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WINDSHIELD WITH LANE DEPARTURE OR DRIVER ASSISTANCE REPAIR RELEASE AGREEMENT

I, ________________________________, acknowledge that I understand that I must immediately take my car to the car dealer manufacturer (or any other appropriate shop and/or person capable of performing the required work)  following the repair of my car windshield to ensure the lane departure and driver assistance cameras mounted on my windshield are recalibrated to ensure their proper functioning. Further, I hereby authorize Auto Glass Solutionsto perform all required and authorized repairs to my vehicle’s windshield.

Moreover, I assume the potential risks and liabilities associated with having Auto Glass Solutions repair and/or replace my windshield, and thereby potentially temporarily altering, de-activating and/or inhibiting the performance of the lane departure and driver assistance cameras mounted on my windshield until I bring same to the car dealer manufacturer (or any other appropriate shop and/or person capable of performing the required work) to recalibrate and ensure their proper functioning. 

Furthermore, I hereby waive any right to sue Auto Glass Solutions for any potential damages (whether to property, person or otherwise) incurred in connection with and/or as a result of the repairs.

I hereby acknowledge that I am at least Eighteen (18) years of age and the record owner of the vehicle for which the windshield is being repaired. I hereby further acknowledge that I have full binding authority to consent to the vehicle repairs being conducted by Auto Glass Solutions.

In accordance with the above-paragraph, by setting my initials on the respective lines, I hereby further acknowledge that I expressly waive all potential claims against Auto Glass Solutions for any damages arising from the acts and/or omissions of Auto Glass Solutions including, but not limited to, those items set forth below, and accordingly take full responsibility for ensuring full compliance with these terms:

_______ I acknowledge and understand that Auto Glass Solutions’s repair and/or replacement of my windshield may result in damage to, de-activation of and/or frustration of the operation of my lane departure and/or driver assistance cameras on my windshield. 

_______ I further acknowledge and understand that it may not be safe to use and/or rely upon the lane departure and driver assistance camera on my vehicle’s windshield after my windshield is repaired and until I have same recalibrated and/or checked for proper functioning by either my car manufacturer or any other person or shop capable of doing same.

_______ I acknowledge and recognize my responsibility to take my vehicle to my car manufacturer, or any other person or shop capable of performing the required work, immediately after (and/or as soon thereafter as is practicable) my windshield is replaced to ensure my lane departure and driver assistance camera are recalibrated and deemed properly functioning.

_______ I acknowledge, understand and agree that any costs associated with the recalibration and/or repairing of my lane departure and/or driver assistance camera, following the repair of my windshield, by my car dealer manufacturer, or any other appropriate shop and/or person capable of performing same, will be my responsibility.  

I hereby acknowledge that I shall defend, indemnify and hold Auto Glass Solutions, its officers, employees and subcontractors harmless from any and all claims, liability damages, losses, expenses, fees, including attorney’s fees, costs and judgments, which may ever come to be asserted against Auto Glass Solutions, arising out of the vehicle’s windshield repairs, as well as any resulting issues to my lane departure and driver assistance camera, that I have authorized herein. 

ACKNOWLEDGMENT: I have read and acknowledge that I fully understand and agree with the terms of this Agreement. 

______________________________________ ____________________________________ Print Name Signature

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