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HomeMy WebLinkAbout13-1709 IN RE: ANTHONY FRISCIA, : IN THE COURT OF COMMON PLEAS OF A minor : CUMBERLAND COUNTY, PENNSYLVANIA : NO. 2013- 1701 CIVIL ACTION C= c : PETITION TO COMPROMISE A M M : CLAIM -70 QwD ;> , (: PRIOR JUDGE: Edward E. Guido,J.! >C f � . PETITION TO COMPROMISE A MINOR'S CLAIM _ c AND NOW, comes the Petitioners, Todd Friscia and Julie Friscia, Guardians of ? Anthony Friscia, a minor, by and through their attorney, Carrucoli and Associates, and Jacqueline M. Verney, Esquire and sets forth the following Petition to Compromise a Minor's Claim: 1. Todd Friscia and Julie Friscia are adult individuals currently residing at 11 Young Drive, Carlisle, Cumberland County, Pennsylvania, 17015. They are the guardians of Anthony Friscia, who was born November 20, 2011 and who died on May 29, 2012. 2. On May 26, 2012 the minor was involved in a motor vehicle accident on Interstate 81 at exit 45 in Cumberland County, Pennsylvania, in which he sustained fatal injuries. I The accident in question was due to the negligence of Benjamin Reid who failed to yield the right-of-way when attempting to merge onto 1-81. 4. As a result of the afore-mentioned accident, Anthony Friscia sustained fatal injuries and died on May 29, 2012. (Attached hereto as Exhibit"A" is a copy of the accident report.) (Also attached hereto as Exhibit"B" is a copy of the death certificate.) 5. On the day of the accident, Benjamin Reid was operating a vehicle that was insured by his parents, Joe V. Reid and Tammy Reid,through Erie Insurance under a policy which provided $250,000 per person and $500,000 per accident in bodily injury liability coverage. (Attached hereto as Exhibit "C" is the insurance Declaration page.) 6. On the day of the accident, the Petitioners were insured by State Farm Insurance Co. for underinsured coverage in the amount of$100,000 per person and $300,000 per accident. Said coverage was stackable as the Petitioners had two vehicles insured. 7. The Petitioners have entered into a settlement agreement with Erie Insurance to accept the limits of that policy for the injuries sustained for Anthony in the 1 3. 71 ,d P-W? 0�� amount of$250,000. (Attached hereto as Exhibit "D" is a copy of the signed Release with Erie Insurance.) 8. The Petitioners have entered into a settlement with State Farm Insurance Co. to accept the limits of that policy, stacked, for the injuries sustained by Anthony, in the amount of$200,000. (Attached hereto as Exhibit"E" is the letter offering said amount and indicating that no release is necessary.) 9. The petitioners have investigated this matter and agree that compensation in the amount of$450,000 is a fair and equitable settlement in light of the situation. 10. Subject to the approval of the Court, the parties have agreed to settle petitioners' claim for the death of their minor son, in the amount of$250,000 from Erie Insurance and $200,000 from State Farm. WHEREFORE, the Petitioners request that this Honorable Court enter an Order approving the Petition to Compromise Anthony Friscia's minor's claim in the amount of $450,000. Respectfully submitted, Carrucoli and Associates 5aLcq ine M. Verney, Esquire 44 S. Hanover Street Carlisle, PA 17013 717-243-9190 Attorney for Petitioners •j'i,slRIFI4aF'TlON We. Todd Friscia and.lulle Friscia_ stir hereto\ 4ertit*% that we are the :eli guardians cif the minor. Anihony Friscia, x4 ho is deceased, We flit\e revsL\;tti tdyti proposed s ttlerrrent and distribution set tc)rth in the toregoiniu, Petition trtcl pr{qo,e,i Order. l'Ile avemlcnt in the P timon are mic and correct to the beet crl OUr knoWl i vc. information and belief. We helieVc that the 111701 0sedt settlemem is lair and ti:Oljit;,hl We 17CCOMmerid that tbe Court;c PriM c tilt Settlement and Order tit'Distribut O"i We understand thii Verincation is Horde Pursuant tO prMisiowi cft'18 fl a.(, �..;, 49('14 rtlatini_` to un`.±lt'om falsiticatim) to authorities. Friscia, Lei!al kitUmfiin o" .'tndlon` FrIscill, EXHIBIT "A" AA-500 TX Incident Number: H02-2123122 Commonwealth of Pennsylvania PAGE 1 Crash Involves: Police Crash Report REPORTABLE CRASH 0 DUI Fatality 0 HR and Run 0 Commercial Vehicle J State Police Vehicle J Local Police Vehicle G WA Q Work Zone 0 ATV 0 Snowmobile C Commonwealth Vehicle 0 Local Gov Vehicle Agency Name Case Closed Patrol Zone Investigation Date o PA STATE POLICE-CARLISLE YES 71 00812012 Dispatch Time rnval Time invesfigator Badge Number 18:18 hrs 18:21 hrs. HOWELL DOUGLAS W 07$89 a u Approval Date Reviewer !Reviewer Badge Number 0 07/1012012 GOULDY,DAVID P 07136 Date of Crasfi nne of Crash ay of the Week Crash Description 05[26120'42 1 18:17 tgs_ SATURDAY HIT FIXED OBJECT County Municipality CUMBERLAND CARLISLE BORO S Weather Conditions Rotation to Roadway a RAIN OUTSIDE TRAFFICWAY s c Rumination Road Surface Conditions ti DAYLIGHT WET #ot Un is #orpeople #of lnjured #Kitied EMS Agency Medical Facility 002 004 003 001 GOODWILL EMS HERSHEY MEDICAL CENTER School Bus Related School Zone Related jPemDOT Notified Type of Intersection Special Location NO NO 140 ON RAMP NOTAPPLICABLE Mrk Zone Work Zone Type Where in Work Zone NO Speed Limit Workers Present Officer Present rcrLane Characteristics Road Closed a $ Closure❑ with Detour Work on Shoulder Movie intermittent or Fon" ❑4r Median ❑ Moving Wa'k ❑ Corttrot ❑Other Route Signing Route Number Segment Number Travel Lanes Speed Limit Orientation STATE HIGHWAY 8021 01 55 MPH NORTH House Number Street Name St.Ending is ENTRANCE 45 HIGHWAY f t Route Signing Route Number Segment Number ravel Lanes Speed Limitt !Orientation t m Used in 5 Interseca. Crashes Street Name i St Ending Route Number Or Mite Post Tenths Or Segment Marker Ramp Use Only Fee, a 0081 045 8 00066 ins Street Name Street Ending Or(tides ch J 181 HIGHWAY Y Route Number Or M3ie Pcs'Tenths Or moment Marker Ramp Use Only The aixlVe entry is the 8 distance from the Crash o !Street Name jStieet Ending Scene to Landmark 1 i fDegrees IMincnes Seconds Decimal Degrees Minutes 1. Seconds Decimal 0. Latitude: % 40 11 13 . ! 812 Longitude: 77 12 19 335 I Traffic Control Device ITraffic Control Functioning v YIELD SIGN nvMCE FUNCTIONING PROPERLY ;r a Lane Closed lane Closure Direction 1 Traffic Detoured Esfimated Time Closed I PARTIALLY NORTH NO <30 MIN. Environmental t Roadway Potential Factors(E1R) Factor 1 actor 2 Factor 3 NONE IF First Harmful Event in the Crash Most Harmful Event in the Crash i Unit Number Harmful Event Unit Number iHarmfui Event IIII 002 Hr r rREE OR SHRUBBERY 002 it HIT TREE OR SHRUBBERY iS lndl abad Prime Factor Unit Number Prime Factor Driver Action DRMR ACTION 001 WAKING IMPROPER ENTRANCE TO HIGHWAY Prime Factor ErnriromentaliRoadway Prim Factor Vehicle Failure Prime Factor Pedestrian Action w Road Surface Type Special Jurisdiction CONCRETE NO SPECIAL JURISDICTION Printed At PA State Police-Carlisle 07120/2012 03:42 PM Page 1 Form N:HOZ-2123122 Incident Number: H02-2123122 Commonwealth of Pennsylvania PAGE 2 Crash Involves: Police Crash Report REPORTABLE CRASH OU1 0*' Fertielity C,Hit and Run Commilimfel vehicle State Police Vehicle Local PolloeVehicle 0 N/A 0 Work Zone 0 ATV 0 Snowmobile COMMOnW081thVehIcle "'D Local Gov Vehicle 001 Phantom Vehicie No F' ,Name IMI Last Name ISuffix IDOB Telephone Number Street Address City State jZip Code 466 BLOSERVII.�LE ROAD PA Gender License Number ILicem State Glass Eperatori Date lOwnerlDriver MALE 30128194 PA C 07122JZ013 I PRIVATE VEHICLE OWNEDILEASED BY DRIVER l'o Driver Presence Physical Condition Primary Vehicle Code Violation Person Charged Z DRIVER OPERATED VEHICLE APPARIENTILY NOF MAL VC13323 STOP SIGNS AND YIELD SIGNS YES I AloohoYDrugs Suspected ----Vwhof Teat Type I Results f NO BLOOD fN RESULTS Driver Action MArjNG WpRopER EWRA14M To HIGHWAY Peclestnian Action Pedestrian Signals Pedestrtan,Clotning Pedestrian Location I St Harmful Event Left or Right Side Most Harmful Utility Pole Number 2nd Harmful Event Left or Riglm Most Harmful UtiftyPoteNumber i3rd Harr*0 Event Left or Right Side Most Harmful UtMy Pole Number 4th HarrOut Event Left or Right Side MostHarmful �Ufility Pole Number Owner First Narne jOwner M! Owner Last Name or Business Name Ulu JOE V REID IS Straet Addoess City State Zip Code .466 BLOSERVILLE ROAD NEWVILLE PA 117241 Vehicle Type special usage Goverrrmnt Equipment Number SMALLTRUCK NOT APPLICABLE Model Year Vehicle Make 'hide Model [Vehicle Color %AN 2004 TOYOTA TACOMA SILVER STEVII-52M74=110045 nse Plate Reg.State Est.Speed lVehicle T 7To-wed By YXKU75 PA 045 NO Insurance Insurance company i,Poficy Number Expiration Date NO Direction of Travel Vehicle Position Vehicle M*vement Initial impact Point NORTH OTHER FORWARD MOVING LANE CHANGING LANE$OR MERG114G NOR-COLLISION Damage Indicator Gradient Road Alignment Possible Venda Failures 14ONE LEVEL STRAIGHT NONE Unit 1 Tag Number Tag Year Tag St" i> !UnitOwner Urfh Make Type Uwt 7 Tag Number Tag Year jag State Unit Make Unit Owner Engine Size Passengerl I le SWrunk? Driver Education? cc Driver Helmet Type Heirnel Stayed On? I DOT/Snell Designation? Eye Protection7 Long Sleeves) Long Pants? ver Ankle Boots7 Passenger? Helme? Printed At:PA state Police-cadets 07/M/2012 03:42 Pill Page 2 Form H02-2123122 . . ;,A-500 TX .Incident Number: H02.2123122 Commonwealth of Pennsylvania PAGE 3 Crash Involves: Police Crash Report REPORTABLE CRASH 0 DUI (e)Fatality Hit and Run Commercial Vehicle 0 State Police Vehicle 0 Local Police Vehicle WA Work Zone AN snowmobile r-,� Commortwean Vehicle C1 Local Gov Vehicle Unit Unit Number Type wrcial Vehicle 002 Motor Vehicle in Transport No First Nam Suffix IDDB Telephone Number TODD C FRISCIA I 101 (717)240-54110 S*reetAddress city State ]Zip Code 11 YOUNG DRIVE CARLISLE PA 47015 Gun MALE License Number Ilicense State Class 'Expiration Date 10-mr/Daver 26953027 PA C 1210912013 j PRIVATE VEHICLE owmED&F-ASED BY DRIVER DfivetPresence physical condition i Primary Vehicle Code Violation Person Charged DRIWR OPERATED VEHICLE APPARENTLY NORMAL NONE NO Alcohol/Drugs Suspected Test Type kohof Test Results TEST C NO NOT GIVEN E Drivw Action No CONTRIBUTING ACTION Pedestrian Action !Pedestrian Signals Pedestrian Clothing Pedestrian Location ist Hamorul,Event II-eft or Right Side Most Harmful Utility Pole Number HIT TREE OR SHRUBBERY i RIGHT YES grid tiarnlfutEvent iLeft or Right Side most Haimdul Utility Poie Number 3rd Hwn-rhe,Event ;Lett of Right Side Most Harmful LItility Pole Number 4th Harmful Event 'left or Ri ght S de Most Harmful Utifity Pole Number Owner First Name Owner MI Owner Las'Name or Business Name Suffix TODD C FRISCIA I Street Address Icily State . code III YOUNG DRIVE CARLISLE PA 17015 Vehicle T Usage Government Equipment Number AUTOMOBILE -TStP=40XP!1CA8LE Model Year IvehideMake Vehicle Model Vehicle Color N 2005 Type I CHEVROLET MALIBU SILVER IGIZT52815F258565 I - I r I License Plate Reg.state Est.Speed Vetride Towed !Towed By FSF9734 PA 060 YES MULLEINS TOWING Insurance 'Insurance Company 112oficy Number Expirabort Date YES 'STATE FARM 1037164CO8380 69108120112 Direction of Travel Vehicle Position vehicle movement Initiat impact Point NORTH RIGHT LANE'CURB" i GOING STRAIGHT NON-COLLISION Damage indicator Gradient Road Alignment Possible Vehicle Failures DISABLING LEVEL STRAIGHT NONE of Units Type Unit i Tag Number Tag Year Tag State 0 > lUnft Make Unit Owner re Lind 2 Tag Numter ITa's fi ar 'Tag State ;Unit Owner IurA male jEngine Stze Passenger? Saddle Sag/Trunk? !Trafler) Driver Edocation? cc Driver Helmet Type Heirnet Stayed On? IDOT.fSnelf Designation? Eye Protection? Sleeves? Long Pants? Over Ankle soots? m=-Ar--) I OnTm I n t�or,,) lev*Proteclion'? ILono Sleeves? Lonq -ne; -asi-n— Pants? Over Ankle Boots? Passenger? Helmet? Head Lights? Meer Reflectors) Printed At,PA State Police•Carlisle 0112012012 03:42 PM Page 3 Form M.H02.2123122 AA-500 TX Incident Number: H02-2123122 Commonwealth of Pennsylvania PAGE 4 Crash Involves: Police Crash Report REPORTABLE CRASH 0 DUI 00 Fatality 4J Nit and Rim 0 Commercial Vehicle (D state Police Vehicle Local Police Vshiclo 0 NIA 0 Work tone ATV 0 sni,mow. 0 Commonwealth Vehicle �� Loot Gov Vehicle Unit#- lbrimer Restrictions Compliance JDdver Endorsement Compliance Driver License Compliance 01 RESTRICTIONS COMPLIED WITH NONE REQUIRED j,L!Principal impact Point idance Maneuver lUnder Ride Indicator NON 7 1 NO UNDERRIDE OR OVERRIDE Emergency Use 1Drug Test Type Test Results NOT IN EMERGENCY USE BLOOD UNKNOiAN TEST RESULTS Unit# JDriver Restrictions Compliance Driver Endorsement Compliance I Driver License Compliance 02 RESTRICTIONS COMPLIED WITH NONE REQUIRED VALID LICENSE FOR CLASS Principal Impact Point rvold'rice Maneuver Under IRAs Indicator 6 ori-M STE=-EVIDENCE OR DRIVER STATED NO UNDERRIDE OR OVERRIDE Emergency Use Drug Test Type Drug Test Results NOT IN EMERGENCY USE NONE NO TEST GIVEN Unit lPmor,No.First Name Ml Last Name suffix 008 0,02 1101 TODD C FRISMA 101W"4 Address City state zip Code 11 YOUNG DRIVE CARLISLE PA 1 17015 2 Phone Number EMS Transport Person Type [Good" Iftifiry Seventy 'S (717)249-UIO YES DRIVER MALE MODERATE INJURY rz -8 a Sent Position Safety Equipment 1 ,7; DRIVER,ALL VEHICLES LAP AND SHOULDER BELT USED I Safety Equipment 2 Extrication IL FRONT AIR SAO DEPLOYED(FOR THIS SEAT) NOT EXTRICATED Election Ejection Path NOT EJECTED NOT EJECTEDINOT APPLICABLE Unity Person No.First Name IMl last Nance Suffix ZOS I 002 1JONATHAN P MILLER "dress city State zip code �Z02 r.PETERSBURG RD CARLISLE PA 17013 Severity Phone Number EMS Transport Person Type Gender Injury (717)7014684 YES PASSENGER MALE MINOR INJURY Seat Position Safety Equipment I FRONT SEAT RIGHT SIDE LAP AND SHOULDER BELT USED Safety Erpopment 2 Extrication FRONT AIR BAG DEPLOYED(FOR THIS SEAT) NOT EXTRICATED r=jedloft JEJection Path NOT EJECTED NOT EJECTEDINOT APPLICABLE Unit Person No.First Name ME 11.0st Name suffix Pos 002 003 JULIE A FRISCIA 1011011994 1. 1 1 1 Street Address ICity state t Zip Code 'I1 YOUNG DRIVE CARLISLE PA 17015 Phone Number EMS Transport Person Type T&;;7de­, 1 injury Severity (717)249.6410 YES PASSENGER FEMALE MODERATE INJURY Seat Position Isalety Equipment 1 SECOND ROW-LEFT SIDE OR MOTORCYCLE PASSENGER LAP AND SHOULDER BELT USED Safety Equipment 2 Extrication NONE USED I NOT APPLICABLE NOT EXTRICATED 1 Ejection Ejection Path NOT EJECTED NOT EJECTEDINOT APPLICABLE Printed At:FA State Police Carlisle 0712012012 03:42 PM Page 4 Form 8:H02-2123122 Incident Number: H02-2123122 Commonwealth of Pennsylvania PAGE 5 Crash Involves: Police Crash Report REPORTABLE CRASH 0 DUl 'OF Fatality 0 Hit and Run Commercial Vehicle 0 State Police Vehicle Local Police Vehicle Local Gov Vehicle Unit# IPerson No.IFirst Name MI Last Name 002 004 ANTHONY i FRISCIA, Suffix 1DO8 Street Address City State Z-.p Code, I I YOUNG DRIVE CARLISLE PA 1 17016 ,.2 Phone Number 'EMS Transport Person Ty lGander Injury Severity ;2 Seat Position Safety Equipment 1 i'i; SECOND ROW-MIDDLE POSITION CHILD SAFETY SEAT USED Safety Equipment 2 Fl*icatico NONE USED I NOT APPLICABLE FREED BY NON4AECHANtGAL MEANS Ejection i NOT EJECTED NOTAPPLICABLE First Name suffix 1phone mber Street Address Icity state 10-37 TEAKWOOD LANE E*OLA PA I First Name Last Name Sufffftfix mber Sbeet Address City State jzilp Code 112 BALFOUR DRIVE MECHANICSBURG PA 17050 IN CARLISLEBORO Mechan IE Printed At PA State Police-Carlisle 0712=12 03:42 PM Page 5 Form H02-21Z3122 ^ . N AA-500 TX Incident Number: H02-2123122 Commonwealth of Pennsylvania PAGE 6 Crash Involves- Police Crash Report REPORTABLE CRASH '0 DUI 00 Fatality 0 Hit and Run C) Commercial Vehicle 0 State Police Vehicle 0 Local Police Vehicle 0 NIA Work Zone 10 ATV 0 Scmobile Commonwealth Vehicle CD Local Gov Vehicle NARRATIVE Crash Synopsis This was a 2 vehicle non•collision accident Unit#1 was traveling north on the 181 on-ramp from Walnut Bottom Road(Exit 45) attempting to enter I&I north. Unit#2 was on 181 traveling north in the right lane and was approaching the area where the on-ramp merges onto 181. Unit#1 failed to yield to Unit#2 and began entering the right lane of 181 north. Unit#2 took an evasive steering action in order to avoid being struck by Unit#1. Unit#2 steered into the left lane abruptly,then counter-steered,causing Unit#2 to begin a clockwise uncontrolled rotation. Unit#2 left the south side of the roadway, traveling down an entlankment and struck a tree with the left rear driver's side door. This impact caused Unit#2 to spin counterclockwise. Unit#2 came to final rest down the enbankment approximately 30'off the roadway. Pfth Details At the location of this collision,SR 0001 is a 2-tans highway traveling north. SR 8021 is the northbound on-ramp to SR 0081 at Exit 45. SR 0081 is a concrete,divided highway with usable asphalt berms. Each lane of SR 0081 is approximately 11'In width. The berms are approximately 8'wide. Streetfights and other sources of ambient fighting are not prevalent In the area of this collision. At the time of this collision,It was raining and the roadway was wet but there was no standing water observed. SR 8021 Is a single lane,concrete entrance ramp that is approximately 11'in width. This was a 2 vehicle non-collWwn accident Unit#1 was traveling north on SR 8021,the on-ramp from Walnut Bottom Road (W 45),aftampting to enter SR 0081 north. Unit#2 was on SR 0081 traveling north In the right fans and was approaching the area where the on-ramp merges onto SR 0091 Unit#1 failed to yield to Unit#2 and began entering the right lane of SR 0081 north. Unit#2 took an evasive steering action In order to avoid being struck by Unit fl. Unit#2 steered into the left lane abruptly,then counter4teered,causing Unlit#2 to begin a clockwise uncontrolled rotation. Unit#2 left the south side of the roadway,traveling down an embankment and made initial Impact with a tree with the left rear driver's site door. This Impact caused Unit#2 to spin counterclockwise. Unit#2 came to final rest down the embankment approximately 30'off the roadway. Operator#1 was able to come to a controlled stop on the berm of SR 0021 just north of Unit#2. Upon this officer's arrival,which was approximately I minute after being dispatched,this officer observed the following evidence: There were no skid marks on the roadway due to the wet roadways. However I did observe a minor scuff mark on the south berm of SRMI which was the beginning of a 60'tire mark leading from the berm down the embankment to the point cif final rest. -There was a tree located at the point of final rest which had a large chunk taken out of It caused by Unit#1 striking ft .Unit#1 came to fhmt rest as depleted in the collision diagram. This was the final rest position upon this officer's arrival, -Unit IM was not Impounded but was examined by Cpl.Gary MAINZER from the CA.R.S,Unit I did observe a large amount of damage to the driver's side rear door,which was the point of impact with the tree. -Upon approach to this accident scene,I was the first PSP responder. I observed a young infant in the arms of an adult mate sitting on the side of the embankment The Infant's head was covered with blood and the infant was crying. INTERVIEWS: Initial interviews with Operator 92 and his wife were not able to be conducted due to EMS personnel tending to their young infant Interview with Operator#1 conducted by this officer on 05126112 at 1933 hours at the scene of the accident Operator#1 related he was driving his Toyota Tacoma up the on-ramp to SR 0081 north from Walnut Bottom Road. He was traveling at approx.45 mph and,as he Printed At-PA State Police-Carlisle 0712=012 03:42 PM Page 6 Form#:HOZ-2123122 AA-600 TX 'Incident Number: H02-2123122 Commonwealth of Pennsylvania PAGE 7 Crash involves: Police Crash Report REPORTABLE CRASH rU DUl O Fatality 0 Het and Run U Commercial Vehicle 0 State Police Vehicle 0 Local Police Vehicle v N/A 0 Work ia114 ATV Snowmobile 0 Commonwealth Vehicle '0 Local Gov Vehicle approached the top of the on-ramp,looked In his mirror to check for traffic. He related he looked in his rear view mirror and turned his head to the left to check his blind spot. He did not see Unit 92 in the right lane of SR 4881 so he began to merge onto SR 0081, As he merged,he caught a glimpse of a quarter panel and realized that there was a car in the right lane of SR 0081. He took an evasive maneuver and pulled his steering wheel to the right to avoid striking Unit#2. He observed Unit#2 swerve to the left and lose control. As Operator#1 was braking,he observed Unit#2 them counter-steer,causing Unit#2 to rotate in a clockwise direction. He observed Unit#2 slide across the right lane of SR 0881 In front of Unit land travel down an embankment Operator#1 pulled his car off the roadway onto the shoulder just past the area where Unit#2 traveled down the embankment He exited his vehicle in order to render assistance to the occupants of Unit#2. Several other motorists stopped and assisted the occupants. Operator#1 was later asked to give a recorded statement to Tpr.Steven NESBIT at P5P Carlisle,which he voluntarily agreed to give. Operator#1 agreed to voluntarily submit to a blood test to determine any Intoxicants. The Waiver of Rights and Consetrtto Search signed by REID will be placed in the crash attachment file. Tpr.NESBIT later placed said blood into evidence at PSP Carlisle under Property Record#H2-15503. The blood was collected by David DUTROW at the Carlisle Regional Medical Center(CRMC)on 05126112 at 2021 hours. I later completed an NMS request for analysis. Tpr.Dominick l NARDONE forwarded the blood to NMS on 06106/13,FedEx tracking number 800327049247. The NMS Request copy will be placed in the crash attachment file:Tpr.NESBIT will be supplementing this report. Tpr.NESBIT entered the recorded statement Into evidence under Property Record#H2.15503& } Interview with Witness#2,Josh Eugene BERGEY,112 Balfour Dr.,Mechanicsburg,PA 17050,484486-8155,DOB 02124175 J conducted by this officer on 05126112 at 1830 hours at the scene of the accident BERGEY was not a witness to this accident but was witness to the aftermath Immediately after the accident and therefore is listed in the above blocks as a witness. He was on scene quickly and was the person holding the infant child when I arrived. BERGEY related that when he pulled up to j the accident scene he saw the child in his father's(Operator#2)arms. Operator#2 was hysterical and BERGEY felt that he should take the baby from him. He asked Operator#2 if he could,and Operator#2 said he could. He held the Infarct until the arrival of"EMS. He could add nothing further to this Investigation. i I Interview with front seat passenger of Unit#2,Jonathan Paul MILLER,conducted by this officer on 05/26112 at 1840 hours at j the scene of the accident MILLER related that he was sitting in the froth passenger seat of Unit#2. They were in the right lane of SR 0081 when he saw a silver pick-up truck,Unit#1,coming up the ramp.Unit#1 did not yield and began corning Into the right lane of SR 0081. Operator#2 swerved to avoid an accident with Unit#1. After Unit#2 lost control,he didn't remember much of anything else other than going down the embankment and hitting something. He related that his Might arm was sore as was his left ribcage. He was tended to by EMS personnel and eventually transported to Hershey Medical Center for examination. Interview with back driver seat passenger of Unit#2,.tulle Ann FRISCIA,conducted by this officer on 05126112 at 1910 hours at j Milton S.Hershey Medical Center(MSHMC). J.FRISCIA was in the trauma bay at the time and a very limited Interview was done. She was unclear as to how the accident occurred and could offer no pertinent information at that time. Interview with Operator#2,Todd Charles FRISCIA,conducted by this officer on 05126/12 at 1928 hours at MSHMC. T.FRISCIA was in a separate trauma bay at the time and a very limited interview was done. He related that he was driving Unit#2 on SR 0081 north in the right lane when he observed a gold or silver pick-up truck coming up the ramp trying to merge onto SR 0081. Operator#2 was traveling at approximately 60mph and was wearing his seatbalt. He thought Unit#1 was going to slow down and enter SR 0081 behind him. unit#2 had a car corning up behind him in the left lane of SR 0081,which prevented him front moving i Printed At:PA State Police-Carlisle 07(2012012 03:42 PM Page 7 Form#:H02-2123122 AA-500 TX -Incident Number. H02-2123122 Commonwealth of Pennsylvania PACE a Crash Involves: Police Crash Report REPORTAM CRASH DUI Fatality L J Hit and Run Commertiai Vehltie 0 State Police Vehicle Local Police Vehicle 0 NIA 0 Work Zone }ATV 3 Snowmobile 0 Commonwealth Vehicle , Local GoV Vehicle f to the left lane to allow Unit#1 to merge. At the last second,when he realized that Unit#1 was not going to stow down and I was in fact going to come into his lane,he Swerved to avoid a collision with unit#1. The last tiring that Operator#2 remembers is traveling off an embankment, Interview with Witness#1,Christopher WALE was conducted by Tpr.Eric KEEBAUGH on 05/26112 and will be supplemented by him for this report. On 05126112 at 2000 hours,I went to the Quiet Room outside the trauma bays and spoke to J.FRISCIA's mother Pattie PARS014S(cell 717-574.1864)and her stepfather Jim PARSONS{cell 717-512-6918},from 1054 S.Pitt St.,Carlisle PA 17013. 1 explained to them the facts that I knew at that time. Person ft4,passenger of UnitX2 Anthony FRISCIA,the 6 month old infant,was later pronounced brain dead while at MSHMC. 1 was Informed of this by Dauphin County[Deputy Coroner John FRIEH on 05129112 at 0843 hours. I was informed that the parents were allowing MSHMC to harvest the infant's organs for donor purposes. FRIEMs phone number is 717.443-1155. I Notification of death was not necessary due to the parents being at MSHMC at the time of pronouncement. Cpl.Aaron LEWIS,Troop H FSU responded to the scene to photograph it on the date of the accident. E Cpl.Gary MAIINZER,Troop H CARS assisted at the scene. Supplemental and GI to follow. Cpl.MAINZER did not take measurements for a diagram and the diagram was completed by this officer. Reasons include:no skid marks,no Apparent f evidence at the scene supporting a collision between both units,and witness accounts corroborating facts indicating that unit #1 failed to yield to Unit#2 while merging onto SR 0081. The crash was entered into the Fatal Crash System in accordance with FR 64,on 05129/12. O.D.Sgt Jonathan MAYS was notified on 05/26112 at approximately 1822 hours. l Cumberland County A.D.A.Jaime KEATING was notified on 05126112 at approximately 1830 hours. He responded to the scene for observation reasons. i Assisted at the scene by Tpr. Natalie WATKIN and Tpr.Eric KEEBAUGH. t mews release prepared and submitted on 05126112. i SP71S sent to both operators. t A copy of this investigation will be forwarded to tide Cumberland County District Attorney's Office for a written detairmination on prosecution once all suppien ientals are received. E On 06106/12,1 received a fax from Jill PAYNE from the Dauphin County Mice of the Coroner. The fax was a copy of the i Coroner's Comprehensive Report of Death Investigation and contains information surrounding the entire accident from the date the deceased arrived at MSHMC until the date the deceased was pronounced brain dead. This document will be placed in the crash attachment file. i On 06108112,1 received a CD from Tpr.KEESAUGH of Operator#1's vehicle while back at PSP Carlisle. 1 also received a CD of photos taken by Cpl.Aaron LEWIS from the F.S.U. Both CD's were placed in the crash attachment file. I Printed At PA State Police-Carlisle 07120!2012 43.42 PM Page 8 Form 0:H02.2123122 I i EXHIBIT "B" LOCAL REGISTRAR'S CERTIFICATION OF DEATH WA#tA INGi ., It is 11"81 to duplicate this copy by phut st t or ph nt q wj= . 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CAUSE OF MEATH APPnaaffieata 2&Part k.Inter the abato ar«Yenta--drraasas.MTlurf#s ar PfNEatlona-tMt dkaetry+xua d t/»aeatrs 041 dT t.rmfnat rvwnL auc»as urakat#r.ax f InRattraf: rani+irarnrY+tract.m YaniNaylar fSnrldraskin wrR}iaVt NtaYdngE'h..arbkYRy-F)6 NOT ABRREYra.Fr_E.eter oniv nne GUa.an a Stn.-.Ana atYd{tias4aF wnaR rr e}rcay-yary ( QnM.2ts 8a«th it,%a,W"kTV uvsl --------- a.Traumai)c t3rstn tnjury j tPhwi dMaaaa M arreditharf �.•..•-_ .••.• "......`. [,u,a m( a a ronse4e.«n+:e➢tk: -0.4;Mn darthl U-Mr9-091`V9 iR:ta `Q k9t'px as eandrS,'rnL Bu4 to t#as a coma u«:nC#af# _..,_....,..._._..___._. _ kkattY«ti .AMiha pia a ' i Ww"crrs#fas,gntorth. t ttrs�ta i]ua ter( as a conxe4u«nta df3•- (ttdeashow"aa Ma,MftatYMat L �_.... F lrrlei4Wrt(to arantr nwfffdnR d. �,..^ M deaeh;tAbT. r...fsu..to fw as a ca+aaauanc.a+); '2.. b,Inter[#haC ut Yrnt rmrdtf.ea In kh«undrrfYMa t-auaa afV.n.M Part F 27,Was an___v armad2 - 1A ware atrtemv fkfdlnpawfrabfe - - tP mf:iMata tha fNdastr+t •tM artt SM Od Tao u C n w 31.Mnn st w h -IMM Past 0 Y.. p Pobaby N3;Yuri tit MOm4 Wq [J' Prapyrtst arIlia at d.aae p C3 4nknown �' rare PtaanfM.eT,bla Pr ansot te.rihfn 42 dada.1­0 ($i S.J9..m t «emm�fk»evwltllstEPn N.a P+aanairi.but Pratfnant ea da.to 1 yearbaeftua tl_tf, 32,o.-ca- xntunr - oar. .)(sww_iA3 Ct sufcwr (' erwrc nat n«daawrnirt«a r•- U.ktM-if pra*fiat++000 T*U.Paw:Yea• May 26,2012 33,--f hY) Apx(}6:7'5 Fl k Yyfa.#UonYf;.ta»atitlGtton sits;fame.:atrha.ai) 3a.L4tatMn at Mfury t=4eraet Graf Number.,ply.state ap Code) HtQt'�^"ay 1-H7 North at mite marker 45,GarUte,PA 17015 ffiJtR'!at om 37.tf T ni,snMN: 3a.f.Mrerrba tler,a.r+rltrtY t1oCLrradf vas *a 4.krarXroaramr L7 PPdwtrfazi Motor VafTic(e Craatt. *a P#+..+agar `C3 oeha.tsDwN'+M �,ya�r«le Ersdtl�'UtJ�s�fiwlsWQr'YO i15sb'aet aP .1 M977 n4orrrad dt tba taus+(.)A+ mrnnar stated r o.-.Mawr*0M 06WWMr Tid.➢r crriMrr-.C'no ,rs@�r ticaMS NamU1r• 39t.Deta ofwy t t3tilrtt+stas$.t'ts'kicil, 127-t S+oftth 28th Stcatst,f ttlrlsGUrg,,PR 714 t May 29.20 12 - e Nnay - • e urn ,•� - a .rfq wrar fne . r l - rs ' l. 49.Ama d wnta ~'r(eas lE3r -t b orapeaNrbr.➢«rmn-NO._,.,��.;y,t,,.?'.yl,'L_�?��._., kIV OTIY6xx EXHIBIT "C" ERIE INSURANCE EXCHANGE FAMILYr�AUTC POLICY CONTINUATION NOTICE I o G) l � .�gc AA7167 J P WOLFE INSLR INC 10/18/11. TO 10/18/12 Q10 1802719 H JOE V REID & TAMMY REID 466 BLOSERVILLE RD NEWVILLE PA 17242-8703 AGENT - J P WOLFE INSUR INC 96 S HIGH ST AGENT PHONE - (717) 776-5213 NEWVILLE PA 17243. 1414 * CONGRATULATIONS! A PIONEER EXPERIENCE RA'Z'ING CREDIT HAS * BEEN APPLIED TO YOUR POLICY PREMIUM, irir^,k###st##�Ir�eskr�cirt^ kk/r,kY4ealrir#{rirY#ie*# th#it*Yr9r�rkkyY*# ir4r##SYIt# F:E1c#k#:k## *#,kk*#�r1riFk***^k�rF/r�rkic�ric* F�r^k**Jef r#*#:k##:t#*�rsk:kk*�r�r# F**:kir7krt�iIt9rkF*#** 47hYrie*^rtYr**###:Fth * YOUR COLLISION COVERAGE AND DEDUC'T'IBLE APPLY TO PRIVATE PASSENGER * AUTOS YOU OR A RESIDENT RELATIVE RENT FOR 45 DAYS OR LESS . THIS IS * SUBJECT TO LIMITS, TERMS AND CONDITIONS IN THE POLICY. ITEM 4. AUTOS COVERED AUTO YR MAKE VIN ST TER PHY LIOTCMCL RATINGCLASS DDiP 1 ..-- 2 04 TOY TACOMA 2WD STEVL52N74Z399t} PA '4F C 071 . A1ASM MM52 3 4 ITEM 5 . _ INSURANCE IS PROVIDED WHERE A PREMIUM, -OR INCL, IS SHOWN FOR THE COVERAGE. COVERAGES, LIMITS AND ANNUAL PREMIUMS ARE AS FOLLOWS- M EQUALS THOUSAND $ #1 42 ##3 ##4 LIABI-JI ROTE CT ION- -- BODILY INJURY $25OM/PERSON $500M/ACC EXHIBIT "D" GENERAL RELEASE ,, Fc,r ine e q� �€�tyryr of vo tq i€�,'t ttired Fifrr Thousand area W1 WD . .. _ ... r.. ................... ...<._ .............. Tn"'»_.?.}i +r which t a t"iweb 7Ghr,C:':.Ti�;.`C,�f3iti, i.:,t° t e_it.tls - and,, e�1=iC.l'arq and for r y d �''-�- MY!; .:r l . �- �� �. r3r m �LtFtotir��:F,c=� 4i:#. ,�,,,~��, ",_r^ti,IT'.sFS f'S °Yi tCSS,i"!#1>7t€L:xrC'}iC 'S: 54} rE±SSKIFSf1d _=_5# i9S. +? "E Tc F'CF 7Em,FrP, rt'aSG aFti{i fir t s"4J' vrie#ca _7 Clmnly Rettl.;~etli!RtMV'S tt!e tf .. . __»..r,..,,._„,._`.«..<_-._.<_._ _ ....._----._ . ...,._,.., .-.__.,...,.. .....,._..._..,. "prt'iT"eui to it r Vie re-, ''SlIc4.e-1-501S, ann 345 :f nxi;. and any c"rr`ir; Ill nlitik-r }`},r;t�t;,.'+F�,, y'r"''•,_*_, vi.r;�E`?iT'€¢,•.„. rte -r >!7's t”" and '�i''`.:"f a`t Eli , 4 wnd rr tg tiFt; , �y,. y E r } s j ,.. ��2 , 5U .i. tct`iQ. �..ii'i.� C! rmit and d Crs, hi3 4), kind.=,n law or in egvit`j, tCnL'`wn cart urzkri*wpb 'whid`"l b'a'te now t" ,ve ar rilwy hereafter iaavil . ancsit, which f'* ?Ytlf'vr "Nt'ititc?i? «.-------- .........----------- . tit;LEly n3s or may hereAftpr have, rrspcciaify t#'e c=i11"'d l4'goll lfaL•llti y of E'P.{f'*asee(s iivhich liabilivi role 3sevis) expresmy f�eriyf*s arising from or by r asoti 1r..'any and aq bodily-car ;z cif igtxy 'andfcar propeny c;:aErmaE. ki .Vr. aria unlE.i'}rJwn. Emov;r!en arxJ 'crrtforeseen `vNictt t retrafctre half hK Ve beeri of, which heretifter may It-e 1SW"ff36I by efus nr*hx?rnirnor afnfer erltioned arming rAit of the acri+dent on air,)btli t r r4r of C, rlss r r tfc�fl ill the Cc.Ut1ty nr Curnbet" , J State Marc sys� ;� in�,UCI)the minor Iforementitneo suswa pt�inxt a t � w trljs rf-S. aniior pr#°SLi#;c far±?3=L i.ate ag(�c- that tl'�, co"SkIerf.,06 t ,et forth sS pocifita4t}y applicable to Tana ptaiit to rriiehis v}ith respect to any anfl all damage to any prapumly, ,e0het real or per1ionat, of rrUnelcrirs Or the rnirwr }tare-mentuar'ier.. ami wit,. respect to an arld all Personal or t)Odity in uny ci.mir~ejours or the minor aforernz:rtt pnev, whether io stvntly xneR rk .r :,irdcrarivn- foreseer or a}iforeseert or writ&i may stxt35lrE;umtly c.eveiigyp and tree conscgcscixar ttr-reef: all is arts+rc from me'#rwen rtti€afw c.acciet sit Like hather&Qree trial the Y011N Watit dt set fc fth aft `V is 5petIT"W311y applicable to and paid to t r-iI us -with respi_';t to any right of rnntri ii:ti r.at`la;?t 3rd Or till Minor i�afrJi"em+InttCtned rrlray l'ic'lL!#",agaEf#rt.the,t�'tcet"acG�S}, ItfSFti#'=Et�ir.'iIS heirs. execulors, r3drninistailars. insurers, 5ucce+sorS aild 'assig m r€lalive 10,claims of Otherr that May he hr[i:)d_7r#t 19 it;V,"rtiP_?u_z or the-minor afar-metlticlried b`><reason of 5f3t##ac mem J` jk'� furthQ,-ag"CVr thJJ the Clan"oderation set forth above is specifically apph atate to my our agrcd'errwrit tt.a; 7r xc r t2}.a !riot f}r }f r+�?i?k"r?tECTi± �E kt.lt %'Ot zoir. riot ,nftcm. p t ia; join the it!Psax `Ft � h p 74Yt Kfifti titf3i and>;2a:aa .isa in an'ji if)ui tr ,icLC,fi U-iat Tt ii L�u broucifir s "w 1I to a t of-,ajd accitaeiv �,`3f.k`S[ T.(* }Yi 7P MSCt.>*.i l•' . 'i r` r t d 1 ' ,r, F � ,.:t;i #Eriarit slr 3lors, `d..,cczzs:;om' and i3ssianis£.J s 1 ` iii F nr•..ti.S'iinifv :tr----c told fnrp f- bnrmfeP,,; elp '€?•}L�z,=.P'F?d§� �±ti'f f?t�'it'YAr�itCE t';rtr r +'t .--�ri -.4 ri*�= .txitT7tt""}S+=tt-rltri^.- of ;ara;a;4cns. a'as1ns? ices imm 1nv'fnt! qr3 it trflevr rl3!W» z. nMlrlcfs or :4rtVc. `. 'hot 'boil`ter be t'uf't~' at any time or brought a lainst the€etF ,,ose(si by rt ejt;-i or zoo t'r'lirw �kr Tt i'sr SFtiCSrtf;�r .#L-1 ar?yoni-,mi our"b+t AIF for ttie Purpose ri>entorcinq a kd„rlheer da€txt.:rary+>`Mtr h tl' S rFtr�ea vf*r*�t'i%i t','S cmv u rio riTEvnfq or oinfir a y Fii.iit i ;tad'pwf';- F i}itl:o- T '%Mutt okE vuf .ring; iii„i 3+ift? ni)W "ila fe Or e*4 3 t rKY1`N1nf r h;I n f..' , it. ,n T '�' '?z rT.r ..�i '�f rxr r;nr rr l,r '.pc.rr y :-4i sing r"It i.r V'Ie accident U for the otner i ag4pa s for ^ti'tlt&-lnT s r€'# ' c T k”�t. .... .i:.?.y t✓SJS..i.1 s: c r h' T,iA , Y i } ... .�": 'sl i1�,.5 3 1':'�7i;5� 'dCi l fC 1 arty rrerie#rt who firauw it'#Y and with Intent to dekauti any anstargnce camttany or i irw pers in fqe$ s#r}apoicaeaart fra€#n5tx:trscp r*r ;.zlamint of ctairr.ccruAirt.nq any rnatenafly t:ise irttrurralion ct varwa. im tRa pur{mse of rau"J"amg,trrtx#rmawin,ctrricri-mig trriy f ti ;naienai tiiex x ccrttmts a'rau t lepf i"Stlrance act,which is a crimr.Etna Stitiov t3►e jzersuri to xim#rwt and civil eir:rrai rs. EXHIBIT "E" State Farm® sun tAast Providing Insurance and Financial Services IN3VANC[O Home Office, Bloomington, Illinois 61710 February 6, 2013 State Farm JACQUELINE VERNEY ESQ Pennsylvania Auto Injury Claims 44 S HANOVER ST PO Box 106115 CARLISLE PA 17013 Atlanta GA 30348-6115 RE: Our Claim Number: 38-1C01-726 Date of Loss: May 26, 2012 Our Insured: Todd Friscia Your Client: Anthony Friscia Dear Mrs. Verney: With regard to your above client's underinsured motorist claim, review of our file reveals that we did previously grant your office consent to settle pertaining to the resolution of your client's third- party liability claim against the tort-feasor. With regard to the underinsured motorist claim, please note that we have completed our evaluation of your client's underinsured claim and based on same we are offering the tender of our insured's applicable household underinsured coverage totaling $200,000. Our offer of tendering of the policy limits totaling $200,000 constitutes the tendering of the stackable underinsured coverage of 100/300 on our insured's 2005 Chevy Malibu, as well as the stackable underinsured coverage of 100/300 on our insured's 2007 Honda CRV. Please note, seeing your client sustain fatal injuries the underinsured motorist settlement will require court approval. Upon your obtaining court approval of the underinsured settlement and your providing to us a copy of the court approval we at that time will be in a position to issue the settlement drafts accordingly. Please note that we do not request or require an underinsured settlement release pertaining to the settlement of your client's underinsured claim. Sincerely, L. Scott Whiteside Claim Representative 610 361 5780 State Farm Mutual Automobile Insurance Company 01/332/1147834 IN RE: ANTHONY FRISCIA, : IN THE COURT OF COMMON PLEAS OF A minor : CUMBERLAND COUNTY, PENNSYLVANIA By his parents,Todd Friscia and Julie Friscia : NO. 2013- (1 0 7 CIVIL ACTION • n '_ PETITION TO SETTLE WRONGFUL DEATH ACTION , .3 PRIOR JUDGE: Edward E. Guido, J.--<?- G, AMENDED PETITION TO SETTLE WRONGFUL DEATH ACTI6, `•'-`' AND NOW, comes the Petitioners, Todd Friscia and Julie Friscia, parentgf Anthony Friscia, a deceased minor, by and through their attorney, Carrucoli and Associates, and Jacqueline M. Verney, Esquire and sets forth the following Amended Petition to settle a Wrongful Death Action: 1. Todd Friscia and Julie Friscia are adult individuals currently residing at 11 Young Drive, Carlisle, Cumberland County, Pennsylvania, 17015. They are the guardians of Anthony Friscia, who was born November 20, 2011 and who died on May 29, 2012. 2. On May 26, 2012 the minor was involved in a motor vehicle accident on Interstate 81 at exit 45 in Cumberland County, Pennsylvania, in which he sustained fatal injuries. 3. The accident in question was due to the negligence of Benjamin Reid who failed to yield the right-of-way when attempting to merge onto I-81. 4. As a result of the afore-mentioned accident, Anthony Friscia sustained fatal injuries and died on May 29, 2012. (Attached hereto as Exhibit"A" is a copy of the accident report.) (Also attached hereto as Exhibit"B" is a copy of the death certificate.) 5. On the day of the accident, Benjamin Reid was operating a vehicle that was insured by his parents, Joe V. Reid and Tammy Reid, through Erie Insurance under a policy which provided $250,000 per person and $500,000 per accident in bodily injury liability coverage. (Attached hereto as Exhibit "C" is the insurance Declaration page.) 6. On the day of the accident, the Petitioners were insured by State Farm Insurance Co. for underinsured coverage in the amount of$100,000 per person and $300,000 per accident. Said coverage was stackable as the Petitioners had two vehicles insured. 7. The Petitioners have entered into a settlement agreement with Erie Insurance to accept the limits of that policy for the injuries sustained for Anthony in the amount of$250,000. (Attached hereto as Exhibit"D" is a copy of the signed Release with Erie Insurance.) 8. The Petitioners have entered into a settlement with State Farm Insurance Co. to accept the limits of that policy, stacked, for the injuries sustained by Anthony, in the amount of$200,000. (Attached hereto as Exhibit "E" is the letter offering said amount and indicating that no release is necessary.) 9. The petitioners have investigated this matter and agree that compensation in the amount of$450,000 is a fair and equitable settlement in light of the situation. 10. Subject to the approval of the Court, the parties have agreed to settle petitioners' claim for the death of their minor son, in the amount of$250,000 from Erie Insurance and $200,000 from State Farm. 11. Pursuant to an agreement between the parents and Carrucoli and Associates, Counsel for the parents is to be paid 25% of the proceeds of the settlement, after costs and fees. 12. The following costs and fees have been incurred in the representation of the parents, for a total of$817.76: A. Hershey Medical Center records- $ 30.00 B. Healthport medical records-Anthony-copying fee $416.86 C. Carlisle Pediatrics records-Anthony-copying fee $ 45.69 D. Filing Fee-Prothonotary of Cumberland County, PA $103.75 $596.30 13. Requested Distribution of the proceeds of the $450,000.00 settlement is as follows: A. Carrucoli and Associates reimbursement for fees and costs $ 596.30 B. Carrucoli and Associates 25% of$449,403.70 $112,350.92 Total $112,947.22 C. Todd Friscia $168,526.39 D. Julie Friscia $168,526.39 WHEREFORE, the Petitioners request that this Honorable Court enter an Order approving the Petition to Settle a Wrongful Death Action in the amount of$450,000 and distribute the proceeds as indicated. Respectfully submitted, Carrucoli and Associates - - V"'Jane M. Verney, Esquir cq li 44 S. Hanover Street Carlisle, PA 17013 717-243-9190 Attorney for Petitioners VERIFICATION I, Jacqueline M. Verney, Esquire, do hereby certify that the averments in the Amended Petition are true and correct to the best of my knowledge, information and belief. I understand this Verification is made pursuant to provisions of 18 Pa.C.S.A. § 4904 relating to unsworn falsification to authorities. Dated: JdcquqYne M. Verney, Esquire Counsel for Petitioners GG » EXHIBIT A AA-500 TX i4identNumberr, H02-2123122 Commonwealth Of Pennsylvania PAGE 1 Crash involves: Police Crash Report REPORTABLE CRASH {0 DUI Fatah Hit and Rua 0 State Police Vehicle r� Local Policb Vehicle Fatality Commercial Vehtcle r+ 0 O NIA 0 Work Zone 0 ATV " Snowmobile 0 Commonwealth Vehicle Q Local Gov Vehicle Agency name Case Closed Patrol Zone Investigation Date PA STATE POLICE-CARLISLE YES 71 0512612012 Dispatch Time Arrival Time Investigator Badge Number 1$:18 hrs. 18.21 hrs. HOWELL,DOUGLAS W 0?869 �? Approval Dale Revievrer Reviewer Badge Number 07110/2012 GOULDY,DAVID P 07136 Date of Crash irtme of Crash Dap of the Week Crash Description 05/2612012 18:17 hrs. SATURDAY HIT FIXED OBJECT County Municipality CUMBERLAND CARLISLE"BORO g Weather Conditions Relation to Roadway t RAIN OUTSIDE TRAFFICWAY lilumination Road Surface Conditions ci DAYLIGHT WET ' #of Unfts #of People J#of Injured Al Killed EMS Agency Medical Facility 002 004 003 001 GOODWILL EMS HERSHEY MEDICAL CENTER School Bus Related School Zone Related PermOOT Notified Type of Intersection Special Location NO NO NO ON RAMP NOTAPPLICABLE Work Zone Work Zone Type Wnere 1n Work Zone NO Speed Limit Workers Present Officer Present Work Zone Characteristics o RcadClos�d —i Work on Shoulder intermittent or Flogger ❑Lane Closure❑ with Detour 11 or Median ❑ Moving Work ❑ Control ❑.Other Route Signing Route Number Segment Number Travel Lanes Speed limit Orientation STAi KiIGRWAY 8021 01 55IMPH NORTH a House Number Street Name St.Ending Z ENTRANCE45 HIGHWAY Ig Route Signing Route Number Segment Number ravel Lanes Speed Limit Orientation Used in = Intersecioa Crasaes . SYreetName SL Ending m Route Number Or Mile Post Tenths lor Segment Marker r2amp Use Only Feet 00$1 045 8 00065 Street No Street Ending Or Rules Menths I81 HIGHWAY Route Number Or I111e Pos Tenths Or Segment,Marker Ramp Use Only The above entry is the m distance from the Crash F. Street Name iSlreet Ending � Scene t0 Landmark 1 . m 1 H � Degrees l�+linutes Seconds Pecimal Dagrees "nutes Seconds Decimal I� Latitude: 40 11 ; 13 . 812 Longitude: . 77 1 2 335 I Traffic Control Device !Traffic Control Functioning U Y'EiD aluk # DEVICE FUNCTIONING PROPERLY Y . m Lane Closed Lane Closure Direction Traffic Detoured Estimated Time Closed I PARTIALLY NORTH NO a 30 MIN. Environmental 1 Roadway Potential Factors(EIR) Factor f Factot 2 !Factor 3 hIONE c Firsf Harmful Event in the Crash Most Harmful Event in the Crash Unit Number Harmful Event Unit Number .Harmful Event 002 IT TREE OR SHRUBBERY 002 1 HIT TREE OR SHRUBBERY Indicated Prime Factor Unii Number Prime Factor Driver Action ° DRIVER ACTION 1001 MAKING IMPROPER ENTRANCE TO HIGHITAY Prime Factor EnviromentaitRoadway Prime Factor Vehicle Failure Prime Factor Pedestrian Action w' Road Surface Type Special Jurisdic!ion CONCRETE NO SPECIAL JURISDIC11ON Printed At:PA State Police-Carlisle 0712012012 03:42 PM Page I Form#:H02-2 2123522 AA-503 TX 'Incident Number: H02-2123122 Commonwealth of Pennsylvania PAGE 2 Crash Involves: Police Crash Report REPORTASLECRASH O DUI 0* Fatality C D Hit and Run 0 Commercial Vehicle (:) state Police vehicle C) Locat Poilce Vehicle 0 NIA 0 work Zone Q ATV 0 Snowmobile v Commonwealth Vehicle J Local Gov Vehicle Unit Number Type Unit Commercial Vehicle 001 Phantom Vehicle No First Name MI Last Name !Suffix DOB Telephone Number $Eh 1A6S:N P RECD 00712111293 ;717)386-0792 Street Address City State Zip Code 456 SLOSSROLL E°OAD NEkkl^qLL E PA 1472241 Gender License Number License State Class Expiration Date Owner/Driver ttXrz 30128194 PA C 0712212013 PRIVATE VEHICLE OWNERILEASED BY DRIVER c_Driver Presenx Physical Condition Primary Veh.le Code Vioiation Person Charged DRIVER OPERATED VEHICLE APPARENTLY NORMAL VC13323 STOP SIGNS AND YIELD SIGNS YES j RlcohollDrugs Suspected icohot Test Type jAlcohol Test Results ti - NO BLOOD UNKNOWN RESULTS Driver Action MAKING IMPROPER ENTRANCE.TO HIGHWAY d Pedestrian Action Pedestrian Signals (Pedestrians Clothing Pedestrian Location ca' I 1st harmful Event Left or Right Side Most Harmful Utility Pole Number 2nd Harmful Evert Leff or Right Side Most ty Harmful Util Pote Number srd Harmful Event Left or Right Side Most Harmful Utility Pole Number 4th Harmful Event Left or Right Side Most Harmful Utility Pole Number Owner First Name Owner MI jOwner Last Name or Business Name Suffix JOE V REID S#est Address City State Zip Code .466$LOSERVILLEROAD NEINVILLE PA 17241 Vehicle Type Specw Usage Government Equipment Number SMALL TRUCK NOT APPLICABLE Model Year Vehicle Matte Vehicle Model [Vehicle Color VIN 2004 TOYOTA TACOMA SILVER STEVL52N7=99045 License Plate Reg.State {Est.Speed Vehicle Towed ITowed By YXK6875 P.A 045 NO Insurance insuranoe Company !Policy Number Expiration Date NO rection ofTmVel 'Posi tion Vehicle Movement initial impact Point _o NORTH OTHER FORWARD MOVING LANE CHANGING LANES OR MERGING NON-COLLISION r6 Damage indicator Gradient Road Alignment Possible Vehicle Failures a€ NONE LEVEL STRAIGHT � NONE S m ff'>t of Units Type Unit 1 Tag Number Tag Year Tag State = 140 Unit Make !Unit Owner I � f 1 'Type Unit 2 Tag Number Tag Year 6tate m t= Unit-Make Unit Owner Engine Size Passenger? .Saddle BaVTrunk? !Trailer? Driver Education? cc 1 PDriver Helmet Type Helmet Stayed On? IDOT/Snell Desionation? Eye Protection? tong 5iaeves? Long Pants? Over Ankle Boots? e i N Pa_scpnaer 44;o _t Tune Helmet Sieyed On? !DOT/Snell Designation? Eve Protection? Long Sleeves? Long Pants? Over Ankle Boots? _ � j m Passenger? �Hetmet7 m Head Lights? jRear Reflectors? 0. Printed At:PA State Police-Carlisle 01/20/2012 03:42 PM Page 2 form# H02-2123122 AA-500 TX incident Number: H02-2123122 Commonwealth of Pennsy(Yaftl3, PAGE 3 Crash Involves: Police Crash Report REPORTABLE CRASH 0 Out Fatality Hit and Run 0 Commercial vehicle 00 State Police Vehicle Q Local Police Vehicle C)NIA O Work Zone C ATV 0 Snowmobile C) Commonwealth Vehicle 0 Local Gov Vehicle Unit.Number IType,Unit Commercial Vehicle 002 j Motor Vehtcle In Transport No First Name MI 'Last Name Su'iix DOB Telephone Number TODD C I FRISCIA 1091C;iSE4 (747)2494:410 Street Address City State Zip Code +1 YOUNG ERIV'E CARLISLE PA ".70'5 Gender License{dumber License State Class 'Expiration Date Owner/Driver MALE 25953027 PA C 1 12/0912013 PRIVATE VEHICLE OWNEDILEASED BY DRIVER o DaverPresence Physical Gond t[on IPrimary Vehicle Code Violation Person Charged E DRWER OPERATED VEHICLE APPARENTLY NORMAL NONE NO howDrugs suspected l4icohol Test Type Alcohol Test Results m NO TEST NOT GIVEN Driver Action NO CONTRIBUTING ACTION d d Pedestrian Action Pedestrian Signals Pedestrian Clothing Pedestrian Location } 0 1st Harmful.Event 'Left or Right Side Most Harmful Uglily Pole Number HIT TREE OR SHRUBBERY i RIGHT YES 2nd Harmful Event Left or Right Side Most Harmful Utility Pole Number 3rd Harmful Event !Left or Right Side Most Harmful Wily Pole Number i 4th Harmful Event 1eR or Right S#de Most Harmtui Utility Pa#e Number Owner Fast Name Owner Ml iOwner Last Name or Business Name Suffix TODD C FRISCIA Street Address City State Zip Code 11 YbUNG DRIVE CARLISLE PA 17015 Vehicle Type Special Usage Government Equipment Number AUTOMOBILE NOT APPLICABLE Model Year Vehicle Make Vehicle Model Vehicle Color VIN 2405 'CHEVROLET MALIBU SILVER IGIZ75281SF25OSSS License Plate Reg.State Est.Speed Vehicle Towed !Towed By FSP9734 PA 060 YES i MULLENS TOWING insurance insurance Company JPolicy Number Expiration Date YES STATE FARM i 1437164=3$D 0910812012. Direction of Travel lVehicle Position Vehicle Movement Initial Impact Point c NORTH RIGHT LANE"CURS" r GOING STRAIGHT NON-COLLISION Damage Indicator Gradient Road Alignmerit Possible Vehicle Failures DISABLING !LEVEL STRAIGHT i NONE c d #of Units Type Unit I Tag Number .lag Year Tag State " 0 t y _ Unit Make Unit Owner SIType Unit2 Tag Nttmber' Tag Year Tag State Unit Make Unit Owner Engine Size Passenger? Saddle Bag/Trunk? Trailer? Driver Education? ',u„ driverHel,retTyp- IHz#rnztStaYed On? DOfirSne:t Designation.? Eye Protection? Long Sleeves? Long Pants? Over Ankle Boots? g c+,.,..,a nn5 nnTiCnc13 nay nna+inr9 Eve Pmtecliono Lona SiaevPS? Lonp Pants? lover Ankle Boots? m (Passenger? Helmet? 'a �Head Lights? 'Rear Reflectors? IL Printed At:PA State Police.Carlisle 0712012012 03:42 PM Page 3 Form 0:H02.2123122 "A-500 TX Incident Number, HOZ-2123122 Commonwealth of Pennsylvania PAIGE 4 Crash Involves, Police Crash Report REPORTABLE CRASH 0 Dw T1 Fatality Hit and Run 0 Commercial Vehicle ) State Police Vehicle 0 Local Police Vehicle 0 NIA 0 Work Zone 0 ATV 0, snowmobile 0 Commonwealth Vehicle, 0 Local Gov Vehicle JUnit 9 JDriver Restrictions Compliance Driver Endorsement Compliance Driver License Compliance 01 RESTRICTIONS COMPLIED WITH NONE REQUIRED Principal Impact Point Avoidance Maneuver Under Ride Indicator NON-=LLfSI0N NO UNDERRIDE Oq OVERRIDE Emergency Use Drug Test Type Drug Test Results NOT IN EMERGENCY USE I I t...t' I BLOOD .1— .1 NOWN TEST RESULTS Unitrt Driver Restrictions Compliance TB;;;r E dorsement compliance lDrrver License Compliance 02 kESTRICTIONSCOMPLIED WITH I NONE nREQUIRED I VALID LICENSE FOR CLASS it Prihiciplaf Impact Point lAvoidarim Maneuver Under Ride Indicator. i' ROr.LOCK STEERING-EVIDENCE OR DRIVER STATED NO UNDERRIDE OR OVERRIDE u. Emergency Use Drug Test Type fDrug Test Results NOT IN EMERGENCY USE NONE NO TEST GIVEN Unit# Person No.First Name MI Last Name suffix iDOB 001 TODD C FRISCIA 1011011984 t' eet Address city Slat Zip Code Address 15 YOUNG DRIVE CARLISLE PA 17015 Phone number JEMIS Transport Person Type Gender Injury Severity 171.7)"2494410 YES DRIVER MALE E MODERATE INJURY Seat Position Safety Equipment I DRIVER.-ALL VEHICLES LAP AND SHOULDER BELT USED 1Safety Equipment 2 Extrtcation FRONT AIR SAG DEPLOYED{FOR THIS SEAT) NOT EXTRICATED Ejection JEjection Path L NOT EJECTED NOT EJECTEDINOT APPLICABLE Uftft'* Person W First Name MI fast Name Suffix DOB 002 1002 First P . MILLER 09i"1811981 Address city state Zip Code i Unit'* RD CARLISLE PA 170t3 Phone Number EMS Transport Person Type Gender (t7l 717)701-0684 YES PASSENGER MALE MINOR INJURY Injury Severity H seat Position Safety Equipment i m Z FRONT SEAT RIGHT SIDE LAP AND SHOULDER BELT USED Safety epipiriont 2 Extrication FRONT AIR BAG DEPLOYED(FOR THIS SEAT) NOT EXTRICATED Ejection Election Path NOT EJECTED NOT EJECTEDINOT APPLICABLE Junitf Person No.First Narre 141 ]Last N.M. Suffix !DOB lI 002 003 JULIE J A I FRISCIA I 101tollem el Address city Stale I Zip Code 51 YOUNG DRIVE CARLISLE PA 17015 o Phone Number ETAS Transport Person Type Gender Injury Severity (717)249.5410 YES PASSENGER FEMALE MODERATE INJURY Seat Position lSafietv Equipment I i SECOND ROW-LEFT SIDE OR MOTORCYCLE PASSENGER LAP AND S40ULDER BELT USED Safety Equipment 2 Extrication NONE USED I NOT APPLICABLE NOT EXTRICATED Ejection Ejection Path NOT EJECTED NOT EJECT EDINOT APPLICABLE Printed At PA State Porice-Carlisle 0712012012 03:42 PM Page 4 Form 0:M02-2123122 AA-500 1 X Incident Number: H02-2123122 Commonwealth of Pennsylvania PAGE 5 Crash Involves: Police Crash Report REPORTABLE CRASH 0 DUI CO)Fatality 0 Hit and Run Commercial Vehicle C state Police Vehicle v Local Police Vehicle NIA L!Work Zone LAN ,J snowmobile 0 Commonwealth Vehicle 0 Local Gov Vehicle Unit# JPerson No,I First Name M! Last Name Suffix DOB' 002 004 ANTHONY J FRISCIA 1 11/2012011 Street Address City State Zip Code ! 11 YOUNG DRIVE CARLISLE PA i 17015 I o Phone Number lEMS Transport Person Type Gender Injury Severity 1 Y @S PASSE NGER ! :'ALE KILLED Seat Position Safety Equipment 1 Z SECOND ROW-MIDDLE POSITION CHILD SAFETY SEAT USED n a safety Equipment 2 F-orication NONE USED I'NOT APPLICABLE FREED BY NON-MECHANICAL(MEANS Ejection Ejection Path NOT EJECTED NOT EJECTEDINOT APPLICABLE First Name MI Last Name Suffix Phone Number n CHRISTOPHER - D HALE - (7172 9794222 N C treetAddress City State Zip Code 1037 TEAXWOOD LANE ENOLJI PA 17025 Fimt.Name MI Last Name Suffix Phone.Number A JOSH D BERGEY (464)656.8185 .5 Street Address City state Zip Code 112 BALFOUR DRIVE MECHANICSBURG PA 17050 IN CARLISLEBORO - Untt it tinil rail M edian ! -� ��•.— la it, '-- _ {Ep JM1IS i�hT.91 iiT� Q dzMoe from A to a=330 ! Printed At:PA State Police•Carlisle 0712012012 03:42 PM Page 5 Form#:H02.2123122 AA-500 TX incident Number: H02-2123122 Commonwealth of Pennsylvania PAGE 6 Crash Involves: nn Police Crash'Repa'rt REPORTABLE CRASH V DUI (i)Fatality i A,Aj-f300 incident Number: H02-2123122 Commonwealth of Pennsylvania PAGE 7 Crash Involves: Police Crash Report REPORTABLECRASH DU! i)Fatality 0 Hit and R.. 0 Commercial Vehicle 0 State Police Vehicle 0 Local Police Vehicle 0 NIA 0 Work Zone ATV snowmobile 0 Commonwealth Vehicle 0 LOW Gov Vehicle approached the top of the on-ramp,looked In his mirror to check for traffic. He related he looked in his rear view mirror and turned his head to the left to check his blind spot He did not see Unit 92 in the right lane of SR 0081 so he began to merge onto SR 0081. As he merged,he caught a glimpse of a quarter panel and realized that there was a car in the right lane of$R 0081. He took an evasive maneuver and pulled his steering wheel to the right to avoid striking Unit#2. He observed Unit#2 swerve to the left and lose control. As Operator#1 was braking,he observed Unit#2 then counter-steer,causing Unit#2 to rotate in a clockwise direction. He observed Unit#2 slide across the right lane of SR 0081 in front of UnIt#1and travel down an embankment Operator#i pulled his car off the roadway onto the shoulder just past the area where Unit 92 tmveied down the embankment He exited his vehicle in order to tender assistance to the occupants of Unit#2. Several other.motorists stopped and Assisted the occupants. Operator#1 was later asked to give a recorded statement to Tpr.Steven NESBIT at PSP Carlisle,which he voluntarily agreed to give. Operator#1 agreed to voluntarily submit to a blood test to determine any Intoxicants. The Waiver of Rights and Consent to Search signed by REID will be placed in the crash attachment file. Tpr.NESBIT later placed said blood into evidence at PSP Carlisle under Property Record#H2-15503. The blood was collected by David DUTROW at the Carlisle -Regional Medical Center(CRMC)on 05126112 at 2021 hours, I later completed an NMS request for analysis, Tpr.Dominick NARDONE forwarded the blood to NMS on 06106112,FedEx tracking number 800327049247. The NMS Request copy will be placed in the crash attachment file.Tpr.NESBIT will be supplementing this report Tpr.NESE31T entered the recorded statement Into:evidence under Property Record#HZ.15503k Interview with Witness#2'r Josh Eugene BERGEY,112 Balfour Dr.,Mechanicsburg,PA 17050,484-886-8165,DOS 02124179 conducted by this officer on 05126112 at 1830 hours at the scene of the accident. BERGEY was not a witness to this accident but was witness to the aftermath Immediately after the accident And therefore is listed in the above blocks as a witness. He was on scene quickly-and was the person holding the infant child when I arrived. BERGEY related that when he pulled-up to the accident scone he saw the child in his father's(Operator#2)arms. Operator#2 was hysterical and BERGEY felt that he should take the baby from him He asked Operator#2 If he could,and Operator#2 said he could. He hold the infant until the arrlvalvf EMS. He could add nothing further to this investigation. Interview with front seat passenger of Unit#2,Jonathan Paul MILLER,conducted by this officer on 0512611'2 at 1840 hours at the scene of the accident MILLER.related that he was sifting in the front passenger seat of Unit#2. They were in the right lane of SR 0081 when he saw a silver pick-up truck,Unit#1,coming up the ramp.Unit#1 did not yield and began coming Into the tight lane of SR MI. -Operator#2 swerved to avoid an accident with Unit#I. After Unit#2 lost Control,he didn't remember much of anything else other than going down the embankment and hitting something. He related that his right arm was sore as was his left ribcage. He was tended to by EMS personnel and eventually transported to Hershey Medical Center for examination. InterviewwIthlback driver seat passenger of Ulnit#2,Julie Ann FRISCIA,conducted by this officer on 06128112 at'1V0 hours at WiltonsS.flersheyVedlcal Center(MSHMC). J.FRISCIA was in the trauma bay at the time and a very limited interview was done. She was unclear as to how the accident occurred and could offer no pertinent information at that time, Interview with.Operator#2,Todd Charles FRISCIA,conducted by this officer on 05126/12 at 1920 hours at MSHMC. T.FRISCIA was in a separate trauma bay at the time and a very limited interview was done. He related that he was driving Unit#2 on SR 0081 north in the right lane when he observed a gold or silver pick-up truck coming up the ramp trying to merge onto SR 0081. f 0 orator#2 was traveling at approximately 60mph and was wearing his seathelt He thought Unit#1 was going to slow down .and enter S. 0081 behind'him. U aft#2 had a car coming up behind hit"T in Vie ieft i a ne of 3R 0 003'11,w1virch ravent-Ad h'.m. f'='. moving Printed At:PA State Police-Carlisle 07/2012012 03:42 PM Page 7 Form 9:802-2123122 AA,500 TX Incident Numben H02-2123122 Commonwealth of Pennsylvania PAGE 8 Crash involves: Police Crash Report REPoRTABLE CRASH Dul Fatality 0 Hit and Run 0 Commercial Vehicle State PollreVehtcle 0 Local Police Vehicle 0 NIA 0 WOM Zone 0 ATV 0 Snowmobile 0 Commonwealth Vehicle 0 Local Gov Vehl.le to the loft,lane to allow Unit#1 to merge. At the last second,when he realized that Unit#1 was not going to,slow down and was in fact going:to come Into his lone,he swerved to avoid a collision with Unit fl. The last thing that Operator#2 remem'b'ers is traveling off an embankment Interview with Witness#1,Christopher NALE was,conducted by Tor.Eric KEEBAUGH on 05/26112 and Witt be supplemented by him for this report. On 05126112 at 2000 hours,I went to the Quiet Room outside the trauma bays and spoke to J.FRISCIA's mother Pattie PARSONS(cell 747-574-1864),and her step-father Jim PARSONS{cell 717-512-6918),from 1054 S.Pitt St,Carlisle PA 17013. 1 explained to them the facts that I knew at that time. Person#4,passenger of Un1t#2 Anthony FRISCIA,the 6 month old infant was later pronounced brain dead while at MSHMC. I was informed of this by Dauphin County Deputy Coronei-John FRIER on 05129112 at 0843 hours, I was informed thatthe parents were allowing MSHMC to harvest the infant's organs for donor purposes. FRIEH's phone number Is 717-443-1155. Nottfic-ation of death was not necessary due to the parents being at MSHMC at the time of pronouncement CoIr k Aaron LEWIS,Troop H FSU responded to the scene to photograph it on the date of the accident. Col.Gary MAINZER,Troop H CARS assisted at the scene. Supplemental and GI to follow. Col.MAINZER did not take measurements for a diagram and the diagram was completed by this officer. Reasons Include:no skid marks,no apparent 'evidence atthe scene supporting a collision between both units,and witness accounts corroborating facts Indicating that Unit #1 failed to yield to Unit#2 white merging onto SR 0081. The crash was-ontered into the Fatal Crash System In accordance with FR 64,on 05129112. O.D.Sgt Jonathan IVIAYS,wts notified on 05=112 at approximately 1822 hours. Cumberland County A.D.A.Jaime KEATING was notified on 051226112 at approximately 1930 hours. He responded to the scene for observation masons. Assisted at the scene by Tor.Natalie WATKIN and Tpr.Eric KEEBAUGH. News release prepared and submitted on 050112. SPI-00%sent to both operators. A copy I of this investigation will be forwarded to the Cumberland County District Attorney's Office for a written determination on prosecution once all supplementals are received. On 06106112,1 received a fax from.Jill PAYNE from the Dauphin County Office of the Coroner. The fax was a copy of the Coroners Comprehensive Report of I)MhJnvestigation and contains information surrounding the entire accident from the date the deceased arrived at VISHMIC until the date the deceased was pronounced brain dead. This document will be placed in the crash attachment file, on 06108112,1 received a CD from Tor.KEEBAUGH of Operator#I's vehicle while back at PSP Carlisle. I also received a CD,of photos taken by Col.Aaron LEWIS from the F,S-U. Both CD's were placed in the crash attachment file. Printed At:PA State Police.Carlisle 0712012M=42 PM Page a Form H02-2123122 I EXHIBIT «B" VW 177E LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING-It is 11tegal to duptioate this copy by photostat or phlltaqrpph. F",ff"T this miifwate. S6.00 !o cc-lire that the irionnalion hiere Pven is ;.orrc'c •l'Coma frorn all orlainal D,'ath t'14 -iti iTe i fwi.i I I he (ITID111W a au thm. State Vit'n, " , z. P 18487956 "AlAt XF Certificwion Nwriber Lo:al Reg,,irar Date Issued TvwpOl..An caMMONWl,:ACTH ot;PENNMVAJ M•DCPAPTMEW OF—L.tk a VITALREG04%10S P--ht CERTIFICATE OF DEATH 5—Me ink 03—li—itit—-be WY0(Spelt-.1 3—2 8'6 5 x y 20 Anthony aameS FVISCift 120/0 Nov- 20 2011 671 09", '1 CurrilDe3r nd M*1 ':. 13110,51.F.Z' a= 4-- --,SO Vo—n —..00—(Sire--and Number-lo—ce"t hlp.I -�Old Oa—d—Li-11 1-- — . . -3 k-4.USA— Spo— Cl—.—P.—00 finit vn.M.Sj r3z. tx,4. [3 Una— 11"C3 Ow.—. 1:3 ul- 2.F—ft-v..—jF'Ort,-'p--Las%.5—.1 23.-.thee.N Is'loo,mitidl..-ft) ToddYciLm Vre' A '7015 sywy ...................... en M Nutting 1! T" C3 Other[S eMf number[ 2EERN-F—ERL: I�-�-w of —th '�Wpl;p 17033 7 Hdfthlay Medical Contor 7=7511 W.Me— —p—l".. Ll B.M-1 0" It 13 C3 n nation May 31, 29, H' O:Efman—RvX--r1 F Un:'VMI- HOMO & Ct70m*t;0r-y 260,'L—O—Of ollp"Itito('Fy Or Town•Matt,and - Zp) . .-1 0 Ale Pat—I"C .Of I CarjiSle, PA 17013 OlaI44L C74;:.ee7p'T�d 111� _.� J q Cng n V--' 1701.3 jiggywa of —91. co ,S high—deprea a,lovit Of��Ol O—Aetod at the Tin-of-death- bol that bPa�,6-1�*Whether the ea. be Oat".— ted hl—ff—I—rsofft.be- ,S fth S-d.—$a- Check In.-.o- 31-- r-j.— C3—d'pd—,nth-12tl,�4. h"It O—d—is 1otSP-obh/HftPAoIULAtIoO- M 811�—A�W—A—kch. C3 Vfamamaxa M kith Sehool zordzate—GCO—OOPIated ED...no, C3—1—todian o,Alaska hlatfY (]other Asian C3 Sa • V.X.-ad.,-.—d•—. 13 I—, M—le—A—NC Ch4-- r3—1—Indl— C3 N-the E3 aa—latt.dea—.(.,s.AA,� ) 0 Y-.P-a—Al—O C3 Ctstnaae C3 d.—Fmn or ch.— M 9aeh*hir'-dea—(&.a."^,^z.es) (3 V--C.— M Ftflpl— C3 se— Y3 M.ila—doff—(..R'MA,MS.MEng.MEd,-SW,MBA) C3--,other 0 I—es. C3 0 a.0tOn'ta la-g-php,Clio)Or P affik..I—t d"— (spaeltv) 13 6v—,(spe.uv) 4,-,% DOS,DVM,LLb-JOj .0t.— 22-De- tXWhOA I 'a"— C3 S--- do—d.1lor m—of—,Ui-C III-00 NOT USE RETIRED. msla.kr A—OWan Korean C3 n.,Al..$.W.0— r3 C3 KO.—/"Ot Sure C3 Alfa-tndt— C3 other/Wen EJ—Fad 22b. M Chmese C3 0 c,"-,(SO—Ifyj N/A 0 U Fillp-h- 13 G.411O.Olwn,OF ch-riwf fTEM52ha_Z"MUST V.,COW�M-8 a—--o—d ..d(=/.­IYI) b. of 1--F—O typ —0. 123.. D 9-kcri;Oft May 294 2012 aad-Data liwov.IM00—y'-o ]11,Tl—11-1h 09.44 AM �...CAUSE OF OF-ATH i Ap-14— 21;,Pa.I. ...... interval: —a- Traumatic Brain injury --filto. DUE t¢4a>.a consaeuwnce oil: death) S*llue"twly Itit ooftdlila,na, W 1. If..Y.,le—ing to the listed on line w.enter the Uwa=Nd CAUN Due ---te-f)- (dIzalls..1 ft,]Ulv that )owated the—resulting d, UIsT. [].Y..top- --plet tb t. I", I Y— --air of death? Ltlt 29. 50.Ma Tb.—U— M �th • 0 Not VeW--—Ithin—at 1--3 (71 —b.h;y ED N-t--I 0"—Ild, E:3 Ona.,.ot I time of d..", M C3 ED A.,iO.— 1-3 & r3 Not pagnaojt,but pmgha:�wIthto 42 den of tl..� M could—be d-M-9d of goi—(M.r—y7y"U-0-.-h)a3 days to 1 year Dafnre dealt C3 UnknO—O if�lioant Wfthlo the Pant VO-1 [may 26,2012 ss, Apx 05-15 P 34.PWFA TFj-n1u;v"tea.home;eo'st-0—Ite;fa—school) ..'—.0.11 Ot lOj-1 chi, ZIP CO—) Highway 1-81 North at mile marker 45,Carlisle,PA 17015 AB.m}uNaY WOYk 3J,if T C2 Va. M 0,F",/Op- C]Iad.-Man Moto,Vehicle Crash, E-I 0th—(Spaelfv)--- —X a, cTmd due to the caustfb;—d m-11st.tdi. M 0--neini a —m lie, the_lse(s)&00 Wo_st—I ,death_—d at the tho..d-..,and A_I d"e to t at *01"1*,d-1, and 01,11,and.—t.——10 and-..0——led Coro 2'gr U—n—--b- 4­1 34h.Na[M /tddre•s• d'LIp Code O.perkon C¢mpl¢tma C8U t'D aih(1 m 2E) 4C Data Signed{MOfD'V/rf1 Gigihbm S.Hetrick,1271 South 28th Str0at,Harrisburg,FA 17.111 REV 4712011 EXHIBIT «CIS ERIE INSURANCE EXCHANGE FAMILY AUTO POLICY CONTINUATION NOTICE AA7167 J P WOLFE .TNSU-R INC 10/18/11. TO 10/18/12 Q10 1802719 H JOE V RETD & TAMMY REID 466 BLOSERVILLE RD NEWVILLE PA 17241-8703 AGENT - J P WOLFE INSUR. INC 96 S HIGH ST AGENT PHONE - (717) 776-5213 - NEWVILLE PA 17241. 1414 y *' CONGRATULATIONS! A PIONEER EXPERIENCE RATING CREDIT HAS * BEEN APPLIED TO YOUR POLICY PREMIUM. *irttyF:kIr9rdtit•k*tkk'k'Jrt�cXrylrir'k�t�cY�c*irt*Ye*dtir*'********�C;k�c''k* k' k*A'***'7F1e*'**ic�t7t'**.*'�t1F*^*�t�r*****9c'k * YOUR COLLISION COVERAGE AND DEDUCTIBLE APPLY TO PRIVATE PASSENGER. * AUTOS 'YOU OR A RESIDENT RELATIVE RENT FOR 45 DAYS OR LESS . THIS IS * SUBJECT TO LIMITS, TERMS AND CONDITIONS IN THE POLICY. ITEM 4. AUTOS COVERED AUTO YR MAKE VIN ST TER PHY LIOTCMCL RATINGCLASS DDP Z .---Y- 2 04 TOYO TACOMA. 2 WSJ p STEVT�:52N74.Z399Q4� ..A 4F ,C A1ASM MM52 - 3 4 ITEM 5 . . INSURANCE IS PROVIDED WHERE A PREMIUM, .OR INeL, IS SHOWN FOR THE COVERAGE. COVERAGES, LIMITS AND ANNUAL PREMIUMS ARE AS FOLLOWS- M EQUALS THOUSAND $ 41 42 #3 . 44 .. . .. .. . . . . . LTABIld-ITY PROTIECTION7 BODILY INJURY $25OM/PERSON $500M/ACC i ' Yfi �11 ill IViW I T Y EXHIBIT «D" GENERALRELEASE h..._ 1�........ ,6r,the� Ttsidcr31#�^.ot Ten*Htai t tlnf i3 ousand an'd 00 l41Q . �-----------_ ...... ....,...,....... - .. ... - - _...,. ,.,M ai"d for my f l;iGtSi���`ari?.S T7 YIS3ilr ',t ri te. .. : #?75£ ��7� ¢'iI 3x,3' ;isr�4 :w0f 5,11-ce' :cuffs and :4 neND: `Cr04 P: -tts...� :.... ....,,', ms..,. _>__..c1' w nv R6.xi- L ._. ..�.. .,... . 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With regard to the underinsured motorist claim, please note that we have completed our evaluation of your client's underinsured claim and based on same we are offering the tender of our insured's applicable household underinsured coverage totaling $200,000. Our offer of tendering of the policy limits totaling $200,000 constitutes the tendering of the stackable underinsured coverage of 100/300 on our insured's 2005 Chevy Malibu, as well as the stackable underinsured coverage of 100/300 on our insured's 2007 Honda CRV. Please note, seeing your client sustain fatal injuries the underinsured motorist settlement will require court approval. Upon your obtaining court approval of the underinsured settlement and your providing to us a copy of the court approval we at that time will be in a position to issue the settlement drafts accordingly. Please note that we do not request or require an underinsured settlement release pertaining to the settlement of your client's underinsured claim. Sincerely, L. Scott Whiteside Claim Representative 610 361 5780 State Farm Mutual Automobile Insurance Company 01/332/1147834