a. What is the nature of the case? Select Breach of Contract Business Torts Civil Rights Defamation Directors and Officers Liability Discrimination E-Commerce Issues Employment Employment: Wrongful Termination Environmental and Toxic Exposure ERISA Fraud & Misrepresentation Governmental Liability Insurance Coverage and “Bad Faith” Intellectual Property Invasion of Privacy Partnership Disputes/Dissolution Personal Injury Products Liability Professional Liability Property Damage Real Estate Securities Sexual Harassment Trade Secrets Wrongful Death OTHER

b. In which court is the case pending? Select NOT FILED Alameda County Superior Court Butte County, California, Superior Court Los Angeles County Superior Court Marin County Superior Court Monterey County Superior Court Napa County Superior Court Orange County Superior Court Placer County, California, Superior Court Riverside County, California, Superior Court Sacramento County Superior Court San Bernardino County Superior Court San Diego County Superior Court San Francisco County Superior Court San Mateo County Superior Court Santa Clara County Superior Court Santa Cruz County Superior Court Sonoma County Superior Court Stanislaus County, California, Superior Court U. S. District Court, San Francisco U. S. District Court, San Jose U. S. District Court, Oakland OTHER

c. What is the court case or action number?

d. How many parties are there? - - 2 3 4 5 6 7 8 9 10

a. Firm name?

b. Address? City State Select AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip

c. Telephone?

d. E-mail?

a. What best describes their legal status in the case (e.g., plaintiff, defendant, etc.)? Select Plaintiff(s) Defendant(s) Defendant(s) + Cross-Complainant(s) Cross-Complainant(s) + Cross-Defendant(s) Cross-Defendant(s) + Intervenor(s)

b. What is their role in this case?
                                                                      (e.g., injured party, product manufacturer, employer, etc.)

a. If there is an assigned judge, please provide their name:

a. Has there been a previous mediation? Select Yes No If “yes,” when? Select Date
                                                                                                              mm/dd/year

i. If “yes,” who was the mediator?

i. Will this be a judge or jury trial? Select Judge Jury

a. If “yes,” please briefly describe what discovery has been completed,
    and what remains to be done:

b. Is discovery still open? Select Yes No If “yes,” when does discovery close? Select Date
                                                                                                                        mm/dd/year

a. Have any rulings on these motions been issued? Select Yes No If “yes,” when? Select Date
                                                                                                                                mm/dd/year

b. If “yes,” please briefly describe the rulings:

a. If “yes,” what is your client’s CURRENT demand or offer?

a. If “yes,” what is your client’s CURRENT demand or offer?

a. If “yes,” are the policy limits adequate? Select Yes No Unknown

b. If “yes,” what is the name of the insurer (or insurers, if excess insurance is involved)?

c. If “yes,” what is the total amount of insurance available?

d. Has any insurer issued a “reservation of rights”? Select Yes No Unknown

e. If “yes,” please briefly describe the basis for the “reservation of rights”:

a. If “yes,” please briefly describe the resources or assets:

a. If “yes,” have you discussed this possibility with your client? Select Yes No

b. If “yes,” have you discussed this possibility with opposing counsel? Select Yes No

c. If “yes,” will there be a “structured settlement” expert or advisor present at the mediation? Select Yes No Unknown

a. If “yes,” by whom?

b. If “yes,” who is the claim for indemnity against?

c. If “yes,” is there a WRITTEN indemnity agreement? Select Yes No Unknown

a. Will the lien claimant be represented at the mediation? Select Yes No Unknown

a. If “yes,” who?

b. If “yes,” please briefly describe their interest?

a. If “yes,” who?

b. If “yes,” please briefly describe their interest?

a. act only as a neutral facilitator of communication between the parties, while providing no neutral evaluation,
   and let the parties and their representatives reach their own resolution, if possible? Select Yes No Unsure

OR

b. provide a private, independent evaluation of the party positions and exposures, while facilitating communication
    between the parties? Select Yes No Unsure

a. communicate to other parties changes in positions, demands and offers,
    from separate meeting (caucus) sessions? Select Yes No Unsure

OR

b. let the parties exchange all changes in positions, demands and offers,
    in “face-to-face” meeting sessions? Select Yes No Unsure

a. a joint mediation session to present your client’s case directly to the other parties and their counsel, and have
    an opportunity to assess their response, in addition to private caucus sessions with the mediator? Select Yes No Unsure

OR

b. private caucus sessions ONLY with the mediator, and NO joint mediation session to present your client’s case
    directly to the other parties and their counsel, and have an opportunity to assess their response? Select Yes No Unsure

By clicking on “Submit”, you will send this information to the mediator only, in the form of a CONFIDENTIAL E-mail.