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Application/Agreement <br />for use of <br />Centerville City Hall Council Chambers <br />Purpose for which facility will be used <br />Hours of use from: to: <br />Date: <br />Organization <br />Mailing Address <br />City <br />Phone <br />Contact Person <br />Zip Code <br />Contact Person Home Phone: Business Phone: <br />The above applicant, its agents, employees and members: <br />1. Agree to indemnify, defend and hold the City harmless from and against any <br />damage, liability or claim of any person or entity for injury to person or property or <br />death arising in any way out of the use of the facility by the applicant, his or its <br />officers, directors, guests, members, employees, agents or assignees. <br />2. Agree the City shall not be liable for damage to the property of any person or entity <br />participating in the activities applied for herein, nor shall it be liable for the death <br />or injury of any such person or entity occurring as a result of the use of the facilities <br />as applied for herein. <br />3. Agree to pay for all damages to City property or equipment over and above normal <br />wear and tear. <br />4. Assumes full responsibility for the conduct of the group during the time this facility <br />Page 4 of 5 <br />