Miscellaneous: D'Ambra, Sr., Vincent et al vs. DP23 Bulldogs LLC., et al

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                                DOCKET NUMBER                  Trial Court of Massachusetts
          CIVIL ACTION COVER SHEET                                                        The Superior Court
                                                                                         COUNTY      WORCESTER
             Vincent D'Ambra, Lisa D'Ambra Individually and as
     Plaintiff                                                               Defendant:  DP23 Bulldogs, LLC., & Daniel Plourde
     ADDRESS:  next friend of Morgan, Charlotte, Lucy, & Vincent Jr.         ADDRESS:   5 Quoaboag Street, Brookfield, MA
              15 Robin Way, Meredith,NH

                     Kelsey Raycroft Rose
     Plaintiff Attorney:                                                     Defendant Attorney:

     ADDRESS: Morgan & Morgan P.A.                                           ADDRESS:

              One State Street, 7th Floor
              Boston, MA 02109
     BBO: 692102                                                             BBO:

                                       TYPE OF ACTION AND TRACK DESIGNATION (see instructions section below)
            CODE NO.                      TYPE OF ACTION (specify)                     TRACK           HAS A JURY CLAIM BEEN MADE?
              B04                   Other Negligence - Personal Injury             F-Fast Track         X   YES          NO
     *If "Other" please describe:
                             Is there a claim under G.L. c. 93A?                            Is there a class action under Mass. R. Civ. P. 23?
                                    YES      X   NO                                                YES      X   NO
                                                STATEMENT OF DAMAGES PURSUANT TO G.L. c. 212, § 3A

     The following is a full, itemized and detailed statement of the facts on which the undersigned plaintiff or plaintiff's counsel relies to determine money damages.
     For this form, disregard double or treble damage claims; indicate single damages only.
                                                                      TORT CLAIMS
     A. Documented medical expenses to date
              1. Total hospital expenses                                                                           $1,500,000.00 (ongoing)
              2. Total doctor expenses
              3. Total chiropractic expenses
              4. Total physical therapy expenses
              5. Total other expenses (describe below)


                                                                                          Subtotal (1-5):  $1,500,000.00
     B. Documented lost wages and compensation to date                                                            $225,000.00 (ongoing)
     C. Documented property damages to date
     D. Reasonably anticipated future medical and hospital expenses                                                 $5,000,000.00
     E. Reasonably anticipated lost wages                                                                             $750,000.00
     F. Other documented items of damages (describe below)                                                         $10,000.00
       Pain & Suffering, Loss of function, Loss of enjoyment, Loss of consortium x5
                                                                                           TOTAL (A-F):   $17,475,000.00
     G. Briefly describe plaintiff's injury, including the nature and extent of injury:
        Permanent paralysis due to hyperextension and fractures of the cervical spine, head injury.
                                                                   CONTRACT CLAIMS
           This action includes a claim involving collection of a debt incurred pursuant to a revolving credit agreement. Mass. R. Civ. P. 8.1(a).
         Item #                                        Detailed Description of Each Claim                                        Amount
         1.
                                                                                                                     Total



     Signature of Attorney/Unrepresented Plaintiff: X                                                               Date:  08/31/21
     RELATED ACTIONS: Please provide the case number, case name, and county of any related actions pending in the Superior Court.


                                                     CERTIFICATION PURSUANT TO SJC RULE 1:18
       I hereby certify that I have complied with requirements of Rule 5 of the Supreme Judicial Court Uniform Rules on Dispute Resolution (SJC Rule 1:18) requiring that I provide my
       clients with information about court-connected dispute resolution services and discuss with them the advantages and disadvantages of the various methods of dispute resolution.

     Signature of Attorney/Unrepresented Plaintiff: X                                                               Date: 08/31/21

       SC0001: 1/22/2021                                     www.mass.gov/courts                                  Date/Time Printed:07-08-2021 15:39:55