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Damage Waiver Form <br />Ur4bnm le 95 Woodlynn Avenue St. Paul, MN 55117 1 Toll Free 800.210.8407 1 onsiteco.cc <br />Sanitation I Climate I Security Phone: 651.429.3781 1 Fax: 651.486.6400 <br />Due to the ever increasing amounts of vandalism and property destruction we offer our customers a damage waiver of <br />our portable restrooms. This damage waiver is a $10.00 charge per Standard Unit & $10.00 per specialty unit per four <br />week billing period. This damage waiver will release you of all repair charges with the exception of a $250.00 deductible <br />for a standard unit & $450.00 deductible for a specialty unit if the unit is completely destroyed. <br />"Replacement cost without Damage Waiver" <br />Regular unit = $850.00 / Specialty unit = $2,600.00 <br />Specialty Units Include: Standard Units Include: <br />• Wheelchair Accessible • Mobile Units <br />• Maxim Flush • Hook Units <br />• Rollaway Units <br />• Sinks <br />Damage Waiver Does Not Cover the Following: Damage Waiver Covers the Following <br />• Stolen or Missing Units • Graffiti, tar and cement removal <br />• Tipped Over Units from the portable restrooms <br />• Special Services / Extra Service • Minor repairs such as: door, urinal <br />and seat repair. <br />If you should choose to decline the damage waiver offered by On Site Sanitation Inc. you there by accept full <br />responsibility for any and all damage, destruction, loss, or theft of any equipment rented from On Site Sanitation. <br />If you choose to decline the Damage Waiver please complete and return the form below to our office as soon as <br />possible. The form must be received in our office before we will remove the Damage Waiver charge from all contracts. <br />Damage Waiver will take into effect as of the date received in our office no retroactive credits will be issued. <br />"This Company Chooses to Decline the Damage Waiver" <br />As an authorized representative of , I am declining to take advantage of <br />(Company or Agency Name) <br />the Damage Waiver offered by On Site Sanitation, INC. I fully understand that choosing to decline the Damage Waiver, <br />this company or agency will be held completely responsible far any and all damages, destruction, or theft of any <br />equipment rented from On Site Sanitation INC. <br />Customer Name: Date: <br />Billing Address: <br />City: State: Zip - <br />Authorized Signature: Title: <br />36 <br />