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HomeMy WebLinkAbout09-1964CHARLES VAUGHN and GIGI NESTER- VAUGHN, as Parents and Natural Guardians of of CHRISTIAN VAUGHN, a minor, PETITIONER, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA VS. _r WILLIAM H. TAYLOR, DOCKET NO. 0 li- RESPONDENT. PETITION OF CHARLES VAUGHN AND GIGI NESTER-VAUGHN,AS PARENTS AND NATURAL GUARDIANS OF CHRISTIAN `VAUGHN, A MINOR, TO COMPROMISE ACTION AND FOR APPROVAL OF SETTLEMENT Petitioners, Charles Vaughn and Gigi Nester-Vaughn, are the natural parents and guardians of Christian Vaughn, a Minor ("Minor"), and reside with the Minor at 148 Holly Street, Hummelstown, Dauphin County, Pennsylvania 17036. 2. Respondent, William H. Taylor, is an adult individual who resides at 4185 Mountain View Road, Apartment 114, Mechanicsburg, Cumberland County, Pennsylvania 17050. 3. The Minor is currently seven (7) years old. His date of birth is September 10, 1999. 4. On October 17, 2004, Respondent was the operator of a 1985 Ford Bronco which struck a motor vehicle operated by Bruce Nester ("Mr. Nester") in the parking lot of the Summerdale Plaza, East Pennsboro Township, Cumberland County, Pennsylvania. The Minor was a rear seat passenger in a vehicle being operated by his grandfather, Mr. Nester. 6. As a result of the impact, Minor sustained a laceration to his right cheek requiring six (6) sutures. 7. Other than removal of the sutures, the Minor has not required follow-up treatment for his physical injuries. 8. The Minor does have a small scar on his right cheek. A copy of the Minor's medical records from Holy Spirit Hospital is attached hereto, incorporated herein by reference and marked as Exhibit A. 9. At the time of the motor vehicle accident, Respondent was an insured under a private passenger automobile insurance policy issued by GEICO Indemnity Company which provided bodily injury liability limits of $100,000 per person and $200,000 per accident. A copy of the Certification of Limits is attached hereto, incorporated herein by reference and marked as Exhibit "B." 10. All of the Minor's medical expenses have been paid by automobile insurance. 11. Petitioners, through their employment, also have medical insurance for the Minor with Highmark Blue Cross and Blue Shield. 12. On behalf of Respondent, GEICO has offered to pay $9,000 by way of a structured settlement to resolve any claim that Petitioners, on behalf of the Minor, may have against Respondent. 13. The structured settlement agreement has been arranged through Cambridge Galaher Settlement and Insurance Services, Inc., with an annuity contract to be issued by Hartford Life Insurance Company. Hartford Insurance Company is rated A+, XV, by Best, AA- by Standard and Poor's, and Aa3 by Moody's. A copy of a letter from Donna M. Pease, Senior Case Manager from Cambridge Galaher dated February 20, 2007 is attached hereto, incorporated herein by reference and marked as Exhibit "C." 14. The structured settlement provides for sixty (60) equal monthly payments of $293.21 totaling $17,592.60 with the first payment of $293.21 being paid on the Minor's eighteenth (18') birthday, September 10, 2017. A copy of the settlement sheet is attached hereto, incorporated herein by reference and marked as Exhibit "D." 15. As part of the settlement, GEICO, on behalf of Respondent, is requesting Petitioners to execute the Uniform Qualified Assignment and Release and Settlement Agreement and Release. A copy of the foregoing documents are attached hereto, incorporated herein by reference and marked as Exhibit "E" and "F," respectively. 16. Petitioners have made a careful and diligent inquiry and investigation to ascertain the facts surrounding the accident, the responsibility therefor, and the nature and extent of the Minor's injuries, and believe that the settlement as outlined above is fair and in the best interest of the Minor. 17. Although executed by Petitioners, this document was prepared by counsel for Respondent in order to assist Petitioners to obtain the necessary Court approval of this settlement. 18. Counsel for Respondent has advised Petitioners of their right to seek legal counsel of their choice. However, Petitioners wish to proceed as set forth in this Petition. WHEREFORE, Petitioners, as parents and natural guardians of Christian Vaughn, a Minor, pray this Honorable Court enter an Order approving this Petition for Minor's Compromise. 3-2-oq Date Respectfully Submitted, Charles Vaughn, Indi 'WIluian lly and as Parent and Natural Gof Christian Vaughn, a Minor Gi ' ter-Vaughn, Individ ly and as Parent and Natural Guardian of Christian Vaughn, a Minor ADM. DATE: 10/17/2004 CHIEF COMPLAINT: Motor vehicle accident HISTORY OF PRESENT ILLNESS: This five -year-old boy was a restrained child in a front facing child seat, when his vehicle was struck on the passenger side by another vehicle. The patient sustained a small laceration on his right cheek. There was no toss of consciousness. The patient dues any neck discomfort or other injuries. PAST MEDICAL HISTORY: Asthma. CURRENT MEDICATIONS: None. ALLERGIES: None. SOCIAL HISTORYIFAMILY HISTORYIREVIEW OF SYSTEMS: Noncontributory. PHYSICAL EXAMINATION: CONSTITUTIONAL General: This is a well developed, well nourished, five Tear-old boy, who was restrained in his child seat and In a hard cervical collar. The collar was removed and the patients nook was examined. There was no spinal tenderness. The patient was taken from the child seat and placed on the liter. HEAD: There is a 3 centimeter curvilinear laceration of the right zygomatic area No bony abnormalities. EYES: Conjunctiva without discharge or injection. Lids without lesions. PERRL ENT: EARS: Tympanic membranes without perforation, injection or bulging. MOUTH: Lips, tooth, and gums normal. THROAT: Oropharynx without lesions, or exudate. Airway patent NOSE: Nasal mucosa normal. SINUSES: No sinus tenderness. NECK: Supple, symmetrical, nontender, no lymphadenopathy. Trachea midline. Thyroid non-palpable. LUNGS: Clear to auscultation and breath sounds. Normal respiratory effort HEART: Regular rate and rhythm without murmurs, ectopy, gallops, rubs, or thrills. GIIABDOMEN: Soft, nontender, normal bowel sounds, no masses. No hepatosplenomegaly. CHEST: Nontender to palpation. EXTREMITIES: Symmetrical. Full range motion. Equal tone and strength. No joint tenderness or effusion. No dubbing or cyanosis. NEUROLOGICAL: Alert and orientated to person, place and time. Cranial nerves intact. Sensory and motor function normal. Reflexes symmetrical. PSYCHIATRIC: Oriented to person, place, and time. Memory normal. Mood and affect appropriate. PROGRESS NOTESIMEDICAL DECISION MAKING: Under I% with epinephrine local anesthesia and sterile conditions five Interrupted" Ethilon sutures were used to approximate the wound edges. A Bacitracin dressing will be applied and the patient will be discharged with wound care Instructions for suture removal in 5 to 7 days. CLINICAL IMPRESSION: Laceration right cheek secondary to motor vehicle accident. Paae 1 of 2 HOLY SPIRIT HOSPITAL Camp Hill, PA NAME: Vaughn, Christian J 97091 MR#: 532070 ROOM: ER1 EMERGENCY ROOM REPORT DR.: PHILLIP MAGUIRE, MO ORIGINAL NAME: Vaughn, Christian J MR#: 532070 PWb DOC #: 507203 D: 10/17/2004 T: 1011 9/200410:00 A 000741175 cc: PHILLIP MAGUIRE, MD_ Pave 2 of 2 HOLY SPIRIT HOSPITAL Camp Hilt, PA NAME: Vaughn, Christian J 17011 MRS: 532070 ROOM: ER1 EMERGENCY ROOM REPORT DR: PHILtJP MAGUIRE, MD ORIGINAL E x?.ib;? .d' ¦ Government Employees Inmrance Company GEICOO : GGEEICO I qty In:surance Companyo y ge100.00M ¦ GEICO Casualty Company One GEICO Boulevard ¦ Fredericksburg, VA 'CfCATION OF LIlVIITS To Whom It May Concern: This will certify that GEICO Indemnity Company has issued an automobile policy, 1070482300, to: WILLIAM H TAYLOR 4185 MOUNTAIN VIEW ROAD APT 114 MECHANICSBURG PA 17050 that was in effect on the accident date of October 14, 2004 providing the following coverage on a 1985 Ford Bronco, Vehicle Identification Number (VIN) 1FMEU15H8FLB00395: Bodily Injury Liability Property.Damage Liability First Party Benefits Medical Expenses Income Loss Funeral Expenses Accidental Death Extraordinary Medical Benefits Uninsured Motorist Bodily Injury Stackable - # vehicles Underinsured Motorist Bodily Injury Stackable - # vehicles Comprehensive Coverage Collision Coverage Tort Option ERS Rental Reimbursement $100,000 per person/ $200,000 per accident N/A per accident N/A per person N/A per person N/A N/A per person N/A per person N/A per person N/A per person/ N/A per accident N/A per person/ N/A per accident N/A deductible N/A deductible N/A per day maximum per accident maximum - L' - - Cindy Lamb Continuing Unit Manager HI PA (10/03) e? I klV+ ?-- Cambridge Galaher -Settlements and Insurance Services, Inc. 30 Hanson Road So. China, ME 04358 Tel: 800-544-1339 43 Direct: 207-445-3779 CAMBRIDGE. Fax: 207-445-3625 donna.pease@cambridge-na.com February 7, 2007 Billy Tibbs Government Employees Ins. Co. One GEICO Boulevard Fredericksburg, VA 22412 Re: Christian Vaughn vs. William Taylor Claim No. 016287 997 0101 037 Dear Billy: This letter will confum the fact that the above-referenced case has settled, pending court approval. Settlement, as we understand it, is outlined by the enclosed. The annuity contract will be issued by Hartford Life Insurance Company, rated A+, XV by Best, AA- by Standard and Poor's, Aa3 by Moody's, and AA by Fitch. GEICO will assign the obligation to make the future payments to Hartford Comprehensive Employee Benefit Service Company (Hartford-CEBSCO). Harlford'Life Insurance Company and Hartford Life, Inc. will each issue an Evidence of Guarantee backing Hartford-CEBSCO's obligation to make the future payments. Please make your check payable as follows and forward to the address below for arrival no later than Tuesday, February 13, 2007, to lock mi the rates. You may wish to use some form of express mail service to ensure its timely arrival. Payee: Hartford-CEBSCO Tax I.D.: 06-1120503 Amount: $9,500.00 Mail to: Donna Pease Cambridge Galaher Settlements 30 Hanson Road So. China, ME 04358 www.cambridgeplaber.com Cambridge Galaher Settlements and Insurance Services, Inc. 30 Hanson Road So. China, ME 04358 Tel: 800-544-1339 Direct; 207-445-3779 CAMBRIDGE. Fu: 207-445-3625 donna.pease@cambridge-na.com February 7, 2007 Billy Tibbs Page 2 The Settlement Agreement and Release and the Uniform Qualified Assignment and Release Agreement are enclosed for signature by Christian's parents and an authorized representative of GEICO. Please return the originals to me; and I will secure Hartford's signature. You will be provided with a fully executed copy at the time of policy issue. To avoid any possible confusion as to the roles of the annuity issuer, assignee, and guarantor as stated in the Court Approval of Settlement, your attorney may wish to. incorporate Sections 5 and 6 of the Settlement Agreement into the Order. Or, if helshe prefers, the Settlement Agreement and Release may be incorporated into the Order in its entirety by attaching it as an exhibit to the Order. If you would like for us to review the Order prior to its submission to the court, we will be happy to do so. To summarize, the following are needed in order that the annuity contract may be issued: • A copy of the fully executed Settlement Agreement and Release • The original of the Uniform Qualified Assignment and Release Agreement • A copy of the Petition and Order approving settlement, when available. If you have any questions or if I may be of any fiuther assistance, please let me know. Very truly yours, (Mrs-) Donna M. Pease Senior Case Manager Enclosures www.cambridgegaia4ercom f-x Wl'? Christian Vaughn Date of Birth: 09/10/1999 Normal Life Expectancy: 72.15 years Today's Date: 02/07/2007 SETTLEMENT Guaranteed Benefits Cost Payout 1. $293.21 per month, payable to Christian Vaughn, guaranteed for 5 years, beginning at age 18 (09/10/2017) $9,500.00 $17,592.60 Plan Total $9,500.00 $17,592.60 The annuity contract will be issued by Hartford Life Insurance Company, rated A+, XV by Best, AA- by Standard and Poor's, Aa3 by Moody's, and AA by Fitch. GEICO will assign the obligation to make the future payments to Hartford Comprehensive Employee Benefit Service Company (Hartford- CEBSCO). Hartford Life Insurance Company and Hartford Life, Inc. will each issue an Evidence of Guarantee baclang Hartford-CEBSCO's obligation to make the future payments. The bene)% and prices above are for illustration purposes only and are not to be construed as a contract or guarantee of benefits or payments of any kind Additionally, the prices quoted are good for only 7 days from 02/07/2007 or the gftctive date of a rate change from the life insurance company writing the annuity, whichever is earlier. ? k*j ? "14 1? Uniform Qualified Assignment and Release "Claimant" "Assignor" "Assignee" 'Annuity Issuer" 'Effective Date" Christian Vaughn GEICO Indemnity Company Hartford Comprehensive Employee Benefit Service Company (Hartford-CEBSCO) Hartford Life Insurance Company This Agreement is made and entered into by and between may be accelerated, deferred, increased or the parties hereto as of the Effective Date with reference to decreased and may not be anticipated, sold, following facts: assigned or encumbered. A. Claimant has executed a settlement agreement or 4. The obligation assumed by Assignee with respect release dated: to any required payment shall be discharged upon (the *Settlement Agreemenn that provides for the mailing on or before the due date of a valid the Assignor to make certain periodic payments to check in the amount specified to the address of or for the benefit of the Claimant as stated in record. Addendum No. 1 (the "Periodic Payments'); and 5. B. The parties desire to effect a *qualified assignment" within the meaning and subject to the conditions of section 130(c) of the Internal Revenue Code of 1986 (the "Code"). 6. NOW, THEREFORE, in consideration of the foregoing and other good and valuable consideration, the parties agree - -asIbIlows: 1. The Assignor hereby assigns and the Assignee 7 hereby assumes all of the Assignor's liability to make the Periodic Payments. The Assignee assumes no liability to make any payment not specified in Addendum No. 1. 2. The Periodic Payments constitute damages on account of personal injury or sickness in a case involving physical injury or physical sickness within the meaning of Sections 104 (a)(2) and 130 (c) of the Code. 8. 3. The Assignee's liability to make the Periodic Payments is no greater than that of the Assignor immediately preceding this Agreement Assignee is not required to set aside specific assets to secure the Periodic Payments. The Claimant has no rights against the Assignee greater than a general creditor. None of the Periodic Payments This Agreement shall be governed by and interpreted in accordance with the laws of the State of The Assignee may fund the Periodic Payments by purchasing a 'qualified funding asset" within the meaning of Section 130(d) of the Code in the form of an annuity oontiact issued by the Annuity Issuer. All rights of ownership and control of such annuity contract shall be and remain vested in the Assignee exduswely. The Assignee may have the Annuity Issuer send payments under any "qualified funding asset" purchased hereunder directly to the payee(s) specified in Addendum No. 1. Such direction of payments shall be solely for the Assignee's convenience and shall not provide the Claimant or any payee with any rights of ownership or control over the 'qualified funding asset or against the Annuity Issuer. Assignee's liability to make the Periodic Payments shall continue without diminution regardless of any bankruptcy of insolvency of the Assignor. 9. In the event the Settlement Agreement is declared terminated by a court of law or in the event that Section 130(c) of the Code has not been satisfied, this Agreement shall terminate. The Assignee shall then assign ownership of any "qualified funding asset" purchased hereunder to Assignor, and Assignee's liability for the Periodic Payments shall terminate. 10. This Agreement shall be binding upon the respective representatives, heirs, successors and assigns of the Claimant, the Assignor and the Assignee and upon any person or entity that may Assignor. GEICO Indemnity Company By' - Audx)w*ed Representative Title Claimant: Charles Vaughn, as Parent and Natural Guardian of Christian Vaughn, a minor Claimant: Gigi Nester Vaughn, as Parent and Natural Guardian of Christian Vaughn, a minor Approved as to Form and Content: assert any right hereunder or to any of the Periodic Payments. 11. The Claimant hereby accepts the Assignee's assumption of all liability for the Periodic Payments and hereby releases the Assignor from all liability for the Periodic Payments Assignee: Hartford-CEBSCO By: Authorrzzed Repmmnta&e Title BY: not applicable Claimant's Attorney Addendum No. 1 Description of Periodic Payments Payee: Christian Vaughn Benefit: $293.211month for 5 years certain, beginning 09110/2017 through and including 0811012022. Initials: Claimant: (CV) Claimant: (GNV) Assignor: (GEICO) Assignee: (Hartford-CEBSCO) ALL-STATE `L-AL 800--1 -L [U'I R[l'VCi ?I: Ex ?ib, + F?7 SETTLEMENT AGREEMENT AND RELEASE This Settlement Agreement and Release (the "Settlement Agreement") is made and entered into this day of , 20_____, by and between: "Claimant" Charles Vaughn, Individually and as Parent and Natural Guardian of Christian Vaughn, a minor Gigi Nester-Vaughn, Individually and as Parent and Natural Guardian of Christian Vaughn, a minor "Defendant" William Taylor "Insurer" GEICO Indemnity Company RECITALS A. On or about October 17, 2004, Claimant was injured in an accident occurring in or near Enola, Pennsylvania. Claimant alleges that the accident and resulting physical and personal injuries arose out of certain alleged negligent acts or omissions of Defendant, and has made a claim seeking monetary damages on account of those injuries. B. Insurer is the liability insurer of the Defendant, and as such, would be obligated to pay any claim made or judgment obtained against Defendant, which is covered by its policy with Defendant. C. The parties desire to enter into this Settlement Agreement in order to provide for certain payments in full settlement and discharge of all claims which have, or might be made, by reason of the incident described in Recital A above, upon the terms and conditions set forth below. AGREEMENT The parties agree as follows:. 1.0 RELEASE AND DISCHARGE 1.1 In consideration of the payments set forth in Section 2, Claimant hereby completely releases and forever discharges Defendant and Insurer from any and all past, present or future claims, demands, obligations, actions, causes of action, wrongful death claims nights, damages, costs, losses of services, expenses and compensation of any nature whatsoever, whether based on a tort, contract or other theory of recovery, which the Claimant now has, or which may hereafter accrue or otherwise be acquired, on account of, or may in any way grow out of the incident described in Recital A. above, including, without limitation, any and all known or unknown claims for bodily and personal injuries to Claimant, or any future wrongful death claim of Claimant's representatives or heirs, which have resulted or may result from the alleged acts or omissions of the Defendant. 1.2 This release and discharge shall also apply to Defendant's and Insurer's past, present and future officers, directors, stockholders, attorneys, agents, servants, representatives, employees, subsidiaries, affiliates, partners, predecessors and successors in interest, and assigns and all other persons, firms or corporations with whom any of the former have been, are now, or may hereafter be affiliated. 13 This release, on the part of the Claimant, shall be a fiilly binding and complete settlement among the Claimant, the Defendant and the Insurer, and their heirs, assigns and successors. 1.4 The Claimant acknowledges and agrees that the release and discharge set forth above is a general release. Claimant expressly waives and assumes the risk of any and all claims for damages which exist as of this date, but of which the Claimant does not know or suspect to exist, whether through ignorance, oversight, error, negligence, or otherwise, and which, if known, would materially affect Claimant's decision to enter into this Settlement Agreement. The Claimant further agrees that Claimant has accepted payment of the sums specified herein as a complete compromise of matters involving disputed issues of law and fact. Claimant assumes the risk that the facts or law may be other than Claimant believes. It is understood and agreed to by the parties that this settlement is a compromise of a doubtful and disputed claim, and the payments are not to be construed as an admission of liability on the part of the Defendant, by whom liability is expressly denied. 2.0 PAYMENTS In consideration of the release set forth above, the Insurer on behalf of the Defendant agrees to pay to the individuals named below ("Payees") the sums outlined in this Section 2 below, inclusive of all liens and medical expenses: 2.1 Periodic payments made according to the schedule as follows (the "Periodic Payments"): Payments to Christian Vaughn in the amount of Two Hundred Ninety-three and 21A00 Dollars ($293.21) per month for five (5) years certain, beginning September 10, 2017, through and including August 10, 2022. All sums set forth herein constitute damages on account of personal injuries or sickness, within the meaning of Section 104(ax2) of the Internal Revenue Code of 1986, as amended. 3.0 CLAIMANT'S RIGHTS TO PAYMENTS Claimant acknowledges that the Periodic Payments cannot be accelerated, deferred, increased or decreased by the Claimant or any Payee; nor shall the Claimant or any Payee have the power to sell, mortgage, encumber, or anticipate the Periodic Payments, or any part thereof, by assignment or otherwise. 4.0 CLAIMANT'S BENEFICIARY Any payments to be made after the death of any Payee pursuant to the terns of this Settlement Agreement shall be made to such person or entity as shall be designated in writing by Payee to the Insurer or the Insurer's Assignee. If no person or entity is so designated by Payee, or if the person designated is not living at the time of the Payee's death, such payments shall be made to the estate of the Payee. No such designation, nor any revocation thereof, shall be effective unless it is in writing and delivered to the Insurer or the Insurer's Assignee. The designation must be in a form acceptable to the Insurer or the Insurer's Assignee before such payments are made. 5.0 CONSENT TO QUALIFIED ASSIGNMENT 5.1 Claimant acknowledges and agrees that the Defendant and/or the Insurer may make a "qualified assignment", within the meaning of Section 130(c) of the Internal Revenue Code of 1986, as amended, of the Defendant's and/or the Insurer's liability to make the Periodic Payments set forth in Section 2.1 to Hartford Comprehensive Employee Benefit Service Company ("the Assignee"). The Assignee's obligation for payment of the Periodic Payments shall be no greater than that of Defendant and/or the Insurer (whether by judgment or agreement) immediately preceding the assignment of the Periodic Payments obligation. 5.2 Any such assignment, if made, shall be accepted by the Claimant without right of rejection and shall completely release and discharge the Defendant and the Insurer from the Periodic Payments obligation assigned to the Assignee. The Claimant recognizes that, in the event of such an assignment, the Assignee shall be the sole obligor with respect to the Periodic Payments obligation, and that all other releases with respect to the Periodic Payments obligation that pertain to the liability of the Defendant and the Insurer shall thereupon become final, irrevocable and absolute. 5.3 Hartford Life Insurance Company and Hartford Life, Inc. will each issue an Evidence of Guarantee that will guarantee the future obligations of Hartford Comprehensive Employee Benefit Service Company. 6.0 RIGHT TO PURCHASE AN ANNUITY The Defendant and/or the Insurer, itself or through its Assignee, reserves the right to fund the liability to make the Periodic Payments through the purchase of an annuity policy from Hartford Life Insurance Company (the "Annuity Issuer"). The Defendant, the Insurer, or the Assignee shall be the sole owner of the annuity policy and shall have all rights of ownership. The Defendant, the Insurer, or the Assignee may have the Annuity Issuer mail payments directly to the Payee. The Claimant shall be responsible for maintaining a current mailing address for Payee with the Annuity Issuer. 7.0 DISCHARGE OF OBLIGATION The obligation of the Defendant, the Insurer and/or Assignee to make each Periodic Payment shall be discharged upon the mailing of a valid check in the amount of such payment to the designated address of the Payee(s) named above, or the deposit by electronic funds transfer in the amount of such payment to an account designated by the Payee(s). If, after the due date, the Payee(s) notifies the Assignee that payment was not received, the Assignee shall direct the Annuity Issuer to initiate a stop payment action. Upon confirmation that such check was not previously negotiated or electronic funds transfer deposited, Assignee shall promptly direct the Annuity Issuer to process a replacement payment. 8.0 ATTORNEY'S FEES Each party hereto shall bear all attorney's fees and costs arising from the actions of its own counsel in connection with this Settlement Agreement, the matters and documents referred to herein, and all related matters. 9.0 REPRESENTATION OF COMPREHENSION OF DOCUMENT In entering into this Settlement Agreement the Claimant represents that Claimant has relied upon the advice of his/her attorneys, who are the attorneys of his/her own choice, concerning the legal and income tax consequences of this Settlement Agreement; that the terms of this Settlement Agreement have been completely read and explained to Claimant by his/her attorneys; and that the terms of this Settlement Agreement are fully understood and voluntarily accepted by Claimant. 10.0 WARRANTY OF CAPACITY TO EXECUTE AGREEMENT Claimant represents and warrants that no other person or entity has, or has had, any interest in the claims demands, obligations, or causes of action referred to in this Settlement Agreement, except as otherwise set forth herein; that Claimant has the sole right and exclusive authority to execute this Settlement Agreement and receive the sums specified in it; and that Claimant has not sold, assigned, transferred, conveyed or otherwise disposed of any of the claims, demands, obligations or causes of action referred to in this Settlement Agreement. 11.0 CONFIDENTIALITY The parties agree that neither they nor their attorneys nor representatives shall reveal to anyone, other than as may be mutually agreed to in writing, any of the terms of this Settlement Agreement or any of the amounts, numbers or terms and conditions of any sums payable to Payees hereunder. 12:0: GOVERNING LAW This Settlement Agreement shall be construed and interpreted in accordance with the laws of the Commonwealth of Pennsylvania. 13.0 ADDITIONAL DOCUMENTS All pasties agree to cooperate fully and execute any and all supplementary documents and to take all additional actions, which may be necessary or appropriate to give full force and effect to the basic terms and intent of this Settlement Agreement. 14.0 ENTIRE AGREEMENT AND SUCCESSORS IN INTEREST This Settlement Agreement contains the entire agreement between the Claimant and the Insurer with regard to the matters set forth in it and shall be binding upon and enure to the benefit of the executors, administrators, personal representatives, heirs, successors and assigns of each. 15.0 EFFECTIVENESS This Settlement Agreement shall become effective immediately following execution by each of the parties. Claimant: Charles Vaughn, Individually and as Parent and Natural Guardian of Christian Vaughn, a minor By: Date: Claimant: Gigi Nester-Vaughn, Individually and as Parent and Natural Guardian of Christian Vaughn, a minor By. Daze: Insurer. GEICO Indemnity Company By: Title: - Date: VERIFICATION I, GIGI NESTER-VAUGHN, state that I have read the Petition for Minor's Compromise and that the facts stated therein are true and correct to the best of my knowledge, information and belief. I understand that any false statements herein are made subject to penalties of 18 Pa. C.S.A. Section 4904, relating to unsworn falsification to authorities. Date: 01 OSTER-VAUGHN GIG 9 VERIFICATION I, CHARLES VAUGHN, state that I have read the Petition for Minor's Compromise and that the facts stated therein are true and correct to the best of my knowledge, information and belief. I understand that any false statements herein are made subject to penalties of 18 Pa. C.S.A. Section 4904, relating to unsworn falsification to authorities. Date: C /J CHARLES VAUGHN I HEREBY CERTIFY that I served a true and correct copy of the foregoing on all parties of record by placing the same in the United States mail at Camp Hill, Pennsylvania, first-class postage prepaid, on the day of I t ujlJ'1?' ?, 2009, and addressed as follows: Mr. Charles Vaughn and Mrs. Gigi Nester-Vaughn 148 Holly Street Hummelstown, PA 17036 MARGOLIS EDELSTEIN By: Angela It. Gayman, Sec tary AW 3 00 P L b ?.. "fo t?-a k"?!1 MAR 312009 47, CHARLES VAUGHN and GIGI NESTER- IN THE COURT OF COMMON PLEAS VAUGHN, as Parents and Natural OF CUMBERLAND COUNTY, Guardians of of CHRISTIAN VAUGHN, 1 PENNSYLVANIA a minor, PETITIONER, VS. WILLIAM H. TAYLOR, DOCKET NO. 69 - IG(o4 OmITFe_rr1 RESPONDENT. ORDER AND NOW, this ?0d day of , 2009, IT IS HEREBY ORDERED AND DECREED that a hearing shall be held in Courtroom No. at 1 . bb o'clock, A.m. on the day of _ , 2009, at the Cumberland County Courthouse, Carlisle, Pennsylvania, at which time all interested parties, including the Minor, shall appear and be heard. DISTRIBUTION LIST: W. ZCharles Vaughn and Mrs. Gigi Nester-Vaughn, 148 Holly Street, Hummelstown, PA 17036 c/Stephen L. Banko, Jr., Margolis Edelstein, 3510 Trindle Road, Camp Hill, PA 17011 COP ces r?? L LL t A S VINb'/11.45NN3d LS :01 WV Z- Ndv 60oz AMONCiH 3H1 ?O 301MO-GlU e e r CHARLES VAUGHN and GIGI NESTER- VAUGHN, as Parents and Natural Guardians of of CHRISTIAN VAUGHN, a minor, vs. WILLIAM H. TAYLOR, PETITIONER, RESPONDENT. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUN'T'Y, PENNSYLVANIA DOCKET NO. - /M oiyii Teirok ORDER AND NOW, this day of , 2009, after hearing upon the Petition for Minor's Compromise, IT IS HERE ORDERED AND DECREED that Petition is GRANTED. The Petitioners shall execute the Qualified Assignment and Release and the Settlement Agreement and Release. A settlement annuity shall be purchased from the Hartford Life Insurance Company and equal monthly payments of $293.21 shall be made to the Minor, or otherwise in accordance with the Uniform Qualified Assignment and Release and Settlement Agreement and Release for sixty (60) months beginning on September 10, 2017. The total amount to be paid is $17,592.60. DISTRIBUTION LIST: ? . Charles Vaughn and Mrs. Gigi Nester-Vaughn, 148 Holly Street, Hummelstown, PA 17036 ?Stephen L. Banko, jr., Margolis Edelstein, 3510 Trindle Road, Camp Hill, PA 17011 Cop, ja ?Fasot L? 9 i:Xo /0 7 R LE'D` Jii^C vLE OF THE FF-110 i" , INOTAPY 2009 MAY - E m Eo: o s