Fillable Form 100 00294 0 (Vermont Judiciary)

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Form 100 00294 0 (Vermont Judiciary)

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100-00294 – Alternate Dispute Resolution Report (09/2003) Page 1 of 1
STATE OF VERMONT
SUPERIOR COURT
CIVIL DIVISION
Unit
Docket No.:
Plaintiff(s)
vs.
Defendant(s)
ALTERNATE DISPUTE RESOLUTION REPORT
Date of ADR Session _______________ Starting Time __________ Finishing Time __________
1. Please indicate the names and addresses of all persons participating in the ADR Session. If either party is a
corporation or company, please indicate the name and title of the representative. Identify with an
asterisk (*) the representative of each party who had decision making authority.
Name
Representative & Title
If Applicable
Street Address
City, State, Zip
Plaintiff
Plaintiff’s Counsel
Defendant
Defendant’s Counsel
Insurance Carrier
Defendant
Defendant’s Counsel
Insurance Carrier
Other
2. Please summarize any substitute arrangement made regarding attendance at the ADR Session.
_______________________________________________________________________________________
_______________________________________________________________________________________
3. Were all appropriate parties in attendance? ☐ Yes ☐ No If No, who failed to appear? _____________
4. Were all parties prepared & did all participate in good faith? ☐ Yes ☐ No
If No, who did not comply? ______________
5. Did each party have a representative present with sufficient authority to participate in good faith to settle
the dispute at the time of the ADR Session? ☐ Yes ☐ No
6. Did the case settle? ☐ Yes ☐ No (If settlement was reached, please append the agreement of the
parties.)
7. If the case did not settle:
A. Can the scope of this dispute be narrowed by stipulation of the parties? If so, please describe:
____________________________________________________________________________________
____________________________________________________________________________________
B. Did the parties agree to a further ADR session? ☐ Yes ☐ No ☐ N/A
Date Printed Name Neutral (signature)
____________________ ______________________________________ ______________________________________
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Completed 15 July 2020

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