CITY OF RIALTO
2023 FEB 15 AM||: 16
CITY OF RIALTO •LITCL
CITY CLERA
LIABILITY
CLAIM FOR DAMAGES
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). 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: 150S. Palm Ave., Rialto, CA 92376 Address: 290 W. Rialto Ave., Rialto, CA 92376
CLAIMANT INFORMATION:
Janeth Penaloza
FULL NAME DATE OF BIRTH
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 Attorney Steven Weaver: 325 W. Hospitality Lane, 212
NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM
(if different from home address provided above): San Bernardino, CA 92408 - Unlimited Civil Cure
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE: _ 11/11/2022 TIME: — 6-12 • AM DIPM
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. - Inside of the residence
3. HOW DID DAMAGE OR INJURY OCCUR?
Janeth Penaloza called 911 because her brother had a seizure. Police arrived with paramedics and tased her brother and placed her in a chokehold and wrongfully arrested her. This was a violation of her constitution rights.
4. WERE POLICE AT THE SCENE? *YES NO WERE PARAMEDICS AT THE SCENE? XI 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 officer placing her in a chokehold without probable cause to do so and wrongfully arresting her in violation of her constitutional rights. While questioning officers who were arresting her brother, they used unreasonable and unnecessary force on Ms. Penaloza, placing her in a chokehold. Oftier's Name:
6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage $ Unlimited A. Flores
HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE:
Item/Date: Pain, suffering, wrongful arrest: 11/11/2022 Amount: $ Unlimited Item/Date: Amount: $
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: $ Unlimited ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN:
Item/Date: Unknown currently Amount: $ Unlimited
Item/Date: Unknown currently Amount: $ Unlimited
TOTAL ESTIMATED AMOUNT PROSPECTIVE DAMAGES: Unlimited
7. WITNESSES TO DAMAGE OR INJURY List all persons known to have information (attach additional pages, if necessary) NAME: _ Cruz Mayoral NAME:
PeNalaza
ADDRESS: ADDRESS:
Rialto, CA 92376 Rialto, CA 92376
TELEPHONE TELEPHONE:
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITAL(S) VISITED:
NAME: NAME:
ADDRESS: ADDRESS:
TELEPHONE: ( TELEPHONE:
DATE: TIME: • AM • PM DATE: _ TIME: _ •AM • PM
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
PARKWAY 2023 FEB 16 AMII:
SIDEWALK TY GLERI RECEIVED CITY OF RIALTO
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
Steven Weaver 2/13/2023
TYPE OR PRINT NAME DATE
Attorney
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