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we TOWN OF MONUMENT LAKE USE PERMIT Applicant Name: Organization: Contact Address: City: State: Zip Code: Contact Phone (Work) (Home) (Cell) Total Number of Participants: Type of Use: Equipment Rental, Food distribution, Business Operations, Classes, etc.) Location of Temp use on property: Lake parking lot, Lake Overflow parking lot, on lake, shore etc.) Operation begin/end dates: Hours of operation (open/close): Requirements, Terms & Conditions. Please initial each line. By initialing you hereby agree to these terms. The Town of Monument requires compliance with all rules and regulations stipulated in the Town Municipal Code. Any violation of these codes will result in the denial of this permit. The Town has the right to terminate this agreement at any time with just cause. This permit is null and void at 11:00 pm on the day of expiration. Noncompliance with this may result in legal action. Boaters (to include Paddle Boards) must observe Colorado Boating Statutes and Regulations established by Colorado Parks and Wildlife in its entirety. A non-negotiable, non-refundable annual fee of $250.00 must be submitted. Please attach 501(c)3 status if applicable. I certify I have obtained a Business License through the Town of Monument. I certify I have Obtained any other necessary/required permits through the Town of Monument. While boating, you may encounter unmarked shallow areas and submerged obstacles. Be observant and use caution while boating. The Town of Monument is not responsible for any damages to watercraft or personal property. Permit Number: ---PAGE BREAK--- Vehicles are not allowed to park on the shoreline, except during loading and unloading in designated loading area(s) only. Parking will be limited to designated parking spots only. The Town has a copy of the company’s Certificate of Liability with the Town listed as additional insured. I, , agree with all requirements, terms & conditions listed. I also agree to not place my business within a handicapped reserved parking or boat ramp area. Please attach the following: Certificate of Liability Insurance ($1,000,000.00 per incident and $2,000,000.00 aggregate, with the Town of Monument named as additionally insured). Release and Indemnification Agreement is required by all users. Parent/Guardian must sign for children under the age of 18. For sports team reservations, parents of all minors participating need to sign and date the last page of this application. Please attach 501(c)3 status. (if applicable) For Rules and Regulations of the parks, please see the attached Town Park Use Guide. Printed Name: Signature: PLEASE NOTE: For reservations of 100 people or more, a Special Event Permit is required per Town of Monument Municipal Code. An application for a special event should be submitted to the Town Clerk for review at least forty-five (45) business days before the event if it involves the sale of alcohol, and thirty (30) business days before the event for all other special events. Conditions of Approval (if applicable): Director of Public Works or Town Manager Approval: (Sign and Date) FOR OFFICE USE ONLY Lake Use Fee Non- refundable Amount: $ 250.00 Check Date: Date Certificate of Insurance Received: Date Indemnification Agreement Received: SIGN ---PAGE BREAK--- USE OF TOWN OF RECREATIONAL FACILITY / SPORTS FIELD RELEASE/INDEMNIFICATION - TOWN OF MONUMENT I. RELEASE OF LIABILITY AND INDEMNIFICATION AGREEMENT: PARTICIPANT MUST READ CAREFULLY BEFORE SIGNING In consideration for being permitted to utilize the Town of Monument 's recreation facility/sports field, I hereby acknowledge, represent, and agree as follows: A. I understand that the above-described activities are or may be dangerous and do or may involve risks of injury, loss, or damage. I further acknowledge that such risks may include but not be limited to bodily injury, personal injury, sickness, disease, death, and property loss or damage. I acknowledge that such risks may arise from a variety of foreseeable and unforeseeable circumstances connected with the use of the recreation facility/sports field. B. By signing this RELEASE AND INDEMNIFICATION AGREEMENT, I hereby expressly assume all such risks of injury, loss, or damage to me or to any third party arising out of or in any way related to the above-described activities, whether or not caused by the act, omission, negligence, or other fault of the Town of Monument, its officers, its employees, or by any other cause. C. By signing this RELEASE AND INDEMNIFICATION AGREEMENT, I further hereby waive, and exempt, release, and discharge the Town of Monument, its officers, and its employees from, any and all claims, demands, and actions for such injury, loss, or damage, arising out of or in any way related to the above- described activities, whether or not caused by the act, omission, negligence, or other fault of the Town of Monument, its officers, its employees, or by any other cause. D. I further agree to defend, indemnify and hold harmless the Town of Monument, its officers, employees, insurers, and self-insurance pool, from and against all liability, claims, and demands, including any third party claim asserted against the Town of Monument, its officers, employees, insurers, or self-insurance pool, on account of injury, loss, or damage, including without limitation claims arising from bodily injury, personal injury, sickness, disease, death, property loss or damage, or any other loss of any kind whatsoever, which arise out of or are in any way related to the above-described activities, whether or not caused by my act, omission, negligence, or other fault, or by the act, omission, negligence, or other fault of the Town of Monument, its officers, its employees, or by any other cause. E. By signing this RELEASE AND INDEMNIFICATION AGREEMENT, I hereby acknowledge and agree that said AGREEMENT extends to all acts, omissions, negligence, or other fault of the Town of Monument, its officers, and/or its employees, and that said AGREEMENT is intended to be as broad and inclusive as is permitted by the laws of the State of Colorado. If any portion hereof is held invalid, it is further agreed that the balance shall, notwithstanding, continue in full legal force and effect. F. I understand and acknowledge that the Town of Monument, its officers, and its employees are relying on, and do not waive or intend to waive by any provision of this RELEASE AND INDEMNIFICATION AGREEMENT, the monetary limitations (presently $150,000 per person and $600,000 per occurrence) or any other rights, immunities, and protections provided by the Colorado Governmental Immunity Act, C.R.S. §24-10- 101 et seq., as amended, or otherwise available to the Town of Monument, its officers, or its employees. G. I understand and agree that this RELEASE AND INDEMNIFICATION AGREEMENT shall be governed by the laws of the State of Colorado, and that jurisdiction and venue for any suit or cause of action under this Agreement shall lie in the courts of El Paso County, Colorado. II. PARTICIPANT SIGNATURE AND DATE : Participant - Print Name : Participant’s Signature : Date of Signature: SIGN SIGN ---PAGE BREAK--- III. IF PARTICIPANT IS UNDER 18 YEARS OLD, PARENT SIGNATURE AND DATE: By initialing above and signing below, I acknowledge that I am the parent of the above-named Participant as the term “parent” is defined in C.R.S. Section 13-22-107(2)(b), and I hereby waive and release any prospective claim of the Participant against the Town of Monument, its officers, and its employees for negligence, to the extent provided in C.R.S. Section 13-22-107(3), in connection with the above-described activities. Parent/Guardian - Print Name: Parent/Guardian - Signature: Date of Signature: H. This RELEASE AND INDEMNIFICATION AGREEMENT shall be effective as of the date set forth below and shall be binding upon me, my successors, representatives, heirs, executors, assigns, and transferees. SIGN SIGN ---PAGE BREAK--- USE OF TOWN OF MONUMENT RECREATIONAL FACILITY/SPORTS FIELD RELEASE/INDEMNIFICATION – TOWN OF MONUMENT REQUIRED PARTICIPANT/PARENT OF PARTICIANT SIGNATURES AND DATE NAME CHILDS NAME DATE