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L <br />EVERETT <br />WASH NciToN <br />SPECIAL USE HOLD HARMLESS <br />Agreement: <br />In consideration of allowing 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 attorney'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 />u nderstand 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 />u nderstand that all City of Everett ordinances and Park codes apply to this event/function <br />application. I, on behalf of this organization, acknowledge that I have received the information <br />o n this form in t P k fjties to ensure compliance. <br />(initial here) <br />I understand that I am required to pay all required fees within 10 days of approval notification by <br />the City of Everet;t F ilure to do so will result in the revocation of my permit and reservation. <br />(initial here) <br />hereby declare the name and address and all other information given 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 be fined up to $5,000 under RCW 9A.76.175 <br />�G( <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 />certify that I have read the foregoing statements and that I have the authority as an official <br />and/or authorized agent of the aforementioned organization to sign on behalf of said <br />o rganization. <br />Signature of person in charge: <br />Date signed: 2 ?V 2O <br />After filling out this application, please email it to recreation@everettwa.gov <br />s:\#common\recreation\forms\facilities\special use form and hold harmless.docx <br />