Legal Acknowledgement Release

LEGAL ACKNOWLEDGEMENT RELEASE

This Legal Acknowledgement Release (Effective Date: ) is entered into as of the Effective Date by and between Releasor Name: with principal address at ("Releasor") and Releasee Name: with principal address at ("Releasee").

RECITALS

WHEREAS, on or about , an occurrence described as: (the "Incident") took place involving the Releasor and circumstances giving rise to potential claims against the Releasee;

WHEREAS, Releasor asserts or may assert claims, demands, causes of action, or liabilities, whether known or unknown, past, present or future, arising out of or related to the Incident and other matters set forth herein; and

WHEREAS, the parties wish to fully and finally resolve all disputes, claims, and controversies between them on the terms set forth in this Release without the expense, delay and uncertainty of further dispute resolution or litigation.

NOW, THEREFORE

In consideration of the mutual covenants and other good and valuable consideration, receipt and sufficiency of which are hereby acknowledged, the parties agree as follows:

1. DEFINITIONS

For purposes of this Release, the following terms shall have the meanings set forth below: (a) "Claims" means any and all claims, actions, causes of action, suits, obligations, liabilities, debts, accounts, contracts, agreements, losses, costs, expenses, demands and damages, whether known or unknown, asserted or unasserted, contingent or fixed, including attorneys' fees and costs; and (b) "Released Parties" means Releasee and Releasee's past and present officers, directors, employees, agents, insurers, contractors and representatives.

2. ACKNOWLEDGEMENT OF FACTS

Releasor represents and acknowledges that Releasor has been given the opportunity to investigate the facts and circumstances relating to the Incident and that Releasor is fully aware of the factual basis of the claims released in this instrument. Releasor further acknowledges that Releasor has not relied upon any representations or statements other than those expressly set forth in this Release.

3. RELEASE AND COVENANT NOT TO SUE

Subject to the terms and conditions of this Release, Releasor, on behalf of Releasor and Releasor's heirs, executors, administrators, successors and assigns, hereby irrevocably and unconditionally releases, remise and forever discharges the Released Parties from any and all Claims arising out of or in any way connected with the Incident or any other matters or occurrences disclosed or contemplated by the parties as of the Effective Date. Releasor covenants and agrees not to institute, prosecute or maintain any action, suit or proceeding against any Released Party with respect to any Claim released by this Release.

The scope of the release expressly includes all Claims whether known or unknown, suspected or unsuspected, which Releasor may have under common law, statute, contract, equity or otherwise, except as expressly reserved in writing in this Release.

4. CONSIDERATION

In exchange for the promises and releases set forth herein, Releasee shall provide consideration to Releasor in the form of: . The parties acknowledge that the consideration is adequate and represents bargained-for consideration.

5. NO ADMISSION OF LIABILITY

The parties agree that this Release and the furnishing of consideration shall not be construed as an admission of liability or wrongdoing by any party, and such liability is expressly denied by the Releasee. This Release is intended solely to avoid further dispute and expense.

6. REPRESENTATIONS AND WARRANTIES

Each party represents and warrants that it has the full power and authority to enter into this Release and that the person executing this Release on behalf of each party is duly authorized to do so. Releasor further represents that Releasor has not assigned, transferred or encumbered any Claim released by this Release.

7. CONFIDENTIALITY

The parties agree that the existence, terms and amount of the settlement and this Release are confidential and shall not be disclosed to any third party except as required by law or to the extent disclosure is necessary to enforce this Release or tax reporting obligations. Any permitted disclosure must be limited to the minimum information necessary.

8. INDEMNIFICATION

Releasor agrees to indemnify, defend and hold harmless the Released Parties from and against any and all losses, liabilities, claims, damages, costs and expenses (including reasonable attorneys' fees) arising out of any breach by Releasor of the representations, warranties or covenants contained in this Release.

9. NOTICES

All notices required or permitted under this Release shall be in writing and shall be deemed delivered upon personal delivery, sent by nationally recognized overnight courier, or three (3) business days after being mailed by certified mail, return receipt requested, to the addresses specified above or such other address as a party may designate in writing.

10. AMENDMENTS; WAIVER

This Release may be amended, modified or supplemented only by an instrument in writing signed by both parties. No failure or delay by any party in exercising any right, power or remedy under this Release shall operate as a waiver of any such right, and no single or partial exercise of any right shall preclude any other or further exercise of such right or the exercise of any other right.

11. GOVERNING LAW

This Release shall be governed by and construed in accordance with the laws of the state specified by the parties: , without regard to conflict of laws principles that would apply the laws of another jurisdiction.

12. ENTIRE AGREEMENT

This Release constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, negotiations, representations and understandings, whether written or oral, relating to the subject matter of this Release.

13. SEVERABILITY

If any provision of this Release is held to be invalid, illegal or unenforceable in any respect, the validity, legality and enforceability of the remaining provisions shall not in any way be affected or impaired thereby, and such provision shall be reformed to the minimum extent necessary to make it enforceable.

14. COUNTERPARTS

This Release may be executed in one or more counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument. Electronic or facsimile signatures shall have the same force and effect as original signatures.

15. MISCELLANEOUS

The headings in this Release are for convenience only and shall not affect the interpretation of this Release. Each party acknowledges having read and understood all terms of this Release and having had the opportunity to obtain independent legal advice prior to executing this Release.

Include unknown claims:    Releasor affirms that this release is intended to include claims that Releasor does not now know or suspect to exist with respect to the matters released above.

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