For Dubuque County Utility Permit No. ___
I,___, state that I am the authorized agent for the company: ___ which is duly organized under the State of ___ as an organization, corporation, or agency and am authorized to bind to this Hold Harmless Agreement.
The organization, corporation, or agency having been issued a permit to construct underground utilities do hereby agree to hold harmless Dubuque County, Iowa, its employees, representatives and agents against all claims, liabilities, losses or damage for personal injury and/or property damage or any other damage whatsoever on account of the activity described above and/or deviation from normal County regulations in the area. The undersigned further agrees to indemnify and hold harmless Dubuque County, Iowa, its employees, representatives and agents against any loss, injury, death or damage to person or property and against all claims, demands, fines, suits, actions, proceedings, orders, decrees and judgments of any kind or nature and from and against any and all costs and expenses, including reasonable attorney fees, which at any time may be suffered or sustained by the undersigned or by any person who may, at any time, be using, occupying, or visiting the premises of the undersigned or the above-referenced public property or be in, on or about the same, when such loss, injury, death or damage shall be caused by or in any way result from or rising out of any act, omission, or negligence of any of the undersigned. The undersigned hereby waives all claims against the county for damages to any building or improvements that are now adjacent to said public property or hereafter built or placed on the premises adjacent to said property or in, on or about the premises and for injuries to persons or property in or about the premises, from any cause arising at any time during the activity described above. The undersigned further agrees to comply with all the rules, regulations, terms and conditions established by Dubuque County, Iowa.
The organization, corporation, or agency further states that it has insurance to cover liability for the above activity in the amount of $1,000,000 as evidenced on the attached proof of insurance certificate. Said certificate shall list Dubuque County, Iowa as an additional insured party.
Dated this ___ day of ___，___
Agent's Signature
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