ARBITRATOR NAME, ADDRESS, TELEPHONE, FAX AND E-MAIL: Reserved for Clerk’s File Stamp STATE BAR NUMBER SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES COURTHOUSE ADDRESS: PLAINTIFF: DEFENDANT: CASE NUMBER: AWARD OF ARBITRATOR INSTRUCTIONS TO ARBITRATOR: In order that this Award may be entered as Judgment, all information must be clear, complete and accurate. Please specify: the full names of all parties (as they appear on the complaint) in the body of the Award; for whom and against whom the award is rendered; precise dollar amounts for all money awards; and a disposition as to each party named on the complaint and any cross-complaint(s). The undersigned Arbitrator, appointed pursuant to Section 1141.10, Code of Civil Procedure and Rule 3.815, California Rules of Court, having been duly sworn, and having heard the above cause on (date) ____________________________, and considered the evidence, awards as follows: IN FAVOR OF: (Show FULL names) AND AGAINST: (Show FULL names) 1. 2. 3. 4. MONEY AWARD FOR ABOVE PARTIES PRINCIPAL INTEREST ATTORNEY FEES COSTS TOTAL 1. $ $ $ $ $ 2. $ $ $ $ $ 3. $ $ $ $ $ 4. $ $ $ $ $ Pages attached for additional parties: ________ Total volunteer hours (including travel time): ________ Dated: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ________________________________________________________ (TYPE OR PRINT NAME) (SIGNATURE OF ARBITRATOR) IMPORTANT! PURSUANT TO CALIFORNIA RULES OF COURT, RULE 3.826, THIS AWARD WILL BECOME A JUDGMENT THIRTY (30) DAYS AFTER ITS FILING IF NO PARTY HAS FILED A REQUEST FOR TRIAL (DE NOVO) WITH PROOF OF SERVICE. SATISFACTION OF JUDGMENT MUST BE FILED WITH THE CLERK OF THE COURT WHEN PAID IN FULL. JOHN A. CLARKE, Executive Officer/Clerk Trial de Novo filed by: Plaintiff Defendant Other: _______________ on: __________ 30 days having passed and no Request for Trial de Novo filed, AWARD ENTERED AS JUDGMENT ON: ____________________ By: _____________________________________________________ Deputy Clerk (See reverse for Proof of Service by Mail) ADR 014 10-03 LASC Approved (Rev. 01-07) AWARD OF ARBITRATOR Code of Civil Procedure, §1141.23 Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com Short Title Case Number PROOF OF SERVICE BY MAIL 1. I am over the age of 18 and not a party to this action. I am a resident of or employed in the county where the mailing occurred. My residence or business address is: 2. I served a true and correct copy of this Award of Arbitrator on all interested parties by enclosing it in an envelope and: a. depositing the sealed envelope with the United States Postal Service with the postage fully prepaid. b. placing the envelope for collection and mailing on the date and the place shown in items 4 and 5 following our ordinary business practices. I am readily familiar with this business’s practices for collecting and processing correspondence for mailing. On the same day that correspondence is placed for collection and mailing, it is deposited in the ordinary course of business with the United States Postal Service in a sealed envelope with the postage fully prepaid. 3. The envelopes were addressed as follows: (If additional space is needed, attach a separate list.) 4. Date of mailing: 5. Place of mailing (city and state): 6. I declare under penalty of perjury under the laws of the State of California that the foregoing, including any attachment, is true and correct. Dated: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ________________________________________________________ (TYPE OR PRINT NAME) (SIGNATURE) ADR 014 10-03 LASC Approved (Rev. 01-07) AWARD OF ARBITRATOR Code of Civil Procedure, §1141.23 Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com