ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar Number and address) FOR COURT USE ONLY TELEPHONE NO.: FAX NO. (Optional): EMAIL ADDRESS (Optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF HUMBOLDT 825 5TH STREET EUREKA, CA 95501 PLAINTIFF(s)/PETITIONER(s): DEFENDANT(s)/RESPONDENT(s): CASE No.: STIPULATION TO PARTICIPATE IN ALTERNATIVE DISPUTE RESOLUTION (ADR) 0 Pursuant to California Rules of Court, Rule 3.726, the parties stipulate that all claims pursuant in this action shall be submitted to (select one): Voluntary Mediation Binding Arbitration NonBinding Arbitration Neutral Evaluation Other (specify): ______________________________ ____________________________________________ Case Type: PI/PDAuto PI/PDOther Contract Other: _______________________________ Is the Neutral you selected listed on the Court's List of Mediators? Yes No Neutral's name: _______________________________ Phone Number: ____________________________ Address: __________________________________ Email (optional): ___________________________ Attorneys signing on behalf of their client(s) have been given the authority to stipulate to ADR. Original signature required. _____________________ Date Date Date Date _________________________________ Name Name Name Name ______________________________ Signature of Party or Attorney for Party _____________________ _____________________ _____________________ Eff. 07/01/2010 ­ Optional Form _________________________________ _________________________________ _________________________________ ______________________________ Signature of Party or Attorney for Party ______________________________ Signature of Party or Attorney for Party ______________________________ Signature of Party or Attorney for Party California Rules of Court, Rule 3.221, Rule 3.726 American LegalNet, Inc. www.FormsWorkFlow.com