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

FREDERICK JACKSON, ASHLEY NICOLE

JACKSON, and BRIANA FREDRANIQUE

ANNETTE JACKSON, 

Plaintiffs,

 v.

G. LOMBARDI, individually and as an officer of the

City of Pittsburg Police Department (Badge # 275),

C. SMITH, individually and as an officer of the City

of Pittsburg Police Department (Badge # 285),

P. DUMPA, individually and as an officer of the

City of Pittsburg Police Department (Bade # 291),

and WILLIAM BLAKE HATCHER, individually

and as an officer of the City of Pittsburg Police

Department (Badge # 274), 

Defendants. /

No. C 09-01016 WHA

SPECIAL VERDICT FORM

Case 3:09-cv-01016-WHA Document 195 Filed 07/21/10 Page 1 of 5
United States District Court

For the Northern District of California

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1. FREDERICK JACKSON:

A. With respect to the tasing, has plaintiff Frederick Jackson proven

that any of the following officers used excessive force against him in violation of

the Fourth Amendment? 

 Yes No

Officer Lombardi ____________ ___________

Officer Smith ____________ ___________

Officer Dumpa ____________ ___________

B. With respect to the alleged slamming against the vehicle, has

plaintiff Frederick Jackson proven that any of the following officers used

excessive force against him in violation of the Fourth Amendment? 

 Yes No

Officer Hatcher ____________ ___________

Officer Smith ____________ ___________

C. With respect to his arrest, has plaintiff Frederick Jackson proven

that any of the following officers arrested him without probable cause in violation

of the Fourth Amendment? 

 Yes No

Officer Lombardi ____________ ___________

Officer Smith ____________ ___________

Officer Dumpa ____________ ___________

Case 3:09-cv-01016-WHA Document 195 Filed 07/21/10 Page 2 of 5
United States District Court

For the Northern District of California

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D. With respect to the tasing, has plaintiff Frederick Jackson proven

that any of the following officers tased him in retaliation for using speech

protected by the First Amendment? 

 Yes No

Officer Lombardi ____________ ___________

Officer Smith ____________ ___________

Officer Dumpa ____________ ___________

E. With respect to the alleged slamming against the vehicle, has

plaintiff Frederick Jackson proven that any of the following officers slammed him

against a vehicle in retaliation for using speech protected by the First

Amendment? 

 Yes No

Officer Hatcher ____________ ___________

Officer Smith ____________ ___________

F. With respect to his arrest, has plaintiff Frederick Jackson proven

that any of the following officers arrested him in retaliation for using speech

protected by the First Amendment? 

 Yes No

Officer Lombardi ____________ ___________

Officer Smith ____________ ___________

Officer Dumpa ____________ ___________

G. If you have answered “yes” to any of the foregoing questions, state

the amount of damages proven for each category of alleged conduct for which

you have answered “yes.” The total damages award, if any, must be apportioned

by you into the three categories shown, i.e., the three categories must add up to

Case 3:09-cv-01016-WHA Document 195 Filed 07/21/10 Page 3 of 5
United States District Court

For the Northern District of California

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the total (if any). (If no damages have been proven but you nonetheless have

found a constitutional violation, you may award nominal damages up to one

dollar.) 

Tasing $____________________

Slamming $____________________

Arrest $____________________

Total $____________________

2. ASHLEY JACKSON:

A. Has plaintiff Ashley Jackson proven that Officer Lombardi used

excessive force against her on March 30, 2008, in violation of the Fourth

Amendment? 

Yes __________ No __________

B. If so, state the amount of any damages proven (or indicate up to

one dollar in nominal damages): 

 $_______________

3. BRIANA JACKSON:

A. Has plaintiff Briana Jackson proven her claim of negligent

infliction of emotional distress as to any of the following defendants? 

 Yes No

Case 3:09-cv-01016-WHA Document 195 Filed 07/21/10 Page 4 of 5
United States District Court

For the Northern District of California

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Officer Lombardi ____________ ___________

Officer Smith ____________ ___________

Officer Dumpa ____________ ___________

B. If so, state the amount of any damages proven: 

 $_______________

4. If you have answered “yes” to any of Questions 1 and 2, state whether plaintiffs

have proven by clear and convincing evidence that punitive damages should be awarded against

any officer you find violated any Fourth Amendment rights: 

 Yes No

Officer Lombardi ____________ ___________

Officer Smith ____________ ___________

Officer Dumpa ____________ ___________

Officer Hatcher ____________ ___________

If you answer “yes” as to this question, then there will be a short supplemental

proceeding immediately after your verdict. The purpose of the short supplemental proceeding

would be to allow you to fix the amount of any punitive damages. 

ONCE YOU HAVE FINISHED ANSWERING THE NECESSARY QUESTIONS UNANIMOUSLY,

PLEASE HAVE THE FOREPERSON SIGN AND DATE THIS FORM. THEN CONTACT THE DEPUTY OR

MARSHAL TO INFORM HIM OR HER THAT YOU HAVE COMPLETED YOUR DELIBERATIONS. 

Dated: July ___, 2010. ______________________________________

 FOREPERSON

Case 3:09-cv-01016-WHA Document 195 Filed 07/21/10 Page 5 of 5