arrow left
arrow right
  • RODRICK BRECKLER et al VS. ASBESTOS DEFENDANTS (B*P) AS REFLECTED ON et al ASBESTOS document preview
  • RODRICK BRECKLER et al VS. ASBESTOS DEFENDANTS (B*P) AS REFLECTED ON et al ASBESTOS document preview 
						
                                
Preview

                                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.

DAVIDR. DONADIO, ESQ. (Bar # 154436) (415) 898-1555
BRAYTON*PURCELL LLP FAXNO.
222 Rush Landing Road (415) 898-1247

Novato, Califone; 9¢ 94948-6169

ATTORNEY FOR (mame), Plaintiff(s)

ELECTRONICALLY
FILED

Superior Court of California,

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN FRANCISCO
400 McAllister Street

STREET ADDRESS.
MAILING ADDRESS:
ciry anpzi cove. San Francisco 94102
BRANCH NAME:

PLAINTIFF RODRICK BRECKLER and JOANN BRECKLER
DEFENDANT: ASBESTOS DEFENDANTS (B%P)

STATEMENT OF DAMAGES

County of San Francisco

OCT 28 2009
GORDON PARK-LI, Cler|
BY: YOLANDA TABO-RAMI
Deputy Clerk

AR

‘CASE NUMBER

(Personal Injury or Wrongful Death) 274566

To (name of one defendant only): CRAFTSMAN ELEVATORS, INC.

Plaintitt (name of one plaintiff only); RODRICK BRECKLER

seeks damages in the above-entitled action, as follows:

1. General damages AMOUNT
a & Pain, suffering, and inconvenience ©2220. e even eee $__ 500,000.00
b, & Emotional distress nce ee ede ccd beeen eee $ __ 250,060.00
c. Oo Loss ofconsortium 206.6 e te terete nee enenene $ ee
d. O Loss of society and companionship(wrongful death actions only) oe eee ee $
a O Other (specify) $ ee
f. O Other (specify) $ enna
g. O Continued on Attachment 1.g.

2. Special damages
a bl Medical expenses (to date) $100,000.00
b. Xl Future medical expenses (present value) $ __.100.900.00
©. O Loss of earnings (f0 date) oe ete eee eee $
d, fl Loss of future earning capacity (present value) 6. tte eee eee eens $ _1,000,000.00
e. Oo Property damage oe cee cece nee e ett ete eset tebe bb ida te eenees $
f. Oo Funeral expenses (wrongful death actions only) $
g. Oo Future contributions (present value) (wrongful death actions only} $
h. 0 Value of personal service, advice, or training (wrongful death actions only)... 0.0. 6. ee $
, B Other (specify) LOSS OF HOUSEHOLD SERVICES 2.0.0.6... e eee c eee ceee $ 50,000.00
i C1 other (specify) 266 eee cece ee eee eee tees $
k. Oo Continued on Attachment 2.k,

3. & Punitive damages: Plaintiff reserves the right to seek punitive damages in the amount of (specify} ...... $ _5,000,000.00

when pursuing a judgment in the suit filed against you.
Date:
idR. D >
(TYPE OR PRINT NAME}
(Proof of service on reverse)
STATEMENT OF DAMAGES
(Personal Injury or Wrongful Death)

Form Adonted for Mandalary Use
Judieial Counc! of California
Civ-050 [Rev. January 1, 2007]

(SIGNATURE OF PLAINTIFF OR ATTORNEY FOR PLAINTIFF)

‘Gods of Civil Procedure, §§ 425.11,425 115
Si courtintace-goe

LexisNexis® Automated California Judicial Councif Forms