HomeMy WebLinkAboutPD San Quentin State Prison Range Hold Harmless and LiabilityCalifornia Department of Corrections and Rehabilitation San Quentin State Prison
San Quentin State Prison
Subject: SQSP-Range Hold Harmless Agreement & Limits of Liability
Date:
California Department of Corrections and Rehabilitation, San Quentin State Prison (SQSP) agrees to allow the User
to use the property described above for training purposes on the following date listed.
Agency Name: City of San Rafael - San Rafael Police Department
(USER)
The undersigned hereby acknowledges, consents and agrees that in no event shall California Department of
Corrections and Rehabilitation, San Quentin State Prison (SQSP) or any of its Warden, managers, shareholders,
officers, and/or employees be held responsible or liable for any acts or omissions, or for any indirect, direct,
incidental, special or consequential damage, injuries or cost whatsoever, resulting from or related to the use of the
Shooting Ranges or Range Facilities by the undersigned.
The undersigned also agrees and consents to hold California Department of Corrections and Rehabilitation, San
Quentin State Prison (SQSP) harmless for any acts or omissions on the part of the undersigned as it related to:
• The direct or indirect handling of firearms and/or equipment
• The use of firearms and/or equipment while participating in live fire events on any of the range.
• The transportation of firearms and/or equipment to and from the facility, and certifies that the method used
to transport said firearms and/or equipment confirms to the laws of the State of California.
The undersigned further acknowledges and admits that California Department of Corrections and Rehabilitation,
San Quentin State Prison (SQSP) had taken every precaution necessary to insure the undersigned's safety during
your visit to its facility and the California Department of Corrections and Rehabilitation, San Quentin State Prison
(SQSP) shall not be held liable for any act or omission outside its jurisdiction or control, or directly related to
negligence on the part of the undersigned. The undersigned further acknowledges receipt and understanding of the
Safety Rules, Range Procedure and protocols of this facility and agrees to abide by them at all times while at the
San Quentin State Prison (SQSP) range. The undersigned acknowledges that failure to comply with the rules could
result in their expulsion from the range and temporary and/or permanent loss of range privileges.
The undersigned affirms, by signature that they have refrained from being under the influence of alcoholic
beverages or drugs while in the state property owned and controlled by California Department of Corrections and
Rehabilitation, San Quentin State Prison (SQSP). The undersigned affirms that they understand that the
consumption of drugs or alcoholic beverages is expressly prohibited on California Department of Corrections and
Rehabilitation, San Quentin State Prison (SQSP) property, and that any person(s) who, strictly by our observation,
appears to be under the influence of alcohol of illicit drugs or emotionally unstable, shall be denied access to any
part of the facility.
By your signature you affirm that you have read, understand, and will the requirements as set forth herein, and do
herby agree to hold California Department of Corrections and Rehabilitation, San Quentin State Prison (SQSP) or
any of its Warden, managers, shareholders, officers, and/or employees harmless for any act or omission for which
you are directly responsible or that cause you harm.
Agency Represer)ktive: Jim c huAz , C i ty_N na g er
Signature:
Date: Zr -oZ0.C)
CONTRACT ROUTING FORM
INSTRUCTIONS: Use this cover sheet to circulate all contracts for review and approval in the order shown below.
TO BE COMPLETED BY INITIATING DEPARTMENT PROJECT MANAGER:
Contracting Department: Police
Project Manager: Roy Leon, Lieutenant
Extension: 415-485-3392
Contractor Name: San Quentin State Prison
Contractor's Contact: David Arvizo
Contact's Email: David.arvizo@cdcr.ca.gov
❑ FPPC: Check if Contractor/Consultant must file Form 700
Step
RESPONSIBLE
DESCRIPTION
COMPLETED
REVIEWER
DEPARTMENT
Project Manager
DATE
Click here to
Check/Initial
❑
1
a. Email PINS Introductory Notice to Contractor
enter a date.
b. Email contract (in Word) & attachments to City
9/24/2020
Atty c/o Laraine.Gittens@cityofsanrafael.org
❑
2
City Attorney
a. Review, revise, and comment on draft agreement
Click here to
and return to Project Manager
enter a elate.
❑
b. Confirm insurance requirements, create Job on
Click here to
PINS, send PINS insurance notice to contractor
enter a date.
❑
3
Project Manager
Forward two (2) originals of final agreement to
Click here to
❑
contractor for their signature
enter a date.
4
Project Manager
When necessary, * contractor -signed agreement
❑ N/A
agendized for Council approval
*PSA > $75,000; or Purchase > $75,000; or
Or
❑
Public Works Contract > $175,000
Date of Council approval
Click here to
PRINT
enter a date
CONTINUE ROUTING PROCESS WITH HARD COPY
5
Project Manager
Forward signed original agreements to City
Attorney with printed copy of this routing form
6
City Attorney
Review and approve hard copy of signed
0�agreement �
VZ
Review and approve insurance in PINS, and bonds
7
City Attorney
(JU
(for Public Works Contracts)
8 City Manager/ Mayor
Agreement executed by Council authorized official�io
l (mss W
+_.
9 City Clerk
Attest signatures, retains original agreement and
�q
l
a
forwards copies to Project Manager
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