CITY OF RIALTO CITY CLERK'S DATE STAMP
LIABILITY CITY OF RIALTO
CLAIM FOR DAMAGES 2022 JUN 15 PM I: 20
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:
MARIANELA L. VENEGAS
-
FULL NAME DATÉ OF BIRTH
• RiALTO CA.92376
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 SAME
NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM
(if different from home address provided above):
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE: _ 5-17-2022 TIME: •AM *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.
CORNER DE RiVERSIDE AVE. ANDWVICTORIA ST
3. HOW DID DAMAGE OR INJURY OCCUR?
SEE aTTached MEMO
AND PITURES.
4. WERE POLICE AT THE SCENE? • 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.
DEEP DITCH AND UNEVEN PAVEMENT ARE NOT VISIBEL
WHEN CROSSING RiVERSiDE AYe, ThERE ARE NO SIgNS
INDICAT CHANEES ON THE ROAD.
6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage $ 1,944.
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:
ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN: $
Item/Date: ESTIMATES
ATTA CHE» 1,944.
Item/Date: Amount: $.
6/15/2022 6-18-2022
Amount: $
TOTAL ESTIMATED AMOUNT PROSPECTIVE DAMAGES: 1944.
7. WITNESSES TO DAMAGE OR INJURY List all persons known to have information (attach additional pages, if necessary) NAME:
NAME:
ADDRESS:
NA ADDRESS:
TELEPHONE:
TELEPHONE: L)
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITAL(S) VISITED:
NAME:
NAME:
ADDRESS: N/f
ADDRESS:
TELEPHONE: L
TELEPHONE: L 1
DATE: TIME:
DATE: _TIME:
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. 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 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 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 DEEP DiACH
RiVERSiDE AVE.
PARKWAY
7 SIDEWALK
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
MARiANELA L. VENEGAS 6-15-2022
TYPE OR PRINT NAME
DATE
RELATIONSHIP TO CLAIMANT
RETURN CLAIM TO: RIALTO CITY CLERK'S OFFICE - 150 S. PALM AVE., RIALTO, CA 92376 NOTE: PRESENTATION OF A FALSE CLAIM IS A FELONY (CA PENAL CODE 72) To: City of Rialto, Ca.
From: Marianela L. Venegas
Date: 6/6/2022
Subject: Request to cover repair cost for the damage to the underside of my automobile due to road construction at corner of Victoria Street and Riverside Avenue On 5/17/2022 1 was driving on Victoria Street and had to cross Riverside Avenue, an avenue with a lot of traffic, to continue on Victoria Street. I have been driving this street for over 20 years without any issues. Construction that was done to re-configure a wheelchair ramp in the crosswalk at the corner of Riverside and Victoria has resulted in a deep ditch and uneven pavement which are not visible when crossing Riverside Avenue and there are no signs to indicate the change on the road. On 5/17/2022 I drove over them which caused the bottom of my vehicle to hit the road pavement very hard. This damaged the underside of my car. As l continued to drive, I noticed that my car started making a loud clunking sound.
Upon taking my car to a service/repair shop for inspection, the technician informed me of problem that is outlined in the attached estimate totaling $1,944. Currently my vehicle is unsafe. The repair will fix the damage and make it safe again.
The reason for bringing this claim to the City, is that there is NO sign nor warning that cars will be driving over uneven pavement and a deep ditch that causes damage to the bottom of vehicles.
I kindly request that based on the attached repair estimate and pictures taken at the site, that the City of Rialto cover the cost for the repairs to fix the damage caused to my vehicle. If proper signs would have been placed at the site for public awareness, this incident would not have occurred.
Thank you in advance,
Marianela L. Venegas
Fontana Tire Center
(909)350-8695
Home: Jun 7, 2022 09:10 AM
Mobile: YMMS: 2010 Toyota Camry SE
Work: Engine: 3.5L Eng
Email: License:
VIN:
Odometer:
TYPE DESCRIPTION PART# QTY PRICE | RATE HOURS LINE TOTAL
SHOCK &/OR STRUT ASSEMBLY -
Remove & Install or Remove &
Labor - - $80.00 $200.00
Replace - [DOES NOT include 2.5
disassemble or alignment.] Both
Parts FRONT STRUTS- MONROE 2.0 $216.00 - $432.00
STABILIZER BAR - Remove &
Replace V6 w/Engine Removal -
[Includes: R&l Engine and
Labor - $80.00
Transmission Assembly with Front - - 13.6 $1,088.00
Suspension. DOES NOT include
wheel alignment.]
Parts SWAY BAR LINK 1.0 $101.25 $101.25
-
Labor ALIGNMENT - - $80.00 1.0 $80.00
Labor: $1,368.00
Parts: $533.25
Shop Supplies: $0.00
Hazardous Materials: $0.00
Labor Taxes: $0.00
Parts Taxes: $42.66
TOTAL: $1.943.91
Customer Signature:
RIALTO AUTO CARE CENTER
135 E. FOOTHILL BLVD Sub Estimate For Or
RIALTO, CA. 92376 313192
Phone: 909-877-5446 Fax: 909-877-3829
ARD00269174
Estimate for Services CAL000440415
Estimate Date: 6/7/2022
VENEGAS, MARIALENA 2010 Tovota - Camrv XI F - 3.5L, V6 (211CI) VIN(K) Odom. in: 66249
Part Description / Number Qty Sale Ext Labor Description Hours Extended
STRUT ASSEMBLY/Suspension Strut 2.00 285.50 571.00 SHOCK &/OR STRUT ASSEMBLY - Remove & and Coil Spring Assembly 2.20 338.80
Install or Remove & Replace - Both - [DOES
172384 NOT include disassemble or alignment.]
BRACKET 1.00 141.00 141.00 STABILIZER BAR CONTROL LINK - Remove &
0.60 92.40
STK Replace - Both
STBLZR BAR LINK/Suspension ALIGNMENT 0.88 109.76
2.00 169.48 338.96
Stabilizer Bar Link Kit YOUR ALIGNMENT COMES WITH A 30-DAY GUARANTEE.
MS86848
OIL PAN OIL PAN &/OR GASKET - Remove & Replace - 3.10 477.40
1.00 221.25 221.25 LE, SE XLE, V6 Lower Oil Pan
STK SUBFRAME - Remove & Replace - [DOES 8.70 1,339.80
NOT include alignment.]
Parts/Supplies: 1.272 21 Labor: 2.358 16 HazMat/Fees: 0.00 Tax 98.60 Total $ 3.728 97
I hereby authorize the above repair work to be done along with the necessary material and hereby grant you and/or your employees permission to operate the vehicle herein described for the purpose to testing and/or inspection. An express mechanic's lien is hereby acknowledged on above vehicle to secure the amount of repairs thereto. Warranty on labor is 3 months or 3,000 miles whichever comes first. Warranty on parts is only from OEM or vendor. Warranty work has to be performed in our shop & cannot exceed the original cost of repair.
Signature Date Time
LATINO'S BEST TIRES INC
Estimate
2793 W FOOTHILL BLVD
CA 92376 Date Estimate #
6/8/2022 47
Name / Address
Marianela L. Venegas
Project
Description Qty Rate Total
Lower Control Arm (Right) 89.99 89.99T
Labor: Install Lower Control Arm (Right) 95.00 142.50
*****************************************
CV Axle (Right) 125.99 125.99T
Labor: Install CV Axle (Right) 1 95.00
95.00 ****************************
44**>******
Oil Pan with Gasket
110.99 110.99T
Labor: Install Oil Pan 95.00
285.00
************************
‹××*****>×
Right Front Struts
169.99 169.99T
Labor: Install Front Right Strut 95.00 95.00
**************************************
0.00 Auto Alignment (NO WARRANTY) 1 59.00 59.00
****************************************
Subtotal $1,173.46
Sales Tax (8.75%) $43.48
Total $1,216.94