User Guide

DUPLICATE KEY RELEASE FORM

PAGE 12

IB/B-T/06

we have no way of evaluating your need for the duplicate or replacement key(s) that you have

requested.

At this time, we must emphasize the potential dangers associated with the misuse of a duplicate or

replacement key to circumvent the sequential operation of a key interlock system and thereby defeat

the protections afforded by the key interlock system. We

also must insist that any duplicate or

replacement key must be secured and controlled by a responsible person to prevent any misuse of

the duplicate or replacement key.

Before complying with your request for a duplicate or replacement key, Kirk Key requires that you

acknowledge the potential dangers associated with the misuse of a duplicate or replacement key to

circumvent the sequential operation of a key interlock system and that you agree that a responsible

person shall secure and control any duplicate or replacement key supplied by Kirk Key to you. Kirk

Key also requires that you acknowledge that Kirk Key shall not be responsible or liable for any

death or injury to any person, including any of your employees or third parties, or any damage to

any property, including loss of use thereof.

Under the circumstances, Kirk Key further requires that you agree to Defend, Indemnify and Hold

Harmless Kirk Key from all claims, demands, lawsuits, including attorneys fees and costs incurred

in defending same, arising from any actual or alleged use of any duplicate or replacement key

supplied by Kirk Key to you that allegedly results in any death or injury to any person or damage to

any property, or loss of use thereof, irrespective of whether it is alleged that Kirk Key was negligent

in supplying such duplicate or replacement key.

Please indicate your agreement by signing the acknowledgement below and returning the executed

acknowledgement along with your purchase order. Upon receipt of the executed acknowledgement

and your purchase order for the requested duplicate or replacement keys(s), Kirk Key will

immediately process your order for prompt shipment.

Acknowledged and agreed:

Signature: ______________________________________________

Printed name: ___________________________________________

Title: __________________________________________________

For: ___________________________________________________

Date: ____________________________

KIRK KEY INTERLOCK

COMPANY

TELEPHONE

211 Wet more Ave nue S.E.

1-800-438-2442

Massillon, OH

44646

1-330-833-8223

USA

FAX

http://www.kirkkey.c om

1-330-833-1528