Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_07-cv-01090/USCOURTS-cand-3_07-cv-01090-16/pdf.json

Nature of Suit Code: 710
Nature of Suit: Fair Labor Standards Act
Cause of Action: 29:201 Fair Labor Standards Act

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United States District Court

For the Northern District of California

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IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF CALIFORNIA

WILFREDO BALCE,

Plaintiff,

 v.

LUCKY CHANCES, INC,

Defendant. /

No. C 07-01090 JSW

COURT’S PROPOSED SPECIAL

VERDICT FORM

Fair Labor Standards Act Claim

Do you find by a preponderance of the evidence:

1. That defendant Lucky Chances proved Mr. Balce’s primary duty was the

management of the enterprise in which he is employed or of a customarily recognized

department or subdivision thereof? 

Answer Yes or No ____________

2. That Lucky Chances proved Mr. Balce customarily and regularly directed the

work of two or more other employees? 

Answer Yes or No ____________

3. That Lucky Chances proved Mr. Balce had the authority to hire or fire other

employees or Mr. Balce’s suggestions and recommendations as to the hiring or firing and as to 

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United States District Court

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the advancement and promotion or any other change of status of other employees were given

particular weight? 

Answer Yes or No ____________

(If you answered Yes to Questions 1, 2, and 3, then proceed to Question 6.)

4. That Lucky Chances, Inc. failed to pay Mr. Balce the overtime pay required by

the Fair Labor Standards Act?

Answer Yes or No ____________

(If you answered No to Question 4, then proceed to Question 6.)

5. That Mr. Balce should be awarded $_________ for earned but unpaid overtime

under the Fair Labor Standards Act.

(After answering Question 5, proceed to Question 6.)

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United States District Court

For the Northern District of California

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Overtime under California Law

Do you find by a preponderance of the evidence:

6. That Mr. Balce was employed by Lucky Chances?

Answer Yes or No ____________

(If you answered No to Question 6, sign and date the form where indicated on the last page

without responding to any further questions and return the form to the clerk or court security

officer.)

7. That Lucky Chances proved Mr. Balce’s duties and responsibilities involved the

management of the enterprise in which he is employed or of a customarily recognized

department or subdivision thereof?

Answer Yes or No ____________

8. That Lucky Chances proved Mr. Balce customarily and regularly directed the work of

two or more other employees therein? 

Answer Yes or No ____________

9. That Lucky Chances proved Mr. Balce had the authority to hire or fire other employees

or Mr. Balce’s suggestions and recommendations as to the hiring or firing and as to the

advancement and promotion or any other change of status of other employees were given

particular weight? 

Answer Yes or No ____________

10. That Lucky Chances proved Mr. Balce customarily and regularly exercised discretion

and independent judgment?

Answer Yes or No ____________

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11. That Lucky Chances proved Mr. Balce spent over fifty percent (50%) of his time

performing management job duties?

Answer Yes or No ____________

(If you answered Yes to Questions 7, 8, 9, 10, and 11, sign and date the form where indicated on

the last page without responding to any further questions and return the form to the clerk or

court security officer.)

12. That Lucky Chances, Inc. failed to pay Mr. Balce the overtime pay required by

California law?

Answer Yes or No ____________

(If you answered No to Question 12, then proceed to Question 14.)

13. That Mr. Balce should be awarded $_________ as earned but unpaid overtime under

California law.

(After answering Question 13, proceed to Question 14.)

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Itemized Wage Statements under California Law

Do you find by a preponderance of the evidence:

14. That the itemized wage statements Lucky Chances provided to Mr. Balce accurately set

forth all the hours he worked and all the wages he earned, including wages for overtime?

Answer Yes or No ____________

(If you answered Yes to Question 14, then proceed to Question 16.)

15. That Mr. Balce should be awarded $_________ as damages for the failure to provide

accurate itemized wage statements.

(After answering Question 15, proceed to Question 16.)

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Meal Periods under California Law

Do you find by a preponderance of the evidence:

16. That Mr. Balce was provided the opportunity to take a 30 minute, uninterrupted meal

period every day he worked in excess of six hours?

Answer Yes or No ____________

(If you answered Yes to Question 16, then proceed to Question 20.)

17. That Mr. Balce was denied the opportunity to take how many meal breaks? ________

18. That Mr. Balce’s regular rate was? ________

19. That Mr. Balce should be awarded $_________ for meal breaks for which he was not

provided an opportunity to take.

(After answering Question 19, proceed to Question 20.)

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Rest Periods under California Law

Do you find by a preponderance of the evidence:

20. That Mr. Balce was provided the opportunity to take a 10 minute rest break for every 4

hours he worked?

Answer Yes or No ____________

(If you answered Yes to Question 20, then proceed to Question 24.)

21. That Mr. Balce was denied the opportunity to take how many rest breaks? ______

22. That Mr. Balce’s regular rate was? _________

23. That Mr. Balce should be awarded $_________ for rest breaks for which he was not

provided an opportunity to take.

(After answering Question 23, proceed to Question 24.)

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United States District Court

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Waiting Time Penalties under California Law

Do you find by a preponderance of the evidence:

24. That Mr. Balce received all wages owed to him at the time of his termination?

Answer Yes or No ____________

(If you answered Yes to Question 24, then sign and date the form where indicated below without

responding to any further questions and return the form to the clerk or court security officer.)

25. That Lucky Chances’ failure to regard Mr. Balce as a non-exempt employee was a

willful failure to pay him his earned wages?

Answer Yes or No ____________

(If you answered No to Question 25, then sign and date the form where indicated below without

responding to any further questions and return the form to the clerk or court security officer.)

26. That Mr. Balce’s daily wage was? ______

27. That Mr. Balce should be awarded $_________ in waiting time penalties.

Please return this form to the clerk or court security officer.

Dated: ______________, 2008 ________________________

FOREPERSON

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For the Northern District of California

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Dated: August 27, 2008 

JEFFREY S. WHITE

UNITED STATES DISTRICT JUDGE

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