Departmental Appeals Board

SAMPLE AGREEMENT TO MEDIATE

The parties voluntarily agree to mediate. The parties understand that mediation may be terminated at any time by either party or by the mediators.

The mediators have no authority to decide any case and are not acting as advocates or attorneys for any party. The parties have a right to representation during mediation.

The confidentiality provisions of the Administrative Dispute Resolution Act apply to this mediation. The ADR Act focuses primarily on protecting private communications between parties and the mediator. Generally, parties oral communications to the mediator during mediation are protected. The same is true for written communications parties prepare for mediation and give only to the mediator.

There are exceptions to the confidentiality provisions in the Act. For example, statements made with all the other parties present or documents provided to all parties are not confidential. Also, in unusual circumstances, a judge can order disclosure of information that would prevent a manifest injustice, help establish a violation of law, or prevent harm to public health and safety. Further, information concerning fraud and criminal activity or threats of imminent harm will not be considered confidential in this mediation.

Parties can agree to more confidentiality if they want. For example, parties can agree in writing to keep statements they make or documents they share with the other parties confidential. Outside parties may, however, still have access to statements or documents as provided by law.

No party shall be bound by anything said or done at the mediation, other than this Agreement to Mediate, unless a written settlement is reached and executed by all necessary parties.

By signature below, we acknowledge that we have read, understand, and agree to the terms of this Agreement to Mediate.

Party:
Date:

Representative(s)
Date:

Party:
Date:

Representative(s):
Date: