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3
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<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.wjth 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 application is true and
<br /> correct.
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<br /> Signature Date
<br /> Printed Name /
<br /> Ce-e• s '! 0 rra74-as-
<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) Sia e
<br /> 2. G.P4y C'o Eo
<br /> 3. Jo4IIr7 .Qes�ela �07� J u c t 5,9w44:,(5,
<br /> 4. /aL,7/ G Carie° 5z a p
<br /> 5. £i-e /7 .o co /i�.o,o�,�P �SAo/Y. '° S
<br /> 6. S 42004)�,�/Z ' oo/' N�. . .i A . .L../,'
<br /> 7.//I SGyq ..o G ..s�e7u j
<br /> Jas►,As,r, ownsAar G€QJlro 4.10t40
<br /> sJ S/X "044 Nes 11 G.Gos0400a00.04,0r
<br /> I4
<br /> 494040e. . 4A'0'3► G4 osrFor, .%4/V# ''
<br /> 1/ .0.Z/.ee 9/ S' G.Gehlkgit, SAVIVE eid.t
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