HomeMy WebLinkAbout20170403_Parent(s) Release_Fitler 1956008PARENT(S) RELEASE AND INDEMNITY AGREEMENT
In consideration of the payment, to the undersigned, of the sum of One Thousand One Hundred and 44/100 Dollars ($1,100.44) the receipt of which is
hereby acknowledged, the undersigned parent(s) and/or'guardian(s) Rob and Susan Filler of, a minor, do/does forever release, discharge and
covenant to hold harmless *Insured/released parties, and any other person, firm or corporation charged or chargeable with responsibility or liability, their
heirs, administrators, executors, successors and assigns, from any and all claims, demands, damages, costs, expenses, loss or services actions and causes of
action, belonging to the said minor or to the undersigned arising out of any act or occurrenceup to the present time, and particularly on account of all
personal injury, disability, property damage, loss or damages of any kind sustained or that may hereafter be sustained by the said minor or by the
undersigned, in consequence of an accident that occurred on or about the November 9,2016 at or near Mitchell Park, San Luis Obispo, CA 93401 . The
undersigned do/does hereby bind ourselves and our heirs, administrators, executors, successors and assigns to repay the said, City of San Luis Obispo and to
any other person, firm or corporation charged with responsibility or liability, their heirs, administrators, executors, successors and assigns, any additional sum
of money that any of them may hereafter to compelled to pay on account of the injuries to said minor because of the said accident.
To procure the payment of the said sum, I/we hereby declare: that no representations about the nature and extent of the said injuries, disabilities or damages
made by any physician, attorney or agent of any of the parties released, have induced me/us to makethis releaseand indemnity agreement; that in
determining the amount of the said sum there has been taken into consideration not only the ascertained injuries, disabilities and damages, but also the
possibility that the injuries sustained may be permanent and progressive and recovery there from uncertain and indefinite, so that consequences not now
anticipated may result from thesaid accident.
The undersigned agree(s), as a further consideration and inducement for this release and indemnity agreement, that it shall apply to all unknown and
unanticipated injuries and damages directly and indirectly resulting from the said accident, as well as those now disclosed.
The undersigned understand(s) that the parties hereby released admit no liability of any sort by reason of said accident and that said payment in the
compromise is made to terminated further controversy respecting all claims for damages that said minor or the undersigned have heretofore asserted or might
personally or through personal representatives hereafter assert because of said accident.
It is further understood and agreed that all rights under Sections 1542 of the Civil Code of California and nay similar law of any state or territory of the
United 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 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."
1/we further understand and agree that this Release is inclusive of any and all present and future liens or claims for subrogation against the payments to be
made in accordance with this Release. I/we understand and agree that I/we are responsible for the payment of any liens or charges against the payments to be
made hereunder should any such liens, subrogation claims, or claims for expenses and charges be asserted. This includes, but is not limited to, medical
expense liens, workers' compensations liens, ERISA liens, liens asserted by any federal, state, or local governmental entity or agency or any health care
benefit claim. Should any person or entity make claim for payment of any liens or charges against the City of San Luis Obispo, CA, I/we agree to
indemnify and hold harmless the City of San Luis Obispo from such liens, charges, fees, claims, attorney fees, costs, interest and any other sum.
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 of L D
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