ILND 44 (Rev. 09/07/18) CIVIL COVER SHEET

The ILND 44 civil cover sheet and the information contained herein neither replace nor supplement the filing and service of pleadings or other papers as required by law, except as 

provided by local rules of court. This form, approved by the Judicial Conference of the United States in September 1974, is required for the use of the Clerk of Court for the purpose 

of initiating the civil docket sheet. (See instructions on next page of this form.)

I. (a) PLAINTIFFS DEFENDANTS

(b) County of Residence of First Listed Plaintiff County of Residence of First Listed Defendant

(Except in U.S. plaintiff cases) (In U.S. plaintiff cases only)

Note: In land condemnation cases, use the location of the tract of land involved.

(c) Attorneys (firm name, address, and telephone number) Attorneys (if known)

II. BASIS OF JURISDICTION (Check one box, only.) III. CITIZENSHIP OF PRINCIPAL PARTIES (For Diversity Cases Only.)

(Check one box, only for plaintiff and one box for defendant.) 

1 U.S. Government 3 Federal Question PTF DEF PTF DEF

Plaintiff (U.S. Government not a party) Citizen of This State 1 1 Incorporated or Principal Place 4 4

of Business in This State

2 U.S. Government 4 Diversity Citizen of Another State 2 2 Incorporated and Principal Place 5 5

Defendant (Indicate citizenship of parties in Item III.) of Business in Another State

Citizen or Subject of a 3 3 Foreign Nation 6 6

 Foreign Country

IV. NATURE OF SUIT (Check one box, only.)

CONTRACT TORTS PRISONER PETITIONS LABOR OTHER STATUTES

110 Insurance PERSONAL INJURY PERSONAL INJURY 710 Fair Labor Standards Act 375 False Claims Act

120 Marine 310 Airplane 530 General 720 Labor/Management Relations 376 Qui Tam (31 USC 3729 (a))

130 Miller Act 315 Airplane Product 367 Health Care/ 740 Railway Labor Act 400 State Reapportionment 

140 Negotiable Instrument Liability Pharmaceutical 751 Family and Medical 410 Antitrust

150 Recovery of Overpayment 320 Assault, Libel & Slander Personal Injury Leave Act 430 Banks and Banking

& Enforcement of Judgment 330 Federal Employers’ Product Liability 790 Other Labor Litigation 450 Commerce

151 Medicare Act Liability 368 Asbestos Personal Injury 791 Employee Retirement 460 Deportation

152 Recovery of Defaulted Student 340 Marine Product Liability

510 Motions to Vacate Sentence

530 General

535 Death Penalty

+DEHDV&RUSXV

540 Mandamus & Other

550 Civil Rights

555 Prison Condition

560 Civil Detainee – Conditions

of

Income Security Act 470 Racketeer Influenced and

Loans (Excludes Veterans) 345 Marine Product Liability Confinement Corrupt Organizations

153 Recovery of Veteran’s Benefits 350 Motor Vehicle 480 Consumer Credit

160 Stockholders’ Suits 355 Motor Vehicle PERSONAL PROPERTY PROPERTY RIGHTS 485 Telephone Consumer

190 Other Contract Product Liability 370 Other Fraud 820 Copyrights Protection Act (TCPA)

195 Contract Product Liability 360 Other Personal Injury 371 Truth in Lending 830 Patent 490 Cable/Sat TV

196 Franchise 362 Personal Injury - 380 Other Personal 835 Patent – Abbreviated 850 Securities/Commodities/

Medical Malpractice Property Damage New Drug Application Exchange

385 Property Damage 840 Trademark 890 Other Statutory Actions

Product Liability 891 Agricultural Acts

893 Environmental Matters

REAL PROPERTY CIVIL RIGHTS BANKRUPTCY FORFEITURE/PENALTY SOCIAL SECURITY 895 Freedom of Information Act

210 Land Condemnation 440 Other Civil Rights 422 Appeal 28 USC 158 625 Drug Related Seizure 861 HIA (1395ff) 896 Arbitration

220 Foreclosure 441 Voting 423 Withdrawal 28 USC 157 of Property 21 USC 881 862 Black Lung (923) 899 Administrative Procedure

230 Rent Lease & Ejectment 442 Employment 690 Other 863 DIWC/DIWW (405(g)) Act/Review or Appeal of

240 Torts to Land 443 Housing/ 864 SSID Title XVI Agency Decision

245 Tort Product Liability Accommodations IMMIGRATION 865 RSI (405(g)) 950 Constitutionality of

290 All Other Real Property 445 Amer. w/Disabilities - 462 Naturalization State Statutes

Employment Application

446 Amer. w/Disabilities - 463 Habeas Corpus - Alien FEDERAL TAXES

Other Detainee (Prisoner Petition) 870 Taxes (U.S. Plaintiff

448 Education 465 Other Immigration or Defendant)

Actions 871 IRS—Third Party

26 USC 7609

V. ORIGIN (Check one box, only.)

Transferred from

Another District

(specify)

Multidistrict

Litigation

Direct File

1 Original

Proceeding

2 Removed from

State Court

 3 Remanded from

Appellate Court

4 Reinstated or

Reopened

 5 6 Multidistrict

Litigation

8

VI. CAUSE OF ACTION (Enter U.S. Civil Statute under which you are filing and

write a brief statement of cause.)

VII. PREVIOUS BANKRUPTCY MATTERS (For nature of suit 422 and 423, enter the

case number and judge for any associated bankruptcy matter previously adjudicated by a judge of this Court.

Use a separate attachment if necessary.)

VIII. REQUESTED IN

COMPLAINT:

Check if this is a class action Under rule 23, 

F.R.CV.P.

Demand $ Check Yes only if demanded in complaint.

Jury Demand: Yes No

IX. RELATED CASE(S)

IF ANY

(See instructions)

Judge Case Number

X. Is this a previously dismissed or remanded case? Yes No If yes, Case # Name of Judge 

Date Signature of attorney of record

T & E CHICAGO LLC THE CINCINNATI INSURANCE COMPANY

Cook Hamilton County, Ohio

ANDERSON + WANCA 847/368-1500

3701 Algonquin Rd., Suite 500 Rolling Meadows, IL 60008

■

■ ■

28 U.S.C. Sec. 1332 (Insurance Declaratory Judgment)

July 8, 2020 /s/ Jeffrey A. Berman

Case: 1:20-cv-04001 Document #: 1-3 Filed: 07/08/20 Page 1 of 2 PageID #:294
INSTRUCTIONS FOR ATTORNEYS COMPLETING CIVIL COVER SHEET FORM JS 44

Authority for Civil Cover Sheet

The JS 44 civil cover sheet and the information contained herein neither replaces nor supplements the filings and service of pleading or other papers as required by law, 

except as provided by local rules of court. This form, approved by the Judicial Conference of the United States in September 1974, is required for the use of the Clerk of 

Court for the purpose of initiating the civil docket sheet. Consequently, a civil cover sheet is submitted to the Clerk of Court for each civil complaint filed. The attorney 

filing a case should complete the form as follows: 

I. (a) Plaintiffs-Defendants. Enter names (last, first, middle initial) of plaintiff and defendant. If the plaintiff or defendant is a government agency, use only the 

full name or standard abbreviations. If the plaintiff or defendant is an official within a government agency, identify first the agency and then the official, giving both 

name and title. 

(b) County of Residence. For each civil case filed, except U.S. plaintiff cases, enter the name of the county where the first listed plaintiff resides at the time of 

filing. In U.S. plaintiff cases, enter the name of the county in which the first listed defendant resides at the time of filing. (NOTE: In land condemnation cases, the 

county of residence of the "defendant" is the location of the tract of land involved.) 

(c) Attorneys. Enter the firm name, address, telephone number, and attorney of record. If there are several attorneys, list them on an attachment, noting in this 

section "(see attachment)". 

II. Jurisdiction. The basis of jurisdiction is set forth under Rule 8(a), F.R.Cv.P., which requires that jurisdictions be shown in pleadings. Place an "X" in one of 

the boxes. If there is more than one basis of jurisdiction, precedence is given in the order shown below. 

United States plaintiff. (1) Jurisdiction based on 28 U.S.C. 1345 and 1348. Suits by agencies and officers of the United States are included here. 

United States defendant. (2) When the plaintiff is suing the United States, its officers or agencies, place an "X" in this box. 

Federal question. (3) This refers to suits under 28 U.S.C. 1331, where jurisdiction arises under the Constitution of the United States, an amendment to the Constitution, 

an act of Congress or a treaty of the United States. In cases where the U.S. is a party, the U.S. plaintiff or defendant code takes precedence, and box 1 or 2 should be 

marked. 

Diversity of citizenship. (4) This refers to suits under 28 U.S.C. 1332, where parties are citizens of different states. When Box 4 is checked, the citizenship of the 

different parties must be checked. (See Section III below; NOTE: federal question actions take precedence over diversity cases.)

III. Residence (citizenship) of Principal Parties. This section of the JS 44 is to be completed if diversity of citizenship was indicated above. Mark this section 

for each principal party. 

IV. Nature of Suit. Place an "X" in the appropriate box. If the nature of suit cannot be determined, be sure the cause of action, in Section VI below, is sufficient 

to enable the deputy clerk or the statistical clerk(s) in the Administrative Office to determine the nature of suit. If the cause fits more than one nature of suit, select the 

most definitive. 

V. Origin. Place an "X" in one of the six boxes. 

Original Proceedings. (1) Cases which originate in the United States district courts. 

Removed from State Court. (2) Proceedings initiated in state courts may be removed to the district courts under Title 28 U.S.C., Section 1441. When the petition for 

removal is granted, check this box. 

Remanded from Appellate Court. (3) Check this box for cases remanded to the district court for further action. Use the date of remand as the filing date. 

Reinstated or Reopened. (4) Check this box for cases reinstated or reopened in the district court. Use the reopening date as the filing date. 

Transferred from Another District. (5) For cases transferred under Title 28 U.S.C. Section 1404(a). Do not use this for within district transfers or multidistrict litigation 

transfers. 

Multidistrict Litigation. (6) Check this box when a multidistrict case is transferred into the district under authority of Title 28 U.S.C. Section 1407. When this box is 

checked, do not check (5) above. 

VI. Cause of Action. Report the civil statute directly related to the cause of action and give a brief description of the cause. Do not cite jurisdictional statutes 

unless diversity. Example: U.S. Civil Statute: 47 USC 553 Brief Description: Unauthorized reception of cable service 

VII. Previous Bankruptcy Matters For nature of suit 422 and 423 enter the case number and judge for any associated bankruptcy matter previously adjudicated 

by a judge of this court. Use a separate attachment if necessary. 

VIII. Requested in Complaint. Class Action. Place an "X" in this box if you are filing a class action under Rule 23, F.R.Cv.P. Demand. In this space enter the 

actual dollar amount being demanded or indicate other demand, such as a preliminary injunction Jury Demand. Check the appropriate box to indicate whether or not a 

jury is being demanded. 

IX. Related Cases. This section of the JS 44 is used to reference related pending cases, if any. If there are related pending cases, insert the docket numbers and the 

corresponding judge names for such cases.

X. Refiling Information. Place an "X" in the Yes box if the case is being refiled or if it is a remanded case, and indicate the case number and name of judge. If 

this case is not being refiled or has not been remanded, place an “X” in the No box.

Date and Attorney Signature. Date and sign the civil cover sheet.

Rev. 09/07/2018 

Case: 1:20-cv-04001 Document #: 1-3 Filed: 07/08/20 Page 2 of 2 PageID #:295