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Release and Waiver of Claims for Filming on Arvada City Property I, on behalf of understand I have been granted a Temporary Use/Film Permit to film on property or premises owned by the City of Arvada (“Arvada”). I agree to the following: 1. Filming shall be limited to located at from 2. I, individually, and on behalf of the undersigned entity (if applicable), waive any and all claims against Arvada, its officers, employees, agents, and assigns, whether based on contract, negligence or otherwise, which may arise as a result of the undersigned’s participation in the filming described in Section 1. 3. I, individually, and on behalf of the undersigned entity (if applicable), agree to indemnify and hold harmless Arvada (and any other applicable special district or political subdivision of the state) and any of its officers, employees, agents, or representatives from any and all claims, damages, liability, or court awards, including costs and attorney’s fees, arising out of, in connection with, resulting from, or in any way related to the filming described in Section 1, by me, the undersigned entity (if applicable), or any of my or its officers, employees, agents, representatives, or contractors in conducting the filming. 4. I agree that neither I, nor the undersigned entity (if applicable), shall use the name "City of Arvada," "Arvada Municipal Court" or "Arvada Police Department" in or on any training materials, merchandise, or advertisement of any kind, or on any type of medium, including on any company maintained, owned, or controlled website, without the prior written permission of the Arvada City Manager. I also agree that neither I nor the undersigned entity (if applicable) shall use any image or other intellectual property depicting any Arvada or Arvada Police Department logo in or on any training materials, merchandise, or advertisement of any kind in or on any type of medium, including on any company maintained, owned, or controlled website, without the prior written permission of the Arvada City Manager. 5. I agree to provide a certificate of insurance indicating I have the following insurance coverage during the time of filming: a. Commercial general liability insurance in the minimum amount of $1,000,000 per occurrence, $2,000,000 annual aggregate, with the City of Arvada endorsed as an additional insured. b. Commercial automobile liability insurance in the minimum amount of $500,000/occurrence (if applicable). c. Workers compensation insurance covering all of the company’s officers, employees, agents, representatives and contractors, to Colorado statutory limits, including employer’s liability in the amount of $100,000,000. 6. I represent and agree that I had the opportunity to avail myself of legal counsel before signing this Release and Waiver of Claims for Filming on Arvada City Property. I represent that I am at least 18 years of age, have read and understand this Release and Waiver of Claims for Filming on Arvada City Property, am competent to execute it, and that I have not been coerced or forced into signing it. I further represent that I am legally authorized to bind the undersigned entity for which I am signing and acknowledge that Arvada is relying upon all representations made by me in this document. Phone: SIGN