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[Attorney name]
[Address]
[Telephone number]

Attorney for Plaintiff, [name]

xxx Court, County of xxx
[xxx District]

xxxxxx ) No. xxx
Plaintiff(s) )
vs. ) CERTIFICATE OF IMPENDING
) IMPAIRMENT
xxxxxx ) (CCP 411.35(b)(2))
Defendant(s) )
___________________________)

[Name] declares:

1. I am the attorney for plaintiff, [name], in this action.

2. This action is one for damages arising out of professional negligence.

3. I am unable to obtain a consultation with a(n) [category of professional to be consulted] as required by Code of Civil Procedure section 411.35 before the impairment of this action.

I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Date: xxx _________________________
[Typed name]
Attorney for xxxxxx

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