SUPERIOR COURT OF CALIFORNIA
County of Sacramento 720 Ninth Street, Room 102 Sacramento, CA 95814-1380 (916) 874-5522--Website www.saccourt.ca.gov
Arbitrator (Name and Address):
For Court Use Only
Telephone No.: E-Mail Address: Plaintiff: Defendant:
Fax No.:
Case Number:
Arbitrator's Fee Statement
Pursuant to rule 3.814(d), California Rules of Court (CRC), I served as Arbitrator and performed all official responsibilities herein and declare I am in good standing with the California State Bar.
VENDOR ID NUMBER: ARBITRATION HEARING DATE: ARBITRATION AWARD DATE: HOURS IN HEARING: PREPARATION HOURS: TOTAL HOURS:
Settlement Date: _____________
Mediation Date: _____________
Arbitrator Signature:_____________________________________ Date:_________________ In accordance with CRC 3.819(c) I hereby affirm that the above entitled information is true and correct and request payment for services rendered as Arbitrator in this matter. For Court Use Only As defined in the CRC/Local Rules; the fee of $________ is approved for payment on:________. Arbitration Administrator / Representative: ______________________________ Claim Date: ______________________
Arbitrator's Fee Statement CV\EARB125 (Rev 02.13.09) Local Form Adopted for Mandatory Use Page 1 of 1