RELEASE OF ALL CLAIMS
KNOW ALL MEN BY THESE PRESENTS:
That the Undersigned, being of lawful age, for sole consideration of
_________________________________
($________), ____________________________________________________do/does hereby and for
my/our/its heirs, executors, administrators, successors and assigns release, acquit and
forever discharge the City of ____________________and his, her, their, or its agents, servants,
successors, heirs, executors, administrators and all other persons, firms, corporations,
associations or partnerships of and from any and all claims, actions, causes of action,
demands, rights, damages, costs, loss of service, liens, attorneys fees, expenses and
compensation whatsoever, which the undersigned now has/have 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 or event which occurred on or about
___________________________________ at or near ______________________________________, CA.
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 said releasees 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
California and any similar law of any state or territory of the United States are hereby
expressly waived. Said section reads as follows:
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.
This settlement is intended to, and the undersigned warrants, that it will dispose of all
liability of the parties released to the undersigned and to all and each of the heirs, executors,
administrators, and assigns of the undersigned and to any other person or entity that might
now or in the future have a claim against the parties released as a result of the injuries
claimed by the undersigned involving the occurrence referred to above. Should any further
claim be made by any person or entity to which the parties released might be liable, directly
or indirectly, as a result of the injuries claimed by the undersigned involving the occurrence
referred to above, the undersigned on behalf of the heirs, executors, administrators, and
assigns of the undersigned, agrees to and will hold harmless and indemnify the parties
released of and from any and all liability for such claim, including all costs, expenses and
attorneys fees in defending such claim.
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 undersigneds judgment, belief 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 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 contractual and not a mere recital.
FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS
FORM:
False or fraudulent claim; penalty. It is unlawful to:
(a) Present or cause to be presented any false or fraudulent claim for the payment of a
loss under a contract
of insurance.
(b) Prepare, make or subscribed any writing with intent to present or use the same or to
allow it to be presented
or used in support of any such claim.
Every person who violates any provision of this section is punishable by imprisonment in
the State prison not exceeding three years, or by fine not exceeding one thousand dollars, or
by both (Stats 1935, c.145, p.511 Sec 556).
THE UNDERSIGNED HAS READ THE FOREGOING RELEASE AND FULLY UNDERSTANDS IT.
Signed, sealed and delivered this ___________ day of ______________________________________,
20_______.
CAUTION:
BELOW
___________________________
Witness
___________________________
READ
BEFORE
SIGNING
________________________________
________________________________
Witness
STATE OF___________________________)
COUNTY OF_________________________)
On ______________________, 20____, before me, the undersigned notary public, personally
appeared
______________________________________________________________________________________________________
personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s)
whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they
executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the
instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the
instrument.
WITNESS my hand and official seal.
Signature________________________________
ADMINISTERED BY THE ASSOCIATION OF BAY AREA GOVERNMENTS
