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