Case 2:15-cv-01939-WB Document 1 Filed 04/14/15 Page 1 of 12

Case 2:15-cv-01939-WB Document 1 Filed 04/14/15 Page 2 of 12

UNITED STATES DISTRICT COURT
FOR THE EASTERN DISTRICT OF PENNSYLVANIA - DESIGNATION FORM to be used by counsel to indicate the category of the case for the purpose of
assignment to appropriate calendar.
Address of Plaintiff: James Grey, 2543 Finley Avenue, Bensalem, PA 19020
Address of Defendant: Ace American Insurance Company, 1 Beaver Valley Road, Wilmington, DE 19808
Place of Accident, Incident or Transaction:

Bristol Township, PA
ny publicly held corporation owni

re of its stock?

YesD
Yeso
Date Ter inated:

1. ls this ase related to property included in an earlier numbered suit pending or within one year previ

February 6, 2015

sly terminated action in this court?

YesD
Noll!!
pending or within one year previously terminated

2.

.,
3. Does this case involve the validity or infringen

NoD
YeslD
of a patent already in suit or any earlier numbered case pending or within one year previously

terminated action in this court?

YesD

4. ls this case a second or successive habeas co

1s, social security appeal, or prose civil rights case filed by the same individual?
YesD

CIVIL: (Place

NolD

NolJ<

V' in ONE CATEGORY ON!

A Federal Question Cases:

B.

I. o Indemnity Contract, Marine Cc

ct, and All Other Contracts

Diversity Jurisdiction Cases:

I. o Insurance Contract and Other Contracts

2. o FELA

2. o Airplane Personal Injury

3. o Jones Act-Personal Injury

3. o Assault, Defamation

4. o Antitrust

4. o Marine Personal Injury

5. o Patent

sfotor Vehicle Personal Injury

6. o Labor-Management Relations

6. o Other Personal Injury (Please specify)

7. o Civil Rights

7. o Products Liability

8. o Habeas Corpus

8. o Products Liability -

9. o Securities Act(s) Cases

9. o All other Diversity Cases

I 0. o Social Security Review Cases

Asbestos

(Please specify)

11. o All other Federal Question Cases

(Please s p e c i f y ) - - - - - - - - - - - - - - - - - - -

ARBITRATION CERTIFICATION
(Check Appropriate Category)
by certify:

I, Robert S. Miller, Esquire

, counsel of record

o Pursuant to Local Civil Rule 53.2, Section 3(c)(2), that tot

$150,000.00 exclusive of interest and costs;
o Relief other than monetary damages is sought

4_13_12_0_1_5_ _ __
DATE: _ _

e damages recoverable in this civil action case exceed the sum of

4
Attomeyl.D.#
NOTE:
reviously terminated action in this court

except as noted above.

DATE: _4_13_12_0_1_5_ __
Attorney I.D.#
CJV. 609 (5/2012)

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