Qualification Statement

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CV-E-ARB-119
ARBITRATOR (Name, State Bar Number, and Address)
FOR COURT USE ONLY
State Bar No.
TELEPHONE NO.
FAX NO. (OPTIONAL)
EMAIL ADDRESS
(Optional)
SUPERIOR COURT OF CALIFORNIA, COUNTY OF SACRAMENTO
th
STREET ADDRESS:
720 9
Street, Room 102
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MAILING ADDRESS:
720 9
Street, Room 102
CITY AND ZIP CODE:
Sacramento, CA 95814
BRANCH NAME:
Gordon D. Schaber
PLAINTIFF:
DEFENDANT:
CASE NUMBER:
QUALIFICATION STATEMENT
ASSIGNED DEPARTMENT:
It shall be the duty of the arbitrator to determine whether any cause exists for his/her disqualification in
the case he/she is to hear upon any of the grounds set forth in Section 170 et seq. of Code of Civil
Procedure governing the disqualification of judges. If any member of the arbitrator’s law firm would
be disqualified under subdivision 4 of Section 170 et seq., the arbitrator is disqualified. Unless the
ground for disqualification is disclosed to the parties in writing and is expressly waived by all parties
in writing, the arbitrator shall promptly notify the Arbitration Unit of any known ground for
disqualification, and another arbitrator shall be selected as provided in rule 3.815 of the California
Rules of Court.
Arbitration services are not paid for by the court and are provided on a pro-bono basis.
I attest that as a court appointed Arbitrator, I have not solicited and will not solicit any private
mediation business from either party to this action. I certify that I have read the foregoing rule and I
know of no cause for my disqualification.
Executed on __________________, at ____________________, California
Arbitrator
QUALIFICATION STATEMENT
CV-E-ARB-119
Page 1 of 1
CIVIL
(Revised June 03, 2013)
CRC 3.815/3.816
MANDATORY

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