Los Angeles local civil form — Civil Case Cover Sheet Addendum and Statement of Location (LASC CIV 109)

Source: https://lascpubstorage.blob.core.windows.net/forms/Forms%20Comprehensive%20List/LASC%20CIV%20109.pdf

SHORT TITLE CASE NUMBER

CIVIL CASE COVER SHEET ADDENDUM AND STATEMENT OF LOCATION (CERTIFICATE OF GROUNDS FOR ASSIGNMENT TO COURTHOUSE LOCATION)

This form is required pursuant to Local Rule 2.3 in all new civil case filings in the Superior Court of Los Angeles County

Step 1: After completing the Civil Case Cover Sheet (Judicial Council form CM-010), find the exact case type in Column A that corresponds to the case type indicated in the Civil Case Cover Sheet. Step 2: In Column B, check the box for the type of action that best describes the nature of the case. Step 3: In Column C, circle the number which explains the reason for the court filing location you have chosen.

Applicable Reasons for Choosing Courthouse Location (Column C)

1. Class Actions must be filed in the Stanley Mosk Courthouse, Central District. 7. Location where petitioner resides.

2. Permissive filing in Central District. 8. Location wherein defendant/respondent functions wholly.

3. Location where cause of action arose. 9. Location where one or more of the parties reside.

4. Location where bodily injury, death or damage occurred. 10. Location of Labor Commissioner Office.

5. Location where performance required, or defendant resides. 11. Mandatory filing location (Hub Cases – unlawful detainer, limited non-collection, limited collection).

6. Location of property or permanently garaged vehicle.

A B C Civil Case Cover Type of Action Applicable Sheet Case Type (check only one) Reasons (see Step 3 above) Auto (22) ☐2201 Motor Vehicle – Personal Injury/Property Damage/Wrongful 1, 4 Tort Death Auto Uninsured Motorist ☐4601 Uninsured Motorist – Personal Injury/Property 1, 4 (46) Damage/Wrongful Death Other Personal ☐2301 Premise Liability (e.g., dangerous conditions of property, 1, 4 Injury/ Property slip/trip and fall, dog attack, etc.) Damage/ Wrongful Intentional Bodily Injury/Property Damage/Wrongful Death 1, 4 Death (23) ☐2302 PropertyDeath (e.g., assault, battery, vandalism, etc.) ☐2303 Intentional Infliction of Emotional Distress 1, 4 Injury/Wrongful 1, 4 ☐2304 Other Personal Injury/Property Damage/Wrongful Death Personal ☐2305 Elder/Dependent Adult Abuse/Claims Against Skilled Nursing 1, 4 Damage/ Facility Other ☐2306 Intentional Conduct – Sexual Abuse Case (in any form) 1, 4

SCLAC CIV 109 Rev. 04/26 CIVIL CASE COVER SHEET ADDENDUM SCLAC Local Rule 2.3 For Mandatory Use AND STATEMENT OF LOCATION

SHORT TITLE CASE NUMBER

A B C Civil Case Cover Type of Action Applicable Sheet Case Type (check only one) Reasons (see Step 3 above) ☐ 2307 Construction Accidents 1, 4 ☐2308 Landlord – Tenant Habitability (e.g., bed bugs, mold, etc.) 1, 4 Product Liability (24) ☐2401 Product Liability (not asbestos or toxic/ environmental) 1, 4 Injury/ 1, 3, 5 Death ☐2402 Product Liability – Song-Beverly Consumer Warranty Act (CA Damage/ Civil Code §§1790-1795.8) (Lemon Law) Personal Medical Malpractice ☐4501 Medical Malpractice – Physicians & Surgeons 1, 4 Wrongful (45) Property Other ☐ 4502 Other Professional Health Care Malpractice 1, 4 Business Tort (07) ☐ 0701 Other Commercial/Business Tort (not fraud or breach of 1, 2, 3 contract) Death Civil Rights (08) ☐ 0801 Civil Rights/Discrimination 1, 2, 3 Defamation (13) 1301 Defamation (slander/libel) 1, 2, 3 ☐ Tort Fraud (16) ☐ 1601 Fraud (no contract) 1, 2, 3 Professional 2501 Legal Malpractice 1, 2, 3 Non-Personal ☐ Injury/Property Negligence (25) 2502 Other Professional Malpractice (not medical or legal) 1, 2, 3 ☐ Damage/Wrongful Other (35) 3501 Other Non-Personal Injury/Property Damage Tort 1, 2, 3 ☐ Wrongful 3601 Wrongful Termination 1, 2, 3 ☐ Termination (36) Other Employment 1, 2, 3 1501 Other Employment Complaint Case ☐ (15) 10 Employment 1502 Labor Commissioner Appeals ☐ Breach of Contract / 0601 Breach of Rental/Lease Contract (not unlawful detainer or 2, 5 ☐ Warranty (06) wrongful eviction) (not insurance) ☐0602 Contract/Warranty Breach – Seller Plaintiff (no 2, 5 fraud/negligence) ☐ 0603 Negligent Breach of Contract/Warranty (no fraud) 1, 2, 5 ☐ 0604 Other Breach of Contract/Warranty (no fraud/ negligence) 1, 2, 5 ☐ 0605 Breach of Rental/Lease Contract (COVID-19 Rental Debt) 2, 5 Collections (09) ☐ 0901 Collections Case – Seller Plaintiff 5, 6, 11 Contract 0902 Other Promissory Note/Collections Case 5, 11 ☐ Collections Case – Purchased Debt (charged off consumer debt 5, 6, 11 ☐0903 purchased on or after January 1, 2014) 0904 Collections Case – COVID-19 Rental Debt 5, 11 ☐ Insurance Coverage 1801 Insurance Coverage (not complex) 1, 2, 5, 8 ☐ (18)

SCLAC CIV 109 Rev. 04/26 CIVIL CASE COVER SHEET ADDENDUM SCLAC Local Rule 2.3 For Mandatory Use AND STATEMENT OF LOCATION

SHORT TITLE CASE NUMBER

A B C
Civil Case Cover Type of Action Applicable
Sheet Case Type (check only one) Reasons (see
Step 3 above)
Other Contract (37) ☐ 3701 Contractual Fraud 1, 2, 3, 5
☐ 3702 Tortious Interference 1, 2, 3, 5
☐ 3703 Other Contract Dispute (not breach/insurance/fraud/ 1, 2, 3, 8, 9 Contract(Continued) negligence)
Eminent Domain/ ☐ 1401 Eminent Domain/Condemnation 2, 6
Inverse Number of Parcels _________
Condemnation (14)
Wrongful Eviction ☐ 3301 Wrongful Eviction Case 2, 6
(33) Property Other Real ☐ 2601 Mortgage Foreclosure 2, 6

Real Property (26) ☐ 2602 Quiet Title 2, 6 ☐ 2603 Other Real Property (not eminent domain, 2, 6 landlord/tenant, foreclosure) Unlawful Detainer ☐3101 Unlawful Detainer – Commercial (not drugs or wrongful 6, 11 – Commercial (31) eviction) Unlawful Detainer ☐3201 Unlawful Detainer – Residential (not drugs or wrongful 6, 11 – Residential (32) eviction) Detainer Unlawful Detainer ☐ 3401 Unlawful Detainer – Post Foreclosure 2, 6, 11 – Post Foreclosure (34) Unlawful Unlawful Detainer ☐ 3801 Unlawful Detainer – Drugs 2, 6, 11 – Drugs (38) Asset Forfeiture ☐ 0501 Asset Forfeiture Case 2, 3, 6 (05) Petition re ☐ 1101 Petition to Compel/Confirm/Vacate Arbitration 2, 5 Arbitration (11)

(02) ☐ 0202 Writ – Mandamus on Limited Court Case Matter 2 Review Writ of Mandate ☐ 0201 Writ – Administrative Mandamus 2, 8
Judicial Other Judicial ☐☐ 39010203 OtherWrit – Writ/JudicialOther LimitedReviewCourt Case Review 2,28
Review (39)
☐ 3902 Administrative Hearing 2, 8
☐ 3903 Parking Appeal 2, 8
Antitrust/Trade ☐ 0301 Antitrust/Trade Regulation 1, 2, 8
Regulation (03)
Asbestos (04) ☐ 0401 Asbestos Property Damage 1, 11 ComplexLitigation Provisionally ☐ 0402 Asbestos Personal Injury/Wrongful Death 1, 11

SCLAC CIV 109 Rev. 04/26 CIVIL CASE COVER SHEET ADDENDUM SCLAC Local Rule 2.3 For Mandatory Use AND STATEMENT OF LOCATION

SHORT TITLE CASE NUMBER

A B C Civil Case Cover Type of Action Applicable Sheet Case Type (check only one) Reasons (see Step 3 above) Construction ☐ 1001 Construction Defect 1, 2, 3 Defect (10) Claims Involving ☐ 4001 Claims Involving Mass Tort 1, 2, 8 Mass Tort (40) Complex Securities Litigation ☐ 2801 Securities Litigation Case 1, 2, 8 (28) ☐ 3001 Toxic Tort/Environmental 1, 2, 3, 8 Litigation(Continued) Toxic Tort Environmental (30) ☐ 4101 Insurance Coverage/Subrogation (complex case only) 1, 2, 5, 8 Provisionally Insurance Coverage Claims from Complex Case (41) Enforcement of ☐ 2001 Sister State Judgment 2, 5, 11 of Judgment (20) ☐ 2002 Abstract of Judgment 2, 6 ☐ 2004 Administrative Agency Award (not unpaid taxes) 2, 8 ☐ 2005 Petition/Certificate for Entry of Judgment Unpaid Tax 2, 8 EnforcementJudgment 2, 8, 9 ☐ 2006 Other Enforcement of Judgment Case RICO (27) ☐ 2701 Racketeering (RICO) Case 1, 2, 8 Civil Other Complaints ☐ 4201 Declaratory Relief Only 1, 2, 8 (not specified ☐ 4202 Injunctive Relief Only (not domestic/harassment) 2, 8 above) (42) ☐ 4203 Other Commercial Complaint Case (non- 1, 2, 8 Complaints tort/noncomplex) Miscellaneous ☐ 4204 Other Civil Complaint (non-tort/non-complex) 1, 2, 8 Partnership ☐ 2101 Partnership and Corporation Governance Case 2, 8 Corporation Governance (21) Other Petitions ☐ 4301 Civil Harassment with Damages 2, 3, 9 Petitions (not specified ☐ 4302 Workplace Harassment with Damages 2, 3, 9 Civil above) (43) ☐ 4303 Elder/Dependent Adult Abuse Case with Damages 2, 3, 9 ☐ 4304 Election Contest 2 ☐ 4305 Petition for Change of Name/Change of Gender 2, 7 ☐ 4306 Petition for Relief from Late Claim Law 2, 3, 8 Miscellaneous ☐ 4307 Other Civil Petition 2, 9

SCLAC CIV 109 Rev. 04/26 CIVIL CASE COVER SHEET ADDENDUM SCLAC Local Rule 2.3 For Mandatory Use AND STATEMENT OF LOCATION

SHORT TITLE CASE NUMBER

Step 4: Statement of Reason and Address: Check the appropriate boxes for the numbers shown under Column C for the type of action that you have selected. Enter the address, which is the basis for the filing location including zip code. (No address required for class action cases.)

REASON: ADDRESS: ☐1. ☐ 2. ☐ 3. ☐ 4. ☐ 5. ☐ 6. ☐ 7. ☐ 8. ☐ 9. ☐ 10. ☐ 11

CITY: STATE: ZIP CODE:

Step 5: Certification of Assignment: I certify that this case is properly filed in the ____________________ District of the Superior Court of California, County of Los Angeles [Code of Civ. Proc., 392 et seq., and SCLAC Local Rule 2.3(a)(1)(E)]

Dated: ___________________ ____________________________________________SIGN (SIGNATURE OF ATTORNEY/FILING PARTY

PLEASE HAVE THE FOLLOWING ITEMS COMPLETED AND READY TO BE FILED IN ORDER TO PROPERLY COMMENCE YOUR NEW COURT CASE: 1. Original Complaint or Petition. 2. If filing a Complaint, a completed Summons form for issuance by the Clerk. 3. Civil Case Cover Sheet Judicial Council form CM-010. 4. Civil Case Cover Sheet Addendum and Statement of Location form SCLAC CIV 109 (01/23). 5. Payment in full of the filing fee, unless there is a court order for waiver, partial or schedule payments. 6. A signed order appointing a Guardian ad Litem, Judicial Council form CIV-010, if the plaintiff or petitioner is a minor under 18 years of age will be required by Court to issue a Summons. 7. Additional copies of documents to be conformed by the Clerk. Copies of the cover sheet and this addendum must be served along with the Summons and Complaint, or other initiating pleading in the case.

SCLAC CIV 109 Rev. 04/26 CIVIL CASE COVER SHEET ADDENDUM SCLAC Local Rule 2.3 For Mandatory Use AND STATEMENT OF LOCATION