Animania 2004 Insurance Policy

Aurora Entertainment Pty Ltd Animania - Insurance Policy [Last updated 08/06/2004]

INDEMNITY Artists, Clubs or Vendors (hereinafter refer to as “Stallholders”) agrees to indemnify and hold harmless Aurora Entertainment Pty Ltd, its officers, directors, staff and volunteers from any losses, damages, costs or expenses resulting from any third party claim or allegation (hereinafter referred to as “Claim”) arising out of or relating to public liability and insurance matters that arise whether intentional or unintentionally inflicted or caused by the Stallholders, including any Claim that arises. This obligation shall survive termination of this Agreement.

PUBLIC LIABILITY INSURANCE Do you, the Stallholder have current public liability insurance and will have during the period of the Convention? If NO, please proceed to “Declaration”. If YES, please fill in the sections below and proceed to “Declaration”. I (please print full name) ________________________________________ on behalf of (please print Stallholders official name) ___________________________________________________________ hereby state that we, the Stallholder currently have public liability insurance policy and will have the said cover effective during the period of the Convention. A copy of the insurance policy is attached / will be made available (please delete non-applicable phrase) for Aurora Entertainment Pty Ltd. We, the Stallholder’s declare that our insurance policy number is ___________with provider being ___________________________.

DECLARATION I (please print full name) ________________________________________ on behalf of (please print Stallholders official name) ___________________________________________________________ solemnly declare that the above details provided to be true and accurate. I understand the consequence (punishable to the full extent of the law) for making false and misleading statements and would be responsible or indemnify the Organiser, Aurora Entertainment Pty Ltd, its officers, directors, staff and volunteers for reliance on such statements. I have read, understood and agree fully with all of the above.

Signature: _____________________________________________Dated: _____________________

Witness’s Full Name: _______________________________________________________________ Witness’s Address: ________________________________________________________________ Witness’s Signature: ____________________________________Dated: _____________________

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