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Contribution Verdict Form - Comparative Negligence Not An Issue - Verdict For Plaintiff

600.14A Contribution Verdict Form--Comparative Negligence Not an Issue--Verdict for

Plaintiff

Verdict Form A

We, the jury, find for ________ and against the following defendant or defendants:

Yes

Defendant #1

Yes

Defendant #2

We further find the following:

First: We find that the total amount of damages suffered by [name of plaintiff] as a proximate

result of the occurrence in question is $________, itemized as follows:

List each category of damages, e.g.

The disfigurement resulting from the injury

$________

Insert other damages categories from IPI

$________

30.05, 30.05.01, 30.07, 30.08, 30.09 or as

applicable

PLAINTIFF'S TOTAL DAMAGES

$________

Second: As to the contribution claims brought by [name of third-party plaintiff], we find:

Yes

Against

Third-party defendant #1

Yes

Against

Third-party defendant #2

Third: Assuming that 100% represents the total combined legal responsibility of all [persons]

[or] [entities] [who] [that] proximately caused [plaintiff's name] injury, we find the percentage of

legal responsibility attributable to each as follows:

a) Defendant #1's name

____%

b) Defendant #2's name

____%

c) Third-party defendant #1's name ____%

d) Third-party defendant #2's name ____%

TOTAL

100%

Section 600, Page 29 of 33

Contribution Verdict Form - Comparative Negligence Not An Issue - Verdict For Plaintiff