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HomeMy WebLinkAboutResolution No. 5324RESOLUTION NO. 5324 A RESOLUTION AUTHORIZING THE SIGNING OF INSURANCE RELEASES THE CITY COUNCIL OF THE CITY OF SAN RAFAEL HEREBY RESOLVES as follows: The MAYOR and CITY CLERK are authorized to execute, on be- half of the City of San Rafael, Releases with: BOBBIE D. or N. GILLESPIE and/or DEBORAH GILLESPIE and WALDO A. or EMMIE ERICSON, copies of which are hereby attached and by this reference made a part hereof. I, MARION A. GRADY, City Clerk of the City of San Rafael, hereby certify that the foregoing Resolution was duly and regularly introduced and adopted at a regular meeting of the City Council of said City held on Tuesday_, the fifth day of July , 1977, by the following vote, to wit: AYES: COUNCILMEN: Jensen, Miskimen, Mulryan and Mayor Bettini NOES: COUNCILMEN: None ABSENT: COUNCILMEN: Nixon MARION A. GRADY, City Clei-k RELEASE OF ALL CLAIMS To be executed by. an _authorized representative of the City_ of San Rafael ------------------------------------------------------------ ------------------------------------------------.......-----------------------------------------------------------------------------------•- The undersigned do(es) hereby acknowledge receipt of Draft No ----- L4949728 for ------ SIX HUNDRED SEVENTY SIX AND 88/100 ------------------------ Dollars ($ 676 88 ---------------------------------------------•--------------------------------------------•----------------'-----------•--.....) Payable to ..... City of San Rafael - -- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- which draft is accepted 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____ Bobbie D. or N. Gillespie and/or Deborah Gillespie _ ------•------------------------------------------------------------------------------------------------------------------------------------------------------------- - 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 flowing therefrom, as a result of an accident, casualty or event which occurred on or about the .......10................................... day of ...... December________________________1976_..at or near...............................San Rafael- , California ------------------------------------------------------------------------------ ------------------------- -------------•----------•-------------------------------------------------------------------------------------------------------------------------------------------------------- and for which the undersigned claims the above named persons or parties are legally liable in damages which legal liability and damages are disputed and denied, and; The undersigned warrants, that no promise or inducement has been offered except as herein set forth; that this release is executed without reliance upon any statement or representation by the person or parties released, or their representatives, or physicians, concerning the nature and extent of the injuries and conse- quential damages, if any, and of legal liability therefor, if any; that the undersigned is of legal age, legally competent to execute this release and accepts full responsibility therefor, and; 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 to 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 favor at the time of executing the release, which if known by him must have materially affected his settlement with the debtor." And ------- _....... do declare that ..._=__have__read._ the__ above__ and..understand it_—to__be .a..ful..l ....... nal__ -se tlefnent-_of--any--and--all --- claims ............. ---------------------------------•-------------------- -------•----.-------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------- Signedat---------------------------------------------------------------- ----------- this -------------- day of------------------------------------- --------- -------- 19 ......... CITY STATE CAUTION: READ BEFORE SIGNING ------ WITNESS TO SIGNATURE ------------------------------------------------------------------------------ ------------------------- '------' ......................... ADDRESS SIGNATURE 2. Mayor,ty Ciof__5an_ Rafael ................. ---------- WITNESS TO SIGNATURE ADDRESS SIGNATURE -Attest:- City Clerk For your protection California law requires the following to appear on this form. 556. It is unlawful to: (a) Present or cause to be presented• any false or fraudulent claim for the payment of a loss under a contract of insurance. (b) Prepare, make, or subscribe any writing, with intent to present or use the same, or to allow it to be presented or used in support of any such claim. Every person who violates any provision of this section is pun- ishable by imprisonment in the State prison not exceeding three years, or by fine not exceeding one thousand dollars, or by both. F 1480 (REV. 8-68) (OVER) RELEASE OF ALL CLAIMS To be executed by .... an__authoriz ed_representative of _the City_ of _San Rafael _ _ The undersigned do(es) hereby acknowledge receipt of Draft No. for---- SIX_MII RLD_.TICRTY_..SNI_Q__AN_D__31/10Q__-------_-_- ----- Dollars 4 622,-31-------------) Payableto ------ City of San Rafael --------------------------------------------------------------------------------------------------------------------------------------------- which draft is accepted 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 Waldo A. or Emmie Ericson 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 flowing therefrom, as a result of an accident, casualty or event which occurred on or about the day of .....November 19 76at or near 15 San Rafael, California and for which the undersigned claims the above named persons or parties are legally liable in damages which legal liability and damages are disputed and denied, and; The undersigned warrants, that no promise or inducement has been offered except as herein set forth; that this release is executed without reliance upon any statement or representation by the person or parties released, or their representatives, or physicians, concerning the nature and extent of the injuries and consequential damages, if any, and of legal liability there- for, if any; that the undersigned is of legal age, legally competent to execute this release and accepts full responsibility there- for, and; 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 to those now disclosed. It is understood and agreed that this release and settlement (and dismissal with prejudice, if appropriate) are not to prejudice the rights, claims, and causes of action accruing to any and all parties herein released and discharged arising out of the subject accident or incident. 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 favor at the time of executing the release, which if known by him must have materially affected his settlement with the debtor." And ______? ________do declare that __I _ hav_e _read the above and understand it to be a full and _______rtl__elemen_of_any_�all_—claims_ Ihave _or_ max__ha_ Signedat---------------------------------------------------------------------------this-------------day of ------------------------------------------------19--------- CITY STATE CAUTION: READ BEFORE SIOr1IlVG 1- ------------------------------------------------------------------------ WITNESS TO SIGNATURE ri ADDRESS SIGNATURE - P�I�or� Ci_ of San Raf el WITNESSTOSIGNATURE jy.J, ------------------------ -Y*' �rL?ice i:� G(_ t �L ADDRESS SIGNATURE Attest: Citv Clerk For your protection California law requires the following to appear on this form. 556. It is unlawful to: (a) Present or cause to be presented any false or fraudulent claim for the payment of a loss under a contract of insurance. (b) Prepare, make, or subscribe any writing, with intent to present or use the same, or to allow it to be presented or used in support of any such claim. Every person who violates any provision of this section is pun- ishable by imprisonment in the State prison not exceeding three years, or by fine not exceeding one thousand dollars, or by both.