Uninsured Contractor Waiver

I. Introduction

This Uninsured Contractor Waiver ("Waiver") is executed by the undersigned contractor, hereinafter referred to as "Contractor", and [YOUR COMPANY NAME], hereinafter referred to as "Company". By signing this document, the Contractor understands they are engaging with the Company without any form of insurance coverage, including but not limited to worker's compensation, liability, or health insurance. This Waiver details the terms under which the Contractor agrees to perform the services and the risks associated.

II. Parties Involved

Company Information:
Name: [YOUR COMPANY NAME]
Address: [YOUR COMPANY ADDRESS]
Telephone: [YOUR COMPANY NUMBER]
Email: [YOUR COMPANY EMAIL]

Contractor Information:
Name: [CONTRACTOR NAME]
Address: [CONTRACTOR ADDRESS]
Telephone: [CONTRACTOR PHONE NUMBER]
Email: [CONTRACTOR EMAIL]

III. Acknowledgment of Risk

The Contractor hereby acknowledges and accepts the risks associated with performing services for the Company without any form of insurance. This includes potential personal injury, illness, permanent disability, or death that might arise from the duties performed under this agreement. The Contractor expressly agrees that they are voluntarily working under these conditions and assume all risks, both known and unknown.

IV. Waiver and Release

The Contractor hereby waives, releases, and discharges [YOUR COMPANY NAME] and its affiliates, officers, agents, employees, or other associated entities from any claims, demands, or causes of action that may arise from or in any way relate to any injury, illness, or damage that might occur during the performance of duties under this agreement. This waiver includes relinquishment of rights the Contractor might have against the Company pertaining to uninsured risks.

V. Indemnification

The Contractor agrees to indemnify and hold [YOUR COMPANY NAME] harmless from any loss, liability, damage, or costs that may incur arising out of or related to the services provided under this agreement that are as a result of the Contractor’s actions or inactions without insurance coverage.

VI. Voluntary Participation

The Contractor affirms that their agreement to the terms and conditions of this Waiver is entirely voluntary, and has been made with a full opportunity to consult with legal counsel of their choice. The Contractor is encouraged to seek independent advice to ensure a clear understanding of the waiver and the risks involved.

VII. Agreement Duration and Termination

This Waiver is effective upon the date of signature by both parties and will remain in effect for the duration of the Contractor’s engagement with [YOUR COMPANY NAME]. The terms of this agreement can only be amended or terminated in writing, agreed upon by both parties.

VIII. Governing Law and Jurisdiction

This Waiver shall be governed by and construed in accordance with the laws of the state of [YOUR STATE], without regard to its conflict of laws provisions. Any dispute arising out of or in connection with this Waiver shall be subject to the exclusive jurisdiction of the courts of [YOUR STATE].

IX. Signatures

By signing below, both parties not only acknowledge but also attest to their full understanding of the contents of this Waiver. This document may be executed in counterparts, which will be considered as an original.

Contractor Signature: ______________________
[DATE]

Authorized Signature: [YOUR COMPANY NAME]
[DATE]