R25-323 RESOLUTION NO. R25-323
A RESOLUTION OF THE CITY COMMISSION OF THE CITY OF BOYNTON
2 BEACH, FLORIDA, APPROVING THE CONDITIONAL SETTLEMENT AND
RELEASES OF CLAIM IN THE MATTER OF LISSETTE PEREZ-INNOCENT
4 AND RODNEY INNOCENT V. CITY OF BOYNTON BEACH, TOTALING
$67,500; AND FOR ALL OTHER PURPOSES.
6
7 WHEREAS, the Code of Ordinances of the City of Boynton Beach, Florida, provides that
8 the authority for settlement of all claims in excess of $50,000 shall require approval of the City
y Commission by formal resolution; and
Io WHEREAS, Lissette Perez-Innocent and Rodney Innocent ("Plaintiffs") brought a claim
11 under claim number 2400002416, stemming from an alleged incident that occurred on or about
12 June 5, 2024 at or near 1020 W. Gateway Boulevard in Boynton Beach, Florida; and
13 WHEREAS, a Settlement and Release of Claim was reached with the Plaintiffs for$135,000,
14 divided evenly as to both Plaintiffs, who will each receive $67,500, in exchange for general releases
IS of all claims, which resolves all claims for damages between the Plaintiffs and the City of Boynton
16 Beach, Tommy Jones, Tristar Risk Management, PGIT Insurance Company, and their employees,
17 as well as attorney's fees and costs, if any; and
18 WHEREAS, the City Commission, upon the recommendation of staff, has deemed it in the
19 best interests of the city's citizens and residents to approve the Settlement Agreement and Full
20 and Final General Releases of Claim in the matter of Lissette Perez-Innocent and Rodney Innocent
21 and the City of Boynton Beach, Tommy Jones, Tristar Risk Management, PGIT Insurance Company
22 and their employees, totaling $135,000.
23 NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE CITY OF BOYNTON
24 BEACH, FLORIDA, THAT:
2s SECTION 1. The foregoing "Whereas" clauses are hereby ratified and confirmed as
26 being true and correct and are hereby made a specific part of this Resolution upon adoption.
2? SECTION 2. The City Commission of the City of Boynton Beach, Florida, does hereby
28 approve the Settlement Agreement and Full and Final General Releases of Claim in the matter of
29 Lissette Perez-Innocent and Rodney Innocent and the City of Boynton Beach, Tommy Jones, Tristar
30 Risk Management, PGIT Insurance Company and their employees, totaling $135,000, divided
31 evenly as to each Plaintiff in the amount of$67,500, in form and substance similar to that attached
RESOLUTION NO. R25-323
32 as Exhibit A.
33 SECTION 3. This Resolution shall take effect in accordance with the law.
34 [signatures on the following page]
35
RESOLUTION NO. R25-323
36
37 PASSED AND ADOPTED this a day of , 2025.
38 CITY OF BOYNTON BEACH, FLORIDA
39 YES NO
40 Mayor- Rebecca Shelton ✓
41
42 Vice Mayor- Woodrow L. Hay ✓
43
44 Commissioner- Angela Cruz
45
46 Commissioner-Thomas Turkin ✓
47
48 Commissioner- Aimee Kelley ✓
49
50 VOTE 5-0
51 ATTEST:
52
53 Ailh!//1//1 / lilt '74P•
54 a Maylee De J sus, MPA, • C Rebecca Shelton
55) City Clerk —•�Y `�. \ Mayor
s6 pF BO Nt0'
i y %GORPOR
57 i V S 9<"';�C‘t�/ APPROVED AS TO FORM:
E L •0
58 (Corporate Seal) i A
1NCORp
60 ' ' 192 O .•• ;• •° jaiA)70. Ge#4
0
61 11`%,"(ORION ' Shawna G. Lamb
62 City Attorney
• J.
•
CI,AIM #2400002416
I, Lissette Perez- i ("RELEASOR"), for the sole consideration of$67,500 00
c In wcent ( RCLEAS( ),
(Sixty Seven Thousand Five Hundred Dollars and NO/XX)("Settlement Funds")to be paid in
accordance with the terms of this Release,do hereby for myself and for my heirs.executors.
administrators,successors and assigns release,acquit and forever discharge The City of Boynton,
Tommy Jones.Tristar Risk Management and PGIT Insurance Company and all of its subsidiaries
and affiliates,and any and all of their agents,servants,successors,heirs,executors,
administrators and all other persons,employees,corporations,subsidiaries,affiliates, firms.
predecessors and successors in interest("RELEASEES"),of and from any and all claims,
actions,causes of action, liens or conditional payments,demands,rights,damages,costs, loss of
service.expense and compensation whatsoever of every name and nature, known or unknown,
which the RELEASOR now has or which may hereafter accrue on account of or in any way
growing out of any and all known and unknown, foreseen or unforeseen bodily and personal
injuries, illnesses and property damage and the consequences thereof resulting from or arising
out of an accident or incident which occurred on or about June 5,2024 at or near 1020 W.
Gateway Blvd in Boynton Beach,FL ("Incident"). The foregoing release and discharge is
intended by RELEASOR to be as broad in favor as RELEASEES as he/she can possibly create.
RELEASOR recognizes that the consideration referred to above is intended to effectuate
the compromise of a doubtful and disputed claim and is not to be construed as an admission of
liability on the part of any of the RELEASEES,each of whom expressly denies liability.
RELEASOR further recognizes that any injuries or illnesses sustained in the Incident are
or may be permanent and progressive and that the recovery from said injuries or illnesses is
finis and in enteringthis Release isnot l in
uncertain and indefinite, rely i g on any statement of any of the
RELEASEES with respect to the nature,extent,or duration of said injuries. RELEASOR further
declares and represents that no promise, inducement or agreement not herein expressed has been
made to RELEASOR. RELEASOR further stipulates that the terms of this Release are
contractual and not a mere recital and that the representations in this Release arc material
representations upon which RELEASEES have relied in making this settlement.
RELEASOR stipulates and agrees that he/she is responsible for payment of all
outstanding and future bills relating to medical and prescription drug items or services associated
with injuries or illnesses arising from or relating to the Incident or forming the basis of the
claims asserted by RELEASOR("Medical Services").
RELEASOR further stipulates and agrees that he/she is solely responsible for satisfying
any conditional payment, lien or other obligation to reimburse the Centers for Medicare&
I Medicaid Services("CMS")and/or its contractors,other governmental entities [or programs,]
insurers or[other sources of payment or benefits] for any Medical Services furnished to
RELEASOR. RELEASOR acknowledges and agrees that it is his/her responsibility, and not that
of RELEASEES,to satisfy all conditional payments, liens,subrogation and other claims
or demands for payment associated with Medical Services that may arise in any manner,
including without limitation under the Medicare Secondary Payer("MSP")statute(42 U.S.C. §
1395y(b)),contract,or other applicable state or federal law.
1. With respect to Medicare status (check relevant box):
VRELEASOR hereby represents and warrants that he/she(a) is not
currently entitled to Medicare benefits,(b) was not entitled to Medicare
benefits on or between the date of the Incident and execution of this
Release and(c)does not reasonably expect to qualify for Medicare
coverage within 30 months of executing this Release;or
RELEASOR hereby represents and warrants that he/she(a)currently
qualifies for Medicare coverage,(b)was entitled to Medicare benefits on
or between the date of the Incident and execution of this Release,or(c)
expects to so qualify within 30 months of executing this Release. In
further consideration for this Release,a Medicare Addendum dated
is attached hereto and incorporated herein by reference.
2. In order to give full effect to the intent expressed in this Release,RELEASOR stipulates
and agrees in consideration for the aforesaid payment,to fully indemnify and hold harmless
RELEASEES from any and all loss associated with any conditional payment, lien,subrogation
or other claim or demand asserted by CMS and/or its contractors,other governmental entities[or
programs],insurers or[other sources of payment or benefits]that may arise in any manner,
including without limitation under the MSP statute(42 U.S.C. § I395y(b)),contract,or other
applicable state or federal law relating to Medical Services or from RELEASOR's failure to
make the payments and satisfaction described in this Release. RELEASOR further agrees to
indemnify and hold harmless RELEASEES from all loss resulting from RELEASOR's failure to
provide accurate representations and warranties or to adhere to the representations and warranties
contained herein. This indemnification from loss includes all damages and costs incurred by
RELEASEES and/or their attorneys, including without limitation,any attorney's fees, fines and
penalties,interest,expenses,judgments,and multipliers.
BY SIGNATURE, RELEASOR AFFIRMS THAT HE/SHE HAS READ THE FOREGOING
RELEASE AND FULLY UNDERSTANDS IT.
SIGNATURE PAGE FOLLOWS NEXT
1
Executed in 31-04)110 County.fwf\(/t CA _ this day of
_2411,41:74I2ilizzzadr_
Name: Lissette Perez-Innocent
STATE OF t`(`2 0
COUNTY OF 1/9..(}wz a\--) to wit:
On the ?As'day 0fA ) ''tlb( ,?c,2l before me personally appeared Lissette Perez-
Innocent.to me known to be the person named in the foregoing Release,and who executed the
foregoing Release and acknowledged to me that she has read the Release and understands the
con is thereof and that she voluntarily executed the same.
2
NOTARY PUBLIC
'r(t)-Q&� 44' c i- ►/1 :; ,.6:4:... JOSEPH M.COHEN
PRINT NAME OF NOTARY MYCOMMISSION 0HH674728 '
• .4: EXPIRES:May 8,2029
MY COMMISSION EXPIRES: S Ig12 Gl
Claim:2400002146
•I
. i
• 'w
RELEASE
CLAIM N 2400002416
I.Rodney Innocent ("RELEASOR"),for the sole consideration of$67.500 00(Sixty
Seven Thousand Five Hundred Dollars and NO/XX)("Settlement Funds")to be paid in
accordance with the terms of this Release.do hereby for myself and for my heirs,executors,
administrators,successors and assigns release,acquit and forever discharge The City of Boynton,
Tommy Jones.Tristar Risk Management and PGIT Insurance Company and all of its subsidiaries
and affiliates,and any• and all of their agents,bents servants,successors,heirs,executors,
administrators and all other persons,employees,corporations,subsidiaries,affiliates, firms,
predecessors and successors in interest("RELEASEES"),of and from any and all claims,
actions,causes of action, liens or conditional payments,demands,rights,damages.costs, loss of
service,expense and compensation whatsoever of every name and nature,known or unknown.
which the RELEASOR now has or which may hereafter accrue on account of or in any way
growing out of any and all known and unknown, foreseen or unforeseen bodily and personal
injuries, illnesses and property damage and the consequences thereof resulting from or arising
out of an accident or incident which occurred on or about June 5. 2024 at or near 1020 W.
Gateway Blvd in Boynton Beach,FL("Incident"). The foregoing release and discharge is
intended by RELEASOR to be as broad in favor as RELEASEES as he/she can possibly create.
RELEASOR recognizes that the consideration referred to above is intended to effectuate
the compromise of a doubtful and disputed claim and is not to be construed as an admission of
liability on the part of any of the RELEASEES,each of whom expressly denies liability.
RELEASOR further recognizes that any injuries or illnesses sustained in the Incident are
or may be permanent and progressive and that the recovery from said injuries or illnesses is
uncertain and indefinite,and in entering this Release is not relying on any statement of any of the
RELEASEES with respect to the nature,extent,or duration of said injuries. RELEASOR further
declares and represents that no promise,inducement or agreement not herein expressed has been
made to RELEASOR. RELEASOR further stipulates that the terms of this Release are
contractual and not a mere recital and that the representations in this Release are material
representations upon which RELEASEES have relied in making this settlement.
RELEASOR stipulates and agrees that he/she is responsible for payment of all
outstanding and future bills relating to medical and prescription drug items or services associated
with injuries or illnesses arising from or relating to the Incident or forming the basis of the
claims asserted by RELEASOR("Medical Services").
RELEASOR further stipulates and agrees that he/she is solely responsible for satisfying
any conditional payment, lien or other obligation to reimburse the Centers for Medicare&
Medicaid Services("CMS")and/or its contractors,other governmental entities [or programs,]
insurers or[other sources of payment or benefits] for any Medical Services furnished to
RELEASOR. RELEASOR acknowledges and agrees that it is his/her responsibility,and not that
of RELEASEES,to satisfy all conditional payments, liens, subrogation and other claims
or demands for payment associated with Medical Services that may arise in any manner,
including without limitation under the Medicare Secondary Payer("MSP")statute(42 U.S.C. §
i 395y(b)),contract,or other applicable state or federal law.
1. With respect to Medicare status(check relevant box):
RELEASOR hereby represents and warrants that he/she(a)is not
currently entitled to Medicare benefits,(b)was not entitled to Medicare
benefits on or between the date of the Incident and execution of this
Release and(c)does not reasonably expect to qualify for Medicare
coverage within 30 months of executing this Release;or
RELEASOR hereby represents and warrants that he/she(a)currently
qualifies for Medicare coverage,(b)was entitled to Medicare benefits on
or between the date of the Incident and execution of this Release,or(c)
expects to so qualify within 30 months of executing this Release. In
further consideration for this Release,a Medicare Addendum dated
is attached hereto and incorporated herein by reference.
2. In order to give full effect to the intent expressed in this Release, RELEASOR stipulates
and agrees in consideration for the aforesaid payment,to fully indemnify and hold harmless
RELEASEES from any and all loss associated with any conditional payment, lien,subrogation
or other claim or demand asserted by CMS and/or its contractors,other governmental entities[or
programs], insurers or[other sources of payment or benefits]that may arise in any manner,
including without limitation under the MSP statute(42 U.S.C. § I395y(b)),contract, or other
applicable state or federal law relating to Medical Services or from RELEASOR's failure to
make the payments and satisfaction described in this Release. RELEASOR further agrees to
indemnify and hold harmless RELEASEES from all Ioss resulting from RELEASOR's failure to
provide accurate representations and warranties or to adhere to the representations and warranties
contained herein. This indemnification from loss includes all damages and costs incurred by
RELEASEES and/or their attorneys, including without limitation,any attorney's fees,fines and
penalties, interest,expenses,judgments,and multipliers.
BY SIGNATURE,RELEASOR AFFIRMS THAT HE/SHE HAS READ THE FOREGOING
RELEASE AND FULLY UNDERSTANDS IT.
SIGNATURE PAGE FOLLOWS NEXT
e,'-'
Executed in (�(OrUGlf� county, 'r Ivt
U f1C1lCA till, 2-4 � clay .,I
/U0VQN1ge f 2cZ'
,:///
L
Name: Rodney Innocent
./ACOSTATE OF L 0 Q
1 1 OA-
COUNTY
UNTY OF V7-olll142 D to wit:
Qroducecl z 17
On the 2 4 day of 41o4emem( ,102-5, before me p anal}y-appeaced Rodney
Innocent,to me known to he the person named in the foregoing Release, and v.ho executed the
foregoing Release and acknoµledged to me that she has read the Release and understands the
con ereof and that she \oluntari ly executed the same.
4114
NOTARY PUBLIC -
�c, 1,, .4 ••. JOSEPH M.COHEN
Tv €p�' 1 (0 1-e MY COMMISSION#HH 674728
:.'.• ''of°` EXPIRES:May 8,2029
PRINT NAME OF NOTARY '•°"`
MY COMMISSION EXPIRES:NS) 2CI
Claim: 2400002146