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Subrogation Waiver
This subrogation waiver template provides the basic framework to create a simple statement regarding the insurance claims in place. You may change the wording and endorsement to meet the needs of the agreement you want to enter.

Free Sample Template
Format: Word PDF
# of Pages: 1
Printable: Yes


Subrogation Waiver TemplateForm 3154
Format: Word PDF
Category: Legal, Statement
Type: Waiver

Subrogation Waiver

Effective Date: ___/___/_____

This Subrogation Waiver Agreement is between:

“Charity”

Name: ________________________________________________________________________________________

Address: ______________________________________________________________________________________

City: ____________________________________ State: _________ Zip Code: ______________________________

AND

“Property Owner”

Name: ________________________________________________________________________________________

Address: ______________________________________________________________________________________

City: ____________________________________ State: _________ Zip Code: ______________________________

Property Location: ______________________________________________________________________________

Where the Charity hereby wishes to use the property for a special event that is to be held on the following date:

___/___/_____

and where the Property Owner wishes to make the property available for the Charity to use.

The Charity and Property Owner agree to the following terms & conditions:

The Property Owner hereby agrees to waive all of their rights of subrogation against the Charity and any of their insurers for any damage that occurs to the property to the extent that any damages are covered by the Property Owner’s insurance or would have been covered except for the insurance deductible.

This Subrogation Waiver is separate and distinct from any other agreement and or lease regarding to the use of the above listed property. It is hereby expressly agreed upon that this Subrogation Waiver is not part of any consideration that is offered under any other agreement. No merger clause of any other written agreement will extinguish this separate and distinct Subrogation Waiver.

Property Owner’s Signature: ____________________________________________________ Date: ___/___/_____

Charity Representative’s Signature: ______________________________________________ Date: ___/___/_____