Inesign Document ID: 254YCL/4-B5L4-4938-A51/-CbC216HA1650
CITY CLERK'S DATE STAMP
CITY OF RIALTO
LIABILITY CITY OF RIALTO
CLAIM FOR DAMAGES 7015 JUN 24 AMIO: 50
TO PERSON OR PROPERTY RECEIVE
CITY CLER*
1. Claims for death, injury to person, or to personal property must be filed not later than six (f) 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 §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:
Cody James Hicks, a Minor (Mother/Guardian Jennifer Hicks)
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 c/o Carlos Urzua, Esq. - AlderLaw, P.C., 12800 Riverside Drive, 2nd Floor
NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM
(if different from home address provided above): Valley Village, CA 91607 | Tel: (310)275-9131
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE: April 22, 2026 TIME: 1:50 (approx.) D AM X 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.
Carter High School, PE Class/Gymnasium Area, 6891 Magnolia Ave., Rialto, CA 92376 Incident occurred during 6th period PE class at approximately 1:50 pm
3. HOW DID DAMAGE OR INJURY OCCUR?
See Exhibit A attached hereto.
4. WERE POLICE AT THE SCENE? AYES• NO WERE PARAMEDICS AT THE SCENE? •YES ZNO
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.
See Exhibit A attached hereto.
6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage $ To be determined HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE:
Emergency medical treatment - CH Pediatric Emergency Dept. - 04/22/2026 Amount: $_TBD Item/Date:
Item/Date: Mental and emotional anguish. Amount: $_TBD
he signed document can be validated at https://app.vinesign.com/erify TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: $ To be determined ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN:
Item/Date: Future medical treatment, therapy, and related care (ongoing symptoms) Amount: $_TBD Item/Date: Amount: $
TOTAL ESTIMATED AMOUNT PROSPECTIVE DAMAGES: $ TBD
7. WITNESSES TO DAMAGE OR INJURY List all persons known to have information (attach additional pages, if necessary) NAME: Jennifer Hicks Mother/Guardian) NAME: Carter H.S. Students/Staff - See Attached ADDRESS. ADDRESS: Carter High School, 6891 Magnolia Avenue, Rialto, CA 92376 TELEPHONE: ( 909) 904-1634 TELEPHONE: L
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITAL(S) VISITED:
NAME: CH Pediatric Emergency Dept. / Dr. A. Torres, MD NAME: Dr. C. Walsh Lang, MD ADDRESS: 11234 Anderson St., Loma Linda, CA 92354 ADDRESS: Same facility as left TELEPHONE: ( 909) 558-4444 TELEPHONE: | )
DATE: 04122/2026 TIME: ~9:25 • AM XPM DATE: TIME: • AM IPM
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.
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.
JUN 24 ITY OF RIALTO
CLERN
CURB
AM 10; 50
PARKWAY
7/F SIDEWALK
I CERTIFY (OR DECLARE) UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
SIGNATURE OF CLAIMANT OR AGENT
Jennifer Hicks (Mother/Guardian for Cody James Hicks) June 18, 2026
TYPE OR PRINT NAME DATE
Mother/Guardian
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
EXHIBIT A
CITY OF RIALTO LIABILITY CLAIM FOR DAMAGES
Cody James Hicks, a Minor (Guardian/Mother: Jennifer Hicks) June 18, 2026
EXHIBIT A
CITY OF RIALTO LIABILITY CLAIM FOR DAMAGES
No. 3.
On April 22, 2026 at approx. 1:50 PM, claimant
special education student with an IEP enrolled at Carter High School in Rialto, CA, was violently assaulted by approximately 10-20 fellow students during PE class while no teacher was present.
A video shows approximately, 4-10 students actively struck claimant; claimant did not fight ack. 11 students were cited by Rialto PD. Claimant sustained facial lacerations, ear injuries emporary hearing loss, and head trauma requiring CT scan. Claimant also suffers from sever mental and emotional anguish. Claimant's injuries are ongoing.
No. 5.
The school, including PE teacher and other staff were absent, failed to protect a special education student (IEP holder). The school failed to provide adequate medical care. Admin downplayed assault. Employees: unnamed PE teacher; Dr. Mendez (Principal); Principal Carol; Dr. Davis; SRO Officer Dan (Rialto Police Department).
Specific causes of action against Rialto Unified School District include but are not limited to the following:
• Breach of Mandatory Duty (Gov. Code § 815.6 / Ed. Code § 44807) • Negligence
• Negligent Supervision
Negligent Hiring/Training/Retention 2029
• Negligent Infliction of Emotional Distress
JUN 24
• Dangerous Condition of Public Property (Gov. Code § 835) Cubit CITY OF RIALTO
• Violation of IEP / Failure to Provide FAPE
Specific causes of action against City of Rialto (SRO Officer Dan) include but are nos limited to the following:
• Negligence / Failure to Intervene
CERTIFIED MAIL®
TALDERLAWI FLARITA CA 913
quadient
12800 Riverside Drive
1026 PM 3 FIRST-CLASS MAIL
2nd Floor
IME US POSTAGE
Valley Village, CA 91607 $006.04°
9589 0710 5270 3705 3880 43 06/19/2026 ZIP 91607
043M31255314
Rialto City Clerk's Office
150 S. Palm Avenue
CITY OF Rialto, CA 92376
92378-648799