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Home My WebLink About06-3038 DARAN J. ALLEN and KIMBERLY A. ALLEN, Individually and as Co-Administrators of the ESTATE OF SENECA C. ALLEN, Deceased, Plaintiff : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA NO. tJ6 -303l? ~ v. : CIVIL ACTION - LAW JANET ADAMS and B & S TRANSPORTATION, INC., Defendant : JURY TRIAL DEMANDED NOTICE 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 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 may be 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 32 S. Bedford Street Carlisle, PA 17013 (717) 249-3166 (800) 990-9108 DARAN J. ALLEN and KIMBERLY A. ALLEN, Individually and as Co-Administrators of the ESTATE OF SENECA C. ALLEN, Deceased, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. v. CIVIL ACTION - LAW JANET ADAMS and B & S TRANSPORTATION, INC., Defendant JURY TRIAL DEMANDED NOTICIA Le han demandado a usted en la corte. Si usted quiere defenderse de estas demand as expuestas en las paginas siguientes. usted tiene viente (20) dias de plazo al partir de la fecha de la demanda y la notificacion. Usted Debe presentar una apariencia escrita 0 en persona 0 por abogado y archivar en la corte en forma escrita sus defensas 0 sus objeciones alas demandas en contra de su persona. Sea avisado que si usted no se defiende, la corte tomara medidas y puede entrar una orden contra usted sin previo a viso 0 notificacion, y par cualquier queja 0 alivio que es pedido en la peticion de demanda. Usted puede perder dinero 0 sus propiedades 0 otros derechos importantes para usted. LLEVE ESTA DEMANDA A UN ABODAGO INMEDIATAMENTE. SI NO TIENE ABOGADO 0 SI NO TIENE EL DINERO SUFICIENTE DE PAGAR TAL SERVICIO, VAYA EN PERSONA 0 LLAME POR TELEFONO A LA OFICINA CUYA DIRECCION SE ENCUENTRA ESCRITA ABAJO PARA AVERIGUAR DONDE SE PUEDE CONSEGUIR ASISTENCIA LEGAL. Cumberland County Bar Association 32 S. Bedford Street Carlisle, PA 17013 (717) 249-3166 (800) 990-9108 DARAN J. ALLEN and KIMBERLY A. ALLEN, Individually and as Co-Administrators ofthe ESTATE OF SENECA C. ALLEN, Deceased, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. rJ {. - 3b.31 v. CIVIL ACTION - LAW JANET ADAMS and B & S TRANSPORTATION, INC., Defendant JURY TRIAL DEMANDED COMPLAINT 1. Plaintiff, Daran J. Allen, is an adult individual who currently resides at 104 Hemlock Road, Mechanicsburg, Cumberland County, Pennsylvania. 2. Plaintiff, Kimberly A. Allen, is an adult individual who currently resides at 104 Hemlock Road, Mechanicsburg, Cumberland County, Pennsylvania. 3. Plaintiffs are the duly appointed co-administrators of the Estate of Seneca C. Allen ("Seneca") having been appointed by the Register of Wills of Cumberland County, Pennsylvania. 4. Defendant, Janet Adams ("Adams"), is an adult individual who currently resides at 315 Hemlock Street, Mechanicsburg, Cumberland County, Pennsylvania. 5. Defendant, B & S Transportation, Inc., ("B & S") is a Pennsylvania corporation that maintains its principle place of business at 2217 Old Gettysburg Road, Camp Hill, Cumberland County, Pennsylvania. 6. On February 6, 2006, at approximately 2:58 p.m., Adams was operating a 1999 Chevrolet School Bus, owned by B & S, on Hemlock Road, Upper Allen Township, Cumberland County, Pennsylvania. 7. At all relevant times, Adams was the agent, employee and/or servant of B & S and acting within the scope of said relationship. 8. Adams was transporting students from the Mechanicsburg Area School District, including Seneca. 9. Adams brought the school bus to a stop in front of the Allen home on Hemlock Road in order to allow Seneca and other children to disembark the bus. 10. Seneca got off of the bus and walked toward the front of the bus and then began to cross in front of it. 11. As Seneca began to cross in front of the bus, Adams was looking in the rear view mirror. Adams suddenly and without warning accelerated the bus and struck Seneca. 12. Adams was unaware that she had struck Seneca as Adams continued to operate the school bus for several hundred feet further on Hemlock Road. 13. As a result of the accident, Seneca sustained fatal injuries. 14. The accident was caused by the negligence, recklessness and carelessness of Adams which consisted of the following: a. failing to stop the school bus in accordance with the proper stopping procedures in that she did not put the vehicle into neutral and apply the parking brake; b. failing to observe the presence of Seneca in front of the school bus; c. looking in the rear view mirror as she began to accelerate the school bus; d. failing to insure that Seneca had reached a point of safety prior to operating the school bus; e. operating the school bus while she was distracted; f. failing to keep a reasonable lookout; g. failing to operate the school bus in accordance with the existing traffic conditions and the presence of pedestrians; h. failing to keep her vehicle under adequate control at all times; and i. violating the rules of the road as contained in the Pennsylvania Motor Vehicle Code. 15. B &S is vicariously responsible for the negligence of Adams. COUNT 1- SURVIVAL ACTION 16. Paragraphs 1 through 15 above are incorporated herein by reference. 17. As a direct and proximate result of the negligence, carelessness and/or recklessness of Adams, Defendants are liable for the following damages: a. Decedent's pain and suffering between the time of her injuries and the time of her death; b. Decedent's loss of eaming power from the time of her death to the end of her normal life expectancy reduced by the cost of her personal maintenance; c. Decedent's loss of retirement and social security income; d. Other financial losses suffered as a result of her death; and e. Such other damages as are permissible in a survival action. WHEREFORE, Plaintiffs, Daran J. Allen and Kimberly A. Allen, individually and as co-administrators of the Estate of Seneca C. Allen, deceased, urge this Honorable Court to enter judgment in their favor for an amount in excess of the jurisdictional amount requiring compulsory arbitration. COUNT 11- WRONGFUL DEATH 18. Paragraphs 1 through 17 above are incorporated herein by reference. 19. Plaintiffs bring this wrongful death action pursuant to 42 Pa.C.S.A. ~ 8301 and Pa. R.C.P. 2202(a) as the personal representatives of the Estate of Seneca C. Allen on their own behalf on behalf of all those entitled to recover damages for the wrongful death of decedent. 20. The names and addresses of all persons legally entitled to recover damages in this wrongful death action for the death of the decedent, and their relationship to decedent are as follows: Daran J. Allen, father 104 Hemlock Road Mechanicsburg, PA Kimberly A. Allen, Mother 104 Hemlock Road Mechanicsburg, PA 21. As a direct and proximate result of the negligence, carelessness and/or recklessness of Adams, Plaintiffs suffered and Defendants are liable for the following damages: a. Funeral expenses for decedent; b. Expenses of administration related to decedent's injuries; c. Loss of the value of Seneca C. Allen's services; d. Such other damages as permitted by the Wrongful Death Act. WHEREFORE, Plaintiffs, Daran J. Allen and Kimberly A. Allen, individually and as co-administrators of the Estate of Seneca C. Allen, deceased, urge this Honorable Court to enter judgment in their favor for an amount in excess of the jurisdictional amount requiring compulsory arbitration. COUNT III - NEGLIGENT INFLICTION OF EMOTIONAL DISTESS 22. Paragraphs 1 through 21 above are incorporated herein by reference. 23. As the school bus stopped, Kimberly A. Allen was in the living room of her home. She heard the bus and looked out the window and watched as Seneca disembarked from the bus. 24. Kimberly A. Allen witnessed the accident that caused the death of Seneca. 25. At the time of the accident, Daran J. Allen was in the basement of the family home. He heard his wife scream. He immediately ran upstairs and out into the street, whereupon he observed Kimberly carrying Seneca into the family home. 26. Daran J. Allen performed CPR on Seneca. 27. Defendants are responsible for the negligent infliction of emotional distress sustained by Plaintiffs. WHEREFORE, Plaintiffs, Daran J. Allen and Kimberly A. Allen, individually urge this Honorable Court to enter judgment in their favor for an amount in excess of the jurisdictional amount requiring compulsory arbitration. NEALON G By: q.'- James G. Nealon, III, Esquire Attorney I.D. #46457 2411 North Front Street Harrisburg, PA 17110 (717) 232-9900 VERIFICATION I, Daran J. Allen, verify that the statements made in the foregoing Complaint are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S.A. 4904 relating to unsworn falsification to authorities. 12- s /if Oaran J. Allen Dated: s- J.3-00 VE~IFICATION I, Kimberiy A. Allen, verify that the statements made in the foregoing Complaint are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S.A. 4904 relating to unsworn falsification to authorities. l~ (~. ut/L-- Kim r1y len Dated: 5- ;;-3-C& \'t ~ (r.. \ V'\ \j ~ \ . ~ ~~: \j ~ ~ ~ ~ ~ ~ \'\ ~L ....... 1::<\ ~~ ~ 'Y ~ .....> 0 ~ 41: (") c.:;;:) C;; cr ::;:l -n ?:: f-n -r: :::: -o,;-\j). -!'1e:; f'.'. i"~; 1-.) U. ::;'\ l,'i, -,,' --."- -Cl Z2 C-j --tr ~,c':' rt1 --~ g ':-? "P-o ~ ft_ cJ) _ 2. ..~- ... DARAN J. ALLEN and KIMBERLY A. ALLEN, Individually and as Co-Administrators of the ESTATE OF SENECA C. ALLEN, Deceased, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 0(, - Jo3~ C4J v. CIVIL ACTION - LAW JANET ADAMS and B & S TRANSPORTATION, INC., Defendant : JURY TRIAL DEMANDED REQUEST FOR PRODUCTION OF DOCUMENTS OF PLAINTIFFS DIRECTED TO DEFENDANT TO: JANET ADAMS and B&S TRANSPORTATION, INC. PLEASE TAKE NOTICE THAT PURSUANT to Pa.R.C.P. 4009, you are required to furnish at our office, on or before thirty (30) days of service hereof, a photostatic copy or like reproduction of the materials concerning this action or its subject matter which are in your possession, custody or control and which are not protected by the attorney/client privilege; or, in the alternative, produce the said matter at said time to permit inspection and copying thereof: 1. The entire contents of any investigation file(s) and any other documentary material in your possession which support or relate to the allegations contained in Plaintiff's Complaint (excluding references to mental impressions, conclusions or opinions representing strategy or tactics and privileged communications from and to counsel). 2. Any and all statements concerning the action, as defined by Rule 4003.4, from all witnesses including any statements from the parties herein, or their respective agents, servants or employees. 3. All photographs taken or diagrams prepared of the scene of the accident or any instrumentality involved therein. 4. Any and all documents containing the names and home and business addresses of all individuals contacted as potential witnesses. 5. Reports of any and all experts who will testify at trial. 6. The following if not otherwise covered by the above requests, the complete claim/investigation/subrogation files of any insurers of Defendant, dealing with the incident in question, with the exclusion of the mental impressions, conclusions, or opinions respecting the value or merit of a claim or defense, or respecting strategy or tactics. 7. The complete personnel file of Janet Adams, including but not limited to applications for employments, drivers records, records of continuing training, discipline reports, memorandums, correspondence or other documents. 8. Complete copies of all insurance policies, primary, excess or umbrella, including declaration pages, forms, endorsements, including applicable limits of liability. Date: Respectfully submitted, NEALON, GOVER & PERRY By: &IU~ ~ ~7&.a_ mes G. Nealon, III, Esquire I.D.#:46457 2411 North Front Street Harrisburg, PA 17110 717/232-9900 ~ (") c ;;:;... ~,~~;,. -;.r.'; ~,- . (I) .<' 5< S~:,. ;:',c;-. ~ . .-.> = C? o~ -.,. i~ -~ (:) -n :t-n n1.F:' -orT; -nC, t) L~ .,~> {~~ f~ c.) -I ~ '-< N <J\ -0 :x <f? .&" o .. ." .. IN TH COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DARA J. ALLEN and KIMBERLY A. ALLE ,Individually and as Co-Ad inistrators of the ESTATE OF SENE A C. ALLEN, Deceased, Plaintiffs, #14711 ADAMS and RANSPORTATION, INC., Defendants. CIVIL DIVISION NO. 06-3038 PRAECIPE FOR APPEARANCE (Jury Trial Demanded) Filed on Behalf of the Defendants Counsel of Record for This Party: Kevin D. Rauch, Esquire Pa.I.D.#83058 SUMMERS, McDONNELL, HUDOCK, GUTHRIE and SKEEL, L.L.P. Firm #911 1017 Mumma Road, Suite 300 Lemoyne, PA 17043 (717) 901-5916 ~ .. ... < IN TH COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DARA J. ALLEN and KIMBERLY A. ALLE ,Individually and as Co-Ad inistrators of the ESTATE OF SENE A C. ALLEN, Deceased, Plaintiffs, CIVIL DIVISION NO. 06-3038 (Jury Trial Demanded) JANE ADAMS and B & S RANSPORTATION, INC., Defendants. PRAECIPE FOR APPEARANCE TO: THE PROTHONOTARY Kindly enter the Appearance of the undersigned, Kevin D. Rauch, Esquire, of the law fi of Summers, McDonnell, Hudock, Guthrie & Skeel, L.L.P., on behalf of the Defen ants, Janet Adams and B & S Transportation, Inc., in the above case. JURY TRIAL DEMANDED Respectfully submitted, SUMMERS, McDONNELL, HUDOCK, GUTHRIE & KEEL, L.L.P. K vin . Rauch, Esquire Counsel for Defendants By: . ... CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing PRAECIPE FOR PPEARANCE has been mailed by U.S. Mail to counsel of record via first class mel', "'''ge p"-peld, lhl,&) de, r ' 2006. James G. Nealon, III, Esquire Nealon Gover & Perry 2411 North Front Street Harrisburg, PA 17110 SUMMERS, McDONNELL, HUDOCK, GUTHRIE & SKEEL, L.L.P. By: "... ". '-' C,'";" c~ ...y.... i""~ (j'\ o -rl .-\ ::r.:-r1 t~~~; ~~ i ) ,J~, . '.'~" . - .-~~, c." of C'" ':n1 . ' -~ :L1 ..<; C,) '"-" DARAN J. ALLEN and KIMBERLY A. ALLEN, Individually and as Co-Administrators of the ESTATE OF SENECA C. ALLEN, Deceased, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 06-3038 v. CIVIL ACTION - LAW JANET ADAMS and B & S TRANSPORTATION, INC., Defendant JURY TRIAL DEMANDED PETITION TO SEAL SETTLEMENT 1. Petitioners DARAN J. ALLEN and KIMBERLY A. ALLEN, have reached a settlement to resolve all wrongful death, survival and individual claims concerning the death of their daughter, Seneca C. Allen, in a motor vehicle accident that occurred on February 6, 2006. 2. The Plaintiffs agreement with the insurers of Defendants, is that this settlement will be kept confidential. 3. If the amount of this settlement becomes a public record and is not sealed, it will be the possible subject of reporting in the press, which would expose the finances of the Plaintiffs to public view to no good purpose. Petitioners request that they be permitted privacy in their financial affairs. 4. No public interest, other than idle curiosity, will be promoted by exposing Petitioners' financial affairs to the public. 5. The grounds for sealing court records were discussed Hutchinson v. Luddv. 417 Pa.Super. 93, 611 A.2d 1280 (1992) at pages 11 and 12 of the Atlantic Reporter, a copy of which is attached to this Petition. 6. The Superior Court in Hutchinson stated in pertinent part as follows: Generally speaking, the question of the openness of the proceedings has been raised in the context of criminal trials, and with respect thereto, the Courts have recognized both a common law and constitutional right of public access.... The common law rule, which also confers a public right of access to Court records, is that every person is entitled to access "provided he has an interest therein for some useful purposes and not for mere curiosity." (Citation omitted) Every Court has supervisory powers over civil proceedings in progress before it, and may deny access, where such access may become a vehicle for harmful or improper purposes.... Thus, the public may be "excluded... to protect private as well as public interests" to protect.. .the privacy.. .(of innocent parties).. . WHEREFORE, Petitioners believe that this Honorable Court has the authority to seal the settlement in this case, and requests that it do so in order to protect the privacy of their financial affairs. Respectfully submitted, g- By James G. Nealon, III, Esquire 2411 North Front Street Harrisburg, PA 17110 (717) 232-9900 I.D. #46457 VERIFICATION I, DARAN J. ALLEN, one of the Petitioners herein, hereby verify that the statements made in the within instrument are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.c.S. Section 4904, relating to unsworn falsification to authorities. 1?:1IL Daran J. Allen Date: '/- /1 - O{p VERIFICATION I, KIMBERLY A. ALLEN, one of the Petitioners herein, hereby verify that the statements made in the within instrument are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.c.S. Section 4904, relating to unsworn falsification to authorities. ~~ Ul. cdP- . erly A. Allen Date: 7-/7 - c:J~ CERTIFICATE OF SERVICE ~ AND NOW, this a day of July, 2006, I hereby certify that I have served the foregoing Consent on the following by depositing a true and correct copy of same in the United States mail, postage prepaid, addressed to: Kevin D. Rauch Summers, McDonnell, Hudock, Guthrie & Skeel, L.L.P. 1017 Mumma Road Lemoyne, PA 17043 q- James G. Nealon, III, Esquire '':.::0 -~'l .';'-1 :=l (u ;;1 --J r~.) i I. I.' - . . ) JUt 1 '1 200j!! DARAN J. ALLEN and KIMBERLY A. IN THE COURT OF COMMON PLEAS ALLEN, Individually and as : CUMBERLAND COUNTY, PENNSYLVANIA Co-Administrators of the ESTATE OF SENECA C. ALLEN, Deceased, NO. 06-3038 Plaintiff v. : CIVIL ACTION - LAW JANET ADAMS and B & S TRANSPORTATION, INC., Defendant : JURY TRIAL DEMANDED ORDER OF COURT AND NOW. this I 7 ~ day of M: ' 2006, upon consideration of the Petition to Seal Settlement heretofore filed this Honorable Court directs the Prothonotary to place the settlement in this case under seal in order to protect the privacy of the financial affairs of the Petitioners. J. :xo ~D ~~\ o ~ed (t _l.LIe(l'lent ~' 1...:;5"cJo cl(8 # ( 1.0,1, . \ I, '; .l. t :lC';l DARAN J. ALLEN and KIMBERLY A. : IN THE COURT OF COMMON PLEAS ALLEN, Individually and as CUMBERLAND COUNTY, PENNSYLVANIA Co-Administrators of the ESTATE OF : SENECA C. ALLEN, Deceased, NO. 06-3038 Plaintiff v. : CIVIL ACTION - LAW JANET ADAMS and B & S TRANSPORTATION, INC., Defendant : JURY TRIAL DEMANDED PRAECIPE TO DISCONTINUE To the Prothonotary: Please mark the above-captioned matter settled, discontinued and ended. Respectfully submitted By: q- James G. Nealon, III, Esquire Attorney I.D. #46457 2411 North Front Street Harrisburg, PA 17110 (717) 232-9900 Attorneys for Plaintiffs CERTIFICATE OF SERVICE AND NOW, this 1 CMt, day o~ ~ ,2006, I hereby certify that I have served the foregoing PRAECIPE TO DISCONTINUE on the following by placing a true and correct copy of same in the United States Mail, postage prepaid, addressed as follows: Kevin D. Rauch, Esquire Summers, McDonnell, Hudock, Guthrie & Skeel, LLP 1017 Mumma Road Lemoyne, PA 17043 y~ James G. Nealon, III, Esquire ~ ~ ~ '"'0 ~ 2 ~. 0' ~\;f. ~'~~ m..-;- ;.i( "",; t;2 \.) zo ~\ Q. ~~ ~~ ~~, ()~ rsrn ~ ~ --0 ::J:. ~ s;:" ....J -~ ''I SHERIFF'S RETURN - REGULAR CASE NO: 2006-03038 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND ALLEN DARAN J ET AL VS ADAMS JANET ET AL " JASON VIORAL , Sheriff or Deputy Sheriff of Cumberland County, Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT & NOTICE was served upon ADAMS JANET the DEFENDANT , at 0954:00 HOURS, on the 9th day of June , 2006 at 315 HEMLOCK STREET MECHANICSBURG, PA 17055 by handing to JANET ADAMS a true and attested copy of COMPLAINT & NOTICE together with REQUEST FOR PRODUCTION OF DOCUMENTS and at the same time directing Her attention to the contents thereof. Sheriff's Costs: Docketing Service Affidavit Surcharge 18.00 9.68 .00 10.00 .00 37.68/ 1//1(01" So Answers: .~fJJ?~~ R. Thomas Kline ~ Sworn and Subscibed to 06/12/2006 NEALON & GOVER By: before me this ~~ day of A.D. "" '~ SHERIFF'S RETURN - REGULAR CASE NO: 2006-03038 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND ALLEN DARAN J ET AL VS ADAMS JANET ET AL JASON VIORAL , Sheriff or Deputy Sheriff of Cumberland County,Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT & NOTICE was served upon B & S TRANSPORTATION INC the DEFENDANT at 1045:00 HOURS, on the 8th day of June , 2006 at 6370 BASEHORE ROAD MECHANICSBURG, PA 17055 by handing to SCOTT SCHOFFSTALL, PRESIDENT, ADULT IN CHARGE a true and attested copy of COMPLAINT & NOTICE together with REQUEST FOR PRODUCTION OF DOCUMENTS and at the same time directing His attention to the contents thereof. Sheriff's Costs: Docketing Service Affidavit Surcharge So Answers: 6.00 8.80 .00 10.00 .00 24.80 ,/ 9w. 1/11/0(, ~t7~ rr,'''" /~. r ;,0..,::' :" .,.' ~-" ,l"1f,~.__ .,~r>; ,.,_4.-::"'~A- R. Thomas Kline 06/12/2006 NEALON & GOVER A.D. '- ~ uty Sheriff Sworn and Subscibed to By: before me this day of DARAN J. ALLEN and KIMBERLY A. ALLEN, Individually and as Co-Administrators ofthe ESTATE OF SENECA C. ALLEN, Deceased, Plaintiff IN THE COURT OF COMMON PLEAS I CUMBERLAND COUNTY, PENNSYLVANlt NO. 06-3038 't .' ( v. CIVIL ACTION - LAW JANET ADAMS and B & S TRANSPORTATION, INC., Defendant JURY TRIAL DEMANDED AND NOW, this ,.3d ORDER day of March, 2007, upon consideration of the Petition 0 Settle Underinsured Motorist Claims, it is hereby ordered that the settlement is approved. Petitio ers are authorized to execute a Release in favor of Nationwide Mutual Insurance Company. The settlement proceeds shall be distributed as follows: TO: Nealon Gover & Perry, $2,000.00 for counsel fees; Wrongful Death Action $3,840.00 TO: Daran J. Allen (Father) $1,920.00; TO: Kimberly A. Allen (Mother) $1,920.00; Survival Action $960.00. TO: Daran J. Allen and Kimberly A. Allen, personal representatives of the Estate of S neca C. Allen. \if~;!\;II\ 1),81'4 [r3d i it ,~\ '-'r ,'''" .-" . "l'-llllln' '" 1\..L \,,:1 It.. },,' j :~ ",', :~,',~~~:~lt,....) BS :01 Wi 82 ?1VW LOOl 1 U\J, t"', ';~' I' (\.1 I 3Hl' .10 I\QV.L\jf\$\..)r'rlv'i:JQ ;J , 381::Ho---o:nl:1 1. Petitioner, Daran J, Allen, is an adult individual who currently mai tains a . DARAN J. ALLEN and KIMBERLY A. : IN THE COURT OF COMMON PLE S ALLEN, Individually and as CUMBERLAND COUNTY, PENNSY VANIA Co-Administrators of the ESTATE OF : SENECA C. ALLEN, Deceased, NO. 06-3038 Plaintiff v. CIVIL ACTION - LAW JANET ADAMS and B & S TRANSPORTATION, INC., Defendant : JURY TRIAL DEMANDED PETITION TO SETTLE UNDERINSURED MOTORIST CLAIM mailing address of P.O. Box 1155, Mechanicsburg, Cumberland County, Penn ylvania 3. Petitioners are the duly appointed Co-Administrators of the 17055. 2, Petitioner, Kimberly A. Allen, is an adult individual mailing address Box 1155, Mechanicsburg, Cumberland County, Pennsylvania 17055. Seneca C. Allen, Deceased. A true and correct copy of the Certificate of Letters of Administration is attached hereto and incorporated herein by refer~n ed as Exhibit "A." 4. On February 6, 2006, at approximately 2:58 p.m., Defendant, Janet Adams was operating a school bus on Hemlock Road, Upper Allen T1 nship, \ Police Report is attached hereto and incorporated herein by reference as Exhibit "B." Cumberland County, Pennsylvania. Seneca C. Allen was a passenger on t school bus, 5. At the time of the accident, Janet Adams was an employee 0 B & S Transportation and within the course and scope of her employment. 6. Seneca C. Allen exited the school bus and was crossing in front 0 it when she was struck and knocked down by the school bus. A true and correct cqp of the 7. As a result of the injuries she sustained in the accident, Seneca . Allen died. A true and correct copy of the Death Certificate is attached her to and incorporated herein by reference as Exhibit "C." 8. Seneca C. Allen died intestate. 9, At the time of the accident, Petitioner, Kimberly A Allen, was pr sent in the family home and witnessed the accident from the living room. Petitioner, aran J. Allen, was present in the family home and contemporaneously perceived the adc dent. 10. Petitioners previously settled all claims against Defendants, Janet Adams and B&S Transportation. 11. At the time of the accident, Petitioners maintained an aut mobile I , insurance policy with the Nationwide Insurance Company. The policy p ovided underinsured motorist coverage of $15,000 each person/$30,000 each ocp rrence slacked on two vehicles. A true and correct copy of the declarations page is r tached hereto and incorporated herein by reference as "Exhibit D." I 12. Subsequent to the settlement of the claims against Janet Adams Transportation, Petitioners made a claim for underinsured motorist be Nationwide. Nationwide has offered the sum of $10,000.00 to settle all claims. is based upon Nationwide's position that the Petitioners have been fully comp for their losses by the prior settlement. 13. Recognizing the uncertainties of litigation and the desire to ~ oid an arbitration hearing, Petitioners believe that the settlement is fair and desire to ac ept it. 14. The name, relationship, address and share of each person en itled to share in the proceeds of any wrongful death or survival action claims are as folio s: Daran J. Allen, father P.O. Box 1155 Mechanicsburg, PA 17055, one half (1/2); Kimberly A. Allen, mother P.O. Box 1155 Mechanicsburg, PA 17055, one half (1/2). 15. The settlement would be in exchange for a General ReleaS. The Release would bar all further underinsured motorist claims arising out of the acci ent. 16. Petitioners propose that the proceeds of the settlement be alloc ted as follows: Wrongful death and survival claims - $6,000.00; Kimberly A Allen - $2,000.00 (individual negligent infliction of e otional distress claim); and Oaran J. Allen - 2,000.00 (individual negligent infliction of otional distress claim). 17. Petitioners would propose that of the $6,000.00 settlement attri~l table to the wrongful death and survival claims, that twenty (20%) percent be attributab e to the survival claim and eighty (80%) percent be attributable to the wrongful death cl m. This is the same allocation previously approved by the court for the settlement of th claims against Janet Adams and B&S Transportation. 18. Subsequent to the accident, Petitioners retained the firm of Nealp & Perry. The Petitioners executed a contingent Power of Attorney and Fee Ag eement providing for Nealon Gover & Perry to be paid a contingent fee of twenty (20%) if the cause of action is settled without suit, and twenty-five (25%) percent i begun. A true and correct copy of the fee agreement is attached her to and incorporated herein by reference as Exhibit "E." 19. Petitioners concur in the proposed settlement and request t~ t it be approved. Petitioners also request that the Court approve the payment of arney's fees. Petitioner believes that the fees were reasonable and necessary to op ain the settlement. Nealon Gover & Perry (attorneys fees) $2,000.00 20. The settlement proceeds should be distributed as follows: Daran J. and Kimberly Allen (wrongful death) $3,840.00 I - WHEREFORE, Petitioners request that an Order be entered appr~ ing the proposed settlement of the wrongful death and survival claims, authorizinQ the co- administrators to execute all necessary Releases and approve the payment of a orneys Individual claim of Daran J. Allen $ 960.00 $1,600.00 Estate of Seneca Allen (survival action) Individual claim of Kimberly A Allen $1,600.00 Petitioners believe that the proposed allocation is fair and reason~ Ie, and 21. their Verification is attached hereto. fees to Nealon Gover & Perry. Respectfully submitted, By: NEALON GOVE Date: 3 /~llc)/ I { James G. Nealon, III, Esquire I.D. #: 46457 2411 North Front Street Harrisburg, PA 17110 717/232-9900 Date: .z /;;;-/07 I I VERIFICATION AND CONSENT I, Daran J. Allen, verify that the statements made in the foregoing petitio~ 0 Settle Underinsured Motorist Claims are true and correct. I understand that f~1 e statements herein are made subject to the penalties of 18 Pa.C.S.A. ~4904 relatin~ 0 i unsworn falsification to authorities. I consent to the settlement and request that itl e approved by the Court. Date: #z- VERIFICATION AND CONSENT I I, Kimberly A. Allen, verify that the statements made in the foregoing Petitio~ 0 Settle Underinsured Motorist Claims are true and correct. I understand that fal e statements herein are made subject to the penalties of 18 Pa.C.S.A. ~4904 relating 0 unsworn falsification to authorities. I consent to the settlement and request th~t it I I be approved by the Court. f' '( h ; b " f I' A Ii REGISTER OF WILLS CUMBERLAND County, Pennsylvania CERTIFICATE OF GRANT F LETTERS No. 2006- 00152 PA No. 21- 06- 152 Estate Of: SENECA CALLEN {First, Middle, Last! Late Of: UPPER ALLEN TOWNSHIP CUMBERLAND COUNTY Deceased Social Securi ty No: 206-78-8613 r WHEREAS, SENECA CALLEN (First, Middle, Lastl la te of UPPER ALLEN TOWNSHIP CUMBERLAND COUNTY died on the 6th day of February 2006 and, WHEREAS, the grant of Letters of Administration is required for the administration of the estate. THEREFORE, I, GLENDA FARNER STRASBAUGH , Register of Wir for CUMBERLAND County, in the Commonwealth of Pennsylvania, hav, this day granted Letters of Administration to: DARAN J ALLEN and KIMBERL Y A ALLEN who have duly qualified as ADMINISTRATOR (RIX) of the estate of the above named decedent and have agreed to administer the es ate ~ccording to law, all of which fully appears of record in my off ce at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA. s in and I ., IN TESTIMONY WHEREOF, I have hereunto set my hand and of my office on the 16th day of February 2006. the seal iv. I" C * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) j;- )( h ;' b " + I' B " ---------. ~ .t'nm CK~ WUU34710 ; o 9 i:i @ l: fil ... .J IIIIlIIIIIII 1I111 1111 1111 Page 1 ot 20 Cr s Number I COMMONWIEALTH Of PlENNSVlVANiA POUCIE CRASH IltIE~OIUING fORM Case Closed Reportable Crash o Yes _ No . Yes 0 No Page [C] W0034710 OThu OFri o Sat o Unk http://www.dot6.state.pa.us/icons/PrintImages/XmlFiles/20060 154641 Beauduy231320060... 2/27/2006 AA "500 1 ! e- l: 1 I!l -f fl .!:! '0 I!. Incident Number I UAT20060200192 Agency Name I Upper Allen Township . paidLIime (mill Arrival Time (J 11504 111509 Reviewer I Peter J Beauduy IIOFFICER TIMOTHY ALBERT Badge Number II 2313 Precinct II Police A!;Iency 1 21104 , I l,nvestig7on Date (.MM-DO- I 02 a~a 2 I Approval Date (MM-DD- l~=~= Ii ~ Ii i:\ 2 .!: III Ii g Municipality Municipality Name 11104 I /Upper Allen Township Crash Time (mil) No Of Units People Injured 11458 I EJ ~ ~ FormF . No School Bus. Yes 0 No School Zone 0 Yes. No No~ify PENNDO Related Related Maintenance o "yo Intersection 0 Multi-le9 0 Off Ramp Intersection O Traffic Circle! 0 On Ramp 0 Crossover Round About 3m County County Name ~ ICumberland Crash Date (MM-DD-YVYV} , ~=~.;12006 Workzone (If Yes,Comp(ete 0 Yes Form M, Section 29) Intersection Drpe 0 4 Way Intersection . Midblock 0 "T" Intersection 'g co o Il!: 4 'iij !!. '~ l: .;: I!. Route Number I Street Name I HEMLOCK Bml1e 5.igning. . Local Road or Street Segment (Optional) Travel lanes Speed limit I~~ s .'" '" Street Ending c I~ 8 o North o South o East . West o Unknown I I o Interstate' 0 Turnpike 0 Turnpike 0 State 0 County (Not Turnpike) (Ea5IM'est) Spur Highway Road Route Number Segment (Optional) Travel lanes Speed limit I II 100 Street Name I ill '<I ~ Ii .s 0 E c: r oS! lJ s t l:l C!I J!! ~ S I!l .. ~ of .5 .. :s o North o South o East o West. o Unknown c o +: '" Street Ending t: 10 ~ fW.lli:. SismiLJ9. 0 Interstate 0 Turnpike 0 Turnpike 0 State 0 County 0 Local Road 0 Private (Not Turnpike) (EaslM'est) Spur Highway Road or Street . Road i! ill Ii .c: Ii: .. 1 5 Ii is ..! oS! 6 I:: '" ! :c 1!I ~ ... .. l: of J: .. ~ :S Intersecting Rt Num Or III1iIe Post Or Segment Marl(er ~ I II I.DI .a Or Intersecting Street Name j I HEMLOCK I ~; 0 North :l: 0 South St Ending, :> 0 East ! E=:J ~ 0 West Please Enter Information for BOTH landmarks if Using N This Option ~ E ~ c .. ..... Intersecting Ilt Num Or III1iIe Post Or Segment Marker I II 1.01 Or Intersecting Street Name I I ~.~ 0 North , :l: 0 South St Ending :> 0 East ID~qwest Degrees Minutes Seconds o D:D.D r;] Degrees Minutes Seconds 7l!Jlatitude:D O:D.D ~ Traffic Control Device 8 a . Not Applicable 0 Traffic Signal I- 0 Flashing Traffic 0 St S' Signal op Ign Longitude: - TeD Functioning . No Controls 0 o Device Not 0 Functioning o Police Officer or Flagman o Other Type TCD o Unknown o Yield Sign o Active RR Crossing Controls o Passive RR Crossing Controls Device Functioning Improperly Device Functioning Properly o North and Sout .. ' East and West o North o South o East o West . 1-3 hrs 03-6 hrs 06-9 hrs FO,RIII , AA.SOO (12102) PENN DOT COpy .rnnt CK:S W0034710 --.J Iflllllll~ 111/1/11111111111 Page 2 of 20 eras umber. I <<:'\O)MWil~fi\!I~1E~lL'ITlXl iOl!F ~lEJitIlIM$,'tr1l. 'IJ Atjl;qi&. ~lOllL!CfE OIA$M IFllEW'OiPl.1BNG IFO~M Page: I'IT]' W0034710 Comm r 'al Vehicle . Ye ONo (If Yes, C. m lete Form C) -I AA 500 2 I Police Use Only . Motor Vehicle in 0 Hit & Run Vehicle 0 lIIegally Parked 0 Legally Parked 0 Non - Motorized ~ Transport Y.!2!.! 0 Pedestrian 0 Pedestrian on Skates, 0 Disabled From 0 Train in Wheelchair, etc Previous Crash (If 'Pedestrian' or 'Pedestrian on Skates, in Wheelchair, etc', Complete Form M. Section 28) First Name MI Date of Birth (MM-DD-YYYY)' I JANET I ~ ~ @:=:J 1948 last Name I ADAMS l': Address I City I State .~ ~3.liHEMLOCKST MECHANICSBURG PA, E Driver License Number i 113536062 I: fil .;:; 11 t: (II '" III '" .... .. ~ Alcohol Test Type a 0 Test Not Given il 0 Blood & (II ::> o ... 10 ; '2 ::l o Phantom Vehicle Driver Presence 1 = Driver Operated Vehicle 2=No Driver 3=Driver Fled Scene 4=Hit and Run 9=Unknown Tag St D Road Ali ent '" traight '" uNed '" nknown Unit No @D Delete? o Tele hone Number ~ http://www.dot6.state.pa.us/icons/PrintImages/XmIFiles/20060 154641 Beauduy231320060... 2/27/2006 7177660119 State Class I~~* AlcohollDruqs Suspected . No 0, Illegal Drugs o Alcohol 0 Alcohol and Drugs Driver or Pedestrian Physical Condition . Apparently 0 Illegal Drug Normal Use O Had Been 0 S' k Drinking IC ' o Fatigue o Asleep o Medication o Unknown . Breath o Urine o Other o Unknown if Test Given O Unknown Results Primary Vehicle Code VIolation Alcohol Test Results [QJ.~ o Test Refused O Test Given, Contaminated Results ~ OwnerlDriver OO=.Not Applicable ~ oi=Private Vehicle Owned! ~ 'Leased by Driver 02=Private Vehicle Not Ownedlleased by Driver 03=Rented Vehicle 04=State Police Vehicle OS=PENNDOT Vehicle 06=Other State Gov Veh 07=Municipal Police Veh 08=Other Municipal Government Vehicle Owner Last Name or Business Name (1f Pedestrian, skip this Section) Same as Owner First Name Driver 0 I UNDEFINED Address I City I State I Zip 12217 OLD GETTYSBURG RD CAMP HILL P A 17011 VIN 11GBL7T1D8XJ109133 License Plate I SC26680 B & S TRANSPORTATION INC Vehicle Make Chevrolet Vehicle Model Model Year 111999 Vehicle Towed I 0 Yes . No Policy No Reg. State Est. Speed I~ j005 Towed By I: o <= OJ E .. 12 ~ .5 fl ~ ;g: fl :>> Insurance Insurance Company _Yes 0 No 0 ~~wnISTATEFARMMUTUAL. F500227Bl138E Traifinq I:i2!!.' 1=Towing Pass. Veh 4=Mobile/Modular Home 7=Semi-Trailer Unit No. of 1()1 Unit 0 2=Towing Truck 5=Camper 8=Other ---:- lr;i~~gL-J - 3=Towing Utility Trailer 6=Full Trailer 9=Unknown Tag No I Direction of EJ .Vehicle Position ~ .Movement ~ .See Special Usaqe Travel Overlay ~ Vehicle Color Vehicle Tvpe 05=Large Truck 20=Unicycle, Bicycle, ~ 06=Yellow ~ 01 ",Automobile 06=SUV Tricycle OO=Not Applicable 07=Silver 02=Motorcycle 07_Nan 21=Other Pedalcycle OI=Fire Veh 08=Gold 03=Bus 10=Snowmobile 22=Horse & Buggy 02=Ambulance 01 =Blue 09=Brown 04=Small Truck ,11 =Farm Equip 23=Horse & Rider 03=Police 02=Red 10=Orange (If Mor, Complete Form 12=Construction Equip 24=Train 08=Other Emergency 03=White 11 =Purple .M. Section 26) 13=ATV 25= Trolley Vehicle 04=Green 12=Other (If M20M or M21 N, Complete 18",Other Type spec Veh 9B=Other 11 =Pupil Transport OS=8lack 99=Unknown Form M, Section 27) 19=Unk. Type Spec Veh g9=Unknown . lnitialltriPact Point 199:'<'1 OO=Non-Collision " 01-12=Clock Points 13=Top Damaqe Indicator 1()1 O=None 2=Functional L:..J ,1 =Minor 3=Disabling 9=Unknown Gradient 3",Downhill m 1 =Level 4=Bottom of Hill L.:.J 2=Uphl'll S=Top of Hill 9=Unkriown 14=Undercarriage lS=Towed Unit 99=Unknown FORM ~ M-SOO (12102) PENNDOT COpy ~'Print CRS W0034710 .J 111111I1~lllllIIlIllllIllI Page 3 of20 C s Number I C(Q)MM(QJINIW(E~Il..'il'~ (Q)!F ~lE~IM$'\fIl.VAWli~ ~~I\JC!E CillA$H ~fE~Olfti'BNG fORM Page: I '[2:]' W0034710 (lfVes, rdal Vehicle . No plete Form C) AA 500 2 I Police Use Only , Charged? CP Yes . No o Motor Vehicle in a Hit & Run Vehicle 0 JIIegally Parked a Legally Parked a Non - Motorized ~ Transport Unit . Pedestrian a fedestrian o~ Skates. 0 Disabled From a Train a Phantom Vehicle In Wheelchair, etc PrevIous Crash (If . Pedestrian' or "Pedestrian on Skates, in Wheelchair, etc', Complete Form M, Section 28) First Name Ml Date of Birth (MM-DD-YYYY) I SENECA @] ~,~ 2000 Delete? Last Name Tele hone Number a I PULLEN I 7176915716 I': Address I City I State . ~ 1104 HEMLOCK ROAD MECHANICSBURG P A j Driver License Number !: I c iii 11 ~ l!I "9 : l 10 ... '2 ::) Unit \110 ~ State Class 101 Atcohol/Druqs Suspected . . No 0 Illegal Drugs o Alcohol 0 Alcohol and Drugs Driver or Pedestrian Physical Condition . Apparently a Illegal Drug Normal Use o H~d ~een a Sick Dnnkln a Fatigue o Asleep - .. ~ Alcohol Test Type a . Test Not Given ~ 0 Blood & ~ 1 =Driver Operated Vehicle 2=No Driver 3=Driver Fled SceM 4=Hit and Run --1- 9=Unknown Og=~e erili Gov Veh 98=~t er 99= n nown I Tag St D o Medication o Unknown Primary Vehicle Code Violation I NONE a Other a Unknown if Test Given a Unknown Resu Its o Breath o Urine o Test Refused O Test Given, Contaminated Results Driver Presence Alcohol Test Results [Q].O D ment =Straiglit =C urved =Unknown http://www.dot6.state.pa.us/iconslPrintImagesIXmlFiles/20060 154641 B eauduy2313 2 0060.. Owner/Driver OO=Not Applicable ,0 01=Private Vehicle Owned! Leased by Driver 02=Private Vehicle Not OwnedlLeased by Driver 03=Rented Vehicle 04=State Police Vehicle OS=PENNDOT Vehicle 06=Other State Gov Veh 07=Municipal Police Veh 08=Other Municipal Government Vehicle Same as Oriver 0 Owner first Name I Owner last Name or Business Name (If Pedestrian, skip this Section) Address I City I State I Zip I VIN I License Plate I Vehicle Make Model Year II Vehicle Model Reg. State Est. Speed ID (000 t: o :0; <il Ii: .. 12 ~ .5 l!I .. :8: ~ Insurance Insurance Company aYes 0 No 0 ~~wnl VehIcle Towed I a Yes a No Policy No Towed By Trailinq , Tvne Unit No. of 0 ~ - Trailing !:!flf! Units: l=Towing Pass. Veh 4=Mobile!Modular Home 7=Semi-Traifer O 2=Towing Truck 5=Camper 8=Other 3= Towing Utility Trailer 6=Full Trailer 9=Unknown Tag No I Direction of D "Vehicle Position 0 "Movement 0 .See Special Usaqe Travel Overlay 0 Vehicle Color Vehicle Type OS=Large Truck 20=Unicycle, Bicycle, D 06=Yel!ow o 01=AutomobilEl 06=SUV Tricycle OO=Not Applicable 07=Silver 02=Motorcycle 07=Van 21 =Other Pedalcycle 01=Fire Veh 08=Gold 03=Bus 10=Snowmobile 22=Horse & Buggy 02=Ambulance 01=Blue 09=Brown 04=Small Truck 11 =Farm Equip 23=Horse 8< Rider 03=Police 02=Red 10=Orange (If Mor, Complete Form 12=Construc:tion Equip 24=Train 08=Other Emergency 03=White 11 =Purple M, Section 26) 13=ATV 25= Trolley 04=Green J 2=Other 18=Other Type Spec Veh 9S=Other Vehicle (If M20N or N21 N, Complete 11 =Pupil Transport 05=Black 99=Unknown Form M, Section 27) 19=Unk. Type Spec Veh 99=Unknown Initia/lmpact Point O OO=Non-Collision 01-12=Clock Points J3=Top Damaqe Indicator O O=None 2=Functional 1 =Minor 3=Disabling 9=Unknown Gradient 3=Downhill D 4=Bottom of Hill I=Level 5=Top of Hill ' 2=Uphill 9=Unknown 14=Undercarriage 15=Towed Unit 99=Unknown FORM' AA-500 (12102) PENNDOT COpy 2/2712006 p - - - rint CRS W0034710 Page 4 of .J COMMONWIEALTH Of PENNSYlVANIA III 11111111111 111II111111 III -, POUCE CRASH ~1El?OR1ING fORM era hN umber Page AA 500 3 I Polic. Us. Only I ~ W0034710 A Person Tvpe: Seat Position: Safetv Equipment One: .~: 1 =Driver o OO=Not A Passenger/Occupant E OO=None Used / Not Applicable G O=Not Applicable 2=Passenger 01=Driver - All Vehicles 01 =Shoulder Belt Used 1 =Not Ejected 7=Pedestrian 02=Front Seat Midd,\e Position 02=lap Belt Used 2= T otallfl Ejected 8=Other 03=Front Seat Right Side 03=lap And Shoulder Belt Used 3=Partia Iy Ejected 9=Unknown 04=Se.cond Row' left Side Or 04=Child Safety Seat Used . 9=Unknown Motorcycle passedier , 05=Motorcycle Helmet Used OS=Se.cond Row - Mi die Position 06=Bizcle Helmet Used ' H Eiection Path: ~: 06:Second Row - Right Side 10=Sa ety Belt Used Improperly O=Not Ejected / Not App ie b Ie B F =Female 07=Third Row Or Greater- 11 =Child Safety Seat Used Improperly 1=Through Side Door Oper n 9 ;: M=Male Left Side 12=Helmet Used Improperly 0 2=Through Side Window ~ U "Unknown 08: Third Row Or Greater - 90=Restraint Used, Type Unknown 3:Through Windshield Middle position 99=Unknown E 09=Third Row Or Greater- 4= Through Back Door 0 Right Side . Safety Equioment Two: 5= Through Back Door Ta I~ t e Opening "" fniw)' Severity: 10=Sleeper Section of Truckcab F OO=None Used / Not Applicable . 6= Through Roof Openin( u nrooff .!: Convertible Top Down C!I C O=Not Injured 11 =In Other Enclosed 01 =Front Air Bag Deployed (For This Seat) 7=Through Roof Openin ( 0 nvertible "[ l=Killed Passenger Or Cargo Area 02=Side Air Bag Deployed (For This Seat) Top Up) . () 2=Major Injury 12"ln Open Area . 03=Other Type Air Bag Deployed w 3=Moderate (Back Of Pickup, Etc.) 04=Multiple Air Bags Deployed 9=Unknown I f- ~ Injury 13= Trailing Unit 05=Motorcycle Eye Protection 4"Minor Injury 14=Riding On Vehicle Exterior 06=Bicyclist Wearing Elbow/Knee/Pads I Extrication: 8=lnjury, Unk 1S"Bus Passenger 1 O=Air Bag Not Deployed, Switch On O"Not Applicable Severity 98=Other 11 =Air Bag Not Deployed, Switch Off 1 =Not Extricated 9=Unknown if 99=Unknown 12=Air Bag Not Deployed, 2=Extricated By Mechanid I ~eans Injury Unk Switch Settin{ 3=Freed By Non - Mecha Ic I Means 13=Air Bag Removed PliOT To Crash} 8=Other 19=Unknown If Air Bag Deployed 9"Unknown 99=Unknown 3 EMS Agency: I LO\VER ALLEN! LIFE LI I Medical Facility: I HERSHEY MEDICAL CENTER \ Unit No Person No Delete? Date of Birth (MM-DD-YVYY) ABC DE. F G H I 4 @:J~ 0 ~-~-11948 I[J~~~~~~ tJD Name I Address / Phone I: ) T ra nsport o Same as IADAMS, JANET A 315 HEMLOCK ST MECHANICSBURG P A 17055717 Yes 0 No Operator " Unit No Person No 0 I ? Date of Birth (MM-DD-YYYY) AB CD E F G ~tJ @CJ~' ate. ~-~-11988 1~~@]EJ~~ro Name I Address / Phone I ~~ Transport o Same as ICORY J. BECHTEL 635 GETTYSBURG PIKE MECHANICS BURG P A 170 Yes . No Operator . Unit No Person No Delete? Date of Birth (MM-DD-YVYY) A B C D E F G H I @CJ~ o ~-~-11996 I[][!]@]EJ~~[~][ ~[?] Name I Address I Phone 1* Transport o Same as ITILER C. BECHTEL 635 GETTYSBURG PIKE MECHANICS BURG P A 17 es _NO Operator ' Unit No Person No D I Date of Birth (MM-DD-YYVY) AB CD E F G ltJ @CJ~ c;e?~-~-11997 '1~~@]EJ~~roI Name I Address I phone I~ IS Transport o Same as I SARAH E. KLEINERT 874 HAWTHORN AVE MECHANICS BURG PA 1705 es _ No Operator Unit No Person 1\10 D J ? Date of Birth (MM-DD-YYY'f) ABC D E F G I @:J~ ate ~-~-11998 I@]~@]~~~~ !(JEJ Name I Address / phone l~ S ransport o ~~~a~~r IKYLE C. FLEMMING 882 HAWTHORN AVE MECHANICSBURG P A 17055 es _NO Unit No Person No D I 7 Date of Birth (MM-DD-YYVY) ABC D, E F G I [20 ~ ate ~-~ -/1996 I~[D@]~~~@] ~j@] Name I Address I Phone I~ S ransport o Same as I MADISON P. LUTZ 884 HAWTHORN A VB MECHANICSB URG P A 17055 't s _NO Operator ' '. ' FORM. AA.500 (12102) PENNDOT COPY I http://www.dot6.state.pa. us/icons/PrintImages/XmlFiles/20060 154641Beauduy231320060... 2/27/2 21T 006 ynntCKS W0034710 .-J COMMONWEALTH Of PENNSVlVANIA ?OUC[C C~ASM RlEI?OR11NG /FORM AA 500 3 I Police Use Only A Person Tvoe: 1 =Driver 2=Passenger 7=Pedestrian 8=Other 9=Unknown e \) :0; III ~ J! ~ l!> ~ o fJ l!. ~: B F =Female M=Male U =Unknown Iniury Severity: C i}.=Not Injured l=Killed 2=Major Injury 3=Moderate Injury 4=Minor Injury 8=lnjury, Unk Severity 9=Unknown if Injury Seat Position: o DD=Not A Passenger/Occupant D1=Driver - Ail Vehicles D2=Front Seat Middle Position 03=Front Seat Right Side 04=Second Row - Left Side Or Motorcycle Passenger OS=Second Row - Middle Position 06=Second Row - Right Side 07=Third Row Or Greater- Left Side 08=Third Row Or Greater- Middle Position 09= Third Row Or Greater - Right Side 10=Sleeper Section of Truckcab 11 =In Other Enclosed Passenger Or Cargo Area 12=ln Open Area (Back Of Pickup, Etc.) 13= Trailing Unit 14=Riding On Vehicle Exterior 1S=8us Passenger 98=Other 99=Unknown 13 EMS Agency: I LOWER ALLEN! LIFE LI Page ID Safety EauiDment One: E OO=None Used INot Applicable 01 =Shoulder Belt Used 02=Lap Belt Used 03..Lap And Shoulder 8elt Used 04..Child Safety Seat Used OS=Motorcycle Helmet Used 06=Bicycle Helmet Used 10=Safety Belt Used Improperly 11 =Child" Safety Seat Used Improperly 12=Helmet Used Improperly 90=Restraint Used, Type Unknown 99=Unknown Safety EquiDment Two: . F OO=None Used / Not Applicable ' Dl=Front Air Bag Deployed (For This Seat) 02=Side Air Bag Deployed (For This Seat) 03=Other Type Air Bag Deployed 04=Multiple Air Bags Deployed . 05=Motorcycle Eye Protection 06=Bicyclist Wearing Elbow/Knee/Pads 1 O=Air Bag Not Deployed, Switch On 11 =Air Bag Not Deployed, Switch Off 12=Air Bag Not Deployed, Unk Switch Setting 13=Air Bag Removed (Prior To Crash} , 19=Unknown If Air Bag Deployed 99=Unknown . , Page 5 of 20 Illlllmll ~ 11lI11flllll~ C a 11 Number I W0034710 ~: G O=Not Applicable 1 =Not Ejected . 2= Totally Ejected 3=Partially Ejected 9=Unknown H ~ection Path: O=Not Ejected / Not A pi able , 1 = Through Side Door Itl ning 2= Through Side Windo;" 3= Through Windshield 4= Through Back Door 5= Through Back Door ai sate Opt!ning 6= Through Roof Openi 9, (Sunroof/ Convertible Top Do'" n) 7= Through Roof Openi g Convertible Top Up) 9=Unknown i- I Extrication:' O=Not Applicable 1 =Not Extricated 2=Extricated By Meehan ca Means 3=Freed By Non - Meeh!T\ al Means 8=Other 9=Unknown I Medical Facility: I HERSHEY MEDICAL CENTER' I 14 IU~i~NO I r~;onNr O~te7 r;~eofT[2~M-DI'~7~96 ItJlFB IIOC I~~~[ [][] Name I Address / Phone ' I I' E ns Transport 0.' Same as ANGELA A. COLEMAN 216 COCKLEY1S DRIVE MECHANICS BURG PA 1 r ) Yes . No Operator , ' AB CD E F ( I[]~~EJ~~~ H I ~~ IE S Transport , '- Yes . No AS CD E Fe I[J~[]EJ~~ 0 H I o l[] Unit No Person No 0 I Date of Birth (MM-DD-YYYY) @CJ ~ ate? ~-~ -12000 Name I Address I Phone o Same as IMICHAEL S, . C, OLLOTIA 904 BONNY LANE MECHANIC,S BURG P A 1705 Operator Unit No Person No 0 I " Date of Birth (MM-DD-YYYY) @CJ @C1 ~e. ~-EJ-11996 Name I Address I Phone o Same as IJAIMAL S. COLLOTIA 904 BONNY LANE ME. CHANICSBURG P A 17055 Operator I Ei S Transport Yes . No Unit No Person No D I Date of Birth (MM-DD-YYYY) @CJ ~ ate? ~-~-11994 Name / Address I Phone o Same as INICOLE E. NISSLEY 209 COCKLEY'S DRIVE MECHANICSBURG PAl Operator ' H I o l~ iii S Transport :: Yes 0 No ABC D E F GH I I~~[]~~~~ ~~ I . E M Transport C-' Yes . No Unit No Person No D I 7 Date of Birth (MM-DD-YYYV} @c]ITCJ ote ~-~-11996 Name f Address f Phone O,Sameas !HAYLEYM. CRO\VNOVER2418 RYECIRCLEMECHANICSBUR, GP. A 170 Operator ABC DE F G H I 1[]~[]EJ~~ro:rfl@] I E \R~ Transport CD lYes . No Unit No Person No D I t 1 Date of Birth (MM-DD-VYYY) ~112 I De EJ-~-11997 Name I Address f Phone D. Same as I DAVID J. MULL 3516 ROLO COURT MECHINICSB. URG PA 17055 717 Operator FORM << "''''-500 112/(2) PENNDOT COpy http://www.dot6.state.pa.us/iconslPrintImageslXmlFiles/20060 154641Beauduy231320060.. 2/27/2006 rnm CK::S W0034710 .-I COMMONWIEAIlTH Of lPlENIMSVlVANIA POUCE CRASH RlEIi'OR1UNG FORM AA 500 3 I Police Use Only A Person TVDe: l=Driver 2=Passenger 7=pedestrian 8=Other 9~Unknown g: () .. Iij E o ""' ,g 1'1 ~ () l ~: B F =Female M=Male U =Unknown Iniury Severity: C O=Not Injured 1=Killed 2=Major Injury 3=Moderate Injury 4=Minor Injury 8=lnjury, Unk , Severity 9=Unknown jf Injury Seat Position: D OO=Not A Passenger/Occupant 01 =Driver- All Vehicles 02=Front Seat Middle Position 03=Front Seat Right Side 04=Second Row - Left Side Or Motorcycle Passenger OS=Second Row - Middle Position 06=Second Row - Right Side 07=Third Row Or Greater. , Left Side 08=Third Row Or Greater- Middle Position 09=Third.Row Or Greater- Ig I e 10=Sleeper Section of Truckcab 11 =In Other Enclosed Passenger Or Cargo Area 12=ln Open Area (Back Of Pickup, Etc.) 13= Trailing Unit 14=Riding On Vehicle Exterior 1S=Bus Passenger 98=Other 99=Unknown 13 EMS Agency: I LOWER ALLEN! LIFE LI Page I [C] Safety EauiDment One: E OO=None Used / Not Applicable 01 =Shoulder Belt Used 02=Lap Belt Used' . 03=Lap And Shoulder Belt Used 04=Child Safety Seat Used OS=Motorcyde Helmet Used 06"Bicycie Helmet Used 1 O"Safety Belt Used Improperly 11 "Child Safety Seat Used Improperly 12,=Helmet Used Improperly 90"Restraint Used, Type Unknown 99=Unknown Safety EoulDment Two: F OO",None Used / Not Applicable 01 =Front Air Bag Deployed (For This Seat} 02=Side Air Bag Deployed (For This Seat} 03=Other Type Air Bag Deployed. 04=Multiple Air Bags Deployed OS=Motorcycle Eye Protection 06=Bicyclist Wearing Elbow/KneeJPads 1 O=Air Bag Not Deployed, Switch On 11 =Air Bag Not Deployed, Switch Off 12=Air Bag Not Deployed, Unk Switch Setting . 13=Air Bag Removed (Prior To Crash} 19=Unknown If Air Bag Deployed 99",Unknown . Page 6 of20' , ~llllllllllmllllllllm Cr s Number ~ W0034710 ~: G O=Not Applicable 1 =Not Ejected 2= Totally Ejected 3=PartiaUy Ejected 9=Unknown H ~Koonfurn: , O=Not Ejected I Not Ap I.i ble 1=Through Side Door 0 e ing 2" Through Side Windo 3= Through Windshield 4= Through Back. Door 5=r-hfO~9trlladc-Eloo il te-epening 6= Through Roof Openin unroof! Convertible Top Dow 7= Through Roof Open in onvertible Top Up} 9=Unknown Extrication: O=Not Applicable 1 =Not Extricated 2=Extricated By Mechanj al 3=Freed By Non - Mecha i 8=Other 9=Unknown ~ IMedical Facility: HERSlIEY MEDICAL CENTER ABC 0 E F I[]~[]~~~ Unit No Person No I Date of Birth (MM-DD-YYYY) ~@:=:J Dote? ~-~-11997 Name! Address I Phone o Same as IANDREW A. HELWIG 3520 ROLO COURT MECHANICSBUR, G P A 17055 Operator ' 14 ABC D E F IEJ[]@]~~~ Unit No Person No D ( , Date of Birth (MM-DD-YYYY) ~EJ ~e. ~-~:-11998 Name I Address I Phone o Same as !ASHLEY E. SHIPE 5547 ROLO COURT MECHANICSBURG P A 17055 7 Operator Unit No Person No D I , Date of Birth (MM-DD-YYYY) ~ ~ ct ~-~ -11995 Name I Address I phone o Same as IERIC], SHIPE 5547 ROLO COURT MECHANICS BURG PA 17055 717 Operator Unit No Person No 0 I ? Date of Birth (MM-DD-YYYY} ~~ ote ~-~-11996 Name / Address / Phone o Same as I BRANDON L. DAlliL 4531ROLO COURT MECHANICSBURG P A 17055 7 Operator ABC D E F G I~~@]~~~@] I E S Unit No PersonNo 0 I , Date of Birth (MM-DD-YYYY) @O~ ote. EJ-~-11994 Name I Address / phone o soame as I DUSTIN M. DAIHL 4531 ROLO COURT MECHANICSBURG P A 17055 7 perator ' . ABC D E F G I~~@]~~~@] LE Unit No, Person No I 1 Date of Birth (MM-DD-YYYY} ~~ Dote EJ-/22 1-11994 Name I Address! Phone ' " . "Same 3s" MICHAEL W. DOWED' 4523RQLO COURT MECHANICSBURG PA '17055 -- -- o Operator FORM # AA-500 (12102) PENNOOT COPY http://www.dot6.state.pa.us/iconslPrintImages/XmlFiles/20060 154641 B eauduy2313 20060.. , 2/2712006 rum t...K., W UU:H'Il 0 .-J COMMONWEAlTH Of PIENNSYlVANIA fOUCE CRASH RIEPiORlTil\!IiG fORM AA 500 3 I Police Use Only A Person Tvpe: 1 =Driver 2=passenger 7=Pedestrian 8=Other 9=Unknown i: (I 0:; fiI E g J;; (!j ~ Q l!l ~ ~: - B F ::Female M::Male U ::Unknown Iniury Severity: C O=Not Injured l=Killed 2=Major Injury 3=Moderate Injury 4=Minor Injury 8=lnjury, Unk Severity 9=Unknown if Injury Seat Position: D OO=Not A Passenger/Occupant 01 =Driver - All Vehicles 02=Front Seat Middle Position 03=Front Seat Right Side 04=Second Row - Left Side Or Motorcycle Passenger OS=Second Row - Middle Position 06=Second Row - Right Side 07=Third Row Or Greater- Left Side 08= Third Row Or Greater - Middle Position 09= Third Row Or Greater - Right Side 10=Sleeper Section of Truckcab 11 =In Other Enclosed Passenger Or Cargo Area 12=ln Open Area (Back Of Pickup, Etc.) 13= Trailing Unit 14=Riding On Vehicle Exterior 15=Bus Passenger 9B=Other 99=Unknown EMS Agency: I LOWER ALLEN/ LIFE LI Safety EQuiDment One: E OO=None Used / Not Applicable 01 =Shoulder Belt Used 02=Lap Belt Used 03=Lap And Shoulder Belt Used 04=Child Safety Seat Used OS=Motorcycle Helmet Used 06=Bicycle Helmet Used 10=Safety Belt Used Improperly 11 =Chilcf Safety Seat Used Improperly U=Helmet Used Improperly 90=Restraint Used, Type Unknown 99=Unknown Safety Eouioment Two: F OO=None Used / Not Applicable 01 =Front Air Bag Deployed (For This Seat) 02=Side Air Bag Deployed (For This Seat) 03=Other Type Air Bag Deployed 04::Multiple Air Bags Deployed OS=Motorcycle Eye Protection 06=Bicyclist Wearing Elbow/KneelPads 10=Air Bag Not Deployed, Switch On 11 =Air Bag Not Deployed, Switch Off 12=Air Bag Not Deployed, Unk Switch Setting 13=Air Bag Removed (Prior To Crash) 19=Unknown if Air Bag Deployed 99=Unknown Page I c=J Page 7 of 20 111111111~ I ~11l1I1111I11~ C a h Number --, W0034710 ~: G .O=Not Applicable 1 =Not Ejected 2= Totally Ejected 3=PartiallyEjected 9=Unknown H Ejection Path: O=Not Ejected I Not AI pi able 1 = Through Side Door p ning 2= Through Side Wlndc W 3= Through Windshield ' 4= Through Back Door S=Through Back Door ai ateOpening 6= Through Roof Openi 9 Sunroofl Convertible Top Dov n) 7= Through Roof Openi 9 Convertible Top Up) 9=Unknown l- I Extrication: O=Not Applicable 1 =Not Extricated 2=Extricated By Meehan G Means 3=Freed By Non - Mech n al Means 8=Other 9=Unknown I Medical Facility: I HERSHEY MEDICAL CENTER I ABC D E F H I IEJ~@]~~~~~ EJ[] Unit No Person No Date of Birth (MM-DD-VYYY) rf\1Il1OI Delete? IMI r11"I I 4 ~~ O' ~-~-1997 Name I Address I Phone o Same as IJASED- CAGLE 3518 ROLO COURT MECHANICSBURG PA 17055 717 Operator. ' . I E S Transport ) Yes . No AB C D EF ( I[]~[]~~~~ H I [][] IE S Transport , Yes. No ABC D E F CHI I[]~~~~~ 0 ,0 1[] Unit No Person No Date of Birth (MM-DD-YYYY) ~ r?1I Delete? ~ f1:1I I ~~ 0 ~~~-1996 Name / Address / Phone OSameas !JESSEH. GARCIA 3518 ROLO COURTMECHANICSBURG PA 17055 7 Operator Unit No Person No I '1 Date of Birth (MM-DD-YYYYJ ~EJ Dote ~-~-11999 Name' Address' Phone o Same as IJACOB L. CAGLE 3518 ROtO COURT MECHANICSBURG PA 1705571 Operator I ~I S Transport ~ Yes . No ABC D E F G H I 12J[!]@]~~~~ ~~ I I N Transport ( Yes . No Unit No Person No Delete? Date of Birth (MM-DD-YYYYJ ~~ 0 ~-~-11999 Name / Address / Phone ' o Same as IKATELINN M. RUSSELL 3523 ROLO COURT MECHANICSBURG PA 170 Operator ABC' D E F ' G H I I~~@]~~~~I[~][] I E Vl~ Transport C;J es _NO Unit No Person No I 7 Date of Birth (MM-DD-YVYY) ~EJ Dote ~-~-11999' Name I Address / Phone o Same as I SIERRA R. WHITE 3514 ROLO COURT MECHANICSBURG P A 17055 7 Operator ABC D E F G H I 1[]~@]~~~rO I, l@] Unit No Person No I Date of Birth (MM-DD-VYYYl f}I] [D Dote7 @C]-~-11995 Name I Address I Phone 0, Same as I ZACHARY D_ LEBO 885 HAWTHORN AVE MECHANICSBURG PA 17055 ~~~ " FORM' AA-SOO (1=) PENI'-mOT COpy I E ~'~ Transport cb es . No http://www.dot6.state.pa.us/icons/PrintImages/XmlFiles/20060 154641 Beauduy231320060... 2/27/2006 -- -- -- - rnm L-K;:) WUU34710 Page 8 of .-l iCOI\liVIIlONW1EALTH Of I?IENNSVlVANIA 1IIIIImll ~ 111I111I111111 /1 I I?OlliCE (~ASH RIEPORlTiNG fORM Ca Number Page AA 500 3 I Police Use Only I D W0034710 A Person Tvpe: Seat Position: Safety EquiDment One: ~: 1 =Driver D OO=Not A Passenil;r/occupant E OO=None Used I Not Applicable G O=Not Applicable 2=passenger 01 =Driver. All Ve icles 01 =Shoulder Belt Used 1 ';Not Ejected 7=Pedestrian 02=Front Seat Middle Position 02=Lap Belt Used 2= T otall1l Ejected 8=Other 03=Front Seat Right Side 03=Lap Arid Shoulder Belt Used 3=Partia Iy Ejected 9=Unknown 04=Second Row - Left Side Or 04=Child Safety Seat Used 9=Unknown Motorcycle passe~er 05=Motorcyde Helmet Used 05=Second Row - Mi die Position 06=BiZcle Helmet Used ' H Ejection Path: 06=Second Row. Right Side 10=Sa ety Belt Used Improperly B ~: 07=Third Row Or Greater - 11 =Child Safety Seat Used Improperly O=Not Ejected / Not ~~ / ia ble g: f =Female Left Side 1 = Through Side Door p n ing (l M=Male 12=Helmet Used Improperly 2=Through Side Window :e:: U =Unknown 08= Third Row Or Greater - 90=Restraint Used, Type Unknown 3=Through Windshield fil Middle Position 99=Unknown IE 09= Third Row Or Greater - 4= Through Back Door il .. 5= Through Back Door a ate Opening 1 Right Side Safetv EauiDment Two: Iniury Severity: 10=Sleeper Section of Truckcab F OO=None Used I Not Applicable 6= Through Roof Openi ~ S unroofl Convertible Top DOIII ~ C O=Not Injured 11=ln Other Enclosed . 01 =Front Air Bag Deployed (For This Seat) 7= Through Roof Openi g C onvertible 'g. 1 = Killed Passenger Or Cargo Area 02=5ide Air Bag Deployed (For This Seat) Top Up) Q 2=Major Injury 12=ln Open Area 03=Other Type Air BagDeployed 9=Unknown f- l 3=Moderate (Back Of Pickup, Etc.) 04=Multiple Air Bags eployeo Injury 13= Trailing Unit OS=Motorcycle Eye Protection 4=Minor Injury 14=Riding On Vehicle Exterior 06=Bicyclist Wearing Elbow/Knee/Pads I ~: 8=lnjury, Unk 15=Bus Passenger 10=Air Bag Not Deployed, Switch On O=Not Applicable Severitj 98';'Other 11 =Air Bag Not Deployed, Switch Off 1 =Not Extricated 9=Unknown if 99=Unknown 12=Air Bag Not Deployed, 2=Extricated By Mechan a Means Injury Unk Switch Settin~ 3=Freed By Non - Mech ni al Means 13=Air Bag Removed Prior To Crash) 8=Other 19=Unknown If Air Bag Deployed 9=Unknown 99=Unknown , 13 EMS Agency: I LOWER ALLEN/ LIFE LI I Medical Facility: I HERSHEY MEDICAL CENTER I Unit No Person No 'D I 7 Date of Birth (MM-DD-YYYY) ABC- D E F H I ~~ eete. ~-~-11998 1~[]EJ~~~~ ~[] 01 . 25 0 14 Name I Address I Phone E S Transport o Same as ILIANN Q. MORRIS 922 BONNY LANE MECHAN1CSBURG P A 17055 71 I l. Yes .No Operator Unit No Person No I ? Date of Birth (MM-DD-YYYY) A B C D E F ( H I ~~ Dote. ~-@C]-11995 1~~[]~~~IO Ole:] Name' Address f Phone o~ S Transport o Same as IERlC J. MORRIS 922 BONNY LANE MECHANICSBURG P A 17055 717 I - Yes . No Operator Unit No Person No . Date of Birth (MM-DD-YYYY) ABC D E F ~ H I ~~ Delete? ~ ~ I I~~@]~~~IO o I~ o 09 - 20. - 1998 Name I Address' Phone ;n ~ Transport o Same as IDA VII) M KEISER 5541 ROLO COURT MECHANICSBURG P A 17055 71 II Yes _NO Operator Unit No Person No I Date of Birth (MM-DD-YYYY) ABC DE, F G H I ~~ Deete? ~ ~ I ICJ~EJ~~~ro 5l~ o 05 - 05 - 2000 Name I Address I Phone , I ~ M Transport o Same as IALLEN, SENECA C 104 HEMLOCK ROAD MECHANICSBURG P A 17055 . Yes 0 No Operator , Unit No Person iIIo o I ? Date of Birth (MM-DD.YYYY) A B C D E F G H I DD ate. 0-0-1 IDDDOOOI I 10 Name I Address I Phone I~ II! Transport o Same as I ;) es 0 No . , Operator Unit No Person No I ? Date of Birth (MM-DD.YYYY) A B C D E F G HI' 01 I Dote D-O-I IDDDOODD 00 Name I Address I Phone I~ ~! Transport o Same as I es ONo Operator FORM' AA.500 (12/02) PENN DOT COpy http://www .dot6.state.pa.us/icons/PrintImagesIXm1Files/20060 154641 Beauduy231320060 .. . 2/27/2 2() 006 . t'nnt CK~ W0034 710 -.J \cOMMONWlEAlll-I OIF ~IENIi\JSYlVAN!A ~OU(E CRASH ~IEPORnNG IFOIilM AA 500 4 I Police Use Only Page 9 of 20 1I111111~ I ~ IIIIIIII~IIII Page ~ W0034710 Cr s Number I Crash Description [:J O=Non.Collision 2=Head On 4=Angle 6:SideSwipe 8 :t: it Pedestrian 1 =Rear End 3=Rear to Rear 5=Sideswi&e .(Opposlte Direction) 9 =C therlUnkoown c ~ (Backing) (Same irection) 7=Hit Fixed Object o C .~ ; Relation to Roadway [!] 1=On Travel Lanes 3=Median 5=Outside Trafficway 7=Gore (Ramp Intersection l et 2=Shoulder 4=Roadside 6=ln Parlling Lane 9=Unknown .2 u c~ l=Daylight 3=Dark . Street - 8=Other - - s~ ~ Illumination ~ 5=Dawn 2=Dark - No lights 6=Dark . Unknown t!:!5 Street Lights 4=Dusk Roadway Lighting u... 1 t I Weather conditions ~ 1,:No Adverse 3=Sleet (Hail) 5=Fog 7=Sleet & Fog 9 \) known -~ Conditions 2,:Rain 4-Snow 6=Rain & Fog 8=Other \.!l E - -- - l Road Surface Conditions ~ O=Dry 2=8nnd, Mud, Dirt, 4=Slush 6=loe Patches 80 er 7=W~r : Standing 1=Wet 3=Snow Covered 5=lce or ovmg t - . - =r = Harm Event L/R )\/lost? Utility Pole Numbar Harmful Events (Harm Event) 30=Hit Fence Or Wall l 1 ~ 0 . I I 01=Hit Urlit 1 31 =Hit Building Unit No 02,:Hit Unit 2 32=Hit Culvert ~C}O D I I 03=Hit Unit 3 33=Hit Bridge Pier Or A utment 0 04=Hit Unit 4 34=Hit Parapet End 05=Hit Unit 5 35=Hit Bridfce Rail 06:Hit Other Traffic Unit 36=Hit Bou der Or at: t Ie I Please Put 3 0 0 I I 07",Hit ~er On Roadway Even Is in 0 OS",Hit Other Animal 37=Hit ImpactAttenu lte Sequential 09",Collision With Other Non 38"Hit Fire Hydrant . Order 00 I I Fixed Object 39=Hit Roadway Equi m nt i c: 4 0 t '",Struck By Unit ,1 40=Hit Mail Box .~ t2=Struck By Unit 2 41 =Hit Traffic lsland 6 .. 13",Struck By Unit 3 42=Hit Snow Bank E Harm Event Uti. Most? Utility Pole Number t 4=Struck By Unit 4 43=Hit Temporary Co 51 clion .e 15=Struck By Unit 5 - 'Barrier E EJD I I 48=Hit Other Fixed Db e< ... 1 . 16=Struck By Other Traffic Unit c: Unit No 21=Hit Tree Or Shrubbery 49"Hit Unknown Fixec 0 ject GJ 50=OverturnlRol! Over ~ ~20 D 22=Hit Embankment -;;; 0 I I 23",Hit Utility Pole 51=Struck By Thrown railing ";:t 24=Hit TraffiC Sign Object '" 25:Hit Guard Rail 52=Pot Holes Or Othe :J Please Put 3 0 D I I 26=Hit Guard Rail End Pavement Irregular' ie Events in ' 0 27=Hit Curb 53=Jacknife Sequential 28=Hit Conaete Or 54=Fire In Vehicle Order 4 0 0 I I Longitudinal Barrier 58=Other Non-Col/isio~ 0 29=Hit Ditch 99=Unknown Harmful v ot First FTarmful Event In the Crash Unit No Harm Event ~~ Unit No Harm Event ~~ Most Harmful Event In the Crash 00 not repeat this il'\(ormat~1e pages 18 Environmental I Roadwav Potential Factors (E/fl) 1 OO=None 01 "Windy Conditions 02"Sudden Weather Conditions 03"Other Weather Conditions 04=Deer in Roadway OS"Obstacle On Roadway 06=Other Animal In Roadway 07=Glare 08=Work Zone Related ~, 20 30 l1=SlipperyRoad Conditions (Ice/Snow) 12=Substance On Roadway 13=Potholes 14=Broken Or Cracked Pavement 15" TCD Obstructed 16=Soft Shoulder Or Shoulder Drop Off 28=Other Roadway Factor 29=Other Environmental Factor 99=Unknown c: .g ... Possible Vehicle Failures (V) E OO"None 06=Exhaust o 01=Tires 07=Headlights :E 02=Brake System 08=Signal Lights .~ 03"Steering System 09=Other Lights !; 04"Suspension 1 O=Horn ~ OS=power Train 11 =Mirrors ... ~ ~~it@I]1~20 ~~it~1~2D 12=Wipers 13=Driver Seating/Control 14=80dy, Doors, Hood, Etc 15= Trailer Hitch 16=Wheels 17 =Airbags 18=Trailer Overloaded 19=U nsecurelShifted Trailer load 2<r-lmproper Towing 21 =Obstructed Windshield 99=Unknown 19 Indicated Prime Factor Do not repeat this information on multiple pages. fIR V D P 00.0 Unit No Factor Code ~~ If E/R is the Prime Factor Type, leave Unit No blank FORM' AA-SOO (12/ll2) PENi'-1DOT COpy 17 =Careless Or Illegal Backing On Roadw y 18,:Driving On The Wr ~ Side Of Road 19=Making Improper Entrance To Highw y 20=Making Improper E It From Highway --1 21 =Careless ParkinglUn ar ing , 22=OverlUnder Compensation At C IN 23=S peeding 24"Driving Too Fast For C nditions . 25"Failure To Mai(\tain rc er Speed 26=Driver Fleeing Police P I Chase) 27 =Driver Inexperienced 28=Failure To Use Sped Hz d Equip 92=Affected 8y Physical :c dition 98=Other Improper Drivi 9 Il,ctions 99=Unknown Driver Action (D) OO=No Contributing Action 01 =Driver Was Distracted 02=Driving Using Hand Held Phone 03=Driving Using Hands Free Phone 04=Making Illegal U-Turn . 05=lmproper/Careless Turning 06= Turning From Wrong Lane 07=Proceeaing WID Clearance After Stop 08=Running Stop Sign 09"Running Red Ugnt 10=Failure To Respond To Other Traffic Control Device 11=Tailgating 12=Sudoen SlowinglStopping 13=lilegally Stopped On Road 14=Careless Passing Or Lane Change, . ' 15=Passing In No Passing Zone 16=Driving The Wrong Way On 1-Way Street ~~it~ 1~ 20 31 ~~it~ 1~2031 140 40 Pedestrian Action (P) OO=None 01 =Entering Or Crossing At Specified location 02=Walking, Running, Jogging, Or Playmg UnitNo~ 03=Working 04=Pusrung Vehicle 05=Approacrung Or leavi 9 ehide 06=Working On Vehicle 07=Standing 98=Other 99=Unknown ~ UnjtNo~ 1}9 I http://www.dot6.state.pa.us/icons/PrintImages/Xm1Fi1es/20060 154641 Beauduy2313 20060... 2/27/2006 rnm C;K~ WU034710 Page 10 of2(J" --I 1lllllmlmlmlllllll~ Cr s Number ---, COMMONWEALTH OF PENNSYLVANIA POliCE CRASH REPORTING FORM Page ~ W0034710 AA 500 5 I Police Use Only : : t 1 ::: : . _..L.__..l.......-l___ L ~L.__L____l ... ~.~ ---._----.- - -'--- :. -l+=Ft=I=F!~==FFFr:1=lFF~::rl=r-=t:r:FFI .........r......f.....mf.........r--.......-r.........r........-r..........r....-.lm....l........r.........r.-....f........f.-....r........l.........f.....-f........f.......T.........r........r.........f.........I..........., ..........:...........r..........i...........!...........;...........:......._..~..._..._.:...........j...........I...........j......_...~...........t..........j...........i...........;...........:,..........r..........!...........i...........j..........l..........1".:........r._.......~............_.....i-.........r.........'1 : 1 l ; : : : : : :: \ ::: : : . . . . . : ! : 1 : ": i . , . . . ; : : i . i :!: ......~.i........_.i.--......i-.........r-.........~...........r..........r..........jn........l.'.........r.........r..........:......'....r.........T..........l...........r-.......r..........l...........~..~........~...........T..........r..........~..-.......r...'-..-r...................l'..........r..........i : : : ; : : : : : : : : : : : : : : : : : : : :: : ~ : : : : : : ;- : ; : : : : : : : 1 : i : ! : : : :: ;:: .f::I-:l:-::l=~rt=I=::I:l--!---t=T=t=!::::;=::;:-l:=:Ft:tl~1::l=I=:-rF::-:t:J::=i O.........!...........I...........:...-......I...........;...........I...........!...........,...........i......mt.........i..........L....._..i..........i...........\...........\...........1...........1...........!...........:...........L..........:...........!......-...!.........J................;...........;.........-; : : : ; : ; : : :. : : . . : : ; , ; 1 : . . : : : . . . . 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"'1'" ~. .....i'........ ..i...........!....... ..,! . ......, t.~._n...~.. ......... i j,.~ j. j~~~ .l! .11 ~tjj 1 j ~~1.1 f i ..m....;.........r.......r........:...._.....;....m....:...........~........"I".-.....r.....-..'.....m-.:...........'...........:.......................'.m.......i...........:...........\..........:..........1".........:...........;..........r.........;..........f........;.........;...........:........"'! .........r.........I"..m...r.......T.........T........T.........r.......r......-r........r........r.......r..........;m......r........r........lmm...r.........j..........r.........,...........:.m......f........-r..........r._....-r........;.-......:.........."1"........: ................ " .' ..............,.... Witness Name 1 KlMBERL Y A. ALLE Add ress 104 HEMLOCK RD MECHANICSBURG P A 1705 1705517055 Phone 71769157 :c 2 Narrative and additional witnesses: Accident Investigation Notification Issued1 0 Property Dam ge 0 tI > ;; l! .. Ii Z " C 11 .. 2 .. tI S j The Upper Allen Township Police Department was dispatched at 1504 hours to an accident where a child was struck by a school bus in the 100 block of Hemlock RD. I, Officer Albert arrived at 1509 hours and was the first emergency personnel on scene. When I arrived, I observed a purple backpack lying in the middle of the road. There were no other cars in the area other than the bus that was a distance away fro m the backback. The bus was facing west towards Route 15. The weather was clear and brisk and it was daylight. When I arrived, Kim and Daran Allen were performing CPR on their daughter Seneca. Seneca was lying on the living room floor, where her mother Kim had laid her after she carried her from the middle of the road. I advised Kim to give Seneca breaths while I gave her chest compressions. I continued doing this until the Upper Allen Township Fire Department ar rived at 1510 hours. Chief Adams also arrived at the same time as the fire department. James Salter of the Upper Allen Fire Department then breathed for Allen while I continued to do chest compressions. Chief Adams remained at the fr ont door in order to make the scene safe for us. When EMS arrived, Salter started to suction some of the blood out of Seneca's mouth. I then assisted by holding a light for the EMS and paramedics to see. I also watched the area of the kitchen and' doorway area to make sure that the family members did not come into the living room area. I then assisted in loading Seneca onto the backboard and then onto the stretcher. Officer Dombroski interviewed a few of the child ren and maintained order on the bus. He also took pictures at the scene, Officer Tappan assisted by interviewing the bus driver, Janet Adams, Allen was then Life Lioned to Hershey Medical Center where life saving efforts ceased at 1607 hours: Adams was taken to Holy Spirit Hospital. , After assisting the EMS and paramedics, I then spoke with the parents and some of the neighbors on the scene. I took some measurements from the back tires of the bus to the spot on the road where there was blood. The distance was 110 feet. I then went to Sheperdstown Elementary School and obtained a list of children that were on the schooL bus. Over the next two days Officer FORM' AA-500 (12ill2) PENNDOT COpy http://www.dot6.state.pa.uslicons/PrintImageslXmlFiles/20060154641Beauduy231320060... 2/27/2006 l'ant CRS W0034710 Page 11 of20 --1 11111111111111111I1111111111 ( iI h Number "I t'C(O~@fiItOl~~UI!.il'lXl tOle: ~lEfid!i\!l$vu.'lfffi\!i\!lOffi,\ lP'(o!!.a~1E OVl.$If\11R1lElJl'(O)mBIM~ rF<<>>1Fl1i1lil o New Page W0034710 . J _ ~ _ C?H ~.~:~~~i9_~ __ ",... , H' M500N J:~li~e.~se o:~_ ._ Nillnative an~ a~ditional witnesses: 22 Tappan and I visited all of the children that were listed on the sheet given to me by the school, that were on the bus. They observed as follows: David Keiser was sitting in seat three on the right side of the bus, opposite of the driver and' obserled the victim drop her backpack under the bus. Then when she reached down to pick it up she was struck. Keiser identified the back right tires as the tires that hit Seneca. Cory Bechtel did not notice anything and his brother Tyler Bechtel was working on his homework and did not obserle anything either. The following students did not obserle, feel or hear anythi ng: Andrew Helwig, Dustin Daihl, Jase Cagle, and Katelinn Russell. David Mull saw a jacket lying on the road and other kids saying that a kid was run over. Ashley Shipe heard the bus driver scream and Eric Shipe felt a bump and heard a scream from th ~ victim. ~ Brandon Daihl felt a bump. ~ fi Z ,. !: 111 WI III ! 3 t:' ~ 11 2 <t! Michael Dowett felt a bump and tvvo seconds later the bus stopped. Jesse Garcia saw the bus driver crying and praying and saw the backpack lying, behind the bus, but thought the victim was not on the bus, that day. Jacob Cagle, who was sitting behind the bus driver, felt a big bump and thought that it was a backpack. Sierra Jones observed the bus driver looking in the mirror and not at the street and then felt a bump. She was also sitting with the victim on the right side of the bus near the front. Zachary Lebo was sitting in the back of the bus and felt a bump. Liann Morris saw the driver looking in the mirror and felt a bump. Eric Morris was sitting in the back of the bus on the right hand side. The bus was going forward and then i t stopped and the driver got off the bus. He did feel the bump. He then saw the victim's mother run to the back of the bus. He believes that the backpack was never on and it f ell and she went to pick it up and was struck by the bus. Eric believes that the impact took place on the right rear side of the bus, due to feeling the bump in that area of t he bus. Sarah Kleinert felt a bump. Kyle Flemmin g felt a bump, FOR<'.1 , AA-sco;v ~ PENNDOT COpy http://www.dot6.state.pa.us/icons/PrintImages/XmlFiles/20060 154641Beauduy231320060.... 2/27/2006 Page 12 of20 l"il'W (ClIP [.i>1E1i\!l1i\!I$i"Il.'IJ~~D~ OOlEromioo~ fO>\lllWd Page _l_BJ o New /111111111111111111111111111 C~ilSh Numb~r I W0034710 o __~~~~i~~a_tion., witnesses: ump and observed the victim's mother run to the girl. I't think that the girl was on the bus and came from somewhere else. She also :ollotia felt a bump. umed that the victim bent over to pick up something but was not sure. She Jrred on the driver's side of the bus. She then said that she saw the girl the road and heard someone yell for the bus driver to stop. ,a felt a bump and then saw the victim lying in the middle of the road. it off the bus after Seneca. As he was getting off the bus, he observed her t of the bus. Myers then walked towards the back of the bus on the I bus. He did not hear anything or see anything until he looked back to see IS getting off the bus. Ryan was not and this is when he saw Senecca lying m continued home and told his grandfather Ernest Myers that Senecca got run is point, Ernest ran up to assist Kim and Dari:in Allen with CPR. By the the location, Seneca was already in the residence and lying on the living Iready been called and he advised that h e assisted with CPR until I at I spoke with was Janet Adams, the bus driver. I spoke with her on again on Feruary 15, 2006 after the incident. Adams explained to me that bus for almost 30 years. She has been driving this particular route for 19 ir bus stop Seneca normally gets off the bus and crosses in front of the :>rothers get off the bus an d continue along the side of the bus towards r house. On this particular day, Adams did not see Seneca get off the bserve her cross the road. She did see Christopher Myers walking down the Is his residence. His brother had not been on the bus that day. At the s he remembers extending the yellow pedestrian stop bar and the stop sign 19 Christopher go down the side of the bus, she brought the bar and stop ~d the bus forvvard. Sierra Jones then yelled "Mrs. Adams" which got her to look up in the mirror. After she started forvvard a few of the lard a boy yell to Adams that she hit Seneca. Adams did not hear them yell ~el a bump and this caused her to stop the bus. At the point that Adams )oked up in the rearview mirror and saw Seneca lying in the middle of the t off the bus and ran towards Seneca and her mother Kim, who had COlDe out o Seneca. As she got close to them, the mother was yelling to call 911. that Seneca was lying on her back in the roadway parallel with the road, Ie other direction. At this point Adams went back to the bus and called Wolfgang. Ace ording to Wolfgang Adams said, "Debbie, I just hit a little ~ and the police here now." Several other times Wolfgang said that Adams ulance was on the way. Adams then waited outside of the bus by the :>lice and ambulances arrived. Adams was then taken to Holy Spirit ~d for anxiety as well as drug and alcohol screening. PENNDOT COpy 'icons/PrintImages/XmlFiles/20060 154641 Beauduy231320060... 2/27/2006 Page 13 of20 ~1l.il'1ill elf [F>lEfi\!fil!I!li'tl'l\ll~fN'ID~ a ~Mfjq1jn!illl~ lFOIFtM Page IT] 0 o New 1/1111111111 I! /1111111111111 W0034710 Crash Number I Changel Continuation I witnesses: j 16th, 2006 I spoke with Kim and 0 aran Allen. On the 16th of February the 1es Nealon was also present. Daran was sleeping and w as woken up by the im, a scream he will never forget. He ran upstairs and went out the side I front of the stairway leading downstairs. Daran rail outside and ran o was in the midst of picking up their daughter from the roadway. He end of the driveway when Kim had start ed towards him with Seneca, Daran from her, but she took her into the house, Daran tried to find the house )ieces due to Kim throwing it into the carport when she ran out of the . had to use the cell phone to call 911 and that is why the call was sent to t Cumberland County. When Kim brought Seneca into the house the both ofthem . living room sitting in the middle of her couch, talking to Marilyn er. Allen has a bay window and from her vantage point she can see Seneca get ' curtains are open. The curtains were open that day. She observed the school ). She watched as Seneca came around to the front of the bus, rolling her r. Allen then noticed that the pedestrian bar was closing while Seneca was s. Then the bus started forward and Seneca put up her hands as if to )nt of the bus then struck Seneca and according to Allen, threw her me Allen threw down her phone and ran outside to her daughter. To go run through the living room, dining room, kitchen and out the side door, md across the lawn to get to the middle of the road. Allen did notgo lr because it was locked and it is difficult to open so they do not use the en got outside the bus was already up the street a nd her daughter was Allen picked up her daughter and brought her into the living room. Allen towards her house when Adams got near them. Allen stated to me that Seneca h the road with her head towards the bus and was lying on her back. She oat and Daran called 911 and they started CPR. They did this until I arrived, PENNDOT COpy Daretzes, who was on the phone with Kim Allen at the time of the accident. d she were talking and Kim stated nOh, is it that time already? Here comes :zes then heard some moving around and then a scream like she has never fe. Kim then said, "God no, oh my God no." then the line went dead. A few Ine rang very funny and when she picked up she heard Kim's voice saying. he won't breathe." She also heard Daran screaming. Daretzes then got a ninutes later telling her to go to Hershey Medical Center. She just got Ie family when the docctor came out and pronounced Seneca dead. Officer Tappan and I attended the autopsy of Seneca Allen. The autopsy phin County Coroner's Office. Dr, Wayne Ross performed the autopsy and :plained to me that the following organs were damaged. The liver, spleen, Her stomach was bruised. Her pelviS was broken on the right side and she s well as kidney, pancreas and small and large intestines hemorraging. A 3r's office received from Usa Potteiger indicated that she died of Iries. Seneca was 46 inches tall and weighed approximately 44 pounds. On ~ of her leg there were marks consistent with that of black top. The ;/icons/PrintImages/XmlFiles/20060 154641 Beauduy231320060... 2/27/2006 Page 14 of20- .'il'D-U '<elf IP'lEr;'I:'Hfll$vn.'V~fMD~ ~lEro(ft'\l'R!i>lI<<3 IFOIreM Page El]o o New ~1111I111111111111111111111 W0034710 CrOlsh Numh~r t Changel Continuation ilVitnesses: ed on the left side of Allen are slightly curved which could mean that side when she was run over by the school bus. These marks are consistent e rear tires of the school bus. Pictures were taken by Offi cer Tappan ~port will be placed into the case jacket when it is received. The received and will be placed into the case jacket. For the exact )mplete list of damaged organs see the coroner's report.' the tires were removed from school bus 32, PA Registration SC26680, VIN 3, by John Scott, an employee with B & S Transportation. The bus is also mspbrtation. Prior to removal, Officer Tappan took pictu res of the ' ir measurements taken and without the use of mirrors, a child that was ~ seen as long as they were 4 feet 11 inches away from the bumper or John Scott, that was used for this test, was 65 inches tall and Adams rding to Scott the seat was not moved after the accident and or prior :lr tires measured 20 3/4 inches from the inner edge of the ins ide edge of the outer tire tread. It also measured 3 feet 1 1/8 inches Ip of the tread. The back right tires measured 20 1/4 inches from the Ie tire tread to the outer edge of the outside outer tire tread. The ~r rear tires measures 3 feet 1 1/4 inches in height to the top of the (ept secured at the Upper Allen Township Police Department until ~y were examined by Doug Hockenberry of the Camp Hill Police Department, watara Township Police Department and Connie Hertzog of the West Shore rtment. They were entered into evide nce under number 06E-029. All the nd then sprayed with Luminal in an attempt to forensically determine er Allen. No forensic evidence was found on the tires. When their Id I have a received a copy, it will be placed in the case jacket. )06, I obtained the jacket, pants, shirt, underwear, shoes and sock of ,ts, shirt, jacket, and underwear had already been cleaned at the dry ,ts had holes in the area of the knees. The red jacket still had grease on Iready been cleaned, They were entered into evidence under the number 'as sent sent, along with the fiber that was found during an examination of 1e bus, to the Penn sylvan ia State Police Laboratory for comparison. h Seneca's kindergarten teacher in an attempt to discover why Seneca may 'us or may have been hit by the bus. I spoke with Kristin McGaw who advised ry day, or show and tell, nor were there any art projects to take home. I kindergartner will stop for anything, whether it is trash, a rock, or Kim and Daran Allen advised me that Seneca was a rock collector and would in her bag as well. :kpack of Seneca Allen in an attempt to determine whether or not something vay. Allen had a purple and pink Dora the Explorer rolling bookbag with a d a pull out handle. Inside th e small pocket was as follows: PENNDOT COpy , white 3x5 card with the word "Look" with the two orange 0' S with lips a face A pink 3x5 card with her name on it A green pencil t op eraser A iconsfPrintIrnages/XmlFiles/20060154641 Beauduy231320060... 2/27/2006 Page 15 of20 ~"iiTI'O (Of l?1Elil!llil!l$vn..\'~li\!Inffi\. a ~rofPi1JnlMllli flQ)~i\lJ Page mO o New /11111/111111111111111111111 W0034710 Crash Number t Changel Continuation I witnesses: olored Canadian dollar A West Virgi nia state quarter A dime <et were the following: t with a hood A "K is for Kitten" book A piece of paper with "Seneca" r squared off red ovals A blue-green hair pick with part of a tine laper gameiNith numbers, animals, colors and personal writing on it A little ltle yellow/orange and a little pink tape dispenser A Scooby Do 2 Game e bookmark with Hannon written on it A small piece of paper that was colored necklace or bracelet Three small rocks An orange hair tie Two small slivers the other various colors An Indiana stat e quarter A small pink angel A )ok mark that had a pur pie Volkswagen Beetle car over top a green turtle of of the car i the items I returned the bookbag to the family. >, Det Sgt Kauffman and I went over to the bus to collect some evidence that bus. With the help of John Scott, a red fiber w as found on. the Anti-Lock Ir wire in front of the left rear axle (similar in color and in texture to the las wearing), a hair was found on the left rear axle behind the brake, a red t rear mud flap was discovered and a hair was found on the right front ng for the axle. Det Sgt Kauffman performed an examination of the bus e envelope's were stored in the evidence room under evidence number items as well as the red jacket and the known hairs from Seneca Allen were mnsylvania State Police Laboratory to be examined, on the 13th of February ,son. garage, Det Sgt Kauffman and I took several more pictures from the driver. According to our observations, if a driver used all the mirrors ~r, they would be able to see the front of the bus and both sides of the lr the bus from their seated position, This buswas not equipped with a the passeng er compartment of the bus. ~umberland County and York County Communications were secured by Detective iry 13, 2006 at 1125 and 1415 hours, respectively and were logged into mee number 06E-029 items 18 and 19. I have spoken with all the callers - York or Cumberland County. Those individuals are Debra Wolfgang and PENNDOT COPY I (Ofe. Tappan) made an inked impression of the left rear tire of unit #1. then entered into evidence under inventory number 06E-029. Officer mp Hill and Connie Hertzog from West Shore Regional police departments ;;s, ation, as stated above, I obtained the 911 tapes, as well as several forensically examined. Also in order to be thorough, I have obtained the lrds to Janet Adams, the bus driver. I have copies of the drug and alcohol JiconsfPrintImageslXmlFiles/20060 154641 Beauduy231320060... 2/27/2006 rnm CK:S W0034710 Page 16 of20 , .J C(o)WiIrMil<Olli\'lWlEffi'.Il.VIXI (O)fF IPlErN.IrN.I$nl\lffi\.li\'ln~ !P'(O)I!.9ClE CM.$1!ll oolEro~ril'nOO((D IF(Q)~1i\Ill Page I~o o New 11111111111111111I1111111111 W0034710 ( il hNumher I AA 500 N I Police Us. Only Changel Continuation 22 Narrative and additiol'lal witnesses: tests as well as a complete personnel file of Adams. This file includes all her updated training as well as her physicals that were required to be a bus driver. I have also obtained her driving record from Penn Dot as well as a non-reportable accident that occurred in Upper Allen Townshif , which was not Adam's fault. She was driving a school bus at the time. On February 21, 2006 Chief Adams, Lt McLaughlin, Detective Sgt Kauffman and I went to the Cumberland County Courthouse to speak with DistrictAttorney Dave Freed concerning the possibility of charging Janet Adams, As a result of the meeting no charges will be filed against Janet Adams. On the 22nd of February, myself and Lt. McLaughlin visited the Allen's with James Nealand present a nd informed them of the meeting that was held with the DA's Office. After giving the Allen's the news we then proceeded to Janet Adams residence and informed her that there would be no charges filed against her. On the 27th of February at 1500 hours, Detective Thompson picked up the specimen of blood belonging to Seneca Allen from the Dauphin County Coroner's Office. The specimen was entered into ev idence under Evidence Number 06E-029, item #20. The blood was then transported to the Pennsylvania State Police Labor atory at 1523 hours for examination. EJ > ~ At this point the investigation is concluded. As far as can be determined, Seneca Allen got off ~ the school bus, turned left.to cross in front of the bus. The bus then started to move forvvard ~ and Seneca came to be under the bus and was struck bya dual set of rear wheels, which caused ~ her death. The UATPD is still waiting results from the State Police Laboratory, but those :: results are not expected to change the outcome of 0 ur investigation QI .5 ~ ~ J! .; ::iI <It , FORl'A' AA-5OON(IMl!t PENNOOT COpy http://www.dot6.state.pa.us/iconslPrintImageslXmlFiles/20060 154641 Beauduy231320060... 2/27/2006 ... U.lH v~'-u VV UUjif /1 V Page 17 of20 --1 <C@~Ib1l<<lJ~W~I!.'ii'1Xl @~ ~~INlWJ$'\fll.'\g~Irt'lDbI. ~l jlllll~I~11l11111I11111 -, ~@~OCIE ll:M$j}{JIRlIE[I!l@~1J'~~<<.n lFiOlfR(~ aNew ( sh Numl::!l Page: M500 C I PolkeU.. only I ~ a Change! W0034710 Continuation Unit No Number of Allies Carrier Phone. ~ ~ (Code Numb... of Allies (1717 I) 1697 1- 109 I ' or '99' for urmnowoJ Carrier Name . I B & S TRANSPORTATION I Address ': GVWR I 12217 OLD GETIYSBURG RD ! I 02600( I I I I Overs i2iE load ~ a e _No I g i ;;; City a 'n nown '" State Zip € I 0 I CAMP fiLL I ~ 117011 I .... .5 (') USOOTl! ICC# PUC # " I 00000000 I I I I I 23]: C> > "ffi Carno Bow TIf1J1! a AUto Transport Vehicle Contiauration .. a Bobtail) .. ,a Not Applicable a FlatBed Truclt Trad r '" a Garbage/Refuse a Not Applicable [!: IE o lfanfEnclosed 1l01l a Dump . Bus (j Passenger Car. Only Record if a Tractor/Se~ j. railel'{s) 0 MediumlHe ~\1 Trudt . Cannot u o Cargo Tanl! a Concrete Miller o Other/Unknown . HazMat placard Displayed 0 o LIght Trude (Van, Mini-Van. Panel, Classify HazilrrJous Material I PiCkup or SUV with HazMat Placard) 0 Small Bus (I ~i ~ 9.15 ~eo!lle, o Yes . No Enter 1-digit hazardous material class a Singl,e Unit Trude (2 Allies, 6 Including 0 11 r) 'V"" 'V"" 'V"" 'V"" Tires) , . Bus (Seats ~ 3i e "flliln 15 D D D D o Single Unit Truck (3 or More Allies) People, Ind !ll tile Driver} o Single Unit Trude (Unknown 0 Other Number of Allies) 0 Unknown D 0 D D o TrudelTrailer(sl ..6- ..6- ..6- .L::>.. Release Indicator '/ = No Release 2 = Release Ckcurred 9 = Unknown Unit No' Number of AllIes Carrier Phone D D (Code Number of Ax'es (! I) I 1--1 I .or '99' for unknown) Carrier Name I I Address GVWa I I I I . Oversize Lo d E; I I aVes aNo e (; aUnk QJ city State Zip o n ~ I IDI II I 0 "'" = (I USDOT# ICC' PUC# 't; I I I I I I :BE C> > ii Carqo Bod!! TVPe o Auto Transport Vehicle ConfiQuration ~ a Trude Trador (0 tail) 0 o Not Applicable o Frat Bed , 0 Garbage/Refuse o Not Applicable E i a Van/Endosed Iloll o Dump o Bus o Passenger Car. Only Record if 0 Trador/Semi -T ai er(s) u o Cargo Tank o Concrete Miller 0 Other/Unknown HazMat Placard Displayed a Medium/Hea VV Tr dt - Cannot o light Truclt (Van, Mini-Van. Panel. Classify Hazardous Material I Pickup or SUV with HazMat Placard) 0 Small Bus {Se at ,S i5 PlIOlO!e, o Yes 0 No Enter '/-digit hazardous material class o Single Unit Truck (2 AllIes. 6 Including Dn ve 'V"" 'V"" 'V"" 'V"" Tires) 0 Bus (Seats I\R Oil T am 15 '0 D 0 D o Single Unit Truck (3 or More AIdes) People. Indu din ~ Driver) o Single Unit Truclt (Unknown 0 Other Number of AllIes} 0 Unknown ' 0 0 D D o TrucktTrailer(s) L::>.. L::>.. .L::>.. L;::". Release Indicator '/ = No Release 2 = Release Occurred 9 = Unknown FOIlIlI ~ AA-5IlllC~ - _. - FENNDOT COpy ttp://WWW .dot6 .state.pa. us/iconslPrintImageslXmlFiles/20060 154641 Beauduy2313 2 0060 ... 2/27/2006 23 h Print CRS W0034710 --1 M 500 F I Police Use Only <C@If5JfK:1J@G\fJ~IW:.!J.m @IF 1i'~1it'I~$VIL~P.lmlO~ ~\JJI~lE <CM$1JIJ illIEroOO'il'Olit'ltliJ !F(\J)OOIMO S"ecial Jurisdiction 0 Military . No Special 0 Indian Reservation Jurisdiction . O N t. I P k 0 CollegelUmversity a lona ar Campus Please complete Unit Information for eam unit involved in a fatal crash. Do not repeat the 'information in the fields above on multiple pa Unit No ~ Road Surface T~ 24 o Concrete . Blacktop Driver Restrictions Compliance o No Restrictions! Not Applicable i: o ~ Driver Endorsement ~ Com!Jliance :i o None Required 25 .. c :; Driver Ucense Compliance o Not licensed Dro" Test T'RIe o None o Brick or Block o Slag, Gravel or Stone o Dirt o Other o unknown . Restrictions , Complied With O Restrictions Not Complied With O Compliance Unknown . Required - 0 Not a Pennsylvania Complied With Driver o Required - Non 0 Unknown Compliance Compliance O Required - Compliance Unknown o Not Required for 0 Unk if COlor Vehicle Class CDL Required O No Valid license 0 Not a Pennsylvania for Class Driver . . Valid license for 0 Unknown Class o Blood .. Urine o Not a Pennsylvania Driver . o Unknown Compliance o Other O Unknown if Test , Given Drug Test Results - (Ue> to Four Results) 0= No Test Given 5 = Amphetamines 1 = No Drug Reported 6 = PCP 2 = Mari{uana 8 = Other 3 = Cocaine 9 = Unknown Test 4 = Opiates Results Unit No ~ Driver Restrictions ComplIance . No Restrictions! Not Applicable s:: o ; III E .. ~ .5 25 ~ s:: ::IJ Driver Endorsement ComplIance . None Required Driver License ComplIance . Not licen5ed Drog Test Type . None uD ~D D o Restrictions Complied With o Restrictions Not Complied With O Compliance Unknown o Required - 0 Not a Pennsylvania Complied With Driver o Requir~d - Non 0 Unknown Comphance Compliance o Required- Compliance Unknown o Not Required for 0 Unk if COt or Vehicle Cla5s CDl Required o No Valid licen5e 0' Not a Pennsylvania for Cla5s Driver o ~~~ License for 0 Unknown o Blood o Urine Drug Test Results - (Up to Four Results) o = No Test Given 5 = Amphetamines 1 '" No Drug Reported 6 = PCP 2 = Marijuana 8 = other 3 = Cocaine 9 = Unknown Test 4 = Opiates Results l'O~IIAA_(I2llIIl!J o Not a Penn5ylvania Driver . o Unknown Compliance o Other o Unknown if Te5t Given ~EJ 0 DO o New Page rT8l 0 Change! 'L-J Continuation Principle Impact Point o Non-Colli5ion OTop o Undercarriage o Towed Unit . Unknown Avoidance Maneuver O No Avoidance Maneuver O Braking - Skid Marks Evident. Braking - No Skid o Marks, Driver , Stated Under l/ide Indicator O No Underride or Override underride, o Compartment Intrusion 11111111111111111I1111111111 W0034710 000 01~1l 12 0,1020 009 ,. 030 o 08 ' 040 07 06 050 00, o Braking - Other Evidence o Steering - Evidence or Driver Stated o Steering and Braking . Evidence or Stated Underride, No o Compartment Intrusion Underride, o Compartment Intru5ion Unknown Emerqency Use 0 Lights Flashing . Not in Emergency 0 Use Siren Sounding , Principle Impact Point o Non-Colli5ion o Top o Undercarriage o Towed Unit . Unknown Avoidance Maneuver o No Avoidance Maneuver O Braking - Skid Marlcs Evident Braking - No Skid o Marks, Driver Stated Under Ride Indicator O No Underride or Override Underride, o Compartment Intrusion Emefflencv Use o Not in Emergency Use PENNDOT COPY 000 01~1l 12 01020_ 009 , ' 03 0 008 040 07 06 050 o 0 Page 18 of20 I n o o t erAvoidance euver c ncJu5ive n nown . o o ~ o Braking - Other 0 0 e Avoidance Evidence M n uver o Steering - Evidence or Driver Stated o Steering and Braking Evidence or Stated Underride, No o Compartment Intrusion Underride, o Compartment Intrusion Unknown o lights Flashing o Siren Sounding if or http://www~dot6.state.pa.us/icons/PrintImages/XmlFiles/20060 154641 B eauduy2313 20060. i. 2/27/2006 2 -- U.llL vJ."\.~ VV VVjq. / 1 V Page 19 of ~ COfi\filfi\fJ<<i)OO_~1l. 'jj'~ Of ~[EIflI)~SiW/i.\f ~~U~ IllllllUllllllIIllllllIl~ I ~O!!..8a ~1liI ~~@'@{ltliN~ fORM 0 New Cah Numlnr Page M500 M I Police Use Only I ~ 0 Change' WOO3471O Continuation Unit No I For Answers to the below (except for Engine Size and Helmet Type) use the following codes; Y = Yes N = N U = Unknown D Engine size:1 eel Driver Protection 7 Helmet Type Passenller Protection 7 Helmet Type D DO'" No Helmet 0 [- o = No Helmet Motorc;yde Has? The Driver Has? Eye Protection 1 '" Full Helmet Eye Protection 1 = Full Helmet lD o Passenger D 2 = 3/4 Style 2 = 3'4 Style ~ Me Education ~ D 3 = Half Helmet D 3 = Half Helmet 6 0 D Saddle Long Sleeves Style long Sleeves Style ... 0 9 = Unknown 9 = Unknown ::E Bag and! D D Helmet Stay On? 0 [~ or Trunk Long Pants Long Pants Helmet Stay On? D Trailer D D Helmet has D Over Ankle Boots [ Helmet has Over Ankle Boots DOT or Snell DOT or Snell Designation Designation .. Unit No Use Codes D passenger?' D Helmet? Unit No Use Codes D Passenger? [ ~ Helmet? lD ~ D Y= Ves D V = Yes 7 ~ . N= No N = No [~ /I U = Unknown D Head . D Rear U = Unknown D Head Rear 'V GI Lights? Reflectors? Lights? Reflectors? II. Unit No Pedestrian Location ~ Unit No pedestrian Location I ~ D 01 = Marked Crosswalks at Intersection 01 = Marked Crosswalks Intersection 02 = At Intersection - No Crosswalks 02 = At Intersection - No r sswalks Pedestrian Si9na1s 03 = Non-Intersection Crosswalks Pedestrian Si9na1s 03 = Non-Intersection Cr( ss valles aVes 04 '" Driveway Access aVes 04 = Driveway Ac(ess II: 05 = In Roadway OS,. In Roadway .. _No aNo 'l: 06 '" Not in Roadway 06 = Not in Roadway ... .. o Not at Intersection 07 = Median -i o Not at Intersection 07 = Median GI 'V 08 = Island 08 = Island ClI It.. Pedestrian Clothin~ 09 '" Shoulder Pedestrian Clothing 09 '" Shoulder . light 10 = Sidewalk aUght 10,. Sidewalk 11 '" < 10 Feet Off Road 11 = < 10 Feet Off Road o Dark 12 = > 10 Feet Off Road o Dark 12 = > 10 Feet.off Road o Reflective 13 '" Outside Trafficway o Reflective 13 = Outside Trafficway o Unknown 14 = Shared PathslTrails o Unknown 14 = Shared PathsfTrails 99 = Unknown 99 ,. Unknown Work Zone Tyoe .IllIhere in wortione ? Work Zone Saeed 0 Lae losure? o Construction o Before 1st Work Zone or Advisory Limit 5Decial Work Zone Rc d Closed with (Long Term) Warning Sign 0 Law Enforcement Characteristics 0 DE o r? . o ,Maintenance o Advance Warning Area Officer' Present (Mark all that 0 W ~ on Shoulder I: 0 (Short Term) aVes apply. If not or dian? N o Transition Area Int 9 .Ii! Workers Present o No involved or 0 r ittent or .. o Utility Company o Activity Area aVes unknow, leave M vi 9 Work? 0 blank} 5: o Other o Termination Area o No o Unknown 0 Fla \I r Control? o Other o Unknown 0 Ot er Ust all Warnin~ 5i!,ns in Narrative Additional M.Page Information FOIlAI , AAoOOOM (t2IllI1J PENNDOT COpy ttp://WWW .dot6.state.pa.us/iconslPrintImageslXmlFiles/20060 154641 Beauduy23132006 0.._ 2/27120 20 .I. 2 28 h 06 Ynnt CKS W0034710 Crash Number: W0034710 Incident Number: UAT20060200192 (f!) ~~~~I~; "'::;;'~~'_'~'~::....,-:..;.,~*.,., ,....... <.'.:;..:;.""" ....,... ..~~!!]?.. .'.0J....>.>....:;::.>S..~ ~i~~~I~~ s':Si:y:.;:,.::::.~.;,~'t:::;-"\" ,::":::::,,,;:''';:~~''''''''';:~~~.,.:.~, ' ..s;..-,;;,~:":}:::;:':'..~,s..:::.::::.,,,:: ,:\,~.~.~,.......:s.:.::-... ....~.~.:":....,.~.... Benre b! Ilg $1l"l.:t; IN;:jT T09cAI..t;=- I ."";i"'.,t..~. .:;::.?-..,.;:.. ;;.:......, .~~~~~. : ':}l:::. "~ ~,,-':;; ;.;.;~....'o;' .'C;:; ~&: ' :;~~~.. .....':"."':.. :;~~.~~~: . n ,'=' I1l o It: ~ .Q e ." J; ct) .:'"-:-~ j~~~~:~B~~~~~ ~"":-' ":', ,.~':::.,,,~~..,: ."~.-,,.,-:s:."::..";::, ~~~~~:t~..>"~~,: ~~~~~.~~~~S.::~~*~::~. i "'0>:,/)J;l.<<'<.~::::~ , ,;"":Y". v.;::'::,., '", , "'~::':":'~~~"&~~"~ "~: ~~~<'~~~~0.'''''~'&'~~~; . '8"~"-:' "';~::::' "~::~ '-'.~ " .;.;, '....;;S'$::. "":-::"':-,:""~':::~'" ':~~:~A~:;*~~::*' '. Page 20 of 20 '\ '=' 11:1 o It: .".. '-' ~ 'S :f 'AP"r '7b http://www.dot6.state.pa.us/iconslPrintImagesIXmlFiles/20060 154641Beauduy231320060.;. 2/27/2006 , ...- ~'~ ;::x~\'h,'1- C- ., .L" W .....nuy Ul<1L Ult; lllIormaoonl1ere given is correctly cor:>j~d from an original certificateofqeat9 :a1 Regi?trar. The original certificate will be forwarded to the State Vital Records Office for perrrianl1 .. me as WARNING: It is illegal to duplicate this: copy by photostat or photogra\?h. .. . ' ~ ' . Fee for this certificate, $6,00 Rl.2273769 . No. 4:07 P Y. 0210612006 <":<'"',", ",- ...::" ........:.....:..CAUSEQlFDfJ..TM{s. ...:.,."anll~).. ',' ,.,';.-."_," ~l1:PWt~~....~~~"':*- ~.Dl'CDft'C'bllor.-IIM~:a\lMd"':lI!N~OOHolal'll...i.rrnNI......."1dI LtcankltrllSt ~~J;:r~;r~~~:;=t~~~'k ~b"'CNM""(If,U.,. &lW"'~YWtQ CAUSE .....,""~lhiln&lId.. ~~ ~......)u.sr. ; =~NMt .=:r:~~~;~~~:~r~~~~ ',' ~!O(Cf&S.~oI'j: c.',- "'Xlia.'fI'\IIii1UD;/l1 ':~ ;;.'OC y" 0" 4..>:..~~.jOt,:,.a~'of};. aw..~:~..: .-.wN.~ti:I~ .c... III o..? -:;: ~'I'. 0 ~ . 3t<:~Dt.~ "',:::z. .~=.~ o ~ O'CaAdNlll:81Ofletri1ed -- c h' b . ,,() II ~'I. I ,f- POLICY ATIONS Page 01 of 02 These Declarations are a part of the policy named above and identified by policy nurn below. They supersede any Declarations issued earlier. Your policy provides the coverages and Iimi s shown in the schedule of coverages. They apply to each insured vehicle as indicated. Your policy c plies with the motorists' financial responsibility laws of your state only for vehicles for which Property Da e and Bodily Injury Liability coverages are provided. Policyholder: Policy Number: (Named Insured) 58 37 C 521659 . KIMBERLY A & DARAN J ALLEN 104 HEMLOCK RD MECHANICSBURG, PA 17055-5817 '0 10 0> o 0> 0> <') o o o ~ 0> ~ ~ C\I Issued: JUN 09, 2005 0> 10 U) N 10 (.) ,.... <') cD 10 NATIONWIDE AU DEC Policy Period From: ! JUL 03, 2005 to JAN 03, 2006 but only if the required premium for this period ha~ een paid and only for six month renewal periods if renewal premiums have been paid as required. This pOlic i initially effective at (1) the time the application for insurance is completed, or (2) 12:01 a.m. on the first day of the Iicy period, whichever is later. Each renewal period begins and ends at 12:01 a. m. standard time at the addre of the named insured stated herein. This policy cancels at 12:01 a.m. at the address of the named insured stated h r in. IMPORTANT MESSAGES: THE FOLLOWING CHANGE(S) HAVE BEEN MADE TO YOUR POLICY: EFFECTIVE JUL 03, 2005 -CHANGED RESIDENTIAL TERRITORY SEE ENCLOSED NOTICE FOR PREMIUM DETAIL iiiiiijijjjjj; iiiiiijijjjjj; iiiiiijijjjjj; - - - ~ - ~ iiiiiijijjjjj; INSURED VEHICLE(S) & SCHEDULE OF COVERAGES - - - 1. 1998 SATU SATURN S Coverages PROPERTY DAMAGE LIABILITY BODILY INJURY LIABILITY UNINSURED MOTORISTS-BODILY INJURY ~ - UNDER INSURED MOTORISTS-BODILY INJURY FIRST PARTY BENEFITS OPTION 1-MEDICAL BENEFIT LIMITED TORT 2. 1997 ISUZ RODEO Sf Coverages PROPERTY DAMAGE LIABILITY BODILY INJURY LIABILITY UNINSURED MOTORISTS-BODILY INJURY UNDER INSURED MOTORISTS-BODILY INJURY FIRST PARTY BENEFITS OPTION 1-MEDICAL BENEFIT LIMITED TORT V-100-A ID #1G8ZH5282WZ311217 Limits Of Liability $ 25,000 EACH OCCURRENCE $ 15,000 EACH PERSON $ 30,000 EACH OCCURRENCE (STACKED) $ 15,000 EACH PERSON $ 30,000 EACH OCCURRENCE (STACKED) $ 15,000 EACH PERSON $ 30,000 EACH OCCURRENCE $ 5,000 ID #4S2CM58V3V4336096 Limits Of Liability $ 25,000 EACH OCCURRENCE $ 15,000 EACH PERSON $ 30,000 EACH OCCURRENCE (STACKED) $ 15,000 EACH PERSON $ 30,000 EACH OCCURRENCE (STACKED) $ 15,000 EACH PERSON $ 30,000 EACH OCCURRENCE $ 5,000 TOT Six Month Premium $ 64.30 $ 36.00 $ 4.60 $ 12.80 $ 18.50 $ 136.20 Six Month Premium $ 67.40 $ 36.00 $ 4.60 $ 12. 80 $ 16. 00 $ 136.80 .. C') C') o C> C> C') o o o """ C> """ """ (\/ C> It) <0 (\/ It) o ,... C') IX) It) - !!!!!!!!!!!! - - !!!!!!!!!!!! - !!!!!!!!!!! ~ !!!!!!!!!!!! ~ ~ - - !!!!!!!!!!!! D AUTO CUSTON'I~R NOTICE Policy Number: 58 37 C 521659 Date Prepared: JUN 09, 2005 Additional Notes: Your auto renewal premium could be reduced if you were to insure your home under one ( f our qualifying Homeowner policies. Please contact your Nationwide Agent for details. HOon't Be Surprised", call your Nationwide Agent for a Care Review (Client Account Review nd be sure your total insurance program meets your needs. Rental Reimbursement -- It's good in a crunch. What if you had an auto accident and need ~.c to rent a replacement vehicle? Are you covered? Ask you Nationwide agent if your policy offers rent. I eimbursement coverage. Nationwide can also help you save $5 a day on your next leisure rental courtesy of Enterprisl Rent-a-Car. Reserve now. Visit enterprise. com and enter customer number NATBFR8. Thank you for choosing Nationwide. We value your business. V-07S0 .... 10 o Ol ~ 8 o v ~ V N Ol 10 to N 10 U .... .., co 10 -- -- == - - !!!!!!!!!!!! - !!!!!!!!!!!! -- !!!!!!!!!!!! -- -- - - !!!!!!!!!!!! Nationwide Insurance PRIVACY STATEMENT We value you as a customer and respect your right to privacy. We know that you products and services because you trust that we stand behind our promises. We commitment to treat your information responsibly, and we created this privacy policy to s we are working hard to protect your privacy. Confidentiality and security We use physical and technical safeguards to protect your information. We restrict ac e s to your information to those who need it to perform their jobs. Third-party business partners are b to use the information only for our purposes. They may not disclose it or use it in any ot comply with all data security laws. Collecting your personal information We collect personal information about you from different sources. For example, we'collect i ormation you send us on applications and forms. We collect information from your transactions w' h our sister companies, others, or us. We may collect information from a consumer-reporti agency, demographic firm, or medical provider. This collection depends on the product or service request. Sharing your personal information We do not sell your information to anyone. We may share this information with a business at carries out services and marketing for us. We may share your information as required or perm' e We may share your information for a legal or regulatory purpose or to combat fraud. T:j depends on the products you select. These include the following types of information: We may share information we receive from you on applications or other forms. This a your name, address, beneficiaries, Social Security number and family member inform t may also include assets, income, and the property address and value. We may share information from your transactions with our sister companies, or us. include your account balance, policy coverage, and payment history. This may al premium paid, preferences, claims, and purchase method. We may share information we receive from a consumer-reporting agency or other report. his may include your credit report, motor vehicle and driver data. This may also include m . al and employment data, loss history reports, and other driver data. We may share information with companies that perform marketing services on our permitted by law, we may disdose some information to other financial institutions with have joint marketing agreements, and we may disclose some information to sister co cross-market. Information sharing and opt out We sent you this privacy statement because you purchased a financial or insurance produc agent that allows us to share your information with other Nationwide Companies to cross-m other products that might interest you. We may have joint-marketing agreements with ot party business partners. We may share your information with these third parties. You can a to share your information for marketing purposes with other Nationwide Companies, ot parties, or both. If you choose to do so, please call us toll free at 1-866-280-1809. If you hav opted out, you do not need to do so again. We will not share the personal information of Vermont customers with any Nationwide aft II third-party companies for marketing purposes without your consent. Using your medical information Sometimes, we must collect medical information to provide you a product or to pay a claim. W use or share your medical information for any marketing purpose unless we receive your per We use medical information when: Underwriting insurance; rom an kat our r third- us not r third lready tes or o not ssion. G-9333-1 (12/8/04) Pa 1 of 2 . D Policyholder I nnation v co o m m (Y) o o o v m v v C\I NOTICE OF AVAILABILITY Under the laws of the Commonwealth of Pennsylvania, insurers are requir d to remind policyholders at every renewal about the availability of two alternatives of full tort i limited tort insurance, and of premium discounts. (Title 75 Section 1791.1 Subs (c) of the Pennsylvania Consolidated Statutes). m LO co C\I LO o "- (Y) IX) LO TORT OPTIONS The law gives you the right to choose either 'of the following two tort options: A. "Limited Tort" Option - "This form of insurance limits your right and the right f members of your household to seek financial compensation for injuries caused by other f ers. Under this form of insurance, you and other household members covered under this po i y may seek recovery for all medical and other out-of-pocket expenses, but not for pain an i uffering or other nonmonetary damages unless the injuries suffered fall within the definiti n of "serious injury" as set forth in the policy, or unless one of several other exceptions notedi the policy applies." (see the Definition of Serious Injury and Exceptions below) B. "Full Tort" Option - "This form of insurance allows you to maintain an unrest ed right for yourself and other members of your household to seek financial compensati n for injuries caused by other drivers. Under this form of insurance, you and other househ members covered under this policy may seek recovery for all medical and other out-of-po k t expenses and may also seek financial compensation for pain and suffering and other n nmonetary damages as a result of injuries caused by other drivers," YOUR TORT OPTION The tort option that currently applies to your policy is shown on the billing n tice under SPECIAL RATING. The "Limited Tort" option is provided at a lesser premium than h "Full Tort" option. If you wish to change the tort option, you must notify your agent, broke r company and request and complete the appropriate form. DEFINITION OF SERIOUS INJURY AND EXCEPTIONS "SERIOUS INJURY" means a personal injury resulting in death, serious impair functions or permanent serious disfigurement. EXCEPTIONS A named insured or relative remains eligible to seek noneconomic loss if the sustai 1. is a serious injury. 2. results as the consequence of the fault of another person who: I a. is convicted, or accepts Accelerated Rehabilitative Disposition (ARD) for dri~ influence of alcohol or a controlled substance in an accident; ! b. is operating a motor vehicle registered in another state; c. intends to injure himself or another person, provided that an individ intentionally injure himself or another person merely because his act or fa I intentional or done with his realization that it creates a grave risk of causin act or omission causing the injury is for the purpose of averting bodily harm another person; or d. has not maintained financial responsibility as required by the Pennsylvania Financial Responsibility Law. However, this exception, (2) (d). shall n insured's limitation to recover noneconomic loss under any Uninsured or I Motorists Coverages provided by this or any other policy. - - - - - - - - - - - - - - nt of body - under the does not re to act is jury or the himself or tor Vehicle affect the derinsured V-6457 PM991V1 age 1 of 2 . ~ ...... o m m (') o o o ..,. m ..,. ..,. C\I m on <0 C\I on o ...... <') co on iiiiiiiiiiji; - = - - - - !!!!!!!!!! iiiiiiiiiiji; !!!!!!!!!! --- --- !!!!!!!!!! D Policyholder 1 Automobile Insurance Merit Rating Plan Informati At Nationwide, we believe in rewarding you as your driving record improves. Our a ing system is designed to lower your premium as your driving record improves. Our researc shows that often drivers who have had accidents or violations - or who lack driving experie e - have a higher future accident potential than other drivers. As a result, insurers gene Iy charge higher premiums to policyholders who have driving violations or "at fault" type a cidents. If your driving record is free from accidents or violations, you will pay a low r premium. The following information explains this in detail: j Violations and At-Fault Accidents Certain violations or at-fault accidents resulting in injury, death or damage to prop rt will result in a surcharge to your premium. This applies to the following coverages: Bodily In u y Liability, Property Damage Liability, Medical Benefits, Combined Loss Benefits, Co rehensive and Collision Coverages. ! The surcharge level is based on the number of violation points, the number 0 accidents in an experience period, and the amount of "time since the latest oc each. When an accident and a minor violation occur at the same time only the acci nt will be surcharged. When an accident and a minor violation occur at the same time and h accident does not meet the chargeable accident definition, only the minor violation will be s r harged. If the accident later meets the chargeable accident definition, the accident surch r e will be applied for the remainder of the surcharge period and the violation surcharge will emoved. When an accident and a major violation occur at the same time only the major viol t on will be surcharged. I Experience Period ! An experience period is the time period in which a chargeable accident or violation i$ ounted. This is determined as follows: · New Business - 35 months ending on the policy effective date. i · Renewal - 35 months ending 45 days prior to the semi-annual due date of thr Violation Points \ Violation points are assigned as follows: ! · No points are assigned for the conviction of one minor violation within 35 month~. · One point is assigned for the conviction of a second minor violation within 35 0 ths. One additional point is assigned for the conviction of each subsequent minor violati n within 35 months. · Five points are assigned for the first conviction of a major violation and five addit/o al points are assigned for the conviction of each subsequent major violation within 35 moryt s. Major violations are defined as follows: ' · Driving or accompanying a driver with a learner's permit while intoxicated 0 influence of drugs, OR · Failure to submit to a chemical test, OR · Failure to stop and report when involved in an accident, OR · Falsification of an accident report, OR · Homicide or assault arising out of the operation of a motor vehicle, OR · Driving while license or vehicle registration is suspended or revoked. OR · Permitting unlicensed person to operate a motor vehicle, OR · Committing a felony with a motor vehicle, OR · Involved in racing or a highway speed contest, OR · Fleeing or attempting to elude a police officer with an auto, OR V-6453-B PM991 S2 (4-05) P e 1 of 3 , co co . 0 C>> C>> (Y) 0 . 0 0 v C>> v v . C\I . C>> on <0 (\j on o ..... (Y) co on Involved in an accident resulting in physical damage, limited to and caus d by flying gravel, missiles, or falling objects, OR Involved in an accident while in the pursuit of official duties as a law e officer, fire fighter, or operator of an emergency vehicle or ambulance, OR Involved in an accident which the responsible party was protected by soverei immunity, OR Involved in an accident which occurred more than 35 months prior to the i the insurance policy. Payments under the Bodily Injury, Property Damage, and/or Collision coverage chargeable if there are valid grounds for recovery of 60 percent or more of the a through subrogation or from a settlement or judgement against the individual r for the accident. == = !!!!!!!!!!!! - o 1 2 3 4 Each Additional Surcharge Factor based on Time Since Latest Accident b Char eable 13-24 Months 0.00 0.40 1.00 1.85 2.85 +1.00 0-12 Months 0.00 0.47 1.10 1.99 3.04 +1.05 Number of Chargeable Accidents V-6453-B PM991 S2 (4-05) Pa 3 of 3 - - - !!!!!!!!!!!! iiiiiiiiiiiii !!!!!!!!!!!! iiiiiiiiiiiii - Note: When a surcharge applies to your policy specific premium information will be in I your declaration. Thank you for choosing Nationwide as your insurance provider. Source: PA Insurance Department Regulation 67.35. !!!!!!!!!!!! NATIONWIDE INSURANCE One Nationwide Plaza. Columbus, Ohio 43215-2220 Hearing or Voice Impaired: 1-800-622-2421 (TTY Only) nationwide. com - r'/.h;\,~-r 'f-' CONTINGENT POWER OF ATTORNEY AND FEE AGREEMENT We, the undersigned, ~"'kJ' V,~6:c~ A- \ \J2.<V ,hereby NEALON GOVER & PERRY, to be our true and lawful torneys for us and in 0 place and stead to investigate, institute and maintain, compromise and settle a at law, equity or otherwise against all responsible individuals, corporations or to recover damages sustained by us and the Estate of Seneca Allen arisi injuries sustained and pain and suffering incurred as a result of a motor vehicle a that occurred on February f.sL, 2006. ppoint name, action tities, from ident I hereby authorize NEALON GOVER & PERRY to execute and endors papers, checks or orders on my behalf in connection with any claim or action ma my behalf. No settlement, however, shall be made without my consent. For their services, NEALON GOVER & PERRY, shall be entitled to a contin nt fee from the gross recovery made or secured of +o)o)JL-.~ percent ~ if said cause of action is settled without suit; j-"",-t.-...L -~"...e:::r: pe:rcent ( \ 0) if suit is begun; and +\'"l,^-"~ .-f:\ J-L- <r percent ( d- ~ %) In the even \ f an appeal. I also understand that from time to time, NEALON GOVER ~ ~~~RY may i.n u . . f s and other costs (e.g. copying fees) that wllllmtlally be paid costs related to filing e~RRY on my behalf, but that I am responsible for such cos NEALON GOVER & P or resolution, I will repay these fees and costs. Upon any settlement, recovery, . . ON GOVER & PERRY, the aforesaid perce~tage of sal , \ hereby assign to NEAL d as security for their fee and authOrize paymen t wh'/ch may be recovere , amoun . directly to them by obligor. \~ % I h. . ~ day of ESS WHEREOF I I set my hand and sea t IS . f 2od~ i~~:ing to be legally bound hereby. I acknowledgc rcce! ~c~r~a~~wer of Attorney and Contingent Fee Agreement. p . -Aft- 'PrIPf {d (//~ . :K.OO above appointment and agreement is hereby approved and accepted this z.J:!:.{tay of February, 2006. I NEALON GO R & PERRY C\- James G, Nealon, III, Esquire s ~ ~ c:> _J ? ~ '" rv ~ _1100 {~~ ~ ::-::\ ~ -'. (.Ii ,----