Laserfiche WebLink
�� ��K�^�� �� <br /> ���������� N����� ����� <br /> Damage~~ 1������ � ~~� Form <br /> . <br /> � .~ <br /> g5VVond|ymmAvenue St. Paul, VIN 55117 1 Toll Free 8OO.21O.84O7 1 nmmitecn.cnm <br /> Samitabori | CUfimmate | Security Phone:: 651.420.3781 1 Fax:: 651.486.6400 <br /> Due tothe ever increasing amounts ofvandalism and property destructionweofferourcusLomersadamagewaiverof <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 e Mobile Units <br /> Maxim Flush e 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 9 Graffiti, tar and cement removal <br /> • Tipped Over Units from the portable restrooms <br /> • Special Services / Extra Service e 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 tmDecline the Damage Waiver" <br /> Asanauthorized representative of I ' | amdeclining totake advantage of <br /> (Company orAgency Name) <br /> the Damage Waiver offered bfully d d that choosingdecline the Damage Waiver, <br /> this company or agency ll be held completely responsible for any and all damages, destruction, ortheft ofany <br /> equipment rented from On Site Sanitation INC. <br /> Customer Name: Date: <br /> Billing Address: <br /> City: State: Zip: <br /> Authorized Signature: Title: <br />