Superior Court of Washington s5

Exhibit K

Superior Court of Washington

County of Kitsap

,
Plaintiff,
vs.
,
Defendant. / NO.
NOTE FOR ARBITRATION SETTING
INITIAL STATEMENT OF ARBITRABILITY
(STA)

TO THE CLERK OF THE COURT AND TO:

Please take notice that this case will be placed on the arbitration setting docket at 9:00 a.m., on Friday, the day of , 20, for assignment to mandatory arbitration.

Nature of Case:

INITIAL STATEMENT OF ARBITRABILITY

This case is subject to arbitration because the sole relief sought is a money judgment and involves no claim in excess of $50,000.00 exclusive of attorney fees, interest and costs. (MAR 1.2)

The undersigned contends that its claim exceeds $50,000.00 but hereby waives any claim in excess of $50,000.00 for purposes of arbitration. (MAR 1.2)

Any party not in agreement with the Initial Statement of Arbitrability shall file and serve a response (KCLCR-Exhibit G) at least three (3) days prior to the arbitration setting docket date. If a response is filed, counsel shall appear on the setting day before the civil motions judge to argue the objection.

DATED: / SIGNED:
Lawyer for:
Address:
Phone:

List the name, address and phone number of all attorneys or parties who were provided notice:

Name: / Name:
Address: / Address:
Phone: / Phone:

Note for Arbitration Setting and Initial Statement of Arbitrability (Rev. 6/05)