CITY CLERK'S DATE STAMP
CITY OF RIALTO
LIABILITY CITY OF RIALTO
CLAIM FOR DAMAGES 2024 JUN 20 AMII: 53
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). 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:
Sonia heyes
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: 4. 4. 24 TIME: 2:00
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. tepe a towin
3. HOW DID DAMAGE OR INJURY OCCUR?
when the car was towed we noticed damages not on
paper filled out on police report.
4. WERE POLICE AT THE SCENE? DYES/NO WERE PARAMEDICS AT THE SCENE? YES IANO
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.
I believe danages occired when it was being towed
6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage $ 4,795.421 HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE:
Item/Date: front Bompe and Grill Amount: $.
Item/Date: fender Amount: $
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: $.
ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN:
Item/Date: Instrument Panel Amount: $
Item/Date: Lonsele 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: () TELEPHONE: L 2
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITAL(S) VISITED:
NAME: NAME:
ADDRESS: ADDRESS:
TELEPHONE: L TELEPHONE: L 1
DATE: TIME: DATE:
TIME: DAM OPM
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.
CURE
PARKWAY
/ 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 I CERTIFY (OR DECLARE) UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
SIGNATURE OF CLAIMANT OR AGENT
Sonia Reyes 6 - 19-24
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 1:46 0 ° 5GUC .l 25% -
Timeline :
Day Trips Insights Places Cities W
- W Lowell St
Summit Ave
W Persimmon Ave
N Locust i
< Sun, Apr 7, 2024 -
3.4 mi
1 visit
7 hr 3 min
Driving
3.4 mi 7 hr 3 min :
Arrived at 2:34 AM
Pepe's Towing Service
2775 N Locust Ave, Rialto, CA 92377
Arrived at 2:34 AM
CALIBER - RIALTO Workfile ID: 341039cc
CALIBER Federal ID: 33-0730794
RESTORING THE RHYTHM OF YOUR LIFE State ID: N/A
Federal EPA: N/A
421 West Rialto Avenue, RIALTO, CA 92376 State EPA: CAL000265317 COLLISION Phone: (909) 874-4470 BAR: ARD299767
FAX: (909) 874-4561
Preliminary Estimate
Customer: Reyes, Sonia
Written By: Arnol Alvarez
Insured: Reyes, Sonia Policy #: Claim #:
Type of Loss: Date of Loss: Days to Repair: 0
Point of Impact:
Owner: Inspection Location: Insurance Company:
Reyes, Sonia CALIBER - RIALTO CUSTOMER PAY
421 West Rialto Avenue
RIALTO, CA 92376
Repair Facility
(909) 874-4470 Business
VEHICLE
2016 CHEV Traverse LT FWD 4D UTV 6-3.6L Gasoline Direct Injection VIN: Interior Color: Mileage In: 168,315 Vehicle Out:
License: Exterior Color: Mileage Out:
State: CA Production Date: 8/2015 Condition: Job #:
TRANSMISSION Intermittent Wipers Stereo Cloth Seats
Automatic Transmission Tilt Wheel Search/Seek Bucket Seats POWER Cruise Control CD Player Reclining/Lounge Seats
Power Steering Rear Defogger Auxiliary Audio Connection Heated Seats Power Brakes Keyless Entry Premium Radio 3rd Row Seat
Power Windows Message Center Satellite Radio WHEELS
Power Locks Steering Wheel Touch Controls SAFETY Aluminum/Alloy Wheels Power Mirrors Rear Window Wiper Drivers Side Air Bag PAINT Heated Mirrors Telescopic Wheel Passenger Air Bag Clear Coat Paint Power Driver Seat Climate Control Anti-Lock Brakes (4) OTHER DECOR Dual Air Condition 4 Wheel Disc Brakes Fog Lamps
Dual Mirrors Backup Camera Traction Control Rear Spoiler Body Side Moldings Parking Sensors Stability Control Signal Integrated Mirrors Privacy Glass Remote Starter Front Side Impact Air Bags TRUCK Console/Storage Home Link Head/Curtain Air Bags Power Trunk/Liftgate Wood Interior Trim RADIO • Communications System
CONVENIENCE AM Radio Hands Free Device
Air Conditioning FM Radio SEATS
6/14/2024 3:38:23 PM 036535 Page 1
Preliminary Estimate
Customer: Reyes, Sonia
2016 CHEV Traverse LT2 FWD 4D UTV 6-3.6L Gasoline Direct Injection Line Oper Description Part Number Qty Extended Labor Paint Price $
1 FRONT BUMPER & GRILLE
2 O/H bumper assy 3.0
* Repl Bumper cover 23328140 1 900.20 Incl. 0.0
4 Add for fog lamps 0.3
5 Repl Lower grille w/chrome trim 20988622 491.40 Incl.
Repl License bracket 22757025 46.50 0.2
FENDER
8 Repl RT Fender liner front 20914932 136.65 0.4
Repl RT Fender liner rear 22850700 124.42 0.3
10 INSTRUMENT PANEL
11 Repl Center bezel w/auto temp control 23132405 1 19.90 ebony
"i2 CONSOLE
13 Repl Trim plate traverna wood 23132407 1 164.42
--
14 FRONT DOOR
15 * Rpr RT Outer panel 4.0 2.1
16 Add for Clear Coat 0.8
17 R&I RT Belt molding chrome 0.2
18 Repl RT Lower molding 22923502 1 195.42 0.4
19 R&I RT Mirror assy 2nd design 0.3
20 * Rpr RT Mirror assy 2nd design 1,0 1l
21 R&I RT R&I trim panel 0.5
22 REAR DOOR
23 * Bind RT Outer panel
24 R&I RT Belt molding black 0.2
25 Repl RT Side molding w/o body color 23104172 1 152.48 0.3 26 R& RT Handle, outside 0.3
27 R&I RT R&I trim panel 0.4
28 # Pre-repair scan 1 40.00 X 0.5
29 # Post-repair scan 1 80.00 X 0.5
30 # Cover Car for Overspray 1 12.00 X 0.3
31 # Mask for Primer 1 12.00 X 0.3
32 # Mask Jambs, Opening, Entry 1 12.00X 0.3
33 # Repl Corrosion Protection / Primer 1 15.00 T 0.3
34 # Flex Additive 1 12.00 T
35 # Refn Color Tint 0.5
36 # DeNib and Polish 1 18.00 1.0
37 # Adhesion Promoter 1 15.00 T 0.1
SUBTOTALS 2,447.39 15.1 6.4
6/14/2024 3:38:23 PM 036535 Page 2
Preliminary Estimate
Customer: Reyes, Sonia
2016 CHEV Traverse LTZ FWD 4D UTV 6-3.6L Gasoline Direct Injection
ESTIMATE TOTALS
Category Basis Rate Cost $
Parts 2,231.39
Body Labor 15.1 hrs @ $ 82.00/hr 1,238.20
Paint Labor 6.4 hrs @ $ 82.00 /hr 524.80
Paint Supplies 6.4 hrs @ $ 59.00 /hr 377.60
Miscellaneous 216.00
Subtotal 4,587.99
Sales Tax $2,650.99 @ 7.7500% 205.45
Grand Total 4,793.44
MyPriceLink Estimate ID / Quote ID:
1230998121450840064 / 137312311
==============================∞£== =============================== Caliber Collision is the industry leader in quality collision repair. Since day one, our highest purpose has been to get people just like you back on the road as quickly as possible and fully restored to the rhythm of your life. You can be sure we do everything possible to ensure your complete satisfaction including:
Personalized, high quality service from the largest collision repair company in the U.S.
Consistently ranked among the highest customer satisfaction scores in the industry.
Approved by every major insurance company in the U.S.
Expedited car rental and towing services to get you back on the road again in no time.
Repair work backed by a written, lifetime warranty honored at every location. 24/7/365 customer service to answer questions and put your mind at ease.
This is a preliminary estimate based on visible damage. There may be additional repairs needed once the vehicle is taken apart by our I-CAR Gold Class technicians to identify any additional damage.
If an insurance company has written an estimate for you, please provide us with a copy. Properly endorsed insurance company checks are welcome as payment for the repair of your vehicle. Caliber Collision gladly accepts all major credit cards, debit cards, cashier's and traveler's checks. See your Caliber Collision center for details on acceptance of personal checks.
Before leaving your vehicle with us, please remove all important personal and valuable items from your vehicle.
Caliber Collision is not responsible for belongings left in your vehicle.
Please let us know how we can be of further assistance, and when we can schedule an appointment for your vehicle to be repaired.
Caliber Collision - Restoring The Rhythm Of Your Life
==============================
6/14/2024 3:38:23 PM 036535 Page 3
Preliminary Estimate
Customer: Reyes, Sonia
2016 CHEV Traverse LT2 FWD 4D UTV 6-3.6L Gasoline Direct Injection
FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM. ANY PERSON WHO KNOWINGLY PRESENTS FALSE
OR FRAUDULENT INFORMATION TO OBTAIN OR AMEND INSURANCE
COVERAGE OR TO MAKE A CLAIM FOR THE PAYMENT OF A LOSS IS
GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON.
THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY
BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED:
MOTOR ABBREVIATIONS/SYMBOLS: D=DISCONTINUED PART,
A=APPROXIMATE PRICE. LABOR TYPES: B=BODY LABOR, D=DIAGNOSTIC, E=ELECTRICAL, F=FRAME, G=GLASS, M=MECHANICAL, P=PAINT LABOR, S=STRUCTURAL, T=TAXED MISCELLANEOUS, X=NON TAXED
MISCELLANEOUS. CCC ONE: ADJ=ADJACENT, ALGN=ALIGN,
A/M=AFTERMARKET, BLND=BLEND, CAPA=CERTIFIED AUTOMOTIVE
PARTS ASSOCIATION, D&R=DISCONNECT AND RECONNECT,
EST=ESTIMATE, EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY, INCL=INCLUDED, MISC=MISCELLANEOUS, NAGS=NATIONAL AUTO GLASS SPECIFICATIONS, NON-ADJ=NON ADJACENT, O/H=OVERHAUL,
OP=OPERATION, NO=LINE NUMBER, QTY=QUANTITY,
RECOND=RECONDITION, REFN=REFINISH, REPL=REPLACE, R&I=REMOVE AND INSTALL, R&R=REMOVE AND REPLACE, RPR=REPAIR, RT=RIGHT, SECT=SECTION, SUBL=SUBLET, LT=LEFT, W/O=WITHOUT, W/_=WITH/_ SYMBOLS: #=MANUAL LINE ENTRY, *=OTHER [IE..MOTORS DATABASE INFORMATION WAS CHANGED], **=DATABASE LINE WITH AFTERMARKET, N=NOTES ATTACHED TO LINE. OPT OEM=ORIGINAL EQUIPMENT
MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT.
''''CURE TIME'' MEANS THE LENGTH OF TIME THAT, PER THE ADHESIVE
MANUFACTURER, THE WINDSHIELD ADHESIVE NEEDS TO CURE UNTIL THE
WINDSHIELD CAN PROPERLY FUNCTION AS A SAFETY DEVICE PURSUANT
TO THE FEDERAL MOTOR VEHICLE SAFETY STANDARDS AND THE
VEHICLE MANUFACTURER'S SPECIFICATIONS.
6/14/2024 3:38:23 PM 036535 Page 4
Preliminary Estimate
Customer: Reyes, Sonia
2016 CHEV Traverse LT2 FWD 4D UTV 6-3.6L Gasoline Direct Injection Estimate based on MOTOR CRASH ESTIMATING GUIDE and potentially other third party sources of data. Unless otherwise noted, (a) all items are derived from the Guide DR1GM09, CCC Data Date 05/16/2024, and potentially other third party sources of data; and (b) the parts presented are OEM-parts. OEM parts are manufactured by or for the vehicle's Original Equipment Manufacturer (OEM) according to OEM's specifications for U.S. distribution. OEM parts are available at OE/Vehicle dealerships or the specified supplier. OPT OEM (Optional OEM) or ALT OEM (Alternative OEM) parts are OEM parts that may be provided by or through alternate sources other than the OEM vehicle dealerships with discounted pricing. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor data provided by third party sources of data may have been modified or may have come from an alternate data source. Tilde sign (~) items indicate MOTOR Not-Included Labor operations. The symbol (<>) indicates the refinish operation WILL NOT be performed as a separate procedure from the other panels in the estimate. Non-Original Equipment Manufacturer aftermarket parts are described as Non OEM, A/M or NAGS. Used parts are described as LKQ, RCY, or USED. Reconditioned parts are described as Recond. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass Specifications. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are not included. Pound sign (#) items indicate manual entries.
Some 2024 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated data from the vehicle manufacturer, labor and parts data from the previous year may be used. The CCC ONE estimator has a list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership.
The following is a list of additional abbreviations or symbols that may be used to describe work to be done or parts to be repaired or replaced:
SYMBOLS FOLLOWING PART PRICE:
m=MOTOR Mechanical component. s=MOTOR Structural component. T=Miscellaneous Taxed charge category.
X=Miscellaneous Non-Taxed charge category.
SYMBOLS FOLLOWING LABOR:
D=Diagnostic labor category. E=Electrical labor category. F=Frame labor category. G=Glass labor category.
M=Mechanical labor category. S=Structural labor category. (numbers) 1 through 4=User Defined Labor Categories.
OTHER SYMBOLS AND ABBREVIATIONS:
Adj.=Adjacent. Algn.=Align. ALU=Aluminum. A/M=Aftermarket part. BInd=Blend. BOR=Boron steel.
CAPA=Certified Automotive Parts Association. D&R=Disconnect and Reconnect. HSS=High Strength Steel.
HYD=Hydroformed Steel. Inc.=Included. LKQ=Like Kind and Quality, LT=Left. MAG=Magnesium. Non-Adj.=Non Adjacent. NSF=NSF International Certified Part. O/H=Overhaul. Qty=Quantity. Refn=Refinish. Repl=Replace.
R&I=Remove and Install. R&R=Remove and Replace. Rpr=Repair. RT=Right. SAS=Sandwiched Steel.
Sect=Section. Subl=Sublet. UHS=Ultra High Strength Steel. N=Note(s) associated with the estimate line.
CCC ONE Estimating - A product of CCC Intelligent Services Inc.
The following is a list of abbreviations that may be used in CCC ONE Estimating that are not part of the MOTOR CRASH ESTIMATING GUIDE:
BAR=Bureau of Automotive Repair. EPA=Environmental Protection Agency. NHTSA = National Highway Transportation and Safety Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number. 6/14/2024 3:38:23 PM 036535 Page 5