ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar Number, & Address) FOR COURT USE ONLY TELEPHONE NUMBER: ATTORNEY FOR (Name): FAX NO.: SUPERIOR COURT OF CALIFORNIA, COUNTY OF MARIPOSA 5088 Bullion Street P.O. Box 28 Mariposa, CA 95338 PLAINTIFF/PETITIONER: DEFENDANT/RESPONDENT: ALTERNATIVE DISPUTE RESOLUTION STATUS REPORT (ADR) Type of Civil Case: [ ] Personal Injury ­ Property Damage/Auto [ ] Personal Injury ­ Property Damage CASE NUMBER: [ ] Contract [ ] Other _______________ Date Complaint Filed: _____________________________ Amount in controversy: [ ] $0 to $25,000 [ ] $25,000 to $50,000 [ ] $50,000 to $100,000 [ ] Over $100,000 (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 (proper filing of a Notice of Settlement or Dismissal form is required by Clerk's Office) [ ] No Reason: ___________________________________________________________________________________________ Alternative Dispute Resolution process concluded: [ ] Yes [ ] No Reason for delay: _______________________________________________________________________________ Next scheduled hearing date: __________________________________ at _________a.m./p.m. Type of resolution process used: [ ] Mediation [ ] Arbitration [ ] Neutral Case Evaluation [ ] Other ________________________________________ Case was resolved by: [ ] Direct Result of ADR Process [ ] 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) _____________________________________ 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) ___________________________ Alternative Dispute Resolution Status Report (ADR) Local Form CV -11-004 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Case name: Case number: 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: _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ Plaintiff(s): Date: _____________ _________________________________________ Signature of Party or Attorney for Party Defendant(s): Date: _____________ _________________________________________ Signature of Party or Attorney for Party ________________________________________ Type or Print Name ________________________________________ Type or Print Name Date: ____________ _________________________________________ Signature of Party or Attorney for Party _________________________________________ Type or Print Name Date: ____________ ________________________________________ Signature of Party or Attorney for Party ________________________________________ Type or Print Name Date: ____________ _________________________________________ Signature of Party or Attorney for Party _________________________________________ Type or Print Name Date: _______________ ________________________________________ Signature of Party or Attorney for Party ________________________________________ Type or Print Name Alternative Dispute Resolution Status Report (ADR) Local Form CV -11-004 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com