ADR Providers Statement-Civil Division {CV-5005}

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA ADR PROVIDER'S STATEMENT/CIVIL DIVISION PLEASE MAIL WITHIN 10 DAYS OF THE COMPLETION OF THE ADR PROCESS TO: ELIZABETH STRICKLAND, ADR ADMINISTRATOR SANTA CLARA COUNTY SUPERIOR COURT 191 N. FIRST STREET, SAN JOSE, CA, 95113 OR FAX TO 408-882-2595 Please complete this statement without breaching confidentiality. Case Name: Your Name: ADR Process: Mediation Case No: Your Phone Number: Neutral Evaluation Other (specify): Type of case: Banking Business/Contract Civil Rights Construction Defamation Disabilities Elder Issues/Abuse Environment Health Care Housing Intellectual Property Insurance Labor - Employment Landlord/Tenant Medical Malpractice Neighborhood Partnership Disputes Personal Injury Probate - Wills Professional Negligence Real Estate Securities Tax Other (specify) Preparation time: hours Total length of ADR sessions hours No. of sessions: Total fee for ADR process for all parties (include any charges for administration, preparation, travel, etc.): $ How did the case resolve? Full resolution Partial resolution Other (specify): No resolution The case did not fully resolve because: Additional discovery was necessary One or more of the parties did not have authority to settle Other (specify): For Mediators Only: Was your primary style in this case Did the parties or counsel ask about the law? Did you discuss the relevant law? For Neutral Evaluators Only: Following your evaluation did you: Conduct a mediation? Conduct a settlement conference? Provide case management assistance? An essential party did not participate The parties reached an impasse Facilitative Yes Yes Directive/Evaluative No No Yes Yes Yes No No No Specify: Yes No Did you give evaluation forms to the parties and counsel? Comments on any of the above matters or on administration of the ADR program: ADR PROVIDER'S STATEMENT/CIVIL DIVISION CV-5005 REV 4/06 American LegalNet, Inc. www.FormsWorkflow.com