CJI-Civ. 9:27D

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 SPECIAL VERDICT FORM B AND ALL JURORS HAVE SIGNED IT.

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

we have all agreed:

1. Did the plaintiff, (name), have (injuries) (damages) (losses)? (Yes or No)

ANSWER: _______

2. Was the defendant, (name of first defendant), negligent? (Yes or No)

ANSWER: _______

3. Was the negligence, if any, of the defendant, (name of first defendant), a cause of

any of the (injuries) (damages) (losses) claimed by the plaintiff? (Yes or No)

ANSWER: _______

4. Was the defendant, (name of second defendant), negligent? (Yes or No)

ANSWER: _______

5. Was the negligence, if any, of the defendant, (name of second defendant), a cause of

any of the (injuries) (damages) (losses) claimed by the plaintiff? (Yes or No)

ANSWER: _______

We, the jury, find for the defendants and award no damages to the plaintiff, (name).

Signatures of all jurors:

______________________________ ______________________________

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 SPECIAL VERDICT FORM A AND ALL JURORS HAVE SIGNED IT.

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

we have all agreed:

1. Did the plaintiff, (name), have (injuries) (damages) (losses)? (Yes or No)

ANSWER: _______

2. Was the defendant, (name of first defendant), negligent? (Yes or No)

ANSWER: _______

3. Was the negligence, if any, of the defendant, (name of first defendant), a cause of

any of the (injuries) (damages) (losses) claimed by the plaintiff? (Yes or No)

ANSWER: _______

4. Was the defendant, (name of second defendant), negligent? (Yes or No)

ANSWER: _______

5. Was the negligence, if any, of the defendant, (name of second defendant), a cause of

any of the (injuries) (damages) (losses) claimed by the plaintiff? (Yes or No)

ANSWER: _______

If you find that the plaintiff did have (injuries) (damages) (losses) and you further

find that one or more of the defendants was negligent and that such negligence was a cause

of any of the plaintiff’s (injuries) (damages) (losses), then answer the following questions:

6. Was the plaintiff, (name), negligent? (Yes or No)

ANSWER: _______

7. Was the negligence, if any, of the plaintiff a cause of (insert applicable pronoun)

own claimed (injuries) (damages) (losses)? (Yes or No)

ANSWER: _______

8. Taking as 100 percent the combined negligence of all parties you find were

negligent and whose negligence was a cause of any of the plaintiff’s (injuries) (damages)

(losses), what percentage of negligence, if any, was that of the defendant, (name of first

defendant), of the defendant, (name of second defendant), and of the plaintiff, (name)?

Enter the figure of zero, “0,” for any party you decide was not negligent or whose

negligence you decide was not a cause of any of the plaintiff’s (injuries) (damages) (losses).

ANSWER:

Percentage charged to (name of first defendant): _______%

Percentage charged to (name of second defendant): _______%

Percentage charged to plaintiff, (name): _______%

MUST TOTAL: 100%

If you determine that the negligence of the plaintiff was equal to or greater than the

combined negligence of the defendants, i.e., 50% or more, then skip question 9.

9. State your answers to the following questions relating to the plaintiff’s damages

that were caused by the negligence of one or more of the defendants, whether the damages

were also caused by the negligence, if any, of the plaintiff (or anyone else).

a. What is the total amount of the plaintiff’s damages, if any, for noneconomic losses

or injuries (, excluding any damages for [physical impairment] [or]

[disfigurement])? Noneconomic losses or injuries are those losses or injuries

described in numbered paragraph 1 of Instruction (insert number of the applicable

Instruction on damages). You should answer “0” if you determine there were none.

ANSWER: $_______

b. What is the total amount of the plaintiff’s damages, if any, for economic losses (,

excluding any damages for [physical impairment] [or] [disfigurement])? Economic

losses are those losses described in numbered paragraph 2 of Instruction (insert

number of applicable Instruction on damages). You should answer “0” if you

determine there were none.

ANSWER: $_______

(c. What is the total amount of the plaintiff’s damages, if any, for [physical

impairment] [or] [disfigurement]? You should answer “0” if you determine there

were none.)

ANSWER: $_______

Signatures of all jurors:

______________________________ ______________________________

Foreperson

______________________________ ______________________________

______________________________ ______________________________