Form 11010 Waiver of Liability

Use of Equipment Consent Waiver and Release

This form is submitted by (name of company here) in order to be allowed by the National Archives and Records Administration (“NARA”) to use certain NARA owned equipment, i.e., lifts, ladders, long johns, and hand jacks (both electric and manual) to help facilitate the opening of a temporary exhibit at the name of NARA facility.

By signing this form name of company agrees that its use of NARA owned equipment is subject to the following conditions:

1. I understand that NARA has made no representation concerning the safety of the equipment, nor shall NARA be responsible for training my employees or representatives on how to use the equipment.

2. I agree to conduct any activities involving NARA equipment so as not to endanger any person; and further agree to indemnify, defend, and hold harmless NARA and the United States against any and all claims, costs or expenses, or loss, injury, or damage to any persons or property, regardless of how the loss or damage is caused.

3. I agree that NARA may revoke my right to use NARA equipment at any time.

4. I certify that I have the legal authority to bind name of company to the terms set forth in this Waiver and Release form.

5. The terms set forth by this Waiver and Release form will be governed by and in accordance with the laws of the United States (without regard to conflicts of laws).

For: name of company

____________________________________ ____________________________________

NAME, TITLE DATE

For: NARA

____________________________________ ____________________________________

NAME, TITLE DATE

NATIONAL ARCHIVES AND RECORDS ADMINISTRATION NA FORM 11010 (09-17)