Personal Injury Settlement Agreement

PERSONAL INJURY SETTLEMENT AGREEMENT

This Personal Injury Settlement Agreement ("Agreement") is made and entered into as of by and between Claimant Name: (hereinafter "Claimant") and Releasee Name: (hereinafter "Releasee"). Claimant and Releasee are collectively referred to as the "Parties."

RECITALS

WHEREAS, on or about , Claimant sustained personal injuries arising out of an incident described as:

WHEREAS, Claimant has asserted or may assert claims for damages related to the incident against Releasee, and Claimant and Releasee desire to resolve fully and finally all such claims and disputes without further litigation or trial.

WHEREAS, Releasee denies liability but is willing to effectuate a settlement to avoid the expense, inconvenience, and uncertainty of continued litigation.

NOW, THEREFORE

In consideration of the foregoing recitals and the mutual covenants and agreements set forth below, the Parties agree as follows:

1. DEFINITIONS

For purposes of this Agreement, capitalized terms shall have the meanings set forth herein: "Claim" means any and all claims, demands, causes of action, suits, liabilities, obligations, damages, losses, costs and expenses (including attorneys' fees and costs) whether known or unknown, suspected or unsuspected, arising out of or in any way related to the incident described above. "Action" means any lawsuit or administrative proceeding filed by Claimant in relation to the Claim.

2. SETTLEMENT PAYMENT

In full and final settlement of all Claims, Releasee shall pay to Claimant the total sum of $ (the "Settlement Amount"). The Settlement Amount shall be payable as follows:

(a) Payment Method: . Payment shall be delivered to the address for notices set forth in Section 12 or to Claimant's counsel at:

(b) Timing: Payment shall be made within days following receipt by Releasee of a fully executed copy of this Agreement and any required proof of authority to execute.

3. RELEASE

In consideration of the Settlement Amount, Claimant, on behalf of Claimant and Claimant's heirs, executors, administrators, successors and assigns, hereby fully and forever releases and discharges Releasee and Releasee's past, present and future owners, directors, officers, employees, agents, insurers, attorneys, successors and assigns (collectively "Released Parties") from any and all Claims, demands, actions, causes of action, suits, debts, liens, contracts, agreements, obligations, damages and liabilities of every kind and nature, whether known or unknown, suspected or unsuspected, asserted or unasserted, which Claimant now has or ever had, arising out of or related to the incident described herein through the Effective Date of this Agreement.

Claimant expressly acknowledges that this release includes, without limitation, all claims for personal injury, emotional distress, property damage, and any other losses or expenses related to the incident and that Claimant is familiar with the legal effect of releasing unknown claims.

4. NO ADMISSION OF LIABILITY

The Parties agree that this Agreement and the payment of the Settlement Amount are not an admission of liability, wrongdoing, or fault by Releasee, and that Releasee expressly denies any wrongdoing or liability.

5. COVENANT NOT TO SUE; DISMISSAL

Claimant covenants and agrees not to institute, prosecute or assist in the institution or prosecution of any action, claim or proceeding against any Released Party with respect to any Claim released by this Agreement. If an Action exists at the time of execution of this Agreement, Claimant shall, within days after receipt of the Settlement Amount, take all necessary steps to effect a dismissal with prejudice of such Action and will execute and deliver any documents reasonably requested to evidence dismissal and satisfaction.

6. CONFIDENTIALITY

The Parties agree that the terms and existence of this Agreement shall be confidential and shall not be disclosed to any non-party except as required by law, to obtain legal or tax advice, for tax reporting purposes, or to enforce the terms of this Agreement.

Check to indicate that the Parties have agreed confidentiality is binding

7. TAXES

Claimant acknowledges and agrees that Claimant is solely responsible for any federal, state, or local taxes, including income taxes or self-employment taxes, imposed on any portion of the Settlement Amount. Releasee makes no representation regarding the tax consequences of the settlement to Claimant. Claimant agrees to indemnify Releasee against any tax obligations assessed against Releasee as a result of payments made under this Agreement that are ultimately held to be Claimant's responsibility.

8. INDEMNIFICATION

Each Party agrees to indemnify and hold the other harmless from and against any losses, claims, costs or expenses (including reasonable attorneys' fees) arising out of any breach of that Party's representations, warranties or obligations under this Agreement.

9. REPRESENTATIONS AND WARRANTIES

Each Party represents and warrants that it has the full power and authority to enter into this Agreement and to perform its obligations hereunder, that the person executing this Agreement on behalf of each corporate entity is authorized to do so, and that the Agreement constitutes the valid and binding obligation of such Party enforceable in accordance with its terms.

10. NOTICES

All notices required or permitted under this Agreement shall be in writing and shall be deemed given when delivered personally, sent by nationally recognized overnight courier, or three days after deposit in the United States mail, postage prepaid, to the addresses set forth below (or such other address as a Party shall designate in writing).

11. AMENDMENT; WAIVER

This Agreement may be amended only by a written instrument signed by both Parties. No failure or delay by any Party in exercising any right under this Agreement shall operate as a waiver of that right, nor shall any single or partial exercise preclude any other or further exercise of any right or remedy.

12. GOVERNING LAW; VENUE

This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to its conflict of laws principles. Any suit to enforce or interpret this Agreement shall be brought exclusively in the state or federal courts located in the county where the Releasee is located, and the Parties submit to the personal jurisdiction of such courts.

13. ENTIRE AGREEMENT; SEVERABILITY

This Agreement constitutes the entire understanding and agreement between the Parties with respect to the subject matter hereof and supersedes all prior and contemporaneous negotiations, agreements, representations and understandings, whether written or oral. If any provision of this Agreement is determined to be invalid or unenforceable by a court of competent jurisdiction, such provision shall be severed and the remaining provisions shall continue in full force and effect.

14. COUNTERPARTS; AUTHORITY

This Agreement may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one instrument. Electronic signatures and scanned counterparts shall be treated as original signatures for all purposes. Each person signing this Agreement represents and warrants that he or she has been duly authorized to enter into this Agreement on behalf of the Party for whom he or she signs.

15. ATTORNEYS' FEES AND COSTS

Except as otherwise agreed in writing, each Party shall bear its own attorneys' fees, costs and expenses incurred in connection with the negotiation, preparation and execution of this Agreement and any related documents.

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