Cal. Code Regs. tit. 10 § 2623.5
Name
Address
Telephone Number of Petitioner or Attorney
BEFORE THE INSURANCE COMMISSIONER OF THE STATE OF CALIFORNIA
| In the Matter of | ) | |||
| ) | ||||
| Insurance Company, | ) | Case No. | ||
| ) | ||||
| Applicant (or | ) | REQUEST FOR AWARD | ||
| Respondent). | ) | OF COMPENSATION | ||
| ) | ||||
____________________ hereby requests an award of compensation in the amount of ____________________ for its contribution in this proceeding. In the support of its request, ____________________ alleges:
I
On ____________________ (date) ____________________, (name of petitioner) was found eligible by the Insurance Commissioner to seek an award of compensation in Departmental proceedings.
II
On ____________________ (date), ____________________, (name of petitioner) filed a Notice of Intent to Seek Compensation in this matter.
III
___________________________
On
____________________
(date)
____________________
, the Commissioner issued a preliminary determination finding that
___________________________
___________________________
(and)
(if applicable)
On ____________________ (date) ____________________, Petitioner was given an interim award of ____________________ and ____________________ in this proceeding.
IV
A final decision by the Insurance Commissioner was issued in this proceeding on ____________________. This request is timely because it is submitted within 30 days of that day.
V
___________________________
__________
substantially contributed to the Insurance Commissioner's final decision in that
___________________________
VI
A detailed description of the services and expenditures of ____________________ in this proceeding are attached and made a part of this Petition and are summarized as follows:
reasonable advocacy fees of:
___________________________
___________________________
reasonable witness fees of:
___________________________
___________________________
other reasonable expenses of:
___________________________
___________________________
VII
___________________________
The amounts set forth in paragraph VI above are reasonable because
___________________________III
On ____________________ (date) ____________________, the Commissioner issued a preliminary determination finding that
___________________________
___________________________
VIII
_________________________'s presentation did not materially duplicate the contribution or presentation of any other party to the proceeding in that ____________________.
IX(If applicable)
Petitioner certifies that it has filed a request for attorney fees under the appropriate statutes in Civil Court (attach a copy).
WHEREFORE, ____________________ respectfully requests an award of compensation in the amount of ____________________ in this proceeding.
DATED:
Respectfully Submitted,
____________________
Signature
Cal. Code Regs. Tit. 10, § 2623.5
Note: Authority cited: Sections 1861.10, 12921 and 12926, Insurance Code. Reference: Section 1861.10(a), Insurance Code; and CalFarm Insurance Company, et al. v. George Deukmejian, et al., 48 Cal.3d 805 (1989).