Judith Grayson 2/27/2019 - Laserfiche WebLink

DocuSign Envelope ID:D1 Cl EFI D-33EB-408C-8A05-77E050DD3894 RELEASE AND SETTLEMENT AGREEMENT Release In consideration of payment the undersigned in the sum of Twenty Thousand Dollars ($20,000.00), receipt of which is hereby acknowledged, the undersigned does hereby release and forever discharge The City of Everett, its agents, employees, assigns and insurers from all claims, demands, damages, actions or causes of action arising out of or resulting from Judith Grayson's accident from a manhole on a City of Everett street that occurred on or about April 22, 2016, and detailed in Ms. Grayson's claim for damages filed with the City. This Release includes but is not limited to the specific release and waiver of any private right of action the undersigned may have against the above-named released parties under 42 USC §1395y(b)(3)(A). Claims Against'the Proceeds, Indemnity,and Hold Harmless The undersigned agrees to satisfy all liens, subrogation claims, or other rights or interests arising from the accident pertaining directly to the undersigned and asserted in or against the above- stated settlement proceeds that pertain directly to the undersigned. The undersigned also agrees to indemnify The City of Everett's its agents, employees and insurers and hold those parties harmless from any and all such liens, subrogation interests or other rights arising from this accident. This includes but is not limited to any and all liens of workers compensation insurance, hospital liens, ambulance liens, attorney liens, unpaid medical bills, insurer's claims for reimbursement of Personal Injury Protection benefits and the liens of any public agencies providing medical or other assistance including but not limited to Medicaid,Medicare. Medicare's Interests The undersigned acknowledges and represents that Medicare has no interests in this settlement. Specifically, the undersigned acknowledges and represents that the undersigned is not a Medicare beneficiary, that Medicare has made no payments for medical treatments in connection with the injuries arising from this accident, that the undersigned does not anticipate becoming a Medicare beneficiary within the next 30 months, and that the undersigned does not anticipate incurring any further medical treatments related to the injuries arising from the accident involved in this settlement. Nature of Damage and Basis of Settlement The undersigned hereby declares and represents that the injuries sustained are or may be permanent and progressive and that recovery is uncertain. In making this release, it is understood and agreed that reliance is placed wholly on the judgment, belief and knowledge of the undersigned as to the nature, extent and duration of said injuries. It is further agreed that the undersigned has not been influenced in making this release by any representations or statements regarding the injuries, or any other matters made by any person or persons representing the parties released. RELEASE& SETTLEMENT AGREEMENT- 1 JAF/6085-85/1 005362