AUTHORITY TO REPRESENT AND CONTINGENCY FEE AGREEMENT

I, the undersigned client, do hereby retain and employ Justin Ziegler, P.L. as my attorney(s) to represent me in my claim for damages against______________________ or any other party, firm or corporation liable therefore, resulting from an accident that occurred on or about ________________.

I HEREBY AGREE to pay for the costs incurred by Justin Ziegler in prosecuting this claim and authorize them to undertake and/or incur such costs as they may deem necessary from time to time. These costs include, but are not limited to, such items as police reports, hospital and medical records, photographs, research, filing fee, costs of serving summonses and subpoenas, court reporters fees, jury list, exhibits, state records, investigation expenses, expert witness fees, including fees for medical testimony and fees for medical conferences. They will make every effort to keep these costs at an absolute minimum consistent with the requirements of the case. At the time the case is closed, an accounting will be made for all disbursements made in my case. As compensation for their services, I agree to pay my said attorneys from the proceeds of recovery the following fee:

a. Before the filing of an answer or the demand for appointment of arbitrators or, if no answer if filed or no demand for appointment of arbitrators is made, the expiration of the time period provided for such action:

1. 33-1/3% of any recovery up to $1 million; plus
2. 30% of any portion of the recovery between $1 million and $2 million; plus
3. 20% of any portion of the recovery exceeding $2 million.

b. After the filing of an answer or the demand for appointment of arbitrators or, if no answer is filed or no demand for appointment of arbitrators is made, the expiration of the time period provided for such action, through the entry of judgment:

1. 40% of any recovery up to $1 million; plus
2. 30% of any portion of the recovery between $1 million and $2 million; plus
3. 20% of any portion of the recovery exceeding $2 million.

c. If all defendants admit liability at the time of filing their answers and request a trial only on damages:

1. 33-1/3% of any recovery up to $1 million; plus
2. 20% of any portion of the recovery between $1 million and $2 million; plus
3. 15% of any portion of the recovery exceeding $2 million.

d. An additional 5% of any recovery after notice of appeal is filed or post judgment relief or action is required for recovery on the judgment.

After the attorney takes his contingency out of the gross proceeds of recovery, costs will then be subtracted and the client will net the balance.

If it is necessary for the attorney to make a claim for medical payments/expenses coverage, this amount will be added to the gross recovery above. IT IS AGREED and UNDERSTOOD that this employment is upon a contingent fee basis, and if no recovery is made, I will not be indebted to my attorneys for any sum whatsoever as attorneys fees. Any costs or expenses incurred on behalf of the client will still be owed. I hereby expressly grant power to the attorney to endorse and deposit in Trust any checks in my name, and authorize the attorney to deduct fees, costs, and expenses, and to pay all appraisal expenses from my share of the recovery. Any unpaid bills for services shall remain the client's obligation.

FEE DISPUTES

Any disputes between you and us as to charges for attorneys' fees, costs and interest, or as to the performance or breach of performance by JUSTIN ZIEGLER in its representation of you, shall be settled through binding arbitration by a Dade County attorney, certified by the Florida Supreme Court as a Circuit Civil Arbitrator who will listen to the presentation of both parties. The decision of the arbitrator shall be binding, final and conclusive and judgment on the award rendered by the arbitrator may be entered in any court having jurisdiction of the parties and subject matter. If the parties are unable to agree as to the selection of an arbitrator, the court will make the determination upon proper notice to the parties. Any and all fees and costs of the arbitrator shall be paid by you.

In the event of a fee dispute, enforcement of payment or the required arbitration procedure may be pursued by us, by the filing of a charging lien with the Civil Court. This means that the Court will have continuing jurisdiction to enforce payment of fees.

In the event it becomes necessary to enforce the terms of this Contract, through arbitration or otherwise, you agree to pay reasonable attorneys' fees and costs (whether taxable or not), in connection with the enforcement and collection proceedings, including fees and costs on appeal.

YOUR FILE

IT IS AGREED and UNDERSTOOD that the firm does not retain original client documents. At the conclusion of your case and following payment of our fees and costs, documents will be returned to you and the balance of your file will be destroyed after two years[1]. Copies of all documents received and generated by our office will be forwarded to you and it is suggested that you retain them.

THE UNDERSIGNED CLIENT HAS, BEFORE SIGNING THIS CONTRACT, RECEIVED AND READ THE STATEMENT OF CLIENT'S RIGHTS, AND UNDERSTANDS EACH OF THE RIGHTS SET FORTH THEREIN. THE UNDERSIGNED CLIENT HAS SIGNED THE STATEMENT AND RECEIVED A SIGNED COPY TO KEEP TO REFER TO WHILE BEING REPRESENTED BY THE UNDERSIGNED ATTORNEY(S).

THIS CONTRACT MAY BE CANCELLED BY WRITTEN NOTIFICATION TO THE ATTORNEY AT ANY TIME WITHIN 3 BUSINESS DAYS OF THE DATE THE CONTRACT WAS SIGNED, AS SHOWN BELOW, AND IF CANCELLED THE CLIENT SHALL NOT BE OBLIGATED TO PAY ANY FEES TO THE ATTORNEY(S) FOR THE WORK PERFORMED DURING THAT TIME. IF THE ATTORNEY(S) HAVE ADVANCED FUNDS TO OTHERS IN REPRESENTATION OF THE CLIENT, THE ATTORNEY(S) ARE ENTITLED TO BE REIMBURSED FOR SUCH AMOUNTS AS THEY HAVE REASONABLY ADVANCED ON BEHALF OF THE CLIENT.

It is AGREED and UNDERSTOOD that although Justin Ziegler shares office space with Dakota Securities International, Justin Ziegler is an organization completely separate and distinct from Dakota Securities International., and Justin Ziegler and Dakota Securities International share no relationship other than sharing office space. Dakota Securities International shall not be liable for any and/or all negligence on the part of Justin Ziegler.

DATED THIS ______ day of ____________________, 2007.

________________________________________
       CLIENT SIGNATURE

______________________________________
       PRINT NAME

The above employment is hereby accepted upon the terms stated above.

By:_____________________________________
       ATTORNEY

The file in your case, consisting of all pleadings, correspondence, transcripts and notes, belongs exclusively to this office and we are under no obligation to surrender the file to you or any other person. Two years following the conclusion of your case, you will be given the opportunity to retrieve the entire file, prior to its destruction.