Supcrlor Court of the District of Columbia STATEMENT OF UNDERSTANDING: MEDIATION AND CASE EVALUATION PLEASE NOTE: This form will be signed by all individuals present immediately prior to the beginning of the mediation/case evaluation session. The mediator or case evaluator indicated below has been assigned to facilitate your case. S/he will serve as a neutral party to help you resolve your dispute. S/he will not act as an attorney or advocate for any party, and has conducted a conflicts check to be sure that neither s/he nor her/his firm represents any party to the mediation or any party whose interests are adverse to the parties in mediation. If you are representing yourself, you may wish to have an attorney review any written settlement agreement before you sign it. If you do not wish to have your agreement reviewed by an attorney, you are not required to do so. The parties, individuals and attorneys whose signatures appear below agree that all proceedings at this settlement conference, on this date and any subsequent meeting(s) or conference(s) including any statement made or document prepared for the(se) conference(s) by any party, attorney or other participant, are privileged and shall not be disclosed in any subsequent proceeding or document, or construed for any purpose as an admission against interest. The phrase “document prepared for the conference by any party, attorney or other participant” shall not be deemed to apply to any settlement agreement that may result from this conference. No party shall be bound by anything said or done at the conference unless a settlement is reached. If a settlement is reached, the agreement shall be reduced to writing and, when signed, shall be binding upon all parties to the agreement. The parties agree not to subpoena the evaluator or mediator or any documents submitted to the mediator or evaluator. In no event will a mediator or evaluator voluntarily testify. Please sign below to acknowledge that you have read and understand this Statement. Plaintiff’s Signature Defendant’s Signature Plaintiff’s Signature Defendant’s Signature Plaintiff Attorney’s Signature Defendant Attorney’s Signature Plaintiff Attorney’s Signature Defendant Attorney’s Signature Other Signature: Specify Title/Role Other Signature: Specify Title/Role Other Signature: Specify Title/Role Other Signature: Specify Title/Role Date: Neutral's Signature: Print Neutral’s Name Here: Case Name: Civil Action No: revised l/98 2001 © American LegalNet, Inc.