CITY CLERK'S DATE STAMP
CITY OF RIALTO
LIABILITY
CLAIM FOR DAMAGES
-im
TO PERSON OR PROPERTY - C
CITY OF RIALT
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 filed not later than one (1) year after the occurrence (Gov. Code 59112). - RETURN TO:
3.READ ENTIRE CLAIM FOR BEFORE FILING Rialto City Clerk's Oflice o
4. ATTACH SEPARATE SHEETS, IF NECESSARY, TO GIVE FULL DETAILS Mail: 150S. Palm Ave., Rialto, CA 92376 Address: 290 W. Rialto Ave., Rialto, CA 92376
CLAIMANT INFORMATION:
José T ozdonez
DATE OF BIRTH
FULL NAME
Lavu
200 HOME TELEPHONE NO
HOME ADDRESS INCLUDING CITY, STATE & ZIP
RIAITO CA 92376 L
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):
22260 2:30 GAM IPM
TIME:
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE:
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. the corner Streets werere Sper serges use Morn Stave
3. HOW DID DAMAGE OR INJURY OCCUR?,
Ine, car was towed for no apparent veason, 1+
• was not in a renzone, yreen zone, or bua tire
hydrant
4. WERE POLICE AT THE SCENE? D YES NO WERE PARAMEDICS AT THE SCENE? DYES 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.
Ine illegal towing of my venicle
6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage $ 1,064.30 HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE: 216.80
Police fee to velease my vehicle Amount: $
Item/Date: Amount: $ 852.50
Item/Date: Towing i Storage fee
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: = |69.30 ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN:
Item/Date: 05/23 Amount s_216.80
Hem/Date: 005/731 852,80
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: Krystal Gonzalez NAME:
ADDRESS: — ADDRESS:
TELEPHONE: TELEPHONE: |)
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITAL(S) VISITED:
NAME: MAME:
ADDRESS: ADDRESS:
TELEPHONE: | 1 TELEPHONE: )
DATE: TIME: L AM PM
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.
If a city/town vehicle was involved, designate by letter "A" location of the City/Town vehicle when you fist saw it, and by "B" location of yourself or your vehicte 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. › Pepes
rovina CITY
277 SN
ocust, CURB :3
Lialto CA
PARKWAY
=
92377 SIDEWALK
I CERTIFY IND NECI ADELINNED DEMALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
SIGNATURE OF CLAIMANT OR AGENT
Fose 7 06 4TH 26
TYPE OR PRINT NAME DATE
SElE.
RELATIONSHIP TO CLAIMANT
RETURN AN EAT ARE I ATE PALANE ALL, A 276
CITY
• A!: 01
CAR, Faded
756~ X MalizzoR Ave
W MORGAN ST
ThIs blactoccora IS MY CAR
NoTiCe
This BrokeN PAst of
The curb! That Iam
TAlkinG AbouT where 20TC bUN +5 CITY O
no keas TiRe wes
at Tehicly s pestin
(S IS 29 zeets
HoT wash My CAr HE HAZATO
WAS A
As you can see
Tiere is small
CITY OF RIALTO
Broken piece of 2018 JUN -5 AHM: 07
CuRe my Peer TiRe
e 13 6x The Bib
Broken piece
OK RIGHT Here is
veraleer From Broken
pice artine curve
TO AlmosT Streigntline
is z Feet and
Rememberted 5
met → Feet oF
cArs pasted on moran
As you can see
Me street line of
Why I added 7
27 Feet 2
Broken part oR the
curve or Teartile
ReetS EqUAl ge
Perts The CAR VASNOT
zlegally parked
7 Feet Adaed. to
22 Feet where
me rees TIRe or
lizzord) = 29 Feets
From The 22 feets
m dizzot st, you
mustat >
To go Around Ta
сме то такетом
cliFRord
on
These are The
7 Feets added
To The 72 on
IclizzoRd.
22+
7=
39 6 8
¾⅙⅜¾⅚¾¾|¾4⅘%*' * ¼% * %%% ****%%% 1643/3**3*1%
LICENSE NUMBER REGISTRATION VALID FROM TYPE TYPE VEHICLE USE ENGINE NUMBER MISC 10/26/2025 TO 10/26/2026 11 AUTO
VEHICLE IDENTIFICATION NUMBER MAKE VLF CLASS "YR YR MODEL TYPE VEH DATE ISSUED HOND AE 2017 2002 10/23/2025
DATE FIRST SOLD STICKER INSTRUCTIONS 2 01-5 110E
BODY TYPE MODEL MP UNLADEN / G / CGW TOTAL FEES PAID - CC/ALCO 2002 $151 1) CLEAN SURFACE • SCRAPE
OFF ACCUMULATED STICKERS RECLIN
WILL NOT STICK IF WET OR DIRTY.
LIENHOLDER 2) REMOVE DECAL BY BENDING CITY CLIPP
PAPER ALONG DOTTED LINE.
3) LIFT EDGE OF DECAL AND -
SLOWLY PEEL.
4) PLACE STICKER ON REAR PLATE
AS SHOWN BELOW:
W 00000 VEHICLES:
CALIFORNIA
REGISTERED OWNER R 00138 In Top Righ Carmer
ORDONEZ JOSE T L 00001
MOTORCYCLES ONLY:
CAL
Reglstration Fee: $151.00 Righl Hall of This Well
554.50
Transaction Humber. 338-840346
Credd Card Authorization Number. IMPORTANT INSTRUCTIONS ON REVERSE SIDE City of Rialto
POLICE
150 S Palm Ave
Rialto, CA 92376-6487
+1 (909) 820-2525
City of Rialto
05/23/2026 12:23PM
U04352-0003 PD24-0000103317
Payment effective date 05/23/2026
MISCELLANEOUS
Vehicle Release Fee
(629833)
2026 629833
1 @ $216.80 $216.80
Payment Id: 102102
$216.80
Subtotal $216.80
Total $216.80
POLICE CC MERCHANT $216.80
Visa ************
Ref=bedc90ca-9c02-4114-b149-3e23aca98047
Auth=067384
Change due $0.00
Paid by: jose ordonez
Thank you for your payent
CUSTOMER COPY
Arati 2129 JUN -5 AMII: 08 CITY OF RIALTO
STATE OF CALIFORNIA
DEPARTMENT OF CALIFORNIA HIGHWAY PATROL
VEHICLE REPORT
CHP 180 (Rev. 4-16) OPI 061 STORED
REPORTING DEPARTMENT SATON CODE GATE OF REPORT NO ERE PERSONNEL LET FILE NO.
RIALTO PD 3609 5 22 26 932606235
LOCATION TOWED / STOLEN FROM VIN CLEAR IN SVS? [X) YES NO DATE / TIME DISPATCH NOTIFIED 744 N CLIFFORD AVE LUNGER RENOMO LOG NO.
LIC CLEAR IN SUS (X) YES I NO S.A.A.
YEAR MAKE MODEL BODY TYPE COLOR LICENSE NO.
2002 HOND CIV •ONE MONTH/YEAR STATE
4D BLK [X TWO 10/26 CA
VEHICLE IDENTIFICATION NO. ENGINE NO. VALUATION BY • OFFICER I OWNER 1 H G C G 3 12752A 0 1 18/2 6 8
• 0-500 501-4000 4001+ •s
REGISTERED OWNER 7 E SAME AS RIO LEGAL OWNER 7
ORDONEZ. JOSE ORDONEZ. JOSE
L L.
* STORED • IMPOUNDED • RELEASED • RECOVERED - VEHICLE / COMPONENT
TOWING / STORAGE CONCERN (NAME, ADDRESS, PHONE) STORAGE AUTHORITY / REASON PEPES NORTH 22651(B) CVC
REASON FOR STOP AIRBAG?
DRIVEABLE? VIN SWITCHED?
PARKING VIOLATION
X YES • NO • YES NO • JUNK [X] UNK • YES X NO
CONDITION YES NO ITEMS YES NO ITEMS YES NO ITEMS YES NO
TIRES / WHEELS CONDITION
WRECKED X SEAT (FRONT) X REGISTRATION
X CAMPER X LEFT FRONT POOR
BURNED HULK per 431(c) CVC X SEAT (REAR) X ALT. / GENERATOR X VESSEL AS LOAD : RIGHT FRONT POOR-.
VANDALIZED RADIO X BATTERY
FIREARMS X LEFT REAR POOR
ENG. / TRANS. STRIP X TAPE DECK X DIFFERENTIAL
X OTHER X RIGHT REAR POOR
MISC. PARTS STRIP X TAPES X TRANSMISSION
* SPARE UNK
BODY METAL STRIP OTHER RADIO X AUTOMATIC HUB CAPS
NO
SURGICAL STRIP per 431(b) CVC X IGNITION KEY X MANUAL SPECIAL WHEELS NO RELEASE VEHICLE TO: X RIO OR AGENT " AGENCY HOLD 22850.3 CVC
GARAGE PRINCIPAL/ AGENT STORING VEHICLE (SIGNATURE) DATE / TIME PEPES 5 22 26
NAME OF PERSON / AGENCY AUTHORIZING RELEASE I.D. NO.
LT. RICE 5123/86 CERTIFICATION: 1, THE UNDERSIGNED, DO HEREBY CERTIFY THAT I AM LEGALLY REALTO PD 01760 AUTHORIZED AND ENTITLED TO TAKE POSSESSION OF THE ABOVE DESCRIBED VEHICLE SIGNATIIRF AF PERRIN ALTHARIZING REI FACE SIGNATURe OF/PERSON TAKING POSSESSION - • STOLEN VEHICLE / COMPONENT EMBEZZLED VEHICLE
• PLATE(S) REPORT
DATE / TIME OF OCCURRENCE DATE / TIME REPORTED NAME OF REPORTING PARTY (R/P) DRIVER LICENSE NO. / STATE
LAST DRIVER OF VEHICLE DATE / TIME ADDRESS OF RIP
TELEPHONE OF RI
SIGNATURE OF PERSON MAKING REPORT
-0 A1
s-
REMARKS
[LIST PROPERTY, TOOLS, VEHICLE DAMAGE, ARRESTS) 20
DRIVER'S NAME ARRESTED / SECTION? REPORTED BY CARGO / TYPE?
VALUES -
•YES IX NO • YES • NO ] BILL OF LADING ATTACHED
UNKNOWN PERSONAL ITEMS
00=00
FRONT LEFT SIDE RIGHT SIDE
REAR
SIGNATURE OF OFFICER TAKING REPORT I.D. NO. SUPERVISOR TOP SUMMERFIELD 02803 REQUIRED NOTICES SENT TO REGISTERED
KB AND LEGAL OWNERS PER 22852
Invoice
Pepe's Towing Service Impound Receipt
PEPES TOWING SERVICE PO Box 7450, Moreno Valley CA 92552 Printed 5/23/2026 14351 VETERANS WAY Phone: (951) 682-5682 | Fax: (951) 682-5030 Moreno Valley CA 12553 951-653-2423
tiburcio 668 n verde ave rialto ca 92376 Phone: 3228162908 26-0522-81785 Reason for Impound 22651-B BLOCKING HIGHWAY 15:22 81785 VIN Number
05/23/2026 Model 2002 Honda Accord (Black)
Sale 932606235
Batch:98 RIALTO PD License Plate
Transo CHIF Drivable No
VISA **/*• 5/22/2026 1:38 PM
• 5037
********* $52.50 5/22/2026 1:38 PM Keys No
AMOUNT: APPROVAL 5/22/2026 1:49 PM Towed from 744 N Clifford Ave, Rialto, CA 92376, USA Resp: 162223 5/22/2026 2:11 PM Stored at Rialto Yard
Code: 614315680487 2775 N Locust, Rialto CA 92377
Ref#: VISA DEBIT 5/22/2026 2:38 PM
All Mane: 40000000031010 Manuel V
8080008000
6800 TRK 54
TSI: 5/23/2026 3:15 PM
Cardholder acknorledges 2 days
receipt of goods and
obligations set forth
• by the cardholder's
agreement with issuer.
Quantity Price Line Total
CUSTOMER COPY $154.00
Thank You : Daily Impound Rate 2 $77.00
Poser ed By ValorPay(v3.0.16) 1 $192.50 $192.50
(Ste
Towing Quantity Price Line Total
1(1h) $385.00 $385.00
(Towing) i per hour)
1 $121.00 $121.00
(Towing) Admin Fee
Towing SubTotal $506.00
Storage SubTotal $192.50
Storage - Storage Fees SubTotal $154.00
Subtotal $852.50
Taxes $0.00
Grand Total $852.50
Amount Due: $0.00 / Paid
Cash payment (Ref # cash) of $800.00 applied on 5/23/2026 Debit payment (Ref # 162223) of $52.50 applied an 5/23/2026 →A
All towing services sales are final at time of payment. By authorizing payment, you agree to the following terms:
Vo Cancellations/Changes: Once service is dispatched or rendered, payments cannot be canceled or modified.
Vo Refunds: All fees (towing, recovery, storage, etc.) are non-refundable. = lo Chargebacks: Disputing valid charges may lead to additional fees y proceeding with payment, you confirm acceptance of these term epe's Towing Service appreciates your business; if you have any questions regarding this invoice, please contact us at 951-682-5682. Thank you.
Jamage Disclaimer:
Have been advised that my vehicle may be damaged if winched, towed, unlocked, jump started, tire changed or left on unattended premises. I recognize the difficulty involvec ind l agree not to hold Pepe's Towing Service responsible for such damages should it result. I, the undersigned do hereby certify that I am legally authorized and entitled to take sossession of the vehicle described and all personal property therein. I have received the vehicle and all personal property in satisfactory condition.
Signature: Date:
CA# 117433 USDOT: 1005094
Upon request, you are entitled to receive a copy of the Towing and Storage Fees and Access Notice https://app.towbook.com/impounds/lmpound?id=28297524#Releasee 1/1