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CIV-050
- DO NOT FILE WITH THE COURT-
-UNLESS YOU ARE APPLYING FOR A DEFAULT JUDGMENT UNDER CODE OF CIVIL PROCEDURE § 585 -
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address): TELEPHONE NO.: FOR COURT USE ONLY
Michael Patrick Rooney, Esq. (248491) (415) 533-0282
580 California Street FL 16 ELECTRONICALLY
San Francisco, CA 94104
F I L E D
Superior Court of California,
JAMES DILLARD
ATTORNEY FOR (name): County of San Francisco
SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN FRANCISCO 01/27/2020
STREET ADDRESS:400 McAllister Street Clerk of the Court
MAILING ADDRESS: BY: NADITA MASON
San Francisco, CA 94102 Deputy Clerk
CITY AND ZIP CODE:
BRANCH NAME:Unlimited Civil
PLAINTIFF: DILLARD
DEFENDANT: ESPINOZA, et al.
CASE NUMBER:
STATEMENT OF DAMAGES
(Personal Injury or Wrongful Death) CGC-19-578321
To (name of one defendant only): HIPOLITO ESPINOZA
Plaintiff (name of one plaintiff only): JAMES DILLARD
seeks damages in the above-entitled action, as follows:
AMOUNT
1. General damages
a. Pain, suffering, and inconvenience ....................................................................................................
$
b. $
Emotional distress. .............................................................................................................................
c. Loss of consortium .............................................................................................................................
$
d. Loss of sociey and companionship (wrongful death actions only) .....................................................
$
e. Other (specify) $
..................................................................................................................................
f. Other (specify) $
..................................................................................................................................
g. Continued on Attachment 1.g.
2. Special damages
a. Medical expenses (to date) ................................................................................................................
$
b. $
Future medical expenses (present value) ..........................................................................................
c. $
Loss of earnings (to date) ...................................................................................................................
d. Loss of future earning capacity (present value) ..................................................................................
$
e. $
Property damage ................................................................................................................................
f. $
Funeral expenses (wrongful death actions only) ................................................................................
g. Future contributions (present value) (wrongful death actions only) ....................................................
$
h. Value of personal service, advice, or training (wrongful death actions only) ......................................
$
i. ✔
Other (specify) Funds misappropriated by contractor upon abandonment $ 14,000.00
..................................................................................................................................
j. Other (specify) $
..................................................................................................................................
k. Continued on Attachment 2.k.
3. ✔
Punitive damages: Plaintiff reserves the right to seek punitive damages in the amount of (specify).. $ 42,000.00
when pursuing a judgment in the suit filed against you.
Date: 1/25/2020
Michael Patrick Rooney, Esq.
(TYPE OR PRINT NAME) (SIGNATURE OF PLAINTIFF OR ATTORNEY FOR PLAINTIFF)
(Proof of service on reverse) Page 1 of 2
Form Adopted for Mandatory Use STATEMENT OF DAMAGES Code of Civil Procedure, §§ 425.11, 425.115
Judicial Council of California www.courtinfo.ca.gov
CIV-050 [Rev. January 1, 2007] (Personal Injury or Wrongful Death)
CIV-050
CASE NUMBER:
PLAINTIFF: DILLARD
ESPINOZA, et al. CGC-19-578321
DEFENDANT:
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.)
1. I served the
a. ✔ Statement of Damages Other (specify):
b. on (name):
c. by serving ✔ defendant other (name and title or relationship to person served):
d. by delivery at home at business
(1) date:
(2) time:
(3) address:
e. by mailing
(1) date: 1/27/2020
(2) place: 1610 Armstrong Ave. San Francisco, CA 94124
2. Manner of service (check proper box):
a. 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. 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.)
d. Mail and acknowledgment 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. 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.)
f. ✔ Other (specify code section): CCP 1012, 1013, 1013a
additional page is attached.
3. At the time of service I was at least 18 years of age and not a party to this action.
4. Fee for service: $
5. Person serving:
a. California sheriff, marshal, or constable f. Name, address and telephone number and, if applicable,
b. Registered California process server county of registration and number:
c. Employee or independent contractor of a registered
California process server
d. ✔ Not a registered California process server
e. Exempt from registration under Bus. & Prof. Code
§ 22350(b)
I declare under penalty of perjury under the laws of the (For California sheriff, marshal, or constable use only)
State of California that the foregoing is true and correct. I certify that the foregoing is true and correct.
Date: 1/27/2020 Date:
(SIGNATURE) (SIGNATURE)
CIV-050 [Rev. January 1, 2007] Page 2 of 2
PROOF OF SERVICE Code of Civil Procedure §§ 425.11, 425.115
(Statement of Damages)
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CIV-050 - DO NOT FILE WITH THE COURT- -UNLESS YOU ARE APPLYING FOR A DEFAULT JUDGMENT UNDER CODE OF CIVIL PROCEDURE § 585 - ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address): TELEPHONE NO.: FOR COURT USE ONLY Michael Patrick Rooney, Esq. (248491) (415) 533-0282 580 California Street FL 16 ELECTRONICALLY San Francisco, CA 94104 F I L E D Superior Court of California, JAMES DILLARD ATTORNEY FOR (name): County of San Francisco SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN FRANCISCO 01/27/2020 STREET ADDRESS:400 McAllister Street Clerk of the Court MAILING ADDRESS: BY: NADITA MASON San Francisco, CA 94102 Deputy Clerk CITY AND ZIP CODE: BRANCH NAME:Unlimited Civil PLAINTIFF: DILLARD DEFENDANT: ESPINOZA, et al. CASE NUMBER: STATEMENT OF DAMAGES (Personal Injury or Wrongful Death) CGC-19-578321 To (name of one defendant only): HIPOLITO ESPINOZA Plaintiff (name of one plaintiff only): JAMES DILLARD seeks damages in the above-entitled action, as follows: AMOUNT 1. General damages a. Pain, suffering, and inconvenience .................................................................................................... $ b. $ Emotional distress. ............................................................................................................................. c. Loss of consortium ............................................................................................................................. $ d. Loss of sociey and companionship (wrongful death actions only) ..................................................... $ e. Other (specify) $ .................................................................................................................................. f. Other (specify) $ .................................................................................................................................. g. Continued on Attachment 1.g. 2. Special damages a. Medical expenses (to date) ................................................................................................................ $ b. $ Future medical expenses (present value) .......................................................................................... c. $ Loss of earnings (to date) ................................................................................................................... d. Loss of future earning capacity (present value) .................................................................................. $ e. $ Property damage ................................................................................................................................ f. $ Funeral expenses (wrongful death actions only) ................................................................................ g. Future contributions (present value) (wrongful death actions only) .................................................... $ h. Value of personal service, advice, or training (wrongful death actions only) ...................................... $ i. ✔ Other (specify) Funds misappropriated by contractor upon abandonment $ 14,000.00 .................................................................................................................................. j. Other (specify) $ .................................................................................................................................. k. Continued on Attachment 2.k. 3. ✔ Punitive damages: Plaintiff reserves the right to seek punitive damages in the amount of (specify).. $ 42,000.00 when pursuing a judgment in the suit filed against you. Date: 1/25/2020 Michael Patrick Rooney, Esq. (TYPE OR PRINT NAME) (SIGNATURE OF PLAINTIFF OR ATTORNEY FOR PLAINTIFF) (Proof of service on reverse) Page 1 of 2 Form Adopted for Mandatory Use STATEMENT OF DAMAGES Code of Civil Procedure, §§ 425.11, 425.115 Judicial Council of California www.courtinfo.ca.gov CIV-050 [Rev. January 1, 2007] (Personal Injury or Wrongful Death) CIV-050 CASE NUMBER: PLAINTIFF: DILLARD ESPINOZA, et al. CGC-19-578321 DEFENDANT: 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.) 1. I served the a. ✔ Statement of Damages Other (specify): b. on (name): c. by serving ✔ defendant other (name and title or relationship to person served): d. by delivery at home at business (1) date: (2) time: (3) address: e. by mailing (1) date: 1/27/2020 (2) place: 1610 Armstrong Ave. San Francisco, CA 94124 2. Manner of service (check proper box): a. 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. 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.) d. Mail and acknowledgment 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. 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.) f. ✔ Other (specify code section): CCP 1012, 1013, 1013a additional page is attached. 3. At the time of service I was at least 18 years of age and not a party to this action. 4. Fee for service: $ 5. Person serving: a. California sheriff, marshal, or constable f. Name, address and telephone number and, if applicable, b. Registered California process server county of registration and number: c. Employee or independent contractor of a registered California process server d. ✔ Not a registered California process server e. Exempt from registration under Bus. & Prof. Code § 22350(b) I declare under penalty of perjury under the laws of the (For California sheriff, marshal, or constable use only) State of California that the foregoing is true and correct. I certify that the foregoing is true and correct. Date: 1/27/2020 Date: (SIGNATURE) (SIGNATURE) CIV-050 [Rev. January 1, 2007] Page 2 of 2 PROOF OF SERVICE Code of Civil Procedure §§ 425.11, 425.115 (Statement of Damages)