Fillable Printable Construction Release of Liability Form

Construction Release of Liability Form

CONSTRUCTION SITE ACCESS

WAIVER OF LIABILITY AND RELEASE

The Undersigned has requested to be permitted access to the Construction Sites for the above-named Construction Program. The

Undersigned agrees and represents that he/she is aware that there are ongoing construction activities at the Construction Sites. The

Undersigned further

agrees and represents that construction sites are a dangerous environment, including the above-referenced

Construction Site, despite the

precautions for safety taken by the Connecticut Department of Transportation (CTDOT), Walsh/PCL Joint

Venture II (WPJV), O&G Industries, Inc., Tutor Perini Corporation, a Joint Venture (OGTP), its subcontractors, or others performing work at

the construct

ion site. In consideration of being granted the right to access the Construction Sites, the Undersigned has agreed to execute this

Waiver of Liability and Release and be bound by the terms hereof.

WHEREFORE, the Undersigned, for himself and for his personal representatives, heirs, next of kin, and assigns, acknowledges and agrees:

1. The Undersigned acknowledges that he/she fully understands that construction and other activities at the Construction Sites

are

dangerous and involve risks of serious injury, death, and/or property damage.

2. To the fullest extent permitted by law, the Undersigned (and on behalf of the Undersigned’s personal representatives, heirs, next

of kin, and assigns) RELEASES, WAIVES AND DISCHARGES, AND COVENANTS NOT TO SUE, the Connecticut Department of

Transportation (CTDOT), Walsh/PCL Joint Venture II (WPJV), O&G Industries, Inc., Tutor Perini Corporation, a Joint Venture

(OGTP), Engineer, any contractor or subcontractor or person engaged by any of them to perform any work or services at the

Construction Sites, and their officers, directors, stockholders, members, employees, representatives, agents, employees, parents,

subsidiaries, sureties, insurance companies, affiliates, partners, joint ventures, attorneys, predecessors, successors, and assigns

(collectively, the “Releasees”) from any and all damages, losses, penalties, liabilities, costs, attorney’s fees and expenses of any

nature, and any demands, claims, suits, and causes of action therefor, arising out of or resulting from the Undersigned’s presence

at the Construction Sites.

3. The Undersigned ASSUMES FULL RESPONSIBILITY FOR, AND RISK OF, INJURY TO HIS/HER PERSON OR HIS DEATH or damage to

his/her property, whether caused by the negligence of the Releasees or otherwise, occurring during or as a result of the

Undersigned’s presence at the Construction Sites.

4. To the fullest extent permitted by law, the Undersigned shall indemnify, defend and hold harmless the Connecticut Department of

Transportation (CTDOT), Walsh/PCL Joint Venture II (WPJV), O&G Industries, Inc., Tutor Perini Corporation, a Joint Venture (OGTP),

Engineer and all of their officers, directors, stockholders, members, affiliates, parents, subsidiaries, employees,

agents, sureties,

insurance companies, predecessors, successors and assigns (collectively, the “Indemnitiees”), from and against any

and all demands,

claims, suits, causes of action, damages, losses, penalties, liabilities, costs, attorney’s fees and expenses of any nature, arising out of

or resulting from the Undersigned’s presence at the Construction Sites. This indemnity obligations shall not be

construed to negate,

or abridge, or otherwise reduce any other right or obligation of indemnity which would otherwise exist under

law except to the

extent that it is caused by the sole negligence of any party indemnified hereunder in which case this obligation shall not apply

relative to such indemnified party.

5. The Undersigned acknowledges that he/she has sole responsibility to evaluate carefully the risks inherent in accessing the

Construction Sites and that he/she has fully considered those risks, including, without limitation, dangers posed by willful or

negligent conduct of himself/herself and/or by others.

6. The Undersigned acknowledges and voluntarily assumes full responsibility for, and full risk of, property damage or loss, or bodily,

mental, or personal injury, including death, relating to his/her presence at the Construction Sites.

7. The Undersigned agrees that if any portion of this document is held invalid, the remaining provisions shall be binding and continue

in full force and effect.

I have read this Waiver of Liability and Release carefully, understand its significance, and voluntarily agree to all of its terms.

Signed Visitor Name: _________________ Date:_____________________________

**I am the parent/legal guardian of the child named on this Waiver. I have carefully read and understand this Wavier of Liability and

Release’s significance, and voluntarily agree to all its terms as parent/legal guardian of this child.

Signed Parent/Legal Guardian Name: _________________ Date:_____________________________

Visitor Name (print): _______________________________________________________

Child Name (if applicable and print) if under age 18: ______________________________

Full Mailing Address: _______________________________________________________

Email Address: ____________________________________________________________

Phone: __________________________________________________________________

Emergency Contact Person: __________________________________________________

Emergency Contact Phone: __________________________________________________

Relationship to Visitor(s): ___________________________________________________

Construction Program: I-95 New Haven Harbor

Crossing Corridor Improvement Program

Construction sites to visit: Projects #92-531, 532,622,

627, the reconstruction of I-91, 95, State Route 34 and

local roads and access points.

Program Owner: Connecticut DOT