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Release and Indemnification To the fullest extent permitted by law, ____________________________(name of entity), of ____________________________________(address), do hereby agree to assume all risk of injury, harm or damage to _____________(entity) or its property (including but not limited to all injuries caused by the negligence of the Portland Water District, its agents, officers or employees) arising during or in connection with use of a water fountain supplied by the Portland Water District for use in conjunction with _________________________________________(event) on ______________ (date). __________________(entity) does hereby release and agree to indemnify and hold harmless the Portland Water District, its agents, officers and employees from any and all liability, actions, claims for attorneys’ fees damages and claims of any kind and nature whatsoever, including but not limited to liability actions, damages and claims for property damage and/or bodily injury, caused by or arising out of the acts of the Portland Water District, its agents, officers or employees that may arise or occur in connection or as a result of the use of the water fountain by _________________________(entity) as described herein. Dated_____________ ___________________________________ Signature ___________________________________ Print Name and Title Address____________________________ ___________________________________ 225 Douglass Street | Portland, ME 04102 | [P] 207.774.5961 | [F] 207.523.5440 | www.pwd.org