Camas, WA · Clark County
Encroachment Permit Indemnification and Hold Harmless Agreement
This agreement records an applicant or contractor’s indemnification commitment for an encroachment permit and is signed by the applicant.
What this form is
This agreement sets out the applicant or contractor’s commitment to defend, indemnify, and hold the City of Camas harmless in connection with the agreement, subject to the terms stated in the document. It is labeled both “Annual Certification (Keep on File)” and “Permit Specific,” with a space for a permit number. It asks for the company or agency name, applicant’s signature, date, printed name, and title.
Who needs it
An applicant or contractor completing an encroachment permit certification needs to provide the company or agency name and sign and date the 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; it asks the applicant to sign and date it and identifies no notarized or sworn attachment.
How to submit this form
- 1
Download The Agreement
Download the Encroachment Permit Indemnification and Hold Harmless Agreement PDF.
- 2
Complete The Agreement
Enter the permit number and company or agency name, then provide the applicant’s signature, date, printed name, and title.
- 3
Gather Permit Information
Have the permit number and company or agency details available; the form identifies no attachment to gather.
- 4
Submit To The City
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What is the Encroachment Permit Indemnification and Hold Harmless Agreement?
- It records an applicant or contractor’s indemnification commitment to the City of Camas. The document is labeled as an annual certification to keep on file and also includes a space for a specific permit number.
- Who completes this agreement?
- The applicant or contractor provides the company or agency name and the applicant’s signature, date, printed name, and title.
- Do I need a notary for the Encroachment Permit Indemnification and Hold Harmless Agreement?
- No. This agreement is signed without a notary; it asks the applicant to sign and date it and identifies no notarized or sworn attachment.
- How do I submit the Encroachment Permit Indemnification and 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 Encroachment Permit Indemnification and Hold Harmless Agreement doesn’t need a notary — but if you have another Camas form that does, a commissioned online notary can help.