Miscellaneous: S Viroja PA Plaintiff vs. Ocean Harbor Casualty Insurance Company Defendant

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                                Case Number: CONO-21-004628 Division: 73
Filing # 121700526 E-Filed 02/19/2021 10:54:21 AM



         FORM           1.997.    CIVIL COVER SHEET

         The civil cover sheet and the information contained in it neither replace nor supplement the filing
         and service of pleadings or other documents as required by law. This form must be filed by the
         plaintiff or petitioner with the Clerk of Court for the purpose of reporting uniform data pursuant
         to section 25.075, Florida Statutes. (See instructions for completion.)


                    I            CASE STYLE

                                 IN THE CIRCUIT COURT OF THE SEVENTEENTH    JUDICIAL CIRCUIT,
                                       IN AND FOR BROWARD   COUNTY, FLORIDA

         S. Viroja, P.A.
         Plaintiff                                                                  Case #
                                                                                    Judge
         vs.
        Ocean Harbor Casualty Insurance Company
         Defendant



                    Il.          AMOUNT OF CLAIM
        Please indicate the estimated amount of the claim, rounded to the nearest dollar. The estimated amount of
        the claim is requested for data collection and clerical processing purposes only. The amount of the claim
        shall not be used for any other purpose.

         OD     $8,000 or less
         $8,001 - $30,000
         1 $30,001- $50,000
         1 $50,001- $75,000
         $75,001 - $100,000
         Oi over $100,000.00

                    Til.         TYPE OF CASE    (If the case fits more than one type of case, select the most
         definitive category.) If the most descriptive label is a subcategory (is indented under a broader
         category), place an x on both the main category and subcategory lines.




                                                            -l-

               #** FILED: BROWARD COUNTY, FL BRENDA D. FORMAN,             CLERK 02/19/2021 10:54:18 AM.*##*
CIRCUIT CIVIL

O Condominium
CO Contracts and indebtedness
CO Eminent domain
CO Auto negligence
0 Negligence—other
        C Business governance
          CO Business torts
           CO Environmental/Toxic tort
          O Third party indemnification
          CO Construction defect
          C Mass tort
          O Negligent security
           CO Nursing home negligence
          O Premises liability—commercial
          O Premises liability—residential
© Products liability
C Real Property/Mortgage foreclosure
       O Commercial foreclosure
       C Homestead residential foreclosure
       O Non-homestead residential foreclosure
       O Other real property actions

OProfessional malpractice
       0 Malpractice—business
          O Malpractice—medical
          O Malpractice—other professional
O Other
          C Antitrust/Trade regulation
          CO Business transactions
          O Constitutional challenge—statute or ordinance
          C Constitutional challenge—proposed amendment
           CO   Corporate trusts
           O    Discrimination—employment or other
          C     Insurance claims
          C     Intellectual property
          CO Libel/Slander
           CO Shareholder derivative action
          O Securities litigation
           CO Trade secrets
          O Trust litigation

COUNTY CIVIL

& Small Claims up to $8,000
O Civil
CO Real property/Mortgage foreclosure
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O Replevins
 O Evictions
        O Residential Evictions
         O Non-residential Evictions
 O Other civil (non-monetary)

                                        COMPLEX BUSINESS COURT

This action is appropriate for assignment to Complex Business Court as delineated and mandated by the
Administrative Order. Yes 1 No X

         Iv.    REMEDIES SOUGHT (check all that apply):
         O Monetary;
               Nonmonetary declaratory or injunctive relief;
         O Punitive

         Vv.        NUMBER OF CAUSES OF ACTION: [ ]
         (Specify)
               41

         VI.        IS THIS CASE A CLASS ACTION LAWSUIT?
                    0 yes
                    &   no


         Vil.       HAS NOTICE OF ANY KNOWN               RELATED CASE BEEN FILED?
                    & no
                    O yes If “yes,” list all related cases by name, case number, and court.

         Vil.       IS JURY TRIAL DEMANDED             IN COMPLAINT?
                    & yes
                    O no

 ICERTIFY that the information I have provided in this cover sheet is accurate to the best of
 my knowledge and belief, and that I have read and will comply with the requirements of
 Florida Rule of Judicial Administration 2.425.

 Signature: s/ Simon E Pineres Jr                          Fla. Bar # 98067
                 Attorney or party                                        (Bar # if attorney)

Simon E Pineres Jr                                 02/19/2021
 (type or print name)                              Date




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