3471470_participation_form.pdf

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EXHIBIT
 
  G   
Six
 
  (6)
   Remnant
 
  Defendants’
 
 
Combined
 
  Subdivision
 
  Participation
 
  and
 
  Release
 
  Form
 
  
(“Combined Participation Form”)
Governmental Entity: Buckeye city
State: AZ
Authorized Official:   /authorized_official/
Address 1:   /address1/
Address 2:   /address2/
City, State, Zip:   /city/                                         /state_pd/                                /zip/
Phone:   /phone/
Email:   /email/
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 six (6) 
Remnant Defendants’ Settlement Agreement (“RDSA”), dated February 3, 2026, and described 
further in Paragraph 1, and acting through the undersigned authorized official, hereby elects to 
participate in the RDSA, release all Released Claims against all Released Entities, and agrees as 
follows:
1. The Governmental Entity hereby elects to participate in the RDSA as a Participating 
Subdivision with each of the following six (6) Remnant Defendants that are parties to the 
RDSA: (1) Associated Pharmacies, Inc. (and American Associated Pharmacies), (2) J M 
Smith Corporation, (3) Morris and Dickson Co., L.L.C., (4) Louisiana Wholesale Drug 
Company, Inc., (5) North Carolina Mutual Wholesale Drug Company, Inc., and (6) 
United Natural Foods, Inc. (and SuperValu).
2. The Governmental Entity is aware of and has reviewed the RDSA, understands that all 
capitalized terms not defined in this Combined Participation Form have the meanings 
defined in the RDSA, and agrees that by executing this Combined Participation Form, the 
Governmental Entity elects to participate in the RDSA and become a Participating 
Subdivision as provided in the RDSAs.
3. 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 against any Released Entity in the RDSA. 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 for each of six (6) Remnant Defendants listed in Paragraph 1 
above substantially in the form found at https://nationalopioidsettlement.com/additional-
settlements/.
4. The Governmental Entity agrees to the terms of each of the RDSA pertaining to Participating

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Subdivisions as defined therein.
5. By agreeing to the terms of the RDSA settlements 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 RDSA 
solely for the purposes provided therein.
7. The Governmental Entity submits to the jurisdiction of the MDL Court and agrees to 
follow the process for resolving any disputes described in the RDSA.
8. The Governmental Entity has the right to enforce the RDSA as provided therein.
9. The Governmental Entity, as a Participating Subdivision, hereby becomes a Releasor for 
all purposes of the RDSA, including without limitation all provisions related to release of 
any claims, and along with all departments, agencies, divisions, boards, commissions, 
districts, instrumentalities of any kind and attorneys, and any person in his or her 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 or permit to be 
brought, filed, or claimed, or to otherwise seek to establish liability for any Released 
Claims against any Released Entity in the RDSA in any forum whatsoever. The release 
provided for in the RDSA is intended by the Parties to be broad and shall be interpreted so 
as to give the Released Entities in the RDSA 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 RDSA shall be a complete bar to any 
Released Claim against the Released Entities.
10. The Governmental Entity hereby takes on all rights and obligations of a Participating 
Subdivision as set forth in the RDSA.
11. In connection with the releases provided in the RDSA, 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.

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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 in the RDSA, 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 
RDSA.
12. The Governmental Entity understands and acknowledges that nothing herein is intended 
to modify in any way the terms of any of the RDSA, to which Governmental Entity 
hereby agrees. To the extent this Combined Participation Form is interpreted differently 
from the RDSA in any respect, the RDSA controls.
I have all necessary power and authorization to execute this Combined Participation Form 
on behalf of the Governmental Entity.
Signature:             /signer_1/
 
                                              
 
 a  
Name:                   /name_1/
 
                                               
 
 a  
Title:                     /title_1/
 
                                                 
 
 a  
Date:                     /date_1/
 
                                                 
 
 a