HTML Preview Damages Release Of Liability Form page number 1.


Customer Code:
day of , 2013.
Printed Customer Name Signature
Printed Property Owners Name Signiture
Address:
City/State:
CGS Services, Inc.
P.O. Box 212 i 2920 E US 52
Morristown, IN 46161
765-763-6258 i1-800-453-5575
I agree to indemnify and hold CGS harmless in the event that any claims of any nature
whatsoever are raised against CGS that allege damage to property, or injury to persons
arising out of the delivery, placement, setting, use, servicing, pick-up and retrieval of the
dumpster.
I agree that the terms of this Release of Liability for Property Damage shall be governed
by Indiana Law.
I agree that this Release of Liability for Property Damage shall be binding upon and inure
to the benefit of the parties hereto and their respective successors and assigns. Neither
party may assign this Agreement without the written consent of the other.
I agree that this Release of Liability for Property Damage sets forth the entire
understanding of the parties, and it may not be changed except by a written document
signed by both parties hereto.
I have hereunto set my hand and seal, or caused the same to be signed and sealed,
RELEASE OF LIABILITY FOR DAMAGES
I, the undersigned, am over eighteen (18) years of age, and have full authority to enter
into this Contract for Payment and Release of Liability for Property Damage and Personal
Injury.
I have been informed by CGS, and I understand that the trucks and related equipment
used by CGS in the delivery, placement, setting, use, servicing, pick-up and retrieval of
the dumpster, may cause damage to yards, sidewalks, driveways, patios or other surfaces
on which those trucks or related equipment travel. I hereby release and hold CGS
harmless for any damage to property, or injury to persons that may arise out of delivery,
placement, setting, use, servicing, pick-up and retrieval of the dumpster.
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