Legal Damage Claim Release Form

Legal Damage Claim Release Form

THIS RELEASE (the "Release") is made on by and between Claimant Name: of Address: and Releasee Name: of Address: .

RECITALS

WHEREAS, on or about (the "Incident Date"), an event occurred involving alleged damage to property and/or person described as:

WHEREAS, Claimant submitted a claim identified by Claim Number: and has asserted damages in the aggregate amount of $ (the "Claim"); and

WHEREAS, the parties desire to settle and fully and finally resolve all disputes, liabilities and claims arising from or related to the Incident Date and the Claim, subject to the terms and conditions set forth in this Release.

NOW, THEREFORE

In consideration of the mutual covenants and promises contained herein 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 Release, the following terms shall have the meanings set forth below: "Claim" means the claim set forth in the Recitals; "Released Parties" means Releasee and Releasee's past and present officers, directors, employees, agents, insurers, attorneys, successors and assigns.

2. RELEASE

Claimant, on behalf of Claimant and Claimant's heirs, executors, administrators, representatives, agents, insurers and assigns, hereby fully, finally and forever releases, relinquishes, and discharges the Released Parties from any and all claims, demands, actions, causes of action, suits, rights, liabilities, obligations, damages, losses and expenses of any nature whatsoever, whether known or unknown, suspected or unsuspected, which Claimant has, had, or may have arising out of or relating to the Incident Date and the Claim, including but not limited to claims for property damage, personal injury, consequential damages, and attorneys' fees.

3. CONSIDERATION AND PAYMENT

In exchange for the Release, Releasee agrees to pay Claimant the total sum of $ (the "Settlement Payment"), to be paid as follows:

Payment Method (select applicable): Check Wire Transfer Other

If Other, describe:

Payment shall be delivered to Claimant at:

4. SCOPE OF RELEASE; KNOWN AND UNKNOWN CLAIMS

The parties intend that this Release shall be construed as a full and complete release of all claims whether presently known or unknown. Claimant expressly acknowledges that Claimant is aware that Claimant may discover facts in addition to or different from those facts now known or believed to be true with respect to the matters released, and agrees that this Release shall be and remain in effect as a full and complete release notwithstanding such different or additional facts. To the extent any jurisdiction prohibits release of unknown claims without express waiver, Claimant expressly waives any such prohibition to the fullest extent permitted by law.

5. REPRESENTATIONS AND WARRANTIES

Claimant represents and warrants that Claimant has the full right, power and authority to enter into this Release and to execute the same, that Claimant has not assigned or transferred any interest in the Claim to any third party, and that Claimant has not previously released any of the Released Parties from the Claim. Claimant further warrants that Claimant will execute any further documents reasonably necessary to effectuate the terms of this Release.

6. COVENANT NOT TO SUE

In consideration of the Settlement Payment and other undertakings herein, Claimant covenants and agrees not to institute, join, maintain or permit to be maintained any action, claim or proceeding against the Released Parties arising out of or relating to the Incident Date and the Claim.

7. CONFIDENTIALITY

The parties agree that the terms, existence and amount of this settlement shall remain confidential and shall not be disclosed to any person or entity except as required by law, as necessary to implement its terms, or to Claimant's immediate family, tax advisor, or counsel, provided such persons are informed of and agree to maintain the confidentiality of this Release.

8. NO ADMISSION OF LIABILITY

The parties agree that this Release is a compromise of disputed claims and that the payment and the execution of this Release shall not be construed as an admission of liability or fault by Releasee, all such liability being expressly denied.

9. INDEMNIFICATION

Each party agrees to defend, indemnify and hold harmless the other party from and against any and all claims, demands, losses or liabilities (including reasonable attorneys' fees) arising out of any breach of the representations, warranties or covenants made by such party in this Release.

10. NOTICES

Any notice required or permitted under this Release shall be given in writing and delivered to the addresses set forth below or to such other address as any party may designate in writing in accordance with this section.

11. GOVERNING LAW

This Release shall be governed by and construed in accordance with the laws of the state of without regard to its conflicts of law principles.

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, representations and understandings, whether oral or written.

13. SEVERABILITY

If any provision of this Release is determined 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.

14. AMENDMENTS; WAIVER

No amendment, modification or waiver of any provision of this Release shall be effective unless in writing and signed by both parties. The failure of any party to insist upon strict performance of any covenant or obligation shall not be deemed a waiver of such party's right to enforce the same in the future.

15. COUNTERPARTS; SIGNATURES

This Release 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. Signatures delivered by electronic means shall be deemed original signatures for all purposes.

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