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HomeMy WebLinkAboutMINUTES - 05152007 - C.15 CLAiM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY �� /Yr BOARD ACTION: MAY 15, 2007 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and-Boar d Actio All Section references are to ) The co of this document mailed to �"1�i �t\r•�� �°'t h� PY Cln•fo� toveinment Codes. ) you is your notice of the action taken APR 16 2007 on your claim by the Board of UNLIMITED JURISDICTION AND IN AN Supervisors. (Paragraph IV below), COUNTY COUNSEL AMOUNT TO BE DETERMINED AT TRIAL. given Pursuant to Government Code MARTI F_Z p'L4� ALSO DEMANDS $1,500,000 TO CONCLUDE Section 913 and 915.4. Please note all AMO l: THIS CASE "Warnings". CLAIMANT: ANN CONROY BORDEAUX ATTORNEY: WALTER C. COOK DATE RECEIVED: APRIL 16, 2007 LAW OFFICES OF JOSEPH D. O''SULLIVAN APRIL 16, 2007 ADDRESS: 1500 — 20th STREET, BY DELIVERY TO CLERK ON: SAN FRANCISCO, CA 94103 BY MAIL POSTMARKED: APRIL 13, 2007 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. APRIL 16, 2007 JOHN CULLEN le,k Dated: By: Deputy If. FROM: County Counsel TO: Clerk of the Board of upervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 9.10 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: 41 1 -7-0-7 By: O QfQ�, t-- 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. OARD 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 this date. Dated:/t-/*,y /<AOHN CULLEN, CLERK, By eputy Clerk WARNi (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. [f 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 tinnes 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 ZW JOHN CULLEN, CLERK By Peputy Clerk ®vE>�rM>ENTAg, CLAIMAP7-VED'���, 7 Dors TO: Contra Costa County co 0. RS c/o Clerk of the Board of Supervisors, Room 106, County Administration Building, 651 Pine Street, Martinez, California 94553 CLAIMANT: Ann Conroy Bordeaux, Date of Birth 1-14-39 CLAIMANT'S c/o her attorney, ADDRESS: Walter C. Cook LAW OFFFICES OF JOSEPH D. O'SULLIVAN 1500 - 20th Street, San Francisco, CA 94103 CLAIMANT'S c/o her attorney, (415) 920-0423 PHONE NO. ADDRESS TO Walter C. Cook, WHICH LAW OFFICES OF JOSEPH D. O'SULLIVAN NOTICES ARE 1500 - 20th Street, San Francisco, CA 94107 TO BE SENT: DATE OF October 17, 2006 OCCURRENCE PLACE OF Olympic Blvd. 5 feet East of BridgefieldRoad, Walnut Creek, OCCURRENCE California. See attached police report. HOW DID See Attached Police Report, Exhibit A. An East Bay Connection ACCIDENT van drove too fast for conditions, and ran into one car which was TAKE PLACE: then forced into the car driven by claimant. Contra Costa County is responsible in some manner for the operation, condition, training, licensing, inspection, and/or regulation of East Bay Connection and/or its drivers, and Contra Costa County breached the standard of care and caused claimant damages with respect to each of those responsibilities. Govt. Claim: Bordeaux v. Contra Costa County, et al. Page I TO: Contra Costa County c/o Clerk of the Board of Supervisors, Room 106, County Administration Building, 651 Pine Street, Martinez, California 94553 DAMAGES Cervical Vertebrae Fracture, soft tissue injuries, and associated pain SUFFERED and suffering. Claimant has been immobilized since the accident, BY and is being monitored closely with respect to future possible CLAIMANT: surgery to fuse and/or otherwise correct the fractured vertabrae. ITEMIZED Place Date Amount EXPENSES: John Muir Hospital 10-17-2006 through To Be Walnut Creek present. Determined Other Medical 10-17-2006 through To Be Providers present Determinde TOTAL To Be Determined DEMAND: Claimant's past and future medical expenses, emotional distress, pain and suffering, and wage loss, in an amount above the jurisdictional limits of the Superior California, Unlimited Jurisdiction, and in an amount to be determined at trial. Claimant also demands $1,500,000 to conclude this case. Dated: LAW OFFI E F J SEP D. LIV N By: Walter Attorneys for Claimant Govt. Claim: Bordeaux v. Contra Costa County,et al. Page 2 a STATE OF CALIFOkNLA TRAFFIC COLLISION REP( O CNP 555 Page 1 (Rev.7-03), OPi 061 e_'k Page M PECl/ CONDITIONS mmutR NTRRim CID' A21'NU --- AIOICML DISTRICT IACALRLPlMBFR uv , t w�tNur e,ersrk?! Oa . .1.11M.1.11MCOUNTY • PVIdBCR RuI[R HtR - REPORTING DISTRICT BC-AT NISpENE0.VIX1 - 0 nc� TR A CZ6,A2 COLLISION OCCURRED ON W. DAY YEAR TRME IYMRq'; NCiCM OFFICER I.D. Z !� KJ 01 - 6Wp . r F- 1MREPOS7 INFORMATION - DAYCFWEEK TOWAWAY MOTOGRAPHS BY: NWONE USM(5W T F S [BYES D NO FEET/MILES OF 0 AT INTERSECTION MATHA STATE NAN REL OR: S FEETARRES OF 15R!,o Sf,��fllrela AO YES NO I PARTY NEpWSUCENSE NUMBER STATE .YA:;b •qIR BAG ;SAFETY Mull VEH.YEAR MAKEMOMUCOLOR LICENEP.NUMBER STATE 1 J tOJ� _L/i� '! ... .�QDf4�f�/17�1Gu/fl...i(a-l!J.I .Ca.t� '... DNVER NAME MAST,NIOOLE LAST) - f'^r,A `^ T/^ I� _ �/ •i i OWNERSNAME ❑ SAME AS DRIVER PEDES- STREEN ADDRESS f - ,•Y TRIAN �! .A �T 113 F T OA... &4 __ OWNFR'SADORESS SAME AS DRIVER PARKED CRYATATEIZB / VENIRE - Q '/Y 44 �y vs( (r(/ �[ N LIT ❑ •4 -C - DISPOSITpH VEFIICIE ON ORDERS OF, ❑T�F FILER Dq DRIVER❑OTHER BICY-. SEX HAIR EYES "Elam WEIGHT �BRTHDATE RACE ( Ml T t,,,�, aA.•� DRY Y f `J " 470 ❑ r* AlAlvl W16o W •. • PRIORMECHAMC&OEFECTS: NOREAPPARENT REFER TO NARRATIVE OTHER H�OME PHONE - BLISWESSPHONE VEHICLE IDENTIF'W"NUMBER: ❑ \ !ZS) 63'6 - x'533 1 GO ^ Zo VEHICLETYPETE VEHICLEDAMAOE SHADE WDAMAGEDAREA INSURANCE CARRIER _ P(1LIC N'JNSER - ❑NONE 0 MINOR ML L a Q D. ❑MAJOR❑ROLL-OVER ` OIR OF TRAVEL ON STREET OGMIGHMMM 9PEEDUWT G DDT / Z_ AIL . 5- CAL-T TCP/P= MGM% PARTY ORIVER'SUCENSE NUMBER - STATECLAKS ARTBAG jSAFETYEOUIP. VEH.YEAR EUKEMODEUCO - :K-ENSE MMBER STATE 2 Y DRIVER NAME(RRST,NIODLEUST) . . .'E-Y. .^I•�•-:...I.C.rJ��.R..., c UAM^R'SNAME .. �VI SAME AS DRIVER PEDES- STREETADDRES6 TRUN - ❑ to OMAdERSADDRESS F\7.SAME AS DRIVER VFARKEDEHICLE CITY)STATEQIP ❑ - L%SPOSRDN OF VEHICLE ON ORDERS OF: _ W OFFICER DRIVER OTHER CLfST Y. SEX HAIR EYES HEIGHTSid We1GHT - BDTNDATE RACE A ,. 7 ..A/ q 544-27.47 .-:4. a _ am DRY .�T mfi ❑ .1 a Ma `4.1 PRIORNMRANIGALOEFECTS: IM NONE APPARENT REFER TO NARRATIVE OTHER HO PHOLE'�y( PFONE VEHICLE DEMPICATION NUMBER: El14 RII • y/2_ BUSML99 m MO VEHDLETYPE DESORDEVERICLEDAMAGE SHAOEINDAMAGEDAREA WsuRANCE CARR✓ER " POUCYryUIMR DUNK ONONE DMINOR AAAd m s" MOD. MAJOR❑ROLLAVER DIR OF 7RA EL ON STREET IWMIIEIµµN.�MTY / y�/ ,! SPEED LIMIT F . M AIw Yy76wV p+ CA OOT d GAL-T TCp/pSC ML--MK_ PARTY DRIVERS LICENSE NUUBER' STATE CU158 AIRBAG- --;ttAFETY EQUIP. V9l YEAR MAKEAMODEMCOLOR LICENSE NVNBER STATE 3 -n'1sn144 ..._-d/...r� 3F�T��/ �✓�-... w1vat NAME(RRST,MIDDLE,MST) ST) r� e-azyg,2191 15och icA OWNERS NAME SAME AS DRIVER PEDES STREET ADDRESS TRIAN - - CWN GADDRESS fC]SAME AS DRIVER PARK ED VpEH1IGTYISTATE21P I� O.E //}} DISPOSITION OF VEHICLE ON ORDERS OF: .AJ I N .. OFFICER DRIVER❑OTHER IN CUST: B�r.^s«NAIN' 'HEIGHT WEIGHT BIRTHDATE RACE ❑ MO WY YRY bA y .,, PMR MECFV•NGL❑EFECTB: NONEAPPARENT r I REFER TO NARRATIVE 07 ME`PIRN ••."'"'�f !�J.. q. BU;JINESS LNiONE .. '. VEHICLE DWIFDATON NUMBER; " !(Q �� • — '/^aid i� G _ - VOLICLETPE DESCRIBEVEHICLEDAMAOE WAGE IN DAMAGED AREA *+aryceGlOAER""- 1,01.1GYRUMBER - .. - .. [:]UNK DINIONE []WHOR MOD. MAJOR,ROLLOVER � . WOF(T/R�tAVBIr OK'STMEET Y SPEED LBdIT DDT -T TCP.PSC _Mcw0 PREPARERS NAME^^-� ^"'^^'""` OISPAI CH N05TFIE0 REVI NA DATE REVIEWED / A i?ns �]No ❑NAA ` _ - 0555 703RD Exhibit to Governmental Claim STATE OF CALIFORNIA TRAFFIC COLLISION CODINCO O CHP 555 Page 2(Rev.7-03 OPI 06'. Page 2, K AATEOF COLDSIDN(MD. .DAY YEAR) RTdER10111 �NGCp OFFICER LO, —i NUMBER -ass 93a 3f _ _ OriTERS NAME OWNERS ADOPEW NOTFIED PROPERTY DYES No DAMAGE DESCRIPTION OF DAMAGE SEATING POSITION SAFETY EQUIPMENT INATTENTION CODES OCCUPANTS L-AIR BAG DEPLOYED 111CC BICYCLE.HELMET A-CELLPHONE HANDHELD ^ A-NONE UI VEHICLE M•AIR BAG NOT DEPLOYED DRIVER PASSENGER B-CELLPHONE KANDSFREE B-UNKNOWN N•OTHER V-NO X-NO C-ELECTRONIC EQUIPMENT C•LAP BELT USED P-NOT REQUIRED W-YES Y-YES D-RADIO/CD D-LAP BELT NOTUSED - - E-SMOKING 1 2 3 1-DRIVER E-SHOULDER HARNESS USED - - F-EATING Q $ G 2T06-PASSENGERS F-SINJULDERHARNESS NOT USED CHILD RESTRAINT EJLC'L@�FROM VEHICLE G-CHILDREN 7-STATION WAGON REAR G-LAIVSHOJLDER HARNESS USED 0-IN VEHICLE USED D-IROT EJECTED H-ANIMALS B•REAR OCC,TRK.OR VAN H-U05HOULDER HARNESS NOT USED R.IN VEHICLE NOT USED I-FULLY EJECTED I-PERSONAL HYGIENE 9-POSITION UNKNOWN J-PASSIVE RESTRAINT USED S-IN VEHICLE USE UNKNOWN - 2-PARTIALLY EJECTED J-READING 7 O-OTHER K-PASSIVE HESiRAINT NOT USED, T-IN VEHICLE IMPROPER USE - 3-UNKNOWN K-OTHER U-NONE IN VEHICLE ITFMS MARKED BELOW FOLLOWED BY AN ASTERISK J-)SHOULD BE EXPLAINED IN THE NARRATIVE. PRIMARY COLLISION FACTOR TRAFFIC CONTROL DEVICES SPECIAL INFORMATION MOVEMENT PRECEDING LIST NUMBER N OF PARTY AT FAULT 1 2 3 1 2 3 COLLISION A vc s[pupvquTc¢ -cnm A CONTROLS FUNCTIONING A HA7ARDOUS MATERIAL A STOPPED 1-♦ _ YES B CONTROLS NOT FUNCTIONING' B CELL PHONE HANDHELD IN USE _ _B PROCEEDING STRAIGHT B OTHER IMPROPER DRIVING`: C CONTROLS OBSCURED C CELL PHONE HANDSFREE IN USE C RAN OFF ROAD D NO CONTROLS PRESENT/FACTOR• D CELL PHONE NOT IN USE D MAKING RIGHT TURN C OTHER THAN DRIVER' TYPE OF COLLISION E SCHOOL BUS RELATED _E MAKING LEFT TURN D UNKNOWN' I A HEAD-ON - F 75FT MOTORTRUCK COMBO F MAKING UTURN B SIDESWIPE G 32 FT TRAILER COMBO G BACMNG C REAR END H H SLOWING I STOPPING WEATHER MARK J TO 21TEMS D BROADSIDE I I PASSING OTHER VEHICLE A CLEAR E HIT OBJECT J J CHANGING LANES B CLOUDY F OVERTURNED K - K PARKING MANEUVER C RAINING - G VEHICLE I PEDESTRIAN L L ENTERING TRAFFIC D SNOWING H OTHER': M M OTHER UNSAFE.TURNING E FOG/VISIBILITY FT. IN N XING INTO OPPOSING LANE F OTHER. MOTORVEHICLE.INVOLVED WITH 10 0PARKED G WIND• A NON-COLLISION - P MERGING LIGHTING B PEDESTRIAN Q TRAVELING WRONG WAY A DAYLIGHT X C OTHER MOTOR VEHICLE 1 2 3 OTHER ASSOCIATED FACTOR(S) R OTHER': B DUSK•DAWN D MOTOR VEHICLE ON OTHER ROADWAY (MARK I TO 2)TEMS) C DARK-STREET LIGHTS E PARKED MOTOR VEHICLE vOKCTWVIN wm. an rs£A y� D DARK-NO STREET LIGHTS F TRAIN •.a ND E DARK-STREET LIGHTS NOT G BICYCLE vcpecnmviEulnoN: CITED❑ YFS FUNCTIONING' ANIMAL: 'IM "+ OND H SOBRIETY•DRUG ROADWAY SURFACE `. vcaemionMOo TAN: aTrur� 1 2 3 K I TO AL YEs. (MARK 1 SI 21TEMS) A DRY I FIXED OBJECT. �. _ No B WET D " ''' '�K* A HAD NOT BEEN DRINKING C SNOWY-ICY J OTHER OBJECT: I I IE VISION OBSCUREMENT: B HBD•UNDER INFLUENCE D.SLIPPERY MUDDY OILY ETC.1 F INATTENTION': C HBD-NOT UNDER INFLUENCE' ROADWAY CONDITION(S) G STOPS GO TRAFFIC ID HBO-IMPAIRMENT UNKNOWN' (MARK I TO 21EMS) PEDESTRIAN'S ACTIONS _H ENTERING I LEAVING RAMP E UNDER DRUG INFLUENCE' A HOLES DEEP RUT' X A NO PEDESTRIANS INVOLVED I PREVIOUS COLLISION IF IMPAIRMENT-PHYSICAL' B LOOSE MATERIAL ON ROADWAY' . B CROSSING IN CROSSWALK- J UNFAMILIAR WITH ROAD I IG IMPAIRMENT NOT KNOWN C OBSTRUCTION ON ROADWAY' AT INTERSECTION K DEFECTIVE VEH.EQUIP.: CITED H NOTAPPLICABLE D CONSTRUCTION-REPAIR ZONE C CROSSING IN CROSSWALK-NOT '❑yes I SLEEPY/FATIGUED' E REDUCED ROADWAY WIDTH AT INTERSECTION Elmo F FLOODED' - D CROSSING-NOT IN CROSSWALK L UNINVOLVED VEHICLE G OTHER': E IN ROAD-INCLUDES SHOULDER M OTHER' _ H NO UNUSUAL CONDITIONS F NOT IN ROAD N NONEAPPARENT G APPROACHING/LEAVING SCHOOL BUS 0 RUNAWAYVEHICLE SKETCH G' C`�tY11�K P�FfQ T f�0 .MISCELLANEOUS IND;CATENMTH DOT ILL � sls � ID I RD 9D CR CRN9:_______--- �3 N/67 l I9C CHP !'il y' .-.DA PD/SO b w�� _.._CT OTHER OSP 03 79147 STATE CF CA!_IFORNIA - - - INJIJR9D/WITNESS!PASSENG� Page ,f CR?555`Pege 3(Rev,1-03) OPI D61 DM.TE OF!:OLIsloI"I^MC` uA^ 'nj R) TIME(2T � NCICD �Q — --0FICi�LD. � E NUMBER - f JU 1 3 i rnmess PAssENGEa EXTENT OF INJURY("X"ONE) _�_ I INJURED WAS("X"ONE) PARTY SEAT AIR IS FET v PGE SEX - —. AlAIN DRIVER pA58. PED- BICYCLIST OTHER UM8 P08. BAG IEOL`IP. INJURY MJURY INJURY OF PAIN NAME I D.O.R.I ACDF..SS IELEPHONE —irz to-za-z3 t7 of -fV�A �r F2/Avui c e`eic cid -ice-J (INJURED ONLY)TRANSPORTED BY: TAKEN TO. DESCRITE INJURIES PAA ❑VICTIM OF VIOLENT CRIME NOTIFIED ❑ ofz ❑ ❑ ❑ OJCAIIII ❑ 1111 1 It/ 6 , - o NAME 10.D B./ADDRC) f I _ U' �� �� C TELEPNOIJE '\ITFA Aj C (INJURED ONLY)TRANSFOR{ED BY: _ TAKENTUJ DESCRIBE INJURIES - ,A PA ❑VICTIM OF VIOLENT CRIME NOTIFIED ❑# 2 17-3 1 YM I ❑ 1 ❑ 1 El 1 2 IEII!RJIE:ll ❑ ❑ NAME l0.0.B./ADDRESS - TELEPHONE IIWUR ONLY) SPORTED BY: TAKENTO: DESCAJBE INJURIES ❑VICTIMOFVIOLENTMINWNOTIFIED ❑ ® 14X.).l F 1 ❑ 1 ❑ I ❑ I ,® I ❑ 10 10 1 ❑ 1 ❑ I 1 17 6 : " Q NAM1E/D.O.B.IADDREBE �, - TELEPFKINE PFE wtCL. C+ C (INJURED ONLY)TRANSPORTED BY:I< Fu CA AAAKEN TO;Sr-Sr-Cry (12- -23 2(-- DESCRIBE AUL)RIES s ❑VICTIM OF VIOLENT CRIME NOTIFIED ❑# ❑ y3 F ❑ ❑ ❑ ® 1 xi ❑ ❑ ❑ ❑ iz t 'L C3 NAME I D.O.B.I AD Se - TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKENTO: - I DESCRIBEINJURIES P4 To k4eciz- VICTIM OF VIOLENT CRIME NOTIFIED ❑" ® S F ❑ ❑ ❑ ❑ 1010101 ❑ i ❑ 12 1 4/ IQ :� 4 NAMEl D.O.D./AWRESS TELEPHONE fL. A IZ ^2 3 0 A5 (INJURED ONLY)TRANSPORTED BY: TWEN TO: DESGRIIE WuRffs ❑VICTIM OF VIOLENT CRIME NOTIFIED PREPARERSNAME Ip.NUMBER MO. DAY YEAR .I REVlEWER5 NAME MO, DAY YEAR STATE OF CALIFORNIA IN LURED!WITNESS/PASSENGE� GHf'555'Page 3(Rev.1-03) OPI 061 raga or DATED COLLISION O. OAY YFAR) TIME(24n0) NC!CM OFFICER LO. - NUMBER - ��-1 - 3 IT 3 z YnTNEss PASSENGER EXTENT OF iNJURY("X"ONE) INJURED WAS('X"ONE) PARTY SFla AIR 'SAFE ONLY ONLY AGE 'SEJECTED IX FATAL SEVE0.E OTNFR VISIBLE COMPLAINT NUMBE PUS. BAG EQUIP. INJURYINJURY wNRY OF PAIN DRIVER PASB. PEO. BICfCLIST OTHER ' ❑# �'� ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ z 3 1 0 NNwG/o.O.B.IADpRESSS.. TELEPHONE FA- MQ/L549 / ��V/ -Iry INJURED ONLY)TRANSPORTED BY: _ TAKEN TO: DESCRIBE INJI!RIES ❑VICTIM OF VIOLENT CRIME NOTIFIED ❑# ® Y� ❑ ❑ ❑ I ❑ I ❑ I ❑ I ❑ I ❑ I ❑ :z 2' Nti ;2 1a NAME I D.O.S./ADDRESS - TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIEB ❑VICTIM OF VIOLENT CRIME NOTIFIED- ❑# ❑ �I rn ❑ ❑ 1 N ❑ IE] Ifkl [ll ❑ ❑ z s a NAME/O.O.B./ADDRESS - TELEPHONE (11 I 0ONLY)TRANSPIX2TED BY: TAKEN TO: cOWN K 2 ' C/ !7 DESCRIBE INJURIES G ❑VICTIM OF 410LENT CRIME NOTIFIED ❑# ElG 11 ❑ El ® ❑ ❑ ElElL 0- NAME f D,O.B./ADDRESS TELEPHONE -3 (INJURED ONLY)TRANSPORTED BY: TAKEN TO: lira R �UEfH! DESCRIBE MJURAES 9 ❑VICTIM OF VIOLENT CRIME NOTIFIED ®# ❑ Dom ❑ ❑ ❑ ❑ ❑ a ❑ ❑ o NAME/D.O.B./ADDRESS TELEPHONE o �-L o b- z- 31 1/5- € a—1 VntLf-zac A `tV$-k 17NIURED ONLY)TRANtPORTEO BY: TAKEN TO: DESCRIBE INJURIES ❑VICTIM OF VIOLENT CRIME NOTIFIED ❑" ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1 ❑ I ❑ I ❑ NAME D.O.0. ADDRESS TELEPHONE IINJURFD ONLY)TRANSPORTED BY. TAKEN TO: CESCNBENLURIES ❑VICTIM OF VIOLENT CRIME NOTIFIED PREPARERS NAME I.O.NUMBER M0. DAY YEAR REVIEWERS NAME W. MY YEAR 4. STATE OF CALWORNIA FACTUAL DIAGRAMPage Oot CHP 555 Page 4(Rev.1-031 OPI 061 _ 0 -- DATE _DATE OF COLLISION(MO. MY YEAR) TIME(IAOD) NCICe OFFICER I.D. _— NDIASER D b6-17-0r. 1 t 3S 193 2Q 1 11.3n _— ALL MEASUREMENTS ARE APPROYJMATE AND NOT TO SCALE UNLESS STATED(SCALE v I --niamp) r no E1,6 INDICATE NORTH V;3 IRA dz 6RI DC E REED P0.EPARm BY I.O.HNMBF.R MO. DAY YEAR REWMMM NAME M. DAY YEAR �oGM i3t L?"Ek�a . — _ �osP OSP STATE OF CALIFORNIA O - O NARRATIVE/SUPPLEMENTAL r •CHP 556(Rev 7.90)OPI 042 _ _ - Page'b _ _ ? DATE OF INCIDF.NT/C:CURRENgE, TIME(2x00) NCIC NUMBER OFFICER LD.NUMBER - NUMBER lo� g32-q tl %•ONE '%'UNE TYPE SUPPLEMENTAL('X'APPOCAPLL) Narrative r Collision report ❑BA update ❑Fatal ❑Hit and run update ❑Supplemertal ❑Other: ❑Hazardous materials_❑School bus ❑Other: GITY/CDUNTYlJUDICIAL DISTRICT REPORTING DLSTR1CTISEAT CITATION NUMBER Ccs)'tMA 3 AP LOCATIOWSNRdE6T - STATE HIGHWAY RELATED _ Q yYb Piz- 6 tufo A f l�2Id$ ice} ®,Yes ❑No 1, E5 CAI : 2. S 6. P&O xf,Vsr 7. St3P 5f 8. OO R t K It jA( 9. V5 .5iaje 10. t G f e 12. 13. 14. CG e 15. _ 16. L 17. 20. r' bL me,-e- c 21. Ao r rXf fgo-Lqv7-1,om 22. 23. L U 24. 25. 1 n.ju 416 26. _ P. QLQ"4A U-0 .elu f" dl= 621 L7$f FIfLQ /�Q �frt/D 91,flDl"' 27. n W oL rnPf� 15Lu0 28• R%Art_T)nS w AZ•,rcauNd ita Ql / w�al- T�iE -,f'�d 1pRc�Lc.�s�aT/4w 29. ._` Lr/y£ ©t &)4jEJ:1f1b AA A&D Ye 72fiC ;fAWW 30. �/��F oF c5k222pfc- 31. PREPARER'S NAME AND I.D.NUMBER - DATE - REVIEWEA'S NAME DATE f2a `tG /Oar. !o . . Use previous editions until depleted. OSP 96 16969 STATF.OF CALIFORNIA 0 O NARRATIVE/SUPPLEMENTAL, ' CHP 556(Rev 7-90)Opt 042 - - Page 7 i DATE OF!NC!DENT/OCCURRENNCIC NUMBER OFFICEfl I.D.NUMBER NUMBER - I._. f %'ONE "rI�OI�NE TYPE SUPPLEMENTAL rX-APPZr-4BLEJ Narrative COtlision report ❑BA update 0 Fatal ❑Hit and run update ❑Supplemental ❑Other: ❑Hazardous materials ❑School bus ❑Other: �CITYICOUNTYNUDICIAL DISTRICT - REPORTING DISTRICT/8F1�T CITATION NUMBER COr�eT&A 6:6 2V 2� LOCATIONSYR rilir - STATE HIGHWAY RELATED es ❑No 2. Goe 4, or sG �e .J7 R .m L w. 3. t asG, f 6. 7. t ( SI1JFti/17 /1!/ 9. 11. 0 L Vjqj P I L BLUA 16 A Tw t ^ 12. gCQ 13. 'r`IQ A o rr . i Y r4v0 IrczeElco 4., Lr.v 14. { ' At f AP C f,' 00,f koC l 15. T14Ar1eAll r-A 0/" i est P'A 4 / 't' P/-` 16. J5 f-U .0- t Ft44W AD 17. /1,5 71w o 1AfaE'L L� -e-Q vu` 18. L / E " Qfozdjr.0 AY 19. . FUCacow 13PU05E F6640 — 5f 0,w - 25Ca"4r AD 21. ftp 22. ig A " 71/. '� .a 23, N A.S• t�ZeZ Qit) 1f64 <. 25, VA44 D e- f ;, I- Y da- 26. 29, r . 30. 31. PREPARER'S NAME AND LD.NUMBER - DATE- AA(( REVIEWER'S NAME Use previous editions until depleted, osP Be INN STATE OF CALIFORNIA - - O NAR RATIV E/SUPPLEMENTAL CHP 556(Aev 7-90)ON 042 -- page DATE OF INCIDENT/OCCURRENCE TWE r,14 DO) NCIC NUMBER OFFICER I.D.NUMBER NUMBER - 1 93 20 /- -K,ONE ' TYPE SUPPLEMENTAL rrAPPLICABLEI :Narrative eR�Collision report ❑BA update ❑Fatal ❑Hit and run update. ❑Supplemental ❑Other: ❑Hazardous materials ❑School bus ❑Other: CITYICOUNTYIJUDICIAL DISTRICT REPORTING DISTRICTIBFJ�T CITATION NUMRER s!G 7J•f YL LOCATIOWSUBJECT - STATE HIGHWAY RELATED ._.,. C 0 mj- Isit-0 r ( � / Yes ❑No 2. A 4 C IVF7-45 - -2 3. ., C + 4 I t LAdd Q ZV Ot 8. o' sA&W A1Q- 9. 12. 'Tkf Com . 11— ZA 13. . 3 6't a Cd U LL ) W fA-s t A/$ w N 14. 15. f2c)"7"4wf N + C 16. 17, 16. 5f E o 20. /Z� Q p �✓ 21. g10 orleCQ /r Mr N /K ' G � 3 160 22. FM a ak ! 4 i r 23. TA 1 4 V r,Irk 24. U E /LAug ` 25. C. V- U7-7.71Z Lc> . O 27. ON 28. 29. 30. 31. PREPARER'S NAME AND I.O.NUMBER DATE REVIEWER'S NAME DATE Use previous editions until depleted. OSP as roves STATE 6F CALIFORNIA O O NARRATIVE/SUPPLEMENTAL CHP 566(Rev 7-90)_OPI 042 Page DATE OF INCIDENTAOCCURRENCE TIME(2600) NCIC NUMBEROFFICER 1.0.NUMBER ]NUMBER - 3zo i+3tfy' 'X"ONE 'J6'ONE TYPE SUPPLEMENTAL r'X•APPLICABLE} Narrative collision report ❑BA update ❑Faial ❑Hit and run update Supplemental ❑Other: ❑Hazardous materials ❑School bus ❑Other: CITY/COUNYUUDICIAL DISTnICT/� - REPORTING DISTRICT/B ffEAT GTATION NUMBER W' LOCATION13""ECTD - - .ff - STATE H AY RELATE ` EfA >� F. 7S C V•D l Yes ❑No ,. -z sem; o s - K -Aflck 414 IA"- 2. Lu O T•' !, 3. t l J Aa 4 Jie,r Ur '� t' 5. GK Af V N JA4?a a. W W lI 1" R PrhflFt1�! 7. 1 o TY W G •2 5 77) 7'krd I We to P w I T- a. C 4w . 10, 11. 12. - o = MX) ! ! zAe d v W dN 13. 04 /,40 5, G' /ar* sf 14, Ile, 1414 k34eA07�z-q 4 r 6,010- 17. IW7 RZICACd 77 'e 18- 5J 44 W A C K- 20. 21. T- O t LLO) 5 LA 740 Hif G4 - s 22, p - 4-) 23. — "' jC 24. c-" E/ 25. OLVrAke-wi 77 6v&ce. G 26. w77L14/C-1/.. . W 27. 28. 29. 30. 31. PREPARERS NAME ANDI.D.NUMBER - DATE REVIEWER'S NAME Use previous editions until depleted. OSP 98 1e9m STATC''OF CALIFORNIA O O NARRATIVE/SUPPLEMENTAL CHP 556(Rev 7-90)OPI 042 Page �0 DATE OF INCIOENTIOCCURRENCE TIME(2400) NCIC NUMBER OFFICER W.NUMBER NUMBER 17, —4G t 3 3 %Ljpdat- 'X'ONE *('ONE rTYPEMENTAL r"X-APPOCABLE/ 9,Narrative [Collision report ❑Fatel ❑Hit and run update ❑Supplemental ❑Other: azardous materials ❑School bus ❑Other: CITY/COUNTY/JUDICIAL DISTRICT REPORTING DISTRICT/REAT C17ATION NUMBER ,F LOCATION19eDMT - - STATE HIGHWAY RELATED Q& &Ujq Ar yes ❑No 2. dJ 3 01w 5. lArZ4W A.5 57PA&E74 !,. " F O. s. c34d r r 7. 4 ttfM.hg.Z' AQ EF 9. n F .., O . C-ff 10. DiorC 12. 13. J f 14. -/ AWzuitt- 1/-Z V1 ffkuwl ti A „ ©. — 16. LAJ c l rw C f? 17. Is. r - v /C.) 19. 20. 21. ,'' 22. AQj -1 `C- CIA./ ASC S E 10 23, Pkotor-s-5 ATekau 41 PhAtPsAIZOAn 24. ME O 25. Rol-7, .. r '174-r- CO AP tA 7. 27. ^ L Pee- 28. W f 7)C.tv 29. rQ 3 ` r 30. F w 116 0 xn P L 31. PREPARERS NAME /AND I.D.NUMBER DATE REVIEWER'S NAME DAIS Use previous editions until depleted. gw CSP 98 16969 STATE OF CALIFORNIA - O NA'RRATIV E/SU PPLEMENTA L CHP 556(Rev 7-90)OPI 042 Page j DATE OF INCIDENTICCCURRENCE TIME(2400/ NCIC NUMBER OFFER LD.NUMBER NUMBER 1G- 20 •X•ONE •X�'ONE TYPE SUPPLEMENTAL rX-APPL"BLE) Narrative IR Collision report - ❑BA update -. El Fatal - ElHit and run update Supplemental ❑Other: ❑Hazardous materials ❑School bus ❑Other: GITY/COUMY/JUDICIAL DISTRICT. - REPORTING DISTRICT/BEAT CITATION NUMBER LOCATIONISUBJECT - STATE HIGHWAY RELATED Lr! % ®ves El No 1. C " • _ Y 3. IAI I&OCALZOCS Z<_ "' 4. F 5. W ou 6. 7. a. N a' 9. 10. 11. 12. 13. 14: 15. 16. 17. 18. 19, 20. 21: 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. PREPARER'S NAME AND I.D.NUMBER - DATE - REVIEWER'S NAME - DA7E Use previous editions until depleted. OSP ee 1690 0 0 LAW OFFICES OF JOSEPH D. O'SULLIVAN 1500-20TH STREET SAN FRANCISCO, CALIFORNIA 94107 WALTER C. COOK TELEPHONE(415) 920-0423 FAX (415) 920-0427 PROOF OF SERVICE I, Walter C. Cook, do hereby declare: I am employed in the City and County of San Francisco, my business address is 1500 - 20th Street, San Francisco, California 94107, and I am not a party to this action. On this date I served: GOVERNMENTAL CLAIM CLAIMANT: Ann Conroy Bordeaux, Date of Birth 1-14-39 by placing a true copy thereof enclosed in a sealed envelope, with postage thereon fully prepaid, in the United States Post Office mail box at San Francisco, California, addressed as set forth below. by personally delivering a true copy thereof to the person at the address set forth below: by giving a true copy thereof enclosed in a sealed envelope to Black Dog Messenger Service for personal service on the persons addressed below: Contra Costa County c/o Clerk of the Board of Supervisors, Room 106, County Administration Building, 651 Pine Street, Martinez, California 94553 I �e lare�rt er penalty of perjury that the foregoin ' true d correct. Executed on at San Francis Calif, mi Wa er C. Cook Q � a . Lu to co �° to N ° 0000 1� i tt} W N w 0 s U W LU s N � N f ® W � V \7 `tr �' a � ar us � o U.p E... W W N c+ Q ag �^ 42 LY O r 6 H" ` CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY Co I<r BOARD ACTION: MAY 15,2007 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), given Pursuant to Government Code AMOUNT: UNKNOWN APR 16 2007 Section 913 and 915.4. Please note all ROSA LOPEZ COUNTY COUNSEL "Warnings". CLAIMANT: MARTINEZ CALIF. ATTORNEY: LARRY NAGELBERG, ESQ. DATE RECEIVED: APRIL 16, 2007 NAGELBERG & ASSOCIATES APRIL 16, 2007 ADDRESS: 10940 WILSHIRE BLVD. ,STE.2W DELIVERY TO CLERK ON: LOS ANGELES, CA 90024 BY MAIL POSTMARKED: APRIL 11, 2007 FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a eopy of the above-noted claim. APRIL 16 2006 JOHN CULLEN, �� Dated: By: Deputy II: FROM: County Counsel TO: Clerk of the Board of Supervisors ( his claim complies substantially with Sections 910 and 916.2. ( ) 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: ` 7- 0-7 By: A deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). I.V. OARD 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 this date. Dated: au Ar JOHN CULLEN, CLERK, By Deputy Clerk WARNI.N (Gov. code section 913) Subject to certain exceptions,you have only six(6) months firom the date this notice was personally served or deposited in the mail to file a covet 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 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 clainnan.t as shown above. Dated: �'Of fC4e_JOHN CULLEN, CLERK By Deputy Clerk AP.R, 11. 2007 8: 09AM CCC RISK MANAGEMENT N0. 396 P. 1 . .x S ARD OF S7TPERVISQRS OF CO.N-U COSTA COT1lVT-Y INSTRUC'i QNS TO CLAINTAIVT A clsiut r g to a cause of action for death or for injury to person Orb petSoual property or growing coos shall be presented not later than six montbs after the accrual of the cause Of action. A of L'n relating to any other cause of action shall be.presented aot later than one year - after the acci ad of the cause of action. (Gov. Code 911.2.) Claims mus be filed with the Clerk of the Board of Supervisors at its office in Room 106, County ation Building, 651 pine Street,Martinez, CA 94553. If claim is a district governed by the Board of Supervisors, rather than the Cotmfy, the name of the )istrict should be filled Ln. >, ' If the claim lis against more tban oat public eatity, separate claims must be filed against each public , ?. Fraud. See malty for fraudulent claims,Penal Code See, 72 at the end of this form. ■aauaraaaaaeaasaa■sasaasaxKwaasemaaueaslaaui�asseeasaesaaai LE: Claim 13y. Reserved for Clerk's$ling,stamp ROSA LOPEZ Agaiist the Counti of Contra Costa or ) EASTERN CONT A' COSTA TRANSIT Af5B3TY cm in the rime) )• The undersigned c lairmar,hereby makes claim against the County of Contra Costa or the above-named district in the FL= Df$ UNKNOWN &rad in.support of this claim r6 presents gas MOM: AT PRESE(VT L When did I be damage or injury occur? (Give exert date and hour) JANUAR 12, •2007 2. Where diad the damage or injury 000=7 (Include city and county) ON A B S OWNED BY CONTRA COSTA COUNTY AND BEING DRIVEN BY LAIDLAW TRANSI1 SERVICES - EAST STREET IN CONCORD CALIFORNIA 3. Haw did a damage or injury occur? (Clive full details;use extra paper if required.) SEE AT ACHED SHEET ATTACHED HERETO AND MADE A PART HEREOF. 4, W1vj'pm1 cular ant or omission on the part of w=ty or district officers, servanfs, or employees caused tht injury or damage? .FAILURE TO PROVIDE OPERABLE SEATBELT/SAFETY EQUIPMENT FOR WHEELBOUND DIC PPED 5 are a r ame � distziCt officsrs,Aervaafs, or employees Musing the dB�Bp rfa�y? REPRESENTATIVES, AGENTS, EMPLOYEES AND ASSIGNS OF CONTRA CO';BTA COUNTY APR. 11. 2007[ 8:09AM CCC RISK MANAGEMENT NO. 396 P. 2 6. What dame e• or injuries do your claim resulted? (Give full extcnt of injuries or dama;es --claimed. -kt,zzb.-two estimates for auto damage.) HEAD NJURIES, FRACTURED TOE, AND INJURIES TO OTHER PARTS OF HER A ATOMY. . 7. How was a amount claimed above computed? (include the estimated amount of any prospective jury or damage,) FULL XTENT OF INJURIES ARE UNKNOWN AT PRESENT. MS. LOPEZ IS. STILL RECEIVING MEDICAL CARE AND TREATMENT. ALL BILLS HAVE NOT BEEN 8. Names•and addresses of witnesses,doctors,and hospitals: RECEIVED. DRIVER, THOMAS - # 612. THE NAMES OF OTHER WITNESSES ARE IN THE POSSE SIGN OF CONTRA COSTA COUNTY AND LAIDLAW TRANSIT. ALL MEDICL RECORDS 9. List the ea euditures you rmde�on account of this accident or injury: WILL BE PROVIDED UPON OUR DA Tun AMO RECIPT. THIS ENFORMATION IS NOT YET AVAILABLE, was r'l9u1r77■77¢ 9Sam laXNAa anis■iNssetltrsan asulanan■uaps us l are Ndlelal ROd vita/s4ur¢u NA -Gov. Code Sec. 910?provides "The claim shall-be signed by the claimant or by some person on his behalf" SEND NOTICES 0: (Attomev Name and adr1rcst of Attorney ) ) LARRY NAGE. ERG, ESQ, ) (Claimauf5 Sipature) NAGELBERG & ASSOCIATES ) 10940 WILSHIRE BLVD. ) 148 N. CATAMARAN C'TR NF. . SUITE 2150 ) ' - (Address) LOS ANGELES CA 90024 PITTSBURG, CA 94565 Telephone No. )Telephone No."( 92 55 ) 2 9:� 9+6 _ r•eO✓715l7tllNrtnewNOmWON Napame�15rr15lsts■usNl¢nisecNSRe¢1577Ra■t77RltNdlnIng aNits scans NOal PUBLIC RECORDS NOTICE: Please be advised t this claim form, or any claim•filed with the County under the Tort Claims Act, is subject to Public disclosure Ler the California Public Records Ant (Gov. Code, §§ 6500 et seq.) Furthermore, any attachments, duras, or supplements attached to the claim form, including medical records, are also subject to public disclosure, tl unit ends am may ■slt¢15its■■A m met is 7ll77J s15715mtli ul7tl A27 Nutitl la1n15715rlANDS a"111 NO s 15111127 pans& NOTICE: Section 92 of the anal Code provfdW: Every person wh ,with intent to defraud,presents fur allowauce or for payment to any state board or officer,or to; any wmty, ty, or district board or officer, m amized to allow or pay the same if genuine, any false or fraudulent ' biflL account voucher, or vdf n& is punishable either by imprisonment in the County jail for a Period of not m than one year, by a fine of not exceeding one thousand dollars (51,0DO N), or by both such imprisonment fine, or by imprisonment in the state- prison, by a fine of not exceeding tan thousand dollars ($10,000),or by oth such imprisonment and fine. BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY NOTICE OF CLAIM....continued..... Rosa Lopez v. Contra Costa County and/or Eastern Contra Costa Transit Authority D/Loss: 1/1/2/07 Question#3: On January 12, 2007, Ms. Lopez is a handicapped amputee, was being transported by Laidlaw Transit to a medical appointment. The bus driver, Mr. Thomas - employee #612, failed to strap Ms. Lopez's wheelchair in claiming the seatbelt was not operable. Due to a sudden stop, Ms. Lopez flew out of her wheelchair and down the bus' aisle sustaining serious injuries to include but, not limited to, head injuries and a fractured toe. We have been advised by Laidlaw Transit Services that they contract with Eastern Contra Costa Transit Authority to supply the buses they drive. NAGELBERG & ASSOCIATES ATTORNEYS AND COUNSELORS AT LAW Telephone The Tower • Suite 2150 • 10940 Wilshire Boulevard (310)208-3220 Larrro Nage(berg,Esq. Los Angeles, California 90024 Facsimile (310)208-3830 i ' April 11, 2007 APR 1 6 iuu,/ C�ERKBOARD CONTRA COS ACo. SOBS Clerk of the Board of Supervisors CERTIFIED MAIL Contra Costa County Administration Bldg. 651 Pine Street, Room 106 Martinez, CA 94553 Re: My Client: Rosa Lopez Date of Loss: 1/12/2007 Dear Sir/Ms.: Enclosed please find our completed and signed Notice of Claim on behalf of our client, Rosa Lopez. Ms. Lopez is a handicapped amputee who was being transported by Laidlaw Transit to a medical appointment. The bus driver, Mr. Thomas - employee 4612, failed to strap Ms. Lopez's wheelchair in, claiming the seatbelt was not operable. Due to a sudden stop, Ms. Lopez flew out of her wheelchair and down the bus' aisle sustaining serious injuries to include but, not limited to, head injuries and a fractured toe. As per the attached letter from Crawford & Company, Laidlaw Transit Service's insurer, Laidlaw contracts with Eastern Contra Costa Transit Authority who provides the buses. Thus, it is our understanding that Eastern Contra Costa Transit Authority owns and maintains the bus being driven by Laidlaw and which transported Ms. Lopez. If this is incorrect, please so advise. Finally, is our understanding that the filing of this Notice of Claim complies with the required governmental claim statutes to include Gov. Code § 911.2 et seq. If Contra Costa County has any other requirements which need to be complied with, please so advise within the statute of limitations. Very truly yours LARRY LN\ag Enc. r � z w m A m Y O r m M r r 0 m w Y m w W w O C Q N 0Di A " m N to -i m t1�• N UI i«i O tit �L o 0 I lri c,3 Gl 4; til 0 CO p w O r O z m c m Z p 0 Ln. N m 0 Er 0 —1 w I W Ampm Ln' m (7 -J 0 O r . .. . .... ,, ? L . C p 6w'C) wjo 0 3 w 0 ( twtrF nga, t, O c 01 z v mZu O Q m x00 0 CIO�y c z vo ao 0 -�O tv0O 'z� r " 'Z a �r.. O O'Y A A r m m OF O O N a' m ul C3 T4s o vl a 4� U3 th _n r' 0 M o n 0 a m a of "4 cr Z z A O Ln m 0 ' cr u5r, N N O -1 LU Ul C1 ro k'• - X A m yam. - Amt O O NNp U1 " C _ WO z � �r W O - r �UNnFp ST A m � 0 P T A Y N ro 0 ,o , co co N 0 0` • = AMENDED CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA.COUNTY BOARD ACTION: MAY 15, 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 D!b, Supervisors. (Paragraph IV below), APR 1 7 given Pursuant to Government Code 2007 Section 913 and 915.4. Please note all AMOUNT: UNKNOWN "Warnings". COUNTY COUNSEL CLAIMANT: ROSA LOPEZ MARTINEZ CALIF. ATTORNEY: LARRY NAGELBERG, ESQ DATE RECEIVED: APRIL 17, 2007 ADDRESS: NAGELBERG.& ASSOCIATES Byv�i�FFLIVERY TO CLERK ON: APRIL 17, 2007 10940 WILSHIRE BLVD. , STE. 2150 LOS ANGELES, .CA 90024 APRIL 12, 2007 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. APRIL 17, 2007 JOHN CULLEN, 1 Dated: By: Deputy 11. FROM: County Counsel TO: Clerk of the Board of S pervisors ( his claim complies substantially with Sections 910 and 910.2. i ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). O Claim is not timely filed. 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: `Tr/ 7 ,d 7 By: 127 Deputy-County Counsel IIL FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) O Claim was returned as untimely with notice to claimant (Section 911.3). 1V. ARD ORDER By unanimous vote of the Supervisors present: 0 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:/7a% �C 400 'JOHN CULLEN, CLERK, By eputy Clerk WARNIIi} . 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 courtaction 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 pei 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 Orderand Notice to Claimant, addressed to the claimant as shown above. DatedJOHN CULLEN, CLERK By Deputy Clerk APR•,•'11. 2001 8:09AM CCC MANAGEMENT (� NQ. 396 P. 1 ��. B M OF SUPERVISORS OF COMM COSTA CQTJhQ W-5=c� pM TO UAWANT A claim Tela _g to a.cause of action for death or far W,317to person or to personal property ox grouting cm s *shall be presented not later tisau. six mont>3s efter the aca-ad of the cause of :action A c ' rcl .acing to any other cause of action shall be.preserud not Istu tbaa one year - after tht ac of the came of wtion. pvv'.Code 911.2.) eleims mus be :ilea with the Clerk of the Board of Supervisors at its office in Room. 106, Cowry Adri'ianon BiZding', 651 Vine Staeels Msrtmez,CA 94553. 4 If claim is e jd= a dis dad gove=ecl by the Board of Supervisors, rather tGaa the Comm the unEe of the Distiot should be filled im If the claim is against more tbgm one public entity, saPMSte claims must be, :led RgainA arch. public eutt. FmueL See enalty for frauduletat dlazms,Penal Code Se(3.72 at the end of this form. caa.aaaaOaaataRtaaaamataaaaAaft aaaaaaamaaaaaRa Egg'Raaa'avaaaaamaA&avianamamaaaaTtaa) 11 Claim$y Reserved for C'lerk's$Iia?V P ROSA LOPEZ RECEIVED It the Court of Coutes Costs.or ) APR 17 [uul ASTERN CONT A COSTA TRANSIT p�� ��TY CLERKBOARD OFSUAERVi50t1S CONTRA COSTA CO. F1.6 the maze) ) Clic zmdersigned hereby makes claim aid=ft Cauuty of Contra.Costa or the aban-named 3iA ct infhe ami of S aNxNOWN and iu supp art ofthis cdalm,=prescats as follows, i AT PRESENT L Wbendidihe damage or snJstrp'ttao=7 (Give exRd date mud h0=) JANUAR 12, 2007 a. Wbera d1d damage or fnjw7 occur? (Include city and county) ON A BIS OWNED BY CONTRA COSTA COUNTY AND BEING DRIVEN BY LAIDLAW TRANSI7 SERVICES - EAST STREET IN CONCORD, CALIFONIA, 3. Haw dial damage or WTQy odour? (Mve full.deu&;use exa Papel re4ume�) SEE AT ACHED SHIEET ATTACHED HERETO AND MADE A PART HEREOF- 41 Wbat'p cular not or omission on the part of W=tY or Astrict Officers, servants, or=Fly aauset3uury or damp? .FAILURE TO PROVIDE OPERABLE SEATBELT/SAFETY EQUIPMENT FOR WHEELBOUND 5 J�DIG PPED are n= " ig*R�o�-distci.at officers,aetvmts,or employees ceusiag damageriulury? REPRESENTATIVES, AGENTS, EMPLOYEES AND ASSIGNS OF CONTRA C05TA COUNTY 'A_PR. 11. 2007 8, 09AM CCC RISK MANACEMEINTO N0. 396 P. 2 �d 6, What lama ear injuries do your claim resulted? (Give full extent of injuries or damages --claimed A two "s =aces for auto damage.) HEAD NJURIES, FRACTURED TOE, AND INJURIES TO OTHER PARTS OF HER ANATOMY. 7. How was he amount claimed above computed? (include the -estimated amount of any prospgclffveqwy . or deuns:Ac) FULL ZXTENT OF INJURIES ARE UNKNOWN AT PRESENT. MS. LOPEZ IS STILL RECEIVING MEDICAL CARE AND TREATMENT. ALL BILLS HAVE NOT BEEN S. Names and dresses of witnesses,doctors, and hospitals: RECEIVED. DRIVE , THOMAS - # 612. THE NAMES OF OTHER WITNESSES ARE IN THE POSSE SION OF CONTRA COSTA COUNTY AND LAIDLAW TRANSIT. ALL MEDICL RECORD: 9. List thee enditures you made•on account of tbU accident or l'njurp: WILL BE PROVIDED UPON OUR DA TIME' AMOUNT RECIPT. THIS INFORMATION IS NOT YET AVAILABLE. a BD Aima Da BasDDD% 5x2URRv&5aQ5=0AB0 D9aa6D9B9 Qon a D B WEBBODD D IID ORB DDR Daa H DBB OR aB D MON 4 D Ba D D& .Gov.Code See, 910?provides 'The claim shall be signed by the claimant or by some person on leis behal�� SEND N07CES O: Attornev Name and addres of Attorney ) ) LARRY NAGELIERGr ESQ. } ainlallt's Signature) NAGELBERG & ASSOCIATES ) 10940 WILSHIRE BLVD. ) SUITE 2150 148 N Ar CATAMARN TR(-TF - ) - LOS ANGELES CA 90024 (Address) PITTSBURG, CA 94565 Telephone No. ( gag ) 29:7 mDdDaoaQassDaeaamRDa©aDsaamaamRDvaDDSDaDBDa4¢DDBB¢aDeQaDa6¢¢sRaeaaaaaaDamarsRasaeae¢i PUBLIC RECORDS NOTICE: Please be advised Ut 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 Art (Gov. Codq, s§ 6500 et seq.) Furthe=ore, nay zVnz1m=%adde idums, or supplements attrAed to the claim form, including medical records, are also subject to public discloffun, p aDDDY6■■■Bal ■■ZVO®aa6Dp2Dlla afaAfDaa REMORDamDaD m Da82117C a aDDamaDDARBDDs mm OWN a 0 PRE RD III NOTICE: Section.72 of the oral Code provides: Every person wli ,with iatmt to defraud,pree=far anowance or for paymeat to aq state board or of$cwr or to; any county, r ty, or distrix board or officer, ut=ized to aUow or pay the same if genuiue, any false or fMudalent clBim, brill, account voucher, or writing is puaisbable either by imprisonment in the County jail for a Period of not mi rr Than one year, by a fine of not seeding one thousand dollars ($1,000.00), or by both sucb imprisonment vi d fine, or by imprisonment in the state prisao, by a fine of not eXeaa ftEr tem ftus lid d011M ($10,000),or by oth such imprisonment and fine. a � BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY NOTICE OF CLAIM....continued..... Rosa Lopez v. Contra Costa County and/or Eastern Contra Costa Transit Authority D/Loss: 1/1/2/07 Question#3: On January 12, 2007, Ms. Lopez is a handicapped amputee,was being transported by Laidlaw Transit to a medical appointment. The bus driver, Mr. Thomas -employee #612, failed to strap Ms. Lopez's wheelchair in claiming the seatbelt was not operable. Due to a sudden stop, Ms. Lopez flew out of her wheelchair and down the bus' aisle sustaining serious injuries to include but,not limited to, head injuries and a fractured toe. We have been advised by Laidlaw Transit Services that they contract with Eastern Contra Costa Transit Authority to supply the buses they drive. NAGELBERG & ASSOCIATES ATTORNEYS AND COUNSELORS AT LAW Telephone The Tower • Suite 2150 • 10940 Wilshire Boulevard (310)208-3220 Larry Noge&rg,Esq, Los Angeles, California 90024 Facsimile (310) 208-3830 April 12;2007 = EEE D ECFiKBO Zuui Clerk of the Board of Supervisors CERTIFIED MAI Contra Costa County Administration Bldg. UPERVISotAs 651 Pine Street, Room 106 TA CC. Martinez, CA94553 Re: My Client: Rosa Lopez Date of Loss: 1/12/2007 Dear Sir/Ms.: Unfortunately, the Notice of Claim forwarded to your attention on April 11, 2007 was not signed. Thus, enclosed please find a completed and sib Notice of Claim. As we advised you in our previous letter, Ms. Lopez is a handicapped amputee who as being transported by Laidlaw Transit to a medical appointment. The bus driver, Mr. Thomas - employee#612, failed to strap Ms. Lopez's wheelchair in claiming the seatbelt was not operable. Due to a sudden stop, Ms. Lopez flew out of her wheelchair and down the bus' aisle sustaining serious injuries to include but, not limited to, head injuries and a fractured toe. As per the attached letter from Crawford& Company, Laidlaw Transit Service's insurer, Laidlaw contracts with Eastern Contra Costa Transit Authority who provides the buses. Thus, it is our understanding that Eastern Contra Costa Transit Authority owns and maintains the bus being driven by Laidlaw and which transported Ms. Lopez: If this is incorrect, please so advise. Finally, is our understanding that the filing of this Notice of Claim complies with the required governmental claim statutes to include Gov. Code § 911.2 et seq. If Contra Costa County has any other requirements which need to be complied with, please so advise within the statute of limitations. M Very trulaAL , LARRYRG LN\ag -� Enc. March 16, 2007 Crawlard Larry Nagelberg Nagelberg and Associates 10940 Wilshire Blvd., Suite 2150 Los Angeles, CA 90024 RE: Principal: American Home Assurance Company Insured: Rosa Lopez Claimant: Laidlaw Transit Services, Inc. Date of Loss: 1/12/2007 Claim Number: 2229-89894 Dear Mr. Nagelberg: Crawford and Company represents American Home Assurance Company who insures Laidlaw`f ai nsff Services, Inc, under a policy of liability insurance coverage. Your letter dated March 9, 2007, has been received. You asked about the ownership of the bus service. Laidlaw Transit Services, Inc. is a corporation. Laidlaw contracts with Eastern Contra Costa Transit Authority to operate the bus service Ms. Lopez was using. Eastern Contra Costa Transit Authority provides the buses used for this service. You also inquired about the policy limits. We are not allowed to disclose this information. However, based on the information you have provided regarding Ms. Lopez's injuries, the policy limit appears adequate for this claim. Please contact me at 1-800-934-9300 extension 9922 if I can be of further assistance. Sincerely, Charlene Davis .. Casualty Claims Representative CRAWFORD & COMPANY Brookhollow Two Suite 500. 2221 East Lamar Blvd •Arlington,TX 76006 • 500-934-9300 LIAR % 2 2007 07 i ul v nw o ;tai ....1 rr Q m O t9 ao aa N a tP F = uJ a a t �oQ w N 0 .' 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