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— ~ DOGKET NURSER > Trial Court of Massachusetts =
CIVIL ACTION GOVER SHEET | 45 2a? The Superior Court %
PLAINTIFF(S): United Walls Systems uc . - county” /
ADORESS: 18 Garland Street, Fitchburg, MA 01420 ee
DEFENDANT(S): Western Bui
| ATTORNEY: Paul J. Hogan
| ADDRESS: 346 Neponset Street, First Floor, Canton, MA 02021 ADURESS: Westen Builders Inc.- 73 Pleasant Street, Granby, MA 01033
The Trustees of The Smith College- 10 Elm Street, College Hall Room 204, Northamaty
: o1063
PE OF ACTION AND TRACK DESIGNATION (se
CODE NO. TYPE OF ACTION (specify) TRACK HAS A JURY CLAIM BEEN MADE?
AN & ces Contract - Services, Labor, and Materials F [x] Yes (] No
*If "Other" please describe: —_ Mechanics Lien in addition to the above stated type of action
s PURSUANT TO G.L. c. 212, §3A
The following is a full, itemized and detailed statement of the facts on which the undersigned plaintiff or plaintiff counsel relies to determine money damages. For
this form, disregard double or treble damage claims: indicate single damages only.
TORT CLAIMS
(attach additional sheets as necessary)
IA. Documented medical expenses to date:
1. Total hospital expenses
2. Total doctor expenses ..
3, Total chiropractic expenses
4. Total physical therapy expenses
5. Total other expenses (describe below) .
8. Documented lost wages and compensation to dal
IC. Documented property damages to dated een nie
D, Reasonably anticipated future medical and hospital expenses
E. Reasonably anticipated lost wages .....
F. Other documented items of damages (describe below)
8
§
s
$
8
Subtotal (A: $
8
$
8
§
$
|G. Briefly describe plaintiff's injury, including the nature and extent of injury: !
i
TOTAL ars
cd
SGONTRAGT CLAIMS Me
(attach additional sheets as necessary)
Provide a detailed description of claims(s):
Defendants failed to pay Plaintiff for labor and materials provided for the improvements to real property. Plaintiff has clairgg TOTAL: $ T7aa7 0 |
for quantum merit, breach of contract, unjust enrichment, Oy Tbe mechanics fien, unfair & deceptive acts.
Signature of Attorney/Pro Se Piainti ( Date: ( of dy / (s
RELATED ACTIONS: Please provide the case number, Ase namg, and county of any related actions pending in the Superior Court
CERTIFICATION PURSUANT TO SJC RULE 1:18
i hereby certify that | have complied with requirements of Rule 5 of the Supreme Judicial Court Uniform Rules on Dispute Resolution (SIC
Rule 1:18) requiring that | provide my clients with information about court-connected dispute resolution services and discuss with them the
Mie oar: 10/4¢/¢¢-|
dCivin ACTION COVER SHEET INSTRUC iiONS
SELECT CATEGORY THAT BEST DESCRIBES YOUR CASE
‘Ac StatelMuntclpality * ER Equitable Remedies RP Real Property
AAJ Contract Action involving Commonwealth, DO Specific Performance of a Contract A C01 Land Taking (F)
Municipality, MBTA, etc. a 102 Reach and Apply © C02 Zoning Appeal, G.L.c. 408 ®
AB1 Tostious Action involving Commonwealth, (DO3 injunction ) C03 Dispute Conceming Title (F)
‘Municipality, MBTA, etc. cy D04 Reform/ Cancel instrament ) C04 Foreclosure of a Mortgage oo
AGI Real Property Action involving DOS Equitable Replevin © G05 Condominium Lien & Charges rs)
apn Gommonweakh, Muricpalty, MBTA at. (4 Ba Conaston or adeniaton ©) C89 Other Real Property Action “
Equity Action involving Commonwealth, impesition of a Trust @)
Municipality, MBTA, etc. a) DOB Minority Shareholder's Suit a _MC Miscellaneous Civil Actions.
AR Administrative Action involving DOS interference in Contractual Relationship (F)
Commonwealth, Municipality, MBTA.ete. (A) D10 Accounting ® E18 Foreign Discovery Proceeding ~
D11 Enforcement of Restrictive Covenant —(F) E97 Prisoner Habeas Corpus ©
CN Contract/Business Cases 12 Dissolution of a Partnership ) £22 Lottery Assignment, G.L.c.10§28 (X)
Di3 Declaratory Judgment, G.L. c.231A a)
A01 Services, Labor, and Materfals F) D14 Dissolution of a Corporation ®) AB-Abusoftiarassment Prevention
A02 Goods Sold and Delivered F) D99 Other Equity Acti ©)
joods Sold and Deli er Equity Action
£8 Cormaral Pane ) £16 Abuse Prevention Petition, G.L. ©. 209A (X)
A04 Employment Contract (F) t E21 Protection from Harassment, G.L. c, 258E(X}
04 Employment Cant 8 PA CWil Actions Involving Incarcerated Party.
ae Senirnanaiia Estate % PAM Contract Action involving an AA Admintatrat
A14 interpleader (F) Incarcerated Party @) E02 Appeat from Administrative Agency,
BA Governance, Gonduct, Internal P81 Tortious Action involving an GL. c, 304 ©
Affairs of Entities ay Incarcerated Party a £03 Certiorari Action, @.L..<.249 $4 wO
BAS Liability of Shareholders, Directors, C1 Real Property Action ‘involving an ECS Confirmation of Arbitration Awards ral
Officers, Pariners, etc tay Incarcerated Party wy G6 Mass Antitrust Act, G. L. ¢. 93 89 @
BB4 Shareholder Derivative a) PD1 Equity Action involving an E07 Mase Anthrust Act, G. L. 6. 93 §8 ri
BB2 Securities Transactions ) PEt a ee Pats invol £08 Appointment of a Receiver
BCt Mergers, Consolidations, Sales of ' nis ne ape n Invelving an E08 Construction Surety Bond, G.L. 0. 149
Assets, Issuance of Debt, Equity, ete, (A) Incarcerated Party © §§20, 298, A
BD1 Intellectual Property @ FR Torts E10 Summary Process Appeal rs)
BD2 Proprietary Information or Trade a E11 Worker's Compensation 0
Secrets “ ' , 516 Auto Surcharge Appeat «0
B41 Financial Institutions/Funds iy B08 Motor Vehicle Negligence - Persona) E17 Givil Rights Act, GL. 0.12 §11H @
BH1. Violation of Antitrust or Trade Shay tlectnetca bee o F:24 Appeal from District Court
Regulation Laws ) B04 Other Negligence - Personal - Commitment, G.L. ¢.123 §9(0) ”
A9S Other Contract/Business Action - Specify (F) Sets Hiebitty ) E26 Pleural Registry (Asbestos cases)
805 Products Liability & E94 Forfeiture, @.i., c265 §56 ~
BO6 Malpractice - Medical / Wrongfui Death (A) E05 Forteture, GU. c.040 §47 ©
. , ener ae ath SL. e220 2A “ £99 Other Administrative Action “0
Choose this case type if ANY party is the fongful Death, GL. 6.228 § ) 201 Medical Malpractice - Tribunal onty,
Commonwealth, a municipality, the MBTA, or an B15 Defamation a)
a ipalty, 1" ty GL. c. 231 §603 *
other governmental enfily UNLESS your case is a Big Asbestos @ 702 Apposi Bene Deiat &
case type listed under Administrative Civil Actions 820 Personal injury Slip & Fall ©
(AA) 821 Environmental ®)
B22 Employment Discrimination ®) $0 Sex Oftender Review
‘+ Choose this case type if ANY party is an BE1 Fraud, Business Torts, etc. @) £12 SDP Commitment,
incarcerated party, UNLESS your case is a casé B99 Other Tortious Action ®) Esa SDP patton OL er age 8
type listed under Administrative Civil Actions (AA) '
of is @ Prisoner Habeas Corpus case (E97). RG Restricted Civil Actions
E19 Sex Offender Registry, G.L.c.6 §178M (x)
E27 Minor Seeking Consent, G.L. 6.712 §125 (x)
TRANSFER YOUR SELECTION TO THE FACE SHEET
EXAMPLE:
CODE NO. TYPE OF ACTION (specify) TRACK HAS A JURY CLAIM BEEN MADE?
B03 Motor Vehicle Negligence-Personal Injury E (] ves (no
STATEMENT OF DAMAGES PURSUANT TO GL. c. 212, § 3A
DUTY OF THE PLAINTIFF - The plaintiff shail set forth, on the face of the civil action cover sheet (or attach additional sheets as necessary), a
statement specifying the facts on which the plaintiff relies to determine money damages. A copy of such civil action cover sheet, including the
statement as to the damages, shall be served with the complaint. A clerk-magistrate shall not accept for filing a complaint, except as
otherwise provided by law, unless it is accompanied by such a statement signed by the attomey or pro se party.
DUTY OF THE DEFENDANT - If the defendant believes that the statement of damages filed by the plaintiff is inadequate, the defendant may
file with his/her answer a statement specifying the potential damages which may result if the plaintiff prevails.
A CIVIL COVER SHEET MUST BE FILED WITH EACH COMPLAINT.
FAILURE TO COMPLETE THIS COVER SHEET THOROUGHLY AND ACCURATELY
MAY RESULT IN DISMISSAL OF THIS ACTION.
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— ~ DOGKET NURSER > Trial Court of Massachusetts = CIVIL ACTION GOVER SHEET | 45 2a? The Superior Court % PLAINTIFF(S): United Walls Systems uc . - county” / ADORESS: 18 Garland Street, Fitchburg, MA 01420 ee DEFENDANT(S): Western Bui | ATTORNEY: Paul J. Hogan | ADDRESS: 346 Neponset Street, First Floor, Canton, MA 02021 ADURESS: Westen Builders Inc.- 73 Pleasant Street, Granby, MA 01033 The Trustees of The Smith College- 10 Elm Street, College Hall Room 204, Northamaty : o1063 PE OF ACTION AND TRACK DESIGNATION (se CODE NO. TYPE OF ACTION (specify) TRACK HAS A JURY CLAIM BEEN MADE? AN & ces Contract - Services, Labor, and Materials F [x] Yes (] No *If "Other" please describe: —_ Mechanics Lien in addition to the above stated type of action s PURSUANT TO G.L. c. 212, §3A The following is a full, itemized and detailed statement of the facts on which the undersigned plaintiff or plaintiff counsel relies to determine money damages. For this form, disregard double or treble damage claims: indicate single damages only. TORT CLAIMS (attach additional sheets as necessary) IA. Documented medical expenses to date: 1. Total hospital expenses 2. Total doctor expenses .. 3, Total chiropractic expenses 4. Total physical therapy expenses 5. Total other expenses (describe below) . 8. Documented lost wages and compensation to dal IC. Documented property damages to dated een nie D, Reasonably anticipated future medical and hospital expenses E. Reasonably anticipated lost wages ..... F. Other documented items of damages (describe below) 8 § s $ 8 Subtotal (A: $ 8 $ 8 § $ |G. Briefly describe plaintiff's injury, including the nature and extent of injury: ! i TOTAL ars cd SGONTRAGT CLAIMS Me (attach additional sheets as necessary) Provide a detailed description of claims(s): Defendants failed to pay Plaintiff for labor and materials provided for the improvements to real property. Plaintiff has clairgg TOTAL: $ T7aa7 0 | for quantum merit, breach of contract, unjust enrichment, Oy Tbe mechanics fien, unfair & deceptive acts. Signature of Attorney/Pro Se Piainti ( Date: ( of dy / (s RELATED ACTIONS: Please provide the case number, Ase namg, and county of any related actions pending in the Superior Court CERTIFICATION PURSUANT TO SJC RULE 1:18 i hereby certify that | have complied with requirements of Rule 5 of the Supreme Judicial Court Uniform Rules on Dispute Resolution (SIC Rule 1:18) requiring that | provide my clients with information about court-connected dispute resolution services and discuss with them the Mie oar: 10/4¢/¢¢-| dCivin ACTION COVER SHEET INSTRUC iiONS SELECT CATEGORY THAT BEST DESCRIBES YOUR CASE ‘Ac StatelMuntclpality * ER Equitable Remedies RP Real Property AAJ Contract Action involving Commonwealth, DO Specific Performance of a Contract A C01 Land Taking (F) Municipality, MBTA, etc. a 102 Reach and Apply © C02 Zoning Appeal, G.L.c. 408 ® AB1 Tostious Action involving Commonwealth, (DO3 injunction ) C03 Dispute Conceming Title (F) ‘Municipality, MBTA, etc. cy D04 Reform/ Cancel instrament ) C04 Foreclosure of a Mortgage oo AGI Real Property Action involving DOS Equitable Replevin © G05 Condominium Lien & Charges rs) apn Gommonweakh, Muricpalty, MBTA at. (4 Ba Conaston or adeniaton ©) C89 Other Real Property Action “ Equity Action involving Commonwealth, impesition of a Trust @) Municipality, MBTA, etc. a) DOB Minority Shareholder's Suit a _MC Miscellaneous Civil Actions. AR Administrative Action involving DOS interference in Contractual Relationship (F) Commonwealth, Municipality, MBTA.ete. (A) D10 Accounting ® E18 Foreign Discovery Proceeding ~ D11 Enforcement of Restrictive Covenant —(F) E97 Prisoner Habeas Corpus © CN Contract/Business Cases 12 Dissolution of a Partnership ) £22 Lottery Assignment, G.L.c.10§28 (X) Di3 Declaratory Judgment, G.L. c.231A a) A01 Services, Labor, and Materfals F) D14 Dissolution of a Corporation ®) AB-Abusoftiarassment Prevention A02 Goods Sold and Delivered F) D99 Other Equity Acti ©) joods Sold and Deli er Equity Action £8 Cormaral Pane ) £16 Abuse Prevention Petition, G.L. ©. 209A (X) A04 Employment Contract (F) t E21 Protection from Harassment, G.L. c, 258E(X} 04 Employment Cant 8 PA CWil Actions Involving Incarcerated Party. ae Senirnanaiia Estate % PAM Contract Action involving an AA Admintatrat A14 interpleader (F) Incarcerated Party @) E02 Appeat from Administrative Agency, BA Governance, Gonduct, Internal P81 Tortious Action involving an GL. c, 304 © Affairs of Entities ay Incarcerated Party a £03 Certiorari Action, @.L..<.249 $4 wO BAS Liability of Shareholders, Directors, C1 Real Property Action ‘involving an ECS Confirmation of Arbitration Awards ral Officers, Pariners, etc tay Incarcerated Party wy G6 Mass Antitrust Act, G. L. ¢. 93 89 @ BB4 Shareholder Derivative a) PD1 Equity Action involving an E07 Mase Anthrust Act, G. L. 6. 93 §8 ri BB2 Securities Transactions ) PEt a ee Pats invol £08 Appointment of a Receiver BCt Mergers, Consolidations, Sales of ' nis ne ape n Invelving an E08 Construction Surety Bond, G.L. 0. 149 Assets, Issuance of Debt, Equity, ete, (A) Incarcerated Party © §§20, 298, A BD1 Intellectual Property @ FR Torts E10 Summary Process Appeal rs) BD2 Proprietary Information or Trade a E11 Worker's Compensation 0 Secrets “ ' , 516 Auto Surcharge Appeat «0 B41 Financial Institutions/Funds iy B08 Motor Vehicle Negligence - Persona) E17 Givil Rights Act, GL. 0.12 §11H @ BH1. Violation of Antitrust or Trade Shay tlectnetca bee o F:24 Appeal from District Court Regulation Laws ) B04 Other Negligence - Personal - Commitment, G.L. ¢.123 §9(0) ” A9S Other Contract/Business Action - Specify (F) Sets Hiebitty ) E26 Pleural Registry (Asbestos cases) 805 Products Liability & E94 Forfeiture, @.i., c265 §56 ~ BO6 Malpractice - Medical / Wrongfui Death (A) E05 Forteture, GU. c.040 §47 © . , ener ae ath SL. e220 2A “ £99 Other Administrative Action “0 Choose this case type if ANY party is the fongful Death, GL. 6.228 § ) 201 Medical Malpractice - Tribunal onty, Commonwealth, a municipality, the MBTA, or an B15 Defamation a) a ipalty, 1" ty GL. c. 231 §603 * other governmental enfily UNLESS your case is a Big Asbestos @ 702 Apposi Bene Deiat & case type listed under Administrative Civil Actions 820 Personal injury Slip & Fall © (AA) 821 Environmental ®) B22 Employment Discrimination ®) $0 Sex Oftender Review ‘+ Choose this case type if ANY party is an BE1 Fraud, Business Torts, etc. @) £12 SDP Commitment, incarcerated party, UNLESS your case is a casé B99 Other Tortious Action ®) Esa SDP patton OL er age 8 type listed under Administrative Civil Actions (AA) ' of is @ Prisoner Habeas Corpus case (E97). RG Restricted Civil Actions E19 Sex Offender Registry, G.L.c.6 §178M (x) E27 Minor Seeking Consent, G.L. 6.712 §125 (x) TRANSFER YOUR SELECTION TO THE FACE SHEET EXAMPLE: CODE NO. TYPE OF ACTION (specify) TRACK HAS A JURY CLAIM BEEN MADE? B03 Motor Vehicle Negligence-Personal Injury E (] ves (no STATEMENT OF DAMAGES PURSUANT TO GL. c. 212, § 3A DUTY OF THE PLAINTIFF - The plaintiff shail set forth, on the face of the civil action cover sheet (or attach additional sheets as necessary), a statement specifying the facts on which the plaintiff relies to determine money damages. A copy of such civil action cover sheet, including the statement as to the damages, shall be served with the complaint. A clerk-magistrate shall not accept for filing a complaint, except as otherwise provided by law, unless it is accompanied by such a statement signed by the attomey or pro se party. DUTY OF THE DEFENDANT - If the defendant believes that the statement of damages filed by the plaintiff is inadequate, the defendant may file with his/her answer a statement specifying the potential damages which may result if the plaintiff prevails. A CIVIL COVER SHEET MUST BE FILED WITH EACH COMPLAINT. FAILURE TO COMPLETE THIS COVER SHEET THOROUGHLY AND ACCURATELY MAY RESULT IN DISMISSAL OF THIS ACTION.