CACB — 6 In re ) Bk. No.

Source: https://www.cacb.uscourts.gov/sites/cacb/files/documents/forms/Mediators%20Report%20of%20Mediation.pdf

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3 UNITED STATES BANKRUPTCY COURT

4 FOR THE CENTRAL DISTRICT OF CALIFORNIA

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6 In re ) Bk. No. ) 7 ) ) [Chapter ] 8 ) Debtor(s). ) 9 ) ) 10 ) Adv. No. ) 11 ) ) 12 Plaintiff(s)/Movant(s), ) MEDIATOR'S CONFIDENTIAL ) REPORT OF MEDIATION 13 v. ) CONFERENCE ) 14 ) CONFIDENTIAL -- NOT ) TO BE FILED WITH THE 15 ) COURT Defendant(s)/Respondent(s). ) 16 )

17 I hereby certify that the following information is true and correct to the best of my

18 information and belief:

19 1. How did you learn of your mediation assignment? (PLEASE CHECK ALL THAT

20 APPLY)

21 (a) Received Court order ; (b) Phone call ;

22 (c) Fax from Mediation Program staff ;

23 (d) Other .

24 2. In what capacity did you serve?

25 (a) Mediator ; (b) Alternate Mediator ;

26 (c) Successor Mediator ; (d) Successor Alternate Mediator .

Form 709 Revised 03/22

1 3. How did the mediation assignment conclude?

2 (a) Settled ; (b) Did NOT settle .

3 4. How many hours did you spend scheduling and preparing for the mediation

4 conference?

5 5. How many hours did you spend attending the conference?

6 6. Which dispute resolution procedure(s) did you use? (IF MORE THAN ONE

7 METHOD USED, PLEASE ESTIMATE PERCENTAGE OF TIME SPENT ON EACH)

8 (a) Early neutral evaluation: ( %)

9 (b) Settlement negotiation: ( %)

10 (c) Mediation: ( %)

11 (d) Other: ( %)

12 (Describe):

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14 7. Were you compensated for your mediation services?

15 8. Have you filed Form 706 (Mediator’s Certificate Regarding Completion of

16 Mediation Conference) with the Court, and mailed courtesy copies to the judge assigned

17 to the matter and to Judge Russell (the Mediation Program Administrator)?

18 9. Comments/suggestions:

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23 DATED: (Name of Mediator) 24 SIGN

25 (Signature of Mediator)

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Form 709 2 Revised 03/22

1 MEDIATION CONFERENCE ATTENDANCE FORM

2 Case Name:

3 Case No.:

Adversary Proceeding Name: 4 Adversary Proceeding No.:

5 Date(s) of Conference(s): 6 Mediator: 7 Instructions: All attorneys and client representatives who attend the conference shall 8 provide the following information to the Mediator. PLEASE WRITE OR PRINT CLEARLY. 9 ATTORNEYS 10 Name: Name: 11 Firm: Firm: 12 Address: Address:

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14 Phone: Phone:

15 E-mail: E-mail:

Attorney for: Attorney for:16

17 Name: Name: 18 Firm: Firm: 19 Address: Address: 20

21 Phone: Phone:

22 E-mail: E-mail:

23 Attorney for: Attorney for:

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25 [Attach additional page(s) if necessary.] 26

Form 709 3 Revised 03/22

1 CLIENT AND/OR CLIENT REPRESENTATIVES

2 Name: Name: 3 Title: Title: 4 Organization: Organization:

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6 Address: Address:

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8 Phone: Phone: 9 Party Representing: Party Representing: 10

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12 Name: Name:

13 Title: Title:

Organization: Organization:14

15 Address: Address: 16

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18 Phone: Phone: 19 Party Representing: Party Representing: 20

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[Attach additional page(s) if necessary.]22

Mail to: Hon. Barry Russell23
Mediation Program Administrator
United States Bankruptcy Court24
255 East Temple Street, Suite 1660
Los Angeles, California 9001225
Mediation_Program@cacb.uscourts.gov

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Form 709 4 Revised 03/22