ADR NEUTRAL NAME, ADDRESS, TELEPHONE, FAX AND EMAIL: NEUTRAL TYPE: Mediator Arbitrator Neutral Evaluator STATE BAR NUMBER Settlement Officer SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES ADR NEUTRAL CONFIRMATION I, ___________________________________, hereby accept my appointment to the Los Angeles Superior Court Alternative Dispute Resolution (ADR) Panel and agree to abide by all applicable California statutes, rules, policies and procedures, and requirements. I certify that I am aware of and agree to comply with: For Mediators: 1) Evidence Code sections 1115-1128; 2) Code of Civil Procedure sections 1775-1775.15; 3) California Rules of Court, rules 3.850-3.860, Rules of Conduct for Mediators in Court-Connected Mediation Programs for Civil Cases; 4) California Rules of Court, rules 3.865-3.872, Requirements for Addressing Complaints About CourtProgram Mediators; 5) California Rules of Court, rules 3.890-3.898; and 6) The Court’s requirement to hold, and meet all requirements to maintain, a valid license in my represented profession during the pendency of my membership on the mediation panel. For Arbitrators: 7) Code of Civil Procedure sections 1141.10-1141.31; 8) California Rules of Court, including rules 3.810-3.830; 9) Applicable provisions of canon 6 of the Code of Judicial Ethics; and 10) The Court’s requirement to maintain active or inactive membership in good standing with the California State Bar. For All ADR Neutrals (including Neutral Evaluators and Settlement Officers): 11) Local Rules, 3.25 (d) & (g); 12) Courtroom Usage Policy for ADR Hearings; 13) Court Policy on Neutrals Charging Fees; 14) Court Policy for Continuance of Court ADR Hearing; 15) Request for Compensation Procedures; 16) The Court’s continuing membership requirements applicable to the panel(s) to which I am appointed; and 17) The Court’s continuing requirement to notify the ADR department if I am convicted of a felony or misdemeanor, the status of my professional license changes, or any disciplinary actions are taken against me. I understand that a violation of the above statutes, rules, policies, procedures, and requirements may result in suspension and/or removal from the Court ADR Panel. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Dated: (TYPE OR PRINT NAME) LAADR 054 (Rev. 07/11) LASC Approved 10-04 (SIGNATURE OF NEUTRAL) ADR NEUTRAL CONFIRMATION Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com