AFFIDAVIT
State of
_____________________
, 19___
County of _____________________ S.S.
BE IT ACKNOWLEDGED, that ________________________
representing ____________________, of ________________________ ("Seller"), the
undersigned deponent, being of legal age does hereby depose and say under oath as follows
(and as may be contained on reverse side or signed addendum sheets):
WHEREAS, _____________________ of ____________________
("Purchaser"), did purchase from the Seller a horizontal friction treatment,
called "pHlurous ™ Traction Treatment" (the
initial application), which said pHlurous ™ Traction
Treatment has been independently tested and proven, upon proper application, to provide an
acceptable coefficient of friction (above .50), as prescribed by Underwriters Laboratory
("UL") and OSHA standards, to prevent slip/falls; and
WHEREAS, the ongoing pHlurous ™
Traction Treatment Cleaner (used after the initial application), when used as
directed, has been found, through independent certified tests to maintain a "very
safe" average range of (.70 to .87 and above) coefficient of friction under the said
UL and OSHA standards ("acceptable coefficient of friction"); and
WHEREAS, upon review of the purchase by the Purchaser, Seller
hereby declares and certifies that sufficient pHlurous ™ Traction
Treatment Cleaner was purchased by Purchaser to have enabled Purchaser to maintain an
acceptable coefficient of friction on the horizontal surface in question, assuming it's
application was in accordance with directions supplied by Seller;
NOW, THEREFORE: it is the Sellers position: 1) that an expert
witness would be able to substantially duplicate the conditions present at the time of an
accident; 2) that the pHlurous ™ Traction Treatment
Cleaner will produce an acceptable coefficient of friction, establishing probative value
for the Purchaser; 3) That under the established case law of the various jurisdictions in
the United States, a finding of an adequate coefficient of friction should be admitted as
relevant evidence of the absence of negligence and should increase the Purchaser's
chance of avoiding liability for a slip fall accident; and 4) that Purchaser, as a
reasonably prudent person(s), exercised due diligence when selecting pHlurous ™ Traction Treatment and Cleaner as it's horizontal surface
safety system and that there is a presumption from the volume of purchased material that
the horizontal surface was maintained in a reasonably prudent manner without any evidence
of negligence.
Witness by hand this ______ day of
______________________, 199___
________________________
by ________________________
Seller
Signed in the presence of:
______________________
______________________
Print
Name
Print Name
______________________
______________________
Number
Street
Number Street
______________________
______________________
City
State
Zip
City State
Zip
(_____)________________
(_____)________________
Phone
Number
Phone Number
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