SUPERIOR COURT OF CALIFORNIA COUNTY OF LOS ANGELES WEST DISTRICT Name of Case VS . Case Number FIRST STATUS CONFERENCE QUESTIONNAIRE Each party appearing at the First Status Conference shall complete and sign this questionnaire and bring it to the First Status Conference. DO NOT FILE IT BEFORE THE DAY OF THE CONFERENCE! THIS FORM FILED BY 1. Rule 7.7 Compliance (a) (b) (c) (d) (e) (f) (9) Date complaint filed Date complaint served explain below) (if over 60 days after (a), ( if over) Date proof of service filed with the court 30 days after (b), explain below) Date cross-complaint filed Date cross-complaint served explain below) (if over 30 days after (d), Date proof of service of cross-complaint filed with the court (if over 60 days after (d), explain below) ; to Date responsive pleading filed: to complaint cross-complaint (if either was more than 30 days after service of complaint or cross-complaint, unless the parties stipulated to a 15-day extension, explain below) EXPLANATION OF ANY DEVIATIONS FROM RULE 7.7: 2. Nature at case: 3. Why is the case filed in the West District? 2000 (C) American LegalNet, Inc. 4. INJURIES - Describe the nature of the injuries suffered: 5. ECONOMIC LOSS - Set out the dollar amount of economic loss to date (actual medical expenses, lost earnings, etc.) 6. MEDIATION - Do you request that the matter be referred to the court non-binding mediation program? Yes No 7. ARBITRATION PLAINTIFF DEMANDS ARBITRATION - and consent to an award of $50,000 or less. Yes No COURT ORDERED ARBITRATION - Do the parties agree that the court may order this case to arbitration, and agree: the matter will take no more than two hours to present to an arbitrator; that they will select an arbitrator today; and that they will complete the arbitration within 90 days unless the court gives permission to exceed this limit? Yes No 8. DIFFERENTIAL CASE MANAGEMENT - Is there any reason that the case should not now be given a trial date within the next 10 months, with a pretrial status conference set about 30 days before the trial date? If so, please explain: 9. BANKRUPTCY - Is any party in bankruptcy? Yes No 10. NOTICE OF THIS HEARING - Did plaintiff or cross-complainant serve all parties with notice of this hearing? Yes No Did plaintiff or cross-complainant bring proof of service of notice of this hearing? Yes 11. No DISMISSAL OF SERVED OR UNSERVED PARTIES - List all parties you are prepared to dismiss at this conference: The undersigned certifies that the information contained in this questionnaire is complete and accurate and has been prepared by an attorney/party in propria persona familiar with the case. Dated: Attorney for 2000 (C) American LegalNet, Inc. DDP/FIRST-SC.QST