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DAMAGE INSURANCE POLICY <br />Due to an ever-increasing amount of vandalism and destruction to our portable <br />restrooms, we offer our customers a damage insurance option. The insurance policy <br />is a $10.00 per regular unit & $15.00 per ADA or specialty unit charge per four- <br />week billing cycle. This monthly non-refundable fee will release you of all repair <br />charges, with the exception of a $350.00 deductible if the unit is destroyed. $550 for <br />ADA or specialty unit. <br />* Replacement cost: Regular unit = 600.00 / Flushable unit = $900.00/ ADA unit = $1850.00 <br />Damage insurance covers the follow: <br />1. Graffiti, tar and cement removal from the portable restroom. <br />2. Minor repairs such as door, urinal and seat repair. <br />3. Obvious destruction by heavy equipment or wind. <br />Damage insurance does NOT cover the following: <br />1. Stolen units. <br />2. Missing units <br />3. Tipped units. <br />4. ADA Handicap Restrooms ( Minor damages excluded) <br />To waive the damage insurance policy, please complete the form below and return to our office as <br />soon as possible. The form must be received in our office before we will remove current insurance <br />charges from your contracts. <br />â– â– rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr <br />Customer Name: <br />Customer Number: <br />As an authorized representative of the Company/Individual, I am declininlr to take <br />advantage of the damage insurance offered by Jimmy's Johnnys, Inc. I fully <br />understand that this Company or I individually will be held completely responsible <br />for all damage, destruction, loss or theft of any equipment rented from Jimmy's <br />Johnnys, Inc. <br />Signature /Title. <br />34 <br />Date <br />