Declaration CCP 585

Cal. Super. - 6th Dist.March 23, 2021

AWN \DOOH-JONUI 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 21 CV380973 Santa Clara - Civil A. VillanL Electronically Filed LAW OFFICES 0F KENNETH J. FREED by Superior Court of CA, KENNETH J. FREED, ESQ. [State Bar No. 125349] County of Santa Clara, DAVID E. WEEKS, ESQ. [State BarNo. 190542] on 7,20,2021 4.29 PM 14226 Vcntura Boulevard R . d B _ A V."Shannan Oaks, California 91423 eV'ewe y' ' ' anueva (818) 990-0888; (818) 990-1047 Facsimile Case #21CV380973 KFREED@KJFESQ.COM Envelope: 6888768 DWEEKS@KJFESQ.COM Attorneys for Plaintiff CREDITORS ADJUSTMENT BUREAU, INC. Our File No. 6060694 SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA SAN JOSE COURTHOUSE, UNLIMITED CIVIL CREDITORS ADJUSTMENT BUREAU, CASE NO. 21CV380973 INC, ) ) Plaintiff, ) DECLARATION OF LUTHER JAO v. ) PURSUANT To C.C.P. SECTION 585(d) ) BOLT CONSTRUCTION, A ) FAX SIGNATURE PER C.R.C. 2.305(d) CORPORATION; BOLT ) CONSTRUCTION LLC FDBA BOLT ) CONSTRUCTION, A CORPORATION; ) and DOES 1 through 10, Inclusive ) ) ) ) Defendants. I, LUTHER JAO, do hereby declare as follows: 1. I am a Senior Collections Representative of STATE COMPENSATION INSURANCE FUND, plaintiff‘s assignor in the action herein pending. I am personally familiar with the following facts and if called to the stand t0 testify, I could and would competently testify with personal knowledge thereto. 2. The documents and records attached hereto were taken from the files of STATE COMPENSATION INSURANCE FUND and were prepared in the ordinary course 0f business aboutthetime that the occurrences cited therein actually took place by employees and/or agents ofSTATE COMPENSATION INSURANCEFUND having personal knowledge ofthe occurrences which are cited in said documents. Declaration of Luther Jao Pursuant eva t0 C.C.P. Section 585(d) .p OOW-«JONU‘I 11 12 13 l4 15 16 17 18 19 20 21 22 23 24 25 26 27 28 3. As a SeniorCollections Representative OfSTATE COMPENSATION INSURANCE FUND, Ihave personal knowledge regarding all issues relating t0 the accounting system and record keeping of STATE COMPENSATION INSURANCE FUND, including issues relating, but not limited t0, price quoting, invoicing, delivery, and applying payments t0, and collection 0f, customer accounts. As part of my duties as a Senior Collections Representative, I maintain custody and control ofthe files with I'CSpect t0 the account pertaining to Defendants. 4. Plaintiff‘s assignor issued t0 Defendants two (2) workers compensation insurance policies, Policy N0. 9225 l 42~18 (covering the period ofJanuary 30, 20 l 8 to January 30, 20 l 9) and Policy N0. 9225 142-19 (covering the period ofJanuary 30, 2019 to July 22, 2029), to Defendants at Defendant’s instance and request. Defendants became indebted to Plaintiff‘s assignor in the amount 0f $48,095.12 for Policy No. 9225 142-18 and in the amount 0f $1,165.48 for Policy N0. 9225142-19, for insurance premiums earned pursuant t0 the terms and conditions 0f the policies. True and correct copies of the outstanding invoices accurately reflecting the obligation owed by Defendant are attached hereto marked as Exhibit "1" and are incorporated herein by this reference as though fully set forth. I have reviewed the invoices and they correctly reflect the status of Defendant’s account. 5. All amounts indicated on the invoices, including, but not limited t0, the user assessment fund and fraud assessment fund, are mandated by the Insurance Commissioner of the State of California. 6. I am authorized by STATE COMPENSATION INSURANCE FUND to assign the above-referenced accounts for collection in the sum of$49,260.60 and thereby assigned the accounts to CREDITORS ADJUSTMENT BUREAU, INC. for collection with full right t0 file legal action in the name 0f CREDITORS ADJUSTMENT BUREAU, INC. A true and correct copy 0f the Assignment is attached hereto marked as Exhibit "2" and is incorporated herein by this reference as though fully set forth. 7. Although demand has been made upon Defendants for payment of same, Defendants have failed and refuses to pay any sum towards the balance. It is therefore respectfully requested that judgment be entered in favor of Plaintiffand against Defendants in the principal sum of $49,260.60, Declaration of Luther Jao Pursuant to C.C.P. Section 585(d) - 2 - \DOOHJQ 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 interest at 10% per annum from the date 0f default in the complaint, cost 0f suit, plus attorney’s fees pursuant t0 California Civil Code Section 1717.5. I declare under penalty ofperjury under the laws offhe State ofCalifomia that the foregoing is true and correct. Executed on this 12th day 0f July 2021, at West Covina, California. Mm LUTHER JAO Declaration 0f Luther Jao Pursuant to C.C.P. Section 585(d) - 3 - EXHIBIT "1" I I " " AMOUNT DUE DUE DATE STATE $48,095.12 05/26/20 COB)! PENSA‘HON IN EIURANCEFUND w...;=rfiflflk’gflafiNQL99-‘E-9_. RQBOXHM 10000?92251421802000050120320000000004809512117 SAN FRANCISCO. CA 94120-7441 05/01/20 3 A 2 BOLT CONSTRUCTION Gmmp 0 Pmmmmn 9225142 " 18 2 775 KAUFMANN CT D SAN JOSE, CA 95116 NA N & ya CHECKBOXAILEFTFQHADDHESS(»MNGE ;.' ADDRESS cm'. STATE zIP YOUR FINAL AUDIT STATEMENT - 2018 PAY ONLINE at www.statefundca.com or detach here and include this remittance siub with your payment. OUCR DUCK 008R BOLT CONSTRUCTION POLICY #: 92251¢2~18 INCEPTION DATE: 01/30/2018 775 KAUFMANN CT EXPIRATION DATE: 01/30/2019 SAN JOSE, CA 95115 SOURCE: AUDIT MANDATORY INSURANCE SURCHARGES CIGA @2.000001 x 9,509.50 190 RCA @0.81h602 x 57,557.60 468 RCFA @U.255002 X 57,55?.60 146 uanT @0.057307. x 57,557.60 32. SIBT @0.3599OZ x 57,557.60 20? 03H? @0.2655OZ x 57,557.60 152 LEC @0.215002 X 57,557.60 123 TOTAL SURCHARGES 1,322 TOTAL CHARGES 58,880 PAYMENTS a CREDITS PREMIUM PAID 10,374. SURCHARGES PAID 411. TOTAL - PAYMENTS & CREDITS 10.785. BALANCE DUE PAY BY 05/26/2020 $48,095.12 ‘Uh'l'tfahnllllfl PIOI Box 7441 SAN FRANCISCO. CA 94120-7441 PAY 0N LINE a1 www.siateiundca.comFLJhflJ 522mmw14m PAGE 002 0F 002 LP Seerevmsefmpaymenunsuucuons Thankyouhryourbudness Questions? Pay by phone? AddreSS Change? Call BBB'STMEFUND [888-732-8338] STATE COMPfiNSA1"10N IN ~VRANCE FUNO AMOUNT DUE $1,165.48 AMOUNT 1:NCLOSEO 'if. ... ~:-r. ~ , .• .• •,r, • . ;, . ·,. , · · .~ ·. · r .• .. ·., •, OU~ DATE 01/06/20 i'-";•.i.::!,~,-!.,,..!'f •W , . •~• • • . .. P.O. BOX 7441 SAN FRANCISCO, CA 94120-7441 10000992251421900000121219000000000000116548110 12/12/19 0 B 0 BOLT CONSTRUCTION 775 KAUFMANN CT SAN JOSE, CA 95116 GROUP POLICY/UNIT 9225142 - 19 NA R & 0 N 0 □ PAY ONLINE at www.statofundca.com or detach here and include this remittance stub with your payment. YOUR FINAL ESTIMATED STATEMENT - 2019 BOLT CONSTRUCTION 775 KAUFMANN CT SAN JOSB 1 CA 95116 TOTAL CHARGES PAYMENTS & CREDITS INITIAL DEPOSIT PREMIUM PAID SUJI.CilARGES PAID TOTAL - PAYMENTS & CREDITS POLICY#: INCEPTION DATE: BXPIRATION DATB1 SOURCB: 9225142-19 01/30/2019 07/22/2019 PAYROLL RSTlMATBO 21,980.22 4,511. 00CR. 15,035. 32CR 1,268. 42CR 20 ,814.74CR BALANCE DUE PAY BY 01/06/2020 $1,165.48 mm P.O. BOX 7441 - •SAN FRANCISCO, CA 94120-7441 oi22 (NEW 1-16) PAY ONLINE at www.s1atefundca.com PAGE 002 OP 002 LP Thank you for your business, Oue, lions? Pay by phone? Address ChanLlo7 Call 888-STATEFUNO (888-78?.-8338) See reverse for payment instru ctions EXHIBIT "2" I I "2 " ASSIGNMENT Creditors Adjustment Bureau, Inc. 14226 Ventura Blvd. Sherman Oaks, CA 91423 RE: BOLT CONSTRUCTION, A CORPORATIONAND BOLT CONSTRUCTION LLC FDBA BOLT CONSTRUCTION, A CORPORATION For and 0n behalf 0f STATE COMPENSATION INSURANCE FUND, I have been authorized t0 assign the above-referenced accounts for collection against BOLT CONSTRUCTION,A CORPORATIONAND BOLT CONSTRUCTION LLC FDBABOLT CONSTRUCTION, A CORPORATION, and any incidental remedies thereto, to CREDITORS ADJUSTMENT BUREAU, INC, for purposes 0f coliection only. We hereby assign the above-referenced accounts t0 CREDITORS ADJUSTMENT BUREAU, INC., for collection with full right t0 file legal action in the name 0f CREDITORS ADJUSTMENT BUREAU, TNC. 6%“ LUTHER JAO Title: Senior Collections Representative [Fax Signature per C.R.C. 2.305(d); Electronic Signature Per C.R.C. 2.257]