RIGHT_OF_WAY_ENTRY FORM.pdf

RIGHT-OF-ENTRY FORM

Instructions: Please fill in the requested information and execute the document at the bottom of the page.

Property Owner’s Information

Owner Name:

Street Address:

City:

State:

Phone: Primary: Alternative:

APN:

1: Scope of Work: This Right-of-Entry authorizes the City of Valdosta and its departments, (Company), and it’s assign, to access the property solely for the purpose of removing storm-related debris from waterways, including down trees and vegetative obstructions that pose a risk to water flow, public infrastructure, or safety.

2: Hold Harmless: The Owner understands that this hold harmless is not an obligation upon the government to perform debris removal. The Owner agrees to indemnify and hold harmless the United States Government, including the Federal Emergency Management Agency, United States Army

Corps of Engineers and Natural Resources Conservation Services, Inc, the State of Georgia, the City of Valdosta and its departments, (Company), and their respective assigns, employees, agents, subcontractors, for damages of any type whatsoever, either to the above-described property or to persons situated thereon. The Owner releases, discharges, and waives any action, either legal or equitable, that might arise by reason of the action of the above entities.

3: Miscellaneous:

a. Owner represents and warrants that Owner has full power and authority to execute and fully perform Owner’s obligations under this hold harmless. If Owner is an entity, Owner also represents and warrants that Owner has such power and authority pursuant to its governing instruments, without the need for any further action, and that the person(s) executing this hold harmless on behalf of Owner are the duly designated agents of Owner and are authorized to do so.

b. The Owner agrees to notify the City of Valdosta or its contractor of the location of any known sewer lines, septic tanks, water lines, or other utilities located on the property, to the best of their knowledge.

c. Legal Authority: This Right-of-Entry is executed in pursuant to the authority granted to City of Valdosta under the Georgia Emergency

Management Act (O.C.G.A. § 38-3-1 et seq.) and other applicable state and local laws; The Robert T. Stafford Disaster Relief and

Emergency Assistance Act as amended, 42 U.S.C §§ 5152-5207;

d. Information is collected to make it possible for the Assistance Providers, to conduct debris removal operations, including tree and vegetative removal directly affected by Hurricane Helene, within the vicinity of the Owner’s property. Information submitted will be shared with other government agencies, their contractors, subcontractors, and employees, as well as with voluntary agencies performing inspections and/or emergency protective, for official use only in accordance with the purposes stated in this Right-of-Entry.

e. No Compensation: The Owner acknowledges that no compensation will be provided for debris removed or for access granted under this agreement.

f. Access Duration: This Right-of-Entry shall remain in effect for a period of 180 Days from the date of execution, unless extended in writing by mutual agreement.

Signature(s):

For the considerations and purposes set forth herein, I hereby acknowledge by my dated signature below.

Owner Signature: Contractor Signature:

Print Name: Print Name:

Date: Date: