First Judicial District of Pennsylvania Philadelphia Court of Common Pleas
(Month)
Term,
(Year)
,
(No.)
(Please indicate type of action) Motor Vehicle (Date of Accident) Versus Delay Damages (Prime Rate +1) Contract Delay Damages (Legal Rate = 6%) Assessment of Damages Other
Arbitration
Report and Award of Arbitrators
And Now , this
day of , Year tors having been duly appointed and sworn, make the following award: , we the undersigned arbitra-
Please name the parties if there are more than one plaintiff and/or defendant. Please address all counterclaims and cross claims. Please complete percentage of negligence on reverse side if applicable.
Chairperson Arbitrator Arbitrator
Please Print Name, Address and I.D. No. Please Print Name, Address and I.D. No. Please Print Name, Address and I.D. No.
List Attorneys of Record and Unrepresented Parties Who: Appeared at the hearing: Did Not Appear at the Hearing:
30-210 (Rev. 1/00)
Questions to be Answered by the Arbitrators in Negligence Cases
Instructions:
Taking the combined negligence that was a substantial factor in bringing about any or all of the plaintiff's injuries, damage or losses as 100%, answer the following questions and state in percentages the causal negligence attributed to each party you have found causally negligent. Do you find that any defendant or additional defendant was negligent? If so, state the name of the party and percentage of negligence attributable to that party. % % % %
Do you find that any plaintiff was negligent? If so, state the name of the party and percentage of negligence attributable to that party. % % % %
Total
100%
Notice of Entry of Award
And Now, this ______day of _____________, Year ______, at ___________________, ______.m., the above award was entered upon the docket and notice thereof given by mail to the parties or their attorneys.
(Arbitration compensation to be paid on appeal $200.00)
Prothonotary
By:
30-210 (Rev. 1/00) Reverse