Loading...
HomeMy WebLinkAbout13-6887 U rAt HANDLER,HENNING&RoSENBERG,LLP Matthew P. Rosenberg (PA 201485) 1300 Linglestown Road, Suite 2 Harrisburg, PA 17110 Ph. 717.238.2000 Fax 717.233.3029 mrosenberg@hhrlaw.com Attorneys for Petitioners IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA JAIDYN STICKLER, a minor, by and through CIVIL ACTION—LAW her natural parents and guardians, HEATHER MINOR'S COMPROMIsti,, / J. SMITH and MATTHEW B. STICKLER, No.: b @7 Petitioners. PETITION FOR LEAVE TO COMPROMISE Pursuant to Pennsylvania Rule of Civil Procedure No. 2039, Heather J. Smith ("Ms. Smith") and Matthew B. Stickler ("Mr. Stickler"), the natural parents and legal guardians of a minor, Jaidyn Stickler ("Jaidyn"), by and through their attorneys, Handler, Henning & Rosenberg, LLP, petition this Honorable Court to enter an Order permitting settlement and compromise of this action, and in support thereof, aver as follows: I Jaidyn was born on January 23, 2006, and is therefore seven (7) years old and a minor. d4b VC Jaidyn was six(6)years old at the time of the incident. 0 3 12-w aq$�7 2. Ms. Smith is a competent adult individual and Jaidyn's natural parent and legal guardian, and she currently resides at 540 North Enola Drive, Enola, Cumberland County, Pennsylvania. 3. Mr. Stickler is a competent adult individual and Jaidyn's natural parent and legal guardian, and he currently resides at 188 Bordnersville Road, Jonestown, Lebanon County, Pennsylvania. 4. At all times material hereto, no custody or child support order involving Jaidyn has been entered by any court. 5. At all times material hereto, Jaidyn lived primarily with her mother, Ms. Smith, at 540 North Enola Drive, Enola, Cumberland County, Pennsylvania, and spends weekends with her father, Mr. Stickler. 6. On June 22, 2012, at approximately 3:02 p.m., Jaidyn was a passenger in a 2005 BMW M3 owned and operated by her father, Mr. Stickler, and bearing Pennsylvania registration number HCA3512 ("Petitioner's Vehicle"). Petitioner's Vehicle was traveling southbound on First Street, near the intersection with High Street, in East Pennsboro Township, Cumberland County, Pennsylvania. A true and correct copy of the Police Report is attached hereto as Exhibit "A." 7. At approximately the same time and place, Ja Kell L. Whitehead (the "Tortfeasor") was the owner and operator of a 2006 Chevy Malibu Maxx LT bearing Pennsylvania registration number HYP9743 (the "Tortfeasor's Vehicle"). The Tortfeasor's Vehicle was traveling northbound on First Street, near the intersection with High Street, in East Pennsboro Township, Cumberland County, Pennsylvania. 8. Suddenly, and without warning, the Tortfeasor's Vehicle veered to the southbound lanes of First Street and violently collided with the front of Petitioner's Vehicle. 2 9. As a direct and proximate result of the Tortfeasor's negligence, Jaidyn suffered personal injuries including, but not limited to, an abrasion from her right shoulder to her hip from the seatbelt, injuries to her back, and a laceration on her right leg that required stitches and resulted in scarring. A true and correct copy of a photograph showing Jaidyn's scarring is attached as Exhibit"B." 10. With the exception of the permanent scarring, Jaidyn has fully recovered from all of her injuries. A copy of correspondence from Jaidyn's treating physician, Dr. Zeliger, is attached hereto as Exhibit"C." 11. At all times material hereto, the Tortfeasor was insured under a liability insurance policy issued by USAA Casualty Insurance Company. The policy provided for $15,000.00 in bodily injury coverage. A copy of the Declaration of Coverage is attached hereto as Exhibit"D." 12. At all times material hereto, the Petitioner, Mr. Stickler, was insured under a liability insurance policy issued by Progressive Casualty Insurance Company. The policy provided for $15,000.00 in stacked Underinsured Motorist coverage. A copy of the Declaration of Coverage is attached hereto as Exhibit"E." 13. Following protracted negotiations, USAA Casualty Insurance Company offered to settle Jaidyn's liability claim in the amount of$15,000.00, representing the liability policy limits of said policy. A copy of the Proposed Settlement Agreement is attached hereto as Exhibit"F." 14. Petitioners believe said settlement is in Jaidyn's best interest and propose to accept the settlement offer from USAA Casualty Insurance Company of $15,000.00, thereby releasing USAA Casualty Insurance Company and the Tortfeasor from any and all liability claims arising out the aforementioned collision. 3 15. Following protracted negotiations, Progressive Casualty Insurance Company offered to settle Jaidyn's Underinsured Motorist claim in the amount of$8,000.00. A copy of the Proposed Settlement Agreement is attached hereto as Exhibit"G." 16. Petitioners believe said settlement is in Jaidyn's best interest and propose to accept the settlement offer from Progressive Casualty Insurance Company of$8,000.00, thereby releasing Progressive Insurance Company from any and all Underinsured Motorist claims arising out of the aforementioned collision. 17. Counsel is of the opinion that said settlements, equaling $23,000.00, are in the best interests of Jaidyn. 18. Matthew P. Rosenberg, Esq., of Handler, Henning & Rosenberg, LLP, has been the attorney of record for Jaidyn and requests reasonable counsel fees of$5,750.00 for services rendered plus costs and expenses of$226.36 pursuant to a Contingent Fee Agreement signed by Petitioners. The 25% fee represents a reduction from the firm's standard 33-1/3% fee. Copies of the Contingent Fee Agreement and Billing Summary are attached hereto and marked as Exhibit "H" and"I," respectively. WHEREFORE, Petitioners respectfully request this Honorable Court to: a. Approve the above-stated compromise; b. Authorize the payment of the above-stated fees and costs from funds due to the minor; and 4 C. Direct payment of the net funds due in accordance with the above- stated Compromise. Respectfully submitted, HANDLER,HENNING&ROSENBERG,LLP Date: Nov. , 2013 By: Mathew P Rosenberg (P 201485) 1300 Linglestown R d, Suite 2 Harrisburg, PA 17 0 Ph. 717.23 8.200 Fax 717.233.30 29 Attorneys for petitioners 5 r A Print CRS W0285687 Page 1 of 7 COMMO"EALTH OF POLL CRASH REPORTING FORM i IIIIIII VIII VIII IIII IIII Gash Number Case Closed Reportable Crash AA SW 1 •Yes ONO a Yes O No 1 W0285687 Incident Number Police en - Patrol Zone 20120600486 21101 002 Name Precinct Invests anon Date(MM-DD-YYYY) I East Pennsboro Township 06 - 22 - 2012 DkpatchTime(mr� Arrival Time(mlo Invests ator Badge Number _$ 1508 1509 PTLM.KEITH MORRIS 1612 Reviewer Bad a Number Approval Date (MM-DD-YYYY) SGT. STUART A SPENCER 1603 I F:]_ 23 - 12012 County County Name Municipal Municipality Name Day of Week a 21 Cumberland 1101 rast Pennsboro Township --� (:)Sun O Thu §� Crash Date(MM-DD-YYYY) Crash Time(mill No of units Peo le Injured Killed* elf>00 O Mon 0 Fri A complete O Tue Q Sat 06 - 22 - 2012 1502 2 3 3 0 Fora,F O wed Q Unk workzone rm MCSeRon 29J Q Yes W No Related us O Yes i♦No Related�e O Yes 0 No o�'E OTQ Yes 0 No O 4 Way Intersection O 'Y'intersection O Multi-Leg O Off Ram ' Intersection p O Railroad Crossing BBL Y Q Midblock ® "T"intersection O Traffic Circlet O On Ram er 00 7 Round About P O Crossover Q Other •$me Q7verle Route Number Segment(Optional) Travel lanes S k t= North F House Number Of applicable) 1019 J 35 0 O South s a Street Name Street Ending 1 O East For Mid-block crashes only.Use FIRST ST z O West postal House Number and make sure e O O Unknown Principal Roadway Street Name is t filed in if using this option e. Route Interstate Turnpike Turnpike State County Local Road Private Other/ swn O Mot Tum ike) O (EastlWest) Q Spur Q Highway O Road or Street O Road O Unknown Route NI merit(Optionaq Travel es S k O South S � 02 25 i0l e treet Name Street Ending O East I HIGH 0 West I ¢ ST O Unknown ,� Interstate Turnpike Turnpike State County ocal Road Private Other/ $ Signing O (Not Turnpike) 0 (EasUWest) O Spur O Highway O Road Ty or Street O Road O Unknown InfersectiF_eg Rt�Num Or Mile ❑ Or merit Marker c 0 O North Feet (�South L�jEnter Or Irrtersecti Street Name SL Endin O East lid--���Jlj Or Miles O West s TH arks Iritersecting Rt Num Or Mile Post Or M Marker g c Distance From Crash Q North ption �I O South Scene to Landmark 1 Or:httersectin Street Name St Ending (For Crash between c Q East Landmark f and O West Landmark 2) r latitude: Degrees �Minutes Seconds .� Longitude: — Degrees Minutes Seconds TrafiSk CanOW revile O Yield Sign Q Police Officer or r 0 Not Applicable O Traffic Signal O Active RR Crossing O Hagman ter T 7CD No Contro ls O Device Functioning O Emergency ice r° Flashing Traffic Controls Improperly Signal Signal 0 Stop Sign O Passive RR O Unknown Q Device Not O Device Functioning O Unknown Crossing Controls Functioning Property Lang Owed(if"Not Applicable,skip rest of the Lane Unsure section) Lane O North O East O North and South Q All O Not Applicable ®Partially O Fully O Unknown Q&II192ba South O West O East and West (N,S,E,W) Yes 0 No Q Ed r'IlLol(;sd Unknown:Q O<30 Min. 30 60 Min. Q 1-3 hrs O 3-6 hrs Q 6-9 hrs Q>9 hours Q Unknown FORM I AA-W(ts+eel PENNOOT COPY http://www.dot6.state.pa.us/crsapp/Printlmages/XmiFiles/20120623382012062307374537. • tl l Print CRS W0285687 Page 2 of 7 J �C®CRASH RE11 NING PORM NIA �I II�I�IBIII�I��Page: Gash Number AA 50012 r°''!ux°nh' 2 W0285687 a Motor Vehide in O t Run Vehicle rove Transport Hi & 0 Illegally Parked O Legally Parked Q Non-Motorized Commercial Vehide no unit O Pedestrian O Pedestrian on Skates,O Disabled From O Train O Phantom Vehicle O Yes ft No in Wheelchair,etc Previous Crash (If Yes,Complete Form Q Of'Pedestrian'or'Pedestrian on Skates,in Wheelchair,etc',Com lete Form M,Section 18 Unit No First Name MI Date of Birth(MM-DD-rrM O1 I JAKELL L� 07 30 1993 Delete? last Name Talo hone Number Q 1 WHITEHEAD 7175642290 rill Address/Cl /State Zi 7063 BEAVER SPRING RD HARRISBURG PA 17111 Driver license Number State Class 30156432 PA AkohoWtuirs SuspecEed Driver or PedesWan Physical Condition 'r 0 No Q Illegal Drugs Q Medication a Apparently Illegal Drug gg Normal Q Use Q Fatigue Q Medication O Alcohol O Alcohol and Drugs O Unknown Had Been Q Dunkin O Sick Q Asleep Q Unknown Alcohol Test Tvpa g Test Not Given Q Breath O Other Primary Vehk/e Code Violation Charged? y O Blood O Urine O Unknown if VEHICLES TURNING LEFT •Yes O No Test Given Alcoho/Test Results O Test Refused O Unknown Driver Presence 1=Driver Operated 3=Driver Fled Scene Results 0 Q a n Test Given, 1 Vehicle and Run Contaminated Results 2=No Driver 9=Uknown Owne#Ddver 00--Not Applicable 02=Private Vehide Not 04=State Police Vehicle 07=Munidpal Police Veh 09=Federal Gov Veh 01-Private Vehide Owned/ OwnedAeased by Driver 05=PENNDOT Vehide 08=Other Municipal 98-Other O1 Leased by Driver 03-Rented Vehide 06=Other State Gov Veh Government Vehide 99-Unknown Some as Owner First Name Owner Last Name or Business Name(if Pedestrian,skip this Section) Driver O JAKELL LYNETTE WHITEHEAD Address/C /State)Zip Vehide Make *Make Code 7063 BEAVER SPRING ROAD HARRISBURG PA 17111 Chevrolet 20 VIN Model Year Vehide Model (see overlay) 1GIZT61876FI58940 12006 SDN License Plate Reg.State Est Speed Vehide Towed Towed By HYP9743 PA 999 •Yes Q No MAGARO'S r Insurance Company Polky No a Yes O No O known USAA 021103062071012 nz T 1=Towing Pass.Veh 4--Mobile/modular Home 7=Semi-Trailer Tag No Tag Year Tag St MILO'TrN ailiing a a 2-Towing Truck 5�amper B=Other r ,! Units: 3-Towing Utility Trailer 6 full Trailer 9=Unknown U Direction of N •VehWe Position 07 *Movement 12 *See Special Usage Overlay Vehide Color Vehide Type 05-Large Truck 20-Unicycle,Bicycle, 00 12=Commercial 06-Yelkny 01=Automobile 06=SUV Tricycle Passenger 07 07=Silver Ol 02=Motor a 07=Van 21=Other Pecialcyde OO-lot Applicable Carrier � 01-Fire Veh 13=Taxi 08--Gold 03=Bus 10=Snowmobile 22=Horse&Buggy 02-Ambulance 21=Tractor Trailer 01=81ue 09--Brown 04--Small Truck 11=Faun Equip 23=Horse&Rider 03--Police 22=Twin Trailer 02=Red 10=Orange Of"02',Complete Form 12--Construction Equip 24--Train 08=Other Emergency 23-Triple Trailer 03=White 11=Purple M,Section 26) 13-ATV 25=Trolley Vehicle 31-Modified Veh 04--Green 12=Other Of 120'or'2l',Complete 18=Other Type Spec Veh 98=Other 11 Pupil Transport 99-Unknown 05--Black 99--Unknown rbrm M Section 27 19=Unk.Type Spec Veh 99--Unknown initial Impact Point • Damage Indicator Gradient 3=Downhill Road Alignment 00-Non-Collision I"ndercarriage O=None 2:Functional 4-Bottom of Hill 1-Straight F0-I -] 01.12=Clock Points 15=Towed Unit 1=Minor 3=Disabling 1=�i S=Top of Hr11 � 2=Curved 13-Top' 99--Unknown 9=Unknown 2=Uphill 9=Unknown 9=Unknown Forcer r AA,&W t12M1 PENNDOT COPY http://www.dot6.state.pa.us/crsapp/Printlmages/Xm1Fi les/20120623 3 82012062219264026... 6/22/2012 Print CRS W0285687 Page 3 of 7 J COMMOKYRALTH OF R1B� ICE CRASH REPORTING FORM F �I IIIII�I�Il Gash Number Page: AA 500 2 1 Pc ice Use Only =. W0285687 Motor Vehicle in O H R&Run Vehicle Q Illegally Parked Legally Parked Non-Motorized Transport Commercial Vshk/e 10 -V Unit O Pedestrian 0 Pedestrian on Skates,O Disabled From Q Train O Phantom Vehicle Q Yes M No in Wheelchair,etc Previous Crash (if'Pedestrian'or'Pedestrian on Skates,in wheelchair,etc' Com lete Form M,Section 28) (If Ye;Complete Form q Unit No First Name MI Date of Birth(MM-OD-YYYY) 02 MATTHEW B❑ O1 23 1976 Delete? Lost Name Tale hone Number Q STICKLER 999999999 Addres I/State. Zi 188 BORDNERSVILLE RD JONESTOWN PA 17038 Drhrer Ucense Number State Gass 23812172 PA g Alcvho0ruos Suspected Driver or Pedestrian Physical Condition 11 II No Q Illegal Drugs Q Medication arelntly Q lUegal Drug Q Fatigue Q Medication 4i Q Alcohol Q Alcohol and Drugs O Unknown Had Been s� O Drinkin 0 Sick 0 Asleep 0 Unknown Akohol Test Type $ a Test Not Given Q Breath O Other Primary Vehicle Code Violation Charged? Z Q Blood Q Urine Q Unn d O Yes 0 No Test Given Alcohol Test Results 0 Test Refused 0 Unknown Driver Presence 1=Driver Operated 3-Driver Fled Scene Resuks ❑ O lest Given, 1 Vehicle 4=Hk and Run Contaminated Results 2=No Driver 9--Unknown Owner/Driver 00--Not Applicable 02-Private Vehicle Not 04=State Police Vehicle 07-Municipal Police Veh 09=Federal Gov Veh O1 O1-Private Vehicle Owned/ Owned/Leased by Driver 05=PENNDOT Vehicle 08-Other Municipal 98-Other Leased by Driver 03-Rented Vehicle 06=Other State Gov Veh , Government Vehicle 99=Unknown Same as Owner First Name Owner last Name or Business Name(if Pedestrian,skip this Section) Dn'r�O I MATTHEW B STICKLER Address/City IF State/Zip Vehicle Make *Make Code 188 BORDNERSVILLE RD JONESTOWN PA 17038 BMW 34 VIN Model Year Vehicle Model (see overlay) WBSBL93455PN62194 112005 CP license Plate Reg.State Est Speed Vehicle Towed Towed By HCA3512 PA 999 •Yes O No I MAGARO'S TOWING Insurance Insurance Company Polity No Yes O No O kin PROGRESSIVE INS 75091441-9 12 frallin 1=Towing Pass,Veh 4=Mobile/Modular Home 7=Semi-Trailer Tag No Tag Year Tag St Unit No;in a Q 2=Towing Truck S=camper 8-Other Unit g 0 3=Towing Utility Trailer 6=Full Trailer 9=Unknown D� •Vehide Position 01 •R9ovement 01 overlay Special usage FS] Vehicle Color Vehide Type OS=Large Truck 20=Unityde,Bityde, 00 12=Commercial 06-Yeilovi 01=Automobile 06=SW Tricycle Passenger 03 07=Silver: O1 02=Motorcycle 07=van 21=Other Pedalcycle 0 = Applicable Carrier 08--Gold 03=8us 10-Snowmobile 22-Horse&Buggy 01=Fre re Veh 13=Taxi 01--Blue 09=Brown 04=Small Truck 11=Farm Equip 23=Hone&Rider 02=Ambulance 21=Tractor Trailer 02=Red 10=Orange (If.02"Complete Form 12--Construction Equip 24=Train 03=Police 22=Twin Trailer 03=White i 1�urple M,Section 26) 13-ATV 25=Trolley 08=Other Emergency 23=Triple Trailer 04--Green 12-Other (If'20"or'21 ,Complete 18-Other Type Spec Veh 98-Other 11:PupilcTransport 99=Un�knfownV� 05=81ack 99=Unknown Form M Section 27) 19=Unk.Type Spec Veh 99=Unknown Initial Imoad Point Damage Indicator Gradient 3-Downhill Road Allanment 00-Non-Collision 14=Undercania a 0-None 2=Functional 4-Bottom of Hill 1=Straight 11 011-112-Clock Points 1S=Towed Unit a 1■Minor 3-Disabling E]1=L� 5-To of Hill 0 2--Curved 113-Top 99-Unknown 9-Unknown 2=Uphill 9=Unknown 9=Unknown FORM S AA-M(12M) PE:NNDOT COPY http://www.dot6.sta te.pa.us/crsapp/PrintImages/XmIFiles/20120623 3 82012062219264026... 6/22/2012 Print CRS W0295687 Page 4 of 7 JCOMMONWEALTH OF PENNSYLVANIA POLICE CRASH REPORTING FORM AA 500 3 ' "u%Only P40 Gash Number W0285687 TY1lE: Seat Pnsirion: t[inment One: A 1=Driver � 00=Not A PassengedOccupant E 00= one Used/Not Applicable C7 0 Applicable 2=Passenger 01 Driver-All Vehicles 01=Shoulder Belt Used 1=Not Ejected 7=Pedestrian 02 Front Seat Middle Position 02-Lap Belt Used 2=TotalF/Ejected 8--Other 03=front Seat Right Side 03=1sp And Shoulder Belt Used 3-Partially Ejected 9--Unknown 04--Second Row-Left Side Or 04=Child Safety Seat Used 9=Unknown Motorcycle Passenger 05=Motorcycle Helmet Used 05=Second Row-Middle Position 06=Biccyyde Helmet Used F/ection Path: I I 06-Second Row-Right Side 10-Safety Belt Used Improperly B F -Female 07-Third Row Or Greater- 11-Child Safety Seat Used Improperly 0-Not Ejected/Not Applicable M=Male Left Side 12=Helmet Used Improperly 1=Through Side Door Opening U-Unknown 08--Third Row Or Greater- 90=Restraint Used,Type Unknown 2=Through Side Window Middle Position 99 Unknown 3-Through Windshield 09-Third Row Or Greater• 5 mro gh Back Door Right Side Eyit Two: gh Back Door Tailgate Opening 4W S�eix 10=Sleeper Section of Trudccab F 0 one sed/No1 Applicable 6=Through Roof Opening(Sunroof/ g C 0=Not Injured 11 in Other Enclosed 01-Front Air Bag Deployed(For This Seat) Convertible Top Down) 1-Killed Passenger Or Cargo Area 02=Side Air Bag Deployed(For This Seat) 7=Through Roof Opening(Convertible 2=Major Injury 12-In Open Area 03--Other Type Air Bag Deployed Top Up) 3-Moderate (Bads Of Pickup,Etc.) 04--Multiple Air Bags Deployed 9=Unknown Rliury 13=Trailing Unit 05=Motorcycle Eye Protection 4-rNinor Injury 4--Riding On Vehicle Exterior 06-Bicyclist Wearing Elbow/Knee/Pads 8-Injury,Unk 15--Bus Passenger 1O=Air Bag Not Deployed,Switch On I Applicable Severity 98-Other 111-Air Bag Not Deployed,Switch Off 1=Not Extricated 9=Unknown if .99--Unknown 12=Air Bag Not Deployed, 2-Extricated By Mechanical Means injury Unk Switch Setting 3=Freed By Non-Mechanical Means 13=Air Bag Removed(Prior To Crash) 8-Other 19=Unknown H Air Bag Deployed 9-Unknown 99-Unknown 13 EMS Agency:I EAST PENNSBORO AND W Medical Facility HARRISBURG HOSPITAL/HERSHEY MEDI Unit No Person No Delete? Date of Birth (MM-DD-YYYY) A B C D E F G H I t4 O 1 O 1 O 07 - 30 - 1993 1[I F❑a O 1 03 O 1 a s❑ Name/Address/Phone EMS Transport ❑Same" WHITEHEAD,JAKELL L 7063 BEAVER SPRING RD HARRISBURG PA Yes O No Unit No Person No Date of Birth (MM-DD-YYYY) A B C D E F G H I Delete?02 O1 O O1 - 23 - 1976 1❑ I ] O1 03 01 U 0❑ la Name/Address/Phone EMS Transport Sam perattoor STICKLER,MATTHEW B 188 BORDNERSVILLE RD JONESTOWN PA 17 0 Yes O No Unit No Person No ���? Date of BI MM-DD-YYYY) A B C D E F G H 02 K:1 O O1 - 23 - 2006 LI F❑ ] 06 03 00 EI F Name/Address/Phone EMS Transport El Operator r STICKLER,JAIDYN 188 BORDNERSVILLE RD JONESTOWN PA 17038 ft Yes O No Unit No Person No Date of Birth (MM-DD-YYYY) A B C D E F G H I D D 000=1 L HLJL Name/Address/Phone EMS Transport ❑Same as Operator O Yes No Unit= Person� DC) D� ❑❑❑ 00F] Name/Address/Phone EMS Transport Same as Operator O Yes ON. Unk No Person No Date of Birth (MM•DD-YYYY) A B C D E F G H I 0 0 0 7 0-o-c�ooac�ooao❑ Name/Address/Phone EMS Transport ❑Same as Operator O Yes Q No Fora"r AA4W(12M) PENNDOT COPY http://www.dot6.state.pa.us/crsapp/Printlmages/XmIFiles/20120623 3 82012062219264026... 6/22/2012 Print CRS W0285687 Page 5 of 7 JCOMMONWEALTH OF PENNSYLVANIA POLICE CRASH REPORTING FORM Page Crash Number AA 500 4 rr ux°ny W0285687 Cash Desedodon 0=Non-CoBislon 2--Head On 4--Angle 6 Sldeswtte S=lit Pedestrian 1=Rear End 3-Ft to Rear 6 (Opposite Direction) (Backing) Same kwion) 7--HR Fixed Object 9=0therlUnknown € Relation to Roam= El 1=On Travel Lanes 3=Medlan SzOutside Trafficway 7-Gors(Ramp Intersection) s 0 2-Shoulder 4=Roadside 6=ln Parking Lane 9--Unknown is 2 Illumination -- 1--DDaylightt 3=Dark•Street S=pDawn 8-Other ---- ---- ry � 2 SM 1aet Lights 4=_Du_5k _ 6=RaadweU Light Weather Conditions - - °A t 3-Sleet(Hall) 5--Fog 7=81set S Fog --9--Unknown--- -� " 2=Rain _ 4=Snow _B=Rain 8.Fog - 8-Other Road Surface Condition -- O. -2=81nd,Mud,Dirt, 4--Slush Ice Patches 8-Othar_� s 0 �' El 1=Wet 3--Snow Covered 5--Ice 7=Wiarr--nSgtanding or Harm vent 1 R Most? UM tl—y o�Te Number Harmful Events!Harm Even- 30--Hit Fence Or Wall i 02 ❑ 01-Hit Unit 1 31-Hit Building Unit No 02-Hit Unit 2 32=Hit Culvert O03—Hit Unit 3 33=Hit Bridge Pier Or Abutment 04=Hit Unit 4 34=Hh Parapet End 05=Hit Unit 5 35-Hh Bridge Rail 06-Hit Other Traffic Unit 36-Hit Boulder Or Obstacle Please Put 07--Hit Deer On Roadway Events in 3 ❑ 08=Hit Other Animal 37=Hft Impact Aftenuator E nt s in 09=Collision With Other Non 38-Hit Fire Hydrant �j r 4 ❑ O Fixed Object 39- -Hit Roadway Equipment 11=5tnrck 6 Unit 1 40-Hit Mail Box 12=Struck By Unit 2 41-Hit Traffic!eland 16 13--Struck By Unit 3 42=Hit Snow Bank S Hann Event 1/R Most? Utility Pole Number 1441ruck By Unit 4 43=Hit Temporary Construction 15=Struck B Unit S Bartier Z 1 11 O n F 16=Struck 8y Other bberK Unit 48=Hit Other Fixed Object �i Unit No 21-Hit Tree Or Shrubbery 49--Hit Unknown Fixed Object W 22=Hit Embankment 50=0verturNRoll Over M 0 "=Hit Utility Pole 51-Struck By Thrown Or Falling 02 2 if �s 24-Hit Tra is Sign Object 25-Hit Guard Rail 52-Pot Holes Or Other Please Put 26=Hit Guard Rail End Pavement Irregularities Events In 3 ❑ �— 27=Hit Curb 5 - ife Sequential 28=Hft Concrete Or 54-Are fire I n Vehicle Order 9=Hto 58=0ther Non-Collision i u 4 O 2 ch 99-Unknown Harmful Event First Unit No Harm Event Most Unit No Hann Evant Driver Action(D) 17-Careless Or Illegal n an^ 1 rimfui 01=No Contributing Action Backing On Roadway vent n O1 02 ven un O1 02 01=Driver Was Distracted 18--Drivi On The Wrong �e Z'ash 02=Driving Using Hand Held Phone Side Road Oo nok repeat th6 N+torngpen an ftmple pno 03=Driving Using Hands Free Phone 19-Making Improper EnvironmenW Roadway 04--Making Illegal U-Turn Entrance To Highway 1 O 1 2 3 05dmproper/Careless Turning 20--Making Improper Exit Potential Factors Me) 06-Tuming From Wrong Lane From Highway 00-None 11=Sli pery Road Conditions(Ice/Snow) 07=Proceeding W/0 21=Careless ParkmglUnparking 01-Windy Conditions + 12=Substance On R Clearance After Stop 22=ComNn sat ^dY Roadway 08--Running Stop Sign Compensation At Curve 02=Sudden Weather Conditions 13-Potholes 09dtunninq Red Ught 23=Speeding 03-Other Weather Conditions 14--Broken Or Cracked Pavement t0=failure To Respond To 24=Dmnrg Too Fast For Conditions 04--Deer In Roadway 1 S=TCD Obstructed Other Traffic Control Device 25=failure 7o Maintain Proper Speed 05=Obstacle On Roadway 16=Soft Shoulder Or Shoulder Drop Off 11=Tailgatingg 06=Other Animal In Roadway 28-Otter Roadway Factor 12=Sudden Slowinn5to ing 26=Drivel Fleeing Police(Pot Chase) 1e 07-Glare 29=Odvr Environmental Factor 13 Illegally Stopped On Road 27=Ddm Inexperienced 08-Work Zone Related 99--Unknown 14-Careless Passing Or lane 92�Aff rre To Use Physical Specialized Equip Change 92�Lftected By Physical Conditwn 98=0ther Improper Driving ctions Possible Vehicle Falhires M 12=Wipers 15=Passing In No Passing Zone 99�Jnknow g 00--None 06-Exhaust 13=Driver Seating/Control 16_-Driving The Wrong Way On 01=Tires 07-Headliyhts 14=g�y Doors,Hood,Etc 1-Way Street LF 02-Brake System OB=Siggnal lights 16--Whfee Hitch Unit 03=Steering System 09=Other lights 16--Wheels O1 1 02 2 OS 3 4 a 04-Suspension 17--Airbags s Porn l ldvirrors 18=TrailerOverloaded 19=T rasecr Load ifted Unit Unit� Trailer Load No 02 1 00 2 3 4 � O 1 t 00 I 20--Improper Towing 2 -Obstructed Windshield Pedestrian Action fP1 03=Working Unit 02 00 99-Unknown 00-None 04--Pushing Vehicle No t 3 1 01-Entering Or Crossing At 05=Approaching Or leaving Vehicle I+ Speclrred Location 06--Working On Vehicle hrdiated Prhne Factor Unit No Factor Code 02=Walking,Running,logging, 07-Standing 0o na spear this hfomwdcwn on Or Playing 98=Other ra muhplepeges. O1 OS 99=Unknown E/R V O P 0 00 0 If f!R is the Prime factor Unit No O 1 Unit No 02 Type,leave Unit No blank sonwtAA-soo(I=) -- - - PENNDOT COPY `- - --- http://www.dot6.state.pa.us/ersapp/PrintImages/XinIFiles/201206233 82012062219264026... 6/22/2012 Print CRS W0285687 Page 6 of 7 COMMONWEALTH OF PENNSYLVANIA POLICE CRASH REPORTING FORM Page Crash Number AA 500 5 W0285687 r .......... ..................... .... ......... .......... . .......... ......................... ........... T i .......... ......... ... i -i........... ......... .................. ........ ............ ........... .......... .................. .......................... ................... ...... .......... .......... ...................A............... .......... .......... .......... .............. ...................................... ..........------- .......... ...._I_........................................................... ........................... .......... ........... J.........i ........... --------.............................. ........... ................. ... ........... .................... ........ ....................................... ............ i "...: t..................... .......... .................... ................................................. ............................................................. .................. ................... .......... ....... ......... ........... .......... ....... ........... ................ .......................4................................................................................ .......... ...... .......... ............ .......... ................... ......... ...................................................... ................... .......... ........... .......... .......... .......... ........... J...........1 ................... ...... .......... ........... .......... .............................. ......................................................... ..........; t ........... ................................... .....................1---.1 -4................... .......... ................. .................................. r ....................... ........... ...............................1.................... Witness Name Address Phone 1 ERIC WICKENS 1455 ARMITAGE WAY MECHANICSBLJRG PA 1 7173953199 2 Narrative and additional witnesses: Aeddent Investigation Notifkation Issued?0 Property Damage 0 Unit#1 was travelling north on Frist Street. Unit#2 was travelling south on First Street. Unit#1 tumed left directly into the path of unit#2 resulting in the two vehicle striking almost head on. Witnessess observed driver of unit#1 using a hand held cell phone while driving and turning left directly in the path of unit#2.Witness also observed driver exit her vehicle after the accident still on her cell phone. All persons were transported to local hospital for injuries suffered at the scene.all vehicles were towed to magaro's towing(705 Tower Road,Enola PA 17025 717-732-6969). t: • FORM 4"-M(I=* PENNOOT COPY http://www.dot6.state.pa.us/crsapp/Printlmages/XmIFiles/20120623382012062219264026... 6/22/2012 5 r Print CRS W0285687 Page 7 of 7 Crash Number:W0285687 Incident Number:201-20600486 -n to High Street -�� r 1Nitness y v �y Exit from Penndot Property �ntt r http://www.dot6.state.pa.us/crsapp/PrintImages/Xm1Fil es/20120623 3 82012062219264026... 6/22/2012 �; �c . `.°� .� . , CONSERVATIVE ORTHOPEDICS 845 Sir Thomas Court • • • BERNARD 1. ZELIGER, U.O. Harrisburg, FACOS, FAOAO, FICS Phone: (717)) 545-7100 17109 Fax: (717) 545-8100 July 10,2012 Matthew Rosenberg, Esq. Handler,Henning,and Rosenberg 1500 Linglestown Road Harrisburg,Penna.17302 RE: JAIDYN STICKLER Dear Attorney Rosenberg: I had the opportunity to examine Jaldyn Stickler in the office on this date at which time this six year old (D.D.S. 1-23-2006)was complaining of pain and disability referable to her neck and thoracic spine.She had an abrasion across her chest from the right shoulder to the left side of her pelvis,and a scar in her right inguinal area which was transverse in position.She was brought to this of0ce by her grandparents, Mr.and Mrs.John Kambic.At the request of the parents and grandparents,I am sending you this letter. Jaldyn was involved in a motor vehicle accident on June 22,2012 at approximately 3:30 P.M. on a dry, sunny day.Her father was driving the car and another vehicle came across from the opposite side, crossed the double yellow line,and hit them head on.This 6 year old beautiful young lady says that she was shocked by what happened,and that it completely"knocked the wind out of me".She was very upset.She was taken from the scene by ambulance to the Hershey Medical Center where she was examined in the E.R.,and they gave her some kind of an Injection which the grandparents think was Morphine,and they then repaired the laceration in the right inguinal area.This laceration measured 5 cm.in length,and was approximately 1"below the crease in the right groin and parallel to the crease. At the present time it is healing very nicely and shows significant healing.She is still very tender in this area,and the area remains red(hyperemic)in color.She has discomfort throughout the inguinal area, but notes that it is getting better.She has palpatory tenderness throughout the thoracic spine,and the lower cervical area,and says that the pain is slowly subsiding in this area.She has a full and complete range of painless motion of the cervical,thoracic,and lumbar spine.The upper and lower extremities are all within normal limits as far as motion goes and strength.She has no complaints referable to her arms or legs at this interval.She has an area of healing abrasion going from the right anterior shoulder down to just below the ribs on the left where the seatbelt cut Into her chest. During the course of this examination every time I mention the accident or asked questions about the accident this child covered her ears because she did not want to hear anything,and was very upset every time it was mentioned. It is noted that she:did not have any x-rays done at the Hershey Medical Center or at least no one is aware that any x-rays were done. If you are aware of any x-rays, I would like to see them. Page 2 RE: Jaidyn Stickler Allergies,medications, past medical,surgical,family and social history were all reviewed and recorded on the chart as per the patient questionnaire.All other systems were reviewed and are as recorded on the chart.Any changes are as recorded on the chart.She has no history of allergies and her immunizations are up to date.She does not take any medications on a regular basis.She had an episode of painful urination—but not presently.She has tubes in her ears from ear Infections.Otherwise the Review of Systems Is entirely within normal limits. Insofar as surgeries are concerned,she had placement of tubes in her ears,and had general anesthesia for that purpose,and repair of the right inguinal laceration. Her father is living at age 36 in fair health,and her mother is 29 and in good health. Her parents are separated.She has no brothers or sisters. She has no history of substance abuse,no smoking,no alcoholic. The patient is pleasant,awake,alert,and oriented X 3 in no acute distress. Respirations are within normal limits.Eyes exhibit normal tracking.There is no evidence of swelling,and there are no rashes. She weighs 52 lbs.,46"tall,and her pulse is 66. The right inguinal scar is healing well,and I will not do anything further to that area. Insofar as the pain in her thoracic and cervical spine,hopefully that will subside.Since the pain Is getting better 1 hesitated ordering x-rays,and I feel that she just has a sprain and strain of the cervical and thoracic spine which probably will subside with time.She likes to swim,and I suggested that she swim and do a lot of exercises In that regard to help relieve her pain.The abrasion over the anterior chest will also heal with time and I do not believe will leave a permanent scar,although the right inguinal area is a permanent scar.- Medications regarding the patients problems were discussed and recommendations were made. If the pain does not subside in one month or if it worsens, I would like to recheck her in one month and we will do further testing at that time. Should you have any further questions,kindly feel free to contact me. Sincerely yours, Bernar D.O. BIZ/caj USAA CASUALTY INSURANCE COMPANY ADDL INFO ON NEXT PAGE MAIL MCH-M-S NEW (A Slak Imnavaoa Company) 9be O1 -- FOLICYM1Mr9i V ` 9800 Fredencksburg Road-San Antonio,Texas 78288 A 7 - m,. 02110 30 620 7101 2 PENNSYLVANIA AUTO POLICY FERIM -(12: 7 A.M.standard tome) DECLARATIONS FROM FEB 24 20' TO AUG 24 2012 OPERATORS Named Insured and Address 01 JA KELL L WHITEHEAD JA KELL L WHITEHEAD Description of Vehicle(s) \81 YEAN TPAOENAME MOM BODY7YPE SYM 1Sm 01 06 CHEV MALBU MAX LT HCHEK 4D 12000 1G1ZT61876F15S940 P The ehide(s)dascrib herein is principally garaged at the above address un ass otherwise"bated. w' m RPmao' VEH 01 HARRISBURG PA 17111-4796 IS O C ProVl a5 osa eovefa e where a premlum is s own OW. limit 5 a 0 n In �ie t clucped y po 4c provlsio s agn� may ,not'be oomkrne i,,%ard @$a o e splumber of vevicles for wrlleh a pram myin Is listellunless s ecificall au—thonaed al cc here In this allc . COVERAGES LIMITS OF LIABILITY Aso ryry11����y77 EH V VEH ("ACV"MEANS ACTUAL GASH VALUE) SlfE06 PREMMN 0=0E0 FWAll!rA D=06D PREMIUM D=DEDJ PREMIUM AMOUN $ OUN $ —Wow $ kMouR7 $ PART A - LIABILITY BODILY INJURY EA PER $ 15100 EA ACC $ 30, 00 PROPERTY DAMAGE EA ACC $ 10100 PART B - FIRST PARTY BENEFITS MEDICAL EXPENSE $ 5, 000 PART C - UNINSURED MOTORISTS STACKED BODILY INJURY EA PER $ 15, 001. EA ACC $ 30, 00 PART C - UNDERINSURED MOTORISTS STACKED BODILY INJURY EA PER $ 15,00 EA ACC $ 30, 00 PART D - PHYSICAL DAMAGE COVERAGE COMPREHENSIVE LOSS ACV LESS D 50 COLLISION LOSS ACV LESS 50 RENTAL REIMBURSEMENT $ 30 A DAY/$ 900 MAXI TOWING AND LABOR TOTAL PREMIUM - SEE FOLLOWING PACE(S) ENDORSEMENTS: A089 (04) A099 (01) ACCFOR(01) 5100PA(01:) INFORMATON FORMS:7APA(06) 86356 (01) PAFRD(Ql)(60DPA(00 663PA(04' (0 r 999PA(19) (05 03) 9991"AL(02) 1fi0 PAlO1 - 1 of RSFIB o0 0 its s 1 s n w0 ve caul is po Iry, ign y our msi am an acre ary at an tonic, exas, On this date F3aRUARy 3, 2012 Stem 116004 elxe* Stuart PerkeT- President 9000 C 07.11 -- -- 3N $3303-0}-01 Z0/Z0 3SVd TSS0861,0TZ ES,8 03/21/2013 10:53 FAX 412 702 9231 PROGRESSIVE CAS INS CO [a 002 KRI INSURANCE PO PR99ALTIff HERSSHEY,HU,P PA 17033 La fflw&w� Policy Number: 75091641-9 Uneenvntten by: Proquiaive northern r6uraRp Co MATTHEW B STICKLER April 26,7012 118 90RDNERSVILLE I Policy Period: Jun 3,2012-Dec,3,2012 IONESTOWN,PA 12038 Pagel of 3 1-717.533.2166 Me INSURANCE Conrad your agent for petmralard service, Auto Insurance p oOnline ea9errl.mm Online Service Coverage Summary Make paymer�,rhed filling activity,update policy information or clerk cralus cf a claim. This is your Renewal 1400-2744499 To report a Cairn. Declarations Page The covem9es,limits and policy period shown apply only it you pay for this policy to renew. Your coverage begins on June 3,701 Z at 12:01 a.m. This policy expires on December 3.2012 at 12:01 a.m. Your insurance policy and any policy endorsements conson a full explanation of your overage, The policy contacts form 9610A PA(05!06). The Connect is modified byforms Z445 PA(03/07)and Z538(10/08). COLLISION COVERAGE FOR RENTAL VEHICLES IF THIS POLICY PROVIDES COLLISION COVERAGE,IT WILL APPLY TO VEHICLES YOU RENT, BUT NOT TO VEHICLES�RENTED FOR b MONTHS OR MORE. FRAUD NOTICE Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or Conceals for the purpose of misleading, information Concerning any fact material thereto commits a fraudulent insurance act which is a crime and subjects suds person m Oiminal and civil penal9es. Underwriting Company Progressive Northern Insurance CD P.O.Box 6807 Cleveland,OH 44101 1-800.876'5581 Drivers and household residents 91 daal;�,�nlm . BSl .. ._ ..__., .........._ ... MATTHEW BSTI0IER Frst Named insured .. . ... .... . ..-- rem 602 PA onto 0]121/2013 10:39 FAI 412 702 9231 PROGRESSIVE CAS INS CO X003 Pdicy Num6ec 75091441-9 tACiEHEWB$nCKIER Paget df 3 Outline of coverage 2005 BMW M3 CP NN WBSBL93455PN62194 Primary use of the vehide: Pleasure Llmla peEomhM Rim, t;abilmToadaa $Its Bodily lnury Jabiltty SSOi each peooNS100,000 each accident Property Damage liability $25,000 each accident ...................................... ............................... �....._..................,.................................... .........._.......,.,..4 .11 rst Parry Benelip Medial Expenses $5,000 ead1 person .,Sta died ,...... . P ...... Uninsured Motadn-Stacked 415;000 each �ersoNE3DA0D each accident 6 c'd ... „ ..._. Ondetlnwred Morons! fitadxd $15 000 each persoN430 000 each actldem 10 ['nmpreh---... ............Actual Cash Value ... . . ... . .. 55 00 85 Collision Adal Cash Value E500 564 .... ................................................_P..... 30 days............. .y................ ..... .. ..............,....................,,...... Renlal Baim6uisemene u [o E30 eachda (maximum 29 Roadside Assisiana 7 Total6 mach pica f premium 8940.00 ..,... piscoum 11 paid in full -102,00 . ._...,...... _..._.....iana ._ full.... ..._._... . ............... . ... ._.. ._._826.,... Toml 6 moastls policy premium it paid in toll 5836.90 Premium discounts N e .............. . .d _ vie ....... .__..... 2005 BMW Airbag and And-Theft Device M3 CP Lienholder information We send certain notices Such as coverage summaries and cancellation notices to the following: Vehicle Lienholder 2005 BMW M3 CP NEW CUMBERLAND FCU WBSBL93455PN62194 NEW CUMBERLAND,PA 17070 Tort Option This policy provides limited t01t insmaoce, Notice of Available Premium Discounts You may be eligible for discounts mandated by Act 6 of 1990' on first party benefits coveiage'1f your car Is equipped Mh a passive restraint system • on comprehensive coverage if your or is equipped with a passive ami-theft device • if all named insureds are$5 or ogler and have sucwsstuiy completed a motor vehicle driver improvement course approved by PennDOT. if you have any questions ah0utyour eligibility,please comma your agent. form aaa9 pp!I:Y1m cwun.d u9/21/2019 10:59 FAX 412 702 9291 PROGRESSIVE GAS INS GO Q004 Policy Number: 7509141-9 WUHEW B SPMER N9e3 of Company officers Pres Secretary krm saes vn(iN% USAA 5/2/2013 7 : 46:43 AM PAGE 4/004 Fax Server PARENTS/GUARDIAN RELEASE AND INDEMNITY AGREEMENT USAAa USAA Casualty Member Name USAA Number UR Number Dare of Loss Insurance Company ]a Kell L Whitehead 021103062 1 06-22-2012 FOR AND IN CONSIDERATION of the payment to me/us of the sum of (515.000.001 Fifteen Thousand Dollars and 00/100. the receipt of which is hereby acknowledged, Uwe, the undersigned, father and mother and/or guardian of ja'dyn Stickler a minor, do forever release, acquit, discharge and covenant to hold harmless la Kell W_gy hibehead and USAA his/her heirs, successors and assigns of and from any and all actions, causes of action, claims, demands, damages, costs, loss of services, expenses and compensation, contribution, Indemnification, on account of, or In any way growing out of, any and all known and unknown personal injuries and property damage which 1/we may now or hereafter have as the parents and/or guardian of said minor, and also all claims or rights of action for damages which the said minor has or may hereafter have, either before or after he/she has reached his/her majority, resulting or to result from a certain accident which occurred on or about June 22. 2012 at or near EnoIPA. I/We do hereby state that said minor is completely recovered from any and all injuries sustained as a result or said accident and promise to bind myself/ourselves jointly and severally, my/our heirs, administrators and executors repay to the said ]a Kell L Whitehead and USAA his/her heirs, successors and assigns any sum of money, except the sum above mentioned that he/she/they may hereafter be compelled to pay because of the said accident. It is further understood and agreed that this settlement is the compromise of a doubtful and disputed claim, and that this payment is not to be construed as an admission of liability on the part of]a Kell L Whitehead and USAA by whom liability is expressly denied. I/We further agree and acknowledge that the releasees, and each of them, expressly reserve all rights of action of whatever kind against me/us, my/our heirs, executors, administrators and assigns and against said minor on account of, or in any way growing out of the above described occurrence or accident. UWe further state that Uwe have carefully read the foregoing release and know the contents thereof, and Uwe sign the same as my/our own free act. PENNSYLVANIA Statutes, 75-1822 states: "Any person who knowingly and with intent to injure or defraud any insurer files an application or claim containing any false, incomplete or misleading information shall, upon conviction, be subject to imprisonment for up to seven years and payment of a fine up to $15,000," Executed at this day of , City/State Day Month Year WITNESSES: CAUTION: READ BEFORE SIGNING Signature Legal Signature Matthew Stickler Address Print Name Signature Legal Signature Address Print Name E=B RAP012-0504 PARENTS'UNDERINSURED MOTORIST RELEASE&INDEMNITY AGREEMENT Page 1 oft KNOW ALL BY THESE PRESENTS:That the undersigned, individually and as legal par- ents and guardians of JAIDYN STICKLER,a minor(hereinafter"Releasors"),for the sole con- sideration of EIGHT THOUSAND DOLLARS AND ZERO CENTS ($8,000.00),receipt of which is hereby acknowledged,have remised,released,and forever discharged and covenant to hold harmless PROGRESSIVE NORTHERN INSURANCE COMPANY,its agents,employees, subsidiaries and affiliates(hereinafter"Releasee")and Releasee's successors and assigns,from any and all claims,actions,and causes of action, demands,costs,and expenses arising under the _4 above^umbered policy for bodily, injpry or damages ofymkind sustained or that may be here-. _ N after sustained by the said minor,or on behal o said minor,or y6 the undersigned,on account of or in any way arising out of an accident caused by an underinsured motorist at or near EAST PENN SBORO,CUMBERLAND COUNTY,on or about JUNE 22,2012. To procure the payment of the stated consideration,the Releasors hereby declare:that no repre- sentations about the nature and extent of the said injuries,disabilities or damages made by any physician,attorney or agent of Releasee,nor any representations regarding the nature and extent of legal liability or financial responsibility,have induced the Releasors to make this Release& Indemnity Agreement;that this Release is entered into in consideration of all known and un- known injuries,disabilities and damages,and also the possibility that the injuries sustained may be permanent and progressive and recovery therefrom uncertain and indefinite,so that conse- quences not now anticipated may result from the said accident. Releasors agree to indemnify and hold harmless said Releasee from any additional sum of money that Releasee may hereafter be compelled to pay on account of the injuries to said minor because of said accident. The Releasee is hereby authorized to take any action which may be desirable or necessary in law or in equity,either in the name of the Releasee or in the name of the Releasors,against any per- - -- —sonmr organization.who�may.be.liable.focsuch injuries or dearm es who has not been heretofore released with our written consent. The Releasors covenant and agree to cooperate Ily with the "---' Releasee in the presentation of such claims and to furnish all papers and documents necessary in such proceedings,submit to such physical or testimonial examinations as may be required in such proceedings,and to attend court and testify if the Releasee deems it to be necessary. (Ed. 11/94) .2. ���R Handler Henning & Rosenberg LLP 11F Attorneys at Law CONTINGENT FEE AGREEMENT I, Heather Smith, natural parent and legal guardian of Jaidyn Stickler, do hereby retain HANDLER, HENNING & ROSENBERG, LLP., of Harrisburg, Pennsylvania, as my attorneys in this matter to represent me and to process,negotiate,arbitrate a settlement orto institute in my name, any legal proceedings or actions that,in theirjudgment are necessary,against any and all persons or against anyone else as a result of injuries and damages I sustained in an incident that occurred on 06/2V2012. 74 —„ I agree not to settle, negotiate or adjust the above claim or any proceedings based thereon without the written consent of my said attorneys. In consideration of the services so to be rendered by Handler, Henning & Rosenberg, LLP, I hereby covenant, promise and agree to pay them for their professional services rendered, THIRTY-THREE AND ONE-THIRD PERCENT(33 Ys%)of whateversum is recovered as a result of settlement without lawsuit;or FORTY PERCENT(40%)of whatever sum is recovered after lawsuit is filed or in the event of arbitration or mediation. I will reimburse Handler,Henning&Rosenberg,LLP.for any necessary expenses advanced on my behalf in pursuing my claim.Examples of typical expenses include Court filing fees,investigation,auto mileage,photocopies,court reporters,medical records,expert witness fees,etc. I further understand that my attorney(s)may have to resolve Medicare,Medicaid,and/or private health insurance reimbursement claims or liens for past and/or future medical care. My attorney(s) may associate separate experts/case workers who will assist with the reimbursement of claims or liens. The expense of any such service will be treated as a case expense. If no money is obtained, client will not owe a legal fee or expenses. I also agree to take possession of my medical files at the conclusion of this case. My failure to take possession of these files within 60 days after the conclusion of the case will authorize my lawyers to destroy said files. I agree that HANDLER, HENNING &ROSENBERG, LLP. may associate additional lawyers to assist with this case and I agree to the sharing of fees between lawyers. I understand the terms herein apply to other lawyers associated on this case. I understand that the association of other lawyers does not increase the amount of the attorney fees at the conclusion of the case. Counsel reserves the right to withdraw if they desire to do so,for any reason(s)they deem proper. I acknowledge that I have read, approved and understood the above Contingent Fee Agreement and I acknowledge having received a copy of the same. The terms set forth herein are accepted. IN WITNESS WHEREOF, I have hereunto set my hand and seal this day f 2012. (SEAL) Heather5mith,n t al pa rent and legal guardian of Jaidyn Stickler y} BMW f NN Handler Henning & Rosenberg LLP Attorneys at Law 1300 LINGLESTOWN ROAD, SUITE 21 HARRISBURG, PA 17110 717 238 2000 1 f 717 233 3029 1 toll free 800 422 2224 1 w .hhrlaw.com Client No: 217768 Miss Jaidyn Stickler Attorney: MPR 540 N. Enola Drive MV Enola, PA 17025 USA Pre-Bill No: 46934 Bill Date. November 18, 2013 INVOICE PAYMENT DUE UPON RECEIPT Motor Vehicle Incident EXPENSES 08/01/2012 CORNERSTONE ADMINISYSTEMS 2050. CASE 08/0112012 $20.50 08/28/2012 CC-SIDS -GOOD HOPE FAMILY PHYSICIANS 47.25 CASE 08/2812012 $47.25 08/28/2012 CC-SIDS- PSNN STATE HERSHEY MEDICAL CENTER 34.74 CASE 08/28/2012 $34.74 04/24/2013 CD formating/copying/burning 3.00 CD 04/24/2013 $3.00 10/2512013 CUMBERLAND COUNTY ORPHAN'S COURT 15.00 CASE 10/25/2013 $15.00 11/08/2013 Photography Costs 1.50 PHOT 11/08/2013 $1.50 11/18/2013 FROTH OF CUMBERLAND CO 103.75 CASE 11/18/2013 $103.75 11/18/2013 CUMBERLAND COUNTY ORPHAN'S COURT -15.00 CASE 11/18/2013 -$15.00 11/30/2013 Document Reproduction 1.40 COPY 11/30/2013 $1.40 11/30/2013 Fax Charges 5.00 FAX 11/30/2013 $5.00 11/30/2013 Postage Costs 2.74 POS 11/30/2013 $2.74 11/30/2013 Postage Costs - 531 POST 11/30/2013 $5.31 hx*N 11/30/2013 Long Distance Telephone Charges 1.17 TELE 11/30/2013 $1.17 �? ' TOTALEXPENSES $226.36 Total due this invoice $226.36 VERIFICATION The undersigned hereby verifies that the statements in the foregoing document are based upon information which has been furnished to counsel by me and information which has been gathered by counsel in the preparation of this lawsuit. The language of the document is of counsel and not my own. I have read the document and to the extent that it is based upon information which I have given to counsel, it is true and correct to the best of my knowledge, information and belief. To the extent that the contents of the document are that of counsel, I have relied upon my counsel in making this Verification. The undersigned also understands that the statements made therein are made subject to the penalties of 18 Pa. C.S. Section 4904, relating to unsworn falsification to authorities. tthew B./84 c er Date: VERIFICATION The undersigned hereby verifies that the statements in the foregoing document are based upon information which has been furnished to counsel by me and information which has been gathered by counsel in the preparation of this lawsuit. The language of the document is of counsel and not my own. I have read the document and to the extent that it is based upon information which I have given to counsel, it is true and correct to the best of my knowledge, information and belief. To the extent that the contents of the document are that of counsel, I have relied upon my counsel in making this Verification. The undersigned also understands that the statements made therein are made subject to the penalties of 18 Pa. C.S. Section 4904, relating to unsworn falsification to authorities. uti Heather J. th Date: IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY,PENNSYLVANIA JAIDYN STICKLER, a minor,by and through her natural parents and guardians, HEATHER J. CIVIL ACTION—LAW SMITH and MATTHEW B. STICKLER, MINOR'S COMPROMISE Petitioners No.: - � Fg� C,-" ORDER APPROVING COMPROMISE, SETTLEMENT,AND DISTRIBUTION AND NOW,this-&/?t day of � �� � / , 2013, upon consideration of the foregoing Petition, IT IS HEREBY ORDERED that the disbursement of funds is approved as set forth in said Petition and shall be disbursed in accordance with the terms and conditions of the settlement agreement as follows: A. Direct payment of$5,976.36 to Matthew P. Rosenberg, Esq., representing reasonable attorney's fees of$5,750.00 and $226.36 for reimbursement of costs; B. Direct payment of the balance, $17,023.64,to be placed into a restricted account in the name of the minor,Jaidyn Stickler, marked not to be withdrawn until the age of majority on January 23, 2024. BY THE COURT: J. C.7 Distribution: ,Matthew P.Rosenberg,Esq. r Handler,Henning&Rosenberg,LLP 1300 Linglestown Road—Suite 2 ; Harrisburg,PA 17110 r' --'C-7) Heather Smith c'.3 540 N Enola Drive T' r c a Fri Enola,PA 17025 " X- Matthew B. Stickler 188 Bordnersville Road Jonestown,PA 17038 e'opi es /u., 1�� IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA JAIDYN STICKLER, a minor, by and through herCIVIL ACTION —LAW c" natural parents and guardians, HEATHER J. MINOR'S COMPROMISE , SMITH and MATTHEW B. STICKLER, �z. No.: 13-6887 Civil Petitioners. D '� kP PROOF OF DEPOSIT AND NOW, comes the Petitioner, by and through her attorneys, HANDLER, HENNING & ROSENBERG, LLP, by Matthew P. Rosenberg, Esquire, pursuant to the November 25, 2013, Court Order, attaches the Proof of Deposit of the minor's settlement proceeds hereto, to wit, the bank certification from Integrity Bank, which is made a part hereof and is marked, Exhibit Respectfully submitted, HANDLER, HENNING & ROSENBERG, LLP By: ` 1' Matthew P. Rosenberg, Esquire Supreme Co t I.D. #201485 1300 Lingle own Road - Suite 2 Harrisburg, PA 17110 (717) 238-2000 DATED: (p44/ t• z41y Attorney for Plaintiff II 'f d f '0 tr ,1a9 i i'"7—,1a. 24'"'7--4-0A4"— e�b�ei$ dg 1r.1..._,5d 1S�e dQl ibo abb db $ l y4r g ji'. ; OA ah :i..'14,r 1; Integrity rt ' 8 A N K . A INTEGRITY BANK COLONIAL ROAD, 301 Colonial Rd,.Harrisburg, PA 17109 KY TIME CERTIFICATE OF DEPOSIT -n' NONTRANSFERABLE AND NONNEGOTIABLE V • $ fl'. Account Title Account Type Taxpayer ID Number P i JAIDYN STICKLER 60 MONTH CD 203-82-2502 ° BY HEATHER SMITH GUARDIAN e r Account Number Amount Date of Issue Mafurity Date Term, 0000000604001490 $ 17,023.64 December 31,2013 . December 31,2018 60 Months/Automatic Renewal; . Interest Rate Per Annum Interest Payment Frequency t4; 1.193 %with art annual percentage yield of 1.20%. e '��Y Monthly 4 la :431 P 4�� Interest Payment Disposition s v. Interest will be capitalized to this til certificate. a °i TIME CERTIFICATE OF DEPOSIT $�� i 1i Agreement. This Time Certificate of Deposit is a part of, and governed by, our Time Deposit Agreement. Among other things, this means �' r that all terms defined in that agreement have the same meanings here. You have received a copy of that agreement, the Truth in Savings r. disclosures(if applicable),and the fee schedule. You have read th m a d,.argree to them. `Early Withdrawal Penalty. We do not have to permit early withdrai ials:f� the account. On each one we do permit, we can charge a . . penalty calculated as follows: If the term is between 30 days and under one;ypar a penalty of one month interest will be assessed. If the term v, is between one year and under three years a penalty of three months of interest will be assessed. If the term is three years and over, a penalty of six months of interest will be assessed. If there is enough accrued interest to cover the penalty, we deduct the penalty from it. If not,we V A. deduct the remainder of the penalty from principal. If the account is a variable rate account, we will calculate the penalty using the interest f v. rate being applied at the time of withdrawal. If the account is an Individual Retirement Account,the early withdrawal penalty will be in addition r4. to any penalty imposed under the Individual Retirement Account(IRA)Disclosure Statement. The minimum early withdrawal penalty is seven y®� days' simple interest on any amount withdrawn (a)within the first six days after the account is opened, or(b)within six days after a previous i� early withdrawal. ` g Nontransferable. This Time Certificate of Deposit is nonnegotiable and nontransferable, All purported holders or assignees of it agree that �'�` Vii di our right of setoff will have priority over any of their claims. a liK INTEGRITY BANK t .041 I+ B 6=�1 By �L� Date At , Pi X ' o U 41 - 1rf:, �� ` 4 to tt . v.s trplp ' EXHIBIT tS D il - :',71 go && ! TIME CERTIFICATE OF DEPOSIT D0001100/20121110 Printed 12/31/2013 1:30:00 PM �' i1P r NONTRANSFERABLE AND NONNEGOTIABLE ©2012 Fidelity National Information Services,Inc.and its subsidiaries. l /0000000604001490 tt A, r 2 /X4JL�p y,4{1? )47;� aTn.'.' .sali �' fp,g1;,; .4p fAr y��� _ '�� S4 I67';6...,,,, -� Qw , ,1 , • ~ . • . TDDEPS 0004 406 51 1 /31/13 1f46 PM Deposit for: Tie Deposit *****140 for $17,023.64 ' I �