o Keep the equipment in good working order, fair wear and tear excepted.
o Ensure that identification marks or labels on the equipment are not removed, defaced, amended
and obscured including those which identify the equipment as belonging to the Borough of
Bellefonte
In the event of the equipment being lost or damaged, the Applicant agrees to pay a replacement cost.
Signed on behalf of the Borough of Bellefonte
Signature______________________________________________ Date __________________________
Print Name ____________________________________________ Position ________________________
Signed on behalf of the Applicant
Signature______________________________________________ Date __________________________
Print Name ____________________________________________ Position ________________________
I HEREBY RELEASE FROM LIABILITY AND AGREE TO INDEMNIFY AND HOLD HARMLESS THE BOROUGH OF
BELLEFONTE, AND ANY OF ITS EMPLOYEES, AGENTS OR VOLUNTEERS REPRESENTING OR RELATED TO
THE BOROUGH OF BELLEFONTE, FOR ANY LIABILITY IN CONNECTION WITH THE USE OR POSSESSION OF
THE EQUIPMENT. THIS RELEASE IS FOR ANY AND ALL LIABILITY FOR PERSONAL INJURIES (INCLUDING
DEATH) AND PROPERTY LOSSES OR DAMAGE OCCASIONED BY, OR IN CONNECTION WITH THE
POSSESSION OR USE OF THE EQUIPMENT.
___________________________________________
Signature
___________________________________________
Print name
__________________________________
Date
RETURNED:
Borough of Bellefonte Initial _____________
Applicant’s Initial _____________
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