PARTY: (Name and Address): TELEPHONE NO: FAX NO. (Optional): E-MAIL ADDRESS (Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF CONTRA COSTA MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: P.O. BOX 911 MARTINEZ, CA 94553 MARTINEZ DO NOT SEND THIS FORM TO THE COURT CASE NAME: CASE NUMBER: MEDIATION STATEMENT PARTIES MUST PREPARE AND GIVE INFORMATION ABOUT THEIR CASE TO THE MEDIATOR AND THE OTHER PARTIES AT LEAST FIVE COURT DAYS BEFORE THE MEDIATION HEARING. YOU MAY USE THIS FORM OR WRITE THE INFORMATION ON YOUR OWN PAPER. MEDIATION STATEMENTS MUST BE 5 PAGES OR LESS. 1. The name and title (or relationship to the case) of all people who will attend neutral case evaluation are as follows: ________________________________________________ ______________________________________________ (NAME) ________________________________________________ (NAME) ________________________________________________ (NAME) ________________________________________________ (NAME) (TITLE) ______________________________________________ (TITLE) ______________________________________________ (TITLE) ______________________________________________ (TITLE)  More information attached to this form. 2. People who are connected with this case or who, if present at mediation, might improve the chances of settlement are: ________________________________________________ ______________________________________________ (NAME) ________________________________________________ (NAME) ________________________________________________ (NAME) 3. (TITLE) ______________________________________________ (TITLE) ______________________________________________ (TITLE)  More information attached to this form. The important issues in this case are as follows: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________  More information attached to this form. ADR-304/Rev. 07/20/07 American LegalNet, Inc. www.FormsWorkflow.com 4. I believe that the liability and damages in this case are as follows: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________  More information attached to this form. 5. Narrowing or resolving these issues early would make it easier to settle this case: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________  More information attached to this form. 6. Summary of the history of this case and any settlement discussions: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________  More information attached to this form. 7. I have attached the following documents to help the mediator better understand the issues in dispute: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________  More information attached to this form. 8. Other comments: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________  More information attached to this form. Date: ________________________________________________ (TYPE OR PRINT NAME OF PARTY SUBMITTING THIS MEDIATION STATEMENT) ADR-304/Rev. 07/20/07 ______________________________________________ (SIGNATURE OF PARTY SUBMITTING THIS MEDIATION STATEMENT) American LegalNet, Inc. www.FormsWorkflow.com