HomeMy WebLinkAboutSIMONSON, KEITH MICHAEL N-2024-320
PROPERTY DAMAGE
OCT 3 1 2024 RELEASE IN FULL SETTLEMENT AND COMPROMISE
o cRoCQ�
Te✓*'urs-lam, Claim No.: 22-8740152
�hAk�a� Cross-Complainant: City of Santa Ana
Whereas we claim to have sustained damage and consequential damage to our property by reason of an occurrence
happening on or about November 4, 2022 , near the intersection of Bristol and Fifth Street, in the city of Santa Ana,
County of Orange, State of California. Whereas we claim that KEITH MICHAEL SIMONSON and all others legally
responsible for his acts and omissions, if any (hereinafter called Releasees) are legally liable therefore. Whereas
Releasees deny said liability.
Whereas the nature, extent and results of the property damages sustained by us are not now all known or unanticipated,
but we nevertheless desire to settle and compromise said claim(s) in full.
Therefore, in consideration of the payment to be received to us of TEN THOUSAND And No/100 Dollars ($10,000.00),
of which we acknowledge receipt and sufficiency, WE HEREBY RELEASE, DISCHARGE AND ACKNOWLEDGE
AS FULLY PAID AND COMPROMISED, ALL CLAIMS, DEMANDS AND CAUSES OF ACTION for property
damage only which we may now have or may hereafter have against the Releasees, their legal
representatives or successors, to recover for damage, including the total loss of or the loss of use of, our property and
including consequential damage thereto, but excluding Personal Injury.
WE UNDERSTAND THAT NO PAYMENT OR CONSIDERATION OTHER THAN THE ABOVE HAS BEEN PROMISED
US OR WILL BE PAID TO US.
WE UNDERSTAND THAT THIS PAYMENT CONSTITUTES THE FULL PAYMENT AND COMPLETE SATISFACTION
OF ANY CLAIM WHICH WE NOW HAVE OR MAY HEREAFTER HAVE FOR DAMAGE TO OUR PROPERTY.
WE ARE ON NOTICE THAT THE STATUTE OF LIMITATIONS FOR FILING A CLAIM FOR DAMAGES OTHER THAN
DAMAGES TO OUR PROPERTY WILL EXPIRE ON November 4, 2025.
I have carefully read and understand the foregoing release.Executed this [ 5 -t day of OC U�'JC'r 2024, at cf 4t jGI B C�.
READ CAREFULLY BEFORE SIGNING
IY( (� II -- JJ
Print Name: LO UCA1144lGIel Signed: A ;
1/(41A-Of- -;3141..-
� � s
Print Name ys�,C /._ Signed: ! hN
C,L
WITNESS: Addre L.,M
NOTE: For your protection the law requires the following to appear on this form:Any person who knowingly presents a false
or fraudulent claim for the payment of a loss and with the intent to injure, defraud or deceive any insurance
company, or files a statement of claim containing any false, incomplete, or misleading information, is guilty of a
crime,and may be subject to fines and confinement in state prison.