Hold Harmless Form

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Please correct the field(s) marked in red below:

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Applicant Information:

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Applicant Information:
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Event Information:

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Event Information:
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Request Information:  (check all applicable options)

If you are requesting the closing of a city street, a lane must be maintained for emergency vehicles at all times. Driveway access for adjoining property owners must be maintained at all times.

Request Information: (check all applicable options) If you are requesting the closing of a city street, a lane must be maintained for emergency vehicles at all times. Driveway access for adjoining property owners must be maintained at all times.
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Items needed from the City of Marion:

Items needed from the City of Marion:
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Sound Systems:


Please note, you must comply with the City of Marion Noise Ordinance. Upon request, City Council may authorize time extensions or sound levels up to 75 decibels. Please indicate if the following will be used:
Sound Systems: Please note, you must comply with the City of Marion Noise Ordinance. Upon request, City Council may authorize time extensions or sound levels up to 75 decibels. Please indicate if the following will be used:
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Trash:

Applicant is responsible for the clean-up of the event area immediately following the event, including trash removal from the site.
Trash: Applicant is responsible for the clean-up of the event area immediately following the event, including trash removal from the site.
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Portable Restrooms:

Please name the individual, organization or contractor responsible for delivery/pick up of portable restrooms.

Portable Restrooms: Please name the individual, organization or contractor responsible for delivery/pick up of portable restrooms.
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Security:

Security personnel may be required by the Chief of Police at the applicant's expense. If required, what type of security will be provided?

Security: Security personnel may be required by the Chief of Police at the applicant's expense. If required, what type of security will be provided?
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If hiring a private security firm, please provide the following:
If hiring a private security firm, please provide the following:

Agreement:

In consideration of the City of Marion, Iowa, granting permission for the activity described above, the undersigned indemnifies and holds harmless the City of Marion, Iowa, its employees, representatives and agents against all claims, liabilities, losses or damage for personal injury and/or property damage or any other damage whatsoever on account of the activity described above and/or deviation from normal City regulations in the area. The undersigned further agrees to indemnify and hold harmless the City of Marion, Iowa, its employees, representatives and agents against any loss, injury, death or damage to person or property and against all claims, demands, fines, suits, actions, proceedings, orders, decrees and judgments of any kind or nature and from and against any and all costs and expenses including reasonable attorney fees which at any time may be suffered or sustained by the undersigned or by any person who may, at any time, be using or occupying or visiting the premises of the undersigned or the above-referenced public property or be in, on or about the same, when such loss, injury, death or damage shall be caused by or in any way result from or rising out of any act, omission or negligence of any of the undersigned or any occupant, visitor, or user of any portion of the premises or shall result from or be caused by any other matters or things whether the same kind, as, or of a different kind that the matters or things above set forth. The undersigned hereby waives all claims against the city for damages to the building or improvements that are now adjacent to said public property or hereafter built or placed on the premises adjacent to said property or in, on or about the premises and for injuries to persons or property in or about the premises, from any cause arising at any time during the activity described above. The undersigned further agrees to comply with all the rules, regulations, terms and conditions established by the City of Marion, Iowa.

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Applicant Agreement

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Applicant Agreement
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Supporting Documents:

Supporting Documents:
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