HomeMy WebLinkAbout94-00042
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IN THE COURT OF COMMON PI,EAS Qh' CUMBERLAND COUN'l'Y. P2NNSYlNANIA
CIVIL ACTION -- LAW
GEORGE R. BROADWAY, SR. , all I
parent and natural guardian ofl
GEORGE R. BROADWAY, JR. a I ,
Minor, .
I :.r;
Plaintiff, I I.
IL!
I
vs. I No, 42 of 1994 "
,
I It I
ALBERT GEYER, I ,..
,
Defendant. I ;...;;
.
~
ORDIR
1~1~ 12...cl Jll J :tUt I l c; ~ Lj ,
AND NOW, a Minor I s Compromise Hearing having been held
,.
before this court March 24, 1994, at which time the Minor and his
mother testified, and it appearing that settlement of this case
in the amount of $5,000.00 is in the best interests of the Minor,
and a Release now having been signed, the Release attached hereto
as Exhibit "A" is hereby approved by this court. Upon payment of
the sum of $5,000.00 Albert Geyer, Fay Geyer, and the Ohio
Casualty Insurance Company are hereby released from any and all
claims arising out of the incident which is the subject of this
suit.
The sum of $1,666.67 is authorized to be paid to the firm of
Saiontz & Kirk for professional services rendered, plus an
additional $8.00 for costs advanced. The balance, being the sum
of $3,325.33 is to be placed in a blocked trust account, to be
paid to the Minor/Plaintiff upon his eighteenth birthday. No
further funds are to be withdrawn from said account without an
order of court..
HI IIA~f Of All CI AIM"
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For and In cOllSldCl.lllon o( tht! 1l/1lI o( ;..::', X, ^ ,'.')OOQ" SLY X~. ,)(, ,x .
Dollm ($ , ) ttlt! rect!ipt o( which Is hereby acknowledged, I/We being o( law(ell age, (or my-
selflourst?lve.. IlIY/C)!" heirs, adminlstratOls, eXI''iu,'pr_~",uc c:essor,l,and .~!gns hereby remise, release, acquit and
(oreverdisch,"ge, "'" hl-HJ'^-:'~ i)....JhV~""fA'..., """"'," "
, , , , , , , , '" hls/hcrsucccssols ,md aSSigns, aptI/or hil, her, tlwlr, and each o( thclr assod.lles,
hdrs, cxccutors ,Hid administrators, ill,d ,III)' ,Ind ,111011 ,e, pe"on" associations and/or corporation, whethcr herein
referred to or not, o( ,md (rom all known or unknowll, ,usp,'cted or unsuspected, P,lst, present and (uture daims,
demoUHls, damage" actions, third.p.lIty ", tions, cau"" o( action, or suits ,IIIilW or in equity, includillg claims
(or (Olltribution dlld/ur indemllity of WhiJlc\tl'r flllhllP, (or or l>ec"u~(' of ,IIlY 1l1i\t1t~r of thing done, Ol11iUl'd or ~lJfferl'd
10 Ill' done, on ,KCOWlt o( or Mising (rom d'"ll'IB". Ir~propc'rty, bodily injury Or.~.llJl resulting o!:)~ re,ult frorn
an ,Kci(knt which occured on or .1}l?}/IlI)IL ' , '.-. C.' d"y o( , . , , , . . , . Jt~V " , 191,-::'. .,.., .11
::, ":::'hlJW. h"~' ",'m;" d" ;S"<_lI<Ll;fl*_ i~ ~';'Yli'h" h", 'hI. "IN~ ."'" eo'
bc construed as all admlssiollo( such hability,
KNOW YE, Th,IIIIWF.
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Any person who knowingly ,Ind with intenllO injurr: or defraud any insurer (iles an application or claim con.
taining any (.llse, incomplete or misleading in(ormation shall, upon conviction, be subject to imprisonment (or
up to seven years and payment o( a finE> up to $15,000. .)\.0'-
IN WITNESS WHEREOF, l/We have hereunto set my/our hand!s) and seal(5) this ",<,:,Ji."",. day o(
.~7Yh(J . . . . . , . ,. ,19 <Il\, . . . ~READ C{~/EFULLY BE~~RiE,SI\c:;~I~~ // "
Witness . ,: .k~ .'....,.. . -:. '/1 -IJ., ~,,((Sf~
"..",." , '."""".", , ,. \;/: '\t"'" 'l'" ,.." .,-..(, "1?fiA~;
Witness. . , . . , , , , , , , , , , , , , , , , , , , , , , , , , , , , '- ,<:;-;(:.~~ ,~'l ~; , g~)~<(l~V'\il' \l(-,' / fiAL)
Stateo( . ,1,)erl'.fS/, 11(',l'."II,~""..,.,,}
County o( /.. iQ~1,t: j1,J, /1'./,', , , , , , . , . , , , SS
On this..;? It, ,CA. , day o( , , , , , , '~f' , , , , , , , , , 19 .9. "Y , , , be(or(je personally app4!ared
t~ ~~~~' ;~~~~~~(;i~~O' ~~16~ '~~~s~' ~~d' ~;'~~~~;e~'g~
Ihat1 ' , ~xecuted the same as.....~(, own (ree aCI~~:-~" 11
Myterrne Ires '.,."."". ( . ,6....-....,-;~.,(}"-~~.
NOrAAIAI. BfAt. '
LAURIE A OlNAll.. Not..., PIJllIIo Notary Public
lanul11r City lanc.st., Co ""
My Commlu'on [JIIllr.. Oct 29: 1994
Form 5114 AA lI'lO
n(o.',,~
Exhibit "A"
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021-4-17
01/11/94
IN THE COURT Of COMMON PLEAS or CUMBERlAND COUNTY, PENNSVLVANIA
CIVIL ACTION--LAW
GEORGE
parent
GEORGE
ve,
R. BROADWAY, SR., a. I
and natural guardian of I
R. BROADWAY, JR. a Minor, I
Plaintiff, I
I
I
I
I
I
No. 4:l ot 11194
ALBERT. GEYER,
Defendant.
PETITION FOR COMPROMISE OF A MINOR'S CLAIM
PURBUAN'J' ...'I.!Ll'ENlfSYLYMfD RUI.E QF..JaYIlLl'ROCEDURE 2039
1. Plaintiff is GEORGE R. BROADWAY, SR., an adult individual
re.iding at 12905 Katoctin Furnace Road, Thur.mont, Maryland 21788.
2. Petitioner is the parent and natural guardian of George
R. Broadway, Jr., a minor. George R. Broadway, Jr. has a date of
birth ot August 17, 1976, and is presently 17 years of age.
3. On February 20, 1993, the Minor/Plaintiff was involved in
an automobile accident in Cumberland County, in which the vehicle
he was operating was struck by a vehicle being operated by Albert
Geyer, the Defendant, while Mr. Broadway was stopped at a stop
Bign.
4. Following the accident, the Minor/Plaintiff complained of
pain in the back of his neck, which was subsequently diagnosed as a
hyperextension/hyperflexion injury of the cervical spine.
S, The Minor/Plaintiff was initially seen February 23,
1993, by the Thurmont Family Practice Clinic of the Gettysburg
Hospital. An MRI performed February 24, 1993, showed a normal
oervical spine.
031-4-17
01/11/94
6. On Maroh 3, 1993, the Minor/Plaintiff began treatment
with Dr. Donald B. Berry, a ohiropraotor, who applied galvanio
etimulation, moiet heat and traotion, for a eeries of vie it. whioh
ended May 14, 1993, at whioh time the Minor/Plaintiff was
disoharged from oare. Copiee of the relevant medioal reoords are
attaohed hereto and are oolleotively marked as Exhibit "A".
7. The Minor/Plaintiff has had no trsatments sinoe that time
and does not antioipate requiring any further medioal oare tor hi.
injury.
8. Defendant's insuranoe oarrier has tended an offer of
$5,000.00 whioh Plaintiff has aooepted, subjeot to the approval of
this Court.
9. Plaintiff believes that the settlement would be in the
beet intereet of the Minor.
10. Throughout, the firm of Saiontz & Kirk, P.A., hae
represented the intorest of the Minor/Plaintiff in thie matter. A
true and oorreot oopy of Contingent Fee Agreement, whioh provides
for a one-third contingent fee plus reimbursement of costs
advanced, is attaohed and is marked as Exhibit "B".
WHEREFORE, Plaintiff prays your Honorable Court for an Order
authorizing the Plaintiff to Dign a release, releasing the olaim of
tho Minor/Pl~intiff for the sum of $5,000.001 authorizing payment
to the firm of Saiontz & Kirk, P.A., in the amount of $1,666.67, as
legal fees and $8.00 as reimbursement for costs advanced, and
depositing the balance, being the sum of $3,325.33, in a block
trust aooount to be paid to the Minor/Plaintiff upon his 18th
- 2 -
031-4-17
11/08/9J
VI"U'ICATIO~
I verify that the statemsnts made in the forsgoing Petition
ere true and correct to the best of my kno\#ledge, information, and
belief. I understand th.t falsB statements herein are made Bubjeot
to the penalties of 18 Pa.C.S. 84904 relating to unsworn
fa18iflcation to authorities.
DATED. I\. L, DI 1'/'1 ;~
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OI:OR R.' ROADWAY, 9R.
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1111;n ~anIJe.e~l. In:,
Acco~nll IS1611 . 181644 All o It II
Acet Olll Oeo I ~lIe Orl Proced~rl 0119 Unitl Alo~nt
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li26H Brold_av. Ir. .GlorOI Prevlo~l 8alanCI : 0.00
03103/93 0 8rolowlV. Ir ..Georol mOa (m/Oft It I Vlllt (lUndld NI_ l.00 7\.00
03/03193 0 8roldwav. Ir ..Glor91 1016 Cemell 501nl. Flu/twtlntlon l.00 60.00
03/03193 0 Brold_IV. Ir. .Goor91 2010 Clmell 501nl, I vie_ l.00 30.00
03103193 0 8rOidwav. Ir. .Georoe 1011 Ceme.,1 SOlne. AP I LAT l.00 60.00
03/03/93 0 Bro.l0wiV. Ir. .Georoe 4000 HotlCold fomllllon 1.00 16.00
03103193 0 BroiOwav. Jr ..Glorge 40~~ Electneal Stll~lltlon l.00 19,00
03/01/93 0 BrolOwIV. Ir, .Georoe 3000 ~anlo~ II t ion l.00 30.00
03/01193 0 8roldway. Jr ..Glorge 1000 HotlCold founllllon l.00 16.00
03/01/93 0 Broadwlv.lr..Georoe I 1002 Eleetneal 5tllulation l.00 IUO
03/08/93 0 Broadway, Ir ..George I 3000 ~anlo~latlon 1.00 30.00
03/08/93 0 Broadl/av. Ir ..GeorlJe 1 4000 Hot/Cold fomllllon 1.00 16.00
03/08/93 0 8roao,av. )r.,George I 1001 Eleelrleal SllIulatlon l.00 19.00
031l7/93 0 8rOadwlY. Ir. .Georoe I 3000 ~lnlO~ lalion 1.00 30,00
031l7/93 0 Brold'IY. Ir, .Georo' I 4000 HollColo fomlltlon LOO IU~
03117/93 0 8rold,ay,lr..Georoe I 4002 (Ieclncal StilolatlOn 1.00 19.00
01119193 0 8ro.o,av. Ir. .Georgl I 3000 ~anlo~latlon 1.00 30.00
03/19113 0 8roaoway, Ir. .Glorge I 4000 HotlCold founlltion 1.00 IUD
03/19/93 0 8rold,ay, Ir, .Georol 1 4001 (Ieelneal Stll~lllion l.00 19.00
03122/93 0 BroaOway, Ir ..Georol 1 3000 M1nlo~lalion 1.00 30.00
03122/93 0 Broioway. Ir. ,Georoe I 4000 Hot/Cold founlitloll 1.00 16,00
03122193 0 8rolowav, Ir ..Georoe I 4001 Electrical Stieulalion LCO IUO
03/24/93 0 Bro.O,ay. Ir. .Georg. I JOOO ~anlo~ latl,on l.00 30.00
03/24193 0 8roaoway._ Ir, ,Georql I aOOO HotlCold fOAenlition l.00 16.00
03/24193 0 8roaO,ay, Ir ..Georoe I aOOI Eleelneal Stleulallon l.00 19.00
03130/93 0 Broadway, Jr ..GeorQe I 3000 ~anlo~lalioo l.00 30.00
03130193 0 Broldway. Ir ..GeorgI 1 3001 Hlnio.. addltlonll a'u l.00 16.00
03130/93 0 Broadway. Ir ..GIorql I 4000 HotlCold Fountltion 1.00 16.00
03130193 0 Broadway. Jr ..George I aOOI lIeetrieal Stilulation 1.00 19.00
0JI01/93 0 8roaOway. Jr ..George I 300e ~aoio~lalion 1.00 30.00
04/01/93 0 Broad,a,. Ir. .GIoroe 1 aOOO HotlCold fOllntltion 1.00 16.00
01/01/95 0 8roaowav, Ir ..George 1 a002 (leetrical Stuulallon l.00 19.00
0JI02l93 0 Broao,ay, Ir ..George 1 3000 Han\o~lation l.00 30.00
04101/93 0 Broad.av, Ir ..George I 4000 HotlCold foeent.tion l.00 16.00
04/02193 0 8roadwlY, Jr..Georqe 1 a009 lntereeqeental Soinal Traclion 1.00 16,00
04112195 0 Broad_ay, Ir "Georqe I 3000 Nanio~lalion 1.00 30,00
0J/11/93 0 Broadway, Jr "GeorQe I 4000 HollCold foeentlllon 1.00 16.00
Oamm 0 8roadway. Jr. .Georoe 1 4001 EleClrical Stuulalion l.00 19.00
............ ......................
TOTALS fOR ACCOUHT 1826a4 PAY~ENTS : 0,00 AOJUSTS : 0,00 CHARGES : 923.00 31.00 91UO
REfUNDS: 0.00
-...................... ................u. .................... ......................
0.00 0,00 923.00 923.00
098/_ .mc.
mai18d date
2-23.93
~""I'O'''(''
,,AIONTI & H,llItl4. ~ A.
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SAIOIHZ i\ "IRK, P."'.
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14103li910'$2
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Pot"!,
~!R OF ^TTORij~~
1., nF.nRr:~_a.. nW:)ADWA~~.,--_.---- the undersigned, do
hereby employ ^nd rotain S^ION~Z & KIRK, P.A., Attorneys-At-Law,
to institute legal proceedingR on behalf of my son/d^ughter.
f"fnR(:&' _H-..BIJ,~AnWA\i_.JJ}.._.____, to x'ocover damages sustainod by
him hor on or a out the ...--Wth day of ~--_,_"~b-!;'~.H'-----~-' 19._\1.3
and I do hereby agree with my attorneys to pay thom thirty-thkee
and ono-third percent (33-1/3\) out of ~ny settlament had in said
oase, ^nd that 1n addition thereto, recoiVe all costs and
diijbursamenta oxpended. In conalderation of said attorn~ya
taking this claim on 11 contingency hasi:'!, I horeby ag~'ef.l (;or
myself and my 8on/dsughter, with my said attorneys, not to make
any settlement unb~s!l they aUl prosollt and receive thoir ahare ir,
aocordance with this Agreement. And by this Agreement, I hereby
bind ~y helre, executors and legal reprcsentatives. I hereby
instruot any insurance company not to issue any drafts without my
attorneys, SAION'l'Z & KIRI<, P.A., namcs on llame. I fUl,'ther
understand that this fec arrangement applies only to caSC6 in
01,.triot Courts and CiX'<Jllit Courts and CommissJ.ollS and does not
apply to any appeals to any court of record.
I IlAVF: Rli:AD OVER AND
FULLY UNDERSTAND THE ABOVE CONTRACT.
~'d2.(,.' . -
am of ar:nt/Guar
Parenti uardian Ofl
DATED I X1l-~U_-
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GEORGE R. BROADWAY JR.
.*. "'''.''*'11'11.*...***.'''***'''..*''.''' ...
This power of Attorney hereby authorizes SAIONTZ & KIRK,
P.A. and lor their representatives to execute any and all
I'. I. P. IMlld Pa~' Form!l, \then appHoable, r.egar.dl.n'1 the automobile
aocident that occurred on or about tho day of
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~ 0 arGlnt/Guardian~--
Parenti uardian of:
GEORGE R. RRAOOWAY JR.
DATEDI~
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