HomeMy WebLinkAboutAgreement_General_03/27/2009RELEASE AND INDEMNITY AGREEMENT
This Release and Indemnity Agreement is entered into this , 7` /day of ~,~ ~ ~ ~ x-'11 , 2009,
by STEVEN MISIASZEK and MELODY MISIASZEK, the undersigned.
For the consideration of Seven Hundred Fifty Three Dollars and Eighty One Cents ($753.81), the
receipt of which is hereby acknowledged by the undersigned, STEVEN MISIASZEK and MELODY
MISIASZEK, do hereby forever jointly and severally release and discharge the VILLAGE OF
TEQUESTA, its heirs, executors, administrators, insurers, successors and assigns, of and from any and all
liability, claims, judgments, demands, controversies, agreements, damages, actions, and causes of action
whatsoever, either in law or equity, which the undersigned, their heirs, executors, administrators,
successors and assigns, have, may have, or could ever have by reason of or in any way, arising out of the
incident which occurred on the 19th day of February, 2009, involving damage to STEVEN MISIASZEK'S
and MELODY MISIASZEK'S vehicle (a 2007 Hyundai Azera Limited, VIN: KMHFC46F17A209235) to
wit: at approximately 8:OOam on the aforesaid date, a Village of Tequesta public works employee was
mowing the lawn at Village Hall, when a piece of debris hidden in the lawn was caught by the lawnmower
and discharged into the aforesaid vehicle. The resulting property damage is documented on the preliminary
estimate dated February 24, 2009 attached hereto as Exhibit A.
In addition to the foregoing, STEVEN MISIASZEK and MELODY MISIASZEK hereby agree to
indemnify and hold harmless the VILLAGE OF TEQUESTA against any claim for damages, compensation
or otherwise, and to reimburse or make good any loss or damages or costs that said VILLAGE OF
TEQUESTA may have to pay if any litigation arises on account of any claims made on their behalf.
It is further understood and agreed that the contents of this Release and Indemnity Agreement is
not, and is not to be construed as, an admission on the part of the VILLAGE OF TEQUESTA of any
liability whatsoever arising out of the incident. /l ,,~ ~
In Witness Whereof, we have hereunto set our hands this ~ ~ day of ! ~ ~ (,{ ~ ~t~ , 2009.
STEVEN and MELODY MISIASZEK:
EN MISIASZEK
MELODY MISIA EK
State of Florida, Palm Beach County, Village of Tequesta
On this ~7 day of rc=n 2009, before me personally appeared STEVEN
MISIASZEK and MELODY MISIASZEK each of whom is known to me to be the person described herein
or who produced ~r~Uers ~..cC~ntS ~ as identification and who executed the foregoing instrument and
who duly acknowledged to me that they executed same for the purposes stated herein.
otary Public (Notary Seal)
NO!fARY PUBLICSTATE OF FLORIDA
,,,..,,.,,, Debra Ann Telfcw
,~ ~ Commission ~ DD844912
"!~••` Expixes: JAN. O5, 2013
BONDED TFiRU ATLAPiT1C Bpp(DINO co., Wc.
WITNESSES:
Q2 /24/2009 at 11:30 AM
15998
Job Number:
BCHIrlIDTB AUTO BODY & GLA88 , INC .
License #:MV11918 Federal ID #:650968669
LIFETIME GUARANTEE ON IiLL REPAIRS
900 S. OLD DIXIE HWY.
J[JPITER, ~°L 339`x$
(561) 746-$900 Fax: {561) 743--85$7
PRELIMINARY Es'rIMATE
Written By: MARK HINKLE
Adjuster:
Insured: STEVE MISIASZEK
Ownor: STEVE MISIASZEK
Address:
Other: (561)339-4100
Inspect
Location:
TnSUrBrioe
Company:
Claim #
policy #
Deductible:
Data of Lpaa:
Type og Loss:
Point of Impact:
Days to Repair
?_.U07 HYUN AZERA LIMITED 6--3.8L-FI 4D SED PEARL WH Int:
'VIN: KMHFC46F17A209235 Lic: Prod Date: Odometer:
Air Cariditioning Rear Defogger Tilt Wheel
Cruise Control Telescopic Wheel Intermittent Wipers
Keyless Entry 'hheft Deterrent/Alarm Steering Wheel Controls
Body Side Moldings Dual Mirrors Console/Storage
Tracr_a.on Control Stability Control ~'pg Lamps
Three Stage Paint Power Steering Power Brakes
Power Windows Power Locks Power Driver Sear
Power Passenger Seat Power Mirrors Fieatec~ Mirrors
AM Radio FM Radio Stereo
Search/Seek CD Player Anti-Lock Brakes (4)
Driver Air Bag Passenger Air Bag Head/Curtain Air Bags
Front Side Impact Ai r Bag 9 Wheel Disc Brakes Leather Seats
Bucket Seats Heated Seats Automatic Transmission
Overdrive Aluminum/A1.l.oy Wheels
NO. OP. DESCRIPTION QTY EX'S'. PRICE LABOR PP,INT
1 FROND' DOOR
2* Rpr LT Outer panel 2.0 2.0
3 Add for Three Stage 1.4
9 R&I LT Body side mldg 0.3
5 R&I LT Belt w'strip 0.3
6 R&I LT Mirror assy manual folding 0.5
w/o memory
7 R&T LT Handle, outside 0.3
8 R&I LT R&I trim panel 0.4
1
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.. ,~
02/24/2009 at 11:30 AM
15948
Job Number:
PRELIMINARY ESTIMATE
2007 HYUN AZERA LIMITED 6-3.SL-FI 4D SED PEARL WH Int:
N0. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
9 FENDER
10 Blnd LT Fender 1.4
11# Rpr DROP L COVER END, Tt&I L H/LAMP 1.5
12 REAR DQOR
13 Blnd LT Outer panel 1.3
14* R&I LT Body side mldg 0.3
15 RBI LT Handle, outside 0.3
16 R&I LT R&I trim panel 0.4
17 R&I LT Belt w'strip 0.3
18# HAZ WZT 1 3.00
19# CAR COV 1 5.U0
20# STRIPE TAPE
--- 1
~- 20.00
--------- -------~ ..~__~..W---
-----------
Subtotals _----------
=_~ --------
28.00 ---------_
6.6 _-------
6.1
Parts 28.00
Body Labor 6.6 hrs @ $ 42.00/hr 277.20
Paint Labor 6.1 hrs @ S 42.00/hr 256.20
Paint Supplies 6.1 hrs @ $ 29.00/hz 146.40
__-------------
SUBTOTAL ------------- -------- ------~--
$ -T------
707.80
Sales Tax Tier 1 $ 707.60 @ 6.5000$ 46.01
GRAND TOTAL $ .753.81
ANY PERSON WHO KNOWINGLY AND WITH INTENT TO INJURE, DEFRAUD, OR DECEIVE ANY'
INSURER FILES A STATEMENT OF CLAIM OR AN APPLICATION CONTAINING ANY FALSE,
INCOMPLETE, OR MISLEAf~7NG INFORMATION IS GUILTY OF A FELONY OF THE THIRD
DEGREE(FLORIDA STATUTES TITLE XLVI, CHAPTER 817.234). FAILURE TO USE THE
INSURANCE PROCEEDS IN ACCORDANCE WITH THE SECURITY AGREEMENT,IF ANY, COU1,D BE A
VIOLATION OF S. 812.014, FLORIDA STATUTES. IF YOU HAVE ANY QUESTIONS, CONTACT
YOUR LENDING INSTITUTION. IF A CHARGE FOR SHOP SUPPLIES QR HAZARllOUS OR OTHER
WASTE REMOVAL IS INCLUDED ON THIS ESTIMATE, PLEASE NOTE THE FOLLOWING: "THIS
CHARGE REPRF~SENTS C05TS AND PROFITS TQ THE MOTOR VEHICLE REPAIR FACILITY FOR
MISCELLANEOUS SHOP SUPPLIES OR WASTE DISPOSAL." IF A CHARGE FOR NEW TIRES OR A
NEW OR REMANUFACTURED LEAD-ACID $ATTERY IS INCLUDED ON THIS ESTIMA~'E, PLEASE
NOTE THE FOLLOWING: A $1.00 FEE FOR EACH NEW MOTOR VEHICLE TIRE SOLD AT RETAIL
IS IMPOSED ON ANY FERSON ENGAGING IN THE BUSINESS OF MAKING RETAIL SALES OF NEW
MOTOR VEHICLE TIRES WITHIN THE STATE OF FLORIDA. FLORIDA STATUTES TITLE XXIX
CHAPTER 903.71,8. A $1.50 FEE FOR EACH NEW OR REMANUFACTURED LEAD-ACIA BATTERY
SOLD AT RETAIL TS IMPOSED ON ANY PERSON ENGAGING IN THE BUSINESS OF p+lAtiTNG
RETAIL SALES OF NEW OR REMANIT~'ACTURED LEAD-ACID BATTERIES WITHIN THE STATE OF
FLORIDA. FLORIDA STATUTES TITLE XXIX 403.71$5.
2
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