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HomeMy WebLinkAbout09-5840i SWARTZ CAMPBELL LLC By: Andrew T. Kravitz, Esquire I.D. No. 80142 275 Grandview Avenue, Suite 104 Camp Hill, PA 17011 (717) 303-1580 Attorney for Petitioner, Nationwide Mutual Ins. Co. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA IN RE: SETTLEMENT OF WRONGFUL No. O q- 5fi q DEATH CLAIM FOR LOGAN M. NORRIS, DECEASED PETITION FOR LEAVE TO APPROVE WRONGFUL DEATH SETTLEMENT Nationwide Mutual Insurance Company, by and through their attorneys, Swartz Campbell LLC, hereby petitions this Honorable Court to enter an Order permitting settlement in compromise of this action, and in support thereof, avers the following: 1. Petitioner Nationwide Mutual Insurance Company (hereinafter "Nationwide"), is a corporation organized and existing under the laws of the State of Ohio and having its principal place of business in Columbus, Ohio, being duly authorized to conduct business in the Commonwealth of Pennsylvania at 1000 Nationwide Drive, Harrisburg, Dauphin County, Pennsylvania, 17105. 2. Respondent, Richard F. Norris, is an adult individual residing at 24 Doe Dr., Carlisle, PA 17015, and is the Administrator of the Estate of Logan M. Norris, Deceased. Richard F. Norris is responding as Administrator of the Estate of Logan M. Norris, although Mr. Norris is the father of Logan M. Norris. A true and correct copy of the Granting of Letters Administration is attached hereto as Exhibit "A". SWARTZ CAMPBELL LLC ATTORNEYS AT LAW 3. Petitioner, Nationwide, has agreed to incur the expense of preparing the instant Petition. 4. On or about May 1, 2008, Decedent, Logan M. Norris, was involved in a motor vehicle accident on Interstate 81 between mile marker 18.5 and 18, when, while trying to change a flat tire he was struck and killed by a vehicle driven by Anthony C. Kratochvil. At the time of his death, Logan M. Norris was not married and did not have any children. Attached hereto and marked as Exhibit "B" is a true and correct copy of the applicable police report. 5. As a result of this collision, the Decedent, Logan M. Norris, was pronounced deceased at the scene of the accident. Attached hereto and marked as Exhibit "C" is a true and correct copy of the Certificate of Death. 6. At the time of the accident, Richard F. Norris, had an automobile insurance policy issued by Nationwide, upon which Decedent, Logan M. Norris was an insured driver. Included within this policy of insurance was Bodily Injury Liability Coverage totaling $100,000.00 per person. Attached hereto as Exhibit "D" is a true and correct copy of the Declarations Page for the applicable insurance policy. 7. Nationwide, at this time, based on its investigation and the circumstances surrounding the accident, has offered the policy limits of $100,000.00, to Respondent, :Richard F. Norris, Administrator of the Estate of Logan M. Norris, in resolution of the Wrongful Death claim of Respondent. 8. Richard F. Norris, as the only surviving parent of the decedent, who had no children, will be the sole beneficiary of the Estate Of Logan M. Norris. SWARTZ CAMPBELL LLC ATTORNEYS AT LAW 9. The full terms of the settlement agreement are contained in the Release Agreement, a copy of which is attached hereto and marked as Exhibit "E". 10. Respondent, Richard F. Norris, Administrator of the Estate of Logan M Norris, is aware that the Release Agreement releases Nationwide Mutual Insurance Company from any further liability for this incident relative to Coverage of Automobile Insurance Policy number 5437A831635. 11. Respondent, Richard F. Norris, Administrator of the Estate of Logan M Norris, is aware of his right to obtain legal representation in this matter and has decided to proceed without legal representation. 12. Respondent, Richard F. Norris, Administrator of the Estate of Logan M Norris, understands that once the Court approves of the settlement and once the settlement documents are executed, no further claim can be made against Nationwide Mutual Insurance Company for the death of Logan M. Norris, under its Coverage of Automobile Insurance Policy number 5437A831635. WHEREFORE, Petitioner Nationwide Insurance Company, respectfully requests this Honorable Court to approve of the compromise and settlement of the wrongful death claim made by Respondent, Richard F. Norris, Administrator of the Estate of Logan M Norris, for the death of Logan M. Norris. SWARTZ CAMPBELL LLC ATTORNEYS AT LAW Respectfully submitted, SWARTZ CAMPAJELL, LLC T. Kravitz i for Petitioner Richard F. Norris Administrator of the Estate of Logan M Norris, Deceased SWARTZ CAMPBELL LLC ATTORNEYS AT LAW EXHIBIT "A" SWARTZ CAMPBELL LLC ATTORNEYS AT LAW STATE OF PENNSYLVANIA COUNTY OF CUMBERLAND SHORT CERTIFICATE a , GLENDA FARNER STR4SBAUGH Register for the Probate of Wills and :granting Letters of administration in and for F.lZI,:AND County, do hereby certify that on CET the 23rd day of May, Tito Thousand and Eight, Letters of ADMINISTRATION in common form were granted by the Register of said County, on the estate of LOGAN M NORRIS sate of 'LOWER FRANKFORD TOWNSHIP /FM-,M M Lass in said county, deceased, to RICHARD FNORRIS X9-14L "AM& Last) and that same has not since been revoked. N TESTIMONY W-FM':ZEuF, I have hereunto set my hand and affixed the seal of said office at CARLISLE, PENNSYLVANIA, this 23rd day of Afay Two Thousand and Eight. File No. PA File No. Date of Death S.S. # 2008-00563 21- 08- 0563 510112008 048-82-6807 Pegister Of rigs I .. •- 1?evraty NIT 17ALID WIT:.UCU ORIGINAL SIGNATURE AND -? ??SSED SEA-1, EXHIBIT "B" SWARTZ CAMPBELL LLC ATTORNEYS AT LAW l ?? PAGE 1 lvania P ennsy of wea th Common trtc{den'4 Number: H03-17b6258 WORTABL.E CRASH Police Crash Report Crash Wolves: O DUI OQ Fatality Hit and Run O COMMOrclai Vehicle O State Polka Vehicle O Local Police Vehicle O A O Work Zane O N! O Snowrrtoblb O Commonwaakh Vehicle O Local.Gov WWI* O AN Case Closed Patrol Zone Inveatigatlon Date a Agency Name NO 70 0610112008 A PA STATE POLICE - CHAMBERSBURG Badg e Number Dispatch TIM = me investigator CHRISTOPHER NEWMAN 10357 17:21 hrs 17:24, rs. , Revtewer Badge Number . nprcw to Reviewer DEPAOLO, JAMES C 08687 6/1b120 3 0 k rash Dewtptfon Date of Crash of Crash Day of the Wee THURSDAY HIT PEDESTRIAN 05/01/2008 17:19 hrs. Munkdpatlty County GREENE TWP FRANKLIN Relation to Roatlwey S then Conditions 3 NO ADVERSE COND111ONS SHOULDER Illumination Road Surface Conditbrts DRY u DAYLIGHT l FacWly Medica oI Units 9 of People of Injured >t 191bd EMS Agwv-y E EMS iii STAT MEDEVAC FAYETTEVILL ?tl?D YORK CHAMBER 004 S of Bus 003 Reated Sch 002 ool Zone Rel 001 ated ODOT Notiired . ype of Intersection S NOT APPLICABLE NO NO MIDBLOCK Wherein Wak Zone Work Zone Work Zone Type e NO Speed Limit UVorkers Present Officer Present Work Zone Charaderistica Work on Shoulder Intermittent or Flogger Road Cbaed i-i Work ? Control ? Oar 13 Movin or Medbn ? Lane Closure ? with Detour LJ g Route Number Segment Number es Speed Limit Orientatbn Route Signing 0081 n02 65 MPH SOUTH i INTERSTATE(NOT TURNPIKE} St [soling Lanes ca l used in i Intersection Crashes Street Name .. Route Number Mib Post Tenths Segment A 'E ? 018 0 V Street Name E ment I S Route Number Or Mile Post Tenths eg w Oil 0 street Name ? o Degrees Minutes Seconds Dedm 208 a Latitude: 39 66 • O " ffic Control Device 0 OT APPLICABLE $ e C ne losure Direction L ff ULL :? e? UTH r T Environmental I R r- First Hnrrrtfui Event in the Crash 0 Unit Number Harmful Event 001 HIT UNIT 2 S Indicated Prime Factor nit Nur DRIVER ACTION 001 > Prime Fader FmlromertlaNRoa -7 w Longitude: . 77 36 Tratfk Control Functioning NO CONTROLS Tratric Detoured Eatlmated 1 YES 3-6 HRS Potential Factors (E1R) 00433 The above entry is the distance from the Crash Scene to Landmark 1 seconds Decimal 03 953 Factor 3 Most Hamdui Event in the Crash nful Event T UNIT 3 BY PHYSICAL CONDITION old Surface, Type NO SPECal- JURISDICTION BLACKTOP Form*: H03 17b62t;4 Printed At: PA State Police - Chambereburg Obl1 W008 06:23 PM Page t ?r. H03-1756264 Commonwealth of Pennsylvania PAGE 2 Polia Crnh ROPOrt REPORTMA CRASH Q DUI Q Fatality r^1 L W and Rum O C mmvi i aMda r0 ?r poke V61I Q Wut Police V"Ide O NA Q Work tone O AW 0 Sw*mbblie Q Coamonw.aM Vehicle 0 Local GoV Vehicle Vehicle %Am Unit No 0o1 Motor Vehicle In Transport SufCa DaB ? Telepho Number First Name MI Last Name 0611711987 (717) 762-7193 ANTHONY C KRATOCHVIL Stale Zip Code 58ress eet City WAYNESBORO PA 17268 86603 03 PI PICADILLY CIRCLE Gender License Number lJoense State r: to OwnerlDriv 1 PRIVATE VEIiICL E NOT OWIVEDILEASED BY DRIVER MALE 27841877 PA 1 on Charged Pers Z O Driver Prsaeiws f'hYa? Code Vldatlon V hk;W 4 37 YES FATIGUE 1 DRIVER OPERATED VEHICLE c Drugs Suspected Tel NO BLOOD Driver Action AFFECTED BY PHYSICAL CONDIM Pedestrian Action 1 st Harmful Event HIT UNIT 2 _ i 2nd Harmful Event HIT UNIT 4 UNKNOWN RESULTS or Krgnt ?iUe MUM YES or RI Side Moat Hanntul Utility Pole NO or Right Side Most Harmful Utility Pole or RICH Side Moat Harmful (UtUltY PoIG SHELLY Street Address 8603 PICADILLY CIRCLE Vehicle TYPO AUTOMOBILE Model Year rCH Make 2000 VROLET Licenn Plate Rep. State ESE Si 7;YES O471 PA 0813 ee lrtsuretrce CornPany STATE FARM MUTUAL n of Travel shk ye Poslbon o` SOUTH LEFT LANE Oamage lndieator Gradient DISABLING LEVEL of of Units Type Unit 1 0 > Unit Make c e Type Unit 2 r .. ? cc Driver Helmet 0 assenper He Passenger? Owrwr MI Owner Last Flame or nusiness maiim A KRATOCHVIL State Zip Code Cihr PA 17268 WAYNESBORO Govemment Equipment Number Special Use" NOT APPLICABLE Ohkis Color N abide Model CAVALIER WHITE 1GIJC124XY7327843 !ehide Towed Towed By YES ROBINSOWS b xpiration Date POW Num er T 7175974-513?$R 08M 312008 ehble Movemant itial Impact Point :2 GOING STRAIGHT O'CLOCK 12 toad Allgntnent Possible Vehicle Failures STRAIGHT NONE Long Sleeves? ILOn9 Ps e 2 Form N: H43-1756254 printed At PA Stara Pollee - Chamberaburg 05115/2008 05:23 PM 9 bar: H03-1766254 - Commonwealth of Pennsylvania PAGE 3 e:: Police Crash Report VJEPMAKEC ASM O Dui OO FaWky O M and ft o O vett+tde O exact. Poke Vahka O Local Poke Vehkie O NIA O Work Zane O ATV O BnawnwbM O Comm weal h Vehkle O Loci Gov Vehicle it Number ype Unit r4nvnenclel Vehicle 1002 Legally Parked No Gender License Number License State Class Expiration Date Owner/Driver c Driver Presenc Ph i l C i e ys ca tion ond Primary Vehicle Code Violation Person Charged NO DRIVER 0 5 Alcohol/Drugs Suspected 1 Test Type hot Test Results e ffi Driver Action NO CONTRIBUTING ACTION ro Pedestrian Action Pedestrian Signals Pedestrian Clothing Pedestrian Location t a 1 at Harmful Event . Left or Right Sloe Most Harmful Utility Pole Number STRUCK BY UNIT 1 NO 2nd Harmful Event Left or Right Side boat Harmful Utility Pole Number HIT UNIT 3 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 utfx RICHARD F NORRIS Street Address City state zip Code 24 DOE DRIVE CARLISLE PA 17015 Vehicle Type Speclal Usage Govemment Equipment Number AUTOMOBILE NOT APPLICABLE Model Year Vehicle Make chide Model [Vehicle Color N 2000 PLYMOUTH NEON SILVER 1P3ES46CSYD530972 License Plate Reg. State Est Spend ahkte Towed Towed By GTE6830 PA 000 YES DAVE'S TRUCK REPAIR nsurance Insurance Company Policy Number Expiration Date YES NATIONWIDE 64A831636 Direction of Travel Vehicle Position ehkde movement Initial Impact Point a SOUTH SHOULDER RIGHT PARKED 6 O'CLOCK Damage Indicator Gradient Road Alignment Possible Vehicle Failures DISABLING LEVEL STRAIGHT NONE • a of Units Type Unit 1 Tap Number Tag Year Tag Stale Y 0 Unit Make It Ownef Type Unit 2 ap Number eg Year ag State 'CC Flt Ytfet Hall s u Read UpMS7 Printed AL PA State Police - Chambersburg 06116f2008 06:23 PM Page 3 Form *:H03.1766254 I Commonwealth of Pennsylvania PAGE 4 f: H03-i756Z64 Police Crash Report ROKMAM MASH se: I? Vehkle O Locsl Police Vehicle O DUI OO Fstslity d la sed [hie Q Coietn4adai Vehitfe Q anti. O WA O Work Zone O ATV O Seowmobge O Commmtwe M Vehl1C* O Local d0V Vehkle Vehicle Number ype Unit 003 Pedestrian a .,e„w,.,, Nimcl First Name LOGAN Street Address 24 DOE DRIVE Gender License Number MALE 0 m Driver Presence c hol/Drugs Suspected m NO Driver Actlon Pedestrian Action WORKING ON VEHICLE ist Harmful Event STRUCK BY UNIT 2 6th Harmful Event M I NORRIS CARLISLE UNKNOWN hol Test Type TEST NOT GIVEN NOT AT INTERSECTION LIGHT Lett or Right Skfe Moat Harmful YES Left or Right Side Most Harmful Left or Right Side Masi Harmful Left or Right Side Most Harmful or Plate Damag, 0 e aP c Y 0 rj > 's Un c c yl r -. mf cc Helmet stayea can r uv rr xmie w --w-----, ? Driver Helmet Type 0 M passenger Helmet Type Helmet Stayed On? DOT/Snell Deslflnation7 Eye Protedan7 • Passenger Helmet? v Rear Reflectors? Head Lights? a Printed At: PA State Police - Chambereburg 05JIU200B 06:23 PM Page 4 0412811 gas (71 n 7A"636 IState Zip Code PA 170ib Person Charged NO Results :lothing Pedestrian Location SHOULDER Mity Pole Number U81[ty Pote Number Ugft Pole Number Long Forme: H03-1766264 .r: H03-1766264 Commonwealth of Pennsylvania PAGE 6 Police Crash Report REPORTABLE CRASH O DUt QQ Fatality ?(,? HR and Run O Co??raa1 Vehkle O State PoOce Vehido O Local Police Vehicle O MA Q Wort, Zone U ATV Q Snowmob0e 0 Commornvealfh Vehicle O Loin Gov Vehicle it Number Type Unit Pedestrian ComrM No G04 First Name 1 Last Name RICHARD A SCHNITZLER Street Address city i01 NORTH PRINCE STREET, APT 0 5114 SHIPPENSBURG Gender License Number License State Class P ra ate owner/oriver c 0 MALE V Physical Condillon Primary Vehicle Code Violation € Driver Presence APPARENTLY NORMAL- 5 haUD.0. Suspected hol lest Type hol T . c NO TEST NOT GIVEN s Dever Action V • strian Action d P Pedestrian SPe de 81148 I e e N LI MT N? NOT AT WORKING ON VEHICLE Q Lett or Right Side Most Harmful st Harmful event 1 YES STRUCK SY'UNIT 1 fill Event Left or Right Sloe Most Harm Loft or Right Side Most Harmful Left or Right Side Most Harmtui Last Name or c 0 a Da a L 0 v r 0 c r* c l° t- yU.. U O Or V T V m a of Units 0 00 Lights? (Rear RetleetorS7 Printed At. pA State Police - Chembersburg 06115f2008 05:23 PM Page 6 Jr 10131/1985 (717) 632-3705 State Zip Code PA 17267 NO SHOULDER Number Long S4eeves4 Form M H03-1756254 H03-1756254 Commonwealth of Pennsylvania PAGE 8 Police Crash Report REPORTABLE CRASH Q DUI Q Fetalit)t 0 IiRselr3 Run C1 CeatntuWl Veh1eN Stale Police Vehicle Q Local Police Vehicle 0 NIA O Wort zone C) ATV O SrlomimoDhe 0 Commonwealth WhIcle Q Locai tbov Vehlele IF? Unit # Driver R@SirICtIORe Compliance Drf" Endasernont Compliance Drtvef Lbertso Compliance ALID LICENSE FOR CLASS 01 NO RESTRlCTiQNS/NOT APPLICABLE NONE REQUIRED V U? Rwe tndlcator principal tmpad Point voidance Maneuver NO UNDERRIDE Oa 12 O'CLOCK NO AVOIDANCE MANEUVER W Emergency Use Drug Test Type Drug Test Results NOT IN EMERGENCY USE BLOOD UNKNOWN TEST RESULTS ---- --------- License Compliance EndorsementCompliance Driver Unit # Driver Restriciotns Compliance NOT REQUIRED FOR VEHICLE CLASS 02 NO RESTRICTIONSINOT APPLICABLE NONE REQUIRED Principal Impact Point voidance Maneuver Under Ride Indicator a 6 O'CLOCK NO AVOIDANCE MANEUVER NO UNDERRIDE OR OVERRIDE Emergency Use Drug Teal Type Drug Test Results NOT IN EMERGENCY USE NONE NO TEST GIVEN Unit # Driver Restrsctiona Compliance Driver Endorsement Compliance Driver License CompItance 03 NO RESTRICTIONSINOT APPLICABLE NONE REQUIRED NOT REQUIRED FOR VEHICLE CLASS Principal Impact Point voidance Maneuver Under Ride Indicator UNKNOWN LL Frnerg5' Use Drvg Teat Type Dtttp Tess Results NONE HO TEST GlYEN Unit # Driver Reatrktiona Compliance Driver Endorsement Compliance Driver License Compliance 04 NO RESTRICTIONSINOT APPLICABLE NONE REQUIRED NOT REQUIRED FOR VEHICLE CLASS )rug Test Typo NONE Unit Person No. First dame 001 001 ANTHONY treaI Address 8603 PICADILLY CIRCLE Phone Number £MS T (T1T) 762-7193 YES 0 5 Seat Positron DRIVER - ALL VEHICLES a $ Safety Equipment 2 rz MULTIPLE AIRBAGS DEPLOYED Ejection NOT EJECTED 003 002 J LOGAN Street Address 24 DOE DRIVE Phone Number EMS (TIT) 248-8636 NO `c Seat Position o NOT A PASSENGER / OCCUPANT Safety Equipment 2 c NONE USED I NOT APPLICABLE Ejection NOT APPLICABLE NO TEST GIVEN C I KRATOCHVIL ;sty WAYNESBORO Person Type Gender DRIVER MALE Safety qE uu nt 1 LAP AND SHOULDER BELT USED ExbiC9130n ^^? NOT EXTRICATED :section Path NOT EJEC T EDI IOT APPLICABLE I M NORRIS Ity CARLISLE Person Type PEDESTRIAN MALE Safety Equipment 1 NONE USED I NOT APPLICABLE Extrication NOT APPLICABLE :jection Path NOT EJECTED/NOT APPLICABLE G6/17/1987 J state Zip Code PA 17268 yury Severity MINOR INJURY PA Injury Severt KILLED 04!28/1988 rip Code 17015 Form #: H03-1766254 Printed At: PA State Pollee - Chambsrsburg 05I1512008 06_23 PI/ Page 6 ' Commonwealth of.Pennsylvania PAGE 7 tunbar: H03-1766254 Police Crasb nowk REPORTANACRASH Ives: W and Run 0 Wyk; 0 >l tm Po6oa Vehicle 0 0 Local P01fce Vehicle DUI Q FaWlty 0 co Mmmesnb Vehkde arrrwW 0 S 0 Local Gov Vehicta 0 IVA 0 Work Zo ne 0 ATV , nv SutPoc DOB nit # Person No. First Name Mt A Lad Name SCHNITZLER JR 1013111985 fl04 003 RICHARD State Zip Code treat Address 101 NORTH PRINCE STREET, APT S S114 City PA 17257 SHIPPENSBURG Injury Seventy d phone Number EMS Transport Person Type PEDESTRIAN er Gen MALE MAJOR INJURY (717} b32?3T05 YES $gfgty Equipment 1 Position c Seat NONE USED ! NOT APPLICABLE A PASSENGER/ OCCUPANT m NOT CL Extrit atlon a Safety Equipment 2 NOT APPLICABLE NE USED ! NOT APPLICABLE NO Ejection Path lection E NOT EJECTEDINOT APPLICABLE NOT APPLICABLE NOT s uffix phone Number MI Last Name (717) 372-3306 First Name L 1COZlAR KRISTINE State Z ip Code treat Add rasa city SHIPPENSBURG PA 17257 18 LARCH DRIVE Suffix Phone Number MI Last Name (301) 992-1094 First Name M SCRIEVER g KRYSTA State Zip Code tree! Address C? GREENCASTLE PA 17225 5525 RICE HOLLOW ROAD Sufrtz Phone Number hone umber Mt Last Name 20 (71T) 597-94 First Name G 14ORNBAKER WESLEY State Zip Code treat Address city GREENCASTLE PA 17225 6204 MAGER ROAD Suffix Phone Number hone umber MI LastNama 18 (71T) 504-82 First Name M JACKSON KATRINA State Zip Code ? Street city CHAMBERSBURG PA 17202 3056 SUNDOWN DRIVE 3058 Suffix phone Number umber MI Last Name 7 (610) y First Name JENNIFER T RUNLE state Zip Code Cod - beetAddress RIEGELSVtLLE City PA ROAD 405 DURHAM Suffix Number one MI Last Name (717) 532.9360 First Name L HARMON - JEAN State Zlp code treat Address city Gty SHIPPENSBURG PA 17257 i 1130 THORNWOOD ROAD r,s.. u„+rro,1 me NoUfu $ ROBERT F. NORRIS Z Reason for Notification DEATH OF LOGAN M. NORRIS lone numuer 0510112008 249-8636 21:18 hrs. (717} Pa 7 Form ?: H03-1755254 Printed At PA State P011Ce • Chambersburq 06/1672008 06:23 PNI 9e Commonwealth of Pennsylvania PAGE 8 :r. H03-1756264 Police Crash Report REPORTABLE CRASH O DUI © Fatafltll O Nit MO Run O cotrrae dd vshicie O stays Polk. Vehicle O Local Poke Vehkie O NIA O Wort Zone O ATV O SworMobiM O Coln maw"Ith vehicle O Local Gov Vehicle RIGHT t-- A SHOULDER/BERM -WITNESS # 3 WITNESS # 4 POINT OF IMPACT WITH WITNESS # 1 UNIT # 1 AND UNIT # 4 `a I ITIAL POINT OF IMPACT UNIT # 1 GOING UNIT # 4 FORWARDAND PINNING UNIT 114 UNIT UNDER THE FRONT LEFT SHOULDER/BERM END INTERSTATE 81 SOUTHBOUND -TANES, 86 MPH POSTED SPEED LIMIT Unit 1 v POINT OF IMPACT WITH UNIT # 2 AND UNIT # 3 __ / yynpl CRAPESIGOUGES Unt1 UNIT # 2 AT FINAL REST CHAMRERSBURG MARKS ?ng2 I ---.FACING WEST WITH UNIT UNIT # 1 BOROUGH, APPROX. # 3 PINNED UNDER SPINNING 1.5 MILES NEATH UNIT* 1 GOING j BACKWARDS MILE POST Nor ro'Afl # 18 SIGN - T I I - .rash Synopsis This crash occurred as Unit # 1 was traveling south in the left lane of Interstate 81. Unit # 2 was disabled on the right shoulder/beret of Interstate 81 between mile marker 18.5 and 18. Unit # 3 (Pedestrian Logan M. NORRIS) and Unit # 4 (Pedestrian Richard Anthony SCHNITZLER Jr.) were changing the right/passenger front tire of Unit # 2. Unit # 1 traveled southwest across the right lane and the front end of Unit # 1 struck the rear of Unit # 2. Unit # 2 was pushed into Unit # 3. Unit # 1 struck Unit # 4. Unit # 2 spun counterclockwise and dragged Unit # 3 under Unit # 2's undercarriage before coming to final rest facing west mostly on the right berm/shoulder and partially in the right lane of travel. Unit # 1 spun clockwise and traveled west through a grassy area, west backwards up a grassy embankment several feet and traveled forward In an easterly direction before coming to final rest facing east with Unit # 4's legs partially trapped under the front end of Unit # 1. ydrratlvs This crash occurred as Unit # 1 was traveling south in the left lane of Interstate 81. Unit # 2 was disabled on the right shoulderlberm of Interstate 81 between mile marker 18.5 and 18. Unit # 3 (Pedestrian Logan M. NORRIS) and Unit # 4 (Pedestrian Richard Anthony SCHNITZLER Jr.) were changing the right/passenger front tire of Unit # 2. Unit was # I traveled Unit #w3. Unit # 1 struckright Un it # and dragged Unit # 3 under Unit # 4. Unit # 2 pun counterclockwise Unit pushed Into Pa e 0 Form #: H03.1756254 Printed At PA Stela Polka - Chambenburg 06I1612008 05:23 Pit 9 or: H03-176SU4 Commonwealth of Pennsylvania PAGE 8 Police Crash Rfport REPORTABLE CRASH O DUI O Falaft O Fitend Rue O Commemlal Vehta. O san Police Vehicle O Local Polka Vehicle O WA O Work Zone O ATV O Snowmobile O Comm m"Ith Vehicle O Local Gov Vehicle r2's undercarriage before coming to final rest facing west mostly on the right bermishoulder and partially in the right lane of travel. Unit # 1 spun clockwise and traveled west through a grassy area, west backwards up a grassy embankment several feet and traveled forward In an easterly direction before coming to final rest facing east with Unit # 4's logs partially trapped under the front end of Unit # 1. The location of the crash Is a divided highway separated by a grass center median. The southbound lanes make up a two lane roadway with shoulders/berms on both sides; left lane, right lane, right shoulder/berm and left shoulderiberm. Interstate 81 is approx. 37'09" across from shoulder to shoulder (including the shoulders/berms). The left shoulderlberm is approx. 4' 3.5" wide and the right shoulderiberm Is approx.10'03" wide. The left lane is approx. 12'03" wide and right lane Is approx. 11*01" wide. At the time of the collision the weather was sunny and clear, the roadway was dry and there were no street lights or house lights In the surrounding area. Upon my arrival at the scene 1 observed the following evidence: Unit # 1 was at final rest with severe damage to the front and, bumper area, hood and windshield. Both front airbags were deployed. Unit # 2 was at final rest with damage to the passenger sidelright rear door, the rear window was broken out and damage to the rear and, Including the bumper and trunk. Unit # 2 had a flat passenger side/ right front tire. I observed Unit # 3 without shoes on and pinned under the center undercarriage of Unit # 2. Unit # 4's leg's were pinned under the front and of Unit # 1.1 observed a scissor jack, jack handlellug toot, and a space saver style spare tire which could be attributed to Unit # 2.1 observed 2 shoes on the right berm which could be attributed to Unit # 3.1 observed several scrapes/gouges, pieces of blue denim and red streaks on the right shoulderiberm. On 05/01108 at approx. 1735 hours I interviewed Witness # 1, Kristine Leanne KOZIAR, at the scene. Witness # 1 related she was traveling south directly behind Unit 01 In the left lane. Witness # 1 related she and Unit # 1 were going approx. 75-80 MPH. Witness # 1 related that she observed Unit # 1 swerve from the left lane over to the right berm hitting Unit # 2. On 05/01/08 at approx. 1737 hours I Interviewed Witness # 2, Krysta Marie SCRIEVER, at the scene. Witness # 2 related she, is not sure where she was when the crash occurred but she was traveling south and applied her brakes heavily and saw Unit # 1 go airborne hitting Unit # 2 off the roadway In her rearview mirror. On 05101108 at approx. 1740 hours I Interviewed Witness # 3, Wesley G. HORNBAKER, at the scene. Witness # 3 related that he was in the left lane when the crash occurred. Witness # 3 related that Unit # 1 never hit his brakes and swerved from the left lane and hit Unit # 2 on the berm. Witness # 3 related he saw a guy standing next to Unit # 2 on the berm just before the crash. On 05101108 at approx.1744 hours I Interviewed Witness # 4, Katrina M. JACKSON, at the scene. Witness # 4 related she was traveling south In the right lane when Unit # 1 swerved from the left lane off to the right berm and hit Unit # 2 as it was parked on the right berm. On 05101/08 at approx. 1747 hours I Interviewed Witness # 5, Jennifer Talley RUHLE, at the scene. Witness # 5 related she was In the felt lane and Unit # 1 was a few cars In front of her in the left lane. Witness # 5 related the next thing she saw was Unit # 1 in the air on the southbound berm. On 05101/08 at approx. 1750 hours I Interviewed Operator # 1 at the scene. Operator # 1 related he was in Shippensburg visiting a friend and he fell asleep Printed At. PA State Police - Chambersburg 0611612008 06:23 PM Page 9 Form 9: H03-1756254 Commonwealth of Pennsylvania PAGE 10 Ember N03-1756254 Police Crash Repoet REPORTABLE CRASH "' 8taEa Polka Vahkle Local Polka Vehicle O ovi U+ FW ty O ? MW Rue 4 cwww; vaAida O Q WA O wont Zone O ATV O .4n0wmobVe O Coaanonwaant+ Vehicle Q Local Gov Vehicle he was driving. Operator # 1 related he was wearing his seatbelt at the time of the crash. On 05/01108 at 1754 hours Franklin County Coroner Jeff CONNER pronounced Unit # 3 (Pedestrian Logan M. NORRIS) dead at the scene. Unit # 3's (Pedestrian Logan M. NORRIS) Pennsylvania Driver's License was turned over to Franklin County Coroner Jeff CONNER at the scene at 1819 hours. Operator # 1 was transported from the scene to Chambersburg Hospital by Fayetteville EMS. Unit # 4 was flown from the scene to York Hospital by STAT MedEvac. Deputy Coroner Susan R. FISHER responded to Chambersburg Hospital where Operator # 1 consented to have blood drawn and a urinalysis. Sgt. William MCAREAVY contacted Franklin County District Attorney Jack NELSON from the scene by telephone. On 05102108 at 1348 hours I spoke to Witness # 6, Jean Lillian HARMON, by telephone. Witness # 6 related she was traveling north and did not see the crash but noticed a crash had occurred. Witness # 6 related she stopped her vehicle in the center grass median and went to help at the scene of the crash. Witness # 6 related Operator # 1 advised her that he fell asleep while he was driving. On 05102108 at 2011 hours I spoke to Unit # 4 (Pedestrian Richard Anthony SCHNITZLER Jr.) by telephone. Unit # 4 was in York Hospital. Unit # 4 related that he was helping Unit # 3 change a front passenger side flat tire on Unit # 2 on the berm. Unit # 4 related he was positioned towards the middle of the passenger side of Unit # 2 and Unit # 3 was using the jack by the fiat tire. Unit # 4 related the next thing he remembers is being put In a helicopter. Notification of death was made to Unit # 3's (Pedestrian Logan M. NORRIS) father, Richard F. NORRIS, In person by Cumberland County Coroner Michael L. NORRIS on 06101108 at 2118 hours. All individuals involved or family members of Individuals involved were mailed a SP7-0015. Deputy Coroner Ken PEIFFER Jr. took photographs at the scene with a Cannon EOS 6.0 Mega pixel digital camera to aid in the investigation. A CD with the photographs was retained in the Crash Attachment File. Sgt. William MCAREAVY, Trooper Scott KEMERER and C.A.R.S. Cpl. Andrew THIERWECHTER assisted at the scene. Other responding agencies: Franklin Fire Department, New Franklin Fire Department, Fayetteville Fire Department, Fayetteville EMS and STAT MedEvac. Fatal Crash System report was entered. A printout was retained in the Crash Attachment File. On 05104108 at 1421 hours Operator # 1 arrived at PSP Chambersburg where he provided a 2 page noncustodial written statement The original statement was entered Into evidence (Property # H3-17469) and a copy was retained in the Crash Attachment File. Both Unit # 1 and Unit # 2 were logged in as evidence at PSP Chambersburg (Property # 1-13-17469 A) and a COPY of the Property Record was retained In the Crash Printed At PA State Polio* - Chambemburg 0611 V2008 05:23 PM Page 1o Form lh H03-1758254 umber: H03-1766264 Commonwealth of Pennsylvania PAGE 11 Police Crash Report REPORTABLE CRASH O DUI Qi Fatality Q Hit and Run Q c0awnerdal Vehicle Q State Police Vehicle Local Poiics Vehicle O WA O Worlt Zone O ATV Q Snowmobfle O Conunonweaith Vehicle O Local Gov Vehicle Attachment File. This crash report will remain open and will be supplemented upon receipt of the Franklin County Coroner's report, Cpi Andrew THiERWECHTER'S report, bloodiurine test, results from Operator # 1 and contact with the Franklin County District Attorney's Office. A Public Information Release Report was prepared and it was placed in the Crash Attachment File. 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' . c ?er..i?!!rw .,.,.•IIa-per.." . . w4mr a:gs?C.d.•anpefrkdno?.am.2?..e {,7av?mamdw W-04 'AjM w.pft,. d}r,6_Mm>m.eea9eff?e an..e? .a?roa?mlx:s '-' {l.mmenvwa?ree--__-_-__-_-____--t_1 m 3t lklD:•>ar.„wQ • N?fieOEaoa'7UauDn E1slhaknLas?inffor a+ttm}. e a b a4nR ffi i?/ ? y tr ?' .a.2ma . , ? aa eol ?, mn a ettme.:na..u4lR?asl SZbtM ame(q rd wmer ?s sf+ki n. Wvalc40fesnCiTiantw?e2?glaYYt? l?+.?lN•.Clnti 'ra'•"an ? !I .? ?I 11 N =P p i F (J I f ? '+s !'? ? FbdPdIdK - ? /- 14 -07 Lml.YM Rd. 1 _. at;• S ..7.S..G .?i ?S 3 a e vCi4 6 ?ab d? ifc EXHIBIT "D" SWARTZ CAMPBELL LLC ATTORNEYS AT LAW NATIONWIDE AUTO POLICY DECLARATIONS Page 01 of 02 These Declarations are a part of the policy named above and identified by policy number below. They supersede any Declarations issued earlier. Your policy provides the coverages and limits shown in the schedule of coverages. They apply to each insured vehicle as indicated. Your policy complies with the motorists' financial responsibility laws of your state only for vehicles for which Property Damage and Bodily Injury Liability coverages are provided. Policyholder: Policy Number: (Named Insured) 54 37 A 831635 RICHARD F NORRIS Issued: MAR 18, 2008 24 DOE DR CARLISLE, PA 17015-7713 Policy Period From: APR 11 , 2008 to OCT 11 , 2008 but only if the required premium for this period has been paid and only for sic month renewal periods if renewal premiums have been paid as required. This policy is initially effective at (1) the time the application for insurance Is completed, or (2) 12:01 a.m. on the first day of the policy period, whichever is later. Each renewal period begins and ends at 12:01 a.m. standard time at the address of the named Insured stated herein. This policy cancels at 12:01 a.m. at the address of the named insured stated herein. IMPORTANT MESSAGES: IF THIS DECLARATIONS PAGE SHOWS THAT COLLISION COVERAGE APPLIES TO YOUR AUTO, THERE IS ALSO COLLISION COVERAGE FOR DAMAGE TO A RENTED AUTO. COVERAGE IS SUBJECT TO CONDITIONS AND LIMITATIONS LISTED IN THE POLICY OR ATTACHED ENDORSEMENTS. INSURED VEHICLE(S) & SCHEDULE OF COVERAGES 1. 2003 FORD EXPDTN X ID #1 FMPU16W13LA48268 Six Month Coverages Limits Of Liability Premium COMPREHENSIVE AND $ 1 500 ACTUAL CASH VALUE LESS $ 50 $ 60.70 IN CUSTOMIZATION COLLISION AND $ 1 500 ACTUAL CASH VALUE LESS $ 100 $ 201.60 IN CUSTOMIZATION PROPERTY DAMAGE LIABILITY 25,000 EACH OCCURRENCE $ 99.90 BODILY INJURY LIABILITY 100,000 EACH PERSON 300,000 EACH OCCURRENCE $ 74.50 UNINSURED MOTORISTS-BODILY INJURY (NON-STACKED 100,000 EA PERSON 300 000 EACH OCCURRENCE STACKED) NON $ 5.70 UNDERINSURED MOTORISTS-BODILY INJURY - ( 100,000 EACH PERSON 300,000 EACH OCCURRENCE 31.60 TOWING AND LABOR 50 EACH DISABLEMENT 1.40 FIRST PARTY BENEFITS OPTION 1-MEDICAL BENEFIT $ 10,000 $ 26.00 LIMITED TORT TOTAL $ 501.40 LIENHOLDER-FORD MOTOR CREDIT CO LIEN EXPIRES ON APR 25, 2011 V-1 00-A t Page 02 of 02 3. 2000 PLYM NEON / LX ID #1 P3ES46C6YD530972 Six Month rages Cov Limits Of Liability Premium e COMPREHENSIVE ZAT AND $1 ACTUAL CASH VALUE LESS $ 50 $ 59.00 ION N DS , COLLISION AND $ ACTUAL CASH VALUE LESS $ 100 $ 285.70 IN CUS?TOMIZATION PROPERTY DAMAGE LIABILITY 25,000 EACH OCCURRENCE $ 93.70 BODILY INJURY LIABILITY 100,000 EACH PERSON 300 000 EACH OCCURRENCE $ 81.70 UNINSURED MOTORISTS-BODILY INJURY (NON-STACKED 100,000 EACH PERSON 300 000 EACH OCCURRENCE $ 5.70 UNDERINSURED MOTORISTS-BODILY INJU RY (NON-STACKED) 100,000 EACH PERSON 300,000 EACH OCCURRENCE $ 31.60 FIRST PARTY BENEFITS OPTION 1-MEDICAL BENEFIT $ 10,000 $ 34.00 LIMITED TORT TOTAL $ 591.40 LIENHOLDER-AMERICHOICE FED LIEN EXPIRES ON JUL 10, 2010 LISTED DRIVERS: Driver Birth Marital # Name Date Status 01 RICHARD F NORRIS 08/11/57 MARRIED 02 PAT NORRIS 06/24/55 MARRIED 03 LOGAN NORRIS 04/28/88 SINGLE 04 CLAYTON NORRIS 01/26/91 SINGLE APPLIED DISCOUNTS: PASSIVE RESTRAINT SAFE DRIVER ACCIDENT FREE GOOD STUDENT ANTI THEFT DEVICE MULTI CAR Policy Form & Endorsements: V037B 3272 3329 3393 Office Use: OCT 11, 2007 $ 0.00 Issued By: NAT I ONWI DE MUTUAL INSURANCE COMPANY 23787 Home Office - Columbus, Ohio Countersigned At: BUTLER, PA. By: JEFFERY M L I PKA IMPORTANT PHONE NUMBERS Nationwide 24-Hour Claims Number: 1-800-421-3535 For QUESTIONS About Your Policy, Call Your NATIONWIDE AGENT : JEFFERY M LIPKA 814-342-6200 814-765-1735 For Hearing Impaired: TTY 1-800-622-2421 Nationwide Regional Office: 800-798-7783 EXHIBIT "E" SWARTZ CAMPBELL LLC ATTORNEYS AT LAW RELEASE AGREEMENT This Release Agreement ("Agreement") is entered into among Richard F. Norris, as Administrator of the Estate of Logan M. Norris, and individually, and Nationwide :Mutual Insurance Company (hereinafter collectively referred to as the "Parties"). The "Insured" shall collectively mean Richard F. Norris, individual, his respective heirs, executors, administrators, personal representatives, successors and assigns; and the "Insurance Company" shall collectively mean Nationwide Mutual Insurance Company and their successors and assigns. I. RECITALS On or about May 1, 2008, Decedent, Logan M. Norris, was involved in a motor vehicle accident on Interstate 81 between mile marker 18.5 and 18, when, while trying to change a flat tire he was struck and killed by a vehicle driven by Anthony C. Kratochvil. (hereinafter referred to as the "Occurrence"). In connection with the Occurrence, the Insured has asserted claims against Nationwide Mutual Insurance Company. NOW THEREFORE, it is hereby agreed as follows: II. UNINSURED MOTORIST RELEASE AGREEMENT Known all men by these presents: That, for sole consideration of the cash payment(s) referred to in Paragraph III.A. from the Insurance Company, the receipt of 1 SWARTZ CAMPBELL LLC ATTORNEYS AT LAW J which is hereby acknowledged, and the Insured in their capacity as an insured does hereby forever release and discharge the Insurance Company of and from any claims of Automobile Insurance Policy number 5437A831635 issued by Nationwide Mutual Insurance Company to Richard F. Norris, as a result of the occurrence. This Release Agreement applies to all claims and/or causes of action. III. PAYMENTS TO INSURED A. Cash at Settlement. Upon Court approval of this settlement Nationwide Mutual Insurance Company agrees to pay One Hundred Thousand Dollars ($100,000) to be distributed to Richard F. Norris, as Administrator of the Estate of Logan M. Norris. B. Nature of Payments. All sums set forth in this paragraph constitute damages on accounts of personal injuries or sickness, arising from the Occurrence, within the meaning of Section 104(a)(2) of the Internal Revenue Code of 1986, as amended. IV. ADEQUATE CONSIDERATION The Insured agrees and acknowledges that the Insured accepts payment of the sums that the Insured is to receive pursuant to this Agreement as a full, complete, final and binding compromise of matters involving disputed issues regardless of whether too much or too little may have been paid. 2 SWARTZ CAMPBELL LLC ATTORNEYS AT LAW L J V. ENTIRE AGREEMENT This Agreement contains the entire agreement between the Insured and the Insurance Company with regard to the matters set forth herein. There are no other understandings or Agreements, verbal or otherwise, in relation thereto, between the Parties except as herein expressly set forth. VI. READING OF AGREEMENT In entering into this Agreement, the Insured represents that the Insured has completely read all terms hereof and that such terms are fully understood and voluntarily accepted by the Insured. VII. FUTURE COOPERATION All Parties agree to cooperate fully, to execute any and all supplementary documents and to take all additional actions that may be necessary or appropriate to give full force and effect to the terms and intent of this Agreement which are not inconsistent with its terms. VIII. DRAFTING OF DOCUMENT AND RELIANCE BY INSURED This Agreement has been negotiated by the respective Parties. The Insured warrants, represents and agrees that the Insured is not relying on the advice of the Insurance Company, or anyone associated with them as to the legal and income tax or 3 SWARTZ CAMPBELL LLC ATTORNEYS AT LAW C 1* other consequences of any kind arising out of this Agreement. Accordingly, the Insured hereby releases and holds harmless the Insurance Company, and any and all counsel or consultants for them from any claim, cause of action or other rights of any kind which Insured may assert because of the legal, income tax or other consequences of this Agreement other than those anticipated by the Insured. The undersigned, and each of them, warrant and represent that no promise, inducement or agreement not herein expressed has been made to them and its Agreement constitutes the entire agreement between the Parties hereto and that the terms of this Agreement are contractual and not mere recitals. The undersigned, and each of them, have read the foregoing Agreement and fully understand it, and are aware of the propriety and legal effect of executing the same, and neither the Agreement nor the compromise and settlement recited herein were induced by fraud, coercion, compulsion or mistake, nor is this Agreement nor the compromise and settlement made by the undersigned in reliance upon any statement or representation of any of the parties hereby released, or their representatives, agents or attorneys. IX. COURT APPROVAL The Insured represents that the Insured has received any and all necessary court approvals to enter into this Agreement. 4 SWARTZ CAMPBELL LLC ATTORNEYS AT LAW s X. CONTROLLING LAW This Agreement shall be construed and interpreted in accordance with the laws of the Commonwealth of Pennsylvania. Dated: zy ?? Richard F. Norris, as Administrator of the Estate of Logan M. Norris, and individually Dated: Duly Authorized Representative for Nationwide Mutual Insurance Company APPLICABLE TO PENNSYLVANIA ONLY: For your protection, Pennsylvania requires the following to appear on this form: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. 5 SWARTZ CAMPBELL LLC ATTORNEYS AT LAW 0 25-09 AUG 25 Ai i i c? S t;; n t 4'18.5-o P b ATT`/ 0,4* 1ai8 tr* a o29'7aa SWARTZ CAMPBELL LLC By: Andrew T. Kravitz, Esquire I.D. No. 80142 275 Grandview Avenue, Suite 104 Camp Hill, PA 17011 (717) 303-1580 Attorney for Petitioner, Nationwide Mutual Ins. Co. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION IN RE: SETTLEMENT OF WRONGFUL No. 04- 58+ 0 e,-.-w-r&k DEATH CLAIM FOR LOGAN M. NORRIS, DECEASED JOINDER IN PETITION I, Richard F. Norris, as Administrator and sole beneficiary of the Estate of Logan M. Norris, deceased, do hereby join in the Petition of Nationwide Mutual Insurance Company for Court Approval of Wrongful Death Action. Date: 31(?[N Richard F. Norris Administrator of the Estate of Logan M. Norris, Deceased SWARTZ CAMPBELL LLC ATTORNEYS AT LAW ( TFir r 1r ?} T 1 2009 AUG 25 AM 11: 4 Q ?r /liIN ! SWARTZ CAMPBELL LLC By: Andrew T. Kravitz, Esquire I.D. No. 80142 275 Grandview Avenue, Suite 104 Camp Hill, PA 17011 (717) 303-1580 Attorney for Petitioners, Nationwide Mutual Ins. Co. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA 0,1VtL DIVISION IN RE: SETTLEMENT OF WRONGFUL No. Oq " 5$q b DEATH CLAIM FOR LOGAN M. NORRIS, . DECEASED ACCEPTANCE OF SERVICE TO THE CLERK OF THE ORPHAN'S COURT: Ctvit lark 1, Richard F. Norris, Administrator of the Estate of Logan M. Norris, deceased, do hereby accept service of the Petition of Nationwide Mutual Insurance Company for Court Approval of the Wrongful Death Settlement. ? Date: I? 10 Richard F. Norris Administrator of the Estate of Logan M. Norris, Deceased SWARTZ CAMPBELL LLC ATTORNEYS AT LAW AN It: g, c .- t ??? b, a SWARTZ CAMPBELL LLC By: Andrew T. Kravitz, Esquire I.D. No. 80142 275 Grandview Avenue, Suite 104 Camp Hill, PA 17011 (717) 303-1580 Attorney for Petitioner, Nationwide Mutual Ins. Co. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA IN RE: SETTLEMENT OF WRONGFUL No. Oil- 5840 (21vit DEATH CLAIM FOR LOGAN M. NORRIS, DECEASED PRELIMINARY DECREE AND NOW, this c? day of aup?eck? , 2009, a hearing on the Petition of Nationwide for Court Approval of Compromise/Settlement is scheduled for , in Court Room -,5_, Cumberland County Courthouse, Carlisle, Pennsylvania. BY THE COURT: ?k -t, ?,4 SWARTZ CAMPBELL LLC ATTORNEYS AT LAW OF THE Pi'? TARY 2099 AUG 31 All : 11 t i SWARTZ CAMPBELL LLC By: Andrew T. Kravitz, Esquire I.D. No. 80142 275 Grandview Avenue, Suite 104 Camp Hill, PA 17011 (717) 303-1580 Attorney for Petitioners, Nationwide Mutual Ins. ( IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA IIN RE: SETTLEMENT OF WRONGFUL No. 09- DEATH CLAIM FOR LOGAN M. NORRIS, DECEASED ORDER AND NOW, this day of S t???w?b?r , 2009, upon consideration of the foregoing Petition for approval of settlement of the wrongful action and hearing on the same, it is hereby ORDERED and DECREED settlement with Nationwide Mutual Insurance Company in the amount of $100 between with Nationwide Mutual Insurance Company and Richard F. N Administrator of the Estate of Logan M. Norris, deceased, is hereby approved. Pursuant to the allocation approved by the Pennsylvania Department $100,000.00 is allocated to Wrongful Death Claim. Richard f. Norris, pursuant Pa.C.S.A §2102 (4), 20 Pa.C.S.A §2103 (1), 20 Pa.C.S.A. 2104 (1) is the sole the 0.00 as nue, 20 iarv. Richard Y. Norris is to receive total cash consideration in the amount of $100,000.00. Pursuant to the agreement between Richard F. Norris and Nationwide b?utual Insurance Company, the cash consideration in the amount of $100,000.00 is to be paid by Nationwide Mutual Insurance Company directly to Prudential Insurance Company of SWARTZ CAMPBELL LLC ATTORNEYS AT LAW America to fund a structured settlement, with Richard F. Norris as the sole beneficiary. SWARTZ CAMPBELL LLC ATTORNEYS AT LAW F1LECr--Di='r:ICJE OF THE 2009 SEP I I Ffi 2: Is J k&- f 6 p d 4d t-ir, Np '0 .5