Hazardous_Activity_Release_Form.pdf
PDF 58 KB Posted
- Solicitation number
- 2023-IFB-CIV-037
- Issued by
- Los Angeles County, California
About this file
This document is a Hazardous Activity Release, Waiver of Liability, Assumption of Risk, and Indemnity Agreement prepared by a city government, likely related to the Alkebu-Lan Cultural Center Storage Building Roof Replacement project in California. The form is designed to protect the city and its representatives by requiring individuals entering a potentially hazardous site to acknowledge and assume risks associated with the location, including potential exposure to dangerous substances such as asbestos, lead, PCBs, mercury, and other chemicals.
The release form requires signatories to waive their rights to legal claims against the city, its directors, commissioners, employees, volunteers, and agents for any injuries or damages sustained while accessing the project site. Participants must agree to indemnify and hold the city harmless from any liability, loss, suits, claims, or expenses arising from their site entry. The document emphasizes the mandatory use of personal protective equipment and establishes a legally binding agreement that cannot be modified orally, with provisions for legal fee recovery if the agreement is challenged.
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Text version
Last Modified 11/15/2021
HAZARDOUS ACTIVITY
RELEASE, WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY
AGREEMENT
PROJECT TITLE:
PROJECT ADDRESS:
In consideration of the City granting permission to enter the Site, the undersigned agree to make the following contractual representations and agreements:
1. Acknowledge that this release, waiver of liability, assumption of risk and indemnity agreement
(“Release and Waiver Agreement”) will be used by the City, its Directors, Commissioner, Officers, Employees, Volunteers, and Agents to govern any actions and responsibilities involved in visiting the Site.
2. Fully realize the dangers in entering the Site and fully assume the risks associated with entering the Site, by way of example and not by way of limitation, the following: the danger of asbestos, lead, PCBs, mercury, and other chemicals which may have been exposed and may be present on the site; risks associated with the use of the mandatory personal protective equipment.
3. I agree, for myself, my executers, administrators, heirs, next of kin, successors and assigns
(collectively, “successors”) to waive, release, and discharge for myself and successors any and all rights and claims which I have or which may hereafter accrue to me or successors against the City, their Directors, Commissioners, Officer, Employees, Volunteers, and Agents, for any and all dangers which may be sustained by me directly or indirectly in connection with, or arising out of, my visit to the Site.
4. I agree, for myself and successors, to indemnify, hold harmless, and defend the City, their
Directors, Officers, Commissioners, Employees, Volunteers, and Agents from any and all liability, loss, suits, claims, damages, costs, judgments, and expenses (including attorney’s fees and costs of litigation) which directly or indirectly result from or arise out of, or are alleged to result from or arise out of my entering the Site, including, but not limited to personal injury (including death at any time) and any other damage sustained.
5. I agree, for myself and successors, that the above representations are contractually binding, and are not mere recitals, and that should I or my successors assert any claim in contravention of this agreement, I or my successors shall be liable for the expenses (including legal fees and costs) incurred by the other party or parties in defending. This agreement may not be modified orally, and a waiver of any provision shall not be construed as a modification of any other provision herein or as consent to any other provision herein or as consent to any subsequent waiver or modification.
Date: Name (print):
Signature:
File details come from the government source that posted it. Updated .