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SUPERIOR COURT OF THE STATE OF CALIFORNIA
IN AND FOR THE COUNTY OF PLACER
Physical Address: Mailing Address:
10820 Justice Center Drive PO Box 619072
Roseville, CA 95678 Roseville, CA 95661
11/20/2020
William Kershaw
401 Watt Ave
Sacramento CA 95864
Re: Rodriguez, Avery, et al vs. Spadaro, Vanessa S-CV-0043883
DOCUMENT:
O Complaint/Petition/Cross-Complaint/Amended OC Answer/Responsive
O Default O Notice of Deposit of Jury Fees
0 Motion/OSC/Demurrer O Proof of Service
Judgment/Order O Request for Dismissal
O Request for Trial Setting (UD) O Notice of Entry of Dismissal
O Abstract/Writ O Substitution of Attorney
O Notice of Unavailability of Counsel O Other:
O Check # for $
YOUR PAPERS WERE NOT FILED; REASONS FOR REJECTION:
ONo filing fee/incorrect filing fee was tendered. The correct filing fee is $C per person.
O Proof of service must include a cover page with the case name, case number and name of the
party filing the proof of service.
OIncorrect case number listed
OINo case number listed.
CO Papers were submitted to the wrong county.
ONo signature on papers.
CNo original signature on papers and papers are not marked as filed by facsimile or electronic
filing.
O Conformed copy of Request for Entry of Dismissal must be attached to Notice of Entry of
Dismissal.
O Your papers do not comply with CRC §3.250.
O First pages of papers must include all the information required by CRC §2.111(1), including
the name, address, bar number (if applicable), telephone number, and fax number and email
address (if available) of the attorney or party presenting the papers.
O Your papers are not in proper filing format . CRC §2.118(a) and §2.100-2.117.O Per Local Rule 10.9s, when submitting a Writ of Execution or Abstract of Judgment, a copy of
the Judgment must be submitted.
O Must answer as named in complaint/cross-complaint
O Your name and/or law office does not appear as the Attorney of Record.
O Per CRC §3.250(a)(21) Notice of Deposit of Jury Fees are not to be filed with the Court.
O Notices of Unavailability (AKA Tenderloin Notices) for civil filing are no longer accepted.
Carl v. Superior Court (Coast Community College Dist.) (2007) 157 Cal. App. 4" 73.
& OTHER: The Order After Hearing must match the Tentative Ruling verbatim;
See Local Rule 20.2.5 and CRC 3.1312(a)(b)
O Documents were placed in pick-up basket at the Historic Courthouse as no envelope was
provided (Local Rule 10.9(N).
O Documents were placed in pick-up basket at the Gibson Courthouse as no envelope was
provided (Local Rule 10.9(N).
O Documents were placed in pick-up basket at the Tahoe Courthouse as no envelope was
provided (Local Rule 10.9(N).
0 You may wish to obtain information from the law library or from an attorney or other
professional.
Jake Chatters,
Clerk of the Superior Court
C L. Sanders, Deputy aacSUPERIOR COURT OF CALIFORNIA, COUNTY OF PLACER
Date: November 20, 2020 Time: 8:30 AM
Judge: Michael W. Jones Dept: LM
Reporter: Clerk:
Rodriguez, Avery, et al vs. Spadaro, Vanessa Present
OC Present
C1 And related Cross Action(s) Case # S-CV-0043883
Law and Motion Minutes
Proceedings RE: Compromise: Minor Claim -
O Dropped. CO continued to D1 by Plaintiff (] by Defendant
O1 by Stipulation [] by Court
(7 Matter argued and submitted.
O submitted on points and authorities without (] argument [] appearance.
1) Motion/Petition granted. [[] Motion/Petition denied.
C1 Demurrer (] sustained [1] overruled [] without [] with leave to [] amend D] answer.
C1 counsel appointed for:
(1 Taken under submission.
(Debtor is sworn and retired with counsel for examination.
D Stipulation to [Judge Pro Tem [commissioner executed in open court.
C1 Counsel for to prepare the written order and submit it to opposing counsel for approval as
to content and form.
O other
The tentative ruling is adopted as the ruling of the court, to wit:
The petition to approve compromise of pending action of minor is
denied without prejudice.
California Rules of Court, rule 7.950 requires the petition to be
prepared on a “fully completed” form MC-350. The mandatory form
requires that Attachment 9 “must be attached” and must include “[a]n
{NEA 0o a
original or a photocopy of all doctors’ reports containing a diagnosis
of and prognosis for the claimant’s injuries”. While petitioner
attaches a report regarding claimant’s present condition, no doctor’s
reports from around the time of the incident have been provided,
despite the assertion that the minor received emergency room and
follow-up treatment from Kaiser Permanente. Additionally, petitioner
fails to attach a copy of the attorney-client fee agreement, as
required by 118(a)(2) of the petition.
If oral argument is requested, appearance of the minor is excused.Electronically Received 11/17/2020 08:57
MC-3514
| Jeffrey M. Schaff, Esq. SBN 269606
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, Stale Bar number, and adores) FOR COURT USE ONLY
Kershaw Cook & Talley PC
401 Watt Ave., Sacramento, CA 95864
TELEPHONE NO: 916-779-7000 FAXNO. (Ontonay: 916-244-4829
E-mail ADDRESS (Optona): jeff@kctleqal.com
ATTORNEY FoR (Name) Plaintiff, Avery Rodriquez by and through GAL
SUPERIOR COURT OF CALIFORNIA, COUNTY OF Placer
streeraooress: 10820 Justice Center Dr.
MAILING ADDRESS:
cry anozip cove: Roseville. CA 95678
BRANCH NAME:
Rodriguez v. Spadaro
CASE NAME:
ORDER APPROVING: CASE NUMBER:
(_) COMPROMISE OF DISPUTED CLAIM sc
004
[2] COMPROMISE OF PENDING ACTION 3883
(—] DISPOSITION OF PROCEEDS OF JUDGMENT HEARING DATE; ANY: DEPT:
[7] Minor [—] Person With a Disability 12/11/2020 3
. Petitioner (name): Kayla Woods has petitioned for court approval of a
proposed compromise of a disputed claim of a minor or a pending action involving a minor or a person with a disability or a
proposed disposition of the proceeds of a judgment for a minor or a person with a disability.
Hearing
a. [_] No hearing was held. The petition is an expedited petition under rule 7.950.5 of the California Rules of Court.
b. LZ) pate: Time: Dept.:
c. Judicial officer:
. Relationship to claimant
Petitioner has the following relationship or relationships to claimant (check all applicable boxes):
a. Parent
Guardian ad litem
Guardian
Conservator
Claimant, an adult person with a disability, is the petitioner.
Other (specify):
OOOCoS
. Claimant (name): Avery Rodriguez
a. (2) isaminor.
b. (1) isa"person with a disability" within the meaning of Probate Code section 3603 who is:
(1) (J An adult. Claimant's date of birth is (specify):
(a) () Without a conservator. Claimant has capacity to consent to this order, within the meaning of
Probate Code section 812, and has consented to this order.
(b) (] A conservatee; a person for whom a conservator may be appointed; or without capacity to
consent to this order, within the meaning of Probate Code section 812.
(2) () Aminor described in Probate Code section 3603(b)(3).
Defendant
The claim or action to be compromised is asserted, or the judgment is entered, against (name of settling or judgment defendant or
defendants (the "payer")):
Vanessa Spadaro
Page 1of4
Form Adopted for Mandatory Use. ORDER APPROVING COMPROMISE OF DISPUTED CLAIM OR PENDING — oi Cv Prveguve 6 272:
§
NCS phew dorary 1.2010) ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR ©! Riot Gai la 137885
MINOR OR PERSON WITH A DISABILITY
(Miscellaneous)MC-351
CASE NAME: CASE NUMBER:
+~ Rodriguez v. Spadaro SCV0043883
6. THE COURT FINDS that all notices required by law have been given.
7. THE COURT ORDERS
a. The petition is granted and the proposed compromise of claim or action or the proposed disposition of the proceeds of the
judgment is approved. The gross amount or value of the settlement or judgment in favor of claimant is $
b. [J Until further order of the court, jurisdiction is reserved to determine a claim for a reduction of a Medi-Cal lien under
Welfare and Institutions Code section 14124.76. The amount shown payable to the Department of Health Care Services
in item 7c(1)(d) of this order is the full amount of the lien claimed by the department but is subject to reduction on further
order of the court upon determination of the claim for reduction.
c. The payer shall disburse the proceeds of the settlement or judgment approved by this order in the following manner:
(1) Payment of fees and expenses
Fees and expenses shall be paid by one or more checks or drafts, drawn payable to the order of the petitioner and the
petitioner's attorney, if any, or directly to third parties entitled to receive payment identified in this order for the following
items of expense or damage, which are hereby authorized to be paid out of the proceeds of the settlement or judgment:
Attorney's fees in the total amount of: $ [12,000.00 payable to (specify):
(b) 74 Reimbursement for medical and all other expenses paid by the petitioner or the
petitioner's attorney in the total amount of: $14,255.48
(c) [2] Medical, hospital, ambulance, nursing, and other like expenses payable directly to
providers as follows, in the total amount of: $ (865.00
(i) Payee (name): Equian for Kaiser Permanente
(A) Address: P.O, Box 36380, Louisville, KY 40233
(B) Amount: $ 865.00
(ii) Payee (name):
(A) Address:
(B) Amount: $
(=) Continued on Attachment 7c(1)(c). (Provide information about additional payees in the above format.)
(4) (_) Other authorized disbursements payable directly to third parties in the total amount of: $
(Describe and state the amount of each item and provide the name and address of each payee):
[1 Continued on Attachment 7c(1)(d).
(e) (__) Total allowance for fees and expenses from the settlement or judgment: $ 17,120.48
MESSI frex: dentery 1, 2010) ORDER APPROVING COMPROMISE OF DISPUTED CLAIM OR PENDING Page 2.04
ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR
MINOR OR PERSON WITH A DISABILITY
(Miscellaneous)MC-351
CASE NAME CASE NUMBER:
~ Rodriguez v. Spadaro SCV0043883
7. THE COURT ORDERS (cont.)
c. The payer shall disburse the proceeds of the settlement or judgment approved by this order in the following manner:
(2) Balance
The balance of the settlement or judgment available for claimant after payment of all allowed
fees and expenses is: $ (22,879.52
The balance shall be disbursed as follows:
(a) [] By one or more checks or drafts in the total amount of (specify): $
drawn payable to the order of the petitioner as trustee for the claimant. Each such check or draft must bear an
endorsement on the face or reverse that it is for deposit in one or more interest-bearing, federally insured
accounts in the name of the petitioner as trustee for the claimant, and no withdrawals may be made from the
accounts except as provided in the Order to Deposit Money Into Blocked Account (form MC-355), which is
signed contemporaneously with this order ("blocked account").
(b) 7) By the following method(s) (describe each method, including the amount to be disbursed ):
by check or draft in the amount of $22,879.52 made payable to MetLife
Assignment Company, Inc., for the purchasing of the structured settlement annuity
that shall provide future benefits to the minor as identified in Addendum A.
[Z1 Continued on Attachment 70(2)\b)
(c) [_] If money is to be paid to a special needs trust under Probate Code section 3604, all statutory liens in favor
of the state Department of Health Care Services, the state Department of Mental Health, the state
Department of Developmental Services, and any city and county in California must first be satisfied by the
following method (specify):
[1 Continued on Attachment 7¢(2)(c).
8. [_] Further orders of the court concerning blocked accounts
The court makes the following additional orders concerning any part of the balance ordered to be deposited in a blocked
account under item 7¢(2)(a):
a. Within 48 hours of receipt of a check or draft described in item 7c(2)(a), the petitioner and the petitioner's attorney, if
any, must deposit the check or draft in the petitioner's name as trustee for the claimant in one or more blocked accounts
at (specify name, branch, and address of each depository, and the amount of each account):
(1) Continued on Attachment 8a.
MC-351 [Rev. Janvay 1.20101 ORDER APPROVING COMPROMISE OF DISPUTED CLAIM OR PENDING Page Sore
ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR
MINOR OR PERSON WITH A DISABILITY
(Miscellaneous)MC-351
CASE NAME:
CASE NUMBER:
~ Rodriguez v. Spadaro SCV0043883
8. Further orders of the court concerning blocked accounts
The court makes the following additional orders concerning any part of the balance ordered to be deposited in a blocked
account under item 7¢(2)(a):
b. The petitioner and the petitioner's attorney, if any, must deliver to each depository at the time of deposit three copies of
the Order to Deposit Money Into Blocked Account (form MC-355), which is signed contemporaneously with this order.
and three copies of the Receipt and Acknowledgment of Order for the Deposit of Money Into Blocked Account (form
MC-356). The petitioner or the petitioner's attorney must file a copy of the receipt with this court within 15 days of the
deposit. The sole responsibilities of the petitioner and the petitioner's attorney, if any, are to place the balance in a
blocked account or accounts and to timely file a copy of the receipt.
c. The balance of the proceeds of the settlement or judgment deposited in a blocked account or accounts under item
7c(2)(a) may be withdrawn only as follows (check (1) or (2)):
(1) (2) No withdrawals of principal or interest may be made from the blocked account or accounts without a further
written order under this case name and number, signed by a judge, and bearing the seal of this court. The
money on deposit is not subject to escheat.
(2) () The blocked account or accounts belong to a minor. The minor was born on (date):
No withdrawals of principal or interest may be made from the blocked account or accounts without a further
written order under this case name and number, signed by a judicial officer, and bearing the seal of this
court, until the minor attains the age of 18 years. When the minor attains the age of 18 years, the depository,
without further order of this court, is authorized and directed to pay by check or draft directly to the former
minor, upon proper demand, all moneys including interest deposited under this order. The money on deposit
is not subject to escheat.
9. Authorization to execute settlement documents
The petitioner is authorized to execute settlement documents as follows (check only one):
a CJ) Upon receipt of the full amount of the settlement sum approved by this order and the deposit of funds, the
petitioner is authorized and directed to execute and deliver to the payer a full, complete, and final release and
discharge of any and all claims and demands of the claimant by reason of the accident or incident described in
the petition and the resultant injuries to the claimant and a properly executed dismissal with prejudice.
b. [_]_ The petitioner is authorized and directed to execute any and all documents reasonably necessary to carry out
the terms of the settlement.
c. The petitioner is authorized and directed (specify):
Kayla Woods is the appointed Guardian ad Litem
Continued on Attachment Sc.
10. Bondis [-_] ordered and fixed in the amount of: $ (J not required.
11. A copy of this order shall be served on the payer forthwith.
12.1] Additional orders
The court makes the following additional orders (specify):
(J Continued on Attachment 12.
Date:
JUDICIAL OFFICER
[1 sicnature FoLiows LAST ATTACHMENT
MC-351 [Rev. January 1, 2010}
Page 4 of 4
ORDER APPROVING COMPROMISE OF DISPUTED CLAIM OR PENDING
ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR
MINOR OR PERSON WITH A DISABILITY
(Miscellaneous)MC-025
Rodriguez v. Spadaro SCV0043883
ATTACHMENT (Number): 7c( 2)( b)
(This Attachment may be used with any Judicial Council form.)
ASI Insurance Group has agreed to make the payment of $22,879.52 to fund the structured annuity set forth in
Addendum A attached. This payment will be provided on a tax-free basis pursuant to Section 104 (a) (2) of
the Internal Revenue Code of 1986, as amended. The sum of $22,879.52 is to be used by ASI Insurance Group
to arrange for the purchase of a tax-free structured settlement annuity policy from Metlife Assignment
Company Inc.
Pee TITLE: CASE NUMBER:
ASI Insurance Group will issue a check in the amount of $22,879.52, (assignment) to Ringler & Associates
(Assignee), Upon doing so, ASI Insurance Group will no longer have obligations whatsoever to the Plaintiff.
The assignee shall purchase structured settlement annuity for $22,879.52 through MetLife Assignment
Company Inc.
It is so Ordered.
Date:
Hon. Judge of the Superior Court
(if the item that this Attachment concerns is made under penalty of perjury, all statements in this Page of
Attachment are made under penalty of perjury.) (Add pages as required)
Form Approved for Optional Use ATTACHMENT wwew.courtinto.ca.gov
MER few sy 9, 2009) to Judicial Council FormMC-025
SHORT TITLE: CASE NUMeER:
Rodriguez v. Spadaro SCV0043883
ATTACHMENT (Number): A.
(This Attachment may be used with any Judicial Council form, )
ATTACHMENT A - Addendum Structured
(If the item that this Attachment concerns is made under penalty of perjury, all statements in this Page of
Attachment are made under penalty of perjury.)
(Add pages as required)
; Opal U Salen
efageal Goenet of Gaara ATTACHMENT
MC-025 [Rev. July 1, 2008] to Judicial Council FormStructure Attachment to Petition and Order
AVERY RODRIGUEZ (date of birth: 06/05/2018)
1.0 Insurer for Defendant(s) (hereafter “Insurer”) hereby agrees to pay the following:
$22,879.52 payable to MetLife Assignment Company, Inc. to fund the
obligation for the Periodic Payments illustrated in Section 1.1
1.1 Periodic Payments to be made to Avery Rodriguez (the “Payee”) according to
the schedule, as follows (the “Periodic Payment”):
$36,503.05 guaranteed lump sum payment on 06/15/2043 (Age 25).
All sums set forth herein constitute damages on account of personal physical injuries or
physical sickness, within the meaning of Section 104(a)(2) of the Internal Revenue Code of
1986, as amended.
2.0 Petitioner acknowledges that the Periodic Payments cannot be accelerated,
deferred, increased or decreased by any Payee; nor shall any Payee have the power to sell,
mortgage, encumber, or anticipate the Periodic Payments, or any part thereof, by assignment or
otherwise.
3.0 Petitioner acknowledges and agrees that Insurer may make a “qualified
assignment” within the meaning of Section 130(c), of the Internal Revenue Code of 1986, as
amended, of Insurer’s liability to make the Periodic Payments set forth in Section 1.1 to
MetLife Assignment Company, Inc. (the “Assignee”). Assignee’s obligation for payment of
the Periodic Payments shall be no greater than that of Insurer (whether by judgment or
agreement) immediately preceding the assignment of the Periodic Payments obligation.
Such assignment, if made, shall be accepted by the Petitioner and Payee without
right of rejection and shall completely release and discharge Insurer from the Periodic
Payments obligation assigned to Assignee. The Petitioner and Payee recognize that Assignee
shall be the sole obligor with respect to the Periodic Payments obligation, and that all other
releases with respect to the Periodic Payments obligation that pertain to the liability of Insurer
shall thereupon become final, irrevocable and absolute. Metropolitan Tower Life Insurance
Company will provide an Evidence of Guarantee as evidence of its financial guarantee over the
periodic payment obligation of MetLife Assignment Company, Inc.
Page 1 of 2Structure Attachment to Petition and Order
AVERY RODRIGUEZ (date of birth: 06/05/2018)
4.0 Any payments to be made after the death of the Payee shall be made to such
person or entity as shall be designated in writing by the Payee to the Assignee, upon the Payee
reaching majority. If no person or entity is so designated by the Payee, or if the person
designated is not living at the time of the Payee's death, such payments shall be made to the
estate of the Payee. No such designation, or any revocation thereof, shall be effective unless it
is in writing and delivered to the Assignee. The designation must be in a form acceptable to the
Assignee before such payments are made.
5.0 Insurer, itself or through the Assignee, reserves the right to fund the liability to
make the Periodic Payments through the purchase of annuity policy from Metropolitan Tower
Life Insurance Company (the “Annuity Issuer”). Assignee shall be the sole owner of the
annuity policy and shall have all rights of ownership. Assignee will have Annuity Issuer mail
payments directly to the Payee. The Petitioner or Payee, upon reaching majority, shall be
responsible for maintaining a current mailing address and mortality information with Assignee.
6.0 The obligation assumed by Assignee to make each Periodic Payment shall be
fully discharged upon the mailing of a valid check or electronic funds transfer in the amount of
such payment on or before the due date to the last address on record for the Payee with the
Annuity Issuer. If the Payee notifies Assignee that any check or electronic funds transfer was
not received, Assignee shall direct Annuity Issuer to initiate a stop payment action and, upon
confirmation that such check was not previously negotiated or electronic funds transfer
deposited, shall have Annuity Issuer process a replacement payment.
Quoted with Metropolitan Tower Life Insurance Company,
Rated A+, XV by A.M. Best Company.
Internal Rate of Return = 2.09%
Taxable Equivalent yield: 2.9\01%
Rate Series = RB200901 (09/01/2020)
Proposal Prepared: 10/26/2020
Proposal Purchase Date: 11/20/2020
The Periodic Payment amounts outlined above are guaranteed based upon a projected annuity
purchase date of 11/20/2020. Any delay in funding of the annuity may result in a change in the
Periodic Payment amounts, which shall be recorded in the qualified assignment document and
annuity contract, without the need to obtain an amended Petition/Court Order, up to 120 days
after the original Proposal Purchase Date illustrated herein.
All parties are required to execute the necessary settlement documents in order to effectuate
the assignment.
Page 2 of 2EXHIBIT A
1.0 Payments
It is further agreed that for consideration set forth, Insurer for Releasee (hereafter “Insurer’”)
hereby agrees to pay the following:
1d $17,120.48 payable to Kershaw, Cook & Talley, P.C. for attorney fees, costs
and any liens
$22,879.52 payable to MetLife Assignment Company, Inc. to fund the
obligation for the Periodic Payments illustrated in Section 1.2
1.2 Periodic Payments to be made to Avery Rodriguez (the “Payee”) according to
the schedule, as follows (the “Periodic Payment”):
$36,503.05 guaranteed lump sum payment on 06/15/2043
All sums set forth herein constitute damages on account of personal physical injuries or
physical sickness, within the meaning of Section 104(a)(2) of the Internal Revenue Code of
1986, as amended.
2.0 Payee’s Rights to Payments
Plaintiff and any Payee acknowledges that the Periodic Payments cannot be accelerated,
deferred, increased or decreased by any Payee; nor shall any Payee have the power to sell,
mortgage, encumber, or anticipate the Periodic Payments, or any part thereof, by assignment or
otherwise.
3.0 Consent to Qualified Assignment
Plaintiff and any Payee acknowledge and agree that Insurer may make a “qualified
assignment” within the meaning of Section 130(c), of the Internal Revenue Code of 1986, as
amended, of Insurer’s liability to make the Periodic Payments set forth in Section 1.2 to
MetLife Assignment Company, Inc. (the “Assignee”). Assignee’s obligation for payment of
the Periodic Payments shall be no greater than that of Insurer (whether by judgment or
agreement) immediately preceding the assignment of the Periodic Payments obligation.
Such assignment, if made, shall be accepted by the Plaintiff and any Payee without right of
rejection and shall completely release and discharge Insurer from the Periodic Payments
obligation assigned to Assignee. The Plaintiff and any Payee recognize that Assignee shall be
the sole obligor with respect to the Periodic Payments obligation, and that all other releases
with respect to the Periodic Payments obligation that pertain to the liability of Insurer shall
thereupon become final, irrevocable and absolute. Metropolitan Tower Life Insurance
Company will provide an Evidence of Guarantee as evidence of its financial guarantee over the
periodic payment obligation of MetLife Assignment Company, Inc.
10/26/2020EXHIBIT A
4.0 Payee’s Beneficiary
Any payments to be made after the death of the Payee shall be made to such person or entity as
shall be designated in writing by the Payee to the Assignee, upon the Payee reaching majority.
If no person or entity is so designated by the Payee, or if the person designated is not living at
the time of the Payee's death, such payments shall be made to the estate of the Payee. No such
designation, or any revocation thereof, shall be effective unless it is in writing and delivered to
the Assignee. The designation must be in a form acceptable to the Assignee before such
payments are made.
5.0 Right to Purchase an Annuity
Insurer, itself or through the Assignee, reserves the right to fund the liability to make the
Periodic Payments through the purchase of annuity policy from Metropolitan Tower Life
Insurance Company (the “Annuity Issuer”). Assignee shall be the sole owner of the annuity
policy and shall have all rights of ownership. Assignee will have Annuity Issuer mail
payments directly to the Payee. The Plaintiff or Payee, upon reaching majority, shall be
responsible for maintaining a current mailing address and mortality information with Assignee.
6.0 Discharge of Obligation
The obligation assumed by Assignee to make each Periodic Payment shall be fully discharged
upon the mailing of a valid check or electronic funds transfer in the amount of such payment
on or before the due date to the last address on record for the Payee with the Annuity Issuer. If
the Payee notifies Assignee that any check or electronic funds transfer was not received,
Assignee shall direct Annuity Issuer to initiate a stop payment action and, upon confirmation
that such check was not previously negotiated or electronic funds transfer deposited, shall have
Annuity Issuer process a replacement payment.
10/26/2020 2MC-025
SHORT TITLE: CASE NUMBER:
Rodriguez v. Spadaro SCV0043883
ATTACHMENT (Number): 9c
(This Attachment may be used with any Judicial Council form.)
ATTACHMENT 9c
(if the item that this Attachment concerns is made under penalty of perjury, all statements in this Page of
Attachment are made under penalty of perjury.) (Add pages as required)
Form Approved for Optional Use wow courtinfo.c8.gov
‘Council of Cafornia
'MC-025 (Rev. July 1. 2003]
ATTACHMENT
to Judi
Council FormCiv-010
FOR COURT USE ONLY
[ATTORNEY (Narre, State Bar number, and adders)
Jeffrey M. Schaff, Esq. /// SBN 269606
Kershaw Cook & Talley, P.C
401 Watt Avenue.
Sacramento, CA 95864
rexerroneno: 916-779-7000 — raxno.(ontnen 916-244-4829
Emil ogress Ontmay jeff@kctlegal.com
avronney FOR Mer Plaintiffs
SUPERIOR COURT OF CALIFORNIA, COUNTY OF Sacramento
street avoress: 720 Ninth Street
MAILING ADDRESS:
crvanpzpcooe Sacramento, CA 95814
RANCH NAME:
PLAINTIFF(PETITIONER: Kayla Woods
DEFENDANTRESPONOENT: Vanessa Spadaro, et al.
APPLICATION AND ORDER FOR APPOINTMENT | omer 04 3b
OF GUARDIAN AD LITEM—CIVIL
(7) _EX PARTE
NOTE: This form Is for use in civil proceedings in which a party Is 2 minor, an incapacitated person, or a person for
whom & conservator has been appointed. A party who seeks the appointment of a guardian ad Iitem In a family taw or ‘
Juvenile proceeding should use form FL-935. A party who seeks the appointment of a guardian ad Iftem in a probate
proceeding should use form DE-350/GC-100. An Individual cannot act as a guardian ad item unless he or she is :
represented by an attomey or Is an attorney.
1. Applicant (name); Kayla Woods
2 the parent of (name): Avery E. Rodriguez
b. C2] the guardian of (name):
(2 the consarvator of (name):
c
o. (J a panty to the suit.
e the minor to be represented (if the minor is 14 years of age or older).
#. (J another interested person (specity capacity):
This application seeks the appointment of the following person as guardian ad litem (state name, address, and telephone number):
Kayla Woods
8622 Bronson Dr.
Granite Bay, CA 95746. Phone: (916) 765-6761
‘The guardian ad litem Is to represent the interests of the following person (state name, address, and telephone number):
Avery E. Rodriguez.
8622 Bronson Dr.
Granite Bay, CA 95746. Phone: (916) 765-6761
4 Mee to be represented fs:
a. a minor (date of birth): 06/05/2018 \
b. L_] an incompetent person. |
c. (_] a person for whom a conservator has been appointed }
5. The court should appoint a guardian ad litem because:
a. (2) the person named In item 3 has a cause or causes of action on which sult should be brought (describe):
Avery E. Rodriguez was injured while under the care of defendants and sustained injuries on
08/16/2019
C) Continued on Attachment 52.
Page tot
Form Adega fo Wer ctcry Use APPLICATION AND ORDER FOR APPOINTMENT Cone OM ee
cvore ev wy 0 OF GUARDIAN AD LITEin item 3, and no application for the appointment of a guardian ad litem has been made by the person identified in
item 2 of any other persen.
c [__] the person named in item 3 has no guardian or conservator of his or her estate,
d, (7) the appointment of a guardian ad litem is necessary for the following reasons (specify)
Avery E. Rodriguez is a minor and requires guardian ad litem to serve and protect her interest in this
claim against the defendant.
Continued on Attachment 5d.
6. eaeposed guardian ad fitem’s relationship to the person he or she will be representing is:
a related (state relationship): Mother
b. (7) not related (specity capacity):
. The proposed guardian ad litem Is fully competent and qualified to understand and protect the rights of the person he or she wili
represent and has no Interests adverse to the Interests of that person. (if there are any issues of competency or qualification or
any possible adverse interests, describe and explnin why the proposed guardian should novortheless be appointed):
(— Continued on Attachment 7. ,
Jeffrey M.Schatt — A
RE OFA
| declare under penatty of perjury under the laws of the Siate of California that the forego/’ nd corre i
Date: SeptemberLy 2019
(TYPE OR PRINT NAME) "LABIGHATURE OF APP UCANT)
CONSENT TO ACT AS GUARDIAN AD LITEM
| consent to the appointment as guardian ad litem under the above petition.
Date: September2g 2019
Kayla Woods >
(TYPE OR PRINT NAME
Kayla Woods
[QWPROVAY AD LITEM)
ORDER f 2-EX PARTE
THE COURT FINDS that It is reasonable and necessary to apgb#it a guardian ad litem for the person named in item 3 of the
application, as requested.
THE COURT ORDERS that (name): Kayla Woods
is hereby appointed as the guardian ad litem for (name): Avery E. Rodriguez
for the reasons set forth in Item § of the application. Alan Pineschi
Date: oct 18 201 oo
JUOGAL OFFICER
[1 store rouoms ust ATTACHHENT
Gv.o10 fev. damary 1, 2008} APPLICATION AND ORDER FOR APPOINTMENT Coens?
OF GUARDIAN AD LITEM—CIVIL {
Preview
SUPERIOR COURT OF THE STATE OF CALIFORNIA IN AND FOR THE COUNTY OF PLACER Physical Address: Mailing Address: 10820 Justice Center Drive PO Box 619072 Roseville, CA 95678 Roseville, CA 95661 11/20/2020 William Kershaw 401 Watt Ave Sacramento CA 95864 Re: Rodriguez, Avery, et al vs. Spadaro, Vanessa S-CV-0043883 DOCUMENT: O Complaint/Petition/Cross-Complaint/Amended OC Answer/Responsive O Default O Notice of Deposit of Jury Fees 0 Motion/OSC/Demurrer O Proof of Service Judgment/Order O Request for Dismissal O Request for Trial Setting (UD) O Notice of Entry of Dismissal O Abstract/Writ O Substitution of Attorney O Notice of Unavailability of Counsel O Other: O Check # for $ YOUR PAPERS WERE NOT FILED; REASONS FOR REJECTION: ONo filing fee/incorrect filing fee was tendered. The correct filing fee is $C per person. O Proof of service must include a cover page with the case name, case number and name of the party filing the proof of service. OIncorrect case number listed OINo case number listed. CO Papers were submitted to the wrong county. ONo signature on papers. CNo original signature on papers and papers are not marked as filed by facsimile or electronic filing. O Conformed copy of Request for Entry of Dismissal must be attached to Notice of Entry of Dismissal. O Your papers do not comply with CRC §3.250. O First pages of papers must include all the information required by CRC §2.111(1), including the name, address, bar number (if applicable), telephone number, and fax number and email address (if available) of the attorney or party presenting the papers. O Your papers are not in proper filing format . CRC §2.118(a) and §2.100-2.117.O Per Local Rule 10.9s, when submitting a Writ of Execution or Abstract of Judgment, a copy of the Judgment must be submitted. O Must answer as named in complaint/cross-complaint O Your name and/or law office does not appear as the Attorney of Record. O Per CRC §3.250(a)(21) Notice of Deposit of Jury Fees are not to be filed with the Court. O Notices of Unavailability (AKA Tenderloin Notices) for civil filing are no longer accepted. Carl v. Superior Court (Coast Community College Dist.) (2007) 157 Cal. App. 4" 73. & OTHER: The Order After Hearing must match the Tentative Ruling verbatim; See Local Rule 20.2.5 and CRC 3.1312(a)(b) O Documents were placed in pick-up basket at the Historic Courthouse as no envelope was provided (Local Rule 10.9(N). O Documents were placed in pick-up basket at the Gibson Courthouse as no envelope was provided (Local Rule 10.9(N). O Documents were placed in pick-up basket at the Tahoe Courthouse as no envelope was provided (Local Rule 10.9(N). 0 You may wish to obtain information from the law library or from an attorney or other professional. Jake Chatters, Clerk of the Superior Court C L. Sanders, Deputy aacSUPERIOR COURT OF CALIFORNIA, COUNTY OF PLACER Date: November 20, 2020 Time: 8:30 AM Judge: Michael W. Jones Dept: LM Reporter: Clerk: Rodriguez, Avery, et al vs. Spadaro, Vanessa Present OC Present C1 And related Cross Action(s) Case # S-CV-0043883 Law and Motion Minutes Proceedings RE: Compromise: Minor Claim - O Dropped. CO continued to D1 by Plaintiff (] by Defendant O1 by Stipulation [] by Court (7 Matter argued and submitted. O submitted on points and authorities without (] argument [] appearance. 1) Motion/Petition granted. [[] Motion/Petition denied. C1 Demurrer (] sustained [1] overruled [] without [] with leave to [] amend D] answer. C1 counsel appointed for: (1 Taken under submission. (Debtor is sworn and retired with counsel for examination. D Stipulation to [Judge Pro Tem [commissioner executed in open court. C1 Counsel for to prepare the written order and submit it to opposing counsel for approval as to content and form. O other The tentative ruling is adopted as the ruling of the court, to wit: The petition to approve compromise of pending action of minor is denied without prejudice. California Rules of Court, rule 7.950 requires the petition to be prepared on a “fully completed” form MC-350. The mandatory form requires that Attachment 9 “must be attached” and must include “[a]n {NEA 0o a original or a photocopy of all doctors’ reports containing a diagnosis of and prognosis for the claimant’s injuries”. While petitioner attaches a report regarding claimant’s present condition, no doctor’s reports from around the time of the incident have been provided, despite the assertion that the minor received emergency room and follow-up treatment from Kaiser Permanente. Additionally, petitioner fails to attach a copy of the attorney-client fee agreement, as required by 118(a)(2) of the petition. If oral argument is requested, appearance of the minor is excused.Electronically Received 11/17/2020 08:57 MC-3514 | Jeffrey M. Schaff, Esq. SBN 269606 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, Stale Bar number, and adores) FOR COURT USE ONLY Kershaw Cook & Talley PC 401 Watt Ave., Sacramento, CA 95864 TELEPHONE NO: 916-779-7000 FAXNO. (Ontonay: 916-244-4829 E-mail ADDRESS (Optona): jeff@kctleqal.com ATTORNEY FoR (Name) Plaintiff, Avery Rodriquez by and through GAL SUPERIOR COURT OF CALIFORNIA, COUNTY OF Placer streeraooress: 10820 Justice Center Dr. MAILING ADDRESS: cry anozip cove: Roseville. CA 95678 BRANCH NAME: Rodriguez v. Spadaro CASE NAME: ORDER APPROVING: CASE NUMBER: (_) COMPROMISE OF DISPUTED CLAIM sc 004 [2] COMPROMISE OF PENDING ACTION 3883 (—] DISPOSITION OF PROCEEDS OF JUDGMENT HEARING DATE; ANY: DEPT: [7] Minor [—] Person With a Disability 12/11/2020 3 . Petitioner (name): Kayla Woods has petitioned for court approval of a proposed compromise of a disputed claim of a minor or a pending action involving a minor or a person with a disability or a proposed disposition of the proceeds of a judgment for a minor or a person with a disability. Hearing a. [_] No hearing was held. The petition is an expedited petition under rule 7.950.5 of the California Rules of Court. b. LZ) pate: Time: Dept.: c. Judicial officer: . Relationship to claimant Petitioner has the following relationship or relationships to claimant (check all applicable boxes): a. Parent Guardian ad litem Guardian Conservator Claimant, an adult person with a disability, is the petitioner. Other (specify): OOOCoS . Claimant (name): Avery Rodriguez a. (2) isaminor. b. (1) isa"person with a disability" within the meaning of Probate Code section 3603 who is: (1) (J An adult. Claimant's date of birth is (specify): (a) () Without a conservator. Claimant has capacity to consent to this order, within the meaning of Probate Code section 812, and has consented to this order. (b) (] A conservatee; a person for whom a conservator may be appointed; or without capacity to consent to this order, within the meaning of Probate Code section 812. (2) () Aminor described in Probate Code section 3603(b)(3). Defendant The claim or action to be compromised is asserted, or the judgment is entered, against (name of settling or judgment defendant or defendants (the "payer")): Vanessa Spadaro Page 1of4 Form Adopted for Mandatory Use. ORDER APPROVING COMPROMISE OF DISPUTED CLAIM OR PENDING — oi Cv Prveguve 6 272: § NCS phew dorary 1.2010) ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR ©! Riot Gai la 137885 MINOR OR PERSON WITH A DISABILITY (Miscellaneous)MC-351 CASE NAME: CASE NUMBER: +~ Rodriguez v. Spadaro SCV0043883 6. THE COURT FINDS that all notices required by law have been given. 7. THE COURT ORDERS a. The petition is granted and the proposed compromise of claim or action or the proposed disposition of the proceeds of the judgment is approved. The gross amount or value of the settlement or judgment in favor of claimant is $ b. [J Until further order of the court, jurisdiction is reserved to determine a claim for a reduction of a Medi-Cal lien under Welfare and Institutions Code section 14124.76. The amount shown payable to the Department of Health Care Services in item 7c(1)(d) of this order is the full amount of the lien claimed by the department but is subject to reduction on further order of the court upon determination of the claim for reduction. c. The payer shall disburse the proceeds of the settlement or judgment approved by this order in the following manner: (1) Payment of fees and expenses Fees and expenses shall be paid by one or more checks or drafts, drawn payable to the order of the petitioner and the petitioner's attorney, if any, or directly to third parties entitled to receive payment identified in this order for the following items of expense or damage, which are hereby authorized to be paid out of the proceeds of the settlement or judgment: Attorney's fees in the total amount of: $ [12,000.00 payable to (specify): (b) 74 Reimbursement for medical and all other expenses paid by the petitioner or the petitioner's attorney in the total amount of: $14,255.48 (c) [2] Medical, hospital, ambulance, nursing, and other like expenses payable directly to providers as follows, in the total amount of: $ (865.00 (i) Payee (name): Equian for Kaiser Permanente (A) Address: P.O, Box 36380, Louisville, KY 40233 (B) Amount: $ 865.00 (ii) Payee (name): (A) Address: (B) Amount: $ (=) Continued on Attachment 7c(1)(c). (Provide information about additional payees in the above format.) (4) (_) Other authorized disbursements payable directly to third parties in the total amount of: $ (Describe and state the amount of each item and provide the name and address of each payee): [1 Continued on Attachment 7c(1)(d). (e) (__) Total allowance for fees and expenses from the settlement or judgment: $ 17,120.48 MESSI frex: dentery 1, 2010) ORDER APPROVING COMPROMISE OF DISPUTED CLAIM OR PENDING Page 2.04 ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY (Miscellaneous)MC-351 CASE NAME CASE NUMBER: ~ Rodriguez v. Spadaro SCV0043883 7. THE COURT ORDERS (cont.) c. The payer shall disburse the proceeds of the settlement or judgment approved by this order in the following manner: (2) Balance The balance of the settlement or judgment available for claimant after payment of all allowed fees and expenses is: $ (22,879.52 The balance shall be disbursed as follows: (a) [] By one or more checks or drafts in the total amount of (specify): $ drawn payable to the order of the petitioner as trustee for the claimant. Each such check or draft must bear an endorsement on the face or reverse that it is for deposit in one or more interest-bearing, federally insured accounts in the name of the petitioner as trustee for the claimant, and no withdrawals may be made from the accounts except as provided in the Order to Deposit Money Into Blocked Account (form MC-355), which is signed contemporaneously with this order ("blocked account"). (b) 7) By the following method(s) (describe each method, including the amount to be disbursed ): by check or draft in the amount of $22,879.52 made payable to MetLife Assignment Company, Inc., for the purchasing of the structured settlement annuity that shall provide future benefits to the minor as identified in Addendum A. [Z1 Continued on Attachment 70(2)\b) (c) [_] If money is to be paid to a special needs trust under Probate Code section 3604, all statutory liens in favor of the state Department of Health Care Services, the state Department of Mental Health, the state Department of Developmental Services, and any city and county in California must first be satisfied by the following method (specify): [1 Continued on Attachment 7¢(2)(c). 8. [_] Further orders of the court concerning blocked accounts The court makes the following additional orders concerning any part of the balance ordered to be deposited in a blocked account under item 7¢(2)(a): a. Within 48 hours of receipt of a check or draft described in item 7c(2)(a), the petitioner and the petitioner's attorney, if any, must deposit the check or draft in the petitioner's name as trustee for the claimant in one or more blocked accounts at (specify name, branch, and address of each depository, and the amount of each account): (1) Continued on Attachment 8a. MC-351 [Rev. Janvay 1.20101 ORDER APPROVING COMPROMISE OF DISPUTED CLAIM OR PENDING Page Sore ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY (Miscellaneous)MC-351 CASE NAME: CASE NUMBER: ~ Rodriguez v. Spadaro SCV0043883 8. Further orders of the court concerning blocked accounts The court makes the following additional orders concerning any part of the balance ordered to be deposited in a blocked account under item 7¢(2)(a): b. The petitioner and the petitioner's attorney, if any, must deliver to each depository at the time of deposit three copies of the Order to Deposit Money Into Blocked Account (form MC-355), which is signed contemporaneously with this order. and three copies of the Receipt and Acknowledgment of Order for the Deposit of Money Into Blocked Account (form MC-356). The petitioner or the petitioner's attorney must file a copy of the receipt with this court within 15 days of the deposit. The sole responsibilities of the petitioner and the petitioner's attorney, if any, are to place the balance in a blocked account or accounts and to timely file a copy of the receipt. c. The balance of the proceeds of the settlement or judgment deposited in a blocked account or accounts under item 7c(2)(a) may be withdrawn only as follows (check (1) or (2)): (1) (2) No withdrawals of principal or interest may be made from the blocked account or accounts without a further written order under this case name and number, signed by a judge, and bearing the seal of this court. The money on deposit is not subject to escheat. (2) () The blocked account or accounts belong to a minor. The minor was born on (date): No withdrawals of principal or interest may be made from the blocked account or accounts without a further written order under this case name and number, signed by a judicial officer, and bearing the seal of this court, until the minor attains the age of 18 years. When the minor attains the age of 18 years, the depository, without further order of this court, is authorized and directed to pay by check or draft directly to the former minor, upon proper demand, all moneys including interest deposited under this order. The money on deposit is not subject to escheat. 9. Authorization to execute settlement documents The petitioner is authorized to execute settlement documents as follows (check only one): a CJ) Upon receipt of the full amount of the settlement sum approved by this order and the deposit of funds, the petitioner is authorized and directed to execute and deliver to the payer a full, complete, and final release and discharge of any and all claims and demands of the claimant by reason of the accident or incident described in the petition and the resultant injuries to the claimant and a properly executed dismissal with prejudice. b. [_]_ The petitioner is authorized and directed to execute any and all documents reasonably necessary to carry out the terms of the settlement. c. The petitioner is authorized and directed (specify): Kayla Woods is the appointed Guardian ad Litem Continued on Attachment Sc. 10. Bondis [-_] ordered and fixed in the amount of: $ (J not required. 11. A copy of this order shall be served on the payer forthwith. 12.1] Additional orders The court makes the following additional orders (specify): (J Continued on Attachment 12. Date: JUDICIAL OFFICER [1 sicnature FoLiows LAST ATTACHMENT MC-351 [Rev. January 1, 2010} Page 4 of 4 ORDER APPROVING COMPROMISE OF DISPUTED CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY (Miscellaneous)MC-025 Rodriguez v. Spadaro SCV0043883 ATTACHMENT (Number): 7c( 2)( b) (This Attachment may be used with any Judicial Council form.) ASI Insurance Group has agreed to make the payment of $22,879.52 to fund the structured annuity set forth in Addendum A attached. This payment will be provided on a tax-free basis pursuant to Section 104 (a) (2) of the Internal Revenue Code of 1986, as amended. The sum of $22,879.52 is to be used by ASI Insurance Group to arrange for the purchase of a tax-free structured settlement annuity policy from Metlife Assignment Company Inc. Pee TITLE: CASE NUMBER: ASI Insurance Group will issue a check in the amount of $22,879.52, (assignment) to Ringler & Associates (Assignee), Upon doing so, ASI Insurance Group will no longer have obligations whatsoever to the Plaintiff. The assignee shall purchase structured settlement annuity for $22,879.52 through MetLife Assignment Company Inc. It is so Ordered. Date: Hon. Judge of the Superior Court (if the item that this Attachment concerns is made under penalty of perjury, all statements in this Page of Attachment are made under penalty of perjury.) (Add pages as required) Form Approved for Optional Use ATTACHMENT wwew.courtinto.ca.gov MER few sy 9, 2009) to Judicial Council FormMC-025 SHORT TITLE: CASE NUMeER: Rodriguez v. Spadaro SCV0043883 ATTACHMENT (Number): A. (This Attachment may be used with any Judicial Council form, ) ATTACHMENT A - Addendum Structured (If the item that this Attachment concerns is made under penalty of perjury, all statements in this Page of Attachment are made under penalty of perjury.) (Add pages as required) ; Opal U Salen efageal Goenet of Gaara ATTACHMENT MC-025 [Rev. July 1, 2008] to Judicial Council FormStructure Attachment to Petition and Order AVERY RODRIGUEZ (date of birth: 06/05/2018) 1.0 Insurer for Defendant(s) (hereafter “Insurer”) hereby agrees to pay the following: $22,879.52 payable to MetLife Assignment Company, Inc. to fund the obligation for the Periodic Payments illustrated in Section 1.1 1.1 Periodic Payments to be made to Avery Rodriguez (the “Payee”) according to the schedule, as follows (the “Periodic Payment”): $36,503.05 guaranteed lump sum payment on 06/15/2043 (Age 25). All sums set forth herein constitute damages on account of personal physical injuries or physical sickness, within the meaning of Section 104(a)(2) of the Internal Revenue Code of 1986, as amended. 2.0 Petitioner acknowledges that the Periodic Payments cannot be accelerated, deferred, increased or decreased by any Payee; nor shall any Payee have the power to sell, mortgage, encumber, or anticipate the Periodic Payments, or any part thereof, by assignment or otherwise. 3.0 Petitioner acknowledges and agrees that Insurer may make a “qualified assignment” within the meaning of Section 130(c), of the Internal Revenue Code of 1986, as amended, of Insurer’s liability to make the Periodic Payments set forth in Section 1.1 to MetLife Assignment Company, Inc. (the “Assignee”). Assignee’s obligation for payment of the Periodic Payments shall be no greater than that of Insurer (whether by judgment or agreement) immediately preceding the assignment of the Periodic Payments obligation. Such assignment, if made, shall be accepted by the Petitioner and Payee without right of rejection and shall completely release and discharge Insurer from the Periodic Payments obligation assigned to Assignee. The Petitioner and Payee recognize that Assignee shall be the sole obligor with respect to the Periodic Payments obligation, and that all other releases with respect to the Periodic Payments obligation that pertain to the liability of Insurer shall thereupon become final, irrevocable and absolute. Metropolitan Tower Life Insurance Company will provide an Evidence of Guarantee as evidence of its financial guarantee over the periodic payment obligation of MetLife Assignment Company, Inc. Page 1 of 2Structure Attachment to Petition and Order AVERY RODRIGUEZ (date of birth: 06/05/2018) 4.0 Any payments to be made after the death of the Payee shall be made to such person or entity as shall be designated in writing by the Payee to the Assignee, upon the Payee reaching majority. If no person or entity is so designated by the Payee, or if the person designated is not living at the time of the Payee's death, such payments shall be made to the estate of the Payee. No such designation, or any revocation thereof, shall be effective unless it is in writing and delivered to the Assignee. The designation must be in a form acceptable to the Assignee before such payments are made. 5.0 Insurer, itself or through the Assignee, reserves the right to fund the liability to make the Periodic Payments through the purchase of annuity policy from Metropolitan Tower Life Insurance Company (the “Annuity Issuer”). Assignee shall be the sole owner of the annuity policy and shall have all rights of ownership. Assignee will have Annuity Issuer mail payments directly to the Payee. The Petitioner or Payee, upon reaching majority, shall be responsible for maintaining a current mailing address and mortality information with Assignee. 6.0 The obligation assumed by Assignee to make each Periodic Payment shall be fully discharged upon the mailing of a valid check or electronic funds transfer in the amount of such payment on or before the due date to the last address on record for the Payee with the Annuity Issuer. If the Payee notifies Assignee that any check or electronic funds transfer was not received, Assignee shall direct Annuity Issuer to initiate a stop payment action and, upon confirmation that such check was not previously negotiated or electronic funds transfer deposited, shall have Annuity Issuer process a replacement payment. Quoted with Metropolitan Tower Life Insurance Company, Rated A+, XV by A.M. Best Company. Internal Rate of Return = 2.09% Taxable Equivalent yield: 2.9\01% Rate Series = RB200901 (09/01/2020) Proposal Prepared: 10/26/2020 Proposal Purchase Date: 11/20/2020 The Periodic Payment amounts outlined above are guaranteed based upon a projected annuity purchase date of 11/20/2020. Any delay in funding of the annuity may result in a change in the Periodic Payment amounts, which shall be recorded in the qualified assignment document and annuity contract, without the need to obtain an amended Petition/Court Order, up to 120 days after the original Proposal Purchase Date illustrated herein. All parties are required to execute the necessary settlement documents in order to effectuate the assignment. Page 2 of 2EXHIBIT A 1.0 Payments It is further agreed that for consideration set forth, Insurer for Releasee (hereafter “Insurer’”) hereby agrees to pay the following: 1d $17,120.48 payable to Kershaw, Cook & Talley, P.C. for attorney fees, costs and any liens $22,879.52 payable to MetLife Assignment Company, Inc. to fund the obligation for the Periodic Payments illustrated in Section 1.2 1.2 Periodic Payments to be made to Avery Rodriguez (the “Payee”) according to the schedule, as follows (the “Periodic Payment”): $36,503.05 guaranteed lump sum payment on 06/15/2043 All sums set forth herein constitute damages on account of personal physical injuries or physical sickness, within the meaning of Section 104(a)(2) of the Internal Revenue Code of 1986, as amended. 2.0 Payee’s Rights to Payments Plaintiff and any Payee acknowledges that the Periodic Payments cannot be accelerated, deferred, increased or decreased by any Payee; nor shall any Payee have the power to sell, mortgage, encumber, or anticipate the Periodic Payments, or any part thereof, by assignment or otherwise. 3.0 Consent to Qualified Assignment Plaintiff and any Payee acknowledge and agree that Insurer may make a “qualified assignment” within the meaning of Section 130(c), of the Internal Revenue Code of 1986, as amended, of Insurer’s liability to make the Periodic Payments set forth in Section 1.2 to MetLife Assignment Company, Inc. (the “Assignee”). Assignee’s obligation for payment of the Periodic Payments shall be no greater than that of Insurer (whether by judgment or agreement) immediately preceding the assignment of the Periodic Payments obligation. Such assignment, if made, shall be accepted by the Plaintiff and any Payee without right of rejection and shall completely release and discharge Insurer from the Periodic Payments obligation assigned to Assignee. The Plaintiff and any Payee recognize that Assignee shall be the sole obligor with respect to the Periodic Payments obligation, and that all other releases with respect to the Periodic Payments obligation that pertain to the liability of Insurer shall thereupon become final, irrevocable and absolute. Metropolitan Tower Life Insurance Company will provide an Evidence of Guarantee as evidence of its financial guarantee over the periodic payment obligation of MetLife Assignment Company, Inc. 10/26/2020EXHIBIT A 4.0 Payee’s Beneficiary Any payments to be made after the death of the Payee shall be made to such person or entity as shall be designated in writing by the Payee to the Assignee, upon the Payee reaching majority. If no person or entity is so designated by the Payee, or if the person designated is not living at the time of the Payee's death, such payments shall be made to the estate of the Payee. No such designation, or any revocation thereof, shall be effective unless it is in writing and delivered to the Assignee. The designation must be in a form acceptable to the Assignee before such payments are made. 5.0 Right to Purchase an Annuity Insurer, itself or through the Assignee, reserves the right to fund the liability to make the Periodic Payments through the purchase of annuity policy from Metropolitan Tower Life Insurance Company (the “Annuity Issuer”). Assignee shall be the sole owner of the annuity policy and shall have all rights of ownership. Assignee will have Annuity Issuer mail payments directly to the Payee. The Plaintiff or Payee, upon reaching majority, shall be responsible for maintaining a current mailing address and mortality information with Assignee. 6.0 Discharge of Obligation The obligation assumed by Assignee to make each Periodic Payment shall be fully discharged upon the mailing of a valid check or electronic funds transfer in the amount of such payment on or before the due date to the last address on record for the Payee with the Annuity Issuer. If the Payee notifies Assignee that any check or electronic funds transfer was not received, Assignee shall direct Annuity Issuer to initiate a stop payment action and, upon confirmation that such check was not previously negotiated or electronic funds transfer deposited, shall have Annuity Issuer process a replacement payment. 10/26/2020 2MC-025 SHORT TITLE: CASE NUMBER: Rodriguez v. Spadaro SCV0043883 ATTACHMENT (Number): 9c (This Attachment may be used with any Judicial Council form.) ATTACHMENT 9c (if the item that this Attachment concerns is made under penalty of perjury, all statements in this Page of Attachment are made under penalty of perjury.) (Add pages as required) Form Approved for Optional Use wow courtinfo.c8.gov ‘Council of Cafornia 'MC-025 (Rev. July 1. 2003] ATTACHMENT to Judi Council FormCiv-010 FOR COURT USE ONLY [ATTORNEY (Narre, State Bar number, and adders) Jeffrey M. Schaff, Esq. /// SBN 269606 Kershaw Cook & Talley, P.C 401 Watt Avenue. Sacramento, CA 95864 rexerroneno: 916-779-7000 — raxno.(ontnen 916-244-4829 Emil ogress Ontmay jeff@kctlegal.com avronney FOR Mer Plaintiffs SUPERIOR COURT OF CALIFORNIA, COUNTY OF Sacramento street avoress: 720 Ninth Street MAILING ADDRESS: crvanpzpcooe Sacramento, CA 95814 RANCH NAME: PLAINTIFF(PETITIONER: Kayla Woods DEFENDANTRESPONOENT: Vanessa Spadaro, et al. APPLICATION AND ORDER FOR APPOINTMENT | omer 04 3b OF GUARDIAN AD LITEM—CIVIL (7) _EX PARTE NOTE: This form Is for use in civil proceedings in which a party Is 2 minor, an incapacitated person, or a person for whom & conservator has been appointed. A party who seeks the appointment of a guardian ad Iitem In a family taw or ‘ Juvenile proceeding should use form FL-935. A party who seeks the appointment of a guardian ad Iftem in a probate proceeding should use form DE-350/GC-100. An Individual cannot act as a guardian ad item unless he or she is : represented by an attomey or Is an attorney. 1. Applicant (name); Kayla Woods 2 the parent of (name): Avery E. Rodriguez b. C2] the guardian of (name): (2 the consarvator of (name): c o. (J a panty to the suit. e the minor to be represented (if the minor is 14 years of age or older). #. (J another interested person (specity capacity): This application seeks the appointment of the following person as guardian ad litem (state name, address, and telephone number): Kayla Woods 8622 Bronson Dr. Granite Bay, CA 95746. Phone: (916) 765-6761 ‘The guardian ad litem Is to represent the interests of the following person (state name, address, and telephone number): Avery E. Rodriguez. 8622 Bronson Dr. Granite Bay, CA 95746. Phone: (916) 765-6761 4 Mee to be represented fs: a. a minor (date of birth): 06/05/2018 \ b. L_] an incompetent person. | c. (_] a person for whom a conservator has been appointed } 5. The court should appoint a guardian ad litem because: a. (2) the person named In item 3 has a cause or causes of action on which sult should be brought (describe): Avery E. Rodriguez was injured while under the care of defendants and sustained injuries on 08/16/2019 C) Continued on Attachment 52. Page tot Form Adega fo Wer ctcry Use APPLICATION AND ORDER FOR APPOINTMENT Cone OM ee cvore ev wy 0 OF GUARDIAN AD LITEin item 3, and no application for the appointment of a guardian ad litem has been made by the person identified in item 2 of any other persen. c [__] the person named in item 3 has no guardian or conservator of his or her estate, d, (7) the appointment of a guardian ad litem is necessary for the following reasons (specify) Avery E. Rodriguez is a minor and requires guardian ad litem to serve and protect her interest in this claim against the defendant. Continued on Attachment 5d. 6. eaeposed guardian ad fitem’s relationship to the person he or she will be representing is: a related (state relationship): Mother b. (7) not related (specity capacity): . The proposed guardian ad litem Is fully competent and qualified to understand and protect the rights of the person he or she wili represent and has no Interests adverse to the Interests of that person. (if there are any issues of competency or qualification or any possible adverse interests, describe and explnin why the proposed guardian should novortheless be appointed): (— Continued on Attachment 7. , Jeffrey M.Schatt — A RE OFA | declare under penatty of perjury under the laws of the Siate of California that the forego/’ nd corre i Date: SeptemberLy 2019 (TYPE OR PRINT NAME) "LABIGHATURE OF APP UCANT) CONSENT TO ACT AS GUARDIAN AD LITEM | consent to the appointment as guardian ad litem under the above petition. Date: September2g 2019 Kayla Woods > (TYPE OR PRINT NAME Kayla Woods [QWPROVAY AD LITEM) ORDER f 2-EX PARTE THE COURT FINDS that It is reasonable and necessary to apgb#it a guardian ad litem for the person named in item 3 of the application, as requested. THE COURT ORDERS that (name): Kayla Woods is hereby appointed as the guardian ad litem for (name): Avery E. Rodriguez for the reasons set forth in Item § of the application. Alan Pineschi Date: oct 18 201 oo JUOGAL OFFICER [1 store rouoms ust ATTACHHENT Gv.o10 fev. damary 1, 2008} APPLICATION AND ORDER FOR APPOINTMENT Coens? OF GUARDIAN AD LITEM—CIVIL {