Fill and Sign the Complaint Auto Accident Form

- 1 - IN THE ______________ COURT OF ______________ COUNTY STATE OF ________________ ) ) ) Petitioner/Plaintiff, ) ) ) NO. Vs. ) ) ) Respondent/Defendant ) ) COMPLAINT COME NOW plaintiffs ___________ and ___________ by and through counsel, and file this Complaint against ___________ and ___________ and in support thereof set forth the following: 1. ___________ is an adult resident citizen of ___________ County, ___________, residing at _______________. 2. ___________is an adult resident citizen of ___________ County ___________, residing at ___________________. 3. Defendant ___________ Poultry is a ___________ Corporation, licensed and doing business in the State of ___________, who may be served with process through its agent, __________________ Corporation System, ________________________, _________________, ___________. 4. Defendant ___________ was the agent, servant and employee of defendant ___________. 5. During all the times herein mentioned defendant ___________ was the owner of an eighteen wheel Mack truck, which at the time of the accident hereinafter described was being driven by ___________, an employee of defendant ___________, during the course and scope of his employment for ___________ with the express permission and consent and for the benefit of ___________. - 2 - 6. As a result, defendant ___________ is responsible both for ___________ actions and conduct pursuant to the doctrine of respondeat superior and for any negligence of its own. 7. On __________, 20____, at about ______ p.m., the plaintiff ___________ was operating an automobile owned by her in a northerly direction on Highway _______ in unincorporated ___________ County, ___________, approaching the on ramp for ___________ ________, ________. 8. At said intersection is a traffic control signal. As plaintiff ___________ approached, it turned red and she brought her car to a stop. 9. Defendant ___________ approached the plaintiff's car from behind and failed to stop, suddenly and violently striking the plaintiff's car from the rear. 10. Said collision was the proximate cause of property damage to plaintiff ___________'s car, temporary injuries to plaintiff and serious and permanent injuries to plai ntiff ___________ 11. Plaintiff ___________ at all times during the occurrence hereinbefore set forth used due care and caution and was completely free from any and all negligence in a ny manner contributing to her injuries and damages as herein complained of 12. Said collision was due to defendant ___________'s negligence in that he was not keeping a reasonable lookout did not have his truck under proper control and was otherwise gui lty of carelessness and negligence in the operation of that motor vehicle. 13 Plaintiffs allege that the proximate cause of the aforementioned collisi on was the negligence of defendant ___________ for which negligence he must stand during the course and scope of his employment for ___________, with the express permission and consent and for the benefit of ___________. 14. Plaintiffs allege that the proximate cause of the aforementioned collision was the negligence of defendant ___________ for which negligence he must stand responsible together with his employer and its liability carrier, jointly and severally, said negligence including, but not limited to, the following acts and omissions: a. Failure to keep a proper lookout; b. Failure to maintain a safe speed; c. Any and all other negligent acts and/or omissions which may be shown during the course of these proceedings. 15. Plaintiffs allege that the proximate cause of the aforesaid collision w as the negligence of defendant ___________ and for which negligence it must stand responsible together - 3 - with its liability carrier, jointly and severally, said negligence including, but not limited to, the following acts and omissions: 1. Negligent entrustment of an oversized motor vehicle; and 2. Any and all other negligent acts and/or omissions which may be shown during the course of these proceedings. 16. As a result of the aforesaid collision, plaintiff ___________ suffered physical injuries requiring medical treatment, and plaintiff ___________ suffered temporary total disa bility and partial permanent disability. 17. As a result of the aforesaid collision, plaintiff *8 suffered emotional trauma and distress and incurred expenses and lost income. 18. As a result of the aforesaid collision, plaintiff ___________ will continue to suffer the aforesaid damages and, further, will continue to incur medical expenses in the future. 19. Because of the injuries suffered in the collision by his wife, plaintiff ___________ has lost and been deprived of the services of his wife, including loss of society, companionship, consortium, and he will continue to be permanently so deprived of as a result of the injuries suffered by plaintiff ___________. WHEREFORE, PREMISES CONSIDERED, plaintiffs pray that defendants, ___________ and ___________ each be served with process of this Court, to appear and answer same, and tha t after due proceedings be had there be judgment herein in favor of plaintiffs and against defendants, jointly and severally, in the amount of One Hundred Thousand Dollars ($100,000) with interes t from the date of judicial demand until paid, for all costs of these proceedings a nd for any and all other legal and equitable relief to which they may be entitled. And, plaintiffs pray for general relief Respectfully submitted, ________________________ PLAINTIFFS