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Filing # 151117027 E-Filed 06/08/2022 03:44:53 PM
IN THE CIRCUIT COURT OF THE THIRTEENTH JUDICIAL CIRCUIT
IN AND FOR HILLSBOROUGH COUNTY, FLORIDA
CIVIL DIVISION
SUSANA JIMENEZ,
Plaintiff, Case No.: 2021-CA-000781
Division: K
v.
UNITED SKATES OF AMERICA, INC.,
Defendant.
/
PLAINTIFF'S MOTION TO COMPEL/MOTION FOR SANCTIONS
FOR FAILURE TO PRESERVE CRITICAL EVIDENCE
AND/OR SPOILATION OF CRITICAL EVIDENCE
COMES NOW the Plaintiff, SUSANA JIMENEZ, by and through her undersigned
counsel, and pursuant to Florida Rule of Civil Procedure 1.380 files this Motion to Compel the
production of critical evidence. In the alternative, Plaintiff moves for sanctions for Defendant's
failure to preserve critical evidence and/or for spoilation of critical evidence, and as grounds
therefore would show as follows:
INTRODUCTION
1. That this is an action for personal injury damages that arises from a fall that took
place at the premises located at 7510 Paula Drive, Tampa, Hillsborough County, Florida 33615
("the premises") and commonly referred to as Town & Country Skate World of Tampa and/or
United Skates of America, Inc. 1
2. This case is set for a jury trial on this Court's February 20, 2023 docket.
3. Plaintiff is informed, believes, and alleges that on the date of the accident that is
l On March 24, 2021, this Court entered a default judgment on liability against the former Defendant, Town &
Country Skate World of Tampa, Inc.
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the subject of this lawsuit, the active Defendant, UNITED SKATES OF AMERICA, INC. leased
the premises from the former Defendant, Town & Country Skate World of Tampa, Inc.
4. In her Amended Complaint, Plaintiff alleges that on August 31, 2018, she was on
the Defendant's premises as a business invitee. Plaintiff was a guest at Defendant's premises for
the purpose of attending her granddaughter's birthday party. Am Compl. 1] 6.
5. Plaintiff further alleges that while she was on Defendant's premises, she was roller-
skating, when her skate's axle "failed, rotated, and/or buckled causing Plaintiff to injure her left
knee, leg, ankle, and foot, which ultimately required multiple surgical interventions." Am.
Compl. 1]7.
6. Plaintiff further alleges that the Defendant owed several duties of care to the
Plaintiff, including the duty to perform regular inspection and maintenance of rental skates,
including "inspection of the pivot points, pivot pin bushings, tightening of kingpins, and all other
skate component parts and any standard maintenance to avoid any defects in the skates causing
unsafe and dangerous conditions, and a non-delegable duty of safety, repair, inspection and
maintenance over the skates and the premises." Am. Compl. 1] 8.
7. Plaintiff further alleges that Defendant breached its duty of care and was ultimately
negligent by failing to perform regular inspection and maintenance of the rental skates, including
the inspection of the pivot pins, pivot pin bushings, tightening of kingpins, and all other skate
component parts and failed to perform any standard maintenance to avoid any defects in the skates
causing an unsafe and dangerous condition. Am. Compl. 1] 10.
8. During the course of discovery, it was ascertained that on the date of the accident,
August 31 , 2018, Defendant prepared an incident report, a copy of which is attached as Exhibit A.
The incident report states, "material prepared for litigation purposes".
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9. Additionally, during the course of discovery, it was ascertained that Defendant
obtained statements from its employees on the date of the accident and had them prepare a
"MATERIAL PREPARED FOR LITIGATION PURPOSES" document, a copy of which is
attached as Exhibit B.
10. Also, during the course of discovery, it was ascertained that on or about the date of
the accident, Defendant prepared a "Skate Inspection Report" acknowledging that at least one
employee of the Defendant took possession of the skates which Plaintiff was wearing on the date
of the accident. The skate inspection report is attached as Exhibit C.
11. On August 4, 2020, counsel for the Plaintiff delivered a letter of representation to
Town & Country Skate World of Tampa at 7510 Paula Drive Tampa, Florida 33615 and 7706 W
Elm Street Tampa, Florida 33615, a copy of which is attached as Exhibit D. In this letter, counsel
requests that any and all video surveillance, incident reports, photographs with respect to this
incident, and the actual skate involved at the time of the incident be preserved and the letter states,
"Accordingly, I ask that no repairs or modifications be performed to any of the
aforementioned items, until such a time as they can be properly examined and viewed. Please
send us a letter advising us as to the location of any of these items, including the subject video and
especially the skate, and granting this office permission to visually examine same. Clearly, our
intent is to properly preserve all available evidence, so that any contested can be addressed in light
of all of the evidence." (Emphasis supplied).
12. On or about January 28, 2021, this lawsuit was commenced.
13. On or about July 15, 2021, Plaintiff served her first Request for Production of
Documents to Defendant, a copy of which is attached as Exhibit E.
14. On or about September 27, 2021, Defendant served its Responses and Objections
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to Plaintiff' s First Request for Production, a copy of which is attached as Exhibit F. In their
responses to Plaintiff" s First Request for Production of Documents, number 12, which asks for
"the actual skates used by the Plaintiff in the fall on August 31 , 2018, at the premises", Defendant
responds "Objection. Plaintiff seeks information that is irrelevant to any claim or defense
in this litigation and therefore is not reasonably calculated to lead to the discovery of
admissible evidence and protected by disclosure by the work product doctrine and Florida
Law. By way of further answer, this inquiry is overly broad in scope and vague and
incorporates any potential work product or attorney/client privilege. To the extent that
Plaintiff identified the skates she was wearing at the time to any personnel or any issue with
the skate, same will be produced. If the skate worn at the time of the incident were obtained
from the Defendant, a record of the skate inspection will be produced."
15. On or about February 7, 2022, Plaintiff served her Second Request for Production
of Documents to Defendant, a copy of which is attached as Exhibit G.
16. On or about March 15, 2022, Defendant served its Responses and Objections to
Plaintiffs Second Request for Production, a copy of which is attached as Exhibit H. In their
responses to Plaintiff" s Second Request for Production, number 3, which asks for "The actual
skate(s) identified as being bagged/tagged in the Skate Inspection Report produced in your
response to Plaintiff"s First Request for Production of Documents", Defendant responds "To be
determined. This information will be provided if documents exist, subject to any
privileges."
17. On or about March 28, 2022, Defendant served its Amended Responses and
Objections to Plaintiffs Second Request for Production, a copy of which is attached as Exhibit I.
In its amended response to the request for "The actual skate(s) identified as being bagged/tagged
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in the Skate Inspection Report produced in your response to Plaintiff" s First Request for Production
of Documents", Defendant responds "To be determined. This information will be provided if
documents exist, subject to any privileges."
18. On April 24, 2022, the undersigned counsel for the Plaintiff sent an email to counsel
for the Defendant containing a copy of this motion and stating that Plaintiff would not file the
motion until after counsel have had an opportunity to confer.
19. On April 27, 2022, Defendant filed its Supplemental Amended Responses and
Objections to Plaintiffs Second Request for Production, a copy of which is attached as Exhibit J.
Defendant amended its response to Plaintiffs request for the actual skates by stating: "After
diligent search, these skates were no longer out of rotation. In 2018, if no notice of a claim
was made with regard to the skates used within 6-months, and the skates passed inspection
or did not need any maintenance, the skates were returned to rotation due to the need to
maintain inventory of the rentals. By way of further Answer, according to Plaintiffs
testimony, she asked for more than one pair of skates at different times during her skate
session to "try out."
20. Based on discovery, it appears that the Defendant took possession of the actual
skates wom by the Plaintiff prior to her fall, inspected the skates, and should still have them in
their possession. However, based on Defendant's most recent response to Plaintiffs Requests for
Production, it appears that the skates have been either placed back into "rotation" without being
properly identified, discarded, altered, lost, and/or destroyed.
21. The actual skates worn by the Plaintiff prior to her fall are key evidence that
Plaintiff needs to prove her case against the Defendant. Therefore, Plaintiff moves this court to
compel Defendant to produce the actual skates immediately.
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22. If these skates have been discarded, altered, lost, and/or destroyed, this would
amount to spoliation of critical evidence and Plaintiff moves for sanctions against Defendant.
MEMORANDUM OF LAW REGARDING SPOLIATION
OF CRITICAL EVIDENCE
23. Florida state courts have consistently held that sanctions are appropriate when
spoliation occurs. The sanctions may include the striking of pleadings, the entry of a default on the
issue of liability, exclusion of expert testimony, the imposition of an evidentiary presumption, and
the dismissal of a claim. See DePuy Inc. vs. Eckes, 427 So. 2d 306 (Fla. 3d DCA 1983). In DePuy,
the Court held that the trial judge did not err in striking a defendant's answer and affirmative
defenses after the defendant returned the plaintiffs crucial piece of evidence, a defective hip
prosthesis, with the fracture site missing. The defendant had performed an electron microscope
examination on the fracture site, which the plaintiff had not yet performed. The defendant's lack
of bad faith in losing the evidence was held to be irrelevant.
24. The principles announced in DePuy were expanded in Rockwell International
Corp. v. Menzies, 561 So. 2d 677 (Fla. 3d DCA 1990). In Rockwell, the Third District, citing
Depuy, affirmed an order striking a table saw manufacturer's answer and affirmative defenses and
entered a default because of the destruction and loss of two bolts attached to another
manufacturer's motor. The bolts were hacked off by the table saw manufacturer's experts in the
course of an inspection of the table saw because they could not otherwise remove the other
manufacturer's motor. When the defendants' experts reinstalled the original motor, they installed
replacement bolts but failed to retain the two original, hacked off bolts. There was no evidence
that this was done in bad faith. The rationale for affirming the default was that the destruction
of the two bolts made it impossible for the plaintiff to rebut the expected testimony of the
manufacturer's expert that the buyer had failed to firmly secure the bolts to the motor plate. The
IIIIIIIIIII
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court has recognized that drastic sanctions, including a default, are appropriate when a
defendant who has been ordered not to destroy evidence does, in fact, alter or destroy critical
physical evidence, and when the plaintiff has demonstrated an inability to proceed without
such evidence. 561 So. 2d at 679 (Emphasis supplied). The court in Rockwell repeated the
standard set in DePuy that whether the defendant destroyed the evidence in "bad faith or
accidentally is irrelevant." Id.
25. The Third District of Florida and other districts have continued to uphold these
rulings with regard to spoliation of critical evidence. In Federal Insurance Co v. Allister, 622
So. 2d, 1348, 1351 (Fla. 4th DCA 1993), the Fourth District set forth five factors to consider before
imposing sanctions for spoliation of evidence: "(1) whether there is prejudice, (2) whether the
prejudice can be cured, (3) the practical importance of the evidence, (4) the good faith or bad faith
surrounding the loss of evidence, and (5) possible abuse if the evidence is not excluded."
26. The court in DePuy further points out that "Whether the [evidence] was destroyed
in bad faith or accidentally is irrelevant in the present case. The evidence is unavailable for the
plaintiffs use, and they have demonstrated an inability to proceed without it... Having lost the
[evidence], [defendants] are now accountable for the ramifications of their act." 427 So. 2d 306 at
308.
27. Similarly, the Fourth District in New Hampshire Ins. Co. v. Royal Ins. Co., 559 So.
2d 102 (Fla. 4th DCA 1990), focused on the importance of the evidence rather than on whether
the destruction was in bad faith: "If appellant has destroyed relevant and material information by
destroying the file, and that information is so essential [to their claim or defense] that it cannot
proceed without it, then the striking of pleadings may be warranted" 559 So. 2d at 102.
28. Alternatively, where a party fails to produce evidence within his control, an adverse
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inference may be drawn that the withheld evidence would be unfavorable to the party failing to
produce it. Valcin v. Public Health Trust of Dade County, 473 So. 2d 1297 (Fla. 3d DCA 1984),
mody'ied by Public Health Trust of Dade County v. Valcin, 507 So. 2d 596 (Fla. 1987).
29. In addition to imposing discovery or pleading sanctions, the Florida Supreme Court
in Public Health Trust of Dade County v. Valcin, set forth certain criteria for imposing evidentiary
presumptions in the event of negligent or intentional destruction of hospital records, as follows: l)
If the hospital is unable to produce the records, the plaintiff must establish that the absence of the
records hinders the plaintiff"s ability to establish a prima facie case, 2) if the plaintiff meets that
burden, a presumption of liability arises and the burden of proof shifts to the hospital to prove the
nonexistence of the fact presumed, and 3) when evidence rebutting such presumption is
introduced, the presumption does not automatically disappear and is not overcome until the trier
of fact believes that the presumed fact has been overcome by whatever degree of persuasion is
required by the substantive law of the case. The court did not require the destruction to be
intentional, mere negligence was sufficient. However, if the spoliation was intentional, the court
left the door open to further sanctions: "[A] wide range of sanctions is available to the trial court
under Florida Rule of civil Procedure 1.380(b)(2l." 507 So. 2d 596 (Fla. 1987).
30. Finally, courts agree that sanctions may be appropriate for evidence destroyed by a
party on notice of "potential litigation". See Continental Insurance Co. v. Herman, 576 So. 2d 313
(Fla. 3d DCA 1990). Further, sanctions may be imposed against a litigant who is on notice that
evidence in its possession is relevant to litigation, or potential litigation, or is reasonably calculated
to lead to the discovery of admissible evidence and destroys such evidence. Moreover, a litigant is
under a duty to preserve what it knows, or reasonably should know, is relevant in the action, is
reasonably calculated to lead to the discovery of admissible evidence, is reasonably likely to be
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requested during discovery, and/or is the subject of a pending discovery request. See William T
Thompson Co. v. General Nutrition Corp., Inc., 593 F. Supp. 1443, 1455 (D.C. Cal. 1984).
31. In summary, in determining whether to impose sanctions or evidentiary
presumptions for spoliation of evidence, Florida state courts generally require the trial court to
consider whether the spoliation 1) impairs the party from presenting its case or its defense to the
case, and 2) was committed willfully or inadvertently. If the evidence is so essential that the party
cannot proceed without it, bad faith is irrelevant and need not be considered in state court actions.
CONCLUSION
32. On August 31 , 2018, Defendant was placed on notice that litigation could ensue as
a result of a fall that occurred on its premises while the Plaintiff was performing skating activities.
In fact, Defendant immediately identified their incident report, employee statements, and the skate
inspection report as material kept for "litigation purposes." Furthermore, in August of 2020,
Defendant was put on notice (again) prior to this lawsuit that they were required to preserve all
evidence, especially the subject skates worn by the Plaintiff. Defendant's responses to Plaintiff"s
Request for Production of the skates, at this juncture, indicate that the skates are no longer in
Defendant's possession, and their whereabouts are unknown. The skates are critical evidence in
this case as they form the basis of Plaintiff" s claim, and she cannot proceed at trial without having
had the opportunity to inspect them.
WHEREFORE, the Plaintiff, SUSANA JIMENEZ, respectfully requests that this
Honorable Court compel Defendant to produce the skates immediately at a mutually agreeable
date and time for Plaintiff and her counsel to inspect. If Defendant cannot produce the skates,
then Plaintiff requests that the Court impose sanctions on the Defendant, including but not limited
to the striking of Defendant's Answer and Affirmative Defenses, and a Default Judgment in favor
6/8/2022 3:44 PM Electronically Filed; Hillsborough County/13th Judicial Circuit Page 9
of the Plaintiff on the issue of liability, and such other and further relief as this Court deems just
and proper.
CERTIFICATE OF GOOD FAITH CONFERRAL
I certify that prior to filing this motion, I attempted to resolve the matter by discussing the
relief requested in this motion by telephone on May 1, 2022, with counsel for the Defendant and
opposing counsel did not agree that the motion could be resolved without the necessity of a
hearing ,
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing document was filed
electronically and sent by E-Mail from the Florida Courts' E-Filing Portal system, to Alicia Caridi,
Esq., at amcaridi@mdwcg.com and Michael V. Caruso, Esq., mcarusoesq@ymail.com, on this 8th
day of June 2022.
MICHAEL A. SE
Flori
mike@mikeserranolaw.com
CANDACE KNOX HARTLEY, ESQ.
Florida Bar No.: 117794
cea@mikeserranolaw.com
SERRANO LAW
25275 Wesley Chapel Boulevard
Lutz, Florida 33559
(8 13) 929-423 l
(813) 948-1905 Fax
Attorneys for Plaintiff
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Page IT of 26
EXHIBIT A
I
INCIQENI REPORT 2:1 '.r
RINK ADDRESS: T51c> Pc1¢.L£QLL2[Y 7?1wpG<, Fl. DATE [lrlchdent occurred): 0518
:- 00
TIME flnddant o::clJf11ad):. AM am 5549i5 TIME (Skaterardvudj: * 9 I o
'5 AM
.____-_-___
TYPE OF ACTIVITY
l: l Camp - Group N a m e : __
D Private Party - Group Name: _
_
_
Sa8sI§:l.Tit*=';."A. - in
U Birlhday party - Birthday €hllld'S Name:
ll- E LeL'ss3 E'8 E U W MEt;
. R e" t a l
INCIDENT LOCATION -'p 0 1 r
EI Skating Floor E Locker Area ENcafé Area
l:lBathroom s III Outside Entrance
D Gam e
EIOther:
Area
Et Kate
-.- .
-
71119
INJLIRED pERSQN InFURMATIQll -
Name: 348894 .gim€v'1€.2. i111111111 El Male .EIIJFemale AGE: =8.s_ DoI
Skates: D owned-size tilJ2enled-size'-i D NfA W earing wrist Guards?
Yor('7If yes: s M L
Injuredwearing: d(1lflK DQ 2d$J_K1f:l"1
Phone: es | 85 vi N I14
Pal'Br\l'sp'chBp€ror'le's Name [if injured peluon under 18).
Were they present? EIYes UNO
fd'l'G1ll PannVtNlrsperunej
Street Address. Apt. #r C i t y: . State: Zip:
..
Phone: -., Email: - 1
INJURY INFORMATION
B od y P ar t:EIWrlst m Arm Wag l:l Ankle D Head Ll Mouth D Hip El Neck D Other:
Injury position (If applicable):El Left ,E:6zight
I m m ed i at e Action Taken (Check all that apply): '{.81ue Applied g=EmsJFile Dept c al l ed
o ParentlChaperor:»e Notltied
EMS #z 26 _ T ime Called: in 7 04pm _ Time Arrived: 10: * G W Did injured leave w:'EMS: M Yee o No
Others Involved in Incident? D Yes 1'2*'No ID or Name of "other" person: _
Phonafaddress:
Location incident report taken: _'S£t%€_ ieoNng 8ivEici _
*lll1111l
STATEMENT OF INJURED PERSON
Name of Person making Statement: §U5QJ"l°\ biwwct [& their relationship] B a l i
Statement T WU5
_ 't;Jvl/tihcl cu'ovlrwd_ Cwwrl -hr\JI1S-\-<'C)l we lag and
Â¥a1l_arL_i;.-_
_
Did injury occur during specialty skate/game? EYes . ho Ifso, type of specialty skaterfgame:
Skating Ability: D intermediate
Beg i n n er EI Advan ced How many times skated in last year: Q.[\Y,lV¢;;\.-41,q
Signature of injured Cr chaperon of? ' / . "" _ Date: 31 {;01'8'
Printed Name MANAGER Tak'I Ig Re .f9L7it'l'l.£A*[ T ime Report taken : [Q `. OM) p YT!
Signature Of MANAGER: 2 , / . 8 _ ; Dabs: 313_i I '21-¥1§
Did injured guest return fc skating? l'JYes JNQ EINM
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Page 18 of 26
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EMPLGYEE5 DM DUTY AT TIME GF INCIDENT
If an employee la a vuitneas, -talked to or asslalad Injured parson, talked b or heard from Cher msmners. or Inspected incident huastlon aNemsrds,
THEY MUST COMPLFFE MATERIAL PREPARED FOR l_ITIGATION PURPOSES FORM
Name All BELEVANT Employees
POSITION NAME wimasaea Indicant Talked To or Talked to DI' Heard inspected Area
(Print) .l"\BBlsted Injured From Other whale incident
Peiann Customers Took Place
am _ In Bldg? l- No
yes Yes No -l yes No Yes W No -
Y"P'**'°
Assist. Mmagar "4
vwkrsrrne Yes'§9n o &r es I No- l- yas|I,E5no it as L Nu
Assist. Manager
rmwcks l uNt€K\ n ' Yes HNQ alYes Ono Yes .E8?No Yg33'
DJ
._i al. • Yes 8 ' N o Y SS -TO N o l-\t8,w ' YQS NO
Floor Guard
4 INK. PA l wzc .f Yes 'lNa Yes W ' Yes pf wo Y: :41NO
Floor Guild l-Yes -l Nu Ye s ' No W Yes No W Yes ' Nu
Fluor Guard M Y es No yes No Yes No yes No
Onnasssion l-
has 4
v Le' l Yes §'No W ees
3. Yes
- No V Y esI n No Yes W No
Other
)u` nI s
Yes!lWm- No Yes E'No Yes 4 No
I CONDITIONS AT TIME OF INCIDENT
AREWM: . 46l-rT s; sEss_lon TYPE: I
Clear JF r ee of Debris:,E9YesEl no Full House Ughts: EI Yas [BoNo L:l Family
MTeen
D r y: ,E'Yes EJ No Medium House Lights: m Yes 'El No El private Party
EI Adult
Low House Lights: Pres EINo r:l Kids Fun, Skate
Last Time Floor was &ra°ept:"1 ' 5C);>w= Name of person who last swept f loor: TS\y}l.\{'\ 1 g'~pf'¥_';l£>YW(;)
Number of Tickets Sold: l 8 3 Approximate Number of Skaters on Skate Floor; IN O _
Manager Completing This Repor t : K1§8(p \'lg3~(w\-g Date:8i ?>i l VK Posltlon:9I'SS`¥'~3*l.Qv'1.*=- M L 4 8 -
Home Address: il'l0"l_ Mc 0xdowd l d r. Tam pm 1 Fl. 38498 cell Phone: '83-(gl8-l3Lo(.}2,
POST-INCIDENT A=cTlo1~ls TA.l"r Date 8
061§)Tt7"t"'
Video Clip Saved: o Y es .E No video Review Fo u Yes D No (nuaeh IrTea]
EOLLOW up CALL:
Fohlaw-up Phone Call Conducted by. M a iI =man=leA of/o§N/13' _
Dare(=398'1
Cus m er end to Hospital: 19383 l: l Cugamer W entt Doemorrurgentcq . In .E
5i7c€>t28 - Q211a1 419 Haw-~ my VfM4v"M as zL9l-#2=1\9_
P r
U 82 h
f
9 I 4. MI » l i N
I r us1'a 1
SMSQM' vucffurvd 4 4£ptvQ.n*r 'WE 'Q 1
\I r
I| 9 | l
Ufmw -Www Wxfn 'Q,\'»d5,.§wn4L¢1 QAM
inI
J
Gat Well C8l'd Sentry Yes 'I
EINu Sent bf x Date: n
Type of Gif! Sent: .QW i& 1 . \ I
ADDITIONALOOMMENTSI
H IS C LAIM #
WW
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M942D2i2n3v44&¢11'§¢ArEb91cQniaallYliiiil§4I'til1l§ib9l
GENERAL INFORMATION
Name of Employee: W\ia$ Y vuL»l Cell Phone: ii13~-I.-A5-Xlgov,
Job at Time of Incident [Please Check One):
,9'Management D Floor Guard El Disc Jockey l:l Conoessioh D Party Host
D stuff Shop l:l Maintenance EI Security D Other: I _-
_
WITNESSED INCIDENT: U Yes ,Ell No
If yes. describe exactly what you witnessed (use names or labels of guest such as teacher, mother, sister): &
include:
What you noticed caused the fall. actions before fall, during fall & after fall
Describe where you were & where injured guest was before, during & after fall
What actions did you take when you saw the fall? Was the guest in a lot of pain, able to walk. move?
-
. TALKED TO OR ASSISTED INJURED PERSON: YOU o No
If yes, describe what you did and@Lvyhat was said (use names of employees or labels of guests such as mother,
teacher, chaperone, sister):
Where was injured when you assisted? Where were you when you Ieamed about the incident?
How (headset. witness. Saw aowd)81 by who (FG's, conoesslon associate - provide names) notified you that the guests was injured?
When you went to scene, who was there? (name employees. family members. dlaperonas, or use labels)
Name other employees or guests who were assisting & be specific about what did they did to assist?
Describe the pain level & mobility you observed of injured guest.
Did injured make any comments? What did they say when you asked them what happened?
Who removed the skates from injured's feet? Who took control of the skates?
How long was the injured person in the facility alter they fell and how did they leave the facility? (i.e. - parent took them home/hospital,
they stayed and left with class on bus, chaperone returned with them to the school within 15 minutes of fall, etc.)
1 was 'i'4f'\'\Y'\ \o a (\'hc.l0A4 mperwofvs wV\CY\ i Vteofd
-loW-1 rod 11 A \<>0*pn)ftr.vwi so e \r'zQ¥€J -to wt \ n
vrmlfw, t as we ML- SW .~414.s-0 my we 3 'Ne So-Od MAS \~~)*~
4-12-2021 402104A09D00001 6020210412012620
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liili@)@2£13aw3V4§h
W as there anything on the floor?: IJ Yes D No
If Yee, Place the Item In a Zlploe bag and attach It to the report
AREAS LIGHTS: SESSION TYPE;
Yes
Clean/Free of Debris: No Full House Lights:
Yes ` No Family Teen
Dry: yes No Medium House Lights: Yes No V Adult
Private Party
Low House Lights: Yes No -i Kids Fun Skate
Employee Signature:
i
Date: 38%/19
4-12-2021 402104A09D00001 6020210412012620
liili@)@2£13aw3V4§her§9n. talked to gr heard_from other customers,
. inspected indent location afterwards, or
THEY MUST COMPLETE THIS MATERIAL PREPARED FOR LITIGATION PURPOSES FORM
FILE IDENTIFICATION
Name of lnjured cusmmen3g.'-5o(\Q jwewr& one aflnciaem: ".4.221 lLK Time:
101
OOAM/l®
GENERAL INFORMATION
Name of Employee: Q3_v€ 9\W;wR\ _ Cell Phone: -
Job at Time of Incident (Plsasa Check Ono):
II] Management D Floor Guard l:l Disc Jockey MConcession D Party Host
l:l Stuff Shop El Maintenance IJ Security l:l Other: - _
WITNESSED INCIDENT: 1 Yes p'no
If yes,jescribe exactly M3341 witrpssed (use names or labels of guest such as teacher. mother, sister): &
include:
What you noticed Qg8§.1_, actions before fall, during fall & after fall
Describe where you were & where injured guest was before, during & after fall
What actions did you take when you saw the fall? Was the guest in a lot of pain. able to walk, move?
1-
-
l TALKED TO OR ASSISTED INJURED PERSON: PYQs IJ No
If yes. describe what you dig and/or what_wa;said (use names of employees or labels of guests such as mother,
teacher, chaperone, sister):
Where was Injured when you assisted? Where were you when you teamed about the Incident?
How (headset, witness. saw crowd) & by who (FG's, concession associate - provide names) notified you that the guests was Injured?
When you went to scene. who was there? (name employees. family members, diaperones, or use labels)
Name other employees or guests who were assisting a be specific about what did they did to assist?
Describe the pain level & mobility you observed of injured guest.
Did Injured make any comments? What did they say when you asked them what happened?
Who removed the skates from Injured's feet? Who took control of the skates?
How long was the injured person in the facility after they fell and how did they leave the fadllty? (l.e. - parent took them homelhospital,
they stag nd left with class on bus, chaperone returned with them to the school within 15 minutes of fall, etc.)
J. was l»Q¢*fl'\i" . m/er' -Jo .serve of_ Qui .
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Preview
Filing # 151117027 E-Filed 06/08/2022 03:44:53 PM IN THE CIRCUIT COURT OF THE THIRTEENTH JUDICIAL CIRCUIT IN AND FOR HILLSBOROUGH COUNTY, FLORIDA CIVIL DIVISION SUSANA JIMENEZ, Plaintiff, Case No.: 2021-CA-000781 Division: K v. UNITED SKATES OF AMERICA, INC., Defendant. / PLAINTIFF'S MOTION TO COMPEL/MOTION FOR SANCTIONS FOR FAILURE TO PRESERVE CRITICAL EVIDENCE AND/OR SPOILATION OF CRITICAL EVIDENCE COMES NOW the Plaintiff, SUSANA JIMENEZ, by and through her undersigned counsel, and pursuant to Florida Rule of Civil Procedure 1.380 files this Motion to Compel the production of critical evidence. In the alternative, Plaintiff moves for sanctions for Defendant's failure to preserve critical evidence and/or for spoilation of critical evidence, and as grounds therefore would show as follows: INTRODUCTION 1. That this is an action for personal injury damages that arises from a fall that took place at the premises located at 7510 Paula Drive, Tampa, Hillsborough County, Florida 33615 ("the premises") and commonly referred to as Town & Country Skate World of Tampa and/or United Skates of America, Inc. 1 2. This case is set for a jury trial on this Court's February 20, 2023 docket. 3. Plaintiff is informed, believes, and alleges that on the date of the accident that is l On March 24, 2021, this Court entered a default judgment on liability against the former Defendant, Town & Country Skate World of Tampa, Inc. 6/8/2022 3:44 PM Electronically Filed; Hillsborough County/13th Judicial Circuit Page 1 the subject of this lawsuit, the active Defendant, UNITED SKATES OF AMERICA, INC. leased the premises from the former Defendant, Town & Country Skate World of Tampa, Inc. 4. In her Amended Complaint, Plaintiff alleges that on August 31, 2018, she was on the Defendant's premises as a business invitee. Plaintiff was a guest at Defendant's premises for the purpose of attending her granddaughter's birthday party. Am Compl. 1] 6. 5. Plaintiff further alleges that while she was on Defendant's premises, she was roller- skating, when her skate's axle "failed, rotated, and/or buckled causing Plaintiff to injure her left knee, leg, ankle, and foot, which ultimately required multiple surgical interventions." Am. Compl. 1]7. 6. Plaintiff further alleges that the Defendant owed several duties of care to the Plaintiff, including the duty to perform regular inspection and maintenance of rental skates, including "inspection of the pivot points, pivot pin bushings, tightening of kingpins, and all other skate component parts and any standard maintenance to avoid any defects in the skates causing unsafe and dangerous conditions, and a non-delegable duty of safety, repair, inspection and maintenance over the skates and the premises." Am. Compl. 1] 8. 7. Plaintiff further alleges that Defendant breached its duty of care and was ultimately negligent by failing to perform regular inspection and maintenance of the rental skates, including the inspection of the pivot pins, pivot pin bushings, tightening of kingpins, and all other skate component parts and failed to perform any standard maintenance to avoid any defects in the skates causing an unsafe and dangerous condition. Am. Compl. 1] 10. 8. During the course of discovery, it was ascertained that on the date of the accident, August 31 , 2018, Defendant prepared an incident report, a copy of which is attached as Exhibit A. The incident report states, "material prepared for litigation purposes". 6/8/2022 3:44 PM Electronically Filed; Hillsborough County/13th Judicial Circuit Page 2 9. Additionally, during the course of discovery, it was ascertained that Defendant obtained statements from its employees on the date of the accident and had them prepare a "MATERIAL PREPARED FOR LITIGATION PURPOSES" document, a copy of which is attached as Exhibit B. 10. Also, during the course of discovery, it was ascertained that on or about the date of the accident, Defendant prepared a "Skate Inspection Report" acknowledging that at least one employee of the Defendant took possession of the skates which Plaintiff was wearing on the date of the accident. The skate inspection report is attached as Exhibit C. 11. On August 4, 2020, counsel for the Plaintiff delivered a letter of representation to Town & Country Skate World of Tampa at 7510 Paula Drive Tampa, Florida 33615 and 7706 W Elm Street Tampa, Florida 33615, a copy of which is attached as Exhibit D. In this letter, counsel requests that any and all video surveillance, incident reports, photographs with respect to this incident, and the actual skate involved at the time of the incident be preserved and the letter states, "Accordingly, I ask that no repairs or modifications be performed to any of the aforementioned items, until such a time as they can be properly examined and viewed. Please send us a letter advising us as to the location of any of these items, including the subject video and especially the skate, and granting this office permission to visually examine same. Clearly, our intent is to properly preserve all available evidence, so that any contested can be addressed in light of all of the evidence." (Emphasis supplied). 12. On or about January 28, 2021, this lawsuit was commenced. 13. On or about July 15, 2021, Plaintiff served her first Request for Production of Documents to Defendant, a copy of which is attached as Exhibit E. 14. On or about September 27, 2021, Defendant served its Responses and Objections 6/8/2022 3:44 PM Electronically Filed; Hillsborough County/13th Judicial Circuit Page 3 to Plaintiff' s First Request for Production, a copy of which is attached as Exhibit F. In their responses to Plaintiff" s First Request for Production of Documents, number 12, which asks for "the actual skates used by the Plaintiff in the fall on August 31 , 2018, at the premises", Defendant responds "Objection. Plaintiff seeks information that is irrelevant to any claim or defense in this litigation and therefore is not reasonably calculated to lead to the discovery of admissible evidence and protected by disclosure by the work product doctrine and Florida Law. By way of further answer, this inquiry is overly broad in scope and vague and incorporates any potential work product or attorney/client privilege. To the extent that Plaintiff identified the skates she was wearing at the time to any personnel or any issue with the skate, same will be produced. If the skate worn at the time of the incident were obtained from the Defendant, a record of the skate inspection will be produced." 15. On or about February 7, 2022, Plaintiff served her Second Request for Production of Documents to Defendant, a copy of which is attached as Exhibit G. 16. On or about March 15, 2022, Defendant served its Responses and Objections to Plaintiffs Second Request for Production, a copy of which is attached as Exhibit H. In their responses to Plaintiff" s Second Request for Production, number 3, which asks for "The actual skate(s) identified as being bagged/tagged in the Skate Inspection Report produced in your response to Plaintiff"s First Request for Production of Documents", Defendant responds "To be determined. This information will be provided if documents exist, subject to any privileges." 17. On or about March 28, 2022, Defendant served its Amended Responses and Objections to Plaintiffs Second Request for Production, a copy of which is attached as Exhibit I. In its amended response to the request for "The actual skate(s) identified as being bagged/tagged 6/8/2022 3:44 PM Electronically Filed; Hillsborough County/13th Judicial Circuit Page 4 in the Skate Inspection Report produced in your response to Plaintiff" s First Request for Production of Documents", Defendant responds "To be determined. This information will be provided if documents exist, subject to any privileges." 18. On April 24, 2022, the undersigned counsel for the Plaintiff sent an email to counsel for the Defendant containing a copy of this motion and stating that Plaintiff would not file the motion until after counsel have had an opportunity to confer. 19. On April 27, 2022, Defendant filed its Supplemental Amended Responses and Objections to Plaintiffs Second Request for Production, a copy of which is attached as Exhibit J. Defendant amended its response to Plaintiffs request for the actual skates by stating: "After diligent search, these skates were no longer out of rotation. In 2018, if no notice of a claim was made with regard to the skates used within 6-months, and the skates passed inspection or did not need any maintenance, the skates were returned to rotation due to the need to maintain inventory of the rentals. By way of further Answer, according to Plaintiffs testimony, she asked for more than one pair of skates at different times during her skate session to "try out." 20. Based on discovery, it appears that the Defendant took possession of the actual skates wom by the Plaintiff prior to her fall, inspected the skates, and should still have them in their possession. However, based on Defendant's most recent response to Plaintiffs Requests for Production, it appears that the skates have been either placed back into "rotation" without being properly identified, discarded, altered, lost, and/or destroyed. 21. The actual skates worn by the Plaintiff prior to her fall are key evidence that Plaintiff needs to prove her case against the Defendant. Therefore, Plaintiff moves this court to compel Defendant to produce the actual skates immediately. 6/8/2022 3:44 PM Electronically Filed; Hillsborough County/13th Judicial Circuit Page 5 22. If these skates have been discarded, altered, lost, and/or destroyed, this would amount to spoliation of critical evidence and Plaintiff moves for sanctions against Defendant. MEMORANDUM OF LAW REGARDING SPOLIATION OF CRITICAL EVIDENCE 23. Florida state courts have consistently held that sanctions are appropriate when spoliation occurs. The sanctions may include the striking of pleadings, the entry of a default on the issue of liability, exclusion of expert testimony, the imposition of an evidentiary presumption, and the dismissal of a claim. See DePuy Inc. vs. Eckes, 427 So. 2d 306 (Fla. 3d DCA 1983). In DePuy, the Court held that the trial judge did not err in striking a defendant's answer and affirmative defenses after the defendant returned the plaintiffs crucial piece of evidence, a defective hip prosthesis, with the fracture site missing. The defendant had performed an electron microscope examination on the fracture site, which the plaintiff had not yet performed. The defendant's lack of bad faith in losing the evidence was held to be irrelevant. 24. The principles announced in DePuy were expanded in Rockwell International Corp. v. Menzies, 561 So. 2d 677 (Fla. 3d DCA 1990). In Rockwell, the Third District, citing Depuy, affirmed an order striking a table saw manufacturer's answer and affirmative defenses and entered a default because of the destruction and loss of two bolts attached to another manufacturer's motor. The bolts were hacked off by the table saw manufacturer's experts in the course of an inspection of the table saw because they could not otherwise remove the other manufacturer's motor. When the defendants' experts reinstalled the original motor, they installed replacement bolts but failed to retain the two original, hacked off bolts. There was no evidence that this was done in bad faith. The rationale for affirming the default was that the destruction of the two bolts made it impossible for the plaintiff to rebut the expected testimony of the manufacturer's expert that the buyer had failed to firmly secure the bolts to the motor plate. The IIIIIIIIIII 6/8/2022 3:44 PM Electronically Filed; Hillsborough County/13th Judicial Circuit Page 6 court has recognized that drastic sanctions, including a default, are appropriate when a defendant who has been ordered not to destroy evidence does, in fact, alter or destroy critical physical evidence, and when the plaintiff has demonstrated an inability to proceed without such evidence. 561 So. 2d at 679 (Emphasis supplied). The court in Rockwell repeated the standard set in DePuy that whether the defendant destroyed the evidence in "bad faith or accidentally is irrelevant." Id. 25. The Third District of Florida and other districts have continued to uphold these rulings with regard to spoliation of critical evidence. In Federal Insurance Co v. Allister, 622 So. 2d, 1348, 1351 (Fla. 4th DCA 1993), the Fourth District set forth five factors to consider before imposing sanctions for spoliation of evidence: "(1) whether there is prejudice, (2) whether the prejudice can be cured, (3) the practical importance of the evidence, (4) the good faith or bad faith surrounding the loss of evidence, and (5) possible abuse if the evidence is not excluded." 26. The court in DePuy further points out that "Whether the [evidence] was destroyed in bad faith or accidentally is irrelevant in the present case. The evidence is unavailable for the plaintiffs use, and they have demonstrated an inability to proceed without it... Having lost the [evidence], [defendants] are now accountable for the ramifications of their act." 427 So. 2d 306 at 308. 27. Similarly, the Fourth District in New Hampshire Ins. Co. v. Royal Ins. Co., 559 So. 2d 102 (Fla. 4th DCA 1990), focused on the importance of the evidence rather than on whether the destruction was in bad faith: "If appellant has destroyed relevant and material information by destroying the file, and that information is so essential [to their claim or defense] that it cannot proceed without it, then the striking of pleadings may be warranted" 559 So. 2d at 102. 28. Alternatively, where a party fails to produce evidence within his control, an adverse 6/8/2022 3:44 PM Electronically Filed; Hillsborough County/13th Judicial Circuit Page 7 inference may be drawn that the withheld evidence would be unfavorable to the party failing to produce it. Valcin v. Public Health Trust of Dade County, 473 So. 2d 1297 (Fla. 3d DCA 1984), mody'ied by Public Health Trust of Dade County v. Valcin, 507 So. 2d 596 (Fla. 1987). 29. In addition to imposing discovery or pleading sanctions, the Florida Supreme Court in Public Health Trust of Dade County v. Valcin, set forth certain criteria for imposing evidentiary presumptions in the event of negligent or intentional destruction of hospital records, as follows: l) If the hospital is unable to produce the records, the plaintiff must establish that the absence of the records hinders the plaintiff"s ability to establish a prima facie case, 2) if the plaintiff meets that burden, a presumption of liability arises and the burden of proof shifts to the hospital to prove the nonexistence of the fact presumed, and 3) when evidence rebutting such presumption is introduced, the presumption does not automatically disappear and is not overcome until the trier of fact believes that the presumed fact has been overcome by whatever degree of persuasion is required by the substantive law of the case. The court did not require the destruction to be intentional, mere negligence was sufficient. However, if the spoliation was intentional, the court left the door open to further sanctions: "[A] wide range of sanctions is available to the trial court under Florida Rule of civil Procedure 1.380(b)(2l." 507 So. 2d 596 (Fla. 1987). 30. Finally, courts agree that sanctions may be appropriate for evidence destroyed by a party on notice of "potential litigation". See Continental Insurance Co. v. Herman, 576 So. 2d 313 (Fla. 3d DCA 1990). Further, sanctions may be imposed against a litigant who is on notice that evidence in its possession is relevant to litigation, or potential litigation, or is reasonably calculated to lead to the discovery of admissible evidence and destroys such evidence. Moreover, a litigant is under a duty to preserve what it knows, or reasonably should know, is relevant in the action, is reasonably calculated to lead to the discovery of admissible evidence, is reasonably likely to be 6/8/2022 3:44 PM Electronically Filed; Hillsborough County/13th Judicial Circuit Page 8 requested during discovery, and/or is the subject of a pending discovery request. See William T Thompson Co. v. General Nutrition Corp., Inc., 593 F. Supp. 1443, 1455 (D.C. Cal. 1984). 31. In summary, in determining whether to impose sanctions or evidentiary presumptions for spoliation of evidence, Florida state courts generally require the trial court to consider whether the spoliation 1) impairs the party from presenting its case or its defense to the case, and 2) was committed willfully or inadvertently. If the evidence is so essential that the party cannot proceed without it, bad faith is irrelevant and need not be considered in state court actions. CONCLUSION 32. On August 31 , 2018, Defendant was placed on notice that litigation could ensue as a result of a fall that occurred on its premises while the Plaintiff was performing skating activities. In fact, Defendant immediately identified their incident report, employee statements, and the skate inspection report as material kept for "litigation purposes." Furthermore, in August of 2020, Defendant was put on notice (again) prior to this lawsuit that they were required to preserve all evidence, especially the subject skates worn by the Plaintiff. Defendant's responses to Plaintiff"s Request for Production of the skates, at this juncture, indicate that the skates are no longer in Defendant's possession, and their whereabouts are unknown. The skates are critical evidence in this case as they form the basis of Plaintiff" s claim, and she cannot proceed at trial without having had the opportunity to inspect them. WHEREFORE, the Plaintiff, SUSANA JIMENEZ, respectfully requests that this Honorable Court compel Defendant to produce the skates immediately at a mutually agreeable date and time for Plaintiff and her counsel to inspect. If Defendant cannot produce the skates, then Plaintiff requests that the Court impose sanctions on the Defendant, including but not limited to the striking of Defendant's Answer and Affirmative Defenses, and a Default Judgment in favor 6/8/2022 3:44 PM Electronically Filed; Hillsborough County/13th Judicial Circuit Page 9 of the Plaintiff on the issue of liability, and such other and further relief as this Court deems just and proper. CERTIFICATE OF GOOD FAITH CONFERRAL I certify that prior to filing this motion, I attempted to resolve the matter by discussing the relief requested in this motion by telephone on May 1, 2022, with counsel for the Defendant and opposing counsel did not agree that the motion could be resolved without the necessity of a hearing , CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing document was filed electronically and sent by E-Mail from the Florida Courts' E-Filing Portal system, to Alicia Caridi, Esq., at amcaridi@mdwcg.com and Michael V. Caruso, Esq., mcarusoesq@ymail.com, on this 8th day of June 2022. MICHAEL A. SE Flori mike@mikeserranolaw.com CANDACE KNOX HARTLEY, ESQ. Florida Bar No.: 117794 cea@mikeserranolaw.com SERRANO LAW 25275 Wesley Chapel Boulevard Lutz, Florida 33559 (8 13) 929-423 l (813) 948-1905 Fax Attorneys for Plaintiff 6/8/2022 3:44 PM Electronically Filed; Hillsborough County/13th Judicial Circuit Page 10 Page IT of 26 EXHIBIT A I INCIQENI REPORT 2:1 '.r RINK ADDRESS: T51c> Pc1¢.L£QLL2[Y 7?1wpG<, Fl. DATE [lrlchdent occurred): 0518 :- 00 TIME flnddant o::clJf11ad):. AM am 5549i5 TIME (Skaterardvudj: * 9 I o '5 AM .____-_-___ TYPE OF ACTIVITY l: l Camp - Group N a m e : __ D Private Party - Group Name: _ _ _ Sa8sI§:l.Tit*=';."A. - in U Birlhday party - Birthday €hllld'S Name: ll- E LeL'ss3 E'8 E U W MEt; . R e" t a l INCIDENT LOCATION -'p 0 1 r EI Skating Floor E Locker Area ENcafé Area l:lBathroom s III Outside Entrance D Gam e EIOther: Area Et Kate -.- . - 71119 INJLIRED pERSQN InFURMATIQll - Name: 348894 .gim€v'1€.2. i111111111 El Male .EIIJFemale AGE: =8.s_ DoI Skates: D owned-size tilJ2enled-size'-i D NfA W earing wrist Guards? Yor('7If yes: s M L Injuredwearing: d(1lflK DQ 2d$J_K1f:l"1 Phone: es | 85 vi N I14 Pal'Br\l'sp'chBp€ror'le's Name [if injured peluon under 18). Were they present? EIYes UNO fd'l'G1ll PannVtNlrsperunej Street Address. Apt. #r C i t y: . State: Zip: .. Phone: -., Email: - 1 INJURY INFORMATION B od y P ar t:EIWrlst m Arm Wag l:l Ankle D Head Ll Mouth D Hip El Neck D Other: Injury position (If applicable):El Left ,E:6zight I m m ed i at e Action Taken (Check all that apply): '{.81ue Applied g=EmsJFile Dept c al l ed o ParentlChaperor:»e Notltied EMS #z 26 _ T ime Called: in 7 04pm _ Time Arrived: 10: * G W Did injured leave w:'EMS: M Yee o No Others Involved in Incident? D Yes 1'2*'No ID or Name of "other" person: _ Phonafaddress: Location incident report taken: _'S£t%€_ ieoNng 8ivEici _ *lll1111l STATEMENT OF INJURED PERSON Name of Person making Statement: §U5QJ"l°\ biwwct [& their relationship] B a l i Statement T WU5 _ 't;Jvl/tihcl cu'ovlrwd_ Cwwrl -hr\JI1S-\-<'C)l we lag and ¥a1l_arL_i;.-_ _ Did injury occur during specialty skate/game? EYes . ho Ifso, type of specialty skaterfgame: Skating Ability: D intermediate Beg i n n er EI Advan ced How many times skated in last year: Q.[\Y,lV¢;;\.-41,q Signature of injured Cr chaperon of? ' / . "" _ Date: 31 {;01'8' Printed Name MANAGER Tak'I Ig Re .f9L7it'l'l.£A*[ T ime Report taken : [Q `. OM) p YT! Signature Of MANAGER: 2 , / . 8 _ ; Dabs: 313_i I '21-¥1§ Did injured guest return fc skating? l'JYes JNQ EINM 4-12-2021 402104A09D00001 6020210412012620 inlvlsiizemaaifac.44d§»aiEI@nua»1ima=1k!ii6He11nbnish;sm»innfsIbH1qunftu8l3th Judicial Circuit Page 11 4f'16/2021 Page 18 of 26 I l i- I 4 14-=:r@1Aa | ."5 1'r.- r ...1 1 ,I 1\I"" 1r al =]i .r.. =IT '-. Ja¢'T|r*1 . | ruiiT MEEQ ~ I EMPLGYEE5 DM DUTY AT TIME GF INCIDENT If an employee la a vuitneas, -talked to or asslalad Injured parson, talked b or heard from Cher msmners. or Inspected incident huastlon aNemsrds, THEY MUST COMPLFFE MATERIAL PREPARED FOR l_ITIGATION PURPOSES FORM Name All BELEVANT Employees POSITION NAME wimasaea Indicant Talked To or Talked to DI' Heard inspected Area (Print) .l"\BBlsted Injured From Other whale incident Peiann Customers Took Place am _ In Bldg? l- No yes Yes No -l yes No Yes W No - Y"P'**'° Assist. Mmagar "4 vwkrsrrne Yes'§9n o &r es I No- l- yas|I,E5no it as L Nu Assist. Manager rmwcks l uNt€K\ n ' Yes HNQ alYes Ono Yes .E8?No Yg33' DJ ._i al. • Yes 8 ' N o Y SS -TO N o l-\t8,w ' YQS NO Floor Guard 4 INK. PA l wzc .f Yes 'lNa Yes W ' Yes pf wo Y: :41NO Floor Guild l-Yes -l Nu Ye s ' No W Yes No W Yes ' Nu Fluor Guard M Y es No yes No Yes No yes No Onnasssion l- has 4 v Le' l Yes §'No W ees 3. Yes - No V Y esI n No Yes W No Other )u` nI s Yes!lWm- No Yes E'No Yes 4 No I CONDITIONS AT TIME OF INCIDENT AREWM: . 46l-rT s; sEss_lon TYPE: I Clear JF r ee of Debris:,E9YesEl no Full House Ughts: EI Yas [BoNo L:l Family MTeen D r y: ,E'Yes EJ No Medium House Lights: m Yes 'El No El private Party EI Adult Low House Lights: Pres EINo r:l Kids Fun, Skate Last Time Floor was &ra°ept:"1 ' 5C);>w= Name of person who last swept f loor: TS\y}l.\{'\ 1 g'~pf'¥_';l£>YW(;) Number of Tickets Sold: l 8 3 Approximate Number of Skaters on Skate Floor; IN O _ Manager Completing This Repor t : K1§8(p \'lg3~(w\-g Date:8i ?>i l VK Posltlon:9I'SS`¥'~3*l.Qv'1.*=- M L 4 8 - Home Address: il'l0"l_ Mc 0xdowd l d r. Tam pm 1 Fl. 38498 cell Phone: '83-(gl8-l3Lo(.}2, POST-INCIDENT A=cTlo1~ls TA.l"r Date 8 061§)Tt7"t"' Video Clip Saved: o Y es .E No video Review Fo u Yes D No (nuaeh IrTea] EOLLOW up CALL: Fohlaw-up Phone Call Conducted by. M a iI =man=leA of/o§N/13' _ Dare(=398'1 Cus m er end to Hospital: 19383 l: l Cugamer W entt Doemorrurgentcq . In .E 5i7c€>t28 - Q211a1 419 Haw-~ my VfM4v"M as zL9l-#2=1\9_ P r U 82 h f 9 I 4. MI » l i N I r us1'a 1 SMSQM' vucffurvd 4 4£ptvQ.n*r 'WE 'Q 1 \I r I| 9 | l Ufmw -Www Wxfn 'Q,\'»d5,.§wn4L¢1 QAM inI J Gat Well C8l'd Sentry Yes 'I EINu Sent bf x Date: n Type of Gif! Sent: .QW i& 1 . \ I ADDITIONALOOMMENTSI H IS C LAIM # WW 4-12-2021 402104A09D00001 6020210412012620 M942D2i2n3v44&¢11'§¢ArEb91cQniaallYliiiil§4I'til1l§ib9l GENERAL INFORMATION Name of Employee: W\ia$ Y vuL»l Cell Phone: ii13~-I.-A5-Xlgov, Job at Time of Incident [Please Check One): ,9'Management D Floor Guard El Disc Jockey l:l Conoessioh D Party Host D stuff Shop l:l Maintenance EI Security D Other: I _- _ WITNESSED INCIDENT: U Yes ,Ell No If yes. describe exactly what you witnessed (use names or labels of guest such as teacher, mother, sister): & include: What you noticed caused the fall. actions before fall, during fall & after fall Describe where you were & where injured guest was before, during & after fall What actions did you take when you saw the fall? Was the guest in a lot of pain, able to walk. move? - . TALKED TO OR ASSISTED INJURED PERSON: YOU o No If yes, describe what you did and@Lvyhat was said (use names of employees or labels of guests such as mother, teacher, chaperone, sister): Where was injured when you assisted? Where were you when you Ieamed about the incident? How (headset. witness. Saw aowd)81 by who (FG's, conoesslon associate - provide names) notified you that the guests was injured? When you went to scene, who was there? (name employees. family members. dlaperonas, or use labels) Name other employees or guests who were assisting & be specific about what did they did to assist? Describe the pain level & mobility you observed of injured guest. Did injured make any comments? What did they say when you asked them what happened? Who removed the skates from injured's feet? Who took control of the skates? How long was the injured person in the facility alter they fell and how did they leave the facility? (i.e. - parent took them home/hospital, they stayed and left with class on bus, chaperone returned with them to the school within 15 minutes of fall, etc.) 1 was 'i'4f'\'\Y'\ \o a (\'hc.l0A4 mperwofvs wV\CY\ i Vteofd -loW-1 rod 11 A \<>0*pn)ftr.vwi so e \r'zQ¥€J -to wt \ n vrmlfw, t as we ML- SW .~414.s-0 my we 3 'Ne So-Od MAS \~~)*~ 4-12-2021 402104A09D00001 6020210412012620 -_ _- liili@)@2£13aw3V4§h W as there anything on the floor?: IJ Yes D No If Yee, Place the Item In a Zlploe bag and attach It to the report AREAS LIGHTS: SESSION TYPE; Yes Clean/Free of Debris: No Full House Lights: Yes ` No Family Teen Dry: yes No Medium House Lights: Yes No V Adult Private Party Low House Lights: Yes No -i Kids Fun Skate Employee Signature: i Date: 38%/19 4-12-2021 402104A09D00001 6020210412012620 liili@)@2£13aw3V4§her§9n. talked to gr heard_from other customers, . inspected indent location afterwards, or THEY MUST COMPLETE THIS MATERIAL PREPARED FOR LITIGATION PURPOSES FORM FILE IDENTIFICATION Name of lnjured cusmmen3g.'-5o(\Q jwewr& one aflnciaem: ".4.221 lLK Time: 101 OOAM/l® GENERAL INFORMATION Name of Employee: Q3_v€ 9\W;wR\ _ Cell Phone: - Job at Time of Incident (Plsasa Check Ono): II] Management D Floor Guard l:l Disc Jockey MConcession D Party Host l:l Stuff Shop El Maintenance IJ Security l:l Other: - _ WITNESSED INCIDENT: 1 Yes p'no If yes,jescribe exactly M3341 witrpssed (use names or labels of guest such as teacher. mother, sister): & include: What you noticed Qg8§.1_, actions before fall, during fall & after fall Describe where you were & where injured guest was before, during & after fall What actions did you take when you saw the fall? Was the guest in a lot of pain. able to walk, move? 1- - l TALKED TO OR ASSISTED INJURED PERSON: PYQs IJ No If yes. describe what you dig and/or what_wa;said (use names of employees or labels of guests such as mother, teacher, chaperone, sister): Where was Injured when you assisted? Where were you when you teamed about the Incident? How (headset, witness. saw crowd) & by who (FG's, concession associate - provide names) notified you that the guests was Injured? When you went to scene. who was there? (name employees. family members, diaperones, or use labels) Name other employees or guests who were assisting a be specific about what did they did to assist? Describe the pain level & mobility you observed of injured guest. Did Injured make any comments? What did they say when you asked them what happened? Who removed the skates from Injured's feet? Who took control of the skates? How long was the injured person in the facility after they fell and how did they leave the fadllty? (l.e. - parent took them homelhospital, they stag nd left with class on bus, chaperone returned with them to the school within 15 minutes of fall, etc.) J. was l»Q¢*fl'\i" . m/er' -Jo .serve of_ Qui . a