Um Release and Trust Agreement Under Uninsured

UM RELEASE AND TRUST AGREEMENT UNDER UNINSURED

MOTORIST INSURANCE PROTECTION COVERAGE

FOR AND IN CONSIDERATION OF the payment to me/us of the sum of One Hundred Thousand Dollars ($100,000.00) byProgressive ClassicInsurance Company and the sum of Twenty-Five ThousandDollars ($25,000.00) by Progressive Bayside Insurance Company (hereinafter referred to as "the Company"), the receipt and sufficiency of which is hereby acknowledged, I/we, Teresa Ann Morris, individually, as surviving spouse and as Administrator of the Estate of David Morris, being of lawful age, have released and discharged, and do by these presents for myself/ourselves, my/our heirs, executors, administrators, and assigns, release, acquit, and forever discharge the Company, parent and subsidiary corporations thereof and any and all/other Progressive Companies (“Progressive”) of and from any and all actions, causes of action, claims or demands for damages, costs, loss of services, expenses, compensation, insurance benefits, uninsured motorist insurance benefits, underinsured motorist insurance benefits, statutory penalties, attorney's fees, consequential damages, or any other thing whatsoever on account of, or in any way growing out of, any and all known and unknown personal injuries and death and property damages resulting or to result from an accident that happened on or about August 20, 2009 at or near Georgia Highway 60, Lumpkin County, Georgia.

LIENS: I do not have any hospital liens bills and havenot received any Medicare, Medicaid benefits or any workers' compensation benefits from the United States Government or pursuant to the laws of any state, arising from the claims hereby released.

The undersigned warrants and covenants that any and all liens, of any nature whatsoever, including but not limited to workers' compensation, Medicaid/Medicare and medical provider/hospital liens, have been paid, will be paid by the undersigned, or have been waived by the lienholder.

I/we further hereby acknowledge that the above-referenced sum paid to me/us in consideration of this Release and Trust Agreement includes, but is not limited to, any and all past, present, or future claims under any policy of motor vehicle insurance issued by Progressive and any Progressive Companiesfor personal injury, pain and suffering, wage loss, loss of income, medical bills, medical expenses, hospital expenses, drug expenses, loss of services, loss of consortium, and any other expense, benefit, or kind of claim whatsoever under any policy of motor vehicle insurance issued by Progressive and any Progressive Insurance Companies for any and all known and unknown personal injuries and death and property damage resulting or to result from said accident.

I/we further hereby acknowledge and agree that the above-specified sum paid to me/us in consideration of this Release and Trust Agreement includes, but is not limited to, the total and complete discharge of Progressive for all damages incurred by me/us, in connection with, arising out of, or to arise or result from said accident.

I/we further hereby covenant never to sue, arrest, attach, garnish or prosecute any claim against Progressive for any claim I/we have or may have arising under the aforesaid policy of insurance or under any statute or laws of the State of Georgia, arising out of, to arise out of, resulting from, or to result from said accident nor shall I/we indirectly or otherwise aid any other person or persons to do what I/we have agreed and covenanted not to do.

I/we further hereby acknowledge and assume all risk, chance or hazard that the said injuries or damages may be or become permanent, progressive, greater, or more extensive than is now known, anticipated, or expected. No promise or inducement which is not herein expressed has been made to me/us, and, in executing this Release and Trust Agreement,

I/we do not rely upon any statement or representation made by or on behalf of any person, firm or corporation hereby released, or any agent, physician, doctor, or any other person representing them or any of them, concerning the nature, extent, or duration of said damages or losses or the legal liability therefor.

I/we further agree, in accordance with the terms, provisions, and conditions of the Company, Policy No’s. 41714186-7 and 33138379-2 to take, through representatives designated by the Company and at the sole expense of the Company, such action as may be necessary or appropriate to recover from Nickolas Alonzo Loveroor any other responsible party, the damages resulting from my/our involvement in said accident.

I/we further agree to hold in trust any monies received as a result of any settlement with or judgment against Nickolas Alonzo Lovero in excess of his liability policy for the damages resulting from said accident, with said monies to be paid to Progressive immediately upon same coming into my/our hands, provided that any sum received in excess of the above-stated amount paid to me/us by Progressive shall be retained by me/us.

I/we further agree to execute and deliver to Progressive Classic Insurance Company and Progressive Bayside Insurance Company and all papers and instruments that may be deemed necessary or appropriate to institute, prosecute, settle, or compromise any action or claim and to carry out the provisions and intent of said coverage under the aforesaid policy of insurance issued by Progressive. In this connection, I/we further agree that no settlement of such claim, demand or cause of action against the owner or operator or organization responsible for the operation of the aforesaid motor vehicle involved in the aforesaid accident or occurrence has been made by me/us or on my/our behalf.

I/we further agree and hereby appoint the managers and/or agents of Progressive and their successors and attorneys in fact with irrevocable power to prosecute and collect any such claim or claims against Nickolas Alonzo Lovero for the damages from said accident, to begin,prosecute, compromise, or withdraw such efforts to collect any such claim or claims in my/our names, and I/we agree to procure, execute, and furnish all papers and documents necessary in such proceedings and to cooperate with counsel retained by Progressive Classic Insurance Company and Progressive Bayside Insurance Company and attend court and testify if Progressive deems such to be necessary.

This release is contingent that the only policies of Progressive applicable to this occurrence are Policy No’s 41714186-7 and 33138379-2.

No agreements or understandings have been made between the parties except as expressed herein, and the terms of this Release and Trust Agreement are contractual and not a mere recital. I/we further state that I/we have carefully read the foregoing Release and Trust Agreement and know the contents thereof, and I/we sign the same/us as my/our own free act.

WITNESS my/our hand(s) and seal(s) this ______day of

______, 20__

______

Teresa Ann Morris, individually, as surviving spouse and as Administrator of the Estate of David Morris.

Sworn to and subscribed before me this

_____ day of ______, 20__.

______

NOTARY PUBLIC

My Commission expires ______.