CITY CLERKS DATE STAMP
RIA CITY OF RIALTO
LIABILITY CITY OF RIALTO
CLAIM FOR DAMAGES 2023 MAY 15 AMII: 26
TO PERSON OR PROPERTY
RECEIVEL
CITY CLERK
1. Clams for deal, injury to person, or to personal property must be filed not later than six (6) months after the oucumence (Guv. Code 5911 2). 2 Claims for damages to real property must be filed not later han one (1) year after the occurrence (Gov Code: 59112) RETURN TO:
3 REAO ENTIRE CLAIM FOR BEFORE FILING
Rialto City Clerk's Office
4.ATTACH SEPARATE SHEETS, IF NECESSARY, TO GIVE FULL DETAILS Mail: 150 S. Paim Ave., Rialto, CA 92376 Address: 290 W. Riallo Ave.. Riailo, CA 92376
CLAIMANT INFORMATION:
Alejandrina Colon
FULL NAME DATE OF BIRTH
C/O 10900 Wilshire Blvd.. 15th Floor.Los Angeles. CA 20024 (424)239-1107 HOME ADDRESS INCLUDING CITY, STATE & ZIP HOME TELEPHONE NO.
Jacoby and Meyers, 10900 Wilshire Blvd., 15th Floor, Los Angeles, CA 90024 ( 424) 239-1107 BUSINESS ADDRESS INCLUDING CITY, STATE & ZIP BUSINESS TELEPHONE NO.
ADDRESS AT WHICH CLAIMANT DESIRES TO RECEIVE Jacoby and Meyers. 10900 Wilshire Blvd.. 15th Floor,
NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM
Los Angeles. CA 90024
(if different from home address provided above):
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE: _11/26/2022 TIME: Approx. 3:45 PM AM 051 PM
2. PLACE OF ACCIDENT (OCCURRENCE) BE SPECIFIC - Describe fully and (if applicable) tocate on diagram on reverse side of this sheet.
Where appropriate, give street names and addresses, measurements and landmarks.
At or near Hawthorne Avenue, approx. 131 feet east of Palm Lane in unincorporated community of Bloomington, County of San Bernardino, State of California, 92335. Please see Attachment "A." Investigation is pending.
3. HOW DID DAMAGE OR INJURY OCCUR?
Picase see Attachment "A." Investigation is pending and Claimant's trcatment is ongoing
4. WERE POLICE AT THE SCENE? X YES CJ NO WERE PARAMEDICS AT THE SCENE? YES CI 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.
Please see Attachment "A." Investigation is pending and Claimant's treatment is ongoing.
6. GIVE TOTAL AMOUNT OF CLAIM Inciude estimate of amount of any prospective injury or damage $ I31D, but escood: 525,000 HOW WAS THE ABOVE AMOUNT COMPUTED? Be specili, list doctor bills, repair estimales, etc. Please attach 2 estimales.
DAMAGES INCURRED TO DATE: This is an unlimited civil case.
Item/Date: Please see Attachment "A." Investigation is pending Amount: $ TBD. exceeds $25,000 Item/Date: and Claimant's treatment is ongoing. Amount: $ TBD, exceeds $25.000 TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: $ TBD, but exceeds $25,000 ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN:
Item/Date: Please see Attachment "A." Investigation is pending and TBD, exceeds $25,000 Amount: $
Item/Date: Claimant's treatment is ongoing Amount: $ TBD. exceeds $25.000 TOTAL ESTIMATED AMOUNT PROSPECTIVE DAMAGES: $ TBD, but exceeds $25,000
7. WITNESSES TO DAMAGE OR INJURY List all persons known lo have information (atlach additional pages, if necessary) NAME: Unknown at this time. Investigation is pending. NAME Unknown at this time. Investigation is pending.
ADDRESS: N/A N/A
ADDRESS:
TELEPHONE: ( N/A N/A
TELEPHONE:
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITAL(S) VISITED:
NAME: Arrowhead Regional Medical Center
NAME: Unknown at this time. Investigation is pending.
ADDRESS: - 400 N. Pepper Ave. ADORESS: and Claimant's treatment is ongoing.
Colton. CA 92324
TELEPHONE: (909) 580-1000 TELEPHONE: | NA
DATE: On or around TIME: Unknown D AM D PM DATE: N/A TIME: N/A • АМ С]РМ П726/2022 at this time. Investigation is pending.
9. PLEASE READ THE FOLLOWING CAREFULLY:
For all vehicle accident claims, place on the following diagram, the names of streets, including NORTH, LAST, 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 il, and by "B' location of yourself or your vehicle when you first saw City/Town vehicle: location of City/Town vehicle at lime 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:IFTHE DIAGRAM BELOW DOES NOT FIT THE SITUATION, PLEASE ATTACH A PROPER DIAGRAM SIGNED BY THE CLARANT IT Y Please see Attachment"A." Investigation is pending and all locations are approximate. 15 m
CURB Hawthorne Avenue RIALTO
L
CLERK ED. AM II:
PARKWAY
26 7 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 DECLARE) UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
SIGNATURE OF CLAIMANT OR AGENT
jessica Behmanesh 5/8/2023
TYPE OR PRINT NAME DATE
Attorney for Claimant
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 Attachment "A"
On November 26, 2022, at approximately 3:45pm., Claimant Alejandrina Colon was walking westbound on Hawthorne Avenue, near the intersection of Hawthorne Avenue and Laurel Avenue in the unincorporated community of Bloomington, San Bernardino County, State of California, 92335. At or around the same time. Jose Navarro was operating a white 2008 Chevrolet Silverado and was headed eastbound on Hawthorne Avenue and approached the intersection of Hawthorne Avenue and Laurel Avenue. where he hit a large defect in the road that caused him to lose control of the vehicle and collide with Claimant. Claimant believes the large defect that caused this collision was a pothole. bump or a dilapidated, uneven portion of the roadway.
As a result of the defect in the road. two pedestrians next to or near Claimant died because of their injuries, and Claimant suffered serious injuries and damages, including but not limited to a fractured neck, fractured ribs, a fractured pelvis, a left-hand fracture, and she required surgeries to her clavicle, right elbow, and ankles.
The location where the incident occurred and where the defect exists, at Hawthorne Avenue. 131 feet east of Palm Lane in the unincorporated community of Bloomington. County of San Bernardino, State of California, 92335, was planned, approved, built, owned, operated controlled, maintained, repaired and/or managed by the unincorporated community of Bloomington, the cities of Fontana and Rialto, County of San Bernardino, and/or the State of California. Through the negligent acts of their/its employees, agents, independent contractors, and representatives, the subject roadway had a defect, creating a dangerous condition.
Furthermore, the unincorporated community of Bloomington, the cities of Fontana and Rialto, the County of San Bernardino, and/or the State of California failed to warn of such a dangerous condition, failed to repair the porholes and failed to property maintain the roadway in a mannered My CITY that is safe for those who travel on it.
As a result of this incident, Claimant sustained past and future economic and noneconomies 15 damages. The total value of damages is to be determined and is in excess of $25.000.00. RIALT Treatment for Claimant's injuries is ongoing. Any witnesses to the incident are unknown at fis time. AMII: 26
Investigation is pending.
Jessians 518/2023
JACOBY&MEYERS:
- INJURY LAWYERS- LOS ANGELES CA 900
11 MAY 2023PM 8 L US POSTAGE™ PITNEY BOWES
10900 Wilshire Boulevard, 15t Floor
Los Angeles, California 90024
ZIP 90024 2023 MAY 60д.84°
02 7H
0006 4. 95 2023
CEN ALT.
CLERK AMI1: 26
Rialto City Clerk's office
150S. Palm Ave
Rialto, CA, 92376
92376-648799