Docusign Envelope ID: C18E2A9F-BB17-467F-B30D-B535ADD02FDB
CITY OF RIALTO CITY CLERK'S DATE STAMP
LIABILITY CITY OF RIALTO
CLAIM FOR DAMAGES 20P1 NOV 12 PM 1: 12
TO PERSON OR PROPERTY RECEIY:
CITY CLER*
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 §911.2).
2. Clains 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:
Michael Anthony Peterson
FULL NAME -
DATE OF BIRTH
( 818) 386-6777
HOME ADDRESS INCLUDING CITY, STATE & ZIP HOME TELEPHONE NO. 4529 Sherman Oaks Avenue, Sherman Oaks, CA 91403
818, 386-6777
BUSINESS ADDRESS INCLUDING CITY, STATE & ZIP BUSINESS TELEPHONE NO.
ADDRESS AT WHICH CLAIMANT DESIRES TO RECEIVE 4529 Sherman Oaks Avenue, Sherman Oaks, CA 91403
NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM
(if different from home address provided above):
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE: 06/02/2024 TIME: 12:30 VI AM OPM
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.
Incident location was S Riverside Avenue and San Bernardino Avenue, in Rialto California.
3. HOW DID DAMAGE OR INJURY OCCUR?
Officers of the Rialto Police Department, namely Officer Matthew Lopez #02065 conducted a traffic stop without probable cause. Officer Lopez thereafter negligently investigated an incident, unlawfully detained and falesly arrested Michael Anthony Peterson without probable cause and charged him with public intoxication, obstruction, and allowing an unlicensed driver to drive.
4. WERE POLICE AT THE SCENE? YES • 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.
Officers of the Rialto Police Department, namely Officer Matthew Lopez #02065 conducted a traffic stop without probable cause, Officer Lopez thereafter negligently investigated an incident, unlawfully detained and falsely arrested Michael Anthony Peterson without probable cause and charged him with public intoxication, obstruction, and allowing an unlicensed driver to drive.
6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage $_5.000,000.00 HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates DAMAGES INCURRED TO DATE:
Item/Date: medical expenses (past and future), pain and suffering, improperly held Amount: _according to proof Item/Date: in custody Amount: $_
CA 913
OSTAG
LAWYERS -
4529 sherman darks Ave
Sherman caks, A 91yu3 7022 0410 0001 2819 8591
Rialto City Clerk's office
150 s. Palm Ave. Rialto, CA 92376
S2376-646799
OF THE RETURN ADDRESS. FOLD AT DOTTED LINE
PLACE STICKER AT TOP OF ENVELOPE TO THE RIGHT
4529 Sherman Oaks Ave, Sherman Oaks, CA 91403
09 213-LAWYERS (213.529.9377) 818.754.6778
yers.com
CITY RECEIT
2 Mire ALTO