CITY CLERK'S DATE STAMP
CITY OF RIALTO
LIABILITY CITY OF RIALTO
CLAIM FOR DAMAGES 2026 FEB 17 AM 9:24
TO PERSON OR PROPERTY
RECEIVE
CITY CLERK
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 §911.2).
2. Claims for damages to real property must be filled 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:
BRENDA BALOERRAMA
FULL NAME DATE OF BIRTH
HOME ADDRESS INCLUDING CITY, STATE & ZIP HOME TELEPHONE NO.
N/A
BUSINESS ADDRESS INCLUDING CITY, STATE & ZIP BUSINESS TELEPHONE NO.
ADDRESS AT WHICH CLAIMANT DESIRES TO RECEIVE 561 c
NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM
(if different from home address provided above):
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE: 01/16/2026 TIME: 8:54 AAMOPM
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.
OCCUARED ON MY PROPERTY AT 595 N. EUCALYPTUS AVE RIALTO.
OFFICERS CHASING ARMED SUSPECT, SUSPECT JUMP OVER FENE
AND OFFICERS NEEDED
OFFICERS STATED IT WAS NECESSARY TO ACCESS MYLOC
BACKYARD BY PULLING DOWN THE LOCKED DOOR
AND DAMAGING THE DOOR ANO FENCE TO GET SUSPEC
4. WERE POLICE AT THE SCENE? I YES •NO WERE PARAMEDICS AT THE SCENE? •YESINO
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 posnown.
THIS HAPPENED ATT MY RESIDENCE, WHILE POLICE CHASING
SUSPECT, WHOM WAS DETERIMNED WAS ARMED
WITH HAND GUN, PER POLICE. SGT. K. BALL INFORMED.
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:
Item/Date: FENCE /DOOR COMBO 01/16/2026 Amount: $ 1, /10,00 Item/Date: Amount: $
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: $ 1,110.00 ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN:
Item/Date: Amount: $
Item/Date: Amount: $
TOTAL ESTIMATED AMOUNT PROSPECTIVE DAMAGES: $ 4110.00
7. WITNESSES TO DAMAGE OR INJURY List all persons known to have information (attach additional pages, if necessary) SGT. K. BAL NAME: BRENDA BALDERRAMA
NAME: —
ADDRESS: RIALTO PO ADDRESS:
TELEPHONE: L TELEPHONE: _
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITAL(S) VISITED:
NAME: NAME:
ADDRESS: ADDRESS:
TELEPHONE: | ) TELEPHONE: L)
DATE: TIME: • AM OPM DATE: _ TIME: • AM 0PM
9. PLEASE READ THE FOLLOWING CAREFULLY:
-or all vehicle accident claims, place on the following diagram, the names of streets, including NORTH, EAST, SOUTH AND WEST directions. Indicate plac of accident by "X" and by showing house numbers or distances to street comers If 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 vehicle 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 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.
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 TO THOSE 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
BRENDA BALDERRAMA 02/17/2026
TYPE OR PRINT NAME DATE
SELF
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 Remit to Main Office Installation
Main Otlice: *ALL COUNTIES- Date
930 N. Main St.
Riverside, CA 92501 Temp _
951-780-9300 FENCE & SUPPLY
Orange County 714-619-0498 Air Quality
WOOD • VINYL • IRON • CHAINLINK
Coachella Valley 760-834-6221 Lic. #717249 • Fully Insured & Bonded * Since 1978 Estimator Arturo Herrera Cell (951) 990-2834 - [email protected] No. 53560
NAME BRENDA BALDERRAMA PRIVACY
Linear Ft. . Description VINTL
ADDRESS
2P 9237G FENCING SPECIFICATIONS
CIYRIALTO
HOME PHONE _ WORK PHONE.
VINYL.
JOB ADDRESS City _.
Fence Hagh Fasce Height
EMAIL CUSTOMER
Were fage man sa HOMELAND SAM
Top Pull Q. D. come on 76 x 6
-Frame O.D.
A.5x5
Live Post 0.D. ... ... Polent D.D..
Comes Post Q.0 Pant D.C..
Gate Poet O.D. ... Post O.D..
Pant Gage O.D. Drive Gates.. N/A
NATIONWIDE
595
<q'→ Mate Ups.
Wolk Gates.. Post on 6' Carter. Dove Stee.
DriverSide Pool on 5 Cente .... Colors
-- D Core Drill
G Fong Ramore • Generator
N EUCALTPTUS AVE BID VALID FOR 10 DAYS
Comments * INSTALL 9 LINEAR FEETOF 70" HOMELAND PRIVACY FENCE WITH (1) WALK GATE:
*INCeCIDES DEMO MNA HAM OF ARTENCE * ANY VEGETATION AND ANY LOOSE /
ALTACHED ITEMS TO BE REMONED EROM FENCE MIME PRIOR TO INSTALL 10% deposit required on acceptance of quote. Contracts without deposits will not be valid until deposit received.
CUSTOMER PAYMENT due day ef completion. Please walk the job with the foreman upon completion.
Payments not received upon completion will be charged 3% per day after 7 days until paid. Customer has 1 year warranty for all materials and labor. Limited lifetime warranty on vinyl from the manufacturer ACCEPTANCE: The vadiusigaad accepts the conditions and tens as stated hereas and agrees thal this proposal bacomes a costract betwee the luo parties whese signatures ausear beiow.
Parchaser agrees to pay All Counties Feace & Bussly 10% of total in case of costract cancellation. ACFAS assumes no refponsibility of utility lines or We agree to Rumish material, labor and instalation complata as speciled above. SIGN→_ lomplete - Inc Tax _ $ 1110
Core Wail Release X
Accepted By X A Work Satisfied X
White - Work Order Yellow - Office Pink - Customer's Estimate/Sales Receipt Cootie Printing, LLC - Form 102 Rav 8 2821
WARRANTY & CONDITIONS
Any alterations during installation ofjob are suhject to price changes. All Counties Fence & Supply is not responsible lor any landscaping that may he damaged during installation. All Counties Fence & Supply does not assume any responsibility for damages to water lines. sprinkler lines. electrical conduit or wiring that is unknown to All Counties Fence & Supply at the time of installation. All wood materials that are used are subject to knot holes. shrinkage. warping, and splitting. All Counties Fence & Supply bears no responsibility for these occurrences or acts of god that may cause additional deterioration. There is a one il) year warranty on all installations.
All property markers must he visible at the start of construction or otherwise we do not assume any responsibility whatsoever for any fences in the wrong location. We assume no responsibility whatsoever for location of property lines.
It is against the law for a contractor to collect payment for work not yet completed. or for materials not yet delivered. However. a ontractor may require a down-payment. The down-payment may not exceed $1000.00 or 10 percent uf'the contract price, whicheve s less under typical conditions. All Counties Fence and Supply reserves the right to requines 50% 20100% deposit/payment 3/ 2 MATERIALS ONLY if fabricetion or special order inaterials are part of the contract.
Please direct all after contract completion questions or corrections to (951) 787-9300. A servipe request form will be generated to address your concerns promptly X ence~
THREE DAY RIGHT TO CANCEL
You. the buyer. have the right to cancel this contract within three husiness days. You may cancel by e-mailing. faxing or delivering a written notice to the contractor at the contractor's place of business by midnight of the third business day after you receive a signed and dated copy of the contract that includes this notice. Include your name. your address and the date you received the signed copy of the contract and this notice.
If you cancel. the contractor must return to you anything you paid within I0 days of receiving the notice of cancellation. For your pan. you must make available to the contractor at your residence, in substantially as good condition as you received it. any goods delivered io you under this contract or sale. Or, you may ask. if you wish, comply with the contractors instructions on how to relun the goods at the contractors expense and risk. If you do make the goods available to the contractor and the contractor does not pick them up within 20 days of the dare or your notice of cancellation. you may keep them without any further obligation. If you fail to make the goods available to the contractor or it you agree to return the goods to the contractor and fail to do so. then you remain liable for performance shall obligationg under the contract.
Misers hereby acknowledge that on 2/3/26ame) i was provided this document entited Three-Day Right to Cancel." • (clicek hox) if Buyer agrees to waive this provision based on an accelerated installation time per the direction of
CALIFORNIA MECHANICS LIEN LAW
Notice: Under the Mechanics Lien Law (California Code of Civil Procedure. Section 1181 ct seg) any contractor. subcontractor. laborer, supplier, or other person who helps improve your property but is not paid for his work or supplies. has a right to enforce a claim against your property. This means that. after a court hearing, your property could be sold by a court officer and the proceeds of the sale used to satisly the indebtedness.
In the event either party becomes involved in litigation, arbitration or any other alternate dispute resolution arising out of or relating to this contract of the performance of it. the court or tribunal in such arbitration or litigation shall award reasonable lees and costs incurred to the prevailing party including altomeys fces, expert witness fees. court costs and other costs arising out of or relating to resolution of the dispute.
acknowledge that I have read and understand all terms and conditions. You are entitled to a completely filled in copy of this ngreement. signed by both you and All Counties Fence & Supply. before any work may be started.
If this proposal is acceptable. please sign both pages of proposal where noted and fax back lo All Counties Fence & Supply at (951) 780-8717. Upon receipt. the estimator will attach the appropriate documentation to the signed proposal and submit the installation packet to our Operations Manager to be assigned an installation date. Our office will then contact you with the installation date. 0/3/251 counties Fence de Suply.
(date) (Contractor or Agent sign here)
(owner sign here)
X
(if mure chan one Owner. Sign Ilere) (cate)
6:59 all
Receipt from All Counties Fence...
$1,110.00
PYMTAC808 $1,110.00
Total $1,110.00
Google Map data ©2026
All Counties Fence & Supply
930 N. Main Street
Riverside, CA 92501
(951) 780-9300
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All Counties Fence & Supply
930 N. Main Street
Riverside, CA 92501
(951) 780-9300
Visa Feb 12 2026 at 1:39 PM
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Auth code: 033942
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