Legal Representation Authority Document

LEGAL REPRESENTATION AUTHORITY DOCUMENT

This Legal Representation Authority Document is made as of by and between Client Name: Client Address: and Representative Name: Representative Address: .

RECITALS

WHEREAS, Client is a party with legal interests in one or more matters described herein and desires to engage Representative to act on Client's behalf with respect to such matters; and

WHEREAS, Representative has the skill, experience and authority to represent Client in legal proceedings, negotiations, administrative actions and other related matters as more fully described below; and

WHEREAS, Client desires to grant Representative the authority to act for Client within the scope set forth in this Document and Representative is willing to accept such authority under the terms set forth herein.

NOW, THEREFORE

In consideration of the mutual covenants and promises contained in this Document, the parties agree as follows:

1. APPOINTMENT

Client hereby appoints Representative as Client's lawful agent and attorney-in-fact, with full authority to act on Client's behalf for the matters and purposes set forth in Section 2. This appointment is a grant of authority, not an assignment of Client's underlying legal claims.

2. SCOPE OF AUTHORITY

Representative is authorized, subject to any limitations in this Document, to take any and all actions reasonably necessary to investigate, institute, prosecute, defend, negotiate, compromise, settle, and conclude legal, administrative, or arbitration proceedings on behalf of Client, including but not limited to the following specific powers (each power may be exercised separately and in combination with others):

Authority (check all that apply): Commence, defend and appear in litigation and proceedings Negotiate, enter into, and execute settlements and releases Sign, file, and execute pleadings, motions, contracts and other documents Obtain, inspect and copy Client's records and third-party records relevant to the matter Receive, disburse and endorse funds on Client's behalf subject to accounting to Client Retain and instruct co-counsel or experts reasonably necessary to prosecute or defend claims

3. AUTHORITY TO SETTLE; BINDING EFFECT

Representative may enter into settlements on behalf of Client up to the amount expressly authorized in writing by Client. Unless a monetary threshold is specified below, Representative shall obtain Client's prior written or electronic consent to settle claims that would materially affect Client's legal rights or obligations.

Settlement threshold (leave blank if none): $

4. COMPENSATION, COSTS AND ACCOUNTING

Representative's fees and the payment of costs will be governed by a separate fee agreement unless otherwise set forth below. If no fee agreement is attached, Representative shall be entitled to reasonable fees and reimbursement of costs advanced on Client's behalf. Representative shall provide written accounting of all sums received and disbursed on Client's behalf upon reasonable request.

5. CONFIDENTIALITY; PRIVILEGE

Representative acknowledges that communications with Representative may be privileged and subject to confidentiality protections. Representative shall take reasonable steps to maintain the confidentiality of privileged communications and shall not disclose confidential information except as directed by Client or as required by law.

6. TERM, REVOCATION AND TERMINATION

This appointment is effective as of the effective date above and continues until the earlier of (a) written revocation by Client delivered to Representative, (b) written resignation by Representative, or (c) completion of the matters described in Section 2. Revocation or termination shall not affect Representative's authority to take reasonable actions to preserve Client's interests during a short period following notice to effect an orderly transition.

7. INDEMNIFICATION

Client agrees to indemnify and hold Representative harmless from and against any and all claims, liabilities, losses, damages and expenses (including reasonable attorneys' fees) arising out of Representative's good faith performance of duties under this Document, except to the extent caused by Representative's gross negligence or willful misconduct.

8. NOTICES

All notices and other communications required or permitted under this Document shall be in writing and delivered to the addresses set forth below (or to such other address as either party may designate by notice to the other).

9. AMENDMENT; WAIVER

This Document may be amended or modified only by a written instrument executed by both parties. The failure of either party to enforce any provision shall not be construed as a waiver of that provision or any other provision.

10. GOVERNING LAW

This Document shall be governed by and construed in accordance with the laws of the state of , without regard to principles of conflicts of law.

11. ENTIRE AGREEMENT

This Document constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements and understandings, whether written or oral, relating to such subject matter.

12. SEVERABILITY

If any provision of this Document is held to be invalid, illegal or unenforceable in any respect, the validity, legality and enforceability of the remaining provisions shall not be affected or impaired thereby.

13. COUNTERPARTS; ELECTRONIC SIGNATURES

This Document may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument. Signatures delivered by electronic means shall be effective as original signatures.

CERTIFICATION

Each party represents and warrants that the person signing below is duly authorized to execute this Document on behalf of the party and that, upon execution, this Document shall be binding on that party in accordance with its terms.

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