INDEMNIFICATION CERTIFICATE

 

 

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Permittee/Organization

 

 

Covenants and agrees to indemnify, defend and hold harmless the State of Arizona, Lake Havasu City and the Arizona State Land Department, their employees, agents or representatives against and from any and all demands or claims on liability of every nature whatsoever, including but not limited to damages to property and/or accidents or injuries to and death of persons, arising directly or indirectly from or in any way connected to or with the use and occupancy in or about the lands described in the attached special event/temporary use permit application for and during the term therefor.

 

 

 

 

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Permittees Signature                                                                      Date

 

 

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Title

 

 

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Organization

 

 

 

 

 

Note: Applicant may retype on own stationery.  Wording and format of above example should be followed.