Damage Waiver Form

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Damage Waiver
THIS PROGRAM IS DESIGNED TO HELP YOU THE CUSTOMER, BY LIMITING THE
LIABILITY FOR VANDALISM, THEFT, AND ACCIDENTAL DAMAGE TO THE
PORTABLE SANITATION EQUIPTMENT PROVIDED BY ASSOCIATED SEPTIC
SERVICES, INC. SOME INFORMATION ABOUT THIS PROGRAM IS LISTED BELOW, IF
YOU HAVE ANY QUESTIONS FEEL FREE TO CALL OUR OFFICE. WE WOULD BE
HAPPY TO GO OVER IT WITH YOU.
1. Protection against fire, theft or vandalism (including graffiti) 24 hours a day 7 days a
week from whoever is damaging the unit (supplier, subcontractor, other)
2. There is a deductible. You are protected against damage over and above a $75.00
deductible on standard units, a $200.00 deductible on all other types of units. The
replacement value of the unit varies on the type of unit being rented.
3. If a unit is stolen from a job site, you the customer, pay only the deductible.
However we do ask that you provide us with a copy of the police report within 7
days.
4. The only restriction to the contract is that all toilets rented by a customer must be
covered.
5. Now, you don’t have to accept this program You or your insurance company can
accept responsibility for any and all damages by signing the DECLINE PORTION
of the form and returning it to us along with a copy of your certificate of insurance.
You will then be bound by our standard rental agreement.
Cost
$7.00 per standard unit per month
$12.00 per non-standard unit per month
Damage Waiver Form
1. I wish to _________________ this damage waiver policy.
Accept
or
Decline
If declined please remit a copy of your certificate of insurance
2. Customer Name___________________________
3. Address__________________________________
__________________________________
__________________________________ Fax#_________________
4. Signature_______________________ Date__________________
5. Printed Name and Title____________________________________

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