Fill and Sign the Exhibits to the Commonwealths Opposition to the Massgov Form

STATE OF VERMONT COUNTY OF , ss. ) Plaintiff (s) ) Superior Court ) V. ) Docket No. )) Defendant(s) ) ALTERNATE DISPUTE RESOLUTION REPORT Finishing Time Starting Time Date of ADR Session 1. Please indicate the names and addresses of all persons participating in the ADR Session. If either party is a corporation or company, please indicate the name and title of the representative. Identify with an asterisk the representative of each party who had decision-making authority. Representative & Title, City, State & Zip Code Street Address Name If Applicable Plaintiff Plaintiff's Counsel Defendant Defendant's Counsel Insurance Carrier Defendant Defendant's Counsel Insurance Carrier Other 2. Please summarize any substitute arrangement made regarding attendance at the ADR Session. If no, who failed to appear? 3. Were all appropriate parties in attendance? If not, who did not comply? 4. Were all parties prepared & did all participate in good faith? 5. Did each party have a representative present with sufficient authority to participate in good faith to settle the dispute at the time of the ADR Session? (If settlement was reached, please append the agreement of the parties.) 6. Did the case settle? 7. If the case did not settle: A. Can the scope of the dispute be narrowed by stipulation of the parties? If so, please describe: B. Did the parties agree to a further ADR session? Date Neutral Name (printed) (signature) Form 294 9/03 SML Yes No N/A SELECT COUNTY SELECT COUNTY