CITY OF RIALTO CITY CLERK'S DATE STAMP
Opp LIABILITY
CITY OF RIALTO
CLAIM FOR DAMAGES 2022 MAR -4 AMII: 41
TO PERSON OR PROPERTY
RECEIVED
CITY CLERK
1. Claims for death, injury to person, or to personal property must be filed not later than six (6) months after the occurrence (Gov. Code §911.2).
2. Claims for damages to real property must be filed not later than one (1) year after the occurrence (Gov. Code §911.2).
3. READ ENTIRE CLAIM FOR BEFORE FILING RETURN TO:
4. ATTACH SEPARATE SHEETS, IF NECESSARY, TO GIVE FULL DETAILS Rialto City Clerk's Office Mail: 150 S. Palm Ave., Rialto, CA 92376
Address: 290 W. Rialto Ave., Rialto, CA 92376
CLAIMANT INFORMATION:
Orlin Alexander Garmendia George
FULL NAME
DATE OF BIRTH
Rialto, CA 92376
HOME ADDRESS INCLUDING CITY, STATE & ZIP HOME TELEPHONE NO.
L
BUSINESS ADDRESS INCLUDING CITY, STATE & ZIP BUSINESS TELEPHONE NO.
ADDRESS AT WHICH CLAIMANT DESIRES TO RECEIVE
NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM
(if different from home address provided above):
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE: 09/02/2021
TIME: 06:14 AM OPM
2. PLACE OF ACCIDENT (OCCURRENCE) BE SPECIFIC - Describe fully and (if applicable) locate on diagram on reverse side of this sheet.
Where appropriate, give street names and addresses, measurements and landmarks.
See Attached.
3. HOW DID DAMAGE OR INJURY OCCUR?
See Attached.
4. WERE POLICE AT THE SCENE? KI YES • NO WERE PARAMEDICS AT THE SCENE? YES ONO
5. WHAT PARTICULAR ACT OR OMISSION DO YOU CLAIM CAUSED THE INJURY OR DAMAGES? Give the name of the city/town employee causing the injury or damage, if known.
See Attached
6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage $ Exceeds $25,000.00 HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE:
Item/Date: See Attached Amount: $
Item/Date: Amount: $.
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: $ Exceeds $25,000.00 ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN:
Item/Date: See Attached. Amount: $
Item/Date: Amount: $.
TOTAL ESTIMATED AMOUNT PROSPECTIVE DAMAGES: $
7. WITNESSES TO DAMAGE OR INJURY List all persons known to have information (attach additional pages, if necessary) NAME: See Attached
NAME:
ADDRESS:
ADDRESS:
TELEPHONE: (
TELEPHONE: | )
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITAL(S) VISITED:
NAME: See Attached. NAME:
ADDRESS:
ADDRESS:
TELEPHONE: ( TELEPHONE: L)
DATE: TIME: DAM PM DATE:
TIME: • AM •PM
9. PLEASE READ THE FOLLOWING CAREFULLY:
For all vehicle accident claims, place on the following diagram, the names of streets, including NORTH, EAST, SOUTH AND WEST directions. Indicate place of accident by "X" and by showing house numbers or distances to street corners.
If a city/town vehicle was involved, designate by letter "A" location of the City/Town vehicle when you first saw it, and by "B" location of yourself or your vehicle when you first saw City/Town vehicle; location of City/Town vehicle at time of accident by "A-1" and location of yourself or your vehicle at the time of the accident by "B-1" and the point of impact by "X".
→ NOTE: IF THE DIAGRAM BELOW DOES NOT FIT THE SITUATION, PLEASE ATTACH A PROPER DIAGRAM SIGNED BY THE CLAIMANT. 2022 MAR,- 4 CITY OF RIALTO
W. Etiwanda Ave
CURB
PARKWAY ERK AMII: 41
SIDEWALK N. Cactus Ave.
I HAVE READ THE FOREGOING CLAIM AND KNOW THE CONTENTS THEREOF; AND CERTIFY THAT THE SAME IS TRUE OF MY OWN KNOWLEDGE EXCEPT AS TO THOSE MATTERS WHICH ARE HEREIN STATED UPON MY INFORMATION AND BELIEF; AND AS TO THOSE MATTERS I BELIEVE THEM TO BE TRUE.
I CERTIFY (OR DECLARE) UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
SIGNATURE OF CLAIMANT OR AGENT
Orlin Alexander Garmendia George 03/01/2022
TYPE OR PRINT NAME DATE
Claimant
RELATIONSHIP TO CLAIMANT
NOTE: PRESENTATION OF A FALSE CLAIM IS A FELONY (CA PENAL CODE 72) RETURN CLAIM TO: RIALTO CITY CLERK'S OFFICE - 150 S. PALM AVE., RIALTO, CA 92376
IDENTIFICATION
Claimant: Orlin Alexander Garmendia George ("Orlin Garmendia") Address:
Rialto, CA 92376
Phone Number:
Date of Birth:
SSN:
Drivers License Number: N/A
State Issued: N/A
DESCRIPTON OF INCIDENT
Date of Occurrence: On or about September 02, 2021
Time of Occurrence: On or about 06:14 AM
Place of Occurrence: On W. Etiwanda Ave. and N. Cactus Ave, Rialto CA 92376 At the intersection
Rialto Unified School District employee bus driver Regina Yvette Herbert Gillon ("Regina Gillon")
The total amount claimed exceeds $25,000.00 and the case would therefore be an unlimited civil case.
The identity of witnesses will be provided at a later date.
The following medical providers were consulted for the injuries to Claimant. This list is preliminary and is without limitations:
1. Ambulance
Unknown at this Time
Rialto, CA 92376
2. Arrowhead Regional Medical Center
400 N. Pepper Ave.
Colton, CA 92324
3. Dr. Kevin Aminian
8920 Wilshire Blvd., #548
Beverly Hills, CA 90211
4. SimonMed Southern CA Redlands
1690 Barton Rd., Suite 108
Redlands, CA 92373
CIRCUMSTANCES GIVING RISE TO THE CLAIM:
On or about September 02, 2021, Claimant was involved in a vehicle accident where a Rialto Unified School District bus driver crashed the bus into Claimant and was the actual and proximate cause of his injuries, included but not limited to:
1) Rialto Unified School District employee Regina Gillon failed to stop in time to avoid a crash with Claimant.
2) Rialto Unified School District employee Regina Gillon was not paying attention to the road and caused the crash.
3) Negligent hiring and negligent training
4) Regina Gillon, Rialto Unified School District, Rialto City, County of San Bernardino, State of California (collectively "Public Entity") were aware of all of the above issues and/or created all of the above issues.
As a result, Claimant sustained property damage and severe injuries, including, but not limited to his brain, head, neck, and upper and lower extremities. Claimant has sustained neurological injuries including but not limited to headaches, nausea, fogginess, grogginess, numbness, concussion, dizziness, loss of concentration, difficulty focusing, slow processing and memory loss. Claimant has also sustained psychological injuries including, but not limited to, irritability, emotional trauma, sleep disturbance, anxiety, and related general damages. Claimant's medical specials to date are currently unascertained. It is anticipated that he will require, and receive, further medical treatment in the future and throughout his lifetime. He has, and probably will continue to suffer loss of earnings and earning capacity in amounts that are currently unascertained. Vehicle damage. The extent of injuries and damages are still being ascertained; Claimant is seeking all economic and non-economic damages allowed under the law.
On information and belief, Regina Gillon was driving a Rialto Unified School District Bus northbound on Cactus Avenue, towards the intersection at Etiwanda Avenue. Claimant was travelling westbound on Etiwanda Avenue, towards Cactus Avenue. Ms. Gillon entered the intersection of Cactus Avenue and Etiwanda Avenue and failed to yield the right-of-way to Claimant or ensure the intersection was clear before proceeding. As a result, Ms. Gillon negligently and violently collided with Claimant, injuring Claimant's person and property.
On information and belief, the Public Entity is responsible under applicable law, including without limitation Gov. Code sections 815.2, 815.6, and 820. The following actions were substantial factors in causing damage: General Negligence. Negligent ownership, control, entrustment, management, repair, maintenance, leasing, and/or operation of the vehicle involved in the collision. Failure to use reasonable care to discover, repair, replace, and maintain the dangerous conditions of the vehicle involved in the collision. Negligent hiring, training, instruction, management, safety protocols, and supervision of employees and/or agents, including without limitation Regina Gillon.
At all times mentioned herein, the Public Entity owned, possessed and controlled the school bus.
At the time of the incident, the public property was a dangerous condition, and the injuries to Claimant were proximately caused thereby. Claimant sustained the kind of injuries which were reasonably foreseeable to defendants.
The dangerous condition set forth herein above was created by the negligence and/or wrongful act of public employees of the Public Entity while in the course and scope of said employment.
The Public Entity had actual or constructive notice of the dangerous condition in sufficient time before the injury to take reasonable measures to have protected against the injury.
These dangerous conditions and these acts and omissions of the Public Entity (and its management, administrative, designers, planners, engineers, maintenance personnel, inspectors and/or other employees, staff, agents or contractors, acting within the course and scope of their duties) proximately caused the Claimant's injuries.
Further, these dangerous conditions were directly attributable wholly or in substantial part to a negligent or wrongful act of these employees of the Public Entity and employees had the authority and the funds and other means immediately available to take alternative action which would not have created the dangerous condition; and/or these employees had the authority and it was his/her/their responsibility to take adequate measures to protect against the dangerous condition at the expense of the public entity and the funds and other means for doing so were immediately available to him/her/them, and he/she/they had actual or constructive notice of the dangerous condition a sufficient time prior to the serious injuries to have taken measures to protect against the dangerous condition.
Further, Public Entity and its employees acting within the scope of their employment undertook, gratuitously or for consideration, to avoid, remedy and/or abate these dangerous conditions.
These undertakings and promises were the kind that they recognized as necessary for the protection of third persons. These entities and their employees acting within the scope of their employment failed to exercise reasonable care in the performance of these undertakings and promises, the failure to exercise reasonable care resulted in physical harm to the third persons; and either (a) their carelessness increased the risk of such harm, or (b) the undertaking or promises were to perform a duty that the other owed to the third persons, or (c) the harm was suffered because either the other or the third persons relied on the undertaking. Due to these acts and failures to act and dangerous conditions, the Public Entity and its employees are liable for Claimant's injuries under the Government Code §S, including, but not limited to, 815.2(a), 820(a), 830.8, 835 and 840.2.
The Public Entity violated mandatory statutory duties relating to the above.
Damages include, but are not limited to, past and future medical and related expenses, pain suffering, and loss of enjoyment of lie, all in an amount according to proof.
GENERAL DESCRIPTIONS OF INDEBTEDNESS, INJURY, DAMAGE OR LOSS Without limitation, Claimant is permanently injured due to the Public Entity's fault and has suffered, and will continue to suffer the following damages:
1. Past future economic damages including, without limitation:
Past and future medical bills
Past and future non-economic damages including, without limitation: pain, suffering, loss of enjoyment of life, physical impairment, inconvenience, grief, anxiety, depression, insomnia, humiliation, emotional distress and other non- economic damages. The damages are in sum the exact amounts of which are not yet known to the Claimant, but which amounts will be proved at the time of trial.
CERTIFIED MAIL
2 MAR. 2022 PM 11E US POSTAGE
$ 007.530
0002604886 MAR 022022
MAILED FROM ZIP CODE 90212
7020 2450 0001 7117 3150
City of Rialto 2022 МАК - 4 нлі..
Attn: City Clerk's Office CITY CLERK RECEIVED CITY OF RIALTO 150 S. Palm Avenue
Rialto, CA 92376
LI
92376-648799