NAME, ADDRESS, AND TELEPHONE NUMBER OF ATTORNEY OR PARTY WITHOUT ATTORNEY: Reserved for Clerk’s File Stamp STATE BAR NUMBER ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES COURTHOUSE ADDRESS: PLAINTIFF: DEFENDANT: CASE NUMBER: STIPULATION TO PARTICIPATE IN ALTERNATIVE DISPUTE RESOLUTION (ADR) The undersigned parties stipulate to participate in an Alternative Dispute Resolution (ADR) process in the above-entitled action, as follows: Mediation Non-Binding Arbitration Binding Arbitration Early Neutral Evaluation Settlement Conference Other ADR Process (describe): _________________________________________________________ Dated: ________________________ ______________________________________ Name of Stipulating Party Plaintiff Defendant Cross-defendant _______________________________________ Name of Party or Attorney Executing Stipulation _______________________________________ Signature of Party or Attorney ______________________________________ Name of Stipulating Party Plaintiff Defendant Cross-defendant _______________________________________ Name of Party or Attorney Executing Stipulation _______________________________________ Signature of Party or Attorney ______________________________________ Name of Stipulating Party Plaintiff Defendant Cross-defendant _______________________________________ Name of Party or Attorney Executing Stipulation _______________________________________ Signature of Party or Attorney ______________________________________ Name of Stipulating Party Plaintiff Defendant Cross-defendant _______________________________________ Name of Party or Attorney Executing Stipulation _______________________________________ Signature of Party or Attorney Additional signature(s) on reverse ADR 001 10-04 LASC Approved (Rev. 01-07) STIPULATION TO PARTICIPATE IN ALTERNATIVE DISPUTE RESOLUTION (ADR) Cal. Rules of Court, rule 3.221 Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com Short Title Case Number ______________________________________ Name of Stipulating Party Plaintiff Defendant Cross-defendant _______________________________________ Name of Party or Attorney Executing Stipulation _______________________________________ Signature of Party or Attorney ______________________________________ Name of Stipulating Party Plaintiff Defendant Cross-defendant _______________________________________ Name of Party or Attorney Executing Stipulation _______________________________________ Signature of Party or Attorney ______________________________________ Name of Stipulating Party Plaintiff Defendant Cross-defendant _______________________________________ Name of Party or Attorney Executing Stipulation _______________________________________ Signature of Party or Attorney ______________________________________ Name of Stipulating Party Plaintiff Defendant Cross-defendant _______________________________________ Name of Party or Attorney Executing Stipulation _______________________________________ Signature of Party or Attorney ______________________________________ Name of Stipulating Party Plaintiff Defendant Cross-defendant _______________________________________ Name of Party or Attorney Executing Stipulation _______________________________________ Signature of Party or Attorney ______________________________________ Name of Stipulating Party Plaintiff Defendant Cross-defendant _______________________________________ Name of Party or Attorney Executing Stipulation _______________________________________ Signature of Party or Attorney ______________________________________ Name of Stipulating Party Plaintiff Defendant Cross-defendant _______________________________________ Name of Party or Attorney Executing Stipulation _______________________________________ Signature of Party or Attorney ______________________________________ Name of Stipulating Party Plaintiff Defendant Cross-defendant _______________________________________ Name of Party or Attorney Executing Stipulation _______________________________________ Signature of Party or Attorney ______________________________________ Name of Stipulating Party Plaintiff Defendant Cross-defendant _______________________________________ Name of Party or Attorney Executing Stipulation _______________________________________ Signature of Party or Attorney ______________________________________ Name of Stipulating Party Plaintiff Defendant Cross-defendant _______________________________________ Name of Party or Attorney Executing Stipulation _______________________________________ Signature of Party or Attorney ADR 001 10-04 LASC Approved (Rev. 01-07) STIPULATION TO PARTICIPATE IN ALTERNATIVE DISPUTE RESOLUTION (ADR) Cal. Rules of Court, rule 3.221 Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com