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HomeMy WebLinkAboutMINUTES - 05062008 - C.10 APPLICATION TO FILE LATE CLAIM' BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA BOARD ACTION Application to File Late Claim ) NOTICE TO APPLICANT`S "` Against the County, Routing ) The copy of this document mailed to you is you Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to ) the Board of Supervisors (Paragraph III,below), California Government Code.) ) given pursuant to Government Code Sections 911.8 and 915.4. Please note the "WARNING" below. ` aa Clalmant4chak(L M.QXth 6nC )OmW5 . • ��6g BVD Attorney: Yl/Ccf I, 2 MAR 14 2008 Address: �p� �w Q 31 COUNTY COUNSEL MARTINEZ�C,A�IF. w Amount: Z , / By delivery to Clerk on: I I Date Received: 10 By mail,postmarked on: 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted Application to File Late Claim. DATED:rYt" J`t' IZ05 . �101IN CI II..,1,EN, Clerk, By: ( DEPUTY II.. FROINI: County Counsel TO: Clerk of theiBoard of Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911.6)i . (� The Board should deny this Application to File Late Claim (Section 911.6). DATED: 3- 1 -/—0O SILVANO B.MARCHESI, County.Counsel, By:. m DEPUTY III.. BOARD ORDER By unanimous vote of Supervisors present (Check one only) " ( ) This Application is granted (Section 911.6). This Application to File Late Claim is denied (Section 911.6): I certify that this a true and correct copy of the Board's Order entered in its minutes for this date. DATE: JOIi.N CLI.L-LFN, Clerk, B DEPUTY WARNING (Gov. Code§9).8) If you wish to file a court action on this matter, you must first petition the appropriate court for an order relieving you from the provisions of Government Code Section 945.4 (claims presentation requirement). See Government Code Section 946.6. Such petition must be filed with the court within six (6) months from the date your aulication for leave to present a late claim was denied. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney,you should do so immediately. IV. FROM: Clerk of the Board TO: (1.) County Counsel (2) County Administrator Attached are copies of the above Application. We notified the applicant of the Board's action on this Application by mailing a copy of this document, and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. DATED: JOIIN CULLEN•, Clerk, By: DEPUTY V. FROAL 1) Courify Counsel .(2) County Administrator TO: le .k of he Board of Supe isors Received copies of this Application and Board Order. DATED: Countv Counsel, By: County Administrator, By: APPLICATION TO FILE LATE CLAIM APPLICATION TO FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA BOARD ACTION Application to File Late Claim �J Pp ) NOTICE TO APPLICANT . Against the County, Routing ) The copy of this document mailed to you is your Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to ) the Board of Supervisors (Paragraph III, below), California Government Code.) l given pursuant to Government Code Sections 911.8 and 915.4. Please note the "WARNING" below. I Clalmant:`R l cko t Pj v l ! r , n-ow r Attorney: rt/cL MAR 14 2000 Address: �'�()� C1C�CLt'1_ C�76 COUNTY COUNSEL MARTINEZ CALIF. Amount: ? Z.,rj /1��1��. By delivery to Clerk on: , r-0 f � � Date Received: By mail,postmarked on: 10--C)s I. FROM: Clerk of the Board of Supervisors TO: . County Counsel Attached is a copy of the above noted Application to File Late Claim. DATED:r udl {'t �Z ��� �JO:H:N CULLEN, Clerk,By:- 1(AU/' 1 V ;(av),� DEPUTY Il. FROM: County Counsel TO: Clerk of thejBoard of Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911.6) ( The Board should deny this Application to File Late Claim (Section 911.6). DATED: 3' 1 9-U 5�- SILVANO B. MARCHESI, County Counsel, By: �7��c _DEPUTY III. BOARD ORDER By unanimous vote of Supervisors present (Check one only) ( ) This Application is granted (Section 911.6). ( ) This Application to File Late Claim is denied (Section 911.6). I certify that this a true and correct copy of the Board's Order entered in its minutes for this date. DATE: JOHN CULLEN, Clerk, By: DEPUTY WARNING (Gov. Code §911.8) If you wish to file a court action on this matter, you must first petition the appropriate court for an order relieving you from the provisions of Government Code Section 945.4 (claims presentation requirement). See Government Code Section 946.6. Such petition must be filed with the court within six (6) months from the date your application for leave to present a late claim was denied. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney,you should do so immediately. IV. FROM: Clerk of the Board TO: (1) County Counsel (2) County Administrator Attached are copies of the above Application. We notified the applicant of the Board's action on this Application by malling a copy of this document, and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. DATED: JOIN CULLEN', Clerk,By: DEPUTY V. FROM: (1) County Counsel (2) County Administrator TO: Clerk of the Board of Supervisors Received copies of this Application and Board Order. DATED: County Counsel, By: County Administrator, By: A' APPLICATION TO FILE LATE CLAIM REEVED D Ll MAR 1 1 20.08 �T7�. .ER'l.BOARD OF S;;?ER ;SORS s= ti C : CONTRA COSTA C`b. =— ^ L 1 cv LF r' 1 1 � r • w. : Nn r - fT, ,. W" 'tin �," • i . "1Cr'.. t„M- __<J.. ..... 'i`a%',�✓ .. S f)'1 OI.��1.C� .. fes- .. ..... t� ,..�, t -�o r O F'1 1 44.1 e 1# ..r © �. _.. . ° $ r e"" to . . `4 ; L i sari �:n�` i �r f I : -. mss . .- 1-� g . ts�v JI .; r r1ON : r :; Ar�� ,©�C : . �� ►erg. �.ta���`, ..... .. ... : { �` c" � BOARD OF SUPERVISORS OF CONTRA COSTA COUN 1 1 . INSTRUCTIONS TO CLAINLANT 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 § 9I 1.2.) 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 1<..itlkiard M ny 4 I r_i l gra sOn cc(I'Lis�-i) Against the County of Contra Costa or ) FEB 1 OAR DistnCt) cop/ OF 7- •IsORs (Fill in the name) - - -- ) �e, oos�R co VIS The undersigned claimant hereby makes claim against the County of Contra Costa.or the above-named district in the sum of$�.Sm;the i1 and in support of this claim represents as follows: f1. When did the damage or injury occur? (Give exact date and hour) a .G6 ,cam:— N v c"V „` •.� '��I . �r 1 �2. Where did the damage or injury occur? (Include city and county) .i....a a; fie.-:sd w.'F{..y Z'\'Kry �>Gu.: .• �..,;IrF+•y�•. _ �� Vy. �..�iY,T1ve `'1 i4�'t':�. ����i /3. How did the damage or injury occur? (Give full details; use extra paper if required) t ' r /4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? 5 What are the names of county or district officers, servants, or employees causing the damage or injury? FQ 1 e`�4 1 Tan, - �e M .. R� i 6ems, 4--'e : p�„ ar- ;• t'. E ..y G l b ? ., t'nR sr�5 c k� 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) o., /7. How was the amount claimed above computed? (Include .the estimated amount of any prospective injury or damage.) wrlqe.S �C1rJ S41ress C 0 € - E 4'nr�,►f y x - � �,v out or ST�Tt=. I Z1 :r-) C ON, (fN z t s�=' �e 1N y JNames and addresses of witnesses, doctors,and hos itals. be i lei t-4�As:r,� a *r � %14A For r e E� 1' was a�t agr as LA;/, 6 F (9� List the expenditures you made on account of this.accident or injury: f ' DATE TRVIE AMOUNT 1—`:.m".-ce- 64 ■aaaaaaaaaaraascae.■�aaaaaaaaaaaasa�aaaaararaaaaaaaaataaa■a■raa■raraaaarraa■ ■ ■ aa�raa� ) 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 Attorneylzk K4, ( aimant s Signature) (Address) -CAI ki )Telephone No. Telephone No� ■■OREN■■aaa■■aaaaaaaauaaaaaaaaEMOaEMowns oamuumuu aaaaaaaa■aa■ ■■aaaaaa■i 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. ■■raaraaaaaaaaaaraaaaa■■aaraaaaaaaarraaaaaaaaa■■aaaaaaaaaa�aaai�aaaaaaaaao■ ■■arrrrr�i NOTICE: Section 72 of the Penal Code provides: Every person who,with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city, or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account voucher, or writing, is punishable either by imprisonment in the 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 ofnot exceeding ten thousand dollars. ($10,000), or by both such imprisonment and fine. f , '.. .. ... 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CES.{a�'�� .`:•_.. .. ........ ... .. rr �, rte. �,- ��� .•� . :r Eoi41 (\io � o r :r i .4 v p .eIr i i - A- U) r. d� o cc:) > �l Uj o L N ±i! l r L O r-i G J �Q Lu ¢ z mo — Y .r—• r � LU U r 2 w - 'C .......o The Boat•d of Supervisors Contra John Cullen Clerk of the Board Costa and Countv Ad):ninistra.tion Bilildino County Administrator 651 Pine Street, Room 106 County (925)335-1900 Martinez, California 9455;-4068 John Gioia.District I cd�`'_sE t on Gayle 13.Uillcctrra.District 11 •' 1•l ary N.Pie!rho.District Ill Susan A.Bonilla, District IV 1.ederal D.Glover, District V 1 Richard Martin Gonshorowski #Q - 39 2006019401 Martinez Detention Facility 901 Court Street Martinez, CA 94553 RE: CLAIM OF RICHARD MARTIN GONSHOROWSKI NOTICE TO CLAIMANT OF LATE-FILED CLAIM (Government Code Section 911.3) The claim you presented to the Board of Supervisors of Contra Costa County, California, as governing body of the County of Contra Costa on February 12, 2008 has been reviewed by County Counsel and is being returned to you herewith because: x Your claim relating to a cause of action for death or for injury to person or to personal property or growing crops was not presented within six months after the event or occurrence as required by law. (See Government Code sections 901 and 911.2.) Your claim relating to a cause of action for anything other than injury to person or to personal property or growing crops was not presented within one year after the event or occurrence as required by law. (See Government Code sections 901 and 911.2.) Because the claim was not presented within the time allowed by law, no action was taken on the claim. Your only recourse at this time is to apply without delay to the Board of Supervisors of Contra Costa County for leave to present a late claim. (See Government Code sections 911.4 to 912.2, inclusive, and 946.6.) Under some circumstances leave to present a late claim will be granted:, (See Government Code section 911.6.) You may seek the advice of an attorney of your choice in connection with this matter. If you desire to consult an attorney, you should do so immediately. Date: Z g o JOHN CULLEN, Clerk of the Board of Supervisors and County Administrator By: D uty .� Enclosure CERTIFICATE OF SERVICE BY MAIL (Code Civ. Proc., §§ 1012, 1013a, 2015.5; Evid. Code, §§ 641, 664) I am a resident of the State of California and over the age of eighteen years, and not a party to the within action. My business address is Clerk of the B and of Supervisors, 651 Pine Street, Room 106, Martinez, CA 94553. On I served a true copy of this Notice to Claimant of Late-Filed Claim by placi g the 6ocuriTent in a sealed envelope with postage thereon fully prepaid, in the United States mail at Martinez, California addressed to as set forth above. I declare under penalty of perjury under the laws of the State of California and the United States of America that the above is true and correct. Executed on at Martinez, California. Deputy Clerk Page 2 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: MARCH 18 , 2008 Claim Against the County, oi• District Govemed 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: $2.5 million Section 913 and 915.4. Please note all "Warnings". CLAIMANT: RICHARD MARTIN GONSHOROWSKI #Q — 39 2006019401 ATTORNEY:UNKNOWN DATE RECEIVED: FEBRUARY 12, 2608 MARTINEZ DETENTION FACILITY FEBRUARY 12, 2008 ADDRESS: 901 COURT STREET, BY DELIVERY TO CLERK ON: MARTINEZ, CA 94553. BY MAIL POSTMARKED: FEBRUARY 11, 2008 r-� RO.M: Clerk of the Board of Supervisors T0: County Counsel o W J Attached is a copy of the above-noted claim. 0 =UFEBRUARY 12, 2008 JOHN CUL LEN q)ate _ By: Deputy C I I.T.. M.: County Counsel TO: Clerk of the Board of Su rvisors m LJ_ a: claim complies substantially with Sections 910 and 910.2. e ) 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). (,.,r�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 fo►' leave to present a late claim (Section 911.3). ( ) Other: Dated: _ �� -()� By: Deputy County Counsel i.II.. FROM: Clerk of the Board TO: County Counsel (1) County Adi-ninisti-ator (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 coi7•ect 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 exceptiais,you have only six(6) months fro►n the date this notice was personally served or deposited in the nkail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice ol'an attorney of your choice in connection with this matter. It'you want to consult an attoniey,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 1.8; and that today t 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: JOFIN CULLEN, CLERK By Deputy Clerk C� vv` '��` BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAEgANT 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 Against the County of Contra Costa or ) FEB Jknk�11a �len^Ar4 ) C�ERKB 1 2 2008 P0121 Distract) CONT �OFsup (Pill in the name) ) RA COSTA Cpp��SOAS The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$,0-.5-m i));aAJ and in support of this claim represents as follows: f1. When did the damage or injury occur? (Give exact date and hour) e=9nN 'Dec (o 0 .2.00(o, C.o"JI;r4VOOS Since 4ben.l pl['q`a�. . °�e� �x�ln►,� A�I dam► 'p '. ✓2. Where did the damage or injury occur? (Include ciy and county) TKA c� 4a ±y �r � � �`�� ►u�i � ,Iti �, V/3. How did the damage or injury occur? (Give full details; use extra paper if required) PleFlsr- Se C. -xPlt m q4i ori 5. 3 . E.xP1q;rrc t W14 ! ✓4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? , 5 What are the names of county or district officers, servants, or employees causing the damage or injury? Tory Tlemlr Iy rl�oih 0� C c*44 rr) G5••! ,,b)is ' ' 'e�.+ r r' t ► ��. ' ✓ 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) �• /7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) tA_.,14Zge51 LA.,-0rry I 54ress cA254 a$ me 4m,i l y tG j W40 ft_VV►N ,. OUT OF TPTIr• rMl CN 44P 0 8. . Names and addresses of witnesses, doctors, and hospitals: �, 5 ,A e C ��m �► be �Ited A9A►NS� 5i}er 114w 10 'For re�vSt�vCs ,ri,�; sc�v�Gr. . .�ti � � r wrls dlosed w/ M. 2.5.x, hl n�►tz. i�ogp� loci rn'f JCJ List the expends es you made on account of this accident or injury: DATE TWE AMOUNT see t-rNeal4k hCre ev L ■■rrrrrerrrrrrree■rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr■I 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) 1 Name and address of Attorney ) (Claimanis Signature) QOl COW 4 51. Q -3� (Address) �`flArc�Jnc�z C�1 ��. �i�i5s"3 ) Telephone No.9�5 �-`8`oiy00 )Telephone No. ■■rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrro01ranErrrorrrrrowrrrrrrorarrrraanENrrrt 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 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. ■■rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrirrrrrrrrSEMEN Nam rrrrri 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 ($10,060),or by both such imprisonment and fine. cc l'o Dec - 0(9 Her-Y-Alec-t o ryoT his CI le- t e tr ��ovecl � � , 15o1Ai�Ot�J Q- rnDd - IIV'IpFG �1Se IrrihIr n,)o J- �+ _ P y �' so he CcvIJ im4e.rvtew me, owns --rrvM tL . , C1.t e�-� Ian ariC ��e9; ►� I �. Whish Z c teras the, Tco5ecu41or4 5t�e cvA , wuc 1s 40 Mt , ,t N. kc prc seN ce cx Kuri klv 400 ver well . im4crv1L w 4OU L-t),14 Ike. I:�o�ll� o -{' fou Dly Ike gAwc �`aclA S a d it) ClLf y 39 o �`�i s module • ,T�c �I ��� s -��nuc v�� pec et \-)C i�e.�tr't ti, q,,7- P5L -1';I 7y n-)ove c1 av 4 off-. 64 1.14"C- I mDf (e4ur(Q coil Hire �n 1 - se Pvvscd A I oma,c C)ui R I oN e -� g 1 e,�o r+e I �r nr•�5��o r�e d 64i>.��er^e ! ever`1 {� N A I LW�. THoosta"Ds v e carr, here t 0)c- o r- LI 4 i'me s . -r bei p I 1 se c- Gc?r%,►s kUrzu wsk t z)f, I I oN GZ T roe Nb 4 P11 off' 4kern Mare , S-A itis- percenA:,� h A-� IN�prmp►�t4.. -for -1 kc (NOW. Cxx tkvjrows�,� Bowes) Toc.)e 2 nlnfa yr Geos mRde I j ieo/C�to I As w -the. �r�sec���oN 18�. m.e s .r . . �i.1�►s . . . +i.r n r, ....... E- r+o.�� : .N.o.. _ .._y. - Tl�e...... .-�Cx�r. • .... . .... .. . : ... ... ..... .... . .. -Ivw��e� .� ��v� d N.;eJ.l�y PA tj 5c hos R mwniC�A -�or� 515N . . .... N . - -Fa eACk +t r�e No+ 9Rc.rnern �pv came +o . me. ' ` borne.. R 1oN� • •runi lc .l IY. e c� y A- -��.c T e- b�N L't jae zkj P►u�d _. -.SAS d Cx00 �4 . -�:elE 'f M gotcme IN cve . boy du II V� o i s dot . - � T�m _►s gory� �nl 5�-� � I c�� ( . I.� 4�CO see r ComJes s ... Ao . vc ve.. beco 1 00 N ► 9 � . • . ! 6 kec-e. t.4 . wt I t )ook. 11 kc �--F1 V 1.51. - ._..'t rOng �D�v tCS r iC'. r�� /Q$ ._ ff He gold mc, -fo bca 5o.lc4 , Ic4 Jh{ ,;, (- l I blot,..? s Q e- f c1 �� e J"�t�t1► c r� ! S t ^b0�i-� 4 CAmi Nok re, v\1 -4 o rn�. I'lc�nlG coo , l Coro�r n CsA p ) 4o l v c eve (nF)N� e,A,,hetit 4ov ScA ov-A yoo kajc 4-o Icovc A I', e. Plow c-C.+ vsel g � Cf1. 1v toc,4- re lord. 4.0 rm ton'?e , . - Owtjl CwMI J -�t1 i'c, 4o Lam. �i ►blit ^Deie�c���r �� mc I Ai m be f-)\)5c rtj()u'td VJcPA r-nc -3 , f ` L . ... ..Cvrrecl� cry :..._. :�_� �. _ r c '._ c��+ �gD__�.. _._ _ c� ►.d. (rc pen-4 oul I Kim� . ca- . ... +.5 b:r.1M95....... .. `� v ACAVolI.........uaeek.. o.. .. . .'�f�..r8�o7. .. TIMI.. ... Coo.(-� ON ... . Record. UvA ve . . . ► more. _16m...... . . . �� rnore.. ma ��s w �vel .. 1�►e TuSe. . dep 35_ Tc l4n.. .-Ic> l, �t . ..:_. .. _. � .: �E re: -l.c► . . .Cnr . oNsha�bwsk v ! .. ` �►►C-7 :. out.. T. .. .sA.� nk . . C)ov . ..... ..� l .el..I ...... y� 5. �v7 .....-...0 n'me5.. :--.....>7 o -Nd.�..__.......T.._Ar i..._._ ..... . rnN5por4eJ.. . . 4a.. C,our dere... . _.. . .�M _.►... Cis oc�� . � . CpN 4.: gel_ .. 4° CW`4,. . 5ome-lhr ry s WCON1 141. 9 CA. df)). ..5 . cP07e. _. )P've( w'14k 11v4.... fny. . CON504 � or �.rese.r�ce . T IeA.rwe.J . T rk here4 F)1nlc ! �Ics Coucse .114 . . 0ocumeTorn -�'�emr,�9 . .goes. off. (00 dA.1. Soh ,-etc I .. I hus.... brir\is ON. the Lj ARMS -tor3Ge-441N IQ . CAP)nl N J Qves4loN5 f)re Lvc)Cori)C'. Wavld -Ire kc, _ Ro) r r ph Ules IVIS r\lmo F)14crNe�l I tig Atj I kcwy F' She aP,S - Ll5g - 2'4 00) (.I0i R lc knr G i!5 . ter-f i b)SCRce 40 II CMA 40 frit 'F C� I I his :C.c I 1 p1-,&Ne 1`1 T)UN9e r' i`if1 ; Chi 5�cr's K r4ow h(c) I,{ %tq 04 -I h'f 5 Prov 40 e %1er%-J cine -ti- of t\io4 ll rN!f . hn ppeo-5 4c, ilvm becot,)5e o� A ., f Ili.-51 Proce vrc Lo ON9 N. have . del )ed oul +.+ere Jwr-5 , Hcl .l MFl24� rel Fir(� 9ocl 1 nrq kvu> PCLUJ [,..\c 1 � - 1eASe 14ot4oc. C.I Fl►ry1 � `��me � � lz t 2 i ° d Cb o f co CL -� raj � i a The Board of Supervisors Contra John Cullen Clerk of the Board. Costa and Cowin,Administration Building count•Administrator 65 1. Pine Street, Room 106GOUnty (925)335-1900 Martinez, California 94553-4068 John Gioia,District I ��'�-sE-L •�� Gayle B.Uilkema,District 11 ti Mary N.Piepho,District III Susan A.Bonilla,District IV . . is Federal B.Glover, Dislricl V 01 x•,._... sr'4 covir"� Richard Martin Gonshorowski #Q - 39 2006019401 Martinez Detention Facility 901 Court Street Martinez, CA 94553 RE: CLAIM OF RICHARD MARTIN GONSHOROWSKI NOTICE TO CLAIMANT OF LATE-FILED CLAIM (Government Code Section 911.3) The claim you presented to the Board of Supervisors of Contra Costa County, California, as governing body of the County of Contra Costa on February 12, 2008 has been reviewed by County Counsel and is being returned to you hereWith because: x Your claim relating to a cause of action for death or for injury to person or to personal property or growing crops was not presented within six months after the event or occurrence as required by law. (See Government Code sections 901 and 911.2.) Your claim relating to a cause of action for anything other than injury to person or to personal property or growing crops was not presented within one year after the event or occurrence as required by law. (See Government Code sections 901 and 911.2.) Because the claim was not presented within the time allowed by law, no action was taken on the claim. . Your only recourse at this time is to apply without delay to the Board of Supervisors of Contra Costa County for leave to present a late claim. (See Government Code sections 911.4 to 912.2, inclusive, and 946.6.) Under some circumstances leave to present a late claim will be granted. (See Government Code section 911.6.) •Y st You may seek the advice of an attorney of your choice in connection with this matter. If you desire to consult an attorney, you should do so immediately. Date: JOHN CULLEN, Clerk of the Board of.Supervisors and County Administrator By: Deputy Clerk Enclosure CERTIFICATE OF SERVICE BY MAIL (Code Civ. Proc., §§ 1012, 1013a, 2015.5; Evid. Code, §§ 641, 664) I am a resident of the State of California and over the age of eighteen years, and not a party to the within action. My business address is Clerk of the Board of Supervisors, 651 Pine Street, Room 106, Martinez, CA 94553. On , I served a true copy of this Notice to Claimant of Late-Filed Claim by placing the document in a sealed envelope with postage thereon fully prepaid, in the United States mail at Martinez, California addressed to as set forth above. I declare under penalty of perjury under the laws of the State of California and the United States of America that the above is true and correct. Executed on at Martinez; California. Deputy Clerk : Page 2 APPLICATION.TO FILE LATE CLAIM r BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA BOARD ACTION Application to File Late Claim ) NOTICE TO APPLICANT Against the County, Routing ) The copy of this document mailed to you is your Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to ) the Board of Supervisors (Paragraph III,below), California Government Code.)' ) given pursuant to Government Code Sections 911.8 and 915.4. Please note the"WARNING" below. Attorney: YVtL. Address: L/110( COCOA- , C Amount: i' Z'6 fInL By delivery to Clerk on: ; ITO I Date Received: By mail,.postmarked on:! 10­03 I. FROM: Clerk of the Board of Supervisors TO: . County Counsel Attached is a copy of the above noted Application to File Late Claim. ` ( ' DATED: : JO.1-JN CULLEN, Clerk, By: � ^ DEPUTY II.. FROM: County Counsel ' TO: Clerk of thejBoard of Supervisors ( ) The Board should grant this Application to File Late Claim. (Section 911.6) ( ) The Board should deny this Application to File Late Claim (Section 911.6). DATED: SILVANO B. MARCHESI, County Counsel, By: DEPUTY 11I. BOARD ORDER By unanimous vote of Supervisors present (Check one only) " ( ) This Application is granted(Section 911.6). ( ) This Application to File Late Claim is denied (Section 911.6). I certify that this a true and correct copy of the Board's Order entered in its minutes for this date. DATE: JOHN CU.LLEN, Clerk,By: DEPUTY WARNING (Gov. Code §911.8) If you wish to file a court action on this matter,you must first petition the appropriate court for an order relieving you from the provisions of Government.Code Section 945.4 (claims presentation requirement). See Government Code Section 946.6. Such petition must be filed with the court within six (6) months from the date your appJcation for leave to present a late claim was denied. You may seek the advice of an attorney of your choice In connection with this matter. If you want to . consult an attorney,you should do so immediately. 1V. FROM: Clerk of the Board TO: (1) County Counsel (2) County Administrator Attached are copies of the above Application. We notified the applicant of the Board's action on this Application by ,Halling a copy of this docuineut, and a memo thereof has been filed and endorsed on the Board's copy of this Claim In accordance with Section 29703. DATED: JOHN CULLEN',Clerk;By:. DEPUTY V. FROM: (1) County Counsel (2) County Administrator TO: Clerk of the Board of Supervisors Received copies of this Application and Board.Order. DATED: County Counsel, By: County Administrator, By: APPLICATION TO FILE LATE CLAIM R E C IEP I V E MAR 1 1 2 I08 CLERK BOARD OF S'LjP!;-!-iikv15ORS 4r 9ijo 5 CONTRA.C0STA tD. Li (YI rm 0 21- 4o �-oic,",, I 11--i Teri- cQ, + r.0 70 ale- s u see rt d ryj re so 0" - en'k Who ktqc;ws T)m 996,49 4o tisk 441 e iA motie, 41 fyw, foc i*.wr-4 364 C905p, Jf) A do .. 100 i< �o CLL) 4c) CVI,' T\qome-+p(I po- -F'ra� s P.(,e � (-)C�C2 Ste , ����� I�C) 1 ?-7 G ('q I -0--f3$_ 7 r ' • D j ga Pit izN r. - -o _. s BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. A claim relating to a cause of action for death or for injury to person or'to personal property or growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be presented not later than one year after the accrual of the cause of action. (Gov. Code § 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be fled against each public entity. ; E. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form. ■ a a r r t t I I■t■■t■■■t■i•■■■i■t■t t■■■I 114110 1 1■■■■■■■■i t■■t t■■man wool RE: Claim By: Reserved for Clerk's filing stamp X v 6A irA M P,?4 i rj Grvm4)arVAAA10 ) Against the County of Contra Costa or ) FEB -Jjp\\. s A CA 1e r n Ja i. ) C/ 2 ?008 J?vV7L —rC-mA r District) CO rRAOFSIJp� (Pill in the name) ) Re / co'SrR CORS The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$,:;2, M i 1)i cal and in support of this claim represents as follows: f1. When did the damage or injury occur? (Give exact date and hour) `P1e�as� dee. �x�lr� rp�► P"I . �2. Where did the damage or injury occur? (Include city and county)M1 �3. How did the damage or injury occur? (Give full details; use extra paper if required) /4. What particular act or.omission on the part of county or district officers, servants, or employees caused the injury or damage? 5 What are the names of county or district officers, servants, or employees causing the damage or injury? J6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) OQ /7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) l.vrqe5, tA;ocrl co. -::;4 01 0,wC� ��1t't -�p�ce APJ�O �v t N OUT o F SToaTF � a I: 8.� Names and addresses of witnesses, doctors, and hospitals:d'"'� eyt rk• -; ,- he ,led ASAV,14 SMf-i' � AA 9 ror re ltl4 ecav� "' �► } Wo List the expenditures you made on account of this accident or injury: lJ DATE TFVIE AMOUNT 4 � see, w%ealerk ■rrrrrrrrrrraresar.■errrrrarraaarararrarrraraarrrrrrrrrraraaaerrraaararaarrrrraaraa�r, ) Gov. Code Sec. 910.2 provides"The claim shall be ) signed by the claimant or by some person on his behalf." SEND NOTICES T0: (Attornev) Name and address of Attorney (Claimant's Signature) f q01 opjrC4 ;I. Q -39 (Address) ) a l�1t�I� 11 � 9� t 81553 ) Telephone No � Telephone No. ■■�aaraaaaaararaarrarrrarrrraaararaarrraarraarrrrrrrrrararaaarrrrrarrarararrrrarrrrai 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, §§ 5500 et seq.) Furthermore, any attachments, addendums,or supplements attached to the claim form, including medical records, are also subject to public disclosure. ■■aar0a0arr5ar90000aa0raaaaa000a0aaa0raaaa000r0a0aaa00ra00rrari11aarr0a0rrrrr0aaraaaaI 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. cm 9 D UPJ �pcjDec Q � ybblp « _ _ n�� r � ,.:_ . ►�o� _anis_ cl._�e �- fnov�� So- Ise Gou 1.J i ii�er v e�' LO :.rte e -)w n- I __ r'caav, GL . � c,�4 C;,j, Arra..-Frc�Oq. :. .LK WIWI c- _ � �A� ... �tC. ._ ._.:�S.S�.`.7T. `���; ��®`�eCt�"�'1 ®nf• �Q�� _cS..�s,��`7fi�a _ .. CA led cbulc� qou- 1► moo_ _ mm� ,• 0. - . _. - -(__R.-A. - .. . o . • � Bd Vol ® vr� ._® . A005 .) �Ppp I C)-3 0I ( Klofa: VlaeoS PlAde tk o -- --_ �.�1 -- moi ._.:- �•c '. -- - --- -- -- - ------ = ---- G fl �. D -- ---- . - { r a a -- -------[ p°-lams-' ---- fot - �1 00, p - c��.�_._ .. o we -('DAV 7614 'Orn Cie/P,� Over � ge..- : rk 6 � � . . i� � c.� Ar • ! ori-� . . f19; b the �'� ata a y ' 4 i t V. . tam e oll lop'vc, 110 (IF ry el r --- -tri ---- - - -- _.; _.c�.tre..._ . -�rp_fta-�,. - ----_I om �e m �+9 _wAo_ _eco-- - -- - __---_-_- - �� ----::rnoe =no. _ . --w1 ►-ue J�--- �i e-- J u05e S 1::N 1-8 -- Sou 1,3 8-S- ...--��'�' '�----------- ---+c) rn ----a'-�-=�--- -,--- -=---:_:___ � 7__,�---C� --�s----��ou�►d-'�--=-1— ---�o+----------- � s 4 -= - -4Q - cwt 4h C-ni --o-r - --.ire_'e.Nce - -. ._ IeArooe. .- --- -!l[*107. --Depuil. e T6Ir cec � —gees- - _o - - �L0Ck) Crd I wt('IOU( P&A115 . C0f . alF 1 bT tii_-e_ e NA arm(cl -5hoof - rti�1 ' e � p PP N01- _ � ._... . - ..-... NI rn G�4;P -?Qhli(, l - - -!:--Co ..IL - _ l" c�. _ C d�R �c --- � Tejo, Sous u 5 3 4o. pipf Qves4iO'N5... are. w(�)curese-.• 4n kc, ell s� F ttj 4hoNy A5kc 9a,5 - LIS6 - 2 14 00) m et Sure 4,e ov RickAr� Rm Scared - 4o coin._ ( ����,�� . c� , 'Df)o �s z 1 S��_c _.fir,%d �._ A �@r _ b��.�� .���:°�'i=�=��� ��� �-o`6-ojuG�� � CAN �i 4S ce-1� ��®tee._• �� �®Un"ge r' 64 pr � . . _.. . _ INS OPA - mei. . hAv ._ ��1 ��� ooh op . -eke( . r 5 Z i.• CS" �(::p t o o 614': M).y � �t N w° ", cL 1 t 1 l f / ' �.A,I CLAIM HOARD OF SUPERVi:SO.RS OF CONTRA COSTA COUNTY BOARD ACTION M Claim Against the County, or District Governed b g Y Y ) the Boai•d 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 ��6g IIV�D on your claim by the Board of Supervisors. (Paragraph IV below), MAR 2.8 2008 given Pursuant to Government Code AMOUNT: 1.:gn.j,,_a0U_)" COUNTY COUNSEL Section 913 and 915.4. Please note all MARTINEZ CALIF. "Warnings". CLAIMANT: ��,IY1.tLTf 1 ATTORNEY: �,•(d,tu U L: i DATE RECEIVED: � I�rlG1�'U'► � X300 � �Lu�y 5� 3 . ADDRESS: BY DELIVERY TO CLERK ON: O t CAa J BY MAIL POSTMARKED: V l ZLCC4 FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim . JOHN CULLE lerk Dated: kw' , h c�-7� OLM g By: Deputy 'lFrtdiGt��l.Gt-��� 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( 4)-fliis claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). O Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send waining of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: By: rn 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). 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 00er entered in its minutes for. this date. Dated: o(o JOHN CULLEN, CLERK, By Dep y Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6) months fi•oin theda a 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 Addidcxial Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I ani now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today i deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this .board Order and Notice to Claimant, addressed to the claigian.t as shown above. Dated: JOHN CULLEN, CLERK By eputy Clei•k CLAiM BOARD OF SUPERVISORS OF CON'r.RA 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 Section 913 and 915.4. Please note all AMOUNT: l�l`l�i'lt'tL?f` I CLAIMANT: �NLlyu_ai'1 "Warnings". ATTORNEY: eciW'Cu-1 Gl ��°�� r � DATE RECEIVED: rI'lG,a2,� l "I; Z� ' .3c"o r urtik N�. C Laci. '(a-za. `sic_ ­Z c ADDRESS: J ABY DELIVERY TO CLERK ON: BY MAIL POSTMARKEDA'qqC•a C t'l 2—bi 71bsl FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, Clerk Dated: I V lC��u l c� !� By: Deputy [ tlF lC�c'L- I.I. FROM.: County Counsel TO: Clerk of the Board of Supervisors ( ) This clairn 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. . . 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 WARNi.NG (Gov. code section 913) Subject to certain exceptions,you have only six(6) months from the date this notice was personally seined or deposited in the mail to file a court action on this claim.See Government Code Sectim 945.6.You may seek the advice of an attorney of your choice in connection whir this matter. if you want to consult an attor*irey,you should do so immediately. *For Additional Warning See Reverse Side ofThis Notice. AFFIDAVIT OF MAILING t 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 claimaii.t as shown above. Dated: JOF-IN CULLEN, CLERK By Deputy Clerk MAR, 26. 2008 9: 09AM CCC R!CK MANAGEMENT NO. 646 2 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLARYLAW 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 zaust be filed with the Clerk of the Board of Supervisors at its office in Room 106, Couaty 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. n.D. If the claim is against more than one public entity, separate claims must be filed against each. public entity. F. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. ROOM one sun RISE 9 P—aft N as DOWNS Effam an MR UUMMINKMARE noun Owsaffeanalan NOIRE 11114RE saw CO so RR: Claim By: Reserved for Clerk's filing stamp Daman NT Ralf 1 er Against the County of Contra Costa or ) [:MAR2 6 2008 — District) CLERK BOARD OF SUPERVISORS (Fill 1n the name) ) CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-clamed district in the sum of$according and in support of this claim represents as follows: to proof 1. When did the damage or injury occur?. (Give exact date and hour) Please see Exhibit "A" 2. Where did the damage or injury occur? (Include city and county) Please see Exhibit "A" . 3. How did the damage or injury occur? (Give full details; use extra paper if required) Please see Exhibit "A" . 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? Please see Exhibit- "A" . . What.are the names of cotmty or district officers, servants, or employees causing the damage or injury? Please see Exhibit "A" Cert. Mail #7007 1490 0002. 88 MAR. 26, 2008 9 09A . CCC R18K MANAGEMENT N0. 646 P. ? 6. 7--V, daimage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage:) Please see Exhibit "A 7. How was the amount claimed above computed? (baclude the estimated amount of any prospective injury or damage.) Please see Exhibit ."A" . Valerie Johnston, DDS 8-. Names and addresses of witnesses, doctors, and hospitals: 156 D i.abl o.;::Rd. , #202, Danvi11e, CA Witnesses: Claimant & unknown officers/deputies Hosptial: Contra Costa County Medical Center, Martinez, CA 9. List the expenditures you made on account of this accident or injury: Kian Farzaneh,DDS DATE TRyiE .AMOUNT 903 San Ramon Valley Blvd. , #126 various approx. $5, 500. 00 ' Danville, CA 94526 to date ■ rat[[....■.■a..4.FRa a Una rarmoss■aones r..■.on..■■..no.Pwin.inn Raaaalraaor2 az a s as a s as 21 ) .Gov. Code Sec. 910.2 rovides``The claim shall be ) signed b atm by s erson on his SEND NOTICES TO: (Attorney) 1 Name and address of Attorney ) ) Edward C. Casey Jr. ) ( aimant'- ignature 300 Frank H. Ogawa Plaza Suite 370 ) Oakland, CA 94612 ) (Address) Telephone No. 510.2 51 . 2 3.0 0 )Telephone No. •••[.....a't[[t�[[[r Yalr■[■.•1a.rt[.[[[[.�t�ata��■�rr�1����[��1/[■�[![[OXIDE r■■e.■■•[[■1 .. PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed with the County under the Tort Claims Act; is subject to Public disclosum under the California Public Records Acta (Gov. Code, §9 6500 et seq.) Furthermore, any% attachments,addeudums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. U.111114 anon■%l r a■r■a■•agear a.r was t M■s[Y■[[■■[...■l.pump R•■A■an [ ■a■[■[[■■■[r a Y Items 0`11111 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 youcher, 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 (S 10,000), or by bath such imprisonment and fine. i I i Exhibit "A" to Claim of Damian V. Butler Law Offices of Edward C. Casey Jr. 300 Frank H. Ogawa Plaza, Suite 370 Oakland, California 94612 510.251.2300 415.39.8.5288 Facsimile: 510.251.2305 e-mail: eccasey@sbcglobal.net March 26, 2008 Clerk of the Board of Supervisors Cert. Mail #:.7007 1490 0002 8285 7567 Contra Costa County 651 Pine Street, Room 106 Martinez, California 94553 Re: Claim of Damian V. Butler Dear Clerk: Mr. Damian V. Butler hereby snakes a claim on the County of Contra Costa, including the ' Contra Costa County Sheriff's Department and certain officers and agents thereof as follows: a. The name of the Claimant is Damian V. Butler. His address is c/o 300 Frank H. Ogawa Plaza, Suite 370, Oakland, California 94612. b. The post office address to which notices should be sent is Law Offices of Edward C. Casey Jr., 300 Frank H. Ogawa Plaza, Suite 370, Oakland, California 94612. c. The occurrence(es)giving rise to this claim began on the evening of September 30,2007. The occurrence(es) took place on or near the Contra Costa County jail facility in Martinez, California. At that time,deputy sheriff personnel were removing Claimant from the back of a police cruiser. Claimant was handcuffed with his hands behind his back and was wearing a body restraint called a"wrap". Two peace officers who are believed to be deputy sheriffs violentlypulled Claimant from the back of the patrol vehicle and threw him face first onto the floor. One or more of the deputies thereafter slammed Claimants face into the floor surface, knocking out at least one of his teeth and cutting his mouth and lips. One of the officers and/or deputies then told Claimant to stop bleeding on"his" floor, as Claimant lay prone,bound, and unable to move on the floor. d. The claimant suffered damages and/or injuries including but not limited to severe shock to his system and/or personal injuries, including but not limited to damaged and broken teeth and gums,lacerations to his face,mouth,and lips,severe emotional upset,loss of liberty,past and future medical/dental expenses, loss of past and future income and/or earning capacity,pain and suffering, and other damages according to proof. The County of Contra Costa is liable to the Claimant under the doctrine of Respondeat Superior,and including but not limited to Government Code sections 915.2 and 920 for the conduct of its officers/deputies including but not limited to those officers who participated in the conduct outlined above..The county is also liable for its failure to properly train,supervise,instruct,control and/or discipline its officers/deputies, including but not limited to the officers/deputies who participated in the conduct outlined above,all of which violated Claimant's civil rights under statutes including but not limited to 42 U.S.C. 1983. Officer, including but not limited to those listed below and others whose identities are unknown at present are indebted to the Claimant for causes of action including but not limited to negligence,assault, battery, intentional infliction of emotional distress,false arrest,unlawful arrest, false imprisonment, excessive force, failure to follow proper police proceduire, and/or other violations of claimant's civil rights and/or improper conduct recognized under 42 U.S.C. 1983,the common law, and/or statutory law..Such officers and person are also liable to the claimant for violation of his Fourth, Fourteenth, and Fifteenth Amendment Rights under the U.S. Constitution and/or violation of Article 1, sections 13 and/or 7 of the Constitution of the State of California. e. The public employees causing the injury or otherwise having involvement in the incident are unknown at present: The nature and extent of the involvement of other officers/deputies is unknown at present. However, investigation is continuing. f. Jurisdiction rests with the Superior Court, Unlimited Jurisdiction. erytruly ours, E and Casey Jr. ae mN w o m�j'�v rn * tv to W W. CIJ !: ,afO MO- \\\ CV LL Of - �ZINR o o a rn U-) C/) r L7 o ma. O cC CO ru c o U 41) a � nj p C] o Ca u QN1 M o `� •�. Ir z _-r _ a U U \ mmmwm � C7 f 'S 3n In d w . UJ , x d 2. fs; U 3 d a APPLICATION TO FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA BOARD ACTION 77 Application to File Late Claim ) NOTICE TO APPLICANT Against the County, Routing ) The copy of this document mailed to you is your Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to ) the Board of Supervisors (Paragraph III, below), California Government Code.) given pursuant to Government Code Sections 911.8 ' e and 915.4. Please note the "WNG" below. � D Claimant: a�m0�,disU�rt MAR 2 .8 200$ Attorney: �a G 1 ot_eff�_ COUNTY COUNSEL (' MARTINEZ CALIF. Address: JG� Cam/- 11 4,il�Gia�C�ic ry i v stt i . �jlk �►�-cel, CA l �^ Amount: - By delivery to Clerk on: 2-J4. 0 'Ir w Date Received: l � � By mail,postmarked on:' 1. FROM: Clerk of the toard of Supervisors TO: . County Counsel Attached is a copy of the above noted Application to File Late Claim. DATEMMWJL, [. �?06b JOHN CIILLEN, Clerk, By:`YIat"P; .) C42 DEPUTY II. FROM: County Counsel TO: Clerk of theiBoard of Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911.6): i The Board should deny this Application to File Late Claim (Section 911.6). DATED: SILVANO B. MARCHESI, County Counsel,By: � �/�� DEPUTY III. BOARD ORDER By unanimous vote of Supervisors present (Check one only) ( ) This Application Is granted (Section 911.6). This Application to File Late Claim is denied (Section 911.6). I certify that this a true and correct copy of the Board's Order entered.in its minutes for this date. DATE: JOHN CUL.LEN, Clerk, By: �' DEPUTY WARNING (Gov. Code §9)1.8) If you wish to file a court action on:this matter,you must first petition the appropriate court for an order relieving you from the provisions of Government Code Section 945.4 (claims presentation requirement). See Government Code Section 946.6. Such petition must be filed with the court within six (6) months from the date your ap�jcation for leave to present a late claim was denied. You may seek the advice of an attorney of your choice iii connection with thistiiatter. If you want to consult an attorney, you should do so immediately. IV. FROM: Clerk of the Board TO: (1) County Counsel (2) County Administrator Attached are copies of the above Application. We notified the applican.•t of the Board's action on this Application by mailing a copy of this document, and a memo thereof has be filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. DATED: JOHN CULLEN', Clerk, By: DEPUTY V. FRONI. (1) Co rity ounsel (2) County Administrator TO: C1 rk of the Board of Supery Received copies of this Application and Board Order. DATED: County Counsel, By: County Administrator, By. APPLICATION TO FILE LATE CLAIM APPLICATION TO FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA BOARD ACTION Application to File Late Claim ) NOTICE TO.APPLICANT G Against the County, Routing ) The copy of this document mailed to you is your Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to ) the Board of Supervisors (Paragraph I1I, below), California Government Code.) ) given pursuant to Government Code Sections 911.8 and 915.4. Please note the "WARNING" below. f Claimant: NAL I.1•\OFId 4� Attorney: ►.eek) CC.--,iuLL ffiL. Address: ii �it l hirc a&o i) �d .1Lc�; (A- Amount: - t � By delivery to Clerk on: . l Date Received: Mai�.�� 91 _) 0By mail,postmarked on:� I. FROXI: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted Application to File Late Claim. DATED:Y l l_ci. 1 ��;`� I� JO1l.i� CI LLG1V, Clerk, By:• kt' DEPUTY I1. FROM: County Counsel TO: Clerk of thejBoard of Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911'6)i ( ) The Board should deny this Application to File Late Claim (Section 911.6). DATED: 'SILVANO B. MARCHESI, County Counsel, By:. DEPUTY II1. BOARD ORDER By unanimous vote of Supervisors present (Check one only) ( ) This Application Is granted (Section 911.6). ( ) This Application to File Late Claim is denied (Section 911.6). I certify that this a true and correct copy of the Board's Order entered in its minutes for this date. DATE: JOHN CULL.EN, Clerk, By: DEPUTY WARNING (Gov. Code.§911.8) If you wish to file a-court action on this matter, you must first petition the appropriate court for an or-der relieving you from the provisions of Government Code Section 945.4 (claims:presentation requirement). See Government Code Section 946.6. Such petition must be filed with the court within six(6) months from the date your ap Ocation for leave to present a late claim was denied. You may seek the advice of an attorney of your choice in connection with this matter. If you want to . consult an attorney, you should do so Immediately. IV. FROM: Clerk of the Board TO: (1) County Counsel (2) County Administrator Attached are copies of the above Application. We notified the applicant of the Board's action on this Application by mailing a copy of this document, and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. DATED: JOHN CULLEN', Clerk,By: DEPUTY V. FROM: (1) County Counsel (2) County Administrator TO: Clerk of the Board of Supervisors.'. Received copies of this Application and Board Order. DATED: County Counsel, By: County Administrator, By: APPLICATION TO FILE LATE CLAIM Office of the County Counsel Contra Costa County 651 Pine Street, 9th Floor Phone: (925)335-1800 Martinez, CA 94553 Facsimile: (925)335-1866 Writer's Direct Dial: (925) 335-1885 Date: March 27, 2008 R E CEt-VEE0 To: Clerk of the Board.of Supervisors . MAR 2 6 2008 Attn: Emy Sharp, Deputy. Clerk CLERK BOARD OF C UPE?VISCM CONTRIA COSTA CO. From: Silvano B. Marchesi, County Counsel By: Monika L. Cooper, Deputy County Counsel — Re: Application to File Late Claim of Raymond Boisvert Please process the attached Application to File Late Claim of Raymond Boisvert. Thank you for your continued assistance. Please call with any questions. Attachment Gargalicana / Graceffa LLP ATTORNEYS AT LAW March 25, 2008 Office of the County Counsel MAR 2 5 2008 County of Contra Costa COUNTY COUNSEL Attn: Monika L. Cooper, Deputy County Counsel MARTINEZ, CALIF. Administration Building 651 Pine Street, 91h Floor Martinez, CA 94553-1229 VIA US MAIL and FACSIMILE TO (925) 646-1078 Re: CLAIM OF RAYMOND BOTSVERT Dear Ms. Cooper: The purpose of this:•letter is to apply to submit•alate-claim by:_Raymond..Boisvert against the County.of Contra Costa.:: Background Raymond Boisvert brings this application for leave in order to present claims deemed untimely by the County. By way of background, Boisvert had originally hired counsel to defend himself in the matter of Sharon Hoey v. Raymond Boislvert, Doctor's Medical Center and Does 1- 25; Alm-n--da County Superior Coiuut Case No. RG07342219. Boisvert's first counsel. did not know or discover that Doctor's Medical Center("DMC") is a public entity. Boisvert himself did not know that DMC.is a public entity. Even Plaintiff in this matter, Sharon Hoey, was unaware that DMC is a public entity and failed to allege as such in her complaint against Boisvert and DMC. Boisvert obtained new counsel who filed and served an answer and cross-complaint against DMC on December 31,2007. On that date, DMC became aware of claims against it by Boisvert. Boisvert then learned that DMC is a public entity and his new attorneys thereafter dismissed tort claims against DMC in order to file a claim against DMC. Boisvert then filed a claim with DMC on,February:28 2008. On March,23, 2008,Boisvert receiveda. letter stating that some claims were untimely, mainly those occurring before August 28, 2008. 11 Embarcadero West,Suite 145 Oakland,CA 94607 T 510.251.2000 F 510.251.2299 www.gandgllp.com Boisvert hereby moves to present a late claim for those claims occurring before August 28, 2008 based on the following: Boisvert's Petition for Late Claim Pursuant to Cal. Gov. Code § 911.4(a) When a claimant fails to present a claim within six (6) months after the accrual of the cause of action, Cal. Gov. Code § 911.4(a) states that"a written application may be made to the public entity for leave to present that claim." Boisvert originally presented his claims on February 28, 2008. Causes of action which accrued prior to August 28, 2007 were therefore considered untimely. These untimely claims pertained to causes of action that occurred in June and July 2007—a few weeks shy of the six (6) month deadline. Boisvert's application to present a late claim pertains to these untimely causes of action. Boisvert presents his late claim within a reasonable time and states reasons for the delay. The application for a late claim may be presented "within a reasonable time not to exceed one year after the accrual of the cause of action and shall state the reason for the delay in presenting that claim." Cal. Gov. Code 5 911.4(b). In the letter Boisvert received On March 23, 2008 from the County, it states that the only recourse is to "apply without delay"to present a late claim. Two days after learning that claims accruing prior to August 28, 2008 were untimely, Boisvert brings this petition. He is applying without delay for leave to present claims considered untimely. He is nowhere near running.afoul of applying for a late claim in excess of one year after the accrual of the cause of action. Cal. Gov. Code § 911.6(b)(b)(1) states that"[t]he board shall grant the application where... [t]he failure to present the claim was through mistake, inadvertence, surprise, or excusable neglect and the public entity was not prejudiced in its defense of the claim..." Boisvert, his counsel and even Plaintiff were mistakenly unaware that DNC is a public entity. Nowhere does Plaintiff allege that DNC is a public entity. As soon as Boisvert became aware of this mistake and inadvertence, he immediately contacted DMC's counsel to inform him.that he would be dismissed tort causes of action, filing a claim, and then refiling the complaint regarding those causes of action. He thereafter filed a claim with the County. Page 2 of 3 DMC was not prejudiced by Boisvert's presenting his original claim two months late because DMC was already on notice of the claims within the statutory timeframe. As mentioned above, one of the requirements for the board togrant the application is that the public entity not be "prejudices in its defense of the claim by the failure to present the claim within the" six (6) month time period. Cal. Gov. Code 911.6(b)(1). Late claims may be presented within six (6) months and one day after the cause of action accrued until twelve (12) months after said cause of action. Although there is no clear guideline as to the point at which the board may be prejudiced by the presentation of a late claim, it is obvious that the longer the claimant waits to present his claim,the more the board may be prejudiced. Here, Boisvert filed a cross-complaint against DMC on December 31, 2007 which put DMC and the County on notice of claims against it. Boisvert thereafter learned that DMC is a public entity and dismissed causes of action against DMC, informed DMC's counsel as much, and then filed a claim against the County on February 28, 2008. Boisvert's first claims originate in June 2007. As such, by filing his claim against DMC in February 2008, Boisvert was a mere two months late in filing. However, DMC had notice of the claims, via Boisvert's civil complaint, back in December 2007, which was within the six months. Therefore, Boisvert's late claim was made within a reasonable time (2 months) after its due date. The late presentation of some of his claims did not prejudice the County in any way because the County was already on notice of said claims via Boisvert's cross-complaint. In addition, some of Boisvert's claims are timely so the County will be required to face this lawsuit regardless. For the reasons discussed above, Boisvert respectfully requests that the board use its discretion to allow him to present these late claims. Very truly yours Deb Graceffa Page 3 of 3 cs V o "C O T ..w. .r Cc) i L Q c T t6 O Cil 6p Ov .> 0r, C•� �O o O ) o - CG -c- 6 v � 0 (o x 00 c' fi 9 sl y CLAiM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: At I tel. 6100S_ Claim. Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section r efei ences 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), APR 0 4 2008 given Pursuant to Government Code Section 913 and 915.4. Please note all AMOUNT: {,�f1 YlUI��n COUNTY COUNSEL "Warnings". I�u AR INEZ CALIF. CLAIMANT: LC40I ua- T ATTORNEY: ®nuns VL - DATE RECEIVED: ADDRESS: Y 11Q 1(1,V°( -� .. BY DELIVERY TO CLERK ON: f) CV Jt,�-tom BY MAIL POSTMARKED: z4" 09 V)pUi.U_� Cx e-A-1 CA. a45gto FROM: Clerk of the Board of Supervisor's T0: County Counsel Attached is a copy of the above-noted claire. JOHN CUL EV, Qerk ' h Dated: 3 � By: Deputy' ` ff. FROM: County Counsel TO: Clerk of the Board of Supervisors (J)/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 clan-non 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.- SOS By: �M ��^--- Deputy County Counsel 1.11. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) (' ) Claim was returned as untimely with notice to claimant (Section 911.3). 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: 65;&/6 JOHN CULLEN, CLERK, By ty Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6) months from the d to this notice was personally served or deposited in the mail to file a court action on this claim.See Government Code Section 9,15.6.You may seek the'adviee of•an attorney of your choice in connection wide this matter. If you want to consult an attorney,you should do so innrnetliately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I ann now, and at all tinnes herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed.to the clainrar .t as shown above. Dated: JOHN CULLEN, CLERK — uty Clerk CLAIM BOARD OF SUPERV,iSORS OF CON'i.RA COSTA COUNTY BOARD ACTION: cU,N 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), givers Pursuant to Government Code Section 913 and 915.4. Please note all AMOUNT: l,LntCY1 �'h "Warnings". CLAIMANT: LO-40['['U(L- J. .�`CZ�u� d ATTORNEY:4001 aG LiIoeVet DATE RECEIVED: ADDRESS: Y�nGIU�% `i�( �' BY DELIVERY TO CLERK ON: r1 CLI BY MAIL POSTMARKED: tool-W- (YWK CA g45q� FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. JOHN CUL E leek ' Dated: By: Deputy '1' 4u c ►L Il. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) Tlris 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 presenia lateclaim (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). IV. 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 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 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. Ifyou want to consult an attorney,you should do so inhnhediately. *For Additiahal Warning See Reverse Side of'This Notice. AFFIDAVIT OF MAILING I declare under penalty of per jury that i. am now, and at all times herein mentioned, have been a citizen of the United States, over age .1.8; and that today I deposited in the United States Postal Service in Martinez, California, Hostage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: JOI-IN CULLEN, CLERK By ,'Deputy Clerk 1 Thomas R. Woelfel, SBN 120358 LAW OFFICE OF THOMAS .R: WOELFEL i�'�i�E1" "'it 2 500 Ygnacio Valley Road, Suite 300 Walnut Creek, CA 94596 3 Tel : (925) 977-9600 APR u 3 2008 Fax: (925) 977-9687 4 CLERK BOARD OF Si!PC--- iSORS CONTRA COSTA 10. 5 Attorney for..Claimant, LATONIA J. HARDY 6 7 8 CLAIM OF .LATONIA J. HARDY, 9 Claimant, CLAIM AGAINST THE COUNTY OF CONTRA COSTA 10 11 (Government Code, Section 910) 12 13 14 TO: THE COUNTY OF- CONTRA COSTA: 15 Pursuant to California Government. Code, section 910 , 'Latonia 16 J. Hardy presents a claim to the County o'f Contra- Costa as follows 17 The claimant is Latonia J. Hardy whose present post office 18 address is 2147 Chestview Lane, Pittsburg, CA 94565 . 19 The circumstances giving rise to this claim are : On October 2. , 20 2007 , at approximately 11 : 30 p.m. , Ms . Hardy was walking home 21 through the old Albertsons parking lot located at 2100 Railroad 22 Avenue in Pittsburg when she fell into an open manhole, thereby 23 sustaining bodily injuries, generally to her neck, back, ribs (two 24 fractured) ; right side and right leg, ' in addition to various 25 bruises, cuts, abrasions, and scrapes . 26 Additionally, Ms . 'Hardy sustained general damages and a ' loss 27. of earnings as'.a result of the fall . 28 A 10/03/07 ""Incident Report" of this fall was prepared by the -1- 1 Pittsburg Police Department, with Case No. C07-7680 . 2 This claimant contends that Contra Costa County' s failure to 3 properly maintain the manhole, so as to have and/or keep it 4 covered, caused the fall by creating a dangerous condition of 5 public property, which . Contra Costa County had notice of a 6 sufficient time prior to have corrected the defective/dangerous 7 condition, and entitles this claimant to monetary damages for the 8 injuries and damages sustained, all in an amount presently unknown 9 but subject to the jurisdiction of the Superior Court, Unlimited 10 Civil Jurisdiction. 11 All notices or other communications regarding this claim are 12 to be sent to the Law Office of .Thomas R. Woelfel , 500 Ygnacio 13 Valley Road, Suite 300 , Walnut Creek, CA 94596 , (925) 977-9600 . 14 DATED: March 31, 2008 15 LAW OFFICE OF THOMAS R. WOELFFL 16 17 By: TH S R. WOELFEL`-- 18 Attorne for Claima t, LATOJ. HARDY 19 20 21 22 23 24 25 26 27 28 -2- Tn V, .,a InItA - % .' � .e : ' • 4A a rA i taii ) 0P r }ATn GN i 7N A F. UrA � �0 O 'o r•t �a it • la; t (L�U A mo (3N 152 GAY C(, 00 . lo U� �• W W •. N a� r a xp � CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: l (o) 2009 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 D ��f�f7f�fj on your claim by the Board of Supervisors. (Paragraph IV below), APR 0 4 2008 given Pursuant to Government Code AMOUNT: Section 913 and 915.4. Please note all COUNTY COUNSEL "Warnings". MA al ALIR CLAIMANT:c)(^` 1fd ATTORNEY: R,1CLI DATE RECEIVED: 14'7..5--08 ADDRESS: ,, ��� BY DELIVERY TO CLERK ON: GA BY MAIL POSTMARKED: 'rl� '67TNL FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CUL ; Clerk , Dated: 3 X08' By: Deputy )Audavu II. FROM: County Counsel TO: Clerk of the Board of Supervisors Oris claim coi-nplies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). O Claim is not.timely filed. The Clerk should return claim on ground that it was .filed late and send warning of claimant's right to apply for leave to present a late claim (Section 91 1.3). ( ) Other: Dated: — 7� �rJJ 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). 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: O 062JOHN CULLEN, CLERK, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptiars,you have only six(6) months from tJ 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 ittoi iiey,you should do so immediately. *For Additional Warning See Reverse Side of'This Notice. AFFIDAVIT OF MAILING I declare under penalty of per jury that I ani now, and at all times.herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the�lai n.t as shown above. Dated: JOHN CULLEN, CLERKS By ty Clerk CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: 2M9 Claim Against the County, or District Governed by ) 'lie 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- Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Ilk, '7YO - ATTORNEY: �/ � DATE RECEIVED: ADDRESS: j, �J (�� BY DELIVERY TO CLERK ON: CA BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. JOHN CUL EN, Clerk , Dated: AJ By: Deputy ' ! zt ' [zUt H. 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. 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 911.3). ( ) Other: Dated: By: _ Deputy County Counsel 1.11. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3).. 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 iii its minutes for this date. Dated: JOHN CULLEN, CLERK, By :Deputy Clerk , WARNING (Gov. code section 913) Subject to certain exceptiars,you have only six(6) months from the date this notice was personally served or deposited in the nail to file a courtaction on this cWini.See Government Code Section 945.6.You may seek the advice of an attoiiiey.of your chore in connection widr this matter..If you want to consult an attol7rey,you should do so immediately. For Additional Warnijig 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 preliaid 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 CO. CO. SHER I FF' S DEPT. Fax: 9256461389 Mar 11 2008 9: 17 P. O1 . Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY SHARON NYMES-OFFORD INSTRUCTIONS TO CLAIMANT APR I '2006 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 100tb day after the accrual of the cause of action. Claims relating to causes of action for death onfor 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 §91.1.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, Countv Administration Building, 651 Pine Street, Martinez, C.A. 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 agami st 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 filling stamp �1 U lam! j 6l(m ) Against the County of Contra Costa RECEIVED or ) APR 0 3 2008 District ) (Fill in name) ) CLERK BOARD OF SUP�.r;;';';SOBS i CONTRA COSTA CO. The undersigned claimant hereby�Y'n�akes claim ag est the County of Contra.Costa or the above- named District in the sum of S /00-60 iG_!G and in support of this claire represents as follows: •1'. When dad the damage or injury occur? (Chive exact date and hour) 2. Where did the damage or injury occur? (Include city and county) /� =/� AJ _ - 7..C�` ...55 � i 6l " Ull(-r(c..6 0s s,-171�w �`w oia/clF'X ter 3ow did the damage or injuxy occur? (Give f611 details; use extra paper if required) --76- ioC.DGf/'>cA Ai LAM 86127 p/fes ��; i%i M%'JR+ rt) Ve /NG /—/'6' Hi/-11 /-lcw'�SGaI.✓G%�C✓.�tRO gC- IHL=L�S61,4/ �C:%d&-t 0/ G Aar.Ui/1ra i/,6'Dc /� � Co L'C 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? /!��o c U /�< <l T. %Ul��l iv /v ��[G" r f�4-!5 A•�-' /� :D�%c- �'�'T (over) CONTRA C'OS T A COUN- t. RECEIVED APR 0 1 2008 R 5K MA;�1AGIEME:N•T 5111q �wb ::xA H. H. SHERIFF'S DEPT. Fax: 9256461389 Mar 11 2008 9: 17 P. 02 5. What are the names of county or district officers, servants oz employees causing the damage or injury? 6qw_ r fey .------ 6_ What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed.) Attach two estimates for auto darnage. 1326&xi i 0 cu 4 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) S. Names and addresses of witnesses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury: DATE ITEM _ AMOUNT U_>i N12a Gov_ Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO : (Attorney) or by some person on his behalf------------------- Name Name and address of Attorney � n6rt (C ` is Signature) 1' (Address Telephone No. Telephone 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 on 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. ) GLASS TECH 1209 AUTO CENTER DRIVE ANTIOCH, CA $4509 PH:925-777-1700 FAX:925-777-1258 Quote 3/14/2008 Q004361 09:20 AM 68-0382659 DAVID JONES DAVID JONES Ford F Series F150 2003 ' 4 Qty Part Number Description Sell Total 1 DD09747YPYNCOM Door-(Rear,Right,Solar Controlled) $125.00 $125.00 1 50F Flat Labor(Flat Rate) (2 Hours) $50.00 $50.00 (0 hrs) (Not Completed) (Mobile) Instructions:QUOTE ONLY Sub Total : $175.00 Tax . $10.31 Total $185.31 r + i F, CONTRA COSTA COUNTY RECEIVED APR 0 1 2008 RISK, MANAGEMENT CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY 130ARD 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 yournotice of the action taken on your claire by the Board of Supervisors. (Paragraph IV below), r APR 0.4 2008M given Pursuant to Government Code ^-- ' Section 913 and 915.4. Please note all AMOUNT: �O MARTINEZ UNSEL 4Warnings". CLAIMANT: ^ ATTORNEY: c��l �� ��� DATE RECEIVED: 3, Cawg ADDRESS: -%C., mutle- Law clm f BY DELIVERY TO CLERK ON: I e�ro W f Y,M�I.L POSTMARKED: San �. c g4a03 —,- FROM: Clerk of the Board o Supervisors T0: County Counsel Attached is a copy of the above-noted claim. JOHN CULT lerk Dated: '3 �g By: Deputy . IL FROM: County Counsel TO: Clerk of the Board of Supervisors (,.Y"l"his claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911-3). O Other: Dated: By: Deputy County Counsel 1II. FROM: Clerk of the Board TO: County Counsel (l) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV 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 fog• this date. Dated: JOHN CULLEN, CLER Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6) montlis fi-onr re date this notice was personally served or deposited in the n-lail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice.of an attorney of your choice in connection widr this matter. If you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side ofThis Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that 1. ane 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 coley of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: JOI-iN CULLEN, CLERK B Deputy Clerk - C LA 11VI' 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 Supervisors. (Paragraph IV below), r given:Pursuant to Government Code -wiSection 913 and 915.4. Please note all AMOUNT: 1"Y t "Warnings". CLAIMANT: m ATTORNEY: j,�l � �� �� DATE RECEIVED: ADDRESS: L) (-vaty BY DELIVERY TO CLERK ON: YMAIL POSTMARKED: Clwa. OA 74ao� FROM: Clerk of the Board o .Supervisors TO: County Counsel Attached is a copy of the above-noted_claim. JOHN CULE , lenk - Dated: �' 1 ;3 CZ08 By: Deputy ,j II. 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 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: JOHN CULLEN, CLERK, By Deputy Clei k WARNING.(Gov. code section 913) Subject to certain exceptions,you Dave 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 Goverununt Code Section 945.6.You may seek the advice of an attorney of your choice in connection wide this matter. lf'you want.to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side of"11is Notice. AFFIDAVIT OF MAILING i. declare under penalty of perjury that 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, Hostage 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 THE MARNE LAW GROUP, P.C. Marin Justice Center 30 North San Pedro Road, Suite 195 San Rafael, Calil:ornia 94903 RECE ED (415)499-8100 APR 0 3 2008 April 3, 2008 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. Pat Edwards, City Clerk Citv of San Ramon 2222 Camino Ramon San Ramon. CA 94583 Board of Supervisor Clerk of the Board 651 Pine Street, Suite 106 Martinez, CA 94553 Robert J. Kochly. District Attorney 725 Court Street Martinez, CA 9455 3) Scott I]older. Chief of Police San Ramon Police Department 2222 Camino Ramon ; San Ramon. CA 94583 Re: Claim the against City of Sail Ramon and County of Contra Costa by Karcem Rasheed Dear Pat Edwards, Board of Supervisor. Robert J. Kochly, and Scott Holder: 1. Claimant's Name: Kareem Rasheed 2. Date of Birth 08/09/1993 3. Claimant's address: 2022 Longleaf Cir., San Ramon, CA 95482 4. Date of Occurrence : 1.-1/28/2007 5. Time of Occurrence: 4:00 p.m. 6. Location: 2022 Longleaf Cir., San Ramon, CA 95482 7. Description of Incident: Kareem Rasheed was falsely arrested and falsely imprisoned, Kareem Rasheed spent 27 days and 26 nights in jail • Page 2 California Government Code 5910 Notice of Claim Adli Rasheed on behalf of minor Kareem Rasheed 8. What specific injury, damage or other losses were incurred: 1) false arrest(violation of Fourth and Fourteenth Amendments); 2) false imprisonment (violation of 42 U.S.C. §§ 1983); 3) loss of liberty; 4) failure to train; 5) race-based violence and/or intimidation; 6) assault and battery; 7) false imprisonment; 8) false arrest; 9) depravation of civil rights under the color of law; 10) violation of due process; 1 1) failure to prevent violation of constitutional rights; and 12) loss of monies expended on attorneys, investigators, and experts. 9. What is the names of the of the City employee(s) whom caused the injury, damage and loss: Robert J. Kochly, Daniel J. Cabral, Carlos Vega, Officer Gunning, Officer Stephens, Officer R. Ransom, A. Medina and the San Ramon Police Department 10. Amount of money Kareem Rasheed is seeking to recover: The amount claimed is more than $10,000,000.00;jurisdiction rests in the Superior Court Unlimited Jurisdiction 11. The basis for claimino that the City of San Ramon, the county of Contra Costa, and City and county employees) are the cause of Kareem Rasheed's injury, damages and loss: False Arrest & False Imprisonment; Kareem Rasheed was arrested and confined based solely on his name and ethnic background. Kareem Rasheed was innocent of any and all charges and the San Ramon Police Department and the Contra Costa District Attorney's Office knew so, and failed to do any investigation whatsoever. Kareem Rasheed was found innocent by the Contra Costa County Superior Court and the underlying criminal matter was dismissed. There was no probable cause to arrest and/or imprison Kareem Rasheed. Very trulv ours, Thee Law Grou , P.C. usscll K. M me ,( , 1 PROOF OF SERVICE BY MAIL 2 [C. C. P. §§1013a, 2015. 5] 3 Re: Government Code `910 Notice of Claim 4 I declare that : 5 I am employed in the County of San Francisco, California . 6 I am over the age of eighteen years and not a party to the within 7 action. My business address is 30 North San Pedro Road, Suite 195, 8 San Rafael, California 94903 . On the date indicated below, I 9 served the within: 10 California Government Code §910 Notice of Claim by Masuma Anwari on behalf of minor Khalid Anwari & California Government Code§910 Notice of Claim by Adli Rasheed 1 l on behalf of minor Kareem Rasheed 12 to Defendants in said cause, by mail as follows : 13 14 Pat Edwards, City Clerk City ole San Ramon 15 2222 Camino Ramon San Ramon, CA 94583 16 Board of Supervisor 17 Clerk of the Board 651 Pine Street, Suite 106 18 Martinez, CA 94553 19 Robert J. Kochly, District Attorney 725 Court Street 20 Martinez, CA 94553 21 Scott Holder, Chief of Police San Ramon Police Department 22 2222 Camino Ramon San Ramon, CA 94583 23 I declare under penalty of perjury that the foregoing is true 24 and correct and that this declaration was executed on April 3, 2008 25 at San Rafael, California . 26 27 28 Bobbi Steger THE MARNE LAW GROUP A Professional Corporation z 30 North San Pedro Road, Suite 195 San .Rafael, California 94903 (415)499-8100 April 3, 2008 Pat Edwards, City Clerk City of San Ramon 2222 Camino Ramon San Ramon, CA 94583 Board of Supervisor Clerk of the Board 651 Pine Street, Suite 106 Martinez, CA 94553 Robert .). Kochly, District Attorney 725 Court Street Martinez, CA 94553 Scott Holder, Chief of Police San Ramon Police Department 2222 Camino Ramon San Ramon, CA 94583 Re: Claim against the City of San Ramon & County of Contra Costa by Khalid Anwari Dear Pat Edwards, Robert J. Kochly. and Scott Holder: 1. Claimant's Name: Khalid Anwari 2. Date of Birth 11/30/1992 3. Claimant's address: 520 Rockcrest Circle, San Ramon, CA 95482 4. Date of Occurrence : 11/28/2007 5. Time of Occurrence: 4:00p.m. 6. Location: On Bollinger Canyon Road, San Ramon, CA 95482 7. Description of Incident: Khalid Anwari was falsely arrested and falsely imprisoned, Khalid Anwari spent 27 days and 26 nights in jail 8. What specific injury, damage or other losses were incurred: False arrest., false imprisonment, assault, battery, loss of liberty, depravation of civil rights under the color of law, loss of money expended on attorneys, investigators, and experts. RUSSELL.-MARNE.COM Paue 2 California Government Code§910 Notice of Claim MaSuma Anwari on behalf of minor Khalid Anwari 9. What is the names of the of the City& County employee(s) whom caused the injury. damage and loss: Robert J. Kochly, Daniel J. Cabral, Carlos Vega. Officer Gunning. Officer Stephens, Officer R. Ransom, Officer A. Medina and the San Ramon Police Department 10. A►nount of money Khalid Anwari is seeking to recover: The amount claimed is more then $10.000,000.00;jurisdiction rests in the Superior Court Unlimited .Jurisdiction 11. ne basis for claiming that the City of San Ramon, the county of Contra Costa, and City and county employee(s) are the cause of Khalid Anwari's injury, damages and loss: Khalid Anwari was arrested and confined based on name and ethnic background. Khalid Anwari was innocent of any and all charges. Khalid Anwari was found innocent by the Contra Costa County Superior Court and the underlying criminal matter was dismissed. There was no probable cause to arrest and/or imprison Khalid Anwari. eLGroup, T e MarC. us RFSSELLONARVE.COM 1 PROOF OF SERVICE BY MAIL 2 [C. C. P. §§1013a, 2015. 51 3 Re: Government Code §910 Notice of Claim 4 I declare that : 5 I am employed in the County of San Francisco, California. 6 I am over .the age of eighteen years and not a party to the within 7 action. My business address is 30 North San Pedro Road, Suite 195, 8 San Rafael, California 94903 . On the date indicated below, I 9 served the within: 10 California Government Code §910 Notice of Claim by Masuma Anwari on behalf of minor Khalid Anwari & California Government Code§910 Notice of Claim by Adli Rasheed 11 on behalf of minor Kareem Rasheed 12- to Defendants in said cause, by mail as follows : 13 14 Pat Edwards, City Clerk City of San Ramon 15 2222 Camino Ramon San Ramon, CA 94583 16 Board of Supervisor 17 Clerk of the Board 651 Pine Street, Suite 106 18 Martinez, CA 94553 19 Robert J. Kochly, .District Attorney 725 Court Street 20 Martinez, CA 94553 21 Scott Holder, Chief of Police San Ramon Police Department 22 2222 Camino Ramon San Ramon, CA 94583 23 I declare under penalty of perjury that the foregoing is true 24 and correct and that this declaration was executed on April 3, 2008 25 at San Rafael, California . 26 1 27 �.., J 28 Bobbi Steger w P: =ys} ,�, y ' U.S POSTAGE'*' PAID k , SAN R99903.CA APR 02.`'08 vvrrFrrsih�Fs - AMOUNT:- POS7dL'SFRVICE ' Napo::, 94553 00!00459-13 ------ P- C3 - c d- -- - ru ni C3 � � � • C3 v NT r\ 73 G v� 50.CIS\ Lu # CO :�- ---` ! `_) w c� AMENDED CLA:1.1%] BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY 0/0 BOARD ACTION-k ML.6 / o' � –, - —1 Claim Against the County, or District Governed by ) the Board of Supervisors, 1Zouting Endorsements, ) NOTICE 7'O CLA.IMANT and Board Action. All Section r f ff The copy of this dOCument mailed to Califin-nia Government C:odes.!!u you is your notice of the action taken APR. 0 3 2008 on your claire by the Board of COUNTY COUNSEL Supervisors. (Paragraph IV below), I' MARTINEZ CALIF. given Pursuant to Government Code ANIOUN'l': 1 q4- Section 913 and 915.4. Please note all "°Warnings". CLAIMANT: Doono, �_Ykelr ATTORNEY: r �' DATE RECEIVED: ADDRESS: C�4 1_15 CAL L-krr t' /--U--lB6Y DELIV:F.RY TO CLERK ON: (�DfC)�`G� B NIHIL t�osTNi�vzl�ED: C, =g FRON.I.: Clerk of the Board of Supervisors hO: County Counsel. Attached is a copy of the above-noted claim. JOHN CULL i Clerk , Dated: '�-� �g By: Deputy It FROM.: County Counsel TO: Clerk of the Board of Supervisors ( I.'his claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with. Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910:8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section-911.3). ( ) Other. Dated: `�'�`- By: _ �� Deputy County Counsel Ht FRO.NI: Clerk ol..the Board TO: County Counsel (1) . County Administrator (2) O Claim was returned as untimely with notice to claimarit (Section 911.3). IV. BOARD ORDER: By L.rna.nin1ous vote of the Supervisors present: '.Chis Claim is rejected in full. ( ) Other: --- --- — _._ 1 certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JOHN C.UL.L_ EN, CLERK, By Dep ty Clerk WARNING (Gov. code section 913). - ---------_._ ..._ Sub b,ject to certain exceptions,you have only six(6)months Froni th date this notice was personally sewed M'deposited in the maul to file a coral action on this claim.See GovernmenfCode 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 ofJbis Notice _ AFFIDAVIT O.1' MA.IL,.I-NG I declare under penalty of perjury that 11 am now, and at all times herein mentioned, have been a citizen of' the United States, over age 18; 111(1 that today I deposited in the United States I.'ostal Service in Martinez, California, postage fully prepaid a certified cop}- of' this Board Order and Notice to Claimant:, addressed to the ch ' as shown above. DaIed: GZ _ J011N C'l_!I-..1-1:N, ('LI.- R.K 13 - DeI)ufV Clerk AMENDED CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: o' g Claim Against the County, or District Governed by ) the Board ol'Supetvisors, .Itoutiug Endorsements, ) N0.1.'IC.E TO CLAIMANT and Board Action. All Section references are to ) The copy of this document inailed to California Government Codes. ) you is your notice of the action taken oil your claim by the Board of -Supervisors. (Paragraph IV below), given Pursuant to.Government Code J , �� Section 913 and 915.4. Please note all AN1Ol1N�': `1 "Warnings". CLA MAN r: . ATTORNEY: DATE RECEIVE'll: nur- J) 3t , 9 _ ADDRESS: (Lt krnu.1BY DELIVERY TO CLERK ON: ty6o C�1IIC.���"`�-� BY MAIL POSTMARKED: l'C.�) J-0 , 0 L7ROM.: Clerk ofthe Hoard of Supervisors I'O: .County Counsel Attached is a copy of the above-noted claim. JOHN CULI,,E. , Clerk Dated: N)t&), 4 By- Deputy r ^,GtG u II. PROM: County Counsel. TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sectiotis 9.10 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. '.Che Board cannot act for 15 clays (Section 910.8). ( ) Clain) 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: Da.ted: . By: Deputy County Counsel 1. .PROM.: Clerk of the Board TO: County Counsel (1) County Admiinistrator.(2) O Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: ( ) "I.-Iris Claim is rejected iii full. ( ) Other: -- — --- I certify that this is a true and correct copy of the Board's Order entered in its minutes for this (late. Dated:_ _ JOFIN CULLE.N, CLERK, By _ .Deputy_ Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(G)moulds iivm the date this notice was personally sewed or deposited in tire nail to file a count action on ibis claim.See Govenunei►t Coile Sectio»945.6,.You may . seek the advice of an attorney of your choice in Connection with this matter. if you Want to consult all attorney,you sl«uld t10 so ill mediately. *For Adtliliot►al Wanri►►g See Reverse Side of 71tis Notice AFFIDAVIT OP MAILING I. declare tinder penalty of pet jury that I am now, and at all times herein mentioned, Have been a citizen of, Lyle United States, over age .18; and that today l deposited in the United States L'ostal Service. ill I\lart.inez, California, postnge fully prepaid a certified copy of' this 13oard Order and Notice to Claimant., addressed to the clai►uaut as sho«'n above. Dated: _. ..... --- J0.HN C"t_!1..,I...f_N, C'I_.i I.t.K Ry Dej)UtV C:le►k. c BOARD OF SUPERVISORS OF CONTRA CQS T A COUNTY INSTRUCTIONS TO C M4N—1 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 accntal of the cause of action. (Gov. Code § 911.2.) Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 146, County Administration Building, 651 Pine Street,Martinez, CA 94553. If claim is against a district governed by the Board of Supervisors, rather thaw the County, the :name of the District should be filled in. If the claim is against more th= one public enfity, separate claims must be filed against each. public entity. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form. i ■■ INS tttttttt 2 I A Z N ■tttRJR NIB L ttitMttttttIIIttt■G C C ttt Gttt■ttt■R■itILK VIM tttCI r E: Claim By: Reserved for Clerk's filing stamp G-R rJ.(\0( ) - C MI against the County of Contra Costa. or ) MAR 3 1 2008 District) a a.Rro:�NRr OF U1�F,v4SvR5 CONT i F;A COS CO. Fill in the name) ) - - _ nhe undersigned claiman` he-ebb makes claim against the Ca 7--,y of Contra Costa or the above-named 3istrict in the sum of$ . `14 and in support of this claim represents as follows: 1. when didthe damage or injury occur? (Give eaacf date and hour) C2 60 2. Where did she damage or injury occur? (Include cit'and county) 3. How did the damage or injury occur? (Give piails;use extra paper if required) �, (,q9 4. What ar�c�t or orrussian do the art of�unty or district officers, ;&L�empl�ees P P caused the injury or damage? a L A I- CL H V0 ons 5 �lhat are the names or county or district officers,sen�ants,, or employees causing the I amage or injury? A r r n-\(A J Mat damage- or injuries do your claim resulted? (Give full extent of injuries or damages - -claimed: -Attach-two estimates for auto damage. nem 4or� ferr oar How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) ) p Names and addresses of witnesses, doctors, and hospitals. (� o A f o rRX �0 f)(!0 FJ iq Oe- 0,00-0 i7l a�-_ 6 r7 f. List the expenditures you rnade-on account of this accident or injury: DATE T114E AMOUNT off, t E R E E C E E E R E a a a[a E an E Rance L e e n a E SIRBINNIZZE Is next REURNSEXI RUN NEIIIIIIINE a EEE us IKRCNKRI ) .Gov. Code Sec. 910.2 provides"The claim shat be )signed by the claimant or by some person on his behalf" SEND NOTICES TO: (Attornev) Name and address of Attorney ) (Claimant's Signature) 4- 9(15. (Address) C Com' ` �j ,t � J 6q / o' 0' 95� - 4q11 Telephone No. )Telephone No. e.R e c[■■E a a E E E E E a KKR III■a■ e a RISK E a E a E■t:C a E a E ME RXERIENRIER■E i■EEE[a E E l E[E t E seaa E t E■■ME It PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed with the County under the Tort Claims Act, is subject to public disclosure under the California Public Records Act (Gov. Code, s"s 6500 et seq.) Furthermore, any attachments,addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. RE E E[E E E E a E t E E BEER UK E E E l■ ■ N NIBS 1 E a E t E E E E E a E USE INERCREWINIERt e E E e a[a[[E[E E E E a E a SEEKS Kiltt NOTICE: Section 71 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 pey the same if;equine, any fele- 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 ($1,MM), or by both such imprisonment and fine, or by imprisonment in the state prison; by a fine of not exceeding ten thousand dollars or by both such imprisonment and fine. Date: 3/14/2008 02:33 PM Estimate ID: 080014001479-67 Estimate Version: 0 Preliminary Profile ID: Mercury Insurance Jim's Califo'rnia Auto Body 2520 Monument Blvd.,Concord,CA 94520 (925)689-6117 Fax: (925)689-7836 LARGEST SHOP IN THE BAY AREA 30 YEARS OF EXPERIENCE Damage Assessed By: DANA AULD Type of Loss: Collision Date of Loss: 2/28/2008 Arrival Date: 3/14/2008 Contact Date: 3/14/2008 Final to Owner: 3114/2008 Deductible: 500.00 Claim Number: 080014001479-67 Owner: DONNA GARDNER Mitchell Service:. .910017,. Description: 2003 Honda Accord LX Vehicle Production Date: 8/02 Body Style: 4D Sed Drive Train: 2.4L Inj 4 Cyl 5A FWD VIN: JHMCM563X3C014246 License: 5CDF707 CA Mileage: 66,096 OEM/ALT: OL::r;e Search Code: None Color: BLUE Options: ALUM/ALLOY WHEELS,AIR CONDITIONING,POWER STEERING,POWER BRAKES,POWER WINDOWS POWER DOOR LOCKS,TILT STEERING WHEEL,AUTOMATIC TRANSMISSION AM-FM STEREO/CDPLAYER(SINGLE),CENTER CONSOLE,PASSENGER-FRONT AIR BAG POWER REMOTE MIRROR,4-DOOR,DRIVER-FRONT AIR BAG Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation Description Part Number Amount Units 1 000661 BDY REMOVEIINSTALL L FRT OTR BELT MOULDING 0.9 # 2 000613 BDY REMOVE/REPLACE L FRT DOOR POWER MIRROR ASSY 76250-SDA-A13ZB 195.88 INC 3 000733 BDY REMOVE/INSTALL L FRT DOOR TRIM PANEL INC #-Labor Note Applies Prior Damage MINOR CHIPS AND SURFACE SCRATCHES tiF?r i,o 7i ESTIMATE RECALL NUMBER: 3/14/2008 14:33:39 080014001479-67 Mitchell Data Version: OEM: FEB_08_V UltraMate is a Trademark of Mitchell International Copyright(C)1994 2008 Mitchell International Page 1 of 3 UltraMate Version: 6.5.015 All Rights Reserved R Date: 3/14/2008 02:33 PM t Estimate ID: 080014001479-67 Estimate Version: 0 Preliminary. Profile ID: Mercury Insurance Esiima$e TOtals Add'I Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals 11. Part Replacement Summary Amount Body 0.9 65.00 0.00 0.00 58.50 Taxable Parts 195.88 Parts Adjustments 9.79- Non-Taxable Labor 58.50 Sales Tax @ 8.250% 15.35 Labor Summary 0.9 :58.50 Total Replacement Parts Amount 201.44 III. Additional Costs 'Amount IV. Adjustments Amount Total Additional Costs 0:00 Insurance Deductible 500.00- Subtotal of Adjustments Exceeds Gross Total Customer Responsibility 259.94- I. Total Labor: 58.50 11. Total Replacement Parts: 201.44 III. Total Additional Costs: 0.00 Gross Total: 259.94 IV. Total Adjustments: 259.94 i;! ! Net Total: 0.00 This is a preliminary estimate. Additional changes to the estimate'inay be required for the actual repair. Point(s)of Impact 9 Left Side(P) Insurance Co: MERCURY CASUALTY INSURANCE Address: P.O.BOX 997195 SACRAMENTO,CA 95899 Telephone: (916)635-0423 (916)635-0423 f Due to many unforseen circumstances in�-the repairing of automobiles, we regret that we can only estimate, not promise a completion date and time. Date vehicle driven in/towed -in: Date vehicle inspected: Number of photos: Estimated number of days to repair:,;,, ,; Closing Type: Send check to facility: Copy of estimate give to ESTIMATE RECALL NUMBER: 3/14/2008 14:33:39 080014' 1479-67 Mitchell Data Version: OEM: FEB_08_V UltraMate is a Trademark of Mitchell International Copyright(C)1994-2008 Mitchell International Page 2 of 3 UltraMate Version: 6.5.015 All Rights Reserved Date: 3/14/2008 02:33 PM Estimate ID: 080014001479-67 Estimate Version: 0 • Preliminary Profile ID: Mercury Insurance ************CARS INSPECTION CLOSING REPORT*************** LKQ PARTS AVAILABLE: SOURCE: PHONE AND REFERENCE: ESTIMATE RECALL NUMBER: 3/14/2008 14:33:39 080014001479=67= • Mitchell Data Version: OEM: FEB_08_V UltraMate is a T4demark.ofMitchell International Copyright(C)1994-2008 Mitchell International Page 3 of 3 UltraMate Version: 6.5.015 All Rights Reserved Usp F`R4 : A A } C� u� N ) �o N C Al\9LNllEU Ct,AtA,.i BOARD OF SUPERVISORS OF CONTitA COSTA COUNTY BOARD ACTION:_ Claim Against the County, or District Governed by � - the Board of Supervisors, R.outi.ng Endorsements, ) NOTICE TO CLAIMAN".1' and Board Action. All Section references are to ) The copy of this document mailed to Calitornia Government. Codes. ou is your notice of the action taken ��g Imn your claim by the Board of upervisors. (Paragraph IV below), APR 0 3 2008 given Pursuant to Government Code ANl O U N'r: 'Sc . COUNTY COUNSEL�o Section 913 and.915.4. Please note all �' ; A f�-l�� �( MARTINEZ CALIF. "Warnings". Cl_:AIMANT: ATTORNEY: DATE.IZECEIVED: ADDRESS: ��� L� �5 BY DELIVERY TO CLERK ON: Com- BY ivlAIL Pos'r.MAKKED: fJ � 1,.RO1Ni: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN Clerk Dated:: �pn�. ;tic By: Deputy /-- � 1✓L'�.,� 11. FROM: County Counsel T0: Clerk of the Board of Supervisors ( Phis claim con►plies.suhstantially xvith Sections 910 a-nd 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 clays (Section 910.13). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send �varning of claimant's right to apply flor leave to present a late claim (Section 91 .1.3). ( ) Other J Dated: _—��—�.� By: �nC9Q-,,CYA, Deputy County Counsel ill. FROM.: Clerk of.the Board TO: County Counsel (1) County Administrator (2) O Claim was returned as untimely with notice to claimant (Section. 911.3). iV. BOARD ORDER: By unanimous vote oftlie Supervisors present: This Claim is rejected in full. ( ) Other: --- — --- 1 certify that this is a true and correct copy of the rd's Order entered in its minutes for this date. Dated: _JORN CULLEN, CLERK, By . Dep_y Clerk ..._ WARNING (Gov. code section 91 3) Subject to cedain exceptions,you have only six(6)months tirint the d,to this notice was personally sen-ed or deposited in the mail to file a conn action on this claim.See Govent vent Cotte Section 945.6.You.ntay step the advice of an attonley of,you - choice in connection will] I11is.111al.len If you want to consult 'kill atton]ey,you sthould tlo so inttnetliately. x I+or Additional Wanting See Reve]se Side of 171is Notice — A.I,FIDAVI'I.' OF N.IAII..fNG I declare under penally of I)Cl jury that i am now, and at all times herein mentioned, have been a citizen of the United Stales, over age 18; and that today 1. deposited in .the United Stales Postal Service ill 1.1artinea, California, postage fully prepaid a certified copy of this Board Order and Notice to (.'laimant, addressed to (lie c int: ,nl. shown above. Dated: __._ .10.11..N CU.I.,1-["N, CI_.F 1.tK B y_ eputti1 l:lerk AMENDED CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUN'T'Y BOARD ACTION: n' ( K 'Zo 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. 1upervisors. ou is your notice of the action taken y D �� n our claim by the Board of !11 0,3'2006 (Paragraph IV below), given Pursuant to Government Code � AMOUNT: �'� ��-�' COUNTY COUNSEL_ I MARTINEZ CALIF. "Warnings". CLAIMAN"I : I` (`r' n ATTORNEY: DATE RECEIVED: L-6,. :v-, ADDRESS: ���� LL .+_ ,. BY DELIVERY TO CLERK ON: �� t�_t 1 (C_')t C.ii BY MAIL POSTMARKED. KII� PROM: Cleric of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN tClerk 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 PAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). O Claim is not timely filed. The Clerk should return claim on ground that it was tiled late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: _ _-- Dated: f 1 `,'�� By: - '� Deputy County Counsel 11I. FROM- Clerk of the Board TO: County Counsel (1) County Administrator(2) O Clain was returned as untimely with notice to claimant (Section 91.1.3). 1V. BOARD ORDER: 13y unanimous vote of the Supervisors present: ( ) This Claim is rejected in full. O Other: 1 certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: _ _ JOHN CULLEN, CLE_K_K, By Deputy Clerk WARNING (Gov. code section 913) Subiecl to cerlaiu except.ious,you have only six(6)months firum the date this notice was personally served or deposited in the mail to fde a court action(ill this claim.See Govei-nment Code Section 945.6.You may seelc the advice of an attorney of your choice in connection with this matter. If you want to consult au attorney,you should do so bumediately. *I+or Additional Waluwlg See Reverse Side of T7iis Notice. AFFIDAVIT OF MAILING 1 declare under peialty of pei jury that 1 ant now, and at all times herein mentioned, have been a citizen of the United States, over age 18; aid that toddy I deposited in the United States Postal Service. ill Martinez, California, postage fully prepaid a certified copy of dlis Board Order and Notice. to Claimaut, addressed to the claimant as shown above. .TORN CULI.,EN, CLERK By __ Del)uty Clerk BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAEMLANT 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 ) MAR 7 200'8 District) CLERK BOARC7 OF SLIPERVISORS CONTRA COSTA CO. (Fill in the name) ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ Jr 50 and in support of this claim represents as follows: 1L) 1. lle n did the damage or injury occur? (Give exact date and hour) CO-(Y&r (o )-007 2. Where did the damage or injury occur? (Include city and coup ) C..vJs� - e(USS uU`i_I IL I e L d'I/`� jf-\' f�-c -Fn a n t e- rbdlj d, �j�- M a r f �e-z- 3. How did the damage or injury occur? (Give full details; use extra papeAf required) 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? '0 e ks e- see- -(lam o f tom_,k4 l Sh e-,-45, 5 What are the names of county or district officers, servants, or employees causing the damage or injury? Uri k n o LTJ i1 b. What damage or injuries do your claim resulted? (Give full extent of.injuries or damages claimed. Attach two estimates for auto damage.) ea ,e.. Le t�J— 0-f Mkt 6 , , 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 8. Names and addresses of witnesses, doctors, and hospitals: 'A livi d et�v� r Pal%k, 13CL SG' -onri Las /AnriP"les t` ,, S gt�o�5 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT PitSee 44-a- toc.ked ■■anaaraman aaarrmean arararaaarraaaaaararaaaaaaaaaaaaaaraaaaraaaaaraaraaaa■■ ■ aaarrrrrl Gov. Code Sec. 910.2 provides"The claim shall be signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney)____) Name and address of Attorney ) (Claimant's Signature) V (Address)q Telephone No. ) Telephone o.5)�, �- 3 U aaraaman aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaawas aaaaaaaaaa as aaa■aaaaai PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed with the County under the Tort Claims Act, is subject to public disclosure under the California Public Records Act. (Gov. Code, §§ 6500 et seq.) Furthermore, any attachments, addendums,or supplements attached to the claim form, including medical records, are also subject to public disclosure. ■a Mae araa■■aaaaaaaaaaaarraaaaaaaaaaaaaaaaaaaaaaaa■■aaaaaaraaariaaaraaaaaaaaaaVia rrrrr� 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. V Continued, from Contra Costa County Claim Form 3. How did the damage or injury occur? I was with another individual, and we were in Martinez to use Court facilities and government buildings. We got to the intersection of Main and Court Street, and we entered the crosswalk to cross the street. The person I was with, Katherine J. Staudt, accidentally and suddenly bumped into me on the right, as we were walking, and I moved left to lessen the impact, because she was coming into me. My left foot twisted badly or twisted under, and I lost my footing, as there was a fissure, gap, crack and abrupt change of level in the painted crosswalk white line, that I stepped on and into. 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? The County of Contra Costa failed to, and continues to fail to maintain safe streets, sidewalks, and walkways and paths of travel around its buildings. It failed to, and it continues to fail to adequately warn. It failed to,.and continues to fail to, provide safe and equal access. It failed to, and continues to fail to provide safe and accessible routes that are unobstructed in violation of the Americans with Disabilities Act. It offers, and it continues to offer for use, streets and sidewalks, paths of travel, walkways, public property, to be used in states of disrepair, -- uneven, old, faulty, etc., and inviting injury. It violated, and continues to violate my civil rights. 6. 1 lost my balance as it was happening, but I was able to recover. I have foot pain and leg pain. I have inflammation in my left foot that is persistent, and causing pain. I have a day brace, and a night brace to wear in an.attempt, according to the physician, to get the swelling to go down. The inflammation is visible. The full extent of the injuries or damages claimed is not known at this time, as I am still receiving medical care for the injury and injuries. I am claiming emotional distress as this should not have happened again, and it was very upsetting as it was happening, and even now, despite the fact that I was able to recover. 7. This claim is being submitted concurrently (next week for the City of Martinez) with a separate tort claim to be presented to the City of Martinez. Billing and payment calculations are on file with the County, as this is a third party matter for payments for medical care, as before. The prospective injury or damage and payments about that are unknown, but the physician told me it may never get better. I am trying to be hopeful about it. I am making a claim for pain and suffering, and future care and medical devices if medical devices are needed. This may affect my employment prospects, in addition. 9. Right now it is mileage to and from the Regional Medical Center in Martinez to go to appointments. The dates are the first two months of this'year. . I will be claiming expenses for recording the scene, photos, etc. where it happened. �J *Please see the following footote: Footnote to this Claim, and Claim Form I would like to request that the county pay for Magnetic Resonance Imaging, as Dr. Baba said-she-would not do one, because of the-cost. An x-ray of my foot has.been done. An M.R.I can be done at a separate facility. .1 called M.R.I. offices, but none will do an M.R.I. without an order from a physician. I feel it is important to preserve evidence, and to see the tissues inside my left foot, to know better about the injury. I am asking that the county arrange for an M.R.I; because Dr. Baba.said she would not order an M.R.I., because of the cost of an M.R.I. Please consider this request. !i i � -WED TZ MAR CI.ERMBQ��U OF SUS CQNTAA COSTA CO. 1t cl , 6L 1. 6-k-p- SUML- a L l cL h l 5()o (mac C t J-)A VQ� Ct-,�►� ncl.S . f7 --_ ]/LCt G� ! 7 _ IA ""I J : t 5 s i i 3 i .i i F S� S is S CLAIM HOARD OF SUPEiiVI.SORS OF CONTRA COSTA COUNTY i j BOARD ACTION: April 8, 2008 Claim Against the County, or District Govenled by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references �r'e 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: $ 85,500.00 MAR 2 1 Z008 Section 913 and 915.4. Please note all ` "Warnings". COUNTY COUNSEL CLAIMANT: Mary A. Staudt fAARTINEZ CALIF. ATTORNEY: DATE RECEIVED; March 7, 2008 ADDRESS: 566 La. Vista Rd. BY DELIVERY TO CLERK ON: March 7, 2008 Walnut creek, CA 94598 BY .MAIL POSTMARKED: N/A FROM: Clerk of the Board of Supervisors TO; County Counsel Attached is a copy of the above-noted claim. March 10, 2008 JOHN CULLEN Clerk Dated: By: Deputy i.I. FROM.: County Counsel TO: Clerk of the Board of Supervisors I (firs claim complies substantially w'.th Sections 910 and 910.2. ( ) This Clairn 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 appy for leave to present a late claim (Section 911.3). ( ) Other: Dated: 3 By: rnC)p uc,__Deputy County Counsel 1.11. FROM: Clerk of the Board T : County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely notice to claimant (Section 911.3). I.V.. 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 co`rect copy of the Board's Order entered in its minutes for. this date. Dated: JOAN CULL EN,.CLER.K, 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 aetiaoil this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your cho�ice in connection with this matter. Ifyou want to consult an immediately.attorney,you should do so immediately. *Fbr Additional Warring See Reverse Side ofThis Notice. AFFIDAVIT OF MAILING I declare under penalty of per jury that .i. am now, and at all times herein mentioned, have been a citizen of the United States, over age 1.8; 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. 'y Dated: JOHN CULLEN, CLERK By Deputy Clerk C ea �V 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 and of this form. ■■r r r N r r r r r r r r r r r r r r r r r r r r r r r r r 1 r r r r r r r r 0 r r r r r r I r/r r r On no r r r r r r r r r r mans ■r r r n r i RE: Claim By: Reserved for Clerk's filing stamp RECEIVED Against the County of Contra Costa or ) MAR 7 2008 A cl �vti CLERK BOARD OF SUPERVISORS District) CONTRA COSTA CO. (Fill in the name) ) The undersigned claimant hereby, makes claim against the County of Contra Costa or the above-named district in the sum of$25, 504 0-" and in support of this claim represents as follows: 1. en did the damage or injury occur? (Give exact date and hour) 1 , 2. "Where did the damage or injury occur? (Include ci and county) � (/(�2 r5 C 6 �Y�- d F POJ(` �'• Cc r'1 G{- btQ S� � / �- e roS S w i-l k. l Q a.d 1^(� "� t�4_ 'F;l a n C e_ (�J, 1 cif - lel w rh iLe-z 3. How did the damage or injury occur? (Give full details; use extra papeMf required) "7 J F1-e45-,PSga- -tom- �� - .�1�� si,-f-AL� 4. What particular act or omission on the part of county or district.officers, servants, or employees caused the injury or damage? 'OPwSe See- 5 C's5 What are the names of county or district officers, servants, or employees causing the damage or injury? Ute k n o L,—(,1 V . 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damaues claimed. Attach two estimates for auto damage.) 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 8. Names and addresses of witnesses, doctors, and hospitals: , � t � ue ; Jnr.( l/ltdi� a, S ( .CLFer- �� j3�►��`i I q(� eNe -& j Lis I eyes l` -� S g00-15 9. List the expenditures you made on account of flus accident or injury: DATE TIME AMOUNT a-fry-cke ee,�s ■.rra■■a■■aaa■■rrrr■■0aa00aaar■■aa0a■■rr■ra8aa0000■aa■■aaarraaaaamararrrraaaarraa0RaI Gov. Code Sec. 910.2 provides"The claim shall be signed by the claimant or by some person on his behalf." SEND NOTICES T0: (Attorneyl ) Name and address of Attorney ) (Claimant's Signature) (Address) Telephone No. ) Telephone o.5)�-53� ■■rrr■rrraarrrar■ra man....■rrrr■■raarrrarr■.raaOaaaaaarrrrrrrrrarrrrrrrra■ ■ aaarra.rl 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. 0000000........rrrrrrrarara■rrrrrrr ■rarrrrrrrrarrar■..■rrrarrarrrr a a a a a a 00 a a0aarrarr1 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 thesame 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. . lJ Continued, from Contra Costa County Claim Form 3. How did the damage or iniury occur? I was with another individual, and we were in Martinez to use Court facilities and government buildings. We got to the intersection of Main and Court Street, and we entered the crosswalk to cross the street. The person I was with, Katherine J. Staudt, accidentally and suddenly bumped into me on the right, as we were walking, and I moved left to lessen the impact, because she was coming into me. My left foot twisted'badly or twisted under, and I lost my footing, as there was, a fissure, gap, crack and abrupt change of level in the painted crosswalk white line, that I stepped on and into. 4. What particular act or omission on the part of county or district officers, servants, or employees caused the iniury or damage? The County of Contra Costa failed to, and continues to fail to maintain safe streets, sidewalks, and walkways and paths of travel around its buildings. It failed to, and it continues to fail to adequately warn. It failed to, and continues to fail to, provide safe and equal access. It failed to, and continues.to fail to provide safe and accessible routes that are unobstructed in violation of the Americans with Disabilities Act. It offers, and it continues to offer for use, streets and sidewalks, paths of travel, walkways, public property, to be used in states of disrepair, -- uneven, old, faulty, etc., and inviting injury. .It violated, and continues to violate my civil rights. 6. 1 lost my balance as it was happening, but I was able to recover. I have foot pain and leg pain. I have inflammation in my left foot that is persistent, and causing pain. I have a day brace, and a night brace to wear in an attempt, according to the physician, to get the swelling to go down. The inflammation is visible. The full extent of the injuries or damages claimed is not known at this time, as I am still receiving medical care for the injury and injuries.. I am claiming emotional distress as this should not have happened again, and it was very upsetting as it was happening, and even now, despite the fact that I was able to recover. 7. This claim is being submitted concurrently (next week for the City of Martinez) with a separate tort claim to be presented to the City of Martinez. Billing and payment calculations are on file with the County, as this is a third party matter for payments for medical care, as before. The prospective injury or damage and payments about that are.unknown, but the physician told me it may never get better. I am trying to be hopeful about it. I am making a claim for pain and suffering, and future care and medical devices if medical devices are needed. This may affect my employment prospects, in addition. 9. Right now it is mileage to and from the Regional Medical Center in Martinez to go to appointments. The dates are the first two months of this year. I will be claiming expenses for recording the scene, photos, etc. where it happened. . LJ *Please see the following footote: Footnote to this Claim, and Claim Form I would like to request that the county pay for Magnetic Resonance Imaging, as Dr. Baba said she would-not do one, because of the cost. An-x-ray of my foot. has been done. An M.R.I can be done at a separate facility. I called M.R.I. offices, but none will do an M.R.I. without an order from a physician. I feel it is important to preserve evidence, and to see the tissues inside my left foot, to know better about the injury. I am asking that the county arrange for an M.R.I, because Dr. Baba said she would not order an M.R.I., because of the cost of an M.R.I. Please consider this request.