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HomeMy WebLinkAbout06-4491IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA No. Action (X) Law O Equity HEATHER YATES, INDIVIDUALLY : D AND J TRUCK REPAIR, 4051 Carlisle Road : INCORPORATED Gardners, PA 17324 : 25 Hershey Road And : Shippensburg, PA 17257 CAMPBELL A. YATES, A MINOR And BY HEATHER YATES, PARENT CURTIS D. DAGUE AND NATURAL GUARDIAN 8475 Roxbury Road 4051 Carlisle Rd. Lurgan, PA 17232 Gardners, PA 17324 Plaintiff(s) & Address(es) I : I Defendant(s) & Address(es) PRAECIPE FOR WRIT OF SUMMONS TO THE PROTHONOTARY OF SAID COURT: Please issue a Writ of Summons in the above-captioned action. X A Writ of Summons shall be issued and forwarded to ( ) Attorney (X) Sheriff. Gerard C. Kramer, Esquirp Schmidt Kramer PC 209 State Street !- Harrisburg, PA 17101 (717) 232-6300 ignature of Attorney Supreme Court I.D. No. 44715 Date: _Vz? WRIT OF SUMMONS TO THE ABOVE NAMED DEFENDANTS: YOU ARE NOTIFIED THAT THE ABOVE-NAMED PLAINTIFFS HAVE COMMENCED AN ACTION AGAINST YOU. ?Z? .2 k4? Op? Prothonotary Date: p Deputy 44, b d I. I SHERIFF'S RETURN - REGULAR CASE NO: 2006-04491 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND YATES HEATHER ET AL VS D AND J TRUCK REPAIR INCORPORA ROBERT BITNER , Sheriff or Deputy Sheriff of Cumberland County,Pennsylvania, who being duly sworn according to law, says, the within WRIT OF SUMMONS was served upon D AND J TRUCK REPAIR INCORPORATED the DEFENDANT , at 1230:00 HOURS, on the 17th day of August -1 2006 at 25 HERSHEY ROAD SHIPPENSBURG, PA 17257 TERRY BLACK, VICE PRESIDENT by handing to ADULT IN CHARGE a true and attested copy of WRIT OF SUMMONS together with and at the same time directing His attention to the contents thereof. Sheriff's Costs: So Answers: Docketing 18.00 Service 15.84 Postage .78 Surcharge 10.00 R. Thomas Kline .00 44.62,/ 08/28/2006 SCHMIDT RONCA KRAMER Sworn and Subscibed to before me this day Deputy Sheriff of , A.D. SHERIFF'S RETURN - OUT OF COUNTY CASE NO: 2006-04491 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND YATES HEATHER ET AL VS D AND J TRUCK REPAIR INCORPORA R. Thomas Kline , Sheriff or Deputy Sheriff who being duly sworn according to law, says, that he made a diligent search and and inquiry for the within named DEFENDANT to wit: DAGUE CURTIS D but was unable to locate Him deputized the sheriff of FRANKLIN serve the within WRIT OF SUMMONS in his bailiwick. He therefore County, Pennsylvania, to On August 28th , 2006 , this office was in receipt of the attached return from FRANKLIN Sheriff's Costs: So answers: Docketing 6.00 Out of County 9.00 Surcharge 10.00 R. Thomas Kline Dep Franklin Co 23.00 Sheriff of Cumberland County .00 48 . 00 ? L ., ??at? ?C) 08/28/2006 SCHMIDT RONCA KRAMER Sworn and subscribe to before me this day of , A. D. CASE NO: 2006-00199 T SHERIFF'S 'RETURN - REGULAR COMMONWEALTH OF PENNSYLVANIA: COUNTY OF FRANKLIN HEATHER YATES ET AL VS CIP"I'IS D DAGUE ET AL Cy ?`nbz?lcxnc? ?-c??tc??y 0 - 4491 J KENNETH W HALL , Deputy Sheriff of FRANKLIN County, Pennsylvania, who being duly sworn according to law, says, the within PRAE WRIT SUMMONS was served upon DAGUE CURTIS D the DEFENDANT at 0011:30 Hour, on the 18th day of August 2006 at FRANKLIN CO SHERIFF' OFFICE CHAMBERSBURG, PA 17201 by handing to CURTIS D DAGUE a true and attested copy of PRAE WRIT SUMMONS together with and at the same time directing His attention to the contents thereof. cv. ?:f's Costs: Luu.K,eting .00 Service .00 Affidavit .00 Surcharge .00 Sworn and Subscribed to before 6 me this 1 day of &00 OW /? A.D. 0 rnC Notar? T Notarial Seal Public Richard D. McCarty'Fran lin County Chambersburg BOro, My Commission Expires Jan. 29, 2007 ------------- - So Answers: KENNETH W HALL By eputy Sheriff 08/21/2006 SCHMIDT KRAMER PC In The Court of Common Pleas of Cumberf .nd County, Pe nisylvania Heather Yates et al v5. D and J Truck Repair Incorporated et al SERVE: Curtis D. Dague No. 06-4491 civil Now, August 7, 2006 , I, SHERIFF OF CUMBERLAND COUNTY, PA, do hereby deputize the Sheriff of Franklin County to execute this Writ, this deputation being made at the request and risk of the Plaintiff. Sheriff of Cumberland County, PA Affidavit of Service Now, ?5- Aug , 2000_(, at : 3o o'clock ? M. served the within i9p!' o-1 po, -#- upon D, by handing to Ctkr 17, D?q ,gr a copy of the original I)L ?,y ?r L` o?-S c? rNs w and made, known to the contents thereof. So answers, COMM ON,W EAI-Ti I OF PENNSYLVANIA : :_'OUNT ; Sheriff f County, PA COSTS Sworn and subscribed before SERVICE $ me this day of , 20 MILEAGE AFFIDAVIT J SCHMIDT KRAMER PC BY: Gerard C. Kramer Attorney at Law Attorney ID No.: 44715 209 State Street Harrisburg, PA 17101 (717) 232-6300 Fax (717) 232-6467 gkramer@schmidtkramer.com Attorney for Plaintiff HEATHER YATES, INDIVIDUALLY AND CAMPBELL A. YATES, A MINOR BY HEATHER YATES, PARENT AND NATURAL GUARDIAN, Plaintiff : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, : PENNSYLVANIA V. : No. 06-4491 D AND J TRUCK REPAIR, CIVIL ACTION - LAW INCORPORATED AND CURTIS D. DAGUE, Defendant : JURY TRIAL DEMANDED PETITION AND RULE OF GERARD C. KRAMER, ESQUIRE TO SHOW CAUSE WHY HE SHOULD NOT BE PERMITTED TO WITHDRAW AS COUNSEL PURSUANT TO PA. R.C.P No. 1012 AND NOW, Gerard C. Kramer, Esquire and Schmidt Kramer PC hereby Petition this Honorable Court to permit them to withdraw as Counsel for Plaintiff for the following reasons: 1. Heather Yates is the parent and natural guardian of Campbell Yates. 2. Plaintiffs, Heather Yates, and her minor daughter, Campbell Yates, were injured in a motor vehicle accident on September 24, 2004. V 3. In October, 2004, Plaintiff, Heather Yates, retained Schmidt Kramer PC as her attorneys to represent her and Campbell Yates regarding their injuries sustained in the motor vehicle accident on September 24, 2004. 4. Under Pa. R. C. P. No. 1012 (b) (1), an attorney may not withdraw his appearance as counsel for a client without leave of court. 5. Under Pa. R.C.P. No. 1012(c) and (d)(1), a petition for leave of court to withdraw an appearance may be sought by counsel if the whereabouts of the party on whose behalf the appearance was entered are known. 6. The whereabouts and current residence of Heather Yates and Campbell Yates are known by Schmidt Kramer PC to be 1265 Goodyear Road, Gardners, Adams County, Pennsylvania, 17324-0913. 7. Under Pa. RPC 1.16(b)(6), a lawyer may terminate representation of a client if the representation has been rendered unreasonably difficult by the client. 8. Representation of Heather Yates and Campbell Yates has become unreasonably difficult for Schmidt Kramer PC because Heather Yates has, for several months, failed to communicate with Schmidt Kramer PC and has failed to participate in the representation of her and Campbell Yates' interests by Schmidt Kramer PC. 9. Under Pa. RPC 1.16(d), upon termination of the representation of a client a lawyer must take reasonable steps to protect the client's interests including: giving the client reasonable notice of the termination and allowing time for the client to employ other counsel. t 10. Schmidt Kramer PC advised Heather Yates by letter several months ago of the difficulties created by her failure to communicate and that she should obtain other counsel. Hence, Schmidt Kramer PC has given her reasonable notice of the intent to terminate the representation and has allowed ample time for Heather Yates to employ other counsel. 11. A Writ of Summons was filed with the Cumberland County Prothonotary on August 7, 2006 by Schmidt Kramer PC on behalf of Heather Yates and Campbell Yates. Schmidt Kramer PC requests that the Court stay the proceeds on that Writ of Summons for a period of sixty (60) days to ensure that this withdrawal of appearance by Schmidt Kramer PC does not prejudice Heather Yates' and Campbell Yates' ability to pursue their case. 12. Under C.C.R.P. 208.3(a)(9), all motions and petitions submitted to the Court of Common Pleas of Cumberland County must contain a paragraph indicating that the concurrence of any opposing counsel of record was sought and the response of that opposing counsel of record. In the above-captioned matter, there is no opposing counsel of record and therefore no concurrence was sought by Schmidt Kramer PC. WHEREFORE, Schmidt Kramer PC and Gerard C. Kramer, Esquire pray Your Honor will grant their Petition to Withdraw as Counsel and their request to stay the proceedings on the above-captioned case for a period of sixty (60) days. I, GERARD C. KRAMER, am the attorney for the Plaintiff in the above- captioned matter. I have prepared this document for filing in this matter. I F w certify that I have read the document, that there are good grounds to support it and that it is submitted in good faith. Respectfully Submitted, SCHMIDT KRAMER PC DATED: By: erard C. Kramer Attorney at Law Attorney ID No.: 44715 209 State Street Harrisburg, PA 17101 (717) 232-6300 Fax (717) 232-6467 gkramer@schmidtkramer.com Attorney for Plaintiff CERTIFICATE OF SERVICE AND NOW, this G l0 day of VGf e1"- , 2007, I, Gerard C. Kramer, Esquire, hereby certify that I have this day served a true and correct copy of the PETITION AND RULE OF GERARD C. KRAMER, ESQUIRE TO SHOW CAUSE WHY HE SHOULD NOT BE PERMITTED TO WITHDRAW AS COUNSEL by depositing a copy of the same in the United States Mail, postage prepaid, at Harrisburg, Pennsylvania, addressed to: Heather Yates 1265 Goodyear Road Gardners, PA 17324-0913 DATED:-/O//6/07 Respectfully Submitted, SCHMIDT KRAMER PC By: erard C. Kramer Attorney at Law Attorney ID No.: 44715 209 State Street Harrisburg, PA 17101 (717) 232-6300 Fax (717) 232-6467 gkramer@schmidtkramer.com Attorney for Plaintiff ? r?..3 r,.i c-? i,.) -T1 ?"7,? ?? r. "'X'i 'r ? ....J -?j ; ??. _ :,y.;:. r`. ?. - ?? x:7"7 %'. r . ? f.,? 14 41 SCHMIDT KRAMER PC BY: Gerard C. Kramer Attorney at Law Attorney ID No.: 447 IS 209 State Street Harrisburg, PA 17101 (717) 232-6300 Fax (717) 232-6467 gkramer@schmidtkramer.com Attorney for Plaintiff HEATHER YATES, INDIVIDUALLY AND CAMPBELL A. YATES, A MINOR BY HEATHER YATES, PARENT AND NATURAL GUARDIAN, Plaintiff V. : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, : PENNSYLVANIA : No. 06-4491 D AND J TRUCK REPAIR, CIVIL ACTION -LAW INCORPORATED AND CURTIS D. DAGUE, Defendant : JURY TRIAL DEMANDED AMENDMENT TO: PETITION AND RULE OF GERARD C. KR.AMER, ESQUIRE TO SHOW CAUSE WHY HE SHOULD NOT BE PERMITTED TO WITHDRAW AS COUNSEL PURSUANT TO PA. R.C.P No. 1012 13. No Judge has ruled upon any other issue in the same or related matter. I, GERARD C. KRAMER, am the attorney for the Plaintiff in the above- captioned matter. I have prepared this document for filing in this matter. I certify that I have read the document, that there are good grounds to support it and that it is submitted in good faith. Respectfully Submitted, SCHMIDT KRAMER PC ? DATED: 0 -o?1 'v7 By: z--'l t rard C. Kramer orney at Law Attorney ID No.: 44715 209 State Street Harrisburg, PA 17101 (717) 232-6300 Fax (717) 232-6467 gkramer@schmidtkramer.com Attorney for Plaintiff C"? N ?, 1 ' ? ? ??'Fra - ,- r; T (a,? , Cm. ? ? :.?.. d ? - ? -- ? -? G.J ?' HEATHER YATES, Individually, and CAMPBELL A. YATES, a minor, by HEATHER YATES, Parent and Natural Guardian, Plaintiffs vs. D AND J TRUCK REPAIR, INCORPORATED and CURTIS D. DAGUE, Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA : CIVIL ACTION - LAW : NO. 06-4491 CIVIL : JURY TRIAL DEMANDED IN RE: PETITION AND RULE OF GERARD C. KRAMER, ESQUIRE, TO SHOW CAUSE WHY HE SHOULD NOT BE PERMITTED TO WITHDRAW AS COUNSEL PURSUANT TO PA. R.C.P. NO. 1012 ORDER OF COURT AND NOW, this -0day of November, 2007, upon consideration of the Petition and Rule of Gerard C. Kramer, Esquire, To Show Cause Why He Should Not Be Permitted To Withdraw As Counsel Pursuant To Pa. R.C.P. No. 1012, a Rule is hereby issued upon all parties to show cause why the relief requested should not be granted. RULE RETURNABLE seven (7) days from date of service. BY THE COURT, J. 'VV esley Oler, ., J. re .y" r ti V N 1 »rs !.r SCHMIDT KRAMER PC BY: Gerard C. Kramer Attorney at Law Attorney ID No.: 44715 209 State Street Harrisburg, PA 17101 (717) 232-6300 Fax(717)232-6467 glcramer@schmidtkramer.com Attorney for Plaintiff HEATHER YATES, INDIVIDUALLY AND CAMPBELL A. YATES, A MINOR BY HEATHER YATES, PARENT AND NATURAL GUARDIAN, Plaintiff V. D AND J TRUCK REPAIR, INCORPORATED AND CURTIS D. DAGUE, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA : No. 06-4491 : CIVIL ACTION - LAW : JURY TRIAL DEMANDED CERTIFICATE OF SERVICE AND NOW, this day of /-)01"-0N-4'Q--2007, I, Gerard C. Kramer, Esquire, hereby certify that I have this day served a true and correct copy of the attached Order of Court dated November 5, 2007 To Show Cause Why Gerard C. Kramer, Esuqire Should Not Be Permitted to Withdraw As Counsel by depositing a copy of the same in the United States Mail, postage prepaid, at Harrisburg, Pennsylvania, addressed to: Heather Yates 1265 Goodyear Road Gardners, PA 17324-0913 Respectfully submitted, SCHMIDT KRAMER PC DATED: By: l Gerard C. Kramer, Esquire Y? HEATHER YATES, IN THE COURT OF COMMON PLEAS OF Individually, and CAMPBELL A. CUMBERLAND COUNTY, PENNSYLVANIA YATES, a minor, by HEATHER YATES, Parent and Natural Guardian, Plaintiffs CIVIL ACTION - LAW VS. NO. 06-4491 CIVIL D AND J TRUCK REPAIR, INCORPORATED and CURTIS D. DAGUE, Defendants JURY TRIAL DEMANDED IN RE: PETITION AND RULE OF GERARD C KRAMER ESQUIRE TO SHOW CAUSE WHY HE SHOULD NOT BE PERMITTED TO WITHDRAW AS COUNSEL PURSUANT TO PA. R.C.P. NO. 1012 ORDER OF COURT AND NOW, this 'day of November, 2007, upon consideration of the Petition and Rule of Gerard C. Kramer, Esquire, To Show Cause Why He Should Not Be Permitted To Withdraw As Counsel Pursuant To Pa. R.C.P. No. 1012, a Rule is hereby issued upon all parties to show cause why the relief requested should not be granted. RULE RETURNABLE seven (7) days from date of service. BY THE COURT, rc J. Wesley Oler, `J Est-?:r,:. cMyaa? whS.. 'Biel{, I here u"ld..' set ci-nf ha-'d -?!' j tha spai of w 9d Court at Garitsyo. Pa 1,11.14 k, day AIW C7 ? G ° c-n -V cn a Fli 1 -1 SCHMIDT KRAMER PC BY: Gerard C. Kramer Attorney at Law Attorney ID No.: 44715 209 State Street Harrisburg, PA 17101 (717) 232-6300 Fax (717) 232-6467 gkramer@schmidtkramer.com Attorney for Plaintiff HEATHER YATES, INDIVIDUALLY AND CAMPBELL A. YATES, A MINOR BY HEATHER YATES, PARENT AND NATURAL GUARDIAN, Plaintiff V. : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, : PENNSYLVANIA : No. 06-4491 D AND J TRUCK REPAIR, CIVIL ACTION - LAW INCORPORATED AND CURTIS D. DAGUE, Defendant : JURY TRIAL DEMANDED WITHDRAWAL OF PETITION TO WITHDRAW AND NOW, Gerard C. Kramer, Esquire and Schmidt Kramer PC, Counsel for Plaintiff, withdraw their PETITION TO WITHDRAW which was filed on October 29, 2007 because Plaintiff, Heather Yates, has reestablished communication with Gerard C. Kramer and Schmidt Kramer PC making it possible for them to represent her and her minor daughter, Campbell Yates, in this matter. Respectfully Submitted, SCHMIDT KRAMER PC DATED : l? By: erard C. Kramer Attorney at Law ? Attorney ID No.: 44715 209 State Street Harrisburg, PA 17101 (717) 232-6300 Fax (717) 232-6467 gkramer@schmidtkramer.com Attorney for Plaintiff CERTIFICATE OF SERVICE AND NOW this ? day of 114qlle , 2007, I, Gerard C. Kramer, Esquire, hereby certify that I have this day served a true and correct copy of the WITHDRAWAL OF PETITION TO WITHDRAW by depositing a copy of the same in the United States Mail, postage prepaid, at Harrisburg, Pennsylvania, addressed to: Heather Yates 1265 Goodyear Road Gardners, PA 17324-0913 DATED: 910 7 Respectfully Submitted, SCHMIDT KRAMER PC By: Berard C. Kramer Attorney at Law Attorney ID No.: 44715 209 State Street Harrisburg, PA 17101 (717) 232-6300 Fax (717) 232-6467 gkramer@schmidtkramer.com Attorney for Plaintiff co SCHMIDT KRAMER PC BY: Gerard C. Kramer Attorney at Law Attorney ID No.: 44715 209 State Street Harrisburg, PA 17101 (717) 232-6300 Fax (717) 232-6467 gkramer@schmidtkramer.com Attorney for Plaintiff HEATHER YATES, INDIVIDUALLY : IN THE COURT OF COMMON PLEAS AND CAMPBELL A. YATES, A : CUMBERLAND COUNTY, MINOR BY HEATHER YATES, : PENNSYLVANIA PARENT AND NATURAL . GUARDIAN, Plaintiff V. : No. 06-4491 D AND J TRUCK REPAIR, CIVIL ACTION - LAW INCORPORATED AND CURTIS D. DAGUE, Defendant : JURY TRIAL DEMANDED PETITION FOR APPROVAL OF MINOR'S SETTLEMENT AND NOW, comes Petitioner, HEATHER YATES, as Parent and Natural Guardian of CAMPBELL YATES, a minor, by and through her attorneys, SCHMIDT KRAMER PC, and respectfully avers as follows: 1. The Petitioner, Heather Yates, is the Parent and Natural Guardian of Campbell Yates 2. The Petitioner, Heather Yates, currently resides at 1265 Goodyear Road, Gardners, Cumberland County, Pennsylvania 17324. 3. The minor, Campbell Yates, currently resides with her mother, the Petitioner, Heather Yates. 4. The minor, Campbell Yates, is six (6) years old, having been born on September 16, 2001. 5. On or about September 24, 2004, at approximately 5:25 p.m. on Carlisle Road in Tyrone Township, Adams County, Pennsylvania, Campbell Yates, was a passenger in a motor vehicle. 6. At the aforementioned time, Campbell Yates, was injured when the vehicle in which she was a passenger in, was rear-ended by a third party's vehicle. (See Police Accident Report attached as Exhibit "A"). 7. As a direct and proximate result of the accident, Campbell Yates, sustained injuries including; a headache and neck pain. (See Carlisle Regional Medical Records attached as Exhibit "B" and Carlisle Pediatric Associates Medical Records attached as Exhibit "C") . 8. Campbell Yates had an office visit with a pediatrician for her neck pain, and it was noted that her neck pain did not inhibit her activities and no treatment was given. (See Carlisle Pediatric Associates Medical Records attached as Exhibit "C" 9. Campbell Yates has not had any other medical problems related to the accident, and her neck pain has since resolved. 10. Campbell Yates' related medical bills totaled $527.44. 11. There are no outstanding liens and medical bills in this case. 12. A compromise has been reached with the third party's insurance company regarding Campbell Yates' claim for her injuries sustained in the motor vehicle accident whereby the insurance company will pay Campbell Yates $800.00. 13. Petitioner, Heather Yates, is satisfied that the offer of settlement is just and reasonable and is willing to accept said offer if it is approved by the Court. (See Verification attached as Exhibit "D"). 14. In pursuing this claim against the third party driver, Petitioner, Heather Yates, engaged the law firm of SCHMIDT KRAMER PC, under a thirty percent (30%) Contingency Fee Agreement. (See Contingency Fee Agreement attached as Exhibit "E"). The firm has reduced the fee to 20%. 15. SCHMIDT KRAMER PC has incurred costs in the amount of Fifty-Three Dollars and 66/ 100 ($53.66) to date, relative to obtaining copies of medical records and costs associated in investigation of this matter. (See Cost Printout attached as Exhibit "F"). 16. There is no outstanding order of child support owed by Campbell Yates. (See documentation attached as Exhibit "G"). 17. The Petitioner requests that the Court distribute the present payment of Eight Hundred Dollars ($800.00) as follows: SCHMIDT KRAMER PC Attorneys' Fees (20% of $800.00) $160.00 SCHMIDT KRAMER PC Attorney Costs $53.66 The remainder to be deposited in the account(s) set forth below on behalf of Campbell Yates, a minor To be deposited in a Savings Account(s), Certificate(s) of Deposit, marked as follows: "Heather Yates, as Guardian of Campbell Yates, a minor" $586.34 Total Settlement Amount $800.00 18. The Petitioner requests that the restricted accounts be authorized without formal appointment of a Guardian of the estate of the minor, Campbell Yates, or entry of security, with Petitioner, Heather Yates, being authorized and directed to invest these funds belonging to Campbell Yates as follows: To invest the funds in one or more accounts in one or more savings institutions insured by a federal government agency, such accounts not exceeding the amount to which accounts are insured and in accordance with Pa. R.C.P. 2039(b)(2). Each account shall be marked as follows: "This money shall be held in trust, not to be redeemed, withdrawn, negotiated, or in anyway alienated, except for renewal of its entirety before September 16, 2019, except by Order of this Court." 19. If this Court sees fit to approve the proposed settlement, Petitioner, Heather Yates, requests that she be authorized to execute the Release attached hereto and marked as Exhibit "H." WHEREFORE, Petitioner, HEATHER YATES, requests this Honorable Court enter an Order approving the foregoing proposed settlement, directing the distributions of proceeds set forth herein, and authorizing Petitioner, HEATHER YATES, to execute the attached Release. I, GERARD C. KRAMER, am the attorney for the Petitioner, Heather Yates, in the above-captioned matter. I have prepared the above document for filing in this matter. I certify that I have read the document, that there are good grounds to support the negotiated settlement offer, and that this Petition is submitted in good faith. Respectfully Submitted, SCHMIDT KRAMER PC By erard C. Kramer Attorney at Law Attorney I.D. No. 44715 209 State Street Harrisburg, PA 17101 (717) 232-6300 Attorney for Petitioner J COMMONWEALTH OF PENNSYLVANIA ?? POLICE CRASH REPORTING FORM M Case Closed Reportable Cr O Page{{ AA 500 1 40 Yes Q No 4W Yes O No 1 IIII?III?VINIgIINI Crash Number P0700852 Incident Number Police Agency Patrol Zone I, ly i2 fi ev (C C? 1'r 0 /f 0 f? Agency flame Precinct investigation Date (MM-DD-YYYY) . I- a o o 16 4 ?? rrs?u,?? Dispatch Time (mil) Arrival Time (miQ Investigator Bade Number Reviewer Bad g# Number Approval Date (MM-DD-YYYY) Coun County Name Municipal' Municipap8 Name ?.?. p '2 10 Day of Week Q Sun Q Thu nI/?-oA)Lr / ?!• ?6Ja/?? v C Crash Date (MM-DD•YYYY) Crash Time (mil) No of Units People Injured Killed` *If > 00 lete 0 Mon a Fri Q Tue Q Sat comp a q - oil- LP 1 O Q lip a a a Form F Q Wed Q Unk (ff Yes, Complete School Bus School Zone Notify PENNOOT 0 Yes 49 No 0 Yes No 0 Yes W No Worktone 0 Yes No Maintenance Related Related Farm M, Sect:on 29) Intersection Tvae 0 4 Way Intersection Q "Y' Intersection 0 Multi-Leg 0 Off Ramp Q Railroad Crossing •sttedal Intersection LQSation O Midblock 0 "T" Intersection 0 Traffic Circle/ 0 On Ramp Q Crossover Q Other Round About • See Overla Route Number Segment (Optional) Travel Lanes Speed Limit O North House Number (if applicable) 0 0 Va ? elJ ?'. South ° c Street Name Street Ending 3 0 East For Mid-block crashes only. Use q C 41 Q West postal House Number and make sure _G e Lo 14, 4- r L TTI l D CD Unknown fill in Roadway Sweet Name is filled ed in if using this option d Route Interstate Turnpike Turnpike State County Local Road Private Other/ 5igniag 0 (Not Turnpike) 0 (East/West) 0 Spur Highway 0 Road 0 or Street 0 Road Q Unknown Route Number Segment (Optional) Travel Lanes S'ppeeed' Urnit (:D North 1f? v7 o O South m ? Street Name Street Ending e Q East C:) West m O O Unknown ;: ,? Route Interstate Turnpike Turnpike State County Local Road Private Other/ Si ni 0 Q 0 0 Q Q Q 0 5 g or Street Road Unknown Road Highway Spur (East/West) (Not Turnpike) ¢ Intersectin Rt Num Or Mile Post Or Se ment Marker h 0 Feet Nort N Q South E 4 -b Please Enter - 8 Or Intersecting Street Name St Ending = E J 1 t E= CD East OWest Or Miles ? E b Information 0tH f a m . ? o w or 8 o Landmarks if Usin ? This Option Intersecting Rt Num Or Mile Post Or Segment Marker n c J d Q North Distance From Crash Scene to Landmark 1 0 South c Or intersecting Street Name St Ending 0 East (for Crash between Landmark I and a ED A O west Landmark 2) D fees Minutes Seconds Degrees Minutes Seconds 1 cf- { FiW longitude: - (EZ ®,? Q Latitude: a Q : ? v Traffic Contra! De0Yield Sign 0 Police Officeror Flagman ® Not Applicable CD Traffic Signal 0 Active RR Crossing 0 Other Type TCD ZCQ-C Device Functioning Emergency ® No Controls Improperly 0 5 9 alptive +' 0 Flashing Traffic (] Stop Sign Passive RR O Unknown Signal Device Not Device Functioning 0 Functioning 0 Properly O Unknown Crossing Controls ( (if 'Not Applicable-, skip rest of the Lane Closure section) UgSW O North Q East Q North and South Q All Lane Closure _ Not Applicable 0 Partially 0 Fully Q Unknown QbWC?W Q South Q West Q East and West (N.S,E,W) m C Traffic Yes 0 No 0< 30 Min. Q 30-60 Min. Q 1-3 hrs Q 3-6 hrs 0 6-9 hrs Q> 9 hours Q Unknown Unknown Q FORM w WSW (12102) PENNDOT COPY PENNSYLVA J POLLI E CRA H ? PORTI G FORM NaA trash Number AA ww 500 2 Polio se OnH Page:? P0700852 ? Motor Vehicle in ort 0 Hit & Run Vehicle Q Illegally Parked Q Legally Parked QNon -Motorized 49 Trans ?mmerdal vehicle p Due Unit Pedestrian on Skates, Disabled From h Q Train Q Phantom Vehicle U Pedestrian Q i C Q P ist Yes No `J rev ous ras in Wheelchair. etc (if Yes, Complete 'oiri C) (if 'Pedestrian' or 'Pedestrian on Skates, in Wheelchair, etc", Com lete Form M, Section 28) Unit No First Name MI Date of Birth (MM-DD-YYYY) Delete? Last Name Telephone Number o D LAIC, Address t Ci i State Zi I Gass a te t Driver License Number s -aa st ta at ? v.Z c 1 0? ?o U LLJ = - Ale:ohoi/Druas suspected Driver or Pedestrian Physical Condition Ille l D tl A illegal Drugs Medication No Q Q y ga pparen rug Fatigue Medication 0 Normal Q Use Q 0 a. O Alcohol Q Alcohol and Drugs 0 Unknown Had Been o Sick Q Asleep Q Unknown 0 Drinkin 4 y Alcohol Test Type Primary Vehicle Code Violation Charged? p` W Test Not Given Q Breath 0 Other 0 Yes Q No e -a r Unknown if Blood Q Urine Q Test Given y Unknown Alcohol Test Results Q Test Refused Q Results T Gi Driver Presence 1=Driver Operated 3=Driver Fled Scene Vehicle 4=Hit and Run J est ven, a Q lt i t d R _ . i 9 k U 2 " e esu s Contam na n nown = =No Dr ver OwnerlDriver 00=Not Applicable 02=Private Vehicle Not 04=State Police Vehicle 07=Municipal Police Veh 09=Federal Gov Veh 01=Private Vehicle Owned/ Owned/Leased by Driver 05=PENNOOT Vehicle 08=Other Municipal 98=Other Leased by Driver 03=Rented Vehicle 06=Other State Gov Veh Government Vehicle 99=Unknown Owner Last Name or Business Name (If Pedestrian, skip this Section) Owner First Name De same as Driver Q b °1f t` LA P ? Address / City / State / Zip Vehicle Make 'Make Code /w7 c ? 3 VIN Model Year Vehicle Model (see overlay) I 3 a 5? 3 v 7 0! g G?cc i c? License Plate Reg. State Est. Speed Vehicle Towed Towed By Y O 3 O Yes Q No Insurance Insurance Company Policy No Yes 0 No Q Un- known `` LC _71 Trailing T 1=Towing Pass. Veh 4=Mobile/Modular Home 7=Semi-Trailer Tag No Tag Year Tag St er 8=Other Truck 5=Cam Unit No To in 2 a = p w g , ? u ? Tradin ing ll Tr 9=Unknown tili il r 6 F il T T i Y a er e = u ow ng U ty ra Units: 3= Direction of 'Vehicle Position e"- o a 'Movement 'See 0 O erla Special Usage 7 rav y v Vehicle Color Vehicle Tvpe 05=large Truck 20=Unicycle, Bicyde, Q Q 12=Commercial Passenger ,-?-, 06=Yeltow F o 31 07=Silver W"'? ,-?-, 01=Automobile 06=SUV Tricycle I a 102=Motor le 07=Van 21=Other Pedalcycle & B H 2 00=Not Applicable Carrier 01=Fire Veh 13=Taxi 08 =Gold 01=8lue 09=Brown 2= orse uggy 03=Bu3 10=Snowmobile 04=Small Truck 11=Farm Equip 23=Horse & Rider 02=Ambulance 21-Tractor Trailer 03=Police 22=Twin Trailer 02=Red 10=0range 1 l (if "02", Complete Form 12=Construction Equip 24-Train 13=ATV 25=Trolle 08=Other Emergency 23=Triple Trailer 03=White 1 =Purp e y M, Section 26) Vehicle 31=Modified Veh 04=Green 12=Other wn k 99=Unkn 05 81 18=Other Type Spec Veh 98=Other or "21 Complete 19=Unk (if `20" Type Spec Veh 99=Unknown 1 1=Pupil Transport 99=Unknown = ac o . Section n 27j form M, init/at Impact Point Damage Indicator Gradient 3=Downhill Road Alignment 1Z 00=Non-Cotlision 14=Undercarriage P T d U i ? O=None 2=Functional 1=Minor 3=Disabling 1=Level 4=Bottom of Hill S=Top of Hitl 1-Straight 2=Curved 10 oints 15= owe n t 01-12=Clock 9=Unknown 2=Uphill 9=Unknown 9=Unknown 13=Top 99=Unknown FORM r M-sW (rte) PENNDOT COPY COMMONWEALTH OF PENNSYLVANIA J POLICE CRASH REPORTING FORM Page: AA 500 2 PoUce A o^??.? Zj% 1 I 1 1111111111111111 Crash Number P0700852 Motor Vehicle in r,.pe ® Transport Q Hit & Run Vehicle Illegally Parked Q Legally Parked CD Non -Motorized Commercial Vehlde tLnrt Pedestrian on Skates, Disabled From Q Train Q Phantom Vehicle 0 Pedestrian Q Q Q Yes No = P„t ?us Crash in Wheelchair, etc (if Yes, Complete Form C) (if *Pedestrian" or 'Pedestrian on Skates, in Wheelchair, etc', Com fete Form M, Section 28) Unit No First Name MI Date of Birth (MM-DD-YYYY) o, 4 1117 Ft-1 Last Name Telephone Number Delete? O Y6 ?r ,7)486- 41e, Address / City / State Zi . 3 a s Driver License Number State Cla s ,2 O ( Ga 0 4 (? J m A(whol/Druas Suspected Driver or Pedestrian Physical Condition a No Q Illegal Drugs 0 Medication Apparently Q Iilllle al Drug Q Fatigue Q Medication Normal e. Q Alcohol Q Alcohol and Drugs 0 Unknown Had Been Sick Q Asleep 0 Unknown 0 Drinking p Alcohol Test Type Test Not Given Q Breath Q Other Primary Vehicle Code Violation Charged? e O Unknown if Blood Q Urine Test Given 0 Yes ® No y Alcohol Test Results Q Test Refused 0 Result wn T st Given Driver Presence 1=Driver Operated 3=Driver fled Scene n Vehicle 4=Hit and Run I Q , e ?v Contaminated Results W 2=No Driver 9=Unknown ••?•L? Owner/Driver 00=Not Applicable 02=Private Vehicle Not 04=State Police Vehicle 07=Municipal Police Veh 09=Federal Gov Veh 01 =Private Vehicle Owned/ Owned/Leased by Driver 05=PENNDOT Vehicle 08=Other Municipal 98=Other m (p Leased by Driver 03=Rented Vehicle 06=Other State Gov Veh Government Vehicle 99=Unknown Same as Owner First Name Owner Last Name or Business Name (ff Pedestrian, skip this Section) Driver Q wn I r l+? 1' P?? O C7 Jv E ft L 5 IC C ' ( 1 Vehicle Make 'Make Code Address / City / State / Zip .;? I _F ohs 7 mar/ T 0 110 VIN Model Year Vehicle Model (see overlay) R 161 csa ,?V;23 qq 171 1 License Plate Reg. State Est. Speed Vehicle Towed Towed B p Yes Q No P Ft 4 S " L oc I P1,41 lo I Insurance Insurance Company Policy No Y No 0 Un- known 1 -3 l/- A LF? ?.aJ W 1=Towing Pass. Veh 4=Mobile/Modular Home 7=Semi-Trailer Tag No Tag Year Tag It TraiJin _ T e Un/t No. i!Df ng V-ri ? 2=Towing TrucS=Camper 8=0ther Trailing 9=Unknown ll T il 6 F il T T i U ili ng er = ra er ra u ow t ty Units3= : ? Direction of a 'Vehicle Position 'Movement T - 5 ? ? ? 2 'See l O Special Usage rav ? c ay ver Y Vehicle Color Vehicle Type 05=Large Truck 20=Unicycle, Bicycle, Q 12=Commercial C?J Passenger 06=Yellow 07=Si(ver 01=Automobile 06=SUV Tricycle 02=Motorc cle 07=Van 21 =Other Pedalcycle Q Y 00=Not Applicable Carrier 01=Fire Veh 13=Taxi 08=Gold 03=Bus 10=Snowmobile 22=Horse & Buggy 02=Ambulance 21=Tractor Trailer 01=Blue 09=brown 04=Small Truck 11=Farm Equip 23 Horse & Rider 03=Police 22=Twin Trailer 02=Red 10=Orange 03=White 11 =Purple (If "02', Complete Form 12=Construction Equip 24=Train Section 26) 13=ATV 25=Trolley M 08=Other Emergency 23=Triple Trailer 04=Green 12=Other , (lf "20" or "21 ; Complete 18=Other Type Spec Veh 98=Other Vehicle 31=Modified Veh 11 =Pupil Transport 99=Unknown 05=81ack 99=Unknown Form A Section 27) 19=Unk. Type Spec Veh 99=Unknown Jnitla! impact Point Damage Indicator Gradient 3=Downhill Road Alignment 00=Non-Collision 14=Undercarriage i ! O=None 2=Functional a 1=Minor 3=Disabling 1=Level 4=Bottom of Hill a 5=Top of Hill 1=Straight © 2=Curved t a 01-12=Clock Points 15=Towed Un U 13=Top 99=Unknown 9=Unknown 2=Uphill 9=Unknown 9=Unknown FORM 0 WSW (12/02) PENNDOT COPY ?• OLfCEC RASH REPORTING FORNiANIA 11111111111111111 P? p 0700852 AA5003 Crash Number A it-' oriw?.. - D 2=Passenger 7-Pedestrian 8_ _Other 9=Unknown B F =Female M=Male U =Unknown Injury Seventy: C 0=Not Injured I =Killed 2=Major Injury 3=Moderate 4--Minor or injury 8=Injury, Unk Severity 9=Unknown if Injury 01=Driver - Ali Vehicles 02=Front Seat (`riddle Position 03=Front Seat Right Side 04=Second Row - Left Side Or Motorcycle Passenger 05=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=13us Passenger 98=Other 99=Unknown 01=5houlder Belt Used 02=Lap Belt used 03=Lap And Shoulder Belt Used 04=Child Safety Seat Used 05=Motorcycle Helmet Used 06=Bicycle Helmet Used 10=Safety Belt Used Improperly 11=Child Safety Seat Used Improperly 12=Helmet Used Improperly 90=11estraint Used, Type Unknown 99=Unknown Eaut Two: Safety 00=NoneUsed/iamen Not Applicable 01=Front Air Bag Deployed (For This Seat) 02=Side Air Bag Deployed (For This Seat) 03=Other Type Air Ba Deployed 04=Multiple Air Bags Deployed 05=Motorcycle Eye Protection 06=Bicyclist Wearing Elbow/Knee/Pads 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 G.7 T=-Not Applicable 1=Not Ejected 2=Tota!! E' 14 3=Partially Ejected 9=Unknown H Ejection Path: O=Not Ejected / Not Applicable 1=Through Side Door Opening 2=Through Side Window 3=Through Windshield 4=Through Back Door 5=Through Back Door Tailgate Opening 6=Through Roof Opening (Sunroof/ Convertible Top Down) 7=Through Roof Opening (Convertible Top Up) 9=Unknown Extrication: O=Not Applicable 1=Not Extricated 2=Extricated By Mechanical Means 3=Freed By Non - Mechanical Means 8=Other 9=Unknown EMS AgencyW???? Medical Facility: Unit No Person No Delete? Date of Birth (MM-DD-YYYY) A B C D E F G H I c?a-ate - t ?? o©am o3 oaaoo as I Name / Address / Phone EMS Transport Same Operator Q Yes O No Unit No Person No Date of Birth (MM-DD-YYYY) A B C D E F G H I b ?-? -?--? Delete? MET b? b 3 D O[D WO a I Name / (Address / PhCQ -I in as EMS Transport Same Operatto or • Yes Q No Unit No Person No Delete? Date of Birth (MM-DD-YYYY) A b t- u It r U n i o 11 aaa? ?>4 60 oon Name / Address I Phone EMS Transport Same as /J__? / ,0 ly 0 Yes tD No _11 6W Operator c . s?'? Unit No Person No m Delete? Date of Birth (MM-DD-YYYY) A 8 C D E F G H I 0 ?_???m?m??0 Name / Address / Phone EMS Transport o Same as erator o Q Yes Q No p Unit No Person No m m Delete? Date of Birth (MM-DD-YYYY) A B C D E F G H I CD m-? 11:1D 0I-10 Name / Address / Phone EMS Transport E:i Same as Operator Q Yes Q No Unit No Person No Date of Birth (MM-DD-YYYY) A B C D E F G H I Delete? F1 -1 n -1 n Name / Address / Phone EMS Transport Same as I O Yes Q No Operator FORM 0 M-500 (17102) PENNDOT COPY J COMMONWEALTH OF PENNSYLVANIA POLICE CRASH REPORTING FORM Page AA 500 4 rake 0i'1 1111111111111111 00700852 Crash Number Crash Description O=Non-C,oitision 2=Head On 4=Angle 6=Sideswipe B=Hit Pedestrian 1=Rear End 3=Rear to Rear 5= ideswi?e (Opposite Direction) `o (Backing) Same Direction) 7=Hit Fused Object 9=0ther/Unknown € Relation to Roadway n 1=0n Travel Lanes 3=Median 5=Outside Trafficway 7=Gore (Ramp Intersection) o s w 2=Shoulder 4=Roadside 6=1n Parking Lane 9=Unknown c r Illumination 1=Dayfight 3=Dark - Street 5=Dawn B=Other 2=Dark • No Lights 6=Dark -Unknown Street hts 4=Dusk Roadwa Li htin Weather Conditions 0] 1=No Adverse 3=Sleet 5=fog 7=Sleet & Fog 9=Unknown Conditions (Hail) g 2=Rain 4=Snow 6=Rain & Fog 8-Other Road Surface Conditions O=Dry 2=$4nd, Mud, Dirt, 4=Slush 6=Ice Patches 8=other it 7=W t r - Standing I 5 ® 1=Wet = ce oroving 3=Snow Covered Harm Event L/R Most? Utility Pole Num r Harmful Events (Harm Event) 30=Hit Fence Or Wall 1 d ? 01= Hit Unit 1 31 =Hit Building it 2 32=Hit Culvert Hit U 02 unit No n = 03=Hit Unit 3 33=Hit Bridge Pier Or Abutment 0 2 04=Hit Unit 4 34=Hit Parapet End 05=Hit Unit 5 35=Hit Bride Rail L??-J 06=Hit Other Traffic Unit 36=Hit Boulder Or Obstacle Please Put Events in 3 I 1 1 0 07=Hit Deer On Roadway 08=Hit Other Animal 37=Hit Impact Attenuator Sequential L?-J L?J 09=Collision With Other Non 38=Hit Fire Hydrant Fixed Object 39=Hit Roadway Equipment c Order 4 m El o 1 2 Struck By Unit 1 41=Hit Trafficcs land i 1 k B 2 S 2 truc y Un = t E 13 Struck By Unit 3 42=Hit Snow Bank Construction Hit Tem orar 43 o ent C/R Most? Utility Pole Number Harm E p y = 14=Struck By Unit 4 15=Struck By Unit 5 Barrier 4.1 v ( 1 16=Struck By Other Traffic Unit 49=Hit Other Fixed Object 49=Hit Unknown Fixed Object Hit Tr O Sh bb 21 d L _1?4J Unlt No ru ery = ee r ll O R ver o 22=Hit Embankment 50=OverturN ?a 2 m 0 23=Hit Utility Pole 51=Struck By Thrown Or Falling n object 24=Hit Traffic Si g r t H l Oth 52 P O o o r e = es 25=Hit Guard Rail Please Put Events in 26=Hit Guard Rail End Pavement Irregularities 27=Hit Curb 53=jacknife h Sequential iC 28=Hit Concrete Or 54=Fire In Ve -Collision Longitudinal Barrier 58=Other Non 4 O Qrder u 29=Hit Ditch 99=Unknown Harmful Event First Unit No Harm Event Most Unit No Harm Event Driver Action (D) 17=Careless Or illegal armful vent in Even iZ antin rn ? ? Q a O 00=No Contributing Action Backing Roadway 01=Driver Was Distracted 18=0nving On n The Wrong I I 1 1 0 e rash rash 02=Drivi1 g Using Hand Held Phone Side Of Road Do not repeat this iniormaton on nuftoe pages 03=Driving Using Hands Free Phone 19=Making improper n t T h E Hi ra way n ce o g 04=Making Illegal U-Turn Environmental / Roadway 1 2 m 3 m Q d FIR 05-Improper/Careless Turning 20=Making improper Exit From Wrong Lane From Highwa 06=Turnin } Potential Factors ( g y l O 21 ki di W P k /U 00=None t t_Sli Road Conditions (Ice/Snow) ppery ng =Care ar npar ng 07=Procee / ess ing Clearance After Slop 22=Over/Under 01 =Windy Conditions 12=Substance On Roadway 02=Sudden Weather Conditions 13=Potholes 08=Running Red Stop Sign Compensation At Curve 09=Running Light 23=5peeding 03=Other Weather Conditions 14=Broken Or Cracked Pavement d 10=Failure To Respond To 24=Driving Too Fast for Conditions 04=Deer In Roadway 15=TCD Obstructe Other Traffic Control Device 25=failure To Maintain Proper Speed 05=Obstacle On Roadway 16=Soft Shoulder Or Shoulder Drop Off R F h d 11=Tailgatingg 25=Driver Fleeing Police (Pol Chase) Sl i i 1 dd t S oa actor er way 06=Other Animal in Roadway 28=Ot 07=Glare 29=Other Environmental Factor en ow n opp 2= u ng 27=priver Inexperienced 13=11legally 5toppe On Road 28=Failure To Use Specialized Equip e 08=Work Zone Related 99=Unknown 14=Careless Passing Or Lane 92=Affected By Physical Condition Change Possible Vehicle Failures (V) 1Z=Wipers 96=Other Improper Driving Actions 15=Passing In No Passing Zone 9k3 Unknown 00=None 06=Exhaust 13=Driver Seating/Control 16=Driving The Wrong Way On .? 01=Tires 07=Headlights 14=Body, Doors, Hood, Etc i-Way Street c 02=Brake System 08=Signal Lights 15=Trailer Hitch 03=Steering System 09:Other Lights 16=Wheels Unit m No ? 1 2 3 4 m rn 17=Airbags H 10 L ?J = o 04=Suspension 05=Power Train 11?Mirrors 18=Trailer Overloaded C C ? 19=U Shifted Unit ?`{ 1 Z I I I Trailer ailer Load No I I I 20=Improper Towing unit No rZ 1 r? 2 3 4 m m m 21 =Obstructed Windshield 49=Unknown Unit 1 ? V 2 m No Pedestrian Action iP? 03=Working 00=None 04=Pushing Vehicle 05=Approachin Or Leavin Vehicle g g 01 =Entering Or Crossing At Specified Location 06=Working On Vehicle Indicated Prime Factor Unit No Factor Code -- 02=Walking, Running, Jogging, 07=Standing 98=Other i 1 Da not repeat tl.s miormatia on ?T muftipkpages. I of I I Or Playing 99=Unknown E/ R V O P F i if E h P i Unit No Unit No Q Q Q me actor /R s t e r 0 0 ® 0 Type, leave Unit No blank FORM • AA-500 (12M) PENNDOT COPY COMM NWEALTH PENNSYLV J , OLI EOCRASH REP RTING FORMANIA Page crash Number AA 500 5 Police O/ lL I..O P 0 7 0 0 V 5 2 ........... ........... ........... ..................... ........... ........ ..... .... ..... ..... ..... ..... ..... ..... ..... ... ...:. t 2 Narrative and additional witnesses: Accident Investigation Notification Issued? 0 Property Damage O r-Physical evidence observed at the scene consisted of the following: 1) skid marks in the and 4) moderate damage to the front of unit #1. Y Prior to this crash unit was traveling soutFi on 4-beliin unit 42. This crash z turn -from-SR V Rd. at which time the front of unit #1 struck-the rear of t #2_ Unit #2 then Tua -_ Z= counterclockwise 180 degrees while traveling across the north bound lane of SR0034. Unit S #2 continued to rave o o the roadway where it came to rest approximately 30 feet east of $ 20-south FUppe Bermudian d. ' t south bound lane Roth unite riu ere-in their ffinaal nsting positions-upon my arrival. tt=i at tite bucix va vy/L,+/u4 at 1 /'1J. vperator Fi sialea ne was wh ft-tum signal and began to slow down. Operator #1 related he "Jammed" on the brakes but was unable, avoid a collision. Operator #1 had no further information. was travelin south on SR0034 when she slowed down t to er Bermudian d_ Operator #2 related at that time her vehicle was struck from behind. Operator #2 had no FORM 0 AA-500 (tZW) PENNDOT COPY ' C011 MOR'1WEALTH OF PERINSYLVAi1 A Crash Number POLICE CRASH REPORTING FORM Page ® New?? POLOCE COd6?SH REPORTING FORM Page ® New AA 500 N raK u? 15?aX3CACo CCoonbnn ation O 17-12 O c7 Raaative and additional witnesses: -- - -§P 1-00 15 completed for each operator. News release completed. Operator #1 cited for ingtobit' se y. • a x t a z s w w 7 22 FOR-Mr AA40 =<< PENHOOT COPY C-'7D 1'- . ADMISSION RECORD \I-A jr- I W V- AI Ef)ICAL CENTER ACCOUNT NO. MEDICAL RECORDS NO. 246 Parker St. Carlisle, PA 17013 Ph:717-249-1212 9292843 0001003347 ADMIT DATE /TIME ROOM 0 . PT FC AGE DATE OF BIRTH SEX RA MS LOCATION PROGRAM F 09/24/2004 18:15 0000 E1 P 3 09/16/2001 F 1 S NS A T PATIENT NAME & ADDRESS SS NUMBER y PATIENT EMPLOYER - , "' 1111 EMPLOYER PHONE NO. YHl r+s , CAMPBELL L+ 111- 11' 1111 iP El• 1JV ED 4051 CARLISLE RD E COUNTY N GARDNERS PA 1-7324 PHONE NUMBER (717)486-4616 CUMBERLAND T US RESPONSIBLE ARTY & ADDRESS YATES, HEATHER M NUMBER RESPONSI L A M L Y PA DEPT OF CORECTIONS EMPLOYER PHONE 4051 CARLISLE RD 194-58-8238 75 UTLEY DR (717)731-7132 U CAMP HILL PA 17 011 A GARDNERS PA 17324 PHONE NUMBER RELATIONSHIP TO PATIENT R (717)486-4616 MOTHER RESPO US EMERGENCY CONTACT NAME EMERGENCY CONTACT PHONE EMERGENCY CONTACT RELATIONSHIP TO PATIENT HEWITT, IRENE & DORSEY (717)486-3870 NEIGHBOR COMMENTS MSP M SO. KEY PRIVACY NPP ADMIT. BY ?Y ®N ?Y NJ EDW PRIVACY 1 PAYER ..LAN POLICY NUMMA DATE OF BIRTH 00/00/0000 00 I INSURANCE CO. NAME & ADDRESS INSURED'S NAME GROUP NUMBER GROUP NAME N AUTHORIZATION S PAVER. 2 PCAN POLI Y NUMBER' DATE OF BIRTH 00/0o/oooa' 000 u INSURAN E C .NAME ADDRESS INSURED'S NAM R GROUP NUMBER GROUP NAME A AUTHORIZATION N 3 PAYER PLAN POLICY NUMBER DATEOF BIRTH INSURAN O. NAME ADD INSURED NAM C \ GROUP NUMBER GROUP NAME E AUTHORIZATION DR. ATTENDING /ADMITTING OR / PRIMARY CARE FAMILY M CLOONAN, CLIFFORD C HOFFMAN, HOLLY C. H. S DIAGNOSIS SIGNS SYMPTOMS J ACCIDENT AjDENT A C MVA--MINOR INJURY / L NO FAULT [ 09/24/2004 PRINCIPAL DIAGNOSIS IThe condmon established after study TO be chiefly resp nsible for DISCHARGE OA /TIME occasioning the admission of the patient to the HOSPITAL for care). COMPLICATIONS COMORBIDITYIIESI PRINCIPAL PROCEDURE A0001A 9292843 00010033147 111111111111111111f11111111111111111111 1iiI1111rr111f11111111I111111111111111111111 MEDICAL RECORDS COPY 111111111111111111111111111111111111111111111111111111111 Carlisle Regional Medical Center nnatnlrtinnc• rirrlp nncifivp - harkslaeh npaative -nrovide additional pertinent information_l NAME: YATES, CAMPBELL L Pt#: 9292843 DATE OF SERVICE: 9/24/04 DOB: 9/16/01 Age: 3 Yrs 0 Mos 0 Wks MR#: 0001003347 Pres Time: 18:15 Sex: F Wt: 13.6 KG Ht: Triage Time: 18:15 Chief Complaint: MVA--MINOR INJURY T: 97.6 R Medicines: NONE P:120 Regular R:20 Unlabored Allergies: NKA BP: 000/000 Sa02-. % Normal / Hypoxia EDP: CLOONAN, CLIFFORD PCP: HOFFMAN, HOLLY C. H. Arrival Mode: BLS Pain Scale: 0 HISTORY OF PRESENT ILLNESS Exam Time: H. by. Patient Family EMS NH Translator Limited by: ALOC Intoxication Severity Unreliable C / C / HPI: (Narrative): C-collar PTA Y / N Ell Medical Screen: Emergent Non-Emergent0 7 7 tj - Timing: Sx started s ddenly / gr ly min/ rs. ays I wks. ag . alinuous intermittent Duration: Sx last m''A?ys / wks. at a time present / absent Location of Injury: head face neck the ck abd upper ext R / L lower ext R / L= 4,"a^.A -J, Quality: cannot describe fall / height ft MVA crush injury punched kicked GSW stab wound Severity: derate severe -10 scale life threatening CIL?tz-:Y \?^ ?.t '07_Lh Context: ciden assaulted MVA held abuse found unresponsive 1 ' Exacerba by: nothing movement palpation Relieved by: nothing rest ice OTC meds %Assoc. Signs & Symptoms: none LOC C.P. o inal pain bleeding deformities REVIEW OF SYSTEMS Ltmited Due To: ALOC Intoxication 4SeveUnreliable Constitutional: fever chills weakness diaphoresis Newologi H seizures weakness confusion ENT: sore throat ear pain facial pain Psychologica : anxious depressed Eyes: pain visual changes Endocrine: polyuria polydipsia Cardiovascular: C. P. palpitations DOE PND Integument: rashes pruritis lesions Respiratory: S.O.B. cough congestion Hematologic: anemia bleeding disorders transfusion GI: N / V diarrhea / constipation pain melena hematemesis Altergyllmm.: frequent infections allergies hives GU: Flank pain dysuria hematuria frequency Other: Musculoskeletal: joint eck / back pain ext. pain All Other Systems Reviewed And Are Negative [] Agree With Nursing Assessment • •- Med. Hx: none IDDM / NIDDM asthma evlewed Past Med. Hx: DENIES Meds. NONE eviewed Allergies: NKA Reviewed Surg. Hx: none APPy Tonsillectomy Family Hx: negative R I L Handed Lives Alone: Y / N Social Hx: day care student occupation: Tobacco: Y / N Packs/Day ! Years ETON: Y / N Drinks/Wk. Drugs: Y IN Immunizations: Up-to-date: Y / N Tetanus: Reproductive Hx: Lli G P AB Pro-MED Maximus Pediatric - Trauma - Page 1 of 2 DCopYngm 2001 Pro-MED Clinical SyStems. L. L.C Rev. 03105/04 rarlicln Roninnnl Madiral Cpntpr n....,.,, +i-. • , .ria n-itivc - hnrkcIneh nanativo nrnvirle nridiiinnal nertinent information-) NAME: YATES, CAMPBELL L Pt#: 9292843 PHYSICAL EXAM MR#: 0001003347 GENERAL: mild !moderate /severe distress VITAL SIGNS:. T 97,6 P120 R 20 BP 000/000 C J AT RR _ OMI HEENT. ^ C V: KICK PMi NL rnurrnurs i6 sys i dys rubs clicks gallops S3/34 Location/Description of Symptoms: r ?. RESP: lungs clear/ equal bilateral es=effort distress rates rhonchi wheezes r+ IL „„-?/ GI: soft fla / di nded bowel sounds NL / ABN tender / n-tender guarding rebound rigidity - MS: OM NL clubbing cyanosis edema SKIN: arm - d diaphoretic rashes I y i{ i NEURO: 2-12 inta t DTRs s mmetric - J I ` PSYCH X3 a =1appropriate for age '+ I ti i I• ? LYMPH: adenopathy GU: NL / deferred Other: ll MEDICAL DECISION MAKING .. ` LABS! AND'STUDIES Et ? Labs reviewed and are negative X-Ray: C-spine: MEDS: CXR: IVF: NL / ABN NL I ABN pelvic DIFF FOLEY: S C.T.: head / abd / pelvis e EKG: NSR no acute disease NG: L UA: SG Prot RBCs WBCs Pulse Ox: % NL / hypoxia RE-EVAL: Time: UCG: +I- Other: ABG: pH 02 C02 Improved Same Worse DOX: concussion cervical strain Fx laceration hematoma skull Fx Critical Care: 30.74 / 75-90 / 91-104 / 105-120 pneumothorax shock spleen injury contusion child abuse other: 121-134 / 135-164 Minutes ? Excl. billable proc. CLINICAL • DISCHARGE INSTRUCTIONS Discharged to: Home Nursing Home Family 2 Follow-up with Patient's Dr. in days. 3. Other Instructions: 4. 5. - - CONSULTATION DISPOSITION Discussed with Dr. Discharge Time Out: Admit Admit: OBS ICU PCU Floor Tele. OR Prescriptions Given: Follow-up in Office Transfer: Old Records Reviewed Y / N AMA: Reviewed D/W Radiologist Y / N DOA: Case D/W Patient / Family Y / N Condition: Improved Stable Deceased RETURN TO ER IF CONDITION WORSENS. Signatures Pro-MED Maximus CCOp-ght 200, -10-MED CbNwi Svscems. L L C See procedure form attached ? PAIARNP Record Complete ? Pediatric - Trauma - Page 2 of 2 Rev OJI05IN ORDER. PROCEDURE FORM Carlisle Regional Medical Center ORTHOPEDIC EMERGENCIES Name:YATES, CAMPBELL L Pt#:9292843 Age: 3YRS DOB: 09/16/2001 Sex: F MR#:0001003347 Date In: 9/24/04 Time: EDP: CLOONAN, CLIFFORD PCP: HOFFMAN, HOLLY C. H. Laboratory Jests Otherbliigno'sti6 Test Order Time C8C rder Sew B rder Tim Radiology CXR PA/LAT - Portable Order Sent By DIVIP CMP Sed Rate C-Spine (X-table) (Complete) Uric Acid RA Factor Drug screen (serum), (urine) ETCH Type & Screen or Cross # Units Cardiopulmonary EKG UA ABG Beta HCG 02 LPM Misc. Orders Medical Necessity Information: Previous Medical Records Physical Therapy • Eval & Tx Weight: Ibs: 30 kgs: 13.6 `Allergies:'NKA ' Order Time Medication / Dosage / Route VO Read Back Aden tim Adm. by Site. Time Reassessment - Pain Initials ?'ti V S ? ? Improved Worse ? ? Unchanged l? ?^ ? ? Improved ? Worse ? Unchanged w ` I v El ? Improved ? Worse ? Unchanged ? Improved ? Worse ? Unchanged ? ? Improved ? Worse ? Unchanged Order Time IVSolution/Added Medication "StartTimeDevicefSize.Locat ion#AttemptsAmount {Start by`- D/GTime AmYlnfused /Cby ? KVO Device: ? IV Fluid: Procedures / Nursing Assistance ? Cardiac Monitor Rate_ Rhythm ? Splint Application ? (Local), (Regional) Anesthesia ? NIBP Monitor ? Pulse Oximetry ? Ace Bandage Application ? Conscious Sedation ? (Cold), (Heat) Application ? Sling Application ? Laceration Repair ? Wound Irrigation ? C-Spine Immobilization ? Cast Application ? Dressings ? Foreign Body Removal ? Fracture Care (open), (closed) Discharge Instructions Initials/Signature. Initials/Si ture: l <`^ PA/ARNP: Initials/Signature: Initials/Sign(atture: '3r J Physician's Si e: 6 Rev 09P4104 EMERGENCY DEPARTMENT ONGOING NURSING ASSESSMENT Date: 9/24/04 Carlisle Reqonal Medical Center Name:YATES, CAMPBELL L Pt#:9292843 Age:3YRS DOB: 09/16i2001 Sex: F MR#:0001003347 EDP: CLOONAN, CLIFFORD PCP: HOFFMAN, HOLLY C. H. NURSING DIAGNOSIS (Number in order of priority. Each.patient.must have at least one selected.)' Airway Clearance, Ineffective Communication Impaired Infection, Potential Self Care Deficit -Anxiety (pninn, Inpffar_.tive -Injurv Pntpnti'AI -Skin IntPnrity Imnairmant -Breathing Patterns, Ineffective Fluid Volume, Alteration in -Knowledge Deficit Thought Processes, Impaired -Car iac Output, Decreased Gas Exchange, Impaired -Mobility Impaired Thought Processes, Alteration in omfort, Alteration in Hyperthermis (Fever) -Non-Compliance Tissue Perfusion, Alteration in Other Other i The GOAL / PLAN for this patient is to assist in meeting identified needs and initiate interventions for ! to: Not Not Met Met Int Met Met Int FB REMOVAL ? IMMOBILIZATION / PROPER ALIGNMENT ? IMPROVEMENT OF BREATHING Met Not Met Int ? ? BLEEDING CONTROL ? DECREASE I PREVENT SWELLING ? STABILIZE PATIENT IN DISTRESS ? PAIN CONTROL ? MAINTAIN STABLE HOMEOSTASIS ? meet ENVIRONMENTAL NEEDS ? ALLEVIATE NN ? MAINTAIN SKIN / TISSUE INTEGRITY ? meet PSYCHOSOCIAL NEEDS ? FEVER CONTROL ? PREVENT FURTHER INJURY ? meet SELF CARE ABILITY NEEDS DEC SE ANXIETY ? MAINTAIN / IMPROVE CIRCULATION ? meet EDUCATIONAL NEEDS ? FETY IN THE ED ? INFECTION CONTROL ? Other Int: N = documentation in nurses notes, other'codes' per Hospital Policy. -Time Nurses Progress Notes & Reassessment Signature ; Time T.. P'. R ?. BP, 02 Sat NG I- Emesi Cardiac: Monitor Urine GCS Pain cal Ic ti ?? r I /V F-A _ y 2-1 Oq Sk I v1 '• -Di-S CVAoL- ..C LI ?C 1 ?t Cs r- t(. C i o?- r ?sucfi a K L e Disposition Discharged in care of: Mather. ? Amb ? W/C ? Strej,Carried Discharge instructions given to nichner- u-v?rbaiized understanding for Room Time: m #: to Dr Read Admit R ._ y : oo Report called at and given to Transfered to ? Transfer Verified Report called at and given to ? Left without treatment ?Left Against Medical Advise t Dis iti C diti n ?E bl i i d I St ?S d on on a pos o : ? re er ous xp mprove e ? a Pain Scale: Pain Location: Patient reports that pain is: O Improved ?Unchanged ?Worse Disposition Vitals: T P R SP 02 Disposition Date: 74 Time: Ztr `t Nurse: -?? ?e? ^J/05104 EMERGENCY DEPARTMENT PEDIATRIC -NURSING ASSESSMENT Date In:9/24/04 Time: Carlisle Regional Medical Center Narrie:YATES, CAMPBELL L Pt#:9292843 Age: 3YRS DOB: 09/16/2001 Sex: F MR#: 000 100334 7 EDP: CLOONAN, CLIFFORD PCP: HOFFMAN, HOLLY C. H. Subjective Notes: Pain, atientdenies pain, - Location: Quality: ?Sharp ODull ?Cramping ?Burning ?Aching ? Rating Scale: Mode of Onset: ? Sudden ? Gradual ? Intermittent WONG/BAKER FACES RATING SCALE Onset: Date: Time: Duration: (:t O nset > 24 hrs, medical attention was sought? ?No ?Yes Date: (:?) (:?) Radiating: ?No ?Yes (specify) 0 2 6 8 10 Psychosocial Caregiver: ? Parents ? Mother ? Father ? Other: Environment: ? No steps ? Few steps ? Many steps Accompanied by: Nutritional status: ? Normal ? Cachetic ? Obese Appearance: ?Clean ?Unkempt ?Other Religious / Cultural preference: ?None (specify) Activity level: ?Awake ?Playful ?Smiles! Laughs Best learn by: (pt/caregiver) ?Verbal ?Written ?Return demo ?Other Learning Barriers: Neurological << Gastrointestinal: Not Assessed ?Awake ?Oriented ?Cooperative ?Crying ?Lethargic Abdomen: ? Soft ? Flat ? Rigid ? Diste ed ?Restless ?Disoriented ?Unresponsive ?Non-Tender ?Tender(Area) Pupils size and reaction: Bowel Sounds: ? Present ? Decreased ? Absent Cardiovascular Elimination: ? Normal ?Constipation ?Diarrhea # of Stools: Skin: Sl- - pZwr ? Cool ? Moist ? Diaphoretic Genitourinary: essed' ? Color ink p,PtTe ? Ashen ? Flushed ?Cyanotic ? Jaundiced Voiding: ?Continent ?Incontinent ?Diaper Potty trained Capillary Refill: ? <2 Secs (Normal) ?>2 Secs (Delayed) ?Dysuha ?Frequency Colors/ Turgor: ? Normal ? Decreased Other findings: Pulses: L Radial: ? Present ? Absent R Radial: ? Present ? Absent L Pedal: ? Present []Absent R Pedal: ? Present ? Absent Respiratory. Musculoskeletal ?NotAssessed ° Airway: )ear ? Other ? Lacerations / Abrasions / Contusions Effort: A ?.. Xtalabored ? Labored ? Mildly ? Severely Location: ? Retractions ? Stridor ? Nasal Flaring Size: Cough: ? None ? Productive ? Non-Productive Bleeding: ? Absent ? Present ? Scant ? Moderate ? Heavy ? Pulsating Lung Sounds: ROM: ? W NL ? Decreased ? Absent ?Clear ? Wheezes ? Rhonchi ?Crackles ? Diminished ?Absent Edema: ? Absent ? 1+ ? 2+ ? 2+ Deformity ? Yes ? No ? R ? L ? R ? L ? R ? L ? R ? L ? R ? L ? R ? L Scars: ? Yes ? No Distal pulses: ? Absent ? Present Growth and Development Weight: KG. Heig ht in " Head Cirtjtnference: cm ?NEW BORN Age 0.1 Month ?1NFANT 1 -12 Months Language: ?Cries Often ?Smiles ?Coos 1 Gurgles ?Babbles Born at Term: ?Yes ?No Delivery: ?Vaginal ?C-Section Diet: ? Breast Feed ?Formula type: Uses: ?Bottle ?Spoon ?Cup Elimination: ? 3 - 8 stools a day Other: Activity: Lifts Head: ?Yes ?No Sits up: ?with help ? without help Crawls: ? Yes ? No Teething: ? Yes ? No Observation of interaction with caregiver is ? Appropriate ?See Nursing Assessment ?TODDLER Age 1.2 Years ?re-School Age 3 -5 Years Language: ?Few Words ?Sentences C1 Easily Understood Diet: ?Finger Foods -2i8egular Diet ?Feeds Self Uses: ?Bottle ? Cup Teething: ?Yes ?No Elimination: ?1 - 2 Stools per day ?Diapers Toilet trained ?Wets bed: ? Rarely ? Occasionally ?Frequently Activity: Walksi' _es ? No ?Walks with assistance ?Walks Independently Observation of interaction with caregiver is ppropriate ?See Nursing Assessment ?SCHOOL AGE Age 6.11 Years ?ADOLESCENT Age 12.16 Years Reached Puberty: ? Yes ?No Learning disability: ? Yes School grade: Diet: ? Eats 3 meals/day ?Eating disorder: (specify) Wears Braces ?Yes ?No Elimination: ? No problem reported ? Wets bed: ?Rarely ?Occasionally ?Frequently Social Habits: Smokes ? Yes ? No Uses Alcohol: ? Yes ?No Uses Drugs: ? Yes ?No Observation of interaction with caregiver is ? Appropriate ?See Nursing Assessment Vital Signs: 18:15 T: 97.6 P: 120 Regular R: 20 BP: 000/000 Nurse Signature: ?! Rev. 03/05/04 INITIAVASSESSMENT FORM Carlisle Regional Medical Center PRIORITY: 4 Patient: YATES, CAMPBELL L Pt#: 9292843 Non-Urgent DOB: 09/16/2001 AGE: 3YRS Sex: F MR#: 0001003347 EDP CLIFFORD : CLOONAN ' , Worker s Comp: DATE: 09/24/2004 PCP : HOFFMAN, HOLLY C. H. Emp. Referred: u:i? Presentation Time: 1 Triage Time: BLS Arrival Mode: Height: Weight: 30.0 lbs. 13.6 kgs. LMP: Last Tetanus: Acc By: Chief MVA--MINOR INJURY Complaint: Brief PT WAS INVOLVED IN MVC IN CAR SEAT IN BACK SEAT. PT FOUND ON GRASS IN CAR SEAT Assessment: POST ACCIDENT NIGHT SWEATS WEIGHT LOSS ANOREXIA SAFETY RESTRAINED DRIVER AIRBAG DEPLOYED NO NO NO NO NO NO NO HEMOPTYSIS NO FEVER NO Vital Signs T: 97.6 R P: 120 Reguiar R: 20 Unlabored BP: 000/000 02: % RA Pain Intensity Scale: 0 /10 Pain Location:Unable to Descr Sudden Onset: Pre-Hospital Treatment: Pediatric Assesment: Past Medical History: Allergies: Medicines Nurse Signature: 126-20-98% RM AIR TRANSPORTED IN CAR SEAT G&D App. for Age - YES, Immunization UTD - YES, Height ft. in., Head Circ. - Grade -, with DENIES NKA NONE Additional Notes: 4 MAJ Rev 04;12'04 Carlisle Hospital -- Emerqencv Department Yates, Campbell L 246 Parker St. Carlisle, PA 17013 -- (717) 245-5500 9/24/04 8:33pm 0001003347 DISPOSITION SUMMARY Patient: Yates, Campbell L SS #: Current Ph: CURRENT Address: City: Zip: Arrival: 9/24/04 8:33pm Disch: 9/24/04 8:35pm MD ED: Cliff Cloonan, MD PMD: Res/PA/NP: PMD Ph: Dx #1: MVA (Unspecified) ICD-9 41: E819.9 #1 Dx Engl: MOTORVA.ESW Rx #1: Motrin Suspension (Ibuprofen) 100mq/5ml Take 1.5 teaspoonfuls by mouth every 6-8 hours as needed 4 ounces Rx #2: Tylenol (Acetaminophen) 160mq/5cc Elixir Aqe/DOB: Medical Record: 0001003347 Disposition: #1 Dx Span: MOTORVA.SSW 1 1/2 tsp every 4 - 6 hours as needed for headache, pain 4 oz Follow-up: HOFFMAN, HOLLY C. H. 804 BELVEDERE STREET CARLISLE, PA F/U MD Ph: 7172431943 F/U D/T: 5 Days Other Instr: Follow up with Dr. Hoffman as needed for persistinq pains, headaches etc.. Return to ED for any faintinq/near fainting, complaininq of abdominal pain, increasinq headache unrelieved by tyienol or motrin OR AS NEEDED. MY SIGNATURE BELOW INDICATES: > I have received and understood the oral instructions reqardinq my current medical problem. > I will arranqe follow-up care as instructed above. > I acknowledge receipt of the written instructions as outlined on this and any previous p (s). I will read and review these instr ons. Z 0 -/ X /(V X 5 Patient (or Le. I GuarJin) Signature Staff (Witness) Signature c/ M E D I C A L C E N 7 E Il 246 Parker St. Carlisle, PA 17013 Ph:71 7-249-1212 PATIENT'S NAME YATES, CAMPBELL L ACCOUNT NO. 9 2 9 2 8 4 3 CONSENT TO HOSPITAL CARE AND TREATMENT CONDITIONS OF TREATMENT AND ADMISSION ATTENDING PHYSICIAN CLOONAN, CLIFFORD C DATF R TIMF OF n.DMI$SION 09/24/2004 18:15 I AM PRESENTING MYSELF FOR EMERGENCY SERVICES OR ADMISSION TO THE HOSPITAL AND I VOLUNTARILY CONSENT TO THE RENDERING OF SUCH CARE, INCLUDING DIAGNOSTIC TESTS AND MEDICAL TREATMENT, BY AUTHORIZED AGENTS AND EMPLOYEES OF THE HOSPITAL, AND BY ITS MEDICAL STAFF, OR THEIR DESIGNEES, AS MAY IN THEIR PROFESSIONAL JUDGEMENT BE DEEMED NECESSARY OR BENEFICIAL TO MY WELL BEING. I ACKNOWLEDGE AND UNDERSTAND THAT MANY OF THE PHYSICIANS ON THE STAFF OF THIS HOSPITAL, INCLUDING THE ATTENDING PHYSICIAN(S) NAMED ABOVE, AND RADIOLOGISTS, ANESTHESIOLOGISTS, PATHOLOGISTS AND EMERGENCY PHYSICIANS, ARE NOT EMPLOYEES OR AGENTS OF THE HOSPITAL, BUT RATHER ARE INDEPENDENT CONTRACTORS WHO HAVE BEEN GRANTED THE PRIVILEGE OF USING THE HOSPITAL FACILITIES FOR THE CARE AND TREATMENT OF THEIR PATIENTS. I AGREE TO ACCEPT THEIR CARE EVEN THOUGH THEY ARE NOT EMPLOYED BY THE HOSPITAL. I UNDERSTAND THAT THE EXAMINATION AND TREATMENT THAT I RECEIVE ON AN EMERGENCY BASIS IS NOT INTENDED AS A SUBSTITUTION OR REPLACEMENT FOR COMPLETE MEDICAL CARE. CONSENT TO RELEASE INFORMATION I HEREBY AUTHORIZE THE HOSPITAL TO DISCLOSE TO INSURANCE COMPANIES, INCLUDING WORKERS COMPENSATION CARRIERS, OR OTHER PARTIES THAT MAY BE LIABLE FOR ALL OR PART OF THE HOSPITAL CHARGES, ALL OR PART OF MY HOSPITAL RECORDS AS MAY BE NECESSARY (INCLUDING ANY TREATMENT FOR ALCOHOL OR DRUG ABUSE OR DEPENDENCE), TO DETERMINE BENEFITS ENTITLEMENT AND PROCESS PAYMENT CLAIMS FOR HEALTH CARE SERVICES PROVIDED. MEDICARE CERTIFICATION RELEASE I CERTIFY THAT THE INFORMATION GIVEN BY ME IN APPLYING FOR PAYMENT UNDER THE TITLE XVIII AND TITLE XIX OF THE SOCIAL SECURITY ACT IS CORRECT. I AUTHORIZE ANY HOLDER OF MEDICAL OR OTHER INFORMATION ABOUT ME TO RELEASE TO THE SOCIAL SECURITY ADMINISTRATION OR ITS INTERMEDIARIES OR CARRIERS ANY INFORMATION NEEDED FOR THIS OR A RELATED MEDICARE CLAIM. I REQUEST THAT PAYMENT OF AUTHORIZED BENEFITS BE MADE ON MY BEHALF TO THE HOSPITAL OR TO THE PHYSICIAN WHO ACCEPTS ASSIGNMENT. PERSONAL EFFECTS AND VALUABLES I UNDERSTAND THAT THE HOSPITAL SHALL NOT BE LIABLE FOR THE LOSS OR DAMAGE OF ANY PERSONAL EFFECTS OR VALUABLES (MONEY, JEWELRY, GLASSES, DENTURES, DOCUMENTS, CLOTHING, ETC.) UNLESS SUCH ITEMS ARE DEPOSITED IN THE HOSPITAL SAFE. THE HOSPITAL WILL NOT BE LIABLE IN EXCESS OF $50 FOR THE LOSS OR DAMAGE OF ANY PERSONAL EFFECTS OR VALUABLES DEPOSITED WITHIN THE HOSPITAL SAFE. ABOUT YOUR BILL I UNDERSTAND THAT I WILL RECEIVE A BILL FROM THE HOSPITAL FOR PROVISION OF THE HOSPITAL SERVICES, INCLUDING STAFF AND EQUIPMENT, AND FOR ANY SUPPLIES OR MEDICINES UTILIZED. I WILL ALSO RECEIVE A BILL FROM ANY PHYSICIAN WHO PROVIDES PROFESSIONAL CARE TO ME. FOR EXAMPLE, I MAY RECEIVE A SEPARATE BILL FROM ONE OR MORE OF THE FOLLOWING TYPES OF PHYSICIANS WHO RENDER SERVICES TO ME: MY ATTENDING PHYSICIAN OR PERSONAL PHYSICIAN, EMERGENCY ROOM PHYSICIAN, RADIOLOGIST, ANESTHESIOLOGIST, PATHOLOGIST, OR ANY OTHER SPECIALIST. INSURANCE ASSIGNMENT I HEREBY ASSIGN TO AND AUTHORIZE THE HOSPITAL AND PHYSICIANS INVOLVED IN CARE DURING THIS PERIOD OF ILLNESS -OR TREATMENT (HEREINAFTER "PHYSICIANS"), OR THEIR DULY AUTHORIZED ASSIGNS TO TAKE ALL NECESSARY STEPS, WITHOUT LIMITATIONS, TO ENSURE THAT ANY INSURANCE BENEFITS OTHERWISE PAYABLE TO ME OR MY ESTATE ARE PAID DIRECTLY TO THE HOSPITAL OR PHYSICIANS. THIS ASSIGNMENT OF INSURANCE BENEFITS INCLUDES BUT IS NOT LIMITED TO BILLING INSURANCE, FILING PETITIONS, FILING SUIT, IN MY NAME OR ON BEHALF OF THE HOSPITAL OR PHYSICIANS, FILING PROOFS OF CLAIM, FILING PROBATE CLAIMS AND FILING GRIEVANCES AND ALL OTHER SIMILAR PROCEDURES, AS MAY BE AMENDED FROM TIME TO TIME WITH THE STATE DEPARTMENT OF INSURANCE. I ALSO AGREE TO PROVIDE AND SIGN ANY OTHER DOCUMENTS THAT MAY BE REASONABLY NECESSARY TO ACCOMPLISH ANY OF THE OTHER PURPOSES. STATEMENT OF FINANCIAL RESPONSIBILITY I UNDERSTAND THAT I AM FINANCIALLY AND LEGALLY RESPONSIBLE FOR CHARGES NOT COVERED IN FULL BY ANY THIRD PARTY. I FURTHER AGREE THAT SHOULD I NOT PAY THE BALANCE WITHIN THIRTY 130) DAYS AFTER THE DATE OF DISCHARGE, MY ACCOUNT WILL BE CONSIDERED DELINQUENT. I AGREE TO PAY COSTS OF COLLECTION, INCLUDING REASONABLE ATTORNEY'S FEES AND COSTS, COLLECTION AGENCY FEES AND COSTS, AND INTEREST WHICH SHALL ACCRUE AT THE MAXIMUM RATE ALLOWED BY LAW. FRAUD ANY PERSON WHO KNOWINGLY AND WITH INTENT TO INJURE, DEFRAUD, OR DECEIVE ANY INSURANCE COMPANY, OR FILES A STATEMENT OF CLAIM CONTAINING FALSE, INCOMPLETE OR MISLEADING INFORMATION MAY BE SUBJECT TO PROSECUTION UNDER APPLICABLE LAW. ADVANCE DIRECTIVE IFOR ADMISSION TO HOSPITAL ONLY) IF I AM TO BE ADMITTED TO THE HOSPITAL, I HAVE BEEN GIVEN WRITTEN MATERIALS ABOUT MY RIGHT TO ACCEPT OR REFUSE MEDICAL TREATMENT. I HAVE BEEN INFORMED OF MY RIGHTS TO FORMULATE ADVANCE DIRECTIVES. I UNDERSTAND THAT I AM NOT REQUIRED TO HAVE AN ADVANCE DIRECTIVE IN ORDER TO RECEIVE MEDICAL TREATMENT AT THIS HOSPITAL. I UNDERSTAND THAT THE HOSPITAL AND MY CAREGIVERS WILL FOLLOW THE TERMS OF ANY ADVANCE DIRECTIVE THAT I HAVE EXECUTED TO THE EXTENT PERMITTED BY LAW. (INITIAL THE FOLLOWING OPTION THAT APPLIES) • I HAVE EXECUTED AN ADVANCE DIRECTIVE AND WILL PROVIDE A COPY OF I?F, MY M DICAL RECORD WITHIN A REASONABLE AMOUNT OF TIME l • I HAVE NOT EXECUTED AN ADVANCE DIRECTIVE AND DO NOT WISH TO SO. I IT (FOLLOW-UP DONE BY DATE • I WISH TO COMPLETE AN ADVANCE DIRECTIVE DURING THIS HOSPITALIZATION. IT I CERTIFY THAT I E READ 1 A E BEN R ADI THE ABOVE CONSENTS AND C RTIFICQTIONS ANO UNDERSTAN AND AGREE WITH THEM. DATE I ?? ??. LL?? ?? t MIOWH DAY Y R SIGNATURE OF.PgTI NT OR LEGALLY h?UTH JORIZED R PRESENTATIVE WITNESS , INIT. PRINT NAM 0 ERSON ABOVE ?1,ll ADOIl 111111111111111 IN 9??II II?3III? ?II?II??II?II?Ii?IIIll?lll ???IIIIII 3J47 ' iiiiiiiii»i11i1111111111111N1lIIII11!!11 .-JAP op EARS EVES F+tEr.X -x ? REM ?Y A ?? W1- NR P-A 17413 won `Il(Jv 0 j **- t .J wr HT HC TEMP IR Fi+K'1 c? r? _ n EAFtu i THROAT s LUNW j r HEART AAD WIT. EXTR9A NEI On sKnv IMP: PLAN: &fL 404 J IV 1% IWO J-01 AA 01=??f dl PATIENT TELEPHONE CALL RECORD -55D 31^ AM -A Date: 10 G`( Time: U...Caller:j Q lv Patient L? Tel. #: sl Re It - Allergic to: Present Meds: Recommendations/Prescription . TO. #: Initials Pharmacy: ZcJ t ?klad ? C?'?- jai 0? l- Place in atien? ; rec2l VERIFICATION I, Petitioner, Heather Yates, mother of Campbell Yates, a minor, hereby verify that the statements set forth herein are true and correct to the best of my knowledge, information, and belief. I am satisfied that the offer of settlement, referred to in this Petition, for my daughter, Campbell Yates' injuries, is just and reasonable and I am willing to accept that offer. I have reviewed the contents of the Petition for Approval of Minor's Settlement and concur with all the facts and statements herein are made subject to the penalties of 18 Pa. C.S. §4904 relating to unsworn falsification to authorities. Date: ?S Heather Yates, arent and Natural Guardian of Campbell Yates, a Minor JOINDER am the father of Campbell Yates, a minor, and hereby state that I have read the foregoing Petition for Approval of Minor's Settlement and that I understand, agree, and approve the contents thereof and join in the Petition. " Date: 111.541-s- CONTINGENT FEE AGREEMENT THIS AGREEMENT entered into the day of ,? ? I- , 20Q? , by and between SCHMIDT, RONCA & KRAMER, P.C. and HEATHER YATES of 4051 Carlisle Road, Gardners, Pennsylvania 17324, hereinafter referred to as "Client." WITNESSETH: The law firm of SCHMIDT, RONCA & KRAMER, P.C., will act as Client's attorney in negotiating for a settlement, and in bringing a claim against D & J Truck Repair and Unknown Driver, arising out of an accident which occurred on September 24, 2004, on Old Carlisle Road, Rt. 34, Adams County, Pennsylvania. In addition, SCHMIDT, RONCA & KRAMER, P.C., will pursue all claims for underinsured or uninsured motorist benefits to which the Client may be entitled under his/her insurance policy. In return, the Client will: 1. Promptly supply accurate information, as requested by SCHMIDT, RONCA & KRAMER, P.C., and cooperate fully, including making myself available for meetings with attorneys and for legal proceedings. Client promises all information supplied will be truthful and accurate. 2. (a) In any claim brought on Client's behalf, to pay to SCHMIDT, RONCA & KRAMER, P.C., for its services an amount equal to thirty percent (30%) of all funds or property accruing to Client as a result of SCHMIDT, RONCA & KRAMER, P.C.'s services in securing a settlement of these claims without litigation; an amount equal to thirty-three-and-one-third percent (33-1/3%) of all funds or property accruing to Client as a result of SCHMIDT, RONCA & KRAMER, P.C.'s services in securing a settlement of these claims after a suit has been filed; and an amount equal to forty percent (40%) if such funds or property are secured after start of trial or as a result of verdict or judgment. Trial begins at the Pre-Trial Conference, or when testimony is taken for trial, whichever occurs first. In any matter submitted to arbitration, suit is filed when the arbitrators are appointed or when a Petition to Appoint Arbitrators is filed, whichever first occurs. In any matter submitted to arbitration, trial starts the first day the arbitrators have convened to hear testimony. (b) Client agrees not to settle or negotiate the above claim or any proceedings based thereon. (c) If Client terminates this Agreement before recovery, Client agrees that SCHMIDT, RONCA & KRAMER, P.C., shall be entitled to a fee based upon work done and benefit conferred. (d) Client agrees to read and follow SCHMIDT, RONCA & KRAMER, P.C.'s "Client Instruction Manual". 3. Client agrees to reimburse SCHMIDT, RONCA 8v KRAMER, P.C., out of any recovery, in addition to attorneys' fees, all costs and expenses incurred on Client's behalf in order to make the claim. All such costs and expenses will be advanced by SCHMIDT, RONCA & KRAMER, P.C. as they are incurred. Such costs and expenses include, but are not limited to, filing fees, cost of medical records, copying costs, fax costs, long distance telephone costs, expert witness fees and sheriffs service costs. In the event there is no recovery, the Client will not be responsible for any costs or interest charges. Costs will be repaid to SCHMIDT, RONCA & KRAMER, P.C., out of any funds or property collected either by settlement or judgment. 4. Claims for first party medical benefits and income loss benefits are separate items. SCHMIDT, RONCA & KRAMER, P.C., will help you process these claims. A separate agreement will have to be entered into for fees if a major dispute occurs requiring the filing of suit for these benefits. The Client has read and does understand this Agreement. Signed the day and year set forth above. WITNESS: I have received a copy of this Client: HEATHER YATES Approved: SCHMIDT, RONCA & KRAMER, P.C. By t Fee Agreement. Initial s O it J N_ -C N % ' N s N CB ? m - s 01 y e ? n N G ? ? o tQ NQ ( ? N c?p 1 C m A tD v ? ?m o s O O N Lit ?i y i-P a S _ w ,3 N l n ? N O ? N lD (D O 7 N o (j) T+ cr cn 0 13 N n N 3 3 io C i CO 14 m 3 0 LT% WSW Ln W 'O m t0 A Pennsylvania Child Support Website - Docket www.childsupport. state. Pa. us vo ^r<+? , ?su Lien Home Lien Search Change Password Change Profile Locate Domestic Relations Office Useful Links Frequently Asked Questions O Lien Home > Lien Search > Results https://www.humanservices.state.pa.us/CS WS/lien_controller.aspx?... I Home I Search I Site Map I Privacy I Contact Us I Help I Lien Search ResultS as of Monday March 03,2008 Print Current Pape Print All The information provided by this Internet site does not constitute an official certification by the Department of Public Welfare of the amount of support arrears. Certifications of arrears amounts must be obtained from the local Domestic Relations Sections under 23 Pa.C.S. § 4352(d.1)(3) and (7). The Department of Public Welfare is not liable if the information provided by this Internet site is incorrect or out of date. The information provided by this Internet site does meet the requirements for insurance intercept purposes defined under 23 Pa.C.S. 4308.1(a) and (b). The arrears balance returned under the search criteria may be utilized to process the insurance intercept action. The Department of Public Welfare is not liable if the information provided by this Internet site is incorrect or out of date. An Insurance Intercept may be disputed in accordance with 23 Pa.C.S. 4308.1(h) and must be based on a mistake in the amount of overdue support, or a mistake in the identity of the obligor. Your Search Criteria Last Name : yates First Name : campbell Social Security Number : 181803904 Date of Birth : 09/16/2001 Return To Liens Search No Results has been found for your Search Criteria The data is as of Monday March 03,2008. Please try again with different criteria. http://www.childsupport. state. pa us I Home I Search I Site Map I Privacy I Contact Us I Help I Disclaimer I Security I Browser Compatibility I Accessibility I 1 of 1 3/7/2008 10:26 AM GENERAL RELEASE CLAIM #.010170772573 For the consideration of Eight Hundred and 00/100 dollars (S 800.00 receipt of which is hereby acknowledged, Ilwe release and discharge, and for myself/ourselves mylour heirs, representatives, executors, administrators, successors and assigns, do hereby remise, release and forever discharge DJ TRUCK REPAIR INC AND TERRY BLACK OWNER, CURTIS DAGUE AND ERIE INSURANCE EXCHANGE hereinafter referred to as the releasee(s), his/her/theirlits heirs, executors, administrators, insurers, successors and assigns, and any and all other persons, firms, corporations, associations, of and from any and all causes of action, suits, judgments, claims and demands of whatsoever kind, in law or in equity, known and unknown, which Ilwe now have or may hereafter have, and/or which the minor CAMPBELL YATES now has or may hereafter have, especially the claimed legal liability of releasee(s) which liability releasee(s) expressly deny(ies), arising from or by reason of any and all bodily or personal injury and/or property damage known and unknown, foreseen and unforeseen which heretofore has/have been or which hereafter may be sustained by melus or the minor aforementioned arising out of the accident on or about SEPT 24 , 200_ at or near YORK SPRINGS RT 34 , in the County of ADAMS - in the State of PA in which the minor aforementioned sustained personal injuries and/or property damage. IIWe agree that the consideration set forth is specifically applicable to and paid to me/us with respect to any and all damage to any property, either real or personal, of mine/ours or the minor aforementioned, and with respect to any and all personal or bodily injury of mine/ours or the minor aforementioned, whether presently known or unknown, foreseen or unforeseen or which may subsequently develop and the consequences thereof, all as arising from the aforementioned accident. I/We further agree that the consideration set forth above is specifically applicable to and paid to melus with respect to any right of contribution that I/we or the minor aforementioned may have against the releasee(s), hisiher/theirlits heirs, executors, administrators, insurers, successors and assigns relative to claims of others that may be brought against melus or the minor aforementioned by reason of said accident. I/We further agree that the consideration set forth above is specifically applicable to mylour agreement that I/we or the minor aforementioned will not join nor attempt to join the releasee(s), his/her/theirlits heirs, executors, administrators, insurers, successors and assigns in any capacity, in any action that may be brought against melus or the minor aforementioned arising out of said accident. In consideration of the aforesaid payment, Ilwe for myself/ourselves and mylour heirs, representatives, executors, administrators, successors, and assigns do hereby: (1) agree to indemnify and hold forever harmless the releasee(s) and his/her/its/their/representatives, administrators, or assigns, against loss from any and all further claims, demands or actions that may hereafter be made at any time or brought against the releasee(s) by me/us or the minor aforementioned, or by anyone In our behalf for the purpose of enforcing a further claim, for which this release is given; (2) warrant that I/we have received no money or other valuable consideration from any other person or persons by reason of any causes of action, suits, covenants, agreements, judgments, claims and demands of whatsoever kind, which I/we now have or may hereafter have, for injuries to person or property arising out of the aforementioned accident or for the other matters for which this release is Cliven. Intending Co be legally bound thereby, WITNESS my/our hand(s) and seal(s) this day of ,-rY?ew7_. WITNESSES; X X_ Falner--Cuard;an (Seat) Mother (Seal) (Seal) Mkar C-41 M (R) 04105 P•d PP91.-RPb,-/.i/. XHA i-ir-MgRH1 HH W.4bi :b RnnR bi 48-1 VERIFICATION I, Petitioner, Heather Yates, mother of Campbell Yates, a minor, hereby verify that the statements set forth herein are true and correct to the best of my knowledge, information, and belief. I am satisfied that the offer of settlement, referred to in this Petition, for my daughter, Campbell Yates' injuries, is just and reasonable and I am willing to accept that offer. I have reviewed the contents of the Petition for Approval of Minor's Settlement and concur with all the facts and statements herein are made subject to the penalties of 18 Pa. C.S. §4904 relating to unsworn falsification to authorities. Date: //-5- 0 b duffv b•6 Heather Yates, anent and Natural Guardian of Campbell Yates, a Minor JOINDER I, 1?1C6w ?s`?'''?p ?t1?. (? am the father of Campbell Yates, a minor, and hereby state that I have read the foregoing Petition for Approval of Minor's Settlement and that I understand, agree, and approve the contents thereof and join in the Petition. Data: ? G C? ?_?: ?? --? .-? _f ,. t .? t?`) t '"r e? _J ;? ?.` G>> ?' 8 SCHMIDT KRAMER PC BY: Gerard C. Kramer Attorney at Law Attorney ID No.: 44715 209 State Street Harrisburg, PA 17101 (717) 232-6300 Fax (717) 232-6467 gkramer@schmidtkramer.com Attorney for Plaintiff HEATHER YATES, INDIVIDUALLY AND CAMPBELL A. YATES, A MINOR BY HEATHER YATES, PARENT AND NATURAL GUARDIAN, Plaintiff V. D AND J TRUCK REPAIR, INCORPORATED AND CURTIS D. DAGUE, Defendant : IN THE COURT OF COMMON : PLEAS : CUMBERLAND COUNTY, : PENNSYLVANIA No. 06-4491 CIVIL ACTION - LAW : JURY TRIAL DEMANDED AMENDMENT TO: PETITION FOR APPROVAL OF MINOR'S SETTLEMENT 20. No Judge has ruled upon any other issue in the same or related matter. 21. In the above-captioned matter, there is no opposing counsel of record and therefore no concurrence was sought by Schmidt Kramer PC. r I, GERARD C. KRAMER, am the attorney for the Plaintiff in the above-captioned matter. I have prepared this document for filing in this matter. I certify that I have read the document, that there are good grounds to support it and that it is submitted in good faith. Respectfully Submitted, DATED: d? f v? SCHMIDT KRAMiER PC By: ge"'rard C. Kramer Attorney at Law Attorney ID No.: 44715 209 State Street Harrisburg, PA 17101 (717) 232-6300 Fax (717) 232-6467 gkramer@schmidtkramer.com Attorney for Plaintiff 0 im = i c r? MAR 17 2008 SCHMIDT KRAMER PC BY: Gerard C. Kramer Attorney at Law Attorney ID No.: 44715 209 State Street Harrisburg, PA 17101 (717) 232-6300 Fax(717)232-6467 gkramer@schmidtkramer.com Attorney for Plaintiff HEATHER YATES, INDIVIDUALLY AND CAMPBELL A. YATES, A MINOR BY HEATHER YATES, PARENT AND NATURAL GUARDIAN, Plaintiff V. D AND J TRUCK REPAIR, INCORPORATED AND CURTIS D. DAGUE, Defendant : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : No. 06-4491 CIVIL ACTION - LAW : JURY TRIAL DEMANDED ORDER AND NOW, this -z-,Aday of , 2008, it is hereby ORDERED and DECREED as follows: 1. The settlement terms as set forth in the foregoing Petition for Approval of Minor's Settlement of the claim of Campbell Yates, are hereby approved. 2. The Court specifically approves the settlement offer in the amount of Eight Hundred Dollars ($800.00) as total payment. This payment is to be Q distributed in accordance with Pa. R.C.P. 2039 as follows: bv? l ew s2s,fc6o - 8'P1r/lr Z- „ c "! Hid Z :4? j c, SCHMIDT KRAMER PC Attorneys' Fees (20% of $800.00) $160.00 SCHMIDT KRAMER PC Attorney Costs $53.66 The remainder to be deposited in the account(s) set forth below on behalf of Campbell Yates, a minor To be deposited in a Savings Account(s), Certificate(s) of Deposit, marked as follows: "Heather Yates, as Guardian of Campbell Yates, a minor" $586.34 Total Settlement Amount $800.00 3. The funds shall be invested by Petitioner Heather Yates on behalf of Campbell Yates, a minor, as follows: To invest funds in one or more accounts in one or more savings institutions insured by a federal government agency, such accounts not exceeding the amount to which accounts are insured and in accordance with Pa. R.C.P. 2039(b)(2). Each account shall be marked as follows: "This money shall be held in trust, not to be redeemed, withdrawn, negotiated, or in any way alienated, except for renewal of its entirety before September 16, 2019, except by Order of this Court." 4. The law firm of SCHMIDT KRAMER PC, shall oversee that the directives set forth in the preceding paragraph are carried out. 5. The Petitioner is directed to execute the Release attached to the Petition as Exhibit "H." BY THE COURT: HEATHER YATES, INDIVIDUALLY AND CAMPBELL A. YATES, A MINOR BY HEATHER YATES, PARENT AND NATURAL GUARDIAN, Plaintiff V. D AND J TRUCK REPAIR, INCORPORATED AND CURTIS D. DAGUE, Defendant : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, : PENNSYLVANIA : No. 06-4491 CIVIL ACTION - LAW JURY TRIAL DEMANDED PROOF OF COMPLIANCE WITH COURT ORDER AND NOW, this day of , 2009, attached for .44A4Z:?? filing is a letter from PSECU verifying that a restricted account has been opened for Campbell L. Yates, a minor, in accordance with the Order signed by Wesley Oler, Jr., Judge on April 2, 2008. Respectfully submitted, SCHMIDT KRAMER PC BY ,.-"Oerard C. Kramer Attorney at Law ?'f Attorney I.D. No. 44715 209 State Street Harrisburg, PA 17101 (717) 232-6300 Attorney for Plaintiff PSE(?k August 18, 2009 Schmidt Kramer PC Gerard C. Kramer, Esquire 209 State Street Harrisburg PA 17101 RE: Cumberland County Campbell L. Yates 181-80-3904 06-4491 To Whom It May Concern: As directed by the court order, we have placed the amount of $586.34 in a court approvedshare. The share has been restricted until the minor reaches the age of 18. This account is federally insured by NCUA- National Credit Union Administration, a US Government Agency. If you have questions, call us at 234.8484 in Harrisburg or call our toll-free number 800.237.7328. At the menu prompt, enter Option 6, then extension 3570. A trained Member Service Representative will help you. Thank you for allowing us to be of service to you. Sind Courtney Ryan White Member Service Representative Certificate/IRA Department Cc: Heather Yates, Parent Pennsylvania State Employees Credit Union Main Address: 1 Credit Union Place, Harrisburg, PA 17110-2990 • 717.234.8484 • 800.237.7328 Mailing Address: P.O. Box 67013, Harrisburg, PA 17106-7013 • 717.777.2100 (TDD) • 800.472.1967 (TDD) psecu.com This credit union is federally insured by the National Credit Union Administration. Equal Opportunity lender CERTIFICATE OF SERVICE AND NOW, thisyday of , 2009, I, Gerard C. Kramer, Esquire, counsel for the Plaintiff, hereby certify that I have, this day, served a copy of the foregoing Proof of Compliance with Court Order by serving a copy of the same in the United States mail, postage prepaid, at Harrisburg, Pennsylvania, addressed to: Ms. Robin R. Gardner Erie Insurance Company PO Box 284 Dillsburg, PA 17019-0284 Respectfully submitted, SCHMIDT KR.AMER PC By: r z Gerard C. Kramer ' I.D.#. 44715 209 State Street Harrisburg, PA 17101 (717) 232-6300 Attorney for Plaintiff OF THE 1P 2009 AUG 21 Hi 2: 31 ;ly 1 r 1r 1`t?f ?('H \??; t scxM W KRAMER PC BY: Gerard C. Kramer Attorney at Law Attorney ID No.: 44715 209 State Street Harrisburg, PA 17101 (717) 232-6300 Fax (717) 232-6467 gkramer@schmidtkramer.com Attorney for Plaintiff HEATHER YATES, INDIVIDUALLY AND CAMPBELL A. YATES, A MINOR BY HEATHER YATES, PARENT AND NATURAL GUARDIAN, Plaintiff V. : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, : PENNSYLVANIA : No. 06-4491 D AND J TRUCK REPAIR, CIVIL ACTION -LAW INCORPORATED AND CURTIS D. DAGUE, Defendant : JURY TRIAL DEMANDED PETITION AND RULE OF GER.ARD C KRAMER, ESQUIRE TO SHOW CAUSE WHY HE SHOULD BE PERMITTED TO WITHDRAW AS COUNSEL PURSUANT TO PA. R.C.P No. 1012 AND NOW, Gerard C. Kramer, Esquire and Schmidt Kramer PC hereby Petition this Honorable Court to permit them to withdraw as Counsel for Plaintiff for the following reasons: 1. Heather Yates is the parent and natural guardian of Campbell Yates. 2. Plaintiffs, Heather Yates, and her minor daughter, Campbell Yates, were injured in a motor vehicle accident on September 24, 2004. 3. In October, 2004, Plaintiff, Heather Yates, retained Schmidt Kramer PC as her attorneys to represent her and Campbell Yates regarding their injuries sustained in the motor vehicle accident on September 24, 2004. 4. Under Pa. R. C. P. No. 1012 (b) (1), an attorney may not withdraw his appearance as counsel for a client without leave of court. 5. Under Pa. R. C. P. No. 1012 (c) and (d) (1), a petition for leave of court to withdraw an appearance may be sought by counsel if the whereabouts of the party on whose behalf the appearance was entered are known. 6. The whereabouts and current residence of Heather Yates and Campbell Yates are known by Schmidt Kramer PC to be 1265 Goodyear Road, Gardners, Adams County, Pennsylvania, 17324-0913. 7. Under Pa. RPC 1.16(b)(6), a lawyer may terminate representation of a client if the representation has been rendered unreasonably difficult by the client. 8. Representation of Heather Yates has become unreasonably difficult for Schmidt Kramer PC because Heather Yates has, for several months, failed to communicate with Schmidt Kramer PC and has failed to participate in the representation of her interests by Schmidt Kramer PC. 9. Under Pa. RPC 1.16(d), upon termination of the representation of a client a lawyer must take reasonable steps to protect the client's interests including: giving the client reasonable notice of the termination and allowing time for the client to employ other counsel. 10. Schmidt Kramer PC advised Heather Yates by letter on several occasions of the difficulties created by her failure to communicate and that she should obtain other counsel. Hence, Schmidt Kramer PC has given her reasonable notice of the intent to terminate the representation and has allowed ample time for Heather Yates to employ other counsel. 11. A Writ of Summons was filed with the Cumberland County Prothonotary on August 7, 2006 by Schmidt Kramer PC on behalf of Heather Yates and Campbell Yates. Schmidt Kramer PC requests that the Court stay the proceeds on that Writ of Summons for a period of sixty (60) days to ensure that this withdrawal of appearance by Schmidt Kramer PC does not prejudice Heather Yates' and Campbell Yates' ability to pursue their case. 12. Under C.C.R.P. 208.3(a)(9), all motions and petitions submitted to the Court of Common Pleas of Cumberland County must contain a paragraph indicating that the concurrence of any opposing counsel of record was sought and the response of that opposing counsel of record. In the above-captioned matter, there is no opposing counsel of record and therefore no concurrence was sought by Schmidt Kramer PC. 13. Judge Wesley Oler, Jr. has singed a previous Petition to Withdraw on November 5, 2007. WHEREFORE, Schmidt Kramer PC and Gerard C. Kramer, Esquire pray Your Honor will grant their Petition to Withdraw as Counsel and their request to stay the proceedings on the above-captioned case for a period of sixty (60) days. I, GERARD C. KRAMER, am the attorney for the Plaintiff in the above- captioned matter. I have prepared this document for filing in this matter. I certify that I have read the document, that there are good grounds to support it and that it is submitted in good faith. Respectfully Submitted, SCHMIDT KR.AMER PC DATED : 0 60c? By: C. Kramer v at Law Attorney ID No.: 44715 209 State Street Harrisburg, PA 17101 (717) 232-6300 Fax (717) 232-6467 gkramer@schmidtkramer.com Attorney for Plaintiff CERTIFICATE OF SERVICE AND NOW, this day of -?)Kf )'QbQA1 , 2009, I, Gerard C. Kramer, Esquire, hereby certify that I have this day served a true and correct copy of the PETITION AND RULE OF GERARD C. KRAMER, ESQUIRE TO SHOW CAUSE WHY HE SHOULD NOT BE PERMITTED TO WITHDRAW AS COUNSEL by depositing a copy of the same in the United States Mail, postage prepaid, at Harrisburg, Pennsylvania, addressed to: Heather Yates 1265 Goodyear Road Gardners, PA 17324-0913 Respectfully Submitted, SCHMIDT KRAMER PC DATED: By: ferard C. Kramer Attorney at Law Attorney ID No.: 44715 209 State Street Harrisburg, PA 17101 (717) 232-6300 Fax (717) 232-6467 gkramer@schmidtkramer.com Attorney for Plaintiff F ? HEATHER YATES, INDIVIDUALLY AND CAMPBELL A. YATES, A MINOR BY HEATHER YATES, PARENT AND NATURAL GUARDIAN, Plaintiffs V. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA : CIVIL ACTION - LAW D AND J TRUCK REPAIR, INCORPORATED AND CURTIS D. DAGUE, Defendants NO. 06-4491 CIVIL TERM IN RE: PETITION AND RULE OF GERARD C. KRAMER, ESQUIRE TO SHOW CAUSE WHY HE SHOULD BE PERMITTED TO WITHDRAW AS COUNSEL PURSUANT TO PA. R.C.P. NO. 1012 ORDER OF COURT AND NOW, this 7`h day of December, 2009, upon consideration of the attached Petition, a Rule is hereby issued upon Plaintiffs and Defendants to show cause why the relief requested should not be granted. RULE RETURNABLE within 14 days of service. PETITIONERS ARE responsible for service of all parties. BY THE COURT, Gerard C. Kramer, Esq 209 State Street Harrisburg, PA 17101 Attorney for Plaintiffs :rc CO lc? J esley Oler, ., J. V, -... FILEf.l'..ORFI4E 'P3F zH' pwor?..tOt,!OT? 2010 JA.N -8 Ali 9: 08 SCHMIDT KRAMER PC BY: Gerard C. Kramer Attorney at Law Attorney ID No.: 44715 209 State Street Harrisburg, PA 17101 (717) 232-6300 Fax (717) 232-6467 gkramer@schmidtkramer.com Attorney for Plaintiff HEATHER YATES, INDIVIDUALLY AND CAMPBELL A. YATES, A MINOR BY HEATHER YATES, PARENT AND NATURAL GUARDIAN, Plaintiff V. D AND J TRUCK REPAIR, INCORPORATED AND CURTIS n. DAGUE, Defendant : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, : PENNSYLVANIA No. 06-4491 CIVIL ACTION - LAW : JURY TRIAL DEMANDED WITHDRAWAL OF PETITION TO WITHDRAW AND NOW, Gerard C. Kramer, Esquire and Schmidt Kramer PC, Counsel for Plaintiff, withdraw their PETITION TO WITHDRAW which was filed on December 2, 2009 because Plaintiff, Heather Yates, has reestablished communication with Gerard C. Kramer and Schmidt Kramer PC making it possible for them to represent her in this matter. Respectfully Submitted, SCHMIDT KRAMER PC DATED: C? By: C, G and C. Kramer ttorney at Law Attorney ID No.: 44715 ' 209 State Street Harrisburg, PA 17101 (717) 232-6300 Fax (717) 232-6467 gkramer@schmidtkramer.com Attorney for Plaintiff CERTIFICATE OF SERVICE AND NOW, this day of , 2010, I, Gerard C. Kramer, Esquire, hereby certify that I have this day served a true and correct copy of the WITHDRAWAL OF PETITION TO WITHDRAW by depositing a copy of the same in the United States Mail, postage prepaid, at Harrisburg, Pennsylvania, addressed to: Heather Yates 265 Goodyear Road Gardners, PA 17324-0913 Curtis D. Dague 8475 Roxbury Road Lurgan, Pennsylvania 17240 D and J Truck Repair, Inc. 25 Hershey Road Shippensburg, Pennsylvania 17257-9407 DATED: BY: )Kerard C. Kramer Attorney at Law Attorney ID No.: 44715 SCHMIDT KRAMER PC BY: GERARD C. KRAMER, ESQUIRE ???? Attorney I.D. No. 44715 kl ? P 13: 4 7 209 State Street Harrisburg, PA 17101 Ci a `= (717) 232-6300 Fax No. (717) 232-6467 Attorneys for Plaintiffs l Tamer schmidtkramer.com HEATHER YATES, : IN HE COURT OF COMMON PLEAS INDIVIDUALLY AND CAMPBELL : C BERLAND COUNTY, L. YATES, A MINOR BY : PE NSYLVANIA HEATHER YATES, PARENT AND NATURAL GUARDIAN, Plaintiff V. No 06-4491 D AND J TRUCK REPAIR, C L ACTION - LAW INCORPORATED AND CURTIS D. DAGUE, Defendant JURY TRIAL DEMANDED TIICE YOU HAVE BEEN SUED IN COUR set forth in the following pages, you must this Complaint and Notice are served, by or by attorney and filing in writing with th claims set forth against you. You are war proceed without you and a judgment may without further notice for any money clair claim or relief requested by the Plaintiff. rights important to you. If you wish to defend against the claims .ke action within twenty (20) days after tering a written appearance personally Court your defenses or objections to the :d that if you fail to do so the case may e entered against you by the Court :d in the Complaint or for any other u may lose money or property or other YOU SHOULD TAKE THIS PAPER NOT HAVE A LAWYER, GO TO OR TELEI THIS OFFICE CAN PROVIDE YOU WITH IF YOU CANNOT AFFORD TO HIRI TO PROVIDE YOU WITH INFORMATION ,4 LEGAL SERVICES TO ELIGIBLE PERSON CUMBERLAND COUP 2 Liberl Carlisle, (71' J YOUR LAWYER AT ONCE. IF YOU DO ONE THE OFFICE SET FORTH BELOW. FORMATION ABOUT HIRING A LAWYER. A LAWYER, THIS OFFICE MAY BE ABLE TOUT AGENCIES THAT MAY OFFER AT A REDUCED FEE OR NO FEE. BAR ASSOCIATION Avenue A 17013 249-3166 AV USTED HA SIDO DEMANDADO/A E las demandas que se presentan mas adelai acci6n dentro de los pr6ximos veinte (20) d Demanda y Aviso radicando personalmentc comparecencia escrita y radicando en la Cc objecciones a, las demandas presentadas e si usted falla de tomar acci6n como se des( proceder sin usted y un fallo por cualquier demanda o cualquier otra reclamaci6n o re puede ser dictado en contra suya por la Cc perder dinero o propiedad u otros derecho: I CORTE. Si usted desea defenderse de to en las siguientes paginas, debe tomar as despu6s de la notificaci6n de esta o por medio de un abogado una rte por escrito sus defensas de, y lui en contra suya. Se le advierte de que ribe anteriormente, el caso puede suma de dinero reclamada en la nedio solicitado por el demandante •te sin mas aviso adicional. Usted puede importantes para usted. USTED DEBE LLEVAR ESTE INMEDIATAMENTE. SI USTED NO TIEN SIGUIENTE OFICINA. ESTA OFICINA ] CERCA DE COMO CONSEGUIR UN ABOG. DOCUMENTO A SU ABOGADO UN ABOGADO, LLAME O VAYA A LA EDE PROVEERLE INFORMACION A 10. SI USTED NO PUEDE PAGAR POR LOS SERVICIOS DE UN ABOGADO, ES POSIBLE QUE ESTA OFICINA LE PU DA PROVEER INFORMACION SOBRE AGENCIAS QUE OFREZCAN SERVICIOS EGALES SIN CARGO O BAJO COSTO A PERSONAS QUE CUALIFICAN. CUMBERLAND COUr 2 Liberi Carlisle, (717)-14 BAR ASSOCIATION Avenue A 17013 )-3166 SCHMIDT KRAMER PC BY: GERARD C. KRAMER, ESQUIRE Attorney I.D. No. 44715 209 State Street Harrisburg, PA 17101 (717) 232-6300 Fax No. (717) 232-6467 Attorneys for Plaintiffs HEATHER YATES, INDIVIDUALLY AND CAMPBELL L. YATES, A MINOR BY HEATHER YATES, PARENT AND NATURAL GUARDIAN, Plaintiff V. D AND J TRUCK REPAIR, INCORPORATED AND CURTIS D. DAGUE, Defendant : IN HE COURT OF COMMON PLEAS C BERLAND COUNTY, PE NSYLVANIA No 06-4491 C11 L ACTION - LAW : JU Y TRIAL DEMANDED AND NOW, comes the Plaintiff, attorneys, SCHMIDT KRAMER PC, and re THER YATES, by and through her sets forth as follows: 1. The Plaintiff, Heather Yates, is an adult individual living at 1265 Goodyear Road, Gardners, Cumberland 2. The Defendant, D and J corporation with a business address Pennsylvania. 3. The Defendant, Curtis D. ty, Pennsylvania. Repair, Incorporated, is a Pennsylvania of 25 Hershey Road, Shippensburg, , is an adult individual that resides at 8475 Roxbury Road, Lurgan, Pennsyl 4. At all times relevant hereto, servant employee in the course and Repair, Incorporated. 5. The facts and occurrences 2004 at the intersection of Upper Bermudi endant Curtis D. Dague is an agent of employment with D and J Truck :inafter took place on September 24, Road and State route 34/Carlisle Road in Adams County Pennsylvania. 6. At the time of the accident eather Yates was operating a Chevrolet Cavalier owned Pennsylvania Departmen of General Services traveling South on State Route 34/Carlisle Road. 7. Defendant, Curtis Dague was Truck Repair, also traveling South on Sti Heather Yates. 8. perating a GMC Truck owned by D and J Route 34/Carlisle Road directly behind Heather Yates slowed at the intersection of State Route 34/Carlisle Road and Upper Bermudian Road in Bermudian Road. or er to take a left hand turn onto Upper 9. The Defendant failed to ob erve the Plaintiff slowing and hit the Plaintiff's vehicle in the rear which causin injuries to the Plaintiff Heather Yates as set forth below. 10. Heather Yates was not in a p ivate passenger vehicle at the time of the accident, therefore is entitled to be treated as to have elected full tort. I 11. Paragraphs 1 through 10 are ' corporated herein by reference and made a part thereof as if set forth in full. 12. The accident was caused by Defendant, Curtis Dague and was in no Plaintiff Heather Yates. 13. The negligence and carele consisted of the following: a. b. C. d. f. 9. h. i. negligence and carelessness of the caused or contributed to by the of the Defendant, Curtis Dauge inattentiveness; distraction; failing to have his ve icle under proper and adequate control; negligently applying the rakes; failing to observe the Pla intiff, Heather Yates', vehicle on the roadway; failing to drive at a spee d and in a manner that would allow him to stop within the a sured clear distance ahead; failing to operate his veh icle in accordance with existing traffic controls and cond itions; failure to use a high deg ree of care for individuals turning in an intersection; and failing to keep a reasona ble lookout for other vehicles - lawfully on the road. 1 14. As a factual result of the suffered injuries which are severe and include the following: a. injury to her shoulder; b. injury to her face in the c. contusion to her face aY d. concussion; e. Low back pain; and f. disc herniation. 15. As a factual result of the incurred medical expenses to date and ident, the Plaintiff, Heather Yates, believed to be permanent which ;ht occipital area; shoulder; t, the Plaintiff, Heather Yates, has continue to incur medical expenses into the future, and thus, a claim for thesi expenses is made. 16. As a factual result of the accid nt, the Plaintiff, Heather Yates, has been advised and, therefore avers, that the injuries may be permanent in nature and effect, and thus, a claim for the e injuries is made. 17. As a factual result of the accide nt, the Plaintiff, Heather Yates, has undergone in the past, and will continue to undergo in the future, great pain and suffering, and thus, a claim for these i njuries is made. 18. As a factual result of the accid nt, the Plaintiff, Heather Yates, may be obliged to spend various sums of money and to incur various expenses for the injuries that he has suffered and may c ontinue to incur the same in the future, and thus, a claim for these losses i made. 19. As a factual result of the accid nt, the Plaintiff, Heather Yates, has suffered a permanent diminution of his abi ity to enjoy life and life's pleasures, and thus, a claim for these losses is made. 20. As a factual result of the accid nt, the Plaintiff, Heather Yates, has suffered a loss of earnings and an impair nt of his earning power and capacity in the future, and thus, a claim f these losses is made. WHEREFORE, the Plaintiff, Heather Yates, demands judgment against the Defendant, Curtis Dauge, in an amou in excess of an amount requiring compulsory arbitration. .TES v. 21. Paragraphs 1 through 20 are made a part thereof as if set forth in full. 22. Defendant Curtis Dague was an herein by reference and servant employee with D and J Truck Repair, Incorporated acting in the course aid scope of his employment. WHEREFORE, Plaintiff, Heather Yates, prays this Honorable Court grant judgment in her favor and against D and Truck Repair in an amount in excess of the amount requiring compulsory arbitrate n. Respe tfully submitted, SCH IDT KRAMER PC DATED: '11,116 By ycI U1 %,. ni auici Attorn y at Law Attorn ey I.D. No. 44715 209 St ate Street Harris urg, PA 17101 (717) 32-6300 Attorn v for Plaintiff 04/01/10 13:07 FAX 7177317093 BUR OF CO" ICORR/HQ Z001 I, HEATHER YATES, verify that I am the Plaintiff in the foregoing action and that the attached Complaint is based upon information which has been gathered by my counsel in the preparation f this lawsuit. The language of the Complaint to the extent that it is based u on information that I have given to my counsel is true and correct to the be, belief. To the extent that the contents of relied upon counsel making this Verificati I understand that intentional false penalties of 18 Pa. C.S.A. § 4904 of my knowledge, information and Complaint are that of counsel, I ;nts herein are subject to the to unsworn falsifications to authorities. Date: 212 ('/1 0 JA&A""A- YATES Johnson, Duffie, Stewart & Weidner C p ' By: Jefferson J. Shipman r d D f f A p I.D. No. 51785 *W; en or e ttorneys ? 301 Market Street P. O. Box 109 ,:, -" r?c > Lemoyne, Pennsylvania 17043-0109 r s ?! (717) 761-4540 - 5 jjs@jdsw.com z , HEATHER YATES, individually, and CAMPBELL L. YATES, a minor, by HEATHER YATES, parent and natural guardian, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 06-4491 Plaintiffs V. D & J TRUCK REPAIR, INC. and CURTIS D. DAGUE, Defendants CIVIL ACTION - LAW JURY TRIAL DEMANDED PRAECIPE TO ENTER APPEARANCE AND NOW, this 19th day of April, 2010, enter the appearance of JEFFERSON J. SHIPMAN, I.D. 51785, on behalf of Defendants in the above captioned suit. JOHNSON, DUFFIE, STEWART & WEIDNER jz'ja - - - - X&I - e rson J. Shi man :398338 CERTIFICATE OF SERVICE AND NOW, this 19th day of April, 2010, the undersigned does hereby certify that she did this date serve a copy of the foregoing document upon the other parties of record by causing same to be deposited in the United States Mail, first class postage prepaid, at Lemoyne, Pennsylvania, addressed as follows: Gerard C. Kramer, Esquire Schmidt Kramer, P.C. 209 State Street Harrisburg, PA 17101 JOHNSON, DUFFIE, STEWART & WEIDNER By: elle H. Spangler 398338 ,. iIV SCHMIDT KRAMER PC BY: GERARD C. KRAMER, ESQUIRE 2d+~ ~'~~ ! `~ ~'~ g' ~~ Attorney I.D. No. 44715 209 State Street Harrisburg, PA 17101 CV~~~~.==~-i~~'~t'~:~ ;:~J~+~i (717) 232-6300 r~Ei~P•a~`l~1l~~'d1A Fax No. (717) 232-6467 Attorneys for Plaintiffs gl~amer(a~schmidtla-amer.com HEATHER YATES, IN THE COURT OF COMMON PLEAS INDIVIDUALLY AND CAMPBELL CUMBERLAND COUNTY, L. YATES, A MINOR BY PENNSYLVANIA HEATHER YATES, PARENT AND NATURAL GUARDIAN, Plaintiff v. D AND J TRUCK REPAIR, INCORPORATED AND CURTIS D. DAGUE, Defendant No. 06-4491 CIVIL ACTION -LAW JURY TRIAL DEMANDED PLAINTIFF'S ANSWER TO DEFENDANT'S NEW MATTER AND NOW, comes the Plaintiff, HEATHER YATES, by and through her attorneys, SCHMIDT KRAMER PC, and respectfully sets forth as follows: 23. Paragraph 23 states a conclusions of law to which no response is necessary. 24. Paragraph 24 states a conclusions of law to which no response is necessary. 25. Paragraph 25 states a conclusions of law to which no response is necessary. 26. Paragraph 26 states a conclusions of law to which no response is necessary. { 27. Paragraph 27 states a conclusions of law to which no response is necessary. 28. Paragraph 28 states a conclusions of law to which no response is necessary. 29. Paragraph 29 states a conclusions of law to which no response is necessary. WHEREFORE, Plaintiff, Heather Yates, respectfully request that the new matter be dismissed and judgment be entered in Plaintiff's favor. Respectfully submitted, SCHMIDT KRAMER PC DATED : ~ ~ ~ a 1) ~ By Berard C. Kramer Attorney at Law Attorney I.D. No. 44715 209 State Street Harrisburg, PA 17101 (717) 232-6300 Attorney for Plaintiff ATTORNEY VERIFICATION I, Gerard C. Kramer, Esquire, verify that I am attorney of record for the Plaintiff. I verify that the facts contained in the foregoing document are true and correct to the best of my knowledge, information and belief. I understand that intentional false statements herein are made subject to the penalties of 18 Pa. C.S.A. ~ 4904 relating to unsworn falsifications to authorities. Date: ~ I ~ Z~ I b rard C. Kramer, Esquire CERTIFICATE OF SERVICE AND NOW, this ~ day of ~~~ , 2010, I, Ashley N. Burris, hereby certify that I have this day served a true and correct copy of the attached Plaintiff s Reply to Defendant's New Matter by depositing a copy of the same in the United States Mail, postage prepaid, at Harrisburg, Pennsylvania, addressed to: Jefferson J. Shipman, Esquire Johnson Duffie 301 Market Street Lemoyne, PA 17043-1628 Respectfully submitted, SCHMIDT KRAMER PC DATED: S/~~/~d By: i~(/ ,~````~-.- Ashley N. urris Johnson, Duffle, Stewart b Weidner By: Jefferson J. Shipman I.D. No. 51785 301 Market Street P. O. Box 109 Lemoyne, Pennsylvania 17043-0109 (717) 761-4540 jjs~jdsw.com HEATHER YATES, individually, and CAMPBELL L. YATES, a minor, by HEATHER YATES, parent and natural guardian, Plaintiffs v. D & J TRUCK REPAIR, INC. and CURTIS D. DAGUE, Defendants CIVIL ACTION -LAW JURY TRIAL DEMANDED CERTIFICATE PREREQUISITE TO SERVICE OF A SUBPOENA PURSUANT TO RULE 4009.22 TO: Gerard C. Kramer, Esquire Schmidt Kramer, P.C. 209 State Street Harrisburg, PA .17101 Attorneys for Plaintiffs As a prerequisite to service of a subpoena for documents and things pursuant to Rule 4009.22, Defendant hereby certifies that: (1) A Notice Of Intent To Serve A Subpoena, with copies of the subpoenas attached thereto, was mailed, via Certified Mail, or delivered to each party at least twenty days prior to the date on which the subpoenas were sought to be served; (2) A copy of the Notice of Intent including the proposed subpoenas, is ~~L~^i. ~P i 4' ; i~ T it _ n•~ ,201 o cWL a1 Pw(t ~ ~ Attorn~~f~.~1e~~id~iitis ~ ~ W Gil,,. ,..... , . ~~ ~ i •i`i; V' IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 06-4491 CIVIL attached to this Certificate; (3) No objection to the subpoenas has been received, the waiting period for objections was waived; and (4) The subpoenas to be served are identical to the subpoenas attached to the Notice Of Intent. DATE: ~ ~ `~ JOHNS , DUFFIE, STEWART & WEIDNER By: J e on J. Ship an, Esquire Attorney I.D. No. 51785 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Attorneys for Defendant CERTIFICATE OF SERVICE AND NOW, this _~~ day o , 2010, the undersigned does hereby certify that he did this date serve a copy o he foregoing document upon the other parties of record by causing same to be deposited in the United States Mail, first class, first class postage prepaid, at Lemoyne, Pennsylvania, addressed as follows: Gerard C. Kramer, Esquire Schmidt Kramer, P.C. 209. State Street Harrisburg, PA 17101 Attorneys for Plaintiffs JOHNSON, DUFFIE, STEWART 8~ WEIDNER ,: Y~ fF rson J. hip n, Esquire Johnson, Duffle, Stewart & Weidner By: Jefferson J. Shipman I.D. No. 51785 301 Market Street P. O. Box 109 Lemoyne, Pennsylvania 17043-0109 (717) 761-4540 jjs@jdsw.com HEATHER YATES, individually, and CAMPBELL L. YATES, a minor, by HEATHER YATES, parent and natural guardian, Plaintiffs v. D & J TRUCK REPAIR, INC. and CURTIS D. DAGUE, Defendants Attorneys for Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 06-4491 CIVIL CIVIL ACTION -LAW JURY TRIAL DEMANDED NOTICE OF INTENT TO SERVE SUBPOENA TO PRODUCE DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO RULE 4009.21 TO: Gerard C. Kramer, Esquire Schmidt Kramer, P.C. 209 State Street Harrisburg, PA 17101 Attorneys for Plaintiffs PLEASE TAKE NOTICE that Defendants intend to serve fiive (5) subpoenas identical to the ones that are attached to this notice. You have twenty (20) days from the date listed below in which to file of records and serve upon the undersigned objections to the subpoena. If no objections are made, the subpoenas may be served. JOHN~N, DUFFIE, STEWART & WEIDNER By: 6~•caM.. efferson J. Shipman, Esquire Attorney I.D. No. 51785 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 DATE: '1 J13~1 ~ Attorneys for Defendant CERTIFICATE OF SERVICE AND NOW, this ~~' day of ~ l~( , 2010, the undersigned does hereby certify that he did this date serve a cop of the foregoing document upon the other parties of record by causing same to be deposited in the United States Mail, certified, first class postage prepaid, at Lemoyne, Pennsylvania, addressed as follows: Gerard C. Kramer, Esquire Schmidt Kramer, P.C. 209 State Street Harrisburg, PA 17101 Attorneys for Plaintiffs JOHNSO , DUFFIE, STEWART & WEIDNER 6 t~~c.. By: Jefferson J. Shipman, Esquire COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Heather Yates and Campbell L. Yates, Plaintiffs vs. File No. 06-4491 D 8 J Truck Repair, Inc. and Curtis D. Dague, Defendants SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: Carlisle Regional Medical Center (Name of Person or Entity) Within twenty (20) days after service ofthis subpoena, you are ordered by the court to produce the following documents or things: Anv and all medical records. resorts, dias~nostic test results. at Johnson. Duffle. Stewart & Weidner. 301 Market Street. P.O. Box 109. Lemovne. PA 17043. You may deliver or mail legible copies of the documents or produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek in advance the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: NAME: ADDRESS: TELEPHONE: SUPREME COURT ID #: ATTORNEY FOR: DATE: 01 / Se I of he Court Jefferson J. Shipman. Esquire 301 Market Street Lemovne. PA 17043 717-761 X540 51785 Defendants BY THE COURT: Prothonotary/Clerk, Civil Division D uty (Eff. 7/97) COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Heather Yates and Campbell L. Yates, Plaintiffs vs. File No. 06-4491 D & J Truck Repair, Inc. and Curtis D. Dague, Defendants SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: Walnut Bottom Radiology (Name of Person or Entity) Within twenty (20) days afterservice of this subpoena, you are ordered by the court to produce the following documents or things: All medical records. reuorts. diagnostic test results, including MRI Lumbar spine (actual film or CDl dated 10/20/04 regarding Heather Yates DOB: 9/4/71 SSN: 1948-8238 at Johnson. Duffle. Stewart 8 Weidner. 301 Market Street. P.O. Box 109. Lemovne. PA 17043. You may deliver or mail legible copies of the documents or produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek in advance the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: NAME: ADDRESS: TELEPHONE: SUPREME COURT ID #: ATTORNEY FOR: DATE: 7 ~a /O Sea of a Court Jefferson J. Shipman. Esouire 301 Market Street Lemovne. PA 17043 717-761-4540 . 51785 Defendants (Eff. 7197) BY THE COURT: COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Heather Yates and Campbell L. Yates, Plaintiffs vs. File No. 06-4491 D & J Truck Repair, Inc. and Curtis D. Dague, Defendants SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: Mas~netic Imaainst Center (Name of Person or Entity) 1IV'~thin twenty (20) days after service of this subpoena, you are ordered by the court to produce the following documents or things: All medical records, resorts. dias~nostic test results, including at Johnson Duffle Stewart 8 Weidner 301 Market Street. P.O. Box 109. Lemovne. PA 17043. You may deliver or mail legible copies of the documents or produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek in advance the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: NAME: Jefferson J. Shiaman. Esquire ADDRESS: 301 Market Street Lemoyne. PA 17043 TELEPHONE: 717-761-4540 SUPREME COURT ID #: 51785 ATTORNEY FOR: Defendants BY THE COURT: : L r honotary/Clerk, Civil Division De u P tY DATE: Seal f t e Court (Eff. 7/97) COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Heather Yates and Campbell L. Yates, Plaintiffs vs. File No. 06-4491 D & J Truck Repair, Inc. and Curtis D. Dague, Defendants SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: Masland Associates s (Name of Person or Entity} Within hventy (20) days after servicaof this subpoena, you are ordered by the court to produce the following documents or things: Anv and all medical records. resorts. dias~nostic test results. correspondence office notes. resaardins~ Heather Yates DOB: 9/481 SS: 194-58-8238 at Johnson Duffle Stewart & Weidner. 301 Market Street. P.O. Box 109. Lemovne. PA 17043. You may deliver or mail legible copies of the documents or produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek in advance the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: NAME: ADDRESS: TELEPHONE: SUPREME COURT ID #: ATTORNEY FOR: DATE: / /O Seal f t e Court Jefferson J. Shipman. Esquire 301 Market Street Lemovne. PA 17043 717-761-4540 51785 Defendants (Eff. 7/97) BY THE COUNT: COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Heather Yates and Campbell L. Yates, vs. Plaintiffs File No. 06-4491 D & J Truck Repair, Inc. and Curtis D. Dague, Defendants SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: Orthosedlc Institute of Pennsylvania (Name of Person or Entity) Within twenty (20) days after service df this subpoena, you are ordered by the court to produce the following documents or things: Anv and all medical records. resorts. dias~nostic test results. corressondence, office notes. res~ardins~ Heather Yates DOB: 9/4/71 SS: 194-58-8238 at Johnson. Duffle. Stewart 8 Weidner. 301 Market Street. P.O. Box 109. Lemoyne. PA 17043. You may deliver or mail legible copies of the documents or produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek in advance the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: NAME: Jefferson J. Shiuman. Esouire ADDRESS: 301 Market Street Lemoyne. PA 17043 TELEPHONE: 717-761-4540 SUPREME COURT ID #: 51785 ATTORNEY FOR: Defendants BY THE COURT: s ~. rothonotary/Clerk, Civil Division De u DATE: /dt / Seal f the Court (Eff. 7/9~ Johnson, Duffle, Stewart & Weidner By: Jefferson J. Shipman I.D. No. 51785 301 Market Street P. O. Box 109 Lemoyne, Pennsylvania 17043-0109 (717) 761-4540 bsojdsw.com HEATHER YATES, individually, and CAMPBELL L. YATES, a minor, by HEATHER YATES, parent and natural guardian, Plaintiffs V. D & J TRUCK REPAIR, INC. and CURTIS D. DAGUE, Defendants TO: Gerard C. Kramer, Esquire Schmidt Kramer, P.C. 209 State Street Harrisburg, PA 17101 Attomeys for Plaintiffs CIVIL ACTION - LAW JURY TRIAL DEMANDED As a prerequisite to service of a subpoena for documents and things pursuant to Rule 4009.22, Defendant hereby certifies that: (1) A Notice Of Intent To Serve A Subpoena, with copies of the subpoenas attached thereto, was mailed, via Certified Mail, or delivered to each party at least twenty days prior to the date on which the subpoenas were sought to be served; (2) A copy of the Notice of Intent including the proposed subpoenas, is Attomeys for Defendants IN THE COURT OF COMMON PLEAS bF CUMBERLAND COUNTY, PENNSYL'? NIA: NO. 06-4491 CIVIL attached to this Certificate; (3) No objection to the subpoenas has been received, the waiting period for objections was waived; and (4) The subpoenas to be served are identical to the subpoenas attached to the Notice Of Intent. JOHNS N, DUFFIE, STEWART & WEIDNER By: tffersoni J. Shipman, Esquire ttmey I .D. No. 51785 o 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 DATE: 91 l a I iQ Attorneys for Defendant CERTIFICATE OF SERVICE 2010, the undersigned does AND NOW, this ? day of A& i hereby certify that he did this date serve a copy of the foregoing document upon the other parties of record by causing same to be deposited in the United States Mail, first class, first class postage prepaid, at Lemoyne, Pennsylvania, addressed as follows: Gerard C. Kramer, Esquire Schmidt Kramer, P.C. 209 State Street Harrisburg, PA 17101 Affomeys for Plaintiffs JOHNSON, DUFFIE, STEWART & WEIDNER By: fferson J. Shipman, Esquire Johnson, Duffle, Stewart & Weidner By: Jefferson J. Shipman I.D. No. 51785 Attorneys for Defendants 301 Market Street P. O. Box 109 Lemoyne, Pennsylvania 17043-0109 (717) 761-4540 bs@jdsw.com HEATHER YATES, individually, and IN THE COURT OF COMMON PLEAS OF CAMPBELL L. YATES, a minor, by CUMBERLAND COUNTY, PENNSYLVANIA HEATHER YATES, parent and natural guardian, NO. 06-4491 CIVIL Plaintiffs CIVIL ACTION - LAW V. : JURY TRIAL DEMANDED D & J TRUCK REPAIR, INC. and CURTIS D. DAGUE, Defendants OT! OF INTENT TO SERVE S O TO PRODUCE DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO 4009.21 TO: Gerard C. Kramer, Esquire Schmidt Kramer, P.C. 209 State Street Harrisburg, PA 17101 Attorneys for Plaintiffs PLEASE TAKE NOTICE that Defendants intend to serve two(2) subpoenas, identical to the ones that are-attached to this notice. You have twenty (20) days from the date listed below in which to file of records and serve upon the undersigned objections to the subpoena. If no objections are made, the subpoenas may be served. JOHNS 'PT, DUFFIE, STEWART & WEIDNER By: J erson J. Shipman, Esquire Attorney I.D. No. 51785 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 DATE: ?? $J t Attorneys for Defendant CERTIFICATE OF SERVICE C-A day of AU a U- 2010, the undersigned does AND NOW, this _ hereby certify that he did this date serve a copy of the foregoing document upon the other parties of record by causing same to be deposited in the United States Mail, certified, first class postage prepaid, at Lemoyne, Pennsylvania, addressed as follows: Gerard C. Kramer, Esquire Schmidt Kramer, P.C. 209 State Street Harrisburg, PA 17101 Attorneys for Plaintiffs JOHNSON, DUFFIE, STEWART & WEIDNER fferson J. Shipman, Esquire COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Heather Yates and Campbell L. Yates, vs. Plaintiffs File No. 06-4491 D & J Truck Repair, Inc. and Curtis D. Dague, : Defendants SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: Vleanstic imaging Center (Name of Person or Entity) Within twenty (20) days after service of this subpoena, you are ordered by the court to produce the following documents or things: All medical records, reports, diagnostic test mlau ta, including at Johnson. Duffie. Stewart & Weidner. 301 Market Street. P.O. Box 109. Lemoyne. PA 17043. You may deliver or mail legible copies of the documents or produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek in advance the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling your to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: NAME: Jefferson J. Shipman. Esquire ADDRESS: 301 Market Street Lemoyne, PA 17043 TELEPHONE: 717-7614540 SUPREME COURT ID 51785 ATTORNEY FOR: Defendants BY HE COURT: PiFt notary/Clerk, 7^:Af Division Deputy DATE: _ Se of he Court (Eff. 7/97) COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Heather Yates and Campbell L. Yates, Plaintiffs vs. D & J Truck Repair, Inc. and Curtis D. Dague, Defendants File No. 06-4491 SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: Draver Physical Therapy Institute (Name of Person or Entity) Within twenty (20) days after service of this subpoena, you are ordered by the court to produce the following documents or things: Any and all medical records. ohvslral therapy tjggo. repo at Johnson Duffle Stewart & Weidner. 301 Market Street P.O. Box 109. Lemoyne. Pfd 17043. You. may deliver or mail legible copies of the documents or produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek in advance the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: NAME: ADDRESS: TELEPHONE: SUPREME COURT ID #: ATTORNEY FOR: Deputy DATE: 8 Sea o the Court Jefferson J. Shipman. Esquire 301 Market Street Lemoyne. PA 17043 717-7614540 51785. Defendants (EfP. 7197) F_.! 140N0 TA -N? FEB 98 M 11: 08 JOHNSON, DUFFIE, STEWART & WEIDNER By: Jefferson J. Shipman I.D. No. 51785 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 (717) 761-4540 jjs@jdsw.com CUMBERLAND COUNT`' ')ENNSYLVANIA Attorneys for Defendants HEATHER YATES, individually, and CAMPBELL L. YATES, a minor, by HEATHER YATES, parent and natural guardian, Plaintiffs V. D & J TRUCK REPAIR, INC. and CURTIS D. DAGUE, Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 06-4491 CIVIL ACTION - LAW JURY TRIAL DEMANDED PRAECIPE TO MARK THE DOCKET SETTLED, SATISFIED AND DISCONTINUED TO THE PROTHONOTARY: Kindly mark the above docket settled, satisfied and discontinued. SCHMIDT KRAMER PC By: Gerard C. Kramer, Esquire Counsel for Plaintiffs DATE: 17 ( 2_- 481180 JOHNSON, DUFFIE, STEWART & WEIDNER A p By. Z41 I , J e n J. Sh' man, Esquire Counsel for Defendants DATE: (l Z