ACO CORP
ACO Agreement to Mediate
Mediation Services Agreement to Mediate
By signing this “Agreement” I agree to try to resolve this dispute through mediation.
Mediation has been explained to me.
It is important that I am comfortable with the mediator, her/his Mediation Style and her/his ability to give the participants impartial regard.
The Mediator will disclose all circumstances and relationships that may raise questions as to her/his ability to give impartial regard. Mediation will proceed with my consent and the consent of the other participants.
Each Member to participate shall sign this document before mediation process begins.
I understand and agree to the following:
- 1. The mediator’s role is to be neutral, not to take sides or to judge whom is right or wrong. The mediator does not represent me, or any of the participants, in an attorney/client or therapist/client relationship and cannot give legal advice to any of us.
- 2. Any participant involved in this dispute has the right to be assisted by legal counsel if they wish. I have been advised to have my attorney review any written settlement agreement before signing if I have questions about its legal effect.
- 3. Confidentiality:
a) I must hold all communication or information gained in the mediation confidential and may not disclose it to any other person, according to the state statute . An option is for all parties present to agree in writing that such information is not confidential.
b) My communication with the mediator in a private meeting (caucus) will not be shared with the other parties, unless I give my permission.
c) I understand that only the following two exceptions apply:
1) This mediator will report to the appropriate authorities any new allegations of elder or child abuse or neglect, or threats of harm or actual harm to another person.
2) Should a mediated agreement be reached, the terms of any signed
mediated agreement are not confidential per State statute.
d) I will not use as evidence in a court proceeding any information that is gained solely in this mediation.
e) The mediator, by law, cannot testify as witness in court and I will not
attempt to call her or him as witness or subpoena her or him and the records of this mediation process.
3. Participation is completely voluntary. I can withdraw or suspend mediation at any time for any reason. I give up no rights to go to court or to take legal action available to me if we do not reach an agreement.
4. The mediator will continue the mediation to resolve any outstanding disputes among the participants as long as all participants make a good faith effort to reach an agreement based on fairness to all. If the mediator, in her professional judgement, concludes that agreement is not possible or that a participant’s bad faith, dishonesty, or nondisclosure is so significant that the fairness and integrity of mediation cannot be maintained, the mediator will withdraw and the mediation conclude. The mediator may also withdraw and end the mediation if she can no longer effectively perform her facilitative role.
5. If we reach an agreement, I will keep my part of the agreement. If new disputes arise, I agree to return to mediation for continuing resolution.
6. I have made individual arrangements with the mediator to pay my portion of the fees.
I have read, understand, and agree to each of the provisions of this agreement.
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