HomeMy WebLinkAbout20181026 OrtizIII Release 1986768n
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RELEASE OF ALL CLAIMS
KNOW ALL MEN BY THESE PRESENTS:
That the Undersigned, being of lawful ape, for sole consideration of Two Hundred and
001100 Dollars ($200.00) to be paid to Juventino Ortiz III 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 11P day of October, 2018, at or near Los Osos Valley Road approaching Los Palos Drive, San Lab 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 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 arc liereby 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(i) 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 parry 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.
I hereby represent that at the time I sign this Release 1 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.
Signe, led and deliv day of
�'�, Wil ness to to //
Address of Witness Signature
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 in state prison.
ACKNOWLEDGMENT UNDER OATH
State of
County of
Before me this
day of
I Ss
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.
CW File: 1986768
came
fully understood its
Notary Public
CW072