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SUBMIT TO CITY CLERK
City Hall
2263 Santa Clara Ave.
, Suite 380
Alameda
, CA 94501
Claimant's
Claimant's Address: 101
Henley Avenue
, Columus
Ohio 43220Robert Zack
Claimant's Daytime Phone No:
Gende
Q/
Date of Birth:
Driver
s License No:
Cell. No:
06/07/52
SSN:
State/Expo Date:
When did the damage or injury occur (date and time)?
11:30 a.
m. - 1:00
May 30
20J 1
at approximtely
Place of occurrence: Crown
Memrial
Beach at Willow St. and Shoreline Dr., Alameda, CA
What happened and why is the City responsible?
PI PriRP RPP ;:rrTar.npo p l eaoi ng
Name of Citys employee(s) causing injury or damage
, If known:
Description of damage or loss:
Please see attached pleading
Total amount claImed:
Please see attached pleading.
* Under Senate Bill 2499
, the "
Medicare
, Medicaid, and SCHIP Extension Act of 2007 (MMSEA)"
, mandatory reporting
requirements for all claimants require a Social Security Number
be provided, under penalty of law.
If total amount claimed is less than $10,
000.
00, enter amount claimed and the basis for computation of that amount. If it
more than $10
000.
, indicate whether the municipal or superior court would have jurisdiction. Government Code Section
910(f).
 
ROBERT E. CARTWRlGHT
, JR.
, ESQ. (SBN:
104284)
DAVID G. YEN, ESQ. (SBN: 234550)
The Cartwright Law Firm
, Inc.
222 Front Street
, 5th Floor
San Francisco
, CA 94111
Phone: (415) 433-
0444
Facsimile: (415) 433-
0449
Attorneys for Claimants ROBERT ZACK
, BERNICE JOLLIFF
ROBERT ZACK
, BERNICE
JOLLIFF
 
GOVERNMENT
Claimants
vs.
CITY OF ALAMEDA
(a.
governent
entity); COUNTY OF ALAMEDA (a
governent
entity); and DOES
through 50
, inclusive;
Respondents.
Name and Address of Claimant:
ROBERT ZACK and BERNICE JOLLIFF
c/o
Robert E. Cartwright
, Jr.
, Esq. and David
G. Yen
, Esq.
; The Cartwright Law Firm
, Inc.
; 222 Front Street
, 5th Floor; San Francisco
, CA94111. Telephone: (415) 433-
0444. (Claimants may only be contacted thIough their counselThe Cmiwright Law Firm
, Inc.
Page 1
GOVERNMENT CLAIM
 
Post
Offce Address for
Notices:
Robert E. Cmiwright
, Jr.
, Esq. and David G. Yen
, Esq.
; The Cmiwright Law Finn
, Inc.
222 Front Street, 5th Floor; San Francisco
, CA
94111.
Date, Place, and Other Circumstances of the Occurrence
Date
, Time
Place:
This incident occuned at Crown Memorial State Beach
located at
Wilow Street
and Shoreline Drive in the City of Alameda
, State of California on May 30
, 2011
between approximately 11:30-
1:00 p.
Circumstances:
ShOlilyafter
11 :00 a.
m. on May 30
, 2011
, Raymond
lack waded into
Crown Memorial State Beach with his clothes fully on. A long-time friend and co-
tenantof
Raymond lack'
, Dolores Berry, who refers to herself as the foster mother ofMr. lack
stopped
a pedestrian on the beach and asked her to call 911. She communicated to 911 dispatch
fit
Raymond lack was
depressed and possibly suicidal and was concerned for his safety
because he
did not know how to swim. The 911 call was placed at 11
:30 a.
m. By 11
:36 a.
, Alamed
Police officers and Alameda firefighters had anived on the scene. At this time
, RaymondZack
was standing in waist to chest high water approximately 50-
150 yards from shore. From II :36
m. to 12:05 p., Raymond
lack continued to stand
in the water
, often looking back
toward
shore. No member of the Alameda Police Department or Fire Department attempted to eIler
the
water to establish contact with him. At around 12:05 p.
, Raymond lack'
s body became
submerged in the water. Shortly thereafter, he was observed floating on the water. Still
, 110
police officer or fire fighter responded. Raymond'
s body continued to float in the water
and
gradually drifted toward shore. At around 12:27 p.
, a civilian bystander
, on her own volition
Page 2
GOVERNMENT CLAIM
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