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TOWN OF MINDEN Residential Dumpster Release of Liability as a residential customer in the Town of Minden, agree to exercise reasonable care in utilizing a residential Dumpster owned by the Town. This includes, but is not limited to, the following conditions: The Dumpster is not to be excessively overloaded. The lid must come within twelve-inches of closing. No Toxic, Hazardous or Flammable Materials are to be placed in the Dumpster. Please call the Town office with any questions on what material is considered hazardous and/or dangerous and how to properly dispose of such waste. No wet cement, large appliances or furniture, or other materials will be placed in the Dumpster that would make pick-up of the Dumpster dangerous to Town employees. If reasonable care is not practiced while the Dumpster is in my possession, I shall be liable for any equipment or bodily damage caused as a result. DELIVERY AND PICKUPS: The Town of Minden cannot guarantee times of delivery or pickups; however, every effort will be made to accommodate delivery requests. I grant permission to the appropriate Town employees to enter my property for the purpose of delivering or picking up the Dumpster. The Town of Minden may refuse to deliver a Dumpster if the location is in any way hazardous. PAYMENT: I agree to pay the Town of Minden for any dumps made outside of the parameters for complimentary use as set forth in current Town policies. USE: While the Dumpster is in my care, I understand that the Town will check and dump the Dumpster every working day. The Dumpster will automatically be taken away one week after delivery unless the Town is notified differently. Please call the Town office if the Dumpster is no longer needed prior to the scheduled pick-up day. LIABILITY: I shall be responsible for any personal injuries occurring to any individual on my premise as a result of Dumpster use, and also for damage caused by fire, theft, or vandalism. The Town of Minden is not responsible for any damage caused by Dumpster because of high winds or other “Acts of God.” I assume the risk of any damage done to my property in the normal use of loading the Dumpster. This includes, but is not limited to, scrapes or indentations on driveways or sidewalks, as well as damage to landscaping in the immediate vicinity due to the size and weight of the Dumpster, or damage done during the course of loading and unloading. The Town of Minden agrees to exercise reasonable care in placement and removal of the Dumpster. PRINT Date: Last First Street Address: TOWN OF MINDEN LIABILITY RELEASE FORM REV. FEB 1, 2010