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CITY OF LARAMIE, WYOMING Release, Indemnification, and Hold Harmless Agreement In consideration of permission to operate within the City of Laramie, the undersigned agrees to release, indemnify, and hold harmless the City of Laramie and its officers, agents, employees, successors and assigns from any cause of action, claims, liabilities or demands arising as a result of the following event. Further, the undersigned agrees to reimburse the City for any costs incurred by it in repairing damage to city property, occurring in connection with the public event proximity caused by the action of the undersigned, his/her officers, employees, agents, or any person who was under the undersigns control. In addition, the undersigned agrees to furnish proof of liability insurance in the minimum amount of Name of Authorized Signature (please print below) Print Name STATE OF WYOMING ) ) SS. COUNTY OF ALBANY ) THE FOREGOING INSTRUMENT was acknowledged before me by this day of WITNESS my hand and official seal. Notary Public My commission expires: