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R25-316 RESOLUTION NO. R25-316 1 A RESOLUTION OF THE CITY COMMISSION OF THE CITY OF BOYNTON 2 BEACH, FLORIDA, APPROVING THE CONDITIONAL SETTLEMENT AND 3 RELEASE OF CLAIM IN THE MATTER OF CHRISTINA SORTORE V. CITY 4 OF BOYNTON BEACH, TOTALING $100,000; AND FOR ALL OTHER 5 PURPOSES. 6 7 8 WHEREAS, the Code of Ordinances of the City of Boynton Beach, Florida, provides that 9 the authority for settlement of all claims in excess of $50,000 shall require approval of the City 10 Commission by formal resolution; and i WHEREAS, Christina Sortore ("Claimant") brought a claim stemming from an alleged 12 incident that occurred on or about December 13, 2019; and 13 WHEREAS, a Settlement and Release of Claim was reached with the Claimant for $100,000 14 in exchange for a general release of all claims, which resolves all claims for damages between the 15 Claimant and the City of Boynton Beach, as well as attorney's fees and costs, if any; and 16 WHEREAS, the City Commission, upon the recommendation of staff, has deemed it in the 17 best interests of the city's citizens and residents to approve the Contingent Settlement Agreement 18 and Release in the matter of Christina Sortore and the City of Boynton Beach, totaling $100,000. 19 NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE CITY OF BOYNTON 20 BEACH, FLORIDA, THAT: 21 SECTION 1. The foregoing "Whereas" clauses are hereby ratified and confirmed as 22 being true and correct and are hereby made a specific part of this Resolution upon adoption. 23 SECTION 2. The City Commission of the City of Boynton Beach, Florida, does hereby 24 approve the Contingent Settlement Agreement and Release in the matter of Christina Sortore and 25 the City of Boynton Beach totaling $100,000, in form and substance similar to that attached as 26 Exhibit A. 27 SECTION 3. This Resolution shall take effect in accordance with the law. 28 29 [SIGNATURES ON THE FOLLOWING PAGE] 30 31 RESOLUTION NO. R25-316 32 33 PASSED AND ADOPTED this d5 day of Q.0 t.M Q_,C , 2025. 34 CITY OF BOYNTON BEACH, FLORIDA 35 YES NO 36 Mayor— Rebecca Shelton ✓ 37 38 Vice Mayor—Woodrow L. Hay ✓ 39 40 Commissioner—Angela Cruz 41 42 Commissioner—Thomas Turkin 43 44 Commissioner—Aimee Kelley ✓ 45 46 VOTE 5-0 47 ATTEST: 48 49 ( ., 50 / j1aylee De J us, MPA, R ecca Shelton 5IV City Clerk Mayor 52 53 APPROVED AS TO FORM: 54 (Corporate Seal) 55n� G� 56 57 Shawna G. Lamb 58 City Attorney CONTINGENT SETTLEMENT AGREEMENT AND RELEASE Employee/Claimant: OJCC Case No. 24-015353TAH Christina Sortore 11622 Hackberry St West Palm Beach, FL 33410 Employer: City of Boynton Beach Claim No. 06330021 100 East Ocean Avenue Boynton Beach, FL 33435 Carrier/Servicing Agent: Commercial Risk Management, Inc. Date of Accident: 12/13/2019 P.O. Box 18366 Tampa, FL 33679 THIS AGREEMENT, subject to the terms and conditions as set forth below, is intended to be a complete, entire and final release and waiver of any and all rights, to any and all benefits, past, present and future, that the Employee/Claimant, Christina Sortore, is, or may be, entitled to under Chapter 440, Florida Statutes, (as more fully set forth below), and any other actions, claims, demands, or causes of actions, whatsoever, that the Employee/Claimant may have against the Employer, City of Boynton Beach, and the Carrier/Servicing Agent, Commercial Risk Management; Inc., hereinafter, Employer/Carrier/Servicing Agent. I. TERMS OF WORKERS' COMPENSATION SETTLEMENT AGREEMENT AND RELEASE PURSUANT TO 440.20(11)(c)(d) & (e) (2013): A. TOTAL SETTLEMENT AMOUNT: The Employer/Carrier/Servicing Agent will pay to the Employee/Claimant, in a lump sum, the amount of $100,000.00 ($100.00 of which is payable to the Employee/Claimant as consideration for an ADA/General employer release) less the OJCC#: 24-015353TAH Page 1 of 13 $2,000.00 that the Employer/Carrier/Servicing Agent has paid to the Employee/Claimant as an advance, payment of which will be issued within thirty (30) days from the date of Certificate of Service on the Order approving the Motion for Approval of Attorney's Fee and Allocation of Child Support Arrearage for Settlement under Section 440.20(11)(c)(d) & (e). It is understood and agreed by the parties that the terms of this agreement are binding and fully enforceable. B. ALL BENEFITS RESOLVED: Payment of the aforementioned lump sum is in full satisfaction of the obligation or liability of the Employer/Carrier/Servicing Agent to pay any benefits of whatever kind or classification available under the Florida Workers' Compensation Law, including, but not limited to, temporary total and temporary partial disability benefits, impairment benefits, permanent total disability benefits, permanent total supplemental benefits, supplemental benefits, wage loss benefits, rehabilitative temporary total disability benefits, vocational benefits, required to be provided by the Employer, death benefits, attorney's fees, past, present and future medical benefits, attendant care, prescriptions, orthotics, prosthetics, transportation, or any other benefits contemplated under Florida Statute 440 relating to the alleged injury or occupational disease arising on account of or in connection with an accident, occurrence, incident, exposure, or event which took place on or about 12/13/2019. The Employee/Claimant acknowledges by her signature below, that upon payment of the consideration referenced in paragraph I.A. herein, she waives all entitlement to any and all further Workers' Compensation benefits and that the Employer/Carrier/Servicing Agent will be fully and forever discharged and released from the obligation or liability to pay any and all benefits of whatever kind or classification payable under the Florida Workers' Compensation Law. The Employee/Claimant stipulates, and the parties agree, that this Settlement Agreement and Release shall constitute an election of remedies by the Employee/Claimant with respect to the Employer/Carrier/Servicing Agent herein. As a result of accepting the above referenced sum, the Employee/Claimant relinquishes all rights for recovery for negligence, intentional torts, employer liability under workers' compensation law, bodily injury and any other potential claims arising under the workers' compensation law and employers' liability policy (including, but not limited, Part II/Coverage B) in effect for the 12/13/2019 date of accident. OJCC#: 24-015353TAH Page 2 of 13 The undersigned Employee/Claimant accepts and assumes all risk, chance, or hazard that said injuries, damages, manifestations or losses are now or may become greater, more numerous or more extensive than is now know, anticipated or expected; and the undersigned Employee/Claimant agrees that this release applies to all injuries, damages, manifestations or losses of every kind and character which have arisen, or which may hereafter arise, even though now unknown, unanticipated or unexpected. The undersigned Employee/Claimant hereby acknowledges full responsibility for all future medical benefits. C. ATTORNEYS FEES: 1. FEES/COSTS PAID BY THE EMPLOYEE/CLAIMANT: The Employee/Claimant will pay her attorney, Vincent Leuzzi, Esq., the sum of$24,972.00 out of the above settlement. Additionally, the Employee/Claimant shall pay the sum of$28.00 as costs. The fee and costs shall be paid from the settlement proceeds, thereby making the net settlement amount $75,000.00 ($100.00 of which is payable to the Employee/Claimant as consideration for an ADA/General employer release). 2. PRIOR REPRESENTATION: The Employee/Claimant will be responsible for any and all attorney's fee liens filed or held by any prior attorney, for representation of the Employee/Claimant. The Employee/Claimant agrees to indemnify and hold the Employer/Carrier/Servicing Agent harmless as to any attorney fee liens. D. CHILD SUPPORT ARREARAGE: The Employee/Claimant agrees that, if there is any outstanding child support, it shall be deducted from the Employee/Claimant's net settlement proceeds pursuant to the Motion for Attorney Fee Approval and Child Support Allocation. Any payments to child support shall be made by the Claimant's Counsel from the Employee/Claimant's net settlement proceeds. The Employer/Carrier/Servicing Agent shall in no way be responsible for any child support owed by the Employee/Claimant. The Employee/Claimant also stipulates and agrees that the Employer/Carrier/Servicing Agent shall be indemnified and held harmless against any action brought by any third party for payment of child support arrearage. OJCC#: 24-015353TAH Page 3 of 13 E. THIRD PARTY LIENS The Employer/Carrier/Servicing Agent does not waive any lien rights pursuant to Florida Statute 440.39 and the lump sum benefits paid herein shall be included in the amount thereof. The Employee/Claimant agrees to give written notification to the Employer/Carrier/Servicing Agent or their attorney as to the filing of any suit against third parties arising out of the accident or injuries giving rise to this claim and to advise as to any recovery received from third parties arising out of the accident or injuries which are the subject matter of this claim. The Employee/Claimant further agrees that no proceeds from any third-party claim shall be disbursed prior to satisfaction of the Employer/Carrier/Servicing Agent's lien. II. STIPULATED FACTS: A. MEDICAL CARE: The Employee/Claimant understands and acknowledges that any and all entitlement to authorized treatment ceased effective the date of settlement as outlined in the parties' November 4, 2025 Memorandum of Contingent Settlement, which is hereby incorporated by reference. B. INDEMNITY BENEFITS: The Employee/Claimant acknowledges that effective the date of settlement, as outlined in the parties' November 4, 2025 Memorandum of Contingent Settlement, she is no longer eligible nor entitled to any past, present, or future indemnity benefits. III. SPECIFIC WAIVERS AND REPRESENTATIONS: A. WAIVER OF RIGHT TO HAVE CASE HEARD BY JUDGE OF COMPENSATION CLAIMS AND RIGHT TO BRING PETITION FOR MODIFICATION: The Employee/Claimant understands that she does hereby relinquish the right to have any unresolved conflicts or disputes involving the right to monetary compensation benefits, impairment benefits, death benefits, attorney's fees, past due medical benefits, future medical benefits, and rehabilitation benefits heard and decided by the Judge of Compensation Claims. The Employee/Claimant also understands that OJCC#: 24-015353TAH Page 4 of 13 this Settlement Agreement and Release shall not be reviewed by the Judge of Compensation Claims in accordance with Florida Statute section 440.20(11)(c). In addition, the Employee/Claimant also understands that the Order approving the Motion for Approval of Attorney's Fee and Allocation of Child Support Arrearage for Settlement under Section 440.20(11)(c)(d) & (e) is not an award under the Florida Workers' Compensation Act and is not subject to modification or review. B. WAIVER OF PENALTIES AND INTEREST: The Employee/Claimant does hereby waive any right she may have to any and all penalties and/or interest on account of the alleged accident or occupational disease referenced herein. C. RIGHT TO FUTURE MEDICAL CARE CLOSED: As provided under Florida Statutes section 440.20(11)(c), the lump sum payable herein will fully discharge and satisfy the Employer/Carrier/Servicing Agent's liability to provide future remedial and palliative medical care under Florida Statute section 440.13 and 440.134, including, but not limited to, follow up examinations, pain medication, diagnostic testing, attendant care, and surgery. The Employer/Carrier/Servicing Agent shall no longer be liable for any medical benefits resulting from the alleged accident or occupational disease referenced herein. Any further/future medical expenses will be the sole responsibility of the Employee/claimant. The Employee/Claimant agrees to notify his treating physicians' that she is now alone fully financially responsible for any and all medical care and treatment. The Employee/Claimant has considered or had the opportunity to consider any and all reports submitted by medical providers and rehabilitation providers. In addition, the Employee/Claimant has consulted with or had the opportunity to consult with medical providers and rehabilitation providers. The Employee/Claimant stipulates and agrees that she has determined that the amount of money being proposed to settle medical care and treatment is reasonable and adequate to meet the Employee/Claimant's future medical needs, in connection with the accident, occurrence, incident, exposure or event, which took place on or about 12/13/2019. OJCC#: 24-015353TAH Page 5 of 13 D. ALL CLAIMS RELATED TO THE EMPLOYEE/CLAIMANT'S EMPLOYMENT WITHDRAWN AND/OR ACTIONS WAIVED: All pending Claims/Petitions for Benefits are hereby voluntarily withdrawn and dismissed, with prejudice. This settlement represents a settlement of any and all claims or actions that may arise from the accident referenced herein and any claims or actions that may have arisen out of the Employee/Claimant's employment with City of Boynton Beach, whether known or unknown, reported or unreported. As part of this settlement, the Employee/Claimant further specifically agrees to release and discharge the Employer, City of Boynton Beach, its officers, agents, servants, employees, directors, successors, assigns, and any other person or entity so connected to the Employer, of any and all claims relating to retaliatory discharge under section 440.205, Florida statutes. In addition, as further consideration for such payment, the Employee/Claimant agrees and does hereby release, discharge, and surrender any and all claims, whether or not asserted, against the Employer, City of Boynton Beach, or its Servicing Agent, or any of their officers, agents, servants, employees, directors, successors, assigns, and any other person or entity so connected to the Employer and/or Servicing Agent, of any nature whatsoever, without limitations thereof. E. EMPLOYER/CARRIER/SERVICING AGENT'S PAYMENT OF PAST MEDICAL BILLS: The Employer/Carrier/Servicing Agent agrees to pay, in accordance with the Workers' Compensation Fee Schedule, any bills for treatment causally related to the work accident or occupational disease, from authorized health care providers/facilities, for dates of service prior to the date of settlement. The Employer/Carrier/Servicing Agent will pay for such services upon receipt of the authorized treating physician's bills, submitted upon proper form. The Employer/Carrier/Servicing Agent does not agree to pay any bills from unauthorized health care providers/facilities and the Employee/Claimant stipulates and agrees that she is solely responsible for resolving and satisfying any liens or attachments filed by any such health care provider/facility that was not authorized by the Employer/Carrier/Servicing Agent. The Employee/Claimant also stipulates and agrees OJCC#: 24-015353TAH Page 6 of 13 that she is not aware of any liens or attachments, filed by any health care provider/facility not authorized by the Employer/Carrier/Servicing Agent. Moreover, the Employee/Claimant stipulates and agrees that the Employer/Carrier/Servicing Agent shall be indemnified and held harmless, against any action brought by any third party for payment of past medical bills for medical treatment not authorized by the Employer/Carrier/Servicing Agent. The Employee/Claimant stipulates and agrees that she is not aware of any liens or attachments, filed by any health care provider/facility or Medicare, including Medicare Advantage Organizations, its assignees, and/or its subcontractors, or Medicaid not authorized by the Employer/Carrier/Servicing Agent. Moreover, the Employee/Claimant stipulates and agrees that the Employer/Carrier/Servicing Agent shall be indemnified and held harmless against any action brought by any third party for payment of past medical bills for medical treatment not authorized by the Employer/Carrier/Servicing Agent. The Employee/Claimant shall be responsible for any Medicare, including Medicare Advantage Organizations, its assignees, and/ or its subcontractors, or Medicaid liens. F. FULL AND COMPLETE KNOWLEDGE: The Employee/Claimant acknowledges that she has full and complete knowledge of all pertinent and material facts in the instant claim and it is her desire to settle this claim, fully and finally, consistent with and under the provisions of Section 440.20 of the Florida Statutes. The Employee/Claimant has entered into this agreement after full discussion and consideration of the matter and with full knowledge of the reports and opinions of the Employee/Claimant's treating physicians and rehabilitation counselors, as well as the Employee/Claimant's own estimate of her physical condition. The Employee/Claimant further represents that her rights under the Florida Workers' Compensation Law have been explained to her satisfaction and that she made independent inquiry concerning the reasonableness of the settlement and medical and disability status or has waived the opportunity to do so. The Employee/Claimant understands that if this case were not settled, the Employee/Claimant would have a period of time following the date of last payment of compensation or furnishing of medical care in which to make a further claim against the Employer/Carrier/Servicing Agent herein because of injuries suffered in this accident. The OJCC#: 24-015353TAH Page 7 of 13 Employee/Claimant feels it is advantageous and in her best interest to terminate this litigation and accept the settlement agreed to hereunder in full and final adjudication and settlement of this claim to compensation and medical benefits. The Employee/Claimant understands that the Employer/Carrier/Servicing Agent also waives substantial rights in settling this claim. The Employee/Claimant also understands that if she initiates legal proceedings pertaining to this Settlement Agreement and Release, after the Judge of Compensation Claims approves that Motion for Approval of Attorney's Fees and Allocation of Child Support Arrearage for settlement under Section 440.20(11)(c)(d) & (e), the Employee/Claimant shall be liable to the Employer/Carrier/Servicing Agent for all its' expenses, including reasonable attorney's fees incurred during the proceeding. As a further consideration and inducement for this compromise settlement, the undersigned Employee/Claimant agrees to indemnify, protect, and hold harmless all the parties named in this Settlement Agreement and Release and all other persons, firms, and corporations whomsoever, from all judgments, costs, attorney's fees and expenses whatsoever arising on account of any action, claim or demand including but not limited to the following: all claims for subrogation, workers' compensation liens, bills and any and all claims under any Federal, State or local income disability act; any claim under the Americans with Disabilities Act; any other public programs providing medical expenses, disability payments or other similar benefits; any and all claims under Medicaid, Medicare, including Medicare Advantage Organizations, its assignees, and/ or its subcontractors; any and ail claims for reimbursement or subrogation under any group medical policy, individual medical policy or any health maintenance organization; any and all claims for reimbursement or subrogation under any health, sickness, or income disability insurance, automobile accident insurance, and any other similar insurance that provides health benefits or income disability coverage; any and all claims for reimbursement or subrogation under any contract or agreement with any group, organization, partnership or corporation which provides for the payment or reimbursement of medical expenses or wages during the period of disability; and any and all actions, claims, demands whatsoever of any type or nature which may hereafter be brought or asserted against the parties named in this Settlement Agreement and Release, on account of any injury, loss or damage resulting from the accident, occurrence, incident or event aforesaid. The undersigned Employee/Claimant warrants that no promise or inducement not herein expressed has been made; that in executing this Release the undersigned Employee/Claimant is not relying upon any statement or representation OJCC#: 24-015353TAH Page 8 of 13 made by any person, firm or corporation hereby released or any agent, physician or doctor or other person representing them or any of them concerning the nature, extent or duration of the injuries, losses or damages here involved or the legal liability therefore, or concerning any other thing or matter; that the payment of the above-mentioned sum is in compromise and in full satisfaction of the aforesaid actions, claims and demands whatsoever; that the undersigned Employee/Claimant is over the age of twenty-one (21) years and legally competent to execute this Settlement Agreement and Release and that the undersigned Employee/Claimant is fully informed of the contents of this Settlement Agreement and Release and signs it with full knowledge of its meaning. G. AGREEMENT NOT TO RE-APPLY The Employee/Claimant previously separated from her employment and will not seek re-employment or volunteer opportunities with the City of Boynton Beach. The agreement to voluntarily separate and not seek re-employment is not being entered into due to any disabilities the Employee/Claimant may allege and is not the sole consideration for settlement of the claim referenced herein. H. VOLUNTARY SETTLEMENT: The parties agree and acknowledge that they attended a private mediation conference on November 4, 2025, which resulted in a contingent settlement agreement. The terms of the parties' Memorandum of Contingent Settlement are incorporated by reference. The Employee/Claimant understands that she, like the Employer/Carrier/Servicing Agent, does not have to settle and is doing so freely, voluntarily and with no duress or coercion from anyone. The Employee/Claimant also affirms that she is mentally competent and understands all of the terms of this agreement and the consequences therefrom and further has had advice of counsel, with whom the Employee/Claimant is satisfied. The Employee/Claimant further understands that she has the right to take any claims/petition for any Workers' Compensation benefits to a hearing to have said claim/petition heard by a Judge of Compensation Claims and that by settling, gives up that right permanently. The Employee/Claimant represents that she has read this Settlement Agreement and Release and hereby acknowledges that she understands and accepts all of the terms and conditions herein and that she has done so with the advice of counsel. OJCC#: 24-015353TAH Page 9 of 13 I. MEDICARE CONSIDERATIONS: Pursuant to Federal Regulations, and in accordance with internal guidelines issued by the Centers for Medicare and Medicaid Services (''CMS''), Medicare's interests must be considered in a workers' compensation settlement where a claimant is already a Medicare beneficiary and the total settlement amount is greater than $25,000.00; or in such cases wherein there is a reasonable expectation that the claimant will be eligible to receive Medicare benefits within thirty (30) months of the settlement date and the anticipated total settlement amount is expected to be $250,000.00 or greater. In the present matter, there is no reasonable evidence that the Employee/Claimant is currently a Medicare beneficiary or will become a Medicare beneficiary, including a beneficiary of a Medicare Advantage Plan, prior to the effective date of this Settlement Agreement and Release. Specifically, the Employee/Claimant affirms and states that the Employee/Claimant is not current receiving any Medicare benefits. including benefits under a Medicare Advantage Plan, will not become a Medicare beneficiary prior to the effective date of this Settlement Agreement and Release, and the settlement is under $250,000.00. In addition, the Employer/Carrier/Servicing Agent have received no notice from Medicare, including Medicare Advantage Organizations ("MAOs"), their assignees, and/ or their subcontractors, CMS or any other third party that the Employee/Claimant is a Medicare beneficiary, including a beneficiary of Medicare Advantage Plan, or will become a Medicare beneficiary prior to the effective date of this Settlement Agreement and Release. The parties have not considered the receipt of any Medicare, including MAOs, their assignees, and/ or their subcontractors, or Medicaid assistance for the purpose of an alternative means of medical recovery pursuant to negotiations. The settlement reached herein has been based upon the full anticipated value of future workers' compensation indemnity and medical benefits exposure offset by future uncertainty as to the nature and extent of the Employee/Claimant's entitlement to these benefits, and available statutory defenses. In the event of Medicare, including MAOs, their assignees, and/ or their subcontractors, or CMS make a claim for past or future Medicare benefits. Medicare Advantage Plan benefits, Medicaid asserts a lien, or there are any child support liens, arrearages, orders. obligations or claims, on any part of this settlement, the Employee/Claimant agrees to fully and completely indemnify, defend and hold harmless OJCC#. 24-015353TAH Page 10 of 13 the Employer/Carrier/Servicing Agent against any resulting obligation, claim, penalty, fine, or lien. The Employee/Claimant expressly agrees to accept full liability for any prior attorney liens for representation or benefits acquired for the Employee/Claimant in relation to the industrial accident(s) and the Employee/Claimant's counsel agrees to hold settlement proceeds in trust until any prior attorney lien, if any, is resolved. The Employee/Claimant acknowledges that the Employee/Claimant has not relied on any representations, advice or counsel of the Employer/Carrier/Servicing Agent, their attorneys, agents or adjusters regarding the Employee/Claimant's entitlement to Social Security, Medicare, Medicare Advantage Plan, or Medicaid benefits or the impact the terms of this Settlement Agreement and Release may have on such benefits. The Employee/Claimant further acknowledges that any decision regarding entitlement to Social Security, Medicare, Medicare Advantage Plan, or Medicaid benefits, including the amount and duration of payments and offset or reimbursement for prior or future payments is exclusively within the jurisdiction of the Social Security Administration, The United States Government, and the United States Federal courts and is determined by Federal Law. As such, the United States Government is not bound by all the terms of this agreement. The Employee/Claimant has been advised of her right to seek assistance from legal counsel of her choosing or directly from the Social Security Administration or other governmental agencies regarding the impact this agreement may have on the Employee/Claimant's present or future entitlement to Social Security, Medicare, Medicare Advantage Plan, Medicaid, or other governmental benefits. Notwithstanding the foregoing, the Employee/Claimant desires to enter into the terms of this Agreement and release of claims. [Remainder of Page Intentionally Left Blank. Signature Pages Follow.] OJCC#: 24-015353TAH Page 11 of 13 This Settlement Agreement and Release was signed by the Employee/Claimant on this / 9— day of ^Iv✓e n-1 r 20.a6 and by the attorney for the Employee/Claimant on this 18th day of November 2025 , and by the attorney for the Employer/Carrier/Servicing Agent on this 18th day of November 20 25 Christina Sortore, Claimant Vincent Leuzzi, Esquire Attorney for Employee/Claimant Mr. Vincent Leuzzi Bichler & Longo 541 South Orlando Avenue, Suite 310 Maitland, FL 32751 1-407-599-3777 /o/ a&caa4n J. scn4 Alison J. Schefer, Esquire Attorneys for Employer/Carrier/Servicing Agent SCHEFER PETRIC & SIMPSON 1645 Palm Beach Lakes Blvd Suite 350 West Palm Beach, FL 33401 561-537-8040 OJCC#: 24-015353TAH Page 12 of 13 STATE OF FLORIDA COUNTY OF ?al-vi -Rd The foregoing instrument was acknowledged before me by means oft -Ohysical presence or 0 online notarization, this /a- day of /(6/4-4e,/' , 2025 by Christina Sortore, f J who is personally known to me or [ J who has produced FG- OZ-- as identification SWORN TO AND SUBSCRIBED before me, by means of L hysical presence or ❑ online notarization, this 0. day of 46ve,34(, 2025 . Christina Sortore Oion,-) 64,___ _.c -6,--vt--.C=2114 & NOTARY PUBLIC, State of Florida My Commission Expires: 324 9? 4 -of) tc)/..c4cY)-aii-L5 (Print, Type or Stamp Commissioned Name of Notary Public) —/ ��� + °°A KERRIAN WISDOM•CATNOTT o Notary Public,State of Florida „�,, ” Commission#HH 576401 ? 1"-"" My comm.expires July 29,2028 1 OJCC No: 24-015353TAH Page 13 of 13 STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS OFFICE OF THE JUDGE OF COMPENSATION CLAIMS EMPLOYEE/CLAIMANT: ATTORNEY FOR EMPLOYEE/CLAIMANT: Christina Sortore Vincent Leuzzi, Esquire 11622 Hackberry St 541 South Orlando Avenue West Palm Beach, FL 33410 Maitland, FL 32751 EMPLOYER: City of Boynton Beach ATTORNEY FOR EMPLOYER/CARRIER: 100 East Ocean Avenue Alison J. Schefer, Esquire Boynton Beach. FL 33435 Attorney for Employer/Carrier/Servicing Agent 1645 Palm Beach Lakes BLVD STE 350 West Palm Beach, FL 33401 CARRIER/SERVICING AGENT: Commercial Risk Management; Inc. OJCC NO.: 24-015353TAH P.O. Box 18366 Tampa, FL 33679 D/A: 12/13/2019 JUDGE: Thomas Hedler MEDICARE AFFIDAVIT State of Florida f County of ��o.f m gi cJ Before me, the undersigned authority, personally appeared, Christina Sortore, who, and after being sworn by me, states as follows: 1. My name is Christina Sortore, and I am the Employee/Claimant in the above captioned workers' compensation matter. 2, I represent that no services, medicine, medical appliances, or X-rays of any kind were received by me from any Veteran's Hospital, Naval or Military Hospital, or any other medical institution maintained by the United States Government, as a result of the accident and injuries described herein. Page 1 of 4 3. I further represent that no medical bills or services have been paid to me or on my behalf by Medicare, including Medicare Advantage Organizations, its assignees, and/ or its subcontractors, as a result of any injuries arising out of and during the course and scope of my employment with the above Employer. If conditional payments were made by Medicare, including Medicare Advantage Organizations, its assignees, and/or their subcontractors, for authorized medical treatment related to my industrial accident, that the Employer/Carrier would have otherwise rendered as authorized medical treatment to me, I understand that the Employer/Carrier would accept responsibility for reimbursement to Medicare, including Medicare Advantage Organizations, their assignees, and/or their subcontractors, of those authorized visits. If conditional payments were made by Medicare, including Medicare Advantage Organizations ("MAOs"), their assignees, and/ or their subcontractors, for unauthorized medical treatment sought by me related to my industrial accident of 12/13/2019, and Medicare, including MAOs, their assignees. and/ or their subcontractors, request reimbursement for same, I understand I would be fully responsible for reimbursement of those conditional payments to Medicare, including MAOs, their assignees, and! or their subcontractors, out of the proceeds of my net settlement funds. 4. I have considered that many common medical expenses are not paid or reimbursable under certain group health policies or the Federal Medicare Program. I also understand that I may, in the future, be entitled to Medicare benefits. I understand that it is not the intent of this settlement to shift the responsibility for my future medical care to the Federal Government. 5. As of the date of the signing of this Affidavit, I have NOT been issued a Medicare or Medicaid benefits card, therefore, it is my understanding that I am not eligible, nor have I been eligible since the date of my workers' compensation injury for Medicare or Medicaid benefits. 6. Additionally, as of the date of the signing of this Affidavit, I do not belong to a Medicare Advantage Plan (separate from regular Medicare), therefore, it is my understanding that I am not eligible, nor have I been eligible since the date of my workers' compensation injury for benefits under Medicare Advantage Plan. Page 2 of 4 7. I have carefully read this Affidavit. I understand the contents thereof and its importance. This Affidavit shall be interpreted in accordance with and governed in all respects by the Laws of the State of Florida. 8. I have signed this Affidavit freely and voluntarily with my own act, and without any promise of any benefits other than those which are specifically set forth in the attached settlement agreement. I represent that at the time I sign this Affidavit, I am mentally competent, and not under the influence of any medications or substances, either legal or illegal, that my affect my ability to make an informed and competent decision. FURTHER AFFIANT SAYETH NAUGHT. Dated this /9- day of No yen b-e ; 20 25—at / gPOCG�/ County, Florida. Christina Sortore STATE OF FLORIDA ) COUNTY OF palm Q ad) The foregoing instrument was acknowledged before me by means of Er-physical presence or 0 online notarization, this 12 day of MVeyyt4Pi, 205 by Christina Sortore, [ ] who is personally known to me or [ t fwho has produced Fe- Q L as identification SWORN TO AND SUBSCRIBED before me, by means of hysical presence or ❑ online notarization, this 12 day of*8,44'20 . Personally known ; Driver's license FG _- b L ; Other (describe) WITNESS my hand and official seal in the County and State last aforesaid this of /Ubverw`'� , 20 Page 3 of 4 even cc--0/ate,^ L . -».-1w- NOTARY PUBLIC y _i'e [1".".."--"--m*Notary Lary NSDOMATNOT7 Pubc,State at Forida576401 mm.expires July 29,2028 /(�, iQn dc,/ e �rG� � � Printed NOTARY signature My commission expires: 9-j�1�' 7 Page 4 of 4 STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS OFFICE OF THE JUDGE OF COMPENSATION CLAIMS Christina Sortore, OJCC Case No.: 24-015353TAH Claimant, DIA: 12/13/2019 v. Judge: Thomas Hedler City of Boynton Beach\ Commercial Risk Management, Inc. Venue: Palm Beach Employer/Carrier/Servicing Agent Vincent Leuzzi, Esquire, Bichler & Longo, Attorney for Employee/Claimant, 541 South Orlando Avenue Suite 310, Maitland, FL 32751 Alison J. Schefer, Esquire, Schefer Petric & Simpson, Attorney for Employer/Carrier. 1645 Palm Beach Lakes Blvd, Suite 350, West Palm Beach, FL 33401 AFFIDAVIT RELATING TO SETTLEMENT AND WAIVER OF ALL CLAIMS PURSUANT TO SECTION 440.20(11)(C)AND (D), FLORIDA STATUTES I, Christina Sortore, certify that the Settlement and Waiver of all Claims Pursuant to Section 440.20(11)(c) and (d), Florida Statutes, was either read by me or read to me, and that the agreement was explained to me by my attorney, Vincent Leuzzi, Esquire, and that 1 am satisfied with the explanation given. I also certify that I was not acting under duress or coercion when I signed this agreement. Moreover, at the time of signing the Settlement Agreement and Release Pursuant to Section 440.20(11)(c) and (d), Florida Statutes, I was competent to handle my own affairs and was not under the influence of alcohol or drugs to the extent that my judgment was impaired. I agree to settle my claim on the terms outlined in the Settlement and Waiver of all OJCC#: 24-015353TAH Affidavit Relating to Settlement and Waiver of All Claims Page 1 of 3 Claims Pursuant to Section 440.20(11)(c) and (d), Florida Statutes. The decision to enter into the agreement, which I understand is final and cannot be changed, was done voluntarily of my own will. FURTHER AFFIANT SAYETH NAUGHT. Dated this / ' day of Ivo✓emiQV, 20 .J at PJM &QC(c 4 County, Florida. fea_t_In Christina Sortore OJCC#: 24-015353TAH Affidavit Relating to Settlement and Waiver of All Claims Page 2of3 STATE OF FLORIDA COUNTY OF Wa)-i The foregoing instrument was acknowledged before me by means ofQhysical presence or ❑ online notarization, this lob day of AMyM , 2025 by Christina Sortore, [ 1 who is personally known to me or[ ✓who has produced FL as identification SWORN TO AND SUBSCRIBED before me, by means ofE'physical presence or❑ online notarization, this f day of/L6Venk 20 25 Christina Sortore, K ✓z-� — 1L1g -,,---a,<- ( NOTARY PUBLIC, State of Florida My Commission Expires: �� 29 902e- KERRIAN WISDOM-CATNOTT x�A pude Notary Public,Slate of Florida ,,•-•., Commission#HH 676401 / My comm.expires July 29,2028 (Print, Type or Stamp Commissioned Name of Notary Public) OJCC#: 24-015353TAH Affidavit Relating to Settlement and Waiver of All Claims Page 3 of 3 CONFIDENTIAL GENERAL RELEASE This Confidential General Release("Agreement")is entered into by and between Christina Sortore ("EMPLOYEE") and City of Boynton Beach (the"EMPLOYER"). WHEREAS,EMPLOYEE was previously employed by the EMPLOYER as a firefighter; WHEREAS,EMPLOYEE previously resigned her employment with the EMPLOYER; WHEREAS, the parties wish to enter into a confidential agreement releasing claims as outlined herein. NOW, THEREFORE, in consideration of their mutual promises and other good and valuable consideration, EMPLOYEE and the EMPLOYER, intending to be legally bound, agree to the following: 1. Full and General Waiver of All Rights and Claims. EMPLOYEE hereby knowingly and voluntarily releases, waives, and forever discharges any and all claims, rights, demands, actions, or causes of actions, of any kind whatsoever, known or unknown, foreseen or unforeseen, foreseeable or unforeseeable, and any consequences thereof, which EMPLOYEE has or may have against the EMPLOYER (including but not limited to, its current and former members, shareholders, partners, attorneys, employees, agents, affiliates, successors and assigns) from the beginning of the world until the date of execution of this Agreement, including, but not limited to, any claim(s)under: • Title VII of the Civil Rights Act of 1964; • The Civil Rights Act of 1991; • The Florida Civil Rights Act of 1992; • Sections 1981 through 1988 of Title 42 of the United States Code; • The Constitutions of the United States and the State of Florida; • The Age Discrimination in Employment Act; • The Older Workers Benefit Protection Act; • Florida Wage and Hour laws; • Florida and federal whistle-blower laws, including § 112.3187,Florida Statutes; • The Internal Revenue Code; • The Rehabilitation Act; • The Consolidated Omnibus Budget Reconciliation Act; • The Immigration Reform and Control Act of 1986; • The Americans with Disabilities Act of 1990; • The Fair Labor Standards Act; • The Equal Pay Act of 1963; • The Family and Medical Leave Act of 1993; or • The Families First Coronavirus Response Act; or • Any other federal, state, or local civil or human rights law or any other federal, state, or local law, regulation, or ordinance. Page 1 of 6 EMPLOYEE also acknowledges and agrees that this release and waiver bars any claim or demand for unpaid wages, damages, costs, fees, or other expenses, including attorneys' fees, incurred in connection with EMPLOYEF,'s employment with the EMPLOYER, EMPLOYEE's resignation from that employment, or with any of the above-referenced claims. EMPLOYEE has reported all hours worked for the EMPLOYER and stipulates that she has been paid for all hours or other increments of time during her employment with the EMPLOYER. EMPLOYEE understands and agrees that with respect to the claims EMPLOYEE is waiving in this Agreement, EMPLOYEE is waiving not only the right to recover money or other relief in any action EMPLOYEE might institute, but also that EMPLOYEE is waiving any right to recover money or any other relief whatsoever in any action that might be brought on EMPLOYEE's behalf by any other person or entity, including but not limited to, the United States Equal Employment Opportunity Commission or any other federal, state or local government agency or department. EMPLOYEE understands that the foregoing list of causes of action, which have been waived, is meant to be illustrative rather than exhaustive, and understands and acknowledges that EMPLOYEE is waiving and releasing the EMPLOYER from any and all causes of action of any nature whatsoever. It is EMPLOYEE's intention to fully, finally and forever resolve and release any and all disputes EMPLOYEE may have or believe to have against the EMPLOYER with respect to any alleged acts occurring before the Effective Date of this Agreement, whether those disputes presently are known or unknown, suspected or unsuspected. 2. Waiver of Employment and Agreement Not to Reapply for Employment EMPLOYEE stipulates and agrees this agreement memorializes her separation from employment with the City of Boynton Beach, which was for reasons unrelated to her pursuing workers compensation benefits. Claimant hereby waives any right to reinstatement or reemployment and agrees not to apply for, solicit, seek,or otherwise attempt to obtain employment with or volunteer with the Employer or any of its related corporations and further agrees that said corporation is not or will not be at any time under any obligation to employ her or allow her to volunteer. EMPLOYEE further stipulates and agrees that she was properly paid for all hours that she worked prior to her separation from the EMPLOYER. 3. Covenant Not to Sue. EMPLOYEE represents and agrees that EMPLOYEE will not hereinafter pursue, initiate, or cause to be instituted any dispute released herein against the EMPLOYER, and represents that EMPLOYEE has not heretofore assigned or transferred, or purported to have assigned or transferred, to any entity or person, any dispute released by her herein. 4. Consideration. In consideration for EMPLOYEE's signing this Agreement, the EMPLOYER agrees to provide EMPLOYEE with = the amount of$100.00, which is being paid upon the execution of this Agreement. The parties agree and acknowledge that the settlement amount constitutes good,valuable, and sufficient consideration for EMPLOYEE's full waiver and release of all claims, and EMPLOYEE's fulfilling all other promises as set forth herein. EMPLOYEE acknowledges that without this Agreement EMPLOYEE would not otherwise be entitled to the consideration EMPLOYEE is receiving pursuant to this Agreement. Page 2 of 6 Consideration for this separate Confidential General Release shall be allocated from the EMPLOYEE's net settlement proceeds from the accompanying workers' compensation Settlement Agreement and Release. 5. Confidentiality. EMPLOYEE recognizes that, as a result of EMPLOYEE's employment with the EMPLOYER, EMPLOYEE has had access to Confidential Information as defined below, which is a valuable asset of the EMPLOYER and which, if disclosed or used without authorization,could cause irreparable harm to the EMPLOYER. Therefore,EMPLOYEE agrees that,except as required by a lawful order of a court of competent jurisdiction or to the extent that EMPLOYEE has written authorization from the EMPLOYER, EMPLOYEE will not, at any time or in any manner whatsoever, either directly or indirectly, reveal, divulge, disclose, or communicate to any person, EMPLOYER, or corporation or use for EMPLOYEE's benefit or for the benefit of others any Confidential Information. For purposes of this Agreement,"Confidential Information"shall include,any confidential proprietary information concerning any matters affecting or relating to the business of the EMPLOYER, regardless of whether it constitutes a trade secret, including but not limited to: (a) any information concerning the identity or needs of the EMPLOYER's clients or prospective clients; (b) any information concerning the business of the EMPLOYER, its method of business, manner of operation, its finances, plans, processes, products, techniques, marketing strategies, computer programs or other data; (c)any information regarding the identity of the EMPLOYER's vendors or their accounts; (d) any other information or documents which EMPLOYEE has been told or reasonably ought to know that the EMPLOYER regards as confidential; or(e) information constituting a trade secret under Florida law. EMPLOYEE agrees she will not at any time, in any fashion,form or matter, either directly or indirectly, divulge, disclose or communicate to any person, firm or corporation in any manner whatsoever any information of any kind, nature or description concerning any matter affecting or relating to EMPLOYER or business of EMPLOYER, including without limiting the generality of the foregoing, the names and addresses of any EMPLOYER customers, patients, prices of goods and services or any other information of, about or concerning the business of EMPLOYER, its manner of operation, its plans, processes or other data of any kind, nature or description without to whether any or all of the foregoing matters would be deemed confidential, or important, the parties hereto stipulating that as between them,the matters are important,material and confidential and gravely affect the effective and successful conduct of the business of EMPLOYER and its goodwill. EMPLOYEE also agrees to keep confidential and not disclose,either directly or indirectly, the terms of this Agreement other than to EMPLOYEE's legal counsel, tax advisor and/or members of EMPLOYEE's immediate family. In the event that EMPLOYEE discloses any information about this Agreement to EMPLOYEE's legal counsel,tax advisor and/or members of EMPLOYEE's immediate family, EMPLOYEE agrees to inform such persons of the confidential nature of the Agreement and, to the extent of EMPLOYEE's control or force or application of law, bind said persons to this provision. Page 3 of 6 6. Non-Disparagement. EMPLOYEE agrees not to engage in any conduct or make any statements(written or oral)that defame or otherwise disparage the EMPLOYER,its principals, or its employees. EMPLOYEE will refrain from making any negative, disparaging, libelous, defamatory or otherwise adverse statements or communications to any third party concerning any EMPLOYER including all officers, directors, shareholders, owners and employees of EMPLOYER. 7. No Pending Lawsuits, Claims or Charges and Covenant Not to Sue. EMPLOYEE represents that she does not have any charges or claims pending against EMPLOYER with any federal,state,or local agency,administrative body,or department,and does not have pending before any court any dispute of any kind against EMPLOYER. EMPLOYEE further represents and agrees that she will not hereinafter pursue, initiate, or cause to be instituted any claim, charge or dispute with any federal, state, or local agency, administrative body, or department against EMPLOYER, and represents that she has not heretofore assigned or transferred, or purported to have assigned or transferred, to any entity or person, any such charge or claim. If it is determined that EMPLOYEE has any lawsuit,charge or claim of any kind pending against EMPLOYER,she agrees to dismiss all such charges,claims and/or lawsuits with prejudice, immediately upon the effective date of this Agreement. EMPLOYEE expressly acknowledges that the confidentiality provisions of this agreement as set forth above and the covenant not to assert any charges or claims of any type with any state, federal or local regulatory authority are material terms to this agreement; and that she will faithfully abide by her agreement to keep all aspects of the business of EMPLOYER strictly confidential. 8. Effective Date. This Agreement will become effective upon the execution of this Agreement by both the EMPLOYEE and the EMPLOYER. 9. Return of Property. EMPLOYEE agrees and understands that EMPLOYEE must return any and all EMPLOYER property in EMPLOYEE's possession before the EMPLOYER will provide EMPLOYEE with the settlement amount, and the parties acknowledge and agree that the EMPLOYER will not be required to tender the settlement amount to EMPLOYEE until EMPLOYEE does so. EMPLOYEE further agrees not to remove or copy any files, paperwork, data, electronic data or other information of any kind that belongs to the EMPLOYER and/or that EMPLOYEE created, used or received while employment by the EMPLOYER. 10. No Admission. Neither this Agreement nor any provision contained herein shall constitute or otherwise be construed as an admission by the EMPLOYER of any liability, wrongdoing, violation of law or unlawful conduct by the EMPLOYER against EMPLOYEE. 11. Governing Law and Severability. This Agreement shall be governed and construed in accordance with the laws of the State of Florida, with venue of any dispute in the Palm Beach County Circuit Court. If any provision of this Agreement is declared illegal or unenforceable by any court of competent jurisdiction and if it cannot be modified to be enforceable, such provision shall immediately become null and void, leaving the remainder of this Agreement in full force and effect. The language of this Agreement shall be construed as a whole, according to its fair meaning, and not strictly construed for or against either party. If the waiver language of this Agreement is declared unenforceable because of actions taken by EMPLOYEE or on Page 4 of 6 EMPLOYEE's behalf, EMPLOYEE shall return all monies paid to EMPLOYEE under this Agreement and this Agreement shall immediately become null and void, and the EMPLOYER will owe nothing further pursuant to that Agreement. 12. Breach of any portion of this Agreement. In the event EMPLOYEE breaches or violates any of the terms of this Agreement, she agrees to immediately return the $100.00 consideration upon written demand. In the event of failure to return this consideration, EMPLOYER may file suit against the EMPLOYEE to recover said funds in which case employee waives all defenses and waives jury trial. 13. Entire Agreement. This Agreement sets forth the entire agreement between the parties and shall supersede any and all prior agreements, understandings, whether written or oral, between the parties, except the accompanying workers' compensation settlement agreement. EMPLOYEE acknowledges that EMPLOYEE has not relied on any representations,promises, or agreements of any kind made to EMPLOYEE in connection with EMPLOYEE's decision to sign this Agreement except for those set forth in this Agreement. 14. Amendment. This Agreement may not be amended except by written agreement signed by all parties. 15. Headings. Section headings are used herein for convenience of reference only and shall not affect the meaning of any provisions of this Agreement. 16. Acknowledgment. EMPLOYEE acknowledges that EMPLOYEE has carefully read and understands this Agreement consisting of Six (6) pages and agrees that the EMPLOYER has not made any representations other than those contained herein. EMPLOYEE also acknowledges that EMPLOYEE enters into this Agreement voluntarily, without any pressure or coercion and with full knowledge of its significance, and this Agreement constitutes a full and absolute settlement and bar as to any and all claims EMPLOYEE had, has, or may have against the EMPLOYER. THE PARTIES HAVE READ, UNDERSTOOD, AND FULLY CONSIDERED THIS AGREEMENT AND ARE MUTUALLY DESIROUS OF ENTERING INTO THIS AGREEMENT. THE TERMS OF THIS AGREEMENT ARE THE PRODUCT OF COMPROMISE BETWEEN THE EMPLOYER AND EMPLOYEE. HAVING ELECTED TO EXECUTE THIS AGREEMENT,TO FULFILL THE PROMISES SET FORTH HEREIN, AND TO RECEIVE THE BENEFITS SET FORTH ABOVE, EMPLOYEE FREELY AND KNOWINGLY, AND AFTER DUE CONSIDERATION, ENTERS INTO THIS AGREEMENT INTENDING TO RELEASE, WAIVE, AND SETTLE ALL CLAIMS EMPLOYEE HAS OR MIGHT NOW HAVE AGAINST THE EMPLOYER FROM THE BEGINNING OF TIME UNTIL THE EFFECTIVE DATE OF THIS AGREEMENT. IN WITNESS WHEREOF, the EMPLOYEE hereto knowingly and voluntarily executed this Agreement as of the date set forth below. Page 5 of 6 Le Christina Sortore EMPLOYEE STATE OF FLORIDA ) COUNTY OF jelai The foregoing instrument was acknowledged before me by means of E]-physical presence or❑online notarization,this P- day of4 'r.-, by Christina Sortore, [ 1 who is personally known to me or[ 1/1 who has produced FL- AL- as identification and who has acknowledged to me that she has had the foregoing General Release read to her and that she has executed the foregoing General Release freely and voluntarily for the uses and purposes therein expressed. SWORN TO AND SUBSCRIBED before me, by means of12'physical presence or ❑ online notarization,this 12- day of16V4'40025 . My Commission Expires: J1.,414tt 91, 2b2g' WITNESS my hand and official seal in the County and State last aforesaid /� this /2-- day of C/ ,20 25. le/rian ------- NOTARY PUBLIC Signature KERRinfd WISDO CATNOTT It Notary Public,State of Florida Commae 578401 0^1. Ay comm.mires July 29,2028 /eecrLGe-r / M.� s NOTARY PUBLIC Printed Page 6 of 6 OFFICE OF THE JUDGES OF COMPENSATION CLAIMS CASE NO. : 24-015353TAH DATE OF ACCIDENT: 12/13/19 EMPLOYEE: CHRISTINA SORTORE REPRESENTED BY: VINCENT LEUZZI EMPLOYER: CITY OF BOYNTON BEACH REPRESENTED BY: ALISON SCHEFER CARRIER/SA: COMMERCIAL RISK MGMT. REPRESENTED BY: ALISON SCHEFER MEDIATION REPORT 1. A private Mediation Conference was conducted by Rand Hoch on November 4, 2025. 2. At the Mediation Conference, the parties agreed to a Lump Sum Settlement, CONTINGENT UPON RATIFICATION BY THE BOYNTON BEACH CITY COMMISSION NO LATER THAN JANUARY 6, 2026. x 3. The Employee affirms that she is not presently under the influence of any medication, drugs or alcohol which would impair the Employee 's ability to knowingly enter into this agreement. 4. The parties have not completed a pretrial stipulation. 5. The DOAH web site reflects that a Petition for Benefits was filed on 6/21/24. 6. If the contingency is met, all claims in dispute shall be resolved and none shall remain unresolved. MEMORANDUM OF CONTINGENT SETTLEMENT Pursuant to the Mediation Report, the parties have reached agreement as set forth below: x This is a CONTINGENT Washout Settlement or a Settlement Agreement. The Employee has elected workers ' compensation as the sole and exclusive remedy. The settlement includes and covers all dates of accidents -- reported or unreported -- with this Employer/Carrier/Servicing. Agent. This is neither a Washout Settlement nor a Settlement Agreement. 1 . THE AGREEMENT SET FORTH HEREIN IS CONTINGENT UPON RATIFICATION BY THE BOYNTON BEACH CITY COMMISSION NO LATER THAN JANUARY 6, 2026. The Page 1 attorney for the Employer/Carrier, the Risk Manager and the adjuster all agree to recommend the settlement and they shall notify the Employee' s attorney of the City Commission' s decision no later than January 10, 2026. x 2. If the contingency is met, The Employer/Carrier/Servicing Agent the sum of $100,000. 00 in full settlement of all claims, medical closed. Out of the settlement, the Employee shall pay attorney' s fees of $25,000. 00 and no costs . 3. In accordance with the Rules of Procedure for Workers ' Compensation Adjudication, the Employee or the Employee' s attorney shall file a copy of this report with the presiding judge. I x 4 . While both parties were satisfied with the services rendered by the mediator, his fees are to be paid by the Employer/Carrier/ Servicing Agent. x 5. Special terms, if the contingency is met: (A) All indemnity at Employer/Carrier/Servicing Agent' s expense shall end on the date the attorney for the Employer/ Carrier/Servicing agent notifies the Employee' s attorney that the City Commission has ratified the settlement. Any and all medical benefits of any kind in any class at Employer/Carrier/ Servicing Agent' s expense shall also end on the afore- referenced date. (B) The Employer/Carrier/Servicing Agent remains responsible for payment of all medical bills for the Page 2 Employee' s care through the date the attorney for the Employer/ Carrier/Servicing agent notifies the Employee' s attorney that the City Commission has ratified the settlement; however, this covers only that care from authorized providers for conditions related to the industrial accident. Payment in accordance with the fee schedule shall be timely made after the bills have been submitted to the Employer/Carrier/ Servicing Agent on the proper forms. ( C ) The Employee has retired and agrees to (1) tender an Agreement Not to Seek Re-employment and/or Volunteer effective the date the attorney for the Employer/Carrier/ Servicing agent notifies the Employee' s attorney that the City Commission has ratified the settlement and (2) execute a mutually agreeable General Release of all claims, including Coverage B, against the Employer/Carrier/Servicing Agent and all related entities. Nothing herein shall effect the employee' s rights to vested benefits, including the right to apply for re-employment compensation However, the Employer has the right to defend/contest entitlement to any re- employment insurance claim. Consideration for the general release is included in the settlement amount. (D) After payment of all attorney' s fees and costs, the Employee shall net $75,000 . 00. 6. The parties agree to the terms as stated herein and consent to their disclosure to -- and the submission of this Report(via DOAH) to -- the Judge of Compensation Claims following ratification by the City Commission. Page 3 7 . The parties have considered Medicare ' s interests, if any, and the Employee agrees to execute all documents, if any, which are necessary to protect all parties and their counsel regarding Medicare issues . 8 . If the contingency is met, the attorney for the Employer/Carrier/Servicing Agent shall prepare all documents necessary to effectuate this agreement (including a workers ' compensation release, if applicable) , and the parties and their counsel agree to promptly submit same to the appropriate authority, and to perform all their agreed upon acts. If this is a Settlement Agreement, the documents shall indicate that the Employer/Carrier/ Servicing Agent shall have fourteen (14) days from the date the Office of the Judges of Compensation Claims issues the Order Approving Attorney' s Fees to pay the settlement proceeds. 9. The preceding Memorandum of CONTINGENT Settlement contains only the key points in the settlement and it is not comprehensive. It may be superceded by a more formal agreement. Notwithstanding, if the contingency is met, the parties intend x this mediation settlement agreement to be binding and specific- ally enforceable. If the Mediator was asked to prepare the initial draft of this Agreement, the parties acknowledge that they, and their lawyers (if any) , reviewed it carefully and had all of the changes and additions made which they wanted, and hold the mediator harmless from all liability arising from his drafting. This agreement shall survive the execution or non-execution of any subsequent documents. Page 4 10. Although the undersigned mediator is also a licensed attorney, the services provided in this matter are solely third party neutral services and the undersigned mediator has not acted as an advocate for any party to this mediation. To the extent the undersigned mediator has assisted in the preparation of this settlement agreement, each party to the agreement has had (or has been advised to have) this agreement independently reviewed by counsel of that party' s choosing before executing the agreement. 11 . The undersigned mediator is not a legal advisor, tax advisor or mental health counselor. Each party will look solely to its attorney, accountant and/or mental health counselor for legal, tax and mental health advice . The mediator will accept no liability for the giving or the failure to give any legal, tax or mental health advice. 12 . The mediation conference and any related post-conference sessions held thereafter are subject to Florida' s Mediation and Confidentiality Act. Communications made during this process are confidential, regardless of whether the mediation conference is court ordered. Violations by any mediation participant are subject to punishment under Section 44.406, Florida Statutes. Moreover, the undersigned mediator is entitled to immunity under Florida Statutes Section 44 . 107 whether or not this mediation is court ordered. 13 . The parties and their counsel agree that, from this date forward until the end of time, in no event shall Rand Hoch be subpoenaed, be called to testify, be called to give a statement or deposition, or be deposed, in any court or other forum in the universe, to resolve any matter or to disclose any communication or Page 5 conduct made during this mediation conference. That having been said, in the event a party attempts to compel the mediator ' s testimony in a court proceeding, that party shall be responsible for and shall pay the mediator ' s fees and costs in defending such an attempt, and shall pay for all time incurred by the mediator in preparing for and participating in any court proceeding at the standard hourly rate. All records , reports, documents and/or communications received by the undersigned mediator will be confidential and under no circumstances shall the undersigned mediator be compelled to divulge records or testify about the mediation conference . By their signatures below, the parties and their counsel represent that they have authority to enter into this Memorandum of Settlement. The undersigned mediator attests the Employee has authorized their attorney to sign this document on their behalf and the undersigned mediator certifies that the Employee stipulated to be bound by their attorney of record' s signature on this document, pursuant to Rule 60Q-6 . 110 (5) , Fla. Admin. Code. Therefore, the foregoing Memorandum of Settlement is stipulated and agreed to by the undersigned parties (or their legal counsel) before Rand Hoch on November 4 , 2025 . /s/ Alison Schefer EMPLOYEE CARRIER/SERVICING AGENT REPRESENTATIVE /s/ Alison Schefer ATTORNEY FOR THE EMPLOYEE EMPLOYER REPRESENTA VE ATTORNEY OR E E/C A This is to certify that a copy of this Media ' n Report ha b n furnished to the parties and/or their attorneys . z� HOCH, CERTIFIED CIRCUIT CIVIL MEDIATOR '.age 6