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n d L s wr Fr <br />A � ISI-73q0�00030-Too <br />4. Payment of banner permit fees MUST be included when the application is submitted: <br />Banner applications ca be faxed in if using a credit card. Fax 682 -4879 Fees are non - refundable <br />Descrrp #ion of fee' =' Amami; acash ❑Check <br />ovISA ❑MC <br />Basic charge $35.00 <br />NAME; ON CARD <br />Administrative too (7 %) $ 2.45 <br />E=xpiration date 1. <br />Total (pay this amount) $37.45 <br />5. Conditions of Approval: <br />Banner specifications: Permittee is responsible for following all specifications established by the City for <br />banners. information regarding the specifications is attached to this application form and is available at <br />Public Works Maintenance. Failure to follow specifications may void City's approval of banner application. <br />Emergency removal: In the case of emergency removal or failure to remove the banner(s) at the <br />scheduled time, the City will contact the organization (permittee) and/or the permittee's listed iinstaller. If the <br />City is required to remove any banner(s), the applicant will be required to cover the City's removal and <br />storage costs. <br />Insurance and indemnification requirements: The organization named in this application, hereafter <br />referred to as Permittee, covenants and agrees to defend, indemnify and hold harmless the City of Eugene, <br />from any and all costs, claims, demands, suits, actions, judgments, and recoveries for or on account of <br />damage or Injury, including death, to property or person to Permittee, its agents, servants or volunteers, and <br />to all members of the public, caused by or arising out of the installation or display of the described banner. <br />Permittee agrees to pay all replacement costs for damage to City facilities or equipment resulting from the <br />installation or display of the described banner. City does not assume any responsibility for the condition of <br />facilities or equipment used. <br />Permittee shall maintain a commercial general and auto liability insurance policy with coverage of not <br />less than $500,000 combined single limit per occurrence, for bodily injury, personal injury and property <br />damage. Such policy shall contain a. contractual liability endorsement to cover Permittee's indemnification <br />obligations under this contract. The policy also shall contain an endorsement naming the City of Eugene as <br />an additional insured, in a form satisfactory to City. Proof of such insurance is regidred by the City <br />when the app lication is subbmilled. <br />6. it14 r 5 � � :` <br />Sign the application (signature indicates you area pra'aof`'ls art _ Qicsd�s =sj�fo,. <br />rep a r f the request jnig�Cq`anrti tion): <br />(( ,,I_ha e r d agree to � ms a ndi 'ons detailed under section #5. <br />Sigrtat ire — f . Date l <br />Title or post ?on-i organ izatio ,V) J 6d /L�l /L <br />7. Incomp Applications will not be rocessed and will be returned to a i lican� <br />8 . Return application to: . <br />Public, Works Maintenance <br />Attn: Banner Program <br />1820 Roosevelt BIvd. <br />Eugene Oregon 97402 <br />Phone: (541)682 -4896 <br />Fax: (541)682 -4879 <br />194 <br />Application ctannor be modified in ony ,manner. Banner applicallon Fern IPTYMNovember 17, 2011 <br />