HomeMy WebLinkAbout20170206 Dingman Release 1953653RELEASE OF ALL CLAIMS
KNOW ALL MEN BY THESE PRESENTS:
That the Undersigned, being of lawful age, for sole consideration of One Hundred Sixty -
Seven and 40/100 Dollars ($167.40) to be paid to Denise Dingman 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 agents, servants, successors, heirs,
executors, administrators and all other persons, firms, corporations, associations or partnerships of and from any and all claims, actions, causes of
action, demands, rights, damages, costs, loss of service, expenses and compensation whatsoever, which the undersigned now has/have or which
may hereafter accrue on account of or in any way growing 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 9' day of December, 2016, at or near 872 Morro Street (in front of the AT&T building), San Luis Obispo, CA 93401.
It is understood and agreed that this settlement is the compromise of a doubtful and disputed claim, and that the payment made is not to be
construed as 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 agreed that all rights under Section 1542 of the Civil Code of California and any similar law of any state or territory of
the United States are hereby expressly waived. 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 the release, which if known by him must have materially affected
his settlement with the debtor."
The undersigned hereby declare(s) and represent(s) that the injuries sustained are or may be permanent and progressive and that recovery
therefrom is uncertain and indefinite and in making this Release it is understood and agreed, that the undersigned rely(ies) wholly upon the
undersigned's judgment, belief and knowledge of the nature, extent, effect, and duration of said injuries and liability therefor and is made without
reliance upon any statement or representation of the party or parties hereby released or their representatives or by any physician or surgeon by
them employed.
The undersigned further declare(s) and represent(s) that no promise, inducement or agreement not herein expressed has been made to the
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 mere recital.
1 hereby represent that at the time I sign this Release I am not hospitalized in a medical facility nor was I admitted to a medical facility within the
past 15 days.
THE UNDERSIGNED HAS READ THE ABOVE D FULLY UNDERSTANDS IT TO BEA FULL AND FINAL RELEASE OF ALL CLAIMS.
Signed, sealed and delivered this it �• day of
Witness to signature
Address of Witness
Witness to signature
Address of Witness
Signature
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 fines
and confinement instate prison.
f r q
State of ACKNOWLEDGMENT UNDER OATH
QIU�IJ�4%lt`G �7
County of idll Lois, Avg SS
Before me this 1 tt A day of kllVal 2017 came
il„ole o n .. 17
known to me to be the individual who executed this release, and acknowledged that
contents and freely executed same for the sole consideration therein expressed.
fully understood its
See Attached for
ary Public
CW File: 1953653 Cw072
CALIFORNIA ALL- PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the identity
of the individual who signed the document to which this certificate is attached,
and not the truthfulness, accuracy, or validity of that document.
State of California
County of 561 Lws 06r
On
7 before me,
C,
personalty appeared %Cf/'2L //f 1 11(X��/?
who proved to me on the basis of satisfactory evi ence to be the person(wwhose
name%) is/ape/subscribed to the within instrument and acknowledged to me that
tVe/she/toy executed the same in h4/her/the rr authorized capacity(jef), and that by
/her/t� signatureKon the instrument {he personal, or the entity upon behalf of
which the personKacted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that
the foregoing paragraph is true and correct.
LEiNNDER CHARLES ULLRICN 1
WITNESS my hand and official seal;' „ !Califorma
21 7 �
s.n.Lw. Obiw County
Kaloda March 12,2020
Notary Publi Signature (Notary Public Seal)
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