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MC-350EX
‘ATTORNEY (Name, State Bar number, and adress): FOR COURT USE ONLY
SAM SALHAB, ESQ., SBN# 251994
| SALHAB LAW CORPORATION, PC E-FILED
2300 TULARE, STREET, SUITE 150, FRESNO, CA 93721 6/24/2020 11:40 AM
TeveProne No: 559-441-9100 FAX NO. (Optional: Superior Court of California
EMAIL ADDRESS (Optionay: SAM @salhablaw.com County of Fresno
ATTORNEY FOR (were): PLAINTIFFS, By: C. York, Deputy
‘SUPERIOR COURT OF CALIFORNIA, COUNTY OF FRESNO.
street aooress: 1130 O STREET
wwaune aooress: 1130 O STREET
crvanaPcoe: FRESNO, CA 93721
BRANCH NAME: CENTRAL DIVISION
CASE NAME: CASE NUMBER:
VOLLHARDT V. ARAMBURO 20CECG00146
EXPEDITED PETITION TO APPROVE: [1 No hearing date is requested.
L¥_] COMPROMISE OF DISPUTED CLAIM
[__] COMPROMISE OF PENDING ACTION Hearine oate: August 20, 2020
[1] DISPOSITION OF PROCEEDS OF JUDGMENT
Minor [__] Person With a Disability oer: 402 Te: 3:30 p.m.
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 3g(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 fo 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.
1
Petitioner (name): Dean Allen Vollhardt
2. Claimant (name): Jillian Alexandria Lynn Vollhardt
a. Address: 4086 W. Peachtree Lane, Fresno, CA 93722
b. Date of birth: 07/01/2012 c. Age: 7 d. Sex: F Minor f. [-] Person with a disability
3. Expedited petition
a The claimant's claim or action is not for damages for the death ofa 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.
c, There are no unresolved disputes concerning liens to be satisfied from the proceeds of the judgment or settlement.
d. 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 finally determined that all settling parties entered into the settlement in good faith.
(1) The judgment for the claimant described in item 5c (exclusive of interest and costs) or the total of the settlement
described in items 12 and 13 payable to the claimant and all other persons named in item 13 is in the amount of
$50,000 or less; or
2 CO The settlement described in item 12 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.) Page1 of 8
Form Adopted for EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED = “*%* Civ ateProcedure
‘Alternative Mandatory Use
Judicial Council of California Code, §§ 3500
372 etet seq.;
seq.
MC-350EX (New January 1, 2010} CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS Cal, Rules of Court, rules 3.1384,
OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY 7.101, 7.960, 7.950.5, 7.951
www. courtinfo.ca.gov
(Miscellaneous)
MC-350EX
CASE NAME: ‘CASE NUMBER:
LVOLLHARDT V. ARAMBURO 20CECG00146
4. Relationship Petitioner's relationship to the claimant (check all 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 4¢ or 4f, state facts on Attachment 4e or 4f showing that the claimant has capacity under Probate Code
section 812 to petition or consent to a petition. Only an 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.)
5. Nature of claim The claim of the minor or adult person with a disability:
a. [__] Isnot the subject of a pending action or proceeding. (Complete items 6-23.)
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: Superior Court of California-County of Fresno
Case no.: 20CECG00146 Trial date: Not set (Complete items 6-23.)
c. [] 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):
Defendants (names):
sf
[1 Additional defendants listed on Attachment 5. [) The judgment was filed on (date):
(Attach a copy of the (proposed) judgment as Attachment 5c and complete items 14-23.)
Incident or accident
The incident or accident occurred as follows:
a. Date: 07/28/2019 Time: 11:18 a.m.
b, Place: Intersection of Olive and Valentine Avenues, City of Fresno, State of California.
©. Persons involved (names):
Dean Allen Vollhardt (Plaintiff)
Hailey Jade Vollharat (Plaintiff)
Jillian Alexandria Lynn Vollhardt (Plaintiff)
Alberto Davalos Aramburo (Defendant)
[1 Continued on Attachment 6.
724 Nature of incident or accident
The facts, events, and circumstances of the incident or accident are (describe):
Motor vehicle accident wherein Defendant negligently made an invalid turn causing his
vehicle to collide with Plaintiff's vehicle thereby causing injury.
[Continued on Attachment 7.
EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED Page 2of 8
(Now January 1201)
CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF
JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY
(Miscellaneous)
MC-350EX
CASE NAME: CASE NUMBER:
}-VOLLHARDT V. ARAMBURO 20CECG00146
8. LZ) injuries
The following injuries were sustained by the claimant as a result of the incident or accident (describe):
Claimant suffered injury to her neck and back wherein she had to be taken to the hospital to
be treated for her injuries.
[1] Continued on Attachment 8.
Treatment
The claimant received the following care and treatment for the injuries described in item 8 (describe):
Claimant was treated at the local hospital immediately proceeding the incident for complaints
to her neck and back. No further treatment was necessary.
[J Continued on Attachment 9.
10. 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 The claimant has recovered completely from the effects of the injuries described in item 8, and there are no
permanent injuries.
b. [2] 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):
[1 Continued on Attachment 10b.
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):
[1 Continued on Attachment 10c.
11 Petitioner has made a careful and ent 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 seriousness 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 se: ing 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 thought to be.
12. Amount and terms of settlement
By way of settlement, the defendants named below have offered to pay the following sums to the claimant:
a.
b.
The total amount offered by all defendants named below is (specify):
The defendants and amounts offered by each are as follows (specify):
s{5,000.00
Defendants (names) Amounts
Alberto Davalos Aramburo $5,000.00
$
$
$
[©] Additional defendants and amounts offered are listed on Attachment 12.
¢. 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.)
Page
3 of 8
(Now nay? 200 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:
--VOLLHARDT V. ARAMBURO 20CECG00146
13.21 Settlement payments to others
a. [] 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.
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. $ 45,000.00
(1) The total amount offered by all defendants to others (specify):
(2) 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
Dean Allen Vollhardt $ 20,000.00
Hailey Jade Vollhardt $ 25,000.00
$
$
Co Additional plaintiffs or claimants and amounts are listed on Attachment 13.
4) 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.
6 CO 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: $ 2,459.32
(2) Total amount paid (including payments by private insurance, Medi-Cal, or Medicare): $ (229.92 )
(3) Total of negotiated reductions, if any:
(4) Total amount of medical expenses to be paid or reimbursed from proceeds: (22982 7 |
(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.)
6. (1) GO None of the claimant's medical expenses have been paid by Medicare.
@ CO 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),)
«. (1) CJ None of the claimant's medical expenses have been paid by Medi-Cal.
(2) 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: s29.92
(Attach a copy of the final Medi-Cal demand letter or letter agreement as Attachment 14c(2).)
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 amountof $[ sid
(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
(See instructions for item 16.)
sS
MC-508X EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED Page 4 of 8
[New January 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:
t-VOLLHARDT V. ARAMBURO 20CECG00146
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
There are one or more liens from medical service providers for payment of claimant's medical expenses.
In full satisfaction of their lien claims, the lienholders have agreed to accept the sum of: s (220.927)
g. (Select (1) or (2) below.)
(1) [1 Latest statements from all medical service providers are attached as Attachment 14g.
(2) All 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 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: $!7,750.00
(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 Cal. Rules of Court. Include a copy of any written attorney fee
agreement in Attachment 15a.)
b. 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
$
[1] Continued on Attachment 15. Tota: s[__
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 15c.
16. Reimbursement of expenses paid by petitioner
Petitioner has paid none of the claimant's expenses listed in items 14 and 15 for which reimbursement is requested.
b. 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) [1 Other expenses included in the total shown in item 15b:
(Attach proofs of the expenses incurred and payments made, ¢.9., bills or
invoices, canceled checks, credit card statements, explanations of benefits
row
from insurers, etc.)
17. Net balance of proceeds for the 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): s[3,020.08
Page Sof 8
(Now Jeraany
1, 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)
MC-350EX
CASE NAME: (CASE NUMBER:
7-VOLLHARDT V. ARAMBURO 20CECG00146
18. Summary
a. Gross amount of proceeds of settlement or judgment for claimant: $ 5,000.00
b. Medical expenses to be paid from proceeds of settlement
or judgment: $ 229.92
Attorney's fees to be paid from proceeds of settlement or
judgment: $ 1,750.00
Expenses (other than medical) to be paid from proceeds
of settlement or judgment: $
Total of fees and expenses to be paid from proceeds of settlement or judgment
(add (b), (c), and (d)): $ (1,979.92 )
Balance of proceeds of settlement or judgment available for claimant after payment of all
fees and expenses (subtract (e) from (a)): $ [3,020.08
19, Information about attorney representing or assisting petitioner
The attorney is not Cis 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 attorney 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):
rom Whom Paid or Expected (name): Date Paid or Expecte Amount Paid or Expected
[1] Continued on Attachment 19b. Tot: s[
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.:
aC s 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).
@ CI 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).
MC-350EX EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED Page
6 of 8
[New January 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:
-VOLLHARDT V. ARAMBURO 20CECG00146
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) [1] 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):
(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).
o) CI $s will be invested in a single-premium deferred annuity subject to
withdrawal only on order of the court. The terms and conditions of the annuity are specified in
Attachment 20a(3).
@CIs 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 property to be transferred are specified in Attachment 20a(3).
b. LZ] 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
will be 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).
2 OO $ 3,020.08 of money will be deposited in insured accounts in one or more financial
institutions in this state, subject to withdrawal only upon the authorization of the court. The name, branch,
and address of each depository are specified in Attachment 20b(2).
@ CO $ of money will be invested in a single-premium deferred annuity, subject to
withdrawal only upon the authorization of the court. The terms and conditions of the annuity are specified
in Attachment 20b(3).
4 CI $ 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) CJ $ 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).
@® CI $ 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.)
@ $ 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).
@ CO $ 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 3611(h).
g CI $ will be paid or transferred to the adult person with a disability. The money or other
property is specified in Attachment 20b(9).
[J Continued on Attachment 20.
-350EX EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED Page
7 of 8
[New January 1, 2010]
CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF
JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY
(Miscellaneous)
Jun.24.2020 11:17 AM NAMMOURS INC 5594923771 PAGE. UV 1
a
From:Gninabd Law Corporation 1ws0A07R447 00/24/2020 10:40 #278 P.002/002
MC-350EX
‘CASE NAME: (CABE NUMBER:
F-VOLLHARDT V. ARAMBURO 20CECG00146
24, Petitioner recommends the compromise settlement or the proposed disposition of the proceede of the judgment for the claimant10
the court as being falr, ceasonable, and in the best interest of the clalmant end requeste that the court approve thie compromise
settlement or proposed disposition end make such other and further ordere a¢ may be just and reasonable,
22, C2) Additional orders
Potitioner requests tha following edditional orders (specify
and explain):
(7) Continued on Attachment
22,
23, Number
of pages atlached: ya
Date: June 24, 2020
Sam Salhab »
TYPE OR PRINT NAME OF ATTORNEY) (BIONATURE OF ATTORNEY]
declare under penaity of perjury under the laws of the Siete of California that (he foregoing is true and correct.
Date: 06/24/2020
Dean Allen Volihardt
‘TYPE OR PRIIT NAME OF PENTHONGR) (SIGNATUREOF PETITIONER)
envy
1 2010) EXPEDITED PETITION TO APPROVE ROMISE OF DISPUTED Pope bere
CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF
JUOGMENT FOR MINOR OR PERSON WITH A DISABILITY
(Miscelteneous)
ATTACHMENT 10
Medical Records
©
CRMC
ED Encounter Report
Service Type: Emergency
Loc: EMERGENCY CRMC Patient: Vollhardt, Jillian
Admit Date: 07/28/2019 MRN: 02266785 CSN: 287913025
COMMUNITY Discharge Date: 7/28/2019 DOB: 7/1/2012 | Age:7 | Sex: Female
MEDICAL CENTERS Type: Hospital Encounter
Admission Information
‘Arrival Date/Time: 07/28/2019 1217 ‘Admit Date/Time: 07/26/2018 1217 1P Adm, Date/Time:
‘Admission Type: Point of Origin: Home, Work Or Non- Admit Category:
Cette health Care Facility
Means of Arrival: Primary Service: Secondary Service:
Transfer Source: Service Area: COMMUNITY MEDICAL Unit: EMERGENCY CRMC
imit Provider: Attending Provider: Riccobonl, Steven, MD Referring Provider: Brueggemann,
Kurt, MD
ED Arrival Information
Arrval a Moans
of Arrival ei Escorted inti
7/28/2019 12:17 Family Member
Arriva Gomplaint — seen ake
Discharge. Information
=
Discharge Date/Time Discharge Disposition Discharge Destination ca Unit
(07/28/2019 1543 Home Or Self Care (Routine) Home: None ‘EMERGENCY CRMC
Chief Complaint
Com) int Comment
Motor Vehicle Crash [160395] Teck pain sip MVA + seat belt mark to right neck, no midline tendemess pt was sitting behind front
passenger Impact on front passenger side
Diagnoses
noe nosis Description Comment ‘Added By Time Added Team Role Provider Speciatty _
‘Motor vehicie Motor vehicle Drake, Chelsea N, PA 7/28/2019 16:30 Physician
collision, lal colliston, initial Medicine, Famly
‘encounter [VB7.7XXA] encounter’ Medicine
/87.7XXA}
Abrasion of neck, Abrasion of neck, Drake, Chelsea N, PA 712812019 16:30 Physician
Initial encounter initia! encounter Assistant Medien, Famy
1810.91XA] [S10.91XA]
lergies as of 7/28/2019
= Fully Reviewed by Beheshti, Anmad-Reza, RN on 3/13/2016
No Known Allergies
Printed on 9/20/19 1104 Page 1
CRMC
e
ED Encounter Report
Service Type: Emergency
Loc: EMERGENCY CRMC Patient: Vollhardt, Jillian
Admit Date: 07/28/2019 MRN: 02266785 CSN: 287913025
COMMUNITY Discharge Date: 7/28/2019 DOB: 7/1/2012 | Age: 7 | Sex: Female
MEDICAL CENTERS Type: Hospital Encounter
ED Notes
ED Provider Notes by Drake, Chelsea N, PA 7/28/2019 13:01
‘Author: Drake, Chelsea N, PA Service: Emer cy ‘Author Type: Physician Assistant
Filed: 7/28/2019 16:10 Creation Time: 7/28/2019 13:01 Status: Signed
Editor: Drake, Chelsea N, PA (Physician Assistant) Cosigner; Brueggemann, Kurt, MD at 8/6/2019 12:23
History
Chief Complaint
Patient presents with
* Motor Vehicle Crash
neck pain s/p MVA + seat belt mark to right neck, no midline tenderness pt was sitting behind front
passenger impact on front passenger side
Jillian is a 7 year old female who presents after MVC today with anterior neck pain. Patient was
restrained passenger. Denies hitting her head. No loss of consciousness. No headache, nausea or
vomiting. No abdominal pain, chest pain or shortness of breath. No difficulty breathing or swallowing.
Past Medical History:
Diagnosis Date
+ Asthma
+ Seasonal allergies
Past Surgical History:
Procedure Laterality Date
» DENIES SURGICAL HISTORY
Review of Systems
Constitutional: Negative for chills, diaphoresis, fatigue and fever.
HENT: Negative for dental problem, facial swelling, nosebleeds, sore throat, trouble swallowing and
voice change.
Eyes: Negative for pain, redness and visual disturbance.
Respiratory: Negative for cough, chest tightness, shortness of breath and wheezing.
Cardiovascular: Negative for chest pain, palpitations and leg swelling.
Gastrointestinal: Negative for abdominal pain, diarrhea, nausea and vomiting.
Musculoskeletal: Positive for neck pain. Negative for back pain, gait problem and neck stiffness.
Skin: Positive for wound. Negative for pallor and rash.
Neurological: Negative for dizziness, syncope, weakness, light-headedness, numbness and
headaches.
Printed on 9/20/19 1104 Page 2
©
CRMC
ED Encounter Report
Service Type: Emergency
Loc: EMERGENCY CRMC Patient: Vollhardt, Jillian
Admit Date: 07/28/2019 MRN: 02266785 CSN: 287913025
COMMUNITY Discharge Date: 7/28/2019 DOB: 7/1/2012 | Age: 7 | Sex: Female
MEDICAL CENTERS Type: Hospital Encounter
ED Notes (continued)
ED Provider Notes by Drake, Chelsea N, PA (continued) 7/28/2019 13:01
—
Physical Exam
Initial vitals:
BP: (!) 101/64|Heart Rate: (1) 110] |Temp: 36.5 °C (97.7 °F)|Temp sre: Orall
Resp: 20|SpO2: 95 %|O2 Device: None (Room air)|
Physical Exam
Constitutional: She appears well-developed and well-nourished. She is active.
HENT:
Head: Atraumatic. No cranial deformity.
Right Ear: Tympanic membrane normal.
Left Ear: Tympanic membrane normal.
Nose: Nose normal.
Mouth/Throat: Mucous membranes are moist. Dentition is normal. Oropharynx is clear.
Eyes: Pupils are equal, round, and reactive to light. Conjunctivae and EOM are normal.
Neck: Trachea normal, normal range of motion, full passive range of motion without pain and
phonation normal. Neck supple. Thyroid normal. No tracheal tenderness, no spinous process
tenderness and no muscular tenderness present. There are signs of injury. Normal range of motion
present.
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voN ~—
~ a
OD
ee
Abrasion along the anterior neck, right infrahyoid muscles
Cardiovascular: Normal rate and regular rhythm.
Printed on 9/20/19 1104 Page 3
«©
CRMC
ED Encounter Report
Service Type: Emergency
Loc: EMERGENCY CRMC Patient: Vollhardt, Jillian
Admit Date: 07/28/2019 MRN: 02266785 CSN: 287913025
COMMUNITY Discharge Date: 7/28/2019 DOB: 7/1/2012 | Age:7 | Sex: Female
MEDICAL CENTERS Type: Hospital Encounter
ED Notes (continued)
ED Provider Notes by Drake, Chelsea N, PA (continued) z
Preview
MC-350EX ‘ATTORNEY (Name, State Bar number, and adress): FOR COURT USE ONLY SAM SALHAB, ESQ., SBN# 251994 | SALHAB LAW CORPORATION, PC E-FILED 2300 TULARE, STREET, SUITE 150, FRESNO, CA 93721 6/24/2020 11:40 AM TeveProne No: 559-441-9100 FAX NO. (Optional: Superior Court of California EMAIL ADDRESS (Optionay: SAM @salhablaw.com County of Fresno ATTORNEY FOR (were): PLAINTIFFS, By: C. York, Deputy ‘SUPERIOR COURT OF CALIFORNIA, COUNTY OF FRESNO. street aooress: 1130 O STREET wwaune aooress: 1130 O STREET crvanaPcoe: FRESNO, CA 93721 BRANCH NAME: CENTRAL DIVISION CASE NAME: CASE NUMBER: VOLLHARDT V. ARAMBURO 20CECG00146 EXPEDITED PETITION TO APPROVE: [1 No hearing date is requested. L¥_] COMPROMISE OF DISPUTED CLAIM [__] COMPROMISE OF PENDING ACTION Hearine oate: August 20, 2020 [1] DISPOSITION OF PROCEEDS OF JUDGMENT Minor [__] Person With a Disability oer: 402 Te: 3:30 p.m. 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 3g(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 fo 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. 1 Petitioner (name): Dean Allen Vollhardt 2. Claimant (name): Jillian Alexandria Lynn Vollhardt a. Address: 4086 W. Peachtree Lane, Fresno, CA 93722 b. Date of birth: 07/01/2012 c. Age: 7 d. Sex: F Minor f. [-] Person with a disability 3. Expedited petition a The claimant's claim or action is not for damages for the death ofa 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. c, There are no unresolved disputes concerning liens to be satisfied from the proceeds of the judgment or settlement. d. 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 finally determined that all settling parties entered into the settlement in good faith. (1) The judgment for the claimant described in item 5c (exclusive of interest and costs) or the total of the settlement described in items 12 and 13 payable to the claimant and all other persons named in item 13 is in the amount of $50,000 or less; or 2 CO The settlement described in item 12 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.) Page1 of 8 Form Adopted for EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED = “*%* Civ ateProcedure ‘Alternative Mandatory Use Judicial Council of California Code, §§ 3500 372 etet seq.; seq. MC-350EX (New January 1, 2010} CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS Cal, Rules of Court, rules 3.1384, OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY 7.101, 7.960, 7.950.5, 7.951 www. courtinfo.ca.gov (Miscellaneous) MC-350EX CASE NAME: ‘CASE NUMBER: LVOLLHARDT V. ARAMBURO 20CECG00146 4. Relationship Petitioner's relationship to the claimant (check all 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 4¢ or 4f, state facts on Attachment 4e or 4f showing that the claimant has capacity under Probate Code section 812 to petition or consent to a petition. Only an 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.) 5. Nature of claim The claim of the minor or adult person with a disability: a. [__] Isnot the subject of a pending action or proceeding. (Complete items 6-23.) 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: Superior Court of California-County of Fresno Case no.: 20CECG00146 Trial date: Not set (Complete items 6-23.) c. [] 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): Defendants (names): sf [1 Additional defendants listed on Attachment 5. [) The judgment was filed on (date): (Attach a copy of the (proposed) judgment as Attachment 5c and complete items 14-23.) Incident or accident The incident or accident occurred as follows: a. Date: 07/28/2019 Time: 11:18 a.m. b, Place: Intersection of Olive and Valentine Avenues, City of Fresno, State of California. ©. Persons involved (names): Dean Allen Vollhardt (Plaintiff) Hailey Jade Vollharat (Plaintiff) Jillian Alexandria Lynn Vollhardt (Plaintiff) Alberto Davalos Aramburo (Defendant) [1 Continued on Attachment 6. 724 Nature of incident or accident The facts, events, and circumstances of the incident or accident are (describe): Motor vehicle accident wherein Defendant negligently made an invalid turn causing his vehicle to collide with Plaintiff's vehicle thereby causing injury. [Continued on Attachment 7. EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED Page 2of 8 (Now January 1201) CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY (Miscellaneous) MC-350EX CASE NAME: CASE NUMBER: }-VOLLHARDT V. ARAMBURO 20CECG00146 8. LZ) injuries The following injuries were sustained by the claimant as a result of the incident or accident (describe): Claimant suffered injury to her neck and back wherein she had to be taken to the hospital to be treated for her injuries. [1] Continued on Attachment 8. Treatment The claimant received the following care and treatment for the injuries described in item 8 (describe): Claimant was treated at the local hospital immediately proceeding the incident for complaints to her neck and back. No further treatment was necessary. [J Continued on Attachment 9. 10. 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 The claimant has recovered completely from the effects of the injuries described in item 8, and there are no permanent injuries. b. [2] 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): [1 Continued on Attachment 10b. 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): [1 Continued on Attachment 10c. 11 Petitioner has made a careful and ent 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 seriousness 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 se: ing 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 thought to be. 12. Amount and terms of settlement By way of settlement, the defendants named below have offered to pay the following sums to the claimant: a. b. The total amount offered by all defendants named below is (specify): The defendants and amounts offered by each are as follows (specify): s{5,000.00 Defendants (names) Amounts Alberto Davalos Aramburo $5,000.00 $ $ $ [©] Additional defendants and amounts offered are listed on Attachment 12. ¢. 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.) Page 3 of 8 (Now nay? 200 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: --VOLLHARDT V. ARAMBURO 20CECG00146 13.21 Settlement payments to others a. [] 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. 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. $ 45,000.00 (1) The total amount offered by all defendants to others (specify): (2) 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 Dean Allen Vollhardt $ 20,000.00 Hailey Jade Vollhardt $ 25,000.00 $ $ Co Additional plaintiffs or claimants and amounts are listed on Attachment 13. 4) 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. 6 CO 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: $ 2,459.32 (2) Total amount paid (including payments by private insurance, Medi-Cal, or Medicare): $ (229.92 ) (3) Total of negotiated reductions, if any: (4) Total amount of medical expenses to be paid or reimbursed from proceeds: (22982 7 | (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.) 6. (1) GO None of the claimant's medical expenses have been paid by Medicare. @ CO 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),) «. (1) CJ None of the claimant's medical expenses have been paid by Medi-Cal. (2) 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: s29.92 (Attach a copy of the final Medi-Cal demand letter or letter agreement as Attachment 14c(2).) 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 amountof $[ sid (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 (See instructions for item 16.) sS MC-508X EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED Page 4 of 8 [New January 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: t-VOLLHARDT V. ARAMBURO 20CECG00146 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 There are one or more liens from medical service providers for payment of claimant's medical expenses. In full satisfaction of their lien claims, the lienholders have agreed to accept the sum of: s (220.927) g. (Select (1) or (2) below.) (1) [1 Latest statements from all medical service providers are attached as Attachment 14g. (2) All 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 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: $!7,750.00 (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 Cal. Rules of Court. Include a copy of any written attorney fee agreement in Attachment 15a.) b. 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 $ [1] Continued on Attachment 15. Tota: s[__ 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 15c. 16. Reimbursement of expenses paid by petitioner Petitioner has paid none of the claimant's expenses listed in items 14 and 15 for which reimbursement is requested. b. 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) [1 Other expenses included in the total shown in item 15b: (Attach proofs of the expenses incurred and payments made, ¢.9., bills or invoices, canceled checks, credit card statements, explanations of benefits row from insurers, etc.) 17. Net balance of proceeds for the 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): s[3,020.08 Page Sof 8 (Now Jeraany 1, 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) MC-350EX CASE NAME: (CASE NUMBER: 7-VOLLHARDT V. ARAMBURO 20CECG00146 18. Summary a. Gross amount of proceeds of settlement or judgment for claimant: $ 5,000.00 b. Medical expenses to be paid from proceeds of settlement or judgment: $ 229.92 Attorney's fees to be paid from proceeds of settlement or judgment: $ 1,750.00 Expenses (other than medical) to be paid from proceeds of settlement or judgment: $ Total of fees and expenses to be paid from proceeds of settlement or judgment (add (b), (c), and (d)): $ (1,979.92 ) Balance of proceeds of settlement or judgment available for claimant after payment of all fees and expenses (subtract (e) from (a)): $ [3,020.08 19, Information about attorney representing or assisting petitioner The attorney is not Cis 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 attorney 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): rom Whom Paid or Expected (name): Date Paid or Expecte Amount Paid or Expected [1] Continued on Attachment 19b. Tot: s[ 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.: aC s 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). @ CI 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). MC-350EX EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED Page 6 of 8 [New January 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: -VOLLHARDT V. ARAMBURO 20CECG00146 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) [1] 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): (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). o) CI $s will be invested in a single-premium deferred annuity subject to withdrawal only on order of the court. The terms and conditions of the annuity are specified in Attachment 20a(3). @CIs 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 property to be transferred are specified in Attachment 20a(3). b. LZ] 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 will be 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). 2 OO $ 3,020.08 of money will be deposited in insured accounts in one or more financial institutions in this state, subject to withdrawal only upon the authorization of the court. The name, branch, and address of each depository are specified in Attachment 20b(2). @ CO $ of money will be invested in a single-premium deferred annuity, subject to withdrawal only upon the authorization of the court. The terms and conditions of the annuity are specified in Attachment 20b(3). 4 CI $ 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) CJ $ 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). @® CI $ 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.) @ $ 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). @ CO $ 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 3611(h). g CI $ will be paid or transferred to the adult person with a disability. The money or other property is specified in Attachment 20b(9). [J Continued on Attachment 20. -350EX EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED Page 7 of 8 [New January 1, 2010] CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY (Miscellaneous) Jun.24.2020 11:17 AM NAMMOURS INC 5594923771 PAGE. UV 1 a From:Gninabd Law Corporation 1ws0A07R447 00/24/2020 10:40 #278 P.002/002 MC-350EX ‘CASE NAME: (CABE NUMBER: F-VOLLHARDT V. ARAMBURO 20CECG00146 24, Petitioner recommends the compromise settlement or the proposed disposition of the proceede of the judgment for the claimant10 the court as being falr, ceasonable, and in the best interest of the clalmant end requeste that the court approve thie compromise settlement or proposed disposition end make such other and further ordere a¢ may be just and reasonable, 22, C2) Additional orders Potitioner requests tha following edditional orders (specify and explain): (7) Continued on Attachment 22, 23, Number of pages atlached: ya Date: June 24, 2020 Sam Salhab » TYPE OR PRINT NAME OF ATTORNEY) (BIONATURE OF ATTORNEY] declare under penaity of perjury under the laws of the Siete of California that (he foregoing is true and correct. Date: 06/24/2020 Dean Allen Volihardt ‘TYPE OR PRIIT NAME OF PENTHONGR) (SIGNATUREOF PETITIONER) envy 1 2010) EXPEDITED PETITION TO APPROVE ROMISE OF DISPUTED Pope bere CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF JUOGMENT FOR MINOR OR PERSON WITH A DISABILITY (Miscelteneous) ATTACHMENT 10 Medical Records © CRMC ED Encounter Report Service Type: Emergency Loc: EMERGENCY CRMC Patient: Vollhardt, Jillian Admit Date: 07/28/2019 MRN: 02266785 CSN: 287913025 COMMUNITY Discharge Date: 7/28/2019 DOB: 7/1/2012 | Age:7 | Sex: Female MEDICAL CENTERS Type: Hospital Encounter Admission Information ‘Arrival Date/Time: 07/28/2019 1217 ‘Admit Date/Time: 07/26/2018 1217 1P Adm, Date/Time: ‘Admission Type: Point of Origin: Home, Work Or Non- Admit Category: Cette health Care Facility Means of Arrival: Primary Service: Secondary Service: Transfer Source: Service Area: COMMUNITY MEDICAL Unit: EMERGENCY CRMC imit Provider: Attending Provider: Riccobonl, Steven, MD Referring Provider: Brueggemann, Kurt, MD ED Arrival Information Arrval a Moans of Arrival ei Escorted inti 7/28/2019 12:17 Family Member Arriva Gomplaint — seen ake Discharge. Information = Discharge Date/Time Discharge Disposition Discharge Destination ca Unit (07/28/2019 1543 Home Or Self Care (Routine) Home: None ‘EMERGENCY CRMC Chief Complaint Com) int Comment Motor Vehicle Crash [160395] Teck pain sip MVA + seat belt mark to right neck, no midline tendemess pt was sitting behind front passenger Impact on front passenger side Diagnoses noe nosis Description Comment ‘Added By Time Added Team Role Provider Speciatty _ ‘Motor vehicie Motor vehicle Drake, Chelsea N, PA 7/28/2019 16:30 Physician collision, lal colliston, initial Medicine, Famly ‘encounter [VB7.7XXA] encounter’ Medicine /87.7XXA} Abrasion of neck, Abrasion of neck, Drake, Chelsea N, PA 712812019 16:30 Physician Initial encounter initia! encounter Assistant Medien, Famy 1810.91XA] [S10.91XA] lergies as of 7/28/2019 = Fully Reviewed by Beheshti, Anmad-Reza, RN on 3/13/2016 No Known Allergies Printed on 9/20/19 1104 Page 1 CRMC e ED Encounter Report Service Type: Emergency Loc: EMERGENCY CRMC Patient: Vollhardt, Jillian Admit Date: 07/28/2019 MRN: 02266785 CSN: 287913025 COMMUNITY Discharge Date: 7/28/2019 DOB: 7/1/2012 | Age: 7 | Sex: Female MEDICAL CENTERS Type: Hospital Encounter ED Notes ED Provider Notes by Drake, Chelsea N, PA 7/28/2019 13:01 ‘Author: Drake, Chelsea N, PA Service: Emer cy ‘Author Type: Physician Assistant Filed: 7/28/2019 16:10 Creation Time: 7/28/2019 13:01 Status: Signed Editor: Drake, Chelsea N, PA (Physician Assistant) Cosigner; Brueggemann, Kurt, MD at 8/6/2019 12:23 History Chief Complaint Patient presents with * Motor Vehicle Crash neck pain s/p MVA + seat belt mark to right neck, no midline tenderness pt was sitting behind front passenger impact on front passenger side Jillian is a 7 year old female who presents after MVC today with anterior neck pain. Patient was restrained passenger. Denies hitting her head. No loss of consciousness. No headache, nausea or vomiting. No abdominal pain, chest pain or shortness of breath. No difficulty breathing or swallowing. Past Medical History: Diagnosis Date + Asthma + Seasonal allergies Past Surgical History: Procedure Laterality Date » DENIES SURGICAL HISTORY Review of Systems Constitutional: Negative for chills, diaphoresis, fatigue and fever. HENT: Negative for dental problem, facial swelling, nosebleeds, sore throat, trouble swallowing and voice change. Eyes: Negative for pain, redness and visual disturbance. Respiratory: Negative for cough, chest tightness, shortness of breath and wheezing. Cardiovascular: Negative for chest pain, palpitations and leg swelling. Gastrointestinal: Negative for abdominal pain, diarrhea, nausea and vomiting. Musculoskeletal: Positive for neck pain. Negative for back pain, gait problem and neck stiffness. Skin: Positive for wound. Negative for pallor and rash. Neurological: Negative for dizziness, syncope, weakness, light-headedness, numbness and headaches. Printed on 9/20/19 1104 Page 2 © CRMC ED Encounter Report Service Type: Emergency Loc: EMERGENCY CRMC Patient: Vollhardt, Jillian Admit Date: 07/28/2019 MRN: 02266785 CSN: 287913025 COMMUNITY Discharge Date: 7/28/2019 DOB: 7/1/2012 | Age: 7 | Sex: Female MEDICAL CENTERS Type: Hospital Encounter ED Notes (continued) ED Provider Notes by Drake, Chelsea N, PA (continued) 7/28/2019 13:01 — Physical Exam Initial vitals: BP: (!) 101/64|Heart Rate: (1) 110] |Temp: 36.5 °C (97.7 °F)|Temp sre: Orall Resp: 20|SpO2: 95 %|O2 Device: None (Room air)| Physical Exam Constitutional: She appears well-developed and well-nourished. She is active. HENT: Head: Atraumatic. No cranial deformity. Right Ear: Tympanic membrane normal. Left Ear: Tympanic membrane normal. Nose: Nose normal. Mouth/Throat: Mucous membranes are moist. Dentition is normal. Oropharynx is clear. Eyes: Pupils are equal, round, and reactive to light. Conjunctivae and EOM are normal. Neck: Trachea normal, normal range of motion, full passive range of motion without pain and phonation normal. Neck supple. Thyroid normal. No tracheal tenderness, no spinous process tenderness and no muscular tenderness present. There are signs of injury. Normal range of motion present. eR voN ~— ~ a OD ee Abrasion along the anterior neck, right infrahyoid muscles Cardiovascular: Normal rate and regular rhythm. Printed on 9/20/19 1104 Page 3 «© CRMC ED Encounter Report Service Type: Emergency Loc: EMERGENCY CRMC Patient: Vollhardt, Jillian Admit Date: 07/28/2019 MRN: 02266785 CSN: 287913025 COMMUNITY Discharge Date: 7/28/2019 DOB: 7/1/2012 | Age:7 | Sex: Female MEDICAL CENTERS Type: Hospital Encounter ED Notes (continued) ED Provider Notes by Drake, Chelsea N, PA (continued) z