On December 14, 2020 a
Proof of Personal Service of Summons Elec Filed - PROOF OF SERVICE OF SUMMONS
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
December 26, 2023
POS-O10
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address) FOR COURT USE ONLY
i Igor Fradkin, Esq. SBN: 299491 |
DOWNTOWN LA LAW GROUP
910 S. Broadway Los Angeles, CA 90015
TELEPHONE NO.: (213) 389-3765 FAX NO. (877) 389-2775 E-MAIL ADDRESS
| |
(Optional):
ATTORNEY FOR (Name)-' Plaintiff: Veronica Reyes
ELECTRONICALLY FILED (Auto)
San Bernardino Justice Center SUPERIOR COURT OF CALIFO RNIA
STREET ADDRESS: 247 West 3rd Street
COUNTY OF SAN BERNARDINO
12/26/2023 1:55 PM
MAILING ADDRESS:
CITY AND ZIP CODE: San Bernardino, CA 9241 5-021 0
BRANCH NAME:
PLAINTIFF: Veronica Reyes, et al. CASE NUMBER: CIV882028140
DEFENDANT: Knolls West Post Acute, LLC, et al.
Ref. No. or File No.:
PROOF OF SERVICE OF SUMMONS Veronica Reyes
(Separate proof of service is required for each party served.)
A . At the time of service | was at least 18 years of age and not a party to this action.
2. | served copies of:
SK
Summons
Complaint
SEEK
Alternative Dispute Resolution (ADR) package
Civil Case Cover Sheet (served in complex cases only)
Cross-complaint
SE other (specify documents): Amendment to Complaint; Certificate of Assignment; Notice of Trial Setting Conference and Notice od
Case Assignment; Statement of Damages
3. a. Party served (specify name ofparty as shown on documents served):
Victor Valley Medical Center, sued herein as DOE 1
b- m 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 pan‘y named in item 3a):
NICOLE STAUSS - Agent for service
4. Address where the party was served: 2710 Gateway Oaks Dr # 150
Sacramento, CA 95833-3505
5. |
se&ed 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): 12l22/2023 (2) at (time): 1:51 PM
b- D 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):
(1) D (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. informed him of her of the general nature of the papers.
|
(2) D (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 ofthe papers.
|
(3) D (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.
(4) D |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): OI‘
Da declaration of mailing is attached.
(5) D | attach a declaration of diligence stating actions taken first to attempt personal service.
Page 1 of 2
EogmAlpgrovedl fofrCM??dat_ory Use Code of Civil Procedure, § 417.10
PROOF OF SERVICE 0F SUMMONS Poso1 0-1/CW499303
$63310 $23? J°anu2iy°§f"goo7]
PETITIONER: Veronica Reyes, et al.
CASE NUMBER:
CIV832028140
RESPONDENT: Knolls West Post Acute, LLC, et al.
c. D 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):
(3) D 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) D to an address outside California with return receipt requested. (Code Civ. Proc., § 415.40.)
d. D by other means (specify means of service and authorizing code section):
D Additional page describing service is attached.
6. The "Notice to the Person Served" (on the summons) was completed as follows:
a. D as an individual defendant.
b- D as the person sued under the fictitious name of (specify):
c. D as occupant.
d- m On behalf of (specify): Victor Valley Medical Center, sued herein as DOE 1
under the following Code of Civil Procedure section:
D 416.10 (corporation) fl 415.95 (business organization, form unknown)
D 416.20 (defunct corporation) D 416.60 (minor)
D 416.30 (joint stock company/association) D 416.70 (ward Or conservatee)
D 416.40 (association or partnership) D 416.90 (authorized person)
D 416.50 (public entity) D 415.46 (occupant)
D other:
7. Person who served papers
a.Name: Krystalyn Souza Cal West Attorney Services, Inc
-
b. Address: 730 Salem Street Glendale, CA 91203
c. Telephone number: (213) 353-9100
d. The fee for service was: $ 187.09
e. lam:
(1) D a not registered California process server.
(2) exempt from registration under Business and Professions Code section 22350(b).
(3) g re istered California process server:
a
(i)
owner D employee independent contractor.
(ii) Registration No.: PS-047
(iii)County: Yuba
8_ a l declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
or
9. D I am a California sheriff or marshal and | certify that the foregoing is true and correct.
Date: 12/26/2023
Cal West Attorney Services, Inc
730 Salem Street
Glendale, CA 91203
(213) 353-9100
vwvw.calwest.info
Krystalyn Souza >
(NAME OF PERSON WHO SERVED PAPERS/SHERIFF OR MARSHAL) V
POS-O1O [Rev January 2007] Page 2 Of2
1,
PROOF OF SERVICE 0F SUMMONS
POS-01 0/CW499303
Document Filed Date
December 26, 2023
Case Filing Date
December 14, 2020
Category
Medical Malpractice Unlimited
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December 26, 2023 POS-O10 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address) FOR COURT USE ONLY i Igor Fradkin, Esq. SBN: 299491 | DOWNTOWN LA LAW GROUP 910 S. Broadway Los Angeles, CA 90015 TELEPHONE NO.: (213) 389-3765 FAX NO. (877) 389-2775 E-MAIL ADDRESS | | (Optional): ATTORNEY FOR (Name)-' Plaintiff: Veronica Reyes ELECTRONICALLY FILED (Auto) San Bernardino Justice Center SUPERIOR COURT OF CALIFO RNIA STREET ADDRESS: 247 West 3rd Street COUNTY OF SAN BERNARDINO 12/26/2023 1:55 PM MAILING ADDRESS: CITY AND ZIP CODE: San Bernardino, CA 9241 5-021 0 BRANCH NAME: PLAINTIFF: Veronica Reyes, et al. CASE NUMBER: CIV882028140 DEFENDANT: Knolls West Post Acute, LLC, et al. Ref. No. or File No.: PROOF OF SERVICE OF SUMMONS Veronica Reyes (Separate proof of service is required for each party served.) A . At the time of service | was at least 18 years of age and not a party to this action. 2. | served copies of: SK Summons Complaint SEEK Alternative Dispute Resolution (ADR) package Civil Case Cover Sheet (served in complex cases only) Cross-complaint SE other (specify documents): Amendment to Complaint; Certificate of Assignment; Notice of Trial Setting Conference and Notice od Case Assignment; Statement of Damages 3. a. Party served (specify name ofparty as shown on documents served): Victor Valley Medical Center, sued herein as DOE 1 b- m 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 pan‘y named in item 3a): NICOLE STAUSS - Agent for service 4. Address where the party was served: 2710 Gateway Oaks Dr # 150 Sacramento, CA 95833-3505 5. | se&ed 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): 12l22/2023 (2) at (time): 1:51 PM b- D 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): (1) D (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. informed him of her of the general nature of the papers. | (2) D (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 ofthe papers. | (3) D (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. (4) D |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): OI‘ Da declaration of mailing is attached. (5) D | attach a declaration of diligence stating actions taken first to attempt personal service. Page 1 of 2 EogmAlpgrovedl fofrCM??dat_ory Use Code of Civil Procedure, § 417.10 PROOF OF SERVICE 0F SUMMONS Poso1 0-1/CW499303 $63310 $23? J°anu2iy°§f"goo7] PETITIONER: Veronica Reyes, et al. CASE NUMBER: CIV832028140 RESPONDENT: Knolls West Post Acute, LLC, et al. c. D 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): (3) D 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) D to an address outside California with return receipt requested. (Code Civ. Proc., § 415.40.) d. D by other means (specify means of service and authorizing code section): D Additional page describing service is attached. 6. The "Notice to the Person Served" (on the summons) was completed as follows: a. D as an individual defendant. b- D as the person sued under the fictitious name of (specify): c. D as occupant. d- m On behalf of (specify): Victor Valley Medical Center, sued herein as DOE 1 under the following Code of Civil Procedure section: D 416.10 (corporation) fl 415.95 (business organization, form unknown) D 416.20 (defunct corporation) D 416.60 (minor) D 416.30 (joint stock company/association) D 416.70 (ward Or conservatee) D 416.40 (association or partnership) D 416.90 (authorized person) D 416.50 (public entity) D 415.46 (occupant) D other: 7. Person who served papers a.Name: Krystalyn Souza Cal West Attorney Services, Inc - b. Address: 730 Salem Street Glendale, CA 91203 c. Telephone number: (213) 353-9100 d. The fee for service was: $ 187.09 e. lam: (1) D a not registered California process server. (2) exempt from registration under Business and Professions Code section 22350(b). (3) g re istered California process server: a (i) owner D employee independent contractor. (ii) Registration No.: PS-047 (iii)County: Yuba 8_ a l declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. or 9. D I am a California sheriff or marshal and | certify that the foregoing is true and correct. Date: 12/26/2023 Cal West Attorney Services, Inc 730 Salem Street Glendale, CA 91203 (213) 353-9100 vwvw.calwest.info Krystalyn Souza > (NAME OF PERSON WHO SERVED PAPERS/SHERIFF OR MARSHAL) V POS-O1O [Rev January 2007] Page 2 Of2 1, PROOF OF SERVICE 0F SUMMONS POS-01 0/CW499303