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4. Payment of banner permit fees MUST be included when the application is submitted: <br /> (Banner applications can be faxed in if using a credit card. Fax 682-4879) Fees are non-refundable <br /> Description of fee Amount VISA r4E 51-10 (31 (it <br /> Basic charge $35.00 NAME ON CARD )24'f - *- (.o-" <br /> Administrative fee (7%) $ 2.45 d <br /> Expiration date *2i <br /> Total (pay this amount) $37.45 <br /> 5. Conditions of Approve'• <br /> Banner specifications: P• -IP is responsible for following all specifications established by the City for <br /> banners. Information re' specifications is attached to this application form and is available at <br /> Public Works Maintenar. --Ilow specifications may void City's approval of banner application. <br /> Emergen. bval or failure to remove the banner(s) at the <br /> schedulec nittee) and/or the permittee's listed installer. If the <br /> City is rei will be required to cover the City's removal and <br /> storage cc <br /> ba_n <br /> Insurance ('ganization named in this application, hereafter <br /> referred tc `�ji C1.) t indemnify and hold harmless the City of Eugene, <br /> from any t_0 i judgments, and recoveries for or on account of <br /> damage o Permittee, its agents, servants or volunteers, and <br /> to all men , I --- � ( • he installation or display of the described banner. <br /> Permittee 7 a to City facilities or equipment resuiting from the <br /> installatior not assume any responsibility for the condition of <br /> facilities of <br /> Permittee liability insurance policy with coverage of not <br /> less than ice, for bodily injury, personal injury and property <br /> damage. endorsement to cover Permittee's indemnification <br /> obligations. lin an endorsement naming the City of Eugene as <br /> an additioi >of of such insurance is required by the City <br /> when the application is subi�tted— <br /> City Use Only <br /> 6. Sign the application (signature indicates you are a Proof of insurance provided: ❑Yes ❑ No• <br /> representative of e requesting organization): <br /> I have rea d r to the terms and conditions detailed un er section#5. '''s l <br /> Signature Date 3 (0(1 :$ <br /> Title or position in organization '�' 1 '' � � � i.. <br /> 7. Incomplete Applications will not be processed and will be returned to applicant. <br /> 8. Return application to: <br /> Public Works Maintenance ecrese <br /> Atte Banner Program City Use Only <br /> 1820 Roosevelt Blvd. <br /> Eugene Oregon 97402 Approved Date_ <br /> Phone: (541)682-4896 <br /> Fax:(5411682879 ❑ Applicant notified Date <br /> Application cannot be modified in any manner. Banner application Form/PWM November 17,1011 <br />