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Home My WebLink About00-05206 ~~ ~"~~ ,~- - ", CHUBB INSURANCE COMPANY OF NEW JERSEY, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff CIVIL ACTION - LAW v. NO. 00-5206 CIVIL RAYMOND H. KISS, Defendant JURY TRIAL DEMANDED PRAECIPE FOR JUDGMENT Enter Judgment in favor of Plaintiff and against Defendant, Raymond H. Kiss, for want of ANSWER TO COMPLAINT. (X) Assess damages as follows: I>eilt --------------------------------------------------------oS; Interest ----------------------------------------------------- S; i\ttorney's COlIUIlission---------------------------------- S; Filing costs------------------------------------------------- S; 1l01li\L-----------------------------------------------------oS; 10,716.66 to be determined to be determined 45.50 10,762.16 plus interest and attorney fees (X) I certify that the foregoing assessment of damages is for specified amounts alleged to be due in the complaint and is calculable as a sum certain from the complaint. (X) Pursuant to Pa.R.C.P. 237 (Notice of Praecipe for Imaljudgment or decree), I certify that a copy of this praecipe has been mailed to each other party who has appeared in the action or to his/her Attorney of Record. (X) Pursuant to Pa.R.C.P. 237.1, I certify that written notice of the intention to file this praecipe was mailed or delivered to the party against whom judgn)ent is to be entered and to . ~lher Attorney of Record, if any, , after the default occurred and at least ten days prior to the ate of the filing 0 is praecipe and a copy of the notice i, """h~ DA llE: Signature. C. ourtne, squire Attorney for Plaintiff 3211 North Front Street Harrisburg, P A 17110 Telephone: (717) 238-8187 Suprerne Court ID#: 74669 NOW,~, 2000, JUDGMENT IS ENTERED AS ABO rothonotarylClerk, Civil Divisi ~(J/)' D, 2. ~02a(~ Deputy Document #: 183312.1 ilIl!I!I",,",-..iWtMl.!!:!ttfi~'t"""~'~~lli,~lii:llilhi~~~~.i,1~~,!lfI!@;"iiill.iM.!~m<;lr J'" ," ".~~ ~-.: - o ~ "" -06: n"lr'C' Z::G zr en,;.;' ..:..( ..~,', !:2'- >> ~O J'>c 2~ =< o o (/) :-;, "'"1,] .-,1 C) .' I ()"'l " 1__= \--n ,,) {1..\ ,- ,", -,', .""C1 -"-" ~? i,l ,~~ -;::> ,p "']--" ~ ~ -- "" " , -' f\"i .. ' ,-"" ~ CHUBB INSURANCE COMPANY OF NEW JERSEY, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYL VANIA CIVIL ACTION - LAW vs. NO. 00-5206 CIVIL RAYMOND H. KISS, Defendant JURY TRIAL DEMANDED TO: Raymond Kiss 5 Church Street Piscataway, NJ 08854 Date of Notice: 21 August 2000 IMPORTANT NOTICE YOU ARE IN DEF AUL T BECAUSE YOU HAVE FAILED TO ENTER A WRITTEN APPEARANCE PERSONALLY OR BY ATIORNEY AND FILE IN WRITING WITH THE COURT YOUR DEFENSES OR OBJECTIONS TO THE CLAIMS SET FORTH AGAINST YOU. UNLESS YOU ACT WITHIN TEN (10) DAYS FROM THE DATE OF THIS NOTICE, A JUDGMENTMA Y BE ENTERED AGAINST YOU WITHOUT A HEARING AND YOU MAY LOSE YOUR PROPERTY OR OTHER IMPORTANT RIGHTS. YOU SHOULD TAKE THIS NOTICE TO A LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE FOLLOWING OFFICE TO FIND OUT WHERE YOU CAN GET LEGAL HELP: Cumberland County Bar Association 2 Liberty Avenue Carlisle, PA 17013 (717) 249-3166 or (800) 990-9108 METZGER, WICKERSHAM, KNSS & ERB, P.C. , By v C. Courtney, Attorney I.D. No. 74669 P.O. Box 5300 Harrisburg, PA 17110-0300 (717) 238-8187 Attorneys for Plaintiff Document N: /83033. / .. - ..... ''''l_'~'il:"r~~~1\rr~~,l1~.",~':.--<JJl''';ii:,Mi:;iH~>i&.,k<~~-;lj{O_ ~- "- ~ ,~,i< .',-..;i( '^ ="', ~'tililIl!I1iill~P'1" IIJ.." o ~ "'"ll93 1Ilp. Z":).~ 2C~ OJ .,J-..~ 2E-.; ~~ :6 -< V~ .'~ ~ o o ,:/) 01 ~ \ 0' .~ " r'_ c~-? '::'1 \,0 ~'t' I, ''I .. <: , I: I I I:: .. () -T'l ; .:;~ :~ J ,. , CERTIFICATE OF SERVICE AND NOW, I, Steven C. Courtney, Esquire, of Metzger, Wickersham, Knauss & Erb, attorneys for Plaintiff, hereby certify that I served the foregoing Important Notice this day by depositing the same in the United States mail, first class mail, postage prepaid, in Harrisburg, Pennsylvania, addressed to: Raymond Kiss 5 Church Street Piscataway, NJ 08854 Dated: 21 August 2000 Documerl1 #: /83033./ . r' L 1f."~~,~'~~~uJJiY""~~ --I,' "'I" .. ...... .. , ... n <u _. .. -......,. '~ !i " c"" \, H , ii , , ii I; I:; ~l " '[' ,I Ii !i I, Ii II I: [, I ii " :1 0 0 l,,> C C) -''-'1 -0 r;:~ (j') ''C"1 rTi r-,"~ ~.O ~t! 1 OJ' .- en t2t~: -::! 2;0 -^'. ~c; :..J PC: ~ L~ 0 :0 ::? <0 -< I" '-- --.. "'n '__'; ',,:, c- OFFICE OF THE PROTHONOTARY OF CUMBERLAND COUNTY Curt Long Prothonotary Telephone: (717) 240-6195 Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff: CHUBB INSURANCE COMPANY OF NEW JERSEY versus Defendant: RAYMOND H. KISS Judgment No. No. 00-5206Civil CERTIFICATE OF. RESIDENCE PA. R. C. P. 236 I, hereby certify that the preCise residence of Plaintiff is: Chubb Insurance Company of New Jersey One Liberty Place 1650 Market Street Philadelphia, PA 19103 AND CERTIFY THAT THE LAST KNOWN ADDRESS OF THE WITHIN DEFENDANT IS: Raymond H. Kiss 5 Church Street Piscataway, NJ 08854 ey, Es ir A ey [0 the Plaintiff Attorney ID# 74669 Metzger, Wickersham, Knauss & Erb, P.c. 3200 North Front Street Harrisburg, PAl 7110 Dc>cument #: 183313.1 ~~~~~~b&'l~~~' ."'- ".v','. - ., ~ u._. ~ ~- L;;;;' i I' 'f: , ~ f: I' I','. , , jl t 7f- ~ ~ ....0 . (') 0 C) 0 C 0 -'1 ~ . .~" (/) ....... ....... C~ ~g-::O 1'1 _..cJ 8 ~ -0 ~ zr.-- , ,~. 3 -0 S2::;:' o. '.",' ;:J -n (:=; P- ;;~~'-:i -v " '-n ~ -.0 )?; C) ;:::::.;; '. " .... E 5>E~ -:..~) ::::)ill ~ ~"--i <~ ::> -""" ~- =< ';'0 t '0 -< ~ ~~ ,~- . . . . ~ .' ~"2' , CHUBB INSURANCE COMPANY OF NEW JERSEY, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff CIVIL ACTION - LAW v. NO. 00.5206 CIVIL RAYMOND H. KISS, Defendant JURY TRIAL DEMANDED TO: RAYMOND H. KISS, Defendant You are hereby notified that on _ QF d l. .,200() , the following r I (GffieF) (Degree) (Judgment) has been entered against you in the above captioned case. For your failure to file an answer to the complaint. A Judgment in the amount of$10,7l6.66. plus costs for a total of$1O,762.l6 and attornev'sfee to be determined. DATE:~() K. I hereby certify that the name and address of the proper person(s) to receive this notice is: Raymond H. Kiss 5 Church Street Piscataway, NJ 08854 A: Raymond H. Kiss, Defendidola (Defendidos/as) Por este rnedio se Ie esta notificando que el de del , ellla siguiente (GffieH) (Deereto) (Fallo) ha sido anotado en contra suya en el caso mencionado en el epigrafe. FECHA: Prothonotario Certifico que la siguiente direccion es la del defendidola segun indicada en el certificado de residencia: Raymond H. Kiss 5 Church Street Piscataway, NJ 08854 Document #: J 8331 0.1 " 'C' '~e>~'.,~~ ,~_ . -'," >..' CHUBB INSURANCE COMPANY OF NEW JERSEY, Plaintiff : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : CIVIL ACTION - LAW vs. RAYMOND H. KISS, Defendant : NO. CO -5' ~()0~ : JURY TRIAL DEMANDED NOTICE TO DEFEND TO: Raymond Kiss 5 Church Street Piscataway, New Jersey 08854 YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take action within Twenty (20) days after this Complaint and Notice are served, by entering a written appearance personally or by attorney and filing in writing with the Court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the Court without further notice for any rnoney claimed in the Complaint or for any other claim or relief requested by the Plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET fORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Association 2 Liberty Avenue Carlisle, P A 17013 (717) 249-3166 Document #: 172832,1 "'"-,. =. NOTICIA LE HAN DEMANDADO A USTED EN LA CORTE. Si usted quiere defenderse de estas demandas expuestas en las paginas siguientes, usted tiene viente (20) dias de plazo al partir de la fecha de la demanda y la notificacion. Usted debe presentar una apariencia escrita 0 en persona 0 por abogado y archivar en la corte en forma escrita sus defensas 0 sus objeciones alas demandas en contra de su persona. Sea avisado que si usted no se defiende, la corte tomara medidas y puede entrar una orden contra usted sin previo aviso a notificacion y por cualquier queja 0 alivio que es pedido en la peticion de demanda. Usted puede perder dinero 0 sus propiedades 0 otros derechos importantes para usted. LLEVE ESTA DEMANDA A UN ABODAGO 1MMEDIATAMENTE. S1 NO TIENE ABOGADO 0 S1 NO TIENE EL DINERO SUF1C1ENTE DE P AGAR TAL SERVIC10, VA Y A EN PERSONA 0 LLAME POR TELEFONO A LA OFIC1NA CUY A DIRECCION SE ENCUENTRA ESCRlTA ABAJO PARA AVERlGUAR DONDE SE PUEDE CONSEGUIR AS1STENC1ALEGAL. Cumberland County Bar Association 2 Liberty Avenue Carlisle,PA 17013 (717) 249-3166 Document #: 172832./ "'""" CHUBB INSURANCE COMPANY OF NEW JERSEY, Plaintiff : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA vs. : CIVIL ACTION - LAW ; NO. HI- S.1tJ(,. ~ I.u- RAYMOND H. KISS, Defendant : JURY TRIAL DEMANDED CIVIL COMPLAINT AND NOW, comes the Plaintiff, Chubb Group of Insurance Companies, by and through its attorneys, Steven C. Courtney, Esquire, and the law firm of Metzger, Wickersham, Knauss & Erb, P.C., and states the following cause of action and in support thereof, avers as follows: 1. Plaintiff, Chubb Insurance Company of New Jersey, is a New Jersey corporation with an office and/or place of business located at One Liberty Place, 1650 Market Street, Philadelphia, Pennsylvania 19103-7301. 2. Defendant, Raymond H. Kiss, is an adult individual with a last known address of 5 Church Street, Piscataway, New Jersey 08854. 3. Plaintiff is, and at all relevant times material hereto was, the insurer of a 1958 Oldsmobile 88, 2 door vehicle with a VIN of 587L02384 and a license's plate number of PDG75B (New Jersey). 4. Defendant is, and at all relevant times material hereto was, the insured of a 1958 Oldsmobile 88, 2 door vehicle with a VIN of 587L02384 and a license's plate number of PDG75B (New Jersey). 5. On April I, 1998, the afore-described vehicle was stolen from a car dealership, Golden Classics, Inc., where the Defendant had placed it on consignment for sale. Document #: 172832.1 :~:.; . J.. _~ . 6. At the time of the aforesaid theft, Defendant was insured under a motor vehicle Insurance policy through Plaintiff that provided insurance coverage on the afore-described vehicle. A true and correct copy of the renewal certificate is attached hereto, incorporated herein and marked as Exhibit "A". 7. At the time of the aforesaid theft, Defendant had entered into a lease agreement with Onyx Leasing Company who was the actual owner of the above-described vehicle. 8. After the theft of the vehicle, Defendant had prepared and submitted to Plaintiff a Report of Automobile Total Theft. A true and correct copy of the Report of Automobile Total Theft is attached hereto, incorporated herein and marked as Exhibit "B". 9. On May 28, 1998, Plaintiff issued a payment to the Defendant in the amount of Eleven Thousand and 00/100 Dollars ($1l,000.00) pursuant to the terms of the insurance agreement between the parties hereto. 10. In the process of obtaining the title to the vehicle, Plaintiff learned that the car dealership's insurance carrier had issued a payment to the owner of the vehicle, Onyx Leasing Company, in the amount of Ten Thousand Seven Hundred Sixteen and 661100 Dollars ($10,716.66) which represented payment of the balance owed on the lease. 11. Plaintiff was never notified that Onyx Leasing Company was reimbursed for the value of the stolen vehicle as the owner until after payment was made to Defendant by Plaintiff. 12. After learning that Defendant was not the owner of vehicle, Plaintiff contacted Defendant on several occasions regarding his obligation to reimburse Plaintiff for the monies that were paid to him as a result of the theft. Document #: 172832.1 13. Despite Plaintiff's numerous written and verbal attempts to obtain reimbursement of the monies, Defendant has failed, refused and continues to refuse to provide payment of the rnonies owed to Plaintiff. 14. Plaintiff has retained the services of the law firm of Metzger, Wickersham, Knauss & Erb, P.C. in the collection of the amounts due from Defendant. 15. As of the filing of this Complaint, Plaintiff has incurred reasonable attorney's fees from the law office of Metzger, Wickersham, Knauss & Erb, P.C. in the collection of the amounts due and owing by Defendant incident to the within action, and Plaintiff shall continue to incur such attorney's fees throughout the conclusion of the proceedings. 16. Any and all conditions precedent to the bringing of this action have been performed by Plaintiff. 17. The amount m controversy IS within the jurisdictional amount requiring compulsory arbitration. COUNT I - BREACH OF CONTRACT 18. The averments set forth in Paragraph One (1) through Paragraph Seventeen (17) are incorporated herein by reference as though fully set forth. 19. The Plaintiff was never notified prior to the payment of monies to Defendant pursuant to the insurance policy that he was not the owner of the vehicle and that any payment should have been made to Onyx Leasing Company as the owner of the vehicle. 20. Despite Plaintiff's reasonable demand for payment, Defendant has failed, refused and continues to refuse to pay all sums due and owing to Plaintiff pursuant to the terms of the insurance agreement attached hereto as Exhibit "A". Document #: 172832. ] ",- 21. Defendant has breached the insurance agreement between the parties by failing to reimburse Plaintiff after being notified of his obligation to do so pursuant to the agreement attached hereto as Exhibit "A" and incorporated herein by reference. 22. As a result of the breach of the insurance agreement, Plaintiff has been damaged in the amount of Ten Thousand Seven Hundred Sixteen and 661100 Dollars ($10,716.66) plus interest, damages for delay, reasonable attorney fees and costs of suit as allowed by law. WHEREFORE, Plaintiff, Chubb Group of Insurance Companies, respectfully requests that this Honorable Court enter a judgment in its favor and against Defendant Raymond Kiss in the amount of Ten Thousand Seven Hundred Sixteen and 66/100 Dollars ($10,716.66) plus interest, damages for delay, reasonable attorney's fees and costs of suit as allowed by law and such other relief as the Court deems just and proper. COUNT II - BREACH OF CONTRACT IMPLIED IN LAW - RESTITUTIONIUNJUST ENRICHMENT 23. The averments of Paragraphs One (1) through Twenty-two (22) are incorporated herein by reference as though fully set forth. 24. If there is any finding that there is no express contract, Plaintiff pleads in the alternative that it conferred a benefit upon Defendant in the amount of Ten Thousand Seven Hundred Sixteen and 661100 Dollars ($10,716.66) which Defendant accepted and retained without any legal right to do so. 25. Defendant would be unjustly enriched if he was permitted to benefit from the monies provided by Plaintiff without being legally and rightfully entitled to said monies. 26. Said enrichment would be unjust if Defendant was not required to pay the monies owed to Plaintiff, and said Defendant accordingly is obligated to Plaintiff in the amount of Ten Document #: 172832.1 ."- . , '~ ~~ ~~, Thousand Seven Hundred Sixteen and 66/100 Dollars ($10,716.66) plus interest, damages for delay, reasonable attorney fees and costs of suit as allowed by law. WHEREFORE, Plaintiff, Chubb Group of Insurance Companies, respectfully requests that this Honorable Court enter a judgment in its favor and against Defendant Raymond Kiss in the amount of Ten Thousand Seven Hundred Sixteen and 661100 Dollars ($10,716.66) plus interest, damages for delay, reasonable attorney's fees and costs of suit as allowed by law and such other relief as the Court deems just and proper. COUNT III - CONVERSION 27. The averments of Paragraphs One (I) through Twenty-six (26) are incorporated herein by reference as though fully set forth. 28. The Defendant has no lawful justification or legal basis to retain the payment made by Plaintiff in the amount of Ten Thousand Seven Hundred Sixteen and 66/100 Dollars ($10,716.66) forreimbursement as a result of the above theft. 29. The Plaintiff has repeatedly notified Defendant of his obligation to reimburse Plaintiff for said payment and Defendant has refused to return said payment. 30. Defendant's repeated refusal to provide payment where he has no lawful justification to retain those monies deprives Plaintiff of the use and possession of said payment and is a conversion of said payment. 31. As a result of Defendant's conversion, Plaintiff has been deprived of the monies in the amount of Ten Thousand Seven Hundred Sixteen and 66/100 Dollars ($10,716.66) plus interest, damages for delay, reasonable attorney fees and costs of suit as allowed by law. Document#:1728321 32. The Defendant's actions were calculated in such a fraudulent manner whereby he collected monies for theft when in fact he was not the owner of the vehicle and when he knew that he was not entitled to said monies thereby entitling Plaintiff to punitive damages. WHEREFORE, Plaintiff, Chubb Group of Insurance Companies, respectfully requests that this Honorable Court enter a judgment in its favor and against Defendant Raymond Kiss in the amount of Ten Thousand Seven Hundred Sixteen and 66/100 Dollars ($10,716.66) plus interest, damages for delay, reasonable attorney's fees and costs of suit as allowed by law and such other relief as the Court deems just and proper. Dated:~IJI~ M, KNAUSS & ERB, P.C. Respectfully submitted, Document #: 172832.1 -~'~~~ ." i 06/22/00 13:15 '8'1 215 981 8127 CHUBB & SONS 141002 VERIFICATION I, Patricia Kahlborn, am an Examiner for the Subrogation Unit for the Chubb Group of t1f (iiiiW :rF:I.!'>e:y Insurance Companie:slland am authorized to act on its behalf. I hereby certify that the following is correct: The undersigned certifies that the facts set forth in the foregoing Complaint are based upon information which I have furnished to counsel, as well as upon information which has been . JIYrowv.....stj gathered by counsel and/or others acting on Chubb Group ofInsurance Companie!JIbehalf in this matter. The language of the Complaint is that of counsel and not my own. I have read the Complaint, and to the extent it is based on information which I have given to counsel, it is true and correct to the best of my knowledge, information and belief. To the extent that the content of the Complaint is that of counsel, I have relied upon such counsel in making this Verification. I hereby acknowledge that the facts set forth in the aforesaid Complaint are made subject to the penalties of 18 Pa.C$.A. 114904 relating to unsworn falsification to authorities. n...,1 \?91~ Jk~~ rl Patricia Kahlbom, Subrogation Examiner Subrogation Unit Chubb Group of Insurance Companies Document #: 172832./ f~I~'=- -~....I_.............. .~~~ Ii , ;; elL..t.;; j' ~'- . 06,122/00 :l3_;~_..'li'l 215 981 8127 CHUBB & SONS 04-10-1998 10: 42f:lM FRll'I The 1_* GrUllllw ~y 'I'll 141002 _iliA!? P.03 . :., ~ by W;ii~~C<o.~., TIl$ Ci.qi ~ Chubb Insurance Company of Now Jers., _OIIA___LA_QF ....~ , I~N~llIIl8r 1II!!!i11l' ~ CMUIlIB Chubb c.vup 0' Insl.1Iance Companlea , ' 15 Mc.OI1aIn V_ Road. Warren. 'New JlIIll8y 01080 "": ," iRENEWAL CERTIFICATE .... '1. Named 1_ & M!uUng' Addless ~ NlIIIlIler..S1reel. Town, Coliiii>'. S-. Zip RAYI\OND H.. KISS" 5 CHURCH ST. PISCATAWAY NJ Ilem 2.. Policy Perk!!! ONE YE,AR Fl~ III I"deplian Dele . EIIPh'I!IQII Date 11/26/97 11/26/98 B. MecIIcaI C. each MddaAt ......... IfllClt ,.. gua.,..-tbi,ilSOiii ' and1!>r CoII_ X_I Agrcl Vlll1ue CaII"ion __, .... ...... . BAS PIP ~ ..' dl~emem Excl. Excl. . 300.000 Vft.i\t 0I1,Jjb11h.,. _"~A. IS lite- AiID8 'lei 'aD .l.Itc(~ Iasu_ by ,"'" llOIIer. 1 2 3 .. 1> III : 4,000 ....:-.~W ;~: ,; 38.50 14.00 .33.00 12.00 35.00 1 2. 3' .. , . , 52.50 45.00 Fenno mwchecI III 1he poIiey, K any. TOTAL Due Oalll ~,;....1llIt......~. ....1. ..... {:i';. ~___ l"'. ::, "-?-~' " f 7::.1, ~~T- ~'~'J ,."'1 '...::'~' fJi(, Serial Name. 87L02384 V1EG154082 . '.'~".' I ~~"""'"b''''' ~ .. _ R.';f~, i AQo tQi;t'.jOr~t.:..~" ~ n.en ',;Aa\..Pr,~ l~ PIllS. .... Reith. _ Stale 1 "'8. ITO ftcsiI!o 2 No .. 18fd Rot. !lYm C_ R62000 R62000 Tw. IS ilUIted. A 1 ~ 2 o a N " '0. " &ute or trailer(s) deGcribed In lhia maI'n;! addresS unlee8 0II1erwi&e :~j':<c;t~Z7;~~,I/'';;2'Ti1~ "r.',,~~~t}.. - . ,,-,.......,.,.'" W'T 1 ONYX LEASING, 50 RT. 9.. "'ORGANVILLE NJ 07751 ~(73'L.r '117- - F'3M , t1-r'l, ( V )~rJv;- ... S SI.U'l Da1.,' G"- ...... . rled:ll MOo 08)' W. -. Yr. DL # K46720436~01525 , s...... Driver Tr;.I". C:::=,. AI SOheal MI,'rrom Ha"", Prine. Go.. 0..... aud8llt AIIlO Credl_ ..... ,':;,.:" ,~'.~,J.~rf,~~::.-:;r~~~,; 'A U T o 2 M O. $ " , 2 3 " ISSUE DATE: 10 06 97: ISO ()ODES: Agreed Value $ 15.000 This page, TIlg$\h8r with fllIIicy jackel provision com~ 1he lIllove numberecl polley. ProduCer & Adw.. Gru~dy Agcy/Admn Collector ~.hicle prog P.O. Box 1209 Glenslde. PA 190386209 .... .~ ~. ""'j~J '" . t= o ---~ .L '0 .. - \ ;\. \),( , . '. REPORT OF AUTOMOBILE TOTAL THEFT CHUBB (; J )I) 01/ PK;)) r. 'q ('-fj J./O{) Telephone: Home: 7! J-l ~Fl' '6/1 Business: d. J l - / J_ Address: )tt }{)~ ~ ~ /. City: (/;(2 L 6 LL- Driver's license no.: I~: q l;0 - 31). I I Name of insured: Policy No)i-$,9,!s7J6 Date of birth: / 1 J. ~ /(2 . / ' State: I~ Do you have more than one residential address? 110 Zip: ,/7 0 ({ Social security no.: JV)~ t../f'7)?LJ , , I ' , If yes, please list: City: State: Zip: Phone no.: Are you presently renting a vehicle? JIb If yes, from whom (name and address of rental agency): Acc no.: Upon completion of rental, obtain a bill and submit with your final settlement papers. Date of theft: Hour: AM: PM: Date vehicle last observed: Hour: AM: PM: Who was last in possession of the vehicle? 6-oL DE>> cLf~<;/L yES I &6'- pt:J1 C:-l.J.} ( IC 4-v!{) Specific location of vehicle at time of theft: Was car parked in a restricted area? lr"IO If other than insured, Name: Address: Phone no.: Driver's license no.: State: "', .~, Where was owner or driver when loss occurred? Was loss reported to the police? PCT/Town: j".jri:EJJDuP ,/l:,~ II.J, By whom? (f[j...f)1!' J/ CLk~Sj( When? Report no.: Alarm no.: How was report made? (a) In person at police station? (b) At scene? Has your vehicle been recovered? .j) b If yes, recovery date: ,/ (c) By phone? Is vehicle drivabie? Name of person who recovered it: Address: Location recovered: Time: o @(C@n'M~ 199B Describe damage due to theft: By____.. '-- ~ ._---. -----~.. ,- -, , .~--- ..--~<~, . -.--- -~-,- -1- PR1NTE '" U.SA o ~. Make of vehicle: Model: . J- ./ M~' COlo~: (;r(J....p J. /lteDJj Gas or Diesel: Lic. plate no.: State: Expires: Serial no. (VIN #): No. of cylinders: )S Approximate Odometer reading: ')57 '7' lo . Equipment of vehicle at time of theft: Details of equipment added since purchase: )/ '" V /yeW U),Art~ foj'AIP - LLLc;11-/t. P,JIlL NO/) ;A ) /1 N &- DJ.J).eft T/ M <j reM , fJVJiv P ;.,JatJ )f2JrvAF{}(( Date vehicle purchased: New/Used: iJSdO cost~/ / ~.o~() ( Who was the vehicle purchased from? Name: c.hJ<)/t. Address: Phone no.: Was vehicle rebuilt? Name of mortgagee: ()jy 'IX /.-, ,[". L. - Address: 1 City: State: Amount of loan:~ &'.O()j) Are payments up-to-date? -/-!!2-- When purchased, how did you pay for vehicle? (Cash/Check/Other) Has the vehicle been repossessed? Is car leased? -'IfJ--- From? Name: 01/1 f J...E/:, ,;:-- Address: . Are you the sole.,owner of the vehicle? If not, explain: ~ ~ JI "J '()!JO In (;jl *1 0 PaL~-!.J ~ Mv Jl ctM-- . Is car mortgaged? .!t:.) Who is the principal user of car? ~ Have you recently offered this car for sale or trade: 3"uLf)t'~ L4YYll~ .- 'r; Principal use of car: ~ To whom? ~ Address: II ~l tw Tb ~~ /...)~ ~"de 1tJ. 'Ui5ft J iJ,f /) iVt#--ll' I1...;,-,1j:; L:...- ~r.p;'/ 6-<676( I ,~- Major repairs since purchase: List: NO?i1 PtvV( b( Completed by: folVC fI P .--- Nie- Address: Date: Cost: When and where car serviced last date: Service station: Address: Do you have any other theft insurance on this vehicle? )/0 If yes, who is the insurance company? Policy no.: ~. -iG - .,. - lit , o o . . Identify your homeowner or tenant insurance carrier and the policy number: "~\ Is there a separate claim regarding personal items left in your car at the time of theft? If yes, type of claim: Have you h any member of your family ever had any auto theft losses with our company or any other insurance com- pany? f r) If yes, attach a separate sheet giving details, insurance companies, dates of loss and policy numbers. Also, on this sheet list recent (three years) insurance losses of other types. Examples would be: homeowner policy losses and vehicle collision and vandalism claill1s. Name 91 prior insurancec\lrrier: Company: Agent: Policy no.: Also submit your original bill of sale or paid original bill to substantiate options or additional equipment added to yourvehicle. b:()J..!)~"J( u,f)5/(., If your vehicle was removed from a garage: Exact name of garage (including inc. or corp.): ;if rJ7:~ )1 ();; ') iu All. Address: ' 1/1 ( fltJo IE 1>'P Was the garage closed and/or fenced as opposed to an open lot? I;J 1:)7 !../rf.L-/1) a>JJ }j.J 0'6 lo/ 6fcN JuT Did you deliver your vehicle to an attendant? or just leave it at the premises? )JfT /1/ fl[j.1/~1 Who parked the vehicle? )/01 J/ N!;';;: If an attendant present: Name: or description: Sex: Age: Race: Height: Weight: Wearing: Were keys left with vehicle? ~/t) 1 Kindly send original claim check to our office with this form. If you had a long term agreement, kindly forward it also with this form. If it was oral, kindly state terms. What are the parking rates? Were the services paid for when the car was initially parked or when the return of the vehicle requested? Was the attendant present when the owner returned for his vehicle? Were any statements made or letters sent to the garage representatives? ,.y \r%"-~'-':- -. - .'r,. .S.( " .,' "'=r j ,IUJ':,:.. '.\.. C,' ',: -~ I'); ,." ' I"') ,'. ' iUIJ MAY 051998 LYli Uy-- :rrJ PHILA 'C,c-;:"c-,-.:------ ..-.-~,-:..-:_L:-':~~(L:.<t 11 -3- ~ ~ o o ) . . / THIS FORM MUST BE NOTARIZED. I have no knowledge of the identity of the thief or the whereabouts of my vehicle. J have read, answered and understood all questions on this Total T Affid. it d a t.. that it is true and correct to the best of my knowledge. Policyholder: Subscribed and sworn to before me, on this j()'th day ofo. pr { I 19~, before me personally came l~rYlancL k l.ss to me known to be the person who answered and completed this affidavit. NQtllry Public: guu-u.q..uJ: ~15fJ.1r ~ f5 My Commission Expires: I J.. -;A i.jJtiJ J . . ItOI'AIliAl. Sl!A! Registration No.: .ll!NNRlI It. ooo....a.y. ~ I'ubIlc: """"" - Clrmhlh..ld~. PA lirJ ~ e.pm., Dee. 24. 2001 I I ! -4- ""'" ~'" .; ,.~ ~ ..""~~-itil- '~~~--~~~-~.....=-' -~,' ,,,~'~"""" -1fl ",,]rlt~" - ~ " ~,. ,~~~ . " . o ~~ ~~ ~~ ~ \] ~ ,""~ ^. ~,__"",.~ ~,' c ~ ~~ '" ~ Cr\ ~ \ \:~ \ ,\ ~ .' o '. . n ;-:. "- $' n'i\:" ;(. .. (,<)-, -< ,-- ~': ~~ t~> ,.:- -j -... 1Di1"'"' .u _ - ~ -'-:: (.; N ~:~j ~1_~ .:.;::; -<. '0 1i<' ,_...- ~~... "- .-.. ' '"" ,', ,~ -' "; .' . CHUBB INSURANCE COMPANY OF NEW JERSEY, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYL V ANlA Plaintiff CIVIL ACTION - LAW v. NO. 00-5206 CIVIL RAYMOND H. KISS, Defendant JURY TRIAL DEMANDED PROOF OF SERVICE BY MAIL I, Steven C. Courtney, Esquire, do hereby certify that on July 29, 2000, a copy of the Court of Common Pleas Complaint filed in the above referenced matter was served upon the following person by certified mail, as is evidenced by the Certified Mail Return Receipt attached hereto. . Raymond Kiss 5 Church Street Piscataway,NJ 08854 MET KERSHAM, KNAUSS & ERB, P.C. By S n C. Co Attorney LD. No.7 P.O. Box 5300 Harrisburg, P A 17110-0300 (717) 238-8187 Dated: J) rlo ( . Attorneys for Plaintiff Document #: 181832.1 "'~ " - ~.~Eilil:' I also wish to receive the i:s! . COmplete items 1 andlor 2 for addltion~ services. follow,'ng seIV,'ees (for a" CfI . Complete items 3, 4a, and 4b. .. =: . Print your name and address on the reverse of this form so that we can return this extra fee): .. card to you. g! . Attach this form to the front of the mailpiece, or on the back if space does not 1. 0 Addressee's Address e . ~~it~Rerum Receipt, Requedmu . v".A1~6 mall piece belQw the article number. 2.-,0 R~strict~d -D~Ii~;rY ! . The Return Receipt will show to whom the article was delivered and the date Co It OS! t t _ delivered. nsu p master or ee. 6 3. Miele Add~ssed to: 4a. Article Number 'C ~ Raymond 'Kiss _--. Z 215. 748 200 'f' ~i~~~~~~~~r:~t 08~Y::<: JU'L~\'\ ~'~:;~:r:~pe :~ (~,> I' . '" ,\ 0 Express Mall !l~ '- 1\ 29 );) 0 Return Receipt for Merchandise ~ L~ ~n{}0 < // 7. D~.. of Deliva ,y,--... ',/ (- '?- - a 0 8. Addressee's Address (Only if requested and fee is paid) , - Ii .~ " "' a. " u " a: c: ~ ::l IXI Certified ~ o Insured I ~ o COD "~ 1 02595-98-8-0229 Domestic PlEnum Receipt 5. Received By: (Print Name) ~ 6. Signa ~ Xi .!! ent) 0:"" PS Form -.. ,;"'C"';" "- .l!0,:, . ~ .e ::l o >> ... c: .. .c: .... '-?'._,,~ ' -~- , - ~~-,.~,' 'ttt CERTIFICATE OF SERVICE AND NOW, this 8th day of August, 2000, I, Steven C. Courtney, Esquire, of Metzger, Wickersham, Knauss & Erb, P.C., attorneys for Plaintiff, hereby certify that I served a copy of the within Proof of Service by Mail this day by depositing the same in the United States mail, postage prepaid, at Harrisburg, Pennsylvania, addressed to: Raymond Kiss 5 Church Street Piscataway,NJ 08854 Document #: 181832.1 ~I ....."'~'l -'iI'llil)' --'....."j,.....tJi"',~~~~ ;I~ ~- ~ ~" -.~" 0 { c ( <::'" ) -uEft ( mrr~ c z-r h ~C J)> '-- -<7 J:'CI s: - ~O ---0 ': )>C~ ~~: ., ...;; {; "'ii '~ ! ~ METZGER, WICKERSHAM, P.C. By: Karen W. Miller, Esquire AttorneyI.D. No. 200037 3211 North Front Street P.O. Box 5300 Harrisburg, PA 17110-0300 (717) 238-8187 CHUBB INSURANCE COMPANY OF NEW JERSEY, Attorneys for Plaintiff Chubb Insurance Company of New Jersey IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff CNIL ACTION - LAW v. NO. 00-5206 CNIL RAYMOND H. KISS, Defendant JURY TRIAL DEMANDED AFFIDAVIT I, Karen W. Miller, Esquire, the undersigned, being duly sworn according to law, depose and say that I am the attorney for Chubb Insurai:j:ce Company of New Jersey in hislher/their/its personal injury claims arising out of the incident on April 1 , 1998 and am authorized to act on hislher/their/its behalf. I hereby certify that the injuries and damages asserted are related to a motor vehicle claim which occurred on April I, 1998. METZGER, WICKERSHAM, KNAUSS & ERB, P.e. tllu lUG Date I ~WJ( aren W. Miller, Esquir 3211 North Front Street P.O. Box 5300 Harrisburg, PA 17110-0300 (717) 238-8187 Attorney for Chubb Insurance Company of New Jersey 356195-1 ~ ~ ~ ~ ~ill!!tclUl\itMliilmtllm~,~$MW.""" -'-."W""'''''. _, '>""b - . , ~ ~ to ~ ~ it:. . \> 0 r-o 0 = CY c = .." 0" ....... W ~-s.. ;p ~." -;v, '"\.1CC ~ O)C-: G5 m- ~ \t-- ..<::-..----. --chi ~ .%\ ::'00 ~ '-> I~ -' 0' -<9 --J .c:: ~ -0 :1.:-8 c:)_ 6"- 6' 3 ::-70 Om ~ ."-1 ~. Z 55 -f... =< (.Jl w .< I>>v/V ~ No. d--OO{J- ~:.t(J~ Gh~bb~^s~r~~L~ COf>vfO-A.! of Ne-w \Tusy (j~. KI5S Co '"'f I~; ""+ a. II -I,h^J-5 frlor +0 ~-/7- Of., (;t. Ie. M+ sCt<./I1l ~J. METZGER, WICKERSHAM, P.C. By: Karen W. Miller, Esquire Attorney LD. No. 200037 3211 North Front Street P.O. Box 5300 Harrisburg, PA 17110-0300 (717) 238-8187 CHUBB INSURANCE COMPANY OF NEW JERSEY, Attorneys for Plaintiff Chubb Insurance Company of New Jersey IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff CNIL ACTION - LAW v. NO. 00-5206 CNIL RAYMOND H. KISS, Defendant JURY TRIAL DEMANDED AFFIDAVIT I, Karen W. Miller, Esquire, the undersigned, being duly sworn according to law, depose and say that I am the attorney for Chubb InsUI'll.l).ce Cornpany of New Jersey in hislher/their/its personal injury clairns arising out of the incident on April I, 1998 and am authorized to act on hislher/their/its behalf. I hereby certify that the injuries and damages asserted are related to a motor vehicle claim which occurred on April I, 1998. METZGER, WICKERSHAM, KNAUSS & ERB, P.C. ~/lu lOb Date I (j;v- W l r aren W. Miller, Esquir 3211 North Front Street P.O. Box 5300 Harrisburg, PA 17110-0300 (717) 238-8187 Attorney for Chubb Insurance Cornpany of New Jersey 356/95-/ iC.> \ ~ #. 0 ..... ~ (') <=> c <=> .... :t!::n CY s:: > -OeD c: mJTj ......... tv ~ m("p <n z::r; ~6 ~ ;;;~!~ '" (j) , -.l _.:r::. ~::B ~ PJ r:::c; -0 :> ,- 00 -..J ~ ~ ::s: 2: ~""'--' Om 4.: C) 6' )>C N ~ Z ., ::<1 Ul -< --t:.... w