Ny University Donation Request Form Page 2
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1
2Asset Management
Administrative Services
105 East 17
th
Street, 2nd Floor
New York, NY 10003-2105
Tel: (212) 998-1040
Fax: (212) 995-4248
Email:
asset.management@nyu.edu
Web Address:
Receipt and Waiver Form
_____________________________________
Not-for-Profit Name (Recipient)
_____________________________________
Address
_____________________________________
City, State, Zip Code
_____________________________________
Firm Representative
Recipient hereby acknowledges receipt from New York University (hereinafter referred to as the
“University”) of the items described in the attached document for use or potential re-use (hereinafter
referred to as “Equipment”) as of the date noted below. The University is a not-for-profit education
corporation and is providing the Equipment to not-for-profit Recipient in such capacity and at no charge.
Recipient voluntarily accepts the above equipment “AS IS” and is solely responsible for any and all costs
associated with the removal of the equipment from the University.
THE UNIVERSITY MAKES NO REPRESENTATIONS OR WARRANTIES WHATSOEVER,
EXPRESSED OR IMPLIED, WITH RESPECT TO THE EQUIPMENT PROVIDED HEREUNDER
INCLUDING, BUT NOT LIMITED TO, ANY IMPLIED WARRANTIES OF FITNESS FOR A
PARTICULAR PURPOSE, MERCHANTABILITY, NONINFRINGEMENT OR OTHERWISE.
FURTHERMORE, IN NO EVENT SHALL THE UNIVERSITY BE LIABLE FOR DIRECT,
INDIRECT, SPECIAL, CONSEQUENTIAL, INCIDENTAL OR PUNITIVE LOSS, DAMAGE OR
EXPENSES ARISING OUT OF OR IN CONNECTION WITH THIS AGREEMENT, INCLUDING
BUT NOT LIMITED TO RECIPIENT'S USE OF THE EQUIPMENT OR REMOVAL OF THE
EQUIPMENT FROM THE UNIVERSITY'S PREMISES, WHETHER BASED ON BREACH OF
CONTRACT OR TORT (INCLUDING NEGLIGENCE).
Recipient hereby releases and discharges the University from any liability or responsibility for any injury
(including death), and for any damage to or loss of property, however caused, that it may suffer as a result
of or in connection with the Equipment, including, without being limited to, injury, loss, or damage that
may result from or arise out of or in connection with the negligent acts or omissions of members of the
faculty or administration or other employees or agents of the University. Furthermore, Recipient shall
indemnify the University and hold it safe and harmless from and against any and all liability, claims,
causes of action, and costs of whatsoever kind and nature including, without being limited to injury,
damage, loss including death, resulting from, arising out of, or occurring in connection with this
agreement, including but not limited to, the use or removal of the Equipment from NYU premises.
______________________________________
_____________
Not-for-Profit Name (Recipient)
Date
______________________________________
_______________________
Signature of Firm Representative
Title
_____________________________________
______________
Signature of Asset Management Representative
Date
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