"Organization/Corporation Hold Harmless Agreement Form" - Township of Bedminster, New Jersey

Organization/Corporation Hold Harmless Agreement Form is a legal document that was released by the Recreation Department - Township of Bedminster, New Jersey - a government authority operating within New Jersey. The form may be used strictly within Township of Bedminster.

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Download "Organization/Corporation Hold Harmless Agreement Form" - Township of Bedminster, New Jersey

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Bedminster Township Recreation Department
One Miller Lane
Bedminster, NJ 07921
●www.bedminster.us
(908) 212-7014
Organization/Corporation Hold-Harmless Agreement
1.
“I/We”, “Me/My” shall mean one of the following:
An ORGANIZATION Name:____________________________________ or
CORPORATION Name:_____________________________________
2.
“You/Your” shall mean the municipal corporation known as the Township of Bedminster, its agents, servants, employees or
contractors.
3.
I sign this Hold-Harmless as my voluntary act and by this act agree to hold You harmless and indemnify You from any claims,
suits or other actions arising from, caused by, or which are the alleged result of any act or omission of any organization,
corporation, guest, invitee, licensee, visitor or other person present on the premises listed above in order to participate in,
organize, assist, enjoy, supervise or in any other way further the activity to be held (as described in this Field/Park Permit
Application) on the dates specified.
4.
I state that the activity listed in this application will not include the consumption of alcoholic beverages, but should any person
described in Paragraph 3 consume alcohol or allow or permit others to consume alcohol then I agree to be bound by the terms
of Paragraph 5 below.
5.
I state that the activity listed in this application will include the consumption of alcoholic beverages and that because of such
consumption I have the following additional duties to perform for the Township of Bedminster related to the use of the site listed
in this application:
a)
That I am solely responsible for the dispensing and consuming of alcohol, including the prudent and responsible
dispensing and consuming of alcohol by all persons involved in the activity described below, including but not limited
to those persons described in Paragraph 3 above.
b)
To acknowledge by the signing of this Hold Harmless that You have no authority, control, or participation in the
dispensation or consuming of alcohol on the site and date listed above and that I will take no step(s), actions(s), or
measure(s) to convey the idea that You in any way have promoted, assisted, or participated in the dispensing and
consuming of alcoholic beverages on the site(s) and date(s) listed in this application.
c)
That I will not allow persons under the age of 21 to dispense or consume alcohol at the site during the activity to be
held on Township of Bedminster property;
d)
To comply with all municipal Ordinances relating to the consumption of alcoholic beverages, including but not limited
to obtaining any necessary permits.
6.
I shall also provide the Township of Bedminster with a Certificate of Insurance and proof of “Special Events Insurance” and that
I shall provide to that municipal officer as soon as practicable and not less than five (5) business days before the date of the
planned activity. Said liability insurance shall be written with a company maintaining a rating of at least “A-“ according to A.M.
Best. Said liability policy shall be in an amount of not less than one million dollars ($1,000,000) per occurrence. IF
ALCOHOLIC BEVERAGES ARE BEING SERVED, SAID LIABILITY POLICY(IES) SHALL BE IN AN AMOUNT OF NOT LESS
THAN THREE MILLION DOLLARS ($3,000,000) PER OCCURRENCE INCLUDING PROOF OF HOST LIQUOR LIABILITY
AND/OR LIQUOR LIABILITY. It is understood the Township of Bedminster will be listed as an additional insured on that
Liability Policy and Certificate of Insurance. In the event said certificate is not provided as set before, I recognize the
activity/event must be cancelled and not be held as scheduled.
7.
(For Corporations Only) I also agree that I am obligated to reimburse the Township of Bedminster for all reasonable
attorney’s fees incurred by the Township of Bedminster to enforce the terms of this Hold-Harmless or to defend You against the
claim, suit, demand for subrogation, or other action which a court of competent jurisdiction later determines should have been
defended by Me or My sole cost and expense pursuant to this Hold-Harmless Agreement.
8.
Legal Signatures:
a. Individual on behalf of ORGANIZATION: _________________________________
_________________________________ or
(Organization Name)
b. Individual/Title on behalf of CORPORATION: _____________________________
_____________________________
(Corporation Name)
Bedminster Township Recreation Department
One Miller Lane
Bedminster, NJ 07921
●www.bedminster.us
(908) 212-7014
Organization/Corporation Hold-Harmless Agreement
1.
“I/We”, “Me/My” shall mean one of the following:
An ORGANIZATION Name:____________________________________ or
CORPORATION Name:_____________________________________
2.
“You/Your” shall mean the municipal corporation known as the Township of Bedminster, its agents, servants, employees or
contractors.
3.
I sign this Hold-Harmless as my voluntary act and by this act agree to hold You harmless and indemnify You from any claims,
suits or other actions arising from, caused by, or which are the alleged result of any act or omission of any organization,
corporation, guest, invitee, licensee, visitor or other person present on the premises listed above in order to participate in,
organize, assist, enjoy, supervise or in any other way further the activity to be held (as described in this Field/Park Permit
Application) on the dates specified.
4.
I state that the activity listed in this application will not include the consumption of alcoholic beverages, but should any person
described in Paragraph 3 consume alcohol or allow or permit others to consume alcohol then I agree to be bound by the terms
of Paragraph 5 below.
5.
I state that the activity listed in this application will include the consumption of alcoholic beverages and that because of such
consumption I have the following additional duties to perform for the Township of Bedminster related to the use of the site listed
in this application:
a)
That I am solely responsible for the dispensing and consuming of alcohol, including the prudent and responsible
dispensing and consuming of alcohol by all persons involved in the activity described below, including but not limited
to those persons described in Paragraph 3 above.
b)
To acknowledge by the signing of this Hold Harmless that You have no authority, control, or participation in the
dispensation or consuming of alcohol on the site and date listed above and that I will take no step(s), actions(s), or
measure(s) to convey the idea that You in any way have promoted, assisted, or participated in the dispensing and
consuming of alcoholic beverages on the site(s) and date(s) listed in this application.
c)
That I will not allow persons under the age of 21 to dispense or consume alcohol at the site during the activity to be
held on Township of Bedminster property;
d)
To comply with all municipal Ordinances relating to the consumption of alcoholic beverages, including but not limited
to obtaining any necessary permits.
6.
I shall also provide the Township of Bedminster with a Certificate of Insurance and proof of “Special Events Insurance” and that
I shall provide to that municipal officer as soon as practicable and not less than five (5) business days before the date of the
planned activity. Said liability insurance shall be written with a company maintaining a rating of at least “A-“ according to A.M.
Best. Said liability policy shall be in an amount of not less than one million dollars ($1,000,000) per occurrence. IF
ALCOHOLIC BEVERAGES ARE BEING SERVED, SAID LIABILITY POLICY(IES) SHALL BE IN AN AMOUNT OF NOT LESS
THAN THREE MILLION DOLLARS ($3,000,000) PER OCCURRENCE INCLUDING PROOF OF HOST LIQUOR LIABILITY
AND/OR LIQUOR LIABILITY. It is understood the Township of Bedminster will be listed as an additional insured on that
Liability Policy and Certificate of Insurance. In the event said certificate is not provided as set before, I recognize the
activity/event must be cancelled and not be held as scheduled.
7.
(For Corporations Only) I also agree that I am obligated to reimburse the Township of Bedminster for all reasonable
attorney’s fees incurred by the Township of Bedminster to enforce the terms of this Hold-Harmless or to defend You against the
claim, suit, demand for subrogation, or other action which a court of competent jurisdiction later determines should have been
defended by Me or My sole cost and expense pursuant to this Hold-Harmless Agreement.
8.
Legal Signatures:
a. Individual on behalf of ORGANIZATION: _________________________________
_________________________________ or
(Organization Name)
b. Individual/Title on behalf of CORPORATION: _____________________________
_____________________________
(Corporation Name)
- Hold Harmless Agreement Page 2 -
If a Corporation, Corporate Acknowledgement is to be attached hereto:
Address of Organization or Corporation and Contact Person:
____________________________________________________________________________________
(Organization/Corporation Name)
____________________________________________________________________________________
(Mailing Address)
____________________________________________________________________________________
(Individual’s Name/Title on Behalf of Organization/Corporation)
Work Telephone: ___________________________ Home Telephone: ___________________________
Email: ____________________________________ Fax: _____________________________________
Date: ____________________________________
and,
Signature on behalf of the Township of Bedminster
____________________________________________________________________________________
Township of Bedminster Authorized Representative
Title: _____________________________________ Date: ____________________________________
For use with Corporations only – provide this only if entity using the premises
is a corporation.
Corporate Acknowledgement
State of New Jersey, County of ____________________________SS:________________
I hereby certify that on ____________________, 20______, _________________________
(Month/Day)
(Year)
(Name of Individual)
personally came before me and this person acknowledged under oath, to my satisfaction,
that:
a. this person is the _______________________ of ___________________________,
(Title)
(Corporation Name)
the corporation named in the attached document.
b. this person is the attesting witness to the signing of this document by the proper
corporate officer who is _____________________, the ______________________ of
(Name)
(Title)
the corporation.
c. this document was signed and delivered by the corporation as its voluntary act duly
authorized by a proper resolution of its Board of Directors:
d. this person knows the proper seal of the corporation which is affixed to this document;
and
e. this person signed this proof to attest to the truth of these facts.
Signed and sworn to before me on ____________________________, 20_______________.
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