Fillable Form 2908 Mooring Liability Waiver (City of Hudson)

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Form 2908 Mooring Liability Waiver (City of Hudson)

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The Form 2908 Mooring Liability Waiver (City of Hudson) form is 3 pages long and contains:

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  • 8 check-boxes
  • 36 other fields

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FOR OFFICE PURPOSES ONLY
PERMIT NO. ISSUED:
INSURANCE EXPIRATION:
OWNERSHIP EXPIRATION:
FEE PAID/RECEIPT NO./DATE:
DATE:
CITY OF HUDSON
SAILBOAT MOORING PERMIT
2021
DATE RECEIVED:
NAME - DESIGNATED MANAGING OWNER (for mailing purposes):
EMAIL:
STREET ADDRESS CITY STATE ZIP CODE
HOME PHONE WORK PHONE CELL PHONE
COUNTY YOU RESIDE IN SCHOOL DISTRICT YOU RESIDE IN
CO-OWNER NAME (if applicable):
EMAIL:
STREET ADDRESS CITY STATE ZIP CODE
HOME PHONE WORK PHONE CELL PHONE
COUNTY YOU RESIDE IN SCHOOL DISTRICT YOU RESIDE IN
SAILBOAT INFORMATION:
Dinghy Y or N
YEAR MAKE MODEL YEAR/MAKE/MODEL
LENGTH COLOR NAME
STATE OF REGISTRATION REGISTRATION NUMBER EXPIRATION DATE
INSURANCE INFORMATION:
COMPANY NAME CITY/STATE POLICY NUMBER EXPIRATION DATE
If a renewal application, do you want to be considered for a different position? Yes No
I (We) have read Section 181-14 of Chapter 181 of the City of Hudson Municipal Code AND Mooring Policy and
understand the procedures that apply to the sailboat mooring area.
Owner Co-owner(s)
I (We) have read and signed the Waiver and Release of Liability, Assumption of Risk and Indemnity Agreement that
applies to the sailboat mooring and dinghy storage area.
Owner Co-owner(s)
MANAGING OWNER SIGNATURE CO-OWNER SIGNATURE
ALL APPLICATIONS TURNED IN OR POSTMARKED LATER THAN March 1, 2021 WILL NOT BE ACCEPTED.
CITY OF H
UDSON - PARKS & RECREATION DEPARTMENT
505 THIRD STREET
HUDSON WI 54016-1694
(715)386-4774 EXT. 110
(715)386-3385 FAX
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Page 1 of 2
HUDSON PUBLIC WORKS AND PARKS DEPARTMENT
BOAT MOORING PERMIT
WAIVER AND RELEASE OF LIABILITY,
ASSUMPTION OF RISK AND INDEMNITY AGREEMENT
I, the undersigned, acknowledge that storing my dinghy on the bank of the Dike Road
involves procedures which may test a person’s physical capabilities and carries with it
the potential for serious injury and property loss. The risks include, but are not limited to,
those caused by the steep and rocky nature of the dinghy storage area facilities on the
bank of the Dike Road, my own physical condition, actions of other people, including but
not limited to, other mooring permit holders. I HEREBY ASSUME ALL OF THE RISKS
OF STORING MY DINGHY ON THE DIKE ROAD AND ALL OTHER RISKS ARISING
OUT OF MOORING MY BOAT IN THE CITY BOAT MOORING AREA. I realize that
liability may potentially arise from any negligence or carelessness of the person or
entities being released, from dangerous or defective equipment or property owned,
maintained or controlled by the persons/entities being released, or because of possible
liability without any negligence of the persons/entities released.
I certify that I am physically fit, am fully capable of climbing/walking on the rip-rap bank
of the Dike Road and to do all things relating to use and storage of my dinghy on the
Dike Road in connection with use of my boat moored in the Hudson boat mooring area,
and that I have not been advised otherwise by a qualified medical person. I hereby
assume full responsibility for any risk of bodily injury, death or property damage arising
out of or related to the Hudson Boat Mooring Area, whether caused by the negligence of
Releasees or otherwise. I acknowledge that this Accident Waiver and Release of
Liability form will be used by the City of Hudson and that it will govern my actions and
responsibilities as a boat mooring permit holder.
In consideration of my application and the City allowing me to moor my boat at the
Hudson Boat Mooring Area and store my dinghy on the banks of the Dike Road, I
hereby take action for myself, my guests, my executors, administrators, heirs, next of
kin, successors and assigns as follows:
(A) I WAIVE, RELEASE, AND DISCHARGE FROM ANY AND ALL LIABILITY
FOR MY DEATH, DISABILITY, PERSONAL INJURY, PROPERTY
DAMAGE, PROPERTY THEFT OR ACTIONS OF ANY KIND WHICH MAY
HEREAFTER OCCUR TO ME ARISING OUT OF MOORING MY BOAT IN
THE BOAT MOORING AREA AND STORING MY DINGHY ON THE DIKE
ROAD. THE FOLLOWING ENTITIES OR PERSONS:
City of Hudson, City Public Works and Parks Department, City officers,
employees, volunteers, representatives, and agents, (Released Persons/
Entities).
Page 2 of 2
(B) I INDEMNIFY AND HOLD HARMLESS THE RELEASED PERSONS/
ENTITIES STATED ABOVE FROM ANY AND ALL LIABILITY OR CLAIMS
MADE AS A RESULT OF MOORING MY BOAT IN THE HUDSON BOAT
MOORING AREA INCLUDING STORING MY DINGHY ON THE DIKE
ROAD, WHETHER CAUSED BY THE NEGLIGENCE OF RELEASED
PERSONS/ENTITIES OR OTHERWISE.
I hereby consent to receive medical treatment that may be deemed advisable in the
event of injury, accident and/or illness during this course.
The Accident Waiver and Release of Liability, Assumption of Risk and Indemnity
Agreement shall be construed broadly to provide a release and waiver to the maximum
extent permissible under applicable law.
I hereby certify that I have read this document; and, I understand its content.
______________________________
____________
Print Participant’s Name
Age if under 18
_____________
________
_____________________________________________________
Signature Date
PARENT/GUARDIAN WAIVER FOR MINORS
(UNDER 18 YEARS OLD)
The undersigned parent and natural guardian does hereby represent that he/she is, in
fact, acting in such capacity and agrees to save and hold harmless and indemnify the
Released Persons/Entities referred to above from liability, loss, cost, claim or damage
whatsoever which may be imposed upon said parties because of any damages, injuries
or losses caused by negligence, carelessness or otherwise and release said parties on
behalf of the minor and the parents or legal guardian.
______________________________
Print Parent/Guardian's Name
______________________________
Signature of Parent or Guardian Date
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Boat Mooring Area Rules, Policies, and Procedures
1
Mooring Policy & Procedures
Updated 4-23-13; Updated 11-15-2018
Boat Mooring Policies established by the Park Board are as follows:
1. Boat Mooring Permit Application. The mooring application must list and be signed by all owners of the boat
intended to be moored. The application shall include evidence of ownership of the boat. When more than one
owner is involved, the application must designate one managing owner to receive all official communications. In the
event the insurance policy or evidence of ownership lists names other than those designated on the application, the
application may be rejected.
Applications must also include a signed Waiver and Release of Liability, Assumption of Risk and Indemnity
Agreement.
Alternates will be ranked in the priority according to the address for the designated managing owner provided on
the application.
All moorings will be for personal use, not commercial use.
2. Proof of Insurance. Each application shall include proof that liability insurance is in effect for the full boat
mooring season. Copy of policy to be submitted with the application and shall include the names of all owners. If
insurance information submitted at the time of application changes, the boat mooring permit holder shall provide
updated insurance information within 10 days of the change. Consequences for non-submission of required
insurance: Failure to timely provide current and correct insurance information may result in loss of the boat
mooring permit.
3. Boat Registration. Each application shall also provide a copy of the appropriate state registration or U.S. Coast
Guard Certificate of Federal Documentation. If registration information changes during the boat mooring season,
the permit holder shall provide updated registration information within 10 days of the change in registration.
Consequences for non-submission of required registration: Failure to timely provide current and correct boat
registration information may result in loss of the boat mooring permit.
4. Priority for Drawing for Available Mooring Spots. Guidelines for drawing with priority as follows: (1) City of
Hudson residents, (2) Hudson school district, (3) St. Croix County, (4) Washington County and (5) others; when filling
openings. Any renewed alternate applications maintain their position on the alternate list under each category of
the priority system.
5. Mooring Assignments. The mooring assignments will be available to the public as long as the craft does not
endanger boats in adjacent mooring positions. Complaints are to be filed with the Director of Parks and Public
Works
Grandfather clause allows the one long boat that has been moored for years to be moored at the east end of our
mooring area with written application to be made no later than March 1 of each year.
6. Vacated Mooring during Mooring Season. A mooring that is vacated can be reassigned. If vacated before July 15,
permit holder will receive a refund of one-half of the mooring fee for the season. New applicant will pay one-half of
the mooring fee for the season plus $15.00 administrative costs.
7. Boat Owner Responsible for Setting and Maintaining Anchor System. Each boat owner will be responsible for
setting and maintaining his anchor system in the assigned position as approved by the Parks Department. Each boat
Boat Mooring Area Rules, Policies, and Procedures
2
Mooring Policy & Procedures
Updated 4-23-13; Updated 11-15-2018
owner is responsible for removal of his mooring anchor system upon vacating his mooring position. Mooring
positions may not be changed without permission from the Parks Department Director or designee.
8. Buoys. Marking buoys are the property of the individual moorers. The type of buoy shall be as specified by the
City and must be numbered with decals to be provided by the City and placed in the assigned mooring position. The
buoy to be used must be a U.S. Coast Guard approved buoy that is white with a 3” reflective blue band with white
vinyl bumper.
9. Boat Requirements. All sailboats are to have a self-bailing cockpit or an automatic bilge pump. Sailboats shall be
limited to 30 feet in length unless approved by the Parks and Public Works Director before approval of the mooring
application.
10. Dinghy Storage and Specifications.
Dinghy Storage: Each mooring holder will be allowed one dinghy that can be stored along the Dike Road
during the mooring season. The City shall designate five areas along the Dike Road bank. A tie down area will be
provided by the City. Mooring holders can secure their dinghies with a chain and lock at the specified tie down
area as noted on the dinghy tie-up map.
Dinghy Specifications: The dinghy shall be no more than 60 inches in width and no longer than 10 feet in length.
The dinghy must meet the U.S. Coast Guard safety standards and shall be cream or white in color. Canoes,
kayaks, or any other types of watercraft not specified will not be allowed.
Any mooring holder that does not comply with the dinghy storage requirements and/or specifications will be
notified of the non-compliance and be ordered to correct the issue immediately. The mooring holder will be
responsible for any and all costs incurred by the City to remedy the non-compliance.
11. Mooring Area. The City will provide and maintain U.S. Coast Guard approved marking buoys around the
mooring area.
12. Removal during July fireworks. All boats and dinghies shall be removed from the mooring area and the dinghy
storage area by 4:00 p.m. on the day of the July fireworks. If not moved, the boat will be towed from the area or the
dinghy removed from the dinghy storage area at the owner’s expense. (Note: This is effective starting with the 2002
season by order of the U.S. Coast Guard.)
13. Vacant Mooring. If mooring is not in use/or to be used by June 1, written explanation shall be given by the
mooring permit holder to the Director of Parks & Public Works. Usage of the moorings will be checked periodically
by the Parks Department. If the Parks Department observes a mooring is vacant for more than two (2) consecutive
weeks after June 1, and the permit holder has not provided the Director of Parks & Public Works with a written
explanation of the absence, the permit holder shall be notified by e-mail or certified mail that their permit is null and
void unless the mooring is put into use by the designated permit holder within five (5) days of receipt of the letter.
14. Boat Decals. All moorings, boats and dinghies shall be marked appropriately with decals as provided by the City.
15. Improper Mooring. If it is determined that any sailboat, dingy, or buoy is not in its assigned position, the City
may correct such placement at owner’s expense, having given reasonable notification.
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Form 2908 Mooring Liability Waiver (City of Hudson)

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Completed 14 July 2020

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