3(a). Model Form of Verdict for Bifurcated Punitive Damage Cases (1). Punitive Damage Liability -- Stage One Determination: Under the circumstances of this case, state whether you find by clear and convincing evidence that punitive damages are warranted against: (defendant) (defendant) Yes _____ Yes _____ No _____ No _____ [Note: List only the defendant(s) whose conduct the court has determined may warrant punitive damages. It may be necessary to modify this verdict form where punitive damages based on either direct or vicarious liability are at issue under PD 1a(3) or (4).] (2). Amount of Punitive Damages -- Stage Two Determination: a. Causes of action arising prior to October 1, 1999: What is the total amount of punitive damages, if any, which you find, by the greater weight of the evidence, should be assessed against defendant[s]? (defendant) (defendant) $ _________________ $ _________________ [Note: List only the defendant(s) against whom the jury has determined, in the first stage of the bifurcated punitive damages trial, that punitive damages are warranted.] If you elect not to assess punitive damages against a defendant, you should enter a zero (0) as the amount of damages. b. Causes of action arising on or after October 1, 1999: What is the total amount of punitive damages, if any, which you find, by the greater weight of the evidence, should be assessed against defendant[s]? (defendant) (defendant) $ _________________ $ _________________ [Note: List only the defendant(s) against whom the jury has determined, in the first stage of the bifurcated punitive damages trial, that punitive damages are warranted.] If you elect not to assess punitive damages against a defendant, you should enter a zero (0) as the amount of damages, and sign and date the verdict form. [If you have elected not to assess punitive damages against (defendant) then you should skip the remaining questions and sign and date the verdict form. If, however, you have elected to assess punitive damages against (defendant), the law requires you to answer the following questions:] [If you have elected not to assess punitive damages against any defendant then you should skip the remaining questions and sign and date the verdict form. If, however, you have elected to assess punitive damages against some but not all of the defendants, you should enter (0) as the amount of damages for any defendant for whom you have elected not to assess punitive damages. You also must answer the following questions:] [At the time of [loss] [injury] [or] [damage] to (claimant), did (defendant) (the managing agent, director, officer, or other person responsible for making policy decisions on behalf of the defendant) have a specific intent to harm (claimant) and did the conduct of (defendant) (the managing agent, director, officer, or other person responsible for making policy decisions on behalf of the defendant) in fact harm (claimant)]? (defendant) Yes _____ No _____ (the managing agent, director, officer, or other person responsible for making policy decisions on behalf of the defendant)? Yes _____ No _____ [Was the wrongful conduct of (defendant) (the managing agent, director, officer, or other person responsible for making policy decisions on behalf of the defendant) motivated solely by unreasonable financial gain and was the unreasonably dangerous nature of the conduct, together with the high likelihood of injury resulting from the conduct, actually known by (defendant) (the managing agent, director, officer, or other person responsible for making policy decisions on behalf of the defendant)? (defendant) Yes _____ No _____ (the managing agent, director, officer, or other person responsible for making policy decisions on behalf of the defendant)? Yes _____ No _____