2008-11-08 Brian Harter at 440 S 3rd St
NAME:
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CITY OF BLAIR
PROPERTY ACCESS
WAIVER OF LIABILITY
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CITY: B lo! (
STATE: Nt:
ADDRESS:
In consideration of being permitted to gain access to the City of Blair property
i-iy-O s" 3(d ~, , the undersigned assumes all risks of damage or
loss either to his/her person or property from any and all causes, including but not
limited to negligence, violation of law, or willful misconduct on the part of the City of
Blair, its employees or agents, during the time the undersigned has access to the City of
Blair property indicated above. It is understood that the City of Blair, it's employees or
agents, shall incur no liability or obligation to the undersigned, his/her heirs, successors
or assignees for any damages, injury or other loss that the undersigned may have as a
result of his/her gaining access to City of Blair property. Further, the undersigned must
fully comply with all safety requirements of the City of Blair.
THIS WAIVER APPLIES TO EACH AND EVERY DATE OR OCCURRENCE
THAT THE UNDERSIGNED HAS ACCESS TO THE CITY OF BLAIR PROPERTY.
Signature:
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Date:
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Printed Name:
Witness:
Date of Access:
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Supervisor Approving Access:
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Staff Person Assigned: