CITY CLERK'S DATE STAMP
CITY OF RIALTO
LIABILITY
CITY OF RIALTO
CLAIM FOR DAMAGES
TO PERSON OR PROPERTY023 FEB-8 PM 2:45
RECEIVE
1. Claims for death, njury to person, or to personal property must be fled not late than six (6) months after the cure de (Gov. Ebd 9112).
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:
Kimberly Avelar Alarcan
-
FULL NAME DATE OF BIRTH
Fontana CA 92337
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
NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM
(if different from home address provided above):
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE: 01/16/2023 TIME: 3:30 - 3:402AM • 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.
Going West of Renaissance Pkwy; between Locust and
Alder Are.
3. HOW DID DAMAGE OR INJURY OCCUR?
Pothole
4. WERE POLICE AT THE SCENE? YES • NO WERE PARAMEDICS AT THE SEE? ENO
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.
Pothole, City of Rialto
6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage $ 800 - 1,000 HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE:
Item/Date: Rim 1/19/23 Amount: $ 593.26
Item/Date: •Tires 1/19/23 (2x) Amount: $_ 300.14
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIMM:
ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN:
Item/Date: Labor
Amount: $ 196
Item/Date: Wincel alignment + Tax Amount: $ 209, 19
TOTAL ESTIMATED AMOUNT PROSPECTIVE DAMAGES: $1,298.59
7. WITNESSES TO DAMAGE OR INJURY List all persons known to have information (attach additional pages, if necessary) NAME:
NAME:
ADDRESS:
ADDRESS:
TELEPHONE: _ )
TELEPHONE: ( )
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITAL(S) VISITED:
NAME:
NAME:
ADDRESS: _
ADDRESS:
TELEPHONE:
TELEPHONE: L |
DATE: _ TIME: • AM • PM
DATE: TIME: L AM LPM
9. PLEASE READ THE FOLLOWING CAREFULLY:
For all vehicle accident calms, 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 copners.
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". when you fiest 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 → NOTE: IF THE DIAGRAM BELOW DOES NOT FIT THE SITUATION, PLEASE ATTACH A PROPER DIAGRAM SIGNED BY THE CLAIMANT.
N Locust
Ave WRenaissance
PkWY
N Laurel
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
218123
TYPE OR PRINT NAME
DATE
RELATIONSHIP TO CLAIMANT
NOTE: PRESENTATION OF A FALSE CLAIM IS A FELONY (CA PENAL CODE 72) RETURN CLAIM TO: RIALTO CITY CLERK'S OFFICE - 150S. PALM AVE., RIALTO, CA 92376 Customer Number:350951 Invoice No: 734211
ONTARIO HYUNDAI
KIMBERLY A AVELAR * INVOICE*
ONTARIO AUTO CENTER
1307 KETTERING LOOP
FONTANA, CA 92337 (909) 390-8484
Home:
Email:
COLOR YEAR SERVICE ADVISOR: 1034 AHMED IBRAHIM
MAKE/MODEL
VIN LICENSE
MILEAGE IN / OUT TAG
INTENSE BL 20 HYUNDAI ELANTRA
DEL. DATE PROD. DATE 41186 / 41195 13064
WARR. EXP. PROMISED
PO NO. RATE PAYMENT
INV. DATE
19JUN20 19:00 16JAN23
R.O. OPENED READY 0.00 CC 19JAN23
OPTIONS: SOLD-STK:20H1422 ENG:2.0_Liter TRN:A
14:47 16JAN23 08:38 19JAN23
LINE OPCODE TECH TYPE HOURS
LIST NET TOTAL
A CUSTOMER HITS REAR RIGHT WHEEL AND FRONT TIRE, REPLACING REAR RIM AND
TIRE, FRONT RIGHT TIRE
OTHER A TRAINED TECHNICIAN WILL ANALYZE
DEANOSIS AS REQUIRED ST BE
PROVIDED TO YOU. DIAGNOSIS FEE DOES NOT
INCLUDE COST OF PARTS AND/OR LABOR TO
COMPLETE REPAIR. PLEASE ADDRESS ANY CONCERNS
DIRECTLY WITH YOUR SERVICE ADVISOR UPON
ARRIVAL. DISCLAIMER REGARDING PRICE: WAIVED CITY CLERK RECEIVED 2023 FEB -8 PM 2:45 CITY OF RIALTO
IF COVERED UNDER FACTORY OR EXTENDED
WARRANTY. DEALERSHIP WILL DETERMINE
ELIGIBILITY.
1023 CPHS
196.00 196.00
1 52910-G3300 WHEEL ASSY-ALUMINIUM
593.26 593.26 593.26
1 005NX-14198-NXK 225/45R17, 91W, N-PRIZ AH8 153.75 153.75 1 STATE STATETIREFEE 153.75
1.75 1.75 1.75
1 225/45R17 NEXEN NPRIZ AH8
144.64 144.64 144.64
PARTS: 893.40 LABOR: 196.00 OTHER:
0.00 TOTAL LINE A: 1089.40
41195 FRONT TIRE, REPLACING REAR RIM AND TIRE, 1.00 REPLACED BOTH
PASSENGER SIDE TIRES, ONE BLOWN AND ONE WITH AIR BUBBLE ON SIDE WALL THAN I REPLACED RIM AS WELL • ALSO SWAPPED SENSOR FROM OLD RIM TO NEW
RIM AND MOUNTED AND BALANCED TIRES VEHICLE IS NOW OKAY TORQUED WHEELS
DOWN TO SPEC
************************************* *************
B 4 WHEEL ALIGNMENT
ALIGN CUSTOMER REQUESTS PERFORM 4 WHEEL ALIGNMENT
1023 CPHS
PARTS: 139.95 139.95
0.00 LABOR: 139.95 OTHER: 0.00
TOTAL LINE B: 139.95
PARTS AND LABOR GUARANTEED THANK YOU FOR THIS OPPORTUNITY ORIGINAL ESTIMATE AUTHORIZED FOR MONTHS OR 12,000 TO YOU. IT IS OUR AIM DESCRIPTION TOTALS
SERVE REVISED ESTIMATE
MILES ON ALL GM INSTALLED PERFORM ALL THE REPAIRS REQUESTED PARTS. WHICHEVER OCCURS TO YOUR SATISFACTION. LABOR AMOUNT FIRST. IF YOU HAVE
90 DAYS OR 4,000 MILES ANY QUESTIONS, PLEASE NOTIFY YOUR $ $ ON ALL OTHER PARTS. PARTS AMOUNT
SERVICE ADVISOR IMMEDIATELY
GAS, OIL, LUBE
NOTICE: VEHICLES NOT PICKED UP WITHIN TWO DAYS AFTER REPAIRS ARE LABOR CHARGES ARE $ COMPLETED WILL BE SUBJECT TO A STORAGE FEE PER FLAT RATE HOUR. SUBLET AMOUNT ALL PARTS USED ARE NEW UNLESS INDICATED OTHERWISE MISC. CHARGES NO VEHICLES acknowledge notice and oral approval of any SALES * SERVICE additional customer or warranty work merfor TOTAL CHARGES RELEASED AFTER LEASING * PARTS and/or increase in the original estimated price. 1
DISCOUNT
also acknowledge approve all repairs as EXTENDED WARRANTY CLOSING HOURS BODY REPAIRS itemized and/or receipt of vehicle.
SERVICE DEPARTMENT HOURS SALES TAX
SERVICE CASHIER HOURS CUSTOMER SIGNATURE
MONDAY THROUGH FRIDAY MONDAY THROUGH FRIDAY PLEASE PAY
7:30 A.M. TO 6:00 P.M. 7:30 A.M. TO 6:00 P.M.
SATURDAYS X THIS AMOUNT
SATURDAYS
8:00 A.M. TO 4:00 P.M., 8:00 A.M. TO 4:00 P.M., BY APPT. ONLY BY APPT. ONLY EPA # 000021303 BAR # ARD056847
CLOSED SUNDAYS Customer Copy
Customer Number:350951 Invoice No: 734211
ONTARIO HYUNDAI
KIMBERLY A AVELAR *INVOICE*
ONTARIO AUTO CENTER
1307 KETTERING LOOP
FONTANA. CA 92337 909) 390-8484
--
Email:
COLOR YEAR MAKE/MODEL SERVICE ADVISOR: 1034 AHMED IBRAHIM
VIN LICENSE
MILEAGE IN / OUT TAG
INTENSE BL 20 HYUNDAI ELANTRA
DEL. DATE PROD. DATE WARR. EXP. 41186 / 41195 T3064
PROMISED PO NO. RATE
PAYMENT INV. DATE
19JUN20 19:00 16JAN23
R.O. OPENED 0.00 CC 19JAN23
READY
OPTIONS: SOLD-STK:20H1422 ENG:2.0_Liter TRN:A
14:47 16JAN23 08:38 19JAN23
LINE OPCODE TECH TYPE HOURS
LIST NET TOTAL
41195 4 WHEEL ALIGNMENT 1.00 4 WHEEL ALIGNMENT PERFORMED SET TIRE
PRESSURE THAN ADJUSTED FRONT TOE THAN TEST DROVE VEHICLE IS NOW OKAY
C MULTI-POINT INSPECTION OEM RECOMMENDED
MPI MULTI-POINT INSPECTION OEM RECOMMENDED
1023 CPHS
PARTS : 0.00 0.00
0.00 LABOR: 0.00 OTHER: 0.00 TOTAL LINE C:
0.00 41195 MULTI-POINT INSPECTION OEM RECOMMENDED 1.00 MULTI-POINT
INSPECTION OEM RECOMMENDED AND PERFORMED
*************** ****************
**
***************** **********************
****
ESTIMATE: 1,139.95 16JAN23 14:47
SA: 1034
CONTACT:
**********
*****+
************ **
#3064 CREATED 2023-01-16 OUR NEW SERVICE HOURS FOR YOUR CONVENIENCE 02:33: 01PM TAKEN BY AH MED MON - FRI 7:00AM - 7:00PM
IBRAHIM
SATURDAY 8: 00AM - 4:00PM
ROMERO MOTOR TEAM THANKS YOU.
ALL PARTS ARE NEW UNLESS SPECIFIED OTHERWISE
PARTS AND LABOR GUARANTEED THANK YOU FOR THIS OPPORTUNITY ORIGINAL ESTIMATE AUTHORIZED FOR 12 MONTHS OR 12,000 TO SERVE YOU. IT IS OUR AIM TO REVISED ESTIMATE DESCRIPTION TOTALS
MILES ON ALL GM INSTALLED PERFORM ALL THE REPAIRS REQUESTED PARTS, WHICHEVER OCCURS TO YOUR SATISFACTION. LABOR AMOUNT 335.95 FIRST. IF YOU HAVE $
90 DAYS OR 4,000 MILES ANY QUESTIONS, PLEASE NOTIFY YOUR $ PARTS AMOUNT ON ALL OTHER PARTS. SERVICE ADVISOR IMMEDIATELY. 893.40 GAS, OIL, LUBE 0.00
NOTICE: VEHICLES NOT PICKED UP WITHIN TWO DAYS AFTER REPAIRS ARE LABOR CHARGES ARE S COMPLETED WILL BE SUBJECT TO A STORAGE FEE. PER FLAT RATE HOUR. SUBLET AMOUNT 0.00 ALL PARTS USED ARE NEW UNLESS INDICATED OTHERWISE MISC. CHARGES 0.00 NO VEHICLES acknowledge notice and oral approval of any SALES * SERVICE additional customer or warranty work performed TOTAL CHARGES 1229.35 RELEASED AFTER LEASING * PARTS and/or increase in the original estimated price. also acknowledge and approve all repairs as EXTENDED WARRANTY 0.00 CLOSING HOURS BODY REPAIRS itemized and/or receipt of vehicle.
SERVICE DEPARTMENT HOURS SALES TAX $ 69.24
SERVICE CASHIER HOURS CUSTOMER SIGNATURE
MONDAY THROUGH FRIDAY MONDAY THROUGH FRIDAY PLEASE PAY
7:30 A.M. TO 6:00 P.M. 7:30 A.M. TO 6:00 P.M. $ 1298.59
X THIS AMOUNT
SATURDAYS
SATURDAYS
8:00 A.M. TO 4:00 P.M., 8:00 A.M. TO 4:00 P.M., BY APPT. ONLY EPA # 000021303 BY APPT. ONLY BAR # ARD056847
CLOSED SUNDAYS Customer Copy
ROMERO MOTORS CORPORAT
1307 KETTERING LOOP
ONTARIO, CA 917610000
01/19/2023 13:11:57
CREDIT CARD
VISA SALE
Card# XXXXXXXXXXXX0817
Chip Card: VISA CREDIT
AID: A0000000031010
SEQ #: 2
Batch #: 153
INVOICE 2
Approval Code: 009816
Entry Method: Chip Read
Mode: Issuer
SALE AMOUNT $1298.59
CUSTOMER COPY
ONTARIO HYUNDAI
HYUNDAI
Dear KIMBERLY A AVELAR,
We at Romero Motor Corporation would like to take this opportunity to thank you for your business. We hope the services or repairs to your HYUNDAI ELANTRA were completed to your utmost satisfaction.
We pride ourselves in giving you the total dealership experience that a HYUNDAI deserves. If there is anything we can ever do to make your visit to Romero Motor Corporation more pleasurable, please do not hesitate to contact us.
Once again, thank you!!
Sincerely,
1034 AHMED IBRAHIM
Service Consultant
Romero Motor Corporation
1307 Kettering Loop * Ontario, California 91761 * (909) 390-8484 * FAX (909) 390-1778 Ontario Hyundai
734211 1307 Kettering Dr. #A
1/18/23 3:24 PM KMHH35LE5LU13571 Ontario, CA 91761
Odometer:41186 909-443-6100
KMHH35LE5LU135711
juan gonzalez
Hyundai: Elantra Touring/GT (2009- ) : 2020 : except Sport, N Line : with 16", 17" Wheel ExpressAlign Total Alignment
Before Measurements
Left Front Right Front
0:6°
-0. 8°
Camber
Camber
Y
6° 3°
Caster
Caster
Front
-0:23°
-0.16°
Toe
Toe -0 38°
Total Toe
14°
Steer Ahead
Right Rear
Left Rear
-0.74
4°
5°
Camber Camber
0.00°
0.00 0.30 Rear
25° 0.13°
U
Toe
Toe
38°
Total Toe
0,06°
Thrust Angle
Current Measurements
Left Front Right Front
-0 5°
•0. 9° Camber
Camber
30 6°
Caster
Caster
Front
0.02°
0.03°
0.30 Toe
Toe 05°
Total Toe
0.05 00°
Steer Ahead
Right Rear
Left Rear
-0.7
3°
5°
Camber
Camber
0.30°
10.00 0.30 Rear 130
24°
Toe
Toe
36°
Total Toe
0.06°
Thrust Angle
One or more values are not within specification. Tire wear, handling and safety problems may result.