Case Document 367 Filed 10/20/16 Page 1 of 5 mm* . IN THE UNITED STATES DISTRICT COURT 0 0 FOR THE SOUTHERN DISTRICT OF MISSISSIPPI CT 0 2915 SOUTHERN DIVISION ARTHUR JOHNSTON 3* . DEPUTY WANDA WILLIAMS, Individually and as Conservator for John Robert Williams, Jr., Incapacitated PLAINTIFF V. Civil No. CG MANITOWOC CRANES, LLC DEFENDANT SPECIAL VERDICT FORM PART 1: Question Number One: On Plaintiff Wanda Williams? claim brought on behalf of Mr. John Robert Williams, Jr., against Defendant Manitowoc Cranes, LLC, that the Model 16000 crane failed to contain adequate warnings or instructions as to the danger of falling counterweights, we the jury ?nd by a preponderance of the evidence in favor of: (Please choose only one.) Plaintiff Wanda Williams Defendant Manitowoc Cranes, LLC Please proceed to Question Number Two. Page 1 of 5 Case Document 367 Filed 10/20/16 Page 2 of 5 Question Number Two: On Plaintiff Wanda Williams? claim brought on behalf of Mr. John Robert Williams, Jr., against Defendant Manitowoc Cranes, LLC, that the Model 16000 crane failed to contain adequate warnings or instructions as to the danger of tandem lifts, we the jury ?nd by a preponderance of the evidence in favor of: (Please choose only one.) Plaintiff Wanda Williams Defendant Manitowoc Cranes, LLC If you found in favor of Plaintiff Wanda Williams in either Question Numbers One or Two, please proceed to Question Number Three. If you found in favor of Defendant Manitowoc Cranes, LLC, on both Question Numbers One and Two, you should not proceed further in Part I, but should proceed to Part II of the Special Verdict Form. Question Number Three: What damages, if any, do you ?nd by a preponderance of the evidence would be reasonable compensation for the injuries actually sustained, if any, by Mr. John Robert Williams, as a result of the June 25, 2014, tip-over of the Manitowoc Model 16000 crane bearing Serial No. 1132? (Do not reduce these amounts for any percentage of fault attributable to other parties since the Court will address this.) Actual Economic Damages 7, Noneconomic Damages m? Total Please proceed to Question Number Four. Page 2 of 5 Case Document 367 Filed 10/20/16 Page 3 of 5 Question Number Four: Has Plaintiff Wanda Williams proved by a preponderance of the evidence her loss of consortium claim against Defendant Manitowoc Cranes, Yes No If your Answer to Question Number Four is ?Yes, proceed to Question Number Five. If your Answer to Question Number Four is ?No, you should proceed to Question Number Six. Question Number Five: What damages, if any, do you ?nd by a preponderance of the evidence were incurred by Plaintiff Wanda Williams resulting from the injury to her husband, Mr. John Robert Williams, Jr.? (Do not reduce these amounts for any percentage of fault attributable to other parties since the Court Will address this.) $507; an? Please proceed to Question Number Six. Question Number Six: Do you ?nd by a preponderance of the evidence that the negligence, if any, of Mr. John Robert Williams, or the negligence, if any, of VT Halter Marine, Inc., proximately caused or contributed to cause Mr. John Robert Williams, r.?s injuries? Yes No If your Answer to Question Number Six is ?Yes, please proceed to Question Number Seven. If your Answer to Question Number Six is ?No, you should not proceed further in Part I, but should proceed to Part II of the Special Verdict Form. Page 3 of 5 Case Document 367 Filed 10/20/16 Page 4 of 5 Question Number Seven: What percentage of fault, if any, do you ?nd by a preponderance of the evidence should be attributed to each responsible party? (The total must equal 100%. If a party?s conduct was not negligent or did not proximately cause Mr. ,Williams? injury, please assess 0% fault as to that party.) Manitowoc Cranes, LLC John Robert Williams, Jr. /0 VT Halter Marine, Inc. 6 '0 Total 100% Please proceed to Part II. Page 4 of 5 Case Document 367 Filed 10/20/16 Page 5 of 5 PART II: FINALIZATION OF THE VERDICT FORM Please date and sign below: Waqaa/? n2 tad Foreperson Juror uror Juror Juror urolU Juror Juror Page 5 of 5