Indemnity Agreement For Special Events Page 3
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3IN WITNESS WHEREOF, the Indemnitor by and through its authorized representative, has executed this
Agreement this
day of
, 20
,
(this date must match the date on the notarization section below).
The undersigned hereby warrants, represents and certifies to the City of Miami Beach that he/she is the
lawful representative of Indemnitor and that he/she has the authority to execute this Agreement by and on
behalf of Indemnitor and bind Indemnitor to the terms and conditions herein.
INDEMNITOR:
(Print name of Legal Entity/Indemnitor) should mirror legal name exactly
as it appears on the Certificate of Insurance.
BY:
(Signature of Indemnitor and/or its authorized representative)
(Print name and title of person signing)
STATE OF FLORIDA
)
)ss:
COUNTY OF MIAMI-DADE
)
The foregoing instrument was acknowledged before me this
day of
,20
, by
(Name), as
(Title)
of
(Name
of
Legal
Entity/Indemnitor), a
corporation (state of incorporation). He/she is
personally known to me or has produced
as identification.
Notary Public
Name of Notary typed or printed
My Commission Expires:
Form Approved
Legal Department
By:
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