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Worksite Intent & <br />Legal Assessment <br />3900 Broadway Everett, WA 98201 <br />425-385-4000 <br />www.everettsd.org <br />WORKSITE INFORMATION <br />Name of Business _________________________________________________________________ <br />Address:___________________________________________________________________________ <br />City/State/Zip: _____________________________________________________________________ <br />Hours of Operation:________________________________________________________________ <br />Website: __________________________________________________________________________ <br />Employer Lead Contact: ___________________________________________________________ <br />Employer Phone and Email:_______________________________________________________ <br />INDEMNIFICATION <br />Each party to this agreement shall be responsible for damage to persons or <br />property resulting from negligence on the part of itself, its employees, agents or <br />officers. No party will be considered the agent of another party and no party <br />assumes responsibility to any other party for the consequences of any act or <br />mission of any person, firm, or corporation not a party to this agreement. <br />Provided, the Employer shall defend, indemnify, and hold harmless the District, <br />including its employees, directors, agents, volunteers, and affiliates, from and <br />against any and all claims, actions, suits, demands, damages, liabilities, <br />obligations, losses, settlements, judgements, costs, and expenses (including <br />reasonable attorney's fees and costs) arising from the Employer's negligence or <br />willful misconduct resulting in injury or other harm to the Student. <br />Worksite Employer <br />Signature: ___________________________________ Date: _______________ <br />City of Everett <br />2930 Wetmore Ave. Ste 10-A <br />Everett, WA 98201 <br />8 a.m. - 5 p.m. <br />everettwa.gov <br />Simone Tarver <br />starver@everettwa.gov, 425-535-5301 <br />06/16/2025