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MC-351
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY
| Richard Aharonian, Esq. (CA State Bar No. 169586)
7108 N. Fresno Street, Suite 320
Fresno, CA 93720
teleptoneno: (§59) 437-6463 FAX NO. (Optional) (559) 431-572
E-MAIL ADDRESS (Optional)
ATTORNEY FOR (name): Christian Montiel Martinez and Roberto Montiel
SUPERIOR COURT OF CALIFORNIA, COUNTY OF FRESNO
‘STREET ADDRESS: 1130 "O" Street
MAILING ADDRESS: 1130 "O" Street
CITY AND ZIP CODE: Fresno, CA 93724 RECEIVED
BRANCH NAME: .F. Sisk Courthouse
3/6/2019 1:02 PM
CASE NAME:
FRESNO 5 OUNTY SUPERIOR COURT
In Re: Natasha Hutsell, a minor y: A. Ramos, Depu
ORDER APPROVING: CASE NUMBER:
[4] COMPROMISE OF DISPUTED CLAIM 19CECG00859
("] COMPROMISE OF PENDING ACTION
[] DISPOSITION OF PROCEEDS OF JUDGMENT HEARING DATE, IF ANY: DEPT.
[Z Minor (] Person With a Disability 4/10/19 501
Petitioner (name): Anna Siphavong 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. [-_] No hearing was held. The petition is an expedited petition under rule 7.950.5 of the California Rules of Court.
b. [71 pate: 4/10/19 Time3:30PM Dept.:.404
c. Judicial officer:
Relationship to claimant
Petitioner has the following relationship or relationships to claimant (check all applicable boxes):
Parent
Guardian ad litem
Guardian
Conservator
Claimant, an adult person with a disability, is the petitioner.
Other (specify):
Claimant (name): Natasha Hutsell
a. (21 is aminor.
b. [J isa “person with a disability" within the meaning of Probate Code section 3603 who is:
(1) 1 An adult. Claimant's date of birth is (specify):
(a) (] 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) [J A conservatee; @ person for whom a conservator may be appointed; or without capacity to
consent to this order, within the meaning of Probate Code section 812.
(2) [) Aminor described in Probate Code section 3603(b)(3).
Defendant
The claim or action to be compromised is asserted, or the judgment is entered, against (name of settling or judgment defendant
or
defendants (the "payer')):
Christian Montiel Martinez and Roberto Montiel
Page 1 of4
FarmJudicial
Adopted for Mandatory Use. ORDER APPROVING COMPROMISE OF DISPUTED CLAIM OR PENDING Code of Civil Procedure, § 372;
Council of California Probate Code, § 3500 et seq.:
MC-351 [Rev. January 1, 2010} ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR Cal. Rules of Court, rules 3.1384, 7.953
wwnw.courtinfo.ca.gov
MINOR OR PERSON WITH A DISABILITY
(Miscellaneous)
MC-351
CASE NAME: ‘CASE NUMBER
— In Re: Natasha Hutsell, a minor
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 Fi roceeds of o
judgment is approved. The gross amount or value of the settlement or judgment in favor of claimantis $ |12,50!
b. [1] Until further order of the court, jurisdiction is reserved to determine a claim for a reduction ofa 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 lien claimed by the department but is subject to reduction on further
order of the court upon determination of the claim for reduction.
©. The payer shall disburse the proceeds of the 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 of the petitioner and the
petitioner's attorney, if any, or directly to third parties entitled to receive payment identified in this order for thefollowing
items of expense or damage, which are hereby authorized to be paid out of the proceeds of the settlement or judgment:
(a) [] Attorney's fees in the total amount of $ payable to (specify):
(b) CI Reimbursement for medical and all other expenses paid by the petitioner or the
petitioner's attorney in the total amount of: Co
(c) [2] Medical, hospital, ambulance, nursing, and other like expenses payable directly to
providers as follows, in the total amount of:
sf]
(i) Payee (name):
(A) Address:
(B) Amount: $
(ii) Payee (name):
(A) Address:
(B) Amount: $
[1] Continued on Attachment 7¢(1)(c). (Provide information about additional payees in the above format.)
(d) (-} 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):
[1 Continued on Attachment 7¢(1)(d).
(e) (J Total allowance for fees and expenses from the settlement or judgment: sl)
MC-351 [Rev. January 1, 2010] ORDER APPROVING COMPROMISE OF DISPUTED CLAIM OR PENDING Page 2 of 4
ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR
MINOR OR PERSON WITH A DISABILITY
(Miscellaneous)
MC-351
CASE NAME: ‘CASE NUMBER:
|~ In Re: Natasha Hutsell, a minor
7. THE COURT ORDERS (cont.)
c. The payer shall disburse the proceeds of the 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: $ [12,500.00 |
The balance shall be disbursed as follows:
(a) {1 By one or more checks or drafts in the total amount of (specify): $
drawn payable to the order of the 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 to Deposit Money Into Blocked Account (form MC-355), which is
signed contemporaneously with this order ("blocked account").
(b) By the following method(s) (describe each method, including the amount to be disbursed ):
By one check or draft in the amount of $12,500.00, made payable to USAA
Annuity Services Corporation, for funding of the annuity on behalf of the
minor/claimant, Natasha Hutsell. Details of the annuity and the future periodic
payments are set forth in Attachment 7.c.(2).(b).
[J Continued on Attachment 7c(2)(b).
@ CO 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 Mental Health, the state
Department of Developmental Services, and any city and county in California must first be satisfied by the
following method (specify):
[2] Continued on Attachment 7e(2)(c).
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):
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 of each depository, and the amount of each account):
[J Continued on Attachment 8a.
MC-361 (Rev, January 1, 2010] ORDER APPROVING COMPROMISE OF DISPUTED CLAIM OR PENDING Page 3 of 4
ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR
MINOR OR PERSON WITH A DISABILITY
(Miscellaneous)
MC-351
CASE NAME: "ASE NUMBER;
In Re: Natasha Hutsell, a minor
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 7¢(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 of the petitioner and the petitioner's attorney, if any, are to place the balance in a
blocked account or accounts and to timely file a copy of the receipt.
The balance of the proceeds of the settlement 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) [] 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.
@ CO 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
written 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 directly to the former
minor, upon proper demand, all moneys including interest deposited under this order. The money on deposit
is not subject to escheat.
Authorization to execute settlement documents
The petitioner is authorized to execute settlement documents as follows (check only one).
a. [1] 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 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 a properly executed dismissal with prejudice.
6 The petitioner is authorized and directed to execute any and all documents reasonably necessary to carry out
the terms of the settlement.
c. [_] The petitioner is authorized and directed (specify).
[1 Continued on Attachment 9c.
10. Bondis [] ordered and fixed in the amount of: $ [1] not required.
11. A copy of this order shall be served on the payer forthwith,
12. ] Additional orders
The court makes the following additional orders (specify):
[1 Continued on Attachment 12.
Date:
JUDICIAL OFFICER
[1 sionature roLtows LAST ATTACHMENT
MC-351 (Rev. January1, 2010] ORDER APPROVING COMPROMISE OF DISPUTED CLAIM OR PENDING Page 4 of 4
ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR
MINOR OR PERSON WITH A DISABILITY
(Miscellaneous)
Attachment 7.c.(2).(b)
ATTACHMENT TO PETITION AND/OR ORDER
FOR MINOR'S COMPROMISE
FOR:
NATASHA HUTSELL - DOB: 01/08/2010
In consideration of the Petition and/or Order for Minor’s Com promise, attached
hereto, CSAA Insurance
Exchange (the “Insure: r”), on behalf of Roberto Montiel, Christian Montiel and Maria Ramit
rez Demontie (the
“Insureds”), agrees to settle this claim for Natasha Hutsell, a minor,
by and through her Natural Parent and
Guardian, Anna Siphavong (the “Claimant”).
Periodic Payments made payable to Natasha Hutsell (the “Payee”
) according to the schedule as follows (the
"Periodic Payments"):
Guaranteed Payout
Guaranteed Lump Sum Payments
Age Amount Pavment Date
18 $ 3,000 01/08/2028
21 $ 5,000 01/08/2031
25 $11,600 01/08/2035 $19,600.00
The cost of the above Periodic Payment is $12,500.00.
This amount is disclosed as a condition of the settlement and in vio
way grants any right, control, or
ownership interest in the Periodic Payments to any Payee, except
the right to receive future Periodic
Payments as described above.
The future Periodic Payments outlined above are guaranteed based
upon a projected funding date. Any
delay in funding the Periodic Payments may resu It in
a delay of the payment date or change in payment
amount. Any rate adjustments m ay result in minor changes
to the Periodic Payments listed above. T) hese
changes shall be recorded in the Settlement Agreement and Releas
e, Qualified Assignment document and
Annuity Contract without the nee d of obtaining an amend
ed Petition or Court Order.
All sums set forth herein constitute dama| ges on account of physic
al injuries or physical sickness, within the
meaning of Section 104(a)(2) of the Inten nal Revenue Code of 1986, as amended.
Payee’s Rights to Payments
No part of the payments called for herein or an: y assets
of the Insureds and/or the Assignee are to be subject to
execution of any legal process for any obligati
on in any manner. The P: ‘ayee shall not have the power to sell or
mortgage or encumber the payments, or any part thereof, nor
antici pate the same, or any part thereof, by
assignment or otherwise. Any such sale, mortgage, encumbrance,
or anticipation by assignment or otherwise
shall be void unless such sal €, assignment, pledge, hypothecation, or
other transfer or encumbrance has been
approved in advance in a “ ‘qualified order” as outlined in Section 5891(b)(2)
of the Internal Revenue Code of
1986, as amended and approved by a court of competent jurisdiction and
otherwise complies with applicable
state law, including without limitation any a md all applicable state structu
red settlement protection statutes, In
the event that Payee attempts to seek such a “qualified order, ” they
do hereby agree and consent to provide
full and timely legal notice of any such Motion or Petitio
n for such a “ qualified order” to Claimant's counsel
and Guardian ad Litem, if appointed. No direct or indirect
transfer o: f structured settlement payment rights
shall be effective and no structured settlement obligor or annuity
issuer shall be required to make any payment
directly or indirectly to any transferee of structured settle
ment paym: ent rights unless the transfer has been
approved in advance in a final court order based on express finding
s b yy the court that:
(1) the transfer is in the best interest of the Pa yee, taking into
account the welfare and support of the Payee's
dependents;
(2) the Payee has been advised in writing by the transferee to seek
independent professiona | advice regarding
the transfer and has either received the advice or knowingly waived the
advice in writing; and
(3) the transfer does not contravene any applicable statute or an order of any court or other governmental
authority.
Consent to Qualified Assignment!
The Claimant acknowled
ges and agrees that the Insureds and/or the Insurer may make a "Qualified
Assignment” within the meaning of Section 130(c), of the Internal Revenue Code
of 1986, as amended, of the
Insureds’ and/or the Insurer’s liability to make the Periodic Pa yments set
forth herein. Specifically, CSAA
Insurance Exchange (the "Assignor"), as the liability insurance carrier for the Insureds
and as the payor of the
consideration recited herein, shall assign its obligation to make the Periodic
Payments called for above in this
Attachment for Minor’s Compromise to USAA Annuity Services Corporation (the "Assignee"), The
Assignee’s obligation for payment of the Periodic Payments shall be no greater
than that of Insureds and/or
the Insurer (whether by judgment or agreement) immediately preceding
the assignment of the Periodic
Payments obligation. USAA Life Insurance Comy pany will guarantee the obligati
on of the Assignee, USAA
Annuity Services Corporation, USAA Life Insur: ‘ance Company has received high
ratings from A. M. Best,
(A++), Standard & Poor's, (AA+), Moody's, (Aal) and Fitch, (AAA). (See attached ratings sheet).
Such assignment shall be accepted by the Claimant without right of rejection and sh:
all completely release and
discharge the Insureds and/or the Insurer from the Periodic Payments
obligation assigned to the Assignee,
The Claimant recognizes that the Assi gnee shall be the sole obligor
with respect to the Periodic Payment s
obligation, and that all other releases with respect to the Periodi
c Payments obligation that pertain to the
lability of the Insureds and/or the Insurer shall thereupon become
final, irrevocabl e, absolute and non-
contingent.
Right to Purchase an Annuity
The Insureds and/or the Insurer, themselves, or throu, igh their Assignee, reserve the right to fund
make the Periodic Payments by purchasing a "qualified funding asset" the liability to
, Within the meaning of Section 130(d)
of the Code, in the form of an annuity policy from USAA
Life Insur: ance Company. The Assignee shall be
the sole owner of the annuity pol icy and shall have all rights of
ownership. The Assignee may have USAA
Life Insurance Company mail the payments direct! ly to the
Payee. The Claimant, prior to the age of 18, or the
Payee, upon reaching the age of majority, shall be respons
ible for maintaining the accuracy of the current
mailing address and mortality information f ‘or the Payee with
the Assignee.
Payee’s Beneficiary
Any payments to be made after tl he death of the Payee pursuan
t to the terms of this Attachment for Minor’s
Compromise shall be made to s uch person or entity as
shall be designated in writing by the Payee, upon
reaching the age of majority, to the Assignee. If no person
or entity is so designated by the Payee, or if the
person designated is not livin, ig at the time of the Payee’s death,
such payments shall be made to the estate of
the Payee. No such designation, nor any revocation thereof, shall
be effective unl less it is in writing and
delivered to the Assignee. The designation must be in a form acceptable to the
payments are made.
Assignee before such
Di ischarge of
iscnarge of Ubiigation
Obligation
The obligation of the Assignee to make each Periodic Payment
shall be discharged upon the mailing ofa valid
check to the designated address or up ‘on electronic transfer to
the designated bank account in the amount of
such payment to the Payee n amed in this Attachment fo: ¢ Minor’
s Compromise. Upon notice from the Payee
that a payment was not received, the Assignee will initiate
reasonable stop payment action and, upon
confirmation that the funds were not negotiated or
d eposited, the Assignee will process a replacement
payment.
* This process involves the herein referenced Insurer issuing a check payable
to USAA Annuity Services
Corporation in the amount specified in this Attachme nt for Mi inor’s Compromise
and signing a Qualified
Assignment and Release document to transfer their obligation for the ese payments to the
Assignee. The check must
be sent directly to Ringler Associates at 540 Lennon Lane, Suite 24, Walnut Creek, CA 94598.
List of Company Ratings
Company: USAA Life Ins Co
Domicile: TX
Established: 1963
:
A.M, Best Company ing : ue Att (1)
Superior, Assigned to com; panies that have, in our opinion, a superior
ability to meet their ongoing obligations to
policyholders.
Standard & Poor's Financial Strength Rating |
AA+ (2)
An insurer rated ‘AA’ has VERY STRONG financial security characteristic
higher. s, differing only slightly from those rated
Moody's Finan: Strength Rating
- Aad (2)
Insurance companies rated Aa offer excellent financi
al security. Together with the Aaa group, they constit
re generally known as high-grade companie: 'S. ute what
They are rated lower than Aaa companies because long-te
appear somewhat larger. rm risks
Fitch Ratings’ Insurer Finanélal Strength; Rating
wis ie AAA
Exceptionally strong, ‘AAA' IFS ratings denote the
lowest expectation of ceased or interrupted paymen
assigned only in the case of exceptionally strong ts, They are
capacity to meet policyholder and contract obli
is highly unlikely to be adversely affected by igations. This capacity
foreseeable e' vents.
Woiss Safety Rating
A(2)
Excellent, The company offers excellent financi
al securit
strategies, business operations and underwritin ig commi 'y. It has maintained a conservative stance in its investment
tments. While the financial Position of any compa
to change, we believe that this company has
thi © resources necessary to deal with severe econom
ny is subject
ic conditions,
Comdex Ranking - VitalSigns Composite index.
99
The Comdex gives the average percentile rankin
g of this com pany in relation to all other compa
rated by the rating services. The Comdex Ranki nies that have been
ng ig is the percentage of companies that are
company. rated lower than this
A Best's Financial Strength Rating opinion addresses the relat tive
ability of an insurer to meet its on, \going insurance obligations. It is
company's financial strength and abi lity to meet its obligations to Policyho
and complete details at http: ww. aambest.com/ratings/notice. lders. View our Important Notice: Best's Credit Ratings for not a warranly of a
a disclaimer notice
Watch list identifiers follow the ratin 9 ifthe company is on the
or unknown change (w) rating service's watch list. The identifier indicates a possible upgrade (w+),
downgrade (w-),
The ratings on this report are current as of J ‘anuary 02, 2019. These ratings
assigned to this insurer, have been selected by your life insurance advisor from among the ratings
Presented by: J Douglas Merritt, Cal lfornia, Ringler Associates, Inc.,
Email: jmerritt@ringlerassociates.co $40 Lennon Lane, 540 Lennon Lane, Walnut Creek, CA 94598
Phone: 8003521912
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MC-351 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY | Richard Aharonian, Esq. (CA State Bar No. 169586) 7108 N. Fresno Street, Suite 320 Fresno, CA 93720 teleptoneno: (§59) 437-6463 FAX NO. (Optional) (559) 431-572 E-MAIL ADDRESS (Optional) ATTORNEY FOR (name): Christian Montiel Martinez and Roberto Montiel SUPERIOR COURT OF CALIFORNIA, COUNTY OF FRESNO ‘STREET ADDRESS: 1130 "O" Street MAILING ADDRESS: 1130 "O" Street CITY AND ZIP CODE: Fresno, CA 93724 RECEIVED BRANCH NAME: .F. Sisk Courthouse 3/6/2019 1:02 PM CASE NAME: FRESNO 5 OUNTY SUPERIOR COURT In Re: Natasha Hutsell, a minor y: A. Ramos, Depu ORDER APPROVING: CASE NUMBER: [4] COMPROMISE OF DISPUTED CLAIM 19CECG00859 ("] COMPROMISE OF PENDING ACTION [] DISPOSITION OF PROCEEDS OF JUDGMENT HEARING DATE, IF ANY: DEPT. [Z Minor (] Person With a Disability 4/10/19 501 Petitioner (name): Anna Siphavong 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. [-_] No hearing was held. The petition is an expedited petition under rule 7.950.5 of the California Rules of Court. b. [71 pate: 4/10/19 Time3:30PM Dept.:.404 c. Judicial officer: Relationship to claimant Petitioner has the following relationship or relationships to claimant (check all applicable boxes): Parent Guardian ad litem Guardian Conservator Claimant, an adult person with a disability, is the petitioner. Other (specify): Claimant (name): Natasha Hutsell a. (21 is aminor. b. [J isa “person with a disability" within the meaning of Probate Code section 3603 who is: (1) 1 An adult. Claimant's date of birth is (specify): (a) (] 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) [J A conservatee; @ person for whom a conservator may be appointed; or without capacity to consent to this order, within the meaning of Probate Code section 812. (2) [) Aminor described in Probate Code section 3603(b)(3). Defendant The claim or action to be compromised is asserted, or the judgment is entered, against (name of settling or judgment defendant or defendants (the "payer')): Christian Montiel Martinez and Roberto Montiel Page 1 of4 FarmJudicial Adopted for Mandatory Use. ORDER APPROVING COMPROMISE OF DISPUTED CLAIM OR PENDING Code of Civil Procedure, § 372; Council of California Probate Code, § 3500 et seq.: MC-351 [Rev. January 1, 2010} ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR Cal. Rules of Court, rules 3.1384, 7.953 wwnw.courtinfo.ca.gov MINOR OR PERSON WITH A DISABILITY (Miscellaneous) MC-351 CASE NAME: ‘CASE NUMBER — In Re: Natasha Hutsell, a minor 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 Fi roceeds of o judgment is approved. The gross amount or value of the settlement or judgment in favor of claimantis $ |12,50! b. [1] Until further order of the court, jurisdiction is reserved to determine a claim for a reduction ofa 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 lien claimed by the department but is subject to reduction on further order of the court upon determination of the claim for reduction. ©. The payer shall disburse the proceeds of the 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 of the petitioner and the petitioner's attorney, if any, or directly to third parties entitled to receive payment identified in this order for thefollowing items of expense or damage, which are hereby authorized to be paid out of the proceeds of the settlement or judgment: (a) [] Attorney's fees in the total amount of $ payable to (specify): (b) CI Reimbursement for medical and all other expenses paid by the petitioner or the petitioner's attorney in the total amount of: Co (c) [2] Medical, hospital, ambulance, nursing, and other like expenses payable directly to providers as follows, in the total amount of: sf] (i) Payee (name): (A) Address: (B) Amount: $ (ii) Payee (name): (A) Address: (B) Amount: $ [1] Continued on Attachment 7¢(1)(c). (Provide information about additional payees in the above format.) (d) (-} 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): [1 Continued on Attachment 7¢(1)(d). (e) (J Total allowance for fees and expenses from the settlement or judgment: sl) MC-351 [Rev. January 1, 2010] ORDER APPROVING COMPROMISE OF DISPUTED CLAIM OR PENDING Page 2 of 4 ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY (Miscellaneous) MC-351 CASE NAME: ‘CASE NUMBER: |~ In Re: Natasha Hutsell, a minor 7. THE COURT ORDERS (cont.) c. The payer shall disburse the proceeds of the 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: $ [12,500.00 | The balance shall be disbursed as follows: (a) {1 By one or more checks or drafts in the total amount of (specify): $ drawn payable to the order of the 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 to Deposit Money Into Blocked Account (form MC-355), which is signed contemporaneously with this order ("blocked account"). (b) By the following method(s) (describe each method, including the amount to be disbursed ): By one check or draft in the amount of $12,500.00, made payable to USAA Annuity Services Corporation, for funding of the annuity on behalf of the minor/claimant, Natasha Hutsell. Details of the annuity and the future periodic payments are set forth in Attachment 7.c.(2).(b). [J Continued on Attachment 7c(2)(b). @ CO 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 Mental Health, the state Department of Developmental Services, and any city and county in California must first be satisfied by the following method (specify): [2] Continued on Attachment 7e(2)(c). 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): 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 of each depository, and the amount of each account): [J Continued on Attachment 8a. MC-361 (Rev, January 1, 2010] ORDER APPROVING COMPROMISE OF DISPUTED CLAIM OR PENDING Page 3 of 4 ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY (Miscellaneous) MC-351 CASE NAME: "ASE NUMBER; In Re: Natasha Hutsell, a minor 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 7¢(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 of the petitioner and the petitioner's attorney, if any, are to place the balance in a blocked account or accounts and to timely file a copy of the receipt. The balance of the proceeds of the settlement 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) [] 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. @ CO 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 written 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 directly to the former minor, upon proper demand, all moneys including interest deposited under this order. The money on deposit is not subject to escheat. Authorization to execute settlement documents The petitioner is authorized to execute settlement documents as follows (check only one). a. [1] 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 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 a properly executed dismissal with prejudice. 6 The petitioner is authorized and directed to execute any and all documents reasonably necessary to carry out the terms of the settlement. c. [_] The petitioner is authorized and directed (specify). [1 Continued on Attachment 9c. 10. Bondis [] ordered and fixed in the amount of: $ [1] not required. 11. A copy of this order shall be served on the payer forthwith, 12. ] Additional orders The court makes the following additional orders (specify): [1 Continued on Attachment 12. Date: JUDICIAL OFFICER [1 sionature roLtows LAST ATTACHMENT MC-351 (Rev. January1, 2010] ORDER APPROVING COMPROMISE OF DISPUTED CLAIM OR PENDING Page 4 of 4 ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY (Miscellaneous) Attachment 7.c.(2).(b) ATTACHMENT TO PETITION AND/OR ORDER FOR MINOR'S COMPROMISE FOR: NATASHA HUTSELL - DOB: 01/08/2010 In consideration of the Petition and/or Order for Minor’s Com promise, attached hereto, CSAA Insurance Exchange (the “Insure: r”), on behalf of Roberto Montiel, Christian Montiel and Maria Ramit rez Demontie (the “Insureds”), agrees to settle this claim for Natasha Hutsell, a minor, by and through her Natural Parent and Guardian, Anna Siphavong (the “Claimant”). Periodic Payments made payable to Natasha Hutsell (the “Payee” ) according to the schedule as follows (the "Periodic Payments"): Guaranteed Payout Guaranteed Lump Sum Payments Age Amount Pavment Date 18 $ 3,000 01/08/2028 21 $ 5,000 01/08/2031 25 $11,600 01/08/2035 $19,600.00 The cost of the above Periodic Payment is $12,500.00. This amount is disclosed as a condition of the settlement and in vio way grants any right, control, or ownership interest in the Periodic Payments to any Payee, except the right to receive future Periodic Payments as described above. The future Periodic Payments outlined above are guaranteed based upon a projected funding date. Any delay in funding the Periodic Payments may resu It in a delay of the payment date or change in payment amount. Any rate adjustments m ay result in minor changes to the Periodic Payments listed above. T) hese changes shall be recorded in the Settlement Agreement and Releas e, Qualified Assignment document and Annuity Contract without the nee d of obtaining an amend ed Petition or Court Order. All sums set forth herein constitute dama| ges on account of physic al injuries or physical sickness, within the meaning of Section 104(a)(2) of the Inten nal Revenue Code of 1986, as amended. Payee’s Rights to Payments No part of the payments called for herein or an: y assets of the Insureds and/or the Assignee are to be subject to execution of any legal process for any obligati on in any manner. The P: ‘ayee shall not have the power to sell or mortgage or encumber the payments, or any part thereof, nor antici pate the same, or any part thereof, by assignment or otherwise. Any such sale, mortgage, encumbrance, or anticipation by assignment or otherwise shall be void unless such sal €, assignment, pledge, hypothecation, or other transfer or encumbrance has been approved in advance in a “ ‘qualified order” as outlined in Section 5891(b)(2) of the Internal Revenue Code of 1986, as amended and approved by a court of competent jurisdiction and otherwise complies with applicable state law, including without limitation any a md all applicable state structu red settlement protection statutes, In the event that Payee attempts to seek such a “qualified order, ” they do hereby agree and consent to provide full and timely legal notice of any such Motion or Petitio n for such a “ qualified order” to Claimant's counsel and Guardian ad Litem, if appointed. No direct or indirect transfer o: f structured settlement payment rights shall be effective and no structured settlement obligor or annuity issuer shall be required to make any payment directly or indirectly to any transferee of structured settle ment paym: ent rights unless the transfer has been approved in advance in a final court order based on express finding s b yy the court that: (1) the transfer is in the best interest of the Pa yee, taking into account the welfare and support of the Payee's dependents; (2) the Payee has been advised in writing by the transferee to seek independent professiona | advice regarding the transfer and has either received the advice or knowingly waived the advice in writing; and (3) the transfer does not contravene any applicable statute or an order of any court or other governmental authority. Consent to Qualified Assignment! The Claimant acknowled ges and agrees that the Insureds and/or the Insurer may make a "Qualified Assignment” within the meaning of Section 130(c), of the Internal Revenue Code of 1986, as amended, of the Insureds’ and/or the Insurer’s liability to make the Periodic Pa yments set forth herein. Specifically, CSAA Insurance Exchange (the "Assignor"), as the liability insurance carrier for the Insureds and as the payor of the consideration recited herein, shall assign its obligation to make the Periodic Payments called for above in this Attachment for Minor’s Compromise to USAA Annuity Services Corporation (the "Assignee"), The Assignee’s obligation for payment of the Periodic Payments shall be no greater than that of Insureds and/or the Insurer (whether by judgment or agreement) immediately preceding the assignment of the Periodic Payments obligation. USAA Life Insurance Comy pany will guarantee the obligati on of the Assignee, USAA Annuity Services Corporation, USAA Life Insur: ‘ance Company has received high ratings from A. M. Best, (A++), Standard & Poor's, (AA+), Moody's, (Aal) and Fitch, (AAA). (See attached ratings sheet). Such assignment shall be accepted by the Claimant without right of rejection and sh: all completely release and discharge the Insureds and/or the Insurer from the Periodic Payments obligation assigned to the Assignee, The Claimant recognizes that the Assi gnee shall be the sole obligor with respect to the Periodic Payment s obligation, and that all other releases with respect to the Periodi c Payments obligation that pertain to the lability of the Insureds and/or the Insurer shall thereupon become final, irrevocabl e, absolute and non- contingent. Right to Purchase an Annuity The Insureds and/or the Insurer, themselves, or throu, igh their Assignee, reserve the right to fund make the Periodic Payments by purchasing a "qualified funding asset" the liability to , Within the meaning of Section 130(d) of the Code, in the form of an annuity policy from USAA Life Insur: ance Company. The Assignee shall be the sole owner of the annuity pol icy and shall have all rights of ownership. The Assignee may have USAA Life Insurance Company mail the payments direct! ly to the Payee. The Claimant, prior to the age of 18, or the Payee, upon reaching the age of majority, shall be respons ible for maintaining the accuracy of the current mailing address and mortality information f ‘or the Payee with the Assignee. Payee’s Beneficiary Any payments to be made after tl he death of the Payee pursuan t to the terms of this Attachment for Minor’s Compromise shall be made to s uch person or entity as shall be designated in writing by the Payee, upon reaching the age of majority, to the Assignee. If no person or entity is so designated by the Payee, or if the person designated is not livin, ig at the time of the Payee’s death, such payments shall be made to the estate of the Payee. No such designation, nor any revocation thereof, shall be effective unl less it is in writing and delivered to the Assignee. The designation must be in a form acceptable to the payments are made. Assignee before such Di ischarge of iscnarge of Ubiigation Obligation The obligation of the Assignee to make each Periodic Payment shall be discharged upon the mailing ofa valid check to the designated address or up ‘on electronic transfer to the designated bank account in the amount of such payment to the Payee n amed in this Attachment fo: ¢ Minor’ s Compromise. Upon notice from the Payee that a payment was not received, the Assignee will initiate reasonable stop payment action and, upon confirmation that the funds were not negotiated or d eposited, the Assignee will process a replacement payment. * This process involves the herein referenced Insurer issuing a check payable to USAA Annuity Services Corporation in the amount specified in this Attachme nt for Mi inor’s Compromise and signing a Qualified Assignment and Release document to transfer their obligation for the ese payments to the Assignee. The check must be sent directly to Ringler Associates at 540 Lennon Lane, Suite 24, Walnut Creek, CA 94598. List of Company Ratings Company: USAA Life Ins Co Domicile: TX Established: 1963 : A.M, Best Company ing : ue Att (1) Superior, Assigned to com; panies that have, in our opinion, a superior ability to meet their ongoing obligations to policyholders. Standard & Poor's Financial Strength Rating | AA+ (2) An insurer rated ‘AA’ has VERY STRONG financial security characteristic higher. s, differing only slightly from those rated Moody's Finan: Strength Rating - Aad (2) Insurance companies rated Aa offer excellent financi al security. Together with the Aaa group, they constit re generally known as high-grade companie: 'S. ute what They are rated lower than Aaa companies because long-te appear somewhat larger. rm risks Fitch Ratings’ Insurer Finanélal Strength; Rating wis ie AAA Exceptionally strong, ‘AAA' IFS ratings denote the lowest expectation of ceased or interrupted paymen assigned only in the case of exceptionally strong ts, They are capacity to meet policyholder and contract obli is highly unlikely to be adversely affected by igations. This capacity foreseeable e' vents. Woiss Safety Rating A(2) Excellent, The company offers excellent financi al securit strategies, business operations and underwritin ig commi 'y. It has maintained a conservative stance in its investment tments. While the financial Position of any compa to change, we believe that this company has thi © resources necessary to deal with severe econom ny is subject ic conditions, Comdex Ranking - VitalSigns Composite index. 99 The Comdex gives the average percentile rankin g of this com pany in relation to all other compa rated by the rating services. The Comdex Ranki nies that have been ng ig is the percentage of companies that are company. rated lower than this A Best's Financial Strength Rating opinion addresses the relat tive ability of an insurer to meet its on, \going insurance obligations. It is company's financial strength and abi lity to meet its obligations to Policyho and complete details at http: ww. aambest.com/ratings/notice. lders. View our Important Notice: Best's Credit Ratings for not a warranly of a a disclaimer notice Watch list identifiers follow the ratin 9 ifthe company is on the or unknown change (w) rating service's watch list. The identifier indicates a possible upgrade (w+), downgrade (w-), The ratings on this report are current as of J ‘anuary 02, 2019. These ratings assigned to this insurer, have been selected by your life insurance advisor from among the ratings Presented by: J Douglas Merritt, Cal lfornia, Ringler Associates, Inc., Email: jmerritt@ringlerassociates.co $40 Lennon Lane, 540 Lennon Lane, Walnut Creek, CA 94598 Phone: 8003521912 Page 1 of 1 Powered by VitalSales Suite, a product of EbixExchange.