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STATEMENT OF QUALIFICATIONS AND EXPRESSION OF INTEREST
FISCAL YEAR COMMENCING JULY 1, 2016
Please answer all questions. Omission of an item may preclude you from being considered. Use
additional sheets if necessary. If you wish to provide additional information related to your
qualifications, please attach it.
1.
GENERAL INFORMATION
LAST NAME FIRST MIDDLE
OTHER NAMES USED
BUSINESS ADDRESS TELEPHONE NO. FACSIMILE NO.
CITY STATE ZIP CODE E-MAIL ADDRESS
2. LAW FIRM AFFILIATION(S) (from date of admission or 1996, whichever is later)
NAME AND LOCATION (CITY, STATE) OF LAW FIRM
FROM TO
PRESENT
3.
LEGAL EDUCATION
NAME OF LAW SCHOOL LOCATION (CITY, STATE) DEGREE RECEIVED
4.
JURISDICTIONS ADMITTED TO PRACTICE (Active Only)
JURISDICTION
DATE ADMITTED
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5.
RANGE OF HOURLY RATES
A. A
pplicant’s __________to____________
B. F
irm’s (if applicable)
i. Partne
rs ____
______to____________
ii. Associates __________to____________
iii. Paralegals __________to____________
6.
Would you consider a contingency fee contract? No Yes
7.
TYPES AND AMOUNTS OF COSTS CHARGED: ("Reasonable Costs" is an insufficient
response. Please enumerate and attach additional sheets if necessary.)
TYPES AMOUNTS
8.
UP TO THREE (3) AREAS OF PRACTICE IN WHICH YOU CONSIDER YOURSELF
PROFICIENT AND FOR WHICH YOU WISH TO BE CONSIDERED (See Notice to
Attorneys for areas of law.)
1.
2.
3.
O
n separate sheets of paper, for each area of practice listed in this question:
Estimate the total number of cases or matters handled;
Describe a representative sample of work performed. For each representative case or
matter described, indicate the client for whom work was performed, when work was
performed, the court in which appearances, if any, were made, and citations to reported
cases, as appropriate.
9.
Provide a list of previous contracts with RCUH, including the dates of the contracts, for the last 10
years (
if applicable).
10.
DIRECT OR INDIRECT CONFLICTS OF INTEREST.
Are you currently representing, or have you in the past represented, a party whose interest is/was adverse to
RCUH or the State of Hawaii?
No Yes*
(*If the answer is yes, on a separate sheet of paper, please identify the adverse matter(s) and the nature of your involvement.
CERTIFICATION BY APPLICANT:
I hereby certify that all statements in this application, including attachments, are true and correct to the
best of my knowledge as of the date of this statement.
Signature of Applicant Date
Email your Statement to: eyoda@rcuh.com, or deliver your Statement to: Research Corporation of the
University of Hawaii,1601 East-West Road, #4020, Honolulu, Hawaii 96848, Attn: Erin H. Yoda.