Backup Documents 02/14/2017 Item #16K3 161( 3
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2.
3. County Attorney Office County Attorney Office KN 2/14/17
4. BCC Office Board of County ','°'fib
Commissioners (6/ Z` \ -\
5. Minutes and Records Clerk of Court's Office c91‘14 10- (Pds-rts-7
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Kevin Noell,As istant County Attorney Phone Number 252-8400
Contact/ Department
Agenda Date Item was 2/14/2017 Agenda Item Number 16K • '5 v/
Approved by the BCC
Type of Document Settlement Agreement-Kane Number of Original 1
Attached Documents Attached
PO number or account n/a
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial Applicable)
1. Does the document require the chairman's original signature? S-j_ KN
2. Does the document need to be sent to another agency for additional signatures? If yes, KN
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be
signed by the Chairman,with the exception of most letters,must be reviewed and signed KN
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's KN
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the KN
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's KN
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip KN
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain _
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on ii"= •• I and all changes made durihig KN
the meeting have been incorporated in the attached do ument. The County '
Attorney's Office has reviewed the changes,if applica le.
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9. Initials of attorney verifying that the attached document is the version approved by the
BCC, all changes directed by the BCC have been made,and the document is ready for the
Chairman's signature.
[2016-CA-76/1318982/1]
16K3
MEMORANDUM
Date: February 15, 2017
To: Kevin Noell, Assistant County Attorney
County Attorney's Office
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: Settlement Agreement - Kane
Attached is a copy of the document referenced above, (Item #16K3) approved by the
Board of County Commissioners on Tuesday, February 14, 2017.
The original document is being held in the Minutes & Records Department as
part of the Board's Official Record.
If you have any questions, please contact me at 252-8411.
Thank you.
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SETTLEMENT AGREEMENT AND MUTUAL RELEASE
THIS SETTLEMENT AGREEMENT AND MUTUAL RELEASE (hereinafter referred
to as the "Agreement and Release") is entered into and made on this day of
, 2017, by and between LORETTA KANE, (hereinafter referred to as
"Plaintiff') and Collier County (hereinafter referred to as the "County").
WITNESSETH:
WHEREAS, Plaintiff filed a lawsuit against the County in the Circuit Court for the
Twentieth Judicial Circuit in and for Collier County, Florida, styled Loretta Kane v. Collier
County, a political subdivision of the State of Florida, Case No. 16-00076-CA (hereinafter
referred to as the "Lawsuit"); and
WHEREAS, Plaintiff and the County, without either party admitting any liability or
fault, desires to settle the Lawsuit and any and all disputes that arise from, relate or refer in any
way, whether directly or indirectly, known or unknown, to the incidents described or allegations
made in the Complaint filed in the Lawsuit; and,
WHEREAS, Plaintiff and the County desire to reduce the settlement to a writing so that
it shall be binding upon both parties' respective owners, principals, elected officials, officers,
employees, ex-employees, agents, attorneys, representatives, insurers, spouses, successors,
assigns, heirs and affiliates.
WHEREAS, the Plaintiff agrees and covenant to fully comply with all applicable
Medicare laws and liens specifically including 42 USC § 1395y.
NOW, THEREFORE, in consideration of the mutual covenants, promises and
consideration set forth in this Agreement and Release, and with the intent to be legally bound,
Plaintiff and the County agree as follows:
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1. Plaintiff and the County adopt and incorporate the foregoing recitals, sometimes
referred to as "Whereas Clauses", by reference into this Agreement and Release.
2. This settlement agreement and mutual release is contingent upon approval by the
Board of County Commissioners of Collier County, Florida.
3. In consideration of the resolution of all disputes or claims arising from or
referring or relating in any way, whether directly or indirectly, to the Lawsuit, and for and in
consideration of the sum of Fifteen Thousand Dollars and 00/100 ($15,000.00) and other
valuable consideration, the receipt and adequacy of which is hereby acknowledged by Plaintiff,
Plaintiff agrees to dismiss the Lawsuit with Prejudice.
4. In consideration of the resolution of the Lawsuit, and for other good and valuable
consideration, the receipt and adequacy of which is hereby acknowledged, Plaintiff, on behalf of
herself, her attorneys, agents, representatives, insurers, heirs, successors and assigns, hereby
expressly releases and forever discharges the County, as well as its elected officials, officers,
employees, ex-employees, agents, attorneys, representatives, successors, assigns, insurers and
affiliates from any and all claims, demands, causes of actions, damages, costs, liens, attorney's
fees, expenses and obligations of any kind or nature whatsoever that she has asserted or could
have asserted in the Lawsuit or that arise from or relate or refer in any way, whether directly or
indirectly, to the Lawsuit or any incident, event or allegation referred to or made in the
Complaint in the Lawsuit.
5. Notwithstanding anything that may be to the contrary in Paragraph 4 of this
Agreement and Release, Plaintiff and the County agree that either of them (as well as any other
persons or entities intended to be bound) shall, in the event of any breach, retain the right to
enforce the terms and conditions of this Agreement and Release.
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6. Plaintiff agrees and covenant to fully comply with all applicable Medicare laws
and liens specifically including 42 USC § 1395y.
7. Plaintiff and the County acknowledge and agree that this Agreement and Release
is intended to and shall be binding upon their respective owners, principals, officials, officers,
employees, ex-employees, agents, attorneys, representatives, insurers, successors, assigns,
spouses, heirs, and affiliates.
8. Plaintiff and the County recognize and acknowledge that this Agreement and
Release memorializes and states a settlement of disputed claims and nothing in this Agreement
and Release shall be construed to be an admission of any kind, whether of fault, liability, or of a
particular policy or procedure, on the part of either Plaintiff or the County.
9. Plaintiff and the County acknowledge and agree that this Agreement and Release
is the product of mutual negotiation and no doubtful or ambiguous language or provision in this
Agreement and Release is to be construed against any party based upon a claim that the party
drafted the ambiguous provision or language or that the party was intended to be benefited by the
ambiguous provision or language.
10. This Agreement and Release may be amended only by a written instrument
specifically referring to this Agreement and Release and executed with the same formalities as
this Agreement and Release.
11. In the event of an alleged breach of this Agreement and Release, Plaintiff and the
County agree that all underlying causes of action or claims of Plaintiff have been extinguished
by this Agreement and Release and that the sole remedy for breach of this Agreement and
Release shall be for specific performance of its terms and conditions or any damages arising
from the breach. In this regard, Plaintiff and the County further agree that the sole venue for any
[2016-CA-761131554911] 3
161( 3 3
such action shall be in the Twentieth Judicial Circuit in and for Collier County, Florida in
Naples, Florida.
12. This Agreement and Release shall be governed by the laws of the State of Florida.
13. Plaintiff agrees to reimburse Medicare and pay for any and all Medicare liens or
any other liens arising out of, or anyway connected to, injuries and/or damages suffered from the
incident described in the Lawsuit, out of the proceeds of the settlement monies.
IN WITNESS WHEREOF, Plaintiff, and the County have signed and sealed this
Agreement and Release as set forth below.
AS TO COUNTY:
ATTEST:
DWIGHT E. : `,I ,, '',Clerk BOARD OF COUNTY COMMISSIONERS
,. .. �:,.,.'D OF COL I OUNTY, FLORIDA
Y By:
Affect 3 E en, . Deputy Clerk PENNY T OR, Cha'
Approved as to form and legality: AS TO PLAINTIFF:
___---''----Z---_---/
__---'' f. ___--- BY: !,i( ../ (9 7Ca
Kevin L. Noell LORETTA KANE, Plaintiff
Assistant County Attorney
STATE OF FLORIDA
COUNTY OF COLLIER
The foregoing instrument was acknowledged before me this ,-snday of
JOYVO , 2017, by LORETTA KANE, who is ( ersonally known to me or ( )
producedC _ as identification.
A CI)
(Signature of Notary Public - S�Florida)
lirNotary Public State o Florida
Candy D Carmona
� ttCpms tong on FF996002 (Print, Type, or Stamp
�►�n Expires 09/0112019
Commissioned Name of Notary Public)
Commissioner Expires q "I -/1
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ADDENDUM TO SETTLEMENT
AGREEMENTS AND GENERAL RELEASES
Representations With Regard to Medicare's Interests
Releasor hereby warrants and represents that I presently am not, nor have ever been enrolled in
Medicare Part A, Part B or Part C. Further, I have no claim for Social Security Disability benefits
nor am I appealing or re-filing for Social Security Disability benefits.
OR
Releasor is a male/female whose date of birth is oll,v'1 /95s_ and has a Medicare claim
number of dots o?—c10(10 Oart 8 . I presently am enrolled in Medicare Part A, Part B or Part
C or previously was enrolled from to . Releasor warrants
and represents there has been full disclosure of his/her Medicare status to Releasee.
Medicare's Interests
In reaching agreement on the terms of this Release, the parties acknowledge Releasor's possible
entitlement to Social Security disability benefits pursuant to 42 U.S.C. § 423, and receipt of
Medicare or Medicaid benefits under 42 U.S.0 § 1395y, as well as the entitlement of the Centers
for Medicare and Medicaid Services ("CMS") to subrogation and intervention, pursuant to 42
U.S.C. §1395y(b)(2) to recover any overpayment made by CMS or other Medicare Advantage
Organization ( MAO).The parties to this Release agree that this Release is not intended to shift to
CMS or an MAO, the responsibility for payment of medical expenses for the treatment of injury
related conditions. The parties agree that this settlement is intended to provide Releasor a lump
sum and/or future periodic payment which will foreclose Releasee's responsibility for future
payment of all injury related medical expenses.
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Non-reimbursable Expenses (where there is an MSA or other future medical expense
consideration)
The parties to this Release understand that many common medical expenses are not payable or
reimbursable under the Medicare program. These medical expenses, not covered by Medicare
but necessary in the ongoing treatment of the Releasor's injury, and without an admission of
liability on the part of the Releasee, have been taken into consideration in the calculation and
settlement of Releasor's future medical expenses. Funds for these non-Medicare covered
medical expenses have been included in the lump sum settlement amount and shall not be
paid from any Medicare allocation amount.
Benefit Eligibility
Releasor acknowledges that any decision regarding entitlement to Social Security benefits or
Medicare or Medicaid benefits, including the amount and duration of payments and offset
reimbursement for prior payments is exclusively within the jurisdiction of the Social Security
Administration, the United States Government, and the U.S. Federal Courts, and is determined by
Federal law and regulations. As such, the United States Government is not bound by any of the
terms of this Release.
Future Benefits
Releasor has been apprised of his/her right to seek assistance from legal counsel of his/her
choosing or directly from the Social Security Administration or other government agencies
regarding the impact this Release may have on Releasor's current or future entitlement to Social
Security or other governmental benefits. Releasor acknowledges that acceptance of these
settlement funds may affect Releasor's rights to other governmental benefits, insurance benefits,
disability benefits, or pension benefits. Notwithstanding this possibility, Releasor desires to enter
into this Release agreement to settle his/her injury claim according to the terms set forth in this
Release.
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Medicare Recovery Action
Releasor agrees to hold harmless, indemnify and defend Releasee from any cause of action,
including, but not limited to, an action by CMS to recover or recoup Medicare benefits or loss of
Medicare benefits, if CMS determines that the money set-aside has been spent inappropriately
or for any recovery sought by Medicare, including past, present, and future and/or conditional
payments. Releasor agrees not to use designated Medicare allocation funds to pay claims for
conditional payments that may have been made by Medicare.
Complete Understanding
Releasor hereby declares that the terms of this Release have been completely read and are
fully understood and voluntarily accepted for the purpose of making a full and final settlement
of any and all claims, disputed or otherwise, on account of injuries and/or damages related to
the Claims set forth herein, and for the express purpose of precluding forever any further
additional claims against the Release arising out of the aforesaid incident, accident or
occurrence.
/1-.clie,dj (r,/, )(a.y.e___
RELEASOR'S SIGNATURE Any person who knowingly and with intent to
injure,defraud,or deceive any insurance
company,files a statement of claim containing
any false,incomplete or misleading information is
STATE OF cLoC-1 guilty of a felony of third degree.
COUNTY OF CULL.I`ZEl SS:
On this ,--3(`, day of ,c\rUC{Y , 20 I 1 before me appeared rvw E - Love-4(A kCiv -
, to me personally know , or who produced ( _ 1) L_ as
identification, and who, after first being duly sworn, acknowledged before me the execution of
the f i��goin i strument as free act and deed for the consideration set forth therein.
Sign ure oçArv7/ k otary Public Notary Public- Print, Type, or Stamp Commissioned
Name
My Commission Expires: C -/ -I
�'►� Notary Public stab of Florida
Candy D Carmona
My Commission FF 988002
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Expires 09/012019
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