ЗАНО САНЕК CITY OF RIALTO COITY CLERKS DATE STAMP
LIABILITY OF RIALTO
RNIA 2024 APR 18 PM 5:34
CLAIM FOR DAMAGES
TO PERSON OR PROPERTY RECEIVED
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:
Steel Tech Industral Corp
FULL NAME
DATE OF BIRTH
HOME ADDRESS INCLUDING CITY, STATE & ZIP L )
HOME TELEPHONE NO.
came
BUSINESS ADDRESS INCLUDING CITY, STATE & ZIP
BUSINESS TELEPHONE NO.
ADDRESS AT WHICH CLAIMANT DESIRES TO RECEIVE 124e8 Sherbornst Coraa Ct 92877
NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM
(if different from home address provided above):
Tow
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE: 4/8/2024 TIME: 8.30 MAMOPM
2. PLACE OF AGGIDENT (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.
Rialto Ave / Willow Ave
3. HOW DID DAMAGE OR INJURY OCCUR?
Ve12500-Dfficer impounded tRuck for Not Oper Veh. otherthan what person 13 licased a
Amended ticket tobe issued by officer Keetle R. Barter-to Renove
4. WERE POLICE AT THE SCENE? DYES NO WERE PARAMEDICS AT THE SCENE? •YES DINO
5. WHAT PARTICULAR ACT OR OMISSION DO YOU CLAIM CAUSED THE INJURY OR DAMAGES? Give the name of the city/town Orticer R Barter 02334 - towing & Storage fees
6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage $ 1104,30 HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE:
Item/Date: 4/8/2024 1104,30
Amount: $
Item/Date:
Amount: $.
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: $ 110430 ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN:
Item/Date:
Amount: $_
Item/Date:
Amount: $
TOTAL ESTIMATED AMOUNT PROSPECTIVE DAMAGES: $ 1104,30
NAME: Hugo Alberto Gonzalez Torez 7. WITNESSES TO DAMAGE OR INJURY List all persons known to have information (attach additional pages, if necessary) NAME:
ADDRESS: _
ADDRESS:
Fontana l'A 92336
TELEPHONE:
TELEPHONE: _)
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITALS) VISITED:
NAME:
NAME:
ADDRESS:
ADDRESS:
TELEPHONE: |) TELEPHONE: | )
DATE: TIME: DAM OPM
DATE: TIME:
0AMOIPM
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 comers.
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
HAVE READ TRE ORE IN CAN A EDU THE CONTENTS TO AN AN AND AS TO THOSE MATES BE THEM TO BE EXCEPT ASTO LEEDIEV IND NEA ADEL NDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
SIGNATÜRE OF CLAIMANT OR AGENT
Elise Robert 2/15/2024/
TYPE OR PRINT NAME DATE
Controller
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, CÁ 92376 Invoice
PEPES TONING SERVICE Pepe's Towing Service Impound Invoice 2715 N LOCUST AVE PO Box 7450, Moreno Valley CA 92552
RIALTO, CA. 92377-4111 Phone: (951) 682-5682 | Fax: (951) 682-5030 Printed 4/8/2024 909-574-1490
¡OROZCO 1268 SHERBON ST CORONA CA 92879
Phone
SALE 24-0408-33920 Reason for Impound
33920 VIN Number
932403742 Model 2018 Freightliner M2 106 (Silver)
REF#: 00000003 932403742 License Plate
Batch #: 293 RIALTO PD Drivable
Yes
04/08/24 4/8/2024 7:32 AM Keys Yes INSIDE VEHICLE
12:25.36 4/8/2024 7:33 AM Towed from
Inv/Tkt #: 33920 willow and rialto
APPR CODE: 180588 4/8/2024 7:42 AM Stored at Rialto Yard Trace: 3 4/8/2024 8:10 AM 2775 N Locust, Rialto CA 92377- VISA 4/8/20248:24 AM
Chip 4/8/20249:00 AM OF
*t/4* 4/8/20248:31 AM 18
Ernie V.
AMOUNT $887.50 TRK 61
4/8/2024 12:23 PM
1 days
tly wrong on 180*** email has been sent for a revised 180
APPROVED
Quantity Price Line Total
is/Storage: Daily Impound Rate 1 $80.00 $80.00
ISA CREDIT
ID: A0000000031010 Quantity Price Line Total
VR: 80 80 00 80 00 1 $95.00 $95.00
SI: 68 00 PORT (price per hour) 1.5 (1 h 30 m) $475.00 $712.50 Towing SubTotal $807.50
THANK YOU Storage - Storage Fees SubTotal $80.00
Subtotal $887.50
Taxes $0.00
STOMER COPY Grand Total $887.50
Amount Due: $0.00 / Paid
Visa payment (Ref # CC 8935) of $887.50 applied on 4/8/2024 Pepe's Towing Service appreciates your business; if you have any questions regarding this invoice, please contact us at 951-682-5682. Thank you.
Damage Disclaimer:
I Have been advised that my vehicle may be damaged if winched, towed, unlocked, jump started, tire changed or left on unattended premises. I recognize the Signature: Date:
CA# 117433 USDOT: 1005094
Upon request, you are entitled to receive a copy of the Towing and Storage Fees and Access Notice https://app.towbook.com/impounds/lmpound.aspx?id=18268063#Payment 1/1
City of Rialto
POLICE
NOTE: CHP 180 IS FURNISHED TO ALL PEACE
150 S Palm Ave STORAGE OFFICERS BY THE CALIFORNIA HIGHWAY PATROL Rialto, CA 92376-6487
+1 (909) 820-2525 )E DATE / TIME OF REPORT NOTICE OF STORED VEHICLE FILE NO. 3-19-24 / 1050 DELIVERED PERSONALLY
City of Rialto 932403742
ODOMETER READING VIN CLEAR IN SVS? X YES
DATE / TIME DISPATCH NOTIFIED
04/08/2024 12:02PM LIC. CLEAR IN SVS? 3-19-24 / 1050
000971-0005 PD24-000002371 BODY TYPE
ONE MONTH/YEAR STATE
Payment Effective Date 04/08/2024 FB SLVR 11/24
× TWO CA
ENGINE NO. VALUATION BY
Z 472 7 OFFICER E OWNER
MISCELLANEDUS • 0-500 501-4000 40017
Vehicle Release Fee X SAME AS R/O LEGAL OWNER
(629833) RP
2024 Item: 629833 STEEL TECH INDUSTRIAL CORP
1268 SHERBORN ST co
1 0 $216.8000
Vehicle Release Fee CORONA, CA 92879
(629833) $216.80
Payment Id: 17468 RELEASED
• RECOVERED - VEHICLE /gOMPONENT
$216.80 STORAGE AUTHORITY / REASON
IT AVE, RIALTO, CA 92377 VC 22651(P)
AIRBAG? DRIVEABLE?
Subtotal $216.80 VIN SWITCHED?
Total X YES NO • 2 X YES • NO • JUNK • UNK
$216.80 • YES X NO
NO ITEMS YES NO ITEMS
YES NO TIRES / WHEELS CONDITION
REGISTRATION X CAMPER X
LEFT FRONT WORN
POLICE CC MERCHANT $216.80
X ALT. / GENERATOR X VESSEL AS LOAD RIGHT FRONT WORN
BATTERY FIREARMS
LEFT REAR WORN
Ref=487e4aa3-47db-4c1a-8600-5cd407dde579 DIFFERENTIAL OTHER
RIGHT REAR WORN
Auth=968005 X TRANSMISSION xxX
SPARE NO
X AUTOMATIC HUB CAPS NO
MANUAL X NO
SPECIAL WHEELS
22850.3 CVC GARAGE PRINCIPAL / AGENT STORING VEHICLE (SIGNATURE) DATE / TIME ERNIE VILLEGAS 4-8-24 / 0745
DATE
04/08/34 CERTIFICATION: I, THE UNDERSIGNED, DO HEREBY CERTIFY THAT I AM LEGALLY AUTHORIZED AND ENTITLED TO TAKE POSSESSION OF THE ABOVE DESCRIBED VEHICLE.
SON REO REASON TIME OSSEN
Change due $0.00
EMBEZZLED VEHICLE • PLATE(S) REPORT
Paid by: BLACK/BRAEDON M PORTED NAME OF REPORTING PARTY (R/P) DRIVER LICENSE NO. / STATE
ADDRESS OF R/P
Thank you for your payment TELEPHONE OF RIP
WS OF SIGNATURE OF PERSON MAKING REPORT
CUSTOMER COPY ECT.
REMARKS
IST PROPERTY, TOOLS, VEHICLE DAMAGE, ARRESTS)
DRIVER'S NAME
ARRESTED / SECTION? REPORTED BY CARGO / TYPE?
HUGO GONZALEZ TORRES O YES X NO A. KEETLE X YES
• BILL OF LADING ATTACHED
VEHICLE WAS STOPPED FOR AN ILLEGAL U-TURN. DRIVER WAS FOUND TO HOLD A CLASS C LICENSE ONLY. VEH GVWR 33K AND REQUIRES A CLASS B LICENSE. LOADED WITH SMALL
STEEL REINFORCEMENTS
REQUIRES CLASS B LICENSE FOR RELEASE
000
FRONT LEFT SIDE
RIGHT SIDE REAR
TOP
SIGNATURE OF OFFICER TAKING REPORT I.D. NO. suPERVISOR
REQUIRED NOTICES SENT TO REGISTERED YES DATE NOTIFIED
A. KEETLE 233
AND LEGAL OWNERS PER 22852 CVC? • NO
An Internationally Accredited Agency Chp180_0416.pdf
CITY OF RIALTO POLICE DEPARTMENT
RIA513821
NOTICE TO:
•APPEAR IN COURT AT: Superior Court Fontana District
ON: 17780 Arrow Blyd
(909) 350-9922
XI RESPOND TO CITATION BEFORE:
DATE: 07/08/2024 8:00AM
To be notified -----> ACT BY THIS DATE TO AVOID
WARRANT OR ADDED FEES
Late or violation mm, / i l time Driver'S License Numer (all states ) Lass State
04/08/2024 07:07
C CA
Name (Frst, Middle, Last)
HUGO ALBERTO GONZALEZ TORREZ
Current Arroce Inn etrant, city, state, zip)
FONTANA CA 92336
1 Date of Birth (mm/dd/yr) Parent Guardian Phone No. •Juvenile Commercial Insurance
| Race/Ethnicity XIN NONE
Sex Halr Eyes
Helght Weight
Hispanic M BRN
BRN 600 202
Vehicle License/VIN State "Reg (mm/yy)
TYear of Veh. Make
CA 11/2024
2018 FRHT
Registered Owner/Lessee semasther
Body Style
STEEL TECH INDUSTRIAL CORPORATION (FLATBED
TRUCK
Autiress 010., sueet, cit, State, zip)Lsane as enver
1268 SHERBOURNE ST CORONA CA 97879 COlOr
Reason for Stop SILVER
U-TURN JCHP/D01/PUC/10C
CITATION DETAILS • Booking Required
Correctable Code/Section Description *M=Misdemeanor
(Fx-R) I=Infraction
N VC 22102 U-Turn in Business District
[м X
N VC 12500(D)
Not Oper. Veh. Other Than What Persords Lic. CIT
OM X
•M•
- OF
Approx. Speed TPF Max Speed ver. LmE.
X) Commerical Ve
VC 15210(b)
RIALTO AVE
W of WILLOW AVE • Hazardous Mal
City/County of Occurrence -VC 353
Rialto - San Bernardino gency Case No.
Comments (weather, road, tramc conations)
• Crash
CLEAR, DRY, LIGHT, LIGHT
Wolators no: commited in my presence, declared on information and belet (VC 40600) dedera under penalty of perjury under the laws of the State of CA hat the folowing is true and correct 04/08/2024 KEETLE 01720
CECL.DATE ARRESTING OR CITING OFFICER Officer ID
DECL. DATE ARRESTING OFFICER (If different from above) Officer ID I promise to act by the date at the top of this citation. Signing DOES NOT admit guilt.
CELL PACNE OFTICAL (may be used tor reminders) EMAIL-OPTIONAL (may be used for reminders)
SIGNATURE
DEFENDANT COPY FORM INFO
Continuation form •
Form Adopsedfor Mana scarruse
-150 Traffic fiscalls Desce :0 ca
SEE REVERSE Vet, Code 0606539
This is the form letme know:
we were given
If we need Vis complete
a different form or Thank you
information is
any Els Roberts
missing Please!
1248 Sherborn st
corona CA 92379 SANTA ANA CA 926
16 APR 2024 PM 4 L
FIR 02 1P
0001155496
MAILED FROM ZIF
CITY OF RIALTO 2024 APR 18 PM 5: 35 RECLIPLO
SIT Y
Rialto Cite Clerk's Office
1505 Palm Ave
Rialto, CA 92374
92376-648799