CITY CLERK'S DATE STAMP
CITY OF RIALTO
LIABILITY
CITY OF RIALTO
CLAIM FOR DAMAGES
TO PERSON OR PROPERTY 2023 SEP 28 PM 12: 38
OTTY CLERK RECELVED
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: 150 S. Palm Ave., Rialto, CA 92376 Address: 290 W. Rialto Ave., Rialto, CA 92376
CLAIMANT INFORMATION:
Pedro Damian Molina
FULL NAME DATE OF BIRTH
Rialto, Ca, 92377
HOME ADDRESS INCLUDING CITY, STATE & ZIP HOME TELEPHONE NO.
L
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):
04/01/2023 TIME: Aprox 11:39amM AM • PM
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE:
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.
The incident began on Easton Street, specifically on the eastbound lane. Proceeding to make a left tum onto Ayala Avenue.
Subsequently, Pedro was instructed by an authority figure to pull over and come to a stop on the off-ramp from the 210 Freeway.
This off-ramp is located in close proximity to the well-known restaurant establishment, Cracker Barrel, situated at the intersection or corner of the aforementioned off-ramp.
3. HOW DID DAMAGE OR INJURY OCCUR?
See Attached page, Section 1
4. WERE POLICE AT THE SCENE? MYES •NO WERE PARAMEDICS AT THE SCENE? DYES MNO
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.
See Attached page, Section 2
6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage $ 1,500,000 HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE:
Item/Date: See Attached page. Section 2 & 3 / 04/01/2023 - 08/16/2023 Amount: $ 1,500,000 Item/Date: See Attached page, Section 2 & 3 / 04/01/2023 - 08/16/2023 Amount: $
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: $1,500,000 ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN:
Item/Date: See Attached page, Section 2 & 3 Amount: $
Item/Date: See Attached page, Section 2 & 3 Amount: $
TOTAL ESTIMATED AMOUNT PROSPECTIVE DAMAGES: $ 3,000,000
7. WITNESSES TO DAMAGE OR INJURY List all persons known to have information (attach additional pages, if necessary) NAME: Melissa Aragon NAME:
ADDRESS: ADDRESS:
Rialto, Ca, 92377
TELEPHONE: TELEPHONE: L
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITAL(S) VISITED:
NAME: Arrowhead Hospital NAME: San Bernardino County West Valley Detention Center ADDRESS: 400 N Pepper Ave ADDRESS: 9500 Etiwanda Ave
Colton, Ca, 92324 Rancho Cucamonga, Ca, 91739
TELEPHONE: (909) 580-1000 TELEPHONE: (909 ) 708-8371
DATE: 04/01/2023 aprox 2
TIME: DATE: 04/01/2023 TIME: _aprox 1
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.
CITY CLERE RECEIVES
CURB
PARKWAY
SIDEWALK
THOSE EATER EAR EASE TO NERATIN ELE AND AS TO THOSE MATER EVE MEN TO BE RECEPT AS TO ^ I CERTIFY (OR DECLARE) UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
SIGNATURE OF CLAIMANT OR AGENT
Pedro Damian Molina 09/2712023
TYPE OR PRINT NAME DATE
barson Himself
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
Section 1. Responses to section 3. I was subjected to a traffic stop due to an incident where my turn signal turned red in the midst of the intersection. I felt unfairly targeted as there were other vehicles in close proximity to me. It is worth noting that I am of Hispanic descent, and my vehicle is registered under my name, which bears a Hispanic identity. To my dismay, I was pulled over, treated with excessive force akin to that of an animal, and denied basic rights throughout the arrest process. Shockingly, I was swiftly incarcerated without the opportunity to exercise my right to legal representation during the proceedings.
Section 2. Responses to section 5. I want to express the immense impact that the city law enforcement's mistreatment has had on my life. It is with great sorrow that I recount tha extent of the damages inflicted upon me. The physical and emotional toll has been severe, leading, exorbitant personal life impacts that I have had to bear. This mistreatment has also resulted if CITY OF RIALTO the loss of my wages and diminished my future earning potential, undermining my financial stability and aspirations. The pain and suffering I have endured cannot be quantified, a it has. deeply affected my well-being and quality of life. Additionally, the damages to my property serve as a constant reminder of the injustice inflicted upon me. Moreover, the countless hours, substantial financial resources, and emotional labor expended due to the city police's negligence have taken an immeasurable toll. The resulting financial burden has been overwhelming, with thousands of dollars spent to rectify the consequences of their actions. It is profoundly disheartening to reflect upon the extent of the harm caused by the city police's actions, and the lasting repercussions it continues to impose on my life.
Section 3. Response to Section 6. I want to convey how deeply this incident has affected my life, with heartfelt empathy for the immense impact it has had on me. The financial strain caused by the damages incurred amounts to thousands of dollars, and the weight of this burden still lingers, leaving me struggling to recover even to this day. Beyond the financial aspect, the incident has permeated my personal life, instilling a pervasive fear that lingers whenever I get behind the wheel of my vehicle-the very same vehicle in which I was pulled over and subjected to such mistreatment. The consequences have seeped into my relationships, particularly my marriage, creating a distressing spiral that has taken its toll on various aspects of my life, including my professional endeavors. Compounding the emotional distress, I haven't even mustered the courage to drive my car, which remains damaged on my driveway from the day I pull it from the towing wreck yard. This incident has had an immense and lasting impact on my mental well-being, and no amount of money can ever truly heal the wounds it has inflicted. I want to express my deepest understanding and compassion for the profound challenges you face as you navigate the lasting effects of this traumatic experience.
CITY OF RIALTO POLICE DEPARTMENT
LIMISDE ME AMOR
NOTICE TO APPEAR IXI TRAFFIC LRONTRAREIO RIA500600
Date of Volation Time Day of Week Case No
04/01/2023 11:39 Saturday 9323
Name (Frst, Middle, Last) (Company) Owner's Responsibility (VC 40001)
PEDRO DAMIAN MOLINA
Address
City State 21P Code • Juvenile (Phone No.)
RIALTO CA 92377
Driver 1k No State Class Commercial Age Birth Date
CA • Yes IX No 36
Sex Hair Eyes Height Weight Race Other Description
M BRO BRO 510 175 CITY 2023 SEP 28 PM 12:
Veh. Lic. No. or VIN State RECEIVEL CITY OF RIALTO
8MKN556 CA • COMM. VEH.
(VC 15210(b)) CLERF
Yr. of Veh. Make Model Body Style Color
2016 MERCEDES B C CLASS 4 DOOR WHITE
Evidence of Financial Responsibility LO HAZ. MAT. co
(VC 353)
Registered Owner of Lessee X Same as Driver
PEDRO DAMIAN MOLINA
City State ZIP Code X Same as Driver
Address
RIALTO CA 92377
• Construction Zone •School Zone
Correctable Violation (VC 40610) •Booking Required (see below) Misdemeanor Yes/No Code and Section Description or Infraction
VC 21453(C) Turn Against Signal M
N
Speed Approx P.F./Max Spd Veh. Lmt. I Safe
Continuation
> - Form Issued
Location Of Violation(s) City/County of Occurrence
at EAST AYALA DR Rialto
RENAISSANCE PKWY
Comments (Weather, Road & Traffic Conditions) • Accident
CLEAR, DRY, LIGHT, LIGHT
Violation(s) not committed in my presence, declared on information and belief.
I declare under penalty of per jury under the laws of the State of Callfonta that the foregoing is true 04/01/2023 BALL 01944
Dec. Date Arresting or Citing Officer Serial No.
Der. Date Name of Arresting Oflicer, Serial No.
if different from Citieg Officer
WITHOUT ADMITTING GUILT, I PROMISE TO APPEAR AT THE TIME AND PLACE INDICATED BELOW.
X Signature
WHEN On a before: 07/06/2023 8:00AM
WHAT IODO LOOM HE INSIRE HIONSHOW
Superior Court Fontana District
11780 Arrow Bivl
(909) 350 9972
• to be notified
bend de 15 to divor
406190240522 0x24502
San Bernardino County Sheriff's Department DR/Case No.
ARREST/BOOKING APPLICATION Arresting Agency
State Date of Arrest
Time of Arrest
Tax
- Ca
Empostr
прву Asthesi
Fare of soo
BLE AS
rOs Onceladaras
Place ef Pers
121 REN7 LAFT
DOCKING CHANGES
ARREST TYPE: S = On Site
! C• Chate O « Osher
Warrant No
EVI IA (DALTEA VILEASE
Code Senten
Water Na
Agnes or Nesses Dyes ONe CITY CLERA RECEIVEL 2023 SEP 28 PM 12: 39 CITY OF RIALTO Any Frequent Medeatons? DYes ENo * Yesta Ether. Expion on Model Sen D No & Yes. Allah
Use déFono O LVR D Taser 0 00
Ponded Unconson? Yes
Special Instructions and Mandatory Information
Emergency Notification TATTOOSISCARS:
Hamo/Restionship Home & Col Phone DESCRIPTION (indicate any gang tattoos) CHEST
Address BACK
Name/Relationship ] Home & CaT Phone NECK T
Address
HEAD
GA)
Amount of Money TIN- TACE
HARM
Amster/Transporting Officer Sagnature ALI
Additiona! Comments TARu
RiG"
Arresting Officer TECT
ALL
Fransporting Officer
Agency
RE High Poise Rediase Notte Bond 2 hour Agency or have stiguang Offer Colduct Plast No (Hogured for At Arests Agency & 24 lu Phone No
Agency Contact Tove and Date Who Was Confacted?
REV carte 15-0554-401 Ree 11/8