Collision And Diminished Value Damage Release (PDF)
Collision And Diminished Value Damage Release (.docx)
Below in this article is a sample of a Collision and Diminished Value Damage Release:
CLAIM NUMBER: CLM123456
COLLISION AND DIMINISHED VALUE DAMAGE RELEASE
Know all men by these presents, that the Undersigned JOHN DOE do(es) hereby acknowledge receipt of $5,500.44 which sum 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 exists, or may hereafter accrue, against and ABC Insurance Company of Georgia and any other person, corporation, association or partnership charged with responsibility for collision diminished value claim of the Undersigned, JOHN DOE and the consequences flowing therefrom, as a result of an accident which occurred on JUNE 15, 2022 at or near Main Street and Green Ave Atlanta, GA and for which the Undersigned claims the above name persons or parties are legally liable in damages; which legal liability and damages are disputed and denied, and:
It is further understood and agreed that the party or parties hereby released do not consent to this release, admit no liability to the Undersigned or others, shall not be estopped or otherwise barred from asserting and expressly reserve the right to assert any claim or cause of action such party or parties may have against the Undersigned or others.
Notwithstanding the payment recited above, any lawsuit seeking damages for personal injuries sustained in this accident must be filed within two (2) years of the accident date, or, JUNE 15, 2024. If not timely filed, said action will be forever barred.
This release is taken and the consideration stated above is paid by the liability insurance carrier of a party released hereby. In taking this release said insurance carrier is acting as an independent contractor and not as an agent of any party released hereby. The Undersigned understands and agrees that this release is taken without the knowledge or consent of any party released hereby and does not preclude the assertation of any claim that any such party may have against the Undersigned, and the Undersigned acknowledges prior written notice of the absence of such knowledge and consent and waives all further notice thereof.
Signed and sealed this day of ,
at , .
(City) (State)
Signed
Signed
In the presence of:
1.
Witness Seal
Address Address
2.
Witness Seal
Address Adress
