Alabama Anytown County Environmental Covenant

GENERAL RELEASE AND SETTLEMENT AGREEMENT

STATE OF ALABAMA

COUNTY OF

KNOW ALL MEN BY THESE PRESENTS: That I, the undersigned,

for the sole consideration of DOLLARS ($),

in hand paid by and DOLLARS

($ and being hereinafter referred to as "Releasees"), being a total

consideration of $ the receipt of which is hereby acknowledged, do release

and discharge and by these presents do for myself, my heirs, executors, administrators, assigns,

and any other person, firm or entity that makes claim for any of the above stated consideration or

the proceeds thereto, hereby release and forever discharge the Releasees, any and all of their or

its agents, employees, subsidiaries, related businesses or assigns and any and all persons, firms or

and corporations, both known and unknown, of and from any and all claims, demands, actions,

and causes of action, prior to and including the present date hereof, relating in any manner

whatsoever to any injuries, both to person or property, resulting, to result from or relating in any

manner whatsoever to the incident and/or accident that occurred on or about

in Alabama.

I, the undersigned, do hereby represent and warrant to said Releasees that if there is a

valid subrogation claim, by any individual or business entity, that said subrogation claim shall be

satisfied out of the above stated consideration. I further warrant and represent that if any

individual or business entity makes claim against any of the Releasees for any rights to monies

paid as a result of the accident then I will indemnify and hold harmless the Releasees for the

amount of any judgment plus costs and attorneys* fees in defending said action.

I hereby further certify that I have received no notice that any hospital or other medical

service provider by which plaintiff has been treated claims a lien for

charges for medical care or treatment or maintenance upon funds paid to me. In the event that

such a lien should be claimed, I hereby agree to satisfy said lien out of the above stated

consideration. In the event that such a lien should be claimed and it is not satisfied by me. I

hereby agree to indemnify and hold harmless the Releasees from any claim made against them

based upon said lien.

Claimant hereby acknowledges and agrees that the release set forth above is a general

release and Claimant further expressly waives and assumes the risk of any and all claims for

damages which exist as of this date but of which the Claimant does not know or suspect to exist,

whether through ignorance, oversight, error, negligence, or otherwise, and which, if known,

would materially affect Claimant*s decision to enter into this settlement agreement. The

Claimant further agrees that he has accepted payment of the above sum as a complete and full

compromise of disputed issues of law and fact and assumes the risk that the facts or law may be

otherwise than he knows.

I understand that the Releasees, by reason of agreement to this compromise settlement,

do not admit liability of any sort and, that Releasees deny any liability and that the Releasees

have made no agreement or promise to do or omit to do any act or thing not herein set forth. I

further understand that this Release is made as a compromise to avoid expense and to terminate

all controversy and claims for damages of whatsoever nature both known and unknown,

including any future developments hereof in any way growing out of or connected with the

accident. I admit that no representation of fact or opinion has been made by the Releasees or

anyone on their behalf to induce this compromise with respect to the extent or permanency of

any alleged damages or as to the likelihood of any future complications therefrom; that the sum

paid is solely by way of compromise of a disputed claim; and that in determining said sum, there

has been taken into consideration the fact that serious or unexpected consequences might result

from damages, both, known and unknown, from the accident, and it is therefore specifically

agreed that this Release shall be a complete bar to all claims or suits for injuries or damages of,

whatsoever nature resulting or to result from said accident.

In further consideration of the above payment, the undersigned agrees to dismiss with

prejudice, with each party to bear his, her or its own costs, the lawsuit styled

Civil Action Number pending in the Circuit Court for

County Alabama, and to file no other claim or lawsuit arising out of the accident.

IN WITNESS WHEREOF, I HAVE HERETO SET MY HAND THIS THE DAY OF

Approved:

Attorney for the Plaintiff

STATE OF ALABAMA

COUNTY OF

I, the undersigned authority, a Notary Public in and for said County, in said State,

do hereby certify that whose name is signed to the foregoing General

Release and Settlement Agreement and who is known to me, acknowledged before me on this

day, that, being informed of the contents of the General Release and Settlement Agreement,

he/she executed the same voluntarily on the day the same bears date.

Given under my hand and official seal, this day of

Notary Public