MWI Agreement to Mediate Form

Please review and indicate that you understand and agree to mediate your matter with MWI according to these terms by completing the form below:

• VOLUNTARY PROCESS:   I understand that mediation is a voluntary process and that I retain their right to a judicial or administrative hearing should I  decide to withdraw before an agreement is reached.
• CONFIDENTIALITY:  I agree that the entire mediation process, including all written submissions and communications, is confidential pursuant to Commonwealth of Massachusetts General Law ch. 233, § 23C, and shall be treated as a negotiation for the purposes of the United States Federal Rules of Evidence and applicable Commonwealth of Massachusetts law. I will not disclose any information including offers, promises, conduct, statements or settlement terms whether oral or written, made by me, my agents, employees, experts and attorneys in connection with the mediation, except where disclosure is required by law or court rule, and all such information shall be inadmissible at trial, provided, however, that no such information which is independently obtained and admissible shall be rendered confidential or inadmissible because it is referred to in the mediation process. I understand that the Mediator will keep the details of the case and all related documents confidential. However, the Mediator reserves the right to disclose information obtained during the course of the mediation concerning a) the risk of serious harm to an individual; and/or b) the planned commission of a crime. The confidentiality and privilege provided for in this Agreement shall not apply to evidence relating to the liability of the Mediator in a subsequent suit against the Mediator or disciplinary proceedings against the Mediator. The confidentiality and privilege provided for in this Agreement shall not apply to information that I agree to in writing, after the conclusion of the mediation, may be disclosed. Unless I agree otherwise in writing, nothing in this Agreement shall prevent me from presenting an interim agreement or signed memorandum of understanding executed as part of the mediation process to a court or other administrative body for purposes of enforcement. I understand that I may disclose information about the mediation to attorneys, financial advisors, therapists, or counselors, and, in the case of a business or non-profit organization, those within the business or organization with a need to know, provided, however, that all such individuals shall be informed that the information being provided is confidential and governed by the terms of this Agreement.
• ROLE OF MEDIATOR:  I understand that the Mediator is a neutral facilitator, and that the Mediator is not a judge and has no decision-making authority. The Mediator’s role is to assist the Parties in their effort to reach their own mutually beneficial agreement.
• CONSULTING WITH COUNSEL:  I understand it is neither MWI’s nor the Mediator’s role to give legal advice, counsel, or to analyze either party’s legal rights and that the Mediator may not act as an advocate for any Party. I understand that unrepresented Parties are encouraged to review their legal rights and obligations before finalizing any mediated agreement.
• RECORDING:  The mediation sessions are private and may not be recorded electronically or broadcast or disseminated in any fashion without written permission of the Parties and the Mediator.
• TESTIMONY AND RECORDS:  I agree that they will not at any time before, during, or after mediation call the Mediator as witness, or subpoena or demand the production of any records, notes, work product or the like that the Mediator produces, in any legal or administrative proceeding concerning the subject matter of the mediation. If I seek to do so, I agree to indemnify the Mediator as to all costs in connection therewith, including attorney’s fees and travel costs, and will compensate the Mediator for time spent, such compensation to be at the Mediator’s then current hourly rate.
• RELEASE OF DOCUMENTS:  This “Agreement to Participate in Mediation” form and any “Memorandum of Understanding,” or written agreement signed by the parties because of this mediation may be used in subsequent relevant proceedings.
• RESOLUTION:   I understand that all terms of a settlement are non-binding until they are put into a written agreement and signed by all of the Parties. Any settlement agreement may affect the legal rights of the Parties. I understand they should have any settlement agreement independently reviewed by their own counsel before executing the agreement.
• MODIFICATIONS OR AMENDMENTS to Agreement to Mediate:  I understand that no modification of this Agreement may be made except in writing, signed by the Parties and the Mediator.
• MISCELLANEOUS:  I understand that this Agreement constitutes the entire agreement of the Parties and the Mediator as to the mediation described above and supersedes all previous oral or written agreements between or among them regarding this mediation. This Agreement may be executed in one or more counterparts, each of which shall be deemed an original, and all of which together shall be deemed to be one and the same instrument. The counterparts of this Agreement and all Ancillary Documents may be executed and delivered by facsimile or other electronic signature by any of the Parties to any other party including the Mediator and the receiving party including the Mediator may rely on the receipt of such document so executed and delivered via email, fax or other electronic means as if the original had been received.
• GOVERNING LAW:   I understand that the terms of this Agreement to Participate in Mediation shall be governed by the laws of the Commonwealth of Massachusetts.