PETITION FOR FORMAL ADMINISTRATIVE HEARING
AND REQUEST FOR REVIEW OF FINAL AGENCY ACTION
[Florida Division of Administrative Hearings]
TABLE OF CONTENTS
- Document Header............................................... 1
- Definitions................................................... 2
- Operative Provisions.......................................... 3
- Representations & Warranties.................................. 5
- Covenants & Restrictions...................................... 6
- Default & Remedies............................................ 7
- Risk Allocation............................................... 8
- Dispute Resolution............................................ 8
- General Provisions............................................ 9
- Execution Block.............................................. 11
[// GUIDANCE: Delete Table of Contents before filing if Florida e-portal auto-generates bookmarks.]
1. DOCUMENT HEADER
1.1 Parties.
a. “Petitioner” – [PLACEHOLDER: Full legal name, type of entity/individual, address, phone, e-mail].
b. “Respondent Agency” – [PLACEHOLDER: Full legal name of Florida agency whose action is being appealed, address, primary contact].
1.2 Caption Information.
• Agency Final Action/Order No.: [PLACEHOLDER]
• DOAH Case No. (to be assigned)
• Filing Date: [PLACEHOLDER]
• Effective Date of Contested Order: [PLACEHOLDER]
1.3 Jurisdiction & Venue.
This Petition is filed pursuant to the Florida Administrative Procedure Act (“APA”), Fla. Stat. ch. 120, specifically §§ 120.569 and 120.57 (2023), and the Uniform Rules of Procedure, Fla. Admin. Code r. 28-106. The Division of Administrative Hearings (“DOAH”) has exclusive original jurisdiction to conduct the requested formal administrative hearing.
1.4 Recitals.
WHEREAS, Petitioner received the Respondent Agency’s “[PLACEHOLDER: title of order or notice]” dated [DATE], which constitutes final agency action subject to administrative review;
WHEREAS, Petitioner’s substantial interests are adversely affected by the Agency Action; and
WHEREAS, Petitioner has timely filed this Petition within twenty-one (21) days of receipt of the Agency Action, thereby satisfying all exhaustion and preservation requirements under Fla. Stat. § 120.57;
NOW, THEREFORE, Petitioner submits this Petition and respectfully requests a formal administrative hearing.
2. DEFINITIONS
All capitalized terms used but not otherwise defined herein have the meanings set forth below.
“Agency Action” means the final order, decision, or other action of Respondent Agency identified in Section 1.2.
“ALJ” means the Administrative Law Judge assigned by DOAH.
“APA” means the Florida Administrative Procedure Act, Fla. Stat. ch. 120, as amended.
“Competent, Substantial Evidence” has the meaning applied by Florida courts: evidence that is sufficiently relevant and material that a reasonable mind would accept it as adequate support for the conclusion reached.
“Petition” means this Petition for Formal Administrative Hearing, together with all exhibits, attachments, and amendments.
“Uniform Rules” means the Uniform Rules of Procedure codified at Fla. Admin. Code ch. 28-106.
3. OPERATIVE PROVISIONS
3.1 Request for Formal Hearing.
Pursuant to Fla. Stat. § 120.57(1), Petitioner hereby requests assignment of an ALJ and the scheduling of a de novo formal administrative hearing on disputed issues of material fact set forth herein.
3.2 Interests Affected.
Petitioner’s substantial interests are adversely affected because [PLACEHOLDER: concise factual explanation—e.g., loss of license, monetary penalty, denial of permit].
3.3 Statement of Disputed Issues of Material Fact.
Petitioner disputes the following material facts underlying the Agency Action:
1. [PLACEHOLDER]
2. [PLACEHOLDER]
3. [ADD additional numbered paragraphs as needed].
3.4 Ultimate Facts Alleged.
The Agency Action is erroneous because:
a. The findings of fact are not supported by Competent, Substantial Evidence;
b. The Agency misapplied controlling statutes and rules;
c. [PLACEHOLDER: any additional ultimate facts warranting reversal].
3.5 Statutory & Rule Grounds for Relief.
Petitioner contends the Agency Action violates, or was issued contrary to, the following authority:
• Fla. Stat. § 120.57(1) – (due process hearing requirements)
• [PLACEHOLDER: cite specific program statutes/regulations]
3.6 Relief Requested.
Petitioner respectfully requests that the ALJ:
i. Enter a Recommended Order finding that the Agency Action is invalid;
ii. Recommend reversal, modification, or withdrawal of the Agency Action; and
iii. Award such other relief as may be just and proper.
3.7 Timing & Exhaustion.
Petitioner certifies that all statutory prerequisites to this appeal—including the twenty-one (21)-day filing deadline and any agency-specific informal review—have been satisfied or waived.
4. REPRESENTATIONS & WARRANTIES
4.1 Authority.
Petitioner represents that the individual executing this Petition is duly authorized to bind Petitioner.
4.2 Accuracy of Facts.
Petitioner warrants that all factual statements herein are based upon personal knowledge or reasonably diligent investigation and are true and correct to the best of Petitioner’s knowledge, information, and belief.
4.3 No Prior Waiver.
Petitioner represents that it has not knowingly or voluntarily waived any rights to an administrative hearing under the APA.
5. COVENANTS & RESTRICTIONS
5.1 Cooperation.
Petitioner shall promptly comply with all lawful orders of the ALJ, including discovery schedules, pre-hearing instructions, and deadlines.
5.2 Disclosure.
Petitioner covenants to disclose, in a timely manner, any additional information that materially alters the factual representations herein.
5.3 Settlement Efforts.
The parties shall engage in good-faith settlement discussions or mediation if ordered by the ALJ.
6. DEFAULT & REMEDIES
6.1 Agency Non-Compliance.
If the Agency fails to (i) timely file its Answer; (ii) comply with discovery; or (iii) obey any directive of the ALJ, Petitioner may seek sanctions, including but not limited to motions to compel, evidentiary sanctions, or motions for summary disposition.
6.2 Attorney’s Fees & Costs.
Pursuant to Fla. Stat. § 120.595, Petitioner reserves the right to seek reasonable attorney’s fees and costs incurred as a result of the Agency’s improper action or position not substantially justified in law or fact.
7. RISK ALLOCATION
[// GUIDANCE: Indemnification and liability caps are generally not applicable in administrative litigation; this section is intentionally minimal.]
7.1 Administrative Penalties.
Petitioner acknowledges that, under applicable program statutes, the ALJ may recommend the imposition of administrative penalties should the evidence warrant such relief against Petitioner.
8. DISPUTE RESOLUTION
8.1 Governing Law.
This proceeding is governed by the APA, related Florida statutes, and the Uniform Rules.
8.2 Forum Selection.
Exclusive venue lies in DOAH for the administrative hearing; any subsequent judicial review shall lie in the appropriate District Court of Appeal pursuant to Fla. Stat. § 120.68.
8.3 Jury Waiver.
As an administrative proceeding, trial by jury is neither available nor applicable.
8.4 Injunctive Relief.
Petitioner reserves the right to seek temporary or emergency relief, including a stay of Agency Action, under Fla. Stat. § 120.68(3) or applicable program statutes, to prevent immediate and irreparable harm pending final disposition.
9. GENERAL PROVISIONS
9.1 Amendments.
This Petition may be amended as of right within twenty (20) days of filing or by leave of the ALJ thereafter, consistent with Fla. Admin. Code r. 28-106.201.
9.2 Service & Filing.
All pleadings shall be filed through the DOAH e-filing portal and served on all parties via the e-Portal and electronic mail, unless otherwise ordered.
9.3 Severability.
Should any provision of this Petition be struck or disregarded, the remaining provisions shall continue in full force to the extent practicable.
9.4 Integration.
This document constitutes the complete Petition; no prior statements or documents shall be deemed part of the record absent proper filing.
9.5 Electronic Signatures.
Signatures transmitted via the DOAH e-Portal, DocuSign, or other Florida-approved electronic means shall be deemed originals for all purposes.
10. EXECUTION BLOCK
Respectfully submitted this ___ day of ____, 20__.
[NAME OF COUNSEL]
Florida Bar No. [BAR #]
[Law Firm]
[Address]
[Phone] | [E-mail]
Counsel for Petitioner
VERIFICATION
I, [NAME], as [TITLE] of Petitioner, hereby verify under penalty of perjury that the factual allegations contained in this Petition are true and correct to the best of my knowledge, information, and belief.
[NAME]
[DATE]
NOTARY ACKNOWLEDGMENT (if required by agency rule)
State of Florida
County of ____
The foregoing instrument was acknowledged before me this ___ day of _, 20_, by [NAME], who is personally known to me or has produced ____ as identification.
Notary Public, State of Florida
Commission No.: _
My Commission Expires: ____
[// GUIDANCE:
1. Replace all [PLACEHOLDER] fields with client-specific information.
2. Attach a copy of the challenged Agency Action as “Exhibit A.”
3. Confirm the governing program statute does not impose shorter appeal periods.
4. If no disputed issues of material fact exist, convert this to an Informal Hearing Petition under § 120.57(2).
5. File via the DOAH e-Portal and serve the Agency’s clerk or general counsel.
]