097-21 - Lee Jr., Kenneth - ContractCITY OF PORT ORCHARD
City Clerk's Office
216 Prospect Street, Port Orchard, WA 98366
Phone: (360) 876-4407 • Fax: (360) 895-9029
citycierk@cityofportorchard.us
www.cityorportorchard.us
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 the contractor toolbox located
outside the fenced area at Van Zee Park, or activities performed by the undersigned or on the
undersigned' behalf out of these activities.
,� 1 17
_
5 ature Signature
''eig-� l�L� L • )-�C-ice_ 7r
Print Name
�''c�, 4 27 2az
Dated f
STATE OF WASHINGTON )
)ss.
COUNTY OF KITSAP )
Print Name
1-1
Dated
I certify that I know or have satisfactory evidence that is the
person who appeared before me and acknowledged that signed this instrument and
acknowledged it to befree and voluntary act for the uses and purpose mentioned in this
instrument.
Dated: C7 �;27- 5? 1
�� CAN, , ...... , • � � �i
1�6+,� Q
tACTA1 m Zr
��• � pis �� � _-
rnbel
WA SH \10 NC•IS
N ary Public in and for t e
Residing at
My appointment pires on
Printed Name c 7ir`' I'll 7
State of Washington,