Jumper Indemnification & Hold-Harmless Agreement

Applicant name

Your name

Confirmation number

Your confirmation number

Phone number

Your phone number

What park would you like to bring a jumper to?

Coyote Point Recreation Area (excluding Magic Mountain Playground Picnic Sites)

Flood Park (excluding Manzanita Picnic Area)

Junipero Serra Park (excluding Buckeye Picnic Area)

Quarry Park

San Pedro Valley Park (excluding Creekside Picnic Area)

Please fill in only one of the options below to indicate the Recreational Jumping Device Company you wish to use.

Enter a Pre-registered Recreational Jumping Device Company

I have entered into a contractual agreement with recreational jumping device company and said company fully meets County Parks Department standards. Said company has further provided proof of liability insurance in an amount no less than $1 Million dollars.

Which Pre-registered Recreational Jumping Device Company are you using?

Bay Area Fun Jumpers

Bay Area Jump

CAL Jumps

Comic Jumps

EB Party Rental Elvia’s Boutique

EJ Jumpers

Party with 630

Peninsula Party Rentals

-OR-

Enter a Non-registered Recreational Jumping Device Company

I have obtained liability insurance in an amount no less than $1 Million dollars and have named the County of San Mateo as additionally insured for this event.

Please enter the information for the Non-registered Recreational Jumping Device Company you are using.

Recreation jumping device company

Insurance company

Policy number

Please email or fax us a copy of your insurance documentation. Email: parksreservations@smcgov.org. Fax: (650) 599-1721.

Hold Harmless Agreement

Please sign.

The duty of permittee to indemnify and hold harmless, as set forth herein, shall include the duty to defend as set forth in Section 2778 of California Civil Code.

It is agreed the permittee, shall indemnify and hold harmless the County of San Mateo, its officers, agents and employees (County) from all claims, suits or actions of every kind and description brought for or on account of injuries to or death of any person or damage to property caused by, arising out of, or in any way connected with Permittee’s activities at the park under this Permit.

Further, it is specifically agreed that permittee (applicant) takes the property “as is” and shall indemnify and hold harmless the County, its officers, agents and employees, from all claims, suits or actions of every kind and description brought for or on account of injuries to, or death of, any person or damage to property caused by, arising out of or in any way connected with Permittee’s activities at the park under this Permit.

Signature

I Agree.

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