On December 14, 2020 a
Proof of Service
was filed
involving a dispute between
Reyes, Veronica,
and
Does 1 Through 100, Inclusive,
Does 2 Through 100, Inclusive,
Knolls West Convalescent Hospital,
Knolls West Post Acute Llc,
Knolls West Post Acute, Llc,
Rios, Leila,
Victor Valley Medical Center,
for Medical Malpractice Unlimited
in the District Court of San Bernardino County.
Preview
June 21, 2022
‘ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, © POS-04
= ar number, and address) FOR COURT USE ONLY
Igor Fradkin, Esq. | SBN: 299491 -
DOWNTOWN LA LAW GROUP
601N. Vermont Ave. Los Angeles, CA 90004 =
‘TELEPHONE NO.: (213) 389-3765 | FAX NO. (877) 389-2775 |E-MAIL ADDRESS (Optional) SUPERIOR COURT OF CALIFORNIA
ATTORNEY FOR (Name): Plaintif: COUNTY OF SAN BERNARDINO
SAN BERNARDINO DISTRICT
¥
San Bernardino Superior Court
JUN 22 2022
STREET ADDRESS: 247 W. Third St >
MAILING ADDRESS:
CITY AND ZIP Cope: San Bernardino, CA 92415
by.
“CHRIS GOLDSTEIN, DEPUTY
BRANCH NAME: San Bernardino
PLAINTIFF: Veronica Reyes, et al.
CASE NUMBER: CIVSB2028140
DEFENDANT: Knolls West Convalescent Hospital, et al. Dept: S28
PROOF OF SERVICE OF SUMMONS Ref, No. or File No.
Veronica Reyes, et al.
(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: BY FAX
a. wy ‘Summons acts
b: Complaint
om
Alternative Dispute Resolution (ADR) package
e.
Civil Case Cover Sheet (served in complex cases only)
Cross-complaint
Bs
f. . . other (specify documents): Certificate of Assignment;Notice of Trial Setting Conference and Notice of Case
+ Assignment;Statement of Damages
a 3. a. Party served (specify name of party as shown on documents served):
Leila Rios,an individual
‘Age: 40’s Weight: 120 Hair: Brown Sex: Female Height: 5"4 Eyes: Brown Race: Asian
oO Person (other than the party in item 3a) served on behalf of 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: 16890 Green Tree Blvd
Victorville, CA 92395-5618
5. I ser the party (check proper box)
a. by personal service. | personally delivered the documents listed in item 2 to the party or person authorized to
receive service of process for the party (1) on (date): 6/20/2022 (2) at (time): 3:00 PM
0 by substituted service. On (date): at (time): | left the documents listed in item 2 with or
in the presence of (name and title or relationship to person indicated in item 3b):
: () Oo (business) a person at least 18 years of age apparently in charge at the office or usual place of business of the
2
Person to be served. | informed him of her of the general nature of the papers.
& @O (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.
40 (physical address unknown) a person at least 18 years of age apparently in charge at the usual mailing
address of the person to be served, other than a United States Postal Service post office box. | informed him of
her of the general nature of the papers.
40 | 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
(date): from (city): or ["] a declaration of mailing is attached.
©) 0 tattacha declaration of diligence stating actions taken first to attempt personal service.
Form. for Mandatory Use Paget of2
ical of Ci Code of Civil Procedure, § 417.10
#6 1S-010 (Rev. January 712007) PROOF OF SERVICE OF SUMMONS
POS010-1/CW442419
PETITIONER: Veronica Reyes, et al. - ~ CASE NUMBER:
CIVSB2028140
RESPONDENT: Knolls West Convalescent Hospital, et al.
oO) by mail and acknowledgment of receipt of service. | mailed the documents listed in item 2 to the party, to the address
shown in item 4, by first-class mail, postage prepaid,
(1) on (date): (2) from (city):
@O with two copies of the Notice and Acknowledgment of Receiptand a postage-paid return envelope addressed to me.
(Attach completed Notice and Acknowledgement of Receipt.) (Code Civ. Proc., § 415.30.)
40 to an address outside California with return receipt requested. (Code Civ. Proc., § 415.40.)
40 by other means (specify means of service and authorizing code section):
Me
eho
Additional page describing service is attached.
The "Notice to the Person Served” (on the summons) was completed as follows:
a as an individual defendant.
b. as the person sued under the fictitious name of (specify):
c., as occupant.
d. Ld On behaif of (specify):
under the following Code of Civil Procedure section:
416.10 (corporation) oO 415.95 (business organization, form unknown)
416.20 (defunct corporation) Oo 416.60 (minor)
416.30 (joint stock company/association) O 416.70 (ward or conservatee)
416.40 (association or partnership) 416.90 (authorized person)
416.50 (public entity) 415.46 (occupant)
wy oO other:
ion
AT Person who served papers
a. Nae: Candis Ayala - Cal West Attorney Services, Inc
ae b. Aiftress: 1201 W. Temple Street Los Angeles, CA 90026
c. Tafephone number: (213) 353-9100
d. The fee for service was: $ 140.00
e. lam:
(1)
qf nL
not a registered California process server.
(2) exempt from registration under Business and Professions Code section 22350(b).
(3) tered California pi S server:
Fi owner employee mo independent contractor.
ar “~ (ii) Registration No.: 1038
(li) County: Riverside
8. oy | declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
‘ or
9.0] tam a California sheriff or marshal and | certify that the foregoing is true and correct.
Tate: 6/21/2022
€al West Attorn Services, Inc
1201 W. Temple et
Los Angeles, CA 90026
(213) 100
www.calwest.info
*? WANE OF PERSON WHO SERVED PAPERS/SHERIFF OR MARSHAL)
18-010
[Rev January 1, 2007] Pago
2 of 2
PROOF OF SERVICE OF SUMMONS
as POS-010/CW442419
os
a ~+* a
Document Filed Date
June 22, 2022
Case Filing Date
December 14, 2020
Category
Medical Malpractice Unlimited
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Preview
June 21, 2022 ‘ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, © POS-04 = ar number, and address) FOR COURT USE ONLY Igor Fradkin, Esq. | SBN: 299491 - DOWNTOWN LA LAW GROUP 601N. Vermont Ave. Los Angeles, CA 90004 = ‘TELEPHONE NO.: (213) 389-3765 | FAX NO. (877) 389-2775 |E-MAIL ADDRESS (Optional) SUPERIOR COURT OF CALIFORNIA ATTORNEY FOR (Name): Plaintif: COUNTY OF SAN BERNARDINO SAN BERNARDINO DISTRICT ¥ San Bernardino Superior Court JUN 22 2022 STREET ADDRESS: 247 W. Third St > MAILING ADDRESS: CITY AND ZIP Cope: San Bernardino, CA 92415 by. “CHRIS GOLDSTEIN, DEPUTY BRANCH NAME: San Bernardino PLAINTIFF: Veronica Reyes, et al. CASE NUMBER: CIVSB2028140 DEFENDANT: Knolls West Convalescent Hospital, et al. Dept: S28 PROOF OF SERVICE OF SUMMONS Ref, No. or File No. Veronica Reyes, et al. (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: BY FAX a. wy ‘Summons acts b: Complaint om Alternative Dispute Resolution (ADR) package e. Civil Case Cover Sheet (served in complex cases only) Cross-complaint Bs f. . . other (specify documents): Certificate of Assignment;Notice of Trial Setting Conference and Notice of Case + Assignment;Statement of Damages a 3. a. Party served (specify name of party as shown on documents served): Leila Rios,an individual ‘Age: 40’s Weight: 120 Hair: Brown Sex: Female Height: 5"4 Eyes: Brown Race: Asian oO Person (other than the party in item 3a) served on behalf of 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: 16890 Green Tree Blvd Victorville, CA 92395-5618 5. I ser the party (check proper box) a. by personal service. | personally delivered the documents listed in item 2 to the party or person authorized to receive service of process for the party (1) on (date): 6/20/2022 (2) at (time): 3:00 PM 0 by substituted service. On (date): at (time): | left the documents listed in item 2 with or in the presence of (name and title or relationship to person indicated in item 3b): : () Oo (business) a person at least 18 years of age apparently in charge at the office or usual place of business of the 2 Person to be served. | informed him of her of the general nature of the papers. & @O (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. 40 (physical address unknown) a person at least 18 years of age apparently in charge at the usual mailing address of the person to be served, other than a United States Postal Service post office box. | informed him of her of the general nature of the papers. 40 | 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 (date): from (city): or ["] a declaration of mailing is attached. ©) 0 tattacha declaration of diligence stating actions taken first to attempt personal service. Form. for Mandatory Use Paget of2 ical of Ci Code of Civil Procedure, § 417.10 #6 1S-010 (Rev. January 712007) PROOF OF SERVICE OF SUMMONS POS010-1/CW442419 PETITIONER: Veronica Reyes, et al. - ~ CASE NUMBER: CIVSB2028140 RESPONDENT: Knolls West Convalescent Hospital, et al. oO) by mail and acknowledgment of receipt of service. | mailed the documents listed in item 2 to the party, to the address shown in item 4, by first-class mail, postage prepaid, (1) on (date): (2) from (city): @O with two copies of the Notice and Acknowledgment of Receiptand a postage-paid return envelope addressed to me. (Attach completed Notice and Acknowledgement of Receipt.) (Code Civ. Proc., § 415.30.) 40 to an address outside California with return receipt requested. (Code Civ. Proc., § 415.40.) 40 by other means (specify means of service and authorizing code section): Me eho Additional page describing service is attached. The "Notice to the Person Served” (on the summons) was completed as follows: a as an individual defendant. b. as the person sued under the fictitious name of (specify): c., as occupant. d. Ld On behaif of (specify): under the following Code of Civil Procedure section: 416.10 (corporation) oO 415.95 (business organization, form unknown) 416.20 (defunct corporation) Oo 416.60 (minor) 416.30 (joint stock company/association) O 416.70 (ward or conservatee) 416.40 (association or partnership) 416.90 (authorized person) 416.50 (public entity) 415.46 (occupant) wy oO other: ion AT Person who served papers a. Nae: Candis Ayala - Cal West Attorney Services, Inc ae b. Aiftress: 1201 W. Temple Street Los Angeles, CA 90026 c. Tafephone number: (213) 353-9100 d. The fee for service was: $ 140.00 e. lam: (1) qf nL not a registered California process server. (2) exempt from registration under Business and Professions Code section 22350(b). (3) tered California pi S server: Fi owner employee mo independent contractor. ar “~ (ii) Registration No.: 1038 (li) County: Riverside 8. oy | declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. ‘ or 9.0] tam a California sheriff or marshal and | certify that the foregoing is true and correct. Tate: 6/21/2022 €al West Attorn Services, Inc 1201 W. Temple et Los Angeles, CA 90026 (213) 100 www.calwest.info *? WANE OF PERSON WHO SERVED PAPERS/SHERIFF OR MARSHAL) 18-010 [Rev January 1, 2007] Pago 2 of 2 PROOF OF SERVICE OF SUMMONS as POS-010/CW442419 os a ~+* a