Proof of Service Summons DLR Civil

Cal. Super. - 6th Dist.March 2, 2021

Electronically Filed by Superior Court of CA, County of Santa Clara, on 4/27/2021 1:23 PM Reviewed By: System System Case #21CV378994 Envelope: 6324949 21CV378994 Santa Clara - Civil System System POS-D10 A'ITORNEY OR PARTY WITHOUTATTORN EY (Name, State Bar number, and address) FOR COURT USE 0NLY VARLACK LEGAL SERVICES Tl EGA VARLACK 225 W WINTON STE 207 HAYWARD, CA 94544 TELEPHONE NO: S1 0-397-2008 FAX NO (Optional): E-MAI L ADDRESS (Optional): tiega@varlacklegal.com ATTORNEY FOR (Name): SUPERIOR COURTOF CALIFORNIA.COUNTY 0F Santa Clara STREErADDRESS: 191 N 1st St MAI LI NG ADDRESS: CITYAND ZIPCODE: SanJose. 951 13 BRANCH NAME: SAN JOSE SUPERIOR COURT PLAI NTI FF / PETITIONERI SHAWN R0BERTSON CASE N U MBER: DEFEN DANT/ RESPONDENT: LUCILLE SALTER PACKARD CHILDREN‘S HOSPITAL AT STANFORD 21 CV378994 Ref. No. or File No.1PROOF OF SERVI CE OF SUMMONS 5546025 (21 0878994) _s (Separate proof of service is required for each party served.) At the time ofservice l was at least 18 years of age and not a party to this action. 2. | served copies of: EDDDEIE ”9519a. summons complaint Alternative Dispute Resolution (ADR) package Civil Case Cover Sheet (served in complex cases only) cross-complaint other (specifiz documents): Summons and Complaint for Da mages (Received Apr 7, 2021 at 12:00PM PDT) 3. a. Pa rty served (specifi/ name ofparg/ as shown on documenm served): LUCILLE SALTER PACKARD CHILDREN'S HOSPITAL AT STAN FORD P' whom substituted service was made) (specifil name and relationship to the party named in item 3a): MICHAEL SZETO, UNIVERSITY COUNSEL 4. Address where the party was served: 450 JANE STAN FORD WAY BLDG 170, 3RD FL, STAN FORD , CA94305 S. l served the pa rty (check proper box) m Person (other than the party in item 3a) served on behalf ofan entity or as an authorized agent (and not a person under item 5b on a. by personal service. I personally delivered the documents listed in item 2 to the party or person authorized to receive service of process for the party (1) on (date): Thu, Apr 22 2021 (2) at (time): 03:02 PM b. D by substituted service. On (date): at (time): l left the documents listed in item 2 with or in the presence of {name and title or relationship to person indicated in item 3): (1) E (business) a person at least 18 years ofage apparently in charge a: the office or usual place of business of the person to be served. I informed him or her ofthe general nature ofthe papers. (2) D (home) a competent member of the household (at least 18 years ofage) at the dWeIIing house or usual place of abode of the party. I informed him or her ofthe general nature ofthe papers. (3) E (physical address unknown) a person at least 18 years ofage apparentiy In charge at the usual mailing address ofthe person to he served, other than a United States Postal Service post offi ce box. | informed him or her ofthe general nature ofthe papers. (4) E Ithereafter mailed (by first-class, postage pre pald) copies of the documents to the person to be served at the place where the copies were left (Code Civ. Proc, § 41S.20). I mailed the documents on (date): from (city): orB a declaration of mailing is attached. (5) E | attach a declaration of diligence statingactions taken first to attempt personal service. FormAdopted for Mandatory Use PROOF 0F SERVICE OF SUMMONS P3391 0"2 Judicial Council ofCaIifornia POS-m 0 [Rev.january 1, 2007] Code of Civil Procedure. § 417.10 PLAI NTIFF / PETITIONER: SHAWN ROBE RTSON CASE NUMBER: DEFENDANT/ RESPONDENT: LUCILLE SALTER PACKARD CHI LDREN'S HOSPITAL AT STAN FORD 21 CV378994 5. c. D by mail and acknowledgment of receipt of service. | mailed the documents listed in item 2 to the party, to the address shown in item 4, by first-class mail, postage prepaid, (1) on (date): (2) from (city): (3) D with two copies of the Notice and Acknowledgment of Receipt and a postage-paid return envelope addressed to me. (Attach completed Notice and Acknowledgement ofReceipt.) (Code Civ. Proc., § 41 5.30.) (4) D to an address outside California with return receipt requested. (Code Civ. Proc.. § 415.40.) d. E by other means (specifi/ means ofservice and authorizing code section): E] Additional page describing service is attached. 6. The "Notice to the Person Served" (on the summons) was completed as follows: a. D as an individual defendant. b. E as the person sued under the fictitious name of (specijjl): c. E as occupant. d. m On behalf of (specifl): LUCILLE SALTER PACKARD CHILDREN'S HOSPITAL AT SI'AN FORD under the following Code of Civil Procedure section:m 416.10 (corporatlon) E 415.95 (business organization, form unknown)D 416.20 (defunct corporation) D 416.60 (minor)E 41 6.30 (joint stock compa ny/association) E 41 6.70 (ward or conservatee) E] 416.40 (association or partnership) a 416.90 (authorized person)D 416.50 (public entity) E 415.46 (occupant)D other: 7. Person who served papers a. Name: CHRISTIAAN GONZALEZ b. Address: 225 W Winton Ave ZOZ-D, Hayward, CA 94544 c. Telephone number: 5‘I 0-461-1 1 55 d. The fee for service was: $75.00 e. | am: (1) E not a registered California process server. (2) E exempt from registration under Business and Professions Code section 22350(b). (3) E a registered California process server: (i) D owner E employee m independent contractor (ii) Registration No: 828 (iii) County: ALAMEDA 8. m l declare under penalty of perjury under the laws ofthe State of California that the foregoing is true and correct. or 9. D I am a California sheriff or marshal andl certify that the foregoing is true and correct. Date: 4/26/2021 CHRISI'IAAN GONZALEZ (NAME OF PERSON WHO SERVED PAPERS/ SHERIFF 0R MARSHAL) (élGN'ATURE) POS-mD [RevJanuary 1, 2007] PROOF OF SERVICE OF SUMMONS Page 2 sz