Preview
PCS-040
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and addlnss): FOR counr
Maiko Nakarai-Kanivas Bar No. 271710
UFNiL
_ Lindbergh Porter, Bar No. 100091 ED
Littler Mendelson, PC.
333 Bush Street, 34th Floor
San Francisco, CA 94104
TELEPHONE no; (415) 433- 1940 FAX N0. (Optional) (415) 723-7247
E MAIL woness (Opllonal): Lporter@littler. com / MNakaraiKanivas@littler. corn
WATTORNEYFORMMIIJ) Defendants Sutter Health and Palo Alto Medical Foundation
SUPERIOR COURT OF CALIFORNIA. COUNTY OF Santa Clara
STREET'ADDRESS: 191 N. First Street
MAILING moness;
crrY AND ZIP cone San Jose, CA 95113
BRANCH NAME:
,
PLAINTIFF/PETITIONER: Diana P. Blum, MD.
DEFENDANT/RESPONDENT: Sutter Health, et al. case NUMBER‘
115-CV-‘277582
PROOF OF SERVICE—CIVIL
Check‘ method of service (only one):
JUDGE:
C] By Personal Service By Mail I] D By Overnight Delivery
C] By Messenger Service D By Fax E By Electronic Service DEPT-i 8
(Do not use this proof of servlce to show service of a Summons and complaint.)
1. At the time of service was over 18 years of age and not a party to this action.
I
2. My residence or business address is: _
Littler Me'ndelson, PC, 1255 Treat Boulevard, Suite 600, Walnut Creek, CA 94597
3. it
‘
The fax number or electronic service address from which served the documents is (complete
I if service was by fax or
electronic service): mamartinez@littler.com
2018
4. On (date):-February 8, I sewed the following documents (specify):
NOTICE OF ENTRY OF ORDER. AND JUDGMENT RE DEFENDANTS SUTTER HEALTH AND PALO ALTO
MEDICAL FOUNDATION'S MOTION FOR NONSUIT
CI The documents are listed in the Attachment to Proof of Service—Civil (Documents Served) (form POS-040(D)).
5. I served the documents on the person or persons below, as follows:
a. Name of person sen/ed: Theresa J. Bar-ta: Marcie Isom Fitzsimmons; Hieu Tran Williams
b, B (Complete if sen/ice was by personal service, mail, ovemlght delivery, or messenger servibe.)
Business or residential address where person was served:
Law Offices of Theresa Barta, 5160 Campus Drive, Newport Beach, CA 92660
Gordon & Rees, LLP, 275 Battery Street, Suite 2000, San Francisco, CA 94111
E (Complete if service was by fax or electronic service.)
(1) Fax number or electronic service address where person-was served:
theresa@barta-law.com; Mlsom@grsm.com; ht'ran@grsm.com
(2) Tune of service:
E] The names, addresses, and other applicable information about persons Served is on the Attachment to Proofof
Service—Civil (Persons Served) (form POS-040(P)).
. The documents were served by the following means (specify): E-MAIL
'a. C] By personal service. I personally delivered the documents to the persons at the addresses listed in item 5. (1) For a
party represented by an attorney, delivery was made to the attorney or at the. attorney's office by leaving the documents.
in an envelope or package clearly labeled to identify the attorney being served, with a receptionist or an individual in
charge of the office, between the hours of nine in the morning and five in the evening. (2) For a party, delivery was made
to the party or by leaving thevdocuments at the party‘s residence with some person not younger than 18 years of age
between the hours of eight In the morning and six in the evening.
Page 1 all
FermApmvodIo onue PROOF OF SERVICE .
C IVIL ..
Coda oiCIvll Procedure .. §§ 10.106 101! . 1013 . 1013a .
JudlolapICounelrologualltomlas 2015.5; Cal. Ruins at Court. mlol 2.250. 2.306
POS-OdOlRov.JIly1,2m#AX (Proof of Service) www.mnscagav
MW'@
Ameriuum-mnclna
.
PCS-040
casé we . . _
CASE'NUMBER:
,
Diana Pr. Blum, MD. v. Sutter Health, et al. 115—-CV-277582
6. b. D By United States mail. I enclosed the decuments in a sealed envelope or package addressed to the persons at the
addresses in item 5 and (specify one):
(1) E] deposited the sealed envelopewith the United States Postal-Service. with the postage fully prepaid.
(2) D placed the envelope for collection-and mailing, following our ordinary business practices. I am readily familiar
with this, business's. practice‘for'collecting and processing correspondence for mailing. On the same day that
correspondence is placed for 'c'ollectidn and mailing, it is deposited in the ordinary course of business 'with the
United States Postal Service, in a sealed envelope with postagefully prepaid.
I am a resident or employed in the county where'the mailing occurred. TheLenvelope or package was placed in themail at
(city andstate): Walnut Creek; CA
By overnight delivery. l-enclosed the documents in an envélopeor package provided byan overnight delivery.
carrier and addressed to‘ the persons at the addresses In Item 5-. I placed the envelope or package for collection
and overnight delivery at an office or a regularly utilized drop box of the overnight delivery carrier.
By messenger'service. I served the documents by plating them in an envelope or“ package addressed tothé persons
at the addresses‘listed in item 5 and providing them to a professional messenger service for service. (A declaration by
the meSSenger mast accompany this Proof of ,Service or be contained in theDec/aration of Messenger below.)
By fax, transmission. Based on an agreementof the parties’lo accept service by fax transmission, l faxed the doc’uments
to the persons at the fax numbers listed in item 5. No error was reported by the‘fax machine that I used. A copy of the.
record of the fax transmission, whichj printed out. is attached.
By electronic servlce. Based on a court order or an agreement of'the parties to accept electronic service. caused the I
documents .to be sent to the persons at the electronic service addresses listed in item 5.
I declare under penalty of perjtiry under‘the laws oflthe State of California that'the foregoing is trueand correct.
Date: February 8, '2018
Monica A.M‘artinez, .
(TYPE OR‘PRINT NAME OF DECLARANT)
A .
’ WWI/div & (SIGNATURE OF DECLARANT)
Liz/WM
(II Item 6d above is checked, the-declaration below must be completed or a separate declaration from a messenger must be attached.)
DECLARATION OF MESSENGER
D By personalgservice. I personally delivered the efnvelopeeor package received from the declarant above to the persons at the
addressesfilisted in item 5. (1) For a party represented by an attorney. deli‘very‘was made to the attorney or at the attorney's
office by leaving the documents in an'envelope or package-which was clearly labeled to identify the attorney being sewed,
with a receptionist o‘r‘an indiyiduel in charge of the ’office, between the hours'of nine in the morning and five in the evening, (2)
For a party; delivery was made'to the party or by leaving the documents at the party's residence with some person not younger
than 18*years of age between the hours of eight in the morning and six in the evening.
At the time of service, I was over 18: years of age. I am not a party to the above-referenced legal proceeding.
1 served the envelope or package, as stated above, on (date):
I declare under penalty of perjury under the law's of the State of California that the foregoing is true and correct.
Date:
(NAMED: DECLARANT) (sternum-15,06: oecuuzm‘n
‘Pogn 2 at 3
Poem e. My 1.2011]
PROOF OF'SERVICE—CIVIL
(Proof of Service)
PCS-040
INFORMATION SHEET FOR PROOF OF SERVICE—CIVIL
'( This information sheet is not part of the official proof of service form and does not need to be copied, served, or filed.)
USE OF THIS FORM
Note: This proof of service form should not be used to show proof of service of a summons and complaint. For that
purpose, use Proof of Service of Summons (form PCS-010).
This form is designed to be used to show proof of service of documents by (1) personal service, (2) mail, (3) overnight
delivery. (4) messenger service, (5) fax. or (6) electronictransmission.
Certain documents must be personally served. For example, an order to, show cause and temporary restraining order
generally must be served by personal delivery. You must determine whether a document must be personally delivered
or can be served by mail or another method.
GENERAL INSTRUCTIONS
A person must be over 18' years of age to serve the documents. The person who served the documents must complete
the Proof of Service. A party to the action cannot serve the documents.
The Proof of Service should betyped'or printed. If you have internet access, a fillable-version of this proof of service form
is available at www.courts.ca.gov/'forms.htm.
Completethe top section of the proof of service form as follows:
First box, left side: In this box print the name, address, and telephone number of the person for whom you served the
documents.
Second box, left side: Print thername of the county in which the legal action is filed and the court's address in this box.
The address for the court should be the same as theaddress on the-documents that you served.
Third box left side: Print the names of the plaintiff/petitioner and defendant/respondent in this box. Use the same
names as are on the documents that you served.
Fourth box leftside: Check the method of service that was used. You should check only one method of service and
should show proof of'only one method on the form. If you served a party by several methods, use a separate form
to show each method of service.
Firstbox, log of form. right side: Leave this box blank for the court's use.
Second box, right side: Print the case number in this box. The case nUmber should be the same as the case number
on the documents that you served.
Third box, right side: State the judge and department assigned to the case. if known.
Complete items 1—6:
1. You are stating that you are over the age of 18 and‘that you are not a party to this action.
2. Print your home or business address.
3. It service was by fax service or electronic service. print the fax number or electronic service address from which service
was made.
4. List each document that you served. If you need more space. check the box in item 4. complete the Attachment to
Proof of Service—Civil (Documents Served) (form PCS-040(0)). and attach it to form PCS-040.
5. Provide the names, addresses. and other applicable information about the persons sewed. If more than one
‘
person was served, check the box on item 5, complete theAttachment to Proof of Service—Civil (Persons Served)
(form POS-O40(P)). and attach it to form PCS-040.
6. Check the box before the method of service that was used. and provideany additional information that is required.
The law may require that documents be served in a particular manner (such as by personal delivery) for certain
purposes. Service by faxor electronic transmission generally requires the prior agreement of the parties.
You must slgn and date the proof of service form. By signing. you are stating under penalty of perjury that the
jnfor‘rnation that you have provided on form PCS-040 is true and correct.
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mm IRW- My 1-- 201" PROOF OF SERVICE—CIVIL
(Proof of Service)
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Anurkankg-l-Vehlne.
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Preview
PCS-040 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and addlnss): FOR counr Maiko Nakarai-Kanivas Bar No. 271710 UFNiL _ Lindbergh Porter, Bar No. 100091 ED Littler Mendelson, PC. 333 Bush Street, 34th Floor San Francisco, CA 94104 TELEPHONE no; (415) 433- 1940 FAX N0. (Optional) (415) 723-7247 E MAIL woness (Opllonal): Lporter@littler. com / MNakaraiKanivas@littler. corn WATTORNEYFORMMIIJ) Defendants Sutter Health and Palo Alto Medical Foundation SUPERIOR COURT OF CALIFORNIA. COUNTY OF Santa Clara STREET'ADDRESS: 191 N. First Street MAILING moness; crrY AND ZIP cone San Jose, CA 95113 BRANCH NAME: , PLAINTIFF/PETITIONER: Diana P. Blum, MD. DEFENDANT/RESPONDENT: Sutter Health, et al. case NUMBER‘ 115-CV-‘277582 PROOF OF SERVICE—CIVIL Check‘ method of service (only one): JUDGE: C] By Personal Service By Mail I] D By Overnight Delivery C] By Messenger Service D By Fax E By Electronic Service DEPT-i 8 (Do not use this proof of servlce to show service of a Summons and complaint.) 1. At the time of service was over 18 years of age and not a party to this action. I 2. My residence or business address is: _ Littler Me'ndelson, PC, 1255 Treat Boulevard, Suite 600, Walnut Creek, CA 94597 3. it ‘ The fax number or electronic service address from which served the documents is (complete I if service was by fax or electronic service): mamartinez@littler.com 2018 4. On (date):-February 8, I sewed the following documents (specify): NOTICE OF ENTRY OF ORDER. AND JUDGMENT RE DEFENDANTS SUTTER HEALTH AND PALO ALTO MEDICAL FOUNDATION'S MOTION FOR NONSUIT CI The documents are listed in the Attachment to Proof of Service—Civil (Documents Served) (form POS-040(D)). 5. I served the documents on the person or persons below, as follows: a. Name of person sen/ed: Theresa J. Bar-ta: Marcie Isom Fitzsimmons; Hieu Tran Williams b, B (Complete if sen/ice was by personal service, mail, ovemlght delivery, or messenger servibe.) Business or residential address where person was served: Law Offices of Theresa Barta, 5160 Campus Drive, Newport Beach, CA 92660 Gordon & Rees, LLP, 275 Battery Street, Suite 2000, San Francisco, CA 94111 E (Complete if service was by fax or electronic service.) (1) Fax number or electronic service address where person-was served: theresa@barta-law.com; Mlsom@grsm.com; ht'ran@grsm.com (2) Tune of service: E] The names, addresses, and other applicable information about persons Served is on the Attachment to Proofof Service—Civil (Persons Served) (form POS-040(P)). . The documents were served by the following means (specify): E-MAIL 'a. C] By personal service. I personally delivered the documents to the persons at the addresses listed in item 5. (1) For a party represented by an attorney, delivery was made to the attorney or at the. attorney's office by leaving the documents. in an envelope or package clearly labeled to identify the attorney being served, with a receptionist or an individual in charge of the office, between the hours of nine in the morning and five in the evening. (2) For a party, delivery was made to the party or by leaving thevdocuments at the party‘s residence with some person not younger than 18 years of age between the hours of eight In the morning and six in the evening. Page 1 all FermApmvodIo onue PROOF OF SERVICE . C IVIL .. Coda oiCIvll Procedure .. §§ 10.106 101! . 1013 . 1013a . JudlolapICounelrologualltomlas 2015.5; Cal. Ruins at Court. mlol 2.250. 2.306 POS-OdOlRov.JIly1,2m#AX (Proof of Service) www.mnscagav MW'@ Ameriuum-mnclna . PCS-040 casé we . . _ CASE'NUMBER: , Diana Pr. Blum, MD. v. Sutter Health, et al. 115—-CV-277582 6. b. D By United States mail. I enclosed the decuments in a sealed envelope or package addressed to the persons at the addresses in item 5 and (specify one): (1) E] deposited the sealed envelopewith the United States Postal-Service. with the postage fully prepaid. (2) D placed the envelope for collection-and mailing, following our ordinary business practices. I am readily familiar with this, business's. practice‘for'collecting and processing correspondence for mailing. On the same day that correspondence is placed for 'c'ollectidn and mailing, it is deposited in the ordinary course of business 'with the United States Postal Service, in a sealed envelope with postagefully prepaid. I am a resident or employed in the county where'the mailing occurred. TheLenvelope or package was placed in themail at (city andstate): Walnut Creek; CA By overnight delivery. l-enclosed the documents in an envélopeor package provided byan overnight delivery. carrier and addressed to‘ the persons at the addresses In Item 5-. I placed the envelope or package for collection and overnight delivery at an office or a regularly utilized drop box of the overnight delivery carrier. By messenger'service. I served the documents by plating them in an envelope or“ package addressed tothé persons at the addresses‘listed in item 5 and providing them to a professional messenger service for service. (A declaration by the meSSenger mast accompany this Proof of ,Service or be contained in theDec/aration of Messenger below.) By fax, transmission. Based on an agreementof the parties’lo accept service by fax transmission, l faxed the doc’uments to the persons at the fax numbers listed in item 5. No error was reported by the‘fax machine that I used. A copy of the. record of the fax transmission, whichj printed out. is attached. By electronic servlce. Based on a court order or an agreement of'the parties to accept electronic service. caused the I documents .to be sent to the persons at the electronic service addresses listed in item 5. I declare under penalty of perjtiry under‘the laws oflthe State of California that'the foregoing is trueand correct. Date: February 8, '2018 Monica A.M‘artinez, . (TYPE OR‘PRINT NAME OF DECLARANT) A . ’ WWI/div & (SIGNATURE OF DECLARANT) Liz/WM (II Item 6d above is checked, the-declaration below must be completed or a separate declaration from a messenger must be attached.) DECLARATION OF MESSENGER D By personalgservice. I personally delivered the efnvelopeeor package received from the declarant above to the persons at the addressesfilisted in item 5. (1) For a party represented by an attorney. deli‘very‘was made to the attorney or at the attorney's office by leaving the documents in an'envelope or package-which was clearly labeled to identify the attorney being sewed, with a receptionist o‘r‘an indiyiduel in charge of the ’office, between the hours'of nine in the morning and five in the evening, (2) For a party; delivery was made'to the party or by leaving the documents at the party's residence with some person not younger than 18*years of age between the hours of eight in the morning and six in the evening. At the time of service, I was over 18: years of age. I am not a party to the above-referenced legal proceeding. 1 served the envelope or package, as stated above, on (date): I declare under penalty of perjury under the law's of the State of California that the foregoing is true and correct. Date: (NAMED: DECLARANT) (sternum-15,06: oecuuzm‘n ‘Pogn 2 at 3 Poem e. My 1.2011] PROOF OF'SERVICE—CIVIL (Proof of Service) PCS-040 INFORMATION SHEET FOR PROOF OF SERVICE—CIVIL '( This information sheet is not part of the official proof of service form and does not need to be copied, served, or filed.) USE OF THIS FORM Note: This proof of service form should not be used to show proof of service of a summons and complaint. For that purpose, use Proof of Service of Summons (form PCS-010). This form is designed to be used to show proof of service of documents by (1) personal service, (2) mail, (3) overnight delivery. (4) messenger service, (5) fax. or (6) electronictransmission. Certain documents must be personally served. For example, an order to, show cause and temporary restraining order generally must be served by personal delivery. You must determine whether a document must be personally delivered or can be served by mail or another method. GENERAL INSTRUCTIONS A person must be over 18' years of age to serve the documents. The person who served the documents must complete the Proof of Service. A party to the action cannot serve the documents. The Proof of Service should betyped'or printed. If you have internet access, a fillable-version of this proof of service form is available at www.courts.ca.gov/'forms.htm. Completethe top section of the proof of service form as follows: First box, left side: In this box print the name, address, and telephone number of the person for whom you served the documents. Second box, left side: Print thername of the county in which the legal action is filed and the court's address in this box. The address for the court should be the same as theaddress on the-documents that you served. Third box left side: Print the names of the plaintiff/petitioner and defendant/respondent in this box. Use the same names as are on the documents that you served. Fourth box leftside: Check the method of service that was used. You should check only one method of service and should show proof of'only one method on the form. If you served a party by several methods, use a separate form to show each method of service. Firstbox, log of form. right side: Leave this box blank for the court's use. Second box, right side: Print the case number in this box. The case nUmber should be the same as the case number on the documents that you served. Third box, right side: State the judge and department assigned to the case. if known. Complete items 1—6: 1. You are stating that you are over the age of 18 and‘that you are not a party to this action. 2. Print your home or business address. 3. It service was by fax service or electronic service. print the fax number or electronic service address from which service was made. 4. List each document that you served. If you need more space. check the box in item 4. complete the Attachment to Proof of Service—Civil (Documents Served) (form PCS-040(0)). and attach it to form PCS-040. 5. Provide the names, addresses. and other applicable information about the persons sewed. If more than one ‘ person was served, check the box on item 5, complete theAttachment to Proof of Service—Civil (Persons Served) (form POS-O40(P)). and attach it to form PCS-040. 6. Check the box before the method of service that was used. and provideany additional information that is required. The law may require that documents be served in a particular manner (such as by personal delivery) for certain purposes. Service by faxor electronic transmission generally requires the prior agreement of the parties. You must slgn and date the proof of service form. By signing. you are stating under penalty of perjury that the jnfor‘rnation that you have provided on form PCS-040 is true and correct. Page} of 3 mm IRW- My 1-- 201" PROOF OF SERVICE—CIVIL (Proof of Service) Whom @ Anurkankg-l-Vehlne. -