CITY OF RIALTO CITY CLERK'S DATE STAMP
LIABILITY
CITY OF RIALTO
CLAIM FOR DAMAGES
TO PERSON OR PROPERTY 2929 JUL - 7 PNI2: 07
1. Claims for death, injury to person, or to personal proporty must be filed not later than six (6) months after the occurrence (Gov. Cada §9112)?)TY CULA
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:
Michall paul Muñoz
FULL NAME DATE OF BIRTH
- t
HOME ADDRESS INCLUDING CITY, STATE & ZIP HOME TELEPHONE NO.
BUSINESS ADDRESS INCLUDING CITY, STATE & ZIP BUSINESS TELEPHONE NO. 335 centennial way
ADDRESS AT WHICH CLAIMANT DESIRES TO RECEIVE
NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM
(if different from home address provided above): TUSTIn, CA 12700
1. WHEN DID DAMAGE OR INJURY OCCUR DATE: 04-08-2024 • TIME: 4:00
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.
MiChaU NO TUM Wetboung on More wa and was gang to mare a left to _ go vainbana on Mape Ave when sudden unar anver facin northbound on Maple blew the stop sign and conded mto the driver die of Michan vehicle.
3. HOW DID DAMAGE OR INJURY OCCUR?
your employee ran a stop sign
4. WERE POLICE AT THE SCENE? & YES I NO WERE AT AT THE SCENE? YES ENO
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.
PLEASE SUE ATTROOD *
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: Amount: $
Item/Date: Amount: $
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: $.
ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN:
Item/Date: - SRECIAL DAMAGES Amount: $_ W EXCESS OF $55,000 Item/Date: _ GENERAL DANGES Amount $ JN EXOSS DE $50,000 TOTAL ESTIMATED AMOUNT PROSPECTIVE DAMAGES: $ IN EXCES 0€ $ 35,000
7. WITNESSES TO DAMAGE OR INJURY List all persons known to have information (attach additional pages, if necessary) NAME: nope.
ADDRESS: ADDRESS:
TELEPHONE: L TELEPHONE: L
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITALS) VISITED:
NAME: Karel NAME:
ADDRESS: 99uel serra Ave ADDRESS:
Fontana, Ct 92335
TELEPHONE: 1.._ TELEPHONE: (.)
DATE: TIME: DAM 0PM DATE: TIME:
9. PLEASE READ THE FOLLOWING CAREFULLY:
Fer all vehicle accident claims, place on the following diagram, the nares 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. a city/town vehicle was involved, designate by letter "A" location of the City/Town vellicle when you first saw it, and by "B" location of yourself or your vehi en you first saw City/Town vehicle; locallon of City/Town vehicle at time of accident by "A-1" and location of yourself or your vehicle at the time of 1 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
Stop PARKWAY
SIDEWALK
- 7
/ /
*CERTIFY (OR DECLAREYUNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
SIGNATURE OF CLAIMANT OR AGENT Y
THAN YSAIS, tsa. 01623/2026
TYPE OR PRINT NAME
HASH TORNIEL
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
CITY OF RIALT
Claimant: MICHAEL PAUL MUNOZ
*125 JUL - 7 P. 12: 06
D.O.L.:
EUL
CITY CLEME
WHAT PARTICULAR ACT OR OMISSION DO YOU CLAIM CAUSED THE INURY OR DAMAGES? Give the name of the city/town employee causing the injury or damage, if known.
The subject incident was caused by Connie Nicole Sanchez (hereinafter, "EMPLOYEE"), while in the course and scope of their employment with the Rialto City Police Department (hereinatter, "CITY"), and while operating a public, city police vehicle CITY.
CITY is responsible, as follows: Government Code $820 (Liability of Public Employee, which states liability for injury caused by a public employee's acts or omissions), Vehicle Code §17001 (liability of public entity for injury to person or property caused by a negligence in the operation of any motor vehicle by an employee of the public entity acting within the scope of his employment), and Government Code §815.2 (Liability of Public Entities, a public entity is liable for injury proximately caused by an act of an employee of the public entity within the scope of his employment...). As such, CITY is liable to Claimant for all personal physical and mental injuries to Claimant caused by EMPLOYEE during the course and scope of her employment with CITY.
ORIGIN ID: DTHA (714) 672-0899 SHIP DATE: 06JUL26
THOMAS MURPHY. ESQ. ACTWGT: 0.10 LE
THOMAS MURPHY LAW GROUP, APC CAD: 105546730/NET453
335 CENTENNIAL WAY
TUSTIN, CA 92780 BILL SENDER
UNITED STATES US
TO RIALTO CITY CLERK'S OFFICE
290 WEST RIALTO AVE 58KJ2/DC4A/484B
RIALTO CA 92376
(714) 705-4789 REF: MICHAEL MUNOZ/DOL 04-08-26
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