IN THE CIRCUIT COURT OF THE ____________ CIRCUIT STATE OF HAWAI`I ) ) ) ) ) Plaintiff(s), ) ) vs. ) ) ) ) ) ) Defendant(s). ) _________________________________ ) CIVIL NO._______________________ ARBITRATION CASE NO.___________ ARBITRATION AWARD (Comparative Negligence is not in Issue) ARBITRATION AWARD (Comparative Negligence is not in Issue) This matter having been arbitrated in accordance with the Hawai`i Arbitration Rules, as amended, the Arbitrator finds as follows: 1. Liability. (Check one) Defendant is liable ______________ Defendant is not liable ______________ 2. Damages. (If Defendant is liable) Special Damages $______________ General Damages $______________ Punitive Damages $______________ 0.00 Total Damages $______________ 3. Costs to the Prevailing Party. To Plaintiff $______________ To Defendant $______________ 4. Covered Loss Deductible ("CLD"). See HRS § 431:1 C-301.5. Make a selection from the following: CLD does not apply in this case. Total damages shall be reduced by a CLD in the amount of __________. DATED: , Hawai`i,____ ________________________ ________. _______________________________________ Arbitrator ARB 17.DOC 1C-P-516 (08/05) American LegalNet, Inc. www.FormsWorkFlow.com