ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address): FOR COURT USE ONLY TELEPHONE NO: ATTORNEY FOR (Name): FAX NO: SUPERIOR COURT OF CALIFORNIA · COUNTY OF FRESNO 1130 "O" Street Fresno, California 93724-0002 (559) 457-1909 PLAINTIFF/PETITIONER: DEFENDANT/RESPONDENT: ALTERNATIVE DISPUTE RESOLUTION STATUS REPORT (ADR) Type of Civil Case: Personal Injury ­ Property Damage/Auto Date Complaint Filed: Amount in controversy: $0 to $25,000 $25,000 to $50,000 $50,000 to $100,000 CASE NUMBER: Personal Injury ­ Property Damage Contract Other Over $100,000.00 (specify) Date of Alternative Dispute Resolution (ADR) Conference: Name, address, and telephone number of person who conducted the Alternative Dispute Resolution (ADR) Conference: Case resolved by Alternative Dispute Resolution: Yes No (proper filing of a Notice of Settlement or Dismissal form is required by clerk's office) Reason: Alternative Dispute Resolution process concluded: Yes No Reason for delay: Next scheduled hearing date: Type of resolution process used: Mediation Arbitration Neutral Case Evaluation Case was resolved by: Direct Result of ADR Process Other (specify): Indirect Result of ADR Process Resolution was unrelated to ADR Process If case went through ADR and resolved, estimate the closest dollar amount that was saved in attorney fees and/or expert witness fees by participating in the process. $0 $250 $500 $750 $1,000 More than $1,000 (specify) If case went through ADR and did not resolve, estimate the closest dollar amount of additional costs incurred due to participation in the ADR process. $0 $250 $500 $750 $1,000 More than $1,000 (specify) TADR-03 R11-011 mandatory ALTERNATIVE DISPUTE RESOLUTION STATUS REPORT (ADR) Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Case Number: Check the closest estimated number of court days you saved in motions, hearings, conferences, trials, etc. as a direct result of this case being referred to this dispute resolution process: 0 Days 1 Day More than 1 day (specify) If the dispute resolution process caused an increase in court time for this case, please check the estimated number of additional court days: 0 Days 1 Day More than 1 day (specify) I would be willing to use the dispute resolution process again: Yes No Please provide any additional comments below regarding your experience with the ADR process: TADR-03 R11-11 mandatory ALTERNATIVE DISPUTE RESOLUTION STATUS REPORT (ADR) Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com