Clarke Electric Cooperative - Used Pole Release Form

RELEASE

I hereby acknowledge receipt of and accept full ownership of used electric pole(s) from Heartland Power Cooperative (the "Cooperative") upon the following terms and conditions:

• 1. The used pole(s) delivered hereunder consist of the following number and size:

• Number of Poles

• Size of pole(s)

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

• 2. The handling fee for said pole(s) is $_________ (see amount below) in hand paid, receipt of which is hereby acknowledged by the Cooperative.

• 3. All poles obtained hereunder are "as is", without any warranties of merchantability or fitness for any general or particular use or purpose. I assume responsibility, at any expense, to have these poles inspected by an independent expert engaged in such testing to determine the suitability or fitness of the poles for any desired use.

• 4. I acknowledge that the Cooperative has advised me that the poles have been treated with preservatives and other chemicals that are subject to control by the EPA, and I have been advised that these poles may contain chemicals and materials that are potentially hazardous to me and any other person or thing coming in contact with these poles. I assume responsibility, at my expense, to have these poles tested to determine the existence of any such hazardous chemicals or materials. I acknowledge that the Cooperative has provided me with a copy of the EPA-approved Consumer Information Sheet relating to creosote, pentachlorophenol and arsenic, attached as to this release. I further acknowledge that I have read and understand the information set forth in the Customer Information Sheet.

• 5. I specifically agree to hold the Cooperative harmless from any and all liability from any cause whatsoever arising out of the use of these poles subsequent to the removal thereof from the Cooperatives premises, and agree to indemnify the Cooperative from any liability in any way arising from and after their removal from the Cooperative's premises. I further agree, that in the event any legal action is brought against the Cooperative arising out of the use of this (these) pole(s) by me, any subsequent owner, or any person, claiming damages by virtue of or in any manner arising out of the use of the pole (s) or damage therefrom, that I agree to hold the Cooperative harmless from any and all costs, charges, expenses, attorney's fees and judgements which may be impose upon or incurred by the Cooperative in any manner arising out of such claim or such litigation.

• Signature of person receiving said pole(s)

  Sign

• Date of signature

  Date

• ACKNOWLEDGED BY: Clarke Electric Cooperative

  Sign