The public works director, or the public works director’s designee, is authorized to establish conditions for use of the electronic speed monitoring device by persons other than city employees which shall include the following minimum conditions:

AGREEMENT FOR USE OF ELECTRONIC

SPEED MONITORING DEVICE

The undersigned person represents that the undersigned is an authorized representative of ___ and does hereby request the City of Everett to grant to the undersigned organization the right to use the electronic speed monitoring device belonging to the City of Everett, for the purpose of encouraging speed reduction and traffic safety in the City of Everett. Said organization does hereby agree to save harmless the City of Everett, the Mayor, and officers and employees for any and all claims for personal injury or damage to property that may be suffered by said person or to others in connection with use of said device. In addition, the undersigned agrees to indemnify and save harmless the City of Everett, its officers and employees, from all claims for personal injury or damage to properly that may be brought against the undersigned arising out of undersigned’s own acts while using said device and shall provide evidence of general liability insurance with a minimum of $500,000 per person/per occurrence. The undersigned agrees to accept responsibility for any and all damage to said device, reasonable wear and tear excepted.

Signed this day of _____, 19__.

Signature on behalf of

Name (Please Print)

Address

Phone

Date of Birth

Age