Sample Agreement to Mediate Letter

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[Your Name, & Address here]



[Recipient Name & address here]

[Date here]

Dear [name],

Agreement for Mediation-

Case Name […]

We, the undersigned, are in agreement to use the mediation services of [mediator company/individual name] to help execute a settlement for the dispute. We fully accept these terms and conditions –

1. The parties agree to appoint [mediator company/individual name] to perform as an arbitrator regarding this matter, and choose to mediate the civil dispute under the conditions of ‘Evidence Code Section’ – [put in relevant section number(s) for your authority].  The negotiator shall perform as a supporter to resolve out the matter, and shall use their best efforts to help the parties reach come to an equally acceptable agreement. The negotiator will act unfavorably toward the parties.

2. Arbitration is a voluntary procedure to execute a settlement. In this background, arbitrators perform as neutral third parties wholly, and don’t stand for any party or otherwise practice law. They shall not give any legal advice. Similarly, an arbitrator is not a judge, nor does he have the authority to strength a settlement on a party. The participants are free to seek advice from their own attorney for their legal rights and responsibilities.

3. All declarations made during this procedure are unacceptable for any purpose in any proceedings. The parties will not ask the arbitrator to be a witness or produce records, reports, remarks, or other documents in possession with the arbitrator during the course of the mediation process.

4. In addition, the arbitrator may have a meeting with any participant in private. In such a meeting, any information shared is confidential, and will not be revealed by the mediator unless the participant gives approval.


5. The arbitrator’s fee shall be $[fee] per hour, plus a $[admin fee] per party. Unless otherwise agreed, the parties shall divide the fee on an equal basis; however, payment should be made as a joint liability of the participants. Any extra unpaid fees and operating expenses shall be paid within one month of receiving the bills. A cancellation request for mediation with an advance notice less than ten days will result in a cancellation fee of $[fee amount], to be paid by the cancelling participant.

6. This agreement includes all legal provisions in the mediation process.


Party Date Counsel Date

_____________________________________ _______________________________________
Party Date Counsel Date

_____________________________________ _______________________________________
Party Date Counsel Date

_____________________________________ _______________________________________
Party Date Counsel Date
[Your name]

Encl: [Enclosures List here]

 Download Sample Agreement to Mediate Letter In Word Format

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