[Insert Date]

Darryl Fohrman
322 Elizabeth Street
Key West, Florida 33040 

 RE: [Insert names, addresses, phone and fax numbers of parties and their counsel]
[Insert number of persons from each side who will be participating in the mediation]
[Insert nature of dispute and dollar amount, if applicable]
[Insert date of conference]
[Insert time of conference/a.m/p.m.]
[Location of conference]

 The parties to this Agreement acknowledge that they have agreed to submit the above matter for non-binding mediation by Darryl Fohrman, at the above location and time under the laws of the State of Florida and pursuant to Darryl Fohrmans Rules of Mediation which the parties have reviewed and approved. 

The parties agree to pay Darryl Fohrman a deposit before the mediation session, and the balance at the conclusion of the session, as follows: 

FEES:

Hourly: Two party cases: $200.00 per hour for each party. This is a minimum non-refundable charge. If the parties submit materials prior to mediation, hourly charges may apply for review time.

Three party cases: $150.00 per hour for each party. This is a minimum non-refundable charge. If the parties submit materials prior to mediation, hourly charges may apply for review time.

Four party or more cases: $125.00 per hour for each party. This is a minimum non-refundable charge.If the parties submit materials prior to mediation, hourly charges mayapply for review time.

Per Diem Rate: $2,000.00 per day or fractions thereof. Any time over eight hours, including any breaks to be billed at the hourly rates above.

Expense Reimbursement: For cases outside of Key West, travel time, both ways, portal to portal, air travel charges, meals and lodging, parking and tolls. For cases in which a total of six or more persons, including attorneys, may participate there will be an administrative charge for the rental of conference facilities.

Cancellation Fee: $200.00, payable by the canceling party(ies), if cancellation is within 14 days of the hearing date. 

Fee Deposit: A non-refundable fee deposit of $200.00 per party is requested at the time of submission. 

Balance of Fees Due: The balance, if any, is payable at the conclusion of the conference. The parties are requested to pay in full the billing for the first day's session before scheduling an additional session. An additional $200.00 per party non-refundable fee deposit shall be paid if an additional hearing session is necessary. The parties are requested to bring to the conference checks for payment of these amounts. 

Each party and their counsel (including that counsel's firm) shall be jointly and severally responsible for the payment of their allocated share of all fees and costs as set forth above. Please note that counsel, including that counsel's firm, and the represented party, have contracted for Darryl Fohrman's services as a mediator. All expenses and disbursements made in connection with any hearing, such as outside room rental fee, meals, express mail and messenger charges, and other charges associated with the case, will also be billed equally to the parties. Payment is due in accordance with the terms of the invoice. In the event that a party and/or its counsel fails to pay in accordance with the terms of this agreement, then the breaching party and/or counsel shall be jointly and severally responsible for all costs and attorney's fees incurred by Darryl Fohrman in connection with the collection of any amount due and owing. The parties and their counsel further understand and agree that payment of additional fees shall be made within 15 days of invoice.

CONFIDENTIALITY AND IMMUNITY:

The parties and the representatives of the parties and their attorneys, and any other person present at the mediation session(s) recognize and agree that this entire process is confidential and privileged as negotiations. Everything that occurs, is said, or things and documents produced during the mediation session(s) and from recess to recess, beforehand or thereafter, are privileged and inadmissable in any litigation, arbitration or related manner to the extent allowed by law. All such matters and any settlement agreement that may be reached shall be kept confidential by all the parties and their attorneys, except where any,, of them may be under a lawful duty to disclose pursuant to an order of court or other circumstances required by law. The parties agree that no one will subpoena or otherwise require the mediator or any of his representatives to testify or produce any notes or records in any future proceeding.

The parties further agree to extend all immunities to the mediator or his representative as provided by section 44.107 of the Florida Statutes, or other applicable law, rule or regulation, including but not limited to statements concerning factual matters and to alleged admissions.

Any changes to the terms of this Agreement must be in writing signed by all parties and Darryl Fohrman.