Hold Harmless Agreement printable pdf download

Hold Harmless Agreement

H. N

OBBY

INDAL

RISTY

ICHOLS

GOVERNOR

COMMISSIONER OF ADMINISTRATION

State of Louisiana

Division of Administration

Office of Risk Management

HOLD HARMLESS AGREEMENT

By signing this document, I agree to the following:

In consideration of the benefit received from my driving, or being transported in, a state-owned

vehicle or vehicle rented to the State of Louisiana, State Department, Agency, Board or

Commission, or authorized driver thereof, I voluntarily and knowingly assume any risk

associated therewith and waive my right to assert any claim against the State of Louisiana, or any

of its Departments, Agencies, Boards and Commissions, as well as its officers, agents, servants,

employees and volunteers for injury or damage to my person or property resulting from my

presence in said vehicle. I further release and hold harmless the State of Louisiana, all State

Departments, Agencies, Boards and Commissions, as well as its officers, agents, servants,

employees and volunteers, from any and all claims, demands, causes of action, expense and

liability arising out of injury or death to my person as a result of my driving or being transported

in, a state-owned vehicle or vehicle rented to the State of Louisiana, State Department, Agency,

Board or Commission, or authorized driver thereof.

Print Name __________________________________

Signature ____________________________________

Date _________________________________________

 Baton Rouge, Louisiana 70821-9106  (225) 342-8500  1-800-354-9548  Fax (225) 342-4470

Post Office Box 91106

An Equal Opportunity Employer

Hold Harmless Agreement