PARTY: (Name and Address): TELEPHONE NO: FAX NO. (Optional): E-MAIL ADDRESS (Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF CONTRA COSTA MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: P.O. BOX 911 MARTINEZ, CA 94553 MARTINEZ DO NOT SEND THIS FORM TO THE COURT CASE NAME: CASE NUMBER: NEUTRAL CASE EVALUATION SUMMARY PARTIES MUST PREPARE AND GIVE INFORMATION ABOUT THEIR CASE TO THE NEUTRAL CASE EVALUATOR AND THE OTHER PARTIES AT LEAST FIVE COURT DAYS BEFORE THE EVALUATION HEARING. YOU MAY USE THIS FORM OR WRITE THE INFORMATION ON YOUR OWN PAPER. EVALUATION STATEMENTS MUST BE 5 PAGES OR LESS. 1. The name and title (or relationship to the case) of all people who will attend neutral case evaluation are as follows: ________________________________________________ ______________________________________________ (NAME) ________________________________________________ (TITLE) ______________________________________________ (NAME) ________________________________________________ (TITLE) ______________________________________________ (NAME) ________________________________________________ (TITLE) ______________________________________________ (NAME) 2. (TITLE)  More information attached to this form. The important issues in this case are as follows: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________  More information attached to this form. 3. I believe that the liability and damages in this case are as follows: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________  More information attached to this form. ADR-504/Rev. 07/20/07 American LegalNet, Inc. www.FormsWorkflow.com 4. Summary of the history of this case and any settlement discussions: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________  More information attached to this form. 5. The documents listed below will help the neutral case evaluator to better understand the issues in dispute: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________  More information attached to this form. 6. Other comments: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________  More information attached to this form. Date: ________________________________________________ (TYPE OR PRINT NAME OF PARTY SUBMITTING THIS EVALUATION STATEMENT) ADR-504/Rev. 07/20/07 ______________________________________________ (SIGNATURE OF PARTY SUBMITTING THIS EVALUATION STATEMENT) American LegalNet, Inc. www.FormsWorkflow.com