HomeMy WebLinkAbout05-5232
SWARTZ CAMPBELL LLC
By: Christina L. Bradley, Esquire
I.D. No. 89107
1631 North Front Street, 2nd Floor
Harrisburg, PA 17102
(717) 233-3515
Attorney for Petitioners,
Nationwide Mutual Ins. Co.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHAN'S COURT DIVISION
No.DS- -.s'~ CiuL'-r~
IN RE: SETTLEMENT OF WRONGFUL
DEATH CLAIM FOR JASON S. NORRIS,
DECEASED
PETITION FOR LEAVE TO APPROVE WRONGFUL DEATH SETTLEMENT
Pursuant to Pa.R.c.P. 2039, Nationwide Mutual Insurance Company, by and through their
attorneys, Swartz Campbell LLC, hereby petitions this Honorable Court to enter an Order permitting
settlement in compromise of this action, and in support thereof, avers the following:
1. Petitioner Nationwide Mutual Insurance Company (hereinafter "Nationwide"), is a
corporation organized and existing under the laws ofthe State of Ohio and having its principal place
of business in Columbus, Ohio, being duly authorized to conduct business in the Commonwealth of
Pennsylvania at 1000 Nationwide Drive, Harrisburg, Dauphin County, Pennsylvania, 17105.
2. Respondents, Steven A. and Glenda I. Norris, are adult individuals residing at 45
Edgewood Drive, Mechanicsburg, Cumberland Coutny, Pennsylvania, 17055 , and are the natural
parents and guardians of Decedent, Jason S. Norris, who was born on August 2, 1986.
3. Petitioner, Nationwide, has agreed to incur the expense of preparing the instant
Petition.
4. On or about February 20,2005, Decedent, Jason S. Norris, was involved in a motor
vehicle accident while driving on Williams Grove Road, Monroe Township, Cumberland County,
SWARTZ CAMPBELL LLC
ATTORNEYS AT LAW. 1631 N. .RONT STREET. 2ND .LOOR . HARRISBURG. PA 17102
SWARTZ CAM PBELL LLC
ATTORNEYS AT LAW. 1631 N. FRONT STREET. 2ND FLOOR. HARRISBURG. PA 17102
Pennsylvania. Attached hereto and marked as Exhibit "A" is a true and correct copy ofthe applicable
police report..
5. The accident occurred when the vehicle that Decedent, Jason S. Norris, was driving
was traveling South on Williams Grove Road, when an unknown passenger vehicle was traveling
North on Williams Grove Road in the middle of the roadway. The vehicle being drive by the
Decedent, Jason S. Norris, swerved to the right side of the roadway in order to miss the vehicle.
While attempting to come back on the land oftravel, the Decedent, Jason S. Norris, lost control of
the vehicle and went into a sideways skid due to icy road conditions and slid into the northbound
travel land and was struck by another vehicle. See Exhibit "A".
6. As a result of this collision, the Decedent, Jason S. Norris, was pronounced dead at
the scene of the accident. Attached hereto and marked as Exhibit "B" is a true and correct copy of
the Certificate of Death.
7. At the time of the accident, Respondents, Steven A. and Glenda I. Norris had an
automobile insurance policy issued by Nationwide, with applicable liability coverage, upon which
Decedent, Jason S. Norris was an insured driver. Included within this policy of insurance was
Uninsured Motorist Coverage totaling $150,000.
8. Nationwide, at this time, based on its investigation and the circumstances surrounding
the accident, has offered policy limits, $150,000.00, to Respondents, Steven A. and Glenda I. Norris
in resolution of the Wrongful Death claim of Respondents.
9. The full terms of the settlement agreement are contained in the Release Agreement,
a copy of which is attached hereto and marked as Exhibit "C".
10. Respondents Steven A. and Glenda I. Norris are aware that the Release Agreement
is a general release of all claims and releases Nationwide Mutual Insurance Company from any
Respectfully submitted,
further liability for this incident.
11. Respondents, Steven A. and Glenda I. Norris are aware of their right to obtain legal
representation in this matter and have decided to proceed without legal representation. Id.
12. Respondent, Steven A. and Glenda I. Norris understand that once the Court approves
of the settlement and once the settlement documents are executed, no further claim can be made
against their liability insurance company for the death oftheir son, Jason S. Norris.
WHEREFORE, Petitioner Nationwide Insurance Company, respectfully requests this
Honorable Court to approve of the compromise and settlement ofthe wrongful death claim made by
Steven A. and Glenda I. Norris for the death of their son, Jason S. Norris.
SWARTZ CAMPBELL, LLC
n i><4-~ko ( ~Cl ol~J.I.4/
Christina L. Bradley 0
Attome;for Petition~rs
,/~"4)J ~
S~en A. Norris -\
Father of Jason S. Norris, deceased
bmyJb
Mother of Jason S. Norris, deceased
SWARTZ CAMPBELL LLC
ATTORNEYS AT LAW' 1631 N. FRONT STREET' 2ND FLOOR' HARRISBURG. PA 17102
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MAR 16 2005 13:13 FR NATIONWIDE INSURANCE 717 657 6594 TO 916106924936
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MAR 16 2005 13: 13 FR NATICUJlDE INSl.RANCE 717 657 6594 TO 916106924936 P.06/17
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POUCI! COPY
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MAR 16 2005 13:14 FR NATIONWIDE INSURANCE 717 657 6594 TO 916106924936 P.07/17
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. ,.;.' JA POLICE CRASH REPORTlNG FORNI
AA 500 4 lffc'~\~~O" \ .
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Q4-1-it Ulit .. J4;oHit Pillilpct End
Os-Hi1 Unit 5 35=Hit a1id~ RiiI
O5IIttt 0_ Tr.Hi, UnIt 36IoHit IOU er Or Oba~di:
Pfei'. Pllt J IT] D DIIIIIJ 07oo1-i\ Deer Onftoldw~
lIfentt In 0 oa..Ht othtl' Aninal 37....it IlJIp.)ct nuator
S.QUentitl og.calalort With other Non 18...lt F"w. H~
0";., 4ITJO DIIIIIJ r_~ )g.,Hit Raildwly Ecluiprllent
I: C') 11.s&Nck BY Unit 1 4o-t-lit Mail 80K
~ 12;SCnKk BY unt 2 41-Hit Traffic l5bnd
l& I 13;:;5truck By Unit 3 42;Hil snow BanIl
Jl. H*'" EYtn1 VR Most? ffi::D:rrJ 1~~Unit4 43..Hil T""~ constNClion
oS lrrnJO- 1~VIICk t UM S B.rier
~ 16-4tNdc Oth<< TraHic Unit 48-Hit other l1i1led O~ect
Unit No 2,..H1'l T11l! 0' ShtubbelY 4laaHlt untl\OWl1 flx ~C\
a: WZ CD 0 0 DIIIIIJ n=HitEE SO=Overt~ tMr
i 23dilt O~ ,o!It 51 =StruO:! By '1tIfown Or Filling
24=1'1it T~ ~n o bjec:t
l! 25-H1t G~ All S2=Pot Holes Or Other
::J Pleue i'yt 3 CD 0 DIIIIIJ 2.Wi~ Guard RIll ~d PCMl1Ient negularitits
II~U '" 0 27.W.1t c.urb . 53-J.1Ck/1lfe 0"'
~l,Ienfll' 2811H1t COII= Or 54.Fire In Vtt1iCIe
I'd'f 4 rn D DIIIIIJ l:gilU naI uarriBr 58"other NonoCallision
0 29,.Hlt ItI:h . 99;&Un~ ~ &~
~ !
m. I~~ ~fj . rn 5j 17..c:it~ Or I~
oo.No Clt\t'lllutinll Action Bad:ln~ Oft Roadw~
01.ori'tCr W~ Oistr..aCQ 18=DrM~ On 1M WfOl19 ..
Ol..tllWlng no Hand Held Phone Sidt 'Road
00 11II ........1lIa in--..an .. ~ .... O~~ IJ5jIl9 H.ndi Free t'hone 19=MaI:i1li1l1!.lPr~
Enviro_t.!/~y [ill] ~rn 2m O4-Ylk=1 U.Tun'l Entrance To hWiy
1 ~ nelii Turrill9 ;ZMhking ~p~ EKlI
&f-diai hctcm (lIW) tl&T~ ffam Wrong lM\t f"'"~. -i
OO..Nont l'~oad Condltlon$ O~) Q7.Pl1 "'9 WIO 2t.'.. g/Un~
01::Wiftdy Condltlon5 '216 On RoIdway C~ Affer Stop lz"OwerAJnder
02.sudden WHther CDndllionl 13-f\ot1'd15 ~.~$~~ c:om~ Al curve
O~ Weilthr:r Condi1iQrl5 1~ Or Cr:DId Pawernent lo.f~O ~o 12~S~~ ~
04=0I:er In Roadway lS=TCD 0bMlQed Orhef Trl1fic I DtIIb! 24:;Orlvlrlg 00 Fet ~or COrOtions
Os.otmacle On ~~ 1 &.Soft ShoIIIclt1 Or stIofJldtr OIOP Off tl~ ~FlIllute To Mlin~in PrllI* ~
o&ocOthet Animal In y ~s.Ottlet ~ F~ '~ . tOl)tCn~ l~Driver RHi1g Po~ (Pol Chai!!)
. 07.GlNe 2~ EMunlMlltal FKlor , ::I Or! ll.lI 27.DrIver mud
I; OIIMWorIl lon, AaIm(J ~knawn '4, Pming Or ~ne 28=J!iilurt To Spedali!ed Equip
, ~,. v./lidlI '1J1Iu,. tv) 12..~ 'ha!\Gll 92-Affed.td 'y fIly!icaJ condItIOn
I 1 S.Pusing ... No ~i~Zolle llII-oth,r 11'1l~tajlff DriYinQ Atticns
ON! (J6~ l1-DMr ~tIOl 1l!lIlOrM1YjjI1hI Wrong ay On 99.Unknown
.e O1l1ln/e! 07~ "= 000lS. . Ett , ,WIY Street
~ 02:Brakt Sys.!I'ft1 ~ " hts lSaTr ~ ~lilllrnzCDlm4rn
I grs~ng 5'lstem Lijhts ,e..lMleeb
nsiO"I 1o.HOl"tl '7~
.a OS~r Trilin 11-Miml/J 1kTrllllf 0ver10aded
) ~~~113Kl2rn '~J:j1WShiftecl ::rn ,~ z[Ij] 3m.0]
t IJloid
200fm ~.
Zl~~
~it ff) t [E]:I CD ~ ~Acfio" (I'J o!.:Warkil'lli
OQ-None 04-FWhing \Ithidc
D'.Ent~ Of crossing AX. 05~1ng or LGYing Vthi,1e
lnd;dtW ~ UnIt No 'IKUII' CUlIe ~ UxaIolI 1I6.WClrlc~ on VeNcill
Do ~Dt """' . ~ G" ~ lIID 02- 1'=. Rullni"9. Jogging, 07..Sttnding
....,..... ...... .OrP ng SJU-Otller
EIIt V D ,. 99;;ijl\ktlown
0 0<<> (:) "tlR~=htW UIftHo[TI rn UnltNarn rn
1)pc, No IlIInt
FORM. M.ao
t7
It
[IN)
POUCE copy
0". . _. . . ., - ... -....
.--.--
._-----.......-...-.-
- .I.-=-=-~.......
.... ...
_'__'M
MAR 16 2005 13:15 FR NATIONWIDE INSURANCE 717 657 6594 TO 916106924936
P.09/17
.'. ..... ,. . .
if '. :. " COMMONWEAlTH OF PENNSYLVANIA
,', ~ POUCE CftASH REPOR11NG FORM
. AA5003 ~''',V\106"l\ ] ,.~
m 1111111I111 Crmh Nwnber
p 0831164
A'",nver
2;::passenwer
7::::Pedertnan
8'=Othtl
9-Unknawo .
D 0 assenQtf,lOeCu~t
Oh,Driwr . All Vih!des
02:lfforrt SNt Mid<I. dPoslt1on
03afront SHt Right 51 e
Q4.Sec:and Row. Left Side Or
MQtI:lrcyClt PUWlgt!l'
os.sec:ond RQW. Middle f'o$~Qn
06-~ot\d Row . ~t Sidl
07.l1'\itd ROW Or G"",
Left 51d,1l .
oa-",ird I\CN'i Or Greater -
Mlddl. Flosition
09-ihird Row Or Gt'Mttr -
Righ1 5ido
,~g8~rS~onofTruc~b
, t'llln 01h... tnd05ed
pOIUQngllr Or CargO Areal
1 ::I.1n O~ AnII
(Back Of P,l<k.up, Etc;.)
13."f~mna Unit
1..IUdl~ on \/Mhil:le Ex1trlor
15-1l~ rlmt"gtf
98o::Other
~Sl-Ullkl\own
!
J
.!
.
~
B F ~~12
M",Msle
U I:SUnkl1owl'l
a:
Iniurv ~-,;r:r:
C OaNOt \nj\.lrecl
1..IC:illtci
2-M:.jor Injury
i1..Mcdl!~:
Inj\lry
4-Mlnar Injury
i-Injury. Unk
Sl!vtIltv
9:Ul'lktIcwn jf
IrlJUlY
tl
G QooHat AppIj~bk
l-NCIt ijei:.Ud
2.Tatlllv ~
3!!f1'lIrtillllyl:jec1rd
9:olJnknowl'l
E Qo. ~~
ol.shouldlr lIeIt Used
02-lJp Belt IJHd
03.lip ,lncI 5houldllr Batt VS<<t
04o:di~d 5I!ety Seat U!i1ld
OS-MotoI'Od. Hllmllt u.:d
OG-8iCyCle HelIMt Uad
10::Wttv '-" IJI8d Imp~l1y
, ,..chId' saf~ S4!!at USed Improperly
, Z..He!met Used Impraptt!y . .
9():;Re!J'alnt Used. Type Unknown
gg..UnI;IlOIIf'l
F ~AClPiC4b1j!
01J1on1 NT 8*9 D.~ (For Thi' Slfatl
02...Slde Ail 8ao Oep~ ~ ThIs 5e3t) ~.
03.0thtr 1We Air 1I1~~ .
Q.4.MultiplC Air Bags UIPI~
os",MOtoi'cJde ! .l"rotKtIOn
'~-a~WHr:v ~ad$
1 D-M _ Not DtpIO)'lC!. ~ 01'1
11.-Ai' _ Not.Qfpl~. Switctl Off
, ;2"AIr Sag Not D8p~,
Unit SWhd1 Sri1i .
1a-Air bt RarnO\lll!d1:riOr To Cmh)
,9.UnknciNn If Air B10 DQp!oyed
99.Unknown
H~n'
o..NGt ~td I NOt AP;lJlcable
, '''f!voIiglol Side Door di=llnlng
~1b~h Sid. WIndow
3.. Tlltough Windshillld
4.l1V'Ilugh U.d< Door
5cl1wuu;h S.t;1( Oeor TaJIgOlIQ Opening
$-llvoogh 1l.001 Opining (Sunroof/,
COr\Yllrtlb1e Top- DoWnl .
1-Throudl Rooi Openll\g (C(ltlvertlble
T UP. U-f))
9.u"kl'lOwn ~
l'rtriGtli0!l;
(lo;NQt ^ppliClbk
,..Not ElC1Iic:atecS
2~d ~:Med1anlcil Means
30rFreed 8Y NOn - Mechanical MetlnS
e.0lhtI
9ooUnknown
.w.
-,
] WS TrllMpOl't
Ove, eNc
l~r;lld;i De~_? m~ffi~ITrrJ[f]~[[][QtJ~~GJ~dJ
Name I Address I Phonfl -'"' t:MS rr.1I1lOr1
tB=~:,.L '. , . \ I OYes~" No
'.
r~l; I Rsi~~r~b~7' rn-rn{IojtIJ~][~lOfu~[Q[jJ[j]~dJ
'. HarM I Addnlu t Phane ~;., E"1$ ~
~ra:rl ~ I .V~ ONo
Unit .." hm.. No Delete? o.tt Q.VYVY) 8 C D E F
[QBJ ~ 0 ~- -~~[ffi](3]~~[QIQ] [i][QJ[j]
tc.med AckIrwu I Phane 1!MS TnI~
o ~.=a;r ~~F"H_' ~~o..s." ~ ~Me ~ 11\!r"A~tA~ tR 1~ "'7-'~ ~_v~ 0 No
U~ No PmoI1 ~ Celetc'f Da-e. '" ..... oDD. A 8 C 0 E F Ci H
IT] IT] 0 [IJ-IT]-ITIIJDDOrnrnrnODD
. N..... I AddtW I PhON'. EMS T~rwport
o~...::..1 - ~ ~J dy~ ONO
D=cooDocbrnrnDDD
rn CD DCbcte? m-
Na(M I ~dr'" rhoM
o ~=:r r
I'OfUII f MoM ttMll
__ _ . _~.-.- .. r---~""""""",=",~ ~
EMS TratI$pCf1
jJ OVe5 ONo
POLICE COPY
"-----"'..-.....",~~~ .~!IP.f)i.-~~"!~.P~ ,..~......::..:.. ~...:-&...-.:...-...:::.:.~
MAR 16 2005 13:15 FR NATIONWIDE INSURANCE 717 657 6594 TO 916106924936
P.10/17
.'.
PENNSYlVANIA STATE POUCE
PUBUC INFORMATION RELEASE REPORT
1. STATION
CARLISLE
3. INVE$Tl(iA11NQ Of:FtCER
TROOPER ELMER HERTZOG
... N.ATU
FATAL CRASH
2. INCIDENT NO.
H02.1460711
I C ce:.NT
02120/05 10:30PM
8. LOCATION
WILLIAMS GROVE ROAD AT FISHER ROAD, MONROE TOWNSHIP, CUMBERLAND COUNTY
:j
I
i
,
7.PERSON(~INVOLV!D
UNIT 1. UNKNOWN PASSENGER CAR
UNIT 1 OPERATOR- UNKNOWN
UNIT 2- 1998 FORD CONTOUR
UNIT 2 OPERATOR - DeCEASED -
JASON NORRIS, 18
MECHANICSBURG. PA
UNIT 3 PASSENGER-
16 YEAR OLD JUVENILE
MECHANICSBURG. FA
UNIT 3- 1995 CHEVROLET BLAZER
UNIT 3 OPERATOR..
17 YEAR OLD JUVENILE
MECHANICSBURG, PA
..
~, INCIDENT OeTAlLS
On 02120/05 at approxlmatsly 10:30 pm the Pennsylvania State PoUce in Cartisl9 wsrs dispatched to a
fatal accident at the Intersection of WIIllIme Grove Road and FIsher Road; Monroe Township In
Cumberland County. Upon IllTival. Troopers found that an unknown passenger vehicle was traveling
north on WmlaIJIS Grove Road in the middle of the roadway When a 1998 Ford Contour driven by Jason
Norris, 18 of Mechanicsburg, Pa was travsUng south on Williams Grove Road. Norris swerved to the
right aide of the I"08dway attempting' to miss the vehicle. While attempting to come back onto the lane of
travel he lost control of the vehicle and weftt Into a sideways skid due to icy ro3d conditions and slid into
the northbound travel lane and was struc:k by a 1095 Chevrolet Blazer d riven by a 17 year old juvenile
from Mechanicsburg, PA. Noms was pronounced dead at the scene by the Cumberfand County
Ceroner Michael Norris, The 11 year old luvenlle drIVer oftne'bl8zer was taken to Harrisburg Hospital
by West Shore EMS and the 16 year old passenger WlS taken to Holy Spirit Hospital by West Shore
EMS. Everyone was wearing their seatbelts. Assi&ted on scene by Upper Allen Police Department, .
Mechanicsburg Fire Department, Fire Police ana West Shore EMS.
** TOTAL PAGE. 14 **
MAR 16 2005 13:15 FR NATIONWIDE INSURANCE 717 657 6594 TO 916106924936 P.11/17
". .':'. COMMON'wiAiTHOFPENNSYLVANIA .'N~ ItUIDllllllnll~11 Cnsh~r
. ~: POUCIi ~ REitOR1lNG fORM p .....
AA 500 N ['1l.~ 1'-\<.6' \I I . EfuJ 0 =-
'1
N.rr.ti~,.nd adcfitional wi1nOSAS:
iIZ
F &ao\\ ~ ~d. ~
, .
..~"~~~:"'.":"r:~.:~',,' ,.(..~..~...r"':':.:'".':~':'''~5~\:':;'~~~"~''';'1.:: .:..'....:. '.' . --, .'
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"
. ........-
. ,:-
,,1-
. ...
. ~
MAR 16 2005 13:16 FR NATIONWIDE INSURANCE 717 657 6594 TO 916106924936
~(.n
~~=~~--:":,"~ANIA . ~ 11I1111111I11111111
rage
AA 500 F l~~~~~l,",lft(')il\ I [J3) a ~OI'
~'J'ti~
Cl No !pKIal
JuflC4lct1on
O N.tig....1 ,.rk a '"lItg.runlw~
,... C,MPUS
PIc.$lJ (bmp'-'t~ Unl. lnturmatlon for fffIICh unit irwalYed In a ,.,., cra.,. Dg rnrt "'j)I~ the informatlG" In tM fittllU.bow an multfcle ~[J.l.
Unit ~
[6E]
tu~ .0 =.rWlth
a Ratfl(tion, Nln
. NQ Anttictionil C:Ompli.d W'rth
Not AppllQblc CQmp/lance
o u~iMMi-
Drflfef EndotHmr:nt 0 "_nd .. 0 Not. Pennsyf.anle
~ Comphd WI1fl Driver
o fteqund - Non 0 UI1knqwn
~ hone ftequlrcd =::ce CornpIiMIQI
o ~ lJnlcncwn
O NGt R~ fot 0 unt if CD!. or
Vahidt Om CDl Requil'll:!
O t.le Valid Ucense ,-. Not a ~YiJnla
for CIm L.....J Drivel"
o NloJt I.ictnilld --Ifd U I
.~ ctnlll lor 0 Unkn_n
a4
Ro<<J $ul'fMf TvW'
o C:on<tt~
o Blacktop
o arid( or Block
o Slaij. GrlVtl 0'
s.o,.
I
15 i
D:"~ LkwnK
P lM1~
I2iJul ~ TIfII. 0 Blood
c-. NorI. 0 UrlM
DlUfI Ten baIItf - (u" iO FoW -.lrIJ
II '.
4 No Te5t ~tvel1 5 ;; Amph~rnine5
, . No P!'U9 Klported ; If PO' .
2 " MarlJuana 8 == O!htr
3 " ~l"e ~ . Unknown Test
4 " Opi~. Rlsult1
UIlIt Nb
IT]
ODin
o Othtr
o UnkncMn
O Not . PennlY",.ni.
Driver
o UnknQWn
~Ii.n~
o Other
a Unknown if Tttt
CiI\IIn
~[Q] 0
DO
o.~..: ~.nll
O~
~~ctNtu. 0 ~~~th
No ReStrlctlonsI 0 ~115 Not
o Nm ~pltcabll! Comp"~ ~
o OJmplltln<t .
,II ~.".,r 0 ='="-Wlth 0 =:r Pennsylqraif
a "",,ired. Non 0 Unknown
_ 0 None Required , c:o:ca CGmpI.ra
zs i 0 ~mpl";' IJnl/MWft
~
~ 0 =1~::1or O~~~,.::
o No Valid LiCtNt 0 Not a Peft'nsvhlenla
101 ClaSS DtMr
a Hat lIcen* 0 = l.IQt"" fur 0 \Inknowtl
Drva Tftt J'We 0 BIaQd
o None 0 l.lrine
l>MIl"Kr ~HuIts -(Up to Fow ~
D . No Test Civen 5 " ^"'~'"int;:5
1"NQ~R~~ I.~
2 . M1rtUIIN I ~ Odler
!I . ~ilnc 9 - UnIcI\DWn Test
4 " Opiitft blUltli
'OM! . M-IClll' (1~
o 0tMr
O Unknown if Tm
Glwn
~D D
DO
PIItt~..., I'Q6lt
o No~lltlon
DTop
o Unden:atriAQe
o Towed Unit
o Unkl\Qwn
~MIMUIM
.-. No A~nce
~ Mlnewet
ot:s~
Inking. NIl Skid
.. MIlD. Dtiwt
$t*d
lWtt Aide ItttMomw
. No Underrlde or
OIIIl'l'Ide
Undar!de.
o ~l'ImfJIIt
IntrUslon
P.12/17
cr..h NuJnberr
I
a Mllbry
o Indi3n 1t_~;rtj0l'l
o Other ~al Sites
a Other
Cl Unk"cwn
0'. a
11 12 01
o~o 020
()D9 03()
o 40
07 06 05
C) 0 0
o 8~itlg . Other
Evldeft(t
o SWIlling' Iivid,nc;8
or Driver StiJted
o Other ~uoldatlte
ManlUWr
Cl Inc:ondusIve
o steering ind Brakiov 0 Ul"ltnoWn
. hid.nQ or Stat.d
Und...ridt, Ng
-- C:~rtlMm
~ Irnrusitm
Underrift, Unknown If
o C~t 0 Undefl'hle or
~ UnlcnClWfl Ovtnid8
O Override, Oth~r
V.",lOa
'-'tJMIty Use 0 llghls ~ing
. ~ in EmetgeI'lfV
__ 0 S'1fef\ ~lIdlng
o BottI light! and
Siren
o Ul'Il!nclWn
JrlIIdIIIIImr>>tt I'Mtf
o Nurt-(oUiwn
o Top
o U"de~rriaf'
o TllWed Unit
o Unlcnown
A~~r
O No AvOIdanttl
MineUWr'
II'iUIa . 5kid
o UarIl5 i'vid.rn
o $~Skid
Umlfr IUtM Iftdafw
O No Undenfde or
~ni9
Und8rrCd8.
o Com~
~
000 L
al~ll 12 01 Q20 r-
009 03CJ
00 40
07 0& 50
o 0
O Braking. Other
E'lidtnet
O ~n; . Evid.n~
or Driwr 5tatM
o ~htr AYoldanCG
rMneuvet
o lIIConclusl\lO
o St~ tnd Sraking 0 unknown
EvJdInCia or 5Uted
Undmide, No
o Com~t 0 ~. other
Intrusion
O Und.rrJde, 0 Unknown if
OlmP!lnment Underride Dr
Intru5Ion Unk~ Ove,r~
,- Use 0 Lights FIalhlng
o ~: In Eme'911fK')' 0 Sirtf\ SoI.mclinQ
o ~h \Jgtlts .nd
511~n
o UnknOMl
'PQU9E COPY .
MAR 16 2005 13:16 FR NATIONWIDE INSURANCE 717 657 6594 TO 916106924936 P.13/17
~ '. COMMO~ OF PENN$YLVAMA RIIHIDIIIIIIIII
.,...-~ 500 :[;; ~~.~ J fIliI : ~ I D I <Am__
22
;:..-W..
~
~
~ ~c.\\~ ,0 'm~ ~
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~ ~~e.~
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. . ':' ......" ", .'-'1" ..',.....,. .~...~:....... "
MAR 16 2005 13:16 FR NATIONWIDE INSURANCE 717 657 6594 TO 916106924936
_. OJMMoNWEAt-nt OF PENNSYLVANiA ..-.- .....-... .... . , .U1.UIIUIIIIIIIID
",. ~ POLICE CRASH R90RTlNG FORM . ,. · .....
, AA 500 N I ~~~ ~~~, c,' \ \ 1 ~ 0 ~tJon
P.14/17
CIosh r4umb<<
2Z
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. ~ .. ':...: ....
P.15/17
Cr.1Ish N\I(I'\~1'
,. MAR 16 2005 ;~~~7 FR NATIONWIDE INSURANCE 717 657 6594 TO 916106924936
_ .,:~, ~g~~:S~i'T,ci~~:~v.:-~ANIA 1IIIIIIlUUIIIIII
~. 4
. . AA 500 5 1~~~\~IoO.'I. J rn P083116
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. MAR 16 2005 13:17 FR NATIONWIDE INSURANCE 717 657 6594 TO 916106924936 P.16/17
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a Bt,tlng-otl'ltl'
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IntruslOf1
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IntrvsiOfl unlcftewn OwIT~
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.JlIbuCE.COPV
** TOTAL PAGE. 17 **
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MAR 16 2005 13:12 FR NATIONWIDE INSURANCE 717 657 6594 TO 916106924936
P.03/17
Fee for this certificate, $6.00
c!l!;JJ1.u~ .?l~ dM<
Date
. --...Jf IJ/JA -11 fI.d ,;,-- ~rl
l.oca1 Registrar .
P 11336540
No.
-...""". ....
CO~OF~ eOEPAR1'llENTOfHlALTU. YlTALnECOlUJS
CEmIFlCATE OF PEATH
(~
'-"
.
....
\..ICX_
....--
-
194-12-4809
I
&
I
or_....IlOll_
February 20. 2005
s
, .' :,. Nonla
1-
-
:="'11(
Hoaroe .
..t::;:=-_
Cumberland ....JiI.~~n-=.. Hectlanicsbur
---.........
Glenda I. Nailor
~
PA 17055
2005
-.-"'-- ~"'l_''''
1--
...0
::"..:::~~~=:
1/Jr./1~/' '"
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RELEASE AGREEMENT
This Release Agreement ("Agreement") is entered into among Steven A. and
Glenda I. Norris, individually, and Nationwide Mutual Insurance Company (hereinafter
collectively referred to as the "Parties"). The "Insured" shall collectively mean Steven A.
and Glenda I. Norris, individuals, their respective heirs, executors, administrators, personal
representatives, successors and assigns; and the "Insurance Company" shall collectively
mean Nationwide Mutual Insurance Company and their successors and assigns.
I. RECITALS
A. On or about January 20, 2005, at or near Williams Grove Road, Mechanicsburg,
Cumberland County, Pennsylvania, Jason S. Norris sustained personal injuries and died as
a result of an automobile accident (hereinafter referred to as the "Occurrence"). In
connection with the Occurrence, the Insured has asserted claims against Nationwide
Mutual Insurance Company.
B. The Parties desire to enter into this Agreement to provide, among other things,
for certain payments in full settlement and discharge of all claims and actions of the
Insured for damages arising out of or due to the Occurrence, on the terms and conditions
set forth herein.
NOW THEREFORE, it is hereby agreed as follows:
II. UNINSURED MOTORIST RELEASE AGREEMENT
Known all men by these presents: That, for sole consideration of the cash
payment(s) referred to in Paragraph IV.A. from the Insurance Company, the receipt of
which is hereby acknowledged, and the Insured in their capacity as an insured does
1
2
hereby forever release and discharge the Insurance Company of and from all claims of
whatsoever kind and nature prior to and including the date hereof growing out of the
Uninsured Motorist Coverage of Automobile Insurance Policy number 58C013252 issued
by Nationwide Mutual Insurance Company to Steven A. and Glenda I. Norris, and
resulting from the Occurrence.
III. INJURIES KNOWN AND UNKNOWN
The Insured acknowledges that the consideration received under this Agreement
is intended to and does release and discharge the Insurance Company for any claims
for, or consequences arising from, such injuries and the Occurrence; and the Insured
hereby waives any rights to assert in the future any claims not now known or suspected
even though, if such claims were known, such knowledge would materially affect the
terms of this Agreement.
IV. PA YMENTS TO INSURED
A. Cash at Settlement. Upon Court approval of this settlement Nationwide Mutual
Insurance Company agrees to pay One Hundred Fifty Thousand Dollars ($150,000) to be
distributed to Steven A. and Glenda I. Norris, individually and as the natural parents of
Jason S. Norris, deceased.
B. Nature of Payments. All sums set forth in this paragraph for constitute damages
on accounts of personal injuries or sickness, arising from the Occurrence, within the
meaning of Section 1 04(a) (2) of the Internal Revenue Code of 1986, as amended.
V. ADEQUATE CONSIDERATION
The Insured agrees and acknowledges that the Insured accepts payment of the
sums that the Insured is to receive pursuant to this Agreement as a full, complete, final
and binding compromise of matters involving disputed issues regardless of whether too
much or too little may have been paid.
VI. ENTIRE AGREEMENT
This Agreement contains the entire agreement between the Insured and the
Insurance Company with regard to the matters set forth herein. There are no other
understandings or Agreements, verbal or otherwise, in relation thereto, between the
Parties except as herein expressly set forth.
VII. READING OF AGREEMENT
In entering into this Agreement, the Insured represents that the Insured has
completely read all terms hereof and that such terms are fully understood and voluntarily
accepted by the Insured.
VIII. FUTURE COOPERATION
All Parties agree to cooperate fully, to execute any and all supplementary
documents and to take all additional actions that may be necessary or appropriate to
give full force and effect to the terms and intent of this Agreement which are not
inconsistent with its terms.
3
4
IX. DRAFTING OF DOCUMENT AND RELIANCE BY INSURED
This Agreement has been negotiated by the respective Parties. The Insured
warrants, represents and agrees that the Insured is not relying on the advice of the
Insurance Company, or anyone associated with them as to the legal and income tax or
other consequences of any kind arising out of this Agreement. Accordingly, the Insured
hereby releases and holds harmless the Insurance Company, and any and all counselor
consultants for them from any claim, cause of action or other rights of any kind which
Insured may assert because of the legal, income tax or other consequences of this
Agreement other than those anticipated by the Insured.
The undersigned, and each of them, warrant and represent that no promise,
inducement or agreement not herein expressed has been made to them and its
Agreement constitutes the entire agreement between the Parties hereto and that the
terms of this Agreement are contractual and not mere recitals.
The undersigned, and each of them, have read the foregoing Agreement and fully
understand it, and are aware of the propriety and legal effect of executing the same,
and neither the Agreement nor the compromise and settlement recited herein were
induced by fraud, coercion, compulsion or mistake, nor is this Agreement nor the
compromise and settlement made by the undersigned in reliance upon any statement
or representation of any of the parties hereby released, or their representatives, agents
or attorneys.
X. COURT APPROVAL
The Insured represents that the Insured has received any and all necessary court
approvals to enter into this Agreement.
XI. CONTROLLING LAW
This Agreement shall be construed and interpreted in accordance with the laws of
the Commonwealth of Pennsylvania.
Dated:
Steven A. Norris
Dated:
Glenda A. Norris
Dated:
Duly Authorized Representative for
Nationwide Mutual Insurance Company
APPLICABLE TO PENNSYLVANIA ONLY:
For your protection, Pennsylvania requires the following to appear on this form: Any person who knowingly
and with intent to defraud any insurance company or other person files an application for insurance or
statement of claim containing any materially false information or conceals a fraudulent insurance act,
which is a crime and subjects such person to criminal and civil penalties.
5
IN RE: SETTLEMENT OF WRONGFUL
DEATH CLAIM FOR JASON S. NORRIS,
DECEASED
No.
SWARTZ CAMPBELL LLC
By: Christina L. Bradley, Esquire
I.D. No. 89107
1631 North Front Street, 2nd Floor
Harrisburg, PA 17102
(717) 233-3515
Attorney for Petitioners,
Nationwide Mutual Ins. Co.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYL VANIA
ORPHAN'S COURT DIVISION
JOINDER IN PETITION
We, Steven A. and Glenda I. Norris, parents and natural guardians of Jason S. Norris,
deceased, do hereby join in the Petition of Nationwide Mutual Insurance Company for Court
Approval of Wrongful Death Action.
Date:
1<;- ~(" -05'
fttiJ h
Sto/enA. No is
Date: ~ -- ;2..G, -0')
SWARTZ CAM PBELL LLC
ATTORNEYS AT LAW' 1631 N. FRONT STREET' 2ND FLOOR' HARRISBURG. PA 17102
IN RE: SETTLEMENT OF WRONGFUL
DEATH CLAIM FOR JASON S. NORRIS,
DECEASED
No.
SWARTZ CAMPBELL LLC
By: Christina L. Bradley, Esquire
I.D. No. 89107
1631 North Front Street, 2nd Floor
Harrisburg, PA 17102
(717) 233-3515
Attorney for Petitioners,
Nationwide Mutual Ins. Co.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHAN'S COURT DIVISION
ACCEPTANCE OF SERVICE
TO THE CLERK OF THE ORPHAN'S COURT:
We, Steven A. and Glenda 1. Norris, parents and natural guardians of Jason S. Norris,
deceased, do hereby accept service of the Petition of Nationwide Mutual Insurance Company for
Court Approval of Wrongful Death Action.
Date:
g~j{p -Or:)
r
/4/] ·
J'A Norris ~
Father of Jason S. Norris, deceased
,H/I'(\ 11G
G~~-Y.
~other of Jason S. Norris, deceased
I
Date:
8-.JG, - 05
SWARTZ CAMPBELL LLC
ATTORNEYS AT LAW. 1631 N. FRONT STREET. 2ND FLOOR. HARRISBURG, PA 17102
c' ~)
D ~ )
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SWARTZ CAMPBELL LLC
By: Christina L. Bradley, Esquire
I.D. No. 89107
1631 North Front Street, 2nd Floor
Harrisburg, PA 17102
(717) 233-3515
Attorney for Petitioners,
Nationwide Mutual Ins. Co.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYL VANIA
.(}fu dANlS COURT DIVISION
IN RE: SETTLEMENT OF WRONGFUL
DEATH CLAIM FOR JASON S. NORRIS,
DECEASED
No. OS- - S~3A..... CL~l--T8z...~
ORDER
AND NOW, this
/:3'
day of
('J ~ 1,_
, 2005, upon
consideration ofthe foregoing Petition for approval of settlement of the wrongful death action and
hearing on the same, it is hereby ORDERED and DECREED that the settlement with Nationwide
Mutual Insurance Company in the amount of $150,000 to Steven A. and Glenda I. Norris, as the
parents and natural guardians of Jason S. Norris, deceased, is hereby approved.
Steven A. and Glenda I Norris are hereby authorized to execute all settlement documents,
including the General Release, copies of which are attached to the Petition.
BY THE COURT:
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SWARTZ CAMPBELL LLC
ATTORNEYS AT LAW. 1631 N. FRONT STREET. .2NO FLOOR. HARRISBURG, PA 17102
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