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Fire Transport Waiver 100 '). RELEASE AND WAIVER KNOW ALL MEN BY THESE PRESENTS: WHEREAS, I, Pam Turner, the undersigned, am participating in an Emergency Medical Intensive Care Technican Course ("EMITC") taking place at the Hutchinson Community Junior College in Hutchinson, Kansas; and, WHEREAS, a number of employees of the Salina Fire Department are participating in the same training course; and, WHEREAS, I have requested the City of Salina and the Salina Fire Department ("City") to grant me permission to ride as a passenger to and from the EMITC course sessions in Hutchinson, Kansas, in a City vehicle for the sole purpose of participating in the EMITC course; and, WHEREAS, the City will not be compensated in exchange for allowing me to ride as a passenger in an official City vehicle to and from the EMITC Course session with the participating City employees in a City vehicle. NOW THEREFORE, I, Pam Turner, in consideration of permission granted to me by the City to ride as a passenger in a City vehicle for the purpose of participating in EMITC course sessions in Hutchinson, Kansas, hereby voluntarily agree that I: (1) assume all risks of personal injury, death, and/or property damage or loss from whatever cause arising while I am so traveling to and from the EMITC Course sessions; (2) do hereby release the City, its officers, employees, agents, and servants from any claim, demand, suit, or cause of action alleging liability therefore or seeking contribution as a joint tort feasor therefore; and, (3) agree to indemnify and hold harmless the City, its officers, employees, agents and servants from any such liability or contribution to such liability. ;LtL IN WITNESS WHEREOF, I have hereunto set my hand this day of January, 1986., () J-;:!, J~ ,a~ Pam Turner Parental Consent: ~~~ loy~ rner O~ J'j ~~ __ h-'L- yU~ Phyll"s Turner - r - ... ~"'. I ;n "'.;.....-. r.: 1-.,' ..i' L~ <,:> STATE FARM HUTUi~L ;\~.HO''lOBI{'' i.I;;,I"! "f,:CE CO. REGIONAL OFFICE MISSOURI-KANSA.S OFF COLUMBIA MO 65217 EXPUNATORY INSfRf .Ii ~: I. '~ f ,I', ~..:~~ ~r~~ CL,I! S S G 4'J 7~J 1 (" c '.: \) 1.. f,~_1'".~,:'-{) i'J:jUHFfJ TURNER( LLOYD :', & NIYL IS M 509 N 9TH Sf SALINA KS 67401 F'!UC','I!U~I'ifiFP 1hO 2998-D10-;'6f 'U -P-27-8~ TO ?,PR-10 'C; nc.-:'::,; i'", ^."-. , ,',:' 1 Vf"H!L! f ~u:'!'~! 'f li.'r\;:;-J:'~ r,j;,iML::r; eli\' f;nF~'/I!tl~\': 11 ~~! L ,1:"1 ;--, ,,' D A r "i Ut.; ;q ?DR JN1PN04S8B~001326 c', ::- : } ;~, ~' ; ]'" , R,(FNl MON1H ~ ~~ ( U r" 4fj::iO? ..,. :-, (\ .- CU',;',' ^ p'~ ~ ') (;.. ') }, '50 i62.63, G2QO ~66.R4, U $8.15 _lr.,1ii:) I ., " . 4',(,~!(':', II ~Lljl~,;'~;FL:f..,- ji- '.~ "1(i:'("; ; I':':. ""J Euc, -. ~., ; ! ,) -.; , '.' r Fr',!'I' :<,:--tJ[:l(: 10r:CC,'"15!Jr'OCC 2)[10J 1r()~WJ ~DC'J'JO [/it 1,' ... 6~OOAS C~G COVS A SOL0~1~ KS 67480.' p~ & U-EFF OCT-10-B4. FINAN(E~-1 SOLOMON ST SK Rt:SIOFNCE-NILES KS 67471 ,\;! COUNrE~SISNE~ BY RObERT R LEON;'PD 1(1 23 G K EEL E Y SALINA, KS o14rJ1 i', ':r Iorl ,., .~,! W I REPt.l., 1:F'29S'8-'U.,: l7 (4M.ARt') NFW P0LICY FORM, ATTACH THIS FORM TO POLICY 800KLET Y816.5 1l1Uh r':J[ICY ((ir,Si:):; ur ii'!S IW;f Aflj'< f'r;[JnHc~ll,ir r~ I S MJI) 'Hf p[Jun SOOKI fI flWvl <} 816. 5 PI ~), St ~<fJr TOC;f f HF~-;. 1544 6fl..... i'~L'~'~-.~'~."'. "'rf'-;'i(:1~':\~Y\~;f~t:.:; .r{~;. ~J "" .,"J':", -)..'I~i;~,;~,.,(!.,.." ~ -,J.j."J, -::....~.-: . ""'lot -'~,,"""..:....._.."'l'~:'~,.;c.,~..."<ll... ~.: ,-'<.........~..,..~ 180 c" ';' 90, _. D 1 c- 16 r :, t.' r~, r;.', ;: , " ; ..~ STATE fAR~ MUTUAL AUTO~OB[LE I~SURANC~ CO_ 10 18 85 MISSOJ~I-KANSAS Off COLUMBIA MO b5~1! 3) 30 '" ".._...,.,._"_._.....~_....._._._._---..._.l----Trl['-dl\j:-A'NC ED U'i-N',:'-U D fS--TH-E--'-'l 1J ;3S1?13.S5 OCT 10 ':"(F~L P'L. Ii ......u._._.......".....__....." YOUR CUi,:R.ENr s Mr"N~~UAl PREMWft1 IS $213.55. I ." '-..., TUiH.jEi~,. LL.;'(il I' '';' PHYLLI S \1 ::,J:; N ,) r H ). S 4 L I 1\ 1\ i( i c:';; '+ Cl / Z-1j'44 / f ) ,/ , .. //'{.C/</ / . I> .:r- hX' / - 8 1 D.I\ T:> <j /4 ';;,L' ~'."5 ,I . ~.~... .... ~ i f f i 1.'- . c. '-./ _.~-,.,.." .-- ~ ..,>- r~ t,,' 1 ; ;:!-, AGENl' F\) l::,T ;. L:,.U1 ;; A t> ~~ 1 C .3:t.S.. I ~C~5283D0021355 5103C01d02998411 > I f ...._--...."".",""~""'~...,'>:-...,-,....~,.'""........_^...::-..,' ~:'"',...........--...;;;:>"o,.,._J 91S"d2:.i-C555