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    Brown

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    Rene Wilson
    Darren Brown Jr. is releasing Faith Freeman, Justin Albert Lewis, and Allstate Indemnity Company from all claims related to a car accident that occurred on August 9, 2020 in Baltimore, MD in exchange for $2,500. Allstate will also pay up to an additional $2,914 for Darren Brown Jr.'s medical expenses incurred before September 18, 2020 that resulted from the accident. Darren Brown Jr. acknowledges that this settlement is a compromise and not an admission of liability, and that he is relying only on his own judgment in making this release.

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    Brown

    Uploaded by

    Rene Wilson
    8 views1 page
    Darren Brown Jr. is releasing Faith Freeman, Justin Albert Lewis, and Allstate Indemnity Company from all claims related to a car accident that occurred on August 9, 2020 in Baltimore, MD in exchange for $2,500. Allstate will also pay up to an additional $2,914 for Darren Brown Jr.'s medical expenses incurred before September 18, 2020 that resulted from the accident. Darren Brown Jr. acknowledges that this settlement is a compromise and not an admission of liability, and that he is relying only on his own judgment in making this release.

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    Darren Brown Jr. is releasing Faith Freeman, Justin Albert Lewis, and Allstate Indemnity Company from all claims related to a car accident that occurred on August 9, 2020 in Baltimore, MD in exchange for $2,500. Allstate will also pay up to an additional $2,914 for Darren Brown Jr.'s medical expenses incurred before September 18, 2020 that resulted from the accident. Darren Brown Jr. acknowledges that this settlement is a compromise and not an admission of liability, and that he is relying only on his own judgment in making this release.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    8 views1 page

    Brown

    Uploaded by

    Rene Wilson
    Darren Brown Jr. is releasing Faith Freeman, Justin Albert Lewis, and Allstate Indemnity Company from all claims related to a car accident that occurred on August 9, 2020 in Baltimore, MD in exchange for $2,500. Allstate will also pay up to an additional $2,914 for Darren Brown Jr.'s medical expenses incurred before September 18, 2020 that resulted from the accident. Darren Brown Jr. acknowledges that this settlement is a compromise and not an admission of liability, and that he is relying only on his own judgment in making this release.

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    © All Rights Reserved
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    of 1

    %%DPS::SI MPLEX

    RELEASE OF ALL INJURY CLAIMS

    OPEN MEDICAL AGREEMENT


    CLAIM # 0595827395

    KNOW ALL MEN BY THESE PRESENTS:

    That I, Darren Brown, Jr] being of lawful age of at least eighteen years, for and in consideration of the sum of Two
    Thoussand Five Hundred Dollars and Zero cents] dollars $2500.00 to be paid upon receipt of the signed release, to the
    undersigned whereof is hereby acknowledged, do hereby and for my heirs, executors, administrators, successors, and assigns
    release, acquit and fully discharge Faith Freeman and Justin Albert Lewis, the Allstate Indemnity Company, and his, her,
    their, or its agents, servants, successors, heirs, executors, administrators, and all other persons, firms, corporations,
    associations or partnerships of and from any and all claims, actions, causes of action, demands, rights, damages, costs, loss of
    service, expenses and compensation whatsoever, which the undersigned how has/have or which may hereafter accrue on
    account of or in any way growing out of any and all known and unknown, foreseen and unforeseen bodily and personal
    injuries and the consequence thereof resulting or to result from the accident, casualty, or event which occurred on or about
    9th day of August 2020, at or near Baltimore, MD.

    For further consideration, the released parties agree to pay an additional amount for usual, reasonable and medically
    necessary expenses:

    Incurred by the undersigned prior to September 18, 2020 up to a maximum of Two Thousand Nine Hundred and Fourteen
    Dollars and zero cents dollars $2914.00 provided such costs are a result of injuries from the accident indicated above.

    TXTB91
    Initials of undersigned

    It is understood and agreed that this settlement is the compromise of a doubtful and disputed claim, and that the payment
    made is not to be construed as an admission of liability on the part of the party or parties hereby released, and that said
    releases deny liability therefore and intend merely to avoid litigation.

    The undersigned hereby declares and represents that the injuries sustained are or may be permanent and progressive and that
    recovery therefrom is uncertain and indefinite and in making this release it is understood and agreed, that the undersigned
    relies wholly upon the undersigned’s judgment, belief and knowledge of the nature, extent, effect and duration of said
    injuries and liability therefore and is made without reliance upon any statements or representation of the party or parties
    hereby released or their representatives or by any physician or surgeon by them employed.

    The undersigned further declares and represents that no promise, inducement or agreement not herein expressed has been
    made to the undersigned, and that is release contains the entire agreement between the parties hereto, and that the terms of
    this release are contractual and not a mere recital.

    Any person who knowingly or willfully presents a false or fraudulent claim for payment of a loss or benefit or who
    knowingly or willfully presents false information in an application for insurance is guilty of a crime and may be
    subject to fines and confinement in prison.

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

    LSIGN91

    Signatures Date

    CP3F1001

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