131030 Sewer Insurance Policy - Laserfiche WebLink

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ExhibitA AGREEMENT FOR THE PURPOSE OF TEMPORARY RIGHT OF ENTRY RELEASE AND INDEMNIFICATION WE, THE UNDERSIGNED, being the Owner(s) and/or Tenant(s) of the real estate described below, give the right, privilege and authority for the purpose of Temporary Right of Entry onto and/or across said real estate for the following purpose: Purpose of Entry: a. For inspection of the private sewer to determine if the line is broken and requires repair and replacement; and b. For making repairs to or replacement of said private sewer line by the City of South Bend, Indiana. Property Location: South Bend, Indiana. (property address) Dates: Beginning on and ending after The undersigned does/do hereby agree to jointly and severally,release,indemnify and hold the City of South Bend (the City), and its agents,employees, contractors,successors and assigns harmless from all suits, claims or proceedings of any kind,as a result of the City's entry on the above property under this Agreement. This does not include release from damage caused by a Program Contractor performing repair work. The undersigned further acknowledge(s) that this release includes but is not limited to any damage to the foundation, the foundation walls and/or the building line and exterior brick wall resulting from excavation necessary to make repair, and that South Bend Municipal Code Sec. 17-61 expressly requires a property owner to be fully responsible for any repair of the lateral sewer line from inside the basement to the outside exterior brick wall of the above property. This means that any sewer line break or malfunction which exists under the building foundation is the owner's sole responsibility and is not covered under the City insurance program. Nor does the Sewer Insurance Program cover any costs relating to removal or replacement of trees, shrubbery, plants, lawns, sprinkler systems, or other landscaping features or hard surface improvements such as driveways, patios, and sidewalks, gas grills, and similar items per South Bend Municipal Code Sec. 17-58. This Agreement shall be interpreted and enforced according to the laws of the State of Indiana. The undersigned persons executing and delivering this Agreement represent and certify that they are the owners or tenants of the said property and have the authority to execute and deliver this Agreement and that all necessary action has been taken and done. DATE: Witness: (City employee requesting access to property) OWNER(S)/TENANT(S): Sig a ure (printed name) Prznted Nome Signature Prznted Nome 9