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APPENDIX
E
EXAMPLE RIGHT OF ENTRY AGREEMENT
I/We
. the owner(s) of
the property commonly identified as
___________________________________ (street)
___________________________
_________________________
State
of
(city/town)
(parish)
do hereby grant and give freely and
without coercion, the right of access and entry to said property
to the Parish/City of ________________________________________ its
agencies. contractors, and subcontractors thereof, for the purpose
of removing and clearing any or all storm-generated debris of
whatever nature from the above described property.
It is fully understood that this
permit is not an obligation to perform debris clearance. The
undersigned agrees and warrants to hold harmless the City/Parish
of
_____________________
State
of __________________. its agencies. contractors, and
subcontractors, for damage of an type, whatsoever, either to the
above described property or persons situated thereon and hereby
release, discharge. and waive any action, either legal or
equitable that might arise out of any activities on the above
described property. The property owner(s) will mark any storm
damaged sewer lines, water lines, and other utility lines located
on the described property.
1/We (have / have not (will / will not
______ received any compensation for debris removal from any other
source including SBA. ASCS, private insurance, individual and
family grant program or any other public assistance program. I
will report for this property any insurance settlements to me or
my family for debris removal that has been performed at government
expense. I am fully aware that an individual who fraudulently or
willfully misstates any fact in connection with this agreement
shall be subject to a fine of not more than $10,000 or imprisoned
for not more than one year or both. For the considerations and
purposes set forth herein. I hereby set my hand this ______ day of
20____.
Witness
Owner
Telephone No. and Address
Witness
Owner
C-10E
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