Legal Mediation Notification Form

LEGAL MEDIATION NOTIFICATION FORM

This Mediation Notification (the "Notice") is given on by and between Claimant Name: represented by Counsel: and Respondent Name: represented by Counsel: .

RECITALS

WHEREAS, a dispute exists between the parties arising from the matters described in the pleadings in the action captioned , filed in , Case No. .

WHEREAS, the parties have agreed that mediation may facilitate a negotiated resolution of some or all outstanding claims and issues without further court proceedings; and

WHEREAS, the parties wish to provide formal notice of their intent to participate in mediation and to set forth reasonable procedures, scheduling, confidentiality expectations and cost allocation for the mediation process.

NOW, THEREFORE

The parties agree as follows:

1. PURPOSE AND SCOPE

The purpose of the mediation is to address and attempt to resolve the disputes and legal claims identified in the case captioned above. The scope of mediation shall include the following issues and claims:

2. CASE INFORMATION

Court:    Case Number:    Filing Date:

3. MEDIATION PROPOSAL

Proposed Mediator: ; Affiliation or Firm: .

Proposed Mediation Dates/Times (list at least three alternatives): , , .

4. CONFIDENTIALITY

All communications, statements, proposals, admissions of fact, documents prepared for mediation and any settlement discussions made in connection with the mediation are confidential and shall be privileged and inadmissible in any judicial or administrative proceeding to the fullest extent permitted by applicable mediation confidentiality statutes and rules and the common law, except to the extent necessary to enforce a resulting written settlement agreement, to present or defend a claim of professional misconduct, or as otherwise required by operation of law.

The parties agree not to subpoena or compel the mediator or party representatives to disclose mediation communications, except as provided above. Any written settlement agreement that results from mediation is admissible to the extent it is reduced to a signed, enforceable document.

5. AUTHORITY TO SETTLE

Each party warrants that the person signing this Notice for that party or the party's designated representative who attends the mediation will have full authority to negotiate and recommend settlement terms, and will have (or will obtain and bring to the mediation) settlement authority sufficient to permit the party to conclude a binding settlement without further consultation, unless otherwise agreed in writing prior to the mediation.

6. COSTS, FEES AND CANCELLATION

The parties agree that mediator fees and administrative costs shall be allocated as follows:

Cancellation or rescheduling less than 7 days prior to the scheduled mediation may result in fee liability as determined by the mediator's cancellation policy, subject to any contrary agreement of the parties.

7. DOCUMENT EXCHANGE AND PARTICIPATION

The parties shall exchange non-privileged mediation position statements and any agreed supporting materials by: . Position statements shall not exceed pages unless otherwise agreed.

Each party must ensure attendance of counsel and persons with decision-making authority as set forth in Section 5. The parties may also designate a claims adjuster or corporate officer to be present with full settlement authority.

8. CONSENT TO MEDIATION; EFFECT ON LITIGATION

By signing this Notice, the parties express their mutual consent to participate in the mediation process under the terms set forth herein. Participation in the mediation will not, by itself, abate any statute of limitations unless the parties expressly agree in writing. Any agreed stay of litigation must be separately documented.

9. NOTICES

All notices required or permitted under this Notice shall be in writing and delivered to the addresses specified below or to counsel of record for each party. Delivery may be made by personal delivery, certified mail, overnight courier, or email to the primary contact provided below, and shall be effective upon receipt.

10. GOVERNING LAW

This Notice and the mediation conducted pursuant to it shall be governed by and construed in accordance with the laws of the jurisdiction in which the mediation occurs, without regard to rules governing choice of law.

11. ENTIRE AGREEMENT

This Notice constitutes the entire agreement of the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous understandings, agreements, representations and negotiations between the parties, whether oral or written, relating to mediation of the disputes identified herein.

12. SEVERABILITY

If any provision of this Notice is found to be invalid, illegal or unenforceable in any respect, such invalidity, illegality or unenforceability shall not affect any other provision and this Notice shall be construed as if such invalid, illegal or unenforceable provision had never been contained herein.

13. AMENDMENTS; WAIVER; COUNTERPARTS

Any amendment or modification to this Notice must be in writing and signed by authorized representatives of all parties. No waiver of any provision hereof will be effective unless in writing signed by the party waiving such right. This Notice may be executed in one or more counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument.

14. ACKNOWLEDGMENT

The undersigned certify that they are authorized to execute this Notice on behalf of the parties identified and that the information provided herein is true and correct to the best of their knowledge.

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