PENTAIR
UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF LOUISIANA
IN RE: POOL PRODUCTS DISTRIBUTION
MARKET ANTITRUST LITIGATION
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THIS DOCUMENT RELATES TO:
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Kistler, et al. v. Pool Corporation, et al.,
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No. 12-1284 (Indirect Purchaser Plaintiffs)
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MDL NO. 2328
SECTION R/2
CHIEF JUDGE VANCE
MAG. JUDGE WILKINSON
PROOF OF CLAIM FORM
PENTAIR
PROOF OF CLAIM FORM
IN RE: POOL PRODUCTS DISTRIBUTION MARKET ANTITRUST LITIGATION
CLASS ACTION SETTLEMENTS – PENTAIR SETTLEMENT WITH INDIRECT PURCHASER PLAINTIFFS
You may be entitled to participate in these settlements if you bought a Pool Product in Arizona, California, Florida, or
Missouri, not for resale that was manufactured by Hayward Industries, Inc., Pentair Water Pool & Spa, Inc. or Zodiac Pool
Systems, Inc. In Missouri, only persons or entities that purchased primarily for personal, family, or household or
residential purposes, and not for resale, are eligible.
“Pool Product” means the equipment, products, chemicals, parts or materials used for the construction, maintenance,
repair, renovation or service of residential and (except in the State of Missouri) commercial swimming pools, including,
among other goods, chemicals, pumps, filters, heaters, covers, cleaners, steps, rails, diving boards, pool liners, pool walls,
and white goods (the parts necessary to maintain pool equipment) manufactured by Hayward, Pentair or Zodiac and sold
by Pool Corporation, or any of its subsidiaries, including but not limited to SCP Distributors LLC (“SCP”) and Superior
Pool Products LLC (“Superior”) (collectively, “PoolCorp”), indirectly to end users.
You may be a member of the Class to which these settlements apply. The Plaintiffs and Pentair have reached proposed
class action settlements in a lawsuit pending in the United States District Court for the Eastern District of Louisiana. This
package of materials (the “Class Notice Package”) describes the proposed settlements of this class action lawsuit and has
been sent to you by order of the Court because you may be a member of the Class and must make a decision about
whether to remain in the Class. If you remain in the Class, you will be entitled to make a claim for a cash award afforded
by these settlements.
If you wish to file a claim, you are not required to hire an attorney or a third party claims processor. Third party claims
processors who offer Class Members assistance with filing a claim for a percentage of your recovery are not authorized by
the Court. If you have hired a lawyer to represent you for your claims in this litigation, please contact your lawyer for
more information. If you have any questions, go to www.poolproductsconsumerlawsuit.com or call toll free 1-866-7533703.
To be fully informed about the benefits and implications of the proposed settlements you may read all the documents
included in this Class Notice Package and you may also review the full settlement materials posted on
www.poolproductsconsumerlawsuit.com, including the Settlement Agreements.
CLAIM FORM
You need to submit this Claim Form, postmarked by December 11, 2015, to receive Class Benefits under these
settlements. If you are a Class Member and you do not submit a Claim Form by this deadline, you will not be eligible for
any benefits under these settlements. Unless you timely exclude yourself from the Class by December 11, 2015, you
cannot sue the Defendants over the claims settled in this case, even if you do not receive Class Benefits because your
Claim Form was untimely.
This Claim Form asks specific questions about you, the Class Member. Please complete the Claim Form to the best of
your ability. Note: You must provide your full name, the last four digits of your social security number (or full
Federal Taxpayer Identification Number, if your business is the Class Member), your address, and your e-mail
address to receive Class Benefits. If you do not provide these items and you do not opt-out of these settlements, you will
still be bound by the Settlement Agreement and its release of Pentair even though you will not be eligible to receive any
money from the settlements. If you do not have or know certain information that is asked for, other than your full
name, last four digits of your social security number and address, you may leave parts of this Claim Form blank
and submit this Claim Form anyway. The Special Master will make a good faith attempt to process the Claim Form by
seeking additional information, if necessary, from you. Obviously, the more information you can provide, the more likely
your claim can be effectively processed.
Please supply the following information, along with the Class Member or Claimant Information above:
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PENTAIR
Last Name of Class Member/Claimant:
First Name of Class Member/Claimant :
Entity Name (if Class Member is a Business):
Street Address of Class Member:
City, State and Zip code of Class Member:
Telephone Number of Class Member:
E-mail Address of Class Member:
ELIGIBILITY QUESTIONS:
Did you reside or operate in Arizona, California,
Florida, or Missouri at any time from January 1, 2008
to July 16, 2013?
Yes
No
Did you buy Pool Products (defined above)
manufactured by Hayward, Pentair or Zodiac in
Arizona, California, Florida, or Missouri, while
residing or operating in that state at any time from
January 1, 2008 to July 16, 2013?
____ Yes ___No
If you resided or operated in Missouri, did you
purchase Pool Products primarily for personal, family
or household purposes?
____ Yes ___ No
Were you the end-user, i.e., the owner/lessee/manager
of the property where the pool was located at the time
of purchase? If you were a pool builder, maintenance
contractor, or similarly situated person/entity capable
of passing on an overcharge to another, your answer
should be no.
Please list the street address and city of the pool(s)
where the Pool Products you purchased were installed
or used.
Yes
No
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Provide the name(s) and address(es) of the pool
retailer/dealer/supplier, pool service or maintenance
company (or individual) from which you purchased
pool equipment, products, chemicals, parts or
materials, including, among other goods, chemicals,
pumps, filters, heaters, covers, cleaners, steps, rails,
diving boards, pool liners, pool walls, and white goods
(the parts necessary to maintain pool equipment). If
you purchased from more than one, please indicate
which purchases were from what provider.
Provide a list containing descriptions and the numbers
of Pool Products (defined above) you purchased from
within Arizona, California, Florida, or Missouri, while
residing in that state at any time from January 1, 2008
to July 16, 2013. Use additional sheets if necessary.
Are you a subsidiary or affiliate of a Defendant in this
action or a government agency?
_____Yes ___ No
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PENTAIR
* Capitalized terms used in this Claim Form are defined in the Settlement Agreements, which can be found on www.
poolproductsconsumerlawsuit.com.
DOCUMENTS: Please attach the following documentation to your Claim Form: (1) a chart containing a listing of all
Pool Products purchased from January 1, 2008 to July 16, 2013 and the name of the retailer, builder or
service/maintenance company from which the products were purchased (REQUIRED – form enclosed); and (2) documents
reflecting the purchase prices of the Pool Products you purchased from January 1, 2008 to July 16, 2013 (should be
provided to the extent you have them, although the Special Master may decide they are not necessary if you do not have
them).
Even if you do not have these documents, you may still qualify, and you can submit the Claim Form anyway.
Please include anything that may help the Special Master determine whether you qualify for Class Benefits. You may, for
example, send photographs of your Pool Products. You also may submit a statement under oath (i.e., under penalty of law
for any false statements you make) that you purchased Pool Products. Please do not include any correspondence between
you and your attorney.
TO COMPLETE YOUR PROOF OF CLAIM FORM, PLEASE COMPLETE THE DECLARATION PROVIDED
BELOW.
Claim Forms and supporting documents must be postmarked by December 11, 2015.
Please mail to:
POOL PRODUCTS END-USER CLAIMS ADMINISTRATOR
c/o Angeion Group
1801 Market Street, Suite 660
Philadelphia, PA 19103
Questions? VISIT www.poolproductsconsumerlawsuit.com or call toll free 1-866-753-3703
DECLARATION
I certify that I have read this Proof of Claim Form; I believe I am a member of the Class,
that I am eligible for Class Benefits; all of the information on this Proof of Claim Form is true and
correct to the best of my knowledge; I have attached to, or enclosed with this Proof Claim Form
all documents or photographs that I have been able to locate; I have not assigned any of my rights
in this Action or any Pending Action to anyone else. Under penalty of perjury, I believe the
information provided is true and correct.
Claimant
Claimant Address
Date
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PENTAIR
Product Description:
Name of Retailer,
Builder, or
Service/Maint.
Company where
Product Purchased:
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Approximate
Date of
Purchase:
Quantity
Purchased:
Estimated or
Actual Purchase
Price
(per Product):