MC-351

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Barnumber, andaddress). FOR COURT USE ONLY

Hark R. Swartz

121922

LAW OFFICE OF MARK R. SWARTZ 11344 Coloma Road, Suite 145 Gold River, CA 95670
TELEPHONENO ( 9 1 6 ) 6 3 1 - 7 7 2 2 fAXm (Optional) ( 9 1 6 ) E-MAiLADDRESS(Optional) M S W A R T Z ( a S W A R T Z - L A W . COM
ATTORNEY FOR (Name)- P l a i n t i f f s SUPERIOR COURT O F CALIFORNIA, COUNTY O F SacramentO

631-72

SR EA D E S 720 N i n t h TETDRS
MAILING ADDRESS

Street CA 9 5 8 1 4

ClTYANDZlPCODE S a c r a i T i e n t o ,
BRANCH NAME

C S NAME:SKATTEBO V. GOLSON AE
O R D E R APPROVING: COMPROMISE O F DISPUTED CLAIM COMPROMISE O F PENDING ACTION DISPOSITION O F P R O C E E D S O F J U D G M E N T I X I Minor I I Person With a Disability 1.
CASE NUMBER;

34-2008-OOC)02074
HEARING DATE, IFANY DEPT-

07/22/2011

24

2.

Petitioner Cname;.-JENNIFER HERNANDEZ has petitioned for court approval of a proposed compromise of a disputed claim of a minor or a pending action involving a minor or a person with a disability or a proposed disposition of the proceeds of a judgment for a minor or a person with a disability. Hearing a. I I No hearing was held. The petition is an expedited petition under rule 7.950.5 of the California Rules of Court. b. [ Y ] Date: 0 7 / 2 2 / 2 0 1 1 Time:9:00 Dept.: 2 4

c. Judicial officenRaoul M. Thorbourne

3. Relationship to claimant Petitioner has the following relationship or relationships to claimant (check all applicable boxes): a. I I Parent b. I X I Guardian ad litem c. I I Guardian d. I I Conservator e. I I Claimant, an adult person with a disability, is the petitioner. f. CZD Other fspec/^;.-

4. Claimant fnamej; JOSEPH MICHAEL HERNANDEZ

a. b. I X I is a minor. I I is a "person with a disability" within the meaning of Probate Code section 3603 who is: (1) I I An adult Claimant's date of birth is (specify): (a) I I Without a conservator. Claimant has capacity to consent to this order, within the meaning of Probate Code section 812, and has consented to this order. (b) I I A conservatee; a person for whom a conservator may be appointed; or without capacity to consent to this order, within the meaning of Probate Code section 812. A minor described in Probate Code section 3603(b)(3).

5.

(2) Defendant The claim or action to be compromised is asserted, or the judgment is entered, against (name of settling orjudgment defendant or defendants (the "payer")): JASOli GOLSON a n d DOES I t h r o u g h X , i n c l u s i v e .

Page 1 of 4 Form Adopted for Mandatory Use Judicial Council of California MC-351 (Rev. January 1, 2010] Code of Civil Procedure, 372, O R D E R APPROVING COMPROMISE O F DISPUTED CLAIM O R PENDING ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR cai RuiesTcou^ mfes^sls^^lsi MINOR O R P E R S O N WITH A DISABILITY Legal (Miscellaneous) ^^Hus

MC-351
CASE NAME: SKATTEBO V . GOLSON
CASE NUMBER

34-2008-00002074
6. THE COURT FINDS that all notices required by law have been given.

7. THE COURT ORDERS a The petition is granted and the proposed compromise of claim or action or the proposed disposition of the proceeds of the judgment is approved. The gross amount orvalue ofthe settlement or judgment in favor of claimant is $ 41,667 I I Until further order of the court, jurisdiction is reserved to determine a claim for a reduction of a Medi-Cal lien under Welfare and Institutions Code section 14124.76. The amount shown payable to the Department of Health Care Services in item 7c(1)(d) of this order is the full amount of the hen claimed by the department but is subject to reduction on further order ofthe court upon determination ofthe claim for reduction. The payer shall disburse the proceeds ofthe settlement or judgment approved by this order in the following manner: (1) Payment of fees and expenses Fees and expenses shall be paid by one or more checks or drafts, drawn payable to the order ofthe petitioner and the petitioner's attorney, if any, or directly to third parties entitled to receive payment identified in this order for the following items of expense or damage, which are hereby authorized to be paid out ofthe proceeds of the settlement or judgment: (a) [ x H Attorney's fees in the total amount of: $ | 10,096 | payable to fspec;7y;.- M a r k R.

Swartz
(b) I X I Reimbursement for medical and all other expenses paid by the petitioner or the petitioner's attorney in the total amount of: (c) I I Medical, hospital, ambulance, nursing, and other like expenses payable directly to providers as follows, in the total amount of: (i) Payee (name): (A) Address: (B) Amount: $ (ii) Payee (name): (A) Address: (B) Amount: $ I (d) I I Continued on Attachment 7c(1)(c). (Provide infonvation about additional payees in the above fonrtat.)

11,279

I Other authorized disbursements payable directly to third parties in the total amount of: $ (Describe and state the amount ofeach item and provide the name and address ofeach payee):

I Continued on Attachment 7c(1)(d). $ 111, 376

(e) I X I Total allowance for fees and expenses from the settlement or judgment:

M . 5 [ e J n ay 1,20101 C3 1 R v a u r

ORDER APPROVING COMPROMISE OF DISPUTED CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY
(Miscellaneous)

page 2 of 4

MC-351 CASE NAME: SKATTEBO V . GOLSON

CASE NUMBER

34-2008-00002074 7 THE COURT ORDERS (cont.) .

c. The payer shall disburse the proceeds ofthe settlement or judgment approved by this order in the following manner: (2) Balance The balance of the settlement or judgment available for claimant after payment of all allowed fees and expenses is: The balance shall be disbursed as follows:

30,291

(a) I X I By one or more checks or drafts in the total amount of (specify): $ 30,291 drawn payable to the order ofthe petitioner as trustee for the claimant. Each such check or draft must bear an endorsement on the face or reverse that it is for deposit in one or more interest-bearing, federally insured accounts in the name of the petitioner as trustee for the claimant, and no withdrawals may be made from the accounts except as provided in the Order fo Deposit Money Into Blocked Account (form MC-355), which is signed contemporaneously with this order ("blocked account"). (b) I I By the following method(s) (describe each method, including the amount to be disbursed):

I (c) I

I Continued op Attachment 7c(2)(b).

I If money is to be paid to a special needs trust under Probate Code section 3604, all statutory liens in favor ofthe state Department of Health Care Services, the state Department of Mental Health, the state Department of Developmental Services, and any city and county in California must first be satisfied by the following method (specify):

I 8. I

I Continued on Attachment 7c(2)(c).

I Further orders of the court concerning blocked accounts The court makes the following additional orders concerning any part ofthe balance ordered to be deposited in a blocked account under item 7c(2)(a): a. Within 48 hours of receipt of a check or draft described in item 7c(2)(a), the petitioner and the petitioner's attorney, if any, must deposit the check or draft in the petitioner's name as trustee for the claimant in one or more blocked accounts at (specify name, branch, and address ofeach depository, and the amount ofeach account):

I Continued on Attachment 8a.

Page 3 of 4

MC.35i[Rev January 1,2010] O R D E R APPROVING COMPROMISE O F DISPUTED CLAIM O R PENDING ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY (Miscellaneous)

MC-351 CASE NAME: SKATTEBO V . GOLSON

CASE NUMBER

34-2008-00002074
8. Further orders of the court concerning blocked accounts The court makes the following additional orders concerning any part of the balance ordered to be deposited in a blocked account under item 7c(2)(a): b. The petitioner and the petitioner's attorney, if any, must deliver to each depository at the time of deposit three copies of the Order to Deposit Money Into Blocked Account (form MC-355), which is signed contemporaneously with this order, and three copies of the Receipt and Acknowledgment of Order for the Deposit of Money Into Blocked Account (form MC-356). The petitioner or the petitioner's attorney must file a copy of the receipt with this court within 15 days of the deposit. The sole responsibilities ofthe petitioner and the petitioner's attorney, ifany, are to place the balance in a blocked account or accounts and to timely file a copy ofthe receipt. c. The balance of the proceeds of the setttement or judgment deposited in a blocked account or accounts under item 7c(2)(a) may be withdrawn only as follows {check (1) or (2)): (1) I I No withdrawals of principal or interest may be made from the blocked account or accounts without a further written order under this case name and number, signed by a judge, and bearing the seal of this court. The money on deposit is not subject to escheat. (2) I I The blocked account or accounts belong to a minor The minor was born on (date): No withdrawals of principal or interest may be made from the blocked account or accounts without a further wntten order under this case name and number, signed by a judicial officer, and bearing the seal of this court, until the minor attains the age of 18 years. When the minor attains the age of 18 years, the depository, without further order of this court, is authorized and directed to pay by check or draft directty to the former minor, upon proper demand, all moneys including interest deposited under this order. The money on deposit is not subject to escheat. 9. I X I Authorization to execute settlement documents The petitioner is authorized to execute settlement documents as follows (check only one): a. I I Upon receipt of the full amount of the settlement sum approved by this order and the deposit of funds, the petitioner is authorized and directed to execute and deliver to the payer a full, complete, and final release and discharge ofany and all claims and demands ofthe claimant by reason ofthe accident or incident described in the petition and the resultant injunes to the claimant and a properly executed dismissal with prejudice.

b. c.

I X I The petitioner is authonzed and directed to execute any and all documents reasonably necessary to carry out the terms of the setttement. I I The petitioner is authorized and directed (specify):

I 10. Bond is 12 I I

I Conttnued on Attachment 9c. I I not required.

I ordered and fixed in the amount of: $

11. A copy of this order shall be served on the payer forthwith. I Additional orders The court makes the following additional orders (specify):

I Continued on Attachment 12. Srti^nrL'Z "

JUDICIAL OFFICER

Date: MgxkR.

RAOUL M. THORBOURNE
I I SIGNATURE FOLLOWS LAST ATTACHMENT Page 4 of 4

M - 5 [Rev January 1,2010] O R D E R APPROVING COMPROMISE O F DISPUTED CLAIM O R PENDING C3 1 ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY (Miscellaneous)

Attachment 9(b)

RELEASE OF A L L CLAIMS IN CONSIDERATION of a valid check or draft for the amoimt of settlement hereinafter set forth, payable to the undersigned in the maimer dhected by the Court, which sum shall be deemed to have been paid upon delivery of the check(s), draft(s), or other negotiable instrument(s) of, or on behalf of, JASON GOLSON, to the attomey of record, Mark R. Swartz, for the Guardian Ad Litem of Minor Claimant JOSEPH MICHAEL HERNANDEZ, namely JENNIFER

HERNANDEZ, following Court approval of a Petition To Approve Compromise Of Disputed Claim Of Minor for the settlement memorialized herein, the undersigned hereby releases and forever discharges the releasees named below, their servants, and employees, parent companies,, subsidiary companies, sister companies, officers, directors, employees, debtors, insurers, and attorneys, of and fi-om any and all claims, demands, damages, actions, suits, claims for sums of money, contracts, controversies, agreements, costs, judgments, orders, motions, rights, causes, and causes of action of every kind, known or imknown, arising out of or in any way connected with the events or incidents, which occurred on or about, at or near the time and place set forth below, including all injuries, deaths and property damage arising therefi:om; . In fiuther consideration of said draft or check and this release and settlement, the undersigned agrees, represents, and warrants as follows: 1. The undersigned authorizes a dismissal with prejudice of all causes of action arising

out of this incident or event, including the actions set forth below as they relate to Jason Golson; 2. This is a fiill and final release applying to all unknown and unanticipated damages

arising out of said casualty, or event, as well as to those now known or disclosed, and the vmdersigned waives all rights or benefits which the tmdersigned now has or in thefiaturemay have tmder the terms of Section 1542 ofthe Civil Code ofthe State of Califomia, which said section reads as follows: A general release does not extend to claims which the creditor does not know or suspect to exist in his or her favor at the time of executing the release, which if known by him or her must have materially affected his or her settlement with the debtor.
RELEASE OF ALL CLAIMS Page 1 of 4

3.

The undersigned understands the liability for said incident is disputed by the parties

herein released and this release is a compromise and shall not be constmed as an admission of liability. 4. There are no liens, or claims of liens, or assigimients in law or equity or otherwise,

of or against the claim or cause of action of the undersigned herein; fiirther that the undersigned is fiilly entitled to give this complete release and discharge. FURTHER, as a condition of the settlement and release I represent and warrant that as of the date of this signing, I have provided the released parties' insurer 21^' Century Insurance Company ("Insurer") all information I know about any and all Medicare rights to recovery as of this date. I agree to reimburse, indemnify and hold harmless each of the persons, firms, corporations released hereunder and their Insurer, including their agents and assigns, with respect to all known and unknown Medicare rights to recovery related to the subject accident for which the federal government may seek repayment as well as any fine or penalty the federal government may seek resultingfi-omthe sufficiency and accuracy of the information I have provided to the Insurer regarding Medicare rights to recovery known as of this date. 5. The undersigned will indemnify and save harmless the parties released from any

loss, claim, expense, demand or cause of action of any kmd or character through the assertion by any party or stranger hereto of a claim or claims connected with the subject matter of this release, and from any loss incurred directly or indirectly by reason of the falsity or inaccuracy of any representation herein by fhe undersigned. 6. This release contains the entire agreement between the parties hereto. The terms of

this release are contractual and not a mere recital. This release is executed without reliance upon any representative of them, and the undersigned has carefiilly read and understood the contents of this release and signs the same of her ownfreeact.

RELEASE OF ALL CLAIMS

Page 2 of 4

PARTIES RELEASED: AMOUNT OF SETTLEMENT: DATE OF LOSS: LOCATION OF LOSS:

JASON GOLSON $41,666.66 February 2,2006 On or about Auburn Blvd. west of San Tomas Drive, in Citrus Heights, County of Sacramento, State of California Ramona Kay Skattebo; Airean Lee Harper, by and through his Guardian Ad Litem, Billy Silvas; Steven Allen Skattebo, HI, by and through his Guardian Ad Litem, Billy Silvas; Joseph Michael Hernandez, by and through his Guardian Ad Litem, Jennifer Hernandez v. Jason Golson; and Does One Through Ten, Inclusive, Sacramento Superior Court Unlimited Jurisdiction CaseNo. 34-2008-00002074

ACTIONS DISMISSED:

DATED

JENNIFER HERNANDEZ, individually and as Guardian on behalf of JOSEPH MICHAEL HERNANDEZ, a minor

The foregoing release was explained to said releasor, and executed in accordance with our direction and advice.

Attomef/(s) fo\ Party Signing this Release

RELEASE OF ALL CLAIMS

Page 3 of 4

ACKNOWLEDGMENT

State of California County of SACRAMENTO /\ui\i4s{ ^1 .QOII before me, A N D R E W G R O U S E , N O T A R Y PUBLIC fine-art r^ffir^r^^\ (insert i-.'imQ on/-l titie of.the officer) name and t l t l o r^f tt^cs

On

personally appeared r who proved to me on the basis of satisfactory evidence to be the personfa^ whose name(?(}(i/^e subscribed to the within instrument and acknowledged to me that fy^^^hg^executed the same in f>i5l(5i^^'^ authorized capacity(je$), and that by,>i%^e^Jjetf signatureOB^on the instrument the p e r s o n ^ or the entity upon behalf of which the person(2fJ acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

WITNESS my hand and official seal.

ANDREW GROUSE II
COMM. #1919795 Notary PubllC'<:allfomia SACRAMENTO COUNTY MyCiowrn.6iy,Jin.l.2015 (Seal) g ^ t }

Signature _