Fillable ALTERNATIVE DISPUTE RESOLUTION (ADR) CLAIM FORM *Only one (Nevada Real Estate Division)

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ALTERNATIVE DISPUTE RESOLUTION (ADR) CLAIM FORM *Only one (Nevada Real Estate Division)

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STATE OF NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY – REAL ESTATE DIVISION
OFFICE OF THE OMBUDSMAN FOR COMMON-INTEREST COMMUNITIES AND COMDOMINIUM HOTELS
3300 West Sahara Avenue, Suite 350, Las Vegas, Nevada 89102
(702) 486-4480 / Toll free: (877) 829-9907 / Fax: (702) 486-4520
E-mail: CICOmbudsman@red.nv.gov / http://red.nv.gov
Revised 2/19/2020 Page 1 of 4 520
ALTERNATIVE DISPUTE RESOLUTION (ADR) CLAIM FORM
Date: Signature of Claimant:
*Only one claimant per claim form is allowed for tracking purposes.
Claimant:
*If individual, provide full name as it appears with the assessor’s office in order to verify that you are a Unit Owner. If an Association, provide
COMPLETE Association name as it appears on the Secretary of State’s website.
Law Firm and Attorney (if applicable):
Please provide the name of the law firm and the name of the attorney. An attorney is not required.
Mailing Address:
Street and number, city, state, and zip code
Phone Number: Fax Number: Email Address:
Respondent:
*If individual, provide full name. If an Association, provide COMPLETE Association name as it appears on the Secretary of State’s website.
Please list only one party. Attach an Additional Respondent Form 520B if there is more than one Respondent.
Mailing Address:
Street and number, city, state, and zip code
Phone Number: Fax Number: Email Address:
PLEASE SELECT YOUR METHOD OF RESOLUTION: Mediation Referee Program*
*Claims involving multiple parties may be excluded from the Referee Program.
**If all parties agree to the Referee Program, the cost will be fully subsidized by the Division, if funds are available.
Has the above-listed Claimant filed an Intervention Affidavit (Form 530) regarding the same or similar
issues?
Yes No
If yes, provide the file number(s):
INITIAL
I have read and agree to the policies stated in the ADR Overview (Form 523).
INITIAL IF
APPLICABLE
I acknowledge that if an Intervention Affidavit (Form 530) has been filed with the Division based upon
the same issues, by filing an ADR claim; the Division will not move forward with investigating the
Intervention Affidavit pursuant to NAC 116.630.
If the Referee Program is selected, and the Respondent choses Mediation, the claim will default to
mediation.
For office use only
Receipt Number: Claim Number: Date Received:
Revised 2/19/2020 Page 2 of 4 520
Address of unit related to this claim:
• Your explanation must start below. You may attach additional pages, if more space is needed. Please, do not write
“SEE ATTACHMENT” in the space below IT IS NOT ACCEPTABLE.
• If this claim is being filed based on a referral from the Intervention process, please ensure that you explain the issue
below. Do not refer to your original complaint.
IDENTIFY THE SECTION OF GOVERNING DOCUMENTS PERTAINING TO THE DISPUTE:
In order for the claim to be considered filed, the following must be submitted, if applicable.
Please indicate that you acknowledge and will follow through with completing each of the items below. Initial that the
following steps have been completed:
INITIAL
Forms:
One (1) Original Claim Form (Form 520)
Two (2) copies of the Claim Form and supporting documents
• Supporting documents may be provided directly to the Mediator or Referee one assigned and need
not be provided with this Claim Form. Should you choose to submit your documents, you must
supply one (1) original set and two (2) copies of the supporting documents.
NONREFUNDABLE Filing Fee of $50.00 payable to “NRED” in the form of:
• Cash (exact change; please do not mail cash)
• Check
• Money Order
I acknowledge that the Subsidy Application will ONLY be accepted and reviewed prior to the claim
being assigned to a Mediator or Referee.
INITIAL IF
APPLICABLE
ADR Subsidy Application for Mediation (Form 668). Subsidy is awarded based on the following:
For a Unit Owner, once during each fiscal year of the State for each unit owned.
For an Association, once during each fiscal year of the State for each unit located within each
individual association. Association must be “in good standing” with Secretary of State and Office of the
Ombudsman.
I acknowledge that the Claimant will NOT be applying for Subsidy for this claim.
Revised 2/19/2020 Page 3 of 4 520
SERVING THE CLAIM
Please be advised, the Claimant will be responsible to have the Respondent(s) served within 45 days from the date the
Division processes the Claimant’s 520 claim form. The packet will contain instructions on how to serve the claim.
The packet that the Claimant will receive in the mail will contain:
• A claim opening letter (keep this letter for your records).
• A receipt for the non-refundable $50.00 filing fee (keep for your records).
• Affidavit of Services Form
o This form must be filled out by the person that serves the claim.
o The form MUST be notarized and returned to the Division within 10 days of the claim being served.
o The packet cannot be served by anyone associated with the claim.
The following items from the packet are required to be served:
• ADR Overview, Form 523
• Copy of the claim that was processed, Form 520
• A blank Response, Form 521
• A blank Subsidy Application, Form 668
• If the Claimant listed more than one Respondent on the Claim Form (520). The Claimant will be responsible to make
copies of the packet, so that each Respondent can be served.
• One (1) Affidavit of Service will have to be notarized and submitted for each Respondent listed on the Claim Form
(520/520B).
• Pursuant to NAC 38.350(2)(a) – The Affidavit of Service MUST be submitted to the Division within 10 days of being
served.
INITIAL
I acknowledge that all forms listed above will be served pursuant to NRS 38.320.
I acknowledge that if the claim is not served within the timeframe set forth by Nevada
Administrative Code (NAC) 38.350 (1), the claim will be closed.
I acknowledge if the Affidavit of Service (AOS) is not submitted to the Division within the
timeframe set forth by Nevada Administrative Code (NAC) 38.350 (2)(a), the Division has the
authority to close the claim.
How service must be made:
• Service on a Nevada Corporation: Service shall be made upon the president or other corporate head, secretary,
cashier, managing agent or resident agent. However, if this is not possible, then upon the Secretary of State in the
manner described in Rule 4 of the Nevada Rules of Civil Procedure.
• Service on a Non-Nevada Corporation: Service shall be made upon the agent designated for service of process, in
Nevada, or its managing agent, business agent, cashier, or secretary within this State. However, if this is not possible,
then upon the Secretary of State in the manner described in Rule 4 of the Nevada Rules of Civil Procedure.
• In all other cases (except service upon a person of unsound mind, or upon a city, town or county): Service shall
be made upon the respondent personally, or by leaving copies at his dwelling house or usual place of abode with some
person of suitable age and discretion then residing therein, or by delivering a copy of the summons and complaint to
an agent authorized by appointment or by law to receive service of process.
• If all the above are not possible because of the absence from the state or inability to locate the respondent: An
Affidavit of Due Diligence can be provided to the Division. If the Division determines adequate efforts were
made to serve the respondent(s), the Division will provide a letter to the claimants acknowledging their
unsuccessful efforts to participate in the ADR program.
“Service by Publication” is not a valid form of service for the ADR Program.
Revised 2/19/2020 Page 4 of 4 520
The following is a listing of the Mediators and Referees for the Alternative Dispute Resolution program. Before making
your selection, you may view the resumes of the Mediators and Referees, and their location availability.
• If the parties do not agree on the selection of Mediator or Referee, the Division will assign a Mediator/Referee at
random.
• This is a requirement, please indicate the Mediator/Referee by initialing next to the party selected.
SOUTHERN NEVADA
MEDIATOR LISTING
Barbara Fenster
Dee Newell, JD
Donald E. Lowrey, Esq.
Eric Dobberstein, Esq.
Henry Melton
Ira David, Esq.
Janet Trost, Esq.
Malcolm Doctors
Phillip A. Silvestri, Esq.
REFEREE LISTING
Donald E. Lowrey, Esq.
Ira David, Esq.
NORTHERN NEVADA
MEDIATOR LISTING
Paul H. Lamboley, Esq.
Michael Matuska, Esq.
REFEREE LISTING
Paul H. Lamboley, Esq.
Michael Matuska, Esq.
Once a claim has been received and processed by the Division an opening packet will be mailed out to the
mailing address provided on page 1 of this form. This packet will include instructions on the next step in this
process (serving the claim).
Submit the required forms and documents to:
Nevada Real Estate Division
ADR Facilitator
3300 West Sahara Avenue, Ste. 325
Las Vegas, NV 89102
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ALTERNATIVE DISPUTE RESOLUTION (ADR) CLAIM FORM *Only one (Nevada Real Estate Division)

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Completed 28 December 2021

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