Waiver_of_Claims_for_Worker.pdf

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AT2015-115 INSPECTION & REPAIR OF DESIGNATED FIRE PROTECTION SYSTEMS
Solicitation number
AT2015_115
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Waiver of Claims

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Waiver of Claims for Worker’s Compensation Benefits

Contractor, _________________________, understands and acknowledges that

Contractor is not an employee of Center and therefore Contractor shall have no right to and hereby waives any right to claim worker’s compensation insurance benefits that

Center may provide to its employees, officers, or other contractors. This waiver shall be made a part of the Subcontracting Agreement between Contractor and Center dated

CONTRACTOR

Signature: ________________________________ Date: ____________________

Print Name: ______________________________

Atterbury Job Corps Center

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