Keith_D_Weiner_Award_Letter_08222022.pdf

MARK BRNOVICH

ATTORNEY GENERAL

OFFICE OF THE ARIZONA ATTORNEY GENERAL

OPERATIONS DIVISION

PROCUREMENT SECTION

LESLIE HEATHCOTTE

CHIEF OPERATING OFFICER

CINDY PALMER

CHIEF PROCUREMENT OFFICER

2005 N CENTRAL AVE, PHOENIX, AZ 85004 602.542.7986 WWW.AZAG.GOV

August 22, 2022

Mr. Michael S. Lewis Keith D. Weiner & Associates Co, LPA 1100 Superior Ave E, Suite 1100 Cleveland, OH 44114 mlewis@weinerlaw.com

RE: BPM004664 Outside Counsel – Out of State Collection Services – Notification of Award

Dear Mr. Lewis:

In accordance with A.R.S. §41-2538 and the evaluation criteria listed in the Request for Proposal, the Arizona Attorney General’s Office has determined that your firm be awarded a contract to perform outside counsel, out of state collections services on behalf of the State of Arizona.

Keith D. Weiner & Associates is awarded for the following State(s) for the service with the set contingency fee %:

1. Indiana 2. Kentucky 3. Ohio

4. West Virginia 5. Wisconsin

Amount Collected Contingency Fee % Amount Collected Contingency Fee % Up to $25,000 25% $100,001 to $500,000 21% $25,001 to $50,000 25% $500,001 to $1,000,000 18% $50,001 to $100,000 25% Over $100,000,001 15%

Enclosed is an executed copy of the contract for your files, retain it for future reference concerning any case that is assigned. The original document(s) is on file in the AZ Attorney General’s Office.

Waivers for Conflict of Interest

The State of Arizona requires that your firm identify and describe any type of matter, regardless of whether the matter involves litigation, in which your firm proposes to become involved or is involved, against the State of Arizona and a concise statement of how your firm proposes to resolve the conflict of interest. In matters involving the AGO’s Civil Rights Section, the AGO asks that your firm request a waiver prior to accepting representation of a respondent. A Request for Waiver Form has been included in this attachment for future use.

Requests for waivers of conflict of interest must be submitted in writing either by mail, e-mail, or transmitted by fax to the AZ Attorney General’s Office. Normal response time is approximately 5-7 business days.

Contact: Dawn Northup, Chief Counsel, State Government Division Mailing Address: 2005 N. Central Ave, Phoenix, AZ 85004

OPERATIONS DIVISION

PROCUREMENT SECTION

LESLIE HEATHCOTTE

CHIEF OPERATING OFFICER

CINDY PALMER

CHIEF PROCUREMENT OFFICER

2005 N CENTRAL AVE, PHOENIX, AZ 85004 602.542.7986 WWW.AZAG.GOV

E-mail: WaiverRequests@azag.gov; cc: Dawn.Northup@azag.gov Email Subject Line: Waiver Request

If you have any questions, you may call me at 602-542-7986.

Sincerely, Cindy Palmer Procurement Manager y, Ci d P l

MICHAEL BERKOWITZ*

THOMAS CANARY JR.*~‡ˆ

JASON DAUNT‡

LINDSEY HALL*

KIM HAMMOND*+‡

CYNTHIA JEFFREY*

MICHAEL LEWIS*

KEITH D. WEINER & ASSOCIATES CO., L.P.A.

ATTORNEYS AT LAW

1100 Superior Ave East, Suite 1100 Cleveland, Ohio 44114

Toll Free 1-866-368-6500 Fax (216) 771-6540 collections@weinerlaw.com

OFFICES IN: OH, WI, KY, WV

LICENSED IN: OH*, WI+, KY‡, WV~, INˆ

C.WESLEY PAGLES‡ˆ

SUZANA PASTOR*

PAUL RODE*

RILEY RODGERS~

KEITH WEINER*

DANIEL WOLTERS*

July 15, 2022

Cindy Palmer, Procurement Officer Office of the Arizona Attorney General 2005 N. Central Avenue Phoenix, AZ 85004

Re: Responses to Notice For Request For Proposal Solicitation # BPM004664 Project # AG23-0004

Dear Mrs. Palmer:

Thank you for allowing us to submit our responses to your Request For Proposal and the opportunity to continue our representation of the State of Arizona. We are confident we would be the right choice to help the Arizona AGO collect its judgments against Defendants who are domiciled, have assets or operate a business in Ohio, Wisconsin, Kentucky, and West Virginia. At the outset we also accept the requirements of Solicitation # BPM004664. Our Firm only represents creditors and governmental entities. We limit our practice to consumer, governmental and commercial debt collection, and liquidation or recovery of related assets. We have been doing so since 1985. We have a very strong focus in governmental collections. I have been fortunate to have consecutive annual appointments as Special Counsel to the Ohio Attorney General since 1994. Additionally, we represent over 20 Ohio cities and municipalities and recently were approved to represent the second largest city in Kentucky. As part of our submission we have attached our Firm’s resume and our attorneys’ resumes.

In addition to our responses and attachments, we have listed some additional attributes of our Firm which we believe enhances our relationships with our clients. They are as follows:

As Special Counsel to the Ohio AG we must endeavor to comply with the strict data security requirements of IRS regulation 1075. This is due to Federal Tax Information we are entrusted to protect. These standards apply to electronic and physical security and are extremely stringent;

Our clients have the option of using our dedicated client website. This allows them to review our collection notes, demand letters, legal pleadings & motions, payments and hearings;

We are AV-rated by Martindale-Hubbell and have an excellent reputation for professionalism and honesty in our community;

We utilize Compliance Management Software which helps us manage all aspects of our policies and procedures, assists us with employee training & testing and provides us with a structure in which to manage our vendors;

Our proprietary Case Management System is customizable to meet the needs of our clients and has been adapted to meet the complex processes required to represent states and cities as well as creditors large and small;

Our VOIP phone system records all calls and recordings are kept for seven years;

Our collectors have online access to a number of skip tracing tools including: Credit Bureau Reports and Triggers, The Work Number, Verified Jobs, TLO, Accurint, Ohio BMV, Google and LinkedIn Searches, and all online court dockets including county auditors for real estate ownership;

We have made a long term commitment to a business consulting firm in an effort to improve Firm culture, employee fulfillment, and enhance all aspects of what we do each day so we continue to thrive.

Our recovery rates have always been impressive. It would be misleading to quote one rate that the AGO could rely upon since a fair comparison would require accounts with similar statistical data. We are, however, very much driven by our recovery performance and our collectors receive a significant portion of their compensation based upon achieving monetary goals.

We appreciate having the opportunity to submit our qualifications and we thank you for your consideration.

We are confident if we are selected that you would be very satisfied with our services and recoveries. We remain available for any follow-up that might be needed. Thank you.

Very truly yours, Michael S. Lewis

MSL|hs Encls.

AG23-0004

OFFER AND ACCEPTANCE

ATTACHMENT I

State of Arizona Office of the Attorney General

2005 N Central Ave Phoenix, AZ 85004

OFFER

TO THE STATE OF ARIZONA:

The Undersigned hereby offers and agrees to furnish the material, service or construction in compliance with all terms, conditions, specifications and amendments in the Solicitation and any written exceptions in the offer. Signature also certifies Small Business status.

Keith D. Weiner & Associates Co., L.P.A.

Firm Name Signature of Person Authorized to Sign Offer

1100 Superior Ave East, Suite 1100 Michael S. Lewis

Company Address Printed Name

Cleveland Ohio 44114 Compliance Attorney

City State Zip Title mlewis@weinerlaw.com (866)368-6500 x125 216) 771-6540

Contact Email Address Contract Phone Number Contact Fax Number

By signature in the Offer section above, the Offeror certifies:

1. The submission of the Offer did not involve collusion or other anticompetitive practices.

2. The Offeror shall not discriminate against any employee or applicant for employment in violation of Federal and/or

State laws.

3. The Offeror has not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to a public servant in connection with the submitted offer. Failure to provide a valid signature affirming the stipulations required by this clause shall result in rejection of the offer. Signing the offer with a false statement shall void the offer, any resulting contract and may be subject to legal remedies provided by law.

4. The Offeror certifies that the above referenced organization IS/ IS NOT a small business with less than 100 employees or has gross revenues of $4 million or less.

ACCEPTANCE OF OFFER

Your offer is hereby accepted:

The Contractor is now bound to sell the materials, services or construction listed by the attached contract based upon the solicitation, including all terms, conditions, specifications, amendments, etc., and the Contractor's offer as accepted by the Office of the Attorney General.

The Contractor is hereby cautioned not to commence any billable work or provide any material or service under this contract until the Contractor receives a purchase order, contract release document or written notice to proceed.

This Contract shall henceforth be referred to as Contract No.:

The effective date of the Contract is:

STATE OF ARIZONA

OFFICE OF THE ATTORNEY GENERAL

Awarded this Day of , Cindy Palmer, Procurement Manager

CTR061801

8/22/2022 22nd August 2022

BUSINESS QUESTIONNAIRE

ATTACHMENT I

State of Arizona Office of the Attorney General2005 N Central AvePhoenix, AZ 85004

Business Questionnaire This section requests information about the contractor. Please follow the format outlined in this section when responding.

Do not provide a standard boilerplate for this information or make reference to a brochure or report as part of your response. If an item is not applicable, indicate so by inserting “N/A”

Keith D. Weiner & Associates Co., L.P.A. 1985

Firm Name Year Firm was Established

1100 Superior Ave East, Suite 1100

Firm Address

Cleveland Ohio 44114 (866)368-6500 (216) 664-9830

City State Zip Primary Phone Number Contact Fax Number

Firm Identified in Proposal as: Parent Company: Branch or Subsidiary Office: Individual Contracted Counsel:

N/A N/A

Name and location of Parent Company (if applicable) Year Parent Company was Established (if applicable)

Number of Personnel by Discipline (count each person only once, by primary function):

1 13 11 23 16

Executives Attorneys Paralegals Support Staff Collectors

16 80

Other: Other: Total Personnel

Names of not more than two Principals to contact:

Keith D. Weiner President (866)368-6500 x209 kweiner@weinerlaw.com

Name Title Phone Number Email Address

Michael S. Lewis Compliance Attorney

(866)368-6500 x125 mlewis@weinerlaw.com

Name Title Phone Number Email Address

Business Focus, by Profile, or Firm’s Relevant Project Experience:

Profile of Business Focus Percentage of Revenue Profile of Business Focus Percentage of Revenue

A. Contingency Collections (Public) 35% D. Litigation 3%

B. Contingency Collections (Private) 45% E. Bankruptcy 10%

C. Foreclosure 5% F. Replevin 2%

CONFLICTS OF INTEREST

ATTACHMENT I

State of Arizona Office of the Attorney General2005 N Central AvePhoenix, AZ 85004

Acceptance of Insurance Requirements:

Indicate that you have read, understand and will comply with the Insurance requirements specified in the Request for Proposal. Check the appropriate response.

Yes, we will comply with the Insurance requirements

Conflicts of Interest

Identify and describe any type of matter, litigation and otherwise, in which your firm is involved with against the State of Arizona or any of its agencies and a concise statement of how your firm proposes to resolve any conflicts of interest with the State of Arizona. Specific Cases or Matters should be listed on the table on the following page or you may add an attachment sheet similar to the table. In the event of the award of a contract, Counsel must receive a waiver of any conflict of interest.

The award of this contract does not create or cause said waiver.

List the specific cases in which your firm has been adverse to the State of Arizona in the last 2 years.

If the case has been on-going for more than two years it should be listed here. Add additional pages if needed.

Court or Case Name Court or Case Number Date Began Date Ended

None

List the specific matter in which your firm has been adverse to the State of Arizona in the last 2 years.

If the matter has been on-going for more than two years it should be listed here. Add additional pages if needed.

Matter Date Began Date Ended

None

List the specific cases in which your firm has represented the State of Arizona in the last 2 years.

If the case has been on-going for more than two years it should be listed here. Add additional pages if needed.

Court or Case Name Court or Case Number Date Began Date Ended

None

BAR COMPLAINTS/MALPRACTICE

ATTACHMENT I

State of Arizona Office of the Attorney General2005 N Central AvePhoenix, AZ 85004

Bar Complaint/Malpractice

Does any current member of your firm have any bar complaint currently being investigated and/or disciplinary action taken by the State Bar Association against them? Add additional pages if needed.

Check the appropriate response Yes No If answer to the above is “Yes”, use the space below to disclose details of any complaint(s):

N/A

Has your firm had any malpractice suit or claim for malpractice filed against it in the last 2 years?

Add additional pages if needed.

Check the appropriate response Yes No If answer to the above is “Yes”, use the space below to disclose details of any suit:

N/A

Do you wish this information to be held confidential in accordance with A.A.C. R2-7-103?

Add additional pages if needed.

Check the appropriate response Yes No If answer to the above is “Yes”, provide a brief statement asserting why this information should be held confidential:

RATE SCHEDULE & SERVICE AREAS

ATTACHMENT I

State of Arizona Office of the Attorney General2005 N Central AvePhoenix, AZ 85004

Rate Schedule

Provide a contingency fee percentage to be based upon the total outstanding debt when referred. Contingency Fee is paid only on the amount collected. Offeror may provide a reduced rate on any individual case assigned.

Amount collected Contingency Fee % Amount collected Contingency Fee %

Up to $25,000 25% $100,001 to $500,000 21%

$25,001 to $50,000 25% $500,001 to $1,000,000 18%

$50,001 to $100,000 25% Over $1,000,001 15%

Areas of Service:

Areas in which your firm is licensed to practice law:

Keith D. Weiner & Associates Co. L.P.A. is a law firm with offices located in Ohio, Wisconsin, Kentucky, West Virginia, and Indiana.

Areas in which your firm is offering to provide service:

Ohio, Wisconsin, Kentucky, West Virginia, and Indiana. The firm represents governmental entities and creditor’s only in the areas of collections, bankruptcy, litigation, and foreclosure.

States or areas of State where Contracted Counsel charges contingency fee only (No Travel Expenses), defined as Contracted Counsel’s “normal geographic area of practice.” (May be specified by county, city, etc.):

Ohio, Wisconsin, Kentucky, West Virginia, and Indiana.

States or areas of State where Contracted Counsel would accept collection matters only if travel expenses were paid in addition to contingency fee (may be specified by county, city, etc.).

N/A

QUALIFICATIONS OF KEY PERSONNEL

ATTACHMENT I

State of Arizona Office of the Attorney General2005 N Central AvePhoenix, AZ 85004

Qualifications and Experience of Key Personnel

Complete this section for the Key Personnel the Offeror is proposing. Key Personnel are the individuals showing the experience and expertise to do the work identified in this RFP. If an item is not applicable, indicate so by inserting “N/A.

Please copy this form as needed.

Keith D. Weiner President

Name of Individual Title Manager Consumer, Governmental & Commercial Debt Collection

Proposed Project Role Area(s) of Expertise 0029000 Ohio 1982

Bar Registration No. State of Issue Year

Bar Registration No. State of Issue Year Cleveland-Marshall College of Law, Cleveland State University

Juris Doctor 1982

Education Degree Year

Education Degree Year

How is this individual associated with the Offeror – e.g. Employee, Independent Contractor, etc.?

Keith D. Weiner is President & Chief Executive Officer of Keith D. Weiner & Associates Co., L.P.A.

Work History:

Founded Keith D. Weiner & Associates Co., L.P.A. in Cleveland, Ohio, in 1985.

Appointed Special Counsel to The Ohio Attorney General in 1994.

Firm has grown steadily since its inception. Firm handles all aspects of Creditors’ Rights Representation. (Bankruptcy, Commercial, Governmental & Consumer Debt Collection, Eviction, Foreclosure, Replevins, and any and all defensive creditor representation relating to those areas. The Firm expanded its footprint include the State of Wisconsin (2013), State of Kentucky (2018), State of West Virginia (2021), and soon expanding to the State of Indiana (late-2022, early 2023).

Any additional relevant training or experience:

In 2004 the Firm expanded its representation to include Ohio Municipalities. Currently the Firm proudly provides representation for over 20 of Ohio’s Cities and Villages located throughout the state ranging in populations from over 2,000 to 80,000. The firm was recently awarded a contract to represent Lexington-Fayette Kentucky which is the 2nd largest metropolitan area in the State. The firm has represented the State of Ohio as Special Counsel since 1994 and the State of Arizona since 2017.

REFERENCES

ATTACHMENT I

State of Arizona Office of the Attorney General2005 N Central AvePhoenix, AZ 85004

References

Provide a minimum of three references to which you have provided similar services.

Reference #1

Company: Office of the Ohio Attorney General Contact: Attorney General policy does not permit AG personnel to be references Street Address: 150 E. Gay Street, 21st Floor City, State, Zip: Columbus, Ohio 43215 Telephone #:

E-Mail:

Service Provided: Collections of all forms of delinquent taxes (Sales, Personal Income Tax, Withholding Tax, Net Profit

Tax. Also, miscellaneous worker’s comp claims, student loans, and destruction of state property.

Reference #2

Company: City of Parma, Ohio

Contact: Mike Mason, Tax Administrator Street Address: 6611 Ridge Road

City, State, Zip: Parma, Ohio 44129

Telephone #: (440) 885-8056

E-Mail: mmason@cityofparma-oh.gov

Service Provided: Collections of all forms of delinquent taxes. (Withholding, net profit, and personal income tax) The firm also provides the city with bankruptcy representation by filing and proof of claims necessary, and making sure the city’s taxes are prioritized correctly within the bankruptcy.

Reference #3

Company: City of Bedford, Ohio

Contact: Keith Laffin, Tax Collections Manager Street Address: 165 Center Road

City, State, Zip: Bedford, Ohio 44146

Telephone #: (440) 735-6508

E-Mail: Klaffin@bedfordoh.gov

Service Provided: Collections of all forms of delinquent taxes. (Withholding, net profit, and personal income tax) The firm also provides the city with bankruptcy representation by filing and proof of claims necessary, and making sure the city’s taxes are prioritized correctly within the bankruptcy.

ATTACHMENT II

Designation of Confidential, Trade Secret & Proprietary Information

State of Arizona Office of the Attorney General

Procurement Section 2005 N Central Ave

Phoenix, Arizona 85004 Solicitation No.:

Project #:

All materials submitted as part of a response to a solicitation are subject to Arizona public records law and will be disclosed if there is an appropriate public records request at the time of or after the award of the contract. Recognizing there may be materials included in a solicitation response that is proprietary or a trade secret, a process is set out in A.A.C. R2-7-103 (*bottom) that will allow qualifying materials to be designated as confidential and excluded from disclosure. For purposes of this process the definition of “trade secret” will be the same as that set out in A.A.C. R2-7-101(52).

This form must be completed and returned with the response to the solicitation and any supporting information to assist the State in making its determination as to whether any of the materials submitted as part of the solicitation response should be designated confidential because the material is proprietary or a trade secret and therefore not subject to disclosure.

All Offerors must select one of the following:

My response does not contain proprietary or trade secret information. I understand that my entire response will become public record in accordance with A.A.C. R2-7-C317.

My response does contain trade secret information because it contains information that:

1. Is a formula, pattern, compilation, program, device, method, technique or process, AND

2. Derives independent economic value, actual or potential, from not being generally known to, and not being readily ascertainable by proper means by, other persons who can obtain economic value from its disclosure or use; AND

3. Is the subject of efforts by myself or my organization that are reasonable under the circumstances to maintain its secrecy.

Please note that failure to attach an explanation may result in a determination that the information does not meet the statutory trade secret definition. All information that does not meet the definition of trade secret as defined by A.A.C. R2-7-101(52) will become public in accordance with A.A.C. R2-7-C317. The State reserves the right to make its own determination of Proposer’s trade secret materials through a written determination in accordance with A.A.C. R2-7-103.

If the State agrees with the proposer’s designation of trade secret or confidentiality and the determination is challenged, the undersigned hereby agrees to cooperate and support the defense of the determination with all interested parties, including legal counsel or other necessary assistance.

By submitting this response, proposer agrees that the entire offer, including confidential, trade secret and proprietary information may be shared with an evaluation committee and technical advisors during the evaluation process. Proposer agrees to indemnify and hold the State, its agents and employees, harmless from any claims or causes of action relating to the State’s withholding of information based upon reliance on the above representations, including the payment of all costs and attorney fees incurred by the State in defending such an action.

Signature of Person Authorized to Sign Printed Name

Title Company Name

*R2-7-103. Confidential Information A. If a person wants to assert that a person's offer, specification, or protest contains a trade secret or other proprietary information, a person shall include with the submission a statement supporting this assertion. A person shall clearly designate any trade secret and other proprietary information, using the term "confidential". Contract terms and conditions, pricing, and information generally available to the public are not considered confidential information under this Section.

B. Until a final determination is made under subsection (C), an agency chief procurement officer shall not disclose information designated as confidential under subsection (A) except to those individuals deemed by an agency chief procurement officer to have a legitimate state interest.

C. Upon receipt of a submission, an agency chief procurement officer shall make one of the following written determinations:

1. The designated information is confidential and the agency chief procurement officer shall not disclose the information except to those individuals deemed by the agency chief procurement officer to have a legitimate state interest;

2. The designated information is not confidential; or

3. Additional information is required before a final confidentiality determination can be made.

D. If an agency chief procurement officer determines that information submitted is not confidential, a person who made the submission shall be notified in writing. The notice shall include a time period for requesting a review of the determination by the state procurement administrator.

E. An agency chief procurement officer may release information designated as confidential under subsection (A) if:

1. A request for review is not received by the state procurement administrator within the time period specified in the notice; or

2. The state procurement administrator, after review, makes a written determination that the designated information is not confidential.

BPM004664

Michael S. Lewis

Keith D. Weiner & Associates Co., L.P.A.Compliance Attorney x

PARTICIPATION OF BOYCOTT ISRAEL State of Arizona Office of the Attorney General 2005 N Central Avenue Phoenix, AZ 85004SOLICITATION NO: Page

1 of 1PROJECT NO:

SPO Form 205 – Participation in Boycott of Israel (rev 10-2019)

Boycott of Israel Disclosure Please note that if any of the following apply to this Solicitation, Contract, or Contractor, then the Offeror shall select the “Exempt Solicitation, Contract, or Contractor” option below:

The Solicitation or Contract has an estimated value of less than $100,000;

Contractor is a sole proprietorship;

Contractor has fewer than ten (10) employees; OR Contractor is a non-profit organization.

Pursuant to A.R.S. §35-393.01, public entities are prohibited from entering into contracts “unless the contract includes a written certification that the company is not currently engaged in, and agrees for the duration of the contract to not engage in, a boycott of goods or services from Israel.”

Under A.R.S. §35-393:

1. "Boycott" means engaging in a refusal to deal, terminating business activities or performing other actions that are intended to limit commercial relations with entities doing business in Israel or in territories controlled by Israel, if those actions are taken either:

(a) Based in part on the fact that the entity does business in Israel or in territories controlled by Israel.

(b) In a manner that discriminates on the basis of nationality, national origin or religion and that is not based on a valid business reason.

2. "Company" means an organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, Limited Liability Company or other entity or business association, including a wholly owned subsidiary, majority-owned subsidiary, parent company or affiliate, that engages in for-profit activity and that has ten or more full-time employees.

5. "Public entity" means this State, a political subdivision of this State or an agency, board, commission or department of this State or a political subdivision of this State.

The certification below does not include boycotts prohibited by 50 United States Code Section 4842 or a regulation issued pursuant to that section. See A.R.S. §35-393.03.

In compliance with A.R.S. §§35-393 et seq., all offerors must select one of the following:

The Company submitting this Offer does not participate in, and agrees not to participate in during the term of the contract, a boycott of Israel in accordance with A.R.S. §§35-393 et seq. I understand that my entire response will become public record in accordance with A.A.C. R2-7-C317.

The Company submitting this Offer does participate in a boycott of Israel as described in A.R.S. §§35-393 et seq.

Exempt Solicitation, Contract, or Contractor

Indicate which of the following statements applies to this Contract:

Solicitation or Contract has an estimated value of less than $100,000;

Contractor is a sole proprietorship;

Contractor has fewer than ten (10) employees; and/or Contractor is a non-profit organization.

Printed Name Signature of Person Authorized to Sign

Company Name Company Address

BPM004664

Michael S. Lewis

Keith D. Weiner & Associates Co., L.P.A. 1100 Superior Avenue East, Suite 1100, Cleveland, Ohio 44114

Email your request to: WaiverRequests@azag.gov Copy to: Dawn Northup @ Dawn.Northup@azag.gov

Doc #: 7309290 (rev 9-2018)

STATE GOVERNMENT DIVISION

DAWN NORTHUP

DIVISION CHIEF COUNSEL

DIRECT PHONE NO. 602-542-8872

DAWN.NORTHUP@AZAG.GOV

REQUEST FOR A WAIVER OF CONFLICT FORM

Standard turnaround for a waiver is 5-7 business days.

Date of Request: Expedited Request:* Yes: No: Date Needed:

*If yes, please provide reason for exceptional circumstance:

Requesting Attorney: Email:

Firm on State Contract: Phone:

Firm Address:

Atty(s) involved in new representation:

State Agency(s) involved (be specific):

REPRESENTATION IN THE NEW MATTER:

Client(s):

Caption Matter:

Court (if any):

Case/ID Number:

Briefly describe your representation (attach copies of any documents relating to your waiver request (i.e., complaint, etc., if any):

To the extent that the firm expresses an opinion that no waiver is required, provide an explanation of the basis for that belief:

Please indicate whether any attorneys who will be working on the matter for which the waiver is sought were employed by AGO, the relevant State entity, or the Governor’s office within the previous 2 years. Additional sheets can be attached as necessary.

Is the firm currently representing any State agency(s), if so, please list any and all cases (include attorney(s) involved in the matter)

If the firm has represented the State in the last 2 years, please list any and all cases (include attorney(s) involved in the matter) and dates of representation:

mailto:WaiverRequests@azag.gov mailto:Dawn.Northup@azag.gov