Irvine, CA · Orange County
Interested Service Provider Listing Disclaimer, Waiver & Indemnification
Irvine seniors complete this disclaimer and waiver to participate in the City’s listing of paid service providers for senior residents.
What this form is
This form explains that the City’s Keen Center for Senior Resources does not screen, recommend, investigate, endorse, supervise, or guarantee listed service providers. A participating senior signs to release and hold the City harmless for claims related to using the list or making service arrangements, subject to the stated exception for gross negligence or willful or wanton misconduct. It also includes guidance about checking references, estimates, insurance, and contractor license information.
Who needs it
A senior participating in Irvine’s listing of paid service providers completes and signs this form.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed without a notary; it has no notarized or sworn attachment, so the signer just signs and dates it.
How to submit this form
- 1
Download The Form
Download the Interested Service Provider Listing Disclaimer, Waiver & Indemnification form.
- 2
Review The Disclaimer
Read the listing disclaimer, waiver, indemnification terms, and provider-related guidance.
- 3
Complete The Form
Print your name, enter the date, and sign. A witness signature is optional.
- 4
Submit To The City
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What does the service provider listing waiver do?
- It explains the City’s disclaimer about listed providers and asks participating seniors to release and hold the City harmless for claims related to using the list or arranging services.
- Who completes this form?
- The form says it is to be completed by a participating senior who is taking part in the City’s interested service provider listing.
- Do I need a notary for the service provider listing waiver?
- No. This document is signed without a notary, has no notarized or sworn attachment, and asks the signer to sign and date it.
- How do I submit the service provider listing waiver?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Interested Service Provider Listing Disclaimer, Waiver & Indemnification doesn’t need a notary — but if you have another Irvine form that does, a commissioned online notary can help.