Legal Compromise Claim Application

LEGAL COMPROMISE CLAIM APPLICATION

This Legal Compromise Claim Application (the "Application") is made on by and between Claimant Name: and Respondent Name: .

Individual    Corporation    Partnership    Other:

RECITALS

WHEREAS, Claimant asserts that Claimant has sustained damages and losses arising out of or related to the incident identified as Claim Reference: which allegedly occurred on .

WHEREAS, the parties wish to avoid the time, expense, and uncertainty of litigation or administrative proceedings and desire to resolve the Claim upon the terms and conditions set forth in this Application.

WHEREAS, Respondent denies liability but is willing to consider compromise settlement subject to the terms herein and subject to appropriate releases and documentation.

NOW, THEREFORE

In consideration of the mutual covenants contained in this Application and other good and valuable consideration, the sufficiency of which is acknowledged, the parties agree as follows:

1. DEFINITIONS

For purposes of this Application, the following terms shall have the meanings set forth below:

"Compromise Amount" means the total gross amount agreed for settlement: .

"Effective Date" means the date on which the last required signature is executed and any specified conditional payments are funded: .

2. DESCRIPTION OF CLAIM

Claim form    Invoices/Receipts    Photographs/Reports    Other:

3. PROPOSED COMPROMISE TERMS

3.1 Compromise Payment. Respondent agrees to pay the Compromise Amount to Claimant as consideration for the release described in Section 5. The Compromise Amount shall be: .

3.2 Payment Method and Timing. Payment shall be made as follows:

Single lump-sum payment on or before .

Installment payments as set forth below:

4. PAYMENT INSTRUCTIONS

Check    Wire transfer    Other:

5. RELEASE & WAIVER

Upon receipt in cleared funds of the full Compromise Amount in accordance with Section 3, Claimant shall execute and deliver a full and final release in form reasonably acceptable to Respondent, releasing Respondent and its agents, employees, successors and assigns from all claims, demands, causes of action, obligations and liabilities, whether known or unknown, arising out of or related to the Claim, to the fullest extent permitted by law.

Claimant acknowledges and agrees that this compromise and any payments hereunder do not constitute an admission of liability by Respondent, and that Respondent expressly disclaims any admission of wrongdoing.

6. CONFIDENTIALITY

Except as required by law, the parties shall keep the terms, amount, and conditions of this Application and any settlement documents confidential and shall not disclose such information to third parties without the prior written consent of the other party. Notwithstanding the foregoing, disclosure is permitted to legal and financial advisors who agree to maintain confidentiality.

7. REPRESENTATIONS AND WARRANTIES

Each party represents and warrants that it has full authority to enter into this Application, that the signatory is authorized to bind the party, and that this Application constitutes a valid and binding obligation enforceable against such party in accordance with its terms.

8. REMEDIES AND NO FURTHER CLAIMS

Upon execution of the release provided for in Section 5, Claimant shall have no further claim against Respondent relating to the matters released herein. The parties acknowledge that monetary damages are the sole remedy available in respect of any breach of the payment obligations under this Application, subject to equitable relief where applicable.

9. NOTICES

All notices required or permitted under this Application shall be in writing and delivered to the addresses set forth below or to such other address as a party may specify in writing. Notices shall be deemed given upon personal delivery, confirmed delivery by overnight courier, or three (3) days after deposit in the United States mail, postage prepaid, certified or registered.

10. AMENDMENTS; WAIVER

This Application may be amended or modified only by a writing signed by both parties. No waiver of any provision shall be effective unless in writing and signed by the party against whom enforcement is sought. No failure or delay in exercising any right shall operate as a waiver.

11. GOVERNING LAW; VENUE

This Application shall be governed by and construed in accordance with the laws of the State of , without regard to principles of conflicts of law. The parties submit to the exclusive jurisdiction of the state and federal courts located in that state for any action arising out of this Application.

12. ENTIRE AGREEMENT; SEVERABILITY

This Application constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior negotiations, representations, and agreements, whether written or oral. If any provision is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

13. COUNTERPARTS; AUTHORITY

This Application 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. Each person signing on behalf of a party represents and warrants that they are duly authorized to sign and bind that party.

Sign Now