Fillable Hold Harmless Agreement/indemnification Agreement printable pdf download

HOLD HARMLESS AGREEMENT/INDEMNIFICATION AGREEMENT

The undersigned, in consideration of the payment of $1.00 and other good and valuable consideration, the

adequacy and receipt of which is hereby acknowledged, hereby executes in favor of Brevard County, Florida, its’ officers,

employees, agent and assigns, this Hold Harmless Agreement.

WITNESSETH:

WHEREAS, the undersigned is seeking a building permit(s) for an improvement that is an encroachment of a

public easement. The following may be permitted as encroachment improvement: fence; air conditioner unit; concrete

pads or an improvement specifically approved by the Planning and Development Department Director or designee.

(

approved by

)

WHEREAS, pursuant to Chapter 22 Code of Brevard County, Florida, the County may issue permit(s) within

unincorporated Brevard County.

NOW, THEREFORE, the undersigned agrees as follows:

1. I, (print name),

the property owner of

(print address)

, hereby agrees that it

shall indemnify, defend and hold harmless Brevard County, Florida, any licensed utility company or independent

contractors, and any of their officers, employees and agents in both their official and individual capacity, from any

and all liability, claims, damages, expenses including attorney’s fees and litigation costs, resulting from or arising

out of the removal or alteration of any existing permitted encroachment structure that exist in or around any

public easement, deemed necessary by the County or licensed utility for the purpose of installing, removing,

repairing or maintaining any improvements allowed within the public

easement.

The undersigned acknowledges

that specific consideration has been given for this indemnity provision. ( ______ initial)

2. I understand and agree that if the County or licensed utility or independent contractor removes, damages or alters

the encroachment structure that I am fully responsible for repair and/or replacement of the encroachment

improvement.( ______ initial)

3. I understand and agree that if I damage or cause damage to any existing structure, improvement, and/or utility

within the easement, I am fully responsible for repair and/or replacement of the existing improvement as deemed

necessary by the County and /or appropriate licensed utility company within ninety days of receipt of written

notice by the County and/or licensed utility company. ( ______ initial)

IN WITNESS THEREOF, the undersigned hereby sets his/her hand this _____day of ____________________, 20_____.

OWNER:

Name Printed

Owner Signature

State of Florida

County of ______________

The foregoing instrument was acknowledged before me this ______ day of __________________________, 20______,

who is personally known to me or who has

produced _

as identification.

S E A L

____________________________________

Notary’s Signature

____________________________________

Name of Notary (Typed, Printed, or Stamped)

Hold Harmless Agreement/indemnification Agreement

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