HomeMy WebLinkAboutItem 3.5 Richard Leon Duncan Claim CITY OF DUBLIN
AGENDA STATEMENT
CITY COUNCIL MEETING DATE: Febuary 13 , 1984
SUBJECT Application For Leave To Present Late Claim By
Richard Leon Duncan and Others
EXHIBITS ATTACHED Application, Declaration, and Claim
RECOMMENDATION Deny application for leave to present late claim
FINANCIAL STATEMENT: Claim in excess of $12 Million
DESCRIPTION On February 2 , 1983 the City received an application
for leave to present a late claim by Richard Leon Duncan and others . This
claim is based on personal injuries sustained by the claimant on
January 31 , 1983 .
It is Staff ' s recommendation that the City Council deny the application for
leave to file a late claim and notify the claimant and the City ' s insurance
carrier .
----------------------------------------------------------------------------
COPIES TO: Richard Leon Duncan and others
7620 Amarillo Road
Dublin, CA 94568
Martin W. Basiszta, Esquire
2 Basiszta and Daniels
ITEM NO. 3•� 22693 Hesperian Boulevard, Ste 160
Hayward, CA 94541
• T) z l
PROOF OF SERVICE BY MAIL (CCP 1013a, 2015.5)
STATE OF CALIFORNIA
COUNTY OF ALAMEDA
I am a citizen of the United States and a resident of the county aforesaid; I
am over the age of eighteen years and not a party to the within entitled action, my
business address is 22693 Hesperian Boulevard, Suite 160, Hayward, California 94541.
On January 31, 1984 I served the within CLAIM FOR PERSONAL INJURIES
(Government Code §910), APPLICATION FOR LEAVE TO PRESENT LATE CLAIM BY
CLAIMANT (Government Code §911.4), DECLARATION OF MARTIN W. BASISZTA IN
SUPPORT OF APPLICATION FOR LEAVE TO FILE LATE CLAIM on the interested
parties to said action, by placing a true copy thereof enclosed in a sealed envelope
with postage thereon fully prepaid, in the United States mail at Hayward, California,
addressed as follows:
Dublin City Manager's Office
6500 Dublin Blvd., Suite 101
Dublin, CA 94568
ECEI `✓ ED
F -u
I declare under penalty of perjury that the foregoing is true and correct.
Executed on January 31, 1984 at Hayward, Ca rnia.
Leatha Curtis
1 MARTIN W. BASISZTA, ESQ.
BASISZTA & DANIELS
2 Hayward Air Plaza
22693 Hesperian Boulevard, Suite 160
3 Hayward, CA 94541
(415) 887-3131
4
Attorneys for Plaintiffs
5
6
7
8 SUPERIOR COURT OF CALIFORNIA, COUNTY OF ALAMEDA
9 RICHARD LEON DUNCAN,
et al.,
10 NO.
Plaintiffs,
11 DECLARATION OF
VS. MARTIN W. BASISZTA IN SUPPORT OF
12 APPLICATION FOR LEAVE TO FILE
13 CITY OF DUBLIN, CALIFORNIA LATE CLAIM
Def endants.
14
15
16 I, MARTIN W. BASISZTA, DECLARE:
17 I am a member of the law firm of BASISZTA & DANIELS, am an attorney
18 at law duly dmitted
y to practice before all the courts of the State of California
19 and one of the attorneys of record herein for plaintiffs, RICHARD LEON DUNCAN,
20 et al.
21 Mr. RICHARD DUNCAN came to my office regarding this matter for
22 the first time on January 30, 1984. Mr. Duncan advised me that he had been told
23 that a lawsuit would have to be filed within one year, but was never advised of
24 the Government Claims Statute time restriction.
25 A principal plaintiff in this matter is ILSE DUNCAN. She was seriously
26
BASISZTA & DANIELS
ATTORNEYS AT LAW
Hayward Air Plaza
22693 Hesperian Blvd.
Suite 160
Hayward.California 94541
(415)887-3131
1 injured in the accident in question on January 31, 1983 and was rendered
2 unconscious. To the present time she has never regained conciousness. She has
3 active brain waves and is not on any type of life support system.
4 I, MARTIN W. BASISZTA do hereby declare that the following matters
5 are of my own personal knowledge, and if called as a witness I could competently
6 testify to the matters stated herein.
7 I declare under penalty of perjury that the foregoing is true and correct,
8 and that this declaration was executed on January 31, 1984 at Hay ard, California.
9 DATED: January 31, 1984 BASIS�T &A jANIELS
10
11 ,-
MARgIN,W.�'B�SISZTA
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
BASISZTA & DANIELS
ATTORNEYS AT LAW
Hayward Air Plaza
22693 Hcsperian Blvd.
Suite 160
Hayward,California 94541
(415)887-3131
1
D 1 _
1 MARTIN W. BASISZTA, ESQ. -
BASISZTA & DANIELS
2 Hayward Air Plaza
22693 Hesperian Boulevard, Suite 160 y
3 Hayward, California 94541
(415) 887-3131 i' L L c 1 V E- D
4
Attorneys for Plaintiffs F :3
5
6
7
SUPERIOR COURT OF CALIFORNIA, COUNTY OF ALAMEDA
8
9 RICHARD LEON DUNCAN,
et al.,
10
Plaintiffs, NO.
11
VS. CLAIM FOR PERSONAL INJURIES
12 (Government Code §910)
CITY OF DUBLIN, CALIFORNIA
13
Def endants.
14 /
15 TO THE CITY OF DUBLIN, CALIFORNIA:
16 YOU ARE HEREBY NOTIFIED that RICHARD LEON DUNCAN, MARK
17 RICHARD DUNCAN, MICHAEL PAUL DUNCAN, DAVID MILTON DUNCAN and
18 BONNIE MARIE DUNCAN, whose address is 7620 Amarillo Road, Dublin, California,
19 94568, claims damages from the City of Dublin, computed as of the date of
20 presentation of this claim, in excess of $12 millon.
21 This claim is based on personal injuries sustained by claimant on January
22 31, 1983, in the vicinity of Amarillo Drive, north of Luna Court, under the following
23 circumstances:
24 That claimant was struck and injured while walking on Amarillo Drive,
25 north of Luna Court, in the City of Dublin, County of Alameda, wherein she was
26 struck and injured by a vehicle. The site where the claimant was injured
BASISZTA & DANIELS
ATTORNEYS AT LAW
Hayward Air Plaza
22693 Hesperian Blvd.
Suite 160
Hayward.California 94541
(415)887-3131
1 was located between two lighted portions of Amarillo Drive, City of Dublin, County
2 of Alameda, a dangerous condition and there existed other dangerous conditions.
3 The name(s) of the public employee(s) causing claimant's injuries under
4 the described circumstances are not known to claimant.
5 The injuries sustained by claimant as far as known, as of the date of
6 presentation of this claim, consists of severe fractures of both legs, a severe
7 fracture of the right arm, and a severe head injury resulting in a state of coma
' 8 for the claimant.
9 The amount claimed, as of the date of presentation of this claim is
10 computed as follows:
11 Damages incurred to date
12 Medical & hospital care expenses in excess of $300,000.00
13 Loss of Earnings for 1984 $18,000.00
14 Special damages for Amount Unknown
15 General damages $10,000,000.00
16 Total damages incurred to date in excess of $10,318,000.00
17 Estimated prospective damages as far as known
18 Future medical & hospital care expenses $85 per day—for life
19 Future loss of earnings $18,000 per year—for life
20 Other perspective special damages Amount unknown
21 Prospective damages Amount unknown
22 Total estimated prospective damages $1,176,000.00
23 Total Amount claimed as of date of this claim $12,000,000.00
24 All notices or other communications with regard to this claim should be sent to
25 the following:
26
BASISZTA & DANIELS
ATTORNEYS AT LAW
Hayward Air Plaza
22693 Hcsperian Blvd.
Suite 160
Hayward.California 94541
(415)887-3131
1 Mr. Richard Leon Duncan
7620 Amarillo Road
2 Dublin, CA 94568
3 Martin W. Basiszta, Esq.
Basiszta & Daniels
4 22693 Hesperian Blvd., Suite 160
Hayward, CA 94541
5
6 DATED: ) / BASISZTA & DANIELS
7
8 _
By:
MARTIN--W: SISZTA
9 Attorneys for Claimant
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
BASISZTA & DANIELS
ATTORNEYS AT LAW
Hayward Air Plaza
22693 Hesperian Blvd.
Suite 160
Hayward,California 94541
(415)887-3131
1 MARTIN W. BASISZTA, ESQ.
BASISZTA & DANIELS
2 Hayward Air Plaza 3 `
22693 Hesperian Boulevard, Suite 160
3 Hayward, CA 94541
(415) 887-3131
4
Attorneys for Plaintiffs
5
6
7
8 SUPERIOR COURT OF CALIFORNIA, COUNTY OF ALAMEDA
9 RICHARD LEON DUNCAN,
et al.,
10 NO.:
Plaintiffs,
11 APPLICATION FOR LEAVE TO PRE-
vs. SENT LATE CLAIM BY CLAIMANT
12 (Government Code §911.4)
CITY OF DUBLIN, CALIFORNIA
13
Defendants.
14
15 TO THE CITY OF DUBLIN:
16 1. Application is hereby made, pursuant to Government Code Section
17 911.4, for leave to present a late claim founded on a cause of action for personal
18 injuries which accrued on January 31, 1983, for which a claim was not presented
19 within the 100-day period provided by Section 911.2 of the Government Code. For
20 the additional circumstances relating to the cause of action, reference is made to
21 the proposed claim attached to this application.
22 2. The failure to present this claim within the 100-day period specified
23 by Section 911.2 of the Government Code was through mistake, inadvertence or
24 excusable neglect, and the City of Dublin was not prejudiced by this failure, all
25 as more particularly shown by the attached declaration of Martin W. Basiszta.
26
BASISZTA & DANIELS
ATTORNEYS AT LAW
Hayward Air Plaza
22693 Hcsperian Blvd.
Suite 160
Hayward.California 94341
(415)887-3131
1 3. This application is being presented within a reasonable time after
2 the accrual of this cause of action, as more particularly shown by the attached
3 declaration of Martin W. Basiszta.
4 WHEREFORE, it is respectfully requested that this application be granted
5 and that the attached proposed claim be received and acted on in accordance with
6 Sections 912.4-913 of the Government Code.
7 DATE;. I )9� BASISZTA &--DAI IELS
8
9 By:
MARTIN W. BASISZTA
10 Attorney for Claimant
11
NOTE: THE ADDRESS TO WHICH NOTICES RELATED TO THIS APPLICATION
12 ARE TO BE SENT:
Mr. Richard Leon Duncan
13 7620 Amarillo Road
14 Dublin, CA 94568
15 Martin W. Basiszta, Esq.
Basiszta & Daniels
16 22693 Hesperian Blvd., Suite 160
Hayward, CA 94541
17
18
19
20
21
22
23
24
25
26
BASISZTA & DANIELS
ATTORNEYS AT LAW
Hayward Air Plaza
22693 Hesperian Blvd.
Suite 160
Hayward,California 94541
(415)887-3131
TRAFFIC COLLISION REPORT I OF d
SPECIAL CONDITIONS NO.IN J UR[D H & R CITY JUDICIAL DISTRICT NUMBER
Fa Lo
❑ DOGUO Lr VL=k)}1c-lt2
NO.HILLED H 8t R COUNTY REPORTING DISTRICT Y[AT
M IS D. S✓,) O��
So
COLLISION OCCURRED ON MO. DAY YR. TIME (2400) NCIC NUMBER OFFICER I.D.
Z Ar?2Aa3 -4�� D g--------------------------------------------------------------- t . 31 . 63 16 5 0 l 00
0
MILEPOST INFORMATION INJURY.FATAL OR TOW AWAY STAT[ HIGHWAY RELATED
f
Q ❑ND El I.. ®NO
V F[.T or MIL.PDST
O 11-0T0-R A►H$
..i AT INTFR 1.C".. WITH
MOR: 1 514 n►pR or CT. ❑YC$ ®NG
PARTY NAME (FIRST.MIDDLE,LAST) OWN[R'S NAME -AMC AS DRIVER
' A N1 = 820 -03ti8
DRIVER STREET ADDRESS HOME 'No.. OWNER-ADDRESS $AMC AS DRIVER
,l EL O tl /70 cr ti,<J 5s
►HOES- CITY/3TATC/ZIP BUsINC-S PHONE DISPOSITION OF V.H. ON ORDERS OF
TRIAN q Q
rz` `c e c� ❑OFFIC.R O.RIVCR OTHER
FARN.D DRIVER'S LICENSE NVMBER STATE BIR TH pATE SEX IR^CC DIRECTION or ON(.AGAO�Y--(STREET OR HIGHWAY) 151111 LIMIT
VEM. MO. DAY YR. TRAVEL
'-? :gyp I`�( W N I A nl)A 0R 25
BICY- V[H.VR(-) MAR[(-)/MODEL(-)/COLOR($) LICEN3.NO.($) STATE(S) CHP USE VEHICLE DAM AGE—.XTENT/LOCATION
CLIST (1'(� 1F�)G T --/I� ONLY
6V OI �I (, - ( ,• G� • I •�v ••. .^O C.. . - •l VCHICLC TYPE ❑ MINOR ❑MODERATE ❑ MANOR ❑TOTAL
OTHER - - v _ l�
pRRK IaLUG NONE
PARTY NAM[ (FIRST,MIDDLE,LAST) OWNER'S NAME SAME AS DRIVER
2 ) L - n) - i1
DRIVER I$TftMgT....... NOME PHONE OWNERS ADDRESS SAME AS DRIVER
7520 0 I R I LLC Dl?
P.DE3-JCITY/ST A T.Izl► BUSINESS PHONE DI3,osITION OF VEH. ON ORDERS OF
_9 L/ . ;I ❑OR FIC(R ❑ DRIVER OTN(R
PAR HQD DRIVERS LICENyL NUMBER STATE BIRTH DATE SEX RACE DIRECTION OF OHfAQR6{{ (STREET OR HIGHWAY) SIXKD LIMIT
MO. DAY YR. TRAVEL
VEN,
II i 2"] i 33 W
BICY- VEM.YR(S) MARK(3)/MODEL($)/COLOR(S) LICENSE NO.(S) STATE(S) CHP USE VEHICLE DAMAGE—(XTENT/LOCATION
CLIST ONLY
VEHICLE TYPE ❑ MINOR ❑MOD...T. ❑MAJOR ❑TOTAL
. . . . . . . . . . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . ,
OTHER
PARTY NAM[(FIRST,MIDDLE,LAST) OWN[Rf NAM. I '$AMC AS DRIVER
3 L�
DRIVER STREET AOD R.33 NOM. PHONE OWNER'S ADDR.S3 SAME AS DRIVER
P.D.S- CITY/STAT./ZIF BVy1NEss PHONE DISPOSITION Or VEH ON ORDERS OF
TRIAN
❑OF rIGCR ❑ DRIVER OTHER
PARNQO DRIV.R'S LICENSE NUMBER STATE BIRTHDATE !.X RACE DIRECTION Or ON/ACROSS (STREET OR HIGHWAY) .—so LIMIT
MO. DAY YR. TRAVEL
V.H.
BICY• VEM,YR(S) MAH.(S)/MOD(L(S)/COLOR(S) LICEN3. No.(S) STATES) CHIP USE V.HICL[DAMAGE—.XTENT/LOCATION
CLIST ONLY
VEHICLE TYP ❑MINOR ❑MOD..ATC ❑ MAJOR ❑TOTAL
. . . . . . . . . . . . . . . . . . . . . . . . , . . . .
OTN[R
PARTY NAM[ (FIRST,MIDOL..LAST) OWNER'S NAM. Lj SAM. AS DRIVER
4
DRIVER STREET ADDRESS MOM. PHoN. OWN[R'i ADORES{ Lj SAME AS DRIVER
P.DES- CITY/STAT[/ZIP BUSINESS FRON[ DISPOSITION OF VCH. ON ORDERS OF
TRIAN
❑OrrICQR ❑ pR1Y.R El OTHER
PAR R.O DRIV.R'S LICENi[ NUMBER STAT[ BIRTH OAT[ S.X RACC DIRECTION OF ON/ACROSS (STR(.T OR HIGHWAY) SEED LIMIT
MO. DAY YR, TRAVEL
V.H.
BICY- V.H.YR(S) MAH.(3)/MOD9L(S)/COLOR(S) LICENSE NO.(s) %TAT.(S) CHIP USE V[NICL. DAMAGE—.XTENT/LOCATION
C LIST ONLY
VEHICLE TYP ❑ MINOR ❑ MOCK..— ❑ MAJOR ❑TOTAL
OTHER
CHP 555—Page 1 (Rev 6.82) OPI 042
TRAFFIC COLLISION CODING � � z •AGE. I
OAT[ Or COLLISION r��( TIME (I.00) NCIC NUMBER ( ) OrrIC�.I..J. NUMBER
MO. DAY I YR, iJ 3 o S o O\! G • 2 8 3 o- U2 7
PROPERTY DAMAGE
DI[SCRIPTION Or DAMAGE
OWNQR'S NAME/ADDRESS NOTIFIED
0 Y[f D..
VIOLATION(S) PARTY I IPARTY 2 PARTY ) PARTY /
CHARGED
PRIMARY COLLISION FACTOR RIGHT OF WAY CONTROL 1 2 ] 1 TYPE OF VEHICLE 1 2 I 1 MOVEMENT PRECEDING
(LIST NUMBER(+)Or PARTY AT FAULT) A CONTROLS FUNCTIONING A PASSENGER CAR/1TA.WAGON COLLISION
K A VC SECTION VIOLATION: B CONTROLS NOT FUNCTIONING B PASSENGER CAR W/TRAILER A fTO1 .
C CONTROLS OBSCURED IC MOTOR Cy CLC/SCOOTER B PROCE[OING STRAIGHT
♦a B OTHER IMPROPER DRIVING• D NO CONTROLS PRESENT D PICKUP OR PANEL TRUCK C RAN OFF ROAD
E PICKUP/PANEL TRK W/TRLR I D MAKING RIGHT TURN
C OTHER THAN DRIVER' TYPE OF COLLISION F TRUCK OR TRUCK TRACTOR E MAKING LEFT TURN
D UNKNOWN• A HK..-ON G TRK/TRK TRACTOR W/TRLR F MAKING V TURN
WEATHER (MARK 1 TO 2ITEMS) B SIDESWIPE H SCHOOL BUS G BACKING
A cLQAR C REAR B.. I OTHER BVS H SLOWING-STOPPING
B CLOUDY D BROADSIDE i EMERGENCY VEHICLE I PASSING OTNQR VEMICLE
C RAINING E HIT OBJECT K MWY COMST.EQUIPMENT J CHANGING LANE$
D SNOWING F OVERTURNED L BICYCLE K PARKING MANEUVER
E roc G AUTO/►[D[STRIAN M OTHER VEHICLE ENTENING TRAPPIC FROM
F OTHER•: H OTHER•: N PEDESTRIAN SHOULDER,MEDIAN,
L
G wIMD O MoFeD ►ww KlNC sywV ow
LIGHTING MOTOR VEHICLE INVOLVED WITH PNIVATE DRIVE
A DAYLIGHT A MON-COLLISION 2 ] 6 OTHER ASSOCIATED FACTOR M OTHER UNSAP.TURNING
1
B DUSK-DAWN B PEDESTRIAN (MARK 1 TO S ITEMS) N XING INTO OPPOSING LANE
C OAR.-STREET LIGHTS C OTHER MOTOR VEHICLE A VC SECTION VIOLATION: O 1A KO
D DARK-MO STREET LIGHTS D MOTOR VEH.ON OTHER ROADWAY P ME——.
STREET LIGHTS NOT E PARKED MOTOR VEHICLE B VC SECTION VIOLATION: O TRAVELING WRO..WAY•
E DARK—
FVNCTIONING• F TRAIN R OTHCw•. pEp,
G BICYCLE C VC SECTION VIOLATION:
ROADWAY SURFACE H ANIMAL: 1 2 J 4 1 SOBRIETY-DRUG-
A Ony D VC SECTION VIOLATION: PHYSICAL
B WET I .E.OBJECT: (MAR. I TO I ITEMi)
C SNOWY—Icy E VISION O■f CURZMKNTS: XI I I I A MAD NOT....DRIM KIMO
D SLIPPERY (MUDDY,OILY.ETC.) J OTHER OBJECT: I I B......... 11 C[
F INATTENTION C.BO—NOT VND[w I.PLV.•
ROADWAY CONDITIONS G STOP&GO TRAFFIC D.BD—IM PA IR MEMT UNKN•
MARK 1 TO S ITEMS) PEDESTRIANS ACTION H [NTK..../LEAVING RAMP E UMD[w DwUG IMF IU[NC[•
A HOLES,DEEP NUTS' A NO PEDESTRIAN INVOLVED I PREVIOUS COLLISION F IM PwIw M[NT-PHYfICAI•
B LOOS[ MATERIAL ON ROADWAY* CROSSING IN CROSSWALK J UNFAMILIAR WITH ROAD G IMPAIRMENT NOT KNOWN
B
C OBSTRUCTION ON ROADWAY• AT INTQRS[CTION K DEFECTIVE VE..EQUIP.: H NOT APPLICABLE
D CONSTRUCTION-REPAIR ZONE C CROSSING IN CROSSWALK-NOT I SLKK"/FATIGUED
E R[DVCED ROADWAY WIDTH AT INTEN SE GTION L UNINVOLVED VEHICLE
F FLOODED• D CROSSING-NOT IN CROSSWALK M OTHER•: I 2 7 S SPECIAL INFORMATION
G OTHER•: E IN ROAD-INCLUDES SHOULDQR N NONE APPARENT A HAZAXOOUS MATERIALS'
H NO UNUSUAL CONDITIONS F NOT IN ROAD O RUNAWAY VEHICLE B PINE INVOLVED*
G APPROACHING/LEAVI.G SCHOOL [US C TINE D[P[CT/r AlluR[•
SKETCH MISCELLANEOUS
d
° N
0
I INOICATE
Q NORTH
I
I Q
i¢1
PoI-PEn.
I
I T1 MPKlD
YEN.
LUNq cr
PHYSICAL DESCRIPTION OF PARTY
NUMBER HAIR .... HEIGHT WEIGHT
IRQPARER'f NAME I.D.NUMBER MO. DAY YR. REVIEWER'S HAM[ MO. DAY YR.
6W 2 ! 31 2-- 1-8�
CHP 555—Page 2 (Rev 6.82)OPI 042 *Explain in narrative
INJQR ED/VV ITNESSES/PASSENGERS 1 3 8
DATE O/ COLLISION (� TIME (2400)
MO. ' DAY YH.Q l I O•PICERI.D, MBCR
GPI ^ 33l"U
Q - 02 7 S// .
EXTENT OF INJURY (check uric) INJURED WAS(Ch Cch one)
WITNESS PASSENGER PARTY
AGE SEX scvcRH wouND oTHeR YISl6 LE Co MPLwINr
ONLY ONLY -ATAL INJURY DRIVER PASS. PC D. nICY CLIir OTHER NUM OER
DISTORTED MCMDER INJURIES OP PAIN
❑ ❑ yy E ❑ ❑ ❑ ❑ ❑ - �2-
NAME TAKCN TO (INJURCO ONLY)
bbl-4u"N I I SC VALL Y M;=^"1 n }Sat 828- 1135
ADDRESS TELEPHONE
767-0 A YYt R I -.Ln QP Q 0 n,L I N
29 1 ❑ u 1= ❑ ❑ ❑ ❑ ❑ ❑ I ❑ I o ❑
NAME TAKEN TO (INJURED ONLY)
D E S CO V I C-ld EMILY TOA N 75"8
ADDRESS TELEPHONE
1989 SARAN DP , PINOLF
IK I ❑ ❑ ❑ ❑ ❑ ❑ 1 ❑ 1 ❑ 1 ❑ 101
NAME TAKEN TO(INJURED ONLY)
LA FOLLI TTE Ht=LlDoN RAY P2 r, — 7 Z.SY
ADDRESS TELEPHONE
32 W1NSLOW PL CAN P RV,A.OPJ
❑ ❑ ❑ ❑ ❑ ❑ ❑ I ❑ I ❑ I ❑ I ❑
NAMH TAKEN TO (INJURED ONLY)
ADDRESS TELEPHONE
❑ a ❑ ❑ o ❑ ❑ 1❑_I ❑ I ❑ 1 ❑
NAMH TAKEN TO (INJURED ONLY)
ADDRESS TELEPHONE
❑ ❑ ❑ u ❑ j ❑ ❑ ❑ ❑ 1 ❑ 1 LJ
NAME TAKEN TO (INJURED ONLY)
ADDRESS TELEPHONE
El ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1 ❑ 1 ❑
NAME TAKEN TO (INJURED ONLY)
AOORESS TELEPHONE
❑ ❑ ❑ ❑ ❑ ❑ ❑ 1 01 ❑ 1 ❑ 1 ❑
NAME TAKEN TO (INJURED ONLY)
ADDRESS TELEPHONE
❑ ❑ ❑ ❑ ❑ o ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑
NAMC TAKEN TO (INJURED ONLY)
ADDRESS TELEPHONE
o 1 ❑ a ❑ ❑ ❑ ❑ ❑ ❑ 1 o i ❑
NAMH TAKEN TO (INJURED ONLY)
ADDRESS TELEPHONE
EXTENT OF INJURY (chech uric) INJURED WAS(check tine/
WITNESS PASSENGER PARTY
qGE SEX
I ONLY ONLY (ATAL INI URV SEVERE WOUNO OTHER VISIBLE COMPLAINT ORIV ER PASS. PCO. BICYCLIST OTHER NUMOER
DISTORTEO MCMHCR IN JURI[S OP PAIN
Pqt►AR HR f NAMH I.D.NUMnlR
CR's DAY
MO. DAY YR, RCVI6 W NAME MO.
AT tiJELSOtJ _ 6YZ ► 3 ) 8-3 L I�i 12-���3
CHP 555—Page 3 (Rev 8-81) OPI 042
FACTUAL DIAGRAM t �/ ►AGE 8
DATE OP COLLISION TIME (I�00(L NCIC NUMUEN OPPICER 1.0, NVMDER
DAY 3 I V R. 8 3 S O l O O
ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED (SCALE t
I I II 1 IIIII
E 13.6 O 08-1
C INOIC wTE
r NORTN I
,•• 3
?�J LL
av
a (�
Q
2"
poiNT OF REST
1
b
3'
3'
b
Po= UNKNOWN
4•
— f
w I
j �
Ill
cY
s °�- s•
6'•
6•
I
0
J
J 7••
7"
LU►JA GT a
(/LS V"ct
I
�.. 2.. 3.• 4.. s.. 6.. 7" 9.
y..
III I III II ! I t I I I I I I II ! II ) I ! I ilIII Iil
PREPARER'S NAME I.D•NUMBER MO, DAY YR. R •S N E MO. DAY
CHP 555—Page 4 (Rev 8.81) OPI 042 aA.-a-'56 9/Ia i.xo w-°'p
' Y- 5 ►AO[
r � ..:N ONH CND• _
NARRATIVE/SUPPLEMENTAL NARRATIVE SUPPLEMENTAL YJ COLLISION REPORT OTHER:
DAY[ OF ORIGINAL INCIO[NT C�[• TIME (2.00) NCIC NUMBER OFFICER 1.0. NU MBHR
MO. / DAY 3/ Y R. e< 3 �� D .� 0 /00 6 S' 3 r -U
CITY/COUNTY/JUDICIAL DISTRICT RHIOR TING OIlTRIC T/a HAT CITATION NUMBER
LOCATION/SUBJECT
FACTS .' 2 RL-CL I \/r 1-) ,PLC Q A N r
x,1`!1 J-^, ,Q i i__L P /(/) 1% \/`f: r,--\T-�-:- D f?. T A p.P r y L. T r = r,C E N E
AT T-r1= SAMP S P 1 F-rl?=- AND Rr T-IC N !
C. - Nf= p,n)A.r{ u 0 D R, c TWO 1 F I r--Vtr L_ Ac rte►-(A ' " P a;�:J a t/
r %t;) t PA 1 , {* )--� C =tl• ►L"Il P P G . -I t\ h P 7-J-1 1m 1 cp 07j--1 !-A h.:f_IS A!P+_
P'Y PAINTeD Q Q ) ;1�1 Y-'/ )tJ 11MES . AWLOILI 2 I
I 1. -!V C.1 R R 1Tl ��- f-1 '- 1 TpE T 1 A)1) f�
I = ARE r;\ L-)PICH THE h u c-
p VT10I�t n - '?1 (/ -r OC'.'aTf:= f T 441 V - . N
-r p / r-: Y / P E-(7-I 0,'\/A L
,1 Q U L/-\iPLJ L =
'; CAL - / T= C -1 L F=(?O N T 1 ►I�J r? /1 I) 1--I ;n -
/-1-1, �'' j S CC T-1-! A L I-I— =1 L 111 0 P c T CA,V'
DIP 7. A, 17.QU7 ?O Vy I 7 i-1.- 1( :T ?� Q.•t� . t� (�� } '(_ i T ,�.�
TI-(`- I�VIi'�J�L'1•� 7V ! > 1!
(),;37 WAS
1 L1 F ? IF f1 T' Lj ! ► I- t f, h L; <I= lT MAY
IR[►ARER'1 NAME I.D.NVMB[R MO. CA' YR. R[VI[W[R•■N I YO. DAY YR,
3I 8 2--1-� 3
CHP 556 (Rev 6-82)OPI 042 Use previous editions until depleted. 2'614-156 t-eZ aSP 100W
.ONE CNECI
NARRATIVE/SUPPLEMENTAL NARRATIVE EJ SUPPLEMENTAL COLLISION REPORT D OTHER:
DAY. OP ORIO INAL INCID■NT TIME (300) -c NUM UEH � OPPIC■R ID, NV Mtl P.R w�/
MO. DAY YR. / 0/ or r- G I (I/��
CITY/COUNTY/JUDICIAL DIRTRICT REPORTING D18TRICT/HPAT CITATION NUMBER
LOCATION/f UDJECT
1-f A v t-F t=F)`J D L4 3 E r -- r ,�-�..I . 7 /F 0 1 S-r[) I2 A , r c- I&J D-1 c Q!P T
J c 7-,A-,'(J 721- t' -lE r n e.1 / / /k 1
, ~ it-►t= U = T)Z 1 K1Jv< - e A -r lt , V
Wool-) F T-1 F- ;7 12 /.J T-
S Y11 F t=l -I A 1�) iJ I LJ ) ! !1�J A 3 l -
U F I k 1 — I, T tii� ;1 - % i. 1 ''� Jr=) r1 T, It✓ C ) it c _; r i 1
Y}1 )2 K W 1-I ! C H L Q F< 0 3 I F F'1-) E "1 • 1 )\J 6— 1-1 A 0 q L IJ e-
s s no ) P t 1 -1 • Pi&F(7- c r c �-,ta 1 I r-
_11 '= 1 f A1_ ; .Ac 1)/
1l/1/I) k' �
r.r-.
.r T)') ,! O 1 Y)'! DA�\C I S U�j k 17 ?0 y! .5 7-/-A TF n I a P!`!T c P T_.
11 - - ,n r r';t ; !- L i! f 117 uL1= ;=- I RTi-I r,('/V.
A>\1 E OF' r L d r
STAT -Mc t,I-r ; r� , � � r < �� C- A ' A WA rz 1 ( Or
1 A - 1 1; ! Y P f' I SA II 17- u c '--)))D J T
J ') I J Q F 1=1-
I gl^.iR*S NAML l....NUM.PR MO. AY YR. RDC MO.- DA♦ YR.
1 83 � 2-- 145
CHP 556(Rev 6-82) OPI 042 Use previous editions until depleted, r5era--`56 7.82 MP loon:
r
7
1 ONE CREC
NAR RAT IVE/SUPPLEMENTAL NARRATIVE CI SUPPLEMENTAL O COLLISION REPORT O OTHER:
OAT. Or ORIGINAL INCIDKNT TIME l2-0l NCIC NUMBER OPPIC.. I.D. NUM.ER
MD. / DAY / YR. Ff 3 / 0 5 O /O U 6 Y Z �S3 v - 0,2 7S ..
CITY/COUNTY/JUDICIAL DISTRICT REPORTING DISTRICT/.EAT CITATION NUMBER
LOCATION/SU.J.CT
O — � , 1- 1 - —Ah1 6-! i �
1 r n r= -1 1
p�4 To 1 - THE r -r)-[[=- ►-r
ro -t
1
rT; DL::SCQV1C1-1 SAM AT rknz wAS, -s7r7A- tjrw\i(,- upy-r e ►
\ =1 7 ' 3=Gc D00Q f,13F - WAS l ?
FR N C F F!-j2 E F-I . /l) -7/A:" Y
AT mss- 1 7/47- As A/ ) 1 /=✓'�J' �i ,�
\ I /Jl
1- ( \ _ 1 I)PnVF.7 CIA<
.' L FOLLF- 7F I r 1- C VIA
JU
! F 0 L - Ti.F c ! W i D vj r,-r c E
cI1 WP/
0-1 VGH /. I ( �'�. �, -- C 1- P 2 �4 r -
1 C U l---r, F—) f ^ 1z• =r T ) :-f/— ! 1-r ]A _ r -r r q :�: ► �—
T 1 L S SAE"C7E/-) /c' /,/T'=5 . -N G//i /A; D rte%
7-/F / r Rz:--^R ZZA�E 1W,, /G TL
PR.►A R.R•fl NAM■ 3!=L0(1 / /E
I.D. UM... MO. DAY Y.. VI SMOT DAY Y.FAS NELSO 6`f - 1 31 1'
r�iPO
2 y3
CHP 556(Rev 6-82)OPI 042 Use previous editions until depleted. "34--1%7-e2 MP taooJ
•, •, 8 PAG[ Y�
( [CN ONE CNN 'NE .
NARRATIVE/SUPPLEMENTAL NARK ATIvE SUPPLEMENTAL Ly COLLISION REPORT O OTHER:
DATE OP ORIGINAL INCIDENT TIM[ NCIC NUMBER 011IC[R I.D. NVMS,2..
MO. ! DAY 31 YR, 3 �/05 0/00 6 Y I 0 027J
CITY/COUNTY/JUDICIAL DISTRICT REPORTING DISTRICT/.BAT CITATION NUMBCR
LOCATION/SUBJECT
- _ — S /� I _
-0 /� ` /C. .
h E f 0,1173-1 U /A-' o
I F l—� HOOD A N D r--- T
62'/
2 F C 0 Yv)011=Q^3-)Q LJ S P0 1\ =
PRE PARCR•f NAMC I.D.NV MBCR MO. DAY Yw. wCVIC WCw•f NAMC MO. DAY w.
CHP 556 (Rev 6-82) OPI 042 Use previous editions until depleted. 2MJ'J-4I 6 7-eZ osr 1000J