ADR Initiation Form

       PLEASE COMPLETE AND FILE WITH ROOM 148 WITHIN THE FIVE-DAY DEADLINE SET
                             FORTH IN THE RULES. NO EXTENSIONS OF TIME ALLOWED.

SUPREME COURT, NY COUNTY
COMMERCIAL DIVISION

------------------------------------------------------X                                                                 Part ___

                                            Plaintiff,                                                                             Index No. ______

                        - against -

                                            Defendant.                                                         ADR INITIATION FORM

[FULL CAPTION OR ATTACH COPY]

------------------------------------------------------X

          1) This case was referred to the Alternative Dispute Resolution Program (order of Justice _____________ dated ___________).

          2) The attorneys for the parties herein are as follows:

For Plaintiff:                                                                                             For Defendant:









Phone:                                                                                                 Phone:

Fax:                                                                                                     Fax:

E-Mail:                                                                                                 E-Mail:

For Others:









Phone:                                                                                                 Phone:

Fax:                                                                                                     Fax:

E-Mail:                                                                                                 E-Mail:

          3) Please briefly describe this case, including, if possible, the damages claimed:





                                                                                                                                                                                          .

          4) In order that the Neutral tentatively selected may run the required conflicts check, counsel for any corporate party must list here or on an attached sheet the names of all corporate parents, subsidiaries or affiliates:





                                                                                                                                                                                           .

          5) This case will be mediated unless otherwise agreed, in which event, identify the procedure selected:

                    Arbitration                                                               Other (Specify):

          6) Please indicate whether there are in this case:

                          Motions sub judice: Yes __ No__                                                   Appeals: Yes __ No __

If you indicated yes to either of the foregoing, please contact the ADR Coordinator immediately.

          7) By signing below, counsel, on behalf of the parties, certify that they have read and will comply with the ADR Rules of the Commercial Division.

For further information, consult the Commercial Division Internet home page (www.courts.state.ny.us/comdiv) or contact the Division’s ADR Program at (646) 386-3020 (Phone) or (212) 608-4873 (Fax).


Counsel for Plaintiff                                                                                                       Counsel for Defendant


Counsel for                                                                                                                  Counsel for

                                                       This form may be filed by fax (212-748-5312)

                                                                                                                                                                                                                            (No. 5   5/15/02)