Download as pdf
Download as pdf
You are on page 1of 1
PROPERTY DAMAGE RELEASE CLAIM NUMBER:20-1718025 DATE:MAY 26, 2021 KNOW ALL BY THESE PRESENT, THAT I/WE, BENJAMIN RAMOS, for and in consideration of the sum of FIVE THOUSAND ONE HUNDRED SEVENTY DOLLARS AND SEVENTY NINE CENTS ($5,170.79) the receipt of which is hereby acknowledged, do hereby for myself/ourselves release and forever discharge PROGRESSIVE DIRECT INSURANCE COMPANY AND ANDRES HEREDIA from any and all claims, actions, causes of acti demands, damages, costs, and any compensation whatsoever, which the undersigned now has/have or which may hereafter accrue for damages to property, including any claims for loss of use, diminution in value or other personal property, arising out of an accident which occurred on or about AUGUST 6, 2020, at or near 13677 E 13TH AVE. It is understood and agreed that this settlement is in full compromise of a disputed claim as to questions of liability and as to the nature and extent of property damages. Further, neither this release. nor the payment pursuant hereto, shall be construed as an admission of liability. THE UNDERSIGNED HAS READ THE FOREGOING RELEASE AND FULLY UNDERSTANDS IT. Benjamin Ramos nist lene bs 2G the) 2202 Print Name Signatur Date Print Name Signature Date

You might also like