On August 25, 2023 a
SUMMONS ON COMPLAINT (TRANSACTION ID # 100212063), PROOF OF SERVICE ONLY, FILED BY PLAINTIFF 3866 CLAY STREET LLC, A CALIFORNIA LIMITED LIABILITY COMPANY SERVED SEP-07-2023, PERSONAL SERVICE AS TO DEFENDANT CERTAIN UNDERWRITERS AT LLOYDS, LONDON, SUBSCRIBING TO POLICY NO.LBW710001
was filed
involving a dispute between
3866 Clay Street Llc, A California Limited,
and
Certain Underwriters At Lloyds, London,,
for CONTRACT/WARRANTY
in the District Court of San Francisco County.
Preview
POS-010
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
FOR COURT USE ONLY
Samuel Ray (SBN 308921)
COLLA & RAY LLP
1561 Powell Street, San Francisco, CA 94133
TELEPHONE NO.: (415) 579-1414 FAX NO. (Optional):
ELECTRONICALLY
E-MAIL ADDRESS (Optional): sam@collaray.com FILED
ATTORNEY FOR (Name): Plaintiff 3866 CLAY STREET LLC Superior Court of California,
County of San Francisco
SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN FRANCISCO
STREET ADDRESS: 400 McAllister 09/08/2023
MAILING ADDRESS: 400 McAllister Clerk of the Court
CITY AND ZIP CODE: San Francisco, 94102 BY: DAEJA ROGERS
Deputy Clerk
BRANCH NAME: Civic Center Courthouse
PLAINTIFF/PETITIONER: 3866 CLAY STREET LLC, a California Limited Liability Company CASE NUMBER:
DEFENDANT/RESPONDENT: CERTAIN UNDERWRITERS AT LLOYDS, LONDON; et al. CGC-23-608647
Ref. No. or File No.:
PROOF OF SERVICE OF SUMMONS 3866 Clay LLC v. Lloyds of London
(Separate proof of service is required for each party served.)
1. At the time of service I was at least 18 years of age and not a party to this action.
2. I served copies of:
a. ✖ summons
b. ✖ complaint
c. ✖ Alternative Dispute Resolution (ADR) package
d. ✖ Civil Case Cover Sheet (served in complex cases only)
e. cross-complaint
f. other (specify documents):
3. a. Party served (specify name of party as shown on documents served):
California Department of Insurance - Agent for Service of Process/Government Law Bureau
b. ✖ 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):
Christine (refused last name), Employee Authorized to Accept. Asian Female, est. age 35, glasses: No, Brown hair, 120 lbs
to 140 lbs, 5' to 5' 3"
4. Address where the party was served:
300 Capitol Mall, Suite 1700, Sacramento, CA 95814
5. I served the party (check proper box)
a. ✖ by personal service. I 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): September 7, 2023 (2) at (time): 4:22 pm
b. by substituted service. On (date): at (time): 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):
(1) (business) a person at least 18 years of age apparently in charge at the office or usual place of business
of the person to be served. I informed him or her of the general nature of the papers.
(2) (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. I informed him or her of the general nature of the papers.
(3) (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. I informed
him or her of the general nature of the papers.
(4) I 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). I mailed the documents on
(date): from (city): or a declaration of mailing is attached.
(5) I attach a declaration of diligence stating actions taken first to attempt personal service.
Page 1 of 2
Form Adopted for Mandatory Use Code of Civil Procedure, § 417.10
Judicial Council of California PROOF OF SERVICE OF SUMMONS
POS-010 [Rev. January 1, 2007]
POS-010
PLAINTIFF/PETITIONER: 3866 CLAY STREET LLC, a California Limited Liability Company CASE NUMBER:
DEFENDANT/RESPONDENT: CERTAIN UNDERWRITERS AT LLOYDS, LONDON; et al. CGC-23-608647
5. c. by mail and acknowledgment of receipt of service. I 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):
(3) with two copies of the Notice and Acknowledgment of Receipt and a postage-paid return envelope addressed
to me. (Attach completed Notice and Acknowledgement of Receipt.) (Code Civ. Proc., § 415.30.)
(4) to an address outside California with return receipt requested. (Code Civ. Proc., § 415.40.)
d. by other means (specify means of service and authorizing code section):
Additional page describing service is attached.
6. 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. ✖ On behalf of (specify): California Department of Insurance - Agent for Service of Process/Government Law Bureau
under the following Code of Civil Procedure section:
416.10 (corporation) 415.95 (business organization, form unknown)
416.20 (defunct corporation) 416.60 (minor)
416.30 (joint stock company/association) 416.70 (ward or conservatee)
416.40 (association or partnership) 416.90 (authorized person)
✖ 416.50 (public entity) 415.46 (occupant)
other:
7. Person who served papers
a. Name: Keith Olson
b. Address: 263 Harding Ave, 1, Sacramento, CA 95833
c. Telephone number: +1 (541) 251-0327
d. The fee for service was: $ 123.70
e. I am:
(1) not a registered California process server.
(2) exempt from registration under Business and Professions Code section 22350(b).
(3) ✖ a registered California process server:
(i) ✖ owner employee independent contractor.
(ii) Registration No.: 2023-009
(iii) County: Sacramento
8. ✖ I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
or
9. I am a California sheriff or marshal and I certify that the foregoing is true and correct.
Date: 9/8/2023
Keith Olson Keith Olson
(NAME OF PERSON WHO SERVED PAPERS/SHERIFF OR MARSHAL) (SIGNATURE)
Page 2 of 2
POS-010 [Rev. January 1, 2007] PROOF OF SERVICE OF SUMMONS
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