Old Brookville, NY · Nassau County
Hold Harmless Agreement
This agreement sets out indemnification obligations for work involving the Village of Old Brookville and is signed by the contractor or other responsible party.
What this form is
The agreement addresses indemnification of the Village of Old Brookville and its officials, employees, and volunteers for certain claims, damages, losses, and expenses arising from work by a contractor or subcontractors. It includes spaces for the signer’s signature, printed name and title, the date, and a witness’s signature and printed name and title. The document does not state when the Village requires it.
Who needs it
A contractor or other responsible party asked to agree to the indemnification terms for work involving the Village should complete and sign this agreement.
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 agreement is signed without a notary; the signer and witness provide signatures, and the signer dates it.
How to submit this form
- 1
Download The Agreement
Download the Hold Harmless Agreement PDF.
- 2
Complete The Agreement
Fill in the date and the signer’s printed name and title.
- 3
Sign The Agreement
Have the signer and witness provide their signatures.
- 4
Submit To The City
Submit the signed agreement to the city department named on the form.
Frequently asked questions
- What does the Hold Harmless Agreement cover?
- It sets out indemnification obligations related to certain claims, damages, losses, and expenses arising from work by a contractor or subcontractors.
- Who signs the agreement?
- The agreement provides spaces for the signer’s signature, printed name and title, and date, as well as a witness’s signature and printed name and title.
- Do I need a notary for the Hold Harmless Agreement?
- No. This agreement is signed without a notary; the signer and witness provide signatures, and the signer dates it.
- How do I submit the Hold Harmless Agreement?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Hold Harmless Agreement doesn’t need a notary — but if you have another Old Brookville form that does, a commissioned online notary can help.