Legal Assistance Request Form

    I hereby request that an Attorney for the Palm Beach County PBA investigate the following incident and provide the legal assistance necessary to obtain the relief sought.

    Personal Information

    Agency Information

    I am seeking representation from the Palm Beach County Police Benevolent Association, Inc. for either a Departmental Investigation, Grievance or a Will.

    PLEASE BE ADVISED, that pursuant to Palm Beach County PBA Legal Assistance Policies, only eligible members are entitled to legal assistance by PBA Attorneys.

    If, at any time, it is determined that an applicant for legal assistance is not a PBA member in good standing, legal assistance by the PBA Attorney will be terminated.

    I acknowledge receipt of this admonition and understand it. I further acknowledge receipt of the Palm Beach County PBA Legal Assistance Policies 6-1 and Florida PBA Policy IV(E) - LEGAL DEFENSE BENEFIT, copies of which can be found

    here, and agree to work cooperatively with my PBA Attorney or attorney in the handling of this matter.

    I have not retained any other attorneys regarding this matter. If I should at any time obtain private counsel in this matter I agree to immediately notify the PBA. I also understand that the PBA will withdraw from this matter and have no further responsibilities to represent me in his case.

    UNDERSTANDING YOUR RIGHTS TO REPRESENTATION BY THE ASSOCIATION - It is the policy of the PBA legal department to represent you in good faith, consistent with organizational policy, the duty of fair representation owed by the Association to you, applicable laws, regulations and ethical standards. Since the PBA is called upon to represent many members with differing and often conflicting interests, you need to be aware of the following aspects of your relationship with the PBA, your responsibility during legal representation, those of the PBA and its attorneys and the limits of your legal representation.
     
    First, as to your responsibilities during legal representation, it is your responsibility to assist us in gathering information, including the names of potential witnesses in this matter. This will allow us to determine the appropriate manner in which to proceed with your case, as well as examining the basic merits of your case. It will further assist us in advising you and Association representatives as to your chances of success, possible areas of settlement, and potential conflicts of interest which may exist.
     
    Second, you need to understand that your PBA attorney is representing you through and with the approval of the Palm Beach County PBA. The attorney does not have the independent authority to commit the Association to file grievances, submit matters to arbitration or initiate other legal proceedings on your behalf except with the permission of the Association consistent with the duty of fair representation owed by the Association to you or to take a position which is not consistent with positions and policies of the Association. What this means is by seeking representation from the Association, you have agreed that the Association has control over your case to the extent that it can require you to accept settlements or determine that a grievance or any other matter should go no further. You should also be aware that because the Association will be making these determinations, it is necessary and can be expected that information relating to your case and the merits of it may be communicated to its officers and representatives in order that they can make an informed decision as to how your case should be processed so they can meet their duty of fair representation. We wanted to make sure you understand this at the beginning of the process.
     
    Finally, as to the limits of your legal representation, you should be aware that PBA attorneys will not be able to assert legal positions on your behalf that conflict with positions of the Association as a whole or that of other members who have also sought the legal assistance of PBA attorneys and who may testify against you in this matter. If at any point in your legal representation it becomes apparent that a conflict of interest exists: we may attempt to resolve the conflict; you may be referred to independent outside counsel; or you may be denied continued legal representation. You will be notified if such a conflict is discovered and what action will be taken by the Association.
     
    I acknowledge receipt of this disclosure statement, agree to its terms and agree to work cooperatively with my PBA attorney in the handling of this matter.

    PALM BEACH COUNTY PBA LEGAL DEFENSE POLICY 6.1 - PLEASE BE ADVISED, that pursuant to Palm Beach County PBA Legal Defense Policy 6.1, only PBA members are entitled to legal assistance by PBA attorneys.
     
    If, at any time, it is determined that an applicant for legal assistance is not a PBA member in good standing, or was not a member in good standing at the time of the incident, legal assistance by a PBA attorney will be terminated and the PBA may exercise any and all legal remedies available to recoup the value of the legal assistance expended in your case.
     
    I acknowledge receipt of this admonition and understand it. I further acknowledge receipt of Palm Beach County PBA Legal Defense Policy No. 6.1 and Florida PBA Policy IV(E) - LEGAL DEFENSE BENEFIT, copies of which are herein attached.

    By selecting the "Submit" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual and/or handwritten signature on this Agreement. By selecting "Submit" using any device, means or action, you consent to the legally binding terms and conditions of this Agreement. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing. By selecting "Submit", you acknowledge receipt of these disclosures statement and agree to work cooperatively with my PBA Attorney in the handling of this matter.