CITY CLERKS DATE STAMP
CITY OF RIALTO
LIABILITY
CITY OF RIALTO
CLAIM FOR DAMAGES
та нанти чи рі), 2024 ОСТ 24 PM 6:00
TO PERSON OR PROPERTY
RECLIVEL
CITY CLERT
1. Clams for death injury to person, or to personal property must be filed not later than six (6) months after the occurrence (Gov Code 59112) 2 Claims for damages to real property must be filed not later than one (T) 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 tail: 150 S. Palm Ave., Rialto, CA 9237
ddress: 290 W. Raito Ave., Rialto, CA 9237
CLAIMANT INFORMATION:
bonnie Close
- DATE OF BIRTH
FULL NAME
HOME ADDRESS INCLUDING CITY, STATE & ZIP HOME TÉLEPHONE 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 INURY OCCUR? DATE: October 24, 2023 _ TIME: 12:30-1:00 SAMPM
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. no +
but do an and ing bry offices ticking the dear to enter of posit. suspect, person.
4. WERE POLICE AT THE SCENE? # YES I NO WERE PARAMEDICS AT THE SCENE? • YES• 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.
Rialto Pelica hicked the back dear to gain entry / Rialto, Ca
6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage s2,119.19 HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE:
Item/Date: Door 10/24/2024 Amount: s_ i, 819,70
Item/Date: Amount: $
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: $_ 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: Watesha, Forter NAME:
ADDRESS: + ADDRESS:
TELEPHONE: 1-xAg+ TELEPHONE: L
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITAL(S) VISITED:
NAME: NAME:
ADDRESS: ADDRESS:
TELEPHONE: L TELEPHONE: (
DATE: _ TIME: DATE: TIMF • Ам • РМ
9. PLEASE READ THE FOLLOWING CAREFULLY:
For all vehicle accident clams, place on the following diagram, the names of streets, inciuding 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 ietter "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
7 SIDEWALK
I HAVE READ THE FOREGOING CLAIM AND KNOW THE CONTENTS THEREOF; AND CERTIFY THAT THE SAME IS TRUE OF MY OWN KNOWLEDGE EXCEPT AS TO 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
Worrie Close 10-20-2074
TYPE OR PRINT NAME DATE
Navantes
RELATIONSHIR 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
LOWE'S
CUSTOMER PROPOSAL 10/24/2024
Let us
install it
for you.
LOWe'S
CALIFORNIA SERVICES SOLUTIONS INSTALLED SALES PROPOSAL
LOWE'S AUTHORIZED REFRESENTATIVE SALES ID DATE CUSTOMER NAME Eddie Aguilar-Faras 852977 10/24/2024 Letesha Porter
STORE NO STREET ADDRESS STREET ADDRESS
1700 16851 SIERRA LAKES PARKWAY
CITY STATE ZIP CITY STATE ZIP
FONTANA CALIFORNIA 92336-1226 Rialto California 92376
TELEPHONE TELEPHONE
(909)350-7900
EMAIL EMAIL
eddie.aguilar-faras @ lowes com
LOWE'S CONTRACTOR LICENSE * LOWES REFRESENTATIVE LICENSE = CREDIT DEBIT CHECK LCC CARD GIFT CARD This is only a quote for the merchandise and services printed below.
INSTALLATION STREET ADDRESS CITY STATF ZIP
964 E Mesa Dr Rialto Calfornia 92376
Lowe's does not offer services to paint, seal or stain fences. dditional charges may apply for permit fees. Installation services guaranteed by Lowe's labor warranty & available thru independer ontractors, licensed, & registered where applicable. License numbers & certifications held by or on behalf of Lowe's Home Center LLC: #991832
IMPORTANT. This is an estimate only. This estimate is subject to change and does not bind you or Lowe's. This estimate is not a measurements or would like a copy of this document, please contact the Lowe's Store Associate. Please review your contract carefully for all charges prior to signing.
MERCHANDISE AND INSTALLATION SUMMARY: (I.E. ITEM NUMBERS, COLORS, DIMENSIONS, CONSIDERATIONS):
Included
Product
Back laundry door install
Installation of back pre hung door for laundry area, removal and haul away included. Door is smooth fiberglass 1/2 ventlite not painted, includes screen, pre hung door new frame, new hinges, new threshold, new weatherstrip and new trim, door locks homeowner to buy, lead time about 4 weeks.
QUOTE TOTAL $2,879.78
Payment (100%) $2,879.78
Job Photos
RO - 81.5-in Frame - 80.75-n
•
- Frame - 33 5-In -
RO - 34-in