Please provide name, address & phone number
Authorization and Waiver
The undersigned does hereby grant and request the City of Happy Valley and its Officers to
check upon the property listed above. The undersigned does hereby agree to hold harmless the
City of Happy Valley; its employees, and agents for any claim for personal injury, loss or damage
to property that may be suffered by the undersigned, through any action or lack thereof, by a
representative of the City of Happy Valley. Further, the undersigned understands and agrees
that this is a voluntary, free service and does not create a special duty upon the City, will be
provided only as time is available, and no guarantee is made nor assurance given against loss,
theft, or damage to premises. The undersigned does hereby agree to secure the premises when
leaving and take whatever security measures at his/her disposal to cooperate in preventing
crime, fire or other incidents from occurring. The undersigned has noted any conditions that
will assist the City staff during these checks and will notify the City of Happy Valley when he/she
returns.