524 S 10th St Knox Box waiver.tif WASKNOTON COUNTY, STATE OF NSRAS Recorded FILED
No 2014-0026 General
INSTRUMENT
Numerical 2014 JAN 28 AM 10: 4 1
® tkad&&w Proofed Photostat KAREN A, [v1ADSEN
WASHINGTON COUNTY
REGISTER OF DEEM Scann,;d REGISTER OF DEEDS
61-AIR, NF
Prepared by and after Recording Return to:
Brenda Wheeler, City Clerk, City of Blair, 218 S. 16th Street, Blair, NE 68008 (402) 426-6694
�_ac� o ac 11.4 20
DATE OF INSTRUMENT:
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 279 12-18-11 114 PC 3
ADDRESS: 524 S 1 0th St
PIN: 890039571
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.
c. If a fire alarm is installed, maintain building security after an alarm investigation by allowing
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
- 0
i
C
i
E
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.
r
5. Owner acknowledges and agrees that this waiver releases, waives and discharges the City
i
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.
i
CERTIFICATION Y APPLICANT
,
', , 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 BlairVolunteer 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; 1 1 r4 , 20 I 4
S 1 `c
Owner(S
9
t
f
Page 2
i
2014 ® 0 026 um
i
I
f
f
i
E
STATE OF NEBRASKA )
) ss
WASHINGTON COUNTY )
The foregoing instrument was acknowledged before me on 0,- g , 20/
by h el\� �e
GENERAL NOTARY - State of Nebraka NOTARY PUBL
lil BRENDA R WHEELE(4
My Comm. UP. June 20,201 6 '
I
t C
t
Approving Official:
Phil Green, Assistant City Administrator
Distribution List:
1. Fire Chief of the Blair Volunteer Fire Department
i
i
f
Page 3
2 014-0026 0
i
�
I
{
Recor6ed '/ FILED
WASHINGTON COUNTY, STATE OF NEBRASKA 'aenerai �
INSTRUMENTN& 14 ® ®Q 6 �� photostat P hoto s at ✓ 2014 JAN 28 AM 10: 41 I
goofed KAREN A, MA€}SEN �
WASHINGTON COUNTY
REGISTER OF DEEDS
REGISTER OF DEEDS 8 LA l R, NE '
r
I
Prepared by and after Recording Return to:
Brenda Wheeler, City Clerk, City of Blair, 218 S. le Street, Blair, NE 68008 (402) 426 -6694
DATE OF INSTRUMENT: ar\ lC aaA 1 T , 20_1
AGREEMENT
The undersigned being the owner(s) of the following described real estate, to -wit:
`rL a�� ��- -1 �� �l (52- S lD ` st
hereby acknowledge that they have made an application to the City of Blair for the waiver of the
requirement for the construction of sidewalks in conjunction with the construction of a
residential/commercial structure thereon. Said owners finther hereby specifically agree that said
waiver is not a permanent waiver, and that at any time the City of Blair requests or requires that a
sidewalk be constructed on such real estate, the owners hereby agree that they will, within a
reasonable time, construct such sidewalk or participate in a sidewalk improvement district if same
is created by the City of Blair. .
The owners hereby specifically agree that this agreement shall constitute a covenant which shall run
with the land, and that upon the filing of this agreement against the real estate described
hereinabove, all successors, assigns, or transferees shall be bound by the terms and conditions of
this agreement as though an original party hereto.
This agreement shall be binding upon the heirs, personal representatives, successors, and assigns of
the undersigned.
Dated: ' 20_f.
r.
Prope ` er(s)
4
STATE OF NEBRASKA )
) ss
WASHINGTON COUNTY )
The foregoing instrument was acknowledged before me on JQnjal - � 20A by
I
i
GENERAL NOT of Nebraska
BRENDA R WHEELER NOTARY PUBLIC
My Comm. Exp. June 20, 2016
I
i
i
i
C
®0®261