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03/11/2011 15:48 FAX 541 682 5593 EUG PERMIT &INFO <br />Li - Ictsa <br />Q 002 <br />1 4. Payment of banner permn: Tees Muo I ve 1"La000U wnen uw appa.. - .a o ............... <br />Banner applications can be fax ed in if using a credit card. Fax 682 -4879 Fees are non - refundable <br />De$cript{on of fee t ... , Amouttt o cash ❑cheek ° S� <br />�'. r: .:.'. •:..... ❑ VISA ❑ MC <br />Basic charge ` $35.00 NAME ON C <br />Administrative fee (7 %) $ 2.45 v rf <br />Expiration date <br />Total (pay this amount) $37A6 <br />S. 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 Pro� a v` a Q S� <br />Public Works Maintenance. FallUre 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 indemnlficatlo, requirements: •The organiz ation 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, sulfa, 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 comrherclal general and auto .11ability insurance policy with coverage of not <br />less than $600,000 combined Tingle 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 forni satisfactory to City. Proof of such Insurance is required by the City <br />when the application is submitted. " <br />s. Sign the application (signature indicates you are a <br />representative of the requesting organization):. <br />I have feed and agree tol the )arms and condltions detailed under section #5.� <br />Signature Date <br />I <br />This or positl in organization <br />t <br />7. <br />8. <br />Return application to: <br />Public Works Maintenance <br />Attu: Banner Program <br />1820 Roosevelt Blvd. <br />Eugene Oregon 97402 <br />Phone: (541)692-4896 <br />Fax: (541)692-4879 <br />Applleolion connol be modoad M any manner. <br />Banner applieallon FonmPFMJaly 2010 <br />ATE-- <br />