VENDOR APPLICATION

 

PAMPLIN VOL FIRE & EMS ANNUAL POKER RUN

 

Date: ____________________________________________________

 

Name of Vendor: ___________________________________________

 

Trading As: _______________________________________________

 

Address: __________________________________________________

__________________________________________________________

 

Phone:_____________________________________________________

 

Email Address:______________________________________________

 

Approximate size of space needed: ______________________________

 

Type of Business: ____________________________________________

 

 

 

 

Vendor shall defend, indemnify, and hold the Pamplin Vol. Fire & EMS, and its officers, employees and agents, harmless from any and all loss, damage, claim for damage, liability, expense or cost, including attorneys’ fees which arise out of or is in any way connected with the Vendor’s temporary business exhibit/booth during the specified special event, not withstanding that the Pamplin Vol. Fire & EMS may have benefited from Vendor’s temporary exhibit/booth. This indemnification provision shall apply to any acts or omissions, willful misconduct or negligent misconduct, whether active or passive, on the part of Vendor or of Vendor’s employees, subcontractors or agents.

 

__________________________________

Owner Signature

 

Please sign and return to Pamplin Vol. Fire & EMS, C/O Debbie Baldwin, 2259 Piney Ridge Road, Pamplin, VA 23958.