CITY OF RIALTO CITY CLERK'S DATE STAMP
CITY OF RIALTO
LIABILITY
2025 MAR - 3 PM 5:08
CLAIM FOR DAMAGES
TO PERSON OR PROPERTY RECEIVED
CITY CLERK
1. Claims for death, injury to person, or to personal property must be filed not later than six (6) months aller the occurrence (Gov. Code $911.2).
2. Claims for damages lo real property must be filed not later than one (1) year after the occurrence (Gov. Code 5911.2).
RETURN TO:
3. READ ENTIRE CLAIM FOR BEFORE FILING
Rialto City Clerk's Office
4. ATTACH SEPARATE SHEETS, IF NECESSARY, TO GIVE FULL, DETAILS Mail: 150 S. Palm Ave., Rialto, CA 92376 Address: 290 W. Rialto Ave., Riallo, CA 92376
CLAIMANT INFORMATION:
res Luis (arrillo
FULL NAME DATE OF BIRTH
HOME ADDRESS INCLUDING CITY, STATE & ZIP HOME TELEPHONE NO.
BUSINESS ADDRESS INCLUDING CITY, STATE & ZIP BUSINESS TELEPHONE NO.
ADDRESS AT WHICH CLAIMANT DESIRES TO RECEIVE
NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM
(if different from home address provided above):
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE: Dec 16, 2024 TIME: 12:23 MAMOPM
2. PLACE OF ACCIDENT (OCCURRENCE) BE SPECIFIC - Describe fully and (if applicable) locate on diagram on reverse side of this sheet.
Where appropriate, give street names and addresses, measurements and landmarks. his damage occurred in a parking lot alley
behind Juan collo on valley biva. ana spruce Ave
I was parked at the time of the incident.
3. HOW DID DAMAGE OR INJURY OCCUR?
Inis camade occurred while e was harassed bu
three hialto Police Officers in a improper Stop and
search while I minded my business on my phonebefore hand.
4. WERE POLICE AT THE SCENE? EYES CINO WERE PARAMEDICS AT THE SCENE? YES LINO
5. WHAT PARTICULAR ACT OR OMISSION DO YOU CLAIM CAUSED THE INJURY OR DAMAGES? Give the name of the city/town Ofticer Breen, Ufficer Bañuelos, and Officer Padilla
were involved in mishandling my Keytob Igave them
in their hand, they were negligent with my property by not giving my key
6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage 750.00 HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE:
BMW Comfort ArRess Keg Fob 12/27 Amount:$. 420.00
BMW Integrated Keg 12/27 80.00
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: $ 500.00 ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN:
Item/Date: esing and Programing Key 255 Amount: $ 125.00 Restorina CAS Module Amount: $_ 125.00
TOTAL ESTIMATED AMOUNT PROSPECTIVE DAMAGES: $. 250.00
7. WITNESSES TO DAMAGE OR INJURY List all persons known to have information (attach additional pages, if necessary) Officer Padilla
ADDRESS: Unkown but I can ADDRESS:
locate him if I want to.
TELEPHONE: Not Known TELEPHONE: L
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITAL(S) VISITED:
NAME: NAME:
ADDRESS: ADDRESS:
TELEPHONE: TELEPHONE: L
DATE: TIME: DAM•PM DATE: TIME: • AM 0PM
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. f 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 vehic! 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 th 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
SIDEWALK
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 I CERTIFY (OR DECLARE) UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
SIGNATURE OF CLAIMANT OR AGENT
Ares Luis Carrillo March 1,2025
TYPE OR PRINT NAME DATE
I Am the Claimant.
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
5. What Actor Unission caused the damages →
i one the ng where Itched, thinking that the had
nisplaced my key ind random place that was not in
the car, L did not return due tothigent Riate polide
larassed again by
officers. My car was teft mobile formonths due to
this incident causing tinancial and emotional distress.
Yahoo Mail - BMW
2/17/25, 4:21 PM
BMW
From:
To:
Date: Monday, February 17, 2025 at 04:19 PM PST
BMW OF ONTARIO
1360 AUTO CENTER DRIVE • ONTARIO, CA 91781
19001290-7880
PAHIS CEPARTMENT HOURS
ROAM, 5:90 PM MONDAY THROUGH FRIDAY
CLOSED SATURORY AND SUNDAY
THANK YOU FOR YOUR BUB NESS'
CE GATE BIVOICE
SOLO BY
CUST NO. TAX EXEMPT MANDER CUSTARD NO. 227627012
SERT PONTENOT
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PART NUMBER/DESCRIPTION NET HOURE.
MOMDAY THRU FRIDAY
125-AD C77 BMW NATURATAR STA 22.54 T0 AM TO 6.30 PM
217139-710 INTEGRATEU KEY TEN SATURDAY
PPED C SPECIAL CADERED I
EASE HACNO RENOTE CONTRO 00034102-30 M
SPECIL CRDERED
SERMS STENCILY CASE
ARMANDMEN'S ANE MADE
ТНЕ ОДОЖНО СПЕРТ
"ART ARE CHORLD.
MASTERGARD SEBA
AMERICAN EXPRESS
SPECHA ORDEPED A
SALEMOCAL PARTE
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SUETS ARE NOT
15% Fending sharge er
1SITS ruined No refl
¡ALL PARTS RETURNED MUST BE IN RESALEARIE CONDITION AND IN witset this insice.
FACTORY PACKAGING OPENIO CHEMICAL AND PYRCTECHNC DEVICES pats must he rebare
ARC MOP HE TURNABLE EASE INSPECT HATS CAREFUL DAMAGED)
PARTS ARE MOT RETURNARE CODED PANTED OR INSTALLED PARTS She angine! packag AX
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lonzed wiess ether
PRICES ARE SUBUEG
1627-52 CUSTOMER COPY NETe53 PAGE 1 OF
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Specialized BMW Tech Invoice
To: Ares Carrillo Date: February 5, 2025
Invoice #: 1
Customer ID: 135
Salesperson Job Payment Terms Due Date
Cesar Coding/Programming Due upon receipt 2/5/25
Qty Description Service Price Total
1.00 Restore CAS Module via Coding $125.00 $125.00
1.00 Program Start/Stop Process ECU $125.00 $125.00
Subtotal $250.00
Sales Tax 0.00%
Total $250.00
Make ail checks payable to Specialized BMW Tech
Thank you for your business!
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