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Ogden City Graffiti Removal Program Release of Liability Form Please Fill Out The Following Information Name (Property Owner/ Manager Address/Location(s) of Phone Number: Email Is the above named property a historic building? O Yes O No Check the following types of removal you would like the Ogden City Graffiti Removal Program to use to attempt removal: O Chemical O Paint O High Pressure Wash O Chemical Wipe O All Available Forms of Removal O Other Please *Please Read the Following Before Signing I, the owner or manager, having authorized legal responsibility for the above property, request that any graffiti painted on said property may be removed by the Ogden City Graffiti Removal Program. If possible, I agree to provide matching paint if required. If I do not supply the paint, I realize that most paints will be gray, beige or brown and the program may not be able to match it exactly without cost to me. I am aware that I have the final determination as to which of the available methods may be used to clean my property and that I am encouraged to be on location to supervise the removal process. I understand that the results are not guaranteed by the City. I understand that in those cases where high pressure solutions are used, the process will not entirely remove all traces of the graffiti due to permanent chemical damage and alterations caused by the graffiti. I am aware that some graffiti residue and shadowing will remain and that the high pressure solution may have some impact on the surface being cleaned. As in any project of this type, I am aware that some impact may occur to the surrounding property and plant life due to accidental spills, overspray or the proximity of other objects to the surface being cleaned. Graffiti Removal supervisors are very careful to reduce impact or damage to any property being cleaned, however, I understand that in the event of accidental damage to any items on my property, I take full responsibility for any damages and related costs for clean-up or repair. I agree that the City will not be liable. ---PAGE BREAK--- Signature Title Date