Court of Appeal Case Number:
COURT OF APPEAL, SECOND DISTRICT, MEDIATION
Case Name: Your name:
Counsel for:
MEDIATION FORM
NOTE TO ALL COUNSEL: Your case is now pending in the court’s Mediation Program. The purpose of this form is to
determine if your case is viable for mediation. This form will not be filed in the court’s docket. All counsel must review,
complete, and submit this form within 14 days of receipt. If this form is not received from all counsel within 21 days, the
case will be taken out of the mediation program with the understanding that not all parties agree to mediate.
Email form to 2d1.mediation@jud.ca.gov; or, fax to 213-830-7033.
THIS FORM IS CONFIDENTIAL AND WILL ONLY BE SHARED WITH THE MEDIATOR.
A. SUBJECT MATTER
List all that apply
Antitrust Corporation Entertainment Landlord-Tenant Probate –
disputes Decedents’
Anti-SLAPP/C.C.P. Defamation Environmental estates
§ 425.16 Legal Malpractice
Disability Family Probate – Trust
Bankruptcy Medical
Discrimination Health Care Malpractice Product Liability
Business/
Education Housing/Home- Partnership Real Estate –
Commercial
owners Assn. Commercial
Elder Abuse Personal Injury
Civil Rights Insurance Real Estate –
Eminent Domain Premises Liability Residential
Construction Intellectual
Employment/ Property Probate – Securities
Contracts Labor Conservatorship
International Tax
B. MEDIATION SESSION DATES
List all available dates verified by ALL parties. Counsel must confer with each other and provide mutually agreeable dates. A
minimum of 3 dates must be listed with at least one month window from the date this form is submitted.
C. PRE-MEDIATION PHONE CONFERENCE DATES
A phone conference is between the mediator and counsel only and typically lasts ½ hour. Counsel must confer
with each other and provide mutually agreeable dates.
AM PM AM PM AM PM
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Case Name: Court of Appeal Case Number:
D. QUESTIONNAIRE
1. Why is your case a good candidate for mediation?
2. What was at issue in the trial court?
3. How much was the plaintiff seeking monetarily?
4. What was the outcome of the case in the trial court?
5. What is at issue at the appellate court?
6. What do you anticipate to be the outcome of the appellate case?
7. Are there related disputes in the trial court or any other court?
8. Are the parties currently conducting settlement talks independent of the court? If so, describe the status of the
present settlement negotiations:
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Case Name: Court of Appeal Case Number:
9. What would you like to accomplish during mediation? (Please list a dollar amount you wish to seek or offer the
opposing party.)
10. What is the current relationship between the parties?
11. List the names and roles of all who will be present during mediation
12. If settlement of this case has been attempted before, please provide the following information:
(a) At what stage were settlement talks held?
(b) How many settlement attempts were made?
(c) What were the results of each settlement attempt?
DATE:
I declare that the foregoing is true and correct. __________________________________
(TYPE INITIALS) (TYPE NAME)
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