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ORDER APPOINTING SETTLEMENT GAL 06/11 pg. 1 IN THE SUPERIOR COURT OF THE STATE OF WASHINGTON FOR KING COUNTY IN THE SETTLEMENT / GUARDIANSHIP OF: ) ) NO. ) ) ORDER APPOINTING ) SETTLEMENT ) GUARDIAN AD LITEM ) (SPR 98.16 W) ) Minor or Incapacitated Person ) (Clerk's Action Required) ) A Petition for Appointment of Settlement Guardian ad Litem having been filed on behalf of the above-named minor or incapacitated person, the Court finding that the facts set forth give the court jurisdiction over this matter and that pursuant to SPR 98.16W, a Settlement Guardian ad Litem or independent attorney is required to investigate and evaluate the proposed settlement; now therefore, THE COURT ORDERS A. Unless otherwise ordered, the hearing on the Petition shall occur at 10:30 a.m. on (date): , in the Ex Parte / Probate Department: KNT Cases: Room 1-J of the Regional Justice Center, 401 Fourth Avenue North, Kent, Washington 98032. SEA Cases: Room W-325 of the King County Courthouse, 516 Third Avenue, Seattle, Washington 98104. Other:. B. Settlement Guardian ad Litem: is a person found or known by the court to be a suitable, disinterested person having the requisite knowledge, training and expertise to perform the duties required by RCW 11.88.090 and SPR 98.16W, and is hereby appointed to represent the interests of the named minor or incapacitated person. American LegalNet, Inc. www.FormsWorkFlow.com ORDER APPOINTING SETTLEMENT GAL 06/11 pg. 2 C. Presumptive Fee Limit. The Settlement Guardian ad Litem shall be paid at an hourly rate not to exceed $200 per hour up to a maximum of ten (10) hours, unless further Court approval is given in advance for additional fees or time. IMPORTANT MESSAGE FOR THE SETTLEMENT GUARDIAN AD LITEM: D. Duties. The Settlement Guardian ad Litem shall have the following duties: 1. To investigate and evaluate the adequacy of the offered settlement in light of the needs and best interests of the minor or incapacitated person. 2. To review written or oral reports from the attorneys, guardians, and medical providers necessary to permit a complete report as required by SPR 98.16W. 3. To provide the court with a written report, which shall include a description, in depth appropriate to the magnitude of injuries and the amount offered, of the following information, as a minimum: a) Summary: State the amount of the settlement that you are recommending, and how the net proceeds will be distributed. Include the name and contact information of parents and another relative: List the name and address of each parent of the minor and another relative. This information will be used in the event the court needs to contact the minor upon turning age 18 or if the court needs to contact the parent for a missing report if required. b) Appointment of Settlement Guardian ad Litem: State your name, date of appointment, and the date that you started working on this matter. Give a brief statement of your experience and qualifications as pertain to serving as a Settlement Guardian ad Litem, or attach a Curriculum Vitae, with this information. Describe your relationship, if any, with involved parents, guardians, insurers, or attorneys. c) Investigation: Describe the investigation you conducted, the persons interviewed, and the documents you reviewed. d) Description of Incident and Cause of Action: Describe the incident and the e) Injuries: Describe the injuries, diagnosis, course of treatment, and prognosis for future disability. Attach a copy of a recent supporting medical report or medical record. f) Damages: Describe the special and general damages that are potentially recoverable. g) Liability Issues: Describe the factors bearing on each potential defendant person or entity's liability, including issues of primary negligence, contributory or comparative negligence, causation and probable chance of recovery. h) Insurance & Assets Available to Satisfy Claim: State the nature and extent of all insurance coverage or assets available to satisfy the claim, whether maintained through the defendant, the family, or available through government entitlements. i) Liens and Subrogation: Identify all liens, subrogation, and reimbursement claims. Make a recommendation regarding how those claims are to be resolved full amount claimed until the final resolution of the claim. American LegalNet, Inc. www.FormsWorkFlow.com ORDER APPOINTING SETTLEMENT GAL 06/11 pg. 3 j) Other Claims: Identify all other claims arising out of the same occurrence. State whether another family member has a claim arising out of the same occurrence, and whether any family member is or could be a plaintiff or defendant in any action based upon the minor's claim or the occurrence from which it arose. k) Apportionment: Indicate the amount, basis, and justification for allocating the gross settlement to be paid among the various claimants of the same family or unrelated claimants, if any. State whether the minor or incapacitated person was independently represented at the time the proposed apportionment was determined. l) Proposed Settlement: Discuss and evaluate the reasonableness of the proposed settlement amount, stating the basis for your valuation of the claim. Also discuss the form the settlement might take (e.g. blocked account, guardianship, structured settlement, or trust) and the proposed settlement documents. m) Expenses and Fees: Discuss and evaluate the reasonableness of the y other deductions from the proceeds of the claim. n) Disposition of Net Proceeds: Set forth your calculation of the net proceeds of and subrogation reimbursements, and settlement guardian ad litem fees. Give your reasons and recommendations regarding as to how the funds should be placed. If a legal guardianship is required, state the nominee and the terms that you recommend. If you recommend a structured settlement, state why that option is preferred; the specific payout schedule recommended and how it relates to the specific needs of the minor; and a statement which includes the cost of the structured portion, the interest rate received, the name and financial rating of the company providing the annuity. If you or any party recommend the creation of a trust as recipient of the settlement funds, give your recommendation as to the special needs of the incapacitated person and how they would be served by having a trust; specific provisions that ought to be included or omitted from the trust; and your nomination of professional to draft the trust, and a recommended fee therefore. o) Settlement Guardian ad Litem Fees: Attach a declaration of your time and services, giving your professional rate and the amounts sought. Indicate who you recommend pay these fees and costs. p) Presence at Hearing: State whether the minor or the Settlement Guardian ad Litem, or which other person(s) should be present at the hearing to approve the settlement. q) Settlement Approval Sought in Other Jurisdiction: State whether the settlement has been submitted for approval in any other court or jurisdiction. r) Conclusion: Give your recommendation as to the adequacy of the offered settlement, and the steps to be followed if you recommend that the settlement not be approved. 4. The Settlement Guardian ad Litem shall file a report with the court within forty five days after appointment and provide a copy to each party, or to their counsel, if they are represented. 5. To accomplish all other duties specifically required under SPR 98.16W and any order of the court filed herein. American LegalNet, Inc. www.FormsWorkFlow.com ORDER APPOINTING SETTLEMENT GAL 06/11 pg. 4 E. The cost of bringing this proceeding and the Settlement Guardian ad Litem's fee will be paid as approved as a part of the settlement, or is reserved for determination at the time the settlement is submitted to the court. F. A court's working copy of the report and supporting documentation shall be delivered not later than 7 days preceding the hearing to the Ex Parte Department of the proper case assignment area who will be hearing the matter. G. The Settlement Guardian ad Litem shall not employ or retain counsel or experts to assist in these duties except as authorized in advance