RELEASE LAPTOP TRAVELERS REVISED.PDF

Claim/FILC #: 731 LR F0A0721 P 
Page 1 of 2 
RELEASE OF PROPERTY 
DAMAGE CLAIM 
 
 
Maricopa County, on behalf of the Maricopa County Department of Public Health, (hereafter 
“Releasors") for payment in the sum of Two Thousand Thirty Seven Dollars and 88/100 Dollars 
($2,037.88), hereby release and forever discharge Kellermeyer Bergensons Services, Zurich 
American, and Constitution State Services ("Travelers"), and (his/her/their/its) successors and 
assigns (hereafter “Releasee(s)”) and any other person, corporation, association or partnership 
related to Releasees allegedly responsible for injuries to the property of the Releasors, and any 
other claims, demands, causes of action, damages, losses, judgments, actions, or lawsuits, 
known or unknown, anticipated or unanticipated against Releasee(s) related to actual damages 
to the County laptop as the result of an accident, incident, casualty or event (the “Incident”) 
which occurred or is alleged to have occurred on June 15, 2023 in Phoenix, AZ in connection 
with a misplaced laptop computer. 
 
The Releasor(s) agree that no promise has been offered except as set forth in this Release; that 
this Release is executed without reliance upon any statement or representation by the 
Releasees, or their representatives, concerning the nature and extent of the injuries and/or 
damages and/or legal liability; and that the Releasor(s) is/are of legal age, legally competent to 
execute this Release and accept(s) full responsibility therefore. 
 
Releasor(s) know that this payment is a full and final settlement of all claims for property 
damage incurred as a result of the Incident. However, this Release does not release any other 
claims arising as a result of the Incident, beyond damage to the laptop itself.  
 
Releasor(s) understand that payment is not an admission of liability or of negligence. It is 
understood and agreed that the Releasee(s) shall not be prevented or barred from asserting, 
any claim or cause of action against other party(ies) not subject to this Release. In fact, the 
Releasee(s) expressly reserve the right to pursue such claims against others not party to this 
Release. 
 
For your protection, Arizona law requires the following statement to appear on this form. 
Any person who knowingly presents a false or fraudulent claim for payment of a loss is 
subject to criminal and civil penalties. A.R.S. § 20-466.03. 
 
Releasor(s) has/have been given an opportunity to read this document and agree(s) that the 
terms are understood. 
 
[Signatures on next page]

Claim/FILC #: 731 LR F0A0721 P 
Page 2 of 2 
 
 
MARICOPA COUNTY, for its DEPARTMENT OF PUBLIC HEALTH 
 
Signature 
 
 
Name 
 
 
Title 
 
Chairman, Board of Supervisors 
 
Date 
 
ATTEST: 
Signature 
 
 
 
Date 
Office of the Clerk of the Board 
 
Signature 
 
Date 
Deputy Attorney for Maricopa County