Form Ogc-Sf-2004-04 - Equipment Damage Agreement - Car Camping Tents (Eureka Timberline Outfitters
ADVERTISEMENT
1Form No. OGC-SF-2004-04
Equipment Damage Agreement
Car Camping Tents (Eureka Timberline Outfitters)
Name: __________________________________________________________________________
Select one:
___ 4-Person
___ 6-Person
Tent Number: _____________
Equipment Checked out by: _________________________________ Date: ____________
General Condition of Tent:
___ Like New
___ Gently Used
___ Obvious Wear & Tear
___ Very Bad
Charges for damages:
1.
Returned dirty equipment (muddy, sandy, etc.)
$5 – $40
2.
Rip/tear in mosquito netting window/door
$10
3.
Rip/tear in tent door, body, rain fly
$15
4.
Damage to zippers
$25
5.
Small holes (pencil-size) in floor, body, rain fly
$5
6.
Lost, broken, or bent stakes
$1
7.
Lost, broken junction tube
$10
8.
Broken shock corded pole section
$10
9.
Lost or broken individual aluminum pole
$20
10.
Lost poles or pole set
$10 – $100
11.
Lost or damaged stuff sack
a.
Stake Sack
$5
b.
Pole Sack
$12
c.
Tent Sack
$20
12.
Lost, stolen, or non-repairable tent
a.
4-person outfitter
$321.99
b.
6-person outfitter
$459.99
Number of Stakes Out ______
Stakes In ______
Tents must be set up by renter upon return to inspect for any damages.
I certify that I have examined and agree to the fee for damages noted above. I agree that this equipment is in good condition and
is acceptable to me for its intended use. I acknowledge that I will reimburse University for any damages beyond normal wear
and tear, or loss that occurs while the said recreational equipment is in my possession. I further agree that the damages and
values should and will be assessed by the Outdoor Adventure Program at the University of Houston. I understand that I have
the right to inspect the equipment before signing. I assume full responsibility for the Department of Campus Recreation-Outdoor
Adventure Program equipment listed above and the associated accessories. I understand that I am liable for all damages,
loss, stolen equipment and rental fees associated with the above listed equipment. All equipment must be returned in a
clean condition as determined by University. A minimum $5.00 per item charge for cleaning will be applied for all items
returned unclean. I understand that I am responsible for returning this equipment and accessories during the Outdoor
Adventure Program’s regular hours on the date indicated above. I also understand that there will be a late fee charged each day
the equipment is returned late. These late fees are twice the additional day rate for each piece of equipment. I understand that
the Department of Campus Recreation, the Outdoor Adventure Program, its staff, University of Houston, or the State of Texas
are not responsible for injury or accident incurred while using this equipment; and I agree to fully Indemnify and hold harmless
each of the aforementioned for any personal injury, property damage, accident, claim, loss or expense of any kind. I understand
that when large amounts of equipment are rented or reserved there may be a deposit check required.
Refund Policy: User must cancel equipment reservation at least two working days prior to checkout time to receive a refund of
rental fees.
State law requires that you be informed of the following:
1.
with few exceptions, you are entitled on request to be informed about the information the University collects about you by use
of this form;
2.
under sections 552.021 and 552.023 of the Government Code, you are entitled to receive and the review the information; and
3.
under sections 559.004 of the Government Code, you are entitled to have the University correct information about you that is
incorrect.
Renter’s Signature: __________________________________________________
Date: ______________________
Official Use Only
Equipment checked in by: __________________________________________
Date: __________________
Damages: __________________________________________________________
Charges: $_____________
Comments:
Note: Modification of this Form requires approval of OGC
Office of the General Counsel
Standard Form Approved
by the University of Houston System
Equipment Damage Agreement – Car Camping Tents
Office of the General Counsel
OGC-SF-2004-04 Revised 05.03.07
Office of Contract Compliance
Page 1 of 1
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business