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This is a sample Agreement to Mediate from the U.S. Department of Interior

Agreement to Mediate

This is an agreement between _______________________, _____________________, and _____________________ (the Parties).

The Parties agree to enter into mediation in good faith, and with a sincere desire to reach a mutually acceptable resolution of their differences regarding ___________________________.

Deadline

The undersigned Parties agree to set aside ___________ full days for mediation sessions. The sessions shall begin on ________________________ and end no later than _________________________.

Logistics

The mediation sessions will be conducted from 8:30 a.m. to 4:30 p.m. in Room __________ of Building (Bureau of Reclamation) at the Denver Federal Center.

Provisions

The provisions of this agreement are as follows:

  1. The mediators are neutral third-party facilitators who will guide the Parties through a process designed to help them reach their own settlement. The mediators will not make decisions about "right" or "wrong" or tell the Parties what to do.
  2. Mediators do not offer legal advice nor do they provide legal counsel. Each party is advised to consult with appropriate attorneys for legal advice and about her/his right to legal representation.
  3. For mediation to work, the Parties agree and understand that open and honest communications are essential. Accordingly, all written and oral communications, negotiations and statements made in the course.of mediation will be treated as privileged discussions and are absolutely confidential.

    Therefore:
    1. The mediators will not reveal to anyone the names of the Parties or anything discussed in mediation unless expressly requested to do so by the Parties. It is understood that the mediators are not required to maintain confidentiality if they have reason to believe that any party is in danger of bodily or egregious psychological harm, or if criminal activity is divulged.

    2. The Parties agree that they will not at any time before, during, or after mediation, call the mediators as witnesses in any legal or administrative proceeding concerning this dispute.

    3. The mediators will destroy any records, notes, work product or the like developed during the mediation process (with the exception of the written settlement/resolution agreement, if one is reached).

    4. Both the agreement to mediate and any written agreement made and signed by the Parties as a result of mediation may be used in any relevant proceeding, and are subject to technical review by appropriate officials before confirmation and implementation.

  4. It is understood that full disclosure of all relevant information is essential to the mediation process. Accordingly, there will be a complete and honest disclosure by each of the Parties to the other and to the mediators of relevant information and documents.

  5. All Parties must be in agreement regarding who will be present during the joint mediation sessions. Who will include not only the Parties themselves, but any representative(s) either party proposes to be part of the mediation sessions. Any proposed changes of personnel must be communicated to the mediators in advance. In this mediation, the Parties present will be _____________________, ______________________, _____________________, and ______________________.

  6. All parties agree not to propose any punitive action or proceed in another forum (such as the negotiated grievance, MSPB, EEO complaint, or administrative grievance process; or court) as long as mediation continues.

  7. Bureau of Reclamation management agrees not to take or propose any formal action which could adversely affect any party to this mediation prior to completion of mediation, unless one or more of the Parties' conduct so seriously violates acceptable standards as to require immediate action.

  8. While all Parties intend to continue with mediation through ___________________, if necessary to reach agreement, it is understood that mediation is voluntary and any Party may withdraw from mediation at any time. It is agreed that if one or more Parties decide to withdraw from mediation, good faith efforts will be made to discuss this decision in the presence of both Parties and the mediators.

  9. If the mediators determine that it is not possible to resolve the issues through mediation, the process can be terminated once this has been conveyed to the parties and confirmed in writing.

  10. If an agreement is reached, the mediators will prepare a written agreement draft to be finalized in a joint session with the Parties. Each party will be advised to seek his/her own representative or legal counsel before the agreement is placed in final form and sent (if appropriate) for technical review. The agreement will be reviewed for technical adequacy within 48 hours of its receipt by appropriate technical specialists and other officials as required to ensure the agreement meets regulatory requirements. Technical review will take place before the agreement is signed by the Parties.

  11. The ways in which any agreement arising out of this mediation may be used will be spelled out as a provision of the agreement itself. The parties agree that this will clarify all future uses of their written agreement.

I have read, understood, and agreed of my own free will and without coercion to each of the provisions of this agreement.

________________________________________
Party #1
_________________
Date
________________________________________
Party #2
_________________
Date
________________________________________
Party #3
_________________
Date

Mediators:

________________________________________
Signature
_________________
Date
________________________________________
Signature
_________________
Date

Technical Reviewers:

________________________________________
Signature
_________________
Date
________________________________________
Signature
_________________
Date