Mediation Certificate Template

Mediation Certificate

This Mediation Certificate is executed as of by and between Mediator Name: (Mediator) and Lead Participating Party Name: (Participant).

RECITALS

WHEREAS, the parties named above agreed to submit certain disputes to non-binding mediation administered by the Mediator for the purpose of attempting a negotiated resolution of contested matters; and

WHEREAS, the Mediator conducted one or more mediation sessions attended by the Participant and such representatives, counsel, or other persons as are listed below, and the Mediator has personal knowledge of the matters certified herein; and

WHEREAS, this Certificate is intended to record attendance, the result of the mediation proceedings, any settlement terms agreed to, and the Mediator's certification regarding confidentiality and filing for the limited purposes set forth below.

NOW, THEREFORE, in consideration of the recitals and the representations set forth herein, the Mediator hereby certifies as follows:

1. MEDIATION ATTENDANCE AND LOGISTICS

The Mediator certifies that mediation sessions were conducted commencing on and concluding on at the following location:

2. MEDIATION OUTCOME

The Mediator hereby certifies the result of the mediation as indicated below. The selection checked below reflects the outcome as determined by the Mediator at the conclusion of the session(s).

Settlement reached in whole or in part; terms are set forth in the settlement summary field below.

No settlement reached.

3. CONFIDENTIALITY AND LIMITATIONS

The Mediator affirms that the mediation communications and documents were treated as confidential in accordance with applicable mediation confidentiality rules and agreed procedures. This Certificate is limited to confirmation of attendance, the date(s) and duration of the mediation, and the existence or non-existence of a settlement. This Certificate does not disclose the substance of privileged communications unless the parties have expressly authorized disclosure in writing.

The Participant acknowledges that this Certificate is not intended to constitute a waiver of any applicable privilege, nor is it an admission by any party of liability or of the truth of any allegation.

4. FEES AND COSTS

The Mediator further certifies the fees and costs associated with the mediation as follows:

5. FILING AND COURT NOTIFICATION

The Mediator certifies whether this Certificate was submitted or filed and to whom it was delivered as indicated below.

Certificate filed with court or tribunal.

Certificate not filed with court or tribunal.

6. MEDIATOR CERTIFICATION

I, the undersigned Mediator, certify under penalty of perjury to the best of my knowledge and belief that the foregoing is true and correct and that I am duly authorized to issue this Certificate. This certification is limited to the matters expressly set forth herein and does not constitute an evidentiary finding on the merits of any underlying dispute.

7. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

This Certificate shall be governed by and construed in accordance with the laws of the jurisdiction agreed to by the parties. This Certificate constitutes the entire understanding between the parties with respect to the matters certified herein. If any provision of this Certificate is determined to be invalid or unenforceable, that determination shall not affect the remaining provisions, which shall continue in full force and effect.

8. NOTICES; AMENDMENT; COUNTERPARTS

All notices required or permitted hereunder shall be in writing and delivered in accordance with any notice provisions agreed by the parties. This Certificate may be amended only by a writing signed by the Mediator and the Participant. This Certificate may be executed in counterparts, each of which shall be an original and all of which together shall constitute one instrument.

9. AUTHORIZED REPRESENTATIVES

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