RELEASE AND SUBROGATION RECEIPT

Claim No: CAR383072

Conveyance: Seaboard Marine, LTD | Containerized: 9/8/2023 | Booking 7742826
RECEIVED FROM NAVIGATORS INSURANCE COMPANY (hereinafter collectively referred to as the
“Company”), THE SUM OF Six Hundred Ninety Six Dollars & 51/100 ($696.51), in full payment,
completely release, discharge and forever hold Navigators Insurance Company harmless from any and all
claims, demands, suits (known or unknown), fixed or contingent, liquidated or unliquidated, whether or not
asserted in the referenced case, as of this date, against said Company, arising from or related to the
events and transactions which are the subject matter of this case surrounding any loss or damage by
reason of Rough Handling, occurring on or about August 23, 2023.

In consideration of, and to the extent of said payment, the undersigned hereby subrogates to Navigators
Insurance Company, all the rights, claims and interest which the undersigned may have against any
party, person, property, or corporation liable for the loss mentioned above, and authorizes the Company
to sue, compromise, or settle in the undersigned’s name or otherwise all such claims and to execute, sign
a release, and to endorse checks or drafts given in settlement of such claims.

Warranted no settlement has been made by the undersigned with any party, person, persons, property or
corporation against whom a claim may lie, and no release has been given to anyone responsible for this
loss, and that no such settlement will be made nor release given by the undersigned without the written
consent of the Company, and the undersigned covenants and agrees to cooperate fully with the
Company in the prosecution of such claims, and to procure and furnish all papers and documents, in the
undersigned’s possession, necessary in such proceedings.

SIGNATURE(S): WITNESS:

_____________________________ _____________________________
Authorized Signature

_____________________________ _____________________________
Print Name Print Name
_____________________________ _____________________________
Title Title
_____________________________ _____________________________
Company Name Company Name
_____________________________ _____________________________
Company Address Company Address

_____________________________ _____________________________
Date Date

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