Fill and Sign the Name of Court Adr Information Form

NAME OF COURT: ADR Information Form This form should be filled out and returned, within 10 days of the resolution of the dispute, to: No. 1. Case name: Other (specify) : PI/PD-Other PI/PD-Auto Contract 2. Type of civil case: Date case resolved 3. Date complaint filed 5. Number of parties 4. Date of ADR conference over $100,000 (specify): $0–$25,000 $50,000–$100,000 $25,000–$50,000 6. Amount in controversy 8.Defendant's Attorney Cross Defendant's Attorney Plaintiff's Attorney Cross Complainant's Attorney 7. ADDRESS TELEPHONE NUMBER TELEPHONE NUMBER 9. Please indicate your relationship to the case: Defendant's attorney PlaintiffDefendant Plaintiff's attorney Other (specify) : 3rd party defendant 3rd party defendant's attorney 10. Dispute resolution process: Mediation Neutral case evaluationOther (specify) : Arbitration 11. How was case resolved? a. As a direct result of the ADR process. b. As an indirect result of the ADR process. Resolution was unrelated to ADR process. c. Check the closest dollar amount that you estimate you saved (attorneys \ fees, expert witness fees, and other costs) by using this dispute resolution process compared to resolving this case through \ litigation, whether by settlement or trial. $0 $250 $500 $1,000 $750 more than $1,000 (specify): $ If the dispute resolution process caused a net increase in your costs in\ this case, check the closest dollar amount of the additional cost: $0 $250 $500 $1,000 $750 more than $1,000 (specify): $ Check the closest number of court days that you estimate the court saved\ (motions, hearings, conferences, trial, etc.) as a result of this case being referred to this dispute resolution process: 1 day more than 1 day (specify): 0 If the dispute resolution process caused a net increase in court time fo\ r this case, check the closest number of additional court days: 1 day more than 1 day (specify): 0 No Would you be willing to consider using this dispute resolution process a\ gain?Yes ADR INFORMATION FORM Form Adopted by the Judicial Council of California ADR-101 [New March 1, 1994] NAME ( ) ADDRESS NAME ( ) 12. 13. 14. 15. 16.