DIY Legal Forms

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Agreement For Release

WHEREAS, on or about [Date], [Name], hereinafter referred to as "Claimant", claims to have suffered an injury due to an automobile collision, and further, Claimant alleges that [Name], hereinafter referred to as "Settlor", is legally responsible for the injury, and,

WHEREAS, [Name], referred to as Insuror, may provide coverage for the alleged injury by virtue of the issuance of an insurance policy to Settlor; and,

WHEREAS, Settlor disputes such liability in its entirety; and,

WHEREAS, Settlor and Claimant desire to enter into a settlement of the claims in this matter, and,

WHEREAS, [Name] is the spouse of Claimant, and alleges a right to recover compensation for loss of consortium, and Settlor disputes such liability in its entirety; and,

WHEREAS, Settlor, Insuror, Claimant and Claimant's spouse desire to enter into a settlement of the disputed claims;

It is therefore agreed:

That the making of this settlement is not an admission of liability or culpability of the Settlor, nor an admission of coverage and applicability of an insurance coverage afforded by Insuror to Settlor;

Insuror and Settlor shall pay to Claimant upon execution of this agreement:

[$-------] on account of property damages to [Enumerate];

[$-------] on account of personal injuries to Claimant, including claims by Claimant's spouse for consortium upon the execution of this agreement; and,

Insuror and Claimant shall pay the sum of [$-------] month to Claimant, every [--] days for a term of the life of the claimant.

The payments under this release agreement are intended as compensation for injuries or sickness as is provided in 26 USC 104(a)(2) and 26 USC 130(c). Claimant has no right to a lump sum settlement of any kind. Neither Insuror nor Settlor made available to Claimant during negotiations a lump sum payment in lieu of the lump sum and periodic payments provided for herein.

In the event of any failure to pay when agreed, time being of the essence, any sums due and unpaid shall bear interest at the highest legal rate until paid. In the event that any installment due is unpaid for more than [--] days, Claimant may declare a default in the agreement. Upon such declaration of default, the Claimant shall be entitled to bring an action and obtain a judgment for the sums unpaid. Such action shall not preclude the right for claimant to sue in the future for any further payments which are unpaid and the rights under this agreement shall not be extinguished in the event that an action is brought to enforce payment of any particular installment or installments.

In the event that more than [--] payments are due at any time, the Claimant may sue to recover either:

(a) the present value of the remaining payments discounted by [--%];

(b) a judgment for those payments due through the commencement of the litigation.

No modification of this Agreement will be effective unless it is in writing and is signed by both parties. Time is of the essence of this contract. This Agreement binds and benefits both parties and any successors. This document, including any attachments, is the entire agreement between the parties.

Amendments of this agreement shall be by mutual consent of the parties only in writing.

Arbitration. Any disputes pertaining to said contractual arrangement being affairs that cannot be settled amicably shall be submitted to an arbitrator under the Rules of the American Arbitration Association or like organization in the City of [city], whose award may be reduced to judgment in any court of competent jurisdiction.

Severability. If any provision of this Agreement shall be held to be invalid or unenforceable for any reason, the remaining provisions shall continue to be valid and enforceable. If a court finds that any provision of this Agreement is invalid or unenforceable, but that by limiting such provision it would become valid or enforceable, then such provision shall be deemed to be written, construed, and enforced as so limited.

Waiver Of Contractual Right. The failure of either party to enforce any provision of this Agreement shall not be construed as a waiver or limitation of that party's right to subsequently enforce and compel strict compliance with every provision of this Agreement.

No Representations. Neither party has made any representations nor promises, other than those contained in this agreement or in some further writing signed by the party making the representation or promise.

Interpretation. This Agreement will in all events be construed as a whole, according to its fair meaning, and not strictly for or against a party merely because that party (or the party's legal counsel) drafted the Agreement. The headings, captions, and titles in this legal Agreement are merely for reference and do not define, limit, extend, or describe the scope of this Agreement or any provision herein. Unless the context requires otherwise,

(a) the gender (or lack of gender) of all words used in this Agreement includes the masculine, feminine, and neuter, and

(b) the word including means including without limitation.

Advice Of Legal Counsel. Each individual party to this Agreement represents and warrants to each other party that such party has read and fully understands the terms and provisions hereof, has had an opportunity to review this Agreement with legal counsel, and has executed this Agreement based upon such party's own judgment and advice of independent legal counsel.

Invalid Provisions. If any provision of this Agreement is held to be illegal, invalid, or unenforceable under any present or future law, then that provision will be fully severable. This Agreement will be construed and enforced as if the illegal, invalid, or unenforceable provision had never comprised a part of this Agreement, and the remaining provisions of this Agreement will remain in full force and effect and will not be affected by the illegal, invalid, or unenforceable provision or by its severance from this Agreement. Furthermore, in lieu of each such illegal, invalid, or unenforceable provision, there will be added automatically, as a part of this Agreement, a provision as similar in terms to such illegal, invalid, or unenforceable provision as may be possible and be legal, valid and enforceable.

Notices. Any notice to be given or to be served upon any party hereto must be in writing and may be given by certified or registered mail, but shall be deemed to have been given and received when a certified or registered letter containing such notice, properly addressed with postage prepaid, is deposited with U.S. Mail. If notice is given in some manner other than by certified or registered mail, it shall be deemed to have been given when delivered to and received by the party to whom it is addressed, Such notices shall be given to the parties hereto at the following addresses:

If to the [Claimant]:
[street address]
[city, state, zip]

If to the [Settlor]:
[street address]
[city, state, zip]

All such notices and communications shall be deemed to have been duly given when delivered by hand, if personally delivered; [--] business days after deposit in U.S. Mail, postage prepaid, if mailed; when answered back, if faxed; and when receipt is acknowledge. Any party hereto may change its address for purposes of this paragraph by written notice given in the manner provided above.

Failure to Object Not a Waiver. The failure of a party to object to, or to take affirmative action with respect to, any conduct of the other which is in violation of the terms of this Agreement shall not be construed as a waiver of the violation or breach or of any future violation, breach, or wrongful conduct until [--] days since the wrongful act or omission to act has passed.

Unenforceable Terms. Any provision hereof prohibited or unenforceable under any applicable law of any jurisdiction shall as to such jurisdiction be ineffective without affecting any other provision of this Agreement. To the full extent, however, that the provisions of such applicable law may be waived, they are hereby waived to the end that this Agreement be deemed to be a valid and binding agreement enforceable in accordance with its terms.

Execution In Counterparts. This Agreement may be executed in several counterparts and when so executed shall constitute shall constitute one agreement binding on all the parties, notwithstanding that all the parties are not signatory to the original and same counterpart.

Incorporation By Reference. All exhibits referred to in this Agreement are incorporated herein in their entirety by such reference.

Cross-References. All cross-references in this Agreement, unless specifically directed to another agreement or document, refer to provisions in this Agreement, and shall not be deemed to be references to any overall transaction or to any other agreements or documents.

Miscellaneous Provisions. The various headings and numbers herein and the grouping of provisions of this Agreement into separate divisions are for the purpose of convenience only and shall not be considered a part hereof. The language in all parts of this Agreement shall in all cases be construed in accordance to its fair meaning as if prepared by all parties to the Agreement and not strictly for or against any of the parties.

Further Assurances. In connection with this Agreement and the transactions contemplated hereby, each party to this Agreement will execute and deliver any additional documents and perform any additional acts that may be necessary or appropriate to effectuate and perform its obligations under this Agreement and the transactions contemplated hereby.

Entire Agreement. This Agreement contains the entire agreement of the parties and there are no other promises or conditions in any other agreement whether oral or written. This Agreement supersedes any prior written or oral agreements between the parties.

Applicable Law. This Agreement shall be governed by the laws of the State of [State].

IN WITNESS WHEREOF, the parties have executed this agreement the day and year as first above written.





*** If Required By State Law ***

This Section for Notary:


STATE OF -------)

) ss: [date]

COUNTY OF ------)

On [Date] before me, [Name of Notary], notary, personally appeared [Name of Person(s) Involved], personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

Witness my hand and official seal.


[Name of Notary Public]

My commission expires: [date]