ACKNOWLEDGEMENT OF CONFIDENTIALITY FOR MEDIATION PROCESS** Case No. Case Name: Date(s) of Mediation Sessions: Consistent with California Evidence Code sections 703.5 and 1115 through 1128 and with and California Code of Civil Procedure section 1775.10, the participants in the mediation of this case agree that: 1. No written or oral communication made by any party, attorney, mediators, or other participants in any mediation session in this case may be used for any purpose in any pending or future proceeding unless all parties, including the mediator, so agree. 2. Disclosure of information that otherwise is privileged shall not alter its privileged character. 3. The parties shall not subpoena the mediator or any documents submitted to or prepared by the mediator during or in connection with the mediation process. The mediator shall not testify voluntarily on behalf of a party. 4. This agreement shall not preclude a report of information to the ADR Administrator or an inquiry by the Administrator pursuant to CRC 3.850.– 3.865; 3.870 – 3.878 or LASC 12.0 et seq. 5. The parties agree, pursuant to Evidence Code section 1123, that any written settlement agreement signed by the parties in the course of mediation is subject to disclosure, and will be binding, enforceable and admissible to prove the existence of, and to enforce, the agreement. Date: Mediator) (Party) (Party’s Attorney) LAADR 050 (Rev. 05/09) LASC Approved 11-03 (Party) (Party’s Attorney) Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Acknowledgement of Confidentiality For Mediation Process – Page 2 Case No. Case Name: (Party) (Party’s Attorney) (Party) (Party’s Attorney) (Party) (Party’s Attorney) (Party) (Party) (Party’s Attorney) (Party) (Party’s Attorney) (Party) (Party’s Attorney) (Party) (Party’s Attorney) (Party’s Attorney) (Other Participant) (Other Participant) (Title) (Title) Representing (specify party) Representing (specify party) ** The Los Angeles Superior Court provides the Acknowledgement of Confidentiality for Mediation Process form to enable Court ADR Neutrals a convenient means to inform participants of the applicable ethical and other rules. LAADR 050 (Rev. 05/09) LASC Approved 11-03 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com