Legal Response Statement

LEGAL RESPONSE STATEMENT

This Legal Response Statement ("Statement") is made and entered into by and between Respondent Name: , entity type: Individual Corporation LLC Other , with principal address: (hereinafter "Respondent"), and Claimant Name: , with principal address: (hereinafter "Claimant"), effective as of .

RECITALS

WHEREAS, Claimant has asserted certain claims, demands or alleged facts identified as Reference or Claim Number: relating to the subject matter described in this Statement; and

WHEREAS, Respondent intends to provide a formal written response to the factual and legal assertions made by Claimant and to certify those responses under penalty of perjury where applicable; and

WHEREAS, the parties desire to set forth the Respondent's statement of facts, admissions, denials, qualifications, and certifications in a single written instrument binding upon the signatory party.

NOW, THEREFORE, in consideration of the mutual covenants and representations set forth below, the parties agree as follows:

1. DEFINITIONS

For purposes of this Statement, the following terms shall have the meanings set forth below: "Statement" means this Legal Response Statement; "Document" means any written, electronic or recorded material produced in connection with the matters described herein; "Parties" means Claimant and Respondent collectively.

2. STATEMENT OF RESPONSE

Respondent hereby submits the following statement in response to Claimant's assertions. The response contains factual statements, admissions, denials, and qualifications. Respondent affirms that the information provided below is true and correct to the best of Respondent's knowledge, information, and belief.

3. REPRESENTATIONS AND WARRANTIES

Respondent represents and warrants that: (a) the statements contained in Section 2 are true and represent Respondent's present recollection and position; (b) Respondent has authority to make the statements and execute this Statement; and (c) Respondent will promptly supplement this Statement with any material correction, amendment or additional information that would render any statement inaccurate in a material respect.

4. CONFIDENTIALITY

Except as required by law, court order, or regulatory process, the parties agree that the content of this Statement and any non-public documents exchanged in connection with it shall be maintained as confidential and used solely for the purposes of resolving, evaluating, or adjudicating the claims between the parties. Disclosure of confidential information to third parties shall require prior written consent of the disclosing party, which consent shall not be unreasonably withheld.

5. USE AND AUTHORIZATION

Respondent authorizes Claimant and Claimant's counsel to rely on the factual statements contained herein for the limited purpose of investigation, negotiation, settlement, or litigation. Such reliance shall not extend to any waiver of legal defenses except as expressly set forth in writing and signed by Respondent.

6. INDEMNIFICATION

Respondent agrees to indemnify and hold harmless Claimant, and Claimant's officers, directors and agents, from and against any damages, liabilities, losses, or costs (including reasonable attorneys' fees) arising from any knowingly false statement or material omission made by Respondent in this Statement.

7. NOTICES

Any notice, demand, or other communication required or permitted under this Statement shall be in writing and shall be deemed properly given if delivered personally, sent by certified mail, return receipt requested, or delivered by recognized 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.

8. AMENDMENTS AND WAIVER

No amendment, modification, or waiver of any provision of this Statement shall be effective unless in writing and signed by authorized representatives of both parties. The failure of either party to enforce any provision of this Statement shall not constitute a waiver of such provision or of the right to enforce it subsequently.

9. GOVERNING LAW

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

10. ENTIRE AGREEMENT; SEVERABILITY; COUNTERPARTS

This Statement constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior agreements and understandings. If any provision of this Statement is held to be invalid or unenforceable by a court of competent jurisdiction, the remainder of the Statement shall remain in full force and effect. This Statement 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.

CERTIFICATION

By signing below, the signatory certifies under penalty of perjury under the laws of the governing jurisdiction that the statements made in this Statement are true, correct and complete to the best of the signatory's knowledge, information and belief.

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