Backup Document 06/14/2022 Item #16K7 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 6
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 6/9/22
4. BCC Office Board of County
Commissioners \IA by MI5/ b/N/z .
5. Minutes and Records Clerk of Court's Office ,M
(.1 le`61?-z_ '718 ` l
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 6/14/22 Agenda Item Number 16K 7
Approved by the BCC
Type of Document Marsha&Anthony 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 6/14/22 and all changes made during the CAK/rev N/A is not
meeting have been incorporated in the attached document. The County Attorney's an option for
Office has reviewed the changes, if applicable. this line.
9. Initials of attorney verifying that the attached document is the version approved by the CAK/rev 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.
Please Expedite and send email copies
I:Forms/County Forms/BCC F to Colleen.Kerins@colliercountyflg.gov i.05,Revised 2.24.05;Revised 11/30/12
and Rosa.Villarreal@colliercountyfl.gov
16K7
Ann P. Jennejohn
From: Ann P.Jennejohn
Sent: Wednesday,June 15, 2022 12:40 PM
To: 'Colleen.Kerins@colliercountyfl.gov'
Subject: Settlement Agreements (6-14-22 BCC Meeting)
Attachments: Item #16K5 (6-14-22 BCC Meeting).pdf; Item #16K7 (6-14-22 BCC Meeting).pdf
Please see the attached executed
settlewtertt agreewtevtts For your records.
Thank you
Ann Jennejohn
13MR Senior Deputy Clerk II
` LaTi�kkr Clerk to the Value Adjustment Board
� '�, Office: 239-2sz-s4o6
r,
}
4 Fax: 239-z52-8408 (if applicable)
Avtvt.Jevlvtejohvt@CollierClerk.cowt
.,, , � Office of the Clerk of the Circuit Court
k""-sn.t` & Comptroller of Collier County
3299 Taw►iawti Trail, Suite #4O1
Naples, FL. 34112-5324
www.CollierClerk.cowt
i
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SETTLEMENT AGREEMENT
THIS SETTLEMENT AGREEMENT (hereinafter referred to as the "Agreement") is
entered into and made on this 1 L 'day of M.4,y\e , 2022, by and between
MARSHA SHARKEY and ANTHONY SHARKEY, hereinafter referred to as
"Plaintiffs,"and COLLIER COUNTY, 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 Marsha Sharkey
and Anthony Sharkey v. Collier County, Case No. 21-CA-0072 (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 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, 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. 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 forty-four thousand dollars and 00/100 ($44,000.00), of which
$40,000.00 to Plaintiff, Marsha Sharkey for her negligence claim and $4,000.00 to Plaintiff
Anthony Sharkey for the loss of consortium claim, and other valuable consideration, the receipt
and adequacy of which is hereby acknowledged by Plaintiffs, Plaintiffs agree to dismiss the
Lawsuit with Prejudice.
[21-CA-0072/1725026/1] 1
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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, Plaintiffs, on behalf of
themselves, their 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, 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.
5. PIaintiffs 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.
6. 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 Plaintiffs or the County.
7. 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.
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, Plaintiffs and the County
agree that all underlying causes of action or claims of Plaintiffs have been extinguished by this
[21-CA-0072/1725026/1] 2
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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.
10. 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.
11. The Plaintiffs hereby agree 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.
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, Plaintiff, Marsha
Sharkey, 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
(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
[21-CA-0072/1725026/1] 3
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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: Marsha N. Sharkey
SOCIAL SECURITY NUMBER: 048-40-7161
DATE OF BIRTH: 5/19/1950
GENDER: Female
MEDICARE HEALTH INSURANCE CLAIM NUMBER(HICN): 2R38-W53-FT46
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 $ 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.
4. Cooperation and Indemnity: Plaintiff and her counsel agree to fully cooperate with the
Defendant(s) and CMS at Plaintiff's own expense with respect to these provisions,
including production of documents or information or preparation of a Medicare set aside.
[21-CA-0072/1725026/1] 4
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Plaintiff agrees to execute any authorizations required by Defendant, her 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 be
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 be 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: Qt,/
Merthe S arkey,Plaintiff
Marsha \
STATE OF FLORIDA
COUNTY OF COLLIER
The foregoing instrument was acknowledged before me by means of ✓ physical
presence or online notarization,this Gkday of c/u-n.e , 2022, by Maitha Sharkey.
(Signe-e-14A, Marsha
f Notary Public-State of Florida
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(Print,Type, or Stamp Commissioners
Name of Notary Public)
Personally Known OR_Produced Identification Type of Identification Produced: :'p�.' Commission
yP '• 'c;=Commission#GG 344160
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"':;pF i?.. Bonded Thru Troy Fain Insurance 800.385.1019
[21-CA-0072/1725026/1] 5
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