CACI VF-3033 Ralph Act (Civ. Code, § 51.7)

VF-3033 Ralph Act (Civ. Code, § 51.7)

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We answer the questions submitted to us as follows:

1.Did [name of defendant] [threaten/commit] violent acts against [name of plaintiff] [or [his/her/nonbinary pronoun] property]?

 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.Was [[name of defendant]’s perception of] [name of plaintiff]’s [race/color/religion/ancestry/national origin/political affiliation/sex/sexual orientation/age/disability/citizenship/primary language/immigration status/position in a labor dispute/[insert other actionable characteristic]] a substantial motivating reason for [name of defendant]’s conduct?

 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.Would a reasonable person in [name of plaintiff]’s position have believed that [name of defendant] would carry out [his/her/nonbinary pronoun] threats?

 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.Would a reasonable person in [name of plaintiff]’s position have been intimidated by [name of defendant]’s conduct?

 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.Was [name of defendant]’s conduct a substantial factor in causing harm to [name of plaintiff]?

 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.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 $

[7.What amount do you award as punitive damages?
$]

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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