(This agreement permits an insurance company to settle your claim,
in exchange for the right to pursue reimbursement from the persons
who caused the damage.)
WHEREAS, on ____________________, INDEPENDENT CONFLAGRATION, an insurance company, was presented with a claim arising from:
under insurance coverage provided to POLICYHOLDER, under its coverage for:
WHEREAS, on ____________, INDEPENDENT CONFLAGRATION paid a claim in an amount of $ (dollars), with a deductible of $ ( dollars), arising from the perils and covered by the policy stated above, NOW, THEREFORE:
POLICYHOLDER, his heirs and assigns, herewith assign and convey to INDEPENDENT CONFLAGRATION and any all rights against any entity who may be liable to POLICYHOLDER for the loss stated above.
POLICYHOLDER shall pursue any and all responsible parties at its own expense, and may at its option, bring such action in its own name or that of POLLIE POLICYHOLDER.
POLICYHOLDER herewith covenants and agrees to fully assist INDEPENDENT CONFLAGRATION in pursuit of its rights of subrogation herein.
INDEPENDENT CONFLAGRATION may at its option pursue the deductible loss of POLLIE POLICYHOLDER. In the event that INDEPENDENT CONFLAGRATION does so, it shall notify POLICYHOLDER, and, further, POLICYHOLDER agrees that if any recovery is made that it will share in all costs related thereto pro rata.
POLICYHOLDER further agrees not to release or exonerate the adverse party or parties or enter into any compromise with them without the prior approval of INDEPENDENT CONFLAGRATION. POLICYHOLDER shall execute any and all instruments reasonably required by INDEPENDENT CONFLAGRATION in connection herewith.