SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA ADR EVALUATION/CIVIL DIVISION PLEASE MAIL WITHIN 10 DAYS OF THE COMPLETION OF THE ADR PROCESS TO: ELIZABETH STRICKLAND, ADR ADMINISTRATOR SANTA CLARA COUNTY SUPERIOR COURT 191 N. FIRST STREET, SAN JOSE, CA, 95113 OR FAX TO 408-882-2595 Case Name: ADR Process: Neutral=s name: Type of case: Banking Business/Contract Civil Rights Construction Defamation Disabilities Elder Issues/Abuse Environment You are: Health Care Housing Intellectual Property Insurance Labor - Employment Landlord/Tenant Medical Malpractice Neighborhood defendant Partnership Disputes Personal Injury Probate - Wills Professional Negligence Real Estate Securities Tax Other (specify) defendant's attorney Mediation Neutral Evaluation Case No: Other (specify) plaintiff plaintiff's attorney other (specify) Your phone number: How did the case resolve? (Do not reveal confidential information): Direct result of the ADR process Resolution was unrelated to the ADR process Indirect result of the ADR process Case was not resolved Other (specify) What was the effect of the ADR process on costs and court time? Reduced costs Increased costs By how much? (estimate) $ Reduced court time? Increased court time How many days? (estimate) On a scale of 1 (very dissatisfied) to 5 (very satisfied) please rate: The ADR process: Appropriateness of the process for your dispute Fairness Opportunity to participate Satisfaction with outcome Would you use this process again? Yes No The neutral: Neutrality Temperament Knowledge of the ADR process Knowledge of the subject matter of the dispute Would you use this neutral again? Yes No Comments on any of the above matters or on administration of the ADR program: ADR EVALUATION/CIVIL DIVISION CV-5002 REV. 5/06 American LegalNet, Inc. www.FormsWorkflow.com