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Home My WebLink About09-5799SCHELL, P.C. W. BISIGNANI, ESQ. .tNEY ID #57982 ,.. JY SELLARS, ESQ. ATTORNEY ID #210302 17 NORTH SECOND STREET 12TH FLOOR HARRISBURG, PA 17101 (717) 731-1970 FAX: (717) 731-1085 AYERS, LLC 107 N. Market Street Mechanicsburg, PA 17055, v. EUGENIA FRENCH 1001 N. Pitt St. Carlisle, PA 17013 Owner or Reputed Owner ATTORNEYS FOR CLAIMANT AYERS, LLC IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA Claimant, No. 6?- e? 7 ? MECHANICS' LIEN ML-6 NOTICE OF CLAIM TO: Defendant Eugenia French. PLEASE BE ADVISED that on August 21, 2009, there was filed in the Court of Common Pleas of Cumberland County, as of Docket No. 2009 - , a Mechanics' Lien Claim, a true and correct copy of which is attached hereto. TRUE COPY FROM R In Testimony w roof, I here unto and the seal of sae Court at C This ....rh?Sf da o POST & SC LL, C. :CORD Amy hand B N W. IGNANI, ESQ. e, Pa. ATTORNEY ID #57982 D. TROY SELLARS, ESQ. ATTORNEY ID #210302 ?..? 17 North Second Street, 12th Floor nary Harrisburg, PA 17101-1601 (717) 731-1970 Attorneys for Claimant, Ayers, LLC Dated: August 21, 2009 POST & SCHELL, P.C. BRIAN W. BISIGNANI, ESQ. ATTORNEY ID #57982 D. TROY SELLARS, ESQ. ATTORNEY ID #210302 17 NORTH SECOND STREET 12TH FLOOR HARRISBURG, PA 17101 (717) 731-1970 FAX: (717) 731-1085 AYERS, LLC 107 N. Market Street Mechanicsburg, PA 17055, Claimant, V. EUGENIA FRENCH 1001 N. Pitt St. Carlisle, PA 17013 Owner or Reputed Owner ATTORNEYS FOR CLAIMANT AYERS, LLC IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA No. Oc)- 5-7G9 MECHANICS' LIEN MECHANICS' LIEN CLAIM Now Comes, Ayers, LLC d/b/a as SERVPRO of New Cumberland/Carlisle and SERVPRO of Lower Paxton/Halifax ("SERVPRO" or "Claimant"), a Pennsylvania Limited Liability Company, and pursuant to Title 49 Pa. Stat. Ann. § 1503 files this Mechanics' Lien Claim against Eugenia French, Owner or Reputed Owner, and against the property herein described and the curtilage appurtenant thereto for the payment of a debt due to SERVPRO as Contractor in the repair to improvements to the property. The following is a statement of the claim of SERVPRO: 1. The name of the Claimant is Ayers, LLC d/b/a as SERVPRO of New Cumberland/Carlisle and SERVPRO of Lower Paxton/Halifax, with its principal place of business located at 107 N. Market Street, Mechanicsburg, Cumberland County, Pennsylvania 17055. Claimant files this claim as Contractor. 2. The Owner or Reputed Owner at the time of furnishing the labor, goods, materials, repairs and other improvements and the attaching of the lien therefor is Eugenia French. Upon information and belief Eugenia French's primary address is 1001 N. Pitt St., Cumberland County, Carlisle, Pennsylvania, 17013. 3. On or about April 12, 2009, a sewage back up caused portions of Eugenia French's residence at 1001 N. Pitt Street Cumberland County, Carlisle, Pennsylvania, 17013 to be flooded with contaminates including, inter alia, raw sewage which contaminated portions of the home. On April 12, 2009, the Claimant contracted with Eugenia French, pursuant to a written work authorizations, to supply labor, goods, equipment and material for the repair and cleaning of the Owner's property described in paragraph 8 herein, including but not limited to the following: supplying dehumidification services; extract and dispose of contaminated "black water" and other material; remove contaminated wall-board, doors, and trim; remove and reset appliances; remove, cut, and bag contaminated carpets; apply antimicrobial agents to certain walls and floors of the residence; and clean the residence from the sewage backup to return the home to a livable condition. A true and correct copy of the written work authorizations between Claimant and Eugenia French is attached hereto, made part hereof and marked as Exhibit "A." A detailed description of the material provided and work performed per room and the prices charged for same is attached as Exhibit "B". 4. The nature and character of the labor and materials furnished by Claimant at the Owner's property described in paragraph 8 herein was repair/mitigation/restoration work to the existing improvement necessary for the residence to return to a habitable condition. Claimant furnished labor, goods, equipment and material necessary for said repair/mitigation/restoration work. Pursuant to the written work authorizations, the Claimant began work at the property on or about April 12, 2009 and completed the work on April 17, 2009. 5. As of the date of the filing of this Claim, Claimant has completed performance of the above described repair/mitigation/restoration work to the improvement. The repair/mitigation/restoration work and improvements performed by Claimant to date at the property and material furnished are free of defect, and has increased the value of the property. Claimant has billed the Owner $10,728.18 for the work and improvements it has performed at the property to date, including material furnished at the site. 6. As of the filing of the within Mechanic's Lien Claim, Claimant has not been compensated pursuant for the work and improvements it has performed at the subject property. The balance or amount or sum claimed to be due for the labor, goods, equipment and materials furnished by Claimant to date at the subject property is $10,728.18, plus interest at the Contract rate of 18% per annum. 7. Claimant's last day of work from which this claim arises occurred on or about April 17, 2009. 8. The labor, goods, equipment and materials were continuously furnished by Claimant free of defect and in accordance with the written work authorizations on the piece of property with curtilage appurtenant thereto, constituting the premises subject to the lien, known as 1001 N. Pitt St., Cumberland County, Carlisle, Commonwealth of Pennsylvania, 17013, Tax Parcel No. 06-19-1641-138, more particularly bounded and described as follows: ALL that certain improved lot of ground situate in the Fifth Ward of the Borough of Carlisle, Cumberland County, Pennsylvania, bounded and described as follows: BEGINNING at an iron pin, which iron pin is at the Northeastern corner of the intersection of Pitt and "F" Streets; thence North thirteen (13) degrees thirty (30) minutes East along the Eastern line of said North Pitt Street, a distance of seventy-eight (78) feet to an iron pin at line of land now or formerly of John Hurley; thence South seventy-six (76) degrees thirty (30) minutes East along said land of John Hurley, a distance of one hundred thirty (130) feet to an iron pin; thence South thirteen (13) degrees thirty (30) minutes West, a distance of seventy-eight (78) feet to an iron pin on the northern side of said "F" street; thence North seventy-six (76) thirty (30) minutes West along said northern side of "F" Street, a distance of one hundred thirty (130) feet to an iron pin, the place of BEGINNING. HAVING thereon erected a one-story brick dwelling house known as and numbered 1001 North Pitt Street, Carlisle, Pennsylvania. SUBJECT to the building restrictions and covenants set forth in a Deed recorded in Cumberland County Deed Book "J", Vol. 8, Page 96. BEING THE SAME, premises which Wilbur P. Stender and Mary J. Stender, his wife, by Deed dated June 12, 1968, and recorded in the office of the Recorder of Deeds in and for Cumberland County in Deed Book "U", Vol. 22, Page 664, granted and conveyed to Brian R. Smith and Rosemary Smith, his wife, the Grantors herein. A copy of the December 27, 1977 Deed from Brian R. Smith and Rosemary Smith to Eugenia French recorded in Cumberland County Deed Book "P" . Vol. 27, Page 35 is Exhibit "C." 9. This lien is claimed against the fee simple interest of the Owner or Reputed Owner in the aforesaid premises. WHEREFORE, Claimant Ayers, LLC claims to have a lien upon the premises herein described in the amount of $10,728.18, plus interest at the contract rate of 18% per annum on said sum, plus costs against Owner or Reputed Owner and the premises. POST & SCHELL, P.C. 4. BRIAN W. SIGNANI, ESQUIRE D. TROY SELLARS, ESQUIRE Attorneys for Claimant, Ayers, LLC Dated: August 21, 2009 AYERS, LLC IN THE COURT OF COMMON PLEAS 107 N. Market Street CUMBERLAND COUNTY, PENNSYLVANIA Mechanicsburg, PA 17055, Claimant, V. No. EUGENIA FRENCH 1001 N. Pitt St. MECHANICS' LIEN Carlisle, PA 17013 Owner or Reputed Owner VERIFICATION BY AFFIDAVIT I, Scott Ayers, being duly sworn according to law, deposes and says that I am a member of Ayres, LLC, Claimant herein, and am authorized to make this Affidavit on its behalf. I further aver that I am familiar with the facts set forth in the foregoing Mechanics' Lien Claim, and that all of the statements contained in the above Claim are true and correct to the best of my knowledge, information and belief. I understand that the statements made herein are made subject to the terms of Title 1.8 Pa. C.S. § 4904 relating to Unsworn Falsifications to Authorities. Scott Ayers, Member Ayers, LLC 6,?) ?-If 4 01/25/2007 02:11 #0806 P.002 /003 • - - • CUSTOMER INFORMATION FORM - WATER DAMAGE rcY1) n NATbN1111A E SERVICE PROVIDER SERVPR0' is a Franchise system niM over 1,350 iinepertae rty Ov?rv`d and operated Iocswns rtalTOrepide.. Sevpro trtdustr? curs... the Franchhim Y reached at 1480aSERVPRO- WORK AUTHORMAXION in order to start ar emergency and regotallm service, you mist sign the "Authorization to P0110nn SMIC4e tarts This allows; us to take action lmmediwely. We do root know your insurance Cw agw therefore. it is knpos5l* tar us to know a K* what your irw rance WALL covet. It is important to understand = are WM* fP (or our services. Your deduolible is payable before we start wark ff for arty tea5oo ingyrartbG tloWBraye ca[rraE be verified at the time of our emergency service, an additional deposit may be required. hats Damage Occurred: Insurance Carrier: Deductible Amount 5 kf 'r RF'Fr=RMCES lire SEl2VPRO• Franchisee would be pleased to provide references upon retptest_ now WE PROCEED The 5LRVPw' will attempt to "preserve and protect" your stnxttre and oo hwwts, The follonring steps may be COMPkted in the emergency Service, a3 ddcmtined to be aPpficablc by the SERVPRO"' Franchisee: ¦ Idertlity SormceJlXpe Of Water - Contaminated water sources 5ke sewage, etc. require spaoar¢ed restoration processes. M' addition, the source of water Shtouhd be conrpiel* strapper, prior to starting any work attar Om the removal process. What, was the w-+^P of this water sxrusim? u ?. Has the source of realer been stopped? []Yes ? No Ltr fd0rtify. Visible Mold Growth -? R is important for us to latoue vthethw any visible. mild gtowli t s PFesul Wf molds may be fm-4 in smal amounts almost anywhere, larger growtls of mold may create hem cOneernS, depadsag on, the reaction of occupants to mok& Have you seer signs of mold grnQ artyadxne in the structure or itscoxte rfs? es Q No Lotari_Ui?; Have you seen mold growth crux: in the past? NYes ? No Have you noticed any odors or musty srne$;?-_ ¦ Mpld Mitigation - Specialized P -ed re>s are required wr mood- it we notice a significant presence of mad, we vM nary tore cwo WW parties so thtey may detamtrke an appropriate cause or aCtiorn- n measure Tempiera xetnxridty for prying Analysis - The process of drying will use equipment to remove moist " front the SA;=L re and writ " of your home. This controlled reducnort of the rdadve haridry level helps reduce property damage and slow mold growth fit Swvey the Emu of Damage and irpect the Promises - Our survey is designed to iderttEy bow much damage has scarred and plan the necessary emergency wortk- The inspection 4 also dare for safety reasons. We cnem the afleclea area for bad noonng, etiling daluaga Visible electrical 1- 1 contents damage., wall and baseboard damage, sewage water, vesiMe mold, etc- Are you aware of any hazards in the builci&tg? Please remove any valuable lots from the areas we are mote aemnst before the job hs Scarfed we are that 0 emergency Water Extraction - Our nerd Step i$ to or as s diet OXKM be tteriooots g"trt osa specej or extra remove as mitten *8W as POSSilft hom the affected deicate treatment due to their vakre: area. lbm will be cocg7k W wlth or wed eactartim e*"wit, ...., is Furniture Moved and Blocked - This is done to ,....,, ? protectorpet and furniewigs in the ag tided ama- 1 /8) ONERLOOKM ITEMS Although our w4mvisors inspect Ill FloOf Service - We calf check to see what type of supervisor an the { and brn Orly Boors ym have. Carpet will be Bled to mspect ftraamg- oveslmAW am or cone eY h to the superw oes AS much water as pa wble will be rerndved. at0 t- IL C;mW Pad - Pad acts tike a sponge and holds water. If the pad is exposed to erg eSa wow. A n*y be necessary to remove the pad to protect sLMK r and speed the dying Moors. 4 Cxpet - Carpet will be checked for restarabEty. attrihadort. visor mold and mildew ft. hh some water damage silitddons Ute carpets may need w be retrtoved_ This can ffx1ide door rerixNai, cu" seams. and1lor metal tireshold rwicrval. ¦ Tteeuaerits. - Our process may include the appbmitim of deodorizers or EPA-reg'Wered ¦ Eguiprrrent - Drying eti iptnent will be used to dry your property. The purpose of the equipment is to remove moister: W4 burg ft rewwe humility teed back to ncrrrlal, it is very koportw we equipment be kept Warring. unless a satay hazard arises. Excessive moisttire can stilt loo present even when ' ail' visible surtates seem dry, which may lead to matt gEwd1 or other damage- We vA m rm mo shire m writ materials. IL Disposal - Any reAtw gems such as carpet pad will be TaxNed and disposed of property- 1WHAT IS RESTORABLE O.M, unirig CAacltr 9( wtsm can be saved until EvdytttitV is ft * ustraay imPassi4te We wits set a follow-up date so we can rtrprih43pr tfre drying process. In.edddi0n, the mstoradori process will be scheduled when the drying. is oomplele. This can kxkide Boor Preparation, lady strip replacement, Carpet and pad nVabation, seaming, carpet clear" and restoring, artd furniture aQd r chg. A scope of services. volt be provided- a) -EXISTING OR PRELOSS.CONDTTIONS During the course of clearirtrl, it ft 6k2ty we twig re movie ftgo4" soanq. enrich e*Ao Carter a your toss` We are happy to Co so. K. however. the removal of pre- exfst M sad requires sky (cant =a chore our' crews will be irstrurried to move on to the nwat imm. Prt~ eumvrrg damage, suturing visible mold growth, will aksn be noted. Has ors sutrctt.re Sisata?4lostC5 or waterrntrtesiorns cn the past? ? Yes M No U/7) PER50MAL ITEE7AS. In to coarse- of ow survey and cieariing, we will sometimes be required li open Doors. cupboards. etc. to qualfy andlor restore the damage. ff any oT these areas contain personal items you would prefer to relocate before we star work. ptease let us know Area: ADjU5TLj?S OR AGENTS We raitlter irsratce adjtrstes nor agem. We cannot aUUtoriae anything to be replaced, repaired or Painted. Oct job is to preserve arts protect, stop father damage from occurring and to restore damaged items to then prior cotdNm when possible- Y'10) EMERGENCY CHARGES The exact price of restOW151 Your proPOV17 foeow a Water darrlage emiggefcy is viraally impasuM to determine on our first visit. However, in order to give you an idea, we will review the SERVPRO' Water Damage Emegency Services Report to provide you an W" e5xtnlate while our oar first ask. The scope of work can change due to unforeseen circtrnstancm The FmW bill will be forwarded to you andkv your insurance carrier upon "L1) HEALTH AND SAFETY Maintaining your personal health and safety is or great concen to us. An occupants and pets should sMy away k0rh the work areas to protrxt char health and safety dursg the work process. Material Safety Data Sheets for or products are aralaW upon request Please ' late I Warrt copies. ? Yes p.,C Exposure to certain mom may cause health problems. If you have airy concern, you snoutd Con%* yotw Pfrysiciaa Has anyWa in the beikNrig evedenced hwJthpxw* to site water irrtnusioru? Yes Do you have any ISeaRlt correerre, about the water koirsion? For addborad irfOrMasion, please see the SERVPRO' Mold Brochure, and cortlact yeti local or state health ,??- C3/12) APPRO)GIMATE COMPLETION The actual time required to compiew ifte restoration process is riffiCtA to estimate We estimate appru*nabd c - days. T HAVE READ AND UNDERSTAND THE ABOVE STA7EEMENFS AND 1111111FOINIAT)ON CONTAINIM HEREK MY ANSWERS TO THE ABOVE QUESTIONS ARE ACCURATE AND COMPLETE. Ck ato @r Name 'K BASmik Ctrstoerte? . -grtamre bate: ?s Signature Date, A-?. -4.e,KZ, C .L (Z- ¦ GUNS AND PAN IFUNI ION Our OV" arc WISts s Md NEVER to much goris or animuntm>_ Far Iris reasm we tegtrest you remove airy such items from the areas we are cleaning. Frarichiselegai No c ( ) corporation. N-ttC, O Partnership. O LLP. f J sale proprietorsihip a JEWELRY. VALUABLF.-% HEIRLOOMS PIOM dflYa SERVPRO• GfAlQ,Nt ) ?' ?d Q+d f 01/Z5/2007 02:12 #0806 P.003 /003 AUTHORIZATION TO PERFORM SERVICES and .. DIRECTION OF PAYMENT The UndemWp d client, :being the linking owner, owners representative, or resident, authorizes the Provider identified below to perk= any and all necessary cleaning. and/or restoration services on Chienfs property located at the property .address below, and with respect to items that need to be cleaned 'at'a fL? location to rernove and dean. such. Rom as necessary. CHerd authorizes c? lnsura . .Company, trein referred to as "Insurance Company,-. pay Provider solely and directly-for -lftat portion of the work covered by Cflent!-Na k9affance. poiiay #, for any feason, Chera reoeiv? a ctxx-* from 4rm ante .C rry made .payable to Client, Client agrees to 'pay Provider irnrrtedately tipon r+ec:W of the check. In -order to expedite payment to Provider, Client hereby appoints Provider as attorney-in-fact, authorizing Provider to endorse Client's .name on insurance Company checks or drafts, and to deposit Insurance Company checks or drafts for Provider services. Client agrees to pay UerWs deductible in the amount of $ ? that applies to this claim. If any amounts owing to Provider for Provider services are not covered by ire, Client agrees to pay those amounts to Provider within Wteen (15) days of ChM's receipt -of .inacace. h is fully understood that Client and its agents, successors., assigns and heirs are personalty responsM for any and all deductibies and any costs not covered by amrance. Interest and finance charges -vdH to charged at the maiarrium aliDwabia by law, or at t..5% .per month, whichever is less, on accounts over thirty (30) days past dire. Time is of the essence. Client agrees that Provider is woeo*v for the Ct t :arid not Client's insurance company or any agenbadOster- RemariQ Property Owned by'. I have read lids Auffx6zation to Perform Servi.es and Diroction of Payment, including the Terms and Conditions of Service on the reverse side bereo#, and agree to same. - crams Die Primed to Fran Legal name c?=WMWn^UC,c»,c>UP.casole w . &Wa sEFNPRd* of CLJ.ke?kd SERYPRO® Franchises am uncle ttly owned and operated. White - SERWRQ® Yellow - Adjuster Pink - Customer 28000 02/07 1FT ' t UIPMEW RESPONSIBILITY FORM AadrerIs: Phonc: Dav. l 1 _ Fvsnng f _- -- -___ Insurai'cc' Cornparly: Adi.rAgent: 1 acknowledge receipt of the following equipment in goon working order: laryc? conrlmewi,li dcehurnidiher." rill ,nOVt!!" Standard conlrnercial dehumidifiers __ __ XhaUSt Ut11t'. activated oxygen generators Other air Scrubber negative air unit (Specify) 104 Meter Reading Start -/ c See--- Meter Reading End Customer has been rnrormea or me ronowing requrrerrrerrss reyaru„ry Cyu,,v--- - ,, -j-- ,,, The equipment should be left operatil-,y at all times. Do not move c qt1 pment unlc SS you contact the SERVPRO' Franchise below, regarding handling procedures. Turning equipment off trill increas,U 1.11110 1e%itod to dry structure, and contents and may cause damage. 2 A. water-darnaged dwelling should rnaintain a temperature, setUry thai piurnot,a ideal drying cunditions i_eaviny windows or doors open during dehumidification or setting air conditioning tna !01P rn iy inch r;se drying time and dainvigr stnwl uc indior r.on(tnl?,. 3. Should customer, have any problems with the ecimpinrent shut it off mi-nediately and call our office lit is oo1 as pos s iblo. i s responsible for dc:mage to, andlor less ot, thi, aquiPmer,t Ir!Mle. rt 1 ill 01"Tomer's ears-. ?Inc::,a.,to ly, rncfuding but not'imited to trr' MISed by belt, v ndtllisln or dlsappealancc ?h ?:untonlc r s r?: Pr n5 billCy t? allow pc rsc?mlc l ?c c;eti *c ust vi . r r:. b,r loon to dieck o t Ind pick up the equipment. vr; c,r.u "W"li, r ry ,ici.(2d LID frl.l.rccn flu, ,rr, ,f tnrnucffi FfOily excluding holiday;. I(iifYn rni 'JiiiI 'i (.> r7t:?l:i"id '':o the F lectnca tiy'. t::rn ri i5lil r GdJf Illni): tiii rl 1 Ill la r?lC',f i Irr `lnr3 the w(egnty rind safety of ecarcal system in the uweIhnclsiructure. It Shall be the C.L :u s responsilAity o have lh.i elec,wr al systcrn inspected and serviced hr.- dalified c le ctricl ar if necessary. d Tel,, ??_,>[ome ig ees to hold the SERVPRO Fr rnu ise uc v,% it° 7,unchi?lui and the u I ispc ctiv offit-c I . directors, employees, agents :Ind aililole , hwinless and indcamnify it from any .11 d all c.l, un i? c. udini costs, expo r1 ,c.s =ind ;wornc.y , tees, resulting from the impropfs the equipmwlt by ,he customer andlor,iny ri ?fectt ill .I r-ae_'lleal s;ystern or plumbing syste : n custorne-'s dwellinglstructure. A deposit of $ - - -- has been collected. Payment J Cash J Check i _ J Credit Card: J MC. ?J VISA J Other: Name on Card: - ---.._? -- -- - ---- ------ ---- ----- Exp. Date: ----- - Ir, the event it becomes necessary to enforce the teens of this agreement, or tHcover SUMS due. customer agrees to pay reasonable attorney fn ('s, coOul-t costs, collection costs, plus intr rcSt. at 5 4, per month or at [11C, highest rater allowed by law. I) Iic. t v ,Ivc red ! ! _ Q ( 1)<Ite i'1c?ked I_)f, --- -- 7,, 1 u r Signoturr X ?_// l(?11,i(lGtL ustoulc.r ign,,tti. s=: _ -- - - SER". ORG Signature: Sicinaturc Equipment Shortages: -- Customer Signature: __-- SERVPRO' Signature-_ Cliont'?, Signature ?nntc: Narnr: A, dry 285CJ9 Revis?>d 08/77 Date Damaged equipment: _---_- Customer Signature: SERVPRO' Signature _..__---- Pro rd?r'S Signature Dale ranc hlse?l r y i' NaITIC corporr,tion. (i? F t'! i i liartnerr.>hip, i) I I P, !) sole proprietorship tir,;?, sE-uvPko .,r ?j?tr.1 t?uwt??t-Ia?-c)? C-C<< ?? Ste F?ich S RVPk(y r- ;nc hise m lependently Omn od aid pup a atccl ?`°'•?" Insured - Claim Number AUTHORIZATION TO REPAIR (To Be Signed Prior to Beginning Services/Repairs) T0: State Farm Fire and Casualty Company I have agreed to use the State Farm Premier Services' Program. I understand the use of this program is voluntary and I have been offered the opportunity to choose any independent contractor and/or independent service provider(s) participating in the State Farm Premier Service Program. I also understand they are independent contractors and/or independent service providers hired by me and not by the State Farm Insurance Companies@. I understand State Farm® is paying for the repairs to the property damage covered under my policy, subject to the deductible and the policy's terms and conditions, and that State Farm is not exercising its option under the insurance contract to repair or replace any part of the property damaged. I have selected and authorize: to perform repairs as indicated on their estimate due to a loss on I understand my deductible is payable to the authorized independent contractor and/or independent service provider(s). I agree to pay my independent contractor and/or independent service provider(s) for any repairs, or additional improvements made at my direction, that are not covered under my policy. Any person who knowingly and with Intent to defraud any insurance company or other person files an application for insurance or a statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. 419 l? ?o cost - - - (Date) (Year) (Insure Signature) To be completed by the contractor Repair Start Date: __1__/ /. Time: am pm Estimated Completion Date: State Farm's Insurance policies, applications, and required notices are written in English. With the exception of any applicable policy language, this document has been translated into another language for the convenience of our customers. In the event of any difference in interpretation, the English language version will control. 1052963 Rev. 06-21.2005 Pennsylvania Page 1 of 2 ?,,b%f? ?x Fire & Water - Cleanup & Restoration' Loss Information Eugenia French 1001 N Pitt St Carlisle, PA 17013 Home: (717) 249-8127 Type: Water Claim #: Policy #: Work: Cause: Sewage Back-Up Servpro of New Cumberland/Carlisle PAOAGHIC:005176 107 N. Market St. Mechanicsburg, PA 17055 Phone (717) 770-2030 Fax(717)545-5321 admin@servpro-ncc.com Tax ID Loss Statistics FNOL Date: 4/1212009 Loss Date: 4/12/2009 Company: Penn National Agent: Adjustor: Estimator: Job Calculations Room Offset Missing Totals IfFloorPerimeter 215.53 102.51 0.00 318.04 sfFloor 754.20 185.93 0.00 940.13 Description 1 Clean Equipment - Black Water 2 Monitor Equipment 3 Setup & Take down Equipment - Black Water 4 Health & Safety Personal Protective Equip. - Black Water 5 Emergency Response - After HR/Weekend Emergency Service - Black Water 6 Disposal Debris - Black Water Quantity UOM Unit Price Total Tax 0/P 6.50 EA $42.07 $273.45 T 3.00 DAY $82.50 $247.50 T 3.00 HR $74.55 $223.65 T 18.00 EA $7.92 $142.56 T 1.00 EA $247.50 $247.50 T 2.00 LD $187.50 $375.00 T Mitigation: $1,236.21 Structure: $1,509.66 Restoration: $273.45 Contents: $0.00 Replacement: $0.00 Total: $1,509.66 Living Room Calculations Room Offset Missing Totals Box IfFloorPerimeter 58.00 0.00 0.00 58.00 sfFloor 206.90 0.00 0.00 206.90 Length: 16 ft 4 in sfWalls 464.00 0.00 0.00 464.00 Width: 12 ft 8 in Height: 8 ft O in Description 7 Drying Air Movers - Black Water (Note: 4 @ 4 days) 8 Dehumidification Dehumidifier, Large - Black Water (Note: 1 @ 4 days) 9 Remove Wall 10 Remove Trim -Black Water 11 Antimicrobial Wall -Black Water 12 Remove Door - Black Water Quantity UOM Unit Price Total Tax O/P 16.00 DAY $45.00 $720.00 T 4.00 DAY $187.50 $750.00 T 55.40 SF $0.47 $26.04 T 58.00 LF $0.63 $36.54 T 116.00 SF $0.38 $44.08 T 1.00 EA $4.95 $4.95 T In Progress Eugenia French Independently Owned and Operated By Ayers, LLC Thursday, July 16, 2009 Page 1 of 6 (c) SERVPRCP Intellectual Property, Inc. 3:12 PM 13 Extraction, Black Floor 206.90 SF $0.85 $175.87 T 14 Antimicrobial Floor - Black Water 206.90 SF $0.30 $62.07 T 15 Clean Floor, Subfloor, Concrete - Black Water 206.90 SF $0.42 $86.90 T 16 Manipulation Fumiture/Contents - Black Water 4.00 HR $82.50 $330.00 T (Note: 2 @ 2) Mitigation: $2,149.55 Structure: $1,906.45 Restoration: $86.90 Contents: $330.00 Replacement: $0.00 Total: $2,236.45 Pink Room Calculations Room Offset Missing Totals Box sfFloor 226.38 0.00 0.00 226.38 Length: 16 ft 8 in sfWalls 484.00 0.00 0.00 484.00 Width: 13 ft 7 in Height: 8 ft O in Description Quantity UOM Unit Price Total Tax O/P 17 Drying Air Movers - Black Water 12.00 DAY $45.00 $540.00 T (Note: 3 @ 4 days) 18 Remove Wall 8.67 SF $0.47 $4.07 T 19 Antimicrobial Wall - Black Water 121.00 SF $0.38 $45.98 T 20 Extraction, Black Floor 226.38 SF $0.85 $192.42 T 21 Antimicrobial Floor - Black Water 226.38 SF $0.30 $67.91 T 22 Clean Floor, Tile - Black Water 226.38 SF $0.56 $126.77 T 23 Clean Contents, Large Box - Black Water 3.00 BOX $72.60 $217.80 T 24 Manipulation Furniture/Contents - Black Water 6.00 HR $82.50 $495.00 T (Note: 3 @ 2 hours) Removed 8'8" of wood. Sprayed 1' up in missing.. Mitigation: $1,345.38 Structure: $977.15 Restoration: $344.57 Contents: $712.80 Replacement: $0.00 Total: $1,689.95 Laundry Room Calculations Room Offset Missing Totals Box Offset Offset 1 1 4 ft 9 in X S ft 9 in X 8 ft O in sfFloor 155.22 47.00 0.00 202.22 efWAC 39n 79 9939A 0.00 544.00 Length: 15 ft 11 in Offset Offset 2 1 3 ft 7 in X 5 ft 6 m X 8 ft O in Width: 9 ft gin Height: 8 ft O in Description 25 Drying Air Movers - Black Water (Note: 2 @ 4 days) 26 Dehumidification Dehumidifier, Large - Black Water (Note: 1 @ 4 days) 27 Remove Wall - Black Water 28 Antimicrobial Wall - Black Water 29 Clean Sink - Black Water 30 Extraction, Black Floor 31 Antimicrobial Floor - Black Water 32 Clean Floor, Tile - Black Water 33 Remove and Reset Appliances - Black Water (Note: Removed Washer and Dryer (Side by Side)) Quantity UOM Unit Price Total Tax O/P 8.00 DAY $45.00 $360.00 T 4.00 DAY $187.50 $750.00 T 12.50 SF $0.70 $8.75 T 136.00 SF $0.38 $51.68 T 1.00 EA $10.59 $10.59 T 202.22 SF $0.85 $171.89 T 202.22 SF $0.30 $60.67 T 202.22 SF $0.56 $113.24 T 1.00 EA $41.25 $41.25 T In Progress Eugenia French independently Owned and Operated By Ayers, LLC Thursday, July 16, 2009 Page 2 of 6 (c) SERVPRd8) Intellectual Property, inc. 3:12 PM 34 Manipulation Furniture/Contents - Black Water 2.00 HR $82.50 $165.00 T (Note: 2 @ 1 hour) Mitigation: $1,567.99 Structure: $1,526.82 Restoration: $165.08 Contents: $206.25 Replacement: $0.00 Total: $1,733.07 Furnace Room Calculations Room Offset Missing Totals Box Offset Offset 1 1 4 ft 2 in X 8 ft 0 in X 8 ft O in sfFloor 74.94 79.17 0.00 154.11 Length: 9 ft 8 in Offset Offset 2 1 5 ft 8 in X 8 ft 1 in X 8 ft O in sfWalls 150.08 286.08 0.00 436.16 Width: 7 ft gin Height: 8 ft O in Description 35 Drying Air Movers - Black Water (Note: 2 @ 4 days) 36 Dehumidification Dehumidifier, Large - Black Water (Note: 1 @ 4 day) 37 Remove Wall - Black Water 38 Antimicrobial Wall - Black Water 39 Extraction, Black Floor 40 Antimicrobial Floor - Black Water 41 Clean Floor, Tile - Black Water 42 Manipulation Furniture/Contents - Black. Water (Note: 1 @ 1 hour) Quantity UOM Unit Price Total Tax O/P 8.00 DAY $45.00 $360.00 T 4.00 DAY $187.50 $750.00 T 8.08 SF $0.70 $5.66 T 109.04 SF $0.38 $41.44 T 154.11 SF $0.85 $130.99 T 154.11 SF $0.30 $46.23 T 154.11 SF $0.56 $86.30 T 1.00 HR $82.50 $82.50 T Mitigation: $1,416.82 Structure: $1,420.62 Restoration: $86.30 Contents: $82.50 Replacement: $0.00 Total: $1,503.12 Entry Way Calculations Room Offset Missing Totals Box Offset Offset 1 1 5 ft 0 in X 4 ft 3 in X 8 ft O in sfFloor 58.16 49.75 0.00 107.91 Length: 11 ft 3 in Offset Offset 2 1 3 ft 0 in X 9 ft 6 in X 8 ft O in sfWalls 152.72 238.00 0.00 390.72 Width: 5 ft 2 in Height: 8 ft O in Description 43 Drying Air Movers - Black Water (Note: 2 @ 3 days) 44 Dehumidification Dehumidifier, Large - Black Water (Note: 1 @ 3 days) 45 Remove Wall 46 Antimicrobial Wall - Black Water 47 Remove Carpet, Metal Strip - Black Water 48 Remove/Cut & Bag Carpet 49 Antimicrobial Floor - Black Water 50 Clean Floor, Hardwood - Black Water Quantity UOM Unit Price Total Tax O/P 6.00 DAY $45.00 $270.00 T 3.00 DAY $187.50 $562.50 T 33.00 SF $0.47 $15.51 T 97.68 SF $0.38 $37.12 T 33.00 LF $2.63 $86.79 T 107.91 SF $0.28 $3011 T 107.91 SF $0.30 $32.37 T 107.91 SF $0.61 $65.83 T In Progress Eugenia French Independently Owned and Operated By Ayers, LLC Thursday, July 16, 2009 Page 3 of 6 (c) SERVPRCP Intellectual Property, Inc. 3:12 PM Mitigation: $1,034.50 Structure: $1,100.33 Restoration: $65.83 Contents: $0.00 Replacement: $0.00 Total: $1,100.33 Calculations Room Offset Missing Totals Bathroom Box Offset Offset 1 1 2 ft 8 in X 3 ft 9 in X 8 ft O in sfFloor 32.60 10.01 0.00 42.61 sfWalls 152.72 72.72 0.00 225.44 Length: 5 ft gin Width: 5 ft 8 in Height: 8 ft O in Description Quantity UOM Unit Price Total Tax O/P 51 Drying Air Movers - Black Water 3.00 DAY $45.00 $135.00 T (Note: 1 @ 3 days) 52 Remove Wall 10.67 SF $0.47 $5.01 T 53 Antimicrobial Wall - Black Water 56.36 SF $0.38 $21.42 T 54 Clean Sink 1.00 EA $7.06 $7.06 T 55 Remove/Cut & Bag Carpet - Black Water 42.61 SF $0.42 $17.90 T 56 Extraction, Black Floor 42.61 SF $0.85 $36.22 T 57 Antimicrobial Floor - Black Water 42.61 SF $0.30 $12.78 T 58 Clean Floor 42.61 SF $0.25 $10.65 T 59 Clean Toilet - Black Water 1.00 EA $19.80 $19.80 T 60 Manipulation Furniture/Contents - Black. Water 1.00 HR $82.50 $82.50 T (Note: 1 @ 1 hour) Remove wood 1' up. EP disenfect 10'8" of wood remove V up Mitigation: $310.83 Structure: $265.84 Restoration: $37,51 Contents: $82.50 Replacement: $0.00 Total: $348.34 In Progress Eugenia French Independently Owned and Operated By Ayers, LLC Thursday, July 16, 2009 Page 4 of 6 (c) SERVPRC) Intellectual Property, Inc. 3:12 PM Category Summa Mitigation Restoration Replacement 0 and P Non Taxable Taxable Total Bathroom $310.83 $37.51 $0.00 $0.00 $0.00 $348.34 $348.34 Entry Way $1,034.50 $65.83 $0.00 $0.00 $0.00 $1,100.33 $1,100.33 Furnace Room $1,416.82 $86.30 $0.00 $0.00 $0.00 $1,503.12 $1,503.12 Job $1,236.21 $273.45 $0.00 $0.00 $0.00 $1,509.66 $1,509.66 Laundry Room $1,567.99 $165.08 $0.00 $0.00 $0.00 $1,733.07 $1,733.07 Living Room $2,149.55 $86.90 $0.00 $0.00 $0.00 $2,236.45 $2,236.45 Pink Room $1,345.38 $344.57 $0.00 $0.00 $0.00 $1,689.95 $1,689.95 $9,061.28 $1,059.64 $0.00 $0.00 $0.00 $10,120.92 $10,120.92 Structure and Contents Summary Structure Contents 0 and P Non Taxable Taxable Total Bathroom $265.84 $82.50 $0.00 $0.00 $348.34 $348.34 Entry Way $1,100.33 $0.00 $0.00 $0.00 $1,100.33 $1,100.33 Furnace Room $1,420.62 $82.50 $0.00 $0.00 $1,503.12 $1,503.12 Job $1,509.66 $0.00 $0.00 $0.00 $1,509.66 $1,509.66 Laundry Room $1,526.82 $206.25 $0.00 $0.00 $1,733.07 $1,733.07 Living Room $1,906.45 $330.00 $0.00 $0.00 $2,236.45 $2,236.45 Pink Room $977.15 $712.80 $0.00 $0.00 $1,689.95 $1,689.95 $8,706.87 $1,414.05 $0.00 $0.00 $10,120.92 $10,120.92 Trade Summary Amount 0 and P Non Taxable Taxable Total Content Moving/ Manipulation $1,196.25 $0.00 $0.00 $1,196.25 $1,196.25 Contents Cleaning $217.80 $0.00 $0.00 $217.80 $217.80 Demolition / Tear-out $568.32 $0.00 $0.00 $568.32 $568.32 Drying / Dehumidification $5,668.65 $0.00 $0.00 $5,668.65 $5,668.65 Emergency Services $1,526.75 $0.00 $0.00 $1,526.75 $1,526.75 Mold Mitigation $142.56 $0.00 $0.00 $142.56 $142.56 Structural Cleaning - Interior $800.59 $0.00 $0.00 $800.59 $800.59 $10,120.92 $0.00 $0.00 $10,120.92 $10,120.92 In Progress Eugenia French Independently Owned and Operated By Ayers, LLC Thursday, July 16, 2009 Page 5 of 6 (c) SERVPRcP Intellectual Property, Inc. 3:12 PM Summary Totals Structure: $8,706.87 Contents: $1,414.05 S/C Total: $10,120.92 Overhead: $0.00 Profit: $0.00 O/P Total: $0.00 Non Taxable: $0.00 Taxable: $10,120.92 Sub Total: $10,120.92 6.00% Sales Tax: $607.26 Total: $10,728.18 Deductible NOT COLLECTED: In Progress Eugenia French Independently Owned and Operated By Ayers, LLC Thursday, July 16, 2009 Page 6 of 6 (c) SERVPR(P Intellectual Property, Inc. 3:12 PM to ? ?" ? ??1? , lSL•CT.-Warranty Daea-Short Form.dkt 1909.Doubte Sheet /? ?r I ?` ?rf AAA K., Hall, Ine., Inelana. Pa. ? J- (/ ?.1 4.?f ?L. Zi /M ?? r (??(i f' T y _ MADE THE C-Z 7 12L day of December in the year of our Lord one thousand nine hundred and seventy-seven (1977) BETWEEN BRIAN R. SMITH and ROSEMARY SMITH, his wife, of P. O. Box 2, Spofford, New Hampshire, Parties of the First Part, herein called the Grantors ,. i? ??fl l 1 and EUGENIA M. FRENCH, single, of the Borough of Carlisle, Second Part, Cumberland County, Pennsylvania, Party herein called the Grantee . WITNESSETH, that in oonsideration of Thirty-One Thousand Five Hundred---------- ($31, 500.00)---------P44rs, in hand paid, the receipt whereof is hereby aeknatDiedped, the said grantors do hereby grant and convey to the said grantee , her heirs and assigns. ALL that certain improved lot of ground situate in the Fifth Ward of the Borough of Carlisle, Cumberland County. Pennsylvania, bounded and.described as follows: BEGINNING at an iron pin, which iron pin is at the Northeastern corner of the intersection of Pitt and "F" Streets; thence North thirteen (13) degrees thirty (30) minutes East along the Eastern line of said North Pitt Street, a distance of seventy-eight (78) feet to an iron pin at line of land now or formerly of John Hurley; thence South seventy-six' (76) degrees thirty (30) minutes East along said land of John Hurley, a distance of one hundred thirty (130) feet to an iron pin; thence South thirteen (13) degrees thirty (30) minutes West, a distance of seventy-eight (78) feet to. an iron pin on the northern side of said "F" Street; thence North seventy-six (76) thirty (30) minutes West along the said northern side of "F" Street, a distance of one hundred thirty (130) feet to an iron pin, the Place of BEGINNING. HAVING thereon erected a one-story brick dwelling house known as and numbered 1001 North Pitt Street, Carlisle, Pennsylvania. SUBJECT to the building restrictions and covenants set forth in a Deed recorded in Cumberland County Deed Book "J". Vol. 8, Page 96.. BEING THE SAME premises which Wilbur P. Stender and Mary J. Stender, his wife, by Deed dated June 12, 1968, and recorded in the office of the Recorder of Deeds in and for Cumberland County in Deed Book "U". Vol. 22, Page 664, granted and conveyed to Brian R. Smith and Rosemary Smith, his wife, the Grantors herein. 9 / ?a .C e b. Co., P e. School Dist. Cum COMMCN4VEALT}{ Of PENNSYIY/:N!A m DEPAUMENT OF REVENUE ' or, r? 3 15.0 0 ?r - s0'0g9" of ER DEC29'11 Cur;16., Co.'Pd , lTY P.8.11162 r Real Eda T der Taa / let, I •. Roal t Tnmfor Tca DiJ. Col, Aql, ,c% . GQO-/?2'7 PACE 35 A i{ i And the said grantors hereby covenant and agres that ththey e property hereby conveyed. will warrant generally n Af. C kAp RL oou ?Adn W NTMA? ?tOw? ? KN•i IN WITNESS WHEREOF, Said grantors have hereunto get their hands eaO- the day and year first above written. 012urb. arw*b mb nothu ee0 Eu the Ilsnsuee of Romith State of . PEN NSYLVA NIA ?ss.... County of CUMBERLAND On this, the day of ,1877, before me, i:•: , the undsrsigntd ofhecr, personally appeared Brian R. Smith.A_ . i. . ' j% knom to me (or satisfactorily proven) to be the person whose name is subaeribed to the within inetrumeW, and acknowledged that he executed same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto fsnt(KA and and o$uiai eaL sags. K FETTERS ... --..ii9i•ARM•P66LIG......_r...._..._:._........._..._. CARLISLE, CUMBERLAUO COUNTY, PA Title Of Officer- My COMMISSION EV&S MAY A 1976 State of New 4W psvyl Tt ss. County of CheSh i re On this, the 2-1 4h day of iDece-rivee , 19"11 , before me, the undersigned officer, personalty appeared Rosemary Smith. known to me (or Satisfactorily proven) to be the person whose nams is Subscribed fq;tie, '; .. , within instrument, and acknowledged that she executed Same for the purpo i?;har@1 ,, !: contained IN WITNESS WHEREOF, I hormaeto Sot my hand and o$e ` ?Es?e%._..1-rte.. _fx?s? .?a?!!.!Y?*.:i:??? _? ^•?c:.{:?:. y . My Comm sslsa Expires June S. 1982 Title of bf]1C8t! • i? I do hereby certify that pre e psidence and/ lets post offin address of the within named grantee it ? r 7 o r 3 fit Attorney for Grantee _,_ _ boax r27 PACs: 36, ?J CFILED..f ICE ?Tr CF THE ply Oe dAul'? Sheriffs Office of Cumberland County R Thomas Kline A D-t !Cc Sheriff ?Y?tr o1 4?t?robrr? OF TARY ?? ??fD Ronny R Anderson 20e9 AUG 28 PH 12: 'S 0 Chief Deputy - Jody S Smith ' Cl Civil Process Sergeant OFFICE OF Ft?7 `"=RIFF p i''? Edward L Schorpp Solicitor Ayers, LLC Case Number vs. 2009-5799 MLD Eugenia French SHERIFF'S RETURN OF SERVICE 08/25/2009 03:25 PM - Mark Conklin, Deputy Sheriff, who being duly sworn according to law, states that on August 25, 2009 at 1525 hours, he served a true copy of the within Notice of Claim and Mechanics Lien Claim, upon the within named defendant, to wit: Eugenia French, by making known unto herself personally, at 1001 N. Pitt Street Carlisle, Cumberland County, Pennsylvania 17013 its contents and at the same time handing to her personally the said true and correct copy of the same. SHERIFF COST: $33.84 SO ANSWERS, AWW*'1?? August 26, 2009 R THOMAS KLINE, SHERIFF By De ty SherAff POST &SCHELL, P.C. BRIAN W. BISIGNANI, ESQ. ATTORNEY ID #57982 D. TROY SELLARS, ESQ. ATTORNEY ID #210302 17 NORTH SECOND STREET 12TH FLOOR HARRISBURG, PA 17101 (717) 731-1970 FAX: (717) 731-1085 AYERS, LLC 107 N. Market Street Mechanicsburg, PA 17055, ATTORNEYS FOR CLAIMANT AYERS, LLC' IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA Claimant, v. No. 2009-5799 MLD EUGENIA FRENCH 1001 N. Pitt St. :MECHANICS' LIEN Carlisle, PA 17013 Owner or Reputed Owner PROOF OF SERVICE I hereby certify that the original Notice of Claim and atime-stamped copy of the Mechanics' Lien Claim were served on Defendant Eugenia French at 1001 N. Pitt Street, Carlisle, PA 17013 on August 25, 2009. Furthermore, I hereby certify that the Sheriff's Return of Service attached hereto as Exhibit "A" is a true and correct copy of said Return of Service. Respectfully submitted, POST &SCHELL, P.C. D. TROY S~ELLARS, ESQUIRE PA Attorney I.D. # 210302 17 North Second Street, 12th Floor Harrisburg, PA 17101-1601 (717) 731-1970 Dated: August 31, 2009 Attorneys for Claimant EXHIBIT "A" Sheriff s Office of Cumberland County R Thomas Kline Sheriff ~,xr of ~ecu~brrf Ronny R Anderson Chief Deputy ~ry~ ~Q,~ ~~• C' Jody S Smith ~`" ~`~"` Civil Process Sergeant arr~c4 QF r~s~ sY:aiFF Edward L Schorpp Solicitor Ayers, LLC vs. Eugenia French Case Number 2009-5799 MLD SHERIFF'S RETURN OF SERVICE 08/25/2009 03:25 PM -Mark Conklin, Deputy Sheriff, who being duly sworn according to law, states that on August 25, 2009 at 1525 hours, he served a true copy of the within Notice of Claim and Mechanics Lien Claim, upon the within named defendant, to wit: Eugenia French, by making known unto herself personally, at 1001 N. Pitt Street Carlisle, Cumberland County, Pennsylvania 17013 its contents and at the same time handing to her personally the said true and correct copy of the same. SHERIFF COST: $33.84 SO ANSWERS, ~;.-., August 26, 2009 R THOMAS KLINE, SHERIFF ~' De ty She ~~ -ILI: ~-; ,~..;1~~ iC9 SAP - { 4~~ ~ l ~ 3 3 C' a" ~~ . .,. ~~ i_~i~ri ~,. ~ i,i,