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Lo qd say So is ev 4. Payment of banner permit fees MUST be included when the application is submitted: Banner applications can be faxed in if us ing a credit card. Fax 682 - 4879 Fees are non - refundable Q:escripfron of fee , r, , Amount: uCash uCheck J ' • ' O VISA a MC Basic charge. $35.00 NAME ON CARD ` Administrative fee (7 %) $ 2,45 Expiration date Total (pay this amount) $37.45 •Conditions of Approval: Banner specifications: Permittee is responsible for following all specifications established by the City for banners. Information regarding the specifications is attached to this application form and is available at Public Works Maintenance. Failure to follow specifications may void City's approval of banner application. Emergency removal: In the case of emergency removal or failure to remove the banner(s) at the scheduled time, the City will contact the organization (permittee) and /or the permittee's listed installer, If the City is required to remove any banner(s), the applicant will be required to cover. the City's removal and storage costs. Insurance and indemnification requirements: The organization named in this application, hereafter referred to as Permitteo, covenants and agrees to defend, inderpnify and hold harmless the City of Eugene, from any and all costs, claims, demands, suits, actions, judgments, and recoveries for or on account of damage or injury, including death, to property or person to Permittee, its agents, servants or volunteers, and to all members of the public, caused by or arising out of the installation or display of the described banner. Permittee agrees to pay all replacement costs for damage to City facilities or equipment resulting from the installation or display of the described banner. City does not assume any responsibility for the condition of facilities or equipment used. Permittee shall maintain a commercial general and auto liability insurance. policy with coverage of not less than $500,000 combined single limit per occurrence, for bodily injury, personal injury and property / damage. Such policy shall contain a contractual liability endorsement to cover Permittee's indemnification obligations under this contract. The policy also shall contain an endorsement naming the City of Eugene as an additional insured, in a form satisfactory to City. Proof of such insurance is required by the City when the application is submitted. W�11'1a, T Z� ,a X1 r , y 6. Sign the application (signature indicates you are a [r?ppi t1+ rep resentativ of the reque ing o anization): �` I haverreadd agree to fh[conditians detailed under section 115. Title or pokition fn organiz'dtion 7. Incomplete Applications will not be processed and will be returned to applicant Q • Return application to: Public Works Maintenance Attn' Banner Program 1820 Roosevelt Blvd. Eugene Oregon,97402 Phone: (541)682 -4896 Fax: (541)682 -4879 Danner application 1'ornLIPD YMNovember 17, 2011 Application cannot be madifred in arty manner.