arrow left
arrow right
  • ROBERT ROSS et al VS. C.C. MOORE & CO. ENGINEERS ASBESTOS document preview
  • ROBERT ROSS et al VS. C.C. MOORE & CO. ENGINEERS 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 GR PARTY WITHOUT ATTORNEY (Name and Address): ‘TELEPHONE NO. DAVID R. DONADIO, ESQ. (Bar # 1 54436) (415) 898-1555 BRAYTON*PURCELL LL] FAX NO. 222 Rush Landing Road (415) 898-1247 ELECTRONICALLY Novato, California 94948-6169 ATTORNEY FOR (name): Plaintiff(s) SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN FRANCISCO streerappress: 400 McAllister Street MAILING ADDRESS: cry anozipcove: San Francisco 94102 BRANCH NAME. FILED Superior Court of California, County of San Francisco APR 05 2012 Clerk of the Court BY: EDNALEEN JAVIER PLAINTIFF: | ROBERT ROSS and JEAN ROSS Deputy Clen DEFENDANT: C.C. MOORE & CO. ENGINEERS, et al. STATEMENT OF DAMAGES re tn (Personal Injury or Wrongful Death) CGC-10-275731 To (name of one defendant only): MIDSTATE MECHANICAL, INC. Plaintiff (name of one plaintiff only}: JEAN ROSS seeks damages in the above-entitled action, as follows: 1. General damages. AMOUNT a. (1 pain, suffering, and inconvenience 00.0.0... ecco occ e cece cece cece eee eevee ene $ b. C1 Emotional distress c. & Loss of consortium d. Oo Less of society and companionship(wrongful death actions only) $ e. C1 otter (specify) o.oo eee cece tee e eee e ee ee eee ceeteeeeeeseees $ t 0 other (specity) oo... eect cece e eee e eet e ete ete ee ee need $ g. o Continued on Attachment 1.g. 2. Special damages a O Medical expenses (fo date) 6... cece ence ete eter nett e eee enenees $ b. oO Future medical expenses (present value} $ c oO Loss of earnings (to date) .... $ d. oO Loss of future earning capacity (present value) $ e oO Property damage... ee eee eee $ f oO Funeral expenses (wrongful death actions only) $ g. ao Future contributions (present value) (wrongful death actions only) $ h. o Value of personal service, advice, or training (wrongful death actions only} $ i 1 other (specify) ooo oe cece cc ccc cc eec eee eeeseseveeeserseneeeseereeeees $ i o Other (specify) 6. eee eee eee beet e eee $ k. (1 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: November 21, 2011 David R. Donadio » . (TYPE OR PRINT NAME} {SIGNATURE OF PLAINTIFF OR ATTORNEY FOR PLAINTIFF) (Proof of service on reverse) Form Adopted for Mandatory Uso STATEMENT OF DAMAGES Cort ot Cit Procedure, G5 425,11, 425.115 (CWV-060 Rov. January 1, 2007) {Personal injury or Wrongful Death) won court. ci gov LexisNexis® Automated California Judicial Council Forms