CITY OF RIALTO CITY CLERK'S DATE STAMP
LIABILITY CITY OF RIALTO
CLAIM FOR DAMAGES 2024 APR 10 AM IO: 35
TO PERSON OR PROPERTY RECEIVEL
CITY CLERK
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).
3. READ ENTIRE CLAIM FOR BEFORE FILING RETURN TO:
4.ATTACH SEPARATE SHEETS, IF NECESSARY, TO GIVE FULL DETAILS Rialto City Clerk's Office Mail: 150 S. Palm Ave., Rialto, CA 92376
Address: 290 W. Rialto Ave., Rialto, CA 92376
CLAIMANT INFORMATION:
Eustacia Hill
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: - 10/15/2023 approx 11pm DAM OPM TIME:
2. PLACE OF ACCIDENT (OCCURRENGE) 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.
Rialto, CA 92376
3. HOW DID DAMAGE OR INJURY OCCUR?
I slipped and fell at home in my restroom due to lack of lighting caused by 'timer' lights the builder installed in my restroom. I requested to have the timer light switches removed, as it was a safety/tripping hazard, but the builder refused to remove them advising the switches were required per County building code. See attached correspondence. I submitted a request to SB County and was advised this is the City of Rialto's jurisdiction.
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.
City building code which requires automatic ('timer') shut off lights caused hazardous conditions and injury.
6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage $ 12,946.47 HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE:
Item/Date: Medical Bills
Amount: $. 4,604.00
Item/Date: Lost Wages, in-home childcare, (12 working days) Amount: $ 8,176.80 Medication, transportation and other expenses $ 165.67
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: $ 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:
NAME:
ADDRESS:
ADDRESS:
TELEPHONE: L TELEPHONE: | )
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITAL(S) VISITED:
NAME: Arrowhead Regional Medical Center
NAME:
ADDRESS: 400 N. Pepper Ave
ADDRESS:
Colton, CA 92324
TELEPHONE: (909) 580-1000 TELEPHONE: )
DATE: 10/16/23 TIME: 10 pm 0AM•PM DATE: DAM OPA
TIME:
9. PLEASE READ THE FOLLOWING CAREFULLY: NIA
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
7 SIDEWALK
HAVE READ THE FOREGOING CLAIM AND KNOW THE CONTENTS THEREOF; AND CERTIFY THAT THE SAME IS TRUE OF MY OWN KNOWLEDGE EXCEPT AS T HOSE MATTERS WHICH ARE HEREIN STATED UPON MY INFORMATION AND BELIEF; AND AS TO THOSE MATTERS I BELIEVE THEM TO BE TRUE CERTIFY (OR DECLAREI UNDER PENAI TY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
SIGNATURE OF CLAIMANT OR AGENT
Eustacia Hill 4-8-24
TYPE OR PRINT NAME DATE
Self
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
RICHMON
AMERICAN HOMES
With us, it's personal."
Richmond American Homes
5171 California Ave., Suite 120
Irvine, Ca. 92617
1/2/2024
Dear Ms. Hill:
We have received your claim regarding an injury sustained in your home on 10/15/2023.
Regarding your request for the removal of motion sensor lights, we regret to inform you that Richmond cannot comply due to the County Title 24 Building Energy Efficiency Standards Code, which prohibits such removal.
"In bathrooms, garages, laundry rooms, and utility rooms, manual-on/ automatic- off occupant sensors automatically turn lights off if an occupant forgets to turn them off when a room is unoccupied.
Additionally, these sensors should readily provide the occupant with the option of turning the lights off manually upon leaving the room. This option should be available without having to remove the switch plate or any other modifications to the sensor. The manual-off feature is critical because it provides the occupants with the flexibility to control the lighting environment to their satisfaction, and results in greater energy savings by allowing the occupants to turn off the lights when they are not needed.
Occupant sensors must be "manual-on", i.e., the sensors must not have the ability to turn the lights on automatically and must not have a setting that can leave the lights in a permanent-on position. If a manual-on occupant sensor has an on/off switch to put the sensor into a temporary programming mode, the on/off programming switch must automatically switch off (for example, within 15 minutes) in the event the end user or installer leaves it in the programming mode." Regrettably, we must respectfully deny your claim and the request for the removal or alteration of motion sensor lights in your home. Thank you for your understanding.
Monty Peacock
Vice President of Construction
California Division
Richmond American Homes of Maryland, Inc. • 5171 California Ave Suite 120 • Irvine, CA 92617 RICHMONDAMERICAN.COM
Arrowhead Regional Medical Center
400 N PEPPER AVE
COLTON, CA 92324
877-818-0672
Eustacia Renell Hill
The following document contains the requested services for Eustacia Renell Hill (Guarantor O If you have any questions, please contact customer service.
Charges Insurance Payments Patient Payments Adjustments Total Balance 4,665.50 -60.69 0.00 0.00 4,604.81
Emergency Visit to ARMC Main Hospital (Acct #1000963460) October 23, 2023 to October 24, 2023
Sve Date Code Description Oty Amount
Charges
10/23/23 99283 HC Emergency Department Level 3 Visit Moderate Severity 1 1,326.00 10/24/23 6370000001 Acetaminophen 325 Mg Tablet (51645-703-01) 2 3.50 10/24/23 70450 HC CT Scan,Head/Brain, W/O Contrast MatI - CT Head WO 1 2,964.00 Contrast
10/24/23 73030 HC X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Left 1 372.00 Total Charges 4,665.50
Insurance Payments and Adjustments
01/08/24 2000 Insurance Payment 1 -60.69
-
RECEIPT
DATE 10-30-23 No. 903053
FROM
$1020=
FOR RENT - DOLLARS
orn home childcare sences
ACCT. CASH
PAID
• MONEV ORDER FROM 10-30-23 TO 11-2-23
DUE
CREDIT CARD
T-46820
RECEPT No. 903052
DATE 10-19-23
$ 2040
FROM
DOLLARS
O FOR RENT
OFOR Child care - in home
ACCT. (CASH
•CHECK FROM 1076-73 TO 10-2625
PAID гон
MONEY ORDER
DUE CREDIT CARD - 420020
BY a
Accessibility Help My Jobs Hello, EUSTACIA HILLI Logout Home Time and Leave Compensation Performance
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Emplovee Appointment Employment Home Sub.
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• General Information
02/28/2024 Employee ID: Selectic
Name: HILL, EUSTACIA Payment Frequ
Appointment ID: Pay Le
11/10/2017
Home Department: PW Work Le
Home Department Desc:
Title: Ne:
Quick Links Title Desc: STAFF ASST Next Step Advanc
Sub-title : A Monthly Calculated
Home Unit :
• Calculated Salary Pay Rate Information
Event Event Base Other Hourly P
Type Description Base Amount
099 REGULAR EARNS true 42.6437
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