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Filing # 195814690 E-Filed 04/09/2024 03:17:20 PM
Form 1.997 Civil Cover Sheet
The civil cover sheet and the information contained herein neither replace nor supplement the filing and
service of pleadings or other papers as required by law. This form shall be filed by the plaintiff or
petitioner for the use of the Clerk of Court for the purpose of reporting judicial workload data pursuant to
Florida Statutes section 25.075. (See instructions for completion).
I. CASE STYLE
(Circuit Court)
MISTY MERCHANT and THOMAS
MERCHANT Case No.:
Judge:
Plaintiffs
Vv.
AMERICAN INTEGRITY INSURANCE
COMPANY OF FLORIDA
Defendant
Il. AMOUNT OF CLAIM
Please indicate the estimated amount of the claim, rounded to the nearest dollar. $$147,725.72 plus
fees and costs.
Ill. TYPE OF CASE (If the case fits more than one type of case, select the most definitive category.)
If the most descriptive label is a subcategory (is indented under a broader category), place an x in both the
main category and subcategory boxes.
CIRCUIT CIVIL
[] Condominium
[X] Contracts and indebtedness
[ ] Eminent domain
[] Auto negligence
[ ] Negligence—other
[ ] Business governance
[] Business torts
[ ] Environmental/Toxic tort
[] Third party indemnification
[] Construction defect
[] Mass tort
[] Negligent security
[ ] Nursing home negligence
[ ] Premises liability—commercial
[ ] Premises liability—residential
[] Products liability
[ ] Real property/Mortgage foreclosure
[ ] Commercial foreclosure
Filing 195814690 VS 05-2024-CA-023818-XXCA-BC.
[ ] Homestead residential foreclosure
[ ] Non-homestead residential foreclosure
[ ] Other real property actions
CL-0891-2001
[] Professional malpractice
[ ] Malpractice — business
[ ] Malpractice — medical
[ ] Malpractice — other professional
[] Other
[ ] Antitrust/Trade regulation
[ ] Business transactions
[ ] Constitutional challenge — statute or ordinance
[ ] Constitutional challenge — proposed amendment
[ ] Corporate trusts
[ ] Discrimination — employment or other
[] Insurance claims
[ ] Intellectual property
[ ] Libel/Slander
[ ] Shareholder derivative action
[ ] Securities litigation
[ ] Trade secrets
[ ] Trust litigation
COUNTY CIVIL
[] Civil
[] Replevins
[] Evictions
[] Other civil (non-monetary)
IV. REMEDIES SOUGHT (check all that apply):
[X ] monetary;
[] non-monetary declaratory or injunctive relief;
[] punitive
V. NUMBER OF CAUSES OF ACTION: (specify)
1. Breach of Contract
VI. IS THIS CASE A CLASS ACTION LAWSUIT?
{lyes
[X ] no
VII. HAS NOTICE OF ANY KNOWN RELATED CASE BEEN FILED?
[X ] no
[] yes If “yes”, list all related cases by name, case number, and court.
Filing 195814690 VS 05-2024-CA-023818-XXCA-BC.
CL-0891-2001
VILL. IS JURY TRIAL DEMANDED IN COMPLAINT?
[X]yes
[]no
I CERTIFY that the information I have provided in this cover sheet is accurate to the best of my
knowledge and belief, and that I have read and will comply with the requirements of Florida Rule of
Judicial Administration 2.425.
Signature /s/ Michael Ciocchetti Fla. Bar # 672645
Attorney or party (Bar # if attorney)
Michael Ciocchetti, Esq. 04/09/2024
(type or print name) Date
FORM 1.997. INSTRUCTIONS FOR ATTORNEYS COMPLETING CIVIL COVER SHEET
Plaintiff must file this cover sheet with first paperwork filed in the action or proceeding (except small claims
cases, probate, or family cases). Domestic and juvenile cases should be accompanied by a completed Florida
Family Law Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases. Failure to file a civil cover
sheet in any civil case other than those excepted above may result in sanctions.
L Case Style. Enter the name of the court, the appropriate case number assigned at the time of
filing of the original complaint or petition, the name of the judge assigned (if applicable), and the name
(last, first, middle initial) of plaintiff(s) and defendant(s).
I. Amount of Claim. Enter the estimated amount of the claim, rounded to the nearest dollar. The
estimated amount of the claim is requested for data collection and clerical processing purposes and is not
considered dispositive of the claim.
TIL. Type of Case. Place an “X” in the appropriate box. If the cause fits more than one type of case,
select the most definitive. If the most definitive label is a subcategory (indented under a broader category
label, place an “X” in the category and subcategory boxes. Definitions of the cases are provided below in
the order they appear on the form.
Circuit Civil
(A) Condominium - all civil lawsuits pursuant to Chapter 718, Florida Statutes, in which a condominium
association is a party.
(B) Contracts and indebtedness - all contract actions relating to promissory notes and other debts,
including those arising from the sale of goods, but excluding contract disputes involving condominium
associations.
(C) Eminent domain - all matters relating to the taking of private property for public use, including
inverse condemnation by state agencies, political subdivisions, or public service corporations.
(D) Auto negligence - all matters arising out of a party’s allegedly negligent operation of a motor vehicle.
(E) Negligence—other - all actions sounding in negligence, including statutory claims for relief on
account of death or injury, that are not included in other main categories.
Filing 195814690 VS 05-2024-CA-023818-XXCA-BC.
(F) Business governance - all matters relating to the management, administration, or control of a
company.
(G) Business torts - all matters relating to liability for economic loss allegedly caused by interference with
economic or business relationships.
CL-0891-2001
(H) Environmental/Toxic tort - all matters relating to claims that violations of environmental regulatory
provisions or exposure to a chemical caused injury or disease.
(1) Third party indemnification - all matters relating to liability transferred to a third party in a financial
relationship.
(J) Construction defect - all civil lawsuits in which damage or injury was allegedly caused by defects in the
construction of a structure.
(K) Mass tort - all matters relating to a civil action involving numerous plaintiffs against one or more defendants.
(L) Negligent security - all matters involving injury to a person or property allegedly resulting from insufficient
security.
(M) Nursing home negligence - all matters involving injury to a nursing home resident resulting from negligence
of nursing home staff or facilities.
(N) Premises liability—commercial - all matters involving injury to a person or property allegedly resulting from
a defect on the premises of a commercial property.
(O) Premises liability—tresidential - all matters involving injury to a person or property allegedly resulting from
a defect on the premises of a residential property.
(P) Products liability - all matters involving injury to a person or property allegedly resulting from the
manufacture or sale of a defective product or from a failure to warn.
(Q) Real property/Mortgage foreclosure - all matters relating to the possession, title, or boundaries of real
property. All matters involving foreclosures or sales of real property, including foreclosures associated with
condominium associations or condominium units. (The amount of claim specified in Section II, of the form
determines the filing fee pursuant to section 28.241, Florida Statutes.)
(R) Commercial foreclosure - all matters relating to the termination of a business owner’s interest in commercial
property by a lender to gain title or force a sale to satisfy the unpaid debt secured by the property.
(S) Homestead residential foreclosure - all matters relating to the termination of a residential property owner’s
interest by a lender to gain title or force a sale to satisfy the unpaid debt secured by the property where the
property has been granted a homestead exemption.
(T) Non-homestead residential foreclosure - all matters relating to the termination of a residential property
owner’s interest by a lender to gain title or force a sale to satisfy the unpaid debt secured by the property where
the property has not been granted a homestead exemption.
(U) Other real property actions - all matters relating to land, land improvements, or property rights not involving
commercial or residential foreclosure.
(V) Professional malpractice - all professional malpractice lawsuits.
(W) Malpractice—business - all matters relating to a business’s or business person’s failure to exercise the
degree of care and skill that someone in the same line of work would use under similar circumstances.
(X) Malpractice—medical - all matters relating to a doctor’s failure to exercise the degree of care and skill that
a physician or surgeon of the same medical specialty would use under similar circumstances.
(Y) Malpractice—other professional - all matters relating to negligence of those other than medical or business
professionals.
(Z) Other - all civil matters not included in other categories.
(AA) Antitrust/Trade regulation - all matters relating to unfair methods of competition or unfair or deceptive
business acts or practices.
(AB) Business transactions - all matters relating to actions that affect financial or economic interests.
(AC) Constitutional challenge—statute or ordinance — a challenge to a statute or ordinance, citing a violation of
the Florida Constitution.
(AD) Constitutional challenge—proposed amendment - a challenge to a legislatively initiated proposed
constitutional amendment, but excluding challenges to a citizen-initiated proposed constitutional amendment
because the Florida Supreme Court has direct jurisdiction of such challenges.
Filing 195814690 VS 05-2024-CA-023818-XXCA-BC.
CL-0891-2001
(AE) Corporate trusts - all matters relating to the business activities of financial services companies or banks
acting in a fiduciary capacity for investors.
(AF) Discrimination—employment or other - all matters relating to discrimination, including employment,
sex, race, age, handicap, harassment, retaliation, or wages
(AG) Insurance claims - all matters relating to claims filed with an insurance company.
(AH) Intellectual property - all matters relating to intangible rights protecting commercially valuable products
of the human intellect.
(AI) Libel/Slander - all matters relating to written, visual, oral, or aural defamation of character.
(AJ) Shareholder derivative action - all matters relating to actions by a corporation's shareholders to protect
and benefit all shareholders against corporate management for improper management.
(AK) Securities litigation - all matters relating to the financial interest or instruments of a company or
corporation.
(AL) Trade secrets - all matters relating to a formula, process, device, or other business information that is kept
confidential to maintain an advantage over competitors.
(AM) Trust litigation — all civil matters involving guardianships, estates, or trusts and not appropriately filed in
probate proceedings.
County Civil
(AN) Civil - all matters involving claims ranging from $8,001 through $30,000 in damages, exclusive of
interest, costs, and attorney fees.
(AO) Replevins — all lawsuits pursuant to Chapter 78, Florida Statutes, involving claims up to $30,000.
(AP) Evictions — all matters involving the recovery of possession of leased land or rental property by process
of law.
(AQ) Other Civil (non-monetary) — includes all other non-monetary county civil matters that were not
described in the other county civil categories.
Iv. Remedies Sought. Place an “X” in the appropriate box. If more than one remedy is
sought in the complaint or petition, check all that apply.
V. Number of Causes of Action. If the complaint or petition alleges more than one cause of
action, note the number and the name of the cause of action.
VI. Class Action. Place an “X” in the appropriate box.
Vil. Related Cases. Place an “X” in the appropriate box.
Vil. Is Jury Trial Demanded In Complaint? Check the appropriate box to indicate whether
a jury trial is being demanded in the complaint
ATTORNEY OR PARTY SIGNATURE. Sign the civil cover sheet. Print legibly the name of the person
signing the civil cover sheet. Attorneys must include a Florida Bar number. Insert the date the civil cover
sheet is signed. Signature is a certification that the filer has provided accurate information on the civil cover
sheet.
Filing 195814690 VS 05-2024-CA-023818-XXCA-BC.
CL-0891-2001
Filing 195814690 VS 05-2024-CA-023818-XXCA-BC.
Preview
Filing # 195814690 E-Filed 04/09/2024 03:17:20 PM Form 1.997 Civil Cover Sheet The civil cover sheet and the information contained herein neither replace nor supplement the filing and service of pleadings or other papers as required by law. This form shall be filed by the plaintiff or petitioner for the use of the Clerk of Court for the purpose of reporting judicial workload data pursuant to Florida Statutes section 25.075. (See instructions for completion). I. CASE STYLE (Circuit Court) MISTY MERCHANT and THOMAS MERCHANT Case No.: Judge: Plaintiffs Vv. AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA Defendant Il. AMOUNT OF CLAIM Please indicate the estimated amount of the claim, rounded to the nearest dollar. $$147,725.72 plus fees and costs. Ill. TYPE OF CASE (If the case fits more than one type of case, select the most definitive category.) If the most descriptive label is a subcategory (is indented under a broader category), place an x in both the main category and subcategory boxes. CIRCUIT CIVIL [] Condominium [X] Contracts and indebtedness [ ] Eminent domain [] Auto negligence [ ] Negligence—other [ ] Business governance [] Business torts [ ] Environmental/Toxic tort [] Third party indemnification [] Construction defect [] Mass tort [] Negligent security [ ] Nursing home negligence [ ] Premises liability—commercial [ ] Premises liability—residential [] Products liability [ ] Real property/Mortgage foreclosure [ ] Commercial foreclosure Filing 195814690 VS 05-2024-CA-023818-XXCA-BC. [ ] Homestead residential foreclosure [ ] Non-homestead residential foreclosure [ ] Other real property actions CL-0891-2001 [] Professional malpractice [ ] Malpractice — business [ ] Malpractice — medical [ ] Malpractice — other professional [] Other [ ] Antitrust/Trade regulation [ ] Business transactions [ ] Constitutional challenge — statute or ordinance [ ] Constitutional challenge — proposed amendment [ ] Corporate trusts [ ] Discrimination — employment or other [] Insurance claims [ ] Intellectual property [ ] Libel/Slander [ ] Shareholder derivative action [ ] Securities litigation [ ] Trade secrets [ ] Trust litigation COUNTY CIVIL [] Civil [] Replevins [] Evictions [] Other civil (non-monetary) IV. REMEDIES SOUGHT (check all that apply): [X ] monetary; [] non-monetary declaratory or injunctive relief; [] punitive V. NUMBER OF CAUSES OF ACTION: (specify) 1. Breach of Contract VI. IS THIS CASE A CLASS ACTION LAWSUIT? {lyes [X ] no VII. HAS NOTICE OF ANY KNOWN RELATED CASE BEEN FILED? [X ] no [] yes If “yes”, list all related cases by name, case number, and court. Filing 195814690 VS 05-2024-CA-023818-XXCA-BC. CL-0891-2001 VILL. IS JURY TRIAL DEMANDED IN COMPLAINT? [X]yes []no I CERTIFY that the information I have provided in this cover sheet is accurate to the best of my knowledge and belief, and that I have read and will comply with the requirements of Florida Rule of Judicial Administration 2.425. Signature /s/ Michael Ciocchetti Fla. Bar # 672645 Attorney or party (Bar # if attorney) Michael Ciocchetti, Esq. 04/09/2024 (type or print name) Date FORM 1.997. INSTRUCTIONS FOR ATTORNEYS COMPLETING CIVIL COVER SHEET Plaintiff must file this cover sheet with first paperwork filed in the action or proceeding (except small claims cases, probate, or family cases). Domestic and juvenile cases should be accompanied by a completed Florida Family Law Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases. Failure to file a civil cover sheet in any civil case other than those excepted above may result in sanctions. L Case Style. Enter the name of the court, the appropriate case number assigned at the time of filing of the original complaint or petition, the name of the judge assigned (if applicable), and the name (last, first, middle initial) of plaintiff(s) and defendant(s). I. Amount of Claim. Enter the estimated amount of the claim, rounded to the nearest dollar. The estimated amount of the claim is requested for data collection and clerical processing purposes and is not considered dispositive of the claim. TIL. Type of Case. Place an “X” in the appropriate box. If the cause fits more than one type of case, select the most definitive. If the most definitive label is a subcategory (indented under a broader category label, place an “X” in the category and subcategory boxes. Definitions of the cases are provided below in the order they appear on the form. Circuit Civil (A) Condominium - all civil lawsuits pursuant to Chapter 718, Florida Statutes, in which a condominium association is a party. (B) Contracts and indebtedness - all contract actions relating to promissory notes and other debts, including those arising from the sale of goods, but excluding contract disputes involving condominium associations. (C) Eminent domain - all matters relating to the taking of private property for public use, including inverse condemnation by state agencies, political subdivisions, or public service corporations. (D) Auto negligence - all matters arising out of a party’s allegedly negligent operation of a motor vehicle. (E) Negligence—other - all actions sounding in negligence, including statutory claims for relief on account of death or injury, that are not included in other main categories. Filing 195814690 VS 05-2024-CA-023818-XXCA-BC. (F) Business governance - all matters relating to the management, administration, or control of a company. (G) Business torts - all matters relating to liability for economic loss allegedly caused by interference with economic or business relationships. CL-0891-2001 (H) Environmental/Toxic tort - all matters relating to claims that violations of environmental regulatory provisions or exposure to a chemical caused injury or disease. (1) Third party indemnification - all matters relating to liability transferred to a third party in a financial relationship. (J) Construction defect - all civil lawsuits in which damage or injury was allegedly caused by defects in the construction of a structure. (K) Mass tort - all matters relating to a civil action involving numerous plaintiffs against one or more defendants. (L) Negligent security - all matters involving injury to a person or property allegedly resulting from insufficient security. (M) Nursing home negligence - all matters involving injury to a nursing home resident resulting from negligence of nursing home staff or facilities. (N) Premises liability—commercial - all matters involving injury to a person or property allegedly resulting from a defect on the premises of a commercial property. (O) Premises liability—tresidential - all matters involving injury to a person or property allegedly resulting from a defect on the premises of a residential property. (P) Products liability - all matters involving injury to a person or property allegedly resulting from the manufacture or sale of a defective product or from a failure to warn. (Q) Real property/Mortgage foreclosure - all matters relating to the possession, title, or boundaries of real property. All matters involving foreclosures or sales of real property, including foreclosures associated with condominium associations or condominium units. (The amount of claim specified in Section II, of the form determines the filing fee pursuant to section 28.241, Florida Statutes.) (R) Commercial foreclosure - all matters relating to the termination of a business owner’s interest in commercial property by a lender to gain title or force a sale to satisfy the unpaid debt secured by the property. (S) Homestead residential foreclosure - all matters relating to the termination of a residential property owner’s interest by a lender to gain title or force a sale to satisfy the unpaid debt secured by the property where the property has been granted a homestead exemption. (T) Non-homestead residential foreclosure - all matters relating to the termination of a residential property owner’s interest by a lender to gain title or force a sale to satisfy the unpaid debt secured by the property where the property has not been granted a homestead exemption. (U) Other real property actions - all matters relating to land, land improvements, or property rights not involving commercial or residential foreclosure. (V) Professional malpractice - all professional malpractice lawsuits. (W) Malpractice—business - all matters relating to a business’s or business person’s failure to exercise the degree of care and skill that someone in the same line of work would use under similar circumstances. (X) Malpractice—medical - all matters relating to a doctor’s failure to exercise the degree of care and skill that a physician or surgeon of the same medical specialty would use under similar circumstances. (Y) Malpractice—other professional - all matters relating to negligence of those other than medical or business professionals. (Z) Other - all civil matters not included in other categories. (AA) Antitrust/Trade regulation - all matters relating to unfair methods of competition or unfair or deceptive business acts or practices. (AB) Business transactions - all matters relating to actions that affect financial or economic interests. (AC) Constitutional challenge—statute or ordinance — a challenge to a statute or ordinance, citing a violation of the Florida Constitution. (AD) Constitutional challenge—proposed amendment - a challenge to a legislatively initiated proposed constitutional amendment, but excluding challenges to a citizen-initiated proposed constitutional amendment because the Florida Supreme Court has direct jurisdiction of such challenges. Filing 195814690 VS 05-2024-CA-023818-XXCA-BC. CL-0891-2001 (AE) Corporate trusts - all matters relating to the business activities of financial services companies or banks acting in a fiduciary capacity for investors. (AF) Discrimination—employment or other - all matters relating to discrimination, including employment, sex, race, age, handicap, harassment, retaliation, or wages (AG) Insurance claims - all matters relating to claims filed with an insurance company. (AH) Intellectual property - all matters relating to intangible rights protecting commercially valuable products of the human intellect. (AI) Libel/Slander - all matters relating to written, visual, oral, or aural defamation of character. (AJ) Shareholder derivative action - all matters relating to actions by a corporation's shareholders to protect and benefit all shareholders against corporate management for improper management. (AK) Securities litigation - all matters relating to the financial interest or instruments of a company or corporation. (AL) Trade secrets - all matters relating to a formula, process, device, or other business information that is kept confidential to maintain an advantage over competitors. (AM) Trust litigation — all civil matters involving guardianships, estates, or trusts and not appropriately filed in probate proceedings. County Civil (AN) Civil - all matters involving claims ranging from $8,001 through $30,000 in damages, exclusive of interest, costs, and attorney fees. (AO) Replevins — all lawsuits pursuant to Chapter 78, Florida Statutes, involving claims up to $30,000. (AP) Evictions — all matters involving the recovery of possession of leased land or rental property by process of law. (AQ) Other Civil (non-monetary) — includes all other non-monetary county civil matters that were not described in the other county civil categories. Iv. Remedies Sought. Place an “X” in the appropriate box. If more than one remedy is sought in the complaint or petition, check all that apply. V. Number of Causes of Action. If the complaint or petition alleges more than one cause of action, note the number and the name of the cause of action. VI. Class Action. Place an “X” in the appropriate box. Vil. Related Cases. Place an “X” in the appropriate box. Vil. Is Jury Trial Demanded In Complaint? Check the appropriate box to indicate whether a jury trial is being demanded in the complaint ATTORNEY OR PARTY SIGNATURE. Sign the civil cover sheet. Print legibly the name of the person signing the civil cover sheet. Attorneys must include a Florida Bar number. Insert the date the civil cover sheet is signed. Signature is a certification that the filer has provided accurate information on the civil cover sheet. Filing 195814690 VS 05-2024-CA-023818-XXCA-BC. CL-0891-2001 Filing 195814690 VS 05-2024-CA-023818-XXCA-BC.