Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-5_08-cv-05296/USCOURTS-cand-5_08-cv-05296-37/pdf.json

Nature of Suit Code: 440
Nature of Suit: Other Civil Rights
Cause of Action: 42:1983 Civil Rights Act

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Case No. 5:08-cv-05296-PSG

VERDICT FORM

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United States District Court

For the Northern District of California

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF CALIFORNIA 

SAN JOSE DIVISION

NATHALIE THUY VAN, 

 Plaintiff,

 v. 

WAL-MART STORES, INC.,

 Defendant.

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Case No. 5:08-cv-05296-PSG

VERDICT FORM

 

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Case No. 5:08-cv-05296-PSG

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United States District Court

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VERDICT FORM

Part A. LIABILITY

False Imprisonment

1. Has Van proven, by a preponderance of the evidence, that on November 24, 

2007, Wal-Mart committed the tort of false imprisonment? 

 ___________ ___________ 

 Yes No

Unruh Act

2. Has Van proven, by a preponderance of the evidence, that on November 24, 

2007, Wal-Mart violated the Unruh Act and denied Van full and equal 

accommodations, advantages, facilities, privileges and service of Wal-Mart’s 

business based on her race, ancestry or national origin? 

 ___________ ___________ 

 Yes No

Section 1981

3. Has Van proven, by a preponderance of the evidence, that on November 24, 

2007, Wal-Mart violated Section 1981 and denied Van equal accommodation 

under the law? 

 ___________ ___________ 

 Yes No

Negligent Hiring, Training, Supervision or Retention

4. Has Van proven, by a preponderance of the evidence, that on November 24, 2007 

Wal-Mart committed the tort of negligent hiring, training, supervision or 

retention? 

 ___________ ___________ 

 Yes No

Intentional Infliction of Emotional Distress

5. Has Van proven, by a preponderance of the evidence, that on November 24, 

2007, Wal-Mart committed the tort of intentional infliction of emotional distress 

against her? 

 ___________ ___________ 

 Yes No

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Case No. 5:08-cv-05296-PSG

VERDICT FORM

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United States District Court

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Negligent Infliction of Emotional Distress

6. Has Van proven, by a preponderance of the evidence, that on November 24, 

2007, Wal-Mart committed the tort of negligent infliction of emotional distress? 

 ___________ ___________ 

 Yes No

Negligent Misrepresentation

7. Has Van proven, by a preponderance of the evidence, that on November 24, 

2007, Wal-Mart committed the tort of negligent misrepresentation? 

 ___________ ___________ 

 Yes No

Negligence Claim

8. Has Van proven, by a preponderance of the evidence, that on November 24, 

2007, Wal-Mart was negligent in its conduct toward Van? 

 ___________ ___________ 

 Yes No

If your answer to Question 8 is “Yes,” then please proceed to Question 9. If your answer to 

Question 8 is “No,” proceed directly to Part B.

9. Was Wal-Mart’s negligence a substantial factor in causing harm to Van? 

 ___________ ___________ 

 Yes No

If your answer to Question 9 is “Yes,” then please proceed to Question 10. If your answer to 

Question 9 is “No,” proceed directly to Part B.

10. Was Rainier negligent?

 ___________ ___________ 

 Yes No

If your answer to Question 10 is “Yes,” then please proceed to Question 11. If your answer to 

Question 10 is “No,” proceed directly to Part B.

11. Was Rainier’s negligence a substantial factor in causing Van’s harm?

 ___________ ___________ 

 Yes No

If your answer to Question 11 is “Yes,” then please proceed to Question 12. If your answer to 

Question 11 is “No,” proceed directly to Part B.

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VERDICT FORM

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United States District Court

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12. What percentage of responsibility for Van’s harm do you assign to: 

 Wal-Mart: _____% 

Rainier: _____% 

TOTAL: _100_% 

Please proceed to Part B. 

Part B. DAMAGES

If you answered “Yes” to any or all of Questions 1, 2, 3, 4, 5, 6, 7, 8 or 9, please answer the 

following questions. Otherwise, stop here, answer no further questions, and have the foreperson 

sign and date this form. 

13. What is the total amount of damages, if any, suffered by Van in each category 

described below? Do not award duplicate damages for the same harm suffered 

from multiple claims.

 Compensatory Damages: $________________ 

 Punitive Damages : $________________ 

TOTAL: $________________ 

14. Did Van use reasonable efforts to mitigate her damages?

 ___________ ___________ 

 Yes No

If your answer to Question 14 is “No,” please proceed to Question 15. If your answer to Question 

14 is “Yes,” stop here, answer no further questions, and have the foreperson sign and date this 

form.

15. How much of Van’s damages could have been mitigated by Van’s reasonable 

efforts?

 $________________ 

Dated: ___________________ 

 _________________________________ 

PRESIDING JUROR

After this verdict form has been signed and dated, notify the court that you are ready to present 

your verdict in the courtroom. 

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