Court Mediation Program Mediator Application

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Contact Information

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Name

First*	Middle	Last*	Suffix
			Name Suffix

Office

Office Name

Address

Address	City	State	Zip
		Us State

Contact Information

Office Phone*	Office Fax	Email*

Website

Hourly Fees

Hourly fees charged for Mediator services*
Do you have a Sliding Scale?*	Yes No
Do you require a fully refundable deposit for time beyond the initial two hours of mediation?*	Yes No
Additional Fee or Deposit Comment

Areas of Expertise

Please indicate up to TEN areas in which you have expertise.

Auto Tort

Auto (Personal Injury)

Uninsured Motorist

Other PI/PD/WD (Personal Injury / Property Damage / Wrongful Death) Tort

Asbestos

Product Liability

Medical Malpractice

Other PI/PD/WD

Non-PI/PD/WD (Other) Tort

Business tort/unfair business practice

Civil rights (e.g., discrimination, false arrest, disability)

Defamation (e.g., slander, libel)

Fraud

Intellectual property

Professional negligence (e.g., legal malpractice)

Other non-PI/PD/WD Tort

Employment

Wrongful termination

Other employment

Contract

Breach of contract / warranty

Collections (e.g., money owed, open book accounts)

Insurance coverage

Other contract

Real Property

Eminent domain / inverse condemnation

Wrongful eviction

Other real property (e.g., quiet title)

Unlawful Detainer

Commercial

Residential

Drugs

Judicial Review

Asset forfeiture

Petition re: arbitration award

Writ of mandate

Other judicial review

Provisionally Complex Civil Litigation

Antitrust / Trade regulation

Construction defect

Mass tort

Securities litigation

Toxic / Environmental tort

Insurance coverage claims arising from the above listed provisionally complex case types

Enforcement of Judgment

Enforcement of judgment

Miscellaneous Civil Complaint

RICO

Other complaint (not listed above)

Miscellaneous Civil Petition

Partnership and corporate governance

Other petition (not listed above)

Probate

Probate Conservatorships of the Person and/or Estate

Probate Decedent's Estate

Trusts

Other

Elder abuse
False imprisonment
Family law
Lemon law
Mechanics lien
Other
Other description

Civil Practice

Civil Case History

Please estimate the number of civil cases for which you have had principal responsibility as attorney in the last five years.
Personal Injury
Business
Other

Number of trials as lead counsel

Civil Litigation Practice

Are you currently active in civil litigation practice?

Yes No

Are you willing to conduct hearings on evenings or weekend?

Yes No

Has the California State Bar or other legal/professional organization imposed any disciplinary action, suspension from practice, or fine in excess of $250 against you?*

Yes No

Please identify what insurance coverage you have which will be applicable to ADR services

Coverage Type
Carrier Name
Limits
(Insurance coverage may become a requirement for panel membership at some future date.)

Agency Discipline or Criminal History

Have you ever been convicted of a felony or misdemeanor?*	Yes No
If so, please contact the ADR administrator, adrprogram@alameda.courts.ca.gov with a list of all convictions since your 18th birthday including: offense, date and place of conviction and sentence and date of release from custody and/or parole.

Have you ever had any disciplinary actions taken against you by any state, federal, or professional licensing board/agency?*	Yes No
If so, please contact the ADR administrator, adrprogram@alameda.courts.ca.gov with a description of the nature of the offense, date of disciplinary action, length of sentence/probation and amount of restitution, if any.

Failure to notify the ADR Program of criminal convictions or professional disciplinary actions will result in removal from the program. Convictions or disciplinary actions will not automatically bar you from the program.

Brief Professional Summary* (3600 characters max.)

Program Compliance

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I will:
attend an ADR Program orientation provided by this court.*
attend at least two sessions per calendar year provided by the ADR Program covering program changes, legislative updates, and other topics.*
attend four hours of continuing education related to the practice of mediation within the next two years and every two years thereafter.*
At least one hour of that education must address ethics, fairness, and bias issues in the mediation context. At least one hour of that education must address practice and ethical issues that arise with self represented litigants in mediation.
comply with all applicable ethical standards for neutrals.*
comply with all applicable Rules of Court and the Mediation Guidelines.*

Certification

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I certify that I meet the requirements to serve as a mediator on the Mediation Panel of the Alameda County Superior Court.*
I agree to abide by the ethical principles established by Cal. Rules of Court, rules 3.850-3.860, and any standards of conduct established by the court.*

I certify:* (one of the two below is required)
There are no matters about which I am required to inform the court pursuant to Cal. Rules of Court, rule 3.856(c).
I have mailed, emailed, or faxed a detailed description of all matters about which I am required to inform the court pursuant to Cal. Rules of Court, rule 3.856(c), to the ADR Program Office.

I agree to provide all scheduling and preparation time and 2 hours of mediation time pro bono on every Court Mediation and Civil Action Mediation case accepted. I also agree to complete, serve as appropriate, and return all required case information forms, including the Notice of Date, Time, and Place of the Mediation and the Notice of Mediator’s Report.*
I agree to accept at least three mediation cases per year through the Day of Court Mediation, Civil Action Mediation, or Court Mediation Program.*
I understand inclusion on a court list of ADR neutrals and eligibility to be recommended or appointed by the court to serve as a neutral are privileges that are revocable and confer no vested right on the neutral. (Cal. Rules of Court, rule 10.781(d)).*

Superior Court of Alameda County Public Portal

ADR Mediator Application

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