HomeMy WebLinkAboutSettlement Participation Form - WalgreensEXHIBIT K
Subdivision Participation and Release Form
Will your subdivision or special district be signing the settlement participation form for the Walgreens
Settlement at this time?
[ ] Yes_wg [ ] No_wg
Governmental Entity: Mason County State: WA
Authorized Signatory: /officialname_walgreens/
Address 1: /address1_ walgreens/
Address 2: /address2_ walgreens/
City, State, Zip: /cit_wg/ /state_wg/ /zi_wg/
Phone: /phone_walgreens/
Email: /email_walgreens/
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 Settlement
Agreement dated December 9, 2022 (“Walgreens Settlement”), and acting through the undersigned
authorized official, hereby elects to participate in the Walgreens Settlement, release all Released
Claims against all Released Entities, and agrees as follows.
1.The Governmental Entity is aware of and has reviewed the Walgreens Settlement, understands
that all terms in this Participation and Release Form have the meanings defined therein, and
agrees that by executing this Participation and Release Form, the Governmental Entity elects to
participate in the Walgreens Settlement and become a Participating Subdivision as provided
therein.
2.The Governmental Entity shall promptly, and in any event no later than 14 days after the
Reference Date and prior to the filing of the Consent Judgment, 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 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.
3.The Governmental Entity agrees to the terms of the Walgreens Settlement pertaining to
Participating Subdivisions as defined therein.
4.By agreeing to the terms of the Walgreens 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.
5.The Governmental Entity agrees to use any monies it receives through the Walgreens
Settlement solely for the purposes provided therein.
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DocuSign Envelope ID: DA8D9ADD-8754-439D-BCCD-33A6405CAF11
360-427-9670
Shelton
411 N. 5th Street
Washington
Kevin Shutty
kshutty@masoncountywa.gov
X
98584
6.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 Walgreens Settlement. The
Governmental Entity likewise agrees to arbitrate before the National Arbitration Panel as
provided in, and for resolving disputes to the extent otherwise provided in, the Walgreens
Settlement.
7.The Governmental Entity has the right to enforce the Walgreens Settlement as provided therein.
8.The Governmental Entity, as a Participating Subdivision, hereby becomes a Releasor for all
purposes in the Walgreens Settlement, including without limitation all provisions of Section XI
(Release), and along with all departments, agencies, divisions, boards, commissions, districts,
instrumentalities of any kind and attorneys, and any person in their official capacity 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 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 Walgreens Settlement are intended by the Parties
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 Walgreens Settlement shall be a
complete bar to any Released Claim.
9.The Governmental Entity hereby takes on all rights and obligations of a Participating
Subdivision as set forth in the Walgreens Settlement.
10.In connection with the releases provided for in the Walgreens 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 Walgreens Settlement.
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DocuSign Envelope ID: DA8D9ADD-8754-439D-BCCD-33A6405CAF11
11.Nothing herein is intended to modify in any way the terms of the Walgreens Settlement, to
which Governmental Entity hereby agrees. To the extent this Participation and Release Form
is interpreted differently from the Walgreens Settlement in any respect, the Walgreens
Settlement controls.
I have all necessary power and authorization to execute this Participation and Release Form on
behalf of the Governmental Entity.
Signature:/signer_1_walgreens/
Name:/name_1_walgreens/
Title:/title_1_walgreens/
Date:/date_1_walgreens/
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DocuSign Envelope ID: DA8D9ADD-8754-439D-BCCD-33A6405CAF11
Kevin Shutty
Commissioner
4/12/2023