Backup Documents 12/12/2017 Item #16K2 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 b K 2
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
4. BCC Office Board of County
Commissioners \f� k \���_\
5. Minutes and Records Clerk of Court's Office
—r' _ la)labi- 3=l'-CO
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 L.Noe , Assistant County Phone Number 252-8424
Contact/Department Attorney
Agenda Date Item was 12/12/17 Agenda Item Number 16K —2.
Approved by the BCC
Type of Document Settlement Agreement&General Release- Number of Original
Attached Encalada 15-CA-2124 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 signa e?Stamp OK KLN
2. Does the document need to be sent to another agency for ad t ' ignatures? If yes, KLN
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 KLN
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 KLN
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 KLN
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 KLN
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip KLN
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 12/12/17 and all changes made during KLN
the meeting have been incorporated in the attached document. The County ;.
Attorney's Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approve. s the KLN f.. .R s nk.
BCC,all changes directed by the BCC have been made,and the document is r ady forrthefl'000 fOt
Chairman's signature. �����
[15-02124-CA/1381813/111: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
16K2
MEMORANDUM
Date: December 13, 2017
To: Kevin Noell, Assistant County Attorney
County Attorney's Office
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: Settlement Agreement & General Release— Encalada 15-CA-2124
Attached is a copy of the document referenced above, (Item #16K2) approved by the
Board of County Commissioners on Tuesday, December 12, 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.
16K2
SETTLEMENT AGREEMENT AND
GENERAL RELEASE
Defendants, Preferred Materials, Inc. and Collier County, a political subdivision of the State
of Florida ("Releasees"), and Jose Encalada("Plaintiff") (collectively the "Parties") agree as follows:
RECITALS: Plaintiff suffered nonfatal injuries as a result of a single vehicle accident that
occurred on December 29, 2014,on Corkscrew Road near the intersection of Whidden Loop Road
in Collier County, Florida(the"Accident").
The Parties deny any negligence or wrongdoing in connection with the Accident.
Plaintiff filed a lawsuit in the Circuit Court of Collier County styled Jose Encalada a. Prefernd
illaterials, Inc. and Collier County, a political subdivision of the State of Florida, Case No. 2015-CA-2124 (the
"lawsuit").
The Parties desire to settle all issues and disputes related to the Accident and avoid the risks
and uncertainties of litigation,along with further time and expense.
In consideration of the mutual covenants contained herein and other good and valuable
consideration, the Parties agree and covenant as follows:
SETTLEMENT ARVIOU.NT: Releasees agree to pay the total sum of Thirty Thousand
Dollars and No/100 ($30,000) made payable to The Pendas Law Firm Trust Account f/b/o Jose
Encalada, the receipt and sufficiency of which is hereby acknowledged by the Plaintiff. The Plaintiff
agrees to accept said payment in consideration of the releases, waivers, covenants, and other
provisions of this Settlement Agreement and General Release (referred to herein as "Release" or
"Agreement"),and in full settlement,accord,and satisfaction of all claims,demands,rights,and liens
the Plaintiff has or may have, now known or unknown, against Releasees in any way arising out of,
or related to, the Accident. Each party will bear its own costs and attorney's fees.
REPRESENTATIONS BY PLAINTIFF: Plaintiff acknowledges,warrants,and agrees to
satisfy all liens, reimbursement rights, subrogation interests, or claims on behalf of Medicare and
Medicaid as required by law.
DISMISSAL OF LAWSUIT: Delivery of the settlement proceeds shall be made within
twenty (20) days of the receipt of the signed and executed Agreement, and the Plaintiff shall file a
' 6K2
Dismissal with Prejudice for claims made against the Releasees in the lawsuit within five (5) days of
the Plaintiff's counsel's receipt of the settlement funds.
GENERAL RELEASES: In return for this payment, the Parties do hereby fully and forever
release,acquit,and discharge each other,including the Parties'respective insurance carriers(including
but not limited to, Liberty Mutual Insurance Company, Liberty Mutual Fire Insurance Company,
American Guarantee and Liability Insurance Company, Zurich, N.A., and their affiliates), officers,
directors, shareholders, agents, employees, predecessors, successors, parent companies, sister
companies, and subsidiaries, from all claims of any nature or character whatsoever, known or
unknown which the Parties have, or may hereafter have, against each other, arising out of, or in
connection with, the Accident.
This Release does not include any claim for damages which Plaintiff may have against any
other person or any entity not named or described herein, as referenced above or intended to be
released herein, and Plaintiff expressly reserves all rights and remedies they may have to pursue and
prosecute those claims which are not released against those persons or entities. By executing this
Release,the Plaintiff authorizes his attorney to dismiss the above-styled lawsuit with prejudice.
RESERVATION OF FIRST PARTY CLAIMS: Notwithstanding anything to the contrary,
this Release shall not release any health, disability, or other insurance carrier or self-insured from its
obligation to provide any personal injury protection coverage, medical payments coverage,uninsured
or underinsured motorist coverage, health insurance coverage, major medical insurance coverage,
workers'compensation benefits/insurance,and/or disability insurance coverage from any claims and
demands, rights, and causes of action of any kind the Plaintiff now has, or hereafter may have, on
account of personal injuries known or unknown to the Plaintiff arising from the Accident. It is the
intention of the Parties to this Agreement to release and discharge each other only, and to reserve all
rights of the Plaintiff to obtain all first party benefits to which the Plaintiffs may be entitled.
WAILER: It is possible that other injuries,damages,losses,or future consequences or results
arising from the Accident, not now known, will develop or be discovered. The general release
contained in the preceding paragraph is expressly intended to cover and include a release by the
Plaintiff of all such future injuries, damages, losses, or future consequences or results of known or
•
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16K2
unknown injuries and known or unknown causes of action that may exist or arise in the future as a
result of the Accident.
MEDICARE COMPLIANCE: It is not the purpose of this settlement agreement to shift
responsibility of medical care in this matter to the Medicare system. Instead, this settlement is
intended to resolve a dispute between the Plaintiff and Released Party.In order to ensure compliance
with Medicare and applicable federal regulations, the Plaintiff acknowledges that he or his attorney
has reported this claim to the Centers for Medicare and Medicaid Services (CMS). The Plaintiff
acknowledges that Medicare will be reimbursed out of these settlement proceeds for any and all
payments made in the past or that may be made in the future related to this accident.
No money out of the settlement is allocated towards future medical treatment. While it is
impossible to accurately predict the need for future treatment, this decision was based upon a good
faith review of the Plaintiff's current medical condition. The Parties have attempted to resolve this
disputed matter in compliance with both state and federal law and it is believed that the settlement
terms adequately consider Medicare's interest and do not reflect any attempt to shift the burden of
future care to Medicare pursuant to 42 U.S.C. §1395y(b). In the event Medicare required
reimbursement related to future medical care,this would be the sole responsibility of the Plaintiff.
HOLD HARMLESS: This Release includes all outstanding liens and possible liens and
subrogation interests including, but not limited to, liens by any insurer for property damage, liens by
providers of medical and related services, liens and subrogation interests of medical benefits
providers,liens and subrogation interests of uninsured and underinsured motorist carriers, liens and
subrogation interests of state or federal governments, liens, and subrogation interests of Medicare,
Medicaid, letters of protection,and child support,liens for workers'compensation benefits,and liens
for attorneys' fees which may have accrued or which are accruing against Plaintiff as a result of the
Accident, and Plaintiff specifically agrees to hold Releasees, as described in the "General Release"
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16K2
provision above, harmless from any liability on account of such liens or subrogation interests.
Plaintiff agrees to waive his right to any private cause of action related to his liability claim pursuant
to 42 L'.S.C. 1395y(b)(3)(A). Plaintiff also agrees to revoke any prior assignment, if any,of rights to
providers which would include a private cause of action brought on behalf of the Plaintiff.
REPRESENTATIONS BY PLAIN11H: Plaintiff acknowledges,warrants,and agrees to
satisfy all liens,reimbursement rights,subrogation interests,or claims on behalf of Medicare,workers'
compensation,and Medicaid as required by law.
NO ADMISSION OF LLABILITY: It is understood and agreed that acceptance of the
payment specified above is in full settlement, accord, and satisfaction of disputed claims, and this
Agreement is for the compromise of disputed claims,and is not to be construed as an admission of
any liability, fault, or responsibility on the part of the Parties, by whom liability and fault are, and
always have been,expressly denied.
CONTIDENTIALITY OF SETTLEMENT: The parties hereto are obligated to keep the
terms of this settlement confidential. It is specifically understood that no release of information
concerning this settlement shall be made to the news media or general public,and that disclosure of
the terms of this settlement shall be restricted to those disclosures which are required by law,required
by Releasees to maintain a separate cause of action for the recovery of funds paid herein, and/or as
may be necessary to enable the undersigned to facilitate appropriate tax reporting or lien settlements,
or in the conduct of business necessary to complete this settlement. If inquiry is made by any person
about this Agreement, the Parties agree that they will state only that they have resolved their
differences amicably and that any litigation has ended. The Parties' reciprocal promises to maintain
confidentiality constitute the sole consideration for the provisions of this paragraph, the sufficiency
of which is hereby acknowledged.
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COiNSTRUCT7ON: It is acknowledged that the Parties participated in the drafting of this
Agreement and this language shall not be presumptively construed either in favor or against any of
the Parties.
ADDITIONAL TERMS:The Parties have read and reviewed with their attorneys,and fully
understand,the complete contents of this Agreement and are voluntarily entering into this Agreement
upon the advice of their attorneys. The Parties expressly understand and agree that this Agreement
shall be binding on their personal representatives, agents, successors, privies, and assigns, and no
rescission, modification, or release of them from the terms of this Agreement will be made for any
mistakes.
The parties may execute this Agreement in separate counterparts, each of which constitutes
an original, and all of which, collectively, constitute only one Agreement. The counterparts may be
delivered in original or electronic versions.
This Agreement comprises the entire agreement between the Parties with respect to the
settlement of claims arising from the Accident. This Agreement supersedes all prior and
contemporaneous oral and written agreements and discussions. It may be amended only by an
agreement in writing, signed by all the Parties to this Agreement.
Executed at 1:4- fl' y ,Florida, this day of November,2017.
Page 5 of 8
16K2
WITNESSES: YOU ARE MAKING A FINAL
SETTLEMENT-THIS IS A RELEASE-READ
CAREFULLY BEFORE SIGNING
Z2re5
Jose Encalada
(Two witnesses required)
STATE OF FLORIDA
COUNTY OF
BEFORE ME, the undersigned authority, personally appeared Jose Encalada, who, after
being duly sworn by me, deposes and says that he has read the foregoing Settlement Agreement and
General Release, understands its terms,and has executed the same for the purposes set forth therein.
SWORN TO AND SUBSCRIBED before me this 3 day of Oo1ehae.r-,2017.
w Yom,
Signatu e p
Qe5c re et..) . r
Name of officer taking acknowledgment
(typed,printed or stamped) �{
My commission expires: 3/(1/20 Z 7& S--12
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1 6 K 2
WITNESSES: YOU ARE MAKING A FINAL SETTLEMENT
-THIS IS A RELEASE-READ CAREFULLY
BEFORE SIGNING
PREFERRED MATERIALS,INC.
By . /IA
V---7Th
(Two witnesses required)
STATE OF
COUNTY OF
BEFORE ME,the undersigned authority,personally appeared ,as
of Preferred Materials,Inc.,who,after being duly sworn by me,deposes and says
that he/she has read the foregoing Settlement Agreement and General Release,understands its terms,
and has executed the same for the purposes set forth therein.
SWORN TO AND SUBSCRIBED before me this day of ,
2017.
(SEAL)
Signature
Name of officer taking acknowledgment
(typed,printed or stamped)
My commission expires:
Page 7 of 8
1
AS TO COUNTY: 1 6 K 2
ATTEST:
DWIGHT E. BROCK, Clerk BOARD OF COUNTY COMMISSIONERS
OF COL E: •UNTY, FLORIDA
lar %i m :r- B //
By:
ft*
At#est as to GhaicThan
Dseputy Clerk PENNY T•or I R, Chai �`
\ \,
signature onty..
Approved as to form and legality:
Kevin L. Noell
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