What is the Sebastopol encroachment permit indemnity agreement?

It is an agreement for applicants or contractors seeking an encroachment permit. The signer accepts the stated indemnity terms and acknowledges the City’s insurance requirements.

Who needs to complete this agreement?

The applicant and/or contractor applying for an encroachment permit must sign it. The applicant also signs if they are not the contractor performing the work.

How do I submit the encroachment permit agreement?

Submit the signed agreement with the permit application, required fees, and insurance documents to the Sebastopol Engineering Division at the address listed on the form.

Do I need a notary for the encroachment permit agreement?

No. The agreement is signed and dated without a notary. The package lists insurance certificates and endorsements as required documents, but no notarized or sworn step.

Sebastopol, CA · Sonoma County

No notary required

Indemnity Agreement and Acknowledgment of Insurance Requirements

This agreement is signed by an applicant or contractor seeking a Sebastopol encroachment permit and is submitted with the permit application and insurance documents.

What this form is

Sebastopol requires this signed indemnity agreement with an encroachment permit application and insurance submittal for work in a public right of way, street, sidewalk, easement, or City-owned property. The applicant or contractor agrees to indemnify the City and acknowledges the insurance requirements. The package also lists insurance documents and endorsements needed for a complete submittal.

Who needs it

Applicants and contractors seeking a Sebastopol encroachment permit for work in a public right of way or on other listed City property need this agreement.

How to submit it

Submit the signed agreement with the encroachment permit application, required fees, and insurance documents to the City of Sebastopol Engineering Division at 714 Johnson Street, Sebastopol, CA 95472.

About notarization

This agreement is signed and dated without a notary; the listed insurance certificates and endorsements are required attachments, with no notarized or sworn step stated.

How to submit this form

1
Download The Agreement
Download the Sebastopol encroachment permit indemnity agreement PDF.
2
Complete And Sign
Enter the contractor and applicant information as applicable, then sign and date the agreement.
3
Gather Insurance Documents
Include the certificate of insurance and required liability and workers’ compensation endorsements listed in the package.
4
Submit To The City
Send the agreement, permit application, required fees, and insurance submittal to the Engineering Division address shown on the form.

Frequently asked questions

What is the Sebastopol encroachment permit indemnity agreement?: It is an agreement for applicants or contractors seeking an encroachment permit. The signer accepts the stated indemnity terms and acknowledges the City’s insurance requirements.
Who needs to complete this agreement?: The applicant and/or contractor applying for an encroachment permit must sign it. The applicant also signs if they are not the contractor performing the work.
How do I submit the encroachment permit agreement?: Submit the signed agreement with the permit application, required fees, and insurance documents to the Sebastopol Engineering Division at the address listed on the form.
Do I need a notary for the encroachment permit agreement?: No. The agreement is signed and dated without a notary. The package lists insurance certificates and endorsements as required documents, but no notarized or sworn step.

Need something notarized?

This Indemnity Agreement and Acknowledgment of Insurance Requirements doesn’t need a notary — but if you have another Sebastopol form that does, a commissioned online notary can help.