Waiver for key lock.tif WASHINGTON COUNTY, STATE OF NEB
F11 Fn
2014 ® 0 2 7W Recorded
INSTRUMENT NO. General . Numerical 2014SEP-3 AM10:21
ir"U1110 a. qa&4wd Photostat KAREN, j,VIADS
Proofed E N'
WASHINGTOI�j
REGISTER OF DEEDS COU�4TY
!�Cannod REGIS7'ER ()F DEEDS
8 Iv
Prepared by and after Recording Return to:
Brenda Wheeler, City Clerk, City of Blair, 218 S. 16th Street, Blair, NE 68008 (402) 426-6694
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
DATE OF INSTRUMENT: - AkA(A(AS+ 2 7 1 20 14
WAIVER FOR KEY LOCK BOX SAFETY REQUIREMENT
The undersigned, hereinafter referred to as "Owner", whether one or more, of the following property,
is required by Section 9-201.01 of the Municipal Code of the City of Blair to install a key lock box for
access to the premises by the Blair Volunteer Fire Department.
Owner warrants and represents that he/she is owner of the following described real estate:
LEGAL: BC TL 219 7-18-12 114 PC 219 2.01 AC
ADDRESS: 575 S 1 st St
PIN: 890022008
Owner hereby specifically acknowledges the following:
1. Owner acknowledges that the Blair Volunteer Fire Department encourages all owners of
buildings not regularly occupied for twenty-four (24) hours every day for seven (7) days of the
week to install a key lock box to provide safe and immediate access to the building in case
of fire or emergency.
2. Owner acknowledges thatthe BlairVolunteer Fire Department enforces rules and regulations
for the authorized use of the key lock box system by fire department personnel and volunteers.
3. Owner acknowledges the following safety benefits derived from installing and using a key lock
box:
a. Immediate building entry by firefighters without waiting for building keys.
b. Eliminate needless forced-entry damage. investigation by allowing
c. If a fire alarm is installed, maintain building security after an alarm
the fire department to relock the undamaged building.
d. If a sprinkler system is installed, immediate building entry will help protect inventory,
equipment and supplies from unnecessary water damage caused by delayed sprinkler
shut-off.
Pagel
2014-02729
I
i
I
I
i
4. Owner acknowledges that without a key lock box the Blair Volunteer Fire Department during
a fire call will gain access into the building through whatever alternative means are available
to them.
5. Owner acknowledges and agrees that this waiver releases, waives and discharges the City
of Blair and the Blair Volunteer Fire Department, their employees, officers, directors, agents,
representatives, and management (hereby referred to as "Releasees ") for any and all loss or
damage to the property caused by a forced entry into the property that occurs within the
normal scope of the Blair Fire Department operating procedure.
6. Owner hereby agrees to indemnify and hold harmless the Releasees from any loss, liability,
damage, or cost they may incur arising out of the entry.
7. Owner hereby assumes full responsibility for any property damage arising out of the entry
and hereby acknowledges that the activities involved are of a hazardous nature and contain
inherent risks of serious property damage.
8. Owner also expressly acknowledges that this waiver extends to all acts of entry by rescue
operations and is intended to be as broad and inclusive as is permitted by the laws of the
State and that if any portion thereof is held invalid, the undersigned agrees that the balance
shall continue in full force and effect.
CERTIFICATION BY APPLICANT
I, 1'Ch!a 'd /Vt a v , certify that I have read and understand the
acknowledgements and requirements listed above. I hereby request the City of Blair to waive the
Key Lock Box Safety Requirement for my business located at the above described real estate. I
further understand that should the Blair Volunteer Fire Department be required to gain access
into the building through alternative means, I agree to release, indemnify, and save harmless the
Blair Volunteer Fire Department, and the City of Blair, from any and all causes of action,
damages, claims, suits or any other liability of any nature or kind arising out of or resulting from
such access to the structure by the Blair Volunteer Fire Department.
Dated: 20Z t A�Z
Owner(s)
Page 2
2014-02729
i
i
i
i
i
STATE OF NEBRASKA )
) ss j
WASHINGTON COUNTY )
The foregoing instrument was acknowledged before me on AU (As 2-7 20_
t_
by
i
GENERALState 01 Nebraska NOTARY PUBLIC
dill BRENDA R WHEELER
=a My Gomm. UP, June 20, 2016
Approving Official:
Phil Green, Assistant City Administrator
Distribution List:
1. Fire Chief of the Blair Volunteer Fire Department
i
i
i
i
i
i
I
i
i
i
i
i
i
I
I
I
Page 3
i
i
X14 ®022