IN THE UNITED STATES DISTRICT COURT WESTERN DISTRICT OF NORTH CAROLINA Case No. ) ) ) Plaintiff(s), ) ) CERTIFICATION OF vs. ) MEDIATION SESSION ) ) ) Defendant(s). ) Instructions: This certificate shall be filed by the mediator or by the plaintiff, and served upon all parties upon completion of the ADR process unless otherwise ordered. The undersigned mediator reports the following result of a Mediated Settlement Conference held on . The following individuals, parties, corporate representatives, and/or claims professionals attended and were available to participate in the session, and the appropriate individuals possessed the requisite settlement authority: All individual parties and their counsel. Designated corporate representatives. Required claims professionals. Other (describe): The following individuals, parties, corporate representatives, and/or claims professionals failed to appear and/or failed to participate as ordered: American LegalNet, Inc. www.FormsWorkFlow.com The outcome of the Mediation session was: The parties have reached an impasse. The case has completely settled. Counsel will promptly notify the Court of settlement by: The filing of a settlement agreement signed by the parties within thirty (30) days of the filing of this report. The filing of a stipulation of dismissal signed by the parties within thirty (30) days of the filing of this report. The case has been partially resolved. Counsel will file a joint stipulation regarding those claims which have been resolved within thirty (30) days of the filing of this report. The report shall also contain a brief summary of the remaining issues for the Court to resolve. I certify that the above is a true and accurate report regarding the result of the Mediation Settlement Conference. Name of Mediator or Plaintiff222s Counsel Signature of Mediator or Plaintiff222s Counsel Date CERTIFICATE OF SERVICE I hereby certify that I have this date served counsel for all parties with the Report of Mediation by sending a copy thereof to the following via email or conventional mail as noted: This the day of , 20 . s/ Mediator/Plaintiff222s Counsel American LegalNet, Inc. www.FormsWorkFlow.com