CITY OF RIALTO TERK'S DATE SIAM
LIABILITY Y OF RIALTO
CITY RNIA 2025 FEB 12 PM 5:43
CLAIM FOR DAMAGES
TO PERSON OR PROPERTY RECEIVED
CITY CLER*
2. Clims for damages to real property must be fled not laler than one (1) your after the octurrence (Gav. Code §011.2). 1. Ciaires for death, injury to person, or to personal property must be Sled net iate: than six (6) mortis after the occurance (Gor. Code 5911 2)
3.READ ENTIRE CLAIM FOR BEFORE FILING RETURN TO:
4. ATTACH SEPARATE SHEETS, IF NECESSARY, TO GIVE FULL DETAILS Rialto City Clerk's Office Mail: 150 S. Palm Ave., Rako, CA 92376
Addrass: 290 W. Riatta Avs., Rialto, CA 92376
CLAIMANT INFORMATION:
Landexeurp LLC.
DATE OF BIRTH
PO BOx 9559 Alta Loma CA, 91701
HOME ADDRESS INCLUDING CITY, STATE & ZIP
HOME TELEPHONE NO.
RO BOX 9559 Alta LOMA CA,9/701
BUSINESS ADDRESS INCLUDING CITY, STATE & ZIP
BUSINESS TELEPHONE NO.
ADDRESS AT WHICH CLAIMANT DESIRES TO RECEIVE PO BoX 9559
NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM
(if different from home address provided above): Alta LoMa CA 91701
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE: December 14,2025 TIME: 12 NOON DAMOPM
2. PLACE OF ACCIDENT (OCCURRENCE) BE SPECIFIC - Describe fully and (if applicabic) focate on diagram on reverse side of this sheet. Where appropriale, give street names and addresses, measurements and landmarks.
Tity main sewer Packe
@MillawSt. And
taw sewage backled into subject commercial Blas.
3. HOW DID DAMAGE OR INJURY OCCUR?
dily main sewer line me to up into was restricted @
willow street causing raw Sewage to barie i into fuc
buildies me dun
4. WERE POLICE AT THE SCENE? OYES CYNO WERE PARAMEDICS AT THE SCENE?
DYES 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.
Mille Orapa, Deputy Directo-uf Maint. advised Me to dispatch an Paviron Mutal / Elan - of company and submit the inWice the city clerk He then took bur w/eleanor due tocktat.
6. GIVE TOTAL AMOUNT OF CLAIM include estimate of amount of any prospective injury or damage $
HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bels, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE:
Item/Date: Patrist Environmental Sray lav # 8133
Amount: $ 1467.38
Item/Date:
Amount: $
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: 1,467.38 $.
ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN: CITY OF RIALTO Item/Date:
Item/Date: 7025 FEB 12 Pp0g43
Amount: $
TOTAL ESTIMATED AMOUNT PROSPECTIVE DAMAGES: RECEIVED 1467-38
CITY CLERF
7. WITNESSES TO DAMAGE OR INJURY List all persans known to have information (attach addlitional pages, il necossary) HAME:
NAME
ADDRESS:
ADDRESS:
TELEPHONE: { )
TELEPHONE: LL
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITAL(S) VISITED:
NAME:
NAME:
ADDRESS
ADDRESS:
TELEPHONE:
TELEPHONE: L
DATE: TIME,
DATE: TIME:
DAMOPM
9. PLEASE READ THE FOLLOWING CAREFULLY:
of accident by "X" and by showing house numbers or distances to street comers. Forall vehicle accident claims, place on the following diagram, the names of streets, induding NORTH, EAST, SOUTH AND WEST directions. Indicate place f a citylown vehicle was involved, designale by letter "A" localion of the City/Town vehicle when you first saw it, and by "B" location of yourself or your vehicle when you frat saw City/Town vehicle; location of City/Town vehicle al time of accident by "A-1" and location of yourself or your vehicle at the time of the accident by 8-1" 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
HAVE READ THE FOREGOING CLAIN AND KNOW THE CONTENTS THEREO; 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 TRU I CERTIFY (OR DECLARE) UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
SIGNATURE OF CLAIMANT OR AGENT
Dustin CHalL 2-9-25-
TYPE OR PRINT NAME
DATE
Antial Rep. Prop
RELATIONSHIP TO CLAIMANT
RETURN CLAIM TO: RIALTO CITY CLERK'S OFFICE - 150 S. PALM AVE., RIALTO, CA 92376 NOTE: PRESENTATION OF A FALSE CLAIM IS A FELONY (CA PENAL CODE 72)
INVOICE
Patriot) CITY OF RIALTO Job Number: 8433
Environmental Services 2025 FEB 12 PM 5: 4 voice Nor: INV402227183 A Crystal Clean Company 1/18/2025
Due Date:
Mira Loma - Patriot RECEITED Customer: 4100441362 Monte CITY CLER* Vista Assets
2151 E Philadelphia St
Ontario CA 91761 Rep: Vincent A Moore
United States Invoice Notes:
Phone: (562) 436-2614
BILL TO SHIP TO
280 S. Palm Ave. Rialto, Ca. 92376
Monte Vista Assets
PO BOX 9559
RANCHO CUCAMONGA CALIFORNIA
91701
United States
CUSTOMER REF. NBR. TERMS CONTACT
SCOPE OF WORK
Respond to sewage spill ...job cancelled
DATE TOTAL
12/14/2024 $1,275.98
START END STRAIGHT RATE/ST OT PREMIUM PT
DATE ITEM QTY UOM OVERTIME AMOUNT
TIME TIME TIME RATE RATE TIME RATE
12/14/2024 Field 17:00
21:00 4.00 HR 0 $96.00 4 $143.50 $186.25 $574.00
Supervisor
12/14/2024 Gear Truck. 17:00 21:00 4.00 $102.00
Less Than 1 HR $25.50
ton
12/14/2024 Truck Driver 17:00 21:00 4.00 HR
$70.25 4 $105.25 $140.50 $421.00
12/14/2024 120 Barrel 17:00 21:00 4.00 HR $44,.745 $178.98 Black Iron
acuur
anke
NOTE: Payments made after the Due Date will be subject to a service fee of Sales Total: $1,275.98 1 5% per month.
Please Make Checks Payable & Remit To: Recovery Fee(15%): $191.40 Patriot Environmental Services, Inc. Total Due(USD): $1,467.38 P.O. Box 1091
Long Beach, CA 90801
www.patriotenvironmental.com
1 0f1
CITY OF RIALTO
2025 FEB 12 PM 5:43 MONTE VISTA
PROPERTIES
RECEITEN
CITY CLERY
Rancho Cucamonga, CA
Phone: (909) 203.1550
City of Rialto Fax: (866) 241-1710
[email protected]
City Clerks Office
290 W. Rialto CA 92376
Dear Mc Gee:
Subject: Request for Reimbursement and Urgent Follow-up Regarding Sewer Backup Incident on December 14*
I am writing to bring to your attention a matter that has caused significant disruption to our property and tenant's business, and to request reimbursement for expenses incurred due to the incident that occurred on December 14, 2023.
On that date, a severe backup in the City's main sewer system resulted in raw sewage entering our commercial property, affecting our tenant's business operations. After consulting with Mike Orona, Director of Maintenance, we were directed to immediately dispatch our own environmental cleanup crew, Patriot Environmental Services, to mitigate the damage. The invoice for their emergency service is attached in the amount of $1,467.38, which we have paid in full and are seeking reimbursement for.
Several hours later, the Fire Department assessed the situation, and Mr. Orona determined that a more extensive cleanup was required, prompting the City to send a third-party service provider, Serve Pro. While Serve Pro has been involved in the cleanup efforts, it appears that work has stalled due to non-payment, leaving our tenant, Mr. Puente unable to fully reopen his business. Although Mr. Puente has partially opened the rear of the shop, he is currently operating on a very limited basis and is facing significant financial hardship due to the ongoing disruption.
We request that you provide a prompt follow-up on this matter as it is an urgent situation for our tenant, whose business is his livelihood. Additionally, we kindly request reimbursement for the initial cleanup expenses incurred by us through Patriot Environmental Services, as directed by your office.
We appreciate your immediate attention to this matter and look forward to your swift resolution. Please do not hesitate to contact me should you require any further documentation or clarification.
Thank you for your understanding and cooperation.
Sincerely,
Dustin Click, Property Manager
Monte Vista Assets, Inc.
Attachments: Invoice from Patriot Environmental Services ($1,467.38) & Claim for Damages Form
Monte Vista Properties Retail U.S. POSTAGE PAID
ZDCO 901: FCM LETTER
CALIMESA, CA 92320
FEB 11, 2025
CITY OF RIALTO
92376 $5.58
2075 FEB 12 PM 5:42 RDC 99
S2324A501385-55
EYE Rialto City Clerk's Office
150S. Palm Ave
Rialto, CA 92376
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