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Home My WebLink About04-6337 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION MUTUAL BENEFIT GROUP vs. No. 01..1- 1033, (liv, L'-T~ COMPLAINT Plaintiff( s) RILLO'S RESTAURANT, INC. Defendant FILED ON BEHALF OF Plaintiff( s) COUNSEL OF RECORD OF THIS PARTY: NICHOLAS D. KRAWEC, ESQUIRE PA ID #38527 CHRISTOPHER M. BOBACK, ESQUIRE PA ID #91730 Bernstein Law Firm, P.c. Firm #718 Suite 2200 Gulf Tower Pittsburgh, P A 15219 412-456-8100 DIRECT DIAL: (412) 456-8114 BERNSTEIN FILE NO. C0053413 )ecember 10, 2004 )age 2 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION MUTUAL BENEFIT GROUP Plaintiff vs. Civil Action No. RILLO'S RESTAURANT, INC. Defendant NOTICE AND COMPLAINT 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 upon you, 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 Plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION Two Liberty Avenue Carlisle, P A 17013 Telephone: 717-249-3166 (1-800) 990-9108 cjh001677V001 12/10/2004 )ecember 10, 2004 )age 3 COMPLAINT 1. Plaintiff is a corporation having offices in Huntingdon, Pennsylvania. 2. Defendant is a corporation having its offices and place of business at 50 Pine Street, Carlisle, Cumberland County, Pennsylvania 17013. 3. On or about February 11,2004, Defendant made application to Plaintiff for ceratin insurance coverage. 4. At the specific instance and request of Defendant, Plaintiff issued to Defendant certain BusinessOwners Policy numbered BU00914128 and Workers Compensation insurance policy numbered WC04914128. True and correct copies of the Declaration Pages are attached hereto, e marked Exhibit "I", and collectively made a part hereof. 5. Defendant received and accepted the aforementioned insurance coverage. 6. The premiums charged by Plaintiff were based upon insurance rules and regulations in effect at the time the policy was issued. 7. The premiums charged by Plaintiff were the premiums that Defendant agreed to pay. 8. Plaintiff avers that the balance due amounts to $5,430.00. 9. Plaintiff claims legal interest as damages on the liquidated debt from March 3, 2004Plaintiff avers that interest amounts to $252.50 to December 13,2004. 10. Although repeatedly requested to do so by Plaintiff, Defendant has willfully failed and refused to pay the aforesaid balance, interest, or any part thereof to Plaintiff. cjhOO1677VOO1 12/10/2004 )ecember 10, 2004 )age 4 WHEREFORE, Plaintiff demands Judgment against Defendant in the amount of $5,682.50, with continuing interest thereon at the rate of 0.5% per month and costs. Respectfull y submitted, BERNSTEIN LAW FIRM, P.C. By: Christopher M. Boback, Esquire Attorney for Plaintiff P A I.D. #91730 Suite 2200 Gulf Tower Pittsburgh, P A 15219 (412) 456-8103 cjh001677V00l 12/1 0/2004 @MUfualBenent Insurance Company BUSINESSOWNERS ~~~~ uruce I...opy A member of Mutual Benefit Group POLICY Transaction Date: 3/03/2004 . . 409 Penn Street, PO Box 577 Effective Date: 2/11/2004 Itl Huntingdon, Pennsylvania 16652-0577 FINAL AUDIT . DIRECT BILLED T'FiiS Ut::I,.;LAKAIIUN::; together with the buslnessowners I-'ollcy {WhiCh consists ot applicable r-orms and t::ndorsements, It any, Issued to torm a part ot It) completes this policy. Policy Number BU00914128 Previous Number BU00914128 Year Risk New 2001 '.jY'Nanieti,illsUred' and Address:.... :::: ""ProduterNam~ 'and .Address; ':~:i~.:~;:t~:;:?;~w>r:~,i:'<&'~f"'COaeA;',;{', RILLO'S INC HOPCRAFT HOCKLEY & O'DONNELL M4782 50 PINE ST INSURANCE AGENCY CARLISLE PA 17013 1 VALLEY STREET SUITE 101 PO BOX 116 CARLISLE PA 17013-0116 Phone 717-243:3915 ~:;~g~:~tfl~;t.iil~~ijO~~l ?/11/3g~1 ~~IL~i~b/;g~RAGE _ sp~2~~~m. standar~~~~:~;~r ~~~i:~;s~ a:;;~IAL ;4,~iMgUg~~{~B~~!:~tl 6. Described Premises SF.F. MORTGAGF.F. SCHF.DUT,F.' t:':~]ij$.U~T~;l~' CORPORATION If more than two locations, see Additional Declarations 001 001 50 PINE STREET CARLISLE PA 17013 RESTAURANTS CUMBERLAND CO t~;CO~(J.'rage$:~jj(t":lmJt$::ijflP'sql1i~~;'i~t[~t~rt.\F'i~:lln return for the payment of the premium. and subject to all the terms of this policy, we agree with you to provide the insurance. as stated in this policy. Audit premiums are due within 30 days of the aUI~~"b!I.lin9 d"f1te'__c.n_ ~.n .n..... c. nn__';,_j ....!-. Business Max _ Wholesaler Max UMrrsOF.1NSURANCE 1 PROPERTY COVERAGES . PREM. NO. BLDG. NO. PREM. NO. BLDG. NO. Deductible $1,000 001 001 Buildings $ 771/000 $ tl Business P~rs.,nal Property $ 150 , 000 $ U Business Income and Extra Expense (also included if blank) $ $ ~ Actual Cash Value. Buildings Option (YIN) N 1 Actual Cash Value. Business Personal Property Option (Y/N) N o Building - Automatic Increase (2 percent if blank) . :CJ~$llnV:~AN(f"EQJ.CAe~~lYM'EHr$:~Y;~~~~': ~~:;~~E" . --~~+,.:~+~~~ ':~~"+""""~7:':' .~~: :~~.;:~7";:~ ~:~:. Except for Fire Legal Liability. each paid claim for be IClII:>V\'l:'Ig coverages reduces the al:,io~iii oi",n"su;an::ewe pr;\'ldedUlI;g the a;:pli:able"ann':ial poli;;- Please refer to Paragraph 0.4. of the Businessowners Liability Coverage Form. LIMITS OF INSURANCE Uability and Medical Expenses $ 1,000 1000 Medical Expenses Per Person $ 5,000 Fire Legal Uability Any One Fire or Explosion $ . 50, 000 I $ 'QeTloNAI,t::CQY~G~~'~~ppii.cab~..9~i\1i-l{~jtX"~JiijQi!~jiJ:kt#~:~.~~~~~:'f~'~:l1:'+'.~.:W}};~,~:}{(t"X: UMIT$OF'I~SUF.lANCE'.~~':.'.:' X Backup of Sewer and Drains Per Occurrence $ 10 , 000 X Outdoor Property (Including Signs) Per Occurrence $ 10,000 Burglary and Robbery (BPP Standard Form) Inside the Premises $ . 20, 000 or Outside the Premises $ 15,000 X Money and Securities (BPP Special Form) X Employee Dishonesty Per Occurrence $ X Forgery or Alteration Per Occurrence $ X Off.Premises Business Personal Property Per Occurrence $ : 15,000 10,000 10,000 .8:f'()rm$ifl1f:f.:l;ijdoi$imj~:[lipptl~te; ~t:~3~.~:?~~~:!l1F~&t;:{~~ti~1~;;;i]H~i~~:i;~Ul~f~'~1jEj~:J.;X{tW;t'i..~':;f:t;:\]t~i'~i.;~;~:~'t~~r;f.~;;iiU)n~~i1~jMi}~t..;~~~.;..;;i;'i:~:~~~'H~t:;i~.:'~.~{1.}'...... AL00010300 BOPMORT112 BP00021299 BP00060197 BP00090197 BP04300196 BP05140103 BP05341102 BPOS381202 BP05421102 BU00300791 BU003S0498 BU00380800 BU00410500 IL02460900 IL09100702 LIAY2K1098 MBBP100498 PROY2K0499 TRIANC0103 000MBG0798 . ~/P4Iicy~ieIij_iUl1i:~iil Total Premium $ 6/709.00 Total Due $ EXH' BIT.).~te 6,709.00 Additional $ 154.00 Countersigned By Authorized Representative This policy shall not be valid unless countersigned by our authorized representative, MB-BP-100 (4/98) @:Mutual Benefit Insuranc~ Coillpany . . A member of Mutual Benefit Group , . 409 Penn Street, PO Box 577 c;. Huntingdon, Pennsylvania 16652-0577 WORKERS' COMPENSATION DECLARATION rtome vrrlce ~opy Transaction Date: Effective Date: 3/03/2004 2/11/2004 NCCI # 16500 FINAL AUDIT DIRECT BILLED Policy Number WC04914128 i1. Nam~c;lliisured and Address - - . RILLO'S INC 50 PINE ST CARLISLE PA 17013 FED. ID# 232370267 RISK ID# 208706 Previous Number Year Risk New 2003 -. ,.,.....,~'..}..,'..:..,.. . producer Nameand Address ~ .' ,:;,..~..~ :i; Code- :.:';j HOPCRAFT HOCKLEY & O'DONNELL M4782 INSURANCE AGENCY 1 VALLEY STREET SUITE 101 PO BOX 116 CARLISLE PA 170130116 Named Insured is: CORPORATION Phone 717 - 243 .3915 '2:Po1icytemf:'"'C~c"::: "F'ROlf',-711'7?'no',' fo:::2/ll72D:OL+:=.:.:"":~c, .- .f?~9j' a.m~ sta_ndarittime afther~siden.ce preiiti~~..~ ; .3A. Work(!rs' Compensation Insurance: I Part One of the policy applies to the Workers' Compensation Law of the states listed here: . PA 3B.. Employers Liability IQsurarice: ..~ _ Part Two of t~e_ policy appl.iest? work i':1 each state listed in i~em ~A. ~e Limits of ~ur liability ..~_~::'.J -'-:': '. ..<.:-'.:''<.':-':.'i:~''}._~:''~:~,;,~:~~: ~.~~~~_~.~~':l.~~r.:~re:.~::;~-:. ...~.~~::;._> ~~. ...:~~_...:..._):::;- :;':2':2:_2f;~:'-:'.~~:~~'.'::"". ..~ Bodily Injury by Accident Bodily Injury by Disease Bodily Injury by Disease ..E.~_~::~~doe_nt..__ ~:~~~:IOyee -. _ r-' -_.- .... ...~:~~~;~mi~. -- - - I ~~::~Qtljgtstal~~IJ:j~_ijtarice,m~~i Part Three of the policy applies to the states, if any, listed here: All s ta tes except NV, ND, I OH, WA, WV, WY and states designated in item 3a of the information pagel I 3D. This Policy Includes tl:Jese endorsements and sciledules:-'-;'- TP.IANC0103 OWCOOOOOOA OWC000001A ~-\Jw~~Ob01B uuwcomr~oo-oo~~~vC~i? ov~:oa042a-vOK:37~cOl 00wC370602 00WC370603 000MBG0798 J)~. G.Iassific;.!!~.ioJ)s 37 CLERICAL OFFICE 37 RESTAURANT - NOC 4J:>r~ffifiirik7~;r~j The premium for this policy will be determined by our manuals of rules, classifications, rates and rating plans. All information required below is subject to verification and change by audit. Audit premiums are due within 30 days of the audit billing date. ~~~r~qi~~!~W~~!#~}jt~'~,::::~-;,~:fi:~:~-F~~~"!;Y;W~~,~~b~~-(;~'~';~~l'{;\~~i,t~l~;:;J~;~;'::Fi::ct~U:~ij!riIutrt-~~~!~~-:'0'~:Jt;!::\~~:~;~!';;:C,~W'.::';j~~~\~]$;:{l~;~;,~:{:~J;\tj( --" Total Estimated Rate Per$100 of Estimated CI;>~e._No.._ . ___Ann~al R~l11ufl_erati91).: ... Rel1)~.mer.~~io!l Annual Cost 0953 21,377 .3600 $77.00 0975 638,763 2.9400 $18,780.00 Premium for Increased Limits Part Two, If Applicable Increased Limits Minimum Premium Total Premium Subject to the Experience Modification Premium Modified to Reflect Experience Mod of . 9440 9 89 8 - P A Schedule Rating Modification. Other Premium Charges Total Estimated Standard Premium Premium Discount, If Applicable 0063 Loss Constant Charge Expense Constant Charge 0900 Other Premium Charges Terrorism Risk Insurance Act Employer Assessment 0938 1.0337 $.00 $.00 $18,857.00 $17,801. 00 $.00 $.00 $17,801. 00 $1,395.00- $.00 $165.00 $.00 $.00 $558.00 Minimum Premium $459.00 Total Estimated Annual Cost Policy Cost Change $17,129.00 $5,276.00 WCOO 00 OlA , . -If ':)-1 q 7:) / ... ,.,.. - VERIFICATION The undersigned does hereby verify under penalty of peI]ury, that he/she IS R--em. RvdJ- gu..puvl~ of ;i1.v.hw.&mfll- [l,vD1f-(> , Plaintiff herein, that he/she is duly authorized to make this Verification and that the facts set forth in the foregoing COMPLAINT are true and correct to the best of his /her knowledge, information and belief. (n~)~ (Sign in Blue Ink) .~ . t. . - . . Aj ~ ~ 1t .~ " --CJ c; ~ ~ ("1 ,......".) " " ,." -<:: ,,) -11 6; ;it! '-"1 : C-. ~ , -' r.-: Co -.- f c"' ~~ ,.' ..' -~, -,~ , -,'.. .1:.- .. -" 4 - - - , c> .-<0.: f IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION MUTUAL BENEFIT GROUP Plaintiff(s) No. 04-6337 vs. PRAECIPE TO SETTLE, DISCONTINUE AND END RILLO'S RESTAURANT, INC, Defendant( s) FILED ON BEHALF OF Plail1tiff( s) COUNSEL OF RECORD OF THIS PARTY: NICHOLAS D. KRAWEC, ESQUIRE PA ID #38527 CHRISTOPHER M. BOBACK, ESQUIRE PA ID #91730 Bernstein Law Firm, P,c' Firm #718 Suite 2200 Gulf Tower Pittsburgh, P A 15219 4] 2-456-81 00 DIRECT DIAL: (4]2) 456-8114 BERNSTEIN FILE NO. C00534I3 . 'ebrua~v 24, 2005 )age 2 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION MUTUAL BENEFIT GROUP Plaintiff vs. Civil Action No. 04-6337 RILLO'S RESTAURANT. INC. Defendant PRAECIPE TO SETTLE. DISCONTINUE AND END TO THE PROTHONOTARY OF CUMBERLAND COUNTY: Settle, discontinue and end the above-captioned matter upon the records of the Court and mark the costs paid. BERNSTEIN LAW FIRM, P.c. C/7rM1IL By: Attorneys for Plaintiff Suite 2200 Gulf Tower Pittsburgh, P A 15219 (412) 456-8100 BERNSTEIN FILE NO: C0053413 Sworn to and subscribed before me this A'~ day of ~ .2005 ~/7'~ Notary. blic Notarial SeaJ U Mary E. Keaney. Notary Public mJ,Of Pittsburgh, Allegheny County MY-.::'-:~Ion Expjms Mar. ii, 20(!G. Member, ;~)enns\~:';~':~'."' """ ';'1tJon Of Notarie~ cjhOOItl.63VOOI 2/24/2005 ,\ ;"":' c- C' e,) - ~ SHERIFF'S RETURN - REGULAR CASE NO: 2004-06337 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND MUTUAL BENEFIT GROUP VS RILLO'S RESTAURANT INC BRIAN BARRICK , Sheriff or Deputy Sheriff of Cumberland County, Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT & NOTICE was served upon RILLO'S RESTAURANT INC the DEFENDANT , at 1355:00 HOURS I on the 22nd day of December, 2004 at 50 PINE STREET CARLISLE, PA 17013 by handing to SUE PALUMBO, CHEF, ADULT IN CHARGE a true and attested copy of COMPLAINT & NOTICE together with and at the same time directing Her attention to the contents thereof. Sheriff's Costs: Docketing Service Affidavit Surcharge So Answers: 18.00 3.70 .00 10.00 .00 31.70 ..:.-~~:~~~_...,~ ~~ r ~"~ tI'.'--l"-" '-'.<;;~.''''''_ ~ R. Thomas Kline ~ Sworn and Subscribed to before By: . /!I!-> me this /0--' day of .~ / l C%. <.J{r~..:c, thonotary ,',-7