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<br /> 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 u Cash u Check
<br /> n VISA MC _
<br /> Basic charge $35,00 NAME ON CARD Michele Pound CASA of Lane County
<br /> Administrative fee (7%) $ 2.45
<br /> Expiration date
<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 installer. 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 Permiltee'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 the City
<br /> when the application is submitted. r< `',. '.>•.�s �,;,;
<br /> 6. Sign the application (signature indicatesyou area
<br /> pp ( 9 'P"roff:sof:.inOrarwcQ`pr_oydedQ;Y0•s;.0:INto,F;.
<br /> representative of the requesting organization):
<br /> I have read and agree oo the terms and conditions detailed under section#5.
<br /> Signatures�`—"�— Date 12/1/17
<br /> Title or position in organization Events Coordinator
<br /> 7. incomplete Applications will not be processed and will be flturned to applicant.
<br /> •I.%. ':y.`_}••t .i .Aim 1 S•(, 7�.j;.. •, :•,�N„+.,1•;.��.::.t.0 •�A
<br /> 8. Return application to:
<br /> 44
<br /> Public Works Maintenance •
<br /> ` �— � � ' ._<,�:z•:
<br /> pki.?? EUGENE
<br /> Atm:Banner Program .`x.';"t'•, ,;: ;nr
<br /> •
<br /> 1820 Roosevelt Blvd, ; �� .�a..:_s; ,
<br /> Eugene Oregon 97402 • . ;,
<br /> . .rte• ••pt. •1:r. .. ',. •, � .ti.<.:
<br /> Phone:(54])682-4896 i" ;•,',..,; M ::i, ' �,.'f: :�Y ;�•a:: w
<br /> Fax: (5411682-4879
<br /> � �.�4ppllc�nit of,�ed:!:=:�: Qui• '; =',"•<''~ .,:::,f� ;�:. ;t�•,.•�. ..;..r
<br /> '°fi. . ... .....'' ?'Y. . .. :''. . , '.u,;::'�: :«•`,:�s_:.�. -^`'':
<br /> Application cannot be modified in any manner. Bonn r application Fonn/Prr'MNovember 17,2011
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