HomeMy WebLinkAbout11-3569FARLES\Clients\3050 Donegal\Current\641\3050.641.Complaint'\tde
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C o
George B. Faller, Jr., Esquire i W ? =-M
MARTSON DEARDORFF WILLIAMS OTTO GILROY & FALLER ?? ?r-
MARTSON LAW OFFICES -<>
Attorney I.D. No. 49813
10 East High Street Fi
Carlisle, PA 17013 -- CDrT1
(717) 243-3341 ; ?:o
Attorneys for Plaintiff
ATLANTIC STATES INSURANCE IN THE COURT OF COMMON PLEAS OF
COMPANY, as Subrogee of CUMBERLAND COUNTY, PENNSYLVANIA
THERESA E. BOOTHE,
3 s(o y
Plaintiff NO.
CIVIL ACTION-LAW
V.
BRIAN J. GUILLEN,
Defendant JURY TRIAL OF TWELVE DEMANDED
NOTICE
You have been sued in court. If you wish to defend against the claims set forth in the
following pages, you must take action within twenty (20) days after this Complaint and Notice are
served, by entering a written appearance personally or by attorney and filing in writing with the court
your defenses or objections to the claims set forth against you. You are warned that if you fail to do
so, the case may proceed without you and a judgment may be entered against you by the court
without further notice for any money claimed in the Complaint or for any other claim or relief
requested by the Plaintiffs. You may lose money or property or other rights important to you.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT
HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS
OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER.
IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO
PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL
SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE:
Lawyer Referral Service of
The York County Bar Association
York County Bar Center
137 East Market Street
York, Pennsylvania 17401
Telephone: (717) 854-8755
.z, 06 fxA
pi-
???sa
George B. Faller, Jr., Esquire
MARTSON DEARDORFF WILLIAMS OTTO GILROY & FALLER
MARTSON LAW OFFICES
Attorney I.D. No. 49813
10 East High Street
Carlisle, PA 17013
(717) 243-3341
Attorneys for Plaintiff
ATLANTIC STATES INSURANCE
COMPANY, as Subrogee of
THERESA E. BOOTHE,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. ! ?- 3 S6 ?TrV
CIVIL ACTION-LAW
V.
BRIAN J. GUILLEN,
Defendant
JURY TRIAL OF TWELVE DEMANDED
COMPLAINT
1. Plaintiff, Donegal Mutual Insurance Company, is an insurance company licensed to
do business in Pennsylvania with an address of 1195 River Road, Marietta, Pennsylvania 17547-
0302.
2. The Defendant Brian J. Guillen is an adult individual residing at 1228 Broadway,
Floor 2, Hanover, Pennsylvania 17331.
3. On or about June 12, 2010, Donegal Mutual Insurance Company insured Theresa E.
Boothe and provided collision coverage for a 2004 Chevy Malibu and uninsured motorist coverage.
4. On or about June 12, 2010, Theresa Boothe's 2004 Chevy Malibu was being operated
by Ronald L. Poorman heading south on Blossom Drive.
5. At that time, Theresa Boothe was a passenger in her vehicle.
6. As they were heading south on Blossom Drive, a 1997 Pontiac Grand Prix owned and
operated by Defendant Brian J. Guillen exited a private driveway striking the passenger side of the
vehicle owned and occupied by Theresa Boothe.
7. As a direct and proximate result of the collision, Theresa Boothe's vehicle was
damaged in the amount of $1,938.40.
8. A copy of the appraisal totaling $1,938.40 is hereby attached as Exhibit A.
9. As a direct and proximate result of the collision, Theresa Boothe incurred rental
expenses of $333.00.
10. Defendant Brian Guillen left the scene of the collision but was stopped shortly
thereafter and said he did not have insurance.
11. As a direct and proximate result of the collision, Theresa Boothe sustained injuries
and incurred medical expenses in excess of her first party coverage from Donegal.
12. As a result of her injuries, Donegal paid Theresa Boothe's uninsured motorist benefits
in the amount of her policy limits of $15,000.00 and Boothe assigned Donegal the subrogation
rights against Brian Guillen. A copy of that Release and Assignment dated November 2, 2010, is
hereby attached as Exhibit B.
13. Donegal Mutual Insurance is subrogated to the rights of Theresa Boothe for all of the
payments made to her.
14. The accident was caused solely as a result of the negligence, recklessness and
carelessness of Brian J. Guillen in that he inter alia, failed to yield the right of way and failed to
avoid striking the Boothe vehicle.
WHEREFORE, Plaintiff demands judgment against Defendant in the amount of $17,268.40,
plus costs, interest, and any other relief that the Court deems appropriate.
MARTSO WO
FF
By
George B. F ller, Jr., Esquire
Attorney I.D. No. 49813
Ten East High Street
Carlisle, PA 17013
(717) 243-3341
Date: Attorneys for Plaintiff
A xirvaeo PAIR
DONEGAL INSURANCE GROUP
1195 RIVER ROAD P.O. BOX 302
MARIETTA, PA 17547-0302
(717) 426-1931 FAX: (717) 426-7023
"" SUPPLEMENT 1 "•
06/1 7/201 0 01:35 PM
.......................................................................................................................................................................................................
..........
Owner
Owner: THERESA BOOTHE
Address: PO BOX 587 Cell: (717)395-3338
City State Zip: MOUNT WOLF, PA 17347 FAX:
Control Information
.......................................................................................................................................................................................................
........................:
Claim # : PAF-PA-01-10-0136794
Loss Datef nms: 06112/2010 08:00 AM
Deductible: $500.00
File # :
Ins. Company: Donegal Insurance Group
Agent: David Hershey
Address:
Email: davidhershey@donegalgroup.com
Insured: THERESA BOOTHE
Address:
Claim Rep: David Hershey
Address:
Email: davidhershey@donegalgroup.com
Loss Payee: SUSQUEHANNA BANK
Insured Policy # : PAF-3098428
Loss Type: Collision
Accounting #: 0004588
Work/Day: (800)877-0600x7726
Cell: (717)395-3338
Work/Day: (800)877-0600x7726
.......................................................................................................................................................................................................
..........................
Inspection
.......................................................................................................................................................................................................
........................:
Inspection Date: 06117/2010
Inspection Location: mt wolf
Address: PO BOX 587
City State Zip: MOUNT WOLF, PA 17347
Primary Impact: Right Rear Side
Driveable: Yes
Assigned Date/Time:
First Contact Datef nme:
Company: DONEGAL INSURANCE
Contact: YVONNE DAVIS
Address: PO BOX 324
City State Zip: WRIGHTSVILLE, PA 17368
Orig Company: DONEGAL INSURANCE
Contact: YVONNE DAVIS
Address: PO BOX 324
City State Zip: WRIGHTSVILLE, PA 17368
...............
i Repairer
Inspection Type: Field
Contact:
Cell: (717)395-3338
Secondary Impact:
Rental Assisted:
Received Daternme: 06114/201004:31 PM
Appointment DatefTime: 06117/2010 08:00 AM
Appraiser License # : 150311
Work/Day: (717)252-1689
FAX: (717)252-1644
Appraiser License # : 150311
Work/Day: (717)252-1689
FAX: (717)252-1644
._... ....:.,.._::.,.:...:::..
.................._
Repairer: TH RNT N CHEVROLET Corrtact: --- UN .. K
Address: 180 S. MAIN ST POBOX 456 Work/Day: (717)266-8800
City State Zip: MANCHESTER, PA 17345 FAX: (717)266-6465
License # : 0 Regulation ID: 030416307
Target Complete Date/Time: Days To Repair: 4
Remarks ....... ...,..........,..,,......,»...,,..,,......,, ........:.......»....:..,.....,,.,,,,......,..,.»...:..:.,,......,,.....,,:..........,.,....,....,...,.......,.....-....................,.
.............
.............................................................................
08/0212010 11:59 AM
Page 1 of 5
EXHIBIT A
2004 Chevrolet Melba LS 4 DR Sedan
Claim t : PAF-PA-01-10-0136794
06/172010 01:35 PM
ALL SUPPLEMENTS DAMAGE MUST BE APPROVED BY THE APPRAISER
-COPY OF APPRAISAL SENT TO OWNER JUNE 17,2010
Vehicle.,-.,...,..,, .....,.....,.,...,,,,,,..,,,r.,..,..,,..,,,..,.»....,.............,.,,.......,...........
2004 Chevrolet Malibu LS 4 DR Sedan
6cyl Gasoline 3.5
4 Speed Automatic
Lic.Plate: HJZ5145 Lic State: PA
Lic Expire: VIN: 1 G 1 ZT54824F 118574
Prod Date: Mileage: 0
Veh InspiM : Mileage Type: Non Readable
Condition: Code: U26438
Ext. Color: RED Int. Color:
EM. Refinish: Two-Stage Int. Refinish:
Options
AM/FM CD Player Air Conditioning Alarm System
Aluminum/Alloy Wheels Anti-lock Brakes Center Console
Cruise Control Dual Airbags Intermittent Wipers
Keyless Entry System Lighted Entry System Power Adjustable Pedals
Power Brakes Power Door Locks Power Mirrors
Power Steering Power Windows Rear Window Defroster
Rem Trunk-UGate Release Tachometer Telescopic Steering Whl
Tilt Steering Wheel Tinted Glass Traction Control System
Velour/Cloth Seats
.................
Damages
Line Op Guide MC Description MFR.Part No. Price ADJ% B% Hours R
1 EU 931 46 Wheel,Rear FIT LIKE KIND & QUAL.PRT $135.00' +25.00 0.2 SM
2 ELI 249 07 Panel Assy,Body Side FIT LIKE KIND & QUAL.PRT $150.00' 8.0' SM
3 L 249 10 Panel Assy,Body Side RT Refinish 2.8` RF
1.9 Surface
0.9 Two-stage
4 RI 194 Plate,Sill RT R & I Assembly INC SM
5 E 1027 Retainer, Rckr Pnl Midg RT MULTI-PART GM Part $15.48` S1 SM
6 E 1199 Retainer, Rckr Pnl Midg RT MULTI-PART GM Part $22.08` S1 SM
7 RI 95 MIdg,Rocker Panel FIT R & I Assembly INC SM
8 BR 208 13 Door Shell,Front FIT Blend Refinish 2.0 RF
0.9 Blend
0.6 Two-stage setup
0.5 Two-stage
9 RI 240 W/Strip,Beft Outer FIT R & I Assembly 0.4 SM
10 1 244 MIdg,Front Door Side FIT Repair 0.4' SM
>> r&i/re-tpe
11 RI 230 Mirror,Sport R/C RT R & 1 Assembly 0.3 SM
12 RI 228 Handle,Front Door Oir RT R & I Assembly 0.2 SM
13 EU 288 Door Assembly, Rear RT LIKE KIND & QUAL.PRT $200.00` +25.00 1.0 SM
>> triple nickle 8009338627 gt376316
14 L 288 Door Shell, Rear RT Refinish 2.8 RF
1.5 Surface
1.0 Edge
0.3 Two-stage
15 RI 335 W/Strip,Beft Outer RT R & I Assembly INC SM
16 RI 311 W/Strip,RR Door Body FIT R & I Assembly 0.5 SM
17 1 261 Mldg,Rear Door Side FIT Repair 0.4' SM
>> r&i/re-tpe
18 RI 329 Applique Assy, Rear Dr RT R & I Assembly INC SM
19 RI 308 Pnl,Inner Door Trim RT R & I Assembly INC SM
20 BR 306 Handle,RR Door Outer RT Blend Refinish 0.2 RF
0.1 Blend
0.1 Two-stage
21 RI 306 Handle, RR Door Outer RT R & I Assembly INC SM
22 RI 400 PnI, Lock Trim RT R & I Assembly INC SM
0810212010 11:59 AM
Pape 2 of 5
2004 Chevrolet Malbu LS 4 DR Sedan
Claim*: PAF-PA-01-1 0-01 36794 06/1712010 01:35 PM
24 1 566 Cover,Rear Bumper Repair 0.4' SM
>> loosen
25 EC Cover Car Exterior Replace Economy $5.00' SM
26 1 Pinstripes-Tape Sublet Repair $8.00` 0.3' SM
27 N Valve Stem Additional Labor $1.50' SM
28 1 Corrosion Protection Sublet Repair $3.00' 0.1' SM
29 1 Tire-Right Rear,Balanced Repair 0.1' SM
30 1 4 WHEEL ALIGNMENT Repair 1.3' SM
31 EC Hazardous Waste Removal Replace Economy $3.00' SM
32 EC FIT REAR TIRE Replace Economy $80.87' S1 SM
32 Items
MC Message
07 STRUCTURAL PART AS IDENTIFIED BY I-CAR
10 INCLUDES AUDATEX TIME TO CLEAR ENTIRE PANEL
13 INCLUDES 0.6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE
46 PRINTABLE ALTERNATE PARTS COMPARE
Estimate Total 3 Entries
. .....................................................................................................................................................................................................
........................:
Gross Parts $37.56
Other Parts $575.37
Paint Materials $179.40
Line Item Markup $83.75
Parts & Material Total
Tax on Parts & Material @ 6.000%
Labor Rate Replace Hrs Repair Hrs Total Hrs
Sheet Metal (SM) $44.00 10.6 3.0 13.6 $598.40
Mach/Elec (ME) $47.00
Frame (FR) $44.00
Refinish (RF) $44.00 7.8 7.8 $343.20
Paint Materiels $23.00
Labor Total 21.4 Hours
Tax on Labor @ 6.000%
Sublet Repairs
Tax on Sublet @ 6.000%
Gross Total
Less: Deductible
Net Total
Rates / Taxes Adjustment S1
Actual Supplement Total $125.53
Less: Previous Net Total
Net Supplement Total
Alternate Parts Y100/00100100100 CUM 01/00/00/01/00 Zip Code: 17368 YORK
Audetex Estimating 6.0.353 S1 08/02/201011:59 AM REL 6.0.353 DT 06/01/2010
Copyright (C) 2009 Audatex North America, Inc.
$876.08
$52.56
$941.60
$56.50
$11.00
$0.66
$1,938.40
$500.00-
$1,438.40
$1,312.87-
$125.53
2.4 HRS WERE ADDED TO THIS ESTIMATE BASED ON AUDATEX'S TWO-STAGE REFINISH FORMULA.
ABBREVIATION LEGEND:
LKQ = LIKE KIND IN QUALITY, AIM = 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=
08/0212010 11:59 AM
Papa 3 of 5
2004 Chevrolet Malbu LS 4 DR Sedan 06/17/2010 01:35 PM
Claim*: PAF-PA-01-10-0136794
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
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.
COSTS THAT EXCEED THE APPRAISED AMOUNT MAY BE THE RESPONSIBILITY OF THE
VEHICLE OWNER.
IF YOU REQUEST, WE CAN PROVIDE YOU WITH THE NAMES OF REPAIR FACILITIES THAT
WILL BE ABLE TO REPAIR THE VEHICLE FOR THE APPRAISED AMOUNT. THERE IS NO
REQUIREMENT TO USE ANY SPECIFIED REPAIR SHOP.
THIS IS NOT AN AUTHORIZATION TO REPAIR. NO SUPPLEMENTS HONORED UNLESS
INSPECTED AND AUTHORIZED BY APPRAISER. IF THE APPRAISAL INCLUDES AFTERMARKET
CRASH PARTS, THE AFTERMARKET CRASH PART SHALL HAVE A WARRANTY EQUAL TO OR
BETTER THAN THE REMAINDER OF THE EXISTING WARRANTY ON THE PART BEING REPLACED.
APPRAISER SIGNATURE:
Op Codes
. = User-Entered Value
EC = Replace Economy
ET = Partial Replace Labor
TE = Partial Replace Price
L -Refinish
TT - Two-Tone
BR - Blend Refinish
CG= Chipguard
AA = Appearance Allowance
E - Replace OEM
OE = Replace PXN OE Srpls
EP - Replace PXN
PM= Replace PXN Reman/Rebit
PC = Replace PXN Reconditioned
SB = Sublet Repair
I -Repair
RI = R & I Assembly
RP = Related Prior Damage
NG = Replace NAGS
UE = Replace OE Surplus
EU - LIKE KIND & QUAL.PRT
UM= Replace Reman/Rebuilt
UC - Replace Reconditioned
N = Additional Labor
IT = Partial Repair
P =Check
This report contains proprietary information of Audatex and may not be disclosed to any third party (other than the
insured, claimant and others on a need to know basis in order to effectuate the claims process) without Audatex's
? udatex prior written consent.
564!m4 ..runPsay
Copyright (C) 2009 Audetex North America, Inc.
Audatex Estimating is a trademark of Audatex North America, Inc.
08/02/201011:59 AM
Pape 4 of 5
2004 Chevrolet Malbu LS 4 DR Sedan
Claim*: PAF-PA-01-10.0136794
06/172010 01:35 PM
Estimate Summary Page
DONEGAL INSURANCE
Gross Total $1,938.40
Less: Deductible $500.00-
Net Total $1,438.40
Rates / Taxes Adjustment S1
Actual Supplement Total $125.53
Less: Previous Net Total $1,312.87-
Net Supplement Total $125.53
Audatex Estimating 6.0.353 S1 08/02/201011:59 AM REL 6.0.353 DT 06/01/2010
Copyright (C) 2009 Audetex North America, Inc.
UtVLWrdU10 11:58 AM
Page 5 015
RII-A. rnrEx
FCYCIABtE
, IT
ay Z-i
DONEGAL COMPANIES
Muletta, PA
RELEASE AND TRUST & INDEMNITY AGREEMENT
POLICYHOLDER THERESA BOOTHE
CLAM NO. PAF-PA-01.10-0138936
POLICY NO. PAF3098428
RECEIVED OF DO GAL hAnUAL INSURANCE COMPANY HEREINAFTER CALLED THE COMPANY, ?HE
SUM OF FIFTEEN THOUSAND 000/100 (SIS.000.00) IN FULL SETTLEMENT AND FINAL DISCHARGE OF ALL
CLAIMS UNDER THE ABOVE NUMBERT3D POLICY FOR BODILY INJURIES KNOWN AND UNKNOWN AND
WHICH HAVE RESULTED OR MAY IN THE FUTURE DEVELOP, SUSTAINED BY 229= BY
REASON OF ACCIDEW OR OCCURRENCE AEI *16 OUT 0F..TRE'OW14ERSHIIP OR OPERA170 AN
r'IINIlVSUREUr OR F C'LE BY BBIAN 7 GWLM WHICH OCCURRED ON OR-ABOUT THE UM DAY,.
For the consideration aforesaid, and to the extent of any payment made thereunder, the undersigned agrees to hold in
trust for the benefit of the Company all rights of recovery which he shall have against any person or organization legally
liable for such bodily injuries, and assigns to the Company the proceeds of any settlement with or judgment against such
perso or organization.
The Company is hereby authorized to take any action which may be necessary either in law or in equity in the name of
the undersigned against any auoh person or organization, and the undersigned covena ft and agrees to cooperate fully
with the Company in the presentation of such claims and to furnish all papers and documents necessary in such
proceedings and to attend court and testify if the Company deems such to. be necessary.
The undersigned further warrants that he has made no settlement with, given any release to or prosecuted any claim to
juudgnnetd against any P or organization legally liable for such bodily injuries, and that no such settlement will be
made, no such release will ba given and no such claim will be prosecuted to juidgment without the written consent of the
Company-
The undersigned acknowledges that Medicare/Highmark Freedom Blue has a lien for medical benefits paid on behalf of
Therese Boothe for injuries sustained in the June 12.2010 motor vehicle accident. The undersigned agrees that the net
proceeds received by • !a Boothe from The Company will be held by Dale E A+>etiM PC in escrow and will not be
disbursed mil the Medicare lien has been satisfied. The undersigned finther agrees .to release, discharge, hold harmless
..:T -?..c.and. ind rmwfy"'Cc nupany A: om=any. claim, lice-u:;actio?i aasarN,d'sy M:dicai Iigti>nsrlrFi dom-Blu o far
paid or payable to the undersigned as a result of the motor vehicle accident of June 12.2010.
Signed, sealed and delivered this "day of _ / I .20 / 0
i
s
XZ
x
Witness -
E
my Pam who Iw m*y aid WA klat to &ftod my jm x & may or odw pwon file an applicstim for iaarnm or
statanent of daim caatoNM say matwially h1n iftmetron or cam als for the papose of mwea ft ud mmuon eoacanoll arty
W "=grill thereto Cona.Yts a Ramer b mime act, which is a crime and subjects such peeve to afmiasf and civil permhies.
1110912010 09:28 AM F294920704 EXHIBIT B
I, Christine E. Richan
Company, acknowledge I have tl
Insurance Company and certify t
gathered by my counsel in the pr
counsel and not my own. I have
information which I have given
information and belief. To the e
upon counsel in making this Vey
This statement and Veri
relating to unsworn falsificatio
averments, I may be subject to c
VERIFICATION
Subrogation Claims Specialist of ponega1?1.MutuaIInsurance
authority to execute this Verification on behalf of Donegal Mutual
foregoing Complaint is based upon information which has been
aration of the lawsuit. The language of this Complaint is that of
ad the document and to the extent the Complaint is based upon
my counsel, it is true and correct to the best of my knowledge,
ent the content of the Complaint is that of counsel, I have relied
cation are made subject to the penalties of 18 Pa. C.S. § 4904
to authorities, which provides that if I knowingly make false
ninal penalties.
^DONEGAL MUTUAL INSURANCE COMPANY
Christine E. Richards
FiFIGES%CliemsU050Darug"u nent16 4 113 05 0.641.Complainr
04/0412011 11:25 AM F29492274
F TILES\Clients\3050 Donegal\Current`.6419050.641.Complaint'\tde
FLED-OFFICE
George B. Faller, Jr., Esquire OF THE PF,OTHONOTARY
MARTSON DEARDORFF WILLIAMS OTTO GILROY & FALLER
MARTSON LAW OFFICES 2011 ADP 12 Phi 1: - j
Attorney I.D. No. 49813 CUMBERLAND COUNTY
10 East High Street PENNSYLVANIA
Carlisle, PA 17013
(717) 243-3341
Attorneys for Plaintiff
DONEGAL MUTUAL INSURANCE IN THE COURT OF COMMON PLEAS OF
COMPANY, as Subrogee of CUMBERLAND COUNTY, PENNSYLVANIA
THERESA E. BOOTHE,
Plaintiff NO. 11-3569
CIVIL ACTION-LAW
V.
BRIAN J. GUILLEN,
Defendant JURY TRIAL OF TWELVE DEMANDED
NOTICE
You have been sued in court. If you wish to defend against the claims set forth in the
following pages, you must take action within twenty (20) days after this Complaint and Notice are
served, by entering a written appearance personally or by attorney and filing in writing with the court
your defenses or objections to the claims set forth against you. You are warned that if you fail to do
so, the case may proceed without you and a judgment may be entered against you by the court
without further notice for any money claimed in the Complaint or for any other claim or relief
requested by the Plaintiffs. You may lose money or property or other rights important to you.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT
HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS
OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER.
IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO
PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL
SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE:
Lawyer Referral Service of
The York County Bar Association
York County Bar Center
137 East Market Street
York, Pennsylvania 17401
Telephone: (717) 854-8755
George B. Faller, Jr., Esquire
MARTSON DEARDORFF WILLIAMS OTTO GILROY & FALLER
MARTSON LAW OFFICES
Attorney I.D. No. 49813
10 East High Street
Carlisle, PA 17013
(717) 243-3341
Attorneys for Plaintiff
DONEGAL MUTUAL INSURANCE
COMPANY, as Subrogee of
THERESA E. BOOTHE,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 11-3569
CIVIL ACTION-LAW
V.
BRIAN J. GUILLEN,
Defendant
: JURY TRIAL OF TWELVE DEMANDED
AMENDED COMPLAINT
1. Plaintiff, Donegal Mutual Insurance Company, is an insurance company licensed to
do business in Pennsylvania with an address of 1195 River Road, Marietta, Pennsylvania 17547-
0302.
2. The Defendant Brian J. Guillen is an adult individual residing at 1228 Broadway,
Floor 2, Hanover, Pennsylvania 17331.
3. On or about June 12, 2010, Donegal Mutual Insurance Company insured Theresa E.
Boothe and provided collision coverage for a 2004 Chevy Malibu and uninsured motorist coverage.
4. On or about June 12, 2010, Theresa Boothe's 2004 Chevy Malibu was being operated
by Ronald L. Poorman heading south on Blossom Drive.
5. At that time, Theresa Boothe was a passenger in her vehicle.
6. As they were heading south on Blossom Drive, a 1997 Pontiac Grand Prix owned and
operated by Defendant Brian J. Guillen exited a private driveway striking the passenger side of the
vehicle owned and occupied by Theresa Boothe.
7. As a direct and proximate result of the collision, Theresa Boothe's vehicle was
damaged in the amount of $1,938.40.
8. A copy of the appraisal totaling $1,938.40 is hereby attached as Exhibit A.
9. As a direct and proximate result of the collision, Theresa Boothe incurred rental
expenses of $333.00.
10. Defendant Brian Guillen left the scene of the collision but was stopped shortly
thereafter and said he did not have insurance.
11. As a direct and proximate result of the collision, Theresa Boothe sustained injuries
and incurred medical expenses in excess of her first party coverage from Donegal.
12. As a result of her injuries, Donegal paid Theresa Boothe's uninsured motorist benefits
in the amount of her policy limits of $15,000.00 and Boothe assigned Donegal the subrogation
rights against Brian Guillen. A copy of that Release and Assignment dated November 2, 2010, is
hereby attached as Exhibit B.
13. Donegal Mutual Insurance is subrogated to the rights of Theresa Boothe for all of the
payments made to her.
14. The accident was caused solely as a result of the negligence, recklessness and
carelessness of Brian J. Guillen in that he inter alia, failed to yield the right of way and failed to
avoid striking the Boothe vehicle.
WHEREFORE, Plaintiff demands judgment against Defendant in the amount of $17,268.40,
plus costs, interest, and any other relief that the Court deems appropriate.
MARTSON YAW
BY ,/l/?? .
George B. Faller, Jr., Esquire
Attorney I.D. No. 49813
Ten East High Street
Carlisle, PA 17013
(717) 243-3341
Date: 4/2/11 Attorneys for Plaintiff
C?1 xF ??,??N??tR
?V??w?r
?XN?'?
DONEGAL INSURANCE GROUP
1195 RIVER ROAD P.O. BOX 302
MARIETTA, PA 17547-0302
(717) 426-1931 FAX: (717) 4267023
"" SUPPLEMENT 1
08117/2010 01:35 PM
.................................................................................................................................................................................................................
Owner
Owner: THERESA BOOTHE
Address: PO BOX 587
City State Zip: MOUNT WOLF, PA 17347
Call: (717)395-3338
FAX:
i Control IMonna*m
.....................................................................................,,..................................................... E
Clain # : PAF-PA-01-10-0138794
Lou DaWi Tine: 06112201008:00 AM
Deductible: $500.00
File d :
Ins. Company: Donegal Insurance Group
Agent: David Hershey
Address:
Email: davidhershey@donsgalgroup.com
Insured: THERESA BOOTHE
Address:
Insured Policy d : PAF-3098428
Loss Type: Collision
Accounting d : 0004588
WorMly: (800)877-0600x7728
Cent: (717)395-3338
Claim Rep: David Hershey
Address:
Entail: WO*May: (800)877-0800x7728
Entail: davidhersheyQdanegalgroup.com
Lose Payee: SUSQUEHANNA BANK
.Inspection ............................ ..................................................................................................................................................................................
.................
:
Inspection Dab: 06/17/2010
Inspection Location: mt wolf
Address: PO BOX 587
City Stab Zip: MOUNT WOLF, PA 17347
Primary Impact: Right Rear Side
Driveable: Yes
Assigned Detw nme:
First Contact DetadTime:
Company: DONEGAL INSURANCE
Contact: YVONNE DAVIS
Address: PO BOX 324
City Side Zip: WRIGHTSVILLE, PA 17388
Orlg Company: DONEGAL INSURANCE
Contact: YVONNE DAVIS
Address: PO BOX 324
City State Zip: WRIGHTSVILLE, PA 17388
Inspection Type: Field
Contact:
Cell: (717)395-3338
Secondary Impact:
Rental Assisted:
RsoNved Date/Tims: 06/14/2010 04:31 PM
APpointmerrt DeWfte: 0811 7/2010 08:00 AM
Appraiser License d : 150311
Work/Day: (717)252-1689
FAX: (717)252-1644
Appraiser License 0: 150311
Work/Day: (717)252-1889
FAX: (717)252-1844
eksr ................................................................................................................................................................................................................
Repairer: THORNTO _CHEVROLET
Address: 180 S. MAIN ST POSOX 456
City State Zip: MANCHESTER, PA 17345
License 0 : 0
Target Complete Data/Time:
Work/Day: (717)288.8800
FAX: (717)2888486
Regulation ID: 030416307
Days To Repair: 4
.....................................................................................................
--"IV »:5o w :
Pw@j0f5
E MIBIT A
2004 Chemiel Mabu LS 4 DR Sedan 0611712010 01:35 PM
Claim t : PAF-PA-01.10-0138794
ALL SUPPLEMENTS DAMAGE MUST BE APPROVED BY THE APPRAISER
-COPY OF APPRAISAL SENT TO OWNER JUNE 17,2010
Vehicle
2004 Chevrolet Malibu LS 4 DR Sedan
8cyl Gasoline 3.5
4 Speed Automatic
Options
Lic-Plats: HJZ5145 Lie Stets: PA
Lie Expire:
VIM: 1G1ZT54824F118574
Pr
Prod Deb: AANeapr 0
Veb
lnqW
: Mllespe Type: Non Readable
d
do Code: U26438
Ext. . Color: RED
Ext Cor: Ir1t Color.
Ext. Refinish: Two-Slaps Int Refinish:
AM/FM CD Player
Aluminum/Alloy Wheels
Cruise Control
Keyless En" System
Power Braces
Power Steering
Rem Tr1mk-UGde Release
Tilt Steering Wheel
Velour/Cloth Seats
Air Conditioning
And-lock Brakes
Dual Aiftp
Lighted Entry System
Power Door Locks
Power Windows
Tachometer
Tinted Glass
Alarm System
Center Console
lntermitteM Wipers
Power Adjustable Pedals
Power Mirrors
Rear Window Defroster
Telescopic Steering Whl
Traction Control System
i .. ....................................................................................................................................................................................................................
Line Op Guide MC Description NFR.Part No. Price ADJ% 8% Hours
1 EU 931 48 Wheel,Rear RT
2 EU 249 07 Panel Assy,Body Side RT
3 L 249 10 Panel Assy,Body Side RT
4 RI 194 Plate,S1I RT
5 E 1027 Relaner,Rckr Pro Midg FIT
8 E 1199 Retainer, Rckr PM Mldg FIT
7 RI 95 MIdg,Rocker Panel RT
8 BR 208 13 Door SheN,Fmrd RT
9 RI 240
10 1 244
11 RI 230
12 RI 228
13 EU 288
14 L 288
15 RI 335
18 RI 311
17 1 281
LIKE KIND & QUALPRT
LIKE KIND & QUALPRT
Refinish
1.9 Surface
0.9 Two-stage
R & I Assembly
MULTI-PART GM Part
MULTI-PART GM Part
R & I Assembly
Blend Refinish
0.9 Blend
0.8 Two-stage setup
0.5 Two-stage
W/S1rip,Belt Outer RT R & I Assembly
MIdg,Front Door Side RT Repair
» r&i/re-tpe
Mtrror,Sport R/C RT R & I Assembly
Harldle,Front Door Olr RT R & I Assembly
Door Assembly,Rear RT LIKE KIND & QUALPRT
>> triple nickle 8009338827 gt378318
Door Shell,Rear RT Refinish
1.5 Surface
1.0 Edge
0.3 Two-stage
W/Strip,Belt Outer RT R & I Assembly
W/Strip,RR Door Body RT R & I Assembly
MIdg,Rear Door Side RT Repair
>> rdJ/re-tpe
$135.00' +25.00
$150.00'
$15.48' S1
$22.08' S1
$200.00' +25.00
0.2 SM
8.0' SM
2.8' RF
INC SM
SM
SM
INC SM
2.0 RF
0.4 SM
0.4' SM
0.3 SM
0.2 SM
1.0 SM
2.8 RF
INC SM
0.5 SM
0.4' SM
18 RI 329 Applique Assy,Rear Dr RT R & I Assembly INC SM
19 RI 308 Prd,lnner Door Trim RT R & I Assembly INC SM
20 BR 308 Handle,RR Door Outer RT Blond Refinish 0.2 RF
0.1 Blend
0.1 Two-stage
21 RI 308 Handle,RR Door Outer RT R & I Assembly INC SM
22 RI
23 RI 400
F.'ad Prd,Lodc Trim RT
T illarrmn Ammmbly RT R & I Assembly
R A I asalnWv INC SM
08/02/2010 1159 AM IN SM
Paps 2015
2004 ChwroW Malibu LS 4 DR Sedan
Clakn # : PAF-PA-01-10-0136794 08/172010 01:35 PM
24 1 566 Cover,Rear Bumper Repair 0.4' SM
>> loosen
25 EC Cover Car Exterior Replace Economy $5.00• SM
26 1 Pinstripes-Tape Sublet Repair $8.00' 0
3' SM
27 N Valve Stem Additional Labor $1.50• . SM
28 1 Corrosion Protection Sublet Repair $3.00' 0
1' SM
29 1 Tire-Right Rear,Balanced Repair .
0
1' SM
30 1 4 WHEEL ALIGNMENT Repair .
1
3' SM
31 EC Hazardous Waste Removal Replace Economy $3.00• . SM
32 EC RT REAR TIRE Replace Economy $80.87•
S1
SM
32 Items
MC Lis
07 STRUCTURAL PART AS IDENTIFIED BY I-CAR
10 INCLUDES AUDATEX TIME TO CLEAR ENTIRE PANEL
13 INCLUDES 0.6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE
46 PRINTABLE ALTERNATE PARTS COMPARE
rEstan?q Tota18 E %N%%%% ............................. ,.. .....,,.., ..?,,,, ..?, ..,.,., w . ...... .. ... . .. ..... ,,.,.. ,, ..,,..,.... ,,,. ,, ,.,...., , ,.,..
...........................................................................................................................................:
Gross Parts $37.58
Other Parts $575.37
Palm Lintedals $179.40
Line Mom Markup $83.75
Parts 3 Mate" Total $876
08
Tax on Parts 5 Materiel ® 6.000% .
$52.58
Labor Rats Replace Hrs Repair Hrs Total Hire
Shsst Metal (SM) $44.00 10.8 3.0 13.6 $598.40
MscWEIec (ME) $47.00
Fronts (FR) $44.00
Refinish (RF) $44.00 7.8 7.8 $343.20
Paint Materials $23.00
Labor Total
Tax on Labor
0 6
000% 21.4 Hours $941.60
Sublet Repairs . $56.50
Tax on Sublet
@ 6.000% $1100
$0
68
Gross Total .
Lou: Deductible $1,938.40
Not Total $500.00
Refss / Taxes Adlustmont
S1 $1,498.40
Actual Suppismsrn Total $125.53
Less: Previous Not Total
Not Supplemerri Total $1,
312.87-
$120
.53
Alternate Parts Y/00/00/00/WOO CUM 01/00/00/01/00 Zip Code: 17388 YORK
Audatox Esdmaft 8-0.358 5108/02/201011:59 AM REL 8.04163 DT 06/01/2010
Copyright (C) 2009 Audstsx North America, Inc.
2.4 HRS WERE ADDED TO THIS ESTIMATE BASED ON AUDATEX'S 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 = RT,mmn_ nccv
Pape 3 of 5
2004 Chewolal Malbu LS 4 OR Sedan
Claim * : PAP-PA-01-10-0138794 08/IM10 01:35 PM
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
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.
COSTS THAT EXCEED THE APPRAISED AMOUNT MAY BE THE RESPONSIBILITY OF THE
VEHICLE OWNER.
IF YOU REQUEST, WE CAN PROVIDE YOU WITH THE NAMES OF REPAIR FACILITIES THAT.
WILL BE ABLE TO REPAIR THE VEHICLE FOR THE APPRAISED AMOUNT. THERE IS NO
REQUIREMENT TO USE ANY SPECIFIED REPAIR SHOP.
THIS IS NOT AN AUTHORIZATION TO REPAIR. NO SUPPLEMENTS HONORED UNLESS
INSPECTED AND AUTHORIZED BY APPRAISER. IF THE APPRAISAL INCLUDES AFTERMARKET
CRASH PARTS, THE AFTERMARKET CRASH PART SHALL HAVE A WARRANTY EQUAL, TO OR
BETTER THAN THE REMAINDER OF THE EXISTING WARRANTY ON THE PART BEING REPLACED.
APPRAISER SIGNATURE:
OP Codes
- User-Entered Value
EC - Replace Economy E - Replace OEM
OE - Replace PXN OE Srpls NG - Replace NAGS
ET - Partial Replace Labor
EP - Replace PXN UE . Replace OE Surplus
TE - Partial Replace Prioe
PM. Replace PXN Remarl/Rebtt EU . LIKE KIND 8 QUALPRT
UM
L . Refinish
TT . Two-Tone PC - Replace PXN Reconditioned . Replace
UC RemaNtioned
• Replace Reconditioned
BR - Blend Refinish S8 - Sublet Repair
I -Repair N
=
Additional R
Labor
CG. Chippuard
AA . Appearance Allowance
RI . R 8 I Assam '
e
IT
- pair
-Partial Repair
P .Check
RP - Related Prior Damage
This report contains proPrietary information of &Kk tax and may not be disclosed to any third parry (other than the
insured, claimant and others on a need to know basis in order to effectuate the claims proce without Auda tex's
Atai#?I?tex prior written cogent. ss)
a 5UWv wmovny
CePYMt#K (C) 2009 AudNex North Amsrlcs, Inc.
Audatex Estimate is a trademark of Audatex North America, Inc.
0802/2010 11:59 AM
Paps 4 7 _5
2004 Chevrolet M4bu LS 4 OR Swan
Claim 6: PAF-PA-01-10-0136794 0&1712010 01:35 PM
Gross Total $1,1138.40
Lou: Oeductlbb $500
00-
Net Total .
$1
438.40
Rate / Taxes AdJusbnsnt ,
S1
Actual Supplenlont Total $125.53
Less: Previous Not Total $1
312.87-
Net Supplement Total ,
$125.53
Audeta (C) ? Audatex North Aundca, Inc. &0-M SI 09'02=10 11:59 AM REL A.0.359 DT 08/01/2010
COPYftM
0&02/201011:59 AM
Paps 5 o
?,Ae?F
4 ?Yl I ?' / >1,
ii 1 Z-6
DONEGAL COMPANIES
M, PA
RELEASE AND TRUST & INDEMNITY AGREEMENT
POLICYHOLDER TFRESA HOOTHE
CLAIM NO PAF-PA I-10.0138936
POLICY NO. IM09
RECMVBD OF
SUM
,QW
CLAMS UNDER TIC ABOVE 1VUZVIDER
WHICH HAVE RLSULTBD OR MAY 1N
REASON OF ?IDIQNT OR OCCM
BLS BY ML
MAN BERMAFTER CAJIM TM COWANY, Tft
J.4 LW 11V AND
FFORULL SETII.HOD1Y'I,EIIJ11 N1' AND F>r1KNOWNALAND DL9CE7AURNKNO(3EWNOF ALL
® FOLICY
JUR>E3
TIM FUTltlitg DEVEMP, SUSTADM PX + BY
PWCE AAMM OUT OF TM 0WWMtSHlP OR. O tA3ION AN 'I
(ntlC Cb 0 CURRED ON OR, ABOUT Tl .= DAY
For the cousidoratim aforesaid, and to the atom of any psyrpnrt made tlwamder, the nedersigped agrees to hold in
trust for the bandit of the Company all sigbb of recovery which he dWl have agaimt any pos of organization lepuy
liable for such bo W injuries, and assigns to the Company the proceeds of any settlement with or judpunt agar such
Igo n or a>rgonization.
The Cornpsny is baeby authorized to take any action whieb may be n
the eiao°d a mpmabon, punt either in law or in equity in the same of
widr die C ? a>rcb l? or and the undersigmd covenuts and spoaa to coapacate fW y
proceedings and to Company a'ttend the coact pres and t testiadgoti of such claims and to f rnik all papers and doc uu..rts , in ouch
fy if the Company deeeas umb to be neceinary.
T
judgment spinst he undersigned fiuttw warranter that he has nude no aettlemm with, 8i,,m any ><eheave to or Prosocuted any claim to
made, no usch rely pe? or organization legally liable for such bodily injuries, ad that no such =Wenwd will be
given and no each claim will be p=ocerted to Judgment without the written conunt of the
compay.
The mda nigned acknowledges that Medicar Hshmsdr Freedom Blue has a lien for medical be wfda paid on behalf of
111RTiY.8JmOn for injuries sudained in the June 12 2010 motor vehicle uxidont, Tire muf"ped agrees flat the net
procoods received by a Hoothe fivm 110 Company will be held by Dale E A? '++ y? in pMOW and will not be
disbatiad urdil the Medicare lien has bean Qa'Wed' Ths under Pond a4*W a? to ire' d' Esc uq% hold humla»
:t - +•?.and.itrd i?i Sbsr: D?,i WW=y •?? lirn.-tw4cCmi auftk&by Mcd' W
paid or payable to the undeessgrvad as a molt of the mota've?e1 of `F?*deai?luo?far ,
Signed, sealed and delivered this day of
Witness ,...
z
Witness . .
Any pataaa mho tniswi?iy ad xiMt ttsas to detMd e0' araprq i
hd M4uiWd dXM0 ' ' i- , Amft wt l "nor b for IA
act, %6 M i8 a aims vd e
1110912010 09:28 AM F2949 20704 EMBIT B
XL-O.
Pain nha o mpltadaa for w w"W err
a afud,ladlq?, ? M
web Pawn to ab" and ctrl) M;;
I, Christine E. Richar
Company, acknowledge I have U
Insurance Company and certify 1
gathered by my counsel in the pr
counsel and not my own. I have
information which I have given
information and belief. To the e
upon counsel in making this Vei
This statement and Veri
relating to unworn falsificatioi
averments, I may be subject to c
VERIFICATION
s, Subrogation Claims Specialist of ponegalOMutuallnsurance
e authority to execute this Verification on behalf of Donegal Mutual
le foregoing Complaint is based upon information which has been
paration of the lawsuit. The language of this Complaint is that of
ead the document and to the extent the Complaint is based upon
my counsel, it is true and correct to the best of my knowledge,
tent the content of the Complaint is that of counsel, I have relied
cation are made subject to the penalties of 18 Pa. C.S. § 4904
to authorities, which provides that if I knowingly make false
penalties.
DONEGAL MUTOAL INSURANCE COMPANY
Christine E. Richards
F:?aso n.n.r•?C1ueaKwtuoso.s? ?. Ca.?l.i.r
04/04/2011 11:25 AM F2949227
FAFILES\Clients\3050 Donegal\Cutrent\641\3050.641.pral
George B. Faller, Jr., Esquire
MARTSON DEARDORFF WILLIAMS OTTO GILROY & FALLER
MARTSON LAW OFFICES
Attorney I.D. No. 49813
10 East High Street
Carlisle, PA 17013
(717) 243-3341
Attorneys for Plaintiff
OF THEFILED-OFFICE
PR'
ARY
2011 AUG 23 PM 3: 4 7
CUMBERLAND COUNTY
PENNSYLVANIA
DONEGAL MUTUAL INSURANCE
COMPANY, as Subrogee of
THERESA E. BOOTHE,
Plaintiff
V.
BRIAN J. GUILLEN,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 11-3569
CIVIL ACTION-LAW
JURY TRIAL OF TWELVE DEMANDED
PRAECIPE
TO THE CUMBERLAND COUNTY PROTHONOTARY:
Enter default judgment in the above-captioned action in favor of Plaintiff and against
Defendant Brian J. Guillen in the amount of $17,268.40 plus interest and costs of suit as prayed for
in the Complaint, for failure to file an Answer to Plaintiffs Complaint.
I do hereby certify that a written notice of intention to file this Praecipe, in the form attached
hereto, was mailed to the Defendant at the address indicated thereon, on August 4, 2011, which date
was subsequent to the date default occurred and at least ten (10) days prior to the date of the
Praecipe.
MARTSON LAW OFFICES
By e" 0
George B. Faller, ., squire
I.D. No. 49813
Ten East High Street
Carlisle, PA 17013 f y v ?l,(y
(717) 243-3341
Dated: 8/19/11 Attorneys for Plaintiff
cre d?yu?
We e bt4 -led
FAFILEWhenta\3050 Donegal\Current\641\3050.641.tendaynoUajt
George B. Faller, Jr., Esquire
MARTSON DEARDORFF WILLIAMS OTTO GILROY & FALLER
MARTSON LAW OFFICES
Attorney I.D. No. 49813
10 East High Street
Carlisle, PA 17013
(717) 243-3341
Attorneys for Plaintiff
DONEGAL MUTUAL INSURANCE
COMPANY, as Subrogee of
THERESA E. BOOTHE,
Plaintiff
V.
BRIAN J. GUILLEN,
Defendant
TO: BRL4,N J. GUILLEN
DATE OF NOTICE: 8/4/11
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 11-3569
CIVIL ACTION-LAW
: JURY TRIAL OF TWELVE DEMANDED
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.
UL YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT
HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE
CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER.
cc_,-
IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO
PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL
SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE.
DAMAGES WILL BE ASSESSED AGAINST YOU IN THE AMOUNT OF THE REPAIR
ESTIMATE UNLESS YOU FILE A WRITTEN PRAECIPE WITHIN TEN (10) DAYS REQUESTING
A TRIAL ON DAMAGES.
Cumberland County Lawyer Referral Service
Cumberland County Bar Association
32 South Bedford Street
Carlisle, PA 17013
Telephone:(717) 249-3166
MARTSO *?"W
By
George B. Fal r, Jr., Esquir
I. D. Number 49813
Ten East High Street
Carlisle, PA 17013
(717) 243-3341
Attorneys for Plaintiff
F:\FHXS\C11ema\3050 DoiscoTurrent\641\3050.641.aff1
Revised: 7/14111 2:3 2PM
George B. Faller, Jr., Esquire
MARTSON DEARDORFF WILLIAMS OTTO GILROY & FALLER
MARTSON LAW OFFICES
Attorney I.D. No. 49813
10 East High Street
Carlisle, PA 17013
(717) 243-3341
Attorneys for Plaintiff
DONEGAL MUTUAL INSURANCE IN THE COURT OF COMMON PLEAS OF
COMPANY, as Subrogee of CUMBERLAND COUNTY, PENNSYLVANIA
THERESA E. BOOTHE,
Plaintiff NO. 11-3569
CIVIL ACTION-LAW
V. .
BRIAN J. GUILLEN,
Defendant : JURY TRIAL OF TWELVE DEMANDED
AFFIDAVIT OF APPRAISER
I do depose and state that I am a licensed appraiser; that the appraisal of $1,938.40 attached
hereto is true and correct and accurately sets forth the damages to the value of the 2004 Chevrolet
Malibu owned by Theresa E. Boothe and; that I have been engaged in the appraisal business for `
years and am qualified and capable to evaluate the appraisal as attached; and the repairs were
necessary and the value indicated thereon was the amount by which the damages to this automobile
would fairly and reasonably have been evaluated.
This statement and appraisal are made subject to the penalties of 18 Pa. C.S. Section 4904
relating to unsworn falsification to authorities, which provides that if I make knowingly false
averments, I may be subject to criminal penalties.
Print Name
George B. Faller, Jr., Esquire
MARTSON DEARDORFF WILLIAMS OTTO GILROY & FALLER
MARTSON LAW OFFICES
Attorney I.D. No. 49813
10 East High Street
Carlisle, PA 17013
(717) 243-3341
Attorneys for Plaintiff
DONEGAL MUTUAL INSURANCE
COMPANY, as Subrogee of
THERESA E. BOOTHE,
Plaintiff
V.
BRIAN J. GUILLEN,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 11-3569
CIVIL ACTION-LAW
: JURY TRIAL OF TWELVE DEMANDED
AFFIDAVIT AS TO MILITARY SERVICE
COMMONWEALTH OF PENNSYLVANIA )
:SS.
COUNTY OF CUMBERLAND
George B. Faller, Jr., Esquire, being duly sworn according to law, deposes and says that he
has authority to make this affidavit on behalf of his client, and to the best of his knowledge,
information and belief, the Defendant Brian J. Guillen above named is not in the military service of
the United States of America, that he has knowledge that the said Defendant is now living at: 1228
Broadway, Floor 2, Hanover, PA 17331. Said Defendant's place of employment is unknown.
George B. Faller, Jr., Eso/a
Sworn to and subscribed before me
this,ja?#4_ day of , 2011.
91,
N Public cMWWWEU.TH OF PENNSYLVANIA
Sam
Mary m. Prig, No
tuy Publk
.18 2015
01*110
VMy1A TWN WARM
George B. Faller, Jr., Esquire
MARTSON DEARDORFF WILLIAMS OTTO GILROY & FALLER
MARTSON LAW OFFICES
Attorney I.D. No. 49813
10 East High Street
Carlisle, PA 17013
(717) 243-3341
Attorneys for Plaintiff
DONEGAL MUTUAL INSURANCE
COMPANY, as Subrogee of
THERESA E. BOOTHE,
Plaintiff
V.
BRIAN J. GUILLEN,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 11-3569
CIVIL ACTION-LAW
: JURY TRIAL OF TWELVE DEMANDED
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA )
: SS
COUNTY OF CUMBERLAND
George B. Faller, Jr., Esquire, being duly sworn according to law, deposes and says that he
is an employee of MARTSON DEARDORFF WILLIAMS OTTO GILROY & FALLER, attorneys
for the Plaintiff in the above captioned matter and that pursuant to the provisions of the Pennsylvania
Rules of Civil Procedure, a notice of intention to enter default judgment against the Defendant Brian
Guillen was given to him by mail on August 4, 2011. Z4 ew
George . Faller, Jr., Es it
Sworn to and subscribed before me
this o2,VQ day of ?µoti , 2011.
(24L
No ublic
COMMONWEALTH OF PENNSYLVANIA
NOOKM Seal
Mary M. Price, Notary Publk
Carme Boro, cumberland county
My CAroniMOn 18, 2015
MENSK FENNMVAMA ANDUATM OF NOTARIES
CERTIFICATE OF SERVICE
I, Nichole L. Myers, an authorized agent of MARTSON DEARDORFF WILLIAMS OTTO
GILROY & FALLER, hereby certify that a copy of the foregoing Praecipe was served this date by
depositing same in the Post Office at Carlisle, PA, first class mail, postage prepaid, addressed as
follows:
Mr. Brian Guillen
1228 Broadway, Floor 2
Hanover, PA 17331
MARTSON LAW OFFICES
By C?r?r?
Nichole L. Myers
Ten East High Street
Carlisle, PA 17013
(717) 243-3341
Dated: 8/19/11
George B. Faller, Jr., Esquire
MARTSON DEARDORFF WILLIAMS OTTO GILROY & FALLER
MARTSON LAW OFFICES
Attorney I.D. No. 49813
10 East High Street
Carlisle, PA 17013
(717) 243-3341
Attorneys for Plaintiff
DONEGAL MUTUAL INSURANCE
COMPANY, as Subrogee of
THERESA E. BOOTHE,
Plaintiff
V.
BRIAN J. GUILLEN,
Defendant
TO: BRIAN J. GUILLEN, Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 11-3569
CIVIL ACTION-LAW
JURY TRIAL OF TWELVE DEMANDED
NOTICE OF ENTRY OF DEFAULT JUDGMENT
You are hereby notified that on the of 3 /Zt day of , 2011, the following
Judgment was entered against you in the above-captioned action: judgment in the amount of
$17,268.40, plus interest and costs of suit as prayed for in the Complaint for failure to file an Answer
to Plaintiff's Complaint.
Date:
Prothonotary
I hereby certify that the name and address of the proper person to receive this notice under
Pa. R. Civ. P. 236 is:
Mr. Brian Guillen
1228 Broadway, Floor 2
Hanover, PA 17331