098-22 - Greg Wilder - ContractCITY OF PORT ORCHAR
City Clerk's Office ✓(�� j��Q
216 Prospect Street, Port Orchard, w 19,?o�Z
Phone: (360) 876-4407 • Fax: (360) 8 �'p0",
www.cityorpo tcityclerk@cityoforcchard usrd.us Rk$op iH-gRa J
Indemnification / Hold Harmless Agreement for the City of Port Orchard
The undersigned hereby agrees to defend, indemnify and hold the City, its Officers, Officials,
Employees and Volunteers harmless from any and all claims, injuries, damages, losses or suits,
including attorney fees, arising out of or in connection with using the Lockers located in the
back of the Active Club Building, or activities performed by the undersigne o he
undersigned's behalf out of these activities.GV
Print Name Organization Name
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Phone Num r
'2- &-r2-e-1 12
Sig�iature Date
STATE OF WASHINGTON
)ss.
COUNTY OF KITSAP )
I certify that I know or have satisfactory evidence that (A�ev I �II�� is the
person who appeared before and acknowledged that she signed this instrument
and acknowledged it to be / he he free and voluntary act for the uses and purpose
mentioned in this instrument
Dated: 7'
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•r••�a�'wA SN sN��,��``' r�ni�yf�
Notary Public in and tor State of Washington,
Residing at X-L,�' ('r:�f,.vt
My appointment expires on 0
Printed NameArI 4 A,}�s—