Page 6 of 6 Application for Special
Event Rev. 1/14/20
19. Organizer’s Acknowledgement
By signing below, the Event Organizers and their representatives agree to the following:
a) I/We hereby affirm that the Organizer of the Event and all Participants will comply with
the Laws of the State of Maryland and the Statutes and Ordinances of St. Mary’s County
and the Town of Leonardtown.
b) I/We will also adhere to the Terms and Conditions set forth in this Permit.
c) The Organizer will obtain Liability and Property Damage Insurance with the limits of
$1,000,000 per incident and provide a Certificate of Liability Insurance for said policy,
specifying the Commissioners of Leonardtown as Additional Insured for this Event.
d) My/Our signatures below confirm that the Organizer and all Participants agree to
indemnify and hold harmless The Commissioners of Leonardtown and its officials,
employees, and agents from and against and all liabilities, judgments, settlements, losses,
costs, or charges (including attorneys’ fees), incurred by the Commissioners of
Leonardtown or any of its officials, employees or agents as a result of any claim, demand,
action or suit relating to any bodily injury (including death), loss of property, damage
caused by, arising out of, related to, or associated with the use of the Property by the User
or by the User’s members, employees, agents or invitees.
e) I/We waive any and all claims against the Commissioners of Leonardtown for any and
all physical loss or damage to the property, including the cost to repair or replace the
property caused by, arising out of, relating to, or associated with the use of the property
by the user of by the user’s members, employees, agents, or invitees.
Organizer (please print name): __________________________________________________
Representative (please print name): _______________________________________________
Representative Signature: ______________________________________________________
20. Agency Approvals
Before signing and giving your approval for your agency, consider the following:
a) Ensure you have the approval authority to sign for your agency to commit manpower and
b) Ensure you have looked over the entire application package, including the Route Map and
Traffic Control Plan. If you identify any problems, have the event organizer address them
prior to signing.
c) If reimbursement is required, ensure you have a mutually agreed upon amount (in
writing) and terms under which payment will be made.
Commissioners of Leonardtown Event Coordinator Date
Commissioners of Leonardtown Town Administrator Date
St. Mary’s County Sheriff’s Office Date
click to sign
click to edit