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Home My WebLink About06-6840 F-IF-ILES\DA T AFILEIMAC9500\CUlTenr1400lpe' j,jonlmas Created: 9/20/04 006PM Revised 10/9/06 048PM 9500,400 CAMERON LIPNICKY, a minor, by his Parents and Legal Guardians, JOHN S. LIPNICKY AND HOLLY HANEVICH-LIPNICKY, Petitioners, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL V ANlA v. NO. 0&. ~ f YO ~ Tit.-- GIANT FOOD STORES, LLC, Respondent. PETITION FOR COURT APPROVAL OF MINOR'S COMPROMISE 1. Petitioners, John S. Lipnicky and Holly Hanevich- Lipnicky, are adult individuals residing at 1126 KentDrive, Mechanicsburg, Cumberland County, Pennsylvania 17050. 2. Petitioner, Cameron Lipnicky, is a minor individual whose date of birth IS December 23, 1992. 3, Respondent operates a retail grocery store located at 310 East Penn Drive, Enola, Cumberland County, Pennsylvania 17025. 4. On May 19, 2006, the minor Petitioner ingested a food product from the Respondent's store that was not properly labeled and thereafter suffered an adverse reaction. 5. The Minor Petitioner was required to obtain medical treatment as a result of this incident. 6. The parties have agreed to settle the Minor Petitioner's claims for consideration of $9,000.00 being paid and invested with a restriction that the funds not be withdrawn, without further order of court or until the Minor Petitionerreaches the age of eighteen (18) on December 23,2010. $1,000.00 is being paid immediately to John and Holly Lipnicky as a result of out-of-pocket expenditures and any claims which they might have against Giant Food Stores. 7. Giant Food Stores, LLC, also has agreed to pay all of the medical. expenses of Minor Petitioner up to the date of the hearing to approve this settlement. WHEREFORE, Petitioners request that this Court approve the settlement ofthe above-referenced matter and authorize John and Holly Lipnicky to sign the Settlement Agreement and Release which is attached hereto as Exhibit "A." Respectfully submitted, ~ By: By: CAMERON LIPNICKY, a minor, by his Parents and Legal Guardians, JOHN S. LIPNICKY AND HOLLY HANEVICH-LIPNICKY, Petitioners, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA v. NO. GIANT FOOD STORES, LLC, Respondent. CONSENT OF PETITIONERS AND LEGAL GUARDIANS The undersigned, John S. Lipnicky and Holly Hanevich-Lipnicky, Petitioners in the above- captioned action and parents of Cameron Lipnicky, a minor, has read the foregoing Petition to approve minor's settlement and has reviewed the terms ofthe Petition and hereby consents to the Petition and hereby agrees to said settlement. '-- ~ J S. Lipnicky, Individually and as Parent Guardian of Cameron Lipnicky, a minor F: IFI LESIDA T AFILElMAC9500ICUlTem\400Ireleaselmas Created 3/4/05 949AM Revised 10/9/0b 0:45PM 9500 400 GENERAL RELEASE FOR AND IN CONSIDERATION OF the payment to JOHN S. LIPNICKY AND HOLLY HANEVICH-LIPNICKY, Individually, and as Parents and Legal Guardians of CAMERON LIPNICKY, of the sum ofTEN THOUSAND DOLLARS and 00/100 ($10,000.00) ($9,000.00 being paid and invested with a restriction that the funds not be withdrawn, without further order of court, until the Minor Petitioner reaches the age of eighteen (18) on December 23,2010, and $1,000.00 is being paid immediately to John and Holly Lipnicky as a result of out-of-pocket expenditures and any claims which they might have against Giant Food Stores), and other good and valuable consideration, the receipt whereofis hereby acknowledged, we, being oflawful age, have released and discharged, and by these presents do discharge GIANT FOOD STORES, LLC AND MAC RISK MANAGEMENT, INC., and any and all for ourselves, our heirs, executors, administrators, successors and assigns, release, acquit and forever other persons, firms, insurers, and corporations, of and from any and all past, present and future actions, causes of action, claims, demands, damages, medical payments, costs, loss of services, insurance benefits, expenses, compensation, third party actions, suits at law 'or in equity, including claims or suits for contribution and/or indemnity, of whatever nature, and all consequential damage on account of, or in any way growing out of any and all known and unknown personal injuries and/or property damage resulting or to result from an alleged accident that occurred on or about May 19, 2006. We do hereby declare and represent that the injuries sustained may be permanent and progressive and that recovery therefrom is uncertain and indefinite, and in making this release and agreement it is understood and agreed that we rely wholly upon our own judgment, belief and know ledge of the nature, extent and duration of said injuries. We understand that this settlement is the compromise of a doubtful and disputed claim, and that the payment is not to be construed as an admission ofliability on the part of the persons, firms and/or corporations hereby released by whom liability is expressly denied. It is understood and agreed that this Release is executed in connection with the settlement of the claims of the undersigned as set forth in a Civil Action entered to No. in the Court of Common Pleas of Cumberland County, Pennsylvania, which action is to be marked as discontinued, settled and withdrawn, as soon as Court Approval of this settlement is obtained. Exhibit "A" . . r v I It is further understood, and agreed, that this is the complete release agreement, and that there are no written or oral understandings, or agreements, directly or indirectly connected with this release and settlement that are not incorporated herein. This agreement shall be binding upon and inure to the successors, assigns, heirs, executors, administrators, and legal representatives of the respective parties hereto. We fully understand that any person knowingly and with intent to defraud any insurance company or other person files a statement of claim containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. This Release is not intended to release any claims which the Plaintiffs may have for medical malpractice, first party benefits, any other health insurance benefits or under insured motorist claims. THE UNDERSIGNED HEREBY DECLARES that the terms of this settlement have been completely read and are fully understood and voluntarily accepted for the purpose of making a full and final compromise adjustment and settlement of any and all claims on account ofthe injuries and damages above-mentioned, and for the express purpose of precluding forever any legal actions arising out of the aforesaid claims. IN WITNESS WHEREOF, we have hereunto set our hands and seal this _ day of , 2006, intending to be legally bound thereby. WITNESS: John S. Lipnicky, Individually, and as Parent and Legal Guardian of Cameron Lipnicky, a minor WITNESS: Holly Hanevich-Lipnicky, Individually, and as Parent and Legal Guardian of Cameron Lipnicky, a mmor . . .' " VERIFICA nON We verify that the statements contained herein are true and correct. We understand that false statements herein Petition are made subject to the penalties of18 Pa.C.S.A. g 4904, relating to unsworn falsification to authorities. ....... Dated: If) 1- 0 b (D() ~ t ---. -<) ""' c- o -C.. ......., ..; ~ ~ -... ~ J ~ I.r, lJ',. ~ 1? u f' '" ~ ("") r-,,) <:::) Sf: c: <:::) ~ <:;I"> !:.lr'"' Z i! SF c? ~~ 0 m;Y <: ~, -..." -om th N 250 ~< ..:--. \.0 - ,1.) t;;::Ci :i!~i 1> ".~ -0 ,;.:) "'1" -,;;,. '.. ~ ::i.t ~ii? :;...(') w ;-,m -....J Z );! '""1 0 53 .~< Ul -< - \ Dre Q.~ ~~ J ~ CAMERON LIPNICKY, a minor, by his Parents and Legal Guardians, JOHN S. LIPNICKY AND HOLLY HANEVICH-LIPNlCKY, Petitioners, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA v. NO. () (,. ~ S ita ~ 11W-' GIANT FOOD STORES, LLC, Respondent. ORDER OF COURT AND NOW, this II,;r dayof ~ ,2006, a hearing is herebysetto consider approval of the minor's compromise. The hearing will be held in Courtroom No. ~fthe Cumberland County Courthouse on -lr-'''' '7J ..r . , 200], at 3,'c#, P.m 1. I ) ~ (p - Oee n ...._. _ . (). .I L-rr~ - ~ :><5 . \~/! I\j\i'/\'t\S[\lr~.jd i '~"l""r"' p-' '....,..jMn~ 1\l.,\~iJt.), '\:-.~ ,:.i~~\=H vf v 90 :01 ~1\f 9- :)30900l !.l:jwlu"[......" ' I.' !'"" j ! :::J'Hl.' .:10 1\ v, 1 "A)C" l\.)CeJ ~ ' 1 38L:I:-iO--O:Jli::l 1 ..~ CAMERON LIPNICKY, a minor, by his Parents and Legal, Guardians, JOHN S. LIPNICKY and HOLLY HANEVICH-LIPNICKY, petitioners IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA v. GIANT FOOD STORES, LLC, Respondent NO. 06-6840 CIVIL TERM ORDER OF COURT AND NOW, this 8th day of January, 2007, after hearing, the Petition to Approve the Minor's Settlement in this matter is granted insofar as the sum of $10,000.00 shall be paid to John S. Lipnicky and Holly Hanevich-Lipnicky, for the benefit of Cameron Lipnicky, with said funds to be placed into a federally insured account with the following restriction: "No withdrawals shall be made from this account before December 23, 2010, without specific Order of Court." Proof of the opening of the said account with the restriction shall be filed with the Prothonotary within 10 days of receipt of the money. petitioners are authorized to discontinue the aforesaid action and to execute a good and sufficient release for all claims against the Defendant Giant Food Stores, LLC, and against MAC Risk Management, Inc., arising out of the injuries to Minor Petitioner. We note that Defendant Giant has also paid petitioners their out-of-pocket medical expenses and attorney fees. B:Y'''the Court (I ! , .-,....~-- ~.~.,~'" Edward E. Guido, J. - VINv/\lASNN3d I it\t("y''-.. :'"'a ',j" ",....'"n''' f\..U"4. ,{..,,\,.: ;::..',' \:1~.~'titr1t v L2 :8 ~ld 6- NVr LOOl Atfv'lONOH1Cod 3H1 :10 381:3:10-0311.:1 H:I" - , - .. Michael Jerominski, Esquire For the Petitioners Jennifer L. Spears, Esquire For the Respondent srs . , , . ,"'f: \FILESIDA T AFILE\MAC9500\Current\400\prallnlm Created: 9120104 0:06PM Revised: 118107 1 1: 11 AM 9500,400 CAMERON LIPNICKY, a minor, by his Parents and Legal Guardians, JOHN S. LIPNICKY AND HOLLY HANEVICH-LIPNICKY, Petitioners IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA v. NO. 06-6840 GIANT FOOD STORES, LLC, Respondent PRAECIPE TO THE PROTHONOTARY OF CUMBERLAND COUNTY: Please file the attached Proof of Deposit as part of the record in the above-captioned matter. Respectfully submitted, By: Date: \ \2 ~()I .. , PSE(~ Cameron H Lipnicky Pa Utma John S Lipnicky Custodian 1126 Kent Dr Mechanicsburg PA 17050-7609 January 18, 2007 Member #-8320XXXXXX Dear Cameron H Lipnicky Pa Utma, Thank you for the opportunity to provide you with another PSECU service, You have made a wise investment and we are sure you will be pleased with your decision, Please review your Certificate Disclosure, outlined below, and contact us immediately if there are any discrepancies, CERTIFICATE DISCLOSURE NON-TRANSFERABLE 48 MONTH CERTIFICATE Certificate Number Purchase Amount Dividend Rate Annual Percentage Yield* Date of Maturity Joint Owners(s) 50 $10000,00 4,890% 5,00% 01/12/2011 Same As Account Purchase Date Dividend Frequency Dividends Paid To Auto Transfer Amount Auto Transfer Frequency Maturity Choice 1/12/2007 Monthly Certificate $ Renew "Annual Percentage Yield (APY) assumes that earnings remain on deposit in the Certificate until maturity. An early withdrawal will reduce earnings, ** *** * * ** ***** * **** *** * ** ** *** * ** * * *** ***** *** * * * * * *** * ** * * ** * * ** Automatic Transfer Service (ATS) If you selected ATS to your Certificate and the transfer amount is not available in your ATS Share Account on the transfer date, only the available funds will be transferred, If you did not elect to have ATS to your Certificate, this option will remain available to you for thirty days from the purchase date of the Certificate, Please contact us if you wish to participate in this service, Rate Increases on IRA Certificates If the certificate is an IRA certificate and you are over the age of 59 1/2, you will be able to request a rate increase if PSECU IRA Certificate rates go up, once every 365 days by contacting PSECU with the request. This applies only if there is a rate increase during the term of your certificate. The increase in rate would then be in effect until the maturity date of the certificate, Withdrawals and Penalties The minimum withdrawal amount is $100, IRA withdrawals may be subject to IRS penalties, A Maturity Notice will be mailed at least ten days before the maturity date, You will have ten calendar days after the maturity date to redeem your certificate without penalty if you do not want to renew, -See Reverse Side- Pennsylvania State Employees Credit Union Main Address; 1 Credit Union Place, Harrisburg, PA 17110-2990 . 717,234,8484 . 800,237,7328 Mailing Address; PO, Box 67013, Harrisburg, PA 17106-7013 . 717,777,2100 (TO D) . 800.4 72,1967 (TO D) . This credit union is federally insured by the Notional Credit Union Administration, Equal Opportunity Lender www.psecu.com p .. 6 CERTIFICATE OF SERVICE We certify that a copy of the foregoing Praecipe was served this date by depositing same in the Post Office at Carlisle, P A, first class mail, postage prepaid, addressed as follows: George B. Faller, Jr., Esquire MARTSON DEARDORFF WILLIAMS & OTTO Ten East High Street Carlisle, P A 17013 By: Holl evich-Lipnicky, dividuallyan as Parent and Legal Guardian of Cameron Lipnicky, a minor By: Dated: \ \ 2 ~) L"1 (") c ~ c,. ~;>; :2. r-..:l = .:::> --' ~ ~,:n flr: -ClCf) -~) cr ::::~O ~~ :f~ ~(;r~ ~E =< '- ~ _-9 ......- rv w -0 :J:: C) -J ,...... ..'1lC.,'''"'~ '~#i, \;, !^ '\ J \ - . F. \FlLESIDA T AFILEIMAC9500ICUlTenI1400Ipra2/nlm Created: 9/20/04 0:06PM Revised: lIS/07 II: I SAM 9500400 CAMERON LIPNICKY, a minor, by his Parents and Legal Guardians, JOHN S. LIPNICKY AND HOLLY HANEVICH-LIPNICKY, Petitioners v. GIANT FOOD STORES, LLC, Respondent IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 06-6840 PRAECIPE TO SETTLE. DISCONTINUE AND END TO THE PROTHONOTARY OF CUMBERLAND COUNTY: Kindly mark the above-referenced matter as settled, discontinued and ended. Date: 1 \ 23 \en Respectfully submitted, By: ~ -d ;;;Z~ ~ Lipnicky, Individually, and as Parent and Legal Guardian of Cameron Lipnicky, a minor By: \. .. ~ CERTIFICATE OF SERVICE We certify that a copy ofthe foregoing Praecipe was served this date by depositing same in the Post Office at Carlisle, P A, first class mail, postage prepaid, addressed as follows: George B. Faller, Jr., Esquire MARTSON DEARDORFF WILLIAMS & OTTO Ten East High Street Carlisle, P A 17013 By: ~ '" J S. Lipnicky, Individuall , and as Parent and Legal Guardian of Cameron Lipnicky, a minor By: Dated: \ \ '2 ~ \01 (") c '" [i5 ~.. :~ ~. f"o,) = = --' o -n :r!-n rl1p -om ,c.-o -,j T' ~.~~ bl\1 ,.,., ~>r ~ C- ~ Z N W V _:,.,'/1" --".T. o \.0