PROGRESSIVE CHOICE INSURANCE VS KULDEEP SINGH

Complaint Information

SHORT TITLE:

, , 1003-011532400 2013011521:21 Lea & Nivinskus (714 sfrbk 'PHW% Progressive vs Kuldeep Singh

10. The following causes of action are attached and the statements above apply to each: (each complaint must have one or more causes of action attached.)

a. Motor Vehicle b. General Negligence C. Intentional Tort - d. [__] Products Liability e. Premises Liability f. [ XJother (specity):

SEE PAGE 5 ATTACHMENT

11. Plaintiff has suffered a.[ ] wage loss b. IXI loss of use of property c.[ ] hospital and medical expenses d. ] general damage e. [ X] properly damage f. [_Tioss of earning capacity g. [_lother damage (specify):

12._1The damages claimed for wrongful death and the relationship of plaintiff to the deceased are a. [__liisted in the Complaint-Attachment 12. b. [:l as follows:

13. Relief sought in this complaint is within the jurisdiction of this court.

14. PLAINTIFF PRAYS for judgment for costs of suit; for such relief as is fair, just, and equitable; and for a. (1) compensatory damages (2) [ ] punilive damages b. The amount of damages is (you must check (1) in cases for personal injury or wrongful death): (1) [ ] according to proof. . (2) EX:I in the amount of” $5,185.88 plus pre-judgment interest at the rate of 10% per annum, pursvant to CCP § 3291.

15. [ XIThe following paragraphs of this complaint are alleged on information and belief (specify paragraph numbers): All

Date: January 11, 2013

.., MarkR. Nivinskus 6 of 10

PLD-PI-001 [Rev January 1, 2007} Page three of three

PLD-PI-001 [Rev January 1, 2007} Page three of three SHORT TITLE: CASE .«UMBER: Progressive vs Kuldeep Singh 1003-011532400 2013011521:21 Lea & Nivinskus (714)533-8828 Page 7 of 10

SHORT TITLE: CASE .«UMBER: Progressive vs Kuldeep Singh 1003-011532400 2013011521:21 Lea & Nivinskus (714)533-8828 Page 7 of 10

Fis,_ CAUSE OF ACTION-Motor Vehicle

ATTACHMENT TO [X]Complaint [__] Cross-Complaint (use a separate cause of action form for each cause of action.) Plaintiff (name): PROGRESSIVE CHOICE INSURANCE COMPANY

MV-1. Plaintiff alleges the acts of defendants were negligent; the acts were the legal (proximate) cause of injuries and damages to plaintiff; the acts occurred on (name): July 31, 2012 at (place). Willow Rd & Bayshore Dr, Menlo Park, CA 94025

MV-2. DEFENDANTS . a. The defendants who operate a motor vehicle are (names): Kuldeep Singh

[X1boes ONE to TWENTY

b. [ XJ The defendants who employed the persons who operated a motor vehicle in the course of their employment are (names):

Does _ONE_to _TWENTY C. The defendant who owned the motor vehicle which was operated with their permission are (names):

[XJDoes _ONE_to _TWENTY d. [ Xthe defendants who entrusted the motor vehicle are (names):

[X]Does ONE to TWENTY

e. [ XJThe defendants who were the agents and employees of the other defendants and acted within the scope of the agency were (names):

Does _ONE to TWENTY t. (X0 The defendants who are liable to plaintifts for other reasons for the liability are [:llisted in Attachment MV-2f as follows: