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NOV-09-2009 09:36 From:EHS REGISTRAR. 4253854402 To:94252578741 Page:214 <br /> «, .. , avvo it..,V rxtt Nc:1 401 0.141 l.1 t Y. ur t rdt r1 101104 <br /> • <br /> 4 <br /> Indemnification, Filold Harmless, and Certification, <br /> As a material inducehcnt 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 my 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 otter legal expenses. <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 willfuli misconduct of the City. <br /> As Applicant, I certify that 1) the information provided on this application is true and <br /> correct; and 2) I amj duly authorized by the sponsoring organization to make this <br /> application and enter into this agreement, an behalf of the sponsoring organization, to <br /> defend,indemnify and(hold harmless the City. <br /> 444111—Pn/kil 11 6 D <br /> Signa ate <br /> AM ES }. Mc ���ry , �,r <br /> Printed Name <br /> i <br /> i r=ile df Pubic Sckob ( q25) 3&5~ g021 <br /> Organization Representing Phone No. <br /> List businesses impae:cd by the event and ask them to sign off if they concur with the <br /> closure, <br /> Businesses Signature of approval <br /> 2. <br /> 3. <br /> 4. Ql <br /> 5. <br /> 6. <br /> 7 <br /> 9 <br />