CLAIM FOR DAMAGES RESERVE FOR FILING STAMP
TO PERSON OR PROPERTY CLAIM NO.
INSTRUCTIONS
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 Sec.9112) RECEIVED
2. Claims for damages to real property must be filed not later than one (1) year after the occurrence. (Gov. Code Sec.911.2)
3. Read entire claim before filing. MAR 08 2023
+ LO See page 2 for diagram upon which to locate place of acciden This claim form must be signed on page 2 at bottom
CITY CLERK DEPARTMENT
6. Attach separate sheets, if necessary, to give full details. SIGN EACH SHEET
7. Claim must be filed with City Clerk. (Gov.Code Sec. 915a) TO: CITY OF VERNON CITY COUNCIL
Name of Claimant Age of Claimant (If natural person)
Marina C. Martin
Home Address of Claimant Colliv and state, Home Telephone Number Business Address of Claimant City and State Business Telephone Number 11561 Paramount Blvd Downey, CA 562-712-0989
Give address to which you desire notices or communications to be sent regarding this claim:
How did DAMAGE or INJURY occur? Give full particulars.
I was driving South on Soto St when my car fell into a hughe pot hole in the street that due to the heavy traffic was not able to see and both of my passenger side tires exploded, my car had to be towed to the dealer Mercedes-Benz of Los Angeles to replace both tires.
When did DAMAGE or INJURY occur? Give full particulars, date, time of day, etc.:
Wednesday, March 1st, 2023 around 3 o'clock pm
Where did DAMAGE or INJURY occur? Describe fully, and locate on diagram on reverse side of this sheet, where approximate, give street names and address and measurements from landmarks:
I was driving South on Soto St, before approaching Washington Bld when my car fell into a hole in the street that I was not able to see and both of my passenger side tires exploded.
What particular ACT or OMISSION do you claim causedthe injury or damage? Give names of City employees, if any, causing the injury or damage, if known:
I believe the City is responsable to maintain the highways free of holes that can cause accidents.
What DAMAGE or INJURIES do you claim resulted? Give full extent of injuries or damages claimed:
As a result of the accident I had to replace three tires in my car.
What AMOUNT do you claim of each item of injury or damage as of date of presentation of this claim, giving basis of computation:
$899.66 see Invoice of Mercedes-Benz of Los Angeles
Give ESTIMATED AMOUNT as far as known you claim on account of each item of prospective injury or damage, giving basis of computation:
$899.66 as per Invoice of Mercedes-Benz of Los Angeles
Were you insured at the time of the incident? If so, provide name of insurance company, policy numbers and amount of insurance payments received:
Yes, Automobile Club of Southern California
Expenditures made on account of accident or Injury: (Date - Item) (Amount) $899.66
Name and address of Witnesses, Doctors and Hospitals:
None
READCAREFULLY
For all accident claims place on following diagram names of streets, including North, East. South, and West: indicate place of accident by "X" and by showing house numbers or distances to street corners.
NOTE: If diagrams do not fit the situation, attach hereto a proper diagram signed by claimant.
FOR AUTOMOBILE ACCIDENTS
SOTO ST. X.
7^Г WASHINGTO BLD
FOR OTHER ACCIDENTS
////
SIDEWALK
сияв)
CURB Y
PARKWAY
SIDEWALK
I declare, under penalty of perjury, that the foregoing, including any attachments, is true and correct.
Typed/Printed Name: Signature of Claimant or person filing on his/her behalf, giving Date:
Marina C Martin relationship to Claimant: 3/8/2023
Marinal.Mastin
NOTE: ALL CLAIMANTS MAY BE REQUESTED TO BE EXAMINED AS TO THEIR CLAIM UNDER OATH. PRESENTATION OF A FALSE CLAIM IS A FELONY (CAL.
PEN. CODE SEC. 72). CLAIMS MUST BE FILED WITH CITY CLERK (GOV.CODE SEC. 915a). STATE LAW PROVIDES THAT IF YOU ARE NOT NOTIFIED OF ANY ACTION BY THE CITY OF THIS CLAIM WITHIN 45 DAYS OF FILING THEN THE CLAIM IS DEEMED DENIED (SEE GOV. CODE SEC. 911.6 & 912.4) Customer Number:890980 Invoice No: 290104
*INVOICE*
Mercedes-Benz
MARINA MARTIN MERCEDES-BENZ OF LOS ANGELES #304
LOS ANGELES, CALIFORNIA 90015
(213) 748-8951
Home: Bus: 562-928-1954 Cell: Remit Payment To: Lithia Motors Support Services PO BOX 679811, Dallas Texas 75267-9811
Email: email home
SERVICE ADVISOR: 187851 Ivan E Velasco
COLOR YEAR MAKE/MODEL LICENSE MILEAGE IN / OUT TAG
SILVER/GRE 14 MERCEDES-BENZ E350W 60275 / 60276 T6727
DEL. DATE PROD DATE WARR. EXP. PROMISED PO NO RATE PAYMENT INV. DATE 28AUG16 19:00 03MAR23 0.00 ESC 03MAR23
R.O. OPENED READY OPTIONS: SOLD-STK:9375C DLR:05737 ENG:3.5] _Liter TRN:A 11:13 02MAR23 16:46 03MAR23
LINE OPCODE TECH TYPE HOURS LIST NET TOTAL
Thank you for allowing us to work with you
if you have any questions or feedback
regarding your service visit please contact
Veronica Contreras directly at (213) 927-7773
[email protected]. We look forward to
serving you in the future!
Mercedes-Benz,
PAID
CASH VISA/ MC
AMEX
KAARMA ONLINE
DATE NAME
riginal Estimate TAtal Analans Approved 8y: Date & Time • HAZARDOUS
WASTE DISPOSAL DESCRIPTION TOTALS
Parts & Labor] Cost Authorized Obtained By
COSTS: We have added this
319.80
Tatalian LABOR AMOUNT
charge to cover costs associated
DE-mal iSto Attached with the handling, management PARTS AMOUNT 780.00 svised Estimate
and disposal of toxic wastes or GAS, OIL, LUBE 0.00
Fox (Ste Antechen
hazardous substances under
SUBLET AMOUNT 0.00
California and Federal Law.
MISC. CHARGES 23.25
ALL PARTS ARE NEW
UNLESS OTHERWISE TOTAL CHARGES 1123.05
signing below, you acknowledge that you were notified of and authorized the 295.00 alership to perform the services/repairs itemized in this Invoice and that you received INDICATED. LESS INSURANCE had the opportunity to inspect) any replaced parts as requested by you. • Some Parts Not Returnable SALES TAX 71.61
DATE CUSTOMER SIGNATURE AUTHORIZED DEALERSHIP REPRESENTATIVE SIGNATURE
PLEASE PAY
$ 899.66
THIS AMOUNT
otice to Consumer: Please read important information on back.
PLEASE READ ON BAER OF TRIS"ORM OUR LIMITED SERRUStOMer COPIES, WARRANTY AND THE SONG-EEVERA-ROP43R718 2263 ALAS ARNEY WCODES: (PRECEDING ART NUMBER) 00-VENDOR OTHER THAN M.BASA 70-CORE CHARG/CREAT Customer Number:890980 Invoice No: 290104
*INVOICE*
Mercedes-Benz
MARINA MARTIN MERCEDES-BENZ OF LOS ANGELES #304
LOS ANGELES, CALIFORNIA 90015
(213) 748-8951
928-1954 Cell: Remit Payment To: Lithia Motors Support Services PO BOX 679811, Dallas Texas 75267-9811
Email: email home SERVICE ADVISOR: 187851 Ivan E Velasco
COLOR YEAR MAKE/MODEL VIN LICENSE MILEAGE IN / OUT TAG
SILVER/GRE 14 MERCEDES-BENZ E350W 60275 / 60276 T6727
DEL. DATE PROD. DATE WARR. EXP. PROMISED PO NO. RATE PAYMENT INV. DATE 28AUG16 19:00 03MAR23 0.00 ESC 03MAR23
R.O. OPENED READY OPTIONS: SOLD-STK:9375C DLR:05737 ENG:3.5 _Liter TRN:A 11:13 02MAR23 16:46 03MAR23
LINE OPCODE TECH TYPE HOURS LIST NET TOTAL
ALIGN PERFORM 4-WHEEL COMPUTERIZED ALIGNMENT PER
CUSTOMER REQUEST COUPON PRICING $229.95
(Retail price $306.00 over $75.00 discount)
229.95: A2:29.95
60276 4-WHEEL ALIGNMENT 1.70 PERFORMED 4 - WHEEL ALIGNMENT AS PER CUSTOMER REQUEST. CHECKED FRONT AND REAR CAMBER, CASTER AND TOE.
ADJUSTED FRONT AND REAR TOE TO SPEC. CENTRED STEERING WHEEL. PERFORMED ROAD TEST. VEHICLE IL
************** ***
PLD PARTS AND LABOR DISCOUNT
-75.00 - 75.00
********************* *********** * * *- *************** **** ESTIMATE: 1,300.00 03MAR23 16:43 'SA: 187851
CONTACT: MARINA
*******************
**** ************* *** *****.
ESTIMATE: 900.00 03MAR23 11 : 33 SA: 187851
CONTACT: MARINA
REVISE ESTIMATE
REPLACE RIGHT FRONT TIRE AND PERFOR ALIGEMNT
************************** *************** **** * *
************* *** * *
ESTIMATE: 500.00 02MAR23 11:13 SA: 187851
CONTACT:
*************** •**** ** * * *
~-9653
Jinal Estimate Total Additional Approved By: Date & Time Authorization •HAZARDOUS WASTE DISPOSAL DESCRIPTION TOTALS Obtained Bya COSTS: We have added this
LABOR AMOUNT
charge to cover costs associated
De-mal (5es Anteched with the handling, management PARTS AMOUNT Revised Estimate and disposal of toxic wastes or
Fax iSce Altached! GAS, OIL, LUBE
hazardous substances under
California and Federal Law. SUBLET AMOUNT
MISC. CHARGES
ALL PARTS ARE NEW
UNLESS OTHERWISE TOTAL CHARGES
Dealership to perform the services rep is emited in is invoice and the ne below. you acknowledge that you were notified of and authorized INDICATED. LESS INSURANCE or had the opportunity to inspect any replaced parts as requested by you. • Some Parts Not Retumable SALES TAX
DATE CUSTOMER SIGNATURE AUTHORIZEO DEALERSHIP REPRESENTATIVE SIGNATURE
PLEASE PAY
THIS AMOUNT
Notice to Consumer: Please read important information on back.
PLEASE READ ON BACK IS FORM OUR LIME RUST GOES, WARN TO THE SONG-BEEF 9429718 2263.
UNNA ARTS ANANYANIS CODES: (PRECEDINGO ART NUMBER AYENDOR OTHER THAN BASA TO CORE CHARS CREAMS Customer Number:890980 Invoice No: 290104
*INVOICE*
Mercedes-Benz®
MARINA MARTIN MERCEDES-BENZ OF LOS ANGELES #304
LOS ANGELES, CALIFORNIA 90015
(213) 748-8951
Home: Bus: 562-928-1954 Cell: Remit Payment To: Lithia Motors Support Services PO BOX 679811, Dallas Texas 75267-9811
Email: email home SERVICE ADVISOR: 187851 Ivan E Velasco
COLOR YEAR MAKE/MODEL VIN LICENSE MILEAGE IN / OUT TAG
SILVER/GRE 14 MERCEDES-BENZ E350W 60275 / 60276 T6727
DEL. DATE PROD. DATE WARR. EXP PROMISED PO NO. RATE PAYMENT INV. DATE 28AUG16 19:00 03MAR23 0.00 ESC 03MAR23
R.O. OPENED READY OPTIONS: SOLD-STK:9375C DLR:05737 ENG:3.5_Liter TRN:A 11:13 02MAR23 16:46 03MAR23
LINE OPCODE TECH TYPE HOURS LIST NET TOTAL
and Cash. We DO NOT accept personal or business checks. PLEASE
USE LINK TO PAY FOR CONTACTLESS TRANSACTION - PAY LINK WILL BE TEXTED AND EMAILED TO YOU UPON COMPLETION OF WORK Bern
PAY We accept Visa, MasterCard, American Express, 3 A
Discover, Debit Cards, and Cash. We DO NOT
accept personal or business checks. PLEASE
151
USE LINK TO PAY FOR CONTACTLESS TRANSACTION
- PAY LINK I.... _- ... ... EMAILED TO YOU
UPON COMPLETION OF WORK
263501 I (N/ C)
************************************
H** CUSTOMER REQUEST TO REPLACE RIGHT FRONT TIRE
CAUSE: REPLACEMENT OF LEFT FRONT TIRE
TIRE CUSTOMER REQUEST ONE TIRE REPLACEMENT
ELIGIBLE FOR FREE TIRE ROTATION EVERY 5,000
MILES FOR THE LIFE OF THE REPLACED TIRE (S)
ONLY AT DTLA MOTORS
264661 CEXP 29.95 29.95
1 Q-8-40-3063 MICHELIN 245/40ZR18 SKU,13787
97Y, PIL 280:00 280.00 280.00
1 TD TIRE DISPOSAL 2.50 2.50 2.50
1 TT TIRE TAX 1.75 1.75 1.75
1 WWS WHEEL KIT 3.50 3 .50 3.50
60275 REPLACEMENT OF LEFT FRONT TIRE
MOUNTED AND BALANCED
OLD DOT
B9 02LX 4616
NEW DOT
1AP 88 05CX 0623
TORQUE TO SPEC.
****************************** •***************
** PERFORM 4-WHEEL COMPUTERIZED ALIGNMENT PER CUSTOMER REQUEST COUPON PRICING $229.95 (Retail price $306.00 over $75.00 discount) AUSE: 4-WHEEL ALIGNMENT
iginal Estimate Total Aduitionat Approved By: Date & Time *HAZARDOUS WASTE DISPOSAL DESCRIPTION TOTALS Cost Authorized Obtalned By: We have added
COSTS: this
charge to cover costs associated LABOR AMOUNT
(Sce Alached
with the handling, management PARTS AMOUNT
vised Estimate and disposal of toxic wastes or
GAS, OIL, LUBE
LE mal i See Attsched hazardous substances under
California and Federal Law. SUBLET AMOUNT
MISC. CHARGES
ALL PARTS ARE NEW
UNLESS OTHERWISE TOTAL CHARGES
signing below, you acknowledge that you were notified of and authorized the INDICATED. LESS INSURANCE alership to perform the services/repairs itemized in this Invoice and that you received had the opportunity to inspect any replaced parts as requested by you. • Some Parts Not Returnable SALES TAX
JATE CUSTOMER SIGNATURE AUTHORIZED DEALERSHIP REPRESENTATIVE SIGNATURE
PLEASE PAY
THIS AMOUNT
›tice to Consumer: Please read important information on back.
SEE READ ON BACK OF THIS FORM OUR LIMITED SERGES tamer CopyIES, WARRANTY AND THE SONG-BEVERLY ACT-LAW HAB 2263 ARTS ARE NEW CODES: (PRECEDING ART NUMBER) 90- VENDOR OTHER THAN MBASA 70-CORE CHARGE/CREDIT
UNLESS SARDICIED OTHERWISE
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Customer Number:890980 Invoice No: 290104
* INVOICE*
Mercedes-Benz
MARINA MARTIN MERCEDES-BENZ OF LOS ANGELES #304
LOS ANGELES, CALIFORNIA 90015
(213) 748-8951-
Home: Bus: 562-928-1954 Cell: Remit Payment To: Lithia Motors Support Services PO BOX 679811, Dallas Texas 75267-9811
Email: email home SERVICE ADVISOR: 187851 /van E Velasco
COLOR YEAR MAKE/MODEL VIN LICENSE MILEAGE IN / OUT TAG
SILVER/GRE 14 MERCEDES-BENZ E350W 60275 / 60276 T6727
DEL. DATE PROD. DATE WARR. EXP. PROMISED PO NO. RATE PAYMENT INV. DATE 28AUG16 19:00 03MAR23 0.00 ESC 03MAR23
R.O. OPENED READY OPTIONS: SOLD-STK:9375C DLR: 05737 ENG:3.5_Liter TRN:A 11:13 02MAR23 16:46 03MAR23
LINE OPCODE TECH TYPE HOURS LIST NET TOTAL
C CUSTOMER STATES VEHICLE WHEN OVER A POTHOLE AND RIGHT FRONT TIRE WHEN
FLAT, REPLACE TIRE AS PER GUEST
CAUSE: REPLACMENT OF RIGHT FRONT
TIRE CUSTOMER REQUEST ONE TIRE REPLACEMENT- BACK
ELIGIBLE FOR FREE TIRE ROTATION EVERY 5,000
MILES FOR THE LIFE OF THE REPLACED TIRE (S)
ONLY AT DTLA MOTORS
263501 CEXP 29.95 . lin. :29.95
1 Q-8-40-3063 MICHELIN 245/40ZR18 SKU, 13787,
97Y, PIL 280.00 280.00 280.00
1 TD TIRE DISPOSAL 2.50 2.50 2.50
1 TT TIRE TAX 1.75 1.75 1.75
1 WWS WHEEL KIT 3.50 3.50 3.50
60275 REPLACMENT OF RIGHT FRONT
RIGHT FRONT TIRE WAS FLAT NEW TIRE HAS BEEN MOUNTED AND BALANCED
OLD DOT
F/R 1AP 88 05CX 3122
NEW DOT
1AP 88 05CX 0223
****************************************************
) PERFORM COMPLIMENTARY MULTI-POINT INSPECTION - COPY PROVIDED UPON
REQUEST- -USE LINK TO PAY FOR CONTACTLESS TRANSACTION-
:AUSE: MPI
EXMPI EXPRESS- PERFORM MULTI POINT INSPECTION
263501 I (N/ C)
RBELONG PLEASE DOUBLE CHECK TO MAKE SURE ANY
PERSONAL BELONGINGS HAVE BEEN REMOVED FROM
YOUR VEHICLE. MERCEDES BENZ OF LOS ANGELES
IS NOT RESPONSIBLE FOR ANY BELONGINGS LEFT
IN YOUR VEHICLE.
99 I (N/ C)
CLIAMS PLEASE BE AWARE INSURANCE CLAIMS MUST BE
PAID IN FULL BEFORE A VEHICLE CAN BE
RELEASED
ginal Estimate Total Additional Approved By: Date & Time Authorization "HAZARDOUS WASTE DISPOSAL DESCRIPTION TOTALS arts & Labor Cost Authorized Obtained Bya We have
COSTS: added this
• Teleon LABOR AMOUNT
Fax (Sco Alichell charge to cover costs associated
with the handling, management PARTS AMOUNT
rised Estimate Telephone and disposal of toxic wastes or Fes ISer • Anachedi GAS, OIL, LUBE
DEmoil (Ste Alteched) hazardous substances under
California and Federal Law. SUBLET AMOUNT
MISC. CHARGES
ALL PARTS ARE NEW
UNLESS OTHERWISE TOTAL CHARGES
signing below, you acknowledge that you were notified of and authorized I the Ilership to perform the services/repairs itemized in this Invoice and that you received INDICATED. LESS INSURANCE had the opportunity to inspect any replaced parts as requested by you. • Some Parts Not Retumable SALES TAX lATE CUSTOMER SIGNATURE AUTHORIZED DEALERSHIP REPRESENTATIVE SIGNATURE
PLEASE PAY
THIS AMOUNT
stice to Consumer: Please read important information on back PLEASE READION BACK OF THiS FORM OUR LIMITED SER Questom exC COVIES, WARRANTY AND THE SONG-BEVERLY REPLAR #48 2263 UNLESS CAN AWIS CODES: (PRECEDING ART NUMBEE), 00-VENDOR OTHER THAN M.B ASA 70-CORE CHARGE/CREDI ALLO ARTS ARE NEW Customer Númber:890980 Invoice No: 290104
*INVOICE*
Mercedes-Benz
MARINA MARTIN MERCEDES-BENZ OF LOS ANGELES #304
LOS ANGELES, CALIFORNIA 90015
(213) 748-8951
Home: Bus: 562-928-1954 Cell: 5 Remit Payment To: Lithia Motors Support Services Email: email PO BOX 679811, Dailas Texas 75267-9811
home SERVICE ADVISOR: 187851 Ivan E Velasco
COLOR YEAR MAKE/MODEL VIN LICENSE MILEAGE IN 1 OUT TAG
SILVER/GRE 14 MERCEDES-BENZ E350W 60275 / 60276 T6727
DEL. DATE PROD. DATE WARR. EXP PROMISED PO NO. RATE PAYMENT INV. DATE 28AUG16 19:00 03MAR23 0.00 ESC 03MAR23
R.O. OPENED READY OPTIONS: SOLD-STK:9375C DLR:05737 ENG:3.5 _Liter TRN:A 11:13 02MAR23 16:46 03MAR23
LINE OPCODE TECH TYPE HOURS LIST NET TOTAL
A VEHICLE HAS BEEN TOWED INTO THE DEALERSHIP. BEFORE ANY WORK CAN BE PERFORMED THERE MUST BE A SIGNED WORK ORDER. DEALERSHIP IS NOT
RESPONSIBLE FOR ANY DAMAGE OR MISSING ITEMS WHILE VEHICLE BEING
TOWED OR WHILE BEING REMOVED FROM TOW TRUCK
TOW VEHICLE HAS BEEN TOWED INTO THE DEALERSHIP.
BEFORE ANY WORK CAN BE PERFORMED THERE MUST
351
BE A SIGNED WORK ORDER. DEALERSHIP IS NOT
RESPONSIBLE . ... .... ...M.M UR MISSING ITEMS D-llas
WHILE VEHICLE BEING TOWED OR WHILE BEING
REMOVED FROM TOW TRUCK HI L
263501 I " "(N/C)
******************** ******* ** **** 30.
B CUSTOMER STATES VEHICLE WHEN OVER A POTHOLE RIGHT AND REAR TIRE WHEN
FLAT, CHECK AND REPORT
CAUSE: REPLACMENTOFRIGHT REAR
TIRE CUSTOMER REQUEST ONE TIRE REPLACEMENT-
ELIGIBLE FOR FREE TIRE ROTATION EVERY 5,000
MILES FOR THE LIFE OF THE REPLACED TIRE (S)
ONLY AT DTLA MOTORS
263501 CEXP 29.95 29.95
19-8-40-3063 MICHELIN 245/40ZR18 SKU, 13787,
97Y, PIL 280.00 220.00 220.00
DOT - 1AP-88-05CX-0223 X1
1 TD TIRE DISPOSAL 2.50 2.50 2.50
1 TT TIRE TAX 1.75 1.75 1.75
1 WWS WHEEL KIT 3.50 3.50 г.) 3.50
60275 REPLACMENTOFRIGHT REAR
BOTH TIRES WERE FLAT ON ARRIVAL FRONT HAD SPARE REMOVED SPARE AND PUT BACK IN SPARE WHEEL WELL RIGHT REAR HAS BEEN REPLACED NEW TIRE 10:
MOUNTED AND BALANCED
OLD DOT
B988 02 LX 4518
NEW DOT
1AP 88 05CX 1522
Iginal Estimate Total Additional Approved By: Date & Tine "HAZARDOUS WASTE DISPOSAL DESCRIPTION TOTALS Parts & Labor) Cost Authorized Oblained Bya
COSTS: We have added this
LABOR AMOUNT
(Seo Arched) charge to cover costs associated
with the handling, management PARTS AMOUNT
visee estante and disposal of toxic wastes or
GAS, OIL, LUBE
hazardous substances under
California and Federal Law. SUBLET AMOUNT
MISC. CHARGES
ALL PARTS ARE NEW
UNLESS OTHERWISE TOTAL CHARGES
signing below, you acknowledge that you were notified of and authorized INDICATED. LESS INSURANCE alership to perform the services/repairs itemized in this Invoice and that you received had the opportunity to inspect any replaced parts as requested by you. • Some Parts Not Returnable SALES TAX
DATE CUSTOMER SIGNATURE AUTHORIZED DEALERSHIP REPRESENTATIVE SIGNATURE
PLEASE PAY
THIS AMOUNT
NEARS ARE NYAS CODES: (PRECEDING@ART NUMBEB, NO-VENDOR OTHER THAN M.BIASA 70-CORE CHARGE/CREDIT Mercedes-Benz of Los Angeles
1801 South Figueroa Street RECEIPT
Los Angeles, CA 90015
(213) 748-8951
Customer Information: Invoice Details:
Marina Martin Invoice #: 9P4GZ5C02D
Invoice Date: Friday, March 03, 2023 04:52
PM
(XXX) XXX-X989 Repair Order/Ref #: 290104
Description of Product/Services Amount
Thank you for your business! $ 899.66
Payment Details:
Paid On: Friday, March 03, 2023 04:53 PM
Credit Card: XXXXXXXXXXXX4657 exp XX
/XXXX
Card Type: Visa
Payment Type: Contactless
Confirmation #: 75867G Customer Signature
Dealer Associate: Ivan Velasco
Cashier: Ivan Velasco
THANK YOU! 300 :
Mercedes-Benz of Los Angeles Processed by myKaarma eBridge Payments