Settlement Agreement and Release
This Settlement Agreement and Release (the "Settlement Agreement") is made and entered into this
_____ day of ____________________, 2004, by and between:
A.. Plaintiff filed a Claim against "Insured" in the Court of_________, County of
___________________ , State of_____________________, Civil Action File No.:___________________,
(the "Claim"), which Claim arose out of certain alleged negligent acts or omissions by Insured. In the Claim,
Plaintiff sought to recover monetary damages as a result of that certain occurrence on or
about________________, at____________________, which resulted in physical/personal injuries
B. Insurer is the liability insurer of the Insured, and as such, would be obligated to pay any
claim made or judgment obtained against Insured which is covered by its policy with Insured.
C. The parties desire to enter into this Settlement Agreement in order to provide for certain
payments in full settlement and discharge of all claims which have, or might be made, by reason of the
incident described in Recital A above, upon the terms and conditions set forth below.
The parties agree as follows:
1.0 Release and Discharge
1.1 In consideration of the payments set forth in Section 2, Plaintiff hereby completely releases
and forever discharges Insured and Insurer from any and all past, present or future claims, demands,
obligations, actions, causes of action, wrongful death claims, rights, damages, costs, losses of services,
expenses and compensation of any nature whatsoever, whether based on tort, contract or other theory of
recovery, which the Plaintiff now has, or which may hereafter accrue or otherwise be acquired, on account of,
or may in any way grow out of the incident described in Recital A above, including, without limitation, any and
all known or unknown claims for bodily and personal injuries to Plaintiff, or any future wrongful death claim of
Plaintiff's representatives or heirs, which have resulted or may result from the alleged acts or omissions of the
1.2 This release and discharge shall also apply to Insured's and Insurer's past, present and
future officers, directors, stockholders, attorneys, agents, servants, representatives, employees, subsidiaries,
affiliates, partners, predecessors and successors in interest, and assigns and all other persons, firms or
corporations with whom any of the former have been, are now, or may hereafter be affiliated.
1.3 This release, on the part of the Plaintiff, shall be a fully binding and complete settlement
among the Plaintiff, the Insured and the Insurer, and their heirs, assigns and successors.
1.4 The Plaintiff acknowledges and agrees that the release and discharge set forth above is a
general release. Plaintiff expressly waives and assumes the risk of any and all claims for damages which
exist as of this date, but of which the Plaintiff does not know or suspect to exist, whether through ignorance,
oversight, error, negligence, or otherwise, and which, if known, would materially affect Plaintiff's decision to