Release of Equipment Liability Waiver Permit Request

In consideration for receiving permission to use a Governors State University, equipment specified below, one must RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE Governors State University, its Board of Trustees, officers, servants, agents, or employees (hereinafter “Releasees”) from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or to any property belonging to me, while using a Governors State University aerial lift, ladder, or scaffold (an aerial Lift device being defined as any device, vehicle mounted or manually propelled, telescoping, or articulating, or both, which is used to position personnel above six feet in height) REGARDLESS WHETHER SUCH LOSS IS CAUSED BY THE NEGLIGENCE OF THE RELEASEES or otherwise and regardless whether such liability arises in tort, contract, strict liability, or otherwise.  

1. I acknowledge I have sufficient training in operating and using the aerial lift(s), and/or ladders, and or scaffold provided to me by Governors State University. I further hereby acknowledge I am trained and certified in the safe operation of aerial lifts in accordance with this policy, the manufacturer’s recommendations, and OSHA CFR 1926.453 and OSHA 29 CFR 1910.67. Additionally, I am competent in the proper use of ladders and/or scaffolds and am knowledgeable in the OSHA regulations pertaining to them, specifically, 29 CFR 1926.1053 and 29 CFR1910.25‐26 for ladders and 29 CFR 1926.450‐454 and 29 CFR 1910.28 for scaffolds.
2. I am fully aware of the risks and hazards associated with specified equipment, including the risk of injury and even death, and I hereby elect to voluntarily use the specified equipment* and to enter the above‐named premises and engage in such activity knowing that the activity may be hazardous to me and my property. I voluntarily assume full responsibility for any risks of loss, property damage, or personal injury, including death, that may be sustained by me, or any loss or damage to property owned by me, as a result of using the specified equipment*, WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEES or otherwise.
3. I further hereby AGREE TO INDEMNIFY AND HOLD HARMLESS THE RELEASEES from any loss, liability, damage, or costs, including court costs and attorneys’ fees, that they may incur due to my use of the specified equipment*, WHETHER CAUSED BY NEGLIGENCE OF THE RELEASEES or otherwise.
4. I further hereby acknowledge that I have the right to examine the specified equipment* prior to my use of it and assume full responsibility for ensuring that the lift is in good working order. I assume full responsibility for the use of appropriate personal protective equipment in using the lift and acknowledge that Governors State University has not provided any such equipment to me.
5. I further hereby acknowledge that my activities in using the specified equipment* are in my capacity as an independent contractor and that I am not employed by Governors State University. I acknowledge that, in the event of any injury, including even death, WORKERS COMPENSATION WILL NOT APPLY.
6. It is my express intent that this Waiver and Hold Harmless Agreement shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representative, if I am deceased, and shall be deemed as a RELEASE, WAIVER, DISCHARGE AND COVENANT NOT TO SUE the above‐named Releasees. I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be construed in accordance with the laws of the State of Illinois.
7. I agree to provide a current valid Certificate of Insurance naming GSU as an additional insured.