DOCKET NUMBER

CERTIFICATION BY PARTIES FOR
OUT- OF- COURT CASE
MANAGEMENT CONFERENCE

(This procedure applicable only in the
Worcester and Springfield District Courts.)

 Trial Court of Massachusetts
 District Court Department

VS.

WORCESTER DISTRICT COURT

 To the above-named parties:

      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.

Plaintiff's Counsel

Defendant's Counsel

Plaintiff's Counsel

Defendant's Counsel

This form may be filed with the court by fax, at fax number 508-797-0716.

Date:

Date:

Date:

Date:

[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