Subrogation Agreement

Subrogation agreement.

WHEREAS, on ____________________, Enter the name of the insurance company, an insurance company, was presented with a claim arising from:

Enter nature of peril resulting in claim

under insurance coverage provided to Enter the name of the insured, under its coverage for:

Enter the type of coverage claim was paid under,

and,

WHEREAS, on _________________________, Enter the name of the insurance company paid a claim in an amount of $ Enter the amount of the claim in numerals (Enter the amount of the claim in numerals dollars), with a deductible of $ Enter the amount of the insured's deductible in numerals (Enter the amount of the insured's deductible in numerals dollars), arising from the perils and covered by the policy stated above, NOW, THEREFORE:

Enter the name of the insured, his heirs and assigns, herewith assign and convey to Enter the name of the insurance company and any all rights against any entity who may be liable to Enter the name of the insured for the loss stated above.

Enter the name of the insured 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 Enter the name of the insured.

Enter the name of the insured herewith covenants and agrees to fully assist Enter the name of the insurance company in pursuit of its rights of subrogation herein. Include the following if the insured's deductible: Will be collected by the insuror

Enter the name of the insurance company may at its option pursue the deductible loss of Enter the name of the insured. In the event that Enter the name of the insurance company does so, it shall notify Enter the name of the insured, and, further, Enter the name of the insured agrees that if any recovery is made that it will share in all costs related thereto pro rata. Include the following if the insured's deductible: Will be retained by the insured

The insured shall retain separately its rights to recover the deductible loss.

Enter the name of the insured further agrees not to release or exonerate the adverse party or parties or enter into any compromise with them without the prior approval of Enter the name of the insurance company. Enter the name of the insured shall execute any and all instruments reasonably required by Enter the name of the insurance company in connection herewith.

Date: _____________________________________

___________________________________________________

Enter the name of the insured

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