Uninsured Contractor Waiver Form Template

Uninsured Contractor Waiver Form Template
This form must be completed by all contractors who are not insured. Please read carefully and fill out all required fields.
Contractor's Full Name
First NameLast Name
Business Name
Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Project Description
Date of Work
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
I, the undersigned, acknowledge that I am an uninsured contractor and waive any claims against the property owner or general contractor for any injuries or damages that may occur during the course of work. I understand the risks involved in working without insurance and accept full responsibility for any incidents that may arise.
Signature of Contractor
Clear
Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: