6-Attachment B - Waiver-Indemnity-Release (Visitor).pdf

Visitor Waiver/Release/Indemnity

In consideration of being permitted to enter the premises of the Pittsburgh Water Treatment Plant, I agree to all of the following:

1. I agree to comply with all applicable rules. I will listen carefully to all information and instructions given to me by my Pittsburgh Water personnel.

2. I agree that I will not deviate into unauthorized or production areas without a Pittsburgh Water escort.

3. I agree that I will conduct myself in an orderly and respectful manner, at all times, while at the Water Treatment Plant.

4. I agree that I will not touch or operate any equipment in the Water Treatment Plant.

5. I agree to wear appropriate clothing, footwear and other personal protective equipment (PPE) in production areas.

6. I agree to NOT use my cell phone or have it out while walking through production areas.

7. I agree to not take any photographs or recordings without expressed consent from a Pittsburgh Water Manager or Security.

8. I understand that the Water Treatment Plant is an industrial facility with certain dangers inherent to such a facility, such as hazardous materials, chemicals, equipment, pipes, water, risk of falling or of items fallings and risks associated with high voltage electricity.

9. In consideration of being allowed to visit the Water Treatment Plant, I, HEREBY, VOLUNTARILY

ASSUME FULL RESPONSIBILITY FOR ANY AND ALL RISK OF PERSONAL INJURY OR DEATH,

PROPERTY DAMAGE, OR LOSS THAT MAY BE SUFFERED DURING MY VISIT TO THE WATER

TREATMENT PLANT, INCLUDING INJURY, DEATH OR DAMAGE CAUSED OR ALLEGED TO ARISE

FROM THE NEGLIGENCE OF THE CITY OF PITTSBURGH, PITTSBURGH WATER OR THEIR

SUCCESSORS/ASSIGNS. I, VOLUNTARILY RELEASE, INDEMNIFY AND HOLD HARMLESS THE CITY

OF PITTSBURGH, PITTSBURGH WATER, THEIR RESPECTIVE SUCCESSORS/ASSIGNS, ALONG WITH

THEIR ELECTED OFFICIALS, OFFICERS, EMPLOYEES, AGENTS, REPRESENTATIVES, CONSULTANTS, VOLUNTEERS AND INDEPENDENT CONTRACTORS, FROM ANY AND ALL LIABILITY AND WAIVE

THE RIGHT TO BRING ANY CLAIM OR LEGAL ACTION, WHATSOEVER, ARISING FROM THE MY

VISIT TO THE WATER TREATMENT PLANT.

If any part of this waiver/release/indemnity agreement is found to be unenforceable or invalid, that portion shall be severed, and the remainder shall remain in full effect.

I HAVE CAREFULLY READ, AND I FULLY UNDERSTAND THE WORDS AND THE LANGUAGE IN THIS

AGREEMENT. I HAVE BEEN ADVISED OF THE POTENTIAL DANGERS THAT I MAY ENCOUNTER WHEN I VISIT THE WATER TREATMENT PLANT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY, ASSUMPTION

OF RISK AND A WAIVER OF ALL CLAIMS BETWEEN MYSELF AND THE CITY OF PITTSBURGH AND

PITTSBURGH WATER. I UNDERSTAND THAT THIS DOCUMENT IS BINDING ON ME, MY HEIRS, ASSIGNS and personal representatives. I sign this document of my own free will.

PLEASE COMPLETE THE FOLLOWING:

Signature of Adult Participant: ____________________________________________________________

Printed Name: _________________________________________________________________________

Date: ________________________________________________________________________________