The undersigned, in consideration of the payment of $1.00 and other good and valuable consideration, the
adequacy and receipt of which is hereby acknowledged, hereby executes in favor of Brevard County, Florida,
its’ officers, employees, agent and assigns, this Hold Harmless Agreement.
WHEREAS, the undersigned is seeking a building permit(s) for an improvement that is an encroachment of a
public easement. The following may be permitted as encroachment improvement: fence; air conditioner unit;
concrete pads or an improvement specifically approved by the Planning and Development Department
Director or designee.
_____________________________________________ __________________________________________
Specific Improvement Description or Name Approved By
WHEREAS, pursuant to Chapter 22 Code of Brevard County, Florida, the County may issue permit(s) within
unincorporated Brevard County.
NOW, THEREFORE, the undersigned agrees as follows
1. I, (print name), ______________________________________________
The property owner of (print address), ____________________________________________________
hereby agrees that it shall indemnify, defend and hold harmless Brevard County, Florida, any licensed
utility company or independent contractors, and any of their officers, employees and agents in both
their official and individual capacity, from any and all liability, claims, damages, expenses including
attorney’s fees and litigation costs, resulting from or arising out of the removal or alteration of any
existing permitted encroachment structure that exist in or around any public easement, deemed
necessary by the County or licensed utility for the purpose of installing, removing, repairing or
maintaining any improvements allowed within the public easement. The undersigned acknowledges
that specific consideration has been given for this indemnity provision.
(initial) _________
2. I understand and agree that if the County or licensed utility or independent contractor removes,
damages or alters the encroachment structure that I am fully responsible for repair and/or
replacement of the encroachment improvement.
(initial) _________
3. I understand and agree that if I damage or cause damage to any existing structure, improvement,
and/or utility within the easement, I am fully responsible for repair and/or replacement of the existing
improvement as deemed necessary by the County and/or appropriate licensed utility company within
ninety days of receipt of written notice by the County and/or licensed utility company.
(initial) __________
the undersigned hereby sets his/her hand this ______ day of ______________________ , 20 _______.
Name Printed
Owner Signature
State of Florida
County of ___________________________
Subscribed and sworn to before me, by physical presence _____, or online notarization _____, this ______
day of, ______________________________ , 20 _______ , personally appeared
_______________________________________ , who is personally known to me or produced
________________________________________ as identification, and who did/did not take an oath.
Notary Public Signature Seal