San Mateo — Statement of Nonagreement

Source: https://sanmateo.courts.ca.gov/system/files/local-forms/adr-cv-11.pdf

Attorney or Party without Attorney (Name, Address, Telephone, Fax, Court Use Only State Bar membership number):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN MATEO Hall of Justice and Records 400 County Center Redwood City, CA 94063-1655 (650) 261-5100 Case Name:

Case number:
STATEMENT OF NONAGREEMENT

First Supplemental

Plaintiff’s counsel or self-represented plaintiff must complete, serve, and file this form Within 10 days after conclusion of an unsuccessful ADR process, or by another date set by the court, in all cases assigned to ADR. In completing this form, the party must not Provide any information beyond what is specifically requested, or Disclose any settlement discussion, confidential communications, or conduct during the ADR session (Evid. Code 1115 et seq.).

1. Parties participated in the ADR Process (check one): a. VoluntaryMediation b. Binding Arbitration(private) c. Neutral Evaluation d. Settlement Conference (private) e. Non-Binding Judicial Arbitration CCP 1141.12 f. Summary Jury Trial g. Other:

2. The ADR process (check one): a. ended on (date): in nonagreement.

b. has not been completed. The parties anticipate that the ADR process will be completed by (date):

NOTICE TO PARTIES: This form does not extend any ADR completion deadline that has been set either by the court and ADR staff. You must request any necessary extension from the ADR Department by completing the extension request form at: https://www.sanmateo.courts.ca.gov/adrStipulationExtension

Date:

Type or Print Name Signature of Plaintiff or Plaintiff’s Attorney

STATEMENT OF NONAGREEMENT

Form adopted for Optional Use Local Court Rule, §§ 3.905(b) Form ADR-CV-11 [Rev. June 2021]