Release Of Claims And Hold Harmless Agreement Form printable pdf download

R E L E A S E O F A L L C L A I M S A N D

H O L D H A R M L E S S A G R E E M E N T

KNOW ALL BY THESE PRESENTS:

That I, ______________________, being of lawful age, for the sole consideration of

________________________ Dollars ($____________) paid to me, as indicated herein below

and receipt of which is hereby acknowledged, do hereby and for my heirs, executors,

administrators, successors and assigns release, acquit and forever discharge The City of

___________ and its agents, servants, successors, heirs, executors, administrators and all other

persons, firms, corporations, associations or partnerships of and from any and all claims, actions,

expenses and compensation whatsoever, under State or Federal law, which I now have or which

may hereafter accrue to me on account of or in any way growing out of any and all known and

unknown, foreseen and unforeseen bodily and personal injuries or death and property damage

and the consequences thereof resulting or to result from the accident, casualty, event which

occurred on or about: ____________________________________________________________

______________________________________________________________________________

_____________________________________________________________________________.

It is understood and agreed that this settlement is the compromise of disputed claims, 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.

I hereby declare 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 I rely wholly upon my 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.

In consideration of payment of the above sum, I represent, warrant and agree that I or my

legal representative will satisfy any and all lien claims against the above sum, or any settlement

or recovery arising out of the incident, casualty or events which occurred as above-described. In

further consideration of the payment of the above sum, I agree to indemnify the City and its

employees, attorneys of record, and their respective liability insurance carriers, and agree to hold

the same harmless against any claim, suit, action or demand asserting a lien against said sum,

settlement or recovery, including the expenses of investigation, attorneys' fees, and other costs of

litigation. In further consideration of payment of the above sum, I agree to pay the expenses of

investigation, attorneys' fees and all other costs of any action brought by the City or its

employees or its attorneys of record, and their respective liability insurance carriers against me to

establish and\or enforce indemnification hereunder.

Release Of Claims And Hold Harmless Agreement Form