(See Articles 1 and 4)
BEFORE THE PUBLIC UTILITIES COMMISSION OF THE STATE OF CALIFORNIA
(B)________________________ | ) | CASE_)___________________________ | ||
___________________________ | ) | (for Commission use only) | ||
___________________________ | ) | (A) Have you tried to resolve this matter | ||
___________________________ | ) | informally with the Commission's Consumer | ||
___________________________ | ) | Affairs staff? | ||
(Fill in Complainant (s) name) | ___________________________ / | ___________________________ | ||
vs. | YES | NO | ||
) | Has staff responded to your complaint? | |||
(C)_______________________ | ) | ___________________________ / | ___________________________ | |
___________________________ | ) | YES | NO | |
___________________________ | ) | Did you appeal to the Consumer Affairs Manager? | ||
___________________________ | ) | ___________________________ / | ___________________________ | |
___________________________ | ) | YES | NO | |
(Fill in Defendant (s) name) | Do you have money on deposit with the | |||
Commission? | ||||
___________________________ / | ___________________________ / | $_________________________ | ||
YES | NO | AMOUNT | ||
Is your service now disconnected? | ||||
___________________________ / | ___________________________ | |||
YES | NO |
___________________________
COMPLAINT
(D) The complaint of ___________________________
(Insert exact legal name, mailing address and telephone number of each complainant)
___________________________
___________________________
respectfully shows that:
___________________________
(E)
1. Defendant(s)
(Insert full name and address of each defendant)
___________________________
___________________________
(F) 2. Explain fully and clearly the details of your complaint. (Attach additional pages if necessary)
___________________________
___________________________
___________________________
___________________________
___________________________
(G) 3. Scoping Memo Information
(a) The proposed category for the Complaint is (check one):
[] adjudicatory
[] ratesetting (if the complaint challenges the reasonableness of a rate)
(b) Are hearings needed? YES NO
(c) The issues to be considered are:
___________________________
___________________________
___________________________
___________________________
___________________________
(d) The proposed schedule for resolving the complaint within 12 months (if categorized as adjudicatory) or 18 months (if categorized as ratesetting) is as follows:
Prehearing Conference: 30 to 40 days from the date of filing of the Complaint.
Hearing: 50 to 70 days from the date of filing of the Complaint.
Explain here if you propose a schedule different from the above guidelines.
___________________________
___________________________
___________________________
___________________________
___________________________
(H) Wherefore, complainant(s) request(s) an order: State clearly the exact relief desired. (Attach additional pages if necessary)
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
(I) OPTIONAL: I/we would like to receive the answer and other filings of the defendant(s) and information and notices from the Commission by electronic mail (e-mail). My/our e-mail address(es) is/are:
_ .___________________________
(J) Dated ______________________________(city), California, this __________(date) day of ____________________(month), 20_____(year)
___________________________ | |
(Signature of each complainant) | |
___________________________ | |
___________________________ | |
___________________________ | |
Signature, address, telephone number, facsimile transmission number, and, if the representative consents to e-mail service, the e-mail address, of representative, if any) | |
___________________________ | |
___________________________ | |
___________________________ | |
___________________________ |
VERIFICATION
(For Individuals or Partnerships)
I am (one of) the complainant(s) in the above-entitled matter; the statements in the foregoing document are true of my knowledge, except as to matters which are therein stated on information and belief, and as to those matters, I believe them to be true.
I declare under penalty of perjury that the foregoing is true and correct.
(K) Executed on ____________________(date), at ______________________________(city), California.
(If more than one complainant, only one need sign)______________________________(Complainant)
___________________________
VERIFICATION
(For a Corporation)
I an an officer of the complaining corporation herein, and am authorized to make this verification on its behalf. The statements in the foregoing document are true of my own knowledge, except as to the matters which are therein stated on information and belief, and as to those matters I believe them to be true.
I declare under penalty of perjury that the foregoing is true and correct.
(L) Executed on ____________________(date), at ______________________________(city), California.
(Signature and Title of Corporate Officer) | ___________________________ |
___________________________ | |
___________________________ |
(M) FILE the original complaint plus 6 copies, plus 1 copy for each named defendant, with the Commission.
(N) MAIL TO: California Public Utilities Commission
Attn: Docket Office
505 Van Ness Avenue, Room 2001
San Francisco, CA 94102
Cal. Code Regs. Tit. 20, div. 1, ch. 1, art. 18, No. 2