HomeMy WebLinkAbout20190507_Nichols ReleaseRELEASE OF ALL CLAIMS
iG+TOW ALL MEN BY THESE PRESENTS:
That the Undersigned, being of lawful age, for sole consideration of Two. Hundred Six
and 87h0Q Dollars ($20fi.871 to be paid to Jang, Nichols doldoes hereby and for my/our/its heirs, executors, administrators, successors
and assigns release, acquit and forever discharge the QX of San Luis Obis o and his, her, their, or its agents, servants, successors, heirs,
executors, administrators and all other persons, firths, 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
haslbave 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 ar event which oecurred.on or about the 24s' day of Aonl. 2019, at or near 1705 Gathe.Drive. 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
e< be construed as an admission of liability on the part of the party or parties hereby released, and that said releases deny liability therefor
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and intend merely to avoid litigation and buy their peace.
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j 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
to
territory of the United States are hereby expressly waived. Said section reads as follows.
"I542. A general release does not extend to claims that the creditor or releasing- party does not know or suspect to exist in his
or her favor at the time of executing the release and that, if known by him or her, would have materially affected his or her
settlement with the debtor or released party.`
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 1s
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
evAtractual and not a mare recital.
I hereby represent.that at the time I sign this Release I stn not hospitalized in a medical facility nor was 1 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 day of1�
Witness — Printed Nance
Witness Signature
Address of witness
Address of Witness
For your protection California law requires the following to appear co' this form.
Any person who knowingly presents a false or fraudulent claim for rhe payment of a loss is guilty of a crime and may be subject to flues
and confinement in state prison.