Civil Remedy Notice of Insurer Violations
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Filing Number:     664405
Filing Accepted:  12/23/2022
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Complainant
Last/Business Name *  
CLYDE DEAN DAVIDSON AND SANDRA C. DAVIDSON   First Name  
Street Address * 705 BIMINI LANE,
City, State Zip * PUNTA GORDA, FL 33950
Email Address * SDIIIDAVIDSON@EARTHLINK.NET
Complainant Type: * Insured
Insured
Last/Business Name*   CLYDE DEAN DAVIDSON AND SANDRA C. DAVIDSON   First Name  
Policy # * FPH4208405-03 Claim #* FPI228468
Attorney
Attorney is Applicable
Last Name* LARA First Name * SANJE Initial
Street Address* 925 S. FEDERAL HIGHWAY, SIXTH FLOOR
City, State Zip* BOCA RATON , FL 33432
Email Address * SLARA@KPATTORNEY.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   FLORIDA PENINSULA INSURANCE COMPANY
NAIC Company Code 10132
 
Name of individual responsible for violation (if any):* KATRINA RAY
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Unsatisfactory Settlement Offer
Unfair Trade Practice
* Statutory provision(s) which the insurer allegedly violated.
 
624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
624.155(1)(b)(3) Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.
626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims.
626.9541(1)(i)(3)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(3)(f) Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Loss settlement provision
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The carrier was put on notice of the insured’s Hurricane Ian claim. The carrier initially attempted to low-ball the claim. Subsequently, the insured prepared a loss package in the amount of $122,135.43 needed to restore the property back to its pre-loss condition. Whereas, the carrier wrongfully represented the damages to the insured’s property to be below the policy deductible. The insured has complied with all of the carrier’s requests to date and the carrier has still failed to treat this claim with good faith. This intentional delay with the claim has led to direct prejudice of the insured. About eighty five days have passed since the original date of loss. The carrier has still refused to pay the fully covered amount owed under the policy. The carrier is aware of damage sustained by the insured’s property and has not taken any meaningful ensuing action. It is clear that the carrier is not treating the insureds with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the insureds; failing to implement proper standards for the adjustment and investigation of claims by its adjusters and placing the company’s interests before the insureds’ interests; refusing to pay the full amount owed to the insureds despite the fact that the carrier has been on notice of the damages and looking for ways to delay full recovery or any recovery to the insureds, when a reasonable carrier in a similar position would have tendered a full payment in accordance with both the policy language and statutory requirements. The carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a); 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c) and 626.9541(1)(i)(3)(f), as well as Section I- Perils Insured Against, subsection 1, providing coverage for direct loss to property unless the damage was caused solely by an excluded or excepted cause of loss; and the loss payment provision under Section I- Conditions requiring payment of a claim within 90 days. All the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a wanton and reckless disregard for the insureds’ rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) Pay the complete covered loss in the amount of $122,135.43, less any applicable policy deductible; 2.) Pay the Insureds’ attorneys’ fees and costs as they have been forced to retain counsel; 3.) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. A copy of this letter and filed form submitted to the FDFS has been sent to the carrier. Please do not hesitate to contact the undersigned or Jackelyne Mere at (561)-892-9980 if you have any questions or concerns. Sincerely, Sanje Lara Attorney at Law
Comments
User Id Date Added Comment
jbosch@qpwblaw.com 02-15-2023 VIA DFS WEBSITE Florida Department of Insurance Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399 Complainant/ Insured: Clyde Davidson and Sandra Davidson Claim No: FPI228468 (“Subject claim”) Policy No: FPH4208405-03 (“Policy”) Loss Location: 705 Bimini LN, Punta Gorda, FL 33950 (“Property”) CRN Filing No: 664405 CRN Acceptance Date: 12/23/2022 RE: CIVIL REMEDY NOTICE - DFS FILING NUMBER 664405 Dear Sir or Madam: The undersigned counsel represents Florida Peninsula Insurance Company (“Florida Peninsula”) in regard to the alleged dispute as to the subject claim number listed above involving an alleged windstorm event with a date of loss of on or about September 28, 2022, made under the Policy of insurance Florida Peninsula issued to the Insureds listed above. This correspondence constitutes Florida Peninsula Insurance Company’s response to the Civil Remedy Notice of Insurer Violations (“Notice” or “CRN”) filed on behalf of Clyde and Sandra Davidson (referenced herein as “Insureds” or “Complainants”) regarding the claim listed above. Based on the response below, the Civil Remedy Notice should be rejected and returned by the Department of Financial Services as it is substantively defective and objectionable for the reasons stated herein, and, without waiving objections, as it completely misstates the facts surrounding this claim. ALLEGED STATUTORY VIOLATIONS 624.155(1)(b)(1): Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests. Florida Peninsula specifically denies the Complainants’ allegation that it has violated the above referenced statute. Florida Peninsula did not violate these provisions. The CRN does not include any facts to support this allegation. Florida Peninsula conducted a thorough investigation in good faith and determined the amount of the loss was under the deductible. When additional information was provided, Florida Peninsula made a good faith settlement offer. 624.155(1)(b)(3): Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage. Florida Peninsula specifically denies the Complainants’ allegation that it has violated the above referenced statute. Florida Peninsula did not violate these provisions. The CRN does not include any facts to support this allegation. Florida Peninsula conducted a thorough investigation in good faith and determined the amount of the loss was under the deductible. When additional information was provided, Florida Peninsula made a good faith settlement offer. 626.9541(1)(i)(3)(a): Failing to adopt and implement standards for the proper investigation of claims. Florida Peninsula specifically denies the Complainants’ allegation that it has violated the above referenced statute. The CRN does not include any facts to support this allegation. Florida Peninsula did not fail to adopt and implement standards for the proper investigation of claims. 626.9541(1)(i)(3)(b): Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. Florida Peninsula specifically denies the Complainants’ allegation that it has violated the above referenced statute. The CRN does not include any facts to support this allegation. Florida Peninsula did not make any misrepresentations regarding this claim or the policy. 626.9541(1)(i)(3)(c): Failing to acknowledge and act promptly upon communications with respect to claims. Florida Peninsula specifically denies the Complainants’ allegation that it has violated the above referenced statute. The CRN does not include any facts to support this allegation. Florida Peninsula consistently and promptly communicated with the Insureds and their representatives via phone, email and formal correspondence. 626.9541(1)(i)(3)(f): Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement. Florida Peninsula specifically denies the Complainants’ allegation that it has violated the above referenced statute. Florida Peninsula did not violate these provisions. The CRN does not include any facts to support this allegation. Florida Peninsula conducted a thorough investigation in good faith and determined the amount of the loss was under the deductible. Florida Peninsula sent a coverage determination letter which provided a reasonable explanation along with the estimate. In addition to the allegations specifically denied above, Florida Peninsula generally denies all allegations presented in this CRN, as Florida Peninsula has not violated any statute, Code or Rule. SPECIFICITY REQUIREMENTS Florida Statute requires that a CRN state the facts and circumstances giving rise to the alleged violations with specificity sufficient to allow an insurer to “cure” the alleged violations within the sixty-day statutory period. See Fla. Stat. § 624. 155(3)(b)(2). See also Lane v. Westfield Ins. Co., 862 So. 2d 774, 777 (Fla. 5th DCA 2003), Talat Enterprises, Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). However, here, the CRN is deficient and defective in that it fails to state with sufficient specificity the necessary facts in support of the Insureds’ contentions, including but not limited to, those that would be necessary for Florida Peninsula to “cure” the alleged violations. Further, the subject CRN provides what appears to be several boilerplate and conclusory statements, which fail to describe any accurate facts constituting violations of the statutes cited therein. Thus, because the allegations in the CRN are incomplete and incorrect, they fail to provide actual notice of the specific allegations and the actions that Florida Peninsula could undertake to cure any alleged violations. 316, Inc. v. Maryland Cas. Co., 625 F. Supp. 2d 1187, 1193 (N. D. Fla. 2008). Blanket references to policy provisions and statutes without specification deems the Civil Remedy Notice deficient. Julien v. United Property and Casualty Insurance Co., (Fla. 4th DCA 2020). For the reasons set forth herein, Florida Peninsula hereby objects to the subject CRN and states it does not intend to waive, ratify or otherwise accept the deficiencies in the CRN, and reserves the right to contest the legal adequacy of the CRN hereinafter as appropriate. As to the content of the CRN here, it is important to note that said CRN is a nullity and should be rejected because the CRN fails to comply with the specific requirements mandated by Florida Statutes §624.155. Specifically, Fla. Stat. § 624.155(3)(b)(2) requires the Complainant to set forth with specificity, sufficient factual allegations to state a prima facie case of an insurer violation, so as to put the insurer on notice and be afforded the opportunity to cure the deficiency. However, the Insureds failed to do so in the subject CRN and instead only included conclusory statements, which lack even minimal specificity and/or lack the underlying factual basis to support them. The Insureds’ failure to describe any actual facts or circumstances to support the alleged statutory violations in the CRN precludes Florida Peninsula from evaluating what error, if any, allegedly occurred during the claim process. Furthermore, contrary to the requirement to “describe the facts and circumstances giving rise to the insurer’s violation as you understand them at this time,” the purpose of which is “to enable the insurer to investigate and resolve [the] claim,” the CRN itself only provides unsupported and incorrect allegations with no basis in fact or circumstances. Consequently, the CRN lacks the requisite minimal specificity and Florida Peninsula is unable to determine what specifically the Complainants are claiming was done by or on behalf of Florida Peninsula that constitutes the bad faith alleged. Due to the absence of specific and accurate information regarding the alleged acts or omissions by Florida Peninsula which allegedly give rise to any violation of the Civil Remedy Statute, Florida Peninsula is limited in its ability to set forth specific facts to address and/or refute these unsubstantiated assertions. Notwithstanding, Florida Peninsula explicitly denies violations of any applicable Florida Statute in the adjustment of the Subject claim and realleges and re-asserts its specific denials to the alleged violations in the subject CRN as set forth above. In addition, Florida Peninsula denies that it has conducted the practices listed under the “reasons for notice” portion of the Notice. Accordingly, without waiver of its objections, rights and defenses, Florida Peninsula maintains that it has acted and continues at all times to act in good faith during the investigation and adjustment of the Insureds’ claim. Further, Florida Peninsula wishes to dispel even the inference of any statutory violation and reiterates below the various reasons which clearly show the proper handling of the Subject claim by Florida Peninsula. Moreover, as stated in Demase v. State Farm Florida Insurance Company (Fla. 5th DCA November 14, 2022), and as a condition precedent to bringing a first-party bad faith case, an insured must provide timely notice of the alleged violation to the authorized insurer and to the DFS. The Insureds have failed to provide such timely notice to Florida Peninsula. BACKGROUND FACTS Aside from the fact that the allegations contained in the subject CRN lack specific facts, the tenor and inferences of statutory violations are wholly without merit, and Florida Peninsula denies each and every one. Below are some of the relevant facts regarding the Subject claim that the Insureds failed to include in the CRN. On September 29, 2022, the Insured reported damages to his home due to hurricane Ian, which took place the day before. Specifically, the Insured stated there was damage to the roof causing the tiles to be scattered around the yard and pool. In addition, all the screens in the lanai and the fence in the back yard were damaged. He advised there was no water damage to the interior. On the same day, September 29, 2022, Florida Peninsula immediately sent correspondence acknowledging receipt of the claim, which included the Florida homeowner claim bill of rights as well as information on mediation and claims handling. The next day, Florida Peninsula sent correspondence to the Insured providing the name and contact information of the adjuster assigned to the claim. On October 12, 2022, the field adjuster inspected the subject property on behalf of Florida Peninsula. On October 28, 2022, Florida Peninsula issued its coverage determination stating as follows: “Enclosed you will find an itemized estimate and statement of loss. Based on the estimate the damage to your property was less than your deductible. Therefore, we are unable to make a payment for your claim. Based on our investigation of your claim, and the terms of your policy, we have determined there is no coverage for part of your claim. The damage to the front slope prior repairs.” On October 31, 2022, Florida Peninsula received an email from the insured attaching a quote for repairs to the attic from damage to the lost soffits. The estimate was prepared by Koala Insulation, and it was in the amount of $2,650. On November 3, 2022, the Insured called and discussed the claim with a representative from Florida Peninsula, who emailed him a copy of the coverage determination letter the same day. On November 9, 2022, Florida Peninsula sent correspondence to the Insured explaining as follows: “We have received your estimate for full re-insulation of your home however based on our inspection your entire attic does not need to be re-insulated. Please have the insulation contractor provide you/us with an accurate estimate on the insulation that was lost as a result of hurricane Ian for our review. Based on the information provided there is no requirement for the entire attic to be re-insulated. At this time we stand behind our original assessment of your damages, should you obtain documentation from an insulation contractor that reflects accurate repairs to the insulation portion of your claim please submit that information.” On November 15, 2022, Florida Peninsula received a letter of representation from Insureds’ counsel seeking claim documents and the subject policy, to which Florida Peninsula responded on December 1, 2022, confirming receipt of same and asking for an estimate and photos of any additional damage claimed. On the same day, Florida Peninsula sent the coverage determination letter to counsel. The subject Civil Remedy Notice was then filed on December 23, 2022. On December 27, 2022, counsel for insured filed a Property Insurance Notice of Intent to Initiate Litigation for improper claim denial with an unknown estimate of damages. On January 10, 2023, Florida Peninsula responded to the Notice of Intent to Litigate stating, “the correspondence stated the Estimate of Damages as Unknown pursuant to Florida Statute 627.70152(3)(a). The Notice provided to Florida Peninsula Insurance Company failed to comply with Florida Statute 627.70152(3)(a).” The letter further states, “Coverage was afforded for the reported loss and the attached/enclosed correspondence was sent to the insured advising that, based on our adjuster’s estimate the cost of damage repairs was less than the applicable policy deductible so we were unable to make a payment for the claim. Coverage was therefore afforded for the claim, and this was not a claim denial as stated in your correspondence. Based on the foregoing information, Florida Peninsula Insurance Company has no option but to formally reject your purported Notice of Intent to Initiate Litigation provided.” Along with the letter, the Florida Peninsula also asked counsel to provide an estimate that supports the amount of damage listed in the civil remedy notice. In response, on January 20, 2023, counsel sent an estimate by Catastrophic Investigations for $122,135.43, which was never provided to Florida Peninsula before. On January 23, 2023, counsel withdrew the previous Notice of Intent to Litigate. On the next day, January 24, 2023, counsel filed a second Notice of Intent to Litigate for “Failure to properly pay the claim” stating that the pre-suit demand was $100,000.00. On February 3, 2023, Florida Peninsula responded to the second Notice of Intent to Litigate and informed the Insured’s counsel that it would be rejecting the amount noted in the demand, but that after continued review and evaluation, it would be open to attempt to resolve the claim, and in the same correspondence, formally made an offer to resolve it. As you can see, Florida Peninsula conducted a comprehensive, good faith investigation and issued a coverage determination letter accordingly. When additional information was provided, Florida Peninsula made a good faith effort to resolve the claim by making an offer to resolve it. INACCURACY OF ALLEGATIONS IN THE SUBJECT CRN The case specific facts related to Florida Peninsula’s handling of the subject claim provided above implicitly address many of the vague allegations contained within the Insureds’ CRN and further establish that Florida Peninsula undertook a thorough investigation in accordance with applicable statutory requirements and professional standards of care. It is important to note that the Insureds have not provided any factual support for any of the above allegations. Instead, the facts support that Florida Peninsula promptly contacted the Insureds, inspected the claim shortly after it was reported, and issued a coverage determination based on a thorough investigation. When additional information was provided in the form of an estimate, Florida Peninsula made a good faith settlement offer. The circumstances support that Florida Peninsula conducted a good faith, thorough, prompt investigation with the information provided. Insureds’ counsel is alleging bad faith in a scenario where Florida Peninsula conducted a comprehensive, prompt investigation in good faith. Also, regarding specific policy language alleged to have been violated, the notice refers to the loss settlement provision. However, Florida Peninsula consistently acted in accordance with the terms and condition outlined in the policy including the loss settlement portion. Furthermore, contrary to the requirement to “describe the facts and circumstances giving rise to the insurer’s violation as you understand them at this time”, the purpose of which is “to enable the insurer to investigate and resolve [the] claim”, the Civil Remedy Notice itself only provides completely false allegations with no basis in fact or circumstances. For example, the Civil Remedy Notice accuses Florida Peninsula of delaying the claim when in reality, the initial coverage determination was provided within a month of reporting the claim. The Notice also inaccurately states Florida Peninsula failed to take meaningful ensuing action despite the significant settlement offer made in response to the estimate. Furthermore, the tenor and inferences of the allegations are without merit, and Florida Peninsula denies each and every one. Some of the relevant facts that Insureds’ counsel failed to include in the notice have been set out above. In their Notice, the Insureds make multiple blanket statements that appear to just be copied and pasted and not based on any facts. The allegations that “the carrier is not treating the insureds with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the insureds; failing to implement proper standards for the adjustment and investigation of claims by its adjusters and placing the company’s interests before the insureds’ interests; refusing to pay the full amount owed to the insureds despite the fact that the carrier has been on notice of the damages and looking for ways to delay full recovery or any recovery to the insureds, when a reasonable carrier in a similar position would have tendered a full payment in accordance with both the policy language and statutory requirements,” are all entirely fabricated, baseless, unfounded and simply not true. As clearly set forth above and contrary to the allegations set forth in the Notice, Edison’s investigation and adjusting of its Insured’s claim was prompt, thorough, and complete. Furthermore, the Insureds have included absolutely no facts or evidence to support any claims in the Notice. All of these baseless claims support Florida Peninsula’s position that the claim was properly adjusted, and the Insureds do not actually have any concrete facts to support a bad faith allegation. The Civil Remedy Notice states that Florida Peninsula can rectify these violations in the following ways: 1.) Pay the complete covered loss in the amount of $122,135.43, less any applicable policy deductible; 2.) Pay the Insureds’ attorneys’ fees and costs as they have been forced to retain counsel; 3.) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. However, mere disagreement as to the amount of coverage does not equate to bad faith. The Civil Remedy Notice does not show how Florida Peninsula has failed to comply with the statutory provisions alleged to have been violated. Evidently, this Civil Remedy Notice was filed in bad faith, as it is being used as an improper mechanism designed solely for the purpose of intimidating Florida Peninsula into overpaying the Insureds. For the aforementioned reasons, Florida Peninsula categorically denies that it has acted with bad faith in connection with this claim. CONCLUSION The purpose of a CRN is to provide the insurer an opportunity to “cure” the alleged wrongdoing. Talat Enterprises, Inc. v. Aetna Casualty and Surety Co. , 753 So. 2d 1278 (Fla. 2000). However, the CRN here does not serve this purpose because it does not provide any means as to how Florida Peninsula can “cure” the alleged defects. This failure to provide a proper opportunity to cure renders the CRN improper. Longpoint Condominium Associations v. Allstate Insurance Co. , 2005 WL 131580 (N. D. Fla. June 2, 2005). Moreover, the method for curing the violations alleged in a civil remedy notice are not determined by the insured. In Talat Enterprises, Inc. v. Aetna Casualty and Surety Co. , 753 So. 2d 1278 (Fla. 2000), the Florida Supreme Court accepted and quoted the reasoning of the court below in its opinion which stated in relevant part, as follows: Section 624. 155 does not impose on an insurer the obligation to pay whatever the insured demands. . . . Section 624. 155(2)(d) would have no effect or purpose under such an interpretation. The law does not support such an expansive and illogical reading of Fla. Stat. Ann. §624. 155(2)(d). . . . To cure an alleged violation and to avoid a civil action, an insurer must pay the claim . . . before the sixty days expire. Talat, 753 So2d at 1282 citing Talat Enterprises Inc. v. Aetna Cas. & Sur. Co., 952 F. Supp. 773, 777-778 (M. D. Fla. 1996). Here, Florida Peninsula properly adjusted the Subject claim as it investigated the loss within the statutory time frame. Florida Peninsula denies all of the allegations contained in the subject CRN, which is defective and improper, as Florida Peninsula has not violated any of the subject statutes. Florida Peninsula further states that the accusations made against it in the subject CRN are patently false. In closing, Florida Peninsula first believes that the Civil Remedy Notice should be rejected and returned by the Department of Financial Services due to its failure to comply with Florida Statute §624.155 and Florida Case law. Due to the lack of any factual and circumstantial basis to support the allegations therein, Florida Peninsula respectfully requests, through this response, that the DFS return and reject the CRN for lack of specificity pursuant to Florida Statutes. Regardless of the rejection, Florida Peninsula denies all allegations contained in the Civil Remedy Notice and submits there are no violations. While Florida Peninsula’s response herein is meant to address the allegations in the Insureds’ Notice, it is based upon the limited information provided in the Civil Remedy Notice and the information presented to date. If the Insureds feel that Florida Peninsula is not in possession of all the facts, please inform the undersigned immediately. Please note that Florida Peninsula’s response is not necessarily exhaustive and does not preclude Florida Peninsula or anyone on Florida Peninsula’s behalf from asserting any other valid reason for seeking rejection and return of the Civil Remedy Notice. Also, this letter or any act or failure to act on the part of Florida Peninsula or any agent or representative of Florida Peninsula should not be construed as a waiver of any rights or defenses available to it by contract or at law, as all such rights and defenses are hereby specifically reserved. On behalf of Florida Peninsula, we trust that this response addresses the allegations in the Civil Remedy Notice of Insurer Violation. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned. Very Truly Yours, QUINTAIROS, PRIETO, WOOD & BOYER, P.A.
Acknowledgement
* The submitter hereby states that this notice is given in order to perfect the rights of the person(s) damaged to pursue civil remedies authorized by Section 624.155, Florida Statutes.

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DFS-10-363
Rev. 10/14/2008