Legal Waiver Report

LEGAL WAIVER REPORT

This Legal Waiver Report (the Report) is executed as of by and between Waiving Party: whose principal address is , and Released Party: whose principal address is .

RECITALS

WHEREAS, on or about an incident occurred at or regarding the location (the Incident) involving the matters described in this Report;

WHEREAS, the Waiving Party asserts or may assert claims, demands, causes of action or liabilities, known or unknown, arising out of or related to the Incident (collectively, the Claims); and

WHEREAS, the parties desire to set forth in writing the facts, the scope of any waiver and release, and the administrative particulars for the resolution and reporting of the Claims without admission of liability.

NOW, THEREFORE

NOW, THEREFORE, in consideration of the mutual covenants and agreements contained in this Report and for other good and valuable consideration, receipt of which is hereby acknowledged, the parties agree as follows.

1. REPORT IDENTIFIERS

2. FACTUAL SUMMARY

3. WAIVER AND RELEASE

3.1 Waiver and Release. Subject to the terms and limitations set forth in this Report, the Waiving Party knowingly, voluntarily and intentionally waives, releases, and forever discharges the Released Party and its past and present affiliates, officers, directors, employees, agents, successors and assigns (Released Persons) from any and all Claims, liabilities, demands, causes of action, losses or damages of every kind and nature, whether known or unknown, suspected or unsuspected, asserted or unasserted, which relate to, arise out of, or are in any way connected with the Incident.

3.2 Scope. The waiver and release described in Section 3.1 is intended to be broad and inclusive. It includes, without limitation, claims for personal injury, property damage, economic loss, attorney's fees, costs and expenses. This waiver does not apply to obligations that are expressly stated in writing and signed by the Released Party after the Effective Date.

4. CONSIDERATION

4.1 Consideration. The Waiving Party acknowledges receipt of good and valuable consideration, the adequacy of which is acknowledged, and which the parties agree is sufficient to support the waiver and release set forth herein. The specific consideration is described as follows:

5. REPRESENTATIONS AND WARRANTIES

5.1 The Waiving Party represents and warrants that the Waiving Party is the sole owner of the Claims being waived, that the Waiving Party has full authority to execute this Report, and that the Waiving Party has not assigned or otherwise transferred any portion of the Claims to any third party.

5.2 The Waiving Party further represents that, to the best of its knowledge, there are no additional material facts relating to the Incident that have not been disclosed in this Report which would materially affect the Released Party's evaluation of the waiver.

The Waiving Party acknowledges that they have read and understand the representations above and confirm the completeness of the facts disclosed.

6. INDEMNIFICATION

6.1 Indemnification. The Waiving Party shall indemnify and hold harmless the Released Persons from and against any and all losses, costs, liabilities, claims, demands and expenses (including reasonable attorney's fees) arising out of any breach of the representations, warranties or covenants made by the Waiving Party in this Report.

7. NO ADMISSION OF LIABILITY

7.1 No Admission. The parties agree that execution of this Report and any payment or performance made pursuant to it is not and shall not be construed as an admission of liability by any party for any purpose.

8. CONFIDENTIALITY

8.1 Confidentiality. The parties agree to keep the terms and existence of this Report confidential, except as required by law or as necessary to enforce its terms. Disclosure to accountants, legal counsel, insurers, or as required by judicial process is permitted provided that reasonable efforts are made to limit further dissemination.

9. NOTICES

9.1 All notices, requests, demands and other communications under this Report shall be in writing and delivered to the parties at the addresses set forth below or to such other address as either party may designate by notice pursuant to this section.

10. AMENDMENTS AND WAIVER

10.1 Amendment. This Report may be amended or modified only by a written instrument signed by both parties. No oral modification will be effective.

10.2 Waiver. No failure or delay by any party in exercising any right under this Report will operate as a waiver of that right. A waiver must be in writing and signed by the waiving party.

11. GOVERNING LAW; VENUE

11.1 Governing Law. This Report shall be governed by and construed in accordance with the laws of the state of , without regard to conflict of law principles.

11.2 Venue. The parties agree that exclusive jurisdiction and venue for any dispute arising from or relating to this Report shall lie in the state and federal courts located within the jurisdiction identified above.

12. ENTIRE AGREEMENT

12.1 Integration. This Report 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 written or oral.

13. SEVERABILITY

13.1 Severability. If any provision of this Report is held invalid or unenforceable by a court of competent jurisdiction, the remaining provisions will remain in full force and effect to the fullest extent permitted by law.

14. COUNTERPARTS

14.1 Counterparts. This Report may be executed in counterparts, each of which will be deemed an original and all of which together will constitute one and the same instrument. Signatures delivered electronically will be binding for all purposes.

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