds on Sale Item No Refunds on Bicycles We appreciate your business! x(3 -3 . o � 3 � � (6 Pinole, CA 94564 - Google Maps Page 1 of l GOress Pinole, CA 94564 X ..... ..... ;v R,Ommd ranter"'" ' ..San .........:: .. . ..':::'.........y, .a.a j` .... ..� �, ...:. gyp,,c..... .... ::•:. . : A. .... ..4:...:Ar.... 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':[:cef_S'f`• ..,.C••. 7•rY, .�><a. 34C:i http://mail.google.com/nail/?attid=0.1&disp=inline&view=att&th=l 106037b8666fe5d 1/26/2007 M a ' M � ✓} �o cel'' ;�F ,. a � � � � � � S� ��,� � v „�" J r � �� i r� � C'�` �� � v .� � � �, �' � �' �, �� � J �� � � � G �o p w� N ��� ';;n � � p0 U ,sem � ' © QZ v f �. � �� � i "Q U o �, N .� ,e � 3 I 0c) a o ) W m0 or ol 't CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: MARCH 06 , 2007 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT TM 1777 and Board Action. All Section references'�ai e to .4 ud The co of this document mailed to California Government Codes. f) you is your notice of the action taken FEB d 2 2007 on your claim by the Board of Supervisors. (Paragraph IV below), COUNTY COUNSEL given Pursuant to Government Code MARTINEZ CALIF. AMOUNT: AN AMOUNT IN EXCESS OF THE Section 913 and 915.4. Please note all JURISDICTION OF THE SUPERIOR "Warnings". CLAIMANT: COURT PATTY HOPSON ATTORNEY: UNKNOWN DATE RECEIVED: FEBRUARY 02 , 2007 ADDRESS: 501 ENTERPRISE AVENUE BY DELIVERY TO CLERK ON: FEBRUARY 02 , 2007 APT. B RICHMOND, CA 94801 BY MAIL POSTMARKED: JANUARY 30, 2007 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. FEBRUARY 02 , 2007 JOHN CULLEN, er Dated: By: Deputy I1. FROM.: County Counsel TO: Clerk of the Board of S ei•visors ( This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we ar-e so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clei•k should return claim on ground that it was filed late and send warning of clairnant's right to apply for leave to present a late claim (Section 911.3). O Other: — 2 Dated: By: f7? Ii�Deputy County Counsel 11.1. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was r•etur•ned as untimely with notice to claimant (Section 911.3). IV./BOARD ORDER: By unanimous vote of the Supervisors present` (� This Claim is rejected in full. O Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for tthhis date. Dated//ea,?VX d 0U4.1bHN CULLEN, CLERK, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6) rnontlis 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 connectiar widr 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 per jury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:���f 1P/ °'?",?�JOHN CULLEN, CLERK By Deputy Clerk RECEIVE® CLAIM AGAINST PUBLIC ENTITY FEB 0 2 2007 [Gov. Code§905,910,910.21 CLERK BOARD OF SUPERVISORS CON'IRA COSTA CO. TO: Contra Costa County Board of Supervisors 651 Pine St. Rm 108A Martinez, CA, 94553 Ms. Patty Hopson ("Claimant") hereby makes a claim against Contra Costa County, 651 Pine St. Rm 108A, Martinez, California 94553, and makes the following statements in support of the claim: 1. Claimant resides at 501 Enterprise Avenue, Apt. B, Richmond, California 94801. 2. Notices concerning the claim should be sent to Ms. Patty Hopson, 501 Enterprise Avenue, Apt. B, Richmond, California 94801. 3. 'On or about August 9, 2006, Claimant sustained personal injuries and damages, as a passenger on a Western Contra Costa Transit Authority bus, when a vehicle driven by Todd Maclarean' collided with the Western Contra Costa Transit Authority bus. 4. That at said time and place, Contra Costa County, and its agents, employees, so negligently entrusted, managed, maintained, drove, operated, repaired, manufactured, and designed said bus in a dangerous and negligent manner along and upon Pinole Valley Road in the City of Pinole, California, proximately causing said bus to collide with the motor vehicle driven by Todd Maclarean so as to proximately thereby cause the hereinafter described injuries and damages to Claimant. 5. As a proximate result of the negligence of Contra Costa County, and its agents, Todd Mclarean's Progressive insurance policy number is 62028716 and the claim number is 06-9009395. 1 employees and other persons whose identities are currently unknown, Claimant was hurt and injured in her health, strength and activity, sustaining injury to her body and shock and injury to her nervous system and person, all of which said injuries caused and continue to cause Claimant great mental, physical, and nervous pain and suffering. 6. The claim is made in an amount in excess of the jurisdiction of the Superior Court. Dated: January 26, 2007 Sincerely, i Patty Hopson Todd Mclarean's Progressive insurance policy number is 62028716 and the claim number is 06-9009395. 2 2�bp pp o� tibb5 ��a� G> oc �7 \\E t�7 CtS .r• a � � \s..! it" Gad to a d �O Ca d �~ d CO 6N rA o ea� w 7006 2760 0005 7,665 2788 '.0 c m C) C) oc., INJ (V � '0 n 1 0 0 JA o. z .j uCIl Ilu >4 co Ln N 4-) U-) C, 15 ;�5 Lr) IA a ff 0 0 5 126u ON 0 2 t 1W1 M 41 u C) na Ef) 1c. 0 4.) 4.) � cr- 0 cn cro C=> Ujo LLS C_j EL-,:C 4i => :;N En P4 = C) QU C) Cc CO Op V— LL- Y CD 7- 4. OD U4 0 w u � 0 0 cn >4 Co 4ttlC4 �E :z L-Acc CLAiM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY 04. BOARD ACTION: MARCH 06 , 2007 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. a EB 0 2 X007 II you is your notice of the action taken � btgiven on your claim by the Board of �, FSupervisors. (Paragraph IV below), Pursuant to Government Code AMOUNT: $5 , 328 .00 COUNTY COUNSEL Section 913 and 915.4. Please note all K4ARTINEZ CALIF. "Warnings". CLAIMANT: SALLY MORGAN WELCH/FFF FRIENDS OF THE FORMERLY FRIENDLESS ATTORNEY: UNKNOWN ANIMAL RESCUE DATE RECEIVED: FEBRUARY 02 , 2007 289 HOLIDAY HILLS DRIVE FEBRUARY 02 , 2007 ADDRESS: MARTINEZ , ,CA 94553 BY DELIVERY TO CLERK ON: And EVANS & PAGE BY MAIL POSTMARKED: HAND .:DELIVERED 1210 22nd STREET, S4N FRANCISCOCA 94199 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. FEBRUARY 02 , 2007 JOHN CULLEN, er Dated: By: Deputy I1. FROM: County Counsel TO: Clerk of the Board of Su ervisors (r leis claim complies substantially with Sections 910 and 910.2. ( ) This Claiin 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: Dated: By: �c��y —Deputy County Counsel i1I. FROM: Clerk of the Board TO: County Counsel (I) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). JV. ARD ORDER: By unanimous vote of the Supervisors present: (Vj�This Claim is rejected in full. ( ) Other: I certify that this is a true and con-ect copy of the Board's Order entered in its minutes for this date. Dated:/4/4), O 4. ZO; N CULLEN, CLERK, By Deputy Clerk WARNING (Gov. code section 913) r 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 charm.See Government Code Section 945.6.You may seek the advice of an attorney of'yom• choice in connection wide this matter. If you want to consult an attoniey,you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:/Y�,Ifa4V-P 196WOJOHN CULLEN, CLERK By Deputy Clerk 12!12/2006 11:44 CONTRA COSTA COUNTY CLERK OF THE 4 914153585855 N0.856e BOAJW OF SUPERVISORS OF CONTRA COSTA COUNTY INSTR KC--TTONS TO CLALM—ANT . '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 eaeb public entity. E. Fraud. See penalty for fraudulent claims,Penal Code See. 72 at the end of this form, RE: I Claim By. Reserved for Clerk's filing stamp RECEIVED Against the County of Contra Costa 2007 FEB 0 2 F (Fill in the name) CLERK ARD NTRA S Q SUPER\JISORS The undersigned claim aim against the County of Contra Costa or theabove-named in the sum of$2 �= above-namedin support of this claim represents as follows: 1. When d* the damage or injury occur? (Give exact date and hour) 2. Where diid e gamage or injury occur?, (Include city and cou—muty) da -he '!d How di I e 3. q- 5,e ZI db,-,: use extra paper if required) �a ge or 1 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? 5 What are the names of county or district officers, servmts, or employees causing the 4� * damage or injury? 12/12/2006 11:44 CONTRA COSTA COUNTY CLERK OF THE 4 914153585855 NO.856 82 b. What damage or injuries do your claim. resulted? (O.ive :Cull extent of injuries or damages claimed. Attach two estimates for auto damage.) ' 7. Ilow was the. amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) $. Names and addresses of witnesses,doctors,and hospitals: 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT ■■■r■• ■■■r<■■■■■r■rra■■■■r■r■■■•r■■■.■••■ear■■rr■■■a••ar■a.■raarrr■■■r■ra.■■■■r■r■■r ) 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 ��-�rte ---' j (Claimaan s Signature} - T j��Gl? /Gl9�19 GLaG�I/ 6(. } (A re S' Telephone No. ��(''1��l��` )Telephone No. ■■■■■r■■rrr■■■■■■■■r■r■■•.a■■••r■■■■■■•rasa•a■■iraa••••■ear■■■■a■r■■■■raraarra■■■■■■r PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed witch the County under the Tort Claims Act, is subject to public disclosure under the California Public Records Act. (Gov. Coda, §§ 6500 et seq.) Furthermore, any attachments, addend.ums, or supplements attached to the claim form., including inedical records, are also subject to public disclosure. •■■■■.■■■r■■■■■■■■■■■•a■r■a■■■■r■•r■ar■■■■■■■�■r■rr■■■■■■■■■rrrr■■ar■ra■r■■rr■■r■.a■r NOTICE: Section 72 ofthe 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, aWiorized to allow or pay the same if genuine, any Use 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 riot 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. BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY CLAIM FORM page l RESPONSES to: QUESTION # 3 : Failure of Contra Costa Animal Services to act despite exigent Circumstances resulted in : neglect and endangerment of trapped cat on balcony of vacated building : neglect and endangerment of trapped cat on balcony through failure to evaluate and/or provide medical care; abuse , endangerment, death of one or more injured animals in unit#301; neglect, endangerment and loss of two cats from #301, failure to provide humane , timely disposal of dead cats in #301; Coverup of recovery and actual site/cause of death of 5 cats; failure to investigate and verify cause of death of 5 cats. FFF/Sally Morgan Welch is now deprived of 4 foster cats/property and companionship derived thereof. Recovery of fostering costs through adoption now moot. QUESTION #4: Failure of the Contra Costa Animal Services to initiate and investigation into Keys#410 building upon release of the building from Fire Department investigation, DESPITE EXIGENT circumstances, led to : (1) the endangerment and neglect of one live cat trapped in a unknown unit without food or water until discovered by FFF representative.(2) endangerment and neglect due to Animal Services' refusal to provide food and/or water to trapped cat, rather relying on untrained workmen from The Keys, who hitherto, had declared no cats were in the building !(3) continued neglect of trapped cat by Animal Services by their refusal to enter unit and remove cat for medical evaluation; (4) inhumane death and/suffering of injured animal(s)that subsequently died in#301;(5) possible death of one cat due to starvation by their refusal to enter#301.(6) loss of two cats from building 410 ,unit#301, whereabouts and medical status unknown. Failure of Contra Costa Services personnel to leave food and water in adjoining units and hallways led to loss of two cats, whereabouts unknown. Failure of Contra Costa Animal Services to provide timely and humane recovery of bodies of cats in#301, prevented ( intentional ?) inability to determine exact time and nature of death. Ignorance of or refusal to act in the face of exigent circumstances to investigate 410 building units and#301 resulted in all of the above#3 responses. Failure of Contra Costa Animal Services to investigate and inter-view actual participant Fire personnel and onsite personnel at time of fire led to loss of two cats, whereabouts unknown and medical condition unknown. Abdication of their responsibilities and powers to untrained Keys personnel and workmen , despite exigent circumstances, resulted in all of the above and#3 responses. CONTRA COSTA COUNTY CLAIMAN`f PAGE 2 QUESTION#6 FORM FFF and Sally Morgan Welch.was deprived of the companionship/property and fostership of healthy cats. Recovery of fostering costs through adoption now impossible. Emotional Distress and loss= $2500 Ongoing search and recovery costs QUESTION #7 Costs were computed accordingly for each cat lost for medical care and !maintenance. Foster costs per cat : food., litter per month=approx $70 per month' Transport to and from vet for maintenance care= $30 per cat Transport to and from adoption site= $35 per month for 4 fcsters. QUESTION# 8 Valerie Mark James Jarvis Pat Wehren, DVM 340 No. Civic Drive 4409 Grays Court Mike Evans DVM. Walnut Creek, Ca Concord, Ca 3340 K San Pablo Dam Rd 94596 94518 94803 QUESTION # 9 4x$70=$280 4x $30= $120 1 otal = $400 $35 transportation for 12 months=$420 Total: $820 Medical. Costs: Animal Care Clinic 3340 K San Pablo Dam Road EI Sobrante, Ca 94803 4 Foster Cats Totals: Steve $318 . Costs 7/04-12/05 Autopsy/disposal costs : $250.00 Edie $251.60. Costs 7/04-12/05 Cowboy $359.45 Costs 7/04-12/05 Rosylyn $78.95 Costs 7/04-12/05 LEGAL COSTS; $750.00 for legal research of Animal Servi ces'authori ties and powers; Production of legal opinion letter regarding such. EVANS &PAGE, 1210 22"d Street, San Francisco, Ca. 94107 ANIMPO. CARE' C1ANfC SORRANTE CA 911901 (!., 0) 222-9966 i../\x ('1i() 22:1 /8118 M v d i. c a .1. R v c o r d IA: 31.686 STHIV II; owrwd by: FR.VENUS HI-:SC UV/SAI.l,Y WEICH 2811 TIOIJDAY lill.l.,S DRV _.,Codes: MARTINEZ, CA '11,1,5. 1.9 .50 CI seal.: Te 1.e: 312 0191 13a1 aric-C., 10,`206.40 1j Cur 1 10,906.40 301);.!V: .00 1 31'-f") 60Day: 00 901)ay: 00 0 CI 1 NOLCI: 1j'1, J 11 0 C12 Not_c: ON CHART if 1.8 r i voice De.:.zc I i p 17 i 11 Gude Ql:y Price Provider ........................ lo,11 /`.':20 1)ISP: ENiSYI, V 1. 101.0 4.00 32.00 Nil) 1-'Xli- NI) GIVE I Mf. ORAIJ,Y "WICE, 1)AI.7,Y POU I!:ACII ND CAT ND Sl? ND PLEASE CAkh 24 HR IN ADVAN'1'_'I-: POR P"'PTLIS ND 1,i.L)91.1 EPA (i..FIJKVrMIA TEST) I`;2000 1 .00 61.1)0 MIN" OFF I CR v I s 1 820 1.00 M; I 1 1.30 .00 I.S.00 MI.: FECAI, F1,0TATION TEST GIARDA.A THST I I 191 G 1..00 3!'2.00 mi-: RARTOW'IJA PCH I I I IPA 1.00 J,.00 ME DISP: ME RO.NH'AZOl.,I:; TAB .1.0.1.0 E;0.00 1().50 mH I:Xll.: 2/0 1./08 MI-: GI.VE ORAUX 114 TAHIJET TWA.C;-: DA.1 IN VOR ME 1.4 DAYS. mF MM ME I?T.I.-'ASI-: CAI,L. 2.1 IfH IN AUVANCH. FOR REVILf'S MF: DISP: MI`:TR0NIDAZ0I,F.'1.'AJ3 2SOM !;0.00 1.0.,)0 ME EXII. : 2./0:1./08 ME' GJ VE 0RAI,I,Y A/4 TWWP: DALI,Y VOR MI-: 11 DAYS. ME Mm mi; Pl..HASE CAl.h 24 HR LN ADVANCE POR RI;:PIIA.S ME 19 Vj:;) FEST 1112000 1.00 55,00 111;-: i. ANIMAL CARL: CLINIC oo EL SOBRANTE CA 94803 (510) 222-9966 FAX (510) 222-7848 P a t i e n t M e d i c a 1 R e c o r d Page 1. Id: 31686 ROSLYEN Owned by: FRIENDS RESCUE/SALLY WELCH n'L..... 289 IiOLIDAY HILLS DRV r Codes: MARTINEZ, CA 94553 L Mths Cl Stat: Tele: (925) 372-0197 :.i:.. Notes: Balance: 6,142.59 Curr: 6,142.59 30Day: .00 te!'er.reri: 60Day: .00 90Day: .00 Reminders (Due Dates) weights: 0/00/00 DENTAL, 0/00/00 FECAL 0 Cll Note: 925-352-7896 ** 1/1.7/06 FELV 0/00/00 FVRCP 0 C12 Note: ON CHART #118 0/00/00 RABIES 0 Service/Vaccination Due in Next 30 Days. ** Service/Vaccination Past Due. Date invoice Description Code Qty Price Provider 12/27/05 0417255 FELINE LEUKEMIA SERIES VACC 14160 1.00 13.95 ME; 0415911IFA LEUKEMIA TEST 112000 1.00 65.00 ME Ufi ANUMAI, CARE Cl..�INIC "'OBRANTE2­_� *,'IHS CA 911803 (!i"10) 222-9966 VAX (51 0) 1: J. c c,_..o. 1`5 95 + ld: 31.685 IZM).YI-:N Owncd by: WRI -:NDS '?89 IrOt,.MAY 11TUS DRV M,K/WTf,!, Codo..;: MARTTNEV, CA 9,i 1;5 3 rt.hday: 12/2'1/03 02 Yr 1, MAI,.; cx: VEMALE CI. SLi.]!:: Iaq: Tc Lc: (9213) 3,0 0197 MO.;mcc: 10,906.,10 CU 1.1 :; 1 4 1) 3011ay: 00 00 90M.1y: 00 0/00/00 PECAI, 0 (71.3, Not-c.: 921; 0/00/00 rvl?cp 0 C,!.:2 Nm ON CHART ;1113 0 Diic_`. iti N(,Yt. 3.0 Day:;. ice/vaccl!wjr;oil P;lst: Otte. i nvoi c c Dc,�;cri.pl toll Codc QLY Pr i.(,(, I,rovidcl: /01, M I /2S5 PE.1,1NE IJ-:OKXMI:A VACC 1.11:1.60 "1 .00 13.9!, NW rz lo'; 041.591.'1 1 VA E.V11KRIVITA TFST 1.1.2000 1_00 115 00 MR ANIMAL CARE CLINIC SOBRANTE CA 94803 (510) 222-9966 FAX (510) 222-7848 ,i.) + P a t i e n t M e d i c a 1 R e c o r d Page t. + i,r '10 T Id: 31686 COWBOY ° + Owned by: FRIENDS RESCUE/SALLY WELCH 289 HOLIDAY HILLS DRV + Codes: MARTINEZ, CA 94553 + Mths I^ 0°�37 C] Stat: C. Tele: (925) 372-0197 Balance: 5,934.60 J/ J Curr.: 5,934.80 30Day: .00 Rcferrcd: 60Day: .00 90Day! .00 Reminders (Due Dates) Weights: 0/00/00 DENTAL 0/00/00 FECAL 7/07/04 - 3 LB 12 OZ 1.7 K Cll Note: 925-352-7896 0/00/00 FELV 0/00/00 FVRCP 0 C1.2 Note: ON CHART 418 0/00/00 RABIES 0 Date Invoice Description Code Qty Price Provider 12/18/05 0417264 IFA LEUKEMIA TEST 112000 1.00 65.00 ME .1.2/28/05 0417255 IFA LEUKIMA TEST 1.00 60.00 ME 04/1'7/05 0386312 BARTONELLA PCR 11193 1.00 105.00 TT 07/0.7/04 0352695 FELINE CASTRATION-RESCUE 21231 1.00 22.50 R1' ABX INJ-INCLUDED W/SURGERY 01526 0.15 RT _ 0'7/08/04 0351887. DISP: STRONGID T 1010 30.00 8.00 RT -' EXP.: 1/01/05 RTQ}�J GIVE 1ML ORALLY PER TEN POUNDS, REPEAT RT (�1� IN 10 TO 14 DAYS. RT ' SR RT \/ PLEASE CALL 24.HR IN ADVANCE FOR REFILLS RT DISP: TORBUGESIC ORAL SUSP 1.00 20.00 RT EXP.: 7/01/04 RT CIVE ORALLY 0.5ml PER 2 lbs EVERY 6-8 RT HOURS AS NEEDED FOR PAIN. RT tom. RT PLEASE CALL 24 HR IN ADVANCE FOR REFILLS RT ANIMAL CARE CLINIC 0° L SOBRANTE CA 94803 (510) 222-9966 FAX (5 10) 222-'1848 P a t i e n t M e d .i c a l R e c o r d Page 1. �.�;�.°'�%� } Id: 31686 EDIE Owned by: FRIENDS RESCUr/SALLY WELCH 289 HOLIDAY HILLS DRV ---Codes: MARTINEZ, CA 94553 2 Mths =.50 * Cl Stat: Tele: (925) 372-0197 Balance: 5,934.80 Curr: 5,934.80 30Day: .00 Referred: 60Day: .00 90Day: .00 Reminders (Due Dates) Weights: 0/00/00 DENTAL 0/00/00 FECAL 0 C11 Note: 925-352-7896 0/00/00 FELV 0/00/00 FVRCP 0 C12 Note: ON CHART 447.8 0/00/00 RABIES 0 Dat.e Invoice Description Code Qty Price Provider 12/18/05 0415911. IFA LEUKEMIA TEST 112000 1.00 65.00 ME 04/1'//05 0386312 BARTONELLA PCR 11193 1.00 105.00 TT 07/17/04 0354119 PIP TEST T-595 112000 1.00 55.00 ME 97/23/04 0354119 BOTTLE-PUPPY/KITTEN OTC 1.00 1.64 ME FELINE A/D CAN DPD 24.00 24.96 ME f V P 0. CLAiM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: MARCH 06 , 2007 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 on your claim by the Board of D Supervisors. (Paragraph IV below), given Pursuant to Government Code AMOUNT: $3, 000').000 .00 FEB 0 8 2007 Section 913 and 915.4. Please note all 000 COUNTY COUNSEL Warnings". CLAIMANT: ANN M. DEYOE MARTINEZCALIF ATTORNEY: RICHARD C. RAINES DATE RECEIVED: FEBRUARY 08 , 2007 RICHARD C. RAINES ADDRESS: GAGEN McCOY BY DELIVERY TO CLERK ON:FEBRUARY 08 , 2007 279 FRONT STREET, DANVILLE, CA 94526 BY MAIL POSTMARKED: HAND DELIVERED. FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, Clerk Dated: FEBRUARY 08 , 2007 By: Deputy If.. FROM.: County Counsel TO: Clerk of the Board of Sup rvisors (,y'fhis 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: Dated: By Deputy County Counsel 11f. FROM.: Clerk of the Board TO: County Counsel (l) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. B ARD ORDER: By unanimous vote of the Supervisors present: (v�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. DateWaA4 V 4067 JOHN CULLEN, CLERK, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection with this matter. If'you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side of'This Notice. AFFIDAVIT OF MAILING I declare under penalty of per jury that 1. am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy,of' this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated/ "W'> © -&-e PJ JOHN CULLEN, CLERK By Deputy Clerk -<---- -1BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT 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.presente:d not later than one year after the accrual of the cause of action. (Gov. Code § 911.2.) i. 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. 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 fi audulent claims,Penal Code Sec. 72 at the end of this form. ■a an HER EaEEEaEEEaaa WNW■sit NEW ME P.gamic aaaEEEEEEaNunn=IX aaaCaL'EEEEEE;a a a anEaEEEERES RE: Claim By: Reserved for Clerk's filing stamp Ann M. Deyoa REC��1/� Against the County of Contra Costa or ) FEB 0 8 2001 District) CLERK (Fill in the name BOARr, J,,SR \1 . ) ) COAITF;;,. ... COVISORS The.undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$_ 3, 0 0 0 , 0 0 0 . 0 Oand in support of this claim represents as follows: 1. When did the damage or injury* occur? (Give exact date and hour) 8/14/06 approx. 7 : 30 a.m. 2. Where did the damage or injury occur? (Include city and county) Vasco Rd. , approx. 8 . 5 miles south of Camino Diablo 3. How did the damage or injury occur? (Give full details;use extra paper if required) I• was southbound on VaEfc.o Rd. when a northbound vehicle crossed over the center line. I don't recall what happened. 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? Dangerous condition of Vasco Rd. , including but not limited to lack of adequate median barrier, lack of adequate roadway width, improper curves and climbs 5 What are the names of county or district officers,servants, or employees causing the damage or injury? unknown y6, damage or injuries do your claim resulted? (Give full extent of injuries or damages -.claimed. -Attach two estimates for auto damage.) Fingers of left hand severed, hospital and medical expenses; loss of earnings . 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or danaage.)Z" 5p pp General Damages! 1Jiedpc�af/hospital charges: $].3n.,�5a1:6; wage loss-$4 , 400/month not including latest expenses, which include hospitalization this week, or S. Names and addresses of witnesses, doctors, and hospitals: future loss of earnings . John Muir Medical Center, Walnut Creek,* CA Richard Wyzekowski 9. Lol ' ce report is not .yet completere witnesses ist t� Ire expenditures you made on account of this accident or injury: DATE TME AMOUNT . none at this time a sa aanaac aaa ana casae million aan■a.ca■a....aacaaaaa■acaa■aaacaacacaa..aaaa ac a ac a aaaaaac a[ ) .Gov. Code Sec. 910.2 provides "The claim shall be ) signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attome-0 1 Name and address of Attorney ) Richard C. Raines ) Gagen, McCoy ) (Clai.mant'S Signature) Richard C. Raines 279 Front Street ) Attorney for Claimant Danville, CA 94526 ) 279 Front Street (Address) Danville, CA 94526 Telephone No. 925-837-0585 )TelephoneNTo, 925-837-0585 OCROINERKIRMIEURN MEN 11INNUE 12 a 11 a KKR am my on Kai 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, s§ 6500 et seq.) Furthermore, any attachments,addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure, a a MR will%us REKKKK Wall aREEK a ■ NMI a.aaaa..a.....anit aaaacamacaaaacaacaaaaacCan asit aacaaamoot NOTICE: Section 73 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 count),, city, or district board or officer, authorized to allow or pay the same if genuine, any false or 'fi-audulent 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. CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: MARCH 06 , 2007 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 on your claim by the Board of Supervisors. (Paragraph IV below), J'Warnings".iven Pursuant to Government Code ection 913 and 915.4. Please note all AMOUNT: $I, 000, 000 .00 FEB p $ 2007 COUNTY COUNSEL JAY DEYOE CLAIMANT: MARTINEZ CALIF. ATTORNEY: RICHARD C. RAINES DATE RECEIVED: FEBRUARY 08 , 2007 RICHARD C. RAINES ADDRESS: GAGEN McCoy BY DELIVERY TO CLERK ON:FEBRUARY 08 , 2007 279 FRONT STREET, DANVILLE, CA 94526 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. FEBRUARY 08JOHN CULLEN, Cl • , 2007 c Dated: By: Deputy II. FROM.: County Counsel TO: Clerk of the Board of Supe•visors 01 ( his claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). O Other: Dated: By: YYZ7,c�.Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). I.V. BPARD ORDER: By unanimous vote of the Supervisors present: ( y/ 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,'L*e4606_ 91!gZ JOHN CULLEN, CLERK, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6) months from the date this notice was personally served or deposited in the mail to file a coot 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. Ef you want to consult an attorney,you should do so irmnediately. *For Additional Warning See Reverse Side ofThis Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that 1. am novv, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated://Q,7' 90X c047 JOHN CULLEN, CLERK By 7 Deputy Clerk BOARD OF SUPERVISORS OF CONTRA COS 1 A COUNTY INS'TRUCT'IONS TO CLAMMET 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 Ic.presented not later than one year . after the accrual of the cause of action. (Gov. Code § 911.2.) 4. 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 945 53. 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. If the claim is against more than one public entity, separate claims must be filed against each. public entity. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form. aaaeaQaaaataataaaMEKKK a a aawar,Bic eaeaetaetaeaasaaaaanaaeeeeeaaetaaRaMIR caaaaaecaeI E: Claim By: Reserved for Clerk's filing stamp Jay Deyoe ) gPERVISORS ED ) 2007 gainst the County of Contra Costa or ) CL District) A co. U in.the name) ) le undersigned claimant hereby makes claire against the County of Contra Costa or the above-named strict in the sum of$1 , 0 0 0 , 0 0 0 . 0 0 and in support of this claim represents as follows: 1 . %en did the damage or injury occur? (Give exact date and hour) 8/14/06 approx. 7 : 30 a..m. 2 . %ere did the damage or injury occur? (Include city and county) Vasco Rd. , approx. 8 . 5 miles south of Camino Diablo 3 . How did the damage or injury occur? (Give hill details;use extra ppap er if required) My wife, Ann Deyoe, was southbound on Vasco Rd. when a northbound vehicle crossed over the center line . 4 . What"particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? Dangerous condition of Vasco Rd. , including but not limited to lack of . adequate median barrier, lack of adequate roadway width, improper curves and climbs . 5 . What are the names of county or disticfofficers;s66iants,or employees causing the` damage or injury? unknown 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages Claimed. -Attach two estimates for auto damage.) Loss of consortium secondary to wife 's injuries . 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) General damages only. 8. Names and addresses of witnesses, doctors, and hospitals: unknown at this time. 9. List the expenditures you made-on account of this accident or injury: DATE TDVM AMOUNT none at this time a It Seca Not law"Iff oil an IKIRROMIN K monamms a MR KNEX Ralass 111111 .Gov. Code Sec. 910.2 provides "The claim shall be signed by the claimant or by some person on his ) behalf." SIfiTD NOTICES TO: (Attorney) 1 Name and address of Attorney ) Richard c. Raines ) Gagen McCoy ) (Claimant's Signature) Richard C. Raines 279 .Front Street ) Attorney for Claimant Danville, CA 94526 ) 279 Front Street (Address) Danville, CA 94526 Telephone No. 925-837-0585 )Telephone No. 925-837-0585 e,saetrsescsstaalataaaaaaaat6manila aacscsacttettcown astafirs attasseesssacc'Ex aaaaaata[ecIII 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. ■ toeassataast■s■atsacecae ■ Ewa [ceccascscteasttccaatstcescscteccstaca■tcssaasa[ecasessi NOTICE: S'ection 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 counts, 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. APPLICATION TO FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY CALIFORNIA BOARD ACTION MARCH 06 , 2007 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 III, below), California Government Code.) ) �givrn_pu�rsuant to Government Code Sections 911.8 and�9�1"54. Please note the"WARNING" below. Claimant: RICHARD KELLY . FEB 0 2 2007 ` Attorney: WILLIAM L. GONSER COUNTY COUNSEL 11ARTI144EZ C¢;L!F. Address: 3717 MT. DIABLO BLVD. , SUITE 220 LAFAYETTE, CA 94549 Amount: $54 , 590 .00 By delivery to Clerk on: FEBRUARY O1 , 2007 I Date Received: FEBRUARY 02 , 2007 By mail,postmarked on:' JANUARY 31 , 2007 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: FEBRUARY 02 , 46FIN C! LLEN , Clerk,By: DEPUTY Il. FROM: County Counsel TO: Clerk of theiBoard o 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:a`5—d�ZSILVANO 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). (vr This Application to File Late Claim is 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. DATEMaPO—A oG ,.&7)�JORN CULLEN', Clerk, By: J� 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 anycation 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:H4i 71M 91 Z4Wr JOHN CULLEN', Clerk,By: DEPUTY V. FR011I: (1) County Counsel (2) County Admiriistt ator O: Clerk of t11e Board of Supervisors Received copies of this Application and Board Order. DATED: County Counsel,By: County Administrator, By: APPLICATION TO FILE LATE CLAIM WILLIAM L. GONSER ATTORNEY AT LAW 3717 MT. DIABLO BLVD.,SUITE 220 LAFAYETTE,CALIFORNIA 94549 TELEPHONE(925)299-9199 )ren+ •-.,f+W FACSIMILE(925)299-0425 iL� i1 f E January 31, 2007 FEB 0 1 2007 CLERK BOARD OF SUPERVISORS To: John Cullen, Clerk of the Board of COh;T� ,�r,07AC0. Supervisors and County Administrator Contra Costa County Re: Claim of Richard Kelly Dear Sir: I have received your notice regarding a late claim filed in the above-entitled matter (please see copy of your letter dated January 25 , 2007) . First of all , I believe the claim is covered by a. one year Statute since it is not a direct claim for injury to persons or to personal property or to growing crops . This claim is for repairs that were undertaken on the easement in order to prevent damage to surrounding property owners . You will note that the claim was submitted to you on January 18 , 2007 and received on January 22 , 2007 . You will further note that the full extent of the major portion of repairs was dated January 19 , 2006 . Please see statement of Evenflow Plumbing that was included in the claim. Additionally, there were other submitted invoices of Expert Tree Service of January 24 , 2006 and a land surveyor' s statement dated February 6 , 2006 . It was not until this latter date that the full extent of the cost of the repairs was ascertained. Consequently! I hope that you would reconsider this claim in light of the one year Statute, together with any applicable. provisions of §911. 4 thru §912 . 2 , including §946 . 6 of the Government Code. Very truly yours, WILLIAM L. GONSER WLG:smd cc : Richard H. Kelly Contra � )till C1111e11 �.� 11 of tIle Pp(►�!!'(t cDr sll�)`_!"i'!S(D!'3 C1edr of the Hoard County AdminiMrntion Building Costa allci 651 Pine Street,.Room 106 Itol Martinez.C'Ifforuia 9455')-4068' County C'oLlnty A.C11111111SLIC (925) 335-1900 John Ginia,District I Gavle It. Uillcenca,District II N. Piephu,District III ; vacant: District IV j ,! . - . Federal 1).(Amen Disiricl \' - "1 CO Uri'fti TO: William L. Gonser 3717 Mt. Diablo Boulevard, Suite 220 Lafayette,'CA 94549 RE: CLAIM OF RICHARD KELLY NOTICE TO CLAIMANT OF LATE-FILED CLAIM (Government Code Section 911.3) The claim you presented to the Board of Supervisors of Contra Costa County, California, as governing body of the County of Contra Costa on January 24, 2007, has been reviewed by County Counsel and is being returned to you herewith because: X Your claim relating to a cause of action for death or for injury to person or to personal property or growing crops was not presented within six months after the event or occurrence as required by law. (See Government Code sections 901 and 911.2.) Your claim relating to a cause of action for anything other than injury to person or to personal property or growing crops was not presented within one year after the event or occurrence as required by law. (See Government Code sections 901 and 911.2.) Because the claim was not presented within the time allowed by law, no action was taken on the claim. Your only recourse at this time is to apply without delay to the Board of Supervisors of Contra Costa County for leave to present a late claim. (See Government Code sections William L. Gonser Re: Claim of Richard Kelly Page Two 911.4 to 912.2, inclusive, and 946.6.) Under some circumstances leave to present a late claim will be granted. (See Government Code section 911.6.) Date: JANUARY 25 2007 JOHN CULLEN, Clerk of the Board of Supervisors and County Administrator By: Deputy Clerk Enclosure CERTIFICATE OF SERVICE BY MAIL (Code Civ. Proc., §§ 1012, 1013a, 2015.5; Evid. Code, §§ 641, 664) 1 am a resident of the State of California and over the age of eighteen years, and not a party to the within action. My business address is Clerk of the Board of Supervisors, 651 Pine Street, Room 106, Martinez, CA 94553. On JANUARY 2 5, 2007 , I served a true copy of this Notice to Claimant of Late-Filed Claim by placing the document in a sealed envelope with postage thereon fully prepaid, in the United States mail at Martinez, California addressed to William L. Gonser, 3717 Mt. Diablo Boulevard, Suite 220, Lafayette, CA 94549, as set forth above. I declare under penalty of perjury under the laws of the State of California and the United States of America that the above is true and.correct. Executed on JANUARY .2 5, 2007 at Martinez, California. Depu Clerk 1:\'I'OltTUZ IS K-MGT\CI..AI M S\L.A'rE\Kel I y.wpd CLAiNI. BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: FEBRUARY 27 , 2007 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 on your claim by the Board of Supervisors. (Paragraph IV below), ' ' '' g�'ven Pursuant to Government Code . : a ctron 913 and 915.4. Please note all AMOUNT: $54 , 599. 00 !;�; i ;(i" arnings". CLAIMANT: RICHARD KELLY C C4K! 1R., ATTORNEY: WILLIAM L. GONSER DATE RECEIVED: JANUARY 24, 2007 ADDRESS: 3717 MT. DIABLO BLVD. , BY DELIVERY TO CLERK ON:JANUARY 2A , 2007 SUITE 220 RECEIVED FROM LAFAYETTE, CA 94549 BY MAIL POSTMARKED: COUNTY COUNSEL FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JANUARY 24 , 2007 JOHN CULLEN, .l Dated: By: Deputy H. FROM: County Counsel TO: Clerk of the Board of Su ervi ors ( ) This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). (t`'Glaim 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: Dated: By: Deputy County Counsel III. F OM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( Claim was returned as untimely with notice to claimant (Section 911.3). 1V. BOARD ORDER: By unanimous vote of the Supervisors present: ( ) This Claim is rejected in full. O Other: f. certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JOHN CULLEN, CLERK, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6) months from the date this notice was personally served or deposited in the mail to file a court action on this claire.See Governunent Code Section 945.6.You may seek the advice of an attorney of your choice in connection widr this matter: If you want to consult an attorney,you should do so immediately: *For Additional NN%arnhwb See Reverse Side of This Notice. AFFIDAVIT OF MAILING 1 declare under penalty of• perjury that I ani now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:'14v7!5_,a s� ' fl,�011N CULLEN, CLERK By eputy Clerk . ..,....r ,f. .•A.il. f:I�. 5. _.. • e.l."41,}.. ., .., .ay..r7_. .1...x.. -;, .T' :a%; r...-.i�.�.. ..,._T � e�� 6 .Y ,:i a.�, .,:,, ,. �'1� �:•: {a a1•��(�:xl.i� d'C��x:;:ts3!� �A.��ilS.i• ��C;"S-i�t?K:a�il��se:#'=r�=?►'��s>}?�E�_r'..�'�_'13`�•si€ >��''.^,s:..C�i"y=:.. COMPLETE •N COMPI ETE THIS SECTIONON DELIVERY xCom`plete items:;1=�2,and.3 Also' `comletek.tf Restricted elives desilecl: ' `�'� !1�� wry: '' t ._ 43 ' I d addre�son.the reverse 1 ? ssee , so.„�t1at•,we'�can r'etur•�tfie card .,;.,:�,y..e *.:•� r��•.i�� j'.r'x'zn , Y "'� B:' eceiv �b Print me ,. 1'C'��,Dat�e of'Delive. 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Restrlcteii"©elroe,7',ExtralFee. . 1?wiax"4;a° s3�.;{:,'.¢:C...F:r:.i.•,fl.���..•�;.%:•.J, , .R.;.• ,p �: a,rfi• :.a>;I..il%� '`$;�. -:a -t .;.:,t ryf ..ti:O,75Yes•�.<.,. .` �•CS�AaS�S�4Y1�=ik.•A�A�`.:. =2: Article,Number x_ '� 0'a .; . � z'. �.. 7004 1160'. 0007 .51-`l>"_ ,...z.. t r... y.n:..:...,.] ;((ransfer;from;serv+ce label)�;r� - �x�.••,n":. 3.2. .iv.es.s.l„�� etia:�.i.::..: -:..�..:•,•,w,YSi's.._..q.,.,... .•.v.e••;SNe.,:an-.,lw �5.�. - .:'T.a'�.'a!f v�`.r`,'' :'r::.3t N- r r., 5y'. :..y. _. -y::ti�T:M:;ai!Pe5r-•�t- 200.1 — ;�qd• �site":�;r '�.y5: ;sl[5:gas.,:; ?:'•�. 2001 3:tt Via= ..z, �;: F r8 1„Aug f +.' Domestic'RetUCn°Recelptr; '102595=02;M;1540 1 I ' t. WILLIAM L. GONSER ATTORNEY AT LAW 3717 MT. DIABLO BLVD.,SUITE 220 LAFAYETTE,CALIFORNIA 94549 TELEPHONE(925)299-9199 FACSIMILE(925)299-0425 J41V c�9cQogq 2 4 1?00 j January 18 , 2007 certified mail - rr otiTq� svp osT, Fq�� Office of County Counsel Contra Costa County 651 Pine Street Martinez , CA 94553 Dear Sir or Madam: I am writing on behalf of my client, Richard Kelly, who lives at 52 Evergreen Drive, Orinda., Contra Costa County, California. Mr. Kelly has a claim resulting from a ruptured pipe on a common easement he shares with three other individuals. I am enclosing a. copy of a claim we previously submitted to the City of Orinda with relevant detail attached. The City of Orinda has taken the position that they did not agree to accept the maintenance of easement from the County. It has recently come to our attention that the County .ma.y well be responsible for maintaining the easement and thus, I am submitting this claim to you on behalf of Mr. Kelly. If there is an additional claim form you wish me to complete, please send that to me at your earliest convenience. Very truly yours, WILLIAM L. GONSER WLG:smd cc : Richard .H. Kelly NOTICE OF CLAIM AGAINST"'THE CITY OF ORRINDA.,CALIFORNIA (Government Cade Secrtions 910,910.2) RETURN TO: City Clerk City of Orinda P.O. Box.2000 14 Altarinda road Orinda, CA 94563 (925) 253-4221 Claimant's Name: KELLY RICHARD H. Last First M.I. Claimant's Address: 52 Evergreen Dr. Number Strut Orinda CA 94563 City. State ZIP (925) 254-7161 Home Phone Number Work Phone Number Fax Number Name and address of person to whom notices regarding this claim should be sent(if different than the name and address provided above); Should be sent to claimant, and his attorney, William L. Gonser, 3717 Mt. Diablo Blvd. #220, Lafayette* CA 9 Date of the accident or occurrence: occurrence commenced on or about 01/01/06 Place of accident or occurrence: occurrence at 52 Evergreen Dr. Cross-streets,if applicable: General description of the accident or occurrence(attach additional pages if more space is needed): See attached statement of Claimant and see attached statement of Wm. L. Gonser. Names, if known,of any public employees causing the injury or loss: n/a 1, 3. 2. 4• Names and addresses of witnesses: n/a Name Address Phone 2. - 3. (------- y----�-- A. 41�i%form Names and addresses of doctors who treated and hospitals where injured were treated(if applicable): n/a Name Address Phone 3. 4. General deswiption of the loss,injury or damage suffered: Total amount claimed(in dollars): S 54,590.00 [Coinit--s of Statements Attached] The basis of oomputing the total amotint claimed is as follows,, Damages incurred to date: Property Damage & Related Items: VWCAMP"Os. $ Evenflow Plumbing 1/5/06 $ 1,290. Evenf IoPiu'.—mbin—g 1/19 06 4-6,200. a. $ Expert Tree Serv. 1/24/06 6,500. b. $ D. Vegvary, L.S. 2T676-6 600. total If--5r,590. (att=h Etev of daimmeno which irubsontiate these amounts,Lf avadable) We, the,undersigned, declare under penalty of perjury that l/we have read the foregoing claim for damages and know the contents thereof;that the same is true of my/our own knowledge and belief,save and except as to those matters wherein stated on information and belief, and as to them,I/we believe it to be true. DATED: Signature of claimant Signature of claimant RECEIVED in the City Clerk's office this day of 20 Signature of City Clerk or official City representative receiving this claim FOR CLAIMS RELATED TO INJURY TO PERSON OR PERSONAL PROPERTY, THIS FORM MUST BE FILED WITH THE CITY OF OR1NDA 'WITHIN SIX MONTHS FROM THE ACCRUAL OF THE CAUSE Of ACTION. A CLAIM RELATED TO ANY OTHER CAUSE OF ACTION SHALL BE PRESENTED NO LATER THAN ONE YEAR AFTER ACCRUAL OF, THE CAUSE OF ACTION. Around the fft of the year alter we had our very big storm,we noticed water erupting od of the grouted abo&A halfway dawn the slope to our common drive on the slim of our house, I wasn't an where the water was ding ftn. In checking, I determined it wasn't water from our how, pool, or watering System. I called the City of Orindoe,Public Works Department and talked to Mr. Tod Fier r, Public Works inspector. He carne out the next morning and suggested that the 10'drainage pipe that ran from the top of the hill to a culvert by.the street was leakirg and to pipe was pwbably broken. Drawings showed a drainage easement.at approximately tts pipe location. There was some erosion on the side of the Bial where the water wenn erupting from the ground. The water was running down thoe slqm to the common drive.Some of the water was Rowing over the curb on the driveway and running down to the culvert at the bohom of the drive and also across the drive intra my nothebors yard causing erasion next to his parking area.Also water for m the lemic or break in the pipe was flowing on the ground next to the cx,rtumn drive causing some erosion and soaking of the roots of a number of tri. Tod Flee ^s as mer it was that In Order to protect my property as well other properties from further erosion or oftr liability problems action should be taken. He fait that the urge two at the bottom of the slope were In jeopardy of frallinq duel to the roots being we**eed by tt'es excessive water. Ted r+ec orrimerded that we contact Evenflow Plumbing to find and fix the problem. I agreed. He railed them, explained the problem,and gave them my name. He said that they were s vary reputable exptractor and that the City had used them. Everiflow came out and suggesftd that thaey dig dawn and find the leak or,breeic. I agreed and Tod concurred. After.digging dawn some 10 to 12 f W Evenflow determined that the pipe was not only broken but also that it was not capable of carrying any or little flow and that all 140 fest of pipe should be replaced. Toil agreed with this ass earn ant. i then authorized therms to do thea work, This was approximately January 19. It was also nated that thieve were four large pine trees and one oak tree that needed to to carat drawn as removing the broken pipe and ineWlilrog the new pipe could further weaken their roft and possibly cause them to fall causing additional party damage to minors and more likely o#w properties. Tod pierner specui€ated that If the tress dict Gall that they would most likely fall and damage maigh 'Woperly and homes. Evenflow oontected Expert Tres Service,referred to therm by Teed Fl eernear,whoindicated that they also did work for the City. The tri were removed aired the 140 feet of pipe wast epiaced. loth cont ector s were paid in foil around the cerxi of January. Qam"s has been done to my I"scape and watering systema. I will need to have work done this spring to repair this damage. 'rod Fie+ner was very helpful wW attentive to this pro,4Ct. fie visited ttxe job site can a regular basis. He also assured the contractom he would gent them all pemilts that might be required. .He also had his supervisor Mark Lcvmry, Qrinda public Works Director, visit the site. I pointed out to Mr. Lowery, as I had done with Tod Fiern er that all County wW City drawings that I had seen showed a I 04 drainage easement at the epprmdmalle Motion of the 16-inch drainage pipe. It wasn't water trorn my property and it wasn't my pipe or drainage easement. However, I did wham had to be do (a: moommended by the City)to potentially protect my property, and also protect me horn any liability I might fare for not acting on a potential pmblem that I had boon made aware of. WILLIAM L. GONSER ATTORNEY AT LAW 3717 MT. DIABLO BLVD.,SUITE 220 LAFAYETTE,CALIFORNIA 94549 TELEPHONE(925)299-9199 FACSIMILE(925)299-0425 March 20, 2006 City Clerk City of Orinda 14 Altarinda Road Orinda, CA 94563 Re: Claimant: Kelly, Richard H. Dear Sirs: I represent Richard Kelly of 52 Evergreen Drive in Orinda. I know that the City is familiar with this claim. It would be appreciated if you would process this claim and let both Mr. Kelly and me know of your conclusions. If you have any questions, please let me know. Very truly yours, WILLIAM L. GONSER WLG:smd E VENFL 0 W PL UMBING CO INC. 2033 National Ave. Unit B, Hayward, Ca 94545 LIC# 735990 Phone # 5101782-3649 Fax #510782-6927 PROPOSAL SUBMITTED TO DATE P.Ofi Richard Kelly January 5,2006 STREET ADDRESS PHONEMAIL 52 Evergreen Drive 925/254-7161 T CITY,STATE,ZIP START DATE APPROX.COMPLIETION DATE Orinda,Ca 94563 CROSS MEET 308 TYPE: USA# Tara WE PROPOSE THE FOLLOWING WORK, Open trench approximately one four foot section of 12 inch storm sewer line. We will inspect existing pipe Once exposed. This estimate includes parts and man labor. Job Total: $11290.00 Note.- It additional work is needed over and above this contract scope and or specifications an additional estimate will be submitted to the property owner for prior approval. WE PROPOSE HEREBY TO FURNISH MATERIAL AND LABOR,COMPLETE IN ACCORDANCE Wn'HABOVE SPECIFICATIONS.FOR THE SUM OF: One Thousand Two Hundred Ninety D Hari and Zero Cents PAYIMT TO BE IMMIE As FOLLOWSt so S DOWN 00%WNW MITAUrION"%V"X cor"MMON All material Is guaranteed to bo as specified 71 "O"T to be completed in a workmariliki;manner iscooirding to standard practices. Any alteration or deviation Authorized ftn above aperirivativns involving owe costs will be executed Only upon Signature written ordcro,and will become on extra eharge over and altivve the A*timate. All agramentA contingent upon strikes, accidents or delays beyond our controt Owner to,carry necessary Insurance. Our workers are hilly oovcmd by Nntc:'This proposal may be withdrawn by us if not accupied within 13 days. Woriu-nan's Compensation insurance. NOTICE We will start this job immediately due io the emergency nature of the job InitialiZing Will W11iVV your right to cancel within three days "Unlet the Mochanics'Lien Law(Califomia,Code of Civil Procedure,Sectior 118 1 at wqj,any contractor,subcontractor,laborer,supplier or other person who helps to improve your property but is not paid for his work or supplies,has a right U21%ticnaky per month will be charged on past One accounis. to 04010119 claim NP11111 YOW PtOPOFtY. This nwittis that after a court hearing, your property could be sold by a court officer and the proceeds or the sale used to satisfy the indebtedness. This can happen even if you have paid your own contractor in full,ir the IftatriactoWr laborer,or s2glier rimml un aid." ACCEPTANCE OF PROPOSAL. The above prices,specifications and conditions am itatiiWory and we hereby accepted. You an authorized to do the Signalum work as specified. Payment*0 tic Mile as outlined above. Dow of Acceptance Signature,_._____ ' EVENF"L0W PLUMBING CO INC 2035 .National Ave. Unit B, Hayward, Ca 94545 LIC # 735990 Phone # 5101782-3649 Fax #510782-6927 PROPOSAL FuRm'1'RD To DATE Richard Kelly January 19, 2006 Estimate#3 STREET ADDRESS PHONE FMAiL 52 Ever en.Drive 9251254-7161 CITY,STATE,ZIP START DATE: APPROX,COMPLETION DATE: Orinda, Ca 94563 CROSS STREF'T 10B TYPE: USAN Tara WE PROPOSE THE FOLLOWING WORK. Replacement of approximately 140 feet of 16 inch asbestos concrete storm drainage pipe. in order to perform above work it wilt be necessary to remove four large trees from site. Once trees are removed we will hand excavate around all public utilities. We will excavate wiL'r backhoe once clear of all public utilities. We will haul away all spoiled native soil to landfill management. We will import crushed drain rock and bed trench line. We will install 140 feet of 16 inch plastic Storm sewer line. We will backfill with code approved materials. We will cleat and remove all job related debris from Site. This estimate includes parts,man labor, materials and equipment. Price is set $330.00 per foot. Jab Total: $46,200.00 WE PROPOSE HEREBY TO FURNISH MATERIAL AND L,48011,COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS,FOR T14E SUM OF: FoM Six Thousand Two Hundred Dollars and Zero Cents pAYKMT To E19 MADE AS tlaor towat so%DOVM atas%TMOIN INSTA LTION soar.V"W CONWLM Ni All MoUrW is guarantied to be as specified. All work to be completed in a wofbnwJiks nawmer ttaoording to standard practices. Any&Iteration or deviation Authorized Onto above spat:ilft:ations Involving em costs will be executed only upon Signmurt_. written orders.and trill become en extra charge over ttad above the estimate. All Agreements oondrip t upon strikes, accidents or delayi beyond our control. Owner to carry mcetsttry insurance. Ourworkers, are filly covered by Note This proposal ntay be withdrawn by us if not accepted within LEdays Wotkrrtan's Compensation Inswance. NOTICE wt wilt 3%n%no)ob immedistety due to aha emwgeney nature of the job. Initializing will waive your right to cancel within three days. "Under the MocitaAics'Lien Law(California Code a'Civil Procedure,Section t 1191 el set{,),any contractor•subcontractor,laborer,supplier or other parson who helps to improve your property but is not paid for his work or s. r)iJL W a nght 1 1/2%penalty per month will be chargee on past due accounts. nog.... ...._.__....___.,.._.... Lsed m Tod fiernar — + Pubhc U:orks Insprdrtor do P G. t3os 2000 — EVENfLOW PLUMBING, INC. 14 AiWrinda no.,, OrinW" CA =9h5;r3 Gary 01modana ;?25•2;3•4Q36 - Senior Estimator NNW ;Z5-76!'•5757 C,i, Fox SBS.FS3 ?h4S' (510)562-1363 CCL No.755990 E'rrtLlil: iF:er,er®ri.orinrio cct.us r h7NPhRI TREE SERVICE INVOICE BRIAN, c3A`TES � Date Rep invoice No. Ccrtilicd eltborist WC-3527 P.O.Boit I2S6 • Orinda, CA 94563 • Phone 925 254-8733 1/24/2006 BG 0301,1085 Mobile$10 9I5.17,42 flax 425 254-5645 • Liconac#621402 PCC#QL So583 J Fay by VISAt`t cW=X9=X ...k Ill To: Eilling Address:. Richard Kelly r.�ra�,�,� 52 Evergreen Drive City:..,_,�.�'� ____State 2i,:I . Utinda,CA 94563 q Signature �'� J 22 P.U.No. Terms Contract No. I7ue on receipt 4550 DESCRIPTION QTY RATE AMOUNT Remove 4 Monterey Pines and leaning live Oak.Grind stumps to facilitate excavation. i 6,5000) 6,500,00 Work is complete. 2-hank you for your business. TOTAL $6,500.00 "Under the Mechanics'lien Law(California Code of Civil Procedures 1,.81 et seq.),my concrac:or,subcontractor,laborer,supplier or other person who hellos to irnprov4 your property but is nor paid for his work or supplies.has the tight to enforce a calm against vour proFerty This means chat,After a court hearing,your property could be sold 6Y a court officer and,.he proceeds of chc sale used to swisfl ch' e indebrecness. This can happen even if vnu have paid your own contractor in full,if the su!actrncraccor.laborer,or supplier remains unpaid." Post Office Box 1236 Grinch, California 94563 ` phone 925 2, 54 - 8733 Office Fax 925 254-5645 #kS21402 Shop t-ax 5i() 5=10-()923 best Control Ap.Dlicarw•i_icensc#Q)1_jt?5S3 DONALD VEGVARY, L.S. LAND SURVEYOR 3927 Mt. Diablo Blvd. # 398 Lafayette, CA 94649 (926)947-1051 --------Fax (926) '832-1026 Febr=7 6,2006 Riobard Kelly 52 Evergreen drive Orinda,CA 94$63 Re: 52 Evergreen Drive,Olinda Assessor's Parcel Number- 268.462.001 Job i wnber: 0603 Dear Mr.Kelly, Find enclosed- 9 2 copies of your"Vorner Record" Total amount now due- 5600. Please do not hesitate to cab me with,any questions or concerns, Thank you, � � lot 1� 1-4 ` � N x-. � •r1 - d1 M Q'. CJ CD 5 . N a a � ttS U n.. v � N � N CD`C. p O N W mO A 10 O N U h t t � s r M f (o' ills t 4A O N c iA to cn N t �o to N a N v h rr.. I"