CERTIFICATION BY PARTIES FOR OUT- OF- COURT CASE MANAGEMENT CONFERENCE (This procedure applicable only in the Worcester and Springfield District Courts.) DOCKET NUMBER Trial Court of Massachusetts District Court Department VS. To the above-named parties: WORCESTER DISTRICT COURT If all parties in this action are represented by counsel, attendance at the Case Management Conference will be excused if the following certification by counsel is filed with the Clerk's office at least seven days before the scheduled date of the Case Management Conference, as set forth in the Notice of Case Management Conference. WE CERTIFY THAT THE FOLLOWING HAS OCCURRED: 1. The parties have considered and discussed SETTLEMENT. 2. The parties have considered and discussed the RESOLUTION OF THIS CASE BY MEANS OF ALTERNATIVE DISPUTE RESOLUTION. 3. The parties report the following STIPULATIONS AND/OR AGREEMENTS, if any: 4. The parties are NOT REQUESTING the court to issue any DISCOVERY orders, and acknowledge that, pursuant to Joint Standing Order No. 1-04, all discovery must be completed prior to the pretrial conference date. 5. The parties agree to be present for a PRETRIAL CONFERENCE in this action on the following date: (Note: This date must be no later than the tenth month after the month in which this action was filed, or such later date as may be scheduled by the court for good cause shown.) Agreed-upon Pretrial Conference Date: Time: 2:00 p.m. Room: 16 Upon receipt of this form, the Clerk will confirm this pretrial conference date and the time and room number for the Conference. Failure to appear on this date may result in sanctions including costs, dismissal or default, as provided in Joint Standing Order No. 1-04. 6. (Check if applicable.) A PRETRIAL CONFERENCE IS NOT REQUIRED and we request that the court schedule a TRIAL DATE. Date: Plaintiff's Counsel Date: Plaintiff's Counsel Defendant's Counsel Defendant's Counsel Date: Date: This form may be filed with the court by fax, at fax number 508-797-0716. [Provisions of Joint Standing Order No. 1-04 that are inconsistent with the procedures set forth above have been suspended by order of the Chief Justice of the District Court.] (Mar. 2011) www.mass.gov/courts/districtcourt American LegalNet, Inc. www.FormsWorkFlow.com