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SUMMARY OF DAMAGES
Medical/Chiropractic expenses $ 4,891.00
Mileage expenses $ 124.05
Lost Wages $ 3,453.12
Purchase computer roller bag & pillow $ 233.29
Damage to vehicle (previously paid) $16,482.19
Diminished Value of vehicle $11,514.00
Vehicle Appraisal $ 275.00
(0.811 times the Special Damages above) $30,000.00
I agree to waive and release all future claims against your company and your insured related to this collision upon the prompt payment of the balance of damages specified above, which totals $50,490.46.
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