SUPERIOR COURT OF THE STATE
COUNTY OF ________
- [PLAINTIFF(S) NAMES]
- [DEFENDANT(S) NAMES]
- CASE NO: _______
- COMPLAINT FOR
- DAMAGES FOR NEGLIGENCE
Plaintiff complains and for causes of
action alleges as follows:
1. Plaintiff, __________ [name], is
an individual and is now,and at all times mentioned in this complaint
was, a resident of __________ County, California.
2. Defendant, __________ [name], is
an individual and is now, and at all times mentioned in this
complaint was, a resident of __________ County, California.
3. The true names and capacities, whether
individual, corporate, associate, or otherwise, of defendants
DOES 1 through 50, inclusive, are unknown to plaintiff at this
time. Plaintiff sues those defendants by such fictitious names
pursuant to Code of Civil Procedure section 474 and will amend
this complaint to show their true names and capacities when they
have been ascertained. Plaintiff is informed and believes, and
based on that information and belief alleges, that each of the
defendants designated as a DOE is negligently or otherwise legally
responsible for the events and happenings referred to in this
complaint, and negligently or otherwise unlawfully caused the
injuries and damages to plaintiff alleged in this complaint.
4. Plaintiff is informed and believes,
and based on that information and belief alleges, that at all
times mentioned in this complaint, defendants were the agents
and employees of their codefendants, and in doing the things
alleged in this complaint were acting within the course and scope
of such agency and employment.
5. On __________ [date of injury], and
at all times mentioned in this complaint, plaintiff and plaintiff's
spouse were husband and wife.
6. __________ [Specify facts showing
that defendant owed a duty, such as the duty of reasonable care,
to plaintiff's spouse at the time of the injury.]
7. On __________ [date], __________
[name of plaintiff's spouse] was injured __________ [physically
or mentally] when __________ [describe defendant's negligent
conduct which injured spouse, for example: defendant negligently
and carelessly drove __________ (his or her) automobile in the
wrong direction on a one- way street and struck the oncoming
car of plaintiff's spouse].
8. As a direct and proximate result
of defendant's negligent conduct, plaintiff's spouse suffered
__________ [describe injuries in detail, for example: spinal
cord injuries which caused __________ (him or her) to become
completely paralyzed from the mid-chest down and in one arm].
9. Before suffering these injuries,
plaintiff's spouse was able to and did perform all the duties
of a __________ [husband or wife] and did perform all these duties,
including assisting in maintaining the home, and providing love,
companionship, affection, society, sexual relations, moral support,
and solace to plaintiff. __________ [Specify any particular duties
the injured spouse performed which he or she is now unable to
perform.] As a direct and proximate result of the injuries, plaintiff's
spouse@ has been unable to perform the duties of a __________
[husband or wife] in that __________ [specify duties injured
spouse can no longer perform, forexample: __________ (__________
(he or she) can no longer assist with housework, have sexual
intercourse, __________ (become pregnant and bear a child or
father a child), participate in family, recreational, or social
activities with plaintiff, or contribute to the household income.
Due to the nature of the injuries sustained by plaintiff's spouse
and the severe physicaland psychological strains they cause __________
(him or her), plaintiff's spouse is no longer able to provide
plaintiff with love, companionship, affection, society, moral
support, andsolace.)] Because of these injuries, plaintiff's
spouse will be unable to perform these duties in the future.
Plaintiff is therefore deprived and will be permanently deprived
of __________ [his or her] spouse's consortium, all to plaintiff's
damage, in a total amount to be established by proof at trial.
WHEREFORE, plaintiff requests judgment
against defendants, and
each of them, for the following:
1. General damages according to proof;
2. Special damages according to proof;
3. Prejudgment interest according to
4. Costs of suit; and
5. Any other and further relief that
the court considers
I, ___, am a ___in the above-entitled
action. I have read the foregoing ___and know the contents
thereof. The same is true of my own knowledge, except as to those
matters which are therein alleged on information and belief,
and as to those matters, I believe it to be true.
I declare under penalty of perjury that
the foregoing is true and correct and that this declaration was
executed at Long Beach, California.
DATED: _________________ ___________________________________