If your answer to Question No. 10 was "no," do not answer Question No. 11. Answer Question No. 12. However, if your answer to Question No. 10 was "yes," you must now answer Question No. 11 (11) Was plaintiff [name]'s negligence a substantial factor in causing his/her harm? Answer "yes" or "no." Answer: _______________________ If your answer to Question No. 11 was "no", answer Question No. 12. If your answers to both Question No. 10 and Question No. 11 were “yes”, write the plaintiff's name in one of the spaces provided in Question No. 13. Then answer Question No. 12. [12] The instructions to the previous questions on this form told you to enter names in the spaces in Question No. 13 depending on your answers to certain questions. What are the total damages, if any, to the plaintiff that were legally caused by the negligence of all of the persons who you have listed in the spaces provided in Question No. 13? (a) Past economic loss: $_________________ (b) Past non-economic loss: $_________________ (c) Future economic loss: $_________________ (d) Future non-economic loss: $_________________ TOTAL: $_________________ If the total amount entered in response to Question No. 12 is $0, do not answer any further questions. The foreperson should date and sign the verdict. However, if you have stated any sum of money in answer to Question No. 12, then answer Question No. 13. (13) The instructions to the previous questions on this form told you to enter names in the spaces below, depending on your answers to certain questions. For each name that you entered in one of the spaces below, you must determine the percentage of fault for the damages identified in your response to Question No. 12. The total must be equal to 100%. Do not add any additional names,
If your answer to Question No. 10 was "no," do not answer Question No. 11. Answer Question No. 12. However, if your answer to Question No. 10 was "yes," you must now answer Question No. 11 (11) Was plaintiff [name]'s negligence a substantial factor in causing his/her harm? Answer "yes" or "no." Answer: _______________________ If your answer to Question No. 11 was "no", answer Question No. 12. If your answers to both Question No. 10 and Question No. 11 were “yes”, write the plaintiff's name in one of the spaces provided in Question No. 13. Then answer Question No. 12. [12] The instructions to the previous questions on this form told you to enter names in the spaces in Question No. 13 depending on your answers to certain questions. What are the total damages, if any, to the plaintiff that were legally caused by the negligence of all of the persons who you have listed in the spaces provided in Question No. 13? (a) Past economic loss: $_________________ (b) Past non-economic loss: $_________________ (c) Future economic loss: $_________________ (d) Future non-economic loss: $_________________ TOTAL: $_________________ If the total amount entered in response to Question No. 12 is $0, do not answer any further questions. The foreperson should date and sign the verdict. However, if you have stated any sum of money in answer to Question No. 12, then answer Question No. 13. (13) The instructions to the previous questions on this form told you to enter names in the spaces below, depending on your answers to certain questions. For each name that you entered in one of the spaces below, you must determine the percentage of fault for the damages identified in your response to Question No. 12. The total must be equal to 100%. Do not add any additional names,
03.21C.docx