New Search
CITY OF EUGENE POS <br /> 1820 ROOSEVELT BLVD <br /> EUGENE. OR. 97402-41:9 <br /> 541-602-4012 <br /> Phone Order <br /> banner permit fees MUST be included when the application is submitted: <br /> xxxxxxxxxxxx9610 ions can be faxed in if using a credit card. Fax 682-4879) Fees are non-refundable <br /> MASTERCARD Entry Method: Manual ? Amount Cash Check <br /> VISA /MC <br /> Amount:$ 37.45 $35.00 <br /> Tax: $ 6.00 (7%) $ 2.45 NAME ON CARD AL-11,:tQ1 ke,J fiy <br /> Expiration date. <br /> Total: $ 37.45 'taunt) $37.45 1 <br /> i31i6i19 11:04:25Approval: <br /> Inv Il, MOW APPr code: 66993C ions: Permittee is responsible for following all specifications established by the City for <br /> APPrvd; Online on regarding the specifications is attached to this application form and is available at <br /> AVS Code: enance. Failure to follow specifications may void City's approval of banner application. <br /> Ca tu.el CO, ✓al: In the case of emergency removal or failure to remove the banner(s) at the <br /> 1HANn roar City will contact the organization (permittee) and/or the permittee's listed installer. If the <br /> remove any banner(s), the applicant will be required to cover the City's removal and <br /> A <br /> Idemnification requirements: The organization named in this application, hereafter <br /> mv;,d,,,J c.p, iittee, covenants and agrees to defend, indemnify and hold harmless the City of Eugene, <br /> UNAM< YOU, ;osts, claims, demands, suits, actions. judgments, and recoveries for or on account of <br /> ncluding death, to property or person to Permittee, its agents, servants or volunteers, and <br /> . . _ A 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. <br /> City Use Only <br /> 6. Sign the application (signature indicates you are a Proof of insurance provided: CI Yes Ii] No <br /> representative of the requesting organization): <br /> I have read and agree[to the terms and conditions detailed under section#5. <br /> fy <br /> Signature e V`ul b_OV viiiDate r2 ) ( / (- <br /> t at lc, <br /> Title or position in organization 111 <br /> 7. Incomplete Applications will not be processed and will be returned to applicant. <br /> 8. Return application to: <br /> Public Works Maintenance <br /> EUGENE <br /> Attn: Banner Program City Use Only <br /> 1820 Roosevelt Blvd. <br /> Eugene Oregon 97402 Approved Date <br /> Phone:(541)682-4896 <br /> Fax:(541)682-4879 CI Applicant notified Date <br /> Application cannot he modified in any manner. Banner application Form PWM November 17,2011 <br />