CLERKIN, SINCLAIR & MAHFOUZ, LIP
ATTORNEYS AT LAW
July 29, 2022
VIA CERTIFIED MAIL
USPS Tracking No.: 7020 0640 0002 1620 6666
City of Rialto
Date of Loss: 5/21/2022
Our File Number: 30184860-2
Dear Sir or Madam:
Our firm has been retained by Garrison Property and Casualty Insurance Company to pursue their subrogation interest. Enclosed, please find a fully executed claim form and supporting documents. Should you require any additional information, or wish to discuss the matter further, please contact our office at 619) 308-6550 or [email protected]. Please reference matter number 30184860-2 in all correspondence with our office.
Thank you for your assistance. If you are not the proper entity to provide notice of our claim, please contact our office to provide information on the proper entity.
Kind regards,
Clerkin, Sinclair & Mahfouz, LLP
CITY CLERK RECEIVED 2022 AUG - 1 AM||: 51 CITY OF RIALTO 2929 NORTH CENTRAL ExPRESSWAY
SUITE 320
RICHARDSON, TX 75080
619-308-6550
WWW.CLERKINLAW.COM
CITY OF RIALTO CITY CLERK'S DATE STAMP
LIABILITY CITY OF RIALTO
CLAIM FOR DAMAGES 2022 AUG - | AMI: 51
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 9237€
Address: 290 W. Rialto Ave., Rialto. CA 9237
CLAIMANT INFORMATION:
Garrison Property and Casualty Insurance Company a/s/o Destany Gross
FULL NAME -
DATE OF BIRTH
HOME ADDRESS INCLUDING CITY, STATE & ZIP HOME TELEPHONE NO. _c/o CSM; 2929 N Central Expressway, Suite 320, Richardson, TX 75080 (619 )308-6550 BUSINESS ADDRESS INCLUDING CITY, STATE & ZIP BUSINESS TELEPHONE NO.
ADDRESS AT WHICH CLAIMANT DESIRES TO RECEIVE Same as above
NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM
(if different from home address provided above):
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE: May 21st, 2022 TIME: 9:00 • AM IX 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.
Riverside Avenue in Rialto, California
3. HOW DID DAMAGE OR INJURY OCCUR?
On May 21st, 2022, USAA's insured was traveling near Riverside Ave in Rialto, California, when a vehicle (2007 Ford Crown Victoria, California License Plate No.: 1256928), owned by the City of Rialto, driven by Anthony Taramona, struck the insured vehicle on the rear end, resulting in property damage.
4. WERE POLICE AT THE SCENE? DYES •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.
Negligence on behalf of the City of Rialto and their employee, Anthony Taramona.
6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage $ 762.99 HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE:
Item/Date: Property damage Amount: $ 762.99
Item/Date: Amount: $.
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: $ 762.99 ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN:
Item/Date:
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: N/A
NAME:
ADDRESS:
ADDRESS:
TELEPHONE: )
TELEPHONE: |)
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITAL(S) VISITED:
NAME:N/A NAME:
ADDRESS: ADDRESS:
TELEPHONE: (
TELEPHONE: ()
DATE: TIME:
•AM 0PM 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.
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
CITY CLERN RECEIVED 2022 AUG-/ AMI1:51 CITY OF RIALTO
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 IOSE MATTERS WHICH ARE HEREIN STATED UPON MY INFORMATION AND BELIEF; AND AS TO THOSE MATTERS I BELIEVE THEM TO BE TRI I CERTIFY (OR DECLARE) UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
SIGNATURE/OF CLAIMANT OR AGENT
Joanna Rodriguez filing on behalf of Garrison Property and Casualty nsurance Company a/s/o Destany Gross. - 7/29/22
TYPE OR PRINT NAME DATE
Representative
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 0000 Froderloksburg Rond
San Antonto, Texas 78288
USAA
LIMITED POWER OF ATTORNEY
United Services Automobile Association, on behalf of itself and its subsidiaries and affiliates, including Garrison Property and Casualty Company, USAA Casualty Insurance Company, USAA County Mutual Insurance Company, and USAA General Indemnity Company ("USAA") hereby appoints Clerkin, Sinclair & Mahfouz, LLP ("Law Firm") to act as its attorney-in-fact for the limited purposes of filing claims, negotiating settlements, and executing settlement agreement documents, including Settlement Agreements, Stipulations for USAA and its subsidiaries and affiliates, received from the responsible party or their insurer on subrogation claim files placed with Law Firm for collection and/or litigation. Law Firm is herein authorized by and on behalf of USAA to bind USAA to enter into settlement agreements by settlement or stipulation in regards to collection and/or litigation of the subrogation claim files USAA has placed with Law Firm.
This Limited Power of Attorney is executed in connection with the Master Engagement Agreement for Legal Services entered into between USAA and Law Firm. Except as expressly stated herein, no other rights, powers, duties or authority is extended to Law Firm by the terms of this Limited Power of This Limited Power of Attorney will remain in effect until written revocation of the Limited Power of Attorney by USAA, but in no even shall it remain in effect after written notification to terminate the Master Engagement Agreement described above.
Dated: 5/25/16 UNITED SERVICES AUTOMOBILE ASSOCIATION
Seats Southe
BY:
-tigation A Managar
(Title)
SYLVIA M GUTIERREZ Bexar
E NOTARY PUBLIC-STATE OF TEXAS
COMM. EXP. 03-31-2019
NOTARY ID 13017321-1
(Notary Public)