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MC-350EX
[ATTORNEY OR PARTY WITHOUT ATTORNEY ‘STATE BAR NUMBER FOR COURT USE ONLY
Name: CONNIE A. RODRIGUEZ, ESQ. SBN: 278086
Firmname: ARROYO LAW, Inc.
street avoress: 900 TRUXTUN AVENUE, SUITE 200
cry: BAKERSFIELD state: CA ZIP CODE:
LeLEPHONE No: (661) 404 — 4334 Faxno: (661) 348 — 4436
Email abbRESS: Connie@conniearroyolaw.com
ATTORNEY FOR (Name): PLAINTIFFS
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
streeTaporess. 1215 TRUXTUN AVENUE
maitincapoRess: 1215 TRUXTUN AVENUE
city AND zip cove: BAKERSFIELD, CA 93301
BRANCH NAME. METROPOLITAN DIVISION — UNLIMITED
CASE NAMEREINA E. ESCOBAR; AND BENJAMIN QUINTERO, A MINOR, BY AND | case numser. BCV-23-102794 GAP
ROUGH HIS GUARDIAN AD LITEM, REINA E. ESCOBAR v MARK
KANDLER: AND DOES 1 TO 100, INCLUSIVE.
(XJ No hearing date is requested.
PETITION FOR EXPEDITED APPROVAL OF COMPROMISE OF —[L_] REARING ORE
CLAIM OR ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT
FOR MINOR OR PERSON WITH A DISABILITY DEPT TIME
NOTICE TO PETITIONER
You must use this form to request expedited court approval ofa qualifying (1) compromise ofa minor's disputed claim, (2) compromise
lof a pending action or proceeding in which a minor or a person with a disability (including a conservatee) is a party, or (3) disposition of
ithe proceeds of a judgment for a minor or person with a disability. (See Code Civ. Proc., § 372; Prob. Code, §§ 3500, 3600-3613.) You
may request expedited approval only if (1) you are represented by an attorney; (2) the statements in items 3a, 3b, 3c, 3d, 3e, 3f, and
leither 3g(1) or 3g(2), below, are true and accurate; and (3) the court does not otherwise order.
lf your compromise or judgment qualifies and you choose to use this form, the court may consider and act on your petition without a
hearing. If your compromise or judgment qualifies for expedited consideration but you choose not to use this form or your compromise
lor judgment does not qualify for expedited consideration, you must use Petition for Approval of Compromise of Claim or Action or
Disposition of Proceeds of Judgment for Minor or Person With a Disability (form MC-350), and the court will schedule a hearing.
1 Petitioner (name or pseudonym”): REINA E. ESCOBAR
is the (check all boxes that apply): (Parent (£X) Guardian ad litem* [J Guardian [) Conservator
() Other (specify relationship):
of the claimant identified in item 2. (“Petitioner may appear under a pseudonym only if appointed as guardian ad litem under that
pseudonym. (See Code Civ. Proc., § 372.5.))
Claimant (name): BENJAMIN QUINTERO, a Minor
a. Address: 3800 PLANZ ROAD BAKERSFIELD, CA 93309
b. Date of birth: 09/02/2007 c. Age: 16 d. (XJ Minor or (Person with a disability
(If the claimant is an adult with a disability who (1) has capacity to consent to the order requested and (2) does not have a
conservator of the estate, check e. and f. and ensure that the claimant personally reads and signs item 21. (Prob. Code, § 3613.))
e. (_] Has the capacity, within the meaning of Probate Code section 812, to consent to the requested order.
f. [-_] Does not have a conservator of the estate.
Qualification for Expedited Approval
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.
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.
Petitioner's attorney did not become involved with this matter, directly or indirectly, at the request of a party against whom the
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.
All defendants that have appeared in a pending action on the claim are participating in the proposed compromise or the court
has made a final determination that all settling parties entered into the settlement in good faith.
(1) [EX] The judgment described in item 4c (exclusive of interest and costs) or the total settlement described in items 11 and
12 payable to the claimant and all other persons named in item 12 is in the amount of $50,000 or less; or
(2) [J The settlement described in item 11 represents payment of the single-person policy limits of all liability insurance
policies covering the defendants named in that item. The investigation described in Attachment 3 shows that all of
those defendants are judgment-proof outside of their insurance coverage. (Describe investigation and results in
Attachment 3.)
Page 1 of 7
Form Adopted for Alternative Mandatory Use Code of Civil Procedure, § 372;
Instead of Form MC-350 PETITION FOR EXPEDITED APPROVAL OF COMPROMISE OF Probate Code, §§ 3500, 2600-3613:
Judicial Council of California Cal, Rules of Court, rules 3 1384,
MC-350EX [Rev. January 1, 2021} CLAIM OR ACTION OR DISPOSITION OF PROCEEDS OF 7.101, 7.950, 7.9505, 7.951
JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY www courts ca gov
MC-350EX
ICASE NAMEREINA E. ESCOBAR; AND BENJAMIN QUINTERO, A MINOR, BY AND | case numser. BCV-23-102794 GAP
THROUGH HIS GUARDIAN AD LITEM, REINA E. ESCOBAR v MARK
KANDLER; AND DOES | TO 100, INCLUSIVE.
4. Claim The claim of the minor or adult person with a disability:
a. [__] Isnot the subject of a pending action or proceeding. (Complete items 5-23.)
b. [(%] Is the subject of a pending action or proceeding that will be compromised without a trial. (Complete items 5-23.)
Name of court: KERN COUNTY SUPERIOR COURT
Case no.: BCV-23-102794 GAP Trial date: CASE SETTLED
c. Is the subject of an action or proceeding in which a judgment has been or will be entered for the claimant against the
defendants named below in the amount (exclusive of interest and costs) of (specify): $ 25,000.00
Defendants (names:
MARK KANDLER
([) Additional defendants listed on Attachment 4. [J The judgment was filed on (date):
(Attach a copy of the (proposed) judgment as Attachment 4c and complete items 13-23.)
5. Incident or accident The incident or accident occurred as follows:
a. Date: DECEMBER 22, 2022 Time: About 8:26 A.M.
b. Place: PLANZ ROAD, APPROXIMATELY 15 FEET EAST OF AKERS ROAD IN BAKERSFIELD, KERN
c. Persons involved (names):
BENJAMIN QUINTERO, a Minor
REINA E. ESCOBAR
MARK KANDLER
PEDRO LUIS TORRES
FELICIA TORRES
AUTUMN TORRES, a Minor
(_) Additional persons listed on Attachment 5.
6. Nature of incident or accident
The facts, events, and circumstances of the incident or accident are (describe what hi
‘ttop ened):
Defendant, Mark Kandler, was driving westbound on Planz Road at a gh rate of speed and struck the rear end
of Plaintiffs’ vehicle while Plaintiff driver, Reina E. Escobar, was stopped at the red light, while her Minor son,
Benjamin Quintero was a front seat passenger. As a result of this collision, Defendant also collided into the
vehicle that Claimant Pedro Luis Torres was operating, Claimant Felicia Torres occupied as a passenger, and
Minor Claimant, Autumn Torres, occupied as a passenger.
() Continued on Attachment 6.
Injuries
fi
The following injuries were sustained by the claimant as a result of the incident or accident (describe):
enjamin Quintero, a minor, sui ered an abrasion to the back of his head, posterior head pain, abrasion to right
wrist and pain, loss of consciousness, post concussive syndrome, and emotional distress.
() Continued on Attachment 7.
Treatment
The claimant received the following care and treatment for the injuries described in item 7 (describe):
Benjamin Quintero, a Minor, received a CT of the head, Chest X-Ray, and right wrist X-Ray in the Emergency
Department.
() Continued on Attachment 8.
MC-350EX [Rev. January 1, 2021] Page
2 of 7
PETITION FOR EXPEDITED APPROVAL OF COMPROMISE OF
CLAIM OR ACTION OR DISPOSITION OF PROCEEDS OF
JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY
MC-350EX
ICASE NAME: REINA E. ESCOBAR; AND BENJAMIN QUINTERO, A MINOR, BY AND| case numser: BCV-23-102794 GAP
THROUGH HIS GUARDIAN AD LITEM, REINA E. ESCOBAR v MARK.
KANDLER; AND DOES 1 TO 100, INCLUSIVE.
Extent of injuries and recovery (An original or a photocopy of any doctors report containing a diagnosis of the claimant's injuries
ora prognosis for the claimant's recovery, and a report of the claimant's current condition, must be attached to this petition as
Attachment 9. A new report is not necessary if a previous report accurately describes the ciaimant's current conditioz.)
a. [__] The claimant has recovered completely from the effects of the injuries described in item 7, and there are no permanent
injuries.
b. [5] The claimant has not recovered completely from the effects of the injuries described in item 7, and the following injuries
from which the claimant has not recovered are temporary (describe the remaining injuries and symptoms):
Benjamin Quintero, a Minor, has made a good recovery but will continue to experience residual
emotional pain due to the injuries.
[] Continued on Attachment 9b.
c. [_] The claimant has not recovered completely from the effects of the injuries described in item 7, and the following injuries
from which the claimant has not recovered are permanent (describe the permanent injuries and symptoms):
[J Continued on Attachment 9c.
10. [-X] Petitioner has made a careful and diligent inquiry and investigation into the facts and circumstances of the incident
or accident in which the claimant was injured; the responsibility for the incident or accident; and the nature, extent,
and seriousness of the claimant's injuries. Petitioner understands that if the compromise proposed in this petition is
approved by the court and consummated, the claimant will never be able to recover any more compensation from the
settling defendants named below even if the claimant's injuries turn out to be more serious than they now appear.
1 . Amount and terms of settlement
To settle the claim in 4a or 4b, the defendants named below have offered to pay the following amounts to the claimant:
a. The total amount offered by all defendants named below is (specify): $ 25,000.00
b. The defendants and amounts offered by each are as follows (specify):
Defendants (names) Amounts
MARK KANDLER $ 25,000.00
$
$
$
[] Additional defendants and amounts offered are listed on Attachment 1 1b.
c. The terms of settlement are described on Attachment 11c. (If the settlement is to be paid in installments, both the total amount
and the present value of the settlement must be included.)
12. Settlement payments to others
a. [__] No defendant named in item 11b 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.
b One or more of the defendants named in item 11b 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 is (specify): $ 30,000.00
(2) [X] Petitioner would receive money under the proposed settlement.
(8) The settlement payments are to be apportioned and distributed as follows:
Other plaintiffs or claimants (names) Amounts
REINA E. ESCOBAR $ 30,000.00
PEDRO LUIS TORRES $ 1,500.00
FELICIA TORRES $ 1,500.00
AUTUMN TORRES, a Minor $ 2,000.00
{_] Additional plaintiffs or claimants and amounts are listed on Attachment 12.
(4) [_] The settlement payments are apportioned between the claimant and each other plaintiff or claimant named above on
a pio rata basis, based upon the special damages claimed by each. The special damages claimed by each other
plaintiff or claimant are specified on Attachment 12.
(6) (XX) Reasons for the apportionment of the settlement payments between the claimant and each other plaintiff or claimant
named above are specified on Attachment 12.
MC-350EX (Rev. January 1, 2025] Page Sof
PETITION FOR EXPEDITED APPROVAL OF COMPROMISE OF
CLAIM OR ACTION OR DISPOSITION OF PROCEEDS OF
JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY
MC-350EX
ICASE NAME: REINA E. ESCOBAR; AND BENJAMIN QUINTERO, A MINOR, BY AND | case numeer: BCV-23-102794 GAP
[ROUGH HIS GUARDIAN AD LITEM, REINA E. ESCOBAR v MARK
KANDLER; AND DOES | TO 100, INCLUSIVE.
13. Claimant's medical expenses—including expenses paid by petitioner, Medicare, Medi-Cal, and private insurers—that are to
be paid or reimbursed from the proceeds of the settlement or judgment
a Totals
(1) Total medical expenses before any reductions: $ 25,456.70
(2) Total medical expenses paid (include payments by private insurance, Medi-Cal, or Medicare): g 11,276.58 )
(3) Total of negotiated, contractual, or statutory reductions, if any: & 3,099.73 )
(4) Total amount of medical expenses to be paid or reimbursed from proceeds: $ 8,176.85
(6) Total amount of statutory or contractual liens, if any: $ 8,176.85
(Identify each medical expense payer and the amount each paid, and explain any differences between items 13a(1), (4), and
(5) in Attachment 13a.)
(1) [J None of the claimant's medical expenses have been paid by Medicare.
(2) [_] Medicare paid some or ail 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 13b(2).)
(1) [[_] None of the claimant's medical expenses have been paid by Medi-Cal.
(2) [XX] Medi-Cal paid some or all of claimant's medical expenses.
(a) Notice of this claim or action has been given to the Director of Health Care Services. (Welf. & Inst. Code, § 14124.73.)
A copy of the notice and proof of 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 cf: $ 8,176.85
(Attach a copy of the final Medi-Cal demand letter or letter agreement as Attachment 13c(2).)
(J 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: $
(Attach statements from the plan showing expense payments and requesting reimbursement.)
[1] Petitioner has paid claimant's medical expenses to be reimbursed in the amount of: $
(See instructions for item 15.)
(1) There are no statutory or contractual liens for payment of the claimant's medical expenses
@) There are one or more liens from medical service providers for payment of the claimant's medical expenses.
In full satisfaction of their lien claims, the lienholders have agreed to accept the sum of: $
(Select (1) or (2) below.)
(1) [-_] Latest statements from all medical service providers are attached as Attachment 13g.
(2) All medical expenses have been paid by private insurance, Medicare, or Medi-Cal.
14. Claimant's attorney's fees and all other expenses (except medical expenses), including fees or expenses paid by petitioner
and claimant's attorney, to be paid or reimbursed from proceeds of settlement or judgment
a. Total amount of attorney's fees for which court approval is requested: $ 6,250.00
(if fees are requested, attach as Attachment 14a a declaration from the attomey explaining the basis for the request, including a
discussion of applicable factors listed in rule 7.955(b) of the Cal. Rules of Court. Include a copy of any written attorney fee
agreement in Attachment 14a.)
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
File Maintenance Fee (S(Split with: other ot) ARRO YO LAW. Inc. 150.00
KCSC OYO W, Inc. 225.83
KCSCE Fi MC- AEX ARROYO LAW. Inc. 3.60
KCSCE Filing Receipt & Ackno ement ARROYO LAW, Inc 3.60
KCSC E Filing POS of Summons/Dismissal (Split) ARROYO LAW, Inc 3.60
Medical/Bi sician Reco RROYO LAW, Inc 119.75
Investigationo!of Defendant (Split) ARROYO LAW, Inc 10.00
Service Attempts and Service to Defendant (Split) ARROYO LAW, Inc. 107.50
[] Continued on Attachment 14b. Total: $, 623.88
c. [__] Costs of suit attributable to more than one settling plaintiff are not apportioned between them on a pro rata basis based
‘on their gross settlement amounts. The apportionment of these costs is described and explained in Attachment 14c.
MC-350EX (Rev. January 1, 2021] Page
4 of 7
PETITION FOR EXPEDITED APPROVAL OF COMPROMISE OF
CLAIM OR ACTION OR DISPOSITION OF PROCEEDS OF
JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY
MC-350EX
\CASE NAME: REINA EB. ESCOBAR; AND BENJAMIN QUINTERO, A MINOR, BY AND | case number) BCV-23-102794 GAP
THROUGH HIS GUARDIAN AD LITEM, REINA E. ESCOBAR vy MARK
KANDLER; AND DOES 1 TO 100, INCLUSIVE.
15, Reimbursement of fees and expenses paid by petitioner
a. [-X] Petitioner has paid none of the fees or expenses listed in items 13 and 14 for which reimbursement is requested.
b. [__] Petitioner has paid the following total amounts of the claimant's fees and expenses for which reimbursement is requested.
(1) (] Medical expenses listed in item 13: $
(2) [__] Attorney's fees included in the total fee amount shown in item 14a: $
(3) [{_] Other expenses included in the total shown in item 14b: $
(Attach proofs of the fees and expenses incurred and payments made, e.g., bills or invoices, Total: $
canceled checks, credit card statements, explanations of benefits from insurers, etc.)
16. Net balance of proceeds remaining for claimant
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): $ 9,949.27
17. Summary
a Gross amount of proceeds of settlement or judgmeni for claimant: $ 25,000.00
b. Medical expenses to be paid from proceeds of settlement or judgment: $ 8,176.85
c. Attorney's fees to be paid from proceeds of settlement or judgment: $ 6,250.00
dq Expenses (other than medical) to be paid from proceeds of settlement
or judgment: $ 623.88
Total fees and expenses to be paid from proceeds of settlement or
judgment (add (b), (c), and (a)): $ 15,050.73
Balance of proceeds of settlement or judgment available for claimant
after payment of all fees and expenses (subtract (e) from (a)): $ 9,949.27
18. Information about attorney representing or assisting petitioner
a. The attorney [1] is not [x] is representing or employed by another party involved in this matter.
(if you answered "is," identify the other party and explain the relationship in Attachment 18a. 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 attorney {J has neither received nor expects to 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 or to be paid, and the dates of payment or expected payment):
Amount
Date Paid or Expected Paid or Expected
PLAINTIFF, REINA E ESCOBAR os an individual Upon Court Approval $ 6,000.00
$
$
$
(J Continued on Attachment 18b. Total: $_ _ 6,000.00
MC-350EX (Rev. January 1, 2021] Page
of 7
PETITION FOR EXPEDITED APPROVAL OF COMPROMISE OF
CLAIM OR ACTION OR DISPOSITION OF PROCEEDS OF
JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY
MC-350EX
GASE NAME: REINA E. ESCOBAR; AND BENJAMIN QUINTERO, A MINOR, BY AND | case womoen BCV.23-100794 GAP
THROUGH HIS GUARDIAN AD LITEM, REINA E. ESCOBAR v MARK
KANDLER; AND DOES | TO 100, INCLUSIVE.
19. Disposition of balance to claimant (check eithera or b, then check each option requested and enter amount(s):
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.:
(1) () Petitioner requests that $ of the proceeds in money or other property 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 19a(1).
(2) [_] 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 19a(1) in one or more insured accounts with financial institutions in this state or with a trust company, subject to
withdrawal only on authorization of the court. The money or other property and the name, branch, and address of
each financial institution or trust company are specified in Attachment 19a(2).
(3) (_) Petitioner proposes that all or a portion of the proceeds not become part of the guardianship or conservatorship
estate. Petitioner requests authority to deposit or transfer these proceeds as follows (check all that apply):
@ Cis to be deposited in insured accounts in one or more financial institutions in this state,
‘subject to withdrawal only on authorization of the court. The name, branch, and address of each depository are
specified in Attachment 19a(3)(a).
») Cs to be invested in a single-premium deferred annuity, subject to withdrawal only on
authorization of the court. The terms and conditions of the annuity are specified in Attachment 19a(3)(b).
© Cos to 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 property to be transferred are
specified in Attachment 19a(3)(c).
b. [XX] There is no guardianship of the estate of the minor or 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 be appointed
and $ of money and other property be paid or delivered to the person so appointed. The money
or other property are specified in Attachment 19b(1).
(2) CX $ 9,949.27 of money be deposited in insured accounts in one or more financial institutions in this state,
subject to withdrawal only on authorization of the court. The name, branch, and address of each depository are
specified in Attachment 19b(2).
@® Cos of money be invested in a single-premium deferred annuity, subject to withdrawal only on
authorization of the court. The terms and conditions of the annuity are specified in Attachment 19b(3).
4) $ be paid or delivered to a parent of the minor on 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 19b(4). (Value of minor's entire estate, including the money or
property to be delivered, must not exceed $5,000.)
© Cys 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 19b(5).
® CIs of money be held on the conditions that the court determines to be in the best interest of the
minor or adult person with adisability. The proposed conditions are specified on Attachment 19b(6). (Value must not
exceed $20,000.)
m Cos of property other than money be heid on the conditions that the court determines to be in the
best interest of the minor or adult person with a disability. The proposed conditions and the property are specified in
Attachment 19b(7).
® Cas 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 3611 {(h).
® Cos be paid or transferred to the adult person with a disability. The money or other property is
specified in Attachment 19b(9).
MC-350EX [Rev, January 1, 2021] Page6 of 7
PETITION FOR EXPEDITED APPROVAL OF COMPROMISE OF
CLAIM OR ACTION OR DISPOSITION OF PROCEEDS OF
JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY
MC-350EX
CASE NAME. REINA E. ESCOBAR; AND BENJAMIN QUINTERO, A MINOR, BY AND J case womser BCV-23-102794 GAP
THROUGH HIS GUARDIAN AD LITEM, REINA E. ESCOBAR v MARK
KANDLER; AND DOES 1 TO 100, INCLUSIVE
20.[[_] Additional orders
Petitioner requests the following additional orders (specify and explain):
{] Continued on Attachment 20.
21.[_] |, the claimant named in item 2, consent to the order or judgment requested in this petition.
(Required if the claimant is an adult with a disability who has the capacity, under Probate Code section 812, to consent to the
order or judgment and does not have a conservator of the estate. (See Prob. Code, § 3613.)
Date:
(TYPE OR PRINT NAME OF CLAIMANT) (SIGNATURE OF CLAIMANT)
22. Petitioner recommends the proposed compromise, settlement, or disposition of judgment proceeds for the claimant to the court as
being fair, reasonable, and in the best interest of the claimant. Petitioner requests that the court approve this compromise,
setilement, or disposition and make any other orders that are just and reasonable.
23. Number of pages attached: 77
Date: March 29, 2024
CONNIE A. RODRIGUEZ
(TYPE OR PRINT NAME) (SIGNATURE OF
\ declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date. March 29, 2024
REINA E. ESCOBAR » eine Garcon
(TYPE OR PRINT NAME OF PETITIONER) (SIGNATURE OF PETITIONER)
MC-350EX Rev. January
1, 2024] Page
7 of 7
PETITION FOR EXPEDITED APPROVAL OF COMPROMISE OF
CLAIM OR ACTION OR DISPOSITION OF PROCEEDS OF
JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY
MC-025
SHORT TITLE. REINA E. ESCOBAR; AND BENJAMIN QUINTERO, A MINOR, BY CASE NUMBER:
}— AND THROUGH HIS GUARDIAN AD LITEM, REINA E. ESCOBAR
v MARK KANDLER; AND DOES | TO 100, INCLUSIVE. BCV-23-102794 GAP
ATTACHMENT (Number): 9
(This Attachment may be used with any Judicial Council form.)
Reports of Claimant’s medical records and current condition are attached hereto, as Attachment 9.
(If the item that this Attachment concerns is made under penalty of perjury, all statements in this Page —_ 1 of 77
Attachment are made under penalty of perjury.)
(Add pages as required)
Form Approved for Optional Use ATTACHMENT ‘wwww.courtinfo.ca.gov
Judicial Council of California Westlaw
Doc & Form Bulider-
(MC-025 [Rev. July1, 2003] to Judicial Council Form
ae Hatt Ambulance
Patient Care Record
Name: ESCOBAR, BENJAMIN
Service Inc
Incident #: 22-00129302 Date: 12/22/2022 Patient 1 of 1
: ESCOBAR 3200 planz rd Inju
BENJAMIN
Bakersfield ~
Male CA
09/02/2007 ———. 93309 ——— ee
15 Yrs,3 Months, 20 Days US Head
90.0lbs- 40.8kg Home eoieo03iis
S Hispanic or Latino head pain
Hispanic or Li 20 Minutes
Mild
ne Pain - Pain (unspecified)
Motorized Vehicle Accident - Auto traffic
accident injures occupant- Street or
Hi - 12/22/2022
Blunt
Trauma
None Noted
None Reported
No —__.
Lower Acui (Green)
Lower Acuity (Green)
Activity, Unspecified
teers tian
Medications None Reported
No known allergies
| History None Reported
Immunizations
[Rast Oralintake |.
rime Avpu [Side] POS” "BP _RR {spo2_ Erco2| co! BG | fe Pain| GCS{E+Vsm)/Qualifier | PTS”
08:57 Alert | Sit 12jP_ 100R I 20R 99 Rm 4 15=4+5+6/NFP 2
09:10 108/664 100 | 18 6
Te: r
oes! z Q : : ler
“TALS Assessment Patient Response: Unchanged ; Successful; Complication: jone; fedical Control Protocol(Standing Order); SALAZAR, DEANNA |
{ 08:15 | Trauma Alert Patient Response: Unchanged; Complication: None; Medical Control: Protocol (Standing Order); SALAZAR, DEANNA |
09:15 [Contact Report Only Patient Response: Unchanged; Complication: None; Medical Control: Protocol (Standing Order); ‘SALAZAR, DEANNA
-e
= = :2
Mental Status Mental Status v Oriented- Event Oriented Person ~ Oriented Place =
Oriented
Rn. - ime
Skin skin No Abnormalities
HEENT Face Face: No Abnormalities ———
Head Head: No Abnormalities ee —
Eyes Both Eyes: PERRL
Neck No Abnormalities
Run Number: 22-00129302 Page 1 of6 01/27/2023 08:40:27
Hospital Chart Number: 3001692649 PCRID: 90ebfdb1-06b0-4258-9738-af73009c4ate
Patient Number: 21271241 Electronically Signed by: SALAZAR, DEANNA
Template Version: PCR-EXTRACT-1.3.1
Data Version: AAAMAAwmdcw=
Hall Ambulance Service Inc
atient Care Record
Name: ESCOBAR, BENJAMIN Incident #: 22-00129302 Date: 12/22/2022 Patient ofl
Time:
mments
Chest Chest General: No Abnormalities
Heart Sounds Not Assessed
Lung Sounds ti No Abnormalities
}0 Abnormalities
No Abnormalities
RU: No Abnormalities
[mack |
Abdomen General No Abnormalities
Back — — Back No Abnormalities i
Pelvis/GU/GI Pelvis/GU/GL Pelvis/GU/GI: No Abnormalities |
fe xtremities Left Arm Whole Arm and Hand: No Abnorm: ies
|
Right Arm Whole Arm and Hand: No Abnorm: ies
Left Leg Left Leg and Foot: No Abnormalities
Right Leg Right Leg and Foot: No Abnormalities
[Neurological Neurological Normal Baseline For Patient
ay ae
c
‘ade three request for mva
s. pt states he was in an accident but does not remember it. pt states he may have had a loc. pt states upon their arrival pt was alert and oriented outside of the car.
ptstates he has pain to back of head. pt denies any back or neck pain. ptis calm at this time and not showing any signs of confusion
©. pt found sitting on curb in front of car. pt is shaking due to weather. pt was assisted to the ambulance with fd for heat and to be seatbelted in for transport while
mom was extricated, pt has laceration to back head and glass in hair. pt has dried blood to right side of face.
Preview
MC-350EX [ATTORNEY OR PARTY WITHOUT ATTORNEY ‘STATE BAR NUMBER FOR COURT USE ONLY Name: CONNIE A. RODRIGUEZ, ESQ. SBN: 278086 Firmname: ARROYO LAW, Inc. street avoress: 900 TRUXTUN AVENUE, SUITE 200 cry: BAKERSFIELD state: CA ZIP CODE: LeLEPHONE No: (661) 404 — 4334 Faxno: (661) 348 — 4436 Email abbRESS: Connie@conniearroyolaw.com ATTORNEY FOR (Name): PLAINTIFFS SUPERIOR COURT OF CALIFORNIA, COUNTY OF streeTaporess. 1215 TRUXTUN AVENUE maitincapoRess: 1215 TRUXTUN AVENUE city AND zip cove: BAKERSFIELD, CA 93301 BRANCH NAME. METROPOLITAN DIVISION — UNLIMITED CASE NAMEREINA E. ESCOBAR; AND BENJAMIN QUINTERO, A MINOR, BY AND | case numser. BCV-23-102794 GAP ROUGH HIS GUARDIAN AD LITEM, REINA E. ESCOBAR v MARK KANDLER: AND DOES 1 TO 100, INCLUSIVE. (XJ No hearing date is requested. PETITION FOR EXPEDITED APPROVAL OF COMPROMISE OF —[L_] REARING ORE CLAIM OR ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY DEPT TIME NOTICE TO PETITIONER You must use this form to request expedited court approval ofa qualifying (1) compromise ofa minor's disputed claim, (2) compromise lof a pending action or proceeding in which a minor or a person with a disability (including a conservatee) is a party, or (3) disposition of ithe proceeds of a judgment for a minor or person with a disability. (See Code Civ. Proc., § 372; Prob. Code, §§ 3500, 3600-3613.) You may request expedited approval only if (1) you are represented by an attorney; (2) the statements in items 3a, 3b, 3c, 3d, 3e, 3f, and leither 3g(1) or 3g(2), below, are true and accurate; and (3) the court does not otherwise order. lf your compromise or judgment qualifies and you choose to use this form, the court may consider and act on your petition without a hearing. If your compromise or judgment qualifies for expedited consideration but you choose not to use this form or your compromise lor judgment does not qualify for expedited consideration, you must use Petition for Approval of Compromise of Claim or Action or Disposition of Proceeds of Judgment for Minor or Person With a Disability (form MC-350), and the court will schedule a hearing. 1 Petitioner (name or pseudonym”): REINA E. ESCOBAR is the (check all boxes that apply): (Parent (£X) Guardian ad litem* [J Guardian [) Conservator () Other (specify relationship): of the claimant identified in item 2. (“Petitioner may appear under a pseudonym only if appointed as guardian ad litem under that pseudonym. (See Code Civ. Proc., § 372.5.)) Claimant (name): BENJAMIN QUINTERO, a Minor a. Address: 3800 PLANZ ROAD BAKERSFIELD, CA 93309 b. Date of birth: 09/02/2007 c. Age: 16 d. (XJ Minor or (Person with a disability (If the claimant is an adult with a disability who (1) has capacity to consent to the order requested and (2) does not have a conservator of the estate, check e. and f. and ensure that the claimant personally reads and signs item 21. (Prob. Code, § 3613.)) e. (_] Has the capacity, within the meaning of Probate Code section 812, to consent to the requested order. f. [-_] Does not have a conservator of the estate. Qualification for Expedited Approval 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. 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. Petitioner's attorney did not become involved with this matter, directly or indirectly, at the request of a party against whom the 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. All defendants that have appeared in a pending action on the claim are participating in the proposed compromise or the court has made a final determination that all settling parties entered into the settlement in good faith. (1) [EX] The judgment described in item 4c (exclusive of interest and costs) or the total settlement described in items 11 and 12 payable to the claimant and all other persons named in item 12 is in the amount of $50,000 or less; or (2) [J The settlement described in item 11 represents payment of the single-person policy limits of all liability insurance policies covering the defendants named in that item. The investigation described in Attachment 3 shows that all of those defendants are judgment-proof outside of their insurance coverage. (Describe investigation and results in Attachment 3.) Page 1 of 7 Form Adopted for Alternative Mandatory Use Code of Civil Procedure, § 372; Instead of Form MC-350 PETITION FOR EXPEDITED APPROVAL OF COMPROMISE OF Probate Code, §§ 3500, 2600-3613: Judicial Council of California Cal, Rules of Court, rules 3 1384, MC-350EX [Rev. January 1, 2021} CLAIM OR ACTION OR DISPOSITION OF PROCEEDS OF 7.101, 7.950, 7.9505, 7.951 JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY www courts ca gov MC-350EX ICASE NAMEREINA E. ESCOBAR; AND BENJAMIN QUINTERO, A MINOR, BY AND | case numser. BCV-23-102794 GAP THROUGH HIS GUARDIAN AD LITEM, REINA E. ESCOBAR v MARK KANDLER; AND DOES | TO 100, INCLUSIVE. 4. Claim The claim of the minor or adult person with a disability: a. [__] Isnot the subject of a pending action or proceeding. (Complete items 5-23.) b. [(%] Is the subject of a pending action or proceeding that will be compromised without a trial. (Complete items 5-23.) Name of court: KERN COUNTY SUPERIOR COURT Case no.: BCV-23-102794 GAP Trial date: CASE SETTLED c. Is the subject of an action or proceeding in which a judgment has been or will be entered for the claimant against the defendants named below in the amount (exclusive of interest and costs) of (specify): $ 25,000.00 Defendants (names: MARK KANDLER ([) Additional defendants listed on Attachment 4. [J The judgment was filed on (date): (Attach a copy of the (proposed) judgment as Attachment 4c and complete items 13-23.) 5. Incident or accident The incident or accident occurred as follows: a. Date: DECEMBER 22, 2022 Time: About 8:26 A.M. b. Place: PLANZ ROAD, APPROXIMATELY 15 FEET EAST OF AKERS ROAD IN BAKERSFIELD, KERN c. Persons involved (names): BENJAMIN QUINTERO, a Minor REINA E. ESCOBAR MARK KANDLER PEDRO LUIS TORRES FELICIA TORRES AUTUMN TORRES, a Minor (_) Additional persons listed on Attachment 5. 6. Nature of incident or accident The facts, events, and circumstances of the incident or accident are (describe what hi ‘ttop ened): Defendant, Mark Kandler, was driving westbound on Planz Road at a gh rate of speed and struck the rear end of Plaintiffs’ vehicle while Plaintiff driver, Reina E. Escobar, was stopped at the red light, while her Minor son, Benjamin Quintero was a front seat passenger. As a result of this collision, Defendant also collided into the vehicle that Claimant Pedro Luis Torres was operating, Claimant Felicia Torres occupied as a passenger, and Minor Claimant, Autumn Torres, occupied as a passenger. () Continued on Attachment 6. Injuries fi The following injuries were sustained by the claimant as a result of the incident or accident (describe): enjamin Quintero, a minor, sui ered an abrasion to the back of his head, posterior head pain, abrasion to right wrist and pain, loss of consciousness, post concussive syndrome, and emotional distress. () Continued on Attachment 7. Treatment The claimant received the following care and treatment for the injuries described in item 7 (describe): Benjamin Quintero, a Minor, received a CT of the head, Chest X-Ray, and right wrist X-Ray in the Emergency Department. () Continued on Attachment 8. MC-350EX [Rev. January 1, 2021] Page 2 of 7 PETITION FOR EXPEDITED APPROVAL OF COMPROMISE OF CLAIM OR ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY MC-350EX ICASE NAME: REINA E. ESCOBAR; AND BENJAMIN QUINTERO, A MINOR, BY AND| case numser: BCV-23-102794 GAP THROUGH HIS GUARDIAN AD LITEM, REINA E. ESCOBAR v MARK. KANDLER; AND DOES 1 TO 100, INCLUSIVE. Extent of injuries and recovery (An original or a photocopy of any doctors report containing a diagnosis of the claimant's injuries ora prognosis for the claimant's recovery, and a report of the claimant's current condition, must be attached to this petition as Attachment 9. A new report is not necessary if a previous report accurately describes the ciaimant's current conditioz.) a. [__] The claimant has recovered completely from the effects of the injuries described in item 7, and there are no permanent injuries. b. [5] The claimant has not recovered completely from the effects of the injuries described in item 7, and the following injuries from which the claimant has not recovered are temporary (describe the remaining injuries and symptoms): Benjamin Quintero, a Minor, has made a good recovery but will continue to experience residual emotional pain due to the injuries. [] Continued on Attachment 9b. c. [_] The claimant has not recovered completely from the effects of the injuries described in item 7, and the following injuries from which the claimant has not recovered are permanent (describe the permanent injuries and symptoms): [J Continued on Attachment 9c. 10. [-X] Petitioner has made a careful and diligent inquiry and investigation into the facts and circumstances of the incident or accident in which the claimant was injured; the responsibility for the incident or accident; and the nature, extent, and seriousness of the claimant's injuries. Petitioner understands that if the compromise proposed in this petition is approved by the court and consummated, the claimant will never be able to recover any more compensation from the settling defendants named below even if the claimant's injuries turn out to be more serious than they now appear. 1 . Amount and terms of settlement To settle the claim in 4a or 4b, the defendants named below have offered to pay the following amounts to the claimant: a. The total amount offered by all defendants named below is (specify): $ 25,000.00 b. The defendants and amounts offered by each are as follows (specify): Defendants (names) Amounts MARK KANDLER $ 25,000.00 $ $ $ [] Additional defendants and amounts offered are listed on Attachment 1 1b. c. The terms of settlement are described on Attachment 11c. (If the settlement is to be paid in installments, both the total amount and the present value of the settlement must be included.) 12. Settlement payments to others a. [__] No defendant named in item 11b 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. b One or more of the defendants named in item 11b 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 is (specify): $ 30,000.00 (2) [X] Petitioner would receive money under the proposed settlement. (8) The settlement payments are to be apportioned and distributed as follows: Other plaintiffs or claimants (names) Amounts REINA E. ESCOBAR $ 30,000.00 PEDRO LUIS TORRES $ 1,500.00 FELICIA TORRES $ 1,500.00 AUTUMN TORRES, a Minor $ 2,000.00 {_] Additional plaintiffs or claimants and amounts are listed on Attachment 12. (4) [_] The settlement payments are apportioned between the claimant and each other plaintiff or claimant named above on a pio rata basis, based upon the special damages claimed by each. The special damages claimed by each other plaintiff or claimant are specified on Attachment 12. (6) (XX) Reasons for the apportionment of the settlement payments between the claimant and each other plaintiff or claimant named above are specified on Attachment 12. MC-350EX (Rev. January 1, 2025] Page Sof PETITION FOR EXPEDITED APPROVAL OF COMPROMISE OF CLAIM OR ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY MC-350EX ICASE NAME: REINA E. ESCOBAR; AND BENJAMIN QUINTERO, A MINOR, BY AND | case numeer: BCV-23-102794 GAP [ROUGH HIS GUARDIAN AD LITEM, REINA E. ESCOBAR v MARK KANDLER; AND DOES | TO 100, INCLUSIVE. 13. Claimant's medical expenses—including expenses paid by petitioner, Medicare, Medi-Cal, and private insurers—that are to be paid or reimbursed from the proceeds of the settlement or judgment a Totals (1) Total medical expenses before any reductions: $ 25,456.70 (2) Total medical expenses paid (include payments by private insurance, Medi-Cal, or Medicare): g 11,276.58 ) (3) Total of negotiated, contractual, or statutory reductions, if any: & 3,099.73 ) (4) Total amount of medical expenses to be paid or reimbursed from proceeds: $ 8,176.85 (6) Total amount of statutory or contractual liens, if any: $ 8,176.85 (Identify each medical expense payer and the amount each paid, and explain any differences between items 13a(1), (4), and (5) in Attachment 13a.) (1) [J None of the claimant's medical expenses have been paid by Medicare. (2) [_] Medicare paid some or ail 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 13b(2).) (1) [[_] None of the claimant's medical expenses have been paid by Medi-Cal. (2) [XX] Medi-Cal paid some or all of claimant's medical expenses. (a) Notice of this claim or action has been given to the Director of Health Care Services. (Welf. & Inst. Code, § 14124.73.) A copy of the notice and proof of 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 cf: $ 8,176.85 (Attach a copy of the final Medi-Cal demand letter or letter agreement as Attachment 13c(2).) (J 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: $ (Attach statements from the plan showing expense payments and requesting reimbursement.) [1] Petitioner has paid claimant's medical expenses to be reimbursed in the amount of: $ (See instructions for item 15.) (1) There are no statutory or contractual liens for payment of the claimant's medical expenses @) There are one or more liens from medical service providers for payment of the claimant's medical expenses. In full satisfaction of their lien claims, the lienholders have agreed to accept the sum of: $ (Select (1) or (2) below.) (1) [-_] Latest statements from all medical service providers are attached as Attachment 13g. (2) All medical expenses have been paid by private insurance, Medicare, or Medi-Cal. 14. Claimant's attorney's fees and all other expenses (except medical expenses), including fees or expenses paid by petitioner and claimant's attorney, to be paid or reimbursed from proceeds of settlement or judgment a. Total amount of attorney's fees for which court approval is requested: $ 6,250.00 (if fees are requested, attach as Attachment 14a a declaration from the attomey explaining the basis for the request, including a discussion of applicable factors listed in rule 7.955(b) of the Cal. Rules of Court. Include a copy of any written attorney fee agreement in Attachment 14a.) 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 File Maintenance Fee (S(Split with: other ot) ARRO YO LAW. Inc. 150.00 KCSC OYO W, Inc. 225.83 KCSCE Fi MC- AEX ARROYO LAW. Inc. 3.60 KCSCE Filing Receipt & Ackno ement ARROYO LAW, Inc 3.60 KCSC E Filing POS of Summons/Dismissal (Split) ARROYO LAW, Inc 3.60 Medical/Bi sician Reco RROYO LAW, Inc 119.75 Investigationo!of Defendant (Split) ARROYO LAW, Inc 10.00 Service Attempts and Service to Defendant (Split) ARROYO LAW, Inc. 107.50 [] Continued on Attachment 14b. Total: $, 623.88 c. [__] Costs of suit attributable to more than one settling plaintiff are not apportioned between them on a pro rata basis based ‘on their gross settlement amounts. The apportionment of these costs is described and explained in Attachment 14c. MC-350EX (Rev. January 1, 2021] Page 4 of 7 PETITION FOR EXPEDITED APPROVAL OF COMPROMISE OF CLAIM OR ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY MC-350EX \CASE NAME: REINA EB. ESCOBAR; AND BENJAMIN QUINTERO, A MINOR, BY AND | case number) BCV-23-102794 GAP THROUGH HIS GUARDIAN AD LITEM, REINA E. ESCOBAR vy MARK KANDLER; AND DOES 1 TO 100, INCLUSIVE. 15, Reimbursement of fees and expenses paid by petitioner a. [-X] Petitioner has paid none of the fees or expenses listed in items 13 and 14 for which reimbursement is requested. b. [__] Petitioner has paid the following total amounts of the claimant's fees and expenses for which reimbursement is requested. (1) (] Medical expenses listed in item 13: $ (2) [__] Attorney's fees included in the total fee amount shown in item 14a: $ (3) [{_] Other expenses included in the total shown in item 14b: $ (Attach proofs of the fees and expenses incurred and payments made, e.g., bills or invoices, Total: $ canceled checks, credit card statements, explanations of benefits from insurers, etc.) 16. Net balance of proceeds remaining for claimant 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): $ 9,949.27 17. Summary a Gross amount of proceeds of settlement or judgmeni for claimant: $ 25,000.00 b. Medical expenses to be paid from proceeds of settlement or judgment: $ 8,176.85 c. Attorney's fees to be paid from proceeds of settlement or judgment: $ 6,250.00 dq Expenses (other than medical) to be paid from proceeds of settlement or judgment: $ 623.88 Total fees and expenses to be paid from proceeds of settlement or judgment (add (b), (c), and (a)): $ 15,050.73 Balance of proceeds of settlement or judgment available for claimant after payment of all fees and expenses (subtract (e) from (a)): $ 9,949.27 18. Information about attorney representing or assisting petitioner a. The attorney [1] is not [x] is representing or employed by another party involved in this matter. (if you answered "is," identify the other party and explain the relationship in Attachment 18a. 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 attorney {J has neither received nor expects to 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 or to be paid, and the dates of payment or expected payment): Amount Date Paid or Expected Paid or Expected PLAINTIFF, REINA E ESCOBAR os an individual Upon Court Approval $ 6,000.00 $ $ $ (J Continued on Attachment 18b. Total: $_ _ 6,000.00 MC-350EX (Rev. January 1, 2021] Page of 7 PETITION FOR EXPEDITED APPROVAL OF COMPROMISE OF CLAIM OR ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY MC-350EX GASE NAME: REINA E. ESCOBAR; AND BENJAMIN QUINTERO, A MINOR, BY AND | case womoen BCV.23-100794 GAP THROUGH HIS GUARDIAN AD LITEM, REINA E. ESCOBAR v MARK KANDLER; AND DOES | TO 100, INCLUSIVE. 19. Disposition of balance to claimant (check eithera or b, then check each option requested and enter amount(s): 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.: (1) () Petitioner requests that $ of the proceeds in money or other property 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 19a(1). (2) [_] 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 19a(1) in one or more insured accounts with financial institutions in this state or with a trust company, subject to withdrawal only on authorization of the court. The money or other property and the name, branch, and address of each financial institution or trust company are specified in Attachment 19a(2). (3) (_) Petitioner proposes that all or a portion of the proceeds not become part of the guardianship or conservatorship estate. Petitioner requests authority to deposit or transfer these proceeds as follows (check all that apply): @ Cis to be deposited in insured accounts in one or more financial institutions in this state, ‘subject to withdrawal only on authorization of the court. The name, branch, and address of each depository are specified in Attachment 19a(3)(a). ») Cs to be invested in a single-premium deferred annuity, subject to withdrawal only on authorization of the court. The terms and conditions of the annuity are specified in Attachment 19a(3)(b). © Cos to 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 property to be transferred are specified in Attachment 19a(3)(c). b. [XX] There is no guardianship of the estate of the minor or 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 be appointed and $ of money and other property be paid or delivered to the person so appointed. The money or other property are specified in Attachment 19b(1). (2) CX $ 9,949.27 of money be deposited in insured accounts in one or more financial institutions in this state, subject to withdrawal only on authorization of the court. The name, branch, and address of each depository are specified in Attachment 19b(2). @® Cos of money be invested in a single-premium deferred annuity, subject to withdrawal only on authorization of the court. The terms and conditions of the annuity are specified in Attachment 19b(3). 4) $ be paid or delivered to a parent of the minor on 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 19b(4). (Value of minor's entire estate, including the money or property to be delivered, must not exceed $5,000.) © Cys 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 19b(5). ® CIs of money be held on the conditions that the court determines to be in the best interest of the minor or adult person with adisability. The proposed conditions are specified on Attachment 19b(6). (Value must not exceed $20,000.) m Cos of property other than money be heid on the conditions that the court determines to be in the best interest of the minor or adult person with a disability. The proposed conditions and the property are specified in Attachment 19b(7). ® Cas 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 3611 {(h). ® Cos be paid or transferred to the adult person with a disability. The money or other property is specified in Attachment 19b(9). MC-350EX [Rev, January 1, 2021] Page6 of 7 PETITION FOR EXPEDITED APPROVAL OF COMPROMISE OF CLAIM OR ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY MC-350EX CASE NAME. REINA E. ESCOBAR; AND BENJAMIN QUINTERO, A MINOR, BY AND J case womser BCV-23-102794 GAP THROUGH HIS GUARDIAN AD LITEM, REINA E. ESCOBAR v MARK KANDLER; AND DOES 1 TO 100, INCLUSIVE 20.[[_] Additional orders Petitioner requests the following additional orders (specify and explain): {] Continued on Attachment 20. 21.[_] |, the claimant named in item 2, consent to the order or judgment requested in this petition. (Required if the claimant is an adult with a disability who has the capacity, under Probate Code section 812, to consent to the order or judgment and does not have a conservator of the estate. (See Prob. Code, § 3613.) Date: (TYPE OR PRINT NAME OF CLAIMANT) (SIGNATURE OF CLAIMANT) 22. Petitioner recommends the proposed compromise, settlement, or disposition of judgment proceeds for the claimant to the court as being fair, reasonable, and in the best interest of the claimant. Petitioner requests that the court approve this compromise, setilement, or disposition and make any other orders that are just and reasonable. 23. Number of pages attached: 77 Date: March 29, 2024 CONNIE A. RODRIGUEZ (TYPE OR PRINT NAME) (SIGNATURE OF \ declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date. March 29, 2024 REINA E. ESCOBAR » eine Garcon (TYPE OR PRINT NAME OF PETITIONER) (SIGNATURE OF PETITIONER) MC-350EX Rev. January 1, 2024] Page 7 of 7 PETITION FOR EXPEDITED APPROVAL OF COMPROMISE OF CLAIM OR ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY MC-025 SHORT TITLE. REINA E. ESCOBAR; AND BENJAMIN QUINTERO, A MINOR, BY CASE NUMBER: }— AND THROUGH HIS GUARDIAN AD LITEM, REINA E. ESCOBAR v MARK KANDLER; AND DOES | TO 100, INCLUSIVE. BCV-23-102794 GAP ATTACHMENT (Number): 9 (This Attachment may be used with any Judicial Council form.) Reports of Claimant’s medical records and current condition are attached hereto, as Attachment 9. (If the item that this Attachment concerns is made under penalty of perjury, all statements in this Page —_ 1 of 77 Attachment are made under penalty of perjury.) (Add pages as required) Form Approved for Optional Use ATTACHMENT ‘wwww.courtinfo.ca.gov Judicial Council of California Westlaw Doc & Form Bulider- (MC-025 [Rev. July1, 2003] to Judicial Council Form ae Hatt Ambulance Patient Care Record Name: ESCOBAR, BENJAMIN Service Inc Incident #: 22-00129302 Date: 12/22/2022 Patient 1 of 1 : ESCOBAR 3200 planz rd Inju BENJAMIN Bakersfield ~ Male CA 09/02/2007 ———. 93309 ——— ee 15 Yrs,3 Months, 20 Days US Head 90.0lbs- 40.8kg Home eoieo03iis S Hispanic or Latino head pain Hispanic or Li 20 Minutes Mild ne Pain - Pain (unspecified) Motorized Vehicle Accident - Auto traffic accident injures occupant- Street or Hi - 12/22/2022 Blunt Trauma None Noted None Reported No —__. Lower Acui (Green) Lower Acuity (Green) Activity, Unspecified teers tian Medications None Reported No known allergies | History None Reported Immunizations [Rast Oralintake |. rime Avpu [Side] POS” "BP _RR {spo2_ Erco2| co! BG | fe Pain| GCS{E+Vsm)/Qualifier | PTS” 08:57 Alert | Sit 12jP_ 100R I 20R 99 Rm 4 15=4+5+6/NFP 2 09:10 108/664 100 | 18 6 Te: r oes! z Q : : ler “TALS Assessment Patient Response: Unchanged ; Successful; Complication: jone; fedical Control Protocol(Standing Order); SALAZAR, DEANNA | { 08:15 | Trauma Alert Patient Response: Unchanged; Complication: None; Medical Control: Protocol (Standing Order); SALAZAR, DEANNA | 09:15 [Contact Report Only Patient Response: Unchanged; Complication: None; Medical Control: Protocol (Standing Order); ‘SALAZAR, DEANNA -e = = :2 Mental Status Mental Status v Oriented- Event Oriented Person ~ Oriented Place = Oriented Rn. - ime Skin skin No Abnormalities HEENT Face Face: No Abnormalities ——— Head Head: No Abnormalities ee — Eyes Both Eyes: PERRL Neck No Abnormalities Run Number: 22-00129302 Page 1 of6 01/27/2023 08:40:27 Hospital Chart Number: 3001692649 PCRID: 90ebfdb1-06b0-4258-9738-af73009c4ate Patient Number: 21271241 Electronically Signed by: SALAZAR, DEANNA Template Version: PCR-EXTRACT-1.3.1 Data Version: AAAMAAwmdcw= Hall Ambulance Service Inc atient Care Record Name: ESCOBAR, BENJAMIN Incident #: 22-00129302 Date: 12/22/2022 Patient ofl Time: mments Chest Chest General: No Abnormalities Heart Sounds Not Assessed Lung Sounds ti No Abnormalities }0 Abnormalities No Abnormalities RU: No Abnormalities [mack | Abdomen General No Abnormalities Back — — Back No Abnormalities i Pelvis/GU/GI Pelvis/GU/GL Pelvis/GU/GI: No Abnormalities | fe xtremities Left Arm Whole Arm and Hand: No Abnorm: ies | Right Arm Whole Arm and Hand: No Abnorm: ies Left Leg Left Leg and Foot: No Abnormalities Right Leg Right Leg and Foot: No Abnormalities [Neurological Neurological Normal Baseline For Patient ay ae c ‘ade three request for mva s. pt states he was in an accident but does not remember it. pt states he may have had a loc. pt states upon their arrival pt was alert and oriented outside of the car. ptstates he has pain to back of head. pt denies any back or neck pain. ptis calm at this time and not showing any signs of confusion ©. pt found sitting on curb in front of car. pt is shaking due to weather. pt was assisted to the ambulance with fd for heat and to be seatbelted in for transport while mom was extricated, pt has laceration to back head and glass in hair. pt has dried blood to right side of face.