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Filing # 141869488 E-Filed 01/12/2022 03:27:13 PM
RETURN OF SERVICE
State of Florida County of Lake Circuit Court
Case Number: 2021-CA-1576 Court Date: 2/11/2022 10:00 am
Plaintiff:
ANA L. MIRANDA
vs.
Defendant,:
TRAVIS N. WARD and GEICO GENERAL INSURANCE COMPANY
For;
Joshua M, Parks, Esquire
Law Office of Terryl Blackmon Walker
901 N. Lake Destiny Road
Suite 10:
Maitland, FL 32751
Received by WILLIAMS PROCESS SERVICE, INC. on the 3rd day of January, 2022 at 9:01 am to be served on
Record Custodian: CarePlus Health Plans, Inc. clo Corporation Service Company, 1201 Hays Street,
Tallahassee, FL 32301,
1, MICHAEL C. NOLAN, do hereby affirm that on the Sth day of January, 2022 at 8:35 am, I:
CORPORATE: served by delivering a true copy of the Subpoena Duces Tecum and Certificate of Compliance
with C.F.R. 164.512, F.R.C.P, 1.354 and HIPAA Regulations and Sestion 90.902(11) Certification/Declaration of
Records Custodian and Notice of Production from Non-Party with the date and hourof service endorsed thereon
by me, to: SHEENA BLACK as AUTHORIZED REPRESENTATIVE for the Registered Agent of Record Custodian:
CarePlus Health Plans, Inc. c/o Corporation Service Company at the address of: 1201 HAYS STREET,
TALLAHASSEE, FL 32304, and informed said person of the contents therein, in compliance wilh slate statutes.
Description of Person Served: Age: 35+, Sex: F, Race/Skin Color: WHITE, Height: 5'6", Weight: 155, Hair:
BROWN, Glasses: N
| certify that | am over the age of 18, have no interest in the above action, and ama Certified Process Server, in
good standing, in the judicial circuit in which the process was served. Under penalty of perjury | declare that the
facts contained herein are true to the best of my knowledge.NO NOTARY REQUIRED PURSUANT TO F.S. 92.525
(2). :
wet,
ae
MICHAEL C, Ni
Certified Process Server, #111
WILLIAMS PROCESS SERVICE, INC.
721 U.S. HIGHWAY 41
SUITE 121
NORTH PALM BEACH, FL 33408
(561) 884-1442
Our Job Serial Number: WPS-2022000060
Ref: 214613789-001
‘Copyright© 1992-2022 Database Services, Inc. ~ Process Sorvar's Teatox V8.2
UIUC TT
FILED: LAKE COUNTY, GARY J. COONEY, CLERK, 01/13/2022 08:41:39 AM
60
IN THE CIRCUIT COURT OF THE FIFTH
JUDICIAL CIRCUIT, IN AND FOR LAKE
COUNTY, FLORIDA
ANA L. MIRANDA,
Plaintiff,
vs.
CASE NO: 2021-CA-1576
TRAVIS N. WARD and GEICO CIVIL DIVISION
GENERAL INSURANCE COMPANY,
Defendants
/
SUBPOENA DUCES TECUM
(Pursuant to F.R.C.P.1,351(c), effective 1/1/2011, this
Subpoena may be served by mail or by hand delivery by a commercial delivery service)
THE STATE OF FLORIDA:
TO: Record Custodian
CarePlus Health Plans, INC.
Corporation Service Company
1201 Hays Street.
Tallahassee, FL 32301
YOU ARE COMMANDED to appear at/mail/email records to (1) Joshua M. Parks, Esq., Law Office of Terry!
Blackmon Walker, 901 N. Lake Destiny Rd, Suite 105, Maitland, FL 32751; Email
OrlandoHC@Progressive.com and {2) Michael J. Stewart, Esq., Law Office of Sarah E. Blazak, 111 N.
Orange Avenue, Suite 1600, Orlando, FL 32801 at the date and time noted, and to have with you at same
regarding the below named individual as follows:
DATE: February 11, 2022
TIME: 10:00 am.
RE: Ana L Miranda ee
0 es
ANY AND ALL claim files/records, concerning any claims made by or on behalf of the above named
individuat for benefits including, but not limited to No Fault ledger, No Fault payments, PIP Log and/or PIP
payments, telephone logs, enrotiment records, authorization logs/records, explanation of benefits (EOBs),
disbursement records of payment, bills, reports of treating and examining physicians, computer printouts,
applications for insurance, questionnaires, statement of claim, notices of injury, lien information, notices of
lien, correspondence and notes; documents concerning any settlement, any payments made to or on behalf of
the above named individual.
These items will be inspected and may be copied at that time. You will not be required to surrender the original
items. You may comply with this Subpoena by providing legible copies of the items to be produced to the attomey
whose name appears on this Subpoena on or before the scheduled date of production (if copies are expected to
exceed $50.00, please contact our office for authorization). You may condition the preparation of the copics upon
the payment in advance of the reasonable cost of preparation. You may mail or deliver the copies to the atlomey
whose name appears on this Subpoena, and thereby, eliminate your appearance at the time and place specified
above. You have the right to object to the production pursuant to this Subpoena at any time before production by
giving written notice to the attomey whose name appears on this Subpoena.
7 ‘HIS WILL NOT BE A DEPOSITION. NO IMONY WILL BE TAKEN.
IF YOU FAIL TO: ay appear as specified; OR
@) fumish the records instead of appearing as provided above; OR
@) object to this Subpoena;
you may be in contempt of court. You are subpoenaed by the attomey whose name appears on this Subpoena, and
unless excused from this Subpoena by these attorneys or the Court, you shall respond to this Subpoena as directed.
DATED this 3rd day of January, 2022
i JOSHUA M. PARKS, ESQUIRE
Attorneys for Defendant
Law Office of Terry! Blackmon Walker
901 N. Lake Destiny Rd., Suite 105
Maitland, FL 32751
(813) 371-4217 (Asst.)
Fax: (866) 516-8617
SERVICE DESIGNATIONS;
Primary: OrlandoHC@Progressive.com
Secondary: Joshua_M_Parks@progressive.com
Florida Bar No. 16866
“Salaried Employees of Progressive Casualty fasurance Company"
Harry Grimaldo/Claim No: 214613789
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Filing # 141869488 E-Filed 01/12/2022 03:27:13 PM RETURN OF SERVICE State of Florida County of Lake Circuit Court Case Number: 2021-CA-1576 Court Date: 2/11/2022 10:00 am Plaintiff: ANA L. MIRANDA vs. Defendant,: TRAVIS N. WARD and GEICO GENERAL INSURANCE COMPANY For; Joshua M, Parks, Esquire Law Office of Terryl Blackmon Walker 901 N. Lake Destiny Road Suite 10: Maitland, FL 32751 Received by WILLIAMS PROCESS SERVICE, INC. on the 3rd day of January, 2022 at 9:01 am to be served on Record Custodian: CarePlus Health Plans, Inc. clo Corporation Service Company, 1201 Hays Street, Tallahassee, FL 32301, 1, MICHAEL C. NOLAN, do hereby affirm that on the Sth day of January, 2022 at 8:35 am, I: CORPORATE: served by delivering a true copy of the Subpoena Duces Tecum and Certificate of Compliance with C.F.R. 164.512, F.R.C.P, 1.354 and HIPAA Regulations and Sestion 90.902(11) Certification/Declaration of Records Custodian and Notice of Production from Non-Party with the date and hourof service endorsed thereon by me, to: SHEENA BLACK as AUTHORIZED REPRESENTATIVE for the Registered Agent of Record Custodian: CarePlus Health Plans, Inc. c/o Corporation Service Company at the address of: 1201 HAYS STREET, TALLAHASSEE, FL 32304, and informed said person of the contents therein, in compliance wilh slate statutes. Description of Person Served: Age: 35+, Sex: F, Race/Skin Color: WHITE, Height: 5'6", Weight: 155, Hair: BROWN, Glasses: N | certify that | am over the age of 18, have no interest in the above action, and ama Certified Process Server, in good standing, in the judicial circuit in which the process was served. Under penalty of perjury | declare that the facts contained herein are true to the best of my knowledge.NO NOTARY REQUIRED PURSUANT TO F.S. 92.525 (2). : wet, ae MICHAEL C, Ni Certified Process Server, #111 WILLIAMS PROCESS SERVICE, INC. 721 U.S. HIGHWAY 41 SUITE 121 NORTH PALM BEACH, FL 33408 (561) 884-1442 Our Job Serial Number: WPS-2022000060 Ref: 214613789-001 ‘Copyright© 1992-2022 Database Services, Inc. ~ Process Sorvar's Teatox V8.2 UIUC TT FILED: LAKE COUNTY, GARY J. COONEY, CLERK, 01/13/2022 08:41:39 AM 60 IN THE CIRCUIT COURT OF THE FIFTH JUDICIAL CIRCUIT, IN AND FOR LAKE COUNTY, FLORIDA ANA L. MIRANDA, Plaintiff, vs. CASE NO: 2021-CA-1576 TRAVIS N. WARD and GEICO CIVIL DIVISION GENERAL INSURANCE COMPANY, Defendants / SUBPOENA DUCES TECUM (Pursuant to F.R.C.P.1,351(c), effective 1/1/2011, this Subpoena may be served by mail or by hand delivery by a commercial delivery service) THE STATE OF FLORIDA: TO: Record Custodian CarePlus Health Plans, INC. Corporation Service Company 1201 Hays Street. Tallahassee, FL 32301 YOU ARE COMMANDED to appear at/mail/email records to (1) Joshua M. Parks, Esq., Law Office of Terry! Blackmon Walker, 901 N. Lake Destiny Rd, Suite 105, Maitland, FL 32751; Email OrlandoHC@Progressive.com and {2) Michael J. Stewart, Esq., Law Office of Sarah E. Blazak, 111 N. Orange Avenue, Suite 1600, Orlando, FL 32801 at the date and time noted, and to have with you at same regarding the below named individual as follows: DATE: February 11, 2022 TIME: 10:00 am. RE: Ana L Miranda ee 0 es ANY AND ALL claim files/records, concerning any claims made by or on behalf of the above named individuat for benefits including, but not limited to No Fault ledger, No Fault payments, PIP Log and/or PIP payments, telephone logs, enrotiment records, authorization logs/records, explanation of benefits (EOBs), disbursement records of payment, bills, reports of treating and examining physicians, computer printouts, applications for insurance, questionnaires, statement of claim, notices of injury, lien information, notices of lien, correspondence and notes; documents concerning any settlement, any payments made to or on behalf of the above named individual. These items will be inspected and may be copied at that time. You will not be required to surrender the original items. You may comply with this Subpoena by providing legible copies of the items to be produced to the attomey whose name appears on this Subpoena on or before the scheduled date of production (if copies are expected to exceed $50.00, please contact our office for authorization). You may condition the preparation of the copics upon the payment in advance of the reasonable cost of preparation. You may mail or deliver the copies to the atlomey whose name appears on this Subpoena, and thereby, eliminate your appearance at the time and place specified above. You have the right to object to the production pursuant to this Subpoena at any time before production by giving written notice to the attomey whose name appears on this Subpoena. 7 ‘HIS WILL NOT BE A DEPOSITION. NO IMONY WILL BE TAKEN. IF YOU FAIL TO: ay appear as specified; OR @) fumish the records instead of appearing as provided above; OR @) object to this Subpoena; you may be in contempt of court. You are subpoenaed by the attomey whose name appears on this Subpoena, and unless excused from this Subpoena by these attorneys or the Court, you shall respond to this Subpoena as directed. DATED this 3rd day of January, 2022 i JOSHUA M. PARKS, ESQUIRE Attorneys for Defendant Law Office of Terry! Blackmon Walker 901 N. Lake Destiny Rd., Suite 105 Maitland, FL 32751 (813) 371-4217 (Asst.) Fax: (866) 516-8617 SERVICE DESIGNATIONS; Primary: OrlandoHC@Progressive.com Secondary: Joshua_M_Parks@progressive.com Florida Bar No. 16866 “Salaried Employees of Progressive Casualty fasurance Company" Harry Grimaldo/Claim No: 214613789