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MC-350EX
ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY
Jennifer Mahgerefteh, Esq. (SBN. 307502)
|Tofer & Associates, 8889 West Olympic Boulevard, Penthouse E-FILED
Beverly Hills, CA 90211 9/30/2019 1:17 PM
tevepHone No: 310-277-9000 FAX NO. (Optional) Superior Court of California
E-MAIL ADDRESS (Optional) County of Fresno
ATTORNEY FOR (Name): Moises Guerrero, Sr. and Moises Guerrero, Jr. By: C. York, Deputy
SUPERIOR COURT OF CALIFORNIA, COUNTY OF Fresno
streeraporess: 1100 Van Ness Avenue
MAILING ADDRESS:
cir AND ZIP CODE: Fresno, CA 93724
BRANCH NAME:
CASE NAME: CASE NUMBER: 19CECG03544
In Re: Moises Guerrero, Jr. - Minor's Compromise
EXPEDITED PETITION TO APPROVE: [Z1 No hearing date is requested.
[2] COMPROMISE OF DISPUTED CLAIM
[1] tearine pate:
[-) COMPROMISE OF PENDING ACTION
[© DISPOSITION OF PROCEEDS OF JUDGMENT DEPT. TIME:
(21 Minor [_] Person With
a Disability
NOTICE TO PETITIONERS
You must use this form if you wish to request expedited court approval of certain (1) compromises of disputed claims of a minor,
(2) compromises of pending actions or proceedings in which a minor or a person with a disability (including a conservatee) is a party,
or (3) dispositions of the proceeds of judgments for a minor or person with a disability. (See Code Civ. Proc., § 372; Prob. Code,
§ 3500 et seq.) You may use this form if (1) you are represented by an attorney; (2) the statements in items 3a, 3b, 3c, 3d, 3e, 3f,
and either 3g(1) or 39(2) below are true; and (3) the court does not otherwise order.
If you qualify and choose to use this form, the court may consider and act on your petition without a hearing. If your compromise or
judgment does not qualify for expedited treatment or you choose not to use this form, you must use the Petition to Approve
Compromise of Disputed Claim or Pending Action or Disposition of Proceeds of Judgment for Minor or Person With a Disability
(form MC-350), and the court will schedule a hearing. See Cal. Rules of Court, rules 7.950, 7.950.5, and 7.951.
Petitioner (name): Moises Guerrero, Sr.
Claimant (name): Moises Guerrero, Jr.
a. Address:[392 N 4th Street, Orange Cove, CA 93646
b. Date of birth: 8/27/2007 c. Age: 11 d. Sex: M e. [Z] Minor f. [] Person with a disability
Expedited petition
a. The claimant's claim or action is not for damages for the death of a person caused by the wrongful act or neglect of another.
b. No portion of the net proceeds of the judgment or settlement in favor of the claimant is to be placed in a trust.
©. There are no unresolved disputes concerning liens to be satisfied from the proceeds of the judgment or settlement.
the
d. Petitioner's attorney did not become involved with this matter, directly or indirectly, at the request of a party against whom
claim is asserted or a party's insurance carrier.
Petitioner's attorney is not representing, employed by, or associated with a defendant in this matter or an insurance carrier.
or the court
All defendants that have appeared in a pending action on the claim are participating in the proposed compromise
has finally determined that all settling parties entered into the settlement in good faith.
(1) [1 The judgment for the claimant described in item 5c (exclusive of interest and costs) or the total of the settlement
of
described in items 12 and 13 payable to the claimant and all other persons named in item 13 is in the amount
$50,000 or less; or
(2) The settlement described in item 12 represents payment of the single-person policy limits of all liability insurance
that all of
policies covering the defendants named in that item. The investigation described in Attachment 3 shows
insurance coverage. (Describe investigation and results in
those defendants are judgment proof outside of their
Page 1 of 8
Attachment 3.)
Form for EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED “full rocedure‘Code,
§ 372 et seq;
§ 3500 et seq.;
Alternative Mandatory Use Cal, Rules of Court, rules 3.1384,
Judicial Council of California CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS 7.401, 7.950, 7.950.5, 7.964
MC-350EX [New January 1, 2010] wunw.courtinfo.ca.gov
OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY
(Miscellaneous)
MC-350EX
CASE NAME: CASE NUMBER:
Ln Re: Moises Guerrero, Jr. - Minor's Compromise
4. Relationship Petitioner's relationship to the claimant (check aif applicable boxes):
Parent g. [_] Other relationship (specify):
Guardian ad litem
Guardian
Conservator
Disabled adult claimant is a petitioner. (See instructions for items 4e and 4f below.)
Disabled adult claimant's express consent to the relief requested in this petition is provided on Attachment 4f.
(if you checked item 4e or 4f, state facts on Attachment 4e or 4f showing that the claimant has capacity under Probate Code
section 812 to petition or consent fo a petition. Onlyan adult claimant who has sufficient capacity and who does not have a
conservator of the estate may petition or consent to a petition. See Probate Code section 3613.)
Nature of claim The claim of the minor or adult person with a disability:
a. LZ) Isnotthe subject of a pending action or proceeding. (Complete items 6-23.)
b. [_] Is the subject of a pending action or proceeding that will be compromised without a trial on the merits of the claim.
Name of court:
Case no.: Trial date: (Complete items 6-23.)
c. [1 is the subject of a pending action or proceeding that has been or will be reduced to a judgment for the claimant against
the defendants named below in the total amount (exclusive of interest and costs) of (specify):
sL
Defendants (names)
Veronica Puentes Gonzalez
[1 Additional defendants listed on Attachment 5. [) The judgment was filed on (date):
(Attach a copy of the (proposed) judgment as Attachment Sc and complete items 14-23.)
6. [7] Incident or accident
‘The incident or accident occurred as follows:
a, Date: 9/2/16 Time: 5:45 p.m.
b. Place: Monson Ave & Manning Avenue, Orange Cove, CA 93646
c. Persons involved (names):
Moises Guerrero Jr. (minor - passenger)
Moises Guerrero Sr. (petitioner -father)
Veronica Puentes Gonzalez (Third Party driver)
Juan Guerrero (driver)
[1 Continued on Attachment 6.
77 Nature of incident or accident
The facts, events, and circumstances of the incident or accident are (describe):
Moises Guerrero Jr., minor, was a restrained passenger in the vehicle driven by Juan
Guerrero, which was travelling Westbound along Manning Avenue, when suddenly and
without warning, Veronica Gonzalez who was travelling SouthBound along Monson Ave.,
collided into the vehicle driven by Juan Guerrero, causing serious injuries to Moises.
[£1 Continued on Attachment 7.
Page 20f 8
[Now Janey 20101 EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED
CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF
JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY
(Miscellaneous)
MC-350EX
CASE NAME: CASE NUMBER:
[-In Re: Moises Guerrero, Jr. - Minor’s Compromise
8. CZ injuries
The following injuries were sustained by the claimant as a result of the incident or accident {describe}:
Life threatening injuries, acute impairment of organ system, head injuries, severe trauma,
acute hemorrhagic contusion of mesentery with hemoperitoneum,
[51 Continued on Attachment 8.
9. Treatment
The claimant received the following care and treatment for the injuries described in item 8 (describe):
Emergency room treatment - Major / critical care
[1 Continued on Attachment 9.
10, C21 Extent of injuries and recovery (An original or a photocopy of all doctors’ reports containing a diagnosis of and prognosis
for the claimant's injuries, and a report of the claimant's present condition, must be attached to this petition as Attachment 10.
A new report is not necessary so long as a previous report accurately describes the claimant's current condition.)
a. [J The claimant has recovered completely from the effects of the injuries described in item 8, and there are no
permanent injuries.
The claimant has not recovered completely from the effects of the injuries described in item 8, and the following
injuries from which the claimant has not recovered are temporary (describe the remaining injuries):
Unknown at this time
[1 Continued on Attachment 100.
c. [-) The claimant has not recovered completely from the effects of the injuries described in item 8, and the following
injuries from which the claimant has not recovered are permanent (describe the permanent injuries):
([) Continued on Attachment 10c.
11 Petitioner has made a careful and diligent inquiry and investigation to ascertain the facts relating to the incident or
accident in which the claimant was injured; the responsibility for the incident or accident; and the nature, extent,
and serlousness of the claimant's injuries. Petitioner fully understands that if the compromise proposed in this
petition Is approved by the court and is consummated, the claimant will be forever barred from seeking any further
recovery of compensation from the settling defendants named below even though the claimant's injuries may in the
future appear to be more serious than they are now thoughtto be.
12.07) Amount and tems of settlement
By way of settlement, the defendants named below have offered to pay the fotiowing sums to the claimant:
a. The total amount offered by all defendants named below is (specify): $[55,000.00
b. The defendants and amounts offered by each are as follows (specify):
Defendants (names) Amounts
Veronica Puentes Gonzalez $ 55,000.00
$
$
$
([) Additional defendants and amounts offered are listed on Attachment 12.
c. The terms of settlement are described on Attachment 12. (If the settlement is to be paid in installments, both the total
amount and the present value of the settlement must be included.)
EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED Pagasofs
[New Sisuay 1 2010
CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF
JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY
(Miscellaneous)
MC-350EX
CASE NAME: CASE NUMBER:
Hn Re: Moises Guerrero, Jr. - Minor's Compromise
13.21 Settlement payments to others
No defendant named in item 12b has offered to pay money to any person or persons other than the claimant to
settle claims arising out of the same incident or accident that resulted in the claimant's injury.
py By way of settlement, one or more defendants named in item 12b have also offered to pay money to a person or
persons other than claimant to settle claims arising out of the same incident or accident that resulted in the
claimant's injury. $
(1) The total amount offered by all defendants to others (specify):
(2) [-1) Petitioner would receive money under the proposed settlement.
(3) The settlement payments are to be apportioned and distributed as follows:
ther plaintiffs or claimants (names) Amounts
$
$
$
$
[1 Additional plaintiffs or claimants and amounts are listed on Attachment 13.
(4) [1
The settlement payments are apportioned between the claimant and each other plaintiff or claimant
named above on a pro rata basis, based upon the special damages claimed by each. The special
damages claimed by each other plaintiff or claimant are specified on Attachment 13.
(5) [) Reasons for the apportionment of the settlement payments between the claimant and each other
plaintiff or claimant named above are specified on Attachment 13.
14. The claimant's medical expenses, including medical expenses paid by petitioner, Medicare, Medi-Cal, and private
insurers, that are to be reimbursed from proceeds of settlement or judgment
a. Totals
(1) Total expenses:
(2) Total amount paid (including payments by private insurance, ledi-Cal, or Medicare): $(143,762.97 )
(3) Total of negotiated reductions, if any: $ 123,855.02 )
(4) Total amount of medical expenses to be paid or reimbursed from proceeds: $
(5) Total amount of medical liens, if any: $
(Identify each medical expense payer and the amount each paid, and explain any differences between items 14a(1), (4) and (5)
in Attachment 14a.)
Bites) None of the claimant's medical expenses have been paid by Medicare.
@C Medicare paid some or all of claimant's medical expenses. In full satisfaction of its lien rights,
Medicare will be reimbursed in the amount of $
(Attach a copy of the final Medicare demand letter or letter agreement as Attachment 14b(2).)
c. (1)
(2) mz None of the claimant's medical expenses have been paid by Medi-Cal.
Medi-Cal paid all or some or all of the claimant's medical expenses.
(a) Notice of this claim or action has been given to the State Director of Health Care Services under Welfare and
Institutions Code section 14124.73. A copy of the notice and proof of its delivery [__] is attached.
was filed in this matter on (date):
(b) In full satisfaction of its lien rights, Medi-Cal has agreed to accept reimbursement
in the amount of:
(Attach a copy of the final Medi-Cal demand letter or letter agreement as Attachment 14c(2).)
5520025}
d. [1 The claimant's health plan is requesting reimbursement for medical expenses paid under
the plan. In full satisfaction of the plan's lien rights, it will be reimbursed in the amount of: $ [sean
on awNET 2
(Attach statements from the plan showing expense payments and requesting reimbursement.)
e. [_] Petitioner has paid claimant's medical expenses to be reimbursed in the amount of ¢ [emanate
(See instructions for item 16.)
Page 40f8
EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED
iNew lanuary 12010] CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF
JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY
(Miscellaneous)
MC-350EX
CASE NAME: CASE NUMBER:
t-In Re: Moises Guerrero, Jr. - Minor's Compromise
14, The clalmant’s medical expenses, including medical expenses pald by petitioner, Medicare, Medi-Cal, and private
insurers, that are to be relmbursed from proceeds of settlement or judgment
There are one or more liens from medical servica providers for payment of claimant's medical expenses.
In full satisfaction of their lien claims, the liennolders have agreed to accept the sum of: $ [703.70]
9g. (Select (1) or (2} befow.)
(1) [1 Latest statements from all medical servics providers are attached as Attachment 14g.
(2) [-_] Ali medical expenses have been paid by private insurance, Medicare, or Medi-Cal.
15. The claimant's attorney's fees and all other expenses (except medical expenses), including fees or expenses paid by
petitioner and claimant's attomey, to be paid or reimbursed from proceeds of settlement or judgment
a. Total amount of attorney's fees for which court approval is requested: s[13,750,00____]
(if fees are requested, attach as Attachment 15a a declaration from the attorney explaining the basis for the request, including
a discussion of applicable factors listed in rule 7.955(b) of the Caf. Rules of Court. include a copy of any written attomey fee
agreement in Attachment 15a.)
The following additional items of expense (other than medical expenses) have been incurred or paid, are reasonable, resulted
from the incident or accident, and should be paid or reimbursed out of claimant's share of the proceeds of the settlement or
judgment:
Items Payees (names) Amounts
Minor’s Comp Filing Fee Tofer & Associates ¢ 435.00
Costs and other filing fees Tofer & Associates $ 964.00
Total: $
[1 Continued on Attachment 15b.
c. [] are not apportioned between them on a pro rata basis based
Costs of suit attributable to more than one settling plaintiff
on their gross settlement amounts. The apportionment of these costs is described and explained in Attachment 15c.
16. Reimbursement of expenses paid by petitioner
a. G4 Petitioner has paid none of the claimant's expenses listed in items 14 and 15 for which reimbursement is requested.
b. [C] Petitioner has paid the following total amounts of the claimant's expenses for which reimbursement is requested.
(1) [) Medical expenses listed in item 14: $
(2) [_) Attorney's fees included in the total fee amount shown in item 15a: $
(3) [£2] Other expenses included in the total shown in item 15b:
(Attach proofs of the expenses incurred and payments made, 6.g., bills or
invoices, canceled checks, cradit card statements, explanations of benefits
vee CT
from insurers, etc.)
17. Net balance of proceeds for the clalmant
The balance of the proceeds of the proposed settlement or judgment remaining for the claimant after payment or
reimbursement of all requested fees and expenses is (specify): $19,943.05
Page Sof 8
(New Sarum 12010 EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED
CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF
JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY
{Miscellaneous)
MC-350EX
CASE NAME: ‘CASE NUMBER:
[In Re: Moises Guerrero, Jr. - Minor's Compromise
18, Summary
a. Gross amount of proceeds of settlement or judgment
for claimant: $ 55,000.00
b. Medical expenses to be paid from proceeds of settlement
or judgment: $19,907.25
Attorney's fees to be paid from proceeds of settlement or
judgment: $ 13,750.00
Expenses (other than medical) to be paid from proceeds
of settlement or judgment: 1,399.00
$ Awe
Total of fees and expenses to be paid from proceeds of settlement or judgment
(add (b), (¢), and (d)): $ (35,056.95 }
Balance of proceeds of settlement or judgment available for claimant after payment of all
fees and expenses (subtract (e) from (a): $¢ 19,943.05
19. Information about attorney representing or assisting petitioner
a. Theattorney [__] isnot Oss representing or employed by any other party involved in this matter.
(if you answered “is,” identify the other party and explain the relationship in Attachment 19a. if the other party is a defendant,
you must use form MC-350 for your petition and are not eligible for expedited consideration by the court. See item 3e on page 1
and Cal. Rules of Court, rule 7.950.5(a)(6).)
The attomey [2] has neither received nor expectsto receive [—] has received or expects to receive attorney's fees
or other compensation in addition to that requested in this petition for services provided in connection with the claim giving rise
to this petition (if you answered “has received or expects to receive,” identify the person who paid or will pay the fees or other
compensation, the amounts paid orfo be paid, and the dates of payment or expected payment):
From Whom Paid or Expected (name): Date Paid or Expected Amount Paid or Expected
[2] Continued on Attachment 19. Tota: $7
20, Disposition of balance of proceeds of settlement or Judgment
Petitioner requests that the balance of the proceeds of the settlement or judgment be disbursed as follows:
a, [] There is a guardianship of the estate of the minor or a conservatorship of the estate of the adult person with a
disability filed in (name of court):
Case no.:
mC I$ of the proceeds in money or other property will be paid or delivered to
the guardian of the estate of the minor or the conservator of the estate of the conservatee. The money
‘or other property is specified in Attachment 20a(1).
@ CO Petitioner is the guardian or conservator of the estate of the minor or the adult person with a disability.
Petitioner requests authority to deposit or invest $ of the money or other
property to be paid or delivered under 20a(1) with one or more financial institutions in this state or with a trust
company, subject to withdrawal only as authorized by the court. The money or other property and the name,
branch, and address of each financial institution or trust company are specified in Attachment 20a(2).
Page
6 of 8
(New dru 1, 2040 EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED
CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF
JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY
(Miscellaneous)
MC-350EX
CASE NAME: CASE NUMBER:
Lin Re: Moises Guerrero, Jr. - Minor's Compromise
20. Disposition of balance of proceeds of settlement or judgment
Petitioner requests that the balance of the proceeds of the settlement or judgment be disbursed as follows:
a. There is a guardianship of the estate of the minor
or a conservatorship
of the estate of the adult person with a disability
(3) [= Petitioner proposes that all or a portion of the procaeds not become part of the guardianship or
conservatorship estate. Petitioner requests authority to deposit or transfer these proceeds as follows.
(check aif that apply}:
(a) $ will be deposited in insured accounts in one or more financial
institutions in this state from which no withdrawals can be made without a court order.
The name, branch, and address of each depository are specified in Attachment 20a(3),
CI s will be invested in a single-premium deferred annuity subjectto
withdrawal only on order of the court. The terms and conditions of the annuity are specified in
Attachment 20a(3).
@Cos will be transferred to a custodian for the benefit of the minor under the
Califomia Uniform Transfers to Minors Act. The name and address of the proposed custodian
and the property to be transferred are specified in Attachment 20a(3).
b. There is no guardianship of the estate of the minoror conservatorship of the estate of the adult person with a disability.
Petitioner requests that the balance of the proceeds of the settlement or judgment be disbursed as follows (check all
that apply):
(1) [) A guardian of the estate of the minor or a conservator of the estate of the adult person with a disability
willbe appointed. $ of money and other property will be paid or delivered to the
person so appointed. The money or other property are specified in Attachment 20b(1).
QO $ 19,943.05 of money will be deposited in insured accounts in one or more financial
institutions in this state, subjectto withdrawal only upon the authorization of the court. The name, branch,
and address of each depository are specified in Attachment 20b(2).
$ of money will be invested in a single-premium deferred annuity, subject to
@) CO
withdrawal only upon the authorization of the court. The terms and conditions of the annuity are specified
in Attachment 20b(3).
@ CO $ will be paid or delivered to a parent of the minor, upon the terms and under the
conditions specified in Probate Code sections 3401-3402, without bond. The name and address of the
parent and the money or other property to be delivered are specified in Attachment 20b(4).
(Value of minor's entire estate, including the money or property to be delivered, must not exceed $5,000.)
6 CI $ will be transferred to a custodian for the benefit of the minor under the California
Uniform Transfers to Minors Act. The name and address of the proposed custodian and the money or other
property to be transferred are specified in Attachment 20b(5).
@® CO $ of money will be held on such conditions as the court in its discretion determines
is in the best interest of the minor or the adult person with a disability. The proposed conditions are
specified on Attachment 20b(6). (Value must not exceed $20,000.)
mC) $ of property other than money will be held on such conditions as the court in its
discretion determines is in the best interest of the minor or the adult person with a disability. The proposed
conditions and the property are specified in Attachment 20b(7).
@ CI $ will be deposited with the county treasurer of the County of (name):
The deposit is authorized under and subject to the conditions specified in Probate Code section 361 1(h).
@ CO $ will be paid or transferred to the adult person with a disability. The money or other
property is specified in Attachment 20b(9).
[1 Continued on Attachment 20.
Page
7 of @
[Now fans 2010] EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED
CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF
JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY
(Miscellaneous)
CASE NAME: MC-350EX
CASE NUMBER:
In Re: Moises Guerrero, Jr. - Minors Compromise
24. Patttioner recommends the compromise settlement or
the disposition of the proceeds of the Judgment for the ofalmant to
the court as being fai, Teason and In ab
the bestle
interes
, t ofthe claimant and requests thet the court approve
this compromise
‘Settlement or proposed disposition and maka such other and further orders as may be just and reasonable,
22. [7] Additionordare
al
Petitioner requests the following additional orders
(apecity and explain):
(J Continued on Attachment 22.
23. Number
of pages attached: __
va: 9/23 /antq |<
Jennifer Mahgerefteh, Esq. d
{TVPE.OR PRINT HAMA OF ATTORNEY) ¢RIQMATURE
OF ATTORNEY)
(declare under penalty of pesury under the laws of the State of Califomla that the foragolng ix true and correct,
Date:
Molses Guerrero
Sr,
(TYPE OR PRINT NAMES OF PETITIONER
» Hotses Gueweo Cole's
{SIGNATURE
GF PETITIONER)
EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED Paypetore
(ow inary
4 2010
CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF
JUDGMENT FOR MINOR OR PERSON WITH A DISABLITY
{Miscellaneous}
ATTACHMENT 3
GRAHAM S LOPEZ
7808 CLAIRMNT MSA 203
SAN DIEGO, CA92111
FARMERS
Ser
INSURANCE
Auto Insurance Renewal Offer
Your Farmers Policy
Policy Number: 18473-97-23
JERRY GONZALEZ Effective: 6/7/2016 12:01 AM
1145 DAISY CT Expiration: 12/7/2016 12:01 AM
DINUBA CA 93618-8041
Your Farmers Agent
Graham S Lopez
7808 Clairmnt Msa 203
4/12/2016
San Diego, CA92111
Dear Jerry Gonzalez, (858) 560-1909
glopez1 @farmersagent.com
Thank you for choosing Farmers for your automobile insurance needs. We appreciate the
opportunity to provide continued coverage for you and your family. To file a claim call
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Please review the renewal documents that have been enclosed:
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Sincerely,
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Graham S Lopez
(858) 560-1909
glopez1@farmersagent.com
LL
farmers.com
25-8164 114
FARMERS
Auto Insurance Declaration Page INSURANCE
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Underwritten By: Mid-Century Insurance Company Your bill with the amount due will be mailed separately.
6301 Owensmouth Ave. Se
Woodland Hills, CA91367
Household Drivers
Driver Status Name Driver Status
Name
Covered Veronica Puentes Gonzalez Covered
Jerry Gonzalez
Vehicle Information
Veh. # Year/Make/Model/VIN Coverage Deductible Limit
1 2013 Dodge Truck Durango 4D 4X2 Sxt Comprehensive: $1,000
1C4RDHAGODC504722 Collision: $1,000
Additional Equipment: $1,000
Coverage Information Premiums by Vehicle
Vehicle 1
Coverage (applicable to all cation
Bodily Injury Liability $50,000 each person $175.60
$100,000 each accident
$50,000 each accident Included
Property Damage Liability
Not Covered
Medical Coverage
$25,000 each person $17.00
Uninsured Motorist Bodily
Injury $50,000 each accident
$56.10
Comprehensive
$150.30
Collision
Included
Additional Equipment
See Endorsement H1157,
$5.90
Uninsured Motorist Property
Damage With Collision coverage C-2
LL
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MC-350EX ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY Jennifer Mahgerefteh, Esq. (SBN. 307502) |Tofer & Associates, 8889 West Olympic Boulevard, Penthouse E-FILED Beverly Hills, CA 90211 9/30/2019 1:17 PM tevepHone No: 310-277-9000 FAX NO. (Optional) Superior Court of California E-MAIL ADDRESS (Optional) County of Fresno ATTORNEY FOR (Name): Moises Guerrero, Sr. and Moises Guerrero, Jr. By: C. York, Deputy SUPERIOR COURT OF CALIFORNIA, COUNTY OF Fresno streeraporess: 1100 Van Ness Avenue MAILING ADDRESS: cir AND ZIP CODE: Fresno, CA 93724 BRANCH NAME: CASE NAME: CASE NUMBER: 19CECG03544 In Re: Moises Guerrero, Jr. - Minor's Compromise EXPEDITED PETITION TO APPROVE: [Z1 No hearing date is requested. [2] COMPROMISE OF DISPUTED CLAIM [1] tearine pate: [-) COMPROMISE OF PENDING ACTION [© DISPOSITION OF PROCEEDS OF JUDGMENT DEPT. TIME: (21 Minor [_] Person With a Disability NOTICE TO PETITIONERS You must use this form if you wish to request expedited court approval of certain (1) compromises of disputed claims of a minor, (2) compromises of pending actions or proceedings in which a minor or a person with a disability (including a conservatee) is a party, or (3) dispositions of the proceeds of judgments for a minor or person with a disability. (See Code Civ. Proc., § 372; Prob. Code, § 3500 et seq.) You may use this form if (1) you are represented by an attorney; (2) the statements in items 3a, 3b, 3c, 3d, 3e, 3f, and either 3g(1) or 39(2) below are true; and (3) the court does not otherwise order. If you qualify and choose to use this form, the court may consider and act on your petition without a hearing. If your compromise or judgment does not qualify for expedited treatment or you choose not to use this form, you must use the Petition to Approve Compromise of Disputed Claim or Pending Action or Disposition of Proceeds of Judgment for Minor or Person With a Disability (form MC-350), and the court will schedule a hearing. See Cal. Rules of Court, rules 7.950, 7.950.5, and 7.951. Petitioner (name): Moises Guerrero, Sr. Claimant (name): Moises Guerrero, Jr. a. Address:[392 N 4th Street, Orange Cove, CA 93646 b. Date of birth: 8/27/2007 c. Age: 11 d. Sex: M e. [Z] Minor f. [] Person with a disability Expedited petition a. The claimant's claim or action is not for damages for the death of a person caused by the wrongful act or neglect of another. b. No portion of the net proceeds of the judgment or settlement in favor of the claimant is to be placed in a trust. ©. There are no unresolved disputes concerning liens to be satisfied from the proceeds of the judgment or settlement. the d. Petitioner's attorney did not become involved with this matter, directly or indirectly, at the request of a party against whom claim is asserted or a party's insurance carrier. Petitioner's attorney is not representing, employed by, or associated with a defendant in this matter or an insurance carrier. or the court All defendants that have appeared in a pending action on the claim are participating in the proposed compromise has finally determined that all settling parties entered into the settlement in good faith. (1) [1 The judgment for the claimant described in item 5c (exclusive of interest and costs) or the total of the settlement of described in items 12 and 13 payable to the claimant and all other persons named in item 13 is in the amount $50,000 or less; or (2) The settlement described in item 12 represents payment of the single-person policy limits of all liability insurance that all of policies covering the defendants named in that item. The investigation described in Attachment 3 shows insurance coverage. (Describe investigation and results in those defendants are judgment proof outside of their Page 1 of 8 Attachment 3.) Form for EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED “full rocedure‘Code, § 372 et seq; § 3500 et seq.; Alternative Mandatory Use Cal, Rules of Court, rules 3.1384, Judicial Council of California CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS 7.401, 7.950, 7.950.5, 7.964 MC-350EX [New January 1, 2010] wunw.courtinfo.ca.gov OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY (Miscellaneous) MC-350EX CASE NAME: CASE NUMBER: Ln Re: Moises Guerrero, Jr. - Minor's Compromise 4. Relationship Petitioner's relationship to the claimant (check aif applicable boxes): Parent g. [_] Other relationship (specify): Guardian ad litem Guardian Conservator Disabled adult claimant is a petitioner. (See instructions for items 4e and 4f below.) Disabled adult claimant's express consent to the relief requested in this petition is provided on Attachment 4f. (if you checked item 4e or 4f, state facts on Attachment 4e or 4f showing that the claimant has capacity under Probate Code section 812 to petition or consent fo a petition. Onlyan adult claimant who has sufficient capacity and who does not have a conservator of the estate may petition or consent to a petition. See Probate Code section 3613.) Nature of claim The claim of the minor or adult person with a disability: a. LZ) Isnotthe subject of a pending action or proceeding. (Complete items 6-23.) b. [_] Is the subject of a pending action or proceeding that will be compromised without a trial on the merits of the claim. Name of court: Case no.: Trial date: (Complete items 6-23.) c. [1 is the subject of a pending action or proceeding that has been or will be reduced to a judgment for the claimant against the defendants named below in the total amount (exclusive of interest and costs) of (specify): sL Defendants (names) Veronica Puentes Gonzalez [1 Additional defendants listed on Attachment 5. [) The judgment was filed on (date): (Attach a copy of the (proposed) judgment as Attachment Sc and complete items 14-23.) 6. [7] Incident or accident ‘The incident or accident occurred as follows: a, Date: 9/2/16 Time: 5:45 p.m. b. Place: Monson Ave & Manning Avenue, Orange Cove, CA 93646 c. Persons involved (names): Moises Guerrero Jr. (minor - passenger) Moises Guerrero Sr. (petitioner -father) Veronica Puentes Gonzalez (Third Party driver) Juan Guerrero (driver) [1 Continued on Attachment 6. 77 Nature of incident or accident The facts, events, and circumstances of the incident or accident are (describe): Moises Guerrero Jr., minor, was a restrained passenger in the vehicle driven by Juan Guerrero, which was travelling Westbound along Manning Avenue, when suddenly and without warning, Veronica Gonzalez who was travelling SouthBound along Monson Ave., collided into the vehicle driven by Juan Guerrero, causing serious injuries to Moises. [£1 Continued on Attachment 7. Page 20f 8 [Now Janey 20101 EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY (Miscellaneous) MC-350EX CASE NAME: CASE NUMBER: [-In Re: Moises Guerrero, Jr. - Minor’s Compromise 8. CZ injuries The following injuries were sustained by the claimant as a result of the incident or accident {describe}: Life threatening injuries, acute impairment of organ system, head injuries, severe trauma, acute hemorrhagic contusion of mesentery with hemoperitoneum, [51 Continued on Attachment 8. 9. Treatment The claimant received the following care and treatment for the injuries described in item 8 (describe): Emergency room treatment - Major / critical care [1 Continued on Attachment 9. 10, C21 Extent of injuries and recovery (An original or a photocopy of all doctors’ reports containing a diagnosis of and prognosis for the claimant's injuries, and a report of the claimant's present condition, must be attached to this petition as Attachment 10. A new report is not necessary so long as a previous report accurately describes the claimant's current condition.) a. [J The claimant has recovered completely from the effects of the injuries described in item 8, and there are no permanent injuries. The claimant has not recovered completely from the effects of the injuries described in item 8, and the following injuries from which the claimant has not recovered are temporary (describe the remaining injuries): Unknown at this time [1 Continued on Attachment 100. c. [-) The claimant has not recovered completely from the effects of the injuries described in item 8, and the following injuries from which the claimant has not recovered are permanent (describe the permanent injuries): ([) Continued on Attachment 10c. 11 Petitioner has made a careful and diligent inquiry and investigation to ascertain the facts relating to the incident or accident in which the claimant was injured; the responsibility for the incident or accident; and the nature, extent, and serlousness of the claimant's injuries. Petitioner fully understands that if the compromise proposed in this petition Is approved by the court and is consummated, the claimant will be forever barred from seeking any further recovery of compensation from the settling defendants named below even though the claimant's injuries may in the future appear to be more serious than they are now thoughtto be. 12.07) Amount and tems of settlement By way of settlement, the defendants named below have offered to pay the fotiowing sums to the claimant: a. The total amount offered by all defendants named below is (specify): $[55,000.00 b. The defendants and amounts offered by each are as follows (specify): Defendants (names) Amounts Veronica Puentes Gonzalez $ 55,000.00 $ $ $ ([) Additional defendants and amounts offered are listed on Attachment 12. c. The terms of settlement are described on Attachment 12. (If the settlement is to be paid in installments, both the total amount and the present value of the settlement must be included.) EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED Pagasofs [New Sisuay 1 2010 CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY (Miscellaneous) MC-350EX CASE NAME: CASE NUMBER: Hn Re: Moises Guerrero, Jr. - Minor's Compromise 13.21 Settlement payments to others No defendant named in item 12b has offered to pay money to any person or persons other than the claimant to settle claims arising out of the same incident or accident that resulted in the claimant's injury. py By way of settlement, one or more defendants named in item 12b have also offered to pay money to a person or persons other than claimant to settle claims arising out of the same incident or accident that resulted in the claimant's injury. $ (1) The total amount offered by all defendants to others (specify): (2) [-1) Petitioner would receive money under the proposed settlement. (3) The settlement payments are to be apportioned and distributed as follows: ther plaintiffs or claimants (names) Amounts $ $ $ $ [1 Additional plaintiffs or claimants and amounts are listed on Attachment 13. (4) [1 The settlement payments are apportioned between the claimant and each other plaintiff or claimant named above on a pro rata basis, based upon the special damages claimed by each. The special damages claimed by each other plaintiff or claimant are specified on Attachment 13. (5) [) Reasons for the apportionment of the settlement payments between the claimant and each other plaintiff or claimant named above are specified on Attachment 13. 14. The claimant's medical expenses, including medical expenses paid by petitioner, Medicare, Medi-Cal, and private insurers, that are to be reimbursed from proceeds of settlement or judgment a. Totals (1) Total expenses: (2) Total amount paid (including payments by private insurance, ledi-Cal, or Medicare): $(143,762.97 ) (3) Total of negotiated reductions, if any: $ 123,855.02 ) (4) Total amount of medical expenses to be paid or reimbursed from proceeds: $ (5) Total amount of medical liens, if any: $ (Identify each medical expense payer and the amount each paid, and explain any differences between items 14a(1), (4) and (5) in Attachment 14a.) Bites) None of the claimant's medical expenses have been paid by Medicare. @C Medicare paid some or all of claimant's medical expenses. In full satisfaction of its lien rights, Medicare will be reimbursed in the amount of $ (Attach a copy of the final Medicare demand letter or letter agreement as Attachment 14b(2).) c. (1) (2) mz None of the claimant's medical expenses have been paid by Medi-Cal. Medi-Cal paid all or some or all of the claimant's medical expenses. (a) Notice of this claim or action has been given to the State Director of Health Care Services under Welfare and Institutions Code section 14124.73. A copy of the notice and proof of its delivery [__] is attached. was filed in this matter on (date): (b) In full satisfaction of its lien rights, Medi-Cal has agreed to accept reimbursement in the amount of: (Attach a copy of the final Medi-Cal demand letter or letter agreement as Attachment 14c(2).) 5520025} d. [1 The claimant's health plan is requesting reimbursement for medical expenses paid under the plan. In full satisfaction of the plan's lien rights, it will be reimbursed in the amount of: $ [sean on awNET 2 (Attach statements from the plan showing expense payments and requesting reimbursement.) e. [_] Petitioner has paid claimant's medical expenses to be reimbursed in the amount of ¢ [emanate (See instructions for item 16.) Page 40f8 EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED iNew lanuary 12010] CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY (Miscellaneous) MC-350EX CASE NAME: CASE NUMBER: t-In Re: Moises Guerrero, Jr. - Minor's Compromise 14, The clalmant’s medical expenses, including medical expenses pald by petitioner, Medicare, Medi-Cal, and private insurers, that are to be relmbursed from proceeds of settlement or judgment There are one or more liens from medical servica providers for payment of claimant's medical expenses. In full satisfaction of their lien claims, the liennolders have agreed to accept the sum of: $ [703.70] 9g. (Select (1) or (2} befow.) (1) [1 Latest statements from all medical servics providers are attached as Attachment 14g. (2) [-_] Ali medical expenses have been paid by private insurance, Medicare, or Medi-Cal. 15. The claimant's attorney's fees and all other expenses (except medical expenses), including fees or expenses paid by petitioner and claimant's attomey, to be paid or reimbursed from proceeds of settlement or judgment a. Total amount of attorney's fees for which court approval is requested: s[13,750,00____] (if fees are requested, attach as Attachment 15a a declaration from the attorney explaining the basis for the request, including a discussion of applicable factors listed in rule 7.955(b) of the Caf. Rules of Court. include a copy of any written attomey fee agreement in Attachment 15a.) The following additional items of expense (other than medical expenses) have been incurred or paid, are reasonable, resulted from the incident or accident, and should be paid or reimbursed out of claimant's share of the proceeds of the settlement or judgment: Items Payees (names) Amounts Minor’s Comp Filing Fee Tofer & Associates ¢ 435.00 Costs and other filing fees Tofer & Associates $ 964.00 Total: $ [1 Continued on Attachment 15b. c. [] are not apportioned between them on a pro rata basis based Costs of suit attributable to more than one settling plaintiff on their gross settlement amounts. The apportionment of these costs is described and explained in Attachment 15c. 16. Reimbursement of expenses paid by petitioner a. G4 Petitioner has paid none of the claimant's expenses listed in items 14 and 15 for which reimbursement is requested. b. [C] Petitioner has paid the following total amounts of the claimant's expenses for which reimbursement is requested. (1) [) Medical expenses listed in item 14: $ (2) [_) Attorney's fees included in the total fee amount shown in item 15a: $ (3) [£2] Other expenses included in the total shown in item 15b: (Attach proofs of the expenses incurred and payments made, 6.g., bills or invoices, canceled checks, cradit card statements, explanations of benefits vee CT from insurers, etc.) 17. Net balance of proceeds for the clalmant The balance of the proceeds of the proposed settlement or judgment remaining for the claimant after payment or reimbursement of all requested fees and expenses is (specify): $19,943.05 Page Sof 8 (New Sarum 12010 EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY {Miscellaneous) MC-350EX CASE NAME: ‘CASE NUMBER: [In Re: Moises Guerrero, Jr. - Minor's Compromise 18, Summary a. Gross amount of proceeds of settlement or judgment for claimant: $ 55,000.00 b. Medical expenses to be paid from proceeds of settlement or judgment: $19,907.25 Attorney's fees to be paid from proceeds of settlement or judgment: $ 13,750.00 Expenses (other than medical) to be paid from proceeds of settlement or judgment: 1,399.00 $ Awe Total of fees and expenses to be paid from proceeds of settlement or judgment (add (b), (¢), and (d)): $ (35,056.95 } Balance of proceeds of settlement or judgment available for claimant after payment of all fees and expenses (subtract (e) from (a): $¢ 19,943.05 19. Information about attorney representing or assisting petitioner a. Theattorney [__] isnot Oss representing or employed by any other party involved in this matter. (if you answered “is,” identify the other party and explain the relationship in Attachment 19a. if the other party is a defendant, you must use form MC-350 for your petition and are not eligible for expedited consideration by the court. See item 3e on page 1 and Cal. Rules of Court, rule 7.950.5(a)(6).) The attomey [2] has neither received nor expectsto receive [—] has received or expects to receive attorney's fees or other compensation in addition to that requested in this petition for services provided in connection with the claim giving rise to this petition (if you answered “has received or expects to receive,” identify the person who paid or will pay the fees or other compensation, the amounts paid orfo be paid, and the dates of payment or expected payment): From Whom Paid or Expected (name): Date Paid or Expected Amount Paid or Expected [2] Continued on Attachment 19. Tota: $7 20, Disposition of balance of proceeds of settlement or Judgment Petitioner requests that the balance of the proceeds of the settlement or judgment be disbursed as follows: a, [] There is a guardianship of the estate of the minor or a conservatorship of the estate of the adult person with a disability filed in (name of court): Case no.: mC I$ of the proceeds in money or other property will be paid or delivered to the guardian of the estate of the minor or the conservator of the estate of the conservatee. The money ‘or other property is specified in Attachment 20a(1). @ CO Petitioner is the guardian or conservator of the estate of the minor or the adult person with a disability. Petitioner requests authority to deposit or invest $ of the money or other property to be paid or delivered under 20a(1) with one or more financial institutions in this state or with a trust company, subject to withdrawal only as authorized by the court. The money or other property and the name, branch, and address of each financial institution or trust company are specified in Attachment 20a(2). Page 6 of 8 (New dru 1, 2040 EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY (Miscellaneous) MC-350EX CASE NAME: CASE NUMBER: Lin Re: Moises Guerrero, Jr. - Minor's Compromise 20. Disposition of balance of proceeds of settlement or judgment Petitioner requests that the balance of the proceeds of the settlement or judgment be disbursed as follows: a. There is a guardianship of the estate of the minor or a conservatorship of the estate of the adult person with a disability (3) [= Petitioner proposes that all or a portion of the procaeds not become part of the guardianship or conservatorship estate. Petitioner requests authority to deposit or transfer these proceeds as follows. (check aif that apply}: (a) $ will be deposited in insured accounts in one or more financial institutions in this state from which no withdrawals can be made without a court order. The name, branch, and address of each depository are specified in Attachment 20a(3), CI s will be invested in a single-premium deferred annuity subjectto withdrawal only on order of the court. The terms and conditions of the annuity are specified in Attachment 20a(3). @Cos will be transferred to a custodian for the benefit of the minor under the Califomia Uniform Transfers to Minors Act. The name and address of the proposed custodian and the property to be transferred are specified in Attachment 20a(3). b. There is no guardianship of the estate of the minoror conservatorship of the estate of the adult person with a disability. Petitioner requests that the balance of the proceeds of the settlement or judgment be disbursed as follows (check all that apply): (1) [) A guardian of the estate of the minor or a conservator of the estate of the adult person with a disability willbe appointed. $ of money and other property will be paid or delivered to the person so appointed. The money or other property are specified in Attachment 20b(1). QO $ 19,943.05 of money will be deposited in insured accounts in one or more financial institutions in this state, subjectto withdrawal only upon the authorization of the court. The name, branch, and address of each depository are specified in Attachment 20b(2). $ of money will be invested in a single-premium deferred annuity, subject to @) CO withdrawal only upon the authorization of the court. The terms and conditions of the annuity are specified in Attachment 20b(3). @ CO $ will be paid or delivered to a parent of the minor, upon the terms and under the conditions specified in Probate Code sections 3401-3402, without bond. The name and address of the parent and the money or other property to be delivered are specified in Attachment 20b(4). (Value of minor's entire estate, including the money or property to be delivered, must not exceed $5,000.) 6 CI $ will be transferred to a custodian for the benefit of the minor under the California Uniform Transfers to Minors Act. The name and address of the proposed custodian and the money or other property to be transferred are specified in Attachment 20b(5). @® CO $ of money will be held on such conditions as the court in its discretion determines is in the best interest of the minor or the adult person with a disability. The proposed conditions are specified on Attachment 20b(6). (Value must not exceed $20,000.) mC) $ of property other than money will be held on such conditions as the court in its discretion determines is in the best interest of the minor or the adult person with a disability. The proposed conditions and the property are specified in Attachment 20b(7). @ CI $ will be deposited with the county treasurer of the County of (name): The deposit is authorized under and subject to the conditions specified in Probate Code section 361 1(h). @ CO $ will be paid or transferred to the adult person with a disability. The money or other property is specified in Attachment 20b(9). [1 Continued on Attachment 20. Page 7 of @ [Now fans 2010] EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY (Miscellaneous) CASE NAME: MC-350EX CASE NUMBER: In Re: Moises Guerrero, Jr. - Minors Compromise 24. Patttioner recommends the compromise settlement or the disposition of the proceeds of the Judgment for the ofalmant to the court as being fai, Teason and In ab the bestle interes , t ofthe claimant and requests thet the court approve this compromise ‘Settlement or proposed disposition and maka such other and further orders as may be just and reasonable, 22. [7] Additionordare al Petitioner requests the following additional orders (apecity and explain): (J Continued on Attachment 22. 23. Number of pages attached: __ va: 9/23 /antq |< Jennifer Mahgerefteh, Esq. d {TVPE.OR PRINT HAMA OF ATTORNEY) ¢RIQMATURE OF ATTORNEY) (declare under penalty of pesury under the laws of the State of Califomla that the foragolng ix true and correct, Date: Molses Guerrero Sr, (TYPE OR PRINT NAMES OF PETITIONER » Hotses Gueweo Cole's {SIGNATURE GF PETITIONER) EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED Paypetore (ow inary 4 2010 CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABLITY {Miscellaneous} ATTACHMENT 3 GRAHAM S LOPEZ 7808 CLAIRMNT MSA 203 SAN DIEGO, CA92111 FARMERS Ser INSURANCE Auto Insurance Renewal Offer Your Farmers Policy Policy Number: 18473-97-23 JERRY GONZALEZ Effective: 6/7/2016 12:01 AM 1145 DAISY CT Expiration: 12/7/2016 12:01 AM DINUBA CA 93618-8041 Your Farmers Agent Graham S Lopez 7808 Clairmnt Msa 203 4/12/2016 San Diego, CA92111 Dear Jerry Gonzalez, (858) 560-1909 glopez1 @farmersagent.com Thank you for choosing Farmers for your automobile insurance needs. 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Underwritten By: Mid-Century Insurance Company Your bill with the amount due will be mailed separately. 6301 Owensmouth Ave. Se Woodland Hills, CA91367 Household Drivers Driver Status Name Driver Status Name Covered Veronica Puentes Gonzalez Covered Jerry Gonzalez Vehicle Information Veh. # Year/Make/Model/VIN Coverage Deductible Limit 1 2013 Dodge Truck Durango 4D 4X2 Sxt Comprehensive: $1,000 1C4RDHAGODC504722 Collision: $1,000 Additional Equipment: $1,000 Coverage Information Premiums by Vehicle Vehicle 1 Coverage (applicable to all cation Bodily Injury Liability $50,000 each person $175.60 $100,000 each accident $50,000 each accident Included Property Damage Liability Not Covered Medical Coverage $25,000 each person $17.00 Uninsured Motorist Bodily Injury $50,000 each accident $56.10 Comprehensive $150.30 Collision Included Additional Equipment See Endorsement H1157, $5.90 Uninsured Motorist Property Damage With Collision coverage C-2 LL Questions? 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