Windham, NY · Greene County
Hold Harmless Agreement and Certificate of Liability Insurance
This agreement sets out liability and insurance terms for a person or organization using a Town of Windham facility or services.
What this form is
The agreement covers a facility user’s responsibility to defend, indemnify, and hold the Town of Windham harmless for certain bodily injury or property damage claims connected with facility use or related activities. It also requires commercial general liability insurance and a certificate of insurance before work or facility use begins, with the town named as an additional insured.
Who needs it
A person or organization using a Town of Windham facility or services should complete this agreement and provide the required insurance certificate.
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; it requires an insurance certificate, but does not state that the certificate or any related step must be notarized or sworn.
How to submit this form
- 1
Download The Agreement
Download the Town of Windham Hold Harmless Agreement and Certificate of Liability Insurance form.
- 2
Complete The Agreement
Provide the information requested for the facility use and agreement.
- 3
Gather The Insurance Certificate
Obtain a certificate of insurance that evidences the requirements in the agreement.
- 4
Provide It Before Use
Provide the certificate to the Town of Windham before work or use of facilities begins.
Frequently asked questions
- Do I need a notary for the Hold Harmless Agreement?
- No. This agreement is signed without a notary. It requires an insurance certificate, but does not state that the certificate or any related step must be notarized or sworn.
- How do I submit the agreement and insurance certificate?
- The document says to provide the Town of Windham with a certificate of insurance before work or facility use begins. It does not specify where to submit the agreement.
- What insurance does the agreement require?
- It lists commercial general liability insurance of $1,000,000 per occurrence and $2,000,000 aggregate, and requires the town to be named as an additional insured.
Need something notarized?
This Hold Harmless Agreement and Certificate of Liability Insurance doesn’t need a notary — but if you have another Windham form that does, a commissioned online notary can help.