HomeMy WebLinkAboutContracts & Agreements_28-2019C0031 Summit Claims 100893 CAPA-00947431
CLAIM NUMBER CAPA-00947431
RELEASE
(FOR PROPERTY DAMAGE ONLY)
For the consideration of the payment of $25,000.00, the receipt of which is hereby acknowledged, I/we,
City of Redlands, hereby release and forever discharge Insured and driver Matthew Rodriquez,
his/her/their heirs, executors, administrators, agents and assigns and all other persons who may claim
coverage from insurer, none of whom admit liability to me, but all expressly deny any liability, from any
and all claims, demands or suits of any kind because of and resulting from damage to property caused by
an accident which occurred on September 10, 2018, at or near Orange Street & Pennsylvania Avenue,
Redlands, CA 92373
This release expressly reserves all rights of the parties released to pursue their legal remedies, if any,
against me, my heirs, executors, agents and assigns
We call to your attention that no lawsuit can be maintained for injuries sustained in the above
accident unless filed within two years of the date of accident for an adult and two years after a
minor turns 18.
I hereby declare that the terms of this settlement have been voluntarily accepted for the purpose of making
a full and final compromise adjustment and settlement of any and all claims, disputed or otherwise,
because of the damages referenced, and for the express purpose of preventing forever any further or
additional claims relating to property damage arising out of the referenced accident
In signing this release, I rely wholly upon my own judgment without reliance upon any statement of the
party or parties being released or their representatives I agree that any disagreement about this release
shall be decided in California under California law
I accept check or checks as final payment of the consideration set forth above
HAVE READ THIS RELEASE AND FULLY UNDERSTAND IT
Executed on CAUTION READ BEFORE SIGNING BELOW
Z 5 2017 City of Redlands
Date Year
X
Mayor -Paul W Foster
Attest
J ne Donaldson - City Clerk
For your protection, California law requires the following to appear on this form
ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE
PAYMENT OF A LOSS IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND
CONFINEMENT IN STATE PRISON
C42A 0712015