Conflict To Peace Mediation Fee Agreement For Marriages And Families Form printable pdf download

Conflict to Peace Mediation Fee Agreement for Marriages and Families

We, ____________________________________________________, have been advised of the fee schedule

for the services of Conflict to Peace. We understand that the fees applicable to the mediation process in

which we have agreed to participate include:

a) A flat fee of $300 for each intake – up to two hours (with written materials). Intakes will be conducted

separately with each participant. Additional intake time after the first two hours will be $150 per hour.

b) Mediation session fees of $300 per hour (The minimum session is two hours; there is a 20% surcharge

for sessions on weekends, holidays, or portions before 9 a.m. or after 6 p.m.). Non-administrative

contact with a conciliator(s) or Conflict to Peace, outside of sessions, whether in person, by phone, or in

e-mail review and response, is $180 per hour. Conflict to Peace reserves the right to charge for

extraordinary case administration time (i.e. to arrange a neutral property appraisal) at $180 per hour.

c) A deposit for the preparation of a memorandum of agreement is $600 (four hours). Additional time, if

needed, is $150 per hour. This fee also applies to time preparing advisory opinions if applicable.

d) Any required regional travel time is at the rate of $150 per hour plus mileage at the prevailing Internal

Revenue Service reimbursement rate.

e) All direct costs of Conflict to Peace and the mediators associated with the case, including long distance

telephone calls, travel, parking, written resources provided, and other out of pocket expenses. These

direct costs shall be shared by both parties, unless otherwise agreed.

f) A cancellation fee of $300 is payable by a party who causes a cancellation of any scheduled mediation

session with notice of less than one full business day. Returned checks are assessed a $35 fee.

We agree to pay all fees and costs of the mediation process in accordance with the above schedule. We

agree to pay for fees for each session as they are incurred, direct costs as invoiced, a deposit prior to the

preparation of a memorandum and the balance upon delivery of the memorandum. Mediation resuming

after 90 days of inactivity will be billed at the then prevailing rate. If we are unable to pay fees when due,

we must request alternate arrangements with Conflict to Peace in advance. Unless otherwise agreed,

interest shall be charged at the rate of two percent per month on balances outstanding over 30 days; in

the event collection action is initiated, we agree to pay all costs and fees associated with such action,

including attorney and conciliator fees. Unless a separate paym ent election is made, we agree

to pay the fees from our joint/m arital resources.

__________________________ _____/_____/_____ _________________________ _____/_____/_____

Signed

Date

Signed

Date

Separate paym ent election: If parties elect to pay fees separately, each person’s share will be their

respective portion of the collective gross income, rounded to the nearest 5%, to a maximum of 80% and a

minimum of 20%, unless otherwise agreed and set forth on the back of this agreement.

We elect to pay separately by initialling here: _______/_______.

We declare our individual gross annual income to be:

$ _______________ for ______________________ and $ _______________ for ______________________

Name

The percentage to be applied are: _______ % for _______________ and _______ % for _________________

Income/Hardship Consideration: We request consideration for reduced fees based on our gross

annual income of $________________, or other documented hardship explained on the back of this

agreement. We understand that, based on this income or other documented hardship, the hourly

mediation session fee rate will be reduced by ______ percent. W e further understand that this

reduction will only be applied to sessions held after acceptable documentation of gross

income or other hardship is provided to Conflict to Peace and will not be applied

retroactively.

Documentation Accepted by ___________________________________

Date _______________

(Conflict to Peace Representative)

C†P MMFA 12_15

Conflict To Peace Mediation Fee Agreement For Marriages And Families Form

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