Burrell et al v. County of Santa Clara et al

Filing 155

VERDICT FORM. Signed by Judge Lucy H. Koh on 5/10/2013. (lhklc3, COURT STAFF) (Filed on 5/10/2013)

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UNITED STATES DISTRICT COURT

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NORTHERN DISTRICT OF CALIFORNIA

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United States District Court
For the Northern District of California

SAN JOSE DIVISION
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ALMA BURRELL,
Plaintiff,
vs.

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COUNTY OF SANTA CLARA,
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Defendant.

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Case No.: 11-CV-04569-LHK

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VERDICT FORM

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Dated: May 9, 2013

_______________________________
LUCY H. KOH
United States District Judge

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Case No: 11-CV-04569-LHK
VERDICT FORM
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ALL JURORS MUST AGREE ON THE ANSWERS TO EACH OF THE QUESTIONS.
We, the Jury in the above-entitled action, find the following Jury Verdict on the

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questions submitted to us:
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I.

DISPARATE TREATMENT (FEHA GOV. CODE § 12940(a))

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The parties stipulate that the County of Santa Clara is an employer covered by the Fair
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Employment and Housing Act and that Plaintiff Alma Burrell has been employed by the County at
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all times relevant in this lawsuit.
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QUESTION 1: Did the County of Santa Clara refuse to promote Alma Burrell?
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ANSWER: Yes ____ No ____
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United States District Court
For the Northern District of California

If your answer to Question No. 1 is yes, then answer Question No. 2. If you answered no,
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stop here, answer no further questions, and have the presiding juror sign and date this form.
QUESTION 2: Was Alma Burrell’s race a motivating reason for the County of Santa
Clara’s refusal to promote Alma Burrell?
ANSWER: Yes ____ No _____
If your answer to Question No. 2 is yes, then answer Question No. 3. If you answered no,
stop here, answer no further questions, and have the presiding juror sign and date this form.
QUESTION 3: Was the County of Santa Clara’s refusal to promote Alma Burrell a
substantial factor in causing harm to Alma Burrell?

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ANSWER: Yes ____ No _____

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If your answer to Question No. 3 is yes, then answer Question No. 4. If you answered no,

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stop here, answer no further questions, and have the presiding juror sign and date this form.

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QUESTION 4: What are Alma Burrell’s damages for discrimination?

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(a)

Past economic loss:

$

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(b)

Future economic loss:

$

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(c)

Past non-economic loss:

$

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(d)

Future non-economic loss:

$
Total: $

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Case No: 11-CV-04569-LHK
VERDICT FORM
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II.

FAILURE TO PREVENT DISCRIMINATION (FEHA GOV. CODE § 12940(k))
QUESTION 5: Was Alma Burrell subjected to discrimination in the workplace because of

her race?
ANSWER: Yes ____ No _____
If your answer to Question No. 5 is yes, then answer Question No. 6. If you answered no,
stop here, answer no further questions, and have the presiding juror sign and date this form.

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QUESTION 6: Did the County of Santa Clara fail to take reasonable steps to prevent the
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United States District Court
For the Northern District of California

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discrimination?
ANSWER: Yes ____ No _____
If your answer to Question No. 6 is yes, then answer Question No. 7. If you answered no,
stop here, answer no further questions, and have the presiding juror sign and date this form.
QUESTION 7: Was the County of Santa Clara’s failure to prevent the discrimination a
substantial factor in causing harm to Alma Burrell?

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ANSWER: Yes ____ No _____

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If your answer to Question No. 7 is yes, then answer Question No. 8. If you answered no,

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stop here, answer no further questions, and have the presiding juror sign and date this form.

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QUESTION 8: What are Alma Burrell’s damages for failure to prevent discrimination?

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(a)

Past economic loss:

$

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(b)

Future economic loss:

$

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(c)

Past non-economic loss:

$

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(d)

Future non-economic loss:

$
Total: $

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You have now reached the end of the verdict form and should review it to ensure it accurately
reflects your unanimous determinations. The Jury Foreperson should then sign and date the verdict
form in the spaces below and notify the Bailiff that you have reached a verdict. The Jury
Foreperson should retain possession of the verdict form and bring it when the jury is brought back
into the courtroom.
DATED: _________________, 2013

By:___________________________
Jury Foreperson

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Case No: 11-CV-04569-LHK
VERDICT FORM
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