Superior Court of California, County of San Mateo Case Management/ADR Conference Questionnaire Name: Firm: Address: Trial Attorney: Phone: Fax: Court Use Only: Superior Court of California County of San Mateo 400 County Center Redwood City, CA 94063-1655 (650) 363-4711 Plaintiff: Defendant: Case No: Date: Time: Dept: File one original and one copy with the courts. Keep a copy for your files, or send copies to be endorsed filed. 1. I am plaintiff cross-defendant Name of Party: ________________________________ party attorney for: defendant intervener cross-complainant other 2. Insurance carrier (if any) for party filing this Questionnaire: Policy limits: Reservation of rights Will coverage issues significantly affect the resolution of this case: yes yes no no 3. 4. 5. The complaint was filed on (date): Please indicate any matters that may affect the court's jurisdiction or processing of this case: Bankruptcy Other SERVICE a. b. c. All parties named in the complaint and cross-complaint have been served, or have appeared, or have been dismissed. Please indicate which parties have not been served or have not answered and why: Please indicate which parties have been served but have not appeared and why: Rev. 12-11-01 1 2002 © American LegalNet, Inc. 6. TYPE OF CASE a. PERSONAL INJURY: Bodily Injury Property Damage Other: (1) Arising From: Auto/Other Vehicle Product Liability Other: Describe the nature of the injuries: Wrongful Death Defamation Premises Liability Malpractice (2) In order to evaluate the appropriateness of a referral, we require that you provide the following: (3) Damages: (Amount) Medical Expenses: Lost Earnings: Property Damage: (4) Please identify lien holders: Basis for lien: b. NON-PERSONAL INJURY: (1) Arising From: Employment: Wrongful Termination Harassment Commercial: Breach of Contract Trade Secrets/Unfair Competition Corp/Partnership Owners Real Estate: Sale/Purchase Environmental Other: Estate Distribution: Will/Trust Contest Remove Fiduciary Other: Insurance: Coverage Bad Faith Rev. 12-11-01 To Date Future Amount: Discrimination Other: Product Failure Collection Other: Land Movement Eminent Domain Conservatorship Breach of Fiduciary Duty Benefits Other: Brokers/Sale of 2 2002 © American LegalNet, Inc. Professional Malpractice: Medical Architect/Engineer (2) Relief Sought: Damages, Amount: Specific Performance Atty Fees & Costs Legal Other: Injunction Declaratory Relief Other: Accountancy Rescission Accounting 7. APPROPRIATE DISPUTE RESOLUTION a. My client is willing to participate in: Mediation Binding Arbitration Private Settlement Conference Discovery Referee b. Neutral case evaluation Judicial arbitration pursuant to CCP '1141.12 Special Master Other: Have all parties stipulated to the above process? Yes No Please attach a copy of the Appropriate Dispute Resolution stipulation form. A timely filing of a stipulation to ADR (received 10 days prior to the first CMC) will cause a notice to continue the CMC. ADR stipulated cases (other than judicial arbitration) will be continued for further ADR status review in 90 days. If the case is resolved in ADR, the status review date may be vacated if the court receives a dismissal or judgment. c. 8. TRIAL a. b. c. d. e. 9. I request a jury trial. I request a court trial The parties have not agreed to an ADR process yet because: This case is entitled to preference under (specify code section): I estimate the trial length to be __________days, This case will be ready for trial within: 12 months 18 months Short Cause (1 day or less) 24 months from the date of filing the complaint Should be exempted from Delay Reduction Rules because: Is there a companion, underlying, or related case? If so, indicate: Where pending: Name: Present status: I intend to file a motion to consolidate Case number: coordinate this action. When filed _____________ Rev. 12-11-01 3 2002 © American LegalNet, Inc. 10. I intend to file a motion reasons): bifurcating serving the following issues or causes of action (specify and give 11. Are there any special considerations affecting calendaring of a settlement conference: Problems with discovery (specify): Dispositive motions ready to be heard by: Other: 12. Has case been dismissed? Yes No ___________________________________________________________________________________________________ _______________________________ Date ________________________________________ Signature of Party or Party's Attorney Rev. 12-11-01 4 2002 © American LegalNet, Inc.