HomeMy WebLinkAboutSettlement Participation Form - AllerganEXHIBIT K
Subdivision and Special District Settlement Participation Form
Will your subdivision or special district be signing the settlement participation forms for the Allergan and
Teva Settlements at this time?
[ ] Yes_ta [ ] No_ta
Governmental Entity: Mason County State: WA
Authorized Signatory: /officialname_teva_allergan/
Address 1: /address1_teva_allergan/
Address 2: /address2_teva_allergan/
City, State, Zip: /cit_ta/ /state_ta/ /zi_ta/
Phone: /phone_teva_allergan/
Email: /email_teva_allergan/
The governmental entity identified above (“Governmental Entity”), in order to obtain and in
consideration for the benefits provided to the Governmental Entity pursuant to the Agreement dated
November 22, 2022 (“Allergan Settlement”), and acting through the undersigned authorized official,
hereby elects to participate in the Allergan Settlement, release all Released Claims against all Released
Entities, and agrees as follows.
1.The Governmental Entity is aware of and has reviewed the Allergan Settlement, understands
that all terms in this Election and Release have the meanings defined therein, and agrees that
by this Election, the Governmental Entity elects to participate in the Allergan Settlement as
provided therein.
2.Following the execution of this Settlement Participation Form, the Governmental Entity shall
comply with Section III.B of the Allergan Settlement regarding Cessation of Litigation
Activities.
3.The Governmental Entity shall, within fourteen (14) days of the Reference Date and prior to
the filing of the Consent Judgment, file a request to dismiss with prejudice any Released
Claims that it has filed. With respect to any Released Claims pending in In re National
Prescription Opiate Litigation, MDL No. 2804, the Governmental Entity authorizes the MDL
Plaintiffs’ Executive Committee to execute and file on behalf of the Governmental Entity a
Stipulation of Dismissal With Prejudice substantially in the form found at
https://nationalopioidsettlement.com.
4.The Governmental Entity agrees to the terms of the Allergan Settlement pertaining to
Subdivisions and Special Districts as defined therein.
5.By agreeing to the terms of the Allergan Settlement and becoming a Releasor, the
Governmental Entity is entitled to the benefits provided therein, including, if applicable,
monetary payments beginning after the Effective Date.
6.The Governmental Entity agrees to use any monies it receives through the Allergan Settlement
solely for the purposes provided therein.
1
DocuSign Envelope ID: DA8D9ADD-8754-439D-BCCD-33A6405CAF11
X
98584
kshutty@masoncountywa.gov
Washington
Kevin Shutty
360-427-9670
Shelton
411 N. 5th Street
7.The Governmental Entity submits to the jurisdiction of the court in the Governmental Entity’s
state where the Consent Judgment is filed for purposes limited to that court’s role as provided
in, and for resolving disputes to the extent provided in, the Allergan Settlement.
8.The Governmental Entity has the right to enforce the Allergan Settlement as provided therein.
9.The Governmental Entity, as a Participating Subdivision or Participating Special District,
hereby becomes a Releasor for all purposes in the Allergan Settlement, including, but not
limited to, all provisions of Section V (Release), and along with all departments, agencies,
divisions, boards, commissions, Subdivisions, districts, instrumentalities of any kind and
attorneys, and any person in their official capacity whether elected or appointed to serve any of
the foregoing and any agency, person, or other entity claiming by or through any of the
foregoing, and any other entity identified in the definition of Releasor, provides for a release to
the fullest extent of its authority. As a Releasor, the Governmental Entity hereby absolutely,
unconditionally, and irrevocably covenants not to bring, file, or claim, or to cause, assist in
bringing, or permit to be brought, filed, or claimed, or to otherwise seek to establish liability
for any Released Claims against any Released Entity in any forum whatsoever. The releases
provided for in the Allergan Settlement are intended to be broad and shall be interpreted so as
to give the Released Entities the broadest possible bar against any liability relating in any way
to Released Claims and extend to the full extent of the power of the Governmental Entity to
release claims. The Allergan Settlement shall be a complete bar to any Released Claim.
10.The Governmental Entity hereby takes on all rights and obligations of a Participating
Subdivision or Participating Special District as set forth in the Allergan Settlement.
11.In connection with the releases provided for in the Allergan Settlement, each Governmental
Entity expressly waives, releases, and forever discharges any and all provisions, rights, and
benefits conferred by any law of any state or territory of the United States or other jurisdiction,
or principle of common law, which is similar, comparable, or equivalent to § 1542 of the
California Civil Code, which reads:
General Release; extent. A general release does not extend to claims that the
creditor or releasing party does not know or suspect to exist in his or her favor
at the time of executing the release that, if known by him or her, would have
materially affected his or her settlement with the debtor or released party.
A Releasor may hereafter discover facts other than or different from those which it knows,
believes, or assumes to be true with respect to the Released Claims, but each Governmental
Entity hereby expressly waives and fully, finally, and forever settles, releases and discharges,
upon the Effective Date, any and all Released Claims that may exist as of such date but which
Releasors do not know or suspect to exist, whether through ignorance, oversight, error,
negligence or through no fault whatsoever, and which, if known, would materially affect the
Governmental Entities’ decision to participate in the Allergan Settlement.
12.Nothing herein is intended to modify in any way the terms of the Allergan Settlement, to
which the Governmental Entity hereby agrees. To the extent this Settlement Participation
Form is interpreted differently from the Allergan Settlement in any respect, the Allergan
Settlement controls.
2
DocuSign Envelope ID: DA8D9ADD-8754-439D-BCCD-33A6405CAF11
I have all necessary power and authorization to execute this Settlement Participation Form on behalf
of the Governmental Entity.
Signature:/signer_1_teva_allergan/
Name:/name_1_teva_allergan/
Title:/title_1_teva_allergan/
Date:/date_1_teva_allergan/
3
DocuSign Envelope ID: DA8D9ADD-8754-439D-BCCD-33A6405CAF11
Commissioner
4/12/2023
Kevin Shutty