Proviso Township Equipment Loan Agreement

To be completed by Borrower or Agent. Upon execution of this Equipment Loan Agreement (the “Agreement”), the Borrower (or Agent of the Borrower) agrees to be bound to the terms and conditions outlined below.

Borrower / Agent Information

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Terms and Conditions

1. Loan of Equipment: Proviso Township (the “Township”) will loan certain medical equipment, including, but not limited to, wheel chairs, canes, walkers and bath seats (the “Equipment”) for the use and benefit of senior citizen residents of the Township at no cost. The Township will make the Equipment available on a “first come, first served” basis. The use of such Equipment shall not replace any required or prescribed medical care or any necessary consultation with a medical professional.

2. Term of Loan: The term of the loan of the Equipment shall be ninety (90) days. The Borrower (or Agent of the Borrower) may renew the term of the loan for an additional ninety (90) days by execution of a Loan Renewal signature on this Agreement. The maximum loan period of the Equipment shall be 180 consecutive days.

3. Borrower’s Obligations: The Borrower shall: (a) acknowledge that the Township retains title to and ownership of the Equipment and agrees not to sell, lend, or otherwise allow another person to use the Equipment; (b) be responsible for thoroughly cleaning the Equipment before and after use; (c) report any stolen, damaged, or lost Equipment to Proviso Township immediately by calling Proviso Township Senior Services; (d) be responsible for the cost of repairs and replacement of broken or lost Equipment and not conceal, alter, repair, or make additions to the Equipment; and (e) return the Equipment in good working condition to Proviso Township at the end of the loan period.

4. Liability: The Township is not responsible for any injury, damages, liabilities, claims, costs, or expenses arising from the Borrower’s use or possession of the Equipment, including those arising from malfunction of the Equipment. The Borrower agrees to use, operate, and possess the Equipment at their sole risk.

5. Use of Equipment: The Township is not responsible for instructing the Borrower in proper use of the Equipment. The Equipment shall be available for inspection and testing prior to execution of this Agreement. If the Equipment becomes ineffective or inoperable at any time during the Borrower’s possession, the Borrower agrees to return it immediately.

Initial Loan Details

I, (name entered in the field below), have read, understand and agree to the Terms and Conditions of the Equipment Loan Agreement.

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Date (initial loan): 01-25-2026

Date equipment must be returned or renewed (initial loan): 2026-04-25

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After you submit this form, a Senior Services Representative will call you to inform you if we have the device you requested. All equipment pickup will be at our Township office:
4565 W. Harrison Street, Hillside, IL 60162