CITY CLERK'S DATE STAMP
CITY OF RIALTO
LIABILITY CITY OF RIALTO
CLAIM FOR DAMAGES 1024 AUG 22 AMIO: 56
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 afler the occurrence (Gov. Code §911.2). RETURN TO:
3.READ ENTIRE CLAIM FOR BEFORE FILING
Mat 1505 Pain ANe. Rial, CA92376
4. ATTACH SEPARATE SHEETS, IF NECESSARY, TO GIVE FULL DETAILS Address: 290 W. Rialto Ave., Rialto, CA 92376
CLAIMANT INFORMATION:
Michelle Wyble
FULL NAME DATE OF BIRTH
HOME ADDRESS INCLUDING CITY, STATE & ZIP HOME TELEPHONE NO.
MA 24003A Ventura Blvd., 2nd Floor, Calabasas CA 91302 1818-285-0222 BUSINESS ADDRESS INCLUDING CITY, STATE & ZIP BUSINESS TELEPHONE NO.
ADDRESS AT WHICH CLAIMANT DESIRES TO RECEIVE Bauman Law, APLC.
NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM
(if different from home address provided above): 24003A Ventura Blvd., 2nd Floor, Calabasas, CA 91302
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE: 02/26/2024 TIME: 12:40 DAM DAEM
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.
On or near a crosswalk at Knollwood Avenue & Riverside Avenue, Rialto, CA 92377 GPS COORDINATES: 34.149383, -117.387722
3. HOW DID DAMAGE OR INJURY OCCUR?
The claimant was walking on the crosswalk when she slipped and fell to the ground. She noticed a pothole where she caught her foot.
4. WERE POLICE AT THE SCENE? •YES IO WERE PARAMEDICS AT THE SCENE? DYES I*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.
If the city had properly inspected, maintained, and/or repaired this crosswalk, the claimant would not have sustained these injuries.
6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage $ $1,000,000.00 HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE:
Item/Date: Emergency Room Treatment Amount: $ Pending
Item/Date: Potential Surgery/Physical Therapy/Pain Management Amount: sPending/Still Treating TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: $1,000,000.00 ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN:
Item/Date: Emergency Room Treatment Amount: $Pending
Item/Date: Potential Surgery/Physical Therapy/Pain Management Amount: $Pending/Still Treating TOTAL ESTIMATED AMOUNT PROSPECTIVE DAMAGES: $1,000,000.00
7. WITNESSES TO DAMAGE OR INJURY List all persons known to have information (attach additional pages, if necessary) N/A NAME: N/A
NAME:
•
ADDRESS: ADDRESS:
TELEPHONE: |) TELEPHONE: L
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITAL(S) VISITED:
• Kaiser Permanente - Multiple Locations NAME: Kaiser Permanente - Multiple Locations ADDRESS: 2295 S, Vineyard Avenue. Ontario, CA ADDRESS: 9961 Sierra Avenue, Fontana, CA 92335 91761
TELEPHONE: (213) 407-6636 TELEPHONE: 909) 427-5000
DATE: 02/26/2024 _ TIME: N/A •AM PM DATE: 2/27/2024 TIME: N/A =
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, Indical, place of accident by "X" and by showing house numbers or distances to street comers. - N ITT
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 GEAMANT.
CURB
PARKWAY
SIDEWALK
!
Animen neari tune nERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
SK.
Heela Wardak, Esq. 08/19/2024
TYPE OR PRINT NAME DATE
Attorney's Office - Bauman Law, APLC.
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
CITY OF RIALTO
24003A VENTURA BLVD, 21 FLOOR, CALABASES CA'S 302 AM 10: 56 BAUMAN LAW, APLC TEL: (818) 285-02224 FAX: (818) 285-0224• INFO@BAUMANLAWED
CITY CLERX
August 19, 2024 SENT VIA CERTIFIED U.S. MAIL + RETURN RECEIPT 9589 0710 5270 2160 3158 23
City Of Rialto
150 S. Palm Avenue
Rialto, CA 92376
ATTN: RIALTO CITY CLERK'S OFFICE
LETTER OF REPRESENTATION; BAUMAN LAW APLC ATTORNEY LIEN AND LETTER OF
PRESERVATION
Dur Client Michelle Wyble
Your Insured: City of Rialt
Claim Number:
Our File #: 11987183
Date of Loss: 2/26/2024
To Whom It May Concern,
Please be advised that we have been retained by the above client regarding claims for personal injuries and damages sustained as a result of the accident on 2/26/2024. We understand that you are the carrier for the above-named insured.
We would appreciate your cooperation in having a representative of your company contact our office. All further communications and inquiries of any sort regarding this matter should be directed to this oflice ONLY rather than to PLEASE TAKE NOTICE that this office possesses a lien for Attorney fees and costs advanced in this matter.
Therefore, you are requested to include BAUMAN LAW APLC as payee, upon any draft or other negotiable instrument given or tendered in payment of any claim, verdict, judgment, award or settlement arising out of the above-mentioned matter.
Pursuant to Boicourt V. Amex Assurance Company, (78 Cal. App 4'h 1390; 93 Cal. Rptr. 2d 763 2000 Cal. App.
Lexis 186), we hereby respectfully request that you provide our offices with your insured's policy limits and a copy of the declarations page evidencing said limits. Please provide our office with a written liability decision in this matter as soon as possible and lastly, we request for you to ask permission of your insured to disclose a current An authorization pursuant to section 2695.2(c) of the California Code of regulations, Title 10 Chapter 5, is enclosed herewith.
Another purpose of this letter is to advise you and your insured/client to preserve the vehicle they were driving at the time of this accident. Please note the vehicle driven by your insured may contain a data recorder, which captures important information, such as whether the brakes were applied, the speed at the time of the impact, the steering angle, among other data. We formally request that the data contained in any black box or similar recording instrument for the above date of loss is preserved until after it may be inspected and information downloaded.
CITY OF RIALTO
24003A VENTURA LVD, 2M LOOR, CALABASA ZA 613022 AMID: 56 BAUMAN LAW, APLC TEL: (818) 285-02224 FAX: (818) 285-0224 * INFO@BAUMAN LAWYED
CITY CLERK
Destroving evidence: "Every person who, knowing that any book, paper, record, instrument in writing, or other matter or thing, is about to be produced in evidence upon any trial, inquiry or investigation whatever, authorized by law, willfully destroys or conceals same with intent thereby to prevent it from being produced, is guilty of a misdemeanor." Thank you very much for your anticipated cooperation in this matter.
Very Truly Yours,
BAUMAN LAW, APLC
Sal T.
Legal Assistant
CERTIFIED MAIL T
Bauman Law, APIC
24003A Ventura Blvd. FIRST-CLASS UR US POSTAGE
2nd Floor
02 1P $ 009.92°
© CAlabasas, CA 91302 0001166478 AUG 19 2024
9589 0710 5270 2160 3158 23 MAILED FROM ZIP CODE 91302
RECEIVED CITY oF RiALTO
2024 AUG 22 AM IO: CITI CLERK'S OFFICE
CI 150 S. PALM AVENUE
RIALTo, CA 92376
S237636487 C002