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Alternative Dispute Resolution Statement

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REPORT OF REFEREE

REFEREE (Name, State Bar number, if applicable, and address):

TELEPHONE NO.:

E-MAIL ADDRESS (Optional):

ADR-111

FOR COURT USE ONLY

FAX NO. (Optional):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF

STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT:

CASE NUMBER:

REPORT OF REFEREE

1. Appointment. The undersigned referee was appointed as follows:

a. Date. By order dated:

b. Statutory authority. Referee was appointed under (check one):

(1) Code of Civil Procedure section 638.

(2) Code of Civil Procedure section 639.

2. Submission. The hearing, if any, was concluded and the matter was submitted on (date):

3. Referee's time and fees. (All items must be completed if referee was appointed under section 639.)

a. Total hours spent by referee:

b. Total fees charged by referee:

c. Referee recommends the following allocation of payment of referee's fees (state the recommended allocation below or in Attachment 3c):

4. Recommendation on the merits. (State the recommendation on the merits of any disputed issues below or in Attachment 4.)

5. Pages and attachments. Number of pages attached:

Date:

Form Approved for Optional Use

Judicial Council of California

ADR-111 [New January 1, 2006]

REPORT OF REFEREE

(Alternative Dispute Resolution)

Page 1 of 2

electronic form © 2005

WWW.LawCA.com

Law Publishers

Code of Civil Procedure, § 643


PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT:

ADR-111

CASE NUMBER:

DECLARATION OF SERVICE OF REPORT OF REFEREE

1. I am at least 18 years of age, not a party to this action, and I am a resident of or employed in the county where the mailing took place.

2. My residence or business address is:

3. I served a copy of the Report of Referee (Alternative Dispute Resolution) (form ADR-111) by enclosing it in a sealed envelope with postage fully prepaid, as follows:

a. I deposited the sealed envelope with the United States Postal Service with the postage fully prepaid.

b. I placed the envelope for collection and processing for mailing following this business's ordinary practice with which I am readily familiar. On the same day that correspondence is placed for collection and mailing, it is deposited in the ordinary course of business with the United States Postal Service.

c. Date of deposit:

d. Place of deposit (city and state):

e. Addressed as follows (name and address of each party):

4. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Date:

ADR-111 [New January 1, 2006]

REPORT OF REFEREE

(Alternative Dispute Resolution)

Page 2 of 2

Enter text

What the Alternative Dispute Resolution Statement Is

An Alternative Dispute Resolution Statement records the parties' agreed method for resolving disputes outside of court, typically arbitration or mediation. It identifies the selected ADR process, scope, timing, and any limits or exclusions, and it becomes part of the underlying contract or transaction when signed by the parties.

Why an ADR Statement Matters for Contract Certainty

Including a clear ADR Statement reduces litigation risk, clarifies expectations about dispute handling, and helps control cost and timing when conflicts arise.

Why an ADR Statement Matters for Contract Certainty

Who Typically Prepares and Signs an ADR Statement

ADR Statements are used by organizations and individuals who prefer private dispute resolution rather than court litigation.

  • Commercial parties and procurement teams seeking predictable dispute timelines and cost control.
  • Healthcare and financial services that require confidentiality and faster resolution than public court records provide.
  • Landlords, tenants, and real estate professionals including ADR clauses in leases and closing documents.

When included early in agreements, ADR Statements provide actionable procedures that reduce the need for immediate litigation and support enforceability.

Core Components to Include in a Professional ADR Statement

A well-drafted ADR Statement is concise but complete: it names the process, sets scope, selects rules and venue, defines arbitrator selection, and addresses confidentiality, remedies, and costs.

Process Type

Specify arbitration, mediation, or staged ADR and whether attendance is mandatory.

Scope

Define which claims and parties are covered, and explicitly note any carve-outs such as injunctive relief.

Governing Rules

Name the procedural rules (e.g., AAA or JAMS) or use bespoke rules tailored to the relationship.

Arbitrator Selection

Describe selection method, number of arbitrators, and qualifications required.

Location & Law

Identify governing substantive law and the seat/venue for arbitration or mediation.

Costs & Confidentiality

Allocate hearing fees, arbitrator fees, and confidentiality obligations including document treatment.

Required Information Commonly Captured in an ADR Statement

Parties: Full legal names
Process Type: Arbitration or mediation
Scope: Covered claims defined
Governing Law: State or federal law
Arbitrator Count: One or three arbitrators
Signature Date: MM/DD/YYYY

Step-by-Step: Completing an ADR Statement

Follow these steps to ensure the ADR Statement is enforceable and aligns with the main agreement.

  • 01
    Identify Process: Choose arbitration or mediation
  • 02
    Define Scope: List claims included and excluded
  • 03
    Select Rules: Name AAA, JAMS, or custom rules
  • 04
    Sign and Date: All parties sign and date

How to Configure an Online ADR Signing Workflow

Set up an eSignature workflow that records intent, provides proper authentication, and retains an audit trail.

Field Configuration
Signer Order Define sequential or parallel signing
Authentication Email, SMS code, or stronger KBA
Required Fields Make names, dates, and signature mandatory
Retention Store PDF and audit trail

Where to Send or File the Completed ADR Statement

Determine the destination based on the parties' needs and any contract filing requirements.

  • Counterpart Exchange: Each party retains an executed copy
  • Contract Folder: Attach to the master agreement file
  • Repository: Store in secure document management
  • Arbitration Provider: File with AAA/JAMS if required

Options for Digital Signing and eSubmission

Use an eSignature platform that captures consent, attribution, and an auditable record.

  • File Formats: PDF | DOCX supported
  • Integrations: Salesforce | NetSuite | Google Workspace
  • Authentication: Email | SMS | KBA

Ensure the provider offers retention, export to PDF/A, and a cryptographic audit trail when required by regulation.

Timing Considerations and Typical Deadlines

ADR Statements affect statutory and contractual deadlines; track any pre-dispute notice periods and arbitration filing windows.

Effective Date:

Date of signature governs applicability

Notice Period:

Follow contract-specified cure or notice windows

Filing Deadline:

Arbitration provider deadlines vary

Statute of Limitations:

Substantive law determines timing

Records Retention:

Keep executed copies per retention rules

Common Mistakes to Avoid When Preparing an ADR Statement

  • Using vague process descriptions that invite interpretation disputes.
  • Failing to specify governing law and arbitration seat clearly.
  • Omitting how arbitrators are selected or their qualifications.
  • Neglecting to state cost allocation or confidentiality rules.

Risks and Consequences of a Defective ADR Statement

Unenforceable Clause: Court may decline to enforce
Class Action Risk: Class waiver may be invalidated
Consumer Statutes: State consumer law can limit enforceability
Confidentiality Breach: Leads to damages and reputational harm
Remedy Loss: Certain equitable relief may remain available
Increased Costs: Poor drafting can raise arbitration expense

eSignature Vendor Comparison for Signing ADR Statements

Compare commonly requested vendor features for eSigning ADR Statements; signNow is listed first for reference.

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Bulk Send Yes Yes Yes Yes Yes
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No
Envelope Cap No cap 100 envelopes/user/year Varies by plan Varies by plan Varies by plan

Examples: How Organizations Use an ADR Statement

Real-world examples show common ADR Statement uses across sectors and transaction types.

Optica Ventures

A real estate investor added an arbitration clause to leases to reduce litigation risk.

  • The clause limited claims to lease disputes.
  • Resulting disputes were resolved faster and confidentially, saving court costs and preserving tenant relationships.

Fertility Centers

A healthcare provider added mediation steps before arbitration for patient disputes.

  • Mediation encouraged settlement.
  • This preserved patient confidentiality, reduced adversarial proceedings, and aligned with HIPAA requirements for handling health information.

Practical Tips for Clear, Enforceable ADR Statements

Follow plain-language drafting, explicit scope, and reasonable procedural rules to improve enforceability and reduce disputes about the clause itself.

Be Specific
Name the ADR process, rules, seat, and governing law to minimize interpretive disputes.
Preserve Equitable Relief
Carve out injunctive or emergency relief if immediate court action may be needed.
Address Costs
Allocate arbitrator and administrative fees, and consider fee-shifting for frivolous claims.
Confirm Consent
Document parties’ consent to electronic signatures and include consumer disclosures when required.

Frequently Asked Questions About ADR Statements

Answers to common questions about enforceability, eSigning, revocation, and state differences for ADR Statements.


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