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HomeMy WebLinkAbout10-2048Johnson, Duffle, Stewart & Weidner By: Jeffrey B. Rettig I.D. No. 19616 Andrew P. Dollman I.D. No. 209466 301 Market Street P. O. Box 109 Lemoyne, Pennsylvania 17043-0109 (717) 761-4540 jbr@jdsw.com F LED-WHOE OF 114E I t''', 11i0N, 0TARY Attorneys fa I?Rr Pr' 1` 4Z ?Y KENNETH BOYER and JANICE BOYER, as parents and natural guardians of, ASHLEY BOYER, a minor 325 Glendale Drive Shiremanstown, PA 17011 Petitioner v KATHLEEN MATHNA, 495 Pondtown Rd. Dillsburg, PA 17019 Respondent IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. - D,,i,iI-Ferm PETITION FOR APPROVAL OF MINOR SETTLEMENT AND ,NOW, comes the Petitioner, Janice Boyer, parent and natural guardian of Ashley Boyer, a minor, and petitions this Honorable Court to approve settlement of the personal injury claim of Ashley Boyer against Kathleen Mathna, Respondent, and in support thereof avers the following: 1. No suit has been filed in this personal injury action. The terms of settlement have been reached without the need for litigation. $Ra..00 PD -ATt'`1 0-0 3129 y9 RT* 12313 1 2. This compromise arises out of an incident which occurred on January 23, 2009 in which Ashley Boyer was a rear-seat passenger in a vehicle being driven by Janice Boyer, which was involved in a collision with a vehicle driven by Respondent, Kathleen Mathna. 3. Ashley treated at Harrisburg Hospital on the date of the accident and received treatment for friction burns on her face and pain in her left shoulder. Copies of medical records from Ashley's treatment and photos are attached hereto as Exhibit "A". 4. Kenneth and Janice Boyer, as parents and natural guardian of their daughter, Ashley Boyer, have agreed to settle Ashley's personal injury claims for a sum of $17,500.00 to be paid into a financial instrument that will provide for a structured settlement. A copy of the proposed Settlement Agreement and Release is attached hereto and marked as Exhibit "B". 5. At the time of the incident on January 23, 2009, Ashley Boyer was 6 years old. Her date of birth is February 19, 2002. 6. Liability for this accident is attributable to the Respondent. 7. As a result of this incident, Ashley Boyer suffered burns and minor scarring on her cheeks. 8. Ashley Boyer was discharged from her doctor's care for the injuries attributable to this incident. 9. Ashley Boyer's accident-related medical bills have been paid in full. 10. Your Petitioners propose that the $17,500.00 sum be used to purchase an annuity that will provide for periodic payments to Ashley Boyer as shown in Exhibit "C", which is attached hereto. 11. There will be no deduction for counsel fees or costs as Respondent's insurer, Liberty Mutual, has retained Petitioner's counsel to seek approval of this settlement. 12. Kenneth and Janice Boyer, parents and natural guardians of Ashley Boyer, as petitioners herein, join and agree that the proposed settlement of $17,500.00 is in the best interest of their daughter, Ashley Boyer. Verification/affidavits signed by both Kenneth and Janice Boyer are attached to this petition. 13. Petitioners shall cause to be filed with the Court a document of the Court's choosing as proof that the $17,500.00 has been used to purchase an annuity for the benefit of Ashley Boyer. WHEREFORE, your Petitioners, Kenneth Boyer and Janice Boyer, parents and natural guardians of Ashley Boyer, a minor, respectfully request that Your Honorable Court authorize them to sign a Settlement Agreement and Release whereby the personal injury claim of their daughter, Ashley Boyer, a minor, related to the January 23, 2009 accident, is settled and released for the sum of $17,500.00. Respectfully submitted, JOHNSO , D N4T & WEIDNER Jeffrey'B'Rettig, Esquire I.D. No. 19616 Andrew P. Dollman, Esquire Attorney I.D. No. 209466 301 Market Street P. O. Box 109 Lemoyne, PA 17043 (717) 761-4540 abrdW-idsw.com 391905 VERIFICATION / AFFIDAVIT The undersigned states that the facts set forth in the foregoing PETITION FOR APPROVAL OF MINOR SETTLEMENT are true and correct, and that the compromise detailed in the Petition is in the best interest of my daughter, Ashley Boyer. This verification is made subject to the penalties of 18 Pa.C.S.A. §4904, relating to unsworn falsifications to authorities. BY: Kenneth Boyer, parent and natural guardian of Ashley Boyer, a minor i MAR G 2610 ,?a:F-?1u?f?? CtUFFIE VERIFICATION / AFFIDAVIT The undersigned states that the facts set forth in the foregoing PETITION FOR APPROVAL OF MINOR SETTLEMENT are true and correct, and that the compromise detailed in the Petition is in the best interest of my daughter, Ashley Boyer. This verification is made subject to the penalties of 18 Pa.C.S.A. §4904, relating to unsworn falsifications to authorities. BY: ?----' Vz- nice Boyer, as par and natural ardian of Ashley Oyer, a minor MAR 6 9 e ?lD ? ?t j :'S uN DUFFLE Exhibit "A" AS FY C-2nc 0290187164-OPT-HER-1/23/2009 ED Facesheet - 1/26/2009 - 1 pg • 01/23/09 800441716 290187164 11W1 S Frooort"P BOYER ASHLEY C F Harrisburg PA 17'101 02/19/2002 EMERGENCY DEPARTMENT p5e? 10818 Primary Care Phys: 800441718 M AFACE SWELLING Dr. Time In Pd a Notibed: ?Yes ? No W. O Medical Command Date/Time Accident: Chief Comp: /*hreAj0 .of AMO HPI: Location: ' AVAO_. Context: Modifying FacSors: Y ??,? Assoc Symptoms: RCS: ls?t ?itl i tla f? EYES: /tip ENT: o?- Ra p: "Al 15C Mlx d0W Gi: 00A11 A GU: Loc . fa SCRAP MS: Integ: Neuro: Endo: Hmtymph: Ail/li nn n: 0'M other systems nsp *W ? Sse rum's rob - mwWA d Hx: Allergies: Meds: Medical: Hx, cant: Family- Social: Tobacco: Ones: ETOM: Uv9 Situation: PE: BP 1 P R T SP02 Wt ? see rears noes - Const. &2•;0f- Mental Stat=44gch: ENT- Altai ENT: a Headitiech: Rasp: J - - CV: Q-9 S-40jd*t PAAA- Gi:? `-Yy GU: integ: ------ : - MS; Lymph. W . ED Course: ------ Too interpretation: Procedtw".- I`?ur?"' n i 3 T 0A.9 00JOY cc ilN- - 7 numv SavigNIM %d Type ?-uo ? - - _ d ? Admission ? ? ? Stable RenMn er: Transfer ? p T ? _ ComplIeft ? Observation ? Critics Care 11 Offer ?? for Dx ?, ? Discher+8e ? Psych Time Syncope, and CAP E.D. Physician - Physiciart's AssWwW Mid-level 13MAI toner Private Physician FORM 531 !11111 187 ER Page 1 of 1 BOYER, ASHLEY C-Enc #290187164-OPT-HER-1/23/2009 ED Report - 1/28/2009 - 1 pg ACCT#=00290187164 TRANSCRIBED DATE=01/28/2009 08:56 UDN 2550833 BOYER, ASHLEY C RM#: MRN: 800-44-1716 CASE: 00290'187164 DOB: 02/19/2002 ADM: 01/23/2009 PinnacleHealth System P.O. Box 8700 Harrisburg, PA 17105-8700 EMERGENCY DEPARTMENT CHIEF COMPLAINT: Motor vehicle accident, face swelling. HISTORY OF PRESENT ILLNESS: This is a six-year-old black female was apparently the passenger in the rear of an auto which was involved in a motor vehicle accident. She claims to have been belted, or at least the mother claims that the child was belted. However, she also stated "I hit the brakes and she came all the way up to the front and was hit by the airbag." The mother f-ur-ther states that "maybe-the belt malfunctioned or she did not close it properly." No loss of consciousness. Her face feels burnt. There is mild neck pain. No nausea, no vomiting, no diaphoresis. No abdominal discomfort. REVIEW OF SYSTEMS: The remainder review of systems on this child is otherwise negative. PAST HISTORY: Medical and surgical history is none. ALLERGIES: NONE. Medications: None. She is up to date on her immunizations. FAMILY HICTC.R`_ : Negative. SOCIAL HIfiTOR": She lists no vices. She lives with parents. PH1STCAL EXAMINATION: vi,,ad signs:-Temperature 36.6, blood pressure 115/54 with a pulse of 104, respirations 22, and pulse ox is 100% on room air. Constitutioaal: Awake, alert, and oriented black female in no distress. She is.s6r..ewha',? ,nxious because she is still in a cervical collar. HEENT with neck--pain, facial irritation and abrasions throughout from bag friction. Respiratory: Clear to auscultation and percussion. Cardiovascular: No murmurs or gallops. Heart sounds normal. GI/GU: The abdomen is soft. No hepatosplenomegaly or masses. No tenderness. No guarding or rebound. Genitorectal deferred. Integument: Please see the above for the face. Otherwise negative. Neurological: Nonfocal. Muscuioskeletal: The left shoulder is tender. No overt fractures. Lymphadenopathy is none. EMERGENCY DEPARTMENT PHYSICIAN TEST INTERPRETATION: The x-rays of the left shoulder are negative. The CAT scan of the neck revealed no fractures. There is minimal subluxation of Cl over C2 most likely due to muscle spasms. EMERGENCY DEPARTMENT COURSE: The child was initially examined while she was on the board and in a cervical collar. After the CAT scan cleared the cervix, she was reexamined again. The musculature of the neck continued to be tight and tender with no spasms. Of course, the facial condition of the friction burns were noted. She also has some swelling in the upper and bottom lip but there are no problems with the oral airway or nasal airway. She is breathing well. There is no stridor. After all the x-rays were cleared, these were discussed with this young child as well as with mom, grandparents, and father I believe. Page ] of 2 AOYr^, =7,27 C-Er.c 41290:37164-OP7-HER-1/23/2009 ED Report - 1/28/2009 - 1 pg DISPOSITION: After all this, she is being discharged. Initially since she was quite uncomfortable on the board, she did receive 2 mg of morphine IM and she is still not having any pain. Again, the potential for musculature tenderness was discussed with the parents and grandparents and the child as well. I asked her to use Motrin as needed, Neosporin and Telfa pads for the burn. While she was here, the burns on the face were covered with Bacitracin and Telfa pads as well to give an idea to the parents how to use this. DIAGNOSTIC IMPRESSION: 1. Motor vehicle accident. 2. Facial friction burns secondary to bag deployment. 3. Left shoulder pain secondary to #l. c: HBG ED BILLING DEPT PCP UNKNOWN Signed by GUTIERREZ MD, JULIAN on 11-Feb-2009 00:35:47 -0400 aULIAN GUTIERREZ, M-D- ? Patient: Ashley Boyer DD: 01/24/2009 255.0833 DT: 01/28/2009 /acz D# . ER REPORT ER REPORT ER REPORT Page 2 of 2 SOYER, ASHLEY C-Enc #290187164-OPT-HER-1/2312009 Radiology Report - SHOULDER COMP MIN 2V LEFT - 1/23/2009 - 1 pg PINNACLEHEALTH System Radiology Imaging Report MR#: 800441716 NAME: BOYER, ASHLEY SSN: 800441716 325 GLENNDALE DR ADM: 000290187164 CAMP HILL, PA 17011 DOB: 02/19/2002 AGE: 6Y ORD DR: GUTIERREZ, JULIAN BED: HER- ORD#: 90001 PTCLASS: E HER ATT DR: EMERGENCY ROOM, ASSOCIATES PCP: UNKNOWN, DR REASON: painfinjury COMMENTS: oba h a a Final ReporC** HARRISBURG DIAGNOSTIC DEPARTMENT PROCEDURE: DIA - 4525 - SHOULDER COMP MIN 2V LEFT PROCEDURE DATE: Jan 23 2009 7:28PM ACCESSION#- 6107435 Exam: Left Shoulder, 2 views at 1908 hours History: Motor vehicle accident and pain. Result There are no prior studies for comparison. There is no acute fracture, dislocation or evidence of bone destruction. The glenohumeral joint is maintained. No significant soft tissue abnormalities are identified. The visualized left hemithorax is normal appearance. Impreaafar Negative examination of the left shoulder. DICTATED: (01/2412009 11:02) TRAi&:-{PSC/PS) ON: 0124/200912:59 INTERPRc-TED AND REVIEWED BY: BRIAN W. HARRIS PH.D., M.D. ELECT,! ONICALLY SIGNED: 0124/200912:59 In the e-r-r : -3f any questions regarding this report, a Quantum Radiologist can be readied by phone at 932-8030. study inberpretatlon provided by Quwtunn Imaging & Therapeutic Associates. tf you have received this document by facsimile. the information oordained in Nut tfaiwnbsiOn is PrM109ed and cordider". If the reader of this message is not the intended reapient, you are hereby notified that any won. distributlon, or copy of this cornmurrcalion is strictly prohibited. If you have received this cormunication in error, please notify us irnrrrediately at: 1-717-782.3240. Printed: January 24, 2009 1:01 PM Page 1 of 1 SOYER, ASHLEY C-Enc #290187164-OPT-HER-1/23/2009 Radiology Report - CT CERVICAL W/O CONTRAST - 1/23/2009 - 1 pg PINNACLEHEALTH System Radiology Imaging Report MRty: 800441716 NAME: BOYER, ASHLEY SSN: 800441716 325 GLENNDALE DR ADM: 000290187164 CAMP HILL, PA 17011 DOB: 02/19/2002 AGE: 6Y ORD DR: GUTIERREZ, JULIAN BED: HER- ORD#: 90002 PTCLASS: E HER ATT DR: EMERGENCY ROOM, ASSOCIATES PCP: UNKNOWN, DR REASON: pain/injury COMMENTS: oba ***Final Reporr" HARRISBURG CT DEPARTMENT PROCEDURE: CTS - 4678 - CT CERVICAL W/O CONTRAST PROCEDURE DATE: Jan 23 2009 6:67PM ACCESSION: 6107436 Exam: CT scan: Cervical spine: Sagittal and corona) reconstructions: History: MVA. Stuck with airbag in the face. Neck pain. Result CT scan of cervical spine with 2 mm contiguous axial cuts. Sagittal and corona) reconstructions. No acute fracture is identified. The vertebral bodies maintain their height and show normal bone architecture. There is minimal rotatory subluxation of C1 over C2 which most likely secondary to muscle spasm. - - _ _ . - There is slight reversal of the cervical lordosis which may be secondary to patient positioning or muscle spasir..- The -prevertebral soft tissue is normal. - - Conclusion: No acute fracture identified. Minimal rotatory subiuxation of C1 over C2 which most likely secondary to muscle spasm. Prevertebral soft tissue is normal. Impression: DICTATED: (01/23/2009 18:41) TRANS: (OITA) ON: 01123/2009 18:42 INTERPRETED AND REVIEWED BY: KIRAN KAPADIA, M.D. ELECTRONICALLY SIGNED: 01/23/2009 18:42 In the evern of any question regarding this report, a Quantum Raftftist can be reacted by phone at 932-8030_ Study FftWaf bw provided try QU8lfti M InMW ft & TherapeadC ASSOChif`@S. If you have received this document by facsimile, the information oorrtahred in this bansrniasion Is privileged and axMftntial. If the reader of this message is not the dgended recipient, you are hereby notified that any diaseminaWn, distribution, or Copy of tNa communication is at way prohibited. M you have received this communication In error, piease ratify us immediafe!fy at: 1.717-M-3240. Printed: January 23, 2009 6:57 PM Page 1 of 1 08/28/2009 10:02 7176206202511 WEST SHORE FAMILY PAGE 07 MUSCulaskehftl EvaImcm Farm WOM Sham Fa oy Pracgk^ P.C. Patiaft NMas Ash&44; a . Aic- a Todo?'a Qa1a: ? .? p =P? MMOItr 8p; / P;, HPOtM ilbc Location: Ctwr Du ak n.. Trigyw_ Programiol ReWww R. I'mult NIY ParsaN NN Assoc. &CV11iesknm: NN Nunbrwso~ NtY Prior sphodeafft N!Y Aga A-ft It. Awl.. Currers't5c Other ROS: - A _ 1 -A Allargies to fads` ? reviewed Q NKDA O NO A's Mod kdat Chronic Meds G mviewed 13 No O's O A's Partinarrt Part rrwditgi Hx D rariawsd, no A+s DA's Social Hx: SmOloer? N {ppd_) ETO147 mkt Onrgo? Pertinent fan* Hx 0 miaowed M No A 13 A's ., A/In -4=NORMA X MIL. PE: GER A9 ? . 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NM PA-C„ FNP-C Date: O qy., R08107 ys,,.C.-.i, Exhibit "B" Settlement Agreement and Release This Settlement Agreement and Release (the "Settlement Agreement") is made and entered into this day of 2009, by and between [among] : "Claimants" - Kenneth Boyer and Janet Boyer as parents and natural guardians of Ashley Boyer, a Minor "Insureds" - Gary Mathna and Kathleen Mathna "Insurer" - Liberty Mutual Fire Insurance Company Recitals A. On or about January 23, 2009, Ashley Boyer was injured in an accident occurring at or near Simpson Ferry Road, Camp Hill, Pennsylvania. Claimants allege that the accident and resulting physical and personal injuries arose out of certain alleged negligent acts or omissions of the Insureds, and have made a claim seeking monetary damages on account of those injuries. B. Insurer is the liability insurer of the Insureds, and as such, would be obligated to pay any claim made or judgment obtained against the Insureds which is covered by its policy with the Insureds. 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, Claimants hereby completely release and forever discharge the Insureds and Insurer from any and all past, present, or future claims, demands, obligations, actions, causes of action, wrongful death claims, rights, 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 Claimants now have, 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 Claimants, or any future wrongful death claim of Claimants' representatives or heirs, which have resulted or may result from the alleged acts or omissions of the Insureds. 1.2 This release and discharge shall also apply to the Insureds' 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. 1.3 This release, on the part of the Claimants, shall be a fully binding and complete settlement among the Claimants, the Insureds and the Insurer, and their heirs, assigns and successors. 1.4 The Claimants acknowledge and agree that the release and discharge set forth above is a general release of their liability claim against the named Insureds. Claimants expressly waive and assume the risk of any and all claims for damages which exist as of this date, but of which the Claimants do not know or suspect to exist, whether through ignorance, oversight, error, 2 negligence, or otherwise, and which, if known, would materially affect Claimants' decision to enter into this Settlement Agreement. The Claimants further agree that they have accepted payment of the sums specified herein as a complete compromise of matters involving disputed issues of law and fact. Claimants assume the risk that the facts or law may be other than Claimants believe. 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 Insureds, by whom liability is expressly denied. 1.5 The undersigned further represents that there are no past or future liens or rights of reimbursement by any hospital, ambulance service, or other medical provider, Medicare, Medicaid, insurance company, workers' compensation provider, or attorney enforceable against the proceeds of this settlement or against the parties released, or persons, firms, or corporations making the payment herein. If such a lien or right is asserted against the proceeds herein or against the parties released or any person, firm or corporation making payment herein, then, in consideration of the payment made to the undersigned, the undersigned covenants to pay and satisfy such asserted lien or reimbursement right. The undersigned promises to obtain a release and discharge such lien or reimbursement right, and to indemnify and hold harmless the parties released and the persons, firms or corporations making the payment herein, from any costs, expenses, attorneys fees, claims, actions, judgments, or settlements resulting from the assertion or enforcement of such liens or reimbursement right by any entity having such lien or right. 3 2.0 Payments In consideration of the release set forth above, the Insurer on behalf of the Insureds agrees to pay to the individual(s) named below ("Payee(s)") the sums outlined in this Section 2 below: 2.1 Periodic Payments. Insurer agrees to make payment to Ashley Boyer "Payee" in the following manner: (i) Lump sum guaranteed payments: On February 19, 2020, guaranteed payment of Five Thousand Dollars ($5,000.00); On February 19, 2023, guaranteed payment of Seven Thousand Five Hundred Dollars ($7,500.00); On February 19, 2027, guaranteed payment of Eighteen Thousand Nine Hundred Twenty-Five Dollars ($18,925.00). All sums set forth herein constitute damages on account of personal injuries and sickness, within the meaning of Section 104(a)(2) of the Internal Revenue Code of 1986, as amended. 3.0 Payee's Rights to Payments Claimants acknowledge that the Periodic Payments cannot be accelerated, deferred, increased or decreased by the Claimants or any Payee; nor shall the Claimants or any Payee have the right or power to sell, mortgage, encumber, or anticipate the Periodic Payments, or any part thereof, by assignment or otherwise. 4.0 Payee's Beneficiary Any payments to be made after the death of Payee, pursuant to the terms of this Settlement Agreement, shall be made to her named beneficiary. If no person or entity is so designated by 4 Payee, or if the person designated is not living at time of the Payee's death, such payments shall be made to the estate of Payee. Payee may request in writing that Assignee change the beneficiary designation under this Agreement. Assignee will do so but will not be liable, however, for any payment made prior to receipt of the request or so soon thereafter that payment could not reasonably be stopped. 5.0 Consent to Qualified Assignment 5.1 Claimants acknowledge and agree that the Insurer will make a "qualified assignment", within the meaning of Section 130(c) of the Internal Revenue Code of 1986, as amended, of the Insurer's liability to make the Periodic Payments set forth in Section 2.1 to Liberty Assignment Corporation ("the Assignee"). The Assignee's obligation for payment of the Periodic Payments shall be no greater than that of Insurer (whether by judgment or agreement) immediately preceding the assignment of the Periodic Payments obligation. 5.2 Such assignment shall be accepted by the Claimants without right of rejection and shall completely release and discharge the Insureds and the Insurer from the Periodic Payments obligation assigned to the Assignee. The Claimants recognize that 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 Insurer shall thereupon become final, irrevocable and absolute. 6.0 Right to Purchase an Annuity The Insurer, itself or through its Assignee, will fund the liability to make the Periodic Payments through the purchase of an annuity policy from Liberty Life Assurance Company of Boston. The Insurer or the Assignee shall be the sole owner of the 5 annuity policy and shall have all rights of ownership. The Insurer or the Assignee may have Liberty Life Assurance Company of Boston mail payments directly to the Payee(s). The Claimants shall be responsible for maintaining a current mailing address for Payee(s) with Liberty Life Assurance Company of Boston. 7.0 Discharge of obligation The obligation of 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 in Section 2 of this Settlement Agreement or upon completion of an electronic funds transfer in the amount of such payment to the deposit account of such Payee. 8.0 Representation of Comprehension of Document In entering into this Settlement Agreement the Claimants represent that the terms of this Settlement Agreement have been completely read and are fully understood and voluntarily accepted by Claimants. 9.0 warranty of Capacity to Execute Agreement Claimants represent and warrant 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 Claimants have the sole right and exclusive authority to execute this Settlement Agreement and receive the sums specified in it; and that Claimants have 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. 6 10.0 Governing Law This Settlement Agreement shall be construed and interpreted in accordance with the laws of the Commonwealth of Pennsylvania. 11.0 Additional Documents All parties 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. 12.0 Entire Agreement and Successors in Interest This Settlement Agreement contains the entire agreement between the Claimants, the Insureds, and the Insurer with regard to the matters set forth in it and shall be binding upon and inure to the benefit of the executors, administrators, personal representatives, heirs, successors and assigns of each. 7 13.0 Effectiveness This Settlement Agreement shall become effective immediately following execution by each of the parties and upon approval by the competent court of local jurisdiction. Claimant Kenneth Boyer as parent and natural guardian of Ashley Boyer, a Minor By: Date: Claimant Janet Boyer as parent and natural guardian of Ashley Boyer, a Minor By: Date: Insurer Liberty Mutual Fire Insurance Company By: Title. Date: 8 Ringler Associates (800) 834-5553 (610) 834-5553 (610) 834-5442; fax Individually Designed Settlement for Ashley Boyer Proposal 2 GUARANTEED TAX-FREE BENEFIT YIELD Ashley Boyer female 02/19/2002 Lump Sums $5,000.00 at age 18 on $5,000.00 2/19/2020 $7,500.00 at age 21 on $7,500.00 2/19/2023 $18,925.00 at age 25 on $18,925.00 2/19/2027 $31,425.00 Total Cost: $17,500.00 Office Court at Walton Point * 490 Norristown Road, Suite 251, Blue Bell, PA 19422 Mailing Address: P.O. Box 1252, Blue Bell, PA 19422 Offices In Principal Cities Nationwide www.ringlerassociates.com Johnson, Duffle, Stewart ~ Weidner By: Jeffrey B. Rettig I.D. No. 19616 Andrew P. Dollman I.D. No. 209466 301 Market Street P. O. Box 109 Lemoyne, Pennsylvania 17043-0109 (717) 761-4540 jbr@jdsw.com C o '~ Attorne s for Petitione~~~~ Y ~ ~= z-rt _ -.r; ~. _ ---' - , c.~ '~ :' ..~, ' ` < ~ t= c`. tv ' i c..w KENNETFI BOYAR and. JANICE BOYER, as parents and natural guardians of, ASHLEY BOYER, a minor 325 Glendale Drive Shiremanstown, PA 17011 Petitioner v. KATHLEEN MATHNA, 495 Pondtown Rd. Dillsburg, PA 17019 ndent NO. 10-2048 Civil Term PRAECIPE FOR SETTLE, DISCONTINUE AND END To the Prothonotary of Cumberland County: Kindly mark the above matter as settled, discontinued and ended. Respectfully submitted, Johnson, Du e, ~ eidner By: Andrew P. Dollman, Esquire Attorney I.D. No. 209466 301 Market Street Lemoyne, Pennsylvania 17043 717-761-4540 apd@jdsw. com:391905 403907 IN THE COURT OF. COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA