ACT OF INDEMNIFICATION AND
HOLD HARMLESS AGREEMENT
BY: ____________________
________
STATE OF LOUISIANA
IN FAVOR OF THE PARISH OF JEFFERSON
P
ARISH OF JEFFERSON
BE IT KNOWN,
that on this
______
day of
_____________, _______
before me
the undersigned Notary Public, duly commi
ssioned and qualified
within the State and
Parish aforesaid, and in
the presence of
the witnesses hereinafter named and
undersigned, personally came and appeared
______________,
owner of the herein
described property, who, being by me
first duly sworn, deposed and said:
(He/She/They) understand and agree to a
ccept a permit under Jefferson Parish
Code of Ordinances,
Section 29-6(D),
which states that the
owner of the property
assumes all risk and will ho
ld Jefferson Parish harmless
from any and all damages or
injuries to self or others resulting from
the mailbox being placed
on a Parish servitude
and/or right-of-way.
(He/She/They) shall allow Jefferson Parish to remove the mailbox at any time
and for any reason if said mail
box remains after the fifth (5
th
) day in which he/she/they
were notified, and without notice in times of
emergency. (He/She/They) shall not be due
compensation for the destruction
or removal of said object by Jefferson Parish for any
public reason whatsoever.
In the event Jefferson Parish must re
move a mailbox in connection with
maintenance of the street, drai
n line, waterline, sewer line,
or any other pu
blic reason,
Jefferson Parish is only obligated to replac
e the removed mailbox with a mailbox that
meets the minimum requirements of
the U.S. Postal Service.
Permits issued for the construction of such
mailbox shall not be transferable.
Jefferson Parish shall not be re
quired to issue a permit for a
“new” mailbox located on a
servitude or right-of-way to
the subsequent property owner.
(He/She/They) shall be fully responsible
for the maintenance of the mailbox, and
accept(s) all responsibility for the mailbox whic
h is located at the municipal address of
_________________________,
and otherwise bearing the legal description
Lot
_____,
Square
____
in
_______________
Subdivision,
Jefferson Parish, Louisiana.
The appearer agrees to protect, defend,
indemnify and save the Parish of
Jefferson, its agents, officials, employees
and servants, including volunteers, harmless
from and against any and all claims, demands,
loss or destruction of property, which
may arise in favor of any per
son or persons on account of
injury resulting from the