ARBITRATION TYPE (Check One) SUPERIOR COURT OF NEW JERSEY □ □ REPORT AND AWARD OF ARBITRATOR(S) AUTO PERSONAL INJURY CIVIL ACTION PLAINTIFF V. COUNTY: DOCKET NO: DEFENDANT DATE: The undersigned arbitrator(s) make(s) the following award(s) for the reasons set forth: Defense presented □ yes PARTY □ no % % % % % $ DEF DEF DEF PL PL ARBITRATOR(S): DAMAGES* Gross Net LIABILITY $ Please sign below and print name next to signature. Parties desiring to reject this award and obtain a trial de novo must file with the division manager a trial de novo request together with a $200 fee within thirty (30) days of today. Parties requesting a trial de novo may be subject to payment of counsel fees and costs as provided by R.4:21A-6(c). Note that unless otherwise expressly indicated this award will be filed today. Counsel and pro se litigants acknowledge receipt of this award by signing below. Print name next to signature. *Exclusive of prejudgmemt interest Revised 7/2007, CN 10977-English American LegalNet, Inc. www.FormsWorkflow.com