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MC-351
ATTORNEY OR PARTY WITHOUT ATTORNEY STATE BAR NUMBER: FOR COURT USE ONLY
NAME: CHRISTOPHER W. WOOD, ESQ. / SBN: 193955
FIRMNAME: Dreyer Babich Buccola Wood Campora, LLP Electronically Filed
5TREETADDRE5S:20 Bicentennial Circle 5/10/2022
CITY:Sacramento STATE:CA ZIPCODE:95826 Superior Court of California
TELEPHONENO.: (916) 3793500 FAXNO.: (916) 3793599 County of Stanislaus
EMAILADDRESS: DBBWC-ESERVICE@dbbwc.com Clerk of the Court
ATTORNEYFOR(Name): Plaintiffs, TIFFANY BURR, et al. By: Yukari Williams, Deputy
SUPERIOR COURT OF CALIFORNIA, COUNTY OF Stani s laus
STREETADDRESS: 801 10th Street, 4th Floor
MAILING ADDRESS:
CITYANDZIPCODE: Modesto, CA 95354
BRANCH NAME:
CASE NAME:
BURR v. GURNEY TRUCKING, INC., et al.
CASE NUMBER:
ORDER APPROVING COMPROMISE OF CLAIM OR ACTION CV-19-001129
OR DISPOSITION OF PROCEEDS OF JUDGMENT
HEARING DATE, IFANY: DEPT.:
FOR MINOR OR PERSON WITH A DISABILITY
1. Hearing
a. No hearing was held. The matter is eligible for expedited approval under rule 7.950.5 of the California Rules of Court.
b. Li A hearing was held: Date: Time: Dept.:
c. Judicial officer:
2. Petitioner (name orpseudonym*): RYAN BURR
is the (check all relationships or representative capacities that apply): parent guardian ad litem*
Li guardian Li conservator Li other (specify):
of the claimant named in item 3. Petitioner has requested approval of the compromise or settlement of a disputed claim or pending
action or the disposition of the proceeds of a judgment for a minor or a person with a disability.
(*petitioner was appointed guardian ad litem under a pseudonym. (See Code Civ. Proc.,§ 372.5.))
3. Claimant (name): TAYLOR BURR
a. is a minor.
b. Li is a “person with a disability” within the meaning of Probate Code section 3603 who is:
(1) Lj An adult. Claimant’s date of birth is (specify):
(2) Li A minor described in Probate Code section 3603(b)(3).
4. Defendant
The claim or action to be compromised or settled is asserted, or the judgment is entered, against (name of settling or judgment
defendant or defendants (the ‘ayer’9).
GURNEY TRUCKING, INC. and ANTONIO JOSE MENDOZA
THE COURT FINDS
5. j Notice has been given as required by law.
6. a. J The claimant is an adult who has the capacity to consent to this order within the meaning of Probate Code section 812 and
does not have a conservator of the estate. The claimant has given express consent to this order.
b. X
Li The claimant’s consent to this order is not required because the claimant is a minor, a conservatee, or a person who lacks
the capacity to consent to the order within the meaning of Probate Code section 812.
Page 1 of 4
Form Adopted for Mandatory Use ORDER APPROVING COMPROMISE OF CLAIM OR ACTION Code of Civil Procedure, § 372;
Judicial Council of California Probate Code, § 3500, 3600—3613;
MC-351 [Rev. January 1, 20211 OR DISPOSITION OF PROCEEDS OF JUDGMENT Cal. Rules of Court, rules 3.1384, 7.953
wwwcourts.ca,gov
CfB Essential FOR MINOR OR PERSON WITH A DISABILITY
ceb.com,f] Forms W-BURR, TIFFANY
MC-351
ASE NAME: CASE NUMBER:
BURR v. GURNEY TRUCKING, INC., et al. CV-19-001129
THE COURT ORDERS
6. The petition is granted and the proposed compromise or settlement, or the proposed disposition of the proceeds of the judgment, is
approved. The gross amount or value of the settlement or judgment in favor of claimant is: $ 31, 4 33. 09
J 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 section14124.76. The amount shown payable to the Department of Health Care Services in item 8a(4)
of this order is the full amount of the lien claimed by the department but is subject to reduction on further order of the court
upon determination of the claim for reduction.
8. The payer must disburse the proceeds of the settlement or judgment approved by this order in the following manner:
a. Payment of fees and expenses
Fees and expenses shall be paid by one or more checks or drafts drawn payable to the order of the 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 of the proceeds of the settlement or judgment:
(1) $
Attorney’s fees in the total amount of: 7, 858 . 27 payable to (specify):
Dreyer Babich Buccola Wood Campora
(2) j Reimbursement for medical and all other expenses paid by the petitioner or the petitioner’s
attorney in the total amount of: $
(3) J Medical, hospital, ambulance, nursing, and other similar expenses payable directly to
providers as follows,in the total amount of: $
(a) Payee (name):
(i) address:
(ii)Amount: $
(b) Payee (name):
(i) address:
(ii)Amount: $
j Continued on Attachment 8a(3). (Provide information about additional payees in the above format.)
(4) U Other authorized disbursements payable directly to third parties in the total amount of: $
(Describe and state the amount of each item and provide the name and address of each payee):
Continued on Attachment 8a(4).
(5) U Total allowance for fees and expenses from the settlement or judgment: $
MC-351 [Rev.Januaryl,2021] ORDER APPROVING COMPROMISE OF CLAIM OR ACTION Page2of4
CEB Essential OR DISPOSITION OF PROCEEDS OF JUDGMENT
ceb.com JForms FOR MINOR OR PERSON WITH A DISABILITY
W-BURR, TIFFANY
MC-351
CASE NAME: CASE NUMBER:
BURR v. GURNEY TRUCKING, INC., et al. CV-19-001129
8. b. Balance for claimant
The balance of the settlement or judgment available for claimant after payment of all allowed
feesandexpensesis: $ 23,574.32
The balance shall be disbursed as follows:
(1) Li By one or more checks or drafts in the total amount of (specify): $
drawn payable to the order of the petitioner in the petitioner’s representative capacity. Each 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 in the petitioner’s representative capacity.
No withdrawals may be made from these
accounts (“blocked accounts”) except as provided in the Order to Deposit Funds in Blocked Account (form MC-355)
signed at the same time as this order.
(2) By the following method(s) (describe each method, including the amount to be disbursed by each):
Please see Attachment 8b(2)
J Continued on Attachment 8b(2).
(3) J If money is to be paid to a special needs trust under Probate Code section 3604, all statutory liens in favor of the state
Department of Health Care Services, the state Department of State Hospitals, the state Department of Developmental
Services, and any city and county in California must first be satisfied by the following method
(specify):
Li Continued on Attachment 8b(3).
J 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 8b(1):
a. Within 48 hours of receipt of a check or draft described in item 8b(1), the petitioner and the petitioner’s attorney, if any, must
deposit the check or draft in the name of petitioner in the petitioner’s representative capacity in one or more blocked accounts at
(specify name, branch, and address of each depository, and the amount of each account):
Continued on Attachment 9a.
MC-351 [Rev. January 1,2021] ORDER APPROVING COMPROMISE OF CLAIM OR ACTION Page 3of4
Essential
CEB” jJFoflflS OR DISPOSITION OF PROCEEDS OF JUDGMENT
ceb.com FOR MINOR OR PERSON WITH A DISABILITY
W-BURR, TIFFANY
MC-351
[EASE NAME: CASE NUMBER:
BURR v. GURNEY TRUCKING, INC., et al. CV-19-001129
9. b. must deliver to each depository at the time of deposit three copies of the
The petitioner and the petitioner’s attorney, if any,
Order to Deposit Funds in Blocked Account (form MC-355), which is signed at the same time as this order, and three copies of
the Acknowledgment of Receipt of Order and Funds for Deposit in Blocked Account (form MC-356). The petitioner or the
15 days of the deposit. The sole responsibilities of the
petitioner’s attorney must file a copy of the receipt with this court within
petitioner and the petitioner’s attorney, if any, are to place the balance in a blocked account or accounts and to file a copy of the
receipt on time.
c. The balance of the proceeds of the settlement or judgment deposited in a blocked account or accounts under item 8b(1) may be
withdrawn only as follows (check (1) or (2)):
(1) Li 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 judicial officer, and file-stamped by this court. The money on
deposit is not subject to escheat.
(2) J The blocked account or accounts belong to a minor, who was born on (date):
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 judicial officer, and file-stamped by this court, until the minor
reaches 18 years of age. When the minor reaches 18 years of age, the depository, without further order of this court,
is authorized and directed to pay by check or draft directly to the former minor, on proper demand, all funds, including
interest, deposited under this order. The money on deposit is not subject to escheat.
10. Authorization to execute settlement documents
The petitioner is authorized to execute settlement documents as follows (check only one):
a. U On 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 (1) a full, complete, and final release and discharge of any and
all claims and demands of the claimant by reason of the accident or incident described in the petition and the resultant
injuries to the claimant and (2) a properly executed dismissal with prejudice.
b. The petitioner is authorized and directed to execute any and all documents reasonably necessary to carry out the terms of
the settlement.
c. Li The petitioner is authorized and directed to (specify):
U Continued on Attachment lOc.
11. Bond is Li ordered and fixed in the amount of: $ Li not required.
12. A copy of this order must be served on the payer immediately.
13. X
J Additional orders
The court makes the following additional orders (specify):
The court sets a Proof of Annuity Purchase hearing for June 23, 2022, at 8:30 a.m. in Dept. 23.
Li Continued on Attachment 13.
5/6/2022
Date:
John Freeland
JUDICIAL OFFICER
SIGNATURE FOLLOWS LAST ATTACHMENT
MC-351 1,2021]
(Rev. January ORDER APPROVING COMPROMISE OF CLAIM OR ACTION Page 4of4
CEB Essential OR DISPOSITION OF PROCEEDS OF JUDGMENT
ceb.com5FonTIs FOR MINOR OR PERSON WITH A DISABILITYW-BURR, TI FFANY
1 ATTACHMENT 8(bW2)
2 Petitioner proposes that the net settlement amount of $23,574.32 fund an annuity with
3 Pacific Life Insurance Company. The proposed annuity is structured in a manner that will provide
4 two payments in Claimant. The first payment in the amount of $5,000.00 will be made to Claimant
5 upon turning the age of 18 years old. The second payment in the amount of $27,252.00 will be
6 made to Claimant upon turning the age of 25 years old. This approach will maximize Claimant’s
7 settlement and allocate the funds in a thoughtful manner as the money will be distributed over a
8 period of time which will assist Claimant in paying for expenses over time.
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MC-351 ATTORNEY OR PARTY WITHOUT ATTORNEY STATE BAR NUMBER: FOR COURT USE ONLY NAME: CHRISTOPHER W. WOOD, ESQ. / SBN: 193955 FIRMNAME: Dreyer Babich Buccola Wood Campora, LLP Electronically Filed 5TREETADDRE5S:20 Bicentennial Circle 5/10/2022 CITY:Sacramento STATE:CA ZIPCODE:95826 Superior Court of California TELEPHONENO.: (916) 3793500 FAXNO.: (916) 3793599 County of Stanislaus EMAILADDRESS: DBBWC-ESERVICE@dbbwc.com Clerk of the Court ATTORNEYFOR(Name): Plaintiffs, TIFFANY BURR, et al. By: Yukari Williams, Deputy SUPERIOR COURT OF CALIFORNIA, COUNTY OF Stani s laus STREETADDRESS: 801 10th Street, 4th Floor MAILING ADDRESS: CITYANDZIPCODE: Modesto, CA 95354 BRANCH NAME: CASE NAME: BURR v. GURNEY TRUCKING, INC., et al. CASE NUMBER: ORDER APPROVING COMPROMISE OF CLAIM OR ACTION CV-19-001129 OR DISPOSITION OF PROCEEDS OF JUDGMENT HEARING DATE, IFANY: DEPT.: FOR MINOR OR PERSON WITH A DISABILITY 1. Hearing a. No hearing was held. The matter is eligible for expedited approval under rule 7.950.5 of the California Rules of Court. b. Li A hearing was held: Date: Time: Dept.: c. Judicial officer: 2. Petitioner (name orpseudonym*): RYAN BURR is the (check all relationships or representative capacities that apply): parent guardian ad litem* Li guardian Li conservator Li other (specify): of the claimant named in item 3. Petitioner has requested approval of the compromise or settlement of a disputed claim or pending action or the disposition of the proceeds of a judgment for a minor or a person with a disability. (*petitioner was appointed guardian ad litem under a pseudonym. (See Code Civ. Proc.,§ 372.5.)) 3. Claimant (name): TAYLOR BURR a. is a minor. b. Li is a “person with a disability” within the meaning of Probate Code section 3603 who is: (1) Lj An adult. Claimant’s date of birth is (specify): (2) Li A minor described in Probate Code section 3603(b)(3). 4. Defendant The claim or action to be compromised or settled is asserted, or the judgment is entered, against (name of settling or judgment defendant or defendants (the ‘ayer’9). GURNEY TRUCKING, INC. and ANTONIO JOSE MENDOZA THE COURT FINDS 5. j Notice has been given as required by law. 6. a. J The claimant is an adult who has the capacity to consent to this order within the meaning of Probate Code section 812 and does not have a conservator of the estate. The claimant has given express consent to this order. b. X Li The claimant’s consent to this order is not required because the claimant is a minor, a conservatee, or a person who lacks the capacity to consent to the order within the meaning of Probate Code section 812. Page 1 of 4 Form Adopted for Mandatory Use ORDER APPROVING COMPROMISE OF CLAIM OR ACTION Code of Civil Procedure, § 372; Judicial Council of California Probate Code, § 3500, 3600—3613; MC-351 [Rev. January 1, 20211 OR DISPOSITION OF PROCEEDS OF JUDGMENT Cal. Rules of Court, rules 3.1384, 7.953 wwwcourts.ca,gov CfB Essential FOR MINOR OR PERSON WITH A DISABILITY ceb.com,f] Forms W-BURR, TIFFANY MC-351 ASE NAME: CASE NUMBER: BURR v. GURNEY TRUCKING, INC., et al. CV-19-001129 THE COURT ORDERS 6. The petition is granted and the proposed compromise or settlement, or the proposed disposition of the proceeds of the judgment, is approved. The gross amount or value of the settlement or judgment in favor of claimant is: $ 31, 4 33. 09 J 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 section14124.76. The amount shown payable to the Department of Health Care Services in item 8a(4) of this order is the full amount of the lien claimed by the department but is subject to reduction on further order of the court upon determination of the claim for reduction. 8. The payer must disburse the proceeds of the settlement or judgment approved by this order in the following manner: a. Payment of fees and expenses Fees and expenses shall be paid by one or more checks or drafts drawn payable to the order of the 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 of the proceeds of the settlement or judgment: (1) $ Attorney’s fees in the total amount of: 7, 858 . 27 payable to (specify): Dreyer Babich Buccola Wood Campora (2) j Reimbursement for medical and all other expenses paid by the petitioner or the petitioner’s attorney in the total amount of: $ (3) J Medical, hospital, ambulance, nursing, and other similar expenses payable directly to providers as follows,in the total amount of: $ (a) Payee (name): (i) address: (ii)Amount: $ (b) Payee (name): (i) address: (ii)Amount: $ j Continued on Attachment 8a(3). (Provide information about additional payees in the above format.) (4) U Other authorized disbursements payable directly to third parties in the total amount of: $ (Describe and state the amount of each item and provide the name and address of each payee): Continued on Attachment 8a(4). (5) U Total allowance for fees and expenses from the settlement or judgment: $ MC-351 [Rev.Januaryl,2021] ORDER APPROVING COMPROMISE OF CLAIM OR ACTION Page2of4 CEB Essential OR DISPOSITION OF PROCEEDS OF JUDGMENT ceb.com JForms FOR MINOR OR PERSON WITH A DISABILITY W-BURR, TIFFANY MC-351 CASE NAME: CASE NUMBER: BURR v. GURNEY TRUCKING, INC., et al. CV-19-001129 8. b. Balance for claimant The balance of the settlement or judgment available for claimant after payment of all allowed feesandexpensesis: $ 23,574.32 The balance shall be disbursed as follows: (1) Li By one or more checks or drafts in the total amount of (specify): $ drawn payable to the order of the petitioner in the petitioner’s representative capacity. Each 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 in the petitioner’s representative capacity. No withdrawals may be made from these accounts (“blocked accounts”) except as provided in the Order to Deposit Funds in Blocked Account (form MC-355) signed at the same time as this order. (2) By the following method(s) (describe each method, including the amount to be disbursed by each): Please see Attachment 8b(2) J Continued on Attachment 8b(2). (3) J If money is to be paid to a special needs trust under Probate Code section 3604, all statutory liens in favor of the state Department of Health Care Services, the state Department of State Hospitals, the state Department of Developmental Services, and any city and county in California must first be satisfied by the following method (specify): Li Continued on Attachment 8b(3). J 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 8b(1): a. Within 48 hours of receipt of a check or draft described in item 8b(1), the petitioner and the petitioner’s attorney, if any, must deposit the check or draft in the name of petitioner in the petitioner’s representative capacity in one or more blocked accounts at (specify name, branch, and address of each depository, and the amount of each account): Continued on Attachment 9a. MC-351 [Rev. January 1,2021] ORDER APPROVING COMPROMISE OF CLAIM OR ACTION Page 3of4 Essential CEB” jJFoflflS OR DISPOSITION OF PROCEEDS OF JUDGMENT ceb.com FOR MINOR OR PERSON WITH A DISABILITY W-BURR, TIFFANY MC-351 [EASE NAME: CASE NUMBER: BURR v. GURNEY TRUCKING, INC., et al. CV-19-001129 9. b. must deliver to each depository at the time of deposit three copies of the The petitioner and the petitioner’s attorney, if any, Order to Deposit Funds in Blocked Account (form MC-355), which is signed at the same time as this order, and three copies of the Acknowledgment of Receipt of Order and Funds for Deposit in Blocked Account (form MC-356). The petitioner or the 15 days of the deposit. The sole responsibilities of the petitioner’s attorney must file a copy of the receipt with this court within petitioner and the petitioner’s attorney, if any, are to place the balance in a blocked account or accounts and to file a copy of the receipt on time. c. The balance of the proceeds of the settlement or judgment deposited in a blocked account or accounts under item 8b(1) may be withdrawn only as follows (check (1) or (2)): (1) Li 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 judicial officer, and file-stamped by this court. The money on deposit is not subject to escheat. (2) J The blocked account or accounts belong to a minor, who was born on (date): 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 judicial officer, and file-stamped by this court, until the minor reaches 18 years of age. When the minor reaches 18 years of age, the depository, without further order of this court, is authorized and directed to pay by check or draft directly to the former minor, on proper demand, all funds, including interest, deposited under this order. The money on deposit is not subject to escheat. 10. Authorization to execute settlement documents The petitioner is authorized to execute settlement documents as follows (check only one): a. U On 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 (1) a full, complete, and final release and discharge of any and all claims and demands of the claimant by reason of the accident or incident described in the petition and the resultant injuries to the claimant and (2) a properly executed dismissal with prejudice. b. The petitioner is authorized and directed to execute any and all documents reasonably necessary to carry out the terms of the settlement. c. Li The petitioner is authorized and directed to (specify): U Continued on Attachment lOc. 11. Bond is Li ordered and fixed in the amount of: $ Li not required. 12. A copy of this order must be served on the payer immediately. 13. X J Additional orders The court makes the following additional orders (specify): The court sets a Proof of Annuity Purchase hearing for June 23, 2022, at 8:30 a.m. in Dept. 23. Li Continued on Attachment 13. 5/6/2022 Date: John Freeland JUDICIAL OFFICER SIGNATURE FOLLOWS LAST ATTACHMENT MC-351 1,2021] (Rev. January ORDER APPROVING COMPROMISE OF CLAIM OR ACTION Page 4of4 CEB Essential OR DISPOSITION OF PROCEEDS OF JUDGMENT ceb.com5FonTIs FOR MINOR OR PERSON WITH A DISABILITYW-BURR, TI FFANY 1 ATTACHMENT 8(bW2) 2 Petitioner proposes that the net settlement amount of $23,574.32 fund an annuity with 3 Pacific Life Insurance Company. The proposed annuity is structured in a manner that will provide 4 two payments in Claimant. The first payment in the amount of $5,000.00 will be made to Claimant 5 upon turning the age of 18 years old. The second payment in the amount of $27,252.00 will be 6 made to Claimant upon turning the age of 25 years old. This approach will maximize Claimant’s 7 settlement and allocate the funds in a thoughtful manner as the money will be distributed over a 8 period of time which will assist Claimant in paying for expenses over time. 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28