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IN THE CIRCUIT COURT OF THE
15™ JUDICIAL CIRCUIT IN AND
FOR PALM BEACH COUNTY,
FLORIDA
JAMES AND RENE KEHOE, individually, GENERAL JURISDICTION DIVISION
AND AS PARENTS AND NATURAL @ 3
GUARDIANS OF KAYLA KEHOE, a minor, CASENO. 502007 CA 024428 XXXXAJ~
2523,
mm _
277 oe
Plaintiffs,
VS.
BLUE STREAK, INC., d/b/a ROYAL
GYMNASTICS CENTER
Defendant.
Sess
PLAINTIFF’S EX PARTE MOTION TO APPROVE MINOR SETT
Plaintiffs, JAMES AND RENE KEHOE, individually and as Parents an’
zo S
Guardians of KAYLA KEHOE, a minor, pursuant to Florida Statute $744.30, ftebyoe et
petition this Honorable Court for approval of a minor settlement, and in support Rate: at
1. A personal injury claim was made on behalf of KAYLA KEHOE, a minor,
due to injuries she sustained on June 29, 2007.
2. On that date, KAYLA KEHOE alleges that Defendant negligently
supervised her during gymnastics camp. Asa result, KAYLA KEHOE
fell into a “foam pit” and fractured her arm.
3. Thereafter, Plaintiffs retained The Law Office of Randy M. Weber, P.A. to
pursue a claim against Defendant for injuries, pain and suffering to the
minor.
4, Fortunately, KAYLA KEHOE has made a full recovery, has no pain,discomfort, loss of strength or range of motion currently and her prognosis
is excellent.
Counsel for the Plaintiff attempted to resolve this matter pre-suit, but
Defendant indicated its unwillingness to resolve this matter.
Asa result of the Defendant’s position, Plaintiff filed this lawsuit.
After filing this suit, JAMES KEHOE was hired by an out-of-state
employer, and the family is in the process of moving to Massachusetts.
Asa result, JAMES and RENE KEHOE advised that they did not wish to
pursue this matter further because of the financial and practical hardship
that traveling to this forum would create for their family.
Consequently, Plaintiffs have agreed to settle this matter in full for
$8,700.00.
Pursuant to Florida Statute §744.387(3)(a), “no settlement after an action
has been commenced by or on behalf of a ward shall be effective unless
approved by the court having jurisdiction of the action.”
Plaintiffs have reviewed and agreed with a closing statement authorizing
disbursement of the settlement proceeds, as well as the Affidavit and
Release of All Claims. A copy of the foregoing is attached:hereto and
marked as Plaintiff's Exhibit “A.”
Because of the amount of the gross settlement, it is unnecessary for the
Court to appoint a Guardian Ad Litem, and the Kehoes should be
permitted to serve as the Natural Guardians of their daughter. See Fla.
Stat. §744.301(2)(e) (Natural guardians are authorized, on behalf of any ofthehir minor children, to: Collect, receive, manage, dispose of, and make
elections regarding the proceeds of any benefit plan as defined by s.
710.102, of which the minor is a beneficiary, participant, or owner,
without appointment, authority, or bond, when the amounts received, in
the aggregate, do not exceed $15,000.)
WHEREFORE, Plaintiffs, by and through their undersigned attorney,
respectfully request this Court enter an order approving the settlement, authorize JAMES
and RENE KEHOE to execute all releases and any other instruments that may be
necessary to effectuate the settlement, and authorize the undersigned law firm to disburse
the settlement proceeds in accordance with the closing statement filed herein, and award
all other and further relief as the Court deems just and proper.
CERTIFICATE OF SERVICE
1 HEREBY CERTIFY that a true and correct copy of the foregoing was served
with via US MAIL and FACSIMILE on this _\ (day of September, 2008, to: John
McClure, Esq., Eight Floor, Courthouse Tower, 44 West Flagler Street, Miami, Fl 33130.
Randy M. Weber, Esq.
Attorneys for the Plaintiff
9350 South Dixie Highway, Suite 1200
Miami, FL33136
Tel:
Fax;
BY:
Ran ” Weber
Fla. Bar No.: 0038880
ce: James and Rene KehoeAUG/28/2008/THU 03:57 PM RESIDENCE. INN FAX No, 407313361 ». 002
Fi p. 002/008
AUG=26-2008 THU 12:39 PM
\ : AFrIDAVIT AND RELEASE OF ALL CLAIMS
For the sole consideration of payment to James and René Kehoe, (AFFIANTS) as parents
- and natural guardians of Kayla Kehoe, a minor, the sum of Eight Thousand Sevan Hundred Dollars
($8,700.00), the receipt and sufficiency of which is hereby acknowedged, AFFIANTS, being under no
lagal disabllity, hereby release, acquit and forever discharge Blue Streak, Inc., and Its members,
directors, officers, agents, servants, employees, insurers and reinsurers, (RELEASEES), from any and
all actians, causes of action, rights, claims, demands, tangible and Intangible damages, costs, attomeys
fees, loss of services and consortium, expenses, compensation, and hosptal and medical bills arlsing
from of on account of, or in any way growing out of any and all bodily and personal injuries, injuries to
reputation or psycha, damage to property, or eny other injury or damage of any description, whsthar
known or unknown, foreseen or unforeseen, as well as any and all claims or demands based on
allegations of clvil rights violations, malicious prosecution and/or Intentional infliction of amotlonal distress,
in connection with an incident involving Kayla Kehoe, a minor, which is allegad to have occurred on
June 28, 2007 cn the premises of Royal Gymnastic Centar, located at 3141 Fortune Way, Wellington, ~
FL 33414, and all sequelae thereof,
This release Is intendad fo Include any and all claims which were or could have been brought by
or on behalf of the plaintiffs against Blue Streak, inc., as well as its members, directors, officers, agents,
servants, employees, Insurers and reinsurers, in the lawsuk entitled - ‘James and René Kehoe, as
parents and natural guardians of Kayla Kehoe, a minor, v. Blue Streak, Inc,, Case No. 502007CA -
024428 XXXXMB, now or recently pending in the Circult Court of the Fifteenth Judicial Circuit in and for
Palm Beach County, Florida,
The following affidavit |s made to induce the RELEASEES and those making payment for or
on thsir behalf to enter such settlement and pay sald sum of money to AFFIANTS;
STATE OF FLORIDA
COUNTY OF PALM BEACH
AFFIANTS, James Kehoe and René Kehoe, on béhalf of themselves and as parents and natural
guardians of Kayla Kehoe, a minor, being first duly swom, hereby affirm thatthere are no llens as listed ©
below or if any of the following listed liens presently exist, they will be satisfied expeditiously from the
proceeds of sattlament :
1. _ Any lien or subrogation right of any hospital in the State of Florida, under the laws of the
* State of Florida, or under any ordinancas of any county or raunicipality;
SS:
2. Any lin or subrogation right of any hospital of the United States Government, Including,
but not limited to a Veterans Hospital, military hospital, and as a result of any other
government-provided medical services, pursuant to the Federal Medical Recovery Act or
otherwise; . .
3. Any lien or subrogation right of Medicare or Medicaid;
4 Any lien or subrogation right of any employer or insurance. carrierfor any employer, for
benefits and services, medical and ‘otherwise, paid by virtue of the workers’ compensation
laws of the State of Florida or any other state; ‘
5. Any fien or subrogation right of any insurance carer for benefits and services, medical
or otherwise, paid by virtue of the motor vehicle law of any state, or any other Insurance
policy, auto or othenwlse; . 7
6. Any lien or eubrogation right of health care insurer for benefits paid or payable under any|
applicable health plan; : a EXHIBIT
ae . we AAUG/28/2008/THU 03:58 PM RESIDENCE INN PAX No, 4073133611 003
AUG=26-2008 THU 12:40 PH - P.008/008
~ AFFIDAVIT AND RELEASE OF Aut CLAIMS
- Kehoe v. Blue Streak, inc., Case No, 50 2007 CA 024428 XXXXMB
Page 2 :
7. Any lien or subrogation right of any group, organization, partnership, corporation, orhealth
insurer or any other health care insurer for benefits paid or payable under any applicable
health Insurance plan.
8. Any lien or subrogation right of any attorney (other than the plaints present attomays
of record) or any private or public adjuster. 7
AFFIANTS undertake and agree to indemnify and hold harmless the RELEASEES and those
making payment for and on their behalf in connection with this settlement against any and all alalms,
sults, losses, costs, expenses and attomey’s fees incurred If any outstanding liens or claims as dascribed
inthe above Affidavit do exist, and agree to pay any losses, costs, expenses and attomey‘s fees incurred
by or on behalf of the RELEASEES In the enforcement of this provision, and/or any losses, costs,
expenses and attomey’s feas incurred by or on behalf of the RELEASEES in defending and/or satisiying
any such Claims of sults. aoe 7 7 :
This release contains the entire agreement between the parties hereto, and the terms of the
Release are contractual and not a mere recital. 7
WE HEREBY SWEAR tha! the above statements are true and correct,
and as
parent and natural
René Kehoe, individually and as parent anct natural
guardian of Kayla Kehoe, a minor-
The foregoing Instrument was swom.to and subscribed before me this _O day of fugvat
2008, by James Kehoe and René Kehoe who:
__ Are personally known to me; :
OR . 7 7
—Sowed the following Identification: . } \ 0enSé€ . : am
BEATRIZ COSIO
'Y COMMISSION #0076644
EXPIRES: MAR 10, 2012
-Bonded through 1st State insurance}
: Printed Name of Notary
My Commission ‘Expires: l ol | a!i daa 15 it: 213 LaW Boston 781-402-3875 >>
IN THE CIRCUIT COURT OF THE
15™ JUDICIAL CIRCUIT IN AND
FOR PALM BEACH COUNTY,
FLORIDA
JAMES AND RENE KEHOE, individually, ) GENERAL JURISDICTION DIVISION
AND AS PARENTS AND NATURAL
GUARDIANS OF KAYLA KEHOE, a minor, CASE NO. 502007 CA 024428
Plaintiffs,
vs.
BLUE STREAK, INC., d/b/a ROYAL
GYMNASTICS CENTER
Defendant.
INTERIM CLOSING STATEMENT
SETTLEMENT $9,700.00
Med pay received 10/12/2007 $1,000.00
Settlement amount $8,700.00
Attomey’s Fees (40% per retainer) . $3,880.00
Roger Slade, Esq. $ 970.00
Weber Law Firm $2,910.00
Cost to Date (see attached breakdown) ; § 909.39
Total Fees and Costs $4,789.39
GROSS SETTLEMENT TO CLIENT $4,910.61
Minus Medicals $0.00
AmtBilled Balance Reduced to =
BCBS Lien 3 8,607.07 $8,607.70 $0.00
Total Medical Bills $ 0.00
P 1/22008
-09-15 17:13
LaW Boston 781-402-3875 >>
NET TO CLIENT $4,910.61
REMARKS
The undersigned hereby acknowledge that he/she has read the above Closing
Statement and the attached itemizations, and assents to the distribution of the funds set
forth therein. The undersigned understands that Florida Statutes may provide for
reimbursement of any medical expenses paid by them from the proceeds of this
Settlement, if applicable. Further, the undersigned understands that a doctor, hospital,
court reporter, expert witness, or other person who has played a role in this claim may
seek payment of a bill following approval of this Closing Statement and the final
disbursement of all monies. I, James and Rene Kehoe, individually and as parent and
natural guardian of Kayla Kehoe, a minor, do hereby agree to pay any and all such bills,
80 long as they are reasonable and hold our attorneys harmless for such bills or
subrogation liens filed by a medical provider including hospitals and/or doctors.
Rove Kebar —aislog
RENE KEHOE, individually, Date «
AND AS PARENTS AND NATURAL ,
GUARDIANS OF KAYLA KEHOE, a minor
Approved by:
w Offiges of Randy M. Weber, PA
But hy, aoa Esq. la a Bok
Roger Slade, Esq. Date
P 2/2Cost report for Kehoe, Kayla v. Royal Gymnastic Center
Date TaskCode Payee Description Cost Acct/Check No
713112007 Postage Randy M. Weber, P.A. Postage for the month of July 2007. $18.82 Reimbursement
7/31/2007 copies Randy M. Weber, PA. Copies for the month of July 2007. 34@$.20 $6.80 Reimbursement
ea
8/3/2007 Records Premium Copy Service Invoice sse01 - records from Palms West $29.62 Operating 5133
fospital.
9/30/2007 copies Randy M. Weber, P.A. copies charges for the month of september $42.20 Reimbursement
9/30/2007 Postage Randy M. Weber, P.A. Postage charges for the month of september. _ $6.96 Reimbursement
10/30/2007 copies Randy M. Weber, P.A. copy charges for the month of october $42.20 Reimbursement
1211112007 Records Bethesda Memorial Ho Invoice 0709-62 - Medical records 7/6/2007 - $55.75 Operating 5262
7/30/2007.
12/27/2007 Filing Palm Beach Clerk of C Filing of lawsuit. $256.00 Operating 5301
12/31/2007 copies Randy M. Weber, P.A. Photocopies for the month of December 2007. $13.80 Reimbursement
69 @ $.20 per copy.
31/2008 Postage Randy M. Weber, P.A. Postage charges for the month of March, 2008 $1.16 Reimbursement
4/30/2008 Facsimile Randy M. Weber, P.A. Facsimile charges for the month of April. $2.80 Reimbursement
14 @ .20 each.
4/30/2008 Postage Randy M. Weber, P.A. Postage charges for the month of April, 2008. $4.92 Reimbursement
4/30/2008 copies Randy M. Weber, P.A. Copy charges for the month ofApril 2008. 8@ $1.60 Reimbursement
eac!
5/2/2008 Service of Proc J.C. Process Service, Invoice 2008000075 - Service on Blue Streak $100.00 Operating 5501
Inc. on 2/29/2008
5/30/2008 Postage Randy M. Weber, P.A. Postage charges for the month of May, 2008 $4.84 Reimbursement
5/30/2008 copies Randy M. Weber, P.A. Copy charges for the month of May, 2008.4 @ $0.80 Reimbursement
20 eat
6/30/2008 Postage Randy M. Weber, P.A. Postage Charges for the month of June, 2008. $0.84 Reimbursement
712212008 Records Orthopedic Center of P Medical records. $34.00
7/31/2008 Postage Randy M. Weber, P.A. Postage Charges for the month of July, 2008. $13.68 Reimbursement
7131/2008 Facsimile Randy M. Weber, PA. Facsimile charges for the month of July, 2008.2 $0.40 Reimbursement
Pages @ .20 each
7134/2008 copies Randy M. Weber, P.A. Copy charges for the month of. ‘July, 2008. 141 $28.20 Reimbursement
@ 20 each.
8/1/2008, Records Ortho Center Palm Bea Records. $34.00 Copy acct 541
/1g/2008 Parking C & J Parking Parking during meeting with client for pre-depo $10.00 Cash
conference.
8/21/2008 Miscellaneous Randy M. Weber, P.A. Miscellaneous charge for unbilled items, gasoline $200.00 Reimbursement
and othe costs assocatied with closing out the
TOTAL COST —_ $909.39
Total Cost By Account
$34.00
Cash $10.00
Copy eect $34.00
Operating $441.37
Reimbursement $390.02
“TrialWorksFL‘ST § 744.301 Page | of 10
West's F.S.A. § 744.301
West's Florida Statutes Annotated Currentness
Title XLIII. Domestic Relations (Chapters 741-759)
“@ Chapter 744. Guardianship (Refs & Annos)
“g Part_III. Types of Guardianship
™»744.301. Natural guardians
(1) The mother and father jointly are natural guardians of their own children and of their adopted
children, during minority. If one parent dies, the surviving parent remains the sole natural guardian
even if he or she remarries. If the marriage between the parents is dissolved, the natural
guardianship belongs to the parent to whom custody of the child is awarded. If the parents are given
joint custody, then both continue as natural guardians. If the marriage is dissolved and neither the
father nor the mother is given custody of the child, neither shall act as natural guardian of the child.
The mother of a child born out of wedlock is the natural guardian of the child and is entitled to
primary residential care and custody of the child unless a court of competent jurisdiction enters an
order stating otherwise.
(2) Natural guardians are authorized, on behalf of any of their minor children, to:
(a) Settle and consummate a settlement of any claim or cause of action accruing to any of their minor
children for damages to the person or property of any of said minor children;
(b) Collect, receive, manage, and dispose of the proceeds of any such settlement;
(c) Collect, receive, manage, and dispose of any real or personal property distributed from an estate
or trust;
(d) Collect, receive, manage, and dispose of and make elections regarding the proceeds from a life
insurance policy or annuity contract payable to, or otherwise accruing to the benefit of, the child; and
(e) Collect, receive, manage, dispose of, and make elections regarding the proceeds of any benefit
plan as defined by s. 710.102, of which the minor is a beneficiary, participant, or owner,
without appointment, authority, or bond, when the amounts received, in the aggregate, do not
exceed $15,000.
(3) All instruments executed by a natural guardian for the benefit of the ward under the powers
specified in subsection (2) shall be binding on the ward, The natural guardian may not, without a
court order, use the property of the ward for the guardian's benefit or to satisfy the guardian's
support obligation to the ward.
CREDIT(S)
Laws 1974, c_ 74-106, § 1; Laws 1975, c. 75-166, § 8; Laws 1975, ¢. 75-222, § 7; Laws 1977, ¢. 77-
190, § 1; Laws 1979, c. 79-221, § 3; Laws 1989, c. 89-96, § 17; Laws 1992, c. 92-200, § 22; Laws
1995, c. 95-211, § 66. Amended by Laws 1997, c. 97-170,.§ 73,.eff. July 1,.1997; Laws 2002,c.
2002-195, § 11, eff. April 29, 2002; Laws 2005, c. 2005-101, § 8, eff, June 1, 2005; Laws 2006, c.
2006-178, § 3, eff. July 1, 2006.
HISTORICAL AND STATUTORY NOTES
Amendment Notes:
Laws 1975, c. 75-166, § 8, substituted “a child born out of wedlock” for “an illegitimate child” in
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IN THE CIRCUIT COURT OF THE 15™ JUDICIAL CIRCUIT IN AND FOR PALM BEACH COUNTY, FLORIDA JAMES AND RENE KEHOE, individually, GENERAL JURISDICTION DIVISION AND AS PARENTS AND NATURAL @ 3 GUARDIANS OF KAYLA KEHOE, a minor, CASENO. 502007 CA 024428 XXXXAJ~ 2523, mm _ 277 oe Plaintiffs, VS. BLUE STREAK, INC., d/b/a ROYAL GYMNASTICS CENTER Defendant. Sess PLAINTIFF’S EX PARTE MOTION TO APPROVE MINOR SETT Plaintiffs, JAMES AND RENE KEHOE, individually and as Parents an’ zo S Guardians of KAYLA KEHOE, a minor, pursuant to Florida Statute $744.30, ftebyoe et petition this Honorable Court for approval of a minor settlement, and in support Rate: at 1. A personal injury claim was made on behalf of KAYLA KEHOE, a minor, due to injuries she sustained on June 29, 2007. 2. On that date, KAYLA KEHOE alleges that Defendant negligently supervised her during gymnastics camp. Asa result, KAYLA KEHOE fell into a “foam pit” and fractured her arm. 3. Thereafter, Plaintiffs retained The Law Office of Randy M. Weber, P.A. to pursue a claim against Defendant for injuries, pain and suffering to the minor. 4, Fortunately, KAYLA KEHOE has made a full recovery, has no pain,discomfort, loss of strength or range of motion currently and her prognosis is excellent. Counsel for the Plaintiff attempted to resolve this matter pre-suit, but Defendant indicated its unwillingness to resolve this matter. Asa result of the Defendant’s position, Plaintiff filed this lawsuit. After filing this suit, JAMES KEHOE was hired by an out-of-state employer, and the family is in the process of moving to Massachusetts. Asa result, JAMES and RENE KEHOE advised that they did not wish to pursue this matter further because of the financial and practical hardship that traveling to this forum would create for their family. Consequently, Plaintiffs have agreed to settle this matter in full for $8,700.00. Pursuant to Florida Statute §744.387(3)(a), “no settlement after an action has been commenced by or on behalf of a ward shall be effective unless approved by the court having jurisdiction of the action.” Plaintiffs have reviewed and agreed with a closing statement authorizing disbursement of the settlement proceeds, as well as the Affidavit and Release of All Claims. A copy of the foregoing is attached:hereto and marked as Plaintiff's Exhibit “A.” Because of the amount of the gross settlement, it is unnecessary for the Court to appoint a Guardian Ad Litem, and the Kehoes should be permitted to serve as the Natural Guardians of their daughter. See Fla. Stat. §744.301(2)(e) (Natural guardians are authorized, on behalf of any ofthehir minor children, to: Collect, receive, manage, dispose of, and make elections regarding the proceeds of any benefit plan as defined by s. 710.102, of which the minor is a beneficiary, participant, or owner, without appointment, authority, or bond, when the amounts received, in the aggregate, do not exceed $15,000.) WHEREFORE, Plaintiffs, by and through their undersigned attorney, respectfully request this Court enter an order approving the settlement, authorize JAMES and RENE KEHOE to execute all releases and any other instruments that may be necessary to effectuate the settlement, and authorize the undersigned law firm to disburse the settlement proceeds in accordance with the closing statement filed herein, and award all other and further relief as the Court deems just and proper. CERTIFICATE OF SERVICE 1 HEREBY CERTIFY that a true and correct copy of the foregoing was served with via US MAIL and FACSIMILE on this _\ (day of September, 2008, to: John McClure, Esq., Eight Floor, Courthouse Tower, 44 West Flagler Street, Miami, Fl 33130. Randy M. Weber, Esq. Attorneys for the Plaintiff 9350 South Dixie Highway, Suite 1200 Miami, FL33136 Tel: Fax; BY: Ran ” Weber Fla. Bar No.: 0038880 ce: James and Rene KehoeAUG/28/2008/THU 03:57 PM RESIDENCE. INN FAX No, 407313361 ». 002 Fi p. 002/008 AUG=26-2008 THU 12:39 PM \ : AFrIDAVIT AND RELEASE OF ALL CLAIMS For the sole consideration of payment to James and René Kehoe, (AFFIANTS) as parents - and natural guardians of Kayla Kehoe, a minor, the sum of Eight Thousand Sevan Hundred Dollars ($8,700.00), the receipt and sufficiency of which is hereby acknowedged, AFFIANTS, being under no lagal disabllity, hereby release, acquit and forever discharge Blue Streak, Inc., and Its members, directors, officers, agents, servants, employees, insurers and reinsurers, (RELEASEES), from any and all actians, causes of action, rights, claims, demands, tangible and Intangible damages, costs, attomeys fees, loss of services and consortium, expenses, compensation, and hosptal and medical bills arlsing from of on account of, or in any way growing out of any and all bodily and personal injuries, injuries to reputation or psycha, damage to property, or eny other injury or damage of any description, whsthar known or unknown, foreseen or unforeseen, as well as any and all claims or demands based on allegations of clvil rights violations, malicious prosecution and/or Intentional infliction of amotlonal distress, in connection with an incident involving Kayla Kehoe, a minor, which is allegad to have occurred on June 28, 2007 cn the premises of Royal Gymnastic Centar, located at 3141 Fortune Way, Wellington, ~ FL 33414, and all sequelae thereof, This release Is intendad fo Include any and all claims which were or could have been brought by or on behalf of the plaintiffs against Blue Streak, inc., as well as its members, directors, officers, agents, servants, employees, Insurers and reinsurers, in the lawsuk entitled - ‘James and René Kehoe, as parents and natural guardians of Kayla Kehoe, a minor, v. Blue Streak, Inc,, Case No. 502007CA - 024428 XXXXMB, now or recently pending in the Circult Court of the Fifteenth Judicial Circuit in and for Palm Beach County, Florida, The following affidavit |s made to induce the RELEASEES and those making payment for or on thsir behalf to enter such settlement and pay sald sum of money to AFFIANTS; STATE OF FLORIDA COUNTY OF PALM BEACH AFFIANTS, James Kehoe and René Kehoe, on béhalf of themselves and as parents and natural guardians of Kayla Kehoe, a minor, being first duly swom, hereby affirm thatthere are no llens as listed © below or if any of the following listed liens presently exist, they will be satisfied expeditiously from the proceeds of sattlament : 1. _ Any lien or subrogation right of any hospital in the State of Florida, under the laws of the * State of Florida, or under any ordinancas of any county or raunicipality; SS: 2. Any lin or subrogation right of any hospital of the United States Government, Including, but not limited to a Veterans Hospital, military hospital, and as a result of any other government-provided medical services, pursuant to the Federal Medical Recovery Act or otherwise; . . 3. Any lien or subrogation right of Medicare or Medicaid; 4 Any lien or subrogation right of any employer or insurance. carrierfor any employer, for benefits and services, medical and ‘otherwise, paid by virtue of the workers’ compensation laws of the State of Florida or any other state; ‘ 5. Any fien or subrogation right of any insurance carer for benefits and services, medical or otherwise, paid by virtue of the motor vehicle law of any state, or any other Insurance policy, auto or othenwlse; . 7 6. Any lien or eubrogation right of health care insurer for benefits paid or payable under any| applicable health plan; : a EXHIBIT ae . we AAUG/28/2008/THU 03:58 PM RESIDENCE INN PAX No, 4073133611 003 AUG=26-2008 THU 12:40 PH - P.008/008 ~ AFFIDAVIT AND RELEASE OF Aut CLAIMS - Kehoe v. Blue Streak, inc., Case No, 50 2007 CA 024428 XXXXMB Page 2 : 7. Any lien or subrogation right of any group, organization, partnership, corporation, orhealth insurer or any other health care insurer for benefits paid or payable under any applicable health Insurance plan. 8. Any lien or subrogation right of any attorney (other than the plaints present attomays of record) or any private or public adjuster. 7 AFFIANTS undertake and agree to indemnify and hold harmless the RELEASEES and those making payment for and on their behalf in connection with this settlement against any and all alalms, sults, losses, costs, expenses and attomey’s fees incurred If any outstanding liens or claims as dascribed inthe above Affidavit do exist, and agree to pay any losses, costs, expenses and attomey‘s fees incurred by or on behalf of the RELEASEES In the enforcement of this provision, and/or any losses, costs, expenses and attomey’s feas incurred by or on behalf of the RELEASEES in defending and/or satisiying any such Claims of sults. aoe 7 7 : This release contains the entire agreement between the parties hereto, and the terms of the Release are contractual and not a mere recital. 7 WE HEREBY SWEAR tha! the above statements are true and correct, and as parent and natural René Kehoe, individually and as parent anct natural guardian of Kayla Kehoe, a minor- The foregoing Instrument was swom.to and subscribed before me this _O day of fugvat 2008, by James Kehoe and René Kehoe who: __ Are personally known to me; : OR . 7 7 —Sowed the following Identification: . } \ 0enSé€ . : am BEATRIZ COSIO 'Y COMMISSION #0076644 EXPIRES: MAR 10, 2012 -Bonded through 1st State insurance} : Printed Name of Notary My Commission ‘Expires: l ol | a!i daa 15 it: 213 LaW Boston 781-402-3875 >> IN THE CIRCUIT COURT OF THE 15™ JUDICIAL CIRCUIT IN AND FOR PALM BEACH COUNTY, FLORIDA JAMES AND RENE KEHOE, individually, ) GENERAL JURISDICTION DIVISION AND AS PARENTS AND NATURAL GUARDIANS OF KAYLA KEHOE, a minor, CASE NO. 502007 CA 024428 Plaintiffs, vs. BLUE STREAK, INC., d/b/a ROYAL GYMNASTICS CENTER Defendant. INTERIM CLOSING STATEMENT SETTLEMENT $9,700.00 Med pay received 10/12/2007 $1,000.00 Settlement amount $8,700.00 Attomey’s Fees (40% per retainer) . $3,880.00 Roger Slade, Esq. $ 970.00 Weber Law Firm $2,910.00 Cost to Date (see attached breakdown) ; § 909.39 Total Fees and Costs $4,789.39 GROSS SETTLEMENT TO CLIENT $4,910.61 Minus Medicals $0.00 AmtBilled Balance Reduced to = BCBS Lien 3 8,607.07 $8,607.70 $0.00 Total Medical Bills $ 0.00 P 1/22008 -09-15 17:13 LaW Boston 781-402-3875 >> NET TO CLIENT $4,910.61 REMARKS The undersigned hereby acknowledge that he/she has read the above Closing Statement and the attached itemizations, and assents to the distribution of the funds set forth therein. The undersigned understands that Florida Statutes may provide for reimbursement of any medical expenses paid by them from the proceeds of this Settlement, if applicable. Further, the undersigned understands that a doctor, hospital, court reporter, expert witness, or other person who has played a role in this claim may seek payment of a bill following approval of this Closing Statement and the final disbursement of all monies. I, James and Rene Kehoe, individually and as parent and natural guardian of Kayla Kehoe, a minor, do hereby agree to pay any and all such bills, 80 long as they are reasonable and hold our attorneys harmless for such bills or subrogation liens filed by a medical provider including hospitals and/or doctors. Rove Kebar —aislog RENE KEHOE, individually, Date « AND AS PARENTS AND NATURAL , GUARDIANS OF KAYLA KEHOE, a minor Approved by: w Offiges of Randy M. Weber, PA But hy, aoa Esq. la a Bok Roger Slade, Esq. Date P 2/2Cost report for Kehoe, Kayla v. Royal Gymnastic Center Date TaskCode Payee Description Cost Acct/Check No 713112007 Postage Randy M. Weber, P.A. Postage for the month of July 2007. $18.82 Reimbursement 7/31/2007 copies Randy M. Weber, PA. Copies for the month of July 2007. 34@$.20 $6.80 Reimbursement ea 8/3/2007 Records Premium Copy Service Invoice sse01 - records from Palms West $29.62 Operating 5133 fospital. 9/30/2007 copies Randy M. Weber, P.A. copies charges for the month of september $42.20 Reimbursement 9/30/2007 Postage Randy M. Weber, P.A. Postage charges for the month of september. _ $6.96 Reimbursement 10/30/2007 copies Randy M. Weber, P.A. copy charges for the month of october $42.20 Reimbursement 1211112007 Records Bethesda Memorial Ho Invoice 0709-62 - Medical records 7/6/2007 - $55.75 Operating 5262 7/30/2007. 12/27/2007 Filing Palm Beach Clerk of C Filing of lawsuit. $256.00 Operating 5301 12/31/2007 copies Randy M. Weber, P.A. Photocopies for the month of December 2007. $13.80 Reimbursement 69 @ $.20 per copy. 31/2008 Postage Randy M. Weber, P.A. Postage charges for the month of March, 2008 $1.16 Reimbursement 4/30/2008 Facsimile Randy M. Weber, P.A. Facsimile charges for the month of April. $2.80 Reimbursement 14 @ .20 each. 4/30/2008 Postage Randy M. Weber, P.A. Postage charges for the month of April, 2008. $4.92 Reimbursement 4/30/2008 copies Randy M. Weber, P.A. Copy charges for the month ofApril 2008. 8@ $1.60 Reimbursement eac! 5/2/2008 Service of Proc J.C. Process Service, Invoice 2008000075 - Service on Blue Streak $100.00 Operating 5501 Inc. on 2/29/2008 5/30/2008 Postage Randy M. Weber, P.A. Postage charges for the month of May, 2008 $4.84 Reimbursement 5/30/2008 copies Randy M. Weber, P.A. Copy charges for the month of May, 2008.4 @ $0.80 Reimbursement 20 eat 6/30/2008 Postage Randy M. Weber, P.A. Postage Charges for the month of June, 2008. $0.84 Reimbursement 712212008 Records Orthopedic Center of P Medical records. $34.00 7/31/2008 Postage Randy M. Weber, P.A. Postage Charges for the month of July, 2008. $13.68 Reimbursement 7131/2008 Facsimile Randy M. Weber, PA. Facsimile charges for the month of July, 2008.2 $0.40 Reimbursement Pages @ .20 each 7134/2008 copies Randy M. Weber, P.A. Copy charges for the month of. ‘July, 2008. 141 $28.20 Reimbursement @ 20 each. 8/1/2008, Records Ortho Center Palm Bea Records. $34.00 Copy acct 541 /1g/2008 Parking C & J Parking Parking during meeting with client for pre-depo $10.00 Cash conference. 8/21/2008 Miscellaneous Randy M. Weber, P.A. Miscellaneous charge for unbilled items, gasoline $200.00 Reimbursement and othe costs assocatied with closing out the TOTAL COST —_ $909.39 Total Cost By Account $34.00 Cash $10.00 Copy eect $34.00 Operating $441.37 Reimbursement $390.02 “TrialWorksFL‘ST § 744.301 Page | of 10 West's F.S.A. § 744.301 West's Florida Statutes Annotated Currentness Title XLIII. Domestic Relations (Chapters 741-759) “@ Chapter 744. Guardianship (Refs & Annos) “g Part_III. Types of Guardianship ™»744.301. Natural guardians (1) The mother and father jointly are natural guardians of their own children and of their adopted children, during minority. If one parent dies, the surviving parent remains the sole natural guardian even if he or she remarries. If the marriage between the parents is dissolved, the natural guardianship belongs to the parent to whom custody of the child is awarded. If the parents are given joint custody, then both continue as natural guardians. If the marriage is dissolved and neither the father nor the mother is given custody of the child, neither shall act as natural guardian of the child. The mother of a child born out of wedlock is the natural guardian of the child and is entitled to primary residential care and custody of the child unless a court of competent jurisdiction enters an order stating otherwise. (2) Natural guardians are authorized, on behalf of any of their minor children, to: (a) Settle and consummate a settlement of any claim or cause of action accruing to any of their minor children for damages to the person or property of any of said minor children; (b) Collect, receive, manage, and dispose of the proceeds of any such settlement; (c) Collect, receive, manage, and dispose of any real or personal property distributed from an estate or trust; (d) Collect, receive, manage, and dispose of and make elections regarding the proceeds from a life insurance policy or annuity contract payable to, or otherwise accruing to the benefit of, the child; and (e) Collect, receive, manage, dispose of, and make elections regarding the proceeds of any benefit plan as defined by s. 710.102, of which the minor is a beneficiary, participant, or owner, without appointment, authority, or bond, when the amounts received, in the aggregate, do not exceed $15,000. (3) All instruments executed by a natural guardian for the benefit of the ward under the powers specified in subsection (2) shall be binding on the ward, The natural guardian may not, without a court order, use the property of the ward for the guardian's benefit or to satisfy the guardian's support obligation to the ward. CREDIT(S) Laws 1974, c_ 74-106, § 1; Laws 1975, c. 75-166, § 8; Laws 1975, ¢. 75-222, § 7; Laws 1977, ¢. 77- 190, § 1; Laws 1979, c. 79-221, § 3; Laws 1989, c. 89-96, § 17; Laws 1992, c. 92-200, § 22; Laws 1995, c. 95-211, § 66. Amended by Laws 1997, c. 97-170,.§ 73,.eff. July 1,.1997; Laws 2002,c. 2002-195, § 11, eff. April 29, 2002; Laws 2005, c. 2005-101, § 8, eff, June 1, 2005; Laws 2006, c. 2006-178, § 3, eff. July 1, 2006. HISTORICAL AND STATUTORY NOTES Amendment Notes: Laws 1975, c. 75-166, § 8, substituted “a child born out of wedlock” for “an illegitimate child” in http://web2.westlaw.com/result/documenttext.aspx?vr=2.0&rp=%2fWelcome%2fFlorida%... 9/15/2008