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PFAS Water Contamination Signup Form

Here's what you are signing up for. We believe 3M and Dupont, including 20 others, are liable for damages because they created and sold a chemical known as PFAS. (Per- and poly-fluoroalkyl substances) PFAs are Man-Made chemicals now found in drinking water because of the corporate negligence of 3M, Dupont, and others. A lawsuit is filed, and you can join it if you have been diagnosed with a specific illness we believe can be attributed to these chemicals. Fill out this form and sign it at the end to submit your personal claim.
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    CONTRACT & POWER OF ATTORNEY


    This agreement (“Agreement”) is made on {pleaseChoose48}, between the following parties: {name} (hereinafter “Client”) and O’CONNOR, ACCIANI & LEVY CO. LPA (hereinafter “OAL”, “Attorney” or “Attorneys”).
    In consideration of the mutual promises herein contained, the Parties agree as follows:
     
    PURPOSE OF REPRESENTATION


    1. Client retains and employs Attorney to represent Client, to investigate and, if appropriate, to file suit for and attempt to recoverany damages and compensation to which Client may be entitled against any party or parties responsible for same, as well as attemptto compromise and settle all claims of Client, in connection with or arising out of the events or event that caused Client personal injury, wrongful death and/or property damage related to environmental, chemical, toxic or other similar type exposures.   This representation includes the initial case matter and any other injury case matter identified by OAL and confirmed by the client.  Attorneyrepresentation DOES NOT include representation for Client’s claims related to any self-insured policies, business interruptionpolicies or other collateral source benefits.  Furthermore, Attorney will not provide income tax advice relating to the implications of remitting claims for lost income.
     
    ATTORNEY FEES
    2. A. In consideration of Attorney’s services rendered and to be rendered as set out above, Client hereby assigns, grants, and conveys to Attorney the following present undivided interest in the Claims as FORTY PERCENT (40%) of any settlement or Recovery.  If no money is recovered for Client, then there will be no attorney’s fee or expense and Client will not owe Attorney for any fee or expense, except at otherwise provided herein.
    2. B. However, if Client has previously employed other counsel without disclosing said employment to Attorney who then incurs expenses, or if expenses are incurred on  behalf of Client who thereafter employs counsel other than Attorney for this matter,  Client agrees to reimburse Attorney within 30 days after receipt of a statement for expenses.
    2. C. Attorney reserves the right to withdraw if Client refuses the recommendation of Attorney to settle the case, if Attorney determines such settlement to be the best option available.  Upon withdrawal, expenses and costs incurred by Attorney on behalf of Client may be required to be reimbursed by Client, at the sole discretion of Attorney.
    2. D. If OAL obtains or holds funds on Client’s behalf in any matter or case, Client  authorizes OAL to use those funds to pay all expenses or fees Client may owe OAL in this or any other matter.
    The 40% payable from the settlement or recovery is defined as a contingency fee and is based upon the gross or toal amount recovered on behalf of Client.
    2. E. Client understands that the Client is assigning at this time to Attorney the amount stated above as the contingency fee, and thatsuch percentage is of the total recovery or settlement before any costs, expenses, or disbursements are deducted (and Client understands that all costs, expenses, and disbursements are paid out of Client’s portion of the recovery, and not out of Attorney’sportion).  The standard 40% interest in the recovery assigned to Attorney is based upon the total amount recovered, and can only be reduced by Court order.


     
    APPROVAL NECESSARY FOR SETTLEMENT


    3. A. Attorney will not settle the claims without Client’s approval. However, pursuant to Section 3.2 of this Agreement, Attorney may take any and all reasonable steps necessary to protect and preserve settlement funds or potential settlement funds on behalf of Client in the event Client is unresponsive or otherwise unavailable for consultation.  Client will not make a settlement or offer of settlementwithout consulting Attorney.
    3. B. Attorney is hereby granted a power of attorney so that it may have full authority to prepare, sign, and file all legal instruments,pleadings, drafts, authorizations, and papers as shall be reasonably necessary to complete representation in this matter, includingsettlement and/or reducing to possession any and all monies or other things of value due to Client in connection with Client’s claims asfully as Client could do in person. Attorney is also authorized and empowered to act as Client’s negotiator in any and all settlementnegotiations concerning the subject of this Agreement.
    3. C. In the event Defendant(s) file for bankruptcy protection, Client herby agrees and authorizes Firm to cast Client’s vote as a creditor, for any proposed bankruptcy plan Firm deems appropriate.
    3. D. Client hereby authorizes Attorney to negotiate a settlement of Client’s claims in whatever manner, and using whatever negotiation strategy Attorney deems appropriate. Client understands and agrees that Attorney may, if appropriate, negotiate asettlement of Client’s claim and the claims of other clients similarly situated on an aggregate basis. However, no such settlement willbe negotiated without providing Client a description of the claims resolved by the settlement, the total settlement fund, the amount tobe received by Client, and the amount to be received by other clients who are qualified to participate in the settlement, subject toclient confidentiality considerations.
    3.E. MEDICARE: Client understands that Medicare regulations may require Attorney to compromise, settle, or execute a release of Medicare’s reimbursement claim prior to payment of any amounts recovered for Client. Client further understands that Attorney maybe required to undertake a determination of whether such reimbursement claims exist even if they have received no such notice fromMedicare prior to any verdict or settlement
    3.F. client agrees to be bound by the terms of any block settlements or negotiated settlements reached with one or more defendants.  client understands that the  attorneys will negotiate for the best settlement possible for CLIENT and client gives attorney broad authority to use ITS judgment and discretion in reaching A settlement.  Client agrees to cooperate fully with ATTORNEY throughout the entirety of the case.  Furthermore, Client understands that ATTORNEY may withdraw from representation in the case at any time, for any reason, at its sole discretion. client may also terminate this agreement at ANYtime subject to the provisions of section 2 of this agreement. 
     


    NO GUARANTEE OF RESULTS

    4. It is understood and agreed that Attorney cannot warrant or guarantee the outcome of Client’s case, and Attorney has notrepresented to Client that Client will recover any damages, compensation, or other payment as a result of Attorney’s representation.Client has also been informed that obtaining a judgment or settlement does not guarantee that the opposing parties will be capable of,willing to or actually satisfy the judgment.
     


    SHARING OF EXPENSES


    5.A. Attorney often represents a number of clients who were all harmed by the same event or events that caused the harm (referred to herein as “similar injury”) to Client or Client’s property. The cause of the similar injury is often determined to be the result a few relatedroot causes and therefore it is advantageous to a group of Attorney’s clients sharing the similar injury to share costs and expenses benefitting the group of clients.
    5.B. Client understands that Attorney may represent numerous other similarly injured clients, and Client agrees that the term“expenses” includes general expenses incurred for the benefit of all such similarly injured clients, including but not limited toretaining and compensating experts, copying documents, postage, research, computerized document management, conference calls,jury consultants, travel, mediation and trial expenses, and costs relating to the depositions of parties, witnesses, experts and others. Suchcommon costs and expenses will be allocated among all benefited clients pro rata.
    5.C. Direct expenses are those expenses which benefit only Client in Client’s individual case. Examples of such direct expenses include, but are not be limited to, payment for Client’s medical records and bills, copying of Client’s case file, payments to doctorsand other health care providers for medical services provided to Client (if any), expert fees associated with determining Client’s lostincome or property value. Direct expenses will not be shared with any other clients.
    5.D. Attorney may advance, as common costs and expenses, any or all of the court costs and expenses that appear to Attorney tobe reasonably necessary for the investigation, preparation, trial, and/or settlement of Client’s matter, including attorneys and/or experts not employed by OAL or third parties who may assist with resolving any Medicare reimbursement claim. All such costsand expenses advanced or incurred by Attorney shall be deducted from the recovery obtained for Client from Client’s portion of recovery.
     


    COURT COSTS AND EXPENSES

    6.A. It is specifically understood and agreed by the parties hereto that all financing expenses such as interest on loans made to financeall reasonable and necessary expenses of Client’s case will be paid by Client by deduction from Client’s share of the recovery aftercalculation of Attorney’s contingent fee. Said financing expenses shall be deducted from the amounts recovered for Client.
    6.A The terms “court costs” and “expenses” include without limitation: filing fees, costs imposed by courts, expert fees (regarding, without limitation, evaluation, reports, and/or testimony), consultant fees, postage, long distance  telephone calls, fax transmissions or receptions, messengers, court reporter fees, record service fees, photocopying, preparation of exhibits and photographs, transportation and/or lodging expenses, court-mandated expenditures, specialized non-enviromental and/or toxic tort outside counsel fees and expenses (i.e., probate, taxation, bankruptcy…etc.), costs associated with collection of judgments, any expenses of a structured settlement, witness’ fees and mileage, medical records, medical records retrieval and review, work history records, work history records retrieval and review, lien resolution services, subpoenas, and all other reasonable and necessary costs  and expenses which Attorney, in its judgment, determines to be reasonably necessary for the prosecution and/or settlement of Client’s claims. It is also specifically agreed and understood by all parties that “expenses” includes without limitation charges for outsourced third-party support services (from companies such as Torticity and Case Works) for such items as investigations into potential duel-rep issues (where a client has signed with two different law firms), record and document retrieval from third parties or Client, medical records review and other records review, Client outreach and communications based on Attorney instructions, assisting with completion of initial draft of court-ordered plaintiff fact sheets and authorization forms for Attorney review, and related technology and support services. Such items are excluded from Attorney overhead and are included in Client expenses.
    6.B. If Attorney represents Client throughout the course of the litigation and/or settlement negotiation and does not obtain for Clienta settlement or recovery, then the Client will not owe Attorney a fee or be required to reimburse any of the above expensesthat have been advanced by Attorney except as otherwise provided herein.
     

    COOPERATION OF CLIENT

    7.A. Client agrees to cooperate with Attorney at all times. Client further agrees to keep Attorney advised of Client’s whereabouts (andprovide changes of address and telephone numbers), shall appear on reasonable notice, shall appear for all depositions and courtappearances upon reasonable notice, and shall comply with all reasonable requests of Attorney in connection with the preparation andpresentation of the aforesaid Claims and causes of action of the Client. Client expressly consents and gives permission to Attorney or their co-counsel or third-parties acting on Attorney’s behalf, at any time to communicate with Client, to monitor or record all communications, and to send messages—including but not limited to emails, texts, facsimiles, and calls using a live operator, software, an automatic telephone dialing system (auto-dialer), or pre-recorded or artificial voice messages— for any lawful purpose, including information about or promotion of legal services, at the telephone number(s) or email addresses provided (even if these result in charges to Client by Client’s carrier), including those Client gives to Attorney and those from which Client contacts Attorney or which Attorney obtains through other means. This consent overrides any state, federal or corporate do-not-call registry rules or list. This consent remains in effect as long as Attorney owes any legal or ethical duty to Client.
    7.B.  Attorney may, at its option, withdraw from the case and cease to represent Client should Client fail to comply with any portion of this Agreement, or should Attorney decide for any reason that it cannot continue to represent Client.
    7.C. Although the Attorneys have agreed to represent Client in connection with Client's claim(s), Client understands that there are strict statutes of limitation on claims, and that if Client's claims are not filed before the statutes of limitation expire, Client may forever be prevented from bringing a claim. Client understands that Defendants may attempt to dismiss Client's claims based upon those statute of limitations. Client understands the statute of limitation in Client's case may have expired before Client ever contacted the Attorneys, or that the statutes of limitation may expire in the very near future. Client understands and agrees that the Attorneys will not be able to determine whether or not to file a lawsuit on Client's behalf unless and until client has provided (1) definitive proof that Client was exposed to a substance in a manner that could cause injury; and (2) the Attorney has received  copies of Client’s medical records that demonstrate both the date of diagnosis of injury and the first manifestation of injury. Client understands that it will take the Attorneys a reasonable amount of time after receipt of such information to further evaluate the merits of Client's claim so as not to inadvertently develop and pursue a claim with no legal basis.
    7.D. Client understands and agrees that the Attorneys are under no obligation to file suit should the Attorneys conclude after reasonable investigation, in Attorney’s sole discretion, that there is no legal causal basis for commencing an action.
    7.E. In investigating and representing Client in litigation related to environmental, chemical, toxic or other similar type exposures, OAL will become intimately familiar with Client’s lawsuit, exposure, and medical history and is in the best position to expediently continue any litigation arising from such matters. Therefore, in the event client dies during the course of a pending claim or lawsuit, Client and his or her successor heirs authorize OAL to take all steps, including but not limited to retaining estate counsel paid out of Client’s or the estate’s portion of any recovery, to open Client’s estate or have an estate administrator appointed in the appropriate jurisdiction and directs Client’s Executor, Personal Representative or other such fiduciary to (1) continue the employment of OAL in accordance with this Agreement, (2) have OAL represent Client’s estate in any pending claim or lawsuit, and (3) authorizes OAL to amend any pending claims or lawsuits to include additional claims, including, but not limited to, a claim for wrongful death of the decedent.
     


    REFERRAL OR ASSOCIATION OF ADDITIONAL COUNSEL


    8. Client expressly agrees, at the Attorney’s discretion, that Attorney may associate as co-counsel, additional lawyers to assist in effectively representing Client and prosecuting Client’s environmental, chemical, toxic or other similar type exposure  cause of action. The association of additional attorneys will not increase the contingency fee owed by Client to Attorney and the additional or associated attorney will be compensated out of the Attorney’s portion of the contingency fee.
     


    DISTRIBUTIONS


    9. O’Connor, Acciani & Levy Co. LPA will make all payments solely to the injured party, or Client’s personal representative, and will not be responsible for allocating settlement proceeds among heirs or multiple payees.
     

    APPLICABLE LAW


    10. Governing Law.  Client understands that this Agreement shall be governed by and construed in accordance with the laws of the State of Ohio without regard to other choice of law rules.
     


    WHEN LEGAL REPRESENTATION BEGINS & RECEIPT OF DOCUMENTS


    11. Client agrees that representation by O’Connor, Acciani & Levy Co. LPA and any of its Attorneys or Associate Counsel, will begin only after Client signs and returns this Agreement, and O’Connor, Acciani & Levy Co. LPA and any of its Attorneys or Associate Counsel, have accepted the case and have also signed this Agreement.  O’Connor, Acciani & Levy Co. LPA and any of its Attorneys or Associate Counsel, will take no action on Client’s case until after representation begins.
     
    AGREEMENT VOLUNTARY AND WITH KNOWLEDGE
    ATTESTATION:  “I REPRESENT THAT I HAVE READ AND FULLY UNDERSTAND THIS AGREEMENT, and voluntarily agree with all provisions.  By signing this Agreement I acknowledge the above.”
     
    EXECUTED effective on this ___ day of ___________________, 2024.
     
    CLIENT SIGNATURE:          ___________________________
     
    PRINTED NAME:                  ___________________________
     
    SSN:                            ___________________________
     
     
                                             
    DATE                                                                         
                      _______________
    ATTORNEY SIGNATURE
    O’CONNOR, ACCIANI & LEVY CO. LPA

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