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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 0 Cash 0 Check -- — ' e-
<br /> o VISA *MC - - . _
<br /> Basic charge $35.00 NAME ON CARD r t-- klutel
<br /> Administrative fee (7%) $ 2.45
<br /> Total (pay this amount) Expiration date._ —
<br /> $37,4b <
<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 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 the City
<br /> when the application is submitted, ax+ qg- ���^a�- . �,r :�, s; ��* x ,
<br /> �r �,7! �'� . '*�' t Ci ,i a•t•}R: �T w
<br /> p �� 4� Z',1- *� of b'U v Yu�;�' `r�`1.t� ,14 w+
<br /> 6. Sign the application (signature indicates you are a 4 _ ��5; ; z,n ac ,i , , s ,tt R,•:�
<br /> t�y r i 4 a n rri.✓ .� A
<br /> representative of the req sting organization): r�.> � z :�.,_r :>.�: e, ?�.r NST :�<F:�;:
<br /> I have re d agree he t and .ieris detailed under section#5.
<br /> Signature ` _ Date 12- Zi job`-
<br /> Title or position In organization Di1-eavk d( 4" - (0iQ
<br /> 7. Incomplete Applications will not be processed and will be returned! to applicant.
<br /> 8Q .key trt� ✓ts F 27 34:. )4 ,',',',.4e'4',' is x i p�
<br /> . Return application to: ,^r" ' `f f�er� a � y~ 1 .c f� =✓1�G, yi
<br /> Public Works Maintenance . `r ,14 a !..11'44104 ),:, : e#,*; �.
<br /> y�c e n�' ' 4r BJGENE '- �`^ r�r ��i r ayi ltxr p
<br /> Attn:Banner Program �� �r ,4.a `�� � '�',� I �,•r•Z�L°t Ah41' r � '6,.r Y� �i �.
<br /> 1820 Roosevelt Blvd. `._ -.).1',1,'� „�r* �. + ,1� ; w � �.` 1
<br /> Eugene Oregon 97402 ,,+.-r. 'i. �r, `�a.r. , :." t j' a , °j°�4 �. y ! t;p
<br /> `'a 4•'e i,�{ 1� l.' a t yr r�. •+!••.• �)r ' ,1Ti
<br /> 'kw r tb k J , ,. 8
<br /> Fax: (5(54 )682-4896 : i � `x c :r i t 1 s
<br /> Fax: (5411682 4879 rerAdVilWf4.4.4.x,
<br /> i:.`t^€. ..ta ' .'-, ' .'s,,, ,,'r'r;�'�'.r 0.11'4',"'` amc "T' y �' ��f
<br /> hAf'' ,. .�-.rYi.3 t't�a r i:a.--...ui......s`�;'8i r.:r 3.nt:c .r�xc2L: c.
<br /> Application cannot be modified in any manner. Banner application Form/PWM November 17,2011
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