IN THE CIRCUIT COURT OF THE STATE OF HAWAII ) ) Plaintiff(s), ) ) vs. ) ) ) Defendant(s). ) ) ___________________________________) CIRCUIT CIVIL NO. _______________________ ARBITRATION CASE NO. __________ ARBITRATION AWARD (Comparative Negligence is in Issue) ARBITRATION AWARD (Comparative Negligence is in Issue) This matter having been arbitrated in accordance with the Hawaii Arbitration Rules, as amended, the Arbitrator finds as follows: 1. Liability. The Arbitrator determines that Comparative Negligence is in issue and finds as follows: % of Negligence of Plaintiff % of Negligence of Defendant Total 100 % % % Reprographics (0 / 1C CommonLook® ) ARB 18 1C-P-517 508 Certified American LegalNet, Inc. www.FormsWorkFlow.com ARBITRATION AWARD: CIVIL NO. _________________________ 2. Damages. The Arbitrator, without considering the question of reducing damages due to Plaintiff's Contributory Negligence, finds Plaintiff's total damages as follows: Special Damages General Damages Punitive Damages Total Damages: Less CLD (if applicable)** Subtotal: Less contributory_____% of subtotal Total Award: 3. *Costs to Prevailing Party. To Plaintiff To Defendant $ ________________ $ ________________ $_______________ $_______________ $_______________ 0.00 $_______________ $ _______________ 0.00 $ _______________ $ _______________ - 0.00 $ _______________ 0.00 4. **Covered Loss Deductible ("CLD"). See HRS §431:10C-301.5. CLD does not apply in this case. DATED: , Hawaii,__________________________________. __________________________________ Arbitrator * If Plaintiff's negligence is 50% or less, costs may be awarded to Plaintiff; if Plaintiff's negligence is more than 50%, costs may be awarded to Defendant. The arbitrator may modify this form as may be appropriate for the case. ARB 18 (REV / ) 2 American LegalNet, Inc. www.FormsWorkFlow.com