Personal Injury Settlement Contract

PERSONAL INJURY SETTLEMENT CONTRACT

This Personal Injury Settlement Contract (the Agreement) is entered into as of Effective Date: by and between Claimant Name: with address at Claimant Address: , and Defendant Name: with address at Defendant Address: .

RECITALS

WHEREAS, Claimant alleges that on or about the incident described below Claim Description: Claimant sustained injuries and losses for which Claimant asserts legal claims against Defendant.

WHEREAS, Defendant denies liability for the incident, but the parties desire to avoid the burden, expense and uncertainty of litigation and to resolve all claims between them.

WHEREAS, the parties have negotiated a settlement pursuant to the terms set forth in this Agreement and wish to memorialize the complete and final settlement of all claims known or unknown arising from the incident described above.

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

1. DEFINITIONS

For purposes of this Agreement: (a) "Claim" means any and all claims, causes of action, demands, liabilities, losses, costs and expenses arising from the incident described in Claim Description; (b) "Settlement Amount" means the gross amount to be paid by or on behalf of Defendant to resolve the Claim as set forth in Section 2.

2. SETTLEMENT PAYMENT

Defendant agrees to pay a total gross Settlement Amount of $ to Claimant in full settlement and final resolution of the Claim. Payment shall be made as follows:

(a) Payee for settlement checks: . Any required endorsements or assignments shall be delivered concurrently with execution of this Agreement.

(b) Payment schedule: Defendant shall deliver the Settlement Amount by Payment Method: on or before Payment Date: . If payment is by check, claimant shall endorse and deposit the check within 10 business days of receipt.

(c) Attorneys' fees and costs: From the gross Settlement Amount, attorneys' fees and litigation costs in the approximate amount of $ shall be paid to Claimant's counsel pursuant to counsel's retainer agreement. Any remaining sums shall be paid to Claimant.

3. RELEASE

In consideration of the payment described in Section 2 and other good and valuable consideration, Claimant, on behalf of Claimant's heirs, executors, administrators, successors and assigns, hereby fully and forever releases and discharges Defendant, Defendant's insurers, agents, attorneys, successors and assigns, and all past and present officers, directors, employees and agents of Defendant (collectively, Released Parties), from any and all claims, demands, actions, causes of action, liabilities, damages, losses, costs and expenses of any kind, whether known or unknown, suspected or unsuspected, arising out of or in any way related to the Claim and the incident described in Claim Description, through the Effective Date of this Agreement.

Claimant expressly waives any rights under any statute or common law principle that would limit the effect of a general release with respect to unknown claims, including any law that would otherwise preserve unknown claims.

4. COVENANT NOT TO SUE; DISMISSAL

Claimant covenants that Claimant will not commence or maintain any action or proceeding against any Released Party with respect to the matters released in Section 3. The parties agree to cooperate in good faith to obtain a dismissal with prejudice of any pending lawsuit relating to the Claim and to exchange any documents necessary to effect the dismissal within Dismissal Period: .

5. CONFIDENTIALITY

The parties agree that the terms and amount of this settlement shall be Confidential: Yes No. If confidentiality is selected "Yes," neither party nor their agents shall disclose the terms of settlement except as required by law, to accountants or attorneys on a need-to-know basis, or in connection with the enforcement of this Agreement.

6. REPRESENTATIONS AND WARRANTIES

Each party represents and warrants that: (a) it has full power and authority to enter into this Agreement and to perform its obligations hereunder; (b) this Agreement has been executed by a duly authorized representative; and (c) there are no outstanding releases or encumbrances preventing the performance of the terms of this Agreement.

7. TAXES

Claimant is solely responsible for reporting and paying any federal, state, or local taxes associated with the portion of the Settlement Amount that is taxable. Defendant makes no representations regarding the tax consequences of the settlement.

8. INDEMNIFICATION

Each party shall indemnify, defend and hold harmless the other party from and against any claims, liabilities, losses, damages, costs and expenses (including reasonable attorneys' fees) arising from any breach of that party's representations, warranties or obligations under this Agreement.

9. ATTORNEYS' FEES AND COSTS

Except as otherwise provided in Section 2(c), each party shall bear its own attorneys' fees and costs incurred in connection with the negotiation, preparation and execution of this Agreement. If any action is brought to enforce this Agreement, the prevailing party shall be entitled to recover reasonable attorneys' fees and costs.

10. NOTICES

Notices shall be in writing and shall be deemed given when delivered personally, sent by certified mail return receipt requested, or by nationally recognized overnight courier to the addresses set forth above or to such other address as a party may designate in writing.

11. AMENDMENT, WAIVER, COUNTERPARTS

This Agreement may be amended only by a written instrument signed by all parties. No waiver of any provision or right shall be effective unless in writing signed by the waiving party. This Agreement may be executed in counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument.

12. GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to principles of conflict of laws.

13. ENTIRE AGREEMENT

This Agreement contains the entire understanding and agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings, negotiations and discussions, whether oral or written, between the parties.

14. SEVERABILITY

If any provision of this Agreement is held to be invalid or unenforceable by a court of competent jurisdiction, such holding shall not affect the validity or enforceability of any other provision of this Agreement, which shall remain in full force and effect.

15. ENFORCEMENT

The parties agree that any dispute arising under this Agreement shall be subject to the exclusive jurisdiction of the state and federal courts located within the State of and that venue shall be proper therein.

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