Form D: Liability Statement Health Promotion and Chronic Disease Prevention grantees and contractors may borrow devices to use while conducting local evaluations. Devices available for loan include, but may not be limited to, Personal Digital Assistants (PDAs), Zircon Sonic Measures, and a SidePak Air Quality Monitor. I, the undersigned, agree to accept responsibility for any device(s) loaned to me by HPCDP until said device(s) is returned. I understand that HPCDP will prep and test each device(s) to ensure that it is working properly and has all its necessary components and accessories before I receive the device(s). I agree to return the device(s) in the same condition I received it. I agree to accept liability for any damage, loss, or theft occurring while the device(s) is on loan to me. I agree to repair or replace component(s) or accessory(ies) that are damaged, lost, or stolen while the device(s) is on loan to me. If the component or accessory cannot be repaired or replaced, I agree to remit payment for comparable replacement equipment to HPCDP. What is considered comparable replacement equipment will be determined jointly by HPCDP and the undersigned. I agree to pay all costs for return of the loaned device(s), component(s), or accessory(ies) to HPCDP on or before the due date indicated herein or upon written demand for the same. Printed Name
Form D: Liability Statement Health Promotion and Chronic Disease Prevention grantees and contractors may borrow devices to use while conducting local evaluations. Devices available for loan include, but may not be limited to, Personal Digital Assistants (PDAs), Zircon Sonic Measures, and a SidePak Air Quality Monitor. I, the undersigned, agree to accept responsibility for any device(s) loaned to me by HPCDP until said device(s) is returned. I understand that HPCDP will prep and test each device(s) to ensure that it is working properly and has all its necessary components and accessories before I receive the device(s). I agree to return the device(s) in the same condition I received it. I agree to accept liability for any damage, loss, or theft occurring while the device(s) is on loan to me. I agree to repair or replace component(s) or accessory(ies) that are damaged, lost, or stolen while the device(s) is on loan to me. If the component or accessory cannot be repaired or replaced, I agree to remit payment for comparable replacement equipment to HPCDP. What is considered comparable replacement equipment will be determined jointly by HPCDP and the undersigned. I agree to pay all costs for return of the loaned device(s), component(s), or accessory(ies) to HPCDP on or before the due date indicated herein or upon written demand for the same. Printed Name
DeviceUserApplication.docx