HomeMy WebLinkAbout10-2569
OF THE P "c t .;: ;,N-nTARY
2010 APR 20 AM 10:: 8
C?iUP?? 44' 7w 1'v ?.+I ? I 1
PENNS 1 LV,t fA
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
CIVIL DIVISION
ATLANTIC STATES INSURANCE CASE NO. 10 -as(oq Gvt I Term
COMPANY, as Subrogee for
JAMES SUCIC and MARY SUCIC, CODE NO.
Plaintiff,
VS.
STEVEN R. SEIBERT, JR.
and STEVEN R. SEIBERT, SR.,
TYPE OF PLEADING:
COMPLAINT IN CIVIL ACTION
FILED ON BEHALF OF:
ATLANTIC STATES INSURANCE
Defendants. COMPANY, as Subrogee for
JAMES SUCIC and MARY SUCIC,
Plaintiff
COUNSEL OF RECORD FOR THIS
PARTY:
File 57779
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
O
4ga.oo BPD
CK.'? 'A33
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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
CIVIL DIVISION
ATLANTIC STATES INSURANCE COMPANY, Case No.
as Subrogee for
JAMES SUCIC and MARY SUCIC,
Plaintiff,
VS.
STEVEN R. SEIBERT, JR.
and STEVEN R. SEIBERT, SR.,
Defendants.
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 j udgment 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
ATLANTIC STATES INSURANCE COMPANY, CIVIL DIVISION
as Subrogee for
JAMES SUCIC and MARY SUCIC, Case No.
Plaintiff,
VS.
STEVEN R. SEIBERT, JR.
and STEVEN R. SEIBERT, SR.,
Defendants.
COMPLAINT IN CIVIL ACTION
AND NOW come(s) ATLANTIC STATES INSURANCE COMPANY, as
subrogee for JAMES SUCIC and MARY SUCIC, Plaintiff, by and through their attorney,
GEORGE A. MILLER, ESQ., and BROMBERG & MILLER, Attorneys at Law, and file(s) the
within COMPLAINT IN CIVIL ACTION as follows:
COUNTI
(NEGLIGENCE AGAINST DRIVER)
1. The Plaintiff is Atlantic States Insurance Company, a licensed insurance
company in a pooling arrangement with Donegal Mutual Insurance Co. whose offices are located
at 1195 River Road, Marietta, PA 17547.
2. Defendant Steven R. Seibert, Jr., is an adult individual whose current address
is 313 Ross Avenue, New Cumberland, Cumberland County, PA 17070.
3. Defendant Steven R. Seibert, Sr., is an adult individual who maintains a
business address at 313 Ross Avenue, New Cumberland, Cumberland County, PA 17070.
4. On or about April 23, 2009, Plaintiff's subrogor, James Sucic was driving his
motor vehicle on the Harvey Taylor Bridge in the City of Harrisburg, Pennsylvania, and was stopped
waiting for traffic to begin moving ahead when the motor vehicle being driven by Defendant Steven
R. Seibert, Jr. was being driven in a negligent manner causing it to strike the right rear portion of the
Plaintiff's subrogor's vehicle.
5. The negligence of Defendant Steven R. Seibert, Jr. consisted, inter alia, of
the following: following too closely; failure to have his vehicle under control; driving at a speed
greater than was reasonable and prudent; failure to have the vehicle in proper operating condition;
and failure to maintain a proper lookout.
6. As a direct and proximate result of the negligence of Defendant Steven R.
Seibert, Jr., Plaintiff's subrogor's motor vehicle sustained damages totaling One Thousand Six
Hundred Eighty-five Dollars and Sixty Cents ($1,685.60).
COUNT II
(NEGLIGENCE ENTRUSTMENT AGAINST OWNER)
7. Plaintiff incorporates by reference the allegations of paragraphs 1 through 6
of this Complaint as if set forth in their entirety.
8. The vehicle being operated by Defendant Steven R. Seibert, Jr. at the time that
he struck the Plaintiff's subrogor's vehicle, and caused the said damages, was registered to and
owned by Susquehanna Heating & Cooling.
9. Susquehanna Heating & Cooling is a company owned and operated by Steven
R. Seibert, Sr., father of Steven R. Seibert, Jr.
-2-
10. Prior to the date of the accident alleged above, the said motor vehicle was
under the control of Defendant Steven R. Seibert, Sr.
11. Prior to the date of the accident alleged above, Defendant Steven R. Seibert,
Jr. had been involved in several automobile accidents and had been charged with a number of motor
vehicle violations, including driving under the influence, and was otherwise an incompetent driver.
Further, the driving privileges of Defendant Steven R. Seibert, Jr. had been suspended as a
consequence of the driving under the influence conviction.
12. Defendant Steven R. Seibert, Sr. was aware of the previous accidents and
motor vehicle violations involving his son, Steven R. Seibert, Jr., and otherwise knew or should have
known that his son was an incompetent driver.
13. Defendant Steven R. Seibert, Sr. continued to permit Defendant Steven R.
Seibert, Jr. to use and operate the said motor vehicle despite the fact that he knew or should have
known that his son was an incompetent driver.
14. At the time of the accident that caused the damages alleged above, Defendant
Steven R. Seibert, Jr. was using the motor vehicle with the knowledge and consent of Defendant
Steven R. Seibert, Sr.
15. At the time of the accident that caused the damages alleged above, Defendant
Steven R. Seibert, Jr. was an employee of Defendant Steven R. Seibert, Sr. and a master-servant
relationship existed between the said driver and owner and Defendant Steven R. Seibert, Jr.; and
Steven R. Seibert, Jr. was engaged in the business of Defendant Steven R. Seibert, Sr. and was acting
within the scope of his employment at the time of the accident.
-3-
16. In the alternative, if Defendant Steven R. Seibert, Jr. operated the said vehicle
without authorization of his father, Defendant Steven R. Seibert, Sr. knew or should have known that
his son would take the motor vehicle without authorization and that his son would operate it in the
tortious manner as described above.
17. As a direct and proximate result of the negligence of Defendant Steven R.
Seibert, Sr., Plaintiff's subrogor's motor vehicle sustained damages totaling One Thousand Six
Hundred Eighty-five Dollars and Sixty Cents ($1,685.60).
COUNT III
(SUBROGATION
18. Plaintiff incorporates by reference the allegations of paragraphs 1 through 17
of this Complaint as if set forth in their entirety.
19. Plaintiff expended the sum of One Thousand Six Hundred Eighty-five Dollars
and Sixty Cents ($1,685.60), less its insured's deductible, pursuant to a contract of insurance with
its subrogors, and now seeks to recoup such expense, including said deductible, from the Defendants
by means of its right of subrogation.
20. A copy of the Police Accident Report is attached hereto and marked as
Plaintiff's Exhibit "A."
21. A copy of the Repair Estimate is attached hereto and marked as Plaintiffs
Exhibit "B."
22. Plaintiff intends to offer the attached Exhibits into evidence pursuant to
Pennsylvania Rules of Civil Procedure, Rule 1305. The repairs have been performed.
-4-
23. Plaintiff has demanded payment of its damages from both Defendants, which
demand has been refused.
WHEREFORE, the Plaintiffdemands judgment against both Defendants, jointly and
severally, in the sum of $1,685.60, together with costs of suit.
Respectfully submitted,
BROMBERG & MILLER
BY:
GEORGE A. MILLER, Esquire
Atlantic States Insurance Company, as Subrogee for
James Sucic and Mary Sucic, Plaintiff
-5-
The undersigned, ,?1'1-FAA IL does hereby verify that hehhe-
is t* url room-,.k,, a?_ of fah {,c 5 s s lc
Plaintiffherein, that he/she is authorized to make this verification on behalf of the Plaintiff, and that
the facts contained in the foregoing COMPLAINT IN CIVIL ACTION are true and correct to the
best of his/her knowledge and belief.
This statement is made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unworn
falsification to authorities.
DONEGAL MUTUAL INSURANCE CO.
By: ?
5"lYQSti ?ls,? ???r?,l TQ?C I ? t'r ?i-
Title
METRO THE HARRISBURG AREA POLICE INFORMATION RESOURCE SYSTEM (ICRIPINC)
PAGE: 1 45/06/09 TZT1 ED21
INC#: HBG 20090410461 DT,TM: 2009 04 23 0759 THU TO:
--- -------------------------------------------------------------
REPORT NO : 04 NR NON REPORTABLE ACCIDENT STATUS: A
-- ------ ----------------------------------------------------
LOC, GRID: FORSTER ST 00001 HBG PA 0206
REPORT OFF: 26 CHAD A SUNDAY 04/24/09 0817 PLAT: Y SECT: R
VEH INFO: INS,OUT: 0 LIGHT: G WEATHER: C TEMP: 45 F
ASSIGN OFF: 00/00/00 DUE:
APPROV OFF: 510 CLIFFORD A KARLSEN 00/00/00
CV HANDBK: PCCD V/W FORM: DON RELAT FORM: EXT SIGNED DOC:
SEC SURVEY: DEFERR PROSBCUT: DA REQ FOR HEAR: STMT / CONFESS:
ARREST(S): FURTHER ARRESTS: CRIM SUMMONS: WARRANT:
FOLLOW UP: N REC ASSIGN TO: NCIC GRIM HIST: N CITY PROP DAN: Z
UNIT NO: 01 WARNING: N CITATIONS:
75 3743 A ACCIDENTS INVOLVING DAlJWIC TO ATTENDED V8H OR
75 7122 3 POSS/SELL COUNTERFEIT TITLE/REG/INSUR/INSPECT
-'75 3736 A RECKLESS DRIVING
ON 4.23.09 AT 0759HU I WAS DISPTACHED TO A TRAFFIC COLLISION
IN THE EASTBOUND LAWS OF THE HARVEY TAYLOR BRIDGE. WHILE
ENROUTE INFORMATION WAS RECEIVED THAT THE STRIKING VEHICLE,
A WHITE CHEVROLET WORK VAN WITH RESIDUE ON THE SIDES FROM
R81MOVED STICKERS, LEFT THE SCENE AND WAS SOUTH ON FRONT ST.
UNITS BEGAN TO SEARCH FOR THE STRIKING VEHICLE.
CONTACT WAS MADE WITH THS OWNER OF UNIT 2 WHO CONTACTED THE
POLICE INITIALLY AND HE WAS ADVISED TO DRIVE HIS VEHICLE
INTO THE PARKING LOT AT THE WATER WORKS PLANT SOUTH OF
FORSTER ON FRONT ST. I THEN MET WITH THE OWNER OF UNIT 2 AND
3 AT THAT LOCATION. I WAS ADVISED BY BOTH PARTIES THAT THE
STRIKING VEHICLE, UNIT 1, WAS PARKED IN THE LOT. I THEN OBSERVED
UNIT 1 AND THE OPERATOR WHO APPROACHED ME. THE OPERATOR OF
UNIT 1 ADVISED THAT HE WAS EASTBOUND ON THE HARVEY TAYLOR
BRIGGE AND OBSERVED STOPPED UNITS 2 AND 3. HE ADVISED THAT %
HE ATTEMPTED TO STOP BUT DUE TO THE BRAKE PROBLEMS HE WAS
HAVING HE WAS UNABLE TO STOP IN TIME. THE OPERATOR ADVISED THAT
THE BRAKES WERE WORN AND HE WAS HAVING PROBLEMS
WITH THE BRAKE SELENOIDS. HE WOULD PDT BRAKE FLUID IN
THE RESEVIOR AND PUMP THE BRAKES IN ORDER FOR THEN!
TO OPERATOR BEFORE HE DROVE THE VEHICLE.
THE OPERATOR OF UNIT 2 ADVISED THAT HE WAS STOPPED IN THE
RIGHT LANE OF TRAVEL WHEN HE OBSERVED UNIT 1 COMING FAST BEHIND
HIM. HE WAS UNABLE TO GO ANYWHERE TO REMOVE HIMSELF FROM THE
SITUATION. HE ADVISED THAT UNIT 1 STRUCK HIM ON THE LEFT REAR
QUARTERPANEL AND LEFT REAR PASSENGER DOOR AND THEN CONTINUED
PAST HIM INTO UNIT 3.
THE OPERATOR OF UNIT 3 ADVISED THAT HE WAS STOPPED IN THE LEFT
LANE OF THE HARVEY TAYLOR BRIDGE AWAITING FOR TRAFFIC TO MOVE
WHEN HE WAS STRUCK IN THE RIGHT REAR OF HIS VEHICLE. HE ADVISED
THE OPERATOR OF UNIT 1 EXITED HIS VEHICLE AND UPON TALKING
WITH HIM THEY AGREED TO PULL OFF THE BRIDGE AND ONTO FRONT ST.
THE OPERATOR OF UNIT 3 FOLLOWED UNIT 1 TO THB LOCATION WHERE
I OBSERVED THEM. THE OPERATOR OF UNIT 2 WAS NEVER CONTACTED
BY UNIT 1 TO FACILITATE THE EXCHANGE OF REQUIRED INFORMATION.
I INSPECTED ALL VEHICLES FOR DAMAGE. UNIT 2 SUSTAINED DAMAGE
METRO THE HARRISBURG AREA POLICE INFORMATION RESOURCE SYSTEM (ICRIPINC)
PAGE: 2 05/06/09 TZT1 IM21
INC#: HBG 20090410461 DT,TM: 2009 04 23 0759
REPORT NO - 04 NR NON REPORTABLE ACCIDENT STATUS: A
--
---------------------------------------------
TO THE LEFT REAR QUATERPANEL OF THE VEHICLE. UNIT 3 SUSTAINED
DAMAGE TO THE RIGHT REAR CORNER OF THE VEHICLE. THE DAMAGE ON
UNIT 1 CONSISTED OF DAMAGE TO BOTH THE LEFT AND RIGHT FRONT
BUMPERS. THIS BEING CONSISTANT WITH UNIT 1 LEAVING ITS LANE OF
TRAVEL AND ATTEMPTING TO 00 INBBTWEEN STOPPED UNIT 2 AND 3
OCCUPYING THE RIGHT AND LEFT LANES OF TRAVEL.
UNIT 1 ALSO HAD WORN BRAKES WHICH HAD NO PAD LEFT AS WELL AS
LEAKING BRAKE CYLINDERS. UPON BACKING THE VEHICLE FROM ITS
PARKING SPACE TO HAVE IT TOWED IT WAS OBVIOUS THAT THERE WAS
LITTLE TO NO BRAKING ABILITY. THE INSPECTION STICKER ON THE
VEHICLE WAS A COUNTERFEIT TENS THE VEHICLE WAS NOT INSPECTED.
UNIT 1 WAS FOUND TO HAVE NO INSURANC COVERAGE AND THE OPERATOR
WAS UNDER SUSPENSION DUI RELATED.. H9 ONLY HAD A PA ID RECORD.
THE OPERATOR OF UNIT 1 IS BEING CHARGE WITH POSSESSING A
CONTBRFEIT INSPECTION STICKER, NO INSPECTION, NO INSURANCE,
DRIVING UNDER SUSPENSION, DRIVING WITHOUT A LICENSE, EQUIPMENT
VIOLATION-HAD BRADS, CARELESS DRIVING, RECKLESS DRIVING,
ROADWAYS LANED FOR TRAVEL, DRIVING UNDER SUSPENSION -DUI
RELATED, AND DRIVING WITHOUT A VALID LICENSE.
---- - ----- -------- -
STEVEN SEIBSRT JR RSA: IM 00
-- ---------------------------------
OPER CDs: DJ,CRT APPEAR:
DOB: 790911 SS#: RESIDENT STATUS: }LISP: CUBN:
ADDR: 313 ROSS AVE
NEW CUMBERLAND PA 17070 PHONE: 717 999 9999
EMPL : OCCCTP :
ADDR: 00000 WRK HRS:
PHONE: 717 000 0000
OLN: 24985238 PA WANT CHK:
COMM:
-- -----------------------------------------:---------
HEATING AND COOL SUSQUEHANNA VALLEY RSA• 00
----- ---------------:-----------------------
ONNR CDs: DJ, CRT APPEAR:
DOB: SS#: RESIDENT STATUS HISP• CUBN:
ADDR: 313 ROSS AVE
NEW CUMBERLAND PA 17070 PHONE: 717 999 9999
EMPL: SUSQUEHANNA VALLEY HEATING AND COOL OCCUP:
ADDR: ROSS AVE 00313 WRK HRS:
NEW CUMBERLAND PA 17070 PHONE: 717 999 9999
OLN: WANT CHK:
COMM:
}`?
METRO THE HARRISBURG AREA POLICE INFORMATION RESOURCE SYSTEM! (ICRIPINC)
PAGE: 3 05/06/09 TZTI HD21
INC#: HBG 20090410461 DT,TM: 2009 04 23 0759
KIRK ------- ---------
R MONTROSE
-- -- --------- --------------------
------- ------- -------------
RSA: WN 45
VICT OWNR OPER -- ---------
CDS: 4 ---------------------
DJ, CRT APPEAR: 2
DOB: 640416 SS#: RESIDENT STATUS: R HISP: N CUBN:
ADDR: 146 QUAIL DRIVE
DILLSBURG PA 17019 PHONE: 717 265 5607
EMPL : UNK OCCITP :
ADDR: 00000 WRK HRS:
PHONE: 717 982 5667
OLN: 20412740 PA WANT CHK:
VICTIM - CO-OP: Y TYP-INJ: N COND: MED AID:
TAKEN TO: NOTIFIED KIN: COR: DA:
COMM:
JAMES - - -------SUCIC -----------
G
- -------- ------
-- ------------------- --------RSA: WM 37 -
--
VICT OWNR OPER ------ ------
CDS: 4 --- ------------------
--- DJ,CRT APPEAR: 2
DOB: 710505 SS#: RESIDENT STATUS: R HISP: N CUBN:
ADDR: 2830 ROSEGARDEN BLVD
MECHANICSBURG PA 17055 PHONE: 717 796 1699
EMPL: UNK OCCUP•
ADDR: 00000
OLN: 22394861 PA WANT CHK:
VICTIM - CO-OP: Y TYP-INJ._N
TAKEN TO:
COW:
WRK HRS.-
PHONE: 717 787 9872
COND.- _MED AID:
NOTIFIED KIN: , COR: DA:
- - -
ITEM# U/CS# TYP ST DATE, TIME EVID MET/CLN DATE BY
STOL ST,DT-CHK,#TIMES
2 1 D 0 090424 0817 N N
VSH MAKE, MODEL: - -- ----------
2002 CHBV VAN -----------------
COL:WHI ---------------------
VALUE: $ .00
REGISTRATION NO: YSW5880 PA ODOMETER:
VIN NUMBER: IGCFG15W621124926 TOWED: N
OTHR CHAR, COND:
INSURANCE: 999999999999 NONE
INVENTORY TAKEN: N DAMAGED: DOORS LOCKED; KEYS IN CAR:
OWNER CARD: BATTERY: RADIO: TAPE PLAYER:
LIEN BAL: HOLDER:
FINES,WARR:
CHARGES:
COMMENT:
METRO THE HARRISBURG AREA POLICE INFORMATION RESOURCE SYSTEM (ICRIPINC)
PAGE: 4 05/06/09 TZT1 HD21
INC#: HSG 20090410461 DT,TM: 2009 04 23 0759
--- -----------------------------------------------
REPORT NO : 04 NR NON REPORTABLE ACCIDENT STATUS: A
- - -
ITEM# U/CS# TYP ST DATE, TIME EVID MET/CLNDATE BY STOLST,DT-CHK#TIMSS
3 2 D 0 090424 0817 N N
------------------------------------------------------------------------------
VEH MAKE, MODEL: 2008 NISS ALTIMA SDN COL:SIL VALUE: $ .00
REGISTRATION NO: ESC2157 PA ODOMETER:
VIN NUMBER: 1N4AL21E28N424575 TONED: N
OTHR CHAR, COND:
INSURANCE: A03090977400 BRIE INSURANCE
INVENTORY TAKEN: N DAMAGED; DOORS LOCKED: KEYS IN CAR;
OWNER CARD: BATTERY: RADIO: TAPE PLAYER:
LIEN BAL: HOLDER:
FINES,WARR;
CHARGES;
COMMENT :
----------------------------------------------------------------
ITEM# U/CS# TYP ST DATE, TIME EVID MET/CLN DATE BY STOL ST,DT-CHK,#TIMBS
4 3 D 0 090424 0817 N N
------------------------------------------------------------------------------
VEH MAKE, MODEL: 2008 HOND CIVIC COL:GRY VALUE: $ .00
REGISTRATION NO: DKS4309 PA ODOMETER:
VIN NUMBER: 2HOPA2697SH340094 TOWED: N
OTHR CHAR, COND:
INSURANCE: PAG3091037 ATLANTIC STATES INS
INVENTORY TAKEN: N DAMAGED: DOORS LOCKED: KEYS IN CAR:
OWNER CARD: BATTERY: RADIO: TAPE PLAYER:
LIEN SAL: HOLDER:
FINES,WARR:
CHARGES:
C014MENT :
DONEGAL INSURANCE GROUP
1195 RIVER ROAD P.O. BOX 302
MARIETTA, PA 17547-0302
(717) 426-1931 FAX: (717) 426-7023
"" ESTIMATE ""
........
Owner
04/24/2009 09:51 AM
Owner: JAMES & MARY SUCIC
Address: 2830 ROSEGARDEN BLVD WorWDay: (717)787-9872
City State Zip: MECHANICSBURG, PA 17055 Home/ AUX. (717)796-1699
Control Information
........... ..... ............................................................... ...................... ........................................................................ ..................... ...........................
:
Claims : PAG-PA-0149-0078717
Loan Date/Time: 04/23/2009 08:00 AM
Deductible: $500.00
File s :
Insured Policy s . PAG-3091037
Lou Type: Collision
Accountings : 0004512
Ins. Company: Donegal Insurance Group
Agent: Denise Shearer
Address:
Email: deniseshearer@donegalgroup.com
Insured: JAMES & MARY SUCIC
Address:
Claim Rep: Dense Shearer
Address:
Email: deniseshow"donegaigroup.com
Loss Payee: AMERICAN HONDA FINANCE
.................................................................................................................................................................................................................................
Inspection ..............................................................................................................................................................................................................
Inspection Date: 04/24/2009
Inspection Location: OWNERS WORK
Addresa: 2830 ROSEGARDEN BLVD
City State Zip: MECHANICSBURG, PA 17055
Primary Impact: Right Rear Comer
Driveable: Yes
Work/Day: (800)877-0600x7416
Work/Day: (717)787-9872
Home/Day: (717)796-1699
Work/Day: (800)877.0800x7416
Inspection Type: Field
Contact:
Work/Day, (717)787-9872
Home/Day: (717)796-1699
Secondary Impact:
Rental Assisted:
Assigned DateMme:
First Contact Date/Time:
Received Date/Time: 04124/2009 07:20 AM
Appointment Date/Time: 04/2712009 08:00 AM
Appraiser Name: JACK CHIARA Appraiser License s : 416512
Address: P.O. BOX 567 Work/Day: (717)737.5757
City State Zip: NEW CUMBERLAND, PA 17070 FAX: (717)737.7501
Re?alrer :.:... ..... .................................................................................... .,............................... .................................................................
--- - ------------------------
Repairer: DELL INGERS AUTO BODY Contact:
Address: 2410 SOUTH MARKET STREET Work/Day: (717)697.8059
City State Zip: MECHANICSBURG, PA 17055 FAX: (717)795-7755
License * : Regulation ID: 25.1641306
Target Complete Date/Time; Days To Repair: 4
Remarks ?....._.,....,,,..,.,,....,,...........:.............,..,.,.,,......,,w...,?,....,.,..,.,.....,.,,...,.,,,.„,.._,a.,,.-_.,...,.._...........,,............, .,.,...:...:..., :..,:::...:...... _....::.....,...-.....
..................................... .............................................................. .............................................. ................ .........................................................
:
ALL SUPPLEMENTAL DAMAGE MUST BE APPROVED BY THE APPRAISER
0412412009 10:01 AM
Pace 1 of 5
2008 Hale Civic EX•L 4 08 Sedan
Claim Y : PAn-PA-01-08.0078717 Ou24/?008 09:51 AM
Vehicle
2008 Honda Civic EX-L 4 DR Sedan
4cyl Gasoline 1.8 VTEC
5 Speed Automatic
LIc.Plste: DKS-4309
Lie Expire:
Prod Dote:
Veh lnspff :
Condition: Good
Ext. Color: GALAXY GREY
Ext. Refinish: Two-Stage
Ext. Paint Code: NH701M (L)
Llc State: PA
VII: 2HGFA16978 H340094
IliNlesge: 11,787
weep Type: Actual
Code: H0303E
Int. Color-
Int. Refinish:
Int. Trim Code:
Options
AM/FM CD Player Air Conditioning Alarm System
Aluminum/Alloy Wheels And-lock Brakes Bucket Seats
Center Console Cruise Control Duel Airbags
Floor Mats Head Airbags Heated Front Seats
Heated Power Mirrors IntermittentWipers Keyless Entry System
Leather Seats Leather Steering Wheel Lighted Entry System
MP3 Player Power Brakes Power Door Locks
Power Moonroof Power Steering Power Windows
Rear Window Defroster Rem Trunk-LJGme Release Side Airbags
Spit Folding Rear Seat Strg Wheel Radio Control Tachometer
Telescopic Steering Whl Theft Deterrent System TIR Steering Wheel
Tinted Glass
......................... ............................................................................. ..................................... .................... ......................................... ........ ................
,
Damages
......
. .......,.................w., k ........,w.... ,, _..... _....., .._._..,.._.,.._........... .
Line Op Gulde MC Description MFR.Psrt No. Price ADJ% 5% Hours R
I Ftt 316 Mldg,Root (kip FIT R & I Assembly 0.8 SM
2 I 390 Panel,0uarter RT Repair 4.5' SM
3 L 390 13 Panel,Ouarter RT Refinish 3.6 RF
2.5 Surface
0.6 Two-stage setup
0.5 Two-stage
>> BLEND WITHIN PANEL
4 1 454 Gutter,Deck Lid FIT Repair 1.0' SM
5 L 454 Gutter,Deck Lid RT Refinish 0.2 RF
0.2 Surtace
6 RI 278 Guard,Mud LT R & I Assembly INC SM
7 RI 279 Guard,Mud FIT R & I Assembly INC SM
8 RI 464 Duct,Ouaner Louver FIT R & I Assembly 1.1 SM
9 E 534 Taillamp Assembly,Otr FIT 335015NAA02 $134.45 0.3 SM
10 N 566 Rear Bumper Cover R&I Additional Labor INC SM
11 E 566 Cover, Rear Bumper 04716SNAA90ZZ $282.68 0.2 SM
12 L 566 Cover, Rear Bumper Refinish 3.1 RF
2.6 Surface
0.5 Two-stage
13 E 475 Brace, Rear Bumper FIT 715936NAA02 $4.18 INC SM
14 1 SET UP AND MEASURE Repair 2.0' SM
15 EC CAR COVER Replace Economy $5.00' SM
16 EC FLEX Replace Economy $8.00' SM
17 EC CORROSION PROTECTION Replace Economy $8.00' SM
18 SB HAZARDOUS WASTE Sublet Repair $3.00' SM
19 EC CAULK/SEAM SEALER Replace Economy $10.00' SM
20 1 COLLISION PULL Repair 2.0' FR'
20 items
MC Message
13 INCLUDES 0.6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE
................................................................................................................................................................................................................................
Estimate Total & Entries E
04/24/200810:01 AM Pape 2 of 5
2008 Fonda 00C EX-L 4 DR $Wan 0/12M2009 09:51 AM
Clahna FAG-PA-01-09-00787 1 7
Gross Parts $421.31
Other Parts $31.00
Paint Materials $158.70
Parts a Material Total $611.01
Tax on Parts 6 Material @ 6.000% $36.66
Labor Rata Replace Mrs Repair Mrs Total Mrs
Shest Metal ISM) $44.00 2.4 7.5 9.9 $435.60
Mech/Elec (ME) $60.00
Frame (FR) $46.00 2.0 2.0 $92.00
Refinish (RF) $44.00 6.9 6.9 $303.60
Paint Materials $23.00
Labor Total 18.8 Hours $831.20
Tax on Labor @ 6.000% $49.87
Sublet Repelrs $3.00
Gross Total $1,531.74
Less: Deductible $500,00.
Net Total $1,031.73
Aliemate Parts C/00/00/00/00/00 CUM 00W00/=00 Tip Code: 17111 HARRISBURG
Audstex Estimating 6.0.025 ES 04/241x00910:01 AM REL 6.0.025 DT 04/01/2009 DB 04115/2009
Copyright (C) 2008 Audatex North America, Inc.
1.6 MRS WERE ADDED TO THIS ESTIMATE BASED ON AUDATEX'$ TWO-STAGE REFINISH FORMULA.
ABBREVIATION LEGEND:
LKQ = LIKE KIND IN QUALITY, A/M = AFTERMARKET, RECOND = RECONDITION, O/H=
OVERHAUL, REPL = REPLACE, RPR - REPAIR, REFN = REFINISH, SECT = SECTION,
R & I = REMOVE AND INSTALL, ALGN = ALIGN, SUBL = SUBLET, BLND = BLEND, ASSY=
ASSEMBLY, FRNT/FRT = FRONT, HL/H/LAMP = HEADLAMP, INR = INNER, L = LEFT,
MLD/MLDG = MOLDING, MTG = MOUNTING, QTR = OUTER, PNLS = PANELS, R/RT = RIGHT,
REPL = REPLACEMENT, SUSP = SUSPENSION, W/O MLD = WHEEL OPENING MOLDING, RIC =
REMOTE CONTROL, BRKT = BRACKET, LIC = LICENSE, R/F = RIGHT FRONT, R/R = RIGHT
REAR, L/F = LEFT FRONT, L/R = LEFT REAR, PNL = PANEL, FT = FRONT, PXN =
PARTS EXCHANGE NEW, OEM = ORIGINAL EQUIPMENT MANUFACTURER, PRT = PART, NAGS =
NATIONAL ASSOCIATION OF GLASS SUPPLIER, REMAN = REMANUFACTURED, PART = PARTIAL
ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR
OTHER PERSON FILES AN APPLICATION FOR INSURANCE OR 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.
WE WILL NOT BE RESPONSIBLE FOR ANY RELATED TOWING SERVICES OR STORAGE CHARGES,
KNOWN AT THE TIME OF THE APPRAISAL, AND INCURRED AFTER THE FOLLOWING
DATE: .......... CHARGES INCURRED AFTER THIS DATE WILL BE THE RESPONSIBILITY
OF THE CONSUMER.
0412412009 10:01 AM - -
Page 3 d 5
2?7
DRAWN ON AbDONEGAL 0 ATLANTIC COMPANY MARKED ® MAID E POMP VA
STATES INS. CO. ?Mwert?, Pawsnv?uu
P..1 DONEGAL MUTUAL INS. CO. CHECK t'
INSURANCE GROUP Q SOUTHERN INS. CO. OF VIRGINIA NO. 41872 ao 313
r A1v9 amit Row. P.O.80R SO!• i kf=A, PA V6474m-a -
? OF LOSS
Poucr too. O ir JR.r `2 ? /
?.. DATE MUr:o S •?
IN PAYMENT OF 1r ` I ,? c ra t-I.Ma?t ?° i ?.S T? A,,,,.c + t,
13ECAUSE OF INJURY TO PERSON OR PAOPERiY 4
AMOUNT I C. 12 t er, 1. 1 t; - y f
PAY e., P y..,, . t -^.t A I "bL 1.
TO ?.7 /'^1"1)
opm
OR
NflN-N, *TIABLE
PRESHIm "TV" a 1dmms Fmm MUE DAW
0510112009 08:49 AM 416AF 2412
DONEGAL INSURANCE GROUP
1195 RIVER ROAD P.O. BOX 302
MARIETTA, PA 17547-0302
(717) 426-1931 FAX: (717) 426-7023
-SUPPLEMENT 1 "•
04/24/2009 09:51 AM
.. ..............................................................................................................................................................................................................................,
Owner
Owner- JAMES & MARY SUCIC
Address: 2830 ROSEGARDEN BLVD Work/Day: (717)787.9872
City State Zip. MECHANICSBURG, PA 17055 Hane/FAAXX. (717)796-1699
:.:,,.:......... r,,,a.,,...,, _..,.:.,,......,..:.._......,,,:.:. .._. ......... ..---- _.._..._........ .......... ....._........._...-........._.............,_._:.,._..... .«.,
Control Information
.. .............. .............................. ... ........ .... ........... .......................... .................................................. ... ......................................................................... i
Claim #: PAG-PA-01-09-0078717
Loss Oats/lime: 04/2312009 08:00 AM
Deductible: $500.00
File # :
Insured Policy # : PAG-3091037
Lose Type: Collision
Accounting # : 0004512
Ins. Company: Donegal Insurance Group
Agent: Dense Shearer
Address:
Email: deniseshearer@donegalgroup.com
Work/Day: (800)877.0600x7416
Insured: JAMES & MARY SUCIC
Address: Work/Day: (717)787.9872
Home/Day: (717)798.1699
Claim Rep: Denise Shearer
Address: Work/Day: (800)877-0600x7416
Email: deniseshearen0donegaigroup.com
Loss Payee: AMERICAN HONDA FINANCE
.........................................................................................................................................
: inspection ..............................................................................................................................................................................................................
Inspection Date: 04/24/2009
Inspection Location: OWNERS WORK
Address: 2830 ROSEGARDEN BLVD
City State Zip: MECHANICSBURG, PA 17055
Primary Impact: Right Rear Comer
Driveable: Yes
Inspection Type: Field
Contact:
Work/Day: (717)787.9872
Home/Day: (717)796.1699
Secondary Impact:
Rental Aselateti:
Assigned Date/Tlme:
First Contact DateMme:
Company: DONEGAL MUTUAL INSURANCE CO
Contact: JACK CHIARA
Address: P.O. BOX 567
City State Zip: NEW CUMBERLAND, PA 17070
Orlg Appraiser Name- JACK CHIARA
Address: P.O. BOX 567
City State Zip: NEW CUMBERLAND, PA 17070
................
.
Repairer
Received Dst*Mme: 04/24/2009 07:20 AM
Appointment DatelTlme: 04127/2009 08:00 AM
Appraiser License # : 416512
Work/Dsy: (717)737-5757
FAX: (717)737.7501
Appraiser License # : 416512
Work/Day: (717)737-5757
FAX: (717)737-7501
Repairer: DELLINGER AUTO BODY Connect:
Address: 2410 SOUTH MARKET STREET Work/Day: (717)697.8059
City State Zip: MECHANICSBURG, PA 17055 FAX: (717)795-7755
License # : Regulation ID: 25-1641306
Target Complete Date/Time: Days To Repair: 4
0& OW2009 03:46 PM Pape 1 of 5
2008 Honda Civic EX-L 4 DR Sedan 0412441 M9 09;51 AM
Claim X PAO-PA-01-09.0078717
Remarks
ALL SUPPLEMENTAL DAMAGE MUST BE APPROVED BY THE APPRAISER
_....._ _, ,...._.- _._...._.
_..._.:..,
Vehicle
.............................. .................... ....... ..................................................................................... .................................................................................
.:
2008 Honda Civic EX-L 4 OR Sedan
4cyl Gasoline 1.8 VTEC
5 Speed Automatic
LIc.Plate: DKS-4309
LIC Expire:
Prod Date:
Veh InW :
Condition: Good
Ext. Color: GALAXY GREY
Ext. Refinish: Two-Stage
Ext. Paint Code: NH701 M (L)
Lic State: PA
VIN: 2HGFA16978 H340094
Mileage: 11,787
Mileage Type: Actual
Code: H0303E
Int. Color:
Int. Refinish:
Int. Trim Code:
Options
AM/FM CD Player Air Conditioning Alarm System
Aluminum/Al oy Wheels Antl-look Brakes Bucket Seats
Center Console Cruise Control Dual Airbags
Floor Mats Head Airbags Heated Front Seats
Heated Power Mirrors Intermittent Wipers Keyless Entry System
Leather Seats Leather Steering Wheel Lighted Entry System
MP3 Player Power Brakes Power Door Locks
Power Moonroof Power Steering Power Windows
Rear Window Defroster Rem Trunk-UG09 Release Side Arbags
Split Folding Rear Seat Sirg Wheel Radio Control Tachometer
Telescopic Steering WhI Theft Deterrent System Tilt Steering Wheel
Tinted Glass
Dam?pes
Line Op Guide MC Description MFR.Part No. Price ADJ% 8% Hours R
I RI 316 MIdg,Root Drip FIT R & I Assembly 0.8 SM
2 1 390 Panel,Quarter FIT Repair S1 6.5' SM
3 L 390 13 Panel,Quarter FIT Refinish 3.6 RF
2.5 Surface
0.6 Two-stage setup
0.5 Two-stage
>> BLEND WITHIN PANEL
4 1 454 Gufter,Deck Lid FIT Repair 1.0' SM
5 L 454 Gulter,Deck Lid FIT Refinish 0.2 RF
0.2 Surface
6 RI 278 Guard,Mud LT R & I Assembly INC SM
7 RI 279 Guard,Mud RT R & I Assembly INC SM
8 E 464 Duct,Quarter Louver FIT 75450SNAA01 $2.67 S1 1.1 SM
9 RI 484 Duct,Ouaner Louver FIT R & I Assembly Si INC SM
10 1 Reseal Trunk Seam Repair S1 0.5' SM'
11 L Reseal Trunk Seam Refinish S1 0.5' RF'
>>SPOT REFIN
12 E 534 TaillampAssembly,OtrRT 33501SNAA02 $134.45 0.3 SM
13 N 566 Rear Bumper Cover R&I Additional Labor INC SM
14 E 566 Cover,Rear Bumper 04715SNAA90ZZ $282.68 0.2 SM
15 L 566 Cover,Rear Bumper Refinish 3.1 RF
2.6 Surface
0.5 Two-stage
16 E 475 Brace,Rear Bumper FIT 71593$NAA02 $4.18 INC SM
17 1 SET UP AND MEASURE Repair 2.0' SM
18 EC CAR COVER Replace Economy $5.00, SM
19 EC FLEX Replace Economy $8,00` SM
20 EC CORROSION PROTECTION Replace Economy $8.00, SM
21 SB HAZARDOUS WASTE Sublet Repair $3.00' SM
22 EC CAULK/SEAM SEALER Replace Economy $10.00' SM
05/ i 9 2009 03:45 PM Page 2 0l 5
2008 Htx Civic EX-L 4 OR Sedan 004=W 09:51 AM
GaimV: PAG-PA-01-09-0078717
23 1 COLLISION PULL Repair 2.0' FR'
23 Items
MC Me$$@"
13 !NCLUDES 0.6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE
............. .._...... _.._.,. :,:._...: _:......, ............................. .... .....
....,...,........ _.,... , .,
Estimate Total & Entries
.................................. ............. ............. ........ .... ...................... -....... .......... ........... .................. .................................. ............................... ,............. i
Gross Parts $423.98
Other Paris $31.00
Point Materials $170.20
Parts & Material Total
Tax on Parts S Material
Labor Rate Replace Mrs Repair Mrs Total Mrs
Sheet Metal (SM) $44.00 2.4 10.0 12.4 $545.60
MechlElec (ME) $60.00
Frame (FR) $46.00 2.0 2.0 $92.00
Refinish (RF) $44.00 7.4 7.4 $325.60
Paint Materials $23.00
Labor Total 21.8 Hours
Tax on Labor @ 8.000%
Sublet Repairs
Gross Total
Laos: Deductible
Net Total
Actual Supplement Total $154.94
Lou: Previous Net Total
Net Supplement Total
Altemate Parts C100100/00100/00 CUM 000/00/00/00 Zip Code: 17111 HARRISBURG
Audatex Estimating 6.0.025 S1 CSMW/2009 03:46 PM REL 6.0.025 DT 04101/4009 DO 06M6/2009
Copyright (C) 2006 Audatex North America, inc.
$625.18
$37.51
$963.20
$57.79
$3.00
$1,696.68
$.00-
$1,186.68
$1,031.74-
$15494
1.6 MRS WERE ADDED TO THIS ESTIMATE BASED ON AUDATErS TWO-STAGE REFINISH FORMULA.
ABBREVIATION LEGEND:
LKQ = LIKE KIND IN QUALITY, A/M = AFTERMARKET, RECOND = RECONDITION, 0/H=
OVERHAUL, REPL = REPLACE, RPR - REPAIR, REFN - REFINISH, SECT = SECTION,
R & I = REMOVE AND INSTALL, ALGN = ALIGN, SUBL = SUBLET, BLND = BLEND, ASSY=
ASSEMBLY, FRNT/FRT = FRONT, HL/H/LAMP = HEADLAMP, INR = INNER, L = LEFT,
MLD/MLDG = MOLDING, MTG = MOUNTING, OTR = OUTER, PNLS = PANELS, R/RT = RIGHT,
REPL = REPLACEMENT, SUSP = SUSPENSION, W/O MLD = WHEEL OPENING MOLDING, RIC =
REMOTE CONTROL, BRKT = BRACKET, LIC = LICENSE, R/F = RIGHT FRONT, R/R = RIGHT
REAR, L/F = LEFT FRONT, L/R = LEFT REAR, PNL = PANEL, FT = FRONT, PXN =
PARTS EXCHANGE NEW, OEM = ORIGINAL EQUIPMENT MANUFACTURER, PRT = PART, NAGS =
NATIONAL ASSOCIATION OF GLASS SUPPLIER, REMAN = REMANUFACTURED, PART = PARTIAL
ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR
OTHER PERSON FILES AN APPLICATION FOR INSURANCE OR STATEMENT OF CLAIM
CONTAINING ANY MATERIALLY FALSE INFORMATION OR CONCEALS FOR THE PURPOSE OF
05/19/2009 03;48 PM Pape 3 o15
GJLC.14?.r/
Si'
lG`f{t")c
`lam, i 2
DRAWN ON COMPANY MARKED ® BUSOtlENANNA BARK
?O?L/?/ ? V? ? ATLANTIC STATES INS. CO. MARETTA, PENlt6'ltvANIA
If DONEGAL MUTUAL INS. CO. CHECK C2cc V 61413"
NSURMaGPJ)UPp ? SOUTHERN INS. CO. OF VIRGINIA NO. ?1?S 313
'n95 Rr= ROAD- P.O. BOX 302• MA)Wr.. CPA;PA V5474= 0-
DATE
Poucr ND. ?i'4• ?j C7 { 1 J 37 R AA ?{ 12 ` J f DATE ISSUED J•• ?d 41 ???
IN PAYMENT i' P l +. h c I
-Q -4 -.7J s
_ BECAUSE OF INJURY TO PERSON OR PROPERTY ON OR ABOUT THE ABOVE LOSS OR ACCIDENT
AMOUNT G tiCrR, l,1?' ?. rt I I t J.7G. lpOL1ARS s? -t
PAY ?"?"l`? V G?:?• E?4+ W
ORDER VOD IF NOT NRD) Vq 1", 6 w1l"" "" MUG DATE
Op r ? ? t .at ?wS. L- ?3,
0512712009 03:05 PM E5C85_14035
M I
FLED-OF
!?F T r ?^ -,!WTARY
i0 AUG 24 AM 10= 32
v"
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
CIVIL DIVISION
ATLANTIC STATES INSURANCE
COMPANY, as Subrogee for
JAMES SUCIC and MARY SUCIC,
CASE NO. 2010-2569
CODE NO.
Plaintiff,
vs.
STEVEN R. SEIBERT, JR.
and STEVEN R. SEIBERT, SR.,
TYPE OF PLEADING:
PRAECIPE TO REINSTATE
COMPLAINT
FILED ON BEHALF OF:
Defendants. ATLANTIC STATES INSURANCE
COMPANY, as Subrogee for
JAMES SUCIC and MARY SUCIC,
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
s
*10. oo P fU ATTJ
a-9 4a37
Ot ay7aaq
File No. 57779 (412) 232-0440
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
CIVIL DIVISION
ATLANTIC STATES INSURANCE COMPANY, Case No. 2010-2569
as Subrogee for
JAMES SUCIC and MARY SUCIC,
Plaintiff,
VS.
STEVEN R. SEIBERT, JR.
and STEVEN R. SEIBERT, SR.,
Defendants.
PRAECIPE TO REINSTATE COMPLAINT
TO: PROTHONOTARY:
Kindly reinstate the Complaint in Civil Action in the above-captioned matter.
Respectfully submitted,
BROMBERG & MILLER
BY: --??',--r
GEORGE A. MILLER, Esquire
Attorney for Plaintiff
SHERIFF'S OFFICE OF CUMBERLAND COUNTY
Ronny RAnderson
Sheriff
a7 n
1?1IItryC, G!? 6T{14N
Jody S Smith
Chief Deputy f .:'. I a 'I:
t
Richard W Stewart
???L 1 f t
Solicitor OFF1t;E ? FTHE
Atlantic States Insurance Company Case Number
vs. 2010-2569
Steven Richard Seibert, Jr (et al.)
SHERIFF'S RETURN OF SERVICE
08/25/2010 Ronny R. Anderson, Sheriff who being duly sworn according to law states that he made a diligent search
and inquiry for the within named defendant, to wit: Steven R. Seibert Jr., but was unable to locate him in
his bailiwick. He therefore deputized the Sheriff of York County, PA to serve the within Complaint and
Notice according to law.
08/25/2010 Ronny R. Anderson, Sheriff who being duly sworn according to law states that he made a diligent search
and inquiry for the within named defendant, to wit: Steven R. Seibert Sr., but was unable to locate him in
his bailiwick. He therefore deputized the Sheriff of York County, PA to serve the within Complaint and
Notice according to law.
10/04/2010 York County Return: And now, October 4, 2010 I, Richard P. Keuerleber, Sheriff of York County,
Pennsylvania, do hereby certify and return, that I made diligent search and inquiry for Steven R. Seibert
Sr. the defendant named in the within Complaint and Notice and that I am unable to find him in the County
of York and therefore return same NOT FOUND. Deputies were advised, Steven R. Seibert Sr. is
currently residing at 916 Green Street, Apartment 3, Harrisburg, PA 17102.
10/08/2010 06:14 PM - York County Return: And now September 16, 2010 at 1814 hours I, Richard P. Keuerleber,
Sheriff of York County, Pennsylvania, do herby certify and return that I served a true copy of the within
Complaint and Notice, upon the within named defendant, to wit: Steven Richard Seibert Jr. by making
known unto himself personally, at 313 Ross Avenue, Post Office Box 496, New Cumberland, PA 17070 its
contents and at the same time handing to him personally the said true and correct copy of the same.
SHERIFF COST: $53.00
October 08, 2010
SO ANSWERS,/
RON R ANDERSON, SHERIFF
{ci CountyS'Ae Shentf. Ie!eosoft Inc.
SHERIFF'S OFFICE OF YORK COUNTY
Richard P Keuerleber PETER J. MANGAN, ESQ.
Sheriff Solicitor
Reuben B Zeager Richard E Rice, II
Chief Deputy, Operations Chief Deputy, Administration
ATLANTIC STATES INSURANCE COMPANY Case Number
vs. 10-2569 CIVIL
STEVEN R. SEIBERT, JR. (et al.)
SHERIFF'S RETURN OF SERVICE
09/16/2010 06:14 PM - DEPUTY BENJAMIN GROVE, BEING DULY SWORN ACCORDING TO LAW, SERVED THE
REQUESTED COMPLAINT IN CIVIL ACTION (CICA) BY "PERSONALLY" HANDING A TRUE COPY TO
A PERSON REPRESENTING THEMSELVES TO BE THE DEFENDANT, TO WIT: STEVEN R.
SEIBERT, JR. AT 313 ROSS AVENUE, POST OFFICE BOX 496, NEW CUMBERLAND, PA 17070.
BENJA IN G OVE, DEPUTY
10/04/2010 [,RICHARD P KEUERLEBER, SHERIFF, WHO BEING DULY SWORN ACCORDING TO LAW, STATES
HE MADE DILIGENT SEARCH AND INQUIRY FOR THE WITHIN NAMED DEFENDANT TO WIT:
STEVEN R. SEIBERT, SR., BUT WAS UNABLE TO LOCATE THE DEFENDANT IN HIS BAILIWICK.
THE SHERIFF THEREFORE RETURNS THE WITHIN REQUESTED COMPLAINT IN CIVIL ACTION
(CICA) AS "NOT FOUND" AT 313 ROSS AVENUE, NEW CUMBERLAND, PA 17070.
NEW ADDRESS IS 916 GREEN STREET, APT 3. HARRISBURG, PA 17102.
SHERIFF COST: $97.50 SO ERS,
October 04, 2010 RICHARD P ERLEBER, SHERIFF
NOTARY
Affirmed and subscribed to before me this
4th OCTOBER 2010>'r?u
day of -,-----
NOTARIAL SEAL
. THORPE, NOTARY PUBLIC
LISA L ure > i
CITY OF YORK, YORK COUNTY 12 2
113
,--
Rrv ? „ ?? `cy :Fr ?Al:?
v
IN THE COURT OF COMMON PLEAS OF
DAUPHIN COUNTY, PENNSYLVANIA
CIVIL DIVISION
ATLANTIC STATES INSURANCE COMPANY
A/S/O JAMES SUCIC AND
MARY SUCIC
Plaintiff, CIVIL DIVISION
VS.
STEVEN SEIBERT, JR.
STEVEN SEIBERT, SR.,
Defendant.
No.: 10-2569
Fled.- O-K,c-
quo NO V 6) ?W I I _s
Cu.rnj?,,tAnj
10
PRAECIPE TO ENTER DEFAULT JUDGMENT
TO: PROTHONOTARY, COURT OF COMMON PLEAS OF DAUPHIN COUNTY
KINDLY ENTER DEFAULT JUDGMENT AGAINST STEVEN SEIBERT, JR.,
ONLY IN THE ABOVE CASE , in the amount of ONE THOUSAND SIX
HUNDRED EIGHTY SIX AND 60/100 DOLLARS ($1686.60) plus costs and
interest from the date of entry, the Defendant (s) having failed
to file an Answer to the Complaint.
More than ten (10) days have elapsed since serving the
Defendant(s) with a copy of the "IMPORTANT NOTICE", a copy of
said Notice with the PROOF OF SERVICE being attached hereto as
EXHIBIT "A".
GEO GE A. MILLER, Esq.
A orney for Plaintiff
1 30 FIFTH AVENUE, STE. 102
PITTSBURGH, PA 15219
(412) 232-0440
?41b0 Q
GO `C*\ 0
61 vv e ?a
IN THE COURT OF COMMON PLEAS OF
DAUPHIN COUNTY PENNSYLVANIA
CIVIL DIVISION
ATLANTIC STATES INSURANCE COMPANY
A/S/O JAMES SUCIC AND
MARY SUCIC
Plaintiff, CIVIL, DIVISION
VS.
STEVEN SEIBERT, JR.
STEVEN SEIBERT, SR.,
Defendants. No.: 10-2569
TO: STEVEN SEIBERT, JR.
313 Ross Avenue
New Cumberland, PA 17070
Date of Notice: October 12, 2010.
IMPORTANT NOTICE
YOU ARE IN DEFAULT BECAUSE YOU HAVE FAILED TO ENTER A WRITTEN
APPEARANCE PERSONALLY OR BY ATTORNEY 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 JUDGMENT MAY BE ENTERED AGAINST YOU WITHOUT A HEARING AND YOU
MAY LOSE YOUR PROPERTY OR OTHER IMPORTANT RIGHTS.
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.
LAWYER REFERRAL SERVICE
CUMBERLAND COUNTY BAR ASSOCIATION
32 S. BEDFORD STREET
CARLISLE, PA 17013
Telephone: (717) 249-31660-990-9108
File 57779
orge A. Miller, sq.
ttorney for Plaintiff
1030 Fifth Avenue, Ste. 102
Pittsburgh, PA 15219
(412) 232-0440
PROOF OF SERVICE
THE UNDERSIGNED, George A. Miller, Attorney for Plaintiff
herein, does hereby verify that the IMPORTANT NOTICE, a copy of
which is attached hereto, was mailed to the Defendant(s) herein
on October 12, 2010, by U.S. Mail, First Class, Postage Paid.
This statement is made subject to the penalties of 18
Pa.C.S., Section 4904, relating to unsworn falsifications to
authorities.
-2-
. .
(7>
-;
rri
Z73 t=
ca
!-- ...
:y c -ri
C.J 7r
cn
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
CIVIL DIVISION
ATLANTIC STATES INSURANCE
COMPANY, as Subrogee for
JAMES SUCIC and MARY SUCIC,
Plaintiff,
VS.
STEVEN R. SEIBERT, JR.
and STEVEN R. SEIBERT, SR.,
Defendants.
Ou4s.o'o .a?Jy
CYO y?3y
File No. 57779
CASE NO.: m - o 6ul
CODE NO.
TYPE OF PLEADING:
AFFIDAVIT IN SUPPORT OF
CERTIFICATION OF MOTOR
VEHICLE JUDGMENT
FILED ON BEHALF OF:
ATLANTIC STATES INSURANCE
COMPANY, as Subrogee for
JAMES SUCIC and MARY SUCIC,
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
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
CIVIL DIVISION
ATLANTIC STATES INSURANCE COMPANY, Case No. 2010-2569
as Subrogee for
JAMES SUCIC and MARY SUCIC,
Plaintiff,
VS.
STEVEN R. SEIBERT, JR.
and STEVEN R. SEIBERT, SR.,
Defendants.
AFFIDAVIT IN SUPPORT OF CERTIFICATION OF MOTOR VEHICLE JUDGMENT
COMMONWEALTH OF PENNSYLVANIA,
COUNTY OF ALLEGHENY,
SS:
I, GEORGE A. MILLER, ESQUIRE, being duly sworn according to law, depose and
state:
1. I am an attorney in good standing, admitted to practice in the courts of this
Commonwealth, and am counsel of record for the Plaintiff-judgment creditor, Atlantic States
Insurance Company, in the above-captioned matter.
2. I am authorized to make this Affidavit on behalf of the Plaintiff.
3. The address of the Plaintiff is 1195 River Road, Marietta, PA 17547.
4. The last-known address of the Defendant, 313 Ross Avenue, New
Cumberland, PA 17070.
5. The judgment reflected at Docket No. 2569 of 2010 of the Court of Common
Pleas of Cumberland County, PA is in the amount of $1,686.60, is valid, enforceable and unsatisfied,
and is the result of a motor vehicle accident upon which suspension of driver's operating privileges
is authorized.
GEORGE A. MILLER, ESQUIRE
SWORN TO and subscribed
before me this Z ?tZ- day
of M6\I .2011.
Public
Mcom _ TH F P N YANL1
No?Asl ? Publk
ps T. P&PWik0, Notary
OLy or h 1u"ne 14, 20 4
etltlfl tr Hwarks