HomeMy WebLinkAboutContract 48176 CITY SECRETARY
UUNIRACT NO.:E22Le
LICENSE AGREEMENT FOR USE OF CITY PROPERTY
FOR PRODUCTION OF PHOTOGRAPHS AND RECORDINGS
This License Agreement("License")for use of City property is made and entered into by and between the
City of Fort Worth,a Texas home-rule municipal corporation("Licensor"),and Chuck Holton,serving as an on call
producer for The Christian Broadcasting Network,Inc.("Licensee").
RECITALS
WHEREAS,Licensee has requested the use of the property described in the attached Exhibit"A",owned
by the Licensor and known as Fort Worth Police Bait Cars,collectively Fort Worth,Texas('Property");and
WHEREAS,Licensor desires to license to Licensee and Licensee desires to license from Licensor the
Property for the purpose of production of two,4 minute news features to be aired on CBN News and the 700
Club, involving the Fort Worth Police Department's use of technology through the Bait Car program to
apprehend car thieves.
NOW, THEREFORE, in consideration of the mutual covenants, promises and obligations contained
herein,the parties agree as follows:
1. PROPERTY LICENSED. Licensor hereby grants unto Licensee a license to enter upon and use the
Property as outlined in the attached Exhibit A. Licensor will provide Licensee full access to the Property during
the Term, as defined herein,during such times as specified in Exhibit A.
2. TERM OF LICENSE. The Term ofthis License shall be for 08/22/2016("Effective Date")and expire on
08/25/2016("Term"),regardless of any conflict in term included in Exhibit A.
3. FEE. Licensee shall pay to Licensor the sum of$0 as consideration for the full Term of the License,on or
before the effective date,and prior to Licensee's entry onto the Property.
4. PROPERTY CONDITION. Licensee hereby acknowledges that(a)it accepts the Property in its present
condition,and(b)Licensor has made no representations to Licensee regarding the safeness thereof or suitability for
any particular purposes. Licensee agrees that it will not install any type device on the Property during the Term of
this License. Licensor shall reserve the right to remove any device(s)installed in violation ofthis section at any time
during the Term of this License,or subsequent to its termination by either party.
5. USE OF PROPERTY.
5.1. Licensee hereby agrees to use the Property strictly in accordance with the terms and conditions of
this License,solely for purposes outlined in Exhibit A.
5.2. Licensee understands and agrees that the Property is public property,and as such,Licensor cannot
agree to Licensee's exclusive use of the Property. To the extent reasonably practical, Licensee shall not prohibit
public use ofthe Property during the Term ofthis License. Licensee agrees to cooperate in good faith with Licensor
and those persons using other portions and areas of the Property.
5.3. Licensee hereby acknowledges and agrees that no alcoholic beverages shall be consumed or
possessed by License its agents, contractors, employees, patrons, performers or guests while in, on or about the
Property.
5.4. The Property shall not be used for the production of any still pictures,motion pictures,videotapes,
photographs,sound recordings and the like that would be considered to be obscene pursuant to state and/or federal
r®FFICiAL RECORD
CIVY SECRETARY
laws. The Property shall not be used in a manner that would portray the Licensor in a negative light, as deemed
solely in Licensor's discretion or that would be defamatory to Licensor. In the event Licensee uses the Property for
the purposes prohibited under this Section 5.8,this License will immediately terminate,and Licensor may avail itself
of any remedies allowed at law or in equity.
6. SAFETY OF PROPERTY.
In allowing the use of the Property by Licensee,Licensor retains and does not relinquish the right to issue
and enforce such rules,regulations and directives as it may deem necessary for the safe,orderly and commercially
sound operation of the Property. Licensor reserves the right to eject any objectionable person or persons fiom the
Property. Licensee,on behalf of itself, its agents and employees, hereby waives any rights and all claims for
damages against Licensor arising from such occurrences under this Section.
7. INSURANCE.
Licensee shall carry the following insurance coverage with a company that is licensed to do business in
Texas or otherwise approved by the Licensor:
7.1 Liability Insurance:
a. Commercial General Liability with a combined limit of not less than$1,000,000 per
occurrence;$2,000,000 aggregate and Umbrella Coverage in the amount of$4,000,000.
Umbrella policy shall contain a follow-form provision...
b. Professional Media Liability coverage with a limit of not less than$5,000,000 per
occurrence.
c. Any other insurance as reasonably requested by City.
7.2 General Insurance Requirements:
a. The above referenced liability policies shall name the"City of Fort Worth"as an additional insured
thereon, as its interests may appear. The term"City of Fort Worth" shall include its employees,
officers,officials,agents,and volunteers in respect to the contracted services.
b. Should any of the above reference policies be cancelled before the expiration date thereof,notice will
be delivered in accordance with the policy provisions.Notice shall be sent to the Risk Manager,City
of Fort Worth, 1000 Throckmorton, Fort Worth,Texas 76102,with copies to the City Attorney at the
same address.
7.3. Licensor may terminate this License immediately upon the failure ofthe Licensee to provide acceptable
documentation of insurance as required by this License.
8. RIGHTS OF LICENSOR.
8.1. Licensor hereby reserves the right to take any action it considers necessary, including immediate
termination ofthis License,to prevent Licensee from performing any action which,in the opinion of Licensor,would
limit the usefulness of the Property or interfere with any third-party's use of the Property.
8.2. Licensor retains the right to cause the interruption of any use of the Property in the interest of public
safety,and to likewise cause the immediate termination of this License when,in the sole judgment of Licensor,such
act is necessary in the interests of public safety.
LICENSE AGREEMENT FOR USE OF CITY PROPERTY FOR
PRODUCTION OF PHOTOGRAPHS AND RECORDINGS PAGE 2 of 8
9. INDEPENDENT CONTRACTOR. It is expressly understood and agreed that Licensee shall operate as
an independent contractor as to all rights and privileges granted herein, and not as an agent, representative or
employee of Licensor. Licensee shall have the exclusive right to control the details of its operations and activities
on the Property and shall be solely responsible for the acts and omissions of its officers,agents,servants,employees,
contractors,subcontractors,patrons,licensees and invitees. Licensee acknowledges that the doctrine of respondeat
superior shall not apply as between Licensor and Licensee, its officers, agents, employees, contractors and
subcontractors. Licensee further agrees that nothing herein shall be construed as the creation of a partnership or joint
enterprise between Licensor and Licensee.
10. INDEMNIFICATION AND ASSUMPTION OF RISK.
10.1. LICENSEE HEREBY ASSUMES ALL LIABILITY AND RESPONSIBILITY FOR
PROPERTY LOSS, PROPERTY DAMAGE AND/OR BODILY INJURY OF ANY KIND, INCLUDING
DEATH, TO ANY AND ALL PERSONS, OF ANY KIND OR CHARACTER, WHETHER REAL OR
ASSERTED,ARISING OUT OF OR IN CONNECTION WITH ITS USE OF OR OPERATIONS ON THE
PROPERTY DURING THE TERM,REGARDLESS OF THE CAUSE.
DURING THE TERM OF THE LICENSE, LICENSEE COVENANTS AND AGREES TO,AND
DOES HEREBY, INDEMNIFY, HOLD HARMLESS AND DEFEND LICENSOR, ITS OFFICERS,
AGENTS, SERVANTS AND EMPLOYEES, FROM AND AGAINST ANY AND ALL CLAIMS OR
LAWSUITS FOR EITHER PROPERTY DAMAGE OR LOSS AND/OR BODILY INJURY,INCLUDING
DEATH, TO ANY AND ALL PERSONS, OF ANY KIND OR CHARACTER, WHETHER REAL OR
ASSERTED,ARISING OUT OF OR IN CONNECTION WITH THE USE OR OCCUPANCY OF THE
PROPERTY,REGARDLESS OF THE CAUSE.
LICENSEE ASSUMES ALL RESPONSIBILITY AND AGREES TO PAY LICENSOR FOR ANY
AND ALL BODILY INJURIES OR DAMAGES TO THE PROPERTY,WHICH ARISE OUT OF OR IN
CONNECTION WITH ANY AND ALL ACTS OR OMISSIONS OF LICENSEE, ITS OFFICERS,
AGENTS, EMPLOYEES, CONTRACTORS, SUBCONTRACTORS, LICENSEES OR INVITEES,
REGARDLESS OF THE CAUSE.
10.2. Licensee,in using the Property,whether such equipment is specifically described or not,does
so at its own risk. Licensor shall not be liable for any damages to property or damages arising from bodily
injuries sustained by Licensee or any of its agents, contractors, employees, patrons, licensees, invitees,
performers or guests, in, on or about the Property, or of any other portion of the Property, including
buildings,parking area walkways of the Property,even if such damage or injury is caused by the Licensor's
negligence. Licensee assumes full responsibility for any property damage or bodily injury which may occur
to Licensee,its agents,contractors,employees,patrons,licensees,invitees,performers or guests in,on or about
the Property,even if such damage or injury is caused by the Licensor's negligence.
10.3. Licensee acknowledges that Licensor lacks legal authority to grant permission for the use of the
names or likenesses of individuals who might appear in the Licensee's project. Licensee shall be solely and
exclusively responsible and liable with respect to obtaining any filming and photography releases required with
respect to persons and third-party property located on, in, or around the Property. At a minimum, Licensee shall
provide and post signage in the immediate vicinity of the Property notifying members of the public that
photographing and/or videotaping is being conducted. LICENSEE AGREES TO RELEASE, INDEMNIFY,
AND HOLD HARMLESS THE CITY FROM AND AGAINST ANY THIRD-PARTY CLAIM RELATING
TO THE UNAUTHORIZED USE,FILMING,TAPING,RECORDING,OR PHOTOGRAPHING OF ANY
INDIVIDUAL OR THIRD-PARTY PROPERTY.
10.4. IT IS FURTHER AGREED THAT LICENSEE SHALL RELEASE, DEFEND,
INDEMNIFY,AND HOLD HARMLESS LICENSOR FROM AND AGAINST ANY AND ALL CLAIMS,
LICENSE AGREEMENT FOR USE OF CITY PROPERTY FOR
PRODUCTION OF PHOTOGRAPHS AND RECORDINGS PAGE 3 of 8
LOSSES, DAMAGES, ACTIONS, OR EXPENSES OF EVERY TYPE AND DESCRIPTION,
INCLUDING, BUT NOT LIMITED TO, ATTORNEY'S FEES, TO WHICH LICENSOR MAY BE
SUBJECTED ARISING OUT OF OR RELATED TO LICENSEE'S USE OF ANY THIRD-PARTY
INTELLECTUAL PROPERTY BY REASON OF AN ALLEGED OR ACTUAL INTELLECTUAL
PROPERTY VIOLATION. LICENSOR EXPRESSLY ASSUMES NO OBLIGATION TO REVIEW OR
OBTAIN APPROPRIATE LICENSING, AND ALL SUCH LICENSING SHALL BE THE EXCLUSIVE
OBLIGATION OF LICENSEE.
11. TERMINATION.
11.1. Abandonment or Non-Use of the Property. If Licensee fails to use the Property pursuant to this
License on the day authorized if a single day Term or within one(1)day of the start of the Term for a multiple day
Term, Licensor may consider this License abandoned for non-use of the Property and immediately terminate this
License.
11.2. Convenience. Either Licensor or Licensee may terminate this License at any time and for any
reason by providing the other party with written notice of termination.
12. NOTICES. Notices required pursuant to the provisions of this License shall be conclusively determined
to have been delivered when(i)hand-delivered to the other party,its agents,employees,servants or representatives,
or(ii)sent via certified mail and deposited in the United States Mail,postage prepaid,addressed as follows:
To LICENSOR:
City of Fort Worth
Fort Worth Police Department
Attn: Chief of Police
505 W.Felix Street
Fort Worth,TX 76115
With a copy to:
City of Fort Worth
City Attorney's Office
1000 Throckmorton
Fort Worth,TX 76102
To LICENSEE:
Company Name:
Attn: L i v-e
Address: �
City: —r %,w rte,State:i,J Zip:2'�q 0
13. COMPLIANCE WITH LAWS ORDINANCES RULES AND REGULATIONS. Licensee
covenants and agrees that it shall not engage in any unlawful use of the Property. Licensee further agrees that it shall
not permit its officers, agents, servants, employees, contractors, subcontractors, patrons, licensees or invitees to
engage in any unlawful use of the Property, and Licensee immediately shall remove fi•om the Property any person
engaging in such unlawful activities. Unlawful use of the Property by Licensee itself shall constitute a breach,and
this License shall immediately terminate.
LICENSE AGREEMENT FOR USE OF CITY PROPERTY FOR
PRODUCTION OF PHOTOGRAPHS AND RECORDINGS PAGE 4 of 8
Licensee agrees to comply with all federal, state and local laws; all ordinances, rules and regulations of Licensor;
and all rules and regulations adopted by the Fort Worth City Council pertaining to the Property. If Licensor notifies
Licensee or any of its officers,agents,employees,contractors,subcontractors, licensees or invitees of any violation
of such laws,ordinances,rules or regulations,Licensee shall immediately desist from and correct the violation.
14. NON-DISCRIMINATION COVENANT. Licensee, for itself, its personal representatives, successors-
in-interest and assigns,as part of the consideration herein,agrees that no persons shall be excluded from participation
in or denied the benefits of Licensee's use of the Property on the basis of race, color, national origin, religion,
handicap, sex, sexual orientation, familial status, gender identity, gender expression, or transgender. IF ANY
CLAIM ARISES FROM AN ALLEGED VIOLATION OF THIS NON-DISCRIMINATION COVENANT
BY LICENSEE, ITS PERSONAL REPRESENTATIVES, SUCCESSORS-IN-INTEREST OR ASSIGNS,
LICENSEE AGREES TO INDEMNIFY LICENSOR AND HOLD LICENSOR HARMLESS.
15. GOVERNMENTAL POWERS. It is understood and agreed that by execution of this License,
Licensor does not waive or surrender any of its governmental powers.
16. NO WAIVER. The failure of Licensor to insist upon the performance of any term or provision of this
License or to exercise any right granted herein shall not constitute a waiver of Licensor's right to insist upon
appropriate performance or to assert any such right on any future occasion.
17. VENUE AND JURISDICTION. If any action,whether real or asserted,at law or in equity,arises on the
basis of any provision of this License or of Licensee's use of the Property, venue for such action shall lie in state
courts located in Tarrant County, Texas or the United States District Court for the Northern District of Texas, Fort
Worth Division. This License shall be construed in accordance with the laws of the State of Texas.
1s. ATTORNEYS'FEES. In the event there should be a breach or default under any provision of this License
and either party should retain attorneys or incur other expenses for the collection of rent, fees or charges, or the
enforcement of performance or observances of any covenant,obligation or agreement,Licensor and Licensee agree
that each party shall be responsible for its own attorneys'fees.
19. SEVERABILITY. If any provision of this License shall be held to be invalid,illegal or unenforceable,the
validity,legality and enforceability of the remaining provisions shall not in any way be affected or impaired.
20. FORCE MAJEURE. If either party is unable,either in whole or part,to fulfill its obligations under this
Agreement due to acts of God; strikes, lockouts, or other industrial disturbances; acts of public enemies; wars;
blockades; insurrections;riots;epidemics;public health crises;earthquakes; fires; floods; restraints or prohibitions
by any court,board,department,commission,or agency of the United States or of any state;declaration of a state of
disaster or emergency by the federal,state,county,or City government in accordance with applicable law;issuance
of an Imminent Threat Alert or Elevated Threat Alert by the United States Department of Homeland Security or any
equivalent alert system that may be instituted by any agency of the United States; any arrests and restraints; civil
disturbances; or explosions; or some other reason beyond the party's reasonable control (collectively, "Force
Majeure Event"), the obligations so affected by such Force Majeure Event will be suspended only during the
continuance of such Force Majeure Event. If a Force Majeure Event occurs,the Licensor may,in its sole discretion,
close or postpone the opening of its community centers,parks,or other Licensor-owned and operated properties and
facilities in the interest of public safety and operate them as the Licensor sees fit. LICENSEE HEREBY WAIVES
ANY CLAIMS IT MAY HAVE AGAINST THE LICENSOR FOR DAMAGES RESULTING FROM ANY
SUCH FORCE MAJEURE EVENT.
21. HEADINGS NOT CONTROLLING. Headings and titles used in this License are for reference purposes
only and shall not be deemed a part of this License.
22. ENTIRETY OF AGREEMENT. This written instrument, including any documents attached hereto or
incorporated herein by reference,contains the entire understanding and agreement between Licensor and Licensee,
LICENSE AGREEMENT FOR USE OF CITY PROPERTY FOR
PRODUCTION OF PHOTOGRAPHS AND RECORDINGS PAGE 5 of 8
its assigns, and successors in interest, as to the matters contained herein. Any prior or contemporaneous oral or
written agreement is hereby declared null and void to the extent in conflict with any provisions of this License.
23. RIGHT TO AUDIT. Licensee agrees that Licensor shall,until the expiration ofthree(3)years after final
payment under this License, have access to and the right to examine at reasonable times any directly pertinent
books, documents, papers and records of the Licensee involving transactions relating to this License at no
additional cost to the Licensor. Licensee agrees that the Licensor shall have access during normal working hours
to all necessary Licensee facilities and shall be provided adequate and appropriate work space in order to conduct
audits in compliance with the provisions of this section. Licensor shall give Licensee not less than ten(10)days
written notice of any intended audits. Licensee agrees to include in all its subcontractor agreements a provision to
the same effect as this Section 26 to the benefit of Licensor.
24. ASSIGNMENT. Licensee shall not assign any of its duties,obligations or rights under this License without
the prior written consent of the Licensor.
25. AMENDMENTS. No amendment of this License shall be binding upon a party hereto unless such
amendment is set forth in a written instrument,and duly executed by an authorized representative of each party.
26. REVIEW OF COUNSEL. The parties acknowledge that each party and its counsel have reviewed this
License and that the normal rules of construction to the effect that any ambiguities are to be resolved against the
drafting party shall not be employed in the interpretation of this License or exhibits hereto.
27. OWNERSHIP OF PRODUCTION•PHOTOGRAPHY OR VIDEO. If Licensee's use of the Property
is for the production of photography or video (including without limitation by means of motion picture, still or
videotape photography or motion pictures),all rights of every nature whatsoever in and to all still pictures,motion
pictures, videotapes, photographs and sound recordings made hereunder, shall be owned by Licensee and its
successors, assigns and licensees. In connection with Licensee's use of the Property and the production of
photography or video, Licensee may refer to the Property, or any part thereof, by any fictitious name and may
attribute any fictitious events as occurring on the Property. NOTWITHSTANDING THE FOREGOING,
LICENSOR SHALL HAVE FINAL APPROVAL RIGHTS OF ANY PHOTOGRAPHY OR VIDEO
PRODUCTION PRIOR TO SUCH PHOTOGRAPHY OR VIDEO BEING BROADCAST ON ANY
TELEVISION SHOW OR MOVIE, ONLINE INTERNET BROADCAST, OR ANY OTHER MEDIUM
WHICH WILL BE VIEWED BY THE PUBLIC. In the event Licensor grants its approval for broadcast,Licensor
irrevocably grants to Licensee and Licensee's successors and assigns the right,in perpetuity to duplicate and recreate
all or a portion of the Property and to use such duplicates and recreations in any media and/or manner now known
or hereafter devised in connection with the Licensee's use, including without limitation sequels and remakes,
merchandising,theme parks and studio tours,and in connection with publicity,promotion and/or advertising for any
or all of the foregoing;provided,however,the Property shall not be used for the production of any movie or scene
that would be considered to be obscene pursuant to state and federal laws or in a manner that would portray the
Licensor in a negative light,as determined in Licensor's sole and reasonable discretion. A violation of this section
by Licensee shall be considered a material breach of this Agreement.
28. COPYRIGHT AND IMAGE PROTECTION. Licensee, its designees, and assignees, may not use
Licensor's name or any marks or copyrights of Licensor or authorize such use on any internet website or on any
other online site,except as specifically approved by Licensor in writing. Licensee,its designees,and assignees,shall
not have the right or license to manufacture or cause the production of merchandise items bearing any of Licensor's
marks or copyrights.
[Remainder of the Page Intentionally Left Blank]
LICENSE AGREEMENT FOR USE OF CITY PROPERTY FOR
PRODUCTION OF PHOTOGRAPHS AND RECORDINGS PAGE 6 of 8
IN WITNESS WHEREOF,the parties hereto have executed this License in multiples,this
day of Q/
LICENSOR: LICENSEE:
CITY QF FORT WORTH COMPANY NAME: L Qe F'RE r+-.<'4"q
By: t By: 0 iA4r�; (4(A.."
Name: C i,r At.) L-lo W-.,,
Assistant City Maner Title: n w ^z
APPROVED AS)PUfORM AND LEGALITY:
By;L IVY6
47 /'V�
Name: pAs-s"_-)
Assistant City Attorney
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ATTEST: ®o°0000coo°o, -
By: .g
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Date
OFFICIAL RECORD
CITY SECRETARY
LICENSE AGREEMENT FOR USE OF CITY PROPERTY FOR 77,o WORM TX
PRODUCTION OF PHOTOGRAPHS AND RECORDINGS o
EXHIBIT"A"
PROPERTY
Licensor does hereby grant,subject to the terms and provisions hereof,to Licensee,permission to use the following
specified personal property listed below or real property, specifically the area(s), ingress and egress thereto via
corridors and public areas devoted to ingress and egress,(the"Property"),for the following use and no other purpose:
Date (s): From—8/22/2016
To—8/25/2016
Description of Permitted Use:Use of Fort Worth Police department bait cars for production of two,4 minute news
features to be aired on CBN News and the 700 Club,involving the Fort Worth Police Department's use of technology
through the Bait Car program to apprehend car thieves.
The following Bait Cars are authorized for use: 10-different baitcars that will be identified by the Fort Worth Police
Department for use under this Agreement.
Authorized Area /Location: The cars will be used all throughout the city of Fort Worth, with such route to be
determined by the Fort Worth Police Department.
LICENSE AGREEMENT FOR USE OF CITY PROPERTY FOR
PRODUCTION OF PHOTOGRAPHS AND RECORDINGS PAGE 8 of 8
FORT WORTH POLICE DEPARTMENT
WAIVER AND RELEASE
I, (name) ( G[/ lP� "�J �D 40 A , my heirs and assigns, do hereby FOREVER RELEASE
AND WAI - Il claims against tLh�_City o FortWorth, its officers, agents and employees, including but not limited to
(officer conducting the ride-in)_'�'r l��r for injuries or damages to me which may
arise from my participation as a ride-in with the Fort Worth Police Department on(date) Z 2 - Z /1u 2t f
This waiver and release is intended to release and forever discharge the City of Fort Worth, its of-ricers, agents, and
employees, including but not limited to(officer conducting the ride-in) ,;1 fie e` from any and all
claims, actions, causes of action, whether real or asserted, of every kind or character, arising out of such ride-in. I hereby
assume the risk of all dangerous conditions or occurrences that may be encountered during my ride-in and waive any and
all specific notice of the existence of such conditions or occurrences. I, and my heirs and assigns, hereby assume all
responsibility and liability for such injuries or damages, including death, and hereby covenant not to sue the entities and
parties named above for such injuries or damages. This release and indemnification shall be construed as expressly
including, but not limited to, alleged acts, omissions, negligence, misconduct, materials, training or the manner of
performance of services by the City of Fort Worth,its officers, agents,or employees,acting officially or otherwise.
I have read this Waiver and Release and fully understand its terms, provisions and conditions. I have not been
influenced to any extent whatsoever by any
/representations or statements not contained within this agreement.
Dated this -2-2• day of !/�``^ /' , 20-(L.
Parent/Guardian Signature(If4plicabk) Ride-In ' nature
,;� (36� t? '-7
Address Date of Birth Driver's License Number
City State Zip Code Address
`/('F-ffzj� W o
Telephone City State Zip Code
-7`Z
elephone
Command Authorization:
Approving Super sor•'s Signature
To Be Completed by Officer
Officer: L /' �e r" LD.: � 3
r rJ r
Shift: Vehicle
HBE/cp: REFERENCE GENERAL ORDERS/CODE OF CONDUCT MANUAL,General Orders 207.00. MVPD-53-3/94 Rev.5/05,
MAV Rev.10/06
FORT WORTH POLICE DEPARTMENT
WAIVER AND RELEASE
I, (name) my heirs and assigns, do hereby FOREVER RELEASE
AND WAIVE all claims against the dity of Fort Worth, its officers, agents and employees, including but not limited to
(officer conducting the ride-ir 1
-:5 • &ni-er for injuries or damages to me which may
arise from my participation as a ride-in with the Fort Worth Police Department on(date) d -
This waiver and release is intended to release and forever discharge th9.- +er
ty of Fort Worth, its offers, agents, and
employees, including but not limited to(officer conducting the ride-in) from any and all
claims, actions, causes of action, whether real or asserted, of every kind or character, arising out of such ride-in. I hereby
assume the risk of all dangerous conditions or occurrences that may be encountered during my ride-in and waive any and
all specific notice of the existence of such conditions or occurrences. I, and my heirs and assigns, hereby assume all
responsibility and liability for such injuries or damages, including death, and hereby covenant not to sue the entities and
parties named above for such injuries or damages. This release and indemnification shall be construed as expressly
including, but not limited to, alleged acts, omissions, negligence, misconduct, materials, training or the manner of
performance of services by the City of Fort Worth,its officers,agents,or employees,acting officially or otherwise.
I have read this Waiver and Release and fully understand its terms, provisions and conditions. I have not been
influenced to any extent whatsoever by any representations or statements not contained within this agreement.
Dated this zz day of , 20_1&_.
Parent/Guardian Signature(If applicable) Ri -n Signature
//-7115 3q�io3oQ
3 13)
Address Dae of Birt Driver's License Number
/05/t/ Fla 4'e.%
City State Zip Code Address
J;- I, te���� AD zr76V
Telephone City State Zip Code
of - u 8-- PWO
Telephone
Command Authorization:
Approvir Strperrisor's Signature
To Be Completed by Officer
�— 1
Officer: r 1 e r' I.D.: rbrj 3
Shift: Vehicle#: Dd eo 8
1.13 vcF REFERENCE GENERAL ORDERS/CODE OF CONDUCT MANUAL,General Orders 207.00. BVPD-53-3/94 Rev.5/05, i
Rev.10/06