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SUPERIOR COURT OF CALIFORNIA
COUNTY OF SAN FRANCISCO
Document Scanning Lead Sheet
Dec-03-2010 10:11 am
Case Number: CSM-10-835916
Filing Date: Dec-03-2010 9:56
Juke Box: 001 Image: 03050254
CLAIM OF PLAINTIFF
SAMIR HOULOUBI HASHIM VS. CAHILL CONSTRUCTION SERVICES, INC.
001003050254
Instructions:
Please place this sheet on top of the document to be scanned.‘Clerk stamps date here when form is filed.
SMALL CLAIMS
Plaintiff's Claim and ORDER
leek Y to Go to Small Claims Court
F
Notice to the person being sued:
* You are the Defendant if your name is listed in @on “ae 2 of this
1 cay ot calito
ses RSS as
form. The person suing you is the Plaintiff, listed in (1) on page 2. pec 03 2010
+ You and the Plaintiff must go to court on the trial date listed below. If you
do not go to court, you may lose the case. CLERK OF THE COURT, /
+ Ifyou lose, the court can order that your wages, money, or property be BY: Der NES
taken to pay this claim.
+ Bring witnesses, receipts, and any evidence you need to prove your case. Fill in court name and street address:
‘Superior Court of California, County of
SMALL CLAIMS
SUNOS OUT
SAN FRANCISCO, CALIFORNIA 94102
* Read this form and all pages attached to understand the claim against
you and to protect your rights.
Aviso al Demandado:
* Usted es el Demandado si su nombre figura en(2) de la pagina 2
de este formulario. La persona que lo demanda es el Demandante, la que
figura en(@)de la pagina 2.
Clerk fills in case number and case name:
Case WRHF- 10-8359 16
Case Name:
Same Hov tovbs Heohon
+ Usted y el Demandante tienen que presentarse en la corte en la fecha del
juicio indicada a continuacién. Si no se presenta, puede perder el caso.
* Si pierde el caso la corte podria ordenar que le quiten de su sueldo, dinero u
otros bienes para pagar este reclamo.
+ Lleve testigos, recibos y cualquier otra prueba que necesite para probar su caso.
. Lea este formulario y todas las paginas adjuntas para entender la demanda en su contra y para proteger sus derechos.
lol ce(-Tm CoMClom omexoll Lad
The people in @ and @ must go to court: (Clerk fills out section below.)
Tim > Department Name and address of court if different from above
220" Plpr "06 Stk Tigen
3.
Date: eo 4 Clerk, by VERLINDA JONES , Deputy
Instructions for the person suing:
You are the Plaintiff. The person you are suing is the Defendant.
Before you fill out this form, read Form SC-150, Information for the Plaintiff (Small Claims), to know your rights.
Get SC-150 at any courthouse or county law library, or go to: www.courtinfo.ca.gov/forms
Fill out pages 2 and 3 of this form. Then make copies of alll pages of this form. (Make 1 copy for each party named in
this case and an extra copy for yourself.) Take or mail the original and these copies to the court clerk’s office and pay
the filing fee. The clerk will write the date of your trial in the box above.
+ You must have someone at least 18—not you or anyone else listed in this case—give each Defendant a court-stamped
copy of all 5 pages of this form and any pages this form tells you to attach. There are special rules for “serving,” or
delivering, this form to public entities, associations, and some businesses. See Forms SC-104, SC-104B,
and SC-104C
+ Go to court on your trial date listed above. Bring witnesses, receipts, and any evidence you need to prove your case.
en
Judicial Council of Califomia, www.courtinfo.ca.gov- Plaintiff's Claim and ORDER $C-100, Page 1 of 5
Cote of Gul Proce, 8511510 04 to Go to Small Claims Court 3
116.220(c), 116.340(9) (Small Claims)GRHATL 0 -8359 16
Y . .
Plaintiff (ist names: Samir tHovlouoi Haskin
@) The Plaintiff (the person, business, or public entity that is suing) is:
Name: Samir Houloubi Hashim Phone:
Street address: 3512 San Bruno Avnue #1 San Francisco ca 94134
Street City State Zip
Maili if di .
ailing address (if different). ona ay Sie ip
If more than one Plaintiff, list next Plaintiff here:
Name: Phone: ( )
Street address:
Street City State Zip
Mailing address (if different):
Street City State Zip
Check here if more than 2 Plaintiffs and attach Form SC-100A.
Check here if either Plaintiff listed above is doing business under a fictitious name. If so, attach Form SC-103.
@ The Defendant (the person, business, or public entity being sued) is:
Name: Cahill Construchon Sevvices Tne. Phone: (415 )986-0600
Street address: 425 California St. # 2300 san Francisco ca 94104
” “Street City ‘State Zip
Mailing address (if different):
‘Street Ciy State Zip
If more than one Defendant, list next Defendant here:
Name: Phone: (___)}
Street address:
Street City State Zip
Mailing address (if different):
Street City State Zp
Check here if more than 2 Defendants and attach Form SC-100A.
Check here if any Defendant is on active military duty, and write his or her name here:
The Plaintiff claims the Defendant owes $ 7,500.00 . (Explain below):
a. Why does the Defendant owe the Plaintiff money? physical and emotional suffering due to a fall at an
artificial side -walk by construction site on Geary blvd. Injuries resulted in right knee, bruises and
extreme pain and inguinal hernia has developed because of this fall. Please see attachment!
b. When did this happen? (Date): December 16, 2009
If no specific date, give the time period: Date started: Through:
c. How did you calculate the money owed to you? (Do not include court costs or fees for service.) TI feel|7, S00 1S wrth
tu oumavet_ A prupiced pan and €ruhcnedl hisWers Z Irae peed cer He |e
Yeas
“1 Check here if you need more space. Attach one sheet of paper or Form MC-031 and write “SC-100, Item 3” at
the top.
a
Rewsed January 1, 2008 Plaintiff's Claim and ORDER SC-100, Page 2 3
to Go to Small Claims Court
(Small Claims)Case Number:
CSM- 10-835916
Plaintiff (list names): _ Carat TC
@) You must ask the Defendant (in person, in writing, or by phone) to pay you before you
sue. Have you done this? TJ Yes No
If no, explain why not: See attachment!
6) Why are you filing your claim at this courthouse?
This courthouse covers the area (check the one that applies):
a. (1) Where the Defendant lives or does business. (4) Where a contract (written or spoken) was made,
(2) Where the Plaintiff's property was damaged. signed, performed, or broken by the Defendant or
(3) Where the Plaintiff was injured. where the Defendant lived or did business when
the Defendant made the contract.
b. Where the buyer or lessee signed the contract lives now, or lived when the contract was made, if this claim
is about an offer or contract for personal, family, or household goods, services, or loans. (Code Civ.
Proc., § 395(b).)
c. Where the buyer signed the contract, lives now, or lived when the contract was made, if this claim is about
aretail installment contract (like a credit card). (Civil Code, § 1812.10.)
d. Where the buyer signed the contract, lives now, or lived when the contract was made, or where the vehicle
is permanently garaged, if this claim is about a vehicle finance sale. (Civil Code, § 2984.4.)
e Other (specify).
G) List the zip code of the place checked in © above (ifyou know): AI
@ Is your claim about an attorney-client fee dispute? O Yes M1 No
If yes, and if you have had arbitration, fill out Form SC-101, attach it to this form, and check here:
Are you suing a public entity? 1 ves & No
Ifyes, you must file a written claim with the entity first. A claim was filed on (date):
If the public entity denies your claim or does not answer within the time allowed by law, you can file this form.
Have you filed more than 12 other small claims within the last 12 months in California?
Yes YJ No Ifyes, the filing fee for this case will be higher.
| understand that by filing a claim in small claims court, | have no right to appeal this claim.
a I have not filed, and understand that I cannot file, more than two small claims cases for more than $2,500 in
California during this calendar year.
I declare, under penalty of perjury under California State law, that the information above and on any attachments to
this form is true and correct.
Date: 11/15/2010 Samir H. Hashim PSR Wi
Plaintiff types or prints name here Plaintiff signs here
Date:
Second Plaintiff types or prints name here Second Plaintiff signs here
Requests for Accommodations
Assistive listening systems, computer-assisted, real-time captioning, or sign language interpreter
= services are available if you ask at least 5 days before the trial. Contact the clerk’s office for Form
MC-410, Request for Accommodations by Persons With Disabilities and Response. (Civil Code, § 54.8.)
en
Revised January 1 2008 Plaintifrs Claim and ORDER SC-100, Page 3 of 5
to Go to Small Claims Court >
(Small Claims)CSM- 10-8359 46
ee
Tomy TIT!) Information for the Defendant (the person being sued)
“Small claims court” is a special court where claims
for $5,000 or less are decided. A “natural person” (not
a business or public entity) may claim up to $7,500,
including a sole proprietor. The process is quick and
cheap. The rules are simple and informal.
You are the Defendant—the person being sued. The
person who is suing you is the Plaintiff.
Do | need a lawyer?
You may talk to a lawyer before or after the case. But you
may not have a lawyer represent you in court (unless this
is an appeal from a small claims case).
How do | get ready for court?
You don’t have to file any papers before your trial, unless
you think this is the wrong court for your case. But bring
to your trial any witnesses, receipts, and evidence that
supports your case. And read “Get Ready for Court” at:
www.courtinfo.ca. gov/selfhelp/smallclaims/getready.htm
What if | need an accommodation?
If you have a disability or are hearing impaired, fill out
Form MC-410, Request for Accommodations. Give the
form to your court clerk or the ADA/Access Coordinator.
What if | don’t speak English well?
Bring an adult who is not a witness to interpret for you, or
ask the court clerk for an interpreter at least five days before
your court date. A court-provided interpreter may not be
available or there may be a fee for using a court interpreter
unless you qualify for a fee waiver. You may ask the court
for a list of interpreters and also the Application for Waiver
of Court Fees and Costs (form FW-001).
Where can | get the court forms | need?
Go to any courthouse or your county law library, or print
forms at: www.courtinfo.ca.gov/forms
What happens at the trial?
The judge will listen to both sides. The judge may make a
decision at your trial or mail the decision to you later.
What if I lose the case?
If you lose, you can appeal. You'll have to pay a fee.
(Plaintiffs cannot appeal their own claims.)
* Ifyou were at the trial, file Form SC-140, Notice of
Appeal. You must file within 30 days after the
judge’s decision.
+ Ifyou were not at the trial, fill out and file Form
SC-135, Notice of Motion to Vacate Judgment and
Declaration, to ask the judge to cancel the judgment
(decision). If the judge does not give you a new
trial, you have 10 days to appeal the decision. File
Form SC-140.
For more information on appeals, see:
www.courtinfo.ca.gov/selfhelp/smallclaims/appeal.him
Revised January 1, 2008,
Plaintiffs Claim and ORDER to Go to Small Claims Court
(Small Claims)
Do | have options?
Yes. If you are being sued, you can:
* Settle your case before the trial. If you and the
Plaintiff agree on how to settle the case, both of you must
notify the court. Ask the Small Claims Advisor for help.
+ Prove this is the wrong court. Send a letter to the
court before your trial, explaining why you think this is
the wrong court. Ask the court to dismiss the claim.
You must serve (give) a copy of your letter (by mail or
in person) to all parties. (Your letter to the court must
say you have done this.)
* Go to the trial and try to win your case. Bring
witnesses, receipts, and any evidence you need to
prove your case. To make sure the witnesses go to the
trial, fill out Form SC-107, and the clerk will subpoena
(order) them to go.
* Sue the person who is suing you. File Form
SC-120, Defendant’s Claim. There are strict filing
deadlines you must follow.
+ Agree with the Plaintiffs claim and pay the
money. Or, if you can’t pay the money now, go to
your trial and say you want to make payments.
* Let the case “default.” If you don’t settle and do not
go to the trial (default), the judge may give the Plaintiff
what he or she is asking for plus court costs. If this
happens, the Plaintiff can legally take your money,
wages, and property to pay the judgment.
What if | need more time?
You can change the trial date if:
+ You cannot go to court on the scheduled date (you will
have to pay a fee to postpone the trial) or
+ You did not get served (receive this order to go to
court) at least 15 days before the trial (or 20 days if you
live outside the county) or
+ You need more time to get an interpreter. One
postponement is allowed, and you will not have to pay
a fee to delay the trial.
Ask the Small Claims Clerk about the rules and fees for
postponing a trial. Or fill out Form SC-110 (or write a
letter) and mail it to the court and to all other people listed
on your court papers before the deadline. Enclose a check
for your court fees, unless a fee waiver was granted.
Need help?
Your county’s Small Claims Advisor can help for free.
Or go to “County-Specific Court Information” at:
www.courtinfo.ca.gov/selfhelp/smaliclaims
‘SG-100, Page 4 of 5
>La “Corte de reclamos menores” es una corte especial
donde se deciden casos por $5,000 6 menos. Una "persona
natural" (que no sea un negocio ni una entidad publica)
puede reclamar hasta $7,500. El proceso es rapido y barato.
Las reglas son sencillas e informales.
Usted es el Demandado — la persona que se esta demand-
ando. La persona que lo esta demandando es el Demandante.
éNecesito un abogado?
Puede hablar con un abogado antes o después del caso.
Pero no puede tener a un abogado que lo represente ante
la corte (a menos que se trate de una apelacién de un caso
de reclamos menores).
~Cémo me preparo para ira la corte?
No tiene que presentar ningunos papeles antes del juicio, a
menos que piense que ésta es la corte equivocada para su
caso. Pero lleve al juicio cualquier testigos, recibos, y
cualquier pruebas que apoyan su caso. Y lea “Prepdrese
para la corte” en: www.courtinfo.ca.gov/selfhelp/espanol/
reclamosmenores/prepararse.htm
éQué hago si necesito una adaptacién?
Si tiene una discapacidad 0 tiene impedimentos de
audici6n, Ilene el formulario MC-410, Request for
Accomodations. Entregue el formulario al secretario de la
corte o al Coordinador de Acceso/ADA de su corte.
éQué pasa si no hablo inglés bien?
Traiga a un adulto que no sea testigo para que le sirva de
intérprete. O pida al secretario de la corte que le asigne uno.
Si quiere que la corte le asigne un intérprete, lo tiene que
pedir como minimo menos cinco dias antes de la fecha en
que tenga que ir a la corte. Es posible que no haya disponible
un intérprete proporcionado por la corte o que tenga que
pagar una cuota por emplear un intérprete de la corte, a
menos que tenga una exencidn de cuotas. Puede pedir a la
corte una lista de intérpretes y la Solicitud de exencion de
cuotas y costos de la corte (formulario FW-001).
zDénde puedo obtener los formularios de la corte
que necesito?
Vaya a cualquier edificio de la corte, la biblioteca legal de
su condado o imprima los formularios en:
www.courtinfo.ca.gov/orms
Qué pasa en el juicio?
El juez escuchara a ambas partes. El juez puede tomar
su decision durante la audiencia o enviarsela por correo
después.
eQué pasa si pierdo el caso?
Si pierde, puede apelar. Tendra que pagar una cuota. (El
Demandante no puede apelar su propio reclamo.)
* Si estuvo presente en el juicio, Ilene el formulario SC-140,
Aviso de apelacion. Tiene que presentarlo dentro de 30 dias
depués de la decision del juez.
+ Si noestuvo en el juicio, Ilene y presente el formulario
SC-135, Aviso de peticién para anular el fallo y
Declaracién para pedirle al juez que anule el fallo
(decisién). Sila corte no le otorga un nuevo juicio, tiene 10
dias para apelar la decisién. Presente el formulario
SC-140.
Para obtener mas informacion sobre las apelaciones, vea:
www.courtinfo.ca.gov/selfhelp/espanol/reclamosmenores/
apelar.htm
Revised January 1, 2008
inforntacion para el demandado (la perso
1 p (la _p na demandada)
Reclamo del Demandante y ORDEN
CSM- 10-835916
éTengo otras opciones?
Si. Si lo estan demandando, puede:
+ Resolver su caso antes del juicio. Si usted y el
Demandante se ponen de acuerdo en resolver el caso,
ambos tienen que notificar a la corte. Pidale al Asesor de
Reclamos Menores que lo ayude.
+ Probar que es la corte equivocada. Envie una carta a la
corte antes del juicio explicando por qué cree que es la
corte equivocada. Pidale a la corte que despida el
reclamo. Tiene que entregar (dar) una copia de su carta
(por correo o en persona) a todas las partes. (Su carta a la
corte tiene que decir que hizo la entrega.)
Ir al juicio y tratar de ganar el caso. Lleve testigos,
recibos y cualquier prueba que necesite para probar su
caso. Para asegurarse que los testigos vayan al juicio,
llene el formulario SC-107, y el secretario emitira una
orden de comparecencia ordenandoles que se presenten.
Demandar a la persona que la demand6. Presente el
formulario SC-120, Reclamo del demandado. Hay fechas
limite estrictas que debe seguir.
+ Aceptar el reclamo del Demandante y pagar el
dinero. O, si no puede pagar en ese momento, vaya al
juicio y diga que quiere hacer los pagos.
No ir al juicio y aceptar el fallo por falta de
comparecencia. Si no llega a un acuerdo con el
Demandante y no va al juicio (fallo por falta de
comparecencia), el juez le puede otorgar al Demandante
lo que esta reclamando mas los costos de la corte. En ese
caso, el Demandante legalmente puede tomar su dinero,
su sueldo o sus bienes para cobrar el fallo.
2Qué hago si necesito mas tiempo?
Puede cambiar la fecha del juicio si:
* No puede ir a la corte en la fecha programada (tendré que
pagar una cuota para aplazar el juicio) 0
* No le entregaron los documentos legalmente (no recibio la
orden para ira la corte) por lo menos 15 dias antes del juicio
(6 20 dias si vive fuera del condado) o
* Necesita mas tiempo para conseguir intérprete. (Se permite un
solo aplazamiento sin tener que pagar cuota para aplazar el
juicio).
Preguntele al secretario de reclamos menores sobre las
teglas y las cuotas para aplazar un juicio. O Ilene el
formulario SC-110 (0 escriba una carta) y envielo antes del
plazo ala corte y a todas las otras personas que figuran en
‘sus papeles de la corte. Adjunte un cheque para pagar los
costos de la corte, a menos que le hayan dado una exenci6n.
@
éNecesita ayuda? El Asesor de Reclamos
Menores de su condado le puede ayudar sin cargo.
O vea “Informacién por condado” en:
www.courtinfo.ca.gov/selfhelp/espanol/reclamosmenores
SC-100, Page 5 of 5
Para Ir a la Corte de Reclamos Menores
(Reclamos Menores)SC.) 9 Inmme
CSM- 10-8359 16
12/03/2010
Dear Sir or Madam:
| want to discuss a matter that is still on my mind concerning an injury resulted from an innocent fall |
suffered on a side walk by Geary Blvd. Near Arguello, and the Chevron Gas Station, on December 16,
2009 at 3:30 p.m. The site was a construction site where there was an artificial passageway for
pedestrians which was specifically designed, supposedly, for the sake of the pedestrian’s safety while
they are crossing by the site on Geary Blvd. In my opinion, this artificial side walk was not safe or at
least made clear and smooth for people to use for the following observed negative points with this
passageway- artificial side walk:
1- No supporting handle bars.
2- Not enough lighting.
3- Road was not leveled or evened out which can cause people to trip, like what happened in my
case then and at the time, meaning, failing of placing a wood board at the point of making a
turn through the artificial side walk passage way.
As a result of this extremely painful fall, | had injured my right knee and my left side got twisted
badly at the time of the fall and then later on, in my opinion, developed what they diagnosed as
inguinal hernia that got repaired this month on Nov. 2nd 2010. My treatment doctors disregard
and had dismissed my claim mentioned to them, that the fall was the cause of the inguinal hernia,
yet, | feel that | am the person who sensed the pain associated with this fall at the time. 1am still in
treatment at San Francisco General Hospital for this injury as of the starting of my follow ups on
December 17, 2009 at 8:00 a.m. By going to the urgent care unit at San Francisco General Hospital
also at the emergency room at California Pacific on California Avenue where | do believe my records
of this injury and the follow up treatment has been documented. Treatment exenses and cost is
been paid and approved by Medical, a State insurance program that | am eligible to receive such
assistance.
| made several attempts to call Cahill Construction Co. to discuss this at the time and by mere chance |
met one of their safety staff employees near their office on Geary Blvd. where | described what
happened to me. However, the very nice lady employee Miss. Ashley said to me that the artificial
passage way was constructed according to city standards and permits and no complaints were found.
Yet, | did say my claim very politely and followed up by making follow up calls but to no avail until
yesterday after | had forwarded my written claim to Cahill Construction via Email. Mr. D. Diamond
responded to me and | explained again to him about the experience. According to Mr. Diamond he has
no information about it and he was to further see if there was to be any documented material about this
at his office.
At the present time, | am feeling better today and | am progressing well in treatment, but | still feel that |
am a victim of this crossing of this artificial passageway on December 16, 2009 and | wonder and
would like to ask again if there is a legal recourse or remedies that | can pursue with this. In my opinion,§C~ 192 Bhw 2?
CSM-10-835916
Ihave suffered because of serious injuries that may be lingering and perhaps, it would be still something
that | have to sort of live with.
Avery innocent walk, on December 16, 2009 3:30 p.m. by a pedestrian who is a citizen and resident of
San Francisco, California
Sincerely yours,
Samir H. Hashim/ 3512 San Bruno Avenue #1 San Francisco, CA 94134
Souk NEE
Preview
IO SUPERIOR COURT OF CALIFORNIA COUNTY OF SAN FRANCISCO Document Scanning Lead Sheet Dec-03-2010 10:11 am Case Number: CSM-10-835916 Filing Date: Dec-03-2010 9:56 Juke Box: 001 Image: 03050254 CLAIM OF PLAINTIFF SAMIR HOULOUBI HASHIM VS. CAHILL CONSTRUCTION SERVICES, INC. 001003050254 Instructions: Please place this sheet on top of the document to be scanned.‘Clerk stamps date here when form is filed. SMALL CLAIMS Plaintiff's Claim and ORDER leek Y to Go to Small Claims Court F Notice to the person being sued: * You are the Defendant if your name is listed in @on “ae 2 of this 1 cay ot calito ses RSS as form. The person suing you is the Plaintiff, listed in (1) on page 2. pec 03 2010 + You and the Plaintiff must go to court on the trial date listed below. If you do not go to court, you may lose the case. CLERK OF THE COURT, / + Ifyou lose, the court can order that your wages, money, or property be BY: Der NES taken to pay this claim. + Bring witnesses, receipts, and any evidence you need to prove your case. Fill in court name and street address: ‘Superior Court of California, County of SMALL CLAIMS SUNOS OUT SAN FRANCISCO, CALIFORNIA 94102 * Read this form and all pages attached to understand the claim against you and to protect your rights. Aviso al Demandado: * Usted es el Demandado si su nombre figura en(2) de la pagina 2 de este formulario. La persona que lo demanda es el Demandante, la que figura en(@)de la pagina 2. Clerk fills in case number and case name: Case WRHF- 10-8359 16 Case Name: Same Hov tovbs Heohon + Usted y el Demandante tienen que presentarse en la corte en la fecha del juicio indicada a continuacién. Si no se presenta, puede perder el caso. * Si pierde el caso la corte podria ordenar que le quiten de su sueldo, dinero u otros bienes para pagar este reclamo. + Lleve testigos, recibos y cualquier otra prueba que necesite para probar su caso. . Lea este formulario y todas las paginas adjuntas para entender la demanda en su contra y para proteger sus derechos. lol ce(-Tm CoMClom omexoll Lad The people in @ and @ must go to court: (Clerk fills out section below.) Tim > Department Name and address of court if different from above 220" Plpr "06 Stk Tigen 3. Date: eo 4 Clerk, by VERLINDA JONES , Deputy Instructions for the person suing: You are the Plaintiff. The person you are suing is the Defendant. Before you fill out this form, read Form SC-150, Information for the Plaintiff (Small Claims), to know your rights. Get SC-150 at any courthouse or county law library, or go to: www.courtinfo.ca.gov/forms Fill out pages 2 and 3 of this form. Then make copies of alll pages of this form. (Make 1 copy for each party named in this case and an extra copy for yourself.) Take or mail the original and these copies to the court clerk’s office and pay the filing fee. The clerk will write the date of your trial in the box above. + You must have someone at least 18—not you or anyone else listed in this case—give each Defendant a court-stamped copy of all 5 pages of this form and any pages this form tells you to attach. There are special rules for “serving,” or delivering, this form to public entities, associations, and some businesses. See Forms SC-104, SC-104B, and SC-104C + Go to court on your trial date listed above. Bring witnesses, receipts, and any evidence you need to prove your case. en Judicial Council of Califomia, www.courtinfo.ca.gov- Plaintiff's Claim and ORDER $C-100, Page 1 of 5 Cote of Gul Proce, 8511510 04 to Go to Small Claims Court 3 116.220(c), 116.340(9) (Small Claims)GRHATL 0 -8359 16 Y . . Plaintiff (ist names: Samir tHovlouoi Haskin @) The Plaintiff (the person, business, or public entity that is suing) is: Name: Samir Houloubi Hashim Phone: Street address: 3512 San Bruno Avnue #1 San Francisco ca 94134 Street City State Zip Maili if di . ailing address (if different). ona ay Sie ip If more than one Plaintiff, list next Plaintiff here: Name: Phone: ( ) Street address: Street City State Zip Mailing address (if different): Street City State Zip Check here if more than 2 Plaintiffs and attach Form SC-100A. Check here if either Plaintiff listed above is doing business under a fictitious name. If so, attach Form SC-103. @ The Defendant (the person, business, or public entity being sued) is: Name: Cahill Construchon Sevvices Tne. Phone: (415 )986-0600 Street address: 425 California St. # 2300 san Francisco ca 94104 ” “Street City ‘State Zip Mailing address (if different): ‘Street Ciy State Zip If more than one Defendant, list next Defendant here: Name: Phone: (___)} Street address: Street City State Zip Mailing address (if different): Street City State Zp Check here if more than 2 Defendants and attach Form SC-100A. Check here if any Defendant is on active military duty, and write his or her name here: The Plaintiff claims the Defendant owes $ 7,500.00 . (Explain below): a. Why does the Defendant owe the Plaintiff money? physical and emotional suffering due to a fall at an artificial side -walk by construction site on Geary blvd. Injuries resulted in right knee, bruises and extreme pain and inguinal hernia has developed because of this fall. Please see attachment! b. When did this happen? (Date): December 16, 2009 If no specific date, give the time period: Date started: Through: c. How did you calculate the money owed to you? (Do not include court costs or fees for service.) TI feel|7, S00 1S wrth tu oumavet_ A prupiced pan and €ruhcnedl hisWers Z Irae peed cer He |e Yeas “1 Check here if you need more space. Attach one sheet of paper or Form MC-031 and write “SC-100, Item 3” at the top. a Rewsed January 1, 2008 Plaintiff's Claim and ORDER SC-100, Page 2 3 to Go to Small Claims Court (Small Claims)Case Number: CSM- 10-835916 Plaintiff (list names): _ Carat TC @) You must ask the Defendant (in person, in writing, or by phone) to pay you before you sue. Have you done this? TJ Yes No If no, explain why not: See attachment! 6) Why are you filing your claim at this courthouse? This courthouse covers the area (check the one that applies): a. (1) Where the Defendant lives or does business. (4) Where a contract (written or spoken) was made, (2) Where the Plaintiff's property was damaged. signed, performed, or broken by the Defendant or (3) Where the Plaintiff was injured. where the Defendant lived or did business when the Defendant made the contract. b. Where the buyer or lessee signed the contract lives now, or lived when the contract was made, if this claim is about an offer or contract for personal, family, or household goods, services, or loans. (Code Civ. Proc., § 395(b).) c. Where the buyer signed the contract, lives now, or lived when the contract was made, if this claim is about aretail installment contract (like a credit card). (Civil Code, § 1812.10.) d. Where the buyer signed the contract, lives now, or lived when the contract was made, or where the vehicle is permanently garaged, if this claim is about a vehicle finance sale. (Civil Code, § 2984.4.) e Other (specify). G) List the zip code of the place checked in © above (ifyou know): AI @ Is your claim about an attorney-client fee dispute? O Yes M1 No If yes, and if you have had arbitration, fill out Form SC-101, attach it to this form, and check here: Are you suing a public entity? 1 ves & No Ifyes, you must file a written claim with the entity first. A claim was filed on (date): If the public entity denies your claim or does not answer within the time allowed by law, you can file this form. Have you filed more than 12 other small claims within the last 12 months in California? Yes YJ No Ifyes, the filing fee for this case will be higher. | understand that by filing a claim in small claims court, | have no right to appeal this claim. a I have not filed, and understand that I cannot file, more than two small claims cases for more than $2,500 in California during this calendar year. I declare, under penalty of perjury under California State law, that the information above and on any attachments to this form is true and correct. Date: 11/15/2010 Samir H. Hashim PSR Wi Plaintiff types or prints name here Plaintiff signs here Date: Second Plaintiff types or prints name here Second Plaintiff signs here Requests for Accommodations Assistive listening systems, computer-assisted, real-time captioning, or sign language interpreter = services are available if you ask at least 5 days before the trial. Contact the clerk’s office for Form MC-410, Request for Accommodations by Persons With Disabilities and Response. (Civil Code, § 54.8.) en Revised January 1 2008 Plaintifrs Claim and ORDER SC-100, Page 3 of 5 to Go to Small Claims Court > (Small Claims)CSM- 10-8359 46 ee Tomy TIT!) Information for the Defendant (the person being sued) “Small claims court” is a special court where claims for $5,000 or less are decided. A “natural person” (not a business or public entity) may claim up to $7,500, including a sole proprietor. The process is quick and cheap. The rules are simple and informal. You are the Defendant—the person being sued. The person who is suing you is the Plaintiff. Do | need a lawyer? You may talk to a lawyer before or after the case. But you may not have a lawyer represent you in court (unless this is an appeal from a small claims case). How do | get ready for court? You don’t have to file any papers before your trial, unless you think this is the wrong court for your case. But bring to your trial any witnesses, receipts, and evidence that supports your case. And read “Get Ready for Court” at: www.courtinfo.ca. gov/selfhelp/smallclaims/getready.htm What if | need an accommodation? If you have a disability or are hearing impaired, fill out Form MC-410, Request for Accommodations. Give the form to your court clerk or the ADA/Access Coordinator. What if | don’t speak English well? Bring an adult who is not a witness to interpret for you, or ask the court clerk for an interpreter at least five days before your court date. A court-provided interpreter may not be available or there may be a fee for using a court interpreter unless you qualify for a fee waiver. You may ask the court for a list of interpreters and also the Application for Waiver of Court Fees and Costs (form FW-001). Where can | get the court forms | need? Go to any courthouse or your county law library, or print forms at: www.courtinfo.ca.gov/forms What happens at the trial? The judge will listen to both sides. The judge may make a decision at your trial or mail the decision to you later. What if I lose the case? If you lose, you can appeal. You'll have to pay a fee. (Plaintiffs cannot appeal their own claims.) * Ifyou were at the trial, file Form SC-140, Notice of Appeal. You must file within 30 days after the judge’s decision. + Ifyou were not at the trial, fill out and file Form SC-135, Notice of Motion to Vacate Judgment and Declaration, to ask the judge to cancel the judgment (decision). If the judge does not give you a new trial, you have 10 days to appeal the decision. File Form SC-140. For more information on appeals, see: www.courtinfo.ca.gov/selfhelp/smallclaims/appeal.him Revised January 1, 2008, Plaintiffs Claim and ORDER to Go to Small Claims Court (Small Claims) Do | have options? Yes. If you are being sued, you can: * Settle your case before the trial. If you and the Plaintiff agree on how to settle the case, both of you must notify the court. Ask the Small Claims Advisor for help. + Prove this is the wrong court. Send a letter to the court before your trial, explaining why you think this is the wrong court. Ask the court to dismiss the claim. You must serve (give) a copy of your letter (by mail or in person) to all parties. (Your letter to the court must say you have done this.) * Go to the trial and try to win your case. Bring witnesses, receipts, and any evidence you need to prove your case. To make sure the witnesses go to the trial, fill out Form SC-107, and the clerk will subpoena (order) them to go. * Sue the person who is suing you. File Form SC-120, Defendant’s Claim. There are strict filing deadlines you must follow. + Agree with the Plaintiffs claim and pay the money. Or, if you can’t pay the money now, go to your trial and say you want to make payments. * Let the case “default.” If you don’t settle and do not go to the trial (default), the judge may give the Plaintiff what he or she is asking for plus court costs. If this happens, the Plaintiff can legally take your money, wages, and property to pay the judgment. What if | need more time? You can change the trial date if: + You cannot go to court on the scheduled date (you will have to pay a fee to postpone the trial) or + You did not get served (receive this order to go to court) at least 15 days before the trial (or 20 days if you live outside the county) or + You need more time to get an interpreter. One postponement is allowed, and you will not have to pay a fee to delay the trial. Ask the Small Claims Clerk about the rules and fees for postponing a trial. Or fill out Form SC-110 (or write a letter) and mail it to the court and to all other people listed on your court papers before the deadline. Enclose a check for your court fees, unless a fee waiver was granted. Need help? Your county’s Small Claims Advisor can help for free. Or go to “County-Specific Court Information” at: www.courtinfo.ca.gov/selfhelp/smaliclaims ‘SG-100, Page 4 of 5 >La “Corte de reclamos menores” es una corte especial donde se deciden casos por $5,000 6 menos. Una "persona natural" (que no sea un negocio ni una entidad publica) puede reclamar hasta $7,500. El proceso es rapido y barato. Las reglas son sencillas e informales. Usted es el Demandado — la persona que se esta demand- ando. La persona que lo esta demandando es el Demandante. éNecesito un abogado? Puede hablar con un abogado antes o después del caso. Pero no puede tener a un abogado que lo represente ante la corte (a menos que se trate de una apelacién de un caso de reclamos menores). ~Cémo me preparo para ira la corte? No tiene que presentar ningunos papeles antes del juicio, a menos que piense que ésta es la corte equivocada para su caso. Pero lleve al juicio cualquier testigos, recibos, y cualquier pruebas que apoyan su caso. Y lea “Prepdrese para la corte” en: www.courtinfo.ca.gov/selfhelp/espanol/ reclamosmenores/prepararse.htm éQué hago si necesito una adaptacién? Si tiene una discapacidad 0 tiene impedimentos de audici6n, Ilene el formulario MC-410, Request for Accomodations. Entregue el formulario al secretario de la corte o al Coordinador de Acceso/ADA de su corte. éQué pasa si no hablo inglés bien? Traiga a un adulto que no sea testigo para que le sirva de intérprete. O pida al secretario de la corte que le asigne uno. Si quiere que la corte le asigne un intérprete, lo tiene que pedir como minimo menos cinco dias antes de la fecha en que tenga que ir a la corte. Es posible que no haya disponible un intérprete proporcionado por la corte o que tenga que pagar una cuota por emplear un intérprete de la corte, a menos que tenga una exencidn de cuotas. Puede pedir a la corte una lista de intérpretes y la Solicitud de exencion de cuotas y costos de la corte (formulario FW-001). zDénde puedo obtener los formularios de la corte que necesito? Vaya a cualquier edificio de la corte, la biblioteca legal de su condado o imprima los formularios en: www.courtinfo.ca.gov/orms Qué pasa en el juicio? El juez escuchara a ambas partes. El juez puede tomar su decision durante la audiencia o enviarsela por correo después. eQué pasa si pierdo el caso? Si pierde, puede apelar. Tendra que pagar una cuota. (El Demandante no puede apelar su propio reclamo.) * Si estuvo presente en el juicio, Ilene el formulario SC-140, Aviso de apelacion. Tiene que presentarlo dentro de 30 dias depués de la decision del juez. + Si noestuvo en el juicio, Ilene y presente el formulario SC-135, Aviso de peticién para anular el fallo y Declaracién para pedirle al juez que anule el fallo (decisién). Sila corte no le otorga un nuevo juicio, tiene 10 dias para apelar la decisién. Presente el formulario SC-140. Para obtener mas informacion sobre las apelaciones, vea: www.courtinfo.ca.gov/selfhelp/espanol/reclamosmenores/ apelar.htm Revised January 1, 2008 inforntacion para el demandado (la perso 1 p (la _p na demandada) Reclamo del Demandante y ORDEN CSM- 10-835916 éTengo otras opciones? Si. Si lo estan demandando, puede: + Resolver su caso antes del juicio. Si usted y el Demandante se ponen de acuerdo en resolver el caso, ambos tienen que notificar a la corte. Pidale al Asesor de Reclamos Menores que lo ayude. + Probar que es la corte equivocada. Envie una carta a la corte antes del juicio explicando por qué cree que es la corte equivocada. Pidale a la corte que despida el reclamo. Tiene que entregar (dar) una copia de su carta (por correo o en persona) a todas las partes. (Su carta a la corte tiene que decir que hizo la entrega.) Ir al juicio y tratar de ganar el caso. Lleve testigos, recibos y cualquier prueba que necesite para probar su caso. Para asegurarse que los testigos vayan al juicio, llene el formulario SC-107, y el secretario emitira una orden de comparecencia ordenandoles que se presenten. Demandar a la persona que la demand6. Presente el formulario SC-120, Reclamo del demandado. Hay fechas limite estrictas que debe seguir. + Aceptar el reclamo del Demandante y pagar el dinero. O, si no puede pagar en ese momento, vaya al juicio y diga que quiere hacer los pagos. No ir al juicio y aceptar el fallo por falta de comparecencia. Si no llega a un acuerdo con el Demandante y no va al juicio (fallo por falta de comparecencia), el juez le puede otorgar al Demandante lo que esta reclamando mas los costos de la corte. En ese caso, el Demandante legalmente puede tomar su dinero, su sueldo o sus bienes para cobrar el fallo. 2Qué hago si necesito mas tiempo? Puede cambiar la fecha del juicio si: * No puede ir a la corte en la fecha programada (tendré que pagar una cuota para aplazar el juicio) 0 * No le entregaron los documentos legalmente (no recibio la orden para ira la corte) por lo menos 15 dias antes del juicio (6 20 dias si vive fuera del condado) o * Necesita mas tiempo para conseguir intérprete. (Se permite un solo aplazamiento sin tener que pagar cuota para aplazar el juicio). Preguntele al secretario de reclamos menores sobre las teglas y las cuotas para aplazar un juicio. O Ilene el formulario SC-110 (0 escriba una carta) y envielo antes del plazo ala corte y a todas las otras personas que figuran en ‘sus papeles de la corte. Adjunte un cheque para pagar los costos de la corte, a menos que le hayan dado una exenci6n. @ éNecesita ayuda? El Asesor de Reclamos Menores de su condado le puede ayudar sin cargo. O vea “Informacién por condado” en: www.courtinfo.ca.gov/selfhelp/espanol/reclamosmenores SC-100, Page 5 of 5 Para Ir a la Corte de Reclamos Menores (Reclamos Menores)SC.) 9 Inmme CSM- 10-8359 16 12/03/2010 Dear Sir or Madam: | want to discuss a matter that is still on my mind concerning an injury resulted from an innocent fall | suffered on a side walk by Geary Blvd. Near Arguello, and the Chevron Gas Station, on December 16, 2009 at 3:30 p.m. The site was a construction site where there was an artificial passageway for pedestrians which was specifically designed, supposedly, for the sake of the pedestrian’s safety while they are crossing by the site on Geary Blvd. In my opinion, this artificial side walk was not safe or at least made clear and smooth for people to use for the following observed negative points with this passageway- artificial side walk: 1- No supporting handle bars. 2- Not enough lighting. 3- Road was not leveled or evened out which can cause people to trip, like what happened in my case then and at the time, meaning, failing of placing a wood board at the point of making a turn through the artificial side walk passage way. As a result of this extremely painful fall, | had injured my right knee and my left side got twisted badly at the time of the fall and then later on, in my opinion, developed what they diagnosed as inguinal hernia that got repaired this month on Nov. 2nd 2010. My treatment doctors disregard and had dismissed my claim mentioned to them, that the fall was the cause of the inguinal hernia, yet, | feel that | am the person who sensed the pain associated with this fall at the time. 1am still in treatment at San Francisco General Hospital for this injury as of the starting of my follow ups on December 17, 2009 at 8:00 a.m. By going to the urgent care unit at San Francisco General Hospital also at the emergency room at California Pacific on California Avenue where | do believe my records of this injury and the follow up treatment has been documented. Treatment exenses and cost is been paid and approved by Medical, a State insurance program that | am eligible to receive such assistance. | made several attempts to call Cahill Construction Co. to discuss this at the time and by mere chance | met one of their safety staff employees near their office on Geary Blvd. where | described what happened to me. However, the very nice lady employee Miss. Ashley said to me that the artificial passage way was constructed according to city standards and permits and no complaints were found. Yet, | did say my claim very politely and followed up by making follow up calls but to no avail until yesterday after | had forwarded my written claim to Cahill Construction via Email. Mr. D. Diamond responded to me and | explained again to him about the experience. According to Mr. Diamond he has no information about it and he was to further see if there was to be any documented material about this at his office. At the present time, | am feeling better today and | am progressing well in treatment, but | still feel that | am a victim of this crossing of this artificial passageway on December 16, 2009 and | wonder and would like to ask again if there is a legal recourse or remedies that | can pursue with this. In my opinion,§C~ 192 Bhw 2? CSM-10-835916 Ihave suffered because of serious injuries that may be lingering and perhaps, it would be still something that | have to sort of live with. Avery innocent walk, on December 16, 2009 3:30 p.m. by a pedestrian who is a citizen and resident of San Francisco, California Sincerely yours, Samir H. Hashim/ 3512 San Bruno Avenue #1 San Francisco, CA 94134 Souk NEE