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HomeMy WebLinkAbout05-4470 TOMASKO & KORANDA, P.C. By: Michael A. Koranda, Esquire PAID #58808 219 State Street Harrisburg, P A 1710J Phone: (717) 238-1100 mkoranda@t-klaw.com Attorneys for Petitioner ESTATE OF JESUS F. RUIZ IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO, OS -.l..f'f76 C;u'lL~~ CIVIL ACTION - LAW lNRE: PETITION FOR LEAVE TO COMPROMISE WRONGFUL DEATH ACTION PURSUANT TO Pa. R.C.P. NO. 2206 TO THE JUDGES OF SAID COURT: NOW COMES, Petitioner, Carmen F. Ruiz, Administratrix of the Estate of Jesus F. Ruiz, deceased, by and through her attorneys, TOMASKO & KORANDA, P.C., and Petitions this Honorable Court as follows: 1. The Petitioner, Carmen F. Ruiz, is an adult individual residing at 2839 Benita Street, Patricia Subdivision, Gayalangin, Tondo, Manilla 1012 Philippines. The Petitioner is the Administratrix ofthe Estate of Jesus F. Ruiz (hereinafter, the "Decedent"), having been appointed such by the Register of Wills of Cumberland County, Pennsylvania, on May 23,2005. A true and correct copy of the Letters of Administration is attached hereto as Exhibit" A" and incorporated herein. 2. The Decedent is survived by the following persons who are all the persons entitled to recover damages on account ofthe decedent's death: NAME RELATIONSHIP ADDRESS Carmen F. Ruiz Sister 2839 Benita Street Patricia Subdivision Gayalangin, Tondo, Manilla 1012 Philippines Gregorio Ruiz Brother 2839 Benita Street Patricia Subdivision Gaya1angin, Tondo, Manilla 1012 Philippines 4. On May 8, 2005, at approximately 0325 hours, Decedent suffered fatal injuries as a result of a motor vehicle accident occurring in the 700 block of Hogestown Road (SR 114), Silver Spring Township, Cumberland County, Pennsylvania. 5. The aforesaid accident was caused by the alleged negligence, recklessness and carelessness of Michael Alvarez, an adult individual currently incarcerated in the Dauphin County Prison, who, among other things, was driving under the influence of alcohol and with a suspended operator's license (DUI related) at the time of the collision. 6. On May 16, 2005, the Petitioner retained the undersigned counsel pursuant to a written contingent fee agreement to pursue all available claims on account ofthe Decedent's death. A true and correct copy of the contingent fee agreement is attached hereto as Exhibit "B" and incorporated herein. 7. At the time of the accident, the Decedent was operating a motor vehicle owned by him and insured by Allstate Insurance Company (hereinafter, "Allstate") under Policy Number 901075818 (hereinafter, the "Policy"). The Policy provided for underinsured motorist ("UIM") benefits up to a maximum of $50,000,00, as evidenced by the Allstate Coverage Report, a true and correct copy of which is attached hereto as Exhibit "c" and incorporated herein. 8. On August 8, 2005, Allstate offered to tender the sum of $50,000.00 to settle all potential DIM claims arising from the accident in exchange for a written Release and Trust -2- Agreement. A true and correct copy ofthe proposed Release and Trust Agreement is attached hereto as Exhibit "D" and incorporated herein. 9. The Petitioner and counsel believes that a settlement of the DIM claim for the sum of $50,000.00 is both fair and reasonable since it represents the maximum recovery available under the Policy. The Petitioner's certification is attached hereto as Exhibit "E" and incorporated herein, and counsel's certification is attached hereto as Exhibit "F" and incorporated herein. 10. Pursuant to 20 Pa, C.S. 9 2103, it is desired that the Court designate the following persons as entitled to share in the following proportions in the proposed settlement of the VIM claim: Name Carmen F. Ruiz Relationship Sister Share 50% (gross recovery of$25,000,OO) Gregorio Ruiz Brother 50% (gross recovery of $25,000.00) 11. Since the proposed settlement represents proceeds of a survival claim, the entire settlement would be considered taxable to Decedent's estate. Consequently, there is no need to obtain approval ofthis proposed settlement from the Pennsylvania Department of Revenue. 12. In the course of representing the Petitioner, counsel incurred the following expenses: Accident Report: Postage and Copying: Filing Fee (Prothonotary) $ 15.00 24,60 55.50 Total $ 95,]0 -3- 13. Pursuant to Pa. R.C.P. 2039, Petitioner requests that this Honorable Court approve the proposed settlement, authorize her to execute the attached Release and Trust Agreement, and distribute the settlement proceeds as follows: Settlement Amount $ 50,000.00 Less Legal Fee to Counsel (25%) - 12,500.00 Less Costs/Expenses to Counsel 95.10 Net Recovery $ 37.404.90 Distribution of Net Recovery To: Carmen F. Ruiz $ 18,702.45 Gregorio Ruiz $ 18,702.45 Total Distribution of Net Recovery $ 37.404.90 14, Pursuant to 20 Pa. C.S.A. 92103, a copy ofthis Petition is being served on the intestate heirs of the Decedent, who are as follows: NAME RELATIONSHIP ADDRESS Carmen F. Ruiz Sister 2839 Benita Street Patricia Subdivision Gayalangin, Tondo, Manilla 1012 Philippines Gregorio Ruiz Brother 2839 Benita Street Patricia Subdivision Gayalangin, Tondo, Manilla 1012 Philippines WHEREFORE, the Petitioner respectfully requests that this Court: (a) Approve the compromise above stated; (b) Authorize the Petitioner to execute the Release and Trust Agreement with Allstate Insurance Company; (c) Designate the persons entitled to share in the proposed settlement and the -4- Register of Wills of Dauphin County, Pennsylvania Short Certificate - - Letters of Administration 0450-2005 Commonwealth of Pennsylvania } SS County of Dauphin I, Sandra C. Snyder , Register of Wills in and for the County of Dauphin, in the Commonwealth of Pennsylvania. DO HEREBY CERTIFY that on the 23RD day of MAY. 2005 LETTERS OF ADMINISTRATION on the Estate of JESUS F. RUIZ deceased, were granted to CARMEN F. RUIZ having first been qualified well and truly to administer the same. And, I further certify that no revocation of said Letters appears of record in my office. Date of Death MAY 8, 2005 Social Security No. 194448480 Given under my hand and seal of office this 24TH day of MAY, 2005 ~lJdla. e. ~rltf Register NOT VALID WITHOUT IMPRESSED SEAL EXPIRES 611 DAYS FROM DATE OF ISSUANCE EXHIBIT A POWER OF ATTORNEY AND CONTINGENT FEE AGREEMENT KNOW ALL MEN BY THESE PRESENTS: BY THIS AGREEMENT, I, Carmen Ruiz. sister of Jesus Ruiz. deceased. and possible Administratrix of the Estate of Jesus Ruiz . of Philippines Pennsylvania (hereinafter, "Client"), do hereby make, constitute and appoint TOMASKO & KORANDA, P.C., (hereinafter, "Attorney") as my true, lawful, sole and exclusive attorney, in law and in fact, to institute and maintain for me and for Jesus Ruiz, deceased, all claims and/or causes of action ("claims") against any individual or entity legally responsible for the injuries and death of Jesus Ruiz on or about Mav 8. 2005 I FURTHER AGREE to the following arrangement for attorney's fees, costs, expenses and other matters in connection with this claim: 1. Attorney shall receive, and the undersigned shall pay, as the legal fees in this matter, twenty-five percent (25%) of the gross amount recovered should a settlement be obtained prior to the filing of a lawsuit or written request for arbitration, and thirty-three and one-third percent (33 1/3%) of the gross amount recovered if a settlement or verdict is obtained after the filing of a lawsuit or written request for arbitration, and before an appeal has been filed by any party. 2. Attorney is to receive the above percentages of recovery BEFORE any deduction for disbursements and costs incurred. Client agrees to repay Attorney for such disbur~ements and costs, including, but not limited to, any court costs, out-of-pocket expenses, experts' fees, costs for postage, photocopies, and long distance telephone calls. Client authorizes Attorney to deduct these costs directly out of the Client's share of recovery. 3. Ifthere is no recovery obtained on Client's claim, Client will not owe nor have to pay any attorney's fees to Attorney. 4. Attorney is hereby granted a lien in protection of its fees, disbursements and costs from any sums recovered in Client's claim. 5, The above fee covers ONLY the handling of the Client's claim up to and including trial, if necessary, and does not include, nor will Attorney prosecute, any appeals to and from Client's claim, unless a separate agreement, in writing, is entered into between Client and Attorney. 6. The above fee is not set by law, but is established between Client and Attorney by agreement.' However, if the injured is a minor, or the claim is for wrongful death and/or survival damages, this Agreement is subject to the approval ofthe Court. -1- EXHIBIT B 7. Client hereby gives to Attorney the power and authority to execute any and all pleadings, contracts, settlements, drafts, checks, compromises, releases, dismissals, or other documents and papers which Client could properly execute, and to receive in the name and stead of Client any monies or other things of value in the name and stead of Client which may properly be payable or deliverable to Client on account of any settlement, verdict or sums recovered on Client's claim, In addition, Client hereby authorizes Attorney to take whatever actions are, in Attorney's discretion, necessary in the prosecution of Client's claim. 8. No settlement will be made without Client's consent. 9. No guarantees or promises regarding the outcome of Client's claim have been made by Attorney. 10. In the event that Client discharges Attorney, or retains a different attorney to handle Client's claim, Attorney shall receive out of any recovery in this matter a sum equal to the number of hours worked on Client's claim times and hourly rate of $200.00 per hour, plus costs advanced and expenses incurred. A lien for these sums is hereby granted to Attorney. 11. If a recovery is obtained, Attorney will direct that payment be made by a check or draft payable jointly to Client and Attorney. Client will endorse the check or draft and return it to Attorney for deposit into Attorney's escrow account. When the original check or draft clears, Attorney will distribute the funds in accordance with this Agreement. Client agrees to sign any necessary release, settlement agreement, distribution memorandum, or all of these, in order to conclude this matter. EXECUTED AND DELIVERED, in duplicate, this if!!:... day of May, 2005, the undersigned hereby acknowledging receipt of one copy hereof. ~~~ .Lo./ .4' ~",~.....w ITNESS e~~ CARMEN RUlZ -2- DESK: B27 CLMNUM: 1555126869 POLNUM: ge1e75818 INSD: JESUS RUIZ ADDR: 66e BOAS ST APT 141e YEAR: 91 MAKE: STORM OPTION (S) : LPC NAME: ADDR: CITY: AGENT NAME: JOSEPH MATT US AG IN AGENT NUM: ACCT CO: e1e ALLST CASUALTY OPT PKG: N/A OPENABLE: AA 5e,eee/1ee,eee BB 5e,eee CC 25,eee CF 2,5ee DD - 25e HH JJ 5e SS 5e,eee/1ee,eee - STACKABLE SU 5e,eee/1ee,eee - STACKABLE UU 3e/3eDAYS *.* COVERAGE DISPLAY - AUTO *** 05/18/05 14:09:23 EFFDT: 01/11 LOSSDT: 05/e8/05 LINE: 1e ORG YEAR: e1 CITY: HARRISBURG ST: VIN: J81RF4360M754e714 LIMITED TORT PA ZIP: 171e21325 TYPE: 1e STANDARD ST: ZIP: e001338 PHONE: 717-545-2626 FM/EDR: AU1e623 AU1e681 POLICY S-CODES: VEHICLE S-CODES: ALLSTATE INSURANCE COMPANY AUTO POLICY PENNSYLVANIA AMENDATORY ENDORSEMENT PASS-RES ENTER ACTIVITY: 1-PRNT SCRN 12-ADL POL-S 13-ADL VEH-S 14-ADL FRMS 17-ADL LPC EXHIBIT C [gJ ALLSTATE INSURANCE COMPANY (hereinafter referred to as Allstate) o ALLSTATE INDEMNITY COMPANY (hereinafter referred to as Allstate) o ALLSTATE NEW JERSEY INSURANCE COMPANY (hereinafter referred to as Allstate) RECEIPT, RELEASE AND TRUST AGREEMENT [gJ UNINSURED MOTORIST INSURANCE -- Coverage SS o UNDERINSURED MOTORIST INSURANCE -- Coverage SU CLAIM # 1555126869-827 In consideration of the payment of Fiftv Thousand Dollars by Allstate, the receipt of which is hereby acknowledged, the undersigned hereby forever releases and discharges Allstate from any and all liability and from any and all contractual obligations whatsoever under the coverage designated above of Policy No, 901075818 issued to Jesus F, Ruiz by Allstate and arising out of IZJ bodily injuries and/or o property damages sustained by Estate of Jesus F, Ruiz due to an accident on or about the 8th day of Mav, 2005, Estate of Jesus F, Ruiz (Name of Insured or Parent or Guardian or Surviving Spouse) hereinafter referred to as the Trustee further agrees in consideration of said payment by Allstate as Beneficiary to hold for the Beneficiary all rights, ciaims, and causes of action which the Trustee has or may have against any person or persons, organization, association or corporation other than the Beneficiary because of bodily injury and/or property damage which is the subject of the claim made against the Beneficiary, The Trustee agrees to take, through any representative designated by the Beneficiary, such action as may be necessary or appropriate to recover the damages suffered by the Trustee from any person or persons, organization, association or corporation other than the Beneficiary who may be legally liable therefor, such action to be taken in the name of the Trustee, the Beneficiary to pay all costs and expense in connection therewith. It is further agreed that any monies recovered by the Trustee as the result of judgment, settlement, or otherwise, will be held in trust by the Trustee and paid to the Beneficiary, provided, however, any sum recovered in excess of the total amount paid by the Beneficiary to the Trustee under the terms of the above mentioned policy, shall be retained by the Trustee for his own use and benefit. IN WITNESS WHEREOF I have hereunto set my hand this day of (Seal) (Insured or Parent or Guardian or Surviving Spouse) Witnesses: Accepted: By Allstate - Beneficiary C2518, 55-SU Receipt, Release & Trust AgE:XHIB IT D rev,06/26/00 INRE: IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF JESUS F. RUIZ NO. CIVIL ACTION - LAW AFFIDAVIT OF PETITIONER. CARMEN F. RUlZ Carmen F. Ruiz, being duly sworn according to law, deposes and says that: 1, I am the Administratrix ofthe Estate of Jesus F, Ruiz, 2. I have reviewed the facts set forth in the attached petition and that those facts are true and correct to the best of my knowledge, information and belief. 3, I have reviewed the proposed settlement with counsel and believe that it. is in be best interest of the Estate. ~F~ CARMEN F. RUIZ Sworn to and subscribed before me on this tAUS 19 2665 dayMDllr) of ')Qe, NO ~ ' !.>AGE NO~~1 'c 1ic ., I NOTAl'( , '''OOIt UA ~I ... to _ .l._ 31, 20llI .. .....) "" Ma., . ~""i MIa. l,12O/1l!! ~bRltli Of' _ lIa .... J~ ..... ",",,~ ".I EXHIBIT E INRE: IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF JESUS F. RUIZ NO. CIVIL ACTION - LAW VERIFICATION OF COUNSEL Michael A Koranda, Esquire, as counsel for the Petitioner in the above-captioned action, hereby verifies that I have investigated the decedent's motor vehicle accident of May 8,2005, and that for the reasons set forth in the attached petition, the settlement of Fifty Thousand Dollars ($50,000.00) in the underinsured motorist claim against Allstate Insurance Company is reasonable and appropriate under the circumstances. ~ MICHAEL A KORANDA EXHIBIT F ~ 7J \.) ~ ~ ~ \l Y\ ~, 0 c;::":' -(I ,...:' V'\ <:.f' -' \) :"\: - \.)J {'"' "Q -U C-,) ~ c) "8 - ~ ?- \ 0 2:; 1- _/ 'F? 1-.1 -, --------- -- ~ECEIVED SEP 0 12005 ....\ ESTATE OF JESUS F. RUIZ IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 05- .l../J.J1D C,u~L ~>7[ CNIL ACTION ~ LAW INRE: ORDER AND NOW, this z,J day of 5y~W ,2005, upon consideration ofthe foregoing Petition to Compromise; to Designate Persons Entitled to Recover Damages; to Allow Deduction of Counsel Fees and Expenses; and to Direct Payment of Balance, it is hereby ORDERED that said Petition is GRANTED, and is further ORDERED that: (a) The compromise in the amount of $50,000.00 with Allstate Insurance Company for underinsured motorist benefits under Policy No. 901075818 is approved. The Petitioner is authorized to sign the Release and Trust Agreement attached to the Petition; (b) The Court designates the following persons as entitled to share in the following proportions in the damages recovered: Name Relationship Share Carmen F. Ruiz Gregoria Ruiz Sister Brother 50% (gross recovery of $25,000.00) 50% (gross recovery of $25,000.00) (c) Payment of attorney's fees in the amount of$12,500.00 and costs of$95.10 to Tomasko & Koranda, P.c. is approved. ~/(f; O~'~ BY THE COURT: AJ.. , J. Alf\irr-',.---' ,.-, 90 :! lid Z- d3S 900l 3Hl :iO :::~:<~:::~n.-JT\u TOMASKO & KORANDA, P.C. By: Michael A. Koranda, Esquire PA ill #58808 219 State Street Harrisburg, P A 1710J Phone: (717) 238-1100 mkoranda@t-klaw.com Attorneys for Petitioner INRE: IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVAN1A ESTATE OF JESUS F. RUlZ NO. 05-4470 CNIL ACTION ~ LAW PETITION FOR LEAVE TO COMPROMISE SURVIVAL ACTION PURSUANT TO Pa. R.C.P. NO. 2206 TO THE JUDGES OF SAID COURT: NOW COMES, Petitioner, Carmen F. Ruiz, Administratrix of the Estate of Jesus F. Ruiz, deceased, by and through her attorneys, TOMASKO & KORANDA, P.C., and Petitions this Honorable Court as follows: I. The Petitioner, Carmen F. Ruiz, is an adult individual residing at 2839 Benita Street, Patricia Subdivision, Gayalangin, Tondo, Manilla 1012 Philippines. The Petitioner is the Administratrix of the Estate of Jesus F. Ruiz (hereinafter, the "Decedent"), having been appointed such by the Register of Wills of Cumberland County, Pennsylvania, on May 23, 2005. A true and correct copy of the Letters of Administration is attached hereto as Exhibit "A" and incorporated herein. 2. The Decedent is survived by the following persons who are all the persons entitled to recover damages on account of the decedent's death: NAME RELATIONSHIP ADDRESS Carmen F. Ruiz Sister 2839 Benita Street Patricia Subdivision Gayalangin, Tondo, Manilla 1012 Philippines Gregorio Ruiz Brother 2839 Benita Street Patricia Subdivision Gayalangin, Tondo, Manilla 1012 Philippines 3. On May 8,2005, at approximately 0325 hours, Decedent suffered fatal injuries as a result ofa motor vehicle accident occurring at the 700 block of Hogestown Road (SR 114), Silver Spring Township, Cumberland County, Pennsylvania. 4. The aforesaid accident was caused by the alleged negligence, recklessness and carelessness of Michael Alvarez (hereinafter, "Alvarez"), an adult individual currently incarcerated in the Dauphin County Prison, who, among other things, was driving under the influence of alcohol and with a suspended operator's license (DUI-rdated). 5. On May 16, 2005, the Petitioner retained the undersigned counsel pursuant to a written contingent fee agreement to pursue all available claims on account of the Decedent's death. A true and correct copy of the contingent fee agreement is attached hereto as Exhibit "B" and incorporated herein. 6. Following counsel's investigation, two (2) sources of potential recovery were identified: (a) a survival action against Alvarez; (b) an underinsured motorist ("VIM") claim against the Decedent's personal automobile insurer, Allstate Insurance Company. 7. Counsel subsequently negotiated a settlement of the UIM claim for $50,000.00, which represented the limits of coverage available. By Order dated September 2, 2005, this Honorable Court approved said settlement and authorized the distribution of the settlement proceeds and payment of attorney's fees. A true and correct copy of the Order dated September 2, -2- 2005, is attached hereto as Exhibit "c" and incorporated herein. 8. At the time of the accident, Alvarez was operating a motor vehicle insured by State Farm Insurance Company (hereinafter, "State Farm") under Policy Number 38K-669-662 (hereinafter, the "Policy"). The Policy provided for bodily injury/liability coverage up to a maximum of $25,000.00 per claim, as evidenced by the State Farm Policy Information printout, a true and correct copy of which is attached hereto as Exhibit "D" and incorporated herein. 9. On December 28, 2005, State Farm offered to tender the sum of$25,000.00 to settle all potential claims against Alvarez in exchange for a written Release. A true and correct copy of the offer letter and proposed Release is attached hereto as Exhibit "E" and incorporated herein. 1 O. The Petitioner and counsel believe that a settlement ofthe potential third party claim for the sum of $25,000.00 is both fair and reasonable. The proposed settlement represents the maximum recovery available under the Policy. Additionally, Alvarez lacks significant assets and is essentially judgment-proof. The Petitioner's certification is ailtached hereto as Exhibit "F" and incorporated herein, and counsel's certification is attached hereto as Exhibit "G" and incorporated herein. 11. Pursuant to 20 Pa. C.S. ~ 2103, it is desired that the Court designate the following persons as entitled to share in the following proportions in the proposed settlement of the third party claim: Name Carmen F. Ruiz Relationship Sister Share 50% of gross recovery -3- Gregorio Ruiz Brother 50% of gross recovery 12. Since the proposed settlement represents proceeds of a survival claim, the entire settlement would be considered taxable to Decedent's estate. Consequently, there is no need to obtain approval of this proposed settlement from the Pennsylvania Department of Revenue. 13. In the course of representing the Petitioner, counsel incurred the following expenses: ~H 7.30 Total $17.30 14. Pursuant to Pa. R.c.P. 2039, Petitioner requests that this Honorable Court approve Postage and Copying: the proposed settlement, authorize her to execute the attached Release and Trust Agreement, and distribute the settlement proceeds as follows: Settlement Amount Less Legal Fee to Counsel (25%) Less Costs/Expenses to Counsel Net Recovery Distribution of Net Recovery To: Carmen F. Ruiz $ 9,366.35 Gregorio Ruiz $ 9,366.35 Total Distribution of Net Recovery $ 18,732.70 15. Pursuant to 20 Pa. C.S.A. ~ 2103, a copy of this Petition is being served on the $ 25,000.00 - 6,250.00 17.30 $ 18,732.70 intestate heirs of the Decedent, who are as follows: -4- NAME RELATIONSHIP ADDRESS Carmen F. Ruiz Sister 2839 Benita Street Patricia Subdivision Gayalangin, Tondo, Manilla 1012 Philippines Gregorio Ruiz Brother 2839 Benita Street Patricia Subdivision Gayalangin, Tondo, Manilla 1012 Philippines WHEREFORE, the Petitioner respectfully requests that this Court: (a) Approve the compromise above stated; (b) Authorize the Petitioner to execute the Release with Alvarez/State Farm Insurance Companies; (c) Designate the persons entitled to share in the proposed settlement and the proportionate share to which each is entitled as follows: Name Relationship Share Carmen F. Ruiz Sister $9,366.35 Gregoria Ruiz Brother $9,366.35 (d) Approve payment from the proposed settlement attorney's fees in the amount of$6,250.00 and costs of$17.30 to Tomasko & Koranda, P.c. Respectfully submitted, TOMASKO & KORANDA, P.c. 219 State Street Harrisburg, P A 17101 Telephone: 717-238-1100 By: .- ~~;q;;;y~ MICHAEL A. KORANDA--"-- Pa. J.D. #58808 -5- Register of Wills of Dauphin County, Pennsylvania Short Certificate - - Letters of Administration 0450-2005 Commonwealth of Pennsylvania } SS County of Dauphin I, Sandra C. Snyder , Register of Wills in and for the County of Dauphin, in the Commonwealth of Pennsylvania. DO HEREBY CERTIFY that on the 23RD day of MAY, 2005 LETTERS OF ADMINISTRA nON on the Estate of JESUS F. RUlZ deceased, were granted to CARMEN F. RUIZ having first been qualified well and truly to administer the same. And, I further certify that no revocation of said Letters appears of record in my office. Date of Death MAY 8, 2005 Given under my hand and seal of office this Social Security No. 194448480 24TH day of ~MAY. 2005 @:/ldlo.. e. ~rJef Register NOT VALID WITHOUT IMPRESSED SEAL EXPIRES 60 DAYS FROM DATE OF ISSUANCE EXHIBIT A POWER OF ATTORNEY AND CONTINGENT FEE AGREEMENT KNOW ALL MEN BY THESE PRESENTS: BY THIS AGREEMENT, I, Carmen Ruiz. sister of Jesus Ruiz. deceased, and possible Administratrix of the Estate of Jesus Ruiz . of Philippines Pennsylvania (hereinafter, "Client"), do hereby make, constitute and appoint TOMASKO & KORANDA, P.C., (hereinafter, "Attorney") as my true, lawful, sole and exclusive attorney, in law and in fact, to institute and maintain for me and for Jesus Ruiz, deceased, all claims and/or causes of action ("claims") against any individual or entity legally responsible for the injuries and death of Jesus Ruiz on or about Mav 8. 2005 I FURTHER AGREE to the following arrangement for attorney's fees, costs, expenses and other matters in connection with this claim: 1. Attorney shall receive, and the tmdersigned shall pay, as the legal fees in this matter, twenty-five percent (25%) of the gross amount recovered should a settlement be obtained prior to the filing of a lawsuit or written request for arbitration, :md thirty-three and one-third percent (33 1/3%) of the gross amount recovered if a settlement or verdict is obtained after the filing of a lawsuit or written request for arbitration, and before an appeal has been filed by any party. 2. Attomey is to receive the above percentages of recovery BEFORE any deduction for disbursements and costs incurred. Client agrees to repay Attorney for such disbur~ements and costs, including, but not limited to, any court costs, out-of-pocket expenses, experts' fees, costs for postage, photocopies, and long distance telephone calls. Client authorizes Attorney to deduct these costs directly out of the Client's share of recovery. 3. If there is no recovery obtained on Client's claim, Client will not owe nor have to pay any attorney's fees to Attorney. 4. Attorney is hereby granted a lien in protection ofi.ts fees, disbursements and costs from any sums recovered in Client's claim. 5. The above fee covers ONLY the handling of the Client's claim up to and including trial, if necessary, and does not include, nor will Attorney prosecute, any appeals to and from Client's claim, unless a separate agreement, in writing, is entered into between Client and Attorney. 6. The above fee is not set by law, but is established between Client and Attorney by agreement. However, if the injured is a minor, or the claim is for wrongful death and/or survival damages, this Agreement is subject to the approval of the Court. -1- EXHIBIT B 7. Client hereby gives to Attorney the power and authority to execute any and all pleadings, contracts, settlements, drafts, checks, compromises, releases, dismissals, or other documents and papers which Client could properly execute, and to receive in the name and stead of Client any monies or other things of value in the name and stead of Client which may properly be payable or deliverable to Client on account of any settlement, verdict or sums recovered on Client's claim. In addition, Client hereby authorizes Attorney to take whatever actions are, in Attorney's discretion, necessary in the prosecution of Client's claim. 8. No settlement will be made without Client's consent. 9. No guarantees or promises regarding the outcome of Client's claim have been made by Attorney. 10. In the event that Client discharges Attorney, or retains a different attorney to handle Client's claim, Attomey shall receive out of any recovery in this matter a sum equal to the number of hours worked on Client's claim times and hourly rate of$200.00 per hour, plus costs advanced and expenses incurred. A lien for these sums is hereby granted to Attorney. 11. If a recovery is obtained, Attorney will direct that payment be made by a check or draft payable jointly to Client and Attomey. Client will endorse the check or draft and return it to Attorney for deposit into Attomey's escrow account. When the original check or draft clears, Attorney will distribute the funds in accordance with this Agreement. Client agrees to sign any. necessary release, settlement agreement, distribution memorandum, or all of these, in order to conclude this matter. EXECUTED AND DELIVERED, in duplicate, this g!A day of May, 2005, the undersigned hereby acknowledging receipt of one copy hereof. ~~.,: .l..,.u?' ~ ~. ..Jw ITNESS e~;s CARMEN RVlZ -2- ifECEIVED SEP 012005 ESTATE OF JESUS F. RUIZ IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. DS" -l-/'f1() C;u~L 182."1 CNIL ACTION - LAW INRE: AND NOW, this 1nd. ORDER ~~) ,2005, day of upon consideration of the foregoing Petition to Compromise; to Designate Persons Entitled to Recover Damages; to Allow Deduction of Counsel Fees and Expenses; and to Direct Payment of Balance, it is hereby ORDERED that said Petition is GRANTED, and is further ORDERED that: (a) The compromise in the amount of $50,000.00 with Allstate Insurance Company for underinsured motorist benefits under Policy No. 901075818 is approved. The Petitioner is authorized to sign the Release and Trust Agreement attached to the Petition; (b) The Court designates the following persons as entitled to share in the following proportions in the damages recovered: Name Relationship Share Carmen F. Ruiz Gregoria Ruiz Sister Brother 50% (g;ross recovery of $25,000.00) 50% (gross recovery of $25,000.00) (c) Payment of attorney's fees in the amount of$12,500.00 and costs of$95.1O to Tomasko & Koranda, P.c. is approved. BY THE COURT: {:~"',~'.~i}~' ~,. ~ ,y #' 'i ;. ,,' i',. ~M! J XHIBIT C Clm: 38-K669-662 Policy Information Ins: WOODWARD, ROBERT Pol: 0594.292-38A 001 S3318C35 DOL: 05-08-05 Lienholder or Leasing Company: Insured: WOODWARD,ROBERT E 112 W HIGH ST APT E CARLISLE PA 17013-2910 Vehicle Year: Make: Model: Bodystyle: VIN: Company: Pol source: Cov in force: 2003 SATURN L 4DR lG8JU54F23Y533259 Supporting Information Eff term: 07-30-04 Pol form no: 9338P4 County: 022 Basic pol: 6 SF Mutual PMR A 25/50/10,C2 Servicing Agent Agent name: Phone: Code: 9099 5,000,D250,G500 EXHIBIT D Pol div no: 7 Prior damage: N On term: State Farm Insurance Companies nAn u..'" A INSUItANCf e December 28, 2005 Claim Central - Complex PO Box 142 Concordville, PA 19331-0142 Michael Koranda 219 State St Harrisburg, PA 17101 RE: Claim Number: Date of Loss: Our Insured: Your Client: 38-K669-662 May 8, 2005 Robert Woodward The Estate of Jesus Ruiz Dear Mr. Koranda: This will serve to confirm our offer of $25,000 as settlement of your client's Wrongful Death and Survival Action on behalf of his estates, This offer represents the available limits under our insured's policy for this loss. Enclosed is our release and proof of the coverage available for this loss. Upon receipt of the properly executed release and Order Approving this settlement, our draft will follow. If you have any questions, please feel free to call me. Sincerely, Jam:~~ Claim Representative (800) 236-4594 State Farm Mutual Automobile Insurance Company ~~-~-~-...._----------_. HOM:E*HI'BIiLfOI~100001 RELEASE Sa E' 38-K669-662 For the Sole Consideration of Twenty-Five Thousand ($25,000) Dollars the receipt and sufficiency whereof is hereby acknowledged. the undersigned hereby releases and forever discharges Robert Woodard and Michael Alven,z T h eir heirs, executors, administrators, agents and assigns, and all other persons, firms or corporations liable or. who might be claimed to be liable. none of whom admit any liability to the undersigned but all expressly deny any liability, from any and all claims, demands, damages. actions, causes of action or suits of any kind or nature whatsoever. and particularly on account of all injures, known and unknown, both to person and property, which have resulted or may in the future develop from an accident which occurred on or about the 8 day of May ,(year) 2005 at or near Hogestown Rd, Mechanlcsburg, Pa This release expressly reserves all rights of the parties released to pursue their legal remedies, if any, against the undersigned, their heirs, executors, agents and assigns. Undersigned hereby declares that the terms of this settlement have been completely read and are fully understood and voluntarily accepted for the purpose of making a full and final compromise adjustment and settlement of any and all claims. disputed or otherwise, on account of the injuries and damages above mentioned, and for the express purpose of precluding forever any further or additional claims arising out of the aforesaid accident. Undersigned hereby accepts draft or drafts as final payment of the consideration set forth above. Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or a 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 such person to criminal and civil penalties. In Witness Whereof, have hereunto set hand(s) and seal(s) this day of , (year) I n presence of" Witness Signe 0, ~) Signed X Address This release is translated into Spanish for the convenience of the reader. However, in the event of any difference in interpretation, the releasor who signed above hereby agrees that the En!l/ish language version controls. 104077_5 Rev_ 08-26-2005 Page 1 of 2 INRE: IN THE COURT OF COMMON PLEAS CIJ.\1I:lERLAND COUNTY, PE!\'NSYLV ANLA ESTATE OF JESlJS F. RUIZ NO. 05-4470 CIVIL ACTlON- LAW AFFlDA VIT OF PETlTlON~:R. CARMEN F. RUIZ Carmen F. Ruiz, being July sworn according to Jaw, deposes and says that: I. I am the Administratrix ofthc Estate ofJcsus F, Ruiz. 2. I have revicwed the facts set forth in the attachcd petition and that those facts are true and correcllo the bcst of my knowledge, in[oll11allon and belief. 3. I have reviewed the proposed settlement with counsel and believe that it is ;n be best interest ofthc Estate. &1/~ CARMEN F. RUIZ i:- I, ~. Sworn to and subscribed before me on this (,-If, day of _. .~"^''''t---. 2()(J6. t' tb 19 &1 6 EXHIBIT F . INRE: IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF JESUS F. RUIZ NO. 05-4470 CNIL ACTION - LAW VERIFICATION OF COUNSEL Michael A. Koranda, Esquire, as counsel for the Petitioner in the above-captioned action, hereby verifies that I have investigated the decedent's motor vehicle accident of May 8,2005, and that for the reasons set forth in the attached petition, the settlement of Twenty-Five Thousand Dollars ($25,000.00) in the survival claim against Michael Alvarez and his insurer, State Farm Insurance Companies, is reasonable and appropriate under the circumstances. //~d MICHAEL A. KORANDA EXHIBIT G ("\ ---- " (J --r', .-< -:-t---f'l: \-i'" ,,' (.-- r.] , d - .. "\ JAN 1 7 2006 <( INRE: IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF JESUS F. RUlZ NO. 05-4470 CIVIL ACTION - LAW ORDER AND NOW, this I'll' day of da.-"j / , 2006, upon consideration of the foregoing Petition to Compromise; to Designate Persons Entitled to Recover Damages; to Allow Deduction of Counsel Fees and Expenses; and to Direct Payment of Balance, it is hereby ORDERED that said Petition is GRANTED, and is further ORDERED that: (a) The compromise in the amount of$25,000.00 with Michael Alvarez and his insurer, State Farm Insurance Companies, is approved. The Petitioner is authorized to sign the Release attached to the Petition; (b) The Court designates the following persons as entitled to share in the following proportions in the damages recovered: Name Relationship Share Carmen F. Ruiz Gregoria Ruiz Sister Brother $9,366.35 $9,366.35 (c) Payment of attorney's fees in the amount of$6,250.00 and costs of$17.30 to Tomasko & Koranda, P.c. is approved. BY THE COURT: ,~4 , J. a\ , ' .... "1..0"> 0:,:: li"\