HomeMy WebLinkAbout20160901 Pults Release 1947284RELEASE OF ALL CLAIMS
KNOW ALL MPN BY TI ]ESE; PRESENTS:
'float the Undersigned, beim of lawful age, for style consideration of One Hundred Eighty
and 54/100 Dollars ($180.54) to be paid to Steve Pults do/does hereby and for my/our/its heirs, executors, administrators, successors and assigns
release, acquit and forever discharge. City of San Luis Obispo, California and his, her, their, or its agonts, servants, successors, heirs, executors,
administrators and all other persons, firms, corporations, associations or partnerships o1' and from any and all claims, actions, causes of action.
clerr€ands. rights, damages, costs, loss of service, expenses and compensation whatsoever, which the undersigned now has/have or which may
hereafter accrue oil account of or in any way grooving out of any and all known and unknown, foreseen and unforeseen bodily and personal
injuries and property damage and the consequences thereof resulting or to result from the accident, casualty or event which occurred on or about
the 20"' dray of,h►ly, 2016, at or near 340 Huchon Street, San Luis Obispo, CA 93401.
it is understood and agreed that this settlement is the compromise of a doubtlirl and disputed claim, and that the payment made is not to be
con5trued ars an admission of liability on the part of the party or parties hereby released, and that said releases deny liability therefor and intend
merely to avoid litigation ,and buy their peace.
it is further understood and ugnecd that all rights undea' Section 1542 of the Civil Code of California and any similar law of- any state or territory of'
the United States are hereby expressly waiwA. Said section reads as follows:
"1542. Certain claims not affected by general release. A general release does not extend to claims which the creditor does not
know or suspect to exist in his favor at the; time of executing tile, release, which if known by him must have materially aff:€cted
his settlement with the debtor "
'File undersi+fitied hereby declare(s) and represents) that the injuries sustained are or may be permanerit and progressive anti that recovery
therefrom is uncerla.in and indefinite and in making this 1Zeiease it is unde.rsiood and agreed, that the undersigned rely,ies) wholly ul,n the
undcrsig€red s -judgment, belief and knowledge of the nature, extent, effect, and duration of said injuries and liability therefor and is made without
reliance; Upon arty statement or representation of the party or parties hereby released or their representatives or by any physician or surgeon by
there employed.
The undershmod further declare(s) and represent(s) that no promise, inducement or agreement not herein expresscd has been made to tite
undersigned, and that this Release contains the entire agreement between the parties hereto, and that the terms of this Release are contractual and
not a nacre recital,
1 lrereb-v represent that at the. time 1 sign this Release I am not hospitalized in a medical facility nor was I admitted to a medical facility within the
past 15 d;:rys.
-x111 t -NI) R516NUI) HAS REAL) HIV AP 0 1", AND ITl,I,Y 111 , ',ItS f< DS IT TO III,, A I%UTL A ' CIN:1L t;LCA5E OF AIA. ('[.AfNfS.
Signed, sealed and delivered this duty of 1-0 �
Witnctis fir sitmaturcr
A -N "0 +M��� T
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Address of Witness
Srtaiatrrre
For your protection California law requires the following to appear on this form.
Any person who knowingly presents a false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to tinea;
and confinement in state prisort.
ACKNOWLEDGMENT LINDER OATH
Statc of
(;ollnty l7f SS
Bcftare nae this day of___ came
knortin to the to be the: individual who execul�ed this release, and acknowledged that fully underslood its
contents and freely executed same; for the sole consideration therein expressed,
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Not ary Public
CW E=`ilc: 1947284
SEP 0 2016 Cw071.
SX-rLVI.S OBIS O, Clq