Orange — Acknowledgment of Confidentiality: Mediation

Source: https://www.occourts.org/system/files/l2754.pdf

ADR NEUTRAL NAME, ADDRESS, TELEPHONE, FAX AND EMAIL:

PLAINTIFF/PETITIONER:

DEFENDANT/RESPONDENT:

ACKNOWLEDGMENT OF CONFIDENTIALITY CASE NUMBER:
MEDIATION SESSION

(DO NOT FILE WITH THE COURT)

This form is provided to offer mediators a convenient means to inform participants of the applicable ethical and other rules.

The participants in the mediation proceeding of this case agree that:

1. The mediation proceeding will be confidential, in accordance with California Evidence Code sections 703.5 and 1115 through 1128.

2. This agreement does not affect the admissibility of a written settlement agreement reached as a result of this mediation proceeding in an action to enforce that settlement.

3. This agreement will not preclude a report of information to the ADR Administrator or an inquiry by the Administrator regarding complaints against a neutral pursuant to California Rules of Court, rules 3.850 through 3.863.

Dated:___________________________ ____________________________________________________ Neutral

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Party Party

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Attorney Attorney

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Party Party

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Attorney Attorney

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Other Participant Other Participant

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Title Title

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Representing (specify party) Representing (specify party)

Additional pages attached (number) _______

ACKNOWLEDGMENT OF CONFIDENTIALITY – MEDIATION SESSION Adopted for Mandatory Use EC §703, 1115, et seq, CCP §1175.10 L2754 (New February 2008) For your protection and privacy, please press the Clear This Form California Rules of Court rule 3.850 et seq button after you are done printing the form. Print This Form

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