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-04/21/2009 13: 15 4252592328 EVERETT FAMILY YMCA PAGE 03/05 <br /> V4/LO/2299 11:28 FAX 926 257 8741 CITY OF EVERETT tb003 <br /> 2 <br /> Indemnification, Hold Harmless, and Certification <br /> As a material inducement and consideration for the City granting this approval, the <br /> Applicant, on behalf of the sponsoring organization, hereby agrees to defend, indemnify <br /> and hold harmless the City from and against any and all Claims for personal injury,death, <br /> property damage or destruction, arising from, relating to, or resulting from the Event that <br /> is the subject of this approval. <br /> "City"shall mean the City of Everett,its officers,employees and agents. <br /> "Claims" shall mean any actions, demands, suits, obligation or liability for payment of <br /> damages, fees, and costs, including, but not limited to, attorney's fees, expert witness <br /> fees,court costs and other legal expenses. <br /> • <br /> Provided, however, this agreement to defend,indemnify and hold harmless the City shall <br /> not apply to Claims arising out of bodily injury or death or property damage or <br /> destruction caused by the sole negligence or•willfull misconduct of the City, <br /> As Applicant, I certify that I) the information provided on this application is true and <br /> correct; and 2) I am duly authorized by the sponsoring organization to make this <br /> application and enter into this agreement, on behalf of the sponsoring organization, to <br /> defend, indemnify and hold harmless the City. <br /> �-- i/2-11O6' <br /> Signature Date <br /> 6A' .L .-re-to AA 5 Ai <br /> Printed Name <br /> . pits t� Wit 4 '2,5V- en. ( ( <br /> Organization R •resenting Phone No. <br /> List businesses impacted by the event and ask them to sign off if they concur with the <br /> closure. <br /> Businesses Signature of approval <br /> e-,:6 <br /> 2. (Ir-kcc �7 r ��„EPri..C�, <br /> • <br /> 3. J f <br /> 4, <br /> 5. <br /> 6. <br /> 7. <br /> 5 <br />