Plaintiff s Claim 1501 to 5000Cal. Super. - 6th Dist.May 27, 2020208C083462 Santa Clara - Civil Plaintiff's Claim and ORDER to Go to Small Claims Court Notice to the person being sued: You are the defendant if your name is listed in® 0n page 2 of this form. The person suing you is the plaintiff, listed in® 0n page 2. You and the plaintiff must g0 t0 court 0n the trial date listed below. Ifyou d0 not g0 t0 court, you may lose the case. Ifyou lose, the court can order that your wages, money, 0r property be taken t0 pay this claim. Bring Witnesses, receipts, and any evidence you need t0 prove your case. Read this form and all pages attached t0 understand the claim against you and t0 protect your rights. Aviso al Demandado: Usted es el Demandado si su nombre figura en® de 1a pégina 2 de este formulatio. La persona que 10 demanda es el Demandante, 1a que figura en CD de 1a pégina 2. Usted y el Demandante tienen que presentarse en 1a corte en 1a fecha del juicio indicada a continuacién. Si n0 se presenta, puede perder el caso. Si pierde el caso 1a corte podria ordenar que le quiten de su sueldo, dinero u otros bienes para pagar este reclamo. Lleve testigos, recibos y cualquier otra prueba que necesite para probar su caso. Clerk stamps date here when form is filed. IEIectronically Filed by Superior Court of CA, County of Santa Clara, on 5/27/2020 4:52 PM |Reviewed By: D. Pinheiro Case #208C083462 IEnvelope: 4384710 Fill in court name and street address: Superior Court of California, County of Santa Clara Downtown Superior Court 191 North First Street San Jose, CA 951 13 Court fills in case number when form is filed. Case Number: 208C083462 Case Name: Justin Lewis-Weber v. Crawford & Company |nt|., |nc., DBA Broadspire Lea este formulario y todas las péginas adjuntas para entender 1a demanda en su contra y para proteger sus derechos. Order to Go to Court The people in Q) and ® must go to court: (Clerkfills outsectz‘on below.) Trial -> Date Time Department Name and address 0f court, if different from above 1,09/10/20 8:30 am 15 2. 3. Date: 6/3/2020 Clerk, by D- Pinheiro , Deputy Instructions for the person suing: You are the plaintiff. The person you are suing is the defendant. Before you fill out this form, read form SC-lOO-INFO, Informationfor the Plaintiff, t0 know your rights. Get SC-lOO- INFO at any courthouse 0r county law library, 0r g0 t0 www.courts.ca.g0v/smallclaims/f0rms. Fill out pages 2 and 3 0f this form. Then make copies 0f all pages 0f this form. (Make one copy for each party named in this case and an extra copy for yourself.) Take 0r mail the original and these copies t0 the court clerk’s office and pay the filing fee. The clerk Will write the date 0fyour trial in the box above. You must have someone at least 18-n0t you 0r anyone else listed in this case-give each defendant a court-stamped copy 0f all five pages 0f this form and any pages this form tells you t0 attach. There are special rules for “serving,” 0r delivering, this form t0 public entities, associations, and some businesses. See forms SC-104, SC-104B, and SC-104C. - G0 t0 court 0n your trial date listed above. Bring witnesses, receipts, and any evidence you need to prove your case. SC-1 00, Page 1 of5 9Plaintiff's Claim and ORDERto Go to Small Claims Court (Small Claims) Judicial Council of California, www.courts.ca.gov Revised January 1, 2020, Mandatory Form Code of Civil Procedure, §§ 116.1 10 et seq., 116.220(c), 116.340(g) Generated by Guide and File Plaintiff (list names): Case Number: 208C083462 Justin Lewis-Weber Q) The plaintiff (the person, business, or public entity that is suing) is: Name: Justin Lewis-Weber Phone; 3 10-304-0590 Street address: 3 Peter Coutts Circle Stanford, CA 94305 Street City State Zip Mailing address (zfdifferent): Street City State Zip If more than one plaintiff, list next plaintiff here: Name: Phone: Street address: Street City State Zip Mailing address (ifdiflerent): Street City State Zip U Check here ifmore than two plaintiffs and attachform SC-IOOA. D Check here ifeitherplaintifi’listed above is doing business under afictitious name. Ifso, attachform SC-103. D Check here ifany plaintiffis a ”licensee” 0r “deferred deposit originator” (payday lender) under Financial Code sections 23000 et seq. ® The defendant (the person, business, or public entity being sued) is: Name: Crawford & Company Intl., Inc., DBA Broadspire Phone: Street address: 5335 Triangle Parkway NW Peachtree Corners, GA 30092 Street City State Zip Mailing address (ifdifferent): Street City State Zip If the defendant is a corporation, limited liability company, or public entity, list the person or agent authorized for service of process here: Name: Corporation SGWice Company Job title, if known: Secretary Address: 2710 Gateway Oaks Drive, Suite 150N Sacramento, CA 95833 Street City State Zip D Check here ifyour case is against more than one defendant, and attachform SC-IOOA. D Check here ifanv defendant is 0n active militarv dutv. and write his 0r her name here: ® The plaintiff claims the defendant owes $ $3,817.80 . (Explain below).- a. Why does the defendant owe the plaintiffmoney? I became ill before a trip, and my physician's determined I was unfit to travel. My travel insurance claim was denied on the basis that I did not Visit my physician in person, but my physician was not accepting in person Visits due to COVID-19. When did this happen? (Date): 3/8/2020 b. If n0 specific date, give the time period: Date started.“ Through: c. How did you calculate the money owed t0 you? (D0 not include court costs 0r fees for service.) My policy was purchased for $4,000 of coverage, and I am requesting the total cost of trip, which is my flights from United and my Scuba rental trip purchase, which totals $3,817.80 Check here ifyou need more space. Attach one sheet Ofpaper orform MC-031 and write “SC-I 00, Item 3 ” at the top. ReVisedJanua’y1'2020 Plaintiff’s Claim and ORDER to Go to Small Claims Court 30'1””, P3992“ (Small Claims) 9 Plaintiff (list names): Case Number: 2080083462Justin Lewis-Weber Q) You must ask the defendant (in person, in writing, or by phone) to pay you before you sue. If your claim is for possession of property, you must ask the defendant to give you the property. Have you done this? Yes D N0 If no, explain Why not: @ Why are you filing your claim at this courthouse? This courthouse covers the area (check the one that applies): a. (1) Where the defendant lives 0r does business. (4) Where a contract (written 0r spoken) was made, (2) Where the plaintiff s property was damaged. signed, performed, 0r broken by the defendant 0r (3) Where the plaintiff was injured. Where the defendant lived 0r did business When the defendant made the contract. b. Q Where the buyer 0r lessee signed the contract, lives now, 0r lived When the contract was made, if this claim, is about an offer 0r contract for personal, family, 0r household goods, services, 0r loans. (Code Civ. Proc., § 395(b).) c. Q Where the buyer signed the contract, lives now, 0r lived When the contract was made, if this claim is about a retail installment contract (like a credit card). (Civ Code, § I812. I 0.) d. Q Where the buyer signed the contract, lives now, 0r lived When the contract was made, 0r Where the vehicle is permanently garaged, if this claim is about a vehicle finance sale. (Civ Code, § 2984.4.) e. D Other (specifiz): List the zip code of the place checked in @ above (ifyou know): 94305 ls your claim about an attorney-client fee dispute? D Yes No Ifyes, and ifyou have had arbitration, fill outform SC-IOI, attach it t0 thisform, and check here: D Are you suing a public entity? D Yes No Ifyes, you mustfile a written claim with the entilyfirst. D A claim was filed 0n (date): Ifthe public entity denies your claim 0r does not answer within the time allowed by law, you canfile thisform. Have you filed more than 12 other small claims within the last 12 months in California? D Yes N0 Ifyes, thefilingfeefor this case will be higher. ls your claim for more than $2,500? Yes U N0 Ifyes, I have notfiled, and understand that I cannotfile, more than two small claims casesfor more than $2,500 in California during this calendar year. I understand that by filing a claim in small claims court, I have no right to appeal this claim. I declare, under penalty 0f perjury under California State law, that the information above and 0n any attachments t0 this form is true and correct. Date; 5/27/2020 Justin Lewis-Weber ’/s/ Justin Lewis-Weber Plaintifi’types orprints name here Plaintiffsigns here Date: Secondplaintifftypes orprints name here Secondplaintiflsigns here Requests for Accommodations Assistive listening systems, computer-assisted real-time captioning, 0r sign language interpreter services are available ifyou ask at least five days before the trial. Contact the clerk’s office for form MC-410, RequestforAccommodations by Persons With Disabilities and Response. (Civ. Code, § 54.8.) RevisedJanua'y1'2020 Plaintiff’s Claim and ORDER to Go to Small Claims Court 30-100! Page 3°f5 (Small Claims) 9 SC-1 00 Information for the defendant (the person being sued) "Small claims court" is a special court where claims for $10,000 or less are decided. Individuals, including "natural persons" and sole proprietors, may claim up to $10,000. Corporations, partnerships, public entities, and other businesses are limited to claims of $5,000. (See below for exceptions.*) The process is quick and cheap. The rules are simple and informal. You are the defendant-the person being sued. The person who is suing you is the plaintiff. DO I need a lawyer? You may talk to a lawyer before or after the case. But you may not have a lawyer represent you in court (unless this is an appeal from a small claims case). How do | get ready for court? You don’t have to file any papers before your trial, unless you think this is the wrong court for your case. But bring to your trial any witnesses, receipts, and evidence that supports your case. And read “Be Prepared for Your Trial” at WWW.courts.ca.gov/smallclaims/prepare. What if | need an accommodation? Ifyou have a disability or are hearing impaired, fill out form MC-410, Request for Accommodations. Give the form to your court clerk or the ADA/ Access Coordinator. What if | don’t speak English well? Ask the court clerk as soon as possible for a court-provided interpreter. You may use form |NT-3OO or local court form to request an interpreter. If a court interpreter is not available at the time of your trial, it may be necessary to reschedule your trial. You cannot bring your own interpreter for the trial unless the interpreter has been approved by the court as a certified, registered, or provisionally qualified interpreter. (See Cal. Rules of Court, rule 2.893, and form |NT-140.) Where can | get the court forms | need? Go to any courthouse or your county law library, or print forms at www. courts. ca.gov/smallclaims/forms. What happens at the trial? The judge wiII listen to both sides. The judge may make a decision at your trial or mail the decision to you later. What if I lose the case?” you lose, you may appeal. You’ll have to pay a fee. (Plaintiffs cannot appeal their own claims.) . If you were at the trial, file form SC-140, Notice oprpeal. You must file within 30 days after the clerk hands or mails you the judge's decision (judgment) on form SC-200 or form SC-130, Notice of Entry of Judgment. . If you were not at the trial, fill out and file form SC-135, Notice of Motion to Vacate Judgment and Declaration, to ask the judge to cancel the judgment (decision). Ifthe judge does not give you a new trial, you have 10 days to appeal the decision. File form SC-140. For more information on appeals, see www.courts.ca.gov/ smallclaims/appeals. Do | have options? Yes. If you are being sued, you can: ' Settle your case before the trial. Ifyou and the plaintiff agree on how to settle the case, the plaintiff must file form CIV-1 10, Request for Dismissal, with the clerk. Ask the Small Claims Advisor for help. Prove this is the wrong court. Send a letter to the court before your trial explaining why you think this is the wrong court. Ask the court to dismiss the claim. You must serve (give) a copy of your letter (by mail or in person) to all parties. (Your letter to the court must say you have done so.) Go to the trial and try to win your case. Bring witnesses, receipts, and any evidence you need to prove your case. To have the court order a witness to go to the trial, fill out form SC-107 (Small Claims Subpoena) and have it served on the witness. Sue the person who is suing you. Ifyou have a claim against the plaintiff, and the claim is appropriate for small claims court as described on this form, you may file Defendant's Claim (form SC-120) and bring the claim in this action. If your claim is for more than allowed in small claims court, you may still file it in small claims court if you give up the amount over the small claims value amount, or you may file a claim for the full value of the claim in the appropriate court. If your claim is for more than allowed in small claims court and relates to the same contract, transaction, matter, or event that is the subject of the plaintiff's claim, you may file your claim in the appropriate court and file a motion to transfer the plaintiff's 's claim to that court to resolve both matters together. You can see a description of the amounts allowed in the paragraph above titled “Small Claims Court.” Agree with the plaintiff's claim and pay the money. Or, if you can’t pay the money now, go to your trial and say you want to make payments. Let the case "default." If you don’t settle and do not go to the trial (default), the judge may give the plaintiff what he or she is asking for plus court costs. If this happens, the plaintiff can legally take your money, wages, and property to pay the judgment. What if | need more time? You can change the trial date if: You cannot go to court on the scheduled date (you will have to pay a fee to postpone the trial), or You did not get served (receive this order to go to court) at least 15 days before the trial (or 20 days if you live outside the county), or You need more time to get an interpreter. One postponement is allowed, and you will not have to pay a fee to delay the trial. Ask the Small Claims Clerk about the rules and fees for postponing a trial. Or fill out form SC-150 (or write a letter) and mail it to the court and to all other people listed on your court papers before the deadline. Enclose a check for your court fees, unless a fee waiver was granted. Need help? Your county’s Small Claims Advisor can help for free. (408) 882-2100 (option #2 then #6) http://www.scscourt.org/se1f_help/smal1_claims/sma11_c1aims_advis m", shTm] Or go to WWW.courts.ca.gov/smallclaims/advisor. * Exceptions: Different limits apply in an action against a defendant who is a guarantor. (See Code Civ. Proc., § 116.220(c).) ReVisedJanua’y1'2020 Plaintiff’s Claim and ORDER to Go to Small Claims Court 30'1””, P3994“ (Small Claims) a SC-1 00 Informacién para el demandado (la persona demandada) La “Corte de reclamos menores” es una corte especial donde se deciden casos por $10,000 o menos. Los individuos, o sea Ias “personas fI’sicas” y Ios propietarios por cuenta propia, pueden reclamar hasta $10,000. Las corporaciones, asociaciones, entidades pUincas y otras empresas solo pueden reclamar hasta $5,000. (Vea abajo para Ias excepciones.*) El proceso es répido y barato. Las reglas son sencillas e informales. Usted es el Demandado-Ia persona que se esté demandando. La persona que Io esté demandando es el Demandante. aNecesito un abogado? Puede hablar con un abogado antes o después del caso. Pero no puede tener a un abogado que Io represente ante Ia corte (a menos que se trate de una apelacién de un caso de reclamos menores). aCémo me preparo para ir a la corte? No tiene que presenter ningunos papeles antes del juicio, a menos que piense que ésta es Ia corte equivocada para su caso. Pero Ileve al juicio cualquier testigos, recibos y pruebas que apoyan su caso. Y lea “Esté preparado para su juicio” en www.courts.ca.gov/reclamosmenores/preparese. LQué hago si necesito una adaptacién? Si tiene una discapacidad o tiene impedimentos de audicién, Ilene el formulario MC-410, Request for Accomodations. Entregue el formulario al secretario de Ia corte o al Coordinador de Acceso/ADA de su corte. LQué pasa si no hablo bien inglés? Solicite un intérprete al secretario de Ia corte Io més pronto posible. Puede usar el formulario |NT-300 o un formulario de su corte local. Si no esté disponible un intérprete de Ia corte para su juicio, es posible que se tenga que cambiar Ia fecha de su juicio. No puede llevar su propio intérprete para el juicio a menos que el intérprete haya sido aprobado por Ia corte como un intérprete certificado, registrado, o provisionalmente calificado. (Vea Ia regla 2.893 de Ias Reglas de Ia Corte de California, y el formulario |NT-140.) aDénde puedo obtener los formularios de la corte que necesito? Vaya a cualquier edificio de Ia corte, Ia biblioteca legal de su condado, o imprima los formularios en www.courts.ca.gov/ smallclaims/forms (pégina esté en inglés). LQué pasa en el juicio? El juez escucharé a ambas partes. El juez puede tomar su decisién durante Ia audiencia o enviérsela por correo después. LQué pasa si pierdo el caso? Si pierde, puede apelar. Tendré que pagar una cuota. (El Demandante no puede apelar su propio reclamo.) . Si estuvo presente en el juicio, Ilene el formulario SC-140, Aviso de apelacio’n (Notice of Appeal). Tiene que presentarlo dentro de 30 dl’as después de que el secretario Ie entregue o enVI’e Ia decisién (fallo) del juez en el formulario SC-200 o SC-130, Aviso de publicacién del faI/o (Notice of Entry of Judgment). . Si no estuvo en el juicio, Ilene y presente el formulario SC-135, Aviso de peticio'n para anular el fallo y Declaracién para pedirle al juez que anule el fallo (decisién). Si Ia corte no Ie otorga un nuevo juicio, tiene 10 dl’as para apelar Ia decisién. Presente el formulario SC-140. Para obtener més informacién sobre Ias apelaciones, vea www. courts.ca.gov/reclamosmenores/apelaciones. aTengo otras opciones? SI’. Si Io estén demandando, puede: . Resolver su caso antes del juicio. Si usted y el Demandante se ponen de acuerdo en cémo resolver el caso, el Demandante tiene que presenter el formulario CIV-1 10, Solicitud de desestimacién (Request for Dismissal) ante el secretario de Ia corte. Pl’dale al Asesor de Reclamos Menores que Io ayude. . Probar que es la corte equivocada. EnVI’e una carta a Ia corte antes del juicio explicando por qué cree que es Ia corte equivocada. Pl’dale a Ia corte que despida el reclamo.Tiene que entregar (dar) una copia de su carta (por correo o en persona) a todas Ias partes. (Su carta a Ia corte tiene que decir que hizo Ia entrega.) . Ir al juicio y tratar de ganar el caso. Lleve testigos, recibos y cualquier prueba que necesite para probar su caso. Si desea que Ia corte emita una orden de comparecencia para que los testigos vayan al juicio, Ilene el formulario SC-107, Citatorio de reclamos menores (Small Claims Subpoena) y entrégueselo legalmente al testigo. . Demandar a la persona que lo demandé. Si tiene un reclamo contra el Demandante, y el reclamo se puede presenter en Ia corte de reclamos menores, tal como se describe en este formulario, puede presenter el formulario SC-120, Reclamo del demandado (Defendant’s Claim) y presentarlo en este mismo caso. Si su reclamo excede el II’mite permitido en Ia corte de reclamos menores, puede igualmente presentarlo en Ia corte de reclamos menores si esté dispuesto a limitar su reclamo al méximo permitido, o puede presenter un reclamo por el monto total en Ia corte apropiada. Si su reclamo excede el II’mite permitido en Ia corte de reclamos menores y esté relacionado con el mismo contrato, transaccién, asunto o acontecimiento que el reclamo del Demandante, puede presenter su reclamo en Ia corte apropiada y presenter una mocién para transferir el reclamo del Demandante a dicha corte, para poder resolver los dos reclamos juntos. Puede ver una descripcién de los montos permitidos en el pérrafo anterior titulado “Corte de reclamos menores”. . Aeptar el reclamo del Demandante y pagar el dinero. O, si no puede pagar en ese momento, vaya al juicio y diga que quiere hacer los pagos. . No ir al juicio y aceptar el fallo por falta de comparecencia. Si no Ilega a un acuerdo con el Demandante y no va al juicio (fallo por falta de comparecencia), el juez Ie puede otorgar al Demandante Io que esté reclamando més los costos de Ia corte. En ese caso, el Demandante legalmente puede tomar su dinero, su sueldo o sus bienes para cobrar el fallo. LQué hago si necesito més tiempo? Puede cambiar Ia fecha del juicio si: ' No puede ir a Ia corte en Ia fecha programada (tendré que pagar una cuota para aplazar el juicio), o ' No Ie entregaron los documentos legalmente (no recibié Ia orden para ir a Ia corte) por Io menos 15 dl’as antes del juicio (é 20 dl’as si vive fuera del condado), o ' Necesita més tiempo para conseguir intérprete. (Se permite un solo aplazamiento sin tener que pagar cuota para aplazar el juicio). PreglJntele al secretario de reclamos menores sobre Ias reglas y Ias cuotas para aplazar un juicio. O Ilene el formulario SC-150 (o escriba una carta) y envielo antes del plazo a Ia corte y a todas Ias otras personas que figuran en sus papeles de Ia corte. Adjunte un cheque para pagar los costos de Ia corte, a menos que Ie hayan dado una exencién. aNecesita ayuda? El Asesor de Reclamos Menores de su condado Ie puede ayudar sin cargo. (408) 882-2100 (option #2 then #6) http://www.scscourt.org/se1f_help/smal1_claims/sma11_c1aims_adVisor.s html O VISIte WWW.courts.ca.gov/reclamosmenores/asesores. * Excepciones: Existen diferentes limites en un reclamo contra un garante. (Vea el Cédigo de Procedimiento Civil, seccién 116.220 (0).) Revised January 1, 2020 Reclamo del Demandante y ORDEN SC-1 00, Page 5 of 5 Para Ir a la Corte de Reclamos Menores (Reclamos Menores) MC-031 _ PLAINTIFF/PETITIONER: Justin Lewis-Weber v. Crawford & Company |nt|., |nc., DBA CASE NUMBER: Br d ir DEFENDANT/RESPONDENT: oa Sp e 203C083462 DECLARATION (This form must be attached to another form or court paper before it can be filed in court.) SC-1 00, Item 3. Explanation of money owed continued: The denial letter from the defendant states "our letter states that "based 0n the documentation received, your loss does not meet the policy criteria for Trip Cancellation coverage as you did not seek in person medical treatment with a physician." // Unfortunately, this is incorrect. I did, in fact, seek in person medical treatment with a physician, however was informed that my health care provider was not seeing patients in person due t0 COVID-19 concerns. The only exception was if this was an emergency, in which case I was directed t0 g0 to the Emergency Room. Because my condition was not an emergency, this would have been an abuse 0f the medical system. Therefore, the policy was demanding that I d0 three things: A. Endanger myselfby entering a doctors office at the peak 0f an epidemic when this was n01: clinically necessary (as determined by my physician) B. Endangering health care professionals (as I had flu-like symptoms, they could not rule out COVID-19) C. Incurring additional cost and unethically burdening the healthcare system by going t0 the Emergency Room When my condition was not an emergency. // Instead 0f doing this, I consulted with my physician as t0 the best course of action, Where he recommended (communicated electronically) that I not attend my trip due t0 my congestion. This is supported by the letter from my physician I provided, and the provided notice from my healthcare provider urging electronic communication instead 0f in person Visits. The letter is dated one day before my communication With Dr. Eisenberg. // LEGAL BASIS // Under the Fair Claims Settlement Practices Regulations, under the CA Code 0f Regulations, Title 10, Chapter 5, Subchapter 7.5, Section 2695.7 "Standards for Prompt, Fair and Equitable Settlements," paragraph (n), the law states "Every insurer requesting a medical examination for the purpose 0f determining liability under a policy provision shall d0 so only When the insurer has a good faith belief that such an examination is reasonably necessary." // It is clear that during a pandemic, requiring a claimant t0 Violate the medical advice 0f his physicians, and potentially commit a crime by intentionally unduly burdening the medical system, would be a Violation 0f "good faith" and constitute an unnecessary examination, rendering the Defendant guilty.// There is legal precedent. According t0 (Egan V. Mutual 0f OmahaInsurance C0. (1979) 24 Cal.3d 809, 817 [169 Cal.Rptr. 691, 620 P.2d 141] “[A]n insurer may breach the covenant 0f good faith and fair dealing When i fails t0 properly investigate its insured’s claim.” // Clearly if the Defendant is making unreasonable demands for information, 0r requiring that I put myself at personal health risk against the direct advice and instruction 0fmy physician in order t0 satisfy their claims process, the Defendant would be guilty 0f acting in bad faith according to the California Insurance Code. // CA Insurance Code, Division 5, Chapter 1, Article 3, Section 14047 states "the insurer, in a timely manner, shall provide the insured With a written status report, establish a primary point 0f contact for the insured, and provide the insured with one 0r more direct means 0f communication With the primary point of contact." // Either myself 0r my employee and assistant, Monet Clayton has called and attempted t0 speak t0 With my point 0f contact, Alexandria Bozzelli, and her manager Idalmis Sanchez, over 22 times since my claim was filed. Not a single time did either answer the phone. Prior t0 this, n0 0f the phone agents would give me either email address or a way t0 contact them. This holds the Defendant in Violation 0f the California Insurance Code, and Alexandria Bozzelli, in Violation of your insurance adjuster license. | declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: 05/27/2020 Justin Lewis-Weber /s/ Justin Lewis-Weber (TYPE 0R PRINT NAME) (SIGNATURE 0F DECLARANT) D Attorneyfor Plaintiff D Petitioner D Defendant D Respondent D 0ther(3pecify): Ffl$££?rééfifié?z?éflfif”;'n$e ATTACHED DECLARATION MC-031 [Rev. July 1, 2005] Page 1 of 1
