Waiver for Damage to Private Streets
.' . ", . W AIYER OF ALL CLAIMS
FOR'DA,MAGE TO PRIVATE STREETS..
C:,";'. ',l:' ',":.' '_-'. "," ~,:-",:"", c..:" .
TheCit)"ofSalitlll, Karislis, isa Cityof'tfie rirstClass ~ithin the State Q(Kallsas(her.elnpfter refen;ed to as
"the City1'). . ,. .'. '.' . ,
. .R:iftrR u~ .'Ht1.A', p;~:einafter referred t,<Jas :"tlle Association") is a homeowners association
wlthm the corporate limits of the City of Salma, Kansas, organized as a Kansas L L ( .
The Association owns private streets, including curbs and gutters, constructed within common area owned
by the Association (the "privately owned streets"),
The City, upon request of the Association, provides a variety of City sl;lrvices to the Association and its
homeowner members, including, without limitation:
Trash pick up
Water and sanitary sewer utility installation, repair, and maintenance
Limb removal resulting from community-wide storm damage
Fall leaf collection
To deliver the requested City services often requires the operation of vehicles, machinery and equipment
upon the Association's privately owned streets. '
IlOlud
Name of Association:
((Nf,., ((UI\
It () A
By:
~:/t'.. t
(name)
(title)
VERIFICA nON
I, ~, having been duly sworn, on oath, veriiY that I am the duly elected
PIf"f!,JII ~i of ((ii/t..fl.,,') ltOA and that I have been duly authorized to execute the
above Waiver of all Claims for Damage to Private Streets on behalf of the association.
~O~mo-nU)eQlth ob \:-\OE!S<chusetts
~~~W-~y OF SA.U?>/E, 5S:
Signed and Sworn to before me on ~ _, 20rft. by
(printed name)
City, State & Zip Code
lP~x Van>e/?j .
~P~~P~&ked
' ot;:lry Public
.Q teA THERINI I. SHEtPH!ftD
tV~ Notary Public
Commonwealth of Massachusetts
My Commission Expires
'.I.-,.~ August IS, 2014
Association Address:
Street & Post Office Box