20001089CA - BUFF, MARIA vs. TARGET CORPORATION

SUMMARY

Judge: Court Type: Case Type:

FISHEL, JOHN L II Circuit Civil NEGLIGENCE PREMISES LIABILITY COMMERCIAL

Case Number: Uniform Case Number: Status:

20001089CA 032020CA001089CAXXXX OPEN

Clerk File Date: Status Date: Waive Speedy Trial:

6/2/2020 6/2/2020

Total Fees Due: Booking Number: Agency:

0.00

Agency Report Number: Custody Location: Foreclosure:

ACTIVE - 6/2/2020

PARTIES

TYPE PARTY NAME ADDRESS ATTORNEY

PLAINTIFF BUFF, MARIA

PLAINTIFF BUFF, ADAM

ROCA, RAFAEL J (Main Attorney)

Email: rroca®800goldlaw.com

DEFENDANT TARGET CORPORATION

DEFENDANT HARRIS, WAYNE

EVENTS

DATE EVENT

1200 SOUTH PINE ISLAND ROAD

PLANTATION, FL 33324

STOKES, JOSEPH B III

Email: jstokes@saalfieldlaw.com

2340 FL77 STOKES, JOSEPH B III (Main Attorney)

PANAMA CITY, FL 32405 Email: jstokes®saalfieldlaw.com

J UDGE LOCATION

No Events on Case

RESULT

OUTSTANDING AMOUNT

COUNT CODE

1 VOCF

2 VSUM

RECEIPTS

DATE

6/2/2020

DESCRIPTION ASSESSMENT PAID WAIVED BALANCE PAYMENT PLAN / JUDGMENT DUE DATE

CIVIL-OTHER FILING FEES $400.00 $400.00 $0.00 $0.00

CLERK TF/DOR SUMMONS $20.00 $20.00 $0.00 $0.00

RECEIPT #

2020023606

CASE DOCKETS

SEQ# IMAGE

33

Request

DATE >ENTRY

Total Outstanding: 1$0.00

APPLIED AMOUNT

$420.00

8/3/2020 EP - PLAINTIFFS SECOND REQUEST FOR PRODUCTION TO TARGET CORPORATION

32 —;R" ;;71 8/3/2020 EP - TARGET CORPORATION AND WAYNE HARRIS NOTICE OF SERVING ANSWERS TO PLAINTIFFS INSURANCE INTERROGATORIES

1

31 Request

18/3/2020 EP - TARGET CORPORATIONS NOTICE OF SERVING ANSWERS TO PLAINTIFFS INITIAL INTERROGATORIES

30 Request

8/3/2020 EP - DEFENDANTS PRIVILEGE LOG

29 FRequest 8/3/2020 EP - TARGET CORPORATION'S RESPONSE TO PLAINTIFFS REQUEST FOR ADMISSIONS

28-1Request

8/3/2020 EP - TARGET CORPORATION'S RESPONSE TO PLAINTIFFS REQUEST FOR PRODUCTION

17;7 Je1s"1 it

27 7/25/2020 EP - RETURN OF SERVICE - SERVED 06/23/2020 WAYNE HARRIS

Request

26 Re 7/22/2020 EP -DFTS NOTICE OF WITHDRAWING NOTICE OF PRODUCTION FROM NON PARTY

25 Request7/22/2020 EP - NOTICE OF PRODUCTION OF RECORDS FROM NON-PARTY

24 r—R;;717/21/2020 EP - RESPONSE TO REQUEST FOR PRODUCTION

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 1 of 96
SEQ# ,IMAGE

23

DATE ENTRY

Request 7/21/2020 EP - NOTICE OF SERVING ANSWERS TO INTERROGATORIES

22 77e47t17/21/2020

Reques]t 7/13/2020

I Request

12

1 1

EP - NOTICE OF SERVING ANSWERS TO INTERROGATORIES

EP - WAYNE HARRIS MOTION TO DISMISS PLAINTIFFS COMPLAINT

EP - REQUEST FOR INSPECTION TO MARIA BUFF - TARGET CORPORATION

6/26/2020 EP - MOTION TO DISMISS- DFT TARGET CORP

6/19/2020 EP - REQUEST FOR PRODUCTION

6/19/2020 EP - NOTICE OF SERVICE OF INTERROGATORIES

6/19/2020 EP - NOTICE OF SERVICE OF INTERROGATORIES

1liZZT1

6/19/2020

Request

Request

EP - NOTICE OF APPEARANCE AND DESIGNATION OF E-MAIL ADDRESS

6/19/2020 EP - RETURN OF SERVICE - SERVED - TARGET - 06/08/20

6/2/2020 PAYMENT $420.00 RECEIPT #2020023606

Request

10 1 Zniest 6/2/2020 EP - REQUEST FOR ADMISSIONS

6/2/2020 CLERK TF/DOR SUMMONS ASSESSED $20.00

6/2/2020 EP - REQUEST FOR PRODUCTION

Request

6/2/2020 EP - NOTICE OF SERVICE OF INTERROGATORIES

FecTimri6/2/2020 EP - NOTICE OF SERVICE OF INTERROGATORIES

3 6/2/2020 EP - SUMMONS ISSUED - WAYNE HARRIS

6 c9 3 6/2/2020 EP - SUMMONS ISSUED - TARGET CORPORATION

3

2

1

El 6 6/2/2020 EP - INITIAL COMPLAINT

rzzzri 6/2/2020 EP - CIVIL COVER SHEET

6/2/2020 JUDGE FISHEL, JOHN L II: ASSIGNED

6/2/2020 DIVISION E ASSIGNED

6/2/2020 CASE FILED 06/02/2020 CASE NUMBER 20001089CA

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 2 of 96
Filing # 108275552 E-Filed 06/02/2020 03:11:41 PM

FORM 1.997. CIVIL COVER SHEET

The civil cover sheet and the information contained in it neither replace nor supplement the filing and service of

pleadings or other documents as required by law. This form must be filed by the plaintiff or petitioner with the

Clerk of Court for the purpose of reporting data pursuant to section 25.075, Florida Statutes. (See instructions

for completion.)

CASE STYLE

IN THE CIRCUIT COURT OF THE FOURTEENTH JUDICIAL CIRCUIT,

IN AND FOR BAY COUNTY, FLORIDA

Case No.: 20001089CA

Judge: 

MariaBuff,AdamBuff

Plaintiff

vs.

Target Corporation,Wayne Harris

Defendant

II. AMOUNT OF CLAIM

Please indicate the estimated amount of the claim rounded to the nearest dollar $30,001

III. TYPE OF CASE (If the case fits more than one type of case, select the most definitive category.) If the

most descriptive label is a subcategory (is indented under a broader category), place an x on both the main

category and subcategory lines.

D

U 10 10 10 I0 I0 10 

Condominium

Contracts and indebtedness

Eminent domain

Auto negligence

Negligence — other

• Business governance

Business torts

Environmental/Toxic tort

Third party indemnification

Construction defect

Mass tort

Negligent security

Nursing home negligence

Premises liability — commercial

O Premises liability — residential

Products liability

Real Property/Mortgage foreclosure

Commercial foreclosure

Homestead residential foreclosure

Non-homestead residential foreclosure

O Other real property actions

0 Professional malpractice

0j . Malpractice — business

0 Malpractice — medical

0_ Malpractice — other professional

LI Other

J . Antitrust/Trade Regulation

LI Business Transaction

j0 . Circuit Civil - Not Applicable

D Constitutional challenge-statute or ordinance

la Constitutional challenge-proposed amendment

O Corporate Trusts

La Discrimination-employment or other

2 Insurance claims

La Intellectual property

La Libel/Slander

La Shareholder derivative action

Securities litigation

La Trade secrets

Trust litigation

0 County Civil

0 Small Claims up to $8,000

0

El

Civil

Replevins

Evictions

Other civil (non-monetary)

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 3 of 96
COMPLEX BUSINESS COURT

This action is appropriate for assignment to Complex Business Court as delineated and mandated by the

Administrative Order. Yes E] No El

IV. REMEDIES SOUGHT (check all that apply):

II Monetary;

Non-monetary declaratory or injunctive relief;

Punitive

V. NUMBER OF CAUSES OF ACTION:

(Specify)

3

VI. IS THIS CASE A CLASS ACTION LAWSUIT?

E Yes

X No

VII. HAS NOTICE OF ANY KNOWN RELATED CASE BEEN FILED?

El No

El Yes — If "yes" list all related cases by name, case number and court:

VIII. IS JURY TRIAL DEMANDED IN COMPLAINT?

El Yes

El No

I CERTIFY that the information I have provided in this cover sheet is accurate to the best of my knowledge and belief, and

that I have read and will comply with the requirements of Florida Rule of Judicial Administration 2.425.

Signature: si Rafael J Roca

Attorney or party

FL Bar No.: 744050

(Bar number, if attorney)

Rafael J Roca

(Type or print name)

Date: 06/02/2020

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 4 of 96
Filing # 108275552 E-Filed 06/02/2020 03:11:41 PM

IN THE CIRCUIT COURT OF

FOURTEENTH JUDICAL CIRCUIT IN

AND FOR BAY COUNTY, FLORIDA

CASE NO.: 20001 089CA

MARIA BUFF and ADAM BUFF, her

husband,

Plaintiffs,

vs.

TARGET CORPORATION, a Foreign

Profit Corporation, and WAYNE HARRIS,

individually,

Defendants.

COMPLAINT

COMES NOW the Plaintiffs, MARIA BUFF and ADAM BUFF, her husband, by and

through their undersigned attorneys, and hereby sues the Defendant, TARGET CORPORATION, a

Foreign Profit Corporation, (hereinafter "TARGET") and WAYNE HARRIS, individually,

(hereinafter "HARRIS"), and allege as follows:

GENERALALLEGATIONS

1. This is an action for damages in excess of the sum of Thirty Thousand ($30,000.00)

Dollars, exclusive of costs, interest and attorney's fees.

2. At all times material hereto, the Plaintiff, MARIA BUFF, is and was a resident of Bay

County, Florida.

3. At all times material hereto, the Plaintiff, ADAM BUFF, is and was a resident of Bay

County, Florida.

1

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 5 of 96
4. At all times material hereto, the Defendant, TARGET, was a corporation duly licensed

and authorized to conduct business in the State of Florida, and doing business in Bay County, Florida.

5. At all times material hereto, the Defendant, HARRIS, is and was a resident of Bay

County, Florida.

6. On or about October 18, 2019, the Plaintiff was legally upon the property of the

Defendant as a business invitee and as a member of the general public that was expressly or impliedly

invited upon said premises for the benefit of the Defendant and was injured when she slipped on a

wet floor and fell.

7. The Defendant, TARGET, its agents, servants, and/or employees acting within the

course and scope of such agency, service or employment, had a non-delegable duty to the general

public to properly maintain said premises in a reasonably safe condition for the general public while

they were on the premises, especially in view of the fact that such condition was known or should

have been known to the Defendant.

8. At all times material hereto, the Defendant, HARRIS, was an apparent agent, agent

and/or employee of the Defendant, TAGET.

COUNTI — NEGLIGENCE AGAINSTDEFENDANT,TARGETCORPORATION

9. The Plaintiff, MARIA BUFF, hereby realleges and reavers each and every General

Allegation contained in paragraphs 1-8, above, as though fully set forth herein.

10. On or about the date of the accident, October 18, 2019, the Defendant, TARGET,

owned, operated, managed and/or was in control of a business located at 2340 FL-77, Panama City,

Bay County, Florida and known as Target.

2

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 6 of 96
11. At the time and place aforesaid, the Defendant, through its agents, servants and/or

employees, while acting within the scope and course of such agency or employment, were negligent

in one or more of the following ways:

a. Failing to maintain the premises and/or its areas of ingress and egress in a reasonably safe

condition.

b. Failing to correct a dangerous condition consisting of a wet floor that it knew or

reasonably should have known existed.

c. Failing to warn plaintiff about a dangerous condition consisting of a wet floor that the

defendant reasonably did or reasonably should have had superior knowledge about and

that plaintiff did not know existed.

d. Failing to correct a dangerous condition consisting of a wet floor that occurred with

regularity and that was therefore foreseeable.

e. Failing to train its employees in the proper methods of inspecting for, cleaning up and/or

warning about a dangerous condition that the defendant knew or should have known

existed or that occurred with regularity and that was therefore foreseeable.

f. Creating the condition by its business activities and the activities of its agents, employees,

vendors, suppliers and/or authorized representatives.

g. By engaging in a negligent or unreasonable mode of business operation.

h. In constructing, repairing, replacing or maintaining its premises in violation of applicable

building codes, statutes and ordinances.

i. The condition occurred with regularity and was therefore foreseeable.

j. The Defendant, TARGET, failed to exercise reasonable care under all of the relevant

surroundings circumstances.

3

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 7 of 96
12. The Defendant, TARGET, had actual or constructive knowledge of the dangerous

condition and failed to take action to remedy it.

13. As a direct and proximate result of the negligence of Defendant, TARGET, the

Plaintiff, MARIA BUFF, suffered bodily injury and resulting pain and suffering, disability,

disfigurement, mental anguish, loss of capacity for the enjoyment of life, expense of hospitalization,

medical and nursing care and treatment, loss of earnings and loss of ability to earn money and

aggravation of a pre-existing condition. The losses are either permanent or continuing in nature and

Plaintiff, MARIA BUFF, will suffer the losses and impairment in the future.

WHEREFORE, Plaintiff, MARIA BUFF, demands judgment for damages against the

Defendant, TARGET CORPORATION, a Foreign Profit Corporation, plus costs and post judgment

interest and further demands trial by jury.

COUNTII — NEGLEIGENCEAGAINSTDEFENDANT,WAYNEHARRIS

14. The Plaintiff, MARIA BUFF, hereby realleges and reavers each and every General

Allegation contained in paragraphs 1-8, above, as though fully set forth herein.

15. At all times material hereto, Defendant, HARRIS, was the manager of the subject

premises owned and operated by Defendant, TARGET, and was acting within the course and scope

of his employment with Defendant, TAGET.

16. At all times material hereto, Defendant, HARRIS, had a duty to maintain the premises

in a reasonable and safe condition.

17. At all times material hereto, while acting within the course and scope of his

employment, Defendant, HARRIS, was directly responsible for maintaining and operating the subject

premises and executing its policies and procedures. Defendant, HARRIS, permitted an unreasonably

dangerous condition to exist on the premises consisting of was on the floor.

4

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 8 of 96
18. At all times material hereto, Defendant, HARRIS, while with superior knowledge of

the manner in which the premises were maintained, failed to warn and/or inspect the premises to

determine the presence of the dangerous manner consisting of was on the floor.

19. The Defendant, HARRIS, his agents, servants, and/or employees acting within the

course and scope of such agency, service or employment, had a non-delegable duty to the general

public to properly maintain said premises in a reasonably safe condition for the general public while

they were on the premises, especially in view of the fact that such condition was known or should

have been known to the Defendant.

20. As a direct and proximate result of the negligence of Defendant, HARRIS, the

Plaintiff, MARIA BUFF, suffered bodily injury and resulting pain and suffering, disability,

disfigurement, mental anguish, loss of capacity for the enjoyment of life, expense of hospitalization,

medical and nursing care and treatment, loss of earnings and loss of ability to earn money and

aggravation of a pre-existing condition. The losses are either permanent or continuing in nature and

Plaintiff, MARIA BUFF, will suffer the losses and impairment in the future.

WHEREFORE, Plaintiff, MARIA. BUFF, demands judgment for damages against the

Defendant, WAYNE HARRIS, individually plus costs and post judgment interest and further

demands trial by jury.

COUNTYIII- CONSORTIUMCLAIMOFPLAINTIFF,ADAMBUFF

AGAINSTDEFENDANTSTARGETCORPORATION AND WAYNEHARRIS

21. The Plaintiff, ADAM BUFF, hereby re-alleges and re-avers all the General

Allegations contained in paragraphs 1 - 8 above, as though fully set forth herein.

22. That at all times material to the cause herein, the Plaintiffs, ADAM BUFF and

MARIA BUFF, were living together as husband and wife.

23. As a direct and proximate result of the afore said negligence of Defendants, TARGET,

and HARRIS, the Plaintiff, ADAM BUFF, has suffered in the past and will continue to suffer for an

5

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 9 of 96
indefinite time in the future the deprivation of the consortium services of his wife, MARIA BUFF,

who prior to the incident herein, had been in good health and fully capable of performing any of her

household and family relationship duties, but now cannot or is limited in doing so.

WHEREFORE, Plaintiff, ADAM BUFF, demands judgment for damages plus costs and

interest against the Defendants, TARGET CORPORATION and WAYNE HARRIS, and further

demands trial by jury.

DATED: June 2, 2020.

LAW OFFICES OF CRAIG GOLDENFARB

Attorneys for Plaintiffs

1800 South Australian Avenue

Suite 400

West Palm Beach, FL 33409

(561) 697-4440 / Fax: (561) 687-1950

By: _/s/RafaelJ. Roca

RAFAEL J. ROCA

FL Bar No.: 744050

Primary Email: BuffMaria6503806@projects.filevine.com

Secondary Email: Rroca@HOgoldlaw.com

Paralegal's Email: Cgordon@800goldlaw.com

6

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 10 of 96
Filing # 108275552 E-Filed 06/02/2020 03:11:41 PM

CIVIL ACTION SUMMONS

IN THE CIRCUIT COURT OF

FOURTEENTH JUDICAL CIRCUIT IN

AND FOR BAY COUNTY, FLORIDA

CASE NO.:20001089CA

MARIA BUFF and ADAM BUFF, her

husband,

Plaintiffs,

vs.

TARGET CORPORATION, a Foreign

Profit Corporation, and WAYNE HARRIS,

individually,

Defendants.

TO DEFENDANT:

By Serving:

SUMMONS

TARGET CORPORATION, a Foreign Profit Corporation

CT Corporation System, Registered Agent

1200 S. Pine Island Road

Plantation, FL 33324

IMPORTANT

Alawsuit has been filed against you. You have 20 calendar days after this summons is served on you to file a

written response to the attached Complaint/Petition with the Clerk of this Court. A phone call will not protect

you. Your written response, including the case number given above and the names of the parties, must be filed

if you want the Court to hear your side of the case. If you do not file your response on time, you may lose the

case, and your wages, money, and property may thereafter be taken without further warning from the Court.

There are other legal requirements. You may want to call an attorney right away. If you do not know an

attorney, you may call an attorney referral service or a legal aid office (listed in the phone book).

If you choose to file a written response yourself, at the same time you file your written response to the Court

you must also mail or take a copy of your written response to the "Plaintiff/Plaintiffs Attorney" named below.

RAFAEL J. ROCA, ESQUIRE

LAW OFFICES OF CRAIG GOLDENFARB, P.A.

1800 S. Australian Ave., Suite 400

West Palm Beach, FL 33409

Fla. Bar No. 744050

(561) 697-4440

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 11 of 96
THE STATE OF FLORIDA

To Each Sheriff of the State:

YOU ARE COMMANDED to serve this Summons and a copy of the complaint/petition in this lawsuit on the

above-named Defendant(s).

Each defendant is required to serve written defenses to the complaint or petition on

RAFAEL J. ROCA, ESQ.

LAW OFFICES OF CRAIG GOLDENFARB

Plaintiff's attorney, whose address is:

1800 S. Australian Avenue, Suite 400

West Palm Beach, FL 33409

(561) 697-4440

within 20 days after service of this summons on that defendant, exclusive of the day of service, and to file the

original of the defenses with the clerk of this court either before service on plaintiff's attorney or immediately

thereafter. If a defendant fails to do so, a default will be entered against that defendant for the relief demanded

in the complaint or petition.

DATED on

(Seal)

6/2/2020

11111

As Clerk of the Court

(4,4 fj. 121 Ej2

`b4r1 -0'6

B

'

y

As Deputy Clerk

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 12 of 96
IMPORTANTE

Usted ha sido demandado legalmente. Tiene 20 Dias, contados a partir del recibo de esta notificacion, para

contestar la demanda adjunta, por escrito, y presentarla ante este tribunal. Una llamada telefonica no lo

protegera. Si usted desea que el tribunal considere su defensa, debe presentar su respuesta por escrito,

incluyendo el numero del caso y los nombres de las partes interesadas. Si usted no contesta la demanda a

tiempo, pudiese perder el caso y podria ser despojado de sus ingresos y propiedades, o privado de sus derechos,

sin previo aviso del tribunal. Existen otros requisitos legales. Si lo desea, puede usted consultar a un abogado

inmediatamente. Si no concoce a un abogado, puede llamar a una de las oficinas de asistencia legal que

aparecen en la guia telefonica.

Si desea responder a la demanda por su cuenta, al mismo tiempo en que presenta su respuesta ante el tribunal,

debera usted enviar por correo o entregar una copia de su respuesta a la persona denominada abajo como

"Plaintiff/Plaintiffs Attomey" (Demandante o Abogado del Demandante).

IMPORTANT

Des poursuites judiciares ont ete entreprises contre vous. Vous avez 20 jours consecutifs a partir de la date de

l'assignation de cette citation pour deposer une response ecrite a la plainte ci-jointe aupres de ce tribunal. Un

simple coup de telephone est insuffisant pour vous proteger. Vous etes oblige de deposer votre response ecrite,

avec mention du numero de dossier ci-dessus et du nom des parties nommees ici, si vous souhaitez que le

triunal entende votre cause. Si vous ne deposez pas votre reponse ecrite dans le relai requis, vous risquez de

perdre la cause ainsi que votre salaire, votre argent, et vos biens peuvent etre saisis par la suite, sans aucun

preavis ulterieur du tribunal. Il y a d'autres obligations juridiques et vous pouvez requerir les services immediats

d'un avocat. Si vous ne connaissez pas d'avocat, vous pourriez telephoner a un service de reference d'avocats

ou a un bureau d'assistance juridique (figurant a l'annuaire de telephones).

Si vous choisissez de deposer vous-meme une reponse ecrite, il vous faudra egalement, en meme temps que

cette formalite, faire parvenir ou expedier une copie de votre reponse ecrite au "Plaintiff/Plaintiffs Attomey"

(Plaignant ou a son avocat) nomme ci-dessous.

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 13 of 96
Filing # 108275552 E-Filed 06/02/2020 03:11:41 PM

CIVIL ACTION SUMMONS

IN THE CIRCUIT COURT OF

FOURTEENTH JUDICAL CIRCUIT 1N

AND FOR BAY COUNTY, FLORIDA

CASE NO.: 20001089CA

MARIA BUFF and ADAM BUFF, her

husband,

Plaintiffs,

vs.

TARGET CORPORATION, a Foreign

Profit Corporation, and WAYNE HARRIS,

individually,

Defendants.

TO DEFENDANT:

By Serving:

SUMMONS

WAYNE HARRIS, individually

Wayne Harris

2340 FL-77

Panama City, FL 32405

IMPORTANT

Alawsuit has been filed against you. You have 20 calendar days after this summons is served on you to file a

written response to the attached Complaint/Petition with the Clerk of this Court. A phone call will not protect

you. Your written response, including the case number given above and the names of the parties, must be filed

if you want the Court to hear your side of the case. If you do not file your response on time, you may lose the

case, and your wages, money, and property may thereafter be taken without further warning from the Court.

There are other legal requirements. You may want to call an attorney right away. If you do not know an

attorney, you may call an attorney referral service or a legal aid office (listed in the phone book).

If you choose to file a written response yourself, at the same time you file your written response to the Court

you must also mail or take a copy of your written response to the "Plaintiff/Plaintiffs Attorney" named below.

RAFAEL J. ROCA, ESQUIRE

LAW OFFICES OF CRAIG GOLDENFARB, P.A.

1800 S. Australian Ave., Suite 400

West Palm Beach, FL 33409

Fla. Bar No. 744050

(561) 697-4440

THE STATE OF FLORIDA

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 14 of 96
To Each Sheriff of the State:

YOU ARE COMMANDED to serve this Summons and a copy of the complaint/petition in this lawsuit on the

above-named Defendant(s).

Each defendant is required to serve written defenses to the complaint or petition on

RAFAEL J. ROCA, ESQ.

LAW OFFICES OF CRAIG GOLDENFARB

Plaintiff's attorney, whose address is:

1800 S. Australian Avenue, Suite 400

West Palm Beach, FL 33409

(561) 697-4440

within 20 days after service of this summons on that defendant, exclusive of the day of service, and to file the

original of the defenses with the clerk of this court either before service on plaintiff's attorney or immediately

thereafter. If a defendant fails to do so, a default will be entered against that defendant for the relief demanded

in the complaint or petition.

DATED on 672/2020

(Seal)

As Clerk of the Court

By

As Deputy Clerk

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 15 of 96
IMPORTANTE

Usted ha sido demandado legalmente. Tiene 20 Dias, contados a partir del recibo de esta notificacion, para

contestar la demanda adjunta, por escrito, y presentarla ante este tribunal. Una llamada telefonica no lo

protegera. Si usted desea que el tribunal considere su defensa, debe presentar su respuesta por escrito,

incluyendo el numero del caso y los nombres de las partes interesadas. Si usted no contesta la demanda a

tiempo, pudiese perder el caso y podria ser despojado de sus ingresos y propiedades, o privado de sus derechos,

sin previo aviso del tribunal. Existen otros requisitos legales. Si lo desea, puede usted consultar a un abogado

inmediatamente. Si no concoce a un abogado, puede llamar a una de las oficinas de asistencia legal que

aparecen en la guia telefonica.

Si desea responder a la demanda por su cuenta, al mismo tiempo en que presenta su respuesta ante el tribunal,

debera usted enviar por correo o entregar una copia de su respuesta a la persona denominada abajo como

"Plaintiff/Plaintiffs Attomey" (Demandante o Abogado del Demandante).

IMPORTANT

Des poursuites judiciares ont ete entreprises contre vous. Vous avez 20 jours consecutifs a partir de la date de

l'assignation de cette citation pour deposer une response ecrite a la plainte ci-jointe aupres de ce tribunal. Un

simple coup de telephone est insuffisant pour vous proteger. Vous etes oblige de deposer votre response ecrite,

avec mention du numero de dossier ci-dessus et du nom des parties nommees ici, si vous souhaitez que le

triunal entende votre cause. Si vous ne deposez pas votre reponse ecrite dans le relai requis, vous risquez de

perdre la cause ainsi que votre salaire, votre argent, et vos biens peuvent etre saisis par la suite, sans aucun

preavis ulterieur du tribunal. Il y a d'autres obligations juridiques et vous pouvez requerir les services immediats

d'un avocat. Si vous ne connaissez pas d'avocat, vous pourriez telephoner a un service de reference d'avocats

ou a un bureau d'assistance juridique (figurant a l'annuaire de telephones).

Si vous choisissez de deposer vous-meme une reponse ecrite, il vous faudra egalement, en meme temps que

cette formalite, faire parvenir ou expedier une copie de votre reponse ecrite au "Plaintiff/Plaintiffs Attorney"

(Plaignant ou a son avocat) nomme ci-dessous.

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 16 of 96
Filing # 108275552 E-Filed 06/02/2020 03:11:41 PM

IN THE CIRCUIT COURT OF

FOURTEENTH JUDICAL CIRCUIT IN

AND FOR BAY COUNTY, FLORIDA

CASE NO.:20001 089CA

MARIA BUFF and ADAM BUFF, her

husband,

Plaintiffs,

VS.

TARGET CORPORATION, a Foreign

Profit Corporation, WAYNE HARRIS,

individually, and ACE AMERICAN

INSURANCE COMPANY, a Foreign

Profit Corporation,

Defendants.

PLAINTIFF'S NOTICE OFSERVINGINITIALINTERROGATORIES TO

DEFENDANT,TARGET CORPORATION

COMES NOW the Plaintiffs, MARIA BUFF and ADAM BUFF, her husband, by and

through his/her/their undersigned counsel, and hereby gives notice of serving their Initial

Interrogatories numbered one through twenty-eight (1 -28) to Defendant, TARGET

CORPORATION, a Foreign Profit Corporation.

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing was served with

Summons, Complaint, Insurance Interrogatories, First Request for Production, and Requests for

Admissions.

LAW OFFICES OF CRAIG GOLDENFARB, P.A.

Attorney for Plaintiffs)

1800 S. Australian Ave., Suite 400

West Palm Beach, FL 33409

(561) 697-4440

By: _A/RafaelJ. Roca

RAFAEL J. ROCA

FL Bar No. 744050

Primary Email: BuffMaria6503806@projects.filevine.com

Secondary Email: Rroca@,800goldlaw.com

Paralegal's Email: Cgordong800goldlaw.com

1

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 17 of 96
Filing # 108275552 E-Filed 06/02/2020 03:11:41 PM

IN THE CIRCUIT COURT OF

FOURTEENTH JUDICAL CIRCUIT IN

AND FOR BAY COUNTY, FLORIDA

CASE NO.: 20001 089CA

MARIA BUFF and ADAM BUFF, her

husband,

Plaintiffs,

vs.

TARGET CORPORATION, a Foreign

Profit Corporation, WAYNE HARRIS,

individually, and ACE AMERICAN

INSURANCE COMPANY, a Foreign

Profit Corporation,

Defendants.

PLAINTIFF'S NOTICE OFSERVINGINSURANCEINTERROGATORIES

TODEFENDANT,TARGET CORPORATION

COMES NOW the Plaintiffs, MARIA BUFF and ADAM BUFF, her husband, by and

through their undersigned counsel, and make notice of serving Insurance Interrogatories to

Defendant, TARGET CORPORATION.

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing was E-Filed and served

with the Summons, Complaint, Initial Interrogatories, First Request for Production and Request for

Admissions.

LAW OFFICES OF CRAIG GOLDENFARB, P.A.

Attorney for Plaintiff(s)

1800 5. Australian Ave., Suite 400

West Palm Beach, FL 33409

(561) 697-4440

By: /s/RafaelJ. Roca

RAFAEL J. ROCA

FL Bar No. 744050

Primary Email: BuffMaria6503806@projects.filevine.com

Secondary Email: Rroc(a &,800goldlaw.com

Paralegal's Email: Cgordon@800goldlaw.com

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 18 of 96
Filing # 108275552 E-Filed 06/02/2020 03:11:41 PM

IN THE CIRCUIT COURT OF

FOURTEENTH JLTDICAL CIRCUIT IN

AND FOR BAY COUNTY, FLORIDA

CASE NO.:20001089CA

MARIA BUFF and ADAM BUFF, her

husband,

Plaintiffs,

vs.

TARGET CORPORATION, a Foreign

Profit Corporation, and WAYNE HARRIS,

individually,

Defendants.

PLAINTIFF'SREQUESTFORADMISSIONSTODEFENDANT,

TARGETCORPORATION

COMES NOW the Plaintiffs, MARIA. BUFF and ADAM BUFF, her husband, by and

through their undersigned counsel, and request the Defendant, TARGET CORPORATION, to admit

or deny the following:

I. Admit that the Plaintiff was legally on the Defendant's property on the date of incident.

2. Admit that the Defendant failed to maintain the premises in a reasonably safe condition.

3. Admit that the Defendant has a nondelegable duty to maintain its premises in a

reasonably safe condition.

4. Admit that the Defendant failed to correct the dangerous condition of water on the floor.

5. Admit that the Defendant failed to warn the Plaintiff about water on the floor.

6. Admit that the Defendant failed to train its employees in proper methods of inspecting,

cleaning and/or waring about water on the floor.

7. Admit that the Plaintiff sustained injuries as a result of this incident.

1

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 19 of 96
8. Admit that the Plaintiff's injuries are causally related to this incident.

9. Admit that the Plaintiff received medical care and treatment that is causally related to this

incident.

10. Admit that the Plaintiff incurred medical bills for treatment as a result of this incident.

CERTIFICATEOFSERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing was E-Filed and

served with the Summons, Complaint, Insurance Interrogatories, Initial Interrogatories and First

Request for Production.

LAW OFFICES OF CRAIG GOLDENFARB, P.A.

Attorneys for Plaintiffs)

1800 S. Australian Ave., Ste. 400

West Palm Beach, FL 33409

(561) 697-4440

By: /s/RafaelJ. Roca

RAFAEL J. ROCA

FL Bar No.: 744050

Primary Email: BuffMaria6503806@projects.filevine.com

Secondary Email: Rroca@,800goldlaw.com

Paralegal's Email: Cgordon@HOgoldlaw.com

2

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 20 of 96
Filing # 108275552 E-Filed 06/02/2020 03:11:41 PM

IN THE CIRCUIT COURT OF

FOURTEENTH JUDICAL CIRCUIT IN

AND FOR BAY COUNTY, FLORIDA

CASE NO.:20001089CA

MARIA BUFF and ADAM BUFF, her

husband,

Plaintiffs,

VS.

TARGET CORPORATION, a Foreign

Profit Corporation, and WAYNE HARRIS,

individually,

Defendants.

PLAINTIFF'SPREMISES REQUESTFORPRODUCTION

TODEFENDANT,TARGET CORPORATION

COMES NOW the Plaintiff, MARIA BUFF and ADAM BUFF, her husband, by and

through their undersigned counsel, and hereby requests the Defendant, TARGET CORPORATION,

a Foreign Profit Corporation, to produce for inspection and/or photocopying within forty-five (45)

days from the date of service of this Request, pursuant to Florida Rules of Civil Procedures, at the

Law Offices of Craig Goldenfarb, P.A., the following:

1. The Table(s) of Contents for any and all manuals or guidelines governing the conduct

of any employees in effect on 10/18/2019, including employee training manuals.

2. Any photographs or video in any form of media, taken by or on behalf of the

Defendant, that relate to the parties and/or the entire store or location of the occurrence, including but

not limited to, in-store photos or video, from five (5) hours before to one (1) hour after the subject

accident.

3. Any and all written or recorded statements obtained from, or signed by, the Plaintiff.

1

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 21 of 96
4. Any/all full and complete liability insurance policies in effect on 10/18/2019

including excess or umbrella policies.

5. Any and all denial of coverage, or reservation of rights letters from your insurance

carrier(s).

6. Any zone log, inspection log, or other form of inspection record from the period 24

hours before the accident, up to and including the entire day of the accident, and 24 hours after the

accident, for the area of the subject location where the Plaintiff had the subject incident.

7. Any post-accident photographs or video in any form or media of the Plaintiff,

including, but not limited to, "surveillance" photographs or video, taken by any person or entity.

8. Any/all correspondence, e-mails, texts, letters, or other communications between the

Plaintiff and Defendant, or between Plaintiff and Defendant's insurance company, or between

Plaintiff and Defendant's adjusters or investigators, from any point in time. (This request is NOT

asking for any work product or attorney client correspondence, it is ONLY requesting documents

sent to or received by Plaintiff).

9. Any/all job descriptions, in effect on the date of the subject incident, for any

employees at or near the scene of the subject incident from one hour before, to one hour after, the

subject incident.

10. Any/all documents showing the existence of slip and fall injury claims (workers comp

or liability) made by employees or customers at the entire subject store location for 2 years prior to

October 18, 2019.

1 1. Any/all store policies in effect on October 18, 2019 at the subject store regarding

what shoes or footwear employees were supposed to wear. If such policies are pursuant to some

OSHA or other standard, rule, or regulation, please provide a copy of such standard.

2

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 22 of 96
12. Any/all communications from or to any witnesses to the subject incident.

13. For any accidents after the subject accident of October 18, 2019, where an

employee or customer slipped and/or fell on a transitory foreign object or substance, please

provide:

a. Address, telephone number, e-mail address and date of birth of the employee or

customer

b. Location of the fall within the store

c. Claim number of the claim, if any

d. The case number and the County in which the lawsuit was filed, if any

e. Name/address of their lawyer, if any

f. Whether the person was a customer or employee

g. The identity of the cause of the fall (i.e., the identity of the transitory object or

substance)

Glanzberg v. Kauffman,788 So.2d 252 (Fla. 4th DCA 2000); Criswell v. Best Western,636 So.2d

562 (Fla. 3d DCA 1994).

14. Any/all documents that show the layout of the entire Defendant's premises on

10/18/2019, including the scene of the accident, in its original format and size. If there is a

reasonable cost in producing such document in its original form and size, please produce this

document, along with an invoice for such reproduction, or provide an electronic version of same.

15. Any/all incident or accident reports for the subject incident. If objected to, please

provide a privilege log, identifying the number of pages of such document(s), the date produced,

by whom, and whose possession the subject report(s) are in, so that an in-camera inspection can

occur, if necessary.

3

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 23 of 96
16. Any/all documents or diagrams or photographs showing which products were on

the entire aisle and which products were displayed at the precise location where Plaintiff's incident

occurred, including but not limited to, any merchandising plans.

17. Any/all documents or diagrams showing any sampling stands, outside vendor

booths or stands, or other such stands, in the store, that were present on the date of the subject

incident.

18. Any/all repair or maintenance records, or other documents, concerning leaks of any

sort from any roofing or machinery or coolers or refrigeration or heating, ventilation or air

conditioning systems, at or near the location of the Plaintiff's incident, for 6 mo. before and one

week after, the subject incident.

19. Pictures of any/all warning or floor safety devices (cones, signs, floor mats or other)

allegedly warning the Plaintiff of any danger, allegedly present in the Defendant's premises on the

date of Plaintiff's incident.

20. An actual exemplar of any actual warning signs or floor safety devices, including

cones or signs or floor safety mats, that were available in the subject store on the date of the subject

incident. If the Defendant is willing to provide same for inspection in lieu of production, please

indicate so, so that such an inspection may be arranged.

21. Any documents or diagrams, showing where floor safety mats were located in the

subject store on the date of the Plaintiff's incident.

22. Any/all purchase orders, receipts, invoices, or other documents identifying the

warning signs or floor safety devices that were available and present in the Defendant's premises

on the date of the Plaintiff's incident, including but not limited to, cones, wet floor signs, safety

mats, or other warning or safety devices.

4

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 24 of 96
23. Any/all manager or management training videos or manuals or other training

documents regarding store safety or prevention of accidents or injuries in effect for a two-year

period prior to October 18, 2019.

24. Any/all employee training videos or manuals or other training documents regarding

store safety or prevention of accidents or injuries in effect for a two year period prior to 10/18/2019.

25. Any/all in house meeting notes, syllabi, memos, handouts, e-mails, minutes, or

videos for ongoing employee and manager training, regarding store safety from a period two years

before 10/18/2019, for the subject store.

26. Any external evaluations or inspections concerning issues of store safety related to

potential slip and fall hazards performed by an outside insurance company, business, vendor,

government agency (including OSHA) of the subject store for a period of three years before

10/18/2019.

27. Any internal evaluations or inspections concerning issues of store safety related to

potential slip and fall hazards performed by the Defendant, of the subject store, by the Defendant

or its corporate parent or subsidiaries, for a period of three years before October 18, 2019.

28. The entire personnel file, with social security number and personal health

information redacted, of all of Defendant's employees identified as having knowledge of the

subject incident, by the Defendant, in response to Plaintiff's interrogatories.

29. Defendant's accident reporting protocol or guidelines for the subject store, in effect

on the date of Plaintiff's incident.

30. Defendant's video preservation protocol or guidelines for the subject store, in effect

on the date of the Plaintiff's incident.

31. Defendant's spill response protocol or guidelines for the subject store, in effect on

the date of Plaintiff's incident.

5

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 25 of 96
32. Please produce a privilege log for any and all documents objected to based on any

privilege in the above request to produce.

33. Copies of any and all documents that reflect cleaning activity located on

Defendant's premises and more specifically, at TARGET, on October 18, 2019.

34. Any and all Documents of any kind whatsoever contained within the personnel file

of Defendant, WAYNE HARRIS, including but not limited to any and all work records,

applications for employment, resignation and/or termination letter, attendance charts, health forms,

application for group health coverage (including claim forms), workers compensation forms and

all other information in your possession or control pertaining the employment of the above

indivival from the first date of employment to the date of termination, or, if still employed, to the

present.

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing was E-Filed and served

with the Summons, Complaint, Insurance Interrogatories, Initial Interrogatories and Requests for

Admissions.

LAW OFFICES OF CRAIG GOLDENFARB, P.A.

Attorney for Plaintiff(s)

1800 South Australian Ave., Suite 400

West Palm Beach, FL 33409

(561) 697-4440

By: _ls/RafaelJ. Roca

RAFAEL J. ROCA

FL Bar No.: 744050

Primary Email: BuffMaria6503806@projects.filevine.com

Secondary Email: Rroca@800goldlaw.com

Paralegal's Email: Cgordon@,800goldlaw.com

6

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 26 of 96
1

BILL KINSAUL

CLERK OF COURT

& COMPTROLLER

B AY COUNTY

ROCA, RAFAEL J

1800 S. AUSTRALIAN AVENUE

SUITE 400

WEST PALM BEACH, FL 33409

Bay County Receipt of Transaction

Receipt # 2020023606

CaseNumber 20001089CA

Judge JOHN L FISHEL II

MARIA BUFF VS TARGET CORPORATION

BILL KINSAUL

Clerk of Court

Bay County, Florida

Cashiered by: HFERNANDEZ

On: 06/02/2020 2:52 pm

Transaction # 2275251

Comments:

Fee Description

(VOCF) CIVIL-OTHER FILING FEES

(VSUM) CLERK TF/DOR SUMMONS

Total

Grand Total

Fee

400.00

20.00

Prior Paid

0.00

0.00

Waived

0.00

0.00

Due

400.00

20.00

Paid

400.00

20.00

Balance

0.00

0.00

420.00 0.00 0.00 420.00 420.00 0.00

420.00 0.00 0.00 420.00 420.00 0.00

PAYMENTS

Payment Type Reference

EFILE 28133382

Amount Refund Overage Change Net Amount

OK 420.00 0.00 0.00 0.00 420.00

420.00 0.00 0.00 0.00 420.00

Page 1 of 1

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 27 of 96
Filing # 109120598 E-Filed 06/19/2020 12:40:08 PM

State of Florida

Case Number: 20001089CA

Plaintiff:

Maria Buff, et al.

vs.

Defendant:

Target Corporation, et al.

For:

Craig Goldenfarb, PA, Law Offices of

1800 S Australian Avenue

Suite 400

West Palm Beach, FL 33409

AFFIDAVIT OF SERVICE

County of Bay Circuit Court

INII!!!!!!111183 1,11 1 III

C

Received by De Novo Attorney Services on the 5th day of June, 2020 at 12:57 pm to be served on Target orporation, silo CT Corporation System, Registered Agent, 1200 S. Pine Island Road, Plantation, FL 33324.

Henri J. Werner, being duly sworn, depose and say that on the 8th day of June, 2020 at 2:50 pm, I:

served a CORPORATION by delivering a true copy of the Summons, Complaint, Request for Admissions, Plaintiffs Notice of Serving Interrogatories to Defendant, Interrogatories, Plaintiffs Notice of Serving Insurance Interrogatories to Defendant, Insurance Interrogatories, and Plaintiffs Request for Production to Defendant with the date and hour of service endorsed thereon by me, to: DONNA MOCH, AUTHORIZED SERVICE TECH FOR CT CORPORATION SYSTEM as Registered Agent at the address of: 1200 S. Pine Island Road, Plantation, FL 33324 on behalf of Target Corporation, s/o CT Corporation System, Registered Agent and informed said person of the contents therein, in compliance with state statutes.

Description of Person Served: Age: 50s, Sex: F, Race/Skin Color: WHITE, Height: 53, Weight: 125, Hair: BROWN, Glasses: N

•1

S

Under penalty of perjury, I declare that I have read the foregoing and that the facts stated in it are true, that I am a

heriff Appointed Process Server in the county in which this defendant/witness was served and have no interest in the above action. Pursuant to FS 92.525(2), no notary is required.

Subscribed and Sworn to before me on the 10th

day of June, 2020 by the affiant who is personally

known to me.

NOTARY PUBLIC

SPS#847

De Novo Attorney Services

3300 Fairchild Gardens Avenue

#30786

Palm Beach Gardens, FL 33420

(800) 846-9696

Our Job Serial Number: NOV-2020001831

Ref: Buff

Copyright 1992-2020 Database Services, Inc.- Process Server's Toolbox V8.1m

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 28 of 96
Filing # 109134904 E-Filed 06/19/2020 03:05:55 PM

IN THE CIRCUIT COURT, FOURTEENTH

JUDICIAL CIRCUIT, IN AND FOR BAY

COUNTY, FLORIDA

CASE NO.: 20201089CA

MARIA BUFF and ADAM BUFF, her

husband,

Plaintiffs,

v.

TARGET CORPORATION, a Foreign

Profit Corporation, and WAYNE HARRIS,

individually,

Defendants.

NOTICE OF APPEARANCE AND DESIGNATION

OFEMAIL ADDRESSESFORSERVICE OFDOCUMENTS

COMES NOW, Joseph B. Stokes, III, Esquire, of SAALFIELD SHAD, P.A., and files this

Notice of Appearance as attorney of record in the above-captioned matter on behalf of the

Defendant, TARGET CORPORATION.

Pursuant to Florida Rule of Judicial Administration 2.516(1)(A), Defendant hereby gives

notice of the primary and secondary email addresses of its counsel as follows:

Counsel's Name Joseph B. Stokes, III

Primary Email Address: jstokes@saalfieldlaw.com

Secondary Email Addresses: llovein@saalfieldlaw.com;

wdean@saalfieldlaw.com

Tertiary Email Address: rjcsmith@saalfieldlaw.com

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing has been e-filed with

the Clerk of the Court by using the Florida Courts Portal system and furnished to the following

named addressees via email on this 19th day of June, 2020:

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 29 of 96
RAFAEL J. ROCA, ESQUIRE

LAW OFFICES OF CRAIG GOLDENFARB

1800 South Australian Avenue, Suite 400

West Palm Beach, FL 33409

Email: BuffMaria6503806@projects.filevine.com,Rroca@800goldlaw.corn,

Cgordon@,800goldlaw.com

Attorneys for Plaintiff

SAALFIELD SHAD, P.A.

/s/ Joseph B. Stokes, III

JOSEPH B. STOKES, III, ESQUIRE

Florida Bar Number: 897183

RUBY JO CATHERINE SMITH, ESQUIRE

Florida Bar Number: 112741

245 Riverside Avenue, Suite 400

Jacksonville, FL 32202

904/355-4401 (phone)

904/355-3503 (facsimile)

Email (Primary) jstokes@saalfieldlaw.corn

Email (Secondary) llovein@saalfieldlaw.com;

wdeangsaalfieldlaw.com

Email (Tertiary) rjcsmith@saalfteldlaw.com

Attorneys for Defendant

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 30 of 96
Filing # 109134904 E-Filed 06/19/2020 03:05:55 PM

IN THE CIRCUIT COURT, FOURTEENTH

JUDICIAL CIRCUIT, IN AND FOR BAY

COUNTY, FLORIDA

CASE NO.: 20201089CA

MARIA BUFF and ADAM BUFF, her

husband,

Plaintiffs,

V.

TARGET CORPORATION, a Foreign

Profit Corporation, and WAYNE HARRIS,

individually,

Defendants.

NOTICE OF SERVICE OF DEFENDANT'S, TARGET CORPORATION,

FIRSTINTERROGATORIES TOPLAINTIFF MARIABUFF

Defendant, TARGET CORPORATION, hereby gives notice that Defendant's

Interrogatories to Plaintiff, MARIA BUFF, numbered one (1) through twenty-eight (28), have

been served upon Plaintiff, c/o Rafael J. Roca, Esquire, by Electronic Mail.

CERTIFICATE OFSERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing has been e-filed with

the Clerk of the Court by using the Florida Courts Portal system and furnished to the following

named addressees via email on this 19th day of June, 2020:

RAFAEL J. ROCA, ESQUIRE

LAW OFFICES OF CRAIG GOLDENFARB

1800 South Australian Avenue, Suite 400

West Palm Beach, FL 33409

Email: BuffMaria6503806@projects.filevine.com,Rroca@800goldlaw.com,

Cgordon@,800goldlaw.com

Attorneys for Plaintiff

SAALFIELD SHAD, P.A.

Is/ Joseph B. Stokes, III

JOSEPH B. STOKES, III, ESQUIRE

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 31 of 96
Florida Bar Number: 897183

RUBY JO CATHERINE SMITH, ESQUIRE

Florida Bar Number: 112741

245 Riverside Avenue, Suite 400

Jacksonville, FL 32202

904/355-4401 (phone)

904/355-3503 (facsimile)

Email (Primary) jstokes@saalfieldlaw.com

Email (Secondary) llovein@saalfieldlaw.com;

wdeanAsaalfieldlaw.com

Email (Tertiary) rjcsmith@saalfieldlaw.com

Attorneys for Defendant

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 32 of 96
Filing # 109134904 E-Filed 06/19/2020 03:05:55 PM

IN THE CIRCUIT COURT, FOURTEENTH

JUDICIAL CIRCUIT, IN AND FOR BAY

COUNTY, FLORIDA

CASE NO.: 20201089CA

MARIA BUFF and ADAM BUFF, her

husband,

Plaintiffs,

V.

TARGET CORPORATION, a Foreign

Profit Corporation, and WAYNE HARRIS,

individually,

Defendants.

NOTICE OF SERVICE OF DEFENDANT'S, TARGET CORPORATION,

FIRST CONSORTIUMINTERROGATORIES TOPLAINTIFFADAMBUFF

Defendant, TARGET CORPORATION, hereby gives notice that Defendant's Consortium

Interrogatories to Plaintiff, ADAM BUFF, numbered one (1) through twenty-one (21), have been

served upon Plaintiff, c/o Rafael J. Roca, Esquire, by Electronic Mail.

CERTIFICATE OFSERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing has been e-filed with

the Clerk of the Court by using the Florida Courts Portal system and furnished to the following

named addressees via email on this 19th day of June, 2020:

RAFAEL J. ROCA, ESQUIRE

LAW OFFICES OF CRAIG GOLDENFARB

1800 South Australian Avenue, Suite 400

West Palm Beach, FL 33409

Email: BuffMaria6503806@projects.filevine.com;Rroca@800goldlaw.com,

Cgordon@,800goldlaw.com

Attorneys for Plaintiff

SAALFIELD SHAD, P.A.

/s/ Joseph B. Stokes, III

JOSEPH B. STOKES, III, ESQUIRE

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 33 of 96
Florida Bar Number: 897183

RUBY JO CATHERINE SMITH, ESQUIRE

Florida Bar Number: 112741

245 Riverside Avenue, Suite 400

Jacksonville, FL 32202

904/355-4401 (phone)

904/355-3503 (facsimile)

Email (Primary) jstokes@saalfieldlaw.com

Email (Secondary) llovein@saalfieldlaw.com;

wdean@saalfieldlaw.com

Email (Tertiary) rjcsmith@saalfieldlaw.com

Attorneys for Defendant

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 34 of 96
Filing # 109134904 E-Filed 06/19/2020 03:05:55 PM

IN THE CIRCUIT COURT, FOURTEENTH

JUDICIAL CIRCUIT, IN AND FOR BAY

COUNTY, FLORIDA

CASE NO.: 20201089CA

MARIA BUFF and ADAM BUFF, her

husband,

Plaintiffs,

V.

TARGET CORPORATION, a Foreign

Profit Corporation, and WAYNE HARRIS,

individually,

Defendants.

DEFENDANT'S,TARGET CORPORATION,FIRSTREQUESTFORPRODUCTION

TOPLAINTIFF MARIA BUFF

Defendant, TARGET CORPORATION, by and through its undersigned attorneys, hereby

requests pursuant to Rule 1.350, Florida Rules of Civil Procedure, that Plaintiff, MARIA BUFF,

produce and permit Defendant to inspect and copy each of the following documents:

1. Medical bills, including but not limited to doctors, hospitals and prescriptions

arising out of the alleged injuries which are the subject of your Complaint.

2. Income tax returns for the years 2015 through 2019, including W-2 forms filed.

3. Hospital records concerning any and all hospitalizations arising out of the alleged

injuries to Plaintiff which are in your or your attorney's possession, custody or control.

4. Medical records from any doctors, nurses or other health care providers who have

seen and/or treated Plaintiff as a result of the alleged injuries pled in the Complaint.

5. Medical reports, opinions or other written memoranda from doctors, nurses or other

health care providers, or expert witnesses containing information concerning the injuries and/or

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 35 of 96
damages allegedly sustained by Plaintiff which are in your or your attorney's possession, custody

or control.

6. Any and all photographs taken in relation to this incident.

7. Any and all statements obtained in relation to this case.

8. All documents which you anticipate you may utilize as exhibits in the trial of this

matter.

9. A copy of the front and back of all health insurance cards including Medicare,

Medicaid, and/or private health insurance carriers in possession of the Plaintiff at the time of the

accident and anytime thereafter.

10. All documents and payment information made by third party/collateral source lien

holders received by Plaintiff or Plaintiff's counsel in connection with the subject accident.

1 1. All documents sent by Plaintiff's counsel to any collateral source lien holders

advising them of the subject accident and/or putting said collateral source lien holder on notice.

12. All documents sent by Plaintiff or received by Plaintiff in connection with any

disability insurance in effect at the time of the subject accident.

13. An original Consent to Release directed to Centers for Medicare & Medicaid

Services (CMS) executed by Plaintiff. (Attached hereto).

14. An original Consent for Release of Information directed to Social Security

Administration executed by Plaintiff. (Attached hereto).

15. An original Authorization for the Use and Disclosure of Protected Health

Information directed to Florida Medicaid TPL Recovery Program executed by Plaintiff. (Attached

hereto).

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 36 of 96
16. An original Request for Copy of Tax Return IRS Form 4506 directed to the Internal

Revenue Service executed by Plaintiff. (Attached hereto).

17. Copies of all records related to any mental health treatment received by Plaintiff in

the last ten (10) years, including but not limited to, psychologists, psychiatrists, counselors or

therapists. This request specifically includes records of treatment for substance abuse, dependency

or addiction.

CERTIFICATE OFSERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing has been e-filed with

the Clerk of the Court by using the Florida Courts Portal system and furnished to the following

named addressees via email on this 19th day of June, 2020:

RAFAEL J. ROCA, ESQUIRE

LAW OFFICES OF CRAIG GOLDENFARB

1800 South Australian Avenue, Suite 400

West Palm Beach, FL 33409

Email: BuffMaria6503806@projects.filevine.corn;Rroca@,800goldlaw.com,

Cgordon@800goldlaw.com

Attorneys for Plaintiff

SAALFIELD SHAD, P.A.

/s/ Joseph B. Stokes, III

JOSEPH B. STOKES, III, ESQUIRE

Florida Bar Number: 897183

RUBY JO CATHERINE SMITH, ESQUIRE

Florida Bar Number: 112741

245 Riverside Avenue, Suite 400

Jacksonville, FL 32202

904/355-4401 (phone)

904/355-3503 (facsimile)

Email (Primary) jstokesAsaalfieldlaw.com

Email (Secondary) llovein@saalfieldlaw.com,

wdean@saalfieldlaw.com

Email (Tertiary) rjcsmithAsaalfieldlaw.com

Attorneys for Defendant

3

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 37 of 96
For. 4506

(March 2019)

Department of the Treasuy

Internal Revenue Service

Request for Copy of Tax Return

00,Do not sign this form unless all applicable lines have been completed.

*Request may be rejected if the form is incomplete or illegible.

Po- For more information about Form 4506, visit wwwirs.goldforrn4506.

OMB No. 1545-0429

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 return. 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.

Ia Name shown on tax return. If a joint return, enter the name shown first. lb 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 or 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)

6 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.

Saalfield Shad, P.A., 245 Riverside Avenue, Suite 400, Jacksonville, FL 32202, Telephone No.: 904-355-4401, Fax No.: 904-355-3503

„ „ . ' • , • , • •

Caution: if the tax return is being mailed to a third party, ensure that you have filled in lines 6 and 7 before signing. Sign and date the form once you

have filled in these lines. Completing these steps helps to protect your privacy. Once the IRS discloses your tax return to the third party listed on line

5, the IRS has no control over what the third party does with the information. If you would like to limit the third party's authority to disclose your return

information, you can specify this limitation in your written agreement with the third party.

. • • •- - • • - - , . . . . . . . .. .

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. I* 1040

Note: If the copies must be certified for court or administrative proceedings, check here

Year or period requested. Enter the ending date of the year or period, using the mm/dd/yyyy format. If you are requesting more than

eight years or periods, you must attach another Form 4506.

12/31/2019 12/31/2018

12/31/2015

12/31/2017

J .4••••••••. ,

, K ^

Fee. There is a $50 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.

a Cost for each return . 's •

b Number of returns requested on line 7 .

c Total cost.Multiply l ine8a by line8b ,

12/31/2016

$ 50.00

5

$250.00

9 If we cannot find the tax return, we will refund the fee. If the refund should go to the third party listed on line 5, check here .

Caution: Do not sign this form unless all applicable lines have been completed.

Signature of taxpayer(s). I declare that I am either the taxpayer whose name is shown on line la or 2a, or a person authorized to obtain the tax return

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, partner,

managing member, guardian, tax matters partner, executor, receiver, administrator, trustee, or party other than the taxpayer, I certify that I have the authority to

execute Form 4506 on behalf of the taxpayer. Note: This form must be received by IRS within 120 days of the signature date.

T 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.

Sign Signature (se instructions

Here

Title (if'line' la above is a 'Corporation, . partnership, estate, or trust)

Date

Phone number of taxpayer on line

1 a or 2a

Spouse's signature Date

For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No. 41721E Form 4506 (Rev. 3-2019)

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 38 of 96
Form 4506 (Rev. 3-20119) Page 2

Section references are to the Internal Revenue Code

unless otherwise noted.

Future Developments

For the latest Information about Form 4506 and its

instructions, go to www.irs.govlform=1506.

Information about any recent developments affecting

Form 4506, Form 4506-1 and Form 4506T-EZ will be

posted on that page.

General Instructions

Caution: Do not sign this form unless all applicable

lines have been completed.

Purpose of form. Use Form 4506 to request a copy

of your tax return. You can also designate (on line 5)

a third party to receive the tax return.

How long will It take? It may take up to 75

calendar days for us to process your request.

Tip. Use Form 4506-T, Request for Transcript of Tax

Return, to request tax return transcripts, tax account

information, W-2 information, 1099 information,

verification of nonfiling, and records of account.

Automated transcript request. 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.

Where to file. Attach payment and mail Form 4506

to the address below for the state you lived in, or the

state your business was in, when that return was

filed. There are two address charts: one for

individual returns (Form 1040 series) and one for all

other returns.

If you are requesting a return for more than one

year or period and the chart below shows two

different addresses, send your request to the

address based on the address of your most recent

return.

Chart for individual returns

(Form 1040 series)

if you filed an

individual return Mail to:

and lived in:

Alabama, Kentucky,

Louisiana, Mississippi,

Tennessee, Texas, a

foreign country, American

Samoa, Puerto Rico,

Guam, the

Commonwealth of the

Northern Mariana Islands,

the. U.S. Virgin Islands, or

A.P.O. or F.P.O. address

Internal Revenue Service

RAIVS Team

Stop 6716 AUSC

Austin, TX 73301

Alaska, Arizona,

Arkansas, California,

Colorado, Hawaii, Idaho,

Illinois, Indiana, Iowa,

Kansas, Michigan,

Minnesota, Mentana,

Nebraska, Nevada, New

Mexico, North Dakota,

Oklahoma, Oregon,

South Dakota, Utah,

Washington, Wisconsin,

Wyoming

Internal Revenue Service

RAIVS Team

Stop 37106

Fresno, CA 93888

Connecticut,

Delaware, District of

Columbia, Florida,

Georgia, Maine,

Maryland,

Massachusetts,

Missouri, New

Hampshire, New Jersey,

New York, North

Carolina, Ohio,

Pennsylvania, Rhode

Island, South Carolina,

Vermont, Virginia, West

Virginia

Internal Revenue Service

RAIVS Team

Stop.6705 S-2

Kansas City, MO

64999

Chart for all other returns

If you lived in

or your business Mail to:

was in:

Alabama, Alaska,

Arizona, Arkansas,

California, Colorado,

Connecticut, Delaware,

District of Columbia,

Florida, Georgia, Hawaii,

Idaho, Illinois, Indiana,

Iowa, Kansas, Kentucky,

Louisiana, Maine,

Maryland,

Massachusetts,

Michigan, Minnesota,

Mississippi,

Missouri, Montana,

Nebraska, Nevada, New

Hampshire, New Jersey,

New Mexico, New York,

North Carolina,

North Dakota, Ohio,

Oklahoma, Oregon,

Pennsylvania, Rhode

Island, South Carolina,

South Dakota,

Tennessee, Texas, Utah,

Vermont, Virginia,

Washington, West

Virginia, Wisconsin,

Wyoming, a foreign

country, American

Samoa, Puerto Rico,

Guam, the

Commonwealth of the

Northern Mariana

Islands, the U.S. Virgin

Islands, or A.P.O. or

F.P.O. address

Internal Revenue Service

RAIVS Team

P.O. Box 9941

Mail Stop 6734

Ogden, UT 84409

Specific Instructions

Line lb. Enter your employer identification number

(EIN) if you are requesting a copy of a business

return. Otherwise, enter the first social security

number (SSN) or your individual taxpayer

identification number (ITIN) shown on the return. For

example, if you are requesting Form 1040 that

includes Schedule C (Form 1040), enter your SSN.

Line 3. Enter your current address. If you use a P.O.

box, please include it on this line 3.

Line 4. Enter the address shown on the last return

filed if different from the address entered on line 3.

Note: If the addresses on lines .3 and 4 are different

and you have not changed your address with the

IRS, file Form 8822, Change of Address. For a

business address, file Form 8822-8, Change of

Address or Responsible Party — Business.

Signature and date. Form 4506 must be signed and

dated by the taxpayer listed on line la or 2a. The

IRS must receive Form 4506 within 120 days of the

date signed by the taxpayer or it will be rejected.

Ensure that all applicable lines are completed before

signing.

You must check the box in the

signature area to acknowledge you

have the authority to sign and request

the information. The form will not be

processed and returned to you if the box is

unchecked.

Individuals. Copies of jointly filed tax returns may

be furnished to either spouse. Only one signature is

required. Sign Form 4506 exactly as your name

appeared on the original return. If you changed your

name, also sign your current name.

Corporations. Generally, Form 4506 can be

signed by. (1) an officer having legal authority to bind

the corporation, (2) any person designated by the

board of directors or other governing body, or (3)

any officer or employee on written request by any

principal officer and attested to by the secretary or

other officer. A bona fide shareholder of record

owning 1 percent or more of the outstanding stock

of the corporation may submit a Form 4506 but must

provide documentation to support the requester's

right to receive the information.

Partnerships. Generally, Form 4506 can be

signed by any person who was a member of the

partnership during any part of the tax period

requested on line 7.

All others. See section 6103(e) if the taxpayer has

died, is insolvent. is a dissolved corporation, or if a

trustee, guardian, executor, receiver, or

administrator is acting for the taxpayer.

Note: If you are Heir at law, Next of kin, or

Beneficiary you must be able to establish a material

Interest in the estate or trust.

Documentation. For entities other than individuals,

you must attach the authorization document. For

example, this could be the letter from the principal

officer authorizing an employee of the corporation or

the letters testamentary authorizing an individual to

act for an estate.

Signature by a representative. A representative

can sign Form 4506 for a taxpayer only If this

authority has been specifically delegated to .the

representative on. Form 2848, line 5a. Form 2848

showing the delegation must be attached to Form

4506.

Privacy Act and Paperwork Reduction Act

Notice. We ask for the information on this form to

establish your right to gain access to the requested

returns) under the internal Revenue Code. We need

this information to properly identify the retum(s) and

respond to your request. If you request a copy of a

tax return, sections 6103 and 6109 require you to

provide this information, including your SSN or EIN,

to process your request. If you do not provide this

information, we may not be able to process your

request. Providing false or fraudulent information

may subject you to penalties.

Routine uses of this information include giving it to

the Department of Justice for civil and criminal

litigation, and cities, states, the District of Columbia,

and U.S. commonwealths and possessions for use

in administering their tax laws_ We may also

disclose this information to other countries under a

tax treaty, to federal and state agencies to enforce

federal nontax criminal laws, or to federal law

enforcement and intelligence agencies to combat

terrorism.

You are not required to provide the information

requested on a form that is subject to the Paperwork

Reduction Act unless the form displays a valid OMB

control number. Books or records relating to a form

or its instructions must be retained as long as their

contents may become material in the administration

of any Internal Revenue law. Generally, tax returns

and return information are confidential, as required

by section 6103.

The time needed to complete and file Form 4506

will vary depending on individual circumstances. The

estimated average time is: Learning about the law

or the form, 10 min.; - Preparing the form, 16 min.;

and Copying, assembling, and sending the form

to the IRS, 20 min_

If you have comments concerning the accuracy of

these time estimates or suggestions for making

Form 4506 simpler, we would be happy to hear from

you. You can write to:

Internal Revenue Service

Tax Forms and Publications Division

1111 Constitution Ave. NW, IR-6526

Washington, DC 20224.

Do not send the form to this address. Instead, see

Where to file on this page.

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 39 of 96
RON DESANTIS

GOVERNOR

MARY C. MAYHEW

SECRETARY

Authorization for the Use and Disclosure of Protected Health Information

Federal law states that we cannot share an individual's health information without the individual's permission, except in certain situations. By

signing this form, you are giving us permission to share the information you indicate below. If you decide later that you do not want us to share

this information any more, you can revoke this authorization at any time in writing or sign the REVOCATION SECTION on the back of this form

and return it to the Florida Medicaid TPL Recovery Program. This form must be completed and signed by the Medicaid recipient or by an

individual who has the authority to act on the Medicaid recipient's behalf (parent of a minor, legal guardian, trustee, power of attorney, personal

representative of the estate, grantor of an annuity).

PLEASE COMPLETE THE FOLLOWING SECTIONS

1. Personal Information:

Medicaid Recipient's Name Date of Birth 

Medicaid ID Number Social Security Number 

2. I give permission to the Agency for Health Care Administration (AHCA) and its contract representatives to share the health information

listed below with the following:

Name of the Law Firm or Law Office Saalfield Shad,P.A.,245 Riverside Avenue,#400,Jacksonville,FL 32202

Name of the Insurance Company 

Other

3. Indicate the purpose for which the disclosure is to be made:

XXTo substantiate Medicaid's lien relating to a lawsuit

To substantiate Medicaid's claim against the estate or against a trust account or annuity

XX Other Litigation pending in the State of Florida

4. Indicate the information that you want to be disclosed, related to the following (check one):

The Medicaid lien relating to the injury or negligence charges, for the period beginning with the date of incident.

Medicaid's claim against the estate.

The amount that is due Medicaid from the trust account, [Please send a copy of the trust agreement].

The amount that is due Medicaid from the annuity account, [Please send a copy of the annuity agreement].

XX Other, [Please be specific]. Paid Claims History

5. Enter the specific date that you want this authorization to expire: (i.e., one year from date of release) 

(If you do not enter a date, this authorization will expire in five years.)

I understand that the information described above may be redisclosed by the person or group that I hereby give AHCA and its contract representatives

permission to share my information with, and that my information would no longer be protected by the federal privacy regulations. Therefore, I release

AHCA, its workforce members, and its contract representatives from all liability arising from the disclosure of my health information pursuant to this

agreement. I understand that I may inspect or request copies of any information disclosed by this authorization if AHCA or its contract representatives

i nitiated this request for disclosure. I understand that I may revoke this authorization by notifying AHCA through its contractor representatives, in writing,

knowing that previously disclosed information would not be subject to my revocation request. I understand that I may refuse to sign this authorization and

that my refusal to sign will not affect my ability to obtain treatment, payment or eligibility for benefits.

6. Recipient Signature Print Name Date 

OR

Name of Legal Representative (Print) Relationship 

Signature of Legal Representative * Date 

* If you are not the individual, but represent the individual, please attach a copy of the legal document that verifies that you are a representative (parent

of a minor, legal guardian, trustee, power of attorney, personal representative of the estate, grantor of an annuity).

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 40 of 96
INSTRUCTIONS FOR THE USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION

1. Complete the front of the form and return it to Florida Medicaid TPL Recovery Program, Post Office Box 12188, Tallahassee, Florida

32317-2188, Phone (toll-free) (877) 357-3268 or Fax (844) 845-8352.

2. If the signer is a guardian, has a power of attorney or is an authorized representative, documentation of the representative's authority

to act on the individual's behalf must be attached. If an agency has custody of a child and a representative signs the release, include a

copy of the custody order.

3. Special kinds of health information have specific laws and rules that have to be followed before that information can be disclosed.

HIV and Sexually Transmitted Diseases (STD): All information about HIV and sexually transmitted diseases is protected under federal

and state laws and cannot be disclosed without your written authorization unless otherwise provided in the regulations. To release HIV

or STD information, this authorization must include a statement in the Information You Want Disclosed section of the specific HIV or STD

information that you are giving permission to release. Re-disclosure of HIV information is not allowed, except in compliance with law or

with your written permission.

Alcohol and Drug Treatment: Alcohol and/or drug treatment records are protected under federal and state laws and regulations and

cannot be disclosed without your written authorization, unless otherwise provided for in federal and state laws or regulations. To release

alcohol and drug treatment information, this authorization must include a statement in the Information You Want Disclosed section of the

specific information that you are giving permission to release, such as "assessment, treatment plan, attendance, discharge plan." Redisclosure of you alcohol and/or drug treatment records is not allowed, except in compliance with law or with your written permission.

Mental Health Treatment: Mental health treatment records are protected under federal and state laws and regulations and cannot be

disclosed without your written authorization, unless otherwise allowed in federal and state laws or regulations. To release mental health

treatment information, this authorization must include a statement in the Information You Want Disclosed section of the specific

information that you are giving permission to release, such as "assessment, treatment plan, attendance, discharge plan." Also, disclosure

of your therapist's own notes (psychotherapy notes) needs separate permission. Re-disclosure of your mental health treatment records

is prohibited, except in compliance with law or with your written permission.

4. You will be provided with a copy of this form.

REVOCATION SECTION

To revoke your authorization, complete the following section and return the form to the Florida Medicaid TPL Recovery Program at the

address given above. (Use of this form to revoke your authorization is optional; however, you must submit your revocation request in

writing.)

I no longer want my information shared.

Name Date of Birth 

Street Address 

City State Zip 

If applicable, your Medicaid ID number 

Signature Date 

OR

Signature of Authorized Representative Date 

Relationship of Authorized Representative 

(Revised March 2019)

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 41 of 96
Consent to Release

Liability Insurance (Including Self-Insurance), No-Fault Insurance,

or Workers' Compensation

Where to find Information on "Consent to Release" vs. "Proof of Representation"

Please refer to the PowerPoint document on this website titled: "Rules and Model Language for 'Proof of

Representation' vs. 'Consent to Release' for Medicare Secondary Payer Liability Insurance (Including SelfInsurance), No-Fault Insurance, or Workers' Compensation" for detailed information on

• When to use a "consent to release" document vs. a "proof of representation" document,

• Appropriate content for both documents,

• The need for appropriate documentation when there are two layers of representatives involved (examples:

attorney 1 refers a case to attorney 2; the beneficiary's guardian hires an attorney to pursue a liability

insurance claim) or when a beneficiary's representative signs a "consent to release" document on the

beneficiary's behalf,

• What liability insurers (including self-insurers), no-fault insurers, and workers' compensation entities must

have in order to obtain conditional payment information, and

• Use of agents by insurers' or workers' compensation.

General

A"consent to release" document is used by an individual or entity who does not represent the Medicare

beneficiary but is requesting information regarding the beneficiary's conditional payment information. A

"consent to release" does not authorize the individual or entity to act on behalf of the beneficiary or make

decisions on behalf of the beneficiary.

Model Language

See attached. Use of the model language is not required, but any documentation submitted as a "Consent to

Release" must include the information the model language requests.

Where to Submit a " Consent to Release" document:

Liability Insurance, No-Fault insurance, Workers' Compensation:

NGHP

PO Box 138832

Oklahoma City, OK 73113

Fax: (405) 869-3309

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 42 of 96
MODEL LANGUAGE

CONSENT TORELEASE

The language below should be used when you, a Medicare beneficiary, want to authorize someone other than

your attorney or other representative to receive information, including identifiable health information, from the

Centers for Medicare & Medicaid Services (CMS) related to your liability insurance (including self-insurance),

no-fault insurance or workers' compensation claim.

(print your name exactly as shown on your Medicare card)

hereby authorize the CMS, its agents and/or contractors to release, upon request, information related to my

injury/illness and/or settlement for the specified date of injury/illness to the individual and/or entity listed

below:

CHECKONLYONE OFTHEFOLLOWING TOINDICATE WHO MAYRECEIVEINFORMATION

AND THENPRINTTHEREQUESTEDINFORMATION:

(If you intend to have your information released to more than one individual or entity, you must complete a

separate release for each one.)

Insurance Company

Name of entity:

Contact for above entity:

Address:

Address Line 2:

City/State/ZIP:

Telephone:

riWorkers' Compensation Carrier

Saafield Shad, RA.

Other Attorney

(Explain)

Joseph B. Stokes, Ill

245 Riverside Avenue

Suite 400

Jacksonville, FL 32202

904-355 4401

CHECKONEOFTHEFOLLOWING TOINDICATEHOW LONG CMS MAYRELEASEYOUR

INFORMATION

(The period you check will run from when you sign and date below.):

El One Year ETwo Years EOther

(Provide a specific period of time)

I understand that I may revoke this "consent to release information" at any time, in writing.

MEDICAREBENEFICIARY INFORMATION AND SIGNATURE:

Beneficiary Signature: Date signed: 

Note: If the beneficiary is incapacitated, the submitter of this document will need to include documentation

establishing the authority of the individual signing on the beneficiary's behalf. Please visit

littps://go.cms.govicobro for further instructions.

Medicare ID (The number on your Medicare card.): 

Date of Injury/Illness: 

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 43 of 96
Social Security Administration Form Approved

Consent for Release of Information OMB No. 0960-0566

Instructionsfor Using this Form

Complete this form only if you want us to give information or records about you, a minor, or a legally incompetent adult, to an

i ndividual or group (for example, a doctor or an insurance company). If you are the natural or adoptive parent or legal guardian,

acting on behalf of a minor child, you may complete this form to release only the minor's non-medical records. We may charge a

fee for providing information unrelated to the administration of a program under the Social Security Act.

NOTE: Do not use this form to:

• Request the release of medical records on behalf of a minor child. Instead, visit your local Social Security office or call our tollfree number, 1-800-772-1213 (TTY-1-800-325-0778), or

• Request detailed information about your earnings or employment history. Instead, complete and mail form SSA-7050-F4. You

can obtain form SSA-7050-F4 from your local Social Security office or online at www.ssa.gov/onl i ne/ssa-7050.pdf.

How to Complete this Form

We will not honor this form unless all required fields are completed. An asterisk (*) indicates a required field. Also, we will not

honor blanket requests for "any and all records" or the "entire file." You must specify the information you are requesting and you

must sign and date this form. We may charge a fee to release information for non-program purposes.

• Fill in your name, date of birth, and social security number or the name, date of birth, and social security number of the person

to whom the requested information pertains.

• Fill in the name and address of the person or organization where you want us to send the requested information.

•Specify the reason you want us to release the information.

•Check the box next to the type(s) of information you want us to release including the date ranges, where applicable.

• For non-medical information, you, the parent or the legal guardian acting on behalf of a minor child or legally incompetent adult,

must sign and date this form and provide a daytime phone number.

• If you are not the individual to whom the requested information pertains, state your relationship to that person. We may require

proof of relationship.

PRIVACY ACT STATEMENT

Section 205(a) of the Social Security Act, as amended, authorizes us to collect the information requested on this form. We will

use the information you provide to respond to your request for access to the records we maintain about you or to process your

request to release your records to a third party. You do not have to provide the requested information. Your response is

voluntary; however, we cannot honor your request to release information or records about you to another person or organization

without your consent. We rarely use the information provided on this form for any purpose other than to respond to requests for

SSA records information. However, the Privacy Act (5 U.S.C. § 552a(b)) permits us to disclose the information you provide on this

form in accordance with approved routine uses, which include but are not limited to the following:

1.To enable an agency or third party to assist Social Security in establishing rights to Social Security benefits and or coverage;

2.To make determinations for eligibility in similar health and income maintenance programs at the Federal, State, and local level;

3.To comply with Federal laws requiring the disclosure of the information from our records; and,

4.To facilitate statistical research, audit, or investigative activities necessary to assure the integrity of SSA programs.

We may also use the information you provide when we match records by computer. Computer matching programs compare our

records with those of other Federal, State, or local government agencies. We use information from these matching programs to

establish or verify a person's eligibility for Federally-funded or administered benefit programs and for repayment of incorrect

payments or overpayments under these programs. Additional information regarding this form, routine uses of information, and

other Social Security programs is available on our Internet website, www.socialsecurity.gov, or at your local Social Security office.

PAPERWORK REDUCTION ACT STATEMENT

This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction

Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget control

number. We estimate that it will take about 3 minutes to read the instructions, gather the facts, and answer the questions. SEND

OR BRING THE COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE. You can find your local Social

Security office through SSA's website at www.soci alsecurity.gov. Offices are also listed under U.S. Government agencies

in your telephone directory or you may call 1-800-772-1213 (TYY 1-800-325-0778). You may send comments on our time

estimate above to: SSA, 6401 Security Blvd., Baltimore, MD 21235-6401. Send onlycomments relating to our time estimate

to this address, not the completed form.

Form SSA-3288 (11-2016) uf

Destroy Prior Editions

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 44 of 96
Social Security Administration Form Approved

Consent for Release of Information OMB No. 0960-0566

You must complete all required fields. We will not honor your request unless all required fields are completed. (*Signifies a

required field. **Please complete these fields in case we need to contact you about the consent form).

TO: Social Security Administration

*My Full Name *My Date of Birth *My Social Security Number

(MM/DD/YYYY)

I authorize the Social Security Administration to release information or records about me to:

*NAME OF PERSON OR ORGANIZATION: *ADDRESS OF PERSON OR ORGANIZATION:

Joseph B. Stokes, III, Esq. 245 Riverside Avenue

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Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 45 of 96
Filing # 109455434 E-Filed 06/26/2020 11:47:51 AM

IN THE CIRCUIT COURT, FOURTEENTH

JUDICIAL CIRCUIT, IN AND FOR BAY

COUNTY, FLORIDA

CASE NO.: 20201089CA

MARIA BUFF and ADAM BUFF, her

husband,

Plaintiffs,

V.

TARGET CORPORATION, a Foreign

Profit Corporation, and WAYNE HARRIS,

individually,

Defendants.

DEFENDANT TARGETCORPORATION'S MOTION TODISMISS

PLAINTIFFS'COMPLAINT

Defendant, Target Corporation, by and through its undersigned counsel, hereby files its

Motion to Dismiss Plaintiffs' Complaint, and in support thereof states as follows:

1. This is a transitory substance premises liability action arising from an incident which

allegedly occurred on October 18, 2019, wherein the Plaintiff contends she slipped in a

transitory foreign substance and fell to the ground.

2. Defendant moves to dismiss the Plaintiff's Complaint on the basis it fails to state a cause

of action as a matter of law. The Plaintiff attempts to state a cause of action under a "mode

of operation" theory which is no longer viable under Florida law. The mode of operation

theory has been abrogated by § 768.0755, Florida Statutes. Specifically, in paragraphs 11

e, f, g, h, and j, Plaintiff alleges several theories of recovery not recognized under Florida

law.

3. By enacting § 768.0755, the Florida legislature repealed § 768.0710, which had partially

codified the Florida Supreme Court's decision in Owens v.Publix Supermarkets,Inc.,802

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 46 of 96
So.2d 315 (Fla. 2001). In Owens,the Court held that if evidence established a specific

negligent mode of operation such that the premises owner could reasonably anticipate the

dangerous condition would arise as a result of the mode of operation, then whether the

owner had actual or constructive knowledge of a specific transitory substance was not at

issue.

4. Significantly, it must be noted that the Legislature deliberately omitted from § 768.0755

the mode of operation theory it had previously included in § 768.0710(2)(4 which allowed

a plaintiff to meet their burden of proof by showing the premises owner "acted negligently"

by not exercising "reasonable care in the . . . mode of operation of the business premises."

5. § 768.0755 controls the Plaintiff's burden of proof in this case. It provides as follows:

1. If a person slips and falls on a transitory foreign substance in a business

establishment, the injured person must prove that the business establishment

had actual or constructive knowledge of the dangerous condition and should

have taken action to remedy it. Constructive knowledge may be proven by

circumstantial evidence showing that:

(a) The dangerous condition existed for such a length of time that, in the

exercise of ordinary care, the business establishment should have known of

the condition; or

(b) The condition occurred with regularity and was therefore foreseeable.

2. This section does not affect any common law duty of care owed by a person or

entity in possession or control of a business premises.

Consequently, in every premises liability action involving allegations of a transitory

foreign substance against a business, the plaintiff must prove that the owner had actual or

constructive knowledge of the dangerous condition. There are no exceptions to this burden

of proof.

6. In Woodman v. Bravo Brio Restaurant Group,215 WL 14836941 (M.D. Fla. 2015), the

United States District Court for the Middle District of Florida considered the application

Case 5:20-cv-00213-MW-MJF Document 1-1 Filed 08/14/20 Page 47 of 96
of mode of operation theory to a slip and fall case. The defendant moved to strike the

plaintiff's "mode of operation" allegations. The plaintiff argued the theory survived the

enactment of § 768.0755. However, the court noted that in interpreting § 768.0755, it must

"strive to effectuate the Legislature's intent." The court held that § 768.0755 "clearly

eliminated the mode of operation theory as a basis for recovery in slip and fall cases and

Plaintiff may not pursue her claim on this basis."

7. The Fourth DCA directly confronted the issue of negligent mode of operation under §

768.0755 in PembrokeLakes Mall,Ltd.v.McGruder,137 So.3d 418 (Fla. 4th DCA 2014).

Comparing the language of Florida's 2002 and 2010 premises liability statutes, the court

pointed out that the older version did not require proof of actual or constructive notice, and

a plaintiff could succeed in a slip and fall case by showing the business premises acted

negligently in its mode of operation. Id. at 426. The new statute, on the other hand, "does

not contain any language regarding the owner's negligent maintenance, inspection, repair,

warning, or mode of operation. Id. at 424 (emphasis added). Because the more recent

statute explicitly requires proof of actual or constructive notice, and the language regarding

mode of operation has been removed, the same plaintiff would not be able to assert a cause

of action based on negligent mode of operation. Id. at 426.

8. Consequently, in this case, the Plaintiff must prove Target Corporation had actual or

constructive knowledge of the transitory substance and should have taken action to correct

it. § 768.0755 precludes the Plaintiff from attempting to establish liability by alleging

Target Corporation's mode of operation of the premises was negligent.

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