Declaration

Cal. Super. - 6th Dist.October 5, 2017

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 -1- Case No. 17CV316847 SMRH:488469288.1 DECLARATION OF BRIAN S. FONG SHEPPARD, MULLIN, RICHTER & HAMPTON LLP A Limited Liability Partnership Including Professional Corporations PAUL S. COWIE, Cal. Bar No. 250131 379 Lytton Avenue Palo Alto, California 94301-1479 Telephone: 650.815.2600 Facsimile: 650.815.2601 Email: pcowie@sheppardmullin.com SHEPPARD, MULLIN, RICHTER & HAMPTON LLP A Limited Liability Partnership Including Professional Corporations BRIAN S. FONG, Cal. Bar No. 262846 AMANDA E. BECKWITH, Cal. Bar No. 312967 Four Embarcadero Center, 17th Floor San Francisco, California 94111-4109 Telephone: 415.434.9100 Facsimile: 415.434.3947 Email: bfong@sheppardmullin.com abeckwith@sheppardmullin.com Attorneys for Defendant GRANITE ROCK COMPANY SUPERIOR COURT OF THE STATE OF CALIFORNIA COUNTY OF SANTA CLARA GEORGE HAFELY, Plaintiff, v. GRANITE ROCK COMPANY; and DOES 1 through 100, inclusive, Defendants. Case No. 17CV316847 DECLARATION OF BRIAN S. FONG IN SUPPORT OF DEFENDANTS’ NOTICE OF MOTION FOR SUMMARY JUDGMENT OR, IN THE ALTERNATIVE, SUMMARY ADJUDICATION [Filed concurrently with Memorandum of Points and Authorities, Separate Statement, Appendix of Exhibits, Declarations of Ann Giusiana, Stephanie Kniffin, Mike McGrath, Shirley Ow, John Seith, and Proposed Order] Judge: Hon. Peter Kirwan Date: February 5, 2019 Time: 9:00 a.m. Dept.: 19 Complaint Filed: October 5, 2017 FAC Filed: November 29, 2017 Trial Date: March 11, 2019 Electronically Filed by Superior Court of CA, County of Santa Clara, on 11/21/2018 8:31 PM Reviewed By: F. Miller Case #17CV316847 Envelope: 2199230 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 -2- Case No. 17CV316847 SMRH:488469288.1 DECLARATION OF BRIAN S. FONG DECLARATION OF BRIAN S. FONG I, Brian S. Fong, declare as follows: 1. I am an associate of the law firm of Sheppard Mullin Richter & Hampton, LLP, attorneys for Defendant Granite Rock Company (“Defendant”), in the above-captioned matter. I am a member in good standing of the State Bar of California. I have personal knowledge of the facts set forth in this Declaration and, if called as a witness, could and would testify competently to such facts under oath. 2. Attached hereto as Exhibit N are true and correct copies of excerpts from Plaintiff George Hafely’s (“Plaintiff” or “Hafely”) document production, produced by Hafely as part of his verified discovery responses in this case. 3. Attached hereto as Exhibit O are true and correct excerpts from volume one of the deposition transcript of George Hafely, which I took on March 29, 2018. 4. Attached hereto as Exhibit P are true and correct excerpts from volume two of the deposition transcript of George Hafely, which my colleague, Amanda Beckwith, took on May 7, 2018. 5. Attached hereto as Exhibit Q are true and correct excerpts from volume two of the deposition transcript of George Hafely, taken in connection with his workers’ compensation claim, on February 26, 2018 6. Attached hereto as Exhibit R is a true and correct copy of the complaint Plaintiff George Hafely (“Hafely”) filed with the Department of Fair Employment and Housing on or about October 5, 2016 and amended October 20, 2016, produced by Hafely as part of his verified discovery responses in this case (P003073-P003080). 7. Attached hereto as Exhibit S is a true and correct copy of the First Amended Complaint filed by Hafely on or about November 29, 2017. 8. Attached hereto as Exhibit T are documents produced by Robert Farahmand in response to his deposition subpoena, which took place on May 22, 2018. 9. Attached hereto as Exhibit U are true and correct excerpts from the deposition transcript of Robert Farahmand, which I took on May 22, 2018. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 -3- Case No. 17CV316847 SMRH:488469288.1 DECLARATION OF BRIAN S. FONG 10. Attached hereto as Exhibit V are true and correct excerpts from Plaintiff’s Verified Responses to Defendant’s Requests for Production of Documents. 11. Attached hereto as Exhibit W are true and correct copies of exhibits from the deposition transcript of Plaintiff George Hafely, volume 1, which I took on March 29, 2018 I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct, and executed this 21st day of November, 2018, in San Francisco, California. Brian S. Fong EXHIBIT N USHW o£ Cali£ornia - S.nta Clara C... ~ 40097468 DOCTOR'S FIRST REPORT OF OCCUPATIONAL ILLNESS OR INJURY 2, EMPLOYER GRlN1T£ ROCK/WATSONVILLE " INSURER ZURICH-AMIRICAN INSURANCE PlEA8E 00 NOT U8ETHI8 3, Street Acid•••• P.O. BOX 50001 8treotAcidro •• P.O. BOX 7774 OOLLNN Oily, Blat., Zip WATSONVILLE CA 95077 Oily, Sblte, ~ SAl'{B'IWICISCO CA 94.1B8 OUtNQ, 4 Sua/nan Tvpe GEN SNOINEIR CONTRACTORS Claim' B, PAllENT NAME (First, MIdit., Lost) 11_ 17~I~a, Incuslry ".£ely, Georqe IIMal. D_~ s, Acid•••• : No, ""d S••.•• , CIty Zip g, Ttltphor» NUn"I>.r ~ounlY GUroy 95020 to, OoaJpatian (Speenlc Job "U.) t 1. SecI.1 Socurlty Number "GO Dr1ver 12, In;'rod tJI: Oily Cwrrty Hawd- - - 13, D.t. and h~ur of Injury 14. Date I8lt worked Me. Day Yr. Ollene or on •• t of llln••• 9/30/04 !"OO AM 11/18/04 15. em and hour 01 ftrot 1S, Hav:.r.'!tIor ~ur _.) pnovlouoly HOIli~llaIluUo~ examination or treatment 11/16/04 3.55 PM treat p on IJ V.. • No 17. PATIENT, PL;A9E DESCRIBE ~OW ~E AOCIDENT OR EXPOSURE ~APPENED (e•• pecina) oceul)allon #20740/qrn/Cynth1a Clark, M.D./jm Pati.nt .tat •• , "I was ••• hin; my chut •• out. I nipped a chut. up and felt a Iharp pa1n go thru Illy shOulder," A«lImou.c. , 8.119J2O, SUBJECTIVE COOPAINTSIOBJEOTIVE FINDIN<10'- retum dalo to: 8peolfy R,strk:tions: 5.. .bDVI. Dootor'. Signature Name .nd e.g,... S1gnature on rile CA U_.. 160094CLAlIK, CYliTlIIA, M.D. IR8Number 'J~-4M"ZIl' 988 WalBh Avenue Sant •• Clara CA 95050 pnon.NumbOr(408) 988-6868Add,. •• N/V PERSON WHO MAKES OR CAUSES TO BE MADE ~V IRTHE PURPOSE OF OBTIIININequettly dee as a resdt cI iii p-eYiOustt !!~ IfIlUrv or ~Iness, the ernJi:lyer mustfite 'MttI1I1fhrt dqI cI knowledge an amended reccrt Mr::abng death In addkm, every seoocs "JUrY, .lness, or deathde...,.ng____ ~ ••• ~ •• or JMiYMMItik rnust be reported Immedtltety by tele~ne or ttlegtartl to the nearest of'flce of the Galtomaa Dveon of Occueetcrer Safety and Healttl vultty of iiI~. rr "-~~ PI,ase do not use~n' ""~~ROCK COMPANY th" column 12. .••••• ,c..,."PI •.....••••- 11711 BERRYESSA ROAD, SAN JOSE, CA. 95133 (408) 487-3138 CASE.UMBER . ••• ""'-£Of" ,. 11711 BERRYESSA ROAD, SAN JOSE, CA. 95133 361 ,-"'" ~ -.,. CONSTRUCTION MATERIAL SUPPLlERIENG CONTRACTOR I', TYPEOf '0""· [J- r 1:- [Joy r r 10lllr GM'l, Ipdy. I.OUSTRY ~ _~ 12,.W ~ ".' j1"t.1f DROYl( _a. DATI Of DEAlI......." .~ -~ ,~" '5:' 0:iU-m I_I I"~'·"" ,~ .0•••••''''' ••''y) a eox06/08/09 I I I~v" I" o- ~ ''''''Of IF~~I SEXD.. Orv08/09 • _ IiiiiiiiliiO AGE ,I~~:N llS!1!A.!!.II...!FR=A/!!!jCrk.lalu. p.ndlng PR2 o not Improvod "gn,fioantiy LI baan dstermlnad to be non-wcrk ralaiad OIAGNOSES (Includ.,CD·9 code,ll po•• ,bl.) 847.0 SPRAIN OF' NECK IR~TMENT III! Office Visil/injury Tr.aim.nt o Start 100Conunue 00Therapy: L um.sl w•• k for L- w•• ks. 0Erijonomlc Eval o Start I 0 Condnuo 0 Chi",: _dm •• lwoekfor w.ek •. 001l1.r _ o M.doI Suppll.s Dlop."_ o Conaultailon I 0 R.Ionoi 0 Roqu.OIod 10 P.ndlng. Specialty 0 Work _. to be d.lBlTnlnod by.poolallst, Estimated l.ngtl1 of trea1mant Is now WORK STATUS o Firat Aid CO•• ___ w•• ks o Retum I 0 Continue." to work without reo1r1etlonc, o Off work until (Data) Estimated period of tolal temporary disability __ days. o ott lhe balance of 1111•• !Ilft only. Then RTW on (0.,.) to D Full I 0 Modlned dulY, D R•.• Volual. work OIalU. befor. next .hllt IX] Return to work as of (Date) 6117/09 () No work near mov ng machinery () No I () Limited u•• of R I L hand to () No I ( ) Limited .tanding or wolklng to () No I ( ) Limited ov~m.od wol1lto () No I ( ) Limited .tooping and bending 10 () No I ( ) Llmltad kIl4tttJIi/ /k/1,- ~t&J. tP;z.1I~!tx -tJ6?/1 ('Id!. iu< 1'Jt3 /fJ-f 1t1/U 06/0912009 1:07PM 000291 P000644 8&/89/89 14:8&:34 RightFax Page 883 2010181017 ~ •• 0' c."o~ I c","" "mp'''' m tnoecete ''''''.,' p"'.'" ",,' ~o "P'" '0 OSHA CUE III EMPLOYER'S REPORT OF Zurich Amencan Insurance Co. OCCUPATIOllAllNJURY OR ILLNES81400 American Lane Schaumburg IL 60196 FATALITY 0 "nl' p••.• on who "'3~"or can •• to be nt"d_ ~n,. \Ilhlnml~ I~.•. rA~LI"~~pmrlllYllr~ tn rIl[lllrtw'!hln II••••d',IIlI knnwlp~o~"\("ry nrrll[lll~nn~llnJLlry or 111'l~'"whtrh rAntrllctor, wholnllillroc_,uwmll, hot ••, elo; I. still. unemploymen11nlurancl!.S!.!!. R st&rd contractor w/mi:x_Ul transit trucks also oper quarry 005-0188-2 8. TfPE Of EMPLOYER. ~pn.alll ri- OCounl1 OCII, o SdloolD'~,ld oOlhe Gov1,SpfcH, INDUSTRY-1 D.l.TEOFINJURYIONSH O' IlLMES; riME lfUORYflLLNESS OCCURRED 9 TIME2'UlOYH 8EG.U WOt~ 10 IFEMPlOH~DIED,DAleOf ~~.I.TH[mmMdf11 OCCUPATl6N~(""'~dIHI tJ/R12009 1 ,. l2:3lL o. 1 .00 •.•• ~ l~l~~Af}ji~O~Mo~~~Jm:O~E 12 csre LAU WORKED(mmlddlh'l 13 OATERETURNEDTO WDRK(mmlddl)'yj 14 IF STILLOFFWORK CHECKntISeOl' 0'" [)5]" D If PAIDruu DAYSWAGESfCflDATEOf 11. aA~RY bCINGCONTINUCD? 17 DATeor EMPlOVER'~HMOW,EOGtI NOTICEor 18 DATEEMPlOYHW.l.3PROVIDEDClAlhlfOR SEX IIIUY ORLAST{29 0" Ova 0 •. INJURYIiLllEn Im,"/~qIyYI06/08/09 (IImMdln) 06/09/2009DAYWORKEO?X v•• 19 SPECIFICIIIJURYo1LLIlESSAlia PARFOF BOOVAFFECTED,MEDICALDIAGIlOSISIf •••,IIIbI8, "V. S.cond d'ire. bUIIIIORrilht Inn, t.ndonKIl on IItt .I"w, 1.111pollonml AGE I neck strajn ", 20. LOCATIOIIWHEREEVENTOR EXPI)SUREOCCURREO('hllnbll, SIrlill. City, ZIp! 201 COUNTY I" G".PLGYER'SP"."", DAILVHOURS u Unknown ri- ~N'~ Union Clt~ CA 94587 Alameda 22 DEPARTMENTWHElIE EVENTOR Exr08URE OCCURREDI.g. 8hlpplllg ••• .tml ••••mlllfol"I lhop. In. Othlr W~'kl"~ecI or NIInIhll 1\I1IIt? Job Site Dv.. X No oAVS PER WffK 24 EQUIPMENT, MATERIALS AND C .cEMICAlS THE EMPLOYEE WAS USING WHEN EVENT DR EXPOSURE OCCURRED. I 9. A('""llnl, .Mclln9 tor(,h, hnn tractor. ICltrolci 0 R Object Or Agent, Not 1 isted WEEKLY HOURS U SPECIFIC ACTIVITYTU EMPlOYH WAS PERFORMING WHEN EVEIIT OR UPOSURE OCCURRED• •. g . W.ld'ng •• am, .1 melal form., loadIng bun onto trud I over exertion l WEEKLY WAGE L. ZB.HOWIIIJURVIILLilESSOCCURRED.DESCRIBESEQUENCEOF EVEIITS SPECIFY08JECT OR EXPOSUREWHICHDIRECTlY PRODUCEOTHEINJURYIlLlNESS.e.\I Wor,., rtllOP" ~~Ito '",plct 1\<1' N ""d ~Ipp.d on Ie,"" ,"""".1 "'.h, rill, U b'Ulh.d IWlln1ll,nh WIld,""d bu,n.d IlgMhind vir srr .•.•.I.T!SHUT IPN!CnS.l.H E While usmg chute scraper - he felt a sharp pam on luft SIde of neck COUNTY, S H Nam _ .nd IdclrMI of II"W.lclln (!lumb ••..• Ir •••• city. 2111l I Phonl Numb.r NATURE OF INJURY US Healtbworks 988 Walsh Ave Santa Clara 95050 408 988-6868 28 HotphUZII!'ri lit lin Inp'ltlf'nl OIlf'rnlg~NO UYn Ify", then. nAme lind '1ddreS5 ofho5plbll (numbPI'. ,trfoef. ell)!, "0) ::18, Phon. Numblr PART OF BODY 29. EmplOYII trl.~1n Imlrglncy+r-- X No TTENTION Thll form conbrlnl ]l'Irolllllllon relating to elll ployee h •• ltllend mUlt b. \I•• d In I mann.rth.t ~tot.cta th. connd.ntl.llne of employ ••• 16 the utent poulbl SOURCEwlllli thl Information I. belnllll •• d .or ocup.llonll .Ifotr Incl IIlth.h PU'POIII 'II CCR nne 814300.28 I III1H',ollo M003ti(b)l21 12 N,I •. S."" 110_ 1n41c.tl c.nfldlntlll _pl~, •• lnf,rmatlolI II IlItld In CClt TItMo.14:!iOO:llllbl12)(E)!*. O. EMPLOYEE NAME ;'1 SOCJALaECUR!TY NUMJER In OAn Of IIRTH(mntf'dfrrJ Halely, Geurge XXXXX6065 XXIXXIXX EVENT I" S (Numblr, Str.lt, City, Z 31. PHOIIE !lUIiBER $ECOIIDARV SOURCE Gilroy CA 95020 IXIM'" OFlmal1 ~CC1J1!ATKfIl (IIllullr jolllltll, 110Inlll.II, abbtlVlatloni or numb"l 311 DATE OF HIRE IJllllllcld1yr) MIXer Dnver 0111211001 37 EMPLOYEEUSUALLYWORKI> 370 EIiPlOYMENT STATUS 31b. UNDERWHATCLASS CODE OF YOUR _5___ dlYl PI! wllk. ____ total woeklW1I0ul'l ~fltUlar, full·tlm. 8Plrt-tlmo POLICYWHEREWAGESASSIGNED ___ hUrl plr day. tomporDry •••• on.1 EXTENT Of INJURY JII GROn WACEtltALAIW ~~ POI' Week J9 OTfIEAO,Y.il£~U HOTR£POHfC A~ WMU"AlAAY (It HPI, 11.,11.•.•.• 011 •• ' bon~I" .I~ 11, o- 181" COll1pl.t,d Br (type or pllnt) Signature & nne Oat. (mmfdtlln) Carol Ilse 06/09109 FILING OF lHll FORM Ie NOT AN "O"'0810N OF U"BII.ITY 361 06/09/2009 1:07PM 000292 P000645 Hb/H9/H9 14:H7:H7 RightFdX Pdge HH4 June 9,2009 RE Claim # insurec. Date cf Loss Claimant 2010181017 Granite Rock Company. ~OO Level Site Codes 6/8/20091 Hately, George Participant listing: PartlclpaDt Last Name Hafely _~F""lrst Name _ George Role Injured Employee MANAGE YOUR CLAIM COSTS! UTILIZE A PPO PROVIDER Preferred Provider Organizations (PPOs) are third party vendors that contract with medical providers to offer a wide range of services and care for Injured employees of our workers comcersanon customers A WCRI study found that PPO networks are generally associated With much lower medical costs - 16 to 46 percent lower if the Injured worker IS treated exclusively by network providers Zunch Services corporanon maintains a nationwide networK of PPO providers to deliver quality medical care to Injured workers. For a list of PF'O providers, please refer to the Zunch CAR E Directory Online at our website, www.zurichna.wmToflndthedirectory.slmplyclickonthe ..OnlineServices .. link.click "Customers", scroll down and click the "Zurich C.a r.e - Directory Online" link. Type "zurichna" In the login box IFyou have any questions please call the Managed Care Service Center directly at 1-800-972-1111 06/09/2009 1:07PM 000293 P000646 8&/89/89 14:87:Z3 RiyhtFilx Page 885 June 9,2009 RE Claim #. Insured: Date of Loss Claimant. 2010181017 Granite Rock Company' 300 Level Site Codes 6/8/2009 1 Hately, George Reported By: Reported By Phone #. Carol lise 8317682018 Care Center Notes While using chute scraper - he felt a sharp pain on left side of neck. Reported by Carol lise Reported by phone. 8317682018 Insured contact name Carol lise Insured contact phone 8317682018 Channel reported' WEB Supervisor name Andy Cicholas Supervisor phone 4084873139 CSR Name Jennifer Sweet 06/09/2009 1:07PM 000294 P000647 06/09/09 TUE 05:49 FAX 408 487 3131 GRANI Tli lrpe: r / Driver License Number: / Injyred? -Yes / No Vehicle License Number; I I Make: Model: Color! / / Descripllon of Injuries, Damage: / _. / / / Instructions for CI~im5 Handling: / \ / / / Insurance corrler. Policy # / \ - / / I - / \ I / I -- Olher Party #2 Informalion •- OVWltness Inror~ationl / --r Nome: IpCddress: \ / / I Phone Number: work: / \/ ho~: Driver license Number: / 1\ IniVred? Yes I t..ro Vehicle License Number: / / \ / I .Make: Mo}lel: Color: / / 'Descrlptlon of InjllrieS"mage: / ~ Insurance Carrier, Policy /I / I - --.~ uescnpnon orlneident SKetCh [Collision Only) - Note: Use cddltlcnct Iheel of paper If needed Us;, cddilloncl sheell! needed I.:J:" t.J::;..." /l.S/A provided to employee. Fecha en que se Ie entrego at empteado fa pew..:uJn. _ 13. Date employer received claun form. Fecha en que eI empieado devotvui la peticion al empteador. 14 Name and address of insurance carrier or adjusung agency Nombre y dn eccion de ta compuiiia de seguros [)ogencia adminstradora de segur,JJ. ZURICH U,~~ __~p~,O~,_B~O~X~~7~7~74~_LI__~S A~N~F~R~A~N~C~I~S~C~O~C~A~9~4~1~8~8~-~7~7.~724_ IS. Insurance! Policy Number.EI mimera de la paliza de Seguro. WC34 7266 7 -00 ~ 16. Signature of employer representative. Firma del represeruante del empleador. :#~~~ 17. Title. Titulo, Wor'~ers' Compensation 18. Telephone.Telifono.~i5/-7")J-Mlr Administrator £L FIRMAR ESTA FORMA NO SIGNIFICA ADMISION DE RESPONSABIUDAD Employer: You are required [0 date rhrs form and provide copies to your insurer or claims administrator and to the employee, dependent or representative who filed the claun within one w()rkin1~day of receipt of the form from the employee Empfeador: Se requsere que Ud.feche esta forma y que pro via copras a 511 com- paiiia de seguros, admcnistrador de recta-nos, 0 dependientelrepresentante de recta- mos y (11 empleado que hayan preseruado esta peucion deruro del plaza de un dia /nibil desde el momenfO de haber ssdo recibida la forma del empleado. SIGNING THIS FORM IS NOT AN ADMISSION OF LIABILITY o Employer (:.uPy!CoJ!w del Emplw,lu( o Erupinyce COlly!Copw del Empieodo o CramsAdlTlllll~lrator!lId"uIJwrudor de Rl'CllImUl 0 'lernporary Rt!celpVReCJbo dr/ rmpl('at!IJ 7/1/04 Rev. 000298 P000651 'age: 1 \.jKANII t: KU\...I\ \...UIVWf\N Y COMPLETE CLAIM STATUS REPORT uale. I II I~/U I :W Ref. ~;.~: 00-0004 .laim No.: 13-802257 EMPLOYEE INFORMATION ---------------------------------------------------------- :Iaimant : HAFEL Y, GEORGE A. Date of Injury: 08/30101 'hat was Employee Doinq when Injured? DELIVERING CONCRETE. WASHING OUT MIXER TRUCK AFTER DELIVERIES. CUT FINGER ON 8/30101 WHILE SHAKING OUT THE CHUTE. ow did the Accident or Exposure Occur? RASH ON HAND DEVELOPED, POSSIBLY DUE TO EXPOSURE TO CEMENT. RASH DEVELOPED AROUND CUT ON MIDDLE FINGER. bject or Substance that Directly Injured Employee? CEMENT AND MIXEF~ CHUTES. ness? NO SHA Facility Code: 361 SHA Illness Code: [ury 1 Illness Code: 68 ouree of Injury Code: 60 ody Part Code: 99 Removed? NO OSHA Recordable? YES DERMATITIS MATERIAL HANDLlNG--MISCELLANEOUS HAND(S) 000300 P000653 -:'W Ref. No : 00-0004 -:'Iaim No.: 13-802257 \=IKJ'I'II I I:. rlUl"I'. l"UIVIt"/,,\I'I , uau::::. I II I.,J/V I COMPLETE CLAIM STATUS REPORT Hospital: NOT SPECIFIED l\ddress : -:'ity/State/Zip : Phys/Clinic: 7 SOUTH VALLEY OCCUP. HEALTH CENTER Address: 9460 NONAME UNO, SUITE 230 City/State/Zip: GILROY, CA 95020 Attorney: NOT SPECIFIED Address: City/State/Zip: Adjuster: 2 CARLITO GARCIA, CNA INSURANCE Address: P. O. BOX 74:30 City/State/Zip/County/Phone: SAN FRANCISCO, CA 94120-7430 SAN FRANCISCO (800)262-7161 Time of Injury: 12:23 Shift: DDate of Injury: 08/30/01 Date of Death : Did Employee Lose at Least One Full Day of Work? NO Terminated or Permanently Transferred Due to Occupational Illness? NO Date of First Knowledge: 08/30/01 Claim Litigated? NO Witnesses: Reported To : ANDY CICHOLAS 1st Occurrence: 2nd Occurrence: 3rd Occurrence: 4th Occurrence: 5th Occurrence: 6th Occurrence: 7th Occurrence: 8th Occurrence: 9th Occurrence: Rehabilitation? NO LOST TIME Lost Time Begin End Restricted Time Begin End 08/30/0108/30/01 08/30/01 Proposed RTW Date: 08/30/01 Lost Time Totals: Calculated Projected Manual Calendar Days: Work Days (OSHA): Proposed RFR Date: Calculated Projected Manual o o N/A N/A N/A N/A 77 55 000301 P000654 r ',_ -- ,~,. ~. "<'''''''', "".".~•.">,<>,~". , ., _ •• ' 'w' " ''''' ," ,~.,_~.".~" ••., _.,,,,,", ,0 -<,.h", • ",,".., ...-~~,,., t"age : .:l I.:IKANII t: KUvl\ I.JUMt'AN r uate : 11n :>/U'I COMPLETE CLAIM STATUS REPORT CW Ref. No : 00-0004 Claim No.: 13-802257 LOSS INFORMATION Year 1 Paid Outstanding Total Month Medical Indemnity Allocated Reserve Incurred 1 0 0 0 0 0 2 0 0 0 0 0 3 0 0 0 0 0 4 0 0 0 0 0 5 0 0 0 0 0 6 0 0 0 0 0 7 0 0 0 0 0 8 0 0 0 0 0 9 0 0 0 0 0 10 0 0 0 0 0 11 0 0 0 0 0 12 0 0 0 0 0 Paid Outstanding Total Year/Qtr Medical Indemnity Allocated Reserve Incurred 2/1 0 0 0 0 0 2/2 0 0 0 0 0 2/3 0 0 0 0 0 2/4 0 0 0 0 0 3/1 0 0 0 0 0 3/2 0 0 0 0 0 3/3 0 0 0 0 0 3/4 0 0 0 0 0 4/1 0 0 0 0 0 4/2 0 0 0 0 0 4/3 0 0 0 0 0 4/4 0 0 0 0 0 Totals 0 0 0 0 0 USER-DEFINED USER DEF #1 : 01 MODIFIED OR ALTERNATIVE WORK ACHIEVED USER DEF #2 : 01 AL TERNATIVE WORK ACHIEVED USER DEF#3: USER DEF#4: USER DEF#5: USER DEF #6: USER DEF #7: USER DEF #8: USER DEF #1 : USER DEF #1 : USER DEF#2: USER DEF #2: USER DEF #3: USER DEF #3: USER DEF #4: USER DEF #4: USER DEF #1 : NO USER DEF #3 : NO USER DEF #5 : NO USER DEF #1 : USER DEF #2 : NO USER DEF #4 : NO USER DEF #6 : NO USER DEF #2: 000302 P000655 t'Clge : "I I..>I"<>ANIIto. I"<>VIJ,,"IJVMt'AN T uate : nnO/U'1 COMPLETE CLAIM STATUS REPORT CW Ref. No : 00-0004 Claim No.: 13-802257 NOTES GEORGE HAS HAD A RASH ON HIS FINGERIHAND FOR 2-3 WEEKS. HE CUT HIS FINGER AND A RASH DEVELOPED AROUND THE CUT. REPORTED TO SUPERVISOR ON 8/30 AND VISITED CLINIC SAME DAY. NOW ON MODIFIED WORK UNTIL RELEASED TO FULL DUTIES. 9/4/01: SPOKE W/GEORGE. HE IS DOING MUCH BETTER - USING VERY STRONG HYDRACORTIZONE. HE MAY GO TO CLINIC EARLY (8/7) TO SEE IF HE CAN BE REL.EASED BACK TO FULL DUTIES. HE CONTINUES TO DO TRAINING AT 3151 IN THE MEANTIME. 11/15/01: LITO CALLED. WE ARE CLOSING THIS CLAIM TODAY. NO FURTHER MEDICAL UPDATES. 000303 P000656 SPECIAL LOCATION CODE State of California CNA Insurance Companies Claim & Loss Prevention Department P.O. Box 7430 San Francisco, CA 94120~7430 1·800·742·0318 EMPLOYER'S REPORT OF OCCUPATIONAL INJURY OR ILLNESS 3&/ J r-/ person \ .ho makes cr calll~ es to be made any k.10\11nglv false or fra-rtlllt.'l] r iatenal statement 0' matertal rcpre.•antanon fo the purpose cf Obtaining or den,'lng wor« I, co 11pc""n33! on benefits or payments IS gu Ity of a felony 01).0004 o Fatality OSHA CASE NO. NOTICE Cahfoma law requires ~oyefS to repor1'Mthm five days a knowIe:ige every occupationct Injuryor illness which restils in lost lima beyond the date ci lhe ulCident OR reqlires medcallreatment beyond first aid. If an ~Ofee suOOequently dies as a roslJt of Q ptevlously reported injury or uoese. the ElfTllIoyer tmSt file Within five days d l UJ 0:: Graniterockc~"'~INCIDENT REPORT Pe.ge_1_ 01___ . .: ',-. ~ ~ PROPERlY DAMAGE NEAR· MISSCircle all that apply'=( INJURY ) COLLISION z S3 I DAyl Y1=Ali BRANCH ,3 (P. /. PHOTOS? YES_ N~ Numbel- __Q~ 30 01 LOCATION OF INCIDENT "7A: 14,IIYdS 2,12 ''1 LJpc.rf~A~ .I- < TIME OF DAY POLICE REPORT TAKEN? YB- N() I e- o O{ I,} .'J.3 ~~ AGENCY AND REPORT NUMBER',J NAME {}n(Je I/o!),!;:' . DRIVER'S LICENSE NUMBER Old OJ0/ GRC VEHICLE NUMBER: ~ Id 4 lYPE Ad/KE1. COLOR 8=00 t!()!V/f.5C 0 DESCRIPTION OF INJURIES AND/OR DAMAGE' IJ9L ~ an kp/?k' .::L ...{?-/1- DRIVER'S LICENSE NUMBER INJURED:YEtL-NOt-' 0:: TAKEN TO(INJUREDAND/ORVEH.\- DRIVER'S LICENSE NUMBER INJURED:YES_ NO I- TAKEN TO(INJUREDAND/ORVEH.l0:: , -c i u, VEHICLE LICENSE NUMBER MAKE MODEl COLOR, 0:: w DESCRIPTION OF INJURIES, DAMAGE OR PREVIOUS MECHANICAL DEFECTS' :r I- a INSURANCE CARRIER, POLICY # , WITNESSES/PI>,SSENGERS: NAME ADDRESS PHONE NUMBER (HOME) PHONE NUMBER (WORK) LOCATION AT TIME OF INCIDENT: ; NOTE: INCLUDE AOOlnOliAl WITNESSES OR PASSENQER INFOAMATIOH IN ·OESC~PTION OF INCIDENT'" SECTION DESCRIPTION OF INCIDENT SKEICH (COLLISION ONLy)' NOTE: USE BACK OF THIS FORM NOTE: USE BACK OF THIS FORM IF MORE SPACE REQUIRED. IF MORE SPACE REQUIRED. ~~£~I1~~f5£ .- - '!JEig~;ljji~~!~.'it\~~~:::1 ~REPARE~B~~ ~/// DATE: Xr so» / ASST.SAFE1YMAN'AGER;<"':.:·::·· •. :......... .... ........... ', . .' . ': ,', " ........ ':.,' . . . ... ':.:." ',' >- t- UJ u, -c (JJ til I- :r Z I- til Cl >- - CD 0 CI ~ a: til u, a 2: 0 ~ til W > o I- a: til < W 0:: Cl e, :J W :::;: (J) CD 0 I- 0:: a (J) u, I- :J 0 :::;: >- UJ < I- :::;: Cl a: 0:: CJ aa Z a. u, _ w • '" 0:: (IJ 0:: (J) '" 0 -c~ ~ 3: ,J W I- ea Z Z WOW ,J Cl CD Z _ < i 0 Q I- ~ ~ ~ w CL. t- ~ -c Z 0 ,J w ,J :::;: a: < I- 0 Z a:- < ,J ••= wu. 0 UJ I- a Z 000305 P000658 ··.~A@'f:{j)¢fARTM~NfU$EQNkX}....•.•.••••.••• :::VATE .•JlEGElV8D::, ..............•:.::.:::... . ;~~~lWt*w~i~k~:).i::.:.,::-, ....:.:. ~ +-R-E-PA-R-E-rJD-ABY/-.d-.r.>--,/-- .4----D-AT-E-.: d,-~-,/-/~~U-;I'-./t-7/-I •.•.•.....•..•.: .:: :......................••..........,.,.:.:.••., ..:...•••:::.:..../ ~ ~R.;' L ,- cf;(f~C? . . :..: . > ur a: CONFIDENTIAL - ATTORNEY/ CLIENT PRIVILEGE WORK PRODUCT,Graniterock SUPERVISOR'S INCIDENT ADVISORY REPORT Page 1 of BRANCH ~~~~ _ LOCATION OF INCIDENT-:?r.,.-:-.----:'='''?""__ --;-''7''C,,-:;:=-::::-:-:--;- _ GRC PERSON d6:::;/.2~ ~~~Y OTHER PARTY#l _ OTHER PARTY #2 MO I DAY/ YEAR,? ..sc:5 ~J TIME OF DAY ,a,'30:3 a.m . z o I- «o o .J Answer the following questions: 1. What happened? (Describe the operation, activity, conditions and how the incident occurred. Be specific, list tools, equipment used and task to be performed, etc.) 2. Why did the incident happen? (Ust reason(s) that caused this incident, did anyone do anything to contribute to or fail to do something that may have prevented this incident) 3. Steps tD prevent recurrence. (Ust all steps that may prevent recurrence) 4. Steps that have already been taken to prevent recurrence. (Ust those steps that have already been taken at the branch to prevent recurrence of this incident) 5. DEADLINE COMPLETION DATES Ust the 'Deadline Completion Date(s)' expected for each improvement and! or step listed, • 6, Was this incident preventable and whvlor why not? 7, Disciplinary action taken? If so, what was given? Use additional page(s) as may be required. L £EO.4:::~6:' /~..c-E2 y" ..z;;./~~/z:.//c~z,/..::,- /~O ~-""/,./~, L./ /~.....s- ~<,/~ Ai &'r A!!E'?J/?C;C:- A?E'C!"/C"'~..o /??.?'/-"7" he ~X.!F/~ ~ #.?'.7;;S-: ~_ YeS·, ~.?J~~ ~A,LJC:-~.4"'..Q £-/.56 .oE dLcJ,v$ ~/2) 7 ...::s't::?/;l -'f2f~?:~' CONFIDENTIAL - ATTORNEY! CLIENT PRIVILEGE WORK PRODUCT 000306 P000659 -- • SOUTH VALLEYFAMILY & OCCUPAnONAL' _.HEALTH CENTER .',' . +J~FEL\lp#.l( . I . WORK STATUS . v ·'.REPORT W~8£:~~ ~OOl/~£/80 ~,- 9460 No Name Uno· ste, 230 Gilroy, CA.95020 -(4Q6)642-1544 Report Called To Employer: . 0 Called 0 Faxed Employer: C) ('h v\." f-c... I Phone; (_._. ) _ Date 5een: 6_'l-/~;..::..;/_'_',o_''--· ~--~-'--- \ 2.', S£) TIme In,: ~~~_. Time Out:-,---'- _ Date of Injury: ---,-__ ~ __ ~_- VisitNo.: --IcQ)-I",,!-' ., . _ Medical Record, ~umber: Employee: ~ n (("i 1 contact Person: ~ Insurance Carrier/Administrator: ~ ~ '--_~ __ -'- _ ',',-.", •. ". " .. :.,''', ': '.',,' ," .'.': '.'. 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"" .O'P ("fdl h" d"-'-:'"-c''',..".~.c.:c...c.,.L':·'-'· ',::,,"'~-'-.--"-'-.: :,",';: ': .<: .... :-::('."...,1 .. :' .. : .".;.::: '..... ~,~~.;. s~.ar~El__: ...: DpeimGROIIITF.ROCI{ RightFax Page !lIB 201 OHI 638 -- -- (ISWA {.ASE NO!;lalo of C"I,lnn,'l r I"o~e rlllnnl~lfJ onIr,phcnt~ (li11n ,r pos ~Ihl~) IyI "" tw ~ r~rlnl tn Lunch American Insurance COEMPLOYER'S REPORT OF OCCUPATIONAL INJURY OR III NE SS 1tlOO Am erican L anc Schaumburg IL 60196 FATA.lITY [J- r nl,'nrn'" hw 'ntl"!" < nm r'ny",' '" r"~r" ""h,,, ftVA"'Y' ~f I-~-'\l/I~~,]o~"n<'1nrrOl(lnhfln,1 '01"'" nr Illno~<••h"" '0,,,1'<, 1<1'fI\1 I,mn hoyflR(Nutl1bu, Shut, City, 11~! 11711 Bcrrycss a Road 21, Phon. Humber I~ CASE NUMBER p S'1R J\8R9 SA 95133 408 487-3138 L 3 l Ar tdlilml,l I(OInUa.lhl~ ~u<1(~r, ~trul. cll), and Zip) 3~ Location Code 0 350 Tcchnology Drive! Wataonv illc CA 95076 OWNI:RSHIPY 3Gl I~ 4 NATUR~ OF BUSINUS, e v P.tlllh,y cennacter ...t.olu;lle yr"&lr.I"Vln,YI, hol.I .• le. G Slate III'IImploymenllluurlnce ~ st&rd contractor w/m ». in tt ansrt trucks also opel. quan v 1005-0188-2 6 TYP~ OF fl,4PlOYER ~Plli'll OS1011 DGou~'1 Our 0 SdlColOlllrld oOtlw Go.l, SpetllJ INDUSTRY J.OATE Of I~JUR~10HHI 0: IItHESS irmE INJORynllNESs otrmnrrr g lU~!~()tom 9EGA~ \II0~K 10 IF(liptOYEE OlEO,om OFOEAI~!""'~~IfY -------OCClipA~''''IJ\Jddlyy! 21712{)O(i i ,. lillL ,. -_. - ,. --- ,. ~tlULHtf~UmO~fT~0mJmi OHE 12 OAH lAST WORKED (1llfTllddlyyl 13 DATERETURNEOYOWORKin1nllddlyyj U IF STILLOFF WORK CHECKTHISBOX DYel [29N. 0 r6.rArD 11/((f~~rime,,!, ",~cM~, '~9p•• [23 Other wor~'r~~r~ .r Itt IlllMs evenl? Unknown DYn X No DAVS PER WEEK 2~ EQUIPMENT, MATI:RtALS AND CHf,M1CAlS THI' EMPLOYEE WASUS1NGWHEN EVENT OR EXPOSURE occuRf:fED, e II Acetyleno, welding torch, farm tractor, tca(~- 0 R Unknown wtc,«. v HOURS26 SP~CIFIC ACTIVITYrus EI.IPlOHE WAS I'fRrOIWING WllEH EVOTCR EXPOSURE OCCURR{O,' Y W.ldl"Q •••• II. of nabl for"n, loading box ••• ",. h"0Htll, ~o II t ~ I, OII.tuftllhl01" 01 nllwbMt) 36 DATE or HIRE (mmldu/'n! [XJMltl. Drelll,!e 1v1IXel Dnvcr ()1/2212001 31. EMPLOYE~ USUALlY\vORKG 37J EUl'lOYIHNT STATUS 37b UNOER WIIAT CLASS CDO~ OF VOIJR _5____ days P&I week, ~r'QUI3f' 'ull tlnte Bpart.llme POLICVWIle R~ WAGES ASSIGNED __ ~ hour. per day, ____ tot~1 wee~lv houri tOlnporuy 18ftiOnei EXTEr.sr OF INJURV02 39 GR09;WACEI:l911l1\~Y I)fr~~ 39 orHE~ 'AY~ENH HOI RC~ORIEOA~ WAOE919A~ARY('9 IIpl . •••• I., n.,U ••e. bonuH', 01<)',----- DVII ~Ha Compldlod lly (type orprlnl! SIOJlature & Title Dale (mm/r.:llllyy) Dan Rutan P2/08/06 i FILINO OF nHn FOAM lD NOT AN ,",OMIOOIONOF lIADIllTYFORM 110110IlItV1) Jun. 200t 361 000310 P000663 APR 20 2006 3:45PM r r UIII +1, s iu. ij! j, .137 HP LASER:JET 32CJO W.d Apr 12 DG,22,46 2006 p, 1 Page 2 of ) KAISER PERMANENTE i)h, T"amcinolona, He olnl, conon and Vinyl glove use and recheck In 4 week. Pt slal.s he ISalf9ady much batler, with smooth.r and more normal.kllt No other ••• as .n.ct.d PMH: No IN, all.rgl •• or olhsr mads, Recent re.r·.nd.r typo MVA With neck strain, non-Rt 19. Fndlngs cOI1tlnued A El 20. DiagnoliS continued' n TrMlmont contirlUod' with tho olan and ifieL, OR will os oblolo avoid ••ontoot w~h tho •.• m.nf 000315 P000668 01/12/09 17:18:28 RightFax Page 003 2080201889 !:tllb! OICalifOfl1'8 r~ln~ eomprete ii' trl?hcate (type ,tpos~lbI6) Mall two copes to Lunch American lnsurance Co. QltHA CAS!! NO EMPLOYER'S REPORT OF OCCUPATlONAllNJURV OR ILLNESS l400 Amencan Lane Schaumburg IL 60196 fATALITY I An~ p.,.on who mlk" OT(3"'" to bit mad. Rny r~hl"ml~ IIIw r~,,'nr~~ pmplrly~r~ 'n r~flnr1lf1'lthl"ftv. day_ "I knnwl~r101lIlv~ry nrrllfl~rlnn~III'JlIry r.r 1I1r>A~"whlrh m<;ull, 11111),1UM l'IAynl'll1lhA knowingly fall I or Iraudulnl malerlal ,tat,m,n' or dale of the InCI(lpn, OR recures mod,cal trealmanl beyond tnst aid If an employee SubS9Qr.ently dies as e rasut of a proV10U~tyrecenec injury or mat.tlal flpflSlntalion for till purp010' N ana 111~p.dPB,t"P ••• .,1,1 .•.lhlilldllt> Dru.lI9a ,,,,n. Irn~ •.•••a.lnO)u'nU rlt/l""od un u, .•.••••v, l~nT IPNlcuun e he was hit on the hea with a long aluminum pole that fell rom a height of -30 feet COUNTYS S 7 Nam. and addr". of ph,tlclan Inumber. Itr •• t, eltr, lip) 11 Phone Number NATURE OF INJURY Monica Donovan ~75 Hospital Pkwy St. 565 San Jose 95119 408 972-6765 :l'9 ).Io.plt.llnd II. IInlnplltterrt c'v.rnigh~N" UY" If V" th.n. nlln" lind IIddr ••• ofhll.pltlll {numb.r, •••.•• 1.elty, ~pl !lilli, Phon. Numb.r PART OF BODY 29. Employ •• treated In "m'rg,ncy room?ny. fXlNO ATTENTION Thl. form contain. Inform Itlon relltlng to .m plo, •• hulth and m uet be u.ed In a manner that grot.cts thl confldenllall:le of Imploy.l. to the IItI.nt po"lbl SOURCE whll, th,lnform.llon I, hlng u •• d·for oc(upatlonailifety anti health purpo ••• , 5.1 CCR Tltl' 8 1430029 ( )(6)-(110) a MOO.36jbJ(2) )2, Nott; Shlded h_ .lIl1ea" eonnd,ntlll rtmplOJ•• lnto'lIIl11on Iff IlIt.d IR CCfIlTlU.114:100.3ll(bllZl(E)Z-. O. EMPlOvEE NAME 131. SOCIAL SECURITY NUt.tIER n.DATE OF IIRTH{mm/dd/n) Hafely, Gcorgt A XXXXX6065 XXIXXIXX EVENT E . HOM""" 511 11mb",str,,:, Clly, "' h. PHONlIIUIIIIER BECONOARV SOURCE P Gilroy CA 95020 L 15<1~ DF.mll, I~OCCUPATIUII\lClgu er JOD 11111, 110 Inttlall, IIID'•.•••auOni ~r numb.s' 36. DATE OF HIRE (mm/dd/1y) X Mile unk 17. 'MPLOY" UIIUALtVWORKS 31a. EMPLArroyo Cir 309997079 Allergies as of 7/31/2014 Reviewed On: 7/31/2014 By Godov, Anabe) S (M.A.) Allergen ! ? Noted Reaction Type 7 Reactions . .7 ' No Known Allergies PER PT Immunizations Administered on Date of Encounter - 7/31/2014 Never Reviewed- .. , ft's' 4? J S* J>.No immunizations on file. Reason For Encounter History User llli Date & Time P1 X : $ 1 p Godov, Anabel S (M.A.) Reason For Encounter : .I; 7/31/2014 3:59 PM. Y i ; ' m M 1 7 - - 1# E J E .1PHYSICAL EXAMINATION Diagnoses ROUTINE ADULT HEALTH CHECK UP EXAM - Primary GERD (GASTROESOPHAGEAL REFLUX DISEASE) INTERMITTENT ASTHMA Vitals BP:# s Pulse Jl. Temp(Src) EM Resp Ht ii: Wt: 118/69 mmHq 78 97.8 °F (36.6 °C) (Oral) 16 5' 8" 246 lb (111.585 ka) BMI i- pi- mi 1111:1: " :| !* . 1 in # in m37.41 kg/m2 1, mk mmi #iFlowsheet (all recorded) FTSM ki f§Pi!f 1 1- ; Encounter Vitals 07/31/14 1559 Mm i. j|7 X :’:;:i ,/ 7 '% %4 ' Y is y"{ Enc Vitals ? iys~ F nw : If# . Hi -si-:I ' 7? E m if L BP 118/69 mmHa AG Heart Rate/Pulse 78 -AG Reso 16 -AG Temp 97.8 °F (36.6 °C) -AG Temp.src Oral -AG Weiqht . 246 lb (111.585 ka) -AG Height 5' 8" -AG User Key (r) = User Reed, (t) = User Taken, (c) = User Cosianed Initials Name m - Effective Dates £ t# il ll ;S:S: 'EE it MAG Godoy, Anabel S (M.A.) 12/22/13 - 12/13/14 Encounter Information Provider illi,j Department ri 11' '11 Center 1E Em7/31/2014 3:30 PM NIKHAT FATHIMA SHAIK MD Gil-Fpr1 >Arroyo Cir GILA lit. E lilt Progress Notes - iiiiisi- ri- m Shaik, Nikhat Fathima (M.D.) at 7/30/2014 1:38 PM Version 1 of 1Author Type: Physician Status: Signed Subjective: Patient is George A Hafely is a 49 Y male , who presents today with PHYSICAL 1620 P001691 PERMANENTE MEDICAL GROUP GIL-ARROYO CIR 7520 ARROYO CIRCLE GILROY CA 95020-7303 Encounter Record HAFELY,GEORGE A MRN: DOB: , Sex: M Enc. Date : 07/31/14 Progress Notes (continued) llWi-M IfJiltW: ' i : i li J 1 Shaik, Nikhat Fathima (M.D.) at 7/30/2014 1:38 PM (continued) Version 1 of 1EXAMINATION HPLPt presents today for a routine Physical exam. Pt is applying for renewal of the Class A commercialDriver's License and needs to have the PE done. Pt works for Granite Rock company and does loading ofthe trucks and not doing the driving now, but needs to still have the license. Pt has no complaints today anddoing well over all. The Asthma is under good control and not using any inhalers. Patient Active Problem List: ‘OTHER MR# EXISTS DEGENERATION OF CERVICAL INTERVERTEBRAL DISC GERD CERVICAL RADICULOPATHY ARTHROPATHY OF FACET JOINT EDEMA, PERIPHERAL CHRONIC PAIN FHX OF CA COLON CASE / CARE MGMT, CHRONIC PAIN MGMT OBESITY OBSTRUCTIVE SLEEP APNEA HYPERLIPIDEMIA TREADMILL STRESS TEST NEGATIVE FOR ANGINA PECTORIS. INTERNAL HEMORRHOIDS WO COMPLICATION INTERMITTENT ASTHMA ALLERGIC RHINITIS MIGRAINE, CLASSIC.. Active Ambulatory Problems Diagnosis Date Noted • ‘OTHER MR# EXISTS • DEGENERATION OF CERVICAL INTERVERTEBRAL DISC 05/24/2006• GERD 09/13/2006 • CERVICAL RADICULOPATHY 01/26/2007 • ARTHROPATHY OF FACET JOINT 07/05/2007 • EDEMA, PERIPHERAL 10/22/2007 • CHRONIC PAIN 04/14/2008 • FHX OF CA COLON 09/04/2008 • CASE / CARE MGMT, CHRONIC PAIN MGMT 06/16/2008 • OBESITY 03/23/2010 • OBSTRUCTIVE SLEEP APNEA 04/06/2010 • HYPERLIPIDEMIA • TREADMILL STRESS TEST NEGATIVE FOR ANGINA PECTORIS. 11/01/2010• INTERNAL HEMORRHOIDS WO COMPLICATION 08/01/2011 • INTERMITTENT ASTHMA 09/16/2011 • ALLERGIC RHINITIS 04/25/2012 • MIGRAINE, CLASSIC.. 08/22/2012 Additional diagnoses from the Past Medical History section Diagnosis Date 1621 P001692 §M§ t a THE PERMANENTE MEDICAL GROUP GIL-ARROYO CIR 7520 ARROYO CIRCLE GILROY CA 95020-7303 Encounter Record HAFELY,GEORGE A MRN: DOB: , Sex: M Enc. Date: 07/31/14 /” Progress Notes (continued) i, Ji . ; / Shaik, NikhatFathimafM.D.) at 7/30/2014 1:38 PM (continued) Version 1 of 1ASTHMA 9/25/2009 NECK PAIN 1/26/2007 PNEUMONIA 2009 Past Surgical History Procedure Laterality Date • Colonoscopy diagnostic 1/29/09 normal study, recheck in 5 years • Vasectomy bilateral 24/2009 • Colonoscopy diagnostic 8/8/11 Internal hemorrhoid noted, recheck in 5 years. Family History Problem Relation Age of Onset • Allergies Mother • Allergies Brother • Alzheimers Disease Grandmother • Colon Cancer Mother 40 • Colon Polyp None • Diabetes None • Heart Disease Grandmother maternal • Hyperlipidemia Grandmother • Hypertension Grandmother • Osteoporosis None • Prostate Cancer None • Stroke Grandmother • Thyroid Cancer None • Thyroid Disorder None History Social History • Marital Status:Married Spouse Name: Kathleen Number of Children: 2 • Years of Education: high schoo Occupational History • construction cement mixer Social History Main Topics • Smoking status: Never Smoker • Smokeless tobacco: Never Used • Alcohol Use: Yes 1622 P001693 PERMANENTE MEDICAL GROUP GIL-ARROYO CIR 7520 ARROYO CIRCLE HAhELY,GEORGE A MRN: DOB: , Sex: M GILROY CA 95020-7303 Enc. Date: 07/31/14 Encounter Record Progress Notes (continued) Shaik, Nikhat Fathima (IVI.D.t at 7/30/2014 1:38 PM (continued) Comment: social • Drug Use: No • Sexually Active: Yes -- Female partner(s) Birth Control/ Protection: vasectomy Other Topics Concern • Military Service No • Blood Transfusions No Social History Narrative Pt lives in Gilroy with wife and 2 children- 3 yrs and 14 months old girls Hobbies: Racing, bowling ns Version 1 of 1 From interviewing the patient, I have updated the patient's problem list & past medical history, family history and social history documentation Review of Systems - History obtained from chart review and the patient General ROS: negative for - chills, fatigue, fever or malaise Ophthalmic ROS: negative for - blurry vision, dry eyes, excessive tearing, eye pain or itchy eyes Respiratory ROS: no cough, shortness of breath, or wheezing Cardiovascular ROS: no chest pain or dyspnea on exertion Gastrointestinal ROS: no abdominal pain, change in bowel habits, or black or bloody stools Genitourinary ROS: no dysuria, trouble voiding, or hematuria Neurological ROS:no TIA or stroke symptoms Dermatological ROS: negative Active Medications as of 07/21/2014: FAMOTIDINE 40 MG ORAL TAB, Sig: Take 1 tablet orally 2 times a day TOPIRAMATE 50 MG ORAL TAB, Sig: Take 1 tablet orally 2 times a day DULERA 100-5 MCG/ACTUATION INHL HFAA, Sig: Use 2 puffs by inhalation 2 times a day After use, rinse mouth thoroughly with water. SHAKE WELL BEFORE USING Prime before using for the first time. Shake well and prime by releasing 4 test sprays into the air. ++++ This Medication Replaces Advair FLUTICASONE 50 MCG/ACTUATION NASL SPSN, Sig: Use 2 sprays in each nostril daily Objective: BP 118/69 | Pulse 78 | Temp(Src) 97.8 °F (36.6 °C) (Oral) | Resp 16 | Ht 5' 8" | Wt 246 lb (111.585 kg) | BMI37.41 kg/m2 Physical Examination:General appearance - alert, well appearing, and in no distress, oriented to person,place, and time, overweight, acyanotic, in no respiratory distress and well hydrated Mental status - alert, oriented to person, place, and time, normal mood, behavior, speech, dress, motor activity, and thought processes, affect appropriate to mood Eyes - pupils equal and reactive, extraocular eye movements intact, sclera anicteric Ears - bilateral TM's and external ear canals normal, hearing grossly normal bilaterally Nose - normal and patent, no erythema, discharge or polyps and sinuses normal and nontender Mouth - mucous membranes moist, pharynx normal without lesions, dental hygiene good, tongue normaland TMJ exam normal, no tenderness, normal excursion 1623 P001694 •»c PERMANENTE MEDICAL GROUP GIL-ARROYO CIR 7520 ARROYO CIRCLE HAFELY,GEORGE A MRN: DOB: , Sex: M GILROY CA 95020-7303 Enc. Date: 07/31/14 Encounter Record i Progress Notes (continued) ill # . L ,• Shaik, Nikhat Fathima (M.D.) at 7/30/2014 1:38 PM (continued) Version 1 of 1Neck - supple, no significant adenopathy, thyroid exam: thyroid is normal in size without nodules or tenderness Lymphatics - no palpable lymphadenopathy, no hepatosplenomegaly Chest - clear to auscultation, no wheezes, rales or rhonchi, symmetric air entry, no tachypnea, retractionsor cyanosis Heart - normal rate, regular rhythm, normal S1, S2, no murmurs, rubs, clicks or gallops Abdomen - soft, nontender, nondistended, no masses or organomegaly, bowel sounds normal, no bladderdistension noted, no pulsatile masses, no CVA tenderness, no inguinal adenopathy, no hernias noted Back exam - full range of motion, no tenderness, palpable spasm, or pain on motion, sacroiliac joints andsciatic notches nontender, normal reflexes and strength bilateral lower extremities, sensory exam intactbilateral lower extremities Neurological - alert, oriented, normal speech, no focal findings or movement disorder noted, screening mental status exam normal, neck supple without rigidity, cranial nerves II through XII intact, DTR's normaland symmetric, motor and sensory grossly normal bilaterally, normal muscle tone, no tremors, strength 5/5,Romberg sign negative, normal gait and station Musculoskeletal - Bilateral Hip and knee joints: no joint tenderness, deformity or swelling, no musculartenderness noted, full range of motion without pain Extremities - peripheral pulses normal, no pedal edema, no clubbing or cyanosis Skin - normal coloration and turgor, no rashes, no suspicious skin lesions noted Data Review: Reviewed lab results: Basename Value Date/Time WBC 6.8 09/06/2013 HCT 44.4 09/06/2013 HGB 15.4 09/06/2013 PLT 252 09/06/2013 CHOL 210 12/07/2013 HDL 49 12/07/2013 LDL CALC 134 12/07/2013 LDL DIRECT 144 07/13/2011 TRIG 135 12/07/2013 ALT 24 09/06/2013 AST 18 09/18/2006 BUN 18 09/06/2013 CREAT 1.05 06/06/2014 GFR-AFRAM >60 06/06/2014 GFR NONAFR AMER >60 06/06/2014 GFR-NONAFRAM >6004/18/2010 K 4.6 06/06/2014 NA 144 06/06/2014 C02 28 10/22/2007 CL 10410/22/2007 TSH 1.94 06/06/2014 PSA 0.9 07/15/2013 PSA 1.0 04/18/2010 PSA 1.4 10/22/2007 GLUC FAST 97 12/07/2013 GLUC 80 07/13/2011 HGBA1C % 5.4 08/23/2012 1624 P001695 ••lflw?w3&THE PERMANENTE MEDICAL GROUP GIL-ARROYO CIR 7520 ARROYO CIRCLE GILROY CA 95020-7303 Encounter Record HAfELY,GEORGE A MRN: DOB: , Sex: M Enc. Date: 07/31/14 Progress Notes (continued) 1 J Shaik, Nikhat Fathima (M.D.) at 7/30/2014 1:38 PM (continued) Version 1 of 1 • ESTIMATED AVERAGE GLUCOSE 108 08/23/2012 Assessment and plan: LABORATORY EXAM AS PART OF ROUTINE GENERAL MEDICAL EXAM (primary encounter diagnosis) Plan: LIPID PANEL, FASTING GLUCOSE, FASTING SODIUM, SERUM POTASSIUM, SERUM CREATININE, SERUM, WITH GLOMERULAR FILTRATION RATE, CALCULATED ALT, SERUM TSH CBC WO DIFF HEMOGLOBIN A1C PSA Please follow the life style recommendations as below: 1- Achievement and maintenance of a healthy weight 2- regular physical activity of at least 30 minutes day on at least five days per week 3- A plant-based diet high in fruits, vegetables and whole grains and low in saturated fats and red meats. 4- Moderate, if any alcohol consumption. GERD Note: stable. ASTHMA Note: no recent flare up. GLUCOSE, FASTING SODIUM, SERUM POTASSIUM, SERUM BUN, SERUM CREATININE, SERUM, WTH GLOMERULAR FILTRATION RATE, CALCULATED ALT, SERUM TSH CBC WO DIFF HEMOGLOBIN A1C PSA Advised to call or return to clinic if s/sx's worsen or not improving as anticipated. Diagnosis recorded for this visit were addressed and are stable unless otherwise indicated by this note. Patient was encouraged to visit my web page on Kp.org and for other health information. 1625 P001696 ^ffeobTHE PERMANENTEMEDICAL GROUP GIL-ARROYO CIR7520 ARROYO CIRCLE HAEELY,GEORGE AMRN:DOB:GILROY CA 95020-7303 Enc. Date: 07/31/14 Encounter Record 1 § 1 ; ; y Progress Notes (continued) 111® 4' Shaik, Nikhat Fathima (M.D.) at 7/30/2014 1:38 PM (continued) Version 1 of 1 Electronically signed by Shaik. Nikhat Fathima (M.D.) on 7/31/2014 4:45 PM t 11 * . 'Iltlt Ill staff Note l : • .1 11 Mill Author: (none) Service: (none) Author Type: (none) Filed: Note Time: 7/31/2014 3:30 PM Status: Signed » ANABEL S GODOY MA Thu Jul 31, 2014 3:59 PM S MOKING Handout Given:N/A A DV.DIRECTIVE :Yes V ERIFY DEMOGRAPHICS & PHARMACY: Yes E MPANELMENT : Yes E XERCISE as VITAL SIGN DV =13yrs>DO YOU FEEL UNSAFE OR THREATENED BY ANYONE?No (Spanish) Se siente usted en peligro o amenazado por alguna persona? No D EPRESSION F IT KIT : N/A O VERDUE PHP,LAB,AND IMMUNIZATIONS ADDRESSED?: N/A R echeck Blood pressure: N/A M DO: Review the providers home page with the the patient. Give KP.Org sign on info if not active on KP.Org : Yes S ECURE MESSAGING: Yes Patient Secure Message No messages in this encounter mm Progress Notes Author ; Status A last Editor Updated Created t $ > i Shaik , Nikhat Fathima Signed Shaik, Nikhat Fathima 7/31/2014 4:45 PM 7/30/2014 1:38 PM (M.D.) (M.D.) Subjective: Patient is George A Hafely is a 49 Y male , who presents today with PHYSICAL EXAMINATION HPI:Pt presents today for a routine Physical exam. Pt is applying for renewal of the Class A commercial Driver's License and needs to have the PE done. Pt works for Granite Rock company and does loading of the trucks and not doing the driving now, but needs to still have the license. Pt has no complaints today and doing well over all. The Asthma is under good control and not using any inhalers. Patient Active Problem List: ‘OTHER MR# EXISTS DEGENERATION OF CERVICAL INTERVERTEBRAL DISC GERD CERVICAL RADICULOPATHY ARTHROPATHY OF FACET JOINT 1626 P001697 GIL-ARROYO CIR 7520 ARROYO CIRCLE HMFELY,GEORGE A MRN: DOB: , Sex: M Enc. Date: 07/31/14GILROY CA 95020-7303 Encounter Record EDEMA, PERIPHERAL CHRONIC PAIN FHXOF CA COLON CASE / CARE MGMT, CHRONIC PAIN MGMT OBESITY OBSTRUCTIVE SLEEP APNEA HYPERLIPIDEMIA TREADMILL STRESS TEST NEGATIVE FOR ANGINA PECTORIS. INTERNAL HEMORRHOIDS WO COMPLICATION INTERMITTENT ASTHMA ALLERGIC RHINITIS MIGRAINE, CLASSIC.. Active Ambulatory Problems Diagnosis Date Noted • ‘OTHER MR# EXISTS • DEGENERATION OF CERVICAL INTERVERTEBRAL DISC 05/24/2006 • GERD 09/13/2006 • CERVICAL RADICULOPATHY 01/26/2007 • ARTHROPATHY OF FACET JOINT 07/05/2007 • EDEMA, PERIPHERAL 10/22/2007 • CHRONIC PAIN 04/14/2008 • FHX OF CA COLON 09/04/2008 • CASE / CARE MGMT, CHRONIC PAIN MGMT 06/16/2008 • OBESITY 03/23/2010 • OBSTRUCTIVE SLEEP APNEA 04/06/2010 • HYPERLIPIDEMIA • TREADMILL STRESS TEST NEGATIVE FOR ANGINA PECTORIS. 11/01/2010 • INTERNAL HEMORRHOIDS WO COMPLICATION 08/01/2011 • INTERMITTENT ASTHMA 09/16/2011 • ALLERGIC RHINITIS 04/25/2012 • MIGRAINE, CLASSIC.. 08/22/2012 Additional diagnoses from the Past Medical History section Diagnosis Date • ASTHMA 9/25/2009 • NECK PAIN 1/26/2007 • PNEUMONIA 2009 Past Surgical History Procedure Laterality Date • Colonoscopy diagnostic 1/29/09 normal study, recheck in 5 years Vasectomy bilateral 24/2009 Colonoscopy diagnostic 8/8/11 Internal hemorrhoid noted, recheck in 5 years. Family History Problem Relation Age of Onset 1627 P001698 MW/5LTHE PERMANENTEMEDICAL GROUP GIL-ARROYO CIR 7520 ARROYO CIRCLE h,,hELY,GEORGE A MRN: DOB: , Sex: M GILROY CA 95020-7303 Enc. Date: 07/31/14 Encounter Record • Allergies Mother • Allergies Brother • Alzheimers Disease Grandmother • Colon Cancer Mother 40 • Colon Polyp None • Diabetes None • Heart Disease Grandmother maternal • Hyperlipidemia Grandmother • Hypertension Grandmother • Osteoporosis None • Prostate Cancer None » Stroke Grandmother • Thyroid Cancer None • Thyroid Disorder None History Social History • Marital Status:Married Spouse Name: Kathleen Number of Children: 2 • Years of Education: high schoo Occupational History • construction cement mixer Social History Main Topics • Smoking status: Never Smoker • Smokeless tobacco: Never Used • Alcohol Use: Yes Comment: social • Drug Use: No • Sexually Active: Yes -- Female partner(s) Birth Control/ Protection: vasectomy Other Topics Concern • Military Service No • Blood Transfusions No Social History Narrative Pt lives in Gilroy with wife and 2 children- 3 yrs and 14 months old girls Hobbies: Racing, bowling From interviewing the patient, I have updated the patient's problem list & past medical history, family history and social history documentation Review of Systems - History obtained from chart review and the patient 1628 P001699 PERMANENTE MEDICAL GROUP GIL-ARROYO CIR 7520 ARROYO CIRCLE KMFELY,GEORGE A MRN: DOB: , Sex: M GILROY CA 95020-7303 Enc. Date: 07/31/14 Encounter Record General ROS: negative for - chills, fatigue, fever or malaise Ophthalmic ROS: negative for - blurry vision, dry eyes, excessive tearing, eye pain or itchy eyes Respiratory ROS: no cough, shortness of breath, or wheezing Cardiovascular ROS: no chest pain or dyspnea on exertion Gastrointestinal ROS: no abdominal pain, change in bowel habits, or black or bloody stools Genitourinary ROS: no dysuria, trouble voiding, or hematuria Neurological ROS: no TIA or stroke symptoms Dermatological ROS: negative Active Medications as of 07/21/2014: FAMOTIDINE 40 MG ORAL TAB, Sig: Take 1 tablet orally 2 times a day TOPIRAMATE 50 MG ORAL TAB, Sig: Take 1 tablet orally 2 times a day DULERA 100-5 MCG/ACTUATION INHL HFAA, Sig: Use 2 puffs by inhalation 2 times a day After use, rinsemouth thoroughly with water. SHAKE WELL BEFORE USING Prime before using for the first time. Shake welland prime by releasing 4 test sprays into the air. ++++ This Medication Replaces Advair FLUTICASONE 50 MCG/ACTUATION NASL SPSN, Sig: Use 2 sprays in each nostril daily Objective: BP 118/69 | Pulse 78 | Temp(Src) 97.8 °F (36.6 °C) (Oral) | Resp 16| Ht 5' 8" |Wt 246 lb (111.585 kg) | BMI37.41 kg/m2 Physical Examination: General appearance - alert, well appearing, and in no distress, oriented to person,place, and time, overweight, acyanotic, in no respiratory distress and well hydrated Mental status - alert, oriented to person, place, and time, normal mood, behavior, speech, dress, motor activity,and thought processes, affect appropriate to mood Eyes - pupils equal and reactive, extraocular eye movements intact, sclera anicteric Ears - bilateral TM's and external ear canals normal, hearing grossly normal bilaterally Nose - normal and patent, no erythema, discharge or polyps and sinuses normal and nontender Mouth - mucous membranes moist, pharynx normal without lesions, dental hygiene good, tongue normal andTMJ exam normal, no tenderness, normal excursion Neck - supple, no significant adenopathy, thyroid exam: thyroid is normal in size without nodules or tendernessLymphatics - no palpable lymphadenopathy, no hepatosplenomegaly Chest - clear to auscultation, no wheezes, rales or rhonchi, symmetric air entry, no tachypnea, retractions orcyanosis Heart - normal rate, regular rhythm, normal S1, S2, no murmurs, rubs, clicks or gallops Abdomen - soft, nontender, nondistended, no masses or organomegaly, bowel sounds normal, no bladderdistension noted, no pulsatile masses, no CVA tenderness, no inguinal adenopathy, no hernias notedBack exam - full range of motion, no tenderness, palpable spasm, or pain on motion, sacroiliac joints andsciatic notches nontender, normal reflexes and strength bilateral lower extremities, sensory exam intactbilateral lower extremities Neurological - alert, oriented, normal speech, no focal findings or movement disorder noted, screening mentalstatus exam normal, neck supple without rigidity, cranial nerves II through XII intact, DTR's normal and symmetric, motor and sensory grossly normal bilaterally, normal muscle tone, no tremors, strength 5/5,Romberg sign negative, normal gait and station Musculoskeletal - Bilateral Hip and knee joints: no joint tenderness, deformity or swelling, no musculartenderness noted, full range of motion without pain Extremities - peripheral pulses normal, no pedal edema, no clubbing or cyanosis Skin - normal coloration and turgor, no rashes, no suspicious skin lesions noted Data Review: Reviewed lab results: Basename Value Date/Time • WBC 6.8 09/06/2013 1629 P001700 > -W&THE PERMANENTEWA MEDICAL GROUP GIL-ARROYO CIR7520 ARROYO CIRCLE GILROY CA 95020-7303 Encounter Record HCT 44.4 09/06/2013 HGB 15.4 09/06/2013 PLT 252 09/06/2013 CHOL 210 12/07/2013 HDL 49 12/07/2013 LDL CALC 134 12/07/2013 LDL DIRECT 144 07/13/2011 TRIG 135 12/07/2013 ALT 24 09/06/2013 AST 18 09/18/2006 BUN 18 09/06/2013 CREAT 1.05 06/06/2014 GFR-AFRAM >60 06/06/2014 GFR NONAFR AMER >60 06/06/2014 GFR-NONAFRAM >6004/18/2010 K 4.6 06/06/2014 NA 144 06/06/2014 C02 28 10/22/2007 CL 104 10/22/2007 TSH 1.94 06/06/2014 PSA 0.9 07/15/2013 PSA 1.0 04/18/2010 PSA 1.4 10/22/2007 GLUC FAST 97 12/07/2013 GLUC 80 07/13/2011 HGBA1C % 5.4 08/23/2012 • ESTIMATED AVERAGE GLUCOSE 108 08/23/2012 h. .-'ELY,GEORGE A MRN: DOB: , Sex: M Enc. Date: 07/31/14 Assessment and plan: LABORATORY EXAM AS PART OF ROUTINE GENERAL MEDICAL EXAM (primary encounter diagnosis)Plan: LIPID PANEL, FASTING GLUCOSE, FASTING SODIUM, SERUM POTASSIUM, SERUM CREATININE, SERUM, WITH GLOMERULAR FILTRATION RATE, CALCULATED ALT, SERUM TSH CBC WO DIFF HEMOGLOBIN A1C PSA Please follow the life style recommendations as below: 1- Achievement and maintenance of a healthy weight 2- regular physical activity of at least 30 minutes day on at least five days per week 3- A plant-based diet high in fruits, vegetables and whole grains and low in saturated fats and red meats.4- Moderate, if any alcohol consumption. GERD Note: stable. ASTHMA Note: no recent flare up. 1630 P001701 PERMANENTE MEDICAL GROUP GIL-ARROYO CIR 7520 ARROYO CIRCLE GILROY CA 95020-7303 Encounter Record K . -ELY,GEORGE A MRN: DOB: , Sex: M Enc. Date: 07/31/14 GLUCOSE, FASTING SODIUM, SERUM POTASSIUM, SERUM BUN, SERUM CREATININE, SERUM, WITH GLOMERULAR FILTRATION RATE, CALCULATED ALT, SERUM TSH CBC WO DIFF HEMOGLOBIN A1C PSA Advised to call or return to clinic if s/sx's worsen or not improving as anticipated. Diagnosis recorded for this visit were addressed and are stable unless otherwise indicated by this note. Patient was encouraged to visit my web page on Kp.org and for other health information. staff Notes Author Status Last Editor Updated - Created : ; -p Shaik,Nikhat Fathima Signed System 7/31/2014 3:30 PM 7/31/2014 3:30 PM(M.D.) » ANABEL S GODOY MA Thu Jul 31, 2014 3:59 PM S MOKING Handout Given:N/A A DV.DIRECTIVE :Yes V ERIFY DEMOGRAPHICS & PHARMACY: Yes E MPANELMENT : Yes E XERCISE as VITAL SIGN DV =13yrs>DO YOU FEEL UNSAFE OR THREATENED BY ANYONE?No (Spanish) Se siente usted en peligro o amenazado por alguna persona? No D EPRESSION F IT KIT : N/A O VERDUE PHP,LAB,AND IMMUNIZATIONS ADDRESSED?: N/A R echeck Blood pressure: N/A M DO: Review the providers home page with the the patient. Give KP.Org sign on info if not active on KP.Org : Yes S ECURE MESSAGING: Yes Past History Review I have reviewed the Medical/Surgical history as displayed in HC on 7/31/14 or the portion(s) as noted in the progress note. I have reviewed the Family history as displayed in HC on 7/31/14 or the portion(s) as noted in the progress note. I have reviewed the Social history as displayed in HC on 7/31/14 or the portion(s) as noted in the progress note. 1631 P001702 ftTHE PERMANENTEMEDICAL GROUP GIL-ARROYO CIR7520 ARROYO CIRCLE GILROY CA 95020-7303 Encounter Record Amount and Complexity of Data Reviewed The following data has been reviewed: Lab Tests \ ELY,GEORGE A MRN: DOB: , Sex: MJfic. Date: 07/31/14 Level of Service - . - . . : INITIAL PREVENTIVE MEDICINE NEW PATIENT 40- ' ‘ 64YRS[99386] Order 4 GLUCOSE, FASTING [82947B] (Order 427495266). : ^ .'.I;*:: ^ v 4. All Orders Order Information Date '4 £ Department : lift OrderlnglAuthorlzIng 1 / If7/31/2014 FAMILY PRACTICE 1 Shaik , Nikhat Fathima (M.D.) if • V Order Jf |lSODIUM, SERUM [84295A] (Order 427495267) Order Information llDate Department • J 2 ; Ordering/Authorizing III ' 7/31/2014 FAMILY PRACTICE 1 Shaik , Nikhat Fathima (M.D.) Order f If H 2:2Y :::::::Y r L f POTASSIUM, SERUM [84132C] (Order 427495268) Order Information Date if if? Y f Department illiii: f Orderlng/Authdrlzing 7/31/2014 FAMILY PRACTICE 1 Shaik, Nikhat Fathima (M.D.) Ord 'y.it BUN, SERUM [84520M] (Order 427495269) Order Information ffe. Orderlng/AulhorlzlnqDate Department i •: ;7/31/2014 FAMILY PRACTICE 1 Shaik, Nikhat Fathima (M.D.) Order 1 i itJ 'k- 1L ' if ' CREATININE, SERUM, WITH GLOMERULARt , f II FILTRATION RATE, CALCULATED[825650](Order| m "Y i t 429840050) Order Information Date" 4: Department k___ If Ordering/Authorizing I 7/31/2014 FAMILY PRACTICE 1 Shaik , Nikhat Fathima (M.D.) Order 5] $$ Wstm 5 /w . i,§ 1 ALT, SERUM [84460B] (Order 429840051) Order Information Date Department £:: Ordering/Authorizing 7/31/2014 FAMILY PRACTICE 1 Shaik, Nikhat Fathima (M.D ) Order r TSH [84443B] (Order 429840052) Order Information 1632 P001703 PERMANENTE MEDICAL GROUP GIL-ARROYO CIR 7520 ARROYO CIRCLE GILROY CA 95020-7303 Encounter Record i .r'ELY.GEORGE A MRN: DOB: , Sex: M Enc. Date: 07/31/14 All Orders (continued) Order Information (continued) Date Department Ordering/Authorizing 7/31/2014 FAMILY PRACTICE 1 Shaik. Nikhat Fathima (M.D.) Order CBC WO DIFF [85027A] (Order 429840053) Order Information Date Department Ordering/Authorizing 7/31/2014 FAMILY PRACTICE 1 Shaik. Nikhat Fathima (M.D.) Order HEMOGLOBIN A1C [83036B] (Order 429840054) Order Information Date Department Ordering/Authorizing 7/31/2014 FAMILY PRACTICE 1 Shaik, Nikhat Fathima (M.D.) Order PSA [84153B] (Order 429840055) Order Information Date Department Ordering/Authorizing 7/31/2014 FAMILY PRACTICE 1 Shaik, Nikhat Fathima (M.D.) PATIENT INSTRUCTIONS All Meds and Administrations (There are no med orders for this encounter) Electronically signed by: Signer Title Date Time NIKHAT SHAIK MEDICAL DOCTOR Jul 31, 2014 16:45:47 1633 P001704 PERMANENTEgJsW/Jg MEOICAL GROUP GIL-ARROYO CIR 7520 ARROYO CIRCLE GILROY CA 95020-7303 Encounter Record b ELY,GEORGE A MRN: DOB: , Sex: M Enc. Date: 07/31/14 Encounter-Level Documents: There are noencounler-level documents. Order-Level Documents: There are no order-level documents. 1634 P001705 EXHIBIT O LA 310.230.9700 • SF 415.445.0105 els@elitigationservices.com • www.elitigationservices.com Court Reporting • Video • Trial Presentation IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA IN AND FOR THE COUNTY OF SANTA CLARA GEORGE HAFELY, ) ) PLAINTIFF, ) ) vs. ) CASE NO. 17CV316847 ) GRANITE ROCK COMPANY; ) AND DOES ) 1 THROUGH 100, INCLUSIVE, ) ) DEFENDANTS. ) ) ) VIDEOTAPED DEPOSITION OF GEORGE HAFELY Taken on March 29, 2018 George Harfely eLitigation Services, Inc. - els@els-team.com Page 1 IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA IN AND FOR THE COUNTY OF SANTA CLARA --o0o-- GEORGE HAFELY, ) ) Plaintiff, ) ) vs. ) No. 17CV316847 ) GRANITE ROCK COMPANY; ) and DOES ) 1 through 100, inclusive, ) ) Defendants. ) ) _____________________________) Videotaped Deposition of GEORGE HAFELY THURSDAY, MARCH 29, 2018 Reported by: KIMBERLEE SCHROEDER, CSR, RPR, CCRR License No. 11414 George Harfely eLitigation Services, Inc. - els@els-team.com Page 2 1 2 3 4 5 6 BE IT REMEMBERED that on Thursday, 7 March 29, 2018, commencing at the hour of 9:58 a.m., 8 at the Law Offices of Sheppard, Mullin, Richter & 9 Hampton, LLP, Four Embarcadero Center, 17th Floor, 10 San Francisco, California, before me, KIMBERLEE 11 SCHROEDER, a Certified Shorthand Reporter in and for 12 the State of California, duly authorized to 13 administer oaths pursuant to Section 2093(b) of the 14 California Code of Civil Procedure, personally 15 appeared 16 GEORGE HAFELY, 17 called as a witness by the Defendants, who, having 18 been duly sworn, was thereupon examined as 19 hereinafter set forth. 20 21 22 23 24 25 George Harfely eLitigation Services, Inc. - els@els-team.com Page 3 1 APPEARANCES 2 For the Plaintiff: 3 BOHM LAW GROUP, INC. 4600 Northgate Boulevard 4 Sacramento, California 95834 Ph: 916-927-5574 5 By: DONALD R. WILLIAMS, JR., ESQ. donald@bohmlaw.com 6 TRACY C. LAW, ESQ. 7 For the Defendants: 8 SHEPPARD, MULLIN, RICHTER & HAMPTON, LLP 9 Four Embarcadero Center San Francisco, California 94111 10 Ph: 415-434-9100 By: BRIAN S. FONG, ESQ. 11 bfong@sheppardmullin.com AMANDA E. BECKWITH, ESQ. 12 abeckwith@sheppardmullin.com 13 Also Present: 14 ANTHONY HENSLEY, Legal Video Specialist 15 TYLER MINICK, Law Clerk 16 Bohm Law Group, Inc. 17 18 19 20 21 22 23 24 25 George Harfely eLitigation Services, Inc. - els@els-team.com Page 4 1 I N D E X 2 DEPOSITION OF GEORGE HAFELY 3 PAGE 4 By Mr. Fong 7 5 ---oOo--- 6 EXHIBITS 7 DEFENDANT'S PAGE 8 Exhibit 1 Plaintiff's Verified Complaint 14 for Damages 9 Exhibit 2 Plaintiff's Verified First 14 10 Amended Complaint for Damages 11 Exhibit 3 Letter dated October 8, 2015, 16 from Shirley Ow to George Hafely, 12 Bates No. GRC0000167 13 Exhibit 4 The Permanente Medical Group 26 medical record for George Hafely, 14 Bates No. P000843 through P000845 15 Exhibit 5 The Permanente Medical Group 34 medical record for George Hafely, 16 Bates No. P000839 through P000842 17 Exhibit 6 Letter dated September 24, 2015, 38 from Ann Giusiana to George 18 Hafely, Bates No. GRC0000169 19 Exhibit 7 E-mail from George Hafely to Ann 44 Giusiana, Bates No. P000040 20 Exhibit 8 Plaintiff George Hafely's 52 21 Responses to Defendant Graniterock Company's Requests 22 for Production of Documents, Set One 23 (Continued) 24 25 George Harfely eLitigation Services, Inc. - els@els-team.com Page 5 1 EXHIBITS 2 DEFENDANT'S PAGE 3 Exhibit 9 The Permanente Medical Group 68 medical record for George 4 Hafely, Bates No. P000831 through P000834 5 Exhibit 10 U.S. HealthWorks Work Status 88 6 Report, Bates No. GRC0000056 7 Exhibit 11 Letter dated September 4, 2015, 101 from Ann Giusiana to George 8 Hafely, Bates No. GRC0000236 9 Exhibit 12 Plaintiff George Hafely's 124 Responses to Defendant 10 Graniterock Company's Form Interrogatories - Employment 11 Law, Set One 12 Exhibit 13 Plaintiff George Hafely's 124 Amended Responses to Defendant 13 Graniterock Company's Form Interrogatories - Employment 14 Law, Set One 15 Exhibit 14 Letter dated June 12, 2015, from 156 John Seith to George Hafely, 16 Bates No. GRC0000174 17 Exhibit 15 Letter dated July 21, 2017, from 188 Andrew Lynch, Esq. To Robert 18 Farahmand, Esq., with attachment 19 Exhibit 16 The Permanente Medical Group, 190 medical record for George 20 Hafely, Bates No. P000930 through P000937 21 ---oOo--- 22 WITNESS INSTRUCTED NOT TO ANSWER 23 PAGE LINE 24 BY MR. FONG: "Is there any other 76 9 25 reason why you believe you got fired?" George Harfely eLitigation Services, Inc. - els@els-team.com Page 6 1 P-R-O-C-E-E-D-I-N-G-S 2 ---oOo--- 3 THE VIDEOGRAPHER: Good morning. 4 We are on the video record, ladies and 5 gentlemen at 9:59 a.m. I am Anthony Hensley from 6 eLitigation Services, Incorporated, in Los Angeles, 7 California. The phone number is (310) 230-9700. 8 This is a matter pending before the Superior 9 Court of California, County of Santa Clara, in the 10 case captioned George Hafley vs. Graniterock Company, 11 case No. 17 CU 316847. 12 This is the beginning of Video 1, Volume 1, 13 in the deposition of George Hafely on March 29th, 14 2018. We're located at Four Embarcadero Center in 15 San Francisco, California. This is taken on behalf 16 of the defendant. 17 Counsel, would you please identify 18 yourselves, starting with the questioning attorney. 19 MR. FONG: This is Brian Fong with Sheppard 20 Mullin on behalf of defendant Graniterock Company. 21 MR. WILLIAMS: Donald Williams, Jr., with the 22 Bohm Law Group on behalf of plaintiff George Hafely, 23 along with associate Tracy Law and law clerk Tyler 24 Minick. 25 THE VIDEOGRAPHER: Would the Court Reporter George Harfely eLitigation Services, Inc. - els@els-team.com Page 7 1 please swear in the witness? 2 GEORGE HAFLEY, 3 after being first duly sworn, was examined and 4 testified as follows: 5 THE VIDEOGRAPHER: You may now proceed. 6 EXAMINATION 7 BY MR. FONG: 8 Q. Would you state and spell your name for the 9 record? 10 A. My name is George Arthur Hafely. Last name 11 is H-a-f, like Frank, e-l-y. 12 Q. Are you being represented by Mr. Williams 13 today? 14 A. Yes. 15 Q. Have you ever had your deposition taken 16 before? 17 A. Yes. 18 Q. How many times? 19 A. I believe just once. 20 Q. When was this? 21 A. Probably somewhere around 2007, 2008. 22 Q. What was that in connection with? 23 A. I was involved in a car accident. 24 Q. Okay. Were you the plaintiff in a 25 litigation? George Harfely eLitigation Services, Inc. - els@els-team.com Page 8 1 A. Yes. 2 Q. What was the result of that litigation? 3 A. We settled the case, and they took care of my 4 medical bills and stuff. 5 Q. And you've testified in deposition how many 6 times? At least once? 7 A. I believe just once. 8 Q. And that's the only time you've ever had your 9 deposition taken? 10 A. That I can remember, yes. 11 Q. I will represent to you that you produced as 12 part of your responses to our Request for Production 13 deposition transcripts related to a Workers' 14 Compensation case that you had against Graniterock. 15 Do you remember that? 16 A. Yes. 17 Q. Do you remember getting your deposition taken 18 in that case as well? 19 A. For? I'm sorry, what was that? 20 Q. For the Workers' Compensation claim you 21 asserted against Graniterock? 22 A. I don't remember. 23 Q. Is there any reason why you can't give me 24 your best testimony today? 25 A. No. George Harfely eLitigation Services, Inc. - els@els-team.com Page 9 1 Q. Are you taking any medication? 2 A. Yes. 3 Q. What medication are you taking? 4 A. Naproxen, Rimeron, Cymbalta, Gabapentin, 5 Ambien. 6 I know there's a couple others. I just 7 can't -- I don't know what their names are. They 8 changed a few of them on me. But one -- both of them 9 are pain pills. 10 Oh, and nortriptyline. 11 Q. So this proceeding is known as a deposition. 12 You've been asked to testify under oath and under 13 penalty of perjury. Your testimony has the same 14 effect as though you were testifying in court, and 15 it's being taken down by a Court Reporter sitting 16 here to your left. It's also being videotaped by 17 this gentleman sitting here to my right. 18 The Court Reporter can only take down one 19 person speaking at a time, so it's important that you 20 wait until I'm done with my question before you 21 respond. And I will wait until you're done with your 22 answer before I continue on with the next question. 23 Do you understand that? 24 A. Yes. 25 Q. From time to time, your attorney may George Harfely eLitigation Services, Inc. - els@els-team.com Page 10 1 interject with objections. Unless he instructs you 2 not to answer, I'm entitled to your response. 3 A. Okay. 4 Q. If you don't understand a question at any 5 point in time, feel free to ask for me to repeat the 6 question or we can have the Court Reporter read it 7 back. If you don't tell me that you don't understand 8 a question, I'm entitled to assume that you 9 understood the question. 10 Do you understand that? 11 A. Yes. 12 Q. You understand that you have to answer all 13 the questions truthfully unless you're instructed by 14 your attorney not to answer? 15 A. Yes. 16 Q. During the deposition, I may ask you to make 17 estimates. This is not a memory contest, but I'm 18 entitled to your best estimate. I am not entitled to 19 a guess. I don't want to speculate or guess about 20 something. 21 Do you understand the difference between a 22 guess and an estimate? 23 A. Yes. 24 Q. Do you have any questions about anything I've 25 said so far? George Harfely eLitigation Services, Inc. - els@els-team.com Page 11 1 A. No. 2 Q. What is the dosage of your Naproxen? 3 A. I don't even remember. 4 Q. How often do you take it? 5 A. About three times a day. 6 Q. Okay. What is that for? 7 A. To help with pain and swelling in the lower 8 back. 9 Q. And what about Rimeron, what is the dosage of 10 your Rimeron? 11 A. That's 30 milligrams. 12 Q. How often do you take that? 13 A. At nighttime. 14 Q. Okay. What's that for? 15 A. Depression. It's an antidepressant. 16 Q. Okay. What about the Cymbalta? 17 A. That's also an antidepressant, and they use 18 that for pain management also. 19 Q. Okay. How often do you take that, and what's 20 the dosage? 21 A. That's 30 milligrams also. And daily, once a 22 day. 23 Q. And Gabapentin? 24 A. That's 900 milligrams and at nighttime. 25 Q. Okay. And what do you take that for? George Harfely eLitigation Services, Inc. - els@els-team.com Page 18 1 says, "If my facts are inaccurate, please contact me 2 no later than Friday, October 16th, 2015." 3 Do you see that? 4 A. Yes. 5 Q. Did you contact Shirley Ow at any point after 6 you received this letter? 7 A. No. 8 Q. Did you attempt to correct the inaccuracy 9 that it was a non-work related injury? 10 A. No. 11 Q. Why not? 12 A. I was already fighting with the depression 13 and the anxiety, and when I got the letter, that was 14 kind of like the final straw. I didn't care anymore. 15 Q. Okay. You didn't care about your job 16 anymore? 17 A. I knew they wanted me gone, so... 18 Q. Why did you know they wanted you to go? 19 A. That was right after I hired the worker comp 20 attorneys, all of a sudden I'm stealing, not doing my 21 job. 22 Q. So you felt like they accused you of stealing 23 after you hired a workers' comp attorney? 24 A. Oh, yeah. 25 Q. Do you feel like they were going after you George Harfely eLitigation Services, Inc. - els@els-team.com Page 40 1 A. Yes. 2 Q. The prior sentence says that the company has 3 not received from you completed Request for Leave of 4 Absence form or Certification of Medical Provider 5 form and that it was considering your time off 6 unapproved. 7 Did you understand that at the time you 8 received this letter that your time off was not 9 approved? 10 A. Yes. 11 Q. Then the last paragraph here says, "In order 12 for the company to approve your leave of absence, 13 you'll need to return the requested forms within ten 14 days of this letter or no later than October 24th, 15 2015; otherwise, your unapproved time off may be 16 cause for termination." 17 Did you understand that at the time? 18 A. Yes. 19 Q. So you decided that you were not going to 20 return the forms, even though you knew that it would 21 result in your termination? 22 MR. WILLIAMS: Objection. Vague, misstates 23 testimony. 24 You may answer. 25 THE WITNESS: Oh, okay. I was told by Robert George Harfely eLitigation Services, Inc. - els@els-team.com Page 61 1 Q. Why were you thinking of killing yourself 2 after you received Exhibit 6? 3 A. Oh, this is the wrong one. 4 Because I knew I wasn't -- how can you be on 5 an unapproved leave of absence when you're on 6 Disability? 7 Q. My question to you was: When you received 8 and read Exhibit 6, did you have an understanding 9 that Graniterock had not received any information 10 regarding your time off of work after September 17th? 11 MR. WILLIAMS: Objection. Speculation. 12 Are you just saying reading this document did 13 he have that understanding from reading this? 14 MR. FONG: Yes. 15 THE WITNESS: Yes. 16 MR. FONG: Q. So you knew that Graniterock 17 hadn't received any documentation of you covering 18 your time off -- 19 MR. WILLIAMS: Objection. 20 MR. FONG: Q. -- after September 17th? 21 MR. WILLIAMS: Objection. Speculation. 22 THE WITNESS: Yes. 23 MR. WILLIAMS: The document speaks for 24 itself. 25 MR. FONG: Q. Did you take any steps to George Harfely eLitigation Services, Inc. - els@els-team.com Page 62 1 inform Graniterock that you had, in fact, faxed in a 2 Work Status Report covering that time? 3 A. I'm not sure. 4 Q. You don't know what you did? 5 A. No. That was two and a half years ago. 6 Q. What do you remember about that time, 7 Mr. Hafely? 8 MR. WILLIAMS: Objection. Argumentative, 9 vague as to time. 10 THE WITNESS: Not much. I was having a rough 11 time with work. 12 MR. FONG: Q. But you were off work? 13 A. You still think about it. 14 Q. Did you have an understanding after reading 15 Exhibit 6 that if you didn't provide the forms that 16 had been requested that you could be terminated? 17 A. Yes. 18 Q. Were you not concerned about your job? 19 MR. WILLIAMS: Objection. Argumentative. 20 You may respond. 21 THE WITNESS: I don't remember what I thought 22 back then. 23 MR. FONG: Q. You don't remember what you 24 thought back then now at the time? 25 MR. WILLIAMS: Objection. George Harfely eLitigation Services, Inc. - els@els-team.com Page 81 1 you called dispatch? 2 A. Yes. 3 Q. Throughout your employment with Graniterock? 4 A. M-hm. Yes. 5 Q. And your regular practice was also to fax any 6 paperwork in? 7 A. Yes. Or if I was there, I would send it up 8 to them. 9 Q. To who? 10 A. To Jenny up north. 11 Q. Is that Graniterock's procedure, to have you 12 contact dispatch? 13 A. Yes. Everything went through dispatch. 14 Q. Why is that? 15 MR. WILLIAMS: Objection. Speculation, lacks 16 foundation. 17 THE WITNESS: Company policy, or at least 18 that's what I was told. 19 MR. FONG: Q. By whom? 20 A. I don't know. Probably my manager. 21 Q. Who? 22 MR. WILLIAMS: Objection. Vague as to time. 23 THE WITNESS: When I first hired in was Andy 24 -- I don't remember his last name. 25 MR. FONG: Q. When was the first time you George Harfely eLitigation Services, Inc. - els@els-team.com Page 82 1 got written up while you were at Graniterock, 2 Mr. Hafely? 3 A. I believe approximately six weeks after 4 hiring my worker comp attorneys. 5 Q. That was the first time? 6 A. Yes. 7 Q. When did you hire worker comp attorneys? 8 A. Approximately March 2015. 9 Q. Do you believe you got written up because you 10 filed for Workers' Compensation? 11 MR. WILLIAMS: Objection. Calls for a legal 12 conclusion and speculation. 13 You may answer. 14 THE WITNESS: Yes. 15 MR. FONG: Q. Why do you have that belief? 16 A. I was hurt and no longer useful. They wanted 17 to get rid of me. 18 Q. When did you get hurt? 19 A. June of 2014. 20 Q. You hired your Workers' Compensation in June 21 of 2015? 22 A. Yes. 23 Q. What about between June of 2014 and March of 24 2015, did you get written up at all during that time? 25 A. No. George Harfely eLitigation Services, Inc. - els@els-team.com Page 89 1 A. The day I went to U.S. HealthWorks on 2 June 3rd. 3 Q. Did U.S. HealthWorks give you this Work 4 Status Report? 5 A. Yes. 6 Q. This is a Work Status Report dated June 3rd, 7 2014, Bates stamped GRC000056. About halfway down it 8 has a return to work date June 3rd, 2014. 9 Do you see that, Mr. Hafely? 10 A. Yes. 11 Q. And then it has various restrictions. No 12 stooping, bending, limited lifting, pulling and 13 pushing up to 10 pounds and sit/stand/walk as-needed 14 for comfort. Is that correct? 15 A. Yes. 16 Q. Is this all of the restrictions that you had 17 at the time that you hurt your back? 18 A. Yes. 19 Q. How did you communicate these restrictions to 20 Graniterock? 21 A. I had asked for the next couple days off, and 22 I was denied, so I went to work the next day with 23 this note and passed it onto John. 24 Q. Why did you ask for the next couple days off? 25 A. I was hurting. I hurt bad. George Harfely eLitigation Services, Inc. - els@els-team.com Page 90 1 Q. Did you ask the doctor to write you off of 2 work for a couple of days? 3 A. I don't remember if I asked the doctor or 4 not. 5 Q. It says here that -- I mean, there's an 6 option for him to write you off of work. But it 7 didn't have that option here; correct? 8 A. Yes. 9 Q. So Graniterock wasn't under any option to 10 allow you to take days off; correct? 11 A. Yes. 12 Q. How did you ask for the days off? 13 A. He wanted me to call when -- 14 Q. "He" meaning? 15 A. John Seith wanted me to call him and let him 16 know. 17 Q. Let him know what? 18 A. What happened at the doctor's office. 19 Q. Okay. And so you called him after you got 20 done with the doctor's office? 21 A. Yes. 22 Q. And you told him what? 23 A. That I was seen here and they gave me some 24 restrictions, and I just asked him, you know, it 25 would be nice if I could have a day or two to kind of George Harfely eLitigation Services, Inc. - els@els-team.com Page 91 1 recoup. I was hoping of course to get better. 2 Q. What did he say to you? 3 A. No, I need to come into work. 4 Q. You're a plant operator; correct? 5 A. Yes. 6 Q. What was your duties as a plant operator? 7 A. Load all the cement mixers throughout the 8 day, do all the repair/maintenance work on the plant, 9 order incoming material for the next day. Or if we 10 have any special jobs coming up, I had to order 11 whatever, you know, was for the job. I had to order 12 all the spare parts, try to keep track of everything. 13 Q. Is it fair to say you were responsible for 14 the plant overall? 15 A. Yes. 16 Q. When you say "loading cement trucks," is that 17 what you described earlier when we were talking about 18 how you injured yourself where there's a hopper that 19 mixes the cement and it loads it up onto the cement 20 trucks? 21 A. I sit inside at a computer, and I ran the 22 plant from that. 23 Q. Pushing buttons on a computer? 24 A. Yes. 25 Q. I'm trying to get an understanding. You George Harfely eLitigation Services, Inc. - els@els-team.com Page 94 1 Q. Who called? 2 A. Dispatch. Because they could see that it was 3 taking longer to load. 4 Q. And do you report to dispatch? Did you 5 report to dispatch? 6 A. Yes. 7 Q. They were your supervisors? 8 A. Not really sure if they were considered my 9 supervisors, but we had to work together. 10 Q. Did they ever write you up? 11 A. No. 12 Q. Did they ever discipline you? 13 A. No. 14 Q. Did they ever counsel you? 15 A. No. 16 Q. Did they have any input into whether or not 17 you got a raise or not to your understanding? 18 MR. WILLIAMS: Objection. Calls for 19 speculation. 20 You may answer. 21 THE WITNESS: Not that I know of, no. 22 MR. FONG: Q. You were just co-workers with 23 them? 24 A. Yes. 25 Q. Who was your supervisor? George Harfely eLitigation Services, Inc. - els@els-team.com Page 97 1 A. I can sit and load, but it would be nice if I 2 could have got up and moved. 3 Q. Could you stand and load? 4 A. You could but then I had to bend over at the 5 waist and that made the back hurt even more. 6 Q. Could you walk around and load? 7 A. Not generally. 8 Q. Did you ask the company to be able to raise 9 the computer platform so you could push buttons 10 standing? 11 A. No. 12 Q. Why not? 13 A. Never thought of that. 14 Q. What did you ask the company to do to 15 accommodate your restrictions? 16 MR. WILLIAMS: Objection. Rifkind. 17 You may respond. 18 THE WITNESS: Just try to help, help, you 19 know, get me as much help as possible for, you know, 20 anything I had to climb or crawl into or anything 21 with much weight. 22 MR. FONG: Q. Did they tell you, no, you're 23 not getting any help. 24 A. No. When we were slower, it was okay. But 25 the busier we got, the drivers have to have so many George Harfely eLitigation Services, Inc. - els@els-team.com Page 98 1 hours off before they're allowed to come back to work 2 by State law. 3 So when we started running later and later, 4 it was getting harder to try to find somebody during 5 the week, you know, that could help do some of that. 6 Q. Who did you talk to about getting help? 7 MR. WILLIAMS: Objection. Vague as to time. 8 THE WITNESS: I would ask the dispatchers if 9 they could find somebody, and I would call John 10 Seith. 11 MR. FONG: Q. What did the dispatchers tell 12 you? 13 A. They would try. It all depends on the jobs. 14 Some days we might do 15-, 1,600 yards. And there's 15 not much time for anything. 16 Q. What did John Seith tell you when you asked 17 for help? 18 A. He didn't like the idea of me asking for help 19 a lot, especially on the weekends. 20 Q. What did he tell you? 21 A. Try to do it by myself, if possible. Or I 22 can bring in one person. 23 Q. Did you tell him that's not enough? 24 A. Yes, because I tell him, "Hey, I got all 25 these -- we got to go through and check," and it was George Harfely eLitigation Services, Inc. - els@els-team.com Page 104 1 Mr. Farahmand in the context of the September 24th 2 letter that you received from Ms. Giusiana. Do you 3 recall that conversation? 4 I'll put in front of you Exhibit 6, if you 5 could put that in front of you. It's a 6 September 24th letter. Then also if you could put 7 Exhibit 7, which is your e-mail to Ms. Giusiana. 8 By way of background earlier, you testified 9 this e-mail was sent on September 30th in response to 10 this letter, Exhibit 6, dated September 24th. 11 A. Yes, because I tried calling. I didn't get 12 anybody, so I sent an e-mail. 13 Q. Okay. And this e-mail says that your 14 attorneys had told you not to respond? 15 A. Right. 16 Q. Did you separately call your attorneys after 17 receiving Exhibit 11 on September 4th? 18 A. Which one is the 11th? Oh, yeah. Every time 19 if I got anything from the company, I would call. 20 Q. Did your attorneys tell you not to respond? 21 A. To this one? 22 MR. WILLIAMS: Objection. Vague as to time. 23 THE WITNESS: I'm not absolutely positive -- 24 sure. 25 MR. FONG: Q. Is there a reason why you George Harfely eLitigation Services, Inc. - els@els-team.com Page 124 1 Exhibit 12 is Plaintiff's Responses to 2 Graniterock Form Interrogatories, Employment, and 13 3 is Amended Responses to Form Interrogatories, 4 Employment. 5 (Defense Exhibit Nos. 12 and 13 were 6 marked for identification.) 7 MR. FONG: Q. Have you ever seen these 8 documents before, Mr. Hafely? 9 A. Yes. 10 Q. In Exhibit 12, I'll have you turn to the 11 second to the last page. Says "Verification." Is 12 that your signature? 13 A. Yes. 14 Q. Is that your handwriting on the document? 15 A. No. 16 Q. Whose -- do you know whose handwriting that 17 is? 18 A. No. 19 Q. Do you see the date here? 20 A. Yes. 21 Q. March 26th. Is that the date you signed this 22 document? 23 A. Yes. 24 Q. Did you sign it in Monterey? 25 A. In Monterey? George Harfely eLitigation Services, Inc. - els@els-team.com Page 125 1 Q. In Monterey, the City of Monterey. Where did 2 you sign this verification? 3 A. A lot of these were e-mailed to me, and I 4 printed them. 5 Q. And then you signed them? 6 A. Signed them. 7 Q. And then you scanned them? 8 A. Yeah. 9 Q. And then you e-mailed them back? 10 A. (Nods head.) 11 Q. Where did you print them at? 12 A. Home. 13 Q. Where is your home? 14 A. Gilroy. 15 Q. You signed them at home? 16 A. Yes. 17 Q. And you scanned them back at home? 18 A. My wife took them to work and scanned them. 19 Q. Okay. Where does your wife work? 20 A. For a company called Transerv. 21 Q. Where are they located? 22 A. Morgan Hill. 23 Q. That's where she works, in Morgan hill? 24 A. Yeah. 25 Q. And Exhibit 13, third last page, third last George Harfely eLitigation Services, Inc. - els@els-team.com Page 126 1 page, it's a document labeled "Verification." You 2 went too far. You went one too far. 3 You see this document labeled "Verification"? 4 A. Yes. 5 Q. Is that your signature? 6 A. Yes. 7 Q. Is that your handwriting? 8 A. No. 9 Q. Do you see the date there? 10 A. Yes. 11 Q. What date is that? 12 A. March 26th is that 2018. 13 Q. Did you sign this document on March 26th, 14 2018? 15 A. That, I'm not sure. 16 Q. Did you send this document along with all the 17 other documents? 18 A. Yes. 19 Q. From your home in Gilroy? 20 A. Yes. 21 Q. And you gave them back to your wife to send? 22 A. (Nods head.) 23 Q. Is this your wife's handwriting? 24 A. No. 25 Q. On Exhibit 13, that's not her handwriting? George Harfely eLitigation Services, Inc. - els@els-team.com Page 157 1 Q. This is the first write-up you've received? 2 A. I believe it's the first one, yes. 3 Q. Did you receive this on or about June 12th, 4 2015? 5 A. Yes. 6 Q. Is this the write-up you received for the 7 missing cement powder? 8 A. Yeah. 9 Q. How many write-ups did you receive in total? 10 MR. WILLIAMS: Objection. Speculation. 11 THE WITNESS: Two or three. I know two for 12 sure, maybe three. 13 MR. FONG: Q. Do you know what the subject 14 of those write-ups were? 15 A. I know one of them was about doing the 16 spreadsheet. I did it for the first time on one day. 17 I missed work the next day. And when I came in -- I 18 think it was a Friday -- it was new; I forget all 19 about it. I told John when he came upstairs, I 20 believe it was that following Monday. I apologized 21 to him. I told him, "Hey, I'm sorry. I forgot to do 22 the spreadsheet Friday." 23 I even made a little Post-it and put it on 24 the computer so I wouldn't forget anymore so it 25 became habit. He told me, "Okay, no problem. Just George Harfely eLitigation Services, Inc. - els@els-team.com Page 160 1 Q. Is the cement inventory your responsibility 2 as the plant operator? 3 A. Yes. 4 Q. So the fact that there was missing cement was 5 something that you were responsible for? 6 A. Yes. 7 Q. So was it also your responsibility to 8 determine what happened to the missing cement powder? 9 A. Yeah. I checked into it to find out what had 10 happened. 11 Q. Did you determine what had happened? 12 A. Yes. 13 Q. What happened? 14 A. An error with accounting. It was actually 15 for Mike McGrath's job. It took a special cement, 16 not the normal powder we used. And somehow it got 17 confused as our regular powder, so it showed we were 18 buying cement, but it didn't go out but it actually 19 did. And I found it in paperwork. 20 Q. What did you do with that paperwork? 21 A. I had a meeting with McGrath, my union reps, 22 the next morning. I tried to tell them, "Hey, I 23 found what happened to the cement." 24 His comment was, "I could care less. I don't 25 even want it." George Harfely eLitigation Services, Inc. - els@els-team.com Page 161 1 I tried to hand it to him. He brushed it 2 away. So I threw it in the garbage. 3 Q. You threw the paperwork in the garbage? 4 A. Yeah. 5 Q. When did you have this meeting with McGrath 6 and your union reps? 7 A. I don't remember the date. 8 Q. But that paperwork -- strike that. 9 Is it your testimony that that paperwork 10 exonerated you from the accusation of stealing? 11 A. Yes. 12 Q. Is it your testimony that that paperwork 13 would show definitively the reason for the cement 14 powder shortage? 15 A. Yes. 16 Q. And is it your understanding that you 17 received this write-up, Exhibit 14, because of issues 18 with maintaining the cement powder inventory? 19 MR. WILLIAMS: Objection. Misstates 20 testimony. You may answer. 21 THE WITNESS: I believe that was part of it, 22 yes. 23 MR. FONG: Q. So in your mind, you were 24 written up unfairly for the cement powder issue; is 25 that true? George Harfely eLitigation Services, Inc. - els@els-team.com Page 162 1 A. Yes. I tried to tell them right off the bat, 2 that I had -- not -- the actual paperwork I had found 3 later, but it had to be a clerical error. 4 But he told me, no, accounting never makes 5 any mistakes, it's me. 6 Q. How long had the cement powder inventory 7 shortage been an issue at the San Jose Concrete 8 Plant? 9 MR. WILLIAMS: Objection. Speculation, vague 10 as to time. 11 THE WITNESS: I'm not sure as far as the 12 plant. 13 MR. FONG: Q. Had it always been an issue or 14 was it something that just came up in relation to 15 this write-up or around the same time? 16 A. As far as I know -- I don't know with the 17 people that did it, that job before me, but as far as 18 me this was like the first time I had heard about it, 19 an issue with that. 20 Q. So this write-up, June 12th, 2015, came out 21 of the blue, or was it an ongoing issue that was 22 trying to be sorted out at the plant as far as you 23 know? 24 A. I'm not sure on that one. 25 Q. Okay. I'll direct your attention to the George Harfely eLitigation Services, Inc. - els@els-team.com Page 164 1 Q. After you had been asked to recalibrate the 2 scale? 3 A. Yeah. 4 Q. So your testimony is that the work was not 5 delayed a month, but only delayed a couple weeks? 6 A. Yes. 7 Q. Did you tell John Seith that when he gave you 8 this write-up? 9 A. I tried to. 10 Q. What did you say to him? 11 A. That they were -- I forgot to call the first 12 few days, and then when I called, they were booked up 13 and they couldn't come out for a couple of weeks. So 14 I told them there's nothing I can do about it. We 15 have to wait for them. 16 Q. Okay. So that issue was in relation to the 17 cement powder shortage -- strike that. 18 You were asked to recalibrate the cement 19 scale to resolve the issue of the cement powder 20 shortage; is that correct? 21 A. They were hoping that was the issue. 22 Q. Okay. So that implies to me that the cement 23 powder issue had been pending for at least two to 24 three weeks before you got this write-up; right? 25 A. (Nods head.) George Harfely eLitigation Services, Inc. - els@els-team.com Page 171 1 couldn't get it to work with our material. 2 And so then they wrote me up for not being 3 able to use a new style bindicator, and I was the 4 only one in the company that was trying it. They 5 were kind of waiting for me at other yards. If it 6 worked, they were going to switch. 7 Q. Was it your decision to go to the new 8 bindicator style? 9 A. I mentioned it to John they had a newer 10 style, and I would like to try it. 11 Q. So was it your recommendation to try to the 12 new bindicator style? 13 A. Yes. 14 Q. It was not Graniterock's decision to go to 15 the new bindicator style? 16 A. No. 17 Q. It was your decision? 18 A. Yes. 19 Q. How long did you make efforts to make the new 20 bindicator work? 21 A. Every day for probably at least a week, and I 22 was on the phone with their engineers, moving it, 23 mounting it in different places. And like they were 24 telling me, no matter what we did, and then they 25 finally said, "Well, it's not going to work with your George Harfely eLitigation Services, Inc. - els@els-team.com Page 173 1 A. No, no hole. 2 Q. So you got written up for not investigating 3 and fixing a hole that didn't exist? 4 A. Yes. 5 Q. Did you say anything at the time -- 6 A. I tried. 7 Q. -- say "Hey, there's no hole there"? 8 A. I tried. I told them there was no hole 9 there. They just sat and looked at me. 10 Q. What about regular drum chipping not being 11 done? 12 A. That one, I started working nights and days. 13 So I did get behind on that. I told them there's 14 nothing, you know, I'm working from 4:00, 5:00 in the 15 morning till 3:00, 4:00 in the afternoon and coming 16 back at 9:00 o'clock at night and working into 17 Saturday morning, then back. 18 I told them I just -- which I did, I got a 19 little behind on it. I brought three guys in on a 20 weekend, and we got it taken care of. 21 Q. Did you tell them that when you got written 22 up? 23 A. M-hm. 24 Q. What was their response? 25 A. No response. George Harfely eLitigation Services, Inc. - els@els-team.com Page 174 1 Q. What issues were being caused at the plant by 2 your failure to regularly chip the drum? 3 MR. WILLIAMS: Objection. Speculation, 4 misstates testimony. 5 THE WITNESS: Just working a lot of hours. 6 MR. FONG: Q. Were there issues being caused 7 at the plant because you didn't chip the drum 8 regularly? 9 MR. WILLIAMS: Objection. Argumentative. 10 You may answer. 11 THE WITNESS: Yes, it started kicking the 12 chain off on the drive, and I told them I found that, 13 and that's what was causing it. And I would take 14 care of it over the weekend, which I did. 15 MR. FONG: Q. Who helped you with that? 16 A. I believe Bill was one of them. 17 Q. Bill Zilowski? 18 A. Zilowski, William Mookini, and a young kid 19 named Ricky. 20 Q. What about not addressing the hole in the 21 lightweight bunker? 22 A. Yeah, that one I had no idea there was a hole 23 until, until we did drain it. That's when I found 24 it. I told him we're going to have to figure out 25 something to plug it up. George Harfely eLitigation Services, Inc. - els@els-team.com Page 175 1 It turns out that hole had been there for I 2 don't know how many years. A lot of the wall was 3 missing. 4 Q. Is that your responsibility? 5 A. Yes. 6 Q. What about this for poor management of hot 7 water installation for night work? 8 A. Oh, well, we were doing hot water, and I've 9 never tried to pump hot water into the plant. I set 10 it up. I tried it. It was a trial run early in the 11 morning just to do -- I think they were a couple of 12 3-yard loads. 13 It turns out it was bypassing or it wasn't 14 supposed to. I told them when it happened, "Hey, 15 we're out of the hot water already, and I got to 16 figure out something else." So when we went to do it 17 again, it was fixed. 18 Q. Why were you written up for poor management 19 of hot water installation? 20 A. I have no idea. They knew I was trying to 21 make it work. 22 Q. How long were you trying to make it work? 23 A. Probably for a couple weeks. 24 Q. Why was there a hot water installation? 25 A. That's what the job called for. It makes the George Harfely eLitigation Services, Inc. - els@els-team.com Page 179 1 in the weekend or late in the day if we were staying 2 late, I would let John and say, "Hey, I don't want 3 this guy back." 4 Q. I'll direct your attention to Exhibit 5, the 5 second page, Bates stamped P000840. You see the 6 paragraph that says, "Patient participation"? 7 A. Yes. 8 Q. This is an encounter in September 29th, 2015. 9 It says, "George reports that he went to an 10 interview and was told he was overqualified." 11 What interview is being referred to here? 12 A. When was this one? 13 Q. September 29th, 2015. 14 A. I believe that may have -- oh, I went to an 15 interview at Peterson Caterpillar. 16 Q. Okay. What job? 17 A. I applied for -- something to do with the 18 parts, run parts. 19 Q. Like run the parts department? 20 A. No, rent them out to customers. 21 Q. Like drive them -- 22 A. Yeah, deliver to customers and put parts away 23 and stockroom and -- 24 Q. Like a delivery driver? 25 A. Yeah, delivery driver slash warehouse in George Harfely m4mm¢wNH W ll 12 13 l4 15 l6 l7 18 19 20 21 22 23 24 25 Page 198 REPORTER'S CERTIFICATE I, KIMBERLEE SCHROEDER, CSR No. 11414, hereby certify that I am authorized to administer oaths or affirmations. (Cal. Code of Civ. P. Sec- 2093 (b) and Fed. R. Civ. P. 28(a))- The foregoing proceedings were taken before me at the time and place therein set forth, at which time the witness was duly sworn by me. (Cal. Code Civ. Proc. 2025.330(a), 2025.540(a) and Fed. R. Civ. P- 30(f)(1))- The foregoing pages contain a full, true and accurate record of all proceedings and testimony. (Cal. Code Civ- Proc. 2025.540(a) and Fed. R. Civ. P. 30(f)(l)). I am not a relative or employee of the parties, nor financially interested in the action. (Cal. Code Civ. Proc. 2025.320(a))- Before completion of the proceedings, review of the transcript [ ] was [ ] was not requested. If requested, any changes made by the witness (and provided to the reporter) during the period allowed, are appended hereto. (Fed. R. Civ. P- 30(e)). I declare under penalty of perjury under the laws of California that the foregoing is true and correct. 3th day o April, 2018 ijU/VW l’l/IOVKJ 04 KIMBERLEE SCHROEDER, CSR, RPR, CCRR License No. 11414 eLitigation Services, Inc. - els@els-team.com EXHIBIT P LA 310.230.9700 • SF 415.445.0105 els@elitigationservices.com • www.elitigationservices.com Court Reporting • Video • Trial Presentation IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA IN AND FOR THE COUNTY OF SANTA CLARA GEORGE HAFELY, ) ) PLAINTIFF, ) ) vs. ) CASE NO. 17CV316847 ) GRANITE ROCK COMPANY; ) AND DOES ) 1 THROUGH 100, INCLUSIVE, ) ) DEFENDANTS. ) ) ) VIDEOTAPED DEPOSITION OF GEORGE HAFELY, VOLUME II Taken on May 7, 2018 George Hafely, Volume II eLitigation Services, Inc. - els@els-team.com Page 199 IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA IN AND FOR THE COUNTY OF SANTA CLARA --o0o-- GEORGE HAFELY, ) ) Plaintiff, ) ) vs. ) No. 17CV316847 ) GRANITE ROCK COMPANY; and ) DOES 1 through 100, ) inclusive, ) Defendants. ) _____________________________) Videotaped Deposition of GEORGE HAFELY Monday, May 7, 2018 Volume 2 Page 199 through 383 Reported by: KIMBERLEE SCHROEDER, CSR, RPR, CCRR License No. 11414 George Hafely, Volume II eLitigation Services, Inc. - els@els-team.com Page 200 1 2 3 4 5 BE IT REMEMBERED that on Monday, May 7, 2018, 6 commencing at the hour of 10:12 a.m., at the Law 7 Offices of Sheppard, Mullin, Richter & Hampton, 8 LLP,379 Litton Avenue in Palo Alto, California, 9 before me, KIMBERLEE SCHROEDER, a Certified Shorthand 10 Reporter in and for the State of California, duly 11 authorized to administer oaths pursuant to Section 12 2093(b) of the California Code of Civil Procedure, 13 personally appeared 14 GEORGE HAFELY, 15 called as a witness by the Defendants, who, having 16 been duly resworn, was thereupon further examined as 17 hereinafter set forth. 18 19 20 21 22 23 24 25 George Hafely, Volume II eLitigation Services, Inc. - els@els-team.com Page 201 1 APPEARANCES 2 For the Plaintiff: 3 BOHM LAW GROUP, INC. 4600 Northgate Boulevard 4 Sacramento, California 95834 Ph: 916-927-5574 5 By: DONALD R. WILLIAMS, JR., ESQ. donald@bohmlaw.com 6 DEREK K. ULMER, ESQ. dulmer@bohmlaw.com 7 8 For the Defendants: 9 SHEPPARD, MULLIN, RICHTER & HAMPTON, LLP Four Embarcadero Center 10 San Francisco, California 94111 Ph: 415-434-9100 11 By: BRIAN S. FONG, ESQ. bfong@sheppardmullin.com 12 AMANDA E. BECKWITH, ESQ. abeckwith@sheppardmullin.com 13 14 Also Present: 15 FRANK QUIRARTE, Legal Video Specialist 16 SHANA WAMUHUL, Law Clerk Bohm Law Group, Inc. 17 18 19 20 21 22 23 24 25 George Hafely, Volume II eLitigation Services, Inc. - els@els-team.com Page 202 1 I N D E X 2 DEPOSITION OF GEORGE HAFELY 3 PAGE 4 By Ms. Beckwith 207 5 ---oOo--- 6 EXHIBITS 7 DEFENDANT'S PAGE 8 Exhibit 17 Work Status Report dated 213 09/17/2015, Bates No. P003089 9 Exhibit 18 Letter dated July 21, 2015, to 266 10 George Hafely from John Seith, Bates No. GRC0000170 11 Exhibit 19 The Permanente Medical Group 281 12 Office Visit for George Hafely dated August 20, 2015, Bates No. 13 1888 through 1901 14 Exhibit 20 The Permanente Medical Group 286 Office Visit for George Hafely 15 dated September 1, 2015, Bates No. 0015 through 0020 16 Exhibit 21 The Permanente Medical Group 289 17 Office Visit for George Hafely dated September 17, 2015, Bates 18 No. 0029 through 0034 19 Exhibit 22 The Permanente Medical Group 296 Office Visit for George Hafely 20 dated December 15, 2015, Bates No. 0106 through 0111 21 Exhibit 23 The Permanente Medical Group 302 22 Office Visit for George Hafely dated January 12, 2016, Bates 23 No. 0124 through 0127 24 (Continued) 25 George Hafely, Volume II eLitigation Services, Inc. - els@els-team.com Page 203 1 EXHIBITS 2 DEFENDANT'S PAGE 3 Exhibit 24 The Permanente Medical Group 311 Office Visit for George Hafely 4 dated January 26, 2015, Bates No. 0146 through 0149 5 Exhibit 25 The Permanente Medical Group 314 6 Office Visit for George Hafely dated January 5, 2016, Bates No. 7 P000904 through P000906 8 Exhibit 26 The Permanente Medical Group 318 Office Visit for George Hafely 9 dated March 8, 2016, Bates No. P000951 through P000956 10 Exhibit 27 The Permanente Medical Group 323 11 Office Visit for George Hafely dated January 5, 2016, Bates No. 12 P000907 through P000911 13 Exhibit 28 U.S. HealthWorks Work Status 328 Report, dated December 2, 2004, 14 Bates No. P000630 15 Exhibit 29 Patient Status and Progress 331 Report, dated February 15, 2006, 16 Bates No. P000674 17 Exhibit 30 U.S. HealthWorks Work Status 333 Report, dated January 15, 2009, 18 Bates No. P000687 19 Exhibit 31 U.S. HealthWorks Work Status 346 Report, dated June 5, 2014, 20 Bates No. P000618 21 Exhibit 32 U.S. HealthWorks Work Status 348 Report, dated June 12, 2014, 22 Bates No. P000616 23 Exhibit 33 U.S. HealthWorks Work Status 350 Report, dated June 19, 2014, 24 Bates No. P000615 (Continued) 25 George Hafely, Volume II eLitigation Services, Inc. - els@els-team.com Page 204 1 EXHIBITS 2 DEFENDANT'S PAGE 3 Exhibit 34 U.S. HealthWorks Work Status 351 Report, dated P000614 4 Exhibit 35 U.S. HealthWorks Work Status 353 5 Report, dated Bates No. P000613 6 Exhibit 36 U.S. HealthWorks Work Status 357 Report, dated August 6, 2014, 7 Bates No. P000612 8 Exhibit 37 U.S. HealthWorks Work Status 360 Report, dated August 20, 2014, 9 Bates No. P000034 10 Exhibit 38 U.S. HealthWorks Work Status 362 Report, dated September 03, 11 2014, Bates No. P000035 12 Exhibit 39 Note from John J. Lettice, MD, 364 dated October 27, 2104, Bates 13 No. P000606 14 Exhibit 40 Note from John J. Lettice, MD, 366 dated March 2, 2015 15 Exhibit 41 U.S. HealthWorks, Work Status 372 16 Report, dated April 8, 2015, Bates No. GRC0000039 17 Exhibit 42 U.S. HealthWorks, Work Status 374 18 Report, dated June 03, 2015, Bates No. GRC0000032 19 ---oOo--- 20 21 22 23 24 25 George Hafely, Volume II eLitigation Services, Inc. - els@els-team.com Page 205 1 WITNESS INSTRUCTED NOT TO ANSWER 2 PAGE LINE 3 Did you ever tell your Workers' 219 12 Compensation lawyer that you had this 4 note? 5 Is there any reason why you waited 219 20 until six months into this lawsuit to 6 get this note? 7 What did they say? 323 21 8 ---oOo--- 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 George Hafely, Volume II eLitigation Services, Inc. - els@els-team.com Page 206 1 P-R-O-C-E-E-D-I-N-G-S 2 ---oOo--- 3 THE VIDEOGRAPHER: Good morning, ladies and 4 gentlemen. We're on video record. The time is 5 approximately 10:12 a.m. I'm Frank Quirarte from 6 eLitigation Services, Inc., in Los Angeles, 7 California. The phone number is (310) 220-9700. 8 This is the matter pending before the 9 Superior Court, State of California for the County of 10 Santa Clara in the case captioned George Hafely vs. 11 Graniterock Company. The case No. 17 CV 316847. 12 This is the beginning of media 1, volume 2, 13 in the deposition of George Hafely on May 7th, 2018. 14 We're located at 379 Litton Avenue in Palo Alto, 15 California. This deposition is taken on behalf of 16 defendant. 17 At this time, will counsel and all present 18 please identify yourselves for the record. 19 MS. BECKWITH: Amanda Beckwith for defendant 20 Graniterock Company. 21 MR. FONG: Brian Fong for defendant 22 Graniterock Company. 23 MR. WILLIAMS: Donald Williams for plaintiff 24 George Hafely. 25 MR. ULMER: Derek Ulmer for plaintiff George George Hafely, Volume II eLitigation Services, Inc. - els@els-team.com Page 207 1 Hafely and -- 2 MS. WAMUHUL: Shana Wamuhul, law clerk. 3 THE VIDEOGRAPHER: Madam Court Reporter, 4 would you please swear in the witness? 5 GEORGE HAFELY, 6 after being first duly sworn, was examined and 7 testified as follows: 8 EXAMINATION 9 BY MS. BECKWITH: 10 Q. Good morning, Mr. Hafely. I know we met 11 briefly a couple months ago. My name is Amanda 12 Beckwith. 13 Can you please state your name and address 14 for the record? 15 A. George Hafely, 892 Ryan Court, Gilroy, 16 California 95020. 17 Q. I know you've been deposed before. I want to 18 remind you of a couple things. 19 Do you understand the oath you've been given 20 is the same oath as though you would take if you were 21 in court? 22 A. Yes. 23 Q. The Court Reporter will be taking down my 24 questions and your answers. She can only take one of 25 us at a time, so it's important if you wait to finish George Hafely, Volume II eLitigation Services, Inc. - els@els-team.com Page 208 1 my questions before you answer, and I'll try to wait 2 for you to finish answering before I ask my next 3 question. 4 A. Okay. 5 Q. The Court Reporter cannot take down nods and 6 shakes. It's important you answer questions 7 verbally. 8 A. Okay. 9 Q. After the deposition is over, the Court 10 Reporter will type up my questions and your answers 11 into a booklet form. You'll have a chance to review 12 it and makes changes to your testimony. 13 A. Yes. 14 Q. If you make any changes to your testimony, I 15 can make comments on that at trial. Do you 16 understand? 17 A. Yes. 18 Q. When answering my questions, I'm entitled to 19 your best recollection, but I don't want a guess. 20 For example, if I were to ask you what was said in a 21 conversation, and you aren't able to quote what was 22 said but remember the gist of what was said, I'm 23 entitled to your best recollection. 24 A. Okay. 25 Q. Do you have any questions before we begin? George Hafely, Volume II eLitigation Services, Inc. - els@els-team.com Page 246 1 Q. How do you know he didn't want to give you 2 the help? 3 A. Because I would ask for guys sometimes, and 4 he would just say, "No, you can't have four or five. 5 You can have two." 6 Q. How often would you ask for four or five? 7 A. Whenever I needed the extra help when I was 8 hurt because a lot of the stuff I couldn't do 9 anymore. 10 Q. Do you remember how many times? 11 A. No. 12 Q. Do you remember when you asked for four or 13 five? 14 A. No. Like I said, all depending what was 15 going on with the plant. 16 Q. Do you remember how many times John Seith 17 would say, "No, you can have two"? 18 A. Towards the end quite a bit. 19 Q. Did he ever say why you could only have two? 20 A. No. 21 Q. What did you tell him when he said you could 22 have two? 23 A. That's when I would argue with him. I would 24 ask him, "Do you want the plant to run Monday or 25 not?" George Hafely, Volume II eLitigation Services, Inc. - els@els-team.com Page 260 1 Q. Do you remember what you told your union 2 reps? 3 A. Just at times I was picking up stuff I wasn't 4 supposed to be doing, and we ultimately ended up 5 having a meeting with Manny and Randall from the 6 union, and John Seith, Mike McGrath and Shirley Ow 7 was there. 8 Q. Do you remember when that was? 9 A. No. 10 Q. Do you remember if it was before or after 11 your first write-up? 12 A. No, it was after a couple. I think after two 13 of them. 14 Q. After two? 15 A. I believe so. 16 Q. Manny and Randall are your union reps? 17 A. No. 18 Q. Do you have any other union reps? 19 A. No. Manny at the time I believe was the 20 president of the union hall in Morgan Hill. I think 21 he's retired since then now. 22 Q. What did you discuss at that meeting? 23 A. They talked about the write-ups and trying to 24 say I wasn't doing my job. The way I looked at it, 25 it was a meeting before termination. George Hafely, Volume II eLitigation Services, Inc. - els@els-team.com Page 261 1 Q. Did anybody tell you that? 2 A. No. Like I said, I knew they wanted me gone, 3 so I think they were pressuring me trying to get me 4 to quit. 5 Q. Did that meeting happen before you went out 6 on leave? 7 A. Yes. 8 Q. Did you complain to your union reps before 9 that meeting that you were lifting bags in excess of 10 your restrictions? 11 A. I believe I mentioned it to them. They were 12 the ones that came upstairs and told me we were 13 having a meeting with John, Shirley and Mike the next 14 morning. 15 Q. What did they tell you? 16 A. Just that we were having a meeting. 17 Q. Did they tell you what it would be about? 18 A. No, he didn't tell me at the time. And 19 that's also when I had the paperwork to show Mike 20 McGrath where the 300 tons of cement powder went, and 21 he didn't even want to look at them. I tried to hand 22 them to him. He just brushed them off and said, "I 23 could care less." 24 Q. What did that paperwork say? 25 A. I found it was an accounting error, and he George Hafely, Volume II eLitigation Services, Inc. - els@els-team.com Page 266 1 work the next. That's when I came back on that 2 Friday. I had forgot about it. And Monday, when I 3 started it, John come up to see me. I told him I 4 apologized for forgetting one day. He told me, 5 "Yeah, okay. No problem. Don't worry about it." 6 He came back an hour or two later and wrote 7 me up for it. 8 MS. BECKWITH: I'll hand the Court Reporter 9 the next exhibit. 18. 10 (Defense Exhibit No. 18 was marked 11 for identification.) 12 MS. BECKWITH: Q. Take a minute to read this 13 over and let me know when you're ready. 14 A. (Reviewing document.) 15 Q. Is this the write-up you're referring to 16 about the spreadsheet? 17 A. Yes. 18 Q. Do you remember receiving this write-up? 19 A. Yes. 20 Q. Did John Seith bring it to you or mail it to 21 you? How did you receive it? 22 A. He brought it upstairs. 23 Q. Do you remember when that happened? 24 A. Sorry, what was -- 25 Q. Do you remember when he brought this to you? George Hafely, Volume II eLitigation Services, Inc. - els@els-team.com Page 272 1 A. Not that I remember, no. 2 Q. Did you think this write-up was fair? 3 A. No, he didn't have to write me up for it. 4 Especially when I admitted to it. 5 Q. Did you ever complain to your union rep about 6 this write-up? 7 A. They saw it at that meeting. 8 Q. Did you complain about this write-up before 9 then to your union reps? 10 A. I don't remember. 11 Q. Had you ever complained to your union reps 12 about any write-ups before? 13 A. Not that I remember. I was never written up 14 until after I hired my worker comp attorneys. 15 Q. Do you remember when that was? 16 A. What's that? When I hired them? 17 Q. Yes. 18 A. No. First part of 2015, I know that. 19 Q. Why didn't you ever complain to your union 20 reps about the write-ups? 21 A. Like I said, I knew they wanted to fire me, 22 so I knew it was just a matter of time. 23 Q. Can your union reps fire you? 24 A. Not that I know of, no. 25 Q. Do you know whether you had a collective George Hafely, Volume II eLitigation Services, Inc. - els@els-team.com Page 276 1 tunnel, if he would have ever taken the time to walk 2 down there, he would have known there was no leaks. 3 Q. Did you ever tell him that? 4 A. Oh, yeah. He does what he wants to do. He's 5 the division manager. 6 Q. Did you ever tell anybody you thought you 7 were unfairly getting written up? 8 A. Didn't have to. Most of the drivers knew I 9 was being written up. 10 Q. How did they know? 11 A. I don't know. Word gets out. Even Danny 12 down south knew I was being written up. 13 Q. Did you tell anyone? 14 A. I told a few people because I was ticked off 15 after that meeting. 16 Q. Do you remember who you told? 17 A. No. 18 MS. BECKWITH: Do you want to break for 19 lunch? Noon-ish? 20 MR. WILLIAMS: That would be great. 21 MS. BECKWITH: Let me make sure I'm at a good 22 stopping point. I think I am. 23 Yeah. Why don't we break for lunch. 24 THE VIDEOGRAPHER: Going off the record. The 25 time is 12:18 p.m. this marks the end of Media 2. George Hafely, Volume II eLitigation Services, Inc. - els@els-team.com Page 288 1 work as a plant operator at Graniterock? 2 A. I don't remember. I was so screwed up in the 3 head. 4 Q. The sentence before that, a couple sentences 5 before that where it says, "He wanted to spend time 6 with a friend from work," which friend was that? 7 A. You know what, I don't even remember now. 8 Q. Is there any way to jog your memory of who 9 the friend was? 10 A. No, I don't remember. Sorry. 11 Q. Don't be sorry. 12 When you say you reported feeling like a 13 failure, is that because of the two write-ups? 14 A. The write-ups, knowing they didn't want you 15 there. 16 Q. Sorry, go ahead. 17 A. I was just going to say because I knew they 18 wanted me gone. So it was really tough to try to get 19 up in the morning. 20 Q. Did anyone tell you they didn't want you 21 there? 22 A. No. 23 MS. BECKWITH: I'm going to hand the Court 24 Reporter the next exhibit. 25 ///// George Hafely, Volume II eLitigation Services, Inc. - els@els-team.com Page 289 1 (Defense Exhibit No. 21 was marked 2 for identification.) 3 MS. BECKWITH: Q. These are notes from your 4 September 17th, 2015, appointment. 5 Do you remember that appointment? 6 A. Yes. 7 Q. Then flip to the next page. Do you see where 8 it says "Updated Status"? 9 A. Yes. 10 Q. Then on the second line down where it says, 11 "A colleague reported that patient's position at work 12 had been posted as a job opening on the internet." 13 A. Oh, Yes. 14 Q. Do you remember who told you that? 15 MR. WILLIAMS: Objection. Asked and 16 answered. 17 THE WITNESS: I believe it was William 18 Mookini, and then I looked it up on my home computer. 19 I wished I would have taken a picture of it. 20 MS. BECKWITH: Q. So you saw it on your own? 21 A. Yes. 22 Q. Do you remember when that was? 23 A. It was when I was out of work. I know that. 24 Q. Was it before or after you were terminated? 25 A. Before. George Hafely, Volume II eLitigation Services, Inc. - els@els-team.com Page 329 1 duties? 2 A. According to this, I must have, yes. 3 Q. To your knowledge, did Graniterock 4 accommodate you for this injury? 5 MR. WILLIAMS: Objection. Speculation. 6 THE WITNESS: Yes, as far as I know, yes. 7 MS. BECKWITH: Q. For this September 30th, 8 2004, injury, did you fax in these Work Status 9 Reports to your supervisor? 10 A. This one here? 11 Q. Yes. 12 A. I probably gave it to them when I walked into 13 work the next morning. I would have given it to the 14 dispatcher, which at that time, we had our own 15 dispatcher in the San Jose yard. 16 Q. Do you remember ever complaining about 17 working through your restrictions for this 18 September 30th, 2004, injury? 19 A. Not that I remember, no. 20 Q. Do you recall an injury on February 7th, 21 2006? 22 A. No. 23 Q. An injury to your hands? 24 A. Oh, that was -- they found I was actually 25 allergic to concrete. A couple of my fingers would George Hafely, Volume II eLitigation Services, Inc. - els@els-team.com Page 330 1 dry out. I couldn't bend them, crack, bleed. 2 Q. Did you communicate that to your supervisor? 3 A. Oh, yeah. 4 Q. And how did you continue performing your job? 5 A. I took the advice of the doctor. I started 6 wearing some other cotton gloves under the gloves we 7 used when you were washing down the truck, cleaning 8 out the shoots. 9 Q. Did you continue to wear gloves throughout 10 the rest of your time at Graniterock? 11 A. I believe I did. When I was in the mixer. 12 Q. Do you not need them when you're a plant 13 operator? 14 A. No. 15 Q. Did anybody ever tell you you couldn't wear 16 gloves? 17 A. No. 18 Q. Do you remember any other work restrictions 19 for that injury? 20 A. No, because I think I kept working. They 21 gave me some medicine for it. 22 Q. Do you remember what kind of medicine? 23 A. No. 24 Q. Do you know what your job duties were when 25 you were a mixer driver? George Hafely, Volume II eLitigation Services, Inc. - els@els-team.com Page 335 1 Q. Do you have any recollection of not being 2 accommodated for any of these injuries other than 3 your back injury? 4 A. No. 5 Q. Do you have any recollection of your 6 restrictions being denied for any of these injuries? 7 A. Not that I remember, no. 8 Q. When I say "these injuries," your prior 9 Workers' Compensation injuries. 10 A. Not that I remember, no. 11 Q. Do you recall any issues with Graniterock's 12 handling of your Workers' Compensation issues? 13 A. Not with these ones, no. 14 Q. What do you think changed then in 2014? 15 A. When I came back from the car accident in 16 '06, I was supposed to work only eight hours. And I 17 came in the yard at like seven and a half, dispatcher 18 told me, "Hey, I have one more load. You have to 19 take it." 20 I reminded him I'm not supposed to work more 21 than eight hours. He told me too bad. Back under. 22 You're next. So I backed under, got loaded, and went 23 out the gate. 24 Q. This was in 2006? 25 A. Yes, that was -- George Hafely, Volume II eLitigation Services, Inc. - els@els-team.com Page 336 1 Q. Roughly? 2 A. Yeah, sometime after when I was on work 3 restrictions for my neck. 4 Q. Did you ever complain about that to anybody? 5 A. I called Shirley Ow. 6 Q. What did she say? 7 A. She wasn't there. I didn't get back on the 8 yard until it was like 7:00 o'clock. 9 Q. Did she ever call you back? 10 A. No. She never called me back, but she had 11 called the manager. 12 Q. Do you know what she told him? 13 A. No, I don't know. I can't say what she told 14 him, but I know he called me in the office because he 15 wasn't happy because I called her. He was mad. I 16 told him, you know, well, that's who I decided to 17 call on the way home that night. 18 Q. Who was your manager? 19 A. Andy. 20 Q. Do you know the last name? 21 A. He's got an odd name, Chiccolas (phonetic), I 22 think it was, Chiccolas. 23 Q. Then what happened? 24 A. I got chewed out for calling Shirley, and 25 then he brought Ed in and, you know, started getting George Hafely, Volume II eLitigation Services, Inc. - els@els-team.com Page 337 1 in on Ed for loading me when he knew I wasn't 2 supposed to. 3 Q. Then what happened? 4 A. After that, I never got loaded after eight 5 hours again. 6 Q. Did you ever tell anyone in your union, union 7 representative? 8 A. I don't even know if we were union at the 9 time. 10 Q. Got it. 11 Once you made a complaint, your work 12 restrictions were no longer violated after that 13 point? 14 A. Yes. 15 Q. And why do you think your back injury was any 16 different? 17 MR. WILLIAMS: Objection. Argumentative. 18 THE WITNESS: Like I said, I know they wanted 19 me gone. 20 MS. BECKWITH: Q. In 2014 when you injured 21 your back. 22 A. The year after, as soon as I hired worker 23 comp attorneys, that's when everything started. 24 Q. In March of 2015? 25 A. It was like a month and a half later George Hafely, Volume II eLitigation Services, Inc. - els@els-team.com Page 340 1 manager? 2 A. No. 3 Q. Do you remember the first time your 4 restrictions were violated? 5 A. I don't remember the dates, no. 6 Q. Was it shortly after injury? Months later? 7 Weeks later? 8 A. I don't remember. 9 Q. Is there anyone you could talk to that would 10 help you remember? 11 A. No. 12 Q. Any documents? Did you write it down? 13 A. No, I didn't write nothing down. 14 Q. Any other documents? 15 A. No. 16 Q. Was the first time your restrictions were 17 violated before or after you hired a worker comp 18 attorney? 19 A. I believe it was after the worker comp 20 attorneys. 21 Q. When you hired a worker comp attorney, did 22 you tell anyone? 23 A. I don't remember if I told anybody at work. 24 Q. Would you have told John Seith? 25 A. No, I would have no reason to tell him. George Hafely, Volume II eLitigation Services, Inc. - els@els-team.com Page 353 1 THE REPORTER: 35. 2 (Defense Exhibit No. 35 was marked 3 for identification.) 4 MS. BECKWITH: Q. We have another Work 5 Status Report dated July 23rd, 2014? 6 A. Yep. 7 Q. With work restrictions, limited lifting, 8 pulling, pushing up to 15 pounds and sit/stand/walk 9 as-needed for comfort. 10 A. Yep. 11 Q. Until your next appointment on August 6th, 12 2014, were these restrictions ever violated? 13 MR. WILLIAMS: Objection. Vague. 14 Do you understand the question? 15 THE WITNESS: I know she's asking me if, you 16 know, like they didn't accommodate me. But I don't 17 really remember. All this stuff started after all 18 the other attorneys. 19 MS. BECKWITH: Q. What do you mean by "other 20 attorneys"? 21 A. When I hired the worker comp attorneys. 22 Q. And what changed? 23 A. It wasn't long after, that's like when they 24 started, you know, harassing and, "Just do it, we're 25 busy." George Hafely, Volume II eLitigation Services, Inc. - els@els-team.com Page 355 1 bring William up so I could actually sit and enjoy 2 lunch. 3 Q. During the period of July 23rd, 2014, and 4 August 6th, 2014, you called dispatch and asked for 5 William? 6 A. Yeah. I mean, you try to eat your lunch, and 7 they would call and want to know why you're slowing 8 down. I haven't ate since 4:00 in the morning, and 9 it's 1:00 o'clock in the afternoon. 10 Q. Do you remember which day during that period 11 you called dispatch? 12 A. No. 13 Q. How do you remember that you called dispatch 14 during the period between July 23rd, 2014, and 15 August 6th, 2014, and called dispatch and asked for 16 William Mookini? 17 A. During the break, I started thinking, and I 18 would ask off and on if William could come up and 19 give me a break for a little bit. 20 Q. You just remembered this during the break? 21 A. Yeah. I was trying to remember, and I 22 cleared the head a little bit, getting up and 23 walking. 24 Q. But you didn't remember in the past five 25 exhibits prior? George Hafely, Volume II eLitigation Services, Inc. - els@els-team.com Page 356 1 A. No. 2 Q. So what makes you remember this one now? 3 MR. WILLIAMS: Objection. Argumentative. 4 You may answer. 5 THE WITNESS: I got up and walked a little 6 bit, tried to clear the head a little, and that's 7 when I remembered that he would come up and every 8 once in awhile and give me a little bit of a break. 9 MS. BECKWITH: Q. Every once in awhile or 10 between the period of July 23rd, 2014, and 11 August 6th, 2014? 12 A. I don't remember the dates, but I know I 13 would call every now and then. 14 Q. Every time you called dispatch, would William 15 come up? 16 A. Unless we were real, real busy, they couldn't 17 afford to give him up. 18 Q. Do you know how many times that happened? 19 A. No. 20 Q. I just want to be clear, from the period of 21 July 23rd, 2014, and August 6th, 2014, do you recall 22 whether you called dispatch and asked for William to 23 come up and help you? 24 MR. WILLIAMS: Objection. Asked and 25 answered. George Hafely, Volume II eLitigation Services, Inc. - els@els-team.com Page 357 1 THE WITNESS: I know I did. Off and on. 2 Like I said, I don't remember the dates. They 3 probably went on past that on top of it. 4 MS. BECKWITH: Q. Are there any documents 5 you could look at to refresh your recollection? 6 A. About asking for William to come up? 7 Q. Yes. 8 A. No. 9 Q. Anyone you could speak to that to refresh 10 your recollection? 11 A. No, not unless dispatch would remember. 12 Q. Anything else you could look at to refresh 13 your recollection? 14 A. No. 15 Q. Did you send this note to Redwood City? 16 A. Yes. 17 MS. BECKWITH: Let's mark the next exhibit. 18 THE REPORTER: 36. 19 (Defense Exhibit No. 36 was marked 20 for identification.) 21 THE WITNESS: (Reviewing document.) 22 MS. BECKWITH: Q. This is a Work Status 23 Report dated August 6th, 2014. 24 A. Yes. 25 Q. Did you send this Work Status Report to George Hafely, Volume II eLitigation Services, Inc. - els@els-team.com Page 363 1 Q. Are there any documents you could look at to 2 help you refresh your recollection? 3 A. No. I know then, I would call, and they 4 would help send a driver up when we were slower to 5 throw in anything if it was heavy. 6 Q. Who would call a driver? 7 A. The dispatcher. 8 Q. At your request? 9 A. Yes. 10 Q. Do you remember if you called dispatch and 11 asked for a driver between this period of time? 12 A. If it was something heavy, I know I did. 13 Q. Do you know whether or not you did? 14 A. I can't say positive. 15 Q. Any documents you could look at to refresh 16 your recollection? 17 A. No. 18 Q. Anyone you could speak to? 19 A. No. 20 Q. Anything else you could look at? 21 A. No. 22 Q. Did you ever complain at this doctor's 23 appointment your restrictions were being violated? 24 A. Not that I can remember, no. 25 MS. BECKWITH: Let's mark the next exhibit George Hafely, Volume II eLitigation Services, Inc. - els@els-team.com Page 367 1 back, I believe, at Dr. Lettice's office. 2 Q. And why is that? 3 A. Tried to do some work on the plant and messed 4 up my back again. 5 Q. What kind of work were you doing? I guess 6 what job duties. 7 A. That day, I was in the drum. 8 Q. Doing what? 9 A. Nobody else wanted to chip it, and I was off 10 my restrictions, so I got in. 11 Q. Who else would normally do the chipping? 12 A. I tried to bring in some of the drivers to do 13 that. 14 Q. I just want to clarify. When you say no one 15 else wanted to, did you ask somebody and they would 16 say no? 17 A. Oh, yeah. They would ask and, "What do you 18 have this weekend?" "Oh, chipping the drum." "Oh, 19 no." 20 Q. Is that what happened after you were placed 21 back to work without restrictions? 22 A. Yeah. Nobody really wanted to do it, so I 23 did. 24 Q. Who did you ask? 25 A. I don't remember specifically now. I just George Hafely, Volume II eLitigation Services, Inc. - els@els-team.com Page 375 1 violated? 2 A. I don't remember. I think they were still 3 working with me fairly well then. 4 Q. When you say "they," you mean dispatchers? 5 A. Yeah, and management, yes. 6 Q. "Management" being John and Mike? 7 A. Yes. 8 Q. Do you remember complaining at this doctor's 9 appointment that your work restrictions were 10 violated? 11 A. No, not that I can remember. 12 Q. I just want to backup and clarify a few 13 things we talked about earlier. 14 You testified earlier you would sometimes ask 15 for four to five people to help you. 16 A. Yes. 17 Q. And you were only given two people to help 18 you? 19 A. Yes. 20 Q. Were you ever flatly refused to have anyone 21 help you? 22 A. I don't think so, no. 23 Q. Did you just disagree about the number of 24 helpers you had? 25 A. Oh, yeah. I used to tell them it made more George Hafely, Volume II mqmwbwmp ll 12 13 l4 15 16 l7 l8 19 20 21 22 23 24 25 Page 383 REPORTER'S CERTIFICATE I, KIMBERLEE SCHROEDER, CSR No. 11414, hereby certify that I am authorized to administer oaths or affirmations. (Cal. Code of Civ. P. Sec. 2093 (b) and Fed- R- Civ. P. 28(a)). The foregoing proceedings were taken before me at the time and place therein set forth, at which time the witness was duly sworn by me. (Cal- Code Civ- Proc- 2025-330(a), 2025.540(a) and Fed. R. Civ. P. 30(f)(l))~ The foregoing pages contain a full, true and accurate record of all proceedings and testimony. (Cal. Code Civ. Proc- 2025-540(a) and Fed- R. Civ- P. 30(f)(1)). I am not a relative or employee of the parties, nor financially interested in the action. (Cal- Code Civ. Proc. 2025.320(a)). Before completion of the proceedings, review of the transcript [ ] was [ ] was not requested. If requested, any changes made by the witness (and provided to the reporter) during the period allowed, are appended hereto- (Fed. R. Civ. P. 30(e)). I declare under penalty of perjury under the laws of California that the foregoing is true and correct. 20th day of May, 2018 KIMBERLEE SCHROEDER, CSR, RPR, CCRR License No. 11414 eLitigation Services, Inc. - els@els-team.com EXHIBIT Q lO ll 12 l3 l4 15 l6 l7 18 l9 20 21 22 23 24 25 BEFORE THE WORKERS' COMPENSATION APPEALS BOARD OF THE STATE OF CALIFORNIA GEORGE HAFELY, Applicant, VS. NO. ADJ10005980 GRANITE ROCK COMPANY and ADJlOlO8439 ZURICH AMERICAN INSURANCE CO., Defendants. vvvvvvvvvvv DEPOSITION OF GEORGE HAFELY VOLUME II SALINAS, CALIFORNIA FEBRUARY 25, 2016 ATKINSON-BAKER, INC. COURT REPORTERS (800) 288-3376 www.depo.com REPORTED BY: Melinda Nunley, CSR NO. 9332 FILE NO: AA00579 Atkinson-Baker Court Reporters www.dep0.com 7O 10 ll 12 l3 l4 l5 l6 l7 18 l9 20 21 22 23 24 25 BEFORE THE WORKERS' COMPENSATION APPEALS BOARD OF THE STATE OF CALIFORNIA GEORGE HAFELY, Applicant, VS. NO. ADJ10005980 GRANITE ROCK COMPANY and ADJ10108439 ZURICH AMERICAN INSURANCE CO., Defendants. VVVVVVVVVVV Deposition of GEORGE HAFELY, VOLUME II, taken on behalf of Defendants, at 21 Maple Street, Salinas, California, commencing at 10:14 a.m., Thursday, February 25, 2016, before Melinda Nunley, CSR No. 9332. 71 Atkinson-Baker Court Reporters www.dep0.com lO ll 12 13 l4 15 16 17 l8 19 20 21 22 23 24 25 A P P E A R A N C E S: FOR APPLICANT: WILSON & WISLER BY: ROBERT B. FARAHMAND, Attorney at Law and BONNIE BINDER WILSON, Attorney at Law 21 Maple Street Salinas, California 93901 (831) 269-3787 FOR DEFENDANTS: WITKOP LAW SAN JOSE BY: ANDREW JOSEPH LYNCH, Attorney at Law 1625 The Alameda Suite 901 San Jose, California 95126 (408) 538-5900 ALSO PRESENT: MATTHEW READE Atkinson-Baker Court Reporters www.depo.com 72 lO ll 12 13 l4 15 l6 l7 18 l9 20 21 22 23 24 25 I N D E X WITNESS: GEORGE HAFELY EXAMINATION PAGE By Mr. Lynch 74 E X H I B I T S NUMBER DESCRIPTION PAGE (NONE ) INSTRUCTIONS NOT TO ANSWER: (NONE) INFORMATION REQUESTED: (NONE) Atkinson-Baker Court Reporters www.dep0.c0m 73 10 ll 12 13 l4 15 l6 l7 18 l9 2O 21 22 23 24 25 GEORGE HAFELY, having first been duly sworn, was examined and testified as follows: EXAMINATION BY MR. LYNCH: Q. Good morning, Mr. Hafely. My name's Andrew Lynch and I'm here for the second part of your deposition today. You recall the first part of your deposition? A. Yes. Q. I'm going to just sort of briefly review some of the ground rules just to make sure that you're familiar once again with the rules for the deposition procedure. You understand you're under oath, correct? A. Yes. Q. And you understand there can be criminal consequences to not giving your best and most accurate answers here today? A. Yes. Q. You remember that you have to respond verbally in words to all my questions -- A. Yes. Q. -- so that the court reporter can enter your answers? A. Yes. Atkinson-Baker Court Reporters www.depo.com 74 lO 11 l2 l3 l4 15 l6 l7 l8 l9 20 21 22 23 24 25 Q. And also if your attorney objects to one of my questions, don't answer it until your attorney tells you it's okay to answer the question. Okay? A. Okay. Q. Okay. So I'm going to start today by focusing on questions that relate to your employment at Graniterock since that impacts both the issues raised in your Labor Code Section 132(a) employment discrimination claim and also because there is a -- what's called a good faith personnel action defense to the psych claim that has been brought, and so I'm going to focus a little more on your employment history at Graniterock than I did the last time. Okay? A. Okay. Q. All right. Okay. So when were you hired at Graniterock? A. I believe it was in February of 2001. Q. And when you were hired, what was your job title? A. Mixer driver. Q. And how long did you work as a mixer driver? A. I think approximately lO years. Q. Till about May -- A. 10 or ll years, somewhere around there. Q. Until around May 2012; does that sound about right? 75 Atkinson-Baker Court Reporters www.dep0.com lO ll 12 13 l4 15 l6 l7 18 19 20 21 22 23 24 25 A. Yeah, that sounds right. Q. And what were your job duties it as a mixer A. To haul concrete to the various job sites. Q. Was there like a home base or a yard that you would start out at every day? A. The San Jose yard, yeah. After you got done delivering, you returned to the same yard. Q. And what kind of trucks were you driving? A. The Peterbilts, Peterbilt mixers. They're 8 Q. And did that require any special licenses or -- A. Yes. Q. -- certification? What kind of license did that require? A. Class A. Thank you. And it also has the tanker endorsement. And that was full time, right? P 0 W O Yes. Q. What kind of schedule did you keep with it, a Monday-through-Friday schedule or did you work weekends or odd hours? How did that work? A. Oh, yeah, odd hours, lots of weekends. It was generally about a 60-hour week on average. 76 Atkinson-Baker Court Reporters www.dep0.com 10 ll 12 13 l4 15 l6 l7 18 l9 20 21 22 23 24 25 Q. Were you paid overtime? A. Yes. Q. And what union were you a member of when you were a mixer driver? A. The Teamsters. Q. Do you know the local or what city the office was in? A. It's in San Jose, the office. They're on Fourth Street. I believe it's Local 237. Q. And so in -- let's say in May of 2012 when you stopped working as a mixer driver, do you remember what your salary was? A. I think it was around 37. Dollars an hour? Yes, because we were nonunion at that time. Was there overtime? Yes. For everything over 4O hours a week? P IO 3’ IO 33 IO Anything over 8 hours a day. Q. Okay. And do you remember about what you earned in, you know, groSs wages in 2011? A. I have my W-ZS. 78,460. Q. Okay. Who was your supervisor when you worked -- who was your supervisor in 2012 when you worked as a mixer driver? 77 Atkinson-Baker Court Reporters www.depo.com 10 ll 12 l3 l4 15 l6 l7 l8 l9 2O 21 22 23 24 25 A. Jim Holmquist. Q. -h-o-l-m-q-u-i- sound right? That sounds -- -- H-o-l-m-q-u-i-s-t, does that I think so. And was he at the San Jose yard? YES. Manager. All right. And driver, were there -- so 2012. Did you ever have your attention either in A Q A Q. Do you know what his title was? A Q so when you worked as a mixer we're talking about before May any performance issues brought to the form of a write-up or a meeting or, you know, a disciplinary action of any kind? A. None that I can remember. Q. And while you worked as a mixer driver, was there ever a time you missed let‘s say more than 3 months of work in a consecutive period for any reason? A. Yes. Q. When was that? A. In 2006. Q. A. Car accident. What did you miss time from work for? Q. Is there any other time when you were a mixer driver where you missed more than 3 months from work for any reason? 78 Atkinson-Baker Court Reporters www.dep0.com lO ll 12 l3 l4 15 l6 l7 18 l9 20 21 22 23 24 25 A. Q. NO. All right. And so did your -- did your position change in 2012? A. Q. A. Q. position A. Yes. To what? Plant operator. So how did you -- how did you find out that that was open? I used to take over for Richard. He trained me on how to run the plant. Q. 0?o>o.>o;vo>co;vp.> Was Richard the plant operator before you? He was, yes. Do you remember his last name? Holand. Holand like -- H-o-l-a-n-d. Do you know how long Richard was a plant manager? He was plant operator. I'm sorry, plant operator. No, I'm not sure how long he did it. Where was the plant? San Jose on Berryessa Road. Is that a different place from where the yard is? No, no, same place. Okay. And so what were the -- so you found out 79 Atkinson-Baker Court Reporters www.dep0.com 10 ll 12 l3 l4 15 16 l7 18 l9 20 21 22 23 24 25 about that position by speaking with Richard? A. Yes, because he quit. Q. All right. Can you explain how the interview process went, who you interviewed with, how many interviews there were; do you recall? A. I believe there was 4 on the interview team and I interviewed in the manager's office. Q. Whose office was that? Jim Holmquist. Okay. Do you remember when that was? No. Like what month it was? No, I don't remember now. A Q A Q A Q. And who else was there when you interviewed? A I know Scott Holand was there. Q Is that Richard's relative? A His brother. Q Okay. A. I believe Barbara Kimball was there, and I don't remember anybody else. Q. So when you were -- when you were interviewing do you recall what your understanding was of what the job duties were as a plant operator? A. Yes. Q. What were those job duties as you understood them 80 Atkinson-Baker Court Reporters www.depo.com lO ll 12 l3 l4 15 16 l7 18 19 20 21 22 23 24 25 when you interviewed? A. Run the plant, do all the maintenance and repair work on the plant, order all the admixtures for the plant, all the cement powder. I was ordering pea gravel myself at the time. I ordered all the color for the plant. Q. All of the what? A. Color, and all the other type of admixtures like fibers, Xypex, and I also ordered like all the repair parts and stuff like that for the plant also. Q. Okay. So from the time you were interviewing, by comparing when you were interviewed for the position, when you were applying for the position as opposed to once you started doing it, did you notice there was a difference in the job duties ~- A. No. Q. -- when you actually started working as the plant operator? A. Yeah. Q. Did you notice a difference or not? A. NO. Q. Okay. A. Richard would go on vacation and I'd do it for 2 or 3 weeks. MS. WILSON: That isn't the question. BY MR. LYNCH: 81 Atkinson-Baker Court Reporters www.dep0.c0m 10 ll l2 13 14 15 16 17 18 l9 20 21 22 23 24 25 Q. Okay. And so how many hours a week was it as a plant operator on average? A. 6O to 70-plus. Q. What kind of hours were they -- were you keeping? Were you working nights or weekends or -- A. Nights, weekends, yeah. Q. Who set your schedule? A. The dispatchers with the jobs that they took. Q. So -- okay. So -- all right. So -- so can you explain as the plant operator -- let's pretend I don't know anything that goes on at Graniterock. Okay? A. Okay. Q. So you're ordering materials, right? A. Yes. Q. Who do you order them from? A. The cement powder I would order from our transportation department, and that would be on a daily basis. All the admixtures I would call Grace. Q. Who's Grace? MS. WILSON: Grace Chemical Company. THE WITNESS: Yeah, Grace Chemicals. And the color would also come from Grace and the fibers, and the Xypex, I would call them directly for that. BY MR. LYNCH: Q. Who's "them"? 82 Atkinson-Baker Court Reporters www.depo.com lO ll 12 13 l4 15 l6 17 l8 l9 20 21 22 23 24 25 A. Xypex, and then I would call I believe his name was Danny for the pea gravel. Q. Do you know where he worked? A. No, I don't know where they came from. Q. Or what company he worked for? A. Hmm-mm, it's just a name and number I was given. Q. Okay. So was your -- so at the -- at the plant, Graniterock was mixing cement -- A. Yes. Q. -- with all of these materials depending on the order that was placed -- A. Yes. Q. -- is that fair? A. Yes. Q. Okay. And so -- oh, shoot. Hold on a second. So where did the orders come from? A. The dispatch office would send a ticket upstairs. Q. Would send a ticket upstairs. Where is upstairs, at the plant? A. Yes. Q. How would that arrive? Like is that a fax or -- A. It would come into the computer, right in my system so I can load the truck. Q. And what was the turn-around time from when an 83 Atkinson-Baker Court Reporters www.depo . com 10 ll 12 13 l4 15 16 l7 18 l9 20 21 22 23 24 25 order would be received to when the plant would be expected to have it mixed? A. Usually within about 2 minutes. Q. Is that possible? Can you -- is that possible to do? A. Hmm-hmm, yes. Okay. A. On busy days I was able to load every minute and a half. Q. So how -- okay. So how are you notified that an order came in? A. It would come up on my screen, on my load-out screen. Q. On your computer? A. Yes. Q. And then what would you do with -- when that order arrived? A. On the computer you just push "start" and it will start weighing everything automatically, and then if it needed some of the admixture, some of them you had to put in by hand. Q. So in terms -- so if you're upstairs at your computer, where is the mixing taking place? A. Right out in front of me. Q. Are you able to watch it as it's going on? 84 Atkinson-Baker Court Reporters www.dep0.com 10 ll 12 13 l4 15 16 l7 18 l9 2O 21 22 23 24 25 A. screen No, I don't actually see it go in the drum. On my it'll show me which gates are opening and closing and what it's weighing up, and then everything will come out on my feed belt and end up going to the drum. Q. So when you say you could keep track of the gates opening and closing, does that mean which materials were being added? A. Q. A. and that means by putting more water in it Yes. And then what would happen? Usually sometimes I would have to adjust the load, to get it to the slump that they want, and from there start dumping into the truck. hopper 0 y D ? W O F O P O How would you know how much water to add? Just with experience. And then it would get put in the truck? Yes. How was that done? By tilting the drum. It would go through my through a boot into the truck. And then what was next? I'd honk them out. You'd what? Honk them out. What does that mean? Atkinson-Baker Court Reporters www.dep0.com 85 lO ll 12 13 l4 15 16 17 18 l9 20 21 22 23 24 25 A. I'd hit a horn so they would know they were done loading. I'd already have sent the ticket down. Q. So that the driver would know that it was done loading? A. Yes, and they would have their ticket so they would know where they're going. Q. And then they drive away? A. No, they would drive around. They‘d wash down it's called, and if I didn't get the slump closed, they would put more water in it and generally hose off the back of their trucks because when they pull out, a little bit of the stuff will hit the back of the hopper and stuff. Q. And all that was still done at the plant? Yes. And then what was next? Then they would head to the job. Okay. How many -- did you supervise the drivers? ?P?O.> I was told I was in charge of them when the manager or the division manager wasn't around. Q. So generally no, you weren't responsible for supervising the drivers; is that correct or -- A. Yes. Q The manager was Holmquist? Did I get that right? A. Holmquist for a while, then John Seith. Q Okay. Holmquist in 2012 when you started? 86 Atkinson-Baker Court Reporters www.depo.c0m lO ll 12 l3 l4 15 16 l7 18 l9 2O 21 22 23 24 25 A. Yes. Q. Okay. All right. So how much of your time was spent receiving the orders and mixing the cement? A. It would all depend on if we were -- how busy we were. Sometimes I might not load a truck for 15, 20 minutes. Then on busy days it was every 2 minutes I was loading a truck and it would be that way from start to finish, no lunch, no breaks. Q. But you would still be, you know, filling these mixing orders maybe at least lO or 20 times a day? A. Oh, yeah. A lot of times over 100. Q. Okay. What other -- what other -- did you supervise anyone? Okay. I know when the manager wasn't there, you would supervise the drivers. A. Yes. Q. Were you responsible for supervising anyone else? Was there a clerical staff or an office staff? A. NO. Q. Was there anyone else you supervised? A. The groups of people I would bring in to try to help do the maintenance on the weekends. Q. What type of maintenance was done on the weekends? A. It could be anything, changing rollers, welding up holes, fixing gates, readjusting the belts on the way they run, adjusting the gates, Changing the filters. 87 Atkinson-Baker Court Reporters www.dep0.com lO ll 12 l3 l4 15 l6 l7 18 l9 20 21 22 23 24 25 Q. So the maintenance, were those Graniterock employees or were those outside employees? A. Graniterock employees. Q. Okay. So when you weren't filling the mixing orders, what other job duties did you have? A. Well, usually if I had time, I'd go out and I'd try to grease, or if we were using admixtures, try to bring more upstairs so everything was ready when the trucks were ready. Q. When you say bring more admixtures upstairs -- A. Like if I had Xypex to put in loads or fibers, I kept them in the shed downstairs. Q. What was involved with bringing those mixtures, those admixtures upstairs? Like what was the physical -- what were the physical requirements of that? How was that done? A. If I had the time, we'd put them on a pallet and use a forklift and raise it up to the deck where I'm at, or if you didn't have much time, you just grabbed a bag and walked upstairs with it, and they were 45-pound bags of Xypex, and a box of fibers were light. They were generally only 20 or 3O pounds. Q. Now, was this something you'd have to do every day? 88 Atkinson-Baker Court Reporters www.dep0.com lO ll 12 13 l4 15 l6 l7 18 l9 20 21 22 23 24 25 Q. How often would you have to bring the admixtures upstairs? A. It all depended on the jobs. Sometimes I might do it every day for a week and then I may not do it for a couple months. Q. Okay. Yes. You said something about the grease? A Q. What would that job duty involve? A You got to grease all the rollers and the ring on the drum, and then the belts all had rollers that you would try to grease most of those rollers, pulleys and the head pulleys, grease the tail try and prevent breakdowns. Q. How often would you have to do -- would you grease the rollers or the pulleys? A. Usually 2 or 3 times a on Saturdays, it would get done Q. So that was more along maintenance responsibilities? A. Yes. Q. All right. What other duties did you have? A. Anything that broke on to fix. Q. Were there some things week, and then when we were again. the lines of your -- what other maintenance the plant I was responsible that you would fix and then other things that you would have outside people come in to 89 Atkinson-Baker Court Reporters www.depo.com lO ll 12 l3 l4 15 16 17 18 l9 20 21 22 23 24 25 fix? A. Never had any outside. Q. Okay. So what sort of things would you have to fix on the plant? A. Oh, I stocked -- air rams would go bad occasionally, air valves. Oil separators would go bad, rollers for the belts, and then the air actuators that control the gates, I'd have to replace those a lot, and welding up a lot of holes. Q. Holes in what? A. In the bins that hold the material, because I've been trying to get the bosses to reline them. Q. All right. How often would you have to weld the holes in the bins? A. That varied too with -- depending how busy. Sometimes we wouldn't do it for months and then all the sudden you might get 2 or 3 a week. Q. What other maintenance responsibilities did you have; do you recall? A. All the filters for like the dust collector. Q. Changing filters? A. Yes, and all the filters up on top where the cement powder was blown in, and plus keeping the plant clean. Q. So was there someone responsible for keeping track Atkinson-Baker Court Reporters www.dep0.com 9O lO ll 12 l3 l4 15 l6 l7 18 l9 20 21 22 23 24 25 of the maintenance to make sure that you were performing those maintenance activities properly? A. No, it was me for all that. I would just let the bosses know what I, you know, found. Q. All right. So do you remember about when Jim Holmquist stopped being the super- -- the plant manager? A. No, I don't remember. Q. Well, just as a frame of reference, what was your last day that you worked at Graniterock? A. I believe it was the second week of August. Q. 2015? A. Yes. Q. Okay. And at that time the supervisor was? A. John Seith. Q. The plant manager was John Seith? A. John Seith, yes. Q. S-e-i-t-h? A. Yes. Q. And so had John been the plant manager for a year before that? A. Yeah, it was probably a year, year and a half. Q. Was there a manager in between Seith and Holmquist? A. NO. Q. Do you know why Jim Holmquist stopped being the Atkinson-Baker Court Reporters www.dep0.com 91 10 ll 12 13 l4 15 16 l7 l8 l9 20 21 22 23 24 25 manager, the plant manager? A. No. Q. I mean was he fired or did he retire? Do you know anything about -- A. No, they moved him. He was now the manager over the drivers. Q. Did your job duties change at all when John Seith became the plant manager? A. No -- well, towards the end when they started having me do a spreadsheet. Q. Did your job duties Change at all after your June 2014 injury? A. Yes, I guess you could say that, some. Q. How did they Change? A. Well, they didn't want me lifting any 45-pound Xypex bags and the lOO-pound white cement bags that we had. Q. Were you able to avoid lifting those bags? A. Some of the time. Q. Were there other times when you would lift those bags still? A. Oh, yeah, not the lOO-pound, just the 45-pound because they were in a hurry. They don't want to wait for anybody. Q. So when you would lift the -- so after your injury 92 Atkinson-Baker Court Reporters www.dep0.c0m lO ll 12 13 l4 15 l6 l7 18 l9 20 21 22 23 24 25 when you would lift the 45-pound Xypex bags, was that because someone was telling you to do it or you would just do it because you were trying to get the cement mixed as quickly as possible? A. Yeah, I was asked to do it. Who would ask you to do it? Usually whoever was dispatching. 0 P O Did the -- were the -- were there multiple people doing the dispatching? Yes. Where were the dispatchers? They're located in Redwood City. Do they know of your physical limitations? v9???» Yes. Q. How did the dispatchers know about your physical limitations after the June 2014 injury? A. Well, I was told the managers had told them, and I would send the paperwork up -- up to Redwood City, so they were the first ones to see it. Q. The disability slips from the doctor? A. Yes. MS. WILSON: Do you want a computer? Do you feel out of shape here without one? MR. READE: I have one. It's right here. (A discussion was held off the record.) 93 Atkinson-Baker Court Reporters www.dep0.c0m lO ll 12 l3 l4 15 l6 l7 18 l9 20 21 22 23 24 25 BY MR. LYNCH: Q. All right. And did your maintenance duties essentially stay the same when John Seith was the plant manager? A. I was told I can have some of the other guys do most of the work but supervise the work. Q. Who were the other guys, guys that are already at the plant? A. They were normally drivers. One was William and one was Javie that normally helped, and another one, Ramon, he would help at times. Q. Is Javie short for Javier? A. Yes. Q. Did you have them help with the maintenance? A. Yes. Q. Were there any issues with the maintenance being done properly after your injury? A. Well, towards the end they were saying I wasn't doing it. Q. Okay. So after you became the plant operator, were there ever any performance issues raised by Graniterock with your work? A. Not until towards the end. Q. Okay. So about when was the first time you recall an issue being brought to you by Graniterock with respect 94 Atkinson-Baker Court Reporters www.depo.com EXHIBIT R STATE OF CALIFORNIA | Business, Consumer Services and Housing Agency GOVERNOR EDMUND G. BROWN JR. DEPARTMENT OF FAIR EMPLOYMENT & HOUSING DIRECTOR KEVIN KISH 2218 Kausen Drive, Suite 100 I Elk Grove I CA I 95758 800-884-1684 I TDD 800-700-2320 www.dfeh.ca.gov I email: contact.center@dfeh.ca.gov AMENDED 12:36 AM October 20, 2016 October 05, 2016 Donald R. Williams, Jr. 4600 Northgate Boulevard, Suite 210 Sacramento California 95834 RE: Notice to Complainant or Complainant’s Attorney DFEH Matter Number: 824002-255064 Right to Sue: Hafely / Granite Rock Company Dear Complainant or Complainant’s Attorney: Attached is a copy of your complaint of discrimination filed with the Department of Fair Employment and Housing (DFEH) pursuant to the California Fair Employment and Housing Act, Government Code section 12900 et seq. Also attached is a copy of your Notice of Case Closure and Right to Sue. Pursuant to Government Code section 12962, DFEH will not serve these documents on the employer. You or your attorney must serve the complaint. If you do not have an attorney, you must serve the complaint yourself. Please refer to the attached Notice of Case Closure and Right to Sue for information regarding filing a private lawsuit in the State of California. Be advised that the DFEH does not review or edit the complaint form to ensure that it meets procedural or statutory requirements. Sincerely, Department of Fair Employment and Housing P003073 STATE OF CALIFORNIA | Business, Consumer Services and Housing Agency GOVERNOR EDMUND G. BROWN JR. DEPARTMENT OF FAIR EMPLOYMENT & HOUSING DIRECTOR KEVIN KISH 2218 Kausen Drive, Suite 100 I Elk Grove I CA I 95758 800-884-1684 I TDD 800-700-2320 www.dfeh.ca.gov I email: contact.center@dfeh.ca.gov AMENDED October 05, 2016 RE: Notice of Filing of Discrimination Complaint DFEH Matter Number: 824002-255064 Right to Sue: Hafely / Granite Rock Company To All Respondent(s): Enclosed is a copy of a complaint of discrimination that has been filed with the Department of Fair Employment and Housing (DFEH) in accordance with Government Code section 12960. This constitutes service of the complaint pursuant to Government Code section 12962. The complainant has requested an authorization to file a lawsuit. This case is not being investigated by DFEH and is being closed immediately. A copy of the Notice of Case Closure and Right to Sue is enclosed for your records. Please refer to the attached complaint for a list of all respondent(s) and their contact information. No response to DFEH is requested or required. Sincerely, Department of Fair Employment and Housing P003074 STATE OF CALIFORNIA | Business, Consumer Services and Housing Agency GOVERNOR EDMUND G. BROWN JR. DEPARTMENT OF FAIR EMPLOYMENT & HOUSING DIRECTOR KEVIN KISH 2218 Kausen Drive, Suite 100 I Elk Grove I CA I 95758 800-884-1684 I TDD 800-700-2320 www.dfeh.ca.gov I email: contact.center@dfeh.ca.gov AMENDED October 05, 2016 George Hafely 4600 Northgate Blvd., Suite 210 Sacramento, California 95834 RE: Notice of Case Closure and Right to Sue DFEH Matter Number: 824002-255064 Right to Sue: Hafely / Granite Rock Company Dear George Hafely, This letter informs you that the above-referenced complaint was filed with the Department of Fair Employment and Housing (DFEH) has been closed effective October 05, 2016 because an immediate Right to Sue notice was requested. DFEH will take no further action on the complaint. This letter is also your Right to Sue notice. According to Government Code section 12965, subdivision (b), a civil action may be brought under the provisions of the Fair Employment and Housing Act against the person, employer, labor organization or employment agency named in the above-referenced complaint. The civil action must be filed within one year from the date of this letter. To obtain a federal Right to Sue notice, you must visit the U.S. Equal Employment Opportunity Commission (EEOC) to file a complaint within 30 days of receipt of this DFEH Notice of Case Closure or within 300 days of the alleged discriminatory act, whichever is earlier. Sincerely, Department of Fair Employment and Housing P003075 STATE OF CALIFORNIA | Business, Consumer Services and Housing Agency GOVERNOR EDMUND G. BROWN JR. DEPARTMENT OF FAIR EMPLOYMENT & HOUSING DIRECTOR KEVIN KISH 2218 Kausen Drive, Suite 100 I Elk Grove I CA I 95758 800-884-1684 I TDD 800-700-2320 www.dfeh.ca.gov I email: contact.center@dfeh.ca.gov AMENDED Enclosures cc: P003076 DFEH 902-1 \DOOflGUl-PUJNH NNNr-r-tr-tr-tr-tr-nr-nr-nr-nr- NHOOOOflaUl-PUJNHO COMPLAINT OF EMPLOYMENT DISCRIMINATION BEFORE THE STATE OF CALIFORNIA DEPARTMENT 0F FAIR EMPLOYMENT AND HOUSING Under the California Fair Employment and Housing Act (Gov. Code, § 12900 et seq.) In the Matter of the Complaint 0f DFEH N0. 824002-255064 George Hafely, Complainant. 4600 Northgate B1Vd., Suite 210 Sacramento, California 95834 VS. Granite Rock Company, Respondent. PO BOX 50001 Watsonville, California 95077 Complainant alleges: 1. Respondent Granite Rock Company is a Private Employer subject t0 suit under the California Fair Employment and Housing Act (FEHA) (Gov. Code, § 12900 et seq.). Complainant believes respondent is subject to the FEHA. 2. On or around October 08, 2015, complainant alleges that respondent took the following adverse actions against complainant: Discrimination, Harassment, Retaliation Terminated, . Complainant believes respondent committed these actions because of their: Age - 40 and over, Disability, Engagement in Protected Activity, Family Care 0r Medical Leave, Medical Condition - Including cancer 0r cancer related medical condition 01' genetic characteristics, Race, Other Failure t0 Engage in the Interactive Process, Failure t0 Accommodate, Failure to Prevent Discrimination, Harassment, and Retaliation, Interference with CFRA rights, CFRA Retaliation. 3. Complainant George Hafely resides in the City of Sacramento, State 0f California. If complaint includes co-respondents please see below. -5- Complaint iDFEH N0. 824002-255064 Date Filed: October 05, 2016 Date Amended: October 20, 2016 P003077 DFEH 902-1 \DOOflGUl-PUJNH NNNr-r-tr-tr-tr-tr-nr-nr-nr-nr- NHOOOOflaUl-PUJNHO Additional Complaint Details: In or around 2001, Complainant GEORGE HAFELY was employed by GRANITE ROCK as Mixer Driver. On or around June 3, 2014, HAFELY injured his back while at work performing his job duties. On or around June 5, 2014, HAFELY went to see a doctor who imposed work restrictions. Upon returning to work, HAFELY provided SEITH with the doctor‘s work restrictions. GRANITE did not make any accommodations for HAFELY. GRANITE ignored HAFELY‘s work restrictions. HAFELY became increasingly stressed due to work. On 0r around June 22. 2015, HAFELY filed a workers‘ compensation claim for his back injury. Before HAFELY filed his workers compensation claim, he had never received any discipline for his job performance. After HAFELY filed his claim, GRANITE began a campaign of discrimination, harassment, and retaliation against HAFELY. Due to the discrimination, harassment, and retaliation, HAFELY became stressed. The stress of the workplace was keeping HAFELY from sleeping. On or about August 14, 2015, after having been unable t0 sleep all night, HAFELY called in sick to work. HAFELY went t0 see his primary doctor, who referred him to a psychiatrist, Dr. Belinda Sangrate. On 0r about September 11, 2015, HAFELY filed a workers compensation claim for stress. On or about August 21, 2015, Dr. Sangrate diagnosed HAFELY with severe clinical depression and anxiety. Dr. Sangrate took HAFELY out 0f work for stress from August 21, 2015 to September 1, 2015. HAFELY informed the dispatch office that he would be on leave and faxed the Work Status Report to GRANITE. On or about September l, 2015, Dr. Sangrate extended HAFELYS leave to September 17, 2015. HAFELY called to inform the dispatcher that his leave was extended and faxed over the appropriate Work Status Report. On 0r about September 4, 2015, GRANITE sent a letter to HAFELY stating that it was their understanding that HAFELY was 0n leave for a non-work related injury. GRANITE enclosed a Request for Leave of Absence and Certification of Health Care Provider, and instructed HAFELY to complete the forms by October 4, 2015. On 0r about September 17, 2015, Dr. Sangrate further extended HAFELYS leave to October 19, 2015. Again, HAFELY called to inform the dispatcher that his leave was extended and faxed over the appropriate Work Status Report. On or about September 24, 2015, GRANITE sent another letter indicating that HAFELY had not been returning voicemail -6- Complaint iDFEH N0. 824002-255064 Date Filed: October 05, 2016 Date Amended: October 20, 2016 P003078 DFEH 902-1 messages and that GRANITE would now consider HAFELYS leave unapproved. However, HAFELY had returned GRANITES calls. On or about September 30, 2015, HAFELY sent an e-mail to GRANITE stating that he was advised by his attorneys not to fill out the Request for Leave of Absence form. On or about October 8, 2015, GRANITE sent a final letter to HAFELY terminating his employment, claiming that HAFELYS failure to complete the requested forms resulted in an unexcused absence. Throughout his employment as a Plant Operator, HAFELY was working twelve to fifteen hours a day. HAFELY would be regularly denied his meal and rest breaks approximately twice a week. Complainant George Hafely files this DFEH complaint against Respondent Granite Rock Company, PO BOX 50001, Watsonville, CA 95077. _7_ Complaint iDFEH N0. 824002-255064 Date Filed: October 05, 2016 Date Amended: October 20, 2016 P003079 DFEH 902-1 [\) \OOOflGUl-PUJ 11 12 13 14 15 16 17 18 19 20 21 22 VERIFICATION I, DONALD R. WILLIAMS, JR., am the Attorney for Complainant in the above-entitled complaint. I have read the foregoing complaint and know the contents thereof. The same is true 0f my own knowledge, except as to those matters Which are therein alleged on information and belief, and as t0 those matters, I believe it t0 be true. On October 05, 2016, I declare under penalty 0f perjury under the laws 0f the State of California that the foregoing is true and correct. SACRAMENTO, CALIFORNIA -8- DONALD R. WILLIAMS, JR. Date Filed: October 05, 2016 Date Amended: October 20, 2016 Complaint iDFEH N0. 824002-255064 P003080 STATE OF CALIFORNIA | Business, Consumer Services and Housing Agency GOVERNOR EDMUND G. BROWN JR. DEPARTMENT OF FAIR EMPLOYMENT & HOUSING DIRECTOR KEVIN KISH 2218 Kausen Drive, Suite 100 I Elk Grove I CA I 95758 800-884-1684 I TDD 800-700-2320 www.dfeh.ca.gov I email: contact.center@dfeh.ca.gov 03:45 PM October 05, 2016 October 05, 2016 Donald R. Williams, Jr. 4600 Northgate Boulevard, Suite 210 Sacramento California 95834 RE: Notice to Complainant or Complainant’s Attorney DFEH Matter Number: 794022-255064 Right to Sue: Hafely / Dear Complainant or Complainant’s Attorney: Attached is a copy of your complaint of discrimination filed with the Department of Fair Employment and Housing (DFEH) pursuant to the California Fair Employment and Housing Act, Government Code section 12900 et seq. Also attached is a copy of your Notice of Case Closure and Right to Sue. Pursuant to Government Code section 12962, DFEH will not serve these documents on the employer. You or your attorney must serve the complaint. If you do not have an attorney, you must serve the complaint yourself. Please refer to the attached Notice of Case Closure and Right to Sue for information regarding filing a private lawsuit in the State of California. Be advised that the DFEH does not review or edit the complaint form to ensure that it meets procedural or statutory requirements. Sincerely, Department of Fair Employment and Housing P003081 STATE OF CALIFORNIA | Business, Consumer Services and Housing Agency GOVERNOR EDMUND G. BROWN JR. DEPARTMENT OF FAIR EMPLOYMENT & HOUSING DIRECTOR KEVIN KISH 2218 Kausen Drive, Suite 100 I Elk Grove I CA I 95758 800-884-1684 I TDD 800-700-2320 www.dfeh.ca.gov I email: contact.center@dfeh.ca.gov October 05, 2016 RE: Notice of Filing of Discrimination Complaint DFEH Matter Number: 794022-255064 Right to Sue: Hafely / To All Respondent(s): Enclosed is a copy of a complaint of discrimination that has been filed with the Department of Fair Employment and Housing (DFEH) in accordance with Government Code section 12960. This constitutes service of the complaint pursuant to Government Code section 12962. The complainant has requested an authorization to file a lawsuit. This case is not being investigated by DFEH and is being closed immediately. A copy of the Notice of Case Closure and Right to Sue is enclosed for your records. Please refer to the attached complaint for a list of all respondent(s) and their contact information. No response to DFEH is requested or required. Sincerely, Department of Fair Employment and Housing P003082 STATE OF CALIFORNIA | Business, Consumer Services and Housing Agency GOVERNOR EDMUND G. BROWN JR. DEPARTMENT OF FAIR EMPLOYMENT & HOUSING DIRECTOR KEVIN KISH 2218 Kausen Drive, Suite 100 I Elk Grove I CA I 95758 800-884-1684 I TDD 800-700-2320 www.dfeh.ca.gov I email: contact.center@dfeh.ca.gov October 05, 2016 George Hafely , RE: Notice of Case Closure and Right to Sue DFEH Matter Number: 794022-255064 Right to Sue: Hafely / Dear George Hafely, This letter informs you that the above-referenced complaint was filed with the Department of Fair Employment and Housing (DFEH) has been closed effective October 05, 2016 because an immediate Right to Sue notice was requested. DFEH will take no further action on the complaint. This letter is also your Right to Sue notice. According to Government Code section 12965, subdivision (b), a civil action may be brought under the provisions of the Fair Employment and Housing Act against the person, employer, labor organization or employment agency named in the above-referenced complaint. The civil action must be filed within one year from the date of this letter. To obtain a federal Right to Sue notice, you must visit the U.S. Equal Employment Opportunity Commission (EEOC) to file a complaint within 30 days of receipt of this DFEH Notice of Case Closure or within 300 days of the alleged discriminatory act, whichever is earlier. Sincerely, Department of Fair Employment and Housing P003083 STATE OF CALIFORNIA | Business, Consumer Services and Housing Agency GOVERNOR EDMUND G. BROWN JR. DEPARTMENT OF FAIR EMPLOYMENT & HOUSING DIRECTOR KEVIN KISH 2218 Kausen Drive, Suite 100 I Elk Grove I CA I 95758 800-884-1684 I TDD 800-700-2320 www.dfeh.ca.gov I email: contact.center@dfeh.ca.gov Enclosures cc: P003084 DFEH 902-1 \DOOflGUl-PUJNH NNNr-r-tr-tr-tr-tr-nr-nr-nr-nr- NHOOOOflaUl-PUJNHO COMPLAINT OF EMPLOYMENT DISCRIMINATION BEFORE THE STATE OF CALIFORNIA DEPARTMENT 0F FAIR EMPLOYMENT AND HOUSING Under the California Fair Employment and Housing Act (Gov. Code, § 12900 et seq.) In the Matter of the Complaint 0f DFEH N0. 794022-255064 George Hafely, Complainant. VS. , Respondent. Complainant alleges: 1. Respondent is a subject t0 suit under the California Fair Employment and Housing Act (FEHA) (Gov. Code, § 12900 et seq.). Complainant believes respondent is subject t0 the FEHA. 2. On or around October 08, 2015, complainant alleges that respondent took the following adverse actions against complainant: Discrimination, Harassment, Retaliation Terminated, . Complainant believes respondent committed these actions because of their: Age - 40 and over, Disability, Engagement in Protected Activity, Family Care 0r Medical Leave, Medical Condition - Including cancer or cancer related medical condition 0r genetic characteristics, Race, Other Failure t0 Engage in the Interactive Process, Failure t0 Accommodate, Failure t0 Prevent Discrimination, Harassment, and Retaliation, Interference with CFRA rights, CFRA Retaliation.. 3. Complainant George Hafely resides in the City of , State of . If complaint includes co-respondents please see below. -5- Complaint - DFEH No. 794022-255064 Date Filed: October 05, 2016 P003085 DFEH 902-1 \DOOflGUl-PUJNH NNNr-r-tr-tr-tr-tr-nr-nr-nr-nr- NHOOOOflaUl-PUJNHO Additional Complaint Details: In or around 2001, Complainant GEORGE HAFELY was employed by GRANITE ROCK as Mixer Driver. On 0r around June 3, 2014, HAFELY injured his back while at work performing his job duties. On or around June 5, 2014, HAFELY went to see a doctor who imposed work restrictions. Upon returning to work, HAFELY provided SEITH with the doctor‘s work restrictions. GRANITE did not make any accommodations for HAFELY. GRANITE ignored HAFELY‘s work restrictions. HAFELY became increasingly stressed due to work. On 0r around June 22, 2015. HAFELY filed a workers‘ compensation claim for his back injury. Before HAFELY filed his workers compensation claim, he had never received any discipline for his job performance. After HAFELY filed his claim, GRANITE began a campaign of discrimination, harassment, and retaliation against HAFELY. Due to the discrimination, harassment, and retaliation, HAFELY became stressed. The stress of the workplace was keeping HAFELY from sleeping. On or about August 14, 2015, after having been unable to sleep all night, HAFELY called in sick to work. HAFELY went t0 see his primary doctor, who referred him to a psychiatrist, Dr. Belinda Sangrate. On 0r about September 11, 2015, HAFELY filed a workers compensation claim for stress. On or about August 21, 2015, Dr. Sangrate diagnosed HAFELY with severe clinical depression and anxiety. Dr. Sangrate took HAFELY out of work for stress from August 21, 2015 to September 1, 2015. HAFELY informed the dispatch office that he would be on leave and faxed the Work Status Report to GRANITE. On or about September l, 2015, Dr. Sangrate extended HAFELYS leave to September 17, 2015. HAFELY called to inform the dispatcher that his leave was extended and faxed over the appropriate Work Status Report. On 0r about September 4, 2015, GRANITE sent a letter t0 HAFELY stating that it was their understanding that HAFELY was on leave for a non-work related injury. GRANITE enclosed a Request for Leave of Absence and Certification of Health Care Provider, and instructed HAFELY to complete the forms by October 4, 2015. On or about September 17, 2015, Dr. Sangrate further extended HAFELYS leave to October 19, 2015. Again, HAFELY called to inform the dispatcher that his leave was extended and faxed over the appropriate Work Status Report. On or about September 24, 2015, GRANITE sent another letter indicating that HAFELY had not been returning voicemail messages and that GRANITE would now consider HAFELYS leave unapproved. However, HAFELY had returned GRANITES calls. On or about September 30, 2015, -6- Complaint - DFEH No. 794022-255064 Date Filed: October 05, 2016 P003086 DFEH 902-1 HAFELY sent an e-mail to GRANITE stating that he was advised by his attorneys not to fill out the Request for Leave 0f Absence form. On or about October 8, 2015, GRANITE sent a final letter to HAFELY terminating his employment, claiming that HAFELYS failure to complete the requested forms resulted in an unexcused absence. Throughout his employment as a Plant Operator, HAFELY was working twelve to fifteen hours a day. HAFELY would be regularly denied his meal and rest breaks approximately twice a week. Complainant George Hafely files this DFEH complaint against Respondent Granite Rock Company, PO BOX 50001, Watsonville, CA 95077. _7_ Complaint - DFEH No. 794022-255064 Date Filed: October 05, 2016 P003087 [\) \OOOflGUl-PUJ 11 12 13 14 15 16 17 18 19 20 21 22 DFEH 902-1 VERIFICATION I, DONALD R. WILLIAMS, JR., am the Attorney for Complainant in the above-entitled complaint. I have read the foregoing complaint and know the contents thereof. The same is true 0f my own knowledge, except as to those matters Which are therein alleged on information and belief, and as t0 those matters, I believe it t0 be true. On October 05, 2016, I declare under penalty 0f perjury under the laws 0f the State of California that the foregoing is true and correct. SACRAMENTO, CALIFORNIA -8- DONALD R. WILLIAMS, JR. Date Filed: October 05, 2016 Complaint - DFEH N0. 794022-255064 P003088 EXHIBIT S BOHM LAW GROUP. INC. 4600 NORTHGATE BOULEVARD. SUITE i2 SACRAMENTO, CALIFORMA 95834 QM-hifiw \‘ C‘ KO 00 Lawrancc A. Bohm (SBN; 208716) Donald R, Williams~ Jr. (SBN: 303 1 26) Tracy C. Law (SBN: 314936) BOHM LAW GROUP, INC. G 4600 Northgate Boulevard, Suite 21 0 ' 98;? Sacramento, California 95834 3’ Telephone: 91 6.9275574 Facsimile: 916.927.2046 Attorneys for Plaintiff, GEORGE HAFELY SUPERIOR COURT OF CALIFORNIA COUNTY 0F SANTA CLARA GEORGE HAFELY, Case. N0: I7CV316847 A . PLAINTIFF’S VERIFIED FIRST Plaintiff: AMENDED COMPLAINT FOR I I DAMAGES V‘ 3. Disability Discrimination (Gov. Code § 12940(a));GRANITE ROCK COMPANY; and DOES 1 through 100‘ inclusive. 2. Failure to Engage 1n the Interactive. Process (Gov. Code § 1294001)); Defendants 3. Failure to Accommodate ‘ (Gov. Code § 12940(m)); Retaliation (Gov. Code, § 1294mm); 5. Failure t0 Prevent Discrimination and Retaliation (Gov. Code § 1294000); 6. California Family Rights Act Interference (Gov. Code§ 12945.2); 7. California Family Rights Act Retaliation (Gov. Code § 12945.2(l)(1)); 8. Adverse Employment Action in Violation of Public Policy. DEMAND FOR JURY TRIAL Ao Plaintiff, GEORGE I'IAF‘ELY, respectfully submits this instant Verified First Amended C 'mplaim for Damages and Demand for. Jury Trial and alleges as follcws: ./// /’// 1 Plaintiff‘s Verified First. Amended Complaint for Damages and Laxwance A. Bohm. Esq. Demand for Jury Tria! Donald R. Williams, Jr.. Esq. quebz 1!. Gimme Rock Compaqv Tracy C. Law, Esq. flown KTA. l7f‘\?3 1 (94’! BOHM LAW GRm 'P, INC. 4600 NORTHGATE BOULEVARD, Sum; 210 SACRAI‘AEN’IO. CALIFORNIA 95834 [‘3 \OOOQQU‘I-bm OVERVIEW 0F THE CASE Granite Rock does not care about its injured employees. When George Hafely, a 13*year Plant Operator. injured his back on the job, Granite Rock accused him 0f faking a workplace injury. Over the next year. Granite Rock ignored Hafely’s work restrictions and forced him to carry bags weighing up t0 forty-flVe (45) pounds because “there was n0 time t0 wait" for another employee. The moment Hafely filed a workers’ compensation claim for his inj ury, Granite Rock escalated the discrimination and harassment against him. Hafely’s supervisor, Mike McGarath, told Hafely to “just get off workers’ compensation and get back to work.” Granite Rock looked for any reason to discipline Hafely and, eventually, blamed him for clerical and engineering errors. When Hafely offered proof t0 show that these errors were outside his control, his manager told him, “I couldn‘t care less. I don‘t care." The stress 0f the hostile work environment and constant discrimination drove Hafely t0 take medical leave for stress. Here, Granite Rock saw its opponunity t0 dispose ofa loyal, but injured, employee and terminated him. PARTIES AND JURISDICTION 1. Plaintiff George Hafely (hereinafter “Hafely” or “P1aintiff") was, at all times relevant t0 this action, a recruit. employee, 0r wrongfully terminated employee 0f Defendant Granite Rock Company {hereinafter “Granite Rock" 0r “Defendant”). While employed by Granite Rock, and at all times relevant to this action, Plaintiff was a citizen 0f California and resided in Santa Clara County, California. At all times reievant t0 this action, Plaintiff was employed at a Granite Rock concrete plant located at 1 1711 Berryessa Road, San Jose, California 95 133. 2. Defendant Granite Rock was, at all times relevant to this action, a corporation. with its corporate headquarters and principle place of business located at 350 Technology Drive, Watsonville. California 95077 in Santa Cruz County. Granite Rock was, at all times relevant to this action. doing business in the State of California. Granite Rock is a Califomia-based connotation that operates twenty-five (25) branches and has more than five hundred (500) employees. Granite Rock was, at all times relevant to this action, an employer as defined by Govemment Code section 12926. subdivision (d). /// 2 Plaintiff’s Verified First Amended Complaint for Damages and Lawrdnce A. Bohm, Esq. Demand for Jury Trial Donald R. Williams, 11“.. Esq. Hn/‘nlu v flvnnim Pnl‘l {’nmnnm; TraCV C L'dW. ESQ. BOHM LAW GROUP. INC 4600 NOR‘muA'ru BOULEVARD, SUITE 210 SACRAMENTO, CALIFORNI x 95 83:1 \COOflONLh-bUJNp-t N N [\J H )-- rn- y-l H y-I p- u-A fi-a ._- Ix) H O \o m ‘4 0\ LI‘I g DJ L) h-k O 23 3. Venue and jurisdiction are proper because the maj ority of the events giving rise to this action took place in Santa Clara County; Defendant was doing business in Santa Clara County; Plaintiffs employment was entered into in Santa Clara County; Plaintiff worked for Defendant in Santa Clara County; the damages sought exceed thejurisdictional minimum 0f this Court; and tho majority of events occurred and witnesses reside in Santa Clara County. 4. Plaintiff is ignorant of the true names and capacities of the Defendants sued herein as Granite Rock Company DOES 1 through 50. Defendants DOES 1 through 50 arc sued herein under fictitious names pursuant tn Code 0f Civil Procedure section 474‘ Plaintiff is informed and believes, and on that basis alleges, that each Defendant sued under fictitious names is in some manner responsible for the wrongs and damages as alleged herein. Plaintiff does not at this time know the true names or capacities of said Defendants, but prays that the same may be inserted herein when ascertained. 5. At all times relax ant, each and every Defendant was an agent and/or employee 0f each and every other Defendant. In doing the things alleged in the- causcs 0f action stated herein, each and every Defendant was acting within the course and scope of this agency or employment, and was acting with the consent, permission, and authorization of each remaining Defendant. All actions 0f each Defendant as alleged herein were ratified and approved by every other Defendant or their officers 01 managing agents. STATENLENT OF FACTS 6. In or around 200 1. George Hafely (hereafter “Hafely“f) began his employment with Granite Rock as a Mixer Driver. 7‘ In or around 2011, Hafely was promoted t0 Plant Operator 0f one 0f Granite Rock’s cement plants located in San Jose. Hafely’s responsibilities included, but were not limited t0, loading cement trucks. ordering repair parts, ordering concrete additives. and completing lightweight work, and ensuring the repair and maintenance of the plant. Hafely was charged with supervising employees when there ware no managers present. 8. On or about June 3, 201 4. Hafely loaded concrete mixture into a concrete truck. The mixture was too dry and plugged up the hopper of the truck. T0 clear the blockage, Hafely 3 Plaintiff’s Verified First Amended Complaint for Damages and Lawrance A. Bohm, Esq. Demand for Jury Trial Donald R. Williams; J11. Esq. l-Ivaln v Crrmilp Rn. 1r (“nmnrmu TT3CV C. 148“" ESQ‘ BOHM LAW GROUP. INC. 4600 NORTHGATE BOULEVARD, SUITE 21 fl SACRAMEM‘O, CALIFORNIA 95834 L.) \DOOMmM-LUJ climbed 0n top of the truck and used a specially designed tool t0 loosen the mixture. Hafely was bent at the waist to inscm the tool into the top of the hopper. When Hafely attempted to retract the tool, the tool became lodged in the hopper. In attempting to retract the tool to remove it from the hopper, Hafely inj m‘ed his back. Hafely immediately informed his supewisor, John Seith (hereafter “Seith”), that he had inj ured his back and needed to see a doctor. Seith asked if Hafely actually hm“: his back at home and waited until he was a1 work to declare an injury. Hafely was offended that Seith accused him 0f being dishonest. Hafely responded that he hurt his back at workjust 110w and not at home. Seith reluctantly allowed Hafely t0 leave work to US Healthworks t0 see a workers’ compensation doctor. 9. The workcrs’ compensation doctor gave Hafely an anti-iuflammatory shot and imposed work restrictions upon Hafely. Hafely’s work restrictions included limited lifting, pulling, and pushing only up to ten (10) pounds. and no steeping and bending. Additionally, the workers’ compensation doctor noted that Hafely should be allowed to sit, stand, and walk as needed for comfofi. 10. After Hafely lefi the worker’s compensation doctor’s office, he called Seith to ask for two (2) days off 0f work to rest his back. Scith denied Hafely’s request without explanation. 1 1. On or abo ut June 4. 2014, Hafely returned t0 work and verbally informed provided Seith with his work restrictions. Seith initially acknowledged Hafely’s work restrictions. Hafely was allowed to direct his subordinates t0 assist him with plant maintenance and loading the cement trucks. However, when the concrete plant was busy, Hafely was unable to get any assistance. Seith did not make any accommodations for Hafely when the concrete plant was busy. Also, Seith continued to instruct Hafely to lifi forty-five (45) pound bags and did not allow Hafely t0 take any breaks t0 rest. his back, as required by Hafely’s work restrictions. 12. From June 2014 to June 20 1 5, Seith continued to ignore Hafely ‘s work restrictions. Scith continued to instruct Hafely to carry fofly-five (45) pound bags. When Hafely told Seith that he was not supposed to lift forty-five pound bags pursuant to his work restrictions, Seith disregarded Hafely’s concerns and said that there was “no time to wait”. /// 4 Plaintiffs Verified First Amended Complaint for Damages and Lawrance A. Bohm, Esq. Demand for Jury Trial Dunald R. Williams, Jr., Esq. unmn n nmm‘m Rnn/r annrmu Tracy C. Law. Esq, BOHM LAW GROUP, INC. 4600 NURTHOATE BOI "LEVARD. SUITE 210 SACRAMENTO, C:\LWORNIA 95834 E0 OKDOOQONUI¥UJ o-Ir-«v-Ay-AHh-Ip-AHn-d OGQQUI-bmmp-A 19 13. On or about June 22, 2015, Hafely filed a workers‘ compensation claim for the back injuxy he suffered while working at Granite Rock. 144 From June 22, 2015 until his termination, Scith and Division Manager, Mike McGarath (hereafter “‘IVIcGaratl1”), increased their visits to the San Jose concrete plant that Hafely operated. Prior t0 Hafely filing his workers’ compensation claim, Seith visited the concrete plant once every one (1) or two (2) months, and McGarath rarely visited the concrete plant. After Hafely filed his worker’s compensation claim, Seith and McGarath visited the concrete plant several times a week. Other employees began to notice and made remarks about Seith and McGarath’s increased presence to Hafely. Seith and McGarath nitpicked Hafely’s work and seemed eager lo find any mistakes to blame on Hafely. 15. in or around July 2015, Hafely aakcd Seith if he could he transferred tn another position where his work restrictions would be implemented. Scith snickered at Hafely and left without responding to Hafely’s request. }6. In or around July 2015, Hafely mot with his coworker, David Minjares. Seith, and McGarath. McGarath told Hafely. “Just get off worker‘s compensation and get back t0 work.” Hafely was confused because he was still working his regular hours and his workers’ compensation Claim had not affected his hours. 17. In or around July 2015, Granite Rock upgraded t0 a new type 0f indicator that showed how much material was m each storage bin. Hafely noticed that the indicators were not working properly. Hafely attempted t0 J‘ESUlV'e the issue with the indicators. When Hafely was unable t0 resolve the issue, he called the manufacturer and was directed to the engineers. The engineers that manufactured the indicators told Hafely that the indicators were not effectch: with the particular material that was being stored. Scith and McGarath gave Hafely a write-up for not resolving the issue with the ineffective indicators. Hafely was shocked that he was disciplined for a problem with the engineering of the indicator. 18. In or around July 2015, Seith noticed that three hundred (.300) tons 0f cement powder, the equivalent of twdve _( 12) doublo-truck loads, were unaccounted for in the inventory repons. A double-truck is a truck with two (2.) trailers‘ which enabled twice the material to be 5 Plaintiff’s Verified First Amended Complaint for Damages and LawraHCc A. Bolnn, Esq. Demand for Jury Trial Donald R. Williams, Jim, Esq‘ unrplu u :mmm pm], r‘nmnnm; Traw C. Law. Esq. BOHM LAW GROUP, INC. 4600 NORTHGATE B(JUL'uv/mo, SUITE 21 0 SACRAMENTO: CALIFORNIA 95834 O 00 \J O‘ ()1 .5 w N o-d HHHHp-a kaJNb-‘O 16 17 18 19 20 21 22 23 24 25 27 28 transported at one time. Seith accused Hafely of stealing the material and selling it t0 a competitor. Seith gave Hafely a write-up for the missing cement powder. Hafely argued that it was ridiculous that Seith thought it was possible that he could steal twelve ( 12) double-tmck loads of cement powder without being noticed. Seith refused to rescind the \Vrite-up. Hafely conducted his own investigation and discovered that the numerical discrepancy was due t0 a clerical error. Hafely compiled the data with the intention of providing it t0 McGarath to get his write-up rescinded. 19. On 0r about July 21. 2015‘ as a result of Hafely’s write-up regarding the cement powder, Seith implemented a new policy that required Hafely t0 complete spreadsheets twice a day to keep track of the amount of materials in the plant. Based on information and belief, nu other plant operator was required to fill out these spreadsheets. 20. On 01‘ about July 24, 2015. Hafely forgot t0 input inventory data into the spreadsheet. 21. On or around July 27, 2015‘ Hafely remembered that he forgot to input the inventory data into Ihc spreadsheet for July 24, 201 5. Hafely apologized to Seith for not inputting the July 24, 201 5 inventory data into the spreadsheet. Scith told Hafely that it was okay and not to worry about going back to fill in the data, and reminded Hafely t0 keep filling out the spreadsheet in the future. A11 hour latcr, Seith returned t0 Hafely’s office and gave Hafely a write- up for failing to input the inventory data. Hafely asked Seith what changed because Scith said earlier that it was fine. Seith laughed and walked away without responding. Hafely did not sign the write-up. 22. In 0r around late July 2015, Hafely, Union Representative Manny, and Union Representative Randall met with Seith, McGarath, and Human Resources (“HR”) Director Shirley Au (hereinafter "Au”). Hafely handed McGaralh paperwork indicating that the missing cement powder was merely a Clerical error. Hafely stated that he found the problem with the cement powder. McGarat'h refused to take the paperwork and stated, “I couldn’t care less. I don‘t care." 23. On 01‘ about August 14. 2015, Hafely called in sick t0 work. Hafely suffered from insomnia due to the work-relatcd stress and was unable to sleep that night. Hafely went to see his 6 Plaintiff’s Verified First Amended Complaint for Damages and Lawrance A. Bohmz Esq, Demand for Jury Trial Donald R. Williams, Jr‘, Esq. Nm’nlv v Crimifa erk ('nmrmm' Tl‘aCV L. Law, ESQ. BuHM LAW GROUP, INC. 4600 NOR'I‘HGATE BOULEVARD. SUITE 21 0 SACRAMENTO, CAL [FUR ‘V'IA 95834 L) MAW 0600\10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 primary care physician. Dr. Shaik‘ Who referred him to a psychiatrist, Dr. Belinda Sangrate (hereafter “Dr. Sangrate”) 24. On 0r about August 2 1 , 20 1 5, Dr. Sangrate diagnosed Hafely with severe clinical depression and anxiety. Dr. Sangratc put Hafely 0n disability leave from August 21, 2015 to September 1, 201 5. Hafely informed Granite Rock’s Dispatch Office that he would be on medical leave and faxed his Work Status Report to Seith. The Dispatch Office acknowlcdged Hafely’s medical leave, but Hafely received n0 response from Seith. 25. 0n or about September 1, 201 5. Dr. Sangrate extended Hafely’s leave to September 17, 2015. Hafely called the Dispatch Office t0 inform the dispatcher that his medical leave was extended t0 Sepiember 17. 201 5. Hafely also faxed over the corresponding Work Status Report. Again, the Dispatch Office acknowledged Hafely} medical leave extension, but Hafely received no response from Seith. 26. On 0r about September 4, 2015, Au sent a letter to Hafely stating that it was Granite Rock’s understanding that Hafely was 0n lcavc for a non-work related injuly. Au enclosed a Request for Leave 0f Absence and Certification 0f Health Care Provider and instructed Hafely t0 complete the forms by October 4, 2015. 27. On 0r about September I 1, 201 5, Hafely filed a new wurkers’ compensation claim for stress. 28. On 01' about September 17, 201 5, Dr. Sangrate extended Hafely’s medical leave to October 19, 2015. Again, Hafely called the Dispatch Office to inform the dispatcher that his medical leave was extended to October 19, 2015. Hafely faxed over the corresponding Work Status Report. 29. On or about September 24. 2015; Au sent another letter to Hafely, indicating that Hafely had not returned her voicemail messages and that, at that moment, Granite Rock considered Hafely’s medical leave denied. However, Hafely only received one voicemail message from Granite Rock, returned the call, and left a message. 30. On 01‘ about September 30, 201 5, Hafer sent an e-mail to Au stating that he was advised by his attorneys not t0 fill out thc Request for Leave of Absence form. 7 Plaintiff’s Verified First Amended Complaint for Damages and Lawrzmce A Bohm, Esq. Demand for Jury Trial Donald R. Williams, Jr., Esq. Hufplv v (?r/mirp. Rnrtk (‘nmnam’ Tracy C. Law, Esq. BOHM LAW GROUP. INC. 4600 NORTHQATE BOULEVARD, Sun E 2 10 SACRAMENTO CALIFORNIA 95834 LAN \OOOQQU‘z-L 31. On 01' about October 8, 2015, Au sent a final letter to Hafely tczminating his employment, claiming that Hafely’s failure to complete the requested fonns resulted in an unexcused absence. The termination caused Hafely t0 have suicidal ideations. For several weeks, Hafely strongly considered taking a handful of muscle relaxers to end his life. 32. Throughout his employment as a Plant Operator for Granite Rock, Hafely worked twelve (. 2) to fifteen (15) hours per day. Hafely was regularly denied his meal and rest breaks approximately twice per week. 33. On 0r about October 5, 2016, Hafely filed a charge of discrimination with the California Department 0f Fair Employment and Housing (“DFEH"). 34. On the same day, the DFEH issued Hafely a Notice of Case Closure and Right to Sue indicating that Hafely must file his civil action within one year from the date uf the notice. (Exhibit 1). FIRST CAUSE 0F ACTION Disability Discrimination (G overnmenl' Code section 12940, subdivision (3)) 35. The allegations set forth in this complaint are hereby re-alleged and incorporated by reference. 36. This cause 0f action is asserted against Defendant. 37. At all times relevant t0 this action, the California Fair Employment and Housing Act and California Govermnent Coda section 12940, et seq” were in full force and effect and binding on Defendant. 38. Defendant is an “employer” as defined in Government Code section 12926, subdivision (d). 39. Plaintiff, as an employee 0f Defendant, was a covered employee under FEHA. /// /// /// /// 8 Plaintiff's Verified First Amended Complaint for Damages and Lawrance A. Bohm, Esq. Demand for Jury Trial Donald R. Williams, Jr., Esq. ano/x: u {?rnnifp P/mk (’nmnrrnv Tracy C Law. ESQ. BOHM LAW GROUP, INC. 4600 NORTHGATE BULILEVARD, SUITE 2 10 SACMMENTO, CALIFORNIA 95834 \OOCQO‘xM-LUJNI-A r-t y-A v-A H r-A y-A r-A r-A v-t |-- KO 00 \J O\ LII 4‘- UJ (J H O 40. At all times relevant to this matter. Plaintiff suffered from a “mental disability” as defined by Government Code section 12926, subdivision (j), and California Code of Regulations, title 2, section 11065, subdivision (d)(1), and a “physical disability" as defined by Government Code section 12926, subdivision (m y. and California Code ochgulations, title 2, section 11065, subdivision (d)(2). 41. Defendant knew that Plaintiff had mental and physical conditions including, but not limited to, stress, depression. anxiety, and an inflamed back that limited Plaintiff’s work for Defendant. 42. Plaintiff was able to perform the cssentia'l job duties With reasonable accommodation for his mental and physical conditions including, but not limited to. stress, depression, anxiety, and an inflamed back. 43. Defendant subjected Plaintiff to adverse employment actions including. but not limited to, failing t0 reasonably acconm‘zodatc his disability, issuing baseless disciplinary write- ups, failing to adhere t0 his work restrictions, terminating his employment, and creating the overall hostile terms and conditions of emplonnent. 44. Plaintiff‘s mental and physics} conditions including, but not limited to, stress. depression, anxiety, and an inflamed back, were a substantial motivating reason for Defendant’s decision t0 fail to reasonably accommodate Plaintiff s disability, issue baseless disciplinary write- ups t0 Plaintiff, fail to adhere to Plaintiff's work restrictions, terminate Plaintiffs cmplnym ant, and create the overall hostile tcnns and conditions of Plaintiff‘s employment. 45. Plaintiff was harmed. 46. Defendant” 9 unlawful conduct was a substantial factor in causing Plaintiffto suffer general and special damages including economic damages and non-economic damages in excess ofthis court’s jurisdiction according to proof at trial. Accordingly. Defendant’s conduct violated Government Code section 13940, subdivision (a), and California Code of Regulations. title 2, section 11064. 47. As an actual and proximate result of Defendant‘s unlawful conduct, Plaintiff has lost wages, benefits. and has incun‘ed other 0ut-of-pocket expenses. 9 Plaintiff‘s Verified First Amended Complaint for Damages and Lawrance A. Bohm, Esq. Demand for Jury Trial Donald R. Williams, Jr., Esq. Hnflfln n {712114in Rnr-L F‘nnmmn.’ TraCV C. Law, Esq. 8011M LAW GROUP, INC. 4600 NORTHGATE Bot 'LEVARD, 5x YITE 210 SACRAMENTO, CALIFORNIA 95834 [=3 OOOOflmUI-hw [Q i--~ y-A r-d L_- é-t s_- ;--: .--n p-a y-a C KO 0° \l C\ L11 h DJ N H 48. As a proximate result ofthe aforementioned violations, Plaintiff has been damaged in an amount according t0 proof, but in. an amount in excess of the jurisdiction 0f this Court. Plaintiff also seeks “affirmative relief’ or “prospective relief” as defined by Government Code § 129mm. 49. As an actual and proximate resul: 0f Defendant’s aforementioned acts. Plaintiff suffered physical injury. Plaintiff experienced weight loss, poor appetite, nausea, depression, insomnia, early awakening, restless sleep, fatigue, anxiety, and loss of concentration. Plaintiff claims general damages for physical injury in an amount according to proof at time Oftrial 50. As an actual and proximate result 0f Defendant‘s aforementionsd acts, Plaintiff also suffered mental upset and other emotional distress. Plaintiff claims general damages for mental distress in an amount according to proof at time of trial. 5 1. The above-described actions were petpetratcd andr’or ratified by a managing agent or officer of Defendant. These acts were done with malicc, fraud, oppression, and in reckiess disregard of Plaintiff’s rights. Further. said actions were despicable in character and warrant the imposition 0f punitive damages in a sum sufficient to punish and deter Defendant‘s future conduct. SECOND CAUSE 0F ACTION Failure to Engage in the Interactive Process (Government Code section 12940, subdivision (n)) 52. The allegations set forth in this complaint are hereby re-allcged and incorporated by reference. 53. This cause of action is assemcd against Defendant. 54. At all times relevant t0 this action“ the California Fair Employment and Housing Act and California Govemment Code section 12940, et scq., were in full force and effect and binding on Defendant. 55. Defendant is an “employer“ as defined in Government Code section. 12926, subdivision (d). 56. Plaintiff, as an empluyec ochfendant. vxas a covered employee under FEHA. 10 Plaintiffs Verified First Amended Complaint for Damages and Lamance A. Bohm, Esq. Demand for Jury Trial Donald R. Williams, Jr., Esq. I-I.yfol1; 1: Crnm'fn Rnr'% Fm'nmmv TraCV C. Law. Esq. BOHM LAW GROUP, INC. 4600 NORTHGATE BOULLVARD, Sum» 210 SACRAMENN i, CALIFORNIA 95834 \OWflQw-DWNH NH r-‘O 13 14 15 16 57. At all times relevant to this matter, Plaintiff suffered from a “mental disability" as defined by Government Code section 12926, subdivision (j). and California Code ofRegulations, title 2, section 11065, subdivision (d)(1), and a “physical disability” as defined by Government Code section 12926, subdivision (m), and California Code 0f Regulations. title 2, section 11065, subdivision (d)(2). 58. Plaintiff had mental and physical conditions including. but not limited to, stress, depression, anxiety, and an inflamed back that limited Plaintiff’s work for Defendant. 59. Plaintiff requested that Defendant make reasonable accommodation for his mental and physical conditions inciuding, bu! not limited t0, sires»: depression, anxiety, and an inflamed back, so that he would be able. t0 perform the essential job requirements. 60. Defendant "failed to participate in a timely and good-faiih interactive process with Plaintiff to determine whether rcasonablc accommodation could be made. 61. Plaintiffwas harmed. 6'2. Defendant’s failure to engage in a good-faith interactive process was a substantial factor in causing Plaintiff to suffer general and special damages including economic damages and non-economic damages in excess 0f this court’s jurisdiction according to proof at trial. Accordingly, Defendant’s conduct violated Government Code section 12940, subdivision (n), and California Code of Regulations‘ titie ’2, section 11069. 63. As Ian actual and proximate result 0f Defendant’s unlawful conduct; Plaintiff has lost wages, benefits, and has incurred other out-of-pockct expenses. 64. As a proximam result 0fthc aforememioued Violations, Plaintiffhas been damaged in an amount according to proof, but in an amount in excess 01‘ the jurisdiction 0f this Coufi. Plaintiff also seeks “affirmative relief’ or “prospective relief” as defined by Government Code § 12926(a). 65. As an actual and proximate result of Defendant's aforementioned acts, Plaintiff suffered physical inj ury. Plaintiff experienced weight loss, poor appetite, nausea. depression, insomnia, early awakening, restless sleep, fatigue, anxiety, and loss of concentration. Plaintiff claims general damages for physical injury in an amount according to proof at time 0f trial. 11 Plaintiff’s Verified First Amended Complaint for Damages and Lawrance A. Bohm, Esq. Demand for Jury Trial Donald R. Williams, J12, Esq. Hafclv v. Grum‘Ie Rock Campanv Tracy C. Law, Esq. BOHM LAW GROUP, INC. 4600 NORmGA'l E BOL'LFVARD, SL‘ITE 210 SACRAMENTO, CALlFORNM 95834 k) \DOOQGXUI-bw 6b. As an actual and proximate result of Defendant's aforementioned acts. Plaintiff also suffered mental upset and other emotional distress. Plaintiff claims general damages for mental distress in an amount according to proof at time 0f trial. 67. The abovc-described actions were perpetrated and/or ratified by a managing agent or officer of Defendant. These acts were done with malice, fraud, oppression, and in reckless disregard 0f Plaintiffs rights. Further, said actions were despicable in character and warrant the imposition of punitive damages in a sum sufficient to punish and deter Defendant’s future conduct. THIRD CAUSE OF ACTION Failure to Accommodate (Government Code section 12940, subdivision (m)) 68‘ The allcgations set fomh in this complaint are hereby re-alleged and incorporated by reference. 69. This cause of action is asserted against Defendant. 70. At all times relevant to this action, the California 13air Employment and Housing Act and California Government Code section 12940, et seq. were in full force and effect and binding on Defendant. 71. Defendant is an "employer” as defined in Government Code section 12926, subdivision (d). 72. Plaintiff. as an employee of Defendant, was a covered employee under FEI IA. 73. At a1} times reicvant to this matter, Plaintiff suffered from a “mental disability” as defined by Government Code section 12926, subdivision (j), and Califomia Code ofRegulations, title 2, section 11065, subdivision ((1)0), and a “physical disability” as defined by Government Code section 12926, subdivision (m), and California Code ochgulations, title 2, section 11065, subdivision (d)(2). 74. Plaintiff had mental and physical conditions including, but not limited to, stress, depression, anxiety, and an inflamed back that limited Plaintiff” s work for Defendant. /// 12 Plaintiff’s Verified First Amended Complaint for Damages and Lawrance A. Bohm, Esq. Demand for Jury Trial Donald R. Williams, Jr., Esq. Hnflrh; v ('Jr/mr'ln Rnuk (‘nnm/mv Tracv C. Law. Esq. BOHM LAW GROUP, m; 4600 NORTHGATE Br)! ILEVARD, Sung 210 SALRAMENTO, CALIFORMA 95834 IQ OOOQO\U\&UJ 75. Defendant knew that Plaintiff had mental and physical conditions including, but not limited to, stress, depression anxiety, and an inflamed back that limited Plaintiff‘s work for Defendant. 76. Plaintiff was able to perfonn the essential job duties with reasonable accommodation for his mental and physical conditions including, but not limited t0, stress, depression, anxiety, and an inflamed back. 77. Defendant failed to provide reamnable accommodation for Plaintiff’s mental and physical conditions including, but not limited to, stress, depression, anxiety, and an inflamed back. 78. Plaintiff was harmed. 79. Defendant’s failure t0 provide reasonable accommodation was a substantial factor in causing Plaintiff to suiTer general and special damages including economic damages and non- cconomic damages in excass 0f this court’s jurisdiction according t0 proof at trial. Accordingly, Defendant’s conduct violated Government Code section 12040, subdivision (m), and California Code 0f Regulations. title 2, section 11068. 80. As an actual and proximate result of Defendant’s unlawful conduct, Plaintiff has lost wages, benefits, and has incurred other out-of-pocket expenses. 81. As a proximate result of the aforementioned violations. Plaintiff has been damaged in an amount according to proof, but in an amount in excess of the jurisdiction 0f this Court. Plaintiff also seeks "affirmatiVe relief” 0r “prospective relief” as defined by Government Code § 1292603). 82. As an actual and proximate result of Defendant’s aforementioned acts, Plaintiff suffered physical injury. Plaintiff experienced weight loss, poor appetite, nausea. depression. insomnia, earl) awakening. restless sleep‘ fatigue. anxiety, and loss of concentration. Plaintiff claims general damages for physical injury in an amount according to proof at time of trial. 83. As an actual and proximate result of Defendant‘s aforementioned acts, Plaintiff also suffered mental upset and other emotional distress. Plaintiff claims general damages for mental distress in an amount according t0 proof at time oftrial. 13 Plaintiff’s Verified First Amended (‘onxplaint for Damages and Lawrance A. Bohm, Esq. Demand for Jury Triai Donald K Williams, 112, Esq. Hafely v. Granite Rock Company Tracy C. Law, Esq. Bt MM LAW GROUP, 1m; 4600 NORTHGATE BOULEVARD, SUITE 21 0 SACRAMEM 0, CALIFORNIA 95834 \O 00 ‘Q O\ ’JI ¥- UJ N v-‘ L-AHH NHO 13 84. The above-described actions were perpetrated and/or ratified by a managing agent or officer of Defendant. These acts were done with malice, fraud, oppression, and in reckless disregard of Plaintiffs rights. Euflher. said actions were despicable in character and warrant the imposition 0f punitive damages in a sum sufficient to punish and deter Defendant‘s future conduct. FOU RTH CAUSE OF ACTION Retaliation (Government Code section 12940, subdivision (11)) 85. The allagations set forth in this complaint are hereby re-alleged and incorporated by reference. 86. This cause 0f action is asserted against Defendant. 87. At all times relevant t0 this action, the California Fair Employment and Housing Act and California Government Code section 12940. et scq., were in full force and effect and binding 0n Defendant. 88. Defendant is an “employer” as defincd in Government Code section 12926, subdivision (d). 89. Plaintiff, as an cmployec 0f Defendant, was a cmered employee under FEHA. 90. Plaintiff reported 10 Defendant his need for a reasonable accommodation for his mental and physical conditions including, but not limited t0, stress, depression, anxiety, and an inflamed back, so that he would be able to perform the essential job requirements. 91. Defendant subjected Plaintiff to adverse employment actions including, but not limited to, failing to reasonably accommodate his disability, issuing baseless disciplinary write- ups, failing t0 adherc to his work resu‘ictions, telminating his employment, and creating the overall hostile terms and conditions 0f employment. Defendant condoned an environment that, among other things, tolerated and encouraged discrimination based 0n disability that materially and negatively impacted the terms and conditions 0f Plaintiff s employment. 92. Plaintiff‘s reporting 0f his need for a reasonable accommodation for his mental and physical conditions including, but not limited to. stress, depression, anxiety. and an inflamed 14 Plaintiff‘s Verified First Amended Complaint for Damages and Lawrance A. Bohm, Esq. Demand for Jury Trial Donald R. Williama .112, Esq. Hm‘fxiu w {Jrnm‘fp Pnr/z {”nmnrmu TTaCV C. Law. ESQ. Box WI LAW GROI IP, MC. 4600 NORI‘HGATI: BOULEVARD, SUITE 210 SACRAMENTO, CALIFORNLA 95834 k) M&U.) KOOONO back. was a substantial motivatmg reason for Defendant‘s decision to subject Plaintiffto adverse employment actions‘ including but not limited to, failing to reasonably accommodate his disability, issuing baseless disciplinary WI‘ite~L1ps, failing to adhere t0 his work restrictions, terminating his employment. and creating the overail hostile terms and conditions ofemploymem. 93. Plaintift‘was harmed. 94. Defendant‘s unlawful conduct was a substantial factor in causing Plaintiff to suffer general and special damages including economic damages and non-cconomic damages in excess of this court’sjurisdiction according t0 proof at trial. Accordingly. Defendant’s conduct violatcd California Government Code section 12940, subdivision (h), and California Code of Regulations, title 2, section 11021. 95. As an actual and proximate result 0f Defendant‘s unlawful conduct, Plaintiff has lost wages, benefits. and has inc urrcd other nut~of-pocl-- H y-d v-A ’-a v-A w-n p-A p4 co \1 ax U1 4; L...) [\J »-I o zo oo \1 ON U1 4; m N r-A O 162. As an actual and proximate result of Defendant’s aforementioned acts, Plaintiff suffered physical injury. Plaintiff experienced weight loss. poor appetite, nausea. depression, insomnia, early awakening. restless sleep, fatigue, anxiety, and loss of concentration. Plaintiff claims general damages for physical inj ury in an amount according to proof at time Oftrial. 163. As an actual and proximate result 0f Defendant’s aforementioned acts, Plaintiff also suffered mental upset and other emotional distress. Plaintiff claims general damages for mental distress in an amount according to proof at time 0f trial. 164. The above-described actions were perpetrated and/or ratified by a managing agent 0r officer 0f Defendant. These acts were done with malice, fraud, oppression, and, in reckless disregard of Plaintiffs rights. Further, said actions were despicable in character and walrant the imposition of punitive damages in a sum sufficient to punish and deter Defendant’s future conduct. PRAYER FOR RELIEF WHEREFORE. Plaintiff demands judgment against Defendants and any other defendants who may be later added t0 this action as follows: 1‘ For Compensatory damages, including, but not limited to, lost wages and non- economic damages in the amount according to proof; 2. For attomeys’ fees and costs pursuant t0 all applicable statutes 0r legal principles; 3. For cost 0f suit incurred: 4. For prej udgment interest on all amounts claimed pursuant to all applicable statutes or legal principles; 5. For punitive damages 01‘ other penalties recoverable by law; and 6. For such other and further relief as the comT may deem proper By/f7l”_} {?I/K I (f; ' xx \.- LAWNCE A BOHM, ESQ DONALDR WILLIAMS, JR £80 TRACY c. LAW, ESQ. Date: November 28, 201 7 Attorneys for Plaintiff, GEORGE HAFELY 23 Plaintiff’s Verified First Amended Complaint for Damages and Luwrance A. Bohm, Esq. Demand for Jury Trial Donald R. Williams, 11:, Esq‘ ’T“...,n.f‘ I .mn L" n BnHM LAW GROUP. INC 4600 NORTHGATE BOULEVARD. St nTE 21 0 SACRAMEVTO, C \LIFORNIA 95834 OOOQQUIJIAWNH p-tp-Ap-Ay-At-ai-Ap-av-np- OOQQM-fimNh-‘O 19 DEMAND FOR JURY TRIAL Plaintiff hereby demands trial by jury for this matter‘" , v] \_ v Date: November 28. 201 7 By: 24 l: \ J/ LAWWCE AEOH'M, ESQ. DGNAL-D R. WILLIAMS, JR., ESQ. TRACY C. LAW, ESQ. x ('2 /'/ “ , h ~ "K Attorneys for Plaintiff, GEORGE HAFELY Plaintiff’s Verified First Amended Complaint for Damages and Demand for Jury Trial Hafely v. Granite Rurk Company Lawrance A. Bohm, Esq. Donald R. Williams, Jr., Esq. Tracy C. Law, Esq. \OOONQUXQLQNH OCQQMAUJNF-‘OCmNmei-DNHO VERIFICATION OF FIRST AMENDED COMPLAINT FOR DAMAGES I, , GEORGE HAFELY‘havc read the attached First Amended Complaint for Damages and hereby attest that the same is true of my own knowledge, except as to those matters, which are therein stated on m_v information or belief, and as to those matter that I believe it to be true. I declare under penalty of perjury under to the laws of the State of California that the foregoing is true and correct. This Verification was executed on ND VQ Mbfl' Z3; Z014” , in Monterey, CA 93940. VERI FICATION OF FIRST AMENDED COMPLAINT FOR DAMAGES EXHIBIT T fl" INBOuND NOTIFICATION : FAX RECEIVED SUCCESSFULLY REMOTE CSID DURATION PAGES STATLgs (331)26973735 260 ll Rece‘lved TIME RECEIVED Apri? 27. 201.8 a1: 10:36:42 AM PDT 1/1’1LLP (831 )28973753Aprl27l20’15 10:27:55 AM Wilson & Wlsler, April 2'7, 201 8 Arnnnda E. Beckwith, Esq, Sheppard, Mullin, Richter & Hampton, LLC Four Embarcaclero Center, 1 7L“ Floor San Francisco, CA 941 l 1-4109 RE: AppIica'nt: George Iiafely Employer: Granite Rock Dear Ms. Beckwith: I am enclosing the following docusrnents pursuant to your Subpoena Duces Tecunn 8/26/201 5: Ernail ChnLn 9/3/201 5: Call Log 9/2 8/2015: Call Log 9/2 8/201 5: Exnai} 9/24/20 1 5: Igetter from Graniterock 9/4/201 5: Email 9/8/201 5: Elnail 9/9/2015: Email chain 1 0/8/201 5: terrnination notice. The aforementioned docurnents will be 1nade accessible to your copy service. I object to the rernainder of your subpoena us tho infotmution and docurnentation sought is either privileged, or is already in the possession of‘ your client a_nd/or its Workers’ Compensation insurance carrier. 1 will provide any further infoxrnation I can during deposition on matters not protected. by the attorney-client privilege. Thank you for your courtesies in this matter. IIOODOOO Sirlcerely, Robert Faralnnand Wilson 85 Wisler, LLP Eonnie Binder Wilson* _ - 'fiEFéH-dith A. \Vi sler‘” MM H Rob ert B. Farah Jnana Eon uig@_§§ $21; lglgl flaw. cczm Margag] 21h (d-don pl_gulngo r11 [ggpgfi)d9u§1§ulgmg - 21 Maple Street o Salinas, CA 93901 - - Phone: (831) 269-3787 - Fax (831) 5269-3783 ~ -c=mnaa saeuausx ~ workers :nmaomauou “w 7m: sum ear ov camemm ea-ra oans-x sneclamnuun Aprl27l20‘l a 1 0:27:55 AM Wilson & Wisler, LLP (831)289-3783 211 ‘l 04/23/1 8 Wilson & Wisler, LLP Page 1 1 :43}: Name Notes Calls vvith this Name: Brown, Melinda [D When ’Tinae Note 729 09/03/1 5 1:03p Number of Records: 1 Cn‘ll with George: he said he broke down last Thursday with an anxiety attack and went to Kaiser for mental health counseling. The doctor took him off work until 9/1 7/1 5 and he wants to know ifhe should file for state disability. I told him to send nme a copy ofhte doctor's note and I will forward it to Andrew Lynch and possibly file an amended (or second) application. Apr127120‘1 6 1 0:27:55 AM Wilson & Wisler, LLP (531 )289-3763 311 1 04/23/18 Wilson Sc Wisler, LLP Page 1 1 :42p Name Notes Calls with this Narne: Brown, Melinda ID )Nhen Time Note 729 09/28/1 5 9: l 6a Call with George - ER is threatening to tenninate him ifhe does not fill out and return leave of absence paperwork. They are considering his stress leave an unapproved absense. Number of Records: l Aprl27120‘16 ‘l 0:27:55 AM Wilson & Wisler, LLP (531 )289-3763 4’1 1 rob doublaul corn From: Robert Farahrnand Sent: Monday, September 28, 2015 3:30 PM To: 'George Hafaly‘ Subject: RE: Leave of absence OK. Go for it. -----OrlgInal Message----- From: George Hafely [maiIto:gkhafely@verizon.net] Sent: Monday, September 28, 2015 2:18 PM To: Robert Farahmand Subject: Leave of absence Hi Robert, l was thinking should l callAnn G. at human resources and let her know that I will not be filling out thoae papers-slncel am on disabiilty. Thank You George Sent from my iPhone= Aprl27120‘la 10:27:55 AM Wilson & Wisler. LLP (831)289-3753 511 ‘l rondoubleulaw-co From: George Hafely Sent: Wednesday. September B, 2015 6: 18 PM To: Robert Farahmand Subject: Re: Dlsabillty My union rep ls Randeil and his number is 408-335-3226 Sent from my iPhone On Sep 9, 2015, at 4:53 PM, Robert Farahmand wrote: OK, please Call me when vou have some tlme so we can discuss. Also, please get the name and contact number for your union rep. I’m going to subpoena your personnel file right now. From George Hafely [maalt :qkhafelv@verjzon_net] Sent: Wednesday, September 9, 2015 3:42 PM To: Robert Farahrnand Subject: Re: Disablllty Hi Robert, No they are not going to pay me.But they want rne to flil out the pape rwork for leave of absence,and file for dlsablllty.They also want my Dr. to fill out some paperwork wanting to know what ls going on and to fill out when I can go back and [f so to what abillty. Thank You George Sent from my iPhone On Sep 9, 2015, at 2:39 PM, Robert Farahmand wrote: Are they agreelng/offering to pay you while you’re out? From George Hafely [malfig:gkbafgngveriggu,ngfi Sent: Wednesday, September 9, 2015 12:04 PM TD: Robert Farahrnand Subject: Re: Disability Hi Robert, Ijust wanted to ask you,my company sent me paperwork to flll out for a leave of absence.Do you think it ls ok for me to fill that our. and send It back to them? Thank You George Sent from my iPhone O" SEP 9» 2015, at 9:11 AM. Rebert Farahmand wrote: Hi George, :n-runm I n nn- n-u r:- n nunu-u ,xun‘nn-y-unnn-unn Since the work status report does not link the reason for your time off to the existing WC claim, you can apply for state disability for the periods indlcatad. We can also discuss filing a new claim if this becomes a recurrent issue, or if you and/or your doctor think you would benefit from professlonal counseling. Please feel free to cail with questions. Regards, l€<')l)err \Fhrn [lmJJrJ-(I, Esq. 6%” @ 6.2% W" Attorneys u: Lav" 21 hda[)16 Street: Staliliae, Califor1fiia 9390 1, 1“¢lephonie: 183 ll 269-3787 Facsimile: [83 1.) £6973783 [w\Vuz.dgubleulvngr_9_1_11 v-«mmmm-uwa‘m-«anngm pRIVA-FE AND CONFH‘DENT,AL wrym*m*x«»u=4<>¢nk~ue+* THIS ELECTRONIC: [\I‘IESSAGE TRANSN‘IISSION IS A CCJMN'ILJNlciA‘TIQN FROM "[‘HE LAW FIRM OF WDLSCJFQ & WlSLER, l,LP Tl~-HS MESSAGE CONTAINE- lNFORMA'I’lON PROTEC‘rED BY TI-lE A' "DRNEY/CLIENT FRIVILEGE AND IS CJONFH'JENTIAL OR OTHERWISE "I‘HE EXCLUSIVE PROPERTY OF THE INT’ENDED RECIPIENW' OR WILSON St WISLER) LLP. THIS INFORMATXON IS SOLELY FOR W‘HE USE OF TFXE INDiV’iDUAL OR ENTITY TI-QAT IS TP‘E INTENDED RECIPIENT. N n” n Aprl27120‘la 10:27:55 AM Wilson & Wisler. LLP (831)289-3753 7/1 ‘l rob doubleul .corn From: Robert Farahmand Sent: Tuesday, September B, 2015 8:42 AM To: 'George Hafeiy' Subject: FW: Kaiser report Scratch that, I got it‘ II Sent: Tuesday, September 8, 2015 8:40 AM To: 'George Hafeiy' Subject: RE: Kalser report H Geo rge, Doesn't look like the fax went throughv Fi-orn: George Hafely [malflt‘ggmi‘gM Eng. E‘]¥@vér‘lvzon.gggl Sent: Frlday, September 4, 2015 10:26 AM To: Robert Farahmand Subject: Re: Kaiser report H7 Robert, Just wanted to let you know Ijust faxed over the papers Thank You George Sent from my iPhone On Sep 4, 2015, at 10:11 AM, Robert Farahmand wrote: HI George, thls ls just a reminder- please send me the Kaiser report/note from last week. l need to see what it says In order to advise you whether to file for state disability or not. Thank you. R()ben Fnlabmzztch, E'sq. Wfi @% ‘QW’ Attorneys at Lavv 2 1 Maple Street: Salinas, California 93901 'l‘elephone: (831) 269-3787 Facsimile: (831) 269~3783 wwxv . don bleu law. c0111 Aprl27120‘16 ‘l 0:27:55 AM Wilson & Wisler, LLP (531 )289-3763 6/1 1 rob doubleula com From: George Hafeiy Sent: Wednesday, August 26, 2015 8:41 AM To: Robert Farahmend Subject: Re: Severance Package I told the I did not want any-thing with my back in it.The company approached the union about this. Thank You George Sent from my iPhone On Aug 25, 2015, at 8:39 AM, Robert Farahmand <1‘ob(@doubleulafl.com> wrote: Awesome George, I 8111 SO glad to hear you are feeling better. Of course I will be happy to look over your severance package. What did you tell your union about your interest in taking it? ---~Original Mes:age----- From: GEORGE HAFELY [mgi1:9;gkhafelx@vcri;gnlu§t Sent: Tuesday, August 25, 2015 3:21 PM To: Robert Farahmand Subject: Severance Package Hi Robert, I wanted to let you know my company contacted my Union to see ifi would be interested in a severance package. Would this have anything to do with my workers comp claim? '1 am thinking it is different from my claim,or could they be sneaky and try to put that in71f I do receive one can you look it over to make sure that it does not do anything to my claim.Good news they did my back yesterday and I am starting to feel pretty good. Thank Y'ou George: ApriZT/ZO'IQ 10:27:55 AM Wllson é Wlsler, LLP (531)26573753 Si] l L Granilerock- Septern her 24, 20 1 5 George Hafely 892 Ryan Court Gllroy, CA 95020 Dear Geo rge, This letter will serve as a follow uh to my letter to you dated 'September 4, 2015, In which I requested information regarding your time off From work. To date we have no: recelved From you the compl'eted,Req'uest for Leave of Absence form or the Certification” of Medical Care'F'rovider form. Therefore, your‘cur‘rent time off ls consldared an unapprov'ed leave of absence. The Branch was expecting you to return ta work on September 18, 2015 based on the Information 'you previously provided to dispatch. I was notlfled' that you had Iafi a voicemail message with dispatch afier the branch closed on September 17, 2015. You indicated that you would need additional tlme off of work. I reached out to you by telephone and lefi voicemail messages on September 18, 2015 and September 22, 2015 requestlng addltlonal Information and .the leave of absence paperwork to be returned. As of the date of thls letter, you have not returned my messages. In order- for the Company to approve your leave of absence you wlll need to return the requested forms within 10 days of this letter“, or‘ no later than October 4, 2015, otherwlse your- unappraved tlme ofl' may be cause for termlr‘natlon. I~ have enclosed another set of request formsv for you convenience- Should you have any questions, please contact me at 83 1/768-2060. Sincerely, Gra ' San Benito Cour! ‘ ' Ann Giuslana . 8 M C ‘a" “‘° “““yHun-Ian Resource Services . Sana. CI-r- Councy File PBym/I - 5mm: Cruz councyEncl: LOA request fbrm Cc: Dispatch John saithMedical Catt farm and Jab Analysis . ' Ahmad“ COW‘W Manny Pinhera, Operating Engineers Local .v c City and County «San an=hao Equal Opportunity Employer P.0- Box SOOOI Watsonvme. CA 95077-sool 83 I.768.zooo Fax 83 I 163.120! www.granltarack.=om ‘IOI‘I‘IWilson & Wisler. LLP (831)289-3753 W Granihmk. October B, 2015 Apr127120‘l a ‘1 0:27:55 AM Mr. George Hafely 892 Ryan Court Guroy, CA $5020 Dear George, ; This flatter Is to inform you that your employment with Graniterock wlll termlnate effective tod-October 8, 2015. ~ Our records show you have been off work since August 21. 2015. In e tartar dated September 4,2Q15>frorn Ann ,Giujsianz, she prs‘vlded yaurwtth instructlans fqr a no,r_m-vy_ork~'relat-dJllry_e;’s_ 9r Injury, form ‘for'you'tolFmpl'e é,' an‘d‘a' ’Certlfic tron o'f )nbludlna t’he ’Re‘quest fér L’eave'ofAb-sence' _Health Care Prthde)’ form \for your treating physician to corp late. lthough you p'ro Ided un'withWork Status Re ports from your personal treating physlclan a ‘(alser _ grmanente plac ng you offwork through Septen'lber 17, 2015, the Company required c mbletfoh of_these forms ortlme offunder the Family Medical Leave Act (FMLA). When both forms were not returned by eptember19, 2015, Ann Glusiana sent you a follow-up letter dated September 24, 2015- She inf rmed outhat your currEnt time off was consldered ‘ - the forms returned, but no later than October a, 203.5. You left her a voice nuessage and sent her anemail dated September 30, 2015 st-tlng, ”I was advised by my sttornles as‘nat to flll out the leaveof absence. I am currently on dlsablllty for work related stress.” I contacted our workers compensation provider, Zurich, and was informed you flied an injury clalnifur stress on September .11, 2015, Zurich followed-up with a letter dated September 23, 2015,denying "ability for your claim of Injury and a copy was sent to your attorney, Wilson & Wiser. Theletter explained why the clairn was deniedV In summary. you had until October 4, 201s, ta submit the forms requlred fortha Company toconsider yOur tirhe off a_s an approved leaveA You failed to return these forms and therefore yourabsence from work was unexcused and just cause for termination. If my facts are Incorrect, pleasegqntaqt me no‘leter than Friday, October 16, 2015. I I __ contact John Selth and we can make If you have any persona? belongings 6n company prupeflv, delivered to your home. After today, you are not to arrangements to have your personal Items any purpose, unless you have earner es‘tabllshad an enter any Granitercck pr0pertv in the future for appointment wlth management. ' ”°"“"‘°V um“? AU final pay is enclosed. - sun emu“: County ' ancsrel . a... mm cam“, ‘ Q“)- snnu cl".an-y Q“”"( SJ w-Cnflc n " ' Shirley Ow- n a ‘ “ u ‘ Vice Presldent, Human Resaurces- Alamnmn enum, ‘ - CRY Ina County dS-rmnnManny Pinherc, Operating Engineers Local 3 Equal Opportunity Employer- Persannel file John Seith Ho. Box SDDOI Waucnvmc. CA 95077-500I a: 1.7632000 Fax 331.753.220I www.granltorock.com Aprl27l20‘la 10:27:55 AM Wilson & Wisler, LLP (831)289-3783 ‘l ‘ll‘l ‘l PROOF 0F SERVXCE BY MAIL -- 1013a, 2015-5 C.C.P. Service by Mail, CCP §1013(a). 1 am readily farnjlizu: “duh this firrn's business practice for due collection nnd processing of correspondence fox mailing with the United States Postal Sexwice. Coxxespondence so collected and processed is deposited with the United States Postal Service that same day with postage cheremn fully prcpaid ac Salinas, California. On April. 27, 2018 at 1ny Place: of business at 21 brinple Street Salinas, (3A 93901, a ccpy of the attached CORRESPONDENCE DATED, .Aptil 27, 2018. was placed for deposit in time LTnjted States Postal Service in a sealed envelope, wil'l1 postage fully prepaid addxessed to chose Listed beloxv. Each scaled envelope \vas plflced for collection 51nd 1naiLing on that date following oxdinary business pxacmces. Or Service by FAX Transmission, CCP §1013(e). On the sanlc date, 4/27/201 8, at my place of business at 21 Maple Street Salixans, CA 93901, I transrnittcd from a {aeshxxile (ransrnission machine whose telephone number is (831)269-3783 the same docLu'nent to those facsixnilc transrnjssion telephone numbers listed belovv. Amanda E. Beckwith, Esq. Sheppard, Mullin, Richter & Hampton, LLC Four Embarcaclero Center, 17'“ Floor San Francisco, CA 941 l 1-41 09 FAX: 415-434-3947 Donald Willizxns, Elsq. Bolun La“; (?roup 4600 Northgate lerd. Ste. 210 Sacramento, CA 95334 Nationwide I..ega1, LLC 1609 Jnxnes M Woods Bovd I..os Angeles, CA 9001 5 TTJXX: 213-249-9990 I declare under penalty ofpcrjury under thc laxvs of d1e State of California that the foregoing i5 u'uc and correct. I.?.xecuted at Salinas, California, on: April 27, 201 8 CQW/W (Date) Ccys cal Villicann EXHIBIT U LA 310.230.9700 • SF 415.445.0105 els@elitigationservices.com • www.elitigationservices.com Court Reporting • Video • Trial Presentation IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA IN AND FOR THE COUNTY OF SANTA CLARA GEORGE HAFELY, ) ) PLAINTIFF, ) ) vs. ) CASE NO. 17CV316847 ) GRANITE ROCK COMPANY; ) AND DOES ) 1 THROUGH 100, INCLUSIVE, ) ) DEFENDANTS. ) ) ) DEPOSITION OF ROBERT FARAHMAND, ESQ. Taken on May 22, 2018 Robert Farahmand, Esq. eLitigation Services, Inc. - els@els-team.com Page 1 SUPERIOR COURT OF THE STATE OF CALIFORNIA COUNTY OF SANTA CLARA GEORGE HAFELY, ) ) Plaintiff, ) ) CASE NO: 17CV316847 v. ) ) GRANITE ROCK COMPANY, ) ) Defendant. ) ) DEPOSITION OF ROBERT FARAHMAND, ESQ. DATE: Tuesday, May 22, 2018 TIME: 8:56 A.M. LOCATION: HILTON SANTA CRUZ/SCOTTS VALLEY 6001 La Madrona Drive Santa Cruz, CA 95060 REPORTER: KRISTIN BELLI, CSR NO. 14120 Robert Farahmand, Esq. eLitigation Services, Inc. - els@els-team.com Page 2 1 APPEARANCES: 2 FOR THE PLAINTIFF: 3 (Telephonically) JUNN PAULINO, ESQ. 4 Bohm Law Group, Inc. 4600 Northgate Boulevard, Suite 210 5 Sacramento, California 95834 (916)927-5574 6 Junn@bohmlaw.com 7 8 FOR THE DEFENDANT: BRIAN FONG, ESQ. 9 Sheppard Mullin Richter & Hampton LLP 4 Embarcadero Center, Floor 17 10 San Francisco, CA 94111-4158 (415)434-9100 11 Bfong@sheppardmullin.com 12 13 --oOo-- 14 15 16 17 18 19 20 21 22 23 24 25 Robert Farahmand, Esq. eLitigation Services, Inc. - els@els-team.com Page 3 1 INDEX OF EXAMINATIONS 2 3 EXAMINATION BY: PAGE 4 Mr. Fong 4 5 6 --oOo-- 7 8 EXHIBITS 9 Exhibit 1 Notice of Deposition 5 10 Exhibit 2 Files produced by Mr. Farahmand 5 11 Exhibit 3 Mr. Hafely's Compromise and Release 16 12 Exhibit 4 July 21st, 2015 Write-up 26 13 Exhibit 5 June 12, 2015 Letter 26 14 Exhibit 6 Work Status Report Dated 8/21/15 32 15 Exhibit 7 Work Status Report Dated 9/1/15 34 16 Exhibit 8 Letter from Ms. Giusiana to Mr. Hafely 39 17 Exhibit 9 Work Status Report Dated 9/17/15 58 18 Exhibit 10 E-mail from Mr. Hafely to Ms. Giusiana 59 19 20 21 --oOo-- 22 23 24 25 Robert Farahmand, Esq. eLitigation Services, Inc. - els@els-team.com Page 4 1 BE IT REMEMBERED that on TUESDAY, the 22nd day 2 of May, 2018, at the hour of 8:56 a.m. of said day, at 3 The HILTON SANTA CRUZ/SCOTTS VALLEY, 6001 La Madrona Dr, 4 Santa Cruz, California, before me, KRISTIN BELLI, a 5 Certified shorthand Reporter, for the State of 6 California, personally appeared ROBERT FARAHMAND, ESQ., who 7 was examined as a witness in said cause. 8 --oOo-- 9 ROBERT FARAHMAND, ESQ. 10 Having been duly sworn to state the truth, the 11 whole truth, and nothing but the truth, testified on 12 oath as follows: 13 EXAMINATION 14 BY MR. FONG: 15 Q. Good morning, Mr. Farahmand. 16 A. Good morning. 17 MR. FONG: Just some preliminaries. We have 18 Junn Paulino from plaintiff's counsel on the phone. I 19 just received notice from Donald Williams about 20 15 minutes ago that we would have a telephonic 21 appearance, so we don't have exhibits prepared for 22 Mr. Paulino to see. I intend to generally introduce 23 exhibits that have been previously introduced, so I will 24 try and identify them for the record and for Mr. Paulino 25 to be able to review them, but unfortunately we didn't Robert Farahmand, Esq. eLitigation Services, Inc. - els@els-team.com Page 5 1 have notice of the telephonic appearance of the depo, so 2 we are not prepared to have exhibits for him. So I will 3 introduce Exhibit 1, which is the notice of deposition 4 of Mr. Farahmand which I will hand to the court 5 reporter. 6 (Whereupon Exhibit 1 was marked and indexed.) 7 BY MR. FONG: 8 Q. Mr. Farahmand, you received this document? 9 A. I received the initial one I believe that had 10 the first scheduled date. My office subsequently 11 rescheduled it to today, so I don't believe that I have 12 seen this specific notice, but I did receive the first 13 one, and I did review it. 14 Q. And you are here pursuant to a subpoena? 15 A. Correct. 16 Q. Could you spell your name -- state and spell 17 your name for the record, Mr. Farahmand. 18 A. Robert Farahmand, R-O-B-E-R-T, 19 F-A-R-A-H-M-A-N-D. 20 Q. As part of that deposition subpoena you also 21 produced portions of your file; is that correct, Mr. 22 Farahmand? 23 A. That's correct. 24 MR. FONG: I will introduce Exhibit 2. 25 (Whereupon Exhibit 2 was marked and indexed.) Robert Farahmand, Esq. eLitigation Services, Inc. - els@els-team.com Page 50 1 Q. So you don't have a recollection of what you 2 told him to do when he tells you that Granite Rock is 3 threatening to terminate him for not filling out the 4 forms? 5 A. Again, at that time, I had not seen the 6 documentation, so I wasn't about to advise my client to 7 sign something that I hadn't had an opportunity to look 8 at. George wasn't articulating that this was an FMLA 9 type of thing, so I really had very limited information, 10 and based on the fact that he had apparently showed it 11 to his doctor and his doctor told him not to sign it, I 12 told him not to sign it. 13 Q. Okay. So I will direct your attention to 14 Exhibit 8, which is the September 4th letter. If you 15 had seen this letter, would your advice to Mr. Hafely 16 have been different? 17 A. Yeah. There's no reason not to fill out an FMLA 18 form if you are -- even if you are alleging an 19 industrial injury because the two can run concurrently. 20 Q. Is there any reason to believe that filling out 21 an FMLA form would have affected his disability claim? 22 A. You mean his -- through EDD or? 23 Q. Through EDD. 24 A. No. I mean, I think he could have applied for 25 state disability benefits and filled out an FMLA form as Robert Farahmand, Esq. eLitigation Services, Inc. - els@els-team.com Page 51 1 well. 2 Q. So if you had known that the company was 3 requesting FMLA documentation, your advice to Mr. Hafely 4 would have been to fill it out, it's not going to affect 5 anything? 6 A. Yeah. 7 Q. And also with regard to the September 24th, 2015 8 letter, which is page nine of Exhibit 2, your previous 9 testimony was that you did not have this letter at the 10 time that you had the September 28th call with 11 Mr. Hafely. Do you recall that testimony, 12 Mr. Farahmand? 13 A. Correct. 14 Q. So if you had seen this letter at the time of 15 your September 28th call with Mr. Hafely, would your 16 advice to him have been go ahead and fill out those 17 forms? 18 A. Well, I mean, not necessarily because the 19 September 24th letter doesn't mention anything about 20 family medical leave act. It just says, "Leave of 21 absence and certification of medical provider forms", so 22 yeah, I probably would have tried to find out more 23 information about exactly what it was that Granite Rock 24 was asking for and try to get it to them. 25 Q. So your testimony that it -- that the September lO ll 12 l3 l4 15 l6 l7 18 19 20 21 22 23 24 25 Page 64 REPORTER'S CERTIFICATE I, Kristin Belli, certify that the witness in the foregoing deposition, was by me duly sworn to testify to the truth in the within-entitled cause; that said deposition was taken at the time and place therein named; that the testimony of said witness was reported by me, a duly-certified shorthand reporter and a disinterested person, and was thereafter transcribed into typewriting. I, Kristin Belli, further certify that I am not of counsel or attorney for either or any of the parties to said deposition, nor in any way interested in the outcome of the cause named in said caption. IN WITNESS WHEREOF, I have hereto set my hand this 30th day of May 2018. 14M” VQZ/ f IWyI'v Kristin Belli, CSR NO. 14120 EXHIBIT V BOHM LAW GROUP, INC. 4600 NORTHGATE BOULEVARD, SUITE 2 10 SACRAMENTO, CALIFORNIA 95834 \OOOQQU‘I-PUJNp-n NNNNNNNNNHt-IHr-AHr-IHy-In-IH OOQONUI-PUJNHOOOOQQm-PUJNHO Lawrance A. Bohm (SBN: 208716) Donald R. Williams, Jr. (SBN: 303 126) Tracy C. Law (SBN: 314936) BOHM LAW GROUP, INC. 4600 Northgate Boulevard, Suite 210 Sacramento, California 95834 Telephone: 866.920.1292 Facsimile: 916.927.2046 Attorneys for Plaintiff, GEORGE HAFELY SUPERIOR COURT OF CALIFORNIA COUNTY OF SANTA CLARA GEORGE HAFELY Case No.: 17CV3 16847 Plaintiff, PLAINTIFF GEORGE HAFELY’S V. RESPONSES TO DEFENDANT GRANITE ROCK COMPANY’S GRANITE ROCK COMPANY; and DOES 1 REQUESTS FOR PRODUCTION OF through 100, inclusive, DOCUMENTS, SET ONE Defendants. Action Filed: October 5, 2017 Trial Date: TBD PROPOUNDING PARTY: Defendant, GRANITE ROCK COMPANY RESPONDING PARTY: Plaintiff, GEORGE HAFELY SET NUMBER: ONE (1) PRELIMINARY STATEMENT AND OBJECTIONS APPLICABLE TO ALL REQUESTS FOR DOCUMENTS It should be noted that Plaintiff has not fully completed his investigation of the facts relating to this case, has not fully completed his discovery in this action, and has not completed his preparation for trial. A11 of the responses contained herein are based only upon such information and documents which are presently available to and specifically known to Plaintiff. It is anticipated that funher discovery, independent investigation, legal research and analysis will supply and/or establish additional facts, new meaning to known facts and entirely new factual Plaintiff’s Responses to Defendant’s RPDs, Set One Lawrance A. Bomn, Esq. Hafely v. Granite Rock Company Donald R. Williams, Jr., Esq. Case No.: 17CV3 1 6847 Tracv C. Law. Esq. BOHM LAW GROUP, INC. 4600 NORTHGATE BOULEVARD, SUITE 210 SACRAMENTO, CALIFORNIA 95834 O\OOOQO\Ul-PUJN:-I NNNNNNNNNp-Ap-Ap-Ap-An-Ip-Ap-Ap-Ap-Au-n OOQONUI-RUJNHOQOOVONUI-RWNH conclusions and legal contentions, all of which may lead to substantial editions, changes and variations to the contentions herein set forth. The following responses are given without prejudice t0 Plaintiff’s right to produce evidence and any subsequently discovered fact or facts which Plaintiff may later recall or discover. Plaintiff accordingly reserves the right to change any and all responses herein as additional facts are ascertained, analyses are made, legal research is completed and contentions are made. The answers contained herein are made in a good faith effort to supply as much factual information and as much specific legal contentions as is presently known, but should in no way be to the prejudice of Plaintiff in relation t0 further discovery, research or further analyses. Inadvertent identification or production of privileged documents or information by Plaintiff is not a waiver 0f any applicable privileges. Documents prepared or sent in connection with the within litigation, including but not limited to pleadings, motions, discovery responses and correspondence between counsel, are not included in the documents produced by Plaintiff. GENERAL OBJECTIONS Plaintiffgenerally obj ects to the production 0f documents at the offices of defense counsel. Plaintiff will mail copies of all documents which it will produce to counsel. Plaintiff objects to this entire request for identification of documents t0 the extent that it seeks production of documents protected by the attorney-client privilege and/or the attorney work-product doctrine. Plaintiff declines to produce such privileged materials. Plaintiff objects to this entire request for identification of documents to the extent that it seeks production of documents protected by the right to privacy. Plaintiff declines to produce such privileged materials. All of the above paragraphs and objections are expressly made applicable to each and every request and are hereby incorporated by reference as if fillly set forth therein. /// /// /// Plaintiff’s Responses to Defendant’s RPDs, Set One Lawrance A. Bohm, Esq. Hafely v. Granite Rock Company Donald R. Williams, Jr., Esq. Case No.: 17CV3 I 6847 Tracv C. Law. Esa. BOHM LAW GROUP, INC. 4600 NORTHGATE BOULEVARD, SUITE 21 0 SACRAMENTO, CALIFORNIA 95834 \OOONQU‘I-bUJNH NNNNNNNNNHHHr-I-I-IHHg-ng-n Wflmm-PWNHOQWNQM-bWNHO REQUESTS FOR PRODUCTION OF DOCUMENTS AND RESPONSES REQUEST NO. 1: A11 DOCUMENTS IDENTIFIED in YOUR responses t0 DEFENDANT’S Form Interrogatories-General, Set One. RESPONSE TO REQUEST NO. 1: Objection. This request calls for information which is available to all parties equally, and is therefore oppressive and burdensome to Plaintiff. (Code Civ. Proc., § 2019.030, subd. (a)(l), Panzalas v. Superior Court (1969) 272 Cal.App.2d 499, Alpine v. Superior Court (1968) 259 Cal.App.2d 45.) This request is unreasonably cumulative or duplicative, or is obtainable from some other source that is more convenient, less burdensome, 0r less expensive. (Code Civ. Proc., § 2019.030, subd. (a)(l).) Without waiving said objections, Plaintiff responds as follows: After a diligent search, Plaintiff will produce all non-privileged responsive documents in Plaintiff’s possession and control, 0f which Plaintiff is aware, and which may relate to this request. REQUEST NO. 2: A11 DOCUMENTS IDENTIFIED in YOUR responses t0 DEFENDANT’S Form Interrogatories-Employment Law, Set One. RESPONSE TO REQUEST NO. 2: Objection. This request calls for information which is available t0 all parties equally, and is therefore oppressive and burdensome to Plaintiff. (Code Civ. Proc., § 2019.030, subd. (a)(l), Panzalas v. Superior Court (1969) 272 Cal.App.2d 499, Alpine v. Superior Court (1968) 259 Ca1.App.2d 45.) This request is unreasonably cumulative or duplicative, 0r is obtainable from some other source that is more convenient, less burdensome, or less expensive. (Code Civ. Proc., § 2019.030, subd. (a)(l).) /// /// /// Plaintiff’s Responses to Defendant’s RPDs, Set One Lawrance A. Bohm, Esq. Hafely v. Granite Rock Company Donald R. Williams, Jr., Esq. Case No.: 17CV3 1 6847 Tracv C. Law. Esa. BOHM LAW GROUP, INC. 4600 NORTHGATE BOULEVARD, SUITE 21 0 SACRAMENTO, CALIFORNIA 95 834 \OOOQONUi-PUJNr-I NNNNNNNNNn-In-In-Ib-lb-lp-Ah-Ip-Ap-An-I OOQQU‘I-PUJNHOQOOQQU‘I-PUJNHO RESPONSE TO REQUEST NO. 95: Objection. This request calls for information which is available to all parties equally, and is therefore oppressive and burdensome to Plaintiff. (Code Civ. Proc., § 2019.030, subd. (a)(l), Panzalas v. Superior Court (1969) 272 Cal.App.2d 499, Alpine v. Superior Court (1968) 259 Ca1.App.2d 45.) This request is unreasonably cumulative or duplicative, or is obtainable from some other source that is more convenient, less burdensome, or less expensive. (Code Civ. Proc., § 2019.030, subd. (a)(l),) Without waiving said obj ections, Plaintiff responds as follows: After a diligent search, Plaintiff will produce all non-privileged responsive documents in Plaintiffs possession and control, 0f which Plaintiff is aware, and which may relate to this request. REQUEST NO. 96: A11 DOCUMENTS RELATING TO YOUR verified contention that on or about Septembel 17, 201 5, YOU faxed a Work Status Report t0 DEFENDANT, as alleged in paragraph 28 0fYOUR COMPLAINT. RESPONSE TO REQUEST NO. 96: Objection. This request calls for information which is available to all parties equally, and is therefore oppressive and burdensome to Plaintiff. (Code Civ. Proc., § 2019.030, subd. (a)(l), Panzalas v. Superior Court (1969) 272 Cal.App.2d 499, Alpine v. Superior Court (1968) 259 Cal.App.2d 45.) Without waiving said objections, Plaintiff responds as follows: Plaintiff currently has no documents responsive to this requést in Plaintiff’s possession custody, 0r control. If such responsive documents become available, Plaintiff will supplemem Plaintiff s production of documents. REQUEST NO. 97: Any DOCUMENTS that YOU faxed t0 DEFENDANT 0n 0r about September 17, 2015 including any Work Status Repon. /// 58 Plaintiff’s Responses to Defendant’s RPDs, Set One Lawrance A. Bohm, Esq. Hafely v. Granite Rock Company Donald R. Williams, Jr., Esq. Case No.: 17CV3 1 6847 Tracv C. Law. Esa. BOHM LAw GROUP, INC. 4600 NORTHGATE BOULEVARD, SUITE 210 SACRAMENTO, CALIFORNIA 95834 \OOOQQU‘I-PUJNp-I NNNNNNNNNr-Ir-IJ-nwr-IHD-Ir-Ir-Ir-I OOQONUI-PUJNr-‘OOOOQONUI-thr-‘O ,mamx F/wwmmx RESPONSE TO REQUEST NO. 97: Objection. This request calls for information which is available to all parties equally, and is therefore oppressive and burdensome to Plaintiff. (Code Civ. Proc., § 2019.030, subd. (a)(l), Panzalas v. Superior Court (1969) 272 Ca1.App.2d 499, Alpine v. Superior Court (1968) 259 Ca1.App.2d 45.) This request is unreasonably cumulative or duplicative, or is obtainable from some other source that is more convenient, less burdensome, or less expensive. (Code Civ. Proc., § 2019.030, subd. (a)(l).) Without waiving said objections, Plaintiff responds as follows: Plaintiff currently has no documents responsive to this request in Plaintiffs possession custody, or control. If such responsive documents become available, Plaintiff will supplemen1 Plaintiffs production of documents. RE UEST NO. 98: A11 DOCUMENTS RELATING TO YOUR verified contention that YOUR medical leave was extended to October 19, 2015, as alleged in paragraph 28 of YOUR COMPLAINT. RESPONSE TO REQUEST NO. 98: Obj ection. This request calls for information Which is available t0 all parties equally, and is therefore oppressive and burdensome to Plaintiff. (Code Civ. Proc., § 2019.030, subd. (a)(l), Panzalas v. Superior Court (1969) 272 Ca1.App.2d 499, Alpine v. Superior Court (1968) 259 Ca1.App.2d 45.) This request is unreasonably cumulative or duplicative, or is obtainable from some other source that is more convenient, less burdensome, or less expensive. (Code Civ. Proc., § 2019.030, subd. (a)(l).) Without waiving said objections, Plaintiff responds as follows: Plaintiff currently has no documents responsive to this request in Plaintiffs possession custody, 0r control. If such responsive documents become available, Plaintiff will supplemen1 Plaintiffs production of documents. /// /// /// 59 Plaintiffs Responses to Defendant’s RPDs, Set One Lawrance A. Bohm, Esq. Hafely v. Granite Rock Company Donald R. Williams, Jr., Esq. Case No.: 17CV3 l 6847 Tracv C. Law. Esa. BOHM LAw GROUP, INC. 4600 NORTHGATE BOULEVARD, SUITE 210 SACRAMENTO, CALIFORNIA 95834 \OOONONU‘I-waw NNNNNNNNNb-Ir-Awwb-Ir-Ar-Ar-Ar-Ar-A OONQMLWNfi-‘OCOONQm-PWNfi-‘O M’M’M rm > f: RESPONSE TO REQUEST NO. 153: Objection. This request is overly broad and remote and calls for information not relevant to the subj ect matter ofthis action nor reasonably calculated to lead to the discovery of admissible evidence. (CBS v. Superior Court (1968) 263 Ca1.App.2d 12, Deaz'le v. Gen’l Telephone (1974) 40 Cal.App.3d 841 .) This request seeks to impermissibly invade the privacy of uninvolved third parties as well as Plaintiff in violation of the constitutions of California and the United States. Without waiving said objections, Plaintiff responds as follows: Plaintiff currently has no documents responsive to this request in Plaintiffs possession, custody, 0r control. If such responsive documents become available, Plaintiff will supplement ‘ L9C/Plaintiffs production of documents. Date: March 13, 2018 By: LAWRANCE A. BOHM, ESQ. DONALD R. WILLIAMS, JR., ESQ. TRACY C. LAW, ESQ. Attorneys for Plaintiff, GEORGE HAFELY 90 Plaintiff’s Responses to Defendant’s MDS, Set One Lawrance A. Bohm, Esq. Hafely v. Granite Rock Company Donald R. Williams, Jr., Esq. Case No.: 17CV3 l 6847 Tracv C. Law. Esq. \OOONQUI#DJNH NNNNNNNNNp-I-tr-Iu-Hp-nwg-Hp-n MVQM-fiwN-‘OWWNQMAWNb-‘O VERIFICATION I, GEORGE HAFELY, the undersigned certify and declare that I am the Plaintiff in this action; I have read the foregoing ?meuas 61.124; wm-r's T&fibwszs TL:- Wm"- eLEMuTE 125w. OomPAv-N‘S ‘\m§sr"fliz mmm gE 'Doémr-frs Sgt OHE and I know the contents thereof are true based upon my own personal knowledge. I declare under penalty of perjury under to the laws of the State of California that the foregoing is true and correct. This Verification was executed on M5104 u to t5 , in Monterey, CA 93940. GEOR 'AFELY VERIFICATION EXHIBIT W ‘ jltéaop La (’V group 1625 The Alameda, Suite 901, San Jose, California 95126 MANAGING ATTORNEY HEARING REPRESENTATIVE ASSOCIATE ATTORNEYSJames T. Witkop Mona L. Palacios Sharon E. Hom Abram M. WattsSENIOR ASSOCIATES Andrew J. LynchBrent K. Jensen Ian R. LeslieKarla C, Nebres OF COUNSEL David J. Camsh Ju1y21,2017 Robert Farahmand, Esq. Wilson & Wisler 21 Maple Street Salinas, CA 93901 RE: George Hafely v. Granite Rock Company Claim No.: 2010240543 (Master); 2010258337; 20102562138 EAMS No.: ADJ10636694; ADJ10005980; ADJ10108439 DOI: 06/03/2014; CT 06/01/2010 - 06/22/2015; CT 9/1/2014 - 9/10/2015 File No.: ZUR-ML/080 Dear M. Farahmand: Pursuant to Rule 10500 we hereby serve the following referable t0 the above-capfioned matter: o Order Approving Second Amended Compromise and Release dated July 14, 2017; and I Second Amended Compromise and Release. ' By copy 0f this correspondence all interested parties are being concurrently served. Very truly yours, W‘ 0p ' w group /"f dre€+4fLyn/ch, Esq. AJszd E110: As stated above cc: See Proofof Service . EXHIBIT ’ - www.witkoplaw.com DAT" [£55 RPTR KSPhone: (408) 538-5900 Fax: (408) 5386901 engation Services Inc, + . STATE OF CALIFORNIA- WORKERS' COMPENSATION APPEALS BOARD #D'T 1'0005‘7 8’0 . - AH)? 1063 069%’ . I .4 ‘ \ . .C?dé'fc’ WILL” ADJ r0! 0 3%5‘1 s‘éapw AIM 3N D 5;) ORDER APPROVING/QOMPROMISE AND RELEASE Having considered the entire record, it is found that the Compromise and Release which the parties have submitted herein is adequate and should be approved. It is assumed that all medica1~legal costs have been 0r will be adjusted. The language in the agreement Which releases the rights of dependents to death benefits has been considered, and is approved. IT IS ORDERED that said Compromise and Release be approved. x x/z/ gigV” STUART CR E Workers’ Com ensation Administrative Law Judge NOTICETO; anflu Lflmca/ E; Pursuant to Rule 10500, you are designated t0 serve the attached document(s) 0n all parties shown on the Official Address Record along wit h proof 0f sewice. You shall maintain proof 0f service, which shall not be filed With the WCAB unless a dispute arises regarding service of the document. By: On: 7IIC/vl-7 I V } 7:: é:C D’UA {klfifiimuifi-K f I! . STATE 0F GALIFORNIA a DIVISION 0F WORKER? COMPENMTION , j WORKERS' coMPENSATION'APPéSALs BOARD COMPROMISE AND RELEASE ADJ [0636694 Case Number 1 I ' ' Case Numbefiq ADJ I 0005980 Case Number 2 Case Number’S ' ADJ] 0‘1 08439 Case Numa- -3 SSN (Numbers Only)‘ 1 Venue Choice is based~Upan; {Cbmpletion'ofthis saclion is required) D County of residence of employee-(Labor Code‘ section 5501 5(a)“) or (6).) DCouniy whefe' injury occurred (LaborCode secfion 5501,5(a)(2) or ((1).) 'Gpunty bf primfipal place-of business of emplbyee’s auome‘y (Labor Code section 5501 .5(a)(3} or'(d).) SAL Select 3 Letter Office. Code For F?.laceNenue oi Hearing (From chume'nt Cover Sheet) Employge(Cdmpletion cf this seq'tibn,lsxrequlred) GEORGE .. . A .F(rstName ‘ ' WIT HAFELY Last Name .892 RYAN CT .AddresslPO Box (Please leave blank spaces between'nurfilbersp names or w'ords) GILRoY CA 950.204m ' ' Employer Information (Completion of this section is ne‘quired) Insured D Sélf-Insmad D Legafl'y Uninsured D Uninsured GRANITE ROCK ,Employer Name(PJease ieave blahk spades Between, numb'ers, name's or words) 1171-1 BERRYESSA RD; . Employer Street AddressIPO‘Box.(Please leave blank Spaces between numbers, name's, o; Words) SAN-Joszs , ‘ _ CA 95133City ’ state Zip Code " gwocA fanmozu (c) (Rev. 1112mm (Page 1 0191 Stafe Zig'Oode . {A.ppli'cant's Attorney orAuthorized Répresentafive: l l Law Ffrm/Afiomey D Non Attorney Representative. ROBERT Fifst Name FARAHMAND Laét Name 6995.724 Law Firm {dumber WILSON WISLER SALINAS Law Firm Name 21 MAPLE ST , .. . Address/RO Box (Please leaVe blank spaces behue‘en numbers, names or wards) CA _ 9390 1; SALINAS State Zip Code City . Defendant's Attorney or A uthorized Representative:l(Law Ffrm/Attomey [j Non A_ttomey Representative +ANDREW First Name LYNCH Last Name 4601297 , LawFirm Number “-- WITKOP LAW SAN JOSE Law Firm Ném'e l625 THE ALAMEDA STE 90] Address/PD Box {Please leave blank Spaces between numbers namesor words)‘ “’5 SAN JOSE . CA 95 I126 . City ' “ ' ‘ State Zip Code Insura'nce Carrier Information (if known and if applicabl-e incl’ude even if carrier is adjusted by claims administmmr) ZURICH SAN FRANCISCO ln'suranc‘e Cam'er Name (Please have blank spaces between rjumbers names o'r words) Po Box 968002 ‘ Insurance Carrier Streat AddrwsIPO Box (Pleasg‘laave blank spaces between numbers. names or words) S‘CHAUMBURG ' , , 1L 60(96.Gfly ' ' State ‘ Zip Cod‘e I Dwo-CA 1mm 1‘9214-(12) (Rpm 1112008) (Page 2 aw) Giaims Adminiii’rrjetbr lnfarmal.- .. ur’ known and If applicablg} Na‘me-(Pleasa léave blank spaces between numbers, nam‘w nerords) Street Address/PO Box(Pléa‘se leave-blank spaces betwee‘fi nu‘mbersmames orwords) I ILL ._~_City I I ' . Stété Zip Code n Is CLAIMED THAT: '1. ThB'l'njUF'ed employeefbal’n 052/1 7/1 965 I alleges thai whileaemquye‘d as a(n) i (DATE 0F BIRTH: MM/DD/ym) PLANT OPERATOR . , sustained injury(OCCUPATIQN ,mf :THE TIME QF INJURY) arising out o‘f a'nd in the course ofempio‘yment “a! th‘e, tocatlbns and during the dates listed below: {State with specificitymefdatém of injuryUas) arid what parfls)"of body. cohdifiqns or system‘s are'being sewed.) Specific lnjLer ADJ10636694 . 06/03/20.l_4' A ‘ _ . ‘ . Case Number 1 B Cumulative Injury (Sl'ari DateI-MMZDE/YYY-Y) (End DatezMM/DDNYYY) ' ‘(lfSpgcific Injuzy, yse the start- dare as. the $5th dare of injuryf Body. Pa'rt 1:W Body Part 2: . Bqdy Part3: Body Part 4: I Other. Body Parts: The JndJCy occurred at'l 1711 BERRYESSA RD I ” '(Streel AddressJPD Box- Pleas'aJeaVE blank spacés bgtwéén numbers. _. namesqr words} SAN JOSE. . . CA 9 133 . .City "'" 'Stat'e Zip Code Body parts, conditions and systfiefnsmay' notbejnoorporaled by reference t‘o medical reports. I pwc-OA farm 1,0214 (n; (Rev, 172005) (Page mar 9}. I U .Spe‘cific Injury@J 10005980 (DENIED) ‘ ' I 06/01/2010 . 06/22/2015 Case Number2 Cumufatwe Injury (start a_azez-MMJDD/WYY) (End Dam: MWDDNYW) . . {IfSpeciflc minim use the s’ta‘r‘t dale as 'the spec‘iflt dai‘ewf'ilnéafy)MRI: MILD SPONDYLOSIS AT L4-5 AND L5-S.l, AS=WELL AS .MILD FACET ARTHROSIS, BUT QDISCI - - . HERNIATIONBody-part 1; .420 BACK. BQdy Parf 2: 850 RESP SYS Body‘FaH '3: ‘ Body Phr‘l ‘4: Other Body Parts: The Injury occurred at '1 J 7171 BERRYESSA RD (Stieet Addreés/PG Box - Please'leaye'btsnk spaces betwsefi numbers; riames or words) SAN'JDSE fl..- CA , 95133City‘ " State 3p. C_qde Bndy pads conditions and system‘s Wincorpomted by reference to medica! reports. D Spécifio lriJuryADJ] 0 I 98439 ' v Case Numb“ r 09/01/201 4 09/1 0/2015I Cumufative Injury (Stan DamMM/QD/WYY) (End Date: MMIDDNYYY)(wSpeclflanjum use th‘e start da'te a5 the specmcd’ate ofinjpzy), BodyPart‘l: 841 STRESS Body Part 21 , Body Pérf 33 Body pad 4': . Other BOdY Part8?W- The injury occurred at 117] l BBRRYES'SA RD _ _'(StreetAddres'lPO Box ~ Fleesa leave' blank spam between numbers. names or‘mrdé) CA 95133 City ' State Zip“ Cede. Body part5, Conditions and systems max-not be incomemted by reférence lo medical report's.D Specffi'c Injury SAN JOSE Case Number 4 Cumulaihre injury {End Date: MMIDp/h’YY-Y) jglafi Date; MMEUW 7 V W. D. (fSpecific Injwjt, use the-stqrra'o'te Q5 2712' specfic date afinjury) Body Part 1-: Body Part 2: Bgdy Part 3: , _ MBody Part 4: Other Body Parts: Theflnlury o‘ccurre‘d at {Stee} AddresslPB Box - Please teéva filank sp'amczbthae'n numbers, namescr words} ' City ‘ Stale Zfifioae . Body pads. conditions and systems may notbe incorporated by reference to medical reports. l ch-CA form 102mm (Rea. 1112008)]th 4 or 9)‘ ’ I L_I Specific Injury ' I Case Numbers ' D Cumulative Injury mmm‘ n a e:‘ {Uspedflc Injmy; use the st'nrt date gs the specific date ofinjury] Body Part 1: Body-Péd 2:. . Body'Part 3: Body Part4: . Other Body Pansy The injury occurred at (StreetAdficem/PO Box- Please leave blank Space's betw‘e‘en h’Umbe‘rs, names or wows) O I City ‘ ' State zip Code Bbdy pans. conditions and system s‘ may hot be lncdrporated by reference to medica! reports. 2. Upon approval of this cofnpromisa agreement by the Workers' Compensation Appgals Board or a wo'rkers' compensationédministtatiw Iawjudge and payment in accordance with the provisions‘hereof, th’e employee releases and foreverdischarges the abovepnamed 'employer(s) and'insur’ance carrierfs) from a1! claims and CauseS-o‘f action. whelher now. knownor ascenained'or wh'lch. may hereafter arisé or develop as a result of the apove-referenced ihjur‘yfles), inqudlngzanyand allliabilftyoftbe employeds} and the Insurance c’am‘er(s) ‘ahd each of them to the dependents, heirs. execmqrs,representatives.administrators or assigns of the empibyee. Execution of this form has no effect on claims that are not within: vzh_e scope of the'workers' compensaflon law .or claims that‘are not subject to the exctusivity provisions of‘th'e workers'compensétion law, umess otherwise expresslysiated. 37This agreement is limited to settlement of thebody pans, conditions, or systems 'and {or the dates of injury s‘et form InParagraph, No. 1 and fudherexplainéd in Paragraph No; 9WWW , , ‘ _ '_ ' 4. Unless otherwise expressly stated. approval o'f this agreement RELEASES ANY AND ALL CLAIMS OF APPL!CANT'S.DEPENDENTS TO DEATH BENEFITS REtATlNG'TO THE INJURY OR INJURIES COVERED'BY THIS COMPROMISEAGREEMENT. The parties h'ave considered therelease of these, benefits ‘I’n anivin‘gatthe-sum in Paragraph ?..A‘ny a‘dde‘ndumdupiicaling this language. pursuent 10 Sumner v WCAB (198,3) 48 QCC 369 Is unnecessary andshall not be 'attgbhecl. .5. ,Unigss otherwise expressly ordered by the Wofke'rs’ Compensation Appeals Board or. a workers’ cofnpe'nsationgdfifinisjraflve law Judge; approvar of this agreement does nbgreieas'e anyclaim applicant may hBVe fo‘r vocationalrehabilitation benefits pr suppfiemenial job displacementbsneflts. 6, The parties represent that tfia following facts are true: (If facts are diéputed, stata‘whai e'ach party contends underParagraph No. 9.) EARNINGS AT TIME 0F mums «9182.33 TEMPORARY D!SABILH’Y INDEMNITY PAID 0.00 H weekly Rates 13074.59, PefiomsWald , . .(sun Days: MMODNWY) ' (End Date: MMIDD/YWY) PERMANENT DISABILITY INDEMNITY PAID 0.00 . Weekly Rate $ 29.0.00/WEEK Period(s) Paid _ ‘ End date (sum Dam: MwDo/ij _ {End Datei MM/DDIY‘?WJ TOTAL MEDICAL BILLS PAID $m Total Unpaid Medical'Expense to be Paid By; magma. Emma; Agngxgg "‘Wamvwin‘ -- 'ncorniu 'I s. . .T 'x .oo' Un125$.otherwis‘e specified herein, the employerwm pay no‘medical expanses In‘curred after approval of this agreement. 2 Dwdmgumwzm (c; (Rev.- 112003} (Page 5 or e) ’ {I The parties agree 16 se'uka the a;bovacla{m.(s)~on' acc‘ounl of‘lhe injuryfies) byme payment ofihe SUM OF' - i 5' 140.000.0'0 SeflreiIie‘nt Amount The following amounts areto be deducted from the semement amount: 3 0’00 _ for permanent disabilityadVances through PRES.ENT« SUBJECT TO FROG}?‘ . S. 5 35,000.00 for temporary disability indemnity DUemayrne‘nr, if any. payabie 1o Avmcmr To ‘sgLF-ADMJMQPER MEDICAR&CQVE'RED INDUSTRIALLYRELATED TREA‘WENT AMER 'OACR, PER ADDBWDUM . payabka‘lo s . . Payabiert}: SM payablle tQ A. . ‘ _'__5% requesied as applicant's-altorney’sfeefi/ . ‘. CG .. .. . . LEAVING A‘ BALANCE pf: 5-m g 7,00 0 . V-J’. after deducting the amountssetfarth above and lessfurther permanent dlsahlmy advances mé‘éieaffer’ the g’ate 596lo aboVe. Iniefest under Lab‘or- Code section 5800 1‘sincluded ff the sums set forth herein are paid within 80 days after the cafe of approvalpfthfs agreement. E. Liens notmenu‘nned in Paragraph No- T are to bg‘disppsed of~as fougws (Aigach an addendum 1f necessary); .‘No LLBNS .ON ADDRESS RECoRD. ‘ ' LI mac». roan 10‘2’14 (c) mew. name) (Page 5 or 9; 9. The parfies‘wfsh to settle these matters to avoidih‘e costs, hazardsand de‘Iays offurther litigation, and agfge that a_ s I serioua diapute exists as to the foilov‘ving iSsuesflniti’ai only moss that apply). ONLYJSSUES INITIALED BY THE APPLIQANTOR HISYHER REPRESENTATIVE AND DEFENDANTS OR THEIR REPRESENTATNES ARE lNCLUDED WITHIN THISSETTLEMENT. W5! Agplicsnt‘Defendant. .’ GH AL eam’ngs GH AL ‘ temporary disabiiity jurisdiction 911m“ AL appofiionment empJoymeni GH . AL injury AOErCOE (on-ADJ: 0005980) n m serious and willful misconduct 12:"; GH L disgriminalion (Labor Code §1 32a) statute 6f limitations .GH AL future 'medical treatment GH AL other PENALTIES, ATTORNEY FEES, COSTS, MILEAGE, SANCHONS GH AL _ permanent disabmty INCLUDING NATURE & EXTENT (3H AL sle-proc'ured medical treatment. exceptas provided in Paragraph 7 vocational rehébilftétion.benefils/supplemental job displacement benefits (on ADJ10005980} COMMENISMVVX Afimcium B 6? Ff} THIS DOCUMENT. ALLCOND'mONs; ADDENDQM A ‘ wcoxpommn HEQEJN. THIS smLEMENTRESOLVEs THE DATES 0F xwuay LISTED IN v t ~ . , EQUELaB Ag BENEFITS RESULTING FROM DATEs-or JNJURY WHICH WERE CLAIMED, 0R.coULD Hm/g 855,»: CLAIMED. ARE RESOLVEpAPPLICAM VEmnes THAT ms ADDRESS 0N 'rms DOCUMENT is‘ACCUM'rE AND THAT ALL co‘mgssporq ' ‘ , _ , o ‘r’HE ADDRESS 1.1st 0N THIS DOCUMENT‘. Tms-smmMENT-WAS JOINTLY Dumb BY-msip‘mmfis; AP‘Pucm HAS Arman m ' o‘cw. sacwgm’ mSABILm' BENEFITS... THIS smug ANY CUMULATIVE‘TMUMA To THE cLA1MED‘GOan‘10NS,,WH‘HHERPLEA‘pED '0,0T. ANp s _ , E's THE CLAW As. To Au, EMpLgyaas WITHIN ms CUMULA'nVE TRAUMA PERIOD. MPLICAN’T HEREBY EUREVEJR' wmvas' mn'uchmEs ANY mGHTTQsma PARTIES srrzruwrs'ro THE FOLLOWING:- Amlot‘rs‘ééwiml 6/320” Lowmck cum; ls ADMITTED AND PD BASED 0N ORTHQPEDK: AME DR. GRAUBARD RATE; A3 1201;.qu15,03- 15,- [1.5121 43014.8 «31%.' 1455me 1s DENIED. THERE 15 No .EVIDENCEOF Aflgsmm’rogv INJURY. OR A SPIN}:. INJURJ. , I . _ uAngmw'shso) om CT 9110mm 'STRESSIPS YCHE CLAIM=IS ADMMEQPQME DR..AL_J,OY RATES PSYCHE Pp A5 1’01.prsz . ‘ . 14m 4941.41-41 4802-38 - 42%. _ _ ‘ 13 SETTLEMENT Doss NOT 'PRECLUDE MY RIGHTS; CLAIMS. CAUSES 0F ACTION QR REMEDIES No“? EXCLus'NELY wrrHIN mEumsdxcmor'x‘ OFTHE WCAB. Any accrued claims forLabdr Code secfinr‘l 5814 penalties are included }n this setUsmenlju‘nless eXpressiy exduded. were a'vaflabfe‘ as of thedate pf filing of this ensation‘administrafive Iaw-Judge may thereafter either a_ppm’ve- this Compromise anddings; and Award after' hearing has bean heid and the matter regula‘rky'submitted'for J. document! and jhat th_e workers' camp Release or disapprove it and issue Fin decision. J. owc-CA tom. 10214 (b) (Rg'v. 1122003) (Pag'qn oi 9). i 11. WARNING To EMPLGYEE: SEWLEMEM 0F YOUR WGWKERS' COMPENSATION CLAIM BY COMPR'Q'MISE AmRELEASE MAY AFFECT OTHER BENEFITS YOU ARE ReeEMNG‘ Tc) WHIGH‘YQU BEGQME ENTITLED TD RECEIVE INTHE FUTURE FROM SOURCES OTHER THAN WORKERS' COMPENSATION, INCLUDING BUT rm? LIMITED ToSOCIAL SECURITY. MEDICARE AND 'LDNG~TERM DISABILWBENEFWS‘ THE APPLICANTS (EMPLOYEES) SEGNATURE MUST BE’ATTESTED T0 BY TRIS DISWTERESTED PERSONS0R ACKNOWLEDGED BEFORE A NOTARY PUBUC By signing this agreement, applicant (empioyee) acknowledges that he/she has read and understands this agreement andhas had any questions he/she may have had abom this agreement ansWered to hls/her satisfaction. ‘ -7.-. 4k '- ‘ ' ‘ ’ ,Witness the stgnature hereof 1his__._.‘>_<_-___day of AWD- J Z; _l 7 at 3k? 1. r: c; S _ _. fr7 . ‘ , -" id: fl . .. L ‘ / ' lql‘ / 4v ..J . H7- ," V .-- a t 7 _ / u ,v' f - 1. I{/fJAC/ffifjé” [Jé7EL ,x' '2' .Czr‘x'.) I I M " v wnfrééy‘flé? ({x 3C; (fl?W51 (Date) EficanHEmpfoygfiff W (Dale) ‘ . . k . "7 ‘ q / ‘ - u}. -' V / ' / /' .'..795.9%)”. CmiLc’; (Or 30" )3 jw-imw 7'5 wt- Mm I C: 311‘ 43/ /Wimessz (Date) Am: _ rorAppnoam (Dare) . film é / 3 D/nbl7 Mbmfiy '0’ DBTEMEHt. Zufi‘ch American Ins. Co“ ' (33M) Interpreler (Date) AnfiréwWEq. a , . ./. .. nfl ' x.. .. _ . - {7/69//7WWGSM. Gran‘de Rack Company '(Eiate) ’ Jame -. Witkbp, Esq. IAtlbfiiéy .fbr.Défendam ‘ ' ‘lba‘iej‘ Artumeyd'or'D‘iaTenda‘m. ’ '(Ddfb) ’ ' l chwc/itum 10214 mam; mannosg-gpage a or 91 . I R’IE'DiCARE RDDENDUM Applicant h’as applied for Social Secun‘iy Disability Banefits. He has not qualified for.S‘déial Secufity‘Disability and 1‘s not Medimrs-eligible. Nevertheless, i1 is the intention oftheparties to take the interests of Medicare into consideratien with 615‘s settlement Accordingly, asoutlined on Page 6 of ‘tln’s document, the parties afllocatc $35,000.00 m applicant’sMedicare-covered future medical expenses. Applicant will retain ‘these funds in an interestbanging saving amount from wlfich he wil’] pay far his own Medicare-covemd medical irozmnc‘ntu‘nfil 1116 ,fij'n'ds arc “Exhausted. Since 'flic applicant is not ainm‘l'fly Medicare eligible, .CMSwill noT review this, orany-oiher “set aside .th'at‘the parties may mmplete; 'If in the future aMedicare Set Aside is required, defendant will intfcmnify and hold harmlcss both applicantGeorge-Hafely and applicant’s counsel Wilson & Wisler, LLP, against Medicare’s interests. Ifthe-npplicant does not qualify for Social Security Disability, “then the fiinds are-the applicant’s forhim to u'sa as he 1512:5565 wiIhom Icsfiction orjimitation. . z ’I /Dated: é/_fl~ / 2;.~/ 7 ., ’ I - .- . _,,u ,«/44mm /' ica'n'r -- Gedfggfi-Iafeliy ~ Affomey fer Applicant - Raberit Farahmand, Esq. Attorney far Defendants - Anfirew Lynch, Esq. ADDENDUM A ‘ Ge'orge Hafely ADJlQOOS980, . ADJ10108439, 1 ,m"-‘- ADI19636694 fig} f] ' Granite Rock Zurich San Francisco Applicant; ADDENDUM: CHARACTERIZATION OF SETTLEMENT PROCEEDS The terms of the-Compromise & Retea'se-ag'reement in George Hafely vs Granite Rock Zurich San Francisco, the. followingtenn's have been reached in‘regard to the settlement proceeds Applidantwi‘ll receive under This Compromisa‘and Rdg‘ase. This Characterization of thasettlemént proceeds is an essential ele’zfient‘of‘the Compromise and Release: l. “Total amount of Campzomisc and Rel‘eas‘e’: S 140.000.00 .less Applicantfs‘ attorney's fee: $421,000.00 2. Permanent disability benefits in the‘amount of.$0;00 have. been advanced to date. . 3. $57,371.08) dollar's are to be construad as temporary total disability benefits p'er‘the report of Dr. A‘lloy who found him-TTD for-qne year. 4. included in the Compromise and Release is the sum om} 4,000.00 ‘ tin consideration for Applicant’s waiiver‘ of’the‘ right to petition to. reop‘en for newvand further disability. 5. included in the Cc‘Jmpromise and Release is the §um offi 1.500;0.0 in consideratibn for Applicant’s waivjer b'fpotential death ban'efitsXSmnner Waiver). 6. Included in the Compromise and Release is th’e sum Qf E 0.00 in consideration. for. Applicant’S'waiver and dismissal of disputedclaims -to 7; ‘Included in th‘eCompromise and Release is the sum offi 35,000.00 to b‘e‘ used for future medical care. ‘ .8. After. deduction of Attom'ey's fees, considefation for waiver and dismissal of disputed claims, n‘ght t9 reapan, temporjary disability, Medicare“ covered ‘an'd no’neMedicare coveredlfilturc medical care, and permanent disability benefits, ‘advfiancedto date; thesum of$ 21,128.92 remains; This sum is being paid t0 Applicant due t0 a Iiferlong permanent disability which Will interfere with Applicant’s ability to engage in gainful employment for--the rest of his/her life". Thiscalculation isbased pn applicant’s date Ufbirth 0’5/1 7/1965 and hiS/her current aga of. 49‘with a life expectancy qf 30.4 based 0n the Social Security Life Exnectancv Calculator estimate of May 10, 2017 (attached as Exhibit b). The calculation 1's as fbllows: ”(#7. above)fi21,128.92 'ab'OVe divided by 51:11 months with the .a'ward payable 'in the sum of$2 413.40 ‘ pej- monfh fox the rest of'Applicant's life“ This is based on Sciarotta -v.Bawm, 337 F.2d 1.35 (3d Cir. 1989),. using the "Hartman" formula. The basis of this calculation. is set forth in Federal Regufation 20 CPR secfion-404.408 ef seq; and Social Security POMS‘DI52150-060. ' ' Retirement & SurvivorsBenpfirs; Life Bx; Social SeanityOnfineW Agltflx Change Gen‘der/Da‘te of Birth Life Ex ectanc Home Page. Retirement Planner Retirement Estimator Survivors Planner Other Things to Consider Aggly for Benefits Online' Qy Calculator hfipg/[xwmssazgov/cgivbin/longovityxgj' Retirement 8: Survivors Benefits sr .. F‘ q’aW Life Expectancy Calculator3M 'h)- ‘T’VIn The following fable lists the aVerag'e number of additional years a male born on May‘ '17, 1965, can expect t‘o We when he’ reaches a specifioage; Additional Life Expectancy Estimated Tatal At Age (in years) Years 51 and 11 30.4 82,4 .month‘sa 62 22.4 B414 57b 18.6 85.6 7O ' 16.5 86.5 é You'r current age. b You‘r normai (or full) refiremen'fvage: Note: The estimat'es of additional fife expectancy: t do not_take into account a widenumbgr ofifactors su’ch as current health! lifestylel and family history that could increase or decrea‘se life expectancy. d a're based on s: the gender and dafe of birth you entered. (your cohort) ando information from our cohort life eXpectancy'tablas. (Some of the information can be found .In 1he 2016 Trustees Report). ( Estimate. as of Wednesday May 1o, 2017‘ 12:24:45 EDT. 5110/1 7, 9:124 AM- M \OOOQO‘xUIAUJ 10 11 12 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Witkop Law San Jose ' Mona Palacios (408) 538-5900 mona@witkoplaw.com PROOF 0F SERVICE BY MAIL (CODE 0F CIVIL PROCEDURE §§1013, 2015.5) STATE OF CALIFORNIA, COUNTY OF SANTA CLARA I am 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 1625 The Alameda, Suite 901,San Jose, CA 95126, on July 21, 2017, I served the within: Order Approving Second Amended Compromise and Release dated July 14, 2017 Second Amended Compromise and Release RE: George Hafely V. Granite Rock Company ADJ10636694; ADJIOOOS980; ADJ10108439 on the parties in the said action, by placing a true COpy thereof enclosed in a sealed envelopewith postage thereon fully prepaid, in the United States mail at San Jose, California; addressedas follows: Michael Leon (via e-mail & USPS) George Hafely Zurich American Insurance Co. 892 Ryan Coufi P.O. Box 968002 Gilroy, CA 95020 Schaumburg, IL 60196 (#2010240543 (Master); 201 0258337) Robert Farahmand, Esq. Wilson & Wisler Stephanie Kniffin (via e-mail) 21 Maple Street Matt Reade (via e~mail) Salinas, CA 93901 Granite Rock Company OD Legal Oakland JoAnn M. Gamoras (Via e-mail) 1515 Clay Street, Suite 701 Wells Fargo Insurance Services USA, Inc. Oakland, CA 94612 SIBTF Sacramento 160 Promenade Circle, #350 Sacramento, CA 95834 I declare under penalty of perjury under the laws of the State of California that theforegoing is true and correct. /Executed 0n July 2] , 2017, at San Jo )6 V lbafine'Dai'i/ 1 625 ‘17ie fiflzmed‘a, Suite 90] San Jose, Cfl 95126 TeE (408) 5384900 rmx- (408) 538-5901 , California. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 -1- Case No. 17CV316847 SMRH:485248776.1 PROOF OF SERVICE PROOF OF SERVICE George Hafely v. Granite Rock Company, et al. Santa Clara Superior Court Case No. 17CV316847 At the time of service, I was over 18 years of age and not a party to this action. I am employed in the County of San Francisco, State of California. My business address is Four Embarcadero Center, 17th Floor, San Francisco, CA 94111-4109. On November 21, 2018, I served true copies of the following document(s) described as: DECLARATION OF BRIAN S. FONG IN SUPPORT OF DEFENDANTS’ NOTICE OF MOTION FOR SUMMARY JUDGMENT OR, IN THE ALTERNATIVE, SUMMARY ADJUDICATION on the interested parties in this action as follows: Lawrance A. Bohm, Esq. Tracy C. Law, Esq. Bohm Law Group, Inc. 4600 Northgate Boulevard, Suite 210 Sacramento, California 95834 Tel: (866) 920-1292 Fax: (916) 927-2046 Email: LBohm@Bohmlaw.com TLaw@Bohmlaw.com Attorneys for Plaintiff, GEORGE HAFELY Erik M. Roper, Esq. Law Offices of Erik M. Roper 2121 Natomas Crossing Drive, Suite 200-117 Sacramento, California 95834 Tel: (916) 281-8249 Fax: (916) 527-0118 Email: Erik@Eroperlaw.com Attorneys for Plaintiff, GEORGE HAFELY BY MAIL: I enclosed the document(s) in a sealed envelope or package addressed to the persons at the addresses listed in the Service List and placed the envelope for collection and mailing, following our ordinary business practices. I am readily familiar with the firm's practice for collecting and processing correspondence for mailing. On the same day that correspondence is placed for collection and mailing, it is deposited in the ordinary course of business with the United States Postal Service, in a sealed envelope with postage fully prepaid. I am a resident or employed in the county where the mailing occurred. BY FAX TRANSMISSION: I faxed a copy of the document(s) to the persons at the fax numbers listed in the Service List. The telephone number of the sending facsimile machine was 415.434.3947. The transmission was reported as complete and without error. No error was reported by the fax machine that I used. A transmission report was properly issued by the sending fax machine. BY E-MAIL OR ELECTRONIC TRANSMISSION: I caused a copy of the document(s) to be sent from e-mail address eruiz@sheppardmullin.com to the persons at the e-mail addresses listed in the Service List. I did not receive, within a reasonable time after the transmission, any electronic message or other indication that the transmission was unsuccessful. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 -2- Case No. 17CV316847 SMRH:485248776.1 PROOF OF SERVICE BY OVERNIGHT DELIVERY: I enclosed said document(s) in an envelope or package provided by the overnight service carrier and addressed to the persons at the addresses listed in the Service List. I placed the envelope or package for collection and overnight delivery at an office or a regularly utilized drop box of the overnight service carrier or delivered such document(s) to a courier or driver authorized by the overnight service carrier to receive documents. BY PERSONAL SERVICE: I personally delivered the document(s) to the person at the addresses listed in the Service List. (1) For a party represented by an attorney, delivery was made to the attorney or at the attorney's office by leaving the documents in an envelope or package clearly labeled to identify the attorney being served with a receptionist or an individual in charge of the office. (2) For a party, delivery was made to the party or by leaving the documents at the party's residence with some person not less than 18 years of age between the hours of eight in the morning and six in the evening. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on November 21, 2018, at San Francisco, California. Elena E. Ruiz Elena E. Ruiz X