Preview
CM-010
_ATTORNEY OR PARTY WITHOUT ATTORNEY (Nametm Bar number, and address): \y FOR COURT USE ONLY
James T. Derfler, Esq. SBN: 180367
WALSH MCKEAN FURCOLO LLP I L E D IA
550 west C Street, smte 950, San Dlego, CA 92101
. .
3%55335 89‘5’21. 32S£k§§833
TELEPHONE No.: 61 9232,8486 FAX No.: 6 19.232.2691 SAN BERNARDONO DiSTRlCT
ATrORNEY FOR (NameisPlaintiff Admiral Insurance Company; a Delaware corporation
SUPERIOR coua'r 0F cALIFonNIA, COUNTY 0F SAN BERNARDINO A P R 0 6 202 1
STREET ADDRESS: 247 West Third Street
ML"WELCH
fi
MAILING ADDRESS:247 West Third Street '“
cmwozwcooe=San Bemardino, 92415-0210 BY W11
BRANCH NAME: San Bernardino District - Civil Division
M'CHAEL u' DEPW
CASE NAME: ADMIRAL INSURANCE COMPANY v. FUSION PACIFIC,
INC. A 'I I
”WW SB
.
CASE
fig CIVIL CASE COVER SHEET Complex Case Designation 2 g g
:7 XUI"
§{ 1:
(Anm'gmfd
E L"td (£15m D Counter E Joinder
JUD G E'
I
I ll g
s demanded demanded is Fi|ed with first appearance by defendant
1E}
exceeds $25,000) $25,000 or less) (Cal. Rules of Court, rule 3.402) DEPT:
u; Items 1—6 below must be completed (see instructions on page 2).
1. Check one box below for the case type that best describes this case:
Provisionally Complex Civil Litigation
E
Auto Tort
Auto (22> E
Contract
D Breach of coniracflwarranty (06)
Rule 3‘740 collections (09)
(cal.Rules 0f coun, ru'es 3.4m-3-403)
Antiirust/Trade regulation (03)
Uninsured motorist (46)
Other Pl/PD/WD (Personal Injury/Property
Damage/Wrongful Death) Tort
E Other collections (09)
Insurance coverage(18)
Construction defec1
Mass ion (40)
(1 0)
Asbestos (O4)
Product liability (24)
E Othercontract(37)
Real Property
DDDDDD
Securities litigation (28)
Environmental/Toxic ton (30)
E Medical malpractice (45) E Eminent domain/Inverse
condemnaflon
Insurance coverage claims arising from the
above complex case
Other PI/PD/WD (23)
E
E WWW
(14)
eVi°“°“ <33)
listed provisionally
types (41)
D
D
Non-PI/PD/WD (Other) Tort
Business ton/unfair business practice (O7)
Other real property (26) Enforcement 01
D Juugmem
Enforcement ofjudgment (20)
E Civil rights (08>
E
Un'awful Detainer
E CommerCiaJ (31) Miscellaneous CivilComplaim
E
E
E
Defamation (13)
Fraud (1e)
D Residential (32)
DFUQS(38)
RICO (27)
Othercomplaim (notspecffied above)(42)
D
D
Intellectual property<19)
Professiona' negligence (25)
E
Judicia' "eVieW Miscellaneous Civil Petition
E
Other nOH'Pl/PD/WD
Employment
Wrongful termination (36)
10ft (35)
D
D
A3591 forfenure (05)
Petition re: arbitration
Wn't oi mandaie
award (11)
E Padnership and corporate governance (21)
Other petition (not Specified above) (43)
2.
[j Other employment (15)
This case E is is not complex under
D Other
rule
judicial
(O2)
review (39)
3.400 of the California Rules of Court. If the case is complex, markthe
factors requiring exceptional judicial management:
a. E Large number of separately represented parties d. E
E
Large number of witnesses
b. D Extensive motion practice raising
be time-consuming
difficult or novel e. Coordination with related actions pending
other counties, states, or countries, or
in
in
one or
a federal court
more courts
c. E issues that
Substantial
will
amount of documentary evidence
to resolve
f. E in
Substantial postjudgmentjudicial supervision
Remedies sought (check all thatapply): am monetary b.- nonmonetary; declaratory or injunctive relief C- Epunitive
Number of causes of action (specify): Four
msnasso
.
This case
If
D is a class action suit.
is not
(4)
there are any known related cases, file and serve a notice of related case. (You may use form CM—015.)
Date: April 5,
Jamec T Derfler Esq
2021
(TYPE OR PRINT NAME]
’ QM ,D
(szATURE OF PARTY OH ATFORNEY FOR PARTY)
NOTICE
o Plaintiff must file this cover sheet with the first paper filed in the action or proceeding (except small claims cases or cases filed
under the Probate Code, Family Code, or Welfare and Institutions Code). (Cal. Rules of Court, rule 3.220.) Failure to file may result
in sanctions.
° File this cover sheet in addition to any cover sheet required by local court rule.
0 lf this case 'Is complex under rule 3.400 et seq. of the California Rules of Court, you must serve a copy of this cover sheet on all
other parties to the action or proceeding.
- Unless this is a collections case under rule 3.740 or a complex case, this cover sheet will be used for statistical purposes only.
a9 e 1 ol 2
Cal. Rules oi Court, rules 2.30, 3.220, 3.400—3.403, 3.740;
Form Adopted for Mandaiory Use
Judicial Council of California
CIVIL CASE COVER SHEET Cal. Skandards of Judicial Adminislration, std. 3.10
CM-01 0 www.caurtinfo.ca.gav
[Rev. July 1. 2007]
Westlaw Doc & Fon'n Builder
\a \v CM-010
INSTRUCTIONS ON HOW T0 COMPLETE THE COVER SHEET
To Plaintiffs and Others
Filing First Papers. If you are filing a first paper (for example. a complaint) in a civil case,
you must
complete and file, along with your first paper, the Civil Case Cover Sheetcontained on
page 1. This information will be used to compile
statistics about the types and numbers of cases filed. You must
complete items 1 through 6 on the sheet. In item 1, you must check
one box for the case type that best describes the case. If the case fits both a general and a more
specific type of case listed in item 1,
check the more specific one. If the case has multiple causes of action, check the box that
best indicates the primary cause of action.
To assist you in completing the sheet, examples of the cases that belong under each case
type in item 1 are provided below. A cover
sheet must be filed only with your initial paper. Failure to file a cover sheet with the first
paper filed in
a civil case may subject a party,
itscounsel, or both to sanctions under rules 2.30 and 3.220 of the California Rules of
Court
To Parties in Rule 3.740 Collections Cases. A "collections case" under rule 3.740 is defined
as an action for recovery of money
owed in a sum stated to be certain that is not more than $25,000, exclusive of interest and attorney's
fees, arising from a transaction in
which property, services, or money was acquired on credit. A collections case does not
include an action seeking the following: (1) tort
damages, (2) punitive damages,
recovery of real property, (4) recovery of personal property. or
(3)
(5) a prejudgment writ of
attachment. The identification of a case as a rule 3.740 collections case on this form
means that it will be exempt from the general
time-for—service requirements and case management rules, unless a
defendant files a responsive pleading. A rule 3.740 collections
case will be subject to the requirements for service and obtaining a judgment in rule 3.740.
To Parties in Complex Cases. In complex cases only, parties must also use the Civil Case Cover
Sheet to designate whether the
case is complex. If a plaintiff believes the case is complex under rule 3.400 of the California
Rules of Court, this must be indicated by
completing the appropriate boxes in items 1 and 2. If a plaintiff designates a case as
complex, the cover sheet must be served with the
complaint on all parties to the action. A defendant may file and serve no later than the
time of its first appearance a joinder in the
plaintiff's designation, a counter-designation that the
case is not complex, or, if the plaintiff has made no designation, a designation that
the case '5 wmplex'
CASE Types AND EXAMPLES
Auto Tort Contract Plovisionally Complex Civil Litigation (Cal.
Auto (22)—Persona| Injury/Property Breach of Contracl/Warranty (06) Rules of Court Rules 3.400—3.403)
Damage/Wrongful Death Breach of Rental/Lease AntitrusVTrade Regulation (03)
Uninsured Motorist (46) (ifthe Contract (not unlawful detainer Construction Defect (10)
case involves an uninsured or wrongful eviction) Claims Involving Mass Tor'l (40)
motorist claim subject to Contract/Warranty Breach—Seller Securities Litigation (28)
arbitration, check this item fraud or negligence)
Plaintiff (not Environmental/Toxic Tort (30)
instead of Auto) Negligent Breach of Contract/ Insurance Coverage Claims
Other Pl/PD/WD (Personal lnjury/ Warranty (arising from pro vIsiona/ly complex
Property Damage/Wrongful Death) Other Breach of Contract/Warranty case type listed above) (41)
Tort Collections (e.g.. money owed, open Enforcement of Judgment
Asbestos (o4) book accounts) (09) Enforcement of Judgment (20)
Asbestos Propeny Damage Collection Case—Seller Plaintiff Abstract of Judgment (Out of
Asbestos Personal Injury/ Other Promissory Note/Collections County)
Wrongful Death Case Confession of Judgment (non-
Product Liability (not asbestos or Insurance Coverage (notprovisiona/Iy
domestic relations)
toxio’environmental) (24) complex) (1 8) Sister State Judgment
Medical Malpractice (45) Auto Subrogation Administrative Agency Award
Medical Malpractice— Other Coverage (not unpaid taxes)
Physicians & Surgeons Other Contract (37) Petition/Certification of Entry of
Other Professional Health Care Contraciual Fraud Judgment on Unpaid Taxes
Malpractice Other Contract Dispute OtheCr Enforcement of Judgment
Other PI/PD/WD (23) Real Property
Premises Liability (e.g., slip Eminent Domain/Inverse Miscellaneous Civil Complaint
and fall) Condemnation (14) RICO (27)
Irrlentional Bodily Injury/PD/WD Wrongful Eviction (33) Other Complaint (not specified
(e.g., assault, vandalism) Other Real Propeny (e.g., quiet title) (26) above) (42)
Intentional Infliction of
Writ of Possession of Real Propeny
Declaratory Relief Only
Emotional Distress lnjunctive Relief
Only (non-
Mongage Foreclosure
Negligent Infliction of harassment)
Quiet Title
Emotional Distress Other Real Properly (not eminent Mechanics Lien
Other PI/PD/WD domain, Iandlord/tenant, or Oiher Commercial Complaint
Non-Pl/PD/WD (Other) Ton foreclosure) Case (non»tort/non»complex)
Business Ton/Unfair Business Unlawful Detainer Other Civil Complaint
Practice (O7) (non-tort/non-complex)
Commercial (31)
Civil Rights (e.g., discrimination, Miscellaneous Civil Petition
Residential (32)
false arrest) (notcivil Partnership and Corporate
Drugs (38) (if the case involves illegal
harassment) (08) Governance (21)
drugs, check this item; othemise,
Defamation (e.g., slander, libel)
Other Pemion (not specified
report as Commercial or Residential)
(13) above) (43)
Judlclal Review
Fraud (16) Civil Harassment
Asset Forfeiture (05)
Intellectual Property (19) Workplace Violence
Petition Re: Arbitration Award (11)
Professional Negligence (25) EIder/Dependem Adult
Writ of Mandate (O2)
Legal Malpractice Abuse
Writ—Administrative Mandamus
Other Professional Malpractice Election Contest
Writ—Mandamus on Limited Court
(not medical or legal) Petition for Name Change
Case Mafler
Other Non-PI/PDNVD Ton (35) Petition for Relief From Late
th—Other Limited Court Case Claim
Employment
Review Other Civil Petition
Wrongful Termination (36)
Other Judicial Review (39)
Other Employmem (1 5)
Review of Health Officer Order
Notice of AppeaI—Labor
Commissioner Appeals
CM-OIO [Rem July 1, 2007]
Page 2 of 2
CIVIL CASE COVER SHEET
Preview
CM-010 _ATTORNEY OR PARTY WITHOUT ATTORNEY (Nametm Bar number, and address): \y FOR COURT USE ONLY James T. Derfler, Esq. SBN: 180367 WALSH MCKEAN FURCOLO LLP I L E D IA 550 west C Street, smte 950, San Dlego, CA 92101 . . 3%55335 89‘5’21. 32S£k§§833 TELEPHONE No.: 61 9232,8486 FAX No.: 6 19.232.2691 SAN BERNARDONO DiSTRlCT ATrORNEY FOR (NameisPlaintiff Admiral Insurance Company; a Delaware corporation SUPERIOR coua'r 0F cALIFonNIA, COUNTY 0F SAN BERNARDINO A P R 0 6 202 1 STREET ADDRESS: 247 West Third Street ML"WELCH fi MAILING ADDRESS:247 West Third Street '“ cmwozwcooe=San Bemardino, 92415-0210 BY W11 BRANCH NAME: San Bernardino District - Civil Division M'CHAEL u' DEPW CASE NAME: ADMIRAL INSURANCE COMPANY v. FUSION PACIFIC, INC. A 'I I ”WW SB . CASE fig CIVIL CASE COVER SHEET Complex Case Designation 2 g g :7 XUI" §{ 1: (Anm'gmfd E L"td (£15m D Counter E Joinder JUD G E' I I ll g s demanded demanded is Fi|ed with first appearance by defendant 1E} exceeds $25,000) $25,000 or less) (Cal. Rules of Court, rule 3.402) DEPT: u; Items 1—6 below must be completed (see instructions on page 2). 1. Check one box below for the case type that best describes this case: Provisionally Complex Civil Litigation E Auto Tort Auto (22> E Contract D Breach of coniracflwarranty (06) Rule 3‘740 collections (09) (cal.Rules 0f coun, ru'es 3.4m-3-403) Antiirust/Trade regulation (03) Uninsured motorist (46) Other Pl/PD/WD (Personal Injury/Property Damage/Wrongful Death) Tort E Other collections (09) Insurance coverage(18) Construction defec1 Mass ion (40) (1 0) Asbestos (O4) Product liability (24) E Othercontract(37) Real Property DDDDDD Securities litigation (28) Environmental/Toxic ton (30) E Medical malpractice (45) E Eminent domain/Inverse condemnaflon Insurance coverage claims arising from the above complex case Other PI/PD/WD (23) E E WWW (14) eVi°“°“ <33) listed provisionally types (41) D D Non-PI/PD/WD (Other) Tort Business ton/unfair business practice (O7) Other real property (26) Enforcement 01 D Juugmem Enforcement ofjudgment (20) E Civil rights (08> E Un'awful Detainer E CommerCiaJ (31) Miscellaneous CivilComplaim E E E Defamation (13) Fraud (1e) D Residential (32) DFUQS(38) RICO (27) Othercomplaim (notspecffied above)(42) D D Intellectual property<19) Professiona' negligence (25) E Judicia' "eVieW Miscellaneous Civil Petition E Other nOH'Pl/PD/WD Employment Wrongful termination (36) 10ft (35) D D A3591 forfenure (05) Petition re: arbitration Wn't oi mandaie award (11) E Padnership and corporate governance (21) Other petition (not Specified above) (43) 2. [j Other employment (15) This case E is is not complex under D Other rule judicial (O2) review (39) 3.400 of the California Rules of Court. If the case is complex, markthe factors requiring exceptional judicial management: a. E Large number of separately represented parties d. E E Large number of witnesses b. D Extensive motion practice raising be time-consuming difficult or novel e. Coordination with related actions pending other counties, states, or countries, or in in one or a federal court more courts c. E issues that Substantial will amount of documentary evidence to resolve f. E in Substantial postjudgmentjudicial supervision Remedies sought (check all thatapply): am monetary b.- nonmonetary; declaratory or injunctive relief C- Epunitive Number of causes of action (specify): Four msnasso . This case If D is a class action suit. is not (4) there are any known related cases, file and serve a notice of related case. (You may use form CM—015.) Date: April 5, Jamec T Derfler Esq 2021 (TYPE OR PRINT NAME] ’ QM ,D (szATURE OF PARTY OH ATFORNEY FOR PARTY) NOTICE o Plaintiff must file this cover sheet with the first paper filed in the action or proceeding (except small claims cases or cases filed under the Probate Code, Family Code, or Welfare and Institutions Code). (Cal. Rules of Court, rule 3.220.) Failure to file may result in sanctions. ° File this cover sheet in addition to any cover sheet required by local court rule. 0 lf this case 'Is complex under rule 3.400 et seq. of the California Rules of Court, you must serve a copy of this cover sheet on all other parties to the action or proceeding. - Unless this is a collections case under rule 3.740 or a complex case, this cover sheet will be used for statistical purposes only. a9 e 1 ol 2 Cal. Rules oi Court, rules 2.30, 3.220, 3.400—3.403, 3.740; Form Adopted for Mandaiory Use Judicial Council of California CIVIL CASE COVER SHEET Cal. Skandards of Judicial Adminislration, std. 3.10 CM-01 0 www.caurtinfo.ca.gav [Rev. July 1. 2007] Westlaw Doc & Fon'n Builder \a \v CM-010 INSTRUCTIONS ON HOW T0 COMPLETE THE COVER SHEET To Plaintiffs and Others Filing First Papers. If you are filing a first paper (for example. a complaint) in a civil case, you must complete and file, along with your first paper, the Civil Case Cover Sheetcontained on page 1. This information will be used to compile statistics about the types and numbers of cases filed. You must complete items 1 through 6 on the sheet. In item 1, you must check one box for the case type that best describes the case. If the case fits both a general and a more specific type of case listed in item 1, check the more specific one. If the case has multiple causes of action, check the box that best indicates the primary cause of action. To assist you in completing the sheet, examples of the cases that belong under each case type in item 1 are provided below. A cover sheet must be filed only with your initial paper. Failure to file a cover sheet with the first paper filed in a civil case may subject a party, itscounsel, or both to sanctions under rules 2.30 and 3.220 of the California Rules of Court To Parties in Rule 3.740 Collections Cases. A "collections case" under rule 3.740 is defined as an action for recovery of money owed in a sum stated to be certain that is not more than $25,000, exclusive of interest and attorney's fees, arising from a transaction in which property, services, or money was acquired on credit. A collections case does not include an action seeking the following: (1) tort damages, (2) punitive damages, recovery of real property, (4) recovery of personal property. or (3) (5) a prejudgment writ of attachment. The identification of a case as a rule 3.740 collections case on this form means that it will be exempt from the general time-for—service requirements and case management rules, unless a defendant files a responsive pleading. A rule 3.740 collections case will be subject to the requirements for service and obtaining a judgment in rule 3.740. To Parties in Complex Cases. In complex cases only, parties must also use the Civil Case Cover Sheet to designate whether the case is complex. If a plaintiff believes the case is complex under rule 3.400 of the California Rules of Court, this must be indicated by completing the appropriate boxes in items 1 and 2. If a plaintiff designates a case as complex, the cover sheet must be served with the complaint on all parties to the action. A defendant may file and serve no later than the time of its first appearance a joinder in the plaintiff's designation, a counter-designation that the case is not complex, or, if the plaintiff has made no designation, a designation that the case '5 wmplex' CASE Types AND EXAMPLES Auto Tort Contract Plovisionally Complex Civil Litigation (Cal. Auto (22)—Persona| Injury/Property Breach of Contracl/Warranty (06) Rules of Court Rules 3.400—3.403) Damage/Wrongful Death Breach of Rental/Lease AntitrusVTrade Regulation (03) Uninsured Motorist (46) (ifthe Contract (not unlawful detainer Construction Defect (10) case involves an uninsured or wrongful eviction) Claims Involving Mass Tor'l (40) motorist claim subject to Contract/Warranty Breach—Seller Securities Litigation (28) arbitration, check this item fraud or negligence) Plaintiff (not Environmental/Toxic Tort (30) instead of Auto) Negligent Breach of Contract/ Insurance Coverage Claims Other Pl/PD/WD (Personal lnjury/ Warranty (arising from pro vIsiona/ly complex Property Damage/Wrongful Death) Other Breach of Contract/Warranty case type listed above) (41) Tort Collections (e.g.. money owed, open Enforcement of Judgment Asbestos (o4) book accounts) (09) Enforcement of Judgment (20) Asbestos Propeny Damage Collection Case—Seller Plaintiff Abstract of Judgment (Out of Asbestos Personal Injury/ Other Promissory Note/Collections County) Wrongful Death Case Confession of Judgment (non- Product Liability (not asbestos or Insurance Coverage (notprovisiona/Iy domestic relations) toxio’environmental) (24) complex) (1 8) Sister State Judgment Medical Malpractice (45) Auto Subrogation Administrative Agency Award Medical Malpractice— Other Coverage (not unpaid taxes) Physicians & Surgeons Other Contract (37) Petition/Certification of Entry of Other Professional Health Care Contraciual Fraud Judgment on Unpaid Taxes Malpractice Other Contract Dispute OtheCr Enforcement of Judgment Other PI/PD/WD (23) Real Property Premises Liability (e.g., slip Eminent Domain/Inverse Miscellaneous Civil Complaint and fall) Condemnation (14) RICO (27) Irrlentional Bodily Injury/PD/WD Wrongful Eviction (33) Other Complaint (not specified (e.g., assault, vandalism) Other Real Propeny (e.g., quiet title) (26) above) (42) Intentional Infliction of Writ of Possession of Real Propeny Declaratory Relief Only Emotional Distress lnjunctive Relief Only (non- Mongage Foreclosure Negligent Infliction of harassment) Quiet Title Emotional Distress Other Real Properly (not eminent Mechanics Lien Other PI/PD/WD domain, Iandlord/tenant, or Oiher Commercial Complaint Non-Pl/PD/WD (Other) Ton foreclosure) Case (non»tort/non»complex) Business Ton/Unfair Business Unlawful Detainer Other Civil Complaint Practice (O7) (non-tort/non-complex) Commercial (31) Civil Rights (e.g., discrimination, Miscellaneous Civil Petition Residential (32) false arrest) (notcivil Partnership and Corporate Drugs (38) (if the case involves illegal harassment) (08) Governance (21) drugs, check this item; othemise, Defamation (e.g., slander, libel) Other Pemion (not specified report as Commercial or Residential) (13) above) (43) Judlclal Review Fraud (16) Civil Harassment Asset Forfeiture (05) Intellectual Property (19) Workplace Violence Petition Re: Arbitration Award (11) Professional Negligence (25) EIder/Dependem Adult Writ of Mandate (O2) Legal Malpractice Abuse Writ—Administrative Mandamus Other Professional Malpractice Election Contest Writ—Mandamus on Limited Court (not medical or legal) Petition for Name Change Case Mafler Other Non-PI/PDNVD Ton (35) Petition for Relief From Late th—Other Limited Court Case Claim Employment Review Other Civil Petition Wrongful Termination (36) Other Judicial Review (39) Other Employmem (1 5) Review of Health Officer Order Notice of AppeaI—Labor Commissioner Appeals CM-OIO [Rem July 1, 2007] Page 2 of 2 CIVIL CASE COVER SHEET