ATTACHMENT CV-5017 ATTORNEY OR PARTY WITHOUT AN ATTORNEY (NAME AND ADDRESS) TELEPHONE NUMBER: FOR COURT USE ONLY ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: PLAINTIFF: DEFENDANT: CASE NUMBER: JUDGES ADR PROGRAM STIPULATION AND ORDER FORM The parties and their attorneys stipulate that the claims in this action be submitted to the Judges ADR Program as a Mediation Settlement Conference. It is further stipulated that the matter be submitted to the following Judge(s), in the following order: 1. The Hon. , Judge, Superior Court of California, County of Santa Clara; or 2. The Hon. , Judge, Superior Court of California, County of Santa Clara; or 3. A Judge of the Superior Court of California, County of Santa Clara assigned by the Civil Supervising Judge. We estimate the trial will take days. Parties and counsel have read and agree to be bound by the Rules of the Judges ADR Program, and the Rules Court of the Superior Court of California, County of Santa Clara. Date: (Attorney for Plaintiff, or Self-Represented Plaintiff) (Signature) (Attorney for Defendant or Self-Represented Defendant) (Signature) (Attach Additional Signature Pages if Necessary) ORDER ON REVERSE SIDE CV-5017 REV 1/1/08 JUDGES ADR PROGRAM STIPULATION AND ORDER FORM Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com ATTACHMENT CV-5017 ORDER: CASE NUMBER: Application for Judges ADR is: Approved Denied This case is submitted for Mediation Settlement Conference to Judge , Department Parties and/or counsel shall contact the ADR Judge within 10 calendar days for scheduling of the hearing. Mediation/Settlement Status Review is set for Department . The Case Management Conference set for Department remains set , 20 , at A.M./P.M. in , 20 is vacated. , at A.M./P.M. in IT IS SO ORDERED. Date: Judge of the Superior Court CV-5017 REV 1/1/08 JUDGES ADR PROGRAM STIPULATION AND ORDER FORM Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com