CJI-Civ. 14:30B

FORM A

District Court County Court Other

County, Colorado

Court Address:

[Insert Information from the original caption here - ex. In Re the

Matter of, etc.]

COURT USE ONLY

Case Number:

Division: Courtroom:

SPECIAL VERDICT FORM A

DO NOT ANSWER THIS SPECIAL VERDICT FORM A IF YOUR FOREPERSON HAS

COMPLETED AND ALL JURORS HAVE SIGNED EITHER SPECIAL VERDICT

FORM B OR SPECIAL VERDICT FORM C.

We, the jury, present our Answers to Questions submitted by the Court, to which

we have all agreed:

1. Do you find that the plaintiff, (name), is entitled to recover damages from the

defendant, (name), on (insert applicable pronoun) claim of (insert appropriate description, e.g.,

“negligence,” “breach of the warranty of…,” etc.) under Instruction No. (insert the number

assigned in the case to the instruction that sets forth the basic elements of liability for the claim,

as in Instructions 14:1, 14:8, 14:10, 14:13, 14:17, 14:20, or 14:22)? (Yes or No)

ANSWER: _______

(Insert additional separately numbered similar paragraphs so as to include all product

liability claims being made against the defendant.)

(ANSWER: _______)

We, the jury, having answered (question No. 1) ([all] [both] of these questions

numbered [insert number]) “no,” find the issues for the defendant, (name).

__________________ __________________

__________________ __________________

__________________ __________________

Foreperson

FORM B

District Court County Court Other

County, Colorado

Court Address:

[Insert Information from the original caption here - ex. In Re the

Matter of, etc.]

COURT USE ONLY

Case Number:

Division: Courtroom:

SPECIAL VERDICT FORM B

DO NOT ANSWER THIS SPECIAL VERDICT FORM B IF YOUR FOREPERSON HAS

COMPLETED AND ALL JURORS HAVE SIGNED EITHER SPECIAL VERDICT

FORM A OR SPECIAL VERDICT FORM C.

We, the jury, present our Answers to Questions submitted by the Court, to which

we have all agreed:

1. Do you find that the plaintiff, (name), is entitled to recover damages from the

defendant, (name), on (insert applicable pronoun) claim of (insert appropriate description, e.g.,

“negligence,” “breach of the warranty of…,” etc.), under Instruction No. (insert the number

assigned in the case to the instruction that sets forth the basic elements of liability for the claim,

as in Instructions 14:1, 14:8, 14:10, 14:13, 14:17, 14:20, or 14:22)? (Yes or No)

ANSWER: _______

(Insert additional separately numbered similar paragraphs so as to include all product

liability claims being made against the defendant.)

(ANSWER: _______)

2. Do you find that the plaintiff was (negligent) (or) (at fault) in causing (insert

applicable pronoun) own (injuries) (damages) (losses) as set forth in Instruction No. (insert

the number assigned in the case to the instruction that sets forth the basic elements of any form

of comparative fault, e.g., as in Instruction 14:28 or 14:29)? (Yes or No)

ANSWER: _______

(Insert, as above in question 2, but in separately numbered questions, any additional

forms of comparative fault.)

(ANSWER: _______)

3. State the total amount of plaintiff’s (injuries) (damages) (losses) under Instruction

No. (insert the number assigned in the case to the instruction that sets forth recoverable

damages) that were caused by the (negligence) (or) (fault) of the defendant.

ANSWER: $_______

We, the jury, having answered (question No. 1) (one or more of the questions

numbered [insert specific numbers of all questions relating to claims of liability against the

defendant]) “yes,” but having answered (question No. 2) ([all] [both] of the questions

numbered [insert specific numbers of all questions relating to the comparative fault of the

plaintiff]) “no,” find the issues for the plaintiff, (name).

__________________ __________________

__________________ __________________

__________________ __________________

Foreperson

FORM C

District Court County Court Other

County, Colorado

Court Address:

[Insert Information from the original caption here - ex. In Re the

Matter of, etc.]

COURT USE ONLY

Case Number:

Division: Courtroom:

SPECIAL VERDICT FORM C

DO NOT ANSWER THIS SPECIAL VERDICT FORM C IF YOUR FOREPERSON HAS

COMPLETED AND ALL JURORS HAVE SIGNED EITHER SPECIAL VERDICT

FORM A OR SPECIAL VERDICT FORM B.

We, the jury, present our Answers to Questions submitted by the Court, to which

we have all agreed:

1. Do you find that the plaintiff, (name), is entitled to recover damages from the

defendant, (name), on (insert applicable pronoun) claim of (insert appropriate description, e.g.,

“negligence,” “breach of the warranty of…,” etc.) under Instruction No. (insert the number

assigned in the case to the instruction that sets forth the basic elements of liability for the claim,

as in Instructions 14:1, 14:8, 14:10, 14:13, 14:17, 14:20, or 14:22)? (Yes or No)

ANSWER: _______

(Insert additional separately numbered similar paragraphs so as to include all product

liability claims being made against the defendant.)

(ANSWER: _______)

2. Do you find that the plaintiff was (negligent) (or) (at fault) in causing (insert

applicable pronoun) own (injuries) (damages) (losses) as set forth in Instruction No. (insert

the number assigned in the case to the instruction that sets forth the basic elements of any form

of comparative fault, e.g., as in Instruction 14:28 or 14:29)? (Yes or No)

ANSWER: _______

(Insert, as above in question 2, but in separately numbered questions, any additional

forms of comparative fault.)

(ANSWER: _______)

3. State the total amount of plaintiff’s (injuries) (damages) (losses) under Instruction

No. (insert the number assigned in the case to the instruction that sets forth recoverable

damages) that were caused by the combined (negligence) (or) (fault) of the defendant and

by the (negligence) (or) (fault) of the plaintiff.

ANSWER: $_______

4. Taking as 100 percent the combined (negligence) (or) (fault) that caused the

plaintiff’s (injuries) (damages) (losses), what percentage was caused by the defendant and

what percentage was caused by the plaintiff?

ANSWER:

Percentage charged to plaintiff, (name): _______%

Percentage charged to defendant, (name): _______%

MUST TOTAL: 100% _______%

__________________ __________________

__________________ __________________

__________________ __________________

Foreperson