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Page 4 of 4 <br /> Revised: 12-28-17 <br /> IN WITNESS WHEREOF, THIS WAIVER, RELEASE AND INDEMNIFICATION <br /> AGREEMENT is executed by the special events holder,acting by and through the undersigned, <br /> who represents that he or she is properly authorized to execute the same and bind the Special <br /> Events Holder hereto. <br /> PRINTED NAME OF SPECIAL EVENTS HOLDER: <br /> PRINTED NAME AND TITLE OF PERSON SIGNING ON BEHALF OF SPECIAL <br /> EVENTS HOLDER: <br /> Name: <br /> Title: gtity, L/� _ /. I.'. i' LTA <br /> Signature: , fiI/.a <br /> Date: V///2-3 <br /> 11cplserver-4\city\Administration\Licenses\Special Event Permits\Release Indemnification <br /> Agreement 12-28-17.docx <br />