Proof of Service Summons DLR Civil

Cal. Super. - 6th Dist.March 30, 2021

21 CV381 529 Santa Clara - Civil J. Ngo POS-01 0 ATTORNEY 0R PARTY WWHOUT ATTORNEY (Name. State Bar number, and address): FOR COURT USE ONLY Scott Barman SBN 191460 Berman North LLP 2225 E. Bayshore Rd 200 |=an Alto, CA 94303 Electronically Filed TEEHONE No.: (650) 320-1685 FAX No. (Optional): by Superior Court of CA, E'MA‘L ADDRESS (Optima!) scott@bermannorth com county Of santa Clara!' ' on 9/27/2021 11:23 AMATTORNEY FOR (Name): Plaintiff Reviewed By: J. Ngo SUPERIOR COURT 0F CALIFORNIA, COUNTY 0F SANTA CLARA - CENTRAL (EFILING) Case #21 CV381 529STREETADDRESS: 191 N FirstSt. . MAILWG ADDRESS: 191 N FirstSt. EnvelOpe: 7344243 CITY ANDZIPCODE San Jose. CA951 13 BRANCH NAME- SUPERIOR COURT 0F CALIFORNIA, COUNTY 0F SANTACLARA- CENTRAL (EFILING) PLAINTIFF/PETITIONER: Michael Harbour CASE NUMBER: 21CV381529DEFENDANT/RESPONDENT: PURE BLUE MEDICAL, INC. Ref. No. or File No.:PROOF 0F SERVICE SUMMONS 10262 (Separate proof ofservice is required for each partyserved.) Atthe time ofservice lwas at least 18 years ofage and not a partyto this action. lserved copies of: Summons; Complaint; Notice ofLawsuit; Civil Case Cover Sheet a. Party served (specify name ofparty as shown on documents served): Pure Blue Medical, Inc. b. E Person (otherthan the partyin item 3a) served on behalf ofan entity or as an authorized agent (and nota person under item 5b on whom substituted service was made) (specify name and relationship to the pady named in item 3a}: REEVE BENARON. white, male, 50+, 6'0, 160, gray hair, Agent of service Address where the party was served: 9722 Monte Mar Dr, Los Angeles, CA 90035 | sewed the party (check properbox) a. E by personal service.l personally delivered the documents listed in item 2 to the partyor person authorized to receive service of process forthe party(1 ) on: 7/1 5(2021 (2) at: 10:42 AM b. E by substituted service. On: at: I 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) D (business) a person at |east18 years ofage apparentlyin charge at the office or usual place ofbusinessofthe person to be served. linformed him or her ofthe general nature ofthe papers. (2) (home) a competent member ofthe household (atleast 18 years of age) atthe dweling house orusualE place ofabode ofthe party. | informed him or her ofthe general nature ofthe papers. (3) E (physical address unknown) a person ofatleast 18 years of age apparenflyin charge atthe usualmailing address ofthe person to be served. other than a United States Postal Service post office box I informed him or her ofthe general nature ofthe papers. (4) ”hereafter mailed (byfirst-class. postage prepaid) copies ofthe documents to the person to be served atE the place where the copies were left (Code Civ. Proc.. § 415.20). I mailed the documents: on: from: or Ea declaration ofmailing is attached. Page‘l 013 POS-mo [Rem January1. 20073 PROOF 0F SERVICE OFSUMMONS ln v0 ice # 47 1 9386-01 PLAINTiFF/PETITIONER: Michael Harbour CASE NUMBER: DEFENDANTIRESPONDENT: PURE BLUE MEDICAL. INC. 21 CV331529 (5) D Iattach a declaration of diligence stating actions taken firstto attempt personal service. 5. c. E by mall and acknowledgment of receipt of service. l mailed the documents listed in item 2 to the party, to the address Shawn in item 4. byfirst-class maii, postage prepaid, (1) 0”: (2) from: (3) E] with two copies ofthe Notice and AcknowledgmentofReceiptand a pustage-paid return envelope addressed to me. (Attach completed Notice and Acknowledgmentof Receipt.) (Code Civ. Proc.. § 415.30.) (4) E to an address outside California with return receipt requested. (Code Civ. Proc.. § 415.40.) d. E by other means (specifi/ means ofserw'ce and authorizing code section):D 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 underthe fictitious name of (special): c. I I as occupant. d. E 0n behalf of (spacffir):Pure Blue Medical. Inc. underthe following Code of Civil Procedure section:E 416.10 (corporation) E 415.95 (business organization. form unknown)E 416.20 (defunct corporation) D 416.60 (minor)D 416.30 (joint stock E 41 6.70 (ward or consenatee)com panylassociation)D 416.40 (association or partnership) E 41 6.90 (authorized person)E 416.50 (public entity) E 415.46 (occupant)E other: 7. Person who served papers a. NamezJohn Gonzalez b. Address: P.O. Box 5383. Walnut Creek, CA 94596 c. Telephone number: 800-675-6666 d. The fee for service was: $75.00 e. lam: (1) E nota registered California process server. (2) D exemptfrom registrah'on under Business and Professions Code secfion 22350(b). (3) E a registered California process server: (i) E owner E employee E independentcontractor. (ii) Registration No.: 2971 (iii) County. Los Angeles POWWRWWM-W PROOF 0F SERVICE OFSUMMONS P=9°=°'3 lnvoice#: 4719386-01 PLAINTIFF/PETmONER: Mohael Harbour CASE NUMBER: DEFENDANTIRESPONDENT: PURE BLUE MEDICAL, INC. 21CV381529 8. E ldeclare under penalty of perjuryunder the laws of the State of California that the foregoing is true and correct. ’ fl. JohnSony ' fie: 0711612021 ngnl MI \llcea ”WWWWHWM PROOFOF SERVICE 0FSUMMONs "8““ lnvoice#: 4719388-01