Certificate Of Compliance For Pro Hac Vice Admission - Oregon Page 2
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Certificate of Compliance
In re: _____________________________ )
For Pro Hac Vice Admission
Name of Out-of-State Attorney
)
I, ______________________________________________________(print name), am an attorney in the State of _______________
and I intend to seek pro hac vice admission in accordance with ORS 9.241 and UTCR 3.170 in the following Oregon court action or
proceeding:
Case Name: ____________________________________________________________________
Court: _____________________________________________ Case No.: __________________
I certify that (check all that apply):
I am an attorney in good standing in the State of ___________________________, as evidenced by the attached good standing
certificate issued by the licensing authority in that state.
I am not subject to any pending disciplinary proceedings in any jurisdiction; or
I am subject to pending disciplinary proceedings in another jurisdiction, the nature and status of which are described in an
attachment to this certificate.
I intend to associate in the above-referenced action or proceeding with ________________________________, OSB No.
____________, an active member in good standing of the Oregon State Bar, who will participate meaningfully in the matter.
I will comply with applicable statutes, laws, and procedural rules of the State of Oregon; be familiar with and comply with
disciplinary rules of the Oregon State Bar; and submit to the jurisdiction of the Oregon courts and Oregon State Bar with respect to
acts and omissions occurring during my pro hac vice admission.
My private law practice activities in Oregon are covered by professional liability insurance substantially equivalent to the Oregon
State Bar Professional Liability Fund plan, as evidenced by the attached certificate of insurance coverage.
I agree, as a continuing obligation of pro hac vice admission, to notify the trial court promptly of any changes in my insurance
coverage, or my admission or disciplinary status in any other jurisdiction.
I will provide to the Oregon State Bar a copy of the order admitting me pro hac vice in the above-referenced matter when such an
order is granted. In the event pro hac vice admission is revoked for any reason, I will promptly notify the Oregon State Bar.
I submit $500 to the Oregon State Bar as payment of the pro hac vice fee established by ORS 9.241 and the rules of the Oregon
Supreme Court. I acknowledge that this fee is for a period of twelve months from the date of the Acknowledgment of Receipt issued
below, and that an additional fee of $500 will be required in order for me to continue my pro hac vice admission in the matter for
every twelve-month period thereafter.
Dated this __________________ day of____________________, 20 ____.
X____________________________
___________________ Bar No.: _____________
(Applicant Signature)
(Home Jurisdiction)
Mailing Address:______________________________
Phone: __________________________________
______________________________
FAX: __________________________________
______________________________
Email: __________________________________
_________________________________________
Acknowledgment of Receipt
As Director of Regulatory Services of the Oregon State Bar, I acknowledge receipt from the above-named out-of-state attorney of the
Certificate of Compliance for Pro Hac Vice Admission and attachments, and the $500 fee for pro hac vice appearance in the above-referenced
Oregon action or proceeding. The fee is for a period of twelve months from the date of this acknowledgment.
Dated this ________________ day of____________________, 20 ____.
SEE MATERIALS ATTACHED:
_______________________________________________________
Dawn Evans, Director of Regulatory Services
Oregon State Bar Regulatory Services, PO Box 231935, Tigard, OR 97281-1935
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