PLEASE COMPLETE AND FILE WITH THE ADR OFFICE BY FAX OR E-MAIL BY END OF BUSINESS DAY FOLLOWING RECEIPTSUPREME COURT, CIVIL BRANCH, NEW YORK COUNTYCOMMERCIAL DIVISION ADR PROGRAM---------------------------------------------------x Part Plaintiff,Index No.-against - ADR INITIATION FORMDefendant.[FULL CAPTION OR ATTACH COPY]---------------------------------------------------x 1.This case was referred to the Commercial Division Alternative Dispute Resolution Program (order of Justice dated).2.The attorneys for all parties herein are as follows (attach an additional sheet if necessary): For Plaintiff:For Defendant: , Esq., Esq. [Firm][Firm] Phone: Phone: E-mail: * E-mail:* Fax: Fax: For Others (Attach an additional sheet if necessary): , Esq., Esq. [Firm][Firm] Phone: Phone: E-mail:* E-mail:* Fax: Fax: Attorney forAttorney for *Required 3. Please briefly describe this case, including, if possible, the damages claimed: 4. In order that a proposed mediator may run a conflicts check as required, counsel for any corporate party must list here or on anattached sheet the names of all corporate parents, subsidiaries, or affiliates: 5. This case shall be mediated unless otherwise agreed.6. Please indicate whether there are in this case: Motions sub judice: Yes No Appeals: Yes No If you indicated ¨Yes? to either of the foregoing, please contact an ADR Coordinator immediately. 7. Please indicate whether you consent to the presence of a mediator in training at the mediation. Yes No 8. By signing below, counsel, on behalf of their clients, certify that they have read and will comply with the ADR Rules of theCommercial Division (www.nycourts.gov/courts/comdiv/PDFs/NYCounty/Attachment1.pdf). (Signature)(Signature) , Esq. , Esq.(Please print)(Please print) (Signature)(Signature) , Esq. , Esq.(Please print)(Please print) For further information, consult the web page listed above or contact the ADR Coordinator Simone Abrams at 212-256-7986 or SAbrams@nycourts.gov. The fax number is 212-952-3772. 5/3/18