Filing Number: 793787
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| Filing Accepted: 11/22/2024 |
| Last/Business Name
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ROBERT MANNING AND THE WILLIAM FOX COMPANY TRUST
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First Name |
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| Street Address
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11371 LONG WATER CHASE CT. |
| City, State Zip
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FORT MEYERS,
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33908
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| Email Address
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MH@WEKLAW.COM |
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Insured |
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| Last/Business Name* |
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ROBERT MANNING AND THE WILLIAM FOX COMPANY TRUST |
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First Name |
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MERYL |
| Policy # * |
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CFH6040790 01 84 |
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Claim #* |
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CFL200122997 |
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Attorney is Applicable
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| Last Name* |
HENDRIX
First Name *
MERYL
Initial
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| Street Address* |
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800 EAST BROWARD BLVD SUITE 510 |
| City, State Zip* |
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FORT LAUDERDALE
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FLORIDA
33301
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| Email Address * |
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MH@WEKLAW.COM |
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| Insurer Type
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Authorized Insurer
Unauthorized Insurer
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| Insurer Name |
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| Insurer Name* |
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CYPRESS PROPERTY & CASUALTY INSURANCE COMPANY
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| Street Address* |
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NAIC Company Code 10953 |
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| Name of individual responsible for violation (if any):*
DOUGLAS BRIAN MOORE II, JENNA MURPHY, DILLION MONROE, WAYNE WALKER, NICHOLAS KALLOO
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| Type of Insurance
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Residential Property & Casualty
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| Reason for Notice
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Claim Denial
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Claim Delay
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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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Other
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misstatement of policy terms and conditions
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Statutory provision(s) which the insurer allegedly violated.
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| 624.155(1)(b)(1) |
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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.
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| 624.155(1)(b)(3) |
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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.
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| 626.9541(1)(i)(3)(a) |
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Failing to adopt and implement standards for the proper investigation of claims.
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| 626.9541(1)(i)(3)(b) |
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Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
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| 626.9541(1)(i)(3)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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| 626.9541(1)(i)(3)(f) |
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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.
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| 626.9541(1)(i)(3)(g) |
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Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
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| 626.9541(1)(i)(3)(h) |
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Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
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| 626.9541(1)(i)(3)(j) |
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Altering or amending an insurance adjuster’s report without:
(I) Providing a detailed explanation as to why any change that has the effect of reducing the estimate of the loss was made; and
(II) Including on the report or as an addendum to the report a detailed list of all changes made to the report and the identity of the person who ordered each change; or
(III) Retaining all versions of the report, and including within each such version, for each change made within such version of the report, the identity of each person who made or ordered such change;
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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
SECTION I – CONDITIONS
I. Loss Payment We will adjust all losses with you. We will pay you unless some other person is named in the policy or is legally entitled to receive payment. Loss will be payable 60 days after we receive your proof of loss and: 1. Reach an agreement with you; 2. There is an entry of a final judgment; or 3. There is a filing of an appraisal award with us.
SECTION I – PERILS INSURED AGAINST A. Coverage A – Dwelling And Coverage B – Other Structures 1. We insure against risk of direct physical loss to property described in Coverages A and B.
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Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
Robert Manning and the William Fox Company Trust (the "Insureds") purchased an insurance policy ("Policy") from Cypress Property & Casualty Insurance Company ("Cypress"), with effective coverage on the date of the loss, on or about September 28, 2022, and policy number CFH6040790 01 84 to insure the property located at 11371 Long Water Chase Ct., Fort Meyers, Florida 33908 (the "Property"). On or about September 28, 2022, the aforementioned Property suffered severe damage as a result of Category 4 Hurricane Ian. As a result of this event, the Property sustained immediate direct wind damage to the tile roofing system, gutters, sliding glass door, pool screen enclosure and exterior, necessitating replacement. Ensuing water damage was sustained to the interior of the property in multiple locations. Once the damages were discovered, the Insureds promptly reported their claim to Cypress on October 5, 2022, which Cypress now alleges through its counsel was not prompt. Cypress acknowledged receipt of the claim by generating claim number CFL200122997.
Cypress retained Burton Claims Service, a third-party vendor to investigate the loss and assigned Jenna Murphy, a Non-Resident Field Adjuster, to conduct an inspection of the property which took place on October 19, 2022. On November 21, 2024, counsel for Plaintiffs deposed Cypress’ Corporate Representative who testified that Ms. Murphy does not have the ability to make a coverage determination on behalf of Cypress nor is she tasked with making a coverage recommendation, however following her inspection, she prepared an estimate of damages that was relied upon by Cypress and was used in making payment to the Insureds on December 3, 2022.
The estimate prepared by Ms. Murphy on October 29, 2022 allows for a roof repair totaling $4,437.20, despite there being an overwhelming amount of damage to the tile roofing system. The estimate also includes minimal amounts to repair the ensuing interior damages and exterior damages. Ms. Murphy’s estimate did include replacement for the screen enclosure. On December 3, 2022 Desk Adjuster Wayne Walker, acting on behalf of Cypress, authored a coverage determination letter, which specifically stated the following: “Burton Claim Service inspected the loss and determined there was no damage to your tile roof related to Hurricane Ian.” Not only is the Insureds’ property located in Fort Meyers, one of the hardest hit areas by Hurricane Ian, but Ms. Murphy’s estimate specifically includes line items for repair of the roof. Cypress’ Corporate Representative testified that this must have been a typo.
The December 3, 2022 letter further states: “the type of tile roof damage found is consistent with faulty or inadequate design, construction and/or workmanship, and is not caused by sudden and accidental event.” At the time this letter was authored and issued to the Insureds, Jenna Murphy was the only person who inspected on behalf of Cypress and Cypress’ Corporate Representative made it clear that she was not tasked with determining cause and origin of the loss and was only tasked with documenting the damage and reporting back to the carrier her findings in the form of an estimate. Therefore, there is absolutely no evidence on the part of Cypress to support these findings contained within this letter that was sent to its Insureds following this catastrophic event.
The December 3, 2022 letter goes on to state that while the policy does not cover the roof damage, the ensuing water damages are covered in the amount of $19,238.50 which represents the amount specifically contained within Jenna Murphy’s estimate, less depreciation and the Insureds $28,560.00 Hurricane deductible. This payment though was classified as a “supplemental payment,” which Cypress’ Corporate Representative testified was another “typo.” Cypress accepted Ms. Murphy’s estimate as accurate and did not do any other investigation prior to making this extremely low-ball payment to its Insureds.
To say the Insureds were shocked upon receiving this payment is an understatement. Due to the inadequate assessment of damages by the carrier’s Non-Resident Field Adjuster Jenna Murphy, the Insureds retained Statewide Claims Services (hereinafter “SCS”) to help assist with the overwhelming loss and claims process as the Insureds were left with no other option. SCS meticulously inspected the insureds property finding extensive damage that was clearly missed by Ms. Murphy. Not surprising though since she lacks the requisite experience to handle a loss of this magnitude. SCS submitted its detailed initial estimate of damages to the carrier totaling $279,751.83, which represented the full cost of repair and/or replacement at that time.
The Insureds also retained the services of Roof Wars to place a peel and stick tarp on the roof to prevent further water from coming into their home, since the first tarp was not adequate, and the Insureds were trying their best to comply with their duties after loss under the policy. Despite the Insureds compliance with policy conditions, Cypress has failed to pay the $12,000 for the necessary tarp, which was used to mitigate further damage to the Insureds property.
It wasn’t until Cypress received notice that the Insureds retained a Public Adjuster that it decided to retain an Engineer to re-inspect the property approximately ten (10) months after Hurricane Ian ravaged Fort Meyers. Cypress retained Grindley Williams, a company known to give opinions for insurance carriers. Stephanie Cleary, P.E. and Alex Sengamphone inspected the property on July 26, 2023. At the time of their inspection the peel and stick tarp was still on the roof and removal would have caused damage to a lot of the tiles, per Ms. Cleary’s report. Although Ms. Cleary confirmed wind damage to the roof covering, she did not observe any storm created openings in the roof and therefore that was eliminated as a source of moisture infiltration. Instead, Ms. Cleary opined that the moisture intrusion was from condensation from torn AC ducts in the attic due to animal activity as well as long-term rainwater infiltration due to inadequately sealed portions of the roof surface.
The Insureds purchased the property in approximately December 2020. The property was in excellent condition as evidenced in multiple publications such as Zillow.com and Realtor.com. A roof inspection report dated August 19, 2020, prepared by Target Roofing & Sheet Metal states that the roof is in good condition and that there were no active leaks throughout the roof system and that it had 12+ years of life remaining excluding any major storms or hurricane. Photographs of the roof taken on August 19, 2020 do not depict any damage to the roofing system. Furthermore, the seller’s disclosure does not indicate any issues with leaks.
Following Grindley William’s inspection of the property, Cypress retained the services of Precision Roof Consulting, LLC to provide a bid for repair of the roofing system, not replacement of the roofing system and received an estimate in the amount of $21,537.71. It’s important to note that Precision never went out to the property to inspect. Upon obtaining this bid from Precision, Cypress requested that Ms. Murphy’s estimate be revised to include Precision’s bid amount and on August 23, 2023 her initial estimate was revised, which included Precision Roof Consulting’s bid in the amount of $21,537.71, however rather than paying this amount, $8,615.08 depreciation was added leaving an ACV amount of $12,922.63. Cypress’ Corporate Representative could not give a reason as to why depreciation was applied to this repair or how it was calculated. On September 27, 2023 a second payment letter was sent to the Insureds. The letter included the findings and conclusions made by its retained engineer and also that it was issuing payment in the amount of $8,485.43, which was based on the August 23, 2023 revised estimate prepared by Jenna Murphy.
Upon receiving this letter and payment, and reviewing the Grindley William’s report in its entirety, the Insureds Public Adjuster immediately contacted Desk Adjuster Nicholas Kalloo who authored the September 27, 2023 letter in an effort to explain what additional items needed to be paid for. These items, which he communicated in an October 5, 2023 email included the sliding glass door separating the living room from the pool deck, allowance for the painting of the exterior and stucco repairs, rental equipment as well as scaffolding due to the high walls. He also explained that the damages observed to the underside of the roof deck, which were documented by the carrier’s engineer further supported the Insureds’ claim of damage to the underlayment, which must be replaced in its entirety to prevent further moisture penetration, which the Insureds had been experiencing, even with the peel and stick tarp. The Insureds’ representative also addressed the HVAC system and how it was damaged from Hurricane Ian. At the conclusion of the email, he asked for a response as well as a payment for interest since the date of loss occurred over a year at this time. No response was received.
On October 6, 2023, the Insureds’ Public Adjuster left Mr. Kalloo a voicemail and sent a third email asking him to acknowledge receipt of the prior emails and asked how the carrier will proceed with the missing line items. It does not appear that Mr. Kalloo ever responded to these emails, which is a violation of Florida Statute 627.70131, which states that upon an insurer’s receiving a communication with respect to a claim, the insurer shall, within 7 calendar days, review and acknowledge receipt of such communication.
A month later, and over a year after Hurricane Ian occurred, Cypress on November 8, 2023, completed a third inspection of the property with a second Field Adjuster from Burton Claim Services, rather than a General Contractor or Roofer. Field Adjuster Dillion Monroe inspected the property, photographed the damage he observed and revised the estimates previously prepared by Jenna Murphy. The estimate dated December 27, 2023 now accounted for the full amount of the Precision Roof Consulting bid repair totaling $21,537.71 and included some minor additions. The very next day after this estimate was prepared by Mr. Monroe, Desk Adjuster Nicholas Kalloo authored a third coverage determination letter, once again reiterating that Cypress was not responsible for a full roof replacement and that it was making a payment in the amount of $29,696.48, which was based solely on the revised estimate prepared by Mr. Monroe. This was the last payment that was made. The three payments made by Cypress totaled $57,420.41 after depreciation and the Hurricane deductible was applied. These three payments fall woefully short of what is needed to bring this beautiful property back to what it looked like before Category 4 Hurricane Ian occurred.
To date, the Insureds have spent well over $57,420.41, including having to take out a $100,000 loan to replace the entire roofing system as a repair was not feasible due to the ongoing water intrusion following Hurricane Ian.
After having three opportunities over the course of a year and three months to investigate the sustained damage, Cypress refused to afford replacement of the roofing system and has underpaid the loss by thousands and thousands of dollars. It is evident that Cypress, has knowingly chosen not to consider the information provided by its Insured and/or the Insureds’ representative from SCS, in its investigation of the claim. The handling, adjustment, and continued failure to meet its obligations under the policy has resulted in multiple breaches of the subject policy of insurance. As such, Cypress is in clear violation of Florida Statutes, ethical considerations, the adjuster code of conduct and the administrative code provisions. These include, but are not limited to, Florida Statutes §624.155 and §626.9541. Cypress has at all times materials hereto, acted for its own interest and not for the interest of its Insureds as set forth in detail above. In so doing, Cypress has taken positions in defending its actions and/or omissions on theories that have no basis under the subject policy and have no basis in fact. Specifically:
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; and 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)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information.
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.
626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
626.9541(1)(i)(3)(j) Altering or amending an insurance adjuster’s report without: (I) Providing a detailed explanation as to why any change that has the effect of reducing the estimate of the loss was made; and (II) Including on the report or as an addendum to the report a detailed list of all changes made to the report and the identity of the person who ordered each change; or (III) Retaining all versions of the report, and including within each such version, for each change made within such version of the report, the identity of each person who made or ordered such change;
To date, Cypress has failed to accept and fully perform its obligations under the operable insurance contract. The Insureds had no choice but to take out a loan and pay money out of their own pockets to make the necessary repairs to start bringing their property back to its pre-loss condition because they have not been paid the necessary, covered insurance proceeds sufficient to return the property back to its pre-loss condition over two years later. As a direct result of the carrier’s insufficient investigation and handling of the claim, deficient extension of coverage and subsequent breaches of not only the policy of insurance, but also Florida Statutes, the Insureds had no choice other than to seek the help of licensed professionals to assist them, including, but not limited to a public adjuster and legal counsel. Considering the aforementioned conduct, it is irrefutable that Cypress knowingly and intentionally, and in bad faith delays the claims process in order to further disadvantage the Insureds. The financial detriment caused to the Insureds is a direct result of Cypress’ dismissive and reckless treatment of the claims process. The Insureds submitted all available requested documents in their custody and control in a timely fashion, made the insureds premises available for three inspections and submitted additional documentation in support of the insurance proceeds sought under their insurance contract. Nevertheless, Cypress failed to properly assess this information and reach the logical conclusion resulting in its gross mismanagement of the claim.
To deny the Insured benefits clearly due and owing under the policy, for which they been making premium payments for and after they have satisfied all their obligations is morally and ethically reprehensible, and reeks of Unfair Claims Practice and Bad Faith. Upon information and belief, the above identified actions taken by the carriers, among others, were made so often as to constitute a general business practice, evidencing a motive to enhance Cypress’ profits, and designed to cause a detrimental effect to its policyholders.
Pursuant to Florida Statute §624.155(1)(b)(1), Cypress has a duty to attempt in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly towards its Insured, and with due regard for their interests. Cypress flagrantly breached these duties in the handling of the claim for, inter alia, financial gain and profit, to wit: when it refused to engage in negotiations or a similar good faith effort to resolve, settle and/or adjust the Claim, as stated supra, failed to assign qualified representatives to adjust the loss, failed to pay an adequate sum as contractually required, and by its refusal to timely tender the necessary payments to properly perform the required repairs/replacements. It is these same actions that also lead to the breach of Florida Statute 626.9541(1)(i)(3)(d) as explained in detail above. Again, pursuant to Florida Statute §626.9541(1)(i)(3)(a), Cypress has a duty to adopt and implement standards for the proper investigation and settlement of claims, which it clearly failed to do in the handling of this claim.
This notice is given in order to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should Cypress fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. Therefore, to cure the defects outlined in this Civil Remedy Notice, Cypress must: (1) Immediately tender all proceeds due and owing to the Insured that are fairly owed to the Insureds under the insurance policy that would reasonably compensate the Insured in order to put the insured premises back to its pre-loss condition; (2) Agree to reimburse the Insureds’ reasonable attorneys’ fees and costs for having to become involved to resolve the claim; (3) Agree to reimburse the Insureds for interest on the amount of benefits that was found to be due and owing to the Insureds, relating back to the date of loss.
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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.
Before submitting a Notice using this system, please verify that all text has been entered
correctly and completely. Once the Notice has been submitted, the text cannot be changed
or deleted.
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DFS-10-363
Rev. 10/14/2008
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