CITY OF RIALTO
CITY OF RIALTO CITY CLERK'S DATE STAMP
2022 SEP - 9 PM 4: 14
LIABILITY
CLAIM FOR DAMAGES RECEIVED
CITY CLERK
TO PERSON OR PROPERTY
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:
Krystle Walker
FULL NAME -
DATE OF BIRTH
Fontana, 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 5861 Pine Ave., Suite A-1, Chino Hills, CA
NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM
(if different from home address provided above): 91709
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE: March 11, 2022 Unknown TIME: •AM • PM
Where appropriate, give street names and addresses, measurements and landmarks. 2. PLACE OF ACCIDENT (OCCURRENCE) BE SPECIFIC - Describe fully and (if applicable) locate on diagram on reverse side of this sheet. 1 received a notice of non-reelection from Rialto Unified School District while on FMLA leave.
I was also harassed and discriminated against by Linda Merino prior to and during my FMLA leave.
3. HOW DID DAMAGE OR INJURY OCCUR?
I was terminated from my position at Rialto Unified School District while on FMLA leave.
I was also harassed and discriminated against by Linda Merino prior to and during my FMLA leave.
4. WERE POLICE AT THE SCENE? • YES M 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.
The decision of the Governing Board to not re-employ me while I was on FMLA leave.
The continued discrimination and harassment by Linda Merino against me both before and during my FMLA leave.
6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage $ $650,000.00 HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE:
Item/Date: Wrongful Termination Amount: $ $250,000.00
Item/Date: Discrimination
Amount: $ 100,000.00
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: $ $350,000.00 ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN:
Item/Date: Harassment
Amount: $ 100,000.00
Item/Date: _ Other unknown future damages
Amount: $200,00.00
TOTAL ESTIMATED AMOUNT PROSPECTIVE DAMAGES: $300,000.00
7. WITNESSES TO DAMAGE OR INJURY List all persons known to have information (attach additional pages, if necessary) NAME: Carton Streeter
NAME: Lapetra Starling
ADDRESS: Unknown ADDRESS: Unknown
TELEPHONE:
TELEPHONE:
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITAL(S) VISITED:
NAME: None NAME: None
ADDRESS: None ADDRESS: None
TELEPHONE: ( None
TELEPHONE: L None
DATE: None TIME: None •AM 0 PM None
DATE:
_ TIME: None
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
PARKWAY
/ 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 DEGLAZEHINDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
SIGNATURE OF CLAIMANT OR AGENT
Matthew T. Falkenstein
August 29, 2022
TYPE OR PRINT NAME
DATE
Attorney for Ms. Krystle Walker
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