Lynwood, CA · Los Angeles County
Indemnity Statement
This indemnity statement records an agreement to protect the City of Lynwood from claims tied to an individual's participation in a requested special event.
What this form is
The statement identifies an indemnifying party and sets out their agreement to protect, indemnify, defend, and hold harmless the City of Lynwood and related officials, staff, and contractors from specified claims. It applies to claims for personal injury or wrongful death caused by an individual's participation in the requested special event. The form asks for a signature, date, name, title, email address, and phone number.
Who needs it
The indemnifying party associated with a requested special event should complete and sign this statement.
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 statement is signed without a notary; the signer just signs and dates it on the form.
How to submit this form
- 1
Download The Statement
Download the Indemnity Statement PDF.
- 2
Complete The Party Details
Enter the indemnifying party's name and provide the requested name, title, email address, and phone number.
- 3
Sign And Date
The indemnifying party signs and dates the statement.
- 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 Lynwood Indemnity Statement cover?
- It sets out an agreement to protect the City of Lynwood and related parties from claims for personal injury or wrongful death caused by participation in a requested special event.
- Who completes the Indemnity Statement?
- The indemnifying party completes the statement and provides a signature, date, name, title, email address, and phone number.
- Do I need a notary for the Indemnity Statement?
- No. This statement is signed without a notary; the signer just signs and dates it on the form.
- How do I submit the Indemnity Statement?
- The document does not list a submission method or contact details. Submit it to the city department named on the form; check the city website for current contact details.