2023A-14580-NPC-ROC Notice of Hearing and Packet MAILED

2023A-14580-NPC-ROC · Registrar of Contractors · 2024-02-21

REGISTRAR OF CONTRACTORS OF THE STATE OF ARIZONA

JD's Pumping LLC, Case No. 2023-14580 COMPLAINANT, Docket No. 2023A-14580-NPC-ROC v. NOTICE OF HEARING ON CONTESTED CASE The Construction Zone Ltd License No. ROC 213542,

RESPONDENT.

This Notice of Hearing is issued under A.R.S. § 41-1092.05(D). HEARING INFORMATION The hearing is set for: April 8, 2024 1:00 PM Velva Moses-Thompson Google Meet. A link will be provided directly from The Office of Administrative Hearings. Go to www.azoah.com to request to appear in-person.

If you have requested to appear in-person at the hearing, the hearing will be held at 1740 W Adams Street, Phoenix, AZ 85007.

You must attend this hearing. This is an adversarial hearing before an administrative

law judge, and is conducted in a similar manner as judicial proceedings. Thus, you must be

prepared to present evidence, including witness testimony and documents, in support of your case.

STATEMENT OF LEGAL AUTHORITY AND JURISDICTION The State of Arizona has determined that the licensing and regulation of construction contractors is a proper state function, and has vested authority in the Registrar of Contractors to administer Title 32, Chapter 10 of the Arizona Revised Statutes. A.R.S. §§ 32-1101 et seq. All hearings for alleged violations of Title 32, Chapter 10 are conducted under Title 41,

Chapter 6, Article 10. A.R.S. § 32-1156.

The statutes and rules governing the hearing can be found at: Arizona Revised

Statutes §§ 41-1092 to -1092.12, and Arizona Administrative Code R2-19-101 to -122.

PARTICULAR ARIZONA STATUTES AND RULES INVOLVED The statutes and rules the Respondent is alleged to have violated are cited in the

complaint and citation, which were served on the Respondent on January 26, 2024. SHORT AND PLAIN STATEMENT OF THE MATTERS ASSERTED The complaint and citation allege that the Respondent committed the following act(s): Charge: 1 A.R.S. § 32-1154(A)(10)

THE PARTIES TO THE ADMINISTRATIVE HEARING Because Respondent is a licensee and is charged with an act(s) or omission(s) that is cause for the suspension or revocation of a license, Respondent is a party to this case and will be a party to the hearing.

Because Complainant alleged Respondent committed an act(s) or omission(s) that is cause for the suspension or revocation of a license, Complainant is a party to this case and will be a party to the hearing. Respondent and Complainant, as the parties to the hearing, will present evidence and argument to the administrative law judge.

RIGHT TO BE REPRESENTED The parties to the administrative hearing may choose to be represented by an attorney.

A.R.S. § 41-1092.07(B). If one of the parties is a company, the company may be represented

by an officer or employee if that person satisfies the conditions set forth in A.R.S. § 32-

1156(B).

CHANGE OF ADDRESS Each party must inform the Registrar and the Office of Administrative Hearings of

any change of address within five (5) days of the change. A.R.S. § 41-1092.04. HEARING PROCEDURES AND RULES The administrative hearing will be conducted in accordance with A.R.S. §§ 41-1092 to -1092.12, and A.A.C. R2-19-101 to -122. The parties should review the statutes, rules, and processes governing the administrative hearing. Copies of the statutes, rules, and articles regarding the administrative hearing process can be found at https://www.azoah.com/.

REGISTRAR’S APPEARANCE BY VIDEO CONFERENCE OR TELEPHONE

The Registrar’s investigators, employees, and attorneys will appear at the hearing via

video conference or telephone unless requested by a party to appear in-person. Requests for

the Registrar’s investigators, employees, or attorneys to appear in-person must be filed with the Registrar and the Office of Administrative Hearings no later than seven (7) calendar days prior to the hearing date.

HEARING PACKET In the interests of administrative efficiency, the Registrar compiles and discloses certain documents to the parties and the Office of Administrative Hearings. These documents are attached to this Notice of Hearing as the “Hearing Packet.” If any party wishes to submit

additional evidence, they must do so during the hearing after completing a disclosure

statement. See “Disclosure Statement” section below.

SUBPOENAS FOR TESTIMONY FROM A WITNESS OR DOCUMENTS The parties to the hearing must be prepared to present evidence in support of their case. If a party wants to obtain testimony from a witness or documents not in the party’s possession, the party must prepare and file a written subpoena for the Administrative Law Judge to review and sign, if approved. A.R.S. § 41-1092.07(C). Forms for requesting a

subpoena can be found on the Office of Administrative Hearings’ website at www.azoah.com.

The party seeking a subpoena must serve notice on all the parties to the hearing, and on the

Registrar. A.R.S. § 41-1092.04.

DISCLOSURE STATEMENT At least seven calendar days before the hearing, each party must prepare and serve a

disclosure statement on all other parties, and file it with the Office of Administrative Hearings. A.A.C. R4-9-118; A.A.C. R2-19-108. The disclosure statement must include any exhibit the

party will use at the hearing. A party’s failure to timely disclose any witness or exhibit, without good cause, may result in the administrative law judge excluding those witnesses or exhibits from being used at the hearing. A.A.C. R4-9-118(C). A sample disclosure form is available on the Registrar’s website at https://roc.az.gov/forms/RC-L-800A%20- %20Prehearing%20Disclosure%20Statement%2020191007v4.pdf

CHANGING THE HEARING DATE

The date of the hearing may only be advanced or delayed on the agreement of the

parties or on a showing of good cause. A.R.S. § 41-1092.05(C). The date of the hearing may

be changed by filing a written agreement of the parties to change the date of the hearing. The written agreement must be filed with the Office of Administrative Hearings, directed to the assigned Administrative Law Judge, and transmitted to the Registrar and all other parties. The assigned Administrative Law Judge may be found on the Office of Administrative Hearings’ web portal at www.azoah.com If a party would like to move the date of the hearing without agreement of all parties, the party must file a written motion with the Office of Administrative Hearings, directed to the assigned Administrative Law Judge, and transmit a copy to the Registrar and all other parties. The motion must state in detail good cause for why the date of the hearing should be advanced

or delayed, and the position of all other parties regarding the advancement or delay.

A party may also file a motion asserting a right to an expedited hearing upon a showing of

extraordinary circumstances or the possibility of irreparable harm. A.R.S. § 41-1092.05(E).

RESOLUTION SHORT OF ADJUDICATION In any case which is resolved or settled by the parties, or which is withdrawn by the Complainant without objection from Respondent after the Notice of Hearing is issued, the parties must notify the Office of Administrative Hearings of the resolution or settlement. Any such cases will be listed on the Registrar’s website and its records under the category: “Closed Complaints – Resolved/Settled/Withdrawn.”

Dated February 20, 2024.

By: /s/ Erika Hoskin Erika Hoskin Legal Secretary Legal Department Arizona Registrar of Contractors

Copy mailed via USPS First Class mail February 20, 2024 to: Respondent(s) The Construction Zone Ltd 1729 E Osborn Rd Phoenix, AZ 85016

Complainant(s) JD's Pumping LLC 4850 Ramada Dr Prescott, AZ 86301

Copy sent electronically this same date to:

Respondent at email address on record with the Registrar Complainant at email address on record with the Registrar

Case No. 2023-14580 /

Katie Hobbs, Governor Martin Quezada, Director

Hearing Packet FAQ What is the Hearing Packet?

The Hearing Packet is a packet of certain documents collected or issued by the Registrar over the course of its investigation.

Who gets the Hearing Packet?

The Hearing Packet is assembled and distributed to all parties and to the Office of Administrative Hearings (“OAH”) prior to an administrative hearing.

What types of cases does the Registrar prepare a Hearing Packet for?

The Registrar prepares a Hearing Packet for Complainant-Handled Cases and No-Pay Cases. Note: If the Docket Number on the Notice of Hearing contains a “CHC” or “NPC”, your case is a Complainant-Handled Case or a No-Pay Case.

What is in the Hearing Packet?

The Hearing Packet contains essential case-specific documents and at a minimum will include the following documents:

● Original complaint;

1700 W. Washington Street, Suite 105 · Phoenix AZ 85007-2812 602.542.1525 · Within AZ 877.692.9762 · Fax 602.542.1599 · roc.az.gov Hearing Packet FAQ

Katie Hobbs, Governor Martin Quezada, Director

● Citation; and ● Answer.

The Hearing Packet will also contain the following documents (if applicable):

● Jobsite inspection notices, notes, and photos; ● Written directives; and ● Compliance inspection notices, notes, and photos.

What if there are documents missing from the Hearing Packet?

If there is any evidence you submitted to the Registrar that are not included in the Hearing Packet it is your responsibility to introduce that evidence at the administrative hearing. Note: The administrative law judge assigned to your case does not have access to the entire Registrar record.

If there is additional evidence you submitted to the Registrar during the investigation that you also want to introduce as evidence during your hearing, it is your responsibility to:

● Properly disclose that evidence to the other party; and ● Introduce the evidence during your hearing.

1700 W. Washington Street, Suite 105 · Phoenix AZ 85007-2812 602.542.1525 · Within AZ 877.692.9762 · Fax 602.542.1599 · roc.az.gov Hearing Packet FAQ

Katie Hobbs, Governor Martin Quezada, Director

How do I disclose evidence I intend to use at a Hearing?

You must properly disclose any and all documents and witnesses you intend to use at your hearing according to the Registrar’s Prehearing Disclosure Rules. See Arizona Administrative Code Section R4-9-118.

A sample prehearing disclosure form and instructions are provided to the parties by the Registrar.

How do I obtain documents I previously submitted to the Registrar?

If you previously submitted documents to the Registrar and need a copy of these documents, please contact the Registrar’s Legal Department or submit a public records request at https://roc.force.com/AZRoc/s/roc-public-request.

1700 W. Washington Street, Suite 105 · Phoenix AZ 85007-2812 602.542.1525 · Within AZ 877.692.9762 · Fax 602.542.1599 · roc.az.gov Hearing Packet FAQ

January 5, 2024

Via U.S. Mail and Email

Complainant JD's Pumping LLC 4850 Ramada Dr. Prescott, AZ 86301

Via U.S. Mail and Email

Respondent The Construction Zone Ltd 1729 E Osborn Rd Phoenix, AZ 85016

Re: Complaint No. 2023-14580

Dear Complainant and Respondent:

The Registrar received a complaint filed against The Construction Zone Ltd for non-payment of materials or services rendered. This complaint is complete and will be substantively reviewed by the Registrar.

Respondent is free to raise any issue or affirmative defense to this complaint by filing a response with the Registrar by January 12, 2024. Please reference the complaint number listed above if you file a response. Respondent may file a response by:

Mail: P.O. Box 18244, Phoenix, Arizona, 85005-8244 In-Person: 1700 W. Washington St., Ste. 105, Phoenix, Arizona, 85007-2812 Email: [email redacted]

The Registrar will not issue a citation before January 12, 2024 and will review Respondent’s response, if one is submitted.

Please be advised that a response to the complaint is not the same as a written answer. If the Registrar issues a citation Respondent must file a written answer to that citation in accordance with A.R.S. § 32-1155.

Sincerely,

/s/ Tedi Quezada ___________________

1700 W. Washington Street, Suite 105 · Phoenix AZ 85007-2812 602.542.1525 · Toll Free 877.692.9762 · roc.az.gov Lg100 4/21 Tedi Quezada Legal Department 1700 W Washington St. Ste 105 Phoenix, AZ 85007

1700 W. Washington Street, Suite 105 · Phoenix AZ 85007-2812 602.542.1525 · Toll Free 877.692.9762 · roc.az.gov Lg100 4/21 Received by Investigations 12/26/2023 2023-14580 Received by Investigations 12/26/2023 2023-14580 Received by Investigations 12/26/2023 2023-14580 Received by Investigations 12/26/2023 2023-14580 Received by Investigations 12/26/2023 2023-14580 Received by Investigations 12/26/2023 2023-14580 0121345ÿ4789ÿ ÿÿÿ ÿÿÿÿ338042Received Legal 01/05/2024 ;<=>?ÿA<BÿC>D?ÿEÿFGHIJÿK?<=>?L<BM>D?NOPQR>SR=PTU

JPMV? > 0ÿ!!" DLW ÿAPR ÿXYXZE [\]^Y CDQ_><?ÿ̀OPT<aÿb#c #!2#6#d e5ÿfÿ5ÿ334ÿÿ87ÿ g7ÿh".c#"9hÿb".c#"9d #7ÿ6iÿ-i!ÿb6ic #!2#6#d5ÿh06!2"c9#hÿb06!2"c9#d5 hf6!2"#c9#hÿbf6!2"#c9#d ÿ(265ÿ +ÿ9ÿ #6ÿ ÿ&!6j!ÿ!!ÿÿÿÿ338042ÿ !ÿ9.ÿ6ÿ##ÿÿ.ÿiÿ*2!! g 4ÿi25

klmnÿpqrsÿtrutvwÿvtqx yztpw{|}ÿqv{~twqÿ€k‚ ƒ ‚mÿ‚nmÿnknn t ‚mÿm„ÿ„„ # #

\ÿ>WW>Q_M<LWa JPMV?>DLWÿAPRÿXYXZE[\]^YÿH<aVPL†<LWÿO<aVPLa<RV†‡ 024) Y^RZYRXZÿB<??ÿ†>M>=<ÿˆHÿO<VPOWRV†‡ 3‰40) BDWL<aaÿaW>W<M<LWaRV†‡ 8‰7) ‡?>=aW>‡‡ÿO<WO<>WŠÿY‹RY]RXZÿB<??ÿ†>M>=<ÿO<V>DOÿDLTPDQ<ÿXRV†‡ 283)

!711""#11$1%&'&( # )*3 %+',)-*9./.01+4) ))0'121134568$6789.58!#58: 010 Received Legal 01/05/2024 Received Legal 01/05/2024 Received Legal 01/05/2024

TRANSMITTAL VIA: email, certified mail DATE: 30 August 2023 TO: Bob Ramsey, Silverleaf Insurance RE: Flagstaff Retreat

REMARKS:

Bob, I am writing this letter to follow up on our phone conversation yesterday and provide notice of damage which occurred on August 29, 2023, during ongoing construction work. The property owned by CZ7 llc located at 5451 south Cassandra boulevard, Flagstaff, AZ 86005 is covered by a Builders Risk policy issued by your office. The damage is primarily to the onsite well that was installed in July of this year. The well was installed by Drill Tech, Incorporated. On August 29, 2023, concrete was being placed on north edge of construction site adjacent to the utilities, including well head location. The utility area was partitioned off from concrete work area entrance by large logs creating an entry path. The concrete work required the use of a concrete pump truck supplied by JD’s Pumping LLC. and delivery trucks from concrete material supplier, Arrow Redi-Mix, incorporated. The concrete pump truck was positioned at the end of the entry path next to a sport court where work was occurring. The concrete pump truck pulled in forward facing sport court while concrete delivery trucks would back in to unload concrete into pump truck. After final concrete delivery truck finished unloading into pump truck, the concrete delivery truck pulled forward out of work area entry path. The concrete delivery truck and concrete placement workers then went to the guest house just south of sport court area to continue additional concrete work. The concrete pump truck began lowering boom, cleaning out lines and packing the truck up to remove from site. At approximately 12:00-12:15 pm the concrete boom truck then proceeded to back out of the work area and the driver veered off the entry access path pushing the logs partitioning the utilities under the truck which then became got lodged under the truck frame and tires. The concrete pump truck continued backing up, rolling over the log partitions striking the well head which sat 12” above grade. This severally damaged well head. The incident and damage were witnessed by two workmen placing the concrete, Juan Lopez and Juan Hernandez. They stated they saw the concrete pump truck over the well head and the concrete pump driver removing logs from under truck. The concrete pump truck driver then got back in truck pulled forward to correct truck path, then backed up down access path out of work area. The concrete placement workers confronted driver of pump truck about incident where he apologized about hitting logs and going off path. Daniel Pappalau, site superintendent employed by The Construction Zone, ltd, returned to site right after incident unaware of the incident or damage. The concrete pump truck driver had parked away from incident area at far end of round about driveway. He was given an invoice for the work by the concrete pump driver, which he signed, and the truck driver left. Concrete placement workers then informed him of the incident and damage to the well. Daniel proceeded to call the pump truck supervisor at JD’s Pumping LLC to notify them of the incident and damage. Daniel was told they would Received Legal 01/05/2024

take care of any damage that occurred. Daniel then called me and Drill Tech to inform us of the incident. The pump truck driver returned to site at this time on foot examining extent of damage. He quickly walked offsite before Daniel could discuss the incident with him. Daniel proceeded to document the damage. Photographs taken by Daniel at that time clearly show tire tracks from concrete pump truck heading straight trough log partition into well head. Th photographs also include the tracks of concrete delivery trucks which followed the entry path and did not cross the utilities or well site. A representative from Drill-Tech is scheduled today to inspect the damage and provide an assessment of the repair and /or replacement required.

I have provided the contact information for all parties involved below.

Concrete Pump Truck JD’s Pumping LLC. 3275 pleasant view drive P.O. Box 26214 Prescott Valley, AZ 86312 (928) 713-3788 [email redacted]

Concrete Material Delivery Arrow Readi-Mix, inc. P.O. Box 2910 Flagstaff, AZ, 86003 (928) 522-9388

eyewitnesses Juan Hernandez (602) 332-0717 Juan Lopez (480) 843-1595

site superintendent Daniel Pappalau (602) 509-9496

Drill Tech inc. 3320 N HWY89 Chino Valley, AZ, 86323 (928) 636-8006

Please contact me with any questions.

Respectfully,

Andy Byrnes, AIA Received Legal 01/05/2024 Received Legal 01/05/2024 Received Legal 01/05/2024 Received Legal 01/05/2024

TRANSMITTAL VIA: email, fax -[number redacted] DATE: 5 January 2024 TO: Arizona Registrar of Contractors RE: Complaint #2023-06690

REMARKS:

The Construction Zone, LTD has received a complaint from the Registrar of Contractors, complaint #2023-14580. The Construction Zone has filed an insurance claim against the complainant for substantial damage to Owner’s property due to their negligence at the Job Location indicated on the invoices. The Construction Zone has repaired and paid for the damage and is awaiting reimbursement from JD’s Pumping, LLC. A copy of the incident report was sent to complainant on 8 August 2023 and is attached to this letter along with the repair invoice totaling $51,319. The Construction Zone has withheld payment as permitted by Arizona Statute 32-1138 subsection C, 7 and will pay the invoices attached to the complaint in full after reimbursement from JD’s Pumping, LLC or their insurance for the damage due to their negligence. The Construction Zone, LTD. would like this complaint completely expunged from the records of our license. Please let me know if there is any additional information required of The Construction Zone, LTD. I have copied Jesse Heck, JD’s Pumping, llc, on the email of this letter.

Thank you for your attention to this matter.

Please contact me at the office or on my mobile, (602) 692-9199, with any questions.

Respectfully,

Michael Groves, CFO Received Legal 01/05/2024

 $ $ #$"

quot;$  

$ #"!$   %$  #

quot;%$  &"!"#!"  #$$     $( #$#'  

( % "( %"%### $ $    Received Legal 01/05/2024 flagstaff retreat well repair 9/5/23 5451 south cassandra boulevard, flagstaff, az 86005 based on incident report dated 8/30/2023 ARCHITECT / CONTRACTOR: The Construction Zone, Ltd.

task trade info description budget subtotal

1500 temporary facilities water (4) 2000 gallon water deliveries to existing storage tank $ 400 material protection site clean up / temporary protection after damage $ 1,520 mitigation delay, assist in damage control / reporting / eyewitness reports $ 300 subtotal $ 2,220 15400 domestic well well repair and replacement based on Drill Tech estimate #11692 $ 39,282 subtotal $ 39,282 17000 general conditions by owner gc permits / city fees / review fees / inspection fees gl / insurance $12/$1000 $ 610 subtotal $ 610 17100 fees complete contracting services for scope listed above $ 6,317 subtotal $ 6,317 17100 taxes taxes state of az/city of flagstaff $ 2,890 subtotal $ 2,890

total estimated cost $ 51,319 $ 51,319 Received Legal 01/05/2024 B9 *538 3    $ GI ,1 5I 0 #

$ ( ""* 0 #

##

* $)*( * $ 0 $ "* " )* "" - "" ** $ / /($ ) ) )) $ ( ", ) ($ ( & . 0

#

( "

#

)* # * * ( & ( # * - "" & #& &# $* # * ( ")

BE 46 C ) ) * # D B BE 46 C & , * F5 ) . B @ &9@5 * 853 ,1 F5 , E3D9 5 B * 5B # 9D B 9C381B75 4I * 5B # 9D B &9D 5CC 1@ * )E23C2 5 * #9C3 -9B5 1 4 @ E 29 7 * H31F1D B (5 D1 CD9 1D54 "12 B D 5H31F1D5 @9D 5CC F945 1 4 4917 C5 * CD9 1D54 "12 B D 69C8 1 4 B5 F5 @E @ CICD5 * CD9 1D54 "12 B D 9 CD1 &9D 5CC 1 4 213 69 * CD9 1D54 "12 B D 9 CD1 5G @E @ CICD5 *

"12 B -9 5 9 54 1D 3DE1 *9 5 9 3EBB54 CD9 1D5 12 B 9C 6 B 1 1 3B5G 6 1449D9 1 3B5G 9C B5AE9B54 B G9 25 14:ECD54 133 B49 7 I

   5CD9 1D5C 1B5 CE2:53D D 381 75 21C54 3EBB5 D 1B 5D @B939 7 1 4 E 5H@53D54 381 75C 4B9 9 7 3 49D9 C *89C 9 3 E45C 2ED 9C D 9 9D54 D 13DE1 45@D8 4B9 54 1D5B91 C     5AE9@ 5 D EC54 D 3 @ 5D5 G5 D 69 1 45@D8 $5G @E @ CICD5 5CD9 1D5C 1B5 6 B 5CD9 1D9 7 @EB@ C5C I 1 4 1B5 21C54 D85 5CD9 1D54 45@D8 6 D85 G5 G9D8 1 5CD9 1D54 @B 4E3D9 6 1D 51CD &# ECD 5B 9C B5C@ C92 5 6 B 1 3 CDC 9 3EBB54 9 4B9 9 7   5AE9@@9 7 6 G5 D 9DC 69 1 45@D8 B D5B 9 1D9 6 D85 @B :53D 2I 59D85B @1BDI B9 *538 9C D B5C@ C92 5 6 B 41 175C 31EC54 D 3ECD 5BC @B @5BDI 4E5 D G51D85B E 6 B5C55 B 5HD5 E1D9 7 39B3E CD1 35C 9 3 E49 7 4B9 3EDD9 7C 4ECD E4 B BEDC

GGG 4B9 D5381 3 REGISTRAR OF CONTRACTORS OF THE STATE OF ARIZONA

Case No. 2023-14580 JD's Pumping LLC,

COMPLAINANT, v. CITATION The Construction Zone Ltd License No. ROC 213542,

RESPONDENT.

The Registrar issues this Citation to The Construction Zone Ltd (“Respondent”) under

A.R.S. § 32-1155(A). If Respondent fails to answer this Citation by February 10, 2024, then under A.R.S. § 32-1155(C), Respondent’s failure to answer may be deemed an admission of the

act or acts charged in the underlying complaint, and the Registrar may then suspend or revoke

Respondent’s license(s).

THE WRITTEN COMPLAINT

On December 26, 2023, JD's Pumping LLC (“Complainant”) filed a written complaint

with the Registrar. A copy of that Complaint is attached to this Citation.

A FORMAL STATEMENT OF THE CHARGES AGAINST RESPONDENT

The Registrar investigated this matter and finds cause to charge Respondent with

violation(s) of Title 32, Chapter 10 of the Arizona Revised Statutes. Respondent is charged

with violating:

Charge :1 A.R.S. § 32-1154(A)(10) — Failure by a licensee or agent or official of a licensee to pay monies in excess of $750 when due for materials or services rendered in connection with the licensee's operations as a contractor unless the

of 5

1700 W. Washington Street, Suite 105 · Phoenix AZ 85007-2812 602.542.1525 · Toll Free 877.692.9762 · roc.az.gov Lg101 8/21 licensee proves that the licensee lacks the capacity to pay and has not received sufficient monies as payment for the particular construction work project or operation for which the services or materials were rendered or purchased.

If the matter proceeds to a hearing and the administrative law judge determines that any of the charges listed above are supported by a preponderance of the evidence, then Respondent’s license(s) may be subject to suspension or revocation, and Respondent may be subject to other penalties provided by law, including civil penalties under A.R.S. §§ 32-1154(E) and (F). FILING A WRITTEN ANSWER Respondent must appear by filing with the Registrar a written answer to the citation and complaint showing cause, if any, why Respondent’s license(s) should not be suspended or revoked. A.R.S. § 32-1155(A). Respondent’s written answer should contain the heading “Written Answer to Citation and Complaint” and should include the case number, which is Case No. 2023-14580. How to File a Written Answer: Respondent’s written answer may be submitted in the following ways: In-Person: 1700 W. Washington St., Ste. 105, Phoenix, Arizona, 85007-2812 Mail: P.O. Box 18244, Phoenix, Arizona, 85005-8244 Email: [email redacted] The Registrar’s normal office hours are 8:00 a.m. to 5:00 p.m., Monday through Friday. If Respondent submits a written answer by mail, it is not filed with the Registrar until the Registrar actually receives it. Deadline for Filing a Written Answer: Respondent must file a written answer with the Registrar no later than February 10, 2024. This deadline is calculated under A.R.S. §§ 32-1155(A) and (B), which provides a

of 5

1700 W. Washington Street, Suite 105 · Phoenix AZ 85007-2812 602.542.1525 · Toll Free 877.692.9762 · roc.az.gov Lg101 8/21 deadline ten days after service of the Citation. Service of the Citation and Complaint is complete five days after the Registrar mails a copy of the Citation and Complaint to Respondent’s latest address of record in the Registrar’s office. Consequences for Failing to File a Written Answer: If Respondent fails to answer, Respondent’s failure may be deemed an admission of the act or acts charged in the written complaint. A.R.S. § 32-1155(C). The Registrar may then suspend or revoke Respondent’s license(s). THE ADMINISTRATIVE HEARING If Respondent files a timely written answer contesting any charges in the Complaint, then the Registrar will request the Office of Administrative Hearings set a date for an administrative hearing and will notify all the parties at least 30 days before that hearing. A.R.S. § 41-1092.05(D). RESPONDENT’S RIGHT TO REQUEST AN INFORMAL SETTLEMENT CONFERENCE Under A.R.S. § 41-1092.06, if Respondent submits a request to the Registrar for an informal settlement conference, the Registrar must hold a conference within 15 days after receiving the request. Respondent’s request for an informal settlement conference must be in writing and must be filed no later than 20 days before the administrative hearing. A.R.S. § 41- 1092.06(A). The Registrar will not close or settle any case without both parties’ appearance at the Settlement Conference. The parties participating in the settlement conference must have the authority to settle the case and must waive their right to object to the participation of the Registrar’s settlement conference representative in the final administrative decision. A.R.S. § 41-1092.06(B). Any statements, either written or oral, made by the parties at the conference, including a written document, created or expressed solely for the purpose of settlement negotiations, are

of 5

1700 W. Washington Street, Suite 105 · Phoenix AZ 85007-2812 602.542.1525 · Toll Free 877.692.9762 · roc.az.gov Lg101 8/21 inadmissible in the administrative hearing. A.R.S. § 41-1092.06(B). RESPONDENT’S PRIOR RECORD Under A.A.C. R4-9-117, in determining the appropriate discipline, the administrative law judge and the Registrar may consider not only facts in the current case, but also facts in prior cases and any documents regarding Respondent on file with the Registrar. Respondent’s prior disciplinary record and current license(s) status may be considered as a mitigating or aggravating factor in determining the appropriate discipline. EVIDENTIARY DISCLAIMER By issuing this Citation, the Registrar is directing Respondent to file a written answer to the Citation and Complaint, showing cause, if any, why Respondent’s license(s) should not be suspended or revoked. A.R.S. § 32-1155(A). This Citation does not constitute proof that any charge or allegation in Complainant’s written complaint is in fact true. This Citation does not constitute proof that Respondent violated any statutory provision or rule adopted by the Registrar. Dated January 26, 2024. By: /s/ Robert Stirling Robert Stirling Assistant General Counsel Legal Department Arizona Registrar of Contractors COPY of the foregoing mailed by Certified Mail, Return Receipt Requested, January 26, 2024 to:

Respondent Certified Mail No: [number redacted]

The Construction Zone Ltd 1729 E Osborn Rd. Phoenix, AZ 85016 Copy mailed by USPS First Class mail this same date to: of 5

1700 W. Washington Street, Suite 105 · Phoenix AZ 85007-2812 602.542.1525 · Toll Free 877.692.9762 · roc.az.gov Lg101 8/21 Respondent The Construction Zone Ltd 1729 E Osborn Rd Phoenix, AZ 85016

Complainant JD's Pumping LLC 4850 Ramada Dr. Prescott, AZ 86301 Copy sent electronically this same date to: Respondent at email address on record with the Registrar Complainant at email address on record with the Registrar Case No. 2023-14580/tq

of 5

1700 W. Washington Street, Suite 105 · Phoenix AZ 85007-2812 602.542.1525 · Toll Free 877.692.9762 · roc.az.gov Lg101 8/21 Received 1/17/2024 ROC Legal Received 1/17/2024 ROC Legal Received 1/17/2024 ROC Legal

January 17, 2024

American Zurich Ins. Co. Recovery Center PO Box 968015 Schaumburg, IL 60196

Our Insured: JD’s Pumping LLC Principal: Obsidian Specialty Insurance Company Policy No.: PTCGL00000239700 Our Claim No.: 2023-38522 Claimant: CZ7, LLC / The Construction Zone, Ltd. Zurich Claim No.: [number redacted] Loss Date: 08/29/2023

To Whom It May Concern:

Croft ClaimWorks, L.C. is an authorized claims representative for Obsidian Specialty Insurance Company (“Obsidian”). Obsidian insures JD’s Pumping LLC (“JD’s”) under the above referenced policy. Please allow this letter to serve as a response to your claim as we have completed our investigation.

Our investigation indicates JD’s was one of many subcontractors hired by CZ7, LLC / The Construction Zone, Ltd to perform work at 5451 S Cassandra Blvd Flagstaff, AZ 86005. It is alleged that an employee of JD’s was operating heavy equipment and ran over a wellhead located at the jobsite on, or about, 08/29/2023. Our investigation shows that on the date of loss there were multiple concrete trucks, a dump truck, and several subcontractors present. Our insured’s foreman was contacted, after our insured driver had left the jobsite, and told that the insured driver had struck the wellhead. Contact was made with our driver, as well as the alleged witnesses, the same day. Our insured driver fully denies having struck the wellhead, there is no damage to the equipment he was operating, and the original witness statements revealed that they had not witnessed any impact at all. The witnesses merely report that our insured driver was in the area but could not confirm having seen our driver cause the damage. Our insured’s foreman came to the jobsite the next day to inspect, but the wellhead had already been dug up. Multiple tire tracks were in the area, and none could be confirmed as the tread belonging to our insured’s equipment. No video evidence or other concrete support has been provided to prove negligence against our insured, and the investigation shows that there were other parties and equipment present that may have caused the damage.

As stated above, our investigation has revealed no evidence to confirm liability rests with our insured for the reported damage. Therefore, we must respectfully deny any liability alleged against JD’s.

This letter is based on the information, facts and circumstances known to us at this time. Should you have, or receive, any information that you believe might impact this coverage determination in any way, please contact the undersigned in writing and provide any documentation for our review and further consideration. If you have any questions, please feel free to contact me. Received 1/17/2024 ROC Legal Page 2 Claim #: 2023-38522

Sincerely,

Patty Burgett

Patty Burgett Senior Claims Rep. Croft ClaimWorks, L.C. Office: (469) 481-4917 Email: [email redacted] Received 1/18/24, 11:01 AM State of Arizona Mail - Complaint No. 2023-14580 1/17/2024 ROC Legal

Legal New Mail - AZROC <[email redacted]>

Complaint No. 2023-14580 Jesse Heck <[email redacted]> Wed, Jan 17, 2024 at 3:47 PM To: Michael Groves <[email redacted]>, "[email redacted]" <[email redacted]> Cc: Andy Byrnes <[email redacted]>, "[email redacted]" <[email redacted]>

Mr. Quezada, please see attached a letter from the boom driver and our foreman along with a copy of the liability denial letter from our insurance. Please let us know if you need anything else from us. Thank you,

Jesse Heck, Owner JD's Pumping, LLC

From: Michael Groves <[email redacted]> Sent: Friday, January 5, 2024 3:50 PM To: [email redacted] <[email redacted]> Cc: Andy Byrnes <[email redacted]>; [email redacted] <[email redacted]>; [email redacted] <[email redacted]> Subject: Complaint No. 2023-14580

[Quoted text hidden]

attachments #1 Letter from Julio [number redacted].pdf 2569K #2 Letter and map from Jacob [number redacted] (1).pdf 587K 2023 38522 Liability Denial PDF.pdf 149K

https://mail.google.com/mail/b/AEoRXRQSm3RfuMiaZ5SpVdjsrL1bpcgclZHIQxWrpAzyMsp-TkYq/u/0/?ik=d3afebeda9&view=pt&search=all&permmsg… 1/1 January 5, 2024

Via U.S. Mail and Email

Complainant JD's Pumping LLC 4850 Ramada Dr. Prescott, AZ 86301

Via U.S. Mail and Email

Respondent The Construction Zone Ltd 1729 E Osborn Rd Phoenix, AZ 85016

Re: Complaint No. 2023-14580

Dear Complainant and Respondent:

The Registrar received a complaint filed against The Construction Zone Ltd for non-payment of materials or services rendered. This complaint is complete and will be substantively reviewed by the Registrar.

Respondent is free to raise any issue or affirmative defense to this complaint by filing a response with the Registrar by January 12, 2024. Please reference the complaint number listed above if you file a response. Respondent may file a response by:

Mail: P.O. Box 18244, Phoenix, Arizona, 85005-8244 In-Person: 1700 W. Washington St., Ste. 105, Phoenix, Arizona, 85007-2812 Email: [email redacted]

The Registrar will not issue a citation before January 12, 2024 and will review Respondent’s response, if one is submitted.

Please be advised that a response to the complaint is not the same as a written answer. If the Registrar issues a citation Respondent must file a written answer to that citation in accordance with A.R.S. § 32-1155.

Sincerely,

/s/ Tedi Quezada ___________________

1700 W. Washington Street, Suite 105 · Phoenix AZ 85007-2812 602.542.1525 · Toll Free 877.692.9762 · roc.az.gov Lg100 4/21 Tedi Quezada Legal Department 1700 W Washington St. Ste 105 Phoenix, AZ 85007

1700 W. Washington Street, Suite 105 · Phoenix AZ 85007-2812 602.542.1525 · Toll Free 877.692.9762 · roc.az.gov Lg100 4/21 Received by Investigations 12/26/2023 2023-14580 Received by Investigations 12/26/2023 2023-14580 Received by Investigations 12/26/2023 2023-14580 Received by Investigations 12/26/2023 2023-14580 Received by Investigations 12/26/2023 2023-14580 Received by Investigations 12/26/2023 2023-14580 Received 2/8/2024 ROC Legal

Written Answer to Citation and Complaint

VIA: email, [email redacted] DATE: 8 February 2024 TO: Arizona Registrar of Contractors RE: Case #2023-14580

REMARKS:

The Construction Zone, LTD has received a citation from the Registrar of Contractors, case #2023-14580. The Construction Zone has filed an insurance claim against the complainant for substantial damage to Owner’s property due to their negligence at the Job Location indicated on the invoices. The Construction Zone has repaired and paid for the damage and is awaiting reimbursement from JD’s Pumping, LLC. A copy of the incident report was sent to complainant on 8 August 2023 and is attached to this letter along with the repair invoice totaling $51,319. The Construction Zone has withheld payment as permitted by Arizona Statute 32-1183(C)(7); “Nothing in this section prevents the contractor or subcontractor, at the time of application or certification to the owner or contractor, from withholding such application or certification to the owner or contractor for payment to the subcontractor or material supplier for any of the following reasons: 7. Damage to a contractor or another subcontractor or material supplier.” The Construction Zone will pay the invoices attached to the complaint in full after reimbursement from JD’s Pumping, LLC or their insurance for the damage due to their negligence. The Construction Zone, LTD. respectfully requests an informal settlement conference prior to an administrative hearing.

Thank you for your attention to this matter.

Please contact me at the office or on my mobile, (602) 692-9199, with any questions.

Respectfully,

Michael Groves, CFO Received 2/8/2024 ROC Legal

TRANSMITTAL VIA: email, certified mail DATE: 30 August 2023 TO: Bob Ramsey, Silverleaf Insurance RE: Flagstaff Retreat

REMARKS:

Bob, I am writing this letter to follow up on our phone conversation yesterday and provide notice of damage which occurred on August 29, 2023, during ongoing construction work. The property owned by CZ7 llc located at 5451 south Cassandra boulevard, Flagstaff, AZ 86005 is covered by a Builders Risk policy issued by your office. The damage is primarily to the onsite well that was installed in July of this year. The well was installed by Drill Tech, Incorporated. On August 29, 2023, concrete was being placed on north edge of construction site adjacent to the utilities, including well head location. The utility area was partitioned off from concrete work area entrance by large logs creating an entry path. The concrete work required the use of a concrete pump truck supplied by JD’s Pumping LLC. and delivery trucks from concrete material supplier, Arrow Redi-Mix, incorporated. The concrete pump truck was positioned at the end of the entry path next to a sport court where work was occurring. The concrete pump truck pulled in forward facing sport court while concrete delivery trucks would back in to unload concrete into pump truck. After final concrete delivery truck finished unloading into pump truck, the concrete delivery truck pulled forward out of work area entry path. The concrete delivery truck and concrete placement workers then went to the guest house just south of sport court area to continue additional concrete work. The concrete pump truck began lowering boom, cleaning out lines and packing the truck up to remove from site. At approximately 12:00-12:15 pm the concrete boom truck then proceeded to back out of the work area and the driver veered off the entry access path pushing the logs partitioning the utilities under the truck which then became got lodged under the truck frame and tires. The concrete pump truck continued backing up, rolling over the log partitions striking the well head which sat 12” above grade. This severally damaged well head. The incident and damage were witnessed by two workmen placing the concrete, Juan Lopez and Juan Hernandez. They stated they saw the concrete pump truck over the well head and the concrete pump driver removing logs from under truck. The concrete pump truck driver then got back in truck pulled forward to correct truck path, then backed up down access path out of work area. The concrete placement workers confronted driver of pump truck about incident where he apologized about hitting logs and going off path. Daniel Pappalau, site superintendent employed by The Construction Zone, ltd, returned to site right after incident unaware of the incident or damage. The concrete pump truck driver had parked away from incident area at far end of round about driveway. He was given an invoice for the work by the concrete pump driver, which he signed, and the truck driver left. Concrete placement workers then informed him of the incident and damage to the well. Daniel proceeded to call the pump truck supervisor at JD’s Pumping LLC to notify them of the incident and damage. Daniel was told they would Received 2/8/2024 ROC Legal

take care of any damage that occurred. Daniel then called me and Drill Tech to inform us of the incident. The pump truck driver returned to site at this time on foot examining extent of damage. He quickly walked offsite before Daniel could discuss the incident with him. Daniel proceeded to document the damage. Photographs taken by Daniel at that time clearly show tire tracks from concrete pump truck heading straight trough log partition into well head. Th photographs also include the tracks of concrete delivery trucks which followed the entry path and did not cross the utilities or well site. A representative from Drill-Tech is scheduled today to inspect the damage and provide an assessment of the repair and /or replacement required.

I have provided the contact information for all parties involved below.

Concrete Pump Truck JD’s Pumping LLC. 3275 pleasant view drive P.O. Box 26214 Prescott Valley, AZ 86312 (928) 713-3788 [email redacted]

Concrete Material Delivery Arrow Readi-Mix, inc. P.O. Box 2910 Flagstaff, AZ, 86003 (928) 522-9388

eyewitnesses Juan Hernandez (602) 332-0717 Juan Lopez (480) 843-1595

site superintendent Daniel Pappalau (602) 509-9496

Drill Tech inc. 3320 N HWY89 Chino Valley, AZ, 86323 (928) 636-8006

Please contact me with any questions.

Respectfully,

Andy Byrnes, AIA Received 2/8/2024 ROC Legal Received 2/8/2024 ROC Legal Received 2/8/2024 ROC Legal Received 2/8/2024 ROC Legal Received 2/8/2024 ROC Legal Received 2/8/24, 1:34 PM State of Arizona Mail - Written Answer to Complaint and Citation, case #2023-14580 2/8/2024 ROC Legal

Answers - AZROC <[email redacted]>

Written Answer to Complaint and Citation, case #2023-14580 message

Michael Groves <[email redacted]> Thu, Feb 8, 2024 at 1:32 PM To: "[email redacted]" <[email redacted]>

Mr. Robert Stirling, I have attached a written response to the complaint filed by JD’s Pumping, llc, case #2023-14580. As stated in the response we are requesting an informal settlement conference per ARS 41-1092.06. Please contact me with any questions. Thank you,

michael groves, architect

the construction zone, ltd 1729 east osborn road phoenix, arizona 85016 m 602 692 9199 o 602 230 0383 czphx.com

attachments written answer to citation and complaint.pdf 192K 08.30.23 well damage BR report.pdf 3011K

https://mail.google.com/mail/b/AEoRXRQXC7BfC3N1pbpeNbv9DqB1e3j2WWoa4LQ20rx9QckDFZ0K/u/0/?ik=581c53cf5c&view=pt&search=all&perm… 1/1 Mediation Notice

Mediation Services Mediation services are available to the parties. What is Mediation? Mediation is a method of resolving disputes where the parties can end conflict without the expense and time associated with the full administrative process. Who Participates in During mediation, a mediator will attempt to help the Mediation? parties find an optimal solution to the conflict. Both parties must agree to participate in mediation, and both parties must bring a representative to mediation that has full authority to settle the entire matter. Mediation Is Not Neither the Registrar nor the Office of Administrative Mandatory Hearings will penalize a party for not agreeing to mediation. Where do the Parties The parties will meet at the Office of Administrative Meet for Mediation? Hearings to participate in mediation.

The Office of Administrative Hearings is located at 1400 West Washington, Suite 101, Phoenix, Arizona 85007. When does Mediation can occur after the Registrar issues a citation, but Mediation Occur? before the administrative hearing. Why Should Parties Mediation can be an alternative to the full administrative Consider Mediation? process. Mediation is beneficial because it is (1) time- efficient, (2) cost-effective, (3) confidential, and (4) capable of providing flexible solutions to complex problems. How to Request If the parties wish to mediate this case, they must file a Joint Mediation Request for Mediation with the Office of Administrative Hearings. A Joint Request for Mediation is included with this Mediation Notice. REGISTRAR OF CONTRACTORS OF THE STATE OF ARIZONA _________________________ Case No. _______________ COMPLAINANT,

v. JOINT REQUEST FOR MEDIATION _________________________ RESPONDENT.

REQUEST

The parties jointly request that this matter be referred to mediation in the Office of Administrative Hearings (OAH). ☐ This matter is set for hearing on __________________(date). ☐ This matter is not currently set for hearing. MEDIATION AGREEMENT By requesting this mediation and signing below, the parties understand, represent, and agree: 1. The parties are prepared to commence mediation and will be ready for mediation on _____________________(date); 2. The parties will participate in the mediation process in good faith; 3. This request for mediation is not intended to hinder or delay administrative proceedings; 4. No party will contend that the mediation limits the power of OAH and its administrative law judges to conduct an administrative hearing and issue decisions under A.R.S. §§ 41-1092 – 1092.12; 5. The parties will be courteous and respectful throughout the mediation process to all participants; 6. The mediation is completely voluntary and the principal purpose is to allow the parties a full and fair opportunity to discuss settlement; of 3 REGISTRAR OF CONTRACTORS 1700 W. Washington St. Suite 105 – PHOENIX, AZ 85007-2812 Telephone (602)542-1525 1-877-692-9762 7. The mediator may conduct joint and separate meetings with the parties and may suggest resolutions to the parties’ dispute, but the mediator has no authority to impose a settlement upon the parties; 8. The mediation process is confidential. Communications made, material created for or used during, and acts occurring during mediation are confidential and may not be discovered or admitted into evidence in any proceeding except as provided by A.R.S. § 12-2238; 9. The mediator is not subject to service of process or a subpoena to produce evidence or to testify regarding any evidence or occurrence relating to the mediation except as provided in A.R.S. § 12-2238(C); 10. Neither the mediator, nor the Registrar of Contractors, nor the Office of Administrative Hearings is subject to civil liability for any act or omission in connection with any mediation service or activity except for acts involving

intentional misconduct or reckless disregard of a substantial risk of injury to the rights of others; 11. Throughout the mediation process, each party must have a representative present who will have full settlement authority to settle all claims at issue in the administrative

proceeding. 12. The mediation process will terminate when: a. The parties reach settlement; b. The mediator determines that further efforts at mediation are no longer likely

to achieve a settlement; or c. One of the parties withdraws from mediation. _____________________________________ _______________________ Complainant (or representative) Date

_____________________________________ _______________________ Respondent (or representative) Date

of 3 REGISTRAR OF CONTRACTORS 1700 W. Washington St. Suite 105 – PHOENIX, AZ 85007-2812 Telephone (602)542-1525 1-877-692-9762 PREHEARING DISCLOSURE STATEMENT INSTRUCTIONS ***DO NOT SUBMIT THESE INSTRUCTIONS WITH THE PREHEARING DISCLOSURE FORM***

ADMINISTRATIVE RULES A copy of the Arizona Administrative Code’s Rules for the Registrar of Contractors can be located on the Registrar’s Website.

PREHEARING DISCLOSURE REQUIREMENT Under A.A.C. R4-9-118(A), before a hearing, the parties must prepare a disclosure statement. The disclosure statement must contain: • A list of all the witnesses the party will call to testify, including the witnesses’ contact information and a brief description of the subject matter of the witnesses’ expected testimony; and • A list of all the exhibits that the party will use at the hearing.

FILE PREHEARING DISCLOSURE STATEMENTS • The Prehearing Disclosure Statements and Exhibits may be submitted to the Arizona Office of Administrative Hearings using any of the following: • Electronically: https://portal.azoah.com/submission/ • In-Person or by Mail: 1740 West Adams Street, Lower Level, Phoenix, Arizona 85007

EXCHANGING DISCLOSURE STATEMENTS AND EXHIBITS Under A.A.C. R4-9-118(B) (effective November 5, 2017), a party to the hearing must serve on every other party and file with the Office of Administrative Hearings a copy of: • The disclosure statement; and, • Any exhibit that the party will use at the hearing. Service: The disclosure statement and exhibits must be served on all parties in accordance with Arizona Administrative Code R2-19-108 Filing Documents. Under A.A.C. R2-19-108, service is completed by: • Personal delivery; • 1st class, certified or express mail; or • Facsimile. Timing: The disclosure statement and the exhibits must be served and filed not less than seven calendar days before the date of the hearing. Under A.A.C. R2-19-108, a document is served on a party: • On the date it is personally served; • Five days after it is mailed by express or 1st class mail; • On the date of the return receipt if it is mailed by certified mail; or • On the date indicated on the facsimile transmission.

CONSEQUENCES FOR FAILING TO DISCLOSE Under A.A.C. R4-9-108(C), if a witness or an exhibit is not timely disclosed as required the rules, and good cause for the failure to disclose is not shown, then the administrative law judge may: • Order that certain witnesses or exhibits not be used at the hearing; • Order that a particular fact is or is not established for the record; or, • Order that a charge, a defense, a claim, or some portion thereof, be dismissed.

Form RC-L-800A Prehearing Disclosure Statement Rev. 10/08/2019 Instructions Form PREHEARING DISCLOSURE STATEMENT FORM RC-L-800A

PART 1: WITNESS LIST DOCKET NO. Under A.A.C. R4-9-118(A), before a hearing, a party must prepare a disclosure statement containing a list of all the witnesses the party will call to testify, including the witnesses’ contact information and a brief description of the subject matter of the witnesses’ expected testimony. If you need additional space to list all witnesses, complete and attach additional Witness Lists. Example 1. Name 2. Telephone Number 3. Email Address

John Doe (123) 456-7890 [email redacted] 4. Subject Matter of Expected Testimony

John Doe will testify regarding the poor workmanship and poor installation of the Garage Door. Mr. Doe will also testify regarding the invoices and change orders for the project.

Witness 1. Name 2. Telephone Number 3. Email Address

4. Subject Matter of Expected Testimony

Witness 1. Name 2. Telephone Number 3. Email Address

4. Subject Matter of Expected Testimony

Witness 1. Name 2. Telephone Number 3. Email Address

4. Subject Matter of Expected Testimony

Witness 1. Name 2. Telephone Number 3. Email Address

4. Subject Matter of Expected Testimony

Form RC-L-800A Prehearing Disclosure Statement Rev. 1/15/2019 Page 1 of 3 PART 2: EXHIBIT LIST DOCKET NO. Under A.A.C. R4-9-118(A), before a hearing, a party must prepare a disclosure statement containing a list of all the exhibits that the party will use at the hearing. Note: All exhibits listed below must be provided to all parties to the hearing. See A.A.C. R4-9-118(B). If you need additional space to list all witnesses, complete and attach additional Exhibit Lists. Example Contract for new garage door. Invoice #10001 – Cost for garage door replacement.

Exhibit Exhibit Name

Form RC-L-800A Prehearing Disclosure Statement Rev. 1/15/2019 Page 2 of 3 PART 3: ACKNOWLEDGEMENT & SIGNATURE I certify that the above information is true and correct and that I will serve a copy of this disclosure statement and any exhibits listed in Part 2 to all parties to the hearing in accordance with A.A.C. R4-9-118. I acknowledge and understand that if I fail to properly disclose a witness or exhibit, the administrative law judge may: • Order that certain witnesses or exhibits not be used at the hearing; • Order that a particular fact is or is not established for the record; or, • Order that a charge, a defense, a claim, or some portion thereof, be dismissed.

I am the (check one):  Complainant  Respondent Docket No.

Print Name Signature Date

Form RC-L-800A Prehearing Disclosure Statement Rev. 1/15/2019 Page 3 of 3