Backup Documents 05/24/2022 Item #16K 8 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 611 8
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 5/16/22
4. BCC Office Board of County
Commissioners VA) 5y i Nf s/t f z Z
5. Minutes and Records Clerk of Court's Office
I vu 2 2Pa. 10152°"w'
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 05/24/22 Agenda Item Number 16K Q
Approved by the BCC
Type of Document Juarez 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? No/CAK/rev
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/rev
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/rev
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/rev
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 5/24/22 and all changes made during the CAK/rev lid`
meeting have been incorporated in the attached document. The County Attorney's oplionitfr
Office has reviewed the changes,if applicable. this lincr
9. Initials of attorney verifying that the attached document is the version approved by the CAK/rev A4srto
BCC,all changes directed by the BCC have been made,and the document is ready for the an option Ali
Chairman's signature. this lute.;
Please Expedite and send email copies
I:Forms/County Forms/BCC Forms, to Colleen.Kerins@colliercountyflg.gov tevised 2.24.05;Revised 11/30/12
and Rosa.Villarreal@colliercountyfl.gov
1611 8
MEMORANDUM
Date: May 26, 2022
To: Colleen Kerins, Assistant County Attorney
County Attorney's Office
From: Martha Vergara, Sr. Deputy Clerk
Minutes & Records Department
Re: Settlement Agreement w/Juarez —
Case No. 21-CA-952
Attached for your records is a copy of the documents referenced above, (Item
#16K8) approved by the Board of County Commissioners Tuesday, May 24, 2022.
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
1 6 II 8
SETTLEMENT AGREEMENT
THIS SETTLEMENT AGREEMENT (hereinafter referred to as the "Agreement") is
entered into and made on this ay4L day of .M cky , 2022, by and between JOSE
JUAREZ AND AMY JUAREZ as individual Plaintiffs and on behalf of, SOPHIA JUAREZ,
hereinafter referred to as "Plaintiffs," and COLLIER COUNTY BOARD OF COUNTY
COMMISSIONERS, hereinafter referred to as "County."
WITNESSETH:
WHEREAS, Plaintiffs 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 S.J., a minor, by
and through her natural parents and guardians, Amy Juarez and Jose Juarez v. Collier County
Board of Commissioners, Case No. 21-CA-952 (hereinafter referred to as the "Lawsuit"); and
WHEREAS, Plaintiffs 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, Plaintiffs and the County desire to reduce the settlement to 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, Plaintiffs and
County agree as follows:
1. Plaintiffs and the County adopt and incorporate the foregoing recitals, sometimes referred
to as "Whereas Clauses," by reference into this Agreement
2. The Plaintiffs, Amy Juarez and Jose Juarez stipulate they are the natural guardians of the
named minor and have no potential adverse interest to the minor. This agreement will be final
upon the Court approval pursuant to Fla. Stat. 744.387.
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 one hundred fifty thousand dollars and no cents ($150,000.00) and other valuable
[21-CA-952/1717204/1] 1
16K
consideration, the receipt and adequacy of which is hereby acknowledged by Plaintiffs, Plaintiffs
agree 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, Plaintiffs, on behalf of
themselves, their attorney, agents, representatives, 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 he 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.
5. Notwithstanding anything that may be to the contrary in Paragraph 4 of this Agreement,
Plaintiffs 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.
6. Plaintiffs 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.
7. Plaintiffs 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.
8. Plaintiffs 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
9. This Agreement may be amended only by a written instrument specifically referring to
this Agreement and executed with the same formalities as this Agreement
[21-CA-952/1717204/1] 2
16K 8
10. In the event of an alleged breach of this Agreement, Plaintiffs and the County agree that
all underlying causes of action or claims of Plaintiffs 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, Plaintiffs 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.
11. Plaintiffs agree 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 losses
whatsoever, arising out of or in any way connected to the incident described in the Lawsuit,
which Plaintiffs brought or could have brought in the subject Lawsuit. The Plaintiffs agree to be
solely responsible for complete payment all other obligations out of the settlement proceeds,
including any future medical bills.
12. The Plaintiffs 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
compensation liens, health insurance liens, Medicaid / Medicare liens, Social Security and any
and all attorney's liens and charging liens herein, other than the lien waiver delineated in
paragraph 11.
As a condition of and to induce settlement, the Defendant(s) and (their/its) insurer(s) have
requested and Plaintiffs and their counsel have agreed to determine if Medicare (hereinafter
CMS and includes Part C Medicare Advantage Organizations (a/k/a MAO) and/or Medicaid [all
collectively referred to as CMS] has any past or future lien interest, and if so, to take all
necessary steps to satisfy such liens, past and future. The settlement is based upon a good faith
determination of the parties in order to resolve a questionable claim. The parties have attempted
to resolve this matter in compliance with both state and federal law and it is believed that the
settlement terms adequately consider Medicare's interests and do not reflect any attempt to shift
the responsibility of treatment to Medicare. The purpose of this settlement is to resolve a
disputed claim.
If Medicare has a lien or has made payments of Medicare benefits, Plaintiffs will do the
following:
1. Reporting: Plaintiff agrees the settlement will be reported to the Center for Medicare
Services (CMS) and determine whether the Plaintiff is a Medicare beneficiary or
Medicare eligible as defined by 42 U.S.C. Section 1395(y) and 42 C.F.R. Section 411.25
[21-CA-952/1717204/1] 3
16K8
(hereinafter the Medicare Secondary Payer Statute). Plaintiff will notify Defendants in
writing if CMS has a lien, reporting or set aside requirement and provide the releasor's
full address, Social Security Number, date of birth, gender and if available, their
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:
FULL NAME ON SOCIAL SECURITY CARD: `n`k i C1 :i..a c,. -e z
SOCIAL SECURITY NUMBER: -1(0B- '- t /N s--
DATE OF BIRTH: 11'u 1. I?
GENDER: e.YV1a
MEDICARE HEALTH INSURANCE CLAIM NUMBER (I IICN): A/A
2. Conditional Payment Liens: Plaintiff further covenants and agrees that if CMS or a
Medicare Advantage 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 disburse the settlement funds until (he/she/they) (has/have) (i) reported the
settlement to CMS; (ii) obtained a Conditional Payment Notice and Demand Letter; (iii)
fully paid and satisfied the Medicare lien; and (iv) obtained proof of iii by faxing
Defendant(s) the Final Payment, Reimbursement and Recovery Demand Letter. Plaintiff
agrees that the released parties may elect to pay CMS or MAO lien directly from the
settlement funds. Plaintiff acknowledges CMS may charge interest on any additional
payments not made within 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 agrees to set aside funds necessary to pay for any anticipated future
medical and/or health care needs of Plaintiff, for any injury and/or condition that requires
treatment that arises from the injuries related and/or caused by the accident in question.
Plaintiff has conferred with their medical experts to determine the amount necessary to
set aside and self administer for anticipated future medical expenses or healthcare needs.
Plaintiff agrees to set aside $ NVA of the settlement for these purposes and
notify Medicare that these funds have been set aside. If an LMSA or Medical Cost
Projection was done, the amount stated therein shall be set aside. Any LMSA or Medical
Cost Projection is hereby incorporated by reference into this agreement. Alternatively, if
nothing has been set aside for future costs it is because Plaintiff has covenanted that he
does not reasonably anticipate that he will require medical and/or health care treatment
for the injuries and/or conditions related and/or arising from the accident in question and
to the extent he does, he will use the net settlement proceeds for related costs if'they are
incurred.
[21-CA-952/1717204/1] 4
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•
4. Cooperation and Indemnity: Plainti!rand his counsel agree to fully cooperate with the
Defendant(s 1 and CMS at Plainti s own expense with respect to these pros isions,
including production of documents or information or preparation of a Medicare set aside.
Plaintiff agrees to execute any authorizations required by Defendant, his insurer(s)
or
CMS for purposes of complying with these paragraphs. Plaintiff and her counsel
understand that these conditions are a basis of the settlement and Plaintiff's counsel
agrees to the above terms. Plaintiff acknowledges that additional reimbursement may he
due to Medicare and as such remain obligated to Medicare for any such additional
payments. Plaintiff agrees to hold harmless and indemnify the Defendant(s) and
(his/her/their)insurers, including their own negligence, from and against any and all liens,
interest, damages, including costs and attorney's fees, for Plaintiff's failure to comply
with the terms of this release, for plaintiff's failure to reimburse Medicare or any
Medicare Advantage Organization (MAO) and for any action taken by Medicare to
determine the validity of this release, the validity of any reimbursement, the validity of
any lien or validity of any set aside(self allocated or otherwise).
12. This Agreement shall he governed by'the laws of the State of Florida.
IN WITNESS WHEREOF, Plaintiffs and the County have signed and sealed this
Agreement and Release as set forth below.
By:
JO, individually and on
behalf of minor. SOPHIA JUAREZ
STATE OF FLORIDA
COUNTY OF COLLIER
The foregoing instrument Na.:c•nowledged before me by means of te --Physical
presence or online notarimtiofiahis y nfl2Ose Juarez.
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