Backup Documents 09/14/2021 Item #16K24 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 K 2 4
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 CAK 9/14/21
4. BCC Office Board of County
Commissioners ``, �
5. Minutes and Records Clerk of Court's Office
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 Colleen A. Kerins Phone Number 252-8400
Contact/ Department
Agenda Date Item was 09/14/21 Agenda Item Number 16K24
Approved by the BCC
Type of Document Settlement Agreement Number of Original 1
Attached Documents Attached
PO number or account
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?
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A
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 CAK
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A
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 CAK
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 CAK
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip N/A
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 09/14/21 and all changes made during tttA is not
the meeting have been incorporated in the attached document. The County an option for
Attorney's Office has reviewed the changes,if applicable. this line.
9. Initials of attorney verifying that the attached document is the version approved by the N/A is not
BCC,all changes directed by the BCC have been made,and the document is ready for the an option for
Chairman's signature. this line.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
16K24
MEMORANDUM
Date: September 14, 2021
To: Colleen Kerins, Assistant County Attorney
County Attorney's Office
From: Martha Vergara, Sr. Deputy Clerk
Minutes & Records Department
Re: Settlement Agreement w/William Kenney—
Case No. 21-CA-1265
Attached for your records is a copy of the documents referenced above, (Item
#161(24) approved by the Board of County Commissioners Tuesday, September 14,
2021.
The original agreement has been kept by the Board's Minutes & Records
Department as part of the Board's Official Records.
If you have any questions, please call me at 252-7240.
Thank you.
Attachment
16K24
SETTLEMENT AGREEMENT
THIS SETTLEMENT AGREEMENT (hereinafter referred to as the "Agreement") is
entered into and made on this I tlY‘ day of **tor-, 2021, by and between
WILLIAM KENNEY, hereinafter referred to as "Plaintiff," and COLLIER COUNTY BOARD
OF COUNTY COMMISSIONERS,hereinafter referred to as"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, in the case styled William Kenney
v, Collier County Board of Commissioners, Case No. 21-CA-1265 (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, accrued or unaccrued, 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, successors, assigns, heirs,
departments, agencies and affiliates.
NOW, THEREFORE, in consideration of the mutual covenants, promises and
consideration set forth in this Agreement, and with the intent to be legally bound, Plaintiff and
County agree as follows:
1. Plaintiff and the County adopt and incorporate the foregoing recitals, sometimes
referred to as "Whereas Clauses,"by reference into this Agreement.
[21-CA-1265/1658006/1] 1
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2. 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 seventy-five thousand dollars and 0/100 ($75,000.00) and other
valuable consideration, the receipt and adequacy of which is hereby acknowledged by Plaintiff,
Plaintiff agrees to dismiss the Lawsuit with Prejudice.
3. 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
himself, his attorneys, agents, representatives, insurers, heirs, successors and assigns, hereby
expressly releases and forever discharges the County, as well as its owners, principals, elected
officials, officers, employees, ex-employees, agents, attorneys, contractors, representatives,
successors, assigns, insurers, heirs, departments,agencies and affiliates, from any and all claims,
demands, causes of actions, damages, costs, liens, attorney's fees, expenses, medical bills 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, accrued or
unaccrued, known or unknown, to the Lawsuit or any incident, event or allegation referred to in
the complaint in the Lawsuit.
4. Notwithstanding anything that may be to the contrary in Paragraph 3 of this
Agreement, 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.
5. Plaintiff and the County acknowledge and agree that this Agreement is intended
to and shall be binding upon their respective owners, principals, elected officials, officers,
employees, ex-employees, agents, attorneys, representatives, insurers, successors, assigns, heirs,
and affiliates.
[21-CA-1265/1658006/1] 2
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6. Plaintiff and the County recognize and acknowledge that this Agreement
memorializes and states a settlement of disputed claims and nothing in this Agreement 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.
7. Plaintiff and the County acknowledge and agree that this Agreement is the
product of mutual negotiation and no doubtful or ambiguous language or provision in this
Agreement 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.
8. This Agreement may be amended only by a written instrument specifically
referring to this Agreement and executed with the same formalities as this Agreement.
9. In the event of an alleged breach of this Agreement, Plaintiff and the County
agree that all underlying causes of action or claims of Plaintiff have been extinguished by this
Agreement and that the sole remedy for breach of this Agreement shall be for specific
performance of the terms and conditions of this Agreement. In this regard, Plaintiff and the
County further agree that the sole venue for any such action shall be in the Twentieth Judicial
Circuit in and for Collier County,Florida in Naples,Florida.
10. Plaintiff agrees to use the proceeds of the settlement funds for the payment and
satisfaction of all liens, medical bills, attorney fees, and all other expenses, costs, debts, or Iosses
whatsoever, arising out of or in any way connected to the incident described in the Lawsuit,
which Plaintiff brought or could have brought in the subject Lawsuit. Plaintiff agrees to be
solely responsible for complete payment of these obligations out of the settlement proceeds.
11. The Plaintiff hereby agrees to indemnify and hold harmless the County from any
and all claims and/or liens and/or subrogated interests, including but not limited to worker's
[21-CA-1265/1658006/1] 3
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compensation liens, health insurance liens, Medicaid / Medicare liens, Social Security and any
and all attorney's liens and charging liens herein. It is further expressed and understood and
agreed, to the extent applicable, the Plaintiff, in concert and consultation with his counsel, aver
and covenant that they do not presently anticipate the Plaintiff will require future medical and/or
health care treatment for the injuries and/or conditions related to and/or arising from the accident
in question.
A• . condition of and to induce settlement, the Defendant(s) and(their/its) insurer(s) have
)�_ requested and ' .intiff and their counsel have agreed to determine if Medicare (hereinafter CMS
and includes Part edicare Advantage Organizations (a/k/a MAO) and/or Medicaid [all
collectively referred to a MS] has any past or future lien interest, and if so, to take all
necessary steps to satisfy such h ' , past and future. The settlement is based upon a good faith
determination of the parties in order to - .lve a questionable claim. The parties have attempted
to resolve this matter in compliance with be state and federal law and it is believed that the
settlement terms adequately consider Medicare's i -rests and do not reflect any attempt to shift
the responsibility of treatment to Medicare. The pu .• e of this settlement is to resolve a
disputed claim.
If Medicare has a lien or has made payments of Medicare .-nefits, Plaintiff will do the
following:
1. Reporting: Plaintiff agrees the settlement will be reported to the Cent- for Medicare
Services (CMS) and determine whether the Plaintiff is a Medicare be -ficiary or
Medicare eligible as defined by 42 U.S.C. Section 1395(y) and 42 C.F.R. Secti.. 411.25
(hereinafter the Medicare Secondary Payer Statute). Plaintiff will notify Defen.• is in
writing if CMS has a lien, reporting or set aside requirement and provide the relea•.is
full address, Social Security Number, date of birth, gender and if available, th.'r
Medicare Health Insurance Claim Number (HICN). Provision of this information is a
condition of settlement and spaces are provided at the end of the release for compliance.
Plaintiffs agree that defendant or its insurer may also report the settlement to Medicare
and consent to such reporting and agree to cooperate fully with the defendant and its
insurer with respect to such reporting. The parties agree that any present or future action
or decision by Medicare on this settlement or Plaintiff's eligibility or entitlement to
Medicare benefits in the future, will not render this release void or ineffective, or in any
way affect the finality of this settlement. Plaintiff agrees the following information may
be reported to Medicare:
[21-CA-1265/1658006/1] 4
16 2-4
FULL NAME ON SOCIAL SECURITY CARD:
SOCIAL SECURITY NUMBER:
DATE OF BIRTH:
GENDER:
MEDICARE HEALTH INSURANCE CLAIM NUMBER(HICN):
2. Condition:1 Payment Liens: Plaintiff further covenants and agrees that if CMS or a
Medicare • .vantage Organization (hereinafter MAO) has made conditional payments
and/or has a lien and/or is expected to make future payments prior to closing, Plaintiff
agrees not to .isburse the settlement funds until (he/she/they) (has/have) (i) reported the
settlement to • S; (ii) obtained a Conditional Payment Notice and Demand Letter; (iii)
fully paid and atisfied the Medicare lien; and (iv) obtained proof of iii by faxing
Defendant(s) the inal Payment, Reimbursement and Recovery Demand Letter. Plaintiff
agrees that the re eased parties may elect to pay CMS or MAO lien directly from the
settlement funds. 'laintiff acknowledges CMS may charge interest on any additional
payments not made ithin 60 days and Plaintiffs agree to be responsible for such interest
should it accrue.
3. Medicare Set Asides: It is further expressly understood and agreed, to the extent
applicable, Plaintiff agre. to set aside funds necessary to pay for any anticipated future
medical and/or health care .eeds of Plaintiff, for any injury and/or condition that requires
treatment that arises from t - injuries related and/or caused by the accident in question.
Plaintiff has conferred with t -ir medical experts to determine the amount necessary to
set aside and self administer fo anticipated future medical expenses or healthcare needs.
Plaintiff agrees to set aside $ of the settlement for these purposes and
notify Medicare that these funds 'ave been set aside. If an LMSA or Medical Cost
Projection was done, the amount sta -d therein shall be set aside. Any LMSA or Medical
Cost Projection is hereby incorporate. .y reference into this agreement. Alternatively, if
nothing has been set aside for future c..ts it is because Plaintiff has covenanted that he
does not reasonably anticipate that he w require medical and/or health care treatment
for the injuries and/or conditions related an• or arising from the accident in question and
to the extent he does, he will use the net sett -ment proceeds for related costs if they are
incurred.
4. Cooperation and Indemnity: Plaintiff and his co nsel agree to fully cooperate with the
Defendant(s) and CMS at Plaintiff's own expens. with respect to these provisions,
including production of documents or information or . eparation of a Medicare set aside.
Plaintiff agrees to execute any authorizations require. .y Defendant, his insurer(s) or
CMS for purposes of complying with these paragrap' . Plaintiff and his counsel
understand that these conditions are a basis of the settle ent and Plaintiff's counsel
agrees to the above terms. Plaintiff acknowledges that additi. al reimbursement may be
due to Medicare and as such remain obligated to Medicare or any such additional
payments. Plaintiff agrees to hold harmless and indemni the Defendant(s) and
(his/her/their)insurers, including their own negligence, from and ag 'nst any and all liens,
interest, damages, including costs and attorney's fees, for Plainti' , failure to comply
with the terms of this release, for plaintiff's failure to reimburse edicare or any
[21-CA-1265/1658006/1] 5
16K24
'r Medicare Advantage rganization (MAO) and for any action taken by Medicare to
determine the validity o' his release, the validity of any reimbursement, the validity of
Ne any lien or validity of any s side(self allocated or otherwise).
12. This Agreement shall be governed by the laws of the State of Florida.
IN WITNESS WHEREOF, Plaintiff and the County have signed and sealed this
Agreement and Release as set forth below.
/ r ;` .. a� /
By: I v/c / /1 A ter`•'`.._.
William Kenney, Pia' tiff
STATE OF FLORIDA
COUNTY OF COLLIER
The foregoing instrument was acknowledged beforp me by means of
presence .r online notarization, this 3 I day of A.-if , 2021,by William
iiir :•'••• JAMESMICHAELSCARMOZZ J (Si ature of Notary Public-State of Florida
141 MY COMMISSION I HH 013076
k... ;49 EXPIRES:September 26,2024
4:0P row Bondy:111 n, • Pubic Undersign (Print,Type,ype, or Stamp Commissioners
Name of Notary Public)
Personally Known OR Produced Identification
Type of Identification Produced:
AS TO COUNTY:
ATTEST:
CRYSTAL K. KINZEL,.Clerk
BOARD F TY CO ON S
OF COL COUN Y, F O
By: {�,��'
a (.1i kii1 BY
' 1; Penny Taylor, Chairperson
Date: t �m; to 0 y. Date: 1-1 4- a 1
Approved as to form and legality
o leen A. Kerins
Assistant County Attorney
[21-CA-1265/1658006/1] 6