Frank v. City of Pensacola Claim Form

Settlement Class Members who seek payment from the Settlement must complete and return this Claim Form one year from the Administrator’s completion of the Initial Notification Process.

Before you complete and submit this Claim, you should read and be familiar with the Notice of Proposed Class Action Settlement (“the Notice”) and the Settlement Agreement available on the documents page. Defined terms (with initial capitals) used in these General Instructions have the same meaning as set forth in the Settlement Agreement.

By filing a valid Claim, you may be eligible to be paid your Total Claim Entitlement Amount. To be eligible to receive payment, you must be a member of the Certified Class. The Certified Class is all natural gas customers of the City of Pensacola whose service address was/is located within the Pensacola city limits upon whom the City of Pensacola had imposed, and from whom the City of Pensacola collected Franchise Fees from August 6, 2011 (the “Class Period”).

Your Total Claim Entitlement Amount is the sum if your Claim Entitlement Amount and your Interest Enhancement Amount. Your Claim Entitlement Amount would be an amount equal to the sum of (i) the Net Settlement Amount ($12,600,000), multiplied (ii) by a fraction, the numerator of which is the total amount you were billed by the City of Pensacola for Franchise Fees since August 6, 2011, and the denominator of which is the Total Franchise Fees Billed to All Class Members ($12,366,732.92).

Certain information is needed to verify a Class Member’s entitlement to receive payment. Claim Forms must include the Class Member’s full name and address of service location. In addition:

• For the Class Members who are not business organizations (i.e., persons including sole proprietorships, general partnerships, and other business organizations which are not registered with the Florida Secretary of State), one of (a) driver’s license number, (b) last four digits of social security number, (c) date of birth, or (d) customer number.
• For those Class Members who are business organizations (i.e., business entities who are or were registered with the Florida Secretary of State): (a) federal employer identification number, (b) Consumer Certificate of Exemption (Florida Department of Revenue Form DR-14), or (c) customer number.