Legal Acknowledgment and Release Form

LEGAL ACKNOWLEDGMENT AND RELEASE FORM

This Legal Acknowledgment and Release Form (the Agreement) is made on , by and between Releasor Name: with address: (hereinafter referred to as "Releasor"), and Releasee Name: with address: (hereinafter referred to as "Releasee").

RECITALS

WHEREAS, on or about , (the Incident Date), an event occurred involving the parties described as:

WHEREAS, Releasor asserts that Releasor has suffered or may have suffered damages, losses, or claims arising out of or related to the Incident described above; and

WHEREAS, Releasee and Releasor desire to fully and finally resolve any and all disputes, claims, demands, actions and causes of action that exist or may exist between them, without admission of liability by Releasee, upon the terms and conditions set forth in this Agreement.

NOW, THEREFORE

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

1. DEFINITIONS

For purposes of this Agreement, "Claims" means any and all actions, causes of action, suits, debts, sums of money, accounts, reckonings, bonds, bills, specialties, covenants, contracts, controversies, agreements, promises, variances, trespasses, damages, judgments, extents, executions and liabilities of every kind and nature, whether known or unknown, suspected or unsuspected, fixed or contingent, which Releasor may have against Releasee arising out of or related to the Incident or the subject matter described in this Agreement.

2. ACKNOWLEDGMENT OF FACTS

Releasor acknowledges and represents that Releasor has been informed of and understands the factual basis for any claims against Releasee, that Releasor has had a full opportunity to investigate the facts and circumstances relating to the Incident, and that Releasor enters into this Agreement voluntarily and without duress or undue influence. Releasor further acknowledges that Releasor has the following knowledge at the time of signing:

3. RELEASE OF CLAIMS

Subject to the terms and conditions herein and in consideration of the consideration described in Section 4, Releasor, for Releasor and for Releasor's heirs, executors, administrators, successors and assigns, does hereby fully, finally and forever release, acquit, discharge and covenant not to sue Releasee and Releasee's agents, employees, affiliates, insurers, predecessors and successors from any and all Claims, whether known or unknown, that arise out of or relate to the Incident.

This release expressly includes, but is not limited to, the release of any Claims under statutes, common law, contract, tort or otherwise, including claims for personal injury, property damage, emotional distress, punitive damages, and attorneys' fees, to the maximum extent permitted by law.

Releasor elects to release the following categories of Claims: Known claims arising from the Incident Unknown and unforeseeable claims, including those described in California Civil Code Section 1542 or similar statutes, to the extent permitted by applicable law

4. CONSIDERATION

In consideration for the release set forth in Section 3, Releasee agrees to provide the following to Releasor:

Releasor acknowledges receipt of the stated consideration, and that such consideration is fair, adequate and fully compensates Releasor for the release set forth herein.

5. COVENANT NOT TO SUE

Releasor covenants and agrees not to institute, maintain or prosecute any legal proceeding, arbitration or administrative claim against Releasee asserting any of the Claims released by this Agreement. If Releasor breaches this covenant, Releasor shall be responsible for all reasonable costs and attorneys' fees incurred by Releasee in defense of such action, to the extent permitted by law.

6. REPRESENTATIONS AND WARRANTIES

Releasor represents and warrants that Releasor has the full right, power and authority to enter into this Agreement; that Releasor has not assigned or transferred any of the Claims released herein; and that Releasor has not previously executed any release or settlement that would conflict with the terms of this Agreement.

7. INDEMNIFICATION

Releasor agrees to indemnify, defend and hold harmless Releasee from and against any and all losses, liabilities, damages, claims, actions, causes of action, and expenses (including reasonable attorneys' fees) arising out of or resulting from any breach of Releasor's representations, warranties or covenants contained in this Agreement.

8. CONFIDENTIALITY

The parties agree that the terms and amount of any monetary consideration paid pursuant to this Agreement shall remain confidential and shall not be disclosed to any third party except as required by law, as reasonably necessary to enforce the terms of this Agreement, or as required for tax reporting purposes. Notwithstanding the foregoing, factual statements about the Incident or the existence of this Agreement may be disclosed with prior written consent of both parties.

9. NO ADMISSION OF LIABILITY

The parties agree that neither this Agreement nor the furnishing of consideration shall be construed as an admission of liability or wrongdoing by Releasee, and Releasee expressly disclaims any liability.

10. NOTICES

All notices required or permitted under this Agreement shall be in writing and shall be delivered personally, by certified mail (return receipt requested), or by overnight courier to the addresses set forth below or to such other address as a party may designate by written notice to the other party.

11. AMENDMENTS; WAIVER; COUNTERPARTS

This Agreement may be amended or modified only by a written instrument signed by both parties. No waiver of any breach of any provision of this Agreement shall constitute a waiver of any other breach of the same or any other provision. This Agreement may be executed in counterparts, each of which shall be deemed an original, and all of which together shall constitute one and the same instrument.

12. GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the state identified below without regard to principles of conflicts of law. The parties agree that any action to enforce this Agreement shall be brought exclusively in the state or federal courts located in the county identified below.

13. ENTIRE AGREEMENT; SEVERABILITY

This Agreement contains the entire understanding of the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, representations and understandings, whether oral or written. If any provision of this Agreement is determined to be invalid or unenforceable, such provision shall be severed and the remaining provisions shall remain in full force and effect.

14. REPRESENTATION BY COUNSEL

Releasor acknowledges that Releasor has had the opportunity to consult with independent legal counsel regarding this Agreement, and has either done so or knowingly declined to do so. Counsel Name (if consulted):

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