COURT First Judicial District of Pennsylvania COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Philadelphia Court of Common Pleas : Index No. : (Month) Plaintiff(s) : -against- Calendar No. Term, (Year) , (No.) JUDICIAL SUBPOENA Arbitration : (Please indicate type of action) Motor Vehicle : (Date of Accident) : Versus Delay Damages (Prime Rate +1) Defendant(s) : ...................................................... Contract Delay Damages (Legal Rate = 6%) THE PEOPLE OF THE STATE OF NEW YORK Assessment of Damages TO Other Report and Award of Arbitrators GREETINGS: And Now , this day of , Year , we the undersigned arbitrators having been duly appointed and sworn, make and following award: aside, you and each of you attend before the excuses being laid WE COMMAND YOU, that all business , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Court in Witness, Honorable County, , one of the Justices of the day of , 20 Please name the parties if there are more than one plaintiff and/or defendant. Please address all counterclaims and cross claims. Please complete percentage(Attorney must sign above and type side below) of negligence on reverse name if applicable. Chairperson Please Print Name, Address and I.D. No. Attorney(s) for Arbitrator Please Print Name, Address and I.D. No. Arbitrator Please Print Name, Address and I.D. No. Office and P.O. Address List Attorneys of Record and Unrepresented Parties Who: Telephone No.: Appeared at the hearing: Did Not Appear at the Hearing: Facsimile No.: E-Mail Address: Mobile Tel. No.: 30-210 (Rev. 1/00) American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. Questions to be Answered by : Calendar No. the Arbitrators in Negligence Cases Instructions: Plaintiff(s) -against- : JUDICIAL SUBPOENA : Taking the combined negligence that was a substantial factor in: bringing about any or all of the plaintiff's injuries, damage or losses as 100%, answer the following questions and state in percentages the causal negligence attributed to each party you have found causally negligent. : Defendant(s) Do you find that any defendant or additional defendant : was negligent? ...................................................... If so, state the name of the party and percentage of negligence attributable to that party. % THE PEOPLE OF THE STATE OF NEW YORK % TO % % GREETINGS: WE COMMAND plaintiff all negligent? Do you find that any YOU, thatwasbusiness and excuses being laid aside, you and each of you attend before , the Honorable the name of the party and percentage of negligence attributable to that party. at the Court If so, state located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed % or adjourned date, to testify and give evidence as a witness in this action on the part of the % % Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a % result of your failure to comply. Witness, Honorable Court in County, Total , one of the Justices of the day of 100% , 20 Notice of Entry of Award (Attorney must sign above and type name below) And Now, this ______day of _____________, Year ______, at ___________________, ______.m., the above award was entered upon the docket and notice thereof given by mail to the parties or their attorAttorney(s) for neys. (Arbitration compensation to be paid on appeal $200.00) 30-210 (Rev. 1/00) Reverse Prothonotary Office and P.O. Address By: Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com