Massachusetts Dispute Resolution Services

Mediation Agreement Form

CASE NAME: _______________________________________________________

MDRS FILE #:_______________________________________________________

We, the undersigned parties, attorneys and/or representatives, and participants agree to participate and commit themselves to a mediated negotiation of the issues involved in this matter. We agree to employ the services of ________________________ who agrees to serve as mediator of our dispute.  We have received a copy of the MDRS Mediation Guidelines and agree that they are applicable to the mediation of this matter.

We further agree to the following:

A. We acknowledge and agree that the mediator’s work product, memoranda and case file shall be confidential and not subject to disclosure in any judicial, administrative or private proceeding. We agree that the mediator will not be called as a witness in any subsequent court or administrative action.

B. We agree that any and all communications made in the course of mediation process relating to the subject matter being mediated shall be a confidential communication and not subject to disclosure in any judicial, administrative or private proceeding.

C. We agree that the mediator and Massachusetts Dispute Resolution Services shall not be liable to us for any act or omission in connection with services performed under this agreement.

D. Each party agrees that the person(s) or representative(s) with full authority to resolve and settle this dispute will attend the mediation session. All parties and MDRS must be advised in advance of the mediaton session if any person(s) or representative(s) with needed full settlement authority cannot attend the mediation session.

E. The undersigned parties agree that they shall pay Massachusetts Dispute Resolution Services $495.00 per party
for a mediation session of two (2) hours or less now payable in full upon submission of this case. Services beyond
two hours will be charged at the rate of $185.00 per hour per party.

F. This Mediation Agreement may be executed in several counterparts, each of which shall be deemed an original,
but all of which shall be considered one and the same valid and enforceable agreement.

Parties to the Mediation:

Plaintiff__________________________________Defendant_____________________________________

Plaintiff’s Attorney__________________________Defendant’s Attorney_____________________________

Mediation Participants:

Participant________________________________Participant_____________________________________

Participant________________________________Participant_____________________________________

Date____________________________________