Legal Settlement Consent Form

LEGAL SETTLEMENT CONSENT FORM

This Legal Settlement Consent Form (the Agreement) is made and entered into as of , by and between Claimant Name: with address (Claimant), and Respondent Name: with address (Respondent).

Recitals

WHEREAS, Claimant has asserted certain claims against Respondent arising out of the events described as: (the Dispute), including any claims identified by Docket Number ; and

WHEREAS, the parties desire to resolve and settle fully and finally all claims, disputes, and causes of action between them without admission of liability and to memorialize the terms of their agreement in writing; and

WHEREAS, the parties acknowledge that settlement is in their mutual interest and intend that this Agreement be a complete and final settlement of the Dispute.

Now, Therefore

NOW THEREFORE, in consideration of the mutual promises and covenants contained herein and for other good and valuable consideration, the sufficiency of which is acknowledged, the parties agree as follows:

1. Definitions

For purposes of this Agreement, the following terms shall have the meanings set forth: "Released Claims" means all claims, demands, causes of action, liabilities, costs and damages, whether known or unknown, asserted or unasserted, that relate to the Dispute and that exist as of the Effective Date.

2. Settlement Payment

In full and final settlement of the Released Claims, Respondent shall pay to Claimant the sum of (Settlement Amount) in accordance with the following terms: Payment Method: ; Payment Due Date: , .

If payment is to be made in installments, the installment schedule shall be set forth in the Settlement Schedule attached as Exhibit A and incorporated by reference. Time is of the essence with respect to the payment obligations herein.

3. Release

Upon receipt of the Settlement Amount in full, Claimant, for itself and its heirs, executors, administrators, assigns and agents, hereby fully, finally and forever releases and discharges Respondent and its past, present and future affiliates, subsidiaries, officers, directors, employees, agents and insurers (the Released Parties) from any and all Released Claims. The foregoing release expressly includes unknown and unanticipated claims to the maximum extent permitted by law.

4. No Admission of Liability

The parties expressly agree that this Agreement and compliance with this Agreement shall not be construed as, or deemed to be, an admission of liability, fault, wrongdoing or responsibility by any party, and such liability is expressly denied.

5. Confidentiality

The parties agree that the terms, amount, and existence of this settlement shall be confidential and shall not be disclosed to any third party except as required by law, regulation, or to the parties' legal and financial advisors who agree to maintain confidentiality; or not confidential. Any permitted disclosure must include substantially similar confidentiality protections.

6. Dismissal; Cooperation

Promptly after receipt of the Settlement Amount, Claimant shall take all reasonable steps to dismiss with prejudice any pending actions related to the Dispute and shall execute and deliver any documents reasonably necessary to effectuate the dismissal. Each party agrees to cooperate in good faith to effect the terms of this Agreement.

7. Attorneys' Fees and Costs

Except as otherwise provided in a separate written agreement, each party shall bear its own attorneys' fees and costs incurred in connection with the Dispute and the negotiation and execution of this Agreement. Any agreement concerning payment of fees or costs shall be set forth in writing and signed by the parties.

8. Indemnification

Each party agrees to defend, indemnify and hold harmless the other party from and against any third-party claims arising out of any breach of this Agreement or any representations or warranties made herein.

9. Taxes

Each party shall be responsible for any taxes assessed against that party as a result of the Settlement Amount. To the extent required by law, taxes shall be deducted or withheld from payments, and the responsible party shall provide appropriate documentation to the other party.

10. Representations and Warranties

Each party represents and warrants that: (a) it has full authority to enter into this Agreement; (b) the person signing on its behalf is duly authorized to execute this Agreement; and (c) upon execution, this Agreement will constitute a legal, valid and binding obligation enforceable against such party.

11. Notices

All notices required or permitted under this Agreement shall be in writing and delivered to the addresses set forth below or to such other address as either party may designate in writing.

12. Amendments; Waiver

This Agreement may be amended or modified only by a written instrument signed by both parties. No waiver by any party of any breach shall be effective unless in writing and signed by the waiving party, and no waiver shall constitute a waiver of any other or subsequent breach.

13. Counterparts; Electronic Execution

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. Signatures transmitted by electronic means (including scanned signatures delivered by electronic mail) shall be binding.

14. Governing Law; Severability; Entire Agreement

This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to its principles of conflicts of law. If any provision of this Agreement is held to be invalid or unenforceable, the remaining provisions shall continue in full force and effect. This Agreement constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous negotiations, representations and agreements, whether written or oral.

15. Miscellaneous

Each party acknowledges that it has read this Agreement, understands its contents, and signs it voluntarily. The headings in this Agreement are for convenience only and shall not affect interpretation.

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