Legal Conflict Waiver Request

LEGAL CONFLICT WAIVER REQUEST

This Legal Conflict Waiver Request is submitted on by Client Name: whose address is (the "Client"), and Law Firm: with matter designation .

RECITALS

WHEREAS, the Firm currently represents or proposes to represent the Client in the matter identified above; and

WHEREAS, the Firm has disclosed to the Client that a potential or actual conflict of interest exists due to the Firm's representation of, or proposed representation of, another person or entity identified as Other Party: ; and

WHEREAS, the Client has been provided a description of the circumstances giving rise to the conflict and has had an opportunity to ask questions and receive answers concerning the practical and legal effects of waiving this conflict.

NOW, THEREFORE, in consideration of the mutual covenants and agreements set forth below, and intending to be legally bound, the parties agree as follows.

1. DEFINITIONS

For purposes of this Waiver: (a) "Conflict" means any concurrent, successive, or potential conflict of interest described in the Recitals or disclosed in writing to the Client; (b) "Matter" means the legal matter identified in the opening paragraph; and (c) "Firm" means the law firm identified above, including its partners, associates and staff.

2. DISCLOSURE OF CONFLICT

The Firm has disclosed the nature of the Conflict to the Client, which disclosure includes a reasonably prompt and complete description of the relevant circumstances, the identity of affected parties, and the foreseeable adverse consequences to Client's interests. The Client acknowledges receipt of that disclosure and confirms the following description of the Conflict:

The conflict disclosed above is indicated as (select all that apply): Concurrent representation Successive representation Potential conflict

3. ACKNOWLEDGMENT AND INFORMED CONSENT

The Client expressly acknowledges that the Client has been informed of the relevant circumstances and reasonably foreseeable adverse effects of consenting to the Firm's continued representation notwithstanding the Conflict. The Client further acknowledges that the Client has had a reasonable opportunity to consult with independent legal counsel of the Client's choosing regarding this Waiver.

By signing this document the Client provides informed consent to the Firm's representation described above, subject to the scope and limitations set forth below.

4. SCOPE OF WAIVER

The waiver applies to the Firm's representation in the Matter identified above and to any related matters expressly specified by the parties. The waiver does not extend to unrelated matters or to circumstances that materially change the nature of the Conflict without additional disclosure and consent.

Additional scope limitations or specifications (if any):

5. CONFIDENTIALITY AND SCREENING

The Firm will maintain appropriate confidentiality measures and, where applicable, will implement an ethical screen to limit access to Client confidential information by personnel involved in other representations. The screen will include reasonable restrictions on communications and document access to the extent required by applicable professional rules.

6. INDEPENDENT COUNSEL

The Client acknowledges the right to seek the advice of independent counsel concerning this Waiver. The Client has had the opportunity to seek such advice and:

Independent counsel retained? Yes No

7. LIMITATIONS; DISQUALIFICATION

This Waiver does not preclude the Firm from withdrawing or from being disqualified pursuant to court order, applicable law, or professional responsibility rules if continuing the representation would place the Firm in violation of law or ethical obligations. The Client understands that disqualification could occur notwithstanding this Waiver.

8. REMEDIES; INDEMNITY

Except for actual fraud or wilful misconduct, the Client agrees that the Firm shall not be liable to the Client for any claim arising solely from the existence of the Conflict that is disclosed herein and to which the Client has consented. The Client agrees to indemnify and hold the Firm harmless from claims by any third party arising from the Client's consent to the representation, except to the extent resulting from the Firm's bad faith, willful misconduct, or gross negligence.

9. NOTICES

All notices required or permitted under this Waiver shall be in writing and sent to the addresses below. Notices are effective upon receipt.

10. GOVERNING LAW

This Waiver shall be governed by and construed in accordance with the substantive laws of the state specified below without regard to its conflicts of law principles.

11. ENTIRE AGREEMENT; SEVERABILITY

This Waiver constitutes the entire agreement between the parties with respect to the subject matter hereof. If any provision of this Waiver is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

12. AMENDMENT AND WAIVER

This Waiver may be amended or modified only by a written instrument signed by both parties. No waiver of any provision shall be effective unless in writing and signed by the party granting the waiver.

13. COUNTERPARTS; ELECTRONIC SIGNATURES

This Waiver may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one instrument. Electronic signatures and transmitted counterparts shall be binding.

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