Accident Release of Liability Form

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									This attorney drafted Accident Release of Liability Form is a template to be utilized by
parties settling a claim based on an automobile accident. The document contains
numerous standard clauses as well as customization options including a confidentiality
clause and common insurance issues clause. This document could be utilized by
individuals involved in an automobile accident wishing to avoid the expense of litigation
and/or insurance claims.
                                Accident Release of Liability Form

This Accident Release of Liability agreement ("Release Agreement") is dated this __ day of
____, 20__ [Instruction: Insert date.] by and between ____ [Instruction: Insert first party’s
full legal name.], and _____ [Instruction and Comment: Insert second party’s full legal
name. If any additional parties are included herein, follow with further similar disclosure
regarding any such additional parties].

The undersigned, for valuable consideration between the parties, receipt and sufficiency of which
is hereby acknowledged, does hereby forever release and discharge the driver [Optional
language: and driver’s insurance company] identified above, from any and all claims or
causes of action which the undersigned now has or may have because of the motor vehicle
accident which occurred at _____ [Instruction: Insert accident location.] on ______ [Instruction:
Insert accident date and approximate time.] (the “Accident”).

It is hereby further understood and agreed that this settlement may be a compromise of a
doubtful and disputed claim and that the consideration exchanged is not to be construed as an
admission of liability on the part of the parties released, and such liability is expressly denied

[Optional language: The parties hereby further acknowledge and agree that each driver
involved in the Accident, and/or each car involved in the Accident is insured in accordance
with the applicable requirements of the jurisdiction in which it is titled or registered, and
that each party has the right to and has chosen to settle such claim through this Agreement
and without submitting a claim to any applicable insurance company, whether or not such
claim may be permitted. Each such party further respectively waives any right to submit
any such claim now or in the future.]

It is also hereby further understood and agreed that this release discharges all liability between
the undersigned and the parties named herein only. The parties expressly reserve the right to
pursue other claims or causes of action against all others who are or may be liable in the above-
referenced Accident, except as otherwise set forth herein.

[Optional Language: The parties agree they will keep the fact, terms, negotiation, and
amount of this Agreement completely confidential and that they will not disclose any
information concerning this Agreement to anyone, provided either party may make such
disclosures as are required by law and as are necessary for legitimate enforcement or tax
compliance purposes. Notwithstanding the foregoing, each of the parties may discuss the
fact, terms, negotiation and amount of this Agreement with their respective attorneys,
accountants and to the extent necessary to enter into this Agreement, employees and/or
directors and/or officers, subject to any such additional persons being subject to this
confidentiality clause.]

© Copyright 2011 Docstoc Inc.                                                             2
This Release Agreement shall be binding upon the parties and their heirs, administrators,
representatives, executors, successors, and assigns, and shall inure to the benefit of the parties
and each of them and to their heirs, administrators, representatives, executors, successors, and

Should any provision of this Release Agreement be declared or be determined by any court of
competent jurisdiction to be illegal, invalid, or unenforceable, the legality, validity, and
enforceability of the remaining parts, terms, or provisions shall not be affected thereby, and the
illegal, unenforceable, or invalid part, term, or provision shall be deemed not to be a part of this
Release Agreement to the extent same shall be declared or determined to be illegal, invalid or

This Release Agreement sets forth the entire agreement between the parties and fully supersedes
any and all prior agreements or understandings, written or oral, between the parties pertaining to
the subject matter hereof. This Release Agreement shall be governed by the laws of the State of
_____ [Instruction: Insert state.] to the extent not preempted by federal law.

This Release Agreement shall be interpreted in accordance with the plain meaning of its terms
and not strictly for or against any of the parties.

Each party represents that it has had the opportunity to consult with an attorney, and has
carefully read and understands the scope and effect of the provisions of this Release Agreement.
Neither party has relied upon any representations or statements made by the other party hereto
which are not specifically set forth in this Release Agreement.

This Release Agreement is executed voluntarily and without any duress or undue influence on
the part or behalf of the parties hereto, with the full intent of releasing all claims. The parties
acknowledge that: (a) They have read this Release Agreement; (b) They have been represented in
the preparation, negotiation, and execution of this Release Agreement by legal counsel of their
own choice or that they have voluntarily declined to seek such counsel; (c) They understand the
terms and consequences of this Release Agreement and of the releases it contains; (d) They are
fully aware of the legal and binding effect of this Release Agreement.

The parties represent and agree that the persons executing this Release Agreement on behalf of
each party has the full and complete permission and authority of the entity for which he is
executing this agreement, and have the full right and authority to commit and fully bind
themselves, their representatives, agents, principals, predecessors, successors, and privies
according to the provisions hereof. This Release Agreement is a legally valid, binding and
enforceable obligation of the parties in accordance with its terms.

This Release Agreement may be executed in one or more counterparts, including by facsimile,
each of which shall be deemed an original and all of which together shall constitute one and the
same instrument.

© Copyright 2011 Docstoc Inc.                                                             3
[Comment: Parties are advised some states may have requirements regarding certain
accidents that must be reported. Please note, this form does not address instances in which
such disclosure is required.]

Executed as of this ___ day of ____, 20__ [Instruction: Insert date.]

__________________                          _______________________
Driver 1 signature                          Driver 2 signature

[Comment: Parties should consult applicable state law regarding the signature
requirements for this type of release document. As a result, no notary or witness lines have
been provided, however same may be added if applicable or necessary.]

© Copyright 2011 Docstoc Inc.                                                    4

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