Orange — Civil Complaint - Personal Injury Complaint

Source: https://www.occourts.org/system/files/selfhelp/shc-civ-02.pdf

SUPERIOR COURT OF CALIFORNIA Self-Help Services COUNTY OF ORANGE www.occourts.org/self-help

CIVIL COMPLAINT - PERSONAL INJURY

SELF-HELP FORM PACKET

SHC-CIV-02 (Rev. 07/01/2026)

Self-Help Services can review your completed forms before you file them with the Court. To request review of your completed forms, visit your nearest Self-Help Center location: • Central Justice Center: 700 Civic Center Drive West, Santa Ana, 92701 • Costa Mesa Justice Complex: 3390 Harbor Blvd., Costa Mesa, 92626 • Harbor Justice Center: 4601 Jamboree Road, Newport Beach, 92660 • Lamoreaux Justice Center: 341 The City Drive South, Orange 92868 • North Justice Center: 1275 N. Berkeley Ave., Fullerton, 92832 • Stephen K. Tamura - West Justice Center: 8141 13th St., Westminster, 92683

www.occourts.org/self-help

SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE CIVIL CASE TIME SCHEDULE

UNLIMITED (OVER $ 5,000)

Day Event Comment Authority 1 Complaint filed with Civil Case Cover Sheet Judicial Officer is assigned for all purposes. SCOC rule 303 CRC 3.220

Varies Request for Entry of Default filed. 10 days after expiration of response time. CRC 3.110(g)

Varies Deadline for filing responsive pleading Parties may stipulate to 15 day extension. CRC 3.110

Varies Service of cross-complaint that names new Proof of service filed within 30 days of filing of cross- CRC 3.110(c) parties complaint.

60 Deadline for filing proof(s) of service on the Failure to meet deadline may result in the court CRC 3.110(b) complaint. scheduling an Order to Show Cause Hearing.

Varies Meet and Confer Parties must meet and confer within 20 days after SCOC rule 315 service of the responsive pleading. Joint Meet and CRC 3.724 Confer Statement (local form #L-964) must be filed within 30 days after service of the responsive pleading.

Anytime Stipulation to Arbitration, Mediation, or Early SCOC rule 360 Neutral Evaluation

180 Deadline for Case Management Conference Court must give minimum of 45 days notice. CRC 3.722(b) and Case Management Order Parties must file Case Management Statement 15 SCOC rule 317 calendar days prior to hearing (Judicial Council Form CRC 3.725(a) #CM-110).

Varies Mandatory Settlement Conference May be scheduled at the Case Management SCOC rule 316 Conference. Settlement Conference Statement (local form #L-52) lodged 5 court days prior to Mandatory Settlement Conference.

10 days Issue Conference and trial related documents Counsel required to meet and confer. Statement of SCOC rule 317 prior to Compliance and trial related documents (local form trial #L-81) submitted by noon, Friday prior to trial.

LIMITED ($ 5,000 OR LESS)

1 Complaint filed with Civil Case Cover Sheet CRC 3.220

Varies Request for Entry of Default filed. 10 days after expiration of response time. CRC 3.110(g)

Varies Deadline for filing responsive pleading Parties may stipulate to 15 day extension. CRC 3.110

Varies Service of cross-complaint that names new Proof of service filed within 30 days of filing of cross- CRC 3.110(c) parties. complaint.

Varies File At-Issue Memorandum For Trial Setting May be filed when the case is at issue any time SCOC rule 339 (local form #L-31) before the Case Management Conference. Case Management Conference will be taken off calendar.

60 Deadline for filing proof(s) of service on the Failure to meet deadline may result in the court CRC 3.110(b) complaint scheduling an Order to Show Cause Hearing.

Varies Meet and Confer Parties must meet no later than 30 calendar days CRC 3.724 before the Case Management Conference.

180 Deadline for Case Management Conference Court must give minimum of 45 days notice. CRC 3.722(b) and Case Management Order Parties must file Case Management Statement 15 SCOC rule 321 calendar days prior to hearing (Judicial Council Form CRC 3.725(a) #CM-110).

Varies Pretrial Settlement Conference May be set by the court when jury trial or court trial is SCOC rule 332 estimated to last one day or more. Parties must submit a Pretrial Conference Brief/Statement at the time of the conference.

Note: Superior Court of Orange County is abbreviated as “SCOC” Information CIVIL CASE TIME SCHEDULE L-1009 (Rev. )

CM-010 ATTORNEY OR PARTY WITHOUT ATTORNEY STATE BAR NUMBER: FOR COURT USE ONLY NAME:

FIRM NAME:

STREET ADDRESS:

CITY: STATE: ZIP CODE:

TELEPHONE NO.: FAX NO.:

EMAIL ADDRESS:

ATTORNEY FOR (name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

CASE NAME:

CIVIL CASE COVER SHEET Complex Case Designation CASE NUMBER:
Unlimited Limited Counter Joinder
(Amount (Amount

demanded demanded is Filed with first appearance by defendant JUDGE: exceeds $35,000) $35,000 or less) (Cal. Rules of Court, rule 3.402) DEPT.:

Items 1–6 below must be completed (see instructions on page 2 and examples on page 3).

1. Check one box below for the case type that best describes this case:

Auto Tort Contract Provisionally Complex Civil Litigation Auto (22) Breach of contract/warranty (06) (Cal. Rules of Court, rules 3.400–3.404) Uninsured motorist (46) Song-Beverly Act: Motor Vehicle Antitrust/Trade regulation (03) Lemon Law (49) Asbestos Construction defect (10) Rule 3.740 collections (09) Asbestos (04) Mass tort (40) Other collections (09) Securities litigation (28) Other PI/PD/WD (Personal Injury/Property Insurance coverage (18) Environmental/Toxic tort (30) Damage/Wrongful Death) Tort Other contract (37) Comprehensive groundwater adjudication (47) Product liability (24) Real Property Insurance coverage claims arising from the Medical malpractice (45) Eminent domain/Inverse above listed provisionally complex case types Other PI/PD/WD (23) condemnation (14) (41) Wrongful eviction (33) Non-PI/PD/WD (Other) Tort Enforcement of Judgment Other real property (26) Business tort/Unfair business practice (07) Enforcement of judgment (20) Unlawful Detainer Civil rights (08) Commercial (31) Miscellaneous Civil Complaint Defamation (13) Residential (32) RICO (27) Fraud (16) Drugs (38) Other complaint (not specified above) (42) Intellectual property (19) Judicial Review Miscellaneous Civil Petition Professional negligence (25) Asset forfeiture (05) Other non-PI/PD/WD tort (35) Partnership and corporate governance (21) Petition re arbitration award (11) Employment Other petition (not specified above) (43) Writ of mandate (02) Wrongful termination (36) Other judicial review (39) Other employment (15) Employment Development Department (EDD)

EDD decision review (48)

Judicial Council of California, courts.ca.gov Rev. July 1, 2026, Mandatory Form Civil Case Cover Sheet CM-010, Page 1 of 3 Cal. Rules of Court, rules 2.30, 3.220, 3.400–3.403, 3.740 Cal. Stds. Jud. Admin., std. 3.10

CM-010 2. Is this case complex under rule 3.400 of the California Rules of Court? Yes No If the case is complex, mark the factors requiring exceptional judicial management:

a. Large number of separately represented parties
b. Extensive motion practice raising difficult or novel issues that will be time-consuming to resolve
c. Substantial amount of documentary evidence
d. Large number of witnesses
e. Coordination with related actions pending in one or more courts in other counties, states, or countries, or in a federal court
f. Substantial postjudgment judicial supervision

3. Remedies sought (check all that apply): a. monetary

   b. nonmonetary; declaratory or injunctive relief

   c. punitive

4. Number of causes of action (specify):

5. Is this case a class action suit? Yes No

6. If there are any known related cases, file and serve a notice of related case. (You may use form CM-015.)

Date:

Type or print name Signature of party or attorney for party

NOTICE

Plaintiff must file this cover sheet with the first paper filed in the action or proceeding (except small claims cases or cases filed under the Probate

Code, Family Code, or Welfare and Institutions Code). (Cal. Rules of Court, rule 3.220.) Failure to file may result in sanctions.

File this cover sheet in addition to any cover sheet required by local court rule.

If this case is complex under rule 3.400 et seq. of the California Rules of Court, or a collections case under rule 3.740, you must serve a copy of this cover sheet on all other parties to the action or proceeding. (Cal. Rules of Court, rule 3.220.)

Unless this is a collections case under rule 3.740 or a complex case, this cover sheet will be used for statistical purposes only.

INSTRUCTIONS ON HOW TO COMPLETE THE COVER SHEET

To Plaintiffs and Others Filing First Papers. If you are filing a first paper (for example, a complaint) in a civil case, you must complete and file, along with your first paper, the Civil Case Cover Sheet contained on pages 1 and 2. This information will be used to compile statistics about the types and numbers of cases filed. You must complete items 1 through 6 on the sheet. In item 1, you must check one box for the case type that best describes the case. If the case fits both a general and a more specific type of case listed in item 1, check the more specific one. If the case has multiple causes of action, check the box that best indicates the primary cause of action. To assist you in completing the sheet, examples of the cases that belong under each case type in item 1 are provided on page 3 of this form. A cover sheet must be filed only with your initial paper. Failure to file a cover sheet with the first paper filed in a civil case may subject a party, its counsel, or both to sanctions under rules 2.30 and 3.220 of the California Rules of Court. To Parties in Rule 3.740 Collections Cases. A "collections case" under rule 3.740 of the California Rules of Court is defined as an action for recovery of money owed in a sum stated to be certain that is not more than $35,000, exclusive of interest and attorney's fees, arising from a transaction in which property, services, or money was acquired on credit. A collections case does not include an action seeking the following: (1) tort damages, (2) punitive damages, (3) recovery of real property, (4) recovery of personal property, or (5) a prejudgment writ of attachment. The identification of a case as a rule 3.740 collections case on this form means that it will be exempt from the general time-for-service requirements and case management rules, unless a defendant files a responsive pleading. A rule 3.740 collections case will be subject to the requirements for service and obtaining a judgment in rule 3.740. To Parties in Complex Cases. In complex cases only, parties must also use the Civil Case Cover Sheet to designate whether the case is complex. If a plaintiff believes the case is complex under rule 3.400 of the California Rules of Court, this must be indicated by completing the appropriate boxes in items 1 and 2. If a plaintiff designates a case as complex, the cover sheet must be served with the complaint on all parties to the action. A defendant may file and serve no later than the time of its first appearance a joinder in the plaintiff's designation, a counter-designation that the case is not complex, or, if the plaintiff has made no designation, a designation that the case is complex. SEE PAGE 3 FOR INFORMATION PURPOSES ONLY.

Rev. July 1, 2026 Civil Case Cover Sheet CM-010, Page 2 of 3

CM-010

CASE TYPES AND EXAMPLES

The list below provides explanations and examples for the case type checkboxes listed in item 1 on this form. The lists of examples below are not meant to be exhaustive, and some case types may have causes of action not listed here.

Auto Tort Contract Provisionally Complex Civil Litigation (Cal. Auto (22)–Personal Injury/Property Damage/ Breach of Contract/Warranty (06) Rules of Court, rules 3.400–3.404) Wrongful Death Breach of Rental/Lease Contract (not Antitrust/Trade Regulation (03) Uninsured Motorist (if the case involves an unlawful detainer or wrongful eviction) Construction Defect (10) uninsured motorist claim subject to Contract/Warranty Breach–Seller Plaintiff Mass Tort (40) arbitration, check this item instead of Auto) (not fraud) Securities Litigation (28) (46) Negligent Breach of Contract/Warranty Environmental/Toxic Tort (30) Other Breach of Contract/Warranty Comprehensive Groundwater Adjudication Asbestos Song-Beverly Act: Motor Vehicle Lemon Law (47) Asbestos (04) (check this item if the case involves a Song- Insurance Coverage Claims (arising from Asbestos Property Damage Beverly Act claim regarding a motor provisionally complex case type listed Asbestos Personal Injury/Wrongful Death vehicle) (49) above) (41) Other PI/PD/WD (Personal Injury/ Rule 3.740 Collections (as defined in Cal. Enforcement of Judgment Property Damage/Wrongful Death) Tort Rules of Court, rule 3.740(a)) (09) Enforcement of Judgment (20) Product Liability (not asbestos or Other Collections (e.g., money owed, open Abstract of Judgment (Out of County) environmental/toxic tort) (24) book accounts, promissory note) (09) Confession of Judgment (non-domestic Medical Malpractice (45) Insurance Coverage (not provisionally relations) Medical Malpractice–Physicians & complex) (18) Sister-State Judgment Surgeons Auto Subrogation Administrative Agency Award Other Professional Health Care Other Coverage Petition/Certification of Entry of Judgment Malpractice Other Contract (37) on Unpaid Taxes Other PI/PD/WD (23) Contractual Fraud Other Enforcement of Judgment Case Premises Liability (e.g., slip and fall) Other Contract Dispute Intentional Bodily Injury/PD/WD (e.g., Miscellaneous Civil Complaint Real Property assault, vandalism) RICO (27) Eminent Domain/Inverse Condemnation (14) Intentional Infliction of Emotional Distress Other Complaint (not specified above) (42) Wrongful Eviction (33) Negligent Infliction of Emotional Distress Declaratory Relief Only Other Real Property (e.g., quiet title) (26) Other PI/PD/WD Injunctive Relief Only (non-harassment) Writ of Possession of Real Property Mechanic's Lien Non-PI/PD/WD (Other) Tort Mortgage Foreclosure Other Commercial Complaint Case Business Tort/Unfair Business Practice (07) Quiet Title (non-tort/non-complex) Civil Rights (e.g., discrimination, false arrest) Other Real Property (not unlawful Other Civil Complaint (non-tort/ (not civil harassment) (08) detainer) non-complex) Defamation (e.g., slander, libel) (13) Unlawful Detainer Fraud (other than contract) (16) Mis

Complaint (non-tort/ (not civil harassment) (08) detainer) non-complex) Defamation (e.g., slander, libel) (13) Unlawful Detainer Fraud (other than contract) (16) Miscellaneous Civil Petition Commercial (31) Intellectual Property (19) Partnership and Corporate Governance (21) Residential (32) Professional Negligence (25) Other Petition (not specified above) (43) Drugs (if the case involves illegal drugs, check Legal Malpractice Civil Harassment this item; otherwise, choose Commercial or Other Professional Malpractice Workplace Violence Residential) (38) (not medical) Elder/Dependent Adult Abuse Other Non-PI/PD/WD Tort (35) Judicial Review Election Contest Asset Forfeiture (05) Petition for Name Change Employment Petition re Arbitration Award (11) Petition for Relief From Government Wrongful Termination (36) Writ of Mandate (02) Claim Requirement Other Employment (15) Writ–Administrative Mandamus Other Civil Petition Writ–Mandamus on Limited Court Case Matter Writ–Other Limited Court Case Review Other Judicial Review (39) Review of Health Officer Order Notice of Appeal–Labor Commissioner Appeals

Employment Development Department (EDD)

EDD Decision Review (if the case involves an Employment Development Department decision, check this item instead of wrongful termination or other employment) (48)

Rev. July 1, 2026 Civil Case Cover Sheet CM-010, Page 3 of 3

SUM-100 SUMMONS FOR COURT USE ONLY (CITACION JUDICIAL) (SOLO PARA USO DE LA CORTE)

NOTICE TO DEFENDANT: (AVISO AL DEMANDADO):

YOU ARE BEING SUED BY PLAINTIFF: (LO ESTÁ DEMANDANDO EL DEMANDANTE):

NOTICE! You have been sued. The court may decide against you without your being heard unless you respond within 30 days. Read the information below. You have 30 CALENDAR DAYS after this summons and legal papers are served on you to file a written response at this court and have a copy served on the plaintiff. A letter or phone call will not protect you. Your written response must be in proper legal form if you want the court to hear your case. There may be a court form that you can use for your response. You can find these court forms and more information at the California Courts Online Self-Help Center (www.courtinfo.ca.gov/selfhelp), your county law library, or the courthouse nearest you. If you cannot pay the filing fee, ask the court clerk for a fee waiver form. If you do not file your response on time, you may lose the case by default, and your wages, money, and property may be taken without further warning from the court. There are other legal requirements. You may want to call an attorney right away. If you do not know an attorney, you may want to call an attorney referral service. If you cannot afford an attorney, you may be eligible for free legal services from a nonprofit legal services program. You can locate these nonprofit groups at the California Legal Services Web site (www.lawhelpcalifornia.org), the California Courts Online Self-Help Center (www.courtinfo.ca.gov/selfhelp), or by contacting your local court or county bar association. NOTE: The court has a statutory lien for waived fees and costs on any settlement or arbitration award of $10,000 or more in a civil case. The court's lien must be paid before the court will dismiss the case. ¡AVISO! Lo han demandado. Si no responde dentro de 30 días, la corte puede decidir en su contra sin escuchar su versión. Lea la información a continuación. Tiene 30 DÍAS DE CALENDARIO después de que le entreguen esta citación y papeles legales para presentar una respuesta por escrito en esta corte y hacer que se entregue una copia al demandante. Una carta o una llamada telefónica no lo protegen. Su respuesta por escrito tiene que estar en formato legal correcto si desea que procesen su caso en la corte. Es posible que haya un formulario que usted pueda usar para su respuesta. Puede encontrar estos formularios de la corte y más información en el Centro de Ayuda de las Cortes de California (www.sucorte.ca.gov), en la biblioteca de leyes de su condado o en la corte que le quede más cerca. Si no puede pagar la cuota de presentación, pida al secretario de la corte que le dé un formulario de exención de pago de cuotas. Si no presenta su respuesta a tiempo, puede perder el caso por incumplimiento y la corte le podrá quitar su sueldo, dinero y bienes sin más advertencia. Hay otros requisitos legales. Es recomendable que llame a un abogado inmediatamente. Si no conoce a un abogado, puede llamar a un servicio de remisión a abogados. Si no puede pagar a un abogado, es posible que cumpla con los requisitos para obtener servicios legales gratuitos de un programa de servicios legales sin fines de lucro. Puede encontrar estos grupos sin fines de lucro en el sitio web de California Legal Services, (www.lawhelpcalifornia.org), en el Centro de Ayuda de las Cortes de California, (www.sucorte.ca.gov) o poniéndose en contacto con la corte o el colegio de abogados locales. AVISO: Por ley, la corte tiene derecho a reclamar las cuotas y los costos exentos por imponer un gravamen sobre cualquier recuperación de $10,000 ó más de valor recibida mediante un acuerdo o una concesión de arbitraje en un caso de derecho civil. Tiene que pagar el gravamen de la corte antes de que la corte pueda desechar el caso. The name and address of the court is: CASE NUMBER: (Número del Caso): (El nombre y dirección de la corte es):

The name, address, and telephone number of plaintiff's attorney, or plaintiff without an attorney, is: (El nombre, la dirección y el número de teléfono del abogado del demandante, o del demandante que no tiene abogado, es):

DATE: Clerk, by , Deputy (Fecha) (Secretario) (Adjunto) (For proof of service of this summons, use Proof of Service of Summons (form POS-010).) (Para prueba de entrega de esta citatión use el formulario Proof of Service of Summons, (POS-010)). NOTICE TO THE PERSON SERVED: You are served [SEAL] 1. as an individual defendant. 2. as the person sued under the fictitious name of (specify):

3. on behalf of (specify):

under: CCP 416.10 (corporation) CCP 416.60 (minor)
CCP 416.20 (defunct corporation) CCP 416.70 (conservatee)
CCP 416.40 (association or partnership) CCP 416.90 (authorized person)
other (specify):
4. by personal delivery on (date):

Form Adopted for Mandatory Use SUMMONS Code of Civil Procedure §§ 412.20, 465 Judicial Council of California www.courts.ca.gov SUM-100 [Rev. July 1, 2009]

PLD-PI-001 ATTORNEY OR PARTY WITHOUT ATTORNEY STATE BAR NUMBER: FOR COURT USE ONLY NAME:

FIRM NAME:

STREET ADDRESS:

CITY: STATE: ZIP CODE:

TELEPHONE NO.: FAX NO.:

EMAIL ADDRESS:

ATTORNEY FOR (name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

PLAINTIFF: DEFENDANT: DOES 1 TO

COMPLAINT²Personal Injury, Property Damage, Wrongful Death CASE NUMBER: AMENDED (Number): Type (check all that apply): MOTOR VEHICLE OTHER (specify): Property Damage Wrongful Death Personal Injury Other Damages (specify): Jurisdiction (check all that apply): ACTION IS A LIMITED CIVIL CASE (does not exceed $35,000) Amount demanded does not exceed $10,000 exceeds $10,000 ACTION IS AN UNLIMITED CIVIL CASE (exceeds $35,000) ACTION IS RECLASSIFIED by this amended complaint from limited to unlimited from unlimited to limited

1. Plaintiff (name or names): alleges causes of action against defendant (name or names):

2. This pleading, including attachments and exhibits, consists of the following number of pages:

3. Each plaintiff named above is a competent adult a. except plaintiff (name): (1) a corporation qualified to do business in California. (2) an unincorporated entity (describe): (3) a public entity (describe): (4) a minor an adult (a) for whom a guardian or conservator of the estate or a guardian ad litem has been appointed. (b) other (specify): (5) other (specify): b. except plaintiff (name): (1) a corporation qualified to do business in California. (2) an unincorporated entity (describe): (3) a public entity (describe): (4) a minor an adult (a) for whom a guardian or conservator of the estate or a guardian ad litem has been appointed. (b) other (specify): (5) other (specify): Information about additional plaintiffs who are not competent adults is shown in Attachment 3.

Form Approved for Optional Use COMPLAINT²Personal Injury, Property Code of Civil Procedure, § 425.12 Judicial Council of California www.courts.ca.gov PLD-PI-001 [Rev. January 1, 2024] Damage, Wrongful Death

PLD-PI-001

SHORT TITLE: CASE NUMBER:

4. Plaintiff (name): is doing business under the fictitious name (specify):

   and has complied with the fictitious business name laws.

5. Each defendant named above is a natural person a. except defendant (name): c. except defendant (name): (1) a business organization, form unknown. (1) a business organization, form unknown. (2) a corporation. (2) a corporation. (3) an unincorporated entity (describe): (3) an unincorporated entity (describe): (4) a public entity (describe): (4) a public entity (describe): (5) other (specify): (5) other (specify):

b. except defendant (name): d. except defendant (name): (1) a business organization, form unknown. (1) a business organization, form unknown. (2) a corporation. (2) a corporation. (3) an unincorporated entity (describe): (3) an unincorporated entity (describe):

(4) a public entity (describe): (4) a public entity (describe):

(5) other (specify): (5) other (specify):

Information about additional defendants who are not natural persons is contained in Attachment 5.

6. The true names of defendants sued as Does are unknown to plaintiff. a. Doe defendants (specify Doe numbers): were the agents or employees of other named defendants and acted within the scope of that agency or employment. b. Doe defendants (specify Doe numbers): are persons whose capacities are unknown to plaintiff.

7. Defendants who are joined under Code of Civil Procedure section 382 are (names):

8. This court is the proper court because a. at least one defendant now resides in its jurisdictional area. b. the principal place of business of a defendant corporation or unincorporated association is in its jurisdictional area. c. injury to person or damage to personal property occurred in its jurisdictional area. d. other (specify):

9. Plaintiff is required to comply with a claims statute, and

   a. has complied with applicable claims statutes, or b. is excused from complying because (specify):

PLD-PI-001 [Rev. January 1, 2024] COMPLAINT²Personal Injury, Property Page 2 of 3 Damage, Wrongful Death

PLD-PI-001

SHORT TITLE: CASE NUMBER:

10. The following causes of action are attached and the statements above apply to each (each complaint must have one or more causes of action attached): a. Motor Vehicle b. General Negligence

    c. Intentional Tort d. Products Liability e. Premises Liability f. Other (specify):

11. Plaintiff has suffered (check all that apply) a. wage loss. b. loss of use of property.

    c. hospital and medical expenses. d. general damage. e. property damage. f. loss of earning capacity. g. other damage (specify):

12. The damages claimed for wrongful death and the relationships of plaintiff to the deceased are

    a. listed in Attachment 12. b. as follows:

13. The relief sought in this complaint is within the jurisdiction of this court.

14. Plaintiff prays for judgment for costs of suit; for such relief as is fair, just, and equitable; and for a. (1) compensatory damages. (2) punitive damages. b. The amount of damages is (in cases for personal injury or wrongful death, you must check (1)): (1) according to proof. (2) in the amount of: $

15. The paragraphs of this complaint alleged on information and belief are as follows (specify paragraph numbers):

Date:

(TYPE OR PRINT NAME) (SIGNATURE OF PLAINTIFF OR ATTORNEY)

PLD-PI-001 [Rev. January 1, 2024] COMPLAINT²Personal Injury, Property Page 3 of 3 Damage, Wrongful Death For your protection and privacy, please press the Clear This Form button after you have printed the form. Print this form Save this form Clear this form

PLD-PI-001(1)

SHORT TITLE: CASE NUMBER:

CAUSE OF ACTION—Motor Vehicle (number)

ATTACHMENT TO Complaint Cross-Complaint

(Use a separate cause of action form for each cause of action.)

Plaintiff (name):

MV- 1. Plaintiff alleges the acts of defendants were negligent; the acts were the legal (proximate) cause of injuries and damages to plaintiff; the acts occurred on (date):

at (place):

MV- 2. DEFENDANTS

a. The defendants who operated a motor vehicle are (names):

Does to

b. The defendants who employed the persons who operated a motor vehicle in the course of their employment are
(names):

Does to
c. The defendants who owned the motor vehicle which was operated with their permission are (names):

Does to

d. The defendants who entrusted the motor vehicle are (names):

Does to

e. The defendants who were the agents and employees of the other defendants and acted within the scope of the
agency were (names):

Does to
f. The defendants who are liable to plaintiffs for other reasons and the reasons for the liability are
listed in Attachment MV-2f as follows:

Does to
Page

Form Approved for Optional Judicial Council of California Use CAUSE OF ACTION—Motor Vehicle Code of Civilwww.courts.ca.govProcedure 425.12 PLD-PI-001(1) [Rev. January 1, 2007]

PLD-PI-001(2)

SHORT TITLE: CASE NUMBER:

CAUSE OF ACTION—General Negligence Page
(number)

ATTACHMENT TO Complaint Cross-Complaint

(Use a separate cause of action form for each cause of action.)

GN-1. Plaintiff (name):

alleges that defendant (name):

Does to

was the legal (proximate) cause of damages to plaintiff. By the following acts or omissions to act, defendant
negligently caused the damage to plaintiff

on (date):

at (place):

(description of reasons for liability):

Form Approved for Optional Judicial Council of California Use CAUSE OF ACTION—General Negligence Code of Civilwww.courts.ca.govProcedure 425.12 PLD-PI-001(2) [Rev. January 1, 2007]

PLD-PI-001(3)

SHORT TITLE: CASE NUMBER

CAUSE OF ACTION—lntentional Tort Page
(number)

ATTACHMENT TO Complaint Cross-Complaint

(Use a separate cause of action form for each cause of action.)

IT-1. Plaintiff (name):

alleges that defendant (name):

Does to

was the legal (proximate) cause of damages to plaintiff. By the following acts or omissions to act, defendant intentionally
caused the damage to plaintiff

on (date):

at (place):

(description of reasons for liability):

Form Approved for Optional Use Code of Civil Procedure § 425.12 Judicial Council of California CAUSE OF ACTION—lntentional Tort www.courts.ca.gov PLD-PI-001(3) [Rev. January 1, 2007]

PLD-PI-001(4)

SHORT TITLE: CASE NUMBER:

CAUSE OF ACTION—Premises Liability Page
(number)

ATTACHMENT TO Complaint Cross-Complaint (Use a separate cause of action form for each cause of action.)

Prem.L-1.(name):

alleges the acts of defendants were the legal (proximate) cause of damages to plaintiff.

On (date): plaintiff was injured on the following premises in the following

fashion (description of premises and circumstances of injury):

Prem.L-2. Count One—Negligence The defendants who negligently owned, maintained, managed and operated the described premises were (names):

Does to

Prem.L-3. Count Two—Willful Failure to Warn [Civil Code section 846] The defendant owners who willfully or maliciously failed to guard or warn against a dangerous condition, use, structure, or activity were (names):

Does to
Plaintiff, a recreational user, was an invited guest a paying guest.

Prem.L-4. Count Three—Dangerous Condition of Public Property The defendants who owned public property on which a dangerous condition existed were (names):

Does to
a. The defendant public entity had actual constructive notice of the existence of the
dangerous condition in sufficient time prior to the injury to have corrected it.
b. The condition was created by employees of the defendant public entity.

Prem.L-5.a. Allegations about Other Defendants The defendants who were the agents and employees of the other defendants and acted within the scope of the agency were (names):

Does to
b. The defendants who are liable to plaintiffs for other reasons and the reasons for their liability are
described in attachment Prem.L-5.b as follows (names):

Form Approved for Optional Judicial Council of California PLD- Use CAUSE OF ACTION—Premises Liability Code of Civil Procedure,www.courts.ca.gov§ 425.12 PI-001(4) [Rev. January 1, 2007]

PLD-PI-001(5)

SHORT TITLE: CASE NUMBER:

CAUSE OF ACTION—Products Liability Page
(number)

ATTACHMENT TO Complaint Cross - Complaint
(Use a separate cause of action form for each cause of action.)

Plaintiff (name):

Prod. L-1. On or about (date): plaintiff was injured by the following product:

Prod. L-2. Each of the defendants knew the product would be purchased and used without inspection for defects.
The product was defective when it left the control of each defendant. The product at the time of injury
was being
used in the manner intended by the defendants.
used in the manner that was reasonably foreseeable by defendants as involving a substantial danger not
readily apparent. Adequate warnings of the danger were not given.
Prod. L-3. Plaintiff was a
purchaser of the product. user of the product.
bystander to the use of the product. other (specify):

PLAINTIFF'S INJURY WAS THE LEGAL (PROXIMATE) RESULT OF THE FOLLOWING:
Prod. L- 4. Count One—Strict liability of the following defendants who
a. manufactured or assembled the product (names):

Does to
b. designed and manufactured component parts supplied to the manufacturer (names):

Does to
c. sold the product to the public (names):

Does to
Prod. L-5. Count Two—Negligence of the following defendants who owed a duty to plaintiff (names):

Does to
Prod. L-6. Count Three—Breach of warranty by the following defendants (names):

Does to
a. who breached an implied warranty
b. who breached an express warranty which was
written oral
Prod. L-7. The defendants who are liable to plaintiffs for other reasons and the reasons for the liability are
listed in Attachment-Prod. L-7 as follows:

Form Approved for Optional Use CAUSE OF ACTION—Products Liability Code of Civil Procedure, § 425.12 Judicial Council of California www.courtinfo.ca.gov PLD-PI-001(5) [Rev. January 1, 2007]

SUPERIOR COURT OF CALIFORNIA COUNTY OF ORANGE

ALTERNATIVE DISPUTE RESOLUTION (ADR) INFORMATION PACKAGE

NOTICE TO PLAINTIFF(S) AND/OR CROSS-COMPLAINANT(S):

Rule 3.221(c) of the California Rules of Court requires you to serve a copy of the ADR Information Package along with the complaint and/or cross-complaint.

California Rules of Court – Rule 3.221

Information about Alternative Dispute Resolution (ADR)

(a) Each court shall make available to the plaintiff, at the time of filing of the complaint, an ADR Information Package that includes, at a minimum, all of the following:

(1) General information about the potential advantages and disadvantages of ADR

and descriptions of the principal ADR processes.

(2) Information about the ADR programs available in that court, including citations to

any applicable local court rules and directions for contacting any court staff responsible for providing parties with assistance regarding ADR.

(3) Information about the availability of local dispute resolution programs funded

under the Dispute Resolutions Program Act (DRPA), in counties that are participating in the DRPA. This information may take the form of a list of the applicable programs or directions for contacting the county’s DRPA coordinator.

(4) An ADR stipulation form that parties may use to stipulate to the use of an ADR

process.

(b) A court may make the ADR Information Package available on its website as long as paper copies are also made available in the clerk’s office.

(c) The plaintiff must serve a copy of the ADR Information Package on each defendant along with the complaint. Cross-complainants must serve a copy of the ADR Information Package on any new parties to the action along with the cross-complaint.

L1200 Rev. Dec. 2019 Page 1 of 4

SUPERIOR COURT OF CALIFORNIA COUNTY OF ORANGE

ADR Information

Introduction.

Most civil disputes are resolved without filing a lawsuit, and most civil lawsuits are resolved without a trial. The courts and others offer a variety of Alternative Dispute Resolution (ADR) processes to help people resolve disputes without a trial. ADR is usually less formal, less expensive, and less time-consuming than a trial. ADR can also give people more opportunity to determine when and how their dispute will be resolved.

BENEFITS OF ADR.

Using ADR may have a variety of benefits, depending on the type of ADR process used and the circumstances of the particular case. Some potential benefits of ADR are summarized below.

Save Time. A dispute often can be settled or decided much sooner with ADR; often in a matter of months, even weeks, while bringing a lawsuit to trial can take a year or more.

Save Money. When cases are resolved earlier through ADR, the parties may save some of the money they would have spent on attorney fees, court costs, experts' fees, and other litigation expenses.

Increase Control Over the Process and the Outcome. In ADR, parties typically play a greater role in shaping both the process and its outcome. In most ADR processes, parties have more opportunity to tell their side of the story than they do at trial. Some ADR processes, such as mediation, allow the parties to fashion creative resolutions that are not available in a trial. Other ADR processes, such as arbitration, allow the parties to choose an expert in a particular field to decide the dispute.

Preserve Relationships. ADR can be a less adversarial and hostile way to resolve a dispute. For example, an experienced mediator can help the parties effectively communicate their needs and point of view to the other side. This can be an important advantage where the parties have a relationship to preserve.

Increase Satisfaction. In a trial, there is typically a winner and a loser. The loser is not likely to be happy, and even the winner may not be completely satisfied with the outcome. ADR can help the parties find win-win solutions and achieve their real goals. This, along with all of ADR's other potential advantages, may increase the parties' overall satisfaction with both the dispute resolution process and the outcome.

Improve Attorney-Client Relationships. Attorneys may also benefit from ADR by being seen as problem- solvers rather than combatants. Quick, cost-effective, and satisfying resolutions are likely to produce happier clients and thus generate repeat business from clients and referrals of their friends and associates.

DISADVANTAGES OF ADR.

ADR may not be suitable for every dispute.

Loss of protections. If ADR is binding, the parties normally give up most court protections, including a decision by a judge or jury under formal rules of evidence and procedure, and review for legal error by an appellate court.

L1200 Rev. Dec. 2019 Page 2 of 4

Less discovery. There generally is less opportunity to find out about the other side’s case with ADR than with litigation. ADR may not be effective if it takes place before the parties have sufficient information to resolve the dispute.

Additional costs. The neutral may charge a fee for his or her services. If a dispute is not resolved through ADR, the parties may have to put time and money into both ADR and a lawsuit.

Effect of delays if the dispute is not resolved. Lawsuits must be brought within specified periods of time, known as statues of limitation. Parties must be careful not to let a statute of limitations run out while a dispute is in an ADR process.

TYPES OF ADR IN CIVIL CASES.

The most commonly used ADR processes are arbitration, mediation, neutral evaluation and settlement conferences.

Arbitration. In arbitration, a neutral person called an "arbitrator" hears arguments and evidence from each side and then decides the outcome of the dispute. Arbitration is less formal than a trial, and the rules of evidence are often relaxed. Arbitration may be either "binding" or "nonbinding." Binding arbitration means that the parties waive their right to a trial and agree to accept the arbitrator's decision as final. Generally, there is no right to appeal an arbitrator's decision. Nonbinding arbitration means that the parties are free to request a trial if they do not accept the arbitrator's decision.

Cases for Which Arbitration May Be Appropriate. Arbitration is best for cases where the parties

want another person to decide the outcome of their dispute for them but would like to avoid the formality, time, and expense of a trial. It may also be appropriate for complex matters where the parties want a decision-maker who has training or experience in the subject matter of the dispute.

Cases for Which Arbitration May Not Be Appropriate. If parties want to retain control over how their dispute is resolved, arbitration, particularly binding arbitration, is not appropriate. In binding arbitration, the parties generally cannot appeal the arbitrator's award, even if it is not supported by the evidence or the law. Even in nonbinding arbitration, if a party requests a trial and does not receive a

more favorable result at trial than in arbitration, there may be penalties.

Mediation. In mediation, an impartial person called a "mediator" helps the parties try to reach a mutually acceptable resolution of the dispute. The mediator does not decide the dispute but helps the parties communicate so they can try to settle the dispute themselves. Mediation leaves control of the outcome with the parties.

Cases for Which Mediation May Be Appropriate. Mediation may be particularly useful when parties have a relationship they want to preserve. So when family members, neighbors, or business partners have a dispute, mediation may be the ADR process to use. Mediation is also effective when emotions are getting in the way of resolution. An effective mediator can hear the parties out and help

them communicate with each other in an effective and nondestructive manner.

Cases for Which Mediation May Not Be Appropriate. Mediation may not be effective if one of the parties is unwilling to cooperate or compromise. Mediation also may not be effective if one of the parties has a significant advantage in power over the other. Therefore, it may not be a good choice if the parties have a history of abuse or victimization.

Neutral Evaluation. In neutral evaluation, each party gets a chance to present the case to a neutral person called an "evaluator." The evaluator then gives an opinion on the strengths and weaknesses of each party's evidence and arguments and about how the dispute could be resolved. The evaluator is

L1200 Rev. Dec. 2019 Page 3 of 4

often an expert in the subject matter of the dispute. Although the evaluator's opinion is not binding, the parties typically use it as a basis for trying to negotiate a resolution of the dispute.

Cases for Which Neutral Evaluation May Be Appropriate. Neutral evaluation may be most appropriate in cases in which there are technical issues that require special expertise to resolve or the only significant issue in the case is the amount of damages.

Cases for Which Neutral Evaluation May Not Be Appropriate. Neutral evaluation may not be appropriate when there are significant personal or emotional barriers to resolving the dispute.

Settlement Conferences. Settlement conferences may be either mandatory or voluntary. In both types of settlement conferences, the parties and their attorneys meet with a judge or a neutral person called a "settlement officer" to discuss possible settlement of their dispute. The judge or settlement officer does not make a decision in the case but assists the parties in evaluating the strengths and weaknesses of the case and in negotiating a settlement. Settlement conferences are appropriate in any case where settlement is an option. Mandatory settlement conferences are often held close to the date a case is set for trial.

ADDITIONAL INFORMATION.

In addition to mediation, arbitration, neutral evaluation, and settlement conferences, there are other types of ADR, including conciliation, fact finding, mini-trials, and summary jury trials. Sometimes parties will try a combination of ADR types. The important thing is to try to find the type or types of ADR that are most likely to resolve your dispute.

To locate a dispute resolution program or neutral in your community: Contact the California Department of Consumer Affairs, Consumer Information Center, toll free, at 1-800-852-5210 Contact the Orange County Bar Association at (949) 440-6700 Look in the telephone directories under “Arbitrators” or “Mediators”

Low cost mediation services are provided under the Orange County Dispute Resolution Program Act (DRPA). For information regarding DRPA, contact: OC Human Relations (714) 480-6575, mediator@ochumanrelations.org

Waymakers (949) 250-4058

For information on the Superior Court of California, County of Orange court ordered arbitration program, refer to Local Rule 360.

The Orange County Superior Court offers programs for Civil Mediation and Early Neutral Evaluation (ENE). For the Civil Mediation program, mediators on the Court’s panel have agreed to accept a fee of $300 for up to the first two hours of a mediation session. For the ENE program, members of the Court’s panel have agreed to accept a fee of $300 for up to three hours of an ENE session. Additional information on the Orange County Superior Court Civil Mediation and Early Neutral Evaluation (ENE) programs is available on the Court’s website at www.occourts.org.

L1200 Rev. Dec. 2019 Page 4 of 4

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name & Address): FOR COURT USE ONLY

Telephone No.: Fax No. (Optional): E-Mail Address (Optional): ATTORNEY FOR (Name): Bar No:

SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE JUSTICE CENTER: Central - 700 Civic Center Dr. West, Santa Ana, CA 92701-4045 Civil Complex Center - 751 W. Santa Ana Blvd., Santa Ana, CA 92701-4512

Harbor-Laguna Hills Facility 23141 Moulton Pkwy., Laguna Hills, CA 92653-1251 Harbor Newport Beach Facility 4601 Jamboree Rd., Newport Beach, CA 92660-2595 North 1275 N. Berkeley Ave., P.O. Box 5000, Fullerton, CA 92838-0500 West 8141 13th Street, Westminster, CA 92683-0500 PLAINTIFF/PETITIONER:

DEFENDANT/RESPONDENT:

ALTERNATIVE DISPUTE RESOLUTION (ADR) STIPULATION CASE NUMBER:

Plaintiff(s)/Petitioner(s),

and Defendant(s)/Respondent(s),

agree to the following dispute resolution process:

Mediation

Arbitration (must specify code) Under section 1141.11 of the Code of Civil Procedure (Judicial Arbitration) Under section 1280 of the Code of Civil Procedure (Contractual Arbitration)

The ADR process must be completed no later than 90 days after the date of this Stipulation or the date the case was referred, whichever is sooner.

An approved fee waiver (FW-003) is attached to this Stipulation, and the selected ADR Neutral(s) are eligible to provide pro bono services.

We understand that there may be a charge for services provided by neutrals. We understand that participating in an ADR process does not extend the time periods specified in California Rules of Court rule 3.720 et seq.

Date: (SIGNATURE OF PLAINTIFF OR ATTORNEY) (SIGNATURE OF PLAINTIFF OR ATTORNEY)

Date: (SIGNATURE OF DEFENDANT OR ATTORNEY) (SIGNATURE OF DEFENDANT OR ATTORNEY)

ALTERNATIVE DISPUTE RESOLUTION (ADR) STIPULATION

Approved for Optional Use California Rules of Court, rule 3.221 L1270 (Rev, 20 )

POS-010 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY

TELEPHONE NO.: FAX NO. (Optional):

E-MAIL ADDRESS (Optional):

ATTORNEY FOR (Name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

PLAINTIFF/PETITIONER: CASE NUMBER:

DEFENDANT/RESPONDENT:

Ref. No. or File No.:

PROOF OF SERVICE OF SUMMONS

(Separate proof of service is required for each party served.)

1. At the time of service I was at least 18 years of age and not a party to this action.
2. I served copies of: a. summons b. complaint

c. Alternative Dispute Resolution (ADR) package
d. Civil Case Cover Sheet (served in complex cases only)
e. cross-complaint
f. other (specify documents):

3. a. Party served (specify name of party as shown on documents served):

   b. Person (other than the party in item 3a) served on behalf of an entity or as an authorized agent (and not a person under item 5b on whom substituted service was made) (specify name and relationship to the party named in item 3a):

4. Address where the party was served:

5. I served the party (check proper box) a. by personal service. I personally delivered the documents listed in item 2 to the party or person authorized to receive service of process for the party (1) on (date): (2) at (time):

b. by substituted service. on (date): at (time): I left the documents listed in item 2 with or
in the presence of (name and title or relationship to person indicated in item 3):

(1) (business) a person at least 18 years of age apparently in charge at the office or usual place of business
of the person to be served. I informed him or her of the general nature of the papers.
(2) (home) a competent member of the household (at least 18 years of age) at the dwelling house or usual
place of abode of the party. I informed him or her of the general nature of the papers.

(3) (physical address unknown) a person at least 18 years of age apparently in charge at the usual mailing
address of the person to be served, other than a United States Postal Service post office box. I informed
him or her of the general nature of the papers.
(4) I thereafter mailed (by first-class, postage prepaid) copies of the documents to the person to be served
at the place where the copies were left (Code Civ. Proc., § 415.20). I mailed the documents on
(date): from (city): or a declaration of mailing is attached.

(5) I attach a declaration of diligence stating actions taken first to attempt personal service.

Form Adopted for Mandatory Use PROOF OF SERVICE OF SUMMONS Code of Civil Procedure, § 417.10 Judicial Council of California POS-010 [Rev. January 1, 2007]

POS-010 PLAINTIFF/PETITIONER: CASE NUMBER:

DEFENDANT/RESPONDENT:

5. c. by mail and acknowledgment of receipt of service. I mailed the documents listed in item 2 to the party, to the address shown in item 4, by first-class mail, postage prepaid, (1) on (date): (2) from (city): (3) with two copies of the Notice and Acknowledgment of Receipt and a postage-paid return envelope addressed to me. (Attach completed Notice and Acknowledgement of Receipt.) (Code Civ. Proc., § 415.30.) (4) to an address outside California with return receipt requested. (Code Civ. Proc., § 415.40.)

   d. by other means (specify means of service and authorizing code section):

   Additional page describing service is attached.

6. The "Notice to the Person Served" (on the summons) was completed as follows: a. as an individual defendant. b. as the person sued under the fictitious name of (specify):

   c. as occupant.

   d. On behalf of (specify): under the following Code of Civil Procedure section: 416.10 (corporation) 415.95 (business organization, form unknown) 416.20 (defunct corporation) 416.60 (minor) 416.30 (joint stock company/association) 416.70 (ward or conservatee) 416.40 (association or partnership) 416.90 (authorized person) 416.50 (public entity) 415.46 (occupant) other:

7. Person who served papers a. Name: b. Address: c. Telephone number: d. The fee for service was: $ e. I am: (1) not a registered California process server. (2) exempt from registration under Business and Professions Code section 22350(b). (3) a registered California process server: owner employee independent contractor. (ii) Registration No.: (iii) County:

8. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

   or

9. I am a California sheriff or marshal and I certify that the foregoing is true and correct.

Date:

(NAME OF PERSON WHO SERVED PAPERS/SHERIFF OR MARSHAL) (SIGNATURE)

POS-010 [Rev. January 1, 2007] PROOF OF SERVICE OF SUMMONS Page 2 of 2