HomeMy WebLinkAbout09-5770IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiff(s) & Address(es)
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Defendant(s) & Address(es)
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CIVIL DIVISION
Case No. 577a Civil Term
Civil Action
PRAECIPE FOR WRIT OF SUMMONS
TO THE PROTHONOTARY/CLERK OF SAID COURT:
Issue summons in the above case
Writ of Summons shall be issued and forwarded t tt rn S •iff. lease Circle choice)
Date : 0 0 Signature of Attorney
Print Name: l eg& T, G>S roeoywS
Address: (a F . L D (lll'#f/L X57.
Ate- LE , l?i4 /?OI?
Telephone #: 7:?( '71- -,iq B ?f O
Supreme Court ID Number: • • • • •
WRIT OF SUMMONS
YOU ARE NOTIFIED THAT THE ABOVE-NAMED PLAINTIFF(S) HAS/HAVE COMMENCED AN
ACTION AGAINST YOU.
v L
Prothonotary/Clerk, Civil Divisioij
Date: by
Deputy
(4)
OF THIS
2069 A U G 20
?d ? 7F s? ?y
??? ?aasa?
BARBARA STRAHOSKY, as parent and : IN THE COURT OF COMMON PLEAS
natural guardian of ASHLY STRAHOSKY, : CUMBERLAND COUNTY, PENNSYLVANIA
a minor child
Plaintiff
No. 09-5770 Civil Term
V.
THERESA A. NIST,
Defendant : CIVIL ACTION -LAW
PETITION FOR APPROVAL OF MINOR'S SETTLEMENT
AND NOW COMES the Petitioner, Barbara Strahosky, parent and natural guardian of
Ashly Strahosky, a minor child, by and through her counsel, George J. Costopoulos, Esquire, and
represents:
1. Petitioner is Plaintiff, Barbara Strahosky, who resides at 125 S. 2nd Street
Newport, PA 17074. She is the parent and natural guardian of Ashly Strahosky, age 12. Ashly's
date of birth is 5/15/97; her social security number is 207-76-6568.
2. On April 19, 2008, Ashly was in an automobile collision while a front seat
passenger in an automobile negligently driven by her aunt, Theresa Nist, who resides at 809
Factory Street, Carlisle, Cumberland County, PA. A copy of the police crash report is attached
as Exhibit "A."
3. The collision, which occurred in Lower Frankford Township, Cumberland
County, PA, caused lacerations and contusions to Ashly's left elbow requiring stitches in the
emergency room followed by doctors' visits and physical therapy.
4. On June 5, 2008, Petitioner retained the undersigned counsel to negotiate a
settlement and/or to institute legal proceedings for Ashly's damages resulting from the collision.
A copy of the fee agreement is attached as Exhibit "B."
5. In July, 2009, the undersigned counsel negotiated a proposed third party
settlement on Ashly's behalf with Geico Insurance Company, the insurer of the vehicle driven by
Ms. Nist, for the full amount of its bodily injury liability limits of $15,000.00. Copies of Geico's
Offer Letter and Certification of Coverage are attached as Exhibits "C" & "D."
6. The undersigned counsel is of the professional opinion that the proposed third
party settlement is reasonable given the exhaustion of Geico's policy limits, and based on
previous settlements in comparable matters.
7. There are no unpaid creditors or liens against the proposed settlement, and
approval thereof will not prejudice any rights Petitioner and/or Ashly may have against any
additional individuals or entities who may potentially be included in future litigation.'
8. From the proposed third party settlement of $15,000.00, Petitioner consents to a
distribution to the undersigned counsel consistent with the contingent fee agreement, which
provides for counsel fees in the amount of 25% ($3,750.00) plus costs in the amount of $235.96.
A summary of counsel's disbursements is attached as Exhibit "F."
9. Petitioner agrees that the proposed third party settlement, along with the
distribution to the undersigned counsel, is fair and reasonable, and accordingly requests that this
Honorable Court enter an Order:
a) approving the settlement for the policy limits of $15,000.00 from Geico, with the
net proceeds of $11,014.04 to be deposited in one or more savings accounts in the name of Ashly
Strahosky in banks, building and loan associations, savings and loan associations or credit
' A potential future claim on behalf of Ashly may include pursuit of underinsured
motorist benefits through her mother's automobile policy with State Farm Insurance. While
State Farm has consented to settlement for Geico's policy limits and waived subrogation, it has
to date denied payment of any underinsured benefits. See Exhibit E. Consequently, litigation is
now being considered to pursue these insurance benefits. An additional petition for approval will
be presented should an underinsured motorist claim be pursued and resolved.
unions, deposits in which are insured by a federal government agency or in one or more accounts
in the name of Ashly Strahosky investing only in securities guaranteed by the United States
government or a Federal Governmental agency managed by responsible financial institutions.
Said accounts shall contain a provision that no withdrawal can be made from any such account
until the minor attains majority, except as authorized by a prior order of court. Proof of the
deposit shall be promptly filed of record; and
b) approving the payment of counsel fees of $3,750.00, plus costs in the amount of
$235.96, for a total of $3,985.96 to the Law Offices of George J. Costopoulos.
10. Petitioner requests that the Court enter the aforementioned Order without the need
for a hearing, and has attached an Affidavit confirming her approval of the proposed settlement
and distribution. See Exhibit "G." However, should the Court deem it necessary to schedule a
hearing, Ashly Strahosky and Petitioner together with the undersigned counsel will be present at
the hearing.
WHEREFORE, Petitioner respectfully requests that this Honorable Court issue an Order
approving the aforementioned proposed settlement on behalf of Ashly Strahosky, a minor, and
the distribution and payment of counsel fees and costs.
RESPECTFULLY SUMMED:
George C stopoulos, Esquire
I.D. No. 78423
10 East Louther Street, First Floor
Carlisle, Pennsylvania 17013
Phone: (717) 243-0407
Attorney for Petitioner
Date: g,2;? 101
VERIFICATION
I, Barbara. Stmhosky, parent and natural guardian of Ashly Strahosky, a minor child, do
hereby verify that the statements made in the foregoing Petition for Approval of Minor's
Settlement are true and correct. I understand that any false statements herein are made subject to
the penalties of 1$ Pa.C.S. § 4904 relating to unsworn falsification to authorities.
o???ecltt
ARA STRAHOSKY
Date:
A%-500 TX
Commonwealth of Pennsylvani% PAGE 1
Incident Number: H02-1753190
Police Crash Report Kar'ORTABLE CRASH
Crash Involves:
0 DUI 0 Fatality 0 Hit and Run 0 Commercial Vehicle 0 State Police Vehicle 0 Local Police Vehicle
•
0 NIA 0 Work Zone 0 ATV 0 Snowmobile 0 Commonwealth Vehicle 0 Local Gov Vehicle
Case Closed Patrol Zone Investigation Date
A Name
gency
YES
22
0411912008
o PA STATE POLICE - CARLISLE
Dispatch Time Arrival Time Investigator Badge Number
a 17:51 hrs
. 18:02 hrs. SOMMERS, ZAKERY R 10477
v A pproval Date Reviewer Reviewer Badge Number
a 05!23/2008 YUNK, JOHN G 3D 07831
Date of Crash Time of Crash Day of the Week Crash Description
04/19/2008 17:45 hrs. SATURDAY HIT FIXED OBJECT
County Municipality
CUMBERLAND LOWER FRANKFORD TWP
m Weather Conditions Relation to Roadway
o NO ADVERSE CONDITIONS ROADSIDE
L
A
Illumination
Road Surface Conditions
U DAYLIGHT DRY
# of Units # of People # of Injured : # Killed EMS Agency Medical Facility
001 004 002 000 CARLISLE EMS HERSHEY MEDICAL CENTER
School Bus Related School Zone Related PennDOT Notified Type of intersection Special Location
NO NO NO MIDBLOCK NOT APPLICABLE
Work ZDne Work Zone Type Where in Work Zone
c NO
0
eed Limit
S
Workers Present
Officer Present
Work Zone Characteristics
o p Road Closed Work on Shoulder Intermittent or Flagger
? or Median 0 Moving Work ? Control Other
Lane Closure
ith D
t
our
e
w
Route Signing Route Number Segment Number Travel Lanes Speed Limit Orientation
no: LOCAL ROAD OR STREET T457 02 35 MPH WEST
a House Number Street Name St. Ending
c 627 T457 ROAD
a`
c Route Signing Route Number Segment Number Travel Lanes Speed Limit Orientation
rc
c Used in
m Intersection
Crashes
Street Name
St. Ending
m
c
a Route Number Or Mile Pos t Tenths Or Segment Marker Ramp Use Only Feet
L Y
E co
2 v Street Name Street Ending Or Miles Tenths
o HILLVIEW DRIVE 00 1
E
e m
v
r4
Route Number
Or Mile Pos
t Tenths
Or Segment Marker
Ramp Use Only
The above entry is the
o E distance from the Crash
V Street Name Street Ending Scene to Landmark 1
OPOSSUM LAKE ROAD
Degrees Minutes Seconds Decimal Degrees Minutes Seconds Decimal
m Latitude: 40 13 ; 08 , ggg Longitude: 77 18 ; 21 528
Traffic Control Device Traffic Control Functioning
o
u NOT APPLICABLE NO CONTROLS
Lane Closed Lane Closure Direction Traffic Detoured Estimated Time Closed
FULLY EAST AND WEST NO 1-3 HRS
J i
Environmental / Roadway Potential Factors (E/R)
C
0
E
`o
c
e
m
w
Factor 1 Factor 2 Factor 3
NONE
First Harmful Event in the Crash Most Harmful Event in the Crash
Unit Number Harmful Event Unit Number Harmful Event
001 HIT BRIDGE RAIL 001 OVERTURN/ROLL OVER
Indicated Prime Factor Unit Number Prime Factor Driver Action
DRIVER ACTION 001 SPEEDING
Prime Factor Enviromental/Roadway Prime Factor Vehicle Failure Prime Factor Pedestrian Action
Road Surface Type ion
I EXHIBIT
Printed At: PA State Police • Carlisle 061111200 Page 1 Form #: H02.1753190
A lincide ant Number: 1102-1753190 Commonwealth of PennsyIvani: PAGE 2
Ici
Police Crash Report n,.-ORTABLE CRASH
Crash lrvolve5:
U DUI U Fatality U Hit and Run I-) Commercial Vehicle State Police Vehicle ?l Local Police Vehicle
• 0 NIA 0 Work Zone 0 ATV 0 Snowmobile 0 Commonwealth Vehicle 0 Local Gov Vehicle
Unit Number Type Unit Commercial Vehicle
001 Motor Vehicle in Transport No
First Name MI Last Name Suffix DOB Telephone Number
THERESA A NIST 01/2511962 (717) 258-4591
Street Address city state Zip Code
809 FACTORY ST. CARLISLE PA 17013
Gender License Number License State Class Expiration Date Owner/Driver
FEMALE 20374552 PA C 01/26/2010 PRIVATE VEHICLE NOT OWNED/LEASED BY DRIVER
o
A
Driver Presence
Physical Condition
Primary Vehicle Code Violation
Person Charged
DRIVER OPERATED VEHICLE HAD BEEN DRINKING 3362 YES
0
c
Alcohol/Drugs Suspected
Icohol Test Type
Alcohol Test Results
A ALCOHOL TEST NOT GIVEN
•c
Driver Action SPEEDING
d
s
e
CL
m
Pedestrian Action
Pedestrian Signals
Pedestrian Clothing
Pedestrian Location
•c
o -
1st Harmful Event
Left or Right Side
Most Harmful
Utility Poie Number
HIT BRIDGE RAIL RIGHT NO
2nd Harmful Event Left or Right Side Most Harmful Utility Pole Number
OVERTURN/ROLL OVER YES
3rd Harmful Event Left or Right Side Most Harmful Utility Pole Number
4th Harmful Event Left or Right Side Most Harmful Utility Pole Number
Owner First Name Owner MI Owner Last Name or Business Name Suffix
CHARLES T NIST
Street Address City State Zip Code
809 FACTORY ST. CARLISLE PA 17013
Vehicle Type Special Usage Government Equipment Number
AUTOMOBILE NOT APPLICABLE
Model Year Vehicle Make Vehicle Model Vehicle Color VIN
1997 FORD ESCORT WHITE 3FALP15P9VR104147
License Plate Reg. State E Vehicle Towed Towed By
EJZ-3114 PA 0 YES MYERS BODY SHOP
Insurance Insurance Company Policy Number Expiration Date
YES GEICO INSURANCE 4125580540 10/03/2008
Direction of Travel Vehicle Position Vehicle Movement Initial Impact Point
WEST RIGHT LANE "CURB" NEGOTIATING CURVE - LEFT 12 O'CLOCK
A
Damage Indicator
Gradient
Road Alignment
Possible Vehicle Failures
DISABLING DOWNHILL CURVED NONE
m
v # of Units Type Unit 1 Tag Number Tag Year Tag State
c
d 0
Unit Make Unit Owner
c
17)
c
Type Unit 2
Tag Number
Tag Year
Tag State
m
r=
Unit Make Unit Owner
Engine Size Passenger? Saddle Bag/Trunk? Trailer? Driver Education?
ro cc
Driver Helmet Type Helmet Stayed On? DOT/Snell Designation? Eye Protection? Long Sleeves? Long Pants? Over Ankle Boots?
2
0
Passenger Helmet Type Helmet Stayed On? DOT/Snell Designation? Eye Protection? Long Sleeves? Long Pants? Over Ankle Boots?
m Passenger? Helmet?
J
V
A Head Lights? Rear Reflectors?
a
Printed At: PA State Police - Carlisle 06/1112008 03:22 PM Page 2 Form #: H02-1753190
as- Tx Commonwealth of PennsIVani: PAGE 3
1'nci cident Number: H02-1753190 y
Crash involves: Police Crash Report n-rORTABLE CRASH
O DUI O Fatality O Hit and Run O Commercial Vehicle O State Police Vehicle O Local Police Vehicle
• O N/A O Work Zone O ATV O Snowmobile O Commonwealth Vehicle O Local Gov Vehicle
Unit # Person No. First Name MI Last Name Suffix DOB
001 001 THERESA A NIST 01125/1962
Street Address city
State
Zip Code
c
809 FACTORY ST.
CARLISLE
PA
17013
Phone Number EMS Transport Person Type Gender Injury Severity
E (717) 258-4591 YES DRIVER FEMALE INJURY, UNKNOWN SEVERITY
c Seat Position
Safety Equipment 1
; DRIVER - ALL VEHICLES UNKNOWN
CL
a
Safety Equipment 2
Extrication
MULTIPLE AIRBAGS DEPLOYED FREED BY NON-MECHANICAL MEANS
Ejection Ejection Path
NOT EJECTED NOT EJECTEDINOT APPLICABLE
Unit # Person No. First Name MI Last Name Suffix DOB
001 002 ASHLY N STRAHOSKY 05/15/1997
treet Address City State Zip Code
c 209 PLAZA DR. BOILING SPRINGS PA 17007
Phone Number EMS Transport Persin Type Gender Injury Severity
E (717) 249-1743 NO PASSENGER FEMALE NOT INJURED
w
c
Seat Position Safety Equipment 1
m
a FRONT SEAT RIGHT SIDE LAP AND SHOULDER BELT USED
a Safety Equipment 2 Extrication
MULTIPLE AIRBAGS DEPLOYED FREED BY NON-MECHANICAL MEANS
Ejection Ejection Path
NOT EJECTED NOT EJECTED/NOT APPLICABLE
Unit # Person No. First Name MI Last Name Suffix DOB
001 003 CHARLES T NIST JR 09/23/1997
Street Address City State Zip Code
c 809 FACTORY ST. CARLISLE PA 17013
Phone Number EMS Transport Person Type Gender Injury Severity
E (717) 258-4591 NO PASSENGER MALE NOT INJURED
0
c
Seat Position
Safety Equipment 1
m
fi SECOND ROW - RIGHT SIDE LAP AND SHOULDER BELT USED
00 Safety Equipment 2 Extrication
a
MULTIPLE AIRBAGS DEPLOYED
FREED BY NON-MECHANICAL MEANS
Ejection Ejection Path
NOT EJECTED NOT EJECTED/NOT APPLICABLE
Unit # Person No. First Name MI Last Name Suffix DOB
001 004 DAEKWON SHEPHERD 06/29/1997
Street Address City State Zip Code
825 FACTORY ST. CARLISLE PA 17013
w Phone Number EMS Transport
Person Type
Gender
Injury Severity
(717) 254-4541 YES PASSENGER MALE INJURY, UNKNOWN SEVERITY
w
c
Seat Position
Safety Equipment 1
m SECOND ROW - LEFT SIDE OR MOTORCYCLE PASSENGER LAP AND SHOULDER BELT USED
n
a Safety Equipment 2 Extrication
MULTIPLE AIRBAGS DEPLOYED FREED BY NON-MECHANICAL MEANS
Ejection Ejection Path
NOT EJECTED NOT EJECTED/NOT APPLICABLE
Printed At: PA State Police - Carlisle 0611112008 03:22 PM Page 3 Form #: H02-1753190
AA-500 TX
Incident Number: H02-1753190 Commonwealth of Pennsylvanir PAGE 4
Police Crash Report K-eCRTABLE CRASH
Crash involves:
* DUI 0 Fatality 0 Hit and Run 0 Commercial Vehicle 0 State Police Vehicle 0 Local Police Vehicle
• 0 N/A 0 Work Zone 0 AN 0 Snowmobile 0 Commonwealth Vehicle 0 Local Gov Vehicle
Final Uncontrolled Rest A
Of Unit #1 ??
pp
UV
Unit 1 Carlisle Boro
\\ Approx. 2 Miles
P.O.I.
Bridge Rail
E
Ln?t
r
~
o unit
Burgners Rd.
NOT TO ST.AL? ':
Crash Synopsis
This crash occurred as Unit #1 was traveling west on Burgers Rd. Unit #1 was traveling too fast, causing it to
travel off the roadway, striking a bridge rail, overturning, and coming to final rest on it's roof, in a creek.
The driver and a passenger were transported by EMS for unknown injuries.
This crash occurred as Unit #1 was traveling west on Burgners Rd. in Lower Frankford Twp, Cumberland Co.
Unit #1 was traveling too fast on this road, traveling off the roadway, and overturning. The vehicle came to final rest
on it's roof, in a creek, just north of Burgners Rd.
I spoke with the operator of the vehicle on 04119108, at approximately 1815hrs, at the scene of the crash. When
asked what had happened, she stated that she was not sure, but she knew that she was involved in a crash. While
speaking with the driver, I detected the strong odor of an alcoholic beverage. When asked what she was drinking,
she stated that she was drinking Iron City Beer. When asked how many she had to drink today she stated "I had 55".
She then stated "Wait, that's not right. What is the right answer?". I informed her that I did not know how much she
had to drink, but that I could smell the odor on her breath. She was informed that she was being flown to Hershey
Medical Center for treatment. Blood results indicating the
Printed At: PA State Police - Carlisle 0611112008 03:22 PM Page 4 Form #: H02-1753190
AA-500 TX
Incident Number: H02-1753190
Crashinvolves:
* DUI O Fatality
O N/A O Work Zone
Commonwealth of Pennsylvania
Police Crash Report
O Hit and Run O Commercial Vehicle
O ATV O Snowmobile
r.-rORTABLE CRASH
PAGE 5
O State Police Vehicle O Local Police Vehicle
O Commonwealth Vehicle O Local Gov Vehicle
amount of alcohol in her system are pending a search warrant of her medical records at Hershey Medical Center.
I spoke with STRAHOSKY on 04119108, at approximately 1820hrs, at the scene of the crash. She informed me that
they were coming from Carlisle, and that they were trying to find a campground in the area. When asked if she
remembered what caused the crash, she stated that they were driving way too fast. She informed me that she asked
the driver to slow down, and to drive the speed limit, but the driver never did.
1 spoke with NIST Jr. on 04119108, at approximately 1825hrs, at the scene of the crash. He stated that he was
trying to tell his mom that she was driving too fast, and that he asked his mom numerous times to slow down.
Physical evidence 1 observed at the scene consisted of small tire marks on the roadway, showing where the
vehicle left the road. I also observed the bridge rails that were knocked down from the vehicle colliding with them.
No property damage was observed at the scene. A Notice of Crash Investigation was mailed to the driver.
The Department of Environmental Protection was advised of the crash, due to the vehicle coming to final rest in a
creek, and the possibility of fuel leaking in to the water.
A Public Information Release Report was prepared and placed in the Crash Attachment File.
Printed At: PA State Police - Carlisle 06/1112008 03:22 PM Page 5 Form #: H02-1753190
LAW OFFICES
GEORGE J . COSTOPOULOS
10 EAST LOUTHER STREET
FIRST FLOOR
CARLISLE, PA 17013
(717) 243-0407
FAX (717) 243-0950
Power of Attorney
and
Contingent Fee Agreement
I, Barbara Strahosky, as Parent and Natural Guardian of Ashly Strahosky, (hereinafter
"client"), do hereby retain the Law Offices of George J. Costopoulos, 10 East Louther Street,
First Floor, Carlisle, Pennsylvania 17013 (hereinafter "attorneys"), 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 resulting from an
automobile collision occurring on or about April 19, 2008 resulting in personal injuries to Ashly
Strahosky against any 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, commercial papers, settlement agreements, compromises and releases, verifications,
dismissals, orders, settlement checks and all other documents that I could properly execute in
connection with this lawsuit.
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.
In consideration of the services performed and to be performed by attorneys, I agree to
pay attorneys' fees from the total amount recovered from any source a contingent fee of 25%.
Costs: It is understood that attorneys may advance out-of-pocket costs incurred by
attorneys in the investigation, prosecution, preparation and trial of this case. Such 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; computer-based 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 that the attorneys may have advanced
on behalf of the claim must be paid by me upon request by said attorneys.
EXHIBIT
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 and incurred as a result of my injuries
shall be chargeable to my share exclusively, unless otherwise paid by insurance.
Client agrees that, in the event that the investigation and discovery performed by
attorneys shall in the judgment of attorneys reveal that no meritorious claims exist on behalf of
client, then attorneys may withdraw from the further representation of the client in this matter.
Client and attorneys further agree that, in the event that client shall become dissatisfied with the
services of attorneys, client shall be permitted to discharge attorneys from their employment in
this matter. However, in the event that client elects to discharge attorneys, attorneys shall be
entitled to receive payment of fees from any recovery which client ultimately makes on these
claims. The fees payable to attorneys shall be in an amount which would reasonably and
equitably compensate attorneys for their efforts on behalf of client in the prosecution of the
claims. If client and attorneys are not able to reach an agreement as to the amount of those fees
at the time of discharge, then the matter shall be submitted to arbitration.
This Contingent Fee Agreement applies to all proceedings up to and including verdict or
decision at trial or arbitration. 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.
And Now, on the day and year written below, 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.
I-,- a?:?
George J. Costopoulos, Esquire
Lara Strahosky, as Parent and
Natural Guardian of Ashly Strahosky
Date: (- 5/0 "r
GEICOO
geico.com
¦ Government Employees Insurance Company
¦ GEICO General Insurance Company
¦ GEICO Indemnity Company
¦ GEICO Casualty Company
One GEICO Boulevard ¦ Fredericksburg, VA 22412-0001
July 9, 2009
LAW OFFICES OF GEORGE COSTOPOULOS
10 EAST LOUTHER ST, 11T FLOOR
CARLISLE, PA 17013
COMPANY:
CLAIM NUMBER:
DATE OF LOSS:
YOUR CLIENT(S):
Dear Mr. Costopoulos,
Geico Indemnity Insurance Company
0344269090101029
4/19/2008
Ashley Strahoskey
This letter confirms our telephone conversation on July 9, 2009, wherein we agreed upon
settlement for $15,000.00 on behalf of your client referenced above. As you know, this
settlement is full and final for any and all damages under the Bodily Injury coverage of Charles
Nist's policy. As we discussed, our insured's Bodily Injury limits are $15,000 per person,
$30,000.00 per accident.
In regards to your conditions listed on your demand dated June 29, 2009, enclosed you will a
certification of our insured's policy limits which meats your condition number (1). In response to
your conditions numbers (2) & (3), these are both items that your office is responsible in
handling. We will allow your office time to receive the approval of the proposed minor's
settlement by the Court of Common Pleas of Cumberland County. Once your office receives this
and provided us a copy, we will then release our limits of $15,000.00.
Should you have any questions or concerns, I can be reached at the number listed below. My
office hours are 8:00am to 4:30pm, EST, Monday thru Friday.
Sincerely,
r
Mark W. Heberger
Claims Examiner
800-841-1003 ext 4251
Encl: Certification of Limits
EX BIT
GEICOe
geico.com
¦ Government Employees Insurance Company
¦ GEICO General Insurance Company
¦ GEICO Indemnity Company
¦ GEICO Casualty Company
One GEICO Boulevard ¦ Fredericksburg, VA 22412-0001
CERTIFICATION OF LIMITS
To Whom It May Concern:
This will certify that Geico Indemnity Insurance Company has issued an automobile policy, 4125580540,
to:
CHARLES T NIST
XXXXX
XXXXX
that was in effect on the accident date of 4/19/2008 providing the following coverage on a 1997 Ford
Escort, Vehicle Identification Number (VIN): 3FALP15P9VR104147
Bodily Injury Liability $15,000.00 per person/
$30,000.00 per accident
Property Damage Liability $5,000.00 per accident
First Party Benefits
Medical Expenses XXX per person
Income Loss XXX per person
XXX
Funeral Expenses XXX per person
Accidental Death XXX per person
Extraordinary Medical Benefits XXX per person
Uninsured Motorist Bodily Injury XXX per person/
Stackable XXX per accident
Underinsured Motorist Bodily Injury XXX per person/
Stackable XXX per accident
Comprehensive Coverage XXX deductible
Collision Coverage XXX deductible
Tort Option XXX
ERS
Rental Reimbursement XXX per day maximum
XXX per accident maximum
David Wilson
Claims Manager
EXHIBIT ) ?2c + q
Date `
Hl PA (10/03)
sun fAaN
'State IFarm®
Providing Insurance and Financial Services
INfYlANia•
Home Office, Bloomington, Illinois 61710
August 13, 2009
GEORGE COSTOPOULOS ESQ
10 E LOUTHER ST 1 ST FLOOR
CARLISLE PA 17013
RE: Claim Number:
Your Client:
Date of Loss:
Dear Mr. Costopoulos:
38-L458-520
Ashley Strahosky, a minor
April 19, 2008
Concordville Operations Center
One Shale Farm Drive
PO Box 142
Concordville, PA 19331-0142
This will confirm that State Farm Mutual Auto Insurance Company waived their subrogation
rights on the above claim for any bodily injury payments made under our Underinsured Motorist
coverage. We waive these rights against Teresa Nist and consent to the liability settlement of
$15,000.00 with Geico Insurance.
I am in receipt of the medical treatment records you forwarded. Based on that information and
the photographs you sent, it would appear the tort limit of $15,000.00 fully compensates you
client for their injury.
Should you have any other information you wish me to review, please forward it at this time.
Sincerely,
I ?1 1116
Perry . Morgan'
Claim Representative
724 743 4963
State Farm Mutual Automobile Insurance Company
24/411/46784
EXHIBIT
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BARBARA STRAHOSKY, as parent and : IN THE COURT OF COMMON PLEAS
natural guardian of ASHLY STRAHOSKY, : CUMBERLAND COUNTY, PENNSYLVANIA
a minor child
Plaintiff
No. 09-5770 Civil Term
V.
THERESA A. NIST,
Defendant : CIVIL ACTION -LAW
AFFIDAVIT
1, Barbara Strahosky, parent and natural guardian of Ashly Strahosky, a minor child,
hereby state and affirm that:
a) I authorize and request that my attorney, George J. Costopoulos, Esquire, finalize
a third party settlement with Geico Insurance Company and its insured for the full amount of
their automobile liability limits of $15,000.00 arising from the personal injuries sustained by my
minor daughter, Ashly Strahosky, in an automobile collision caused by Theresa A. Nist on April
19, 2008;
b) I consent that out of this settlement of $15,000.00 may be deducted attorney's
fees of 25% equaling $3,750.00, plus costs amounting to $235.96, for a total of $3,985.96. I
agree that this amount is fair and reasonable, and is consistent with the contingent fee agreement;
C) I agree that the remaining net proceeds of $11,014.04 will be deposited in one or
more savings accounts in the name of Ashly Strahosky in banks, building and loan associations,
savings and loan associations or credit unions, deposits in which are insured by a federal
government agency or in one or more accounts in the name of Ashly Strahosky investing only in
securities guaranteed by the United States government or a Federal Governmental agency
managed by responsible financial institutions. Said accounts shall contain a provision that no
Page 1 of 2 EXHIBIT
I
withdrawal can be made from any such account until the minor attains majority, except as
authorized by a prior order of court;
d) I agree to promptly provide and file with the Court proof of this deposit on behalf
of Ashly Strahosky;
e) I understand and acknowledge that Court approval of this proposed settlement and
distribution is necessary, and have submitted along with my attorney the attached Petition and
proposed Order;
f) I ask that the Court approve the proposed settlement and distribution, and enter
the attached Order, without the need for a hearing. Should the Court deem it necessary to
schedule a hearing, however, I will present with Ashly Strahosky and my attorney; and
g) I sign this Affidavit of my own free will, and verify that the statements made
herein are true and correct. I understand that any false statements herein are made subject to the
penalties of 18 Pa.C.S. § 4904 relating to unworn falsification to authorities.
Barbara Strahosky, parent and natural
guardian of Ashly Strahosy, a minor chil
Date: qa1 ic
Page 2 of 2
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BARBARA STRAHOSKY, as parent and: IN THE COURT OF COMMON PLEAS OF
Natural guardian of :CUMBERLAND COUNTY, PENNSYLVANIA
ASHLY STRAHOSKY, a minor,
PLAINTIFF
V.
THERESA A. NIST,
DEFENDANT 09-5770 CIVIL TERM
ORDER OF COURT
AND NOW, this ~-i'~ day of September, 2009, IT IS ORDERED THAT:
(1) The settlement of the claim of petitioner, Barbara Strahosky, as parent and
natural guardian of Ashly Strahosky, a minor child, offered by Geico Insurance
Company in the amount of $15,000.00, IS APPROVED. Distribution shall be as
follows:
(a) Ashley Strahosky, a minor: $11,014.04
(b) Law Offices of George J. Costopoulos $3,750.00
(Counsel fee at 25%)
(c) Law Offices of George J. Costopoulos 235.96
(Costs Advanced)
TOTAL $15, 000.00
(2) The net proceeds of $11,014.04 shall be placed in a federally insured
interest bearing investment at Orrstown Bank, IN THE NAME OF ASHLY
STRAHOSKY, BORN MAY 15, 1997.
(3) The account shall contain the following notation: "NO WITHDRAWAL CAN
BE MADE PRIOR TO ASHLY STRAHOSKY, BORN MAY 15, 1997, OBTAINING HER
MAJORITY EXCEPT BY AN ORDER OF A COURT OF COMPETENT
JURISDICTION."
(4) Barbara Strahosky is authorized to sign any release necessary to effectuate
this settlement, and to then settle and satisfy the docket.
(5) Counsel for petitioner, George J. Costopoulos, Esquire, shall file with the
Prothonotary, and forward a copy to this chambers, proof of compliance with this order.
By the Co
Edgar B. Bayley, J.
George J. Costopoulos, Esquire
For Petitioner
:sal
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BARBARA STRAHOSKY, as parent and IN THE COURT OF COMMON PLEAS
natural guardian of ASHLY STRAHOSKY, :CUMBERLAND COUNTY, PENNSYLVANIA
a minor child
Plaintiff
No. 09-5770 Civil Term
v.
THERESA A. NIST,
Defendant :CIVIL ACTION -LAW
AFFIDAVIT OF DEPOSIT OF MINOR'S FUNDS
I, George J. Costopoulos, Esquire, counsel for Ashly Strahosky, a minor, in the above-
captioned matter, hereby state and affirm as follows:
1. On November 15, 2009, the sum of $11,014.04 was deposited into a federally
insured interest-bearing Certificate of Deposit (Account No.: 4000035540), with Orrstown Bank,
pursuant to the Court Order entered on September 1, 2009.
2. A copy of the above-referenced Court Order was provided to Orrstown Bank at
the time the Certificate was opened.
3. The Certificate of Deposit is in the name of the minor, Ashly Strahosky, born May
15, 1997, and the express prohibition of withdrawals of income or principal before the minor
attains majority, except by order of Court, has been noted on the depository's records. A copy of
Orrstown Bank's Records is attached hereto as Exhibit "A."
BY:
Georg J. Costopoulos, Esquire
I.D. # 78423
10 East Louther Street, First Floor
Carlisle, PA 17013
Phone: (717) 243-0407
Attorney for Plaintiff
Date: ~ ~ ' ~ ~ - ~
ate
pened• 11 / 15 / 0 9 'rem; 6 6 Months
CERTIFICATE OF DEPOSIT COPY
AND
ERTIFICATE OF DEPOSIT SIGNATURE CARD
Orrstown Bank
22 South Hanover St
mount of
eposit: Eleven thousand fourteen & 04/100 $ 11, 014 .04
his Tie Deposit is Issued to: Issuer:
Ashly Strahosky Born May 15 1997
Barbara StrahoskyParent&Natural Guardian
No Withdrawals prior of 18 unless Ct Ord
648 Campbell Drive
Newport PA 17074
~t Negotiable -Not Transferable -Additional terms are below.
mbine: N
ewire: N
Additional Terms and Disclosures
tis form contains the terms for your time deposit. It is also the Minimum Balance Requirement: You must make a minimum deposit to
uth-in-Savings disclosure for those depositors entitled to one. There
additional terms and disclosures on page two of this form, some of open this account of $ 2 , 0 0 0 . 0 0
uch explain or expand on those below. You should keep one copy of
s form. ®You must maintain this minimum balance on a daily basis to earn the
aturity Date: This account matures 05 / 15 / 15 annual percentage yield disclosed.
(See below for renewal information.) Withdrawals of Interest: Interest ^ accrued ®credited during a
ite Information: The ic_erest rate for this account is 3 .20 96 term can be withdrawn: ~Y Time After Crediting To
th an annual percentage yield of 3 .25 96. This rate will be The Account During The Current Term
id until the maturity dat° specified above. Interest begins to accrue on Early Withdrawal Penalty: If we consent to a request for a withdrawal
business day you deposit any noncash item (for example, a check). that is otherwise not permitted you may have to pay a penalty. The
Brest will be compounded Monthly penalty will be an amount equal to:
Brest will be credited And Added Back to the CD twelve months
Every month interest on the amount withdrawn.
~ The annual percentage yield assumes that interest remains on deposit Renewal Policy:
until maturity. A withdrawal of interest will reduce earnings. ^ Single Maturity. If checked, this account will not automatically
~ If you close your account before interest is credited, you will not renew. Interest ^ will ^ will not accrue after maturity.
receive the accrued interest. (~ Automatic Renewal: If checked,. this account will automatically
ie NUMBER OF ENDORSEMENTS needed for withdrawal or any .renew on the maturity date. (see page two for terms)
per purpose is: 1 Interest ~ will ^ will not accrue after final maturity.
;COUNT OWNERSHIP: You have requested
3 intend the type of account marked below.
~ Individual
~ Joint Account -With Survivorship lm~,,,„ ~
~ Joint Account - No Survivorship ~,~ ~ r~~~
~ Trust: Separate Agreement Dated
~ Revocable Trust Designation as defined in this
reement (Beneficiaries' names and addresses)
Tax
ID•
207-76-6568
BACKUP WITHHOLDING CERTIFICATIONS
TTN; 207-76-6568
® Taxpayer I.D. Number -The Taxpayer
Identification Number shown above (TIN) is
my correct taxpayer identification number.
® Backup Withholding - I am not subject
to backup withholding either because I have
not been notified that I am subject to backup
withholding as a result of a failure to report
all interest or dividends, or the Internal
Revenue Service has notified me that I am noc
longer subject to backup withholding.
EX IBIT
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~y 9 1993 Bankers Systems, Inc., St. Loud, MN Fwm CD-AA-NPD (2) 1/3/2001
Number:
4000035540
Account Number: 4000035540
^ Exempt Recipients - I am an exempt
recipient under the Internal Revenue Service
Regulations.
SIGNATURE - I certify under penalties of
perjury the statements checked in this
sso~on tbat U.S. person
(iticlu U.S. r 'dent all ):
DA
'AGREE TO THE N AGE ONE AND PAGE TWO.
READ PAGE TWO FOR ADDITIONAL TERMS (page f o121
11/16/09
Ashly Strahosky
Collateral
TIC D$POSIT I~TQIIIRY
SgA4040
Message
Per Court Order on record "No withdrawal can be made prior
to Ashly Strahosky, born May 15, 7.997, obtaining her
majority except by an Order of a court of competent
jurisdiction "
10:32:19
4000035540 ~
Expiration User
Date Code
0/00/00
0/00/00
0/00/00
0/00/00
Bottom
F3~Exit
Z 00 'd
F10~A11 Accounts
aonz ~ vz '~N x~~
F20=Fold/Unfold
~s
nv tz~ot Norr soot-s~-noN
11/16/09 Tine Deposit Inquiry Page 1 of 5 10:15:34
Ashly Strahosky CIS' number: - S~A4040
Barbara StrahoskyParent&Natural Guardian Phone:(H) (717) 829-9850 Birth date:
No Withdrawals prior of 18 unless Ct Ord (B) (000) 000--0000 5/15/1997
648 Campbell Drive Tax ID number:
Diewport PA 17074 C/0 type: 12 60-11.9
Memo posted New today
Current balance:
Accrued interest:
Penalty amount:
Current cash value:
Issue date:
Original balance:
Has messages
11,014:00
.00
11,014.04
11/15/09
11,014.04
Last payment date: 11/7.5/09
Last renewal date: 11/7.5/09
Last renewal balance: .00
Date redeemed: 0/00!00
Interest pmt freq: 1 M
Interest disposition: Add to balance
F1=Add! functions F2=Image
F5=History F6=Messages
E00 ~d
VOOZl6Z '°N XYj
Account number:
Internet Bankiaq
Certificate no:
Interest rate:
A1?X
C/D term:
Maturity date:
Hold amount:
Y-T-b interest:
Per diem:
Next payment date:
Next pay amount:
Value after next pmt:
Renewable:
Deposit Acct/Type:
F3=Exit
F8=Maintenance
1S ~INMI
207-76-6568
Month Growth
4000035540
1 of 1
3.200000
3.25
66 M
5/15/15
.oa
.oo
.00000
12/15/09
.00
.00
Yes
amore...
F4=Sweep Inquiry
F24=More Keys
!~V VS ~ fi0 N01'1 fi007,-91-ftON
VERIFICATION
I, George J. Costopoulos, counsel for Ashly Strahosky, a minor child, do hereby verify
that the statements made in the foregoing Affidavit are true and correct. I understand that any
false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn
falsification to authorities.
GEO E J. COSTOPOULOS
Date: t 1 ` l (.r - d
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