United States Bankruptcy Court Northern District of Illinois Eastern Division _______________________________, Debtor Case No. _____________________________ _____________________________ _______________________________ ________________________ _______________________________, Plaintiff Chapter Judge Date (if applicable) _______________________________, Defendant Adv. Proc. No. _____________________________ BANKRUPTCY MEDIATION AGREEMENT This is an agreement by and between and (hereinafter referred to as "the Parties") and their representatives. The Parties have agreed to enter into mediation with the intention of reaching a consensual settlement of their dispute. 1. The Parties agree to make complete and accurate disclosure of all information necessary for an understanding of each party's factual and legal position. 2. The Parties, together with their representatives and those in privity with them, agree to comply with the provisions of the local Bankruptcy Rules governing confidentiality and discovery of mediation proceedings, and further agree that disclosure by a party of privileged information to the mediator does not waive or otherwise adversely affect the privileged nature of the information. However, nothing in this agreement shall be construed to prevent or excuse the Parties or those in privity with them from reporting matters such as crimes, imminent threats of bodily injury, or such other matters as to which the law imposes a duty to report. 3. The Parties and their representatives understand that the Mediator will not be offering legal advice to any party. Nor will the mediator be rendering any opinion or decision in connection with the mediation. The Mediator's role is to aid the parties in seeking a fair agreement in accordance with their respective interests. The Parties understand that they have a right to be represented by legal counsel in the mediation proceedings, and that such representation is recommended by the court. None of the Parties or those in privity with them will be permitted to employ the Mediator nor any attorney of his or her firm in any legal proceeding or other matter relating to the subject of the mediation, nor for any matter while the mediation is pending. 4. Any Party may withdraw this dispute from mediation at any time pursuant to Local Bankruptcy Rule 9060-3F. 5. The Parties agree to share the fees and expenses of the Mediator as follows: ______________________________________________________________________________ _________________________________________________________________________________________ ______________________________________________________________________________ _________________________________________________________________________________________ ________________________________________________________________________________. However, any party who fails to comply with the Local Bankruptcy Rules governing mediation or the terms of this agreement without good cause will be responsible for any expenses of the other parties arising out of the failure to comply as determined by the court on notice with an opportunity for a hearing. 6. The Parties hereby release, indemnify and hold harmless the Mediator from any liability arising in connection with the performance of his or her duties as Mediator in accordance with this Agreement and the Local Bankruptcy Rules. However, nothing in this Agreement shall release the Mediator for liability arising from the willful derogation of his or her duties as mediator. 7. The Local Bankruptcy Rules governing mediation are expressly made a part of this agreement and are incorporated by reference herein. The Parties agree to be bound by these Rules. American LegalNet, Inc. www.USCourtForms.com 8. The Parties agree that any dispute arising out of this mediation shall be heard and resolved by the bankruptcy judge, and the Parties expressly waive any requirement of the Federal Rules of Bankruptcy Procedure that relief pursuant to or arising out of this mediation be sought in the form of a complaint, and hereby consent to the application of Fed. R. Bankr. P. 9014 to any request for relief relating to this agreement. Furthermore, to the extent that any such request for relief is not a core proceeding under 28 U.S.C. § 157(b), the Parties hereby agree that a bankruptcy court may nevertheless enter appropriate orders and judgments with respect to the request for relief. I have read, understand and agree to each of the provisions of this agreement. SIGNED:_________________________________________ DATE:_____________________ SIGNED:_________________________________________ DATE:_____________________ SIGNED:_________________________________________ DATE:_____________________ SIGNED:_________________________________________ DATE:_____________________ American LegalNet, Inc. www.USCourtForms.com