Fillable Printable Hold Harmless Agreement Form
Fillable Printable Hold Harmless Agreement Form
Hold Harmless Agreement Form
HOLD HARMLESS AGREEMENT FORM #2
AGREEMENT
THIS AGREEMENT, made and entered into this day of , 20
by and between,
(Hereinafter the “Owner”), the owner of certain real property, more particularly described
as
as recorded in Deed Book at Page , and the Board of Supervisors of
Fairfax County, Virginia (hereinafter the “County”),
Witnesseth that:
WHEREAS, part of the above-described property of the Owner crosses the 100 year flood plain
as designated and adopted by the County; and
WHEREAS, the County has advised and warned the Owner of the location and existence of the
flood plain; and
WHEREAS, the Owner nonetheless wishes and elects to build at its own risk within that flood
plain;
NOW, THEREFORE, in consideration of the mutual covenants herein contained and other good
and valuable consideration, the parties hereto agree as follows:
1.
� T
he County hereby permits the Owner to construct or cause to be constructed a hou
se
o
n the above-described property having access through that flood plain as shown on
Attachment A.
2.
� T
he Owner, its executors, administrators, assigns and any other successors-in-interes
t
sh
all indemnify and hold the County, its agents, and employees harmless for any and all
damages, accidents, casualties, injuries, costs, charges, liabilities, occurrences or claims
which might arise or be asserted against the County by reason of the construction,
existence, presence of flooding of the access to the described property or any
appurtenances thereto.
In the event a claim is asserted against the County or its agents or employees, the
County shall promptly notify the Owner, and the Owner or its successors-in-interest shall
defend such claim or suit at its own expense. If any judgment or claims are allowed
against the County or its agents or employees, the Owner or its successors-in-interest
shall pay all costs and expenses in connection therewith.
3.
� I
t is expressly understood and agreed that the maintenance of the access shall be solel
y
t
he responsibility of the Owner or its successors in interests.
4.
� T
his Agreement shall constitute a covenant real running with the land and shall b
e
r
ecorded amongst the land records of Fairfax County, Virginia.
Project # TAX MAP #
Updated Feb 2015 �
Page 1 of 2
I a Notary Public in and for the County and State aforesaid,
Whose commission expires on the of 20
do hereby certify that name(s) is/are signed to the
foregoing Agreement bearing date of the of 20
has acknowledged the same before me in my said County and State.
GIVEN UNDER M Y HAND this of 20
Notary Public
STATE OF: COUNTY OF:
I a Notary Public in and for the County and State aforesaid,
Whose commission expires on the of 20
do hereby certify that name(s) is/are signed to the
foregoing Agreement bearing date of the of 20
has acknowledged the same before me in my said County and State.
GIVEN UNDER M Y HAND this of 20
Notary Public
Project # TAX MAP #
Updated Feb 2015
Page 2 of 2
W
itnesses �
The following signatures and seals: �
OWNER and SEAL (Please print name and title): �
OWNER and SEAL (Please print name and title): �
F
AIRFAX COUNTY, VIRGINIA BOARD OF SUPERVISORS
By Director, Site Development and Inspections Division, Land Development Services
,
D
epartment of Public Works and Environmental Services
STATE OF: COUNTY OF:
