CITY OF RIALTO CITY CLERK'S DATE STAMP
LIABILITY CITY OF RIALTO
CLAIM FOR DAMAGES 2024 HAR 11 AM 9:05
TO PERSON OR PROPERTY
2.Claims for damages to real property musi be filed not later than one (1) year after the occurrence (Gov. Code 59112). 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:
Vincent Joseph Vodnik
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
NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM
(if different from home address provided above):
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE: 11 / 15 / 2023 TIME: 6:30 DAMÉPPM Where appropriate, give street names and addresses, measurements and landmarks.
The incident occurred on west Foothill Bird and Space Ave in Rialto, California 923lle.
3. HOW DID DAMAGE OR INJURY OCCUR?
The dainace occurred due to heavy raintall which caused floading. Due to improper drainage system, the Hoodina
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4. WERE POLICE AT THE SCENE? •YES ENO WERE PARAMEDICS AT THE SCENE? •YES ENO
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 city of Rialto does not have enough gutter systems on West Foothill Bird and North spruce to manage the dangerous floods.
There were no signs that indicated flouds.
6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage $ 10,558.13 HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE:
Item/Date: Amount: $
Item/Date: Amount: $
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: $ ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN:
CITY OF RIALTO
Item/Date: Amount: $
Item/Date: 2024 MAR I Amoun $ 05
TOTAL ESTIMATED AMOUNT PROSPECTIVE DAMAGES: $
7. WITNESSES TO DAMAGE OR INJURY List all persons known to have information (attach aditional pages, it necessary) NAME: Ashley Boiorquet NAME: Daniel Arqueta
ADDRESS: ADDRESS:
TELEPHONE:
TELEPHONE:
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITAL(S) VISITED:
NAME: NAME:
ADDRESS: ADDRESS:
TELEPHONE: L TELEPHONE: ()
DATE: TIME: DATE: TIME: DAM 0PM
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 West Foothill Bivd
incident
PARKWAY North
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. -------•_ - PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
SIGNATURE OF CLAIMANT OR AGENT
Vincent Vounik 2-23-2024
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 3/10/24,7:15 PM mail-attachment.googleusercontent.com/attachment/u/0/?ui=2&ik=6319c 3a33f&attid=0.2&permmsgid=msg-f:1786572486725757..
Labor Hirs
0.00 hr
Labor Rate
Dynamic Pricing | Customer Pay
Bil His
0.00 hr
Labor Price
0.00 Tech story
amed Part
Search Caller Quantity On Hand ETA Unit Price Total price Status Watching records found
4.00 hr
Labor Rate
Dynamic Pricing | Customer Pay
Bil lis
4.00 hr
Labor Price
968.73
Tech story
canoed be tues over, is after rest pe in are sater soaked, les and fould on tons eved yee an and reed started on mister after one read VOTE: missing undercarriage covers. recommend to install covers to assist in preventing future damage Billed Parts
S0.00
Part Quantity On Hand ETA Unit Price Total price Status Fees
S0.00
Fee Code
Total Price
Natal@lastound
RO Reference
Select RO Reference
Job Reference
Sekect..
https://mail-attachment.googleusercontent.com/attachment/u/0/?ui=2&ik=6319c3a33f&attid=0.2&permmsgid=msg-f:1786572486725757660&th = 18c... 2/4 ADVANCED AUTO TECH REPAIR ORDER#
8747 VINEYARD AVE. SUITE 160
040798
Rancho Cucamonga, CA. 91730
Phone: 909-945-0300 Fax: 909-945-0344
REPAIR ORDER - RO Scheduled: 12/27/2023 08:55 AM Print Date: 12/30/2023 VODNIK, VINCENT 2019 Dodge - Charger Scat Pack - 6.4L, V8 (392CI) VIN(J) Lic #:
VIN#:
Cust ID: 5153 MG Date: 12/27/2023
Last Service: No History Current Odom : 85000 Elapsed: 0 Labor Requested / Part Description Part # Oty Parts List Extended LONG BLOCK - Remove & Replace - V8, Normally Aspirated, RWD - [Consists of a Cylinder Block fitted with Pistons, 3,500.00 Rings, Connecting Rods, Crankshaft and all Bearings, Cylinder Head(s), Camshafts), Timing Chain or Belt and Includes (where
ENGINE ASSEMBLY 4,000.00 4,000.00
PARTS 1.00 600.00 600.00
Hazardous Materials 5.00
ADVANCED AUTO TECH
8747 VINEYARD AVE =160
RANCHO CUCAMO, CA 91730
1210/2023 11:54:21
CREDIT CARD
DISCVR SALE
C.ik Card: Discov:
AD A0000001523)11
SEC #:
Bach # 23:
INVOICE
Aroova Code:
Ergy Method: Chip Real
Noce: Issue
SALE AMOUNT $4000 (11
CUSTOMER COPY
Parts: 4,600.00 HazMat: 5.00
Labor: 3,500.00 Tax: 356.50 Total: 8,461.50
Deposit: 4,000.00 Balance: 4,461.50
TEARDOWN STATE me i be saded until need otherine Save al parts. _days of the date shown above if I choose not to authorize the service recommended. All Parts removed will be discarded unless instructed otherwise: _ NOT RESPONSIBLE FOR LOSS OR DAMAGE TO
CARS OR ARTICLES LEFT IN CARS IN CASE OF FIRE, THEFT OR ANY OTHER CAUSE Authorized By. Date Time
Service Advisor: Ramirez, Juan Page 1 of 1 Copyright (c) 2023 Mitchell Repair Information Company, LLC ropartdetai2 dj 7.218
ADVANCED AUTO TECH INVOICE
8747 VINEYARD AVE. SUITE 160 40798
Rancho Cucamonga, CA. 91730
Phone: 909-945-0300 Fax: 909-945-0344
INVOICE Printed Date: 02/17/2024 Work Completed: 02/17/2024 VODNIK, VINCENT 2019 Dodge - Charger Scat Pack - 6.4L, V8 (392CI) VIN(J) Odometer In: 84832
Part Description / Number Qty Sale Ext Labor Description Ext
ADVANCED AUTO TECH
8747 VINEYARD AVE #160
RANCHO CUG MO, CA 91730
09:06:1
7/2024
CREDLI LAND
DELVRSALE
card a
Distor:
Ci. Cad: A0000001231.
SEC, #: 23
Bach #
INDICE 01
Arora Code
Say Method:
Nece
LE AMOUNT $5:3
CUSTOMER LOPY
Org. Estimate 8,472.03 Revisions 982.38 Current Estimate 9,454.41 Labor: 3,640.00 Taxes 8 Foes 575:30 Auionzed DV-VODNIk SINCENT. Date :232024 Fred 2.12 PM: tated By 3h0907.08 Labor: 80.00 Subiet $0.00 Parts: 5,516.85 HazMat: 5.00
SubTotal: 9,161.85
Tax: 427.56
Total: 9,589.41
Bal Due: $0.00
[Payments - Discover - $9,589.41 ]
Vehicle Received: 2/17/2024 Customer Number : 5153
NDER WARRANTY MOST BE PERFORM AT ADVANCED AUTO TECH ONLY NO EXUDES. WHEN PERFORMING PARTIAL REPAIRS LIKE HEAD GASKETS WE ARE NC ESPONSIBLE FOR LOWER END OF ENGINE OR ANY OTHER COMPONENT THAT MAY FAIL OTHER THEN THE REPAIRS RELATED TO THE REPAIF Signature Date.
Service Advisor: Ramirez, Juan, Tech: Vasquez, Samuel 1 Page 2 of 2 Copyright (c) 2024 Mitchell Repair Information Company, LLC invhrs 5122kr