CITY CLERK'S DATE STAMP
CITY OF RIALTO
LIABILITY
CITY OF RIALTO
CLAIM FOR DAMAGES
TO PERSON OR PROPERTY 2026 AUG |/ AMIO: 38
RECEIVED
1. Claims for death, jury to person, or to personal property must be filed not later than six (6) months after the occurrence (Gov. Code SgiFa.TY CLERK
2. Claims for damages to real property must be filed not later than one (1) year after the occurrence (Gov. Code 5911.2). RETURNTO: :
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:
jinia Campos Martinez
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
NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM
(if different from home address provided above):
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE: _05/27/26 TIME: 08:40 am DAM DIPM
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.
Slover and date Ave Latitude -34,063438 - Longitude -11,7.367940
3. HOW DID DAMAGE OR INJURY OCCUR?
Rialto City Worker ArKan Issa Abdo was turning left on to Date Ave He was drivingaround 5mph Then made a Complete stop lenving my vehicle
4. WERE POLICE AT THE SCENE? EYES NO WERE PARAMEDICS AT THE SCENE? YES 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.
Enterpise Imtrust LSR City of Rialto LSE City Work name Arkan Issu Abdo failed to use rearview mirror or even look aver his shoudler when trying to reverse his Vehicle
6. GIVE TOTAL AMOUNT.OF CLAIM Include estimate of amount of any prospective injury or damage $ 8,069.81 HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE:
Item/Date: 05/21/2026 2017 Honda Accord Amount: $ 8.069.87 Item/Date: Amount: $
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: $ ESTIMATED PROSPECTVE DAMAGES, AS FAR AS KNOWN:
Item/Date: Amount: $_
Amount: $
Item/Date:
TOTAL ESTIMATED AMOUNT PROSPECTIVE DAMAGES: $
7. WITNESSES TO DAMAGE OR INJURY List all persons known to have information (attach additional pages, if necessary) NAME: Luis Bonitacio Albarren: NAME:
ADDRESS: 150 = Plam are Rialto CA ADDRESS:
92376 USA
TELEPHONE:...... TELEPHONE: L 1
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITAL(S) VISITED:
NAME: NAME:
ADDRESS: ADDRESS:
TELEPHONE: L 1 TELEPHONE: | 1
DATE: TIME: • AM PM DATE: TIME: • A 0PM
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. → 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 r. nICERTIFY (OR DECLARE) UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
SIGNATURE OF CLAIMANT OR AGENT
8 1126
Ijinia Campos
TYPE OR PRINT NAME DATE
RELATIONSHIP TO CLAIMANT
NOTE: PRESENTATION OF A FALSE CLAIM IS A FELONY (CAPENAL CODE 72) RETURN CLAIM TO: RIALTO CITY CLERK'S OFFICE - 150 S. PALM AVE., RIALTO, CA 92376 •
3) Rialto City Worker Arkan Issa Abdo
- Was turning left on to Date Ave
- Hewas driving around 5 mph Then Made
- a Complete Stop leaving my Vehicle
-in the middle of the Intersection
= between Date eve and slever aver
- The driver Proceed to put the Vehicle
- in reverse failed to check his mirrors
or look aver his shoulder to see behind
- him, I sound my horer to notiFy the
- the Driver of my presence behind him
- the Driver didn't hear the hore and
- Ultimately Struck the front of My
- Vehicle
5)Enterpise Fm trust LSR City of Rialto
LSECity Work name Arkan Issa Abdo
- Failed to use rearview mirror or even
- look over his shoudler when trying te
- reverse his Vehicle
STATE OF CALIFORNIA
DEPARTMENT OF CALIFORNIA HIGHWAY PATROL Page 1 of 6
TRA PARASION REPORT
SPECIAL CONDITIONS UMBEL HIT & RUN CITY JUDICIAL DISTRICT LOCAL REPORT NUMBER
JURE FELONY
RIALTO Fontana Superior Court 932606498
NUMBER HIT & RUN COUNTY REPORTING DISTRICT BEAT DAY OF WEEK [TOWAWAY KILLED MISD.
SAN BERNARDINO 193 4 Wednesday
COLLISION OCCURRED ON DAY YEAR TIME (2400) INCIC # OFFICER I.D.
DATE AVE 05/27/2026 0849 3609 02557
MILEPOST INFORMATION I GPS COORDINATES PHOTOGRAPHS BY • NONE 20-100S FEET LONGITUDE -117.367940
OF LATITUDE 34.063438
1826
• AT INTERSECTION WITH STATE HWY REL R. ZEPEDA
• OR 33 FEET NORTH OF SLOVER AVE •
PARTY DRIVER'S LICENSE NUMBER STATE, CLASS AIR BAG SAFETY EQUIP. VEH. YEAR MAKE / MODEL / COLOR LICENSE NUMBER 1 A1895141 CA A G Ford RANGER WHITE - 1028216
..$
DRIVER NAME (FIRST, MIDDLE, LAST)
X ARKAN ISSA ABDO OWNER'S NAME • SAME AS DRIVER
PEDES- STREET ADDRESS
TRIAN
150S. PALM AVE OWNER'S ADDRESS
PARKED CITY / STATE / ZIF 9315 OLIVE BLD SAINT LUIS MO 63132
VEHICLE
RIALTO / CA 92376 DISPOSITION OF VEHICLE ON ORDERS OF: OFFICER DRIVER • OTHER BICY: SEX HAIR HEIGHT RACE
EYES WEIGHT BIRTH DATE Drivable
CLIST
M BLK GRN 511 210 01/27/1972 PRIOR MECHANICAL DEFECTS: • NONE APPARENT • REFER TO NARRATIVE OTHER HOME PHONE SUSINESS PHONE VEHICLE IDENTIFICATION NUMBER: 1FTER1EH3NLD39910 (909) 437-2764 (909) 820-2602 VEHICLE TYPE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGE AREA INSURANCE CARRIER POLICY NUMBER • UNK. • NONE X MINOR
22 SELF INSURED • MOD. • MAJOR O ROLL-OVER
DIR OF TON STREET OR HIGHWAY [SPEED LIMIT CA DOT
TRAVEL
NORTH DATE AVE 25 CAL-T TCP/PSC MC/MX
PARTY DRIVER'S LICENSE NUMBER STATE CLASS AIR BAG SAFETY EQUIP (VEH. YEAR MAKE / MODEL/COLOR LICENSE NUMBER STATE 2 Y3771988 cA M 2017 HONDA ACCORD GRAY 9GPK579 GA
DRIVER NAME (FIRST, MIDDLE, LAST)
IJINIA CAMPOS MARTINEZ OWNER'S NAME • SAME AS DRIVER
PEDES I STREET ADDRESS LULA CAMPOS MARTER
11065 SPRUCE AVE OWNER'S ADDRE • SAME AS DRIVER
PARKED CITY/STATE / ZIP 11065 SPRUCE AVE BLOOMINGTION, CA 92316 VEHICL
BLOOMINGTION CA 92316 DISPOSITION OF VEHICLE ON ORDERS OF: OFFICER X DRIVER • OTHER BICY- I SEX | HAIR ¡EYES HEIGHT WEIGHT BIRTH DATE RACE
CLIST
F BRO BRO 510 220 11/20/1999 H PRIOR MECHANICAL DEFECTS: X NONE APPARENT • REFER TO NARRATIVE OTHER HOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER: 1HGCR2F18HA115872 (323) 944-8864 (909) 437-2764 VEHICLE TYPE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGE AREA INSURANCE CARRIER POLICY NUMBER • UNK. • NONE • MINOR
01 ADRIANA INSURANCE SERVICES 1PGACA1901447351-03 • MOD. • MAJOR • ROLL-OVER
DIR OF ON STREET OR HIGHWAY SPEED LIMIT
CA DOT
TRAVEL
NORTH DATE 25 CAL-T TCPIPSC
PARTY DRIVER'S LICENSE NUMBER ¡STATE clASS (AIR BAG SAFETY EQUIP. VEH. YEAR MAKE / MODEL / COLOR LICENSE NUMBER STATE 3 DRIVER NAME (FIRST, MIDDLE, LAST)
OWNER'S NAME • SAME AS DRIVER
PEDES. STREET ADDRESS
TRIAN
• SAME AS DRIVER
PARKED CITY / STATE / ZIP
VEHICLE
DISPOSITION OF VEHICLE ON ORDERS OF: OFFICER • OTHER
BICY- SEX |HAIR EYES ] HEIGHT WEIGHT BIRTH DATE RACE
CLIST
PRIOR MECHANICAL DEFECTS: •I NONE APPARENT • REFER TO NARRATIVE OTHER HOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER:
VEHICLE TYPE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGE AREA INSURANCE CARRIER POLICY NUMBER O UNK. O NONE O MINOR
• MOD. O MAJOR D ROLL-OVER
SIR OF TON STREET OR HIGHWAY [SPEED UMIT DoT Controlled Copy
RAVEL CA
CAL-T TCP/PSC Comfidential Copv
PREPARER'S NAME DISPATCH NOTIFIED REVIEWER'S NAME
Restricted PC 10442WF 143
ZEPEDA, RUDY D2557 Yes • No X NIA BREEN, JUSTIN 01023
Not For Third Party Release
The Rialto P.D.
REL TO: MRB 06/10/2026
STATE OF CALIFORNIA
DEPARTMENT OF CALIFORNIA HIGHWAY PATROL
TRAFFIC COLLISION CODING Page 2 of 6
CHP 555 Page 2 (Rev. 4-11) OP| 060
DATE OF COLLISION (MO. DAY. YEAR) TIME (2400) NCIC # OFFICER I.D. NUMBER 05/27/2026 0849 3609 02557 932606498
OWNER'S NAME OWNER'S ADDRESS "NOTIFIED
: • YES O NO
PROPERTY DAMAGE
DESCRIPTION OF DAMAGE
SEATING POSITION SAFETY EQUIPMENT AIR BAC INATTENTION CODES OCCUPANTS HILD RESTRAIN 3 - UNKNOWN - CELLPHONE HANDHELI A - NONE IN VEHICLE. - IN VEHICLE USE 3 - CELLPHONE HANDSFREI 8 - UNKNOWN R - IN VEHICLE NOT USED
C - LAP BELT USED - IN VEHICLE MRS OREOURED
D - LAP BELT NOT USED
2 TOB- PASSENGERS DRIVER E - SHOULDER HARNESS USED U - NONE IN VEHICLE EJECTED FROM VEHICL - - EATINC 1 2 3 F - SHOULDER HARNESS NOT USE G- CHILDREN
5 6 7 - STATION WAGON REA G - LAP/SHOULDER HARNESS USE - NOT EJECTE ANIMA 8- REAR OCC. TRK OR VAR- LAP/SHOULDER HARNESSNST USE DRICERCYCLESSENGER - FULLY EJECTE PERSONAL HYGIE 9 - POSITION UNKNOWN J - PASSIVE RESTRAINT USED V - NO X- NO J- READIN 7 0 - OTHER - PASSIVE RESTRAINT NOY USE W - YES Y-YES < - OTHEI • - NOT REQUIRED
ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK (*) SHOULD BE EXPLAINED IN THE NARRATIVE PRIMARY COLLISION FACTOR 2 3 SPECIAL INFORMATION 1 | 2 3 MOVEMENT PRECEDING
TRAFFIC CONTROL DEVICES
LIST NUMBER (# OF PARTY AT FAULT COLLISION
1 A VSECTION VIOLATED X A CONTROLS FUNCTIONING A HAZARDOUS MATERIAL x A STOPPED 22106 B CONTROLS NOT FUNCTIONING* B CELL PHONE HANDHELD IN USE B PROCEEDING STRAIGHT OTHER IMPROPER DRIVING: C CONTROLS OBSCURED C CELL PHONE HANDSFREE IN USE C RAN OFF ROAD B
D NO CONTROLS PRESENT/FACTOR* XX D CELL PHONE NOT IN USE D MAKING RIGHT TURN OTHER THAN DRIVER• TYPE OF COLLISION E SCHOOL BUS RELATED E MAKING LEFT TURN D UNKNOWN" A HEAD - ON F 75 FT MOTORTRUCK COMBO F MAKING U TURN SIDESWIPE G 32 FT TRAILER COMBO G BACKING
REAR END H SLOWING / STOPPING
WEATHER (MARK 1 TO 2 ITEMS) BROADSIDE I PASSING OTHER VEHICLE
A HIT OBJECT J CHANGING LANES
CLEAR
X B CLOUDY OVERTURNED K PARKING MANEUVER
RAINING G VEHICLE PEDESTRIAN L ENTERING TRAFFIC
D SNOWING H OTHER*: M OTHER UNSAFE TURNING
E FOG / VISIBILITY .FT N XING INTO OPPOSING LANE
IF OTHER*: MOTOR VEHICLE INVOLVED WITH O PARKED
G WIND A NON- COLLISION P MERGING
LIGHTING PEDESTRIAN Q TRAVELING WRONG WAY
A DAYLIGHT OTHER MOTOR VEHICLE OTHER ASSOCIATED FACTORS) R OTHER®:
MICK. AN MOTOR VEHICLE ON OTHER ROADWAY (MARK 1 TO 2 ITEMS)
DARK - STREET LIGHTS PARKED MOTOR VEHICLE CITED
A VE SECTION VIOLATON
DARK - NO STREET LIGHTS TRAIN
G BICYCLE B VOSECTION VIOLATON CITED
E DARK- • STREET LIGHTS NOT
FUNCTIONINC SOBRIETY - DRUG
- ANIMAL: aruse Frantion
ROADWAY SURFACE CHEU PHYSICAL
DRY ¡ FIXED OBJECT:
WET XX A HAD NOT BEEN DRINKING
SNOWY - ICY J OTHER OBJECT: E VISION OBSCUREMENT B HBD - UNDER INFLUENCE SLIPPERY (MUDDY, OILY, ETC.) F INATTENTION*: C HBD - NOT UNDER INFLUENCE.* G STOP & GO TRAFFIC D HBD. -IMPAIRMENT UNKNOWN."
ROACHAY CONDITONS HARK 1 TO 2 ITEMS
PEDESTRIAN'S ACTIONS H ENTERING / LEAVING RAMP E UNDER DRUG INFLUENCE* A HOLES, DEEP RUTS [A NO PEDESTRIANS INVOLVED PREVIOUS COLLISION F IMPAIRMENT - PHYSICAL• B LOOSE MATERIAL ON ROADWAY" CROSSING IN CROSSWALK J UNFAMILIAR WITH ROAD G IMPAIRMENT NOT KNOWN OBSTRUCTION ON ROADWAY• AT INTERSECTION DEFECTIVE VEH. EQUIP. H NOTAPPLICABLE K SLEEPY I FATIGUED®
E REDUCED ROADWAY WIDTH C ATINTERSECTION SWALK - NOT
F FLOODED* D CROSSING - NOT IN CROSSWALK L UNINVOLVED VEHICLE G OTHER:" E IN ROAD - INCLUDES SHOULDER M OTHER
X'H NO UNUSUAL CONDITIONS F NOTIN ROAD XX NONE APPAREN
G APPROACHING/ LEAVING SCHOOL BUS RUNAWAY VEHIC
Miscellaneous
• "See Attached Sketch"
"See Attached factual diagram"
Controlled Copy
Confidential Copy
Restricted PC 11142-11143
Not For Third Party Release
The Rialto P.D.
REL TO: MRB 06/10/2026
DEPARTMENT OF CALIFORNIA HIGHWAY PATROL
INJURED / WITNESS / PASSENGER
CHP 555 Page 3 (Rev. 4-11) OPI 060
DATE OF COLLISION (MO. DAY. YEAR) TIME (2400) NCIC # OFFICER I.D. NUMBER 05/27/2026 0849 3609 02557 932606498
EXTENT OF INJURY ("X" ONE) INJURED WAS ("X" ONE)
WITNESS ONLY AGE SEX EJECTED
FATAL SEVERE OTHER VISIBLE INJURY COMPLAINT OF DRIVER PASS PED. BICYCLIST OTHER
INJURY INJURY
49 M •
NAME / D.O.B. / ADDRESS Telephone
LUIS BONIFACIO ALBARRAN 09/07/1976 150 $ PALM AVE RIALTO CA 92376 USA 9096440655 (INJURED ONLY) TRANSPORTED BY EMS RUN NUMBER TAKEN TO
DESCRIBE INJURIES
57 F • 3 M 0
NAME / D.O.B. / ADDRESS Telephone
ANA CAMPOS MARTINEZ / 02/25/1969 11065 SPRUCE AVENUE BLOOMINGTON CA 92316 USA (323) 635-3621 (INJURED ONLY) TRANSPORTED BY EMS RUN NUMBER TAKEN TO
DESCRIBE INJURIES
NAME / D.O.B. / ADDRESS Telephone
(INJURED ONLY) TRANSPORTED BY EMS RUN NUMBER TAKENTO
DESCRIBE INJURIES
• •
NAME / D.O.B. IADDRESS Telephone
! /
(INJURED ONLY) TRANSPORTED BY EMS RUN NUMBER TAKEN TO
DESCRIBE INJURIES
• •
NAME/ D.O.B. /ADDRESS Telephone
(INJURED ONLY) TRANSPORTED BY EMS RUN NUMBER TAKEN TO
DESCRIBE INJURIES
•
NAME / D.O.B. / ADDRESS Telephone
/ I
INJURED ONLY) TRANSPORTED BY EMS RUN NUMBER TAKEN TO
DESCRIBE INJURIES
Controlled Copy
Confidential Copy
PREPARED BY TID NUMBER [NO DAY YEAR REVIEWERS NAME Restricted PC 119429M 143 ZEPEDA, RUDY 02557 02557 05/27/2026 BREEN, JUSTIN O1 Not For Third Pastelease The Rialto P.D
REL TO: MRB 06/10/2026
STATE, OF CALIFORNIA
DEPARTMENT OF CALIFORNIA HIGHWAY PATROL
SKETCH
CHP 555 Page 4 (Rev. 4-11) OPI 060
DATE OF COLLISION (MO. DAY. YEAR) TIME (2400) INCIC # OFFICER I.D. NUMBER 05/27/2026 0849 3609 02557 932606498
ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED 2085
& Date Ave
2091
S Dale Ave
LAVO Slover Ave
gogi /Map data ©2026 Imagery ©2026 Airbus
Controlled Copy
Confidential Copy
PREPARED BY ID NUMBER MO DAY YEAR REVIEWERS NAME
Restricted PC 1+0142E91143
ZEPEDA, RUDY 02557 02557 05/27/2026 BREEN, JUSTIN 01 ot For Third Paily Release The Rialto P.D.
REL TO: MRB 06/10/2026
STATE OF CALIFORNIA
• DEPARTMENT OF CALIFORNIA HIGHWAY PATROL Page 5 of 6
NARRATIVE/SUPPLEMENTAL
CHP 556 Page 4 (Rev. 4-11) OPI 060
DATE OF COLLISION (MO. DAY. YEAR) I TIME (2400) INCIC # OFFICER I.D. NUMBER 05/27/2026 0849 3609 02557 932806498
1 NOTIFICATION:
2 On 05/27/2026, I was assigned to work traffic enforcement in the city of Rialto as T5 with my Field Training 4 Officer, D. Martinez. At approximately 0902 hours, I responded to the area of Date Avenue and Slover 5 Avenue in reference to a non-injury traffic collision. I arrived on scene at approximately 0907 hours.
All times, speeds, and measurements in this investigation are approximate. 7 8 SCENE DESCRIPTION:
9 10 At the scene of this collision, Date Avenue is a northbound/southbound city street consisting of two lanes 11 with no painted lanes. The roadway is straight and level. The surface is composed primarily of asphalt. The 12 incident location was just north of Slover Avenue. Slover Avenue is an eastbound/westbound city street 13 consisting of two lanes separated by a double yellow line. The roadway is straight and level. The surface is 14 composed primarily of asphalt. See diagram.
15 16 STATEMENTS:
17 18 PARTY 1 (ABDO)
19 I contacted Abdo at the incident location. The following is a summary of his statements. 20 According to P1, he was northbound on Date Avenue when he noticed he was on the wrong street. P1 then 21 stopped his vehicle and put it in reverse. As he attempted to back up, he did not notice P2's vehicle behind 22 him. As PI reversed at approximately less than 5 miles per hour, the rear bumper of PI's vehicle collided 23 with the front of P2's vehicie.
24 25 PARTY 2 (CAMPOS MARTINEZ)
26 I contacted Campos Martinez at the scene. The following is a brief summary of her statements. 27 According to P2, she was traveling northbound on North Date Avenue from Slover Avenue when she 28 observed P1 stop in the middle of the road and put his vehicle in reverse. While P2 was at a complete stop 29 and sounded her horn, P1 continued to reverse and ultimately struck P2's vehicle in the front. 30 31 SUMMARY:
32 33 P1 was attempting to go northbound on Date when he realized he was on the wrong road. As he reversed, 34 he failed to notice P2's vehicle behind him and collided with it. 35 36 AREA OF IMPACT:
37 38 The area of impact was determined to be approximately: Controlled Copy Confidential Copy
PREPARED BY ID NUMBER MO DAY YEAR REVIEWERS NAME Restricted PC 17942-1143 ZEPEDA, RUDY 02557 02557 05/27/2026 REEN, JUSTIN 019ot For Third Parly Rolease The Rialto P.D.
REL TO: MRB 06/10/2026.
STATE OF CALIFORNIA
' DEPARTMENT OF CALIFORNIA HIGHWAY PATROL
NARRATIVE/SUPPLEMENTAL Page 6 of 6
CHP 556 Page 4 (Rev. 4-11) OPI 060
DATE OF COLLISION (MO. DAY. YEAR) TIME (2400) INCIC# OFFICER I.D. NUMBER 05/27/2026 0849 3609 02557 932606498
39 33' N/NCLP of Slover Avenue.
40 8W/ECL of Date Avenue.
41 This was determined by drivers' statements and corresponding marks in the roadways. Measurements were 42 obtained via satellite imagery.
43 44 CAUSE:
45 46 P1 is at fault for this collision by being in violation of CVC 22106, unsafe backing. 47 48 RECOMMENDATIONS:
49 50 None.
Controlled Copy
Confidential Copy
PREPARED BY ID NUMBER MO DAY YEAR REVIEWERS NAME Restricted PC 1*0142E*1143 ZEPEDA, RUDY 02557 02557 05/27/2026
REEN, JUSTIN O1Rot For Third Paroslease
The Rialto P.D.
REL TO: MRB 06/10/2026
Majestic Auto Craft Workfile ID: edf8de66
Federal ID:
861 N E STREET, San Bernardino, CA 92410 BAR: ARD
Phone: (951) 744-5778
Final Bill
RO Number: 1822
Customer: Insurance: Adjuster: CHRISTINA Estimator: HECTOR CAMPOS, IJINLA PRONTO INSURANCE Phone: (657) 600-6030 Create Date: 6/9/2026 X203079 Day
11605 SPRUCE AVE Claim: 30018097-V1
BLOOMINGTON, CA 93316
RIAL
VIN: 1HGCR2F18HA115872 Interior Color: Mileage In: Vehicle Out:
License: 9GPK579 Exterior Color: IMODERN STEEL Mileage Out:
State: CA Production Date: 11/2016 Condition: Good Job #:
Line Ver Operation Description Qty Extended Part Labor Type Paint Price $ Type
1 S01 INFORMATION LABELS
2 S01 Remove/Replace Rpl information labels 0.3 Body
3 S01 Remove/Replace AC label w/o Plug-in, w/o Hybrid 1 4.66T OEM 0.0 Body 4 S01 Remove/Replace Info label radiator cap 1 4.80T OEM 0.0 Body 5 S02 WHEELS
6 S02 Remove/Replace RT/Front Wheel, alloy 19' 1 220.00T RECOND 0.3 Body 7 502 Remove/Install RT/Front Wheel, spare 17' 0.1 Body 8 S02 TIRES
S02 Remove/Replace ROY BLACK 235/40ZR19 RACINGTRAC 1 214.04T Other 00 Body 10 S02 Sublet Tire mount & wheel balance 1 25.00 Other
11 E01 FRONT BUMPER
12 S01 Remove/Replace O/H front bumper 2.3 Body
S01 Remove/Replace Bumper cover w/o Hybrid w/o prk sensr 1 198.70T Non OEM 0.0 Body 28 14 S01 Add for Clear Coat 1.1
15 S01 Remove/Replace Add for fog lamps 0.2 Body
E01 Remove/Replace Lower molding w/o Hybrid 1 77.15T Non OEM 0.0 Body 17 E01 Remove/Replace Lower grille w/o pre-crash 1 37.11T Non OEM 0.0 Body 18 E01 Remove/Replace License frame w/o Hybrid 1 11.00T Non OEM 0.2 Body 19 S01 Remove/Install Impact bar (HSS) 0.4 Body
20 E01 GRILLE
21 E01 Remove/Replace Grille surround 1 156.00T Non OEM 0.0 Body 22 E01 Remove/Replace Grille 1 150.00T Non OEM 0.0 Body 23 E01 Remove/Replace Molding strip upper 111.00T Non OEM 0.0 Body 24 E01 Remove/Replace Emblem 103.08T OEM 0.0 Body
25 S01 Remove/Replace Reinf bracket 45.00T Non OEM 0.0 Body 26 S01 Remove/Replace Sight shield 2.4 liter 1 43.00T OEM 0.0 Body 27 S01 Remove/Replace Molding strip lower 1 48.55T Non OEM 0.0 Body 28 S01 FRONT LAMPS
fechanical, Ref = Refinish, Struc = Structura
8/5/2026 11:24:48 AM Page 1
Final Bill
RO Number: 1822
2017 HOND Accord Sedan Sport SE w/Continuously Variable Transmission 4D SED 4-2.4L Gasoline Gasoline Direct Injection MODERN STEEL 29 S01 Remove/Install RT R&I headlamp assy 0.0 Body
30 501 Remove/Install LT R&I headlamp assy 0.0 Body
31 S01 RADIATOR SUPPORT
32 S01 Refinish Components 1.6
33 S01 Remove/Replace Radiator support w/o Plug-in, w/o Hybrid 1 370.30T Non OEM 11.5 Body 0.0 w/o pre-crash
34 S01 Remove/Replace Add for auto trans 0.2 Mech
35 S01 Remove/Install Lower shield w/o Plug-in, w/o Hybrid 0.0 Body w/o 6 speed auto
36 S01 COOLING
37 S01 Remove/Replace Radiator assy Denso 1 170.10T Non OEM 0.0 Body 38 S01 AIR CONDITIONER & HEATER
39 S01 Remove/Replace Condenser 1 127.20T Non OEM 0.0 Body 40 S01 Remove/Replace AC Service evacuate & recharge 1.4 Mech 41 S01 Remove/Replace AC Service refrigerant recovery 0.4 Mech 42 E01 HOOD
43 E01 Remove/Replace Hood 2.4L (ALU) 1 570.50T Non OEM 1.5 Body 3.0 44 S01 Overlap Major Non-Adj. Panel (0.2)
45 S01 Add for Clear Coat 1.2
46 E01 Add for Underside (Complete) 1.5
47 E01 LINE ADJUSTMENT 0.2
48 S01 Remove/Install Insulator w/o Hybrid 0.0 Body
49 S01 Remove/Replace RT Hinge w/o Hybrid 1 57.13T Non OEM 0.3 Body 0.3 50 S01 Add for Clear Coat 0.1
S01 Remove/Replace LT Hinge w/o Hybrid 1 57.13T OEM 0.3 Body 0.3 S01 Add for Clear Coat 0.1
53 S01 Remove/Replace Insulator clip w/o Hybrid 12 11.76T OEM NOTE: Part included with insulator, 12 of these are required. 54 S01 Remove/Replace Seal to hood w/o Hybrid 1 45.37T OEM 0.0 Body 55 S01 FENDER
56 S01 Repair RT Fender 0.5 Body 2.2
S01 Overlap Major Adj. Panel (0.4)
58 S01 Add for Clear Coat 0.4
59 S01 Repair LT Fender 0.5 Body 2.2
60 S01 Overlap Major Adj. Panel (0.4)
61 S01 Add for Clear Coat 0.4
62 S01 ELECTRICAL
63 S01 Repair D&R Battery 0.3 Body
64 S01 VEHICLE DIAGNOSTICS
65 S01 Repair Pre-repair scan 0.5 Mech
66 S01 Repair Post-repair scan 0.5 Mech
67 E01 MISCELLANEOUS OPERATIONS
68 E01 Remove/Replace Hazardous waste removal 1 5.00 OEM 69 E01 Remove/Replace Flex additive 1 7.00T Other
70 S01 Repair Setup & measure 2.0 Frame
Mechanical, Ref = Refinish, Struc = Structural
8/5/2026 11:24:48 AM Page 2
Final Bill
RO Number: 1822
2017 HOND Accord Sedan Sport SE w/Continuously Variable Transmission 4D SED 4-2.4L Gasoline Gasoline Direct Injection MODERN STEEL 71 S01 Remove/Replace Car Cover 1 8.00T Other 0.2 Body
72 S01 Remove/Replace Color tint / color match 0.5 Body 73 S01 Repair Color sand and buff 1.0 Body
74 S01 Remove/Replace Corrosion protection 1 15.00T Other 0.3 Body 75 S01 Repair Memory function resets 0.5 Mech
76 S01 Remove/Replace Coolant 1 35.00T Non OEM
77 S01 Remove/Replace Set back wiring 1 5.00T Other 0.3 Body Estimate Totals Discount $ Markup $ Rate $ Total Hours Total $ Parts 2,896.58
Labor, Body 95.00 21.0 1,995.00
Labor, Refinish 95.00 16.4 1,558.00
Labor, Frame 145.00 2.0 290.00
Labor, Mechanical 195.00 3.5 682.50
Material, Paint 820.00
Miscellaneous 37.00
Subtotal 8,279.08
Sales Tax 325.81
Grand Total 8,604.89
Deductible (1,000.00)
Net Total 7,604.89
Estimate Version Total $
Original 3,440.34|
Supplement S01 4,629.53
Supplement S02 535.02
Insurance Total $: 7,604.89
Received from Insurance $: 2,440.34
PRONTO INSURANCE 8/05/2026 2,440.34
Balance due from Insurance $: 5,164.55
Customer Total $: 1,000.00
Received from Customer $: 1,000.00
CAMPOS, IJINLA 8/05/2026 1,000.00
Balance due from Customer $: 0.00
AKNOWLEDGEMENT OF NOTICE AND CONSENT:
I hereby acknowledge notice and verbal approval of the change in the original estimated price.
Signature:_ Date: _/
LIFETIME WARRANTY:
Certified Auto, (Certified) warrants against defects in material and workmanship for as long as the original customer owns the vehicle.
New OEM parts and New Non-OEM parts are covered under the manufacturer's warranty for the conditions and time set by the manufacturer. There is T = Taxable Item, RPD = Related Prior Damage, AA = Appearance Allowance, UPD = Unrelated Prior Damage, PDR = Paintless Dent Repair, A/M = Aftermarket, Rechr = Rechromed, Reman = Remanufactured, OEM = New Original Equipment Manufacturer, Recor = Re-cored, RECOND = Reconditioned, LKQ = Like Kind Quality or Used, Diag = Diagnostic, Elec = Electrical, Mech = Mechanical, Ref = Refinish, Struc = Structural
8/5/2026 11:24:48 AM Page 3
Final Bill
. RO Number: 1822
2017 HOND Accord Sedan Sport SE w/Continuously Variable Transmission 4D SED 4-2.4L Gasoline Gasoline Direct Injection IMODERN STEEL no warranty on rust repairs, reconditioned, or used parts.
This warranty shall only apply if the defects occurred under normal driving conditions and not where any vehicles has been subjected to accidents, negligence, abuse or misuse.
This is a fragmented four part Written Warranty and specific additional stipulations pertaining to each fragmented part are hereafter.:
1. METALWORK: Certified provides a Written Warranty against defective workmanship to include welding and the applications of materials utilized in making collision repairs against cracking, flaking, pitting or deterioration.
The Shop at it's sole option, repair and re-paint any metal work warranted hereby.
2. PAINTING, STRIPES AND DECALS: Certified provides a written warranty on painting-related priming and painting work against solvent blistering, peeling, hazing and excessive loss of pigmentation and a written warranty on the application and adhesion of decorative stripes and decals, excluding defects caused by extreme environmental conditions to which the vehicle maybe exposed. The Shop will, at its sole option, re prime, re-paint, re-stripe or re-decal the specific section or sections of the vehicle warranted hereby.
Paint Warranty is valid only when paint applied over original factory finishes that are free of defect.
3. MECHANICAL REPAIRS: Certified provides a written warranty on all mechanical repair pertaining directly to original collision damage, including suspension, air conditioning or other electrical assemblies or components.
The Shop will, at its own sole option, re-repair any mechanical assembly or component warranted hereby.
4. PARTS: Certified quarantees that parts or materials used are of the first quality. Those parts or materials are subject to guarantee of that supplier. We will assist you in handling any claim under the supplier's guarantee.
We guarantee that used parts or other than original equipment manufactured parts were not used without authorization from you as noted on the Repair Order.
SPECIFICALLY EXCLUDED are incidental costs, such as towing fees, car rental charges, travel expenses nor are consequential damages such as damage to other assemblies and components resulting from defective part or installation of such part installed or repaired during the repair included in this WRITTEN WARRANTY.
Acknowledgement and acceptance of vehicle:
Authorized Signature of Owner or Agent
Date
T = Taxable Item, RPD = Related Prior Damage, AA = Appearance Allowance, UPD = Unrelated Prior Damage, PDR = Paintless Dent Repair, A/M = Aftermarket, Rechr = Rechromed, Reman = Remanufactured, OEM = New Original Equipment Manufacturer, Recor = Re-cored, RECOND = Reconditioned, LKQ = Like Kind Quality or Used, Diag = Diagnostic, Elec = Electrical, Mech = Mechanical, Ref = Refinish, Struc = Structural
8/5/2026 11:24:48 AM Page 4
PRONTO INSURANCE
PCAS
[email protected]
CITY OF RIALTO
P.O. Box 8128
Newport Beach, CA 92658 2026 AUG |1 AMIO: 38
Phone: (949) 851-6362 30018097-V1
Fax: (949) 851-9694 9429d808
TY CLERI
Supplement of Record 1 Summary
Written By: ANGEL CERVANTES, License Number: 462415, 6/12/2026 4:02:59 PM Adjuster: STANNARD, CHRISTINA, (999) 999-9999 Business
Insured: Ijinia Campos Owner Policy #: Claim #: 30018097-V1 Martinez
Type of Loss: Collision Date of Loss: 05/27/2026 12:00 AM Days to Repair: 0 Point of Impact: 12 Front Deductible: 1000.00
Owner (Insured): Inspection Location: Appraiser Information: Repair Facility:
Ijinia Campos Martinez 11065 Spruce Ave. [email protected] Majestic Auto Craft 11065 Spruce Ave. Bloomington, CA 92316-3223 (657) 356-0415 861 NE STREET Bloomington, CA 92316-3223 Desk San Bernardino, CA 92410 (323) 944-8864 Cellular (951) 744-5778 Business
[email protected]
VEHICLE
2017 HOND Accord Sedan Sport SE w/Continuously Variable Transmission 4D SED 4-2.4L Gasoline Gasoline Direct Injection Grey VIN: 1HGCR2F18HA115872 Production Date: 11/2016 Interior Color: unk License: 9GPK579 Odometer: 12000 Exterior Color: Grey
State: CA Condition:
TRANSMISSION CONVENIENCE AM Radio SEATS
Automatic Transmission Air Conditioning FM Radio Bucket Seats POWER Intermittent Wipers Stereo Reclining/Lounge Seats Power Steering Tilt Wheel Search/Seek Leather Seats
Power Brakes Cruise Control CD Player Heated Seats
Power Windows Rear Defogger Auxiliary Audio Connection WHEELS Power Locks Keyless Entry SAFETY Aluminum/Alloy Wheels
Power Mirrors Alarm Drivers Side Air Bag PAINT
Power Driver Seat Message Center Passenger Air Bag Clear Coat Paint DECOR Steering Wheel Touch Controls Anti-Lock Brakes (4) OTHER Dual Mirrors Telescopic Wheel 4 Wheel Disc Brakes Fog Lamps Tinted Glass Climate Control Front Side Impact Air Bags Traction Control Console/Storage Backup Camera Head/Curtain Air Bags Stability Control Overhead Console RADIO Hands Free Device Rear Spoiler
6/12/2026 4:03:00 PM 462415 | 2.0.05.04170 Page 1
Claim #: 30018097-V1
Workfile ID: 9429d808
Supplement of Record 1 Summary
2017 HOND Accord Sedan Sport SE w/Continuously Variable Transmission 4D SED 4-2.4L Gasoline Gasoline Direct Injection Grey Line Oper Description Part Number Qty Extended Labor Paint Price $
1 # Rpr >>DESK REVIEW<<
2 INFORMATION LABELS
S01 Rpl information labels 0.3
4 S01 Repl AC label w/o Plug-in, w/o Hybrid 80050T2FH00 1 4.66 Incl. 5 S01 Repl Info label radiator cap 19046RAAA00 1 4.80 Incl. 6 S01 Repl Emission label SEE FOOTNOTE 1 Inci.
FRONT BUMPER
8 S01 O/H front bumper 2.3
** Repl A/M CAPA Lower molding w/o P892241 1 77.15 Incl.
Hybrid
10 ** Repl A/M CAPA Lower grille wo P15630 1 37.11 Incl pre-crash
11 ** Repl A/M License frame w/o Hybrid HO1068125 1 11.00 0.2 12 ** S01 Repl A/M CAPA Bumper cover w/o P894741 1 198.70 Incl 2.8 Hybrid w/o prk sensr
13 S01 Add for Clear Coat 1.1
14 S01 Add for fog lamps 0.2
15 S01 • R&I Impact bar (HSS) 71130T2FA00ZZ 0.4
NOTE: no visible damage
16 GRILLE
17 ** Repl A/M CAPA Grille surround H01210148C 1 156.00 Incl. 18 ** Repl AIM CAPA Grille HO1200229PP 1 150.00 Incl.
19 ** Repl A/M CAPA Molding strip upper HO1217109C 1 111.00 Incl. 20 Repl Emblem 75700TA0A00 1 103.08 Incl.
** S01 Repl A/M Reinf bracket H01207113 1 45.00 Inci.
22 ** S01 Repl A/M CAPA Sight shield 2.4 liter H01224115C 1 43.00 Incl. 23 ** S01 Repl A/M CAPA Molding strip lower P11020 1 48.55 Incl 24 FRONT LAMPS
25 S01 R&I RT R&I headlamp assy 33100T2AA61 Incl.
26 S01 R&I LT R&I headlamp assy 33150T2AA61 Incl
27 RADIATOR SUPPORT
28 S01 Refinish Components 1.6
29 ** S01 Repl A/M CAPA Radiator support w/o P893701 1 370.30 11.5 Incl.
Plug-in, w/o Hybrid w/o pre-crash
30 S01 Add for auto trans m 0.2 M
31 S01 R&I Lower shield w/o Plug-in, w/o 74110T2FA01 Incl.
Hybrid w/o 6 speed auto
32 COOLING
33 ** S01 Repl A/M Radiator assy Denso PR13363KA 1 170.10 m Incl. 34 AIR CONDITIONER & HEATER
35 ** S01 Repl A/M Condenser PC4165 1 127.20 m Incl.
36 S01 AC Service evacuate & recharge m 1.4 M
37 S01 AC Service refrigerant recovery m 0.4 M
6/12/2026 4:03:00 PM 462415 | 2.0.05.04170 Page 2
Claim #: 30018097-V1
Workfile ID: 9429d808
Supplement of Record 1 Summary
2017 HOND Accord Sedan Sport SE w/Continuously Variable Transmission 4D SED 4-2.4L Gasoline Gasoline Direct Injection Grey 38 HOOD
39 ** Repl A/M CAPA Hood 2.4L (ALU) P895741 1 570.50 1.5 3.0 40 Add for Clear Coat 1.2
41 Add for Underside(Complete) 1.5
42 S01 R&] Insulator w/o Hybrid 74141T2FA00 Incl.
43 ** S01 Rep| A/M RT Hinge w/o Hybrid P20781 57.13 0.3 0.3 44 S01 Add for Clear Coat 0.1
45 ** S01 Repl A/M LT Hinge w/o Hybrid P20782 1 57.13 0.3 0.3 46 S01 Add for Clear Coat 0.1
47 S01 Repl Insulator clip w/o Hybrid 91501SWA003 12 11.76 48 S01 Repl Seal to hood w/o Hybrid 74147T2FA01 1 45.37 Incl. 49 FENDER
50 * S01 Rpr RT Fender 60211T2FA90ZZ 0.5 2.2
51 S01 Overlap Major Adj. Panel -0.4
52 S01 Add for Clear Coat 0.4
* S01 Rpr LT Fender 60261T2FA90ZZ 0.5 2.2
54 S01 Overlap Major Adj. Panel -0.4
55 • S01 Add for Clear Coat 0.4
56 ELECTRICAL
57 # S01 Rpr D&R Battery cable 0.3
VEHICLE DIAGNOSTICS
59 # S01 Rpr Pre Repair scan 0.5 M
60 # S01 Rpr Post repair scan 0.5 M
61 MISCELLANEOUS OPERATIONS
62 # Subl Hazardous Waste Disposal 1 5.00 x
63 ** Repl A/M Flex additive 1 7.00 T
64 # S01 Pull and square 1 2.0 F
65 # 501 Car cover/ bag 1 8.00 0.2
66 # S01 Rpr Tint Color 0.5
67 # S01 color sand and buff 1 1.0
68 # 501 corrosion protection 1 15.00 0.3
69 # S01 Memory function resets 0.5 M
70 # S01 non oem coolant 35.00
71 # S01 set back wiring 1 5.00 0.3
SUBTOTALS 2,474.54 26.1 16.4
NOTES
Prior Damage Notes:
None reported
6/12/2026 4:03:00 PM 462415 | 2.0.05.04170 Page 3
Claim #: 30018097-V1
Workfile ID: 9429d808
Supplement of Record 1 Summary
2017 HOND Accord Sedan Sport SE w/Continuously Variable Transmission 4D SED 4-2.4L Gasoline Gasoline Direct Injection Grey
ESTIMATE TOTALS
Category Basis Rate Cost $
Parts 2,462.54
Body Labor 20.6 hrs @ $95.00/hr 1,957.00
Paint Labor 16.4 hrs $ 95.00/hr 1,558.00
Mechanical Labor 3.5 hrs @ $ 195.00 /hr 682.50
Frame Labor 2.0 hrs $145.00 /hr 290.00
Paint Supplies 16.4 hrs $50.00/hr 820.00
Miscellaneous 12.00
Subtotal 7,782.04
Sales Tax $ 3,289.54 @ 8.7500% 287.83
Total Cost of Repairs 8,069.87
Deductible 1,000.00
Total Adjustments 1,000.00
Net Cost of Repairs 7,069.87
6/12/2026 4:03:00 PM 462415 | 2.0.05.04170 Page 4
Claim #: 30018097-V1
Workfile ID: 9429d808
Supplement of Record 1 Summary
2017 HOND Accord Sedan Sport SE w/Continuously Variable Transmission 4D SED 4-2.4L Gasoline Gasoline Direct Injection Grey
SUPPLEMENT SUMMARY
Line Oper Description Part Number Qty Extended Labor Paint Price $
Changed Items
4 ** Repl A/M CAPA Lower grille w/o P15630 1 -37.11 -0.4 pre-crash
10 ** S01 Repl A/M CAPA Lower grille w/o P15630 1 37.11 Incl. pre-crash
10 ** Repl A/M CAPA Grille HO1200229PP 1 -150.00 -0.7
18 ** S01 Repl A/M CAPA Grille HO1200229PP 1 150.00 Inci.
Deleted Items
5 * Rpr Bumper cover w/o Hybrid w/o prk 71101T2FA50ZZ -1.0 -2.8 sensr
6 Add for Clear Coat -1.1
FENDER
18 * BInd RT Fender 60211T2FA90ZZ -1.1
19 * BInd LT Fender 60261T2FA90ZZ -1,1
Added Items
2 INFORMATION LABELS
S01 Rpl information labels 0.3
4 S01 Repl AC label w/o Plug-in, w/o Hybrid 80050T2FH00 1 4.66 Ind. 5 S01 Repl Info label radiator cap 19046RAAA00 1 4.80 Ind. 6 S01 Repl Emission label SEE FOOTNOTE 1 Incl.
8 S01 O/H front bumper 2.3
12 ** S01 Repl A/M CAPA Bumper cover w/o P894741 1 198.70 Incl. 2.8 Hybrid w/o prk sensr
13 S01 Add for Clear Coat 1.1
14 S01 Add for fog lamps 0.2
S01 R&I Impact bar (HSS) 71130T2FAOOZZ 0.4
NOTE: no visible damage
** S01 Repl AIM Reinf bracket H01207113 1 45.00 Incl.
22 ** S01 Repl A/M CAPA Sight shield 2.4 liter HO1224115C 1 43.00 Incl. 23 ** S01 Repl A/M CAPA Molding strip lower P11020 1 48.55 Incl. 24 FRONT LAMPS
25 S01 R&T RT R& headlamp assy 33100T2AA61 Incl.
26 S01 R&I LT R&I headlamp assy 33150T2AA61 Inci.
27 RADIATOR SUPPORT
28 S01 Refinish Components 1.6
29 ** S01 Repl A/M CAPA Radiator support w/o P893701 1 370.30 11.5 Incl.
Plug-in, w/o Hybrid wo pre-crash
30 S01 Add for auto trans m 0.2 M
31 S01 R&T Lower shield w/o Plug-in, w/o 74110T2FA01 Incl.
Hybrid w/o 6 speed auto
COOLING
6/12/2026 4:03:00 PM 462415 | 2.0.05.04170 Page 5