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4
<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 /> c•rrect.
<br /> 7----_, (7
<br /> 7 �����/ �`- G�1 Fes/ O 4/
<br /> ature Date
<br /> =_,,9� Ca, C_1?J ��-
<br /> Printed Name (9u)
<br /> 19 G ) �� c.C-��rL.�, ,�',Z 317 1—f 3
<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 /> JBusinesses/Individuals (print) /� Signature
<br /> 1. 79//,/ L - rci 0r ti/r` SroiChIA)6eft..1 „01, �� �.✓�r
<br /> 2. iei, Lep 1arS 7r gr tick., $ E�r.,itntr .-1 :"--
<br /> 1 :-- r �
<br /> AVIV .A.11°.r
<br /> 4. `/ rf , 7 '//fes ► i 'N rdEf!'
<br /> 5. 100 fi`Le: I% _) ivy k =t_ ‘��.,. r/ AI: -
<br /> 6i i _ ■ IJ I ,G,€ .i1 .rte . I _ --
<br /> 7-
<br /> 7. i'?131 axo '." be Uich./vA p. . ; 1 _ I
<br /> 97 f7 Lc0.,2/j
<br /> DR M• 44 UK o :4A,
<br /> d q l ? Le/bh p-ga Dk. Ever ; C4,,
<br /> ,,LA
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