2011-11-03Nov 0311 08:14p Midland Trenching
CITY OF SLAIR
PROPERTY ACCESS
MINER OF LIABILITY
NAME: Pamida
ADDRESS: 8802 F Street, Omaha, NE 58127
402 - 573 -8264 p.1
In consideration of being permitted to utilize the sidewalks in the Downtown
Area on Friday, November 4, 2011 from 11:34 am to 12.30 pm, the undersigned
assumes all risks of damage or loss either to his / her person, cast members and/or
crew members from any and all causes, including but not limited to negligence, violation
of law, or willhil 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 lass 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 THE DATE OR OCCURRENCE THAT THE
UNDERSIGNS? HAS ACCESS TO THE CITY OF BLAIR PROPERTY.
R
Signature:' 1 mate:
Printed Name: Stephanie Ki e " g — Pamida
Phone: (402) 250 5304
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Authorization b City 1. D 111
Y tY D
Wheeler, City Clerk