Subpoena Rec'd 10-9-2025 Sandra Mercedes Day vs Zuhao CuiIIIIIIIIIIII*CA1
2 II O 8 61 II II II II II
LOCATION SERVE
CITY OF CUPERTINO PUBLIC WORKS
10555 MARY AVE
CUPERTINO, CA 95014-1322
ATTN: RECORDS CUSTODIAN
CASE NAME:
SANDRA MERCEDES DAY v ZIHAO CUI
FILE NO.: 20026
RECEIVED
OCT 92025
CUPERTINO CITY CLERK
IIII OlD UI DIU DID Il11 Ill 1111 I DI 01111 liffi II11Th II
*CA 1200861 -040 *
CITY OF CUPERTINO PUBLIC WORKS
Custodian of Records
10555 Mary Ave
Cupertino, CA 95014-1322
200861 1�1
1 1' 1 • 1 1'
llII 11D III 11hI HID IIU 111I IDI I0I DI II*301146561*
FORM NO. 2VB-1LB
COMPEX
Comerica Bank
10900 Wilshire irree Blvd.
Legal Services, Inc.
Los Angeles, CA 90024-4595
FEES ACCOUNT
P.O.BOX 2736 - TORRANCE, CA 90509-2738
THIS CHECK WILL BE VOID FOR PAYMENT
(310) 782-1801
AFTER 90 DAYS FROM DATE OF ISSUE
NOT VALID OVER $15.00
PAY TO THE CITY OF CUPERTINO PUBLIC WORKS
ORDER OF
FIFTEEN DOLLARS ONLY
Patient: Sandra Day
Order #: CA1200861-040 Memo:
301146561
DATE 09-18-2025
90-4284/1222
NOT VALID OVER $15 (FIFTEEN DOLLARS)
VOID AFTER 90 DAYS
AUTHORIZED SIGNATURE
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Compex Order#:
CA1200861-040
Hello! Toschi, Doyle, Houvener & Wellen has assigned Compex as the deposition officer to obtain records to assist in
resolving a dispute involving Sandra Day.
City of Cupertino Public Works was named as a keeper of documents that are required for resolution of the disputed
matter. Please see the attached Business Records for the specific items and/or documents being requested.
Your time is valuable, and we know it! Please review the following information for proper production and to avoid
follow up phone calls from Compex.
3 Simple Steps to Completion:
❑ Prepare records for sending by 10/23/2025.
❑ Sign and Date the Custodian Affidavit and include the document with the prepared records.
Note: Complete the "Certification of No Records" for any records that cannot be provided.
❑ Send the records and the Custodian Affidavit and/or Certificate of No Records to Compex.
Options include:
1. Upload to our secure custodian portal at cpxlegal.com. If you do not have an account, you can self -register!
2. E-mail the records to records@compexlegal.com
3. Fax the records with the Custodian Affidavit as the cover sheet to 888-531-2922
4. Mail records or physical items to our nearest office location:
325 Maple Avenue, Torrance, California, 90503
If prepayment is required: Email invoices to records@compexlegal.com or Fax them to 888-531-2922.
To cover the cost of providing the requested documents or items, you may submit an itemized invoice for payment.
Please ensure the invoice adheres to the fee schedule as defined in your state codes. We want to pay you quickly,
please indicate on your invoice if you accept credit card payments.
Do you have questions regarding the fee schedule in your state? Just give us a call!
Something else needed? Please contact us:
Phone: 844-918-0955
Email: cservice@compexlegal.com
***If we do not receive a response by 10/30/2025, we will begin escalating based on our company process, including sending
demand letters and increasing the frequency of calls to your office***
Have a great experience and want to tell us about it? Did something go wrong and we need to make some adjustments?
You have a direct connection to our Operations Directors. Sendanemailtoopsdir@compexlegal.com. Youwill receivearesponse
within 48 hours.
Going Digital
Meet our virtual digital assistant, Ivy! Did you know? Digital processes increase speed,
workflow, and communication efficiency and are preferred by most Custodian of Records. By
enrolling in our digital program, we will turn off phone calls, allowing you to respond to us on
your own timeline using secure links that get delivered via email.
WHAT YOU CAN DO BY ENROLLING
i
All on your schedule. We will only reach out if we have not received the Records, Certificate of
No Records, or extension request within 30 days from the original request by the due date.
(800) 326-6739 I www.compextegat.com
Attestation Regarding a Requested Use or Disclosure of Protected Health Information
Potentially Related to Reproductive Health Care
The entire form must be completed for the attestation to be valid. Completion of the form does not guarantee
the request will be accepted or the records will be provided
Name of Requestor
Illia Serpik, Toschi, Doyle, Houvener & Wellen
Name of healthcare provider
City of Cupertino Public Works
Name and Date of Birth of Customer/Patient
Sandra Day, 12/06/1963
Description of PHI requested
Medical records as described in the attached Subpoena or Authorization form; Business Records -
I attest that the use or disclosure of PHI that I am requesting is not for a purpose prohibited by the HIPAA Privacy Rule at
45 CFR 164.502(a)(5)(iii) because of one of the following (Check only Box 1 or Box 2):
Box 1. The purpose of the use or disclosure of protected health information is not to investigate or impose liability
on any person for the mere act of seeking, obtaining, providing, or facilitating reproductive health
care or to identify any person for such purposes.
❑ Box 2. The purpose of the use or disclosure of protected health information is to investigate or impose liability
on any person for the mere act of seeking, obtaining, providing, or facilitating reproductive health care, or to
identify any person for such purposes, but the reproductive health care at issue was not lawful under the
circumstances in which it was provided.
I understand that I may be subject to criminal penalties pursuant to 42 U.S.C. 1320d-6 if I knowingly and in violation of
HIPAA obtain individually identifiable health information relating to an individual or disclose individually identifiable
health information to another person.
Signature of the person requesting and receiving the PHI
Date 09/18/2025
If you have signed as a representative of the person requesting PHI, provide a description of your authority to act for that
person.
CA1200861-040
(�A19ilf1RR1-fldfl cr ton —
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
ILLIA SERPIK (BAR#: 235841)
FOR COURT USE ONLY
TOSCHI, DOYLE, HOUVENER & WELLEN
5145 JOHNSON DRIVE
PLEASANTON, CA 94588
TELEPHONE NO.: FAX NO.: 510-835-7800
E-MAIL ADDRESS: iserpik@tcdlegal.com
ATTORNEY FOR (Name): ZIHAO CUI
SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA
STREET ADDRESS: 99 NORTE DAME
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME: CIVIL
PLAINTIFF/PETITIONER: SANDRA MERCEDES DAY
DEFENDANT/RESPONDENT: ZIHAO CUI
DEPOSITION SUBPOENA
CASE NUMBER:
25CV456261
FOR PRODUCTION OF BUSINESS RECORDS
THE PEOPLE OF THE STATE OF CALIFORNIA, TO (name, address, and telephone number of deponent, if known):
CUSTODIAN OF RECORDS: CITY OF CUPERTINO PUBLIC WORKS
10555 MARY AVE, CUPERTINO, CA 95014-1322
T VU AKC urcu r r -U 1O rKUUUCE I nt BUSINESS RECORDS described in item 3, as follows:
To (name of deposition officer): COMPEX LEGAL SERVICES
On (date): 10/23/2025 At (time): 09:00 A.M.
Location (address): 325 MAPLE AVENUE, TORRANCE, CALIFORNIA, 90503 or records(acompexlegal com
Do not release the requested records to the deposition officer prior to the date and time stated above.
a. ❑ by deliverinq a true, leqible, and durable copy of the business records riescriheri in itam A anrincarl ir, n caolo.J 1
wrapper with the title and number of the action, name of witness, and date of subpoena clearly written on it. The inner
wrapper shall then be enclosed in an outer envelope or wrapper, sealed and mailed to the deposition officer at the
address in item 1.
b. ® by delivering a true, legible, and durable copy of the business records described in item 3 to the deposition officer at the
witness's address, on receipt of payment in cash or by check of the reasonable costs of preparing the copy, as
determined under Evidence Code section 1563(b).
c. ❑ by making the original business records described in item 3 available for inspection at your business address by the
attorney's representative and permitting copying at your business address under reasonable conditions during normal
business hours.
2. The records are to be produced by the date and time shown in item 1 (but not sooner than 20 days after the issuance of the
deposition subpoena, or 15 days after service, whichever date is later). Reasonable costs of locating records, making them
available or copying them, and postage, if any, are recoverable as set forth in Evidence Code section 1563(b). The records shall
be accompanied by an affidavit of the custodian or other qualified witness pursuant to Evidence Code section 1561.
3. The records to be produced are described as follows (if electronically stored information is demanded, the form or
Forms in which each type of information is to be produced maybe specified):
RECORD SUBJECT: SANDRA DAY AKA: SANDRA MERCEDES DAY; SANDA JOVEL MONTENEGRO
DOB: 12/06/1963 SSN:
® Continued on Attachment 3
4. IF YOU HAVE BEEN SERVED WITH THIS SUBPOENA AS A CUSTODIAN OF CONSUMER OR EMPLOYEE RECORDS UNDER
CODE OF CIVIL PROCEDURE SECTION 1985.3 OR 1985.6 AND A MOTION TO QUASH OR AN OBJECTION HAS BEEN
SERVED ON YOU, A COURT ORDER OR AGREEMENT OF THE PARTIES, WITNESSES, AND CONSUMER OR EMPLOYEE
AFFECTED MUST BE OBTAINED BEFORE YOU ARE REQUIRED TO PRODUCE CONSUMER OR FMPI OVFF Rl=rnonc
DISOBEDIENCE OF THIS SUBPOENA MAY BE PUNISHED AS CONTEMPT BY THIS COURT. YOU WILL ALSO BE LIABLE
FOR THE SUM OF FIVE HUNDRED DOLLARS AND ALL DAMAGES RESULTING FROM YOUR FAILURE TO OBEY.
Date issued: 09/22/2025
ILLIA SERPIK
(TYPE OR PRINT NAME)
/S/ ILLIA SERPIK
(SIGNATURE OF PERSON ISSUING SUBPOENA)
ATTORNEY
(TITLE)
Page I or 2
Form Adopted for Mandatory Use DEPOSITION SUBPOENA FOR PRODUCTION Code of Civil Procedure, §§ 2020.410-2020.440:
Judicial Council of California Government Code § 68097.1
SUBP-010 [Rev. January 1, 2012] OF BUSINESS RECORDS www.courts.ca.gov
OAl2nns61-040
SUBP-010
PLAINTIFF/PETITIONER: SANDRA MERCEDES DAY CASE NUMBER:
25CV456261
DEFENDANT/RESPONDENT: ZIHAO CUI
PROOF OF SERVICE OF DEPOSITION SUBPOENA FOR
PRODUCTION OF BUSINESS RECORDS
1. I served this Deposition Subpoena for Production of Business Records by to the person served as follows:
a. Person served (name):
b. Address where served:
10555 Mary Ave, Cupertino, CA 95014-1322
c. Date of delivery:
d. Time of delivery:
e. (1) ® Witness fees were paid.
Amount: $ 15.00
(2) ❑ Copying fees were paid.
Amount:$
f. Fee for service: $
2. I received this subpoena for service on (date):
3. Person serving:
a. ❑ Not a registered California process server.
b. ❑ California sheriff or marshal.
c. ❑ Registered California process server.
d. ❑ Employee or independent contractor of a registered California process server.
e. ❑ Exempt from registration under Business and Professions Code section 22350(b).
f. ® Registered professional photocopier.
g. ❑ Exempt from registration under Business and Professions Code section 22451.
h. Name, address, telephone number, and, if applicable, county of registration and number:
Compex Legal Services, Inc.
325 Maple Avenue
Torrance, CA 90503
I declare under penalty of perjury under the laws of the State of
California that the foregoing is true and correct.
Date:
(SIGNATURE)
(For California sheriff or marshal use only)
I certify that the foregoing is true and correct.
Date:
(SIGNATURE)
SUBP-010[Rev.January1, 2012] DEPOSITION SUBPOENA FOR PRODUCTION Page2ofl
OF BUSINESS RECORDS
CA1200861-040
ATTACHMENT 3
PERTAINING TO:
Sandra Day
AKA: Sandra Mercedes Day; Sanda Jovel Montenegro
Date of Birth: 12/06/1963, Social Security Number:
DOCUMENTS AND TANGIBLE THINGS TO BE PRODUCED
You are hereby commanded to produce the following documents and electronically stored information for the time period
of 10:51AM to 12:51PM on 1/24/2023.
DEFINITIONS:
• "THE INTERSECTION" shall refer to the entire area of the vehicular intersection at De Anza Blvd. and
Homestead Rd. in Cupertino, CA including all approaches, crosswalks, and traffic control devices.
• "THE INCIDENT" shall refer to the motor vehicle accident that occurred on or about the date and time referenced
above.
• "THE RELEVANT TIME PERIOD" shall refer to the period from 10:51AM to 12:51PM on 1/24/2023.
REQUESTED ITEMS:
Section 1: Traffic Signal Information
1. All Traffic Signal Timing and Phasing Reports for THE INTERSECTION for THE RELEVANT TIME PERIOD.
2. All Controller Event Logs, also known as sequence of operation logs, showing the moment -by -moment activity of
the traffic signals at THE INTERSECTION during THE RELEVANT TIME PERIOD. This request includes data on:
o The start and end time of each signal interval (green, yellow, red).
o The duration of each signal interval, including all -red clearance intervals.
o Any pedestrian signal activations ("walk" / "don't walk").
o Any preemption or priority calls (e.g., for emergency vehicles).
3. The official Signal Timing Plan or Chart in effect for THE INTERSECTION on the date of THE INCIDENT.
4. All records of maintenance, repair, complaints, or reported malfunctions concerning the traffic signals at THE
INTERSECTION for the six (6) months prior to and including the date of THE INCIDENT.
Section•2: Video and Photographic Evidence
1. Any and all video recordings, digital video files, and/or photographs in your possession, custody, or control that
depict THE INTERSECTION during THE RELEVANT TIME PERIOD. This request includes, but is not limited to,
footage from:
o Traffic monitoring cameras (sometimes called ITS cameras).
o Red-light enforcement cameras (even if no violation was triggered).
o Any other surveillance or closed-circuit television (CCTV) cameras aimed at or capturing any portion of THE
INTERSECTION.
2. Please produce all video files in their native electronic format. If the video is part of a proprietary system, please
also provide information on the necessary software required for viewing.
CA1200861-040
SUBP-025
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
FOR COURT USE ONLY
ILLIA SERPIK (BAR# 235841)
TOSCHI, DOYLE, HOUVENER & WELLEN
5145 JOHNSON DRIVE
PLEASANTON, CA 94588
TELEPHONE NO.: FAX NO. (Optional): 510-835-7800
E-MAIL ADDRESS (Optional): iserpik@tedlegal.com
ATTORNEY FOR (Name): ZIHAO CUI
SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA
STREET ADDRESS: 99 NORTE DAME
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME: CIVIL
PLAINTIFF / PETITIONER: SANDRA MERCEDES DAY
CASE NUMBER:
DEFENDANT / RESPONDANT: ZIHAO CUI
25CV456261
NOTICE TO CONSUMER OR EMPLOYEE AND OBJECTION
(Code Civ. Proc., §§ 1985.3,1985.6)
NOTICE TO CONSUMER OR EMPLOYEE
TO (name): SANDRA DAY
1. PLEASE TAKE NOTICE THAT REQUESTING PARTY (name): ZIHAO CUI
SEEKS YOUR RECORDS FOR EXAMINATION by the parties to this action on (specify date): 10/23/2025
The records are described in the subpoena directed to witness (specify name and address of person or entity from whom records
are sought): CITY OF CUPERTINO PUBLIC WORKS
10555 MARY AVE
CUPERTINO, CA 95014-1322
A copy of the subpoena is attached.
IF YOU OBJECT to the production of these records, YOU MUST DO ONE OF THE FOLLOWING BEFORE THE DATE
SPECIFIED
IN ITEM a. OR b. BELOW:
a. If you are a party to the above -entitled action, you must file a motion pursuant to Code of Civil Procedure section 1987.1 to
quash or modify the subpoena and give notice of that motion to the witness and the deposition officer named in the
subpoena at least five days before the date set for production of the records.
b. If you are not a party to this action, you must serve on the requesting party and on the witness, before the date set for
production of the records, a written objection that states the specific grounds on which production of such records should be
prohibited. You may use the form below to object and state the grounds for your objection. You must complete the Proof of
Service on the reverse side indicating whether you personally served or mailed the objection. The objection should not be
filed with the court. WARNING: IF YOUR OBJECTION IS NOT RECEIVED BEFORE THE DATE SPECIFIED IN ITEM 1,
YOUR RECORDS MAY BE PRODUCED AND MAY BE AVAILABLE TO ALL PARTIES.
YOU OR YOUR ATTORNEY MAY CONTACT THE UNDERSIGNED to determine whether an agreement can be reached in
writing to cancel or limit the scope of the subpoena. If no such agreement is reached, and if you are not otherwise represented by
an attorney in this action, YOU SHOULD CONSULT AN ATTORNEY TO ADVISE YOU OF YOUR RIGHTS OF PRIVACY.
Date: 09/22/2025
ILLIA SERPIK
(TYPE OR PRINT NAME)
/S/ ILLIA SERPIK
(SIGNATURE OF
❑ REQUESTING PARTY ❑X ATTORNEY)
OBJECTION BY NON-PARTY TO PRODUCTION OF RECORDS
1. ❑ I object to the production of all of my records specified in the subpoena.
2. ❑ I object only to the production of the following specified records:
3. The specific grounds for my objection are as follows:
Date:
(TYPE OR PRINT NAME) (SIGNATURE)
(Proof of service on reverse) Page 1 of 2
Form Adopted for Mandatory Use NOTICE TO CONSUMER OR EMPLOYEE AND OBJECTION Code of Civil Procedure,
Judicial Council of California
§§ 1985.3. 1985.6,
SUBP-025 [Rev. January 1, 2008] 2020.010-202.510
www. court i n fo. ca. go v
CAI 200861-040
PLAINTIFF/PETITIONER: SANDRA MERCEDES DAY CASE NUMBER:
25CV456261
DEFENDANT/RESPONDENT: ZIHAO CU!
SUBP-025
PROOF OF SERVICE OF NOTICE TO GONSUMtK UK tMNLUYtt AND UtS.Jtl: I lON
(Code Civ. Proc., §§ 1985.3,1985.6)
❑ Personal Service/Email ® Mail
1 • At the time of service I was at least 18 years of age and not a party to this legal action.
2. I served a copy of the Notice to Consumer or Employee and Objection as follows (check either a orb):
a. ❑ Personal service/Email. I personally delivered the Notice to Consumer or Employee and Objection as follows:
ben@theswansonlawgroup.com
(1) Name of person served: (3) Date served:
(2) Address where served: (4) Time served:
Mail. I deposited the Notice to Consumer or Employee and Objection in the United States mail, in a sealed envelope
with postage fully prepaid. The envelope was addressed as follows:
(1) Name of person served: Benjamin D. Swanson (3) Date of mailing: 09/22/2025
(2) Address: 31824 Village Center Road, Unit G (4) Place of mailing (city and state):
Westlake Village CA 91361 Sacramento, CA
(5) I am a resident of or employed in the county where the Notice to Consumer or Employee and Objection was
mailed.
c. My residence or business address is (specify):1816 Tribute Road, Suite 100
Sacramento, CA, 95815
My phone number is (specify): 800-426-6739
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date: 09/22/2025
Valerie G. Farrell
(TYPE OR PRINT NAME OF PERSON WHO SERVED) (SIGNATURE OF PERSON WHO SERVED)
PROOF OF SERVICE OF OBJECTION TO PRODUCTION OF RECORDS
(Code Civ. Proc., §§ 1985.3,1985.6)
❑ Personal Service ❑ Mail
At the time of service I was at least 18 years of age and not a party to this legal action.
I served a copy of the Objection to Production of Records as follows (complete either a orb):
a. ON THE REQUESTING PARTY
(1) ❑ Personal service. I personally delivered the Objection to Production of Records as follows:
(i) Name of person served: (iii) Date served:
(ii) Address where served: (iv) Time served:
(2) ❑ Mail. I deposited the Objection to Production of Records in the United States mail, in a sealed envelope with
postage fully prepaid. The envelope was addressed as follows:
(i) Name of person served: (iii) Date of mailing:
(ii) Address: (iv) Place of mailing (city and state):
(v) I am a resident of or employed in the county where the Objection to Production of Records was
mailed.
b. ON THE WITNESS
(1) ❑ Personal service. I personally delivered the Objection to Production of Records as follows:
(i) Name of person served: (iii) Date served:
(ii) Address where served: (iv) Time served:
(2) ❑ Mail. I deposited the Objection to Production of Records in the United States mail, in a sealed envelope with
postage fully prepaid. The envelope was addressed as follows:
(i) Name of person served: (iii) Date of mailing:
(ii) Address: (iv) Place of mailing (city and state):
(v) I am a resident of or employed in the county where the Objection to Production of Records was
mailed.
3. My residence or business address is (specify):
4. My phone number is (specify):
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(TYPE OR PRINT NAME OF PERSON WHO SERVED) (SIGNATURE OF PERSON WHO SERVED)
SUBP-025[Rev.January1, 2008] NOTICE TO CONSUMER OR EMPLOYEE AND OBJECTION Page2of2
CA1200861-040
Certificate of Satisfactory Assurance
As required by the Standards for Privacy of Individually Identifiable Health Information ("Privacy
Regulations") promulgated pursuant to the Health Insurance Portability and Accountability Act of 1996
("HIPAA"), this certification provides satisfactory assurances that appropriate steps have been taken to
notify and/or otherwise protect the privacy of the individual who is the subject of the protected health
information that is being requested.
X Notice
In compliance with 45 C.F.R. § 164.152(e)(1), I hereby certify that I have made a good faith attempt to
provide written notice to Sandra Day ("the individual"), whose protected health information I am
requesting, or if the individual is represented by and attorney, mailed a notice to:
Benjamin D. Swanson
The Swanson Law Group
31824 Village Center Road, Unit G
Westlake Village, CA 91361
A copy of such written notice was included in the packet of documents served to your office.
I certify that the notice included sufficient information about the litigation or proceeding in which the
protected health information is requested to permit the individual to raise an objection to the court or
administrative tribunal. Further, I certify that the time for the individual to raise objections to the court or
administrative tribunal has elapsed and either: (1) no objections were filed; or (2) all objections filed by the
individual have been resolved by the court or the administrative tribunal and the disclosures being sought
are consistent with such resolution.
Qualified Protective Order
In compliance with 45 C.F.R. § 164.152(e)(1), I hereby certify that:
The parties to the dispute giving arise to this request for information have
agreed to a qualified protective order and have presented it to the court
or administrative tribunal with jurisdiction over the dispute; or
I requested a qualified protective order from the court or administrative
tribunal on
A copy of the qualified protective order or my request for such order is attached to this
Certification.
Valerie G. Farrell
Name
J /
Signature
10/08/2025
Date
Compex Legal Services
Company
COMPEX LEGAL SERVICES
AFFIDAVIT - (Pursuant to Cal Evidence Code 1561)
CA1200861-040
I hereby declare under penalty of perjury under the laws of the State of California that the following statements are true to
the best of my knowledge and belief.
I am over the age of 18 and the duly authorized custodian of records for:
CITY OF CUPERTINO PUBLIC WORKS
10555 MARY AVE, CUPERTINO, CA 95014-1322
and have the authority to certify that the records made available to COMPEX LEGAL SERVICES for reproducing are all of
the records under my custody and control, described and called for in the SUBPOENA/Authorization served with this
declaration in the matter relating to said individual or thing pertaining to:
RECORDS OF: SANDRA DAY
AKA: AKA: SANDRA MERCEDES DAY; SANDA JOVEL MONTENEGRO
DATE OF BIRTH: 12/06/1963
SOCIAL SECURITY#:
HOW ORIGINAL RECORDS WERE PREPARED
HANDWRITTEN NOTES TYPED/DATA ENTERED
TRANSCRIBED OTHER
TYPE OF RECORDS PRODUCED
MEDICAL BILLING LI FILMS INSURANCE
EMPLOYMENT PAYROLL SCHOLASTIC
OTHER
Said records were prepared by personnel of the business in the ordinary course of business at or near the time of the act,
condition, or event. I have delivered all of the records/items requested with the following exception(s):
CUSTODIAN NAME (PLEASE PRINT) PHONE NUMBER
SIGNATURE OF CUSTODIAN
DATE
I AM THE ATTORNEY'S REPRESENTATIVE AND I STATE THAT I MADE TRUE COPIES OF
ALL THE ORIGINAL RECORDS DELIVERED TO ME BY THE CUSTODIAN OF RECORDS OF
THE ABOVE LOCATION.
I DECLARE UNDER PENALTY OF PERJURY & UNDER THE LAWS OF THE STATE OF CALIFORNIA
THAT THE FOREGOING IS TRUE AND CORRECT.
DATE SIGNATURE PRINT NAME
PURSUANT TO BUSINESS & PROFESSIONS CODE SECTION 22462,1 WILL MAINTAIN THE INTEGRITY & CONFIDENTIALITY OF ANY AND ALL
INFORMATION OBTAINED, AND DISTRIBUTE THE RECORDS COPIED BY COMPEX LEGAL SERVICES TO THE AUTHORIZED PERSON OR ENTITIES.
CA1200861-040 Certificate of No Records
Record Subject: SANDRA DAY
AKA: AKA: SANDRA MERCEDES DAY; SANDA JOVEL MONTENEGRO
DOB: 12/06/1963
SSN:
I, the undersigned, being the duly authorized custodian of records or other qualified witness for the following entity:
CITY OF CUPERTINO PUBLIC WORKS
10555 MARY AVE
CUPERTINO, CA 95014-1322
With personal knowledge of the facts set forth below, and authority to certify said facts, do herby attest as follows:
Yes No
1) A complete and thorough search of all active, inactive, and stored files has been made for the records.
❑ ❑
2) All identifying information provided, including but not limited to, dates of birth, social security numbers, file numbers,
dates of treatment or service, and names of involved parties was used in the search.
El ❑
3) All possible information that can be used to search for the records of the record subject named above was provided,
❑ El
and no further search with additional information is possible.
4) All branch offices and other business locations for the entity listed above have been searched.
❑ El
5) All records from all branch offices and other business locations for the entity listed above have been provided.
❑ El
6) The entity listed above has no separate private records or other separate files, including consultations, treatment
❑
classifications or chronological files that were in any way excluded from the search for these records.
❑
�) To the best of my knowledge and belief, the entity listed above does not now and never has operated under other
El El
names or at other locations that were in any way excluded from the search for these records.
❑ ❑
8) To the best of my knowledge and belief, none of the requested records currently exist.
For any "No" answers, please provide a detailed explanation:
The records called for and described cannot be produced for the following specific reasons:
Records Requested Never Existed Lost Destroyed Retention Policy Other (please explain)
MEDICAL ❑ El El
X-RAYS El ❑ O
BILLING El ❑ ❑
PAYROLL ❑ El ❑
EMPLOYMENT ❑ El El
OTHER El ❑ El
I hereby declare under penalty of perjury, pursuant to the laws of the State of CA that the foregoing is true and correct.
Executed On: at , CA Phone
(Date)
Signature: Print name:
As an agent of Compex Legal Services, Inc., I hereby declare that all information provided to Compex regarding these records was
communicated to the custodian prior to the execution of this Certificate of No Records.
NOTE: The Custodian was requested to sign this certificate and refused, electing instead to generate a similar document
Agent's Signature:
Date: Compex Order #: CA1200861-040