Winshield Washing Permit
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Windshield Washing Permit
Permit for Conducting Windshield Washing Project at:
Rest Area Location: County: District:
Organization or Chapter Name:
Contact Person: Telephone:
Address:
Date Requested: Time:
By exercising this permit, the organization or club agrees to and does hereby voluntarily and knowingly release and forever discharge the State of Illinois, its departments and agencies, from any claim, demand, right or cause of action or suits at law or in equity for any and all damages, injuries and losses to the organization or club, its officers, employees, agents, invitees, guests and property, both known and unknown and foreseen and unforeseen, and all consequences thereof incurred by or suffered by or resulting to organization or club, its officers, employees, agents, invitees, guests and property from or in any way arising out of or connected with, directly or indirectly, the performance of this Agreement by the organization or club and by the department and by their respective officers, employees, and agents.
By exercising this permit, the organization or club agrees to assume all responsibility and to indemnify and save harmless the State of Illinois, its departments and agencies and its officers and employees from and against any and all liabilities, judgments, claims, demands, loss, damages, destruction, injury, or death which occurs or results from the performance of this permit by the organization or club and by the department, and their respective officers, employees and agents.
The organization or club officers, members or agents are not employees or agents of the State of Illinois for the purposes of this permit. The State of Illinois shall in no manner be obligated or liable under any Worker’s Compensation laws as a result of any activities undertaken pursuant to this permit.
Signature: Date: Organization or Club Representative
For Department of Transportation Use Only
I hereby give permission to the Cycle Rider Safety Training Program (CRSTP) and the above named organization or club to staff the Illinois Department of Transportation sponsored Windshield Washing Project at the above rest area on the date(s) and time(s) listed. Rest area banners and motorist awareness brochures will be provided by the CRSTP. The site coordinator and organization or club has agreed to comply with the rules and furnish all supplies.
District Signature: Title:
Date:
Printed 4/5/2018 BSPE 709 (Rev. 01/18/17) Formerly TS 709