On March 25, 2024 a
Judgment
was filed
involving a dispute between
Barensten, Kimberly Ann,
and
Department Of Insurance,
for WRITS OF MANDATE OR PROH., CERTI., ETC./ADMIN. AGEN
in the District Court of San Francisco County.
Preview
CIV-110
[ATTORNEY OR PARTY WITHOUT ATTORNEY STATE BAR NUMBER: 137465 FOR COURT USE ONLY
NAME: Adam G. Slote
FIRMNaME: Slote, Links & Boreman, PC
STREET ADDRESS: 50 California St., 34th Floor
city: San Francisco state: CA zip CODE: 94111
TELEPHONENO.: 415-393-8012 FAX NO. ELECTRONICALLY
E-MAIL ADDRESS: adam@slotelaw.com FILED
JATTORNEY FOR (name): KIMBERLY ANN BARENTSEN Superior Court of California,
County of San Francisco
SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN FRANCISCO
STREET ADDRESS: 400 McAllister Street 03/25/2024
MAILING ADDRESS: Clerk of the Court
CITY AND ZIP CODE: San Francisco 94102 BY: YOLANDA TABO
BRANCH NAME: Deputy Clerk
PLAINTIFF/PETITIONER: KIMBERLY ANN BARENTSEN
DEFENDANT/RESPONDENT: DEPARTMENT OF INSURANCE
CASE NUMBER:
REQUEST FOR DISMISSAL CPF-24-518501
Acconformed copy will not be returned by the clerk unless a method of return is provided with the document.
This form may not be used for dismissal of a derivative action or a class action or of any party or cause of action ina
class action. (Cal. Rules of Court, rules 3.760 and 3.770.)
TO THE CLERK: Please dismiss this action as follows:
a. (1) With prejudice (2) [28] Without prejudice
b. (1) Complaint (2) [_] Petition
(3) Cross-complaint
filed by (name): on (date):
(4) Cross-complaint
filed by (name): ‘on (date):
(5) Entire action of all parties and all causes of action
(6) Other (specify):*
(Complete in all cases except family law cases.)
The court [_] did [24 did not waive court fees and costs for a party in this case. (This infor ition may be obtained from
the clerk. If court fees and costs were waived, the declaration on the back of this form must be mpleted).
Date: March 25, 2024
Adam G. Slote
(TYPE OR PRINT NAME OF [98] ATTORNEY
> Loe
[_] Party witHour aTToRNey) (SIGNATURE)
*if dismissal requested is of specified parties only of specified causes of action only, or Attorney or party without attorney for:
of specified cross-complaints only, so state and identify the parties, causes of action, [2] Plaintiff/Petitioner [] Defendant/Respondent
or cross-complaints to be dismissed
[] Cross-Complainant
3. TO THE CLERK: Consent to the above dismissal is hereby given.**
Date:
>
(TYPE OR PRINT NAME OF [—] ATTORNEY [_] PARTY wiTHouT ATTORNEY) (SIGNATURE)
* Ifa cross-complaint - or Response (Family Law) seeking affirmative relief - is on Attorney or party without attorney for:
file, the attorney for cross-complainant (respondent) must sign this consent if required
by Code of Civil Procedure section 581 (i) or ().
[__] Plaintift/Petitioner [] Defendant/Respondent
[J Cross-Complainant
4 . [_] Dismissal entered as requested on (date):
5. . [-_] Dismissal entered on (date): as to only (name): DISMISSAL ENTERED
03/25/2024
6. . [__] Dismissal not entered as requested for the following reasons (specify):
By: YOLANDA TABO
Deputy Clerk
a. [__] Attorney or party without attorney notified on (date):
b. [-_] Attorney or party without attorney not notified. Filing party failed to provide
[1 acopy to be conformed [1 means to return conformed copy
Date: Clerk, by , Deputy
Page 1 of 2
Form Adopted for Mandatory Use REQUEST FOR DISMISSAL Code of Civil Procedure, § 581 et seq
Judicial Council of California Gov. Code,
§ 68637(c); Cal. Rules of Cour, rule 3.1390
CIV-110 [Rev, January 1, 2013] www courts.ca.go
CIV-110
PLAINTIFF/PETITIONER: KIMBERLY ANN BARENTSEN CASE NUMBER:
CPF-24-518501
DEFENDANT/RESPONDENT: DEPARTMENT OF INSURANCE
COURT'S RECOVERY OF WAIVED COURT FEES AND COSTS
If a party whose court fees and costs were initially waived has recovered or will recover $10,000 or
more in value by way of settlement, compromise, arbitration award, mediation settlement, or other
means, the court has a statutory lien on that recovery. The court may refuse to dismiss the case until
the lien is satisfied. (Gov. Code, § 68637.)
Declaration Concerning Waived Court Fees
4 The court waived court fees and costs in this action for (name):
2. The person named in item 1 is (check one below):
a. [__] not recovering anything of value by this action.
b. [__] recovering less than $10,000 in value by this action.
c. [__] recovering $10,000 or more in value by this action. (If item 2c is checked, item 3 must be completed.)
3. All court fees and court costs that were waived in this action have been paid to the court (check one): [__] Yes [] No
| declare under penalty of perjury under the laws of the State of California that the information above is true and correct.
Date:
>
(TYPE OR PRINT NAME OF [__] ATTORNEY [_] PARTY MAKING DECLARATION) (SIGNATURE)
Clv-110 [Rev. January
1, 2013] REQUEST FOR DISMISSAL Page 2 of 2
Document Filed Date
March 25, 2024
Case Filing Date
March 25, 2024
Category
WRITS OF MANDATE OR PROH., CERTI., ETC./ADMIN. AGEN
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CIV-110 [ATTORNEY OR PARTY WITHOUT ATTORNEY STATE BAR NUMBER: 137465 FOR COURT USE ONLY NAME: Adam G. Slote FIRMNaME: Slote, Links & Boreman, PC STREET ADDRESS: 50 California St., 34th Floor city: San Francisco state: CA zip CODE: 94111 TELEPHONENO.: 415-393-8012 FAX NO. ELECTRONICALLY E-MAIL ADDRESS: adam@slotelaw.com FILED JATTORNEY FOR (name): KIMBERLY ANN BARENTSEN Superior Court of California, County of San Francisco SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN FRANCISCO STREET ADDRESS: 400 McAllister Street 03/25/2024 MAILING ADDRESS: Clerk of the Court CITY AND ZIP CODE: San Francisco 94102 BY: YOLANDA TABO BRANCH NAME: Deputy Clerk PLAINTIFF/PETITIONER: KIMBERLY ANN BARENTSEN DEFENDANT/RESPONDENT: DEPARTMENT OF INSURANCE CASE NUMBER: REQUEST FOR DISMISSAL CPF-24-518501 Acconformed copy will not be returned by the clerk unless a method of return is provided with the document. This form may not be used for dismissal of a derivative action or a class action or of any party or cause of action ina class action. (Cal. Rules of Court, rules 3.760 and 3.770.) TO THE CLERK: Please dismiss this action as follows: a. (1) With prejudice (2) [28] Without prejudice b. (1) Complaint (2) [_] Petition (3) Cross-complaint filed by (name): on (date): (4) Cross-complaint filed by (name): ‘on (date): (5) Entire action of all parties and all causes of action (6) Other (specify):* (Complete in all cases except family law cases.) The court [_] did [24 did not waive court fees and costs for a party in this case. (This infor ition may be obtained from the clerk. If court fees and costs were waived, the declaration on the back of this form must be mpleted). Date: March 25, 2024 Adam G. Slote (TYPE OR PRINT NAME OF [98] ATTORNEY > Loe [_] Party witHour aTToRNey) (SIGNATURE) *if dismissal requested is of specified parties only of specified causes of action only, or Attorney or party without attorney for: of specified cross-complaints only, so state and identify the parties, causes of action, [2] Plaintiff/Petitioner [] Defendant/Respondent or cross-complaints to be dismissed [] Cross-Complainant 3. TO THE CLERK: Consent to the above dismissal is hereby given.** Date: > (TYPE OR PRINT NAME OF [—] ATTORNEY [_] PARTY wiTHouT ATTORNEY) (SIGNATURE) * Ifa cross-complaint - or Response (Family Law) seeking affirmative relief - is on Attorney or party without attorney for: file, the attorney for cross-complainant (respondent) must sign this consent if required by Code of Civil Procedure section 581 (i) or (). [__] Plaintift/Petitioner [] Defendant/Respondent [J Cross-Complainant 4 . [_] Dismissal entered as requested on (date): 5. . [-_] Dismissal entered on (date): as to only (name): DISMISSAL ENTERED 03/25/2024 6. . [__] Dismissal not entered as requested for the following reasons (specify): By: YOLANDA TABO Deputy Clerk a. [__] Attorney or party without attorney notified on (date): b. [-_] Attorney or party without attorney not notified. Filing party failed to provide [1 acopy to be conformed [1 means to return conformed copy Date: Clerk, by , Deputy Page 1 of 2 Form Adopted for Mandatory Use REQUEST FOR DISMISSAL Code of Civil Procedure, § 581 et seq Judicial Council of California Gov. Code, § 68637(c); Cal. Rules of Cour, rule 3.1390 CIV-110 [Rev, January 1, 2013] www courts.ca.go CIV-110 PLAINTIFF/PETITIONER: KIMBERLY ANN BARENTSEN CASE NUMBER: CPF-24-518501 DEFENDANT/RESPONDENT: DEPARTMENT OF INSURANCE COURT'S RECOVERY OF WAIVED COURT FEES AND COSTS If a party whose court fees and costs were initially waived has recovered or will recover $10,000 or more in value by way of settlement, compromise, arbitration award, mediation settlement, or other means, the court has a statutory lien on that recovery. The court may refuse to dismiss the case until the lien is satisfied. (Gov. Code, § 68637.) Declaration Concerning Waived Court Fees 4 The court waived court fees and costs in this action for (name): 2. The person named in item 1 is (check one below): a. [__] not recovering anything of value by this action. b. [__] recovering less than $10,000 in value by this action. c. [__] recovering $10,000 or more in value by this action. (If item 2c is checked, item 3 must be completed.) 3. All court fees and court costs that were waived in this action have been paid to the court (check one): [__] Yes [] No | declare under penalty of perjury under the laws of the State of California that the information above is true and correct. Date: > (TYPE OR PRINT NAME OF [__] ATTORNEY [_] PARTY MAKING DECLARATION) (SIGNATURE) Clv-110 [Rev. January 1, 2013] REQUEST FOR DISMISSAL Page 2 of 2