SUPERIOR COURT OF CALIFORNIA, COUNTY OF YUBA 215 5TH STREET, SUITE 200 MARYSVILLE, CA 95901 (530) 740-1800 CIVIL MEDIATION EVALUATION FORM (Please return to the Court within 10 days of the mediation.) Case Name: Case Number: 1. 2. I am the plaintiff defendant or the attorney for plaintiff defendant. Nature of Dispute: Malpractice Real Estate Business/Contract Personal Injury ­ Auto Personal Injury ­ Other Employment Other ADR Process Employed: Court Sponsored Mediation Program Private Mediation The case resolved: As a result of the ADR process As a result of the Settlement Conference Other The case did not resolve at ADR because: Additional discovery/preparation needed A necessary party was not present Other 3. 4. 5. 6. Did your side save time (trial time, preparation) or money (attorney's fees, court costs) as a result of the Mediation Program by the Yuba County Superior Court? If so, days and/or $ money. Please rate the mediation services provided by the Yuba County Superior Court from 1 (very poor) to 5 (very satisfied). Rating: CIVIL MEDIATION EVALUATION FORM CV08017 Page 1 of 2 7. Yuba County Superior Court Effective 2/28/08, Rev. 1/4/17 American LegalNet, Inc. www.FormsWorkFlow.com 8. If your case settled, please rate the fairness or adequacy of the settlement agreement from 1 (very dissatisfied) to 5 (very satisfied). Rating: If your case settled, did you experience any particular difficulties in carrying out and obtaining compliance with the settlement? Yes No. Please explain: 9. 10. Please rate your willingness to use the Mediation Program of the Yuba County Superior Court in the future form 1 (very unwilling) to 5 (very willing). Rating: Please rate your willingness to recommend the Mediation Program services of the Yuba County Superior Court to others who are involved in disputes from 1 (very unwilling) to 5 (very willing). Rating: 11. PLEASE RETURN THIS FORM WITHIN 10 DAYS OF THE MEDIATION TO: Yuba County Superior Court, Attn: Civil Clerk 215 5th Street, Suite 200 Marysville, CA 95901 NOTE: A fillable version of this form is available on the Court's website: www.yubacourts.org. Yuba County Superior Court Effective 2/28/08, Rev. 1/4/17 CIVIL MEDIATION EVALUATION FORM CV08017 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com