AAA FORT STORAGE – INSURANCE ADDENDUM
CUSTOMER NAME (PRINT) _______________________________________
UNIT NUMNER ______________
NO, I DO NOT WANT INSURANCE ___________ PLEASE INITIAL IF IT IS YOUR INTENT TO WAIVE INSURANCE. I acknowledge and understand that this storage facility does not insure my goods. I understand that this facility: respects my freedoms and my right to decide whether or not to insure my goods; does not mandate the purchase of renters insurance; nor does it require proof of coverage for property in storage. I acknowledge and agree that this waiver places no burden, responsibility or liability upon this storage facility. I assume full liability and responsibility for any and all loss or damage that may occur to my goods from any cause while in storage, including without limitation, personal, consequential, special, or incidental damages, even if storage facility has been advised of the possibility or foreseeability of such damage. Furthermore, I hold this facility harmless and release them for causing and damage or injury to my property or person. Also, I will indemnify this storage facility for any loss or damage that may be caused as a result of my use of this facility. I ACKNOLEDGE AND AGREE THAT ANY LOSS OR DAMAGE TO MY GOODS OR PERSON THAT OCCURS WHILE Y GOODS ARE IN STORAGE IS FULLY MY RESPONSIBILITY AND AT MY EXPENSE, AND I WAIVE THE RIGHT TO SUE FOR ANY SUCH DAMAGES, AS STATED IN PARAFRAPHS NUMBER 6 AND 7 OF THE LEASE AGREEMENT.
Signature ___________________________________ Date___________________________
YES, I WANT INSURANCE Please check Initial the Box to the left of the Premium amount COVERAGE LIMITS WITH 50% BURGLARY COVERAGE WITH 100% BURGLARY COVERAGE
$1000.00 _____ $6.95 _____ $10.95
$5000.00 _____ $9.95 _____ $16.95
10,000.00 _____ $19.95 _____ $31.95
$15,000 _____ $34.95 _____ $44.95
I agree to participate in the Safestor Tenant Insurance Program and to pay the above indicated monthly premium when due. I understand that a portion of the price I’m agreeing to pay for the insurance covers the storage company’s cost of collecting, accounting for and remitting premiums to the insurance company. I understand the storage facility is not responsible for paying my premiums. If I fail to make payment on storage rent and insurance, I understand that this will result in cancellation of my insurance coverage.
Signature ___________________________________ Date___________________________ INSURANCE ADDENDUM.DOCX
AS OF 1/30/13