HomeMy WebLinkAbout000651 Original Contract v1 A Y 2 9 20 W'L"I"D ID 1 0 FM HURON LkI GRUJI1 FAX Ido, 350-692-4H7 p
City of Port Angeles Fi ij 1J
Record # 000651
GG038484-GV
RELEASE OF ALI. CLAIMS & SETTLEMENT ......
-Tiat the Undersigned, BenLamin C-astman (referred to below as Releasor) for the soie
conslderation of One Hundred Tw�t -five Thousand and 00/100---Dollars g125,000-00). the receipt
alld sufficiency of which is hereby acknowledged, does hereby forever release, discharga, and dismiss
the Qty 2LPort_Anqe,1es, Sct, J. Winfield, Washington Cities Insurance Authority, and their officers,
ernplayees, SL=assors, heirs, and all other persons, corporations, and entities of any kind (referred to
below as Releasees) from any and all claims, actions, causes of action, demands, rights, damage%
costs, attorney fees, loss of services, expenses, and compensation, either known or unknown to the
Releasor, which in anyway relate to any known 01' Unknown personal kljUrles, property damage, and/or
other losses or expenses resulting from or caused in any way by the accident, casualty, or event that
occurred on or about 111312012 at or near,_ Port Angeles, WA.
Raleasoagrees by signing this Release and Agreement, that the payment of the consideration
therefore: (1) does not constltute an adT-nission of any liabflity by any Releasee, and, in fact, all
dispute the claim and deny liability, and (2) includes full and final settlement of all the
Releasor's claims, both present and future, arising from this event and applies to any and all past and
future injuries, damages, and medical expenses (including any injuries not now known or the extent of
which is not now known and which may later develop, be discovered, or worsen), (3) the Releascr
agrees to pay from these settlement proceeds any person, corporation, or entity who has a lawful lien
or subrogation claim against these funds for a.ny medical bills, insurance payments, attorney's fees,
and/or the claims of any governmental entity, Releasor agrees to defend, indemnify, and hold harmless
all Releasees from any such liens, subrogation claims, or other such claims of any person or entity
ciaiming any interest in the settlement funds being paid pursuant to this agreement.
The undersigned further daCiare(S) and represent(s) that no promise, inducement, or agreement
ha.s been made to the Undersigned, and Vint this Release contains the entire agreement between the
parties hereto, and that the terms of this Release are contractual and nut a mere recital and that it is
intended to be binding on my/our/its heirs, executors, administrators, successors, and assigns,
WASHINGTON CITIES INSURANCE AUTHORITY DOES NOT LEGALLY REPRESENT THE UNDERSIGNED.
THE UNDERS16NED UNDERSTANDS ANY QUESTIONS REGARDING THIS RELEASE SHOULD BE
DIRECTED TO HIS OR HER OWN PERSONAL ATTORNEY PRIOR TO SIGNING.
THE UNOERSIGNED HAS READ THE FOREGOING AND FULLY UNDERSTANDS IT.
DATED this day of
201__.
X
X-
State of Washin t i 4 it nature of Releasor(s)
County of *U—
certify that I know or have satisfactory evidence that 261\1 GAS'1-m is the person who
appeared before me, and said person acknowledged that (he/she) signed this instrument and
acknowledged it to be (his/her) free and voluntary act for the uses and purposes mentioned in the
instrument.
Dated, IF
SJ n ture Notary Publfc
I lc�
A State of Wasbinlgbon
()f
Title SAGHA R=ADLER-TURK,
e
My appoint-nent expires 23 L'-1 I My Appointment Expir-4s Mat 2�.. 2d15
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