Fill and Sign the Product Liability Form

IN THE CIRCUIT COURT OF_________ COUNTY, ____________ NAME OF PLAINTIFF )       ) ) V. ) NO. ) ) NAME OF DEFENDANT )       ) COMPLAINT Plaintiffs allege: I. Plaintiffs are adult resident citizens of ______________ County, __________________, who reside at ____________________________, ____________, ___________________. II. 1. The defendant, ____________________________ (____________________________) is a ____________________________ corporation, with its principal place of business at ____________________________, _______________, __________________, and may be served with process of this Court by service on its registered agent for service of process, ________________________, ____________________________, ____________________________. At all relevant times herein, _____________________ was doing business in the State of __________________, although not qualified, and was in the business of manufacturing and selling ____________________________. 2. The defendant, _____________________, (____________________________), is an organization with its principal place of business in the State of _____________________, and may be served with process of this Court by service on its agents, __________________ and _________________________________. At all relevant times herein, _________________ was doing business in the State of _____________________________, selling and distributing ________________________. 3. The defendant, _______________________ (__________________________), is a _________________________ corporation with its principal place of business at ____________________________, ___________________. ____________________________ is the successor company to ____________________________ and at all relevant times herein was doing business in the State of _____________________________, selling and distributing ____________________________. ____________________________ may be served with process of this Court by service upon its registered agent, ____________________________, - 1 - ____________________________, ____________________________. Plaintiff is informed and believes that ____________________________ and ____________________________ are the same company. 4. The defendant, ____________________________, (_____________________), is an adult resident citizen of _______________ County, ___________________________, and may be served with process of this Court at his place of residence which is ____________________________, ____________________________ ___________________. At all relevant times herein, ____________________________ was an agent of, and in the course and scope of his employment with ____________________________, now ____________________________, selling and distributing ____________________________. 5. The defendant, ____________________________ (______________________), is a government entity which operates the public schools in the City of ____________________________, ____________________________ County, ____________, and may be served with process of this Court by service upon its superintendent, ____________________________, ____________________________, ___________________, and __________________________. At all relevant times herein, the plaintiff, ____________________________, was in the course and scope of her employment with _____________________________. 6. The Board of Trustees of the ____________________________ Public School District (The Board) is a political subdivision of the State of _____________________. The Board of Trustees is the governing authority of ____________________________. Said Trustees, all adult resident citizens of ____________________________ County, _____________________, are ____________________________, ____________________, ____________________________, ____________________________, ____________ and ____________________________. The Board of Trustees may be served with process of this Court by service on its President, ____________________________, at ____________________________, __________________, _____________________. 7. The defendant, ____________________________, (______________________) is a _____________________________ corporation. At all times relevant herein, _____________________________ was qualified to do, and doing business, in the State of _____________________, selling and distributing __________________________. ________________ may be served with process of this Court by service on its registered agent, ____________________________,____________________________, ___________________, _____________________. 8. The true name or capacities, whether individual, corporate, associate or otherwise, of defendant John/Jane Doe 1 - 10, inclusive, are unknown to plaintiffs who therefore sue said defendants by such fictitious names. Plaintiffs are informed, and believe, and thereon allege that each of the defendants designated herein as a John/Jane Doe is negligently responsible and strictly liable in some manner for the events and happenings herein referred to, and caused injury and damages proximately thereby to the plaintiffs as herein alleged. - 2 - III. On ____________________________ ____________________________, 20_________, the plaintiff, ____________________________, while in ____________________________ County, _____________________, at her place of employment with _____________________, at ____________________________, suffered severe respiratory injuries, and other injuries, when utilizing _________________________, a product manufactured by _______________, distributed by ____________________________, now ____________________________, and sold and delivered by ___________________________________, _______________________, __________________________, and ____________________________ to plaintiffs employer, ____________________________, as governed by The Board. Said product was sold and delivered to _________________________ in the State of _____________________. Said injuries include, but are not limited to, the following: 1. chemical bronchitis with bronchospasm; 2. difficulty breathing; 3. chronic bronchitis: 4. potential for infection due to inhalant; 5. continuous coughing and wheezing; 6. burning throat and eyes; 7. allergic reactions; 8. chemical gas inhalation; and, 9. respiratory distress. IV. When the product was sold and used by plaintiff, _______________________, it was in a defective condition unreasonably dangerous to the consumer. Despite the product's defective condition, defendants negligently represented to plaintiff, _________________________ a housecleaner employed with ____________________________, that she could use - 3 - ____________________________ with other cleansers, and that the product contained no harmful chemicals. Plaintiff, while in the course and scope of her employment with ___________________, used ____________________________ at the direction of defendants and was overcome with toxic fumes, causing her injury. Defendants, ____________________________ and The Board, breached their implied contract with the plaintiff to provide her with a safe place to work and, further, breached their employment contract with plaintiff by terminating her due to health conditions caused by the toxic fumes and because she was required to wear protective clothing which her employer prohibited. V. As a proximate cause of the defendants' negligence and wantonness, breach of implied warranty of merchantability, breach of implied warranty of fitness, breach of express warranty, breach of contract, failure to warn, and under the doctrine of strict liability, the defendants are liable to the plaintiff, ____________________________, for the following damages: 1. medical bills; 2. loss of past and future wages; 3. pain and suffering; 4. permanent respiratory injuries; 5. mental anguish; 6. future pain and suffering; and, 7. psychological injuries and emotional distress. As a proximate cause of the defendants' negligence and wantonness, breach of implied warranty of merchantability, breach of implied warranty of fitness, breach of express warranty, breach of contract, failure to warn, and under the doctrine of strict liability, the defendants are liable to the plaintiff, ____________________________, for loss of consortium damages. WHEREFORE, PREMISES CONSIDERED, the plaintiffs demand judgment against the defendants, ____________________________, ____________________________, ____________________________,____________________________, _____________________, _________________________ and The Board, jointly and severally, in the amount of $00.00 compensatory damages, and the sum of $00.00, punitive damages, post - judgment interests, pre - judgment interests, attorneys' fees, and all costs of this action. RESPECTFULLY SUBMITTED, this the ____________________________ day of ____________________________, 20________. - 4 - ____________________________ BY: ____________________________ OF COUNSEL MSB #____________________________ MSB #____________________________ MSB #____________________________ __________________________________ - 5 -