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HomeMy WebLinkAbout09-11-08SCHMIDT KRAMER PC BY: CHARLES E. SCHMIDT, JR., ESQUIRE I.D. #19198 209 State Street Harrisburg, PA 17101 (717) 232-6300 c7 ~' ~ 7 ~ ~ _ `rr ~ ~ E.. ~'.. ~~_~~ - -I -rte f_'`'t ~: ,... T7 t __ ~ c~ ;~ , Attorneys for Petitioners IN RE: CHRISTOPHER J. BLINN, a minor, by MICHAEL and SANDRA BLINN, his Parents and Natural Guardians, Petitioners IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHAN'S COURT DIVISION NO. o`~~ 68 Qq~B PETITION FOR APPROVAL OF MINOR'S SETTLEMENT PETITION FOR APPROVAL OF MINOR'S SETTLEMENT AND NOW, come the Petitioners, Michael and Sandra Blinn, by their counsel, Schmidt Kramer PC, and set forth the following Petition in accordance with Pennsylvania Rules of Civil Procedure 2039. 1. Petitioners, Michael and Sandra Blinn, are the Parents and Natural Guardians of Christopher Blinn, a minor (Birth Date: June 22, 1998), who was injured in a collision on October 13, 2006, in Cumberland County, Pennsylvania. 2. Petitioners and Christopher Blinn live together at 200 Hollywood Circle, Camp Hill, Cumberland County, PA, 17011. 3. Petitioners' minor was a passenger in a vehicle which was rear- ended in the 5800 block of the Carlisle Pike, in Hampden Township, Cumberland County, PA, 17011. (See Hampden Township Police Department attached as Exhibit A.) 4. The driver, who hit the vehicle in which Christopher rode, was unable to give the Hampden Township police a reason for why he did not stop. The other driver's liability was clear. 5. Petitioners' minor was injured as a result of the collision. (See Treatment Summary attached as Exhibit B.) 6. The tortfeasor, Srikanth Vadlakonda, was insured by Geico General Insurance Company at the time of the collision, under policy numbered 4073655591. Geico paid its $30,000 occurrence limit. Petitioners' minor, Christopher Blinn, received $1,000 of the settlement, with the remainder distributed to four other members of the Blinn family who were also injured. The remainder of the funds was distributed to Christopher Blinn's parents, and his two brothers. (See Geico Declarations and Settlement Checks attached as Exhibit C.) The third party settlement is not the subject of this petition. 7. The vehicle, in which Christopher Blinn rode at the time of the collision, was owned by Petitioner, Michael Blinn. The vehicle was insured by USAA Casualty Insurance Company under a policy numbered 003861636071013, and the policy was effective from May 16, 2006 through 2 November 16, 2007. The policy provided underinsured motorist-bodily injury coverage in the amount of $600,000 per person and $1,000,000 per accident, after stacking. (See USAA Declarations attached as Exhibit D.) 8. After USAA was presented with a demand for payment, Petitioners' attorney negotiated a settlement in the amount of $8,750.00, which Petitioners tentatively agreed to accept. 9. It is the opinion of Petitioners and their counsel, Charles E. Schmidt, Jr., Esquire, that this settlement is fair considering Christopher Blinn's injuries. Petitioners and their counsel believe the settlement is in the best interest of Petitioners' minor, Christopher Blinn. 10. The proposed allocation to Christopher Blinn, after attorney's fees and costs, is $6,407.68. 11. Petitioner, Michael Blinn, entered into a Contingency Fee Agreement with Petitioner's counsel, Schmidt Kramer PC. The agreement calls for a fee of 25% on any recovery, which in this case amounts to $2,187.50. (See Contingency Fee Agreement attached as Exhibit E.) Petitioners came to engage Schmidt Kramer PC by way of a referral from Steven J. Schiffman, Esquire, Seratelli, Schiffman, Brown and Calhoun, 2080 Linglestown Road, Harrisburg, PA 17110, who will receive one half (1 / 2, or $1,093.75) of attorney's fees. 12. In addition, Petitioners have incurred costs in the amount of $154.82. (See Printout of Costs attached as Exhibit F.) 13. Petitioners request the amount to be awarded to the minor, 3 Christopher Blinn, or $6,407.68, be distributed without the formal appointment of a guardian, to be placed in a sequestered bank account in compliance with Pa. R.C.P. 2039(b)(2), by Michael and Sandra Blinn, Parents and Natural Guardians, in the name of the minor until the minor reaches eighteen (18) years of age. Said account shall be marked as follows: "This money shall be held in trust, not to be redeemed, except by Order of this Court, before June 22, 2016." 14. A copy of the proposed Release is attached hereto as Exhibit "G." 15. The Petitioners request that your Court enter an Order: (a) approving the minor's settlement; (b) approving attorneys' fees; (c) approving reimbursement of costs to Schmidt Kramer PC; and (d) authorizing Michael and Sandra Blinn, Parents and Natural Guardians, of Christopher Blinn, a minor, to sign the Release attached to this Petition as Exhibit "G." Dated: ~ fi~ `f , ~~ Respectfully submitted, IDT KRAM R PC ~f By ~ ~ _~~C Charles E. Schmi t, Jr., Esquire Attorney I.D. # 19198 209 State Street Harrisburg, PA 17101 (717) 232-6300 Attorneys for Petitioners 4 VERIFICATION I, Charles E. Schmidt, Jr., attorney for Petitioners, verify that I am attorney of record for the Petitioners, and that the foregoing document contains no facts within the knowledge of the Petitioners, but rather, is based upon the record or facts solely within the knowledge of the attorney; and, for that reason, I make this Verification on behalf of Petitioners. I verify that the facts contained in the foregoing document are true and correct to the best of my knowledge, information and belief. I understand that intentional false statements herein are made subject to the penalties of 1$ Pa. C.S.A. X4904 relating to unsworn falsifications to authorities. c .~~ ~ , By: Charles E. Schmi t, Jr., Esquire Attorney I.D. # 19198 209 State Street Harrisburg, PA 17101 (717) 232-6300 Attorneys for Petitioners Date: ~e~~ `f , dcx~8 Print CRS W0044863 ...J CONflRAO(NUUE~ILTH OF PENPNSYLV~INIA POLICE CRd~SH Rfi:POQtTIR6G PORfiA Casa Closed Reportable Crash AA~'500 i 0 Yqs Q No Q Yes Q No Page 1 of 9 iiinuueiaimi a..__ ~ incident Number Police A eo Patrol Zone HAM20061000449 21103 100 en Name Prednd Investi anon Date {MM-DD-YYYY) Hampden Township ] 0 f 3 - 2006 ~~ -~ ~~ ~ Dis stch lime (m!q Arrival Time (rrrfp Invest for Numb g 1502 1806 CPL JEFFREY A SNYDER 19-11 g Reviewer Bad a Number A val Date (MM-0D-YYYY) SGT SHAUN A. FELTY 19-2 10 - 20 - 2006 Coun Coun Name Munk al Muntd alit Name Qay of b9/eek q 2l Cumberland ~ 103 ampden Township O sun O m~ l ~ Crash Data MM-DD- Gash Time (mi!) No of Unks Pea le In ured Killed• •!f > 00 ~ Mon Q Fri ~ D sat 10 - 13 - 2006 1802 3 G 1 0 complete O We Form F O Unk d f Y Complete School Bus School Zone Noti PENNDOT Worlaona~~ S (~ Yes Q No 29) o Yes O No O Yes O No s Q N ti t O Y n e ec wr o Re ated Related Mai tenance ~ fete lore R~n~ O 4 Way Intersection Q 'Y' Intersectan Q Muib-Ley O OFf Ram • htersecuon P O Railroad Crossing erJal (] Midblock Traffic CircW R4Cdit7ZQ O 'T' Intersecion O Round About O On Ramp ~ Crossover Q Other Soe Oveal RouteRoute N~ Se ment {O tiorraq 7ra~ es ~mit O ~ 0011 OS 40 8 House Number (if appGcaWe) ~ l Stree4 Name Street Ending O East ° For Mid-block crashes ordy. Use o H N b ~ Q West PK • CARLISLE O Q UnkrroNTl ouss um er a make sure p Pnnupal Roadway Rreei Name is filled in if using this option Ali ~ Interstate 0 Turnpike O Turnpike O State O County O Local Road ~ Pivate ~ Other/ Wot Turnpike) (EastMlest} Spur H' hwa Road or Street Road Unknown (Route Number Se meet ( ~tw`n`aq} T-ave! lanes Speed Umft ~ 02 25 ~ O southh C~ ~ ~ Street Name Street Ending ~ O ~~ JEFFREY ~ O west O o Unknown _ S1D111tl& O Interstate O Tump~ke O Turnpike O Stale O County O Local Road Private OtheN (Not Turnpike) {EastNVest) Spur Highway Road or Street Q Road ~ Unknown Intersectin Rt Num Or Mik Post Or Se ment Marker ~ North F t . ~ ~ O O ~~ O e y Or Intarsectin Street Name St E ~ di Please n n Q East Enter Information ~ E ~ West Or Miles fer BOTH ' ~ ^ landmarks if Using h lntersacting Rt Nunt Or Mile Post Or S meat Marker N c ~ - Distance from Crash T is Option w ~ ~~ . ^ ~ Q South ti O I St Scene to Landmark t C h b (F g r ntersec n reet Name St Endin ~ O East or ras etween ~ O West landmark t and Landmark 1) De reel Minutes Sewnds De rees NBnutes Seconds Latitude: 40 14 3I .000 Longitude: - 76 59 ; 21 ~ 000 Traffic Control Device Q Yield Sign ~ Pofice Officer or O Not Applicable O Traffic Signal Active RR Crossing Flagman ~ No Controls O bevrce functioning ~ pre~emptr ve O Other Type TCD Improperly O Controls Flashing Traffic Sigr~l O Signal O Stop Sign O Passive RR O Unknown Q DevKe Not O Device Functioning O Unknown Crossing Contros Functioning Properly L~rt.Llasd Rf 'Not gpplieble', skip rest of the lane Uosrnp sercUorQ ( ©NoAh (~ East Q North and South (~ AO a O Not AppNcable O Partially O Fugy Q Unknown ~ Q South Q West O East and West (N.S,E,W) g r~ Y~ o N~ o 9 Unknown Q ~ O < 30 Min. O 30.60 Min. Q i-3 hrs Q 3-6 hrs Q 6-9 hrs Q > 9 hours Q Unknown r e r~oror r,aA~soo tteaal PENNt70T COPY 1 http://www.dot6.state.pa.us/icons/PrintImages/XmlFiies/2006I02906I GUTSHALL 1950... 1 I /14/2006 Print CRS W0044$b3 ~~~ ~ ~~ I~S~(Ldt~~~~ POUCH t1~a11F~1A~VFYIING ~itiiR Pagr AA 500 2 "°'~"~0i1j' ~. Page 2 of 9 ~~niiimx Gash Number W0044863 O Motor Vehide in O Hit & Run Vehcle O Illegally Parked O Legally Parked ONon -Motorized 7~ Transport Commercial Yehide Unft PedesVian on Skates, Disabled Fran Train O Phantom Vehicle --- O Pedestrian O in Wheelchair etc O Previous Crash 0 Q Yes O No , ' (!t Yer~ Complete Form ~ Com fete form M Section 28 'Pedesirlan' or 'pedestrian on Skate; In Wheelchair etc Unft No First Name MI Data of Birth (N1M-DO-YYYY) O1 SRIKANTH ~ 08 15 1977 last ~~ Tale hone Number Dekte7 ~ VADLAKONDA 7603176444 Addrr~ I I state Zi 3521 SIPTEMBER DR APT 5 CAMP HILL PA 17011 Driver Llanse Number S P eA da~~ 29030835 Aloohol/Dttas Susaected Driver or Pzdes"uian Phw>tcaf Condition O ~ O Illegal Drugs O MedkaUon O ~~renty O IIIe4al Orug O Fatigue Q Medicat'ron O Alcohol O Alcohol and Drugs O Unknown O Dnnkrn~n O Sick O Asleep O Unknown ~ Alcohol Test TYp~ O Test Not Given O Breath O Other primary Vehlde [ode Ylofatlon Charged? ~ ~] Blood r0 urine O Ten" cif DRIVING VEHICLE AT SAFES O Yes O No ~(cnhof Test Results (~ Test Refused O Reurl~n i DNver Presence 1=Driver Operated 3=Driver Fled Scene Vehicle 4=Hit and Run ven, O Test G ^. ~ O Contaminated Results 1 ~ 2=No Driver 9=Unknown OsvnerlDdver 00=Not Applicable 02=Private Vehicle Not 04=State Pdke Vehcle . 07=lVlunioipal PoUce Veh 09=Federai Gov Veh 01=Private Vehide Owned/ OwnedlLeased by Driver OS=PENNDOT Vehicle OB=Other Municipal 48xOther O1 teased b/ Driver 03~tented Vehicle 06=Other State Gav Veh Government Vehide 99=Unknown Owner Flrst [dame Owner Last Nama or Business Name (If Pedestrian, skip this Section) Sams #s Driver O SRIKANTH VADLAKONDA Address / t State / 2l Vehkle Make •Make Code 3521 SEPTEMBER DR APT 5 CAMP HILL PA 17011 Honda 37 VIN Modal Year Vehicle 1~dodel (see overlay) 1HGGB7678PA067682 1993 CUEX Ltoense Plate Reg. State Est, Speed Yehkke Towed Towed $Y GLX4226 PA 025 O Yes O No ROADSIDE AUTO R insurance Insurance Company Policy No OY~ O ~ O ~~,n GEICO 4073-65-55-9i z 7ira17Fn 1=Tovrr+ng Pass. Veh 4=MobileMbdular Home 7=Seml•T~ailer Tag No Tag Year Tag St Unit Trd~xi Q tin ~ 2=Towing Truck S=Camper 6=Other ~ [~'~ Unk n ~ J 9 l T g e now _ = railer 3aTowin Utili Trailer 6~ul Units: a Direction of ^ •Vehick PosRlon 03 'Movement 01 'See E overla SireWl Usage y ~ y ~t VehWe Tune OS=large Truk 20=unicycle, Bicycle, l -- _ r 12~ommerdal ~ O6=Yelkrw 09 07=Saver 01=Automobile O~wV Tn~ Ul 02=AAotorcycle O7iVan 21=Other Pedakycle se & B 22 H il 00=Not Applicable Carrk 9 Ot=Fire Veh 13_Taxi OB=Gold 0}=Blue 09=Brown or = uggy e 03=Bus 10=5rtowrrrob 04aSmall Truck 11=Farm Equip 23=Horse & Rider p2=Ambulance 21=Tractor Trailer 03.Pdke 22rTwin Trat'1er 02=Red 10=Orange (il '02", Complete Form 12=Construclron Equip 2d=Treat 13=ATV 25.Trolley OB=Other Emergency 23=Triple Trailer 03=White 11=Ptrrple M, Section 261 Complete j ~ "20' or "21' Un k T p Sp cc Vehicle 31=Moddred Veh 1 }=Pupil Transport 99=Unknown 05-BWck g9=Unknown , known Veh 99= y 9~1n form f~ Section 27) ~Nal fmaact Po/et 1)amave lndfator Gradient 3=Downhill Road Alionmenf 00=Non•CoiCrsion 14=Undercarrlage 12 Ol Points 15=Towed Unit 12dlod 0=None 2=Functiawl ~ 1=Minor 3=Disabling 4=Bottom of Hi-1 ~ 1'level 5=Top of Hill hRl 1=Straght Q 2=Curved c • 13=Top 99at1nknotim 4=Unknown 2=Up 9=Unknown 9=Unknown row+ rr ~soo trams PENNDOT COPY http://vvww.dot6.state.pa.uslicons/PrintITnages/XmlFiles/20061029061 GUTSHALL1450... 11/14/2006 Print CRS W0044863 ~E.IQE ~15911i~~RYPNG iF+rDQt11R ~- 500 2 ~~°^~ H~III~11 Page: ~~~ W0044863 Page 3 of 9 Gash Number Motor Vehkk In Hit & Run Vehicle O illegally Parked ©Legally Parked O Non • Motorised Tree O Transport O Commenlaf Yehide llnff Pedestrian on Skates, Disabled From h O Train O Phantom Vehkle Q Pedestrian O i i h C h l i O P 0 Y~ 0 Po ras rev ous n W r, etc ee a c pf Ye; Complete Form C~ f 'Pedestrian' or 'Pedestrian on Skater !n Wheelchair etc' Com kte Form M Section 28 Unit No First Name PRI Date of Birth (MM-OD•YY1'1r) 02 SANDRA A^ 03 08 1966 Lsst Name Tele hone Number Delete? O gL~ 7177379343 Address / q !State Zi 200 HOLLYWOOD CIR CAMP HILL PA 17011 Driver License Number State Class 21270383 PA Aleohol'iDruos Suspected Driver ar Pedrstitan Phvsiat Condition O No O Illegal Drugs O Medication O ~~nt1y O Illegal Orug O Fatigue O Medication O Akohd O Akohol and Drugs O Unknawrt O ~ Been O Skk O Asleep O Unknown M Afmhof Test Tvpe O Test Not Given O Breach Q Other Primary Vehkte Code Vklaiion Charged? = O stood Q Urine O 7eri~ G~rvenif O Yes O No ~y Alcohol Test Results O Test Refused O Res t Giv T n Driver Pnsertcs 1=Driver Operated 3.Driver Fled Scene Vehicle 4=Hit and Run ~ ~ , es e lts inated Res O C t D -U I 2 9 k D i N ~ on am u r ver - nown = o n OumeNDriver 00=Not Applicable 02.Private Vehicle Not 04=State Pollee Vehtde 07=Municipal Police Veh 09=Federal Gov Veh Ot=Private Vehkle Owned/ Ovvned/leased by Driver OS=PENND07 Vehicle 08=Other Municpal 98=Other ~ 1 Leased by Driver 03=Rerned Vehkk l]b~thes State Gov Veh Government Vehkte 99=Unknown owner First Name Owner Last Noma or Business Name pf Pedestrian, sk1 this Sedlon) ~~ ~ D'~"" O MICHAEL A BL1Nl~t Address / C /State / ZI Yehicte Maka 'Make Code 200 HOLLYWOOD CIR CAMP HILL PA 17011 Dod a 07 VIN Model Yesr Vehicle Modal (~ oveday) 2B8GP44312R594978 2002 CAR !~ License Plata Reg. State Est. Speed Vgh cis T rued Towed 8y EPF9568 PA 000 O Yes O No ROADSIDE AUTO R /nsunnoe Insurance Company Policy No OY~ O -~ O k~, USAA CASUALTY INS CO 00386 i6 3GC 71013 I r mpka t Yawing Pass. Veh 4=Mot>ile/Modular Home 7=Semi-Trager Tag No Tag Year Tag St B r Oth f N i 7 S C = ~~ e amper Onk o. o ~ ~ 2=Tow ng rudc = Trailing 9=Unknown F il i ili il 6 ll T T er ra er ty ra = u ng Ut 3=Tow Units: s D~ ~ 'Vehicle Position 03 'Movement 03 O erla jai ilsaae v y Vehicle Color Vehfde Type OS=Large Truck 20~Jnicycle, Bicycle, ~~ 12 PM~~r~at Of~Yellow OS 07=Silver 01oAutomabite O6.dW Tricycle U1 02=Motorcycle 07=Van 21=Other Pedalcycle 00=IVotApplicable Carrier 01=Rre Veh 13=Taxi OB=Gold 03=gam 10=Snowmobile I2=Horse & Buggy 02=Ambuiance 21 Tractor Trailer O7=Blue 09=Brawn 02=Red 10~range 04=Small Trudr 11=Farm Equip 23^Horse & Rider (Jf 'D2", Complete form 12=Construction Equip 24=Train 03.Pdice 22=Twin Trailer pg=Other Emergency 23=Triple Trailer 03=White t 1=Purple 04--Green 12=Other h4 SttYkn 2) 13=ATV 25=Trolley (if "10' ar '2 t ;Complete 18=Other Type Spec Veh 96 Uther Vehicle 3t=MOdiRed veh 11,pupil Transport 99=Unknown 05=81ack 99=Unknown form M, SecUan 27) 19=Unk. Type Spec Veh 99=Unknown Mftisi impact Point Damage lndiotor Gndlen 3^DownhiB Road Aihlmnent 06 00=Non•ColUsion 14=Undercarriage i 2 DaNone 2=Futxtionat 1=Minor 3=Disabling ^ 1 1=Level 4.Bottom of KII S=TOpof Hill 1 1=SUai~t 2=Curved t 01-12=elodt Points ]S=Towed Un 9°Unk"~n 2=Uphill 9=Unknown 9=Unknown t3=Top 99=Unkrwwn rorw • rwsoo pa~ozt PE.NNDOT GQPY http://www.dot6.state.pa.us/icons/PrintIrnages/XmlFiles/20061029061 GUTSHALL1950... 11114/2006 Print CRS W0044863 J c4~ ®1` ~(kR15Y1rVAF~1~ ~1~ d~N RE~BING fGOtRA AA 500 2 '°~°' `"° On1j Page: W0044863 Page 4 of 9 Gash Number O Mo~~ ide In O Hit & Run Vehicle O INegaly Parked O Legaly Parked ONon -Motorized Commerrlal Vehcle T Unit O Pedestrian [~ Petlesinan on Skates. O Disabled From O Train O Phantom Vehicle in Wtteek:hair, etc Previous Crash O Yes O ~ (If Y l t f C C N 'Pedestrian' or 'Pedestrian on Skates in Wheelchafr etc' Com ete Form Section 28 omp e orm e 1 es Unit No Frst Norma MI bate of Birth (MM-0D•YYYY) 03 BONITA A^ 02 t3 1960 last Name Tefc hone Numbe- Deletel p WELLS 717732308b Addreu t l State ZI 705 CARRIAGE LN MECHANICSBURG PA 17050 prtver license Number S p [las~ 17233380 _ . ~ Alcohgl/Drugs Sirsvetted Orfver or Pedestrian Phvsicaf Condition g Q No O illegal Drugs O Medication O ~ ty O fU~al Drug O Fatigue Q Medication O AJcohd O Alcohol and Drugs O Unknown O Had Been O Skk Q Asleep Q Unknown Dr'mkin t4koho! Te~ae Q Test Not Given Q Breath O Other Primary Vehlde Code Violation Charged? ~ Unknown iF O Blood O Urine O Test Given O Yes Q No y Akoho! Test Results [~ Test Refused O Resin T t G'n n giver Presence 1=Driver Operated 3=Driver Fled Scene Vehicle 4=Hit and Run I , es re d Results i t ~ ~ O C t ~ k '~•J•-• i 4~J N D am na e . on n nown r ver 2= o OwneNDrlver 00=lJo! Appkcabte 02=Private Vehicle Not O4=State Police Vehicle 07=Municipal Police Veh 09~ederal Grnr Veh Ot=Private Vehicle Owned/ OwnedA.eased by Driver 05=PENNDOT Vehlde 08=Other Municipal 98=Other OI Leased by Driver 03=Rented Vehicle 06=Other State Gov Veh Government Vehicle 99=Unknown Stone ~ Owner First Nsme Owner Last Name or Businoss Narne [If Pedestrian, ski this Section} orhrer ~ BONITA A & MITC WELLS Address / /State / Zf Vehicle Make 'Make Code 12 705 CARRIAGE LN MECHANICSBURG PA 17050 Ford V~ Mode) Year Whicle Mode! (~ overlaYl 1FMDU77K44UA53395 2004 EPR Lkense Plate Reg. Sate Est. Spend Vehkfe Towed Towed By YPE 1203 PA 000 O Yes O No ~~ insurance Insurance Company Polley No (~ Yes p tro O known AIyI)rRICAN FIRE & CASUAL •GVA 036525$0 ' t ~~pirt 1=Towing Pass. Veh 4=Mobile/Modular Home 7=5emi•Trailer Tag No Tag Year Ta St er 8=Other of n win Tn[ck S-Cam it - No n 2 T U p Un . g n = o Troifurg u r 9=Unkrwwn ~~( F ll T il i ili il f U T er ra e ng n u t ty ra 3aTow Units: ~n of E~"" "Y~Itk PpslUon 03 •iWoyement 03 "See O k i D S etts~ i tlsaue y ver r ave Vihide Color Vehcle TYwe OS=Large Truck 20~Unicyde, Bicycle, 00 12=C dal 06=Yelkrrv O8 07=Silver Oi+v4utomobile ~'SW Td~~ ~ 02=Motorcycle 07=Van 21~iher Pedalcyde o0=NOt Applicable Carrier Ot=Fire Veh t3=Taxi OB=Gold 01=Blue 09=Brawn 03.Bus 10=Snowntabile 22=Horse & Bu 04=5maA Truck 11=Fans Equip 23=Florae & Rider 02=Ambulance 21=Tractor Trailer 03~Pd'Ke 22=Twin Trailer 02=Red 10=Orange (If '02", Complete Form 12=ConstnrRwn Equip 24=Thin 13.ATV 25=Trolley l 08=Other Emergency 23=Triple Trailer 03=White tf~urple 04=Green 12>~ther } h4Section (If "20" or '21', Complete 18=Other Type Spec Veh 98.Other Vehicle 31stv10rJtfiedVeh 11=Pupil Transport 99.unknown 05=Blade 99-~Jnknown form M, Seaton 17} 19=Unk. Type Spec Veh 99=Unknown impact Paint ln/t/aJ Damage lndlator Gradient 3=pownhill Road Alignment , 06 ~=~~~s~ 1A=V~orcert~~ 01-12dkxk Prints 15=Towed Unit 1 O~None 2=Functional ~ 1=Minor 3=Disabling I 1~level 4=Bottom of HiR ^ 5=lop of Hill 2 h ll U 1 1=5Vaight ~ 2=Curved 13=lop 99=Unknown 9-Unknown = r p 9rrUnknovvn 9=Unknown PDRM ~ M-600 trtA21 PENNDOT COPY http://www.dot6.state.pa.us/icons/PrintImages/XmtFiles/20061029061 GUTSHALL 1950... 11/14/2006 Print CRS W0044863 COMNA(yP11~LTF9 OiP PENNSYLVANIA POUGE CRASFI REPORTING FORBfl pia AA 5t}0 3 ~• us. ony Page 5 of 9 ~~iiia Gash Number W0044863 Q tt=Dr~rve~r~ D Qoassmgerl0ccupant E Oo= one /Not Applicable (-,7 Not applicable 2=PassenQer 01=Driver -All Vehicles Ot=Shoulder Belt Used 1=Not Effected 7=Pedestrwn 02~ront Seat Middle Position Ob.lap Bek Used 2:Totally Ejected 8=Other 03=Front Seat Right Side 03=lap And Shoulder Beh Used 3=Partially Ejected 9=Unknown Q4=Second Row -Left Side Or 04=Chiid Safety Seat Used 9=Unkrwwn Motorcyck Passenger 05=MOtorcytk Helmet Used 05=Second flow -Middle Position 06z8icycie t~leVnet Used i H p ~ e t Used Improperly ~. 06=Second Row -Right side t0..5atety Be No E je ct d /Not Applicable B F =Female 07=Third Row Or Greater - tl~hi Safety Seat Used Improperly 1=Through Side Daor Opening Left side 12=:Helmet Used Im rly M=Wlale 2=Through Side Window e Unknown 9D R sVaint Used t G d R O Thi , yp = er - e ow rea r r 3=Through tNindshieid U =Unkrwwn ~= Middk Portion 99=Unknown 4=Through Back Door 09=Third Row Or Greater - S=Through Back Door Tailg?te Opening Right side 6:Through Roof Opening (sunroof/ 10=sleeper section of Truckcab ~ 00= one s /Mot Applicable Convertble Top Down) OYNot In red 11-In Other Encbsed 01=Front Air Bag De d (for This SeaU 7='~trough Rooi Opening (Convertible 1=Killed Passenger Or Largo Area 02=side Air Bag yed (For 7fus seat) Top ljp) T i D b d ype A r ag ebyp ye Z=Major Injury 12Mn ppen Area 03=Other g„Unknown 3:Moderate (Back Of Pickup, Etc.) 04aMultipk Air Bags DeP P t i d E ye ro ect on e In ry 13 7radirg Unit OS=Motorcy 4- ator Injury ~ 14=Riding On Vehkie Exterlcr OfFBicyclist Weanng Elbow/Knee/Pads B=Ir>jury, Unk 15~us Passenger 10=Air Bag Not Deployed, Switch On ~ O=Not Applicable Severity 98=Other 1t=Air Bag Not Deployed, switch Off 1aNot Extrcated 9=Unknown if 99=llnknown t2=Afr Bag Not Deployed, 2:Extricated By Mechanical Means Unk Switch Settin g 3sFreed By Non -Mechanical Means klury 13=Air Bag Removed (Prior To trash) g:Other 19=Unknown If Air Bag Depoyed 9=Unknown 99=Unknown Etws Agency: AMB 71, CO 30 Medical Fadllty: HOLY SPIRIT HOSPITAL Unit No Person No Date of Birth (MM-DD-YYYY) A B C D E F G H I O1 OI De0 ~ 08 - IS - 1977 1~ M~ 0~ O1 03 00 1~ 0~ 1~ Nams /Address !Phone EMS Transport ^ ~ t~or VADLAKONDA, SRIKANTH 3521 SEPTEMBER DR APT 5 CAMP HILL P p Y~ O No Unit No Person No Delete? Date of Birth (MM-DD•YYY1~ A B C R E F G H I 02 O 1 O 03 - 08 - 1966 1~ F~ ~ O1 03 10 1~ ~ 1~ Name /Address /Phone EMS Transport ~ Same as gl,~jj~~ SANDRA A 200 HOLLYWOOD CIR CAMP HILL PA 1701 1717 Oyes p No Operator Unit No Person No DeteteT Date of BI MM-0D-YYYY) A B C E F G H 02 02 O OS - 04 - 1964 2~ M~ 0~ 03 03 10 1~ 0~ I~ Nams /Address /Phone EMS Transport ^ op~e ar wr MICHAEL A BLINK 200 HOLLYWOOD CIR CAMP HILL PA 17011 717 p yes O No Unft No Peron No DeleteT One of Birth (MM•OD-YYYYy A B C D E F G H I 02 03 O 06 - 22 - 1998 2~ M~ 0~ ~ 03 ~ 1~ 4~ 1~ Name 7 Address /phone EMS Transport ~ same as CHRISTOPHER I BLINK 200 HOLLYWOOD C[R CAMF HILL PA 17011 O Yes O No Operator Unit No Person No DeleteT Date of Birth tMM-DD-YY`M A B C D E F G H I 02 04 O 06 - 22 - 1991 2~ M~ 0~ 06 03 ~ 1~ 0~ 1~ Kama /Address /Phone EMS Transport ~ soma as DAVID N BLINK 200 HOLLYWOOD CTR CAMP HILL PA 17011 71773 Oyes O No Operator Unit No Person No Delete? Date of Birth (MM-0D•YYYY) A B C D E F G H I 03 Ol O 02 - 13 - 1960 1~ F^ ~ O 1 03 10 Name /Address /Phone EMS Transport ~ same as WELLS, BONITA ANN 705 CARRIAGE LN MECHANICSBURG PA 17050 O Yes O No Operator FoaN • rwaoo nbsD PEfVfVDOT COPY http:!/www.dot6.state.pa.us/icons/PrintImages/XmlFiles/2006 i 029061 GUTSHALL 1954... 11 /14/2006 Print CRS W0044863 J co~wwjo~rE~~rao o~ p~~a~sv~v~~i~- POUCE CRI!<SOi REPORTIP6G FORRA Page AA 500 4 'e°°° t"' °ny' ' ~~ Page 6 of 9 ,,, i Crash Desrrlntlon ~ 1~ear End ~ 3.p~~t~ pear ~~ab ~ ~~? BaFNt Pedestrian ~ ~ (Baddng) ~ B~rec9on) 7=FIAObject 9=odterNnknoxm Rektiorr to Roadway ~ 1~n Travel lanes 3^Medfan 8^Outskle Treffk:way 7diore (Aarnp Inleraectfon) - 2^St oukt r 4 p i id r e ^ oat s e 6^In Parking lane 9=Unlurosim IUuminatlon 1^Deylight Street 5^DaYm 8~ther -"~ 2~ ei ~ ~ a n ~ s1r ms ROechv lqh ~- T ~ ~ _ iNeatherCondlflons ~ t~r~ 3=fleet (Hail) 5~og 7:Sleet A Fog g=UNmown -~ 3r _ 2=Rakr 4wSnow ti~iain li Fvg 8.Olhor ~ -_ -- ~ `"- 2=~nd, Mud, Oln, 4=Slush t~lw Patches Boas! Swfaa Conditions a O~ryr tt>~iher - 1=Wet 3=Snow Covered 6=iCe 7°a S~ng mt R ast l o;Te i~ilm-bar i 02 a Q HarmlW Events (Harm Fventl 30=Hit Fence Or Wall W'~ 01=Hit Urrt 1 31=Hit Buikfag Unit No 02=Hk Urrt 2 32=Hit Culvert 0 j 2 ~ Q 03.Hit Udt 3 33*Hit Bddge Pier Or Abutment 04.Hit Udt 4 34=Iiit Parapet End 05=Hit Urwt 5 35=Hk Bdd R i a ge O6.Hk Other Traffic Unit 36-Hk Boulder Or Obstacle Please Put 3 ~ ^ Q 07=Hit Deer On Roadway 08 Hit O h ! 37 A i FR I Events in S uenNal ~ = = er n t ma t mpact ttenuata 09=Cdfsion Wdh Other Non 38=Ffit Fire Hydrant Fi d 39 }G rder 4 ~ ^ Q ~ xe = t 11=Struck B+~ilnit 1 40=Hit MazBo Equipment 12=StrtKk By Unit 2 41~Ik Traffic Blard 13^S1r k B U it 3 42 Hi 5 Harm Event L/R Most? UtRity Pole Number y n = tK t raw Bank 14=51nxk By Unit 4 43=Hit Temporary CorKtnrcGon 15=Strta:k B Unit 5 Barrier S .. T j j ~ Q 16=Struck By Other Traffic Unk 464Hit Other Fixed 21 Hk T , , Unit No ^ ree Or Shrubbery 49^Hk Unkrwwn Rxed 22=Hit Embankment 50--OverturNRoll Over ~1~ , 02 2 03 O 23^Hk Ut~(y Pole 51 ^Stnrck Sy Tlmown Or Falling 24=Hit Traffic Si Ob t gn jec ~ Wease Put 9 ~ a 25=Nk Guard Rail 52=Pot Hiles Or Other 26=Hit Guard Rail End PavenKnt kregularities EMenis in ~ Seauentiaf 27=H1t Curb 53=Jadcnife 28=i6t Caxrete Or 54tF'ire In Vehicle Order 4 ~ ^ 0 longitudinal Barrier SB~ther Non-Cdlision 29=Hit Ditch 99=Unkrgwn Harmful Event First Unit No Harm Evart Most Unit No Harm Evert a ~ Oj 02 vaen tn~ 02 11 Driver Action fa) 17=Careless Or Illegal ~o Contn'6uting Action Backing On Roadway d 18`Driyin9 On The Wron 01=priver Wss Distract U+e Cr i g e 02.Drivin Side Oi Road Usin Hand H ld Ph to ~a ^wr wr hrom^s^, ^~ ~nar weR g g e one 03-_priring Using Hands Free Ptwne 1g-0vlaking lmAroper Envlronmartal/Roadway t Potentla! Factoa (FRi) ~ 2 ~ 3 ~ 04^Making Illegal U-Twn EnUance To Hghway OS=Improper/Carekss Turning 20~vlakinq Improper Ewt 0l~Tumin F W l ~ 00=Nork: 11a5itmery Aoad Conditions (kp/5now} g rom rong ane From I igMaray 07=P-oaednlg Wro 21=Careless ParkmglUnparking Cleararxe Aker Sto 22 0 Ot=W ~ymd Conditions 12=Substance On Roadway 02=Sudden Weather Conditions 13.Potholes 03~ h W h i p = verNnder 08-Komi Sto n nunngg ~ ~ C~~~n At Curve ~ t ~ er t eat er Condit ons 14~roken Or [racked Pavement 04=Deer In Roadwa 'S=TCD Ob t t d ~ 10-faiure To p~ To Zq,~p~ ~j of y s ru e 05=0l~tade On Roadway 16=Soft Shoulder Or Shoulder Drop OH Other Traffic t-onGOt Cavite _S~aiwre Te MarMaln Pro 11=T aung p C w ~ O6.Other Animal In Roadway 2~Od~er Roadway Factor 07^Glare 29=Other Environmental faROr 26=Driver p~;ng Pdice (Pat s 12=Sad-den Sbwinol~top~ng 21~rhrer I rienced 13=Ulegally Stoppe8 On Road 28 F il T OB=Work Tone Related 99^lNdmawn = a ure Specialind Equip 14~arekss Passing Or lane 92w4ffected B Ph skal nddti C . y o on Change Y g E PbssibJe Vehida FaNures M 12=Wipers 00_None 06=E,diaust 13=Drover SeatlncyConVd 15~.Passirg In No Passing Tone 98~Other improper Ornnng Actiorn t6=Driving The Wrong Way On 99=Unknown ° ~ 01.Yves 07=Headlights 14°Body Doan Hood, Etc 02=Bnke System 08-5 nal L'ghts 15=7raifer Hitch i-Way Street p~Sy~m 1 ~~ 16=~~s 17- O 1 1 j j 2 3 4 OS^POwer Tran 11=Mirrors 18=Tra~7er Overbaded Unk 19=Unsecure/Sh O j 1 00 2~ Trailer load N UnR No 02 1 00 2 3 4 , 2 2 0 ~r~ted Nfi sh~ekl Unit ~ 02 1 ~ 2 ~ p~estrkn Action f~ 03^Wodcing 00=None 04=Pushing Vehicle Ot~ntedng Or Crossing Ai 05^MwoarAing Or leaving VefQde 064Workin V hi l S +ti O hrdiated Prime factor Unk No Factor Code g n e pec ed locatpn c e 024Walkirz). Running, Jogging, 07=Standing ~u~ w«ewuon un 01 j j Or ~"ny 99~nknovm E/R v a r ~ Q Q Q IiE/R k the Prime Factor Unit No Oj 00 Unit No 02 00 type, leave Unit No blank PENPiDOT COPY 6 http://www.dot6.state.pa.us/icons/PrintImages/XmlFiles/20061029061 GUTSHALL 1950... 1 I / 14/2006 Print CRS W0044863 COAAMOA11fllEALTH O~ P~W1Pd5YLVAAIIA POLICE CRASH REPORYIiNG FpRNA page AA 500 4 ~""0r1y Page 7 of 9 s~wiiinei ~.m ~ W0044863 Gash Demktlon 0=Han-CoAlelort 2.Head On 4 e 8=Sld 8=Hit Pedestrian ~ ~ a ,=Hear tend _ er ~Flaer ~~reclion) 7^ (H10t~~jerf 9=OttregUnfaavrtt Iteration fo Roadwsv a 1~n Travel Lanea 3~uledtan f S~utaide TralRCway 7.Qore (Fiamp Intersectlon) 2*Sllouldef 4=Roar~lde ti=lo Park(ng Lane ~llnlmaxm { ~ HfumJnatlon 1 2,"p~g0 t.fghts~~ ~* 8=Olher ~~ - ~+ n ~ Street 4~uak U~- ~Vjg_thrr CondlHons ]~ i'~ o~rea 3.Sbet (Hatt 6=Fog ~ 7=Sleet!, Fop `~ 9=Unknown --- 2=Aaln 4=Snow 8^Nain i Fog 8=OBter s Road Sur/ace Condltfans a 0=Dry 2, Mud, Dirt, 4^~tralt D=ice Patc4tes -=-- a=Other 1=Wet 3=Snoty Covered (l=ice 7 w vent ost7 t~PT tTum~et Harmful Events (Harm Et!ent) 30=Hit Fence Or Wall~~ f l2 ^ ~ ~ Oi=HitUrrtl 31=FfM1BrriWing Unk NO 02=Hi1 Unit T 32=Hit Cuhert ^ 03.Hit UnN 3 33=Hit Bridge Pier Or Abutment 03 2 ~ 04~IR Un$ 4 34=Hit Parapet End 05~iit Urrt S 35=Hit Bn' Rail Oti~iR Other Traffic Unit 3f,=Hit Boulder Or Obstacle please put O7dli! Oeer On Roadway Events In 3 ~ © OB=tfit Other Animal 37=Hit ImpaR Atienuator S uenUa! 09{oBision With Other Hon 38=FIit Fie Hydrant Order Fixed Object 39.Hit Roadway Equipment 4 ~ ^ Q ~ t t=struck By Unit t 40=Hit Mail Box 12=Stnxk fly Unit 2 41=Hit Traffic Island 13=Struck By that 3 42=HN Snow Bank Hatm Event L/R Most7 UtBity Pde Number 15=Struck Bey l~but• S 43' ~~' Conswction f ~ ^ ~ 16~Struck BY Other TraHit Unit 4e=H$ Other Fixed ObieCt Uritt [+b 21=Hil Tree Or Shrubbery 49=Hit Unknown F Object 22=Hil fmbankment 50=OverturrVRoU Over Z ~ ^ ~ 23=Hi1 UtrTi_ty Pde 51^Strudk By Thrown Or Falling 24=Hit Traffic 5Surg~n Object 25=Hit Girard Rani S2=Pot Holes Or Other please p~ 3 ~ ^ 2fi=Flit Guard Rail End Pavement irregularities Events !n ~ 27=Hit Curb 53=Jacknrfe Sequential 28dtioit~Concrete Or 54=13re In Vehicle Order 4 ~ ~ O 29=Hit Dikh nal earner S~U~na~aH rdml fu Event F! Unit No Harm Event ~t Unit flo Harm Event OrlverAcdon fD) t7=Care>eu Or IBega1 ~ O1 02 acv nr m_ U2 11 loo Contnlwting Action 6ackin9 On Roadway the c sn Ot=Driver Was Detracted 18=Dmring On The Wrong 02-0riving Using Harts Held Phone Side Of Road ~ ~ ~ ~ ~+~ m wo~c 03=Driving Using Hands Free Phone 19=Making Improper ~/Rosdtvay 04~viaking Regal U•Turn Entrance To Highway ~ 1 DD 2 3 OSdmproper/Careless Twning 20=Makirtg Improper Exit PotirrNar (rectors (FlRJ ~ ~ ~ O6=Tirming kom Wrong lane From Hghway OO~lorie 11=5 pery Road Conditions OcelSriow) 07=Proceeding Wi0 21=Careless ParkinglUnparki+tg 01=Windy Cand6ons tz=Substance On Roadway Clearance After Srop 22~ver/Under O2~Strdden Weather Condition 13=Potholes ~=R~~9 Stop S•g n Compensation At Curare 03~lher Weather Condition 14~roken Or Cracked Pavement 09'Runnrrg Red l.ght 23=Speeding 10=Faidrre To Res~p~!dd To 2q=Drin T 04^Deer In Roadway . t 5=TCR Obstructed Olher Traffc COnUO! Device 25=faturre 7 MaMtain Pr onditio45 05~bstack On 1C>=Soft Shoulder Or Shoukfer Drop tiff 11=Taipating~ °~ O6=Odter Animal In Roe ay 28.OIher Roadway faRor 12.Sudden SlowirxyStoppin 2fi=Driver Fleeing Police (PoI Chase) 07=GIare 29=Other Environmental Factor 13=Illegally S~t~oP~P~~edd On Rooaad 27=Driver lnex~vienced 08=YVotk Zone Related 99=Unknown 1A=Careless Passing Or lane 28=FaBure To the SpeciaTtred Equip Cage 92~Aifected By Physical Condition ! Pes~lbfs Vehlsle paQures (Vj 12=Wipers 15.Passing In No Pacing Zone 98+~titer Improper Drrvng AcUarts 00=None 06=Exhaust 13~rrver 5eatingKonVol 1f>=Oriving The Wrong Way On 99=Unknown 5 01=Ties 07=Headli hts I Doors, Hood, Etc 1•Way Street E 02~rake System O0~~SSiigqnalg~ghts 15=Tral r~ Hitch Unit P 03=Steering System 09.Ofher lights 1~Wh¢ek po 03 f 00 2 3 4 4 04=Suspension 10.Nara jg.T a Overbaded S~ 05=Po+w+er Train 1 t:.Mirrors if i Not 03 f QO 2 ~ 2o, p per~SOWindg °u ~ f Q z ~ 3 ~ 4l~„~ 2t~~1~ Windshield pedesdlan Action fpi 03=working Noh ~ 1 ~ 2 ~ OD=None 04=Pushing Vehicle 01=Entering Or Crossng At 0 caching Or leaving Vehicle Specified location Ofs • g On Vehicle Mdiated P(!me Factw Unk No Factor Code 02=Walking, Running, logging, 07=Standing Do not spat We inramKion an Or lrlayrig 98=0ther mufuWe vN~• Ol 11 99=Unkric+vn E/R V D P O O O O Jf F/R h the Prime Factor unit No 03 00 unit No Type, leave Unit No blank ..,^,..,M.w ~.~,,,~, PIENNDOT COPY 7 http://www.dot6.state.pa.us/icons/PrintImages/XmlFiles/20061029061 GUTSHALL1950... 11 /14/2006 Print CRS Vi~0044863 J COMMONWEALTH OF PENN5YLVAAt1A POLICE CRASH REPORTING 60RM AA 500 5 ~ '"° °i~' ~ 'n~~i Page 8 of 9 Crash Number j f ~ r r ! i i ~ ' F i ~ ~ ~ j s i i ~ i i i I f E I F ~ f ~ F f i . .........~. ' s ~ F i ~ i I ~ ~ ..F i +` 1 i I F I ~ i i\., I i ~ ~ t I t 7 . .~ ........_ _..._... i i i 1 z ~ ~ I -.-F__•__..E...._...y.....- ~ .....tw .._...~ ... ._ .. ._...i.__....E.... __.L.._._.j...._ . ._i-».__..F._....._I.._...... i......_._ ! I._....._! ° I i ~ e ~ ,..y...._.__~.__......,. .. 1 E _. ._. ~_ ..•_ a F F ! E i i ! .I._.__..1.._....«3.._ ,~ . [ I ~ F [ ~ ~ F j _.. i i ~ i ~ r s ~ F w.._ ._....-, F j _ I F = j . ~ ~._._ _._._. e i ~ ~ s ; .....~. _.._._........f .. F i ~ i ~ ' ~ ~ ~ I t i __. •. _._ .. ce. ._..._.. ~._._... ~ .._._... ,.._.__.,........ ~....._._ _ ._._.. ~....._._~ ~ ~•_-._.F I _. _ .. ~ I ' j .-.....`... f F !_. ~ ~ ' i ~ i f i E # I Witness Name Address Phona 1 2 Narrative and additional witnesses: Acddent investigatiExs NotificatiEm issued? Q Property Damage O V1, V2 & V3 WERE ALL EASTBOUND iN THE LEFT LANE OF THE 5800 BLK OF THE CARLISLE PIKE. V3 STOPPED 1N FRONT OF V2 & V2 STOPPED IN FRONT OF V1. V1 WAS UNABLE TO STOP AND REAR-ENDED V2 CAUSING V2 TO REAR-END V3. V1 & V2 WERE TOWED BY(f0 ROADSIDE AUTO RESCUE. OPER V2 WAS TRANSPORTED BY AMBULANCE 71 TO HOLY SPIRIT HOSPITAL. S OPER V1 DID NOT HAVE AN EXPLANATION FOR THE CRASH. HE STATED THAT HE WAS ATTENTIVE, NE WASN'T SPEEDING OR TAILGAITING AND THAT V1'S BRAKES W ERE COMPLETELY OPERATIONAL. M ~ y i FORM 1 M-l00 n7~ PENNDOT CDPY http://www.dot6.state.pa.us/iconsiPrintTmages/XmlFiles/20061029061 GUTSHALL 1950... 11 /I4/2006 Print CRS W0044863 Page 9 of 9 Crash Number. W0044863 Incident Number. HAM20061000449 _......_.-._.._............--•-- ............j ~~T F~ ~~~~ -~~ I V -- ~~ -Unit t- ilnd S-'~Jnit Z- --bJnit 3-- - o d lr I~ 5800 blk Carlisle Pike - U 5 i 1 ~ ~ ~. ;•- 9 http://www.dot6.state.pa.us/icons/PrintTmages/~mlFiles120061029061 GUTSHALL1950... 11/14/2006 Page 1 of 2 Close Window Synopsis Q Quality Assurance Synopsis ~ Report Crash Synopsis created 11/14/2006 for Crash Number W0044863 Web Group: DA. Police Agency Data: Tha crash report was recorded by police agency 21103-Hampden Township, petrol zone -100, urxfer incident number HAM20061000449. The dispatch date was 10/13/2006, the dispatch time was 1802 hours, the investigation date was 10/1312006, the arrival time was 1806 hours. The investigator was CPL JEFFREY A SNYDER, badge number 19-11. The report was approved by SGT SHAUN A. FELTY, badge number 19-2 on 10/2012006. Crash Data: This rear-end crash occurred in Cumberland county, in the municipality of Hampden Township, on Friday, 10!1312006 at 1802 hours. The illumination at the time of the crash was daylight. The 3-unlt crash involved 8 people with 1 injury. There were no fatalities. This is a reportable crash. Highway maintenance was not notified. The crash was not school bus related. The crash was not school zone related. There was no PennDOT property damaged. The crash did not occur in a work zone. The roadway surface was dry. Weather conditions included No adverse conditions. A notification of an axident investigation was Issued. Other environmental !roadway potential factors included None. The indicated prime factor for this crash was a driver's action (Tailyating) for unit 01. The first harmful event for this crash was that unil 1 Hit unit 02 and the most harmful event for this crash was that unit 2 was struck by unit 1. Type Location: This was a four way intersection crash, which occurred ai no special location. Principal Roadway: Cumberland County, route 0011, the orientation of the roadway was East, there were 05 travel lane(s), the speed Limit was 40 Mph, with State highway route signing. Intersecting Road: Cumberland County, JEFFREY Road, the orientation of the roadway was South, there were 02 travel lane(s), the speed limit was 25 Mph, with Local road or street route signing. GPS: The police-artefact Latitude was 4014:31.000 and the police-entered Longitude was 78 59:21.000 TCD: Traffic Control Device: a traffic signal, functioning property. Work zone: Type of Work Zone: not a work zone. Lane Ciosure: Partially closed. Lane closure dirsctfon East. Traffic detoured no. Estimated hours closed 30 - 60 minutes. UNIT INFORMATION: 1 Unit Number 1 was a motor vehicle in transport. The unit was owned by SRiKANTH VADLAKONDA. Address: 3521 SEPTEMBER DR APT 5, CAMP HILL, PA 17011. This 1993 Honda identified by VIN: 1HGC67678PA067682 was regisfered in PA with License GLX4226. Travel speed: 025. Unit insured: vehicle has insurance, Insurance Company: GEICO, Policy number: 4073-65-55-91. The Unit was towed by ROADSIDE AUTO RESCUE. This was not a commercial vehicle. This Unit was an automobile, Vehicle color. Brown, Specla! Usage: Not applicable. The initial impact point was at 12 o'clock, Damage Indicator: Functional {mod. -may be undmeabfe), Vehicle role: Striking, Vehicle position: in the left lane. Direction of travel: East, Movement: Going straight, Gradient: on a level roadway, Alignment: Straight. Driver Information: The driver of this unit was SRIKANTH VADIAKONDA. Address: 3521 SEPTEMBER DR APT 5 CAMP HILL PA 17011, Telephone: 760-317- 6444, Height: 5 Ft 10 In. Drivers License #: 29030835, State; PA. D08: OSl15i1977, Age: 29, Sex: Male. Seating position: driver's seat. Primary safety equipment: lap and shoulder hart were used. Secondary safety equipment: None used /Not applicable. Injury severity: Not injured. Ejection: Not ejected. Extrtcatlon: Not extricated. EMS Transport: No. AlcohoUDrugs Suspected: none suspected, Alcohol Test Type: Test not given, Alcohol Test Results: Result = 0.00. Drivers action(s), 1 Tailgating. The individual's condition was apparently normal. Vehicle code DRIVING VEHICLE AT SAFE SPEED was violated. Citation was written. UNIT INFORMATION: 2 Unit Number 2 was a motor vehicle in transport. The unN was owned by MICHAEL A BLINK. Address: 200 HOLLYWOOD CIR, CAMP HiLL, 10 http://www.dot6.state.pa.us/crash.nsf/Synopsis?OpenForm&Seq=1 11 /14/2006 Page 2 of 2 PA 1701 i. This 2002 Dodge identified by VIN: 2BBGP44312R594978 was registered in PA with License EPF9568. Trave! speed: Stopped. Unit insured: vehicle has Insurance, Insurance Company: USAA CASUALTY INS CO, Policy number: 00386 16 36C 7101 3. The Unit was towed by ROADSIDE AUTO RESCUE. This was not a commercial vehicle. This Unit was an automobile, Vehicle color: Gold, Specal Usage: Not applicable. The initial knpact point was at 6 o'clock, Damage Indicator: Functional (mod. -may be undriveable), Vehicle role: Both striking and struck, Vehicle position: in the left lane. Direction of travel: East, Movement: Stopped In traffic lane, Gradient: on a level roadway, Alignment: Straight. Driver Information: The driver of this unk was SANDRA A BLINN. Address: 200 HOLLYWOOD CIR CAMP HILL PA 17011. Telephone: 777-737-9343, Height: 5 Ft 6 tn. Drivers License #: 21270383, State: PA. DOB: 03/0811966, Age: 40, Sex: Female. Seating position: driver's seat. Primary safety equipment: lap and shoulder belt were used. Secondary safety equipment: Air bag not deployed, switch on. Injury severity: Minor injury. Ejection: Not ejected. Extrication: Not extricated. EMS Transport: Yes. AlcohoUDrugs Suspected: none suspected, A~ohol Test Type: Test not given, Alcohol Test Results: Result a 0.00. Drivers action(s), 1 No contributing action. The individual's condition was apparently normal. Passenger Information: A passenger (1): MICHAEL A BLINN, Address: 200 HOLLYWOOD CIR CAMP HILL PA 17011. Telephone: 717-737-9343. DOB: 05/04/t964 Age: 42, Sex: Male. Seating position: Front seat right side. Primary safety equipment: lap and shoulder belt were used. Secondary safety equipment: AEr bag not deployed, switch on. Injury severity: Not injured. Ejection: Not ejected. Extrication: Not extricated. EMS Transport: No Passenger tntonnation: A passenger (2): CHRISTOPHER J BLINN, Rddress: 200 HOLLYWOOD CIR CAMP H1LL PA 17011. Telephone: 717-737-9343. DOB: 06/22/1998, Age; O8, Sex: Male. Seating position: Sewnd row -left side ar motorcycle passenger. Primary safely equipment: lap and shoulder belt were used. Secondary safety equipment: None used /Not applicable. Injury severity: Not injured. Ejection: Not ejected. Extrication: Not extricated. EMS Transport: No. Passenger Information: A passenger (3): DAVID N BLINN, Address: 200 HOLLYWOOD CIR CAMP HILL PA 17011. Telephone: 717-737-9343. DOB: 06122!1991, Age: 15, Sex: Male. Seating position: Second row - right sEde. Primary safety equipment: lap and shoulder belt were used. Secondary safety equipment: None used /Not applicable. Injury severity: Not Injured. Ejection: Not ejected. Extrication: Not extricated. EMS Transport: No. UNIT INFORMATION: 3 Unit Number 3 was a motor vehicle in transport. The unit was owned by BONITA A & MITCHELL WELLS. Address: 705 CARRIAGE LN, MECHANICSBURG, PA 17050. This 2004 Ford Identified by VIN: 1FMDU77K44UA53395 was registered in PA with License YPE1203. Travel speed: Stopped. Unit Insured: vehicle has insurance, Insurance Company: AMERICAN FIRE & CASUALTY, Policy number. DVA 03852586. The Unit was not towed. This was not a commercia! vehicle. This Unk was a small truck, Vehicle color. Gold, Special Usage: Not applicable. The initial impact point was at 8 o'clock, Damage Indicator: Minor (able to be driven), Vehicle role: Struck, Vehicle posHton: In the left tans. Direction of travel: East, Movement: Stopped in traffic lane, Gradient: on a level roadway, Alignment: Straight. Driver Information: The driver of this unit was BONITA A WELLS. Address: 705 CARRIAGE LN MECHANICSBURG PA 17050. Telephone: 717-732-3086, Height: 5Ft 2 In. Drivers License fi: 17233380, State: PA. DOS: 02113!1960, Age: 46, Sex: Female. Sealing position: drivers seat. Primary safety equipment: lap and shoulder heft were used. Secondary safety equipment: Air bag not deployed, switch on. Injury severity: Not injured. Ejection: Nof ejected. Extrication: Not extricated. EMS Transport: No. AlcohollDrugs Suspected: none suspected, Alcohol Test Type: Test not given, Alcahol Tesl Results: Result = 0.00. Drivers actions}, 1 No contributing action. The individuals condition was apparently normal. ,Close Window 11 http://www.dot5.state.pa.us/crash.nsf/Synopsis?OpenForm&Seq=1 11/14/2006 Christopher Blinn Summary of Treatment after October 13, 2007 Auto Collision Christopher Blinn was very shaken after the accident. Physically, he found it necessary to see a chiropractor for shoulder pain and for a feeling of needles in his back. He came under the treatment of David W. Gerhart, D.C., beginning on November 3, 2006. Dr. Gerhart found Christopher to have stiffness in his neck and shoulder, and diagnosed him with cervical and thoracic sprain/ strain. Dr. Gerhart treated Christopher seventeen (17) times after the initial examination. He focused on Christopher's C6 vertebrae in his cervical spine and on the 2nd and 8~ vertebrae in his thoracic spine. Christopher completed his treatment with Dr. Gerhart on February 16, 2007. Christopher met with Bernard I. Zeliger, D.O., on February 19, 2007, as he continued to experience pain in his cervical and thoracic spine. He also reported to Dr. Zeliger that he was still having pins and needles in his back. Dr. Zeliger related the injury to the motor vehicle crash on October 13, 2006. On examination, Christopher was found to have discomfort in his neck and upper thoracic spine. Dr. Zeliger diagnosed him as having cervical and upper thoracic sprain and strain. Dr. Zeliger saw Christopher again on April 12, 2007, and found that he continued to have pain in his neck and upper thoracic spine. Dr. Zeliger ordered an MRI, because he thought Christopher should be getting better, and he was not. On May 22, 2007, Dr. Zeliger met with Christopher and his parents to review the results of the MRI. Because he found only a small abnormality, Dr. Zeliger continued to feel Christopher was suffering from cervical and thoracic sprain/strain, now seven months after the collision. Christopher Blinn continued to treat with physical therapy until July, 2007, at which point he was discharged from Central PA Rehab Services, Inc. 35/14/2007 10:09 5402667265 GEICQ CLAIMS PAGE 02f02 ~ ^ Governxrzent panployces ~surauce Company 1i CsBICt7' General insurax-ce Company w GETCO InQeartrrity Cornpemy ~D~ #a.GCyl't"t M G}riC4CasusityCo~aapany One G>~tC~'1 boulevard IR Fredericksburg, VA ~J.CATI4N U~' LAS To Whom It May Goncerrz: This will certify that GEICO General Insurance Company has issued as automobile policy, 4073655591, to: Szikau,th Vadlskonda 3521 Septctvber Drive, Apt 5 Camp Hiii, I'A tliak was ixz effect on the accident date of 10!13/2046 providing tixe £ailawing coverage an a 1993 Honda j Accord EX, Vehicle Identification Number (~VIN)1FIGC8767$PAfl676$2: Bodily Injury Lisisility Property Damage Inability First Paxty Benefit`s Medical Expanses Income Lass Funeral Expenses Accidental Death Extraordinary Medical Benefits Uninsured Matcrrist Bodily Injury Stackable- # vehicles Underinsured Motorist Bodily It+jury Stackabie - # vehicles CompreheztsivE Coverage Collision Coverage Tort Option ERS Rental ReimbursEment $] 5,440 per pexsan! ~34,40fl per accident NIA per accident N!A per person N!A per person NIA N!A per person N/A per ptrsan N!A per person. 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T'n lI1 C.~ L'O O 0 ~. ___ USAA CASUALTY INSURANCE COMPANY • ?y„ ~'•~ (A Stock Insurance Company) U~A~® 9800 Fredericksburg Road - San Antonio, Texas 78288 PENNSYLVANIA AUTO POLICY RENEWAL DECLARATIONS MICHAEL A BLINN 200 HOLLYWOOD CIR CAMP HILL PA 17011-2627 PAGE 5 ADDL INFO ON NEXT PAGE MAIL MCH-M-i State t)b U( VaA PQLICY NUMBER 7 tart 00386 16 36C 7101 3 OPERATORS 01 MICHAEL A BLINN 03 SANDRA ANN BLINN eSCrt t10r1 Ot Vel1l Cle S VEH USE* woAx/scNOOt H YEAR TRADE NAME MODEL BODY TYPE ~ IDENiIFiCATION NUMBER SYM Molles a° apa~s W Week 6 02 DODGE GRCVN SPT WAG 4X2 4D 13000 268GP44312R594978 11 W 02 5 T 04 HONDA CRV LX UTILITY 10000 JHLRD78S14C012346 11 W 03 5 Vehicie(s describe herein is principally garaged at the above address Un ass otherwise stated, rc= ark/scnnul• s=B sinesr F-Farm~P=Pleasure EH Ob CAMP H ILL PA 17011-2627 EH 07 CAMP H - ILL PA 17011-2627 TFis r~o Ilcv provi es t ose_ coverages w ere a aremium s sown a ow. The limits s own vehtcies for which a premium !s !lstea_unless speclttcalry autnorizea els~where.in this Rolicv. wOVERAGES LIMITS OF LIABILITY ("AGV" MEANS ACTUAL CASH VALUE) VEH ~~f'j{.~ ~ AED P~EMIUIUi ~ MOUN S QVEH (~Q~ D~DED PREMIUM MOU S VEH D=DED PREMIUM MOUN S VEH O=DED PREMIUM OUN S .RT A - LIABILITY BODILY INJURY EA PER $ 300,00 EA ACC $ 500,00 69.39 76:59 PROPERTY DAMAGE EA ACC $ 50,00 49.68 S4.b9 RT B - FIRST PARTY. BENEFITS MEDICAL EXPENSE $ 10,000 WORK LOSS $ 5,000/$1,000 MO FUNERAL EXPENSE $1,500 19.31 28.6 RT C -UNINSURED MOTORISTS STACKED BODILY INJURY EA PER $ 300,00 EA ACC $ 500,00 25.13 25.1 RT C - UNDERINSURED MOTORISTS STACKED BODILY INJURY EA PER $ 300,00 EA ACC $ 500,00 60.37 b0.3 TOTAL PREMIUM -) SEE FO~LOWihIG PAGEI(S ) SS PAYEE H 06 CHASE MANHATTAN BANK, DALLAS TX H 07 USAA FEDERAL SAVINGS BANK, SAN ANTONIO TX DORSEMENTS: ADDED 05-1b-Ob - A100PA(02) MAIN IN EFFECT(REFER TO PREVIOUS POLICY)- A081(04) A089(04) A400CW(01} A142(01} S100PA(01} FORMATION FORMS(NOT PART OF POLICY)- 39PA(01} ~bOPA(02) bb3PACIC(03) 999PACIC(17) ~sizoll~op01 i f M~„p7R0122opo0pol I i NI I laf I I I i l l i~l I i~l ~ utT L~~ ve cause~tTiis policy o be signe your esi en an cre ary at sn Antonio, exa on this data APR I ,L~jj 9 , 2006 USAA CASUALTY INSURANCE COMPANY 1A Stack Insurance Company} U$ BSDO Fredericksburg Road - San Antonio. Texas 78288 PENNSYLVANIA AUTO POLICY RENEWAL DECLARATIONS ed Insured and Address MICHAEL A BLINK 200 HOLLYWOOD CIR CAMP HILL PA 17011-2627 VEH YEAA TRADE NAME MODEL BODY TYPE Ob 02 DODGE GRCVN SPT WAG 4X2 07 04 HONDA CRV LX UTILITY e e tc e s escrr a eretn s pnncr a y ara e a e VEH 06 CAMP HILL PA 17{11-~62~? VEH 07 CAMP HILL PA 17011-2627 PAGE & State Ob 07 vab POLICY NUMBER T.n 0038b 16 36C,~ 7101 IDENTIFICATION NUMBER 10000 ~ JHLRD78514C012346 a the EH USE f~w,oaK~`scr SYM die°v 1 ~1 11 IW 103 COVERAGES LIMITS OF LlAB1UTY (""ACV"" MEANS ACTUAL CASH VALUE? 0~~" b-MONTH D=DED PREMIUM MOON 8 C~ln b-MONTH D=DED PREMIUM MOON g vr=>, D=DED PREMIUM OUN S vtrt DaDED PREMtUh MOON 8 COMPREHENSIVE LOSS ACV LESS D 20 25.64 200 30.2 COLLISION LOSS ACV LESS D 50 90.76 500 113.76 INCREASED RENTAL REIMBURSEMENT 21.62 21.6 OTHER COVERAGES EXTRAORDINARY MEDICAL BENEFIT 12.4 17.7 4.301 1428 , b MONTH PREMIUM $ 803.08 FULL TORT APPLIES THE FOLLOWING COVERAGES) DEFINED IN THI POLIC ARE NOT P VIDE FOR: VEH 06 - TOWING AND LABOR VEH 07 - TOWING AND LABOR THE LAWS OF THE COMMONWEALTH OF ENNS LVANIA, AS E ACTED Y T E GENERAL ASSEMBLY, ONLY REQUIRE T AT Y PURCH SE LIABILI Y AN FIRST PARTY MEDICAL BENEFIT COVE AGES. ANY A DITI NAL C VERQ ES OR COVERAGES IN EXCESS OF THE LIMITS REQUIRED BY LAW ARE PROVIDED ONLY AT YOUR REQUEST AS ENHANCEMENTS TO BASIC COVERAGES. THE PREMIUM FOR THE BASIC COVERAGE I5: BI 15/30 $ 77.75 PD 5000 $ 94.56 FIRST PARTY MEDICAL BENEFIT 5000 $ 33.29 ~, we nave caused this policy to be signed by our President and Secretary at San Antonio, Texas, on this date ~A~P~R,,I L~ 9 , 2006, ' PAGE 7 ctc 00386 t6 3b 7tot SUPPLEMENTAL INFORMATION >J$~® EFFECTIVE MAY 16 2006 TO NOV 16 2006 The following approximate premium discounts or credits have already been applied to reduce your policy premium costs. NOTE Age or senior citizen status, if allowed by your state/location, was taken inta consideration when your rates were set and your premiums have already been adjusted VEHICLE 46 DAYTIME RUNNING LIGHTS DISCOUNT -$ 3.81 MULTI-CAR DISCOUNT -$ 54.28 PASSIVE RESTRAINT DISCOUNT -$ 9.19 VEHICLE INJURY RATING DISCOUNT -$ 14.75 VEHICLE 47 MULTI-CAR DISCOUNT -$ 56.92 PASSIVE RESTRAINT DISCOUNT -$ 12.29 CONTINGENT FEE AGREEMENT THIS AGREEMENT entered into the .~ a day of ~~ ~ci, 2008, by and between SCHMIDT KRAMER PC and Michael A. Blinn, as parent and natural guardian of Christopher Blinn, hereinafter referred to as "Client." WITNESSETH: The law firm of SCHMIDT KRAMER PC, will act as Client's attorney in negotiating for a settlement, and in bringing an underinsurance claim against liSAA arising out of an accident which occurred on October 13, 2006. In return, the Client will: 1. Promptly supply accurate information, as requested by SCHMIDT KRAMER PC, and cooperate fully, including making herself available for meetings with attorneys and for legal proceedings. Client promises all information supplied will be truthful and accurate. 2. (a) In any claim brought on Client's behalf, to pay to SCHMIDT KRAMER PC, for its services an amount equal to twenty five percent (25°l0) of ail funds or property accruing to Client as a result of SCHMIDT I~RAMEP. PC's services in securing a settlement or resolution of these claims. (b) Client agrees not to settle or negotiate the above claim or any proceedings based thereon. (c) If Client terminates this Agreement before recovery, Client agrees that SCHMIDT KRAMER PC, shall be entitled to a fee based upon work done and benefit conferred. (d) Client agrees to read and follow SCHMIDT KRAMEP. PC's "Client Instruction Manual". 3. Client agrees to reimburse SCHMIDT KRAMER PC, out of any recovery, in addition to attorneys' fees, all costs and expenses incurred on Client's behalf in order to make the claim. All such casts and expenses will be advanced by SCHMIDT KRAMER PC as they are incurred. Such costs and expenses include, but are not limited to, filing fees, cost of medical records, copying .costs, fax costs, long distance telephone costs, expert witness fees and sheriffs service costs. In the event there is no recovery, the Client will not be responsible for any costs or interest charges. Costs will be repaid to SCHMIDT KRAMER PC, out of any funds or property collected either by settlement or judgment. 4. Claims for first party medical benefits and income loss benefits are separate items. SCHMIDT KRAMER PC, will help you process these claims. A separate agreement will have to be entered into for fees if a major dispute occurs requiring the filing of suit for these benefits. The Client has read and does understand this Agreement. Signed the day and year set forth above. WITNESS: Client: Michael A. Blinn, as parent and natural guardian of Christopher Blinn Approved: SC I ~ T K ER C ~. I Y I have received a copy of this Contingent Fee Agreement. MB Initials O .~1 r rn ~ w, ~ 3 ID a+ ~~~~ ~ ~ ~~ 3 61 ~ m ~ e xx°' ~ ~ C> ~ m m cn ~ o ~, ~ N C"> ~ 3 N 'O ~ UN '~ O ~^ N ~ ~ c. rn~W O w o o °~ ~ o ~ o, w C ~ A ~~~ fl. o. ~~~ c ~, ~ n ~ o`D~ 3 -cs ~_ ~ ro ~ n n ~O-~ 6 .~ a j 7 O G < N ~ ~ NO N ~~ ~v ~~ ~~ W ~ ~ ~ ~cwD~ A ~ ~ ~~ 0 ~ ~ pp N N N ~ N Ni yO ~ ~ ~ ~ ~ ~ ~ N ~ ~(3 0 ~ N ~ N A 3 0 3 0 C 'C d USAA USAA° tii~r~/'LUU2i 1z : 14 : L4 1~M 1~AGlr ~i oo~ r~ax server PARENTS/GUARDIAN RELEASE AND INDEMNITY AGREEMENT USAA Casualty Insurance Company Member Name USAA Number UR Number Des of Loss Michael A. Blinn 3861636 14 1413-2006 Cr1R AIJ I11A1 r`~AiCI~CD ATt r'i At ..F ati.. .. .. ..s •-- _~.._ _t aL_ .. _t it. n rn n. . ._.__. _.._rC>•:~:G.:i:-..........av uic~iiiiivi lW O,!]U VUI **eiaht thousand^seven hundred fifty dollars and no/100*** , the receipt of which is hereby acknowledged, Ilwe, the undersigned, father and mother and/or guardian of Christopher Blinn a minor, do forever release, acquit, discharge and covenant to hold harmless _ Michael A. Blinn his/her heirs, successors and assigns of and from any and all actions, causes of action, claims, demands,damages, costs, loss of services, expenses and compensation, contribution, Indemnification,on account of, or in any way growing out of, any and all known and unknown personal injuries and property damage which ilwe may now or hereafter have as the parents and/or guardian of said minor, and also all claims or rights of action for damages which thesaid minor has or may hereafter have, either before or after he/she has reached his/her majority, resulting or to result from a certain accideniwhich occurred on or about _ October 13, 2006 ator near Hamgden Townshi,~, PA I/We do hereby state that said minoris completely recovered from any and all injuries sustained as a resultof said accident and promise to bind myselflourselves jointly and severally, my/our heirs, administrators and executors repay to the said Michael A. Blinn his/her heirs, successors and assigns any sum of money, except the sum above mentioned that he/she/they may hereafter be compelled to pay because of the said accident. It is further understoodand agreedthat this settlement is the compromise of a doubtful and disputed claim, and that this payment is not to be construed as an admission of liability on the part of _ Michael A. Blinn by whom liability is expressly denied. I/We further agree and acknowledge that the releasees, and each of them, expressly reserve all rights of action of whatever kind against me/us, my/our heirs, executors, administrators and assigns and against said minor on account of, or in any way growing out of the above described occurrence or accident. I/We further state that Uwe have carefully read the foregoing release and know the contents thereof, and I/we sign the same as mylour own free act. a, Ps_ _ s a Pc' nv ntrsnn w n nnw nn v an w n en o Incomplete or mfsi up to seven years Executed at, WITNESSES: Signature Address Signature Address en aoalloa[gn Or City/State for this day of , Day iulonth Year CAUTION: READ BEFORE 31GNING Legal Signature Michael Blinn Print Name Legal Signature Sandra A. Blinn Print Name RAP012-0504 PA - D - 7101 -8 •6843 161 ^ 209 State Street Harrisburg, Pennsylvania 17101 717.232.6300 FAX 717.232.6467 www.schmidtkramer.com I N J U R Y LAWYER S September 8, 2008 Register of Wills Cumberland county Courthouse 1 Courthouse Square, 1St Fl. Carlisle, PA 17013 Re: Petition for Approval of Minor's Settlement Dear Madam: Please find enclosed our Petition for Approval of Minor's Settlement on behalf of Petitioners Michael and Sandra Blinn, for their minor child, Christopher Blinn. You will also find enclosed our check for $15.00. I have included two copies of the Petition. After you have entered the document, would you be willing to return a stamped copy to my office? I have enclosed an envelope for your convenience. Should you have any questions, please telephone me at my office. ~Ie~,truly yours, PC r~ ~,< _~ Charles E. Schmidt Jr. ~_ _, : ' f Attorney at Law =~ _ ~ <J ~_. __ •`z _ _., :. _, CES/d~c c-~ ~' ~~ O r- - _ ~~~ __. y Enclosures ~ ~ `~~ ~ .? cc: Steven J. Schiffman, Esq.