As a condition of receiving authorization to operate a UAS on/over University lands as described above, [name of consultant/contractor] (“Contractor”) hereby agrees to the following:

1.Contractor agrees that any photos or images of UW premises and buildings taken by the UAS will not be used for marketing or promotional purposes without separate written permission of University.

2.Contractor agrees to maintain flight records of all UAS flights authorized hereunder, and to provide UW with a copy of any FAA accident reports and relevant UAS flight data upon request.

3.Contractor affirms that all flights will be conducted in full compliance with applicable FAA regulations and state and local law.

4.The contractor agrees to indemnify, defend and hold harmless the University of Wisconsin-Madison, the Board of Regents of the University of Wisconsin System, its officers, employees and agents from and against any and all claims, losses, liability, costs or expenses (hereinafter collectively referred to as “claims”) occurring in connection with or in any way incidental to or arising out of the UAS

operations associated with this authorization, but only to the extent that such claims are caused by or result from the negligence, misconduct or other fault of the contractor, its agents, employees, subcontractors or contractors.

5.Company agrees to maintain policies of insurance for the duration of UAS operations on University premises, as described below.

INSURANCE REQUIREMENTS

• Aircraft Liability*+

                ($5,000,000 Each Occurrence/Aggregate)

• Commercial General Liability*

           Products & Completed Operations

               ($1,000,000 Each Occurrence/$2,000,000

                Aggregate)

• Automobile Liability*(if Company vehicles

           will be present on University lands)

               ($1,000,000 Combined Single Limits)

• Workers’ Compensation

                (Statutory)

*The following Additional Insured language applies to this coverage and must be shown on the certificate: The Board of Regents of the University of Wisconsin System, its officers, agents and employees.

The Certificate Holder should read:

University of Wisconsin-Madison

ATTN: Facilities Planning & Management

21 North Park Street, Sixth Floor

Madison, Wisconsin 53715

+ Lower limits may be available for low-risk operations per approval of the UW Risk Management Office

Please upload the following documents to the box below:

1.Copy of Remote Pilot Certificate for RPIC

2.Copy of Insurance Certificate covering UAS operations

3.Safety plan to prevent injuries to persons, animals or property

4.UAS accident and incident reporting procedure