Subpoena - Melissa Names v AecomIIIIIIIIIIIIIIHIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
CAii04987-002
LOCATION SERVE
CITY OF CUPERTINO PUBLIC WORKS
10300 TORRE AVENUE
CUPERTINO, CA 95014
ATTN: EMPLOYMENT & PAYROLL RECORDS CUSTODIAN
CASE NAME:MELISSA NAME,S v AECOM
30189291662-0001
DECEUVE
SEP 1 3 2022
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CUPERTINO CITY CLERK
FILE NO.:
PM3
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CA1104987-002
CITY OF CUPERTINO PUBLIC WORKS,
4 0300 Torre Avenue
Cupertino, CA 95014
CA1104987-002
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COMPEX Compex Order #:CA1104987-002
Hello! Sedgwick has assigned Compex as the deposition officer to obtain records to assist in resolving a dispute
involving Melissa Names.
City Of Cupertino Public Works was named as a keeper of documents that are required for resolution of the disputed
matter. Please see the attached Payroll/Employment/Medical for the specific items and/or documents being requested.
Your time is valuable, and we know it! Please review the following information for proper production and to avoid
follow up phone calls from Compex.
3 Simple Steps to Completion:
€ Prepare records for sending by 09/26/2022.
€ Sign and Date the Custodian Affidavit and include the document with the prepared records.
Note: Complete the "Certification of No Records" for any records that cannot be provided.
€ Send the records and the Custodian Affidavit and/or Certificate of No Records to Compex.
Options include:
1. Mail records or physical items to our nearest office location:
325 Maple Avenue, Torrance, California, 90503
2. Upload to our secure custodian portal at cpxlegal.com. If you do not have an account, you can self-register!
3. Fax the records with the Custodian Affidavit as the cover sheet to 888-531-2922
4. E-mail the records to records@compexlegal.com
If prepayment iS required: Fax invoices to 888-531-2922 or email them to records@compexlegal.com
To cover the cost of providing the requested documents or items, you may submit an itemized invoice for payment,
Please ensure the invoice adheres to the fee schedule as defined in your state codes. We want to pay you quickly,
please indicate on your invoice if you accept credit card payments.
Do you have questions regarding the fee schedule in your state? Just give us a call!
Something else needed? Please contact us:
Phone: 877-223-1929
Email: cservice@compexle@al.com
***lf we do not receive a response by 10/04/2022, we will begin escalating based on our company process, including sending
demand letters and increasing the frequency of calls to your office***
Have a great experience and want to tell us about it? Did something go wrong and we need to make some adjustments?
You have a direct line to our Operations Directors. Call 800-788-2001 Ext. 4309 and leave a message or send an email to
opsdir@compexlegal.com. You will receive a response within 48 hours.
CA1104987-002
STATE OF CALIFORNIA
DEPAR'nVIENT OF INDUSTRIAL RELATIONS
DIVISION OF WORKERS' COMPENSATION
WORKERS' COMPENSATION APPEALS BOARD
CaseNo. ADJ11306652
MELISSA NAMES
Claimant/Applicant,
(IF APPLICATION HAS BEEN FILED, CASE NUMBER
MUST BE INDICATED REGARDLESS OF DATE OF INJLIRY)
SUBPOENA DUCES TECtJM
VS.
(When records are mailed, identify them by using above
Case number or attaching a copy of subpoena)
AECOM Where no application has been filed for injuries on or after
January 1, 1990 and before January 1, 1994, subpoena will
be valid without a case number, but subpoena must be sei'ved
on claiinant and employer and/or insurance carrier.
Employer/Insurance Camer/Defendant.See inshuction below.*
The People of the State of California Send Greetings to:
CITY OF CUPERTINO PUBLIC WORKS
10300 TORRE AVENUE
CUPERTINO, CA 95014
WE COMMAND YOU to appear before COMPEX LEGAL SERVICES
at 325 MAPLE AVENUE, TORRANCE, CALIFORNIA, 90503
on the 26th day of September, 2022 at O9:00 o'clock A.M. to testify in the above entitled matter and to big with you
and produce the following described docui'nents, papers, books and records:
SEE ATT ACHMENT 3
(Do not produce X-rays unless specifically mentioned above.)
For failure to attend as required, you may be deemed guilty of a contempt and liable to pay to the parties aggrieved all
losses and dainages sustained thereby and forfeit one hundred dollars in addition thereto.
This subpoena is issued at tbe request of the person making the declaration on the reverse hereof, or on the copy which is
served herewith.
Date: 09/06/2022 WORKERS' COMPENSATION APPEALS BOARD
OF THE STATE OF CALIFORNIA
Secretary, Assistant Secretary, Workers' Compensation Judge
*FOR INJtJRIES OCCURING ON OR AFTER JANUARYI, 1990
AND BEFORE JANUARY 1, 1994
If no Application for Adjudication of Claim lias been filed, a declaration under
penalty of perjuxy tbat the Ennployee's Claim for Workers' Conipensation Benefits
(FOIITI DWC-1) lias been filed pursuant to Labor Code Section 5401 must be
executed properly.
SEE RF.VERSE SIDE
[SUBPOENA INVALID WITHOUT DECLARATION]
You may fully comply with this subpoena by mailing the records described (or authenticated copies Evid. Code 1561) to the person and place
stated above within ten (10) days of the date of service of this subpoena.
This subpoena does not apply to any member of the Highway Patrol, Shei'iff's Office or city Police Depaitnient unless accompanied by notice
Jrom this Board that deposit of the witness fee has been made in accordance with Govei'nment Code 68097.2, et seq.
DWC WCAE3 32 (Side I) (REV. 06/18)
DECLARATION FOR SUBPOENA DUCES TECUM
Ca"eNO. ADJ11306652
STATE OF CALIFORNIA, County of SANTA CLARA
The undersigned states:
That he /she is (one of) the attorney(s) of record / representative(s) for the applicant/defendant in the action captioned
on the reverse hereof. That the subpoenaed Custodian of Records
has in his/her possession or under his/her control the documents described on the reverse hereof. That said documents are
material to the issues involved in the case for the following reasons:
To assist in determining one or more of the following: To determine present and/or past physical conditions; nature, extent and
duration of sickness; injury, disability arising out of employment and in the course of employment and/or necessity of further
treatment; employment occupation and duties, earnings and eaniings capacity self-procured and futiu'e medical treattnent, vocational
rehabilitation under Labor Code 129.5 and status as Q.I.W (Qualified Injured Worker).; Jiuisdiction and statute of limtations. If no
objection is made by any party to this case prior to copying then no valid objection exists.
Declaration for Injuries on or After January 1, 1990 and Before January 1, 1994
[g That an Employee's Claim for Workers' Compensation Benefits (DWC Form 1) has been filed in accordance with
Labor Code Section 5401 by the alleged injured worker whose records are sought, or if the worker is deceased, by the
dependent(s) of the decedent, and that a tnie copy of the form filed is attached hereto. (Check box if applicable and
part of the declaration below. See instructions On front of subpoena.)
I declare under penalty that the foregoing is true and correct
Executed on 09/07/2022 , at LONG BEACH California.
/S/ TERI KERR
Signature
SEDGWICK
3760 KILROY AIRPORT WAY, S{JITE
400
LONG BEACH, CA 90806
Address
562-492-1800
Telephone
DECLARATION OF SERVICE
STATE OF CALIFORNIA, County of
I, the undersigned, state that I served the foregoing subpoena by showing the original and deliveffig a tnie copy thereof,
together with a copy of the Declaration in support thereof, to each of the following named persons, via , at the
date and place set forth opposite each name.
Name of Person Served Date Place
10300 TORRE AVENUE
CUPERTINO, CA 95014
I declare under penalty of perjui'y that the foregoing is tnue and correct
Executed on
Signature
CA1104987-002
CA1104987-002
ATT ACHMENT 3
PERTAINING TO:
Melissa Names
Date of Birth: l 1/08/1965, Social Security Number: 570-65-9679
Any and all non-privileged records stored in any format or method, including but not liinited to payroll records, payroll
history, personnel files and personnel records, coinmission istory, attendance records, perfonnance evaluations,
employment applications, resuine, job description and duties, pay scale, payment histories, W-2 wage and tax statement;
W-4 forms, disability notes ai'id records, workers compensation infonnation and/or claims, workers compensation
payments, medical records in file including records regarding work related injuries, pre-employment exams, amiual
physicals, physical fitness programs, lien claims, insurance infonnation, I-9 fomis, work absence records, employee
progress reports, explanation of benefits, payments, and any other records maintained.
CA1104987-002
AITORNEY OR PAIITY WjTHOlff ATTORNEY TELEPHONENO
TERI KERR (BAR # ) 562-492-1800
S:'DGWICK
3760 KILROY AIRPORT WAY, SUITE 400, LONG BEACH, CA 90806
ATTORNEY FOR: AECOM
FOR COURT USE OIY
WCAB, COUNTY OF SANTA CLARA
SIREET ADDRESS: 100 PASEO DE SAN ANTONIO, #241
MAILING ADDRESS:
crry AND ZIP CODE: SAN JOSE, 95113
BRA1%TCHNAME: SAN JOSE WCAB
PLAINTIFF/PETITIONER. MELISSA NAMES
DEFENDANT/RESPONDENT: AECOM
CASENUMBER: ADJ11306652
NOTICE OF DEPOSITION
NOTICE TO ALL PARTIES AND THEIR ATTORNEY(S):
1. The production of documents by tlie Custodian of Records of the following business will be required as follows:
CITY OF CUPERTINO PUBLIC WORKS
10300 TORRE AVENUE,
CUPERTINO, CA 95014
DATE
09/26/2022
TIME
09:00 AM
NO DEPOSITION TESTIMONY WILL BE TAKEN, the deponent need not appear if he or she complies with
Evidence Code Sections 1560 through 1566, and Code of Civil Procedure Section 2018 through 2021. True, legible
and durable copies of all docuinents described in the Affidavit supporting Subpoena Duces Tecum, which are certified
by the above nained Custodian will be accepted as sufficient compliance by said Custodiaii.
Date: 09/06/2022
TERI KERR
(Type or Pmt Name)
/S/ TERI KERR
(Signature)
ATTORNEY AT LAW
(Title)
NOTICE OF DEPOSITION c.c.p. 1985
REQUEST: CA1104987
I am employed in Los Angeles County, California. I am over the age of 18 and not
a party to the within action; my business address is: 325 Maple Avenue
Torrance, CA 90503
On 09/07/2022, I gave notice to: SEE SERVICE LIST BELOW
On the above date, I served true copies of the following docunnents;
Subpoena
To each party appearing in this action, at the address below, by placing true copies thereof enclosed in a sealed envelope
with postage fully pre-paid, in the United States mail at 325 Maple Avenue
Torrance, CA 90503
I declare ui'ider penalty of perjui'y under the laws of the State of Califoinia that the foregoing is true and
correct, and that this declaration was executed on 09/07/2022.
Marlene Marquez
Butts & Johnson
Thoinas J. Butts
675 North First Street, Suite 975
San Jose, CA 95112
Proof of Service by Mail
REQUEST: CA1104987
I am employed in Los Angeles County, Califoia. I am over the age of 18 and not
a party to the within action; my business address is: 325 Maple Avenue
Torrance, CA 90503
On 09/07/2022, I gave notice to: SEE SERWCE LIST BELOW
On the above date, I served true copies of the following docui'nents;
Subpoena
To each party appearing in this action, at tlie address below, by placing tnie copies thereof enclosed in a sealed envelope
with postage fully pre-paid, in the United States mail at 325 Maple Avenue
Torrance, CA 90503
I declare under penalty of perjuiy under the laws of the State of California that the foregoing is true and
correct, and that tliis declaration was executed on 09/07/2022.
Marlene Marquez
D'Andre Law LLP
Teresa Pagan
6203 San Ignacio Ave., #l 10
San Jose, CA 95119
PROOF OF SERVICE BY MAIL
COMPEX LEGAL SERVICES
AFFIDAVIT - (Pursuant to Cal Evidence Code 1561)
CA1104987-002
I hereby declare under penalty of perjury that the following statements are ti'ue to the best of my knowledge and belief.
I ain over the age of 18 and the duly authorized custodian of records for:
CITY OF CUPERTINO PUBLIC WORKS
10300 TORRE AVENUE, CUPERTINO, CA 95014
and have the authority to certify that the records made available to COMPEX LEGAL SERVICES for reproducing
are all of the records under my custody and control, described and called for in the S{JBPOENA/Authorization
served with this declaration in the matter relating to said individual or thing pertaining to:
RECORDS OF: MELISSA NAMES
AKA:
DATE OF BIRTH:
SOCIAL SECURITY#:
11/08/1965
570-65-9679
HOW ORIGINAL RECORDS WERE PREPARED
g HANDWRITTENNOTES
€ TRANSCRIBED
@ TYPED/DATAENTERED
@ OTHER
TYPE OF RECORDS PRODUCED
@ MEDICAL [1] BILLIING @ FILMS
€ PAYROLL
@ INSURANCE
@ SCHOLASTIC
0 0THER
Said records were prepared by personnel of the business in the ordinary course of business at or near the time of the
act, condition, or event. I have delivered all of the records/items requested with the following exception(s):
CUSTODIAN NAME (PLEASE PRINT)PHONE NUMBER
SIGNATURE OF CUSTODIAN DATE
I AM THE ATTORNEY'S REPRESENTATIVE .Aa'JD I STATE THAT I MADE TRUE COPIES OF
ALL THE ORIGINAL RECORDS DELIVERED TO ME BY THE CUSTODIAN OF RECORDS OF
THE ABOVE LOCATION.
I DECLARE UNDER PENALTY OF PERJURY & UNDER THE LAWS OF THE ST ATE OF CALIFORNIA
THAT THE FOREGOING IS TR?JE AND CORRECT.
DATE SIGNATURE PRINT NAME
PURSUANT TO BUSINESS & PROFESSIONS CODE SECTION 22462, I WILL MAINTAIN THE n%lTEGRITY & CONFIDENTIALITY OF ANY AND ALL
INFORMATION OBTAINED, AND DISTRIBUTE THE RECORDS COPIED BY COMPEX LEGAL SERVICES TO THE AUTHORIZED PERSON OR ENTITIES.
Certificate of No Records
CA1104987,002
Record Subject: MELISSA NAMES
AKA:
DOB:
SSN:
11/08/1965
570-65-9679
I, the undersigned, being the duly authorized custodian of records or other qualified witness for the following entity:
CITY OF CUPERTINO PUBLIC WORKS
10300 TORRE AVENUE
CUPERTINO, CA 95014
With personal lmowledge of the facts set forth below, and authority to certify said facts, do herby attest as follows:
1 ) A complete and thorough search of all active, inactive, and stored files has been made for the records.
2 ) All identifying infonnation provided, including but not limited to, dates of birth, social security numbers, file ntnnbers,
dates of treatii'ient or service, and names of involved parties was used in the search.
3 ) All possible infonnation that can be used to search for the records of the record subject named above was provided,
and no further search with additional information is possible.
4 ) All branch offices and other business locations for the entity listed above have been searched.
5 ) All records from all branch offices and other business locations for the entity listed above have been provided.
6 ) The entity listed above has no separate private records or other separate files, including consultations, treatment
classifications or chronological files that were in any way excluded from the search for these records.
7 ) To the best of my knowledge and belief, the entity listed above does not now and never has operated under other
names or at other locations that were in any way excluded from the search for these records.
B) To the best of my knowledge and belief, none of the requested records currently exist.
For any "No" answers, please provide a detailed explanation:
Yes No
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The records called for and described cannot be produced for the following specific reasons:
Records Requested Never Existed Retention Policy Other (please explain)
MEDICAL
X-RAYS
BILLING
PAYROLL
EMPLOYMENT
OTHER
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I hereby declare under penalty of perjury, pursuant to the laws of the State of CA that the foregoing is true and correct.
Executed On:
Signature:
(Date)
at SANTA CLARA, CA
Print name:
Phone
As an agent of Compex Legal Services, Inc., I hereby declare that all infomiation provided to Compex regarding these records was
communicated to the custodian prior to the execution of this Certificate of No Records.
€ NOTE: The Custodian was requested to sign this certificate and refused, electing instead to generate a similar document
Agent's Signature:
Date:Compex Order #: CA1104987-002