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 RECEIVED han six (6) months after the occurrence. (Gov. Code Sec. 9112
2. Claims for damages to real property must be filed not later than one (1) yea after the occurrence. (Gov. Code Sec.911.2) JUN 0 8 2023
3. Read entire claim before filing.
+ƯỚ CƠN CITY CLERK'S OFFICE
Altach separate sheets, if necessary, to give full details. SIGN EACH SHEE1 Claim must be filed with City Clerk. (Gov. Code Sec. 915a TO: CITY OF VERNON CITY COUNCIL
Name of Clalmant Age of Claimant (If natural person)
Norissa Alberta White-Isaacs
Home Address of Claimant City and State Home Telephone Number Business Address of Claimant City and State Business Telephone Number Give address to which you desire notices or communications to be sent regarding this claim:
Asseraf Law, PC at 8383 Wilshire Bivd. Suite 800 Beverly Hills, CA 90211 How did DAMAGE or INJURY occur? Give full particulars.
Claimant was struck by a vehicle while crossing the street inside of the crosswalk. Claimant was walking across the street from the Southeast Corner sidewalk to the Southwest corner sidewalk.
When did DAMAGE or INJURY occur? Give full particulars, date, time of day, etc.:
The injury occurred on 01-04-2023
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:
The injured occurred inside of the intersection of S. Soto street and 46th Street. Claimant was walking across the street from the Southeast Corner sidewalk to the Southwest corner sidewalk.
What particular ACT or OMISSION do you claim causedthe injury ordamage? Givenames of City employees, if any. causing the injury or damage, if known:
Liability against City of Angeles is based on Dangerous Condition of Public Property pursuant to Government Code Section 835 et seg. and liability for the negligence or reckless acts of employees, agents or independent contractors pursuant to Government Code Sections 815.2, 815.4 and 820(a) et seq. a) et seq.
What DAMAGE or INJURIES do you claim resulted? Give full extent of injuries or damages claimed:
Claimant sustained injuries to the Head, brain, back, neck, face, jaw, mouth, shoulders, arms, legs, ribs, chest, eyes, hands, feet, abdomen, ankles, legs, knees, hips, wrists, face, psych, PTSD, & stress.
WhatAMOUNT do you claimofeach item of injury or damage as of date of presentationofthisclaim, giving basis of computation:
Claimants' damages are in excess of the jurisdictional minimum of the Superior Court of the State of California. The exact amount of said losses will be stated according to proof, pursuant to Section 425.10 of the California Code of Civil Procedure.
Give ESTIMATED AMOUNT as farasknownyou claim on account of each item of prospective injury or damage, giving basisof computation:
Claimants' damages are in excess of the jurisdictional minimum of the Superior Court of the State of California. The exact amount of said losse will be stated according to proof, pursuant to Section 425.10 of the Califomia Code of Civil Procedure Were you insured at the time of the incident? If so, provide name of insurance company, policy numbers and amount of insurance payments received:
Claimant was a pedestrian. Claimant is receiving workers' compensation benefits.
Expenditures made on account of accident or Injury: (Date - Item) (Amount) The amount is subject to proof. The Claimant reserves the right to amend and/or supplement this claim for damages upon discovery of new or additional information or facts.
Name and address of Witnesses, Doctors and Hospitals:
See attached Traffic Collision Report No. CR23-0022.
READ CAREFULLY
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 comers.
NOTE:If diagrams do not fit the situation, attach hereto a proper diagram signed by claimant.
FOR AUTOMOBILE ACCIDENTS
SEE PAGE 5 OF
FOR OTHER ACCIDENTS
TRAFFIC
COLLISION
CODORR23-0022
S. SOTO STREET/ SIDEWALK
46TH ST. cura/
46th St.
CITY QF VERNON CURB>
PARKWAY
SIDEWALK
Typedarter dampenalty of perjury, that grature e gain or person ang attach beat, Is true and correct.
Signature of Claimant or person filing on his/her behalf, giving relationship to Claimant:
NIR ASSERAF, ESQ ATTORNEY 4/ 06-05-2023
NOTE: ALL CLAIMANTS MAY BE REQUESTED TO BE EXAMINED AS TO THEIR CLAIM UNDER O TH. 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) Rov. BAre