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PHILIP WERNER, Esq.
1111 Garfield Avenue
Albany, CA 94706-1212
Bar No. 84129
(510) 527-8616 Phone
(510) 527-8629 Fax
Attorney For Plaintiff
=
6 2015 D
LERK OF THE COURT
/E STATE OF CALIFORNIA
SUPERIOR COURT OF CALIFORNIA
COUNTY OF CONTRA COSTA
FEDERATED MUTUAL INSURANCE
COMPANY, a corporation
Plaintiff,
Vs.
FRANCIS ROLANDO MACHADO,
Defendants
et al,
Case No.
EXHIBIT COVER SHEET
cr4-01919
The following exhibits are attached and submitted for the
Court’s consideration:
1. Declaration of Dale Peterson, plaintiff’s insured's
manager of Pre-Owned Sales (Exhibit "1").
2. Declaration of Philip Werner,
Esq. (Exhibit "2").
3. Niello Company Report of Claim (Exhibit "3").¥
ab
wn
é
4. Title and Salvage Worksheet (Exhibit "4").
Respectfully submitted:
April I,
2055
loGip Werner, Esq.
Attorney for PlaintiffEXHIBIT. 1+
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PHILIP WERNER, Esq.
1111 Garfield Avenue
Albany, CA 94706-1212
Bar No. 84129
(510) 527-8616 Phone
(510) 527-8629 Fax
email: PhilWernerLaw@aol.com
Attorney For Plaintiff
SUPERIOR COURT OF CALIFORNIA
COUNTY OF CONTRA COSTA
WAKEFIELD TAYLOR COURTHOUSE
Case No. C14-01919
DECLARATION IN SUPPORT OF
DEFAULT JUDGMENT
(CCP SECTION 585 (d))
FEDERATED MUTUAL INSURANCE
COMPANY, a corporation
. Plaintiff,
Vs.
FRANCIS ROLANDO MACHADO, GUELSI
AGUIAR, JUAN RUIZ, ROADKING AUTO
TRANSPORT CORP., et al,
Defendants
I, DALE PETERSON, hereby declare that if called upon and sworn
as a witness, I would testify competently as follows:
1. At all times herein mentioned I was, and I still am,
employed by NIELLO ACURA, part of THE NIELLO COMPANY, as the
manager of pre-owned vehicle sales, and I am authorized to make the
following representations on its behalf.
2. At all times herein mentioned, THE NIELLO COMPANY was a
corporation, having its principal place of business in the City andPo @ @
County of Sacramento, California, and engaged in the retail sale of
motor vehicles. At the time of the incident that is the subject of
the complaint, THE NIELLO COMPANY was insured with FEDERATED MUTUAL
INSURANCE COMPANY, plaintiff herein, for the losses of the kind
that were described in the complaint.
3. Part of my duties is to manage the inventory of pre-owned
cars at NIELLO ACURA, which entails, among other things, the
purchasing of vehicles to place in inventory. Often, as in this
instance, we will purchase a vehicle as a distant location and have
that vehicle transported to our Sacramento location. For this
purpose NIELLO uses the services of a company called WHITE
LIGHTNING LOGISTICS, an independent transportation broker, which
acts as an agent on our behalf, to make those transportation
arrangements with various common carriers, one of which was
ROADKING AUTO TRANSPORT, INC., a defendant herein.
4. Acting on our behalf, WHITE LIGHTNING. LOGISTICS contracted
with ROADKING AUTO TRANSPORT for the transport of a 2011 Acura RDX
motor vehicle, VIN 578TB1H55BA002872, from Windsor, Florida to our
Sacramento location.
5. A copy of the written terms of the transport contract
between WHITE LIGHTNING TRANSPORTATION, our agent, and ROADKING
AUTO TRANSPORT, are attached hereto as Exhibit "1." Paragraph 1
states, in pertinent part: THE ABOVE-VEHICLE WIL BE HAULED ON THE
ABOVE CARRIER'S TRUCK UNDER YOUR AUTHORITY WITH YOUR INSURANCE.
Paragraph 6 states, in pertinent part: YOU WILL BE RESPONSIBLE FOR
ALL DAMAGE TO THE VEHICLE. .
6. While dn éransté to our location, the Acura sustained such
damage that it was determined to be a total loss and, in fact, ittrecover said loss from the defendants, without success). The
; e @
was never delivered to us. As a result, THE NIELLO COMPANY
Lpresented a claim for the loss of the Acura under and pursuant to
its insurance policy with plaintiff (after first attempting to
price that we originally paid for the Acura was $29,275.00, and at
Ithe time of our purchase, the Acura had ten miles on the odomete
I hereby declare under penalty of perjury, under the laws of
the State of California, that the foregoing is true and correct and
{that the above is. within my. own. personal knowledge. 0g vl
Dated: Blue , 2015, at Sacramento, California
gleeExhibit — 1° . ‘ . @
COMTRACT TERMS *“PLEASE READ CAREFULLY
By Accepting this egreamsni on Central You Agree to he Fettowing:
1. The above vehicis will bs hauied on the above Ganiar's ruck under your authoriy with your ineurancs, and yeu will usa your Bil ai
* Lading form. IF YOU SUB OUT OF DOUGLE BROKER THIS LOAD, erin any way make your insurance Invalid’ on Ils iad YOU WL
NOT BE PAID, NO EXGEPTIONG! We will also be requesting an Insuranes certieals fam your ireurancs. Your payment will be pele
until we gels cariiicate faued from your Inauranes company.
8. IN ORDER TO HAVE YOUR PAPERWORK SUBMITTED TG AGGOUN TING: You must fex us a G0: with an inspection ter ite
order, signed by the parties listed tn this order ONLY. (With the excapiion of reluzals by auctions), Me musi alse ressive a YES be
eligible for payment proosesing. Your WE MUST maich (#6 sesarde via thelr TIN mainhing proeeea. B your W6 doss notmeinn AS
Records, your payment will be delayed urdl your supply us with @ VLG thei dees match, or you may ap ior payment wit 2 deduction
of83% for backup withheiding & papenyerk ‘ee. Hf you de nothans & curentuntoched W-9 on Qentrel, Ris your seaporelility to a 12
1 ve with your paperverk, iiyou sign fer a “company check? en your order wa mall payments $e the address feted on your ALB. Byou
do not provide us with 2 corest address and your "sampany cheat payment goss missing in the mall, tis your resnenzbilly t& nay Sz
the 12 month step payment ize fai our bank charges.
3, YOU MAY NOT CHARGE US FOR EXTRAS: Nothing will be pald for above and beyond whet ls listed Ip this conbect This Incudss
but not innited te: late pickup or celery, far ciorage of any kind, for loading izes ar coors @ Inad inoperable vehicies, nemsonal
properly in the ear, lowered or mediified vehiales, cosis aesoclated wih an operable venlele that becomes maperable during zeneport,
dead batiaries, low or fai ives, or vahiclas that rut cute! fuel, Any auntion sisrage thatis relrnbursed will Be for storage batprs your
Hiok up dats, and must Inelude the ‘perirait’ oritiad receipt showing paymen! yes of “cash”. Ifyou sharge the eusiomer i any otis
above, expect in have i dedugied irom your payment. fi you chergs a GOD eusiomer tor any of ize Tollawing, exnect in mesive
negative feedback, and a biti fram us for reimbursement.
4, YOU WILL CALL AHEAD AND VERIFY INFORMATION ABOUT YOUR VEHIGLE SEFORE ARRIVING FOR PIGKUP. You wif Paid
White Lightning Legietics & Transsori, LLC not atiauitior any vshiele thal Is listed az opsrabie, bulls netaperable upon arrival sims
venisle, vehielse that are nol ready to b9 ransparied, cegardiees of reassn (ales including vehicles not paid tor yet, vehleles hat ars.
ne lenger af the plekup location, or any vahigle that le nat as expesied by the carvisr. No dry run charges will 69 said, and negeive
and neural isedback may nethe leit ior White Lightning Legistes & Transport LLG.
&. YOU) WILL PIGK UP AND DROP OFF YCUR YEHIGLE ON TIME: (There are ne Setimaied dates) Fallurs t do eo may mean hat
Watie Lightning Logisiies & Teanspori LLG may deduct the cost of additional storege irom the sarrlers paymani, of tne carer may be
bilisd for the sisragé cegis. Vehicles must be delivered by the dais specified in this order, and delivery alter te date specifier ati Re
considered a iste delivery, charged at the raie\of 680 per vehicle per day penally.
6. YOU WILL BE RESPONSIBLE FOR DAMAGES TC THE VEHICLES: All damages susiained @ the vehicle during anspor, loadieg,
orunieading are the sols reoponslbillty af the carter even f tie rensiving party cigne a bit of lading, and the carrier shell defend,
indemnify and held hemmiess White Lightning Lagiaties & Tramsnori, LLG for any damage claims assoclsied with Ss oner,. Any
Vehicle picked up at an auaton MUST have ihe damages noied on ihe gals pees. Any-vehicles delivered in the darker daliverac
Girly, wilf be eubjset i Inspeoiien, No vehiclge are shipped "AS-IS" and any damages notnoted al pickup will stil be the responsisiiiey
ofthe carrier. Any payment due fo the sarter fer anspor, will Se held unill all damages i the cusiamers venice have hoon raasived.
in the event that the damages are less thet the contract amourt abave, he cost of re damages will be deducted from the payment, .
and the remainder will be seriis tia carer, the damages are greater, the neyrmert for this order may ge mward ihe canieracaga
deductible. All damages musi be paid in ull sy the accepting carries, with no deductible @ the customer.
7. ¥GU UNDERSTAND THAT THESS VEHICLES BELONG TO GLUSTOMERS OF WHITE LIGHTNING LOGISTICS & TRANSPORT:
This Contract Signed sy the carer is the only Contract in effect during the gansport ef this iead. Ne other contrast shall be made
between tha Caniey and the Shipper or Reosivar af this ioed, Any Bil of Ladings os Involase ar any ather paoergork hei ays signed
by the Shipper or Resaiver can only be used fer nepaciion pumosees, and any contracts regarding iteallily of teeaa are YOR).
YGU WILL NOT DISGUSS PRICING OR PUT PRIGES ON THE BILL OF LADING OR ANY CTHER PAPERWORK SIGNED BY THE
CUSTOMER AT PIGKUP OR DROPOFF. 26 NOT FAX IT TOUS WITH PRICES EITHER, Falluye @ de thie may resuli in a B166.00
penalty at Whits Lighining’s discretion,
we
8.17 1S YOUR RESPONSIBU ITY TO BE RESPONSIBLE! in the event that hs carier does ret kesp t thia caneact, the-nariar agrees
to be reeponsinle for an aduitional sleooure fr penal) af20% wih a minimum fas of $180.00, slus ary and all etameys tees, court° . . . ® ®@
ges, collation ise, ander head fees, and any otter ises or costs eacociated with camplsling this agreement. By sleuiranically
eigning ier this order, he euner al ine Garier's company will be personally responsiate for any costs jor damages or ises inpnsed.
., PLEASE Gh/E THE GUSTOMER AT LEAST A 24 HOUR NOTICE FOR PICKUP AND DELIVERY. PLEASE 00 A THOROUGH
INSPECTION OF THE VEHICLE OM PIGKUP. :
“ Authority te wanepor this vehisie is hereby aselgned is Readking Aute Tranezert Corp, Sy accepting this agrsement Readking Auis
‘Trenapert Carp esrilfies that 8 has the proper legal authority end insurance to cary the above deseribed vahicie, only on tuaks
owned by Readking Auto Transport Garp. All imeises musths accompanied by a signed dellvery recsiptand faxed is Whe
Lightning Legisties & Transport L4G, The above agresd upon priee includes any and elf surchames unises oltehvies egrasd 2 by
both Readking Auto Traneport Gerp and White Lighting Logistics 2 Trenspori LLG.
The agrecment osiween Roadiing Avie Tranopent Corp ane Whits Lightning Lagisiies & Trenenort LLG, as dencibed is hie diesatch
sheel isselely between Roadking Aut Transport Gam and White Uphining Cogistes & Trenepact LLG, Destevvenk Genbelitenatch,
ine, Ie neta garly % such agresment, has ne ebligatian under such agreement and oxorecsly dieciaims alt tabitiy whaisesver arizing
out o€ cr in connesiion with suck agreement
OD relerence # 48SESeeEXHIBIT 2
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_ @||PHEILIP WERNER, Esq.
{}1111 Garfield Avenue
Albany, CA 94706-1212
Bar No. 84129
(510) 527-8616 Phone
(510) 527-8629 Fax
email: PhilWernerLaw@aol.com
Attorney For Plaintiff
SUPERIOR COURT OF CALIFORNIA
I COUNTY OF CONTRA COSTA
WAKEFIELD TAYLOR COURTHOUSE
| FEDERATED MUTUAL INSURANCE : Case No. C14-01919
|COMPANY, a corporation : DECLARATION IN SUPPORT OF
Plaintiff : DEFAULT JUDGMENT
,
(CCP SECTION 585 (d))
Vs.
RANCIS ROLANDO MACHADO, GUELSI
GUITAR, JUAN RUIZ, ROADKING AUTO
‘RANSPORT CORP., et al,
, Defendants
[as a witness, I would testify competently as follows:
1. I am the attorney for the plaintiff, duly licensed to
|{practice law before all the courts in the State of California.
2. 2 am making this declaration, requesting that it be
}| considered along with the Declaration of Dale Peterson, plaintiff's
[Sales Manager, since there are items within my knowledge that are
i/not necessarily within his knowledge.
I, Philip Werner, hereby declare that if called upon and sworna B WN
3. On October 23, 2012, while in transit and being
[transported by a Peterbilt truck, Florida license plate number
[Z4388V, towing a car carrier, on Interstate Highway 5, in the City
fof La Mirada, Los ‘Angeles County, California, the driver of said
truck lost control of it, striking a freeway guardrail, whereupon
said truck collided with a freeway perimeter chain link fence,
|zesulting in a fire and the total destruction of the Acura (please
see attached Traffic Collision Report, Exhibit "i").
4. In actuality, and in contravention of the transportation
contract, as well as the laws of the State of Florida, ROADKING
AUTO TRANSPORT was a dissolved corporation as of September 28,
12012, mineteen days prior to the time that ROADKING accepted the
|contract to transport the Acura (please see Exhibit "2"). In
addition, also in contravention of the transportation contract, the
ltruck that was transporting the Acura was not owned by ROADKING but
|was owned by defendant FRANCIS ROLANDO MACHADO (please see
Certified Record from the State of Florida) (Exhibit "3").
5. As of April 13, 2010, defendant GUELSI AGUIAR was the
President of ROADKING AUTO TRANSPORT, INC. (please see Exhibit
"4") and was the last officer of record for that corporation.
Therefore, under Florida Statute 607.1421, GUELSI AGUIAR is
personally liable for these damages (please see Exhibit "5").
6. As a result of the total loss of the Acura, and under and
lfpursuant to the insurance policy between NIELLO and plaintiff, on
May 20, 2013, plaintiff issued a draft in the amount of $29,275.00,
made payable to The Niello Company, for the total loss value of
I|}said Acura (please see Exhibit "6"), based upon the wholesale price
that The Niello Company paid for the vehicle. At the time of[Niello Acura's purchase of the vehicle, it had ten miles on the
odometer (please see Exhibit "7").
I hereby declare under penalty of perjury, under the laws of
the State of California, that the foregoing is true and correct and
that the above is within my own personal knowledge.
Dated: pl / , 2015, at Sacramento, California
7 :
Philip LE ase.Exhibit — 1DEPARTMENT OF CALIFORNIA HIGHWAY PATROI.
TRAFFIC COLLISION REPORT, . :
CHP $58 Page"! (Rev. 4-1) OPI 060_Fga @ : rap Lia
SPECHY, CONE TONS: ignaer luraan [erry ‘JUDICIAL DISTRICT | LOCAL REPORT NUMBER .
: o | 1) |Ls miaaod Donny {0-34
$ PD [Rasewouro parame [COUNTY REPORTING DISTRICT ‘BEAT JOAY OF WEEK TOW AWAY
o 1D [hes Srteee> Sei |su@wrr apis Ove |
| [OOLUISION OCOURRED ON MO. DAY YEAR [Tne (2400) NCIC GRACERID,
Bl L-5 wR (cower doe ee) pape louse | oso | 13386
fe [Muerostinrormanion =" 35 [GPS GOORDINATES PROTOORAPHB EY! BQNONE
3 recite So GLA fear 33.8°7699" rovers 117 .015¢27
© |Elarinensecnon wrt Srare ree
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parry] ORMERS LIGENGE NUMDER STATE [AREAG [APETV EQUIP, [VEH, YEAR TICENGE NUWBER STATE
T'hese-256—s6e123-0 ja | le | a leet preBhormm/ Bu aussev |p.
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ag fee eles loa lon oewela RADLEY Tywdie® enamali ind og 965-2407
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(OTHER | HOME PHONE BUSINESS PHONE: | VEHICLE IDENTIFICATION NUMBER:
OV186) 23)-"1832 305) 7eK-0010 TERETE — [pena VERE ONCE SDE WORDED ITER
TNSURANCE GARRIER FOLEY NBER Junk. []sone [Juinor
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PARTY [DRIVERS LIGENSE NUMBER STATE [OLABS. [AIRBAG [SAFETY EQUIP. [VEN YEAR | MAKEMODEL/COLOR OENES NUNEER SATE
2
| ORIVER | NAME (FIRST, MIDDLE, LAST) I
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ae STREET ADDRESS
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PRIOR MECHANICAL DEFECTS: [none apparent _[]REFER TO NARRATIVE
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oO VERIGLETYPE [DESCRIBE VERICLE DAMAGE ‘SHADE IN OAMAGED AREA
[ENSURANCE CARRIER POUSY NUMBER [Juxx [Jnone [minor
I Jmop. (Juaior []ROu-oveR
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PREPARERS NAME (DISPATCH NOTIFIED REVIEWERS NAME BATEREVIEWED
BG. HONTANER, 13396 [pes Co Come | A, Power 201U8 let,alt Yemeni Heeritine
+ DEPARTMENT OF CALIFORNIA HIGHWAY PATROL
TRAFFIC, COLLISION GODIN . _ @
CHP 556 Palip 2 (Rav. 4-11) OPI 060 Page 2. of G
DATE OF COLLISION (MO, DAY YEAR) | TOE (2«an) inci # - GFFICERLD. NUMBER
{0-23-12 OP st 9559 1334
OWNER'S NAME . . OWNERS ADDRESS ‘ JNOTIFIED *
PROPERTY |ST3GE of Couigoemnd, . Lves_[ xo
DAMAGE [DESCRIPTION OF Danae .
a ? ai
G0'OF pangGep Gusr® Rin, 260° of DANsGED CHaMm Lust Fence .
SEATING POSITION SAFETY EQUIPMENT AIR BAG INATTENTION CODES
OCCUPANTS ‘CHILD RESTRAINT B- UNKNOWN AA- GELLPHONE HANDHELD
"NONE IN VEHICLE Q-INVERICLE USED =| L-AIR BAG DEPLOYED 8 - CELLPHONE HANDSFREE
|B - UNKNOWN A-IN VEHICLE NOT USED M-AIR BAG NOT DEPLOYED G~ELECTRONIC EQUIPMENT
pa }C~LAP BELT USED S-IN VEHICLE USE UNKNOWN | N+ OTHER: D+ RADIO/CD
4123) 2t06-PASsENGERS | F SHOULDER HARNESS NOT USED “ EJECTED FROM VEHICLE o-ailonen
4 § 6 | 7-STATIONWAGONREAR |g] AP/SHOULDER HARNESS USED MLC BICYCLE HELMET O-NOTEJECTED . +H ANIMALS
8- REAR OCC. TRK. OR VAN 1H. LAP/SHOULDER HARNESS NOTUSEO DRIVER PASSENGER 1 FULLY EUECTED t GOAL HYGIENE
9-POSTTION UNKNOWN | J. PASSIVE RESTRAINT USED ¥-NO_— -X-NO 2-PARTIALLY EJECTED J+ READI
7 / 0-OTHER K- PASSIVE RESTRAINT NOT USED W-YES Y.YES 3- UNKNOWN eZ
+ |P-NOT REQUIRED
ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK (") SHOULD BE EXPLAINED IN THE NARRATIVE,
Le TT SN EAT OR uur |. _-_ TRAFFIC CONTROL DEVICES 4f2}a SPECIAL INFORMATION 4] 2] 3] __ MOVEMENT pREcEONG
(A vesecnoH WcutTeD: a, [A CONTROLS FUNCTIONING [A HAZARDOUS MATERIA ‘A STOPPED
4] 22sec} [xo |_ |B CONTROLS NOT FUNCTIONING” BB CELL PHONE HANDHELD INUSE B PROCEEDING STRAIGHT. fF
B OTHER IMPROPER DRIVING: ‘ CONTROLS OBSCURED [CELL PHONE HANOSFREE IN USE C RAN OFF ROAD
: D NO CONTROLS PRESENT/ FACTOR (D CELL PHONE NOTIN USE D MAKING RIGHT TURN
© OTHER THAN DRIVER™ TYPE OF COLUSION E SCHOOL BUS RELATED. E MARNG LEFT TURN
D UNKNOWNS A HEAD-ON : F 76 FT MOTORTRUCK COMBO MAKING UTURN
B SIDE SWIPE [G S2FTTRARER COMBO 1G BACKING
C REAR END H : |H_SLOWING/ STOPPING
WEATHER AR TO 3TES) 1D BROADSIDE 1 1 PASSING OTHER VEHICLE
A CLEAR E Hit OBJECT J “J CHANGING LANES
B cLoupy F OVERTURNED K PARKING MANEUVER
‘RAINING G VEHICLE / PEDESTRIAN L L_ ENTERING TRAFEIO
D sNowiNc H OTHER*: iM [MOTHER UNSAFE TURNING:
E FOG/ VISIBILITY Flt - N NXING NTO OPPOSING LANE
F OTHER MOTOR VEHICLE INVOLVED WITH oO 0 PARKED
G WIND A NON- COLLISION P MERGING
LigHTING Bi PEDESTRIAN z ‘GL TRAVELING WRONG WAY
A DAYLIGHT © OTHER MOTOR VEHICLE OTHER ASSOCIATED FACTOR(S) ROTHERSCINSAPE PURO]
B OUSK- DAWN D_MOTOR VEHICLE ON OTHER ROADWAY {MARK 170 2:7BHS)
C OARK- STREET LIGHTS: E PARKED MOTOR VEHICLE A YESECTON VIOLATION: oe
D_OARK-NO STREET UGHTS ~[F TRAIN, Gro
E DARK- STREET LIGHTS NOT * |G Bicycus B Voeteicn vataTOn
FUNCTIONING* ‘H ANIMAL: 2 ‘SOBRIETY - DRUG
ROADWAY SURFAGE. * : lel Coes 2/3 PHYSICAL
“A ORY 1 FIXED OBJECT: - ara : (HARK 1 TO 2 /TEMS)
B Wer Guard rine D a (A RAD NOT BEEN ORINKING
C SNOWY ~ICY ‘J OTHER OBJECT: : E VISION OBSCUREMENT: BHD - UNDER TRE INFLUENCE
D SLIPPERY (MUDDY, OILY, ETO) F INATTENTION': ‘CHAD - NOT UNDER INFLUENCE”
ROADWAY CONDITIONS G STOP & GO TRAFFIC HAD - IMPAIRMENT UNKNOWN
(MARK 1 70 2 (TEMS) PEDESTRIAN'S ACTIONS” 1H ENTERING / LEAVING RAMP ~ [E UNGER ORUG INFLUENCE
‘A HOUES, DEEP RUT "A NO PEDESTRIANS INVOLVED | BREVIOUS COLLISION F IMPAIRMENT - PHYSICAL*
Bi LOOSE MATERIAL ON ROADWAY" [|B CROSSING IN CROSSWALK - UNFAMILIAR WITH ROAD G INPAIRMENT NOT KNOWN.
© OBSTRUCTION ON ROADWAY" ATINTERSECTION - K DEFECTIVE VEH.EQUIP; ome H NOT APPLICABLE
D_GONSTRUCTION - REPAIR ZONE G CROSSING IN GROSSWALK - NOT ives|__{- | SUBEPY / FATIGUED™
E REDUCED ROADWAY WIDTA ATINTERSECTION A
F FLOODED BD GROSSING -NOTIIN CROSSWALK L_UNINVOLVED VEHICLE
‘G OTHER EIN ROAD - INCLUDES SHOULDER OTHER":
No UNUSUAL CONDITIONS F_NOT IN ROAD N_NONE APPARENT
~_ [|G APPROACHING /LEAVING SCHOOL BUS ‘0 RUNAWAY VEHIGLE ;
SKETCH . f wai Ta Te MISCELLANEOUS
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STATE OF CALIFORNIA @ ‘ eo
. ‘NARRATIVE/SUPPLEMENTAL pace ++
DATE OF INCIDENT "TIME NCIC NUMBER OFFICER 1D, ° NUMBER
19/28/12 0454 9550 13386
NOTIFICATION:
I received.a call of'a traffic collision with an ambulance tesporiding at 0504 hours. I responded from the
California Highway Patrol office located in the City of Santa Fe Springs and arrived on scene at 0512
hours, Upon arrival, this incident was determined to be a property damage only collision.
All times, speeds, and measurements are approximate, a measurements were taken by rollmeter and
pacing.
OTHER FACTUAL INFORMATION:
Vehicle #1 came to rest on Firestone Blvd. north of Coyote Creek, caught on fire, and released diesel fuel
onto the roadway. The Los Angeles County Fire Department, Engine 35, contained the leak and used water
and foam to extinguish the fire. After dawn and some time for evapioration to occur, Danny Reddig, a
~ Supervisor for the City of La Mirada arrived on scene, The Los Angeles County Department of Public
Works was requested by the City of La Mirada to check the storm drain for possible Diesel Fuel
contamination. Ricardo Reyes with the Los Angeles County Department of Public Works Flood
Maintenance Division located Diesel Fuel in the storm drain. The Los Angeles County Firé Department
was notified. Mr. Ellis, 1.D. #288509, from the Los Angeles County Fire Department Hazardous Materials
Division assumed scene management for the spill (OES # 12-6396). Ocean Blue Environmental Services
‘was summoned to the scene to handle the clean up. Mr. Rico Ruiz, Supervisor with Ocean Blue related
that 2,700 Gallons of a Diesél, Water, and Debris combination would be contained in a vessel and taken to
Crosby and. Overton in the City of Long Beach for storage.
Vehicle #1°s mechanical components were inspected for possible steering failure, Vehicle #1’s right front
wheel with steering components still attached was located separated from vehicle #1. The separation and
damage was.attributed to the impact with the concrete curb (A.O.1, #2), There were no abnormalities
located that would impair the function of the steering prior to the collision, ,
* The Los Angeles County Sheriffs Department provided information of a possible witness, Mr. Octavio
Gonzales, 7-21-54, was called (714) 812-7912 and left a message and was asked to return a call if he had
seen the collision or had information regarding the collision. As of 10-29-12, he had not returned the call
and had not left a message..
Party #1. (Machado) was unable to provide current insurance information at the scene due to the burned
condition of his vehicle. He was asked to call the C.H.P. and leave a message with the insurance
information. As of 10-29-12, party #1 had not retumed the call and had not left a message.
PREPARBR’S NAMB LD. NUMBER DATE REVIEWER'S NAME DATE
G.V. MONTANEZ __" 13386 10/23/12me
OGOPOADAUABRYWN—
~
12
STATE OF CALIFORNIA . e
‘NARRATIVE/SUPPLEMENTAL __ pace &
DATE OF INCIDENT TIME NCIC NUMBER, OFFICER 1D, NUMBER
10/28/12 0454 9550 13386
STATEMENTS:
Party #1 (Machado) related that he was driving his vehicle northbound on the I-5 freeway approaching
Coyote Creek at 55 M.P.H. in the #4 lane. He was driving from Tucson Arizona and had been driving for
about.seven and one-half hours, Party #1 related that he was not sleepy. He thought his right front tire
flattened when his vehicle swerved to the right: Party #1 did not remember if he applied his brakes or
depressed his accelerator pedal. When his vehicle stopped, he saw fire coming from the right side of his
vehicle, He and his passenger exited the vehicle a after a short time, assistance arrived,
SUMMARY:
Party #1 (Machado) was driving vehicle #1 northbound on the 15 frooway in the #4 lane at 55 M.P.H. south
of Coyote Creek, Party #1 allowed vehicle #1 to turn to the tight where vehicle #1’s right side collided
with a wood and metal guard rail (A.O.1, #1). Vehicle #1 continued in a northeasterly direction where
vehicle #1’s right front wheel collided with the south edge of the raised concrete curb of Coyote Creek
(A.O.L #2), This impact caused vehicle #1’s right front wheel to bend and the wheel to deflate. Vehicle #1
coritinued in a northeasterly direction where vehicle #1's right front collided with the freeways perimeter
chain link ferice (A.0.1. #3). Vehicle #1 traveled through the perimeter fence and onto the Firestone Blvd.
where it came to a stop. Party #1 and his passenger exited vehicle #1 and waited for assistance to arrive.
The opinion was based on facts, statements, and physical evidence.
AREA OF IMPACT (AOD:
AOI #1 (V-1 VS, Guard Rail) was: .
61’ south of the south edge of Coyote Creek and.
2 east of the east roadway edge of I-5 northbound,
AOI #2 €V-1 VS. Concrete Curb) was:
6’ north of the south edge of Coyote Creek and
2’ east of the east roadway edge of 1-5 northbound.
AOI #3 (V-1 VS. Perimeter Fence) was:
144 north of the north edge of Coyote Creek and
14 east of the east roadway edge of I-5 northbound,
PREPARER'S NAMB, LD, NUMBER . DATE "REVIEWER'S NAMB DATE
G.V. MONTANEZ__- 13386 + 10/23/12COUIAUAWNHE
STATE OF CALIFORNIA @
2% PPLEMENTAL. pace 6
DATE OF INCIDENT TIME. NCIC NUMBER OFFICER LD. NUMBER
10/28/12 0454 9550 13386
CAUSE:
Party #1 (Machado) caused this collision. and was in violation of section 22107 of the California Vehicle
Code (C.V.C.) unsafe speed for conditions,
Section 22107 C.V.C. states: no person shall turn a vehicle from a direct course or move right or left upon
a roadway until such movement can be made with reasonable safety and then only after the giving of an
appropriate signal in the manner provided in this chapter in the event any other vehicle may be affected by
the movement. - . ,
Party #1 was also found to be in violation of section 16028(c) C.V.C. no proof of insurance,
Section 16028(c) C.V.C. states: Whenever a peace officer, or a regularly employed and salaried employee
of a city or county who has been trained as.a traffic collision investigator, is summoned to the scene of an
accident described in Section 16000, the driver of any motor vehicle that is in any manner involved in the
accident shall furnish written evidence of financial responsibility upon the request of the peace officer or -
traffic collision investigator. If the driver fails to provide evidence of financial responsibility when
‘requested, the peace officer may issue the. driver a notice to appear for violation of this subdivision. A
traffic collision investigator may cause a notice to appear to be issued for a violation of this subdivision,
upon review of that citation by a peace officer,
RECOMMENDATIONS:
A complaint to be filed should be issued to party #1 (Machado) for section 16028(c) C.V.C, no proof of
insurance.
PREPARER’S: NAME LD, NUMBER, DATE REVIEWER'S NAME DATE.
G.V, MONTANEZ 13386 10/23/12STATEOF CANFORNIA | * @ e@
‘DEPARTMENT OF CALIFORNIA HIGHWAY PATROL 1 . .
TRUCK / BUS COLLISION SUPPLEMENTAL REPORT — PARTY NUMBER
CHP 655D (Rev. 1-07) OPI 082 t
DATE OF COLLISION rE (00) NIG NUMBER (OFFICER LD, NUMBER ‘]NuNBER
10-23-12 04:54 9550 13386
GENERAL INSTRUCTIONS ~ COMPLETE THIS FORM area QUALIFYING VEHICLE IF ae GRASH BEETAG GRITERIA ON BAGK OF THIS FORM.
oh Tie acone Z Lec nue
THIS FORI1S BEING GON PLETED BECATSE THB VEHICLE
[1 A truck or truck combination > 10,006 lbs. GVWR/ GCWR
[1 A bus with seats for 9 or more persons, including driver
A vehicle of any type with a hazardous materials placard (Includes auto, light truck, van, 10,000 Ibs. or lesa)
uae
TOTAL INVOLVED VEHICLES IN THEORASH [AT THE TIME OF THE CRAGH, THIS VEHIOLE WAS:
1 [2] Operating on a Traffioway open to the public (In-Transporl)
NUMBER OF PERSONS SUSTAINING FATAL INJURIES |
0 2 . (D Parked on or off the Traffleway
NUMBER OF INJURED PERSONS TRANSPORTED FOR IMMEDIATE MEDICAL TREATMENT [COMMERCIAL ORIVER LIOENSE (ODL).
0 Wives [no
NUMBER OF VEHIOLES TOWED FROM SOFNE DUE TO DISABLING DAMAGE [QDLLIENGE CLASS (Oheck one):
ClassA ([]ClassB [] ClessC [] GlassD [J ClasoM
“VEHIGLE CONFIGURATION Tear ona ode from below) ‘CARGO BODY TYPE (Enter one cose from halow}
11-Paseonger Car (only vahets has Hazardous Mi 0- Not Apacble 'No Cargo Body.
ScLan Teas oohotit hoo ards ana Pucan) {= But (oats for 46 paope, ncating eve)
+ §~Bus (dedts for 9-16 people, Including dive '2- Bue (seats for 16 peopls or more, Including driver)
4+ Bus (aaats for 18 poople ot more, ficudlg ever) = Van Enelosed Box
§~ Bingls-Unit Truck (2 axies, 6 tires) /4~Cargo Fath
8~ Singta-Unit Truck (9 or more axis) 5 - Flatbed
7 =Truek Tratlera) SlnglUnk Truck wth Trelis) = Dump
ua rater tee, Soll oradonse) = Conerato ber
{= Ymotor/ Som Tal (ona taller} 8 Aub Transpeter
10 Tran / Dia (voter 9-Gabeqa/ Rotase
114 Tractor Trips (ree tall 40 - Grain, Chips, Gravl
89-Othor Truck > {9,000 Ib, (notlstod above} 4 Pole
GVWR IGCVIR (Enter ano ead from bolowe, Vou OCWR far ruck combinations. i yaa Ties ers Mole Vette
44 Loating
88 - Other Caryo Body (ot leted above)
1-10,000 be. or Less HAZARDOUS MATERIALS INVOLVEMENT
SS ai DIO THE VEHICLE HAVE AHAZHATPLAGARD? =~
Bus Use (Enter one code trom below) Ores [ZNO
IF YES, INCLUDE THE FOLLOWING INFORMATION FROM THE PLACARD:
O-Note Bus Talntorely . RM 4 Dist or name ftom eemand of box:
Sen area) sone” HM Clas rom bom o mont:
Wes Hct domed em TH too Oyes [no
CHECK ONE:
Interstate Garrler [7] intrastate Carrler [7] Not In Commerca~Govemment [7] Not in Commerce ~ Other Trucks (Over 10,000ibs, GVWR/ GCWR
Canter Name: Jaen Auto Transport
Gartler Street Address (P.O, Box only if no street address): 994 8. 42nd ST.
Clty / State / ZIP Code: Hialeah FL, 33013 Phone Number: (786) 231-7832 .
Carrier ID Number(s): NONE: x USDOT#
NOTE: FOR THI8 VEHICLE, LIST UP TO FOUR EVENTS
Eventt: [18] event2: (78) events: 18] ventas [_]
NON-GOLLISIONS : NOW-CoOLLSIONS (continua) COLLISION INVOLVING / WITH (continued)
4 Ran Of Road + 8 Equipment Faure (Tree, Brakes, Stnering, etc) 18 Tran
2 Jackin 40 Othor Nan-Coftsion 18 Pedloyeis
8 Overtam (Ratover. 47 Antool
4 Bownfi unaway 48 Fad Object
5 Cargo Loss or Shit COLLISION INVOLVING WITH 49 Work Zone Maintenance Equipment
4 Explodion or Fire 12 Pedeetrlan . 20 Other Moveable Object
7 Geparaton of Unita 43 Mator Vehiolo In-Traneport +8 Other (Deectbe}:
3 Gree lodan /enerne 4 Parked Motor Vehida
PREPARED BY , REVIEWED BY PATE
G, Montanez 1,D, 13386
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‘ATE OF CALIFORNIA.
IENTAL : PAGE S-4
DATE OF INCIDENT TIME NCIC NUMBER. OFFICER ID. NUMBER
10-23-2012 0454 _ 9550 . 13386 . 10-534
: SUPPLEMENTAL
On .08-14-2013, | received a request for a a supplemental report front Toni Willey,
General Adjuster, of Federated Insurance, regarding traffic collision report # 10-534,
The request was made to add a vehicle that was part of a cargo load being carried by:
Vehicle #1on behalf of White Lightning Logistics and Transport LLC. The vehicle in
question was a 2011 Acura RDX, VIN #5J8TB1H55BA002872, sustained total damage
as a result of Vehicle #1 catching fire after the collision. The original collision report did
not contain any information about this vehicle, because the fire destroyed the vehicle as
‘well as the shipping paperwork that was in Vehicle #1 that would have identified the
vehicle. As a result, the invéstigating officer was unable to obtain any information about
the vehicle and it was not listed in the report.
The investigating officer was contacted and vetted ‘that there were e vehicles on the
trailer of Vehicle: #1. Toni Willey provided documentation proving that the 2011 Acura
RDX was one of the vehicles being transported by Vehicle #1 at the time of the collision
and did sustain total damage as a result of the collision. This supplemental adds an
other: factual information section to include the following vehicle as. part.of the cargo-
load for Vehicle #1: .
- 2011 Acura RDX, VIN # 8J8TBt H55BA002872.
This supplemental also includes Federated Insurance as the registered owner of the
Acura RDX and makes them.a party to the traffic collision. ‘No other changes are to be
made to report #1 0-534 at this time.
PREPARER’S NAME ~LD.NUMBER OATE REVIEWER'S NAME
P. CONKLE ” 16882 08/14/2013 Grae FIS44Exhibit — 2Bevariment af State
| certify the attached is 2 true and correct copy of the Articles of incorporation, as
amended to date, of ROADKING AUTO TRANSPORT CORP., a corporation
organized under the laws of the Siaie of Florida, as. shown by the records of this
office. , :
The document number of this corporation is PO9000108556.
| further certify that said corporation was administratively dissolved on
September 28, 2012.
‘Given under my hand and the
Great Seal of the Stats of Florida
__ at Tallahassee, the Capital, this the
Twenty-second day of July, 2014
CR2E022 (1-11)Exhibit — 3issunibare “*
TITLE STATUS ,
DATE *
CERT DEST ISS DT
CERT REPOSS DATE
AUTHORIZED
DESTRUCTION DATE
TOW TYPE
TOW DATE
TITLE CANCEL DATE
PREV. TITLE STATE
PRV TITL ISS DT
SALVAGE TYPE -
SALES TAX REG NUM
SALES TAX EXEMPT
PROCESSED DATE
STATE/NUM
COMMENT
MAIL TO CUSTOMER
UNSTRUCTURED NAME
TITLE NUM 109252048 TRANS. ID
VEH ID, HUM, 1NPSDB9X01N562760
06/30/2012
06/30/2012
OK
(NONE)
06/30/2012
eo RETR ALL
ELEC. TITLE
STATUS
TITLE STATUS
TITLE TYPE
LEGAL OWNERSHIP
DUP CERT DEST
RSN
DUP CERT REPO
RSN
CANC. REASON
PREV REG STATE
DUP TITL RSW
TRANSACTION CODEOUT
TRANSFER EQUITY
FLAG
TOP FLAG
FAST TITLE FLAG
DUPL TITLE FLAG
OK /723006306030B
col
++. E-MAIL
LOCATE
PAPER TITLE
ORIGINAL ~ USED
LAND CRAFT
PTID
VOIDED
C oe
_ CURR STATE FL
HISTORY DETAIL,
PRINT
|-OWNER NUM —NAME
a FRANCIS
| INSPECTION
ROLANDO MACHADO
JOINT CODE-DETAILS—|
NONE
DETAILS
INSPECTION STATUS
INSPECTION
DATE
INSPECTION REASON
INSPECTION
CUSTOMER
Maureen Johnson, Chief, Bureau of Records, Division
¥ Motoiat Services, Department of Highway
Motor Vehicles of the State of Florida, do hereby certify
that this is a true and correct copy of the motor vehicle oF
dtiver lioanse record from the offical records on fie in this
department.
LV Losssen YokoncaserADDR. TYPE M ADDR SEQ 12 or SEQ 18 APT
STREET AGDR. ‘ 270 E'57TH STREET
crny y* > “ HIALEAH : FL 33013 -2246 2
county 1 COUNTRY US FOREIGN POSTAL
NUMBER « CODE
PHONE Num.
PHYS. LOCATION . RETR ALL
CHANGED BY WEB_VO_USER CHANGED DATE 05/01/2013
ADDR. TYPE M _ ADDR SEQ 11 CUSTOMER SEQ 18 APT NUM|
STREET ADDR. 270 E 57 STREET
crry HIALEAH FL 33013 2246
couNTY 1 COUNTRY US
NUMBER CODE
PHONE NUM.
PHYS. LOCATION RETR ALL
CHANGED BY WEB_VO_USER CHANGED DATE 05/01/2013
ADDR. TYPE R__ ADDR SEQ’7 - CUSTOMER SEQ 18 “APT NUM
STREET ADDR. 270 E 57TH STREET
crTy HIALEAR FL 33013 2246
counry 1 couNTRY us
NUMBER CODE
PHONE NUM.
PHYS. LOCATION RETR ALL
CHANGED BY WEB_VO_USER CHANGED DATE 05/01/2013
ADDR. TYPE R ADDR SEQ.6 CUSTOMER SEQ 18 APT NUM
STREET ADDR. 270 E 57 STREET
crry HIALEAR FL 33013 2246
COUNTY 1 COUNTRY US
NUMBER CODE
PHONE NUM
PHYS. LOCATION RETR ALL
CHANGED BY WEB_VO_LUSER CHANGED DATE 05/01/2013
SYNC HISTORY
DRIVER LICENSE TRANSACTION DATE AMOUNT VOIDED
PRINT
PHONE NUMBER CELLULAR 786 2318703 26-SEP-2008
‘ * 15:35:36
CELLULAR 786 2318703 26-SEP-2008
15:24:34
E-MAIL ADDRESS
1, Maureen Jonnson, 1
of Motorist Services, Department of Highway Safety and
Motor Vehicles of the State of Florida, do hereby cerify
the {this is a true and correct copy of the motor vehicle oF
diver license record from the official records on file in this
department.
QHALLN 7Exhibit — 4aa @ 4 e
$4¥13/2010 04:11 FAX 3056400 wy see :
ais 9056400282 LAXMY "SXCARRIER 603/005.
Articles of Amendment
to
Articles of Incorporation
af
JS & JR AUTO TRANSPORT INC.
(Name of Corporation as currently filed with the Florida Dept, of State)
P09000103556
(Document Number of Corporation (if known)
Pursuant to the provisions. of section. 607.1006, Florida. Statutes, this Florida Profit Corporation adopts the following
amendmeni{s) to its Articles of Incorporation: =”
A. [famending name, enter the new name of the corporation:
ROADKING AUTO TRANSPORT CORP. The new
nane must be distinguishable and contain the word “corporation,” “company,” or “incorporated” op the
abbreviation. “Corp,," "Inc," or Co." or the designation. “Corp, “ine, “ or “Co”. A professional corporation
name must contain the word “chartsred," “professional association," or the abbreviation "PA."
incipal office address, if les
B. Enter new principal office address, if applicable:
(Principal office addresx MUST BE A STREET ADDRESS )
C. Enter new mailing address, if applicable:
(Mailing address MAY BE A POST OFFICE ROX}
D. Iamending the registered agent and/or registered office address In Florida, enter the game of the
mow, andioj istered 2 address:
Nunte of New Regiviered Agent:
New Regis ice Address: (Florida street address)
Florida,
(Cin) (Zip Code)
ew Registered Agent’a Si, re, if changing Registered it:
Thereby accept the. appointment ax registered agent, fam familiar with and accept the obligations of the position.
Signature of New Registered Agent, if changing
Page { of 3oo. e eo e
04/13/2010 04:14 FAX 3058400282 LARNY’ S¥CARRTER 004/005
ms
,
Ifamending the Officers and/or Directors, enter the title and name of each officer/direstor being
removed and titlo, name, and address of en ice! lor
(Attach additional sheets, if necessary)
Title Name Address, Type of Action
P GUELS! AGUIAR (1119 WOKBECHOREE RO EI Add
NIT #44 D Remove
HIALEAH. FL 39018
O Ade
C1 Remove
© Add
Remove
E, Ifamending or adding addithonal Articles, enter changefs) here:
(astach additional sheets, ifnecessary), (Be specific)
F, Ifan amendment provides for.an exchange, reclassification, or cancellation of issued shares,
wisions fi lementin; i ontuings in ghe amen tye} .
(if not applicable, indicate N/A)
Page 2 of 3.”
0471872010 04:11 FAX 3056400282 " LAXMY 'S&CARRIER 0057005
« 7 } .
-# aoc
Tha date of each amendment(s) adoption: 04/13/2010
(dare of adoption is required)
Effective date ify ‘applicable: 04/43/2010
(nu more than 90 days afler amendment fite dare)
Adoption of Amendment(s) (CHECK ONE)
[The anandment(s) was/were adopted by the shareholders. The number of votes cast for the amendment(s)
dy the shareholders was/were sufficient for approval.
(2) The amendment(s) was/were approved by the shareholders through voting groups, The allowing statement
must be separately provided for each voting group entitled to vote separately an the amendment(s):
“The number of votes cast forthe amendment(s) was/were sufficient for approval
by ” :
(voting group) .
‘The amendment(s) was/were adopted byt the board of directors without shareholder action and shareholder
action was not required. i
oO ‘The amendment{(s) was/were adopted by the Incorporators without shareholder action and-shareholder
action was not required.
Dane 04/19/2010
Signature lL h—
( ‘director, president or other officer — if directors or officers have not been
goltered, by an incorporator « ifin the hands of a recelver, trustee, or other court
appointed fiduciary by that fiduclary)
JUAN RUIZ
(Typed or printed name of person signing)
PRESIDENT
(Title of person signing)
Page 3 of 3Exhibit —5Chapter 607 Section 1421 ee Florida Statutes - The Floridggyenste Page | of 1
The Florida Senate
2011 Florida Statutes
Title XXXVI "Chapter 607 -_ ~~ ~ SECTION 1421 ~e
BUSINESS ORGANIZATIONS. CORPORATIONS Procedure for and effect of
: administrative dissolution.
: Entire Chapter
.607,1421- Procedure for and-effect of administrative dissolution.—
(1) Ifthe Department of State determines that one or more grounds exist under s. 607.1420 for dissolving a
corporation, it shall serve the corporation with notice of its intention to administratively dissolve the corporation. If
the corporation has provided the department with an electronic mail address, such notice shall be by electronic
transmission. Administrative dissolution for failure to file an annual report shall occur on the fourth Friday in
September of each year. The Department of State shall issue a certificate of dissolution to each dissolved corporation.
Issuance of the certificate of dissolution may be by electronic transmission to any corporation that has provided the
department with an electronic mail address. ,
(2) If the corporation does not correct each ground for dissolution under s. 607.1420(1)(b), (c), (d), or (e) or
demonstrate to the reasonable satisfaction of the Department of State that each ground determined by the department
does not exist within 60 days of issuance of the notice, the department shall administratively dissolve the corporation
by issuing a certificate of dissolution that recites the ground or grounds for dissolution and its effective date. Issuance
of the certificate of dissolution may be by electronic transmission to any corporation that has provided the department
with an electronic mail address.
(3) A corporation administratively dissolved continues its corporate existence but may not carry on any business
except that necessary to wind up and liquidate its business and affairs under s. 607.1405 and notify claimants under s.
607.1406.
(4) A director, officer, or agent of a corporation dissolved pursuant to this section, purporting to act ori behalf of
the corporation, is personally liable for the debts, obligations, and liabilities of the corporation arising from such action
and incurred subsequent to the corporation’s administrative dissolution only if he or she has actual notice of the
administrative dissolution at the time such action is taken; but such liability shall be terminated upon the ratification
of such action by the corporation’s board of directors or shareholders subsequent to the reinstatement of the
corporation under ss. 607.1401-607.14401.
(5) The administrative dissolution of a corporation does not terminate the authority of its registered agent.
History.—s. 128, ch. 89-154; s. 1, ch. 95-211; s, 34, ch. 97-102; s. 10, ch. 2009-72.
Disclaimer: The information: on this system is unverified. The journals. or printed bills of the respective chambers
should be consulted for official purposes.
Copyright © 2000- 2014 State of Florida.
http://www. flsenate.gov/Laws/Statutes/2011/607.1421 7/31/2014Exhibit — 6oo e @
Check number: 05421872 Date issued 05/07/2013
Enclosures N:
Reference no: 000216876 _— Date of loss 10/17/2012
Insured name THE NIELLO COMPANY (A CORP)
Federated Mutual Insurance Company
PO Box 328
PBST SXXXX
Sh IE NIELLO. Siksoooy (A CORP) Owatonna, MN 55060
1481 RIVER PARK DR (507)455-5200
SACRAMENTO, CA, 95815-4501
Explanation of Rayment
Payment for wholesale value of 2011 Acura RDX VIN: 2872. $5,000.00 deductible waived: Fire Loss
'VX0001 (08-08)
Federated Mutual msurance Cormmpany FEDERATED ee Bis Check No.. 05421872
PO Box 328 ‘ " ‘5 ‘Van Wert, OH, 45991
ae. MN 55060 INSURAN CL Acct. No. 9600023079
« 56-382
412
Reference no. 000216876 THE NIELLO' COMPANY (A CORP)
Date issued 05/07/2013 VOID - NON-NEGOTIABLE
Void if not colored background:
VOND-ALO | DCAD THEO MAYO SEVENO|DVN/ OH O/OIDOVOHD:
Pay to the otder-of Amount $*****29,275.00
THE NIELLO. COMPANY (A. CORP) 1
Authorized Signer - Federated Mutual Insurance CoExhibit — 7ee
aS
on
ie
Alb 81b-/EXHIBIT 3
MO Mixed Sources
2 ESC © 1996 Forest Stewardship Council oy“07/05/2006 weD 15:36 vax ' , (oo1sooz
yee. )
6. #% (Sot?
NIELLO COMPANY REPORT OF CLAIM
Nore:
Ail claims MUST he reported to the Business Office. The Business Office wili provide a copy to the Company
Coniroiler who will determine whether fo report the claim to the Insurance company.
Deatersm@__Aewed RepoarDarg__4-23~(3
CLAIM NUMBER A ws] CLAIMDATE, ia \»
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TYPE OF CLAIMS
Cl Theft
CI: Vandalism
I Auto Accident
‘zh. Other (Specify) eR AGE
Vehicle(s) Involved (any additional may be reported on the back of this page, Please note if you have done so):
Year _2ov\ Make Arew ade Model__ ROK vine BA 002872
Year Make Model VIN #
Party (ies) Involved: Witnesses:
wine LINING Teac peer - Baeez- (WT)
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Describe what happened in detail, including estimated losses/damages and when/where occurred:
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lo-2% 7 RBceyo CH( TRVek Was Ww Actos WIT AvoTiNe.
cTewey. AU veieles Burne, Dewep Peo, Polleware wes
WELT calle And INPpameo Us He ouwe- oF Tevee Mtoe
Fedvoulawr lam Agour Tavee ww Acccoawr ¢ sree 0 Daiwa,
Twans Our Tevet coveltr Pies Awd Vitel Butwsko, Dawen ¢
owen wil nor Reso ro Avrempreo towrter, SRwees ¢ ounce
POLICE REPORT OBTAINED? [] Yes §BNo (ncugence wae Céncel/éo Bo anys
Rev, 10/03 ts
pecan to WeteeT WHEN WILT Veamep Inc, Polcery
iv Sttewsa Coreint Busy APrER- tmeiewr Tooe place,1 @ 6
NIELLO COMPANY REPORT OF CLAIM
Page 2
‘What couid have prevented this/how to.avoid again:
Att Papesumons whet ties, using BRoveRs Canes.
Mite Boon Freier punzerly arypieadly peavSars Ks
Feom Mcp p Ems tare
What hasbeen done fend-when) to prevent a recterrence?
Wit eesrrer (arPo
Dan _@S3) Sb(- 3.447
teesss (53) 2os- 6774
_ ME Linen wi teaepear @. aia 4 coma
Supervisor Comments:
tine. Licirnicde —thawepoer Uke Bebe DEALte
Feeseur- Arreanty Riedeoi rye Clas. Ar TAS post
E__Dowt perreve trey ull 98 Svecess Fue,
CHT THE
th Insurance xéimbuxsément: a
2, Deductible (or non-reinibarsement amount)?
sionmn: ~~ nele Kans
r
Office: Masiager
3 Total Loss
General Manager
Rev, 10/03mm
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Mixed Seurces
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“EXHIBIT 4aon os @ Title and Salvage Worksheet
Federated Service Insurance Company
Cause of Loss: Comprehensive Date of Loss: 10/17/2012 Loss Number: _216876-1
Owner’s Name_The Niello Company | insured | Claimant] Dealer
. Ifa DEALER, does LOSS PAYEE need to be CYes
Attorney's Name, included on the check? TINo
Address 1451 RIVER PARK DR Paying for Rental Car?“ Yes [No
represented; SACRAMENTO CA 95815 SIR? CYes DINo
Phone # Does a Liability LYes LJNo] Amount
(Aitomey's if represented); (916) 334-6300 Deductible Apply to o $
- Nileei Pane this Vehicle?
Contact Person: Does aGK Deductible [lYes CINo| Amount
E-mail: npane@niello.com Apply to this Vehicle? $
Vehicle Information:
Vehicle: 2011 Acura RDX Tech Packg VIN: 5J8TB1H55BA002872
Year, Make, Model and Type (Type Example: 2-WD, 4-WD, 2-Dr Hatch, 4-DR Hatch, 2-Dr Sedan, etc.)
Repair Estimate written? [] Yes [JNo Or Copart Condition Report/Obvious Total: []Yes []No
Color: Mileage: Is Vehicle? Owned Ci Leased
Salvage Sold By: _LiCopart [L]JunkProgram [JPool [J] Bidder [|Contract []OwnerRetained [J Unrecovered Theft
$ ‘Amount of $ Salvage Value Lot Number
Salvage Bid Retained
Has unit been moved?
Name of pool, auction, or bidder
(Yes [No
Contact Person
Date moved.
Address, lino, is itin possession of owner?
City, State,