Today’s Date: __________________ COURT OF APPEAL SECOND APPELLATE DISTRICT CONFIDENTIAL MEDIATION INFORMATION FORM To be sent to the mediator only – not to be filed with the court. Case Name(s): __________________________________________________________ Court of Appeal No(s).: _________________________________ Los Angeles County Superior Court No.: ____________________________________ Submitted by _____________________________________________ on behalf of: Appellant: ______________________ Respondent:________________________ Address:________________________________________________________________ Phone: __________________ Fax: _________________ E-mail:__________________ Cross-appellants(s):______________________________________________________ Date of judgment or order from which appeal is taken: ________________________ The judgment or order resulted from: ( ) Jury trial ( ) Court trial ( ) Summary judgment ( ) Demurrer ( ) Dismissal ( ) Nonsuit ( ) Arbitration award ( ) Administrative mandamus Other (specify): ________________________________________________________________ Summarize the substance of the judgment: Please answer the following questions. (Attach additional pages, if necessary.) 1. Describe the current status of the case: 2. Summarize the appellate issues you anticipate and the relief sought: 3. Describe any related disputes, including cases pending in this or other courts: 1 American LegalNet, Inc. www.FormsWorkflow.com 4. Describe the status of any present or previous settlement negotiations, including the terms of any offers or demands the parties have exchanged: 5. List the names and interests of persons necessary to settle this appeal, whether they are named parties or not, including insurance carries and other entities. Attendance by all parties necessary to settle the case is mandatory. • Attach a copy of the judgment or order from which the appeal or cross-appeal is taken. • Submit the original of this form and the requested judgment or order to the appointed mediator within twenty (20) days of the date of the letter from the court scheduling the mediation. • By participating in the mediation process, all parties agree that the courtappointed mediator shall be deemed for all purposes to be a “person presiding at [a] judicial or quasi-judicial proceeding” within the meaning of Evidence code section 703.5, which restricts the competence of such persons to testify regarding what occurs at the mediation. 2 American LegalNet, Inc. www.FormsWorkflow.com