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HomeMy WebLinkAboutMINUTES - 05202008 - C.9 i t 1 i t j C 1 i � 1 p rY CI�•� O '�`f U � � a � ���Cy... Ir W O •* �' ' o �/w r O n ujN ij UQ .t1 J -> O o �} 1 � �o N u�tt�ps . � o a N `� n to 0 � r N i r � + , r y r 7 Com' � 7Z � N ON v O 0 t,� J G, %4i � 4 y BOARD OF SUPERVISORS OF CONTRA COSTA COUN'T'Y INSTRUCTIONS TO CLAMANT (� D 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 accntal 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 § 9112.) B. Claims must be filed with. the Clerk of the Board of Supervisors at its office in Roam 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 elaun 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, MEN a MW a mass .1 RE: Claire By: Reserved for Clerk's filing stamp TONYA YORK and STEVE CAVALLI ) ) Against the County of Contra Costa or ) District) (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$ _ ..�and in support of this claim represents as follows: Sum. in excess of $10,000 (Superior Court) . 1. When dict the damage or injury occur? (Give exact date and how) Damages occurred on 11/15/07 2. Where did the damage or injury occur? (Include city and county) Alamo, California, at the intersection of Danville Blvd. and Orchard Court. 3. How did the damage or injury occur? (Give full details;use extra paper if required) The injury occurred when Tonya York, a pedestrian within a mared rosswalk, was struck by a vehicle driven by Gary Beard. See attached police report ( Exhibit A) . 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? See attached. 5 What are the names of county or district officers, servants, or employees causing the damage or injury? Please see attached. f ' fi. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two es mates for auto damage.) Please see attached. 7. How was the amount claimed above pomputed? (Include the estimated amount of any prospective injury or damage.) The proper venue for this action is Superior Court. g. Names and addressos of witnesses, doctors,and hospitals: Please see traffic collision report ( Exhibit A) . Plaintiff was treated at John Muir Medical Center, as well as other providers that are unknown at this . time. 9. Fist the expenditures you made on account of this acrident or injury: �3AT'E TM AMQT�. agas moor aafuss gobs//aa ago a■aaa■1a•as a a a as as alamass amp aamoves any swap aByraw►a■aaa■1■aaI } Gov. Code Sec. 910.2 provides"Me claim shall be signed by the claimanf or by some person an his behalf." SENA NOTICES TO: L ttorney) } Name and address of Attorney Douglas S. Saeltzer, Esq. Walkup, Mel odi a, Kelly & Claimant's Signature) Schoenberge )DOUGLAS S. SAELTZER, 650 California Street, 26th Fl . ) Attorney for Claimants TONYA YORK and STEVE CAVALLI San Francisco, CA 94108 ) (Address) } (415) 981-7210 . } Telephone No. }Telephone No. aaa►aaa•aaaaaaaaaaaawas a■•asap■.•r■•araaraaaaaasasa►apses■apeaaaaaaa■aaaaao■may mammal PUBLIC RECORDS NOTICE: Pimse 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. Codo, §5 5500 et seq.) Furthermore, any attachmants, addendurns,or supplements attached to the claim form, including medical records, are also subject to public disclosure. aswap and a■aaaaaaaaaaasense aaaaaaaaaaaaaaaaaY•was soon aaaaaaaaaali■news apass aaaseem Yalaw 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 gonuine, any false or frauduleut 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 find of not ex=ding 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. ATTACHMENT TO CLAIM Claimants: Tonya York and Steve Cavalli Respondent: County of Contra Costa 4. On November 15, 2007, at or about 7:30 a.m., claimant Tonya York was taking her morning jog. At this time she attempted to cross Danville Boulevard, using the crosswalk at its intersection with Orchard Court. As she was in the intersection, a southbound vehicle driven by Gary Beard struck her, causing severe injuries. This intersection has no stop signs nor traffic lights for traffic traveling on Danville Boulevard. Claimants are informed and believe that the County of Contra Costa owned, operated, designed, constructed, maintained, inspected, repaired, and controlled this intersection, including the parking lot adjacent to this crosswalk, as well as the surrounding roadway and adjoining streets. Upon information and belief, the County of Contra Costa was/were negligent and careless in the design, construction, maintenance, inspection, repair, and control of this roadway, and the adjacent area, such that the roadway presented a dangerous, defective, and hazardous condition. At all relevant herein mentioned, the design, construction, maintenance, inspection, repair, and control of the roa&vay and surrounding area presented a reasonably foreseeable substantial risk to harm to members of the public who were lawful pedestrians, such as claimant, or were lawfully operating vehicles on the roadway. This incident was directly and legally caused by the acts and or omissions of the County of Contra Costa, or its employees, including, but not limited to: a. Failure to warn of and/or prevent and/or correct a "dangerous condition" (a condition ofproperty that creates a substantial [as distinguished from a minor, trivial or insignificant] risk of injury when SUCII property or adjacent property is used with due care in a manner in which it is reasonably foreseeable that it would be used) on or immediately adjacent to, public property; b. Failure to provide and/or maintain adequate traffic control devices and warning signs alerting motorists to the presence of pedestrians and the crosswalk as they approached this intersection, including,but not limited to, using highly reflective signs, keeping warning signs free from obstruction by surrounding vegetation and/or trees, and using high visibility roadway markings; C. Failure to provide and/or maintain adequate traffic control devices and warning signs alerting motorists to the crosswalk and the presence of pedestrians; d. Failure to restrict pedestrians from crossing Danville Boulevard at Orchard Court, and instead placing a crosswalk at this location that encourages pedestrians to cross at this location; e. Failure to post a clear and unambiguous speed limit; f. Failure to provide stop signs, or traffic lights at this intersection for Danville Boulevard traffic; g. Failure to provide adequate lighting for the subject intersection, especially toward the western side of Danville Boulevard at the crosswalk where this incident occurred. The need for better lighting is highlighted by the amount of traffic, the speed of traffic, the lack of traffic controls, and the other deficiencies with sighs, lighting, markings, road characteristics, and complaints discussed hereill; h. Failure to provide clear roadway markings and signs alerting motorists to tile presence of pedestrians and this crosswalk, especially in light of the fact that for southbound traffic this crosswalk is at the crest of a hill, and does not have a light above it; i. Failure to address the high speed of vehicles using Danville Boulevard; j. Failure to provide and/or maintain adequate signs, signals, "active" warning devices, channellzers, pavernellt markings and striping; k. Creating a confusing roadway area in terms of the number of entry and exit points, speed advisories, signage, and pavement markings that failed to adequately alert motorists to the crosswalk where this incident occurred and that pedestrians would be using this crosswalk, and failure to warn or redirect pedestrians away from this intersection; 1. Failure to post additional/supplemental signage, lighting, traffic control devices, and/or pavement markings in view of a significant accident history, history of hear misses, and complaint history from residents In this area that was known or should have been known by the County of Contra Costa to have been dangerous for pedestrians; nl. The failure to properly respond to the accident history in this area and complaints regarding auto-versus-pedestrian collision dangers. The above factors, both individually and in combination, created a dangerous condition Of pub]ic property and presented a substantial risk of iijjury to members of the general public, including Tonya York, who use the property, or adjacent property, with reasonable care, and in a reasonably foreseeable manner. Likewise, these factors, both individually and lll.comblnatlon, constituted a dangerous condition which had been, but was not, remedied by agents and employees of the County of Contra Costa. The County of Contra Costa negligently created and/or possessed knowledge, actual or constructive, of the above-described dangerous conditions, as well as the hazards and defects present in said roadway, and the surrounding area. As a direct and legal result of the above-described dangerous condition and the negligence and carelessness of the County of Contra Costa, acting by and through their employees and agents, Tonya York was involved in this motor vehicle versus pedestrian collision causing severe injuries. She has suffered and will continue to suffer economic damages including medical bills, diminution in earning capacity, and other economic damages of an undetermined amount. She has also suffered noneconomic damages in an undetermined amount. 5. Please see attached. 6. Tonya York suffered a severe head laceration, a closed-head injury, concussion, and back injuries, including but not limited to a fracture in her lumbar spine, as well as other injuries to her body. She will be claiming all personal iniury damages, including past lost wages, diminution in future earning capacity, past medical bills, and future medical bills. Her husband, claimant Steve Cavalli, claims loss of consortium damages. EXHIBIT A SPATE OF C:ALIFURNIA TRAFFIC COLLISION REPORTS ' CHP 555 CARS PAGE.(REV 11-06)001665 PAGE 1. OF 8 SPECIALCONDITIONSRu.iFA H;1 I RuN CITY _ JUDICIAL DISTRICT LOCM REPORT NUMBER IWUREO ir.UNY, 1 ALANIO WALNUT clu,lac 11-206: NUMOI:R KILL[ mmLRUN COUNTY REPORTING DISTRICT EIFAT DAY OF WEEK ! TOW AWAY NL:DEMEANUR : r 0 CONTRA COSTA 61 THURSDAI' YES y.j'j . —�- COLLISION OCCURRED UNC _ MO DAY YEAR TIM11E(2d00J ECIC A OFFICER'I.D. Z' DANVIl LE,BLVD. I 11/15/2007 1 0730 9320 012308 CD r-i UNF. MILEPOST INFORMATION: GPS COORDINATES PIIOTDGRAPHS BY! N IL]JLI < LATITUDE LONGITUDE C) __j AT INTERSECTION WITH: - --__ STATE IIWY REI. DR: 5.Ft,,rTSOU'1'1.10TOIZC7lARr)C'I'. L7 YES I,z NO PARTY CRIVF:fI'S LICENSE NUMBERSTATE CLASS AIR BAC SAFETY EQUIP. VEII.YEAR MAKE I MODEL I COLOR LICENSE NUIVOER STATE 1 DRIVER NAME(FIRST,MIDDLE,LAST) _ _. .- ..'rONYA YORK -- --- ' P R'S N4h1E� SAME AS DRIVER .... :-.. �—...-_.......-...:_. OYIM-_ .. - .. .... ... .......... .........._ -....................................................._.._.... ... ......._.__....__.....-.._......._... ...... PEOCS. SIREE'TADUHESS. AN X 21 ORCHARD U I. OWNER'S ADDRESS ❑SAtAF AS DRIVEN RANKED CITY/STAILI LIP -- VEHICLE ALA�10 CA 94507 DISPOSITION OF VEHICLE ON ORDERS OF: �I OFFICER f Uf(IVER OTHER_ -- .. BICV- SEX HAIR EYES HEIGHT WEIGHT DIRIII'A'iE RACE CLIS'I'. MU Ur.Y YEAR M . lil.k IIRN 04/07/1962 w PRIOR MECH.DEFECTS......... .. ...... J.. ...I­..... . ...—NONE APP.. REFER TO NARRATIVE OTHER, IIOME PI IONE BUSINESS PHONE VEHICLE IDENTiFICAIION NUMDI"R: - - (925)3(12-4015 VEHICLE TYPE OLSURRHz.VF,H.CLE DAMAGE. SHADE IN UAMAGLU AREA ' INSURANCE.CARRIER POLICY NUMBER HUNK NONL MMR.I.I.-OVER 6O MDU MAJOR nIR OF'IRAVEIJ ON ti l(iFET ON!IIGHIYAY 30�SI'lED LIMIT CA!:i `.._TCPiPSC vol I?BLVD .--- --- ------"- ---- . R' DAtiVILLL�'U Ncmx PARTY (I)RIVL,V.s I ICFNSE NUN I STAIF CI ASS AIR UAU SAI L1Y 1,111111'. I VF.H.YEAR MAKE/tADDEi.I COLUIt LICEftSE NUr.1BER �C 7 I N4011860 CA I C' M G i 95 FORD RANGER(ILK 71-'56242 CA ---.-...---"—- I- iUHIVF.HI NAh9E(1=Itis T,MIODIE.LAST! I ) X GAR)"BEARD OWNER'S NAME- SAMEA5 UR1'VL;N I PFUES-�STREET ADDRESS ) CLARA IIIA R7'INI:, I TRIAN +346 HARMOIN RD. �DWNER'SAODRESS SAME AS DRIVER ;PAItKFO CITY/SLATE/LIP �VLIIICL: - hL SUBRA:NTE CA 94803 1 DISPOSITION OF VEHICLE ON URUIRS OF: OFFICF4 X1DRIVER 07TIFR 1 I31CY- SEX HAII< EYES REiGlif WEIGHT IIRiTHDAIE iRf.CE D121VIiN A1FA}, CLISIMO I DAY YEAR I _.._—_ Al U IIRN ARIA08 08 170 09;1()/1115I5 }I' PRIORMECHANICAL DF:FEC IS —X NONE APP, REFER TD NARRATIVE I r ' OTHER I IDMS PHONE BUSINESS PHONEI�VEHICLE nlDEN IIFICA7IUIJ NUMBER: -- (110)d 17-2211 (510)815-(1314 VEHICLE TYPE DESCRIL'C VEHICLE DAMAGE SHADE IN DAMAGED AREA 1-N IMlSURANf.F CARRIER POLCY NUMBER LIMY, FI NONE X MINOR _ __ _ _ _i_...... C'I'Ac.) 4109-02-97-53 Y2 Moo .,'I.R RDLL"Vt.r: I Ti STIIFE7 CH NIGHWAY SPEED LIMIT CA COT ) ANVILLE BLVD, 30 1 CAL-i TCPIPSC —_ -MWAIX (PARTY DNIVER'S'LICENSE NUMBER STATE. CLASS AIR HAG SAFETY EQUIP, VEH.YEAR MAKE VCRLL COLOR LICENSE NUMBER STA'rF 3 IDRiVEK NAr•9E(FITISI,r.11UU(.F,1.ASI; ! I OWNER'S NAME SAME ns DRIVER fJ PEDES- SrREETADDRLSS URIAN O'WNFR'S ADDRESS SAME AS DRIVE, - IP�D r.1ril5T—Al E/zIP !VEHICLE — _._..... ...n(r'i- '::1,:l:...:. iv�ilt�.•.. .�. �EYi:S �' 1:Ei::HT. ..�Vv r:i(:H.i.. . � �u(nT;iUATP.,:.......- HACcxe'. �.�::".�.: ..........................._..,.......a ..... ... .. ... .. .. ... .. C(.)ST' .. MO UAV YEAH ! --_-......_.._.—_....___—_ �•. .4EFCH TO 11.IIIATIVC PRIOR MECHANf.IAL DEFECTS y NOtJC APP. �� — 1.... ...... ....... ._._-. __ ..... ._ __. : t nTTIER 110.Mr PHONE BUSINESS PHONE: VEHICLE IDUNTIFICATIO'J NU,V.DFII. I VEHICLE TYPE: DESCRiDE VEHICLE DAMAGE SHADE N:DAMAGED ARFA RiRURANCE CARRIER POLICY NUM6C:R ��UNY. f;UNi=. MN1UR Ir 1.. _ MUD NAJORR:LI.-)'.'ER � l'llk Of TRAVE Orl STREET OR HIGkI•.VAy SPEED LI'l11' DOT I IIIc CAL•T ICPIP5C MC/MIX —. PRE.PA.RER'S NAME. 0I5PATCII NOTIFIED REVIEWER !AE DATE REViLWED U.L..'CARRINC'TON 012308 X YES ,No rn MA S, cn -_ u TRAFFIC COLLISION CODING ( CHP 555 CARS PAGE2.JREV.11-06)UPI 065 PAGE OF OFFICE I. DATE OF COLLISION IblV:'DAY YEAR1 71ME(2400J NCIC 4 L. NUMBER 111151 U7;iU 93'20 013308 II-206 – — OWNER OWNER ADDRESS NODFIED PROPE}2T []YES[]NO ' DAMAGE DEScwrr10NOFDAMAGF- SEATING POSITION SAFETY EQUIPMENT INATTENTION CODES OCCUPANTS L-'AIR BAG DEPLOYED MIC BICYCLE-HELM E_F M-AIR BAG NOT DEPLOYED DRIVER PASSENGER A•CLLL PHONE HANDI'IELD .A-NUNS IN VEHICLE B-CELL PHONE HANUSFREE Fi-UNKNOWfJ N•OThJER V-NO %-NU C-LAI'BELT USED. P-NOT REQUIRED W•YES Y-YES C-ELECTRONIC EQUIPMENT D_RADIO J CD I 2 3 1-DRIVER D,LAP BELT NOT USED E-SMOKING E-SHOULDER HARNESS USED 2 700-PASSENGERS CHILD RESTRAINT Ej ECTED.h4iOM VEHICLE F-EATING 4.. 5 .6 F-SHOULDER HARNESS NOT USED -- G-CHILDREN 7•STA.WGN REAR U-IN VEHICLE USED 0-NOT EJECTED G-LANSHOULDER HARNESS USED R-RR.UCC�FRK.OR VANR-IN VEHICLE NOT USED H-ANIMALS H•LAPISHOULDER HARNESS 1407 USED 1-FULLY EJECTED I- PERSONAL HYGIENE 9•POSITION UNKNOWN S=1N VEHICLE-USE UNKNOWN 2-.PARTIALLY EJECTED ;I-PASSIVE RESTRAINT USED 7 U-OTHER " T.-.IN VEHICLE IMPROPERUSE: R J•READING n:YHJJIVe RESTRAINT'IVV 1'llacv___...... ... ..... ... ....................... ,.1...1IMKNl1lN I., ' U-NUNE.IN VEI11Cl.E K•OTIICR ITEMS MARKED BeLOW FOLLOWED BY AN ASTERISK I')SHOULD BE EXPLAINED IN THE NARRATIVE.. PIUMARY COLLISION FACTOR MOVEMENT.PRECEDING LIST NUMBER(a)OF PARTY AT FAULT TRAFFIC CON"FROI.DEVICES 1 z .3 SPECIAL INFORMATION ] Z 3 CULLISIOtJ A VC SECTION VIOLATED: CITED YE A CONTI{OLS FUNCTIONING A HAZARDOUS.MATERIAL ASSSTOPPED 21950(0I NO� B CONTROLS NOT FUNCTIONING' B CELL PHONE IIANDHELD IN USE B PROCEEDING STRAIGHT ---- - - — - - -'-- - I ' ....:.........:Or).ir:n.;Enuupnc^.C'Li::r;;Jr•. .. (,'_rn.�r�r-,,nLc:nacCUPcn..............:..:_.. ...C.CELL�P1!O?J�'HANUZEPEE IN USlE C. RAI•I.OF,F.ROAt).............. U NO CDNTROLS PRE"SENI I FAC"rOR' D CELT PHONF NOT IN USE D MAKING RIGHT TURf4`1 C OTHER THAN DRIVER' IYPE OF COLLISION E SCHOOL DUS RELATED I E MAKING LEFT T URN !] UNKNOWN' JA BEAD ON F 75 FT MOTORTRUCK COMBO ? F MAKING U TURN B SIDE SWIPE G 72 FT TRAILER COMBO G BACKING C REAR END IJ ~li SLOWIN'G'I 5TUPJiINIi ^JEAThiEI{ (MARK I TO 21TEMSj ~TD BROADSIDE I I PASSING OTHER Vf HICLE X A CLEAR E HIT OBJECT J J CHANGING LANES - - B CLOUDY F OVERTURNED K _ K PARKING MANEUVER C RAINING X G VEHICLE I PEDESTRIAN L L ENTERING TRAFFIC D SNOWING II Ui11Eh2'; M N1 U iHER UNSAFE Tll i2PJIP;G c FOG/VISIBILITY F7'. I N N XING INTO OPPOSING i..11J_- ..._._-... _ __ ....... ._ ._........_..... .... _........... .-- LF OIIIEIi:• MOTOR VEHICLE INVOLVED WITH 0__- 0 PARKED .._..._... .. - ..._...__- _.__ _..... G WIND A NON-COLLISION P .P MERGING LIGHTING )( B PE:LTESTRIAN --- O TRAVELING WRONG WAY X A DAYLIGE IT. C UIIi�R MOTO R.VEHICLE OrIIER ASSOCIATED FACTORS R OTHER': B DUSK:DALVN. —i C "."UTOR VFHIC!.G ONO FHER RCADWAY I 2 (MARK 1 TO 2IIEMS) _ '_ C DARK-STRF-F.T LIGIITS A cfl E PARKED MOTOR VEHICLE °:: ve se::lrc:a uiul.^rr'n: ..,. YrS 6 DARK-NO 51 RESET I.IGH 1 S F TI{itlN 6NO F DA14K-STREETLIGHTS PJUI j G EICYCLL © ��•ecn.,l..�l„1.u- cilc� YL-s. FUlJCIIONIPJG• .................. __.__-_.__.......-._ _.... _.--_ H ANIMAL: SOI'IRIETY-DRUG ROADWAY SURI'ACE C VC 51"GTIJN('I)1 ATt'1:- -[:TL'J --- PHYSICAL ._ _. .. - ARK 1 TO 2ITEt X A DRY I FIXED OBJECT: ___ JO✓ ( _-...-_ Ei WET D ..:.+' :::::: A HAD NOI.UEEN DRINKING -E-S-4-6, •ICY OTHER OBJECT: F VISION OHSCURI=MEfJT: X X B HBb-UNDFH IN FLULNCE D SLIPPERY(MUDDY,OILY,ETC.) 1:INATTENI)ON': G 11H1)-NOT.UNDER INFLUEtJCE' ROADWAY CONDITION(S) G S1 UP t GO TRAFFIC 1D HOD-IMPAIRMENTUNKNOWN' (MARK'1 TO 2ITEMS) H ENTERING I LEAVING.RAMP E UNDER DRUG INFLUENCE' PEDESTRIAN'S ACTIONS A HOLES,DEEP RU I- A NO PEDESrRIANS INVOLVED I PREVIOUS CCl_LISION F INIPAIRMENT-PHYSICAL' H 1.005E t.1ATERiAL OiJ i{UA01'Vf,Y' X 0 CROSSING IN CROSSWALK J UNFAMILIAR L'11711 ROAD - _- G I7.":F'All{MF..NT NOTKNOWN - C OHS"FRLJGiIOIJO;JROADWAY' -� Al iuTERSEC"I ION K DEFEC IIVE VEH.EQUIP.: CII ED H NOT APPLICABLE D (:ONSTRi1Cl1UN-KEPAIR ZUtJ F: I C CROSSING UJ CROSSWALK•NOT YE5 I SLEEPY i FATIGUED E I{LUUCL'U ROAE'VAY WIDTH ATINTERSE:C"FION NO 1 ............-.._..__ _---_......._..___....-_ F FLOODED' L CROSSING-NOT IN CROSSWALK L UNINVOLVED VEHICLE G 01 HER': E IN ROAD-INCLUDES SHOULDER M 0111EIV: X i+. NO UNUSUAL CU`JDIT1 NS F NOT IN ROAD X XI N PJOIJE APPilRENT SKETCH I( I DA.n/V1SLC 6L.W% MISCELLtf NEOUS' ----- INDICATE NORIH 5-2 CR CRNR._.._._-_------ CMP ala PD/SO 077 CT OTHER i 'J 111 I c:U!"VHLIIV I(IVI/1 TRAFFIC COLLISION CODING CHP 555 CARS PAGE2,(REV.11-06)OPI 065 PAGE OF DATE OF COLIA510N(MEI'DAY YEAR) TIME(2500) NCIC G OFFICER I.D. NUMBER 1.1/15/2007 0730 9320 - — 012308 _- II-206 - 1 OWNER OWNER ADDRESS NOTIFIED i PROPERT _ �_ - - - .F.IYES[]NO DAMAGE .DDSCRIF''fION.OF DAMAGE 1 SEATING POSITION SAFETY EQUIPMENT INATTENTION CODES OCCUPANTS L-AIR BAG DEPLOYED MIC HICYCLE-HFL h1EI" .A-NONE IN VEHICLE M-AIR DAG NOT DEPLOYED DRIVER PASSENGER A-CEL.L.PIIDNE HANDtIELC B-UNKNOWN N-OTHER V-NO X-NO B-CELJ.PHONE HANUSFREE C-LAP BELT USED P-NOT REUUIKED W YES Y-YES C_ELECTRONIC EQUIPMENT D-RADIO/CD D,LAP BELT NO Y USED 1 2' 9 1-DRIVER E•5lv10KItJG E-SHOULDER HARNESS USED CHILL)RESTRAINT F-EATING TO 5-PASSENGERS _ EJECTED FROM VEHICLE- ¢ 5 7-STA.WGN PEAR F-SHOULOC-R HARNESS NOY USC•U 0-IN VEHICLE USEDG-CHILDREN G_LAPJSHOULDER HARNESS USED 0-NOT EJf=CTED 8-RR.UCC"TRK.OR VAN R-IN VEHICLE NOT USED H-ANIMALS H-LANSHOULDE'R HARNESS NOT.USED 1- LILLY EJECTED 9-POSITION UNKNOWN FULLY S•IN VEHICLE USE UNKNOWN I- PERSONAL HYGIENE J-PASSIVE RESTRAINT USED 2-PARTIALLY EJECTED 7 0-OTHER T-IN VEHICLE.IM PROPER USE .�-UNKNOWN NKNOWN. J- READING . .................�.. ._....... ... ._....__....... ii-rxJJly c' ca lnxlry lIvv l'uacu ... ......... .. .. ...... .......... ..... U•NONE IN VEHICLE K•OTtiCR ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK I')SHOULD BE EXPLAINED IN THE NARRATIVE. - P MARY COLLISION FACTOR MOVEh1ENTVFTECEDING LIST NUMIULR(0)OF PARTY AT I-AULI TRAFFIC CONI RUL.DEVICES' ( Z 3, SPECIAL INFORMATION ` 3 ' � COLLISION ( A VG SECTION VIOLATED:CITEDnYE A.CONTROLS FUNC.IIONING A HAZARDOUS'MATERIAL - A S:!OPPED: 21950(6) 11Hi1 NO 0 CONTROLS NOT FUNCTIONING' B.CELL.PHONE IIANDHELD IN USE9 PROCEIANNG Sl"RAIGHT ...: .:..,.... 6 nTnocn r'I!i.V4.NC'. C.CUr 'a_c65BSCUar0_ C CELL PHONE HANDSFo_.c It.U!c. . (:..,RAIJ.OFF.n.L1AD....._-........ ....... ... D NO CONTROLS PRESENT!FACTOR' D CELL PHONE NOT IN USE D MAKING RKiHT TURtJ I C OTHER THAN UHIVER' TYPE OF COLLISION E SCHOOL:OUS RELATED I :E PlAKING LEFT TURN 1) UNKNOWN'_ - A HEAD-ON F 75 FT MOTORTRUCK COMBO I I F MAKING U•TURA B SIDE SWIPE G 72 FT iRAI1,Ek COh1H0 G BACKihG _.............. — C:HEAR END H SLOWING/STOPPING WEATHL-H (MARK 1 TO 2 11EMIS) 11, BROADSIDE - I J II PASSING 0 YHE:R VL.HIC'LE 'X A CLEAR JE HIT OBJECT J I J CHA14GING LANES. B CLOUDY F OVE111URNEP K 'K. PARKING MANEUVER C RAINING X G VEHICLE J PEDESTRIAt•: L .. L GPJIERI!JG TRAFFIC O SNOWINs' li'OTHER': M M OTHER UNSAFE TURNING E FUO./VISIBILITY 'Fl I N N XINGINIO OPPOSING LANE F Ol"Hf�R:' MOTOR VEHICLE INVOLVED WITH 0 - O PARKED G VO IJ L` IA NON-COLLISION TI- P — P MERGING LIGHTING X HPE:Ok:S FRIAN 1 0 0 TRAVELING.WRONG WAY X A DAYLIGHT C OTHER MOTOR VEHICLE OTHER ASSOCIATE:U FACTORSR tI�-R" 121 6 DUSK-DAWN D MOTDR VEHICLE ON OTKiEP.RC'ADVJAY , ( 3 (MARK TO 2ITEMS) - _ .................. C DARK-S"TREET LIGHTS E PARKED MOTOR VEHICLE -1 Ji vr,srr.Ilnrlviuurerr, clrec rYFs U DARK-NO STREET LIGHTS F TRAIN NO _.- ........_.. E DARK-STREET LIGHTS NOT G BICYCLE vi sEcr:/I uv.IcO' :Eo Y_s _ f ___ _ FUPJCTIONING' ... ... > NO - LI H ANIMAL: � - -_ SOBRIETY DRUG ROADWAY SURFACEvc sl.c�lou nn Mr." UTED PHYSICAL ---- cLIIYEs 1 7 3 (1(MARKX DRY i FIXED OBJECT: NO •- 1 TO 211E.1 S) A - - U WET IJ( :: X X A HAD NOT BEEN DRINKING _ -- C SNOWY.ICY I OTHER OBJECT; E VISION OHSCUREME.NT: B HOD-UNDER INFLUENCE U SLIPPERY(MUDDY,OILY,t-TC.) F.INATTENTIOPJ': 1 C HP.D-NOT UNDER INFLUENCE' j ROADWAY CONDITION(5) G STOP 8.GO TRAFFIC - U t16D-IAIPAIRMEN'I-UNKNOWN' ARK i TO 2 ITEMS ("P ) PEDESTRIAN'S ACTIONS H ENTERING I LEAVING RAMP E UNDER DRUG INFLUENCE' i A !TOLES,OEmP Rut- A NO PEDES'1"RIANS INVOLVED I PREVIOUS COLLISION F IMPAIRNIENT-PHYSICAL* _ _ _ _ R 1.6505E h1A1 E.RIAL ON ROADWAY' X B CROSSING IN CROSSWALK t_ J UNFAMILIAR WITH ROAD G IMPAIRMENT NOT KNOWN __'E __......._______.___-_-_ t C OHS'iRUC1101J O:V ROADWAY' AT INi EF2SECTION K DEFECTI'JE VEIi.EQUIP.: Cl IED Fi NOTAPPLICABLE 1) CONSTRUCIIUN-REPAIR ZONE C CROSSING IN CROSSWALK•NO F YLS I SLEEPY i FATIGUED ---......_.._...._ ......... _ ...._ _...._._.,— .__..._._-_ E REDUCED ROADWAY WIDTH A F INTERSECTIOPJI ---.-_--_,.,,1_1 NO - 1 ._....._..—_ _ __.......__. .................. .....- f F FLOOOLD' I D CROSSING.,-NOT IN CROSSWALK IL UNINVOLVED VEIIIGLE 'G OI HER•: TIN ROAD-INCLUDES SHOULDER M 01 14ER': --------.-..___.: --- .. _......-... --................_—.- -------- X H NO UNUSUAL CONDITIONS TNOT IN ROAD X (N NONEAPPARENT ..,.......... ..........:......::.„................... SKETCH r ( 1 -R iV,1 LLE--BLVI>: MISCELL NEOUS DOT ~,y} INDICA7ENJHIH a s Z CR S-/ 19L CHP -_ I STATE OF CALIFORNIA INJURED L WITNESSES/PASSENGERS PACE 3 OF 8 CHP 555_CARS PAGE 3(REV 11-06)OPI 065 DATE ORCOI_LISIOK(M0. DAYYEAR) TIME(24DD) NCIC ri OFFICER I.D. — NUMBER 11/15/3007 0730 9320 012308 11-206 WITNESS PASSENGER EXTENT OF INJURY(W ONE) ONLY AGE SEX INJURED AFI?INJURED WAS('X'ONE) PAJ;iv SF,AT AIR SAFETY ONLY FATAL :'SEVERE OTHER VISIBLE COMPLAINT NUMBER POS- RAG' EQUIP. I DRIVER PASS. PED. DlCYCLISTOTHER INJURY INJURY INJURY OF PAIN El # a 45 F El El o ❑ ❑ ❑ [- ❑ 0 1 0 ( ?:A ME IU.O.B./ADDRESS TFLEPIIONE fONI'A PORK (04/07/1962) 21 ORCHARD:CT.AI,AMO CA 94107 (1)25)36?-4()155 (INJURED ONLY)TRANSPORTED BY: TAKEN TO: s' SAN RARION FIRE.DEI''{'. JOHN NII11R MJ.;;D CENTER DESCRIBE INJURIES: CU'1'"1'O BACK OF HEAD.SENIERE BRUISING RIGH'('1111'AND Al1RASIONS'1'O LEFT SIDE. VICTIM OF VIOLENT CRIME(NOTIFIED Li off ..... .. _ ED xl T Li I I NAME/U.U.H./ADDRESS TELEFI IONL 'PERRY WAYNE ROBINSON (01!11/1966) 19 M19URII,I,O CT.OAKI.liY CA 94561 (925)848-6806 ji7:J:iR E:..O'a_Y)T;LANSPORTEU BY: TAKEN TO: ;DESCRIBE INJURIES:: F-1 VICTIM OF VIOLENT CRIME NOTIFIED NA P.1E J D.O.R::A D D R E55 — -_. TELEPHON:: S , _ -_.___........_........._.___ f (INJURED ONLY)TRANSPORTED BY: TAKEN To; S:. F .. i DESCRIBE INJURIES: I VI"Tlr ❑ ❑ ❑ ❑ ❑ ❑ ❑ 101, _.._1....__11-..._. : PJAM1IE/U.O.F3.f ADDIiF":SS "iELFPHOPJE z; (INJURED ONLY)TRANSPORTED BY: TAKEN TO: n i I DESCRIBE INJURIFS: i i : I VICTIM OF VIOLENT CHIr:,E NOIIFIEUEJ- I F r .::.: :. ... aNARE/D.O.B. ADDRESS . .. 1"E I:EF'HONE . i ti IINJUHf:IJ ONLY)TRANSPORTED 65'; TAKEN TO: I DESCRIBE:INJURIES: VICIi M OF VIOLENT CRIME NOTIFIED i — I� U ( u u::t _j i , NAME 1 D.O.H;l ADDRESS —___...._.__. I.-.r ( TH.LPIAON� M i (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES: VICTIM OF VIOLCFJT CRIME NOTIFIED PREPARER'S NA M11E I.D.NUMBER M0. DAY YEAR REVIEWER'S NAME MO. (JAI' YEAR, 15..1•:CA 1t R I N GTO N 012308 1 1;15/20117 STA'FE OF CALIFOKNIA FACTUAL DIAGRAM C'111'555 'ane4QZc0111.Q12 PAGE 4 OF 8 TIME �UppN.C.IDENT ONUMBER R.I.D. NR11/1:5/27, 0730 012308 111-206 ALL MEASUREMENT S ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED(SCALE= DANVI,f-.LE BLVD ................... UN t 144--.4--144_....H Do ........... IAC ii O-B lea CA 16B- ORCHART CT. ........... . . ........ ................... ..................................... 7-- LL ob ALAMO PLAZA I LPREPARED-LIY --' I.D.NUMDER DATE------ D. L. CARRINGTON 0123085/2007 sTnTE 01'CnL(-ORNIA NARRATIVE/SUPPLEMENTAL PAGE S 01' 8 ' DATE. OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 11/15/2007 0730 9320 012308 11-206 1 LECEN.D: 2 3 A—6" raised .micrete curb 4 B —Solid white. line 5 C—Broken white lane Linc .. ..............,.. . . ,.. , , c yellovvl, 7 E—.asphalt roadway 8 1, - 6"raised concrete island 9 10 PIIYSICAl, FVII)E>NCE: � 1.1 12 , —36' li)cl<;ed whee.l skid mark from V-2 13 h— Blood pool 14 15 P01N'I'OF REST': 16 17 1 -- l.%1'of V-2 %N,as 18' south of the south roadwa` edge prolon.cyntion of Orchard Ct. and ^8' edst of the 18 west roadway edge of Danville Blvd. 19 2-- IUF of'V-2 was 8' south of th.c sotltl.: roadway edge prolongation ofOrchard Ct. and 25.' east of the west 20 roadway edge of Danville Blvd. 21 22 23 Po . PRE'ARED BY I.C.NUMBER DATE REVIEWER'S NAME DA7 D. L. CARRINGTON 01230.8 11/15/2007 I i V. STATI;OF CALIFORNIA NARRATIVE/SUPPLEMENTAL _ _ _ PAGE 6 OF s DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 1111 5/M7 0730 9320. .012308 11-206 1 j{ACTS: 2 3 NOTIFICATION: I 4 5 1 was dispatched to a call of an hkiury traffic:collision, with art ambulance respondirly at 0740 hoin-s. I .... ...........6. ...... .....iesppiideti from f-(ib0 s/h at-Frcat Blvd.aria"arrived oil scene at 0745 flours._......................_.............. ...........-..... ..................... ....... I i. 7 l :.. .:.; ::8 All times:speeds and:measurements.in this investigation.are;approxinlatc. Ivle.asurements were taken 9 by rollineter; excenf.whcrc ot}ierwise indicated. 10 t. r�. 11 SCENE': : 12 13 At the scene of this collision, Danville Blvd. is a northboulul/S00thboutld city street consisting elf four 14 lanes. The roadway is strait ht.and level. The SLLrfaCC ]5 composed primarily of asphalt. 15 16 PA.10114:S: 1.7 18 Party 11 1 (York) was. contacted in the emergency room at .Inhn Muir Llospital beim attended to by 19 medical personnel. P-I received a hiceration to the back of her head, bruising,. to the right hip and 20 abrasions to her left side: 21 �2 . =rx•}?artti'/%F._;�.B -d): was.locctted staliding.tl;r his veliicle.a.t;tllc Seeiie oCihe.accident. 1'-2 w:1S identified 23 by a valid California driver's license. P-2 was.placed as the driver of N1-2 at the time of this collision 24 by his valid California driver's license and by statenwrrts of all`lnvolved parties. V-2. was located on it 25 wheels fkirig in a southerly direction as shtnvn on the diagram. V-2 sustained minor right ticint 26 darll(l2e. .. 28 i PREPARED BY I.D.NUMBER DATE REVIEVIi_R'S NAME DATE t. D. L. CARRINGTON 012308 11/15/2007 I l .. STATE OF CALIFORNIA NARkATIVE/SUPPLEMENTAL PAGE 7 OF s DATE.OF INCIDENT TIME NCIC NUMBER OFFICER I.D. .NUMBER 11/15/2007 0730 9320 0.12308 11-206 1 STATEMENTS: 2 3 PARTY#.1. ( orl� related that she was jogging n/b oil Danville Blvd. in the hike. lane. She saw cars 4 stopped at the crosswalk at Alarno Plaza. She noticed that the vehicles were turning right into the shopping 5 center. The first car made a right into the shopping center and the second vehicle came to a stop. She . , , __, C� o cnteren iilc .�rosti� aJl: gnu Degall'tCI(TC)SS i:J9(.`Slt'Cei,....she U,U noC.see ne L),ack ruck. Stii.Iuu,:�u 7 to check h/b tr�Jflic, when she Joolced left again she heard skirls and was hit by the truck. 8 9 PARTY #2.( 13earcl related that he was s,fb on Danville Blvd. at 30-32 n.iph in the left lade. Ile saw one cal- 10 Stopped in the crosswalk and another stopped jList prioI'to the crosswalk; both vehicle had there right turn 11 sional:on. Out of the corner of his eye he saw the jogger come from his right. I.le hit the brakes and tried to 12 `-:o lch to avoid.hcr. "as unable to.slop and hll her. 13 14 'VN'1.1'NLSS.4 1 (Terry Itohinson) was contacted standing oil the right curb at the scene.. Robinson related 15 that related lie was in the right Lane s'h on Danville Blvd. stopped behind a white vehicle at the crosswalk. 16 He saw the jogger coming rl/b in the bike lane: Vehicle ahead was stopped and the jogger made a right into 17 the crosswalk to cross llanville Blvd. W-1 saw the black U'uck.Conlin,' s/b in the# 1 lane at '35-40 nigh. 18 Neither party saw the other olid the jogger continLlcd across the street richt in front of the truck. 19 20 21 OPINIONS AND CONCLUSIONS: 22 23 SUMMARY: 24 25 I'A (York) was jogging n/b on Dam,illc..Blvcl. in the s/b bike lane approaching the driveway for the 26 Alai-no Plaza shopping.center. L/ Y (JSC lJ'Cl) VIaS§,/t:) Un IJFll7VJfie-15,l\'Ct, lrl t71c if 1 muaclJng s ioc ,. oir= SnJnac > I7 28 vehicle stopped at the crosswalk with there right.turrJ indicators on. P-I crossed the Alamo Plaza — - ---.........— PREPARED BY I.D.NUMBER DATE REVIEWER`S NAME DAiE D. L_. CARRINGTON 012308 11/15/2007 f STATF Or CALIFORNIA NARRATI'/EISUPIP LEMENTAL PAGE._K �.>_}�� DATE OF INCIDENT TIME NCIC NUMBER. OFFICER I.D. NUMBER 11/15/2007 0730 9320 012308 11-206 1 driveway and noticed a vehicle stopped at the crosswalk. P-1 for an unknown reason (lid not see V-2 2 approaching the crosswalk in the# I lane. P-1 entered the crosswal-.and looked to her right to check I 3 for n/b traffic on Danville.Blvd. P-2 saw P-1 out of the corner of his eye as lie passed began to cross 4 over the crosswalk. P-I Continued across the crosswalk in front of`i-2. P 2 lilt the brakes of V-2 as 5 he swerved to the left to avoid P-1. V-2 was unable to avoid and hit P-l. ... ........... o ......................... .__ .................... .._...... . 7 AREA.OF IMPACT(AOI): The AOT was based upon statements of all involved parties and by 8 physical evidence. The A01 was �' s/of the south roadway edge prolongation of Orchard ( t. and 22' 9 e/of the west roadway ed-,c of Danville Blvd. 10 11 CAUSE: 12 13 Party 8 1 (York) was at fault ii) this coIIision. for 21950 (B) VC; (suddenvallcing or rtunnin4, i:i fio It 14 of traffic). Ttie cause was based upon statements ol.'a.il involved pa.rlies and witness statenierats. 15 16 17 18 RECONII ENDA'TIONS: 19 I 1 PREPARED BY l.D.NUMBER DATE REVIEWER'S NAME­ DAl E: D. L. CARRINGTON 012308 11/15/2007 I DECLARATION OF PRESENTATION OF CLAIM IC.C.P. >z1013(a)1 2 I am over the age of eighteen years and not a party to the within action; my business 3 address is and I am employed at Walkup, Melodia, Kelly& Schoenberger, 650 California Street, 4 San Francisco, California 94108. On the date below I presented the affixed claim by depositing 5 the original and two copies thereof in the United States Mail in Sall Francisco, California, 6 produced on paper purchased as recycled,in accordance with Rules of Court §201(b): 7 to: 8 VIA CERTIFIED MAIL Clerk of the Board of Supervisors 9 County Administration Building 651 Pine Street, Room 106 10 Martinez, CA 94553 11 BY CERTIFIED MAIL. I caused such envelope with postage thereon fully prepaid to be 12 placed in the United States mail at San Francisco, California. 13 BY PERSONAL SERVICE. 1 caused such document(s) to be delivered by hand to the office of the person(s) listed above. 14 BY FEDERAL EXPRESS. In addition to serving this document by Certified Mall, 1 15 caused a courtesy copy of such document to be delivered by Federal Express to the office of the person listed above. 16 BY FAC:SIM.ILE TRANSMISSION. I caused such documcnt(s) to be delivered by 17 facsimile transmission at or about Enter time on that date. This document was transmitted by using a facsimile machine that complies with California Rules of Court Rule 2003(3), 18 telephone number (415) 391-6965. The transmission was reported as complete and without error. A copy of the transmission report, properly issued by the transmitting machine, is 1.9 attached. Tile names and facsimile numbers of the person(s) are as set forth above. 20 1 declare under penalty of perjury that the foregoing is true and correct. Executed on April 21 10 2008, at San Francisco, California. 22 ��_�SiFju I 23 HEATHER M. EHMKE 24 25 26 27 28 u!:\I.I LIF,N11:1AIIA,KLL1.l W1(_]I] &S(7i()ENI,GRGER :::.•n%.;i s�I5�-'.,_ .o:,rye PROOF OF SERVICE - CLAiM C y BOARD OF SUPERViSO.RS OF CONTRA COSTA COUN"rY BOARD ACTION: 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., D you is your notice of the action taken t5 v I on your.claim by the Board of `APR 1 0 2008 Supervisors. (Paragraph IV below), given Pursuant to Government Code ` Ij �� COUNTY COUNSEL Section 913 and 915.4. Please note all AMOUNT: �4 MARTINEZ CALIF. "Warnings". CLAIMANT: 5ol;i bak ATTORNEY: iuMoAew J. q 0 j f* DATE RECEIVED: &At ADDRESS: it BY DELIVERY TO CLERK ON: to zag T 5T 5b,9u,n PMMc_fsCO, 64 (Iq'I1I BY MAIL POSTMARKED: FROM: Clerk.of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CUL N, u�Q Clerk- Dated: o ��� By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors (This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present.a late claim (Section 911.3). ( ) Other: Dated: By: Deputy County Counsel III. FROM: Clerk of the Board . TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). . IV. BOARD ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in full. Other: I certify that this is a true and correct copy of theBoar Order entered in its minutes for this date. Dated: o JOHN CULLEN, CLERK, By Depu y Clerk WARNING (t3ov. code section 913) Subject to certain exceptions,you have only six(6) months firom tile date this notice was personally served or deposited in the litail 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. lf'you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side ofThis Notice.. AFFIDAVIT OF MAILING 1. declare under penalty of• tier 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 pre id a certified coley of' this Board Order and Notice to Claimant, addressed to the claim it a slrown above. Dated: JOHN CULLEN, CLERK By D uty Clerk �_ ... CLAIM BOARD. OF SUPERVISORS OF CONTRA COSTA COUNTY I BOARD ACTION: Claim Against the C�)unty, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT . and Board Action. A11 Section references are.to ) The copy of this document mailed to California Government Codes. ) you is your notice of the action taken on your claire by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4.Please note all AMOUNT:(,LIikI o0n "Warnings". CLAIMANT: JGI-` IN, Vury GL ATTORNEh2t1? Jta 1)LaA l� DATE RECEIVED: .i�lrJu � •. � ADDRESS: BY DELIVERY TO CLERK ON: .96,ri r�, (7.lnCQ$CO, (A Clq-I(I BY MAIL POSTMARKED: NIL) FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CUL N, Clerk• Dated:611at .'G J_ By: Deputy,' 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with:Sections 910 and 910.2.. ( ) This Claim FAILS to comply substantially with Sections 9.10 and 910.2, and we are so notifying claimant. The .Board cannot act for 15 days (Section 910.8). i (. ) Clairn is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of etaimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: i Dated: ! By: Deputy County Counsel 111. FROM: Clerk of the Board . TO: County Counsel (1) County Administrator (2) ( ) Claim was tjetu•ned as untimely with notice to claimant (Section 91 l.3). 1V. BOARD ORDER: By unanimous vote of the Supervisors present: ( ) This Claire is rejected in full. ( ) Other: I certify thai this is a true and correct copy of the Board's O.rdei• 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 claim.See Government Code Section 945.6.You may seek the advice of an attorney ofyour choice in connection wide this matter. Ifyou want to consult an attorney,you should do so immediately. *Fo.r•Addi6maI War•nijig See Reverse Side ofThis Notice. AFFIDAVIT OF MAILING I declare under.pe!nalty 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 clairrrant as shown above. Dated: JOHN CULLEN, CLERK By Deputy Clerk i K W/31/2008 09:58 CONTRA COSTA COUNTY CLERK OF THE 3 9141 -- 0449 140.220 D0 BOARD OF SUPERVISORS OF CONTRA COSTA C TV 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.' Issas mefee sasoidsrffyrameaSamos aaso9aOtago glass%fees*$Doug"49660698soove•■a.so09 RE: Claim By: Reserved for Clerk's filing stamp Sarah Kimball ) RECEIVE® Against the County of Contra Costa or } APR 1 0 2008 Count ) y of Contra Cgs/-a District CLERK BOARD OF SUPERVISORS� (Fill in the name) ) CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ unknown and in support of this claim represents as follows: I. When did the damage or injury occur? (Give exact date and hour) See attached Pleadings. 2. Where did the damage or injury occur? (Include city and county) See attached Plead.inc . 3. How did the damage or injury occur? (Give full details; use extra paper if required) See attached pleading. 4. What particular act or omission on the part of county or district officers, servants, or employees causedthe injury or damage? . see attached pleading. 5 What are the names of county or district officers, servants, or employees causing the damage or injury? . See attached Pleading. 07/31/2@@8 09:58 CONTRA COSTA COUNTY CLERK OF THE 4 9141 @449 NO,220 Q@ b. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) See attached pleading, 7. How was the amount claimed above computed? (include the estimated amount of any prospective injury or damage.) See attached pleadincr. S. Names and addresses of witnesses,doctors, and hospitals: See attached pleading. , . 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT Unknown at this time. ••f•a///////r/assets form••rfffffffaa■was•f/f/••ff■•rff•ffff/famore*//f/fo/arx/f to as V1 ) Gov. Code Sec. 910.2 provides"The claim shall be )signed by the claimant o ome person on his behalf." SEND NOTICES T0: (Attorney) ) Name and address of Attomey ) Alatthew J. Quinlan, Esq, ) The Cartwright Law Firm, i C. (Claimant's Signature) 222 Front Street,. 5th FlJ San Francisco, CA 94111 ) (Address) Telephone No. (415)_ 433-0444 )Telephone No. •�aai//�//•ff////f•f/•a�rafrffff/f//�//f//ff/f/�/■/f�•f■//////�/////��/////�/��/ff�/o 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. ///Floors ff//s/■/1r//poseff/f/flfffsugar ffwere guess f/a//f//ff■fee frffffe 0 fr•agate ouvi NOTICE: Section 72 of the Penal Code provides: Every person who, witil intent to defraud, presents for allowance or for payment to any state board or officer, or i 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 telt thousand dollars ($10,000), or by both such imprisonment and fine. 1 ROBERT E. CARTWRIGHT, JR., ESQ. (SBN: 104284) MATTHEW J. QUINLAN, ESQ. (SBN: 236507) - The Cartwright Law Firm, Inc. 3 222 Front Street, 5th Floor San Francisco, CA 941 1 1 4 Phone: (415) 433-0444 5 Facsimile: (415) 433-0449 Attorneys for Claimant Sarah Kimball 7 SARAH KIMBALL, ) 9 ) GOVERNMENT CLAIM 111 Claimant, 11 vs. ) 1z Cl'I y OF LAFAYETTE (a ) 13 government entity); COUNTY OF 0:� 1 r r4-ED CONTRA COSTA (a government ) Iia entity); and DOES 1 through 50, APR 1 0 2008 I> inclusive; ) CLERK BOARD C..� rc.:;1;1S0RS 16 Respondents. CONTRA CUt:)T�;CO. 17 ) 1s ) 19 ) ,11 Name and Address of Claimant: SARAH KIMBALL, c/o Robert E. Cartwright, Jr., Esq. and Matthew.J. Quinlan, Esq.; ,3 The Cartwright Law Firm, Inc.- 222 Front Street, 5th Floor- San Francisco, CA 941 1 1. 4 Telephone: (415) 433-0444. (Claimants may only be contacted through their counsel, The 25 Cartwright Law Fir7», Inc.) '16 ?7 zs Post Office Address for Notices: GO VERNMEN 1 CLAIM Robert E. Cartwright, Jr., Esq. and Matthew J. Quinlan; Esq.; The Cartwright Law Finil, Inc.; 222 Front Street, 5th Floor; San Francisco, CA 94111. 3 .1 Date, Place, and Other Circumstances of the Occurrence: G Date, Time & Place: The tortious conduct occurred at the intersection of Mt. Diablo 7 Boulevard. and Dewing Avenue in Lafayette, California on December 5, 2007 at approximately s 8:15 p.m. 9 Io Circumstances: Claimant was walking southbound along Dewing Avenue crossing Mt. 12 Diablo Boulevard. While within the crosswalk, Claimant was suddenly and violently struck by a 13 vehicle driven by Sharon Morgan. Ms. Morgan was traveling eastbound on Mt. Diablo -4 i_ Boulevard. At the time ofthe incident. there were no functioning or operational traffic signals at 10 this intersection. There is ample evidence that this was a busy intersection with IICaVV VChlClllar 17 and pedestrian traffic. In tact, there is even evidence that traffic s1g112.11S had been Constructed, but is were not in operation that night. The lack oi�properly functioning tral'fic signals renders this intersection a danu.erous condition. Respondent is liable for lalling to warn, maintain, inspect, 2n ,I install, and make safe this dangerous condition for which Respondent had actual and Constructiv 2_2 notice. 23, 24 Liability: The following govel'Illllellt entitles are responsible for Claimant's illluriCS and 2 26 dlamaoes, and are liable to Claimant: CONiRA COSTA COUNTY and CITY O 27 LAFAYET"i"E. These government entities tailed to warn, maintain, inspect, install_ and make 28 sale the dam-,erous condition of the intersection at Mt. Diablo Boulevard and Dewing. AVC11l1C. -19 r.,!'C 2 GOVI.:kNniEN I CLAIM 1 These entities faded to install properly functioning traffic signals for that intersection. These entities had both actual and constructive notice of this dangerous condition. These government 3 entities" negligence were the direct and proximate cause of this accident. . a Claimant reserves the right to pursue all her claims against these named and unnamed 6 public employees and government entities at common law (where allowed) and under all 7 applicable statutes, both state and federal, all applicable regulations, and in equity. Is CONTRA COSTA COUNTY and the CITY OF LAI"AYETTI', their employees, both 9 10 named and unnamed, are liable pursuant to, but not limited to, the following: various I1 provisions of the Constitutions of the State of California and the federal Constitution. Iz CONTRA COSTA COUNTY and the CITY OF LAI"AYITTE, their employees, both named 13 and unnamed, are liable to Claimant for. infer(diu, negligence, negligence per se. and 1 { ne�Oligent infliction of emotional distress. Additionallv, CONTRA COSTA COUNTY and the 15 16 CITY OF LAFAYLTTI'. .Ire liable (under the doctrine and applicable 17 statutes, for Al tOrtS.COmmltted against the Claimant by any of their employees and agents, 1s named and Unnamed. 19 '0 21 Names of witnesses: Paul Clark Borden. His inl'ormation is included within the police report. Discovery and investigation are continuing and Claimant reserves the right to amend this Claim when further za information is acquired. 26 27 General Description of the In jury and Danjapes Known at this Time: 2s )q (.OVER'vM1::' YC I.MNI Physical injuries, including but not limited to a fractured pelvis, torn MCL, ACL, PCL , and meniscus requiring two surgeries for total right knee reconstruction. trauma and lacerations to the head, abdominal bleeding, and general pain and suffering damages to the Claimant. These a damages include, but are not limited to, economic and non-economic damages. Claimant's r, economic damages include, but are not limited to, attorneys' fees and costs, wage loss, loss of earning capacity. and medical bills. Claimant's non-economic damages include, but are not s limited to, general damages, damages for pain and Suffering, loss of enjoyment of life, and Io emotional distress. 11 1' Name(s) of Public Emplovee(s) Causing the Injury and Damages: 1, None at this time. Discovery and investigation are continuing. Claimant reserves the 1-I right to amend this Claim if names ol'employees are discovered. 1 1 c, 17 Amount Claimed: is Jurisdiction IS in Contra Costa Superior Court, Unlimited Rlrisdiction. Discovery and investigation are COntlllUillg. Claimant is uncertain as to the precise amount of the claim. Due to �o ,1 the Significant injuries described above, however, Claimant contends that the amOUnt claimed is Ill CXCCSS Of the all1011llt regUlred for Unlimited .ILIriS(IiCti011. ,a Name and Address of Representative: -15 26 Robert F. Cartwrioht. .ir.. .F_.sq. and Matthew .i. Quinlan, Esq.- "l'he Cartw rip.ht Law ,7 Firm, inc.; ??2 Front Street. nth I lour; San Francisal, CA 9�}1 1 1. Telephone: (�11 5) 4ii- 0444. rr.,_,c 4 1 DATFD: April 9, 2008 TI I/CAR'Tl' RIP.uinlkan, R.M. INC. 4 By: J. 6 Allnrne.l..' .fin- Claimant Sarah Kimhull 7 e 1n II 1' 13 14 15 16 17 I's Iv 2(l '1 ,z w ,7 c;i)VI.K\MEN I c_LAIM cLArlvl BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: 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 APR 1 O 2008 Supervisors. (Paragraph IV below), given Pursuant to Government Code UV COUNTY COUNSEL Section 913 and 915.4. Please note all AMOUNT: bVer MARTINEZ CALIF. "Warnings . o Tr ! CLAIMANT: y�,11,)1�". _- `J ATTORNEY: Jf7CLr1 - DATE RECEIVED: Q, — to �xvg Ptti�iPaf2i" �©Rl°ol��Tt= C�enYl� ADDRESS- oalk-pDrt 5f) 4-Ll © BY DELIVERY TO CLERK ON: Oa-kLatij, ( /A g4(o2—i BY MAIL POSTMARKED: CLQ, C a[S�g FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. JOHN CUL E leak� .. Dated: By: Deputy iI. FRO*.: County Counsel TO: Clerk of.the Board of Supervisors ( lis 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 claire on ground that it was .filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 1" , L(I 09By: rj/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). 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- this date. r Dated: &A)t JOHN CULLEN, CLERK, By Depu leek WARNING ( ov. 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 snail 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 sliould do so iinrnediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING Ldeclare under penalty of perjury that I ani now, and at all tinnes herein mentioned, have been a citizen of the United States, over age 18; and that today 1 deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claiinaint, addressed to the clai itshown above. Dated: JOHN CULLEN, CLERK By eputy Clerk I • CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY i BOARD ACTION: cj �o2J r Claim Against the C6unty, 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: CUV 261Section 913 and 915.4. Please note all "Warnings". CLAIMANT: oaG- re� ATTORNEY: JfJhfl l. . bcrl^�5 DATE RECEIVED: �11P�oi2i C�R1°ol��T ADDRESS- (0q Ii Dpwr 5f,/ "#kt � BY DELIVERY TO CLERK ON: alkLat-01. CA g4(o2.1 BY MAIL POSTMARKED: CCULLL ci FROM: Clerk of the Board.of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. //�� JOHN CUL E lerk Dated: U �� a�c� By: - Deputy - 1,P/la/l�t P 1 ,�(X-� I.I. FRO .: County Counsel TO: Clerk of the Board.of Supervisors ( ) This claim complies substantially with Sections 9.10 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: i i I Dated: By: Deputy County Counsel III. FROM: Clerk of the Board. TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: ( ) This Claim is rejected in full. O Other: i I 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 n-Lpil 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,yon should do so immediately. *ForAdditional Warning See Reverse Side ofThis Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that f am now, and at all times herein mentioned, have been a citizen of.t.he 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 claintan.t as shown above.. Dated: JOHN CULLEN, CLERK. By Deputy Clerk i LAW OFFICES OF JOHN L. BURRIS www.mohnburrislaw.com John L. Burris John.Burris@JohnBurrisLaw.com Ben Nisenbaum Ben.Nisenbaum@JohnBurrisLaw.com Adante D. Pointer April 09, 2008 Adante.Pointer@JohnBurrisLaw.com Contra Costa County K15 ;F" Board of Supervisors APR 1 ii 2008 651 Pine Street, Suite 107 Martinez, CA 94553 CLERK BOARD OF: urFIV1sORs CONTRA CO>� CO. RE: Claim Form for Danny Godfrey D.O.1: October 10, 2007 Location of Incident: In the City of Richmond Dear Board of Supervisors: Enclosed, you will find an original and one copy of the claim for the above mentioned person. We are enclosing a self-addressed stamped envelope for the return of an endorsed copy. Thank you for your assistance; if you have any questions please do not hesitate to contact our office. Yours truly, THE LAW OFFICES OF JOHN L. BURRIS Maxine ohnson Paralegal maxine.johnson@iohnbur7islaw.com Enclosure AIRPORT CORPORATE CENTRE • 7677 OAKPORT STREET,SUITE 1120 • OAKLAND, (;A 94621 • TEL(510)839-5200 • FAX(510)839-3882 SUMO 01 CONM COM COURM �tUWANT A. A chdiun IvIatkS to a cauft of w1jon for dea or for Wuay to p==or go pawwl pao or jpa' ".be pvwaW awe Tata rmoaft efta dw a=RWof the cmw of mon. A,clews reIdi% to any other eme of xdwp be..pres=W not Ida t=one ym , aft the aamw of the com of acdon. B. C14im mug be &A with to Clwk of*e Bow of 3vavims g iu *I&C in RD= 106, ` ` Gn Builft&65 2 PPO StW4 MR61mv,CA 94553. G. if ekim is Bpi=a dis48ict Vverned by tho Dowd 9f *a Cc=ty, ehe of Di*ia dowd be MW aa. tie cwm is ftmast Mon tbaw ora®puwa"dry. opma OW=mw be APM each pnmblae�atl�. E. sea pawty for ftwwcw dams,Paw Coda Sec. ?a at aw end of dais AM eve eve soo0a 40p000, 00 60000000003 00600 goof DANNY GODFREY, c/o LAW OFFICES ) F OF JOHN L. BURRIS. RECEIVED AgaivA*a Cquay Of C0=a Costa or j A'DR 1 G 2008 CONTRA COSTA COUNTY - j CLERK BOARD (Fill in diG ame) CC)N T RA COSTA Cts. w6ni h by cWm affinst&e Cour Of COaft or tt a boved diadet iAof�OV $25 00%d j ftf*dzrepmWIS as f®Ii � ' 1. MM did ft&Mage Of i4j"0=0 (ire mod d ) : PLEASE SEE ATTACHMENT "A" 2, %me did*e dmap or ? (X=jUft city ad �) IN THE VICINITY OF THE INTERSECTION OF 5TH & MARKET ST. , IN HE . T OF RICHMOND PLEASE SEE ATTACHMENT "A" - 4. , palwax not d oem on the y of county,07 `a "ct off, or employees ' or damage? PLEASE SEE ATTACHMENT "A' Y or ftwet ofoom. %or employeftoa . . d=W ar W 118 CONTRA COSTA COUNTY SHERIFF' S DEPARTMENT, AND DOES 1-25 (names of Sheriff' s Deputies unknown), d overy ' is still continuing ' Date:. April 081 2008 . PLNL L�" BURRIS, ESQ. LAW OFFICES OF JOHN L. BURRIS Airport Corporate Centre 7677 Oakport Street,.suite 1120 Oakland, CA 94621 510-839-5200 office 510-839-3882 fax Attachment "A" Name of Claimant: Mr. Danny Rene Godfrey Claimant's address: C/O LAW OFFICE OF JOHN L. BURRIS, ESQ. (510)839-5200 Address to.which all notices are to be sent: LAW OFFICES OF JOHN L. BURRIS,. Airport Corporate Centre, 7677 Oakport Street, Suite.1120, Oakland, CA 94621 PLEASE NOTE: COUNSEL REPRESENTS CLAIMANT AND ALL CONTACT SHOULD BE MADE WITH HIS ATTORNEY. DATE OF INCIDENT: October 10, 2007 Location of Incident: In the vicinity of the Intersection of 5th and Market Street, in the City of Richmond "A GENERAL DESCRIPTION OF THE INDEBTEDNESS, OBLIGATION, INJURY, DAMAGE OR LOSS INCURRED SO FAR AS IT MAY BE KNOWN AT THE TIME OF PRESENTATION OF THE CLAIM" AND "THE NAME OR NAMES OF THE PUBLIC EMPLOYEE OR EMPLOYEES CAUSING INJURY, DAMAGE, OR LOSS OF KNOWN". {Per Government Code Section 910} DESCRIPTION OF INCIDENT: This incident took place.on October 10, 2007. Mr. Danny Godfrey was riding a motor- cross dirt bike while driving on 5th Street a marked MARTINEZ POLICE and/or the CONTRA COSTA SHERIFF'S vehicle hit Mr. Godfrey on the left side of.the bike. Mr. Godfrey was knocked off the motorcycle rendering him unconscious, resulting in multiple fractures to his left ankle. Several minutes later, an ambulance arrived and transported Mr. Godfrey to Contra Costa County Regional Medical Center in Martinez. Mr. Godfrey was hospitalized for several days, because his ankle required major surgery. After being released from the hospital, Mr. Godfrey was never-charged. As a result of the injuries sustained from being hit by the CITY OF MARTINEZ POLICE and/or the CONTRA COSTA SHERIFF'S, Mr. Godfrey has had.three surgeries on his ankle and his ankle may never fully recover. Claim for Danny Godfrey DESCRIPTION OF CLAIM: Claimant alleges that the acts of the MARTINEZ POLICE DEPARTMENT and/or the CONTRA COSTA SHERIFF'S DEPARTMENT and their individual employees, agents and/or servants constitute civil rights violations, by the assault and battery of Claimant with a vehicle, causing serious injury to Claimant. Claimant alleges that individual employees, agents and/or servants of the CITY OF MARTINEZ and/or the CONTRA COSTA SHERIFF'S DEPARTMENT are responsible for Claimant's civil rights violations and acts and/or omissions committed within the course or scope of employment under the theory of Respondeat Superior liability. Respondeat Superior liability includes but is not limited to, negligent supervision, control and/or discipline. Individuals employees, agents, and/or servants of the MARTINEZ POLICE DEPARTMENT and/or the CONTRA COSTA SHERIFF'S DEPARTMENT, including but not limited to, the pain and agony that Mr. Godfrey had to endure by being placed in the hospital for several days, and missing work due to the seriousness of his injury. Claimant is informed and believes and thereon alleges that the conduct of individual employees, agents and/or servants of the MARTINEZ POLICE and/or the CONTRA COSTA SHERIFF'S DEPARTMENT officers as alleged herein was intentional, malicious, oppressive and/or done with a conscious and reckless disregard for the safety of the Claimant. CLAIM FOR DAMAGES: Claimant have a claim for damages arising from the acts and/or omissions of the CITY OF MARTINEZ and/or the CONTRA COSTA SHERIFF'S DEPARTMENT employees, agents, and/or servants, including but not limited to the Officer operating the police vehicle, and/or DOES 1=25, individually and/or while acting in concert with one another, as alleged herein based on theories of liability which is include. But, is not limited to the use of excessive force,.assault and battery and the infliction of emotional distress, negligence per se, also the violation of his civil rights, including but not limited to, the violation of the United States Constitution and/or statutory rights under California law. Claimant has, or may have in the future, a claim for general damages, including, but not limited to, a claim for excessive force, which may include a claim for assault and battery by the Martinez Police Department, along with the infliction of emotional distress, in amounts to be determined according to proof. Claimant has and/or may continue to have in the future, a claim for special damages, including, but not limited to, a claim for lost wages, property damages, as well as permanent scarring resulting from future surgeries to his ankle, in amounts to be determined according to proof. Claimant has damages in excess of$25,000. Claim for Danny Godfrey 2 NAME OF PUBLIC EMPLOYEE(S) BELIEVED TO HAVE CAUSED INJURY OR DAMAGE: City of Martinez; Contra Costa Sheriffs Department, and Does 1-25 (names of the police officers and/or Deputy Sheriff's unknown), discovery is still continuing. DEMAND FOR PRESERVATION OF EVIDENCE: Claimant does hereby demand that the MARTINEZ POLICE DEPARTMENT, including, but not limited to, the CITY OF MARTINEZ and/or the CONTRA COSTA SHERIFF'S DEPARTMENT, its employees, servants and/or attorneys, maintain and preserve all evidence, documents and tangible material which relates in any manner whatsoever to the subject matter of this Claim, during the pendency of this case, and until the completion of any and all civil and/or criminal litigation. This demand for.preservation of evidence included, but is not limited to, a demand that all police departments and/or public safety entities preserve all tapes, logs and/or other tangible materials of any kind be preserved until the completion of all and all civil and criminal litigation, which maybe the subject matter of thi laim. DATED: April 8, 2008 P��N L. BURRIS f�krney for Claimant Claim for Danny Godfrey 3 Til— _-._,-_.__-...._._......_..__.-._..._�....-.:_Ii:;UOA:u Vll l"'I.ouu.UUYCUCA7I.oJU:4UJ.5JJJ -._..__.:._..._......-._Zi .— o M. t CD CL cu .94 Llw a t _ smE'l Lj 9 15 „- mx El m 0 Ll C. j a�a 3wmx z 0 wa_ oAv a = oLL"a o- a =dP LL2v� LLry `a LL,n? fE v S NZu '-' R O J E U Yea ❑ e= ryo 01 e m - - Li C >.E V ppb W W Ov me ' , N :5A �f A' y, sy ❑LL 2'. i s � tem •� mLL�z FmzS orT�z •_ tW.;E O I -OQ_l.m:`o- C d ESA a� to vv W .�Ea li�a0 to W O o Y¢w - m affi _ S W_ @� Q. D.E O. LL •C A. a a _ q d IO.G-acOWS l J W ` - Y W y� �(�cr� atl� N.E W _O Gmm�"� ._a V •' 7 o{`_mo2 ILa_ Lb E2� kull F2U V IiSm d � w O € sic � E N VJ 53 E Z: Za _ � _n W 6�'�vvi0 n �g w W G ^� W . .LL.z li t LL W Iizt�Q d liC H fail zZ e dIp fna- fb = OC Z¢i " : co Ln ru r-u \ C. n, ru 1 1 CO r wli r zLO N ft-oft i it co v; fnzl 3V3H -933d -IR131di.73H N . C" I ` i� avc,v,mvnnm Yms-ion"nno•i mni•vanni WARD 09 summizopa or CONM conk Comm A. A cwm relack s to a exatz of aglion fig a8 for Wt9y,to PW=W so wwwl pwpmy or Somiag emps 6A be pr&=W I= lata the !dx =nft efta dw atcgIld of*c cm&w of man. A cleign seiatiag to say Otlff crosc®1'aviom 8bo be preamud tat lax tm One yen ' afor the ame Of the(am of HWOL (cay' . cods 911.2.) B. Claim tug be. fifltd with thg perk Of Board of S g at ib officc fa Rc= 106, CW49y' & afi®n BW&7a&651 fte Swag,Ma*.�,- CA 94553. C, If cWm k awe a diAdct gated by the Sgoli of s L-on, rim Ihm Ike COUMy,Phe Of dw Disgust d tae&W ia; D. W tie eldm is VAWIA mots d= 04V F "ft Nywo claim mug be li @d Aom mth public,eW. Ir. d, sea ty f6i ftmhdm d $,Pad C*da Sm 72 at ft aLj of 000 GOCaOOOOCDC aDOD noDoa0aOOOD000000D00QOODDOOOODODODPD0Ra00000DoDoaco000000CDC a t 1$iye 16-sanyad fa clatog raft HEMP I DANNY GODFREY •c/o LAW OFFICES OF- JOHN L. BURRIS I Aggnat lh§Cam of aft or ) CONTRA COSTA COUNTY �iudi@mine) The undcojenW de&aw herby wkes c ST COU07 of Cmira Caste Oc ft disiet in to mm of$0 V $2 5,_0 0 in gin of s �=tq as follows: ' . i 1• Wbo dad tt dmdge-Os WWY (Oe=ad dm wd l=) PLEASE SEE ATTACHMENT : "A" 2. Whege d Or WW7 fir? a=1W@ OiPy od cogi) IN THE VICINITY OF THE INTERSECTION OF 5TH & MARKET ST. ,. IN EIE . T OF RICHMOND PLEASE SEE ATTACHMENT "A" 4, Wha panivwRz aO8 Oa® sig thei gM of cmraaty m dinict msec: nryo-1-5,W wpbs ' PLEASE .SEE ATTACHMENT "A' 5 Whu WG ft mus of couwy OT dis at 0fdomo six or employms ax CONTRA COSTA. COUNTY SHERIFF ' S DEPARTMENT, AND DOES 1-25 (names of Sheriff ' s Deputies unknown) , disery Date: Apr ' is s ill continuing April 08 , 2008 JO N L. B RRIS , ESQ. LAW OFFICES OF JOHN L. BURRIS Airport Corporate Centre 7677 Oakport Street, suite 1120 Oakland, CA 94621 510-839-5200 office 510-839-3882 fax Attachment "A" Name of Claimant: Mr. Danny Rene Godfrey Claimant's address: C/O LAW OFFICE OF JOHN L. BURRIS, ESQ. (510)839-5200 Address to which all notices are to be sent: LAW OFFICES OF JOHN L. BURRIS, Airport Corporate Centre, 7677 Oakport Street, Suite 1120, Oakland, CA 94621 PLEASE NOTE: COUNSEL REPRESENTS CLAIMANT AND ALL CONTACT SHOULD BE MADE WITH HIS ATTORNEY. DATE OF INCIDENT: October 10, 2007 Location of Incident: In the vicinity of the Intersection of 5th and Market Street, in the City of Richmond "A GENERAL DESCRIPTION OF THE INDEBTEDNESS, OBLIGATION, INJURY, DAMAGE OR LOSS INCURRED SO FAR AS IT MAY BE KNOWN AT THE TIME OF PRESENTATION OF THE CLAIM"AND "THE NAME OR NAMES OF THE PUBLIC EMPLOYEE OR EMPLOYEES CAUSING INJURY, DAMAGE, OR LOSS OF KNOWN". {Per Government Code Section 910} DESCRIPTION OF INCIDENT: This incident took place on October 10, 2007. Mr. Danny Godfrey was riding a motor- cross dirt bike while driving on 5th Street a marked MARTINEZ POLICE and/or the CONTRA COSTA SHERIFF'S vehicle hit.Mr. Godfrey on the left side of the bike. Mr. Godfrey was knocked off the motorcycle rendering him'unconscious, resulting in multiple fractures to his left ankle. Several minutes later, an ambulance arrived and transported Mr. Godfrey to Contra Costa County Regional Medical Center in Martinez. Mr. Godfrey was hospitalized for several days, because his ankle required major surgery. After being released from the hospital, Mr. Godfrey was never charged. As a result of the injuries sustained from being hit by the CITY OF MARTINEZ_ POLICE and/or the CONTRA COSTA SHERIFF'S, Mr. Godfrey has had three surgeries on his ankle and his ankle may never fully recover. Claim for:Danny Godfrey 1 DESCRIPTION OF CLAIM: Claimant alleges that the acts of the MARTINEZ POLICE DEPARTMENT and/or the CONTRA COSTA SHERIFF'S DEPARTMENT and their individual employees, agents and/or servants constitute civil rights violations, by the assault and battery of Claimant with a vehicle, causing serious injury to Claimant. Claimant alleges that individual employees, agents and/or servants of the CITY OF MARTINEZ and/or the CONTRA COSTA;SHERIFF'S DEPARTMENT are responsible for Claimant's civil rights violations and acts and/or omissions committed within the . course or scope of employment under the theory of Respondeat Superior liability. Respondeat Superior liability includes but is not limited to, negligent supervision, control and/or discipline. Individuals employees, agents, and/or servants of the MARTINEZ POLICE DEPARTMENT and/or the CONTRA COSTA SHERIFF'S DEPARTMENT, including but not limited to, the pain and agony that Mr. Godfrey had to endure by being placed in the hospital for'several days, and missing work due to the seriousness of his injury. Claimant is informed and believes and thereon alleges that the conduct of individual employees, agents and/or servants of the MARTINEZ POLICE and/or the CONTRA COSTA SHERIFF'S DEPARTMENT officers as'alleged herein was intentional, malicious, oppressive and/or done with a'conscious and reckless disregard for the safety of the Claimant. CLAIM FOR DAMAGES: Claimant have a claim for damages arising from the acts and/or omissions of the CITY OF MARTINEZ and/or the CONTRA COSTA SHERIFF'S DEPARTMENT employees, agents, and/or servants, including'but not limited to the Officer operating the police vehicle, and/or DOES 1-25, individually.and/or While acting in concert with one another, as alleged herein based on theories of liability which is include. But, is not limited to the use of excessive force,;assault and battery and-the infliction of emotional distress, negligence per se, also;.the violation of his civil rights, including but not limited to, the violation of the United States Constitution and/or statutory rights under California law. Claimant has, or may have in the future, a claim for general damages, including, but not limited to, a claim for excessive force, which may include a claim for assault and battery by the Martinez Police Department, along,with the infliction of emotional distress, in amounts to be determined according to proof. Claimant has and/or may continue to have in the future, a claim for special damages, including, but not limited to, a claim for lost wages, property damages, as well as permanent scarring resulting from future surgeries to his ankle, in amounts to be determined according to proof. Claimant has damages'in excess of$25,000. Claim for'Danny Godfrey 2 NAME OF PUBLIC EMPLOYEE(S) BELIEVED TO HAVE CAUSED INJURY OR DAMAGE: City of Martinez; Contra Costa Sheriffs Department, and Does 1-25 (names of the police officers and/or Deputy Sheriff's unknown), discovery is still continuing. DEMAND FOR PRESERVATION OF EVIDENCE: Claimant does hereby demand that the MARTINEZ POLICE DEPARTMENT, including, but not limited to, the CITY OF MARTINEZ and/or the CONTRA COSTA SHERIFF'S DEPARTMENT, its employees, servants'and/or attorneys,.maintain and preserve all evidence, documents and tangible material which relates in any manner whatsoever to the subject matter of this Claim, during the pendency of this case, and until the completion of any and all civil and/or criminal litigation. This demand for preservation of evidence included, but is not limited to, a demand that all police departments and/or public safety entities preserve all tapes, logs and/or other tangible materials of any kind be preserved until the completion of all and all civil and criminal litigation, which.maybe the subject matter of thi laim. DATED: April 8, 2008 N L. BURRTs rney for Claimant Claim for Danny Godfrey 3 CO 0 04 ¥ �2t cr-3 � � Q iJ% 2- \ku » wa702 �}\ \\\ •k. . ��\ CLAIM BOARD OF' SUPERVISORS OF C01VT•RA COSTA COUNTY BOARD ACTION:MCUA 20, 2L Claim Against the County, or District Governed by.) the Board-of Supervisors, Routing; Endorsements, ) NOTICE TO CLAIMANT and Board Action.. All Section references are toti The copy of this document mailed to Cali forniawGovernment Codes. 7 you is your notice of the action taken on your claim by the Board of 6 2008 Supervisors. (Paragraph IV below), vNTY COUNSEL given Pursuant to Government Code AMOUNT: &ty) Q(,n, MARTINEZ CALIF. Section 913 and 915.4. Please note all "Warnings". CLAIMANT: torn ua.Le o ATTORNEYV(tVOi "go W& DATE RECEIVED: ADDRESS: C[DI ftY&Kd­ -.� 5�� BY DELIVERY TO CLERK ON: 10, zz� 3M5��' Gq gq(o3 BY MAIL POSTMARKED: FROM: Clet•k of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. JOHN CUL N, ]erk� Dated: _ , By: Deputy, II. FRO County Counsel TO: Clerk of the Board of Supervisors (�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 retum claim on ground that it was filed late and send warning of claimant's right to apply for.leave to present a late claim (Section 911.3). ( ) Other. Dated: By: Meg � 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). 1V. BOARD ORDER: By unanimous vote of the'Supervisors present: This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JOHN CULLEN, CLERK, By De t Clerk WARN]. G (Go . 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 cNim.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 attonley,you should do so immediately. *For Addition"'ll 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 coley of this Board Order and Notice to Cl. imant, addressed.to the claim- as shown above. Dated: '1- AA JOHN CULLEN, CLERK By ' eputy Clerk ICLAr1VI BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: --� Z 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 / y Section 913 and 915.4. Please note all AMOU.N'I: cuI tit" � "Warnings". CLAIMANT: r11 PiU.t ,Z,UC ATTORNEY:PiTIVO MULKC 0 W6 -DATE RECEIVED: Z� ADDRESS: rOl jrY�CtY - � (j�L� LI BY DELIVERY TO CLERK ON: �5(Z!'Ii `�c:t�' G1,1 q l L J BY MAIL POSTMARKED: / _ FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. JOHN CUL, N, leek Dated: By: Deputy`�( (�7.��1t iI. FRO 1.: County Counsel TO: Clerk of the Board of Supervisi.rs ( ) Tills claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 91012, 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 i•etuili claim on ground that``.it was filed late and send warning of claimant's right to apply for leave to present a late claire (S60ion 91.1.3). ( ) Other: i Dated: By: Deputy ounty 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. 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 this date. Dated: JOHN CULLEN, CLERK, By Deputy Clerk WARNING (Gov. code section 913) ' Subject to ceitairn exceptions,you have only six(6) months fi-om the date this notice was personally served or deposited in the nwil to file a court action on this clanirn.See Government Code Section 945.6.You.may seek the advice of'an attorney of your choice in connection witrn this matter. ll'you want to consult an attorney,you should do so immediately. *For Additional War-nirigSee Reverse Side of•This Notice. AFFIDAVIT OF MAILING t declare under penalty.of perjury that r. 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 lrepaid a certified copy of this Board Order and Notice to Claimant, addressed to the clainnau.t as shown above. Dated: JOHN CULLEN, CLERK By ' Deputy Clerk 04/15/2008 15:57 7079633171 INGLEWOOD AVENUE PAGF 01/01 ».� �`�✓'' ��: 3 �43N7l�q C!°'PIA cm Y OLM t7F TNS X60.273 ' IMI A. A 4411 010ig t*a can of*Cft:fm dt w hr 4*7 w p aaa ar to pe at pr6yywy M F*wmg aqt be pmwood in lea to is mandu a tet do w=W of do esus¢ of acd*M A VWM WINiag to A.y 069 CBM of Wtm 11 be PNCMW U01 IdOr thao*ate you aftr ft amw oil cam of so-TICA° ,Code 19112,) , cWw Avg be Aw vittt the +Claik of dw Baud of SupuvWa 4 'its odge In Rom 106, CMVW A ai uya$*W4&651 lis t 94559. C° If ataim to 4SAui a diaaict InvenAd by ft bond of S /bon,after thea ft Cowly,ft Hama ofthe Dl*ict shmid be AIW in. D, If ft cWM is apim Mmt to He gxdty, chbW mM be fits! agrhW ewh Inc eatity. E. jawt&a pftdty for A ud ad a .PWA code Sac. 72 a the 006 of two the : aapapbedoO hat aAOYsraOtie go•aOaWOwaa&Oliva 0#aA,otl9ai3OpdQ Nfj*MOWNI&SOOW00„41atWam®vb09911 RE: Claim 157 � $ CIwk°s flag amp fi— ED . 0inst*a ,►ty off Ccs .Coto.ar APR 1 6 2008 (Fa it did rra) CONT �,��``'`v41li0RS t. '%Ise McleW baby WAL"',zwni 24 the*KQq d tetra Cava of tie AbovoAmmd district in ft SUM of 60 _ is sxip t of qts dtaim saw 1, dW the d nap c r 1sVuW c , (Give sasot dat and hour) 4w dtst !go ityuxy wAsc? cr Oulu city am ty) �� �,� ,tea 3. I ow c as s*wYa 4, What >a attar ,c!a the , ac' URS iJf¢ , t-a S� �- 1 t� R d" 4 a tom 113E a xsf county of disnict axe=.ate,ar etap]+a;*.w to orwiry? . ri '!�►1O�i S tC. Q'� Y'��rGi.. �rJ�-� ,�-�' 12 c 1()�'tcX, /4 a6a�{ 'Wd8Z.0 80°56 �dY 'Of3eC0St��6 `•a :Ap 1uvg d aGe !RVSO; 44 80-9G-jdy _ .V .rto 1.ua3 .. V C LAIM BOARDSUPERVISORSOF OFCONTRA COSTA COUNTY BOARD ACTION: Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsernents, ) NOTICE TO CLAIMANT and Board Action. All Section refer �� � The copy of this document mailed to California Government Codes. you is your notice of the action taken APR �Qo� on your claim by the Board of Supervisors. (Paragraph IV below), COUNTYCOUNSEL given Pursuant to Government Code ©` �6 MARTINEZ CALIF. AMOUNT: , �1 a Section 913 and 915.4. Please note all "Warnings". G- 1/ CLAIMANT: Auf onw V (f I'E'X-a STW,�"''T)N: DATE RECEIVED: ADDRESS: p® td '�C BY DELIVERY TO CLERK ON: /`' BY MAIL POSTMARKED: ���^(,� q o260L FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. nn JOHN CUL leek Dated: U.� ��{' By: Deputy . /�Ll,��✓lQi II. FRO i.: County Counsel TO: Clerk of the Board of Supervisors (v<'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: 'TAW d By: m Deputy County Counsel i1I. 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: 1�. 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: /� OA JOHN CULLEN, CLERK, By. e Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6) inontlis fronn tine 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 ofThis Notices. AFFIDAVIT OF MAILING I declare under penalty of perjury that I ann 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 1'u11y pre 'd a certified copy of this Board Order and Notice to Claimant, addressed to the clair n.t as hown above. Dated: —Co)( JOHN CULLEN, CLERK By Depu Clerk i. i CLAIM BOARD OF SUPERVi:SOIZS OF CONTRA COSTA COUNTY BOARD ACTION: Mac —�-� �� 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..(Paragrapb IV below), given Pursuant to Government Code A MOUNT: 76 Section 913. and 915.4. Please note all :.� �� � "Warnings". CLAIMANT: ( j►1 /��. �I t;-�'�G� -T-T$R.s I.tM ?rl Yi . 1'1Si CrUi 1DATE RECEIVED: ADDRESS: p�}: 1v Z l BY DELIVERY TO CLERK ON: BY MAIL POSTMARKED: fiC q FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. i JOHN CULN, leek :1 Dated:CYE By: Deput 11. FRONT.: County Counsel TO: Clerk-of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2,and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should retui7i claire on ground that it was filed late and send wai7ning of claimant's right to apply for leave to present a late claim (Section 911.3). O Othei-: Dated: By: Deputy.County Counsel III. FROM.: Clerk of the Boai•d 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 ill full. ( ) Other: I certify that this is a true and.con-ect copy of the Board's Ordei- entered in its minutes foi- 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 claaiih.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 attonie ' y;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 iioiv, and at all times herein mentioned, have been a citizen of the United States, over age 1.8; and that today I deposited in the United States Postal Service in (Martinez, California, postage fully prepaid a certified coley of this .Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: JOHN CULLEN, CLERK By Deputy Clerk STATE FARM State Farm Insuranc •e ` .Companies INSURANCE State Farm Insurance Subrogation Services . April 9, 2008 PO Box 2371 Bloomington, IL 61702-2371 Certified Mail-Return Receipt Requested Clerk of the Board of ,Supervisors Room 106 County Administration Building ,;—� ;- —� 651 Pine Street Martinez, CA 94553 APR 1 4-?008 _- CLEHK JOanf)cF StIE �;�•;soRs RE: Claim Number: 55-J174=032 �'C`�Rr1Co• _ . Our Insured: Alfonso. Valtierra Date of Loss : February 14 , 2008 Your Insured: Contra Costa County Your Insured Driver: Gary P Zimpel Your Claim Number: Your Policy Number: Loss Location: Solona Way & Heaton Circle Concord, CA Dear Sir or Madam: Facts of Loss : Insured proceeding down Solona� Way. County vehicle had stop sign, but failed to yield right of way and drove out in front of insured. Insured tried to avoid, but hit County vehicle on the side . It is our understanding that you are self insured. Our investigation indicates you are responsible for this claim. Therefore, we are seeking recovery from you. This letter is to notify you of our subrogation claim and request your cooperation in settling this matter. .; To assist you in your review, here• is a breakdown of the amounts State Farm paid by Cause of Loss : 041/045 - Uninsured Motorist BI $ 042 - Uninsured Motorist PD $ 300 series/400 - Comp/Collision $555 . 76 501 - Rental/Loss of Use $175 . 00 600-050 - Med Pay/PIP $ Other $ Salvage Recovery $ Amount State Farm Paid $730 . 76 Insured Deductible $500 . 00 Total Claim Amount $1, 230 . 76 HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001 Page 2 April 9, 2008 Based on the assessment of liability between the parties, State Farm Mutual Automobile Insurance Company is seeking 1000 of . the Total Claim Amount listed above . The amount payable to State Farm Mutual Automobile Insurance Company for this loss is $1, 230 . 76 . Please remit payment of this claim and include our claim number on the payment . If you have any questions, please call and any member of Team # may assist you. Thank you for your cooperation. In order to assist you in evaluating and processing the subrogation claim we are asserting, we may provide nonpublic personal information about our customer. We are sharing this information to effect, administer, or enforce a transaction. authorized by the consumer. However, you are neither authorized nor permitted to: (1) use the customer information we provided for any purpose other than to evaluate and process the subrogation claim, or (2) disclose, or share .the customer information we provide for any purpose other than to evaluate . and process the subrogation claim. Sincerely, Kay dgcomb Claim Processor (877) 457-8276, Team 60 State Farm Mutual Automobile Insurance Company Enclosure (s) BOARD OF SUPERVISORS OF CONTRA,COSTA COUNTY f INSIRUCTIONS TO CL,AIl1l,AN'F A. A claim relating to a cause of action for death or for injury to persoa or to personal pr*rty or growing crops shall be presented not later thzn six months after the accrual of the cause of action A claim relating to any other cause of action shall b@ presented not later than one year after the accrual of the cause of action. (Goat. Code & 911.2.) B. Claims must be Eed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 fine Street,Mardnez,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. am own am Raw a 299m NEWS a MR Nos WE ON won:auk a VENTMEARONAZIE A a WXPN apdauxEnd ME kruNtleam z r a at RE: Claim By: Reserved for Clerk's filing stamp 5 �e 50X rrn A&so V ) Against the County of Contra Costa or ) APR 1 4 2008 District) CLERKBOARD OF SU�a:r;4'iSOHS (Fill in the name) ) CONTRA C,o 1"'Co. The undersigned claimant hereby makes claim agaiast the County of Contra Costa or the above-named district is the sum of$ 13 M 0. and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) a- Iy-off Zy59m 2. Where did the damage or injury occur? (Include city anal county) So(one 1� 4 H ,e(m eC;re 1e- COn oo rd C f� Conir Q C oS-� ou. 2extra j3. How did the damage or injury. -occur? (Give full.atails; paper if required) �nSKreA was dr;� do�rn Solot�a Cow.. y vP.h' c!� kaA &4f S;�. .-4qa'�leol `�o �'eW 4o oncirm;v �raF�;c 4- drove out 1h, VMo'- 1-w6wred ve-h;e..te, 1hSL4red Fra ed rto cLVOW +uf n +t +ke le1;i- bu;f CoIIided W ii-h (-roux Side o�(- oa,,� �;c_1e 4. What parf?cular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? ray l u r e 1 ie u r i�" off' 5 What are the rues of county or district officers, servants, or employees causing the damage or injury? Ga r j Z'i m pe t 1N3W39VNVW SIN )Do 1AIVAA :4 nnn> or Clal�ted Attach two f urieS do your cI estzmates forauto r0stdted? (Give full �h2 image.) exfe�t ° �jrzries or �ro bier' o aoo� �oteL `Co ` ss 7 MOW 92S 60 =00t claimed above computed? (include the estim=ated ama�r of �y pzospectidamage.)e injury or damage.) JS557l0 es�I`ma � �Sbo.oc� �ea�c,c ;bf� ,W75,00 do R a3o. 116 Toi l 8. Names and addresses of witnesses, doctors, and hospitals; i �or;� (�u.QrrtoS qa5- 1�83- 16 t3 — �-J'i+hess 9. List the expenditures you made on account of this accident or injury: DATE AMOUNT i Mtn a t R t f R t R R t R R f R a t lt R NAM R f R 1K R R R R t R R f R t f R a R R a R R a R a f R N R Nunn■■■t a f R R R t R t R a H R Y R a R R t a R R R a t ) .Gov. Cod--Sec. 910.2 provides"The claim shall be ) siped by the claimant or by some pexsan on his behalf." SEND NOTICES TO: (Attorney) 1 Name and address of Attorney ) (claim.ant s signature) G' © a3-7 t (Address) ' 7 7- YS 7- g a7 Telephone No, )Telephone No. K tut Ins van on RAN anus A Ana■alANN a a a RAN MR XkXPR X*a HIM AXIts■R■RR It an R t Ism RIMER■l■Apr■R itRf t tttl 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 Califomia Public Records Ae, (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. W 1"Iskoil RANRN■aRattaltusbill IttRttfXRYLRYttRAttonRRtRAown map aIMR4RtReRRtRRRR99ao7Rtis1■t[tc NONCE: 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 offlcer,or to any;'-county, city, or district board or officer, authorized to allow or pay the same Lf genuine, any false o: 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 zine, or by impriso=ent Ln the state prison, by a fine of not eaceedhng ten thousand dollars ($10,000), or by both such imprison-nem and fine. 'd / ;2 "Citi S=•=�.•.. RB Z 0 0 0 6 Z date : 04-09-08 page : 1 ..:: :::.::: .:..... roue :tti;s;: Sottarr STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY AUTO PAYMENTS BY COL ................... ... ................ c:;la :;nvr; policy number .......... .... .............. ........... .................. ......... 01 -IL3 =761 - 5 �>G ......... ..................... .............. ................................ named insured date of loss VALT= ERRA ALF(DNSO O 2 — 1 4 — O 8 COL - 4 O O C denotes consolidated payment E denotes EFT payment P denotes previous data COL: 400 indemnity: 555 . 76 dir rcov: 0 . 00 expense: 0 . 00 payment number payee amount status COL pay cd rsn reporting party E 112012974K BRUCE' S BODY SH 555 . 76 PAID . 400 1 Named Insu CO L 5 O -1- C C denotes consolidated payment E denotes EFT payment P denotes previous data COL:. 501 indemnity: 175 . 00 dir rcov: 0 . 00 expense: 0 . 00 payment number payee amount status •• COL pay cd rsn reporting party E 112012142K ENTERPRISE RENT 175 . 00 PAID 501 1 Named Insu RBZ00032 date : 04-09-08 .N.°�•�<< time : 07 : 01 AM ......................................................... .............. ct'e Sc;o STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY VEHICLE DAMAGE REPORT ..... .................................... c1.am>ntiuitr date of loss .................... ...... .............. 5:5: :: '7>: >: C :` :> 02-14-08 .... ...... ..... ................ ........................................ Estimate Vehicle Info Vehicle Owner: VALTIERRA, ALFONSO Vehicle Description: 02 TOYO TACOMA 4X2 XTRAC 2D P/U SILVER �c �+carc �c �c �c -trc -E -*cytc -c -trc -+E -�c -cmc -zk -c -AC tAc -Ar tAc _jAr3ctnctc -J*c -►k -jc -JC --►c -jc -Ac --4L- -jc 03/03/2008 AT 03 : 03 PM JOB NUMBER: 3395 60346 BRUCE' S BODY SHOP LICENSE # :EPA000C42198 FEDERAL ID # : 942792553 "WHERE QUALITY IS EXCEEDED" 2348 NORTH WILSON WAY STOCKTON, CA 95205 (209) 948-0712 FAX: (209) 948-8742 SUPPLEMENT OF RECORD 1 WITH SUMMARY WRITTEN BY: TERRI PERRY 03/03/2008 03 : 03 PM ADJUSTER: CLAIM REP -TEAM 7 INSURED: ALFONSO VALTIERRA CLAIM #55-J174-03201 OWNER: ALFONSO VALTIERRA POLICY # ADDRESS : 1455 LLOYD THAYER CIR DEDUCTIBLE: $500 . 00 STOCKTON, CA 95206-5521 DATE OF LOSS : 02/14/2008 AT 02 : 45 PM EVENING: (209) 982-5946 TYPE OF LOSS: COLLISION DAY: (209) 617-1139 POINT OF IMPACT: 12 . FRONT INSPECT BRUCE' S BODY SHOP BUSINESS : (209) 948-0712 LOCATION: 2348 NORTH WILSON WAY STOCKTON, CA 95205 INSURANCE STATE FARM INSURANCE COMPANIES COMPANY: 1533 LAKEWOOD AVE. DAYS TO REPAIR MODESTO, CA 95355 VEHICLE DROP OFF DATE: 02/26/2008 REPAIR START DATE: 02/26/2008 REPAIR COMPLETION DATE: 02/29/2008 PROMISE DATE: 03/03/2008 VEHICLE PICK UP/RETURN DATE: 03/03/2008 2002 TOYO TACOMA 4X2 XTRACAB PRE SSIDE 4-2 . 7L=FI 2D P/U SILVER INT: VIN: 5TESM92N22Z046118 LIC: 6V74098 CA PROD DATE.: ODOMETER: 181.980 CONDITION: EXCELLENT CLOTH SEATS STYLED STEEL WHEELS REAR STEP BUMPER AUTOMATIC TRANSMISSION OVERDRIVE POWER STEERING TILT WHEEL POWER BRAKES AM RADIO FM RADIO STEREO SEARCH/SEEK CD PLAYER AIR CONDITIONING DRIVER AIR BAG PASSENGER AIR BAG DIGITAL CLOCK INTERMITTENT WIPERS DUAL MIRRORS METALLIC PAINT CLEAR COAT PAINT -- --- ----------------- -------------------------------------------------------- - NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT' ----------------------------------------- ------ ------ ----- --------------------- 1# Sol AUTHORIZATION TO PAY SECURED 1 2# S01 OWNER PROVIED WITH COPY. OF 1 EST / FINAL BILL 3# S01 FINAL BILL 1 4 FRONT BUMPER 5 O/H FRONT BUMPER 1 . 5 6**S0l REPL RECOND BUMPER CHROME 1 232 . 00* INCL. 7* S01 REPL VALANCE PANEL 1 143 . 36* INCL. 0 . 0* 8* S01 REPL UPPER COVER 1 120 . 75* INCL. 1 . 2 1 03/03/2008 AT 03 : 03 PM JOB NUMBER: 3395 60346 SUPPLEMENT OF RECORD 1 WITH SUMMARY 2002 TOYO TACOMA 4X2 XTRACAB PRE SSIDE 4-2 . 7L-FI 2D P/U SILVER INT: -------------------------------------------------------------=----------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 9 SOl ADD FOR CLEAR COAT 0 . 5 10# SUBL HAZARDOUS WASTE REMOVAL 1 3 . 00 11# REPL FLEX ADDITIVE 1 5 . 00 T 12# COLOR TINT 1 0 . 5 13* SO1 REPL REINFORCEMENT 1 145 . 03* INCL. 14* SO1 REPL RT SUPPORT ARM 1 31 . 69* INCL. 15* SO1 REPL LT SUPPORT ARM 1 31 . 69* INCL. --- -- --- ----------------------------------------------------------------------- SUBTOTALS =_> 712 . 52 2 . 0 1 . 7 PARTS 707 . 52 BODY LABOR 2 . 0 HRS @$ 62 . 00/HR 124 . 00 PAINT LABOR 1 . 7 HRS @$ 62 . 00/HR 105 . 40 PAINT SUPPLIES 1 . 7 HRS @$ 32 . 00/HR 54 . 40 SUBLET/MISC. 5 . 00 ------------------------------------------------- --- SUBTOTAL $ 996 . 32 SALES TAX $ 766 . 92 @ 7 . 7500% 59 . 44 ---------------7--------------------------------- --- GRAND TOTAL $ 1055 . 76 ADJUSTMENTS : DEDUCTIBLE 500 . 00 ------------------------------------------------- --- CUSTOMER PAY $ 500 . 00 INSURANCE PAY $ 555 . 76 2 03/03/2008 AT 03 : 03 PM JOB NUMBER: 3395 60346 SUPPLEMENT OF RECORD 1 WITH SUMMARY 2002 TOYO TACOMA 4X2 XTRACAB PRE SSIDE 4-2 . 7L-FI 2D P/U SILVER INT: . FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM: ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON. THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR ABBREVIATIONS/SYMBOLS : D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES : B=BODY LABOR D=DIAGNOSTIC E=ELECTRICAL F=FRAME G=GLASS M=MECHANICAL P=PAINT LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED' MISCELLANEOUS PATHWAYS : ADJ=ADJACENT ALGN=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL RECY=QUALITY RECYCLED PART QUAL REPL=QUALITY REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT W/O=WITHOUT W/ =WITH/ SYMBOLS : #=MANUAL LINE ENTRY *=OTHER [IE. .MOTORS DATABASE INFORMATION WAS CHANGED] **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE. MQVP=MANUFACTURER' S QUALIFICATION AND VALIDATION PROGRAM. OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. NWCPP=NATIONWIDE CRASH PARTS PROGRAM. 3 03/03/2008 AT 03 : 03 PM JOB NUMBER: 3395 60346 SUPPLEMENT OF RECORD 1 WITH SUMMARY 2002 TOYO TACOMA 4X2 XTRACAB PRE SSIDE 4-2 . 7L-FI 2D P/U SILVER INT: ESTIMATE BASED ON MOTOR CRASH ESTIMATING GUIDE. UNLESS OTHERWISE NOTED ALL ITEMS ARE DERIVED FROM THE GUIDE ARM8510, CCC DATA DATE 01/01/2008 , AND TH:E PARTS SELECTED ARE OEM-PARTS MANUFACTURED BY THE VEHICLES ORIGINAL EQUIPMENT MANUFACTURER. OEM PARTS ARE AVAILABLE AT OE/VEHICLE DEALERSHIPS . OPT OEM (OPTIONAL OEM) OR ALT OEM (ALTERNATIVE. OEM) PARTS ARE OEM PARTS THAT MAY BE PROVIDED BY OR THROUGH ALTERNATE SOURCES OTHER THAN THE OEM VEHICLE DEALERSHIPS . OPT OEM OR ALT OEM PARTS MAY REFLECT SOME SPECIFIC, SPECIAL, OR UNIQUE PRICING OR DISCOUNT. OPT OEM OR ALT OEM PARTS MAY INCLUDE "BLEMISHED" PARTS PROVIDED BY OEM' s THROUGH OEM VEHICLE DEALERSHIPS . ASTERISK (*) OR. DOUBLE ASTERISK (**) INDICATES THAT THE PARTS AND/OR LABOR INFORMATION PROVIDED BY MOTOR MAY HAVE :BEEN MODIFIED OR MAY HAVE COME FROM AN ALTERNATE DATA SOURCE. TILDE SIGN (-) ITEMS INDICATE MOTOR NOT-INCLUDED LABOR OPERATIONS . NON-ORIGINAL EQUIPMENT MANUFACTURER AFTERMARKET PARTS ARE DESCRIBED AS AM, QUAL R:EPL PARTS OR COMP REPL PARTS WHICH STANDS FOR COMPETITIVE REPLACEMENT PARTS . USED PARTS ARE DESCRIBED AS LKQ, QUAL REC'Y PARTS, RCY, OR USED . RECONDITIONED PARTS ARE DESCRIBED AS RECOND. RECORED PARTS ARE DESCRIBED AS RECORE. NAGS PART NUMBERS AND BENCHMARK PRICES ARE PROVIDED BY NATIONAL AUTO GLASS SPECIFICATIONS . LABOR OPERATION TIMES LISTED ON THE LINE WITH THE NAGS :INFORMATION ARE MOTOR SUGGESTED LABOR OPERATION TIMES . NAGS LABOR OPERATION TIMES ARE NOT INCLUDED. POUND SIGN (#) ITEMS INDICATE MANUAL ENTRIES . SOME 2006 VEHICLES CONTAIN MINOR CHANGES FROM THE PREVIOUS YEAR. FOR THOSE VEHICLES, PRIOR TO RECEIVING UPDATED DATA FROM THE VEHICLE MANUFACTURER, LABOR AND PARTS DATA FROM THE PREVIOUS YEAR MAY BE USED. THE PATHWAYS ESTIMATOR HAS A COMPLETE LIST OF APPLICABLE VEHICLES . PARTS NUMBERS AND PRICES SHOULD BE CONFIRMED WITH THE LOCAL DEALERSHIP. CCC PATHWAYS - A PRODUCT OF CCC INFORMATION SERVICES INC. 4 03/03/2008 AT 03 : 03 PM JOB NUMBER: 3395 60346 SUPPLEMENT OF RECORD 1 WITH SUMMARY 2002 TOYO TACOMA 4X2 XT:RACAB PRE SSIDE 4-2 . 7L-FI 2D P/U SILVER INT: --- -- -------------------------------------------------------------------------- NO. OP. . DESCRIPTION QTY EXT. PRICE LABOR PAINT' ------------------ -----------------------7--- - --------- - -------- ------------- - - --- --- CHANGED ITEMS-------- 2** REPL RECOND BUMPER CHROME 1 -230 . 00 INCL. 6**S01 REPL RECOND BUMPER CHROME 1 232 . 00* INCL. 3* REPL VALANCE PANEL 1 -140 . 64 INCL. 0 . 0* 7* Sol REPL VALANCE PANEL 1 143 . 36* INCL. 0 . 0* ------- DELETED ITEMS------- 5* RPR UPPER COVER 1 . 0*. -1 . 2 6 ADD FOR CLEA:R COAT -0 . 5 ------- ADDED ITEMS --=---- 1# S01 AUTHORIZATION TO PAY SECURED 1 2# S01 OWNER PROVIE:D WITH COPY OF 1 EST / FINAL :BILL 3# S01 FINAL BILL 1 8* Sol REPL UPPER COVER 1 120 . 75* INCL. 1 . 2 9 Sol ADD FOR CLEAR COAT 0 . 5 13* S01 REPL REINFORCEMENT 1 145 . 03* INCL. 14* S01 REPL RT SUPPORT ARM 1 31 . 69* INCL. 15* Sol REPL LT SUPPORT ARM 1 31 . 69* INCL. ----------------------------- -------------------- ------------------------------ SUBTOTALS '==> 333 . 88 =1 : 0 0 . 0 PARTS 333 . 88 BODY LABOR -1 . 0 HRS @$ 62 . 00/HR -62 . 00 PAINT LABOR 1 . 7 HRS @$ 62 . 00/HR 105 . 40 ADDITIONAL SUPPLEMENT LABOR -105 . 40 PAINT SUPPLIES 1 . 7 HRS @$ 32 . 00/HR 54 . 40 ADDITIONAL SUPPLEMENT MATERIALS/SUPPLIES -54 . 40 -- ------------ ------------------------------------- SUBTOTAL $ 271 . 88 SALES TAX $ 333 ..88 @ 7 . 75000 25 . 88 -- -------------------------------------------------- TOTAL SUPPLEMENT AMOUNT $ 297 . 76 NET COST OF SUPPLEMENT $ 297 . 76 ESTIMATE 758 . 00 TERRI PERRY SUPPLEMENT S01 297 . 76 TERRI PERRY -------- CUSTOMER PAY $ 500 . 00 JOB TOTAL $ 1055 . 76 INSURANCE PAY $ 555 . 76 5 03/03/2008 AT 03 : 03 PM JOB NUMBER: 3395 60346 SUPPLEMENT OF RECORD 1 WITH SUMMARY 2002 TOYO TACOMA 4X2 XTRACAB PRE SSIDE 4-2 . 7L-FI 2D P/U SILVER INT: FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM: ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON. THE FOLLOWING IS A LIST OF ABBREVIATIONS. OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR ABBREVIATIONS/SYMBOLS : D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES : B=BODY LABOR D=DIAGNOSTIC E=ELECTRICAL F=FRAME G=GLASS M=MECHANICAL P=PAINT LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS : ADJ=ADJACENT ALGN=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL RELY=QUALITY RECYCLED PART QUAL REPL=QUALITY REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT W/O=WITHOUT W/ =WITH/ SYMBOLS: ##=MANUAL LINE ENTRY *=OTHER [IE. .MOTORS DATABASE INFORMATION WAS CHANGED] **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE. MQVP=MANUFACTURER' S QUALIFICATION AND VALIDATION PROGRAM. OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. NWCPP=NATIONWIDE CRASH PARTS PROGRAM. 6 03/03/2008 AT 03 : 03 PM JOB NUMBER: 3395 60346 SUPPLEMENT OF RECORD 1 WITH SUMMARY 2002 TOYO TACOMA 4X2 XTRACAB PRE SSIDE 4-2 . 7L-FI 2D P/U SILVER INT: ESTIMATE BASED ON MOTOR CRASH ESTIMATING GUIDE. UNLESS OTHERWISE NOTED ALL ITEMS ARE DERIVED FROM THE GUIDE ARM8510 , CCC DATA DATE 01/01/2008 , AND THE PARTS SELECTED ARE OEM-PARTS MANUFACTURED BY THE VEHICLES ORIGINAL EQUIPMENT MANUFACTURER. OEM PARTS AIRE AVAILABLE AT OE/VEHICLE DEALERSHIPS . OPT OEM (OPTIONAL OEM) OR ALT OEM (ALTERNATIVE OEM) PARTS ARE OEM PARTS THAT MAY BE PROVIDED BY OR THROUGH ALTERNATE SOURCES OTHER THAN THE OEM VEHICLE DEALERSHIPS . OPT OEM OR ALT OEM PARTS MAY REFLECT SOME SPECIFIC, SPECIAL, OR UNIQUE PRICING OR DISCOUNT. OPT OEM OR ALT OEM PARTS MAY INCLUDE "BLEMISHED" PARTS PROVIDED BY GEM' S THROUGH OEM VEHICLE DEALERSHIPS . ASTERISK (*) OR DOUBLE ASTERISK (**) INDICATES THAT THE PARTS AND/OR LABOR INFORMATION PROVIDED BY MOTOR MAY HAVE BEEN MODIFIED OR. MAY HAVE COME FROM AN ALTERNATE DATA SOURCE. TILDE SIGN (-) ITEMS INDICATE MOTOR NOT-INCLUDED LABOR OPERATIONS . NON-ORIGINAL EQUIPMENT MANUFACTURER AFTERMARKET PARTS ARE DESCRIBED AS AM, QUAL REPL PARTS OR COMP REPL PARTS WHICH STANDS FOR COMPETITIVE REPLACEMENT PARTS . USED PARTS ARE DESCRIBED AS LKQ, QUAL RECY PARTS, RCY, OR USED. RECONDITIONED PARTS ARE DESCRIBED AS RECOND. RECORED PARTS ARE DESCRIBED AS RECORE. NAGS PART NUMBERS AND BENCHMARK PRICES ARE PROVIDED BY NATIONAL AUTO GLASS SPECIFICATIONS . LABOR OPERATION TIMES LISTED ON THE LINE WITH THE NAGS :INFORMATION ARE MOTOR SUGGESTED LABOR OPERATION TIMES . NAGS LABOR OPERATION TIMES ARE NOT INCLUDED. POUND SIGN (4) ITEMS INDICATE MANUAL ENTRIES . SOME 2006 VEHICLES CONTAIN MINOR CHANGES FROM THE PREVIOUS YEAR. FOR THOSE VEHICLES, PRIOR TO RECEIVING UPDATED DATA FROM THE VEHICLE MANUFACTURER, LABOR AND PARTS DATA FROM THE PREVIOUS YEAR MAY BE USED. THE PATHWAYS ESTIMATOR HAS A COMPLETE LIST OF APPLICABLE VEHICLES . PARTS NUMBERS AND PRICES SHOULD BE CONFIRMED WITH THE LOCAL DEALERSHIP. CCC PATHWAYS - A PRODUCT OF CCC INFORMATION SERVICES INC. 7 03/03/2008 AT 03 : 03 PM JOB NUMBER: 3395 60346 SUPPLEMENT OF RECORD 1 WITH SUMMARY 2002 TOYO TACOMA 4X2 XTRACAB PRE SSIDE 4-2 . 7L-FI 2D P/U SILVER INT: ALTERNATE PARTS SUPPLIERS 6 RECOND BUMPER CHROME PART NO. TO1002174R PRICE 232 . 00 KEYSTONE - COMPLETE (800) 339-5033 4067 WEST SHAW AVE (559) 271-6750 FRESNO, CA 93722 KEYSTONE - COMPLETE (425) 251-8670 6528 S . 216TH STREET (800) 843-2886 KENT, WA 98032 KEYSTONE - COMPLETE (800) 243-4340 751 E. KINGS HILL PLACE (310) 329-3624 CARSON, CA 90746 KEYSTONE - COMPLETE (800) 264=7560 3615 NE. 109TH AVE (360) 260-8400 VANCOUVER, WA 98682 KEYSTONE - COMPLETE (800) 421-7866 1754 CEDAR ST. STE A (909) 986-4586 ONTARIO, CA 91761 KEYSTONE - COMPLETE (360) 733-7585 1538 KENTUCKY STREET (800) 538-3388 BELLINGHAM, WA 98229 KEYSTONE - COMPLETE (509) 534-7844 3200 E. TRENT AVE BLDG 3 STE B SPOKANE, WA 99202 KEYSTONE - COMPLETE (800) 263-9727 1627 ARMY COURT (209) 948-1101 STOCKTON, CA 95206 8 03/03/2008 AT 03 : 03 PM JOB NUMBER: 3395 60346 SUPPLEMENT OF RECORD 1 WITH SUMMARY 2002 TOYO TACOMA 4X2 XTRACAB PRE SSIDE 4-2 . 7L-FI 2D P/U SILVER INT: ALTERNATE PARTS USAGE AFTERMARKET PARTS AFTERMARKET SELECTION METHOD: MANUALLY LIST NO. OF TIMES USER WAS NOTIFIED THAT AN AFTERMARKET PART WAS AVAILABLE: 3 NO. OF AFTERMARKET PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0 OPTIONAL OEM PARTS OPTIONAL OEM SELECTION METHOD: MANUALLY LIST NO. OF TIMES USER WAS NOTIFIED THAT AN OPTIONAL OEM PART WAS AVAILABLE: 0 NO. OF OPTIONAL OEM PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0 RECONDITIONED PARTS RECONDITIONED SELECTION METHOD: MANUALLY LIST NO. OF TIMES USER WAS NOTIFIED THAT A RECONDITIONED PART WAS AVAILABLE: 2 NO, OF RECONDITIONED PARTS THAT APPEAR IN THE FINAL ESTIMATE: 1 RECYCLED PARTS NO. OF TIMES USER WAS NOTIFIED THAT A RECYCLED PART WAS AVAILABLE: 2 NO. OF RECYCLED PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0 9 55J 174032 , Alfonso Valtierra, 14-02-2008 Page 1 of 1 Rental Invoice Rental Vendor Information Billing Detail Enterprise Rent-A-Car(3011) ENTERPRISE RENT-A-CAR Description Rate Amount STOCKTON,CA 95202-2334 209-462-5900 7 DAYS @ 24.80 173.60 7 DAYS DW @ 9.00 63.00 1 SALES TAX% 8.00 13.89 Claim Information Claim Number: 55J174032 Insured Name: VALTIERRA,ALFONSO Total Ticket Charges: $250.49 VALTIERRA, Total Amount Received: $75.49 Renter Name: ALFONSO Total Billed to Others: Driver Name: Total Amount Due: $175.00 Date of Loss: 02/14/2008 Rental Information Payment Information Bill Start Date: 02/26/2008 Tax Identification#:` 431514861 Bill End Date: 03/03/2008 Remit To Address:; Pb BOX 576246/4623 MCHENRY#B MODESTO i MODESTO, CA 95357 Invoice Number: 3011D372347 Group/Branch Location: 30DD littp://sfnet.opr.statefarni.org/RentalManagement2/asps/Pages/frmV iewBill.aspx?format=.1... 4/9/2008 Ms i `i ------------------ .......... - ----- - 00 i . 3 _.i 3.. t i . ( 5« i �1 �i ^i ,�. � �, w �i� •'p K' t �'r � f ����`• •f,i �/ ./,` � ;(t �..-' t 1 ai 1' ,�.e3.�. .. .. :.. .. .. ,�" .�3?:%"':.tL�.:.. .....Ss�S(''e{.n NY;t�.'�5.... ___ .�.—•„"'.r"�"'°X�s"�.�+"��'�a--! '._.j/f,i ;� �. 1 p.2 SCALIFORNI .DEPARTMBNT OF CALIFORNIA HIGWAY PATROL 575 17// f 03rZ. -.TRAFFIC COLLISION REPORT-Property Damage Only ! CHP 855-03(Rev.9-99) OPI 061 Original to officer,copyeas)to involved partyyies) SPECIALCCHDITIDNS HIT& P J DI AL DIST`RILT NUMBER �- C / REPDRTING bl8 CT BEAT d/vi lZh' Q,S irf `�' y7 f CCLL'BI DON 1 •MO. QDAY YEAR b lfigE r2 HC IC .OFFICER I.D. / 'y r AT INTERBECT10N riTrl{ /'i DAY OF _ OW AWAY STATE HIGHWAY RELATE r: Fesdafile■ .. ^' '-^ r Yes No 4j ❑ Yes Nc -} DRI Is LICENSENUMBE8T C iB BAEEIY EoINPMENT _ Y E "(A LI O AGENCY USE QNIY) !! DAMAGEDReport taken Yes ❑ No R RST,M1�DL!?• AREA r ter- Exchange of information es ❑ No PE "STREETAO / PIK-V-�Ei BEX BIRTH IN SV N3E .RRIER rWCYNUM8ER A � 81 LE DIP. C EET HIMNNI V SPEED LIMP 'BIS,, _J PART•'y � i. VEH. R. MAKE1MC EUCOLOR,� •LICENSENUMBE�� � 5 TE VEH.TYPE � J � �" .r 1 p I VERs LIC[NSE .. STATE CLASS SAFETY IPM NT SHADE �. "�;�.�E:s ' DAMAGED DRIVER lrANE rFIRSTy�DlE.�LASTJ � � � AREA �• `�••• A. S ETAGD9E3S �•y .:a_^. �- - PKVEH 9F9- I BzTE INSURANCE CM�ER POUCY NUMBER 6 .E DIR. C%t H..IaIIMWY � SPEED LIMIT ' S .5 9'N p VEH R MAKE r M 031 Cc_CR LIC E M VEH.TYPE PARTY —/ r r �� z z 4L y�� AGE SEX E A�RESS J , PHONE NUtJ18E PARTY N0. AGE SEX ADDR / _i + PHONEN AR1Y 40. l _ DR IIMPORTANT` EAD CAREFULLY Keep this report. This is your record-of this accident. To corn I with California Vehicle Code(VC"S ction 20002 (duty where ,,!...,:property damaged), you must either: a.Give the owner or person in.charge of such property the name and address of the driver and owner of the vehicle: or in the €: absence of the owner, b. Leave a written notice in.a conspicuous place on the other vehicle or damaged property, giving the name and address of the driver and owner of•the vehicle involved and a statement of the circumstances. This information is necessary r the compietioq of your state SR-1 Form. Report of Traffic Accident, and your insurance report. .41-1ICLE.CODE SECTION 16000 The driver of a vehicle involved in an accident resulting in damage to the property of any ONE.party in excess of$500 or in the injury or death:of.any.person MUST submit.a SR-1 Form to the California Department of Motor Vies within 10 days,or as goon as passible. Note: Failure to comply may result in suspension of your driv f's license. Form SR-1.may be obtained XM the Department of Motor Vehicles,.the California Highway Patrol,any police station, motor vehicle club, insurance agent, or DMV internet web site (SR-9A). If city or state property is damaged, you will be contacted regarding possible liability. I: b(pw enforcement reports do not satisfy the DMV report requirezt. r am, Jslco A a J �02 IM 111@PITNEY BOWES 000 245894 APR 0 28' 11111 H1111 7008 0150 0003 5890 3904 I 'L MAILED FROMZIPCO�DE 6110 oomington, Illinois 61702-2371 i FIRST-CLASS MAIL CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY "BOARD ACTION: 00 ; Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsernents, ) NOTICE TO CLAIMANT and Board Action. All Section ref The co of this document mailed to California Government Codes. .yx copy you is your notice of the action taken APR 1 6 2008: on your claim by the Board of Supervisors. (Paragraph IV below), COUNTY COUNSEL . given Pursuant to Government Code MARTINEZ.CALIF. AMOUNT:`ai- uiouv n Section 913 and 915.4. Please note all _ "Warnings". CLAIMANT: Gtn 7 M11 cS Q•� �UOu' A-L berf yen5�-�-, �.ntie y�or ATTORNEY: �uJ 05-e(P � DATE RECEIVED: � �g 1, ADDRESS: •l b�l '1�� BY DELIVERY TO CLERK ON:5 69-5 (owatta� 5f BY MAIL POSTMARKED: 10i Sao lei ant-vCD 04 �4 IC(- 3n3.3 FROM: Clerk of the Boar of Supervisors TO: County Counsel Attached is.a copy of the above-noted claim. JOHN CUL EC"leek Dated: By: Deputy j`C(Jl�;ytC�(/i�l.Q� �i�(�a{A II. FROKI: County orinsel 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 claire on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). Dated: �f 3�'O By: m Deputy County Counsel iII.. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV, BOARD ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: o$ JOHN CULLEN, CLERK, By 7De�,,uiyleek WARNIN (Gov. code section 913) Subject to cei'Lain excepti.oiis,you have only six(6) months from the date this notice was personally semed 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 your choice in connection widi this matter. If'you want to consult an attoniey,you should do so inuriediately. *For Additional War-nirigSLv 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 .l 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 clainra shown above. Dated: 2 b b JOHN CULLEN, CLERK t Clerk . c® CLAIM BOARD OF SUPERVISORS .OF CONTB& COSTA COUNTY BOARDCTION.: `�; (, z. Clairn Against the County, or District Governed by ) tine Board of Supervisors, Routing Endorsements, ) `NOTICE TO CLAIMANT and Board Action.`All Section ref ,, (�'j Cal / The copy of this document mailed to ifornia Government Codes. v you is your notice of the action.taken APR 1 6 2008 ori your claim.by the Board of Supervisors. (Paragraph IV below), COUNTY COUNSEL given Pursuant to Government.Code MARTINEZ CALIF. Section 913 and 915A. Please note all AMOUNT:��n j�r1C)t�7n "Warnings". CLAIMANTI:q-t.i1 .vi,ng 51-ve_t) bcm &U0 Xu, ATTORNEYAr)( riu-1 1 DATE RECEIVED: ADDRESS: c.[ ¢ f'li�C'f'1 t��it1� ` BY DELIVERY TO CLERK ON: CL BY MAIL POSTMARKED: to �'�) Wil - FROM: Clerk of the Board oIS Upel-visol's T0: County Counsel Attached is a copy of the above-noted claim. JOHN CUL E Clerk �}ll��J . Dated: L� By: DeputyEa�x�.l��u, %i.%t:CC4,t�1 11, FROM: County ounsel .. TO: Clerk. of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to coiY)ply substantially with Sections 910 and 910.2; and we arse 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). ( ) Other: Dated: By: Deputy County Counsel III. FROM.: Clerk of the Board T0: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 91 l.3). 1V. BOARD ORDER: By unanimous vote of the Supervisors present: ( ) This Claire is rejected in full.' ( ) Other•: I certify that this is a true and correct copy of the Board's Order entered in its minutes for• this date. Dated: JOHN CULLEN, CLERK; By . Deputy Clerk WARNi.NG (Gov. code section 913) Subject to certain exceptions,you have only six O months from the date this notice was personally served or deposited in the mail to file a couu-t action on this clahn.See Government Code Section 945.6.You may seek the advice of an attomey of your choice in connection with this matter..tf you want to consult an attorney,you should do so immediately. *For Additioi'll Warning See Reverse Side.ofThis Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I are, now, and at all times herein mentioned, have been a citizen of the United States, over age 1.8; and that .today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified coley of this Board Orderand Notice to Claimant, addressed to the claimant as shown above. Dated: JOI-IN CULLEN, CLERK By Deputy Clerk i LAW OFFICES OF MEISEI, & KRENTSA 565 COMMERCIAL.S'rIuJ-;r,T►nrin FL.00a SAN FRAW'ISCO,CALIFORNIA 94111-3033 (415)788-2035 FACSIMILE: FILE NO.: (415)398-4366 A2299 2AM y.:r�•. ire April 10, 2008 I �,�R 1 4 208 Clerk of the Board of Supervisors County of Contra Costa .:::. 651 Pine Street, Room 106 �S Martinez, CA 94553 Re: Lian Ying Shen, et a/. v. City of San Ramon; County Of Contra Costa, et al. Dear Sir/Madam: Enclosed please find one signed original and one copy (for each claimant) of the Claim Against County of Contra Costa. Please return conformed copies in the enclosed envelope. Thank you for your assistance in this matter. If you have any questions, please call our office. Very truly ours, Andrew H. Meisel Attorney at Law AHM:wp Enclosures: Claim (0+1 for each of 3 claimants) Self-addressed, stamped envelope A2299 govt claim 040908 ANDREW-H. MEISEL, S N 107615 LAW OFFICES OF MEWL& IKRENTSA 5.55 Commercial Street, 3rd Floor San Francisco, CA 94111-3033 (415) 788-2035 MEMO O (415) 398-4366 Facsimile APR 1 4 2008 Attorney for Claimants OLEgr,Bo RR 1: :ll'c.�:�i,soRs Co;dTR COS TA ca. LIAN YING SHEN; LIAN GUO XU; CLAIMS OF LIAN YING SHEN; ALBERT YIN TSUI, a minor; LIAN GUO XU; ALBERT YIN TSUI (a minor) AGAINST CITY OF SAN Claimants, RAMON; COUNTY OF CONTRA COSTA; AND DOES 1-25, PUBLIC vs. ENTITY AND ITS EMPLOYEES CITY OF SAN RAMON; COUNTY OF CONTRA COSTA, and DOES 1-25, public entity and its employees. CLAIMANT NAMES: Lian Ying Shen; Lian Guo Xu; Albert Yin Tsui, a minor; CLAIMANT'S ADDRESS: 9583 Davona Drive, San Ramon, CA 94853 ADDRESS TO WHICH NOTICES ARE TO BE SENT, IF DIFFERENT FROM ABOVE: Law Offices of Meisel & Krentsa, 565 Commercial Street, 3rd Floor, San Francisco, CA 94111-3033 DATE OF ACCIDENT: January 9, 2008 TIME: Approximately 5:30 p.m. LOCATION OF ACCIDENT: Alcosta Blvd. at the intersection of Broadmoor Drive in the City of San Ramon, County of Contra Costa, State of California STATEMENT OF DATE, PLACE, AND OTHER CIRCUMSTANCES OF THE OCCURRENCE: On January 9, 2008, claimant Lian Ying Shen and her grandson Albert Yin Tsui, a minor (DOB 02/12/2006), were crossing Alcosta Blvd. in the pedestrian crosswalk at the intersection of Broadmoor Drive in the City of San Ramon, proceeding in generally a southeastly direction towards the Country Club Village shopping center when they were struck by a motor vehicle operated by Roberto Miguel Nodhal, Jr., operating a 1997 Audi A4. The County of Contra Costa and the City of San Ramon and its subdivisions are a public entity which exercise ownership and/or control over Alcosta Blvd. at, near, and around the intersection at Broadmoor Drive in the City of San Ramon, and have the A2299 govt claim 040908.doc CLAIMS OF L1AN YINGHEN; LIAN GUO XU; ALBERT YI UI (a minor)AGAINST CITY OF SAN RAMONSDUNTY OF CONTRA COSTA; ANOES 1-25, PUBLIC ENTITY AND ITS EMPLOYEES Page 2 statutory and regulatory authority and responsibility to properly own, operate, manage, control, plan design, construct, repair, and maintain certain streets and highways including Alcosta Blvd. at, near, and around the intersection of Broadmoor Drive in the City of San Ramon, along with all characteristics and attributes of said intersection, .including but not limited to traffic signs, markings.., warnings, devices, crosswalks, control of traffic, and the like. The County of Contra Costa and the City of San Ramon, and each of them and their subdivisions, failed to properly design, plan, construct, repair, manage, own, operate, control, and maintain Alcosta Blvd. at, near, and around the intersection of Broadmoor Drive in the City of San Ramon, and specifically at the location of the incident shown.on Traffic Collision Report No. 08-135, a copy of which is attached as Exhibit 1 and incorporated herein by reference, thereby creating dangerous conditions of public property at the time the injuries herein were sustained. Said dangerous conditions include, but are not limited to, all the characteristics and conditions that existed at, near, and around the said intersection including, but not limited to, observing pedestrians in the crosswalk, control of traffic, control of pedestrians, the deceptive, defective, and inadequate nature of traffic signs, devices, warnings, markings, and signals at, near, and around the intersection, the configuration of adjacent and nearby.intersections, and all .such other unusual and unanticipated factors creating a dangerous condition and/or a deceptive roadway for motorists and/or pedestrians. Said dangerous conditions proximately caused the injuries sustained, said dangerous conditions created a reasonably foreseeable risk of the kind of injuries which were incurred, said dangerous conditions were created by an employee of the public entity's wrongful act or omission within the course and scope of said employment and/or the City of San Ramon and Contra Costa County had actual or constructive notice of the dangerous conditions in time to take protective measures. The name(s) of the public entity employee(s) who caused the incident is/are not known at this time, and therefore not named herein. Further, the City of San Ramon and Contra Costa County are liable to claimant, and each of them for all of claimants' injuries which were proximately caused by the failure to provide traffic or warning signals, signs, markings, or devices, described in the California Vehicle Code, as same were necessary to warn of a dangerous condition which endangered the safe movement of traffic, and which would not be reasonably apparent to, and would not have been anticipated by, a person exercising due care. Further, the City of San Ramon had a mandatory duty imposed by an enactment of the City of San Ramon to protect against the kind of injuries suffered by claimants herein, and the City of San Ramon breached said duty, thereby proximately causing the injuries sustained, as alleged herein. A2299 govt claim 040908.doc CLAIMS OF LIAN YIN HEN; LIAN GUO XU; ALBERT YINSUI (a minor) AGAINST CITY-OF SAN RAMO OUNTY OF CONTRA COSTA; A DOES 1-25, PUBLIC 'ENTITY AND ITS EMPLOYEES Page 3 INJURY OR DAMAGE CLAIMED: Injuries include, but are not limited to, the following: Lian Ying Shen sustained serious bodily injuries, including, but not limited to, head and brain injuries such that she has been unconscious and in a comatose state since the date of the incident. Damages for Lian Ying Shen include, but are not limited to, medical and related expenses, nursing care, attendant care, lost wages, lost earning capacity, pain, suffering, loss of enjoyment of life, and general damages in an amount to be determined but consistent with an unlimited civil case. Lian Guo Xu is the husband of Lian Ying Shen and as such has sustained loss of consortium damages including, but not limited to, _loss of love, companionship, affection, society, solace, comfort, moral support, intimate relations, and physical assistance in maintaining and operating the home as a result of the bodily injuries suffered by his wife. Albert Yin Tsui is a minor, date of birth February 12, 2006, who sustained multiple fractures, bruises, abrasions, lacerations, cuts, and a head injury. Damages for Albert Yin Tsui include, but are not limited to, medical and related expenses, nursing care, attendant care, lost wages, lost earning capacity, pain, suffering, loss of enjoyment of life, and general damages in an amount to be determined but consistent with an unlimited civil case. Damages are sought in an undetermined amount, pursuant to California Government Code, 910, and said damages are alleged to .be within the jurisdiction of unlimited actions in the Superior Court of the State of California. Signed by or on behalf of claimants Lian Ying She Lian Guo Xu, and Albert Yin Tsui: ndrew H. Mels I Attorney for Clai ants A2299 govt claim 040908 CLAIMS OF LIAN YING SHE:N; LIAN GUO XU; ALBERT YIN TSUI (a minor) AGAINST CITY OF SAN RAMOIWOUNTY OF CONTRA COSTA; A* DOES 1-25, PUBLIC ENTITY AND ITS EMP'COYEES Page 4 PROOF OF SERVICE I, the undersigned, 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 LAW OFFICES OF MEISEL &'KRENTSA, 565 Commercial Street, 3rd Floor, San Francisco, California 94111-3033. 1 served, or caused to bo served, the following: CLAIMS OF LIAN YING SHEN; LIAN GUO XU; ALBERT YIN TSUI (a minor) AGAINST CITY OF SAN RAMON; COUNTY OF CONTRA COSTA; AND DOES 1-25, PUBLIC ENTITY AND ITS EMPLOYEES By personal delivery of the documents(s) listed above to the person(s) at the! address(es) as follows: City Clerk City of San Ramon 2222 Camino Ramon San Ramon, CA 94583 I declare under penalty of perjury under the laws of the State of California that the above is true and correct. Executed on , at S&iA California. Signature Print Name r A2299 govt claim 040908 CLAIMS OF LIAN YING SHEN; LIAN GUO XU; ALBERT Y TSUI (a minor) AGAINST CITY OF SAN RAMOSCOUNTY OF CONTRA.COSTA; AM DOES 1-25, PUBLIC ENTITY AND ITS EMPLOYEES Page 5 PROOF OF SERVICE I, the undersigned, 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 LAW OFFICES OF MEISEL & KRENTSA, 565 Commercial Street, 3rd Floor, San Francisco, California 94111-3033. 1 sen+ed, or caused to be served, the following: CLAIMS OF LIAN YING SHEN; LIAN GUO XU; ALBERT YIN TSUI (a minor) AGAINST CITY OF SAN RAMON; COUNTY OF CONTRA COSTA; AND DOES 1-25, PUBLIC ENTITY AND ITS EMPLOYEES by placing a true copy of the document(s) listed above in a sealed envelope, with postage thereon fully prepaid, in the U. S. Mail addressed as Set forth below Clerk of the Board of Supervisors County of Contra Costa 651 Pine Street QimmtOfo Martinez, CA 94553 I declare under penally of perjury under the laws of the State of California that the above is true and correct. Executed on at at San Francisco, California. Elizabeth . ailey A2299 govt daim 040908 CLAIMS OF LIAN YING SHEN; LIAN GUO XU; ALBERT YIN TSUI (a minor) AGAINST CITY OF SAN RAMO OUNTY OF CONTRA COSTA; A*DOES 1-25, PUBLIC :.ENTITY AND ITS EMIYEES Page 6 PROOF OF SERVICE I, the undersigned, 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 LAW OFFICES OF MEISEL & KRENTSA, 565 Commercial Street, 3rd Floor, San Francisco, California 94111-3033. 1 served, or caused to be served, the following: CLAIMS OF LIAN YING SHEN; LIAN GUO XU; ALBERT YIN TSUI (a minor) AGAINST CITY OF SAN RAMON; COUNTY OF CONTRA COSTA; AND DOES 1-25, PUBLIC ENTITY AND ITS EMPLOYEES By placing a true copy of the document(s) listed above in a sealed envelope, with postage thereon fully prepaid, in the U. S. Mail addressed as set forth below City Clerk City of San Ramon 2222 Camino Ramon San Ramon, CA, 94583 I declare under penalty of perjury under the laws of the State of California that the above is true and correct. Executed on , at /)A X01 California. A2299 govt claim 040908 EXH I B IT ___ KArriV t,AvLL1,IVN KtPOK� } ,HP 555 CARS Page 1(Rev 1-03)OPI 061 page ( Ot SPECIAL CONDITIONS Nmuft CITY JUDICI ICT LOCAL REPORT NUMBER MWIlRTD tEl 2 SAN RAMON WAI,NUI'CR1.1-K 5 (T 11A.��JIKM{LV IHt""'AN ccumv REPORTING DISTRICT BEAT 08-135 N70EApANg1 0 �J CONTRA COSTA 72• 2 COLLISICN OCCURRED ON: MO DAY . YEAR T6RE(240q NCICaOFFICER LD. Z ALCOSTA BLVD U92008 1741 0740 SR015 O MILEPOST INFORMATION: DAY OF WEEK � TOW AWAY PFM010CNAPHS BY: NOME V WEl)NI'sSl]AY YES NO M()N'113MAY0I2 QI)( IAT INTERSECTION ATM: STATE MY REI. —OR: RROADMOOR DR CI YES ljI NO ARTY DRIVER'S LICENSE NUMBER FCA TATE CLASS AR BAG SAFETY EQUIP, VFJ1.YEAR MAKE M MOtlEI(COLOR LICENSE NUMBER STATE D8187172 C N G 1997 AUDI A413LK 3UXW990 CA )RIVER NAME(FIRST,MIDDLE,LAST) - IX-I ROBE-RTO MIUUE3.1.NODIIAI.,JR OWNER$NAME SAME AS DRIVER TOES. STREFTADDROSS ANA NC)I)HAL RIAN 2201 WiNT CRIIEK DR OWNER'S ADDRESS Irl SAME A6 DRIVER MKED CITYISTATEIZIP b*CLE I— SAN RAM(.)N CA 94583 DISPOSITION OF VEHICLE ON ORDERS OF: Fj OFFICER DORIVER 1 'OTHER Icy- SEK HAIR EYES HEIGHT WEICHr BIRTHDATE RACE SAN RAMON TOW-(925)820-6304 Ll_-J� I M RI.K I3RN 15-08 I35 MI(123IIRJR9 YuMP 11 PRIdR MEG+,DEFECTS AILYE APP, 171REFER TO NARRATIVE "R HOME PHONE BUSINESS PHONE VEHICLE DEMIFIOATION M,MBER: I—" (925)828-0310 VEHICLEIYFE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAOF,O AREA 1 INSURANCE CARRIER PCL ICY NWSER DUNK []NONE XEMINOR FARMERS 96 16R20 72 47 01 Moo FIMAIOR ROLL-OVER WA OF TRAVEL 1 ON STREET OR HIGHWAY SPEED LIMIT CA DOT Ii ALC0STA BIND 35 CAL-T TOPIPSC MCNIX ARTY ORIVER•S LICENSE NUMBER SLATE CLASS AIR BAG SAPETY EOUIP, VEH.YEAR MAKE I MOOEL T COLOR LICENSE NUMBER STATE Z 11) CA U i' P IRIVL•R NAMEJFaRST,MIODLE,LAST) I_f LIAN YING SHUN OWNERS NAME ISI SAME AS DRIVER FOES- STREET ADDRESS RIAN IX_I 9583 DAVONA DR OWNER'S ADDRESS ❑SAME AS DRIVER ARKED CITY I STATE/ZIP ErucLE SANRAMON CA 94583 ::I DISPOSITION OF VEHICLE ON ORDERS OF: �IOFFICER I IORIVT;A I�IOTMER ;ICY- SrK HAIR ]EYES FEIGFRT WEIGHT DIRTHDATE RACE J "IISTI F - 13I.K RRN SIGH 125 MI(}/661949 Y� A PRIOR MECHANICAL NxFECTS NQtE APP. REFER TO NARRATI4E ITHER HOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER: I`I (925)803-9613 VEHICLE TYPE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGI!D AREA INSURANCE CARRIER POLICY NUMBER UNK ' )NOW- I 1MINOR NONE 4 1M� IIS AJORROLLOVER OIR OF TRAVEL I ON STREEt CR 11OMWAY SPEED LIMIT CA' DOT S ALCO57'A BLVD 35 CAL•T TCPIPSC MCIMX ARTY DRIVERS LICENSE NUMBER STATE CLASS NR BAG SAFETY EOUIP. VEH.YEARMAKE!MODEL I COLOR LICENSE NUMBER STATE 3 NIA U p p RIVER NAME(FIRST,M IDDLF,LAST) rl AI.EiF:R'I'YIN'I'SIJI eFI41 y�,�„� �R U j,— STRF•FTADORESS, 0RIG I llyj" X- 9583 DAVONA DR OWNER'S ADORE g/M+E RIVER %RKED CITY I STATE I ZIP , HSE SAN RAMON CA 94583 DISPOSITION OF VEHICLE ON ORDERS OF: 1:1 OFFICER �—)DRIVER I^� -eR JICY- SEK HAIR EYES HEIGHT WEIGHT OIR=TE RACE { J :L1AST Mo DAy Yas I-_I M HLK BRN 211220( A PRIORMEcKmicIALDEFECTS N"APP, DREFERTONARRATIVE THER HOME PHONE BUS0433 PHONE VEHICLE IDENMICATION NUMBER: (92$)803-9653 VENNCLETYPE DESCRIBE VEHICLE DAMAGE ^? SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER • DUNK ClNONE I `-0. NONE: MODAWOR ROLL-OVER IF-1 EIFI DIR OF TRAVEL I ON STREET OR HICHWAY SPEED LMM7T s ALCOSTA 13VLD 35 CA DoT CAL•T TCP/PSc MCMIK agPRARER-eSWAME.. . .. DISPAiC-NHNOTIFIED. .. .. VIFWER'r .... _....-�- -- - ..... -- --- REVIEWED K.F.R1I7isK WO 15 I_IYES IJP I�IwA ..n• ... .�..r,....,...... ....v...v S� HP 555 CARS Paget(Rev.1-03)OPI 061 Page 2 01 T.V 0 COLLISION(MO. DAY YEAR) TIME(24001 N=# � OFFICER I D NUMBER 9/200x 1741, i 10740 SRC lS OR-135 OWNER OWNER ADDRESS NOTIFIED PROPERTY ofES i_INO DAMAGE DEscRlanoNOFDAaAOE SEATING POSITION SAFETY EQUIPMENT INATTENYION CODES OCCUPANTS L-AIR BAG DEPLOYED MIC BICYCLE-HELMET A-CELL PHONE HANDHELD A-NONE IN VEHICLE: M-AIR BAG MIT DEPLOYED DRIVER PASSENGER 8-GELL PHONE HANDSFREE B-UNKNOWN N-OTHER V-Np X-NO G- E6TRON{C EOk1iPMENT C-LAP BELT USED P-NOT -OUIREO W'YES Y-YES p-LAP BELT NOT USED D-RADIO I CO 1 2 3 1-DRIVER E-SMOKING E-SHOULDER HARNESS USED 270 6-PASSENGERS CHILD RESTRAINT F-EATING 4 5 6 F-SHOULDER HARNESS LVOT USED EJECTED FROM VEHICLE 7-STA.WGN REAR O-IN VEHICLE USEDG-CHILDREN G-LAP/SHOULDER HARNESS USED 0-NOT EJECTED 8•RR.OCC TRK.OR VAN R-IN VEHICLE NOT USEDH•ANIMALS H-LAP/SHOULDER HARNESS NOT USED 1-FULLY EJECTED 9-POSITION UNKNOWN S-IN VEHICLE USE UNKNOWNt- PERSONNEL HYGIENE Z 0-OTHER J-PASSIVE RESTRAINT USED T-IN VEHICLE IMPROPER USE 2-PARTIALLY EJECTED J, READING K-PASSIVE RESTRAINT NOT USED U-NONE IN VEHICLE 3-UNKNOWN K-OTHER ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK(•)SHOULD BE EXPLAINED IN THE NARRATIVE PRIMARY COLLISION FACTOR MOVEMENT PRECEDING LIST N11RER IN)OF PARTY ATFAII.T TRAFgC CONTROL(DEVICES I 2 3 SPECIAL INFORMATION ] 2 3 COLLISION VC SECTION VIOLATED: CITEDVES A CONTROLS FUNCTIONING A HAZARDOUS MATERIAL A STOPPED A 21 950(A) UCMO B CONTROLS NOT FUNCTIOMNG• B CELL PHONE HANDHELD IN USE X X B PROCEEDING STRAIGHT B OTHrR IMPROPER DRIVING' C CONTROLS OBSCURED C CELL PHONE HANDSFREE IN USE C RAN OFF ROAD X D NO CONTROLS PRESENT J FACTOR' X X X D CELL PHONE NOT W USE D MAKING RIGHT TURN C OTHER THAN DRIVER- TYPE OF COLLISION E SCHOOL BUS RELATED I JE MAKING LEFTTURN O UNKNOW N' A HEAD-ON F 75 FT MOTORTRUCK COMBO F MAKING U TURN E! SIDESWIPE G 32 FT TRAILER COMBO 0 BACKING C REAR END H H SLOWING I STOPPING WEATHER (MARK 1 T02ITEMS) D BROADSIDE 1 1 PASSING OTHER VEHICLE A CLEAR E HR OBJECT J J CHANGING LANES B CLOUDY F OVERTURNED I K K PARKING MANEUVER C RAINING X la VEHICLE I PEDESTRIAN IL L ENTERING TRAFFIC D SNOWING H OTHER': IM M OTHER UNSAFE TURNING E FOG/VISIBILITY Fr. N N XING INTO OPPOSING LANE F OTHER:' MOTOR VEHICLE INVOLVED WITH O O PARKED G WIND A NON-COLLISION P P MERGING LIGHTING X B PEDESTRIAN 0 0 TRAVELING WRONG WAY A DAYLIGHT IC OTHER MOTOR VEHICLE OTHER ASSOCIATED FACTORS IR OTHER.; B DUSK-D AW N lo MOTOR%IEHICLEE ON OTHER ROADWAY I 2 3 (MARK 1 TO 21TEMS) C DARK-STREETLIGHTS E PARKED MOTOR VEHICLEA wa4cna+NaAIED alto yes D DARK-NO STREET LIGHTS F TRAIN �NO E DARK-STREET LIGHTS NOT G BICYCLE B veafmch'AuAho aho R FUNCTIONING' H ANIMAL � SOBRIETY-DRUG ROADWAY SURFACE C VC31C.C11MVIC ATM CIMV YES 213 PHYSICAL A DRY I FIXED OBJECT: �� (MARK 1 TO 2 ITEMS} B WET D l! X X A HAD NOT BEEN DRINKING C SNOW Y-ICY OTHER OBJECT. E VISION OBSCUREMENT: B HBD-UNDER WFLUENCE p SLIPPERY(MUDDY,OILY,ETC.) X F INATTENTION': K-OTHER C HBO-NOTUNDER INFLUENCE' ROADWAY CONDITIONS) G STOP 8 GO TRAFFIC D HRP-IMPAIRMENT UNKNOWN' (MARK I TO 2 ITEMS) PEDESTRIAMS ACTIONS H ENTERING I LEAVING RAMP E UNDER DRUG INFLUF,NCE- A HOLES.DEEP RUT' A NO PEDESTRIANS INVOLVED IN F IMPAIRMENT-PHYSICAL'e LOOSE MATERIAL ON ROADWAY' X B CROSSING IN CROSSWALK J U F O a IMPAIRMENT NOT KNOW N C OBSTRUCTION ON ROADWAY' ATINTERSECTION K F£CT TTED H NOT APPLICABLE D CONSTRUCTION-REPAIR ZONE C CROSSING IN CROSSWALK-NOT _ __ YES I SLEEPY J FATIGUED E REDUCED ROADWAY WIDTH AT INTERSECTION NO F FLOODED' D CROSSING-NOT INCROSSWALK L UNINVOLVED VEHICLE G OTHER': E IN ROAD-INCLUDES SHOULDER M OTHER': H NO UNUSUAL CONDITIONS F NOT IN ROAD X X N NONE APPARENT G APPROACHING I LEAVING SCHOOL BUS I I 1 10 RUNAWAY VEHICLE KETCH FOR SKETCH DIAGRAM,SEE.PAGE 50 MISCELLANEOUS INDICATE NORTN NJURED/WITNESSES!PASSENGERS HE 555 CARS Page 3(Rev 1-0310PI 061 Page 3 or )ATE OF COLLISION(MO. DAY YEAR) TIME(2400) NCIC it OFFICER I.D. NUMBER /9/2()08 1741 0740 SRO 15 08-135 wrrNESS PASSENGER AGE sex EXTENT OF INJURY('X'ONE) INJURED WAS('X'ONE) PARTY SEAT AR SAFETY EJECTEDMY ONLY NUMBER POS. BAG EQUIP. FATAL SEVERE OTHER VISIBLE GOt,IPL1UNT DRIVER PASS. PEO. BICYCLIST OTHER IQURY NUURY PUURY OF PAIN 1" ❑ 58 F i-1 IDX 1:J 1-1 I-1 1-11 I x I I 1=1 1012 0 r P 0 TAME I D.O.B.i ADDRESS TELEPHONE .IAN YING SHL•'N (10/06/1949) 9583 DAVONA DR SAN RAMON CA 94583 (925)803-9653 INJURED_OWn.lRANSPORTED_B'C - -TAKEN-TO ;AN RAMON VALLEY FIRE'PROTECTION DIST. J011N MUIR MEDICALC EN'I'L'•R iESCRIBE INJURIES: S(IC>ARACIINOID INJI.IRY,(:13R113RAI,li"D MA,I (DURAL III MORRIIAGL, RAC71AnD RIGHT PELVIS,FRACI'URI:D RIC?IITTIBIA/ 1:113ULA AND NUMEROUS FACIA(,FRACI'URliS. _ Irl VICTIM OF VIOLENT CRIME NOTIFIED _1# I f-1 Im .1 1_I j ❑ CEJ 1 1_I 1 cI 1_1 1X1]7171 0 TAME/D.O.B.I ADDRESS TELEPHONE \I.IlFR'I'YIN'l-SUI (02/1212006) 9583 DAVONA DR SAN RAMON CA 94583 (925)803-9653 INJURED ONLY)TRANSPORTED BY: TAKENTO: iAN 14AMON VALLEY I,'IRE'1'l0Yl ?CI'lON 17151'. CHILDRENS 110SP(TALOAKLAND DESCRIBE INJURIES: FRAC IVRED RIGHT COLLAR BONIi f l VICTIM OF VIOLENT CRIME NOTIFIED M ❑ U i_7 0 l_I I_I I_I cI TI_I AME/D.O.B.I ADDRESS TELEPHONE VI?SI.I:Y BARTHOLOMI.ENCIS (04/07/1964) 7598 MAY WAY SAN RAMC)N CA 94583 (925)829-7444 INJURED ONLY)TRANSPORTED BY: TAKEN TO: ,ESCRIBE INJURIES: VICTIM OF VIOLENT CRIME NOTIFIED 2 1_) 34 M U i�l II 1-1 I_I ❑ AME I O.O.B.I ADDRESS n' TELEPHONE '11(7MAS JEFFERSON I1ORN (01/26/1973) 8466 N LAKl:DR AIT('G DIAILIN IA 94GRIGINAL � (925)828-7128 NJURED ONLY)TRANSPORTED BY: TAKEN . ESCRIBE ByIURIES: n VICTIM OF VIOLENT CRIME NOTIFIED 3 ❑ 16 M 1 1-11 LI 1=.1 ❑ E ❑ I-1 AME/D.D.B./ADDRESS TELEPHONE MICA 1.GE SCHUMUCKER (04/)2/1991) 3231 DOU..)RGti DR SAN RAMON CA 94583 (925)828-3890 Ni URED ONLY)TRANSPORTED BY: TAKEN TO: ESCRIBE INJURIES: rl VICTIM OF VIOLENT CRIME NOTIFIED Sj# 4 ❑ M _ ❑ 1=1 I La 1 ❑ 1:11 ❑ I !=1 I c1 0 1 1 ' 1 1 -T� AME I D.O.B.I ADDRESS TELEPHONE OGEL1OARANDA (11/20/1943) 9736.1'11UNDERIURDVR SAN RAMON CA 94583 (225)803-1340 NJURED ONLY)TRANSPORTED BY: TAKEN TO: ESCRIBE INJURIES: 0 VICTIM_OF VIOLENT CRIME-NOTIFIED REPARER'S NAME I.D.NUMBER MO. DAY YEAR REVIEWER'S NAMEMO. DAY YEAR K.E.RITI'tiR SROI;i 1/9/2008 NJURED I WITNESSES I PASSENGERS Page 4 of $ ;HP 555 CARS PM 3(Rev 1-03)OPI 061 )ATE OF COLLISION IMO. DAY YEAR) 71ME(2400) NCK q OFFICER I.D. NUMBER /9/2009 1741 (1740 SR015 08-135 NrtNESS PASSENGER ACE SEX EXTENT OF INJUR'YCX ONE) INJURED WAS rX ONE) Pam SEAT MR SAFETY ONLY ONLY FATAL SEVERE OTHER VISIBLE COMPLNNf NUMBER POS. BAG EQUIP. EJIECTEO INJURY INJURY INJURY OF PAIN DRIVER PASS. BICYCLIST OT/ER K 1# 5 1-1 57 M ❑ Cl El Q IJ Cl I_I ❑ AME I O.O.B.I ADDRESS TELEPHONE 11.FRFD l0SI'iPH BRU (119/!0/195(1) 2.5 f:I.MWOOD DR SAN RAMON CA 94583 L925)829-5103 NJURED QNLY)'TRANSPQRMO BY-- TAK[p�Tp _ ESCRIBE INJURIES: VICTIM OF VIOLENT CRIME NOTIFIED r I# I❑ 36 Iv I ❑ ❑ ❑ I❑ T c I❑ c] AME/D.O.B.I ADDRESS TELEPHONE 31.1 XU (10/02/1971) 9583OAVONADR SAN RAMON CA 94583 {'425)803-9653 NJURED ONLY)TRANSPORTED BY: TAKEN TO: ESCRIBE INJURIES: ( I—I VICTIM OF VIOLENT CRIME NOTIFIED �� ❑ I_I I_I (__I I_I (.I I_I I_I I.1 I_I WE/D.O.B./ADDRESS TELEPHONE VJUREO ONLY)TRANSPORTED BY: TAKEN T0: 3SCRIBE INJURIES: VICTIM OF VIOLENTCRIME NOTIFIED c] T_�+El cI I-D 1- 4 1 -71 WE I D.O.B./ADDRESS TELF,PHONE ,UURED ONLY)TRANSPORTED BY; TAKEN TO; :SCRIBE IWURIES; I� VICTIM OF VIOLENT CRIME NOTIFIED J'- To j cl I cl I o I ci I T IME I D.O.B.!ADDRESS TELEPHONE LJURED ONLY)TRANSPORTED BY. TAKEN TO: :SCRIBE INJURIES: VICTIM OF VIOLENT CRIME NOTIFIED a# ❑ I�I ❑ cI ❑ 1=1 ❑ ❑ ❑ TOT .ME/O.O.B./ADDRESS TELEPHONE IJUREO ONLY)TRANSPORTED BY: TAKEN TO; SCREE IWURIES: VICTIM OF VIOLCNTCRIME NOTIFIED ;EPARHR'S NAME 1.0.NUMBER MO. DAY YEAR RF-VIEWFR'S NAME MO. DAY YEAR F RITTfR SRO15 1/92009 STATE OF CALIFORNIA SKETCH DIAGRAM (=IIP 555 Page4(Itcv.8-97) 0111 0421 PAGE 5 OF S� _ DATE OF INCIDENT _ TIME NCIC NUMBER OFFICER I.D. NUMBER 01/09/2008 1741 0740 SR015 08-135 ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED(SCALE= ) 6;� % • O~O Yyl'J OPl -- ---FROM g Country Club Village / Shopping Center X�a PREPARED BY I.D.NUMEREVIEWER'S NAME DATE R. E. RITTER SR015 01/09/2008 STATE OF CALIFORNIA FACTUAL DIAGRAM • Clip 555 1'age4(Rev.8.97)0111042 PAGE 5 OF 5� DATE OF INCIDENTTIME NCIC NUMBER OFFICER I.D. NUMBER 1 01/09/2008 1741 10740 SR015 108-135 J ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED(SCALE= ) j��- .O GO) �` O (D C PIE® FRO ' / ORIGNAL a► �G P VILLAGE SHO P NG CEM ER inn a to 2D 30 n wf PREPARED BY I.D.NUMBER DATE REVIEWER'S NAM DATE R. E. RITTER SR015 01/09/2008 � ncr,n,M NAWfacAr } ' wVf -- , C !FD FROM ORlG! AL CtCA 50 � p 10 20 30 44 �s NARRATIVE/SUPPLEMENTAL PAGE B? OF 5"1 _ DATE OF INCIDENT[' ME NC1C NUMBER FICER E.D. NUMBER 01/09/08 qa 1 0740 07-135 FACTUAL DIAGRAM: On 1-10-20081 was assigned to prepare the factual diagram. Officer Springer and Officer Heinbaugh assisted by collecting scene measurements. They utilized a Leica Forensic Mapping; System to take scene measurements. The measurements were stored on TDS Recon system handheld data -collector with PockctZone software:Cad Zone-Crash Zone was then utilized to create the final computer generated drawings. All distances listed are approximate. The following is the text file indicating the location of each data point which was downloaded. Pt North East Elev Description Note 1 0.000 0.000 0.000 Inst Point 2 83.925 -0.224 -0.466 RMI RM-1. 3 -0.434 19.976 -1.418 IGNORE 4 -0.491 20.064 -1.417 AOI AOI-1 5 2.836 14.925 -1.265 EM1. wheel Part 6 4 .246 15.110 -1.240 GOU1 Gouge 7 4.527 15.247 -1.237 GOU1 Gouge 8 4 .762 15.326 -1.235 GOU1 Gouge 9 1..891 14 .238 -1.273 SCUFFI Scuff-1 10 1.981 14 .704 -1.214 SCUr•F1 Scuff-1 1.1. 2.331 14 -986 -1.273 SCUT F'1 Scuff-1 1.2 2.717 1.5.314 -1.269 SCUFFI Scuff-1. 13 3.240 1.5.588 -1.2 1 ...-_-_ ZSCUFF2 1 Scuff-1 1.4 2.710 1.6.623 -1.21/COPIED2 Scuff-2 1.5 2.868 1.6.646 -1.2.9 2 Scu.f..f:-2 16 3.084 16.573 -1.28 ORIG2 SCLI.Ef-2 17 3.264 1.6.489 -1.28 Scuff-2 18 3.406 16.484 -1.285 SCUFF'2 Scuff-2 19 3.634 16.588 -1.279 SCUFF2 Scuff-2. 20 -0.790 25.360 -1.539 EP5 Hair Band 21 10.502 11.484 -0.993 EP6 Plastic Wagon Wheel Lac. 22 14 .206 8.813 -0.847 E27 Wood Rail 23 14 .527 9.521 -0.865 EP7 Wood Rail 24 1.7.131 11.629 -0.588 EP8 Wood Rail 25 16.824 11.776 -0.662 EP8 Wood Ra.i.l. 26 17.337 12.921 -0.677 EP8 Wood Rail 27 17.989 12.508 -0.392 EP8 Wood Rail 28 17.745 1.2.197 -0.825 F..P9 Wagon Wheel End Cap 29 19.1.20 13.540 -0.642 EP10 wood Rail, Blanket, Cap 30 18.481 14.490 -0.336 EP10 Wood Rail, Blanket, Cap 31 18.975 15.381 -0.128 EP10 Wood Rail, Blanket, Cap 32 19.613 16.894 0.309 EP3.0 Wood Rail, Blanket, Cap 33 20.771 16.937 0.177 EP10 wood Rail, Blanket, Cap 34 20.635 15.606 0,278 EP10 Wood Rail, Blanket, Cap 35 18.371 14 .909 -0.705 EP1.0 Wood Rail, Blanket, Cap 36 17.661 14.913 -0.843 EP1.0 Wood Rail, Blanket, Cap 37 16.705 15.535 -0.778 EP10 Wood Rail, Blanket, Cap 38 18 .175 17 .259 -0.825 EP10 Wood Rail, Blanket, Cap 39 18.801 1.6.663 -0.501. E210 Wood Rail, Blanket, Cap PRF.PARr:I7 fly I.D.NUMBER DA1'I: RI,VII:W13R'S NAME' DATE. John A. Goyich 40 1-30-20081 NARRATIVE/SUPPLEMENTAL Ak PAGE 41 OF-54 _ DATE OF INCIDENT E NCIC NUMBER WFICER I.U. NUMBER 01/09/08 qr4I 0740 40 07-135 40 19.288 1.6.317 0.295 EP10 Wood Rail, Blanket, Cao 41 1.7.805 21.367 -0.850 EP11 Pillow 42 20.003 3.9.783 -0.809 EM12 Clothing 43 20.021 22.228 -0.973 EM13 Wood Rai.], 44 18.982 23.733 -1.050 EM13 Wood Rail 45 23:091 20.529 =0.849 BM-14 Wood Rail 46 22.375 20.395. -0.859 EM14 Wood Rail 47 22.497 20.961 -0.894 EM14 Wood Rail 48 26.936 18.261 0.1,18 EM15 Baby Blanket 49 22.599 25.406 -0.956 EM16 Wood Rail 50 22.755 26.353 -0.958 EM16 Wood Rail 51 17.777 28.293 -1.1.74 EM17 Pacifi.e.r. 52 30.003 25.834 0.182 EM18 53 27.861 24 .485 0.01.4 EM18 54 28.268 23."13.5 -0.024 EM18 55 30.636 25.045 0.070 EM18 56 27.127 25.399 -0.870 EM19 57 26.724 26.215 -0.953 EM20 58 26.170 26.914 -0.956 EM20 59 23.844 29.789 -1.067 EM21. 60 28.495 29.995 -0.961 EM22 61 29.702 32.245 -0.930 EM23 62 12.994 44.218 -1.550 EM24 63 13.656 57.502 -1.472 EM25 64 23.876 52.382 -1.479 BLOOD 65 22.57.2 52.765 -1.507 BLOOD 66 22.381 52-558 -1.. 1 -----_ ,OOD 67 25.854 56.428 -1. OPIED FROM13 OOD 68 25.056 55.449 -1. 96 OR�GI�A� B OOD 69 25.329 54.570 -1. B OOD 70 24 .099 53.625 -1.530 BLOOD 71 21..592 55.803 -1..616 BLOOD 72 19.030 57.533 -1.733 BLOOD 73 18.784 58.412 -1-805 BLOOD Y4 18.030 58.914 -1.831 BLOOD 75 19.558 60.218 -1.863 BLOOD 76 19.074 59.218 -1.843 BLOOD 77 21.183 57.159 -1..647 BLOOD 78 22.138 56.001 -1.626 BLOOD '79 22.848 57.748 -1.632 BLOOD 80 24 .148 58.339 -1.176 BLOOD 81 25.929 57.B1.7 -1.470 BLOOD 82 26.003 56.309 -1.469 BLOOD 83 23.138 52.471 -1.408 EM26 84 24.206 56.1.60 -1..022 EM21 85 27 .933 39.672 -1.148 EM28 86 29.261. 43.444 -11115 EM29 87 32.941 42.779 -1.017 EM30 88 35.626 42.265 -0.839 E431 89 36.555 41.648 -0.852 EM31 90 38.206 34 .326 -0.766 EM32 91 38.694 32.266 -0.674 EM33 92 40.022 31.820 -0.028 EM34 PRITARPT)BY 1.0.NUMEIE:R 0XIT, REVIIiWEER'8 NAMb DATEi John A. Goyich 40 1-30-2008 NARRATIVEISUPPLEMENTAL PAGE 100E 154 _ DATE OF INCIDENT 1'1ME NCIC NUMBER FFICI3R I.D. NUMBER 01/09/08 0741 0740 40 07-135 93 41.438 48.139 -0.916 EM35 94 42.049 48.091 -0.945 EM35 95 34 .063 61.882 -1.342 EM36 96 34 .399 46.060 -0.982 LR 97 40.580 .52.099 -1.039 LF 98 36.59-6 564530 --0.154 RF.' 99 30.382 50.340 -0.153 RR 100 26.128 80.093 -0.072 EM37 101 36.022 .17.791 .. 0.466 EM38 102 35.425 1.7.817 .. 0.499 EM38 103 31.357 12.413 0.474 EM39 104 32.471 11..852 0.370 EM39 105 47.388 13.875 0.181 EM40 1.06 48.169 13.254 0.165 EM40 107 23.808 52.924 -0.475 HEAD 1.08 24 .161. 53.712 -0.558 IGNORE 109 20.644 55.696 -0.613 FOOT 110 -42.509 51.919 0.081 EP1 111 -32.341 43.066 -0.388 EP1 112 -22.341. 38.660 -0..842 EPI 113 -7.089 39.311 -0.945 EP1 114 13.869 55.170 -0.715 EPI 115 37.231 77.334 -0.444 ul 116 120.188 155.831 1.125 EP1 117 1.25.785 147.402 1.057 FLI 118 -2.01.2 26.601 -0.6 ------ L1 119 9.1.22 20.782 -0.2 oCOPIED FROM L1 1.20 117.370 1.22.945 1..0 2 ORIGINAL Ll 121 ' 142.437 129.800 2.352 122 1.22 19.935 14.278 0. 671 E22 .1.23 19.935 14.278 0.671 EP2 124 19.533 11.225 0.842 EP2 125 22..460 11.175 1.050 EP2 126 22.458 11.175 1.050 EP2 127 1.14 .71.5 97.834 3.073 EP2 12.8 114.709 97.830 3.073 EP2 129 1.22.716 104 .303 3.144 EP2 130 133.953 111.937 2.263 EP2 131 149.648 1.21.832 2.441. EP2 132 145.269 125.065 4 .377 POLE 1.33 32.051 22.789 3.069 POLE 134 111.516 83.062 1.038 ARROW 135 104 .4'06 85.158 1.932 ARROW 136 27.099 11.935 0.449 ARROW 137 34.091 10.069 0.258 ARROW 138 117.132 85.188 1.092 LL16 139 102.421. 70.256 0.789 LL16 140 22.679 -4.737 0.277 L1:16 141 31..393 -13.645 0.121 CL2 142 164.316 .1.11.745 1..61.6 CL2 143 172.566 102.873 1.293 CL3 1.44 41.495 -20.280 -0.354 CL3 145 179.590 96.138 1.275 E1?3 PREPARED 13Y I.D.NUMBER DACE REV Ewl"It'S NAME DA'L'E John A. Goyich 40 1-30-2008 NARRATIVE/SUPPLEMENTAL PAGE 1,I�•OF5-q DATE OF INCIDENT TIME NCIC NUMBER FFICER I.D. NUMBER 01/09/08 0741 0740 40 07-135 146 71.018 -6.053 -0.663 EP3 147 56.483 -19.669 -0.749 EP3 3.48 44 .096 -32.6'10 -0.827 EP3 149 41.611 -39.113 -0.745 EP3 150 43.073 -49.727 -0.396 EP3 151 49.062 -58.076 -01118 E-P3 3.52 56.844 -66.233 0.054 EP3 153 82.311 -93.166 0.307 EP3 154 76.522 -98.478 0.293 FL2 155 35.778 -55.362 -0.134 FL2 156 68.439 -104 .667 0.629 DYIJ1 157 28.800 -62.403 0.028 DYL1 158 37.303 -75.245 0.226 STOP LEGEND 159 32.294 -70.342 0.1.37 STOP LEGEND 160 27.394 -75.169 -0.005 STOP LEGEND 161. 63.801 -114 .917 0.461 FL3 1.62 1.9.156 -71.234 -0.106 FL3 1.63 57.275 -1.19.013 0.388 EP4 1.64 17.477 -77 .599 -0.214 EP4 165 7.032 -74 .162 -0.365 EP4 166 -4 .726 -78.078 -0.558 EP4 167 -19.538 -91.544 -0.341 EP4 168 -38.958 -109.763 -0.172 EP4 169 -152.012 -216.667 0.690 EP4 170 -158.808 -209.'563 0.822 FL4 171 -9.525 -68.701 -0 - - FL4 172 -166.007 -200.310 1 OMP 1ED FROM � CL4 173 -21.858 -63.942 0 219,���G,��L j CL4 174 -173.724 -1.91.058 2.65? TL5 175 -159.373 -177.108 2.551 FL5 . 176 -166.268 -179.368 2.451 ARROW 177 -173.368 -177.535 3.578 ARROW 1.78 -181.3.91 -179.329 4 .796 POLE 179 -37.520 -58.281 1.600 POLE 180 -183.309 -177.668 1.930 EP5 3.81 -163.827 -159.483 1.929 EP5 182 -151.274 -150.006 1..777 EP5 183 -136.389 -140.481 1.753 EP5 184 -119.890 -130.259 1.568 EP5 185 -101.61.8 -13.6.681 1.352 EP5 186 -94.148 -109..933 1.244 EP5 187 -33.507 -52.661 0.611 EP5 188 -33.507 52.660 0.610 EP5 189 30.259 -52.676 0.694 EP5 190 -30.698 -55.313 0.855 EPS 191 -41.648 -56.665 0.321 ARROW 192 -48.261 -54 .667 0.251 ARROW 193 -99.791 -11.1.460 0.784 ARROW 194 -106.830 -110.004 0.727 ARROW 195 -1.12.265 -110.340 0.539 FL6 196 -39.932 -42.021 0.095 FL6 197 -49.115 -34 .242 -0.060 CL5 198 -193.575 -170.662 1.018 CLS PRI IARI: NARRATIVE/SUPPLEMENTAL- ,ilk PAGE J.JOE574 DATE OF INCIDENT TIME NCIC NUMBER MWFFICER I.D. NUMBER 01/09/08 0741 0740 40 07-135 199 -185.223 -1.75.493 1.297 BOX 200 -189.461 -170.996 1.123 BOX 201 -195.505 -176.719 1.150 BOX 202 -1.93.470 -166.857 0.936 BOX 203 -197.629 -162.293 0.746 BOX 204 -?_03.640 -168F.039 0.937 'Box 205 -244 .052 -213.921 1.252 BOX 206 -247.599 -210.144 1.144 BOX 207 -253.702 -215.572 1.190 BOX 208 -241.704 -228.144 1.555 BOX 209 -235.795 222.706 1.532 BOX 210 -239.367 -21.8.887 1.478 BOX 211 -248.851 -206.865 1.023 FL7 212 --195.889 -156.644 0.688 FL7 213 -191.702 -152.772 0.697 FL7 214 -59.594 -28.058 -0.236 FL7 215 -201.664 -148.169 0.747 EP6 216 -90.754 -43.483 0.025 FP6 217 -74 .582 -28.310 -0.012 EP6 218 -69.693 -21.778 -0.251 EP6 21.9 -67.436 -8.369 -0.090 EP6 220 -68.440 -1.311 0.056 EP6 221 -71.699 6.504 0.320 EP6 222 -78.1.47 13.448 0.393 EP6 223 -57.543 33.044 0.253 EP7 224 -47.618 22.380 -0.112 EP7 225 -44 .051 .18.621 -0.148 _ EP7 226 -43.346 16.141 -0.EOORIG�N�� D FRO{VI EP7 227 -44.318 14 .576 -0. .EP7 22B -47.677 15.023 a. 'EP7 229 -50.495 17.944 0. - -- EP7 230 -55.762 23.453 0.459 EP7 231 -44.719 15.621. 0.098 SIGN 232 -41.426 19.018 -0.491 EL14 233 -25.520 33.781 -0.839 EL14 234 -34.102 25.740 -0.619 CL6 235 -37.333 29.085 -0.571 CL6 236 -46.926 39.158 -0.222 CL6 237 -40.1.80 34.767 -0.406 STOP_LEGEND 238 -34.787 29.186 -0.649 STOP LEGEND!_ 239 -29.439 34 .340 -0.669 STOPILEGEND_ 240 -48.234 27.063 -0.21.4 STOP__.TEGEND_ 241 -42.503 21.765 -0.423 STOP LEGEND 242 -37.397 26.679 -0.520 STOP_LEGEND 243 -25.705 41.785 -0.362 S1.1'OP 244 -24 .317 35.837 -0.875 xwi 245 35.967 -39.298 -0.335 xwi. 246 -1..472 -75.112 -0.404 xwl 247 14 .444 -75.297 -0.368 Xw2 248 42.126 -49.014 -0.512 xw2 249 44 .095 -31..636 -0.915 Xw3 250 -12.095 37.618 -1.153 Xw3 251 -15.285 24 .435 -0.871 LINE PRETAX ED BY I.U.NUMUCH DA'Z'E; REVIEWER'S NAMH Mill., John A. Goyich 40 1-30-2008 t J NARRATIVE/SUPPLEMENTAL PAGE 0 OF DA'Z'E OF INCIDENT TIME NCIC NUMBER FFICER I.U. NUMBER 01/09/08 0741 0740 40 07-435 252 -7.232 31.688 -0.934 LINE 253 -3.659 27.068 -0.548 LINE 254 -11.344 19.750 -0.621 LINE 255 -7.500 15.036 -0.412 LINE 256 0.284 22.452 -0.385 LINE 257 3.917 17:952 -0:26-0 LINE 258 -3.894 10.247 . -0.319 LINE 259 0.197 5.861 -0.133 IGNORE 260 -0.197 5.861 -0.133 LINE - 261 7.785 13.511 -0.099 LINE 262 11.657 8.558 0.112 LINE 263 3.510 1.247 0.069 LINE 264 7.284 -3.528 0.239 LINE 265 15.487 3.930 0.309 LINE 266 1.9.211 -0.814 0.279 LINE 267 10.893 -8.208 0.244 LINE 268 1.4 .64 6 -1.21.948 0.190 LINE 269 22.907 -5.395 0.223 LINE 270 26.995 -10.155 0.174 LINE 273. 18.421 -17.542 0.1.88 LINE 272 2.1..959 -22.083 0.1.73 LINE 273 30.402 -14.784 0.201 LINE 274 34 .073 -19.617 -0.002 LINE 275 26.227 -27.172 0.0 276 29.741 -31.587 -0.0 O�OPIED FRO LINE 277 37.899 -24.121. -0.2 7 ORIGl1�L LINE 276 41.827 -28.582 -0. LINE 279 33.505 -36.367 -0.264 LINE 280 41.468 -20.346 -0.311 LINE 287. 45.882 -16.2S4 -0.333 LINT. 282 50.242 -12.102 -0.314 'LINE 283 54 .562 -8.203 -0.323 LINE . 284 45.491 -0.350 0.099 LINE 285 51..210 5.050 0.157 LINE 286 62.398 15.597 0.044 LINE 287 68.305 21.031 0.081. LINE 288 -1.143 -16.352 0.219 MH 289 -22.1.97 -20.093 0.003 MH 290 -30.768 53.1.38 0.046 TREE2 291 -21.294 49.446 -0.250 TREE2 292 -16.242 48.71.1 -0.305 TREE2 293 -7.281. 50.793 -0.113 TREE2 294 -0.779 55.223 -0.039 TREE2 295 -68.338 -2.144 0.501 Sw 296 -77.793 -4 .695 0.695 Sw 297 -77.898 -4 .701 0.690 Sw 298 -77.293 -10.540 0.378 Sw 299 -71.805 -15.332 0.371 Sw 300 -79.540 18.562 0.237 Sw 301 -81.941 -21.575 0.224 Sw 302 -86.836 -26.230 0.225 Sw 303 .83.922 -0.220 0.549 RM2 Ref Measure 2 PREPARED RV I.D.NUMBER rwrii 1RL'VIEWi;R'S NAME; DATE John A. Goyich 40 1-30-2008 REPORT NARRATIVE/SUPPLUAENT.AL PAGES DA79 OF INCIDENT I OCCURRENCEE NCIC NUMBER OFI-- ID NUMBER 1-9-08 1741 hou 0740 SR015 08-135 CITY/COUNTY I JUDICIAL DISTRICT REPORTING DISTRICT l BEAT CITATION NUUBER San Ramon I Contra Costa I Walnut Creek 7212 NIA LOCATION/SUEIECT STATE HIGHWAY RELATED Alcosta Blvd im Broadmoord Or none Throw Distance: Max and Min Throw Velocity- Results Solve for Max and Min Throw Velocity: vex = 2'g'p'D. . v2•g•y•D j= y COPIED FROM ORIGINAL Variables Name Variable Vetue Unit Coefficient of Friction µ 0.70 Name Variable Value Unit Throw Distance D 43.00 ft Calculation Result Name Variable Value Unit Max.Throw Velocity V MAX 44.03 fps Varlable Value Unit V MAX 30.02 mph Name Verieble Value Unit Min. Throw Velocity V MIK 36.07 fps Variable Value Una V MIN 24.59 mph PREPARERS NAME I.D.NUMBER MONTH I DAY I YEAR REVIEW ER'S NAME , / MONTH I DAY I YEAR R.ititter SR015 t-9=4S _ iA""'' Mc4�nt n.e.rr.tuerlm 0N1.nl•tw lei Iwo. 1l.9. tOOO V k Cm.t uarrrnt hK—riwitm Mtr—ni.nn.r..a u.c.1 STATE OF CALIFORNIA NARRATIVEISUPPLEMWAL PAGE 16 017$4 DATE OF INCIDENT TIME NCIC NUMBER OFF( ER I.D. NUMBER 01/09/2008 1741 0740 SR015 08-135 1 Facts 2 Notification: 3 On Wednesday 1109/08 at approximately 1742 hrs, San Ramon P.D. office_rs were dispatched and 4 responded to a reported vehicle verses a pedestrian on Alcosta Blvd near Village Parkway in San 5 Ramon. Additional information was given to responding units that an air ambulance was being 6 dispatched to this collision. PST Officer T. Montemayor#SR501 responded at 1743 hrs and 7 arrived at 1748 hrs. Sgt E. Webb#SR005 and Officer R. Steaveson #SR017 responded at 1744 8 hrs. Sgt Webb arrived at 1749 hrs and Officer Steaveson arrived at 1752 hrs. Motor Officer's D. 9 Heinbaugh #SR019, J. Springer#SR024 and t, R. Ritter#SR015 responded at 1746 hrs and 10 arrived at 1753 hrs. Scene supervisor Sgt D. White#SR007 responded at approximately 1754 hrs 11 and arrived at 1816 hrs. Officer A. Molien#SR039 responded.at 1748 hrs and arrived at 1752 12 hrs. Sgt Webb advised that all eastbound lanes of Alcosta Blvd from Village Parkway to the Iron 13 Horse Trail were shut down as well as the northbound Village Parkway transition lane to 14 eastbound Alcosta Blvd. 15 16 San Ramon Valley Fire Protection District( Pararnelic#39 responded at 1743 hrs and 17 arrived at 1747 hrs. Engine#39 responde riFAWArldved at 1747 hrs. Rescue medic 18 #34 responded at 1748 hrs and arrived at 752qjFyGtblion31 responded at 1748 hrs and 19 arrived at 1756 hrs. Engine#34 responded at 1749 hrs an was cancelled while enroute. Truck 20 #34 responded at 1749 hrs and arrived at 1800 hrs. 21 22 Paramedic unit#39 transported P-3 to Children's Hospital in Oakland and Rescue Medic#34 23 transported P-2 to John Muir Medical Center in Walnut Creek. 24 25 San Ramon Valley Fire unit Paramedic#39 requested an air ambulance at 1747 hrs but cancelled 26 the air ambulance request at 1758 hrs. 27 28 Measurements were collected by the use of a Leica Total Station Forensic Mapping System. All 29 times and speeds are approximate. 30 31 Additional Investigation Duties: 32 PST Officer T. Montemayor, Evidence collection and photographs. 33 Officer D. Heinbaugh, Data and Evidence collection. 34 Officer J. Springer, Data and evidence collection. 35 Officer J. Goyich, Scene diagram. .36 Sgt White, Scene Supervisor, data and evidence collection. 37 Sgt Webb, Traffic control and lane closure. 38 Officer Steaveson, Traffic control and lane closure. 39 40 41 PREPARED BY I.D.NUMBER DATE REVIEWER'S NAME DATE R. E. RITTER SRO 1115 01/09/2008 i STATE OF CALIFORNIA NARRATIVE/SUPPLEMWAL PAGE 14; OF 91 DATE OF INCIDENT 14WIME NCIC NUMBER FFICER I.D. NUMBER 01/0912008 1741 0740 ..SR015 08-135 1 Scene Description: 2 This collision occurred within the four-way intersection of Alcosta Blvd at Broadmoor Dr and the 3 driveway entrance/exit to the Country Club Village shopping center. There is a posted stop sign 4 and roadway markings that control S/13 traffic-on Broadmoor Dr at Alcosta blvd and a stop-sign 5 that controls N/B traffic exiting from the driveway of the Country Club Village shopping center onto 6. Alcosta Blvd. There are no traffic:controls on Alcosta Blvd at this intersection. There is a marked 7 crosswalk that starts/ends at the NM comer of.Alcosta Blvd at Broadmoor Dr and extends across 8 the N/B and S/B lanes Broadmoor Dr where it startslends at the N/E corner of Alcosta Blvd at 9 Broadmoor Dr. There is another marked crosswalk:that t its/ends at the N/E corner Alcosta Blvd 10 and extends across the W/B and E/B Ian � loon: wftiere it starts/ends the S/E comer of 11 Alcosta Blvd at the Country Club Village s op tEgDt�oway exit to Alcosta Blvd. 12 13 Alcosta Blvd is a major four-lane arterial roadway that primarily traverses the City of San Ramon 14 in a north/south direction. At the scene of this collision, Alcosta Blvd travels in an east/west 15 direction with two EIB lanes and two W/B lanes. There is a designated left tum lane that leads to 16 N/B Broadmoor Dr from E/B Alcosta Blvd and a designated left tum lane that leads from W/B 17 Alcosta Blvd S/B into Country Club Village shopping center. Alcosta Blvd is made from asphalt 18 and is separated by a raised concrete median containing shrubbery and small trees and is 19 bordered by raised concrete curbs/sidewalks. There are designated bicycle lanes in both 26 directions of Alcosta Blvd and are designated only by signs on poles, no roadway markings. On 21 the eastbound sidewalk of Alcosta Blvd west of the driveway entrance/exit to the shopping center, 22 there are nine newspaper stands and one USPS mailbox. 23 24 Broadmoor Dr is a two lane undivided collector road that primarily travels in a north/south direction 25 through the City of San Ramon. Broadmoor Dr starts/ends at Alcosta Blvd and travels north 26 where it starts/ends at Ascot Dr. Broadmoor Dr is made from asphalt and is bordered by raised 27 concrete curbs/sidewalks as well as numerous residential driveways. 28 29 The Country Club Village shopping center is elevated approximately 5-6 feet from the intersection 30 and roadway. The driveway is made of colored concrete, has a downhill grade and levels out as it 31 intersects with Alcosta Blvd. The:driveway entrancelexit lanes are separated by a raised concrete 32 median containing small plants and a few leafless trees. Both lanes are bordered by raised 33 concrete curbs.and sidewalks. 34 35 Refer to the factual diagram for additional information. 36 37 Parties 38 Party#1 (P-1, Nodhal): 39 Upon my arrival P-1 was located at the scene and was found standing near V-1 at its point of rest 40 (POR). P-1 verbally and along with his valid California driver's license, identified himself to PST 41 Montemayor and to me. His statements and the statements of witnesses identified him as the 42 driver of V-1. P-1 was not injured in this collision. PREPARED BY I.D.NUMBER DATE REVIEWER'S NAME DATE R. E. RITTER SR015 01/09/2008 3 s'rA,rE OF CALIFORNIA NARRATIVEISUPPLEAL _ PAGE 11 OF-61q DATE OF INCIDENT TIMENCI NUMBER OFFICER I.D. NUMBER 01/49/2008 1741 0740 SR015 08-135 1 Vehicle#1 (V-1, 1997 Audi A4): 2 V-1 was found on all four of its wheels at its POR as depicted in the'factual diagram. VA was. 3 facing EIB in the #2 E/B lane of Alcosta Blvd approximately 40 feet east of the intersection. V-1 4 .sustained minor to moderate damage-to its hood,windshield, fenders and front bumper area. V-1 5 sustained minor damage to the left fender and left front bumper caused by striking a small child's 6 red wagon that P-3 was riding in.. The windshield was heavily damaged on the passenger side 7. close.to the bottom of the "A" pillar caused by being struck by P-2. Moderate damage to the right 8 front bumper, right fender, right h.eadiamp assembly, and the right front hood area caused by 9 striking P-2. Minor damage to the top of the passenger side "A" pillar caused by striking P-2. 10 Minor damage to the right side passenger door's exterior mirror caused by contact from P-2. V-1 11 was found with all of its lights on with the exception of the right front headlamp. That right front 12 turn signal assembly was dislodged from the vehicle. 13 14 V-1 was impounded per 22655.5(a) CVC-Impound for Evidence. V-1 was towed from the scene 15 by San Ramon Tow(925) 820-6304. 16 OM 17 Party#2 (P-2, Shen): COPIED FAL 18 Upon my arrival P-2 had already been trans ort t%_1_ %rr�ll�air Medical Center in Walnut Creek. 19 She was transported by San Ramon Valley Ire Protection District's Rescue Medic#34 for major- 20 head injuries. P-2 had been struck by V-1 and was found lying on her left side in a fetal position 21. perpendicular to the sidewalk. The lower half of her body was in the bicycle lane and her upper 22 half was in the#2 E/B lane of Alcosta Blvd. P-2 was eventually identified by her adult daughter 23 and by P-2's husband at John Medical Center. 24 25 Party#3 (P-3,Tsui): 26 Upon my arrival P-3 was being treated by Paramedics inside Paramedic unit#39 and was 27 subsequently transported to Children's Hospital in Oakland. P-3 was transported by San Ramon 28 Valley Fire Protection District's Paramedic#39 for a broken right collar bone, a.contusion to his 29 head, and for cuts and scrapes. P-3 was eventually identified by his mother and father at 30 Children's Hospital. 31 32 Witness#1 (W-1, Enos): 33 W-1 identified himself at the scene to Officer Springer by his California driver's license. 34 35 Witness#2 (W-2, Hom): 36 W-2 identified himself at the scene to Officer Springer by his California driver's license. 37 38 Witness #3 (W-3, Schmucker): 39 W-3 identified herself at the scene to Officer Springer by her California driver's license. 40 Witness #4 (W-4, Aranda): 41 W-4 verbally identified himself to me at the scene. 42 PREPARED BY I.D.NUMBER DATE REVIEWER'S NAME DATE R. E. RITTER SR01.5 .01/0912008- i STATE OF CALIFORNIA NARRATIVEISUPPLF-M&TAL PAGEJS:OF DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 01/09/2008 1741 0740 SR015 08-135 1 Witness #5 (W-5, Bru): 2 W-5 verbally identified himself to me by telephone on 1/11108. 3 4 Witness#6 (W4, Xu): .. 5 W-6 verbally indentified herself to me at John Muir Medical Center as the mother of P-3 and the 6 daughter of P-2. 7 8 Physical Evidence: 9 Evidence collected in this investigation was documented in the attached factual diagram. The 10 locations of items of evidence depicted on the diagram were documented by using the Leica Total 11 Station model FMS 307 and a TDS Recon Data collector coupled with Crash Zone software. The 12 diagram was completed using the, Crash Zone software. Officer Heinbaugh operated the Leica 13 Total Station and Officer Springer was on the prism pole. 14 Cvej ) FROM 15 The following items of evidence and properte from the scene and stared at SRPD 16 or at other locations as indicated for further r—v-er-safekeeping. 17 1. V-1 was removed from the scene by San Ramon Tow and was taken to their covered 18 secured storage for further investigation. 19 2. V-1's right low beam headlamp bulb was removed from the headlamp assembly for 20 inspection and was photographed. The bulb was placed into evidence at SRPD. 21 3. Several items of evidence were collected by PST Montemayor i.e. the red wagon, items 22 from inside the wagon, some of P-2's clothing and vehicle parts from V-1. Refer to PST 23 Montemayor's supplement for further details. These items were placed into SRPD 24 evidence. 25 4. The red wagon and some of the bigger pieces of debris were moved from their original 26 points of rest by fire department personnel so they could park their units within the 27 collision scene. The specific and exactnumber of pieces moved is unknown 28 29 Roadway: 30. V-1: was found at its Point of Rest (POR) as depicted on the factual diagram. 31 32 Other Factual Information: 33 1 removed the right front headlamp bulb from its housing assembly and inspected it. I used a 1 Ox 34 loupe to magnify the filament. The single tungsten filament was stretched, oblong and broken 35 near the upper connection point. One of the broken points was melted at the end. These indicate 36 that the light bulb was on at the time of the impact commonly referred to "hot shock". 37 38 Accident Reconstruction Calculations: 39 To establish a speed of V-1 when it impacted P-2 and P-3, I used the "Searle Formula" found in 40 the WeCare Accident Reconstruction Calculator, produced by Rudy Degger and Associates. The 41 variables used in this formula were coefficient of friction (CoF) and throw distance. The CoF value PREPARED BY I.D.NUMBER DATE REVIEWER'S NAME DATE R. E. RITTER SR01 5. .01/09/2008 STATE OF CALIFORNIA NARRATIVEISUPPLEMIMAL PAGE .rjOF64 _ DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 01/09/2008 1741 0740 SR015 08-135 i 1 of 0.70 was used as recommended. The throw distance of 43 feet (actual distance of 43.75)was 2 measured from the point where P-2 was struck (within the crosswalk)to where the body of mass 3 of P-2 came to rest next to the sidewalk. This formula combines maximum and minimum throw 4 velocities, so the results are ranged. Based on these throw velocities, I-determined that V-1 was 5 traveling at or about the speed of 24 to 30 mph at the time of impact. See Accident 6 Reconstruction Calculations report results of formulas. 7 8 Photographs: 9 PST Montemayor took-numerous digital photos of the collision scene. He completed a photo log 10 and attached it to his supplement. He submitted the photos to San Ramon PD records division 11 per department policy. 12 13 1 took several digital photos of the right headlamp bulb from V-1. 1 completed a photo log and 14 attached it to this report. I submitted the photos to San Ramon PD records division per 15 department policy. = 16 COPIED FROM 17. Stateme WRIGINAL 1s 19 All statements are paraphrased and organized from handwritten notes and from summarized 20 digital recordings. Exact words or statements are denoted with quotation marks. 21 22 Party#1 (Nodhal) 23 P-1 was contacted at the scene and he told me the following. I asked P-1 to start his statement 24 from the start of his day. P-1 stated he drove V-1 to his high school and attended classes all day. 25 After school, he drove to his brother's friend's house, picked up his brother, drove him home and 26 was there until his mother arrived home in the early evening. They all decided to have Thai food 27 for dinner. P-1 said his mother telephoned in an order to go from the Bangkok 101 restaurant in 28 Dublin. P-1 said he left his residence at approximately 1715 hrs. He stopped for some gasoline 29 for V-1 at the Unocal gas station located at the S/W corner of Amador Valley Blvd and Regional St 30 in Dublin. After putting gas into V-1, he drove to the Bangkok Restuaraunt at the corner of 31 Amador Valley Blvd at Village Parkway where he picked up their to-go order at approximately 32 1730 hrs. This pick-up time was evidenced by the date/time stamped receipt he had shown me 33 from Bangkok 101. P-1 said he pulled out onto E/B Amador Valley Blvd and had pulled into the 34 left turn only lane that leads to NSB Village Parkway. P-1 said he made a left turn to NIB Village 35 Parkway and travelled NIB towards Alcosta Blvd. 36 37 As P-1 approached the intersection of Village Parkway at Alcosta Blvd, he could see the traffic 38 signal regulating NIB traffic on Village Parkway to Alcosta Blvd was green. P-1 said he stayed in 39 the right lane of Village Parkway which turns into a right tum only transition lane to E/B Alcosta 40 Blvd. P-1 said he slowed V-1 down to almost a complete stop. He looked over his left shoulder 41 and could see that the E/B traffic on Alcosta Blvd was still stopped so he slowly accelerated V-1 42 into the#2 E/B lane of Alcosta Blvd towards the intersection of Alcosta Blvd at Broadmoor Dr. P-1 PREPARED BY I.O.NUMBER DATE REVIEWER'S NAME DATE R. E. RITTER SR015 01/0912008 PEJ J STATE OF CALIFORNIA NARRATIVEISUPPLEMA111'TAL PAGE4 OF v DATE OF INCIDENT . TIME NCIC NUMBER OFFICER D. NUMBER ..s 01/09/2008 1741 0740 SR015 08-135 1 stated that V-1 has transmission problems causing it to have slower acceleration. P-1 said he 2. slowly accelerated as he traveled in the#2 EIB of Alcosta Blvd and estimated his top speed at 3 approximately 30-35 mph. P-1 said he could see bright headlights in his rear view mirror causing 4 him difficulty seeing. He saidthe figi�fs appeared to be on a SUV or were on a vehicle that had 5 the bright Halogen type of headlights. P-1 said he was about even with a group of newspaper 6 stands on the right sidewalk of Alcosta Blvd when'he reached up with his right hand to the 7 windshield mounted rear view mirror. P-1 said he was going to physically rotate the mirror 8 downward so he could see better. He said he wasn't going to use the mirror adjustment fever at 9 the base of the mirror. P-1 said before he rotated the mirror, something told him to look down. He 10 looked down and saw a red wagon directly in front of him as he was nearing the crosswalk. He 11 said he immediately"slammed on his brakes"to stop V-1, P-1 said he heard a loud 12 crashing/thumping sound as he brought V-1 to a stop. P-1 said he came to a stop just east of the 13 crosswalk and was in the#2 lane. He immediately got out of V-1 and hollered "help" a couple of 14 times. He saw P-3 in the roadway near the #1 lane and could hear him crying. He reached into 15 V-1, grabbed his cell phone and dialed 911. He was able to get through to the California highway 16 Patrol Dispatch and advised them what had happened. P-1 said that the dispatcher wasn't able to 17 transfer the call to San Ramon Valley and this was when San Ramon Valley Fire Protection 18 District arrived. P-1 said he walked over to the baby, P-3, and asked him a couple of times if he 19 was ok, but the baby kept crying. P-1 said he looked over and saw P-2 was lying face down on 20 the ground near the sidewalk and he hollered, "oh my god" a couple of times. P-1 said he walked 21 over to P-2 and asked her if she was ok b �e-didn't respend. He said he could hear her 22 breathing. P-1 said a couple of p� o sh + PdoW&& AEE helping the paramedics with the 23 lady and the young child. ORIGINAL 24 25 1 asked P-1 if the black Audi A4, (V-1) stopped in the#2 EIB lane of Alcosta Blvd was his and he 26 said, "Yes". I asked him if he was driving V-1 at the time of the collision and he said, "Yes". 27 28 1 asked P-1 to estimate approximately how long it took him to travel from Village Parkway to the 29 AOI. He said it took, "approximately 12-14 seconds". I asked him how fast he thought he was 30 going and he again estimated his speed at approximately 30-35 mph. I asked him if he.could see 31 P-2 or the red wagon P-3 was riding in at anytime other than right before the impact and he said, 32 "No". P-1 stated he got V-1 from his mother's sister-in-law when he was approximately 15 years 33 old. P-1 said he has been the primary driver of V-1 since he was 16 years old. P-1 said they've 34 had the same mechanic for V-1 since they got it. The mechanics name was Roger Ramirez from 35 Berkeley Auto Service and their phone number was (510) 841-2568. P-1 said he was recently 36 advised by Mr. Ramirez to take V-1 to a transmission shop to have it checked and inspected. Mr. 37 Ramirez had told P-1 that the transmission wasn't working like a normal transmission should. 38 39 Party#2 (Shen) 40 At the time of the report no statement had been obtained from P-2 due to her being hospitalized 41 for her injuries. P-2 was on life support and was unable to speak to anyone. 42 PREPARED BY I.D.NUMBER DATE REVIEWER'S NAME DATE R. E. RITTER SR0.15 0110912008s STATE OF CALIFORNIA NARRATIVE/SUPPLEMMAALL PAGE Al ON 51 Q)ATE OF INCIDEN—T TIME �NCIC NUMBER OFFICER I.D. NUMBER 01/09/2008 1741 0740 SR015 08-135 ' 1 2 Party#3 (Tsui) 3 No statement was obtained from P-3 due to his g@pPIED FROM 4 - ORIGINAL5 Witness#1 (Enos) ---- 6 W-1 was originally contacted at the scene and gave Officer Springer a brief statement. On Friday 7 1-11-08 at approximately 1300 hrs, I met with W-1 at the scene and he-told me the following. W-1- 8 stated he was alone in his vehicle and was driving S/B on Broadmoor Dr towards Alcosta Blvd. 9 He came to a stop at the stop sign on Broadmoor Dr at Alcosta Blvd. When he carne to a stop, he 10 could see P-2 pulling a red wagon with P-3 sitting up inside the wagon. They were at the N/E 11 corner of Alcosta Blvd at Broadmoor Dr. They entered the crosswalk traveling S/B across the W/B 12 lanes of Alcosta Blvd. W-1-said tie didn't see P-2 look to her left and/or to her right before she 13 started into the crosswalk. W-1 said he saw three vehicles approach from the east (W/B) with the 14 vehicle in the left turn lane coming to a stop. He said the vehicle in the #1 lane and the vehicle in 15 the#2 lane slowed down but didn't come to a stop. W-1 said that P-2 and P-3 were approximately 16 in front of the left tum lane when both vehicles got to the crosswalk and continued into the 17 intersection. W-1 said he never saw P-2 look to her left or to her right at anytime while she was 18 walking in the crosswalk. She was always looking down towards the crosswalk and slightly ahead 19 or forward. W-1 said P-2 and P23 were near the center median of Alcosta Blvd when he first saw 20 V-1 out of the corner of his right eye. He said V-1 was approaching E/13, west of the intersection 21 approximately 100 feet prior to the intersection, was "really moving out" and was not slowing 22 down. W-1 said he thought V-1 might have been accelerating at the time. W-1 thought that V-1 23 was going to drive by P-2 and P-3 to try and scare them. He quickly looked back at P-2 and P-3, 24 and then saw V-1 strike P-2 and 17-3. He said they were both inside the crosswalk at the time they 25 were struck. W-1 said he could see P-2 strike the front area of V-1 and then strike the windshield. 26 W-1 said P-2 traveled up into the air landed on the roadway as V-1 came to a stop. W-1 stated 27 there was no E/B traffic on Alcosta Blvd other than V-1. W-1 doesn't recall seeing any vehicles 28 exiting the shopping center and saw only three vehicles W/B on Alcosta Blvd. He said his view 29 west of the intersection was unobstructed and.view east of the intersection was limited due to a 30 fence/wall. W-1 said he didn't hear any vehicle horns sounding, and didn't hear any skidding tires 31 or heavy braking sounds from any vehicles. W-1 said P-2 was walking at a slow to moderate 32 pace as she walked across the crosswalk. He said she never slowed down or increased her pace 33 at anytime. W-1 believes P-2 walked for approximately 10-12 seconds in the crosswalk before 34 she was struck. W-1 said he didn't see any bright headlights to the west but only VA's 35 headlights. W-1 said this incident happened very fast. 36 37 W-1 was approximately 90' away from the AOi's. 38 39 Witness#2 (Horn) 40 W-2 was originally contacted at the scene and gave Officer Springer a brief statement. On Friday 41 1-11-08 at approximately 1600 hrs, I met with W-2 at the scene and he told me the following. "I- 42 2 stated he was alone in his vehicle and was traveling N/B in the driveway exit that leads to PREPARED BY I.O.NUMBER DATE REVIEWER'S NAME DATE R. E. RITTER SR015 01/09/2408 mut. STATE OF CALIFORNIA NARRATIVE/SUPPLEMB'AL PAGEIZ 1.../��,111�OFa swiss r.-w i�rr1®s ar DATE OF INCIDENT IME NCIC NUMBER OFFICER I.D. NUMBER 01/09/2008 1741 0740 SR015 08-135 1 Alcosta Blvd and out of the Country Club Village shopping center. W-2 said he was in the right 2 turn only lane and came to a stop at the stop sign at Alcosta Blvd. When he came to a stop, he 3 could see P-2 holding onto.a rets wagon that P-3 was riding in.and was standing at the N/E cornea .4 of Alcosta-Blvd at Broadmoor far. He said they were basically-straight out in front of his vehicle 5 due to the angle of the crosswalk. W-2 said one W/B vehicle had crossed the intersection before 6 P-2 entered the crosswalk.: W-2 said P-2 subtlety looked to her left then to her right, then entered 7 the crosswalk while pulling wagon-behind her. .He said he could see. P-3 sitting up in the wagon. 8 W-2 said P-2 never lookedleft or right again but only downward at the roadway and kind of out in 9 front of her. W-2 said he felt that P-2 was looking at him as.she neared the center divide based 1 d on her head facing forward. He described P-2's pace as being slow but steady. W-2 said he 11 didn't see V-1 until right before it struck P-2 ande-said V-- s speed appeared to be"fairly 12 fast', approximately 45 mph. COPIED FROM 13 ORIGINAL 14 W-2 stated there was no E/B traffic on Alcosta hamV=t;he doesn't recall seeing any 15 vehicles on Broadmoor Dr and saw only one vehicle W/B on Alcosta Blvd in the left turn lane. He 16 believed that vehicle had made the left turn into the:shopping center just prior to the collision. He 17 said his view west and to the east of the intersection was unobstructed. W-2 said he didn't hear 18 any vehicle homs sounding, and didn't hear any skidding tires or heavy braking sounds from any 19 vehicles. W-2 said P-2 walked for approximately 10 seconds in the crosswalk before she was 20 struck. 21 22 W-2 was approximately 20' away from the AOI's and approximately 100' away from the N/E 23 corner of Alcosta Blvd at Broadmoor Dr. 24 25 Witness #3 (Schmucker) 26 W-3 was originally contacted at the scene and she gave Officer Springer a brief statement. On 27 Friday 1-11-08 at approximately 1530 hrs, I met with W-3 at the scene and she told me the 28 following. W-3 said she was alone in her vehicle and was traveling W/B on Alcosta Blvd near the 29 Iron Horse Trail just east of this intersection and was in the#1 lane. W-3 said she first saw P-2 30 and P-3 walking S/B across the W/B lanes of Alcosta Blvd and were in front of the#1 lane when 31 she pulled into the left tum only lane. At first she thought P-2 was pulling a stroller but when she 32 got closer she could see P-2 was pulling a small red wagon. W-3 said she came to a stop at they 33 crosswalk. W-3 said she watched as P-2 and P-3 started crossing the E/B lanes of Alcosta Blvd. 34 W-3 was going to make her left turn into the shopping center but saw V-1 approaching E/B in the 35 #2 lane west of the intersection. She said V-1 was approximately 50 feet west of the intersection 36 when she first saw V-1. She realized that P-2 was not going to make it across the crosswalk 37 without being hit by V-1. She continued to watch V-1 as it struck P-2 and P-3. After the collision, 38 W-3 said she immediately pulled into the shopping center where she used her cell phone to call 39 her mother then 911. 40 41 W-3 said there was no W/B traffic on Alcosta Blvd other than herself. She doesn't recall seeing 42 any vehicles exiting the shopping center and didn't'see any vehicles on Broadmoor Dr. She said PREPARED BY I.D.NUMBER DATE REVIEWER'S NAME DATE R. E. RITTER SR015 01/09/2008 STATE OF CALIFORNIA NARRATIVE/SUPPLEN&AL • PAGEa:3 OF5_4 DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 01/09/2008 1741 0740 SR015 08-135 1 her view west of the intersection was unobstructed. W-3 said she didn't hear any vehicle horns 2 sounding, didn't hear any skidding tires and/or heavy braking sounds from any vehicles. W-3 said 3 P-2.was walking at a fast pace as she walked across the crosswalk and'never slowed down or 4 increased her-pace-at anytime: -W-3-said R-2 never looked to her right before she started across 5, the E/B lanes of Alcosta Blvd. W-3 estimated V-1's speed at approximately 40 mph.. W-3 didn't 6 recall seeing any.bright lights corning from the direction of Village Parkway, west of this 7 intersection. 8 9 W-3 was approximately 15' away from the AOI's. . COPIED FROM 10 ORIGINAL 11 Witness #4 (Aranda) - - —_- 12 W-4 was contacted at the scene by me and he gave me the following statement. W-4 stated he 13 was driving EIB on Alcosta Blvd from N/B Village Parkway when he came upon this collision. HE, 14 could see P-2 lying in the roadway near the right shoulder of E/B Alcosta Blvd and could see P-3 15 in the#1 E/B lane. He said P-3 tiled to stand up, but fell down and appeared to be stumbling 16 around. He could tell immediately that P-3 was a small child so he went over to him and picked 17 him up. W-4 said he saw P-1 standing outside V-1 and was calling someone on his cell phone. 18 W-4 said he held onto P-3 until fire department personnel arrived. W-4 stated he did not witness 19 this collision. 20 21 Witness #5 (Bru) 22 W-5 was contacted by me by telephone on Friday 1-11-08. W-5 stated he was traveling W/B on 23 Alcosta Blvd at Broadmoor Dr and saw what appeared to be a collision in the E/B lanes of Alcosta 24 Blvd. He said he pulled over to the right shoulder about even with Starbucks building in the 25 shopping center and called.911. 'W-5 stated he did not witness this collision. 26 27 Witness #6 (Xu) 28 W-6 was contacted at John Muir Medical Center by me on Wednesday 1-9-08 at 2045 hrs. She 29 verbally identified P-2 as her mother and P-3 as her son. W-6 stated that her cousin's family had 30 come by her residence at approximately noon today and was their till approximately 1400 hrs. 31 They were the last ones to talk to and to see P-2 before the collision. She also said that her 32 parents have been living with her and her husband on Davona Dr for approximately 2% years. 33 She believes that her mother was walking to the new Asian Market in the Country Club Village 34 shopping center as she has done several times in the past. 35 36 ORinions and Conclusions 37 38 Summary: 39 P-1 had driven to the Unocal gas station located at the corner of Amador Valley Blvd at Regional 40 St in the City of Dublin and then onto the Bangkok.101 restaurant located at the comer of Village 41 Parkway at Amador Valley Blvd in the City of Dublin. He arrived at approximately 1720-1725 hrs. PREPARED BY I.D.NUMBER DATE REVIEWER'S NAME DATE R. E. RITTER SR015 . 01109/2008 ,x} I STATE OF.CALIFORNIA NARRATIVEISUPPLE TAL PAGE 2d OF SSP DATE OF.INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 01/0912008 1741 0740 SR015 08-135 1 He picked up his order to goat approximately 1730 hrs as evidenced in the receipt he showed 2 me. He left the restaurant and traveled E/B on Amador Valley Blvd to the intersection at Village_ 3 Parkway. He made a left turn onto N/B Village Parkway and traveled NIB until he reached the 4 traffic signal-controlled intersection-of Village Parkway at Alcosta Blvd in the City of.San Ramon. 5 6 P-2 was walking and pulling a recd wagon that P-3'was riding in. P-2 subtlety looked to her left, T. then toher right before she.stepped off into the marked crosswalk., It appears P-2 felt ltwas'safe: 8 to enter the crosswalk. She stepped into the crosswalk from the N/E corner on Alcosta Blvd at 9 Broadmoor Dr and walked S/B across the W/B lanes of Aloosta Blvd towards Country Club Village 10 shopping center. P-2 was walking in the crosswalk with her head facing downward and ahead. 11 12 P-1 made a right turn from N/B Village Parkway to.EIS Alcosta Blvd and was traveling in the #2 13 lane as he approached the intersection of Broadmoor Dr and the driveway entrancelexit to 14 Country Club Village. He said his speed was approximately 30-35 mph at this point. The speed 15 limit for Alcosta Blvd is posted at 35 mph. When P-2 was at the center divide area and assuming 16 if P-2 had looked to her right before entering the E/B lanes of Alcosta Blvd, she would have seen 17 V-1 approaching eastbound. P-2 did not look to her right, (W/B) before she crossed the E/B lanes 18 of Alcosta Blvd according to witnesses. P-1 had taken his attention away from the front of V-1 to 19 adjust his windshield mounted rear view mirror. When P-1 looked forward, he saw the red wagon 20 in the crosswalk and applied his brakes. P-1 was almost at the crosswalk when he saw the 21 wagon. When P-1 was approaching the intersection and assuming if P-1 had reached towards 22 the mirror without looking at it, he would have seen P-2 and P-3 in the crosswalk. P-1 was almost' 23 at the crosswalk when he saw the wagon. V-1s ance before the left front struck 24 P3, the wagon and the right front struck P-2. 25 . ORIGINAL 26 The leading edge of-the left front bumper of V-1 struck P-3 and the wagon P-3 was riding in. The 27 impact caused P-3 to be thrown from the wagon onto the roadway and the wagon to be knocked 28 over. P-3 came to rest in the#1 lane according to witnesses. The leading edge of the right front 29 bumper of V-1 struck P-2 in the Tibia/Fibula area of her right leg. P-2 slid up the right front portion 30 of the hood and her head slammed down onto V 1's passenger's side of the windshield near the 31 "A" pillar. This caused the windshield to shatter at that location. Several hairs from P-2's head 32 were embedded into the windshield at the same location. As V-1 was coming to a stop, P-2 was 33 thrown off V-1 and came to rest approximately 43.75 feet to the southeast or the AOI in the#2 34 lane and the bike lane. P-2 came to rest with her head facing the center median and her feet 35 were towards the sidewalk. 36 37 On several occasions following this collision, I observed numerous vehicles travel N/B on Village 38 Parkway to US Alcosta Blvd. The vehicles appeared to accelerate at what appeared to be a 39 normal acceleration rate. After observing these vehicles, I feel that P-1's statements were 40 consistent with the other vehicles I had observed regarding the time it takes a vehicle to travel 41 from Village Parkway to the crosswalk. 42 PREPARED BY I.D.NUMBER DATE REVIEWER'S NAME DATE R. E. RITTER SRO 1.15_ 01/09/2008 STA,rE OF CALIFORNIA NARRATIVEISUPPLEM AL PAGEA4 OF S� _ DATE OF INCIDENT IME NCIC NUMBER OFFICER I.D. NUMBER 01/0912008 1741 0740 SR015 08-135 1 All of the witnesses stated they never saw any vehicles with high beam headlamps on or with high 2 intensity headlamps. I was never able to identify or locate this vehicle that P-1 had described. 3 Area(s) of Impacts (AOI's): 4 The AOI's were measured by using the Crash Zone"software with the facfual diagram. 5 1. AQI#1 (V-1 vs. P-2) was located based on physical evidence as 17'11" 6 E/of the.ECL priblongation of Broadmoor Dr-and 1511 N1 of the SCL of Alcosta . Blvd. $ 2.AOI #2 (V-1 vs. P-3) was located based on physical evidence as 15'6" 9 E/of the ECL prolongation of Broadmoor Dr and 21'5" N/of the SCI_ of Alcosta 10 Blvd. �COpIEp FROM 11 . 12 Intoxication Narrative: ORIGINAL 13 1 conducted a DUI investigation and determined that.P-1 was not under the influence of an 14 alcoholic beverage and/or d.rug'(s;l at the time of this:collision. P-1 agreed to provide a voluntary 15 blood sample. Officer Molien transported P-1 to San Ramon Police Department where he 16 provided blood samples to Phlebotomist Jonathan Young. Phlebotomist Young collected four 17 vials of blood from P-1 at 1937 hrs, placed them into. a blood kit#41347 and gave the completed 18 kit to Officer Molien. Officer Molien collected the completed blood kit#41347 as evidence and 19 placed into the SRPD evidence refrigerator. 20 1 received faxed copies of the laboratory examination reports from the Contra Costa County 21 Sheriffs Office Forensic Services division regarding the results of the blood alcoholldrug test from 22 P-1. The results showed that the iblood alcohol was negative and the drug screen was negative. 23 24 Cause: 25 The primary cause of this collision is P-1 (Nodhal) driving V-1 in violation of CVC section 26 21950(a). CVC section 21950(a) states, "The driver of a vehicle shall yield the right-of-way to 27 a pedestrian crossing the roadway within any marked crosswalk or within any unmarked 28 crosswalk at an intersection. 29 30 Recommendations: 31 PREPARED BY I.D.NUMBER DATE REVIEWER'S NAME DATE R. E. RITTER SR015 01109/20'08 �,! . zc 1ITIATE: 17:41:03 01/09/08 CALL NUMBER: C0968 1TRY: 17:42:00 C T STATUS: CLOSED :SPATCH: 17:43:24 P RY UNIT: 25M10 ISCENE: 17:48:33 CASE NUMBER: SR080000O135 .OSE: 03:23:19 01/10/08 DISPOSITION: AIC :RE CALL: CF/080090008 and more )CATION: VILLAGE PW/ALCOSTA BL ,SRA (9499 VILLAGE PW/9125 ALCOSTA BL) )CATION COMMENTS: ,REA: SRA :AT: 72 MAP PAGE: 693H1 OLD TYPE: -MEDPD FINAL: .1713I ACCIDENT 'INJURY 4573 693H1 PRIORITY: 3 693H1 PRIORS ':42:00 SC25 ENTRY TEXT:ONE DRIVER LAYING ON THE GROUND. WHEN ,RP PASSED**** 2 OR 3 VEHS INVOLVED \COMP:VIA CHP/AL /PASSERBY/ OPT 1021 \LOC:CP \PH:925 577 1719 :42:00 SC25 PRIOR CP 1710 11/24/07 -8) 23:23:30 (5 MORE) :43:04 SC35 MISC .968, MY PR ADV ALCOSTA/IRON HORSE FOR FEM HIT BY VEH :43:04 SC25 UPDATE TYPE:1183-->MEDPD DTYPE:TC NO DETAILSC3-->MED POLICE NEED PRI:1P-->l :43:04 SC25 SUPP TEXT:CITZ TRYING TO DIRECT TRAFFIC #1 SMALL DK BLU SEDAN, #2 SMALL PICK UP #3 UNK DESC. . .UNK IF ALL THESE VEHS ARE INVOLVED, THESE ARE ALL OS. RP NOW SAYING HE DOESNT KNOW IF ITS A VEH ACCIDENT - STARTING FIRE :43:24 SC22 DISP-ENR 25Q1 .._.... :43:24 SC22 ID 25Q1 <SR501>MONTEMAY0R,TROY �!ORIGINAL � � F�,Q :44:02 SC22 BACK-ER 25Q1 25W3 :44:02 SC22 ID 25W3 <SR005>WEBB,l3RIC :44:15 SC25 MISC .968, SRVF STILL RINGING :44:55 SC22 BACKUP 25W3 25X2 :44:55 SC22 ID 25X2 <SR017>STEAVESON,ROBERT :44:57 SC25 MISC .968, SRVF ADVISS13D THEY ARE OS/FEMALE HIT BY VEH AT LOC :45:53 SC22 MISC 25Q1, ANY EXTEND OF INJURIES YET ? :46:25 SC22 BACKUP 25X2 25M8 25MIC 25M9 :46:25 SC22 ID 25M8 <SR024>SPRINGER,JAMES :46:25 SC22 ID 25M10 <SR015>RITTER,RANDALL :46:25 SC22 ID 25M9 <SR019>HEINBAUGH,DAVID :46:30 SC22 FNLTYPE FINALTYPE:MEDPD--:.1179 PRI:1-->1P :46:35 SC22 ENROUTE 25M9 :46:35 SC22 ENROUTE 25M8 :46:35 SC22 ENROUTE 25M10 :47:45 SC22 MISC 25Q1, COPIED ON SCANNER AIR AMB RESPONDING :48:10 S108 BACK-ER 25X2 25X3 :48:10 S108 ID 25X3 <SR0392-MOLIEN,ALLEN :48:33 7140 ONSCENE 25Q1 :49:13 5119 ONSCENE 25W3 :50:12 SC22 MISC 25Q1, NEED ALCOSTA/VILLAGE SHUT DOWN :50:25 SC22 MISC 25Q1, 1 CRITICAL HELICOPTER LANDING:AT FIRCREST /ALCOSTA :50:34 SC22 MISC 25W3, I HAVE VILLAGE/ALCOSTA SHUT DOWN :51:29 SC22 MISC 25W3, CTC NEED FLARES VILLAGE/ALCOSTA :52:45 5108 ONSCENE 25X3 :52:52 5110 ONSCENE 2SX2 „ :53:28 SC21 ONSCENE 25M10 :53:28 SC21 ONSCENE 25M8 :53:28 SC21 ONSCENE 25M9 :58:55 SC21 MISC 25M10, FEM ADULT BEING TRANSPORTED TO JMMC BY GROUND, CRITICAL. INFANT 1:5 GOING BY HELO TO CHILDRENS :06:44 SC34 MISCX ANON FEM RECD 2ND HAND INFO RE A FEM LAYING ON THE GROUND NR CAL HIGFs OFF BROADMOOR, UNK TIME FRAME, POSS RELATED TO THIS TC :09:17 SC32 CROSSREF CF/080090008 :10:45 SC21 CHGLOC 25W3 BROADMOOR/CAL HIGH :12:06 S119 ONSCENE 25W3 :15:15 SC21 MISC 25W3, UTL AT CAL HIGH :15:17 SC21 CHGLOC 25W3 VILLAGE, PW/ALCOSTA BL ,SRA :16:18 SC21 BACK-OS 25M10 25M6 :16:18 SC21 ID 25M6 <SR007>WHITE,DAVE :16:46 SC31 MISC .968, MARK LUKE W/ CITY OF SRA CALLED ASKING FOR LOC OF INC. 17:04 SC21 QUERY 25M10 Q_T/3UXW990 Page 1 Gam"" �.., .�.. a.ru•au,acv✓amu,itv�GIC1V aCn/m JJUlif SU-"lj-�`�' �� 1:25:56 SC21 RCONTACT 25M10 1:25:56 SC21 RCONTACT 25M8 1:25:56 SC21 RCONTACT 2SM9 1:25:56 SC21 RCONTACT 25Q1 :25:56 SC21 RCONTACT 25X2 ;:25:56 SC21 RCONTACT 25X3 ':26:12 SC21 RCONTACT 25M6 1:26:17 SC21 RCONTACT 25W3 ;:27:09 SC21 BACK-ER 25X3 2523 :27:09 SC21 ID 25Z3 <SR041>STEPHENS,JONATHAN ;:35:27 SC31 MISCX PER MARK LUKE. .SRA PUB WKS RESPONDING W/ REQ EQUIPMENT. ETA 20MINS. :37:10 SC21 ONSCENOK 25M10 :37:10 SC21 ONSCENOK 25M6 :37:10 SC21 ONSCENOK 25M8 :37:10 SC21 ONSCENOK 25M9 :37:10 SC21 ONSCENOK 2SQ1 :37:10 SC21 ONSCENOK 25X2 :37:10 SC21 ONSCENOK 25X3 :37:10 SC21 ONSCENOK 25W3 :38:11 S103 ONSCENE 25Z3 •:38:35 7140 MISC 2501, DL NAME/YING,SHEN AGE/58 :38:39 SC21 ONSCENOK 2523 :49:17 SC21 INSRVICE 25Z3 :02:54 SC21 TRANSPRT 25X3 2220 CAMINO RAMON ,SRA, SM 000 ,SGT AWARE. :06:22 SC21 RCONTACT 25X3 :06:44 SC35 MISC .968, BAD CALL :07:17 SC35 CROSSREF CF/080090009 :09:12 SC35 MISCX BAD TECH ETA 20 :12:13 SC21 ONSCENE 25X3, EM 5.4 :12:15 SC21 ONSCENOK 25X3 COP IED FROM :23:02 S110 INSRVICE 25X2 :23:06 SC21 CASE 25MIO SR080000013.5 Assigned ORIGINAL :27:11 5119 INSRVICE 25W3 :44:09 7140 QUERY 25Q1 Q L/3UXW990 :57:54 SC21 PREEMPT 25M6 :58:09 SC21 BACK-OS 25M10 2SM6. :58:09 SC21 ID 25M6 <SR007>WHITE,DAVE :58:15 SC21 ONSCENOK 25M6 :05:05 SC21 CHGLOC 25X3 VILLAGE PW/Al COSTA SL ,SRA, W/RESP SM SAME AS ENDING :05:30 SC21 ONSCENOK 25X3 •:07:01 SC25 MISCX FRIEND OF ROBERTO NODHAL AT STA/WASNT ASKED TO COME DOWN BUT HAS SOME QUESIONS AND WOULD LIKE TO OFFER HER FRIEND A RIDE HOME - RP ERIN STARKWEATHER IS AT THE FRONT DOOR :11:14 SC26 TRANSPRT 25X3 2220 CAMINO RAMON ,SRA :14:55 SC26 ONSCENE 25X3, EM 1.3 :14:58 SC26 ONSCENOK 25X3 :34:49 5108 INSRVICE 25X3 :42:06 SC26 MISC 2501, SAN RAMON TOW RESPOND WITH A FLAT SED AND AHVE THEM 98 US IN THE PLOT OF BLOCKBUSTER AND WE WILT., DIRECT THEM FROM THERE :43:12 SC26 CHGLOC 25M10 1601 YGNACIO VALLEY RD ,WCR . :44:22 SC26 MISC .968, SAN RAMON TOW ENR ETA OF LESS THAN 20 :31:27 SC26 ONSCENOK 25M10 :59:24 7140 CHGLOC 2501 2220 CAMINO RAMON ,SRA :02:34 SC25 RCONTACT 25Q1 :22:00 7140 ONSCENOK 25Q1 :38:01 SC33 MISC 25M9, ROADWAY IS OPEN :38:17 SC33 CHGLOC 25M9 MOTOR OFFICE :38:21 SC33 CHGLOC 25M8 MOTOR OFFICE :38:28 SC33 CHGLOC 25M6 MOTOR OFFICE :39:07 SC33 MISC 25M6, ROADWAY IS OPEN :44 :34 SC33 INSRVICE 25M10 :44:57 SC33 BACK-OS 25M6 25M10 :44:57 SC33 ID 25MIO <SR015>RITTER,RANDALL :45:14 SC33 TRANSPRT 25M10 VILLAGE PW/ALCOSTA BL ,SRA,. SM 2.4 :45:26 SC33 MISC .968, 25W1 ADVD :45:45 SC33 MISC 25M10, COURTESY TRANSPORT TO X-RAY :53:46 SC33 INSRVICE 25M6 :56:33 SC33 ONSCENE 25M8 :56:35 SC33 ONSCENOK 25M8 :05:25 SC33 TR-CMPT 25M10, EM 18.6 :09:18 SC33 ONSCENOK 25M9 :11:09 SC33 CHGLOC 25M10 MOTOR OFFICE Page 2 ��;,3 —IN'S-RV�lwCE 25M9 .-38-03 SC33 INSRVICE 25M8 ./10/08 1;23-30 7140 CHOLOC 2501 6001 NORRIS CANYON RD SPA 1:.25:10 7140 ONSCENOK 2501 1:35:18 7140 INSRVICE 2501 .:23:19 SC33 FNLTYPE 25MI0 FINALTYPE:1179-->17131 PRI:1P,-->3 :23:19 SC33 CLEAR 25MI0 AIC :23.19 SC33 CLOSE 25MI0 AIC 'ERATOR ASSIGNMENTS: SC25 66677 FERRER,.MARY SC35 64161 KENOYER,DEBBIE SC22 55421 'ENEA j KA AY $108 SR039 MOLII:-.N,ALLEN 7140 SR501 MONTEMAYOR,TROY 5119 SR005 WEBB,ERIC 5110 SR017 STEAVESON,ROBERT SC21 64163 WIT1-(,PATRICE SC34 49198 KEREMIAN,LINDA SC32 61781 AHERN,MIKE SC31 72529 BOUZEK,LATASHA S103 SR041 STEPHENS,JONATHAN SC26 64151 REZENDSS,KIM SC33 71876 MAYNARD,RENE COPIED FR�OIVI '. L j ORIGLMAL Page 3 DEPARTMENT OF CALIFORNIA HIGHWAY PATROL. �/r NOTE. CHP'FFJO IS ?URNISHED TO ALL PEACE VEHICLE REPORT OFFICERS BY THE CALIFORNIA HIGHWAY rATHOL CHP 180(Rev. 12-06) OPI 062 AOL _ REPORTING DEPARTMENT. I J N CODE DATE J TIME Of REPORT NOTICE OF STORED VEHICLE FILE NO. S 17A-m 04 Q Iz, 1 g.pg/ � ; bELIVEREO PERSONALLY ❑ 0$ 3 LOCATION TOWED I STOLEN FROM �/�1 ODOMETER READING VIN CLEAR IN SVS9�YES ❑ NO DATE J TIME DISPATCH NOTIFIED LOG NO. LIC.CU YEAR :1 MODEL � BODY TYPE COLORS IN SVS?LICENSE❑NO. NO MONTH/YEAR STATE` VEHICLE IDENTIFICATION NO. yENGINE NO. VALUATION BY ]OFFICER ❑OWNER W R v 9 1r..l�l=_., )1 V 114-1—014-1 IL17 3 p 1r)(1-300 ❑301-400044001+ ❑$ REGIISST�ERrE/D�OWNER '� r LEGAL OWNER -, , S:Qn1.2(�rr1v,�f 9 ysy'2— I_ J L _1 ❑ STORED 5k""IMPOUNDEID ❑ RELEASED ❑ RECOVERED-VEHICLE/COMPONENT TOWING/STORAGE CONCERN(NAME,ADDRESS.PHONE) STORAGE AUTHORITY I REASON Ste' R.4"4;..j •77.4}. Zj� Pc3/�Qc1� �SF j /2>14ii'1 `�z�$70. � ZZ ' Ste. S Cvel TOWED TO I STORED AT fj�,� AIRBAG? DRIVEABLE? VIN SWITCHED? �S P(.1?�i.. —95-1 /�.f'1rr!CKJ YES ❑ NO ❑ 1 J[j; 2 JS�VES ❑NO ❑JUNK I:]UNK ❑YES +lEg7NO CONDITION YES NO ITEMS YES NO ITEMS YES NO ITEMS YES NO TIRES DI I WHEELS CONTION WRECKED SEAT(FRONT) REGISTRATION CAMPER LEFT FRONT BURNED HULK par 431(c)VC SEAT(REAR) ALT./GENERATOR VESSEL AS LOAD RIGHT FRONT �— VANDALIZQD RADIO '>< BATTERY i FIREARMS LEFT REAR ENG.J T HANS.STRIP x TAPE DECK DIFFERENTIAL . OTHER RIGHT REAR MISC.PARTS STRIP TAPES TRANSMISSION SPARE BODY METAL STRIP ,hAl OTHER RADIO AUTOMATIC ur HUB CAPS SURGICAL STRIP pgr431(h)VC x IGNI'(i0N KEY MANUAL SPECIAL WHEELS REL.FASE VEHICLE TO: 1-1 RIO OR AGENT• (>J AGENCY HOLD ❑22850.3 VC GA E PRIN /AG�ORING EFIICLE(SIGNATURE) DATE!TIME NAME OFPERSON F AGENCY AUTHORIZING RELEASE I.D.NO. GATE ALLY CERTiFICAT10N: I,THE UNDERSIGNED,DO HEREBY CERTIFY THAT I AM LEGALLY +� AUTHORIZED AND ENTITLED TO TAKE POSSESSION OF THE ABOVE DC-SCRI89D VEHICLE. SIGNATURE OF PERSON AVTHORIZJNG RELEASE SIGNATURE OF PERSON TAKING POSSESSION Cl STOLEN VEHICLE I COMPONENT [J EMBEZZLED VEHICLE ❑ PLATE(S)REPORT DATE)l IME OF OCCURRENCE DATE!TIME REPORTED NAME OF REPORTING PARTY(RIP) DRIVER LICENSE NO.I STATE LAST DRIVEN OF VEHICLE DATE/TIME ADDRESS OF WP /TELEPHONE OF RIP l 1 CERTIFY OR DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF SIGNATURE OF PERSON MAKING REPORT THE STATE Or CALIFORNIA THAT THE FOREGOING IS TRUE AND CORRECT. REMARKS )LIST PROPERTY,TOOLS,VEHICLE DAMAGE,ARRESTS) DRIVER'S NAME ARRESTED I SECTION? REPORTED BY CARGO/TYPE? VALur;S ❑YES ❑NO ❑YES []NO ❑ BILL OF LADING ATTACHES FRONT ® LEFT SIDE RIGHT SIDES ® REAR TOP SIGNATURE OF OFFICER TAKKIIN,,.GwRE_PORRT I.D.NNO. )REOtIiRED NOTICES SENT TO F2E?Gi5I tItEO I"�YES~ D/1I E NOTIFIED ND LEGAL ONJNERS PER 22852..VC? OBJ'Ori99591 cI80 r,OG.lrp FATE Ur L;ALIrUKNIA _ CPARTMENT OF CALIFORNIA HIGHWAY PAI ROL �EH1Cl.E REPORT NOTE; CHP 180 IS FURNISHEDTO ALL PEACE: �jr�G N r, O OFFICERS BY THE CALIFORNIA HIGHWAY PATROL NP 180(Rev.12-06) OPI 062 :PORTING DEPARTMENT. LOCA CODE IA)!T�§OF REPORT ND0 EOF STORED KED PERSONALLY LE FILE NO. _ '& lLRAM�,J _ tom' _t� R ,1 , ❑ 08 13 5 )CATION TOWED!STOLEN FROM ODOMETER READING VIN CLEAR IN SVS? - YES ❑ NO DATE 1 TIME DISPATCH NOTIFIED LOG NO. )LGp 7A 13t:V0 AD M 1) 1 3Z0 LIC.CLEAR IN SVS? YES ❑ NO !AR MAK ! , �� MODEL� B�TYPE� n COLOR C'� LICENSE N0. - DONE MONTH 1 YEAR STATE . L� u !1J(J r4 & 3UYW 0) o R � 6A EHICLE IDENTIFICATION NIG.. I I 1, a ENGINE NO. V-ALUATION BY OFFICER OWNER =J1 I^i=t-�I_LV. ! 11 Q , . .� L 0'300 ❑301-4000 4001 + $ r REGISTERED OWNER �- LEGAL OWNER -� SAME AS RIOGORE — J STORED IMPOUNDED ❑ RELEASED ❑ RECOVERED VEHICLE COMPONENT 'OWING I STORAGE CONCERN(NAME,ADDRESS.PHONE) STORAGE AUTHORITY!REASON K'po.�I`�O ro2`P_u.R W�= 'PIPJ rnbel el0'�5- 8'�p -CQ�o �vG � (05l �b)_ 'OWED TO!S'1 D AT AIRBAG7 ORIVEABLE'I VIN SWITCH10? Q,��(;' (� YES ❑ NO n 1 g2 �QYES ❑NO ❑JUNK ❑UNK ❑YES X NO CONDITION YES NQ ITEMS YES NO ITEMS YES NO ITEMS YES NO TIRES T WHEELS:;-r CONDITION NRECKED SEAT(FRONT) REGISTRATION __x CAMPER _x LEFT FRONT 3URNED HULK{,nr 431(c)VC SEAT(REAR) ALT.I GENERATOR VESSEL AS LOAD RIGHT FRONT JANDALIZ£D RADIO BATTERY FIREARMS LEFT REAR _ ENG.!TRANS,STRIP TAPE DECK -1( DIFFERENTIAL _ OTHER 7C RIGHT REAR ^ MISC.PARTS SI'RIP TAPES -_ _ 'TkANSMiSSION _ SPARE- ~- BODY METAL 57 RIP I OTHER RADIO �[_ Al1TOMATI(: P HUH CAPS SURGICAL STRIP per 431(A)VC IGNITION KEY MANUAL ix I SPECIAL WHEELS RrLEASE VEHICLE TO: I X_ RIO OR AGENT ❑AGENCY HOLD 22050.3 VC GARAGE PRINCIPAL!AGENT STORING VEHICLE(SICNYAI'URE) JDATE/.TIME NAME OF PERSON!AGENCY AUTHORIZING RELEASE I.D.NO. uATE CERTIFICATION; I,THE UNDERSIGNED,DO HEREBY CERTIFY THAT I AM LEGALLY Df cek Ram- =`r' lSl�o 145 y a-(`d tJ AUTHORIZED AND ENTITLED TO TAKE POSSESSION OF THE ABOVE DESCRIBED VEHICLE. §IGIJAVR OF ' SON T ORIZINQ RrLEASE SIGNATURE OF PERSON TAKING POSSESSION ❑ STOLEN VEHICLE 1 COMPONENT ❑ EMBEZZLED VEHICLE ❑ PLATE(S)REPORT DATE I TIME Or OCCURRENCE DATE 1'fIME IiEPORTED NAME OF REPORTING PARTY(RIP) DRIVER LICENSI:NO.I STATE LAST DRIVER OF VEHICLE DAI'E 1 TIME ADDRESS OF RIP /TELEPHONE OF RP l 1 I CERTIFY OR DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS DI' SIGNATURE OF PERSON MAKING REPORT 'THE:STATE OF CALIFORNIA THAI'l HE FORECOINC9 IS TRUE AND CORRiECT. REMARKS (LIST PROPERTY,TOOLS,VEHICLE DAMAGE.ARRESTS) OHIVER'.S NAME ARItESTF.D/SECTION? REPORTED BY CARGO!TYPE? VALUE S l l ❑YES ��NO p,, ��r� -�J ❑YES ❑NO ❑ HILL OF LADING ATTAGMED SQL L"LLC(. (MSS L?A161�A�I.1�.�_JT2�Vi/1�d ez rvi l- l�rr;, rj T47,h (J -7z���.� �� >�`�• oP . �h� r�Jo n�o;�3��o,.>�._1��3�off.__ -- ��—� FRONT LEFT SIDE RIGHT SIDE REAR TOP SIGNYTlr4C OF F GEN TAKING REPORT 1.0.NC), VIS R RrEQIJIREO NOTICES SENT'TO ItEOtSTERt:D YES I7ATF NOTIFIEO AND LEGAf,CAAINERSPL-Ft 22652 VC? NO c�' ?1 OiP 0(i OT)S'J 1 ci(i(1_r00,1�p • �J/� 7 c �.s �.✓raJfr _ ci < �o,n„rTlprd IWA San Ramon Police Dem. Photo Data Record DR#08-135 l Date: 08 Taken By. titer#15 pewCcanwm: .Film Location: Sony Cibet=shot 256 mg card Alcom Blvd @Broa&mrDr Shot No. Description of Photo Dist. 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ADDRESS "'CITY PHONE# .. :.........:.,....:.:..::.....:. ......:... PROPERTY CODE: FP=FOUND PROPERTY E=EVIDENCE SW=SEARCH WARRANT SK=SAFEKEEPING SR=STOLEN/RECOVERED S=STOLEN DV=DOMESTIC VIOLENCE(12028.5) DS=DESTRUCTION WI=5150/8102 LST=LOST PRO-PRINTS REOURIED H&S=DRUGS PROPERTY/EVIDENCE: Describe in detail PROP.comm MAKE MODEL COLOR $VALUE OTHER DESCRIPTION r— 1Bul" SERIAL NUMBER FCN NUMBER PROP.CODE MAKE MODEL COLOR. $ VALUE OTHER DESCRIPTION . CO FROM ` SERIAL NUMBER PROP.CODE MAKE MODEL COLOR $VALUE OTHER DESCRIPTION SERIAL NUMBER r FCN NUMBER PROP.CODE MAKE MODEL COLOR $VALUE OTHER DESCRIPTION i SERIAL NUMBER FCN NUMBER PROP.CODE MAKE MODEL COLOR $VALUE OTHER DESCRIPTION SERIAL NUMBER FCN.NUMBER PROP.CODE MAKE MODEL COLOR . $VALUE OTHER DESCRIPTION SERIAL NUMBER FCN NUMBER ADDITIONAL COMMENTS/SPECIAL INSTRUCTIONS: RECEIVING OFFICER & ID#1 CITIZEN SIGNATURE DATE r P, ZT Tat 16 PAGE t OF IMPORTANT: CITIZENS REFER TO BACK PAGE FOR NOTIFICATION AND RIGHTS DISTRIBUTION: WHITE COPY TO PROPERTY. YELLOW TO CITIZEN STATE OF CALIFORNIA '/ NARRATIVEISUPPLEM TAL PAGEq OF 54 DANE OF IRECIDENT WTIME N I NUMBER OFFICER I.D. NUMBER .� 1-9-08 1742 0740 15 48.135 l SUPPLEMENTAL REPORT- 2 On 1-9-08 at approximately.1742 hours, I heard San Ramon Valley Fire Captain Mark Anderson 3 advise..San Ramon Valley. Fire Dispatch via radio that.an unidentified citizen had contacted .4 personnel at Fire.Station 39 to advise-them of.a collision involving a pedestrian at the intersection 5 of Alcosta Blvd and Broadmoor Drive. I responded from the intersection of Alcosta Blvd and 6 Summerwood Loop and arrived at approximately 1748 hours. .. : .. .. .. .. .: ..... .... . 8 Upon my arrival, V-1 vn as stopped in the eastbound #2 lane of Alcosta Blvd east of the intersection 9 of Broadmoor Drive. P-1 was standing on the south sidewalk of Alcosta Blvd with an unidentified 10 off-duty Concord PD detective and identified himself with a valid California driver license. P-1 told I I me he was the driver of V-1 at the time of the collision. 12 13 P-2 was laying in the eastbound bike lane endi south curb with her feet closest to 14 the curb and her head in a northerly dire ti G,� fere rendering aid to P-2 and she 15 appeared to be unconscious. P-•2 had a la ge ~a�9�blo4d about her head and an obvious 16 injury to her right leg. 17 18 P-3 was inside of San Ramon Valley Fire Paramedic 39 being held by a paramedic.. P-3 was 19 crying and appeared to have several abrasions on his body. 24 21 After the scene had been stabilized and the injured parties transported to the hospitals, I tools a 22 series of digital photographs of the scene and associated evidence. Additionally, I had San 2; Ramon Valley Fire position Truck 34 west of the scene and extend the telescoping ladder to a 24 height of thirty-five feet: I then took aerial photos of the intersection. All of the photographs were 25 submitted to San Ramon PD records per department policy. After I completed photographing the 26 scene, I collected the following evidence: 27 28 Item 5—Gray hair band 29 Item 10 — Pink comforter and salmon pillow 30 Item 11 — Red pillow 31 Item 12— Blue shorts 32 Item 15—White blanket 33 Item 17 -White pacifier 34 item 18 — Red Roadmaster wagon 35 Item 24—Gray Champion left shoe 36 Item 25— Sears Garage door remote control opener 37 Item 31 —Grill from V-1 38 Item 36 — Bumper cap from V-1 39 Item 37—Gray Champion right shoe 40 Item 41 —Samsung cellular telephone 41 Item 42 —Clump of hair from windshield of V-1 42 PREPARED BY I.O.NUMBER DATE R VIEWER' 04 AME DATE T.Montemayor 501 1.10-08 j_I L/ STATE OF CALIFORNIA NARRATIV�E/SU_PPLEM TAL PAGE J .OF DATE OF INCIDENT WTIME NC-1C NUMBER OFFICER I.D. NUMBER 1-9-08 1742 0740 15 08-135 I The above listed items were.placed into evidence at San Ramon PD. 2 3 5 9 10 H 12 13 14 15 16 17 COPIFD�FROM 18 ORIGINAL 20 21 23 24 25 26 27 28 29 30 31 32 34 35 - 36 37 38 39 40 41 42 PREPARED BY 1.0•NUMBER DATE REVIEWER'S NAME DATE T.Montemayor 501 1.10.06 a yt Sanamon Police Department— Photo Lo P 9 Case#08-135 Camera Make:Canon Model#:A560 Camera#: 408 Photos Taken By:T.Montemay-Or Date: 1-9-08 1 Time: 1749 Photo # Photo Sub'ect Location Distance 1 P-2 atpoint of rest Alcosta Blvd 6' 2 Area of impact Alcosta Blvd 4' 13 " Debris from wagon Alcosta Blvd 8' 4 Wagon debris in westbound lane Alcosta-Blvd 5' 5 Wagon debris in westbound lane: Alcosta Blvd 5' 6 Wagon debris in westbound lane Alcosta Blvd 5' 7 Wagon debris in westbound lane Alcosta Blvd 5' 8 Wagon debris in westbound lane Alcosta Blvd 6' 9 Item 11 Alcosta Blvd 8' 10 Item 17 COPIED FROM Alcosta Blvd 10' 11 Item 24 L (costa Blvd 10' 12 Rear of V-1 Alcosta Blvd 10' 13 Item 17 Alcosta Blvd 4' 14 Wagon at point of rest Alcosta Blvd 6' 15 #1 lane beside V-1 Alcosta Blvd 8' 16 Rear of V-1 Alcosta Blvd 6' 17 Blood and clothing Alcosta Blvd 6' 18 P-2's pointof rest Alcosta Blvd 4' 19 P-2's point of rest Alcosta Blvd 4' 20 Blood puddle Alcosta Blvd 4' 21 Right rear fender of V-1 Alcosta Blvd 6' 122 Right side doors of V-1 Alcosta Blvd 6' 23 Right front fender of V-1 Alcosta Blvd 6' 124 V-1 windshield Alcosta Blvd 4' 25 Item 36 Alcosta Blvd 4' 26 Right front bumper of V-1 Alcosta Blvd 2' 27 Right front hood of V-1 Alcosta Blvd 2' 28 Wagon wheel next to V-1 Alcosta Blvd 4' 29 Waqon wheel in center divide Alcosta Blvd 4' 30 Left side of V-1 Alcosta Blvd 15' 1 31 Left front fender of V-1 Alcosta Blvd 6' ' 32 Front of V-1 Alcosta Blvd 6' 33 Front bumper of V-1 Alcosta Blvd 3' 34 Front bumper of V-1 Alcosta Blvd 3' 35 Front bumper of V-1 Alcosta Blvd 3' 136 Headlight and hood of V-1 Alcosta Blvd _ 2' INSTRUCTIONS:THIS PHOTO LOCI MUST BE COMPLEIgD FOR ALL PHOTOS ATTACHED TO YOUR REPORT 1.1� • 0 San Raman Police Department — Photo Log Case#08-135 Camera Make: Canon Model :A560 Camera#:408 Photos Taken By:T.Montemayor Date: 1-9-08 - Time: 1749 { Photo# Photo Subject. Location Distance 37 Windshield of'V-1 Alcosta Blvd 5' 38 Hair embedded in windshield Alcosta Blvd 2' 39 Passenger door mirror Alcosta Blvd 2' 40 V-1 A pillar Alcosta Blvd 3'.. 41 Ri ht front fender.of V-1 Alcosta Blvd 8' 42 V-1 at point of rest Alcosta Blvd 20' 43 Item37 Y _ Alcosta Blvd 5' 44 V-1 and-crosswalk COPIED Fo to Blvd 20' 45 V-1 at point of rest OgIGINA Zta co to Blvd 15' 46 Wagon at point of re ---- Blvd 4' 47 Wa on at point of rest Alcosta Blvd 4' 48 Item 15 . Alcosta Blvd 3' 49 Wagon at point of rest Alcosta Blvd 6' { 50 Bedding and wa on Alcosta Blvd 6' 51 Bedding and wagon Alcosta Blvd 6' 52 Front seats of V-1 Alcosta Blvd 4' 53 V-1 Steering iheel and dash Alcosta Blvd 4' 54 V-1 windshield and mirror Alcosta Blvd 4' � 55 V-1 windshield Alcosta Blvd 4' 56 Overview of scene Alcosta Blvd 25' 57 Gouge and plritic at AOI Alcosta Blvd 4' 58 Scuff marks at AOI Alcosta Blvd 4' 59 Item 5 Alcosta Blvd 4' 60 Item 6 Alcosta Blvd _ 4' 61 Item 7 Alcosta Blvd 4' fit Item 8 and 9 Alcosta Blvd 4' 63 Wa on debris Alcosta Blvd 6' 164 Item 11 Alcosta Blvd 4' 65 Item 12 Alcosta Blvd 4' - 66 Item 13 Alcosta Blvd 4' 67 Item 14 Aicosta Blvd 4' 68 Item 15 Alcosta Blvd 4' 69 Item 16 Alcosta Blvd 4' 70 Item 17 Alcosta Blvd 4' 71 Item 18 Alcosta Blvd 6' 72 Item 19 and 20 Alcosta Blvd 14' Y� INSTRUCTIONS:THIS PHOTO LOG MUST BE COMPLETED FOR ALL PHOTO$ATTACHED TO YOUR REPORT '4fv . a � y� San Ramon Police Department - Photo Log Case#08-135 Camera Make:Canon Model#:A560 I Camera#:408 _Photos Taken By:T.Montemaycr Date: 1-9-08 1 Time: 1749 Photo# Photo Subject Location Distance 73 - -Item 21 _ - Alcosta Blvd 4' 74 Item 22 and 23 Alcosta Blvd 6' 75 Aerial overview of scene Alcosta Blvd 35' 76 Aerial overview of scene Alcosta Blvd: - . . 35' 77 Aerial overview of scene Alcosta Blvd 35' 78 Aerial overview of scene Alcosta Blvd 35' 79 Aerial overview of scene Alcosta Blvd 35' 80 Aerial overview of scene Alcosta Blvd 35' 81 Item 24 Alcosta Blvd 4' 182 item 25 Alcosta Blvd 4' 83 Item 26 Alcosta Blvd 4' 84 Item 27 Alcosta Blvd 4' 85 Item 28 - Alcosta Blvd 4' 86 Item 29COt Alcosta Blvd 4' 87 Item 30 SRO Alcosta Blvd 4' 88 Item 31 Alcosta Blvd 4' 89 Item 32 Alcosta Blvd 4' 90 Item 33 Alcosta Blvd 4' 91 Item 34 Alcosta Blvd 4' 92 Item 35 Alcosta Blvd 4' 93 Item 36 Alcosta Blvd 4' 94 Item 37 Alcosta Blvd 4' 95 Item 38 Alcosta Blvd 4' 96 Item 39 Alcosta Blvd 4' 97 Item 40 Alcosta Blvd 4' 98 Eastbound view from #2 lane Alcosta Blvd 215' 99 Eastbound view from #2 lane Alcosta Blvd 215' 1 100 Driver's floor mat Alcosta Blvd 4' 101 Interior rear view mirror Alcosta Blvd 2' 102 Front passenger seat Alcosta Blvd 4' 1 103 V-1 left front fender Alcosta Blvd 4' 104 V-1 left front fender Alcosta Blvd 2' 105 V-1 left front fender Alcosta Blvd 4' 106 V-1 left front bumper Alcosta Blvd 6' 107 V-1 fight front bumper Alcosta Blvd 6' 108 V-1 right front hood Alcosta Blvd 4' INSTRUCTIONS:THIS PHOTO LOG MUST DE COMPLETED FOR ALL PHOTOS ATTACKED TO YOUR REPORT San Ramon Police Department — Photo Log Case#08-135 ' Camera Make: Canon Model#:A560 Camera M 408 Photos Taken t3y:T.Montemayor Date: 1-9-08 Time: 1749 Photo # T Photo Subject Location Distance 109 V-1 left front fender Alcosta Blvd 4' 110 V-1 passenger side mirror Alcosta Blvd 2' ill P-2's blouse and gloves Alcosta Blvd 4' 112 P-2's dress Alcosta Blvd 4' 113 P-2's sweater Alcosta Blvd 4' 114 P-2's jacket Alcosta Blvd 4' 115 East center divide and sin Alcosta Blvd 8' 116 West center divide and sin Alcosta Blvd 8' 117 Eastbound lanes Alcosta Blvd 1 S' 118 Eastbound lanes Alcosta Blvd 15' 119 Eastbound lanes Alcosta Blvd 20' I f:RQ �. M 1 i INSTRUCTIONS:THIS PHOTO LOG MUs'r BE COMPLETgO FOR ALL PHOTOS ATTACHED TO YOUR REPORT I STATE OF CALIFORNIA )r `/a� e` /WWv 609 W NARRATIVE/SUPPLEMI KAL • PAGE I OF DATE OFINCIDENT —MPTIME NCIC NUMBER OFFICER I.D. NUMBER 1-9-08 1742 0740 15 08-135 1 SUPPLEMENTAL REPORT: 2 On 1-9-08 at approximately 1742 hours, I heard San Ramon Valley Fire Captain Mark Anderson 3 advise San Ramon Valley Fire Dispatch via radio that an unidentified citizen had contacted 4 personnel at Fire Station 39 to advise them of a collision involving a pedestrian at the intersection 5 of Alcosta Blvd and Broadmoor Drive. I responded from the intersection of Alcosta Blvd and 6 Summerwood Loop and arrived at approximately 1748 hours. T. 8 Upon my arrival, V-1 was stopped in the eastbound #2 lane of Alcosta Blvd east of the intersection 9 of Broadmoor Drive. P-1 was standing on the south sidewalk of Alcosta Blvd with an unidentified 1 10 off-duty Concord PD detective and identified himself with a valid California driver license. P-1 told I 1 I me he was the driver of V-1 at the: time of the collision. 12 13 P-2 was laying in the eastbound bike lane perpendicular to the south curb with her feet closest to 14 the curb and her head in a northerly direction. Paramedics were rendering aid to P-2 and she 15 appeared to be unconscious. P-2 had a large amount of blood about her head and an obvious i 16 injury to her right leg. 17 18 P-3 was inside of San Ramon Valley Fire Paramedic 39 being held by a paramedic. P-3 was 19 crying and appeared to have several abrasions on his body. 20 21 After the scene had been stabilized and the injured parties transported to the hospitals, I took a 22 series of digital photographs of the scene and associated evidence. Additionally, I had San 23 Ramon Valley Fire position Truck 34 west of the scene and extend the telescoping ladder to a 24. height of thirty-five feet. I then took aerial photos of the intersection. All of the photographs were 25 submitted to San Ramon PD records per department policy. After I completed photographing the 26 scene, I collected the following evidence: 27 28 Item 5-- Gray hair band 29 Item 10 —Pink comforter and salmon pillowl FROM 30 Item 11 — Red pillow COPIBC 31 Item 12— Blue shorts ORIGINAL 32 Item 15—White blanket 33 Item 17 —White pacifier 34 Item 18— Red Roadmastee waggon 35 Item 24— Gray Champion.left shoe 36 Item 25— Sears Garage door rernote control opener 37 Item 31 — Grill from V-1 38 Item 36 — Bumper cap from V-1 39 Item 37 — Gray Champion right shoe 40 Item 41 — Samsung cellular telephone 41 Item 42 — Clump of hair from windshield of V-1 42 PREPARED BY I.D.NUMBER DATE RELVIEwER' ARAE DATE T.Montemayor 501 1-10-08 ��\k STATE OF CALIFORNIA NARRATIVEISUPPLEM TAL PAGE ?-OF DATE OF INCIDENT IWIME NCIC NUMBER 'OFFICER I.D. NUMBER 1-9-08 1742 0740 15 08-135 I The above listed items were place=d into evidence at San Ramon PD. 2 3 4 , 5 G 9 10 11 12 13 14 15 lb 17 18 19 20 21 LORIGINLAL II✓D FROM ...I 22 23 24 25 26 27 28 79 30 31 32 34 35 36 37 38 39 40 41 42 PREPARED BY I.D.NUMBER DATE REVIEWER'S NAME DATE T.Montemayor 501 1-10-08 1t,0 ❑ Continuation SAN RAMON POLICE DEPARTMENT-CA0000 Beat 2 Supplemental 2222 Camino Ramon,San Ramon,CA 94583 [3 Arrest[]Gun [3 Use of Force 1.OR No. 2.City Code 1 3.crirxmK;iassiricatic-n 4.Detail 1. 17131 5.Reclassi 08-135 SR/72 T/C-Injury(17131) 2. tication 0. m im Na.. ,, ateng. eport 8.Employee No. ❑ Ying,Shen 01/09/2008 39 9.Address I Location or Occurrence 1 uspectsame Alcosta BI.@ Village Parkway San Ramon Nodhal, Roberto 11.Property Description: Impounded,Recovered.Found,Lost,Stolen-Item Number,Article,Quantity,Brand/Maka/Manufacturer's Model Number,Serial Number,Miscellaneous Description,Location WhereTaken,Value,Include Total Loss-LIST IN FOLLOWING ORDER:A Currency,Notes:B Jewelry;C Furs;D Vehicles;E)Office Equipment;F Radio,TVs etc.:G Firearms;H Household Goods;I)Misc. Recovered Prope 13.Narrative/Statements na This is a supplemental report to officer Riter's original report. On 1/9/2008 at about 1742 hours, I responded to a report of a vehicle vs, pedestrian at the above listed location. After assistance with traffic.. control at the .per-imeter, I was requested to respond to the scene of the accident. At about 1900 hours, at the request: of Officer Ritter I provided transportation to San Ramon Police Department for Roberto Nodhal, the driver of the car involved in the accident. Nodhal agreed to assist SRPD in the: investigation of the accident by providing a voluntary blood test on his own free will. I requested a blood technician to respond to SRPD for the blood draw. At about 1935 hours blood technician J. Young arrived at SRPD. Prior to the blood draw, I advised Nodhal the blood test he was about to undergo was voluntarily and on his own free will. The admonishment was recorded on the PE, in-house video system. At 1937 hours, I watched as J. Young drew four vials of blood from Nodhal's left arm using blood kit #41347. Nurse Young then sealed the vials in the kit,. in my presence and gave the kit to me. I placed the kit into the evidence cooler at SRPD. Nodhal was transported back to the scene of the accident. COPD FROM, ORIGINAL 14.Distribution 15.Additional Routing ❑ Chief ❑ captain ❑ Bureau Commander TRAFFIC DIVISION 16.Reporting Officer(Print) 17.Datefrime Written 18.Dispo ❑ Administration Lt. IN Investigations ❑ Narcotics Molien,A. 01/10/2008-0600 CLR ❑ Property ❑ Crime Prevention ❑ SRO 19. proving supv(Print) upv o. 1.Date age SGT E WEBB 5 011008 1 of 1 wo -sin e0 PON_ LAW OFFICES OF MEISEL & KRENTSA ' 02 1p 565 COMMERCIAL STREET,THIRD FLOOR � MAO ED FROM ZIP CODE 92690396 kPR 10 4111 SAN FRANCISCO,CALIFORNIA 94111-3033 1 ! 4 51L pOSTAL SERVICE 2000 LASE 107 jUNE RECEIVED oard Of Supervisors (_._ `_ Clerk Of the B Costa A >� 4 �nnq County of.Contra Ro s, ,106 I_ Street, CLERK scaRU C= Martinez, CA 94553 COW Ra COSTA Martinez, CLAiM HOARD OF' SUPERVI.SO11S OF CONTRA COSTA COUNTY BOARD ACTION: mm Claim Against the County, or District Governed by .) the Board of Supervisors, Routing, Endorsements,. ) NOTICE TO CLAIMANT and Board Action. All Section references j The copy of this document mailed to California Government Codes. D i- you is your notice of the action taken on your claim by the Board of APR 1 8 2008M Supe-visors. (Paragraph IV below), ^^n' n COUNTY COUNSEL given Pursuant to Government Code AMOUNT M& MARTINEZ CALIF. Section 913 and.915.4. Please note all n• f_ "Warnings". CLAIMANT: 'oy ron. 1'� �2i R-�-C � 1�14gQ( ATTORNEY: ►t k DATE RECEIVED: A ADDRESS:,%' n Qtftf_-Atli BY DELIVERY TO CLERK ON: _ BY .MAIL POSTMARKED: AVI- its FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. JOHN CUL A Dated: W . 2 � By: Deputy � u [I. FROM: County Counsel TO: Clerk of the Board of Supervisors (44his 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: 7 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, 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 this date. � P Dated: b JOHN CULLEN, CLERK, By eputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6) niontlis from the date this notice was personally served or deposited in the niail 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 iii»mediately. *For Additional Warning See Reverse Side ofTliis Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I. ani n6v, and at all times herein mentioned, have been a citizen of the United States, over age 18; aid 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 claim as shown above. Dated: o JOHN CULLEN, CLERK B Deputy Clerk CLAiM HOARD OF SU:PERVISO.RS OF CONTRA COSTA COUNTY BOARD ACTION: 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:�,J 11ML Section 913 and 915.4. Please note all )' "Warnings". CLAIMANT: r.cln ATTORNEY: YV(� . DATE RECEIVED: ADDRESS:)) Q-a ft- ly) .pptc;0r) BY DL-LIVERY TO CLERK ON:. BY .MAIL POSTMARKED: t'fp (I FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. JOHN CUL Clerk Dated-AmuL le 2Ec,8 By: Deputy ( t;fliP�lc+�i��Lc - Ceti; 11. FRO : County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The' Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: By: Deputy County Counsel 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). 1V. BOARD ORDER: By unanimous vote of the Supervisors present.: ( ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for. this date. Dated: 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 nail to file a court actin 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. tf you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side ofThis Notice. AFFIDAVIT OF MAILING t declare under penalty of perjury that :f. am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today .1 deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: JOHN CULLEN, CLERK By Deputy Clerk i 1To C e r V\. APR 1 8 2008 CLERK;BOARD OF SUPC�sV!SOR£i COPdTRACOTACO. - 1 V ova( .iN\6,- li—m Lrnr r�p�,J j�v IM\,AC i M60e,r Ne-6,se Se��. 'me n a Via ccS 'no (,c re 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 RECEIVED Against the County of Contra Costa or ) APR 1 S 2008 District) CLERK BOARD OF S!'"DaRVISORS (Fill in the name) ) CONTRA COSTA CO. ) The undersigned claimant hereby makes 4,lairn against the County of Contra Costa or the above-named district in the sum of$ p��,an in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) \\ �ove�nbcc- 3��� a��7 a� �:y5�.r, . 1`(ov�t�•bcr 1 1,E c�.0��� �� d �ovombe� I�'i ) 2. Where did the damage or injury occur? (Include city and county) ltil4r�icez tie-�c��iot. fo.c'�1�3.� � ur, iV1�r3�c�:z-. CO%_Nkra, . (&S�* Cov►4y. 3. How did the damage or injury occur? (Give full details; use extra paper if required) (Sa E PAGiL 3 t=ort Fou. OeTaLs 8t^ evet4vs) 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? j-lacaxs� � �'►oliceovts t CQ9PCvAkut,�J acrL�ar Ass&' tA4 orad Ba�w � Lr4mk%Nb,1Tea�ac�s-� T>1r�a�S� CAA to.\\urc +iz. tRi'eNCt\e +0 AA.csc *A-s- An4 -�i4,,9 fa\sc. �r��a�h�s ►�.c�o�t 5 What are the names of county or district officers, servants, or employees causing the damage or injury? .0e�"ij NorVeNI) �)epuAy 3OheS� Depu+y l.��es, 44nA 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.)Lf VP,` a�� US�na\ ��h\s�.�,�c,�� Vii\a�to�s of \Jne rCW66 E m OA-4 m� 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) i--\--, ` Nocvel\s t\c-V%ons a>OOo,o�p�°' , 17e)�4fy tires beexvy Loec.s tai\ucei-o in3crvcre SOa 000,'�'�. S��_ j�a�o��o,Yl Pius J3h�CGt�ak� (Cw%c-� \1 8. Names and addresses of witnesses doctors, and hospitals: Mark f> Kc (So wl ere icn ��L � I�a�le �r'iifsh 3330-7dnS A\ic 4C, 00-V, h�) MCAAk 3.& 4, SV_ R\elnn�ont�� �• °1�ah� l;rno�},y . w;111D'v's)°I01 Cavr� Sk. Me�c`�\nc Cq`�Jt1r� ' iMm-k .tar end �+� `Dot. 9. List t e expenditures you mane do account of s accede 1 r injury: DATE TIME AMOUNT ■■mmrmmmmmName cmmm■mnow woman mrmmmmmmMEN MEN rrmmmrmmi 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 ) Cl ' is Signature) Sb rt e AT,S�4e �A,D�N (Address) -- J Telephone No. )Telephone No. among man 1059095521 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. ■■mmmmmmOmni mmmmmmmmMORE mmmmmemmmmmmean museum amrmmmrrmwas mmmmml NOTICE: Section 72 of the Penal Code provides: Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city, or district board or officer, authorized to.allow or pay the same if genuine, any false or fraudulent claim, bill, account voucher, or writing, is punishable-either by imprisonment in the County jail for a period of not more than one year, by a fine of not exceeding one thousand dollars ($1,000.00), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000), or by both such imprisonment and fine. � T �e .�drr,o��_ �r 1Y1.�viC'�I OriLur'? l ''ve ©+ YY\y viS� 1 eer,- w%S +Vrnea . o -- - rnner9en�.l. .�ti�1�� of-ger. _l�. e`au�y �Uos .le,� osKe� Cor� r ou gh �he e\ao� jf�)ok L Y,^y = Oct ��m- �/�s�-�-, a see - - I%X XAP s� ,�e Z__ was \�ov<se.a on . `. module. �CP�*y Nocve�\ WO Vea away. )C u-� ._ orve\� come 36,(- , -6 eSCor�e� rNe AJ o, �\.S\ 5 .rozrr,. �OU (�o �1p ._ �►-�- +V- o,A- 6i1 or\ M"PAeSS .\JOU'rC �o`c4 .hn�'. _ wire. _orgy �01' ery S> 1 Uf,(lb -CA 0 ) h4 �vorvc\» came +6 --- - LVe rv" . 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Gave y ' . r 10 wl—,��",��-N-Q-O\ub�l \ P o�ryL ='1 , _ W-r\ �a,'�('(1 _�1as c�.\�a ''lofi NAVA ►h_rQ._ �` i _ CONTRA COSTA DETENTION FACILITIES Incident Report incident#: 7007328 Incident Dt/Tm: 11-11-2007 2131 Incident Type Code: 006 Disruptive Conduct Additional Code 2 : 053 Threatening Staff Member . Additional Code 3 : 021 Insubordinate/Insolent Participants: Name (L,F,M,S): CIN/Book#. Facility Mod Sect Rm Bed Inv PIKE, MARK C. 70187886/2007002310 1 B A 28 B I SHIELDS, BYRON P: 70162771 /2007016727 1 Q A 13 B V Incident Occurred: Fac: 1 Mod:1B Sect: Location: B module, room 28 Officer:71142, NORVELL Submitted Dt/Tm: 11-12-2007 0038 Update By: 52882, RAFANAN Update Dt/Tm: 11-12-2007 0359 Supervisor: Approval Dt/Tm: Use of force? N CS Violence? N Inmate Violence? N Contraband? N . Facility Damage? N Disciplinary? Y Hearing Required? Y Action Taken: Approval Action: Inmate became insolent to.the point of wanting to fight with staff. Inmate movements toward jumping off the top teir then said he wanted to throw himself down the stairs. Sgt called. Taken to intake. . Facility: 1 Page 1 of 3 Printed: 11-12-2007 0401 5271 MAIN Printed By: 52882, RAFANAN CONTRA COSTA DETENTION FACILITIES Incident Report Incident Information: Entry Dt/Tm: 11-11-20072142 Entered By: 71142 , NORVELL Updated By: 52882 , RAFANAN Narrative: On Sunday, 11/11/2007, 1 was assigned to B module as the primary deputy. While making my first room check of . the evening at approximately 1830 hours I stopped at room 28 which houses I-Shields, Byron (Bk#2007016727) and I-Pike, Mark (Bk#2007002310) to speak with I-Shields about why he had problems following directions during day shift. He told me that he was going through a tough time in his personal life. I informed him though he may have problems in his personal life that it stili does not give him the right to not follow directions. I told I-Shields that those actions would mean that he needed to leave the module. I-Shields responded, "Fuck you! I won't go anywhere!" I asked for]-Pike to come with me down stairs so I could secure him in visit room#2 due to the fact that I-Shields appeared agitated and would put up a fight. Upon my return to room 28 I-Shields had his shoes on and was leaning against the wall with both of his hands on the chair in his room. I told ]-Shields that I would like him to put the chair down and turn around. ]-Shields said, "Fuck you! Let's do this!" I then told him to place the chair on the ground and get on his knees. An unknown inmate yelled to I-Shields to put the chair down. I-Shields placed the chair on the ground and laid face down on the ground. I handcuffed I-Shields, checked for tightness then double locked the handcuffs. Once I got I-Shields to his feet I was going to place him in a rear wrist lock to escort him downstairs to visit room 1. ]-Shields twisted his body to get out of the hold and ran towards the railing of the top tier saying that he was going to throw himself off the tier and tell everyone I did it. At this point, we were out of the room and in sight of the inmates in rooms 20-26. 1 advised I-Shields that he would not get far with that claim due to the fact that my hands were in the air, clearly not touching him, and inmates were able to see that. Once he looked around and saw inmates looking through the window in the doors he decided that jumping off the top tier was not in his best interest. Because of his actions I placed my left hand under his right arm on his back which made him bend at the waist. I felt that I would have better control of his movements in case he decided to throw himself down the stairs. I escorted him to visit room 1 without incident. As I was shutting the door to visit room 1 I-Shields said, "Fuck you! Take the cuffs off and we can go!" I asked him to please take a seat. He complied. I took I-Pike back up to room 28 and had him collect the belongings of I-Shields and place them in a plastic bag. I called Sergeant Bailey and informed her of the situation. I returned to visit room 1 to check on I-Shields. He was pacing back and forth. Once he saw me he stated, "I guarantee I can beat you. You're lucky that you put handcuffs on me, otherwise I would have taken you out." He then told me if he had done what he was thinking, he should have done it and it would have taken about 30 officers to save me because he would have beaten me to the ground. I-Shields told me he is a trained fighter and the way he feels now if he has to take an extra charge of assaulting an officer then that is ok. A short time later I returned to visit room 1 to check on I-Shields. He spontaneously told me that he was only thinking of jumping off the top tier so he could get me in trouble and collect money, but then he thought that he might break his neck so he decided against it. I-Shields went on to say had I not been holding on to him he would have thrown himself down the stairs in hopes of suing the county. I-Shields has told me in the past that he files a lot of paper on people to get them in trouble and in hopes of some sort of monetary gain. Deputy Jones and Lopes responded at approximately 1940 hours to take I-Shields to intake. I-Shields was escorted to intake and placed in room 4 without incident. No deputies or inmates were injured. 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A-D.44166101N, /5 AV_,67 GGJi01►> %✓ i By: —Date: Pink:Kept by Inmate Yellow:Reply to Inmate White:To Booking DET 024:FRM 1/2/.91 CONTRA COSTA COUNTY ETENTI®N FACILITY ( ) INMATE REQUEST FOR INFORMATION ( ) MEDICAL REQUEST To: '=r .1.' 'µ.k. From: ' c" i (DOB)+ • Date: / .... / Housing Assignment: t Check One: ( } Request (,4Grievance ( ) Appeal ( ) Other Request:`)"j c i `_ tea—'_ .^�_• _ � _ Ac'.sti�ry_L -+Y1'_ F ��i': <.. �.^•fl;r-n!'tS,i t �-1'?yt ''�' _�,.`d ,1 + {ti::s'.P" -.:5-; d .� ... Fti '?r—� r'!.�hi. h,�.'.i:.i�_t;,`s,.. .,��• .�, J �;,;.�. Z.1"��+ :�'..4AS�'': � '.. - .• _,.^. .fit:�...— ° M4.. ,. 2.4 i..... {�)i�Ai "f { 1'�. :_! ter•' '.f,^"{`' iLY.%' e.'i1•i: _I. CR`�T�`E .'1_!'y k .4:7,.1±{,7:••f '"lF -�.a>y:!_`+`. c:..+.... L,-j, .1+ .-. .. �..}::. - :."�;i< _ Y.,. :a` -1ti,rt - •iy.. 'I fii{=. 'F •✓ ^'°r.- Rec'd Bv: Lzj Routed To: ANSWER: ( ) APPROVED ( ) DENIED-(state reason) By: Date: Pink:Kept by Inmate Yellow:Reply to Inmate White:To Booking DET 024:FRM 1/2/91 CONTRA COSTA COUNTY DETENTION FACILITY ( ) INMATE REQUEST FOR INFORMATION ( ).MEDICAL REQUEST From: -, �� r'.v,., Bkg# :',z;W) �'�%~!.. -:� Date: (Dba� / ,�� / Z > o DHusing Assignment: Check One: ('. ) Request (L/).Grievance ( ) Appeal ( ) Other a Request: •rlf',!- '�„ r s :1 ' '': r.!, ,_i Fs.{, J:r. ::,'e:y ,.r.' '✓: rz' r;}''..'-_ i,`,�".' ..,reY,%f„k� `'.�i� ;e 4 ..P•. r." 1-r•r: .f.�r � 1 •'- '��' '��.�—,. ' Date Rec'd: +Rec'd By: LA 4 Routed To: ANSWER: ( ) APPROVED ( ) DENIED-(state reason) I By: Date: / —/--- Pink:Kept by Inmate Yellow;Reply to inmate White:To Booking DET 024:FRM 1/2/91 CONTRA COSTA COUNTY DETENTI®N FACILITY ( ) INMATE REQUEST FOR INFORMATION ( ) MEDICAL REQUEST 6. From: ;: .\ z� S.s, .r Bkg# (Dos) Date: Housing Assignment: C_%) Check One: { ) Request (Grievance ( ) Appeal ( ) Other Request: ... ..v. •: �_ ems.: .:� ���,",•,. ._ (��'y Y,\, :' .. YY�6 �: {,.•1^:J h'i R '!\.. +', CY j-k\t" t:\ ?,r i� *• ° 1 °Y+t'3..� AC,:; '..e�3-+A i,"1f', _— ,�~ t -� i...,Y �_;. }• 1 '� Y'"1.��^ .i'a" ..�. , .J ;"� •'S yF,,,?y.,rr;y2^ 1�!."'ir'y f`'i � - ~i'>�fy i1'1,,e�_./ Date Rec'd: ! `1�/ ��'� Rec'd By: 71q-) Routed To: ANSWER: ( ) APPROVED ( ) DENIED-(state reas(,n) I BY — ,nate: Pink:Kept by Inmate Yellow:Reply to r;nate White:To Booking DET 024:FRIA 1/2/91 I j i i j I ' ! 1 � ' f i i Il` CONTRA COSTl3. COUNTY DETENTION FACILITY - ( ) INMATE REQUEST FOR INFORMATION ( ) MEDICAL REQUEST From: r J':�. tC.'•� r ;.,:r Bkg# I _ (DOB) Date: i j / ti J : ? Housing Assignment: Check One: ( ) Request (,'��Grievance ( ) Appeal ( ) Other { Request: "T6' .. .��; ' a ,;i Ir't x' I i^�`I Z; r, 46D I ��:;F+,,,. Ufa. �t....- '•.i'�f%'�`'- Date Recd: Recd a, I L L A- Routed To: ANSWER: ( ) APPROVED ( ) DENIED-(state reason) I By: Date: _I 1 Pink:Kept by Inmate Yellow:Reply to Inmate White:To Booking i DET 024:FRM 1/2/91 I CONTRA CA COUNTY DETENTION FACILITY -7 , i INMATE REQUEST FOR INFORMATION MEDICA��_�R l9•ST . From: 1 a �a s� �:. .�: Bkg#� Z,3--x.$ F ., YDOB) Date: Housing Assignment: Y k Check One: (V;,Request ( ) Grievance ( ) Appeal ( ) Other Request: V- rFt. til '�iS 4'+1t`k4r`•. a 4 X4.FF 'FYl4'!^' ` �:),*i �£ f AL,ii' rr. yrc_ ea.. ,.A>n .t 4^• A F./i. k=v 6 !a.. f�4,.'P.� 'i�•-t.'.w.,e fi.�^':t,d ',++ r,:..k efC:L .:�. , s' S/i.,F p.�._jr+ �>`�r- 'S.� �:�k"X't.��'f�`..fid,�''`.k 6�a��"�.,s.�•,. ��.,�y•. Y & '� ��� � � ` ;i '".�«c.,A�t"� t"�t!`1.�-,• .�`L�a"`i:� �4,ir'�e. ��..*.s'��2 L� �'d^".E'F se3e.`��., �-'��i:f+:1#'-,.i.e••.. : '�rtFA.f'_ ����R't�.�' "�i�'�. P f�,.�.��t:'�.'�, 'i:^=. �N'-'; �. �,�3:�:�:.,� Date Recd: l�i/ / � �Rec'd Bv: Routed-To: ANSWER: ( ) APPROVEDDENIED-(state reason) Date: By: �D,a✓,'�r_� / Pink:Kept by Inmate Yellow:Reply to Inmate White:To Booking DET 024:FRM 1/2/91 r f i 9 Ta Zrl vl CD CIDS 61) , f CV, ' c o o -n co 0 O � W N P, OD V \ 1� CLAIM BOARD OF SUPERVi:SO.RS OF CONi'RA COSTA COUNTY BOARD ACTION: Claim Against the County, or District Governed by ) the Board of Supervisors, Routing l?ndorsernents, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to California Government Codes. D 4gawm you is your notice of the action taken. on your claim by the Board of I APR I 7 ZOOS Supervisors. (Paragraph IV below), given Pursuant to Government Code COUNTY COUNSEL Section 913 and 915.4. Please note all AMOUNT: D. OQ MARTINEZ CALIF. "Warnings". CLAIMANT: rVL.'Ck`a4,k 6. N\'a1%rl- ATTORNEY: DATE RECEIVED: ADDRESS: Z2.4 i S�c.-, ^''`cxe or X321 BY DELIVERY TO CLERK ON: BY .MAIL POSTMARKED: ` V FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy o he above noted claim. JOHN CULLEN erk Dated:1- 1119ya By: Deputy fl. FRO County Counsel TO: Clerk of the Boardof ervisors ( T1nis claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to cornply 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: B In Deputy County Counsel III. FROM: Clerk of the Board TO: County.Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the-Supervisors present: This Claim is rejected in full. ( .) Other: I certify that this is a true: and correct copy of the Board's Order entered in its minutes for this date. Dated: L JOHN CULLEN, CLERK, By eputy 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 widi this matter. If you want to consult an attorney,you should do so immediately. *For Additional Warnii�g 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, overage 18; and that today I deposited in the United States Postal Service in N.-tartinez, California,postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as wn above. Dated: �Y O JOHN CULLEN, CLERK By Deputy Clerk C LA.I.IM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: (J � Claim Against the County, or District Governed by ) the Board of Supervisor's, 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: 50. c9® Section 913 and 915.4. Please note all ",Warnings". CLAIMANT: F_NA'.CJA a.a.A r>. 1'Y\zv%r­ ATTORNEY: DATE RECEIVED: Vi �' ✓I LC�� ADDRESS: ZZD i.S -'�`^�e"�r �3�BY DELIVERY TO CLERK ON: Anicock CNS 9VXC77 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy;trk he above-noted claim. JOHN CULLEN Dated:- o9ylz By: Deputy iI. FRO County Counsel TO: Clerk of the Board of ervisor•s. ( ) This claim complies sUl stantially with Sections 910 and 910.2. ( ) This Claim FA1LS.Ap coniply substantially with Sections 910 and 910.2, and we are so notifying claimant. The 0�iard cannot act for 15 days (Section 910.8). ( ) Claim is not timelyfiled. The Clerk should return claim on ground that it was filed late and send warning of claimant.'s right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: By: ' Deputy County Counsel 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. BOARD ORDER: By unanimous vote of the Supervisors present: ( ) This Claim is rejected in full. ( ) . Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for. this date. Dated: JOHN CULLEN, CLERK, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6) mouths froln the date this notice was personally served or deposited in the mail to file a couit action on this claim.See Government Code Section 945.6.You may seek the advice of an attonney of your choice in connection with this matter. It'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 tine United States Postal Service in [Martinez, California, postage fully prepaid`a certified copy of• this Board Order and Notice to Claimant, addressed to the ciaiman.t as shown above. Dated: JOHN CULLEN, CLERK By Deputy Clerk y" Claim to: BOARD OF SUPIE:RVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented no later than the 100'" day after the accrual of the cause of action. Claims y„ relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. 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 fled 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 filling stamp IV atr N ) RECEIVED Ag Inst the County of Contra Costa ) APR 1 4 2008 or ) CLERK BOARD OF SUPERVISORS _District ) CONTRA COSTA CO. (Fill in name) ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above- named District in the sum of$_ ,2�t� — and in support of this claim represents as follows: ctiaI 2�c -7 g l 5 r2,nil_ 0 Z(o 1. When did the daroage or inJury occur? (Give exact date add.hour) 9a D 1 -,cc���M. ��i v��Z_3Z A-y)h o c h , al , eonb-n (_ Usa Co, 2. Where did the damage or injury occur?(Include city and county) ISGGU 64f, rotice rno1h(ncn- . CoRCWd-rrA1Hon 3. How did thedamage or uijur occur`? (Give full.details; use extrh paper if required) 7w dead bo )f and cbcx am were inn d irreyeura 4. What particular act or omission on the part of county or district officers, rvants or employees caused the injury or damage? (C" � (over) t i c) one vias bonne. aP FI i �rv�f'. Sec Pc L(-Cc' c ffCavOcd ko l oca 1 e an a p -m- - ana. cA fl�C :moo r - c oo�r. i s f t,n a - -H/u, I bcL -p y 5 �m fjU ffGA-Pry)thi- . El-\i-� rte: c o o --- r nu'r� L,-,?- rq (c.ccd ct w. �0' (4atr n a ccutsed. 4-� ccsv�� r�u eco whu-) y 4��`'✓{ C e 40 rl / r cad bo commas 0 u- cf wtzs -6ho- V-cd, D0 -�� -v�ay- , f 6t,. atqj t c �, ��(�(act, s � _��. - was ct� � 5. What are the names of county or district officers, servants or employees causing the damage or injury? � cry R Pa�KCF.N 61-4�ta Inc 6. What damage or injuries do ou Jlairn resulted? (Give frill extent of injuries or damages claimed.) Attach two estimates for auto damage. clecldbol� wz b7(p,kW. cloor yuouo no� tai' ParyGunlL whm( C'OA�)i 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) cp` 8. Names and addresses of witnesses, doct__V aos itals. Q,rh ne�- ��}�FY N r 9. �1, st the expenditures you nmade on account of this ccident ori jury: DATE ITEM AMOUNT ' Go Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO : (AttorneX or bv some verson on his behalf" Name and address of Attorney ,�-- (Claimant's Signature) ;_2Z0 -5e D---112-37_1 (Address) 4n -OCb C 9-ffo;9 Telephone No. Telephone No. gZc NO'T'ICE 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 on thopsand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and tine. ) CLAiIVI HOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: 20 Clairn Against the County, oi• District Governed by ) the Board of Supervisors, Routing Endorsements, ). NOTICE TO CLAIMANT and Board Action. All Section ref, The copy of this document mailed to California Government Codes: �`�''� )� you is your notice of the action taken APR 2008 . on your claim.by the Board of . Supervisors. (Paragraph IV below), COUNTY COUNSEL given Pursuant to Government Code MARTINEZ CALIF. Section 913 and 915.4. Please note all AMOUNT: I noW n '.'Warnings". CLAIMANT:'V'err"v--, rl `�SGiiLa ATTORNEY: EdWard Podze_w1RhE RECEIVED: 6a l ADDRESS- BY n� pat�hon xSftiman BY DELIVERY TO CLERK ON: �, i� )2 _�n 1� BY MAIL POSTMARKED: / `f' :W FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. JOHN CULL Jerk Dated: By: Deputy 11. 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 9.10.8). ( ) Claim is not timely filed. The Clerk should returit 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). ( ) Other: Dated: Z- b a— By: /"1/1 �`- 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 BOARD ORDER: By;unanimous vote of the Supervisors present: This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy o f the Board's Order entered in its minutes for this date. I Dated: A g JOHN CULLEN, CLERK, Byrll_ Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6) months frons 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 Skates, 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 claimait s shown above. Dated: o� JOHN CULLEN, CLERKy eputy Clerk M ....'CLAIM. BOARDO7 SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: 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: LU1KCloW n Section 913 and 915.4. Please note all "Warnings" CLAIMANT:Ver- l:�..`{'� u :��tUh-CAszrl Lf SS 600v9tCt.C�Lt U / ATTORNEY: L,C1.wCUM J kodze-W.' '' hhr RECEIVED: (, �.t.� I �'L' ). V i ll y °�CLC�rh.S��►1 1..<5"fzd7l ICL A . ADDRESS: BY DELIVERY TO CLERK ON: 6v narlo Pt G _ > BY MAIL POSTMARKED: FROM: Clerk of theBoard of Supervisors T0: County Counsel Attached is a copy of the above-notgd claim. JOHN CULL: . leek ��._ �j7 By: Deputy`PQ_ h.�• /�/�' t�,1.au� : Dated: ' -T I.I. FRONT County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. 'Tile 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). ( ) Other•: Dated: By: Deputy County Counsel 1.11. FROM:. Clerk of the Board TO: County Counsel (1) County Administrator•(2) O Claim was retiu•ned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: ( ) This Claire is.r•ejected in full. ( ) Other I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JOHN CULL;EN, 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 nitail to file a court.ction on this.claim.See Government Code Sectiai 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 Addifiorral Warning See Reverse Side ofllnis 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 1.8; and that today I deposited in the United States Postal Service in Ntartinez, California, postage fully prepaid a certified copy of this Board Order and Notice;to Claimant, addressed to the claimant as shown above. Dated: JOHN CULLEN, CLERK ` By Deputy Clerk - . Ec :]1 EDWARD J. RODZEWICH, ESQ. — State Bar No. 159466 8VALERIAN,PATTERSON& STRATMAN 'viSCRS2 1650 Harbor Bay Parkway, Suite 100 u. Alameda, CA 94502-3013 3 Phone: (510) 521-0612 Fax: (510) 337-0125 4 Attorney for Defendant and Cross-Complainant 5 VERNITA DAVIDSON 6 7 8 SUPERIOR COURT OF THE STATE OF CALIFORNIA 9 FOR THE COUNTY OF CONTRA COSTA 10 VERNITA DAVIDSON, CLAIM FOR PERSONAL INJURIES, 11 Cross-Complainant, INDEMNITY, & CONTRIBUTION Government Code Section 910 12 vs. 13 CRESTWOOD BEHAVIORAL SERVICES, INC., CONTRA COSTA COUNTY HEALTH 14 SERVICES, and ROES 1-20, inclusive, 15 Cross-Defendants. 16 17 To: CONTRA COSTA COUNTY HEALTH SERVICES 18 1. You are now notified that VERNITA DAVIDSON,through her attorney, whose address 19 is listed above, claims damages from the CONTRA COSTA COUNTY HEALTH 20 SERVICES.. 21 2. The claim is based upon personal injuries alleged by Joan Monroe in Contra Costa 22 County Complaint Case No. C08-00166 filed on January 24, 2008. A copy of which is 23 attached. In that complaint, Ms. Monroe has filed a wrongful death action for the death 24 of her son, Stephen Hauser. The death occurred at 4228 Treat Blvd. in Concord, 25 California on March 22, 2006. Vernita Davidson is a defendant in that action and this 26 claim is for contribution and indelnnity against CONTRA COSTA COUNTY HEALTH 27 SERVICES. 2s Claim For Personal Injuries -I 1 3. The public employees causing the injuries are case worker Tanya White and director 2 Victor Montoya of CONTRA COSTA COUNTY HEALTH SERVICES. Through 3 actions or inactions,these public employees failed to prevent the death of Stephen 4 Hauser. 5 4. In the complaint, the plaintiff has asked for compensatory damages according to proof. 6 This is a wrongful death action. 7 5. All notices or communications with regard to this claim should be sent to the attorney for 8 claimant, Edward J. Rodzewich, at the above address. 9 10 DATED: April 16, 2008 VALERIAN, 'TER.. N& STRATMAN / r 12 BY: Z7 P-PWARP.J., IDZEWI H, ESQ. 13 ttorney for VERNITA DAVIDSON 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Claim For Personal Injuries -2 ... . ..:.. PLD-PI-001 ATTORNEY OR PARTY WnHOUT ATTORNEY(Name,Sta, nwntxr,and FOR COURT use ONLY Louis. M. Bernstein, SBN 30636 Michael R. Lauer, SBN 177997 1425 Leimert Boulevard; Suite 203 i , Oakland, CA 94 602 TELEPHONE NO.: (510) 4 8 2—410 0 FAX NO.(0p9w&Q. (510) 482-4111 E-MAIL ADDRESS(Optbedl I ATTORNEYFOR(Nmol.. Joan Monroe,; Plaintiff J SUPERIOR COURT OF CALIFORNIA,COUNTY OF CONTRA COSTA STREETIIDDRESs: 725 Court Street • '-�f;�,I uAuwo ADomss: P. 0. Box 911 C(rYANDz1PCODE: Martinez, CA' 94553 BRANCH NAME: R PLAINTIFF: JOAN MONROE Sof fONSI, .. - DEFENDANT: VERNITA DAVIDSON, CRESTWOOI) BEHAVIORAL HEALTH, INC., M DOES r TO 10 PER LOCAL RULE 5 HIS COMPLAINT-Personal Injury,Property damage,Wrongful Death CASE 116SIGNED 0 Q AMENDED(Number): DEPT. tCJ _ Type(check all that apply): C] MOTOR VEHICLE ® OTHER(specify): Premies Liability, Genera Q Property Damage ® Wrongful Death (] Personal Injury Q Other Damages(specify): Jurisdiction(check all that apply): CASE NUMBER: Q ACTION IS A LIMITED CIVIL CASE Amount demanded E] does note'xceed s10,000 Gr 0 8 _ 0 0 x 6 6 ® exceeds$ 0,000,but does not exceed$25,000 M ACTION IS AN UNLIMITED CIVIL CASE(exceeds$25,000) 0 ACTION IS RECLASSIFIED by this amended complaint C] from limited to unlimited from unlimited to limited 1. Plaintiff(name ornames): Joan Monroe alleges causes of action against defendant(name or names): Vernita Davidson, Crestwood Behavioral Health, Inc., Does 1 to 10 2. This pleading,including attachments and exhibits,consists of the following number of pages: 5 3. Each plaintiff named above is a competent adult a. ❑ except plaintiff(name): (1)0 a corporation qualified to do business in California (2)0 an unincorporated entity(describe): (3)E3 a public entity(describe): (4)0 a minor Q an adult .(a)0 for whom a guardian or conservator of the estate or a guardian ad litem has been appointed (b) Q other(specify}: (5) ❑ other(specify): b. Q except plaintiff(name): (1) ❑ a corporation qualified to do business in California (2)❑ an unincorporated entity(describe) (3) ❑ a public entity(describe) (4)❑ a minor E] an adult (a)Q for whom a guardian or conservator of the estate or a guardian ad liters has been appointed (b)Q other(specify) (5) ❑ other(specify): Q Information about additional plaintiffs who are not competent adults is shown in Attachment 3. Page t of �aciatcniiopp w se ,N„krAwt _ COMPLAINT-Personal Injury,Property coded Crvii Pme"www courfftda-p PLD-PI-001 lRev.Jmu®ry 1,2ao7 ..o �SSEMif141 f08Glj" Damage,Wrongful Death Monroe v. Davidson, et al. _ PLD-PI-001 SHORT TITLE: + ') .ASE NUMBER MONROE. v. DAVIDSON 4. J3 Plaintiff(name): is doing business under the fictitious name(specify): and has complied with the fictitious business name laws. 5. Each defendant named above is a natural person a. ® except defendant(name)': c. except defendant(name): Crestwood Behavioral Health, Inc. (1) r] a business organization,form.unknown (1) 0 a business organization,form unknown (2) ® a corporation ; (2) 0 a corporation (3) Q an unincorporated entity(describe): (3) Q an unincorporated entity(describe): (4) 0 a public entity(describe): (4) 0 a public entity(describe) (5) 0 other(specify): (5) E3 other(specify): b. except defendant(name): d. (]except defendant(name): (1) 0 a business organization,form unknown (1) Q a business organization,form unknown (2) ❑ a corporation (2) Q a corporation (3) ❑an unincorporated entity(describe): (3) 0 an unincorporated entity(describe): (4) ❑ a public entity(describe): (4) 0 a public entity(describe): i (5) ®other(specify) ° ' (5) 0 other(specify): 0 Information about additional defendants who are not natural persons is contained in Attachment 5. S. The true names of defendants sued as Does are unknown to plaintiff. a. 0 Doe defendants(specify Doe numbers): were the agents or employees of other named defendants and acted within the scope of that agency or employment. b. ® Doe defendants(specify Doe numbers): 1 to 10 are persons whose capacities are unknown to plaintiff. 7. ❑ Defendants who are joined under Code of Civil Procedure section 382 are(names): 8. This court is the proper court because a. ®at least one defendant now resides in its jurisdictional area. b. ® the principal place of business of a defendant corporation or unincorporated association Is in its jurisdictional area. c. ® injury to person or damage to personal property occurred in its jurisdictional area. d. ® other(specifyr Death to Stephen Hauser, plaintiff' s adult son, occurred in its jurisdictional area . i 9. 0 Plaintiff is required to comply with a claims statute,and a.❑ has complied with applicable claims statutes.or b.❑ is excused from complying because(specify): PLD-PI-WI IRay.January 1.20071 CORAPLAINT•Personal Injury.Property PW 1°I7 Q--. uFtimm"r Damage,Wrongful Death MONROE v. DAVIDSON, et al. Essti�ut Foa�s� i r _ PLD-Pi-001 SHORT TITLE: CASE NUMBER: MONROE" V. DAVIDSON, et dal. 10. The following causes of action are attached and the statements above apply to each(each complaint must have one or more causes of action attached): a. [3 Motor Vehicle i b. Q General Negligence c. Q Intentional Tort d. Q Products Liability e. ® Premises Liability f. Q Other(specify): t 11. Plaintiff has suffered a. 0 wage loss b. [3 loss of use of property c. (] hospital and medical expenses d. 0 general damage e. Q property damage f. Q loss of earning capacity g. ® other damage(specify): See allegations in Paragraph 12.' I 12. Q The damages claimed for wrongful death and the relationships of plaintiff to the deceased are a. Q listed in Attachment 12. b. ® as foilows: Plaintiff Joan Monroe is the! mother of deceased, Stephen Hauser, and his sole surviving heir. 13. The relief sought in this complaint is within the jurisdiction of this court. 14. PJalntiff prays for judgment for costs of suit;for such relief as is fair,just,and equitable:and for a. (1)® compensatory damages (2)Q punitive damages The amount of damages is(in cases for personal injury or wrongful death,you must check(I)).- (1) t)).(1) ® according to proof (2)Q in the amount of:$ 1 S. Q The paragraphs of this complaint alleged on information and belief are as follows(specify paragraph numbers): Date: January 23, 2008 T.nuj-,a M_ Rarnsi-Pin (TYPE OR PRINT NAME) (SIGNA E OF PLAINnFF OR ATTORNEY) PL3-P1-=lRev.January S,20071 COMPLAINT-Personal4nfury,Property Pap a or 3 Damage,Wrongful Death OBalm F961#S MONROE v. DAVIDSON, et al. PLO-PI-001(4) SHORT TITLE: t CASE NUMBER: MONROE v. DAVIDSON, et al. FTRST CAUSE OF ACTION -Promises Liability Page 4 (number) i ATTACHMENT TO ®Complaint ;, Q Cross-Complaint (Use a separate cause of action form for each cause of action.) i Prem.L-1. Plaintiff(name): JOAN; MONROE alleges the ads of defendants vrere the legal(proximate)cause of damages to plaintiff. On(date): March 22, 21006 plaintiff was injured on the following premises in the following fashion(description of premises:and circumstances of injury): On said date, at 4228 Treat Boulevard, Concord, Contra Costa County, California, plaintiff's son, Stephen Hauser, was murdered by Nathan Gideon, by stabbing. Stephen Hauser and Nathan Gideon were then tenants of said premises, owned by defendants Vernita Davidson and Does 1 to 5. Prior to said stabbing death, said defendants knew, or should have known, that Nathan Gideon was a mentally unstable and violent person who had physically attacked others at said premises and they took no steps to evict or have Nathan Gideon removed from said premises, enabling him to kill Stephen Hauser. Prem.L-2. ® Count One-Negligence The defendants who negligently owned,maintained,managed and operated the described premises were(names): Vernita Davidson and ® Does ,1_ to 5 Prem.L-3. ® Count Two-Willful Failure to Warn[Civil Code section 8461 The defendant owners who willfully or maliciously failed to guard or warn against a dangerous condition, use, structure, or activity were (names): Vernita Davidson and ® Does r 1 to 5 Plaintiff,a recreational user,was 0 an invited guest® a paying guest. Prem.L-4. 0 Count Three-Dangerous Condition of Public Property The defendants who owned public property on which a dangerous condition existed were(names): [] Does _ to a.0 The defendant public entity had 0 actual 0 Constructive notice of the existence of the dangerous condition in sufficient time.prior to the injury to have corrected it. b.[] The condition was created by employees of the defendant public entity. Prem.L-5. a. ® Allegations about Otlier Defendants The defendants who were the agents and employees of the other defendants and acted within the scope of the agency were(names): Vernita Davidson and ® Does L—. to `+ b. 0 The defendants who are liable to plaintiffs for other reasons and the reasons for their liability are ® described in attachment Prem.L-5.b 0 as follows(names): Papa 1 or I Forrtt App,, r,,,e CAUSE OF ACTION-roved for Opdonal.Use Code of Civil Procedee.S 425.12 cCdofceidoPremises Liability WWW.OX911rbCA90V PL"4001(4)tRev.January I,20071 C .Virile CYna1 _ ONEIR4faaw MONROE v. DAVIDSON, et al. . PLD-PI-001(2) I SNORT TITLE: 11.1iEkWBER: MONROE v. DAVIDSON, et al . sFc wn CAUSE OF ACTION- General Negligence Page S (number) ATTACHMENT TOM Complaint Q Cross-Complaint (Use a separate cause of action form for each cause of action.) GN-1.Plaintiff(name): Jo a n M;o n r o e i alleges that defendant (name): Crestwood Behavioral Health, Inc. (Crestwood) and ®Does fi— to 1 was the legal (proximate) cause of damages to plaintiff. By the following acts or omissions to act, defendant negligently caused the damage to plaintiff on(date): Prior to march 22, 2006, Crestwood and does 6 to 10 released Nathan Gideon from its at[place): custody in Pleasant hill California and into the residence (description of reasons for liability) : facility of defendants Vernita Davidson and Does 1 to .5. Defendants Crestwood and Does 6 to 10 knew, or, in the exercise of reasonable care, should have known, that Nathan Gideon was subject to violence against other persons and was not mentally stable enough to function socially in the environment of said residence facility. Nor did Crestwood and Does 6 to 10 reasonably supervise nor oversee Nathan Gideon's adjustment to living at said residence facility, nor the ability of others to live safely in said facility in the presence of Nathan Gideon. Crestwood and Does El to 10 failed to act to remove Nathan Gideon from said facility prior to March 22, 2006, even though they knew, or in the: exercise of reasonable care should have know that Nathan Gideon was a violent person and was a threat to the safety of Stephen Hauser and the other residents and occupants of the said residence facility, thereby providing the opportunity for Nathan Gideon to commit violence against Stephen Hauser, resulting in Stephen Hauser's death on March 22, 2006, by stabbing administered by Nathan Gideon. i Pape 1011 Form App`oroera gkmalUseCAUSE OF CTIO -General Negligence Code of Civil Procedure 4a12 J did eased of Wifamie »,w.eaatinlo.ea gay PLD-PI-001[2j[Rev.Januory 1.20071xnnie 13L*40' OESSIXImFORMS` Monroe v. Davidson, at al. I I 1 Re: Monroe v. Davidson, et al. Case Number: MSC08-00166 2 3 PROOF OF SERVICE Code of Civil Procedure §§ 1013a, 2015.5 4 I am a resident of the State of California and over the age of eighteen years, and not a party to 5 the within action. My business address is 1650 Harbor Bay Parkway, Suite 100, Alameda, CA 94502-3013. On April , 2008, I served the following document(s): 6 7 CLAIM FOR PERSONAL INJURIES,INDEMNITY, & CONTRIBUTION Government Code Section 910 8 . 9 by placing the document(s) listed above in a sealed envelope, addressed as set forth ✓ below, and placing the envelope for collection and mailing in the place designated for 10 such in our offices, following ordinary business practices. 11 by transmitting via facsimile the document(s) listed above to the fax number(s) set 12 forth below on this date before 5:00 p.m. 13 By causing a true copy thereof to be personally delivered to the person(s) at the 14 address(es) set forth below. 15 Clerk of the Board of Supervisors 16 Room 106 17 The County Administration Building 651 Pine Street 18 Martinez, CA 94553 19 I am readily familiar with the firm's practice of collection and processing correspondence for 20 mailing with the United States Postal Service. Under that practice, it would be deposited with U.S. Postal Service on that same day with postage thereon fully prepaid in the ordinary course of business. 21 I am aware that on motion of the party served, service is presumed invalid if postal cancellation date 22 or postage meter date is more than one day after date of deposit for mailing in affidavit. 23 1 declare under penalty of perjury under the laws of the State of California that the above is true and correct. 24 Executed on April_ i , 2008, at Al meda, ali, is 25 26 27 VREN D. FROMY 28 Claim For Personal Injuries -3 G � jr %U, ,.r G �u D O G O .t G I; U' O C ~ �Q ��N uNrr�aSr a LnUl .a Ln 40 K 'rJ 91 CD ul r�J 4 U N CO to 0 N CLAiM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION:. 26 2 bF Claim Against the County, or. District Governed by ) the Board of Supervisors, Routi > 1 NOTICE TO CLAIMANT and Board Action. All Section r' ra The copy of this document mailed to California Government Codes. APR 1 6 zQQ$) you is your notice of the action taken on your claim by the Board of COUNTY COUNSEL Supervisors. (Paragraph IV below), MARTINEZ CALIF.�ncgi MN ven Pursuant to Government Code A .0U. "f: �s�"t MCCACS a C.41Section 913 and 915.4. Please note all "Warnings". CLAIMANT: ay }e� ATTORNEY: DATE RECEIVED: Ap C► ADDRESS: Q5?3 ��}� BY DELIVERY TO CLERK ON: A Dr', (-XAnGIunci, , Crk 9q(0Cg BY MAIL POSTMARKED: FROM: Clerk of the Board o[Supervisors visors T0: County Counsel Attached.is a copy of the above-noted claim. JOHN CULLEN, Clerk Dated: /�Y-, L Ifv l X006 By: Deputy II. FROM.: County Counsel TO: Clerk of the Board of Supervisors ( Kilis claim complies substantially with Sections 910 and 91.0.2. ( ) 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: 3D—U 1 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. BOARD ORDER: By unanimous vote of the Supervisors present: (kj This Claim is rejected in full: ( ) Other: foi- 1 certify that this is a,true and correct copy of the Board's Order.entered in its minutes this date. i \ ' Dated: o JOHN CULLEN, CLERK, By Deputy Clerk WARNING (Gov. code section 91.3) Subject to certain exceptions,you have only six(6) rnontlns from thi date this notice was personally seined.. or deposited in the mail to file al court action on this claim.See Government Code Section 945.6.You may seek the .pdviee of an attorney of your choicie.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 Udeclare 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 Ntartinez, California,. postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the clainnari.t . shown.above. Dated: �i2 JOHN CULLEN, CLERK By Deputy Clerk CLAIM BOARD OF SUPERViSORS OF CONTRA COSTA COUNTY BOARD ACTION: lv 2C � 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), 0. 0�� given Pursuant to Government Code AMOUNT: es E Y''10'C 5 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: �� 2szllclY-�e� ATTORNEY: DATE RECEIVED: Agr"% 1 Ib ,1C)OF ADDRESS: �t�8 ��}� BY DELIVERY TO CLERK ON: t-t p' U15___eo- s ()D V_l ah4 , 6A CWOC$ BY MAIL POSTMARKED: v1 6., FROM: Clerk of the Board of Supervisors TO: County.Counsel Attached is a'copy of the above-noted claim. JOHN.CULLEN, Clerk Dated: A!py-;L 16 By: Deputy T.I. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ).,This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other*: Dated: By: Deputy County Counsel 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). V. BOARD ORDER: By unanimous vote of the Supervisors present: 7 ( ) This Claim is rejected in full. O Other: I certify that this is a true aild 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 nail to file a court action on this chaim.See Government Code Section 945.6.You may seek the a.dvice of an attorney of your choice in connection wide this matter. l.f 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 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: JOHN CULLEN, CLERK By Deputy Clerk r Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be ; presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street,Martinez, CA 94553, either by mail or in person. 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. xirxx'e�c9e�e*�c�e�e'exxtFirk�k�ek9eie9e�cx4�e�eic�e�e$ca'c9eiexicx9e9eiexxx�F�9ede9e�e�c�rxx'e*�e�c*F'e�x9e'e�en'c�e . RE: Claim By ) Reserved for Clerk's filing stamp Dizella Carter Against the County of Contra Costa or R The Housing Authority of Contra Costa (.District) I. . . (Fill in name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of and in support of this claim represents as follows: ua 19, 02Q0� �:/U�o •Al 1. When did We damage or injury occur? (Give exact date and hour) t3 dv di afok bvve�v m IQvc�C7J GSA A4" lAv C,t-kla to 2. W sere did the damage or injury occur? (Include city and county) i 3. Flow did the damage or injury occur? (Give full details; use extra paper if required) el e5 2 Syeen �z- ear 4. What particigr r act or omission oil the part of county or district officers, servants or cinployees caused the injury or damage? dmRn-m UJ2"e/flAt e 5. What are %e names of cou ty or district officers, servants or employees causing the damage or injury? 6. What damage or injuries do you claim resulted? (Gi full extent of injuries or � damages claimed. Attached two estimates for auto damage.). 7. How was the amount claimed above computed? (Include the'estimated amount of any prospective injury or damage.) J�12Prt�" 6 i`e ?AS- - 0U- 7t41 An eikA 9` ,51 96-4- 9033- 8. Names and addresses of witnesses, doctors and hospitals. ,�Oz ?W/. gib XA".",/ 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICE TO: (Attorney) or by some Orson on his be lf." Name and Address of Attorney (Claimants Signature) (Address) r Telephone No. Telephone No. 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 ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000) or by both such imprisonment and fine." chnlorm j '. i Date: 3/14/2008 12:48 PM Estimate ID: 1546 Estimate Version: 0 Preliminary Profile ID: San Pablo Auto Body SAN PABLO AUTO BODY PAINT 2926 SAN PABLO AVE,OAKLAND,CA 94608 (510)663-2345 Fax: (510)663-1123 Tax ID: 942955396 BAR#: AJ212694 EPA#: CAL000218917 Damage Assessed By: JASON CHUNG Deductible: UNKNOWN Owner: DIZELLA CARTER Address: 988 36TH ST.,OAKLAND,CA 94608 Telephone: Home Phone: (415)377-0542 Mitchell Service: 912121 Description: 2004 Honda CR-V EX Body Style: 4D Ut Drive Train: 2AL Inj 4 Cyl 4WD VIN: JHLRD78844CO31418 License: 5KHL495 Options: ALUM/ALLOY WHEELS,AUTOMATIC TRANSMISSION ALL CRASH PARTS ON THIS ESTIMATE ARE "NEW" ORIGINAL EQUIPMENT MANUFACTURER PARTS, UNLESS OTHERWISE SPECIFIED. PARTS DESCRIBED AS RECHROMED, RECORED, REMANUFACTURED, OR RECONDITIONED •ARE CONSIDERED "REBUILT" PARTS. CRASH PARTS DESCRIBED AS' "QUALITY REPLACEMENT PART" ARE NON—ORIGINAL EQUIPMENT MANUFACTURER AFTERMARKET PARTS. Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation Description Part Number Amount Units 1 _ 201476 BDY, REPAIR R QUARTER OUTER PANEL Existing '4.0'# 2 AUTO REF REFINISH R QUARTER PANEL OUTSIDE C 2.4 3 933021 REF ADUL OPR DE-NIB AND FINESSE 0.5` 4 AUTO REF ADD'L OPR CLEAR COAT 1.0 5 933003 REF ADDT OPR TINT COLOR 0.5' 6 AUTO ADUL COST PAINTIMATERIALS 117.00 7 AUTO ADD'L COST HAZARDOUS WASTE DISPOSAL 3.00 . " -Judgment Item #-Labor Note Applies C - Included in Clear Coat Calc i ESTIMATE RECALL NUMBER: 311412008 12:48:52 1546 Mitchell Data Version: OEM: FEB-08_A UltraMate is a Trademark of Mitchell International Copyright(C)1994-2008 Mitchell International Page 1 of 2 UltraMate Version: 6.5.015 All Rights Reserved � I Date: 3/14/2008 12:48 PM Estimate ID: .1546 Estimate Version: 0 Preliminary Profile ID: San Pablo Auto Body Estimate Totals Add'I Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount Body 4.0 70.00 0.00 0.00 280.00 Refinish 4.4 70.00 0.00 0.00 308.00 Total Replacement Parts Amount 0.00 Non-Taxable Labor 588.00 Labor Summary 8.4 588.00 III. Additional Costs Amount IV. Adjustments Amount i, Taxable Costs 117.00 Customer Responsibility 0.00 Sales Tax @ 8.750% 10.24 Non-Taxable Costs 3.00 Total Additional Costs 130.24 1. Total Labor: 588.00 ll. Total Replacement Parts: 0.00 III. Total Additional Costs: 130.24 Gross Total: 718.24 IV. Total Adjustments: 0.00 Net Total: 718.24 This is a preliminary estimate. Additional changes to the estimate may be required for the actual repair. I HEREBY AUTHORIZE SAN PABLO AUTO BODY & PAINT TO COMMENCE REPAIRS ON MY VEHICLE PER THIS ESTIMATE: ALSO ESTIMATE GOOD FOR 30 DAYS. SIGNED DATE IT IS ESSENTIAL TO HAVE THIS .COPY FOR FUTURE REFERENCES. PLEASE DO NOT LEAVE PERSONAL ITEMS IN VEHICLES. ANY REPAIRED VEHICLES LEFT ON THE PROPERTY AFTER 20 DAYS SHALL BE CHARGED A STORAGE FEE OF $40 PER DAY. PLEASE NOTE: WE ARE NOT RESPONSIBLE FOR LOST OR STOLEN ITEMS! ! SAN PABLO AUTO BODY & PAINT- ESTIMATE RECALL NUMBER: 3/14/2008 12:48:52 1546 Mitchell Data Version: OEM: FEB_08_A UltraMate is a Trademark of Mitchell International Copyright(C)1994-2008 Mitchell International Page 2 of 2 UltraMate Version: 6.5.015 All Rights Reserved Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO-CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after.January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not.later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553, either by mail or in person. 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. xde*kx*x'exp'e�x**k�e4k'e'e�r*�:*nFnkx�rxFF*ie 9cYF*F'eke*:kir*'eaeF9e*x*kxF�edex�e*��xx9e'e'e�r�***fie RE: Claim By ) Reserved for Clerk's filing stamp Dizella Carter 1 Against the County of Contra Costa ! r or The Housing Authority of Contra Costa (District) ...:..:.::.: . (Fill in name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of and in support of this claim represents as follows: h�giU.O .A/ 1. When did t e damage or injury occur? (Give exact date and hour) B Vv I�i afa iVe�a in /Qvc�r7l 64 Akea. IAO 0.000 ILet 570 2. W ene did the damage or injuryoccurlude city and county) 3. How did the damage or injury occur? (Give full details; use extra paper if required) D CS g tL eq r 4. What partic r acts or ornission on the part of county or di i riot officers, servants or r employees caused the injury or damage? ! 5. What are t e names of cou ty or district officers, servants or empl ees causing the damage or injury? A S'r��. .vry �� v� t)ulue% Was da,"ta C day & No e�-w Vlou o�/y1 � �6. What damage or injuries do you claim resulted? (Gi full extent of injuries or lei damages claimed. Attached two estimates for auto damage.) stc 4I&&t.. C'944t4A--5 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) �vh�>� til vy re gks-9r4-SOas -7�iW. A,, &,44 47AS--95--; - S03r 8. Names and addresses of witnesses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT kkk-kkkkkk# kkkk*kk#*kkk=kik##kkkkkkk%kkkkkkkkkkk-kkkkkkkk%kkkkkkkkk:kkkkkkkkkk%k Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICE TO: (Attorney) or by some arson on his be lf." Name and Address of Attorney (Claimant s Signature) (Address) Telephone No. Telephone No. goIY�-- NOTICE Section 72 of the Penal Code provides: "Every person1who, 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 ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars($10,000) or by both such imprisonment and fine." ' clmfinin Date: 311412008 12:48 PM Estimate ID: 1546 Estimate Version: 0 Preliminary Profile ID: San Pablo Auto Body SAN PABLO AUTO BODY PAINT" 2926 SAN PABLO AVE,OAKLAND,CA 94608 (510)663-2345 Fax: (510)663-1123 Tax ID: 942955396 BAR#: AJ212694 EPA#: CAL000218917 Damage Assessed By: JASON CHUNG Deductible: UNKNOWN Owner: DIZELLA CARTER Address: 988 36TH ST.,OAKLAND,CA 94608 Telephone: Home Phone: (415)377-0542 Mitchell Service: 912121 Description: 2004 Honda CR-V EX Body Style: 4D Ut Drive Train: 2AL Inj 4 Cyl 4WD VIN: JHLRD78844CO31418 License: 5KHL495 Options: ALUM/ALLOY WHEELS,AUTOMATIC TRANSMISSION ALL CRASH PARTS ON THIS ESTIMATE ARE "NEW" ORIGINAL EQUIPMENT MANUFACTURER PARTS, UNLESS OTHERWISE SPECIFIED. PARTS DESCRIBED AS RECHROMED, RECORED, REMANUFACTURED, OR RECONDITIONED ARE CONSIDERED "REBUILT" PARTS. CRASH PARTS DESCRIBED AS "QUALITY REPLACEMENT PART" .ARE NON-ORIGINAL EQUIPMENT MANUFACTURER AFTERMARKET PARTS. Line Entry Labor Line Item Part Type/ Dollar,, Labor Item Number Type Operation Description Part Number Amount. Units 1 201476 BDY REPAIR R QUARTER OUTER PANEL Existing 4.0'# 2 AUTO REF REFINISH R QUARTER PANEL OUTSIDE C 2.4 3 933021 REF ADD'L OPR DE-NIB AND FINESSE 0.5" 4 AUTO REF ADUL OPR CLEAR COAT 1.0 5 933003 REF ADD'L OPR TINT COLOR 0.5` 6 AUTO ADUL COST PAINT/MATERIALS 117 00 7 AUTO ADD'L COST HAZARDOUS WASTE DISPOSAL 3f00 " * -Judgment Item #- Labor Note Applies C -Included in Clear Coat Calc i ESTIMATE RECALL NUMBER: 311412008 12:48:52 1546 Mitchell Data Version: OEM: FEB-08_A . UltraMate is a Trademark of Mitchell International Copyright(C)1994-2008 Mitchell International Page 1 of 2 UltraMate Version: 6.5.015 All Rights Reserved r, Date: 3/14/2008 42:48 PM Estimate ID: 1546 t" Estimate Version: 0 Preliminary Profile ID: San Pablo Auto Body Estimate .Totals Add'I Labor Sublet I. Labor Subtotals Units Rate_ Amount Amount Totals II. Part Replacement Summary Amount_ Body 4.0 70.00 0.00 0.00 280.00 Refinish 4.4 70.00 0.00 0.00 308.00 Total Replacement Parts Amount 0.00 Non-Taxable Labor 588.00 Labor Summary 8.4 588.00 111. Additional Costs Amount IV. Adjustments Amount Taxable Costs 117.00 Customer Responsibility 0.00 Sales Tax @ 8.750% 10.24 Non-Taxable Costs 3.00 Total Additional Costs 130.24 I. Total Labor: 588.00 II. Total Replacement Parts: 0.00 III. Total Additional Costs: 130.24 Gross Total: 718.211 IV. Total Adjustments: 0.0.0 Net Total: 718.24 This is a preliminary estimate. Additional changes to the estimate may be required for the actual repair. I HEREBY AUTHORIZE SAN PABLO AUTO BODY. & PAINT TO COMMENCE REPAIRS ON MY VEHICLE PER THIS ESTIMATE. ALSO ESTIMATE GOOD FOR 30 DAYS. SIGNED DATE IT IS ESSENTIAL TO HAVE THIS COPY FOR FUTURE REFERENCES. PLEASE DO NOT LEAVE PERSONAL ITEMS IN VEHICLES. ANY REPAIRED VEHICLES LEFT ON THE PROPERTY AFTER 20 DAYS. S:HALL BE CHARGED A STORAGE. FEE OF $40 PER DAY. PLEASE NOTE: WE ARE NOT :RESPONSIBLE: FOR LOST OR STOLEN ITEMS! ! - SAN PABLO AUTO BODY & PAINT I ESTIMATE RECALL NUMBER: 3/1412008 12:48:52 1546 Mitchell Data Version: OEM: FEB-08_A UltraMate is a Trademark of Mitchell International Copyright(C)1994-2008 Mitchell International Page 2 of 2 UltraMate Version: 6.5.015 All Rights Reserved Date: 4/14/2008 02:41 PM Estimate ID: 12063 Estimate Version: 0 Preliminary Profile ID: Mitchell QUALITY BODY & FENDER 2510:MARTIN LUTHER KING JR WAY,OAKLAND,CA 94612 (510)839-3122 Fax: (510)83971726 Tax ID: 94-2769852 Damage Assessed By: John Ponce Appraised For: OWNER Payer: Customer Deductible: 0.00 Claim Number: 12063 Owner: DIZELLA CARTER Address: 988 36TH ST,OAKLAND,CA 94608 Telephone: Work Phone: (415)377-0542 Home Phone: (510)655-7899 Mitchell Service: 912121 Description: 2004 Honda CR-V EX Vehicle Production Date: 1/04 Body Style: 4D Ut Drive Train: 2.41-Inj 4 Cyl 4WD VIN: JHLRD78844C031418 License: 6KHL496 CA OEM/ALT: O Search Code: None Color: RED Options: ALUM/ALLOY WHEELS,AUTOMATIC TRANSMISSION Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation Description Part Number Amount Units 1 201219 REF BLEND R REAR DOOR OUTSIDE C 1.0 2 201231 BDY REMOVE/INSTALL R REAR OTR BELT MOULDING 0.6 # 3 202445 BDY REMOVE/INSTALL R REAR DOOR CLADDING 0.4 4 201283 BDY REMOVE/INSTALL R REAR OTR DOOR HANDLE 0.4 # 5 900500 BDY* ADD'L LABOR OP, NIB SAND&POLISH Existing 1.0* 6 201476 BDY REPAIR R QUARTER OUTER PANEL Existing 6.0*# 7 AUTO REF REFINISH R QUARTER PANEL OUTSIDE C 2.4 8 201500 BDY REMOVE/INSTALL R QUARTER WHEEL OPENING MLDG 0.2 9 201524 BDY REMOVE/INSTALL R LWR QUARTER TRIM PANEL Existing INC 10 201553 GLS REMOVE/INSTALL R QUARTER GLASS 1.5 # i 11 201868 BDY REMOVE/INSTALL R REAR COMBINATION LAMP 0.9 # 12 201893 BDY REMOVE/INSTALL REAR BUMPER ASSY 1.0 13 936012 ADD'L COST HAZARDOUS WASTE DISPOSAL 300 14 AUTO REF ADD'L OPR CLEAR COAT 1.2 15 933003 REF ADD'L OPR TINT COLOR 0.5* 16 933005 BDY ADD'L OPR RESTORE CORROSION PROTECTION 12.00 * 0.3* 17. 933018 REF ADD'L OPR MASK FOR OVERSPRAY 5.00 * 0.3* 18 AUTO ADD'L COST PAII4T 178.50 * * -Judgment Item #-Labor Note Applies C-Included in Clear Coat Calc ESTIMATE RECALL NUMBER: 4/14/2008 14:41:42 12063 Mitchell Data Version: OEM: MAR_08_V UltraMate is a Trademark of Mitchell International i Copyright(C)1994-2008 Mitchell International Page 1 of 3 Ultra Mate Version: 6.5.016 All Rights Reserved I 1 Date: 4/14/2008 02:41 PM Estimate ID: 12063 Estimate Version: 0 Preliminary Profile ID: Mitchell Estimate Totals Add'I Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount Body 9.8 79.00 12.00 0.00 786.20 Refinish 5.4 79.00 5.00 0.00 431.60 Total Replacement Parts Amount 0.00 Glass 1.5 79.00 0.00 0.00 118.50 Non-Taxable Labor 1,336.30 Labor Summary 16.7 1,336.30 III. Additional Costs Amount IV. Adjustments Amount Taxable Costs 178.50 Insurance Deductible 0.00 Sales Tax @ 8.750% 15.62 Customer Responsibility 0.00 Non-Taxable Costs 3.00 Total Additional Costs 197.12 1. Total Labor: 1,336.30 11. Total Replacement Parts: 0.00 III.. Total Additional Costs: 197.12 Gross Total: 1,533.42 IV. Total Adjustments: 0.00 Net Total: 1,533.42 This is a preliminary estimate: Additional changes to the estimate may be required for the actual repair. Insurance Co: Owner To Pay Authorized and Accepted: I hereby authorize to make the specified repairs from attached Estimate. I understand that payment in full for the repairs will be due upon release of vehicle, including additional supplemental damage charges. I hereby grant Quality Body & Fender's employees permission to operate the vehicle on streets, highways, or elsewhere for the purpose of testing and or inspecting vehicle.•. An express lien is hereby acknowledged on the vehicle to secure the amount of the repairs. Owner of the vehicle will not be held responsible for loss or damage to the vehicle due. to fire, theft, and accident while in custody of Quality Body & Fender. Quality Body & Fender will not be responsible for any lost or missing articles or items left in the car. Once customer is notified of vehicle repair completion, vehicle must be picked up .within two .business days, otherwise storage charge will accrue at $40•.00 a day, as of the second business day completed. I hereby consent a verbal authorization for the original repairs, or an increase from the original repairs specified to me. All parts removed ESTIMATE RECALL NUMBER: 4/14/2008 14:41:42 12063 Mitchell Data Version: OEM: MAR-08_V UltraMate is a Trademark of Mitchell International Copyright(C)1994-2008 Mitchell International Page 2 of 3 UltraMate Version: 6.5.016 I All Rights Reserved Date: 4/14/2008 62:41 PM Estimate ID: 12063 Estimate Version: 0 Preliminary Profile ID: Mitchell from the vehicle will be junked unless otherwise instructed and specified by owner of the vehicle in a timely manner. Signing this document acknowledges receipt of the final repair order and will put in effect the Guaranty given by Quality Body & Fender after. completion of repairs on the vehicle. All unibody/Structural Repair specified on final repair order is guaranteed lifetime as long as you own the vehicle. All paintwork specified on final repair order is guaranteed 60 months (5 years) , against peeling, cracking, or checking. All mechanical repairs specified on final repair order are Manufacturer Warranty for 1 year. All Guaranty work for the vehicle specified on hte repair order should be brought back to Quality Body & Fender, in order to fufill the Guaranty. If vehicle is taken elsewhere, the guaranty is automatically revoked. No exceptions. Authorizing Signature Date Insurance Coverage Confirmed: Yes NO. Owner to Pay: Yes NO Repairs Inspected By: Date ESTIMATE RECALL!NUMBER: 4/14/2008 14:41:42 12063 Mitchell Data Version: OEM: MAR-08_V Ultra Mate is a Trademark of Mitchell International Copyright(C)1994-2008 Mitchell International Page 3 of 3 Ultra Mate Version: 6.5.016 All Rights Reserved MEMORANDUM TO: Beth Campbell FP OM: Dizella Carter DATE: February 20; 2008 CC: Rudy Tamayo ' Joseph•Villarreal SUBJECT: Personal Vehicle Damage on Bayo Vista Property I drove into the parking lot of 120 California St by unit 799.on Tuesday,February 19, 2008 at about 4:1Op.m. .I park to look at the hillside with Robert Moore and Ted Ancheta. While leaving the parking area I went to back out and there are like six(6) metal poles that are there I was driving very slow and the_ passenger.back side of my car scraped one of the post and damage my car. The reason for this is I thought I clear the pole and did not because you cannot see the poles because_ there is no color caution around the poles and they are too low to see.- I will be getting estimates and want to know whom do I give them to, so that my vehicle can be repaired. I have pictures of the area and my car. I also asked the maintenance supervisor to put some yellow taping around the poles and maybe get some kind of plastic covers to cover the poles. .I appreciate what can be done to get my vehicle repair. • i G February 25, 2008 Dizella Carter Via Email Dear Ms Carter: Claims relating to the damage of personal property or injuries must be presented to the Board of Commissioners of the Housing Authority of the County of Contra Costa. Enclosed is a claim form,with instructions, which should be completed and mailed to ,! the Clerk of the Board within six months from the date of the incident. Once your claim form has been acted on by the Board of Commissioners of the Housing Authority of the County of Contra Costa notification will be mailed to you by the Clerk of the Board. Sincerely, Judy Hayes Administrative Services Officer Enclosures cc: Mr. Brandon Schlenker Carl Warren & Co. P.O. Box 3975 Walnut Creek, CA 94598