REQUEST FOR JUDICIAL ALTERNATIVE DISPUTE RESOLUTION (J-ADR) JD-CV-130 Rev. 12-15 (Use for Civil Cases Only) STATE OF CONNECTICUT www.jud.ct.gov SUPERIOR COURT CIVIL DIVISION For Court Use only Instructions 1. Fill out all sections below. 2. File this form in the case or cases for which you are requesting Judicial ADR. 3. For a list of Judges, go to www.jud.ct.gov/external/super/mediatorlist.pdf Name of applicant 1. Case name (Plaintiff v. Defendant) 3. Judicial District where case is pending 4. Trial date REQJADR *REQJADR* 2. Docket number 5. Estimated length of time for session(s) ½ day Full day More than 1 day 6. Briefly describe the case: 7. List any cases this case is consolidated with: Case name Docket number Judicial District 8. Is this Judicial ADR session requested for all consolidated cases? 9. List all plaintiffs and their counsel: Plaintiff's name Counsel's name and address Yes No Counsel's e-mail address Counsel's phone # 10. List all defendants and their counsel: Defendant's name Counsel's name and address Counsel's e-mail address Counsel's phone # 11. Do all parties and counsel consent to this request? 12. Requested Judges (list at least 3): Yes No 13. Dates all parties and counsel are available (list at least 3): (Page 1 of 2) American LegalNet, Inc. www.FormsWorkFlow.com 14. Where do the parties want the session(s) to be held? Please rank the locations in order of preference or indicate no preference. Where Judicial ADR Judge presently sits Waterbury Mediation and Dispute Resolution Center, 400 Grand Street, 4th Floor, Waterbury Hartford Mediation and Dispute Resolution Center, 95 Washington Street, 4th Floor, Hartford No preference 15. Subject to prior court approval, videoconferencing or teleconferencing equipment may be used during your Judicial ADR session. Will any party request to use (check applicable): Videoconferencing equipment Yes No Teleconferencing equipment Yes No If videoconferencing or teleconferencing equipment will be requested please complete the following: Name/location of participant Participant's e-mail address Participant's phone number for conference Participant's videoconferencing equipment, if applicable Notice to Counsel and Parties of Record · A Judicial ADR session will not delay the progress of the case or interfere with scheduled events, for example, trials, jury selections, etc. · Judicial ADR is a voluntary nonbinding process. Counsel and parties are expected to take part in good faith and make an effort to resolve outstanding issues. · A notice will be sent to all parties with the date, time, and location of the session, and with the Judge's procedural requirements. · The Judge may request copies of pleadings and motions. · The Judicial ADR session is confidential. · A JD-CV-21 (Motion for Continuance) must be filed for any continuance request. Certification I certify that a copy of this document was or will immediately be mailed or delivered electronically or non-electronically on (date) to all attorneys and self-represented parties of record and that written consent for electronic delivery was received from all attorneys and self-represented parties receiving electronic delivery. Name and address of each party and attorney that copy was mailed or delivered to* *If necessary, attach additional sheet or sheets with name and address which the copy was mailed or delivered to. Signed (Signature of filer) Print or type name of person signing Date signed Telephone number u Mailing address (Number, street, town, state and zip code) ADA NOTICE The Judicial Branch of the State of Connecticut complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation in accordance with the ADA, contact a court clerk or an ADA contact person listed at www.jud.ct.gov/ADA. JD-CV-130 Rev. 12-15 (Page 2 of 2) American LegalNet, Inc. www.FormsWorkFlow.com