Form 1 "Hold Harmless Agreement" - Fairfax County, Virginia

What Is Form 1?

This is a legal form that was released by the Land Development Services - Fairfax County, Virginia - a government authority operating within Virginia. The form may be used strictly within Fairfax County. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2017;
  • The latest edition provided by the Land Development Services - Fairfax County, Virginia;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 1 by clicking the link below or browse more documents and templates provided by the Land Development Services - Fairfax County, Virginia.

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Download Form 1 "Hold Harmless Agreement" - Fairfax County, Virginia

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FORM #1
Project Number
Tax Map Number
HOLD HARMLESS AGREEMENT
THIS AGREEMENT, made this
day of
,
, by and
between
hereinafter the “Owner”, and the Board of Supervisors of Fairfax County, Virginia, hereinafter the “County”:
WITNESSETH:
WHEREAS, the Owner is the owner of certain real property, more particularly described as
Insert Legal Description of Property
as recorded in the land records of Fairfax County, Virginia, in Deed Book
at Page
,
hereinafter called the “Property;” and
WHEREAS, part of the above-described property of the Owner is located within the
flood plain as designated and adopted by the County; and
WHEREAS, the County has advised and warned the Owner of the location and existence of the flood
plain; and
WHEREAS, the Owner nonetheless wishes and elects to build at its own risk within that flood plain:
NOW, THEREFORE, in consideration of the mutual covenants herein contained and other goods and
valuable consideration, the parties hereto agree as follows:
1. The County hereby permits the Owner to construct or cause to be constructed
on the above-described property within the
flood plain as shown on Attachment A.
2. The Owner, its executors, administrators, assigns and any other successors-in-interest shall
indemnify and hold the County, its agents and employees harmless for any and all damages,
accidents, casualties, injuries, costs, charges, liabilities, occurrences or claims which might arise or
be asserted against the County by reason of the construction, existence, presence of flooding of the
or any appurtenances thereto.
3. In the event a claim is asserted against the County, its agents or employees, the County shall
promptly notify the Owner, and the Owner shall defend at his own expense any suit based on such
claim. If any judgment or claims against the County, its agents or employees shall be allowed, the
Owner shall pay all costs and expenses in connection therewith.
4. It is expressly understood and agreed that the maintenance of the
shall be solely the responsibility of the Owner or its successors in interests.
5. This Agreement shall constitute a covenant real running with the land and shall be recorded
amongst the land records of Fairfax County, Virginia.
Page 1 of 2
Revised March 2017
FORM #1
Project Number
Tax Map Number
HOLD HARMLESS AGREEMENT
THIS AGREEMENT, made this
day of
,
, by and
between
hereinafter the “Owner”, and the Board of Supervisors of Fairfax County, Virginia, hereinafter the “County”:
WITNESSETH:
WHEREAS, the Owner is the owner of certain real property, more particularly described as
Insert Legal Description of Property
as recorded in the land records of Fairfax County, Virginia, in Deed Book
at Page
,
hereinafter called the “Property;” and
WHEREAS, part of the above-described property of the Owner is located within the
flood plain as designated and adopted by the County; and
WHEREAS, the County has advised and warned the Owner of the location and existence of the flood
plain; and
WHEREAS, the Owner nonetheless wishes and elects to build at its own risk within that flood plain:
NOW, THEREFORE, in consideration of the mutual covenants herein contained and other goods and
valuable consideration, the parties hereto agree as follows:
1. The County hereby permits the Owner to construct or cause to be constructed
on the above-described property within the
flood plain as shown on Attachment A.
2. The Owner, its executors, administrators, assigns and any other successors-in-interest shall
indemnify and hold the County, its agents and employees harmless for any and all damages,
accidents, casualties, injuries, costs, charges, liabilities, occurrences or claims which might arise or
be asserted against the County by reason of the construction, existence, presence of flooding of the
or any appurtenances thereto.
3. In the event a claim is asserted against the County, its agents or employees, the County shall
promptly notify the Owner, and the Owner shall defend at his own expense any suit based on such
claim. If any judgment or claims against the County, its agents or employees shall be allowed, the
Owner shall pay all costs and expenses in connection therewith.
4. It is expressly understood and agreed that the maintenance of the
shall be solely the responsibility of the Owner or its successors in interests.
5. This Agreement shall constitute a covenant real running with the land and shall be recorded
amongst the land records of Fairfax County, Virginia.
Page 1 of 2
Revised March 2017
IN WITNESS of all of which, the parties hereto have caused this Agreement to be executed under seal on their behalf.
Signature
Signature
Print name and title
Print name and title
Address (Type or Print):
STATE OF
: COUNTY/CITY OF
:
I,
, Notary Public in and for the State and County/City aforesaid, do hereby certify
that
whose name(s) is/are signed to the
foregoing instrument, this day personally appeared before me in my State and County/City aforesaid and
acknowledged the same.
Given under my hand this
day of
,
My commission expires:
NOTARY PUBLIC (sign & seal)
IN WITNESS of which, the Board has caused this Agreement to be executed on its behalf:
BOARD OF SUPERVISORS OF FAIRFAX COUNTY, VIRGINIA
By:
Director, Land Development Services or designee
COMMONWEALTH OF VIRGINIA
COUNTY OF FAIRFAX:
This
day of
,
, appeared before me in
my State and County aforesaid,
Director,
Land Development Services, and acknowledged signature.
My commission expires:
NOTARY PUBLIC (sign & seal)
Page 2 of 2
Revised 3/3/2017
Page of 2