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Contents

  1. Occurrence

, , , hereinafter referred to as Releasor, and , , , hereinafter referred to as Releasee, in consideration of the promises made herein, agree as follows:

Occurrence

Releasor has sustained arising out of that occurred on in .

On , Releasor filed an action in the Court for the County of , California, case number , entitled . This action arose out of the occurrence described in Occurrence.

Releasor, on behalf Releasor, Releasor's heirs, executors, administrators, and assigns, and in consideration of paid to Releasor by Releasee, hereby fully releases Releasee, Releasor's successors, and all other persons and associations, known or unknown, from all claims and causes of action by reason of any which has been sustained, or may be sustained, as a result of the above-described occurrence.

Releasor acknowledges and agrees that this release applies to all claims that Releasor may have against Releasee arising out of the above-described occurrence for injuries, damages, or losses to Releasor's person and property, real or personal, whether those injuries, damages, or losses are known or unknown, foreseen or unforeseen, or patent or latent.

Releasor certifies that Releasor has read Section 1542 of the Civil Code, set out below, and indicates that fact by signing Releasor's initials here:

"A general release does not extend to claims which the creditor does not know or suspect to exist in his or her favor at the time of executing the release, which if known by him or her must have materially affected his or her settlement with the debtor."

Releasor hereby waives application of Section 1542 of the Civil Code.

Releasor understands and acknowledges that the significance and consequence of this waiver of Section 1542 of the Civil Code is that even if Releasor should eventually suffer additional damages arising out of the above-described occurrence, Releasor will not be permitted to make any claim for those damages. Furthermore, Releasor acknowledges that Releasor intends these consequences even as to claims for injury and/or damages that may exist as of the date of this release but which Releasor does not know exist, and which, if known, would materially affect Releasor's decision to execute this release, regardless of whether Releasor's lack of knowledge is the result of ignorance, oversight, error, negligence, or any other cause.

Releasor warrants and represents that in executing this release, Releasor has relied on legal advice from the attorney of Releasor's choice, that the terms of this release and its consequences have been completely read and explained to Releasor by that attorney, and that Releasor fully understands the terms of this release.

Releasor acknowledges and represents that Releasor has been apprised of all relevant information and data furnished by and all other information relevant to Releasor's claim and this release, including, without limitation, . Releasor further acknowledges and represents that, in executing this release, he/she has not relied on any inducements, promises, or representations made by Releasee or any party representing or serving Releasee.

Releasor acknowledges and warrants that Releasor's execution of this release is free and voluntary.

This release pertains to a disputed claim and does not constitute an admission of liability by Releasee for the above-described occurrence.