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: [Defendant #1] [Defendant #2] Yes No _____ Yes _____ No _____ 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 find: $__________ $__________ $__________ Second: As to the contri bution claims brought by [ name of third party plaintiff], we Against Against Third-party defendant #1 Third-party defendant #2 Yes _____ No _____ Yes _____ No _____ Third: Assuming that 100% represents the total com bined legal responsibility of all [persons] [or] [entities] who [that] proximately caused [name of plaintiff]'s injury, we find the percentage of legal responsibility attributable to each as follows: (a) (b) (c) (d) [Defendant #1's name] [Defendant #2's name] [Third-party defendant #1's name] [Third-party defendant #2's name] ______% ______% ______% ______% 100% TOTAL (Instructions to Jury: If you find any party listed on the verdict form was not legally responsible in a way that proximately caused plaintiff's injury, then you should enter a zero (0) % as to that party.) ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ Verdict Form adopted January 2010.