CITY CLERK'S DATE STAMP
CITY OF RIALTO CITY OF RIALTO
SANTO, CO LIABILITY
2025 MAR 26 PM 4: 52
CLAIM FOR DAMAGES
RECEIVEL
TO PERSON OR PROPERTY CITY CLERA
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 59112).
2. Claims for damages to 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 Mail: 150S. Palm Ave., Rialto, CA 92376
4. ATTACH SEPARATE SHEETS, IF NECESSARY, TO GIVE FULL DETAILS Address: 290 W. Rialto Ave., Rialto, CA 92376 CLAIMANT INFORMATION:
Benjamin Batrez
DATE OF BIRTH
FULL NAME
HOME ADDRESS INCLUDING CITY, STATE & ZIP HOME TELEPHONE NO.
BUSINESS TELEPHONE NO.
BUSINESS ADDRESS INCLUDING CITY, STATE & ZIP
ADDRESS AT WHICH CLAIMANT DESIRES TO RECEIVE
NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM
(if different from home address provided above):
TIME: DAM O PM
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE /2/24-3/25
2. PLACE OF ACCIDENT (OCCURRENCE) BE SPECIFIC - Describe fully and (if applicable) locate on diagram on reverse side of this sheet.
Where appropriate, give sfreet names and addresses, measurements and landmarks.
Occured at
Daveway 3 garage Concrete damage:
3. HOW DID DAMAGE OR INJURY OCCUR?,
was due to the city tree
foots growing under the
4. WERE POLICE AT THE SCENE? DYES VANO WERE PARAMEDICS AT THE SCENE? DYES TANO
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 coots to the city tree cracked and lifted the garage foundation. driveway and the
$
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 bills, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE:
Amount: $/1060-15,0008
Item/Date: Clve way Garage Foundatio
Permits Plans Amount: $500 - 20008
Item/Date:
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: 0- ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN:
Item/Date: Amount: $
Item/Date: Amount: $
TOTAL ESTIMATED AMOUNT PROSPECTIVE DAMAGES: $
7. WITNESSES TO DAMAGE OR INJURY List all persons known to have information (attach additional pages, if necessary) NAME: _ Michael Springer (Arborist) NAME:
ADDRESS: City Employee ADDRESS:
TELEPHONE: ) TELEPHONE: L 1
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITALS) VISITED:
NAME: NAME:
ADDRESS: ADDRESS:
TELEPHONE: L TELEPHONE: )
DATE: TIME: DAM 0PM 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. 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
I HAVE READ THE FOREGOING CLAIM AND KNOW THE CONTENTS THEREOF; AND CERTIFY THAT THE SAME IS TRUE OF MY OWN KNOWLEDGE EXCEPT AS T THOSE MATTERS WHICH ARE HEREIN STATED UPON MY INFORMATION AND BELIEF; AND AS TO THOSE MATTERS I BELIEVE THEM TO BE TRUE R DECLARE) UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
SIGNATURE CLAIMANT OR AGEN
Alanin 325k5
TURE OR PRINT HAME DATE
omer
TRAC
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 Grand West Coast Construction INVOICE
INV0001
211 South Grand Avenue, West Covina, CA, USA
6262221824 DATE
01/30/2025
DUE
On Receipt
BALANCE DUE
USD $12,000.00
BILL TO
Nicholas Batrez
Nick
Na
Na
18 na
DESCRIPTION RATE QTY AMOUNT
Concrete Removal $12,000.00 14 $12,000.00
Concrete Disposal
Repour concrete with Rebar 3k psi
Iff additional concrete needs to be removed due to roots moving towards foundation additional cost will be added
TOTAL $12,000.00
BALANCE DUE USD $12,000.00
C&C Concrete LLC
1120 S Lilac Ave. Rialto, CA 92376 - [email protected] Omar (951) 250-7384 - Lic No. 1105723
Client Name: Benjamin Batrez
Address: Invoice Number: 2024 - 102
Phone number: Date: 11/29/2024
Email:
We hereby submit specifications and estimates for:
UNITS AMOUNT: USD
REMOVE CONCRETE DRIVEWAY & GARAGE SLAB
HAUL AND DUMP TREE ROOTS & CONCRETE DEBRIS
GRADE, LEVEL AND COMPACT DIRT
REPLACE AND POUR - 4" THICK NATURAL CONCRETE WITH #3 REBAR @ 16" O.C AND BROOM FINISH
***GRASS RESTORATION IS TO BE EXCLUDED***
NOTES:
First Payment
Second Payment
Final Payment
Total $11,000.00
Company Authorized Signature & Seal
Omar Cardenas s outlined abov
Benjamin Cardenas
Date:
Client Authorized Signature & Seal :
Notes: TBD = To Be Determined (not included into cost)
1744 W. lowell
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1/44 W Loudl
- Maple Ave -
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- W. Lowell -
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1744 W Lowell Si
Garage l
→
Dcideway
Goocle Ear
gonna /Copertious
.=; Tree
City Goots
Driveway Tree
that caused the
Garage Foundation Damage
12:55
X
Were told by
Micheal Springer
On this Date
"Was a Wealthy 3:22:55 PM
Dec 4
tree, it could not
14 be removed, and
the roots were
not the issue."
Roots growing towards the
Garage
December 28, 2024 Edit
10:35 AM
I HDR
Tee being
lemovad after
City confirmed
that roots
Fram the city
tree caused
damage to
Garage Faundatin
§ Doiveway
Garage Faundation
lifting
JOHnSOn Si LIFE
GUAR
24 Garage Slab
Lifting
(e)
DECRE
EG aC