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HomeMy WebLinkAbout09-6183I'D A a. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION GOODVILLE MUTUAL CASUALTY COMPANY, subrogee for ROBERT J. CASE NO. D 9 - 9'3 c EDWARDS and MARY P. EDWARDS, CODE NO. Plaintiff, TYPE OF PLEADING: VS. COMPLAINT IN CIVIL ACTION MOHAMED EL BAUMY, FILED ON BEHALF OF: Defendant. File No. 57752 GOODVILLE MUTUAL CASUALTY COMPANY, subrogee for ROBERT J. EDWARDS and MARY P. EDWARDS, Plaintiff COUNSEL OF RECORD FOR THIS PARTY: GEORGE A. MILLER, ESQUIRE Pa. I.D. No. 22525 BROMBERG & MILLER FIRM I.D. No. 937 1030 Fifth Avenue, Suite 102 PITTSBURGH, PA 15219 (412) 232-0440 l IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION GOODVILLE MUTUAL CASUALTY COMPANY, subrogee for No. O 9_ 6 1?-3 t N I l 4< rA, ROBERT J. EDWARDS and MARY P. EDWARDS, Plaintiff, vs. MOHAMED EL BAUMY, Defendant. NOTICE TO DEFEND 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 defense 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 maybe 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 BRING 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. Lawyer Referral Service Cumberland County Bar Association 32 S. Bedford St. Carlisle, PA 17013 (717) 249-3166 (800) 990-9108 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION - LAW GOODVILLE MUTUAL CASUALTY COMPANY, subrogee for ROBERT J. EDWARDS and MARY P. EDWARDS, Case No.: C) y _ g' 3 c ;4'1 4erm- Plaintiff, vs. MOHAMED EL BAUMY, Defendant. COMPLAINT IN CIVIL ACTION AND NOW COMES, GOODVILLE MUTUAL CASUALTY COMPANY, subrogee for ROBERT J. EDWARDS and MARY P. EDWARDS, by and through their attorney, GEORGE A. MILLER, ESQUIRE, and files the within COMPLAINT IN CIVIL ACTION as follows: The Parties 1. The Plaintiffsubrogee is Goodville Mutual Casualty Company whose business address is 625 W. Main Street, New Holland, PA 17557. 2. The Plaintiff subrogors are Robert J. Edwards and Mary P. Edwards whose address is 178 Franklintown Road, Dillsburg, PA 17019. 3. Defendant Mohamed El Baumy is an adult individual whose business address is 1111 Spring Road, Carlisle, PA 17013. Facts 4. During the relevant time period, Defendant was a residential tenant for premises owned by the subrogors and located at 104 South Locust Street, 2A, Shiremanstown, PA. 5. On or about September 29, 2007, Defendant was in the process of vacating the subject premises. 6. In the process of disconnecting his washing machine, Defendant temporarily turned off the water for the entire building because there was no spigot handle for the hot water feed to the washing machine. 7. Thereafter, Defendant returned to his own apartment and connected a water hose to the hot water spigot. 8. After connecting the hose to the hot water spigot in his apartment, Defendant turned the water back on for the entire building, and completed moving his belongings, including the washing machine, from the apartment. 9. The hose which Defendant connected to the hot water spigot in his apartment did not have a rubber washer at the end, and hot water sprayed out from the hose for a couple days thereafter. Cause of Action - Negligence 10. The Plaintiff incorporates by reference Paragraph 1 through 9 as if more fully set forth herein. 11. The action by Defendant of connecting a leaking hose to the hot water spigot in his apartment was negligent, as Defendant had a duty to determine whether the hose would leak after he vacated the subject premises. 12. The Defendant knew or should have known that the hose was defective, and that water would continue to run from the hose after he vacated the premises. 13. As a proximate result of the foregoing, the Plaintiff subrogors suffered damages totaling $11,020.23. 14. Pursuant to a policy of insurance between Plaintiff and its subrogors, Plaintiff paid its subrogors damages totaling $10,520.23, which does not include a $500.00 deductible paid by the subrogors. 15. Estimates, bills, and other receipts are attached hereto and marked collectively as Plaintiff's Exhibit "A." 2 16. Plaintiff intends to offer the attached Exhibits into evidence pursuant to Pennsylvania Rules of Civil Procedure, Rule 1305. The repairs have been performed. 17. Pursuant to the insurance contract, and the attached subrogation receipt, a copy of which is attached hereto and is marked as Plaintiff's Exhibit "B," Plaintiff is entitled to pursue this claim for damages, including the subrogors' deductible, against the Defendant by virtue of its right of subrogation. WHEREFORE, Plaintiff claims damages from the Defendant, in the sum of Eleven Thousand Twenty Dollars and Twenty-three Cents ($11,020.23), together with costs of suit. Cause of Action - Breach of Contract 18. The Plaintiff incorporates by reference Paragraph 1 through 17 as if more fully set forth herein. 19. Pursuant to the Lease between Plaintiff subrogors and Defendant, Defendant is responsible for damages to the subject premises. 20. The Defendant failed to perform pursuant to the terms of the said agreement. 21. As a consequence of said failure performance, Plaintiff subrogors and now Plaintiff suffered the aforedescribed damages. 22. The written lease is not accessible to the Plaintiff at this time, but maybecome available prior to trial, and should already be available to Defendant. WHEREFORE, Plaintiff claims damages from the Defendant, in the sum of Eleven Thousand Twenty Dollars and Twenty-three Cents ($11,020.23), together with costs of suit. Respectfully submitted, BROMBERG & MILLER BY: •?Z?-1-? GEORGE A. MILLER, Esquire Attorney for Plaintiff VERIFICATION I verifythat the statements made in this Complaint in Civil Action are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S.Section 4904 relating to unswom falsification to authorities. GOODVILLE MUTUAL CASUALTY COMPANY Title I Estimate 70374 f^•?:JI: J Robert 8 Mary Edwards ..^rl= Capitol Adjusters, Ltd. Suite 300 764 Corporate Circle New Cumberland. PA 17070 Office: (717) 774-8365 FAX (717) 774-3246 Claim No 137313 t 0IIi:Y NC- bale of Loss ire I BC90; 191 ' I09!2 r I RaP;n OdI@ Adiustar 9 Z60i First - 1011012007 ?f7G^SS ?ir..__ t78 Franidintown Road IY-ia Fsr - Dillsburg PA 170ig 432-4745 24 East Green Street Sherem ansrown Camp Hill. PA 17011 r,t?t f.IZT.1r - =77'7-ae rAY. Rental Property Unnit S357; 000 00 Deductible 5500 DG Living Room Floor 34.67 SY Wall 592 SF Ceiling 312 SF Floor Perim 74 Fr Ceiling Perim 74 FT Roam-standard Langlh 27A 00 FT Width 13.00 FT. Height 8A0 FT Operation dty Un (t Description -- Paint 304 SF Drywall Or Plaster 2 Coats - seal and pa+n1 Cost RC DEP ACV Replace 1 r 12 LF Base Molding Clamshell base 2-112" finger- aint n 0 RO i 23 20 0 00 1-2320 Paint 2 Coals 1$ LF . l pi e Base Molding. Clamshell base 2-1.2" fingzi oml 266 45 54 0 00 44 58 Remove 312 . y . piny? Sand. edge. and finish light sand existing floor 091 1r = 56 0.00 14.58 Replace 312 5F Sand edge. and linrah light sand ex4shng Boor 000 0 00 coo coo Paint 31 LF Hot Water Bast: Heat Cover 2 Mars 145 1 07640 000 1(17640 . 1 39 5143 O.GD 51.43 Living Roam Totals; 1,511 33 000 1.311 13 Kitchen Floor 10 67 SY Wall 320 SF Ceiling 96 SF Floor Perim 40 FT Carling Perim 40 FT Roorn-standard Length 1 2 110 FT. Width 8 A6 FT. Height 8'60 FT Dperation Qty Unit Description Minimum I EA 112" Drywall -repair nung & fire taped only, Cost RC DEP ACV Replace 151 8 SF Sheathing. COX plywood 518" thick 1584.4 19844 0 D 44 Replace 107.52 SF Vinyl floor standard grads 275 41745 0.00 0 4117 ' 45 Replace 17 12 LF ? Base Moldrrtg. Clamshell base 2-112" finger-taint pin 3 23 341-29 0 00 347 ,9 Paint . Costs 1 6 LF e Base Molding Clamshell base 2-112° fin 2 66 45 5a coo 4{ 5A Rem E Reinstall 8 LF ger-joint pine Kitchen cabinet Lower standard 0.91 1456 7 0 Do . 1 6 grade Nate Cabinet must be come out to remove r y0"91 ` 8 16 ` 28 0 OG 7 2 tb g emaining Camaged sub-Boor material . Rem 8 Reinstall 8 SF Countarlop. Plastic laminate Hat-laid Replace 10 7 LF . Kick Plate at base of cation! Prefinished ?1 / c 174 6 u 00 1 08 Rem 8 Reinstall 1 EA . Sink. Kitchen Stainless steel 14° by 18" single bowl 2 v6 e7 , 4 2A 4a" 0.00 28.46 _ 2 r a a7 23 0.00 47 -33 Kitchen Totals: 1446 33 0.00 1.440.33 Hall Floor 5 di SY VV-all 304 SF Ceibno 60 SF Floor Perim 35 FT Ceiling Perim 38 FT Raon,-stanrard Rength 15 I FT t+Yd[n 4 00 FT Height !1 l7D FT Operation Qty Unit Description Cost RC OEP ACV i IPU Page 1 T Estimate Claim No. 137313 File No 7037'. I 1`134cy No Date or Loss Paporc 8C5D7191 Z Riiport Date Adjuver D 9120D7 First 1011012007 Remove 60 Sand edge. and finish hardwood Hoot light sand 0 00 . existing floor . 000 0.00 0.00 Replace 60 SF Sand. edge and thish hardwood floor light sand 3 45 7 existing floor 20 00 0.00 207 00 Paint 2 Coats 21 LF Base Molding. Clamshell base 2-112" finger-joint pine 091 Paint 360 SF . Drywall or Plasler 2 coat 1911 0.00 19.11 0 80 291 20 0 00 291210 Hall Totals: 51731 000 51731 Bedroom 1 _ Floor 15 SY Wall 384 SF Ceiling t35 SF Float Perim 48 FT Ceding Penm 48 FT Room-standard Length 15 00 FT y ath 9 00 FT Height 8 00 FT Operation Qty Unit Description Remove 135 Sand edge. and fnish hardwood floor light sand Cost 0 0 RC DEP ACV existing floor 0 (300 0.00 000 Replace 135 SF Sand. edge and fnish hardwood floot light sand 3 45 existing floor 46575 0 00 4 65 7., Paint 2 Coats 48 LF Base Molding Clam-shell base 2-112° tingeryomt pine 0 91 Pail 519 SF Drywall or Pla-,ter, 2 coats • seal 8 paint 43 68 0.00 A368 Patna 2 Coats 2 EA Inienor doors. hardboard smooth or wood-lextured 0 80 415 20 0.00 415.20 Paint 2 Coats 34 LF Casing Clamshell 2-112" finger-lornt pine 35.55 51 0 71 10 0 00 7110 Paint 15 LF Bseboard Heat Covef - paint 2 coats . 30.94 0 00 30 91 1 39 2085 000 2085 Bedroom 1 Tota ls: t 047 52 Goo 1.04752 Bath 1 Floor 4.14 SY Wall 708 SF Ceding 40 SF Floor Perim 26 FT Ceding Perim 29 FT Room standard Lengln 8 00 FT Width 5 00 FT Height 8 00 FT Operation Oty Unit Doscription Replace a4 SF Sheathing. COX plywood 5i8" ihrck Cost RC DEP ACV Replace 44 8 SF . Vinyl floor. standard grade 2 75 1 1-71 00 0 DD 121.00 Replace 9.63 LF Base Mokliog. Clamshell base. 2.1;2- flinger-joint pine 3- 3 2 65 144 70 0.00 144 70 Paint _ Coats 9 LF Bass Molding Clamshell base 2-1i2" iinget ornt ine . 0 9 25.5= 000 2., .,2 Paint 248 SF y p Drywall or Plaster 2 coal - seal and paint 1 0 60 8 14 0 00 8 19 Paint 1 EA Door Interior 2 coats 198 40 0 L+0 19840 Paint 2 Coals 17 L F . Casino Clarnshall 2-112" (finger-tarot pine 35 55 3555 0 DD 35.55 D.51 15 47 0 00 1547 Bath 1 Totals: 548.93 0 D0 548 93 Basement Floor 5 78 SY Wall 304 SF Ceiling 85 SF Floor Perim 39 FT G=dvna Perim 38 _,-T Room-standard Length 1 s q0 FT. Width 6.00 FT lieighl R OD Operation Qty Unit Description Cost RC DEP ACV Replace 88 5F 1+2" Drywall hung $ fire taped only 2 ; 5 243 00 0 00 242 00 Note Finished but not painted Basement Totals: - 24200 0 00 2-S 2 OD Pegs Estimate Claim No. 137313 I: i;& No PZ)6cy N:7 70374 160507 191 Date of Losk5 R=Pon 09+7.912007 First I Report Date AypwlBr 110+10;2007 RC R DEP NR DEP ACV Subtotal 5,70122 000 OAO 5.7x722 Overhead 570.72 0 00 D_00 570.72 Profit 570.72 0.00 0 00 570.72 Rental Property Loss: 6.848.56 0.00 D.DD 6.048.66 Totals: 5 1348.66 000 0.00 6 848 66 Less Deductible Applied 500 00 ACV Claim 6,348.66 For your protection. Pennsylvania requires the following to appear on this form: "Any person w11o knowingly and with intent to injure or defraud any insurer files an application or claim containing any false. incomplete or misleading tnformabon shall. upon conviction. be subject to imprisonment for up to seven years and payment of a fine up to $15.000." Page 3 101 -?03:`='f J t37 10-. Ib _1_",,993 E. FESTDP.E(A- PE PAri-E 71.`E?E R estcCore Restoring humes, businesses and lives. FACSIMILE TPUNSMITTAL SHEET ROW l?Ot1L,* tiL!?mi RestoreCore Capital Adjtutm 0!3/07 r nh P-V!jCl:.Ft 1:!'17.1 ,17-f-4-324(3 6 1'l l tl %I .: prIJ g71L' IN OIJU., 11,M. N,? 1Sitir.li: 17-7-774-3 00(3 "17-233-1500 Rab Edtrrds Claim M NOVA"! 71,111 NUNII.I.Iq ? URC=1.` I d I IIit 11.1.%.11.,X0 I'LI:1?F. UI` MI.t'; ? 1•I.l,.lil Al.i•1.Y 131't•1 IS' It, D= Doug. Here is I:he EmczMC ' jrrrses estimate for the claim for Rob E-chr=d (104 South L neust tit, Slvrcmammu-n). Plcz c contact T;tic Nirzar.Ek at 71--?1_'-1300 (office) or -1--343-5118 {cEIP it Tou have nnr question;-. 'ibank -rou! Y 7,r, mik Project Admini-Rtntur kcstorecofe. Inc. 2322 NORTH aL•VF_N'TH CTRF>GT $4'kRXI5BtTHC. PA 17110 :4 HOLIRS A bAY. ; OAVS q [41ErA E%tpRrEVrv SEjmr-E T'HO?IE 171'7) 232-1500 TOLL FREE fAMS) 2?t.l:al FAX (717) 232-793b 19 OJ _Uit, iU: lb .-1-_3=49SE• F.EST,3PE,'C+PE R.:?GE Ear 4l6 RestorcCure Z32 Xnrth Sn--.nth Street Harrisburg. Penn Mvvnia 17110 717-23'24500 da> 717-232-9936 EL, 25-1 ?67-17.5 Clicar Uwards, Rob Home ('7171329-935 Prnp-rn- 104SLocus, 5t. Shiemanct UM. PA 17011 Opcrator Tnfo_ Opcratar L-PPti140 Estimmor. Eric Vamzek Ivpe of Estuoatc: Water Mmar;c Va:LK: Date Entcred: I D .,01;200-e Mcc List PAHA4B?C ?tesctaran on'Serticc.Rcmodd Estimate; t D-(17119-54E Business: ('17) 343-5135 Datc Assigucd. 09.'29 2nD? Estimate for hot water time breskitlg at the Edwards residertco in SjKifcm8nStna%.PA. 1?+ tt ,"'t3t3 16:1E '1'2;299_6 PESETOPECOPE PAGE RestnreCore North Sct•7nth Sweet Harrisburg. Pennsylvania 171 10 117Z32-1500 fax 717-.3'_-9936 EN 25-176;7'; Room: U%inj Room 10.0709-54E DTSCRIPTTON Q-%-n' UNIT COST TOTAL Baseboard- Detach 16.00 LF ? it 14 = 1.64 Dchtlm,difiier (per ?4 hour pcnod) -1'Large • No monitoring 3 00 FA o. 101 3 _ 1413 's. Mete: t dehumidifier rnr 1 dare Drying-Tnj. tYPe {per 2; [IT pcriodl Vo monk- ;-irin DA I an no 420.00 Vote; I irrscctoT dry sm,t for 3 days. AJT rntr:Vr (per 2,t hour periods -No monitonng 6.00 EA 2E 25 94 = 1;- 6A Dote 2 air movers for : days. Room: Kitchen DE5CRTP•TTDN QNTV UNIT COST TOT,AT_ Bascbosd Acta4h 10.IDD LF;R 0.5a = 6.64 Teat aw non-salvageahle vinyl. cur R hape . agar hr 1; 9_ttn SF;& I,nR = 149.11; Tcar nut non-sale underlayment & bag - aftt:r business hrs 135.00 SF r?; 169 -4 Air ritivtr (per ?s hour period) - Xp monimnng 3.00 T;. a 25.9a = . 77.S2 Pete; I air movers for 3 days. Remorc Reno--c toc kick 10.00 LF 0- 1 211; - l 1. bC+ Equip. setup. ukc down & monitoring -a tier hrn 0.30 HR 23 99 Room: Aallwav DESCRTPTrOY QNTY UNIT COST TOTAL Bascboard • Detaeh 5.00 LF _ 0,5a e Z 7n Room: Bedrvottr T DFSCRfP770ti QN-n. UNIT COST TOTAL 'nehumiditier Iper 24 hour periods - Large .. No monitoring Note: I darumiditerfor 3 daps. pn,ng-fni. 13-pc fpcr 24 hr period) No monit. Nast; 1 injcuur dry unit rur 3 da?x. 4,r rnov:r (.pcr 24 hour period) - Nn rnnmtornng 10-0109-541: 0.00 LF0 0.53= 4-36 3.00 EA 65.00 = ?1)4.00 ,,.nn DA .'a 14p,i)o = 420.oo 3.00 EA.E. 25.94 - 7-82 In o2.2an- Face: r Restore0we 2321• North Sik%vnth StrCer Harrisburg. Pconsyt anm I 1110 71-7-232-1500 6017-1-12-99M CON WED - Bedroom 1 DESCRTPTTON QiVTV twu COST TOTAL v ' Nofc: I air mn4er far 3 days, Equip. sclup, mkc down &- rnowtarnag - afcxhr- ;.nn H ;d- 4;.9, Room: Bamment DESCRTP-ITON Q1TY Lti I I COST TOTAT. Tear out wet dry-idl. elm, bar. -,fter husiRt:.rc hatrra 77,00 SF a• O b?l = 5313 Dchmaudtcrtpcr 24 hour vsr:nlt ari'c • Nn uari s tree EA ,? 101.;< 3? "5 dare: T deltueim?iii??r??`iy? 3 tfa?s , ' 'Equip sctvp, take i?+?v,r' iitc?ftic?sring- afierfris U.50 HR Cf 47311 Room: Bathroom (full) DESCREMON I. I Q.M, L:N1T COST TOTAL Tricerme dnor - Detach & Iinset - slab onl;? 1.00 E.4 a 1320- 13?4 Aa?rbvard Dctat:b 9.00 LF i' W54 = 416 Toilet •lDczacb & rtsci 1.414 £A 6. ; I?1 SS Iii jK 1 Tcar out non-=11Y sgcablc . un%'I cur & bag for disposal ?7.?]Q SF n: 1? Z t = t $S Tcv ,gut uan-sal; u>trlcrtayraeni'&'bag 1'orarcpn:af'0 ? ZT.06'?5F i> ? 11.93 - ?? ?t Appl; anti-mrt r?+trial 3otnt 01, R17:3 n I fi - eCi Room: Mircello aeons DESCIZPTION Q>`? UNPIT COST TOTAL EmQTcncti acrvicc call - after bus,nes; hours 1.60 F-.i (iL 143.00 - I.a3:(ttl tnre: this ,s s after hr ernersenc}' service call fo, samrday 9.29rfl7 Tull dC11t15 - per Pickttp,trj4t1; Imd . inzhIdi+k r 'rc ).66 Gcacral clean • up d fM HP = 29 33 = 1 19:3- Note: 2 technic,ns 3 hm to da a general clc2n- In-n?0° Sale 1U 12 2110' P] PE: 3 Res+torcCnre 2322 tiorah Scycnth Sre--z Flanisburg,Penncylvnia 1?110 717-232.1500 fax 717-132-9936 EN 15-1761775 Grand Total Arm: A.00 SF walls 0.00 SF Finer 0 r10 SF Lon-7 6 Wall 0.01) SF Ceiling 11 On SY Floormg 0.00 SF Shom lvall 400 SF Wall: and Ccilinv- OAM LF 1oorPcnmcrcr riff) LF CcO. Per,mecer 0.00 Floor Arcs 0.00 Fxtc6orWall Arch n 00 Surfacc Arm 0.00 Total Rid= Length 0 00 Total Arca U10 Everiar Prntnctcr of Walls 0.00 Number of Squerzs 1.00 Total Mp Lcngth 0 00 ln[crior WWII Area 0 0n Tnral Pcnmcrct Lcrigth I D-0-I90-INE i n-112 lri- 'age. -1 RestoreCore 22 North SR,enth Street NarriSba", ?CnrlsyIVAM'a 17310 i17-232-15M fax 137-232-99;6 T-7W14 -11 (017,1 Snrnmarv for Facer Damage tunc ltcm Total 3,263-82 btstcrial Sales Tax a, 6.OVM,' s 11.57 0.70 Clesnint; Sltl T3s ;a F 1}O? n [ 0.85 0.05 Subtntai 3.266.57 Ciranmg SaIcA Tix rd. 6.013014% x 2 451 59 147.11) Repuccmcni Cost Value 3.413 67 Net Osim 3.;13.67 Eric,Mrozck 1G-0'09-54E 10-021007 Pate SWORN STATEMENT IN PROOF OF LOSS 70374 AMT. OF POLICY AT TIME OF LOSS 9/15/07 DATE ISSUED 9/15108 DATE EXPIRES To the Goodville Mutual Casualty Com an of New Holland. PA. SC907191 Qilisbura, PA POLICY NUMBER AGENCY AT Community Banks Insurance AGENT At the time of loss, by the above indicated policy of insurance you insured Robert and Marv Edwards. LOSS: 24 Egs-1 Green Street. Shiremanstown. PA, against loss by water to the property describe in Schedule'A", according to the terms and conditions of the said policy and all forms, endorsements, transfers and assignments attached thereto. 1. Time and Origin: A water loss occurred about the hour of _ o'clock M ., on the 29'" day of SePtem er 20Q7__- The cause and origin of the said loss were, Water damage to the insured's rental property,.. 2_ Occupancy: The building described, or containing the property described, was occupied at the time of the loss as follows, and for no other purpose whatever tenant occupied . 3. Title and Interest: At the time of the loss the interest of our insured in the property described therein was Robert and Map Edwards . No other person or persons had any interest therein or incumbrance thereon, except: _. 4. Changes: Since the said policy was issued there has been no assignment therof, or change of interest, use, occupancy, possession, location or exposure of the property described, except: _. 5. Total Insurance: The total amount of insurance upon the property described by this policy was. at the time of the loss _. as more particularly specified in the apportionment attached under Schedule "C," besides which there was no policy or other contract of insurance, written or oral, valid or invalid. _ 10,262.33 6. Emergency Services and Repairs .......................................................................S 7. Loss of Rent ....................................................................................................S 675.00 -500.00 8. Deductible ......................................................................................................5 9. The Amount Claimed under the above numbered policy is ................ 10,437.33 The said loss did not originate by any act, design or procurement on the part of your insured, or this atfiant; nothing has been done by or with the privity or consent of your insured or this affiant, to violate the conditions of the policy, or render it void; no articles are mentioned herein or in annexed schedules but such as were destroyed or damaged at the time of said loss; no property saved has in any manner been concealed, and no attempt to deceive the said company, as to the extent of said loss, has in any manner been made- Any other information that may be required will be furnished and considered a part of this proof. The furnishing of this blank or the preparation of proofs by a representative of the above insurance company is not a waiver of any of Its rights. State of County of Insured Subscribed and swom to before me this _ _ dray of 20 Notary Public fir C onltort Serb ices Inc, aro?.rfK. r 305 Iroquois Trail York Haven. PA 17370 Bill To Rob Edwards 178 Franklintotcn Rd DiIIshurp Pa 17019 Yurmenswu n bid r, Invoice Date Invoice w 10,1 , 2_119 3r_,9-1 P.Q No. Terms Project Quantity Description Rats Amount I No heal Ball found the 15 amp lust Ii as stolen lnm panct hnt replant-d Iiu: and Irslul C%VnIllln`S CIICCkCLI tillL a tar the 11441Vr4 had river to them 1111, 011 - ni, III, Total sbU.l.ii 1 PPE, Electric Utilities Electric Service Fur ROHERT 1 L•nvrfV j)S W S Lr.ECr_rST ST APt' _,t SAM Fkt %NsT 01VN' t'A 170j) Final Bill i PPL Electric Utilities C11-Metner Senice 427 Hausman Rd. Anualu%o,• PA 1-00-0.3432--577; IF.?S00-D? 4P},L? R'te', ppletertri c .core Page 3 P P Bitting Details Current Charges j'vi![fflli ,05-9 Cba .ges for, ?PL ELECrittC Residential Rate: its for 5e 2 _ )c n EM=S Distribution Charge- Customer P ? Ut Chaat 10? r? 86 KWH ar 2.4r;;Qt10000C er KWT_1 ]0 KW}1 at 2.236()(!0()07perKUt''l-I Transmissian Char e. 188 KWH :it 1l.ti-0(10000.9 per K" Tnnsitit)n C7targe: 86 KWTI at 13 38000c)oe 102 cr KWl1 K1 at L 1860onofl-per KWH Cieberatiorl Charge: C$pacity imd Fncr j02KWH at,- P T 7 000008 per K WI-1 1C_ ' at 5.0340p00bp Per.KWH PA Sale ax Adj Stirrharge at O, l26{lOt)Of1?? es 7'a.; Ta4il PPL Ec rein' II_r_fLrr1hS C'ltarge, General Information Account >Elaladce 3.53 ?•?2 1.15 1.21 4.93 ;. J 3 (1.01 1.30 -? $Z.9tJ $22.90 Thank you for the oppvrtuuity to serve_yp? Uur oal is to pprovide a level ofsernce that ensures you ale e ve venn• setrsLed We?tave cstabL'shed xour accntrnt wtth?iut a depufsit. M of_ynur bill each month by the 'Due Date" ensures that we will not charge yttu a deposir_ Please C;@ us i1'yuu have any questions. GrXeration prices and charges arc set b you have chmn- The Public l.h.iliry Co the electric generation supplier prices and services. The Federal Ede tnrntssiott y Mates di n gtd iransMission prices and services. Y kel ulator 'a?tissi an M regulates AdditioIl. utiii $13q of 01is billtP $1.49 ol-this Vs The PA 616_ ss leCei y stet( taxes, In tits Ta,t The Transition Charge includes an Intangible 'l-ransition Char a (ITC) and the applicable -Coss receipts tat which to ether amount to J.? . is a pet rrsxge car e ? ? The 1TC PPi. Elertnc U l; roved by the Pub§.ic Utili tilines co gets as a •c ty CumnRission which Pond t' b nt Fur PPL rleciric U14hies Transition incurredrecover a portion ofPPLt1 ie . l.fi;iii1e$? strunded costs. •rbe Bross receipts taX, which is collected for the C mtmonwealrh of PeunsYlvattia, is equal to 6.00% of the ITC_ Foryour convenience, you: ran nowv a your bill usin MasterCard, Discover. or ATM Car all 13i111;iar •? voile 00 Bil1"21su will charge your credit and ATNI card a Sea ice f O for mtik ng this pavrnent. $efore diggin around yourhome or ro state's Otte Call P Pere', you .sbcntld always rdI the You can do this bvrsimply diM?gq 811,1 which Vizlj Com tC y uu o the trine Call system 13e safe andcall 911 before you dig. ' • Page 1 ;:..; . ... . . ....:••Y:uJlt:till:Rctialla?>xr .. :: pr P. Electric P? (097{1-730?t} Utilities 1Jx H;;,,cn?u1 C Rasp... . Electric Summary Page Service ?o.oo Baleacc as of Oct 12, 20117 F - - - " Charles: 522.9l) rBH1 TQt p-cs:.1;LECTRIC UTTL ITIE:S Charges zA 522.9t) 1?ntt Cotal Charges ?; . pt1?Ta Lyter tlEtaUluv ?:1DU7 :. • .. 1m,?'?• 'b90 . Accutml Bal3flce this biu? Please contact us by KQV 2 at 1-840-341-M5 (1-844-DIAL-PPL) or -rTitC t0: C'ustamer Service 827 liaust = Rd- Allelltowu, PA 181 U1-9392 W-%-W. Pp1 e1LVtric.mm AYrter Readinti Intortnatiaa Electric KN3'H -Average Per Uay Meter OV484911 - tr7 V Se ,,t 1 4704 Oct 12 Actual 13 Sep 29 Nnud 20 188 13 Da s KU 14 Ailied [his part of your bill helps you undtand VOW e?ertnc use. Ib The mph stdie average number of K« 'fl Ym used each day. You used 188 J-1 KW14 ?n 13 days, or an avenge of 14 KW1.1 Types of Meter Readings: a day. 8 Actual 0 { Estimated Q ' Customer F7 J a 0 2006 zwnl ur arm The average daily lewpt3atrc for yo la-4 man %W% {1 7uit7 P It a- otber important information on back 3 Retum 1111. part to address below with a Cb©ck payable in PPL E1ftibic Lltilitia C"otlwtsti0n Yo?rrI3?1•;#c;?unt ?I? r•• 60970-73059 AT (11 056199 358386319 A"3DGT R0146AT 7 EMAV ROS 17% mAjN1til?zuwN RU ntLT 4ilT.uto r.a 17019-49764 14 522.90 =2. A,momi Enclosed E} C?. PPL FUCTUC7 tftTLrms 2 NORriq -,Tll STREET Rl'c- E3tN] ALLLNTC)WN PA !81111-1 P5 1 8400110022904 00©00229T]1 6097073051 "G# Corporair Circle, Snile 300 Lim&Un Commerce Park New Cambertand, PA 170-0 November 21, 2007 A MuWline Adjusihig Gimpany Goodville Mutual Casualty Cornpaity P. D. Box 489 New Holland, PA 17557-0459 AM: Donna Townsend, Claim Supervisor RE: Your Claim 137313 Insured Robert and Mary Edwards D/I.oss 9/29/07 Our Fite 70374 -1 -t-3004 F1?1 -1---•s-3246 -padjustf-rerilun.n et ROBERT C Ft1;1.FF D6va Phone -1- --4-A361 DoCm%S J. &IORRIS llirrct Phone `t`-"-4-6.565 This will serve as our progress report on the above-captioned water dainage loss. Tire insured has now submitted the electric bill for $22.90 which was incurred for running fans, dehumidifiers, and other equipment for the repairs to the dainaged property- There is also an ifavoice of $60.00 for a 15-amp fuse which was "stolen froln panel box". 77ie insured contends that the tenant removed the fuse. Do you want its to secure a supplemental Proof of Loss for subrogation purposes? We will await your advice. Submitted by, CAPITOL ADJUSTPRS, LTD. Douglas 1. Morris DJM:Zlr otiloJus* d sm,D c soum ci rRAt. 111NI NS LVAINLt 70374 SWORN STATEMENT IN PROOF OF LOSS AMT. OF POLICY AT TIME OF LOSS 9/15107 DATE ISSUED 9/15108 DATE EXPIRES To the Goodville Mulual Casualty Company of New Holland. PA. BC907191 POLICY NUMBER Dillsbura. PA AGENCY AT Communitv Banks Insurance AGENT At the time of loss, by the above indicated policy of insurance you insured Robert and M Edwards. LOSS: ' 4 Easj Green Street. Shiremanstown. PA. against loss by water to the property describe in Schedule "A", according to the terms and conditions of the said policy and all forms, endorsements, transters and assignments attached thereto. 1. Time and Origin: A water loss occurred about the hour of o'clock M ., on the 291" day of SepteMq@r 2007. The cause and origin of the said loss were: Water damage to the insured's rental property . 2. Occupancy: The building described, or containing the property described, was occupied at the time of the loss as follows, and for no other purpose whatever tenant occupied . 3. Title and Interest: At the time of the loss the interest of our insured in the property described therein,was Robert and Maly Edwards . No other person or persons had any interest therein or incumbrance thereon, except: 4. Changes: Since the said policy was issued there has been no assignment therof, or change of interejst, use, occupancy, possession, location or exposure of the property described, except: _. 5. Total Insurance: The total amount of insurance upon the property described by this policy was, at the time of the loss , as more particularly specified to the apportionment attached under Schedule "C," besides which there was no policy or other contract of insurance, written or oral, valid or invalid. 6. Electric Usage ........................ ....................................................................... S 7. Furnace Fuse .............. ...................................................................................S 8. Deductible ....................................................... •............................. ------........$a 9. The Amount Claimed under the above numbered policy is .......................... ............ S 22.90 60.00 The said loss did not originate by any act, design or procurement of the part of your insured. or this alfiant: nothing has been done by or with the privity or consent of your insured or this affiant, to violate the conditions of the policy, or render it void: no articles are mentioned herein or in annexed schedules but such as were destroyed or damaged at the time of said loss: no property saved has in any manner been concealed, and no attempt to deceive the said company, as to the extent of said loss, has in any manner been made. Any other information that may be required will be furnished and considered a part of this proof. The furnishing of this blank or the preparation of proofs by a representative of the above insurance company is not a waiver of any of its rights. State of ?p r't County of yo r K -moo Subscribed art swam to before me this Ll 6 day of -Dc i Per, 4 t,- 20o'? 1 ?. COMMONWEA TH Of PEN??S r•.Ypu eA Notary Public NOTAR V IL -91E _ JOHN J. RICHMOSON. JR.. Nuts, a utlltc Dillsburg Borough Y4ft, C;au»iy M Commission Eviles Oct 3. _.!:A, Insured claim # Loss Date Policy Number Insured Policy Period R 137313 DLT 9/29/07 SM 907191 37 DB Robert J Edwards 9/15/07 - 9/15/08 Claimant name: ROBERT EDWARDS Loss Description: Building ------------------------------------------------------------------------------------------ Payee Name: Robert J Edwards and Mary P Edwards Check Number: 4578$4 Address: Date Issued: 11/27/07 Check Amt: $ 82.90 Check notes: increased electric charges and stolen amp 'Claim # Loss Date Policy Number Insured Policy Period R 137313 DLT 9/29/07 SM 907191 37 DB Robert J Edwards 9/15/07 - 9/15/08 Claimant name: ROBERT EDWARDS Loss Description: Building ------------------------------------------------------------------------------------------ Payee. Name: Robert J Edwards and Mary P Edwards and Check Number: 456421 Address: Members 1st Federal Cr Un ATIMA Date Issued: 10/17/07 178 Franklintown Road Check Amt: $ 10,437.33 Dillsburg PA 17019 Check notes: $500.00 deductible building water loss of 9/29/07 SUBROGATION RECEIPT Kno% All Men By These Presents: That. In consideration of the sumo c'r1 Do-liars. {S ;I paid to the Undersigned by the i;aodvii7e Muluai Casually Company hefeinafterreferred to as Insurer, under Policy No BCSOT lsi . in full settlement of all claims and demands by reason of loss which occured on % tom 5/ ;/i.?r,l '? i;.aRemab;;;. Building. Slock Etc i ;Sf-?Y A the Undersigned hereby assign. set over. transfer and subrogate to the said Insurer. all the rights, claims. i nitefest, chases or things in action to the extent of the amount paid as aforesaid. which the Undersigned may have gamst any person, persons, or corporation. who may be liable, or hereafter adjudged liable for the loss or damage' aforesaid. and hereby authorized and do empower the said Insurer to sue. compromise, or settle in the nairnle of the Undersigned or otherwise. and the said Insurer is hereby fully substituted in the place of the Undersigned and subrogated to all rights in the premises to the amount so paid. The undersigned Warrants that no settlement has been made with the wrongdoer for the aforesaid loss or damage It is expressly stipulated that any action taken by the said Insurer shall be without charge or cost to the Undersigned Any person who knowingly and with intent to defraud any insurance company. or other person, files an applilcaUcin for insurance or statement of claim containing any matenally 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. Ill fitness VI' hereoF the hand//and/seal of the Undersigned is set hereunto this /Z day Of Witness L I V" ` W L S Signature Address Witness. Address Address. signature Address LS OF F«E?i C" L THE 1119SI:PII P, 2:19 C', ? - 7 ?, s? I?A C' -7 ,6,rd - & l P, l-e,- LkO 3 Ul ? Sheriff s Office of Cumberland County R Thomas Kline Sheriff Ronny R Anderson Chief Deputy Jody S Smith Civil Process Sergeant Edward L Schorpp Solicitor ?a`,?titr aC ? i ?r?brrfa?r? 4FFiC.E?.., ? ??ER1F1= OF Tu? 2 a^ cTP f o N. : `? C? r Goodville Mutual Casualty Company I Case Number vs. 2009-6183 Mohamed El Baumy SHERIFF'S RETURN OF SERVICE 09/15/2009 R. Thomas Kline, Sheriff, who being duly sworn according to law, states that he made a diligent search and inquiry for the within named defendant to wit: Mohamed El Baumy, but was unable to locate him in his bailiwick. He therefore returns the within Complaint and Notice as not found as to the defendant Mohamed El Baumy. The resident of 1111 Spring Road Carlisle, PA 17013 is the defendant's brother. The brother stated Mohamed El Baumy is currently in Egypt and would be returning in a few months. An exact address is not available. 1-1 SHERIFF COST: $38.84 September 15, 2009