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Utility Box Art Program <br />city of Santa Ana <br />i' RELEASE FROM LIABILITY <br />Personal Information (Please prim <br />Pull Name: Alberto Donjuan Ramon <br />Address: 1 S8C0 Parkconter tat Apt R75 <br />City: Tustin Stata;GA 4`p,92782 <br />Emorganoy Contact: neatnz pooluan (714) sos 8044 <br />Social Security/Individual Tex Payer IC (ITIN) #: 870-31. 02 <br />Waiver and Liability Release <br />I have read and understand the Artists Agreement and will adhere to the rules and regulations sat <br />forth wherein and act in a respectful manner while representing the City of Santa Ana. I assume <br />the responsibility of mental and physical fitness to participate In the assWnment, and agree to abide <br />by all rules and requirements of the program. I also understand that failure to abide by the above <br />may lead to my termination from the program. <br />I understand that I am not considered an employee of the City of Santa Ana for purposes of <br />Workers' Compensation, but that the City provides volunteer accident Insurance In excess of any <br />other medical Insurance I may have. I agree to comply with the Clly's pohcy regarding any Injuries 1 <br />Incur while under the C(ty's supervision, <br />agree to hold harmless the City of Santa Ana, its officers, amployoos and volunteers from and <br />agalnat any and ail liability arising out of or in any way connected with my participation In the <br />program. This release shall apply even though liability may arias out of negfigahoo or carelessness <br />on the part of those discharged Including their employees, agents and volunteers. <br />This waiver and liability release shall apply to myself, as well as any of my heirs, executors or <br />administrators. <br />I am of lawful age and legally competent to sign this agreement, I understand the Germs and have <br />signed this document as my own free act. <br />I have fully Informed myself of the contents of this release by reading It before I signed H. I realize <br />that by sfgning He document I am giving up legal fights to which f may be entitled. <br />on the thy -owned utility box assigned to me, <br />Alberto Oonluan Ramon <br />_._.Ww Printed Name <br />