On March 26, 2024 a
Clerk Notice
was filed
involving a dispute between
Vermont Mutual Insurance Co.,
and
City Of Boston,
for Actions Involving the State/Municipality
in the District Court of Norfolk County.
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Date Filed 3/26/2024 12:04 PM
Superior Court - Norfo
Docket Number 2.0
@
DOCKET NUMBER, Massachusetts Trial Court
CIVIL ACTION COVER SHEET 2482cv00291 Superior Court Se
— COUNTY Norfolk Superior Court (Dedham)
Plaintiff Vermont Mutual Insurance Co. (a/s/o Malachi Defendant: Gity of Boston
ADDRESS) Austin-Gaylor) ADDRESS. 1 City Hall Square, Boston, MA 02201
89 State Street, P.O. Box 188, Montpelier, Vermont 05601
Plaintiff Attorney: Shannon D. Resnick, Esq. Defendant Attorney:
ADDRESS: Law Office of Shannon D. Resnick, P.C. ADDRESS:
175 Derby Street, Unit 8, Hingham, MA 02043
BBO: 691375 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?
AAI Action involving municipality A Xj Yes [J no
~
*If "Other" please describe:
Is there a claim under G.L. c. 93A7 Is there a class action under Mass. R. Civ. P. 23?
(yes X] no (J ves {no
STATEMENT OF DAMAGES REQUIRED
BY G.L. ¢..212, § 3A
The following is a full, itemized and detailed statement of the facts on which the undersigned plaintiff or plaintiff's counsel relies to determine money damages.
(Note to plaintiff: for this form, do not state double or treble damages; indicate single damages only.)
‘ORT CLAIMS,
A. Documented medical expenses to date
4, Total hospital expenses RECEIVED and DOCKETED 3/26/2024
2. Total doctor expenses
3. Total chiropractic expenses
4. Total physical therapy expenses
5, Total other expenses (describe below)
Subtotal (1-5): $0.00
B. Documented lost wages and compensation to date
C. Documented property damages to date
D. Reasonably anticipated future medical and hospital expenses
£. Reasonably anticipated lost wages
F. Other documented items of damages (describe below) $28,017.49
[rollision property damage, PIP, renial
TOTAL (A-F): $28,017.49
G. Briefly describe plaintiff's injury, including the nature and extent of the injury:
CONTRACT CLAIMS
[_] This action includes a claim involving collection of a debt incurred pursuant to a revolving credit agreement. Mass. R. Civ. P. 8.1(a).
Item # Detailed Description of Each Claim Amount
4
Total
Signature of Attorney/Self-Represented Plaintiff: X Mew fe [pate March 25, 2024
RELATED ACTIONS: Please provide the case number, case name, and counly of any related actions pending in the Superior Court.
[ CERTIFICATION UNDER S.J.C. RULE 1:18(5)
Thereby certify that | have complied with requirements of Rule 5 of Supreme Judicial Court Rule 1:18: Uniform Rules on Dispute Resolution, requiring that | inform my clients about
court-connected dispute resolution services and discuss with them the advantages and disadvantages of the various methods of dispute resolution.
Signature of Attorney: X Pon fA 7, | [Date: March 25, 2024
SC0001: 02/24 www.mass.govicourts, Date/Time Printed:03-25-2024 13:40:34
Document Filed Date
March 26, 2024
Case Filing Date
March 26, 2024
Category
Actions Involving the State/Municipality
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Date Filed 3/26/2024 12:04 PM Superior Court - Norfo Docket Number 2.0 @ DOCKET NUMBER, Massachusetts Trial Court CIVIL ACTION COVER SHEET 2482cv00291 Superior Court Se — COUNTY Norfolk Superior Court (Dedham) Plaintiff Vermont Mutual Insurance Co. (a/s/o Malachi Defendant: Gity of Boston ADDRESS) Austin-Gaylor) ADDRESS. 1 City Hall Square, Boston, MA 02201 89 State Street, P.O. Box 188, Montpelier, Vermont 05601 Plaintiff Attorney: Shannon D. Resnick, Esq. Defendant Attorney: ADDRESS: Law Office of Shannon D. Resnick, P.C. ADDRESS: 175 Derby Street, Unit 8, Hingham, MA 02043 BBO: 691375 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? AAI Action involving municipality A Xj Yes [J no ~ *If "Other" please describe: Is there a claim under G.L. c. 93A7 Is there a class action under Mass. R. Civ. P. 23? (yes X] no (J ves {no STATEMENT OF DAMAGES REQUIRED BY G.L. ¢..212, § 3A The following is a full, itemized and detailed statement of the facts on which the undersigned plaintiff or plaintiff's counsel relies to determine money damages. (Note to plaintiff: for this form, do not state double or treble damages; indicate single damages only.) ‘ORT CLAIMS, A. Documented medical expenses to date 4, Total hospital expenses RECEIVED and DOCKETED 3/26/2024 2. Total doctor expenses 3. Total chiropractic expenses 4. Total physical therapy expenses 5, Total other expenses (describe below) Subtotal (1-5): $0.00 B. Documented lost wages and compensation to date C. Documented property damages to date D. Reasonably anticipated future medical and hospital expenses £. Reasonably anticipated lost wages F. Other documented items of damages (describe below) $28,017.49 [rollision property damage, PIP, renial TOTAL (A-F): $28,017.49 G. Briefly describe plaintiff's injury, including the nature and extent of the injury: CONTRACT CLAIMS [_] This action includes a claim involving collection of a debt incurred pursuant to a revolving credit agreement. Mass. R. Civ. P. 8.1(a). Item # Detailed Description of Each Claim Amount 4 Total Signature of Attorney/Self-Represented Plaintiff: X Mew fe [pate March 25, 2024 RELATED ACTIONS: Please provide the case number, case name, and counly of any related actions pending in the Superior Court. [ CERTIFICATION UNDER S.J.C. RULE 1:18(5) Thereby certify that | have complied with requirements of Rule 5 of Supreme Judicial Court Rule 1:18: Uniform Rules on Dispute Resolution, requiring that | inform my clients about court-connected dispute resolution services and discuss with them the advantages and disadvantages of the various methods of dispute resolution. Signature of Attorney: X Pon fA 7, | [Date: March 25, 2024 SC0001: 02/24 www.mass.govicourts, Date/Time Printed:03-25-2024 13:40:34