CITY OF RIALTO CITY CLERK'S DATE STAMP
CITY OF RIALTO
LIABILITY
2023 OCT 26
CLAIM FOR DAMAGES AMI1: 24
TO PERSON OR PROPERTY RECEIVEL
CITY
CLERA
1. Claims for death, injuny 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 $911.2). RETURN TO:
3. READ ENTIRE CLAIM FOR BEFORE FILING
Rialto City Clerk's Office
4. ATTACH SEPARATE SHEETS, IF NECESSARY, TO GIVE FULL DETAILS Mail: 150 S. Palm Ave., Rialto, CA 92376 Address: 290 W. Rialto Ave., Rialto, CA 92376
CLAIMANT INFORMATION:
Reese Estefania Orosca
-
FULL NAME DATE OF BIRTH
San Bernardina, lA 92410
HOME ADDRESS INCLUDING CITY, STATE & ZIP HOME TELEPHONE NO.
BUSINESS ADDRESS INCLUDING CITY, STATE & ZIP BUSINESS TELEPHONE NO.
ADDRESS AT WHICH CLAIMANT DESIRES TO RECEIVE
NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM
(if different from home address provided above):
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE: July 18,2023 TIME: 11:5 DI AM O PM
2. PLACE OF ACCIDENT (OCCURRENCE) BE SPECIFIC - Describe fully and (if applicable) locate on diagram on reverse side of this sheet.
Where appropriate, give street names and addresses, measurements and landmarks.
In l Rialto avenue, headed west bound inbetween
S tamarisk avenue and Loretta street.
3. HOW DID DAMAGE OR INJURY OCCUR?
While driving west bound on Palto aulie, I hit a huge asphalt lump In the road and then immedian after hit a huge pothole: 7 had Do chorse bat to drile thragh these since there was a car next to me.
4. WERE POLICE AT THE SCENE? • YES • NO WERE PARAMEDICS AT THE SCENE? • YES$ 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 omission of the asphalt being left in an unnatural
State and the pothole not being fixed. The bump is the size of a speed bump,however there are no speed tump warnings.
6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE:
Item/Date: Mechanical Repair Dill 10/20/2023 Amount: $2,690.11 Item/Date: Amount: $
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: $ 2,690.11 ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN:
Item/Date: Amount: $_
Item/Date: Amount: $_
TOTAL ESTIMATED AMOUNT PROSPECTIVE DAMAGES:
7. WITNESSES TO DAMAGE OR INJURY List all persons known to have information (attach additional pages, if necessary) NAME: Francisco Lopez IR (passenger NAME:
ADDRESS: ADDRESS:
San Bernardino ee 924s0
TELEPHONE: TELEPHONE: |)
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITAL(S) VISITED:
NAME: NAME:_
ADDRESS: ADDRESS:
TELEPHONE: | 2 TELEPHONE: )
DATE: TIME: ПАМ • РМ DATE: TIME:
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
/ SIDEWALK
LAVE READ THE FOREGOING CLAIM AND KNOW THE CONTENTS THEREOF; AND CERTIFY THAT THE SAME IS TRUE OF MY OWN KNOWLEDGE EXCEPT AS 1 HOSE MATTERS WHICH ARE HEREIN STATED UPON MY INFORMATION AND BELIEF; AND AS TO THOSE MATTERS I BELIEVE THEM TO BE TR I CERTIFY (OR DECLARE) UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
SIGNATURE OF CLAIMANT OR AGENT
10-252023
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 - 150 S. PALM AVE., RIALTO, CA 92376 Additional Information
To Whom it may concern:
I have attached an estimate from BMW for the repairs of rear wheel. I did not go through BMW for the repairs but attached it since two estimates were needed. I attached the final invoice for the repairs on the wheel that were done at Unitech Auto Repair. I wasnt able to get the repairs done until just recently since the car that had the damages to it was at BMW of Ontario until 10/13/2023 due to other repairs unrelated to the tire. I have also attached a diagram of where the incident occured, as well as pictures of the bump in the road and the pothole that followd right after. Included will also be a trip timestamp of when the incident occured in the car that was damaged for more evidence.
Thank you,
Reese Orosco
10/25/2023
"Wo Rallo ave
-
I tamarisk cave
BMW of Ontario
Repair Order Estimate
Printed Date: August 9, 2023
Prepared for: REESE OROSCO
Year: 2021 Service Advisor: CESAR VELAZQUEZ
Make: BMW RO: 608646
Model: 3 SERIES Tag: C693
VIN: 3MW5U7J05M8B53354
Odometer: 43,455
We have performed our multi-point inspection on your vehicle and the following services are recommended.
EXISTING SERVICES
Job Quote
OLDER VEHICLE
DUE TO AGE OF VEHICLE PARTS MAY BE BRITTLE AND BREAK DURING N INTERNAL SUNROOF & CONV. TOP
CLIENT HAD SUNROOF REPAIRS PERFORMED AT BMW OF MURIETTA AN WARRANTY
COOLING SYSTEM
CLIENT STATES THERE HAS BEEN MULTIPLE COOLANT REPAIRS PERFOR INTERNAL
INTERIOR RATTLES
CLIENT STATES THERE IS A THUD OR RATTLE NOISE COMING FROM THE WARRANTY
TIRE PRESSURE CHECK
CUSTOMER REQUESTS TIRE PRESSURE CHECK INTERNAL
MULTI-POINT INSP
CUSTOMER REQUESTS COMPLIMENTARY VEHICLE INSPECTION. INTERNAL
TOUCHLESS SERVICE
INTERNAL
CAR WASH
CUSTOMER REQUESTS COMPLIMENTARY CAR WASH. INTERNAL
KEY READ
CUSTOMER REQUESTS FOR BMW OF ONTARIO SERVICE ADVISOR TO PE INTERNAL
SUNROOF TRIM
WARRANTY
SUNROOF CHANNEL BENT/GETTING CAUGHT
WARRANTY RENTAL CAR WARRANTY
1350 Auto Center Drive, Ontario, GA 91761 Service: 866 745-9039 BMW of Ontario
SUGGESTED SERVICES
Job Quote
WHEEL/TIRE CONCERN IMMEDIATE ATTENTION
THUDWIBRATIONS COMING FROM REAR OF VEHICLE 3,534.12
RIGHT REAR WHEEL EXCESSIVELY BENT.
Qty_. Part Number Part Description Price Ext Price
1.00 36-11-8-090-094 DISC WHEEL LIGHT AL 778.00 (78.00
1.00 36-10-6-879-168 REP. KIT, SCREW VAL 46.61g 46.61
1.00 33-30-6-899-304 WHEEL CARRIER, REAF 999.92 999.92
1.00 33-32-6-760-668 SELF-LOCKING COLLAR 6.97
6.97)
1.00 07-11-9-906-489 HEXAGON SCREW WITH 9.97, 9.97,
1.00 33-30-6-861-943 HEX BOLT 27.06 27.06%
1.00 07-14-6-887-900 HEXAGON SCREW WITH 21.91 21.91
1.00 31-20-6-866-022 COLLAR SCREW WITH S 35.71, 35.71.
4.00 31-20-6-872-920 ROUND COLLAR SCREW 15.06 60.24
1.00 33-40-6-899-174 WHEEL HUB WITH BEAR 449.58 449.58
Misc Code Misc Description Ext Price:
PVA DONATION - PARALYZED VETE 0.00
1:0020 439109094290021800029509
Labor 3.50 Hrs! 885.00
Parts 2435.97
MISC
Tax 213.15
Total 3534.12
Job Quote
WHEEL ALIGNMENT
CUSTOMER REQUESTS FOUR-WHEEL ALIGNMENT. 295.00
RECOMMEND AFTER SUSPENSION REPAIRS ON RIGHT REAR
more won unave.
Misc Code Misc Description Ext Price
PVA : DONATION - PARALYZED VETE 0.00
[Labor 2.50 Hrs) 295.00
Parts 0.00
Misc
Tax 0.00
Total 295.00
Total Estimate $ 3829.12
1350 Auto Center Drive, Ontario CA 91761 Service: 866-745-9039 BMW of Ontario
RECOMMENDED NOT DONE
These items were recommended by our certified BMW Technician but not completed during this visit.
All estimates are good for 30 days from time of estimate. Taxes and other fees are subject to change.
$1350 Auto Center Drive, Ontario, CA 91761. • Service: 866-745-9039 7:17 4 59
Trip details
7/18/2023, 11:57 AM
3.5 mi 13 min
16.4 mph Average
14.7 mpg (US)
0.2 gal total
CO2 600.7 g/mi
2.1 kg total
0% ECO PRO
0 mi
0% Coasting
0 mi
)
2505W Foothill Siva
S.
Rialto
1312 S Riverside Ave
.:
Unitech Auto Repair and Invoice # 2214
Smog Check 3726
544 W First St. suite D P.O.
Rialto, CA, 92376 Date Oct 20, 2023
Phone: 909-879-0454
Email: [email protected] Time 05:55 pm
ARD278513
IN VOICE Page Lot 2
Year 2021 Mileage 44,217 Labor $767.00
Reese Orosco Make BMW Tag 9EPP901 Parts $1,788.94
Model 3 SERIES Vehicle # Misc $0.00
San Bernardino, CA 92410 Engine 3.0L DOHC TURBO (N55) (B58) Subtotal $2,555.94 Cell:
Email: VIN 3MW5U7J05M8B53354 - Tax $134.17
Total $2,690.117
4 WHEEL ALIGNMENT $260.00
BALANCE 4 TIRES $130.00
CHANGE TIRE $26.00
REMOVE & REPLACE REAR WHEEL BEARING (ONE) $351.00
33-30-6-899-30
Wheel Carrier 1.00 $725.00 $725.00
4 33-40-6-899-17 WHEEL HUB ASSEMBLY $362.50
1.00 $362.50
4 36-11-8-090-09
Disc Wheel 1.00 $580.00 $580.00
4 36-10-6-879-16 Tire Pressure Sensor 1.00 $33.35 $33.35 8 33-32-6-760-66 $4.307
Self-Locking Collar Nut 1.00 $4.31
8 07-11-9-906-48 1.00 $5.554
9 Hexagon Screw with Flange $5.55
33-30-6-861-94 Control Arm Hex Bolt $20.692 $20.69
1.00,
$2,690.11
SIGNED Me cu DATE 10-20-2023 Amount Due $0.00
Unitech Auto Repair and Invoice # 2214
Smog Check
544 W First St. suite D P.O. 3726
Rialto, CA, 92376 Date Oct 20, 2023
Phone: 909-879-0454
Email: [email protected] Time 05:55 pm
ARD278513
I N VOICE Page 2 ur 2
Year 2021 Mileage 44,217 Labor $767.00
Reese Orosco Make BMW Tag 9EPP901 Parts $1,788.94
Model 3 SERIES Vehicle #. Misc $0.00
San Bernardino, CA 92410
Celli Engine 3.0L DOHC TURBO (N55) (B58) Subtotal $2,555.94 Email: VIN 3MW5U7J05M8B53354 Tax $134.17
Total $2,690.11
07-14-6-887-90 Suspension Track Bar Bolt
0 1.00 $17.40 $17.40
31-20-6-866-02 Axle Bolt
2 1.00 $27.666 $27.67
31-20-6-872-92 Hub Assembly Mount Bolt 1.00 $12.47 $12.47 Notes:
IN THE STATE OF CA, STATUTES.403.7185 MANDATES A $1.50 FEE TO BE COLLECTED FOR EACH BATTERY SOLD With my signature below, an express mechanics lien is acknowledged on the IN THE STATE OF FLORIDAPL. STATUTE S.403.718 MANDATES A $2.00 FEE TO BE COLLECTED FOR EACH NEW above vehicle to secure the amount of repairs thereto, until such time as TIRE SOLD. SHOP SUPPLIES OR WASTE DISPOSAL FEES MAY BE CHARGED, THIS CHARGE REPRESENTS COSTS payment has been received by the repair facility in full. I affirm that the facility AND PROFITS TO THE MOTOR VEHICLE REPAIR FACILITY FOR MISCELLANEOUS SHOP SUPPLIES OR WASTE not responsible and shall be held harmiess for any and all loss or damage to DISPOSAL. NO STORAGE CHARGE WILL BE APPLIED FOR A PERIOD OF 3 WORKING DAYS FROM DATE OF my vehicle caused by fire, theft, or acts of nature. I accept this invoice as a NOTIFICATION OF COMPLETION. STORAGE FEES ARE 50 PER DAY. ALL PARTS ARE NEW UNLESS complete and comprebensive description of the repair work done on this OTHERWISE STATED. PARTS AND LABOR HAVE A MINIMUM LIMITED GUARANTEE FOR 3 MONTH OR 3.000 MILES vehicle. warranty is one year on parts three months on labor unless otherwise is WHICHEVER COMES FIRST.NO WARRANTY ON CUSTOMER SUPPLIED PARTS specified. must show receipt.
Cash Payment $2,690.11
SIGNED Kees le DATE /0-20-2023 Amount Due $0.00
Bump Follow