HomeMy WebLinkAbout20170518 Peterson-Sfx5 Release 1958591RELEASE OF ALL CLAIMS
KNOW AI.1. MEN BY THESE PRESENTS:
That the Undersigned, being of lawful age, for sole consideration of One Thousand Three
Hundred Forty -One and 72/100 Dollars ($1,341.72) to he paid to Nicole Peterson do/does hereby arid for my/our/its heirs, executors,
administralots, SuCcessor:s and assigns release, acquit and forcve.r discharge City of Satz Luis Obispo, Californian 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 clain)s, 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 anti property damage and the consequences thereof resulting or to result from the accident, casualty or
event which occurred on or about the 17tr' day of ]March, 2017, at Or near 1.311 Fredericks Street, San Luis Obispo, CA 93405.
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 Cite 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 ]taw ofany state or territory of
the United States are hereby expressly waived. Said section reads as follows:
"1542. Pertain claims not affected by general release. A general release does not extend to claims which alae creditor does not
knew or suspect to exist in his favor at the time of executing the release, which if known by hill) must have materially affcca.ed
his settlement with the debtor."
The undersigned hereby declare(s) and represunl(s) that the, injuries sustained are or may he 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 judgnnent, belief and knowledge ofthe nater€,, extent, effect, and duration of said injuries and liability therefor and is tirade without.
reliance upon any statement or representation of the party or parties hereby relea+;ed or their representatives or by any physician or surgeon by
then) employed.
The undersigned further declare(s) and represerit(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 merit recital,
I hereby represent that at the time 1 sign this Release l am not hospitalized in a medical facility nor was I admitted to a medical facility within (tic,
past 15 days.
'I'tIE IJNDERSIG ED HAS It D TI3E ABO VE AND rtjL..LY UNDERSTANDS IT TO BE A FULL AND RNAL RELEASE OF ALL CLAIMS.
deliver d this day t►f ----,
A(ft
ll<ss of wi Signature .-.
-Witness sign" lur..
Address of witness Signature
F'or 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 sarbjett to fines
and c-onfine.tnent in state prison.
state of
County of
Before me this
ACKNOWLEDGMENT UNDER OAT1l
SS
day of _ carne
known to n)e to be.: the individual who executed this release, and acknowledged that
contents and freely executed same: for the sole consideration therein expressed.
CAA file: 1958501-5fx5
fully understood its
Notary Public
Cwt)72