AEG SF Field Trip Reg Form by sanmelody

VIEWS: 8 PAGES: 5

									                AEG San Francisco Section
       FIELD TRIP REGISTRATION FORM

 San Francisco – Oakland Bay Bridge Seismic Safety Project

                       Friday September 17, 2010

To reserve a spot (one participant per registration form), please FAX this
form to the AEG SF Field Trip Chair, Phil Johnson (408-354-1852).

You must include your email address on the registration form, and you must
submit all three signed liability waivers when you register.


Name

Company

Email address

Phone Number
tAil' ArDerican/If-
~     Bridge /     1E If n fl A"llllSl
                     tI= lY7 yo    no
                         A JDlliT VElirURf




                        VISITOR RELEASE AND HOLD HARMLESS AGREEMENT

In consideration of permission from American Bridge Company/Fluor Enterprises, Inc., A Joint Venture
(hereinafter referred as "ABFJV") for the undersigned Visitor (hereafter referred as "Visitor") to enter the Project
Premises of ABFJV located at:

                                                     Contract 04-0120F4
                                                     04-SF-80-13.2/13.9
                                                     San Francisco Oakland Bay Bridge
                                                     East Span Seismic Retrofit Project
                                                     Self-Anchored Suspension Bridge
                                                     (Superstructure and Tower)

I (Visitor) agree to waive all rights and claims against ABFJV, American Bridge Company, Fluor Enterprises, Inc.
and the State of California, including each of their respective parents, subsidiaries, related entities, officers,
directors, agents and employees, and each of them and T.Y. Lin International I Moffatt & Nichol Engineers, a
Joint Venture and its consultants and subconsultants (hereafter collectively referred to as "Indemnitees") for
losses or damages due to bodily injury, sickness, disease, emotional injury, death and/or any damage to
property including the loss of use thereof, of every kind or nature whatsoever, arising out of my (Visitor)
presence on and/or use of any facility, transport or other properly of Idemnitees at the Project Premises.

To the fullest extent permitted by law, I (Visitor) further agree to indemnify, defend, and hold harmless
Indemnitees from and against any and all claims, demands, causes of action, damages, costs, expenses, actual
attorneys' fees, losses or liabilities, in law or in equity, of every kind and nature whatsoever arising out of and/or
my (Visitor) presence on any facility, transport or other property on the Project Premises, regardless of the
existence or degree of fault of Indemnitees.

I (Visitor) expressly agree that this Visitor Release and Hold Harmless Agreement is intended to be as broad
and inclusive as permitted by the laws of the State of California in the United States of America and this Release
shall be governed by and Interpreted in accordance with the laws of the State of a California. I (Visitor) agree
that In the event that any clause or provision of this Visitor Release and Hold Harmless Agreement shall be held
to be invalid by any court of competent jurisdiction, the invalidity of such clause or provIsion shall not otherwise
affect the remaining provisions of this Release which shall continue to be enforceable.

In signing this release, I (Visitor) acknowledge and represent that I (Visitor) am 18 years or age or older, have
read the foregoing, understand it and sign it voluntarily; no oral representations, statements or Inducements
have been made; I (Visitor) am fully competent and I (Visitor) execute the Visitor Release and Hold Harmless
Agreement for full, adequate and complete consideration fUlly intending to be bound by the same.

VISITOR:


                  (Signature)                                                                  Dale

                 (Print Name)



                  (Company)


TItle· (if Visitor Is Representing their Employer)




                                                                                            REV 4 - APRIL, 2008
                 VISITOR ACKNOWLEDGMENT, WAIVER, RELEASE AND
                       AND AGREEMENT TO HOLD HARMLESS
     I, [print name]                                           , hereby acknowledge and represent that (a) I am 18 years of
age or older, (b) 1 wish to visit the project site generally known as the San Francisco Oakland Bay Bridge (the "Site) and
have been granted pennission by                                           ("Contractor") to do so, and (c) I will be joining
personnel of CirclePoint and/or HNTB Corporation ("HNTB"), in visiting the Site, including possible transport to, from, in
and around the Site. In consideration for being pennitted to enter upon the premises of the Site, including possible
transport to, from, in and around the Site, for my own purpose and interest, I acknowledge and agree, on behalf of myself,
my spouse (if any), and other survivors (if applicable) to the following:

•   I will follow all rules, procedures, and instructions provided by CirclePoint and HNTB personnel. Neither CirclePoint
    nor HNTB make any representation or warranty that such rules, procedures and instructions will eliminate all risks and
    hazards or will protect me from any injury or loss.

•   I will follow all safety instructions of CirclePoint and HNTB personnel, including the wearing of personal protective
    equipment. Neither CirclePoint nor HNTB make any representation or warranty that such instructions and protective
    equipment will eliminate all risks and hazards or will protect me from any injury or loss.

•   I understand that the Site, including possible transport to, from, in and around the Site, is a construction site that is
    actively in operation, where hazards may exist and I am aware and appreciate the risks which may result. There may
    be machinery and equipment in use, and this machinery and equipment represent hazards and can cause injury,
    including death. In addition, there may be other hazards inherent to the Site and areas which may not be safe for entry
    or which pose a risk of personal injury, including death. I am also aware that accidents occur on construction sites and
    that I may be seriously injured or killed as a result. I will observe all safety and warning signs and notices posted at the
    Site. I am voluntarily entering onto the Site with knowledge of the dangers involved and I agree to accept any and all
    risk of injury or death.

•   I understand that the Contractor may have safety devices, procedures, and policies in place at the Site and for
    individuals visiting the Site. However, neither CirclePoint nor HNTB make any representation or warranty that the
    Contractor's safety devices, procedures, and policies have eliminated the hazards from the Site or will protect visitors
    from injury or loss, including death. Furthennore, neither CirclePoint nor HNTB will provide any additional safety
    devices, make any repairs or improvements, or take any measures in addition to those already in place at the Site to
    protect the safety of visitors.

•   I am visiting the Site, including possible transport to, from, in and around the Site, at my own risk. ON BEHALF OF
    MYSELF, MY SPOUSE (IF ANY), AND OTHER SURVIVORS (IF APPLICABLE), I ASSUME ANY AND
    ALL RISK OF BODILY INJURY, SICKNESS, DISEASE, EMOTIONAL INJURY, DEATH AND/OR
    DAMAGE TO PROPERTY INCLUDING THE LOSS OF USE THEREOF, OF EVERY KIND OR NATURE
    WHATSOEVER, ARISING OUT OF MY VISIT TO THE SITE AND ANY TRANSPORT RELATED
    THERETO.

    ON BEHALF OF MYSELF, MY SPOUSE (IF ANY), AND OTHER SURVIVORS (IF APPLICABLE), I
    WAIVE ALL RIGHTS AND CLAIMS AGAINST CIRCLEPOINT, HNTB, ANY OF THEIR AFFILIATED
    ENTITIES, AND EACH OF THEIR EMPLOYEES, OFFICERS, DIRECTORS, AGENTS AND
    SUBCONTRACTORS, FOR LOSSES OR DAMAGES DUE TO BODILY INJURY, SICKNESS, DISEASE,
    EMOTIONAL INJURY, DEATH AND/OR DAMAGE TO PROPERTY INCLUDING THE LOSS OF USE
    THEREOF, OF EVERY KIND OR NATURE WHATSOEVER, ARISING OUT OF MY VISIT TO THE SITE
    AND ANY TRANSPORT RELATED THERETO.

    ON BEHALF OF MYSELF, MY SPOUSE (IF ANY) AND OTHER SURVIVORS (IF APPLICABLE), TO
    THE FULLEST EXTENT PERMITTED BY LAW, I AGREE TO INDEMNIFY, DEFEND, AND HOLD
    HARMLESS CIRCLEPOINT, HNTB, ANY OF THEIR AFFILIATED ENTITIES, AND EACH OF THEIR
    EMPLOYEES, OFFICERS, DIRECTORS, AGENTS AND SUBCONTRACTORS (HEREAFTER
    COLLECTIVELY REFERRED TO AS "INDEMNITEES") FROM AND AGAINST ANY AND ALL
    CLAIMS, DEMANDS, CAUSES OF ACTION, DAMAGES, COSTS, EXPENSES, ACTUAL ATTORNEY'S
    FEES, LOSSES OR LIABILITIES, IN LAW OR IN EQUITY, OF EVERY KIND AND NATURE

                                                           Page 1
     WHATSOEVER ARISING OUT OF MY VISIT TO THE SITE AND ANY TRANSPORT RELATED
     THERETO, REGARDLESS OF THE EXISTENCE OR DEGREE OF FAULT ON INDEMNITEES.

•    In signing this document, I intend to release, in advance, and to waive my rights against and discharge all of the
     persons and entities mentioned above from any and all claims for bodily injury, sickness, disease, emotional injury,
     death and/or damage to property including the loss of use thereof, of every kind or nature whatsoever which I may
     have as a result of my visit to the Site, and any transport related thereto, even though that liability may arise from
     negligence or carelessness on the part of persons or entities being released, or from dangerous or defective property or
     equipment owned, maintained, or controlled by them or the Contractor, or because of their possible liability, without
     fault.

•   I expressly agree that this Visitor Acknowledgment, Waiver, Release and Agreement to Hold Harmless is intended to
    be as broad and inclusive as permitted by the laws of the State of California and that this agreement shall be governed
    by and interpreted in accordance with the laws of the State of California. In the event that any clause, term, or
    provision of this document shall be declared or adjudicated void or invalid, it shall in no manner affect the other
    clauses, terms and provisions hereof, which shall remain in full force and affect, as if the clause, term or provision so
    declared or adjudicated invalid were not originally a part thereof.

•   In signing this document, I further acknowledge and represent that I have carefully read the foregoing, understand it
    and sign it voluntarily; no oral representations, statements or inducements have been made; I am fully competent and I
    execute this document for full, adequate and complete consideration fully intending to be bound hereby. I understand
    that this document is binding upon the undersigned and each of his, her, or their respective heirs, assigns and legal
    representatives.

THIS IS AN IMPORTANT LEGAL DOCUMENT. READ CAREFULLY BEFORE SIGNING BELOW.


VISITOR:


Signature                                                               Date


Print Name


Company & Title (if Visitor is representing their employer)




                                                              Page 2
    ASSOCIATION OF ENVIRONMENTAL & ENGINEERING GEOLOGISTS
                     SAN FRANCISCO SECTION




                                      LIABILITY WAIVER
                                 FOR FIELD TRIP PARTICIPANTS
The undersigned having been fully advised as to the nature and possible dangers and hazards of the field trip,
hereby acknowledges and agrees that:

1. (please print name)                                                     (herein referred to as "Participant")
   intends to participate in a field trip sponsored by the Association of Environmental & Engineering Geologists
   - San Francisco Section (herein referred to as "AEG-SF").

    The field trip for which this waiver is being made is to be held on September 17, 2010.

2. Participant agrees and understands that during such field trip(s), he/she will be under the direction and control
   of the trip leader approved by the AEG-SF, and specifically agrees to comply with all reasonable directions
   and instructions by the trip director during the course thereof.

3. Participant understands and acknowledges that there are risks of injury to person and/or property that are
   associated with field trips, including without limitation risks related to travel hazards, terrain, weather,
   boating hazards, and other circumstances. Participant hereby voluntarily assumes all risks connected with or
   arising out of his/her participation in field trip activities, and waives any claim against AEG-SF, its officers,
   directors, employees, agents and members for any injury, harm, damage or other liability arising out of field
   trip activities.

4. Participant understands and acknowledges that AEG-SF, its officers, and field trip leaders assume no liability
   for personal injuries or property damages to participants or to third persons arising out of field trip activities.
   Participant agrees to hold AEG-SF, its officers, and field trip leaders harmless from any liability for harm
   arising out of the acts or omissions of AEG-SF or Participant during any such field trip, and indemnify AEG-
   SF, its officers, and field trip leaders against any and all awards or judgments in favor of third parties for
   losses and damages (including attorney’s fees and any costs involved because of said claims), on account of
   injury, death or property damage, or inconvenience or loss of money due to delay that may arise, by reason of
   Participant's participation in field trip activities.

5. I understand that my use of alcohol or drugs would impair my judgment and coordination, and I hereby
   waive, and will hold the AEG-SF harmless from, any and all claims of bodily injury or other harm arising
   from my use of either. I will indemnify AEG-SF against awards or judgments in favor of third parties for
   losses or damages (including attorney's fees and costs), of whatever nature, arising out of my use of alcohol or
   drugs while participating in field trip activities.


Date:                                     Signed:
                                                                           Participant's Signature

								
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