Roslyn Harbor, NY · Nassau County
Indemnification/Hold Harmless Agreement
This agreement sets out a contractor’s promise to indemnify and hold harmless the Village of Roslyn Harbor and is signed by the contractor.
What this form is
This agreement sets out a vendor or contractor’s obligation to indemnify and hold harmless the Incorporated Village of Roslyn Harbor, its officers, employees, and agents for specified claims connected with the vendor’s or contractor’s work, goods, or services. The agreement includes an exception for claims resulting from the Village’s gross negligence or willful misconduct. It asks for the firm’s name and address, contractor’s signature and printed name and title, and witness signature, date, and printed name.
Who needs it
A vendor or contractor completing the agreement provides firm details and signatures for the undertaking, products, goods, merchandise, services, or work described in the document.
How to submit it
The agreement does not specify a submission method. 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; the contractor signs and dates it, and a witness provides a signature and printed name.
How to submit this form
- 1
Download The Agreement
Download the Indemnification/Hold Harmless Agreement PDF.
- 2
Complete Firm Details
Enter the firm name and address, then provide the contractor’s printed name and title.
- 3
Sign And Date
The contractor signs and dates the agreement. A witness signs and prints their name.
- 4
Submit The Agreement
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What does the Indemnification/Hold Harmless Agreement do?
- It records a vendor or contractor’s agreement to indemnify and hold harmless the Village of Roslyn Harbor and its officers, employees, and agents for specified claims connected with their work, goods, or services.
- Who signs the agreement?
- The form provides spaces for the firm name and address, contractor’s signature and printed name and title, and a witness signature, date, and printed name.
- Do I need a notary for the Indemnification/Hold Harmless Agreement?
- No. This document is signed without a notary; the contractor signs and dates it, and a witness provides a signature and printed name.
- How do I submit the agreement?
- The document does not give a submission method. Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Indemnification/Hold Harmless Agreement doesn’t need a notary — but if you have another Roslyn Harbor form that does, a commissioned online notary can help.