You will also be asked to sign this agreement.

RIGHT OF ENTRY/HOLD HARMLESS AGREEMENT
As a participant in the Poudre Canyon Fire Protection District Pre-Fire Program, I acknowledge and agree to the following:

RIGHT OF ENTRY: I certify that I am the owner or the owner’s authorized agent of the property described in the pre-fire report and that I have the legal authority to enter into this agreement. I grant freely and without coercion, the right of access and entry to my property to the Poudre Canyon Fire Protection District Pre-Fire Program, and its affiliated agents, at a mutually agreed upon date and time to develop a customized pre-fire report.

HOLD HARMLESS: I agree to hold harmless the Poudre Canyon Fire Protection District Pre-Fire Program, its elected and appointed officials, and its employees, agents, and representatives for damages of any type whatsoever, either to the property described in the assessment report and/or any improvements on, or a part of the property, or to persons situated thereon. I release, discharge, and waive any action, either legal or equitable, that might arise by reason of any action of the above entities while completing the pre-fire report.

DISCLOSURE OF HOMEOWNER INFORMATION: I understand that the Poudre Canyon Fire Protection District Pre-Fire Program and its affiliated agents will collect data regarding my property in order to prepare a customized pre-fire plan. With the exception of agencies and agents directly affiliated with the Poudre Canyon Fire Protection District Pre-Fire Program, including the 911 dispatch center, program administrators will not share identifiable data with third parties. I further understand that to the extent the data is public information, disclosure may be subject to the Colorado Open Records Act (C.R.S. 24-72-201 et seq.) and other legal requirements. I further acknowledge that the Poudre Canyon Fire Protection District Pre-Fire Program may disclose the name, address, and pre-fire report details to their 911 dispatch center.

DISCLAIMER: I have read and understand the following Disclaimer: Fire is a phenomenon of nature, and is therefore not fully predictable or controllable by human intervention. Property owners and their assigns are given no guarantee and shall have no expectation that any information contained in pre-fire reports will prevent or limit damage to property or life. No information on pre-fire reports constitutes binding legal advice, nor shall those personnel performing Pre-Fire Program Assessments be liable for any damages occurring as the result of the pre-fire assessment. Property owners and their assigns agree to release the Poudre Canyon Fire Protection District, their personnel, their Board and members, and all affiliates performing pre-fire assessments from any claims associated with the Poudre Canyon Fire Protection District Pre-Fire Program.

SIGNED: All owners/agents must sign the Right of Entry/Hold Harmless Waiver, either on this form or on the signature line of the pre-fire report.
Property Address:____________________________________________________
Printed Name:________________________________________________________
Signature:____________________________________________________________
Date:_________________________________________________________________
Initial if signing digitally on the signature line of the pre-fire report:________________________