Kinsey Law Offices 
Complaint For Negligence (Premises Liability)
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    ((Name, Address Of Party or attorney)
    ____________
    ____________
    ____________
    State Bar No: ______
    (____) _____ - ________
    Attorney for _______ (Or "In Pro Per")

 

SUPERIOR COURT OF THE STATE OF CALIFORNIA

COUNTY OF ________

 

[PLAINTIFF(S) NAMES]
Plaintiffs,

 

v.
 
[DEFENDANT(S) NAMES]
Defendants
 
 
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CASE NO: _______
 
COMPLAINT 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 __________ [store] is now, and at all times
mentioned in this complaint was, a corporation organized and
existing under the laws of the State of California, with its
place of business in __________ County, California.

3. Plaintiff does not know the true names of defendants
DOES 1 through __, inclusive, and therefore sues them by those
fictitious names. __________ [Optionally, in addition to
language in charging allegations that includes fictitiously
named defendants: Plaintiff is informed and believes, and on
the basis of that information and belief alleges, that each of
those defendants was in some manner negligently and proximately
responsible for the events and happenings alleged in this
complaint and for plaintiff's injuries and damages.]

4. Plaintiff is informed and believes, and on the basis of
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 that agency
and employment.

5. At all times mentioned in this complaint, defendant
__________ [store] and defendants DOES 1 through 50 owned and
operated a __________ [grocery or as the case may be] store
known as __________ [store name], located at __________
[address], __________ [city], __________ County, California.
Defendants invited the general public, including plaintiff, to
enter the premises of the __________ [grocery or as the case may
be] store and to purchase various __________ [food or as the
case may be] items from defendants.

6. On __________ [date], at approximately __________
[time], __________ [describe incident, such as: plaintiff was
on the premises of defendants' grocery store for the purpose of
purchasing groceries. After entering the store, plaintiff
proceeded to the produce aisle when suddenly and without warning
plaintiff slipped on an unknown substance and fell violently to
the floor, causing plaintiff to sustain the serious injuries and
damages described below].

7. Defendants, as owners and operators of a __________
[grocery or as the case may be] store negligently:

a. Failed to maintain the floor of the __________
[grocery or as the case may be] store in a reasonably safe
condition;

b. Allowed a slippery substance to come into contact
with and remain on the floor of the __________ [grocery or as
the case may be] store when defendant knew, or in the exercise
of reasonable care should have known, that the substance created
an unreasonable risk of harm to customers in the store;

c. Failed to warn plaintiff of the danger presented
by the presence of the slippery substance on the floor;

d. Failed to install a nonslip surface on the floor
of the store; and

e. Failed to otherwise exercise due care with respect
to the matters alleged in this complaint.

8. As a direct and proximate result of the negligence of
defendants as set forth above, plaintiff slipped and fell while
in the store.

9. As a further direct and proximate result of the
negligence of defendants as set forth above, plaintiff sustained
the following serious injuries and damages: __________ [set
forth injuries and damages in detail, including medical
expenses, lost wages, pain and suffering, and physical
injuries].

WHEREFORE, plaintiff demands judgment against defendants,
and each of them, for the following:

1. General damages according to proof;

2. __________ [Specify special damages, for example:
Damages for medical and related expenses according to proof;

3. Damages for loss of earnings according to proof;]

4. __________ [Specify any other relief sought;]

5. Interest according to law;

6. Costs of this action; and

7. Any other and further relief that the court considers
proper.

 

 DATED: _______________  __________________________________________
   (Signature)

VERIFICATION

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: _________________ ___________________________________

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