HomeMy WebLinkAbout20180314 Bartley-Sfx1 Release 1965350 � '—�� ��
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� RELEASE OF ALL CLAIMS
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7 KNOW ALL MEN BY THESE PRESENTS:
Q° ' �� That[he�Undersigned, being of lawful age, for sole consideration of Twenty•Six Thousand
(� Five Hundred Thirty-Five and 52/100 Dollazs ($26,535.52) m be paid to Kymba Bartley do/does hereby and for my/our/its heirs, exewtors,
0 adminisVa[ors,successors and assigns release,acquit and forever discharge City of San Luis Obispq California and his,her,their,or iLs agents,
f/1 servants, suwessors,heirs, exewtors, administrators and all o[her persons, firms, corporations, associations or partnerships of and from any and
Zn all claims, actions, causes of action, demands, rights, damages, cos[s, loss of service, expenses and compensation wha[soever, which the
undersigned now has/have or which may hereafter acerue on accou�t of or in any way growing out of any and all known and unknown,foreseen
Z and unforeseen bodily and personal injuries and property damage and the consequences thereof resulting or to result from the accidenh,casualry or
R1 event which occuned on or abou6[he 2nd day of.June,2017,at or neaz 2135�&2137 Beebce Street,San Lyis Obispo,�CA 93401.
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� �It is understood and agreed [hat this set[lemen[ is Ihe compromise of a doubtful and disputed claim, and that Ihe payment made is no[ to be -
D construed as an admission of liability on the part of tke pazty or parties hereby released�, and that said releases deny liability therefor and intend
� merety ro avoid litiga[ion and buy their peace.
A II is further understood and agreed thatall righ[s under Section 1542 of the Civil Code of Califomia and any similaz law of any state or[erritory of �
N the�Uni[ed 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 credi[or does not
� , know or suspecL[o exist in his favor at Ihe time of executing the release,which if known by him must have materially affected
his settlement with the debtor."
The undersigned fiereby, dec!are(s), a�d represent(s) that Ihe injuries sustained are or may be permanent and progressive and that recovery
fherefrom is uncertain and inde6ni[e'and in making this��Ralease�it is unders[ood and agreed, [ha[ the undersigned rely(ies) wholly upon the
� unleisibnc�s j�tig�iicr.l,u-�ic,Pdr.f ic;uwieuge�ui'ii c,u�uiurc;;eXleny eiC�ci;sn¢'�utautin oisuid injurie�.a��u i;auility tUcreforanu�is made�wiu�uui
reliance upon any sta[emen[or representa[ion of the par[y�or parties��hereby released or Iheir represen[atives or by any physician or surgeon by
them employed. ,
The.undersigned further declaze(s) and represent(s) that no promise, inducement or agreement no[ fierein expressed has been made [o the ' �
undersigned,and Iha[[his Release�con[ains-.[he entire agreemen[between the par[ies hereto, and tha[[he teans of this Release are contractual and .
not a mere recital. "
I hereby represent that at the time I sign this Release I am no[.hospitalized in a medical facility nor was I admit[ed to a medical facility within the
pas[15 days. ,
THE UNDERSIGNED HAS READ THE AB�OVE AND F(JLLY UNDERSTANDS TT T BE A FULL AND FINAL R�LE SE OF�b�LAIMS. '
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Signed,sealed and delivered this / � ��day of�li�� ���
Witness[o signature � -
Address of Wi[ness �� � a re�
Wi[ness m signa[ure
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 paymen[of a loss is guilty of a crime and may be subject to fines
and conFinement in s[ate prison.
ACKNOWLEDGMENT UNDER OATH
State of
County of }SS ,
Before me�this day of came '
known to me to be the individual who executed this release,and acknowledged[hat fully understood i[s
contents and freely executed same for the�sole consideration therein expressed.
CW File: 1965350-Sfxl Notary Public
CW072
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. YE�FOqEVER
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CARL WARREN & COMPANY
Claims Management and Solutions
PO BOX 2411
Tustin.CA 927gI
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