COURT-ANNEXED MEDIATION REQUEST JD-CL-61 Rev. 12-06 1. 2. 3. 4. STATE OF CONNECTICUT SUPERIOR COURT INSTRUCTIONS For a list of mediators, check the website under "MEDIATION." Complete the Case Information section. Mail/Fax the referral to the Mediation Coordinator at the address shown below. The Mediation Assignment section is to be completed by the Mediation Coordinator and a notice of assignment is sent to all counsel and pro se parties of record. www.jud.ct.gov TO: Mediation Coordinator, 225 Spring St., Wethersfield, CT 06109 or fax to (860) 263-2773 CASE INFORMATION NAME OF CASE DOCKET NO. CV FA JUDICIAL DISTRICT OF CASE TYPE (e.g., Contract, Dissolution of Marriage, etc.) TRIAL DATE EST. LENGTH OF TIME FOR SESSION PLAINTIFF'S TRIAL COUNSEL/PRO SE (Print Name, Firm Name and Address) TELEPHONE NUMBER FAX NUMBER DEFENDANT'S TRIAL COUNSEL/PRO SE (Print Name, Firm Name and Address) TELEPHONE NUMBER FAX NUMBER CHILD'S COUNSEL, IF ANY (Print Name, Firm Name and Address) TELEPHONE NUMBER FAX NUMBER INSURANCE CARRIER, IF ANY (Print Name and Address) TELEPHONE NUMBER FAX NUMBER PREFERRED MEDIATOR(S) 2) 3) 1) 2) 3) 4) 5) 6) 1) AVAILABLE SCHEDULING MEDIATION ASSIGNMENT NAME OF MEDIATOR JURIS NO. OF MEDIATOR LOCATION OF SESSION DATE/TIME OF SESSION NOTICE TO COUNSEL AND PRO SE PARTIES OF RECORD 1. Counsel and parties are advised that mediation will not delay the progress of the case or interfere with scheduled events, i.e., trials, jury selection, etc. 2. Mediation is a voluntary nonbinding process. Counsel and parties are expected to participate in good faith and make an effort to resolve outstanding issues. 3. The requirements of the mediation session are printed on the back/page 2 of this form. (continued on back/page 2) American LegalNet, Inc. www.FormsWorkflow.com Mediation Requirements Once the mediation session is confirmed, a notice will be sent to all parties stating the Mediator's requirements in regard to the position summation. The summation MUST be submitted to the Mediator no later than the date stated in the notice. Late submittal may result in cancellation of the mediation at the Mediator's discretion. The Mediator may request copies of pleadings and motions. Trial counsel and pro se parties of record are required to attend. Plaintiffs and defendants are required to attend. However, in civil matters, defendants who are represented by insurance companies need not attend unless the claim is in excess of the coverage, but the claims representatives with authority to settle must attend. In insurance carrier cases, the order for the defendant's appearance should be determined on a case to case basis. Failure to attend may result in the imposition of sanctions unless excused in advance by the Mediator. The Mediator may waive any requirement. The mediation session is confidential. Information related to the mediation may not be placed in the court file without the agreement of the parties. Only the referral form and stipulations for judgment may become part of the court file. As a general proposition, there should not be ex parte conversation with the mediator outside the mediation process and only in the process as agreed by the parties. At the conclusion of the session, the Mediator will communicate the outcome to the Mediation Coordinator. Continuance Policy Continuances are allowed only for extreme hardship and must be ordered by the Mediation Coordinator after consultation with the Mediator. Any continuance request must be in writing and submitted to the Mediation Coordinator with copies to all counsel and pro se parties of record. The request must note whether the request is by agreement of the parties. Counsel will be notified of the decision and will be responsible for notifying all other parties. Questions may be directed by telephone to the Mediation Coordinator at (860) 263-2734. JD-CL-61 (back/page 2) Rev. 12-06 American LegalNet, Inc. www.FormsWorkflow.com