Independence, IA · Buchanan County
Indemnification and Hold Harmless Agreement
This agreement is for property owners who receive an Independence major mailbox structure or major encroachment permit and must agree to protect the city from specified claims related to the permitted encroachment.
- licensed online notary
- ~15 min average
- Notarized PDF emailed
What you’ll need
- Government-issued photo ID
- Webcam-enabled device (laptop or phone)
- This form, ready to upload as a PDF
What this form is
Independence requires this agreement from property owners as a condition of issuing a Major Mailbox Structure or Major Encroachment Permit for an encroachment in the city right of way. The owners identify their property and the encroachment, then agree to defend, indemnify, release, and hold the city and its representatives harmless from specified liability connected with the permit and the encroachment. The agreement also binds successors in interest.
Who needs it
Property owners who apply for and receive an Independence Major Mailbox Structure or Major Encroachment Permit for work in the city right of way need this agreement.
How to get this notarized
- 1
Download the Agreement
Get the Indemnification and Hold Harmless Agreement from the City of Independence.
- 2
Fill In the Agreement
Enter the property description, parcel ID, permit details, encroachment information, and the owners' names.
- 3
Book an Online Notary
Schedule a remote notarization for the property owners who must sign and take the oath.
- 4
Sign on Video
Sign and swear to the agreement during the online notary session.
- 5
Submit to the City
Submit the completed, notarized agreement to the City of Independence as part of the permit process.
Preview the form
The blank PDF straight from Independence. Look it over, then upload your filled copy to start the notary session.
You’ll need ID and a webcam.
A licensed online notary will join you on video, verify your government-issued ID, witness your signature, and apply their seal. You’ll receive the notarized PDF by email when the session ends.
Frequently asked questions
- How do I complete this agreement?
- Identify the property and permitted encroachment, complete the agreement, and sign under oath before a notary. Submit the signed agreement as part of the city permit process.
- Do I need to sign this agreement in front of a notary?
- Yes. The form includes a subscribed-and-sworn jurat, so the property owners named in the agreement must sign and take the oath before a notary.
- Can I sign this agreement with an online notary?
- Iowa authorizes remote online notarization by its notaries under Iowa Code §9B.14A. A commissioned online notary can notarize the oath by video; confirm the city will accept the completed document.
- When does Independence require this agreement?
- The form says the agreement is a condition of issuing a Major Mailbox Structure or Major Encroachment Permit for an encroachment in the city right of way. Contact the city with questions; confirm with the city if unsure.