CITY CLERK'S DATE STAMP
CITY OF RIALTO
CITY OF RIALTO
LIABILITY
CLAIM FOR DAMAGES 2024 JUL 31 PM 4: 59
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 5911.2). 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:
Fidel N. Gutierrez Jr.
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):
00:32 MAMOPM
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE: 07-28•24 TIME:
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.
My car was parked on the city street at 1527W Rialto Ave. Riulto, Ca. 92376
3. HOW DID DAMAGE OR INJURY OCCUR?
My car was towed because I didn't have this years sticker: although my registratien and insurance was already paid it wasn't updated in the system. Even as of today the dmy system says my registration is expired ofter I picked up my cument year segistration sticker.
4. WERE POLICE AT THE SCENE? EYES NO WERE PARAMEDICS AT THE SCENE? DYESNO
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 DMV system didnt update my wrent registrahon and resulted in towing my Vehicle regardless the fact that everything is paid and up to date, I just had pick up my stider because Duv never sent it through mail. Therefore a huge mistake in the sstem
6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage $ 887.80 HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE:
Item/Date: Rialto P.D. Vehicle Release 07-29-24 Amount: $ 216.80 Item/Date: Pepe's Towing fees 07-29.24 Amount: $ 671.00 TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: $ 887,80 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: ) TELEPHONE: L)
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: • AM OPM DATE: TIME: DAMO 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.
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
AVE READ THE FOREGOING CLAIM AND KNOW THE CONTENTS THEREOF; AND CERTIFY THAT THE SAME IS TRUE OF MY OWN KNOWLEDGE EXCEPT AS OSE MATTERS WHICH ARE HEREIN STATED UPON MY INFORMATION AND BELIEF; AND AS TO THOSE MATTERS I BELIEVE THEM TO BE TRI I PEDTIEV IND DEMI ABEL HIER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
SIGNATURE UF CLAIMAN I UGAGENT
Fidel futierrez 07-30-24
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 REGISTRATION CARD VALID FROM: 12/10/2023 TO: 12/10/2024 MAKE YR MODEL YR IST SOLD VLF CLASS *YR TYPE VEH TYPE LIC LICENSE NUMBER LEXS 2019 2018 JH 2021 120 11
BODY TYPE MODEL MP MO VEHICLE ID NUMBER
4D G FG
TYPE VEHICLE USE DATE ISSUED CC / ALCO DT PEE RECVD PIC STICKER ISSUED AUTOMOBILE 07/29/24 33 12/03/23 8 R2734647
PR EXP DATE: 12/10/2023
REGISTERED OWNER AMOUNT PAID
GUTIERREZ FIDEL N 415.00
12812 SOVITE WAY AMCULT DJE AMOUNT RECO
$ 415.00 CASH :
CHCK :
MORENO VALLEY CRDT . 415.00
CA 92555
LIENHOLDER
LEXUS FNCL SVC
PO BX 105386
ATLANTA
GA 30348
H01 545 11 0041500 0016 CS H01 072924 11 8GVK901 274
BRISTOL WEST
NSURANCE GROUP
Underwritten by: Coast National Insurance Company PERSONAL AUTO DECLARATION (Page 1) PO Box 31029 POLICY NUMBER Policy Period
Independence. OM 44131-0029 From To
1-888-888-0080 G01 4308439 00 09/06/2024 12 01a.m.
03/06/2024 tear of 1201 a x or me
Inqure or pay your bit prene using
-Unless canceled sooner for yalid reasons.
0461028
Named Inaured:
LYDIA GUERRA RAPID INSURANCE SERVICES, INC.
12812 SOVITE WAY 2319 N SAN FERNANDO BLVD
MORENO VALLEY CA 92555-4577 BURBANK CA 91504-3352
Telephone: 818-235-5313
THESE DECLARATION PAGES INCLUDING ANY ENDORSEMENT THERETO, THE WRITTEN APPLICATION AND THE AUTO POLICY INCLUDING ANY ENDORSEMENTS THERETO, COMPRISE THE COMPLETE POLICY.
VEHICLE PREMIUM TOTAL (all vehicles) $908.96
includes $18.08 for Policy Fee and 30.88 for Fraud Pee
* EFT/instalmert Fees 1510.00 per peyment) $50.00
* Tomi induding EFT/insi
+ # sour outst ding policy balance as pad in tul prior a ne next payment du cy setst.
POLICY DECLARATION
Additional Drivers on
Policy tated SA22 Birth License Humi State ACC Com
FIDEL GUTIERREZ 1978 CA
0 0 0t
ALEX GUTIERREZ N 1998 CA
ELENA GUTIERREZ N 1992 F2151103 CA
1003(11/10) CNIC 196H CAPCE CAPCE 01(09716)
Year / Make / Model: 2019 DEXU 1S 300 State: CA Vehicle Use: Ple Venicle Identifications: Territory: 058 Symbol: 1311--SYYY Driver: LYDIA GUERRA Mileage: 14500
License Number: Rate Class: SM43 Birth: 12/16/1964
Acc/Conv Totals: 1/0 Marital s
License State: CA Status:
Years Experienced 43
Discounts: Good Driver Anti-That
Go Paperless: Not Enrolled
Garaging Location: Same
Loss Payee: NA
Additional Inte NA
*Per Person "Per Accident *Premium Deductible
Coverage.: Limit Limit
BODILY INJURY 15,000 30,000 449.00
PROPERTY DAMAGE 5,000 :441.00
Limits are reduced is 16.000/30,000.000 toxcertair
CNCA-BO-301 11119) laved Date: 03082024 INSURED Authoried Signature
STATE OF GALIFORNIA NOTE: CHP 180 IS FURNISHED TO ALL PEACE
DEPARTMENT OF CALIFORNIA HIGHWAY PATROL OFFICERS BY THE CALIFORNIA HIGHWAY PATROL
CHICLE REPORT
CHP 180 (Rev. 4-16) OP| 061
FILE NO.
LOCATION CODE | DATE / TIME OF REPORT NOTICE OF STORED VEHICLE 93240.7976 PORTING DEPARTMENT 728/24 ฿ : 32ELIVERED PERSONALLY
Кіп ІГО 3609 DATE TIME DISPATCH NOTIFIED LOG NO.
OLOMETER READING VIN CLEAR IN SVS? EYES ONO
LOCATION TOWED / STOLEN FRON UnK ¡LIC. CLEAR IN SVS? IX YES L NO 07/28/2024 6:32 1527W Kin/TO NVenUC [MONTH/YEAR STATE
TIMENCE NIN DONE
BODY TYPE COLOR CA
12/23
mate XUS NOIS 300 4 Door maL EX TWO
VENG
TENGINE NO (VALUATION BY X OFFICER OWNER
DONATIN NA
- • 0-500 501-4000 4001+
LEGAL OWNER
REGISTERED, OWNER * SAME AS RIO
Gutierrez Fidel N Lexus FNCL Service
P.0. BOX 105384
Moreno Valley, CA 92555 AtLanta, GA 30348
RECOVERED - VEHICLE / COMPONENT
IMPOUNDED RELEASED
X STORED STORAGE AUTHORITY / REASON
TOWING / STORAGE CONGERN (NAME, ADDRESS, PHONE 2975 N. Locust Ave, Rint, CN 92374 CUC 2265ICoXIXa 10 wing DRIVEABLEA i VIN SWITCHED?
REASON FOR STO • JUNK X UNK & NO
T YES NO
expired Resisto hon IX YES LI NO CONDITION
YES NO TIRES / WHEELS
CONDITION NO ITEMS LEFT FRONT
X SEAT (FRONT) REGISTRATION
WRECKED VESSEL AS LOAD X RIGHT FRONT fail
ALT. / GENERATOR
BURNED HULK per 431(c) CVC SEAT (REAR) LEFT REAR
RADIO RIGHT REAR 510
INDALIZED OTHER
TAPE DECK DIFFERENTIAL
3./ TRANS, STRIP X SPARE
TRANSMISSION
TAPES HUB CAPS
MISC. PARTS STRIP
OTHER RADIO AUTOMATIC
BODY METAL STRIP SPECIAL WHEELS
IGNITION KEY MANUAL DATE /TIME Co i
SURGICAL STRIP per 431(b) CVC| GARAGE PRINCIPAL / AGENT STORING VEHICLE (SIGNATURE) 1 AGENCY HOLD 22850.3 CVC
RELEASE VEHICLE TO: DRO OR AGENT OPcO 7-28-2
DATE CERTIFICATION: 1, THE UNDERSIGNED, DO HEREBY CERTIFY THAT I AM LEGALLY NAME OF PERSON / AGENCY AUTHORIZING RELEASE. L.D. NO. AUTHORIZED AND ENTITLED TO TAKE POSSESSION OF THE ABOVE DESCRIBED VEHICLE.
REECE 47 729-14
SIGNATURE OF PERSON TANG
SIGNATURE OF PERSON AUTHORIZING RELEASE
Frat
• EMBEZZLED VEHICLE [LATE(S) REPORT
STOLEN VEHICLE / COMPONENT DRIVER LICENSE NO. / STATE
NAME OF REPORTING PARTY (R/P) •
DATE / TIME REPORTED
DATE / TIME OF OCCURRENCE
TELEPHONE OF R/P
ADDRESS OF RIP
DATE /TIME )
LAST DRIVER OF VEHICLE (
SIGNATURE OF PERSON MAKING REPORT
I CERTIFY OR DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT THE FOREGOING IS TRUE AND CORRECT.
REMARKS
[LIST PROPERTY, TOOLS, VEHICLE DAMAGE, ARRESTS]
CARGO / TYPE? VALUES
ARRESTED / SECTION? REPORTED B
Tent/sor • BILL OF LADING ATTACHE
- BACILpACIL Alled w sudas and Water. Marijuana Pipe.
REAR TOP
RIGHT SIDE DATE NOTIFIED
FRONT LEFT SIDE REQUIRED NOTICES SENT TO REGISTERED [] YES ILD. NO: 1 SUPERVISOR
7129/24, 4:56 PM Invoice
Pepe's Towing Service Impound Invoice
PO Box 7450, Moreno Valley CA 92552 Printed 7/29/2024
Phone: 951) 682-5682 | Fax: (951) 682-5030
Towing
Released To FIDEL GUTIERREZ 12812 SOVIET WAY MORENO VALLEY CA 92555 Phone:9092587764 Invoice # 24-0728-40907 Reason for Impound 22651-0 EXPIRED REGISTRATION Call # 40907 VIN Number
Case # 932407976 Model 2019 Lexus IS 300 (Silver)
Case # 932407976 License Plate
Account RIALTO PD Drivable No
Date/Time Requested 7/28/2024 6:32 AM Keys
Date/Time Dispatched 7/28/2024 6:33 AM Towed from 1527 W Rialto Ave, Riälto, CA 92376, USA Date/Time Arrived to scene: 7/28/2024 6:41 AM Stored at Rialto Yard Date/Time Towing Time: 7/28/2024 6:59 AM 2775 N Locust, Rialto CA 92377 Date/Time Destination Arrival: 7/28/20247:16 AM
Date/Time Completed: 7/28/2024 7:25 AM
Date/Time Impounded: 7/28/2024 7:25 AM
Driver Rícardo D
Truck TRK 34.
Date/Time Released: 7/29/20244:45 PM
Days Held in Impound 2 days
Notes
Storage charges Quantity Price Line Total
2 $77.00 $154.00
(Storage - Storage Fees) Impounds/Storage: Daily Impound Rate Towing charges Quantity Price Line Total
$95.00 $95.00
(Towing) Admin Fee
(Towing) AFTER HOURS TOWING FEE PORT TO PORT $422.00 $422.00 Towing SubTotal $517.00
Storage - Storage Fees SubTotal $154.00
Subtotal $671.00
Taxes $0.00
Grand Total $671.00
Amount Due: $0.00 / Paid
Visa payment (Ref # CC 7991) of $671.00 applied on 7/29/2024 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:
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/Impound.aspx?id=19576709#Payment 1/1 City of Rialto PEPES TOWING SERVICE
POLICE 2775 N LOCUST AVE
150S Palm Ave RIALTO, CA. 22377-4111
Rialto, CA 92376-6487 909-574-1490
+1 (909) 820-2525
City of Rialto
DEBIT SALE
1/29/2024 04:23PM
01313-0019 PD24-000003353
ayment Effective Date 07/29/2024 REF#: 00000009
Batch #: 384 RRN: 729235613
ISCELLANEOUS 07/29/24 16:56-13
Vehicle Release Fee Inv/Tke #: 40907
(629833) APPR CODE: 459577
2025 Item: 629833 Trace: 9
1 @ $216.8000 DEBIT
Vehicle Release Fee *********7991 Contaciless
• (629833) $216.80
Payment Id: 30243 AMOUNT
$671.00
$216.80
abtotal $216.80 APPROVED
stal $216.80
ILICE CC MERCHANT $216.80 US DEBIT
Visa ***********: AD: A00000009
:f=@e8fb1e4-05ad-47da-9b10-7cbb20483d15 TVR: 00 00 00 00.00 rth=072219
THANK YOU
Fidel Diri
CUSTOMER COPY
lange due $0.00
id by: GUTIERREZ JR/FIDEL N
Thank you for your payment
CUSTOMER COPY