Osaac Form – Fill Out and Use This PDF

Office of Special Admissions/Specialization	File No. _________________
180 Howard Street · San Francisco, CA 94105-1639
(415) 538-2111 · osaac@calbar.ca.gov	9.43

Certificate of Out-of State Attorney Arbitration Counsel (OSAAC)

California CCP §1282.4 and California Rules of Court Rule 9.43

There are two steps to this process and all fields must be completed.

Instructions. (1) One Certificate must be completed and signed by each out-of-state attorney (“Applicant”). This Certificate must be served on all parties and counsel in the arbitration whose addresses are known to the Applicant, the arbitral forum and the State Bar of California (at the address above together with a non-refundable processing fee of $50 in the form of a check made payable to the State Bar of California.) (2) If the Arbitral forum or arbitrator(s) approve(s) the appearance of the Applicant, the Applicant must serve a copy of this Certificate bearing such written approval on all other parties and counsel in the arbitration whose addresses are known to the Applicant and file the original Certificate with the State Bar of California at the address above. Service must comply with California Code of Civil Procedure Section 1013a.

1.Arbitral Forum (or name of arbitrator(s)): ______________________________________________________________

2.Address of Arbitral Forum (or arbitrators(s)): ___________________________________________________________

City: ________________________________ State: ________________________ Zip: __________ + ____________

3.a) Arbitration Case Number: ____________________________________________________________________; and

b) Arbitration Name (or names of parties): _____________________________________________________________

4.Street Address of Arbitration Hearing Site in California: __________________________________________________

City: ________________________________ State: ________________________ Zip: __________ + ____________

5.Name of Out-of-State Attorney (“Applicant”): ___________________________________________________________

6.Applicant’s Firm Name: ___________________________________________________________________________

Applicant’s Office Address: ________________________________________________________________________

City: ________________________________ State: ________________________ Zip: __________ + ____________

Phone: (_____) _______-_________ Fax: (_____) _______-_________ E-mail: _______________________________

7.Applicant’s Residence Address: _____________________________________________________________________

City: ________________________________ State: ________________________ Zip: __________ + ____________

8.a) Bar Number of Active State Bar of California Attorney of Record Associating with Applicant: ___________________

b) Name of California Attorney of Record: _____________________________________________________________

9.Address of California Attorney of Record: _____________________________________________________________

City: ________________________________ State: _____ Zip: _______ + _____ Phone: (_____) _______-________

OSAAC Certificate 2009-1

9.43

10.All courts before which Applicant has been admitted to practice and is in good standing. Attach additional sheets if necessary.

Date Admitted	State/Court	Status
	(e.g. Ohio, 9th Circuit, etc.)	(e.g. Active)
_____________	_____________________________________________________________	_____________
_____________	_____________________________________________________________	_____________

11.All applications by Applicant to appear in California courts as counsel pro hac vice or out-of-state arbitration counsel in the last 2 years from the date of this application. Attach additional sheets if necessary.

Date	Case Name (or Names of Parties)	Court or Forum	Result
			(Granted/Denied)
_____________	_____________________________	_____________________________	_____________
_____________	_____________________________	_____________________________	_____________

12.If Applicant has made repeated appearances, list any special circumstances warranting Applicant’s appearance in this arbitration. __________________________________________________________________________________

______________________________________________________________________________________________

13.Applicant represents that Applicant: (i) is not currently on suspension or disbarred from the practice of law before any court; (ii) is not a resident of the State of California, (iii) is not regularly employed in the State of California; and (iv) is not regularly engaged in substantial business, professional or other activities in the State of California.

14.Applicant agrees to be subject to the jurisdiction of the courts of the State of California with respect to the law of the State of California governing the conduct of attorneys to the same extent as a member of the State Bar of California.

Applicant declares under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this certificate is executed on:

Date: ___________________________

Applicant’s Signature: __________________________________________

(CERTIFICATE BEARING ORIGINAL SIGNATURE IS REQUIRED – COPY WILL NOT BE ACCEPTED)

APPROVAL/DISAPPROVAL OF ARBITRAL FORUM/ARBITRATOR

(Certificate bearing original signature must be returned to Applicant – copy will not be accepted)

(Applicant: Certificate bearing original signature of Arbitral Forum/Arbitrator must be returned to the State Bar)

Subject to the provisions of California Code of Civil Procedure (“CCP”) Section 1282.4 and applicable law, Applicant’s appearance in the arbitration matter referenced in Section 1 above is (check one) approved or disapproved.*

Approved By:	_____________________________________________________________________________________
	(signature)
Name:	_____________________________________________________________________________________
	(print or type)
Title:	_____________________________________________________________________________________
Date:	_____________________________________________________________________________________

*Note that CCP Section 1282.4 states that, in the absence of special circumstances, repeated appearances shall be grounds for disapproval of the appearance and disqualification from serving as an attorney in the arbitration for which the Certificate was filed. Also, failure within a reasonable period of time to serve this Certificate on all other parties and counsel in the arbitration whose addresses are known to the Applicant and file the Certificate with the State Bar of California shall be grounds for disapproval of the appearance and disqualification from serving as an attorney in the arbitration for which the Certificate was filed. An applicant is not an Out-of-State Arbitration Counsel until approved, and the application is not complete until such approval is sent to the State Bar.

OSAAC Certificate 2009-1