CJI-Civ. 9:29B

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 or only defendant), (negligent) (or) (at fault)?

(Yes or No)

ANSWER: _______

3. Was the (negligence) (or) (fault), if any, of the defendant, (name of first or only

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] [or] [at fault]? [Yes or

No]

ANSWER: _______)

(5. Was the [negligence] [or] [fault], 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 defendant(s) 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 or only defendant), (negligent) (or) (at fault)?

(Yes or No)

ANSWER: _______

3. Was the (negligence) (or) (fault), if any, of the defendant, (name of first or only

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] [or] [at fault]? [Yes or

No]

ANSWER: _______)

(5. Was the [negligence] [or] [fault], 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 (the defendant) (one or more of the defendants) was (negligent) (or) (at fault) and

that such (negligence) (or) (fault) was a cause of any of the plaintiff’s (injuries) (damages)

(losses), then answer the following questions:

6. Was (name or other appropriate description of designated nonparty) (negligent) (or)

(at fault)? (Yes or No)

ANSWER: _______

7. Was the (negligence) (or) (fault), if any, of (name or other appropriate description of

designated nonparty) a cause of any of the (injuries) (damages) (losses) claimed by the

plaintiff? (Yes or No)

ANSWER: _______

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

that were caused by the (negligence) (or) (fault), if any, of the (defendant) (one or more of

the defendants) and the (negligence) (or) (fault), if any, of the nonparty, (name or other

appropriate description):

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: $_______

9. Taking as 100 percent the combined (negligence) (or) (fault) of the (defendant)

(defendants) and nonparty you find were (negligent) (or) (at fault) and whose (negligence)

(or) (fault) was a cause of any of the plaintiff’s (injuries) (damages) (losses), what

percentage of (negligence) (or) (fault), if any, was that of the defendant, (name of first or

only defendant), (of the defendant, [name of second defendant],) and of the nonparty, (name

or other appropriate description)? Enter the figure zero, “0,” for the nonparty (and any

defendant) you decide was not (negligent) (or) (at fault) or whose (negligence) (or) (fault)

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

ANSWER:

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

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

Percentage charged to (name of nonparty): _______%

MUST TOTAL: 100%

Signatures of all jurors:

______________________________ ______________________________

Foreperson

______________________________ ______________________________

______________________________ ______________________________