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MEDIATION SUMMARY FOR MEDIATOR

CONFIDENTIAL MEDIATION COMMUNICATION
Protected by Mediation Privilege

BASIC INFORMATION

Field Information
Submitting Party: _________________________________
Attorney/Representative: _________________________________
Phone: _________________________________
Email: _________________________________
Case/Matter Name: _________________________________
Case Number (if any): _________________________________
Mediation Date: _________________________________
Mediator: _________________________________

1. THE DISPUTE IN BRIEF

Summarize the dispute in 3-5 sentences:

___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________

2. PARTIES

Our Client:

  • Name: __________________________________________
  • Role: __________________________________________

Opposing Party:

  • Name: __________________________________________
  • Counsel: _______________________________________

Other Parties (if any):

___________________________________________________

3. KEY FACTS

List the 5-10 most important facts:

  1. ________________________________________________
  2. ________________________________________________
  3. ________________________________________________
  4. ________________________________________________
  5. ________________________________________________
  6. ________________________________________________
  7. ________________________________________________
  8. ________________________________________________
  9. ________________________________________________
  10. _______________________________________________

4. DISPUTED ISSUES

Identify the main areas of disagreement:

Issue Our Position Their Position
____________ ____________ ____________
____________ ____________ ____________
____________ ____________ ____________
____________ ____________ ____________

5. DAMAGES CLAIMED

Category Our Client Claims Opposing Party Claims
Economic Damages $____________ $____________
Non-Economic Damages $____________ $____________
Other $____________ $____________
TOTAL $____________ $____________

6. PRIOR SETTLEMENT DISCUSSIONS

☐ None
☐ Yes - Most recent positions:
- Our demand/offer: $____________
- Their demand/offer: $____________
- Gap: $____________

What happened:
___________________________________________________
___________________________________________________

7. WHAT WE WANT FROM MEDIATION

Primary Goals:
1. ________________________________________________
2. ________________________________________________
3. ________________________________________________

Settlement Range:
- Opening: $____________
- Target: $____________
- Authority: $____________

8. OBSTACLES TO SETTLEMENT

What do you see as the main barriers?

☐ Factual disagreements about: _________________________
☐ Legal issues regarding: _____________________________
☐ Valuation gap: ____________________________________
☐ Emotional/relationship issues: _______________________
☐ Authority limitations: ______________________________
☐ Third-party issues (liens, insurance): _________________
☐ Other: ___________________________________________

9. WHAT WOULD HELP

What could the mediator do to help move this case toward resolution?

___________________________________________________
___________________________________________________
___________________________________________________

10. ATTENDEES AT MEDIATION

Name Role Settlement Authority
____________ ____________ ☐ Full ☐ Limited
____________ ____________ ☐ Full ☐ Limited
____________ ____________ ☐ Full ☐ Limited
____________ ____________ ☐ Full ☐ Limited

Person with final settlement authority:
☐ Will be present
☐ Available by phone/video at: _________________________

11. SENSITIVE MATTERS

Anything the mediator should know about dynamics, personalities, or sensitivities:

___________________________________________________
___________________________________________________
___________________________________________________

12. KEY DOCUMENTS

List 3-5 most important documents (attach if requested):

  1. ________________________________________________
  2. ________________________________________________
  3. ________________________________________________
  4. ________________________________________________
  5. ________________________________________________

13. TIMELINE

Date Event
____________ _________________________________
____________ _________________________________
____________ _________________________________
____________ _________________________________
____________ _________________________________

14. LITIGATION STATUS

☐ No lawsuit filed
☐ Lawsuit pending:
- Court: _________________________________________
- Trial date: _____________________________________
- Next deadline: __________________________________

15. ADDITIONAL COMMENTS

___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________

Submitted by:

Signature: __________________________________________
Date: ______________________________________________

CONFIDENTIAL - FOR MEDIATOR USE ONLY

This template is provided for informational purposes only and does not constitute legal advice. Consult with a qualified attorney before use.

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MEDIATION SUMMARY FOR MEDIATOR

GENERAL TEMPLATE

Effective Date: [DATE]
Party A: [PARTY A NAME]
Address: [PARTY A ADDRESS]
Party B: [PARTY B NAME]
Address: [PARTY B ADDRESS]
Governing Law: [GOVERNING STATE]
This document is entered into by and between [PARTY A NAME] and [PARTY B NAME], effective as of the date set forth above, subject to the terms and conditions outlined herein and the laws of [GOVERNING STATE].
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