HomeMy WebLinkAbout20171017 Starr Signed Release 19709224
RELEASE OF ALL CLAIMS
KNOW ALL MEN BY THESE PRESENTS:
That the Undersigned, being of lawful age, for sole consideration of Two Hundred Forty Six
& 63/100 Dollars ($246.63) to be paid to Ruth Starr do/does hereby and for my/our/its heirs, executors, administrators, successors and assigns
release, acquit and forever discharge the City of San Luis Obispo, Steve Gonzalez, Mattheew Polkow and Devin Reiss 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 18th day of August 2017, at or near 1621 Gathe, San Luis Obispo, CA .
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 lit(g_,rien and buy &.cir 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 AND FULLY UNDERSTANDS IT TO BE A FULL AND FINAL RELEASE OF ALL CLAIMS.
Signed, sealed and delivered this Z day of X G G i , I 7 .
Witness to signature
Address of Witness
Witness to signature
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 in state prison.
ACKNOWLEDGMENT UNDER OATH
State of
County of SS
Before me this day of
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.
came
fully understood its
Notary Public
CW File: 1970922•LFM CW072