DECEMBER 2010 SETTLEMENT WEEK

LAKE COUNTY COMMON PLEAS COURT

I would like to nominate the following case to be considered for Settlement Week

mediation. Pertinent information about the case is as follows:

Case No.________________________ Case Name____________________________________________

Judge___________________________ Type of Case_________________________________________

                                                       (p.i., contract, etc.)

1. All necessary parties are:                             (A) Joined              ( )

                                                          (B) Represented         ( )

                                                          (C) Entered in case     ( )

2. Discovery is:                                          (A) Not necessary       ( )

                                                          (B) Completed           ( )

                                                          (C) Adequate to proceed ( )

                                                          (D) Not started         ( )

3. Expert witnesses:                                      (A) Not necessary       ( )

                                                          (B) Reports exchanged   ( )

                                                          (C) Disposed            ( )

4. Liability is:                                          (A) Clear               ( )

                                                          (B) Relatively clear    ( )

                                                          (C) Contested           ( )

5. Dispositive Motions:                                   (A) Not applicable      ( )

                                                          (B) Ruled upon          ( )

                                                          (C) Filed and pending   ( )

                                                          (D) To be filed         ( )

6. Negotiations:                                          (A) Have not yet begun  ( )

                                                          (B) In progress         ( )

                                                          (C) At an impasse       ( )

7. Amount in controversy: $__________________________________

The real party in interest is:________________________________________________________

                                       (name of insurance company, etc.)

Other factors which make this case suitable for inclusion in Settlement Week:

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

I understand that nomination of this case does not mean that it will be

automatically scheduled for Settlement Week Mediation.

________________________________________________________

(Signature)

Name__________________________________________________________________________________
                                      (Print)

Firm__________________________________________________________________________________

Address_______________________________________________________________________________

______________________________________________________________________________________

Telephone Number______________________________________________________________________

Name of Opposing Counsel______________________________________________________________

Firm__________________________________________________________________________________

Address_______________________________________________________________________________

______________________________________________________________________________________

Telephone Number _______________________ E-Mail Address ______________________________

Please return to: The Lake County Bar Association
                  Lake County Courthouse West Annex
                  P.O. Box 490
                  Painesville, OH 44077

PLEASE RETURN THIS FORM BEFORE NOVEMBER 12, 2010.