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• <br /> • <br /> i a <br /> .+►,!^' SPECIAL USE HOLD HARMLESS • <br /> Agreement <br /> In consideration of allowirig this organization to hold its special event at the City of Everett Parks <br /> &Community Services,the organization hereby accepts full responsibility and agrees to <br /> release, indemnify and promise to defend and save harmless the City of Everett, its officers, <br /> employees and agents from and against any and all liability, loss, damage, expense, actions <br /> and claims, including costs and reasonable attomey's fees, incurred by the City of Everett, its <br /> officers, employees and agents in defense thereof, for both personal and/or property damage <br /> resulting from or connected directly or indirectly to the execution of this event, provided, <br /> however, the undersigned organization will not be required to hold the City of Everett, its <br /> officers, employees and agents harmless from the sole negligence of the City, its officers, <br /> employees and agents. <br /> This organization also agrees to accept full responsibility for all damages to any equipment or <br /> property owned by City of Everett. I, as an authorized agent on behalf of this organization, <br /> understand that my organization may be banned from use of Parks facilities for failure to comply <br /> with all specified rules/regulations including but not limited to cleaning requirements for parks <br /> and facilities and additionally I, as an authorized agent on behalf of this organization, also <br /> understand that all City of Everett ordinances and Park codes apply to this event/function. <br /> application. L, on behalf of this Organization, acknowledge that I have received the information <br /> on this form in codes to ensure compliance. <br /> (initial here) <br /> • R. <br /> I understand at I am required to pay all required fees within 10 days of approval notification by <br /> the City of E . ail e to do so will result in the revocation of my permit and reservation. <br /> (initial here) <br /> I hereby d Clare the name and address and all other information givbn on this application to be <br /> true and correct. If the information is found to be false, I understand that I could be subject to <br /> prosecution and e,cLup to $5,000 under RCW 9A.76.175 <br /> (initial here) <br /> Insurance. Depending on the size or activity of your group, you may be required to be covered <br /> by bodily injury and property damage liability insurance in an amount ascertained by the City of <br /> Everett, naming the City of Everett as an additional insured. Prior to the event the organization <br /> will be responsible for obtaining said insurance and notifying the proper officials. <br /> I certify that I have read the foregoing statements and that I have the authority as an official <br /> and/or authorized agent of the afore rationed o niz 'on to sign on behalf of said <br /> organization. <br /> Signature of person in charge: Date signed: /e3W49-1 <br /> s:l#commonlrecreationlformslfacilities12020 special use form and hold harmless.docx <br /> 22 <br />