HomeMy WebLinkAboutAUSTIN BRITOINSURANCE NOT REQUIRED Return ORIGINAL
executed copy to COTC, A-2020-198
WORK MAY PROCEED M-30
f1CiERK OF COUNCII.
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J f Qualified Assignment and Release Agreement
In Accordance With Internal Revenue Code Section 130
"Ciaenant(s)":
"Assignor":
rder Approving Unopposed Petition for Compromise of the arms o
"Settlement AgreomenV: BMlnor ,.8yand hT rough His Guardian Ad Litem, Yaneli Alonso Dated 09/24/2020
[Date and title of settlement agreement, order or other document embodying
the Assignor's obligation to make the agreed periodic payments]
"Assignee": Mall w+ ns,; gmm�nt mm�an� Inr
"Annuity Issuer": mranna Comm
"Effective Data":
This Qualified Assignment and Release Agreement is made and entered Into as of the Effective Dale
by and among the undersigned parties with reference to the following facts:
A. Clalmant(s) and Assignor are parties to or are otherwise sub act to or entitled to receive payments
under the above -referenced Settlement Agreement, under which Assignor has liability to make certain
periodic payments to or for the benefit of Clalmant(s) as specified or referred to In paragraph 12 of
this Agreement (the "Periodic Payments"); and
B. Assignor and Assignee wish to effect a "qualified assignment" within the meaning and subject to the
conditions of Section 130(c) of the Internal Revenue Code of 1986, as amended (the "Code").
Now, therefore, in consideration of the foregoing and for other good and valuable consideration, the
parties agree as follows:
1. Assignment and Assumption; Release of Assignor. Assignor hereby assigns to Assignee, and
Assignee hereby accepts and assumes, all of Assignor's Iiabillt to make the Periodic Payments
described In paragraph 12. Each Claimant hereby accepts and consents to such assignment by
Assignor and assumption by Assignee. Effective on the Effective Date, each Claimant hereby
releases and discharges Assignor from all liability to make the Periodic Payments.
2. Nature of Periodic Payments. The Periodic Payments constitute
1. damages (other than punitive damages), whether by suit or agreement, or
Ii. compensation under a workers' compensation act,
on account of personal Injury or sickness in a case involving physical injury or physical sickness,
within the meaning of Sections 130(c) and 104(a) of the Code.
3. Extent of Assignee's Liability. Assignee's liability to make the Periodic Payments shall be no
greater than the liability of Assignor immediately prior to the Effective Date. Assignee assumes no
liability other than the liability to make the Periodic Payments. Assignee's liability to make the Periodic
Payments described in Addendum No. 1 shall be unaffected by any bankruptcy or Insolvency of
Assignor.
4. Qualified Funding Asset. Assignee will fund the Periodic Pa ments by purchasing from Annuity
Issuer a "qualified funding asset," as defined In Section 130(d�af the Code, In the form of an annuity
contract (the "Annuity") issued by Annuity Issuer and providing foe payments corresponding to the
Pen dk Payments. Assignee shall be desi nated as the owner of the Annuity. All rights of Legal
ownership and control of the Annuity shallsubJect to paragraph 9 of this Agreement) be and remain
vested exclusively in Assignee; provided, however, that the Annuity shell be used by Assignee to fund
the Periodic Payments and shall at all times be designated by Assignee on Its records as being taken
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Into account, under Section 130 of the Code, with respect to this Agreement. Notwithstanding
anything to the contrary contained In this Agreement, neither any Claimant nor any Successor Payee
shall have any rights with respect to the Annuity or the payments thereunder that would cause any
amount attributable to the Annuity to be currently Includible in the recipient's income or would
otherwise affect the determination of when any recipient Is treated as having received any payment
for income tax purposes, or would otherwise prevent this Agreement from satisfying all of the
conditions for a "qualified assignment" within the meaning of Section 130(c) of the Code.
S. Delivery of Payments. Assignee may have Annuity Issuer sand payments directly to a Claimant, or,
If applicable, to a Successor Payee (as d6fllied In DoEflaraph 8 of this Aereoment), or deliver
pa ments by electronic funds transfer to a depository Institution In the United States for credit (directly
or Indirectly) to an insured account In the name of such Claimant or Successor Payee. Such direction
of pa men under the Annuity shall not be deemed to afford the Claimant or any Successor Payee
any rights of ownership or control of the Annuity. Each Claimant and any Successor Payee shall at all
t(mes keep Annuity issuer apphsed of sucb Clalmanfa or Successor Payoo's cui runt street address
and telephone number and, If such Claimant or Successor Payee receives payments by electronic
funds transfer, the name, addresa, bank identifier number ((BIN) and telepphone number of the
applicable depository Institution and the account number of the account to which the payments are to
8. Discharge of Llability, The Assignee's liability to make each Periodic Payment to the Claimant or
Successor Payee designated to receive such payment shall be discharged automatically at such time
as a corresponding payment is made to such Claimant or Successor Payee by the Annuity Issuer.
7. Acceleration, Transfer of Payment Rights. None of the Periodic Payments and no rights to or
Interest in any of the Periodic Payments (all of the foregoing being hereinafter collectively referred to
as "Payment Rights") can be
I. Accelerated, deferred, increased or decreased by any recipient of any of the Periodic Payments;
or
If.. Sold, assigned, pledged, hypothecated or otherwise transferred or encumbered, either directly or
ndiroctly, unless such sale, assignment, pledge, hypothecation or othartransfer or encumbrance
an such transartlon being hereiinafter referred to as a "TransfaW') has been approved in
advance Ina "Qualified order" as defined In Section 5891(b)(2) of the Code (a "Qualifed Order")
and otherwise complies with applicable state (aw, Including without limitation any applicable state
structured settlement protection statute:
No Claimant or Successor Payee shall have the power to effect any Transfer of Payment Rights
except as provided In sub -paragraph (tl) above, and any other purported Transfer of Payment Rights
shall be wholly void. If Payment Rights under this Agreement become the subject of a Transfer
approved in accordance with sub-pparagraph (II) above the rights of any direct or Indirect transferee of
such Transfer shall be subject to tha terms of this Agreement and any defense or claim in
recoupment arising hereunder.
8, Beneficiaries. Any Periodic Payments to be made after the death of any Claimant or Successor
Payee shall be made to such party as shall have been designated in, or in accordance with, the
Settlement Agreement or, if the Settlement Agreement does not provide for such designation, then to
tha party de ad in conformity with this paragraph B. Any party so designated is referred to in this
Agreement as a "Beneficiary." If no Benefinfary Is livingg at the time of the death of a Claimant or
Successor Payee, payment shall be made to the decedenfe estate, As used In this agreement the
term "Successor Payee" refers to a Beneficiary or an estate that has become entitled to receive
Periodic Payments following the death of a Claimant or a Successor Ps ea. Except as otherwise
provided in the 5ettlem t Agreement, no designation or change of designation of a Beneficiary shall
e effective unless such change (p is requested In a written request submitted to Assignee (or its
authorized agent) in accordance with Assignee's customary procedures for processing such requests;
and (li) Is confirmed by Assignee (or Its authorized agent). Except for a designation that is expressly
Identified In the Sottiemant Agreement as Irrevocable, any designation of a Beneficiary shall be
deamed to be revocable; an no party that is designated as a Beneficiary (other than a party
irrevocably designated as a Beneficiary In the Set ament Agreement) shall, solely by virtue of its
designation as a Beneficiary, be deemed to have any cognizable Interest in any Periodic Payments.
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9, Failure to Satisfy Section 130(c). If at any tIms prior to completion of the Periodic Payments, the
Settlement Agreement is declare dd terrrdnat(ad In a final, non -appealable order of a court of competent
Jurisdiction (or in the case of a workers' compensation settlement, a final order of the applicable
workers' compensation authority) or if it Is determined In any such final order that the re uirements of
Section 13%) of the Code have not been satisfied In connection with this Agreement: (I1 the
assignment bby Assignor to Aasignse of the liability to make the Periodic Pa menu Asslgnea's
aocepfancs of such assignment and the release by Claimant(s) of Assignor s liabil�ty shall be of no
force or effect; (il) Aealgnee shall be conclusively deemed to be eating as the agent of Assignor, (lit)
the Annuity shall be owned by Assignor, which shall retain the liability to make the Periodic
Payments; (Iv) Assignee shall have no liability to make any Perlodlo Payments; and (v) the parties
hereto no
(o cooparste in taking such actions as may be necessary or appropriate to Implement
tha foregoing.
10. Governing Law; Disclosure of Certain Tax Information; Binding Effect.
(1) This Agreement shall be governed by and Interpreted in accordance with the internal laws of the
State of Delaware; provided, however, that any Transfer of Payment Rights under this Agreement
may be subject to the laws of other states in addition to the state designated above.
This Agreement shall be binding upon the parties hereto and their respec0ve successors, heirs,
executors, administrators and permitted assigns, including without limitation any party asserting
an Interest In Payment Rights.
11, Advice, Comprehension of Agreement. In entering into this Agreement, each Claimant represents
and warrants that (1) such Claimant has relied solely upon the legal and tax advice of ouch Claimant's
own atforneysand other advisors, who are the attorneys and advisors of such Claimanfa choice,
concerning the legal and Income tax consequences of this Agreement; and (II) the terms of this
Agreement have been completely read by and explained to such Claimant and are fully understood
and voluntarily accepted by such Claimant,
12. Description of Periodic Payments. The Periodic Payments are as set forth Immediately below or (if
not set forth below) as set forth in attached Addendum No, 1, which Is hereby incorporated In and
made a part of this Agreement.
Description of Periodic Payments:
$12 250 QO Lump um Payment nt on 05/04/2035
$12,250.00 Lump Sum Payment on 05/04/2038
_ $12,250.00 Lump Sum Payment on 05/04/2041
$12,250.00 Lump Sum Payment on 05/04/2044
$12,250,00 Lump Sum Payment on 05/04/2047
$12,250.00 Lump Sum Payment on 05/04/2050
Periodic payments payable to: Yaneli Alonso (as paraent and guardian):
$5,000.00 Lump Sum Payment on 12/15/2020
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A-2020-198
This Qualified Assignment and Release Agreement Is signed In one or more counterparts as of the
Effective Date by the following:
Assignor: City of Santa Ana Assignee: Meti-ife Assignment Company, Inc.
6y. By,
—Authorized Representative
O: CMO ( )
Title: Title:
Clalmant(s): Austin Brito, a minor by and
through his Guardian nil l item
Yaneli Alonso
CLEl4K®PTHE COUNCIL
Daisy Gomez, MMC
Clerk of the Council
Kristine Ridge
City Manager
Approved as to Form and
Law Offices of Dale K.
Page 4 Version v I 2.00/rl 2.00 - QAR
Addendum No. 1
Description of Periodic Payments
Claimant (1):
Austin Brito
Claimant Address:
Claimant Social Security
Number: Date of Birth: 05/04/2017
Payee Name:
Austin Brito
Payee Address:
Benofit(s):
1, Guaranteed Lump Sum - $12,250.00 paid as a hurip sum on 05/04/2035
guaranteed.
2, Guaranteed Lump Sum - $12,250.00 paid ass lump sum on 05/04/2038
guaranteed.
3, Guaranteed Lump Sum - $12,250.00 paid as a hunp sum on 05/04/2041
guararrtood.
4. Guaranteed Lump Sum. - $12,250.00 paid as a lump sum on 05/04/2044
guaranteed.
S. Guaranteed Lump Sum - $12,250.00 paid as a lump sum on 05/04/2047
guaranteed.
6. Guaranteed Lump Sum - $12,250.00 paid as a hunp sum on 05/04/2050
guaranteed.
Payee Name: Yaneii Alonso, as parent and guardian
Initials
Assignor:
Assignee:
Claimant(s):
tor Atney
Attorvey
7. Guaranteed Lump Sum - $5,000.00 paid as lump sum on 12/15/2020
guaranteed.
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