CERTIFICATE OF OBSERVATION Mediated Settlement Conference Program Rule 8.C, Rules Implementing Statewide Mediated Settlement Conferences and Other Settlement Procedures in Superior Court Civil Actions Note: All applicants for mediator certification are advised to review MSC Rule 8.C prior to completing their observations.* Pre-Litigation: Case Caption: Case/File No.: Yes No I hereby certify that: 1. I am currently certified by the NC Dispute Resolution Commission as a superior court mediator. 2. On , I conducted a mediated settlement conference in the above matter, which was observed by from the beginning of the mediation until its conclusion by settlement or impasse. (Date) (Type Or Print Name Of Observer) Signature Of Mediator Name Of Mediator (Type Or Print) Email Address Of Mediator This, the day of 20 . *Attorney applicants must observe two (2) mediated settlement conferences conducted by a certified superior court mediator from beginning to impasse or settlement, at least one (1) of which must be of a superior court case. Conferences eligible for observation are those disputes mediated prior to litigation by agreement of the parties, or cases pending before the NC Superior Court, the NC Court of Appeals, the NC Industrial Commission, the NC Office of Administrative Hearings, or the US District Courts for North Carolina, that are ordered to mediation or conducted by agreement of the parties, and which are conducted in accordance with the rules for mediation of the applicable entity. MSC Rule 8.C. Non-attorney applicants must observe five (5) mediated settlement conferences conducted by at least two (2) different certified superior court mediators from beginning to impasse or settlement, at least two of which must be of superior court cases. Conferences eligible for observation are those disputes mediated prior to litigation by agreement of the parties, or cases pending before the NC Superior Court, the NC Court of Appeals, the NC Industrial Commission, the NC Office of Administrative Hearings, or the US District Courts for North Carolina, that are ordered to mediation or conducted by agreement of the parties, and which are conducted in accordance with the rules for mediation of the applicable entity. MSC Rule 8.C. AOC-DRC-07, Rev. 7/14 � 2014 Administrative Office of the Courts American LegalNet, Inc. www.FormsWorkFlow.com