ATTORNEY OR PARTY WITHOUT ATTORNEY (Name & Address): FOR COURT USE ONLY Telephone No.: E-Mail Address (Optional): ATTORNEY FOR (Name): Fax No. (Optional): Bar No: CONFIDENTIAL SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE Central Justice Center, 700 Civic Center Dr. West, Santa Ana, CA 92701-4045 Civil Complex Center, 751 W. Santa Ana Blvd., Santa Ana, CA 92701-4512 NOT TO BE FILE STAMPED CASE NUMBER: PLAINTIFF / PETITIONER: DEFENDANT / RESPONDENT: SETTLEMENT CONFERENCE STATEMENT UNLIMITED CIVIL Case assigned to: Judge: Department: Date complaint filed: Hearing date: 1. Describe the nature of the case: 2. Describe any equitable relief being sought: % a. The probability of plaintiff receiving a favorable judgment regardless of amount: The probability of cross-complainant receiving a favorable judgment regardless of amount: % b. The minimum and maximum potential judgment according to your evaluation. Maximum $ Minimum $ 3. If the case involves a defense(s) of comparative negligence, your assessment of negligence attributable to the parties: Plaintiff Defendant Defendant Defendant Cross-Complainant Cross-Defendant Cross-Defendant % % % % % % % Page 1 of 3 SETTLEMENT CONFERENCE STATEMENT Approved for Optional Use L-0052 (Rev. July 1, 2009) www.occourts.org Superior Court of Orange County, rule 316 American LegalNet, Inc. www.FormsWorkFlow.com SHORT TITLE: CASE NUMBER: a. Describe the conduct of plaintiff/cross-complainant that will bar or diminish any recovery: b. Describe the factual basis of any legal defenses that will bar or diminish any recovery by plaintiff/cross-complaint. 4. If this is a personal injury or wrongful death action, each plaintiff/cross-complainant shall complete the following: a. Nature and extent of injuries: b. Permanent injuries being claimed: c. Nature of any surgical procedures recommended or scheduled: d. Total medical expenses to date: e. f. Future medical expenses: Loss of earnings to date: g. Future loss of earnings: h. Other special damages: SETTLEMENT CONFERENCE STATEMENT Approved for Optional Use L-0052 (Rev. July 1, 2009) Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com SHORT TITLE: CASE NUMBER: i. General damages: j. Punitive damages: 5. If this is not a personal injury case, each plaintiff shall state the following with respect to each alleged item of damage: a. Identify each item of damage supported by documentary evidence (type and amount): _____________________________________________________________________________ _____________________________________________________________________________ b. Identify each item of damage not supported by documentary evidence (type and amount): 6. If you are a plaintiff/cross-complainant in this action, state your demand in order to settle this matter: 7. If you are a defendant/cross-defendant in this action, state the terms of your demand in order to settle this matter: 8. Describe the status of any previous settlement negotiations: SUBMIT THIS DOCUMENT NO LATER THAN FIVE (5) COURT DAYS PRIOR TO THE MANDATORY SETTLEMENT CONFERENCE HEARING. Date: (SIGNATURE OF PARTY OR ATTORNEY) Attorney for: SETTLEMENT CONFERENCE STATEMENT Approved for Optional Use L-0052 (Rev. July 1, 2009) Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com