Complaint Limited Up to 10KCal. Super. - 6th Dist.April 1, 2021E-FILED 4/1/2021 12:00 AM Clerk of Court Superior Court of CA, County of Santa Clara 21CV381456 Reviewed By: D Harris 21CV381456 Wm § “Rm? WETHOUT ATTORNEY (Name state bar number and addsass) ‘ FOR coum‘usxa' ONLY Mark R. Nivinskus, Bar No.: 195335 ‘ Nivinskus Law Cramp, A Law Corpm ation 134 W. Wilshire Ave. Fullertim, CA §2832 niggigcaiifsubmxom ?EEEMME N0: (714) 533~8110 FAX No, (Optionar): (714) 533-8828 A1T0RNEY FOR (Name): Plaintiff 21000432 NAME 0F COURT: SUPERIOR COURT 0F CALIFORNIA, COUNTY OF SANTA CLARA STREET ADDRESS: 1531 Ngrflx First St. CITYAND ZEP 000E: San Jose, CA 95113 BRANCH NAME: SANTA CLARA FACILITY PLAINTIFF: PROGRESSIVE WEST INSURANCE COMPANY DEFENDANT: GREGORY S. POWERS EX] DOES 1 T0 20 INCLUSIVE COMPLAINT- Persona! Injury, Property Damage, Wrongfui Deathm AMENBED (Number): Type {check ail that apply): MQTOR VEHIGLE E3 OTHER (specify): Property Bamage D Wrongful Death :3 Fersunal injury [j Other Damages f‘spmfiy}: Jurisdiction (check an that appiy): mes mafia: mAfiTEON ES A LiMiTED CEVEL CASE Amount demanded: $3,458.28 D ACTEON is AN UNLMTEQ cw“. CASE (exceeds $25,000) D.ACTmN as REcLAssuFaEm by this amended complaint3 from iimited to uniimited :Efrom uniimited to limited 1. PLAINTIFF (name): PROGRESSIVE WEST INSURANCE COMPANY alieges causes of acfiian against DEFENDANT (name): GREGORY S. POWERS ;DOES 1 TO 20, INCLUSIVE 2. This pieading, including attachments and exhibits, consists of the foiflowing number of pages: 5 3. a. Each plaintiff named above is a competent adult DI! except paaintifimame). PRGGRESSIVE WEST INSURANCE COMPANY (1) 3‘ a corporation qualified to do business In California (2) {:3 an unincorporated entity (describe): (3) [:3 a public entity (descn’bej: (4)E a minor [:3 an adult (a)D for whom a guardian or conservator of the estate or a guardian ad Eitem has been appointed (b)E other (specify).- (5)D other (specify): b. D except plaintiff (name): (1)E a corporation qualified to do business in Caiifornia (2)m an unincorporated entity (describe): (3) C] a public entity (descfibe): (4)D a minor E] an aduit (a)E for whom a guardian or conservator of the estate 0r a guardian ad litem has been appointed (b)E other (specim- (5)B other (specify): _{::jlnformaiion about additional piaintifis who are not competent adults is shown in Complaint-At‘tachment 3.- (Continued on reverse) Pagem 07mm 5&1? wbéamd for Omicnai Use nm«san. dam ma COMPLAINT - PerSonal injury, Propertysud 8: Code cf Civil Pmcedure i § 425.712 PL'J-Pi-{E(HiRev January? 2007‘ Damage wrongful Death I File By Fax 1003-033010246 021033010. 12 Lea & Nivinskus (714) 533-8828 Page 6 of 13 6 of 13 SHORT TETLE: 3 CASE NUMBER: Progressive West Insurance vs Gregory S. Powers 4. E3 Plaintiff (name): ES doing business under the fictitious name of (specifix): and has complied with the fictitious business name flaws, 5. Each defendant named above is a natural person an [j except defendant (name): c.E except defendant (name): (1)Z a business organizatien, form unknown (1)m a business organization, form unknown (2) a corporation (2)m a corporation (3)w an unincorporated entity (describe): (3)m an unincorporated entity (describe): (4)a a pubiic entity (describe): (4) E] a public entity (descn'be): (5)D other (specific: (5) E: other (specifiv); b. {:3 except defendant (name): d.m except defendant (name): (1) E3 a business organization, form unknown (1) W‘a business organization, form unknown (2)m a corporation (2)m a corporatien (3) {:3 an unincorporated entity (descn‘be): (3)m an unincorporated entity (describe): (4) [j a public entity (describe): (4)D a pubiic entity (describe): (5)D other (specify): (5)m other (specify): m information about additionat defendants who are not natural persons is contained in Compiaint-Afiachment 5. 6. The true names of defendants sued as Does are unknown to plaintiff; a. m Doe defendants (specify Doe numbers): were the agents or empioyees of other ““““ named defendants and acted within the scope of that agency Gr employment, b. [EC Doe defendants (specify Doe numbers): 1 to 20 are persons whose capacities are unknown to plaintiff. 7.D Defendants who are joined pursuant to Code of Civil Procedure section 382 are (names): 8. This court is the proper court because a. :at least one defendant now resides in its jurisdictional area. b. the principie place of business 0f a corporation or unincorporated association is in its jurisdictional area. X injury to person or damage to personai property occurred in its jurisdictional area“cu d. [j other {speciMs 9. E] Piaintiff is required to comply with a ciaims statuie. and a. plaintiff has compiied with applicable ciaims statutes. or b, plaintiff is excused from complying because (specify): (Continued on page three) PLD-Pi-Om {Rev January 1‘ 2007] Page two of lhreeCOMPLAENT - Personal injury, Prcperty Damage, Wrongful Death File By Fax 1003-033010246 021033010:12 Lea & Nivinskus (714) 533-8828 Page 70f 13 7 of 1 3 SHORT TETLE: CASE NUMBER: Progressive West Insurance vs Gregory S. Powers 10. The failowing causes of action are attached and the statements above apply to each: (each complaint must have one or more causes of action attached.) a. '1‘ Motor Vehicie Genera! Negligence Intentional Tort Products Liability Premises Liabiiity Other (specify): SEE PAGE S ATTACHMENT #9219 11. Piaintiff has suffered a. [j wage loss bum floss of use of property c.D hospitai and medicai expenses d.E general damage e. property damage f. [:3 floss of earning capacity g,D ether damage (specific): 12.E The damages claimed for wrongful death and the relationship of plaintiff to the deceased are a. D listed in the Compiaint-Attachment 12. b. D as foilows: 13. Relief sought in this complaint is within the jurisdiction of this court. 14. PLAINTIFF PRAYS forjudgment far costs of suit; for such relief as is fair, just, and equitable; and for a. (1) ’1‘ compensatory damages (2) [:3 punitive damages b. The amount of damages is (you must check (1) in cases forpersonai injury or wrongful death): (1) E] according to proof. (2) m in the ameunt oft $3,458.28 plus pre-judgment interest at ths rate of 10% peer annum, pursuant to CCP § 3291K 15. D The following paragraphs of this compiaint are alieged on information and beiief (specify paragraph numbers): A11 Date: March 29, 2021 Mark R. Nivinskus . V............... ( .M’E bkbkm NAME), ,,,,,, . ; ‘ . PLD-Pl-Om [Rev. January 1: 2007} Page three of ihraeCOMPLAENT - Personal injury, Property Damage, Wrongful Death File By Fax 1003-033010246 021033010:12 Lea & Nivinskus (714) 533-8828 Page 8 of 13 8 of 1 3 SHORT TITLE: CASE NUMBER: Progressive West insurance vs Gregory S. Powers First CAUSE CF AQTEQN”MO&OT VBhiCle F‘agefour ATTACHMENT T0 bloompiaint E Cross-Compiaint (£139 a separate cause of action fon’n for each cause of action.) Piaintiff (name): PROGRESSIVE WEST INSURANCE COMPANY MV-1. Plaintiff aiieges the actS of defendants were negligent; the acts were the Eegai (proximate) cause of injuries and damages to piaintiff; the acts occurred on (name): March 28, 20 1 8 at (place): Connie Dr. at Virginia Ave., Campbcll, CA 95008 MV-Z. DEFENDANTS a.mme defendants who operate a motor vehicie are (names): Gregory S. Powers III Does ONE to TWENiYm b. mThe defendants who employed the persons who operated a motor vehicle in the course of their employment are (names): 'i Does ONE to TWENIL a '3 :The defendant who owned the motor vehicle which was operated with their permission are (names): IKE Does ONE to TWENTY d. mThe defendants who entrusted the motor vehicle are (names): mikes ONE tu_mm e. .1. The defendants who were the agents and empioyees 0f the other defendants and acted within the scope 0f the agency were (names): [Emma ONE to TWENTY miisted in Attachment MV-Zfm as foliows: Manes ONE to TWENTY CQMPLAENT - Personai Injury, Property Bamage, File B Fax Wrongful Death ccwmjg 1003-033010246 021033010:12 Lea & Nivinskus (714) 533-8828 Page 9 of 13 9 of 1 3 I'm} N 14‘s U1 h.) (5‘; {\D 2.] Tm) CO ?SHORTTWLE CASENUMBER Progressive West insurance vs Gregory S. Powers Aml.0 At all times relevant plaintiff was and ls duly autho» rized to transact a multiline insurance business in the State Of LWlifornia. Ar2¢0 At a1” times re evant. plaintiff’s insur‘ed Sara Werp vas wavered b}? a p0.1.icy of automxbije Ansuran«c issued by plaintiff. A~3.0 As a result 0f the negligence 0f the defendant(s), plaintiff's insured saC.fered damages which plaintiff was rem quired to pay for purguant to the terms Of the aforamentioned automobile insurance poliC”. “s Amé‘fi Plaintiff’s insured has assigned the right to Uldlrt.*“ to collect any ieducti le pai:j by its insured. Page b ATTACHMENT PAGE - CQMPLAENT File B Fax 1003-033010246 021033010. 12 Lea & Nivinskus (714) 533-8828 Page 10 of 13 1 0 of 1 3
