CITY CLERK'S DATE STAMP
CITY OF RIALTO
LIABILITY CITY OF RIALTO
CLAIM FOR DAMAGES 2024 NOV 25 PM 1: 33
TO PERSON OR PROPERTY
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 5911.2).
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:
Ginger Rooksby
FULL NAME DATE OF BIRTH
HOME ADDRESS INCLUDING CITY, STATE & ZIP HOME TELEPHONE NO.
N/A
BUSINESS ADDRESS INCLUDING CITY, STATE & ZIP BUSINESS TELEPHONE NO.
ADDRESS AT WHICH CLAIMANT DESIRES TO RECEIVE Same
NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM
(if different from home address provided above):
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE: June 30, 2024 TIME: 9:30 X AM • PM
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 the west side of North Alder ave on the sidewalk, just north of Sunrise Street. No street address faces Sunrise at that location. Rialto Fire Station 4 is across the street.
3. HOW DID DAMAGE OR INJURY OCCUR?
Walking south on the sidewalk Ginger tripped on a joint separation in the concrete sidewalk.
One side of the sidewalk was raised up from the other side.
4. WERE POLICE AT THE SCENE? * YES • NO WERE PARAMEDICS AT THE SCENE? • YES DINO
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 sidewalk separates at the joints because of tree roots pushing up under the sidewalk.
Ginger was transported to Arrowhead Regional Medical Center by Rialto paramedics.
Rialto police spoke with Ginger at the hospital.
6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage $75.000 (including pain & HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates. suffering) DAMAGES INCURRED TO DATE:
Item/Date: City of Rialto Ambulance Service 6/30/24 Amount: $1,833.25 Item/Date: ARMC Main Hospital 6/30/24 Amount: $$19,890, $1,776.09 remaining
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: $ $23,901.75 ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN:
Item/Date: Reverse Gravity Medical Aesthetics 7/30/24 & 9/11/24 Amount: $2,178.50 Item/Date: Future laser/scar revision repair Amount: $$7,500 TOTAL ESTIMATED AMOUNT PROSPECTIVE DAMAGES: $7,500
7. WITNESSES TO DAMAGE OR INJURY List all persons known to have information (attach additional pages, if necessary) NAME: John Grable NAME:
ADDRESS: ADDRESS:
TELEPHONE: _ TELEPHONE: | )
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITAL(S) VISITED:
NAME: Arrowhead Regional Medical Center NAME:
ADDRESS: 400 N Pepper Ave. Colton Ca. 92324 ADDRESS:
TELEPHONE: (877) 873-2762 TELEPHONE: |)
DATE: June 30. 2024 . TIME: 10:30 X AM • PM DATE: TIME:
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.
W Buena Vista Dr.
NORTH CURB Alder Ave.
NO PARKWAY Location of accident: Rialto Fire Station 4
Here
7, SIDEWALK XXXX Sunrise st.
WEST
THOSE MATERS MICH ARE EAN STATE UPON A FORMATION AND BELE AND AS TO THOSE METER BEAVE HE BEDE EXCEPT AS TO I CERTIFY (OR DECLARE) UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
SIGNATURE OF CLAIMANT OR AGENT
Ginger Rooksby 11-25-2024
TYPE OR PRINT NAME DATE
Same
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 November25, 2024
City Of Rialto City's Clerks Office
150 S. Palm Ave
Rialto, CA 92376
Re: Claim for Ginger Rooksby Grable
Date of Loss: 6/30/2024
Location of Loss: Alder and Sunrise Street in the City of Rialto Dear City of Rialto,
Please accept this letter as a formal request to settle my bodily injury claim due to the negligence of the City of Rialto. On the morning of June 30, 2024, I was out for a walk on a Rialto City sidewalk with my husband on the West side of North Alder, just North of Sunrise Street. As I was walking, all of the sudden I tripped and fell directly onto my face due to a large joint separation in the concrete sidewalk, caused by city tree roots pushing up under the sidewalk. Due to the amount of blood and me screaming in dire pain, my husband frantically called 911 in which I was transported to Arrowhead Regional Medical Center emergency department.
I am a healthy, active, 72 year old woman who is very cautious and aware of my surroundings at all times. Due to a prior accident where I was run over by a scooter, resulting in fracturing my hip and elbow, I am extra cautious and careful when I am out for walks due to my eggshell status. I was wearing comfortable, walking tennis shoes. I have never walked this particular path prior to this incident and was not aware of the dangerous sidewalk that the City of Rialto has failed to upkeep. Had the City of Rialto upkept their sidewalks, this incident would have never occurred. In fact, as evidenced in photos provided, the city had recently been out to that location as there were fresh paint marks on the sidewalks nearby.
Liability:
There is no denying that the City of Rialto is responsible for the upkeep and maintaince of their city sidewalks to ensure pedestrians can safely walk without any tripping hazards. There are no property owners in this specific location that would bear any liability for upkeep at this location as it is all city property. Across the street from where I fell, there is a City of Rialto Fire department. There is also a city public school on the other side of the street. There is fresh paint on the crosswalk near where I fell, as well as paint marks on the sidewalk indicating that city representatives have been out to this location prior to this incident where there was a defect in the sidewalk, yet nothing was done to fix the problem. I have also attached a police report from the officer who came out to the scene. Even city police officer Rusty Lamm contacted Lieutenant Quarker to make sure that they notified public works that they need to come and fix the defected sidewalk. Your own city employee agreed this was a hazardous condition that needed to be fixed. And yet, here we are almost 5 months post loss and the sidewalk has still yet to be fixed, showing additional negligence on the City of Rialto.
Injuries:
As mentioned above, I was transported to Arrowhead Regional Medical Center via ambulance.
My entire face was battered and bruised, and there was an enormous amount of blood, as shown in the attached photographs. My cuts were so severely deep, that they required over 11 stitches to my face. I pride myself on keeping up with my looks, even at my young age of 72, and this absolutely destroyed me. My self-confidence of going out in public and my overall quality of life has changed since this accident. I now live with 2 very noticeable scars on my face that do not appear to be getting any better at this point. I have had to have some aesthetic procedures done to try to cover up and help with the overall appearance of my face, however, it looks like I am ultimately going to need a scar revision surgery. Please see my medical bills to date attached:
City of Rialto Ambulance Service: $1,833.25
Arrowhead Regional Medical Center: $19,890.10
Reverse Gravity Aesthetics: $2,178.50
Future Scar Revision: $7,500-$15,000
Total Specials: $38,901.85
Conclusion:
This incident has taken a tremendous toll on my life, and I can only hope that the city takes responsibility for their negligence in this matter. Further, the city needs to have this fixed so there are no further incidents with other pedestrians. I look forward to hearing from you within 45 days from the date of this letter with regards to a settlement offer. I would like to resolve this issue outside of litigation, but I am prepared to take the next steps should we not come to an amicable agreement to resolve my injury claim. I look forward to hearing from you.
Sincerely, 1.
Ginger Rooksby Grable
INCIDENT REPORT
ORI#: Report Date/Time: OCA#.
Agency Name:
RIALTO POLICE DEPARTMENT 07/06/2024 02:57:00
Incident Start Date/Time: DOW: Report Type: Case Screening: CHP 180 COURTESY Total Loss
06/30/2024 09:33:00 Sunday Г Serialized Property • Hate Crime Incident End Date/Time: Internal Incident Status: F Evidence Collected Г Gang Related 50.00 06/30/2024 09:40:00 Г PC 293 Sex Crime Domestic Viol.
Incident Location: Secondary Location:
SUNRISE DR /I ALDER AVE RIALTO CA 92376-
Case Description: UCR Status: Cleared Reporting Area:
AXON, PHOTOGRAPHS R1004
Operation Method:
Penal Code: UCR Code: Penal Code Description: Counts: Comp/At:
INCIDENT 00 INCIDENT
Structure Bias Motivation: Offense Location:
NONE HIGHWAY / ROAD I ALLEY
Weapon Used: Situation Code: Premise:
OTHER / NA HIGHWAY (STREETS, ALLEYS,
Penal Code: UCR Code: F/M: | Penal Code Description: Counts: Comp/:
LL Structure TOD: Bias Motivation: Offense Location:
Situation Code: Premise:
Weapon Used:
Phone: Cell Phone:
• Person Name:
Г Business Pager:
Address (Street, Apt., City, State, Zip):
Victim Type (Business): Domestic r | LEOKA Activity: LEOKA Assignment:
Involvement Type (Person:
Violence
Employer Address: Employer Phone:
Occupation: Employer:
Relationship to Offender (Person): DOB: Age: Sex: Height: Weight: Rejury Type;, Minor Injuries Unconscious
Internal Injuries Teeth Injury
Ethnicity: SSN: License (#, Class, State): Related Offenses): Lacerations Later juries F None • Bone Injury Race:
Phone: Cell Phone: Pager.
Suspect #1 Name:
Occupation: Employer:
Address (Street, Apt., City, State, Zip):
Primary Action: Employer Address: Employer Phone:
Suspect Forced Victim:
DOB: Age: Sex: Height: Weight: Build: Complexion: Eye Color:
Solicited/Offered: Suspect Force:
License (#, Class, State): Related Offense(s): Hair Color: Hair Length: Hair Style:
Race: Ethnicity: SSN:
State ID #: Facial Hair: Speech: Teeth:
Clothing Description: NCIC#:
Body Markings (Type, Location, Description): Persons:
Arrested: Suspects:
LAMM. RUSTY W 02306 07/06/2024 02:57:00
Reporting Officer ID# Date Reporting Officer Signature
Assisting Officer Signature. w
Assisting Officer ID# Date 5071
SMITH, DANIEL 02320 07/06/2024 16:36:06 Reviewing Officer Signatüre* 1132011100 Reviewing Officer ID# Date FOR THIRD PARI RELEA
Page1 of 3 3
•. ROCKSBY GINGER
51 3.142024
INCIDENT REPORT - NARRATIVE
Agency Name: ORI#. Report Date/Time: OCA#:
RIALTO POLICE DEPARTMENT 07/06/2024 02:57:00
NARRATIVE
ASSIGNMENT/ARRIVAL
On 6/30/2024, I was assigned to work park patrol between the hours of 1000 hours and 2200 hours.
At approximately 0941 hours. I was dispatched to the area of Sunrise Drive and Alder Avenue in reference to a female that had tripped and fell while walking on the sidewalk.
BACKGROUND INFORMATION
Prior to arriving at the incident location I received information from the Rialto Police Department dispatch center that the injured female had been transported to Arrowhead Regional Medical Center by the Rialto City Fire Department.
INVOLVED PARTY CONTACT
Ginger Robert Rooksby. DOB
/ contacted Ginger inside the emergency room at Arrowhead Regional Medical Center where she was located in Emergency Room Bed 9. Upon contacting Ginger, she stated that she was walking southbound on Auger Avenue, just north of Sunrise Drive. when she tripped over a raised portion of the sidewalk that she did not see was raised. When she tripped and fell, she stated that she hit her head on the ground, causing her to receive a large laceration above her eyebrow and on the bridge of her nose.
ASSIGNMENT/ARRIVAL
On 6/30/2024, I was assigned to work. Ginger had no further information regarding this case.
MEDICAL INFORMATION
While at Arrowhead Regional Medical Center, I contacted hospital staff and obtained Ginger's medical record number which was M004251509. Hospital staff informed me that Ginger would need to have stitches placed in her forehead and the bridge of her nose due to the severity of the laceration on her face.
PHOTOGRAPHS
I responded to the incident location where I took photographs of the raised sidewalk and uploaded them to evidence.com.
NOTIFICATION
I contacted Lieutenant Quarker and advised him of the incident and stated that public works would need to fix the curb when
DISPOSITION CONTROLED COP:
COF2OMA C
RES RICTED P0:122-1113
NOT PORTMPO% RELEASE
"ERATO COMOS • DEPARTMEN:
• 10:8204824
2. C.*4/2023
INCIDENT REPORT - NARRATIVE
Agency Name: ORI#: Report Date/Time: OCA#:
RIALTO POLICE DEPARTMENT 07/06/2024 02:57:00
NARRATIVE
Case to date forward to the Rialto Police Department station file for documentation. 93 720422000
C0 ADENTAL207
RESTRICTED PO 11142111-3
THERA TO COUCE DEPARTMENT
" ROOKSBY SINGER
*: 42022
Reverse Gravity Medical Aesthetics
Invoice to
ginger grable
Email Invoice No: AR6311722378065
Invoice Date: 07/30/2024 03:27 PM
Payment on: 07/30/2024 03:27 PM
ITEM DESCRIPTION PRICE
45 units of Botox priced $11.50 $517.50
ITEM DISCOUNT CUSTOM DISCOUNT TOTAL
TAX
$0.00 $0.00 $20.00 $382.50
AMOUNT
PAYMENTS
$382.50
Credit Card ending
(ginger grable)
Reverse Gravity Medical Aesthetics +19094355559
Reverse Gravity Medical Aesthetics
Invoice to
ginger grable
Email
Invoice No: AR7341726076389
Invoice Date: 09/11/2024 10:39 AM
Payment on: 09/11/2024 10:56 AM
ITEM DESCRIPTION PRICE
14 units of Botox priced $11.50 $161.00
1 units of Cheek Augmentation priced $950.00 $950.00
1 units of Voluma Juvederm priced $0.00 $0.00
1 units of Under-Eye Filler priced $900.00 $900.00
TAX ITEM DISCOUNT CUSTOM DISCOUNT TOTAL
$0.00 $0.00 $215.00 $1,796.00
PAYMENTS AMOUNT
Cash $400.00
Credit Card ending 8354 $1,396.00
(ginger grable)
Reverse Gravity Medical Aesthetics
FOR BILLING INQUIRIES CALL: 1(800) 906-6552 RUN NUMBER TATEMENT DATE AMOUNT DUE PST - 8:00am to 4:30 pm 24-537944 10/21/2024 11/10/2024 1,833.25 RUN NUMBER: 24-537944
INCIDENT NO: 24-158726 AMOUNT PAIDI
DATE OF SERVICE: 06/30/2024
ADDRESSEE: PLEASE REMILTON
7000000870160. 003.0.63467/2
CITY OF RIALTO AMBULANCE SERVICE
GINGER ROOKSBY PO BOX 269110
SACRAMENTO CA 95826-9110
PLEASE RETURN THIS PORTION WITH YOUR PAYMENT SEE REVERSE SIDE FOR ADDITIONAL INFORMATION RUN NUMBER: 24-537944 INVOICE
INCIDENT NO: 24-158726
DESCRIPTION CHECK# QUANTITY COST PER UNIT DATE TOTAL CHARGE Paymen Electronic Transfer 488182035- 07282024. 0.00
0.00 Aleaneed Ambulance Service 1,579.25 1,579.25
25.40 254.00
covered by ancare payed per airina on 2024 for the reason: CO22 Payment adjusted because this covered by ancarer payer per ordination of benerfor the reason: 0022 Payment adjusted because this TOTAL
AMOUNT
DUE
1,833.25
DO NOT PAY FROM THIS INVOICE. We filed a claim with your Insurance company and they have not responded. Please call your insurance regarding payment of this claim. Contact our customer service with your Insurance payment status. Thank you!
CITY OF RIAL TO AMBULANCE SERVICE
ARMC Service Area
Visit Accounts
Currently viewing: Active accounts
Active accounts Year to date Last year Date range
Pending Insurance
These accounts are not due and are only displayed for your information. You may be responsible for these accounts in the future.
Emergency Visit at ARMC Main Hospital Pending insurance Jun Hospital Services
Provider: Dr. Arnold Sin Billed $19,890.10
30 Patient: Ginger Rooksby Insurance Covered -$18,114.01 2024 Primary Payer: Generic Medicare Advantage $1,776.09 Pending Insurance
Account # Your Balance $0.00
Detailed Account Information
IV Therapy - General Classification $1,575.00
Radiology - Diagnostic - General Classification $402.00 CT Scan - General Classification $9,606.00
Emergency Room - General Classification $8,218.00
Pharmacy - Extension of 025x - Single Source Drug $89.10 Payments and Adjustments
Generic Medicare Advantage -$18,114.01
anna
Location of fall,
Crack/uplift of
Side walk
City sign in exact
spot where I tell
fresh paint in
crosswalk & on side-
walk showing City
officials have recently
been in this Area
Blood from my fall
Picture of me un
hospital betore
Stitches
Photo after Stitches
Phots of me the
next day
Current Scars
on my face