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HomeMy WebLinkAboutD-2628 'f' " ... This page is part of your document - DO NOT DISCARD RECORDING REQUESTED BY WHEN RECORDED MAIL TO 03 3459220 RECORDEDIFILEO IN OFFICIAL RECORDS RECORDER'S OFFICE LOS ANGELES COUNlY CAI,-~qNlA 8:04 AM NOV 17 2003 ...1 FOLD HERE FOLD HERE TITLE(S) : ... c< , - FEE I 0, , FEE $16 00 I f-------------- OAF $2 , , , C-20 4 u, , ---~-'----~ CODE 20 - [ CODE , CODE I I I 19 I 24 I ~- I , ---- ---- - - - --- CODE i 9_1 - ~ ~T __J ... Assessor's Identification Number (AIN) . To be completed by Examiner OR Title Company in black ink. , I Number of Parcels Shown [TTTl-n ... I I LJ THIS FORM NOT TO BE DUPLICATED ... lYI"'IL ~... '" ~,.. ._ C~ty ~iyj\tcadia/DdD/Engr. .' - 240 W Huntmgton Dr Arcadia, CA 91007 I 03 3459220 --1 7/ CITY OF ARCADIA DEVELOPMENT SERVICES DEPARTME~T HOLD HARMLESS AGREEMENT ,r' _u.. - -- Proiect in Public Riqht Of Way : \ This Agreement IS made and entered inlo by and between-the Clly - of Arcaal~ a municipal organization organized under the laws of the State of California (City), and 0'; "".f E<< '" <?", .6 /: e r ... ~ , (Owner) and cannot be modified or term nated without wntt approval of lhe Clly &"0 S. f>Or/~l.V,'~ .Ave Property Address: Assessor's Parcel Number: Re ProJecl Descnptlon oS ,'ci e w q 11.. s /~O-..., , /;, ~< P/-t.thl12..- s:.~ 0... l~Ur~ 6v\. -J{.J... futhL. L.- <;:-- 't --/0.. lei ( k-, In consideration of and as a condition to Issuance of an off-site or encroachment permit for the above descnbed obstructlon(s), the undersigned agrees 10 indemnify, defend, and hold harmless the City of Arcadia, ItS officers, agents, and employees from and against all losses, claims, demands, payments, SUits, and Judgements of every nature and descnptlon brought or recoverable against It or them (the City et. al) by the owner, hiS agents or employees, or third parties ansing out of or In any way attnbulable to the above Job Owner(s) shall be fully responsible for care and maintenance of subject proJect, agree to carry continuous insurance In amounts determined by lhe Clly, and shall name the City and ItS officers, officials, employees, and agents as Additional Insured Owner(s) ackf10wledge and agree that the permitted encroachment IS subject to removal upon notice from lhe City, If not removed by owner per City Notice, City may remove and replace same al owner's expense ThiS documenl shall be binding on all successors In Inlerest to subject property All parties to thiS agreement have executed thiS Instrument on the date shown below their signatures, ... ( /" . ~~ - ''..1: / r tJ c..c- /., -; 1""""\ ",":' ~ .-,< d~:::'~_ _ - , ture- ~~ cz, ~ r Slgnature- - 'D:.((e....~ h:uhe", Pnnl Name .0_ J!" /1 L h /'cl_ e ...e,- Print Name .I~/~';"'I O~ Date /O-/f-03 Date r- ~'Ff>o:,..'~_'..'ll:'".......",,~. ;.,.""";>!.......(.."l:WJt..I."...,~i.,,~._~:i"'~.,__;.'~;.~.1i~I,"'-... -"--','w...,.....,.. .~.....'~':-~ ~.".......~ h _~ "-;;.1\'He"''''!-.J ~"'"-""'~l . 70, J'"";W I"'~.,.~l~-)~~~_- c;;;;00CUMENT'MUS'f BE'SIGNEOiB'i'AU,",I!EGAI! OWNERS;ANO:NOTARIZEO,P.RIOR<TO 'CIT.Y?AFlPROV Al:!.;t - ,<; ~~"f~ ,J'''''':;<,.1''!J~ ~.t2<.;l!"'( ,,;~.,~,;;;z.H"','~"'~-!1 '~r.;, "..;;: ~:.,':~m~_'";' ..~_-ilj:r~~"ii.;'m,','!'{"';~-:::;',::7 ~ ,"{..-:'I~~ ,,....0::70;-:...-:- ~tr-,":{- ",~;,)~::-.tl!.::.. ~ ~,F~V ~_"t_...-.r_).5l;IC.....~ .",'>"'; .'_.0....- "",......"'~~. _", "",.".. _ly....._ '... ,__""".~-.., >-:ff",,? '''.'''"'' .__ "'''~ l'\;"'~<""_~'__ ,..... _._ ,~.~._,>-""'_ CITY APPROVED AS TO F"ORM ~y P./~ BY, f I - " .' 03 3459220 CALIFORNIA ALL.PURPOSE ACKNOWLEDGMENT 7 State of Callfomla personally appeared eft, Namll(s)oISlgoer(s) ~ersonallY known to me roved to me on the basIs vidence of satisfactory I, ~--_...._------~ a RAFAELA MURILLO COmml!SIOn# 1336519 ~ ~ Notary Public - California ~ 1 Los Angeles County f MyCoTTn1 b;:;1l'" Dec27, 2005 ____J..________ to be the person(s) whose name(s) Is/are subscnbed fa the wlthm mstrument and acknowledged to me that he/she/they executed the same In his/her/theIr authorIzed capacltY(les), and that by his/her/their slgnature(s) on the mstrument the person(s), or the entIty upon behalf of which the person(s) acted, executed the Instrument OPTIONAL Though 1M tn/anna/ton below IS not reqUIred by law, 1/ may prove valuable to persons relYll1g on the dtxumenl and could prevent fraudulent removal and reattachment of thiS form to another document Descriplion of AttaChed Documenl Title or Type of Document i2~/Jdof~ SQ;t.()le~ Def'fA-(-~ ' Document Datel 15 - / V -() .3 Number of Pages Slgner(s) Other Than Named Above Capacily(ies) Claimed by Signer SIgner's Name o IndIVIdual Q.-cOrporate Officer - Title(s) €"Pllr1ner - 0 limited 0 General o AttomeY-ln-Fact o Trustee D Guardian or Conservator o Other Top of lhumb here Signer Is Representing 019>1>1 N"'llonal Notary ASSOCiation' 9350 De SOlO Ave. PO Box 2402 . Chillsworth CA 91313.2402. w_ nllllonalnoli1ry ol'\l P,OO No 5907 RllOrder Call Toll-Free 1-800-8766827 CALIFORNIA ALL.pulil~oSE ACKNOw'~EDGr~li~I"'T r~>''''''''''<'''';'Q&1l:)1;;:~'&.'''''~~''2i8<'.&:5:l'ioQ~=:l'~~='&<> I State of Calif 01 nli' } ~ :'\ S5 County of Lo... .I::\~d(>" On ()('\ "Q~L-4003_beloreme....-Ho.t\o/\t~ ~'-N\{\l\:o.~ Jale I':lImeardTllleofOthcoir(cg,"JlIneOoo NOlllryPublic.") personally appeared ~\\~ M;~"'It~Q (" , N(lm~(slolSllP1er(sl , , . :\" 't'; --~------..-. RECORDER'S MEMO, POOR RECORD IS DUE TO QUALITY OF ORIGINAL DOCUMENT ~' ~----::~=r-f tM8tA~I.:'~ _ ~ Ccffi.." -, . 141ll601 i _ NoIary NIle. CaIIoINa j _ _ _ ~~~~2lf7t , , 03 3459220 r " I o personally known to me ;l(l proved to me on the baSIS of satisfactory evidence to be the person(\) whose name(t\) ist"'e subscrrbsd to the within Instrument and aCKnowledged to me that h\!shettlfFr executea the ~dl-ne IIi' h~ih&(IU l\iir authorized capacltY(I~s), and that by h1l>thertt~err slgnabre(~ on the Instrument the person{\;), or the entity upon behalf of which the person(\;l acted, executed the .nstrument S my hand an1tffl lal seal. , I ~,--- S,gnatll'Il..AI.:oI...-yPu,:,l,.; I ~, > i J OPTIONAL Though the mformatlon be/ow IS not reqUlrod by law, It may prove valuable 10 persons relymg on the document and could pre~ent fraudulent removal and reattachment of thiS form to another document Description of Attached Document ., .' Title or Type 01 Document Document Date ---o.tS ' \\0\& \-\p..<,W\.\e.-\". .,,9';>, ,.!,)OO':' %('€(:'.~I!''''\ Number of Pages -1 ,I Slgner(s) Other Than Named Above Capacity(ies) Claimed by Signer Signer's Name' o Individual o Corporate Officer - Tille(s) o Partner - 0 Limited 0 General o AttorneY'ln.Fact o Trustee o GuardIan or Conservator o Other: ___. "J ~ ~ Tcp 01 thumb here q Signer Is Representing: j '. ' g~~'@~~~.=~~~"\R~~~_ Cl999NatIcnaJNolaryAucdatlQn'9350D9SoIo/lve go eax2~~'Chatswol1h C"'''13132A02'_...n.llonfolnololry'''ll Prod No 5901 Reo<dotrCanTolI Free 1 <<IC-87tH'.B27