Below is what he sent me along with a SC290 Form.
READ BEFORE SIGNING
In signing the following Release of All Claims, you are giving up all your rights and claims resulting the accident, casualty, or event referred to the Release, which you may not even hlOW or suspect to exist and which if known by you would have materially affected your settlement.
I acknowledge that I have read and understand the above Notice.
RELEASE OF ALL CLAIMS
To be executed by (Name):
The undersigned does hereby accept the amount of , to be paid by check payable to MELISSA JOHNS, in full compromise settlement and satisfaction of, and as sole consideration for, the final release and discharge of all actions, claims and demands whatsoever, that now exist, or may hereafter accrue against BARRY WOODS, STACEY WOODS and any other person, corporation, association or partnership responsible in any manner or degree for injuries to the person and property of the undersigned, and the treatment thereof,
and the consequences following therefrom, as a result of an accident, casualty or event which
OCCUlTeodn or about the
day of at/or near 11575 Prospect
Hill Drive, Gold River, CA 95670 and for which the undersigned claims the above named persons or parties are legally liable in damages.
The undersigned agrees, as a further consideration and inducement for this compromise settlement, that it shall apply to all unknown and unanticipated injuries and damages resulting from said accident, casualty or event, as well as those now disclosed. The undersigned hereby expressly waives the provisions of Section 1542 of the Civil Code of the State of California which reads as follows:
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.
The undersigned agrees to abandon and dismiss with prejudice all causes of action arising out of said event, including Action No.: 12SC05031 in the Sacramento County Superior Court
and authorize BARRY WOODS to execute a Request for Dismissal with prejudice of said action.
The Dismissal with prejudice of such any Complaint or Cross-Complaint shall not operate as a retraxit by the parties released herein. This release shall not destroy or otherwise affect the rights of persons on whose behalfthe payment is made or persons who may claim to be damaged by reason of injury to or damage sustained by persons on whose behalf the above payment is made because of the accident, incident or event or preclude such persons from pursing any legal
The amount of this settlement is a compromise settlement of a doubtful and disputed claim for all damages arising out of the accident, incident or even referred to above. This settlement is not to be considered as an admission of any responsibility whatsoever, in whole 0 in part, for said accident, incident or event by the parties released, their agents or representatives.
The undersigned hereby represents and warrants as follows:
A. No promise or inducement has been offered except as herein set forth.
B. This release is executed without reliance upon any statement or representation by the person or parties release, their representatives, or physicians concerning the nature and extent of the injuries and consequential damages, if any, and of legal liability therefore, if any.
C. The undersigned is of legal age, legally competent to execute this release and accepts full responsibility therefore.
D. Said accident, incident or event did not arise out of and in the course of any employment of the undersigned.
E. The undersigned has not made claim a workers compensation claim by reason of said mjunes.
F. No governmental agency, insurance company or other entity, public or private
(including, but not limited to, Medi-Cal under Welfare and Institution Code, Sections
14124.70 et seq. or the United States Government under Public Law 87-693) has claim and/or lien for hospitalization and/or medical treatment and/or payment of medical expenses by reason of said injuries. If any such lien exists, the undersigned agrees to compromise and settle or otherwise satisfy said lien out of the proceeds of the settlement and provide parties released with a release of lien.
G. The undersigned has provided the released parties and their insurer(s) all information the undersigned knows about and all Medicare rights to recovery as of the date this document is executed.
H. No part of the claim herein released has been assigned 0 any person or entity.
The undersigned agrees to reimburse, indemnify and hold harmless each of the persons, firms, and corporations released herein and their insurer(s), including their agents and assigns, with respect to all known and unknown Medicare rights to recovery related to the subject
accident referred to above for which the Federal government may seek repayment, as well as any
fine or penalty the Federal government may seek resulting from the insufficiency and/or inaccuracy of the information the undersigned has provided to the parties released and their
insurer(s) regarding Medicare rights to recovery known as of this date.
The undersigned further agrees to indemnify and defend the parties released, their insurance carriers, and their attorneys of record from any claims for workers compensation, medical, attorney, governmental or other lien arising out of said incident which relate to claims, injuries, or the settlement sum set forth above in this release. The undersigned further agrees to defend, hold harmless and fully indemnify the party or parties herein released, including their attorneys and insurance carriers from any loss incurred directly or indirectly by reason of the falsity or inaccuracy of anyone or more of the representations or warranties made herein.
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 MAYBE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON. (California Insurance Code Section 1871.2)
Signed at Gold River, CA" this day of , 2013
IMPORTANT - READ ALL PAGES - BEFORE SIGNING