Personal Injury Claims

FULL RELEASE OF ALL CLAIMS WITH INDEMNITY

Claim number 22-9610096

KNOW ALL BY THESE PRESENT, THAT Teresa Williams, for and in consideration of the payment of Three Hundred Dollars ($300), the receipt and sufficiency of which is hereby acknowledged, does (do) hereby for myself (ourselves) and for my (our) heirs, executors, administrators, successors, assigns and any and all other persons, firms, employers, corporations, associations, or partnerships forever release, acquit, discharge and agree to hold harmless Kevin Johnson and his/her/their agents, employees, servants, heirs, administrators, successors, executors, assigns and all other persons, firms, corporations, associations or partnerships of, and from any and all claims, actions, causes of actions, demands, rights, damages, costs, loss of wages, expenses, hospital and medical expenses, loss of consortium, loss of service, and any compensation whatsoever, known or unknown, which the undersigned now has/have or which may hereafter accrue on account of or in any way arising out of an accident which occurred on or about 7/31/2022 at or near Washington, DC.

It is understood and agreed that this settlement is in full compromise of a doubtful and disputed claim as to both questions of liability

and as to the nature and extent of the injuries and damage, and that neither this Release, nor the payment made pursuant thereto,

shall be construed as an admission of liability, such being denied.

The undersigned hereby declare(s) and represent(s) that my (our) injuries are or may be permanent and that recovery therefrom is uncertain and indefinite. In making this Release, it is understood and agreed that the undersigned rely(ies) wholly upon the undersigned’s judgment, belief and knowledge as to the nature, extent, effect and duration of said injuries and liability therefore. This Release is made without reliance upon any statement or representation of the party(ies) being released, or their representatives, or by any physician or surgeon by them employed.

As a further consideration, I (we) warrant and covenant that all medical and/or hospital bills if incurred have been paid; or will be paid

by me (us), that there is not a hospital lien, and that any and all liens, if any, of any nature whatsoever, including but not limited to workers’ compensation liens and hospital liens, have been paid, will be paid by me (us), or have been waived by the lienholder. I (we) further agree to INDEMNIFY and HOLD HARMLESS the parties released herein from any such liens.

In consideration of the payment of the amount noted above, the undersigned further agree(s) to indemnify and hold harmless the

above-released parties and/or their insurers from any and all further liability, loss, payment, damage, claims of subrogation,

reimbursement or expense, arising out of injuries and damages, and, if necessary in order to save them so harmless, to satisfy on their

behalf any judgment against them arising in any way out of the aforesaid accident.

The undersigned further declare(s) and represent(s) that no promise, inducement or agreement not herein expressed has been made

to the undersigned and that this Release contains the entire agreement between the parties hereto, and that the terms of this Release

are contractual and not a mere recital.

THE UNDERSIGNED HAS READ THE FOREGOING RELEASE AND FULLY UNDERSTANDS IT.

Signature Date Witness Signature Date

Signature Date Witness Signature Date

Any person who knowingly and with intent to defraud any insurance company or other person files a statement of claim

containing any materially false information, or conceals for the purpose of misleading information, concerning any fact

material thereto, commits a fraudulent insurance act, which is a crime.

Notice: Pursuant to the laws of the District of Columbia, if a person involved in an automobile accident, or his/her/their parent or guardian, executes, within 21 days of a motor vehicle accident, a release of liability, without the assistance of legal counsel, pursuant to the settlement of a claim for personal injury, that person or his/her/their parent or guardian may void the release; provided, that the insurance carrier or other settling party receives written notice of the intent to void the release within 12 days of the date that the release was executed, and the written notice is accompanied by any check or settlement proceeds related to the claim for personal injury that has been delivered to the claimant.

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