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2. APPLICATION FOR PERMIT FOR TRAIN STATION USE
   Village of Riverside / 27 Riverside Road, Riverside, IL 60546 / 708-447-2700 / www.riverside.il.us
4. Rules & Regulations for Use of the Train Station

   Please read before completing this form.
6. Organization making request
7. Contact Person
9. Address
11. Phone
12. Email address
14. Briefly Describe the Event
16. Number of Anticipated Participants
17. Number of Riverside Residents Participating
19. Will there be an admission charge?

    1. Yes
    2. No
20. Amount
22. Date of Event
23. Start & End time of Event
25. Event will require use of (Please check all that apply)

    1. East Portico
    2. Train Station Interior Waiting Room
    3. West Portico
27. Organization/Individual acceptance and agreement to adhere to Village of Riverside regulations.
    I have received and read the regulations of the Village of Riverside as they pertain to the use of the train station and agree to those regulations.
29. It is understood that the total rental fee is: $___________________.
31. It is understood that a deposit of $______________ is required, returnable if no damages are incurred, and Train Station is left in the same condition as found and all rules and regulations are adhered to.
33. It is understood that the Organization/Individual is solely responsible for all damages to the Train Station, including any equipment or other personal property located within the Train Station.
35. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
37. Electronic Signature
38. Date
    Date
40. Waiver and Release: As a condition of approval to use the Train Station, a permittee shall sign an indemnification and hold harmless agreement provided by the Village. In certain situations where the event or gathering activities warrant, the Village Manager may require as a condition of use, that the permittee provide proof of comprehensive general liability insurance, and dram shop or host liquor liability insurance (with the Village of Riverside, President and Board of Trustees, appointed and elected officials, employees, agents, volunteers, engineers and attorneys named as additional insureds) for the event or gathering in amounts and terms that are acceptable to the Village Manager.
    
    To the fullest extent permitted by law, the undersigned hereby agrees to defend, indemnify and hold harmless the Village of Riverside, its officials, agents and employees, against injuries, deaths, loss, damages, claims, suits, liabilities, judgments, cost and expenses (including attorneys fees), which may in anywise accrue against the Village of Riverside, its officials, agents and employees, arising in whole or in part or in consequence of the undersigned's use of the Riverside Train Station or which may in anyway result therefore, except that arising out of the sole legal cause of the Village of Riverside, its officials, agents or employees. The undersigned shall, at its own expense, appear, defend and pay all charges of attorneys and all costs and other expense arising therefore or incurred in connections therewith, and, if any judgment shall be rendered against the Village of Riverside, its officials, agents and employees, in any such action, the undersigned shall, at its own expense satisfy and discharge the same.
    
    The invalidity or unenforceability of any of the provisions hereof shall not affect the validity or enforceability of the remainder of this Agreement.
42. Agreed this ________ day of ______________________, 20______.
44. Name of Organization/Individual
46. By:
48. Nothing set forth in this Agreement shall be deemed a waiver by the Village/City of any defenses or immunities relating to any person or entity or their property, that are or would be otherwise available to the Village/City or its Representatives under the provisions of the Illinois Local Government and Governmental Employees Tort Immunity Act, or that are otherwise available to local governments and their corporate authorities, officers, employees, agents and volunteers under the common law of the State of Illinois or the United States of America.
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