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Filing # 131464227 E-Filed 07/27/2021 10:34:10 AM
IN THE CIRCUIT COURT OF THE TWENTIETH JUDICIAL CIRCUIT
IN AND FOR CHARLOTTE COUNTY, STATE OF FLORIDA
JOSE ALBERTO CORTES ESTRADA,
Plaintiffs,
-Vs-
Case No. 21-CA-000245
PETER H. KONDO and AYANO LUISA
KONDO,
Defendants.
/
DEFENDANTS’ MOTION TO COMPEL DISCOVERY
COME NOW Defendants, by and through their undersigned attorneys, and pursuant to
Rule 1.380 Florida Rules of Civil Procedure and file this Motion to Compel Plaintiff's Answers to
Discovery propounded on April 16, 2021, and as grounds therefore states as follows:
1 That at all times material hereto Defendant has been sued for an action sounding in
negligence resulting from an alleged incident in Charlotte County, Florida.
2 On April 16, 2021, Defendants propounded Initial Interrogatories, Medicare
Interrogatories, Request to Produce and Medicare Request to Produce, a copy of which is attached
and incorporated herein as ExhibitA.
4 On June 14, 2021 Defendants a good faith effort to resolve this dispute. A copy of
the letter sent to opposing counsel is attached and incorporated herein as Exhibit B.
5 On June 21, 2021 and July 6, 2021, respectively, Defendants granted Plaintiffs
request for additional time to respond, a copy of which is attached and incorporated herein as
Exhibit C.
6. Despite responses to this discovery now being overdue, Defendants have yet to
receive responses.
WHEREFORE, these Defendants respectfully request that this Court enter an Order
compelling Plaintiffto respond to Defendants’ discovery as well as any and all other relief deemed
just and appropriate.
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing has been served via
the Court’s E-filing Portal on July 27, 2021 to the following:
Jason W. Gelinas, Esq.
FBN 010456
Morgan & Morgan
12800 University Drive, Suite 600
Fort Myers, FL 33907
P (239) 432-6637
F (239) 204-2432
igelinas@forthepeople.com
togilvie@forthepeople.com
jenniferdiaz@forthepeople.com
Attorney for Plaintiff
By __[e] Lauren L, Flagnes
Lauren L. Haynes, Esquire
FBN 0085105
BANKER LOPEZ GASSLER P.A.
501 East Kennedy Blvd., Suite 1700
Tampa, FL 33602
(813) 221-1500; Fax No: (813) 222-3066
service-lhaynes@bankerlopez.com
Attorney for Defendant
EXHIBIT “A”
Filing # 125091373 E-Filed 04/16/2021 03:34:20 PM
IN THE CIRCUIT COURT OF THE TWENTIETH JUDICIAL CIRCUIT
IN AND FOR CHARLOTTE COUNTY, STATE OF FLORIDA
JOSE ALBERTO CORTES ESTRADA,
Plaintiffs,
-Vs-
Case No. 21-CA-000245
PETER H. KONDO and AYANO LUISA
KONDO,
Defendants.
/
NOTICE OF SERVING INITIAL INTERROGATORIES TO PLAINTIFF
COME NOW, Defendants, PETER H. KONDO and AYANO LUISA KONDO ,by and
through undersigned counsel, and hereby propounds to the Plaintiff, JOSE ALBERTO CORTES
ESTRADA, pursuant to Rule 1.340 of the Florida Rules of Civil Procedure, the attached
Interrogatories, answers to which will be due within thirty (30) days of the date of service.
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing has been served via
the Court’s E-filing Portal on April 16, 2021 to the following:
Jason W. Gelinas, Esq.
FBN 010456
Morgan & Morgan
12800 University Drive, Suite 600
Fort Myers, FL 33907
P (239) 432-6637
F (239) 204-2432
igelinas@forthepeople.com
togilvie@forthepeople.com
jenniferdiaz@forthepeople.com
Attorney for Plaintiff
By lo] LaurenL. Haguee
Lauren L. Haynes, Esquire
FBN 0085105
BANKER LOPEZ GASSLER P.A.
501 East Kennedy Blvd., Suite 1700
Tampa, FL 33602
(813) 221-1500; Fax No: (813) 222-3066
service-lhaynes@bankerlopez.com
Attorney for Defendant
INTERROGATORIES TO PLAINTIFFS
(If answering for another person or entity, answer with respect to that person or entity, unless
otherwise stated.)
1 What is the name and address of the person answering these interrogatories, and, if
applicable, the person's official position or relationship with the party to whom the
interrogatories are directed?
ANSWER:
List the names, business addresses, telephone numbers, and dates of employment and rates
of pay regarding all employers, including self-employment, for whom you have worked in
the past ten years.
ANSWER:
List all former names and when you were known by those names. State all addresses where
you have lived for the past ten years, the dates you lived at each address, your Social
Security number, your date of birth, your Driver's License Number and State of issuance,
and, if you are or have ever been married, the name of your spouse or spouses.
ANSWER:
Have you ever been convicted of a crime, other than any juvenile adjudication, which under
the law under which you were convicted was punishable by death or imprisonment in
excess of one year, or that involved dishonesty or a false statement regardless of the
punishment? If so, state as to each conviction, the specific crime, the date and the place of
conviction.
ANSWER:
Were you suffering from physical infirmity, disability, or sickness, at the time of the
occurrence of the accident described in the Complaint? If so, what was the nature of the
infirmity, disability, or sickness?
ANSWER:
Did you consume any alcoholic beverages, or take any drugs or medications within twelve
(12) hours before the occurrence of the incident described in the Complaint? If so, what
type, and amount of, alcoholic beverages, drugs, or medications were consumed, and where
did you consume them?
ANSWER:
Describe in detail each act or omission on the part of any party to this lawsuit that you
contend constituted negligence which was a contributing legal cause of the incident in
question.
ANSWER:
Describe each injury for which you are claiming damages in this case, specify the part of
your body that was injured, the nature of the injury, and, as to any injuries you contend are
permanent, the effects on you that you claim are permanent.
ANSWER:
List each item of expense or damage, other than loss of income or earning capacity, that
you claim to have incurred as a result of the incident described in the Complaint, giving
for each item the date incurred, the name and business address to whom each was paid or
is owed, and the goods or services for which each was incurred.
ANSWER:
10. Do you contend that you have lost any income, benefits, or earning capacity in the past or
future as a result of the incident described in the Complaint? If so, state the nature of the
income, benefits, or earning capacity, and the amount and the method that you used in
computing the amount.
ANSWER:
11 Has anything been paid or is anything payable from any third party for the damages listed
in your answers to these interrogatories? If so, state the amounts paid or payable, the name
and business address of the person or entity who paid or owes said amounts, and which of
those third parties have or claim a right of subrogation.
ANSWER:
12 List the names and business addresses of each physician who has treated or examined you,
and each medical facility where you have received any treatment or examination for the
injuries for which you seek damages in this case; and state as to each, the date of treatment
or examination and the injury or condition for which you were examined and treated.
ANSWER:
13 List the names, business addresses, and business telephone numbers of all other physicians,
dentists, medical facilities or other health care providers by whom or at which you have
been examined and/or treated in the past ten years; and state as to each the dates of
examination or treatment and the condition or injury for which you were examined and
treated.
ANSWER:
14. List the names and addresses of all persons who are believed or known by you, your agents
or attorneys, to have any knowledge concerning any of the issues raised by the pleadings,
and specify the subject matter about which the witness has knowledge.
ANSWER:
1S Have you heard or do you know about any statement or remark made by or on behalf of
any party to this lawsuit, other than yourself, concerning any issue in this lawsuit? If so,
state the name and address of each person who made the statement or statements, the name
and address of each person who heard it, and the date, time, place and substance of each
statement or remark.
ANSWER:
16. State the name and address of every person known to you, your agents, or attorneys, who
has knowledge about or possession, custody, or control of any model, plat, map, drawing,
motion picture, video tape, or photograph pertaining to any fact or issue involved in this
controversy; and describe as to each what such person has, the name and address of the
person who took or prepared it, and the date it was taken or prepared.
ANSWER:
17. Do you intend to call any non medical expert witnesses at the trial of this case? If so,
identify each witness, describe his qualifications as an expert, state the subject matter upon
which he is expected to testify, state the substance of the facts and opinions to which he is
expected to testify, and give a summary of the grounds for each opinion.
ANSWER:
18 Have you made an agreement with anyone that would limit that party's liability to anyone
for any of the damages sued upon in this case? If so, state the terms of the agreement and
the parties to it.
ANSWER:
19. Please state whether or not you have been involved in any accidents or incidences resulting
in any personal injury, prior to or after the incident described in the Complaint. And, if so,
state the place of said accidents or incidences, the date of each said accident or incident,
any personal injuries that you may have received in any such accident or incident, the name
of and each of every medical practitioner treating you or examining you for each of said
injuries.
ANSWER:
20. State the extent of your schooling, the dates it was secured, and the dates of your formal
education.
ANSWER:
21. Please advise if you have been involved in any automobile accidents in the last seven (7)
years. If so, please advise the date and specific location of said accident(s).
ANSWER:
22 Please state whether or not you have ever made a claim for personal injuries, and whether
or not you have ever been involved in any lawsuit or workmen's compensation claim which
involved a claim for personal injuries either prior to or subsequent to the accident in
question and, if so, state the nature of such lawsuit or claim, the name and last known
address of the parties to said lawsuit or claim, the court and address where such lawsuit or
claim was filed, if any, the date of such lawsuit or claim, and the disposition of said lawsuit
or claim.
ANSWER:
23. Please list the names, addresses, telephone numbers of all companies, entities, or
individuals where you have applied for employment in the past three (3) years.
ANSWER:
24. With respect to any injuries or symptoms described in your answer to Interrogatory #8,
please state whether you, at any other time, ever had any similar injury to or similar
symptom of the same or similar area of your body, and if so, itemize each such injury or
symptom, the part of your body involved, the date and duration of such injury or symptom,
and the names and addresses of each physician(s) or hospital(s) that you treated with for
such injury or symptom.
ANSWER:
25 Have you ever received a disability rating of any type whatsoever from any individual or
private governmental organization before or after the incident described in the Complaint?
If so, state as to each, the name and address of the physician or organization giving such
rating, the date of such rating, the amount of the disability rating, and describe the nature
of the incident causing the disability rating.
ANSWER:
26. State whether or not, in the past five (5) years, you made application for any insurance or
employment requiring a physical examination; and if so, state the name and address of the
medical practitioner who examined you, giving the date of the examination, and the name
and address of such insurance company and/or employer.
ANSWER:
27 Describe in detail how the incident described in the Complaint happened, including all
actions taken by you to prevent the incident. In addition, please state the specific address
of the store location where this incident occurred.
ANSWER:
28 Do you wear glasses, contact lenses, or hearing aids? If so, who prescribed them, when
were they prescribed, when were your eyes or ears last examined, and what is the name
and address of the examiner?
ANSWER:
29. Are you currently, have you ever receiving/received, have you applied for Medicare, Social
Security or Social Security disability benefits, and if so, please state what benefits you are
receiving, how much is being received, how long you have received benefits and when
application for benefits was made.
ANSWER:
10
STATE OF FLORIDA
COUNTY OF
VERIFICATION
On this day personally appeared before me, an officer duly authorized to administer oaths,
JOSE ALBERTO CORTES ESTRADA, who being first duly sworn by me says: She has read and
understands the foregoing Interrogatories and Answers to those Interrogatories and believes that
the Answers to those Interrogatories and the facts states therein are true.
SWORN TO AND SUBSCRIBED before me by JOSE ALBERTO CORTES ESTRADA,
personally known to me, or has produced as identification, this
day of , 2021.
JOSE ALBERTO CORTES ESTRADA
WITNESS MY HAND and official seal in the County and State named above this
day of , 2021.
NOTARY PUBLIC
My Commission Expires:
11
Filing # 125091373 E-Filed 04/16/2021 03:34:20 PM
IN THE CIRCUIT COURT OF THE TWENTIETH JUDICIAL CIRCUIT
IN AND FOR CHARLOTTE COUNTY, STATE OF FLORIDA
JOSE ALBERTO CORTES ESTRADA,
Plaintiffs,
-Vs-
Case No. 21-CA-000245
PETER H. KONDO and AYANO LUISA
KONDO,
Defendants.
/
NOTICE OF SERVING MEDICARE INTERROGATORIES TO PLAINTIFF
COME NOW, Defendants, PETER H. KONDO and AYANO LUISA KONDO ,by and
through undersigned counsel, and hereby propounds to the Plaintiff, JOSE ALBERTO CORTES
ESTRADA, pursuant to Rule 1.340 of the Florida Rules of Civil Procedure, the attached Medicare
Interrogatories, answers to which will be due within thirty (30) days of the date of service.
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing has been served via
the Court’s E-filing Portal on April 16, 2021 to the following:
Jason W. Gelinas, Esq.
FBN 010456
Morgan & Morgan
12800 University Drive, Suite 600
Fort Myers, FL 33907
P (239) 432-6637
F (239) 204-2432
igelinas@forthepeople.com
togilvie@forthepeople.com
jenniferdiaz@forthepeople.com
Attorney for Plaintiff
By lo] LaurenL. Haguee
Lauren L. Haynes, Esquire
FBN 0085105
BANKER LOPEZ GASSLER P.A.
501 East Kennedy Blvd., Suite 1700
Tampa, FL 33602
(813) 221-1500; Fax No: (813) 222-3066
service-lhaynes@bankerlopez.com
Attorney for Defendant
MEDICARE INTERROGATORIES
What is your:
a. Full Name
b. Date of Birth
Address
Social Security Number
e Medicare Health Insurance Claim Number (HICN)
ANSWER:
Are you currently receiving Social Security Disability Income (SSDI) payments?
ANSWER:
Are you currently eligible for or receiving Medicare benefits?
ANSWER:
Have you ever applied for disability benefits with the Social Security Administration? If
so, what was the status of your application?
ANSWER:
Have you applied for Social Security Disability and been denied benefits but anticipate
appealing the decision?
ANSWER:
Are you in the process of appealing the decision of Social Security Disability ineligibility?
ANSWER:
Do you anticipate applying to the Department of Health and Human Services or the Social
Security Administration for disability benefits?
ANSWER:
Do you have end stage renal disease?
ANSWER:
Has Medicare paid any benefits to you or to anyone else on your behalf in connection with
any treatment you have received as a result of the accident forming the basis for this
lawsuit? If so, state the following:
The date you applied for said benefits;
The amount of benefits paid to date;
The case number, policy number or other identifiers for any benefits paid or payable;
Whether benefits are still being paid to you or to a third party on your behalf by
Medicare as of the date of answering this Interrogatory;
Whether you or anyone on your behalf has provided notice to Medicare of the instant
lawsuit, and if so, when;
Whether a lien has been asserted for the amount of benefits paid, and if so, the date you
received notice of the lien and the amount of the lien; and
Identify and produce a copy of any documents that contain any of the information
requested in this Interrogatory.
ANSWER:
10. Has Medicaid paid any benefits to you or to anyone else on your behalf in connection with
any treatment you have received as a result of the accident forming the basis for this
lawsuit? If so, state the following:
a The date you applied for said benefits;
b. The amount of benefits paid to date;
The case number, policy number or other identifiers for any benefits paid or payable;
Whether benefits are still being paid to you or to a third party on your behalf by
Medicaid as of the date of answering this Interrogatory;
Whether you or anyone on your behalf has provided notice to Medicaid of the instant
lawsuit, and if so, when;
Whether a lien has been asserted for the amount of benefits paid, and if so, the date you
received notice of the lien and the amount of the lien, and
Identify and produce a copy of any documents that contain any of the information
requested in this Interrogatory.
ANSWER:
11 Has any other entity paid any benefits to you or to anyone else on your behalf in connection
with any treatment or injuries you have received as a result of the accident forming the
basis for this lawsuit, including, but not limited to, any other type of medical assistance,
disability pension, income or insurance, including social security benefits, Department of
Public Welfare benefits and/or worker’s compensation? If so, state the following:
a Identify the entity who has paid any benefits;
b. The date you applied for said benefits;
The amount of benefits paid to date;
The case number, policy number or other identifiers for any benefits paid;
Whether benefits are still being paid to you or to a third party on your behalf by the
entity identified in subsection (1) above, as of the date of answering this Interrogatory;
Whether you or anyone on your behalf has provided notice to the entity identified in
subsection (a) above, of the instant lawsuit, and if so, when;
Whether a lien has been asserted for the amount of benefits paid, and if so, the date you
received notice of the lien and the amount of the lien; and
Identify and produce a copy of any documents that contain any of the information
requested in this Interrogatory.
ANSWER:
12 In the past 10 years, has any entity paid any benefits to you or to anyone else on your behalf
in connection with any treatment or injuries you have received regardless of whether you
maintain that they are the result of the accident, including, but not limited to, Medicare,
Medicaid or any other type of medical assistance, disability pension, income or insurance,
including social security benefits, Department of Public Welfare benefits and/or worker’s
compensation? If so, state the following:
a Identify the entity what has paid any benefits;
b. The date you applied for said benefits;
The amount of benefits paid to date;
The case number, policy number or other identifiers for any benefits paid or payable;
Whether benefits are still being paid to you or to a third party on your behalf by the
entity identified in subsection (a) above, as of the date of answering this Interrogatory;
Whether you or anyone on your behalf has provided notice to the entity identified in
subsection (a) above, of the instant lawsuit, and if so, when;
Whether a lien has been asserted for the amount of benefits paid, and if so, the date you
received notice of the lien and the amount of the lien; and
Identify and produce a copy of any documents that contain any of the information
requested in this Interrogatory.
ANSWER:
STATE OF FLORIDA
COUNTY OF
VERIFICATION
On this day personally appeared before me, an officer duly authorized to administer oaths,
JOSE ALBERTO CORTES ESTRADA, who being first duly sworn by me says: He/She has read
and understands the foregoing Medicare Interrogatories and Answers to those Medicare
Interrogatories and believes that the Answers to those Medicare Interrogatories and the facts states
therein are true.
SWORN TO AND SUBSCRIBED before me by JOSE ALBERTO CORTES ESTRADA,
personally known to me, or has produced as identification, this
day of » 2021.
JOSE ALBERTO CORTES ESTRADA
WITNESS MY HAND and official seal in the County and State named above this
day of , 2021.
NOTARY PUBLIC
My Commission Expires:
Filing # 125091373 E-Filed 04/16/2021 03:34:20 PM
IN THE CIRCUIT COURT OF THE TWENTIETH JUDICIAL CIRCUIT
IN AND FOR CHARLOTTE COUNTY, STATE OF FLORIDA
JOSE ALBERTO CORTES ESTRADA,
Plaintiffs,
-Vs-
Case No. 21-CA-000245
PETER H. KONDO and AYANO LUISA
KONDO,
Defendants.
/
DEFENDANTS’ REQUEST FOR PRODUCTION OF DOCUMENTS TO PLAINTIFF
Defendants, PETER H. KONDO and AYANO LUISA KONDO, by and through
undersigned counsel, and pursuant to Florida Rules of Civil Procedure 1.350, hereby requests
Plaintiff, JOSE ALBERTO CORTES ESTRADA, produce for inspection and/or copying by
counsel for the Defendant the following documents, said documents to be produced at the offices
of Defendant’s attorneys located at 501 E. Kennedy Boulevard, Suite 1700, Tampa, Florida 33602:
DEFINITIONS AND INSTRUCTIONS
A The term “Document” means the original (and copies if no original is available)
written, printed, typed, recorded, or graphic matter of every type and description, however and by
whomever prepared, produced, reproduced, disseminated or made, in any form, whether in draft
or final, which is or was in your actual or constructive possession, custody, or control, or within
your knowledge, including electronically stored information.
B The terms “you” or “your” are defined as Plaintiff, and any employees, agents,
attorneys, representatives or other persons acting on his/her behalf.
Cc As used herein “Defendant” shall refer to the Defendant in the above-referenced
action, JOSE ALBERTO CORTES ESTRADA and shall include any agents or attorneys acting
on its behalf.
D “Person” or “party” includes any individual, official, corporation, partnership, firm,
association, joint venture, business organization, agency, department or other body, or an
employee or agent thereof.
E. The singular shall include the plural and vice versa. Whenever used herein, “and”
may be understood to mean and vice versa whenever such construction results in broader
request for information.
F The phrases “referring to, «6 relating to,” “regarding” mean in any manner, way,
form, or respect relating to, referring to, concerning, mentioning, embodying, encompassing,
supporting, describing, evidencing or constituting the subject matter indicated in the document
request.
G The term “Property” refers to the property at issue in the Complaint.
H If the response to all or any part of the request is not presently known or available,
include a statement to that effect, and furnish the information known or available.
I In any response to any request, whenever a reference is made to one or more
persons, please specify by name the particular person to whom reference is intended and that
person’s last known address.
J If any document is withheld on any claim of privilege, or otherwise, pursuant to
current law, set forth the following:
1 the basis of the privilege claim;
ii. the author of the document;
iii. the date of the document;
Iv, the recipient or intended recipient of the document;
a brief description of the substance of the document;
Vi all persons who received copies of the document or shown copies of the
document, along with an identification of each person.
REQUESTS
Copies of Federal Income Tax Returns, W-2 withholding tax statements, and any
and all other business records and/or income records, and any other evidence of income for the last
five years; or in the alternative, provide a duly executed Internal Revenue Service Form 4506,
“Request for Copy of Tax Form or Tax Account Information” for said tax years.
2 Any and all medical or related bills, paid or owing, allegedly resulting from the
within accident or occurrences.
3 Any and all medical records, hospital records, chiropractic records, osteopathic
records, faith healer’s records, physical therapy records, or any other non-privileged medical
information in Plaintiffs’ possession, which have not previously been provided to Defendant or
Defendant's insurance carrier.
4 Please provide duplicate copies of any radiographic materials such as x-ray films,
CT films, MRI films, etc.
5 Please furnish any and all medical reports, doctors’ reports, or reports rendered by
experts applicable to any and all issues in this cause, for which the Plaintiffs intend to use the
author of said report as an expert witness at trial.
6. Please provide copies of any written and/or recorded statements taken from the
Defendant, or any witness to this action, other than the Plaintiffs, concerning this action or its
subject matter or a stenographic, mechanical, electric or other recording or transcription of a
statement that is a substantial verbatim recital or an oral statement. Please furnish the name of the
witness or party from whom the statement came, the date taken, and the means of recording or
preserving same.
7
Any and all written and/or recorded statements taken from the Defendant in this
cause, concerning this action or its subject matter or a stenographic, mechanical, electric or other
recording or transcription of a statement that is a substantial verbatim recital or an oral statement.
8 Please provide laser copies of any and all photographs of the accident scene, as
depicted at the time of the accident as described in the Complaint.
9 Any and all photographs, graphs, charts and other documentary evidence of the
scene, parties involved in or pertaining to the subject accident or occurrence or issues in this cause
which the Plaintiffs will use at trial, or which has been furnished to any expert who will be listed
as an expert witness for trial.
10. Any and all insurance policies providing benefits or coverage to the Plaintiffs, for
any claimed injury or damage from the subject accident or occurrence.
11. Copies of all written materials concerning any settlement by Plaintiffs with any
other person or entity who may have been liable for the damages claimed by the Plaintiffs, together
with all “Mary Carter ” or other similar Agreements.
12. Copies of all written materials evidencing payment by any source of medical bills
any other expenses alleged to have been incurred by Plaintiffs as a result of the subject matter.
13. Copies of all other medical and/or disability insurance policies, including all
booklets concerning any group policies, which provide or may provide medical or disability
payments to Plaintiffs, regarding damages alleged to have been incurred as a result of the subject
accident, together with the relevant Declarations or face sheet reflecting available coverages and
deductibles.
14. Copies of any applications for insurance including health, disability, casualty,
automobile, hospital, business interruption, or umbrella liability policies that may provide benefits
to the Plaintiffs for injuries sustained as a result of the accident described in the Complaint.
15. Please provide copies of all notices of intent to claim damages from tortfeasor,
which have been sent to any collateral source providers.
16. Please provide copies of diaries and personal calendars written by the Plaintiffs that
contain any information relevant to the claim.
17. Please provide copies of any correspondence between the Plaintiffs and the
Defendant.
18. Please provide copies of any correspondence between the Plaintiffs and/or
Plaintiffs’ counsel and any of the Plaintiffs’ physicians.
19, Please provide copies of all documents that support the Plaintiff's wage loss claim.
20. Please provide copies of any photographs depicting the Plaintiff within eight weeks
of the incident.
21. Please provide copies of any interviews or statements given by the Plaintiffs to
anyone other than counsel within the period of time from the date of accident to the present, which
pertain to the incident as described in the Complaint.
22. Any and all documents of whatever nature or kind which evidence any and all
payments made to the Plaintiffs as a result of this incident.
23. Please produce a copy of your Driver’s Licenses.
24. If any document is withheld on any claim or privilege or otherwise, pursuant to
current law, set forth the following:
(a) The basis of the privileged claim;
(b) The author of the document;
(©) The date of the document;
(d) The recipient or intended recipient of the document;
(e) A brief description of the substance of the document;
(f) All persons who received copies of the document or were shown copies of the
document, along with an identification of each such person.
25. Plaintiff(s) is/are requested to produce a completed, signed IRS Form 4506 (see
attached).
26. Plaintiff(s) is/are requested to produce a completed, signed SSA Form 7050-F4 (see
attached).
27. Plaintiff(s) is/are requested to produce a completed, signed SSA Form 3288 (see
attached).
28. Plaintiff(s) is/are requested to produce a completed, signed AHCA Form (see
attached).
29. Plaintiff(s) is/are requested to produce a completed, signed CMS Medicare Form
(see attached).
30. Plaintiff(s) is/are requested to produce a completed, signed Tri-Care Authorization
Form (see attached).
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing has been served via
the Court’s E-filing Portal on April 16, 2021 to the following:
Jason W. Gelinas, Esq.
FBN 010456
Morgan & Morgan
12800 University Drive, Suite 600
Fort Myers, FL 33907
P (239) 432-6637
F (239) 204-2432
jgelinas@forthepeople.com
togilvie@forthepeople.com
jenniferdiaz@forthepeople.com
Attorney for Plaintiff
By lo] LaurenL. Haynes
Lauren L. Haynes, Esquire
FBN 0085105
BANKER LOPEZ GASSLER P.A.
501 East Kennedy Blvd., Suite 1700
Tampa, FL 33602
(813) 221-1500; Fax No: (813) 222-3066
service-lhaynes@bankerlopez.com
Attorney for Defendant
IRS FORM 4506
rom 4506 Request for Copy of Tax Return
{October 2020) > Do not sign this form unless all applicable lines have been completed. OMB No. 1545-0429
> Request may be rejected if the form is incomplete or illegible.
of the Treasury
Intemal Revenue > For more information about Form 4506, visit www.irs.gov/form4506,
Tip. You may be able to get your tax return or return information from other sources. If you had your tax return completed by a paid preparer, they
should be able to provide you a copy of the retum. The IRS can provide a Tax Return Transcript for many returns free of charge. The transcript
provides most of the line entries from the original tax return and usually contains the information that a third party (such as a mortgage company)
requires. See Form 4506-T, Request for Transcript of Tax Return, or you can quickly request transcripts by using our automated self-help service
tools. Please visit us at IRS.gov and click on “Get a Tax Transcript...” or call 1-800-908-9946.
ta Name shown on tax return. If a joint return, enter the name shown first. 1b First social security number on tax return,
individual taxpayer identification number, or
employer identification number (see instructions)
2a If a joint return, enter spouse’s name shown on tax return. 2b Second social security number individual
taxpayer identification number if joint tax return
3 Current name, address (including apt., room, or suite no.), city, state, and ZIP code (see instructions)
4 Previous address shown on the last return filed if different from line 3 (see instructions)
5. If the tax return is to be mailed to a third party (such as a mortgage company), enter the third party's name, address, and telephone number.
Banker Lopez Gassler P.A. (813) 221-1500
501 E. Kennedy Boulevard, Suite 1700
Tampa, Florida 33602
Caution: If the tax return is being sent to the third party, ensure that lines 5 through 7 are completed before signing. (see instructions).
6 Tax return requested. Form 1040, 1120, 941, etc. and all attachments as originally submitted to the IRS. including Form(s) W-2
schedules, or amended returns. Copies of Forms 1040, 1040A, and 1040EZ are generally available for 7 years from filing before they are
destroyed by law. Other returns may be available for a longer period of time. Enter only one return number. If you need more than one
type of return, you must complete another Form 4506, >
Note: If the copies must be certified for court or administrative proceedings, check here oO
Year or period requested. Enter the ending date of the tax year or period using the mm/dd/yyyy format.Tees instructions).
/ / / / / / / /
/ / / / / / / /
Fee. There is a $43 fee for each return requested. Full payment must be included with your request or it will
be rejected. Make your check or money order payable to “United States Treasury.” Enter your SSN, ITIN,
or EIN and “Form 4506 request” on your check or money order.
Cost for each return 43.00
bNumber of returns requested on line 7.
c Total cost. Multiply line 8a by line 8b
9 If we cannot find the tax return, we will refund the Tee. if the refund Should go to the third party sted ‘on line 5, check here
Caution: Do not sign this form unless all applicable lines have been completed.
Signature of taxpayer(s). | declare that | am either the taxpayer whose name is shown on line 1a or 2a, or a person authorized to obtain the tax retum
requested. If the request applies to a joint return, at least one spouse must sign. If signed by a corporate
officer, 1 percent or more shareholder,
managing member, guardian, tax matters partner, executor, receiver, administrator, trustee, or other than the taxpayer, | certify that | have the authorityto
execute Form 4506 on behalf of the taxpayer. Note: This form must be received by IRS within 120 days of the signature date.
[| Signatory attests that he/she has read the attestation clause and upon so reading
declares that he/she has the authority to sign the Form 4506. See instructions. Phone number of taxpayer on line
taor2a
|
) Signature (see instructions) Date
Sign
Here ) Print/Type name Title (i line 1a above is a corporation, partnership, estate, or trust)
) Spouse's signature Date
) PrintvType name
For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No. 41721 Form 4506 (Rev. 10-2020)
Form 4506 (Rev. 10-2020) Page 2
Section references are to the Internal Revenue Code Individuals. Copies of jointly filed tax returns may
unless otherwise noted.
Chart for all other returns be furnished to either spouse. Only one signature is
required. Sign Form 4506 exactly as your name
For returns not in appeared on the original return. If you changed your
Future Developments Form 1040 series, Mail to: name, also sign your current name.
For the latest information about Form 4506 and its, if the address on Corporations. Generally, Form 4506 can be
instructions, go to www.irs.gov/form4506. the return was signed by: (1) an officer having legal authority to bind
the corporation, (2) any person designated by the
General Instructions Arizona, Arkansas, board of directors or other governing body, or (3)
Caution: Do not sign this form unless all applicable Connecticut, Delaware, any officer or employee on written request by any
lines, including lines 5 through 7, have been Georgia, Indiana, Maine, principal officer and attested to by the secretary or
completed. Maryland, other officer. A bona fide shareholder of record
Massachusetts, owning 1 percent or more of the outstanding stock
Designated Recipient Notification. Internal Michigan, New Internal Revenue Service
RAIVS Team
of the corporation may submit a Form 4506 but must
Revenue Code, Section 6103(¢), limits disclosure Hampshire, New Jersey, provide documentation to support the requester's
and use of return information received pursuant to New York, North ‘Stop 6705 S-2 right to receive the information.
the taxpayer's consent and holds the recipient Carolina, Ohio, Kansas City, MO Partnerships. Generally, Form 4506 can be
subject to penalties for any unauthorized access, Pennsylvania, Rhode 64999
signed by any person who was a member of the
other use, or redisclosure without the taxpayer's Island, South Carolina, partnership during any part of the tax period
express permission or request. Tennessee, Vermont, requested on line 7.
‘Taxpayer Notification. Internal Revenue Code, Virginia, West Virginia, All others. See section 6103(e) if the taxpayer has
Section 6103(0), limits jisclosure and use of return Wisconsin died, is insolvent, is a dissolved corporation, or if a
information provided pursuant to your consent and trustee, guardian, executor, receiver, or
holds the recipient subject to penalties, brought by Alabama, Alaska, administrator is acting for the taxpayer.
private right of action, for any unauthorized access, Arizona, Arkansas,
other use, or redisclosure without your express Note: If you are Heir at law, Next of kin, or
permission or request. California, Colorado, Beneficiary you must be able to establish a material
Florida, Hawaii, Idaho, interest in the estate or trust.
Purpose of form. Use Form 4506 to request a copy Illinois, lowa, Kansas,
of your tax return. You can also designate (on line 5) Louisiana, Minnesota, Documentation. For entities other than individuals,
a third party to receive the tax return. Mississippi, Missouri, you must attach the authorization document. For
How long will it take? It may take up to 75 Montana, Nebraska, example, this could be the letter from the principal
calendar days for us to process your request. Nevada, New Mexico, officer authorizing an employee of the corporation or
North Dakota, Internal Revenue Service the letters testamentary authorizing an individual to
Where to file. Attach payment and mail Form 4506 Oklahoma, Oregon, RAIVS Team act for an estate.
to the address below for the state you lived in, or the ‘South Dakota, Texas, P.O. Box 9941 Signature by a representative. A representative
state your business was in, when that return was Utah, Washington, Mail Stop 6734 can sign Form 4506 for a taxpayer only if this
filed. There are two address charts: one for Wyoming, a foreign ‘Ogden, UT 84409 authority has been specifically delegated to the
individual returns (Form 1040 series) and one for all country, American
Preview
Filing # 131464227 E-Filed 07/27/2021 10:34:10 AM IN THE CIRCUIT COURT OF THE TWENTIETH JUDICIAL CIRCUIT IN AND FOR CHARLOTTE COUNTY, STATE OF FLORIDA JOSE ALBERTO CORTES ESTRADA, Plaintiffs, -Vs- Case No. 21-CA-000245 PETER H. KONDO and AYANO LUISA KONDO, Defendants. / DEFENDANTS’ MOTION TO COMPEL DISCOVERY COME NOW Defendants, by and through their undersigned attorneys, and pursuant to Rule 1.380 Florida Rules of Civil Procedure and file this Motion to Compel Plaintiff's Answers to Discovery propounded on April 16, 2021, and as grounds therefore states as follows: 1 That at all times material hereto Defendant has been sued for an action sounding in negligence resulting from an alleged incident in Charlotte County, Florida. 2 On April 16, 2021, Defendants propounded Initial Interrogatories, Medicare Interrogatories, Request to Produce and Medicare Request to Produce, a copy of which is attached and incorporated herein as ExhibitA. 4 On June 14, 2021 Defendants a good faith effort to resolve this dispute. A copy of the letter sent to opposing counsel is attached and incorporated herein as Exhibit B. 5 On June 21, 2021 and July 6, 2021, respectively, Defendants granted Plaintiffs request for additional time to respond, a copy of which is attached and incorporated herein as Exhibit C. 6. Despite responses to this discovery now being overdue, Defendants have yet to receive responses. WHEREFORE, these Defendants respectfully request that this Court enter an Order compelling Plaintiffto respond to Defendants’ discovery as well as any and all other relief deemed just and appropriate. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served via the Court’s E-filing Portal on July 27, 2021 to the following: Jason W. Gelinas, Esq. FBN 010456 Morgan & Morgan 12800 University Drive, Suite 600 Fort Myers, FL 33907 P (239) 432-6637 F (239) 204-2432 igelinas@forthepeople.com togilvie@forthepeople.com jenniferdiaz@forthepeople.com Attorney for Plaintiff By __[e] Lauren L, Flagnes Lauren L. Haynes, Esquire FBN 0085105 BANKER LOPEZ GASSLER P.A. 501 East Kennedy Blvd., Suite 1700 Tampa, FL 33602 (813) 221-1500; Fax No: (813) 222-3066 service-lhaynes@bankerlopez.com Attorney for Defendant EXHIBIT “A” Filing # 125091373 E-Filed 04/16/2021 03:34:20 PM IN THE CIRCUIT COURT OF THE TWENTIETH JUDICIAL CIRCUIT IN AND FOR CHARLOTTE COUNTY, STATE OF FLORIDA JOSE ALBERTO CORTES ESTRADA, Plaintiffs, -Vs- Case No. 21-CA-000245 PETER H. KONDO and AYANO LUISA KONDO, Defendants. / NOTICE OF SERVING INITIAL INTERROGATORIES TO PLAINTIFF COME NOW, Defendants, PETER H. KONDO and AYANO LUISA KONDO ,by and through undersigned counsel, and hereby propounds to the Plaintiff, JOSE ALBERTO CORTES ESTRADA, pursuant to Rule 1.340 of the Florida Rules of Civil Procedure, the attached Interrogatories, answers to which will be due within thirty (30) days of the date of service. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served via the Court’s E-filing Portal on April 16, 2021 to the following: Jason W. Gelinas, Esq. FBN 010456 Morgan & Morgan 12800 University Drive, Suite 600 Fort Myers, FL 33907 P (239) 432-6637 F (239) 204-2432 igelinas@forthepeople.com togilvie@forthepeople.com jenniferdiaz@forthepeople.com Attorney for Plaintiff By lo] LaurenL. Haguee Lauren L. Haynes, Esquire FBN 0085105 BANKER LOPEZ GASSLER P.A. 501 East Kennedy Blvd., Suite 1700 Tampa, FL 33602 (813) 221-1500; Fax No: (813) 222-3066 service-lhaynes@bankerlopez.com Attorney for Defendant INTERROGATORIES TO PLAINTIFFS (If answering for another person or entity, answer with respect to that person or entity, unless otherwise stated.) 1 What is the name and address of the person answering these interrogatories, and, if applicable, the person's official position or relationship with the party to whom the interrogatories are directed? ANSWER: List the names, business addresses, telephone numbers, and dates of employment and rates of pay regarding all employers, including self-employment, for whom you have worked in the past ten years. ANSWER: List all former names and when you were known by those names. State all addresses where you have lived for the past ten years, the dates you lived at each address, your Social Security number, your date of birth, your Driver's License Number and State of issuance, and, if you are or have ever been married, the name of your spouse or spouses. ANSWER: Have you ever been convicted of a crime, other than any juvenile adjudication, which under the law under which you were convicted was punishable by death or imprisonment in excess of one year, or that involved dishonesty or a false statement regardless of the punishment? If so, state as to each conviction, the specific crime, the date and the place of conviction. ANSWER: Were you suffering from physical infirmity, disability, or sickness, at the time of the occurrence of the accident described in the Complaint? If so, what was the nature of the infirmity, disability, or sickness? ANSWER: Did you consume any alcoholic beverages, or take any drugs or medications within twelve (12) hours before the occurrence of the incident described in the Complaint? If so, what type, and amount of, alcoholic beverages, drugs, or medications were consumed, and where did you consume them? ANSWER: Describe in detail each act or omission on the part of any party to this lawsuit that you contend constituted negligence which was a contributing legal cause of the incident in question. ANSWER: Describe each injury for which you are claiming damages in this case, specify the part of your body that was injured, the nature of the injury, and, as to any injuries you contend are permanent, the effects on you that you claim are permanent. ANSWER: List each item of expense or damage, other than loss of income or earning capacity, that you claim to have incurred as a result of the incident described in the Complaint, giving for each item the date incurred, the name and business address to whom each was paid or is owed, and the goods or services for which each was incurred. ANSWER: 10. Do you contend that you have lost any income, benefits, or earning capacity in the past or future as a result of the incident described in the Complaint? If so, state the nature of the income, benefits, or earning capacity, and the amount and the method that you used in computing the amount. ANSWER: 11 Has anything been paid or is anything payable from any third party for the damages listed in your answers to these interrogatories? If so, state the amounts paid or payable, the name and business address of the person or entity who paid or owes said amounts, and which of those third parties have or claim a right of subrogation. ANSWER: 12 List the names and business addresses of each physician who has treated or examined you, and each medical facility where you have received any treatment or examination for the injuries for which you seek damages in this case; and state as to each, the date of treatment or examination and the injury or condition for which you were examined and treated. ANSWER: 13 List the names, business addresses, and business telephone numbers of all other physicians, dentists, medical facilities or other health care providers by whom or at which you have been examined and/or treated in the past ten years; and state as to each the dates of examination or treatment and the condition or injury for which you were examined and treated. ANSWER: 14. List the names and addresses of all persons who are believed or known by you, your agents or attorneys, to have any knowledge concerning any of the issues raised by the pleadings, and specify the subject matter about which the witness has knowledge. ANSWER: 1S Have you heard or do you know about any statement or remark made by or on behalf of any party to this lawsuit, other than yourself, concerning any issue in this lawsuit? If so, state the name and address of each person who made the statement or statements, the name and address of each person who heard it, and the date, time, place and substance of each statement or remark. ANSWER: 16. State the name and address of every person known to you, your agents, or attorneys, who has knowledge about or possession, custody, or control of any model, plat, map, drawing, motion picture, video tape, or photograph pertaining to any fact or issue involved in this controversy; and describe as to each what such person has, the name and address of the person who took or prepared it, and the date it was taken or prepared. ANSWER: 17. Do you intend to call any non medical expert witnesses at the trial of this case? If so, identify each witness, describe his qualifications as an expert, state the subject matter upon which he is expected to testify, state the substance of the facts and opinions to which he is expected to testify, and give a summary of the grounds for each opinion. ANSWER: 18 Have you made an agreement with anyone that would limit that party's liability to anyone for any of the damages sued upon in this case? If so, state the terms of the agreement and the parties to it. ANSWER: 19. Please state whether or not you have been involved in any accidents or incidences resulting in any personal injury, prior to or after the incident described in the Complaint. And, if so, state the place of said accidents or incidences, the date of each said accident or incident, any personal injuries that you may have received in any such accident or incident, the name of and each of every medical practitioner treating you or examining you for each of said injuries. ANSWER: 20. State the extent of your schooling, the dates it was secured, and the dates of your formal education. ANSWER: 21. Please advise if you have been involved in any automobile accidents in the last seven (7) years. If so, please advise the date and specific location of said accident(s). ANSWER: 22 Please state whether or not you have ever made a claim for personal injuries, and whether or not you have ever been involved in any lawsuit or workmen's compensation claim which involved a claim for personal injuries either prior to or subsequent to the accident in question and, if so, state the nature of such lawsuit or claim, the name and last known address of the parties to said lawsuit or claim, the court and address where such lawsuit or claim was filed, if any, the date of such lawsuit or claim, and the disposition of said lawsuit or claim. ANSWER: 23. Please list the names, addresses, telephone numbers of all companies, entities, or individuals where you have applied for employment in the past three (3) years. ANSWER: 24. With respect to any injuries or symptoms described in your answer to Interrogatory #8, please state whether you, at any other time, ever had any similar injury to or similar symptom of the same or similar area of your body, and if so, itemize each such injury or symptom, the part of your body involved, the date and duration of such injury or symptom, and the names and addresses of each physician(s) or hospital(s) that you treated with for such injury or symptom. ANSWER: 25 Have you ever received a disability rating of any type whatsoever from any individual or private governmental organization before or after the incident described in the Complaint? If so, state as to each, the name and address of the physician or organization giving such rating, the date of such rating, the amount of the disability rating, and describe the nature of the incident causing the disability rating. ANSWER: 26. State whether or not, in the past five (5) years, you made application for any insurance or employment requiring a physical examination; and if so, state the name and address of the medical practitioner who examined you, giving the date of the examination, and the name and address of such insurance company and/or employer. ANSWER: 27 Describe in detail how the incident described in the Complaint happened, including all actions taken by you to prevent the incident. In addition, please state the specific address of the store location where this incident occurred. ANSWER: 28 Do you wear glasses, contact lenses, or hearing aids? If so, who prescribed them, when were they prescribed, when were your eyes or ears last examined, and what is the name and address of the examiner? ANSWER: 29. Are you currently, have you ever receiving/received, have you applied for Medicare, Social Security or Social Security disability benefits, and if so, please state what benefits you are receiving, how much is being received, how long you have received benefits and when application for benefits was made. ANSWER: 10 STATE OF FLORIDA COUNTY OF VERIFICATION On this day personally appeared before me, an officer duly authorized to administer oaths, JOSE ALBERTO CORTES ESTRADA, who being first duly sworn by me says: She has read and understands the foregoing Interrogatories and Answers to those Interrogatories and believes that the Answers to those Interrogatories and the facts states therein are true. SWORN TO AND SUBSCRIBED before me by JOSE ALBERTO CORTES ESTRADA, personally known to me, or has produced as identification, this day of , 2021. JOSE ALBERTO CORTES ESTRADA WITNESS MY HAND and official seal in the County and State named above this day of , 2021. NOTARY PUBLIC My Commission Expires: 11 Filing # 125091373 E-Filed 04/16/2021 03:34:20 PM IN THE CIRCUIT COURT OF THE TWENTIETH JUDICIAL CIRCUIT IN AND FOR CHARLOTTE COUNTY, STATE OF FLORIDA JOSE ALBERTO CORTES ESTRADA, Plaintiffs, -Vs- Case No. 21-CA-000245 PETER H. KONDO and AYANO LUISA KONDO, Defendants. / NOTICE OF SERVING MEDICARE INTERROGATORIES TO PLAINTIFF COME NOW, Defendants, PETER H. KONDO and AYANO LUISA KONDO ,by and through undersigned counsel, and hereby propounds to the Plaintiff, JOSE ALBERTO CORTES ESTRADA, pursuant to Rule 1.340 of the Florida Rules of Civil Procedure, the attached Medicare Interrogatories, answers to which will be due within thirty (30) days of the date of service. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served via the Court’s E-filing Portal on April 16, 2021 to the following: Jason W. Gelinas, Esq. FBN 010456 Morgan & Morgan 12800 University Drive, Suite 600 Fort Myers, FL 33907 P (239) 432-6637 F (239) 204-2432 igelinas@forthepeople.com togilvie@forthepeople.com jenniferdiaz@forthepeople.com Attorney for Plaintiff By lo] LaurenL. Haguee Lauren L. Haynes, Esquire FBN 0085105 BANKER LOPEZ GASSLER P.A. 501 East Kennedy Blvd., Suite 1700 Tampa, FL 33602 (813) 221-1500; Fax No: (813) 222-3066 service-lhaynes@bankerlopez.com Attorney for Defendant MEDICARE INTERROGATORIES What is your: a. Full Name b. Date of Birth Address Social Security Number e Medicare Health Insurance Claim Number (HICN) ANSWER: Are you currently receiving Social Security Disability Income (SSDI) payments? ANSWER: Are you currently eligible for or receiving Medicare benefits? ANSWER: Have you ever applied for disability benefits with the Social Security Administration? If so, what was the status of your application? ANSWER: Have you applied for Social Security Disability and been denied benefits but anticipate appealing the decision? ANSWER: Are you in the process of appealing the decision of Social Security Disability ineligibility? ANSWER: Do you anticipate applying to the Department of Health and Human Services or the Social Security Administration for disability benefits? ANSWER: Do you have end stage renal disease? ANSWER: Has Medicare paid any benefits to you or to anyone else on your behalf in connection with any treatment you have received as a result of the accident forming the basis for this lawsuit? If so, state the following: The date you applied for said benefits; The amount of benefits paid to date; The case number, policy number or other identifiers for any benefits paid or payable; Whether benefits are still being paid to you or to a third party on your behalf by Medicare as of the date of answering this Interrogatory; Whether you or anyone on your behalf has provided notice to Medicare of the instant lawsuit, and if so, when; Whether a lien has been asserted for the amount of benefits paid, and if so, the date you received notice of the lien and the amount of the lien; and Identify and produce a copy of any documents that contain any of the information requested in this Interrogatory. ANSWER: 10. Has Medicaid paid any benefits to you or to anyone else on your behalf in connection with any treatment you have received as a result of the accident forming the basis for this lawsuit? If so, state the following: a The date you applied for said benefits; b. The amount of benefits paid to date; The case number, policy number or other identifiers for any benefits paid or payable; Whether benefits are still being paid to you or to a third party on your behalf by Medicaid as of the date of answering this Interrogatory; Whether you or anyone on your behalf has provided notice to Medicaid of the instant lawsuit, and if so, when; Whether a lien has been asserted for the amount of benefits paid, and if so, the date you received notice of the lien and the amount of the lien, and Identify and produce a copy of any documents that contain any of the information requested in this Interrogatory. ANSWER: 11 Has any other entity paid any benefits to you or to anyone else on your behalf in connection with any treatment or injuries you have received as a result of the accident forming the basis for this lawsuit, including, but not limited to, any other type of medical assistance, disability pension, income or insurance, including social security benefits, Department of Public Welfare benefits and/or worker’s compensation? If so, state the following: a Identify the entity who has paid any benefits; b. The date you applied for said benefits; The amount of benefits paid to date; The case number, policy number or other identifiers for any benefits paid; Whether benefits are still being paid to you or to a third party on your behalf by the entity identified in subsection (1) above, as of the date of answering this Interrogatory; Whether you or anyone on your behalf has provided notice to the entity identified in subsection (a) above, of the instant lawsuit, and if so, when; Whether a lien has been asserted for the amount of benefits paid, and if so, the date you received notice of the lien and the amount of the lien; and Identify and produce a copy of any documents that contain any of the information requested in this Interrogatory. ANSWER: 12 In the past 10 years, has any entity paid any benefits to you or to anyone else on your behalf in connection with any treatment or injuries you have received regardless of whether you maintain that they are the result of the accident, including, but not limited to, Medicare, Medicaid or any other type of medical assistance, disability pension, income or insurance, including social security benefits, Department of Public Welfare benefits and/or worker’s compensation? If so, state the following: a Identify the entity what has paid any benefits; b. The date you applied for said benefits; The amount of benefits paid to date; The case number, policy number or other identifiers for any benefits paid or payable; Whether benefits are still being paid to you or to a third party on your behalf by the entity identified in subsection (a) above, as of the date of answering this Interrogatory; Whether you or anyone on your behalf has provided notice to the entity identified in subsection (a) above, of the instant lawsuit, and if so, when; Whether a lien has been asserted for the amount of benefits paid, and if so, the date you received notice of the lien and the amount of the lien; and Identify and produce a copy of any documents that contain any of the information requested in this Interrogatory. ANSWER: STATE OF FLORIDA COUNTY OF VERIFICATION On this day personally appeared before me, an officer duly authorized to administer oaths, JOSE ALBERTO CORTES ESTRADA, who being first duly sworn by me says: He/She has read and understands the foregoing Medicare Interrogatories and Answers to those Medicare Interrogatories and believes that the Answers to those Medicare Interrogatories and the facts states therein are true. SWORN TO AND SUBSCRIBED before me by JOSE ALBERTO CORTES ESTRADA, personally known to me, or has produced as identification, this day of » 2021. JOSE ALBERTO CORTES ESTRADA WITNESS MY HAND and official seal in the County and State named above this day of , 2021. NOTARY PUBLIC My Commission Expires: Filing # 125091373 E-Filed 04/16/2021 03:34:20 PM IN THE CIRCUIT COURT OF THE TWENTIETH JUDICIAL CIRCUIT IN AND FOR CHARLOTTE COUNTY, STATE OF FLORIDA JOSE ALBERTO CORTES ESTRADA, Plaintiffs, -Vs- Case No. 21-CA-000245 PETER H. KONDO and AYANO LUISA KONDO, Defendants. / DEFENDANTS’ REQUEST FOR PRODUCTION OF DOCUMENTS TO PLAINTIFF Defendants, PETER H. KONDO and AYANO LUISA KONDO, by and through undersigned counsel, and pursuant to Florida Rules of Civil Procedure 1.350, hereby requests Plaintiff, JOSE ALBERTO CORTES ESTRADA, produce for inspection and/or copying by counsel for the Defendant the following documents, said documents to be produced at the offices of Defendant’s attorneys located at 501 E. Kennedy Boulevard, Suite 1700, Tampa, Florida 33602: DEFINITIONS AND INSTRUCTIONS A The term “Document” means the original (and copies if no original is available) written, printed, typed, recorded, or graphic matter of every type and description, however and by whomever prepared, produced, reproduced, disseminated or made, in any form, whether in draft or final, which is or was in your actual or constructive possession, custody, or control, or within your knowledge, including electronically stored information. B The terms “you” or “your” are defined as Plaintiff, and any employees, agents, attorneys, representatives or other persons acting on his/her behalf. Cc As used herein “Defendant” shall refer to the Defendant in the above-referenced action, JOSE ALBERTO CORTES ESTRADA and shall include any agents or attorneys acting on its behalf. D “Person” or “party” includes any individual, official, corporation, partnership, firm, association, joint venture, business organization, agency, department or other body, or an employee or agent thereof. E. The singular shall include the plural and vice versa. Whenever used herein, “and” may be understood to mean and vice versa whenever such construction results in broader request for information. F The phrases “referring to, «6 relating to,” “regarding” mean in any manner, way, form, or respect relating to, referring to, concerning, mentioning, embodying, encompassing, supporting, describing, evidencing or constituting the subject matter indicated in the document request. G The term “Property” refers to the property at issue in the Complaint. H If the response to all or any part of the request is not presently known or available, include a statement to that effect, and furnish the information known or available. I In any response to any request, whenever a reference is made to one or more persons, please specify by name the particular person to whom reference is intended and that person’s last known address. J If any document is withheld on any claim of privilege, or otherwise, pursuant to current law, set forth the following: 1 the basis of the privilege claim; ii. the author of the document; iii. the date of the document; Iv, the recipient or intended recipient of the document; a brief description of the substance of the document; Vi all persons who received copies of the document or shown copies of the document, along with an identification of each person. REQUESTS Copies of Federal Income Tax Returns, W-2 withholding tax statements, and any and all other business records and/or income records, and any other evidence of income for the last five years; or in the alternative, provide a duly executed Internal Revenue Service Form 4506, “Request for Copy of Tax Form or Tax Account Information” for said tax years. 2 Any and all medical or related bills, paid or owing, allegedly resulting from the within accident or occurrences. 3 Any and all medical records, hospital records, chiropractic records, osteopathic records, faith healer’s records, physical therapy records, or any other non-privileged medical information in Plaintiffs’ possession, which have not previously been provided to Defendant or Defendant's insurance carrier. 4 Please provide duplicate copies of any radiographic materials such as x-ray films, CT films, MRI films, etc. 5 Please furnish any and all medical reports, doctors’ reports, or reports rendered by experts applicable to any and all issues in this cause, for which the Plaintiffs intend to use the author of said report as an expert witness at trial. 6. Please provide copies of any written and/or recorded statements taken from the Defendant, or any witness to this action, other than the Plaintiffs, concerning this action or its subject matter or a stenographic, mechanical, electric or other recording or transcription of a statement that is a substantial verbatim recital or an oral statement. Please furnish the name of the witness or party from whom the statement came, the date taken, and the means of recording or preserving same. 7 Any and all written and/or recorded statements taken from the Defendant in this cause, concerning this action or its subject matter or a stenographic, mechanical, electric or other recording or transcription of a statement that is a substantial verbatim recital or an oral statement. 8 Please provide laser copies of any and all photographs of the accident scene, as depicted at the time of the accident as described in the Complaint. 9 Any and all photographs, graphs, charts and other documentary evidence of the scene, parties involved in or pertaining to the subject accident or occurrence or issues in this cause which the Plaintiffs will use at trial, or which has been furnished to any expert who will be listed as an expert witness for trial. 10. Any and all insurance policies providing benefits or coverage to the Plaintiffs, for any claimed injury or damage from the subject accident or occurrence. 11. Copies of all written materials concerning any settlement by Plaintiffs with any other person or entity who may have been liable for the damages claimed by the Plaintiffs, together with all “Mary Carter ” or other similar Agreements. 12. Copies of all written materials evidencing payment by any source of medical bills any other expenses alleged to have been incurred by Plaintiffs as a result of the subject matter. 13. Copies of all other medical and/or disability insurance policies, including all booklets concerning any group policies, which provide or may provide medical or disability payments to Plaintiffs, regarding damages alleged to have been incurred as a result of the subject accident, together with the relevant Declarations or face sheet reflecting available coverages and deductibles. 14. Copies of any applications for insurance including health, disability, casualty, automobile, hospital, business interruption, or umbrella liability policies that may provide benefits to the Plaintiffs for injuries sustained as a result of the accident described in the Complaint. 15. Please provide copies of all notices of intent to claim damages from tortfeasor, which have been sent to any collateral source providers. 16. Please provide copies of diaries and personal calendars written by the Plaintiffs that contain any information relevant to the claim. 17. Please provide copies of any correspondence between the Plaintiffs and the Defendant. 18. Please provide copies of any correspondence between the Plaintiffs and/or Plaintiffs’ counsel and any of the Plaintiffs’ physicians. 19, Please provide copies of all documents that support the Plaintiff's wage loss claim. 20. Please provide copies of any photographs depicting the Plaintiff within eight weeks of the incident. 21. Please provide copies of any interviews or statements given by the Plaintiffs to anyone other than counsel within the period of time from the date of accident to the present, which pertain to the incident as described in the Complaint. 22. Any and all documents of whatever nature or kind which evidence any and all payments made to the Plaintiffs as a result of this incident. 23. Please produce a copy of your Driver’s Licenses. 24. If any document is withheld on any claim or privilege or otherwise, pursuant to current law, set forth the following: (a) The basis of the privileged claim; (b) The author of the document; (©) The date of the document; (d) The recipient or intended recipient of the document; (e) A brief description of the substance of the document; (f) All persons who received copies of the document or were shown copies of the document, along with an identification of each such person. 25. Plaintiff(s) is/are requested to produce a completed, signed IRS Form 4506 (see attached). 26. Plaintiff(s) is/are requested to produce a completed, signed SSA Form 7050-F4 (see attached). 27. Plaintiff(s) is/are requested to produce a completed, signed SSA Form 3288 (see attached). 28. Plaintiff(s) is/are requested to produce a completed, signed AHCA Form (see attached). 29. Plaintiff(s) is/are requested to produce a completed, signed CMS Medicare Form (see attached). 30. Plaintiff(s) is/are requested to produce a completed, signed Tri-Care Authorization Form (see attached). CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served via the Court’s E-filing Portal on April 16, 2021 to the following: Jason W. Gelinas, Esq. FBN 010456 Morgan & Morgan 12800 University Drive, Suite 600 Fort Myers, FL 33907 P (239) 432-6637 F (239) 204-2432 jgelinas@forthepeople.com togilvie@forthepeople.com jenniferdiaz@forthepeople.com Attorney for Plaintiff By lo] LaurenL. Haynes Lauren L. Haynes, Esquire FBN 0085105 BANKER LOPEZ GASSLER P.A. 501 East Kennedy Blvd., Suite 1700 Tampa, FL 33602 (813) 221-1500; Fax No: (813) 222-3066 service-lhaynes@bankerlopez.com Attorney for Defendant IRS FORM 4506 rom 4506 Request for Copy of Tax Return {October 2020) > Do not sign this form unless all applicable lines have been completed. OMB No. 1545-0429 > Request may be rejected if the form is incomplete or illegible. of the Treasury Intemal Revenue > For more information about Form 4506, visit www.irs.gov/form4506, Tip. You may be able to get your tax return or return information from other sources. If you had your tax return completed by a paid preparer, they should be able to provide you a copy of the retum. The IRS can provide a Tax Return Transcript for many returns free of charge. The transcript provides most of the line entries from the original tax return and usually contains the information that a third party (such as a mortgage company) requires. See Form 4506-T, Request for Transcript of Tax Return, or you can quickly request transcripts by using our automated self-help service tools. Please visit us at IRS.gov and click on “Get a Tax Transcript...” or call 1-800-908-9946. ta Name shown on tax return. If a joint return, enter the name shown first. 1b First social security number on tax return, individual taxpayer identification number, or employer identification number (see instructions) 2a If a joint return, enter spouse’s name shown on tax return. 2b Second social security number individual taxpayer identification number if joint tax return 3 Current name, address (including apt., room, or suite no.), city, state, and ZIP code (see instructions) 4 Previous address shown on the last return filed if different from line 3 (see instructions) 5. If the tax return is to be mailed to a third party (such as a mortgage company), enter the third party's name, address, and telephone number. Banker Lopez Gassler P.A. (813) 221-1500 501 E. Kennedy Boulevard, Suite 1700 Tampa, Florida 33602 Caution: If the tax return is being sent to the third party, ensure that lines 5 through 7 are completed before signing. (see instructions). 6 Tax return requested. Form 1040, 1120, 941, etc. and all attachments as originally submitted to the IRS. including Form(s) W-2 schedules, or amended returns. Copies of Forms 1040, 1040A, and 1040EZ are generally available for 7 years from filing before they are destroyed by law. Other returns may be available for a longer period of time. Enter only one return number. If you need more than one type of return, you must complete another Form 4506, > Note: If the copies must be certified for court or administrative proceedings, check here oO Year or period requested. Enter the ending date of the tax year or period using the mm/dd/yyyy format.Tees instructions). / / / / / / / / / / / / / / / / Fee. There is a $43 fee for each return requested. Full payment must be included with your request or it will be rejected. Make your check or money order payable to “United States Treasury.” Enter your SSN, ITIN, or EIN and “Form 4506 request” on your check or money order. Cost for each return 43.00 bNumber of returns requested on line 7. c Total cost. Multiply line 8a by line 8b 9 If we cannot find the tax return, we will refund the Tee. if the refund Should go to the third party sted ‘on line 5, check here Caution: Do not sign this form unless all applicable lines have been completed. Signature of taxpayer(s). | declare that | am either the taxpayer whose name is shown on line 1a or 2a, or a person authorized to obtain the tax retum requested. If the request applies to a joint return, at least one spouse must sign. If signed by a corporate officer, 1 percent or more shareholder, managing member, guardian, tax matters partner, executor, receiver, administrator, trustee, or other than the taxpayer, | certify that | have the authorityto execute Form 4506 on behalf of the taxpayer. Note: This form must be received by IRS within 120 days of the signature date. [| Signatory attests that he/she has read the attestation clause and upon so reading declares that he/she has the authority to sign the Form 4506. See instructions. Phone number of taxpayer on line taor2a | ) Signature (see instructions) Date Sign Here ) Print/Type name Title (i line 1a above is a corporation, partnership, estate, or trust) ) Spouse's signature Date ) PrintvType name For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No. 41721 Form 4506 (Rev. 10-2020) Form 4506 (Rev. 10-2020) Page 2 Section references are to the Internal Revenue Code Individuals. Copies of jointly filed tax returns may unless otherwise noted. Chart for all other returns be furnished to either spouse. Only one signature is required. Sign Form 4506 exactly as your name For returns not in appeared on the original return. If you changed your Future Developments Form 1040 series, Mail to: name, also sign your current name. For the latest information about Form 4506 and its, if the address on Corporations. Generally, Form 4506 can be instructions, go to www.irs.gov/form4506. the return was signed by: (1) an officer having legal authority to bind the corporation, (2) any person designated by the General Instructions Arizona, Arkansas, board of directors or other governing body, or (3) Caution: Do not sign this form unless all applicable Connecticut, Delaware, any officer or employee on written request by any lines, including lines 5 through 7, have been Georgia, Indiana, Maine, principal officer and attested to by the secretary or completed. Maryland, other officer. A bona fide shareholder of record Massachusetts, owning 1 percent or more of the outstanding stock Designated Recipient Notification. Internal Michigan, New Internal Revenue Service RAIVS Team of the corporation may submit a Form 4506 but must Revenue Code, Section 6103(¢), limits disclosure Hampshire, New Jersey, provide documentation to support the requester's and use of return information received pursuant to New York, North ‘Stop 6705 S-2 right to receive the information. the taxpayer's consent and holds the recipient Carolina, Ohio, Kansas City, MO Partnerships. Generally, Form 4506 can be subject to penalties for any unauthorized access, Pennsylvania, Rhode 64999 signed by any person who was a member of the other use, or redisclosure without the taxpayer's Island, South Carolina, partnership during any part of the tax period express permission or request. Tennessee, Vermont, requested on line 7. ‘Taxpayer Notification. Internal Revenue Code, Virginia, West Virginia, All others. See section 6103(e) if the taxpayer has Section 6103(0), limits jisclosure and use of return Wisconsin died, is insolvent, is a dissolved corporation, or if a information provided pursuant to your consent and trustee, guardian, executor, receiver, or holds the recipient subject to penalties, brought by Alabama, Alaska, administrator is acting for the taxpayer. private right of action, for any unauthorized access, Arizona, Arkansas, other use, or redisclosure without your express Note: If you are Heir at law, Next of kin, or permission or request. California, Colorado, Beneficiary you must be able to establish a material Florida, Hawaii, Idaho, interest in the estate or trust. Purpose of form. Use Form 4506 to request a copy Illinois, lowa, Kansas, of your tax return. You can also designate (on line 5) Louisiana, Minnesota, Documentation. For entities other than individuals, a third party to receive the tax return. Mississippi, Missouri, you must attach the authorization document. For How long will it take? It may take up to 75 Montana, Nebraska, example, this could be the letter from the principal calendar days for us to process your request. Nevada, New Mexico, officer authorizing an employee of the corporation or North Dakota, Internal Revenue Service the letters testamentary authorizing an individual to Where to file. Attach payment and mail Form 4506 Oklahoma, Oregon, RAIVS Team act for an estate. to the address below for the state you lived in, or the ‘South Dakota, Texas, P.O. Box 9941 Signature by a representative. A representative state your business was in, when that return was Utah, Washington, Mail Stop 6734 can sign Form 4506 for a taxpayer only if this filed. There are two address charts: one for Wyoming, a foreign ‘Ogden, UT 84409 authority has been specifically delegated to the individual returns (Form 1040 series) and one for all country, American