Accident Claims Release of Liability

This Release of Liability ("Release") is made on this day [DATE], between the Releasor: [Your Name], residing at [Your Company Address] ("Releasor"), and the Releasee: [RELEASEE'S NAME], residing at [RELEASEE'S ADDRESS] ("Releasee").

I. Acknowledgment

The Releasor hereby acknowledges that:

1. On [DATE OF ACCIDENT], the Releasor was involved in an accident ("Accident") with the Releasee.

2. As a result of the Accident, the Releasor suffered injuries including [SPECIFIC INJURIES].

3. The Releasor has received medical treatment for the injuries sustained from the Accident, including but not limited to [MEDICAL TREATMENTS RECEIVED].

4. The Releasor is aware of the risks, dangers, and potential complications associated with the injuries sustained from the Accident.

5. The Releasor acknowledges that this Release is being executed voluntarily and without any duress or undue influence.

II. Release and Waiver

In consideration of a sum of [$ AMOUNT], the Releasor releases the Releasee, and its agents, successors, assigns, subcontractors, and affiliates, from all liabilities, claims, demands, actions, causes of action, costs, and expenses, legal or otherwise, whether at law or in equity, whether known or unknown, arising out of or in connection with the Accident, including but not limited to:

• Any and all medical expenses incurred as a result of the Accident.

• Any and all loss of earnings or earning capacity as a result of the Accident.

• Any and all damages to personal property as a result of the Accident.

• Any and all pain, suffering, and inconvenience experienced as a result of the Accident.

• Any and all other damages, whether economic or non-economic, arising from the Accident.

The Releasor acknowledges that this Release and Waiver is a full and final settlement of all claims, demands, and causes of action that the Releasor may have against the Releasee arising from or in connection with the Accident.

III. Indemnification

The Releasor agrees to indemnify, defend, and hold harmless the Releasee, and its agents, successors, assigns, subcontractors, and affiliates, from and against any and all losses, liabilities, damages, costs, and expenses, including reasonable attorney's fees, arising out of or in connection with:

1. Any breach of this Release by the Releasor.

2. Any claim or action brought against the Releasee by any third party arising out of or in connection with the Accident, including but not limited to claims for personal injury, property damage, or wrongful death.

The Releasor agrees to cooperate fully with the Releasee in the defense of any such claim or action and to not settle any such claim or action without the prior written consent of the Releasee.

IV. Entire Agreement and Jurisdiction

This document constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements and understandings, whether written or oral, relating to such subject matter.

This Release shall be governed by and construed in accordance with the laws of the State of [STATE], without regard to its conflict of law principles.

Any legal action or proceeding arising out of or relating to this Release shall be brought exclusively in the courts of the State of [STATE] or in the United States District Court for the District of [DISTRICT], and each party consents to the jurisdiction of such courts for such purposes.

Releasor's Name: [Your Name]
Date: [Date Signed]

Releasee's Name: [RELEASEE’S NAME]
Date: [Date Signed]

This Release of Liability was written by [Your Name] on behalf of [Your Company Name], located at [Your Company Address].

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