Forms and Waivers

All forms and waivers require Adobe Acrobat. If you do not have Adobe Acrobat, please click here

For questions regarding the processing and/or submittal of a form or waiver, contact Risk Services at:

risk@ucanr.edu

Forms for Facility Use Agreements

New! Facility Use Agreement (FUA) Guidance

Attachment A: Preferred Hold Harmless and Indemnification Clause

If a facility use agreement contains a clause that compromises The Regents' assets by leaving open the potential for lawsuits from any and all parties, the County Director or Regional Director need to review the language and negotiate changes to the contract language.

Attachment B: Alternate Hold Harmless and Indemnification Clause

Certificates of Insurance

Attachment D: Preferred ANR Use Agreement

Use this form as a simple facility use agreement when the business or organization does not have a standard use agreement or contract.

Attachment E: Alternate ANR Use Agreement

Alternate form to use as a simple facility use agreement when the business or organization does not have a standard use agreement or contract.

Negotiated Indemnification Agreements
Agreements with Joint Powers Authorities (JPAs) and state agencies on indemnification language for use of facilities at school districts, community colleges, California State University (CSU) campuses, fairs, etc.

Other Forms

Incident Reports

Incident Report (other than employee injury)

Any incident resulting in property loss/damage and/or causalities (including property damage, theft, injuries to non-employees, and all auto accidents) must be reported using this form.

Vehicle Insurance/Incident Report Packet

This package of information should be placed in all ANR vehicles to provide proof of insurance, an Incident Report and other forms to use in the event of an automobile accident.

DMV Employer Pull Notice enrollment

EPN Employee Notification form

Use this form to enroll the employee in the DMV Employer Pull Notice program when an employee drives a UC or County vehicle for work.

Alcohol Permit Request

Equipment Loan
Equipment Loan - UC as Borrower
Equipment Loan - UC as Lender

Waivers

Elective/Voluntary Activity Waivers

English and in Spanish covering liability issues for elective/voluntary events, including 4-H programs.

Volunteer Forms

4-H Volunteer application and enrollment

Master Gardener volunteer application

Master Food Preserver volunteer information