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Home My WebLink About02-5477 G:~WPDATA~DOCS~Petitions to Approve Compromise Settlements\Richards Rebecca - Petition for Approval of Minor Setllernent.wpd JA uzz,. 1820 Linglestown Road P.O. Box 60545 Harrisburg, Pennsylvania 17106-0545 Telephone Number: (717) 234-3700 Fax Number: (717) 234-8212 REBECCA RICHARDS, CHARLES SMITH, her Parent and Natural Guardian, Petitioners Mo ROBERT KOLESAR and LANE CONSTRUCTION COMPANY, Respondents PETITION IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA AMICABLE ACTION AND NOW, comes the Petitioners, Rebecca Richards and Charles Smith, the Parent and Natural Guardian of Rebecca Richards, by and through their attorneys, Shollenberger and Januzzi, and do respectfully represent the following: 1. The Petitioner, Rebecca Richards, is a minor, having been born on April 3, 1985. Petitioner, Charles Smith, is the father of Petitioner, Rebecca Richards and resides at 1836 York Road, Gettysburg, Pennsylvania, 17325. 2. Respondent, Robed Kolesar, is an adult individual who currently resides at RD 3, Box 467B, Mill Hall, Clinton County, Pennsylvania. 3. On or about September 1, 2000, the Petitioner, Rebecca Richards, was a passenger in a vehicle being operated by Petitioner, Charles Smith, when it was struck in the rear by the vehicle being operated by Respondent, Robert Kolesar. G:\WPDATA~DOCS~Petiiions to Approve Compromise Settlements~Richards Rebecca - Petition for Approval of Minor Settlernent.wpd 4. At the time of the collision, Respondent, Robert Kolesar was operating a 1993 Ford Ranger owned by his employer, Lane Construction Company. 5. A copy of the police report from said collision is attached hereto and incorporated by reference herein as Exhibit "A". 6. The Petitioner, Rebecca Richards, suffered sedous and permanent injuries including, but not limited to, acute cervicodorsal strain/sprain and acute lumbosacral strain/sprain. A copy ora report dated January 5, 2001 from Edwin A. Aquino, M.D., her treating physician, is attached hereto and incorporated by reference herein as Exhibit "B". 7. Petitioners believe and therefore aver that Rebecca Richards sustained the injuries stated above as a result of the negligence of the Respondent. 8. At the time of this collision, Liberty Mutual had issued to Respondent, Lane Construction Company a policy of insurance bearing Policy Number AS2-611-004030.110. 9. By letter dated September 24, 2002, the adjuster representing Liberty Mutual on behalf of the Respondents forwarded a Release to be signed by Petitioners indicating a settlement amount of $5,990. A copy of said modified Release is attached hereto and incorporated herein as "Exhibit C". 10. Petitioners believe that the above-referenced offer of settlement is fair and reasonable. 11. The Petitioners have retained the services of the law offices of Shollenberger and Januzzi to represent them and have agreed to pay twenty-five (25%) percent contingent fee to said attorneys. A copy of the Contingent Fee Agreement between the Petitioners and their counsel is attached hereto, incorporated by reference herein and marked as Exhibit "D". G:\WPDATA~DOCS~Petitions to Approve Compromise Settlements\Richards Rebecca - Petition for Approval of Minor Seltlement.wpd 12. The Petitioners have further agreed to pay out of their share of the recovery any and all costs incurred or advanced on their behalf. The amount of the costs that were incurred and advanced on Petitioner's behalf to date in this matter total $451.41. An itemization of all costs is attached hereto, incorporated by reference herein and marked as Exhibit "E". 13. Petitioners request that the Court approve the compromise settlement set forth above and order that the Proceeds be distributed as foJJows: Shollenberger and JanuT_zi (Reimbursement of costs advanced) $ 451.41 Shollenberger and Januz. zi (Attorney's fees at twenty-five (25%) percent) $1,475.00 Rebecca Richards and Charles Smith, her Parent and Natural Guardian $3,973.59 14. Attorney Shollenberger has been handling personal injury cases for twenty years and has tried cases to verdict in five different counties and the federal district court serving the Middle District of the Commonwealth of Pennsylvania. He has lectured and written extensively on the Pennsylvania Motor Vehicle Financial Responsibility Law. Mr. Shollenberger is routinely appointed to be an arbitrator on behalf of claimants in uninsured and underJnsured motorist cases and has served as a court appointed arbitrator in Dauphin County. WHEREFORE, the Petitioners, Rebecca Richards and Charles Smith, her Parent and Natural Guardian, request this Honorable Court to approve the Compromise Settlement and Distribution of the Proceeds or in the alternative to set up a hearing on this Petition. G:\WPDATA~DOCS~PeIitions to Approve Compromise Settlements~Richards Rebecca - Petition for Approval of Minor Settlernent.wpd Respectfully submitted, SHOLLENBERGER AND JANUZZI A~or°~, IA. ~) .S ~/-~34~erger, ~ squ ire 4 G:\WPDATA~DOCS~Petitions to Approve Compromise Setllements\Richa rds Rebecca - Petition for Approval of Minor Settlement.wpd SHOLLENBERGER & JANUZZl, LLP 1820 Linglestown Road P.O. Box 60545 Harrisburg, Pennsylvania 17106-0545 Telephone Number: (717) 234-3700 Fax Number: (717) 234-8212 REBECCA RICHARDS, CHARLES SMITH, her Parent and Natural Guardian, Petitioners ROBERT KOLESAR and LANE CONSTRUCTION COMPANY, Respondents IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO.: AMICABLE ACTION ORDER AND NOW, this day of ,2002, upon presentation and due consideration of the foregoing PETITION TO APPROVE COMPROMISE SETTLEMENT & DISTRIBUTION OF PROCEEDS, it is hereby ORDERED and DECREED in accordance with the provision of Pa. R.C.P. 2206 that the Petition is GRANTED. Payment of fees and expenses as listed in the Petition is approved and payment of $3,973.59 to Petition, Rebecca Richards, is directed to be made as follows: (a) The sum of $3,973.59 to be distributed on behalf of Rebecca Richards to be deposited in one or more savings accounts in the name of Rebecca Richards in banks, building and loan associations, savings and loan associations, or credit unions, deposits in which are insured by a Federal government agency, provided that the amount deposited in any one such savings institution shall not exceed the amount to which accounts are thus insured, or in one or more accounts in the name of Rebecca Richards investing only in G:~WPDATA~DOCS~Petitions to Approve Compromise Settlernents~Richards Rebecca - Petition for Approval of Minor Settlement.wpd securities guaranteed by the United States government or a Federal governmental agency managed by responsible financial institutions. (b) No withdrawal can be made from said chosen account until Rebecca Richards attains majority, except as authorized by a prior court order of this Court. (c) Petitioner shall provide proof of deposit by filing proof thereof with the Prothonotary of Dauphin County; (d) Counsel shall be permitted to collect an attorney's fee equivalent to twenty-five 3ercent (25%) of $5,900, or $1,475, and reimbursement of costs in the amount of $451.41 (e) Petitioners, Rebecca Richards and Chades Smith, her Parent and Natural Guardian, upon receipt of the proceeds of the foregoing PETITION TO APPROVE COMPROMISE SETTLEMENT & DISTRIBUTION OF PROCEEDS, are authorized to execute the revised Release and Indemnity Agreement marked and offered as Exhibit "C". BY THE COURT: Jo G:~WPDATA\DOCS\Petitions to Approve Compromise SeQlements~Richards Rebecca - Petition for Approval of Minor Settlement,wpd SHOLLENBERGER & JANUZZl, LLP 1820 Linglestown Road P.O. Box 60545 Harrisburg, Pennsylvania 17106-0545 Telephone Number: (717) 234-3700 Fax Number: (717) 234-8212 REBECCA RICHARDS, CHARLES SMITH, her Parent and Natural Guardian, Petitioners ROBERT KOLESAR and LANE CONSTRUCTION COMPANY, Respondents IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO.: AMICABLE ACTION ORDER AND NOW, this ~ day of ,2002, a hearing on the PETITION TO APPROVE COMPROMISE SETTLEMENT & DISTRIBUTION OF PROCEEDS is scheduled on ,2002, at o'clock. .M. in Court Room # of the Cumberland County Court House. BY THE COURT: Jo 09×21×00 11:18 ~REFER TO DVERLAT SHEETS I-INCIDENT ESP ,.-> 71'7 2348212 " OI~CF. ACCdD~NTRi~ORT . ~E~DOT USE ~LY 2000-09-Z¢ ~ NA~E OaTE Upper Allen Township Police EADGE HUMBER 2307 SADGE ! ~IGNUAT . .1 CONTROL 2 09/01/2000 T~.E 22:22 INTERSECTING ROAD: ~.AC¢~DEST 09/01/2000 OATE KILLED o CLE HAVE TO 8E REMOVED FR~ THE SCENE? UN[T 1 UNIT 2 18. HAZARDI:~JS MATERIALS Y 0 N [] 'r YN PARKED? PLATE ~,DR HO.OR STREET NAHE ~G~C~'Y" LIMIT HIGH,AY CONTROL OF UNITS 4 £FNOTAT;N'I-F, RSF.~.£ION: STREET O~ ACCZDE.T y SE;M~NT ~RrER W Lisburn Rd (SR-200~) o-.o.E u.,T , sxTE ® s w 1-LIGHT FRO~ S~TE 3~6 2'~ODERATE ZONE ~] CONTRO, ~ PROPERTT T [] N ~ DEVICE TITLE OR OUT-OF-STATE V~'N 1F/C/R10L~PPA55764 Lane Ckx~struction ~y AOORESS 965 East Main Street ~ ~lerlclen, CT 06450 ~ Ford I ~o. PIODEL- (NOT SPEED 35 4207 M ADDRESS Mill I~all, PA 17751 SlRT. 05/31/1941 CLASS PARKED7 PLATE OUT-OF-S~ATE V~N 45170885003 . 0~HER 41' 5 York ~d .ClT~,STATE ._ ~ Z~c0~E- N~ ~o~, PA 17350 FT. Mi. 1992 Chevrolet Y~,E) Blazer TYPE :~S USAGE 0 POINT 06 STATUS 0 GP.,,AO [ EN T 1 PRESENCE HUHEER 21-298-415 NO UNKO SPEEO O0 CONDITION 1 Carole A Gallagher 2181 King Arthur's Ct Apt A-3 ZIPCODE }{aZ'~i~ PA 17110 oF SIRTH 04/13/1948 ADDRESS CLASS $4:1-0536 EXHIBIT CONFIG, OF AXLES BODY NATERIALS CORFIG. AXLES r~y TYPE Of ffAZ MAT CENTER FOR NIGH~AY SAFETY ,'~,Ke~FUNUIt/~ I:M-~ AGENCY 7'9.M~O [ C~L FACILITY NO.15? ( '~NCZD~'T # :2000_09_i4 (~).ROAD SURFACE L~ 8&,PE#RSYLVANIA SCHOOL DISTRICT APPLICABLE) 85.0ESCRIPTION OF DAMAGED PROPERTY "AODRESS : ~ * ' ............................... : I ~n ~ival. v~cles ~1~ ~ ~ f~ ~siti~ s~ stated t~t ~ ~s t~l~ ~ ~ U S ~te 15 in t~ right l~e of t~ffic, w~ he fail~ ~o o~e~ ~cles st~ ~ ~ ~s l~e of t~ffic, rear of ~cle ~rator $2 stat~ t~t s~ ~s st~ ~ ~ right 1~ of U S ~te ~5 ~~ for ~ traffic si~l, wh~ ~cle $1 ~lli~ ~to t~ ~ of ~r ~cle ~9 s~ in~o t~ ~ of ve~cle $3, stud ~ fz.~ of ~r ~cle. ~rator $3 s~at~ t~t s~ ~s st~ ~ t~ right 1~ of U S colli~ ~o ~ re~ of her ~cle, ~ s~ ~to the ~ of ~cle in fz~b of ~ ~cle. ~tor $4 stat~ ~t ~ ~ st~ ~ t~ ~ght 1~ of U S ~te 15 ~ v~cle $3 colli~ ~to the ~ of ~s ~cle. I.?_v~ci~ci~ s~ ~t ~tor ~1 ~d fail to ~ v~cl~ st~ ~e~ -~ ~, , ~ ~les~ ~iv~ P~C 3714 PAGE:. CENTER FOR NIGHQA¥ SAFETY 09×21×00 11:18 (~LREFER TO OVERLAY S#EET$ 1, INCIDENT NUMBER 2000-09-14a NAHE PRECI#CT D 8¥ INVEST,DnT DAre 09/01/2000 I:ATE 09/01/2000 OF 22:15 Upper Allen Township Police SA0~E NUMBER 2307 SADI 0 1 VEHICLE HAVE TO TIME 22:22 oF UEEK Friday OF UN]TS ~ ACCxDENT y N O-NONE UN]T_,,~ ['~ 1-LIGHT Z-MODERATE 3-SEVERE U#IT~[~ PROPERT, ¥ [] N [] [] . [] Y [] N [] PARCEl} PLATE T~TLE ~ OUT-OF-STATE VIN 41790643001 Mol]ssa L Jacc~ AODL~ESS 7130 Old Harrisbum~ Rd zJPcooE York Sprin~s, PA 17372 1989 Chevrolet (NOT BODY TTPE) Co~ic~ N [] UNK~ TYPE 04 USAOE 0 OWNERSHIp ~NZTIAL IMPACT POINT 6 STATUS 0 S~EED O0 PRESENCE CONDITION 1 .U~SER 21-269-638 ?4~lissa Lynn Jacaby A~RESS 7130 Old Harri~ Rd & ziPu~E York Sprin~s, PA 17372 ADDRESS & Z~PCOUE REPORTABLE ~ NON-REPORTABLE NO. 157 .COUNTY PEMNDOT USE ONLY Cumberland c~E 2i LITY Upper Allen Township P~NCIFAL ROADWA Y INFO~ 2'YO~ STREET NA~E U S ~te 15 U~]T NP HO.OR HIGHWAy 1 :O#TROL 2 ROAD: STREET NAME LIMIT .ACCESS IF ;,10T A T INT~RSI:'CTiON.: MARKER W Lisburn l%d (SR-2004) F?. FRDM SITE ~) S E W FRD~ SiTE 346 .EASUREO [] ;STmATEO [] ZONE ~ CONTROL ~ DEVIce PARKED? PLATE AYP-6286 T~TLE OR OUT-OF-STATE VIN 44077343102 Jor~tharl M Frazier AODRES$ 621 ~pitol ~ill & ZZPCODE Dillsbul~, PA 17019 1991 Saturn ~NOT mcmY TYPE) GL-2 TYPE .04 USAG~ 0 POINT 6 STATUS 0 GRADIENT '1 PRESENCE NL~4BER 22-583-871 1 SPEED O0 CORDITIoN 1 NAME J~nathan NX~n~y Frazier ~DRESS 621 Capitol Hill Rd ~abux~, PA 17019 D04 ADDRESS 7'5.NO. OF PAGE: CENTER FOg HIGHWAY SAFETY ~ILLUM:NAT]ON~ ~),ROAO SURFACE~ CtF AP~LIC*BLE) ~)-~ATHER ION OF DA~IAGEO PROPERTY ]VE-I SEqUEKE EVENTS, DETAILS, LIKE INSURANCE INFO,#AT]ON AND LOCATION OF TO~EO VEHICLES, IF UNIT ,~. ~ITNESEES None USE USE PAGE:_ O0 MO CQMPLETE? REFusE CEI~TER FOR HIGH~Ay SAFETY · . {~),R;FEIII TO O¥~I~LA¥ SHEETS ESP *~ 717 2~48212 AEPO~TABLE ~#O~J'AEPORTABLE DATE ADDRESS NO. 157 PEN#DOT USE ONLy H ! d I~ L and collided into same. vehicle #1 was towed to Hess ]~on by wrecker of same. PAGE:~ CE#TER FO~ HIGHkA¥ SAFETY Edwin A. Aquino, M.D., P.C. 845 Sir Thomas Court, Suite 10 Harrisburg, PA 17109 (717) 541-5406 Fax (717) 541-5449 Physical Medicine & Rehabilitation Medical Acupuncture Attorney Ron S. Chima 1820 Linglestown Road P.O. BOX 60545 Harrisburg, PA 17106-0545 January 5, 2001 RE: REBECCA M. RICItARDS SS/t: 216-08-0632 Age: 15 DOI: 9/1/00 Dear Attorney Chima, This is in response to your inquiry on Rebecca M. Richards dated January 3, 2001. Rebecca was first initially seen on 11/7/00 and she came with her father. She is a 15 year old female, student, who was involved in a motor vehicle accident on 9/1/00. At that time, she was a passenger seated in the front seat ora Blazer driven by her mother. They were stopped when hit on the right rear end by a truck. Rebecca mediately experienced pain, light headedness and whole back pain. Her father brought her to the Harrisburg Hospital but it was packed so they went home. She woke up the following morning with generalized aches, pains and stiff~ess. Her father brought her to the Gettysburg Hospital. There, she was examined and x-rayed. There was nothing broken and she was advised to take lbuprofen or Tylenol for pain and follow up with her family physician if she did not improve. She went to the Biglerville Family Practice and she was prescribed with Ibuprofen. She was advised that her symptoms would improve in time. She also started treating with Herme's Chiropractic in Gettysburg. She was treated for 1 1/2 months and continued to do so. She reported some improvement of her symptoms but these remm.'ned persistent. COMPLAINTS (11/7/00) I. ~ This is now intermittent in nature with radiation to the base of the skull. This may also radiate to the back of the head and progress into headache. The neck pain is described as tightness and spasm, intermittent in nature. Usually this is brought about by neck positioning such as flex in school reading and studying. The neck pain is graded at 6-7/10. Page 2 Rebecca M. Richards January 5, 2001 2. Headache. This occurs if the neck pain is severe. It starts in the nuchal area and may end up as a severe frontal headache. The duration and severity vary. She denies nausea or vomiting. 3. Whole back pain. This involves the dorsal and lumbosacral region. The back pain is described as tightness and spasm, intermittent in nature of varying degrees of severity. This is graded at 5-7/10. For the past few days following the motor vehicle accident, she reported radiating pain from the shoulder distally to the left upper extremity with numbness and paresthesia of some digits of the hand. She also has a similar radiation from the sacrum to the left lower extremity distally to the toes. These radiating complaints have since resolved. PHYSICAL EXAMINATION (11/7/00) Rebecca was not in any acute distress. There was no ambulation dysfunction noted. She was coherent and cooperative. The head was normocephalic. The pupils were equally reactive to light and accommodation. The neck was tender to palpation with tight myofascial bands extending to the nuchal region proximally and to the upper dorsal region distally. There was spasm noted at the lower cervical region. The neck AROM were full in forward flexion with pain complaints. Extension was full with endranges pain complaint. Lateral rotation and lateral bending were full but with pain complaints at the left more than the right. Lhermitte's sign was negative. The dorsal region revealed palpatory tenderness with tight myofascial bands especially in the dorsal region. Shoulder shrug was intact but with pain complaints against resistance. Shoulder AROM were full and fairly asymptomatic. Both upper extremities revealed grossly normal muscle strength tone and AROM. The lumbosacral region revealed palpatory tenderness with fight myofaseial bands. There were trigger points identified in the sacrum. The back AROM were full but with endrange pain complaints in extension and lateral bending and rotation to the left. Both lower extremities revealed grossly normal muscle strength tone and AROM. Supine straight leg raising were close to full bilaterally with mild back pain complaints. Lasegne was bilaterally negative. Patrick test increased the low back pain but negative for inguinal pain. Page 3 Rebecca M. Richards January 5, 2001 There was no sensory deficit to sharp and dull stimuli in both upper extremities. The deep tendon reflexes of both upper extremities were bilaterally brisk and symmetrical. There was no sensory deficit to sharp and dull stimuli in both lower extremities. The deep tendon reflexes of both lower extremities were bilaterally brisk and symmetrical. IMPRESSION (11/7/00) 1. Acute cervicodorsal strain/sprain. 2. Acute lumbosacral strain/sprain. COMPLAINTS (12/27/00) 1. ~ This has since resolved. 2. _Headache. This has since resolved. 3. ~ This has significantly improved. However, there would be recurrence of her lower dorsal and lumbosacral pain with gym activity. After 2 minutes of running, there would be recurrence of this pain and graded at 3-4/10. This is fairly localized. PHYSICAL EXAMINATION (12/27/00) Rebecca was not in any acute distress. The neck was firm and not tender to palpation and without any tight myofascial bands. The neck AROM were full and asymptomatic. The dorsal region revealed mild palpatory tenderness with mildly tight myofascial bands in the lower region. Shoulder shrug was intact and asymptomatic even against resistance. Shoulder AROM were full and asymptomatic. Both upper extremities revealed grossly normal muscle strength tone and AROM. The lumbosacral region revealed mild palpatory tenderness with mildly tight myofaseial bands. There were no spasms or true trigger points identified. The back AROM were full and asymptomatic. Both lower extremities revealed grossly normal muscle strength tone and AROM. IMPRESSION (12/27/00) 1. Cervical strain/sprain, resolved. Page 4 Rebecca M. Richards January 5, 2001 2. Dorsal strain/sprain, improved. 3. Lumbosacral strain/sprain, improved. DIAGNOSTIC STUDI~.q 1. Cervical spine x-ray (9/5/00): normal cervical spine series. CAUSATION I state that within reasonable degree of medical certainty, there is a direct causation of the motor vehicle accident of 9/1/00 to her injuries, symptoms and dysfunction. The past medical history is non contributory. TREATMENT Rebecca was prescribed with Naprosyn (af[er her medical insurance denied Celebrex). She also underwent active physical therapy program with instruction for home exercises. She has significantly improved that on 12/27/00 she was discharged from my service to an independent home program of exercises. Limitation was imposed on her gym class that she was only to mn as tolerated because of aggravation of the back pain. Presently I do not see any indication for further doctor visits as well as physical therapy program barring unforeseen events. PROGNOSIS Her prognosis is very good. I am optimistic of resolution of the persistent low back pain in due time. She has an existing disability that she can not run as much or as long as she could prior to the motor vehicle accident. However this disability would eventually resolve with resolution of her persistent low back pain which is intermittent. There is no impairment or handicap noted. If you have any questions please feel fi'cc to give me a call. EAA/ka Sincerely, M.D. Claim Number: AB505-088880-03 PARENTS-GUARDIAN RELEASE AND INDEMNITY AGREEMENT FOR AND IN CONSIDERATION of the payment to me/us of the sum of Five Thousand Nine Hundred Ninety Dollars ($5990.00) the receipt of which is hereby acknowledged. I/we the undersigned, father and mother and/or guardian of Rebecca Richards, a minor, do forever release, acquit, discharge and covenant to hold harmless Robert Kolesar, Lane Construction Corp. and Liberty Mutual Insurance; Co., including any and all its subsidiaries, heirs, successors and assigns of and from any and all actions, causes of action, claims, demands, damages, costs, loss of services, expenses and compensation, on account of, or in any way growing out of, any and all known and unknown personal injuries and property damage which we may now or hereafter has as the parents and/or guardian of said minor, and also all claims or rights of action for damages which the said minor has or may hereafter have, either before or after she has reached her majority, resulting or to result from a certain accident which occurred on or about the 1st day of September 2001 at or near Mechanicsburg, PA. Except as to Robert Kolesar, Lane Construction Corp. and Liberty Mutual Insurance Company, I/we specifically reserve my/our continuing actions, causes of action, claims or demands for first party benefits paid or payable pursuant to the Pennsylvania Motor Vehicle Financial Responsibility Law and for benefits paid or payable by any program, under any group contract or other arrangement responsible for paying my collision related medical bills and expenses or wage loss. I/we further promise to bind myself/ourselves jointly and severally, my/our heirs administrators and executors to repay the said Lane Construction Corp. and Liberty Mutual Insurance Company heirs, successors and assigns any sum of money, except the sum above mentioned that he/she/they may hereafter be compelled to pay on behalf of said minor because of said accident. Except as necessary for the enforcement of this Release or the settlement of which this Release is a part, or for valid tax or accounting purpose or as required by law or order of Court, neither the undersigned, nor any of the undersigned's agents, other representatives or attorney, if any, shall make any statements, or otherwise make available information to any person revealing the fact of, or the amount of term of this Release, or the settlement or which this Release is a part, or the incident giving rise to this settlement. This release expresses a full and complete SETTLEMENT of all liability claimed and denied, regardless of the adequacy of the above consideration, and the acceptance of this release shall not operate as an admission of liability on the part of anyone nor as an estoppel, waiver or bar with the respect to any claim the party or parties released may have against the undersigned. G:~GLOBAL\WPDATA~DOCS\RELEASE~Richards Rebecca - Liberty Mutual,wpd Witness my hand and seal. 1. Dated 2002 (4)x (Witness Signature) (Address) (5) (Witness Signature) YOU ARE MAKING A FINAL SETTLEMENT (Settlement inclusive of any and all liens Rights of Subrogation & Rights of Reimbursement) THIS IS A RELEASE: READ BEFORE SIGNING I (2) WE HAVE READ THIS RELEASE (3) X (Mother (3) X (Father) (Signature) (Signature) (L.S.) (L.S.) G:\GLOBAL~WPDATA~DOCS\RELEASE~Richards Rebecca - Liberty Mutual.wpd Power of Attorney and Contingent Fee Agreement I, Rebecca Richards, by her parent and natural guardian, do hereby retain Shollenberger & Januzzi, LLP of Harrisburg, Pennsylvania, as my attorneys to negotiate for me a settlement or to institute for me in my name any legal proceedings or actions that in their judgment are necessary in connection with my claim for damages sustained on September 1, 2000 against P.~,~e'~r I~c~.¢~$~.and any other person, firm, corporation or entity who may be responsible for my claim, and/or to obtain an amicable settlement. I hereby give to my attorneys a Power of Attorney to execute all documents connected with the claim for the prosecution of which the attorney is retained, including pleadings, contracts, commemial papers, settlement, agreements, compromises and releases, verifications, dismissals, orders, settlement checks and all other documents that I could propedy execute in connection with this lawsuit. I agree not to settle or adjust the above claim or any proceedings arising from said claim. I agree to fully cooperate with my said attorneys in the prosecution of the claim that comprises the subject matter of this Agreement. This includes, but is not limited to, making myself available for legal proceedings and consultations with my said attorneys; keeping my said attorneys informed as to my current mailing address, phone number and the current status of my medical condition. I warrant that the information which I have supplied and will supply during the course of my/our representation is true and accurate, and has not been and will not be obtained through fraud or illegal activities. I agree to pay attorneys' fees from the total amount recovered from any source, except first party benefits (i.e., work loss and medical benefits), on account of my bodily injury claim, including my claim for uninsured or underinsured motorist benefits, on the following basis: Sholienbetger ~' J~uzzl, LIP 234-3700 · FAX (717) Settlement of third party tort claim prior to filing of legal action 25% of total sum recovered Settlement of third party tort claim on or after filing of legal action Settlement of uninsured or underinsured motorist claims prior to selection of my arbitrator 33-1/3% of total sum recovered 25% of total sum recovered Settlement of uninsured or underinsured motorist claims after selection of mY arbitrator 33-1/3% of total sum recovered Costs: Costs are to be paid from my (the client's) share of the total amount recovered and include, but are not limited to: photocopies; fax charges; postage; notaries; long distance telephone charges; mileage for attorneys and staff; investigation charges; photographs; court costs; LEXIS research charges; medical records costs; fee for police report; deposition costs; expert witness fees; stenographer costs; and, video deposition fees. In the event that no recovery is obtained on this claim, the attorneys will make no charges for their time or services. However, any costs or expenses which the attorneys may have advanced on behalf of the claim must be paid by me upon request by said attorneys. My attorneys agree that they will only request repayment of costs if I/we fail or refuse to follow their advice regarding settlement of the claim. As one possible settlement option, I authorize the said attorneys to explore the possibility of a structured settlement through the use of deferred periodic payments. I agree that if my claim is settled through such structure, the attorneys' fees may be paid directly to said attorneys from the insurance company, either in one lump sum payment at settlement, or, at the sole option of said attorneys and/or insurance company, deferred into future payments. However, in any event, said attorneys' fees shall be calculated in the percentage as set forth above based upon the cost of the structured settlement or present value thereof in accordance with applicable law. All medical bills for which I am legally responsible incurred as a result of my injuries shall be chargeable to my share exclusively, unless otherwise paid by insurance. The Contingent Fee Agreement applies to all proceedings up to and including verdict or decision at trial or arbitration, except proceedings which are or may be required to collect first party benefits. If, in the discretion of the attorneys, post-trial proceedings, including appeals, are warranted, they will not be covered by this Contingent Fee Agreement and a new fee agreement will be required by said attorneys. This Contingent Fee Agreement and Power of Attorney shall not apply to any right, claim or cause of action that we may have for collection of first party benefits, (i.e., work loss benefits and medical bills). In Witness Whereof, I have hereunto set my hand(s) and seal(s) this ~"'--- (Seal) (Seal) And Now, this ~ $~' day of ~ ' ,2000, the above Contingent Fee Agreement and Power of Attorney has been read, approved, and understood by me and the receipt of a copy thereof acknowledged. The terms set forth are agreeable. (Seal) (Seal) Oct 2/2002 Shollenberger & Januzzi, LLP Page Client Ledger ALL DATES Date Received From/Paid To Che# General Bld Trust Entry# Explanation Rcpt# Rcpts Disbs Fees Inv# Acc Rcpts Disbs Balanc~ p633 Richards, Rebecca 001213 Date of accident - 9/1/00 (Minor - fee 25%-33 1/3%) Sep 30/2000 Expense Recovery 00227 1.50 37170 Facsimilies - Sept Oct 24/2000 ChartOne Inc 2630 25.63 37947 Medical Records - inv#106136100424 Gettysburg Hosp Oct 24/2000 Herman Chiropractic Centers 2631 25.00 37949 Medical Records - Rebecca Richards Oct 31/2000 Expense Recovery 00261 13.03 38534 Postage - Oct Oct 31/2000 Expense Recovery 00266 7.50 38807 Facsimilies - Oct Oct 31/2000 Expense Recovery 00269 3.00 39156 Photocopies - Oct Nov 30/2000 Expense Recovery 00271 1.50 39324 Facsimilies - Nov Nov 30/2000 Expense Recovery 00295 4.00 40816 Telephone - Nov Dec 31/2000 Expense Recovery 00292 3.90 40543 Photocopies - Dec Jan 15/2001 Edwin A Aquino, MD 2983 350.00 40314 Outside Professional - legal letter R Richards Jan 31/2001 Expense Recovery 00306 1.54 41242 Postage - Jan Jan 31/2001 Expense Recovery 00307 1.50 41339 Facsimilies - Jan Jan 31/2001 Expense Recovery 00311 3.45 41584 Photocopies - Jan Feb 28/2001 Expense Recovery 00318 1.02 42203 Postage - Feb Feb 28/2001 Expense Recovery 00319 0.60 42301 Photocopies - Feb Feb 28/2001 Expense Recovery 00322 2.50 42420 Telephone - Feb May 31/2001 Expense Recovery 00377 2.25 44916 Photocopies - May Feb 28/2002 Expense Recovery 00518 0.34 52176 Postage - Feb Feb 28/2002 Expense Recovery 00521 0.15 52301 Photocopies - Feb Aug 31/2002 Expense Recovery 00583 1.50 56482 Facsimilies - August Sep 30/2002 Expense Recovery 00595 1.50 57351 Facsimilies - September I UNBILLED I TOTALS CHE+ RECOV FEES+ = TOTAL PERIOD 400.63 50.78 0.00 451.41 END DATE 400.63 50.78 0.00 451.41 I BILLED DISBS + FEES + 0.00 0.00 0.00 0.00 I I-- BALANCES --I TAX - RECEIPTS = A/R TRUS9 0.00 0.00 0.00 0.0( 0.00 0.00 0.00 0.0( I UNBILLED I FIRM TOTALS CHE+ RECOV FEES+ = TOTAL PERIOD 400.63 50.78 0.00 451.41 END DATE 400.63 50.78 0.00 451.41 I BILLED DISBS + FEES + 0.00 0.00 0.00 0.00 I I-- BALANCES --I TAX - RECEIPTS = A/R TRUS~ 0.00 0.00 0.00 0.0( 0.00 0.00 0.00 0.0( REPORT SELECTIONS Report: Requested by: Finished: Date Range: Matters: Clients: Major Clients: Responsible Lawyer: Client Ledger CLE Wednesday, October 02, 2002 at 03:47:51 PM ALL DATES 001213 All All Firm Totals Only: All Entries Shown - Billed Only: No Oct 2/2002 Shollenberger & Januzzi, LLP Page Client Ledger ALL DATES Date Received From/Paid To Che# General Bld Trust Entry# Explanation Rcpt# Rcpts Disbs Fees Inv# Acc Rcpts Disbs Balanc( Introducing Lawyer: Ail Assigned Lawyer: Ail Type of Law: Ail Sort by Resp Lawyer: No New Page for Each Lawyer: No New Page for Each Matter: No Totals Only: No No Activity Date: Dec 31/2199 Vet: 5.53.20010830 Entries Shown - Disbursements: Yes Entries Shown - Receipts: Yes Entries Shown - Trust: Yes Entries Shown - Time or Fees: Yes Working Lawyer: No Incl. Matters with Retainer Bal: No Incl. Matters with Neg Unbld Disb: No Trust Account: All Show Client Address: No NOV :I Z00Z G:\GLOBAL\WP DATA\DOCS\Petitions to Approve Compromise Settlements\Richards Rebecca - Petition for Approval of Minor Settlement,wpd SHOLLENBERGER & JANU771, LLP 1820 Linglestown Road P.O. Box 60545 Harrisburg, Pennsylvania 17106-0545 Telephone Number: (717) 234-3700 Fax Number: (717) 234-8212 REBECCA RICHARDS, CHARLES SMITH, her Parent and Natural Guardian, Petitioners ROBERT KOLESAR and LANE CONSTRUCTION COMPANY, Respondents IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA AMICABLE ACTION 3RDER AND NOW, this J~'l~l~ day of 1~ ~ , 2002, upon presentation and due consideration of the foregoing PETITION TO APPROVE COMPROMISE SETTLEMENT & DISTRIBUTION OF PROCEEDS, it is hereby ORDERED and DECREED in accordance with the provision of Pa. R.C.P. 2206 that the Petition is GRANTED. Payment of fees and expenses as listed in the Petition is approved and payment of $3,973.59 to Petition, Rebecca Richards, is directed to be made as follows: (a) The sum of $3,973.59 to be distributed on behalf of Rebecca Richards to be deposited in one or more savings accounts in the name of Rebecca Richards in banks, building and loan associations, savings and loan associations, or credit unions, deposits in which are insured by a Federal government agency, provided that the amount deposited in any one such savings institution shall not exceed the amount to which accounts are thus insured, or in one or more accounts in the name of Rebecca Richards investing only in G:\GLOBAL\WPDATA\DOCS~Peti[ions to Approve Compromise Settlements\Richards Rebecca - Petition for Approval of Minor Settlement.wpd securities guaranteed by the United States government or a Federal governmental agency managed by responsible financial institutions. (b) No withdrawal can be made from said chosen account until Rebecca Richards attains majority, except as authorized by a prior court order of this Court. (c) Petitioner shall provide proof of deposit by filing proof thereof with the Prothonotary of.l~igiatai~County; (d) Counsel shall be permitted to collect an attorney's fee equivalent to twenty-five percent (25%) of $5,900, or $1,475, and reimbursement of costs in the amount of $451.41 (e) Petitioners, Rebecca Richards and Charles Smith, her Parent and Natural Guardian, upon receipt of the proceeds of the foregoing PETITION TO APPROVE COMPROMISE SETTLEMENT & DISTRIBUTION OF PROCEEDS, are authorized to execute the revised Release and Indemnity Agreement marked and offered as Exhibit "C".