CITY OF RIALTO CITY CLERK'S DATE STAMP
LIABILITY CITY OF RIALTO
CLAIM FOR DAMAGES 2023 APR -4 AM 9:49
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: 150S. Palm Ave., Rialto, CA 92376
Address: 290 W. Rialto Ave., Rialto, CA 92376
CLAIMANT INFORMATION:
N ancy Nohemi Alvarado
FULL NAME
DATE OF BIRTH
Kialto, CA92376
HOME ADDRESS INCLUDING CITY, STATE & ZIP
HOME TELEPHONE NO.
CELL
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): Rialto CA 92376
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE: 11 / 19/2022 TIME: 9:00
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.
Car was parked in front of my house and it was
under a city tree. It was a renny wince day an
& big branch tell on the driver side
4. WERE POLICE AT THE SCENE? DYES NO WERE PARAMEDICS AT THE SCENE? YES NO ne tree belongs to the city of Rialto
Caose its not on my property
6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage $ $1150€ HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE:
Item/Date: Repair Estimates 2-24-23 1150
Amount: $_
Item/Date: Repair Estimates 3-3-23 Amount: $_ 1905
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: $1150°° ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN:
Item/Date: Described on Invoice 2/24/2023
Item/Date: Amount: $ 1150
Described on Invoice 3 3 2073
TOTAL ESTIMATED AMOUNT PROSPECTIVE DAMAGES: Amount: $ 1905 $
7. WITNESSES TO DAMAGE OR INJURY List all persons known to have information (attach additional pages, if necessary) NAME: Police Department of Rial ME:
ADDRESS: Incident # 22119-0095
ADDRESS:
TELEPHONE: L
TELEPHONE: | 1
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:
• 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. 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 cityftown 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. iverside Ave.
ETREE Branchcame
< North Orange Ave cales
CAR -TREE South→
PARKWAK
SIDEWALK
THOSE MATTERS WHICH ARE HEREIN STATED UPON MY INFORMATION AND BELIEF; AND AS TO THOSE MATTERS I BELIEVE THEM TO BE TRUE. 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 I CERTIFY (OR DECLARE UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
SIGNATURE OF CLAIMANT OR AGENT
Nancy Alvarado 4-4-2023
TYPE OR PRINT NAME
DATE
self.
RELATIONSHIP TO CLAIMANT
RETURN CLAIM TO: RIALTO CITY CLERK'S OFFICE - 150S. PALM AVE., RIALTO, CA 92376 NOTE: PRESENTATION OF A FALSE CLAIM IS A FELONY (CA PENAL CODE 72) Rialto Police Courtesy Notice
Date "/19/1022 mo 0910 Day orwook o SAMDAy.
Comment
22119-0095
A, CORTEZ Badge No. 2232
Officer
CONTACT RIALTO P.D.-(909) 820-2550 FOR FURTHER INFORMATION (Over)
GT3870 auto repainorder
adams
carbonless • 3-par
репате auo body
NAME
16618 ceres ave SuiTs ADDRESS
Lantana CA 94335
909371732
MATERIAL: ALL PARTS NEW UNLESS SPEGIFIED: U-USED, R-REBUILT. RC-RECONDITIONED - 2ND AUTHORIZED NAME PHONE
QTY PART NO. NAME OF PART
PRICE WARRA M
REGENED (DATE & TIME) CUSTOMER'S INFORMATION
A.M. CUSTOMER'S ORDER NO. PROMISED (DATE 8 TIME
P.M. A.M.
YEAR • MAKE • MODEL
SERIAL HAVIN
Hens DORS ER
0290. LIDENSE ME BRey МОТОВ :
ODOMETER WRITTEN BY
LUBE OIL. CHANGE
FLUSH TRANS. FLUSH DIFE WASH
POLISH
CHARGE FOR HAZARDOUS OR OTHER WASTE REMOVAL*
2100
TOTAL PARTS METHOD OF PAYMENT: Daily Storage feo after repair work has been MECHANICS RECOMMENDATIONS • CHECK _ CHARGE completed and customer has heen notified. LABOR ONLY No
• CASH charges shall accrue on be due and payable for a PARTS pariod of 3 working deys from date et notification.
LABOR ACCESSORIES
I FLAT RATE HOURLY GUARANTEED ITEMS,
GAS, OIL & GREASE
Estimated cost $. BOTH MISC. MERCHANDISE
Estimate Charge Basis for Charge GUARANTEE EFFECTIVE UNTIL:
LO RETAIN PARTS SUBLET REPAIRS
PLEASE READ CAREFULLY, CHECK ONE OF THE STATEMENTS BELOW, AND SIGN: TIME - • I DESTROY PARTS STORAGE FEE
| UNDERSTAND THAT, UNDER STATE LAW, LAM ENTITLED TO A WRITTEN ESTIMATE MILEAGE
AUTHORIZED BY TAX
INCLUDING A COMPLETION DATE, IF MY FINAL BILL. WILL EXCEED $100. ($50 in MD) - I REQUEST A WRITTEN ESTIMATE, THE FINAL BILL MAY NOT EXCEED THIS TOTAL • ESTIMATE WITHOUT MY WRITTEN APPROVAL. You are entilled by law to the retum of all parts replace excepthose for whin there to a core charge untess you agree other vise by sofalling the flowing:._ I do undesire the retum of any of the parts that are —IDO NOT REQUEST A WRITTEN ESTIMATE, AS LONG AS THE REPAIR COSTS DO NOT EXCEED replaced curing the authorized repars THE SHOP MAY NOT EXCEED THIS AMOUNT WITHOUT MY WRITTEN OR ORAL APPROVAL. Estate gone for 30 daye. Not resporscle for demane caused beneft, fre on ans of nature astrie the above realis along anti any necessary matenas o and your employees to operate my - I DO NOT REQUEST A WRITTEN ESTIMATE. vetuce for the purpose of test. inspector Ma apres mechanic s ten is harets so neergod on ho above vehicle to secure 100 am a shared, l concal repains arior to their competion for any reason, a dear con are reusse
*Checked lines apply (Preparer must check at least one): was be appled. -This charge represants costs and profits to the motor vehicie repair facility for miscellaneous shop supplies or waste disposal. SIGNED -_ This amount includes a charge of $ _ which is required under_ a adems _law. DATE. 02. GT3870
09-11
Insurance Welcome
Kandy Paint Jobs WE BUY WRECKED CARS
Frame Repair Free Towing With Major Repairs
Body Kits & Aftermarket Parts Smo We Can Help With Insurance WE PAINT WHEELSIT Deductible!!!
735 W. Rialto Ave. Ste "A"
Rialto, CA 92376 A Rape 2909233.0010
EVINER
NANCY avarado
ISURANCE CO
RiAltO CA 92376
Estimate of Auto Repairs sEE o-chevtrackera Brown
TENI SANE RAN IS.
OTY. DESCRIPTION OF LABOR OR MATERIAL
PARTS PAINT LABOR
Replese L-side FeNder $375 ·500 $ 200
Blend door Pavel 5200 5185
+ Bend Hood $200 5183
PARTS $ 37 SL
OLD PARTS REMOVED FROM CARS WILL BE JUNKED UNLESS OTHERWISE INSTRUCTED IN WRITING. LABOR $ S701 THE ABOVE IS AN ESTIMATE BASED ON OUR INSPECTION AND DOES NOT COVER ADDITIONAL PARTS OR LABOR WHICH MAY BE REQUIRED AFTER PANT S 9001 THE WORK HAS BEEN OPENED UP. OCCASIONALLY, AFTER WORK HAS STARTED, WORN PARTS ARE OISCOVERED WHICH ARE NOT EVIDENT ON FIRST INSPECTION. BECAUSE OF THIS, THE ABOVE PRICES ARE NOT GUARANTEED.
TOTAL AS LISTED FOR LABOR AND MATERIALS, VERBAL AGREEMENTS NOT BINDING. AFTER 3 (THREE DAYS OF THE JOB BEING FINISHED TAX $ 60 :
IMPERIAL AUTO BODY REPAIR WILL CHARGE AN ADDITIUNAL S35 FEE FOR STORAGE PER DAY.
AFTER 30 DAYS OF STORAGE, THE VEHICLE WILL BE SUBJECT TO LIENSALE. WE ARE NOT RESPONSIBLE FOR ANY ITEMS LEFT INSIDE TOTAL $ 1905
REPAIRS ALTHORIZED BY DATE
NOTES:
03-03-23
REPAIRS INSPECTED AND ACCEPTED BY DATE