HomeMy WebLinkAbout20160209 StateFarmForFrench Release-Original 1919101PROPERTY DAMAGE RELEASE
KNOW ALL MEN BY THF.SF PRFSFNTS:
That the Undersigned., being of lawful age, for sole consideration of Seven
't'housand SixHundred Sixty -Five and I2/1IHl Dollars ($7,fiiti5.12) to be Maid to State Farm Insurance as Subrogee
for Mary French (State Farm Claim No. 55-711G-223) doldoes hereby and for nay/our/its heirs, executors,
administrators. successors and assigns release, accIuit and forever discharge the City of San Luis Obispo, CA and his,
her, their, or its agents, servants, successors, heirs, executors, administrators rind all other persons, firms, corporations,
associations or pkirwerships for and from any and all claims, actions, causes of action, demands, rights, dranages, costs,
loss of service, expenses and compettsation whatsoever, which the undersigned now bass/have or which may hereafter
accrue on account of or in any way growing out of any and all brown and unknown, foreseen and unforeseen property
(Li merge and the cousequerices th.ercof resulting or to result from tine occurren.cc tnt or about the 16th day of August, 2111.5,
at or near the intersection of Osos Street. and Marsh Street, 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 t.tid releasecs deny liability therefor
and intend merely to avoid litigation arid buy their peace. The undersigned further declare(s) arid represent(s) that no
promise, inducement or agreement not herein expressed has been ruade to the undersigned, and that the Release contains
the entire agreement between the pautics hereto, and that the terms of this Release are contractual and not a mere recital.
It is fiu•tllcr atrtderstood and agreed that all rights under Section 1542 of the Civil Code of California and any similar lase
of any state or territory of the United S( a.tcs arc hereby expressly waived. Said section reads as follows:
";1542. Certain claiatZs not affected by general release. A general release dries not extend to claims which
the cre(litor docs not know or suspect to exist in hitt favor at the time of executing the release.., which if
known by hire) must have materially affected his settlenyaent with the debtor."
FOR YOUR PROTECTION CALIFORNIA LAW REQUTIRE:S THE FOLLOWING TO APPEAR ON THIS FORM;
Any person who 1cltowingly presents 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.
T TE UNDERSIGNED HAS READ THE, FOREGOING RE, LEAST AND FULLY UNDERSTANDS IT,
STATUTE OI, L1",%4TTATION8 ON YOi R INWRY CLAIM. IF ANY. EXPIRES ON N/A,
Section 11553 of the Insurance Codc requires that notice be made to you of the following: 1 _ The statute of limitations for.
hodily injury actions expires two years t�onl the date; of accident unless the injured party is a minor. In that case, flee
statute expires two years from the date the minor reaches arajority. (Section 333.1, Code of Civil Procedure). 2. The
statute of liartita.tions for bodily injury against it Goverritnental entity expires six months from the; (late of the notice of
rejection. (Section 045.6 of [lie California Government Code.)
I
Si;�ne(1, se.ale€i an(i cleliverc.d this day of%_.
CAUT1014 READ BEFORE SIGNING IIF.I.f W
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Witness Signature Brian S e er, State Fann Mutual Auto►nobile. insurance _o►npany
CARL ` ARREN& CO
Print Name and Title.
FEB 0 9 2016
Address
,LUIS OBISPO, CA
Address
CA C W FiIc: 1919101 CW082
Providing Insurance and Pinencial Services
Koine Office. Bloomington, IL
February 04, 2016
Carl Warren & Co Sub Auto Litigation Office
Attn: Jim Vosseler PO Box 106172
PO Box 1052 Atlanta GA 30348-6172
Sn Luis Obisp CA 93406-1052;},
'd1
RE: Claim Number: 55-711 G-223
Our Insured: Mary French
Responsible Party: City Of San Luis Obispo-Office Of The City Clerk
Date of Loss: August 16, 2015
Amount of Release: $.14,615.6" .12
Your File Number: 1919101
Mr. Vosseler:
Enclosed is your release which we have executed.
Please forward payment payable to:
State Farm Mutual Automobile Insurance Company
State Farm Insurance Company
ATTN: Subrogation Services
P.O. Box 106172
Atlanta, GA 30348-6172
Thank you for your prompt attention to this matter:
If you have any questions or need additional information, please call me at the number listed
below. If I am not available, any other member of my team may assist you.