UNITED STATES DISTRICT COURT CENTRAL DISTRICT OF CALIFORNIA CASE NUMBER PLAINTIFF(S) v. ADR PROGRAM QUESTIONNAIRE DEFENDANT(S). (1) What, if any, discovery do the parties believe is essential in order to prepare adequately for a settlement conference or mediation? Please outline with specificity the type(s) of discovery and proposed completion date(s). Please outline any areas of disagreement in this regard. Your designations do not limit the discovery that you will be able to take in the event this case does not settle. (2) What are the damage amounts being claimed by each plaintiff? Identify the categories of damage claimed [e.g., lost profits, medical expenses (past and future), lost wages (past and future), emotional distress, damage to reputation, etc.] and the portion of the total damages claimed attributed to each category. ADR-09 (04/10) ADR PROGRAM QUESTIONNAIRE American LegalNet, Inc. www.FormsWorkFlow.com (3) Do the parties agree to utilize a private mediator in lieu of the court’s ADR Program? Yes G No G (4) If this case is in category civil rights - employment (442), check all boxes that describe the legal bases of plaintiff claim(s). G Title VII G Age Discrimination G 42 U.S.C. §1983 G California Fair Employment and Housing Act G Americans with Disabilities Act of 1990 G Rehabilitation Act G Other I hereby certify that all parties have discussed and agree that the above-mentioned responses are true and correct. Date Attorney for Plaintiff (Signature) Attorney for Plaintiff (Please print full name) Date Attorney for Defendant (Signature) Attorney for Defendant (Please print full name) ADR-09 (04/10) ADR PROGRAM QUESTIONNAIRE American LegalNet, Inc. www.FormsWorkFlow.com