Jerome, AZ · Yavapai County
Hold Harmless Agreement
This agreement is for people or businesses performing work in Jerome who agree to protect the town and its agents and employees from related claims.
What this form is
The agreement covers loss, damage, or injury to a person or property during work performed in the Town of Jerome. It asks for the signer’s name, the name of the person or business performing the work, the work period, a date, the signer’s signature and printed name, and a witness signature.
Who needs it
A person or business performing work in the Town of Jerome who is signing an agreement to indemnify and hold the town harmless may use this document.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed without a notary; the signer dates it and provides a signature, and a witness also signs.
How to submit this form
- 1
Download the Agreement
Download the Hold Harmless Agreement PDF.
- 2
Complete the Agreement
Enter the signer’s name, the person or business performing the work, the work period, and the date.
- 3
Sign the Agreement
The signer provides a signature and printed name; a witness also signs.
- 4
Submit to the City
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What does the Hold Harmless Agreement cover?
- It addresses loss, damage, or injury to a person or property during work performed in the Town of Jerome, and names the town, its agents, and employees.
- Who signs the agreement?
- The signer provides a signature, printed name, and date. The form also includes a space for a witness signature.
- Do I need a notary for the Hold Harmless Agreement?
- No. This document is signed without a notary; the signer dates it and signs, and a witness also signs.
- How do I submit the agreement?
- Submit it to the city department named on the form; check the city website for current contact details.