Application For Use Of Buildings, Facilities Or Grounds Form Page 2

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INDEMNITY
The organization shall indemnify, defend and hold harmless University of Hawaii, its officers,
employees, agents or any person acting on its behalf from and against any claim or demand for
loss, liability or damages, including, but not limited to, claims for property damage, personal injury or
death, by whomsoever brought, based upon any accident, fire or other incident on the premises
and areas adjacent thereto and arising from any act or omission of the organization, its officers,
employees, contractors, agents or invitees, or occasioned by any failure on the part of the
organization to observe or perform any of the terms and conditions herein or any regulations,
ordinances and laws of the federal, state, municipal or county governments. Furthermore, the
organization shall reimburse University of Hawaii, its officers, employees, agents or any person acting
on its behalf for all attorney’s fees, costs and expenses incurred in connection with the defense of
any such claims.
INSURANCE
____________________ shall during the period of this agreement, at its own cost and expense,
maintain liability insurance providing Combined Single Limit Coverage (bodily injury and property
damage) in the minimum amount of $____________________ per occurrence; said policy shall name
1,000,000
the University of Hawaii as additional insured and a copy thereof shall be deposited with the Vice
Chancellor of Administrative Services.
Name:
_______________________________________________________________________
Title:
_______________________________________________________________________
Organization:
_______________________________________________________________________
Signature:
_______________________________________________________________________
Date:
_______________________________________________________________________
Rev. 11/04

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