CITY CLERK'S DATE STAMP
CITY OF RIALTO
LIABILITY
CITY OF RIALTO
CLAIM FOR DAMAGES
TO PERSON OR PROPERTY 2028 APR 15 PM 5: 10
1. Claims for death, injury lo person, or to personal property must be filed not later than six (6) months after the occurrence (Gov. Code 59112) CITY CLER*
2. Claims for damages to real property must be filed 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., Rialio, CA 92376
CLAIMANT INFORMATION:
Victor Monyaras and Guadalupe Cardenas.
MATE OF BIRTH
FULL NAME
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: _ TIME: • AM O PM
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. black Trel root damaged concrete by the garage infront of the i gate door. Garage is locate on the corner of Iris Are and
Carter Ave.
3. HOW DID DAMAGE OR INJURY OCCUR?
The city taeg tw and his rats outwards inside tee
side black door gate.
4. WERE POLICE AT THE SCENE? YESTINO WERE PARAMEDICS AT THE SCENE? •YEST NO
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.
city tree
6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage $ 5750-6900 HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE: Estimats- have not complotel repairs. Estimde I Hem/Date: CBA Holdings Compano Propse Amount: $ 5,750.00 Item/Date: Ban Constructia InC Proposit Amount: $4,900.0 Estimale 2
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: $ 5750-1900 ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN:
Same as previas paje 51750 Estinde.
Item/Date: Amount: $.
Item/Date: We receives two separte estimates to Amountis 46,900 stink 2 TOTAL ESTIMATED AMOUNT PROSPECTIVE DAMAGES: du repair of concate.
7. WITNESSES TO DAMAGE OR INJURY List all persons known to have information (attach additional pages, if necessary) NAME: — N/A
ADDRESS: ADDRESS:
TELEPHONE: () TELEPHONE:
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITAL(S) VISITED: /A ADDRESS: ADDRESS:
TELEPHONE: L TELEPHONE: |)
DATE: TIME: L AM •PM DATE:_ TIME: • AM •PM
9. PLEASE READ THE FOLLOWING CAREFULLY:
For ail vehicle accident claims, place on the foliowing 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 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
7. 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 CLAMAN A AGENT
4/15/2026
PF OR PRINT NAMEC DATE
myself
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
PROPOSAL
CB HOLDINGS COMPANY
CHARLY BANAGA (526)4832453
[email protected]
ADDRESS: RIALTO CA. 92376 03-25-2026
BREAK DOWN
DESCRIPTION:
NEW CONCRE
-REMOVE EXISTING CONCRETE 4' X 12'
-CUT A LINE THROUGH CONCRTE OF 12'
-NEW GRADING
- INSTALLATION OF REBAR #4
-INSTALLATION OF FORMS 2X4
-INSTALL NEW CONCRETE WITH A PROFESSIONAL FINISH
- REMOVE EXISTING FORM 2X4
-CLEAN AREA
-THROW ALL THE TRASH IN THE DUMPSTER
IOTAL: 5.750.00
PROPOSAL
DATE 04/15/2026
CONSTRUCTION CUSTOMER ID 041526
EXPIRATION DATE 04/15/2026
BAU CONSTRUCTION INC.
ELENA ESPINOZA (909) 965-77-30
BILL TO
Name: VICTOR MONJARAS SAAVEDRA
Addres
City- RIALTO CA 92376
DESCRIPTION MATERIAL LABOR TOTAL
-
NEW CONCRETE 59"X 144"
1.- CUT THE CONCRETE AND DEMOLISH THE DAMAGED CONCRETE
2.- SOIL PREPARATION AND INSTALLATION OF STEEL WIRE
3.-NEW CONCRETE 2,500 PCS
_OTHER COMENTS SUBTOTAL
Sales Tax
Total 6,900.00
This is a quote on the goods named, subject to the conditions noted below:
To accept this quote, sign here and return
Chas
Thank You For Your Business! C ELENA ESPINOZA
CUSTOMER'S
•..