Superior Court of California, County of Alameda René C. Davidson Courthouse Alternative Dispute Resolution (ADR) Program 1225 Fallon Street, Room 109 Oakland, CA 94612 Ph: (510) 891-6055 Fax: (510) 267-5727 adrprogram@alameda.courts.ca.gov www.alameda.courts.ca.gov/adr NOTICE OF MEDIATOR SELECTION FORM Case Name: Assigned Judge: Case No.: Dept.: Plaintiff/Plaintiff's counsel/Cross Complainant Defendant/Defense counsel/Cross Defendant (Person filing the lawsuit or counterclaim) Name: Phone: Address: email: Name: Phone: Address: email: (Person being sued or countersued) Name: Phone: Address: email: Name: Phone: Address: email: All counsel and parties to this case represent that has been contacted, informed that this is a court mediation case, and is willing to: a. Accept the case and be appointed as mediator and, (the completion deadline). b. Mediate this case before I, with the selection of this mediator. (mediator) represent that all counsel and parties to this case agree Your Signature Date NOTE: If you have been ordered to advise the assigned judge as to the selection of the neutral; you should notify the judge in addition to this Notice of Mediator Selection. File this Mediator Selection Form via delivery, fax or mail to: Rene' C. Davidson Courthouse, 1225 Fallon Street, Room 109, Oakland, CA 94612 OR Hayward Hall of Justice, 24405 Amador Street, Hayward, CA 94544 Rev. Jan 2013 gal American LegalNet, Inc. www.FormsWorkFlow.com