LAW OFFICES OF 1306 W. Magnolia Blvd.
Burbank, CA 91506
Z ANDREW ZEYTUNTSYAN Tel: (323) 882-6500
A PROFESSIONAL CORPORATION Fax: (800) 506-7176
www.a2zlegal.com
September 30, 2022
VIA PERSONAL SERVICES ONLY
City of Rialto
290 W. Rialto Ave.,
Rialto, CA 92376
CITY CLERK RECEIVED 2022 SEP 30 PM 3: 14
RE: Our Client (s): Stacy Bernadette Reyes
Date of Accident: 04/02/2022
To Whom It May Concern:
This office has been retained to represent the above-named clients for a claim against the City of Rialto, for the personal injuries and property damage arising out of an incident that occurred on the above-mentioned date. Also, enclosed please find the Claim for Damages forms.
Please advise us as to any irregularities or errors that need to be corrected to secure the proper and timely acceptance of this claim. In the event we do not hear from you, we will assume that all necessary requirements have been met.
Should you have any question or comments, please do not hesitate to contact this office.
ANDREW ZEYTUNTSYAN, ESQ.
Dictated but not read by Andrew Zeytuntsyan, Esq.
CITY OF RIALTO
LIABILITY 2022 SEP 30 PM 3: 14
CLAIM FOR DAMAGES RECEIVED
TO PERSON OR PROPERTY 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 5911.2).
2.Claims for damages to real property must be filed not later than one (1) year after the occurrence (Gov. Code §911.2). RETURN TO:
3.READ ENTIRE CLAIM FOR BEFORE FILING Rialto City Clerk's Office
4. ATTACH SEPARATE SHEETS, IF NECESSARY, TO GIVE FULL DETAILS Mail: 150 S. Palm Ave., Rialto, CA 92376 Address: 290 W. Rialto Ave., Rialto, CA 92376
CLAIMANT INFORMATION:
Stacy Bernadette Beyes
DATE OF BIRTH
FULL NAME
El Monte, CA 71732
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 1300e W. Magnoia Blude
NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM
(if different from home address provided above): BurbanK, cA 9150c
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE: _ 04/02/2002 . TIME: 12:30 MAMOPM
2. PLACE OF ACCIDENT (OCCURRENCE) BE SPECIFIC - Describe fully and (if applicable) locate on diagram on roverse side of this sheet.
Where appropriate, give street names and addresses, measurements and landmarks. 1284 W. Randall Ave, Bloamingtan, CA 923kce
3. HOW DID DAMAGE OR INJURY OCCUR?
Police was Crashing a venice Which cause to hit arother Vehicie The Vehicles Cross into our Client's hame. As a result of this impack ax client was inlured.
4. WERE POLICE AT THE SCENE? • YES DINO WERE PARAMEDICS AT THE SCENE? 60 YES DINO
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.
Police _ Caused the car they were chasing to crash.
6. GIVE TOTAL AMOUNT OF CLAIM Include eslimate of amount of any prospective injury or damage $ HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE:
Amount: $
Item/Date:
Item/Date: Amount: $
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM:
ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN:
Item/Date: Amount: $-
Item/Date: Amount: $_
TOTAL ESTIMATED AMOUNT PROSPECTIVE DAMAGES: • Quer 25,000
7. WITNESSES TO DAMAGE OR INJURY List all persons kurown to have Information (attach additional pages, If necessary) NAME:. Unknown at the present time NAME:
ADDRESS: ADDRESS:.
TELEPHONE: L 1 TELEPHONE: L
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITALS) VISITED:
NAME: _ Garfield Medical Center
ADDRESS:. ADDRE88:
Masterous Park, CA
TELEPHONE: | TELEPHONE: (
DATE 4/2/2022 ME: 20:35 RAMPA DATE: TIME: DAMO PH
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 comers.
If a cityltown vehicle was Involved, deegnate by letter "A" location of the Cly Town vehicie when you first saw It, and by "B® location of yoursell or your vehlele when you firet saw City/Town vehicle; location of Clly/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 PIT THE SITUATION, PLEASE ATTACH A PROPER DIAGRAM SIONED BY TRECLAMANT.
CITY CLERK RECEIVED
CURB PH
PARKWAY 3:14
/ SIDEWALK
I HAVE READ THE FOREGOING CLAIM AND KNOW THE CONTENTS THEREOF; AND CERTIFY THAT THE SAME IS TRUE OF BY OWN KNOWLEDGE EXCEPT AS TC THOSE MATTERE 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
Andrew Zeytuntsyan 9/30/8022
TYPE OR PRINT NAME DATE
Attorney
RELATIONSHIP TO CLAIMANT
NOTE: PRESENTATION OF A FALSE CLAIM IS A FELONY (CA PENAL CODE72) RETURN CLAIM TO: RIALTO CITY CLERK'S OFFICE - 150 8. PALM AVE., RIALTO, CA 92376