On July 27, 2022 a
Complaint,Petition
was filed
involving a dispute between
Hernandez, Katherine Marie,
and
Arrowhead Regional Medical Center,
County Of San Bernardino,
Does 1-25,
Kim Do, Jennifer,
Lyons M.D., John Michael,
for Medical Malpractice Unlimited
in the District Court of San Bernardino County.
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V POS-01 0
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): cortrwsaore :2;
Gilbext Manurino, Es . SBN: 117689 SUPERIOR COURT OF CALIFORNU J’
—LAW OFFICES OF BERT MATURINO COUNTY OF SAN BERNARDINO
5850 Etiwanda Avenue, Suite 208 SAN BERNARDINO WSTRICT
Mira Loma, CA 91752
TELEPHONE No; (95 D68 1 -7 1 88 FAX No. (Optional): (95 1)68 1 -1434
BUT 18 202?.
EMAIL ADDRESS (Optional).-gilbert@maturinolaw.com
ATTORNEY FOR (Name):P1aintiff, Katherine Marie Hernandez
SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDNO L&v
STREET ADDRESS: 247 West Third Street Cj L&bha\;,
MAILING ADDRESS 247 West Third Street \
CITY AND ZIP CODE: San Bemardino, 92415-0210
BRANCH NAME: San Bernardino District - Civil Division
PLAINTIFF/PETITIONER: Katherine Marie Hernandez CASE NUMBER:
CIVSB 2214500
DEFENDANTIRESPONDENT: County of San Bemardino, et a1.
Ref‘ No‘ or File No.:
PROOF OF SERVICE OF SUMMONS
(Separate proof of service is required for each party served.)
1. At the time of service | was at least 18 years of age and not a party to this action.
2. | served copies of:
a- summons
b. [E complaint
c.
d.
E
m
Alternative Dispute Resolution
Civil Case Cover Sheet (served
(ADR) package
in complex cases only)
e.
f.
E cross-complaint
other (Specify documents): Notice of
Tn'al Settling Conference and Notice 0f Case Management, Notice of Re—
Assignment of Case For A11 Purposes and Initial Trial Settling Conference Statement.
3. a. Party served (specify name of party as shown on documents served):
JOHN MICHAEL LYONS, M.D.
b. E Person (other than the party in item 3a) sewed on behalf 0f an entity or as an authorized agent (and not a person
under item 5b on whom substituted service was made) (specify name and relationship to the party named in item 3a):
4. Address where the party was served: 400 North pepper Avenue
Colton, CA 923 24- 1 8 1 9
served the party (check proper box)
5. |
a. E by personal service. | personally delivered the documents listed
receive service of process for the party (1) on (date):
in item 2 to the party or person authorized to
(2) at (time):
b. by substituted service. On (date):09/14/2022 at (time):4:15pm I left the documents listed in item 2 with or
in the presence of (name and title or relationship to person indicated in item 3):
Maribel Doe, Person in charge at time of service
(1) (business) a person at least 18 years of age apparently in charge at the office or usual place of business
be sewed. informed him or her of the general nature ofthe papers.
of the person to I
(2) E (home) a competent member of the household (at least 18 years of age) at the dwelling house or usual
place of abode of the party. informed him or her of the general nature of the papers.
|
(3) E (physical address unknown) a person
address of the person to
at least 18 years of age apparently in charge at the usual mailing
be served, other than a United States Postal Service post office box. informed I
him or her of the general nature of the papers.
(4) | thereafter mailed (by first-class, postage prepaid) copies of the documents to the person to be served
at the place where the copies were left (Code Civ. Proc., § 415.20 . | mailed the documents on
Loma a declaration of mailing attached.
(5) E (date):09/14/2022
I
from (city):Mira
attach a declaration of diligence stating actions taken first to attempt personal service.
is
Page 1 of 2
Codeof Civil Procedure, § 41 7.10
Form Adopted for Mandatory Use
Judicial Counci‘ of California
PROOF OF SERVICE OF SUMMONS Wesnaw Do: & Form Builder'-
POS-O1O [Rev. January 1, 2007]
\r
\ur
PLAINTIFF/PETITIONER: Katherine Marie Hernandez CASE NUMBER:
—'
DEFENDANT/RESPONDENT: County of San Bernardino, CIVSB 2214500
et a1.
5_ C_ D by mail and acknowledgment of receipt of service.
address shown in item 4, by first—class mail, postage prepaid,
l mailed the documents listed in item 2 to the party. to the
(1) on (date): from
(3) E with two copies of the Notice
(2) (city):
and Acknowledgment ofReceipt and a postage—paid return envelope addressed
(4) E to
to
me. (Attach completed Notice and Acknowledgement of Receipt.) (Code Civ. Proc., 41 5.30.)
an address outside California with return receipt requested. (Code
§
Civ. Proc., § 415.40.)
d_ E by other means (specify means of service and authorizing code section):
E Additional page describing service is attached.
6. The "Notice t0 the Person Served" (on the summons) was completed as follows:
as an individual defendant.
9.0.65»
as the person sued under the fictitious name of (specify):
DUE as occupant.
On behalf of (specify):
under the following Code of Civil Procedure section:
D 416.10 (corporation) E
D 416.20 (defunctcorporation) D
415.95 (business organization, form unknown)
D 416.30 (joint stock company/association) D
416.60 (minor)
E 416.40 (association or partnership) D 416.70 (ward or conservatee)
416.90 (authorized person)
D 416.50 (public entity) E 415.46 (occupant)
7. Person who served papers
E other:
a. Name: Norma Sepulveda
Address: 5850 Etiwanda Avenue #208, Mira Lorna, CA 91752
99.0.5
Telephone number: (95 1) 3 12—3 131
The fee for service was: $-0-
l am:
(1)
(2) D
D E
not a registered California process server.
exempt from registration under Business and Professions
a registered California process server:
Code section 22350(b).
(3)
(i)
(ii)
owner
Registration No.:
Demployee E independentcontractor.
(iii) County:
8. | declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
9. E or
| am a California sheriff or marshal and l certify that the foregoing is true and correct.
Date:
Norma Sepulveda
g/gl/%a'}
(NAME 0F PERSON WHO SERVED PAPERS/SHERIFF 0R MARSHAL)
,
W (SIGNATURE )
POW" [Rev'mm ”m PROOF 0F SERVICE 0F SUMMONs Page 2 of 2
Document Filed Date
October 13, 2022
Case Filing Date
July 27, 2022
Category
Medical Malpractice Unlimited
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V POS-01 0 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): cortrwsaore :2; Gilbext Manurino, Es . SBN: 117689 SUPERIOR COURT OF CALIFORNU J’ —LAW OFFICES OF BERT MATURINO COUNTY OF SAN BERNARDINO 5850 Etiwanda Avenue, Suite 208 SAN BERNARDINO WSTRICT Mira Loma, CA 91752 TELEPHONE No; (95 D68 1 -7 1 88 FAX No. (Optional): (95 1)68 1 -1434 BUT 18 202?. EMAIL ADDRESS (Optional).-gilbert@maturinolaw.com ATTORNEY FOR (Name):P1aintiff, Katherine Marie Hernandez SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDNO L&v STREET ADDRESS: 247 West Third Street Cj L&bha\;, MAILING ADDRESS 247 West Third Street \ CITY AND ZIP CODE: San Bemardino, 92415-0210 BRANCH NAME: San Bernardino District - Civil Division PLAINTIFF/PETITIONER: Katherine Marie Hernandez CASE NUMBER: CIVSB 2214500 DEFENDANTIRESPONDENT: County of San Bemardino, et a1. Ref‘ No‘ or File No.: PROOF OF SERVICE OF SUMMONS (Separate proof of service is required for each party served.) 1. At the time of service | was at least 18 years of age and not a party to this action. 2. | served copies of: a- summons b. [E complaint c. d. E m Alternative Dispute Resolution Civil Case Cover Sheet (served (ADR) package in complex cases only) e. f. E cross-complaint other (Specify documents): Notice of Tn'al Settling Conference and Notice 0f Case Management, Notice of Re— Assignment of Case For A11 Purposes and Initial Trial Settling Conference Statement. 3. a. Party served (specify name of party as shown on documents served): JOHN MICHAEL LYONS, M.D. b. E Person (other than the party in item 3a) sewed on behalf 0f an entity or as an authorized agent (and not a person under item 5b on whom substituted service was made) (specify name and relationship to the party named in item 3a): 4. Address where the party was served: 400 North pepper Avenue Colton, CA 923 24- 1 8 1 9 served the party (check proper box) 5. | a. E by personal service. | personally delivered the documents listed receive service of process for the party (1) on (date): in item 2 to the party or person authorized to (2) at (time): b. by substituted service. On (date):09/14/2022 at (time):4:15pm I left the documents listed in item 2 with or in the presence of (name and title or relationship to person indicated in item 3): Maribel Doe, Person in charge at time of service (1) (business) a person at least 18 years of age apparently in charge at the office or usual place of business be sewed. informed him or her of the general nature ofthe papers. of the person to I (2) E (home) a competent member of the household (at least 18 years of age) at the dwelling house or usual place of abode of the party. informed him or her of the general nature of the papers. | (3) E (physical address unknown) a person address of the person to at least 18 years of age apparently in charge at the usual mailing be served, other than a United States Postal Service post office box. informed I him or her of the general nature of the papers. (4) | thereafter mailed (by first-class, postage prepaid) copies of the documents to the person to be served at the place where the copies were left (Code Civ. Proc., § 415.20 . | mailed the documents on Loma a declaration of mailing attached. (5) E (date):09/14/2022 I from (city):Mira attach a declaration of diligence stating actions taken first to attempt personal service. is Page 1 of 2 Codeof Civil Procedure, § 41 7.10 Form Adopted for Mandatory Use Judicial Counci‘ of California PROOF OF SERVICE OF SUMMONS Wesnaw Do: & Form Builder'- POS-O1O [Rev. January 1, 2007] \r \ur PLAINTIFF/PETITIONER: Katherine Marie Hernandez CASE NUMBER: —' DEFENDANT/RESPONDENT: County of San Bernardino, CIVSB 2214500 et a1. 5_ C_ D by mail and acknowledgment of receipt of service. address shown in item 4, by first—class mail, postage prepaid, l mailed the documents listed in item 2 to the party. to the (1) on (date): from (3) E with two copies of the Notice (2) (city): and Acknowledgment ofReceipt and a postage—paid return envelope addressed (4) E to to me. (Attach completed Notice and Acknowledgement of Receipt.) (Code Civ. Proc., 41 5.30.) an address outside California with return receipt requested. (Code § Civ. Proc., § 415.40.) d_ E by other means (specify means of service and authorizing code section): E Additional page describing service is attached. 6. The "Notice t0 the Person Served" (on the summons) was completed as follows: as an individual defendant. 9.0.65» as the person sued under the fictitious name of (specify): DUE as occupant. On behalf of (specify): under the following Code of Civil Procedure section: D 416.10 (corporation) E D 416.20 (defunctcorporation) D 415.95 (business organization, form unknown) D 416.30 (joint stock company/association) D 416.60 (minor) E 416.40 (association or partnership) D 416.70 (ward or conservatee) 416.90 (authorized person) D 416.50 (public entity) E 415.46 (occupant) 7. Person who served papers E other: a. Name: Norma Sepulveda Address: 5850 Etiwanda Avenue #208, Mira Lorna, CA 91752 99.0.5 Telephone number: (95 1) 3 12—3 131 The fee for service was: $-0- l am: (1) (2) D D E not a registered California process server. exempt from registration under Business and Professions a registered California process server: Code section 22350(b). (3) (i) (ii) owner Registration No.: Demployee E independentcontractor. (iii) County: 8. | declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. 9. E or | am a California sheriff or marshal and l certify that the foregoing is true and correct. Date: Norma Sepulveda g/gl/%a'} (NAME 0F PERSON WHO SERVED PAPERS/SHERIFF 0R MARSHAL) , W (SIGNATURE ) POW" [Rev'mm ”m PROOF 0F SERVICE 0F SUMMONs Page 2 of 2