CLAIM FOR DAMAGES RESERVE FOR FILING STAMP
TO PERSON OR PROPERTY CLAIM No.
RECEIVED
INSTRUCTIONS
JUL 1 4 2025
an six (6) months after the occurrence. (Go
2. Claims for damages to real property must be filed not later than one (1) yea fter the occurrence. (Gov. Code Sec.911.2 CITY CLERK DEPARTMENT
3. Read entire claim before filing.
This chaim form must be signed on page 2 at place of accident ttach separate sheets, if necessary, to give full details. SIGN EACH SHEE aim must be filed with City Clerk. (Gov. Code Sec. 915:
TO: CITY OF VERNON CITY COUNCIL
Name of Caman Manooki an Ape of Claimant (If natural person) Fred
Mama Address of Clhimant
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:
While driving on S. Alameda st. in the left lane my Vehicle sont to deep barge and firemar my potholes. this caused thes Laner Car
When did DAMAGE or INJURY occur? Give full particulars, date, time of day, etc.:
5/10/25 at around 7:30 A.M.
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 Main road S. Alameda st. between E41 st street and
E y, st place, left lane, across from the 4111 building, Vernon, CA 90058 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:
The two Large and deep potholes caused immediate
damage resulting in two flat tires.
What DAMAGE or INJURIES do you claim resulted? Give full extent of injuries or damages claimed:
the front rights and back right tires were blown out.
the potholes caused a flat tires.
What AMOUNT do you claim of each item of injury or damage as of date of presentation ofthisclaim, giving basisof computation:
/ invoice,
I was charged #1008.33 for tire replacement. assached
Give ESTIMATED AMOUNT as faras known you claim on account of each item of prospective injury or damage, giving basis of computation:
I have been charged # 1,008.33 for tire reglacement. / invoice I also reported tulse 2 potholes with 311 and credit card charle
I have a Confermation # 00879868 attached
Were you insured at the time of the incident? If so, provide name of insurance company, policy numbers and amount of insurance yes, I was insured and I did NOT receive payment for this loss.
This was a looner car that I was driving back to the dealer. WaWanesa Expenditures made on account of accident or Injury: (Date - Item) The dealer charged me # 1008.33 to replace the tires.
Name an our messes, ceos and hospat wed the car to the dealer (proof attached services who → BMw of Down town los Angites-Terry velasques 16393) 583-1901 AAA Towing
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 corners. vehicle at the time of accident by "8 1" and the point of Impact by "X." NOTE: If diagrams do not fit the situation, attach hereto a proper diagram signed by claimant FOR AUTOMOBILE ACCIDENTS Marked with X
pothole location
s. Alameda st.
4/11 3.
/ Alameda
CURB/
CURB,
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 fling on his/her behalf, giving Date:
relationship to Claimant:
Fred Manookian medi 1/9/25
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 & 9124) Rev. 84/16
INVOICE
Agreement#: Checkout Date: Return Date:
Bill to: 05/12/2025
A39142 05/07/2025
FRED MANOOKIAN Driver: Agreement Days: Insurance Policy#:
FRED MANOOKIAN 12783840
Claim #: Repair Order #: Service Advisor:
204332 Jerry Velasquez
VIN: Vehicle Plate:
Vehicle Type: Distance Driven:
2024 BMW X3 xDrive30i SA 52
BMW of Downtown Los
Angeles
6333 S ALAMEDA ST CHARGES DATE AMOUNT
Los Angeles, CA 90001 Tire Replacement (x2) @ 1,008.33 charged once 05/12/2025 1,008.33 1 (323) 583-1901 TAXES
TOTAL CHARGES 1008.33
PAYMENTS DATE AMOUNT
05/12/2025 150.00
Visa
visa 05/12/2025 858.33
TOTAL DUE 0.00
We thank you for your business.
I Manage your account online Mobile: Download the
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ACCOUNT ACTIVITY
Date of
Transaction Merchant Name or Transaction Description $ Amount
PAYMENTS AND OTHER CREDITS
05/22 Payment Thank You Bill Pay Service -500.00
PURCHASE
05/12 BMW/MINI OF DTLA BMWDTLA.COM CA 150.00
05/12 BMW/MINI OF DTLA BMWDTLA.COM CA 858.33
2025 Totals Year-to-Date
otal fees charged in 202 $0.00
Total interest charged in 202: $495.83
ear-to-date totals do not reflect any fee or interest refun you may have receive
INTEREST CHARGES
Your Annual Percentage Rate (APR) is the annual interest rate on your account.
Annual Balance
Balance Type Percentage Subject To Interest
RATe TAPH Interest Rate Charges
v) = Variable Rati
d) = Dailv Balance Method (including new transactions
a) - Average Daily Balance Method (including new transactions) Please see Information About Your Account section for the Calculation of Balance Subject to Interest Rate, Annual Renewal Notice, How to Avoid Interest on Purchases, and other important intormation, as applicable.
Statement Date: 05/25/25
FRED MANOOKIAN
This Statement is a Falsifie hee - Not an original
MAMA 93686 1A51000000r0002seRO
00001 FA99D9
Customer Service: Mobile: Download the
• freedom I lie or come one on www.chase.com/cardhel 1-800-524-3880 Chaso Mobilol app today
Late Payment Warning: If we do not receive your minimum payment ww.ultimaterewards.com by the date listed above, you may have to pay a late fee of up to $40.00 and your APR's will be subject to increase to a maximum Penalty APR of 29.99%. You earn unlimited 5% Cash Back rewards on Chase Travel, unlimited 3% cash back on dining at restaurants and drugstore Minimum Payment Warning: If you make only the minimum purchases, and unlimited 1.5% cash back on all other purchases ayment each period, you will pay more in interest and it will take you It's automatic! Redeem for cash with no minimum, and your Cash onger to pay off your balance. For example Back rewards do not expire as long as your account is open.
ACCOLNT SLIMMARY
YOUR ACCOUNT MESSAGES
IMPORTANT NOTICE: Your APR(s) were lowered.
Your new APR(s) are shown in the "interest Charges" section of your statement; they apply to current, non-promotional balances unis Statements a racsimmeR woran ongunal
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-
pothole #1
Pothole# 2
15:52 •SC
5 Messages
15 Vehicle Service...
Front Right
tire
See More
FM Fred Manookian 09:59
15:52 •1SC
img_3130.jpg ~ Done
Back Right
Tire
Automobile Club of Southern California AAA.com
June 02, 2025
FRED MANOOKIAN Member No.
Dear Fred Manookian:
As you have requested, a synopsis of the call(s) you placed for Emergency Roadside Assistance are located on the next page(s).
The SERVICE CHARGE (YES/NO) field:
NO = the call counted as part of your service call entitlements.
YES = you were charged for this service call.
The SERVICE CHARGE AMOUNT is the monetary value of the service.
Should you have any questions, or if I may be of further assistance, please do not hesitate to call me at the number below or Toll Free: 888-222-9441.
Sincerely,
Shown Saing
Shawn Sainz
This is the verification
714-850-5479
ERS Administrative Services
of the tow service
that was provided to
mare the car from the
Location of the damage to
the Dealer.
Administrativa Offices: PO. Box 25001. Santo Ana, CA 92700.5001 Headquarters: 2601 S. Figueroa. Los Angeles. CA 90007-3254 Auto Club Enterprises provides service 1o more than 17 millon members We're always with you."
Automobile Club of Southern California AAA.com
Call: 1 Date: 05/10/2025 Time: 8:29 AM
Location:
4321 S Alameda St Problem: Tow
Vernon, CA Tow Dest: 6333 S Alameda St
Vehicle: 2025 Black BMW Miles: 3
Service Charge: No Service Charge Amount:
Service Status: Completed
Administrative Offices: PO. Box 25001, Santa Ana. CA 92709-5001 Headquarters: 2601 S. Figueroa, Los Angoles. CA 90007-3254 Auto Club Enterprises provides service to more than 17 million members We're always with you."
Fred Manookian Retail
JUL 10, 2025
90058 $1.77
RDC 99 S2322W502091-04
City of Vernon Clerk
4305 s, Santa Fe ave
Vernon, CA 90058
90058-171405