Waiver Claim Settlement and Release Agreement

Last Modified: July 29, 2025

I hereby certify that the information provided in this claim submission is true and accurate and acknowledge receipt of the insurance fraud notices available here.

I understand that if a claim payment is made and it is revealed that any materials submitted were fraudulent, materially inaccurate, or materially misleading TheGuarantors has the right to seek reimbursement from me.

In consideration of the claim payment, if any, made by TheGuarantors, the Insured (Landlord) does hereby release TheGuarantors of and from any and all past, present and future liability that TheGuarantors has had, now has, or may have, by virtue of its issuance of the related Insurance Policy solely to the extent of the loss value as determined by TheGuarantors.

In further consideration of the aforesaid payment, Insured does hereby sell, assign, transfer and set over unto TheGuarantors the Insured's claims, rights, causes of action, title and interest in and to the account which arose and became due and owing to Insured from any third party and were guaranteed by the Insurance Policy (solely to the extent of the loss value as determined by TheGuarantors), and does hereby irrevocably constitute and appoint TheGuarantors as Insured's lawful agent and attorney-in-fact, with full power and authority to prosecute and withdraw any suits or proceedings at law or in equity therefore.