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<br />GENEF~~-L E~E~EA.SE c:..Aln~ #. 01071022007
<br />ror the consideration of Twenty Thousand Three Hundred and Twenty One and 12/100
<br />dollars ($ 20,321.12 )
<br />receipt of which is hereby acknowledged, I/we release and discharge, and for myself/ourselves and for my/our heirs,
<br />representatives, executors, administrators, successors and assigns, do hereby remise, release and forever discharge
<br />Sharon Deaton
<br />hereinafter referred to as the releasee(s), his/her/their/its heirs, executors, administrators, insurers, successors and
<br />assigns, and any and all other persons, firms, corporations, associations, of and from any and all causes of action,
<br />suits, rights, judgments, claims and demands of whatsoever kind, in law or in equity, known and unknown, which
<br />I/we now have or may hereafter have, especially the claimed legal liability of releasee(s) arising from or by
<br />reason of any and all bodily or personal injuries and/or property damage known and unknown, foreseen and
<br />unforeseen which heretofore has/have been or which hereafter may be sustained by me/us arising out of the
<br />accident on or about December 8th
<br />at or near Brookpark and Great Northren Blvd
<br />in the county of Cuyahoga in the State of Ohio
<br />which liability releasee(s) expressly deny(ies).
<br />IJWe further release and discharge any and all claims for interest (whether under R.C. 1343.03 or otherwise) that I/we
<br />may have arising out of the claim for bodily or personal injuries and/or property damage, or arising out of the settlement
<br />and/or payment of my/our claim
<br />I/We agree that the consideration set forth above is specifically applicable to and paid to me/us with respect to
<br />any and all damage to any property, either real or personal, of mine/ours and with respect to any and all personal
<br />or bodily injury of mine/ours, whether presently known or unknown, foreseen or unforeseen or which may
<br />subsequently develop and the consequences thereof, all as arising out of the aforementioned accident.
<br />I/We further agree that the consideration set forth above is specifically applicable to and .paid to me/us with respect
<br />to any right of contribution that I/we may have against the releasee(s), 'his/herJtheir/its heirs, executors, administrators,
<br />insurers, successors and assigns relative to claims of others that may be brought against me/us by reason of said
<br />accident.
<br />I/We further agree that the consideration set forth above is specifically applicable to my/our agreement that I/we
<br />will not join nor attempt to join the releasee(s), his/her/their/its heirs, executors, administrators, Insurers, successors and
<br />assigns In any capacity, in any action that may be brought against me/us arising out of said accident.
<br />I/We warrant for myself/ourselves and my/our heirs, representatives, executors, administrators, successors and assigns
<br />that I/we have received no money or other valuable consideration from any other person or persons by reason of any
<br />causes of action, suits, covenants, agreements, judgments, claims and demands of whatsoever kind, which I/we now
<br />have or may hereafter have, for in~urles to my/our person or property or for the other matters for which this release is
<br />given.
<br />I/We further understand and agree that this Release is inclusive of any and all present and future liens or claims for
<br />subrogation against the payments to be made in accordance with this Release. I/we understand and agree that I/we are
<br />responsible for the payment of any liens or charges against the payments to be made hereunder should any such liens,
<br />subrogation, claims or claims for expenses and charges be asserted. This includes, but is not limited to, medical expense
<br />liens, worker's compensation liens, ERISA liens, liens asserted by any federal, state or local governmental entity or
<br />agency or an ~ medica! expense claim. Should anv person or entity make claim for payment of any liens or charges
<br />against The ERIE or their counsel, I/we agree to indemnify and hold harmless The ERIE and their counsel from any and
<br />all such liehs, charges, fees, claims, attorney fees, costs, Interests and any other sum.
<br />IJWe understand that this settlement is the compromise of a disputed claim, and that the payment is not to be construed
<br />as an admission of liability on the part of the persons, firms and corporations hereby released by whom liability is
<br />expressly denied.
<br />No promise, inducement or agreement not herein expressed has been made to Releasor, and this Release contains the
<br />entire agreement between the parties hereto.
<br />Intending to be legally bound thereby, WITNESS my/our hand(s) and seal(s) this day of
<br />SEAR
<br />NOTICE: OHIO REVISED CODE SECTION 3999.21 AS ENACTED BY HOUSE BILL 347, REQUIRES US TO INFORM YOU THAT "ANY PERSON
<br />WHO, WITH INTENT TO DEFRAUD OR KNOWING THAT HE IS FACILITATING A FRAUD AGAINST AN INSURER, SUBMITS AN
<br />APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE FRAUD."
<br />WITNESS
<br />2007
<br />YEAF
<br />EXHIBIT
<br />- - a Q
<br />C-41 A-OH (R) 0707
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