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HomeMy WebLinkAbout02-3863 CHRISTINE ANDELA, Administratrix of the Estate of JOHN D. ANDELA, Decedent, Plaintiff, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION - LAW v. JAMES E. PRUITT; COVENANT TRANSPORT, INC.; and SOUTHERN REFRIGERATED TRANSPORT, NO. IJ.,),- 3.1'(.3 ~J f.tA- Defendants JURY TRIAL DEMANDED NOTICE TO DEFEND You have been sued in court, If you wish to defend against the claims set forth in the following pages. you must take action within twenty (20) days after this Complaint and Notice are served, by entering a written appearance personally or by attorney and filing in writing with the Court your defenses or objections to the claims set forth against you, You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the Court without further notice for any money claimed in the Complaint or for any other claim or relief requested by the Plaintiff, You may lose money or property or other rights important to you, YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP, COURT ADMINISTRATOR 4th Fl., Cumberland County Courthouse Carlisle, Pennsylvania 1710 I (717) 240-6200 NOTICIA Le han demandado a usted en la corte, Si usted quiere defenderse de estas demandas expuestas en las paginas sugnuientes, usted tiene viente (20) dias de plazo al partir de Ia fecha de la demanda y la notificacion. Usted debe presentar una apariencia escrita 0 en persona 0 por abogado y archivar en la corte en forma escrita sus defensas o sus objeciones alas demandas en contra de su persona. Sea avisado que si listed no se defiende, la corte tomara medidas y puede entrar una orden contra usted sin previo aviso 0 notificacion y por cualquier queja 0 alivio que es pedido en la peticion de demanda, Usted puede perder dinero 0 sus propiedades 0 otros derechos importantes para usted, LLEVE ESTA DEMANDA A UN ABOGADO IMMEDIATEMENTE, SI NO TIENE ABOGADO 0 SI NO TIENE EL DINERO SUFICIENTE DE PAGAR TAL SERVICIO, VAYA EN PERSONA 0 LLAME POR TELEFONO A LA OFICINA CUYA D1RECCION SE ENCUENTRA ESCRITA ABAJO PARA AVERIGUAR DONDE SE PUEDE CONSEGUIR ASISTENCIA LEGAL. COURT ADMINISTRATOR 4th Fl., Cumberland County Courthouse Carlisle, Pennsylvania 17101 (717) 240-6200 ORIGINAL 237860.1 IMTGILC3 CHRISTINE ANDELA, Administratrix of the Estate of JOHN D. ANDELA, Decedent, Plaintiff, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION - LAW v. JAMES E. PRUITT; COVENANT TRANSPORT, INC.; and SOUTHERN REFRIGERATED TRANSPORT, NO. 0:1. 3.1'(...3 ~ T u--<---- Defendants JURY TRIAL DEMANDED COMPLAINT 1. Plaintiff Christine Andela is an adult individual and a citizen of the Commonwealth of Pennsylvania who resides in Lebanon, Lebanon County, Pennsylvania. Ms. Andela was appointed as the Administratrix of the Estate of John D. Andela on July 16,2001, by the Register of Wills of York County, Pennsylvania. 2. Decedent, John D. Andela, was a citizen of York County, Pennsylvania. The Decedent was born on February 10, 1966, and died on June 26,2001. 3. Defendant James E. Pruitt is an adult individual who resides at One Ives Drive, North Little Rock, Arkansas 72117. 4. Defendant Covenant Transport, Inc. (hereinafter Covenant) is a corporation with a principal place of business located at 400 Birmingham Highway, Chattanooga, Tennessee 37419-2346. 5. Defendant Southern Refrigerated Transport (hereinafter Southern) is a corporation with a principal place of business located at 210 Highway #71 North, Ashdown, Little River County, Arkansas 71822. 237860.1\MTG\LC3 6. On or about June 26, 2001, Decedent John D. Andela was operating a delivery truck in the course and scope of his employment with Schenk's Pastry Shoppe. Mr. Andela was traveling in an eastbound direction on Trindle Road (SR 641), Cumberland County, Pennsylvania. 7. At the same time, Defendant James E. Pruitt was acting in the course and scope of his employment and/or as an agent of Defendant Southern and/or Defendant Covenant, and was operating a tractor-trailer owned by Defendant Covenant in an eastbound direction on Trindle Road. 8. Defendant Pruitt was attempting to locate the Ralston Purina business and became lost. 9. Defendant Pruitt stopped his tractor-trailer in front of a railroad bridge near the 5000 block of Trindle Road in Hampden Township, Cumberland County because he feared that his truck would not fit under the thirteen-foot six-inch (13' 6") bridge. 10. Defendant Pruitt did not place appropriate warning signs and/or signals around his stopped tractor-trailer. 11. Mr. Andela stopped his delivery van behind Defendant Pruitt's tractor-trailer as it was blocking the eastbound lane, and in essence, was disabled. 12. Defendant Pruitt approached Mr. Andela, asked for directions to Ralston Purina, and asked whether Mr. Andela thought the tractor-trailer would fit under the bridge. After a discussion, Mr. Andela offered to stand near the tractor-trailer and watch the top of the tractor- trailer as Defendant Pruitt drove under the bridge. 13. Due to the size and noise of the tractor-trailer, Mr. Andela had to stand on the left side of the tractor-trailer to assist Defendant Pruitt, 237860.llMTGILC3 2 14. While Mr. Andela was guiding Defendant Pruitt under the bridge, Heather Frampton was operating a Nissan Sentra in a westbound direction on Trindle Road. 15. As Ms. Frampton drove under the railroad bridge, she caused the front of her vehicle to strike Mr. Ande1a and pushed him approximately eighty-eight feet (88'). 16. Mr. Andela died as a result of the impact. COUNT I Christine Andela. Administratrix of the Estate of John D. Andela, Decedent v. James E. Pruitt. Covenant Transport, Inc.. and Southern Refrigerated Transport 17. Paragraph I through 16 of the Complaint are incorporated herein by reference. 18. The foregoing accident and all of the injuries and damages set forth hereinafter are the direct and proximate results of the negligent, careless, wanton, and reckless manner in which Defendant James Pruitt, while an employee and/or agent of Defendant Covenant Transport, Inc., and/or Southern Refrigerated Transport and operated his tractor-trailer as follows: (a) failure to know the height of his tractor-trailer; (b) failure to properly plan his route to avoid becoming lost and to avoid potentially low bridges; (c) failure to place appropriate warning signs or signals around his stopped tractor-trailer in accordance with 75 Pa.C.S.A. g4530 and 45 CFR 393.95; (d) negligently creating a dangerous situation which led to the foreseeable death of Mr. Andela; and (e) stopping his vehicle upon the highway in a manner endangering persons and property and in a reckless manner with careless disregard to the rights and safety of others and in violation of the Motor Vehicle Code of the Commonwealth of Pennsylvania. 237860,1\MTGILC3 3 CLAIM I - SURVIVAL ACTION 19. Paragraphs I through 18 of the Complaint are incorporated herein by reference. 20. Plaintiff, Christine Andela, Personal Representative of the Estate of John D. Andela, deceased, brings this action on behalf of the Estate of John D. Andela under and by virtue of the Act of 1976, July 9, P.L. 586, No. 142, ~2, 42 Pa.C.S.A. ~8302. WHEREFORE, Plaintiff demands judgment against Defendants James E. Pruitt, Covenant Transport, Inc., and Southern Refrigerated Transport in an amount in excess of Twenty-five Thousand ($25,000.00) Dollars, exclusive of interest and costs and in excess of any jurisdictional amount requiring compulsory arbitration. Date: Cb~ ()~ ANGINO & ROVNER, P.C. ~ 1.D. No. 35956 4503 N, Front Street Harrisburg, PA 17110 (717) 238-6791 Attorney for Plaintiff 237860.1\MTG\LC3 4 VERIFICATION I Christine Andela, Plaintiff, have read the foregoing COMPLAINT and do hereby swear or affirm that the facts set forth in the foregoing are true and correct to the best of my knowledge, information and belief. I understand that this Verification is made subject to the penalties of 18 Pa,C,S.A. S 4904, relating to unsworn falsification to authorities. WITNESS: ~ /)f .-7 l/rv'LLUhrJ Christine Andela /-/ ,^ '<:'j, l/l.nuU' 0... Dated: if'/ I) '1- 0 J- 237860, I\MTGILC3 ;{, () C~) 0 c: ;''-., ~ -~,. ~ r ~ ""(1(:'.: F n ~ r-- -~-) "-, "2;(-'- ~ C'-' f,. Vol '., " ,. >.-. ." -<:: .. - -<:: "" - .... V>, to,) 0 () " d :.(! " , 'I 'I CHRISTINE ANDELA, Administratrix of the Estate of JOHN D. ANDELA, Decedent, Plaintiff, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION - LAW v. JAMES E. PRUITT; COVENANT TRANSPORT, INC.; and SOUTHERN REFRIGERATED TRANSPORT, NO. 02-3863 Civil Term Defendants JURY TRIAL DEMANDED 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.e., 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 Pastry Shoppe. The decedent, Mr. John Andela, was operating a delivery truck owned by Schenk's Pastry Shoppe and was travelling in an eastbound direction on Trindle Road, Cumberland County, Pennsylvania. 250208,1 IDLL\MTG 4. Defendant 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 Toodle Road in Hampden Township. It is believed that Defendant Pruitt stopped his truck because he thought that the truck 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 and it is assumed that Defendant Pruitt 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 Defendant Pruitt drove under the bridge. 6. While the decedent was guiding Defendant Pruitt 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. 2S0208,IIDLL\MTG 2 1\ '\ 11. In addition to making a third-party claim, Petitioner, by and through counsel, Angino & Rovner, filed a Claim Petition for worker's compensation benefits, 12. The employer filed an Answer and thereafter the parties filed a Stipulation of Undisputed Facts Claim Petition. 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 hearing 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 . Your Honorable Court approved the worker's compensation settlement and attached hereto as Exhibit D is Your Court's July 24, 2002, Order approving the compromise and release. 16. The Petitioner initiated the present action against the Defendants in the Court of Common Pleas of Cumberland County. Attached as Exhibit E is a copy of the Complaint. 17. Thereafter, the Defendants offered to settle the present action for the consideration of $25,000.00, pending approval by Your Honorable Court. Attached as Exhibit F is the proposed Release to settle the above-captioned action, 18. The Petitioner retained the law firm of Angino & Rovner to prosecute this action. 19. Angino & Rovner seeks to recover 30% or $7,500.00 of the $25,000.00 settlement for attorney's fees. 250208.1\DLLIMTG 3 20. Additionally, Angino & Rovner, P.C., has spent more than $325.00 in out-of- pocket expenses. Attached hereto as Exhibit G is a computer print-out of incurred out-of-pocket expenses. 21. 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 September 6, 2002, letter from the Department of Revenue, attached as Exhibit H. 22. Petitioner believes that a fair, just, and equitable distribution would be as follows: (a) Estate of John D. Andela, deceased, under the Survival Action $ 3,435,00 (b) Estate of John D. Andela, deceased, under the Wrongful Death Action $13,740.00 (c) Angino & Rovner, P.C" professional fees based on 30% of the gross amount recovered (d) Angino & Rovner, P.C., out-of-pocket expenses $ 7,500.00 $ 325.00 $25,000.00 TOTAL PRESENT DISTRIBUTION 23. Distribution of the net proceeds of $54,972.00 from the third-party settlement payable to the Estate of John Andela should have been distributed as follows: $54,972.00 - Net proceeds $30.000.00 - To surviving spouse, Christine Andela $24,972.00 - Balance $12,486.00 - To surviving spouse, Christine Andela $12,486.00 - To surviving minor child, Brandon Andela However, Your Petitioner, Christine Andela, Administratrix of the Estate of John D. Andela, expended the $12,486.00 proceeds that should have been paid into an account for Brandon Ande1a to purchase a new home and furniture. Therefore, all of the net proceeds of 250208.1 IDLLIMTG 4 ~ $17,175.00 due to the Estate of John D. Andela from the $25,000.00 settlement from the Defendants herein, should be deposited into an account for Brandon Ande1a in the First Union Bank. WHEREFORE, Petitioner prays Your Honorable Court to enter an Order approving said compromised settlement, directing the distribution of the proceeds in accordance with the averments of this Petition and permit Christine Andela, Administratrix of the Estate of John D. Andela, to execute the proposed Release. Date: \~ ~~\O'l ANGINa & ROVNER, P.C. ~ David L. Lutz J.D. No. 35956 4503 N. Front Street Harrisburg, P A 1711 0 (717) 238-6791 Attorney for Plaintiff/Petitioner 250208,l\DLLIMTG 5 VERIFICATION I, Christine Andela, Administratrix of the Estate of John D. Andela, deceased, Plaintiff, hereby verify that the facts set forth in the foregoing document are true and correct to the best of my knowledge, information and belief, I understand that any false statements therein are made subject to the penalties of 18 Pa,C,S.A. ~4904, relating to unsworn falsification to authorities. WllNESS: ~ (~h~~ flanr1P1CL Christine Andela, Administratrix of the Estate of John D. Andela Date: ((~ f-cJd- 2S0208,1\DLLIMTG Exhibit A ">'..~~~.~'--- - --~-_._-----~- Exhibit B Police Agency Patrol Zone CiliIilQEJ ITIJ Investigation Date (MM-DD-VYYY) I [QK]-~-(z..IOloll J I radr NIb] 12-1 ' Approval Date (MM-DD-yyyY) [[1]- [Zffi-I ~ <:G[LJ Dav 0' Week \ U.)f. a Sun a Thu No Injured No Killed (If > 00. a Mon a Fri ~ ~ Complete ., Tue 0 Sat L2JQj ~ ~A~~ F 1) a Wed 0 Unk School Zone Related PennDOT Property o Ves . No a Yes . No FI MI Telephone Number 1M I [!J '717-S0Z..:rJ73 ~ State Zip I 1LL$t?UA..G, II'PA 11\7019 Model Year Vehicle Make. IJlilliIJ 1"3/51 Reg. State Travel Speed [EKJ ITIJ Policy No Insurance Company Phone N\wUAL-117Z8 15Sb-Aoz.-3841-r17-7bb_ileq Towed To Towed By Tow Agency Phone N-M\fl) 8'-!i\J.:JP \-6u CE"U"i'T II J'<.oooSIl>S AUIO ~ j1,.,- ~::,q7 _ b2.0J FI MI Telephone Number 001 State Zip 101 Model Year Vehicle Make. ID DID CD Travel Speed ITIJ Policy No II Towed By II COi\ilMOI'1WEAlTH OF PENr' 'LVANIA POLICE CRASH REPORTING' . -,RM . New ~A 45 1 1 Case Closed .. Ves 0 No o Changel Continuation Page: [Q!Qill 9 7 Agency Name -HkM PbeJ"--IuJf \-6L1 c.f: Dispatch Time (mm Arrival Time (mil) o lij I~ /8110/'+-/3131 Reviewer {~ CLA '1 'd:::b-n Investigator I n-LM. S\-\-4\J,..l A. VELT.Y Badge Number CillIfCIJ County County Name ~ IC.UM1b@2.LAND Reportable Crash .. Ves 0 No eNo Jnit Number QJIJ . Motor Vehicle in ~ Ii. Transport Unit , 0 Pedestrian o Hit & Run Vehicle 0 Illegally Parked o Pedestrian on Skates. 0 Disabled From in Wheelchair. etc Previous Crash Delete? o s o.ddress 4-01 s. 6A LTI 'fY1 0 P-t:: ST. 'nsurance . Ves Insurance Company o ~;~wnI5"rfrlt <FM<M e ONa Vehicle Towed ., Ves 0 No Jnit Number 01z.1 o Motor Vehicle in ~ .. Transport Unit , lIB Pedestrian a Hit & Run Vehicle 0 Illegally Parked D ~edestrian 0." Skates. 0 Disabled from In WheelchaIr. etc Previous Crash Delete? a \ddress /IN -I 1_1 I I-LCTI I-I .icense Plate Reg. State =rn=:rTl I~ CD Insurance Company Un- I o Yes 0 No a known Towed To nsurance /ehide Towed o Yes 0 No RM ,~ AA.45_L~..!!.~_1} Crash Number f}'tjdt jJ~_ . 0140974 o legally Parked a Non - Motorized o Train a Phantom Vehicle Commercial Vehicle aYes _ No (If Yes. Complete Form, AA45 C t) .Refer to li5t on Back of Overlay o legally Parked 0 Non - Motorized o Train o Phantom Vehicle' Commercial Vehicle aVes DNa (If Yes. Corn plete Form: AA45 C 1) .Refer to list on Back of Overlay Insurance Company Phone I.' J I tw'..e~ '."e, t I (-;"i. hi t i ..,'~ " " ~ { I J CQI\~MONVYEAlTH OF PEN"J~YlVANIA POLICE CRAsH REPORTIN( )RM Crash Number .. New \0140974 I AA 45 2 1 Page: I 0 I c I z I o Changel Continuation Unit Number Trailina Unit(s) Tv"e of Unit 5=Camper ~OTagNO I I Tag I [Q]J] Number [Q] t=Towing Passenger Veh 6= Trailer ] Tag 0 2=Towing Truck 7=5emi-Trailer Year Slale of Trailing 3=Towing Utility Trailer 8=0lher ~ 0 Tag No I I Tag I 1 Units: Tag 0 4=Mobile or Modular Home 9=Unknown Year State Vehicle Color IDI"2-1 Vehicle Tv"e ~ ~ 10101 01=81ue ~ 12=Commercial 02=Red 08=Gold 01=Automobile, 11=EarmJ:,quip,__ , 22=Horse and Buggy OO=Not Applicable Passenger Carrier 03=White 09=Brown 02=Motorcycle 12=Construction Equip 23=Horse and Rider 01=Fire Veh - 13=Taxj- ,- 04=Green 10=Orange 03=Bus lB=Other Type Special Veh 24= Train 02=Ambulance 21=Tractor Trailer 05=81ack II=Purple 04=Small Truck 19=Unknown Type Special Veh 25= Trolley 03=Police 22=Twin Trailer 06=Yellow 12=Other OS=Large Truck 20=Unicycle, Bicycle. Tricyc", 98=Other 08=Other Emergency 23=Triple Trailer 07 =Silver 99=Unknown 10=Snowmobile 21 =Other Pedalcycle 99=Unknown Vehicle 31=Modified Veh 1 I=Pupil Transport 99-Unknown Initial/moact Point [ill] Damaae Indicator ~ Vehicle Role [0 Vehicle P05it;on [QIIJ '~' O=None OO=Not Applicable OO=Non-Collision I=Minor (Driveablel O=Non-Collision 01=Right Lane (Curbl 2=Functional t=Striking 02=Right Turn Lane OB=L!ft of Trafficway (Moderate Damage, 2=Struck 03=Left Lane 09=R'ght of Trafficway 09 03 13=Top 3=Both Striking 04=left Turn Lane 10=HOV Lane 14=Undercarriage May Not be Driveable) 05=2-Direction 11=Shoulder Right 08 04 15=Towed Unit 3=Disabling (Severe - and Struck Center Turn Lane 12=Shoulder Left 07 06 05 Not Driveable) 06=Other Forward 13=One Lane Road 99=Unknown 9=Unknown Moving lane 9B=Other 07=Oncoming Traffic Lane 99=Unknown Direction of ~ Movement [Q[IJ 07 Entering a Parked 14 Backing Up !imOOJ1 ITJ Travel Position 15=Changing Lanes 3=Oownhill 01=Going Straight 08= Trying to Avoid Animal. or Merging 4=5ag/Bottom of Hill N=North 02=510wing/Stopping in Lane Ped, Object. Veh, etc 16=Negotiating 1=Level Roadway 5=Crest/Top of Hill S=South 03=Stopped in Traffic Lane 09= Turning Right on Red Curve - Right 2=Uphill 9=Unknown E=East 04=Passing/Overtaking Veil to= Turning Right 17=Negotiating W=West 11=Turning Left on Red Curve - Left Alionment OJ l=Straight H U=Unknown 05=leaving a Parked Position 12=Turning Left 91l=0ther 2=Curved 06=Parked 13=Making a U-Turn 99=Unknown 9=Unknown Unit Number Trailino Unit(s) TVDe of Unit 5 Camper ~D Tag No I ~ Number 0 1_ Towing Passenger Veh 6_ Trailer I Tag I I Tag I ) I 2=Towing Truck 7=Semi.Trailer Year State of Trailing 3=Towing Utility Trailer 8=Other ~D Tag No I I Tag I I I Units: Tag L-=:J 4-Mobile or Modular Home 9=Unknown Year State Vehicle C%r [JJ Vehicle TVDe IT] ~ CD 01 =Blue ~ t2=Commercial 02=Red 08=Gold 01=Automobile 11=Farm Equip 22=Horse and Buggy OO=Not Applicable Passenger Ca trier. 03=Wllite 09=Brown 02=Motorcycle 12=Construction Equip 23=Horse and Rider 01=Fire Veh 13=Taxi 04::::;Green 10:0range 03=Bus 18=Other Type Special Veil 24=Train 02=Ambulance 21=Tractor Trailer 05=Black 11 =Purple 04=Small Truck 19=Unknown Type Special Veh 25= Trolley 03=Police 22= Twin Trailer 06=Yellow 12=Other 05=Large Truck 20=Unicycle. Bicycle. Tricycle 98=Other 08=Other Emergency 23:Triple Trailer 07=Silver 99=Unknown 10=Snowmobile 21=Other Pedalcycle 99=Unknown Vehicle 31=Modified Veh 11=Pupil Transport 99 Unknown InitiallmDact Point IT] Damaae Indicator 0 Vehicle Role D Vehicle. Position rn '~ O=None OO=Not Applicable OO=Non-Collision I=Minor (Drive able) O=Non-Collision 01=Right Lane (Curb) 2=Functional 1=Striking 02=Right Turn Lane OB=L!ft of Trafficway 03=Left Lane 09 03 13=Top (Moderate Damage. 2=Struck 04=Left Turn Lane 09=R'ght of Trafficway May Not be Driveable) 3=Both Striking 10=HOV Lane 14=Undercarriage 05=2-Direction II=Shoulder Right 08 04 3=Disabling (Severe - and Struck Center Turn lane 15=Towed Unit 12=Shoulder Left 07 06 OS 99=Unknown Not Driveable) 06=Other Forward 13=One Lane Road 9=Unknown Moving lane 98=Other 07=Oncoming Traffic lane 99-Unknown Direction of D Movement CD 07-Entering a Parked 14-Backing Up 0 T ra vel Position 15=Cllanging Lanes Gradient 3=Downhill 01=Going Straight 08= Trying to Avoid Animal. or Merging 4=Sag/Bottom of Hill N=North 02=Slowing/Stopping in Lane ped. Object. Veh. elc 16=Negotiating 1=level Roadway S=CreSt!Top of Hill 5=Soutll 03=Stopped in Traffic Lane 09=Turning Right on Red Curve. Right 2=Uphill 9=Unknown E=East 04=Passing/Overtaking Veil 10=Turning Right 17=Negotiating W=West 11=Turning Left on Red Curve. Left Alianment 0 l=Straight U:;;Unknown 05=Leaving a Parked Position 12=Turning Left 9B=Other 2=Curved 06=Parked 13=Making a U-Turn 99=Unknown 9:;;Unknown j ::>RM !I AA-4S (01/01) ---1 I J COMMONWEALTH OF PENNSYLVANIA POLicE CllASH REPORTINC )RM ......d;)11 ''''UIIIU~1 . New ")0140974 J Unit Number [QJJ] Address LYOI S. !'bAcnmo((...1::: license Number Page: 10/0 b I o Changel Continuation AA 45 3 1 'S"\". FI MI Telephone Number . [[] [R] ,..., tI- ~-z...-:- O"J3-;f CIty State Zip II blLLS(OUlLG IL!!J~ State [fKJ If License Number is unknown or driver is not licensedr see manual _ No o Alcohol Alcohol Test Type e Test Not Given o Blood Alcohol Test Results o Illegal Drugs o Alcohol and Drugs o Medication o Unknown c o += .. E .. o ... of Pedestrian Sirmal at Scene of Cram o No Pedestrian Signal o Pedestrian Signal Pedestrian Location o Not at Intersection Driver or Pedestrian Phvsical Condition _Apparently 0 Illegal Drug Normal Use ,--., Ha.d ~een 0 Sick '---' Drlnkong o Fatigue o Asleep ,0 Medication o Unknown O I R dO" to Feet Marked Crosswalks n oa way Off Road o at Intersection 0 Not in Roadway o > 10 Feet o At Intersection. No 0 Median' Off Road Crosswalks 0 o Island Outside Trafficway o Non-Intersection 0 Shared Pathsl Crosswalks 0 Shoulder Trails o Driveway Access 0 Sidewalk 0 Unknown Vehicle Code lis~ any Vehicle Cod~ Section this driver has Charged with VIolated and mark If they were charged. Violation' I lOves ~ No I lOves 0 No [QICIJ 0 Breath 0 Other r 0 Urine 0 Unknown if 0 Test Given c .. Unknown .;: 0 Test Refused 0 ... .. Results .. 0 Test Given. "II .. Contaminated Results ... Owner/Driver Code 101-z.1 OO-Not Applicable 01 =Private Vehicle Ownedl leased by Driver 02=Priva1e Vehicle Not Ownedlleased by Driver last Name 03 Rented Vehicle 04=State Police Vehicle 05=PennOOT Vehicle 06=Other State Gov Vehicle 07=Municipal Police Vehicle OB-Other Municipal Government Vehicle 09=Federal Gov Vehicle 98=Other 99=Unknown Driver Presence f\I 1=Driver Operated 3=Oriver Fled Scene L!..J Vehicle 4=Hit and Run 2=No Driver 9=Unknown Alcohol Test Results Unit Number 10121 Address State Zip I ?'3b5 6 (CoSS'TOuJN R-D IIW€LLS\1 ILLt I []!] ~ l~nsz..e Nu:err> I C- -, 8 (~1 A I ~ C=> -. c::::> tC- _ r If License Number is unknown or driver is not Iicensed~ see manual Alcohol/DruQs Suspected g Pedestrian Sienal at Scene of Crash .. No 0 Illegal Drugs 0 Medication ':;; 0 No Pedestrian Signal o Alcohol 0 Alcohol and Drugs 0 Unknown ~ 0 Pedestrian Signal Alcohol Test Type ] Pedestrian Location - In Roadway 0 "10 Feet .. Test Not Given 0 Breath 0 Other 0 Marked Crosswalks Off Road ,--., Blood 0 Urine 0 Unknown if 6 at Intersection 0 Not in Roadway 0 > 10 Feet '---' Test Given cOAt Intersection. No 0 Median Off Road .. Crosswalks 0 :s Non-Intersection 0 Island Olltside Trafficway ~ 0 Crosswalks 0 Shoulder 0 f~';:f;d hthsl ~ 0 Driveway Acc~ss 0 Sidewalk 0 Unknown Vehicle Code list any Vehicle Cod~ Section this driver has Charged with VIolated and mark If they were charged. Violation? FI MI Telephone Number [f]WI .. Not at Intersection [Q].CIJ o o Test Refused Test Given, Contaminated Results o Unknown Results Driver or Pedestrian Physical Condition C) Apparently 0 Illegal Drug Normal Use C) Had Been 0 Sick Drinking C) C) Fatigue o . Medication I I o Yes o No Asleep Unknown o Yes o No Owner/Driver Code /0101 00 Not Applicable 01=Private Vehicle Ownedl Leased by Driver 02=?rivate Vehicle Not Owned/leased by Driver 03-Rented Vehicle 04=State Police Vehicle 05=PennDOT Vehicle 06=Other State Gov Vehicle 07=Municipal Police Vehicle OB=Other Municipal Government Vehicle 09=Federal Gov Vehicle 9B=Other 99=Unknown Driver Presence o 1:::0river Operated 3=Oriver Fled Scene Vehicle 4=Hit and Run 2:::No Driver 9=Unknown FORM it AA.4$ (01101) Pl=Nt\lnnT rnDV r COMMONWEALTH OF PENI\IC;YLVANIA PbLlCE CRASH REPORTING JRM Crash Number . New )0140974 -, AA 45 4 1 Page: 10/0 I tJ.! o Change/ Continuation Person TVRJ:; Seat Positio..n: Safetv Eauioment One: Eiection: A 1_Driver D OO=Not A Passenger/Occupant E OO-None Used / Not AJ'plicable G O=Not Applicable 2=passenger 01 =Driver. All Vehicles 01=Shoulder Belt Use 1 =Not Eiected 7=Pedestrian 02=Front Seat Middle Position 02=lap Belt Used 2=Total Yi Ejected 8=Other 03=Front Seat Right Side 03=lap And Shoulder 8elt Used 3=Partia Iy Ejected 9=Unknown 04=Second Row - left Side Or 04=Child Safety Seat Used 9=Unknown Motorcycle Passenf/er 05=Motorcycle Helmet Used 05=Second Row - Midd e Position 06=Bi'(.c1e Helmet Used Eiection Path: Sex: 06=Second Row - Right Side 10=Sa ety 8elt Used Improperly H O-Not Ejecte~ I Not Applicable B F ,=female 07=Third Row Or Greater. 11 =Child Safety Seat Used Improperly '" - left Side 12=l-Ielmet Useatmproperly- -, -- 1= Through SIde Door Opening M=Male 08=Third Row Or Greater- 90=Restraint Used, Type Unknown 2= Through Side Window U =Unknown Middle Position 99=Unknown 3= Through Windshield 09=Third Row Or Greater- 4= Through 8ack Door Right Side F Safetv Eauioment Two: 5= Through Back Door Tailgate Openi ng IniuN Severitv: 10=Sleeper Section Of Truckcab OO=None Used / Not Applicable 6=Through Roof Opening (Sunroof/ 11=ln Other Enclosed 01=Front Air Bag Oef.loyed (For This Seat) Convertible Top Down) CO-Not Injured Passenger Or Cargo Area 02=Side Air Bag Dep oyed (For This Seat) 7=Through Roof Opening (Convertible l=Killed 03=Other Type Air Bag Oeployed Top Up) 2=Major Injury 12=ln Open Area 9=Unknown t- 3=Moderate (Back Of Pickup, Etc.) 04=Multiple Air Bags Deployed Injury 13=Trailing Unit 05=Motorcycle Eye Protection 4=Minor,lnjury 14=Riding On Vehicle Exterior 06=Bi~c1ist Wearing Elbow/Kneel E~l'atiDn. 15=Bus Passenger Ot er Pads 9=Unknown 10=Air Bag Not Deployed, Switch On I 0= ot Appl,cable 98=Other l=Not Extricated 99=Unknown 11=Air Bag Not Deployed. Switch Off 2=Extricated By Mechanical Means 12=Air Bag Not Deployed. ' 3=Freed By Non - Mechanical Means Unk Switch Settin8 8=Other 13=Air Bag Removed Prior To Crash) 9=Unknown 19=Unknown If Air Bag Deployed 99=Unknown 'tNo Person No Date of Birth (MM-DD-VYYY) ABC 0 E F G H I ill] [Q]IJ D~te? [iliJ-lo Is I-~ITJ[E]~~[Q@]I 0 10 1[QJ~eJ ne / Address / Phone S e, S ,'rA I EMSTransport i E A'T'""t-l1S\'L K:A~ ~a.A-lY\ PToI-l) -+01 . I\crimoRE )\..~~w;.~ 110lQ a Yes . No itNo Person No Date of Birth (MM-DD-YVYV) ABC 0 E F G H I ~ 'Z-/,[QJJJ D~te? [Qli]-CLlQ] -~ GJ ~ ITJI~ Ie/I ala I f010l @~!Q] 11e / Address / Phone I EMS Transport ol{~ ""D. AN b 6Lo '3'Ob'56 ((.o~S.TO\.9)tJ Q.b I I W EU..S \H LU:;:: '\1\ lJ~S a Yes . No tNo Person No Date of Birth (MM-OO-YVYY) ABC 0 E F G H I IJ CIJ D~te? CIJ-CIJ -CLIIJDDDrnrn mOOD ne I Address / Phone 1 EMS Transport a Yes aNo tNo Person No Date of Birth (MM-DD-YYYY) ABC 0 E F G H I IJ CIJ D~te? CIJ-CIJ -CLIIJDDornrn mOOD 11e / Address / Phone J EMS Transport a Yes aNo tNo Person No Delete? Date of Birth (MM-DD-YYYY) ABC D E F G H I IJ CIJ 0 CO-CO-CIIIJOOornrnCOOOO ne I Address I Phone EMS Transport 1 o Yes 0 No tNo Person No Date of Birth (MM-DD-YYYY) ABC D E F G H J IJ CIJ D~te? CO-CO -CIIIJ Ooornrn CO 000 ne I Address / Phone EMS Transport 1 o Yes o No :JRM )j AA.45 (01101) .,.......0...............,.. ...................,. J COMMONWEALTH OF PENN<;YlVANIA POLICE CFlA!5H REPORTING ,~M _New AA 45 5 1 Page: I 0 I 0 /s I o Change o "Y" Intersection 0 Off Ramp Special Location Traffic Circle! 0 . Not Applicable 0 Bridge 0 Cross Over Related o Crossover Round About 0 Underpass 0 Tunnel 0 DrivewaYIParking lot O Multi-leg 0 Railroad Crossing 0 Ramp 0 Toll Booth 0 R &. Intersection amp Bridge o On Ramp 0 Other (If 'Ramp' is indicated, please see manual) 0 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. ILy_ou _have a mid block crash, you should enter information in_ the_'Oistance from landmark' Section, the GPS Section. or the House-Number' Section in the Princi al Road area. County Route Number Segment (Optional) Travel lanes [?JJJ CQ&EDJ o=rTI 1012/ Street Name Intersection Type - o o Midblock 4 Way Intersection "T" Intersection Speed limit ffiQJ Street Ending [lli] Route SiClninq r--'\ Interstate 0 Turnpike 0 Turnpike .. State L...I (Not Turnpike) (East/West) Spur Highway :(l County Route Number Segment (Optional) Travel lanes ~ [I] ITITICIIIJ ITJ .0 Street Name ~ ~ .. .s ~ .e .. ~ ....,u.)" 1''1\'''''''''1:1 0140974 -, o North J. 0 South o East @ West o Unknown House Number (if applicable) r:rr=ITfJ 0 County 0 local Road o Private C) Other! Road or Street Road Unknown Speed limit o North CD J o South f- Street Ending o East CD o West o Unknown o State 0 County 0 local Road 0 Private Highway Road or Street Road -" ~ ~ .. E '"' '0 S Please c Enter .:l 'lS Information .!;! <Q for BOTH ~ landmarks lE if Using N ~ .e This Option ~ . .. E ~ '0 C . ~ C) Other! Unknown 10 North o South St Ending 0 E" ast ~ 0 West Feet Ur13E1?J Or Miles ITJ.O Intersecting Rt Num Or Mile Post 1 ~ ITII 0 o North ~~. o South Or Intersecting Street Name St Ending 0 East ~YH==-8IIIIITIIJ [IE] o West Degrees Latitude: c=cJ Traffic Control Device Minutes Seconds [TI:ITJ.rn Distance From Crash Scene to Landmark 1 (For Crash between Landmark 1 and Landmark 2) Longitude: Degrees Minutes Se<onds ITIJ CD:CD.rn o o o o Passive RR Crossing Controls Police Officer or Flagman Other Type TCD Unknown o C) o Stop Sign Yield Sign Active RR Crossing Controls - o o Not Applicable Flashing Traffic Signal Traffic Signal TeD FunctioninQ . No Controls o Device Not Functioning o o Device Functioning Improperly Device Functioning Properly o Emergency Preemptive Signal o Unknown - Not a Work Zone Work Zone Location 0 Construction 0 Transition Area 0 0 Before 1st Work 0 Activity Area Maintenance Zone Warning Sign 0 Utility Company 0 Advance Warning 0 Termination Area 0 Other Area 0 Other Type of Work Zone (If "Not a Work Zone", skip rest of Work Zone section) Work Zone (Mark all that apply) o Lane Closure 0 Work on Shoulder O Road Closed with 0 or Median Detour Intermittent or Mavin Work Lane Closed (If "Not Applicable". skip rest of the Lane Closure section) ~ 0 Not Applicable 0 Partially &I Fully 0 Unknown ~ 0: Lane Closure Direction * C) North ~ C) South " o East o West o North and South & East and West ORM il AA-45 (OH01) Work Zone Speed Limit co Traffic Detoured Estimated Time Closed o < 30 Minutes o 30-60 Minutes n~;l,I"II""l""""T ,-..,-.,,..."', o Flagger Control o Other Workers Present DYes 0 No o Unknown .'Yes 0 No III ,.3 hours o 3-6 hours o 6-9 hours o 9-12 hours o > 12 hours o Unknown Crash Number J GOMMON~EALTH OFPH'-'SYLVANIA POLICE CRASH REPORTIN,- .'ORM P0140974 . New -, Page: [iliill' o Changel AA 45 6 1 Continuation 0 O=Non-Collision 2-Head On 4=Angle 6=Sideswipe 8-Hit Pedestrian Crash Descriotion 1=Rear End 3=Rear to Rear 5=Sideswffie (Opposite Direction) (Backing) (Same irection) 7=Hit Fixed Object 9=Other/Unknown 3 v [[] 1=On Travel lanes 3-Medlan S-Outside Trafficway 7 -Gore (Ramp Intersection) v ~ Relation to Roadwav 2=Shoulder 4=Roadside 6=ln Parking lane 9=Unknown ~ - [?J 1-0aylight 3 Dark - Street S=Dawn 8=Other 3 Illumination 2=Oark - No lights 6=Dark - Unknown ' Street lights 4-Dusk Roadway lighting 5 1 No Adverse ~ OJ 3=Sleet (Hail) S_Fog 7=Sleet & Fog 9=Unknown ,. Weather Conditions Conditions 4=Snow 6=Rain & Fog 8=Other v 2_Rain 5 2 Sand. Mud. Dirt, 4-Slush 6=lce Patches 8-0ther E @] O=Ory Oil 7=Water - Standing - Road Surface Conditions 1=Wet 3=Snow Covered 5=lce or Mavin Harm Event LIR Most? [QgJ 0 0 Unit No [2I[] 2 ITJ 0 0 Please Put 3ITJ 0 0 Events in Sequential Order 4ITJ 0 0 Harm Event L/R Most7 1 ITID 0 0 Unit No IOI2-/2ITJ 0 0 Please Put 3ITJ 0 0 Events in Sequential Order 4ITJ 0 0 Mlm Harmful Event in the Crash 00 not repeat this In'orm~tion on multiple pageol 2LU 3IT] E.iu.t. Harmful Event in the Crash Unit No Harm Event [QIT] [2E] Environmental / Roadwav Poten tial Factors (EIR) OO=None 01=Windy Conditions 02=Sudden Weather Conditions 03=Other Weather Conditions 04=Oeer in Roadway 05=Obstacle On Roadway 06=Other Animal In Roadway 07=Glare 08 Work Zone Related Unit No Harm Event IT] IT] Harmful Events (Harm Event) 30-Hit Fence Or Wall 01_Hit Unit 1 31=Hit Building 02=Hit Unit 2 32=Hit Culvert 03=Hit Unit 3 33=Hit Bridge Pier Or Abutment 04=Hit Unit 4 34=Hit Parapet End OS=Hit Unit 5 35=Hit Bridge Rail 06=Hit Other Traffic Unit 36=Hit 80ulder Or Obstacle 07=Hit Oeer On Roadway 08=Hit Other Animal 37=Hit Impact Attenuator 09=Collision With Other Non 38=Hit Fire Hydrant Fixed Object 39=Hit Roadway Equipment 11=Struck By Unit 1 40=Hit Mail Box 12=Struck By Unit 2 41=Hit Traffic Island 13=Struck By Unit 3 42=Hit Snow Bank 14=5truck By Unit 4 43=Hit Temporary ConstrU<lion IS=Struck By Unit 5 Barrier 16=Struck By Other Traffic Unit 48=Hit Other Fixed Object 21=Hit Tree Or ShrUbbery 49=Hit Unknown Fixed Object 22=Hit Embankment ' 50=0vertumIRoII Over 23=Hit UtiJ!!y Pole 51=Struck By Thrown Or Falling 24=Hit TraffiC S~n Object 2S=Hit Guard Rail 52=Pot Holes Or Other 26=Hit Guard Rail End Pavement Irregularities 27=Hit Curb S3=Jacknife 2ll=Hit Concrete Or S4=Fi~ In Vehicle longitudinal Barrier 5ll=Other Non-Collision 29=Hit Ditch 99=Unknown Harmful Event Left/1/ioht (1/11) l=left R-Right O=Other U=Unknown Driver Action (D) 16_Driving The Wrong Way On 1-Way Street OO=No Contributing Action t7=Careless Or Illegal 01=Oriver Was Oistracted Backing On Roadway 02=Oriving Using Hand Held Phone 1ll=Oriving On The Wron9 03=Oriving Using Hands Free Phone Side of Road 04=Making Illegal U-Turn 19=Making Improper OS=lmproper/Careless Turning Entrance to Hi9hway 06=Turning From Wrong Lane 20=Making Improper Exit 07=Proceeding W/O From Highway Clearance After Stop 21=Careless Parklng/Unparking 08=Running Stop Sign 22=Over/Under 09=Running Red light Compensation At Curve 1ll=FaiJure To Respond To 23=Speeding Other Traffic Control Device 24=Driving Too Fast For Conditions 11=Tailgating 2S=Failure To Maintain Proper Speed 12=Sudden 510wing/Stopping 26=Driver Fleeing Police 13=lIIegally Stopped On Road (Police Chase) 14=Care'ess Passing Or lane 27=Driver Inexperienced Change 28=Failure To Use Specialized Equip 15=Passing In No Passing Zone 98=Other Improper Drivin9 Actions ~~itm 1m 2IT] 3 IT] 4Q] 1m 2IT] 3m t- 1 [Q]QJ 11=Slippery Road Conditions (Ice/Snow) 12=Substance On Roadway 13=Potholes 14=Broken Or Cracked Pavement 1S=TCO Obstructed 16=Soft Shoulder Or Shoulder Drop Off 28=Other Roadway Factor 99=Unknown Possible Vehicle Failures (V) OO=None' 06:Exhau.st 01=Tires 07=H.eadltghts 02=Brake System 08=Slgnal l.'ghts 03=Steering System 09=Other lights 04=Suspension 10=H,?rn 05=Power Train 11=Mlrrors ~~it [Q]QJ 1 CD 2 [I] ~~it CD 1 CD 2 [I] Indicated Prime Factor Do not I""epeat this information on multiple pages 12_Wipers 13=Oriver SeatinglControl 14=Body, Doors, Hood, Etc 1S=Trailer Hitch 16=Wheels 17=Airbags 18=Trailer Overloaded 19=Unsecure/Shifted Trailer load 20=lmproper Towing 21=Obstructed Windshield 99:Unknown Unit m No 4Q] Pede,trian Action (P) OO=None 01=Entering Or Crossing At Specified location 02=Walking. Running, Jogging, Playing, Or Cycling 03=Working 04=Pushing Vehicle OS=Approaching Or leaving Vehicle 06=Playing Or Working On Vehicle 07=Slanding 9B=Other Unit No Factor Code 1012110171 EIR C) v C) D o P - If E/R ;s the Prime Factor Type. leave Unit No blank ...E.O.B.M lLAA,~S_IQ'''''()Jl U~it No ~ [ili] Unit No IT] rn J COMMONWEALTH OF PE"'''!.'iYLVANIA POLICE CR'ASH REPORTlN, ORM . New o Changel Continuation AA 45 7 Page: /0 10/7/ o Delete Page .;..... ,,~:~JD:, ....i ..., ..... .....n.~. " ...--...;........,..... ...:.........:.... ......., .~J!L ................ . ........~....... ........:..'.....J ~:.~tDJ.~~' ro ..;:)" , . -. ......-.... -. .. ... ..~........~.... -....~ ..... , , . '. : . . . - . ..- ...-~........ r'" .... ~.... .....~....-....:.... . : . . ... . .. ~. -- . . .. . :' . . . . ..:........:........:........:. ....:.... ,-.. ..:.....-...~ ..... , , ....;........!........i.........!.........!........;.... .... i.. ..... -!....... -i..-..... i........~...... , , , . , . . , ..................................... , . . . . . . , , , , . , , , , , . ...'..'I....:::1::::::r...' ~ ...:........:-... .....;........ ~_..... ...~. ......... ........ .. ':.>00" ...."",..,',....,..,, '....f;;;~?'..,~\:~~:':',..,..,' ,,-,",,..;' '.... ....,..., ---:- .......~~.~~"... ...., .;....- ..... -...~....... ;r ."l> ,..,G.. "-... ,Q, '\)). JD..,..~ ......, ....'.s :> ........,~, VJ "% a ~ '''J' ..0 ';) 'Z ,,:I!..,~ V)I .....! ....i FORM :I AA.45 (01101) nC:"I.J.If"\"""""" ........"'.....,.. l.rasn Numoer ?0140975 j ...~....... .: ,,1"\ ~ .......~......... ....... ................ .......:................ .. ..... - - - -.~ ~ . . . , . , ................ . . . . . . .' ....r.......r......T....... ....... r' ......;........:-....... T........r... ....f... ..... ~........ ~........ ....~ u~.1.:.~r~..~.:,~:....~.,.:~~'.'., , , , , , , ....-................-... , , , , , . .-........-........;-.. "L 'T .0..~ ;,..~~-F~ITL~L(+.... ..... .... r..... .'[........t-...... ................... ....:.. ......~ ....... -... ....~h..... '~n... ...?.. .....i........ ~........ ,..,p..;. , i...~+:-E'I,.......!........I-..,... ;:-r~.jf,Ff ....~.........i........+....~._....t........;........;........~......" . :--: ; ;- . ; : ..-(....')......"+"..,+-..,..;...""'!,...."'[",.."'!.,.,.... "ii)' ::to . .....~........~.... .;........1........ '.. . .... ~.........;.........~........~..~... .....~........1........ . . . . . . . . . . . . fA-rt:~..<:>~.."i....." ..'r'....!......'i....,..;......,,~r!\~t , , ' ......-........-........;.... ....;.........~........;....... ~ Place emergency transport, witness, and other information here. It is not required to restate information from the form. Responding EMS Agency: HAMflJeJ """TwP, Medical Facility: NcN~ loWb"'I'L ALD=N 1W~ Witness 1: -:r-f'rrYt e;:, o , '~vi1f Address: !J~~~':>Li~ ArZ. 1"2..1\1 Phone: (S'fO) ., 8"3 - 4 7'5 Witness 2: . ----- Address: Phone: " Narrative: SElS All A: e...\- t b'!'> ~ () l$1\l D Q 1Y\ , , - ---1 J C.OMMONVVEAlTH OF PEf\J"'SYlVANIA POLICE CRASH REPORTIN, ORM AA 45 8 1 Page: 1010/8/ ORM .. AA-45 (01/01) ,....-10....11.....,...,.... ,...,..........,. Lrasn NumOer . New o Changel Continuation o Delete Page P0140974 J Road Surface Tvpe 0 Brick or Block 0 Dirt Special Jurisdiction a Military o Other Federal Sites CJ Concrete 0 Slag, Gravel or 0 Other . No Speda I a Indian Reservation o Other .. Stone 0 Unknown Jurisdiction Blacktop 0 National Park a College/University o Unknown Campus .ase 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 Principle Impact Point C2IiJ o Non-Collision e 0 0 - , .., '" ",' - " D'~'D - Driver Restrictions 0 Restrictions 0 Not a Pennsylvania o Top Compliance Complied With Driver No Restrictions/ 0 Restrictions Not o Unknown a Undercarriage a 09 03 0 @ Complied With Compliance Not Applicable Compliance a Towed Unit 008 040 0 Unknown 07 06 05 Driver Endorsement 0 Required - o Not a Pennsylvania a Unknown a 0 Compliance Complied With Driver 0 Required - Non Unknown Avoidance Maneuver C!1l None Required 0 Compliance o Compliance . No Avoidance 0 Required - Maneuver a Braking - Other o Other Avoidance Compliance Unknown Evidence Maneuver Driver License 0 Not Required for 0 Unk if COlor a Braking - Skid a Steering - Evidence o Inconclusive Marks Evident Compliance Vehicle Class CDl Required or Driver Stated 0 No Valid license 0 Not a Pennsylvania Braking - No Skid a Steering and Braking o Unknown 0 Not licensed for Class Driver a Marks, Driver Evidence or Stated Stated ~ Valid license for 0 Unknown Class Under Ride'lndicator Druq Test Tvpe 0 o Other a No Underride or Underride, No Blood a Compartment o Override, Other ., o Unknown if T""t Override Intrusion Vehicle None 0 Urine Given Underride, Underride, Unknown if Druq Test Results - (Up to Four Results) ~[QJ [QJ o Compartment o Compartment o Underride or Intrusion Intrusion Unknown Override o = No Test Given 5 = Amphetamines 1 = No Drug Reported 6 = PCP EmerQencv Use 2 = Marijuana 8 = Other ~ [QJ a lights Flashing o B.oth lights and 3 = Cocaine 9 = Unknown Test . Not in Emergency Siren 4 = Opiates Results Use o Siren Sounding o Unknown Unit Number Princi,,'e Imoacr Point CD a Non-Collision 0 0 0 t- D'~'D Driver Restrictions 0 Restrictions o Not a Pennsylvania aTop Como/lance Complied With Driver No Restrictions! 0 Restrictions Not o Unknown o Undercarriage a 09 03 0 0 Complied With Compliance Not Applicable Compliance a Towed Unit o 0 04a 0 Unknown 07 06 05 I Driver Endorsement 0 Required - a Not a Pennsylvania a Unknown o 0 a Comollance Complied With Oriver 0 Required - Non a Unknown Avoidance Maneuver 0 None Required Compliance Compliance a No Avoidance 0 Required - a Braking - Other a Other Avoidance Compliance Unknown Maneuver Evidence "- Maneuver Driver License 0 Not Required for a Unk if COlor a Braking - Skid a Steering - Evidence b Inconclusive Comollance Vehicle Class CDl Required Marks Evident or Driver Stated 0 No Valid license a Not a Pennsylvania Braking - No Skid a Steering and Braking 0 Not Licensed for Class Driver a Marks. Driver a Unknown Valid license for Stated Evidence or Stated 0 a Unknown Class Under Ride Indicator DruQ Test Tvoe 0 Blood a Other a No Underride or a Underride, No Override, Other 0 a Unknown if Test Override Compartment a Vehide None 0 Urine Intrusion Given a Underride Underride, Unknown if Druq Test Results - (Up to Four Results) ~D D Compart,,{ent a Compartment a Underride Or Intrusion Intrusion Unknown Override '0 = No Test Given 5 = Amphetamines 1 = No Drug Reported 6 = PCP 2 = Marijuana 8 = Other D D Emerqenev Use a lights Flashing a 80th lights and 3 :::: Cocaine 9 = Unknown Test a Not in Emergency Siren 4 = Opiates Results Use a Siren Sounding a Unknown =OAM .'1 AA.4SF (01101) J LUIVIIVIUNVVI:ALIH UI" t"I:NI'oI:'YLVANIA POLICE GRASH REPORTINf 'JRM AA 45 F 1 Page: /01019/ PENNDOT COpy . New J o Change/ Continuation Page 1 Accident # 97-0 I June 26, 2001 (Fatal) PtIm. Shaun A. Felty At 0428 this officer was disp-atchedto the 5000 BIk ofTrindle 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 railroad 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 detennined 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, Mechanicsburg Pa 17055, (H)(717) 791-1276 (W)(717) 605-7301 stated that he was driving eastbound on Trind1e Rd. and was approaching the accident scene when he saw a car of unknown description traveling westbound on Toodle 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 Purina when he was traveling eastbound on Trindle Rd. and came to the raiItoa.d bridge overpass. He saw the sign that stated the bridge was a heighthf 13' 6" and wasn't sure ifhis trailer would fit under the bridge, He pulled his tractor forward and under the bridge and exited his truck to see uhis 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 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 ifhe would like him CAndela) to watch the bridge while he drove under it. Pruitt then tried to drive his tractor trailer lll1der the bridge. Pruitt saw Andela standing in the westbound lane ofTrindle Rd. next to Pruitt's tractor. Pruitt was looking back and forth between Andela 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 bit her car. This officer found Heather K. 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 P A 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 :from 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 down the street and turned around in a business parking lot. She then drove back towards the accident scene and saw that the truck wasstill stopped in the eastbound lane anrldrJlY.edOwn1he right hand side of the truck; usmg 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 0 btain more information from Pruitt who was with the Lower Allen Twp. EMTs. Pruitt appeared distraught and blamed ~self 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 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 ow- 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 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 onIy 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 ofthe roadway. The overhead light sits on a telephone pole at a height above the bottom ofthe railroad bridge and the light is obscured by a tree which sits between the light and the railroad 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 from the railroad 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 ofthe 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 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 trailer: This officer also interviewed Pruitt at the station on the morning of June 26th 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 ifhis trailer would clear. He saw a truck pull . ---up-behind-andwent back to the truck to asked the-drivertAndela) for directions, Andela provided directions to Ralston Purina a~d Pruitt asked Andela ifhe thought his trailer would clear the bridge. Andela told PruItt that he thought the trailer would clear the bridge and then asked Pruitt ifhe 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 of a car or the taillights of a car. Pruitt never saw the car approaching prior to collision since he was looking from 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 off the 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 Rei, Mechanicsburg Pa 17050, (H) 763-5716. Franks stated that she has worked with Frampton for I -2 months at Country Meadows. On the morning of the accident Frampton was suppose to get off work 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 of a individual who has been struck by a vehicle traveling less than 30 MPH. Page 4 DriverNehicle Information (not involved in coJIision) Driver - James E. Pruitt, 1 Ives Dr, N Little Rock, AR 72117, AR/227279679 Vehicle - 2001 FRHT, TN/58924HY, VIN IFUYDSEB9WP96779, white. Registered owner, Covenant Transport Inc., 400 Binningham Hwy, Chattanooga 1N 37419-2346. Pruitt works for Southern Refrigerated Transport, (888) 778-7670. Tractor was towing a: 53 ft trailer, white, empty. Vehicle - 1999 Ford PAlZS34675, VIN 1FDXF46F1XED43960 white, Registered owner, Schenks Pastry Shoppe INC., 5303 E. Toodle Rd., Mechanicsburg Pa 17050. This vehicle had been driven by John Andela and was left parked behind the above tractor trailer during the accident. p",.?~ I, J~p I L e-f--+- 1~'rojV\ -rhe- eXl'f- 2.7 I/A J )-ucJ( :;t-q e"+-~!, s _/v1or-jUt AJJ)-9C?I"tJJ) -tq 'f'he. yC(JSTo~ !iiPlAY'LvC{, PI0;J"t TO_ P!'c.-/{ up qq,/o,C{J. L _t.~!lowec/ i;1M y d I_'re-e- tt" O!JS TLJ:-5.:; Ivev spr-,'.v9 Sy-OCf d. i:lbu +___,_.c 0 _l-t. 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O;;l. - ~;t~ Cu'~(~ J~~ Petitioner ORDER AND NOW, this q :.t/..... day of ,') I a.~_ , 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 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% ofthe gross amount recovered $24,000.00 $ 1.028.00 $80,000.00 (d) Reimbursement of out-of-pocket expenses TOTAL PRESENT DISTRIBUTION BY THE COURT: /5/ ,2j.,'" '-2J .', c!.'. '*n...., J. TRt~... Ct.......'v '.."''''~,., ".,,'..........R-O ,}~. ".,."' ~ /.,,,,,...-,,, "".' ~''';'^'~ "., " ..~ "'''';:.,... fl'~"1.'I't ll~:,Jt'" ". !n T:~mlmoIiY W"')(l;Xd.. ! i.gtft W:!/)';;01 ;;~y h;Jnd and thl' attll (;t ::~;d ',;;Xgt at G;liH,;ie, loa rhis..'1jL .uay, or, ' -'~+44, '_2~(':L . '.if" U. ?!./-, f'l/'.1 uY7' L'jJ-~J-' ~~,'lf;,"t, \~, , tfFV1fH J L.. 244672,l\DLL\MTG Exhibit D JUl 0 8 2002 ~ IN RE: PETITION OF CHRISTINE ANDELA, ADMINISTRATRIX OF THE ESTATE OF JOHN D. ANDELA, DECEDENT, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. Petitioner NO. 02:'2222Tivil Term AND NOW, this ,,(~+h day of , 2002, upon consideration of the Petition for Approval of a Compromise Settlement d 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 $10,000.00 TOTAL PRESENT DISTRIBUTION BY THE COURT: J. 245852,l\DLLIMTG Exhibit E CHRISTINE ANDELA, Administratrix of the Estate of JOHN D. ANDELA, Decedent, Plaintiff, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION - LAW v. JAMES E. PRUITT; COVENANT TRANSPORT; INC.; lirld SOUTHERN REFRIGERATED TRANSPORT, NO. Defendants JURY TRIAL DEMANDED NOTICE TO DEFEND You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this Complaint and Notice are served, by entering a written appearance personally or by attorney and filing in writing with the Court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the Court without further notice for any money claimed in the Complaint or for any other claim or relief requested by the Plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. COURT ADMINISTRATOR 4th FI., Cumberland County Courthouse Carlisle, Pennsylvania 17101 (717) 240-6200 NOTICIA Le han demandado a usted en la corte. Si usted quiere defenderse de estas demandas expuestas en las paginas sugnuientes, usted tiene viente (20) dias de plazo al partir de la fecha de la demanda y la notificacion. Usted debe presentar una apariencia escrita 0 en persona 0 por abogado y archivar en la corte en foma escrita $US defensas o sus objeciones a las demandas en contra de su persona. Sea avisado que si usted no se defiende, la corte tomara medidas y puede entrar una orden contra usted sin previo aviso 0 notificacion y por cualquier queja 0 alivio que es pedido en la peticion de demanda. Usted puede perder dinero 0 sus propiedades 0 otros derechos importantes para usted. LLEVE EST A DEMANDA A UN ABOGADO IMMEDIA TEMENTE. SI NO TIENE ABOGADO 0 SI NO TIENE EL DINERO SUFICIENTE DE PAGAR TAL SERVICIO, VAYA EN PERSONA 0 LLAME POR TELEFONO A LA OFICINA CUYA DIRECCION SE ENCUENTRA ESCRITA ABAJO PARA AVERIGUAR DONDE SE PUEDE CONSEGUIR ASISTENCIA LEGAL. COURT ADMINISTRATOR 4th Fl., Cumberland County Courthouse Carlisle, Pennsylvania 17101 (717) 240-6200 237860,l\MTGlLC3 6M,{;cT E CHRISTINE ANDELA, Administratrix ofthe Estate of JOHN D. ANDELA, Decedent, Plaintiff, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION - LAW v. JURY TRIAL DEMANDED g ? -o6~ q)c~ ~;E ~t~_: ~~:: s:; (= z ~ 9, // JAMES E. PRUITT; COVENANT TRANSPORT, INC,; and SOUTHERN REFRIGERATED TRANSPORT, NO. 0.2; 39t,5~7i- o I" ?" c:: C'> :-=== c.~\ ".~ i2 .m .i<:} _.~.)\~\ Defendants "'C' ::,,'1: COMPLAINT r-:: '-" ('0 ,:;{~f '::~\ -1-,' ':b ::<: 1. Plaintiff Christine Andela is an adult individual and a citizen of the Commonwealth of Pennsylvania who resides in Lebanon, Lebanon County, Pennsylvania. Ms. Andela was appointed as the Administratrix of the Estate of John D. Andela on July 16,2001, by the Register of Wills of York County, Pennsylvania. 2. Decedent, John D. Andela, was a citizen of York County, Pennsylvania, The Decedent was born on February 10, 1966, and died on June 26, 2001. 3. Defendant James E. Pruitt is an adult individual who resides at One Ives Drive, North Little Rock, Arkansas 72117. 4. Defendant Covenant" '''ort, Inc. (hereinafter Covenant) is a corporation with a principal place of business located at 400 Birmingham Highway, Chattanooga, Tennessee 37419-2346. 5. Defendant Southern Refrigerated Transport (hereinafter Southern) is a corporation with a principal place of business located at 210 Highway #71 North, Ashdown, Little River County, Arkansas 71822. 237860.1\MTGlLC3 6. On or about June 26, 2001, Decedent John D. Andela was operating a delivery truck in the course and scope of his employment with Schenk's Pastry Shoppe. Mr. Andela was traveling in an eastbound direction on Trindle Road (SR 641), Cumberland County, Pennsylvania. 7. At the same time, Defendant James E. Pruitt was acting in the course and scope of his employment and/or as an agent of Defendant Southern and/or Defendant Covenant, and was operating a tractor-trailer owned by Defendant Covenant in an eastbound direction on Trindle Road. 8. Defendant Pruitt was attempting to locate the Ralston Purina business and became lost. 9. Defendant Pruitt stopped his tractor-trailer in front of a railroad bridge near the 5000 block of Trindle Road in Hampden Township, Cumberland County because he feared that his truck would not fit under the thirteen-foot six-inch (13' 6") bridge. 10. Defendant Pruitt did not place appropriate warning signs and/or signals around his, stopped tractor-trailer. 11. Mr. Andela stopped his delivery van behind Defendant Pruitt's tractor-trailer as it was blocking the eastbound lane, and in essence, was disabled. 12. Defendant Pruitt approached Mr. Andela, asked for directions to Ralston Purina, and asked whether Mr. Andela thought the tractor-trailer would fit under the bridge, After a discussion, Mr. Andela offered to stand near the tractor-trailer and watch the top of the tractor- trailer as Defendant Pruitt drove under the bridge. 13. Due to the size and noise of the tractor-trailer, Mr. Andela had to stand on the left side of the tractor-trailer to assist Defendant Pruitt. 237860,IIMTGILC3 2 14. While Mr. Andela was guiding Defendant Pruitt under the bridge, Heather Frampton was operating a Nissan Sentra in a westbound direction on Trindle Road. 15. As Ms. Frampton drove under the railroad bridge, she caused the front of her vehicle to strike Mr. Andela and pllshed him aeproximately eighty-eight feet (88'). 16. Mr. Andela died as a result of the impact. COUNT I Christine Andela. Administratrix of the Estate of John D. Andela. Decedent v. James E. Pruitt. Covenant Transport. Inc.. and Southern Refril!:erated TransPOrt 17. Paragraph I through 16 of the Complaint are incorporated herein by reference. 18. The foregoing accident and all of the injuries and damages set forth hereinafter are the direct and proximate results of the negligent, careless, wanton, and reckless manner in which Defendant James Pruitt, while an employee and/or agent of Defendant Covenant Transport, Inc., and/or Southern Refrigerated Transport and operated his tractor-trailer as follows: (a) failure to know the height of his tractor-trailer; (b) failure to properly plan his route to avoid becoming lost and to avoid potentially low bridges; (c) failure to place appropriate warning signs or signals around his stopped tractor-trailer in accordance with 75 Pa.C.S.A. ~4530 and 45 CFR 393.95; (d) negligently creating a dangerous situation which led to the foreseeable death of Mr. Andela; and (e) stopping his vehicle upon the highway in a manner endangering persons and property and in a reckless manner with careless disregard to the rights and safety of others and in violation of the Motor Vehicle Code of the Commonwealth of Pennsylvania. 237860,1 IMTG\LC3 3 CLAIM I - SURVIVAL ACTION 19. Paragraphs I through 18 of the Complaint are incorporated herein by reference. 20. Plaintiff, Christine Andela, Personal Representative of the Estate of John D. Andela, deceased, brings this action on behalf of the Estate of John D. Andela under aIldJ)y virtue of the Act of 1976, July 9, P.L. 586, No. 142, ~2, 42 Pa.C.S.A. ~8302. WHEREFORE, Plaintiff demands judgment against Defendants James E. Pruitt, Covenant Transport, Inc., and Southern Refrigerated Transport in an amount in excess of Twenty-five Thousand ($25,000.00) Dollars, exclusive of interest and costs and in excess of any jurisdictional amount requiring compulsory arbitration. <;:'f..1\ ('\) Date: l) '\"0 ( ANGINa & ROVNER, P.C. ~ I.D, No, 35956 4503 N. Front Street Harrisburg, P A 1711 0 (717) 238-6791 Attorney for Plaintiff 237860,IIMTGILC3 4 VERIFICATION I Christine Andela, Plaintiff, have read the foregoing COMPLAINT and do hereby swear or affirm that the facts set forth in the foregoing are true and correct to the best of my knowledge, . iilformlitioii-anab6lief.' I understand that this VerificationU is made-subject to the penalties of 18 Pa.C.S.A. g 4904, relating to unsworn falsification to authorities. WITNESS: ~ (~!t<L,J..~tihj Christine Andela . i ,..,. Ul n<>:u / ,( Dated: if - i)' '1- () J- 237860,1 IMTGlLC3 Exhibit F ...'---,-"'-"..,.,....~.",-,~...- CHRISTINE ANDElA, Administratrix of the Estate of John D. Andela, Decedent,: Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. vs. No. 02-3863 JAMES E. PRUITT, COVENANT TRANSPORT, INC.; and SOUTHERN REFRIGERA TED TRANSPORT, CIVIL ACTION -LAW GENERAL RELEASE AGREEMENT KNOW ALL MEN BY THESE PRESENTS that I, CHRISTINE ANDElA, Administratrix of the Estate of John D. Andela, Decedent, for the sole consideration of Twenty-Five Thousand Dollars ($25,000.00), paid by JAMES F. PRUITT and COVENANT TRANSPORT, INC., Payers, the receipt whereof is hereby acknowledged, has released and discharged, and by these presents does for myself, my heirs, executors, administrators and assigns release and forever discharge the said Payers, their insurance companies and all other persons, firms and corporations, both known and unknown, their heirs, executors, administrators, affiliates, successors and assigns, of and from any and all claims, demands, damages, actions, causes of action, or suits at law or equity, of whatsoever kind or nature, for or because of any matter or thing done, omitted or suffered to be done by anyone prior to and including the date thereof on account of known or unknown injuries, losses and damages allegedly sustained by the Plaintiff,Christtne Andela, individually and as Administratrix of the Estate of John D. Andela, arising out of a motor vehicle accident which occurred on or about June 26, 2001, which is the subject of fOllowing lawsuit in the Cumber/and County Court of Common Pleas: EM,}/r- F Covenant Trans rt fne and Southern Refri erated Trans ort Defendants, Docket No. 02- 3863 Civil. We understand that Payers, by reason of agreeing to this compromise payment, neither admit nor deny liability of any sort, and said Payers have made no agreement or promise to do or omit to do any act or thing not herein set forth and we further understand that this Release is made as a compromise to avoid expense and to terminate all controversy and/or claims for injuries or damages of whatsoever nature, known or unknown, including future developments thereof, in any way growing out of or connected with said incident. We admit that no representation of fact or opinion has been made by the said Payers or anyone on their behalf to induce this compromise with respect to the extent or nature of "damages and that the sum paid is solely by way of Compromise of a disputed claim, and that it is specifically agreed that this Release shall be a complete bar to all claims, suits, and/or recoveries for losses of whatever nature resulting or to result from said incident, including subsequent litigation relating to the above-described incident or matters. 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 which 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, including the Plaintiff, Christine Andela, AdminiSftatrixofthe Estate of John D. Andela, Decedent. It is further understood and agreed and made a part hereof that neither the undersigned, Christine AndeJa, Administratrix of the Estate of John D. Andela, Decendent, or any of her attorneys, agents or other representatives, will in any way divulge to any person what;oeve, 0' pubUdze 0' ",",e to be pubUdzed ;n any new, '" commun;cat;on, med;~ including but not limited to, newspapers, magazines, journals, radio or television, the facts, terms or conditions of this Release and settlement. All parties to this Agreement expressly agree to decline comment on any aspect of the Release and settlement to any member of the news media. This paragraph is intended to become part of the consideration for the settlement of this claim, It is further understood and agreed that we, the undersigned, are responsible for the payment of any lien or charges against this settlement sum. Should any person or entity make a claim for payment of any liens or charges against Payors, their attorneys, agents, servants, and/or employees, , hereby agree to indemnify and hold harmless Payors, their attorneys, agents; servants, and/or employees from any and all liens, charges; .fees, costs, interest, demands, and any and all other sums, including payment of all costs and attorneys fees, The undersigned hereby declares for herself that the terms of this settlement have been completely read, 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 of the injuries and damages mentioned above, and for the express purpose of precluding forever any further or additional suits arising out of the aforesaid claims. '."~"---'-<-'-"""-' IN WITNESS WHEREOF, I have hereunto set my hand this ,2002. day of CAUTION: READ BEFORE SIGNING In the presence of: Witness Christine Ande/a, Executrix of the Estate of John D. Andela, Decedent Address Sworn to and subscribed before me this day of ,2002. Notary Public My Commission Expires: Exhibit G Angina. Rovner, P.C. ** CASB/.ICCOtnrn:HG RBGISmR ** PILE HtOGDDl............. 01172 PREPARED. 9/10/2002 PAGIl. 1 CLIBH'1'.................. ARDBLA, B~ aI JOSH ~ IB OFFICB.......... 7/13/2001 TYPB or CASB............ H DIlPBIIIllIIIT ( S) . .. .. . . .. . .. III!lmIIIIl KAY PIWlP'l'OB ~RItBY IN CBAR.GB...... DLL PO~............... RANDY I~MBRM~, BSQUXRB ~................ SPBCDL IfO'J!Il(S)......... P<lRIIllIlDBR'S PBB - 1/3 DBSCRIPTIOII CRBDI'l' PROM PRIOR lIKTrLIIIIIIII' BXPBIISB TDB ~. CIlBDI'l' PROM PIUOR sm"J:L1IIIBII' PAX CIWIGBS (PBR PAGIl) PAX CIIARGIlS (PBR PAGIl) PAX CIIARGIlS (PBR PJlGIl) PAX CIIARGIlS (PBR PJlGIl) PAX CIlIlRGBS (PBR PJlGIl) BDBIISB nPB 'l'OBL, PAX CIWIGIIS (PER PAGIl) IXVlISTIGM!IOB TIMB BllPIlIISB IIIVIIllTIcwrIOH TIMB IIllPBIISB IXVlISTIGM!IOB TIMB BllPIIIISB IIIVIIllTIGM!IOB TIMB IIllPBIISB IXVlISTIGM!IOB TIMB BDIIIISB BDIIIISB nPB 'l'OBL. IIIVIlSTIGM!IOII 'rIHB IlXPBIISB DI.L - IlXPBIISBS DI.L - IlllPBIISBS DI.L - IlllPBIISBS BXPBHSB TYPB '1'O'rAL. IlIVBSTXGATZOH BXPD'SB LOIlG DIS'rABCB BXPBRSB TYPE '1'O'J!U.. LONG DISTARCB *** PILB BXPBlISBS *** ~ QUJIII'rI'rr UBr.r/PJtJ:CB '/28/2002 8/21/2001 11/01/2001 1/22/2002 2/01/2002 4/22/2002 7/17/2001 7/18/2001 7/20/2001 7/23/2001 11/0'/2001 8/08/2001 4/17/2002 '/1'/2002 4/04/2002 1,00 2.00 4.00 4,00 2,00 1.'0 ,7' .7' .n 1.00 llMOUII'r 1,028,00- PIIIl80II 1,028.00-* 1.00 1.00 1.00 2.00 1.00 4.00 1.00 4.00 1.00 2,00 -------- 13.00 * 70.00 105.00 !WI 70.00 52.'0 !WI 70,00 52.50 !WI 70.00 52.50 !WI 70.00 70,00 !WI ---------- 332.50 . 46.80 16.00 19.20 ----------- 82.00 . 20.00 20.00 * e~I'h;t G Angino . Rovner, P. C, .. CASB/ACCOUH'l'ING RBGISTBR .. PRBPARBD. 9/10/2002 PILB HDMBBR...........,' 01172 PAGB. 2 CLIlDiI"1'.................1 ARDBLA, BSTAD OF JOB JWI - HILIWlB 7/17/2001 7,68 BXPDD TYPB TOTAL. Mn.EAGB 7.68 ... PBO'l'OCOPIBS PBorocOPIBS PBO'l'OCOPIBS P&a.I!OCOPIBS 4/04/2002 4/04/2002 9/09/2002 9/10/2002 838.00 40,00 150.00 437.00 .25 ,25 .25 .25 209.50 10,00 37.50 109.25 BllPBRSB TlPB 'l'ODL. PIIO'.L'OCOPIBS 366.25 . POlITAGB POlI'rAGB POS'DGB POlI'rAGB 4/05/2002 5/13/2002 9/09/2002 9/10/2002 46.13 1.36 1.11 38.90 BllPBRSB TlPB 'l'ODL, POSTAGH 87.50 . StJB-TCl'.rAL 119.. 07-** ... CIIIIC1ItllllPBRSBS ... DBSCRIP'fiOR DM'Jl CBBClt' AIIOUII'.r DMPDBJI T01lIISBIP VOL, nRB co, 7/25/2001 49297 208.00 RBGI_ OP IRLLS 7/25/2001 910728 45,00 IIIT1lIlIIAL RBVBIItIII SBR.v:ICB 8/07/2001 49422 138,00 C01lllllllftCllll GRAPBICS . copy 11/20/2001 5075a 9.54 COllllCllllBALft RllP~1IG 3/13/2002 52026 59.55 PR.C7.rIl OF CUJIBBRLARJ) COURT!' 5/03/2002 52811 45.50 PRarJI OP ClIHIIIIRLAIlD COUIlTr S/09/2002 53741 50.50 StJB-'l'ODL 556.09 .. 'l'ODL llllPBH8B8 437.. 02 .*. ..*** RBCBIPTS *.... SOURCB u. S. :rRBA8uay RIWIOII copy RIP. DM'Jl 11/29/2001 AIIOUII'.r 115.00 RBCBIP'l'S TCl'.rAL 115.00 ... ---------------------------------------------------------------------------------------------------- . OUTSTAHDIHG IRVOJ:CBS . CU8'rolD!R HAMIl IHV' IHV_ $BILLED $PAJ:D $DUB OUTllTAIIDIIIG IIlVOICB TCl'.rAL .00 *** 'l'ODL.. , 322.02- ---------------------------------------------------------------------------------------------------- .. BHD OF PILa *. Exhibit H . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPARTMENT 280601 HARRISBURG, PA 17128-0601 Telephone 09-06-2002 717-783-0972 David L Lutz, Esquire Angino & Rovner 4503 North Front Street Harrisburg, P A 17110-1708 Re: Estate of John D Andela File Number: 6701-1027 Court Number: Cumberland- Dear Mr. Lutz: 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, $ 20,000.00 to the wrongful death claim and $ 5,000.00 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,reEstate ofMenyman.. 669 A.2d 1059 (pa. Cmw1th. 1995). I trust that this letter is a sufficient representation of the Department's position on this matter. As the Department 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. Sincerely, ~ ~ Inheritance Tax Division Bureau ofIndividua1 Taxes E>fh; b,f- H--- 11 . CERTIFICATE OF SERVICE I, Mary T. Geraets, an employee of the law firm of Angino & Rovner, P.C., do hereby certify that I am this day serving a true and correct copy of the PETITION FOR APPROVAL OF A COMPROMISE SETILEMENT AND DISTRIBUTION OF PROCEEDS PURSUANT TO Pa.R.C.P. 2206 upon all counsel of record via postage prepaid :first class United States mail addressed as follows: Frank Marshall, Esquire 20 South 36th Street Camp Hill, PA 17011 Attorney for Defendants Dated: \ D /ifb-Od 247786,l\DLL\MTG ~ ""C.' i:: rr.l ' -.7 -"T ~;;'; (h>:: r:; '- ?~ f.-j >c.:: z ::<! o c ~"'~ t -~ ,'") ,-~ f'-v ~.. ,l J'- ['..) ~~~ ~,. " =< :.n U1 OCT 2 5 200? ~ CHRISTINE ANDELA, Administratrix of the Estate of JOHN D. ANDELA, Decedent, Plaintiff, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION - LAW v. JAMES E. PRUITT; COVENANT TRANSPORT, INC.; and SOUTHERN REFRIGERATED TRANSPORT, NO. 02-3863 Civil Term Defendants JURY TRIAL DEMANDED W\ 0 AND NOW, this r day of , 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 will be allocated as follows: (a) Estate of John D. Andela, deceased, under the Survival Action $ 3,435.00 (b) Estate of John D. Andela, deceased, under the Wrongful Death Action $13,740,00 (c) Angino & Rovner, P.C., professional fet:s based on 30% of the gross amount recovered $ 7,500.00 (d) Angino & Rovner, P.C., out-of-pocket expenses $ 325.00 TOTAL PRESENT DISTRIBUTION $25,000.00 250208,lIDLL\MTG 'II " (2) The net proceeds of $17,175.00 due to the Estate of John D. Andela shall be deposited to the First Union Bank, in an account for the sole benefit of Brandon Andela and no withdrawal shall be made therefrom until minor reaches majority age of 18, absent Court Order. BY THE COURT: P. J. L~~ JJ-1-0~ l ~ CO " ~tS3itSo.4 RovJe.i\, PC. 250208.1 IDLLIMTG . / \,:"f',.,I\<'\l/\SNN3d ,ui\:f':C"~' '-'{};.:?;<vnJ '1" .7i I' " t, i .(, : C.C i - "iil ';0 L. j ~litV c.: I 'r', j... '::1..) CHRISTINE ANDELA, Administratrix of the Estate of JOHN D. ANDELA, Decedent, Plaintiff, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA v. CIVIL ACTION - LA W JAMES E. PRUITT; COVENANT TRANSPORT, INC.; and SOUTHERN REFRIGERATED TRANSPORT, NO. 02-3863 Civil Term Defendants JURY TRIAL DEMANDED PROOF OF DEPOSIT In accordance with Pennsylvania Ru1e of Civil Procedure 2039, attached is a photocopy of a Brokerage Services Deposit Ticket in the amount of $17,176.28, as proof of deposit of the settlement proceeds. Per Your Court's November 7, 2002, Order, no withdrawal can be made from any such account until the Minor attains majority, except as authorized by a prior Order of Court. Date: ,_~\)~? ANGINO & ROVNER, P.C. ~LU~ I.D, No. 35956 4503 N. Front Street Harrisburg, P A 17110 (717) 238-6791 Attorney for Plaintiff 255806.1\DLL\MTG Wachovia Securities is the trade name under which Wachovia Corporation provides brokerage ~ervices through two registered broker-dealers, which are non-bank afflliates'of Wachovia Corporation: Wachovia Securities, Inc" member NYSE/SIPC, and Wachovia Securities Financial Network, Inc., member NASD/SIPC. Accounts carried by First Clearing Corporation, member NYSE/SIPC. "W"ACHOVIA SECURITIES BROKERAGE SERVICES DEPOSIT TICKET Depositing Bank Name Depositing Branch Name Depositing Branch Number Employee ID Number Time 85474 A3~9036 0'-lG-Ol 14'13 n, T PALMYRA Completed By Cust~TS'T'TNE A ANDF:I,A CIF Nam~NDON M ANDF.LA UTMA Addr~~ PALM CJTY PARK ANNVILLE PA 17003-9730 Tax 10 Nu~,p+f) 9 f~ ~'.'~ Cj LJ Brokerage Account Number 11 4 7 4 4 3 '] Cash Deposit 1) Check Deposit $17.176.28 2) Check Deposit 3) Check Deposit Deposit Total Amount $'17.176.28 0000536743 (50/pkg Rev 05) CUSTOMER RECEIPT CERTIFICATE OF SERVICE I, Mary T. Geraets, an employee of the law firm of Angino & Rovner, P.c., do hereby certify that I am this day serving a true and correct copy of the PROOF OF DEPOSIT upon all counsel of record via postage prepaid first class United States mail addressed as follows: Frank Marshall, Esquire 20 South 36th Street Camp Hill, PA 17011 Attorney for Defendants Dated: \,-(}'\J -\) ') 255806.1\DLL\MTG () c: s: -0 \:0 q;! rrl .... ::I) Zr;:. Cf)? ~e )> z8 )>c ~ o (J.) "- :coo Z N N ""Q :x r:-:? ~ o o -n ---.;, ~~ :!J , .. r- --,1'1'1 "'0 ~'(.'':_.L._ ~.=::'i{.J ,~i~ ::;:-: "'n ~.:> . ~ -< CHRISTINE ANDELA, Administratrix of the Estate of JOHN D. ANDELA, Decedent, Plaintiff, v. JAMES E. PRUITT; COVENANT TRANSPORT, INC.; and SOUTHERN REFRIGERATED TRANSPORT, Defendants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION - LAW NO. 02-3863 Civil Term JURY TRIAL DEMANDED PRAECIPE To the Prothonotary of Cumberland County: Please mark the above-captioned action settled, satisfied, and discontinued. Date: l-o~ -a?;; 249537,l\DLL\MTG AN~OVNERP.C. David L. Lutz J.D. No. 35956 4503 N. Front Street Harrisburg, PA 17110 (717) 238-6791 Attorney for Plaintiff II CERTIFICATE OF SERVICE I, Mary T. Geraets, an employee of the law firm of Angino & Rovner, P.C., do hereby certify that I am this day serving a true and correct copy of the PRAECIPE upon all counsel of record via postage prepaid first class United States mail addressed as follows: Frank Marshall, Esquire 20 South 36th Street Camp Hill, P A 17011 Attorney for Defendants Dated: t ~ ~3 -07 249537,I\DLL\MTG (') 0 ~~; c (....J 5: -u C' :;~ '::2 c;- '~:;P /~ C rv (/) .~ -< c::: '- "",;-,. C' ~.: Z 0 " l, ) );> . , Cj l-;~i C ~~ Z :::> :,;~ ~ ~,., '...! ::<.: