Free Stipulation - District Court of Arizona - Arizona

Exhibit A

Exhibit A

Doc. #493280 v.1

Case 2:04-cv-00347-FJM

Document 156-2

Filed 03/03/2006

Page 1 of 5

FORM OF VERDICT ONE (use one of the two alternatives below)

We, the Jury, duly empaneled and sworn in the above entitled action, upon our oaths, do find in favor of plaintiff Northland on its breach of contract claim regarding the Valdez matter, and find the full damages to be $ ________________.

_________________________________ FOREMAN

We, the Jury, duly empaneled and sworn in the above entitled action, upon our oaths, do find in favor of defendant Correctional Medical Services, Inc., on the breach of contract claim regarding the Valdez matter.

_________________________________ FOREMAN

Doc. #493280 v.1

Case 2:04-cv-00347-FJM

Document 156-2

Filed 03/03/2006

Page 2 of 5

FORM OF VERDICT TWO (use one of the two alternatives below)
We, the Jury, duly empaneled and sworn in the above entitled action, upon our oaths, do find in favor of plaintiff Northland on its indemnification claim regarding Mr. Perez, and find the full damages to be $ ________________. We find the relative degrees of fault to be: (If a party [or nonparty] listed below is not at fault, put a zero (0) on the percentage line for that party [or nonparty].)

Defendant Correctional Medical Services, Inc.

________%

[Other (Correctional Services Corporation)]

________%

[Other (State of Arizona)]

________%

[Other (Maricopa County)]

________%

_________________________________ FOREMAN We, the Jury, duly empaneled and sworn in the above entitled action, upon our oaths, do find in favor of defendant Correctional Medical Services, Inc., on the indemnification claim regarding the Perez matter.

_________________________________ FOREMAN

Doc. #493280 v.1

Case 2:04-cv-00347-FJM

Document 156-2

Filed 03/03/2006

Page 3 of 5

FORM OF VERDICT THREE (use one of the alternatives below)
We, the Jury, duly empaneled and sworn in the above entitled action, upon our oaths, do find in favor of plaintiff Northland on its fraud claim against Correctional Medical Services, and find the full damages to be $ ________________.

_________________________________ FOREMAN

We, the Jury, duly empaneled and sworn in the above entitled action, upon our oaths, do find in favor of defendant Correctional Medical Services, Inc., on the fraud claim against Correctional Medical Services.

_________________________________ FOREMAN

Doc. #493280 v.1

Case 2:04-cv-00347-FJM

Document 156-2

Filed 03/03/2006

Page 4 of 5

FORM OF VERDICT FOUR (use one of the two alternatives below)
We, the Jury, duly empaneled and sworn in the above entitled action, upon our oaths, do find in favor of plaintiff Northland on its breach of contract claim regarding the Perez matter, and find the full damages to be $ ________________.

_________________________________ FOREMAN

We, the Jury, duly empaneled and sworn in the above entitled action, upon our oaths, do find in favor of defendant Correctional Medical Services, Inc., on the breach of contract claim regarding the Perez matter.

_________________________________ FOREMAN

Doc. #493280 v.1

Case 2:04-cv-00347-FJM

Document 156-2

Filed 03/03/2006

Page 5 of 5