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jo�b <br />ADM <br />ariirkiit5VVVIZF <br />iR]T1 YIItN 14{ <br />Address: <br />Business Rance: <br />Attachment 1 <br />Ante Graffiti Program <br />Public Works Agency <br />Maintenance Division <br />220 S'outhDai:y Avemm Santa Ana, California 92702 <br />Teleplraae: (714),547-3339 Fix: (714) 647.7345 <br />CONSENT TO ENTER & RELEASE OF LIABILITY <br />TO THE 4LM OF SAY TA ANA. 7sD THE 6itd.FEM REMOVAL C0NfPA.l y ; <br />Effective date of audwrization: Front <br />. s�i�rr <br />i `tt <br />�, A ��s. <br />Santa Ann. CA <br />Authorization is effective froIn the dare Conielft Ip Enter is signed enrol permission is denied by written notification. <br />❑ The City of Santa {lira may use any ofits five specific colors of paint for tie removal of the gmffili. <br />The unders:gned owner of the property, or agent representing the property owner at the address noted above, hereby <br />conseists to earn, upon said property bypersomiel and egnfpsnen of the City of Smita Ana or its Contractor as is <br />necessary to remove, reduce, m obliterate the writing of graffiti on the: <br />Pleasecheck: ❑ Building ❑ Felice 11 Wall ❑ Olher improvement <br />by using vapor atemn, uaterlriastnag, panzting. muse of solvems. <br />l understand tint the cleaning may be in blocks or strips where the lettering appears mad that fire cleaned m processed <br />area pray not "hitch precisely the original saMace'but every effort will be made to hatch colors to the rennahader of the <br />above improvements, that die cleaning will not include the entire =face, but only block, patches or snaps thereof, and <br />fire Contractor and fhe City assume no reslmusibitity if colors do not precisely match; and that Conte residue of the <br />existing graffhi etay renlain. <br />I request and authorize the City of Santa Alta or its Contractor to enter and use said eguipnvnrt and nlatertals with my <br />frill knowlcdge of the above information. <br />F Hereby release tie City of Santa Ana and its Contractor. its officers, agents mad employees, of and from anylall <br />claims, demands, causes of action or obligations whatsoever nismg out of or reta.ting to entry on my property, and <br />incidemat damage to shmhbs and plains, tae cleaning operations hereirmbove described, and iYmal appearance of said <br />improvements. <br />Print Name. <br />signature: <br />Telephone: <br />Title: ❑ Owner ❑ Agent ❑ Manager <br />Date Signed: <br />Return signed form to: Public Works Agency— Maintenance MUM <br />Attn: Graffiti Abatement Carew Supersisor <br />224 South Daisy, Balding A <br />Santa Ana, CA 92702 <br />Art i _ -- <br />City of Santa Ana GRSC Services RFP Be �� Page 57 <br />