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3 <br /> Acknowledgement of Conditions & Certification <br /> As a material consideration to the City granting this approval, and without which the City <br /> would not do so, Applicant agrees to and does hereby indemnify and hold the City, its <br /> officers, employees and agents harmless from and against any and all claims, actions, <br /> demands, suits, losses or liability resulting at any time from injury to or death of any <br /> person or persons, and or damage to any and all property occurring or arising from this <br /> approval, or resulting from any non-compliance with any law, ordinance or regulation <br /> respecting the performance of approval granted herein, or otherwise arising or resulting <br /> from the approval granted. With limiting the generality of the foregoing, the within <br /> indemnification by Applicant of City, its officers, employees and agents shall include <br /> indemnification from any claim, action, demand, cause of action, suit, or proceeding, and <br /> said indemnification shall in all events include any and all attorney's fees, court costs and <br /> other legal expenses, and shall include the obligation of Applicant to appear in and <br /> defend any and all such claims, actions, or other legal proceedings whether judicial, <br /> quasi judicial, administrative or otherwise, against or affecting City, its officers, <br /> employees and agents arising out of or pertaining to the approval granted herein. <br /> This paragraph does not purport to indemnify the City, its officers, employees and agents <br /> against liability for damages arising out of bodily injury to persons or damages caused by <br /> or resulting from the sole negligence or willful misconduct of the City, its officers, <br /> employees or agents acting within their scope of employment. <br /> Also, as Applicant I certify that the information provided on this application is true and <br /> correct. /1014 J <-2+ <br /> ' <br /> 2 -l4 03 <br /> Signature Date <br /> Printed Name <br /> Organization Representing Phone No. <br /> List businesses/individuals impacted by the event that you have contacted and ask them to <br /> sign off if they concur with the closure. <br /> Businesses/Individuals (print) Signature <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> 6. <br /> 7. <br /> fD <br />