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HomeMy WebLinkAbout07-7091THIS IS AN ARBITRATION MATTER. ASSESSMENT OF DAMAGES HEARING REQUIRED. GORDON & WEINBERG, P.C. BY: FREDERIC I. WEINBERG, ESQUIRE Identification No.: 41360 JOEL M. FLINK, ESQUIRE Identification No.: 41200 1001 E. Hector Street, Ste 220 Conshohocken, PA 19428 484/351-0500 Peerless Insurance Company P.O. Box 2050 Keene NH 03431 vs. Global Supply Chain & Distribution, LLC 5267 Simpson Ferry Road Mechanicsburg PA 17050 COURT OF COMMON PLEAS CUMBERLAND COUNTY DOCKET NO. : L)7 - !bq / NOTICE C10;07Z2,? 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 JUDGEMENT MAY BE ENTERED AGAINST YOU BY THE COURT WITHOUT FURTHER NOTICE FOR ANY MONEY 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 32 S. BEDFORD STREET CARLISLE, PA 17013 (717) 249-3166 COMPLAINT IN CIVIL ACTION 1. At the special instance and request of the defendant, plaintiff sold to the defendant insurance coverage, on the dates, of the kinds, in the amounts and for the prices set forth in a true and correct copy of the plaintiff's books of original entry attached hereto, made part hereof, and marked Exhibit "A". 2. Defendant accepted said insurance coverage without complaint. 3. The amounts of the premiums set forth in Exhibit "All are the amounts which the defendant agreed to pay therefor. 4. All the credits, if any, to which the defendant is entitled are set forth in Exhibit "A". 5. Plaintiff has made demand upon the defendant for payment of the amount due, but the defendant has failed and refused and still refuses to pay the same or any part thereof. 6. Defendant's last payment on account was made on October 29, 2005. WHEREFORE, plaintiff claims of the defendant the sum of $19,902.00 plus applicable costs, interest and attorney's fees. GORDON & WEINBERG, P.C. BY: FREDERM-1,49tINBERG, ESQUIRE JOEL M. FLINK, ESQUIRE Attorney for Plaintiff POlI VERIFICATION FREDERIC I. WEINBERG, ESQUIRE, hereby states that he is the attorney for the Plaintiff in this action and verifies that the statements made in the foregoing pleading are true and correct to the best of his knowledge, information and belief. The undersigned understands that the statements herein are made subject to the penalties of 18 Pa.C.S.A. Section 4904 relating to unsworn falsification to authorities. FREDERI I. W INBERG, ESQUIRE EXHIBIT "A" Peerless Insurance. Member of liberty Mutual Group Global Supply Chain & Dist. #200445710 IM-9920487 12/31104 to 12/31105 $ 2,500.00 New Business Premium $ 325.00 Endorsement eff 07/01/05 2,825.00 Total Premium Due BA-9920950 01/13/05 to 01/13/06 $ 1,817.00 New Business Premium $ 1,817.00 Total Premium Due CBP-9924348 12/31/04 to 12/31/05 $ 6,485.00 New Business Premium $ (222.00) Endorsement eff 12/31/04 $ 3,307.00 Endorsement eff 07/01/05 $ 7,683.00 Final Audit Premium $ 17,253.00 Total Premium Due WC-9925148 12/31/04 to 12/31/05 $ 9,082.00 New Business Premium $ 5,797.00 Endorsement eff 12/31/04 $ 12,219.00 Final Audit $ 27,098.00 Total Premium Due Payments Made $ (4,517.00) $ (5,343.77) $ (3,173.19) $ (1,670.76) $ (8,153.85) $ (6,327.43) $ (29,186.00) 1/17/2005 4/1/2005 6/2/2005 7/15/2005 9/6/2005 10/28/2005 Total amount paid by insured 0 P.O. Box 2050 Keene, New Hampshire 03431 800-228-7830 Peerless Insurance Company (Not Licensed in New Jersey) Excelsior Insurance Company Peerless Indemnity Insurance Company The Netherlands Insurance Company Summary of Policy $ 48,993.00 $ 35.00 $ 60.00 $ (29,186.00) 19,902.00 Total Premiums Due Service Charges Reinstatement Fees Payments made Total Amount Due Company PHYSICAL At InIT Peerless Insurance,. •??'• v.iw. VnILIJ.IILVV'T I V 141a 114VV7 Policy Numltier:'CBP9924348 Policy Period From 12:01 AM 12/3112004 To 12:81 AM 12131/.2005 Coverage Is Provided th PEERLESS INSURANCE COMPANY - A STOCK COMPANY Named Insured and Malting Address: Agent: GLOBAL SUPPLY CHAIN 81 CARLISLE INSURANCE SERVICES [DISTRIBUTION LLC 1 VALLEY ST SUITE 101 5267 SIMPSON FERRY ROAD CARLISLE PA .17013-0000 MECHANICSBURG PA 17050 Agent Code: 3222059 Agent Phone:. (717)-241-5995 ?a•,nnvm nvv! t X71 h ? CIYI GV' 1 . COMMERCIAL GENERAL LIABILITY COVERAGE PART LOCATIOINI.OF PREMISIES Location Number Address of All Premises You Own, Rent or Occupy 001 5267.SIMPSON FERRY ROAD CUMBERLAND COUNTY MECHANICSBURG PA 17055 001 2850 APPLETON STREET CAMP HILL PA 17055 'Class Code Classification Description Rates Earned Premium Premium Territory Prods/ All Prods/ Ali Base Code Comp Ops Other Comp Ops Other -PA Location 001 99938 WAREHOUSES PRODUCTS-COMPLETED OPERATIONS ARE SUBJECT TO THE AGGREGATE LIMIT $ 90,024 010 INCL $ 38.287 INCL PAYROLL PER $1000 Location 002 99938 WAREHOUSES PRODUCTS-COMPLETED OPERATIONS ARE SUBJECT TO THE AGGREGATE LIMIT. $ 246,540 010 INCL $ 38.287 INCL PAYROLL PER $1000 Commercial General Liability Coverage Part Total Earned Premium Terrorism Risk Insurance Act Of 2002 Coverage Total Earned Premium $ 17-75 (12194) AUDIT COPY 12!3112004 9924348' NHGPATMM8D4 PGDMMD J18719 $ 3,447 $ 9,439 $ 12,886. REJECTED 12,886.00 STACKWE 00000098 Pw 1 17-75 (12194) AUDIT COPY 19!31/2004 9624348 NHOPATM®604 a(4nLmmn JIA?la 4TArWinr nmmnm. a P- ULOBAL SUPPLY CHAIN & Carrier: Peerless Insurance Company dISTRIBUTION LLC Agent: CARLISLE INS Bra,pch: Auditor: 1012 - Amy C. Baker PHYSICAL Type: Annual 1213112004 I?'a 1213112005 12/31/2004 12/31/2005 A 99838. 334 _ 1- PA 2 ? P --_, $100,000 _M $90,024 -$9,976 12/31/2004 1213112005 Description: WAREHOUSE NOC Prem. Base Description: A 99938 334 1 PA 1 _ P - $8_5,80.0 __$246,540 _ $16_0,740 _ 1 B7% 12/31/2004 12/31/2005 Description: WAREHOUSE NOC M Prem. Base Description: Msumaiea =130Sure Total: *185,800 Actual Exposure Total: $336,564 Year/QTR Gross Payroll Verification Adjustment Comment: $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 U41 Totals: $0.00 $0.00 $0.00 Deviation: $0.00 Year/QTR Gross Payroll Verification Adjustment Comment: 2004 4th $0.00 $62,261.00 $0.00 2005 1 st $0.00 $68,974.00 $0.00 2005 2nd $0.00 $123,901.00 $0.00 2005 3rd $0.00 $172,200.00 $0.00 2005 4th $430,536.00 $3,200.00 $0.00 3MG $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 APR Q $0.00 $0.00 $0.00 Ent(0}AA-Loc(o) Totals: $430,536.00 $430,53600 $0.00 Deviation: $0.00 Grand Totals: Gross Payroll: Verification Total: Deviation: $430,536.00 $430,536.00 $0.00 Audited by: 'Amy Baker Workers Compensation And Employers Liability Insurance Policy PHYSICAL AUDIT 9"3 q'? Peerless 10?lnsurancefv Audit Period From 12/3112004 PREMIUM AUDIT STATEMENT To .1213172005 Moer?Y oil I Policy Number: WC 9925148 Policy Period: From-12:01 AM 12/312004. To 12:01 AM 121312005 Coverage Is Provided in PEERLESS INSURANCE COMPANY - A STOCK COMPANY NCCI Number: 11355 Named Insured and Mailing Address: Agent: GLOBAL SUPPLY CHAIN & CARLISLE INSURANCE SERVICES, DISTRIBUTION LLC 1 VALLEY ST SUITE 101 5267 SIMPSON I:ERRY ROAD CARLISLE PA 17013-0000 MECHANICSBURG PA' 17050 Agent Code: 3222059 Agent Phone; (717)-241-5995 Federal Employer ID Number: 342016234- Filing.Number: Coda Premium Basis Rate Per $100 Earned Number Classifications Actual Remuneration of Remuneration . Premium PA 0813 WAREHOUSE-STORAGE, PUBLIC. 227,.346 12.1700 27,.688,-D0. 095.3 CLERICAL OFFICE EMPLOYEES 167, 901 0.5900 .991.00 SuTotal.. . .............................................. ...................................................... $ 28, 659..00 State Total Earned Standard Premium ...... ..: ...........................:............ ., $ . 28,859.00 0063 State Premium Discount ........................................................................................ $ -2,679.00 Terrorism Risk Insurance Act of 2002 Coverage .................................................... $ 198.00 0938 PA Employer'Assessmen# - usingfactor .0.02360 ........................... . $ 620.00 State Total Earned Cost ............................................. ....... ........................ $ 26, 898.00 POLICY PREMIUM-TOTALS Total Earned Standard'Premium ...................................................................:...... $ 28,'857. 00 0900 Expense Constant ................................................................................. ...:............ $ 200.00 Total Premium Discount ........................................................................................ $ -2,579.00 Total Earned Premium :...:............................................... ...............:.............. $ 26, 478.00 Total Assessments/Funds/Surcharges .................................................................. $ 8 2 0. 0 0 Total Earned Cost' .................................................................................................... $ 27,098.00 Less Previously Charged" ....... ............................. ................................................... $ 14 879.00 ADDITIONAL PREMIUM ...................................................................................... 5 12,219.00 • If the. poliq Is on an 'Installment basis', the final premium is subject to to payment of all Instalknent premlums. Date issued: 04/052008 Copyright, 1997 Mdlonel CouncB an Compensation Insurance 25-198 (06194) AUDIT COPY onn1AnAnn 149rr4n crA..v,,.c PW% n4 n 12- PHYSICAL -1213112004 Ext: 12/3112005 12/31/2004 12/31/2005 A 953() 1 PA 1 Description: I CLERICAL OFFICE / I l Est. Exp Act, Exp __$182,000 $167,901 $14Y099? B% 12/3112004 12/31/2005 Year/QTR Gross Payroll Verification AdJustment Comment: $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 941 Totals: $0.00 $0.00 $0 00 . Deviation: 60.00 Year/QTR Gross Payroll Verification AdJustment Comment: 2004 4th $0.00 $62,261.00 $0.a0 20051st $0.00 $68,974.00 $0.00 2005 2nd $0.00 $123,901.00 $0.00 2005 3rd $0.00 $172,200.00 $0.00 2005 4th $430,536.00 $3,200.00 $0.00 TMG $0.00 $0 00 $0.00 $0.00 APIA 5 20 . $0.00 $0.00 $0.00 $0.00 $0.00 Ent(O)-AA-Loc(o) Totals: $430,536.00 $430,538.00 $0 00 . Deviation: $0.00 Grand Totals: Gross Payroll: Verification Total: $430,536.00 $430 536.00 ' Deviation: 50.00 Audited by; 'Amy Baker ? ??O1C GL0aAd.'SIVPPLYCHAIN& Carrier: Peerless Insurance Company blS7R18UTION LLC Agent: CARLISLE INS Brunch: Auditor: 1012 _ Amy C. Baker Type: Annual A 813() 1 PA 1 8117,000 _ $227,346 $110,346 94% 12/31/2004 12/31/2005 Description: / WAREHOUSE -STORAGE PUBLIC Estimated Exposure Total: $299,000 Actual Exposure Total: $395,247 Untitled PREMIUM AUDIT STATEMENT PART 1 * PAGE 1 OF 1 *** SCREEN 1 OF 1 TRANSACTION TYPE PHYSICAL AUDIT BILLING TYPE DIRECT BILL AUDIT PERIOD FROM 12/31/2004 TO 12/31/2005 POLICY NUMBER WC 9925148 EFFECTIVE DATE 12/31/2004 EXPIRATION DATE 12/31/2005 COVERAGE IS PROVIDED PEERLESS INSURANCE COMPANY NCCI NUMBER 11355 AGENT Insured Name & Mail Addr CARLISLE INSURANCE SERVICES GLOBAL SUPPLY CHAIN & 1 VALLEY ST SUITE 101 DISTRIBUTION LLC CARLISLE PA 17013 000OWCXSCH/30 * PAGE 1 OF 1 *** SCREEN 1 OF 2 * CLASSIFICATION CODE PAYROLL RATE PR EMIUM PA WAREHOUSE-STORAGE, PUBLIC 0813 227,346 12.17000 27668.00 CLERICAL OFFICE EMPLOYEES 0953 167,901 0.59000 991 00 SUBTOTAL . 28659.00 STATE TOTAL ESTIMATED STANDARD PREMIUM 28659.00 STATE PREMIUM DISCOUNT 0063 -2579.00 STATE TOTAL ESTIMATED PREMIUM 26080.00 TERRORISM RISK INSURANCE ACT OF 2002 9740 395,247 0.05000 198 00 PA EMPLOYER ASSESSMENT 0938 0.02360 . 620.00 STATE TOTAL ESTIMATED COST 26898.00 0 FOR NEXT SCREEN - SELECT OPREMIUM AUDIT STATEMENT PART 3 1OF1* Total Earned Standard 28857.00 0900 Expense Constant 200.00 Total Premium Discount -2579.00 Total Earned Premium 26478.00 St AssmentS/Funds/Surch 620.00 Total Earned cost 27098.00 LESS PREV CHARGED 14879.00 ADDITIONAL PREMIUM 12219.00 DATE ISSUE 04/04/2006 0 FOR NEXT SCREEN, 1 TO EDIT - SELECT 0 * PAGE 1 OF 1 *** SCREEN Page 1 N r w c? o a0 J cm V r T E V ?. 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Tl too SHERIFF'S RETURN - NOT FOUND CASE NO: 2007-07091 P COMMONTWEALTH OF PENNSYLVANIA -COUNTY OF CUMBERLAND PEERLESS INSURANCE COMPANY VS GLOBAL SUPPLY CHAIN & DISTRIBU R. Thomas Kline duly sworn according to law, inquiry for the within named GLOBAL SUPPLY CHAIN & unable to locate Them in his COMPLAINT & NOTICE , -,Sheriff or Deputy Sheriff, who being says, that he made a diligent search and DEFENDANT DISTRIBUTION LLC but was bailiwick. He therefore returns the the within named DEFENDANT DISTRIBUTION LLC 5267 SIMPSON FERRY ROAD NOT FOUND , as to GLOBAL SUPPLY CHAIN & MECHANICSBURG, PA 17050 GIVEN ADDRESS IS SITE OF BIG UGLY WAREHOUSE. Sheriff's Costs: So a Docketing 18.00 Service 11.52 _ Not Found 5.00 Surcharge `DIX 10.00 00 ,f? i' ' 44.52 Sworn and Subscribed to before me this day of A. D. R . -Thomas Kline Z f of Cumberland County N & WEINBERG 12/05/2007