Party Statement: KIM KONAMI VS. ARYAN DAVANI ET AL

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                                - DO NOT FILE WITH THE COURT-

ClV-050

-UNLESS YOU ARE APPLYING FOR A DEFAULT JUDGMENT UNDER CODE OF CIVIL PROCEDURE § 585 -

 

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address):

Neal H. Konami, Esq. (SBN 111730)
1050 Hyde Street
San Francisco, CA 94109-4917

TELEPHONE NO.

415-274-0956

ATTORNEY FOR (name) Kim Konami

 

SUPERIOR COURT OF CALIFORNIA, COUNTY OF San Francisco
street avoress. 400 McAllister Street
MAILING ADDRESS:
citvanozieceoe. San Francisco, CA 94102-4512
pranca name Main Courthouse, Civic Center

 

PLAINTIFF: Kim Konami
DEFENDANT: Aryan Davani et al

FOR COURT USE ONLY

ELECTRONICALLY
FILED

Superior Court of Callfornia,
County of San Francisco

08/05/2016
Clerk of the Court
BY:NADITA MASON

Deputy Clerk

 

 

STATEMENT OF DAMAGES
(Personal Injury or Wrongful Death)

 

 

CASE NUMBER

CGC-15-548211

 

To (name of one defendent only): DOE 8 ("GREG MILLER")
Plaintiff (name of one plaintiff only): Kim Konami
seeks damages in the above-entitled action, as follows:

1. General damages
Pain, suffering, and inconvenience

b, Emotional distress.

 

¢, E21 Loss of consortium

d.) Loss of sociey and companionship (wrongful death actions only)

 

f.

gC Continued on Attachment t.g
Special damages
a.(_] Medical expenses (to date)

nN

b, C1 Future medical expenses (present value)

c. C1] Loss of eamings (to date)

cd, Loss of future earning capacity (present value)

e. [J Property damage ..

+ CJ Funeral expenses (wrongful death actions only)

g. 1] Future contributions (present value) (wrongful death actions only)

h. J Value of personal service, advice, or training (wrongful death actions only)
i 21 other (specify)

j Co other (specify)

k. C2) continued on Attachment 2.k

Other (specify) Harassment, sleep deprivation, trespass, nuisance, etc. 7
Other (specify) Illegal Business Practices (Unpermitted Rooming/Lodging House)

AMOUNT
$ To be determined
$ To be determined
$
$
$To be determined
$ To be determined

3. 21 punitive damages: Plaintiff reserves the right to seek punitive damages in the amount of (specify). § To be determined

when pursuing a judgment in the suit filed against you
Date: June 23, 2016
Neal H. Konami, Esq. (SBN 111730) >

TIYPE OR PRINT NAME)
(Proof of service on reverse)

‘STATEMENT OF DAMAGES
(Personal Injury or Wrongful Death)

Form Adopted for Mandatory Use
Tde-al Counel of Caltorhia
CIV-050 fRev. January 1, 2607)

(IGNATURE OF PLAINTIFF OR ATTORNEY FOR PLAINTIFF)

Page 12

‘Code of Gil Procedure, §§ 425.11, 425.175,
ww.courtinto ca govCIV-050

 

|__ PLaintire: Kim Konami
perenpant: Aryan Davani et al

 

CASE NUMBER

CGC-15-548211

 

 

 

PROOF OF SERVICE
(After having the other party served as described below. with any of the documents identified in item 1, have the person who served
the documents complete this Proof of Service. Plaintiff cannot serve these papers.)

 

Statement of Damages [other (specify)
b. on (name): DOE 8 ("GREG MILLER")

 

©. by serving

   

by delivery athome [let business
(1)date: June 28, 2016
(2) time: 7:26 AM

defendant © L_lother (name and title or relationship to person served)

(3)address: 1048 Hyde Street San Francisco, CA 94109-4917

e. Lo] by mailing
(1) date:
(2) place:

Nn

Manner of service (check proper box)

a. CZ] Personal service. By personally delivering copies. (CCP § 415.10)

b. [] Substituted service on corporation, unincorporated association (including partnership), or public entity. By
leaving, during usual office hours, copies in the office of the person served with the person who apparently was in
charge and thereafter mailing (by first-class mail, postage prepaid) copies to the person served at the place where the

copies were left. (CCP § 415.20(a))

c. (2) substituted service on natural person, minor, conservatee, or candidate. By leaving copies at the dwelling house,
usual place of abode, or usual place of business of the person served in the presence of a competent member of the
household or a person apparently in charge of the office or place of business, at least 18 years of age, who was
informed of the general nature of the papers, and thereafter mailing (by first-class mail, postage prepaid) copies to the
person served at the place where the copies were left. (CCP § 415.20(b)) (Attach separate declaration or affidavit
stating acts relied on to establish reasonable diligence in first attempting personal service.)

4. (2) ait and acknowedgment service. By mailing (by first-class mail or airmail, postage prepaid) copies to the person
served, together with two copies of the form of notice and acknowledgment and a return envelope, postage prepaid,
addressed to the sender. (CCP § 415.30) (Attach completed acknowledgment of receipt.)

e. C1 Certified or registered mail service. By mailing to an address outside California (by first-class mail, postage prepaid,
requiring a return receipt) copies to the person served. (CCP § 415 40) (Attach signed return receipt or other

evidence of actual delivery to the person served.)

t. £2) other (specify code section)
additional page is attached

3. At the time of service | was at least 18 years of age and not a party to this action

4, Fee for service: $
5. Person serving

a. C1 California sheriff, marshal, or constable

b. Registered California process server

c. Employee or independent contractor of a registered

California process server

4. L-] Nota registered Califomia process server
Exempt from registration under Bus. & Prof. Code
§ 22350(b)
| declare under penalty of perjury under the faws of the
State of California that the foregoing is true and correct.

Date ee 2016 eed
(SIGNATURE)

 

 

f. Name, address and telephone number and, if applicable

county of registration and number:

Neal H. Konami, Esq. (SBN 111730)

1050 Hyde Street

San Francisco, CA 94109-4917

(415) 274-0956
(For California sheriff, marshal, or constable use only)
| certify that the foregoing is true and correct.

Date:

>

(SIGNATURE)

 

(C1V.050 [Rev. January 1, 2007]

PROOF OF SERVICE

Page 20f 2
Code of Civil Procedure §§ 425.11, 425.118

(Statement of Damages)