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HomeMy WebLinkAbout14-5091 Supreme Co ► : ;ennsylvania Cour .ofeco- j�rno leas For Prothonotary Use Only. il``c4 b er She tt IGIp wf� ,., L Docket No: Si Cu c� `dank, �' County The information collected on this form is used solely.for court administration purposes. This form does not supplement or replace the filing and service of pleadings or other papers as required by law or rules of court. Commencement of Action: S F1 Complaint 0 Writ of Summons F1 Petition E ® Transfer from Another Jurisdiction J Declaration of Taking C Lead Plaintiffs Name: Lead Defendant's Name: Marsha Stevens Christopher Rittenhouse T I Are money damages requested? 0 Yes El No Dollar Amount Requested: Ixr within arbitration limits O (check one) !i outside arbitration limits N Is this a Class Action Suit? 0 Yes 0 No Is this an MDJAppeal? El Yes El No A Name of Plaintiff/Appellant's Attorney: Andrew Smialowicz, Esquire Check here if you have no attorney(are a Self-Represented [.Pro Se] Litigant) Nature of the Case: Place an"X"to the left of the ONE case category that most accurately describes your PRIMARY CASE. If you are making more than one type of claim,check the one that you consider most important. TORT{do not include Mass Tort} CONTRACT(do not include Judgments) CIVIL APPEALS ® Intentional © Buyer Plaintiff Administrative Agencies n Malicious Prosecution ® Debt Collection:Credit Card 0 Board of Assessment Motor Vehicle Ea Debt Collection:Other 0 Board of Elections [3Nuisance E] Dept.of Transportation S n Premises Liability © Statutory Appeal:Other ® Product Liability (does not include E mass tort) l'rl Employment Dispute: ® Slander/Libel/Defamation Discrimination C 0 Other: Employment Dispute:Other Q Zoning Board T Other: Other: O MASS TORT ® Asbestos N [3Tobacco Q Toxic Tort-DES Toxic Tort-Implant REAL PROPERTY M Toxic Waste MISCELLANEOUS Other: Ejectment 0 Common Law/Statutory Arbitration B n Eminent Domain/Condemnation 0 Declaratory Judgment El Ground Rent [ Mandamus Q Landlord/Tenant Dispute Non-Domestic Relations 0 Mortgage Foreclosure:Residential Restraining Order PROFESSIONAL LIABLITY 0 Mortgage Foreclosure: Commercial0 Quo Warranto E3Dental n Partition El © Legal Replevin Quiet Title El Other: © Medical n Other: Other Professional: E i Updated 11112011 THIS IS AN ARBITRATION MATTER. ASSESSMENT OF DAMAGES HEARING CLEARFIELD&KOFSKY IS REQUIRED. By: Andrew Smialowicz,Esquire Identification No. 307420 Attorney for Plaintiffs Suburban Station Building-Suite 355 1617 JFK Boulevard Philadelphia,PA 19103 (215)563-6333 MARSHA STEVENS COURT OF COMMON PLEAS 595 Pebble Blvd. CUMBERLAND COUNTY Covington,GA 30016 ,��r S�q/ and NO. !!/ ADRIANA FOSTER, minor,by and through her parent and natural guardian MARSHA STEVENS,in her own right 595 Pebble Blvd. Covington,GA 30016 and , JERRAN PARKS,minor,by and through his parent and natural guardian MARSHA STEVENS,in her own right 595 Pebble Blvd. Covington,GA 30016 and KAYLA FOSTER,minor,by and r through her parent and natural guardian MARSHA STEVENS,in his own right ,, 595 Pebble Blvd. r q Covington,GA 30016 r=� and RAYANN FOSTER, minor,by and -v, through her parent and natural guardian > MARSHA STEVENS,in his own right { Y 595 Pebble Blvd. e_ Covington,GA 30016 V. CHRISTOPER RITTENHOUSE 52795 Fir Road Granger,IN 46530 and CON-WAY TRUCKING 4701 E.32"d Street Joplin,MO 64803 NOTICE TO DEFEND You have been sued in court. If you wish to defend against the claims set forth in the following pages,you must take action within twenty(20)days after this Complaint and Notice are served,by entering a written appearance personally or by an attorney and filing in writing with the Court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment maybe entered against you by the Court without further notice for any money claimed in the Complaint or for any other claim or relief requested by the plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE,GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 Liberty Avenue Carlisle,PA 17013 ^ (717)249.3 166 J (800)990-9108 6 IIS, 7� 0XIio, c7l�s� s (J GENERAL AVERMENTS 1. Plaintiff, Marsha Stevens, is an adult individual who resides at the above- captioned address. 2. Plaintiff, Adriana Foster (Minor), is a minor individual who resides at the above- captioned address with her parent and natural guardian, Marsha Stevens. 3. Plaintiff, Jerran Parks (Minor) is a minor individual who resides at the above- captioned address with his parent and natural guardian, Marsha Stevens. 4. Plaintiff, Kayla Foster (Minor) is a minor individual who resides at the above- captioned address with her parent and natural guardian, Marsha Stevens. 5. Plaintiff, Rayann Foster (Minor), is a minor individual who resides at the above- captioned address with her parent and natural guardian, Marsha Stevens 6. Defendant, Christopher Rittenhouse, is an adult individual who resides at the above-captioned address. 7. Defendant, Con-Way Trucking, is a business, company, entity, partnership, franchise, fictitious name, proprietorship or corporation existing and/or qualifying under the laws of the Commonwealth of Pennsylvania, with a registered office for the acceptance of service or a principal place of business at the address listed in the caption of this Complaint. 8. At all times material hereto, Defendant, Christopher Rittenhouse, did operate, manage and control co-Defendant, Con-Way Trucking's 2010 Kenworth Truck, Indiana Tag No.76 AP 9W, which was involved in this accident. 9. On or about February 18, 2013, traveling South on Interstate 81, Cumberland County, Pennsylvania, Defendant, Christopher Rittenhouse, so carelessly and negligently -2- operated the aforementioned vehicle so as to cause it to collide with the vehicle being operated by Plaintiff, Marsha Stevens, in which minor co-plaintiffs, Adriana Foster, Jerran Parks, Kayla Foster and Rayann Foster, were passengers within, causing them to sustain the injuries and other losses hereinafter more fully set forth. 10. The negligence and carelessness of the Defendants, acting as aforesaid,consisted of the following: (a) operating the aforementioned vehicle at an excessive rate of speed; (b) failing to have proper and adequate control of the aforementioned vehicle so as to avoid accidents; (c) failing to warn of the approach of the aforementioned vehicle with due regard for the rights and safety of the plaintiffs; (d) failing to keep a proper lookout; (e) failing to stop; (f) failing to keep a safe distance from other vehicles; (g) violating the pertinent provisions of the Pennsylvania Motor Vehicle Code; (h) failing to use due care under the circumstances; (i) Defendant, Con-Way Trucking, negligently consented and entrusted their vehicle to co-Defendant, Christopher Rittenhouse, who they knew or should have known would operate the vehicle in a negligent and careless manner, and had a propensity toward negligence and recklessness; (j) negligence per se; and -3- (k) in being otherwise careless, reckless and negligent, the particulars of which are presently unknown to plaintiffs but which may be learned by discovery procedures provided by the Pennsylvania Rules of Civil Procedure or which may be learned at the trial of this case. 11. The aforesaid accident was due solely to the negligence and carelessness of the Defendants, acting as aforesaid, and was due in no manner whatsoever to any act or failure to act on the part of the plaintiffs. COUNT PLAINTIFF, MARSHA STEVENS v. ALL DEFENDANTS THIRD PARTY LIABILITY 12. Plaintiff, Marsha Stevens, incorporates by reference hereto, all of the allegations contained in the General Averments, as if they were set forth at length herein. 13. As a result of this accident, Plaintiff, Marsha Stevens, has suffered injuries which are or may be serious and permanent in nature, including but not limited to: cervical strain and sprain, brachial neuritis, brachial radiculitis, headache, face pain, lumbar strain and sprain, sciatica, thoracic strain and sprain, left hip pain, left thigh pain, left shoulder pain, as well as other injuries as may be diagnosed by Plaintiffs health care providers, all of which injuries have in the past, and may in the future, cause Plaintiff great pain and suffering. 14. As a further result of this accident, Plaintiff, Marsha Stevens, has been or will be required to receive and undergo medical attention and care and to expend various sums of money and to incur various expenses, and may be required to continue to expend such sums or incur such expenditures for an indefinite time in the future. -4- 15. As a further result of this accident, Plaintiff, Marsha Stevens, has or may hereafter suffer a severe loss of earnings and impairment of earning power and capacity. 16. As a further result of this accident, Plaintiff, Marsha Stevens, has suffered medically determinable physical and/or mental impairment, which prevents the plaintiff from performing all or substantially all of the material acts and duties that constituted the plaintiffs usual and customary activities prior to the accident. 17. As a direct and reasonable result of the accident aforementioned, Plaintiff, Marsha Stevens, has incurred or may hereafter incur, other financial expenses that exceed or may exceed the amount which plaintiff may otherwise be entitled to recover. 18. As a further result of the accident aforementioned, Plaintiff, Marsha Stevens, has suffered severe physical pain, mental anguish and humiliation, and may continue to suffer same for an indefinite time in the future. WHEREFORE, Plaintiff, Marsha Stevens, demands judgment against the defendants, jointly and/or severally, for damages, in an amount not in excess of the arbitration limits, plus interest and costs. COUNT II PLAINTIFF, ADRIANA FOSTER(MINOR)v. ALL DEFENDANTS THIRD PARTY LIABILITY 19. Plaintiff, Adriana Foster (Minor), incorporates by reference hereto, all of the allegations contained in the General Averments and Count I, as if they were set forth at length herein. 20. As a result of this accident, Plaintiff, Adriana Foster(Minor), has suffered injuries which are or may be serious and permanent in nature, including but not limited to: cervical strain -5- and sprain, cervical subluxation, cervicalgia, lumbar strain and sprain, lumbalgia, lumbar subluxation, thoracic strain and sprain, thoracalgia, right hip pain, right thigh pain, right shoulder pain, as well as other injuries as may be diagnosed by Plaintiffs health care providers, all of which injuries have in the past, and may in the future, cause Plaintiff great pain and suffering. 21. As a further result of this accident, Plaintiff, Adriana Foster (Minor), has been or will be required to receive and undergo medical attention and care and to expend various sums of money and to incur various expenses, and may be required to continue to expend such sums or incur such expenditures for an indefinite time in the future. 22. As a further result of this accident, Plaintiff, Adriana Foster (Minor), has or may hereafter suffer a severe loss of earnings and impairment of earning power and capacity. 23. As a further result of this accident, Plaintiff, Adriana Foster (Minor), has suffered medically determinable physical and/or mental impairment, which prevents the plaintiff from performing all or substantially all of the material acts and duties that constituted the plaintiffs usual and customary activities prior to the accident. 24. As a direct and reasonable result of the accident aforementioned, Plaintiff, Adriana Foster (Minor), has incurred or may hereafter incur, other financial expenses that exceed or may exceed the amount which plaintiff may otherwise be entitled to recover. 25. As a further result of the accident aforementioned, Plaintiff, Adriana Foster (Minor), has suffered severe physical pain, mental anguish and humiliation, and may continue to suffer same for an indefinite time in the future. WHEREFORE, Plaintiff, Adriana Foster (Minor), demands judgment against the defendants, jointly and/or severally, for damages, in an amount not in excess of the arbitration limits,plus interest and costs. -6- COUNT III PLAINTIFF MARSHA STEVENS v. ALL DEFENDANTS 26. Plaintiff, Marsha Stevens, incorporates by reference hereto, all of the allegations contained in the General Averments and Counts I and II, as if they were set forth at length herein. 27. Plaintiff, Marsha Stevens,has been or will be required to expend various sums of money and to incur various expenses, on behalf of minor Plaintiff, Adriana Foster, and may be required to continue to expend such sums or incur such expenditures for an indefinite time in the future. WHEREFORE, Plaintiff, Marsha Stevens, is empowered to bring a claim to recover outstanding medical expenses and, demands judgment against the Defendant, jointly and/or severally, for damages, in an amount not in excess of the arbitration limits, plus interest and costs. COUNT IV PLAINTIFF,JERRAN PARKS (MINOR)v. ALL DEFENDANTS THIRD PARTY LIABILITY 28. Plaintiff, Jerran Parks (Minor), incorporates by reference hereto, all of the allegations contained in the General.Averments and Count I, II and III, as if they were set forth at length herein. 29. As a result of this accident, Plaintiff, Jerran Parks (Minor), has suffered injuries which are or may be serious and permanent in nature, including but not limited to: cervical strain and sprain, headaches, face pain, lumbar strain and sprain, lumbalgia, thoracic strain and sprain, thoracic root lesions, left hip pain, left thigh pain, sacroilitis, right shoulder pain, as well as other -7- injuries as may be diagnosed by Plaintiffs health care providers, all of which injuries have in the past, and may in the future, cause Plaintiff great pain and suffering. 30. As a further result of this accident, Plaintiff, Jerran Parks (Minor), has been or will be required to receive and undergo medical attention and care and to expend various sums of money and to incur various expenses, and may be required to continue to expend such sums or incur such expenditures for an indefinite time in the future. 31. As a further result of this accident, Plaintiff, Jerran Parks (Minor), has or may hereafter suffer a severe loss of earnings and impairment of earning power and capacity. 32. As a further result of this accident, Plaintiff, Jerran Parks (Minor), has suffered medically determinable physical and/or mental impairment, which prevents the plaintiff from performing all or substantially all of the material acts and duties that constituted the plaintiffs usual and customary activities prior to the accident. 33. As a direct and reasonable result of the accident aforementioned, Plaintiff, Jerran Parks (Minor), has incurred or may hereafter incur, other financial expenses that exceed or may exceed the amount which plaintiff may otherwise be entitled to recover. 34. As a further result of the accident aforementioned, Plaintiff, Jerran Parks (Minor), has suffered severe physical pain, mental anguish and humiliation, and may continue to suffer same for an indefinite time in the future. WHEREFORE, Plaintiff, Jerran Parks (Minor), demands judgment against the defendants, jointly and/or severally, for damages, in an amount not in excess of the arbitration limits,plus interest and costs. -8- COUNT V PLAINTIFF MARSHA STEVENS v. ALL DEFENDANTS 35. Plaintiff, Marsha Stevens, incorporates by reference hereto, all of the allegations contained in the General Averments and Counts I, II, III and IV, as if they were set forth at length herein. 36. Plaintiff, Marsha Stevens, has been or will be required to expend various sums of money and to incur various expenses, on behalf of minor Plaintiff, Jerran Parks, and may be required to continue to expend such sums or incur such expenditures for an indefinite time in the future. WHEREFORE, Plaintiff, Marsha Stevens, is empowered to bring a claim to recover outstanding medical expenses and, demands judgment against the Defendant, jointly and/or severally, for damages, in an amount not in excess of the arbitration limits, plus interest and costs. COUNT VI PLAINTIFF, KAYLA FOSTER(MINOR)v. ALL DEFENDANTS THIRD PARTY LIABILITY 37. Plaintiff, Kayla Foster (Minor), incorporates by reference hereto, all of the allegations contained in the General Averments and Count I, II, III, IV and V, as if they were set forth at length herein. 38. As a result of this accident, Plaintiff, Kayla Foster (Minor), has suffered injuries which are or may be serious and permanent in nature, including but not limited to: cervical strain and sprain, muscle spasms, headaches, face pain, lumbar strain and sprain, lumbalgia, thoracic strain and sprain, thoracic root lesions, right hip pain, right thigh pain, sacroilitis, as well as other -9- injuries as may be diagnosed by Plaintiffs health care providers, all of which injuries have in the past, and may in the future, cause Plaintiff great pain and suffering. 39. As a further result of this accident, Plaintiff, Kayla Foster (Minor), has been or will be required to receive and undergo medical attention and care and to expend various sums of money and to incur various expenses, and may be required to continue to expend such sums or incur such expenditures for an indefinite time in the future. 40. As a further result of this accident, Plaintiff, Kayla Foster (Minor), has or may hereafter suffer a severe loss of earnings and impairment of earning power and capacity. 41. As a further result of this accident, Plaintiff, Kayla Foster (Minor), has suffered medically determinable physical and/or mental impairment, which prevents the plaintiff from performing all or substantially all of the material acts and duties that constituted the plaintiffs usual and customary activities prior to the accident. 42. As a direct and reasonable result of the accident aforementioned, Plaintiff, Kayla Foster (Minor), has incurred or may hereafter incur, other financial expenses that exceed or may exceed the amount which plaintiff may otherwise be entitled to recover. 43. As a further result of the accident aforementioned, Plaintiff, Kayla Foster(Minor), has suffered severe physical pain, mental anguish and humiliation, and may continue to suffer same for an indefinite time in the future. WHEREFORE, Plaintiff, Kayla Foster (Minor), demands judgment against the defendants, jointly and/or severally, for damages, in an amount not in excess of the arbitration limits, plus interest and costs. -10- COUNT VII PLAINTIFF, MARSHA STEVENS v. ALL DEFENDANTS 44. Plaintiff, Marsha Stevens, incorporates by reference hereto, all of the allegations contained in the General Averments and Counts I, 11, III, IV, V and VI, as if they were set forth at length herein. 45. Plaintiff, Marsha Stevens, has been or will be required to expend various sums of money and to incur various expenses, on behalf of minor Plaintiff, Kayla Foster, and may be required to continue to expend such sums or incur such expenditures for an indefinite time in the future. WHEREFORE, Plaintiff, Marsha Stevens, is empowered to bring a claim to recover outstanding medical expenses and, demands judgment against the Defendant, jointly and/or severally, for damages, in an amount not in excess of the arbitration limits, plus interest and costs. COUNT VIII PLAINTIFF, RAYANN FOSTER(MINOR)v. ALL DEFENDANTS THIRD PARTY LIABILITY 46. Plaintiff, Rayann Foster (Minor), incorporates by reference hereto, all of the allegations contained in the General Averments and Count I, II, III, IV, V, VI and VII, as if they were set forth at length herein. 47. As a result of this accident, Plaintiff, Rayann Foster (Minor), has suffered injuries which are or may be serious and permanent in nature, including but not limited to: cervical strain and sprain, cervicalgia, lumbar strain and sprain, lumbalgia, thoracic root lesions, lumbar subluxation, left shoulder pain, as well as other injuries as may be diagnosed by Plaintiffs health -11- care providers, all of which injuries have in the past, and may in the future, cause Plaintiff great pain and suffering. 48. As a further result of this accident, Plaintiff, Rayann Foster (Minor), has been or will be required to receive and undergo medical attention and care and to expend various sums of money and to incur various expenses, and may be required to continue to expend such sums or incur such expenditures for an indefinite time in the future. 49. As a further result of this accident, Plaintiff, Rayann Foster (Minor), has or may hereafter suffer a severe loss of earnings and impairment of earning power and capacity. 50. As a further result of this accident, Plaintiff, Rayann Foster (Minor), has suffered medically determinable physical and/or mental impairment, which prevents the plaintiff from performing all or substantially all of the material acts and duties that constituted the plaintiffs usual and customary activities prior to the accident. 51. As a direct and reasonable result of the accident aforementioned, Plaintiff, Rayann Foster (Minor), has incurred or may hereafter incur, other financial expenses that exceed or may exceed the amount which plaintiff may otherwise be entitled to recover. 52. As a further result of the accident aforementioned, Plaintiff, Rayann Foster (Minor), has suffered severe physical pain, mental anguish and humiliation, and may continue to suffer same for an indefinite time in the future. WHEREFORE, Plaintiff, Rayann Foster (Minor), demands judgment against the defendants, jointly and/or severally, for damages, in an amount not in excess of the arbitration limits, plus interest and costs. -12- COUNT IX PLAINTIFF,MARSHA STEVENS v. ALL DEFENDANTS 53. Plaintiff, Marsha Stevens, incorporates by reference hereto, all of the allegations contained in the General Averments and Counts I, II, III, IV, V, VI, VII, and VIII, as if they were set forth at length herein. 54. Plaintiff, Marsha Stevens, has been or will be required to expend various sums of money and to incur various expenses, on behalf of minor Plaintiff, Rayann Foster, and may be required to continue to expend such sums or incur such expenditures for an indefinite time in the future. WHEREFORE, Plaintiff, Marsha Stevens, is empowered to bring a claim to recover outstanding medical expenses and, demands judgment against the Defendant, jointly and/or severally, for damages, in an amount not in excess of the arbitration limits, plus interest and costs. r-- CLEARFIELD & Y BY: ANDREW SMI Z WICZ, ESQUIRE Attorneys for Plaintiffs,Marsha Stevens, Adriana Foster(Minor), Jerran Parks (Minor) Kayla Foster(Minor) and Rayann Foster(Minor) -13- VERIFICATI®N hereby verify that I am the in the attached (` n��11fT� , and that the facts set forth herein are true and correct to the best of my knowledge, information and belief. I understand that false statements made herein are subject to the penalties of the 18 PA C.S. §4904, relating to unsworn falsification to authorities. NAME ADDRESS-V� �!S. DATE �' VERIFICATI®111 r- ��r,-�- Q� 76\c"% hereby verify that I am the in the attached C` ;� , and that the facts set forth herein are true and correct to the best of my knowledge, information and belief. I understand that false statements made herein are subject to the penalties of the 18 PA C.S. §4904, relating to unsworn falsification to authorities. NAME ADDRESS,5cJ!s DATE �' VERIFICAI'I®N h hereby verify that I am the in the attached _(`r1 ���� - , and that the facts set forth herein are true and correct to the best of my knowledge, information and belief. I understand that false statements made herein are subject to the penalties of the 18 PA C.S. §4904, relating to unsworn falsification to authorities. NAME ADDRESSY:�,. DATE �' �. VERIF'ICAI'I®N I, v-��M hereby verify that I am the in the attached CLL, blyor} , and that the facts set forth herein are true and correct to the best of my knowledge, information and belief. I understand that false statements made herein are subject to the penalties of the 18 PA C.S. §4904, relating to unsworn falsification to authorities. NAME ADDRESSS� g GATE �' 1 VERIFICATION lhereby verify that I am the in the attached C-\C)m and that the facts set forth herein are true and correct to the best of my knowledge, information and belief. I understand that false statements made herein are subject to the penalties of the 18 PA C.S. §4904, relating to unsworn falsification to authorities. NAME -- I-A-k-�S- - ADDRESS.� -R.�l� DATE �' J CLEARFIELD & KOFSKY BY: ANDREW C. SMIALOWICZ, ESQUIRE Identification Number: 307420 1617 John F. Kennedy Boulevard, Suite 355 Philadelphia, PA 19103 215-563-6333 ADRIANA FOSTER and JERRAN PARKS and KAYLA FOSTER and RAYANN FOSTER, minors by their p/n/g Marsha Stevens and MARSHA STEVENS v. Attorney for Plaintiff : CUMBERLAND COUNTY : COURT OF COMMON PLEAS : NO. 14-5091 CHRISTOPHER RITTENHOUSE and CON -WAY TRUCKING AFFIDAVIT OF SERVICE OF COMPLAINT I, Andrew C. Smialowicz, Esquire, hereby certify that copies of the Complaint in Civil Action were served upon out of state Defendant, Con -Way Trucking on September 8, 2014, by Certified Mail, Return Receipt Requested (Receipt No. 7014 0150 0000 7822 9620) and via regular first class mail. SWORN TO AND SUBSCRIBED BEFORE ME THIS a DAY OF � J , 2014 NOTA Y PUBLIC COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL Public AGNES BEILAND, Notary . p City of Philadelphia, Phila. County My Commission Expires January 20, 2017 OWICZ, ESQUIRE is Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. ■ Print your name and address on the reverse so that we can return the -card to you. j ■ -(attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed.to:. CoV1— w °i ' i SUc.\L'r. rug 9901 E . 3a1.6 S}i'ccc! MO (A803 • A. Si:=cure /ON ON DELIVERY 0 Agent CI Addressee C. Date of Delivery D. Is delivery =ddress different from item 1? 0 Yes - If YES, enter delivery address below: 0 No Se ice Type ttd Certified Mall° 0 Priority Mall Express' CI Registered 111"Return Receipt for Merchandise 0 Insured Mall . C] Collect on Delivery 4, Restricted Delivery?'(Extra Fee) Yes 2. ArticleNumber (Transfer m froservice labeq 7C1'1;`tE c- t. ;b20 L PS Form 3811, July 2013 estic Return Receipt . ti USPS.com® - USPS TrackingTM https://tools.usps.com/go/Track... 9/16/2014 English Customer Service USPICOM Quick Tools USPS TrackingTM USPS Mobile Manage Your' Ma)) Register l Sign In Search USPS.com or Track Packages Subr Sn09 Business Solutions Customer Service Have questions? We're here to help. Tracking Number: 70140150000078229620 Product & Tracking Information Postal Product: it DATE&TIME September 9, 2014 , 10:19 am Features: Certified Mail`s STATUS OF ITEM k LOCATION Delivered JOPLIN, MO 64801 Your item was delivered at 10:19 em on September 9, 2014 in JOPLIN, MO 64801. September 9, 2014 , 8:12 am September 9, 2014 , 4:15 am September 9, 2014 , 12:02 am September 8, 2014 , 8:40 pm September 7, 2014 , 5:43 pm September 6, 2014 , 8:20 am September 5, 2014 , 10:30 pm Arrived at Unit Departed USPS Facility j Arrived at USPS Facility Departed USPS Facility Arrived at USPS Facility Departed USPS Facility Arrived at USPS Facility JOPLIN, MO 64801 SPRINGFIELD, MO 65801 SPRINGFIELD, MO 65801 KANSAS CITY, MO 64121 KANSAS CITY, MO 64121 PHILADELPHIA, PA 19176 PHILADELPHIA, PA 19176 Available Actions Text Updates Email Updates Return Receipt After Mailing Track Another Package Tracking (or receipt) number Track It LEGAL Privacy Policy r Terms of Use FOIA: No FEAR Act EEO Date r ON USPS.COM Government Services Buy Stamps 6 Shop , Print a Label with Postage , Customer Service Delivering Solutions to the Last Mile Site Index: C M. Copyright32014 USPS. Al Rights Reserved. ON ABOUT.USPS.COM About USPS Home Newsroom , USPS Service Alerts Forms S Publications , Careers OTHER USPS SITES Busiress Customer Getaway Postal Inspectors Inspector General Postal Explorer r National Postal Museum , https://toois.usps.comlgo/Track... USPS.com® - USPS TrackingTM USPS.co- USPS TrackingTM CLEARFIELD & KOFSKY BY: ANDREW C. SMIALOWICZ, ESQUIRE Attorney for Plaintiff Identification Number: 307420 1617 John F. Kennedy Boulevard, Suite 355 Philadelphia, PA 19103 215-563-6333 • ADRIANA FOSTER and JERRAN PARKS : CUMBERLAND COUNTY ', and KAYLA FOSTER and RAYANN : COURT OF COMMON PLEAS - FOSTER, minors by their p/n/g Marsha : r- '� c"`" s Stevens and MARSHA STEVENS : NO. 14-5091 s f co- N) ---c v. : • CHRISTOPHER RITTENHOUSE and • CON-WAY TRUCKING • PRAECIPE TO REINSTATE COMPLAINT TO THE PROTHONOTARY: Kindly reinstate the Civil Action Complaint for an additional thirty(30)days in the above- captioned matter. CLEARFIELD & K Pf BY: ANDREW C. SMIALOWICZ, ESQUIRE CW.:\ ci4L\ 1 QjI- 3104 CLEARFIELD & KOFSKY BY: ANDREW C. SMIALOWICZ, ESQUIRE Identification Number: 307420 1617 John F. Kennedy Boulevard, Suite 355 Philadelphia, PA 19103 215-563-6333 C7. OCT -6 Pry 12: Attorney or f a tv C 1 U t o 1 '� ADRIANA FOSTER and JERRAN PARKS : CUMBERLAND COUNTY and KAYLA FOSTER and RAYANN : COURT OF COMMON PLEAS FOSTER, minors by their p/n/g Marsha Stevens and MARSHA STEVENS : NO. 14-5091 v. CHRISTOPHER RITTENHOUSE and CON -WAY TRUCKING AFFIDAVIT OF SERVICE OF COMPLAINT I, Andrew C. Smialowicz, Esquire, hereby certify that copies of the Complaint in Civil Action were served upon out of state Defendant, Christopher Rittenhouse on September 27, 2014, by Certified Mail, Return Receipt Requested (Receipt No. 7014 0150 0000 7822 9637) and via regular first class mail. SWORN TO AND SUBSCRIBED BEFORE ME THIS 1 DAY OF , 2014 NOTARY PUBLIC CLEARFIELD-8/C)________ OF SKY 4 BY: ,l SMIALOWICZ, ESQUIRE COMMONWEALTH OF PENNEWLVANI/� NOTARIAL SEAL AGNES BEILAND, Notary Public City of Philadelphia, Phila. County My Commission Expires January 20, 2017 SENDER: COMPLETE THIS SECTION �. Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. �..r. itrar Print your name and address on the reverse + so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. COMPLETE THIS SECTION ON DELIVERY • 1. Article Addressed to: iI s o? cr (PNt AAts n houSC. 53r195F',r'Aoct Gra y c) 11V 14(0530 Received by (Printed Name) 0 Agent ❑ Addressee C. Date of Delivery D. Is d very. address different from item 1? ES, enterICl livery address below: c v cc ❑ Yes ❑ No 4 3. Service Type NICertified Mail® 0 Priority Mail Express" ❑ Registered [i 'Return Receipt for Merchandise EI Insured Mail 0 Collect on Delivery 4. Restricted Delivery? (E tra Fee) CI Yes 2. Article' Nurhbe ' ! i j a (Trans er fromr ervice abe Li PS Form 3811, July 2013 1?Qi4i alto nap 1782211%87 'i } Domestic Return Receipt Joint General Court Regulation Trial Division and Orphans' Court Division No. 97-1 Minors and Incapacitated Person Checklist Settlement/Trial Division: Cumberland County Court Term: 2014 Caption: Jerran Parks, a minor by his p/n/g Marsha Stevens v. Con -Way Trucking, et al Number: 5091 Companion Cases (indicate Court Term and Number): Any Pleadings filed in Orphans' Court: Yes X No Are the following items included in the Petition/Order: YES NO 1. Minor/Incapacitated Person's: a. Date of Birth x b. Social Security Number x c. Address x d. Written approval of settlement if minor is 16 years or older x 2. Parent/Guardian verification attached x 3. If Guardian of Estate was appointed, is Order attached x 4. Information concerning mother and father x 5. Details concerning the injuries x 6. Doctor's report of present condition of minor/incapacitated person x 7. Statement from parent and/or guardian certifying the condition of minor/incapacitated person and approval of proposed settlement x 8. Counsel's reasons for approval of proposed settlement x 9. Petition signed by counsel x 10. Department of Welfare or any entity lien or claim x 11. Does the Order contain the following: a. Itemization of costs for reimbursement x b. Counsel fee computed on net settlement x c. Affidavit will be filed certifying compliance with Order x d. Amount to minor/incapacitated person (in restricted accounts, typically if under $350,000.00) x e. Amount to guardian of minor/incapacitated person (typically if over $350,000.00) x I verify the answer abd; 1; to be true and correct and understand that sanctions may be imposed for inaccurate or incomp1eteanswees. /j f ID# 307420 ANDREW C. S,MIALbWICZ, ESQUIRE 1 CLEARFIELD & KOFSKY By: Andrew C. Smialowicz, Esquire Identification No.: 307420 One Penn Center at Suburban Station Suite 355, 1617 J.F.K. Boulevard Philadelphia, PA 19103 (215) 563-6333 JERRAN PARKS, a minor by and through : his parent and natural guardian MARSHA : STEVENS v. CHRISTOPHER RI' IENHOUSE and CON -WAY TRUCKING Attorney for Plaintiff - Cr FICF. THF PRO T HC?i TA, R Y DEC -3 PK CUMBERL A NO COUNTY PENNS YLVA NIA COURT OF COMMON PLEAS CUMBERLAND COUNTY NO. 2014-5091 PETITION FOR LEAVE TO SETTLE OR COMPROMISE A MINOR'S ACTION TO THE HONORABLE, THE JUDGES OF THE SAID COURT: The Petition for Jerran Parks, a minor, by and through his legal guardian, Marsha Stevens (see PA. R.C.P. 2028), by his attorney, Andrew C. Smialowicz, Esquire respectfully requests: Petitioner is Jerran Parks, a minor. 2. The minor was born on July 13, 1997, and his social security number is 211- 76-5908. The minor resides with his mother at the following address: 595 Pebble Boulevard Covington, GA 30016 4. A guardian was not appointed for the minor. 5. The minor's mother is Marsha Stevens. 6. The defendants are as follows: Christopher Rittenhouse 52795 Fir Road Grander, IN 46530 7. On February 18, 2013, the minor following location: Con -Way Trucking 4701 E. 32nd Street Joplin, MO 64803 sustained the following injuries at the Location: I-81; Carlisle, Pennsylvania Injuries: lower back 8. A Complaint was filed against the defendants. 9. Attached hereto is a statement under oath of the minor's guardian certifying approval of the proposed settlement and distribution, herein as Exhibit "A". 10. A Doctor's report is attached hereto, herein as Exhibit "B". 11. All medical treatment was paid by first party benefits; Hertz Claim Management. 12. The following settlement has been proposed: GROSS AMOUNT OF SETTLEMENT: LESS LEGAL FEES: Clearfield & Kofsky NET PROCEEDS: LESS COSTS: Medical Records Lawsuit & Filing Fee Courier Service $ 35.00 $ 12.75 $ 60.00 $ 3,500.00 $ 875.00 $ 2,625.00 $ 107.75 AMOUNT DUE TO CLIENT: $ 2,517.25 13. Counsel is of the professional opinion that the proposed settlement is reasonable due to the following: Plaintiff, Jerran Parks, a minor, has fully recovered from the injuries he sustained in this accident. 14. Counsel has incurred the following expenses for which reimbursement is sought: GROSS AMOUNT OF SETTLEMENT: LESS LEGAL FEES: Clearfield & Kofsky NET PROCEEDS: LESS COSTS: 4 $ 3,500.00 $ 875.00 $ 2,625.00 $ 107.75 Medical Records Lawsuit & Filing Fee Courier Service $ 35.00 $ 12.75 $ 60.00 AMOUNT DUE TO CLIENT: $ 2,517.25 15. The following costs have been incurred by or on behalf of the minor and must be paid from the proceeds of settlement: $ 107.75 16. Counsel requests a fee in the sum of $ 875.00. A copy of the retainer agreement is attached hereto and incorporated by reference as Exhibit "C". 17. Counsel has not and will not receive collateral payments as counsel fees for representation involving the same matter from third parties. 18. The net settlement payable to the minor (after deduction of costs and attorney's fee) is $ 2,517.25. WHEREFORE, Petitioner requests that he be permitted to enter into the settlement recited above and that the Court enter an Order of Distribution as follows: TOTAL AMOUNT OF SETTLEMENT: $ 3,500.00 a. To: Clearfield & Kofsky $ 107.75 (Reimbursement for Costs) b. To: Medical Providers c. To: Clearfield & Kofsky (Counsel Fees 25%) d. To: Adult Plaintiff(s) e. To: Jerran Parks, a minor, in restricted accounts not to be withdrawn before majority upon prior leave of Court. By: CLEARFIELD & K l $ N/A $ 875.00 $ N/A $ 2,517.25 a ANDREW C. SkIALQWICZ, ESQUIRE Attorney for Minor IIlaintiff JERRAN PARKS 5 CLEARFIELD & KOFSKY By: Andrew C. Smialowicz, Esquire Identification No.: 307420 One Penn Center at Suburban Station Suite 355, 1617 J.F.K. Boulevard Philadelphia, PA 19103 (215) 563-6333 Attorney for Plaintiff JERRAN PARKS, a minor by and through . his parent and natural guardian MARSHA COURT OF COMMON PLEAS STEVENS CUMBERLAND COUNTY v. NO. 2014-5091 CHRISTOPHER RITTENHOUSE and CON -WAY TRUCKING ATTORNEY'S AFFIDAVIT I, Andrew C. Smialowicz, am the attorney in this action and hereby verify that the settlement described is fair and reasonable based on the liability involved in the accident, the injuries sustained, the medical treatment rendered an the p cy limits a ilable. t CLEARFIELD &,KbFSK✓Y By: ANDREW ,C. SIvIIALOWICZ, ESQUIRE Attorney fSJ/iinor Plaintiff JERRAN PARKS 6 JP EXH1BIT CLEARFIELD & KOFSKY By: Andrew C. Smialowicz, Esquire Identification No. 307420 Suburban Station Building - Suite 355 1617 JFK Boulevard Philadelphia, PA 19103 (215) 563-6333 JERRAN PARKS, a minor, by and through p/n/g MARSHA STEVENS Attorney for Minor Plaintiff AFFIDAVIT AND VERIFICATION I, MARSHA STEVENS, the parent and natural guardian of JERRAN PARKS, a minor, am the Petitioner in this action and hereby verify that the statements made in the foregoing Petition are true and correct to the best of my knowledge, information and belief. Furthermore, MARSHA STEVENS, specifically approve of the settlement of this action as set forth in the Petition and does affirm that presently, JERRAN PARKS, a minor, herein, has fully recovered from the injuries sustained in this accident. I understand that the statement in said Petition are made subject to the penalties of 18 § C.S.A. 4904 relating unsworn falsification to the authorities. MARS A STEVENS, parent and legal guardian of JERRAN PARKS, a minor CLEARFIELD & KOFSKY By: Andrew C. Smialowicz, Esquire Identification No. 307420 Suburban Station Building - Suite 355 1617 JFK Boulevard Philadelphia, PA 19103 JERRAN PARKS, a minor Attorney for Minor Plaintiff VERIFICATION AND AFFIDAVIT I, JERRAN PARKS, hereby verify that I am over the age of 16 and I approve of the settlement as stated in the enclosed Petition. Furthermore, I, JERRAN PARKS, specifically approve the settlement of this action as set forth in the Petition and does affirm that presently, I have fully recovered from the injuries I sustained in this accident. I understand that the statement in said Petition are made subject to the penalties of 18 PA. C.S.A. § 4904 relating unsworn falsification to the authorities. JERRAN PARKS EXHIBIT Chart Notes Jerran Parkes Billingsley & Luckett Chiropractic & Rehab 3289 Salem Road Covington, GA 300162863 Phone: 770-760-1396 Fax : 770-760-7904 Patient: Parks, Jerran Ins Co Hertz Claim Management PoI # 0220134063 Insured Date 04/03/2013 Provider Aaron Rossi, DC Subjective: Jarran sought treatment today complaining of frequent aching and throbbing discomfort in the low back. He rated the intensity of discomfort as a level 7 on a scale of 1 to 10 with 10 being the most severe. The discomfort was reported to increase with prolonged sitting. The discomfort was reported to decrease with chiropractic care, movement and heat. Jarran also complained of intermittent numbing and tingling discomfort in the left palm. He rated the intensity of discomfort as a level 8 on a scale of 1 to 10 with 10 being the most severe. The discomfort was reported to increase with coughing / sneezing and applied pressure. The discomfort was reported to decrease with chiropractic care and heat. Objective: Jarran had a re-exam today. Based upon today's findings, in my opinion he is only slightly better. Additional care on a proactive basis is advised. Range of Motion An updated assessment of Mr. Parkes's cervical and lumbar spinal movement, in each direction. His cervical and lumbar spine had a normal range of movement in all directions. Proprioceptive test Tandem Romberg is positive to the left, but is suspected related to brain injury as a child. Based upon palpatory findings of paraspinal muscle tone and symmetry, spinal segmental position and movement, overall spinal curvature and posture, proprioceptive signals and leg checks; prone and supine - the adjustment was indicated at occiput, C6, T7 and sacrum. Assessment: He has completed his symptomatic recovery from the auto accident. Further care will be for the purpose of improved neurospinal integrity on a proactive basis which is highly recommended. Plan: A reexamination was performed today on Mr. Parkes along with a specific spinal adjustment in three regions. The Objective portion of today's note describes the findings. Printed: Wednesday, April 10, 2013 11:17:11 AM Page 1 Of 15 Chart Notes Jerran Parkes Billingsley & Luckett Chiropractic & Rehab 3289 Salem Road Covington, GA 300162863 Phone: 770-760-1396 Fax : 770-760-7904 Patient: Parks, Jerran Ins Co Hertz Claim Management PoI # 0220134063 Insured Date 04/03/2013 Provider Aaron Rossi, DC *** continued from previous page *** Jarran has completed the auto accident case today. Further care is advised on a proactive basis. Diagnosis 847.0: Cervical strain/sprain 784.0: Headache face/head pain 847.2: Lumbar sprain or strain 724.2: Lumbalgia 353.3: Thoracic Root Lesions 353.3 847.1: Thoracic sprain/strain 719.41: Pain - shoulder Right 719.45: Pain - hip/thigh Left Doctor Signature X 04/03/2013 07:10 P Printed: Wednesday, April 10, 2013 11:17:11 AM Page 2 Of 15 EXHIBIT ► G CONTINGENT FEE AGREEMENT Ys as m attorneys to prosecute a claim for personal injuries against or any other parties who shall be liable. The Claimant is Ze 'eck,\ -CAI\ k s for an accident/incident which occurred on FtbruArut 1 Aain3 I hereby agree that the compensation for my attorneys for all services shall be as follows: Out of whatever sum is secured from the D endant(s) by way of settlement or verdict, the attorneys shall retain forty percent ( of thereof. My attorneys, at their option, may advance the costs and expenses of my claim on my behalf. However, nothing in this agreement shall require my attorneys to pay all said costs and expenses. My attorneys, at their option, may pay said costs and expenses, or my attorneys may withdraw from representing me on my claim. The expenses of processing my claim, including investigation, trial preparation, expert and non -expert witness fees, if any, shall be deducted from my share of the proceeds derived from settlement or verdict of the claim/suit after the calculation of attorneys fees. If my Lawyer does not recover any money then he shall receive no fee. If litigation commenced on my claim is unsuccessful, my attorney shall not be required to file an appeal. I hereby authorize' my attorneys to pay bills for medical and hospital treatment directly to the physician, hospital or third party payee, upon successful resolution of the claim only. I also, for the purpose of litigation only; authorize my attorneys to negotiate; endorse, deposit and distribute any checks received on my behalf. I have read this Agreement, and agree to its terms and conditions. There are no r oral agreements between myself and said attorneys, regarding the subject ►tel. CLIENT NAME Joint General Court Regulation Trial Division and Orphans' Court Division No. 97-1 Minors and Incapacitated Person Checklist Settlement/Trial Division: Cumberland County Court Term: 2014 Caption: Adriana Foster, a minor by her p/n/g Marsha Stevens v. Con -Way Trucking, et al Number: 5091 Companion Cases (indicate Court Term and Number): Yes X No Any Pleadings filed in Orphans' Court: Are the following items included in the Petition/Order: YES NO 1. Minor/Incapacitated Person's: a. Date of Birth x b. Social Security Number x c. Address x d. Written approval of settlement if minor is 16 years or older 2. Parent/Guardian verification attached x 3. If Guardian of Estate was appointed, is Order attached 4. Information concerning mother and father x 5. Details concerning the injuries x 6. Doctor's report of present condition of minor/incapacitated person x 7. Statement from parent and/or guardian certifying the condition of minor/incapacitated person and approval of proposed settlement x 8. Counsel's reasons for approval of proposed settlement x 9. Petition signed by counsel x 10. Department of Welfare or any entity lien or claim x 11. Does the Order contain the following: a. Itemization of costs for reimbursement x b. Counsel fee computed on net settlement x c. Affidavit will be filed certifying compliance with Order x d. Amount to minor/incapacitated person (in restricted accounts, typically if under $350,000.00) x e. Amount to guardian of minor/incapacitated person (typically if over $350,000.00) I verify the answer ab understand that inaccurate or inc x x x ve to be true and correct and s may be imposed for nswers. ANDREW C 1 OWICZ, ESQUIRE ID# 307420 CLEARFIELD & KOFSKY By: Andrew C. Smialowicz, Esquire Identification No.: 307420 One Penn Center at Suburban Station Suite 355, 1617 J.F.K. Boulevard Philadelphia, PA 19103 (215) 563-6333 ADRIANA FOSTER, a minor by and through her parent and natural guardian MARSHA STEVENS V. CHRISTOPHER RITTENHOUSE and CON -WAY TRUCKING Attorney for Plaintiff • i THE PR 0 iK.INO T 2714 DEC -6 P9 2: 55 • CUMBERLAND COUNT"( PENNSYLVANIA COURT OF COMMON PLEAS CUMBERLAND COUNTY NO. 2014-5091 PETITION FOR LEAVE TO SETTLE OR COMPROMISE A MINOR'S ACTION TO THE HONORABLE, THE JUDGES OF THE SAID COURT: The Petition for Adriana Foster, a minor, by and through her legal guardian, Marsha Stevens (see PA. R.C.P. 2028), by her attorney, Andrew C. Smialowicz, Esquire respectfully requests: 1. Petitioner is Adriana Foster, a minor. 2. The minor was born on March 29, 2000, and her social security number is 206-78-3784. The minor resides with her mother at the following address: 595 Pebble Boulevard Covington, GA 30016 4. A guardian was not appointed for the minor. 5. The minor's mother is Marsha Stevens. 6. The defendants are as follows: Christopher Rittenhouse 52795 Fir Road Grander, IN 46530 Con -Way Trucking 4701 E. 32nd Street Joplin, MO 64803 7. On February 18, 2013, the minor sustained the following injuries at the following location: Location: 1-81; Carlisle, Pennsylvania Injuries: neck & upper back - pain 8. A Complaint was filed against the defendants. 9. Attached hereto is a statement under oath of the minor's guardian certifying approval of the proposed settlement and distribution, herein as Exhibit "A", 10. A Doctor's report is attached hereto, herein as Exhibit "B". 11. All medical treatment was paid by first party benefits; Hertz Claim Management. 12. The following settlement has been proposed: GROSS AMOUNT OF SETTLEMENT: $ 3,500.00 LESS LEGAL FEES: $ 875.00 Clearfield & Kofsky NET PROCEEDS: $ 2,625.00 LESS COSTS: $ 141.30 Medical Records Lawsuit & Filing Fee Courier Service $ 68.55 $ 12.75 $ 60.00 AMOUNT DUE TO CLIENT: $ 2,483.70 13. Counsel is of the professional opinion that the proposed settlement is reasonable due to the following: Plaintiff, Adriana Foster, a minor, has fully recovered from the injuries she sustained in this accident. 14. Counsel has incurred the following expenses for which reimbursement is sought: GROSS AMOUNT OF SETTLEMENT: $ 3,500.00 LESS LEGAL FEES: $ 875.00 Clearfield & Kofsky NET PROCEEDS: $ 2,625.00 LESS COSTS: $ 141.30 4 Medical Records Lawsuit & Filing Fee Courier Service $ 68.55 $ 12.75 $ 60.00 AMOUNT DUE TO CLIENT: $ 2,483.70 15. The following costs have been incurred by or on behalf of the minor and must be paid from the proceeds of settlement: $ 141.30 16. Counsel requests a fee in the sum of $ 875.00. A copy of the retainer agreement is attached hereto and incorporated by reference as Exhibit "C". 17. Counsel has not and will not receive collateral payments as counsel fees for representation involving the same matter from third parties. 18. The net settlement payable to the minor (after deduction of costs and attorney's fee) is $ 2,483.70. WHEREFORE, Petitioner requests that she be permitted to enter into the settlement recited above and that the Court enter an Order of Distribution as follows: TOTAL AMOUNT OF SETTLEMENT: $ 3,500.00 a. To: Clearfield & Kofsky $ 141.30 (Reimbursement for Costs) b. To: Medical Providers $ N/A c. To: Clearfield & Kofsky $ 875.00 (Counsel Fees 25%) d. To: Adult Plaintiff(s) $ N/A e. To: Adriana Foster, a minor, in $ 2,483.70 restricted accounts not to be withdrawn before majority upon prior leave of Court. By: CLEARFIELD �' AiihL ANDREW ► IALOWICZ, ESQUIRE Attorney for Minor Plaintiff ADRIANA FOSTER 5 CLEARFIELD & KOFSKY By: Andrew C. Smialowicz, Esquire Identification No.: 307420 One Penn Center at Suburban Station Suite 355, 1617 J.F.K. Boulevard Philadelphia, PA 19103 (215) 563-6333 Attorney for Plaintiff ADRIANA FOSTER, a minor by and through her parent and natural guardian COURT OF COMMON PLEAS MARSHA STEVENS CUMBERLAND COUNTY V. NO. 2014-5091 CHRISTOPHER RITTENHOUSE and CON -WAY TRUCKING ATTORNEY'S AFFIDAVIT I, Andrew C. Smialowicz, am the attorney in this action and hereby verify that the settlement described is fair and reasonable based on the liability involved in the accident, the injuries sustained, the medical treatment rendered and the policy limits available. CLEARFIELD By: ANDREW C.'M •WICZ, ESQUIRE Attorney for Minor Plaintiff ADRIANA FOSTER 6 A1= EXHIBIT IA CLEARFIELD & KOFSKY By: Andrew C. Smialowicz, Esquire Identification No. 307420 Suburban Station Building Suite 355 1617 JFK Boulevard Philadelphia, PA 19103 (215) 563-6333 ADRIANA FOSTER, a minor, by and through p/n/g MARSHA STEVENS Attorney for Minor Plaintiff AFFIDAVIT AND VERIFICATION I, MARSHA STEVENS, the parent and natural guardian of ADRIANA FOSTER, a minor, am the Petitioner in this action and hereby verify that the statements made in the foregoing Petition are true and correct to the best of my knowledge, information and belief. Furthermore, MARSHA STEVENS, specifically approve of the settlement of this action as set forth in the Petition and does affirm that presently, ADRIANA FOSTER, a minor, herein, has fully recovered from the injuries sustained in this accident. I understand that the statement in said Petition are made subject to the penalties of 18 § C.S.A. 4904 relating unsworn falsification to the authorities. MARSHA STEVENS, parent and legal guardian of ADRIANA FOSTER, a minor EXHIBIT 13 12-06-13;15:43 ;bi I I ingsley-luckett Chart Notes Adriana Foster 18665204002 ;7707607904 # 25/ 26 Billingsley & Luckett Chiropractic & Rehab 3289 Salem Road Covington, OA 300162883 Phone: 770.760-1396 FOX: 770-7604904 Patient: Foster, Adriana OS: 3/29/2000 Ins Co Hertz Claim Management Poi # 0220134063 Date 04/03/2013 italfitV' Insured .10147-71,1,W,kra.$?„' vc”•1•470:,:?,,,;.3*.ip",r17,:mtI7 Ag0,7r. Subjective: Adrianna reports some discomfort in the lower and right aspect of her lower back. It is most bothersome when in a crouching position. Objective: Adriana had a re-exam today. Based upon today's findings, in my opinion she is better. Range of Motion An updated assessment of Ms. Fosters cervical and lumbar spinal movement, in each direction. Her cervical and lumbar spine had a normal range of movement in all directions. Palpatory findings of paraspinal muscle tone and symmetry, spinal segmental position and movement, overall spinal curvature and posture, proprioceptive signals and leg checks; prone and supine - the adjustment was indicated at occiput, Cl, L3 and sacrum. Assessment: She has completed her symptomatic recovery from the auto accident. Further care will be for the purpose of improved neurospinal integrity on a proactive basis which Is highly recommended. Plan: A reexamination was performed today on Mrs. Foster along with a specific spinal adjustment in three regions. The Objective portion of today's note describes the findings. She has completed her recovery related to the symptoms originating from the motor vehicle accident. Further care is advised proactively. Diagnosis 847.0: Cervical strain/sprain 839.00: Traumatic Cervical subluxation 1 vertebra 723,1: Cervicalgia 847.2: Lumbar sprain or strain 724,2: Lumbalgla 739.3: Lumbar Subluxation 847.1: Thoracic sprain/stralh 724,1: Thoracalgia 719.45: Pain - hip/thigh Right 719.41: Pain - shoulder Right Printed: Thursday, r10. 2013 9:46:15 AM Page 14 , 12-06-13;15;43 ;billingsley-luckett Chart Notes Adriana Foster 18665204002 ;7707607904 # 26/ 26 Billingsley & Lucked Chiropractic & Rehab 3280 Salem Road Covington, GA $00162863 Phone: 770-760-1396 Fax: 770-760-7904 Patient: Foster, Adriana ins CO Hertz Claim Management Date 04/03/2013 DOB: 3129/2000 1301g 0220134063 4.1:;„rT1 „ (We 1,4 N 4 t A r:SA1Nrf II Provider Signature X Insured 04/03/2 13 07:0 PM Printed: Thursday, September 19, 2013 0:45:16 AM Page 16 Of 15 EXHIBIT ► CONTINGENT FEE AGREEMENT attorneys to prosecute a claim for personal injuries against ys as or any other parties who shall be liable. The Claimant is AC./ (c, (NCI, .F;cf-f?(-- for an accident/incident which occurred on FAbazl4 I hereby agree that the compensation for my attorneys for all services shall be as follows: Out of whatever sum is secured from the D endant(s) by way of settlement or verdict, the attorneys shall retain forty percent (4D0) thereof. My attorneys, at their option, may advance the costs and expenses of my claim on my behalf. However, nothing in this agreement shall require my attorneys to pay all said costs and expenses. My attorneys, at their option, may pay said costs and expenses, or my attorneys may withdraw from representing me on my claim. The expenses of processing my claim, including investigation, trial preparation, expert and non -expert witness fees, if any, shall be deducted from my share of the proceeds derived from settlement or verdict of the claim/suit after the calculation of attorneys fees. If my lawyer does not recover any money then he shall receive no fee. If litigation commenced on my claim is unsuccessful, my attorney shall not be required to file an appeal. I hereby authorize. my attorneys to pay bills for medical and hospital treatment directly to the physician, hospital or third party payee, upon successful resolution of the claim only. I also, for the purpose of litigation only, authorize my attorneys to negotiate, endorse, deposit and distribute any checks received on my behalf I have read this Agreement, and agree to its terms and conditions. There are no oral agreements between myself and said attorneys, regarding the subject CLIENT NAME Joint General Court Regulation Trial Division and Orphans' Court Division No. 97-1 Minors and Incapacitated Person Checklist Settlement/Trial Division: Cumberland County Court Term: 2014 Caption: Rayann Foster. a minor by her p/n/g Marsha Stevens v. Con -Way Trucking. et al Number: 5091 Companion Cases (indicate Court Term and Number): Any Pleadings filed in Orphans' Court: Yes X No Are the following items included in the Petition/Order: YES NO 1. Minor/Incapacitated Person's: a. Date of Birth x b. Social Security Number x c. Address x d. Written approval of settlement if minor is 16 years or older 2. Parent/Guardian verification attached x 3. If Guardian of Estate was appointed, is Order attached 4. Information concerning mother and father x 5. Details concerning the injuries x 6. Doctor's report of present condition of minor/incapacitated person x 7. Statement from parent and/or guardian certifying the condition of minor/incapacitated person and approval of proposed settlement x 8. Counsel's reasons for approval of proposed settlement x 9. Petition signed by counsel x 10. Department of Welfare or any entity lien or claim x 11. Does the Order contain the following: a. Itemization of costs for reimbursement x b. Counsel fee computed on net settlement x c. Affidavit will be filed certifying compliance with Order x d. Amount to minor/incapacitated person (in restricted accounts, typically if under $350,000.00) x e. Amount to guardian of minor/incapacitated person (typically if over $350,000.00) x x x I verify the answer above to be true and correct and understand that sar go s may be imposed for inaccurate or inc. '1 - ans < ers. ID# 307420 ANDREW ♦. S1�I` " Z, ESQUIRE 1 CLEARFIELD & KOFSKY By: Andrew C. Smialowicz, Esquire Identification No.: 307420 One Penn Center at Suburban Station Suite 355, 1617 J.F.K. Boulevard Philadelphia, PA 19103 (215) 563-6333 RAYANN FOSTER, a minor by and through : her parent and natural guardian MARSHA STEVENS v. Attorney for Plaintiff +` T j1:1;41 -ti. ; `tet iFi� `l DEC -8 P1 2: PN CUf1Bt LHi1D COUNTY PENNSYLVANIA COURT OF COMMON PLEAS CUMBERLAND COUNTY NO. 2014-5091 CHRISTOPHER RITTENHOUSE and CON -WAY TRUCKING PETITION FOR LEAVE TO SETTLE OR COMPROMISEA MINOR'S ACTION TO THE HONORABLE, THE JUDGES OF THE SAID COURT: The Petition for Rayann Foster, a minor, by and through her legal guardian, Marsha Stevens (see PA. R.C.P. 2028), by her attorney, Andrew C. Smialowicz, Esquire respectfully requests: 1. Petitioner is Rayann Foster, a minor. 2. The minor was born on March 29, 2001, and her social security number is 173-80-3165. 3. The minor resides with her mother at the following address: 595 Pebble Boulevard Covington, GA 30016 4. A guardian was not appointed for the minor. 5. The minor's mother is Marsha Stevens. 6. The defendants are as follows: Christopher Rittenhouse 52795 Fir Road Grander, IN 46530 7. On February 18, 2013, the minor following location: 3 Con -Way Trucking 4701 E. 32nd Street Joplin, MO 64803 sustained the following injuries at the Location: I-81; Carlisle, Pennsylvania Injuries: upper back - pain 8. A Complaint was filed against the defendants. 9. Attached hereto is a statement under oath of the minor's guardian certifying approval of the proposed settlement and distribution, herein as Exhibit "A". 10. A Doctor's report is attached hereto, herein as Exhibit "B". 11. All medical treatment was paid by first party benefits; Hertz Claim Management. 12. The following settlement has been proposed: GROSS AMOUNT OF SETTLEMENT: $ 3,500.00 LESS LEGAL FEES: $ 875.00 Clearfield & Kofsky NET PROCEEDS: $ 2,625.00 LESS COSTS: $ 107.75 Medical Records Lawsuit & Filing Fee Courier Service $ 35.00 $ 12.75 $ 60.00 AMOUNT DUE TO CLIENT: $ 2,517.25 13. Counsel is of the professional opinion that the proposed settlement is reasonable due to the following: Plaintiff, Rayann Foster, a minor, has fully recovered from the injuries she sustained in this accident. 14. Counsel has incurred the following expenses for which reimbursement is sought: GROSS AMOUNT OF SETTLEMENT: $ 3,500.00 LESS LEGAL FEES: $ 875.00 Clearfield & Kofsky NET PROCEEDS: $ 2,625.00 LESS COSTS: $ 107.75 4 Medical Records Lawsuit & Filing Fee Courier Service $ 35.00 $ 12.75 $ 60.00 AMOUNT DUE TO CLIENT: $ 2,517.25 15. The following costs have been incurred by or on behalf of the minor and must be paid from the proceeds of settlement: $ 107.75 16. Counsel requests a fee in the sum of $ 875.00. A copy of the retainer agreement is attached hereto and incorporated by reference as Exhibit "C". 17. Counsel has not and will not receive collateral payments as counsel fees for representation involving the same matter from third parties. 18. The net settlement payable to the minor (after deduction of costs and attorney's fee) is $ 2,517.25. WHEREFORE, Petitioner requests that she be permitted to enter into the settlement recited above and that the Court enter an Order of Distribution as follows: TOTAL AMOUNT OF SETTLEMENT: $ 3,500.00 a. To: Clearfield & Kofsky $ 107.75 (Reimbursement for Costs) b. To: Medical Providers $ N/A c. To: Clearfield & Kofsky $ 875.00 (Counsel Fees 25%) d. To: Adult Plaintiff(s) $ N/A e. To: Rayann Foster, a minor, in $ 2,517.25 restricted accounts not to be withdrawn before majority upo prior leave of Court. By: CLEARFIELD SICA' ANDREW C. ALOWICZ, ESQUIRE Attorney for Minor Plaintiff RAYANN FOSTER 5 CLEARFIELD & KOFSKY By: Andrew C. Smialowicz, Esquire Identification No.: 307420 One Penn Center at Suburban Station Suite 355, 1617 J.F.K. Boulevard Philadelphia, PA 19103 (215) 563-6333 Attorney for Plaintiff RAYANN FOSTER, a minor by and through : her parent and natural guardian MARSHA COURT OF COMMON PLEAS STEVENS CUMBERLAND COUNTY v. NO. 2014-5091 CHRISTOPHER RITTENHOUSE and CON -WAY TRUCKING ATTORNEY'S AFFIDAVIT I, Andrew C. Smialowicz, am the attorney in this action and hereby verify that the settlement described is fair and reasonable based on the liability involved in the accident, the injuries sustained, the medical treatment rendered and the policy limits available. CLEARFIELD By: ANDREW IALOWICZ, ESQUIRE Attorney for Minor Plaintiff RAYANN FOSTER 6 RF EXHIBIT CLEARFIELD & KOFSKY By: Andrew C. Smialowicz, Esquire Identification No. 307420 Suburban Station Building - Suite 355 1617 JFK Boulevard Philadelphia, PA 19103 (215) 563-6333 RAYANN FOSTER, a minor, by and through p/n/g MARSHA STEVENS Attorney for Minor Plaintiff AFFIDAVIT AND VERI=FICATION I, MARSHA STEVENS, the parent and natural guardian of RAYANN FOSTER, a minor, am the Petitioner in this action and hereby verify that the statements made in the foregoing Petition are true and correct to the best of my knowledge, information and belief. Furthermore, MARSHA STEVENS, specifically approve of the settlement of this action as set forth in the Petition and does affirm that presently, RAYANN FOSTER, a minor, herein, has fully recovered from the injuries sustained in this accident. I understand that the statement in said Petition are made subject to the penalties of 18 § C.S.A. 4904 relating unsworn falsification to the authorities. dita 41111.1112111 X CV' PIP:31'Fir .11.01PP --- MARSHA STEVENS, parent and legal guardian of RAYANN FOSTER, a minor f Chart Notes Rayann Foster Billingsley & Luckett Chiropractic & Rehab 3289 Salem Road Covington, GA 300162863 Phone: 770-760-1396 Fax : 770-760-7904 Patient: Foster, Rayann Ins Co Hertz Claim Management PoI # 0220134063 Insured Date 04/03/2013 Provider Aaron Rossi, DC Subjective: Rayann sought treatment today complaining of intermittent dull and tingling discomfort in the low back. She rated the intensity of discomfort as a level 4 on a scale of 1 to 10 with 10 being the most severe. The discomfort was reported to increase with movement and applied pressure. The discomfort was reported to decrease with rest and chiropractic care. Rayann also complained of occasional dull and tingling discomfort in the upper back. She rated the intensity of discomfort as a level 2 on a scale of 1 to 10 with 10 being the most severe. The discomfort was reported to increase with movement. The discomfort was reported to decrease with rest and chiropractic care. Objective: Rayann had a re-exam today. Based upon today's findings, in my opinion she is better. Range of Motion An updated assessment of Ms. Foster's cervical and lumbar spinal movement, in each direction. Her cervical and lumbar spine had a normal range of movement in all directions. Palpatory findings of paraspinal muscle tone and symmetry, spinal segmental position and movement, overall spinal curvature and posture, proprioceptive signals and leg checks; prone and supine - the adjustment was indicated at C1, C5, T4 and sacrum. Assessment: She has completed her symptomatic recovery from the auto accident. Further care will be for the purpose of improved neurospinal integrity on a proactive basis which is highly recommended. Plan: A reexamination was performed today on Mrs. Foster. Along with a spinal adjustment in three regions. The Objective portion of today's note describes the findings. She is released from her auto accident case today. Further proactive care is recommended. Printed: Wednesday, April 10, 2013 10:42:35 AM Page 1 Of 13 Chart Notes Rayann Foster Billingsley & Luckett Chiropractic & Rehab 3289 Salem Road Covington, GA 300162863 Phone: 770-760-1396 Fax : 770-760-7904 Patient: Foster, Rayann Ins Co Hertz Claim Management PoI # 0220134063 Insured Date 04/03/2013 Provider Aaron Rossi, DC Diagnosis 847.0: Cervical strain/sprain 723.1: Cervicalgia 847.2: Lumbar sprain or strain 724.2: Lumbalgia 353.3: Thoracic Root Lesions 353.3 839.20: Traumatic Lumbar subluxation 719.41: Pain - shoulder Right Doctor Signature X *** continued from previous page *** ll 04/03/2013 07:1 P i Printed: Wednesday, April 10, 2013 10:42:36 AM Page 2 Of 13 CONTINGENT FEE AGREEMENT I hereby a... ' • " • eys as m attorneys to prosecute a claim for personal injuries against or any other parties who shall be liable. The Claimant is lay ay) IA, "ci f.A for an accident/incident which occurred on Fthy, 1 � '�}-0(9) I hereby agree that the compensation for my attorneys for all services shall be as follows: Out of whatever sum is secured from the D endant(s) by way of settlement or verdict, the attorneys shall retain forty percent (4 0) thereof. My attorneys, at their option, may advance the costs and expenses of my claim on my behalf. However, nothing in this agreement shall require my attorneys to pay all said costs and expenses. My attorneys, at their option, may pay said costs and expenses, or my attorneys may withdraw from representing me on my claim. The expenses of processing my claim, including investigation, trial preparation, expert and non -expert witness fees, if any, shall be deducted from my share of the proceeds derived from settlement or verdict of the claim/suit after the calculation of attorneys fees. If my lawyer does not recover any money then he shall receive no fee. If litigation commenced on my claim is unsuccessful, my attorney shall not be required to file an appeal. I hereby authorize my attorneys to pay bills for medical and hospital treatment directly to the physician, hospital or third party payee, upon successful resolution of the claim only. I also, for the purpose of litigation only; authorize my attorneys to negotiate, endorse, deposit and distribute any checks received on my behalf. I have read this Agreement, and agree to its terms and conditions. There are no other - • .or oral agreements between myself and said attorneys, regarding the subject 05011111 191 CLIENT NAME Joint General Court Regulation Trial Division and Orphans' Court Division No. 97-1 Minors and Incapacitated Person Checklist Settlement/Trial Division: Cumberland County Court Term: 2014 Caption: Kayla Foster, a minor by her p/n/g Marsha Stevens v. Con -Way Trucking, et al Number: 5091 Companion Cases (indicate Court Term and Number): Any Pleadings filed in Orphans' Court: Yes X No Are the following items included in the Petition/Order: YES NO 1. Minor/Incapacitated Person's: a. Date of Birth x b. Social Security Number x c. Address x d. Written approval of settlement if minor is 16 years or older 2. Parent/Guardian verification attached x 3. If Guardian of Estate was appointed, is Order attached 4. Information concerning mother and father x 5. Details concerning the injuries x 6. Doctor's report of present condition of minor/incapacitated person x 7. Statement from parent and/or guardian certifying the condition of minor/incapacitated person and approval of proposed settlement x 8. Counsel's reasons for approval of proposed settlement x 9. Petition signed by counsel x 10. Department of Welfare or any entity lien or claim x 11. Does the Order contain the following: a. Itemization of costs for reimbursement x b. Counsel fee computed on net settlement x c. Affidavit will be filed certifying compliance with Order x d. Amount to minor/incapacitated person (in restricted accounts, typically if under $350,000.00) x e. Amount to guardian of minor/incapacitated person (typically if over $350,000.00) x x x I verify the answer above to be true and correct and understand that c i • > s may be imposed for inaccurate or inco to wers. ANDREW C. 1 -fez, SQUIRE ID# 307420 CLEARFIELD & KOFSKY By: Andrew C. Smialowicz, Esquire Identification No.: 307420 One Penn Center at Suburban Station Suite 355, 1617 J.F.K. Boulevard Philadelphia, PA 19103 (215) 563-6333 KAYLA FOSTER, a minor by and through her parent and natural guardian MARSHA STEVENS v. CHRISTOPHER RITTENHOUSE and CON -WAY TRUCKING Attorney for Plaintiff 1i S i� ds �'�jTHON ,T�to `� f F w -8 PM 2: 5 CUMSERL yip COUNTY PENNSYLVANIA COURT OF COMMON PLEAS CUMBERLAND COUNTY NO. 2014-5091 PETITION FOR LEAVE TO SETTLE OR COMPROMISEA MINOR'S ACTION TO THE HONORABLE, THE JUDGES OF THE SAID COURT: The Petition for Kayla Foster, a minor, by and through her legal guardian, Marsha Stevens (see PA. R.C.P. 2028), by her attorney, Andrew C. Smialowicz, Esquire respectfully requests: 1. Petitioner is Kayla Foster, a minor. 2. The minor was born on November 02, 2003, and her social security number is 167-82-7458. 3. The minor resides with her mother at the following address: 595 Pebble Boulevard Covington, GA 30016 4. A guardian was not appointed for the minor. 5. The minor's mother is Marsha Stevens. 6. The defendants are as follows: Christopher Rittenhouse 52795 Fir Road Grander, IN 46530 7. On February 18, 2013, the minor following location: 3 Con -Way Trucking 4701 E. 32nd Street Joplin, MO 64803 sustained the following injuries at the Location: I-81; Carlisle, Pennsylvania Injuries: lower back - pain 8. A Complaint was filed against the defendants. 9. Attached hereto is a statement under oath of the minor's guardian certifying approval of the proposed settlement and distribution, herein as Exhibit `A". 10. A Doctor's report is attached hereto, herein as Exhibit "B". 11. All medical treatment was paid by first party benefits; Hertz Claim Management. 12. The following settlement has been proposed: GROSS AMOUNT OF SETTLEMENT: $ 3,500.00 LESS LEGAL FEES: $ 875.00 Clearfield & Kofsky NET PROCEEDS: LESS COSTS: Lawsuit & Filing Fee Courier Service AMOUNT DUE TO CLIENT: $ 12.75 $ 60.00 $ 2,625.00 $ 72.75 $ 2,552.25 13. Counsel is of the professional opinion that the proposed settlement is reasonable due to the following: Plaintiff, Kayla Foster, a minor, has fully recovered from the injuries she sustained in this accident. 14. Counsel has incurred the following expenses for which reimbursement is sought: GROSS AMOUNT OF SETTLEMENT: $ 3,500.00 LESS LEGAL FEES: $ 875.00 Clearfield & Kofsky NET PROCEEDS: $ 2,625.00 LESS COSTS: $ 72.75 4 Lawsuit & Filing Fee $ 12.75 Courier Service $ 60.00 AMOUNT DUE TO CLIENT: $ 2,552.25 15. The following costs have been incurred by or on behalf of the minor and must be paid from the proceeds of settlement: $ 72.75 16. Counsel requests a fee in the sum of $ 875.00. A copy of the retainer agreement is attached hereto and incorporated by reference as Exhibit "C". 17. Counsel has not and will not receive collateral payments as counsel fees for representation involving the same matter from third parties. 18. The net settlement payable to the minor (after deduction of costs and attorney's fee) is $ 2,552.25. WHEREFORE, Petitioner requests that she be permitted to enter into the settlement recited above and that the Court enter an Order of Distribution as follows: TOTAL AMOUNT OF SETTLEMENT: $ 3,500.00 a. To: Clearfield & Kofsky $ 72.75 (Reimbursement for Costs) b. To: Medical Providers $ N/A c. To: Clearfield & Kofsky $ 875.00 (Counsel Fees 25%) d. To: Adult Plaintiff(s) $ N/A e. To: Kayla Foster, a minor, in $ 2,552.25 restricted accounts not to be withdrawn before majority upon prior leave of Court. By: CLEARFIELD & ANDREW C. ' OW Attorney for Min.r Plaintiff KAYLA FOSTER 5 ESQUIRE CLEARFIELD & KOFSKY By: Andrew C. Smialowicz, Esquire Identification No.: 307420 One Penn Center at Suburban Station Suite 355, 1617 J.F.K. Boulevard Philadelphia, PA 19103 (215) 563-6333 Attorney for Plaintiff KAYLA FOSTER, a minor by and through her parent and natural guardian COURT OF COMMON PLEAS MARSHA STEVENS CUMBERLAND COUNTY v. NO. 2014-5091 CHRISTOPHER RITTENHOUSE and CON -WAY TRUCKING ATTORNEY'S AFFIDAVIT I, Andrew C. Smialowicz, am the attorney in this action and hereby verify that the settlement described is fair and reasonable based on the liability involved in the accident, the injuries sustained, the medical treatment rendered and the policy limits available. CLEARFIELD & KO By: ANDREW C. ', IA Attorney for Minor Plaintiff KAYLA FOSTER IC ESQUIRE 6 K'F EXHIBIT CLEARFIELD & KOFSKY By: Andrew C. Smialowicz, Esquire Identification No. 307420 Suburban Station Building - Suite 355 1617 JFK Boulevard Philadelphia, PA 19103 (215) 563-6333 KAYLA FOSTER, a minor, by and through p/nlg MARSHA STEVENS Attorney for Minor Plaintiff AFFIDAVIT ANI) VERIFICATION I, MARSHA STEVENS, the parent and natural guardian of KAYLA FOSTER, a minor, am the Petitioner in this action and hereby verify that the statements made in the foregoing Petition are true and correct to the best of my knowledge, information and belief. Furthermore, MARSHA STEVENS, specifically approve of the settlement of this action as set forth in the Petition and does affirm that presently, KAYLA FOSTER, a minor, herein, has fully recovered from the injuries sustained in this accident. I understand that the statement in said Petition are made subject to the penalties of 18 § C.S.A. 4904 relating unsworn falsification to the authorities. MARSHA STEVENS, parent and legal guardian of KAYLA FOSTER, a minor f Chart Notes Kayla Foster Billingsley & Luckett Chiropractic & Rehab 3289 Salem Road Covington, GA 300162863 Phone: 770-760-1396 Fax : 770-760-7904 Patient: Foster, Kayla Ins Co Hertz Claim Management PoI # 0220134063 Insured Date 04/03/2013 Provider Aaron Rossi, DC Subjective: Kayla sought treatment today complaining of frequent sharp, tightness, aching, burning and tingling discomfort in the low back. She rated the intensity of discomfort as a level 9 on a scale of 1 to 10 with 10 being the most severe. The discomfort was reported to increase with movement, applied pressure and prolonged sitting. The discomfort was reported to decrease with rest and chiropractic care. Kayla also complained of constant sharp, tightness, aching, dull and tingling discomfort in the mid chest. She rated the intensity of discomfort as a level 9 on a scale of 1 to 10 with 10 being the most severe. The discomfort was reported to increase with movement, applied pressure and prolonged sitting. The discomfort was reported to decrease with rest and chiropractic care. Objective: Kayla had a re-exam today. Based upon today's findings, in my opinion she is better. Proprioception tests were within normal limits. Palpatory findings of paraspinal muscle tone and symmetry, spinal segmental position and movement, overall spinal curvature and posture, proprioceptive signals and leg checks; prone and supine - the adjustment was indicated at C1, C3, T5 and sacrum. Assessment: She has completed her symptomatic recovery from the auto accident. Further care will be for the purpose of improved neurospinal integrity on a proactive basis which is highly recommended. Plan: A specific spinal adjustment in three regions was performed today. The Objective portion of today's note describes what was adjusted. A reexamination was performed today on Mrs. Foster. Her auto accident case is completed today. Further care on a proactive basis is recommended. Printed: Wednesday, April 10, 2013 11:00:33 AM Page 1 Of 16 Chart Notes Kayla Foster Billingsley & Luckett Chiropractic & Rehab 3289 Salem Road Covington, GA 300162863 Phone: 770-760-1396 Fax :770-760-7904 Patient: Foster, Kayla Ins Co Hertz Claim Management Pol # 0220134063 Insured Date 04/03/2013 L Provider Aaron Rossi, DC Diagnosis 847.0: Cervical strain/sprain 728.85: Spasm of muscle 784.0: Headache face/head pain 847.2:. Lumbar sprain or strain 724.2: Lumbalgia 847.1: Thoracic sprain/strain 353.3: Thoracic Root Lesions 353.3 719.45: Pain - hip/thigh Right 720.2: Sacroiliitis Doctor Signature X *** continued from previous page *** 04/03/2013 06:6 P i Printed: Wednesday, April 10, 2013 11:00:33 AM Page 2 Of 16 EXHIBIT C CONTINGENT FEE AGREEMENT eys attorneys to prosecute a claim for personal injuries against or any other parties who shall be liable. The Claimant is Kety 16,L 'Fb kr for an accident/incident which occurred on Fthrikar14 g 2o i.3 I hereby agree that the compensation for my attorneys for all services shall be as follows: Out of whatever sum is secured from the D endant(s) by way of settlement or verdict, the attorneys shall retain forty percent (4 0) thereof. CDS-2. My attorneys, at their option, may advance the costs and expenses of my claim on my behalf. However, nothing in this agreement shall require my attorneys to pay all said costs and expenses. My attorneys, at their option, may pay said costs and expenses, or my attorneys may withdraw from representing me on my claim. The expenses of processing my claim, including investigation, trial preparation, expert and non -expert witness fees, if any, shall be deducted from my share of the proceeds derived from settlement or verdict of the claim/suit after the calculation of attorneys fees. If my lawyer does not recover any money then he shall receive no fee. If litigation commenced on my claim is unsuccessful, my attorney shall not be required to file an appeal. I hereby authorize* my attorneys to pay bills for medical and hospital treatment directly to the physician, hospital or third party payee, upon successful resolution of the claim only. I also, for the purpose of litigation only; authorize my attorneys to negotiate, endorse, deposit and distribute any checks received on my behalf I have read this Agreement, and agree to its terms and conditions. There are no r oral agreements between myself and said attorneys, regarding the subject CLIENT NAME IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY NINTH JUDICIAL DISTRICT JERRAN PARKS, a minor by and through . his parent and natural guardian MARSHA . STEVENS V. CHRISTOPHER RITTENHOUSE and CON -WAY TRUCKING COURT OF COMMON PLEAS CUMBERLAND COUNTY° -.-r NO. 2014-5091 ,,te�rr ORDER AND NOW, this (Ly 14, upon consideration of the outstanding petition for leave to settle minor's action, a proposed settlement having a gross value of $3,500.00 is hereby approved to be distributed as follows: rrr__ C".); ;.:; TO: Clearfield & Kofsky - Attorney Fee $ 875.00 TO: Clearfield & Kofsky - $ 107.75 Reimbursement for Costs TO: Jerran Parks, a minor, to be placed into an $ 2,517.25 investment/account authorized by Pa. R.C.P. 2039(b)(2) IN THE NAME OF THE MINOR, which investment/ account shall bear the notation "not to be redeemed or withdrawn except for the renewal in its entirely prior to July 13, 2015 except upon Order of the Court." Marsha Stevens, parent and natural guardian of Jerran Parks, a minor, are ORDERED and DIRECTED to file an affidavit of compliance regarding the opening of the restricted investment/account with the Prothonotary of Cumberland County (along with a copy to the undersigned) within thirty days. Clear tddc <sky /ndrew C.Srniaiowiez, BY THE COURT: 911 ,� 2 A IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY NINTH JUDICIAL DISTRICT ADRIANA FOSTER, a minor by and through her parent and natural guardian MARSHA STEVENS v. CHRISTOPHER RITTENHOUSE and CON -WAY TRUCKING COURT OF COMMON PLEA'-_ µv .. n -i �. CUMBERLAND COUNTY NO. 2014-5091 r- • (7) • (-) ORDER AND NOW, thi/b day %f✓,r,Cts b1014, upon consideration of the outstanding petition for leave to settle minor's action, a proposed settlement having a gross value of $3,500.00 is hereby approved to be distributed as follows: TO: Clearfield & Kofsky - Attorney Fee $ 875.00 TO: Clearfield & Kofsky - $ 141.30 Reimbursement for Costs TO: Adriana Foster, a minor, to be placed into an $ 2,483.70 investment/account authorized by Pa. R.C.P. 2039(b)(2) IN THE NAME OF THE MINOR, which investment/ account shall bear the notation "not to be redeemed or withdrawn except for the renewal in its entirely prior to March 29, 2018 except upon Order of the Court." Marsha Stevens, parent and natural guardian of Adriana Foster, a minor, are ORDERED and DIRECTED to file an affidavit of compliance regarding the opening of the restricted investment/account with the Prothonotary of Cumberland County (along with a copy to the undersigned) within thirty days. Arlie1/4/ .Smialowiez,L bP(17 2 BY THE COURT: r IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY NINTH JUDICIAL DISTRICT RAYANN FOSTER, a minor by and through : her parent and natural guardian MARSHA . STEVENS V. CHRISTOPHER RITTENHOUSE and CON -WAY TRUCKING AND NOW, this/0 ORDER (77,• COURT OF COMMON PLEAS r' CUMBERLAND NO. 2014-5091 COUNTY'S C< r J i 4, upon consideration of the /ivy—. outstanding petition for leave to settle minor's action, amel.ftyllowingira.4,tettritrtgitmlatyi the proposed settlement having a gross value of $3,500.00 is hereby approved to be distributed as follows: TO: Clearfield & Kofsky - Attorney Fee TO: Clearfield & Kofsky - Reimbursement for Costs TO: Rayann Foster, a minor, to be placed into an investment/account authorized by Pa. R.C.P. 2039(b)(2) IN THE NAME OF THE MINOR, which investment/ account shall bear the notation "not to be redeemed or withdrawn except for the renewal in its entirely prior to March 29, 2019 except upon Order of the Court." $ 875.00 $ 107.75 $ 2,517.25 Marsha Stevens, parent and natural guardian of Rayann Foster, a minor, are ORDERED and DIRECTED to file an affidavit of compliance regarding the opening of the restricted investment/account with the Prothonotary of Cumberland County (along with a copy to the undersigned) within thirty days. ✓Andrew C. ogrnialowiCz, BY THE COURT: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY NINTH JUDICIAL DISTRICT KAYLA FOSTER, a minor by and through her parent and natural guardian MARSHA STEVENS v. CHRISTOPHER RITTENHOUSE and CON -WAY TRUCKING COURT OF COMMON PLcu- rl 7.13 EAS CUMBERLAND COUNTX— NO. 2014-5091 ORDER AND NOW, this/0 day 014, upon consideration of the outstanding petition for leave to settle minor's action, , the proposed settlement having a gross value of $3,500.00 is hereby approved to be distributed as follows: TO: Clearfield & Kofsky - Attorney Fee $ 875.00 TO: Clearfield & Kofsky - $ 72.75 Reimbursement for Costs TO: Kayla Foster, a minor, to be placed into an $ 2,552.25 investment/account authorized by Pa. R.C.P. 2039(b)(2) IN THE NAME OF THE MINOR, which investment/ account shall bear the notation "not to be redeemed or withdrawn except for the renewal in its entirely prior to November 02, 2021 except upon Order of the Court." e - Marsha Stevens, parent and natural guardian of Kayla Foster, a minor, are ORDERED and DIRECTED to file an affidavit of compliance regarding the opening of the restricted investment/account with the Prothonotary of Cumberland County (along with a copy to the undersigned) within thirty days. Andrew C . �mialowicz ►Esct. ;led IPPtliaii°11,40 2 BY THE COURT: CLEARFIELD & KOFSKY By: Andrew C. Smialowicz, Esquire Identification No. 307420 One Penn Center at Suburban Station Suite 355, 1617 J.F.K. Boulevard Philadelphia, PA 19103 (215) 563-6333 ADRIANA FOSTER and JERRAN PARKS and KAYLA FOSTER and RAYANN FOSTER, minors by and through : their p/n/g MARSHA STEVENS and MARSHA STEVENS v. CHRISTOPHER RITTENHOUSE and CON -WAY TRUCKING Attorney for Plaintiff. COURT OF COMMON PLEAS OF CUMBERLAND COUNTY NO. 2014-5091 ORDER TO SETTLE, DISCONTINUE AND END TO THE PROTHONOTARY: Kindly mark the above captioned matter Settled, Discontinued and Ended upon payment of your costs only. BY: CLEARFIELD ANDREW Attorney for P1 ICZ, ESQUIRE .ter... I