HomeMy WebLinkAbout23-69 Electronic Signature Version
Resolution No. 23-69
RESOLUTION
AUTHORIZING PARTICIPATION AND THE EXECUTION OF SUBDIVISION AND
SPECIAL DISTRICT SETTLEMENT PARTICIPATION FORMS RELATING TO THE
NATIONAL OPIOID SETTLEMENTS WITH TEVA, ALLERGAN, CVS, WALGREENS
AND WALMART
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF ELGIN, ILLINOIS,
that City Manager Richard G. Kozal is authorized and directed to execute five (5) Subdivision and
Special District Settlement Participation Forms on behalf of the City of Elgin in connection with
the National Opioids Settlements with Teva, Allergan, CVS, Walgreens and Walmart, copies of
which are attached hereto and made a part hereof by reference.
s/ David J. Kaptain
David J. Kaptain, Mayor
Presented: April 12, 2023
Adopted: April 12, 2023
Vote: Yeas: 8 Nays: 0
Attest:
s/ Kimberly Dewis
Kimberly Dewis, City Clerk
New National Opioids Settlements: Teva, Allergan, CVS, Walgreens, and Walmart
Opioids Implementation Administrator
opioidsparticipation@rubris.com
Elgin city, IL
Reference Number: CL-384345
TO LOCAL POLITICAL SUBDIVISIONS AND SPECIAL DISTRICTS:
THIS PACKAGE CONTAINS DOCUMENTATION TO PARTICIPATE IN THE NEW
NATIONAL OPIOID SETTLEMENTS. YOU MUST TAKE ACTION IN ORDER TO
PARTICIPATE.
Deadline: April 18, 2023
Five new proposed national opioid settlements (“New National Opioid Settlements ”)
have been reached with Teva, Allergan, CVS, Walgreens, and Walmart
(“Settling Defendants”). This Participation Package is a follow-up communication to
the Notice of National Opioid Settlements recently received electronically by your
subdivision or special district (“subdivision”).
You are receiving this Participation Package because Illinois is participating in the
following settlements:
Teva
Allergan
CVS
Walgreens
Walmart
If a state does not participate in a particular Settlement, the subdivisions in that
state are not eligible to participate in that Settlement.
This electronic envelope contains:
Participation Forms for Teva, Allergan, CVS, Walgreens, and Walmart,
including a release of any claims.
The Illinois Opioid Allocation Agreement
The Participation Form for each settlement must be executed, without
alteration, and submitted on or before April 18, 2023, in order for your
subdivision to be considered for initial participation calculations and
payment eligibility.
Based upon subdivision participation forms received on or before April 18 th, the
subdivision participation rate will be used to determine whether participation for
each deal is sufficient for the settlement to move forward and whether a state earns
its maximum potential payment under the settlement. If the settlement moves
forward, your release will become effective. If a settlement does not move forward,
that release will not become effective.
DocuSign Envelope ID: 88F67FF9-E69C-4B7A-9D39-57722A5C9203
Any subdivision that does not participate cannot directly share in the settlement
funds, even if the subdivision’s state is settling and other participating subdivisions
are sharing in settlement funds. Any subdivision that does not participate may also
reduce the amount of money for programs to remediate the opioid crisis in its state.
Please note, a subdivision will not necessarily directly receive settlement funds by
participating; decisions on how settlement funds will be allocated within a state are
subject to intrastate agreements or state statutes.
You are encouraged to discuss the terms and benefits of the New National Opioid
Settlements with your counsel, your Attorney General’s Office, and other contacts
within your state.
Monies coming to Illinois from the New National Opioid Settlements will be allocated
in accordance with the Illinois Opioid Allocation Agreement, a copy of which is
included with this packet for your reference. As stated above, even if your
subdivision is listed in the Allocation Agreement as one eligible to receive a direct
share of opioid settlement monies, you still must sign each of the Participation
Forms for these five settlements in order to receive a direct distribution under each
of the settlements. Additionally, please note that pursuant to Paragraphs 2.B and
2.C of the Illinois Opioid Allocation Agreement, when notified by the Illinois Attorney
General that Illinois has reached a settlement with one or more Opioid Defendants,
participating local governments shall release their claims against such Opioid
Defendant(s).
Information and documents regarding the New National Opioid Settlements can be
found on the national settlement website at https://nationalopioidsettlement.com/.
This website will be supplemented as additional documents are created.
How to return signed forms:
There are three methods for returning the executed Participation Forms and any
supporting documentation to the Implementation Administrator:
(1)Electronic Signature via DocuSign : Executing the Participation Forms
electronically through DocuSign will return the signed forms to the
Implementation Administrator and associate your forms with your
subdivision’s records. Electronic signature is the most efficient method for
returning Participation Forms, allowing for more timely participation and the
potential to meet higher settlement payment thresholds, and is therefore
strongly encouraged.
(2)Manual Signature returned via DocuSign : DocuSign allows forms to be
downloaded, signed manually, then uploaded to DocuSign and returned
automatically to the Implementation Administrator. Please be sure to
complete all fields. As with electronic signature, returning manually signed
Participation Forms via DocuSign will associate your signed forms with your
subdivision’s records.
DocuSign Envelope ID: 88F67FF9-E69C-4B7A-9D39-57722A5C9203
(3)Manual Signature returned via electronic mail : If your subdivision is unable to
return executed Participation Forms using DocuSign, signed Participation
Forms may be returned via electronic mail to
opioidsparticipation@rubris.com. Please include the name, state, and
reference ID of your subdivision in the body of the email and use the subject
line Settlement Participation Forms – [Subdivision Name, Subdivision State] –
[Reference ID].
Detailed instructions on how to sign and return the Participation Forms, including
changing the authorized signer, can be found at
https://nationalopioidsettlement.com . You may also contact
opioidsparticipation@rubris.com.
The sign-on period for subdivisions ends on April 18, 2023.
If you have any questions about executing these forms, please contact your
counsel, the Implementation Administrator at opioidsparticipation@rubris.com , or
the Illinois Attorney General’s Office at opioidsettlement@ilag.gov.
Thank you,
National Opioids Settlements Implementation Administrator
The Implementation Administrator is retained to provide the settlement notice
required by the respective settlement agreements referenced above and to manage
the collection of settlement participation forms for each settlement.
DocuSign Envelope ID: 88F67FF9-E69C-4B7A-9D39-57722A5C9203
EXHIBIT 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: Elgin city State: IL
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: 88F67FF9-E69C-4B7A-9D39-57722A5C9203
150 Dexter Court
60120
kozal_r@cityofelgin.org
Illinois
Richard G,Kozal
X
847.931.5590
Elgin
City of Elgin—CMO
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: 88F67FF9-E69C-4B7A-9D39-57722A5C9203
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: 88F67FF9-E69C-4B7A-9D39-57722A5C9203
Richard G.Kozal
4/14/2023
City Manager
Exhibit K
Subdivision and Special District Settlement Participation Form
Governmental Entity: Elgin city State: IL
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 (“Teva Settlement”), and acting through the undersigned authorized
official, hereby elects to participate in the Teva Settlement, release all Released Claims against all
Released Entities, and agrees as follows.
1.The Governmental Entity is aware of and has reviewed the Teva 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 Teva Settlement as provided
therein.
2.Following the execution of this Settlement Participation Form, the Governmental Entity shall
comply with Section III.B of the Teva Settlement regarding Cessation of Litigation Activities.
3.The Governmental Entity shall, within 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 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 Teva Settlement pertaining to
Subdivisions as defined therein.
5.By agreeing to the terms of the Teva 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 Teva Settlement
solely for the purposes provided therein.
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 Teva Settlement.
1
DocuSign Envelope ID: 88F67FF9-E69C-4B7A-9D39-57722A5C9203
Elgin Illinois
Richard G,Kozal
City of Elgin—CMO
kozal_r@cityofelgin.org
150 Dexter Court
60120
847.931.5590
8.The Governmental Entity has the right to enforce the Teva 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 Teva Settlement, including but not limited
to all provisions of Section V (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 Teva
Settlement are intended by Released Entitles and the Governmental Entity 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 Teva 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 Teva Settlement.
11.In connection with the releases provided for in the Teva 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 Teva Settlement.
12.Nothing herein is intended to modify in any way the terms of the Teva Settlement, to which
Governmental Entity hereby agrees. To the extent this Election and Release is interpreted
differently from the Teva Settlement in any respect, the Teva Settlement controls.
2
DocuSign Envelope ID: 88F67FF9-E69C-4B7A-9D39-57722A5C9203
I have all necessary power and authorization to execute this Election and Release 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: 88F67FF9-E69C-4B7A-9D39-57722A5C9203
4/14/2023
City Manager
Richard G.Kozal
EXHIBIT K
Subdivision Participation and Release Form
Will your subdivision or special district be signing the settlement participation form for the CVS
Settlement at this time?
[ ] Yes_cv [ ] No_cv
Governmental Entity: Elgin city State: IL
Authorized Signatory: /officialname_cvs/
Address 1: /address1_cvs/
Address 2: /address2_cvs/
City, State, Zip: /cit_cv/ /state_cv/ /zi_cv/
Phone: /phone_cvs/
Email: /email_cvs/
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 (“CVS Settlement”), and acting through the undersigned authorized
official, hereby elects to participate in the CVS Settlement, release all Released Claims against all
Released Entities, and agrees as follows.
1.The Governmental Entity is aware of and has reviewed the CVS 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 CVS 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 CVS Settlement pertaining to Participating
Subdivisions as defined therein.
4.By agreeing to the terms of the CVS 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 CVS Settlement
solely for the purposes provided therein.
1
DocuSign Envelope ID: 88F67FF9-E69C-4B7A-9D39-57722A5C9203
Richard G. Kozal
kozal_r@cityofelgin.org
Illinois
City of Elgin—CMO
150 Dexter Court
60120Elgin
X
847.931.5590
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 CVS 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 CVS Settlement.
7.The Governmental Entity has the right to enforce the CVS Settlement as provided therein.
8.The Governmental Entity, as a Participating Subdivision, hereby becomes a Releasor for all
purposes in the CVS 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 CVS 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 CVS 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 CVS Settlement.
10.In connection with the releases provided for in the CVS 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 CVS Settlement.
2
DocuSign Envelope ID: 88F67FF9-E69C-4B7A-9D39-57722A5C9203
11.Nothing herein is intended to modify in any way the terms of the CVS Settlement, to which
Governmental Entity hereby agrees. To the extent this Participation and Release Form is
interpreted differently from the CVS Settlement in any respect, the CVS 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_cvs/
Name:/name_1_cvs/
Title:/title_1_cvs/
Date:/date_1_cvs/
3
DocuSign Envelope ID: 88F67FF9-E69C-4B7A-9D39-57722A5C9203
Richard G. Kozal
4/14/2023
City Manager
EXHIBIT 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: Elgin city State: IL
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.
1
DocuSign Envelope ID: 88F67FF9-E69C-4B7A-9D39-57722A5C9203
150 Dexter Court
60120
847.931.5590
X
City of Elgin—CMO
IllinoisElgin
Richard G. Kozal
kozal_r@cityofelgin.org
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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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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4/14/2023
City Manager
Richard G. Kozal
EXHIBIT K
Subdivision Participation Form
Will your subdivision or special district be signing the settlement participation form for the Walmart
Settlement at this time?
[ ] Yes_wm [ ] No_wm
Governmental Entity: Elgin city State: IL
Authorized Official: /officialname_walmart/
Address 1: /address1_walmart/
Address 2: /address2_walmart/
City, State, Zip: /cit_wm/ /state_wm/ /zi_wm/
Phone: /phone_walmart/
Email: /email_walmart/
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 November 14, 2022 (“Walmart Settlement”), and acting through the undersigned
authorized official, hereby elects to participate in the Walmart Settlement, release all Released Claims
against all Released Entities, and agrees as follows.
1. The Governmental Entity is aware of and has reviewed the Walmart 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 Walmart Settlement and
become a Participating Subdivision as provided therein.
2. The Governmental Entity shall promptly, and in any event within 14 days of the Effective
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 Walmart Settlement pertaining to
Subdivisions as defined therein.
4. By agreeing to the terms of the Walmart 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 Walmart
Settlement solely for the purposes provided therein.
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X
Elgin
Richard G. Kozal
150 Dexter Court
City of Elgin—CMO
Illinois 60120
847.931.5590
kozal_r@cityofelgin.org
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 Walmart
Settlement.
7.The Governmental Entity has the right to enforce the Walmart Settlement as provided
therein.
8.The Governmental Entity, as a Participating Subdivision, hereby becomes a Releasor for all
purposes in the Walmart Settlement, including but not limited to all provisions of Section X
(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 Walmart 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 Walmart
Settlement shall be a complete bar to any Released Claim.
9.In connection with the releases provided for in the Walmart 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 Walmart Settlement.
10.Nothing herein is intended to modify in any way the terms of the Walmart Settlement, to
which Governmental Entity hereby agrees. To the extent this Election and Release is
interpreted differently from the Walmart Settlement in any respect, the Walmart Settlement
controls.
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I have all necessary power and authorization to execute this Election and Release on behalf of the
Governmental Entity.
Signature:/signer_1_walmart/
Name:/name_1_walmart/
Title:/title_1_walmart/
Date:/date_1_walmart/
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City Manager
4/14/2023
Richard G. Kozal
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