Section 1: Your Contact Information
Your Name
*
First Name
Last Name
Your Role
Please Select
Attorney for Claimant/Plaintiff
Attorney for Respondent/Defendant
Party Representative
Insurance Representative
Corporate Counsel
Other
Your Organization
ZIP Code
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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Section 2: Type of Engagement
Nature of Services Requested
Mediation (Facilitated settlement discussions)
Early Neutral Evaluation (Dispute assessment)
Arbitration (Binding decision)
Project Neutral® Assignment (Project oversight)
Fact Finding (Investigation and report)
Other
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Section 3: Project Information
Matter Name
*
Project Name (If Different)
Project Location
Project Type
Please Select
Commercial Construction
Residential Development
Infrastructure/Public Works
Industrial/Manufacturing
Healthcare Facility
Educational Facility
Mixed-Use Development
Other
Financial Scope
Original Contract Value
Current Contract Value
Amount in Dispute
Timeline
Project Status
*
Please Select
Pre-construction
Under construction
Substantially complete
Project complete
Abandoned/Terminated
Project Start Date
-
Month
-
Day
Year
Date
Original Completion Date
-
Month
-
Day
Year
Date
Current Projected Completion
-
Month
-
Day
Year
Date
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Section 4: Legal Proceedings
Current Legal Status
No formal proceedings filed
Litigation pending
Arbitration pending
Mediation scheduled
Other ADR in progress
Court/Venue
Judge/Arbitrator
Case Number
Filing Date
-
Month
-
Day
Year
Date
Trial/Hearing Date
-
Month
-
Day
Year
Date
Caption and proof of service list, if applicable
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Section 5: Party Information
Primary Parties
Owner/Claimant
*
Type
Please Select
Corporation
LLC
Partnership
Government
Individual
Contact Person
First Name
Last Name
Title
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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Section 5: Party Information
Primary Parties
Contractor/Respondent
*
Type
Please Select
Corporation
LLC
Partnership
Government
Individual
Contact Person
First Name
Last Name
Title
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Add Additional Parties?
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Section 6: Legal Representation
Attorney Information
Claimant/Plaintiff Counsel
Law Firm
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
State Bar Number
Respondent Counsel
Law Firm
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
State Bar Number
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Section 7: Insurance & Surety Information
Insurance Companies Involved
General Liability Carrier
Professional Liability Carrier
Umbrella/Excess Carrier
Property Insurance
Builder's Risk
Other
Primary Insurance Company
Policy Number
Claims Rep Name
Claims Rep Email
example@example.com
Claims Rep Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Insurance Attorney
Attorney Firm
Attorney Email
example@example.com
Surety Company
Bond Number
Surety Contact
Surety Email
example@example.com
Surety Attorney
Surety Attorney Email
example@example.com
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Section 8: Dispute Details
Primary Dispute Categories
Contract interpretation
Scope of work disputes
Change order disputes
Payment/billing disputes
Schedule delays
Defective work claims
Design deficiencies
Site conditions (differing/unforeseen)
Mechanics liens
Licensing issues
Safety violations
Termination issues
Warranty claims
Professional liability
Other
Brief Dispute Summary
Key Issues at Stake
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Section 9: Technical Expertise Required
Select Specialties
Architecture
Structural Engineering
Civil Engineering
MEP Engineering
Geotechnical Engineering
Environmental Engineering
Construction Management
Schedule Analysis/CPM
Construction Defect Analysis
Cost/Financial Analysis
Safety/OSHA Compliance
Code Compliance
Waterproofing Systems
Roofing Systems
HVAC Systems
Electrical Systems
Plumbing Systems
Fire Protection Systems
Other
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Section 10: Scheduling & Logistics
Urgency Level
*
Emergency (within 1 week)
Urgent (within 2 weeks)
Standard (within 1 month)
Flexible (2+ months)
Preferred Date, if available
-
Month
-
Day
Year
Date
Meeting Format
*
Virtual (Google Meet)
In-Person
No Preference
Preferred Location
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
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Section 11: Additional Information
Prior Mediation Attempt?
No
Yes
What were the results?
Prior Arbitration Attempt?
No
Yes
What were the results?
Special Considerations
Media Attention
Yes
No
Public Records Issues
Yes
No
Are there special concerns about confidentiality?
Language Interpretation Needed?
No
Yes
ADA Accommodation Needed?
No
Yes
Additional Comments
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Section 12: Agreement & Submission
Signature
*
Submit
Submit
Should be Empty: