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Liability Release and Waiver
<br />I, Jv st t. G f i 5.5 5 , intend to use equipment, property, or
<br />facilities ("equipment") owned and/or o erated by the South Bend Police Department ("SBPD").
<br />SBPD is donating said equipment to: -p f S ti j 1 I:e PD , with the transfer
<br />taking place witho t exchange for any consideration. Said equipmen&,mw
<br />'more expressly
<br />identified as: no-- fc, r K—
<br />In consideration for the transfer and use of the equipment, I expressly agree to and
<br />acknowledge the following:
<br />1. For myself and on behalf of my heirs, administrators, successors, and assignees, I
<br />voluntarily waive, release and hold harmless the City of South Bend and SBPD, their
<br />employees, agents, instructors, boards, officers, suppliers, and representatives, from any
<br />claim, suit, cause of action, cost or expense that I might have due to negligence, personal
<br />injury, death, property damage, or loss, known or unknown, arising either directly or
<br />indirectly from my use of the equipment.
<br />2. This Liability Release and Waiver shall be governed by and construed in accordance with
<br />the laws of the State of Indiana and the parties agree that in any action, venue shall lie
<br />exclusively in St. Joseph County, Indiana.
<br />If for any reason, any provision of this Liability Release and Waiver is held to be invalid,
<br />illegal, or unenforceable in any respect, such invalidity, illegality, or unenforceability
<br />shall not affect any other provision hereof, and this Liability Release and Waiver shall be
<br />construed as if such invalid, illegal, or unenforceable provision had never been contained
<br />herein.
<br />I have read this Liability Release and Waiver Form, which is a waiver of ALL liability, fully
<br />understand its terms, understand I have given up substantial rights by signing it, and have signed
<br />it freely and voluntarily without any inducement, assurance or guarantee being made to me and
<br />intend my signature to be a complete and unconditional release of ALL liability to the greatest
<br />extent allowed by law.
<br />Printed Name/Title: 0 h yr(AS Signature: o A*P-- Date: if
<br />Address: cl bh ^+6L-)k 9-0 ity: 60i( LrSUi"e StateTA)
<br />Contact: V vS�', G ri,( ( S Phone No.: 1 4
<br />SBPD Liability Release and Waiver
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