On August 17, 2017 a
Miscellaneous
was filed
involving a dispute between
State Farm Fire And Casualty Company,
and
Scott Robillard Plumbing & Heating,Llc,
for Torts
in the District Court of Middlesex County.
Preview
of
- DOCKET NUMBER Trial Court of Massachusetts
CIVIL ACTION COVER SHEET i
The Superior Court
PLAINTIFF(S): State Farm Fire and Casualty Company ICOUNTY
Middlesex
ADDRESS: P.O. Box 106173, Atlanta, GA 30348
DEFENDANT(S): —_ Scott Robillard Plumbing & Heating, LLC
ATTORNEY: Robert M. Strasnick
ADDRESS: Principe & Strasnick, P.C. ADDRESS: 187 Beal Road, Waltham, MA 02453
17 Lark Avenue, Saugus, MA 01906
781-233-9191 ext. 302 rob@psbostonlaw.com
BO: 637598
TYPE OF ACTION AND TRACK DESIGNATION (see reverse side)
CODE NO. TYPE OF ACTION (specify) TRACK HAS A JURY CLAIM BEEN MADE?
Bo4 Other Negligence - Property Damage F (yes
“If "Other" please describe: Subrogation
STATEMENT OF DAMAGES PURSUANT TO GLL. 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)
|A. 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 date ..
IC. Documented property damages to dated ...
1D. Reasonably anticipated future medical and hospital expenses
E. Reasonably anticipated lost wages ....
IF. Other documented items of damages (describe below)
36,618.42
PADHPAH PHPHHH
1G. Briefly describe plaintiff's injury, including the nature and extent of injury:
The defendant negligently installed a valve on a toilet which burst, thereby causing a flood in the plaintiff's insured's home.
TOTAL (A-F):$ 36,618.42
CONTRACT CLAIMS.
(attach additional sheets as necessary)
Provide a detailed description of claims(s):
TOTAL: $
Signature of Attorney/Pro Se Plaintiff: X vate: A i Z
IRELATED ACTIONS: Please provide the case number, case name, and aay related actions pending in the Superior Court.
CERTIFICATION PURSUANT TO Suc RULE 1:18
| hereby certify that | have complied with requirements of Rule 5 of the Supreme ‘ial Court Uniform Rules on Dispute Resolution (SJC
Rule 1:18) requiring that | provide my clients with information about lispute resolution services and discuss with them the
advantages and disadvantages of the various /;
Date:” P|
Signature of Attorney of Record: X
Document Filed Date
August 17, 2017
Case Filing Date
August 17, 2017
For full print and download access, please subscribe at https://www.trellis.law/.
Preview
of - DOCKET NUMBER Trial Court of Massachusetts CIVIL ACTION COVER SHEET i The Superior Court PLAINTIFF(S): State Farm Fire and Casualty Company ICOUNTY Middlesex ADDRESS: P.O. Box 106173, Atlanta, GA 30348 DEFENDANT(S): —_ Scott Robillard Plumbing & Heating, LLC ATTORNEY: Robert M. Strasnick ADDRESS: Principe & Strasnick, P.C. ADDRESS: 187 Beal Road, Waltham, MA 02453 17 Lark Avenue, Saugus, MA 01906 781-233-9191 ext. 302 rob@psbostonlaw.com BO: 637598 TYPE OF ACTION AND TRACK DESIGNATION (see reverse side) CODE NO. TYPE OF ACTION (specify) TRACK HAS A JURY CLAIM BEEN MADE? Bo4 Other Negligence - Property Damage F (yes “If "Other" please describe: Subrogation STATEMENT OF DAMAGES PURSUANT TO GLL. 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) |A. 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 date .. IC. Documented property damages to dated ... 1D. Reasonably anticipated future medical and hospital expenses E. Reasonably anticipated lost wages .... IF. Other documented items of damages (describe below) 36,618.42 PADHPAH PHPHHH 1G. Briefly describe plaintiff's injury, including the nature and extent of injury: The defendant negligently installed a valve on a toilet which burst, thereby causing a flood in the plaintiff's insured's home. TOTAL (A-F):$ 36,618.42 CONTRACT CLAIMS. (attach additional sheets as necessary) Provide a detailed description of claims(s): TOTAL: $ Signature of Attorney/Pro Se Plaintiff: X vate: A i Z IRELATED ACTIONS: Please provide the case number, case name, and aay related actions pending in the Superior Court. CERTIFICATION PURSUANT TO Suc RULE 1:18 | hereby certify that | have complied with requirements of Rule 5 of the Supreme ‘ial Court Uniform Rules on Dispute Resolution (SJC Rule 1:18) requiring that | provide my clients with information about lispute resolution services and discuss with them the advantages and disadvantages of the various /; Date:” P| Signature of Attorney of Record: X