Request Restraining OrderCal. Super. - 6th Dist.January 28, 2021Petition for Workplace Violence Restraining Orders Read How Do l Gel cm Order (o Prohibit Workplace Violence (form WV- IOO-INFO) before completing this form. NOTE: Petitioner must be an employer with standing to bring this action under Code of Civil Procedure section 527.8. Also fill out Confidential CLETS Information (form CLETS-OOI ) with as much information as you know. <1) Petitioner (Employer) a Name: Momentum for MentalHealth isa E corporation D (specifil): and is filing this suit on behalf ofthe employee identified in item® D sole proprielorship b. Lawyer for Petitioner (zfanyfor this case) Name: Adam Fiss Firm Name: Littler Mendelson, P.C. State Bar No.1 Clerk stamps date here when form is filed. FILE JAN 2 8 2021 Fill In court name and street address: 211799 Superior Court of California. County of Santa Clara 161 North First Street San Jose, CA 951 13 Petitioner’s Address (IfIhe petitioner has a lawyer, give the lawyer 's information.) c. Address: 50 W. San Fernando SL, 7th Floor City: San Jose Telephone: (408) 998-4150 E-Mail Address: afiss@littler.com Employee in Need of Protection Full Name: Mai Nguyen Fax: (408) 668-0992 Court fllls in case number when form Is filed. Case Nugbirzc H 00 98 3 8 State: CA Zip: 95113 Sex: D M E F Age: 39 Respondent (Person From Whom Protection Is Sought) FullName: Pedro R.Quinones Age: 56 Address (ifknowrz): City: State: CA Zip: ® Additional Protected Persons a. Are you asking for protection for any family or household members of the employee or for any other employees at the employee‘s workplace or at other workplaces ofthe petitioner? E Yes D No (Ifyes, lisrthem): Full Nam; Hien K. Truong M 42 Ayden K. Truong M 5 52x Ag:W RJiaIiQushimQfimnm E Yes D No Husband E Yes D No Son D Yes D No D Additional protected persons are listed in Attachment 4a. This is not a Court Order. “'““°°“"°"°'°“’°‘"“-W'°°“”‘v°"" Petition for Workplace Violence Restraining Orders (Workplace Violence Prevention) Revised January 1. 201a. Manuawy Form Code ofovil medue. §§ 527.8 and 527.9 WV-100, Page 1 of6 -> K. NGUYEN. FILED BY FAX Case Num?r1 C H 00 98 38 b. Why do these people need protection? (Explain): D Response is stated in Attachment 4b. See attached Declaration in Support of Petition. Relationship of Employee and Respondent a. How does the employee know the respondent? (Describe): D Response is stated in Attachment 5a. Employee provides social services (housing assistance) to clients of Momentum for Mental Health. Respondent is a recurring client who frequently seeks social services at Momentum for Mental Health. b. Respondent D is E is not a current employee of petitioner. (Explain any decision Io retain, terminate, or otherwise discipline the respondent): D Response is stated in Attachment 5b. Venue Why are you filing in this county? (Check all that apply): a. E The respondent lives in this county. b. E The respondent has caused physical or emotional inj ury to the petitioner’s employee in this county. c. E Other (specifii): Threats against Petitioner's em ployees have been made in this county. Other Court Cases a. Has the employee or any ofthe persons named in®been involved in another court case with the respondent? E No D Yes Ifyes, check each kind ofcase and indicate where and when each wasfiled: H. I E: E1 l. i: ES I: Elle H I YE! P (l) D Workplace Violence (2) D Civil Harassment (3) D Domestic Violence (4) D Divorce, Nullity, Legal Separation (5) D Paternity, Parentage, Child Support (6) D Eviction (7) D Guardianship (8) D SmallClaims (9) D Postsecondary School Violence (10) D Criminal (ll) D Other (specifi): b. Are any restraining ordels or criminal protective orders now in effect relating to the employee or any of the persons in@ and the respondent? E No D Yes ([fyes, attach a copy ifyau have one.) This is not a Court Order. Petition for Workplace Violence Restraining Orders WNW» Page 2°” (Workplace Violence Prevention) a Revised Jammy 1. 2018 Case Number: ‘ 21cflQg9833 Description of Respondent's Conduct a. Respondent has (check one or more): (I) D Assaulted, battered, or stalked the employee (2) E Made a credible threat ofviolence against the employee by making knowing or willful statements or engaging in a course of conduct that would place a reasonable person in fear for his or her safety or the safety of his or her immediate family. b. One or more of these acts (check eilher or both): (1) E Took place at the employee’s workplace (2) E Can reasonably be construed to be carried out in the future at the employee‘s workplace Address of workplace: 2001 The Alameda, San Jose, CA 95126 21 15 Thc Alameda, San Jose, CA 95126 c. Describe what happened. (Provide details; include the dates ofall incidents beginning with the most recent; tell who did what t0 whom; identifiz any witnesses): D Response is stated in Attachment 8c. See attached Declaration in Support of Petition. d. Was the employee harmed or injured? E Yes D No (lfyes, describe harm or injuries): D Response is stated in Attachment 8d. Ms. Nguyen has suffered emotional harm, fear and apprehension caused by Respondent's threatening behavior. e. Did the respondent use or threaten to use a gun or any other weapon? E Yes D No (1fyes. describe): D Response is stated in Attachment 8c. Respondent threatened to kill Ms. Nguyen and her colleagues by arson in text messages sent to Ms. Nguyen. Respondent has previously threatened t0 use a knife to harm clients and staffat Riviera Therapeutic Community Living. This is not a Court Order. R""‘“"‘"""2°'° Petition for Workplace Violence Restraining Orders WV“°°' P39°3°fs (Workplace Violence Prevention) '9 Case Nfiuieen ”U 98 3 8 f. For any ofthe incidents described above, did the police come? E Yes D No D I don’t know lfyes, did the employee or the respondent receive an Emergency Protective Order? D Yes E No D I don‘t know If yes, the order protects (check all that apply): D the employee D the respondent D one or more of the persons in @. M(tach a copy ofthe order ifyou have one.) Check the orders you want E ® E Personal Conduct Orders l ask the court t0 order the respondent not to do any 0fthe following things to the employee or to any person to be protected listed in@: a. E Harass, intimidate, molest, attack, strike, stalk, threaten, assault (sexually or otherwise), hit, abuse, destroy personal property of, or disturb the peace of the person. b. E Commit acts of unlawful violence on or make threats ofviolence to the person. . E Follow or stalk the person during work hours or to or from the place ofwork.c d. E Contact Ihc person, either directly or indirectly, by any means, including, but not limited to, in person, by telephone, in writing, by public or private mail, by interoffice mail, by e-mail, by text message, by fax, or by other electronic means. . E Enter the person’s workplace. E Other (specify): D As stated in Attachment 9f. Respondent must not engge in conduct prohibited b) lhe conduct orders listed in section 9a.-f. toward Ms. Eguyen as well as any other employee of Momentum for Mental Health. :‘fifl The respondent will be ordered no! lo take any action Io get the addresses or locations ofany prolecledperson unless (he courlfinds good cause not Io make the order. Stay-Away Order a. I ask Ihc court to order the respondent to stay at least 300 yards away from (check all that apply): (l) E The employee. (8) E The employee’s vehicle. (2) E The other persons listed in @ . (9) E Other (specifiz): Respondent must stay at least 300 yards awgy from the persons/places listed in 9(f) as well as the items (3) E The employee’s workplace. (4) E The employee’s homc' listed in |0(a)(2)-(8) for each person and each (5) D The employee’s school. worksite/facility of Petitioner. (6) D The school ofthe employee’s children. (7) D The place of child care of the employee's children. This is not a Court Order. Petition for Workplace Violence Restraining Orders WV"°°' "9““ (Workplace Violence Prevention) 9 Rmdnmuy 1.2010 CaseNumbgl CHUU 98 38 b. If the court orders the respondent to stay away from all the placas listed above, will he or she still be able to get to his or her home, school, orjob? E Yes D No (Ifno, explain): D Response is stated on Attachment 10b. ® Guns or Other Firearms and Ammunition Does the respondent own or possess any guns or other firearms? D Yes D No E l don’t know lfthejudge grams a protective order. the respondent will be prohibitedfrom owning. possessing, purchasing. receiving, 0r attempting Io purchase or receive a gun. otherfirearm, and ammunition while the proleclive order is in efl‘ecl. The respondent will also be ordered r0 turn in Io law enforcement, or sell (o or store wirh a licensed gun dealer, any guns orfirearms within his or her immediate possession or control. ® ETemporary Restraining Order I request that a Temporary Restraining Order (TRO) be issued against the Respondent to last until the hearing. l am presenting form WV-l IO, Temporary Restraining Order, for the court’s signature together with this Petition. Has the Respondent been told that you were going to go to court to seek a TRO against him/hcr? D Yes E No (Ifyou answered no, explain why below): D Reasons are stated in Attachment 12. Ms. Yiguyen fears that Respondent wiIl engage in physical violence and/or continue to engage in threatening conduct and may engage in physical violence towards her and/or hcr coworkers ifthe TRO is not granted immediately. ® E Request for Less Than Five Days' Notice of Hearing You mus! have your papers personally served on the respondent a! Ieaslfivc days before (he hearing, unless (he court orders a shorter Iimefbr service. (Form WV-200-1NFO explains what is proofofpersonal service. Form WV-200. Proof of Personal Service, may be used Io show the court (hat Ihe papers have been served.) lfyou want there to be fewer than fivc days bctwccn service and the hearing, explain why: D Reasons are stated in Attachment 13. On information and belief, Petitioner believes that serving Respondent may be very difficult. To Petitioner‘s knowledge, Respondent is unemployed and chronically homeless, and has a history of violent and erratic behavior. Therefore, Petitioner requests that service be allowed up to two days before the date for the hearing. E No Fee for Filing l ask that there be no filing fee because the respondent has threatened violence against the employee, or stalked the employee, or acted or spoken in a manner that has placed the employee in reasonable fear ofviolence. This is not a Court Order. Petition for Workplace Violence Restraining Orders WV"°°v Pm 5°” (Workplace Violence Prevention) '9 Rcvlud Jammy 1, 2016 Cm Numbcr 21CH009838 ® D No Fee to Serve Orders I ask the coun to order the shedfl"or marshal to serve the respondent with the others for fi'ee because this request for orficts Is based on a credible threat ofviolence or stalking .@D Court Costs I ask the court to order the mpondcnt to pay my court costs. ® Addltlonal Orders Requested l ask the coun to make the following additional orders (specwr): U Additional ordcts requested am stated in Attachment l7 If Reqnondent needs to contact Petitioner for am reason other than for purposes 0t medical treatment hp mm: dn m Lhmuoh Betitioner' s attorney ot record Littler Mendelson (Adam Fiss) at (408) 9g8-4150. Number ofpaga attached to this ram, if any; | 3 Due; 1/28/2021 Adam J . Fiss ’ Lawyer 's name (ifany) Lawyer 's signature I declare under penalty ofpctjury under the laws of tbc State of California that the information above and on all attachments ls true and oonect. I z v 2. 1 Name ofpemioner r Signature gh7 r . r ; ‘ s Title This Is not a Court Order. WWW" Pefltlon for Workplace Violence Restraining Orden “‘1” “'9‘ 5 °‘ 3 (Workplace Violence Prevention)
