HomeMy WebLinkAboutC-9509-1 - Release and Hold HarmlessCHILDREN'S HOME SOCIETY OF CALIFORNIA
Release and Hold Harmless
While participating in the Child Care Assistance Program (CCAP) through Children's Home Society
of California (hereafter referred to as the "AGENCY"), I do agree as follows (pages I and 2):
Fully agree and discharge forever the Agency, and its agents, employees, officers, directors,
trustees, representatives, attorneys, subsidiaries, divisions, related corporations, assigns,
successors, and affiliated organizations (hereafter referred to collectively as the "Released
Parties"), and each and all of them, from any and all civil and criminal liabilities, claims,
causes ofaction, charges, complaints, obligations, costs, losses, damages, injuries, attorneys'
fees, and other legal responsibilities, orally form whatsoever, whether known or unknown,
unforeseen, unanticipated, or unsuspected, the Provider, their heirs, administrators,
executors, successors in interest, and/or assigns have incurred or expect to incur, or now own
or hold, or have at any time heretofore owned or held, or may at any time own, hold, or claim
to hold by reason of any matter or thing arising from any cause whatsoever prior to the date
of the Provider's execution of this Release.
2. Agree to indemnify and defend any and all of the Released Parties for and against any and all
costs, loss or liability, including reasonable attorneys' fees, caused by any action or
proceeding, which is brought by me or my successors in interest if such action arises out of,
is based upon, or is related to any claim, demand or cause of action released herein.
Expressly waive all our rights under Section 1542 of the California Civil Code. Said Section
reads as follo%%s:
Section 1542. [Certain claims not affected by general release.] A general release does not
extend to claims which the creditor does not know or suspect to exist in his favor at the time
of executing the release, which if known to him must have materially affected his settlement
with the debtor.
4. Understand and agree that I at no time act and perform as an employee in connection with
any relationship I have with the Agency. I understand that no work, act, commission, or
omission by the Agency or me shall be construed to make or render me an employee of the
Agency. I further acknowledge that the Agency expects me to control the manner and means
in which I provide child care.
(Continues to Page 2)
i hereby acknowledge that I have read and understand this Release and I fold I [armless (page 1 and
2), that i have been provided a full and ample opportunity to study it, and that i am relying solely
upon the contents of this document and am not relying on any other representations whatsoever of
the Agency as an inducement to sign this document. APPROVED AS TO
—' / CITY ATfOR.NEY'S
Print Name (First and Last):
Licensed ProvicVr' P 11t Facility Name:
Tl !
Full Si
Rcic.-cc & I loll nannlc.%.4, rgsdcr (Re% 12 )014) Attest:
Attorney i2/zi/s3
\m,
CHS Release and Hold Harmless
Page 2
5. Understand that the Agency is interested only in the results to be achieved by me as a
Provider. The manner and method of performing my Provider services and achieving (lie
desired results shall be under my exclusive control.
(}. Understand that I, as a non -employee, am entirely ineligible for any benefits associated with
employment, including but not limited to, unemployment insurance benefits, disability
benefits, and workers' compensation benefits. In light of this fact, 1 agree that I will not
pursue any claims against the Agency in an employee capacity either during or after my
Provider responsibilities end.
7. Understand that if licensed, I must to carry a comprehensive general and automobile liability
insurance policy including premises operations, products -completed operation, blanket
contractual and personal injury with limits, of S300,000 combined single limit and an
aggrcgate limit of no less than $500,000 in a form mutually acceptable to both parties to
protect provider and Agency with a certificate of insurance, copy of bond evidencing all
coverage and endorsements required here under including a thirty (30) day written notice of
cancellation or reduction in coverage and/or signed parent affidavit. The affidavit will state
that the parent has been informed that the provider does not carry liability insurance or a
bond according to standards established by the state. These affidavits will be reviewed at
each licensing inspection. The State Department of Social Services Community Care
Licensing shall initiate proceedings to revolve the license of any licensed provider that is out
of cotllpllanee witll tliis section. I will provide a copy of liability insurance coverage, bond,
or affidavits) to the Agency as requested.
If 1 am licensed and either partially or fully self -insured for its liability and/or property
exposures, I will notify the Agency in writing and provide the Agency with a signed
statement which states that I agree to hold harmless, defend and indemnify the Agency and
its officers, employees, and agents as if the insurance requirements in the above paragraphs
are in full force and effect.
9. If I am a licensed provider, I hereby waive any rind all rights of recovery against the Agency
and its offices, agents, and employees, for loss or damage to provider or its property or the
property of others under its control to the extent that such loss or damage is insured under
any valid and collectible insurance policy in force at the time of such loss or damages.
shall, upon obtaining the policy(ies) of insurance required as stated above, give notice to the
insurance carrier or carriers of the foregoing waiver of subrogation.
Sign and date the bottom section on Page I of this document.
Rckase & i10d 11annkis.proWer (Re%. 12 1,2014) Oripwd•C 11% YcHi m-proxOcr