Hold Harmless Agreement Template for Object in City Right-Of-Way - City of Vancouver, Washington

This fillable ""hold Harmless Agreement Template for Object in City Right-Of-Way" - City of Vancouver, Washington" is a document issued by the Department of Public Works - City of Vancouver, Washington specifically for Washington residents.

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Hold Harmless Agreement
O
C
R
-
-W
BJECT IN
ITY
IGHT
OF
AY
Whereas, _______________________________ (“Grantee”) has applied for a Long-Term Right-of-Way permit under
City Ordinance codified at VMC 11.60.040.
NOW, therefore, Grantee on behalf of itself, its agents, heirs and assigns, and in consideration of the grant of the
Street Permit, and other good and adequate consideration, the receipt of which is hereby acknowledged, agrees to
indemnify, hold harmless and defend the City of Vancouver, its appointed and elected officers, employees, agents
and assigns from any and all claims which may arise or be claimed to arise as a result of granting this permit.
The City shall not be liable to Grantee, or any other party for any claim whatsoever arising in connection with this
permit, except for negligence solely and entirely the fault of the City.
Dated this ____ day of _________________, 20 ___ .
Signature:
__________________________________
__________________________________
STATE OF WASHINGTON )
) : ss
COUNTY OF CLARK
)
I certify that I know or have satisfactory evidence that ___________________________ (name of signer) is the person
who appeared before me, and said person acknowledged that ______ (he/she) signed this instrument, on oath stated
that
______
(he/she)
was
authorized
to
execute
the
instrument
and
acknowledged
it
as
the
__________________________ (type of authority, e.g., officer. trustee, etc.) of ____________________________
(name of party on behalf of whom instrument was executed) to be the free and voluntary act of such party for the uses
and purposes mentioned in the instrument.
Dated: _________________, 20 ____.
______________________________
__________________________
(Signature)
Title (such as “Notary Public”)
(SEAL OR STAMP)
My appointment expires: _______________
Hold Harmless Agreement
O
C
R
-
-W
BJECT IN
ITY
IGHT
OF
AY
Whereas, _______________________________ (“Grantee”) has applied for a Long-Term Right-of-Way permit under
City Ordinance codified at VMC 11.60.040.
NOW, therefore, Grantee on behalf of itself, its agents, heirs and assigns, and in consideration of the grant of the
Street Permit, and other good and adequate consideration, the receipt of which is hereby acknowledged, agrees to
indemnify, hold harmless and defend the City of Vancouver, its appointed and elected officers, employees, agents
and assigns from any and all claims which may arise or be claimed to arise as a result of granting this permit.
The City shall not be liable to Grantee, or any other party for any claim whatsoever arising in connection with this
permit, except for negligence solely and entirely the fault of the City.
Dated this ____ day of _________________, 20 ___ .
Signature:
__________________________________
__________________________________
STATE OF WASHINGTON )
) : ss
COUNTY OF CLARK
)
I certify that I know or have satisfactory evidence that ___________________________ (name of signer) is the person
who appeared before me, and said person acknowledged that ______ (he/she) signed this instrument, on oath stated
that
______
(he/she)
was
authorized
to
execute
the
instrument
and
acknowledged
it
as
the
__________________________ (type of authority, e.g., officer. trustee, etc.) of ____________________________
(name of party on behalf of whom instrument was executed) to be the free and voluntary act of such party for the uses
and purposes mentioned in the instrument.
Dated: _________________, 20 ____.
______________________________
__________________________
(Signature)
Title (such as “Notary Public”)
(SEAL OR STAMP)
My appointment expires: _______________
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