HomeMy WebLinkAbout20160307 Parks Release 1928696RELEASE OF AHI, CLAIMS
KNOW A1..1, MEN BY THESE PRESENTS:
That the Undersigned, being of lawful age, for sole consideration of Five Thousand and
00/100 Dollars (55,000.00) to be paid to !liana Carol Parks 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 alit! all other persons, firms, corporations, associations or partnerships of and Froin any and all claims_, actions, causes of
action, demands, rights, damages, costs, loss of service, expenses and compensation whatsoever, which the undersigned now haslhave or which
may lhcreafter 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 tlae consequences thereof resulting, or to result from the accident, casualty or event which occurred on or about
the 10i' day of November, 2015, at or near the southwest corner of Casa Street and Foothill Boulevard, San Luis Obispo, CA.
U is tmderstood 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 adinissJon of liability on the part of the party or parties he.rehy releRwd, and thnt said releasee 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 Caliiornia and any similar law of any slate or territory of
the United States are hereby expressly waived. Said section reads as follows:
"1542. Certain claims riot affected by general release. A general releasc does not extend to claims which the creditor does not
know or suspect tA) exist in his favor at the time of executing the release, which if known by him mast have materially affected
his settlement with the debtor."
The undersigned hereby declare(s) and represent(s) that the injuries sustained arc or may be permanent and progressive and that recovery
the:refronn is uncertain and indefinite and in ranking this RelcaSL it is understood and agreed, that the undersigncd rely(ics) wholly upon the
undersigned's jrrdgrrrent, bolief-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
thein 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 Rcicasc contains the entire agreement between the parties hereto, and that the terms of this Release are contractual and
not a metre recital.
I hereby represent that at tire time l sign this Release I am not hospitalized in a medical facility nor was l admitted to a medical facility within the.
past 15 drays.
1-11 E IiNDERSIGNI:D HAS READ THF, ABOVE AND IT -1-0 RE A FULL AND FINAL RELEASE 01 ALL. C AIMS.
Sigrrc4, pealed arae liyeri-cfitais day of
, 'rN`iLit rns to signature
Addra.ss ol`Wilne;
Witness tosignature
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 claire for the payment of a loss is guilty of a crime and may be sul. ject to fines
and confinement in sty to prison.
State of
County of
Before 1110 this
day of
AC, KNOW LEDGMENT UNDER OATH
SS
carne
known to me to be the individual who executed this release, ane] acknowledged that
contents and freely executed same for the sole consideration therein expressed.
XXEX& Co
(AV Dile: 1928696 ma 0
5X9 , VIS OBISPO,
fully understood its
Notary Public
C V 072