Sample Contractor Liability Waiver Form

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WAIVER
________________________ (“Sub-Contractor”) hereby waives all claims of liability,
both present and future, against _________________ (“Repair Shop”) arising when Sub-
Contractor enters the premises of the Repair Shop, either at the request of the Repair Shop or at
the direction of a third-party, to perform repairs or other work on an automobile. As part of an
Insurance Company repair program, an Insurance Company may require pre-approved Sub-
Contractors, other than the Repair Shop, to enter the premises of the Repair Shop and perform
work as specified in a separate contract between the Insurance Company and the Sub-Contractor.
The work performed under the contract between either the Insurance Company and the Sub-
Contractor or the Repair Shop and the Sub-Contractor will be performed solely by the Sub-
Contractor, on the premises of the Repair Shop, without any assistance or supervision from the
Repair Shop. The Repair Shop will not subsequently inspect or approve any work completed by
the Sub-Contractor. The Sub-Contractor agrees to waive all liability that may potentially arise
against the Repair Shop as a result of the work performed by the Sub-Contractor. All work
performed by the Sub-Contractor on the premises of the Repair Shop and as agreed upon by the
Insurance Company and the Sub-Contractor or the Repair Shop and the Sub-Contractor is
covered under this waiver.
Witness my signature this _____ day of ____________, 2003.
___________________________________
(Sub-Contractor)
By: ________________________________
Its: ________________________________
G:/10665/waiver

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