special events permit application - Hernando County

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HERNANDO COUNTYBOARD OF COUNTY COMMISSIONERS20 North Main Street, Room 460Brooksville, Florida 34601352-754-4002352-754-4477 (fax)SPECIAL EVENTS PERMIT APPLICATIONNameOf Organization/Individual ________________________________________________________Address___________________________________________________________________________Street City ZipContact Person ____________________________________________________________________Telephone_________________________________________________________________________Name of Roadway/Right of Way to be used _____________________________________________Please provide detailed description or mapProposed Utilization Date____________________________________________________________Alternate Date (due to inclement weather)______________________________________________Proposed Hours of Utilization________________________________________________________Purpose of Event __________________________________________________________________Detour Route (if applicable)____________________________________________________________________________________________________________________________________________Roadway/Right of Way to be Utilized from (location)_____________________________________to _______________________________________________________________________________
INDEMNITYAGREEMENTThis AGREEMENT OF INDEMNITY entered into this__day of___---.-- between (hereinaftercalled "REQUESTOR") andthe BOARD OF COUNTY COMMISSION~RS,HERNANDO COUNTY, FLORIDA, (hereinafter called "COUNTY");WITNESSETH:WHEREAS, the REQUESTORhas requested ofthe COUNTYfor permissionto utilize public roadways, to-wit:WHEREAS, the COUNTY has granted to the REQUESTOR permission toutilize public roadways conditioned upon the executing ofa good and sufficientIndemnity Agreement to save and hold harmless the COUNTYfrom any and all claims,suits, actions at law, demands or other liabilities which may arise or accrue against theCOUNTYas a result ofsaid roadway utilization bythe REQUESTOR.NOW, THEREFORE, the REQUESTOR, and each ofthem for themselves,and each oftheir heirs, executors, administrators, successors and assigns, jointly andseverally do hereby covenant and agree to indemnify and keep indemnified from andagainst all loss and damage, including damage to persons or property, whether privateor public arising from any negligent act, any intentional act orfrom any· other actiontaken by the REQUESTOR or any other person relating in any way to theREQUESTOR'S utilization ofthe roadway.The REQUESTOR further agrees to indemnify the COUNTY against any suits,actions, or actions at law or in equity which may be brought against the COUNTY, itsBoard of<strong>County</strong> Commissioners, its officers and employees, individually or otherwise,to recover damages for accidents, negligence, or occurrences gro\ving out ofor arisingfrom said roadway utilization above described, or from any other cause, or anyproceedings that may be taken against COUNTY, individually or otherwise, arising
Page 1 and 2: SPECIAL EVENTS POLICYPOLICY NO. 17-
Page 3: Revised: October 12, 2004Revised: M

special events permit application - Hernando County

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