CACI VF-3001 Public Entity Liability (42 U.S.C. § 1983)

VF-3001 Public Entity Liability (42 U.S.C. § 1983)

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We answer the questions submitted to us as follows:

1.Did the [name of local governmental entity] have an official [policy/custom] [specify policy or custom]?

 Yes   No

If your answer to question 1 is yes, then answer question 2. If you answered no, stop here, answer no further questions, and have the presiding juror sign and date this form.

2.Did [name of local governmental entity] know, or should it have been obvious to it, that this official [policy/custom] was likely to result in a deprivation of the right [specify right violated]?

 Yes   No

If your answer to question 2 is yes, then answer question 3. If you answered no, stop here, answer no further questions, and have the presiding juror sign and date this form.

3.Was [name of officer or employee] an [officer/employee/[other]] of [name of local governmental entity]?

 Yes   No

If your answer to question 3 is yes, then answer question 4. If you answered no, stop here, answer no further questions, and have the presiding juror sign and date this form.

4.Did [name of officer or employee] [intentionally/[insert other applicable state of mind]] [insert conduct allegedly violating plaintiff’s civil rights]?

 Yes   No

If your answer to question 4 is yes, then answer question 5. If you answered no, stop here, answer no further questions, and have the presiding juror sign and date this form.

5.Did [name of officer or employee]’s conduct violate [name of plaintiff]’s right [specify right]?

 Yes   No

If your answer to question 5 is yes, then answer question 6. If you answered no, stop here, answer no further questions, and have the presiding juror sign and date this form.

6.Did [name of officer or employee] act because of this official [policy/custom]?

 Yes   No

If your answer to question 6 is yes, then answer question 7. If you answered no, stop here, answer no further questions, and have the presiding juror sign and date this form.

7.What are [name of plaintiff]’s damages?

[a.Past economic loss

[lost earnings $]

[lost profits $]

[medical expenses $]

[other past economic loss $]

Total Past Economic Damages: $]

[b.Future economic loss

[lost earnings $]

[lost profits $]

[medical expenses $]

[other future economic loss$]

Total Future Economic Damages: $]

[c.Past noneconomic loss, including [physical
pain/mental suffering:]$]

[d.Future noneconomic loss, including [physical
pain/mental suffering:] $]

TOTAL $

After [this verdict form has/all verdict forms have] been signed, notify the [clerk/bailiff/court attendant] that you are ready to present your verdict in the courtroom.

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