CITY CLERK'S DATE STAMP
CITY OF RIALTO
LIABILITY
CITY OF RIALTO
CLAIM FOR DAMAGES
TO PERSON OR PROPERTY 2025 FEB 11 PM 3: 57
RECENED
1. Claims for death, injury to person, op to personal property must be filed not later than six (6) months atter the occuence (GOV. Code 59112.T Y CLERK
2. Claims for damages to real property must be filed not later than one (1) year after the occumence (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:
Destiny Cazares
FULL NAME DATE OF BIRTH
HOME ADDRESS INCLUDING CITY, STATE & ZIP HOME TELEPHONE 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 INJURY OCCUR? DATE: Jan. 20.2025 TIME: 4:15 DAM 2PM
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.
The powerline on & Jackson st that stands in house address 606 to acress the street to 587 E. Jacksen st, Landed on Car That was parked in the street between address listed.
3. HOW DID DAMAGE OR INJURY OCCUR?
The power line snapped in half and landed on top of
my car and bushes Causing it to Catch on fire and melting the side of my Car
4. WERE POLICE AT THE SCENE? YESO NO WERE PARAMEDICS AT THE SCENE? YES ENO
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 City not maintaining powerlines.
6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage $3,500 HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE:
Item/Date: Total 10st. Amount: 5_3,410
Item/Date: lost of insurance Amount: $ 96.00
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM:
ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN:
Item/Date: CITY OF RIALTO Amount: $ 3,500
Item/Date: 2075 FEB 11 PM 3: 57 Amount: $ 96.00
TOTAL ESTIMATED AMOUNT PROSPECTIVE DAMAGES: E CEI $
7. WITNESSES TO DAMAGE OR INJURY List all persons known to have information (ărach adultonal pages If necessary) NAME: Omar Carares NAME: Angelica 4. Nelson - Collier
ADDRESS: ADDRESS: -
TELEPHONE: were u 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: L AM L PM DATE: TIME: •AM C 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 tirst saw it, and by "B" location of yourself of your vehicle when you first saw City/Town vehicle; tocation 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. 60s 587 575
• Jackson 5t.
Z
CURB
PARKWAY
sadles SIDEWALK
606 588
+
HAVE READ THE FOREGOING CLAIM AND KNOW THE CONTENTS THEREOF; AND CERTIFY THAT THE SAME IS TRUE OF MY OWN KNOWLEDGE EXCEPT AS T HOSE MATTERS WHICH ARE HEREIN STATED UPON MY INFORMATION AND BELIEF; AND AS TO THOSE MATTERS I BELIEVE THEM TO BE TRUE CERTIFY (OP DECLABE) UNDER PENAŁTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
EIGNATURE OF CLAIMANT OR DOENT C
Destinu Caraves 2.10.25
TYPE OR PRINT NAME DATE
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 RIALTO
EST. 1905 CITY OF RIALTO
2025 FEB 11 PM 3:57
NFIRS-1 Basic
A RECEIVED
36185 101 CITY CLERK
CA | 2025 Station 202 125-019902
202)
FDID
Station
B Location Type
Census tract:
- Street Addres
Intersectio
LIn Front Of
•Rear Of | 588 HE-East ]JACKSON
| st-street
Adjacent To
• Directions
US National Grid
Rialto City 92376
ite/Room
E1 E2
Dates and Times Shifts and Alarms
Incident Type
Alarm 01 20 2025 16:13
440-Electrical wiring/equipment problem, other
Arrival 01/20 2025 16:18
D
Controlled_/LILIU
Aid Given Or Received
Last Unit 01/20 202517:32
Cleared
E3
Special Studies
• 1 Mutual Aid Receive ID#
• 2 Auto. Aid Receiver
Г 3 Mutual Aid Given
• 4 Auto. Aid Given
Г 5 Other Aid Given
F None
F Actions Taken G1 G2
Resources
Estimated Dollar Losse End Values
10-Fire control or extinguishment, other Losses:
Suppression 3 OF RIALTO
EMS • Property: $L 7025 FEB 1 4 PM 3:57
Other | o Contents: $L
FRI Pre-Incident Values: SITY CLEAR
Property: $L F
Contents: $l F
Completed Modules H1 Casualties F None H3 ' Mixed Use Property Deaths injuries Hazardous Materials Release [Not Mixed
1 - Natural Gas Г 10 - Assembly Use
Fire • 2 - Propane Gas • 20 - Education Use
Service Г 3 - Gasoline • 33 - Medical Use
Г 6 -EMS Civilian 4 - Kerosene • 40 - Residential Use
L 7 - HazMat • 5 - Diesel Fuel / Fuel Oi • 51 - Row Of Stores • 8- Wildland Fire C 6-Household Solvents • 53 - Enclosed Mall Г 9 - Apparatus Г 7 - Motor Oil F 58 - Business and
[10 - Personnel • 8 - Paint
Г 11 - Arson H2 Detector • 0- Other
• None
Г 1 - Detector Alerted Occupants
Г 2 - Detector Did Not Alert Them • 65 - Farm Use
Г 3 - Unknown Г 00 - Other Mixed Use
Property Use None 341Г Clinic, Clinic-Type Infirmary
539 Household Goods, Sales, Repairs
Structures 342Г Doctor/Dentist Office 571 • Gas or Service Station 131 Г Church, Place of Worship 361Г Prison or Jail, Not Juvenile 579 Motor Vehicle/Boat Sales/Repairs 161 Restaurant or Cafeteria 419F 1- or 2-Family Dwelling 599 Business Office 162 Bar/Tavern or Nightclub 429Г MultiFamily Dwelling 615Г Electric-Generating Plant 213Г Elementary School, Kindegarten 439 Rooming/Boarding House 629Г Laboratory/Science Laboratory 215Г High School, Junior High 449Г Commerical Hotel or Motel 700 Manufacturing Plant 241Г College, Adult Education 459Г Residential, Board and Care 19Г Livestock/Poultry Storage (Bar 311Г Nursing Home 464 Dormitory/Barracks 82 Non-Residential Parking Garag 331Г Hospital 519 Food and Beverage Sales 891Г Warehouse Outside 938F Graded/Cared for Plot of Land Property Use:
124Г Playground or Park 946 Lake, River, Stream
655Г Crops or Orchard 951F Railroad Right-of-Way
669/ Forest (Timberland) 960Г Other Street
807 Outdoor Storage Area 961Г Highway/Divided Highway
919 Dump or Sanitary Landfill 962Г Residential Street/Driveway 931Г Open Land or Field 981 Construction Site
936| Vacant Lot 984 Industrial Plant Yard
K1
Person/Entity involved 5624724673
MS-Ms. | Destiny Cazares
588 |E-East JACKSON ST-Street
Rialto City
CA _ 92376
K2
Owner | Owner CITY OF RIALTO
9495714770
2015 FEB | 1 PM 3:58
MS-Ms. Eva | Coates
Kdhara
587 E-East [JACKSON ST-Street
Rialto City
CA | 92376
L Remarks:
ME202 was dispatched to 588 E Jackson St for a report of power lines down a car sparking in the nearby bushes. We also had a report of a grass fire in the backyard of the house across the street. Upon arrival we found a power line down on a vehicle id in the street. The line was sparking causing some smoke in the bushes located next to the vehicle on the parkway. W so had the other end of the powerline down in the backvard of the house across the street. Some of the grass around th sparking line caught fire and was extinguished by Rialto Police with a dry chem extinguisher. ne area was evaluated and both properties were evacuated by Rialto PD. Comm Center was contacted, and So Cal Ediso was requested. The bushes started on fire and created a significant amount of smoke. The booster line from ME202 wa pulled and once it was deemed safe, water with class A foam was sprayed on the fire in the bushes and the passenger side of sheund veg thation beind the Second mouse was monitored bie not apredied. Dirt Washrow from a distance to mother any vegetation that was smoldering.
So a Frayed arn ense reme do ensue corsete extingut dent. The are in the backyard oF 7 Jacksons was also sprayed down with wa....
M Authorization
000841 Bender, James | Captain
_ 01/20/2025
000841 Bender, James Captain _ 01/21/2025
NFIRS-9 Apparatus or Resources
A
CITY OF RIALTO
36185 | 2025
CITY CLERA RECENTED
Apparatus/Resource of Peopie Appa
Actions Taken
ID: BC803 101/20/2025|16:23 E Suppression
F sent d
• EMS
Type: 91-Mobile command post 01/20/2025 16:23 F Other
01/20/2025 16:43
ID: ME201 01/20/2025 16:23 F sent lef
E Supression
Type: 11-Engine 01/20/202516:32 Other
01/20/2025 16:33
ID: ME202 Dispatch 01/20/2025 16:13 sent d E Suppression [EMS
Type: 11-Engine Arnival 01/20/2025 | 16:18 • Other
Clear: 01/20/2025 | 17:32
NFIRS-10 Personnel
A
CITY OF RIALTO
36185 2025 Station 202 llo
(202) 250P025 FEB LL BM 3:58
CHI CLER*
Apparatus/Resource
ID: всвоз 01/20/202516:23 Г Sent Suppression L
Г EMS
Type: 91-Mobile command post | 01/20/2025 16:23 Г Other 01/20/2025 16:43
ersonnel ID Rote Attend Actions Taken
ID: MEZ01 01/20/2025|| 1623 Г sent o suppression
[EMS
Type: 11-Engine 01/20/202516:32 Г Other
01/20/2025 16:33
Personnel ID Name Rank Role Attend Actions Taken
ID: 01/20/2025 | |16:13 • sent lo Suppression L
Г EMS
Type: 11-Engine 01/20/2025 16:18 F Other
01/20/2025 17:32
ersonnel ID Name Rank Role Attend Actions Taken
NFIRS-1S Supplemental
A
CITY OF RIALTO
36185 Station 202
25-01999025 FEB |LPM 3:58
RECEIVE
CITY CLERK
Primary Narrative:
ME2OZ was dispatched to 588 E Jackson St for a report of power lines down a car sparking in the nearby bushes. We also had a report of a grass fire in the backyard of the house across the street. Upon arrival we found a power line down on a vehicle and in the street. The line was sparking causing some smoke in the bushes located next to the vehicle on the parkway. We also had the other end of the powerline down in the backyard of the house across the street. Some of the grass around the sparking line caught fire and was extinguished by Rialto Police with a dry chem extinguisher.
The area was evaluated and both properties were evacuated by Rialto PD. Comm Center was contacted, and So Cal Edison was requested. The bushes started on fire and created a significant amount of smoke. The booster line from ME202 was pulled and once it was deemed safe, water with class A foam was sprayed on the fire in the bushes and the passenger side of the vehicle that was receiving heat damage. The front right tire on the vehicle melted. The fire was extinguished. The ground vegetation behind the second house was monitored but not approached. Dirt was thrown from a distance to smother any vegetation that was smoldering.
o cal Edison arrived on scene and was able to shut the circuit down, de-energizing the power lines. The fire in the bushe vas sprayed down a second time to ensure complete extinguishment. The area in the backyard of 587 E Jackson ST was alsı sprayed down with water and class A foam.
Approximately 10 feet of bushes in front of 588 E Jackson burned.
The vehicle that received heat and fire damage was a
1998 Toyota Camry
Lic: CA3TJE356
VIN: 4T1BG22K7VU011345
Person/Entity Involved
Omar Cazares
588 JACKSON
Rialto City
CA 92376
Zip Code
Person/Entity Involved Occupant
Cherokee Miller 2025 FEB 1/1 PM 3: 58
RECE
587 JACKSON
Rialto City
| 92376
Additional Narrative (#1 of 1):
01/20/2025 16:11:47SYS [1] WPH2 LAT:34.12011265 LON:-117.359690 METERS:11 %:090 | 01/20/2025 16:11:47SYS [2] ELV 362 UNC 2.278125 | 01/20/2025 16:11:47SYS 3] Validity of address cannot be determined:2750 W 2ND ST. 01/20/2025 16:11:58K4007 [4] HOUSE | 01/20/2025 16:11:59SYS [5] WPH2 LAT:34.12008047 LON:-117.359691 METERS:14 %:090 | 01/20/2025 16:11:595YS [6] ELV 362 UNC 3.460078 | 01/20/2025 16:11:59SYS of address cannot be determined:2750 W 2ND ST. | 01/20/2025 16:11:59SYS the ANI/ALI Viewer for details | 01/20/2025 16:12:04K4007 19 RIAC 0120/2025 16 e. slare bid has occure chec Aborted 10. Non-medical call | 01/20/2025 16:12:32K4007 (111 RP ADVS POWELINE FELL ON DAUGHTERS CAR AND IS NOW SPARKING IN BUSHES | 01/20/2025 16:13:00K4007 [12] RP ADVS SEES WHITE SMOKE OMING OUT. | 01/20/2025 [131 COMING* | 01/20/2025 16:13:07J6787 [14] * PRD REVIEWED THE INCIDENT * | 01/20/2025 [15] RP ALSO ADVS POWERLINE POSS STARTED A FIRE IN NIGHBORS YARD / RP HEARD POPPING I 01/20/2025 16:15:02J6924 [16] ADDTL RP NOW ADVS BACK YARD NOW ON FIRE / GRASS ON FIRE | 01/20/2025 [17] RIAC - RP ADVS FIRE IS ABOUT 2 FT FROM HOUSE | 01/20/2025 16:18:36J6787 [19] LINE 18 ENTERED IN ERROR | 01/20/2025 16:20:03D8157 [20] ME202 START EDISON - LIVE WIRES DOWN | 01/20/2025 16:23:22D8157 21 BC803 OS - START 1 ADD ENG 01/20/2025 16:24:19D8151 22] ***EDISON REOUESTED*** - ORDER # 5204197 - WILL CB WITH ETA | 01/20/2025 16:24:37BC801 tac [TC, BC803] | 01/20/2025 16:30:06C803 (24] 587 and 588 have been evacuated due to lines down in their yardl [TC, BC803] | 01/20/2025 16:49:25BC803 25] Edision on scene. [TC, BC803] | 01/20/2025 16:49:55D8157 ME202 EDISON OS
CITY OF RIALTO
Response Checklist:
2025 FEB 11 PM 3: 58
RECEIVLO
Information Sources the FD can use conduct a size up: CITY CLERA FACP - Fire Alarm Control Panel
• BMS - Battery Management System
Visual
• SME - Subject Matter Expert
• ROC - (Regional Operation Center)
• Cameras if installed
Questions to ask the Control Center/SME:
Is anyone missing or not accounted for?
• Ifso, what type of work were they doing?
• Can you see the person on the cameras? If there are cameras • Are they in contact with any equipment or away from equipment? • Have you received any alarms?
• What is the BMS showing? State of Charge - Any over temp Cells/Modules? • Has the trouble equipment been isolated? - IF not the batteries, can it be de- energized?
• What is the ETA of the SME?
The following additional questions should be asked for any type of event at the site:
Are there any active alarms?
• If so what alarms? Gas/heat/smoke
What is the BMS showing?
• Are there any over temperature cells/modules?
• If so, how many?
• What is the SOC (State of Charge) of the batteries? 0% - 100% • Has the BMS isolated any equipment?