Insurance Company, I will be credited with the amounts recovered.

5. Fees owed to these law firms are separate and apart from fees I may owe other
attorneys who have been previously or may later represent me. I shall be responsible
for the law firms’ fees for their work done, and said fee shall constitute a lien on any
recovery that I may make.

6. I further agree that I will fully cooperate with my attorneys in the prosecution of my
claim, and I will sign all necessary papers to properly prosecute this claim. I will appear
at the request of my attorneys for all depositions, medical examinations, hearings or
other appearances required in the proper presentation of my claim, and I will keep in
contact with my attorneys and advise them of my whereabouts at all times so that they
will be able to contact me when necessary.

AGREED AND UNDERSTOOD:

Attorney Client

Date Date
 STATEMENT OF CLIENT'S RIGHTS

Before you, the prospective client, arrange a contingency fee agreement with a lawyer, you
should understand this Statement of your rights as a client. This Statement is not a part of the actual
contract between you and your lawyer, but as a prospective client, you should be aware of these rights:

1. There is no legal requirement that a lawyer charge a client a set fee or a percentage of
money recovered in a case. You, the client, have the right to talk with your lawyer about the proposed
fee and to bargain about the rate or percentage as in any other contract. If you do not reach an
agreement with one lawyer you may talk with other lawyers.

2. Any contingency fee contract must be in writing and you have three (3) business days to
reconsider the contract. You may cancel the contract without any reason if you notify your lawyer in
writing within three (3) business days of signing the contract. If you withdraw from the contract within
the first three (3) business days you do not owe the lawyer a fee although you may be responsible for
the lawyer's actual costs during that time. If your lawyer begins to represent you, your lawyer may not
withdraw from the case without giving you notice, delivering necessary papers to you, and allowing
you time to employ another lawyer. Often, your lawyer must obtain court approval before withdrawing
from a case. If you discharge your lawyer without good cause after the three-day period, you may have
to pay a fee for work the lawyer has done.

3. Before hiring a lawyer, you, the client, have the right to know about the lawyer's
education, training and experience. If you ask, the lawyer should tell you specifically about his or her
actual experience dealing with cases similar to yours. If you ask, the lawyer should provide
information about special training or knowledge and give you this information in writing if you request
it.

4. Before signing a contingency fee contract with you, a lawyer must advise you whether
her or she intends to handle your case alone or whether other lawyers will be helping with the case. If
your lawyer intends to refer the case to other lawyers he or she should tell you what kind of fee sharing
arrangement will be made with the others lawyers. If lawyers from different law firms will represent
you, at least one lawyer from each law firm must sign the contingency fee contract.

5. If your lawyer intends to refer your case to another lawyer or counsel with other
lawyers, your lawyer should tell you about that at the beginning. If your lawyer takes the case and later
decides to refer it to another lawyer or to associate with other lawyers, you should sign a new contract
which includes the new lawyers. You, the client, also have the right to consult with each lawyer
working on your case and each lawyer is legally responsible to represent your interest and is legally
responsible for the acts of the other lawyers involved in the case.
 6. You, the client, have the right to know in advance how you will need to pay the
expenses and the legal fees at the end of the case. If you pay a deposit in advance for costs, you may
ask reasonable questions about how the money will be or has been spent and how much of it remains
unspent. Your lawyer should give a reasonable estimate about future necessary costs. If your lawyer
agrees to lend or advance you money to prepare or research the case, you have the right to know
periodically how much money your lawyer has spent on your behalf. You also have the right to decide,
after consulting with your lawyer, how much money is to be spent to prepare a case. If you pay the
expenses, you have the right to decide how much to spend. Your lawyer should also inform you
whether the fee will be based on the gross amount recovered or on the amount recovered minus the
costs.

7. You, the client, have the right to be told by your lawyer about possible adverse
consequences if you lose the case. Those adverse consequences might include money which you might
have to pay to your lawyer for costs, and liability you might have for attorney's fees to the other side.

8. You, the client, have the right to receive and approve a closing statement at the end of
the case before you pay any money. The statement must list all of the financial details of the entire
case, including the amount recovered, all expenses, and a precise statement of your lawyer's fee. Until
you approve the closing statement you need not pay any money to anyone, including your lawyer. You
also have the right to have every lawyer or law firm working on your case sign this closing statement.

9. You, the client, have the right to ask your lawyer at reasonable intervals how the case is
progressing and have these questions answered to the best of your lawyer's ability.

10. You, the client, have the right to make the final decision regarding settlement of a case.
Your lawyer must notify you of all offers of settlement before and after the trial. Offers during the trial
must be immediately communicated and you should consult with your lawyer regarding whether to
accept or reject a settlement.

11. If at any time, you, the client, believe that your lawyer has charged an excessive or
illegal fee, you, the client, have the right to report the matter to The Florida Bar, the agency that
oversees the practice and behavior of all lawyers in Florida. For information on how to reach The
Florida Bar, call 800-342-8060, or contact the local bar association. Any disagreement between you
and your lawyer about a fee can be taken to court and you may wish to hire another lawyer to help
resolve this disagreement. Usually fee disputes must be handled in a separate lawsuit.

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