Providing Insurance and Financial Services So State Farm® Home Office, Bloomington, IL
July 11, 2024
City Of Rialto State Farm Claims
150 S Palm Ave PO Box 106171
Rialto CA 92376-6406 Atlanta GA 30348-6171
RE: Claim Number: 55-66D6-60J
Date of Loss: April 16, 2024
Our Insured: Rafael Chavez
Claimant Name: City Of Rialto
To Whom It May Concern:
Attached is the police report and the City of Rialto Liability form.
If you have questions or need assistance, call us at 844) 292-8615 Ext. 462.
Sincerely,
Ruben Limon
Claim Specialist
(480) 842-3194
Fax: (855) 820-6318
State Farm Mutual Automobile Insurance Company
CITY CLERK RECEIVED 2024 JUL 22 AMII: 57 CITY OF RIALTO
CITY CLERK'S DATE STAMP
CITY OF RIALTO
LIABILITY CITY OF RIALTO
CLAIM FOR DAMAGES 2024 JUL 22 AMII: 57
TO PERSON OR PROPERTY RECEIVED
CITY CLERK
1. Claims for death, injury to person, or to personal property must be filed not lafer fhan 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 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:
State Farm on bealft of Rafael Chavez
FULL NAME DATE OF BIRTH
HOME ADDRESS INCLUDING CITY, STATE & ZIP HOME TELEPHONE NO.
P.O. Box 106134 Atlanta, GA 30348 1844) 292-8615
-
BUSINESS ADDRESS INCLUDING CITY, STATE & ZIP BUSINESS TELEPHONE NO.
ADDRESS AT WHICH CLAIMANT DESIRES TO RECEIVE P.O. Box 106134 Atlanta, GA 30348
NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM
(if different from home address provided above): [email protected]
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE: 04/16/2024 TIME: 1842
2. PLACE OF ACCIDENT (OCCURRENCE) BE SPECIFIC - Describe fully and (if applicable) locate on diag ram on reverse side of this sheet.
Where appropriate, give street names and addresses, measurements and landmarks.
Loss occured on Cactus ave at the Intersection with Rialto ave.
California Highway Patrol report number 9860-2024-01209
3. HOW DID DAMAGE OR INJURY OCCUR?
A police vehice cut in front of our insured's vehicle before turning on their sirens and they collided.
4. WERE POLICE AT THE SCENE? *YES O NO WERE PARAMEDICS AT THE SCENE? AYES ONO
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.
Officer Andrew Villasenor, an employee of the City of Rialto Police Department was liable for improper position for a rig
6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage $ HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE:
Item/Date: Pending insured's attorney Amount: $
Item/Date: Amount: $
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: $ ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN:
Item/Date: Vehicle damages- Total loss net indemnity 05/16/24 21,623.09 Amount: $
Item/Date: Rental Reimbursement 04/29/24 Amount: $ 411.64 TOTAL ESTIMATED AMOUNT PROSPECTIVE DAMAGES: $ 22,034.73
7. WITNESSES TO DAMAGE OR INJURY List all persons known to have information (attach additional pages, if necessary) NAME: NAME:
ADDRESS: ADDRESS:
2024
TELEPHONE: () TELEPHONE: ()
JUL 22
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITALS) VISITED: O CITY OF RIALTO NAME: : First law Group NAME:
314 E ROWLAND ST, COVINA, CA, AM I!:
ADDRESS: ADDRESS:
91723
сл
TELEPHONE: |) 6268385700 TELEPHONE: |)
DATE: TIME: • AM • PM DATE: . TIME: •AM • 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
HAVE READ THE FOREGOING CLAIM AND KNOW THE CONTENTS THEREOF; AND CERTIFY THAT THE SAME IS TRUE OF MY OWN KNOWLEDGE EXCEPT AS T THOSE 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
Ruben Limon 07/11/2024
TYPE OR PRINT NAME DATE
State Farm Claim Adjuster
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 For Customer Support refer to the
• LexisNexis® appropriate platform below:
Police Records Retrieval
RISK SOLUTIONS 800-934-9698
[email protected]
For tips on ordering visit:
statetips.lexisnexisrisk.com Accurint for Insurance
866-277-8407
[email protected]
PAGE COUNT: 8
CLIENT: 6625
DIVISION:
ADJUSTER:
CLAIM: 5566D660J
TRANSACTION #:
DATE: 2024-06-25 10:36:36.0
DATE OF LOSS: 04/16/2024 TIME OF LOSS: 0:0:0
STREET: W RIALTO AVE & S CACTUS AVE
CITY: RIALTO
COUNTY: SAN BERNARDINO
STATE: CA
INVESTIGATING AGENCY: CA HP
REPORT NUMBER: 9860
REPORT TYPE: AUTOACCIDENT
PARTY1: RAFAEL CHAVEZ 2024 JUL 22 AMII: 57 CITY OF RIALTO PARTY2:
PARTY3:
CAR: ACCORD MAKE: HONDA YEAR: 2022
TAG:
ADDITIONAL INFO:
NOTE:
THANK YOU FOR YOUR ORDER!
STATE OF CALIFORNIA
DEPARTMENT OF CALIFORNIA HIGHWAY PATROL
TRAFFIC CRASH REPORT
CHP 555 Page 1 (Rev. 2-22) OPI 060 Page 1 of 7
SPECIAL CONDITIONS NUMBER HIT 2 OUN CITY JUDICIAL DISTRICT LOCAL REPORT NUMBER FELONY
RIALTO SAN BERNARDINO SUPERIOR COURT FONTANA
ON-DUTY EMERGENCY VEHICLE 9860-2024-01209
COURTHOUSE
NUMBER AT CRUS COUNTY REPORTING DISTRICT BEAT DAY OF WEEK TOVI AWAY
MISDEMEANOR
SAN BERNARDINO S MOW TFS D]YES ENO
CRASH OCCURRED ON CRASH DATE EAR CRASH TIME (2400) NOTIF. TIME (2400) NCIC • OFFICER D CACTUS AVE. 04/16/2024 1840 04/16/2024 1842
STATE MY REL DIGITAL MEDIA
X AT INTERSECTION WITH DYES
OR RIALTO AVE.
GPS COORDINATES FOR LOCATION (LOC.) AND AREAS OF IMPACT (ACI IS SAME AS LOCATION LAT. LONG. AOT LAT. LONG A LAR REFER TO MARRATAE LONG
LOC.
34.099579 -[17.383418 34.099579 -117.383418
LONG. AO! LAT. LONG. I LAT LONG
4 PARTY DRIVERS LICENSE NUMBER STATE CLASS AIR BAG SAFETY EQUIP. VEH. YEAR MAKENODEL COLOR LICENSE NUMBER STATE CA M G 2020 CA
FORD EXPLORER BLK/WHI 1595138
DRIVER NANE (FIRST ADOLE LAST. ON-DUTY EMERGENCY VEHICLE
ANDREW VILLASENOR CINER'S NAME
• SAME AS DRIVER
STREET ADDRESS CITY OF RIALTO
OWNER'S ADDRESS •SAME AS DRIVER
CITY/STATE/OP 249S WILLOW AVE RIALTO CA 92376
VEHICLE
RIALTO CA 92376 DISPOSITION OF VEHICLE ON ORDERS OF: OFFICER X DRIVER OTHER
SEX HAIR EYES MEIGHT WENGHT RACE
CUST DRIVEN AWAY
M BRN BRN 6'0" 160 H PRIOR MECHANICAL DEFECTS X NONE APPARENT REFER TO NARRATNE
OTHER HOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER IFMSK8AH9LGC99753
NONE (909) 586-8339 VENICLE TYPE DESCRIBE VEHICLE DAMAGE TOMVAV INSURANCE CARRIER POLICY NUMBER UNK. NONE MINOR
48 SELF INSURED SELF INSURED MOD. MAJOR ROLL-OVER
3000C
DIR OF ON STREET OR HIGHWAY LANE TMRU TOTAL SPEED
TRAVEL LANES LANES LIMIT CA DOT
W RIALTO AVE LT 2 3 40 CALL - ICAPSC.-
PARTY DRIVER'S LICENSE NUMBER STATE CLASS AIR BAG SAFETY EQUIP VEH. YEAR MAKEINODELCOLOR LICENSE NUMBER STATE CA L G 2022 HOND ACCORD BLU 9DAL616 CA
DRIVER NAME (FIRST, MIDOLE, LAST)
RAFAEL. CHAVEZ JR OWNER'S NAVE
X' SAME AS DRIVER
PESES:
OWNER'S ADDRESS
CITY/STATEJ2IP
VEHICLE
RIALTO CA 92376 DISPOSITION OF VEHICLE ON ORDERS OF OFFICER [X) DRIVER OTHER
SEX HAIR EYES HEIGHT WEIGHT RACE PRIVATE ASSISTANCE
THAT Y
CUST
M BLK BRN 6'1" 220 PRIOR MECHANICAL DEFECTS: X NONE APPARENT REFER TO NARRATIVE OTHER MOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER:
(909) 678-4309 NONE VEHICLE TYPE DESCRIBE VEHICLE DAMAGE INSURANCE CARRIER POLICY AUMBER •UNK NONE X MINOR
STATE FARM 620 3795-D11-55 01 MOD. MAJOR ROLL-OVER
DIR OF ON STREET O9 HIGHWAY LANE THAU TOTAL SPEED
TRAVEL LANES LANES LIMIT CA DOT.
RIALTO AVE
CAL-T _ NOMX
PARTY DRIVERS UCENSE NUMBER STATE CLASS AIR BAG SAFETY EQUIP VEH. YEAR MAKEMODELCOLOR LIGENSE NUMBER STATE
DRIVER NAME (FIRST MIDDLE LASTI
OWNER'S NAME SAME AS DRIVER
PEDES STREET ADDRESS
TRIAN
OWNERS ADDRESS I SAME AS DRIVER
CITY/STATE/LIP
DISPOSITION OF VEMICLE ON CRDERS OF •OFFICER TROTHER-
SEX HAIR EYES THEIGHT WEIGHT RACE
N
PRIOR MECHANICAL DEFECTS. NONE APPARENT DIREFER TO NARRATVE OTHER HOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER.
VEHICLE TYPE DESCRIBE VEHICLE DAMAGE
OFER: •UNK. - NONE MINOR * O AM I|:
INSURANCE CARRIER POLICY NUMBER
ATOR ALTO
•I MOD. • MAJOR • ROLL-OVER
DIR OF TON STREET CR HIGHWAY THRU | TOTAL сл
LANE
TRAVEL LANES LANES LIMIT DOT.
CAL-T TCPIPSC VEMX
PREPARER'S NAME DISPATCH NOTIFIED REVIEWER'S NAME DATE REVIEWED RAYMOND J GARCIA, 022630 [X] YES • NO • NIA
An Internationally Accredited Agency Destroy Previous Editions
STATE OF CALIFORNIA
DEPARTMENT OF CALIFORNIA HIGHWAY PATROL
TRAFFIC CRASH CODING
CHP 555 Page 2 (Rev. 2-22) OPI 060 Page 2 or 1
CRASH DATE (MO. DAY YEAR) CRASH TIME (2400) OFFICER ID NUMBER 04/16/2014 1840 9860-2024-01209
PROPERTY OWNER'S NAME OWNER'S ADDRESS
DAMAGE
PERSON NOTIFIED & SAME AS OVINER TELEPHONE NUMBER METHOD OF NOTIFICATION (MARK ALL THAT APPLYI LOG / INCIDENT NUMBER HIN PERSON PHONE DISPATCH CHP 422
DESCRIPTION OF DAMAGE
SEATING POSITION SAFETY EQUIPMENT AIR BAG INATTENTION CODES OCCUPANTS CHILD RESTRAINT 8- UNKNOWN
A - NONE IN VEHICLE L - AIR BAG DEPLOYED A - CELLPHONE HANDHELD • - IN VEHICLE USED ฿ - CELLPHONE HANDSFREE
1 TO 9 - STANDARD SEATING B - UNKNOWN & - IN VEHICLE NOT USED A - AIR BAG NOT DEPLOYED
POSITION C- LAP BELT USED N- OTHER C - ELECTRONIC EQUIPMENT D - LAP BELT NOT USED S - IN VEHICLE USE UNKNOWN 9. NOT REQUIRED D- RADIO / CD 10 - REAR OCC. TRK.. VAN. E - SHOULDER HARNESS USED T - IN VEHICLE IMPROPER USE E - SMOKING 2 3 U - NONE IN VEHICLE F. EATING
STATION WAGON, ETC.* F - SHOULDER HARNESS NOT USED EJECTED FROM VEHICLE 6 G • LAP/SHOULDER HARNESS USEO ) - NOT EJECTED G - CHILOREN MIC RICYCLE. HELMET
11 - POSITION UNKNOWN® H- LAP/SHOULDER HARNESS NOT USED 1 - FULLY EJECTED H - ANIMALS 7 8 9 DRIVER PASSENGER I - PERSONAL HYGIENE
J- PASSIVE RESTRAINT USED V - NO X - NO PARTIALLY EJECTED 0- OTHER* K-PASSIVE RESTRAINT NOT USED 3 - UNKNOWN J- READING 10 Y-YES
P• NOT REQUIRED K- OTHER
ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK (*) SHOULD BE EXPLAINED IN THE NARRATIVE.
PRIMARY CRASH FACTOR
LIST NUMBER (# OF PARTY AT FAULT TRAFFIC CONTROL DEVICES VEHICLE AUTOMATION LEVEL 2 3 MOVEMENT PRECEDING CRASH
CITED X A CONTROLS FUNCTIONING X
A CACHETON VOLA TOO A SAE LEVEL -0 A STOPPED
VC 22100(A) YES
ND B CONTROLS NOT FUNCTIONING B SAE LEVEL • 1 B PROCEEDING STRAIGHT B OTHER IMPROPER DRIVING: C CONTROLS OBSCURED Ç SAE LEVEL -2 RAN OFF ROAD D NO CONTROLS PRESENT / FACTOR• D SAE LEVEL - 3 D MAKING RIGHT TURN C OTHER THAN DRIVER• TYPE OF CRASH E SAE LEVEL • 4 E MAKING LEFT TURN D UNKNOWN A HEAD-ON F SAE LEVEL - 5 F MAKING U TURN
B SIDE SPE G UNKNOWN* G BACKING
C REAR END H SLOWING/STOPPING
WEATHER (MARK 1 TO 2 ITEMS) VEHICLE AUTOMATION ENGAGED
X D BROADSIDE PASSING OTHER VEHICLE
X A CLEAR E HIT ORJECT A NO AUTOMATION I CHANGING ANES
B CLOUDY F OVERTURNED B DRIVER ASSISTANCE K PARKING MANELIVER
C RAINING G VEHICLE / PEDESTRIAN C PARTIAL AUTCMATION L ENTERING TRAFFIC D SNOWING H OTHER: D CONDITIONAL AUTOMATION MOTHER UNSAFE TURNING E FOG / VISIBILITY FT. MOTOR VEHICLE INVOLVED WITH E HIGH AUTOMATION IN XING INTO OPFOSING LANE F OTHER' MARK 1 TO 9 ITEMS) F FULL AUTOMATION O PARKED
G WIND A NONCOLLISION G UNKNOWN' P MERGING.
LIGHTING B PEDESTRIAN R TRAVELING WRONG WAY
A DAYUGHT C OTHER MOTOR VEHICLE OTHER ASSOCIATED FACTORS R OTHER•:
D MOTOR VEHICLE ON OTHER ROADWAY 3 MARK 1 TO 2 ITEMS
B DUSK - DAWN S LANE SPLITTING
C DARK - STREET LIGHTS E PARKED MOTOR VEHICLE ONE SERMON MOLATION CrED 3 SOBRIETY - DRUG - PHYSICAL
D DARK - NO STREET LIGHTS F TRAIN 2 (MARK ALL THAT APPLYI
E DARK - STREET LIGHTS NOT G BICYCLE CVC SECTIM VIOLA TIDN X A HAD NOT BEEN DRINKING •YES
FUNCTIONING* H ANIMAL •NO B H8O- UNDER INFLUENCE
ROADWAY SURFACE FIXED OBJECT C HBD• NOT UNDER INFLUENCE• X A DRY INO D HBD - IMPAIRMENT UNKNOWN*
B WET J OTHER OBJECT D E UNDER DRUG INFLUENCE•
C SNOWY - ICY. E VISION OBSCUREMENT DRE EXAM. CONDUCTED D SLIPPERY (MUDDY, OILY. ETC.) K ADDITIONAL OBJECTS) STRUCK F INATTENTION : STIMULANT
ROADWAY CONDITION(S) PEDESTRIAN'S ACTIONS G STOP & GO TRAFFIC HALLUCINOGEN (MARK I TO 2 ITEMS) XA NO PEDESTRIANS INVOLVED H ENTERING / LEAVING RAMP DISSOCIATIVE ANESTHETICS
A HOLES DEEP RUT' B CROSSING IN CROSSWALK PREVIOUS CRASH NARCOTIC ANALGESIC
B LOOSE MATERIAL ON ROADWAY AT INTERSECTION J UNFAMILIAR WTH ROAD INHALANT C OBSTRUCTION ON ROADWAY' CROSSING IN CROSSWALK - NO K DEFECTIVE VEH. EQUIP. 0*L0 •YES CANNABIS
T INTERSECTIO DEPRESSANT
D CONSTRUCTION - REPAIR ZONE NO
E REDUCEO ROADWAY WIDTH D CROSSING - NOT IN CROSSWALK UNINVOLVED VEHICLE F IMPAIRMENT - PHYSICAL F FLOODED E IN ROAD - INCLUDES SHOULDER M OTHER• G IMPAIRMENT NOT KNOWN G OTHER*. TE NOT IN ROAD XX N NONE APPARENT H NOT APPLICABLE
X H NO UNUSUAL CONDITIONS G APPROACHING / LEAVING SCHOOL BUS O RUNAWAY VEHICLE SLEEPY / FATIGUED
SKETCH MISCELLANEOUS
3 SPECIAL INFORMATION
REFER TO SKETCH PAGE(S) HAZARDOUS MATERIAL
A
INDICATE NORTH B CELL PHONE HANDHELD IN USE
C CELL PHONE HANDSFREE IN
USE
X S D CELL PHONE NOT IN USE
E CELL PHONE USE UNKNOWN
IF SCHOOL BUS RELATED
2 BIKEWAY FACILITY
A SHARED ROADWAY
B CLASSI - BIKE PATH
C CLASS II - BIKE LANE*
D CLASS II! - BIKE ROUTE•
E CLASS IV - SEPARATED
BiKEWAY®
REPER TO NARRATIVE FOR ADITIONAL INF CRMATION
An Internationally Accredited Agency
18310 22 T05 1202
STATE OF CALIFORNIA
JSPARTMENT OF CAUFORNIA HIGHWAY PATROE
INJURED / WITNESS / PASSENGERS of 7
CHP 555 Page 3 (Rev. 2-22) OPI 060
CRASH DATE (NO DAY YEAR) CRASH TiME (2400) NCIC B OFFICER ID NUMBER 04/16/2024 1840 9860-2024-01209
EXTENT OF INJURY ("X" ONE) INJURED WAS ("X" ONE)
PARTY SEAT AIR SAFETY EJECTED
SUSPECTED SERIOUS SUSPECTED MINOR NUMBER POS BAG EQUIP, OPER.
23 G
NAME /C.O. B./ADDRESS TELEPHONE
BRIANNA GUADALUPE CERVANTES (04/16/2001) 444 W. ALRU ST. RIALTO CA 92376 (909 440-7921/KONE (INJURED ONLY) TRANSPORTED BY EMS RUN NUMBER TAKEN TO.
RIALTO FIRE DEPARTMENT P201 ARROWHEAD REGIONAL MEDICAL CENTER
DESCRIBE INJURIES
COMPLAINT OF PAIN TO CHEST AND BACK
VICTIN OF VIOLENT CRIME NOTIFIED
NAME ID. O. B. FADERESS TELEPHONE
(INJURED ONLY) TRANSPORTED BY• EMS RUN NUMBER TAKEN TO:
DESCRE INJURIES
VICTIM OF VIOLENT CRIME NOTIFIEO
NAME / D. O. 8./ ADDRESS TELEPHONE
ONJURED ONLY) TRANSPORTED BY: EMS RUN NUMBER ¡ TAKEN TO
DESCRIBE INJURIES
VICTIM OF VIOLENT CRIME NOTIFIED
0*
NAME /D OB/ADDRESS TELEPHONE
(INJURED ONLY) TRANSPORTED BY EMS RUN NUMBER TAKEN TO
DESCRIBE INJURIES
VIC TIA OF VIOLENT CRIME NOTIFIED
NAME/D O.B. / ADDRESS
INJURED ONLY) TRANSPORTED BY EMS RUN NUMBER ( TAKEN TO
DESCRIBE INJURIES
20 VICT CE VIOLENT CRIME NORFIED
П*
NAME: 0. 0.8 / ADORESS
INJURED ONLY) TRANSPORTED BY EMS RUN NUMBER TAKEN TO
DESCRIBE INJURIES
I VICTIM OF VIOLENT CRIME NOTIFIED
PREPARER'S NAME ID NUMBER MO. DAY YEAR REVIEWER'S NAME MO. DAY YEAR RAYMOND J GARCIA 022630 04/16/2024
An Internationally Accredited Agency
STATE OF CALIFORNIA
DEPARTMENT OF GALIFORNIA HIGHWAY PATROL
SKETCH DIAGRAM
CHP 555 Page 4 (Rev. 3-20) OP 060 Page 4 o17
CRASH DATE (MO. DAY YEAR CRASH TIME (2400) NCIC # OFFICER ID NUMBER 04/16/2024 1840 9860-2024-01209
N
DATE PREPARER CAPTURED IMAGE: 04/16/2024
PROPRIETOR OF IMAGE: Google Maps W E
COPYRIGHT YEAR OF IMAGE: 2024
RAFFIC LIGHT
TRAFFIC LIGHT
*
- CL
TRAFFIC LIGHT! NTRAFFIC LIGHT: 3D
cogle
limagery $2024 Google, Map data ©2024 United Statea Termis Privacy Send Product Feedbari: 20 ft CITY CLERK RECEIVED JUL 22
ITY OF RIALTO
AM I|:
THIS OVERHEAD IMAGE IS PROVIDED TO DEPICT THE CRASH SCENE ENVIRONMENT ONLY. ANY VEHICLES,
PEDESTRIANS, OR OTHER ROAD USERS CAPTURED IN THE OVERHEAD IMAGE NOT DEPICTED IN THE SUMMARY/CAUSE WERE NOT ASSOCIATED WITH THIS CRASH.
ALL VEHICLE DIMENSIONS AND MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED.
PREPARED BY ID NUMBER MO. DAY YEAR REVIEWER'S NAME MO. DAY YEAR RAYMOND J GARCIA 022630 04/16/2024
An internationally Accredited Agency
STATE OF CALIFORNIA
NARRATIVE/SUPPLEMENTAL PAGE 5 OF Z
DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER
04/16/2024 1840 9860-2024-01209
1 All times, speeds, and measurements throughout this report are approximate. Measurements were obtained using visual estimation and GPS unless otherwise sated. All opinions and conclusions were hased on 3 evidence andfor statements.
4 5 OTHER FACTUAL INFORMATION:
6 7 P-l showed me his bodycam footage of the incident on scene, utilizing his cellular device. Sergeant J. 8 Rodriguez, ID 21422, was provided a website link to an online database to observe the bodycam footage 9 worn by P-1. The bodycam was located near the abdomen of P-1; thus, I was unable to see P-I's point of 10 view. The bodycam footage revealed what seemed to be V-1 parked along the north curb of Rialto Ave., 11 east of Cactus Ave. P-1 was utilizing his mobile computer device. Suddenly, P-| placed his vehicle in 12 drive, accelerated rapidly, and made a strong jerking movement to the left with the steering wheel towards 13 the left turn lane of Rialto Ave., at the intersection of Cactus Ave. I was able to observe the light was green 14 for westbound traffic. P-J did not slow down V-1, executed an aggressive turn to the right, causing his tires 15 to screech. Simultaneousiy, P-1 began to raise his right hand towards the control panel for the emergency 16 lights and siren, located near the rearview mirror of V-l. I continued to hear tires screech, and then heard 17 the traffic crash. After the impact, I heard V-1's audible siren. 19 After the crash, P-1 exited his vehicle and checked on the well-being of P-2 and V-2's passenger. As the 20 footage continued. I was able to hear P-2 and Passenger Cervantes tell P-l that he did not have his lights and 21 siren on. At no point did P-I contest their statements. 22 P-i advised me that he was not logged into his patrol vehicles dashcam prior to the crash. 24 25 Due to the safety parameters of the website, I was unable to download a copy of the footage. No further 26 videos of the incident have been provided by the Rialto Police Department. 27 28 At the time of the crash, P-1 was on-duty as an Officer with the Rialto Police Department and was wearing a 29 departmentally approved black uniform while driving a fully marked black and white Rialto Police 30 Department patrol vehicle.
31 32
33 34 CITY CLERK RECEIVED 024 JUL 22 AMII: 58 CITY OF RIALTO 35 36
37 38
39 40
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43 PREPARED BY I.D. NUMBER DATE REVIEWER'S NAME DATE
RAYMOND J GARCIA 022630 04/16/2024
•
STATE OF CALIFORNIA
NARRATIVE/SUPPLEMENTAL PAGE 6 OF 7
DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER
04/16/2024 1840 9860-2024-01209
1 STATEMENTS:
2 3 Party #1 (P-1, Villasenor) was contacted at the scene where he related to me the following information:
4 P-l was driving Vehicle #1 (V-1, Ford) within the westbound left turn lane of Rialto Ave., approaching the 5 intersection of Cactus Ave. at approximately 5 miles per hour. P-1 activated his emergency lights and siren 6 due to a pursuit occurring north of his location. P-1 observed a vehicle stopped within the westbound #1 7 lane of Rialto Ave., west of the intersection of Cactus Ave. P-1 did not see V-2 prior to the crash. P-1's 8 light was green, so he accelerated to approximately 10 miles per hour, and proceeded to make a right turn to 9 head northbound onto Cactus Ave. from the left turn lane. Suddenly, P-1 felt an impact to the right side of 10 his vehicle. After the crash, P-1 stopped his vehicle to check on the wellbeing of P-2 and V-2's passenger. 11 P-1 relocated his vehicle to expedite traffic and awaited CHP arrival. 12 13 Party #2 (P-2, Chavez Jr.) was contacted at the scene where he related to me the following information:
14 P-2 was driving Vehicle #2 (V-2, Honda) within the westbound #2 lane of Rialto Ave., approaching the 15 intersection of Cactus Ave. at approximately 5 miles per hour. P-2 related prior to entering the intersection 16 he heard a siren coming from a separate patrol vehicle entering the intersection northbound on Cactus Ave.. 17 south of Rialto Ave. P-2 stopped his vehicle and allowed the patrol vehicle to travel through the 18 intersection. After the intersection was clear, P-2's light was green. so he began to proceed through the 19 intersection at approximately 5 miles per hour. P-2 related he did not see V-1 due to a vehicle to his left 20 within the westbound #1 lane of Rialto Ave., west of the intersection with Cactus Ave. P-2 did not hear an 21 audible siren, nor did he see V-1 prior to the crash. Suddenly, V-1 was directly ahead of him, and they 22 crashed. After the crash, P-2 put his vehicle in park, and was assisted by Rialto Police Department 23 personnel. Rialto Police Department personnel assisted P-2 in moving V-2 to the north curb of Rialto Ave., 24 west of Cactus Ave. P-2 remained on scene and awaited CHP arrival. 25 26
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33 CITY CLERK RECEIYEU 2024 JUL 22 AMII: 58 CITY OF RIALTO 34 35
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42 43
PREPARED BY T.D. NUMBER DATE REVIEWER'S NAME
RAYMOND J GARCIA 022630 04/16/2024
STATE OF CALIFORNIA
NARRATIVE/SUPPLEMENTAL PAGE 7 OF 7
DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER
04/16/2024 1840 9860-2024-01209
1 SUMMARY/CAUSE:
Party #1 (P-1, Villasenor) was driving Vehicle #1 (V-1, Ford) within the westbound left turn lane of Rialto Ave., approaching the intersection of Cactus Ave. at approximately 5 miles per hour. V-l was to the left of V-2. Party #2 (P-2, Chavez Jr.) was driving Vehiele #2 (V-2, Honda) within the westbound #2 6 lane of Rialto Ave., approaching the intersection of Cactus Ave. at approximately 5 miles per hour. 7 8 This crash was caused due to P-I's improper position for a right turn. A circular green light illuminated the 9 intersection allowing westbound traffic to proceed through the intersection. A separate Rialto Police 10 Department officer was involved in a pursuit north of the intersection. P-2 yielded for a Rialto Police 11 Department vehicle heading northbound through the intersection with emergency lights and siren activated. 12 P.I executed a right turn from the left turn lane (22100(a) VC- Improper Position for a Right Turn) and 13 entered the intersection. Simultaneously, P-2 entered the intersection. Due to P-I's improper position for a 14 right turn, as P-1 proceeded northbound through the intersection in front of V-2, the front left of V-2 crashed 15 into the right side of V-1 (AOI #1).
17 After the crash, both parties stopped their vehicles within the intersection. P-1 checked on the wellbeing of 18 P-2 and V-2's passenger: V-2 was moved by Rialto Police Department personnel to the north curb of Rialto 19 Ave., west of Cactus Ave. P-1 drove V-t to the east curb of Cactus Ave., north of Rialto Ave. Both parties 20 remained on scene and awaited CHP arrival.
CITY CLERK RECEIVEL 2024 JUL 22 AMII: 58 CITY OF RIALTO PREPARED BY T.D. NUMBER DATE REVIEWER'S NAME
RAYMOND J GARCIA 022630 04/16/2024
FIRST-CLASS MAIL
State Farm U.S. POSTAGE
PRESORTED FIRST-CLASS PAID
State Farm Claims STATE FARM
P.O. Box 52250
Phoenix, AZ 85072-2250
CITY CLERK RECEIVEL 2024 JUL 22 PM 12: 03 CITY OF RIALTO 019 FID-AP1 92376
166-1130 g.1-PH 08-14-2019