Common use of APPOINTMENT OF SPECIAL MASTER Clause in Contracts

APPOINTMENT OF SPECIAL MASTER. The Court, by this Order, appoints Judge Xxxxxx Xxxxx as Special Master to hear motions to dismiss claims that fail to comply with the terms of the Agreement, and to recommend to this Court rulings on any other motions, as specified in the Agreement. IT IS SO ORDERED this day of , 0000 XXXXXXXXX XXXXXX X. SIPPEL UNITED STATES DISTRICT JUDGE NOTICE OF INTENT TO OPT 41527 M FOR UNFILED CLAIMS IN FOR THIS FORM APPLIES TO INDIVIDUALS WHO ALLEGE AN INJURY OCCURRING PRIOR TO FEBRUARY 7, 2014 RESULTING FROM THE USE OF NUVARING, AND WHO HAD SIGNED A RETAINER AGREEMENT WITH AN ATTORNEY OR LAW FIRM PRIOR TO FEBRUARY 7, 2014 FOR LEGAL REPRESENTATION OF SAID INDIVIDUAL RELATING TO AN INJURY ALLEGEDLY RESULTING FROM THE USE OF NUVARING, BUT WHO DO NOT HAVE A LEGAL CASE RELATING TO NUVARING PENDING IN STATE OR FEDERAL COURT. IF YOU WISH TO PARTICIPATE IN THE NUVARING RESOLUTION PROGRAM (the “Program”) AND TO BE POTENTIALLY ELIGIBLE FOR AN AWARD UNDER THE PROGRAM, YOU MUST SUBMIT THIS FORM, ALONG WITH THE ACCOMPANYING DECLARATION OF COUNSEL FORM SIGNED BY YOUR ATTORNEY, ON OR BEFORE 11:59 p.m. CT ON MARCH 10, 2014 AS FOLLOWS: Online: Go to xxx.xxxxxxxxxxxxxxxxxxxxxxxxxx.xxx, which is the official website of the Claims Administrator, and follow the instructions provided there. The date of submission will be the date the form is provided online. NOTICE OF INTENT TO OPT 41528 M FOR UNFILED CLAIMS IN FOR By timely submitting this form, you agree to be bound by the terms of the Master Settlement Agreement and the jurisdiction of the Special Master and the MDL Court or the New Jersey Coordinated Proceeding Court with regard to all matters pertaining to the Master Settlement Agreement and the Program contained therein. You acknowledge that you will not be eligible for an award unless you also timely submit a completed Claim Package that meets the requirements set forth in the Master Settlement Agreement. You agree that the Special Master will hear motions to dismiss claims that fail to comply with the Settlement Agreement and make recommendations to the court in which those cases are pending. You also agree that appeals of determinations by the Claims Administrator as to whether a Claimant is eligible for payment under the terms of the Settlement Agreement will be resolved by the Special Master and that the Special Master’s decisions will be binding on the parties. You acknowledge that the Special Master’s rulings on these appeals are separate from recommendations he makes as a Special Master on appointment from the MDL Court, New Jersey Coordinated Proceeding Court, or other court. By checking the box below and executing this form, you acknowledge that you have been fully advised of your rights under the Master Settlement Agreement and elect to participate in the Program, and that such election is irrevocable. I elect to participate in the NuvaRing Resolution Program. CLAIMANT AND CLAIM INFORMATION (NuvaRing Product User) Claimant Name Last First Middle Social Security Number | | | | - | | | - | | | | | Xxxxxxx Xxxxxx Xxxx Xxxxx Xxx Xxxxxxx Telephone Number ( ) - Email Alleged Injury (check all that apply) VTE (e.g. pulmonary embolism or deep vein thrombosis) ATE (e.g., heart attack or stroke) Wrongful Death Other (Define) Date of Alleged Injury (Month/Day/Year) / / Dates of NuvaRing Usage State of Residence at Time of Injury Attorney Name Last First Middle Address Street City State Zip Country Telephone Number ( ) - Facsimile ( ) - Signature Date / / (month) (day) (year) Printed Name First MI Last DECLARATION OF COUNSEL THIS FORM APPLIES TO ATTORNEYS REPRESENTING INDIVIDUALS WHO DO NOT HAVE A LEGAL CASE RELATING TO NUVARING PENDING IN STATE OR FEDERAL COURT, BUT WHO ELECT TO PARTICIPATE IN THE NUVARING RESOLUTION PROGRAM (the “Program”) BY SUBMITTING A NOTICE OF INTENT TO OPT IN FORM FOR UNFILED CLAIMS PURSUANT TO THE PROGRAM. THIS DECLARATION FORM MUST BE COMPLETED AND SIGNED BY THE ATTORNEY REPRESENTING SUCH INDIVIDUAL IN CONNECTION WITH HER NUVARING INJURY CLAIM. THIS DECLARATION MUST BE SUBMITTED, ALONG WITH THE NOTICE OF INTENT TO OPT IN FORM FOR UNFILED CLAIMS SIGNED BY THE CLAIMANT, ON OR BEFORE 11:59 p.m. CT ON MARCH 10, 2014 AS FOLLOWS: Online: Go to xxx.xxxxxxxxxxxxxxxxxxxxxxxxxx.xxx, which is the official website of the Claims Administrator, and follow the instructions provided there. The date of submission will be the date the form is provided online. 41531 DECLARATION OF COUNSEL I, , hereby certify as follows: I am an attorney in good standing who is admitted to practice law in the State of . I hereby certify that the Claimant identified below had executed a retainer agreement prior to February 7, 2014 (the Execution Date) with me or with my law firm for legal representation of said Claimant relating to an injury allegedly resulting from the use of NuvaRing. Claimant Name Last First Middle Attorney Name Last First Middle Firm Name Address Street City State Zip Country Telephone Number ( ) - Facsimile ( ) - Signature Date / / (month) (day) (year) Printed Name First MI Last NUVARING RESO 41533 GRAM CLAIM FORM LUTION PRO The Claim Package, including a completed copy of this Claim Form, must be submitted no later than the Claim Package Deadline for all Claimants, including unrepresented (pro se) Claimants, in the NuvaRing Resolution Program (the “Program”) outlined in the Master Settlement Agreement of February 7, 2014 (the “Agreement”). Counsel for Claimants may complete this Claim Form, but the Claimant must personally sign the Certification and Authorization in Section VII. All Pro Se Claimants must complete this Claim Form in its entirety. I. A. CLAIMANT INFORMATION (NuvaRing Product User) 1. Claimant Name Last First Middle 2. Social Security Number | | | | - | | | - | | | | | Date of Birth / / (Month/Day/Year) 3. Xxxxxxx Xxxxxx/X.X. Xxx Xxxx Xxxxx Xxx 0. Telephone Number ( ) - 5. Email 6. Any other names by which Claimant has been known, including but not limited to maiden name: Last First Middle Last First Middle 1. Attorney Name Last First Middle 2. Firm Name Law Firm 0. Xxxxxxx Xxxxxx Xxxx Xxxxx Zip Country

APPOINTMENT OF SPECIAL MASTER. The Court, by this Order, appoints Judge Xxxxxx Xxxxx Xxxxxxxxx Xxxxxxx Xxxxxxxxx as Special Master to hear motions to dismiss claims that fail to comply with the terms of the Agreement, and to recommend to this Court rulings on any other such motions, as specified in the Agreement. IT IS SO ORDERED this day of Date: Xxxxxxxxx Xxxxx X. Herndon Chief Judge, 0000 XXXXXXXXX XXXXXX X. SIPPEL United States District Court UNITED STATES DISTRICT JUDGE COURT SOUTHERN DISTRICT OF ILLINOIS ) IN RE: XXXXXX AND YAZ (DROSPIRENONE) ) MARKETING, SALES PRACTICES AND PRODUCTS ) LIABILITY LITIGATION ) 3:09-md-02100-DRH-PMF MDL No. 2100 NOTICE OF INTENT TO OPT 41527 M FOR UNFILED OUT FORM ALL MDL PLAINTIFFS WITH PERSONAL INJURY CLAIMS ALLEGING GALLBLADDER DISEASE AND/OR GALLBLADDER INJURIES, EITHER ALONE OR IN FOR THIS FORM APPLIES TO INDIVIDUALS WHO ALLEGE AN INJURY OCCURRING PRIOR TO FEBRUARY 7COMBINATION WITH ANOTHER INJURY, 2014 RESULTING FROM THE USE OF NUVARINGFILED AND SERVED ON OR BEFORE MARCH 25, AND WHO HAD SIGNED A RETAINER AGREEMENT WITH AN ATTORNEY OR LAW FIRM PRIOR TO FEBRUARY 7, 2014 FOR LEGAL REPRESENTATION OF SAID INDIVIDUAL RELATING TO AN INJURY ALLEGEDLY RESULTING FROM THE USE OF NUVARING, BUT WHO DO NOT HAVE A LEGAL CASE RELATING TO NUVARING PENDING IN STATE OR FEDERAL COURT. IF YOU WISH TO PARTICIPATE 2013 ARE AUTOMATICALLY ENROLLED IN THE NUVARING MDL GALLBLADDER RESOLUTION PROGRAM (the “Program”) UNLESS: (1) THE CASE ALLEGES A GALLBLADDER INJURY AND TO BE POTENTIALLY ELIGIBLE FOR AN AWARD UNDER A VENOUS THROMBOEMBOLISM (INCLUDING, BUT NOT LIMITED TO, DEEP VEIN THROMBOSIS OR PULMONARY EMBOLISM) OR ARTERIAL THROMBOEMBOLISM (INCLUDING, BUT NOT LIMITED TO, HEART ATTACK OR ARTERIAL THROMBOEMBOLIC STROKE) INJURY, PENDING IN MDL DOCKET NO. 2100; OR (2) THE PLAINTIFF SUBMITS THIS FORM OPTING OUT OF THE PROGRAM. (1) Preferred option for submission: Online at xxx.xxxxxxxxxxxxxxxxxxxxx.xxx, YOU MUST SUBMIT THIS FORM, ALONG WITH THE ACCOMPANYING DECLARATION OF COUNSEL FORM SIGNED BY YOUR ATTORNEY, ON OR BEFORE 11:59 p.m. CT ON MARCH 10, 2014 AS FOLLOWS: Online: Go to xxx.xxxxxxxxxxxxxxxxxxxxxxxxxx.xxx, which is the official website of in accordance with instructions provided therein by the Claims Administrator. (2) By email to all of the following: (a) XxxXxXxxXxxXxxxxx@xxxxxxxxxxxxxxxxxxxxx.xxx (Claims Administrator) (b) XxxXxXxxXxxXxxxxx@xxx.xxx (BHCP’s counsel) (c) XxxXXXxxxxXxxxxx@xxxxxxx.xxx (NPC); (3) By United States Mail or other carrier, and follow return receipt requested, to all of the instructions provided therefollowing: Yaz Settlement Claims Administrator BrownGreer PLC P.O. Box 85006 Richmond, VA 23285-5006 Xxxx Xxxxxx Xxxxx, Xxxxx & Xxxxx L.L.P. 0000 Xxxxx Xxxx. The date of submission will be the date the form is provided online. NOTICE OF INTENT TO OPT 41528 M FOR UNFILED CLAIMS IN FOR Kansas City, MO 64108-2613 Xxxxx X. Xxxxxx Xxxxxxxxxx, Xxxxxx & Xxxxxx, LLP 000 Xxxxx Xxxxxx Xx., Xxx 000 St. Xxxxx, MO 63102 By timely submitting this form, you acknowledge and agree that you will not be entitled to seek an award under the Gallbladder Resolution Program. Failure to timely submit this form means that you will automatically be bound by the terms of the Master Settlement Agreement and the jurisdiction of the Special Master and the MDL Court or the New Jersey Coordinated Proceeding Court with regard to all matters pertaining to the Master Settlement Agreement and enrolled in the Program contained therein. You acknowledge that (unless your case alleges a gallbladder injury and a venous thromboembolism or arterial thromboembolism injury), although you will not be eligible for an award unless you also timely submit a completed Claim Package that meets the requirements set forth in the Master Settlement Agreement. You agree that the Special Master will hear motions to dismiss claims that fail to comply with the Settlement Agreement and make recommendations pursuant to the court in which those cases are pending. You also agree that appeals of determinations by the Claims Administrator as to whether a Claimant is eligible for payment under the terms of the Settlement Agreement will be resolved by the Special Master and that the Special Master’s decisions will be binding on the parties. You acknowledge that the Special Master’s rulings on these appeals are separate from recommendations he makes as a Special Master on appointment from the MDL Court, New Jersey Coordinated Proceeding Court, or other courtProgram. By checking the box below and executing this form, you acknowledge that you have been fully advised of your rights under the Master Settlement Agreement and elect to participate in opt out of the Program, and that such election is irrevocable. □ I elect to participate in opt out of the NuvaRing Gallbladder Resolution Program. CLAIMANT AND CLAIM INFORMATION (NuvaRing Product User) Claimant Name Last First Middle Social Security Number | | | | - | | | - | | | | | Xxxxxxx Xxxxxx Xxxx Xxxxx Xxx Xxxxxxx Telephone Number ( ) - Email Alleged Injury (check all that apply) VTE (e.g. pulmonary embolism or deep vein thrombosis) ATE (e.g., heart attack or stroke) Wrongful Death Other (Define) Date of Alleged Injury (Month/Day/Year) / / Dates of NuvaRing Usage State of Residence at Time of Injury Attorney Name Last First Middle Address Street City State Zip Country Telephone Number ( ) - Facsimile ( ) - Signature Date / / (month) (day) (year) Printed Name First MI Last DECLARATION OF COUNSEL THIS FORM APPLIES TO ATTORNEYS REPRESENTING INDIVIDUALS WHO DO NOT HAVE A LEGAL CASE RELATING TO NUVARING PENDING IN STATE OR FEDERAL COURT, BUT WHO ELECT TO PARTICIPATE IN THE NUVARING RESOLUTION PROGRAM (the “Program”) BY SUBMITTING A NOTICE OF INTENT TO OPT IN FORM FOR UNFILED CLAIMS PURSUANT TO THE PROGRAM. THIS DECLARATION FORM MUST BE COMPLETED AND SIGNED BY THE ATTORNEY REPRESENTING SUCH INDIVIDUAL IN CONNECTION WITH HER NUVARING INJURY CLAIM. THIS DECLARATION MUST BE SUBMITTED, ALONG WITH THE NOTICE OF INTENT TO OPT IN FORM FOR UNFILED CLAIMS SIGNED BY THE CLAIMANT, ON OR BEFORE 11:59 p.m. CT ON MARCH 10, 2014 AS FOLLOWS: Online: Go to xxx.xxxxxxxxxxxxxxxxxxxxxxxxxx.xxx, which is the official website of the Claims Administrator, and follow the instructions provided there. The date of submission will be the date the form is provided online. 41531 DECLARATION OF COUNSEL I, , hereby certify as follows: I am an attorney in good standing who is admitted to practice law in the State of . I hereby certify that the Claimant identified below had executed a retainer agreement prior to February 7, 2014 (the Execution Date) with me or with my law firm for legal representation of said Claimant relating to an injury allegedly resulting from the use of NuvaRing. Claimant Name Last First Middle Attorney Name Last First Middle Firm Name Address Street City State Zip Country Telephone Number ( ) - Facsimile ( ) - Signature Date / / (month) (day) (year) Printed Name First MI Last NUVARING RESO 41533 GRAM CLAIM FORM LUTION PRO The Claim Package, including a completed copy of this Claim Form, must be submitted no later than the Claim Package Deadline for all Claimants, including unrepresented (pro se) Claimants, in the NuvaRing Resolution Program (the “Program”) outlined in the Master Settlement Agreement of February 7, 2014 (the “Agreement”). Counsel for Claimants may complete this Claim Form, but the Claimant must personally sign the Certification and Authorization in Section VII. All Pro Se Claimants must complete this Claim Form in its entirety. I. A. CLAIMANT INFORMATION (NuvaRing Product User) 1. Claimant Name Last First Middle 2. Social Security Number | | | | - | | | - | | | | | Date of Birth / / (Month/Day/Year) 3. Xxxxxxx Xxxxxx/X.X. Xxx Xxxx Xxxxx Xxx 0. Telephone Number ( ) - 5. Email 6. Any other names by which Claimant has been known, including but not limited to maiden name: Last First Middle Last First Middle 1. Attorney Name Last First Middle 2. Firm Name Law Firm 0. Xxxxxxx Xxxxxx Xxxx Xxxxx Zip Country

APPOINTMENT OF SPECIAL MASTER. The Court, by this Order, appoints Judge Xxxxxx Xxxxx Xxxxxxxxx to serve as Special Master to hear motions under the terms of Agreement, and directs that all applications to dismiss claims that fail for a failure to comply with the terms of the AgreementAgreement shall be heard by Judge Corodemus, and to recommend who shall make a recommendation to this Court rulings on the resolution of any other motions, as motions specified in the this Agreement. IT IS SO ORDERED this day of , 0000 XXXXXXXXX XXXXXX X. SIPPEL KUGLER UNITED STATES DISTRICT JUDGE COURT NOTICE OF INTENT TO OPT 41527 M IN FORM FOR UNFILED CLAIMS IN FOR THIS FORM APPLIES TO INDIVIDUALS INDIVIDUALS: 1. WHO ALLEGE AN INJURY OCCURRING PRIOR TO FEBRUARY 7, 2014 RESULTING FROM THE USE COMMENCING PRIOR TO MAY 1, 2015 OF NUVARINGOLMESARTAN PRODUCTS IN THE UNITED STATES, AND 2. WHO HAD ALSO SIGNED A RETAINER AGREEMENT WITH AN ATTORNEY OR LAW FIRM PRIOR TO FEBRUARY 711:59 P.M. ET ON AUGUST 23, 2014 2017 FOR LEGAL REPRESENTATION OF SAID INDIVIDUAL RELATING TO AN THE INJURY ALLEGEDLY RESULTING FROM THE USE OF NUVARING, OLMESARTAN PRODUCTS; 3. BUT WHO DO DID NOT HAVE A LEGAL CASE RELATING TO NUVARING OLMESARTAN PRODUCTS PENDING IN STATE OR FEDERAL COURTCOURT ON OR BEFORE AUGUST 1, 2017. IF YOU WISH TO PARTICIPATE IN THE NUVARING OLMESARTAN PRODUCTS RESOLUTION PROGRAM (the “Program”) AND TO BE POTENTIALLY ELIGIBLE FOR AN AWARD UNDER THE PROGRAM, YOU MUST SUBMIT THIS FORM, ALONG WITH FORM AS PART OF THE ACCOMPANYING DECLARATION OF COUNSEL FORM SIGNED BY YOUR ATTORNEY, OPT IN PACKAGE FOR UNFILED CLAIMS ON OR BEFORE 11:59 p.m. CT ON MARCH 10ET SEPTEMBER 15, 2014 AS FOLLOWS: Online: Go to xxx.xxxxxxxxxxxxxxxxxxxxxxxxxx.xxx2017 (UNLESS EXTENDED TO A LATER DATE PURSUANT TO THE TERMS OF THE SETTLEMENT AGREEMENT), which is the official website of the Claims Administrator, and follow the instructions provided thereIN ACCORDANCE WITH SUBMISSION INSTRUCTIONS PROVIDED BY THE CLAIMS ADMINISTRATOR. The date of submission will be the date the form is provided onlineSEE WWW. NOTICE OF INTENT TO OPT 41528 M FOR UNFILED CLAIMS IN FOR By timely submitting this form, you agree to be bound by the terms of the Master Settlement Agreement and the jurisdiction of the Special Master and the MDL Court or the New Jersey Coordinated Proceeding Court with regard to all matters pertaining to the Master Settlement Agreement and the Program contained thereinXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX.XXX. You acknowledge that you will not be eligible for an award unless you also timely submit a completed Claim Package that meets the requirements set forth in the Master Settlement Agreement. You agree that the Special Master will hear motions to dismiss claims that fail to comply with the Settlement Agreement and make recommendations to the court in which those cases are pending. You also agree that appeals of determinations by the Claims Administrator as to whether a Claimant is eligible for payment under the terms of the Settlement Agreement will be resolved by the Special Master and that the Special Master’s decisions will be binding on the parties. You acknowledge that the Special Master’s rulings on these appeals are separate from recommendations he makes as a Special Master on appointment from the MDL Court, New Jersey Coordinated Proceeding Court, or other court. By checking the box below and executing this form, you acknowledge that you have been fully advised of your rights under the Master Settlement Agreement and elect to participate in the Program, and that such election is irrevocable. I elect to participate in the NuvaRing Resolution Program. CLAIMANT AND CLAIM INFORMATION (NuvaRing Product User) Claimant Name Last First Middle Social Security Number | | | | - | | | - | | | | | Xxxxxxx Xxxxxx Xxxx Xxxxx Xxx Xxxxxxx Telephone Number ( ) - Email Alleged Injury (check all that apply) VTE (e.g. pulmonary embolism or deep vein thrombosis) ATE (e.g., heart attack or stroke) Wrongful Death Other (Define) Date of Alleged Injury (Month/Day/Year) / / Dates of NuvaRing Usage State of Residence at Time of Injury Attorney Name Last First Middle Address Street City State Zip Country Telephone Number ( ) - Facsimile ( ) - Signature Date / / (month) (day) (year) Printed Name First MI Last DECLARATION OF COUNSEL THIS FORM APPLIES TO ATTORNEYS REPRESENTING INDIVIDUALS WHO DO NOT HAVE A LEGAL CASE RELATING TO NUVARING PENDING IN STATE OR FEDERAL COURT, BUT WHO ELECT TO PARTICIPATE IN THE NUVARING RESOLUTION PROGRAM (the “Program”) BY SUBMITTING A NOTICE OF INTENT TO OPT IN FORM FOR UNFILED CLAIMS PURSUANT TO THE PROGRAM. THIS DECLARATION FORM MUST BE COMPLETED AND SIGNED BY THE ATTORNEY REPRESENTING SUCH INDIVIDUAL IN CONNECTION WITH HER NUVARING INJURY CLAIM. THIS DECLARATION MUST BE SUBMITTED, ALONG WITH THE NOTICE OF INTENT TO OPT IN FORM FOR UNFILED CLAIMS SIGNED BY THE CLAIMANT, ON OR BEFORE 11:59 p.m. CT ON MARCH 10, 2014 AS FOLLOWS: Online: Go to xxx.xxxxxxxxxxxxxxxxxxxxxxxxxx.xxx, which is the official website of the Claims Administrator, and follow the instructions provided there. The date of submission will be the date the form is provided online. 41531 DECLARATION OF COUNSEL I, , hereby certify as follows: I am an attorney in good standing who is admitted to practice law in the State of . I hereby certify that the Claimant identified below had executed a retainer agreement prior to February 7, 2014 (the Execution Date) with me or with my law firm for legal representation of said Claimant relating to an injury allegedly resulting from the use of NuvaRing. Claimant Name Last First Middle Attorney Name Last First Middle Firm Name Address Street City State Zip Country Telephone Number ( ) - Facsimile ( ) - Signature Date / / (month) (day) (year) Printed Name First MI Last NUVARING RESO 41533 GRAM CLAIM FORM LUTION PRO The Claim Package, including a completed copy of this Claim Form, must be submitted no later than the Claim Package Deadline for all Claimants, including unrepresented (pro se) Claimants, in the NuvaRing Resolution Program (the “Program”) outlined in the Master Settlement Agreement of February 7, 2014 (the “Agreement”). Counsel for Claimants may complete this Claim Form, but the Claimant must personally sign the Certification and Authorization in Section VII. All Pro Se Claimants must complete this Claim Form in its entirety. I. A. CLAIMANT INFORMATION (NuvaRing Product User) 1. Claimant Name Last First Middle 2. Social Security Number | | | | - | | | - | | | | | Date of Birth / / (Month/Day/Year) 3. Xxxxxxx Xxxxxx/X.X. Xxx Xxxx Xxxxx Xxx 0. Telephone Number ( ) - 5. Email 6. Any other names by which Claimant has been known, including but not limited to maiden name: Last First Middle Last First Middle 1. Attorney Name Last First Middle 2. Firm Name Law Firm 0. Xxxxxxx Xxxxxx Xxxx Xxxxx Zip CountryCLAIMS