Fill and Sign the Covenant Not Sue Form 497333545

Covenant not to Sue by Husband and Wife for Accidental injuries Covenant not to sue executed this __________________ (date) , by __________________ (Name of Husband) and __________________ (Name of Wife) , husband and wife, of _____________________________________________ (street address, city, county, state, zip code), the Covenantors, to __________________ (Name of Covenantee) , of _____________________________________________ (street address, city, county, state, zip code), the Covenantee. Whereas, on or about __________________ (date of injury) , Covenantors sustained certain personal injuries and damage to their property from __________________ (description of accident) ; and Whereas, Covenantors declare that no representations about the nature and extent of their injuries, disabilities or damages made by Covenantee or any person in privity with Covenantee, including, but not limited to, any attorney, physician or agent of Covenantee, have induced them or either of them, to make this covenant; and Whereas, Covenantors have taken into consideration not only the ascertained injuries, liabilities and damages, but also the possibility that the injuries sustained may be permanent and progressive, and the fact that recovery from the injuries is uncertain and indefinite so that consequences not now anticipated may result; Now, therefore, Covenantors hereby declare that this covenant shall apply to all unknown and unanticipated injuries and damages resulting from the above-described accident as well as those now disclosed. I. Covenant not to Sue. In consideration of $ __________________ paid to Covenantors by Covenantee, receipt of which is jointly and severally acknowledged, Covenantors covenant for each of them and for their respective heirs, legal representatives and assigns, to irrevocably bind themselves to refrain from making any claim or demand, or to commence, cause or permit to be prosecuted any action in law or equity against Covenantee, on account of any personal injury, disability, property damage, loss of services, expenses or other damages of any kind that Covenantors have sustained in consequence of the above-described accident. II. Covenant as Defense to any Action. Covenantors agree that this instrument may be treated as a defense to any action or proceeding that may be brought, instituted or taken by Covenantors or in their behalf, against Covenantee, and shall forever be a complete bar to the commencement or prosecution of any action or proceeding whatever against Covenantee, on account of injuries and damages sustained by Covenantors as described above. III. Payment not an Admission. Covenantors understand that Covenantee admits no liability of any sort by reason of the above-described accident, and that payment of the above-recited sum is made to terminate further controversy respecting all claims for damages that Covenantors or either of them have previously asserted, or that Covenantors or either of them or the legal representative of either of them might later assert, against Covenantee because of such accident. IV. Reservation of Rights. Covenantors specifically reserve their right to prosecute their claims against any parties other than Covenantee who might be responsible for their injuries. Any damages recovered by Covenantors against or from any or all other joint or concurrent tortfeasors shall be reduced to the extent of the pro rata share of the damages for which Covenantee, but for this Agreement, would have been liable. V. Violation of Covenant. Covenantors recognize the possibility that they or either of them may violate this covenant and prosecute an action and recover from Covenantee a sum in addition to that paid under this covenant. They do now assign and transfer any and all such sums they might so recover, and substitute Covenantee in their place for any adjudicated claim that they may ever assert and on which they ever obtain a judgment. This assignment and transfer, and this substitution shall be effective only on violation of the covenant by Covenantors, or either of them, as stated above. VI. Voluntary Execution. Covenantors have read this covenant and understand all its terms. They have executed this instrument voluntarily and with full knowledge of its significance. _________________________ (Signature of Husband) __________________ (Printed Name of Husband) _________________________ (Signature of Wife) __________________ (Printed Name of Wife)