CITY CLERK'S DATE STAMP
CITY OF RIALTO
LIABILITY CITY OF RIALTO
CLAIM FOR DAMAGES
2024 JAN 29 PM12: 00
TO PERSON OR PROPERTY
ASCEIVEL
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). CITY CLERK
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 9237 Address: 290 W. Rialto Ave., Rialto, CA 92376
CLAIMANT INFORMATION:
De Angelo Banks -
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 Formica Law Group
NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM
(if different from home address provided above): 5900 Wilshire Bld Ste 2250 Los Angeles, CA 90036
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE: 08/13/2023 TIME: _04:37 » AM • 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. 805 W Rialto Ave Rialto, CA 92376
3. HOW DID DAMAGE OR INJURY OCCUR?
Mr. Banks was a pedestrian struck by a vehicle (two or more).
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.
Individuals including members of the Rialto Police Department negligently and carelessly and in violation of police department protocol struck and killed decedent, De Angelo Banks. Rialto Police Department negligently and carelessly and in violation of police department protocol failed to follow proper procedure including preservation of evidence and camera footage available of the incident, as well as investigation protocol surrounding potential causes of the fatality. As a result of anna tele send RaDerment and/or possibly others. claimant's decedent heirs suffer and will continue to suffer damages as a result of his wrongful death.
6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage $ 15 million HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE:
Item/Date: wrongful death Amount: $ 15 million
Item/Date: Amount: $
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: $ 15 million ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN: CITY OF RIALTO Item/Date: wrognful death
2074 JAN Amount S
Item/Date: Amount/8: 00
TOTAL ESTIMATED AMOUNT PROSPECTIVE DAMAGES: AECEIVELS
7. WITNESSES TO DAMAGE OR IN UR Lit al Persons known to have irmain fatach ardiona pages, these NAME: unknown
NAME:
ADDRESS: ADDRESS:
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 0PM 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. r a cityrown venice 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 vehicl 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.
S
→>
CURB 60
W RIALTO AVE
PARKWAY
SIDEWALK
SIGNATURE OF CLAIMANT OR AGENT
Stefano Formica 1/25/24
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 JAN 26, 2024
TESS FIRMLY TO SEAL PRESS FIRMLY TO SEAL
92376 $30.45
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