Laserfiche WebLink
DocuSign Envelope ID 465DCC77-DCEA-4CA9-8641-2BDF97F2755B <br />EXHIBITK <br />Subdivision and ,SUecial District Settlement EaUicination Form <br />Will your subdivision or special district be signing the settlement participation forms for the Allergan and <br />Teva Settlements at this time? <br />[X] Yes [ ] No <br />Governmental Entity: Mayfield village I State: OH <br />Authorized Signatory: Brenda T. Bodnar, Mayor and Stephen Schutt, President of Council <br />Address 1: 6622 Wilson Mills Road <br />Address 2: <br />City, State, Zip: Mayfield Village, Ohio 44143 <br />Phone: 440-461-2210 <br />Email: c/o Diane Wol amuth, Director of Administration dwolgamuth@mayfieldvillage.com <br />The governmental entity identified above ("Governmental Entity'), in order to obtain and in <br />consideration for the benefits provided to the Governmental Entity pursuant to the Agreement dated <br />November 22, 2022 ("Allergan Settlement'), and acting through the undersigned authorized official, <br />hereby elects to participate in the Allergan Settlement, release all Released Claims against all Released <br />Entities, and agrees as follows. <br />1. The Governmental Entity is aware of and has reviewed the Allergan Settlement, understands <br />that all terms in this Election and Release have the meanings defined therein, and agrees that <br />by this Election, the Governmental Entity elects to participate in the Allergan Settlement as <br />provided therein. <br />2. Following the execution of this Settlement Participation Form, the Governmental Entity shall <br />comply with Section II1B of the Allergan Settlement regarding Cessation of Litigation <br />Activities. <br />3. The Governmental Entity shall, within fourteen (14) days of the Reference Date and prior to <br />the filing of the Consent Judgment, file a request to dismiss with prejudice any Released <br />Claims that it has filed. With respect to any Released Claims pending in In re National <br />Prescription Opiate Litigation, MDL No. 2804, the Governmental Entity authorizes the MDL <br />Plaintiffs' Executive Committee to execute and file on behalf of the Governmental Entity a <br />Stipulation of Dismissal With Prejudice substantially in the form found at <br />haps : /nation a! opioidsett! ement.com. <br />4. The Governmental Entity agrees to the terms of the Allergan Settlement pertaining to <br />Subdivisions and Special Districts as defined therein. <br />5. By agreeing to the terms of the Allergan Settlement and becoming a Releasor, the <br />Governmental Entity is entitled to the benefits provided therein, including, if applicable, <br />monetary payments beginning after the Effective Date. <br />6. The Governmental Entity agrees to use any monies it receives through the Allergan Settlement <br />solely for the purposes provided therein. <br />1 in <br />