On April 11, 2023 a
Miscellaneous
was filed
involving a dispute between
Brown, Louis M,
and
City Of Leominster,
John Does 1 Through 10,
Massachusetts Interlocal Insurance Association,
Mazzarella, Dean,
for Torts
in the District Court of Worcester County.
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Date Filed 4/11/2023 12:06 PM
Supe = r
Docket Number
DOCKET NUMBER ‘Trial Court of Massachusetts
CIVIL ACTION COVER SHEET ( fis 2),
)
ASBSCv0 0333 - }) The Superior Court
Plaintift
COUNTY Worcester Superior Court (Worcester)
Louis M. Brown Defendant: City of Leominster
ADDRESS: 16 Green Mountain Ave |ADDRESS: 25 West Street
Leominster, MA 01453
Leominster, MA 01453
Plaintiff:
'
Defendant: Dean Mazzarella
ADDRESS:
ADDRESS: 25 West Street
Leominster, MA 01453
Plaintiff Attorney: Defendant: Massachusetts Interlocal Insurance Association
ADDRESS: ‘ADDRESS: 15 Cabot Rd
Wobum, MA 01801
BBO:
TYPE OF ACTION AND TRACK DESIGNATION (see instructions section on
next page)
CODE NO, TYPE OF ACTION (specify) TRACK HAS A JURY CLAIM BEEN MADE?
Bi Other Negligence - Personal Injury F
YES 0 xo
“If "Other" please describe:
Is there a claim under G.L. c. 93A7 is there a class action under Mass. R. Clv. P. 23?
(C yYes no Ores [no
STATEMENT OF DAMAGES REQUIRED BY GL. c. 212, §3A
‘The following is a full, itemized and detailed statement of the facts on which the undersi
|(Note to plaintiff:
igned plaintiff or plaintiffs counsel relies to determine money damages.
for this form, do not state double or treble damages; indicate single damages only.)
|A. Documented medical expenses to date
1. Total hospital expenses
2, Total doctor expenses
$8,000.00
3. Total chiropractic expenses
4. Total physical therapy expenses
5. Total other expenses (describe below)
Subtotal (1-5): $8,000.00
B. Documented lost wages and compensation to date
C. Documented property damages to date
$30,000.00
D, Reasonably anticipated future medical and hospital expenses
E. Reasonably anticipated lost wages
F. Other documented items of damages (describe below)
$100,000.00
[Gress negligence
TOTAL (A-F): $138,000.00
G. Briefly describe plaintiff's injury, including the nature and extent of the injury:
[knee injury and property damage
SONTRACT CLAIMS.
(717 This action includes a claim involving collection of a debt incurred Pursuantto a revolving credit
agreement. Mass. R. Civ. P. 8.1(a).
tem # Detailed Description of Each Claim Amount
1
Total}
Signature of Attorney/Self-Represented Plaintiff: XL, i lb fLE OEE
RELATED ACTIONS: Please provide the case number Fr, case Name, and county
of any related actions pending in the Superior Court.
[ April 14, 2023
L $0001: 1/13/2023. _|
www.mass.gov/courts Date/Time Printed:04-11-2023 11:29:50
Document Filed Date
April 11, 2023
Case Filing Date
April 11, 2023
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Date Filed 4/11/2023 12:06 PM Supe = r Docket Number DOCKET NUMBER ‘Trial Court of Massachusetts CIVIL ACTION COVER SHEET ( fis 2), ) ASBSCv0 0333 - }) The Superior Court Plaintift COUNTY Worcester Superior Court (Worcester) Louis M. Brown Defendant: City of Leominster ADDRESS: 16 Green Mountain Ave |ADDRESS: 25 West Street Leominster, MA 01453 Leominster, MA 01453 Plaintiff: ' Defendant: Dean Mazzarella ADDRESS: ADDRESS: 25 West Street Leominster, MA 01453 Plaintiff Attorney: Defendant: Massachusetts Interlocal Insurance Association ADDRESS: ‘ADDRESS: 15 Cabot Rd Wobum, MA 01801 BBO: TYPE OF ACTION AND TRACK DESIGNATION (see instructions section on next page) CODE NO, TYPE OF ACTION (specify) TRACK HAS A JURY CLAIM BEEN MADE? Bi Other Negligence - Personal Injury F YES 0 xo “If "Other" please describe: Is there a claim under G.L. c. 93A7 is there a class action under Mass. R. Clv. P. 23? (C yYes no Ores [no STATEMENT OF DAMAGES REQUIRED BY GL. c. 212, §3A ‘The following is a full, itemized and detailed statement of the facts on which the undersi |(Note to plaintiff: igned plaintiff or plaintiffs counsel relies to determine money damages. for this form, do not state double or treble damages; indicate single damages only.) |A. Documented medical expenses to date 1. Total hospital expenses 2, Total doctor expenses $8,000.00 3. Total chiropractic expenses 4. Total physical therapy expenses 5. Total other expenses (describe below) Subtotal (1-5): $8,000.00 B. Documented lost wages and compensation to date C. Documented property damages to date $30,000.00 D, Reasonably anticipated future medical and hospital expenses E. Reasonably anticipated lost wages F. Other documented items of damages (describe below) $100,000.00 [Gress negligence TOTAL (A-F): $138,000.00 G. Briefly describe plaintiff's injury, including the nature and extent of the injury: [knee injury and property damage SONTRACT CLAIMS. (717 This action includes a claim involving collection of a debt incurred Pursuantto a revolving credit agreement. Mass. R. Civ. P. 8.1(a). tem # Detailed Description of Each Claim Amount 1 Total} Signature of Attorney/Self-Represented Plaintiff: XL, i lb fLE OEE RELATED ACTIONS: Please provide the case number Fr, case Name, and county of any related actions pending in the Superior Court. [ April 14, 2023 L $0001: 1/13/2023. _| www.mass.gov/courts Date/Time Printed:04-11-2023 11:29:50