Civil Remedy Notice of Insurer Violations
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Filing Number:     800893
Filing Accepted:  1/14/2025
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Complainant
Last/Business Name *  
TIMMERMAN   First Name   JOHN AND PATRICIA
Street Address * 500 JOHNS PASS AVE
City, State Zip * MADEIRA BEACH, FL 33708
Email Address * CFAUNTLEROY@FSATLAW.COM
Complainant Type: * Insured
Insured
Last/Business Name*   TIMMERMAN   First Name   JOHN AND PATRICIA
Policy # * 1501-2005-4261 Claim #* FL24-0117762-J424
Attorney
Attorney is Applicable
Last Name* FAUNTLEROY First Name * CHRISTOPHER Initial B
Street Address* 100 S ASHLEY DRIVE, SUITE 600
City, State Zip* TAMPA , FLORIDA 33602
Email Address * CFAUNTLEROY@FSATLAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY
NAIC Company Code 10861
 
Name of individual responsible for violation (if any):* ZACHARY ROMEO AND UNIVERSAL AND ITS ADJUSTERS
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
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.
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)(d) Denying claims without conducting reasonable investigations based upon available information.
626.9541(1)(i)(3)(e) Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

specific policy language that is relevant to violation: Coverage A: SECTION I – PROPERTY COVERAGES A. Coverage A – Dwelling 1. We cover: a. The dwelling on the "residence premises" shown in the Declarations, including structures attached to the dwelling; and b. Materials and supplies located on or next to the "residence premises" used to construct, alter or repair the dwelling or other structures on the "residence premises". 2. We do not cover land, including land on which the dwelling is located. Loss Payment J. 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 upon the earliest of the following: 1. 20 days after we receive your proof of loss and reach written agreement with you; or 2. 60 days after we receive your proof of loss and: a. There is an entry of a final judgment; or b. There is a filing of an appraisal award or a mediation settlement with us. 3. Under Florida Statutes we are required to pay or deny an initial, reopened, or supplemental property insurance claim or portion of a claim, within 60 days of notice of such claim unless there are reasonable circumstances which prevent us from so doing. Our failure to comply with this paragraph shall not form the sole basis for an action against us for breach of contract under this policy or for benefits under this policy. 4. Payment of a portion of the claim(s) being asserted in a loss under this policy does not act as a waiver on our part to dispute or deny any unpaid portion of any claim(s) that you may assert arose from a loss. Loss Settlement: d. We will initially pay at least the actual cash value of the insured loss, less any applicable deductible. We will then pay any remaining amounts necessary to perform such repairs as work is performed and expenses are incurred, subject to 2.a. and 2.b. above. . ***ADDITIONAL STATUTORY PROVISIONS ALLEGED TO HAVE BEEN VIOLATED ARE AS FOLLOWS:*** §624.155(1)(B)(1) Any person may bring a civil action against an insurer when such person is damaged: By the commission of any of the following acts by the insurer: 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 towards its insured and with due regard for her interests; 2. Making claims payments to insures or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made; or 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. §624.155 (5) No punitive damages shall be awarded under this section unless the acts giving rise to the violation occur with such frequency as to indicate a general business practice and these acts are: (a) Willful, wanton, and malicious; (b) In reckless disregard for the rights of any insured; or (c) In reckless disregard for the rights of a beneficiaries under a life insurance contract; (8) The damages recoverable pursuant to this section shall include those damages which are a reasonably foreseeable result of a specified violation of this section by the authorized insurer and may include an award or judgment in an amount that exceeds the policy limits. §627.70131 Insurer’s duty to acknowledge communications regarding claims; investigation (1)(a) Upon an insurer’s receiving a communication with respect to a claim, the insurer shall, within 14 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer which reasonably prevent such acknowledgement. If the acknowledgement is not in writing, a notification indicating acknowledgement shall be made in the insurer’s claim file and dated. A communication made to or by an agent of an insurer with respect to a claim shall constitute communication to or by the insurer. (4) For purposes of this section, the term “insurer” means any residential property insurer. §626.9541(i) Unfair Claim Settlement Practices
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

In Florida, the work of adjusting insurance claims engages the public trust. Universal Property & Casualty Insurance Company (UPC) has breached this duty in the adjustment of John Timmerman’s and Patricia Timmerman’s (the Timmermans’) claim. UPC has failed to adopt and implement proper standards for investigation, evaluation and adjustment of claims; has failed to properly train, manage, supervise and promote claims adjusters so that policy holder receives good faith, fair, prompt adjustment of claim, service and indemnity; has failed to conduct a full and fair investigation of the claim and has failed to provide full reasons and facts to the claimant for delay of the claim resulting in statutory violations as set forth in this notice. Furthermore, UPC has engaged in unfair claim delay; has used business or outcome-oriented investigations and experts to determine the outcome of the claim; has wrongfully denied the claim without fully stating reasons and reserving unwritten reasons; has looked for ways to, delay payment and otherwise “stonewall” the claim; and has used improper claims practices to rush the claims process and profit from wrongful claims practices. The Timmermans’ claim results from damage to the windows and interior of their home from Hurricane Debby that occurred on August 4, 2024. To mitigate the damages to their home, the Timmermans contacted their insurance company, UPC, to report the damages. As part of the investigation of the Timmermans’ claim, UPC assigned a claim number FL24-0117762-J424 and claims examiner Zachary Romeo. Subsequently, UPC denied the claim of damages and did not provide the Timmermans with any monetary coverage to return their property back to pre-loss condition. In view of the foregoing, it is clear and unequivocal that UPC has failed to provide proper and sufficient compensation to repair the damages caused to the Timmermans’ property. Due to UPC’s handling of the Timmermans’ claim, the Timmermans chose to retain Fairwinds Construction Services, LLC, to further assess the damages to their home. As such, upon inspection and view of the damages, it was clear that the windows and interior of the property required extensive repair. After the inspection, Fairwinds Construction Services, LLC, provided an estimate for repairs in the amount of $73,598.91, which is the full amount to return Timmermans’ home back to pre-loss condition. UPC continues to hold their stance for their claim determination concerning the Timmermans’ loss. The Timmermans have complied with all conditions under the policy. Nonetheless, UPC failed to properly compensate the Timmermans for their loss. The facts of this claim show that for whatever reason, UPC not only substantially misinterpreted the scope of damages to the Timmermans’ property, but also failed to conduct a thorough investigation as to the scope of damages to the windows and interior. Upon view of UPC’s claims handling procedures, it is clear UPC conducted a limited and quick outcome orientated investigation in the hopes that the Timmermans would make the required repairs with their own money. The Timmermans now must incur costs for assistance to obtain what should have been paid had they been treated fairly and honestly by UPC. Florida Statute §626.9744(2) provides that “When a loss requires replacement of items and the replaced items do not match in quality color or size, the insurer shall make reasonable repairs or replacement of items in adjoining areas”. In the instance of UPC, their adjusters and the estimate provided, it is clear that UPC did not adhere to Florida law, as their estimate provides paltry repair items that would result in mismatching areas which fails to acknowledge the true extent of damage of Timmermans’ home as well as the surrounding areas that would need to be replaced. Florida Statute §624.02, defines “insurance” as a contract where one undertakes to indemnify another or pay or allow specified amounts, or a determinable benefit, upon determinable contingencies – inherent is the fact that payment must be made timely and promptly. The fact that payment must be made timely and promptly so that the insureds may mitigate their damages, and to put the insureds back into the position they enjoyed prior to the loss as quickly as possible. UPC has breached this duty by improperly investigating the Timmermans’ claim and failing to properly pay the Timmermans for their loss. UPC has refused and/or failed to tender insurance proceeds as required by the policy and/or Florida law. It has refused and/or failed to settle the claim when under all the circumstances it could have and should have done so if it had acted fairly and honestly towards the Timmermans. In view of the facts surrounding the Timmermans’ claim, it is evident that UPC has failed to create and implement adequate guidelines for proper investigations to evaluate claims handling for training and supervision of employees in violation of Fla. Stat. §624.155 and §626.9541 statutory regulations, as well as the applicable provisions in the Florida Administrative Code resulting in the statute violations set forth herein. As stated, UPC has failed and/or refused to investigate the insureds’ claim thoroughly, accurately, and completely for damages. Furthermore, UPC has failed to adopt and implement proper standards for investigation, evaluation, and adjustment of claims; has failed to properly train, manage, supervise, and promote claims adjusters so that policy holder receives good faith, fair, prompt adjustment of claim, service, and indemnity, has failed to conduct a full and fair investigation of the claim. Florida Statutes Violated by UPC are as applied to the facts in this matter is as follows: § 626.951 engaging in acts defined as “unfair trade practices” relating to the business of insurance in accordance with the intent of congress as expressed in the act of congress of March 9, 1945 (pub. L. No. 15, 79th congress), by defining, or providing for the determination of, all such practices in this state which constitute unfair methods of competition or unfair or deceptive acts or practices and by prohibiting the trade practices so defined or determined. § 624.155(1)(b)(1) to tender all insurance proceeds monies due and owing the insured or assist the insured in the mitigation of their damages. The insurer breached these statutory duties. Not attempting in good faith to settle claims when, under all circumstance, insurer could have and should have done so, had the insurer acted fairly and honestly toward its insured and with due regard. § 624.155(1)(b)(3) failing to promptly settle claims, when the obligation to settle the 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 investigations of claims. § 626.9541(1)(i)(3)c Failing to acknowledge and to act promptly upon communications with respect to claims. Their actions are willful, wanton and in disregard of the rights of its insured and occur with such a frequency as to indicate a general business practice. UPC can cure this default by the following: A. Create, adopt, and implement adequate standards and/or guidelines for the proper investigation and adjustment of claims. B. Provide sufficient training and supervision of employees and agents to avoid further violations as set forth in the paragraphs above from occurring in the future. C. Tender payment to the Timmermans in the amount of $73,598.91, which is the amount to return the Timmermans’ home back to pre-loss condition. D. Tender prejudgment interest from the date the claim was reported through today. E. Agree to pay the Timmermans’ reasonable attorney’s fees pursuant to Florida Statute §627.428 and all taxable costs.
Comments
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sm1130@universalproperty.com 03-05-2025 March 5, 2025 VIA ELECTRONIC FILING Florida Department of Financial Services Bureau of Consumer Assistance Civil Remedy Section 200 East Gaines Street Tallahassee, FL 32399-0322 Re: DFS File No.: 800893 Filing Date: 1/14/2025 Complainant(s): John and Patricia Timmerman Insured(s): John and Patricia Timmerman Policy No.: 1501-2005-4261 Claim No.: FL24-0117762-J424 Please allow this to serve as Universal Property & Casualty Insurance Company’s (“Universal”) formal response to the above-referenced Civil Remedy Notice (“Notice”) filed by attorney, Christopher B Fauntleroy, on behalf of Complainants, John and Patricia Timmerman (also referenced as “Insureds.”) The Notice alleges violations of Secs. 624.155, 626.9541, and 627.70131, Florida Statutes. Universal specifically denies each allegation contained in the Notice. Additionally, Universal denies it violated these or any statutes, Florida law or policy provisions regarding the claim adjudication of this matter. With that said, Universal asserts the Notice fails to comply with the specific notice and information requirements as set forth in the Civil Remedy Notice of Insurer Violation document provisions, Sec. 624.155, Fla. Stat. and Florida law. The Notice is deficient as a matter of law as it fails to comply with Sec. 624.155, Fla. Stat. See, 316, Inc. v. Maryland Cas. Ins. Co., 625 F. Supp. 2d 1187 (N.D. Fla. 2008); Rousso v. Liberty Surplus Ins. Corp., 2010 WL 7367059, (S. D. Fla. 2010); Heritage Corp. of South Fla. v. Nat’l Union Fire Ins. Co. of Pittsburgh, P.A., 580 F. Supp. 2d 1294 (S.D. Fla. 2008); Talat Enterprises, Inc. v. Aetna Cas. & Surety Co., 753 So. 2d 1278 (Fla. 2000). Pursuant to Sec. 624.155(3)(b), Fla. Stat., the Notice “shall state with specificity” the following information: 1. The statutory provision, including the specific language, which the authorized insurer allegedly violated; 2. the facts and circumstances giving rise to the violation; 3. the name of any individual involved in the violation; 4. reference to specific policy language that is relevant to the violation, if any...; and 5. a statement that the Notice is given to perfect the right to pursue the civil remedy authorized by this section. Moreover, the Florida Department of Financial Services (“DFS”) created form DFS-10-363, which sets out fifteen (15) requirements the Complainant(s) must respond to with specificity. The Florida Supreme Court holds that Sec. 624.155, Fla. Stat. “must be strictly construed.” Talat Enterprises, Inc. v. Aetna Cas. and Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). Strict construction is appropriate as “this statute is in derogation of the common law.” Id. When interpreting a statute in derogation of the common law, “[a] court will presume that such a statute was not intended to alter the common law other than as clearly and plainly specified in the statute.” Time Ins. Co., Inc. v. Burger, 712 So. 2d 389, 393 (Fla. 1998). Such an interpretation would mean that statutory bad faith cases cannot proceed unless the Complainant(s) specifically complied with all statutory requirements. Pin-Pon Corp. v. Landmark American Ins. Co., 500 F. Supp. 3d 1336 (S.D. Fla. 2020); Julien v. United Property & Casualty Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021). The Notice fails to meet the requirements of Fla. Stat. § 624.155 on several grounds. First, the Civil Remedy Notice requires the Complainant(s) “pursuant to section 624.155, Florida Statutes, please indicate all statutory provisions alleged to have been violated.” The Notice filed by Complainants in this matter includes almost every statutory provision that could be claimed against an insurance company. The Notice, however, fails to specify any facts to support when or how or by whom any of these statutes were violated. Because the Notice fails to provide the requisite specificity, it does not comply with Section 624.155, Florida Statutes. The Notice fails to provide Universal with the necessary notice of what needs to be corrected, if anything at all. Second, with respect to the requirement to set forth with specificity the “facts and circumstances giving rise to the violation,” the Notice fails to specify any facts that would put Universal on notice that it violated any policy provision or statute. The Complainants lists four (4) reasons for filing the Notice: “Claim Delay,” “Claim Denial,” “Unsatisfactory Settlement Offer,” and “Unfair Trade Practice.” However, the Complainants’ allegations regarding these “Reasons for Notice” have no factual support anywhere in the Notice. In addition, the Notice asserts general allegations consisting of inaccurate and conclusory statements without the requisite specificity. As an example, the Notice states in part “UPC not only substantially misinterpreted the scope of damages to the Timmermans’ property, but also failed to conduct a thorough investigation…” The Complainants fail to provide any facts to support these conclusory statements. Further, the Notice asserts general allegations consisting of conclusory and boilerplate language in lieu of specifying facts to support any allegation. As an example, the Notice states in part: “UPC has engaged in unfair claim delay; has used business or outcome-oriented investigations and experts to determine the outcome of the claim; has wrongfully denied the claim without fully stating reasons and reserving unwritten reasons; has looked for ways to, delay payment and otherwise “stonewall” the claim; and has used improper claims practices to rush the claims process and profit from wrongful claims practices. … Furthermore, UPC has failed to adopt and implement proper standards for investigation, evaluation, and adjustment of claims; has failed to properly train, manage, supervise, and promote claims adjusters so that policy holder receives good faith, fair, prompt adjustment of claim, service, and indemnity, has failed to conduct a full and fair investigation of the claim.” The Complainants fail to specify any facts or circumstances that give rise to any of the above referenced boilerplate allegations. As an additional example, the Notice states “[Universal’s] actions are willful, wanton and in disregard of the rights of its insured and occur with such a frequency as to indicate a general business practice.” The Complainants are required to provide with specificity the facts and circumstances giving rise to the alleged violation strictly related to Complainants’ allegations, not conjecture or speculation of what may be the carrier’s business practices. A written notice which is vague and “shotgun” in nature or is written in general terms fails to satisfy the specificity requirement of the statute. See Heritage Corp. of South Fla., 580 F. Supp. 2d at 1300; 316, Inc., 625 F. Supp. 2d at 1193; see also Rousso, 2010 WL 7367059 at *3-6; Valenti v. Unum Life Ins. Co. of America, 2006 WL 1627276 (M.D. Fla. 2006). The Notice also generally alleges that Universal violated Fla. Stat. Sec. 626.9541(1)(i)(3)(b) by “[m]isrepresenting pertinent facts or insurance policy provisions relating to the coverages at issue.” However, the Notice does not specify any facts regarding any misrepresentations made by Universal, does not identify the person or persons who made such misrepresentations, nor does it identify to whom any misrepresentations were made. As a result, the Complainants fail to comply with Sec. 624.155(3)(b)(2), Fla. Stat. Third, the Notice fails to satisfy the requirement to identify the person or persons representing the insurer most responsible for or knowledgeable of the facts giving rise to the allegations. In order to comply with the requirements of Section 624.155, Florida Statutes, the Complainant(s) must name the individual(s) involved with specificity as it relates to the purported violation(s) to allow Universal to properly investigate the allegations. The Notice lacks the requisite specificity as required by Section 624.155, Florida Statutes. Here, the Notice states “ZACHARY ROMEO…” however, the Notice fails to include any specificity as to what facts the named individual has knowledge of that gave rise to any purported allegation(s) and/or what, if anything, they did or failed to do as it relates to the claim at issue. The Complainants also attempt a “catch-all” by stating “AND UNIVERSAL AND ITS ADJUSTERS” which significantly prejudices Universal because the Complainants are failing to notify Universal of the individuals that purportedly committed statutory violations or the specific statutory violations any individual purportedly committed. The failure to provide the requisite specificity precludes Universal from taking any corrective action and potentially curing any purported allegation. Specific identification of a person or persons with the most knowledge within Universal is of particular importance because, as noted, the Complainants allege that Universal “misrepresent[ed] pertinent facts or insurance policy provisions relating to coverages at issue” in the Notice. The Notice, however, fails to include the requisite specificity as to whom made any misrepresentations or when any of these misrepresentations occurred. Accordingly, the Notice is insufficient as a matter of law. Fourth, the Notice fails to satisfy Sec. 624.155(3)(b)(4), Fla. Stat., because it fails to reference specific policy language relevant to the alleged violation. Instead, the Notice improperly cites additional violations of Fla. Stat. Sections 624.155, 626.9541, and 627.70131, none of which are policy provisions and the inclusion here is improper as the Complainants fail to put Universal on notice as to any alleged violation of the Policy. Further, the Notice is broad in scope and fails to identify “specific policy language” relevant to any specific alleged violation. Instead, the Notice lists various provisions and sections but fails to state how, if at all, the cited language is relevant to any alleged violation and provides no guidance or explanation, such that Universal is left to wonder what policy provisions Complainants believe were allegedly violated or breached and why. General, vague and overbroad references to policy provisions and sections does not satisfy the specificity required by § 624.155(3)(b)(4), Fla. Stat. As such, the Notice is deficient as a matter of law. See generally Julien v. United Property & Casualty Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021). Lastly, the Notice does not provide a proper means whereby Universal can “cure” the alleged defects, without paying additional benefits which are not due and owing to the Insured. The purpose of a Civil Remedy Notice 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). Section 624.155, Florida Statutes, however, does not impose on an insurer the obligation to pay whatever amount its insured demands. Talat, 753 So. 2d at 1282. To the contrary, the Florida Supreme Court holds that the scope of what can be “cured” in responding to a civil remedy notice, is limited to contractual amounts due to the insured. See Talat, 753 So. 2d at 1281. The Notice demands among other things, that to cure the alleged defects, Universal must “[a]gree to pay the Timmermans’ reasonable attorney’s fees…” Thus, the Notice is deficient as it does not provide Universal an opportunity to “cure” the alleged violations without paying extra-contractual damages. Universal is only obligated to pay contractual amounts owed to cure a civil remedy. See Id. at 1278. In summary, as outlined above, Complainants failed to respond to each of the fields set forth on the DFS Form with the requisite specificity as stated herein, including but not limited to, failing to identify the person or persons representing the insurer who are most responsible for and knowledgeable of the facts giving rise to the allegations in the Notice, failing to sufficiently allege facts and circumstances giving rise to any violation, failing to reference specific policy language relevant to any alleged violation, and failing to allow Universal to cure the Notice without imposing an obligation to pay extra-contractual damages. Therefore, the Notice is legally deficient and fails to satisfy the condition precedent to filing a bad faith action. See Julien, 311 So. 3d 875 (Fla. 4th DCA 2021). For the aforementioned reasons, the Notice is deficient as a matter of law. Nonetheless, and without waiving the above-referenced deficiencies, the following shall provide you with the facts and circumstances regarding this claim, which shall demonstrate that Universal has not violated any Policy terms or statutory provisions. On August 7, 2024, Universal was notified by the Insured, Patricia Timmerman, that the insured location was damaged on August 5, 2024. On August 8, 2024, Universal inspected the property and documented any visible damage. On August 11, 2024, pursuant to the terms of the Policy, Universal advised the Insureds that there was no available coverage for the claim. Universal did not breach any duty to its Insureds. An insurer is not required to pay whatever amount its insureds demand. As outlined above, the alleged statutory violations outlined in the Notice lack factual support and are without merit. Therefore, the Notice is legally deficient and fails to satisfy the condition precedent to filing a bad faith action. Universal complied with all policy provisions and applicable Florida law regarding the adjudication of the claim. We trust that the preceding is sufficient to advise you of Universal's position regarding this matter and fully responds to the Notice filed by the Complainants. Sincerely, /s/ Stephen Methe Stephen Methe
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