CITY OF RIALTO CITY CLERK'S DATE STAMP
LIABILITY CITY OF RIALTO
cITy 2022 MAR - 3 PM 12: 37
CLAIM FOR DAMAGES
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: 150S. Palm Ave., Rialto, CA 92376
Address: 290 W. Rialto Ave., Rialto, CA 92376
CLAIMANT INFORMATION:
Ruth Brown
FULL NAME -
DATE OF BIRTH
Rialto, CA 92377
HOME ADDRESS INCLUDING CITY, STATE & ZIP HOME TELEPHONE NO.
BUSINESS ADDRESS INCLUDING CITY, STATE & ZIP BUSINESS TELEPHONE NO.
ADDRESS AT WHICH CLAIMANT DESIRES TO RECEIVE Russell & Lazarus APC NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM 1401 Dove Street, Newport Beach, CA 92660 (if different from home address provided above):
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE: 08/29/2021 TIME: _ 1:14 • AM I PM
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.
Approximately 36 feet south of the intersection of North Linden Avenue and Bohnert Avenue in the city of Rialto, county of San Bernardino, state of California.
3. HOW DID DAMAGE OR INJURY OCCUR?
See attachment - Claim Against Public Entity
4. WERE POLICE AT THE SCENE? X YES • NO WERE PARAMEDICS AT THE SCENE? * YES • NO
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 attachment - Claim Against Public Entity.
6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage $ Unknown at this time but exceeds Limited Court jurisdiction.
HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE:
Item/Date: Amount: $.
Item/Date: Amount: $
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: $_ Unknown at this time but exceed ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN: Limited Court jurisdiction Item/Date:
Amount: $
Item/Date: Amount: $.
TOTAL ESTIMATED AMOUNT PROSPECTIVE DAMAGES: $. _Unknown at this time but exceed:
Limited Court jurisdiction.
7. WITNESSES TO DAMAGE OR INJURY List all persons known to have information (attach additional pages, if necessary) NAME:
NAME:
ADDRESS:
ADDRESS:
TELEPHONE: L TELEPHONE: )
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITAL(S) VISITED:
NAME: NAME:
ADDRESS: ADDRESS:
TELEPHONE: ( TELEPHONE: (
DATE: TIME: • AM • 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.
CURB
PARKWAY
SIDEWALK
HAVE READ THE FOREGOING CLAIM AND KNOW THE CONTENTS THEREOF; AND CERTIFY THAT THE SAME IS TRUE OF MY OWN KNOWLEDGE EXCEPT AS T 'HOSE MATTERS WHICH ARE HEREIN STATED UPON MY INFORMATION AND BELIEF; AND AS TO THOSE MATTERS I BELIEVE THEM TO BE TRUE \CERTIFY (OR DECLARE) UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
SIGNATURE OF CLAIMANT OR AGENT
Marc Lazarus 02/28/2022
TYPE OR PRINT NAME DATE
Attorney for 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 1 CLAIM AGAINST PUBLIC ENTITY
2 TO: THE STATE OF CALIFORNIA/DEPARTMENT OF TRANSPORTATION 3 RUTH BROWN hereby makes a claim against CITY OF RIALTO for an amount within the 4 Superior Court jurisdiction and makes the following statements in support of her claim. 5 1. Claimant, Ruth Brown, as the surviving wife and heir at law of Decedent, 6 Gary Brown, as well as a successor in interest to the Estate of Gary Brown, deceased, is entitled to bring 7 this action pursuant to C.C.P. §337.30, 337.60 and 377.61. 8 9 Claimant's address is 3390 Laurel Avenue, Rialto, CA 92377. 10 3. Notices concerning this claim should be sent to Russell & Lazarus, 1401 Dove 11 Street, Ste. 310, Newport Beach, California 92660.
12 The date and place of the occurrence giving rise to this claim are on or about 13 August 29, 201 at or near North Linden Avenue, in the city of Rialto, county of San Bernardino, State of 14 California.
15 The facts giving rise to this claim are as follows:
16 17 On or about the above date and location, claimant, Katelyn Brown, was driving a vehicle (owned 18 by her parents, Ruth and Gary Brown) along with Gary Brown riding in the passenger seat, heading 19 northbound on North Linden Ave., in the City of Rialto, County of San Bernardino, State of California, 20 when she began to brake for an approaching stop sign and her vehicle was struck from behind by another vehicle and pushed into a large and/or oversized electrical power pole located dangerously near 22 the roadway, causing Decedent, Gary Brown, to suffer catastrophic, and ultimately fatal, injuries. 23 6. Pursuant to all relevant and applicable government code statutes, CITY OF RIALTO is 24 25 liable and responsible due the known dangerous condition on public property that was owned, 26 controlled, and maintained by said public entity. The dangerous condition includes, but is not limited to, the negligent, careless, and reckless placement and maintenance of an electrical power pole at or near an 28 GOVERNMENT CLAIM/CLAIM AGAINST PUBLIC ENTITY
1 intersection of North Linden Avenue and Bohnert Avenue, in the city of Rialto, county of San 2 Bernardino, state of California. Based on information and belief, the electrical power pole constituted a 3 reasonable foreseeable dangerous condition because it was precariously located in an area where it was 4 reasonably foreseeable that a traffic collision at the intersection would result in a motor vehicle straying 5 into and striking said electrical power pole, thereby resulting in a motor vehicle being engulfed in flames 6 and causing serious injuries and damages to claimants). At said date, time and place, claimants) were 7 occupants in a motor vehicle when their vehicle was forcefully rear-end and pushed across the 8 9 intersection into the electrical power pole at which time the motor vehicle was engulfed in flames and 10 caused serious injuries and damages to claimants, including fatal injuries to Gary Brown. Said public 11 entity knew or should have known of said dangerous condition for a long enough time to have protected 12 against it.
13 Decedent, Gary Brown, suffered catastrophic and fatal injuries. 14 On information and belief, the name of the public employee causing the claimant's 15 16 injuries is unknown at this time.
17 8. The claim amount claimant is requesting is consistent with the unlimited 18 jurisdiction of the Superior Court.
19 DATED: February 28, 2022 RUSSELL & LAZARUS
20 21
By:
22 MARC LAZARUS
Attorney for Claimant,
23 RUTH BROWN and KATELYN BROWN
24 25
26 27
28 GOVERNMENT CLAIM/CLAIM AGAINST PUBLIC ENTITY
PROOF OF SERVICE
(Declaration)
2 (C.C.P. §§1013(a) and 2015.5)
3 STATE OF CALIFORNIA )
SS.
4 COUNTY OF ORANGE
5 I, the undersigned, declare:
6 I am employed in the County of Orange, State of California. I am over the age of 18 and not a 7 party to the within action. My business address is 1401 Dove Street, Ste. 310, Newport Beach, California 92660.
8 On February 28, 2022 I served the following documents) STATE OF CALIFORNIA 9 GOVERNMENT CLAIM/CLAIM AGAINST PUBLIC ENTITY on the interested parties in this 10 action by placing a true and correct copy of each document thereof, enclosed in a sealed envelope, addressed as follows:
11 Office Of Risk and Insurance Management
12 Government Claims Program
P.O. Box 989052, MS414
13 West Sacramento, CA 95798-9052
14 15 (X) By Mail: I am readily familiar with Russell & Lazarus' business practice for collection and processing of correspondence for mailing with the United States Postal Service. I know that the 16 correspondence is deposited with the United States Postal Service on the same day this declaration was 17 executed in the ordinary course of business. I know that the envelope was sealed and, with postage thereon fully prepaid, placed for collection and mailing on this date, following ordinary business 18 practices, in the United States mail at Newport Beach, California. 19 Executed on February 28, 2022 at Newport Beach, California. 20 (X) (State) I declare under penalty of perjury under the laws of the State of California that the 21 foregoing is true and correct.
22 (Federal) I declare that I am employed in the office of a member of the bar of this court at whose direction this service was made.
23 24
25 / MULS
27 28
GOVERNMENT CLAIM/CLAIM AGAINST PUBLIC ENTITY
SANTA ANA CA 926
RUSSELL «LAZARUS US POSTAGEIMIPITNEY BOWES
RL 1 MAR 2022 PM 5 L
PERSONAL INJURY TRIAL ATTORNEYS -1S
1401 Dove Street, Suite 310 | Newport Beach, CA 92660 ZIP 92660 000.530 02 7H
0001339295 FEB 28 2022
Lialto City Clerks Office
150 S. Palm Ave. CITY CLEKF RECEIVE 2022 MAR -3 PM 12: 37 CITY OF RIALTO Rialto, CA 92376
92376-648799 RB