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Hold Harmless Agreement Sample 2
Hold Harmless Agreement Sample
HOLD HARMLESS AGREEMENT/INDEMNIFICATIO
N AGREEMENT
The undersigned, in consideration of the payment of
$1.
00 and other good and valu
able consideration, the
adequacy and receipt of which is hereby acknowledged, hereby executes in favor of Brevard County, Florida, its’ officers,
employees, agent and assigns, this Hold Harmless Agreement.
WITNESSETH:
WHEREAS, the undersigned is seeking a building permit(s) for an improvement that is an encroachment of a
public easement. The following may be permitted as encroach
ment improvement: fence; air conditioner unit; concrete
pads or an improvement specifically approved by the P
lanning
and
Develop
ment Department Director or designee.
(
approved by
)
WHEREAS, pursuant to Chapter 22 Code of Brevard County, Florida, the County may issue permit(s) within
unincorporated Brevard County.
NOW, THEREFORE, the undersigned agrees as follows:
1.
I, (print name),
the property owner of
(print address)
, hereby agrees that it
shall indemnify, defend and hold harmless Brevard County,
Flori
da, any licensed utility company or independent
contractors, and any of their officers, employees and agents in both their official and individual capacity, from any
and all liability, claims, damages, expenses including attorney’s fees and litigation costs, resulting from or arising
out of the removal or alteration of any existing permitte
d encroachment structure that exist in or around any
public easement, deemed necessary by the County or licensed utility for the purpose of installing, removing,
repairing or maintaining any improvement
s allowed within the public easement
.
The undersigned acknowledges
that specific consideration has been given fo
r this indem
nity provision. ( ______ initial)
2.
I understand and agree that if the County or licensed utilit
y
or independent contractor rem
oves, damages or alters
the encroachment structure that I am fully responsible for repair and/or replacement of the encroachment
improvement.( ____
__ initial)
3.
I understand and agree that if I damage or cause damage
to any existing structure, improvement, and/or utilit
y
within the easement, I am fully responsible for repair and/or replacement of the existing improvement as deemed
necessary by the County and /or appropriate licensed utility company within ninety days of receipt of written
notice by the County and/or licensed utility company. ( ______ initial)
IN WITNESS THEREOF, the undersigned hereby sets his/
her hand this _____day of __
______________
____, 20____
_.
OWNER:
Name
Printed
Owner
Signature
State of Florida
County of ______________
The foregoing instrument was acknowledged before me
this ______ da
y of ________
______________
____, 20______,
by
who is personally known to me or who has
produced _
as identification.
S
E
A
L
_______________
______________
_______
N
o
t
a
r
y
’
s
S
i
g
n
a
t
u
r
e
_______________
______________
_______
Name
of
Notary
(Typed,
Printed,
or
Stamped)
Download
Hold Harmless Agreement Sample
PDF | 19 KB | 1 Pages
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Hold Harmless Agreement Sample 1
PDF | 14 KB | 1 Page
Hold Harmless Agreement Sample 3
WORD | 20 KB | 1 Page
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