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Home My WebLink About02-22222002 IN RE: PETITION OF CHRISTINE ANDELA, ADMINISTRATRIX OF THE ESTATE OF JOHN D. ANDELA, DECEDENT, Petitioner AND NOW, this day of 2002, upon consideration of the Petition for Approval of a Compromise Settlemen~dDistribution of Proceeds Pursuant to Pa.R.C.P. 2206, IT IS HEREBY ORDERED THAT: (1) The settlement of Christine Andela, Administratrix of the Estate of John D. Andela, is hereby approved and the proceeds will be allocated as follows: (a) Estate of John D. Andela, deceased, under the Survival Action $10,994.40 (b) Estate of John D. Andela, deceased, under the Wrongful Death Action $43,977.60 (c) Angino & Rovner, P.C., professional fees based on 30% of the gross amount recovered $24,000.00 (d) Reimbursement of out-of-pocket expenses $ 1,028.00 TOTAL PRESENT DISTRIBUTION $80,000.00 BY THE COURT: 244672. BDLLLMTG IN RE: PETITION OF CHRISTINE ANDELA, ADMINISTRATRIX OF THE ESTATE OF JOHN D. ANDELA, DECEDENT, Petitioner PETITION FOR APPROVAL OF A COMPROMISE SETTLEMENT AND DISTRIBUTION OF PROCEEDS PURSUANT TO Pa.R.C.P. 2206 The Petitioner, Christine Andela, Administratrix of the Estate of John D. Andela, deceased, by and through her attorneys, Angino & Rovner, P.C., hereby avers as follows: 1. Your Petitioner is the Administratrix of the Estate of John D. Andela, deceased, by Letters of Administration granted to her by the Register of Wills of York County, Commonwealth of Pennsylvania. The Letters of Administration were granted on July 16, 2001, and attached as Exhibit A is a copy of the Grant of Letters. 2. The decedent, John D. Andela, was the husband of the Petitioner, Christine Andela. The decedent was bom on February 12, 1966, and died on June 26, 2001, as a result of a motor vehicle accident occurring in Cumberland County, Pennsylvania. 3. Immediately before the subject fatal motor vehicle accident on June 26, 2001, the decedent was operating a delivery truck, traveling in an eastbound direction on Trindle Road, Cumberland County, Pennsylvania. 4. James R. Pruitt had been operating a tractor-trailer in an eastbound direction on Trindle Road and had stopped his tractor-trailer on the west end of a railroad bridge near the 500 block of Trindle Road in Hampden Township. It is believed that Mr. Prultt stopped his truck because he thought that the truck and trailer would not fit under the 13' 6" clearance of the bridge. 244672.1 ~DLL~VITG o delivery van behind Pruitt's trailer. trailer would fit under the bridge. Given the stopped tractor-trailer on Trindle Road, the decedent stopped his Pruitt asked the decedent whether he thought the tractor- After discussion, the decedent offered to stand beside the tractor-trailer and watch the top of the tractor-trailer as Mr. Pruitt drove under the bridge. 6. While the decedent was guiding Mr. Pruitt and the tractortrailer under the bridge, Heather K. Frampton was operating a Nissan Sentra, traveling westbound on Trindle Road. 7. As Ms. Frampton drove under the railroad bridge, the front of her vehicle struck the decedent. John D. Andela died as a result of the motor vehicle accident. Attached as Exhibit B is the Hampden Township Police Accident report. 8. State Farm Insurance Company provides liability insurance coverage to Heather K. Frampton relevant to the subject fatal motor vehicle accident. 9. Although disputing liability for the fatal motor vehicle accident, State Farm has agreed to pay and compromise the disputed claim arising from the subject motor vehicle accident and offer $80,000.00 of its policy limits of $100,000.00. Attached as Exhibit C is James Ramsey's April 3, 2002, letter and proposed Joint Tortfeasor Release. 10. Petitioner contemplates, subject to approval of Your Honorable Court, executing the joint tortfeasor release, releasing Heather K. Frampton and State Farm, while preserving a claim against James R. Pmitt and his employer, Covenant Transport, Inc., and Southern Refrigerated Transport. 11. In view of the disputed claim and uncertainty of securing a verdict in the Court of Common Pleas of Cumberland County, Petitioner considers the $80,000.00 offer to be fair, just, and equitable and in the best interests of the Estate. 244672.1 \DLL~ITG 2 12. Petitioner retained the law firm of Angino & Rovner to prosecute this action and entered into a Contingency Fee Agreement with said attorneys for their professional services of any amount recovered, plus expenses. A copy of the Power of Attorney and Fee Agreement is attached hereto as Exhibit D. 13. Pursuant to the Power of Attorney and Fee Agreement, Angino & Rovner seeks to receive 30% of the gross amount recovered, plus expenses. 14. Angino & Rovner, as attorneys for the Petitioner, has incurred expenses for the investigation, procurement of records, and other out-of-pocket expenses totaling $1,028.70. Attached as Exhibit E is a computer print-out of expenses. 15. Petitioner's counsel has received approval of the allocation between the Wrongful Death Action (80%) and Survival Action (20%) from the Department of Revenue. See, Paul Dibert's April 11, 2002, letter fi'om the Department of Revenue, attached as Exhibit F. 16. Petitioner believes that a fair, just, and equitable distribution would be as follows: (a) Estate of John D. Andela, deceased, under the Survival Action $10,994.40 (b) Estate of John D. Andela, deceased, under the Wrongful Death Action $43,977.60 (c) Angino & Rovner, P.C., professional fees based on 30% of the gross amount recovered $24,000.00 (d) Reimbursement of out-of-pocket expenses $ 1,028.00 TOTAL PRESENT DISTRIBUTION $80,000.00 WHEREFORE, Petitioner prays Your Honorable Court to enter an Order approving said compromised settlement, directing the distribution of the proceeds in accordance with the 244672. I~DLLhMTG 3 averments of this Petition, and authorizing the Petitioner, as the Administratrix of the Estate of John D. Andela, and execute the joint tortfeasor release. Date: ANGINO & ROVNER, P.C. David L. ~Lutz~ I.D. No. 35956 4503 N. Front Street Harrisburg, PA 17110 (717) 238-6791 Attorney for Petitioner 244672. I~DLLWITG 4 VERIFICATION I, Christine Andela, Administmtrix of the Estate of John D. Andela, deceased, Petitioner, hereby verify that the facts set forth in the foregoing document are true and correct to the best of my knowledge, information and belief. I understand that any false statements therein are made subject to the penalties of 18 Pa.C.S.A. §4904, relating to unswom falsification to authorities. WITNESS: ]~_l~il~e~ _A?dela, Administratrix of the Estate of John D. Andela 244672.BDLL~MTG Exhibit A Register of Wills of YORK County, Pennsylvania Certificate of Grant of Letters No. 6701-01024 ESTATE OF ANDELA JOHN DANIEL WHEREAS, kK COUNTY WHEREA~, the grant of letters of required for the administration of Late of WARRINGTON TOWNSHIP Deceased Social Security No. 146-62-6003 ANDELA JOHN DANIEL late of WARRINGTON TOWNSHIP , died on the __ June 2001; 26th day of administration the estate. THEREFORE, I, BRADLEY C JACOBS , Register of Wills and for the County of YORK , in the · monwealth of Pennsylvania, have this day granted Letters of Administration to ANDELACHRISTINEA ) has duly qualified as administrator(rix) of the estate the above named decedent and has agreed to administer the estate according law, all of which fully appears of record in my Office at YORK ]NTY COURT HOUSE, YORK, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal my Office on the 16th day of July 2001. ~glsE~r OI Wills Exhibit B J COf~IMON~,EALTH OF PENff' ,LVANIA POLICE CRASH REPORTING. JRM New Crash Number ,0140974 Case Closed Page: C) Continuation AA 45 1 1 ~ Yes 0 No Incident Number Police Agency Patrol Zone Agency Name Precinct Investigation Date (MM-DD-YYYY) I[ I Dispatch Time (mi~ Arrival Time (mih Investigator Badge Number County Coun~ Name Municipali~ Municipality Name Day of Week ~ Tue 0 Sat :1ol 1- -I 1olo ~ Complete ~45F1 O Wed ~ Unk Repo~able Crash Noti~ Highway Maintenance S(hool ~us Related Schoot Zone Related PennDOT Prope~ ~ Yes O No O Yes ~ No O Yes ~ NO O Yes ~ No O Yes ~ No Motor Vehicle in O Hit & Run Vehicle O Illegally Parked O Legally ~arked O Non - Motorized Unit Number Delete? Type ~ ~ Transpo~ 0 Unit ~ 0 Pedestrian O Pedestrianin Wheelchair,°n SkateS,ere O Disabledprevious CrashFr°m Owner Last Name (If Pedestrian, $kip to Form AA 45 3 ~) FI MI Telephone Number VIN Model Year Vehicle Make* (If Yes, Complete License Plate Reg. State T~avel Speed *Refer to List on Towe~ To To~ed By To~ A~en~ Phone Vehicle Towed Unit Number 0 Motor V~hide in 0 Mit · ~un Vehlde 0 IR~ally Parked 0 t*~ally Parked 0 Non - Motorized ~ ~ Pedestrian on Skates. Disabled From Delete? ~ Uni~ ~ Pedestrian ~ in Wheelchair, etc ~ Previous Crash ~ Train ~ Phantom Vehicle O~~k~ ~ ~rm ~ ~ 3 1) FI MI Telephone Number ~ J J co.mercia, Vehicle A~dress Ci~ Stat~ Zip ~ Yes VI~ Model ~ar Vehid~ Insurance Company Poli~ No Insurance Company Phone Towed To Tow~ By Tow A~en~ P~one Veh~e ~wed FORM # AA*4S (01101) J ' COMMONWEALTH OF PENN(;YLVANIA [ P'OLiCE chASH REPORTINC JRM AA 45 2 1 Page: Crash Number mNew 0140974 Change/ Unit Number Trailina Unit(s) Number of Trailing I v I Units: Type of Unit 5=Camper 1=Towing Passenger Veh 6=Trailer 2=Towing Truck 7=Semi-Trailer 3=Towing Utility Trailer 8=Other 4=Mobile or Modular Home 9=Unknown Year State Tag Tag No [[ I state Vehicle. Color. ~ 01=Blue 02=Red 0B=Gold 03=White 09=Brown 04=Green 10=Orange 05=Black 11=Purple 06=Yellow 12=Other 07=Silver 99=Unknown initial Imoact Point 09 03 08 04 Vehicle Tree 01=Automobile 02=Motorcycle 03=Bus 04=Small Truck 05=Large Truck 10=Snowmobile 00=Non-Collision 13=Top 14=Undercarria9e 15=Towed Unit 99=Unknown 11=Farm Equip 22=Horse and Buggy 12=Construction Equip 23=Horse and Rider 18=Other Type Special Veh 24--Train 19=Unknown Type Special Veh 25=Trolley 20=Unicycle, Bicycle, Tricycle 98=Other 21=Other Pedalcycle gO=Unknown Saeciel ~ Usaae 12=Commercial 00=Not Applicable Passenger Carrier 01=fire Veh 13=Taxi 02=Ambulance 21=Tractor Trailer 03=Police 22=Twin Trailer 08=Other Emergency 23=Triple Trailer Vehicle 31=Modified Veh 1=Pupil Transport gO=Unknown Damaae Indicator ~ 0=None 1=Minor (Driveable) 2=Functlonal (Moderate Damage, May Not be Dr[veable} 3=Disabling (Severe - Not Drlveable) 9=Unknown Vehicle Role ~ O=Non-ColEsion 1=Striking 2=Struck 3=Both Striking and Struck Vehicle Position 00=Not Applicable 01=Right Lane (Curb) 02=Right Turn Lane 03=Left Lane 04=Left Turn Lane 05=2-Direction Center Turn Lane 06=Other Forward Moving Lane 07=Oncoming Traffic Lane 08=Left of Trafficway 09=Right of Trafficway 10=HOV Lane 11=Shoulder Right 12=Shoulder Left 13=One Lane Road 98=Other gO=Unknown Direction of Travel N=North S=South E=East W=West U=Unknown Movement ~ 07=Entering a Parked Position 01=Going Straight 08=Trying to Avoid Animal, 02=Slowing/Stopping in Lane Ped, Object, Veh, Otc 03=Stopped in Traffic Lane 09=Turnlng Right on Red 04=Passing/Overtaking Veh 10=Turning Right 11=Turning Left on Red 05=Leaving a Parked Position 12=Turning Left 06=Parked 13=Making a U-Turn Unit Number Trailina Unit(s) Number ~ of Trailing I ] Units: Tvoe of Unit 5=Camper 1=Towing Passenger Veh B=Trailer 2=Towing Truck 7=Semi-Trailer 3=Towing Utility Trailer 8=Other 4=Mobile or Modular Home 9=Unknown 14=Backing Up 15=Changing Lanes or Merging 16=Negotiating Curve. Right 17=Negotiating Curve - Left SS=Other Gradient ~ 3=DownhiU 4=Sag/Bottom of Hill 1=Level Roadway 5=Crest/Top of Hill 2=Uphill g=Unknown Alianment [-~9=Unknown2=Curvedl=Straight ITag Year ! Tag State Year State TagNoI Vehicle Color ~ 01=Blue 02=Red 08=Gold 03=White 09=Brown 04=Green 10=Orange 05=Black 11=Purple 06=Yellow 12=Other 07=Silver gO=Unknown Vehicle Tvoe 01=Automobile 02=Motorcycle 03=Bus 04=Small Truck 05=Large Truck 10=Snowmobile 11=Farm Equip 22=Horse and Buggy 12=Construction Equip 23=Horse and Rider 18=Other Type Special Veh 24=Train 19=Unknown Type Special Veh 2S=Trolley 20=Unicycle, Bicycle, Tricycle 9R=Other 21=Other Pedalcycle 99=Unknown Special ~ U;~age 12=Commercial 00=Not Applicable Passenger Carrier 01=Rte Veh 13=Taxi 02=Ambulance 21=Tractor Trailer 03=Police 22=Twin Trailer 08=Other Emergency 23=Triple Trailer Vehicle 31=Modified Veh 11=Pupil Transport 99=Unknown Initial Impact Point 10~2 09 03 08 04 00=Non-Collision 13=Top 14=Undercarriage 15=Towed Unit 99=Unknown Damaae Indicator ~-~ 0=None 1=Minor (Driveable) 2=Functional (Moderate Damage, May Not be Driveable) 3=Disabling (Severe - Not Driveable) 9=Unknown Vehicle Role ~ 0=Non-Collision 1=Striking 2=Struck 3=Both Striking and Struck Vehicle Position ~-~ 00=Not Applicable 01=Right Lane (Curb) 02=Right Turn Lane 03=Left Lane 04=Left Turn Lane O5=2-Direction Center Turn Lane 06=Other Forward Moving Lane 07=Oncoming Traffic Lane 08=Left of Trafficway gO=Right of Trafficway 10=HOV Lane 11=Shoulder Right 12=Shoulder Left 13=One Lane Road 98=Other 99=Unknown Direction of ~ ~v~l N=North S=5outh E=East W=We~ U=Unknown 01=Golng Straight 02=Slowing/Stopping in Lane 03=Stopped in Traffic Lane 04=Passing/Overtaking Veh OS=Leaving a Parked Position 06=Parked 07=Entering a Parked Position 08=Trying to Avoid Animal, Pod, Object, Veh, OtC 09=Turning Right on Red 10=Turning Right 11=Turning Left on Red 12=Turning Left 13=Making a U-Turn 14=Backing Up IS=Changing Lanes or Merging 16=Negotiating Curve - Right 17=Negotiating Curve - Left 98=Other 99=Unknown Gradient ~-~ 3=Downhill 4=Sag/Bottom of Hill 1=Level Roadway 5=Crest/Top of Hill 2=Uphill 9=Unknown Alienment ~ 2=Cu~edl=Straight 9=Unknown J COMMONWEALTH OF PENNSYLVANIA Crash Number PO.iCE C.AS..EPO.T, NC .ew 0140974 Unit Number Last Name FI MI Telephone Number Address City State Zip License Number State Alcohol/Dru 5 Sus e~ed ~ Pede~trian Siqnal at S(ene of Crash ~ No O Illeoal Drugs O Medication ~ O No Pedestrian Signal O Not at Inteme~ion O Alcohot O Alcohol and Drugs O Unknown ~ O Pedestrian Signal Alcohol Test Type ~ Pedestrian location O In Roadway O < 10 Feet ~ Test Not Given O Breath O Other ~~ O Marked Crosswalks Off Road Unknown if at Interse~ion O Not in Roadway 10 Feet Blood Urine Test Given ! c O At Interse~ion- No O Median O > Off Road Crosswalks O Ou~ide Trafficway Alcohol Test Results O island ~ Test Refused ~ Unknown ~ ~ Non-lnterse~ion ~~ Resul~ ~ . Crosswalks ~ Shoulder ~ Shar~ Paths/Trail~ ~ Test Given · Contaminated Resu ts ~ ~ Driveway Access ~ Sidewalk ~ Unknown Driver or Pedestrian Physical Condition Vehicle Code List any Vehicle Code Se~ion this driver has ~arged with violated and mark if they were charged. ~olafion? ~ ApparentlYNormal ~ lllegaluse Drug ~ Fatigue '~ Medication I O Had Been O Sick O Asleep O Unknown Yes No Drinking I IOYes O N° Owner/Driver 00=Not Applicable 03=Rented Vehicle 08=Other Municipal Driver Presence Code 01=PHvate Vehicle Owned/ 04=State Police Vehicle Government Vehicle ~ 1=Driver Operated 3=Driver Fled Scene Leased by Driver 05=PennDOT Vehicle 09=Federal Gov Vehicle Vehicle 4=Hit and Run 02=Private Vehicle Not 06=Other State Gov Vehicle 98=Other Owned/Leased by Driver 07=Munidpal Police Vehicle 9~Unknown 2=No Driver ~=Unknown Unit Number Last Name FI MI Telephone Number IAI'I I ILIol I I I [ I I I I I I I Addres~ (i~ State Zip Alcoho~Druqs Susce~ed ,~ Pedestrian Siqnal at Scene of C~sh ~ No ~ illegal Drugs ~ Medication ~ ~ No Pedestrian Signal ~ Not at Inteme~ion ~ Aicohol ~ Alcohol and Drugs ~ Unknown ~ ~ Pedestrian Signal Alcohol Test Type ~ Pedestdan L~ation ~ Test Not Given ~ Breath ~ Other ~ ~ Marked Crosswal~ ~ In Roadway ~ < 10 Feet -- Off Road Unknown if ~ at Inte~ion ~ Not in Roa~ay ~ Blood ~ Urine ~ 10 F~t Te~ Given c ~ At I~e~e~ion - No ~ Median Off Road · Cr~swal~ ~ O~ide Traffi~ay Alcohol Test Results '~ ~ Island ~ ~ ~ ~ Test Refused ~ Unknown ~ ~ Non-lnte~e~ion Resul~ · CrosswaJ~ ~ Shoulder ~ Shared Paths/ Trails · 0 Test Given Con~m naiad Resu ~ ~ 0 Ddveway A~cess ~ Sid~alk 0 Unknown Driver or Pedestrian Physical Condition Vehicle Code Ust any Vehicle C~e ~e~ion this dr~er has ~arg~ with violated and mark if they were charged. Violation? ~ Apparently ~ Illegal Drug ~ Fatigue ~ Medication Normal Use 0 HadBeen [ I~ Yes ~ N° Drinking ~ Sick ~ Asleep ~ Unknown ~ 1~Yes ~ N° Owner/Driver O0=Not Applicable 03=Rented Vehicle 08=~her Municipal Driver ~sence Code 01=Private Vehicle Owned/ ~=State Police Vehicle Government Vehicle ~ 1=Driver O~rated ]=Driver Fled Scene Leased by Driver 05=PennOOT Vehicle 0g=Federal Ggv Vehicle Vehicle 4=H~ and Run 02=Private Vehicle Not 06=Other S~te Gov Vehicle 98=Other Owned/Leased by Driver 07=Municipal Police Vehicle 99=Unknown 2=No Driver 9=Unknown FORM ~ AA-45 (011(]1) PENNBOT COPY J - CQMMONWEALTH OF PENlUC;YLVANIA POLICE CRASH REPORTINC; )RM 454 1 Page: New c~Change/ Continuation Crash Number "0140974 Person Tvoe: l=Driver -- D 2=Passenger 7=Pedestrian 8=Other 9=Unknown Sex~__: F --Female M--Male U =Unknown In'u Severit : l=Killed 2=Major Injury 3=Moderate Injury 4=Minor Injury 9=Unknown Sea t Position: 00=Not A Passenger/Occupant E 01=Drlver- AIl Vehicles 02=Front Seat Middle 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 TruckcabF 11=1n Other Enclosed Passenger Or Cargo Area 12=1n Open Area (Back Of Pickup, Etc.) 13=Trailing Unit 14=Riding On Vehicle Exterior 15=Bus Passenger 98=Other 99=Unknown _Safety Equipment One: 00=None Used / Not Applicable 01=Shoulder Belt Used 02=Lap Belt Used 03=Lap And Shoulder Belt Used 04=Chitd Safety Seat Used 05=Motorcycle Helmet Used 06=Bicycle Helmet Used lO=Safety Belt Used Improperly 11 =Child Safety Seat Used Improperly 12=Helmet Used Improperly gO=Restraint Used, Type Unknown 9g=Unknown Safety Ec~uioment Two: 00=None Used / Not Applicable 01=Front Air Bag Deployed (For This Seat) 02=Side Air Bag Deployed (For This Seat) 03=Other Type Air Bag Deployed 04=Multiple Air Bags Deployed 05=Motorcycle Eye Protection 06=Bicyclist Wearing Elbow/Knee/ Other 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 E~ G 0=Not Applicable 1=Not E ected 2=Totally Ejected 3=Partially Ejected 9=Unknown Eiection Path: H 0=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) I ~cable 1=Not Extricated 2=Extricated By Mechanical Means 3=Freed By Non - Mechanical Means 8=Other Unit No Person No Dateof Birth (MM-DD-YYYY A B C D E F G H Name / Address / Phone EMS Transport HEcFr'"a ,'- q-el 6.A m c,.r I o Ye, No: Unit No Person No Date of Birth (MM-DD-YYYY A R C D E F G H Name / Address / Phone EMS Transport Unit No Person No Date of Birth (MM-DD~YYYY A B C D E F G H Name / Address / Phone EMS Transport O Yes C~ No Unit No Person No Dateof Birth (MM-DD-YYYY A B C D E F G H ' Delete? I-Tql-q o IIIII-lt--Ii-IF-F-II-q-I l-ql-ll-q Name / Address / Phone EMS Transport IOYes C) No U nit No Person No Delete7 Name / Address / Phone Dateof Birth (MM-DD-YYYY A B C D E F G H I--Fq- -I IIIIF-11-1F-Ii-F-I I- FqI-!I--I EMS Transport I(~ Yes (~ Noi U nit No Person No C) . Name / Address / Phone Date of Birth (MM-DD-YYYY A B C D E F G H EMS Transport I C~) Yes (~ No POI~I~E CRASH REPORTING ~M renew 0140974 Intersection Type (~ "Y" Intersection (~ Off Ramp S~oecial Location e Midblock (~) Traffic Circle/ (~) Crossover O Not Applicable (~ Bridge (~ Cross Over Related ~ 4 Way Intersection Round About ~ Underpass ~ Tunnel ~ Driveway/Parking Lot Multi-Leg ~ Railroad Crossing ~ Ramp ~ Toll Booth ~ Ramp & Bridge ~ "T" Intersection ~ Interse~ion ~ On Ramp ~ Other (If "Ramp" is indicated, please see manual) ~ Unknown Complete the Principal Road Se~ion for ail type of crashes. For crashes at interse~ions, enter information in the Inte~e~ing Road Se~ion or the GPS Se~ion. If you have a midbtock, crash, you should enter information in the "Di~ance from Landmark" Se~ion, the GPS Se~ion, or the House Number Se~ion in the Principal Road area. Coun~ Route Number Segment (Optional) Travel Lanes Speed Limit ~ NoAh House Number (if applicable) IIo1 1 1 II I I I I IIIIIII Street Name Street Ending I East '~ ~ West I I I I I I I I o OUnknown Route Si~ning ~ interstate ~ Turnpike ~ Turnpike ~ State ~ Coun~ ~ Local Road ~ Private ~ Other/ (Not Turnpike) (Easiest) Spur Highway R~d or Street Road Unknown ~ County Route Number Segment (Optional) Travel Lanes Speed Limit '~ Street Name Street Ending ~ O East ~ ~ C ~ Unknown ~ Route Siqninq ~ ~ Interstate ~ Turnpike ~ Turnpike ~ State ~ Coun~ ~ L~al Road ~ Private ~ Other/ ~ (Not Turnpike) (Easiest) Spur Highway Road or Street Road Unknown Interse~ing Rt Num Or Mile Post Or Segment Marker > ~ Or Interse~ing Street Name St Ending ~ 0 East ~ Please ~ ~ Enter Isl Isl¢lo I"1 1 I 1' IblLIow' o..,,., ~ for BOTH ~ Landmarks Interse~ing Rt Num Or Mile Post Or Segment Marker (Fo~ ~sh be~een Degrees Minutes S~onds Degrees Minutes S~onds Passive RR TCD Fun~ioninq Traffic Control Device ~ Stop Sign ~ Crossing Controls ' ' ~ Not Appli~ble Device Fun~ioning Emergen~ ~ Flashing Traffic ~ Yield Sign~ FlagmanP°lice Officer or ~ No Controls ~ Improperly ~ Preemptive Signal Device Not Device Fun~oning ~ Unknown ~ Signal ~ Controls ~ A~ive RR Crossing ~ Other Type TCD ~ Fun~ioning Properly ~ Traffic Signal ~ Unknown Type of Work Zone (If "Not a Work Zone ", skip rest of Work Zone se~ion Work Zone (Mark a# that apply) ~ Not a Work Zone ~ ~ne Closure ~ Work on Shoulder ~ Flagger Control or Median ~ Constru~iOnMaintenance ~W°rkBef°reZ°ne LocatiOnlst Work ~ Transition Area ~ RoadDetourCIOs~ with ~ Inte~i~ent or ~ Other Zone Warning Sign © A~ivi~ Area Moving Work Advance Warning ~ Termination Area Work Zone ~ Workers ~ Utili~ Company ~ Area Speed Umit Present I I I Yes No Unknown ~ Other ~ Other Lane Closed (If 'Not App#cable ", skip rest of the Lane CJosure se~ion) i ~ ~ ~ Not Applicable ~ Pa~ialiy ~ Fully ~ Unknown TrafficDetoure~ ~'Yes ~ No ~ Lane Closure Dire~ion E~imated Time Close. ~ 1-3 hours ~ 9-12 hours ~ ~ No~h ~ East ~ No~h and South ~ < 30 Minutes ~ 3-6 hours ~ > 12 hours ~ ~ South ~ West ~ East and West ~ 3~60 Minutes ~ 6-9 hours ~ Unknown PENNDOT COPY Crash Number J ' C]OI'91MON,,WEALTH OF PEP'"$YLVANIA .eL,cE . O.M e ..w 'P 0 Z 4 0 9 7 4 ~ 45 6 i " Page: ~ ~ Change/ ~ Continuation I I [ I ~ I t II - 0=Non-Collislon 2=Head On 4=Angle 6=Sideswipe 8=Hit Pedestrian ~CLCC~2J~ 1=Rear End 3=Rear to Rear 5=Sideswioe (Opposite Direction) (Backing) (Same Direction) 7=Hit Fixed Object 9=Other/Unknown ~-~ 1=On Travel Lanes 3=Median 5=Outside Trafficway 7=Gore (Ramp intersection) Relation to Roadway~' r 2=Shoulder 4=Roadside 6=In Parking Lane 9=Unknown [~ 1=Daylight 3=Dark - Street 5=Dawn 8=Other ~ 2=Dark - No Lights $=Dark o Unknown ' [/ I Street Lights 4=Dusk Roadway Lighting r-~ 1=No Adverse 3=Sleet (Hail) 5=Fog 7=Sleet & Fog g=Unknown Weather Conditions Conditions I ~ I 2=Rain 4=Snow 6=Rain & Fog 8=Other 0=Dry 2=Sand, Mud, Dirt, 4=Slush 6=Ice Patches 8=Other - 7=Water - Standing cf n i i ns 1=Wet 3=SnowOil Covered 5=Ice or Moving Harm Event LIR Most? UtiEty Pole Number Harmful Events (Harm Event) 30=Hit Fence Or Wall Unit No ~-~©1 I I I I I [ I °l=HitUnitl 31=Hit Building I 02=Nit Unit 2 32=Hit Culvert 03=Hit Unit 3 33=Hit Bridge Pier Or Abutment i 11 i i i i i i i i - HitUn , 34=Hit Parapet End OS=Hit Unit 5 35=Nit Bridge Rail 06=Hit Other Traffic Unit 36=Hit Boulder Or Obstacle Please Put 08=Hit Other Animal 37=Hit Impact Attenuator Sequential 09=Collision With Other Non 38=Hit Fire Hydrant Fixed Ob oct 39=Hit Roadway Equipment 12=Struck By Unit 2 41=Nit Traffic Island 13=Struck By Unit 3 42=Hit Snow Bank 14=Struck By Unit 4 43=Hit Temporary Construction Harm Event LIR Most? Utility Pole Number 15=Struck By Unit 5 Barrier [xT -I II 21=Hit Tree Or Shrubbery 49=Hit Unknown Fixed Object 22=Hit Embankment 50=Overturn/Roll Over Iol- l=E-l-]l-] 01 I [ i I I I I Uti" Po'e24=Hit Traffic Sign 51=Struck By Thrown Or Fai[ingobject 25=Hit Guard Rail 52=Pot Holes Or Other Please Put ~-~ 27=Hit Curb 53=Jacknife Eventsin 3~ O I [ I I I I I I26=HitGuardRailEnd Pavementlrregularities Sequential 28=Hit Concrete Or 54=Fire In Vehicle Longitudinal Barrier 58=Other Non-Collision Order 4[~[-~©1 i i iI i , i i 2g=HitDitch 99=Unknown Harmful Event Left/Riaht (UR) L=Left R=Right O=other U=Unknown First Unit No Harm Event Most Unit No Harm Event Driver Action CD) 16=Driving The Wrong Way Event in Event in 00=No Contributing Action 17=Careless Or Illegal the Crash the Crash 01=Driver Was Distracted Backing On Roadway Do not repeat t~is information on mult]~e page~ O2=Ddving Using Hand Held Phone 18=Driving On The Wrong ~ 03=Driving Using Hands Free Phone Side of Road Environmental/Roadwav~-~-~-~O4=MakinglllegalU-Turn 19=Making Improper Potential Factors (EIR) I 2 3 OS=Improper/Careless Turning Entrance to Highway 00=None 06=Turning From Wrong Lane 20=Making Improper Exit 01=Windy Conditions 11=Slippery Road Conditions (Ice/Snow) 07=Proceeding W/O From Highway 02=Sudden Weather Conditions 12=Substance On Roadway Clearance After Stop 21=Careless Parking/Unparking 03=Other Weather Conditions 13=Potholes 08=Running Sro Si n 04=Deer in Roadway 14=Broken Or Cracked Pavement 09=Running Rte~°Li~g~t 22=OverlUnder Compensation At Curve 05=Obstacle On Roadway 15=TCD Obstructed 10=Failure To Respond To 23=Speeding 06=Other Animal In Roadway 16=Soft Shoulder Or Shoulder Drop Off Other Traffic Control Device 24=Driving Too Fast For Conditions 07=Glare 28=Other Roadway Factor 11=Tailgatiog 25=Failure To Maintain Proper Speed 08=Work Zone Related 99=Unknown 12=Sudden Slowing/Stopping 26=Drlver Fleeing Police 13=Illegally Stopped On Road (Police Chase) Possible Vehicle Fa/lures (V) 12=Wipers 14=Careless Passing Or Lane 27=Driver Inexpedenced 00=None 06=Exhaust 13=Driver Seating/Control Change 28=Failure To Use Specialized Equip 01=Tires 07=Headlights la=Body, Doors, Hood, Etc IS=Passing In No Passing Zone 98=Other Actions Improper Driving 02=Brake System OB=Signal Lights 15=Trailer Hitch -- 03=Steering. System 09=Other Lights 16=Wheels Unit~--~ ~--~ [---~ ~ I I 04=Suspension 10=Horn 17=Airbags No 1 2 3 4 OS=Power Train 11=Mirrors 18=Trailer Overloaded 1g=Unsecure/Shifted Unit Unit 20=Improper Towin 21=Obstructed Winc~shield U Unit [-~ [-----~ [----~ 90=Unknown PedestrianActi~ll (P) 03=Working No I 2 00=None 04=Pushing Vehicle 01=Entering Or Crossing At OS=Approaching Or Leaving Vehicle Specified Location 06=Playing Or Working On Vehicle Indicated Prime Factor Unit No Factor Code 02=Walking, Running, Jogging 07=Standlng Do not repeat this information on ~ ~ Playing, Or Cycling 98=Other If E/R is the Prime Factor C~ C~ C~ ~ Type, leave Unit No blank FORM ii AA-4S (01~1) I COMMONWEALTH OF PENni:SYLVANIA POLICE CRASH REPORTIN~ ORM AA 45 7 1 ' ' Page: O New C]) Change/ Continuation C~ Delete Page Crash Number ,°0140975 Crash Number F;OLICE CRi~$H REPORTIN, ORM I .e. P 0:[.40974 ~ Change/ AA 45 8 1 ' ' Page: (~) Delete Page Place emergency transport, witness, and other information here. It is not required to restate information from the form. Responding EMS Agency: ~-lj~ b~J '~'L~, Medical Facility: ~ ~ Witness 2: , Address: Phone: Narrative: S~ ~t ~ ~ 0 ~ b 0 ~ COMMONWEALTH OF PENNSYLVANIA POEICE (~RASH REPORTIN¢ 3RM New A~A 45 F 1 · Page: ~ C) Change/ Road Surface Type C) Brick or Block C) Dir~ Special Jurisdiction C) Milita~] C) Other Federal Sites No Special (~) indian Reservation C~) Other Slag, Gravel or C~ Other O Jur[sdi~ion ~ Concrete ~ Stone College~niversi~ ~ Unknown ~ Blacktop ~ Unknown ~ National Park ~ Campus Please complete Unit information for each unit invoNed in a fatal crash. Do not repeat the information in the fields above on multiple pages. Unit Number Principle Impact Point ~ ~ Non-ColEsion ' ~ ~1~01 Restri~ions Not a Pennsylvania ~Top Driver Restrictions ~ Compliance Complied With Driver ~ No Restri~iong O Complied With O Compliance 0 04 Compliance ~ Towed Unit Not Applicable ~ Unknown ~ Driver Endorsement ~ Required - Not a Pennsylvania ~ Unknown Complied With ~ Driver Compliance Required - Non m Unknown Avoidance Maneuver ~ ~ None Required ~ Compliance ~ Compliance -- Required - ~ No Avoidance ~ Braking - ~her ~ Other Avoidance .~ ~ Compliance Unknown Maneuver ~ Evidence ~ Maneuver ~ ~ Braking - Skid ~ Steerin9 - Evidence ~ Inconclusive , Driver License ~ Not Required for ~ Unk if CDL or O Marks Evident ~ or Driver Stated Compliance Vehicle Class ~ CDL Required ~ Not Licensed ~ No Valid License ~ Not a Pennsylvania Braking - No Skid ~Steering and ~rakin9 ~ Unknown for Class ~ Driver ~ Marks, Driver ~ Evidence or Stated Stated ~ Valid License for ~ Unknown Class Under Ride'Indicator Underride, No Druq Test Type ~ ~lood ~ Other ~ No Underride or ~ Compa~ment ~ Override, Other Override Intrusion ~ Vehicle ~ Unknown if Test ~ None ~ Urine ~ Given Underride, Underride, Unknown if Druq Test Resul~ - (Up to Four Results)~ ~ ~ Companmentlnt~sion ~ Compa~ment ~ Underride or Intrusion Unknown Override 0=NoTe~Given 5=Amphetamines ~ iD I l=NoDrugRepo~ed 6=PCP 2 = Marijuana 8 = Other ~ ~ ,merqen~Use 0 U,hB Flashing ~ B°th Lights and 3 = Cocaine 9 = Unknown Te~ ~ Not in Emergen~ ~ Siren 4 = Opiates Results ~ Use O Siren Sounding O Unknown Unit Number Principle Impa~ Point ~ 0 Non-Collision Driver Restrictions ~ Restri~ions ~ Not a Pennsylvania ~ Top Compliance Compiled With ~ Driver Re~ri~ions Not ~ Unknown ~ Undercarriage No Restri~ion~ ~ Complied With ~ Compliance 0 04 ~ Not Applicable ~ Unknown Compliance O Towed Unit Required - ~ Not a Pennsylvania ~ Unknown ~ .. ~° Driver Endorsement ~ Complied With ~ Driver Required © Required - ~on ~ ~nkno~n Avoidance M~neuv~r -- Required - ~ No Avoidance ~ Compliance Unknown Maneuver ~ Braking - Other ~ ~her Avoidance .~ Eviden(e ~ Maneuver = ~ Braking - Skid ~ Steerin9 - Eviden(e ~ Incond~ive Driver License ~ Not Required for ~ Unk if CDL or ~ Marks Evident ~ or Driver Stated ~ Vehicle Class ~ CDL Required ~ Not Licensed ~ No Valid License ~ Not a Pennsylvania Braking - No Skid ~ ~teering and Bra~ing ~ Unknown for Class ~ Driver ~ Marks, Driver ~ Evidence or ~tated Stated ~ Valid License for ~ Unknown Class Under Ride Indicator Underride, No Override, Other Druq Te~t Type ~ 81god ~ Other ,~ ~ No Underride or ~ CompaAment ~ Vehicle ~ Unknown if Test Override Intrusion ~ None ~ Urine ~Given Underride, Underride, Unknown if Druq Test Resul~ - (Up to Four Results) ~ CompaAment ~ CompaAment ~ Underride or -0 = No TeA Given 5 = Amphetamines ~ ~ ~ Intrusion Intrusion Unknown -- Override ~ =NoDrug Reposed 6=PCP 2 = Mari'uana 8 = Other ~ ~ gmerqencF Use ~ Ligh~ Flashing~ SirenB°th Lights and 3 = Coca'ne 9 = Unknown Te~I I I I ~ Not in Emergen~ 4 = Opiates Results Use ~ Siren Sounding ~ Unknown PENNDOT COPY Page 1 Accident # 97-01 June 26, 2001 (Fred) Ptlm. Shaun A. Felty At 0428 this officer was dispatched tothe 5000 Blk of Trindle Rd. for a struck pedestrian. I arrived on the scene at 0433 to find a tractor trailer stopped in the eastbound lane with the tractor under the navy raikoad bridge overpass. Standing by the tractor was James E. Pruitt who identified himself as the driver of the tractor trailer. The tractor trailer did have it's headlights on upon my arrival. Also on the scene were Susan'Mayernick and Randall Keebaugh who identified themselves as the individuals who called 911. The body of John Andela was in the westbound lane between the tractor trailer and a Shenks Pastry truck. West Shore ALS had arrived on the scene at the same time this officer arrived and paramedic had determined that Andela was already dead. Susan Mayernick, 31 Mayernick Dr., Mechanicsburg Pa 17055 ,(717) 691-9705 stated that she did not see the accident but had come upon it in her travel and called 911. Randall Keebaugh, 5340 Oxford Circle, Apt 39, Mechanlesbu~g Pa 17055, (H)(717) 791-1276 (W)(717) 605-7301 stated that he was driving eastbound on Trindle Rd. and was approaching the accident scene when he saw a car of unknown description traveling westbound on Trindle Rd. away fi.om the scene. Keebangh did not see the accident but did call 911. James E. Pruitt, 1 Ives Dr., N Little Rock AR 72117 stated that he was lost and was looking for Ralston Purina when he was traveling eastbound on Trindle Rd. and came to the railroad bridge overpass. He saw the sign that stated the bridge was a height of 13'6" and wasn't sure if his trailer would fit under the bridge. He pulled his tractor forward and under the bridge and exited his truck to see if his trailer would clear when a truck pulled up behind him and stopped. He went back to the track (Shenks Pastry) and spoke with the driver who was John Andela. Pruitt asked Andela for directions to Ralston Purina and then asked Andela if he thought the trailer would clear the bridge. Andela told him he did think that the trailer would clear the bridge and asked Pruitt if be would like him (Andela) to watch the bridge while he drove under it. Pruitt then tried to drive his tractor trailer under the bridge. Pruitt saw Andela standing in the westbound lane of Trindle Rd. next to Pruitt's tractor. Pruitt was looking back and forth between An&la and the bridge when a red "blur" went past and Andela was gone. It was at this time that this officer was informed by a Lower Allen Twp. EMT that a young woman had arrived on the scene stating that she had been in an accident and that something had hit her car. This officer found Heather I42 Frampton by a red Nissan Sentra with Pa registration BSM3413. The Sentra had minor front end damage to the driver side comer and had a large whole in the windshield by the PA inspection sticker. The windsheild wipers were in the up position. The car was located on the east side of the accident scene behind this officers patrol car. Heather K. Frampton stated that she was on her way home fi.om Country Meadows, where she works. She was driving westbound on Trindle Rd. and approaching the Page 2 railroad overpass and saw a tractor trailer stopped with it's lights on. She slowed down and when she drove past the truck something hit her car. She drove downthe street and turned around in a business parking lot. She then drove back towards the accident scene and saw that the truck was still stopped in the eastbound lane and drove down the right hand side of the truck, using the shoulder. Frampton drove back to Country Meadows to call her mother. During my initial encounter with Frampton she appeared calm and never mentioned that she had struck someone. Frampton was not told by myself or Officer Kopko who was also present with her that she had struck a individual. Frampton was also not in a position to see John Andela's body. I then attempted to obtain more information fi.om Pruitt who was with the Lower Allen Twp. EMTs. Pruitt appeared distraught and blamed .himself for the accident. Pmitt was not injured but was transported by Lower Allen Twp Ambulance to Holy Spirit to speak with a crisis worker. Frampton's mother, Mary Shreve, arrived on the scene and it was at this time that Frampton was informed by this officer that she had struck and killed a individual. This officer noticed that Frampton began to cry and shake. Frampton was requested to follow Officer Kopko back to our station so that we could get a written statement as to what occurred. Frampton and her mother did go to the station and Frampton did provide a written statement to Officer Kopko. A review of the accident scene showed that there were no gouges or scratches in the roadway to indicate a point of impact. From statements that Pruitt made the area of impact is believed to be close to but behind the tractor dryer door. Small particals of glass were seen on the roadway between the area of impact and Andela's final resting place. The glass could only be seen by shinning a flashlight over the mad surface. There is a overhead light in the area which is 43 feet fi.om the railroad bridge abutment on the westbound side of the roadway. The overhead light sits on a telephone pole at a height above the bottom of the railroad bridge and the light is obscured by a tree which sits between the light and the raikoad bridge. Lighting under the railroad bridge is poor. The area of impact is believed to be 45 feet east of bridge abutment on the westbound side of the roadway. The body was 43 feet fi.om the raikoad bridge abutment on the westbound side of the roadway. Frampton's vehicle was transported to the Hampden Township Police Station by Roadside Auto Rescue. Photo graphs and videotape of the accident scene were taken by Dennis Brown, Hampden Twp. Fire Dept photographer. After clearing the scene this officer returned to the station and breifly spoke with Frampton who had akeady provided a written statement. Frampton was asked if she knew what the speed limit was (40 MPH), which she did. Frampton was asked how fast she thought she was going to which she replied that she didn't know but that she had slowed down when she saw the stopped tractor trailerS. This officer also interviewed Pruitt at the station on the morning of June 26t~ after he left Holy Spirit Hospital. Page 3 Pruitt stated that he had become lost and was approaching the railroad bridge when he saw the sign that indicated the bridge height was 13'6". He pulled his tractor forward under the bridge and exited the truck to see if his trailer would clear. He saw a track pull up behind and went back to the truck to asked the driver (Andela) for directions. Andela provided directions to Ralston Purina and Pruitt asked Andela if he thought his trailer would clear the bridge. Andela told Pruitt that he thought the trailer would clear the bridge and then asked Pruitt if he would like him (Andela) to watch while Pruitt drove under the bridge. Pruitt went and started his truck and Andela was standing in the westbound lane looking up at the bridge. Pruitt was pulling forward and Andela was telling him to keep going he has 8 more feet. Pruitt was looking between Andela and the bridge when saw a red blur go by and heard a crunch. Pruitt exited his tractor and saw a car traveling westbound and that it appeared to be driving onto the westbound shoulder. At this time two cars pulling up and he told them to call 911. Pruitt could not say if the red" blur "was the color ora car or the tail lights of a car. Pruitt never saw the car approaching prior to collision since he was looking 15om the bridge to Andela. Pruitt could not say at what speed he thought the red "blur "may have been traveling. Pruitt did not believe that Andela saw the vehicle coming since he did not say anything to impact nor did he say anything afterwards. Pruitt provided this officer with a written statement. In a attempt to determine how Andela traveled offthe Nissan Sentra the vehicle was processed using Luminal and Ultra Violet lighting. During this process no blood was found to be on the exterior of the vehicle. Scuffmarks were found on the fi'ont driver side quarter panel. Additional photographs were taken of the Nissan Sentra by thi~ officer. On 27 June 2001 this officer interviewed Patricia Franks, 4902 Delbrook Rd, Mechanicsburg Pa 17050, (H) 763-5716. Franks stated that she has worked with Frampton for 1 -2 months at Country Meadows. On the morning of the accident Frampton was suppose to get offwork at 0400. There was nothing unusual about the shift. Frampton did not appear in a hurry nor did she say anything about being in a hurry. Franks was present at Country Meadows when Frampton returned there after the accident. Frampton stated to Franks that something had just hit her car. Frampton called her mother and stated" Mom you have to come get me something tilt me ". Fmmpton was upset and Franks got her calmed down and they noticed the emergency vehicles driving past Count[y Meadows towards the accident scene. Franks told Frampton that she should remm to the scene. It was Franks opinion that Frampton was not aware that she had struck someone. Mike Norris, Cumberland County Coroner, has stated that injuries sustained by Andela are consistent with those ora individual who has been struck by a vehicle traveling less than 30 MPH. Page 4 Driver/Vehicle Information (not involved in collision) Driver - James E. Pmitt, 1 Ives Dr, N Little Rock, AR 72117, AR/227279679 Vehicle - 2001 FRHT, TN/58924HY, VIN 1FUYDSEB9WP96779, white. Registered owner, Covenant Transport Inc., 400 Birmingham Hwy, Chattanooga TN 37419~2346. Pmitt works for Southern RefiSgerated Transport, (888) 778-7670. Tractor was towing a 53 ft trailer, white, empty. Vehicle - 1999 Ford PA/ZS34675, VIN 1FDXF46F1XED43960 white. Registered owner, Schenks Pastry Shoppe INC., 5303 E. Trindle Rd., Mechanicsburg Pa 17050. This vehicle had been driven by John Andela and was left parked behind the above tractor trailer during the accident. I Exhibit C State Farm Insurance Companies April 3, 2002 State Farm Insurance 115 Limekiln Road PO Box 257 New Cumberland PA 17070-0257 David L. Lutz Angino & Rovner 4503 N Front St Harrisburg, PA 17110-1708 RE: Your Client: Our Insured: Our Claim No.: Date of Loss: Estate of John Andela Mary L. Shreve 38-J725-714 June 26, 2001 Dear Mr. Lutz: This will confirm our conversation last week wherein we had agreed to settle your clients cliam in the amount of $80,000. As agreed, this settlement will need court approval. Please find enclosed a release that will need to be properly executed and returned. Upon my receipt of the signed release as well as a copy of the court approval, we can issue our draft accordingly. Should you have any questions, feel free to call me at the number listed below. Sincerely, Claim ~ecialist (717)/774-9074 State Farm Mutual Automobile Insurance Company cc: Richard H. Wix HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001 RELEASE (Person and Property) Joint Tort - Release of One Tortfeasor) Know all men by these presents that the undersigned: being of legal age. for and in consi~ration of the payment of ~L~ ~ ~ '~OH~ (hereinafter referred to as "Relea~s") ~e r~eipt of ~ich is hereby ~knowled~d, has/have retea~d and dis- charge, and by this relea~ do for my~lf/our~lves, my/our heir, ex~uto~, administratom and a~igns, forever ~lea~ and di~har~ the said Releases from all claims, damages, ~tions and suits of whats~ver kind, known or unknown, prior to and including the date hereof, and particularly for all injuri~ to person or damage to pmpe~, known or unknown, rmulting from or to re. It from an ~cident which occur~d on or about the ~ ~ ~ ~ day Should it appear that two or more persons or entities am jointly or ~verally liable for the ~id injuries to person or dama~ to prope~ reciting from or arising out of said a~ident, the consideration for this relea~ ~all ~ received in complete satisf~tion to the full extent of the fault of the ~id Re~s, whether propo~ionally all~ated or total, as ultimately determined under the law and for ~ich ~e said Relea~ are ultimately found liable. I/we ~ecifically re~e all claims and cauls of ~tion arising out of the able mentioned ~cident against all other to~feasors. It is ~rther ~r~d that by this relea~ the undersigned reduce(s) my/~r claim against the other tortfeasor(s) by the am~nt of the consideration paid he.under or by the propo~ion ~e Releases' ultimate liabiliW bears to the total dama~s, whichever is greater, and fu~her, ~e undersigned, knowing that the Releases herein are not paying the total of the undersi~ed's full am~nt of damages, d~s/do he.by credit and satisfy that potion of the undersigned's total amount of damages which has ~en cau~d by the negli~nce, if any, of such of the Releases hereto as may ~ hereafter determined to be the ca~ in the trial or other disposition of the undersigned's claim. The payment made to me is upon my/our warranW that I/~ have not r~eiv~ ~tofore any consideration what- e~r for, nor h~e I/we rele~d heretofo~ any pemon, fi~ or co~orati~ from, any claim or liability for any injuries to ~rson or properW arising from ~id ~ident, ~d I/~ ag~ to hold hakims and indemnify the said Relea~s and their insurance carrier of and from any Io~, claim, liability, cost or ex~n~ arising out of any claim a~inst them or either of ~em for c~tri~ti~ by any ailed joint ~r under the Uniform Contribution Among Tortfeaso~ Act of the Common~alth of Pennsylvania. It is understood that this relea~ and any payment ma~ ~ant the~to is a compromi~ ~ttlement and not an admi~ion of le~l liabiliw by the Relea~s and is not to ~ c~stm~ as ~ch. the Rele~ expressly denying said liabiliW and this ~ttlement ~ing m~e merely to avoid the ex~s of liti~tion. The undersigned have carefully mad the forgoing Relea~ and know the c~ten~ t~reof, and are signing the same as my/our own f~ ~t. I/we understand that the injuries ~ained and the ~ffering and dam~ ~lting therefrom may ~ unce~ain and indefinite and that in making this ~lea~ and agr~ment it is underwood and agreed that I/we rely on my/our own ~liefs and knowled~ and that of physicians and other individuals ~om I/we may have con. Ired as to the nature, extant and duration of the symptoms and injuries. I/~ ~r~er intend to ~ le~lly ~und by the promi~s heroin contained. If this relea~ is executed by more than one person as releasors, the obli~ti~, ~sibiliW and liability of each such per~n shall ~ joint and several. WITNESS my/our hand(s) and ~al(s) this _ day of , ~ , in the witness of: (SEAL) (SEAL) Address (160) G 5281 Printed in Exhibit D POWER OF ATTORNEY AND FEE A~l~e~lz, lvlr~ln x ~Y SIGNING THIS AGREEMENT, I (WE) ACKNOWLEDGE THAT 1 ('~,) 'rL~VE ENGAGED THE LAW FIRM OF ANGINO & t~.OVNER, P.C. (HEREINAFTER A & R), TO REPRESENT ME (US) UNDER THE FOLLOWING TERMS AND CONDITIONS: 1. A & R may on my (our) behalf secure medical, work and other similar records, conduct an invastigat on, negotiate, d if necas s~tart..~,s~uit against anyone responsible for my (our) injuries and losses xvith respect to an~b~- L'~ ,io~d~ , with full power and authority to appear on behalf of the undersigned in any ~o~rt of redord or in any administrative or other proceeding, to do and perform all and every act and thing whatsoever that may be requisite and necessary to be done in connection with the above claim as fully as the undersigned might or could do if personally present; hereby ratifying and confirming all that said attorneys shall lawfully do or cause to be done therein by virtue of this power of attorney. 2. I (we) understand that so long as the ease is handled by an A & R attorney, I (we) will not be responsible for any fees and/or expenses unless a recovery or benefit is obtained. 3. If my (our) case is handled to a successful completion by an A & R attorney, I (we) agree to pay A & R all reasonable out-of-pocket expenses without the payment of interest, plus a fee for time expended as follows: A & R ME (US) a. SETTLEMENT pRIOR TO STARTING SUIT 30~/° 70°'~ b. SETTLEMENT FOLLOWING SUIT BUT PRIOR TO TRIAL OR ARBITRATION 35% 65% c. SI~ iYLEMENT OR VERDICT AT TRIAL OR ARBITRATION, AFTER TRIAL, ARBITRATION~ OR APPEALS OR SHORTLY BEFORE TRIAL AND AFTER CASE HAS BEEN TOTALLY PREPARED 40% 60% NO-FAULT RECOVERY OR NON-MONETARY BENEFIT: RICHARD C. ANGINO ($500); NEIL J. ROVNER ($450); d. I:SSOCIATES ($400) PER HOUR BUT NOT TO EXCEED 40°,~ OF TOTAL RECOVERY OF VALUE OF BENEFIT e. OTHERCASES J I 4. If for any reason I (we) take my (our) case to another attorney or law firm including a former A & R attorney or handle it myself(ourselves), 1 (we) recognize that A & R has, in good faith, expended money and time for my (our) benefit and I (we) therefore agree to pay, or have my (our) new atlorney pay, immediately, upon severing the A & R attorney/client relationship, all the out-of-pocket expenses incurred on my (our) case plus interest a~ the rate of 6% per annum from the date of each expenditure. In addition, when the case is successfully concluded, I(we) agree to pay or to direct my (our) new attorney to pay as a fee 20% of the gross recovery to A & R. 5. In the event that any settlement is made on a structured or deferred payment basis, A & R shall be entitled to receive their percentage based on the present value of the structured settlement, if paid as a lump sum at the time of settlement. I (we) agree not to settle or discuss settlement of my (our) ease without the written consent ora & R. READ, UNDERSTOOD, AND RECEIVED A COPY OF SAME AND AGRIRIRIRIRIRIRIRIRIR~E WITH 1TS TERMS AND C - W1TNESS(E~J~ ~ CLIENT(S): Crr~ .l~det-,~- (SEAt,) (OVER) Exhibit E FIL~ NUMBER ............ : 01172 8/08/2001 46.90 46.80 4/04/2002 20.00 20.00 7/17/2001 7.68 4/04/2002 838.00 .25 208.50 4/04/2002 40.00 .25 10.00 219.50 FILE N~.~ER ............ = 01172 SUB-TOTAL 683.61 ** AMO~JNT 200.00 45.00 138.00 9.54 59.55 460.09 ** 1,145.70 Exhibit F d~181128~2 13:87 717-783-3467 4/ll/2002 Dav/d L Lu~z, Ea]u/re Aris/n0 & Rovner 4503 North lrront Strect Harrisburg, ]PA 17110-1708 INHERITANCE TAX COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXEs DEPARTMENT 280601 HARRISBURG, PA 17128-0601 PAGE Telephone 7]?-783-0972 02182 Re: Esta~coflolmD Andch File Number: 6701-1027 ~jec~u m ~ ~o~sed a~ of ~e ~ ~ of~ a ~Y ~m ~ D~t of~ ~ ~ be a~g ~y cc: ~!~ County Clerk ofO~phans Coum I Paul Di'oc~ Iaheritance Tax D/vi~ian Bureau of Individual Taxes ~r IN RE: PETITION OF CHRISTINE ANDELA, ADMINISTRATRIX OF THE ESTATE OF JOHN D. ANDELA, DECEDENT, Petitioner IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. NO. 02-2222 Civil Term PETITION FOR APPROVAL OF A COMPROMISE SETTI,EMENT AND DISTRIBUTION OF PROCEEDS PURSUANT TO Pa.R.C.P. 2206 Pastry Shoppe. Schenk's Pastry Cumberland County, Pennsylvania. The Petitioner, Christine Andela, Administratrix of the Estate of John D. Andela, deceased, by and through her attorneys, Angino & Rovner, P.C., hereby avers as follows: 1. Your Petitioner is the Administratrix of the Estate of John D. Andela, deceased, by Letters of Administration granted to her by the Register of Wills of York County, Commonwealth of Pennsylvania. The Letters of Administration were granted on July 16, 2001, and attached as Exhibit A is a copy of the Grant of Letters. 2. The decedent, John D. Andela, was the husband of the Petitioner, Christine Andela. The decedent was born on February 12, 1966, and died on June 26, 2001, as a result of a motor vehicle accident occurring in Cumberland County, Pennsylvania. 3. Immediately before the subject fatal motor vehicle accident on June 26, 2001, the decedent was operating a delivery truck while in the scope of his employment with Schenk's The decedent, Mr. John Andela, was operating a delivery truck owned by Shoppe and was travelling in an eastbound direction on Trindle Road, 4. James R. Prultt had been operating a tractor-trailer in an eastbound direction on Trindle Road and had stopped his tractor-trailer on the west end of a railroad bridge near the 500 block of Trindle Road in Hampden Township. It is believed that Mr. Pruitt stopped his truck 245852. BDLL~ITG because he thought that the track and trailer would not fit under the 13' 6" clearance of the bridge. 5. Given the stopped tractor-trailer on Trindle Road, the decedent stopped the Schenk's delivery van behind Pruitt's trailer. Pmitt asked the decedent whether he thought the tractor-trailer would fit under the bridge. After discussion, the decedent offered to stand beside the tractor-trailer and watch the top of the tractor-trailer as Mr. Pruitt drove under the bridge. 6. While the decedent was guiding Mr. Pmitt and the tractor-trailer under the bridge, Heather K. Frampton was operating a Nissan Sentra, traveling westbound on Trindle Road. 7. As Ms. Frampton drove under the railroad bridge, the front of her vehicle struck the decedent. John D. Andela died as a result of the motor vehicle accident. Attached as Exhibit B is the Hampden Township Police Accident report. 8. State Farm Insurance Company provided liability insurance coverage to Heather K. Frampton relevant to the subject fatal motor vehicle accident. 9. Although disputing liability for the fatal motor vehicle accident, State Farm agreed to pay and compromise the disputed claim arising from the subject motor vehicle accident and offer $80,000.00 of its policy limits of $100,000.00. 10. Your Honorable Court approved the third-party settlement and attached as Exhibit C is Your Court's May 9, 2002, Order approving the settlement. 11. In addition to making a third-party claim, Petitioner, by and through counsel, Angino & Rovner~ filed a Claim Petition for worker's compensation, attached as Exhibit D (without exhibits). 245852.1\DLLWITG 2 12. The Defendant, Schenk's Pastry Shoppe, filed an Answer, attached as Exhibit E and thereafter the parties filed a Stipulation of Undisputed Facts Claim Petition, Exhibit F, and a First Hearing Filing, Exhibit G. 13. Essentially, the dispute presented before worker's compensation Judge Christina Tarantelli was whether the decedent's son, Brandon Andela, was a dependent of the decedent and entitled to death benefits. 14. After a heating before Judge Tarantelli on February 6, 2002, and before a second hearing was scheduled, the parties reached an amicable resolution, pending approval of Your Honorable Court. 15. In a letter dated April 29, 2002, Attorney Michael Farrell, counsel to Schenk's Pastry Shoppe, extended a settlement offer of $10,000 and that the worker's compensation lien in any third-party settlement be waived. Attached as Exhibit H is Attorney Farrell's April 29, 2002, letter. 16. In a hearing before Judge Tarantelli on June 26, 2002, she approved the Compromise and Release. Attached as Exhibit I is Judge Tarantelli's June 26, 2002, decision. 17. Petitioner retained the law firm of Angino & Rovner to prosecute this action. 18. Angino & Rovner seeks to recover 20% or $2,000.00 of the $10,000 settlement for attorney's fees. 19. Petitioner's counsel has received approval of the allocation between the Wrongful Death Action and Survival Action from the Department of Revenue. See, Paul Dibert's May 27, 2002, letter from the Department of Revenue, attached as Exhibit J. 245852.1~DLLWITG 3 20. Petitioner believes that a fair, just, and equitable distribution would be as follows: Estate of John D. Andela, deceased, under the Survival Action (a) (b) (c) Estate of John D. Andela, deceased, under the Wrongful Death Action Angino & Rovner, P.C., professional fees based on 20% of the gross amount recovered $ 6,400.00 $1,600.00 $ 2,000.00 TOTAL PRESENT DISTRIBUTION $10,000.00 WHEREFORE, Petitioner prays Your Honorable Court to enter an Order approving said compromised settlement, directing the distribution of the proceeds in accordance with the averments of this Petition. ANGINO & ROVNER, P.C. David L. Lutz I.D. No. 35956 4503 N. Front Street Harrisburg, PA 17110 (717) 238-6791 Attorney for Petitioner 245852.1'~DLL'uMTG 4 VERIFICATION I, Christine Andela, Administratrix of the Estate of John D. Andela, deceased, Petitioner, hereby verify that the facts set forth in the foregoing document are tree and correct to the best of my knowledge, information and belief. I understand that any false statements therein are made subject to the penalties of 18 Pa.C.S.A. §4904, relating to unswom falsification to authorities. WITNESS: , E~;tate of John D. Andela 245852. P, DLL'~MTG Exhibit A Register of Wills of YORK County, Pennsylvania Certificate of Grant of Letters No. 6701-01024 ESTATE OF ANDELA JOHN DANIEL Late of WARRINGTON TOWNSHIP ~0~ ~UU~'l'~, Deceased Social Security No. 146-62-6003 WHEREAS, ANDELA JOHN DANIEL late of (~'r, ~'1', M~) ' kK COUNTY , died on the' 26th day of June WHEREAS, the grant of letters of administration required for the administration of the estate. WARRINGTON TOWNSHIP 2001; THEREFORE, I, BRADLEY C JACOBS , Reg±ster of Wills and for the County of YORK , in the ~nonwealth of Pennsylvania, have this day granted Letters of Administration to ANDELA CHRISTINE A - ~ has duly qualified as administrator(rix) of the estate the above named decedent and has agreed to administer the estate according law, all of which fully appears of record in my Office at YORK ~TY COURT HOUSE, YORK, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal my Office on the 16th day of July 2001. ~g~sq?r of wills J COi¥!MOItlWEALTH OF PENI~- 'LVANIA POLICE CRASH REPORTING, uRM AA 45 1 1 case C,osed O Yes O No New Crash Number 0Z40974 Incident Number Page: ~ 0~--~ C~) Change/ Continuation Police Agency AgencyName Precinct I'll J I ~ IC~ I~ Dispatch Time (mil) Arrival Time (mil) Investigator Reviewer Patrol Zone Investigation Date (MM-DD~Yyyy) Badge Number Badge Number Approval Date (MM-DD-Yyy~') Municipality Name County County Name Municipality Crash Date (MM-DD-YYyy) Crash Time (Military) No of Units -~ Complete ~ Tue ~ Sat Form: Repo~able Crash AA 45 F 1) ~ Wed ~ Unk Noti~ Highway Maintenance School Bus Related ~ ~ ~ Yes O No ~ O Yes ~ No 0 Yes ~ .o~ School Zone Related ~ PennOOT Prope~y O Yes ~ NO O Yes Unit Number ~ No Delete? Type ~ ~ Motor Vehicle in 0 Hit & Run Vehicle 0 IIl~al~ Parked 0 Legally Parked ~ Non- Motorized Transpo~ 0 Uni~ O Pedestrian O Pedestrian on Skates, ~ Disabled From ~ Train in Wheelchair, otc ~ Previous Crash ~ Phantom Veh Owner Last Name (If Pedestrian, skip to Form AA 45 3 1) FI MI Telephone Number Vehicle Address Ci~ State Zip ~ Yes VIN Model Year Form: AA ~5 C 1) License Plate Reg. State Travel Speed Insurance Insurance Company Poli~ ~o Vehicle To.ed Towed To Towed 8y Unit Number Delete? © *Refer to List on Back of Overlay Insurance Company Phone Tow Agency Phone Owner Last Name (If Pedestrian, skip to Form AA 45 3 1) FI MI ~.mber i ity State Zip _ I I I tt !IIIIIII I I_] I] °delYear VehicleMa,e. License Plate Reg, State Travel Speed ' Back of Overlay Insurance Insurance Company Policy No Vehicle Towed Towed To Towed By FORM # AA. 45 (01/01) Type ~ (~ Motor Vehicle in 0 Hit & Run Vehicle 0 Illegally Parked I~) Legally Parked C~) Non - Motorized Transport Uni~ ~ Pedestrian (~) Pedestrian on Skates Disabled From in Whee chair, otc (~) I~ Train Previous Crash C~) Phantom Vehicle Commercial Vehicle C~ Yes C~ No Ill Yes, Complete Form: AA45 C 1) Insurance Company Phone Tow Agency Phone ,COMMONWEALTH OF PENI~,c~YLVANiA POLICE CkASH REPORTINC JRM AA 45 2 1 Uni~ Number ~ I of Trailing IUnits: '' Page: ~ 5=Camper 1=Towing Passenger Veh 6=Trailer 2=Towing Truck 7=Semi-Trailer 3=Towing Utility Trailer 8=Other 4=Mobile or Modular Home 9=Unknown New Change/ Continuation Crash Number '0140974 Tag Year ~_~. I Tag State 01=Blue . 02=Red 08=Gold 03=White 09=Brown 04=Green 10=Orange 05=Black 11=Purple O6=Yellow 12=Other 07=Silver 99=Unknown ~ehicle Type 01=Automobile 02=Motorcycle 03=Bus 04=Small Truck 05=Large Truck 10=Snowmobil Initial Impact Point 09 ~ 03 I 07 ~ 05 00=Non-Collision 13=Top 14=Undercarriage 15=Towed Unit 99=Unknown 11=Farm Equip 22=Horse and Buggy 12=Construc"tion Equip 23=Horse and Rider 18=Other Type Special Veh 24=Train 19=Unk'nown Type Special Veh 25=Trolley 20=Unicycle, Bicycle, Tricycle 98=Other 21=Other Pedalcycle 99=Unknown ~)amaqe Indicator ~ 0=None 1=Minor (Driveable) 2=Functional (Moderate Damage, May Not be Driveable) 3=Disabling (Severe - Not Driveable) 9=Unknown V~ehicle Role ~ 0:Non-Collision 1=Striking 2=Struck 3=Both Striking and Struck Direction of Travel ~ N=North S=South E=East W=West U=Unknown Unit Number [ I I 07=Entering a Parked Movernen~ (~ J Position 01=Going Straight 08=Trying to Avoid Animal, 02=Slowing/Stopping in Lane Pad, Object, Veh, otc 03=Stopped in Traffic Lane 09=Turning Right on Red 04=Passing/Overtaking Veh 10=Turning Right 05=Leaving a Parked Position 11=Turning Left on Red 06=Parked 12=Turning Left 13=Making a U-Turn 1U~ ~ 5=Camper Number ~-~ of Trailing ~ nits: Tag -- Tag ~ ~oeda_/ ~'~ _~Sage 12=Commercial 00=Not Applicable Passenger Carrier 01=Fire Veh 13=Taxi 02=Ambulance 21=Tractor Trailer 03=Police 22=Twin Trailer 08=Other Emergency 23=Triple Trailer Vehicle 31=Modified Veh 11=Pupil Transport 99=Unknown 1=Towing Passenger Veh 6=Trailer 2=Towing Truck 7=Semi-Trailer 3=Towing Utility Trailer 8=Other 4=Mobile or Modular Home 9=Unknown 01=Blue 02=Red 08=Gold 03=White 09=Brown 04=Green 10=Orange 05=Black 11=Purple 06=Yellow 12=Other 07=Silver 99=UnknownI Initial Impact Point 07 ~*~ 05 Direction Tra ve_l N=North S=South E=East W=West U=Unknown 01=Automobile 02=Motorcycle 03=Bus 04=Small Truck OS=Large Truck 10=Snowmobile 00=Non-Collision 13=Top 14=Undercarriage 15=Towed Unit 99=Unknown V~ehicle Position 00=Not Applicable 01=Right Lane (Curb) 02=Right Turn Lane 03=Left Lane 04=Left Turn Lane 05=2-Direction Center Turn Lane 06=Other Forward Moving Lane 07=Oncoming Traffic Lane 14=Backing Up 15=Changing Lanes or Merging 16=Negotiating Curve - Right 17=Negotiating Curve - Left '8=Other '9=Unknown TagNo [ 11=Farm Equip 22=Horse and Buggy 12=Construction Equip 23=Horse and Rider 18=Other Type Special Veh 24=Train 19=Unknown Type Special Veh 25=Trolley 20=Unicycle, Bicycle, Tricycle 98=Other 21=Other Pedalcycle 99=Unknown Ve~hhicleRo!~ ~j 0=Non-Collision 1=Striking 2=Struck 3=Both Striking and Struck FORM ~ AA-45 (01/Q1) Damaqe indicator ~ 0=None 1=Minor (Driveable) 2=Functional (Moderate Damage, May Not be Driveable) 3=Disabling (Severe - Not Driveable) 9=Unknown Movement ~ 07:Entering a Parked Position 01=Going Straight 08=Trying to Avoid Animal, 02=Slowing~Stopping in Lane Pad, Object, Veh, otc 03=Stopped in Traffic Lane 09=Turning Right on Red 04=Passing/Overtaking Veh lO=Turning Right 05=Leaving a Parked Position 11=Turning Left on Red 06=Parked 12=Turning Left 13=Making a U-Turn 08=Left of Trafficway 09=Right of Trafficway 10=HOV Lane 11=Shoulder Right 12=Shoulder Left 13=One Lane Road 98=Other 99=Unknown G~radien~ ~ 3=Downhill 4=Sag/Bottom of Hill 1=Level Roadway 5=CrestJTop of Hill 2=Uphill 9=Unknown Alinnment. ~ l=Stralght 2=Curved '=Unknown ---] Tag E -- ! Tag ~----- Year S~te Tag ~[~ecial ~ U~aae 12=Commercial 00=-Not Applicable Passenger Carrier' 01=Rre Veh 13=Taxi 02=Ambulance 21=Tractor Trailer 03=Police 22=Twin Trailer 08=Other Emergency 23=Triple Trailer Vehicle 31-Modified Veh 1=Pupil Transport 99 Unknown V_Vehicle Position~ 00=Not Applicable 01=Right Lane (Curb) 02=Right Turn Lane 03=Left Lane 04=Left Turn Lane 05=2-Direction Center Turn Lane 06=Other Forward Moving Lane .~7=Oncoming Traffic Lane 14=Backing Up IS=Changing Lanes or Merging IS=Negotiating Curve - Right 17=Negotiating Curve. Left 98=Other 99=Unknown 08=Left of TraffiCVvay O'=Right of Trafficway 10=HOV Lane 11=Shoulder Right 12=Shoulder Left 13=One Lane Road 98=Other 99=Unknown Gradient ~ 3=Downhill 4=Sag/Bottom of Hill 1=Level Roadway 5=Crest/Top of Hill 2:Uphill 9=Unknown Al~ictnment. ~ 1=Straight 2=Curved 9=Unknown · COMMONWEALTH OF PENNSYLVANIA POLICE CRASH REPORTINC )RM AA45 3 1 Unit Number Last Name Page: O New C~) Change/ Continuation 0140974 Alcohol/Dru s Sq.~_~ected No Alcohol FI MI Telephone Number Address State License Number ~' ~' Q~ ~' (O ~ O ~ Stat~ If LicenseNumberisunknewn or driver is not licensed, see manual C~) Illegal Drugs O Medication '~ C) No Pedestrian Signal C) Not at Intersection C:) Alcohol and Drugs C:) Unknown C~ Pedestrian Signal .P. edestrian Location C~) Breath C~) Other ~ C~ Marked Crosswalks C~) In Roadway C~) < 10 Feet Off Road C) Urine C~) Unknown if at Intersection C) Not in Roadway Test Given C) At Intersection - No C~ Median' C) > 10 Feet Off Road Crosswalks ~ ~ (~ Test Refused ~) Unknown Non-Intersection O Island C~) Outside Traficway Results (~ Crosswalks (~) Test Given, (~) Shoulder Q Shared Paths/ · Trails Contaminated Results (~ Driveway Access (~ Sidewalk (~ Unknown I VehideCode List any Vehicle Code Section this driver bas Charged with Apparently Illegal Drug violated and mark if they were Charged. V elation? ~ Normal (~ (~ Fatigue '(~ Medicatio C~ HadBeen Use n/ [~__~~ ] Drinking C~) Sick C~) Asleep ~ Unknown C) Yes C) No Alcohol Test Type ~ Test Not Given C~) Blood A/coho/Test Results Driver or Pedestrian ~cal Condition Owner/Driver 00=Not Applicable 03=Rented Vehicle 08=Other Municipal Code 01=Private Vehicle Owned/ 04=State Police Vehicle Government Vehicle Leased by Driver 05=PennDOT Vehicle 09=Federal Gev Vehicle 02=Private Vehicle Not 06=Other State Gev Vehicle 98=Other Owned/Leased by Driver 07=Municipal Police Vehicle 99=-Unknown Unit Number Last Name -~ C~) Yes Q No _Ddver Presence 1=Driver Operated 3=Driver Fled Scene Vehicle 4=Hit and Run 2=No Driver 9=Unknown FI MI Telephone Number Address City State Zip Number F ... nor Alcohol/Dru s Sus ecte~ -- __ ~ ~ ff License Number is unknow - I ~ ~stnanJiqnalatSceneofOash ~ Alcohol Test Type Ill ........ an ,Ignal ..... L et Given ~ ~;~h alkso ~ ;~;~ ~F~;d ~ if o ,~ ~ven ~1 ~ ~_l_~ter~ion - No ~ Media- ~ ~ A/coho/Test Results .~ I ~ Crosswalks " ' . -ff Road ~ ~ ~ Test Refused ~ ~l ~ N~qnters~ion O Island O O~ide Traffi~a . ~ Resul~ · ~ Cr ~ n y ~" ' ' ~ Contaminated Results ~1 ~ .... ' .... Trails Driver or Pedestrian Physical Condition ~ I~ ~iveway Access ~ S~dewalk ~ Unknown ~ Apparently Illegal Drug V~hide Code Ust any Vehicle Code Se~ion this driver has ~arged with Normal ~ ~ Fatigue ~ Medicatior violated and mark if they were charged. Viola~on? Use ~ Had Been ~ ~ Drinking ~ Sick ~ Asleep ~ Unknown , ~ Yes ~ No Owner/Driver 00=Not Applicable 03=Rented Vehicle 08=Other Municipal _Driver Presence Code FORM # AA-4S (01/01) 01=Private Vehicle Owned/ 04=State Police Vehicle Government Vehicle Leased by Driver 05=PennDOT Vehicle 09=Federal Gev Vehicle 02=Private Vehicle Not 06=Other State Gev Vehicle 98=Other ' Owned/Leased by Driver 07=Municipal Police Vehicle 99=Unknown 1=Driver Operated 3=Driver Fled Scene Vehicte 4=Hit and Run 2=No Driver 9=Unknown ,_ ........ PENNDOT COPY COMMONWEALTH OF PENNSYLVANIA POLICE CRASH REPORTINC~ )RM 4541 Page: I New C~) Change/ Continuation Crash Number 0140974 A 1=Driver -- 2=Passenger 7=Pedestrian B=Other 9=Unknown B F =Female M=Male U =Unknown I_niury Severity: C O=Not Injured 1=Killed 2=Major Injury 3=Moderate Injury 4=Minor.Injury 9=Unknown D 02=Front Seat Middle 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 OB=Third Row Or Greater - Middle Position 09=Third Row Or Greater - ~eat PosiCLo~: Safety Equfpment One: 00=Not A Passenger/Occupant E ~]0=None Used / Not App icab e 01=Driver - All Vehicles 01=Shou der Be t Use(J 02=Lap Belt Used 03=Lap And Shoulder Belt Used 04=Child Safety Seat Used 05=Motorcycle Helmet Used 06=Bic~Ycle Helmet Used 10=Sal'ety Belt Used Improperly 11 =Child Safety Seat Used Improperly 12=Helmet Used Improperly 90=Restraint Used, Type Unknown 99=Unknown Right Side Safety Equipment Two: 10=Sleeper Section Of TruckcabF 00=None Used / Not Ap~plicable 11=In Other Enclosed 01=Front Air Bag Deployed (For This Seat) Passenger Or Ca rgo Area 02=Side Air Bag Deployed (For This Seat) 12=1n Open Area 03=Other Type Air Bag Deployed (Back Of Pickup, Etc.) 04=Multiple Air Bags Deployed 05=Motorcycle Eye Protection 06=Bicyclist Wearing Elbow/Knee/ 13=Trailing Unit 14=Riding On Vehicle Exterior 15=Bus Passenger 98=Other 99=Unknown Other 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 0=.o- --pta plicable 1=Not Ejected 2=Totally Ejected 3=Partially Ejected 9=Unknown .Eiection Path: H ~=Not Ejected/NotApp icable 1=Through Side Door Opening 2=Through Side Window 3=Through Windshield 4=Through Back Door 5=Through Back Door Tailgate Openincl 6=Through Roof Open ng (Sunro0f/ - Convertible Top Down) 7=Through Roof Opening (Convertible Top Up) 9=Unknown 1=Not Extricated 2=Extricated By Mechanical Means 3=Freed By Non - Mechanical Means 8=Other 9=Unknown Jnit No Person No Date of Birth (MM-DD-YYYY) Name/Address/Phone C} ~'~- ~ - ~ ~ EMS Transpo~ Jnit No Person No ~ame / Address / Phone© ~-~-~ O Yes ~ No Jnit No Person No Delete? Dateof ~ame / Address / Phone EMS Transpo~ Jnit No Person No Delete? DateofBi~h (MM-DD-~) ' ~ ~ ~ D E Yame / Address / Phone EMS Transpo~ ~ Yes ~ No 3nit No Person No ~ame / Address / Phone EMS Transpo~ Init No Person No 0 Yes ~ No ~ ~ Delete, ~'h~Y~~5 C D ~ EMS Transpo~ AA455 1 .COMMONWEALTH OF PENNSYLVANIA POLICE CRASH REPORTING New Page: ~ C~) Change IntersectionT_.~ C~) "Y" Intersection C) off Ramp O Midblock C~ 4 Way Intersection C~) Traffic Circle/ Round About C~) Crossover O "T" Intersection C~ Multi-Leg C~) Railroad Crossing Intersection O14O974 S~oecial Location Toll Booth C~ Ramp & Bridge O Not Applicable C~) Bridge C~) Underpass C~) Tunnel C) Ramp (~ Cross Over Related C~ Driveway/Parking Lot C~) on Ramp C~) Other (If "Ramp' is indicated, please see manual) C~ Unknown Complete the Principal Road Section for all type of crashes. For crashes at intersections, enter information in the Intersecting Road Section or the GPS Section. If you have a midblock crash, you should enter information in the "Distance from Landmark' Section, the GPS Section, or the House Number Section in the Pr~al Road area, County Route Number Segment (Optional) Travel Lanes Speed Limit (~ North ~umber (if applicable) Q~ East I~t West C~) Unknown Street Name Street Ending Route Si,qninq C~) Interstate O Turnpike C~) Turnpike g State C~ County C~) Local Road C~) Private C) Other/ (Not Turnpike) (East/West) Spur Highway Road or Street Road Unknown ~ County Route Number Segment (Optional) Travel Lanes Speed Limit C) South Street Name Street Ending C~ East 0 West O Unknown Route Siqninq C~ interstate C~ Turnpike C~ Turnpike C~) State (Not Turnpike) (East/VVest) Spur Highway C~) County C~) Local Road C~) Private C~ Other/ Road or Street Road Unknown Or Segment Marker Please Enter Information for BOTH Landmarks if Using This Option Intersecting Rt Num Or Mile Post '!1 I I 11 I I IE E'I IIIII I] . ~ r Intersecting Street Name ;X~ th ~' ~ ~-~ ~ ~ L '~ f -- St Ending ~ East Degrees Minutes Seconds Or Intersecting Street Name ' ' ' ' ~ J ~C~) South ' St Ending -:~C~ East Intersecting Rt Num Or Mile Post Or Segment Marker Traffic Control Device Not Applicable Flashing Traffic Signal Traffic Signal Passive RR 0 Stop Sign C~) Crossing Controls (~ Yield Sign ~ Police Officer or Flagman (~ Active RR Crossing Controls (~ Other Type TCD (~ Unknown T e~_~_Work Zone (If "Not a Work Zone", skip rest of Work Zone section g Not a Work Zone C~ Construction C~) Maintenance C~) Utility Company C~ Other Work Zone Location C) Transition Area C~) Before 1st Work Zone Warning Sign C~ Activity Area C~ Advance Warning C~ Termination Area Area ~ Other Lane Close_~d (If "Not Applicable", skip rest of the Lane Closure section) C~) Not Applicable C~) Partially O Fully C~ Unknown Lane Closure Direction C~) North C~) East C~) South C~) West C~) North and South ~ East and West Degrees Minutes Seconds Feet Or Miles Distance From Crash Scene to Landmark 1 (For Crash between Landmark I and Landmark 2) O No Controls (~ Device Functioning Improperly (~ Device Not Device Functioning Functioning (~ Properly [] Lane Closure [] Work on Shoulder [] Flagger Control [] Road Closed with or Median Detour [] Intermittent or Movi_~9 Work [] Other Work Zone ~ Workers ~ ~ C) Yes ~ No C~ Unknown T_Trraffic Detoured ~ Yes C~) No Estimated Time Closed ~ 1-3 hours C} 9-12 hours C~) < 30 Minutes ~ 3-6 hours C~ > 12 hours (~) 30-60 Minutes (~ 6-9 hours ~ Unknown C) Emergency Preemptive Signal C~) Unknown ...... l_. PFNNDOT COPY 'C;OFVIMON,~VEALTH OF PEI~"'SYLVANiA POLICE CRASH REPORTINg..;ORM AA 45 6 i Crash Number · , New 'P0140974 - LJ 0=Non-Collision 2=Head O~ 4=Angle 6=Sideswipe 8=Hit Pedestrian 1=Rear End 3=Rear to Rear $=$ideswi~e (Opposite Dire~ion) (Ba(king) (Same Dire~ion) ?=Hit Fixed Obje~ 9=OtherlUnknown ' 1=On Travel Lanes 3=Median $=Out$ide Traffi(way 7=Gore (Ramp Interse~ion) 2=Shoulder 4=Roadside 6=In Parking Lane 9=Unknown 1=Daylight 3=Dark - Street 5=Dawn 2=Dark - No Lights 6=Dark - Unknown" 8=Other Street Ligh~ 4=Dusk Roadway Lighting 5=Fog 6=Rain & Fog 1=No Adverse Conditions 3=Sleet (Hail) 2=Rain 4=Snow 0=Dry 2=Sand, Mud, Dirt, Oil 1=Wet 3=Snow Covered 7=Sleet & Fog 9=Unknown 8=Other 6=Ice Patches 7=Water - Standing 8=Other or Moving 30=Hit Fence Or Wall 31=Hit Building 32=Hit Culvert 33=Hit Rridge Pier Or Abutment 34=Hit Parapet End 35=Hit Bridge Rail 36=Hit Boulder Or Obstacle On Roadway 37=Hit Impact Attenuator 38=Hit Fire Hydrant Harm Event LIR Events in 3 Sequen tia/ Order Most? Utility Pole Number Harm Event L/R UnitNo 1~-~ ~ Events in 3 Sequential Most? Utility Pole Number Harmful Even( in the Crash Unit No Harm Event Mos~t Unit No Harm Event ~ ~ Harmfu~l ~vent in ~ ~T~ the Crash Potential Factors (EIR) I 2 3 O0=None 01=Windy Conditions 11=Slippery Road Conditions (Ice/Snow) 02=Sudden Weather Conditions 12=Substance On Roadway 03=Other Weather Conditions 13=Potholes 04=Deer in Roadway 14=Broken Or Cracked Pavement OS=Obstacle On Roadway 15=TCD Obstructed 06=Other Animal In Roadway 16=Soft Shoulder Or Shoulder Drop Off 07=Glare 28=Other Roadway Factor 08=Work Zone Related 99=Unknown Possible Vehicle Failure~ (V) 00=None 06=Exhaust 01=Tires 07=Headlights 02=Brake System 08=Signal Lights 03=Steering System 09=Other Lights 04=Suspension 10=Horn 05=Power Train 11=Mirrors Unit 12=Wipers 13=Driver Seating/Control 14=Body, Doors, Hood, Etc 15=Trailer Hitch 16=Wheels 17=Airbags 18=Trailer Overloaded 19=Unsecure/Shifted Trailer Load 20=Improper Towing 21=Obstructed Windshield 99=Unknown Indicated Prime Factor Do not repeat this information on multiple pages EIR V D p Unit No Factor Code If E/R is the Prime Factor Type, leave Unit No blank 4=Slush 5=Ice H~armfu/ Events (Harm Event;) 01=Hit Unit 1 02=Hit Unit 2 03=Hit Unit 3 04=Hit Unit 4 05=Hit Unit 5 06=Hit Other Traffic Unit 07=Hit Deer 08=Hit Other Animal 09=Colllslon With Other Non Fixed Object 11=Struck By Unit 1 12=Struck By Unit 2 13=Struck By Unit 3 14=Struck By Unit 4 15=Struck By Unit S 16=Struck By Other Traffic Unit 21=Hit Tree Or Shrubbery 22=Hit Embankment 23=Hit Utility Pole 24=Hit Traffic Sign 2S=Hit Guard Rail 26=H~t Guard Rail End 27=Hit Curb 28=Hit Concrete Or Longitudinal Barrier 29=Hit Ditch 39=Hit Roadway Equipment 40=Hit Mail Box 41=Hit Traffic Island 42=Hit Snow Bank 43=Hit Temporary Construction Barrier 48=Hit Other Fixed Object 4g=Hit Unknown Fixed Object 50=Overtum/Roll Over 51=Struck By Thrown Or Falling Object 52=Pot Holes Or Other Pavement Irregularities 53=Jacknife 54=Fire In Vehicle $8=Other Non-Collision 99=Unknown Harmful Event R=Right O=Other U=Unknown 16=Driving The Wrong Way On 1-Way Street 00=-No Contributing Action 01=Driver Was Distracted 02=Driving Using Hand Held Phone 03=Driving Using Hands Free Phone 04=Making Illegal U-Turn 05=Improper/Careless Turning 06=Turning From Wrong Lane 07=Proceeding W/O Clearance After Stop 08=Running Stop Sign 09=Running RedUght 10=Failure To Respond To Other Traffic Control Device 11=Tailgating 12=Sudden Slowing/Stopp ng 13=Illegally Stopped On Road 14=Careless Passing Or Lane Change IS=Passing In No Passing Zone ~o 1 Unit ~ 17=Careless Or Illegal Backing On Roadway F 18=Driving On The Wrong Side of Road 19=Making Improper Entrance to Highway 20=Making Improper Exit From Highway 21=Careless Parking/Unparking 22=Over/Under Compensation At Curve -' 23=Speeding 24=Driving Too Fast For Conditions 25=Failure To Maintain Proper Speed 26=Driver FleeinQ Police (Police Chase~ 27=Driver Inexperienced 28=Failure To Use Specia zed Equip 98=Other Improper Driving Actions O0=None 01=Entering Or Crossing At Specified location 02=Walking, Running, Jogging, PfayJn~, Or Cycling U~it No [~ [~ 03=Working 04=Pushing Vehicle 05=Approaching Or Leaving Vehicle 06=Playing Or Working On Vehicle 07=Standing 98=Other Unit No [~ ~ COMMONWEALTH OF PEIV~SYLVANiA POLICE CRASH REPORTIN~ ORM AA 45 7 1 New Change/ Continuation Delete Page ?0140975 FORM ~ AA-45 (01/01) J. ,C,'ONIMONWEALTH OF PEN.,SYLVANiA POLICE CRASH REPORTIN, ORM AA 45 8 1 " ~ New C~) Change/ Continuation P0140974 Page: ~ C~ Delete Page Place emergency transport, witness, and other information here. It is not required to restate information from the form. Responding EMS Agency: ~]'Ar__~~{:~ -"m"kJ~, Medical Facility: /iNJC)/kJ'l;:~ Witness l:"~Fyryi ~ Witness 2: , Address: Phone: FORM # AA-45 (01/01) POLICE (2R;~,SH REPORTINr A~45 F 1 I'-UIVIIVIUI~JVVt:::/~LI Iff UI- ~'l-I~ll~b YLV~-~I~II~ 3RM Road SurfaceT___~y~ C) Brick or Block C) Concrete Slag, Gravel or C) Other t~ Blacktop C~) Stone C~) Unknown Page: New C) Change/ Continuation C) Dirt ~ C~) Militar~ C~) Other Federal Sites I Ill No Special I.~, Jurisdiction C~) Indian Reservation C~) Other College/University J C~ National Park C~) Campus C~) Unknown )lease complete Unit Information for each unit involved in a fatal crash. Do not repeat the information in the fields above on multiple pages. Unit Number Driver Restrictions C~) Restrictions Not a Pennsylvania Compliance Complied With C~) Driver Restrictions Not Unknown ~ No Restrictions/C~) Complied With C~ Compliance Not Applicable Compliance C~) Unknown Driver Endorsement Required - Not a Pent Compliance O Complied With O Driver I~) None Required C~ Required - Non Unknown Compliance (~ Compliance Required - C~) Compliance Unknown Not Required for Unk if CDL or Driver License C~) Vehicle Class CDL Required Compliance C~) (~ Not Licensed C~) No Valid License Not a Pennsylvania for Class C) Driver I~ Valid License for Class O Unknown Druq Test Type C~ Blood C~) Other m None C~) Urine C~) Unknown if Tesl Given Test Result~ - (Up to Four Results) ? _= NO Test Given '=Amphetamines ~ ~ - No Drug Reported 6 PCP ~ 2 = Marijuana 8 = Other 3 = Cocaine 9 = Unknown Test ~ [~ 4 = Opiates Results Unit Number ~river Restrictions C~) Restrictions ~ Not a Peru Compliance Complied With '~' Driver Restrictions Not ~ Unknown C~) No Restrictions/C~) Complied With '-'-' Compliance Not Applicable Compliance C~) Unknown ~)river Endorsement Compliance C) None Required Required - ~--~ Not a Pennsylvania C~) Complied With '--'Driver C~ Required - Non r~ Unknown Compliance '~ Compliance Required - C) Compliance Unknown Driver License C~) Not Required for Unk if CDL or ~6mpliance Vehicle Class C~) - CDL Required C~) Not Licensed C) No Valid License (--'lNot a Pennsylvania for Class ~ Driver C~ Valid License for Class C~) Unknown Druq Test Type C) Blood C) Other CD None C) urine r-~ Unknown if Test ~ Given Druq Test Results - (Up to Four Results) - No Drug Reported 6 PCP 2 = Mariiuana 8 = Other 3 = Cocaine 9 = Unknown Test 4 = Opiates Results FORM # AA-45F (01/01) C) Non-Collision C~) Top C~ Undercarriage C) Towed Unit C~) Unknown .A. voidance Maneuver 0 09~~.03 C~ CZ) m No Avoidance Maneuver C) Braking - Skid Marks Evident Braking. No Skid C~) Marks, Driver Stated Under Ride'lndicator C~ No Underride or Override Underride, C) Compartment Intrusion C~ Braking - Other Evidence O Steering - Evidence or Driver Stated C~ Steering and Braking Evidence or Stated Underride, No C~) Compartment Intrusion Underride, C) Compartment Intrusion Unknown 0 Other Avoidance Maneuver 0 Inconclusive C) Unknown C~ Override Other Veh cie Unknown if C~ Underride or Override 0 Lights Flashing ~Not in Emergency Use C~) Siren Sounding C~) Both Lights and Siren C~) Unknown Princiole Impact P_oint C) Non-Collision C~) Top C~) Undercarriage C~) Towed Unit C~) Unknown A~voidance Maneuyer 0 °~04C3 CZ) 06 °~Z) CD F C~) No Avoidance Maneuver C~ Braking - Skid Marks Evident Braking - No Skid 0 Marks, Driver Stated Under Ride Indicator Braking - Other Evidence C~) Other Avoidance Maneuver Steering - Eviden(e'" or Driver Stated C~ Inconclusive Steering and Braking 0 Unknown Evidence or Stated Underride No Override Other C~ No Underride or C) Compartr~'ent Override C~) Vehicle ' intrusion C~) !nderride, Underride, Unknown if ;~artment C) Compartment C) Underride or ntrusion intrusion Unknown Override E__mereq~ncy Use C~) Lights Flashing C~) Not in Emergency Use C~) Siren Sounding C~ Both Lights and Siren C~) Unknown PENNDOT COPy Page 1 Accident # 97-01 June 26, 2001 (Fatal) Ptlm. Shaun A. Felty At 0428 this officer was dispatched to.the 5000 Blk of Trindle Rd. for a struck pedestrian. I arrived on the scene at 0433 to find a tractor trailer stopped in the eastbound lane with the tractor under the navy raikoad bridge overpass. Standing by the tractor was James E. Pru_itt who identified himself as the driver of the tractor trailer. The tractor trailer did have it's headlights on upon my arrival. Also on the scene were Susan Mayernick and Randall Keebaugh who identified themselves as the individuals who called 911. The body of John Andela was in the westbound lane between the tractor trailer and a Shenks Pastry truck. West Shore ALS had arrived on the scene at the same time this officer arrived and paramedic had determined that Andela was akeady dead. Susan Mayernick, 31 Mayernick Dr., Mechanicsburg Pa 17055 ,(717) 691-9705 stated that she did not see the accident but had come upon it in her travel and called 911. Randall Keebaugh, 5340 Oxford Circle, Apt 39, Mechanicsburg Pa 17055, (I~(717) 791-1276 (W)(717) 605-7301 stated that he was driving eastbound on Trindle Rd. and was approaching the accident scene when he saw a car of unknown description traveling westbound on Trindle Rd. away from the scene. Keebaugh did not see the accident but did call 911. James E. Pruitt, 1 Ives Dr., N Little Rock AR 72117 stated that he was lost and was looking for Ralston Pur~n~ when he was traveling eastbound on Trindle Rd. and came to the railroad bridge overpass. He saw the sign that stated the bridge was a height of 13'6" and wasn't sure Lfhis trailer would fit under the bridge. He pulled his tractor forward and under the bridge and exited his truck to see it'his trailer would clear when a truck pulled up behind him and stopped. He went back to the truck (Shenks Pastry) and spoke with the driver who was John Andela_ Pruitt asked Andela for directions to Ralston Purina and then asked Andela it'he thought the trailer would clear the bridge. Andela told him he did think that the trailer would clear the bridge and asked Pruitt if he would like him (Andela) to watch the bridge while he drove under it. Pruitt then tried to drive his tractor trailer under the bridge. Pruitt saw Andela standing in the westbound lane of Trindle Rd. next to Pruitt's tractor. Pruitt was looking back and forth between Andela and the bridge when a red ~' blur c~ went past and Andela was gone. It was at this time that th~ officer was informed by a Lower Allen Twp. EMT that a young woman had arrived on the scene stating that she had been in an accident and that something had hit her car. This officer £ound Heather K. Frampton by a red Nissan Sentra with Pa registration ]3SM3413. The Sentra had m~uor front end damage to the driver side comer and had a large whole in the windshield by the PA inspection sticker. The windsheild wipers were in the up position. The car was located on the east side of the accident scene behind this officers patrol car. [qeather I(. Frampton stated that she was on her way home from Country Meadows, where she works. She was driving westbound on Trindle Rd. and approaching the Page 2 raikoad overpass and saw a tractor trailer stopped w/th it's lights on. She slowed down and when she drove past the truck something hit her car. She drove down the street and turned around in a business parking lot. She then drove back towards the accident scene and saw that the truck was still stopped in the eastbound lane and drove down the right hand side of the truck, using the shoulder. Frampton drove back to Country Meadows to call her mother. During my initial encounter with Frampton she appeared calm and never mentioned that she had struck someone. Frampton was not told by myself or Officer Kopko who was also present with her that she had struck a individual. Frampton was also not in a position to see John Andela's body. I then attempted to obtain more information from Pruitt who was with the Lower Allen Twp. EMTs. Pruitt appeared distraught and blamed himself for the accident. Pruitt was not injured but was transported by Lower Allen Twp Ambulance to Holy Spirit to speak with a crisis worker. Frampton's mother, Mary Shreve, arrived on the scene and it was at th/s time that Frampton was informed by this officer that she had struck and killed a individual. This officer noticed that Frampton began to cry and shake. Frampton was requested to follow Officer Kopko back to our station so that we could get a whtten statement as to what occurred. Frampton and her mother did go to the station and Frampton did provide a written statement to Officer Kopko. A review of the accident scene showed that there were no gouges or scratches in the roadway to indicate a point of impact. From statements that Pruitt made the area of impact is believed to be close to but behind the tractor driver door. Small particals of glass were seen on the roadway between the area of impact and Andela's final resting place. The glass could only be seen by shinning a flashlight over the road surface. There is a overhead light in the area which is 43 feet from the railroad bridge abutment on the westbound side of the roadway. The overhead light sits on a telephone pole at a height above the bottom of the raikoad bridge and the light is obscured by a tree which sits between the light and the railroad br/dge. Lighting under the railroad bridge is tx)or. The area of impact is believed to be 45 feet east of bridge abutment on the westbound side of the roadway. The body w ~ side of the roadway, as 4~ feet from the railroad bridge abutment on the westbound F ~ ' rampton s vehicle was transported to the Hampden Township Police Station by Roadside Auto Rescue. Photo graphs and videotape of the accident scene were taken by Denrfis Brown, Hampden Twp. Fire Dept photographer. After clearing the scene this officer returned to the station and breifly spoke with Frampton who had already provided a written statement. Frampton was asked if she knew what the speed limit was (40 MPH), which she did. Frampton was asked how fast she thought she was going to which she replied that she didn't know but that she had slowed down when she saw the stopped tractor tra/ler~. Th/s officer also intervSewed Pruitt at the station on the morning of June 26t~ after he left Holy Spirit Hospital. Page 3 Pruitt stated that he had become lost and was approaching the railroad bridge when he saw the sign that indicated the bridge height was 13'6". He pul/ed his tractor forward under the bridge and ex/ted the truck to see if his trailer would clear. He saw a track pull up behind and went back to the track to asked the driver (Andela) for directions. Andela provided directions to Ralston Purina and Pmitt asked An&la if he thought his trailer would clear the bridge. Andela told Pruitt that he thought the trailer would clear the bridge and then asked Pruitt if he would like him (Andela) to watch while Pmitt drove under the bridge. Pruitt went and started his track and Andela was standing in the westbound lane looking up at the bridge. Pmitt was pulling forward and Andela was telling him to keep going he has 8 more feet. Pruitt was looking between Andela and the bridge when saw a red blur go by and heard a crunch. Pmitt exited his tractor and saw a car traveling westbound and that it appeared to be driving onto the westbound shoulder. At this time two cars pulling up and he told them to call 911. Pruitt could not say tithe red "blur "was the color of a car or the tail lights ora car. Pruitt never saw the car approaching prior to collision since he was looking fi.om the bridge to Andela. Pmitt could not say at what speed he thought the red "blur "may have been traveling. Pmitt did not believe that Andela saw the vehicle coming since he did not say anything to impact nor did he say anything afterwards. Pmitt provided this officer with a written statement. In a attempt to dete~'l',,ine how Andela traveled offthe Nissan Sentra the vehicle was processed using Luminal and Ultra Violet lighting. During this process no blood was found to be on the exterior of the vehicle. Scuffmarks were found on the front driver side quarter panel. Additional photographs were taken of the Nissan Sentra by this officer. On 27 June 2001 this officer interviewed Patricia Franks, 4902 Delbrook Rd, Mechanicsburg Pa 17050, (H) 763-5716. Franks stated that she has worked with Frampton for 1 -2 months at Country Meadows. On the morning of the accident Frampton was suppose to get offwork at 0400. There was nothing unusual about the shift. Frampton did not appear in a hurry nor did she say anything about being in a hurry. Franks was present at Country Meadows when Frampton returned there after the accident. Frampton stated to Franks that something had just hit her car. Frampton called her mother and stated "Mom you have to come get me something hit me ". Frampton was upset and Franks got her calmed down and they noticed the emergency vehicles driving past Country Meadows towards the accident scene. Franks told Frampton that she should return to the scene. It was Franks opinion that Frampton was not aware that she had struck someone. Mike Norris, Cumberland County Coroner, has stated that injuries sustained by Andela are consistent with those ora individual who has been struck by a vehicle traveling less than 30 MI>H. Page 4 Driver/Vehicle Information (not involved in collision) Driver - James E. Pruitt, 1 Ives Dr, N Little Rock, AR 72117, AR/227279679 Vehicle - 2001 FRHT, TN/58924HY, VIN 1FUYDSEB9WP96779, white. Registered owner, Covenant Transport Inc., 400 Birmingham Hwy, Chattanooga TN 37419-2346. Pmitt works for Southern Refrigerated Transport, (888) 778-7670. Tractor was towing a 53 ft trailer, white, empty. Vehicle - 1999 Ford PA/ZS34675, VIN 1FDXF46F1XED43960 white. Registered owner, Schenks Pastry Shoppe INC., 5303 E. Trindle Rd., Mechanicsburg Pa ~7050. This vehicle had been driven by John Andela and was left parked behind the above tractor trailer during the accident. Exhibit C ~¥ o ? ~? ~ IN RE: PETITION OF CHRISTINE ANDELA, ADMINISTRATRIX OF THE ESTATE OF JOHN D. ANDELA, DECEDENT, Petitioner / NO. ORDER. AND NOW, this 9 :Zt~ day of ----)~1~_~, 2002, upon consideration of the Petition for Approval of a Compromise Settlement and Distribution of Proceeds Pursuant to Pa.R.C.P. 2206, IT IS HEREBy ORDERED THAT: (1) The settlement of Christine Andela, Administratrix of the Estate of John D. Andela, is hereby approved and the proceeds wilI be allocated as follows: (a) Estate of John D. Andela, deceased, under the Survival Action (b) Estate of John D. Andela, deceased, under the Wrongful Death Action (c) Angino & Rovner, P.C., professional fees based on 30% of the gross amount recovered (d) Reimbursement of out-of-pocket expenses TOTAL PRESENT DISTRIBUTION $10,994.40 $43,977.60 $24,000.00 $ 1 028.00 $80,000.00 BY THE COURT: 244672.1 \DLLgdTG TRUE COPY FROM RECORD tn Tesl'lmo~y whereof, I here unto set my hand and the Seal ot ~id Court at Carlisle, Thl~oaY ~ ot 'Tr/t., ~' Exhibit D DE pAR~'M ...... ==~, coMPENSATiON 1171S. _C-Z~_.~n,,RG pat7t04-2501 (TOLL FREE'} 800-482 2383 CLAIM pETITION FOR WORKERS' coMPENSATION EMPLOYEE John :irst Name Last Name AF~ela if Deceased ° Dependent or Guardian First Name ~ fc~' ~ ~:~' a [t3:~3~, ~c Last Name ~ 179 Lebanon Village Address AddresS Lebanon state PA City/Town County Lebanon Telephone ( 717) 270-0409 zip 17046 EMPLOYEE SociAL s~CU~RgY_ NUMBER _ ~-~N~H~- DAY EMPLOYER Name ~S ~as~ Shop~ Address 5303 ~aS~ ~[e R~ Address State ~ Zip ci~own coun~ C~i~d FBN Telephone ( 717 ) 697-0476 . · VS.~ Name C~C Address P'O' ~X 1155 Address State PA Zip 17055 Ci~own ~c~iCsb~g Telephone ( 7~7 ) 763-9863 Bureau Code c~[~ coun~ FEIN Un~ s including all parts of body affected. injury or illnes ..... + s fatally ~_nju~e~ 1. Complete description of ~ t~ scO~ of ~lu~, ...... ~ copy of t~ H~en T~ship Jo~ ~de~, ~e Attac~ ~ ~ibit A is a was st~ck by ~ aut~bile- ~?,__~ ~-~- ~---~~-~ ~o~ce ~e~- ~, ~, ~ _,, , · ~ and/or 2.. o~p~tio~S ois.-, gi~e t~e t~t O~te of e~¢oy~e~t'~ ~ ~-~ .~ .... ~ L_. DAY . . y~A~ ......... _.m~--~ r~T----~ '- T F last date of exp~ure '. ~ ] L__]__ ] ~ ......... ~ ..... YEAR 3. Give date of injury or onset of disease 0 ..... 5~~ase occur on employeFs premises? ~-~ Yes ~'. No Where? (Be specific.) 6. Notice of your injury or disease was served on your employer following manner: probably contacted by the Police. 7. What was your job title at the time of injury or disease? on L (OVER) LIBC-362 REV 11-97 YEAR _ . . MONTH DAY __ ............... --- ' ~ in the - 2 6-2 O; O: 1 0 6 ..................... ._W,~e m~^~+~ a nC Corpo MONTH DAY 9. Did this problem cause you to stop working? ~Yes V~No ifYes, givedate. 0 ,o ~-~ 10. Are you back to work with the same employe~ ~ Yes ~ No If Yes, ;~ Regul'ar~o~-~.; ~t~e~ob / Give title. 11. Are you working with another employer? ~ Yes ~No If Yes, give name and address of new employer: ~ ' , '-Hour :~:Day ~'orWeek 12. What were your wages at the time of inju~? $~ ~ ' ~ ' · n~ous ~e~ests. · ~ Same ~ Less Un~- ~t~P~ ~s~your inju~ or illness, are you earmng .~ More _ 13.1fyouhavereturneatow°ms~ ~ , [ ~ ~ .~Hour~-~Day~ orWeek than you were at the time of inju~? Current earnings $ . , ; ; , ' ...... 14. I am seeking payment for (check all that apply): X ~th MONTH DAY ......... ~ ~-~ ~_ L_.-~ ...... ~-~ ..... ~ Medical bills (give name of doctor/hospital, address, ~pe of treatment and bill in space below). ~ Counsel fees to be paid by the employer. ~ Loss or loss of use of arm, hand, finger, leg, foot or toe. ~ Disfigurement (scars) of head, face, or neck. ~ Additional compensation from the Second Injuw Fund (due to existence of prior physical disability). ~ Loss of sight. ~ Loss of hearing. 15. Other ~ath ~n~fits 16. Is there other pending litigation in this case? ~ Yes ~ No If Yes, explain below: A th~-~ty action is cont~lat~ - Date of Petition PLEASE ENTER MY APPEARANCE FOR PETITIONER: Attorney Name David L. Lutz, Esquire PAAffomey ID Number 35956 Angino & Rovner, P.C- 4503 N. Front Street Firm Name Address Address City/Town Harrisburg State PA Zip Code 17110 Telephone (717) 238-6791 ~ NOTICE: This Petition must be filled out as fully as possible. The original must be sent to i, n -"1 i 8 -i2 0 1 · ........... ~¥ MONTH as been sent to the employer. Signature ~ Employee _-x Attorney the Bureau of Workers' Compensation, 1171 South Cameron Street, Room 103 Harrisburg, b ou to the employer. Information on th;; completion 7 4-2501.Acopy must be sent y,Y ~ - -~^~ e s Corn ensation Helpfine at %/~ ~t~isl?oarm may be obtained by carling the ~urea ...... rkr' P 800-482-2383. Any individual filing misleading or incomplete information knowingly and with intent to defraud is in v o at on of Section 1102 of the Pennsy van a Workers' Compensation Act and may a~so be subject to criminal and civil penatties through Pennsy vania Act 165. ~ LIBC-362 REV 11-97 Exhibit E · COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF LABOR AND INDUSTRY BUREAU OF WORKERS' COMPENSATION 1171 S. CAMERON STREET. ROOM 103 HARRISBURG. PA 17104-2501 (TOLL FREE) 800-482-2383 DEFENDANT'S ANSWER Social Secudty Number: 146 62 TO CLAIM PETITION Date of Injury:06 ./. 26 / 2001 UNDER MM oo ~w PENNSYLVANIA WORKERS' PA BWC Claim Number: 2300781 (~F mOW,) COMPENSATION ACT 6003 Employee First Name Last Name JOHN ANDEI~ (Deceased} Christine for Brandon Andela, a minor, son of decedent. Street 2 179 LEBANON VILlaGE ~'"~NO N PA 17046 -__ Telephone ~_°~ANON { 717) 270 - 0409 vs. Employer $CHENK'S PASTRY SHOPPE 5303 EAST TRINDLE ROAD State Z~p Code PA 17055 -__ CHANICSBURG County CUMBERLAND Telephone FEIN ~717) 697 -0476 Insurer or Third Party Administrator (if self-insured) Name CINCINNATI INSURANCE CO. Stree[ 1 "O BOX 145496 CINCINNATI OH 45250 - 5496 Buresu Code Telephone 206 ( ) County Claim Number FEIN TO YOUR HONORABLE JUDGE: In answer to the captioned claim, the Defendant respectfully pleads as follows: (Answers must be identified by numer- ical order in direct response to corresponding numbered allegations on claim petition.) 1. Admitted in part and denied in part. Answering Defendant admits that Decedent was fatally injured when he was struck by an automobile while outside of his delivery van. Answering Defendant denies that Decedent was in the course and scope of his employment at the time of the fatal accident, having substantially deviated from his course of employment. Strict proof to the contrary is demanded. 2. Not applicable. 3. Admitted. 4. Admitted in part and denied in part. Answering Defendant admits that Decedent was assisting the truck driver by .quiding the truck through the underpass. Answering Defendant also admits that Decedent was struck and killed by an oncoming vehicle at that time. Answering Defendant denies that Decedent was in the course and scope of his employment when the accident occurred and strict proof thereof is demanded. Continued on a Separate Pa,qe NOTICE: This answer should be clearly completed (preferably typed) and original mailed directly to the office of the Judge to whom the case is assigned. Answers must be filed within 20 days. Every fact alleged in the claim petition not specifically denied by this answer shall be deemed to be admitted. L[BC-374 REV 12-97 (OVER) )HI~ ANDELA (Deceased) Claimant, V. ;HENK'S PASTRY SHOPPE Defendant. S.S. No. 146 62 6003 Date of Injury: 06/26/2001 DEFENDANT'S ,ANSWER TO CLAIM PETITION UNDER P E N N SYLVAN IA WORKE RS' COMPENSATION ACT - Cont. Page 1 .~fendant's Plea Admitted. Notice to the employer of Decedent's accident and death is not disputed. Admitted. Denied. Answering Defendant is without knowledge or information sufficient to form a belief as to the truth or Isity of the averments contained in paragraph 8 of the Claim Petition and demands strict proof thereof. Admitted. Admitted. Admitted. !. Denied. Answering Dependent will provide a statement of wages at the time of the first hearing in this matter. Not applicable. Admitted in part and denied in part. Answering Defendant admits that a claim is being made for death :nefits on behalf of Brandon Andela and a request for counsel fees is also being made. Answering Defendant :hies that Brandon Andela is entitled to the receipt of death benefits under the provisions of the Worker's 3mpensation Act and strict proof is demanded. i. Admitted in part and denied in part. Answering Defendant admits that a claim is being made for death :nefits. Answering Defendant specifically denies that Brandon Andela is entitled to the receipt of death benefits ~der the provision of the Workers' Compensation Act. L Admitted. LIBC-374 As a matter of further defense, the Defendant states the following: 1. Claimant has failed to state a cause of action upon which the requested relief can be granted. 2. Brandon Andela was not a member of decedent's household at the time of decedent's death. 3. Brandon Andela was not dependent on decedent, John Andela, for support at the time of the death of John Andela. 3. Brandon Andela does not meet the requirement of Section 307 of the Pennsylvania Workers' Compensation Act for the receipt of death benefits. 4. Decedent, John Andela, substantially deviated from the course and scope of his employment at the time of accident causing his death. 5. Brandon Andela is unable to establish dependency on John Andela at all times matedal to this petition. WHEREFORE, the Defendant requests that the claim petition be dismissed or in the alternative disallowed. Defendant MICHAEL A. FARRELL Date: 11 / 05 / 2001 Attorney Date: 11 / 05 / 2001 MM DO ~ PLEASE ENTER MY APPEARANCE FOR DEFENDANT: Attorney First Name Last Name MICHAEL A. FARRELL FARRELL & RlCCl, P.C. !4423 NORTH FRONT STREET Street 2 City/Town State Zip Code HARRISBURG PA 17110 - Telephone PA A~tomey ID Number (717) 230- 9201 41067 Any individual filing misleading or incomplete information knowingly and with intent to defraud is in violation of Section 1102 of the Pennsylvania Workers' Compensation Act and may also be subject to criminal and civil penalties through Pennsylvania Act 165 of 1994. CERTIFICATE OF SERVICE I, Michael A. Farrell, Esquire, do hereby certify that I served a true and correct copy of Defendant's Answer to Claim Petition on this 5th day of November, 2001, by depositing it in the United States first-class mail, postage prepaid and addressed as follows: The Honorable Christina Tarantelli Workers' Compensation Judge 1661 Old Philadelphia Pike Lancaster, PA 17601 David L. Lutz, Esquire Angino & Rovner, P.C. 4503 North Front Street Harrisburg, PA 17110 Dated: 11/05/01 By: Michael A. Farrell, Esquire FARRELL & RICCI, P.C. Attorneys and Counselors at Law · 4423 North Front Street, Harrisburg, PA 17110 * 717-230-9201 Exhibit F STIPULATION OF UNDISPUTED FACTS CLAIM PETITION WCJ CHRISTINA M. TARANTELLI, YORK/LANCASTER COUNTY Claimant 146-62-6oo3 Social Security Number Is this claim for medical bills only? 1. Yes Defendant Insurance Company No X The Pennsylvania Workers' Compensation Act applies to this claim. Part/es 2. The Claimant and Employer were in an employee-employer relationshio at the time of the accident/injury. . Parties, 3. The accident/injury arO,)~e out of and in the scope of employment. 4. Date of alleged accident/injury: ~-2~:~-0]. . Parties ~ 5. Date when Employer was advised Parties, or learned of accident/injury: ~ 6. Timely notice of injury was given to Employer within 21 days. Partfe$ 7. Timely notice Parties agree given to Employer within 120 days. 8. Claimant filed a timely ~Claim Petition. Parties, 9. Employer filed a timely Answer to the Claim Petition. Parties 10. Claimant's average week y wage was $ ~ resulting ih a COmpensation rate of $ ~. Parties 11. Claimant has not returned to work following the alleged acciden~njury. X 12. Who was the insurance carrier at the time of the alleged injury? Carrfer No Insurance Self-insured 13. If cther S.r S~tip.tipulations. please attach a Separate Sheet signed by .both COunsel. Date: 2-6-02 Counsel for Claimant Exhibit G FIRST HEARING FILING WCJ CHRISTINA M. TARANTELLI, YORK/LANCASTER COUNTY Claimant s:~ha~,s ~ ~ Defendant ~46-62--6003 Social Security Number Insurance Company 1. Specific relief requested: 2. Allegations and issues of fact and law involved: 3. Proposed amendments to pleadings: N/A. 4. Identify Moving Party's witnesses and proposed method of presentation. Include name, address, and purpose of proposed testimony. ~ ~NTl~]a, 179 r~4ser~n Viii ~O=' [~-,=:~Q~, -PA 17046. Will t~stify about ti~ clec~rlm~'s s~?xt ~ %o the ~'s miter scn. Scheduled dates of deposition for Moving Party's witnesses: 6. Estimated headng time required for presentation of Moving Party's case-in-chief: Has Moving Party exchanged documents and records in conformance with 34 Pa. Code § 131 61 (a)~ Yes X No If not, explain: Exhibit H Michael A. Farrell Joseph A. Ricci ~ Marc T. Levin * Daniel J. Stephen R Hards Colleen E. Ehresraan, R ~,'.. Gr~ory D. Geiss Thomas M. Fratit~ La~A'ence F. Barone Lynn A. Matz · also admittedin 9T~w J~ '~ David L. Lutz, Esquire ANGINO & ROVNER, P.O. 4503 North Front Street Harrisburg, PA 17110-1708 Farrell & R&ci, P.C. Atwrneys and Counselors at Law 4423 North Front Street Harrisburg, PA 17110 (717) 230-9201 (717) 230-9202 mfarrelI~frpclaw.com April 29, 2002 Re: Estate of John Andela v. Schenk's Pastry Shoooe Bureau Claim No. 2300781 Our File No. CIN-130 Dear Dave: Please allow this letter to confirm our conversation on April 24, 2002 concerning the revised settlement offer that was extended to you and your client in the above matter. As we have previously discussed, should the Claim Petition be granted, Brandon Andela would be able to receive death benefits until he attained the age of 18 or 23, depending upon whether or not he continued to be a full time student in an accredited college or university. Based upon the amount of benefits he would receive on a weekly basis, he would receive approximately $44,000.00 over the l.ifetime of'this c]a_i.m. However, Cincinnati Insurance Company, which is the workers' compensation insurer for Schenk's Bakery, would be able to subrogate against the Third Party settlement proceeds that are available to Brandon Andela. The settlement of the case for $80,000.00 is more than sufficient to satisfy the entire subrogation lie.n that Cincinnati Insurance Company would have in this case. Accordingly, it. could recover the approximate $44,000.00 that it would be obligated to pay to Brandon Andela. However, Cincinnati Insurance Company would have to pay to Brandon Andela the amount of attorneys' fees that he paid to you in order to secure that settlement. Assuming that your attorneys' fee is one-third (1/3) of the settlement amount, Cincinnati would have to pay approximately $15,000.00 to Brandon Andela. Again, that assumes that the Judge grants to Brandon Andela all that is being requested in the Claim Petition. Certified as a Civil Trial Advocate by the National Board of Trial Advocacy A Pennsylvania Supreme Court Accredited Agency David L. Lutz, Esquire April 29, 2002 page 2 As we have also discussed, I believe the Claim Petition has a 50/50 chance of being successful. It is for that reason that the initial offer of $7,500.00 was provided to your client. However, given the litigation costs and attorneys' fee that would be involved in fully litigating the Claim Petition, my client has been persuaded to increase its settlement offer to $10,000.00. That is the amount that is now being offered to your client in order to resolve all aspects of the Claim Petition. Please be advised that my client has indicated that there will be no further settlement offers. Should the settlement offer be acceptable to your client, the Claim Petition can be resolved by the parties entering into a Compromise and Release Agreement, which I will prepare for your review and signature, as well as the signature of the legal representative of Brandon Andela. A hearing will then be scheduled in front of a workers' compensation judge to have the Compromise and Release Agreement approved. Once that is done, I suggest that a Petition be filed in the Court of Common Pleas to have a Common Pleas Judge approve the agreement since we are dealing with the settlement of the legal rights of a minor. Please discuss this settlement offer with your client and advise me as soon as possible if this matter is able to be resolved based upon the above offer. Should you have any questions concerning this matter, please let me know. Thank you for your attention to this matter. Very truly yours, Michael A. Farrell MAF/dab P,So Cincinnati Insurance Company would not maintain any subrogation lien against the settlement proceeds from the Third Party action for the $10,000.00 it is now being offered to your client. Thanks, Mike. Exhibit I 'UTR-00~ REV 09/05/00 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF LABOR AND INDUSTRY BUREAU OF WORKERS' COMPENSATION 717-299-7591 Circulation Date: 06/28/2002 DAVID L. LUTZ, ESQ. ANGINO & ROVNER PC 4503 N FRONT ST HARRISBURG PA 17110-1708 DECISION RENDERED COVER LETTER Bureau Claim Number: 2300781 Insurer Claim Number: WC8945842 Petitions: Claim-Pet Amended To: Pet-To Seek Approval of Compromise and Release JOHN ANDELA 3365- B ROSSTOWN ROAD WELLSVILLE, PA 1-7365-0000 BRANDON ANDELA 31 PALM CITY PARK ANNVILLE, PA 17003-0000 DAVID L. LUTZ, ESQ. ANGINO & ROVNER PC 4503 N FRONT ST HARRISBURG, PA 17110-1708 Vs SCHENKS PASTRY SHOPPE 5303 EAST TR/NDLE ROAD MECHANICSBURG, PA 17055-0000 MICHAEL A. FARRELL, ESQ. FARRELL & R/CCI PC 4423 N FRONT ST HARRISBURG, PA 17110 CINCINNATI CASUALTY CO PO BOX 145496 CINCINNATI, OH 45250-5496 Judge: Christina Tarantelli 1661 Old Philadelphia Pike Lancaster, PA 17602 The attached Decision of the Judge is final unless an appeal is taken to the Workers' Compensation Appeal Board as provided by law. If you do not agree with this Decision, an appeal must be filed with the Workers' Compensation Appeal Board within 20 days from but not including the date of this notice. Forms for an appeal may be obtained from the Workers' Compensation Appeal Board, Capital Associates Building 901 North Seventh Street Third Floor South Harrisburg, PA 17102 Page 1 of 2 JOHN ANDELA - 2300781 .Employee Witnesses & Exhibits: None Emolover Witnesses & Exhibits' None EMPLOYEE COUNSEL Witnesses & Exhi CHRISTINE ANDELA EMPLOYER COUNSEL Witnesses & Exhi D-01 STATEMENT OF WAGES Hearings: 6/26/2002 12:45:00 Held 4/24/2002 15:00:00 Held 2/6/2002 09:00:00 Held Page 2 of 2 JOHN ANDELA CLAIM PETITION CLAIM #2300781 FINDINGS OF FACT 1. During these proceedings, the parties requested that the Petitions filed in this matter be amended in order to request approval by this Judge of a Compromise and Release Agreement pursuant to Section 449 of the Pennsylvania Workers' Compensation Act, as amended. 2. A hearing concerning the Compromise and Release Agreement was held on June 26, 2002, at which time the parties submitted a fully executed copy of the Compromise and Release Agreement. 3. Following the hearing, this Judge is satisfied that the Claimant, in accordance with Section 449 of the Pennsylvania Workers' Compensation Act, understands the full legal significance of the Agreement and therefore, it is approved. CONCLUSIONS OF LAW 1. The parties to these proceedings are bound by the provisions of the Pennsylvania Workers' Compensation Act, as amended. 2. The Compromise and Release Agreement submitted by the parties is approved since this Judge is satisfied that the Claimant understands the full legal significance of the Agreement. ORDER AND NOW, this 26th day of June, 2002, the Compromise and Release Agreement submitted by the parties is approved. The Defendant is instructed to pay the amounts as indicated in the Agreement. An attorney's fee as set forth in the Agreement is approved and shall be payable directly to Claimant's attorney. Defendant is authorized to deduct said amount from the lump sum and pay the same directly to Claimant's attorney. NAM. TARANTELLI, JUDGE COMMO,~4WEALTH OF PENNSYLVANIA E~,EPA~'~,TMr~,~T bF LABOR AND INDUSTRY BURE,^.U OF W.QRKERS' COMPENSATION 117.! S. CAMERON STREET, ROOM 103 HARRISBURG, PA 17104-2501 (TOLL FREE) 800~.82-2383 TTY 800-362-4228 www,dli.state.pa.u$ C.; U M I-'1~ U MI ,.~ 1::: ANU RELEASE AGREEMENT BY STIPULATION PURSUANT TO SECTION 449 OF THE WORKERS' COMPENSATION ACT Date of Injury: uu / ,:.,., L .... MM OD yyyy PA BWC Claim Number: 2300781 {IF KNOWN) Employee John Andela (Deceased) 179 Lebanon Villaqe City/Town Slate Zip Code Lebanon PA 17046 - Counly Telephorle Lebanan (.717) .270 - .040g TO THE PARTIES: DO NOT SUBMIT THIS AGREEMENT TO THE BUREAU. SUBMIT IT TO THE ASSIGNED WORKERS' COMPENSATION JUDGE. TO THE EXTENT THIS AGREEMENT REFER- ENCES AN INJURY FOR WHICH LIABILITY HAS NOT BEEN RECOGNIZED BY AGREEMENT OR BY ADJUDICATION, THE TERM "INJURY" AS USED IN THIS AGREEMENT SHALL MEAN "ALLEGED INJURY". Employer Schenk's Pastry Shoppe Street 1 5303 East Trindle Road Street 2 Mechanicsburq PA 1 7055 . Cumberland (717).697 - 0476 Insurer or Third Party Administrator (if self-insured) Cincinnati insurance Company 'P.O. Box 1155 1. This is an agreement in the case of the above listed employee and the above listed employer, insurer, or third party administrator in regards to an injury or occupational disease. 2. State the date of injury or occupational disease. 06 / 26~_2001 3. State the average weekly wage of the employee, as calculated under Section 309. $ 283.36(322.00)/wk Mechanicsburq PA 17055 (717)763 - 9863 Cumberland WC 8945842 State the injJry, the precise nature cf the injury, and the nature of the disability, whether total or partial. Death. The Claimant's average weekly wage at the time of his death was $283.36 per week. Section 307 provides that in no case shall wages of the decedent be less than 50% of the state wide average weekly wage. The state wide average weekly wage for the year 2001 was $644.00 per week, and, therefore, Claimant's average weekly wage for the Continued on a Separate Page State the weekly compensation rate or payable. $ .. 255.03(103.04}/wk State the amount of indemnity benefits paid or due and unpaid to the employee or dependent up to the date of the stipulation or agreement or death. $ 0.00 State the amount of the payment of indemnity benefits to be made at or after the date of the stipulation or agree- ment or death, and the length of time such p; ~qt of benefits is to continue. $ 0.00 for LIBC-755 REV 8-01 LI8C-755 Does this claim arise out of the death of an employee? If Yes, provide the following information: [] yes ~ No a. Date of death: 06 / 26 / 2001 Name and address of the widow or widower (include any maiden names, aliases and names upon remarriage, if applicable): N/A. c. Names, addresses and dates of bir~h of all children: Brandon Andela, 179 Lebanon Village, Lebanon, PA 17046; Date of Bir~h: 02/15/1993. do If it is claimed tl~at the dependency of any child continues.beyond the age of eighteen (18) years, identify that child and state specifically the factual basis for this claim. N/A. State the name, address and relationship to the employee of any other person claiming to be a dependent, logether with a brief summary of the factual basis for this claim. N/A. Summarize all of the medical benefits paid, or due and unpaid, to or on behalf of the employee (or each'depen- dent identified in Paragraph 8 above) up to the date of this agreement. N/A. This is a fatal claim. 10. Summarize all benefits to be paid on and after the date of this stipulation or agreement for reasonable and necessary medical treatment causally related to the injury and the length of time such payment of benefits is to continue. None. 11. Does the insurer/employer/administrator assert a lien or potential lien for subrogation under Section 3197 [] Yes [] No If Yes, state the total amount of compensation paid or payable which should be allowed to the insurer/employer/ administrator for subrogation under Section 319. $ 80,000.00 1 2,. Are ther~ any current child or spousal support orders in place against the claimant2 _ E~Yes [] No If Y'es, please explain: 1 3. List all benefits received by, or available to, the claimant; e.g. Social Security (Disability or Retirement), private health insurance, Medicare, Medicaid, etc. For such benefits, list the amount(s), period of payments of benefits, and status of eligibility determination. N/A. 4. Check as appropriate: [] A vocational evaluation of the employee was completed on / / by A copy of this report is attached hereto. 'MM ' eo % [] A vocational evaluation of the employees has been waived by mutual agreement of the parties. 5. State the issues involved in this claim and the reasons why the parties are entering into this ag~:eement.. This matter involves a Claim Petition filed for the benefit of Decedent, John Andela's Estate. The Claim Petition was seeking relief in the nature of death benefits for Claimant's minor child identified as Brandon Andela, Date of Birth: 02/15/1993. The parties have stipulated that the death occurred within the course and scope' of Claimant's employment. The only issue in dispute is whether the Claimant's child, Brandon Andela, is a pendent" as that term "de - is defined in the Pennsylvania Workers' Compensation Act. Claimant's Estate has settled a third party claim for the sum of $80,000.00. Employer/Insurer is entitled to subrogation against the third party recovery pursuant to Section 319. The parties have entered this Compromise and Release Agreement to resolve the Claim Petition and the amount of death benefits payable to Bran.don Andela as a result of the fatal claim. This Compromise and Release Agreement also resolves Employer's subrogation interest against the third party recovery. 16. The fee agreement between claimant and counsel must be attached. 1 7. Employer shall be responsible for litigation costs in the total amount of $ 1 8. Miscellaneous provisions, if any. Decedent/Claimant's average weekly wage was $283.36 with a corresponding weekly compensation rate of $255.03. Section 307 of the Act provides that in no case shall wages of the deceased be taken to be less than 50% of the state wide average weekly wage for the purpose of awarding death benefits. The state wide maximum average weekly wage for the year 2001 is $644.00. Therefore, the applicable average weekly wage in this case is $322.00. Section 307(1 )(a) Continued on a Separate Page _REMINDER TO PARTIES: Upon approval of this Agreement, please promptly withdraw all appeals pending before the Workers' Compensation Appeal Board, Commonwealth Court, Pennsylvania Supreme Court, etc., which are also resolved by this Agreement. 3 LI8C-755 EMPLOYEE'S CERTIFICATION . _ I certify that have read this entire agreement, or to the best of my knowledge, information and belief (if applica- ble) this agreement has been read to me, and I understand all of the contents of this agreement as well as the full legal significance and consequences of entering into this agreement. I understand that, if this agreement is approved, I will receive only the benefits mentioned in this agreement, unless the agreement provides specifically for additional amounts. I understand that my employer, its insurance company or its administrator will never have to pay any other workers' compensation benefits for the injury. Except for the amounts or benefits listed in this agreement I have been offered nothing of value to convince me to sign this agreement. ' I have been represented by an attorney of my own choosing durinc~:h,is case. My the content of this agreement and its effects upon my rights. X/~ ~'~" attorney has explained to me (Employee's Initials) --OR-- I have not been represented by an attorney of my own choosing. However, I have been told that i have the right to be represented by an attorney of my own choosing in this proceeding. I have made my own decision not to have an attorney represent me. (Employee's Initials) Unless specifically Stated in this agreement, I understaq.d_that._this agreement is a compromise and release of a workers' compensation claim, and is not considered an admission of liability by employer and/or insurer and/or administrator. DO NOT SIGN THIS DOCUMENT UNLESS YOU UNDERSTAND THE FULL LEGAL SIGNIFICANCE OF THIS AGREEMENT. All parties have read this agreement and agree to its contents. We u_nderst~and that under this agreement, all petitions · ~ resolved. MM DO ~~ EMPLOYEE (SIGNATURE) ~ _Day d L. Lutz, Esquire TNESS 3~O EMPLOYEE'S SIGNATURE EMPLOY~'E'S COUleEL EMPLOYER/INSURER/THIRD PARTY ADMINISTRATOR (SIGNATURE) EMPLOYEE'S SIGNATURE ~*~ ,/~ '~ Michael A. Farrell, Esquire ~ EMPLOYER/INSURER/THIRD PARTY ADMINISTRATOR COUNSEL If not witnessed above, this agreement must be notarized as follows: ~ AFFIDAVIT/ACKNOWLEDGMENT: ~ Befo.[,e mc, the,undersigned Notary Public, in and for the aforesaid County and State, personally appeared ~/¢~ r/,~/,""~,-~... _. who being first duly sworn, does depose arid state that he/she knows (or has satisfa, ctoriiy proven to be) the individual identified as th_.e employee in the foregoing compromise and release agree- e and release agreement for the purposes stated herein. NO'C'~R.Y"~L~Co~,r, uch Lebanon County, F.~ [ /idb (_;OMPROMIS~r~.~w2~_ 'p.~-LF_.A,5~. AGREEMENT IS NOT VALID AND BINDING UNLESS APPROVED BY 3OMPENSATION JUDGE IN A DECISION. A WORKERS' ~,ny individual filing misleading or incomplete information knowingly and with intent to defraud is in violation of .~ection 1102 of the Pennsylvania Workers' Compensation Act and may also be subject to criminal and civil penalties hrough Pennsylvania Act 165. Jd,hr~ Anaa:a (Deceased) Claimant, V, Schenk's Pastry Shoppe Defendant. Date of Injury: 06t26/2001 Compromise and Rele. Agreement by Stipulation Pursu to Section 449 of the Work~ Compensation Act- Cc Pa§ 4. Nature of Injury :urpose of calculating death benefits shall be $322.00. 18. Miscellaneous Provisions des that if there is one child compensation shall be paid to the guardian of the child or the child at the rate of 32 per centu ~: ,ages of the deceased. The applicable compensation rate to which Brandon Andela would be entitled is $103.04 per we, ;alculated as follows: $322.00 [(50% of state wide average weekly wage for the year 2001) x .32 = 103.04).] -he parties have agreed [hat the minor child, Brandon Ande!a and his guardian will accept the one lump sum payment in tmount of $10,000.00 to resolve the Claim Petition for death benefits. Employer/Insurer has also agreed to waive its subrogati(: '~terest in the third party se.ttlement pursuant to Section 309. )ue to the fact that this Compromise and Release Agreement is addressing the rights of a minor child, the parties intend to file )etition before the Pennsylvania Common Pleas Court in order to obtain approval of the settlement. 'his Compromise and Release Agreement shall forever release and discharge Cincinnati Insurance Company and Schenk' 'astry Shoppe from any and all liability for workers' compensation'death benefits for any and all of Decedent's dependents. POWER OF' A'I'I'OIC~I~ ~' ~a~D r ~r~ ~sxt.~s~,s~ , s BY~ SIGNING THIS AGREEMENT, I (WE) ACKNOWLEDGE THAT I (WlO HAVE ENGAGED THE LAW FIRM OF ANGINO & ROVNER, P.C. (HEREINAI'-i I:,R A & R), TO REPRESENT ME (US) I IN'DER THE FOLLOWING TERMS AND CONDITIONS: A & R may on my (our) behalf secure medical, work and other similar records, conduct an investigation, negotiate. and if necessary start suit against anyone responsible for my (our) injuries and losses with res ect to /~]/~- 03~. [, JO~t4/~,~._O,~ , w,th full power and author,fy to appear on behalf of .. . - · · .... the undersigned ,n any Court of record or in any administrative or other proceeding, to do and perform all and every act and thing whatsoever that may be requisite and necessary to be done in connection with the above claim as fuliy as the undersigned might or could do if personally present; hereby ratifying and confirming ail that said attorneys shall lawfully do or cause to be done therein by virtue of this power of attorney. I (we) understand that so long as the case is handled by an A & R attorney, I (we) will not be responsible for any fees and/or expenses unless a recovery or benefit is obtained. If my (our) case is handled to a successful completion by an A & R attorney, I (we) agree to pay A & R all reasonable out-of-pocket expenses without the payment of interest, plus a fee for time expended as follows: A & R ME (US) a. Si.-. 1 I LEMENT PRIOR TO STARTING SUIT 30% 70% b. SLI I LEMENT FOLLOWING SUIT BUT PRIOR TO TRIAL OR ARBITRATION 35% 65% c. SE 1 fI..EMENT OR VERDICT AT TRIAL OR ARBITRATION, AFTER TRIAL, ARBITRATION, OR APPEALS OR SHORTLY BEFORE TRIAL AND AFTER CASE HAS BEEN TOTALLY PREPARED 40% 60% d. IF NO-FAULT RECOVERY OR NON-MONETARY BENEFIT: RICHARD C. ANGINO ($500); NElL J. ROVNER ($450); ASSOCIATES ($400) PER HOUR BUT NOT TO EXCEED 40% OF TOTAL RECOVERY OF VALUE OF BENEFIT i "e' OTHERCASES [ I If for any reason I (we) take my (our) case to another attorney or law firm including a former A & R attorney or handle it myself(ourselves), l (we) recognize that A & R has, in good faith, expended money and time for my (our) benefit and I (we) therefore agree to pay, or have my (our) new attorney pay, immediately, upon severing the A & R attorney/client relationship, all the out-of-pocket expenses incurred on my (our) case plus interest at the rate of 6% per annum from the date of each expenditure. In addition, when the case is successfully concluded, l(we) agree to pay or to direct my (our) new attorney to pay as a fee 20% of the gross recovery to A & R. In the event that any settlement is made on a structured or deferred payment basis, A & R shall be entitled to receive their percentage based on the present value of the structured settlement, if paid as a Dump sum at the time of settlement. I (we) agree not to settle or discuss settlement of my (our) case without the written consent ofA & R. BY SIGNING THIS AGREEMENT, THIS /,_~,/~ DAY OF~._.'~U l¥' , 20 O I, I (WE) ACKNOWLEDGE THAT I (WE) HAVE RE, a>, tmDERSTOOO, Am> RECEIVED A COPY OF S,,av E AND AGREE W TH T 'TERMS AND CONDITiOnS. W1TNESS(E~ ~ CLIENT(S): ? - :~;Iz~ ~ ,~ t,k~eLpr (SEAL) (OVER) v00 Exhibit J 05-22-2002 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPARTMENT 280601 HARRISBURG, PA 17128-0601 Telephone 717-783-0972 David L Lutz, Esquire Angino & Rovner 4503 North Front Street Harrisburg, PA 17110-1708 Re: Estate of John D Andela File Number: 6701-1027 Court Number: Cumberland- Dear Mr. Lu~: The Department of Revenue has received the Petition for Approval of Settlement Claim to be filed on behalf of the above-referenced Estate in regard to a wrongful death and survival action. It has been forwarded to this Bureau for the Commonwealth's approval of the allocation of the proceeds paid to settle the actions. Pursuant to the Petition, the 35 year old decedent died as a result of a motor vehicle-pedestrian accident. Decedent is survived by. Please be advised that, based upon these facts and for inheritance tax purposes only, this Department has no objection to the proposed allocation of the gross proceeds of this action, $ 8,000.00 to the wrongful death claim and $ 2,000.00 to the survival claim. Proceeds of a survival action are an asset included in the decedent's estate and are subject to the imposition of Pennsylvania inheritance tax. 42 Pa.C.S.A. {}8302; 72 P.S. §§9106, 9107. Costs and fees must be deducted in the same percentages as the proceeds are allocated. In re Estate of Merryman, 669 A.2d 1059 (Pa. Cmwlth. 1995). I trust that this letter is a sufficient representation of the Department's position on this matter. As the Depadanent has no objections to the Petition, an attorney from the Department of Revenue will not be attending any hearing regarding it. Please contact me if you or the Court has any questions or requires anything additional from this Bureau. Finally, the approval of this allocation is limited to this estate and does not reflect the position that the Department may take in any other proposed distribution of proceeds of a wrongful death / survival action. Inheritance Tax Division Bureau of Individual Taxes JUL 0 8 ZOO2' IN RE: PETITION OF CHRISTINE ANDELA, ADMINISTRATRIX OF THE ESTATE OF JOHN D. ANDELA, DECEDENT, Petitioner IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. NO. 02-2222 Civil Term AND NOW, this of , 2002, upon consideration of the Petition for Approval of a Compromise S Distribution of Proceeds Pursuant to Pa.R.C.P. 2206, IT IS HEREBY ORDERED THAT: (1) The settlement of Christine Andela, Administratrix of the Estate of John D. Andela, is hereby approved and the proceeds will be allocated as follows: (a) Estate of John D. Andela, deceased, under the Survival Action $ 6,400.00 (b) Estate of John D. Andela, deceased, under the Wrongful Death Action $ 1,600.00 (c) Angino & Rovner, P.C., professional fees based on 20% of the gross amount recovered $ 2,000.00 TOTAL PRESENT DISTRIBUTION $10,000.00 BY THE COURT: 245852.1~DLLLMTG