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Q--) 0 9,,Cf\ <br /> 'Ack) <br /> 4. Payment of banner permit fees MUST be included when tlt r , <br /> (Banner applications can be faxed in if using a credit card.Fax 682-4879) Fees are mon-ref <br /> Description of fee Amount r Cryo <br /> Basic charge $35.00 <br /> '�L�A�� A55- 7.. 2,700 000 '40 . <br /> NAME ON CARD frI{Ch —i,t.)1A- -- <br /> Administrative fee (7%) .2 45 <br /> Expiration date <br /> Total �/�� ' <br /> (pay this amount) $37.45 i <br /> 5. Conditions of Approval: 31,145 X 3 1 I'D. , 3 5 <br /> Banner specifications: Permittee is responsible for following all specifications established by the Cit or <br /> banners. Information regarding the specifications is attached to this application form and is availab': a. <br /> • <br /> Public Works Maintenance. Failure to follow specifications may void City's approval of banner applicatio . <br /> Emergency removal: In the case of emergency removal or failure to remove the banner(s) at he <br /> scheduled time. the City will contact the organization (permittee) and/or the permittee's listed installer. 1 he <br /> City is required to remove any banner(s), the applicant will be required to cover the City's removal nd <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 barrel'. <br /> Permittee agrees to pay all replacement costs for damage to City facilities or equipment resulting front the <br /> installation or display of the described banner. City does not assume any responsibility for the conditidn 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 required by theCity <br /> when the application is submitted. <br /> I City Use Only <br /> 6. Sign the application (signature indicates you are a I Proof of insurance provided: Yes No i <br /> repres-ntative of the requesting organization): <br /> I hay: rea• and.ree to the ter •., and con.;.;' detailed under section#5 <br /> Signature �ti[ /✓4,!/,11./ -��/ D'ate 2� '� <br /> Title or position in organization Y>f✓S'CV-esti- <br /> VL1, PtillW t id R5 <br /> 7. Incomplete Applications will not be processed and will be returns ci to,_lppiicart. <br /> 8. Return application to: <br /> Public Works Maintenance .,ci,,,i1 soli <br /> :stun: Banner Program City Use Only <br /> 1820 Roosevelt Blvd. _ <br /> Eugene Oregon 97402 Approved__ Date <br /> Phone:(541)682-4896 <br /> Fax: (5411682-4879 , Applicant notified Date_ <br /> Application cannot he modified in any nunmer Bawler appirtatmoi I•eu111 i'Wil July :oi U <br /> • <br /> f R <br />