2014/03/26 Council Agenda Packet

• 6 ATeiireASigNiEt SPECIAL USE MILD HARMLESS Agreement: in r onsiderration of al#owing this organization to hold its special event at the City of Everett Parks • &Recreation Department,the organization hereby accepts full responsibility and agrees to release, indemnify and promise to defend and save harmless the.City of Everett,its officers, employees and agents from and against any and all liability,lose,damage,expense,actions and claims, including costs and reasonable attorney's fees, incurred by the City of Everett,its officers,employees and agents in defense thereof,for both personal and/or property damage resulting from or connected directly or indirectly to the execution of this event,provided, however, the undersigned organization will not be required to hold the City of Everett,its officers,employees and agents harmless from the sole negligence of the City, its officers, employes and agents_ • This organization also agrees to accept full responsibility for all damages to any equipment or properly owned by City of Everett. I, as an authorized agent on behalf of this organization, understand that my organization may be banned from use of Parks facilitieafor failure to comply with all specified rutestregulations including but not limited to cleaning requirements for parks and facilities and additionally I,as an authorized agent on behalf of this organization,also - understand.that all City of Everett ordinances and Park codes apply to this event function • application. I,on behalf of this organization,acknowledge that I have received the information on this form in the FA jrcodes to ensure compliance. (initial here) tzir I understand gat I am required to pay all required-fees within 10 days of approval notification by the City of Evere E 'ure to do so will result in the revocation of my permit and reservation. • (initial here) I hereby de e the name and address and all other information given on this application to be true and correct. If the information is found to be false, I understand that I could be subject to prosecution and be fined up to$5,000 under RCW 9A.76.175 (initial here) ' es Insurance: lpending on the size or activity of your group,,you may be required to be covered by bodily injury,and property damage liability insurance in an amount ascertained by the City of Everett, naming the City of Everett as an additional insured. Prior to the event the organization will be responsible for obtaining said insurance and notifying the proper officials. . I certify that I have read the foregoing statements and that I have the authority as an official and/or authorized agent of the aforementioned organization to sigrf on behalf of said organization. iced: 1//`y f - - Sign Date siature of person in charge: g • s tk mmorke mat ollirrsrirTsk', !st' rorc?i ativIRdid tipsrnims 48