E990A518-E8F3-4318-3125803AC770B0DD.pdf

This is an invoice template document related to mediation services. The form captures essential billing information including vendor name, remittance address, month and year of service, date of service, case number, and case type. The document requires documentation of participant names and details regarding mediation sessions provided. The invoice structure includes line items for mediation session charges and associated fees for no-shows.

The pricing structure establishes a mediation session fee of $150 per session, with a $25 charge for no-shows. The template provides fields for calculating total amounts due and is designed as Attachment A to a larger contracting document. The form does not specify contract term, renewal options, funding sources, or set-aside information within its content, as it functions primarily as a standardized billing instrument for recording and invoicing mediation services rendered.