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Attachment 5 RIGHT OF ENTRY PERMIT AND AGREEMENT Property Address/Description Name(Owner or Tenant) County: INDIAN RIVER Telephone Number State: FLORIDA Zip: Date: Right of Entry I certify that I am the owner,or an owner's authorized agent,of the property described above. I grant,freely and without coercion,the right of access and entry to said property to Indian River County, its agents,contractors, subcontractors,for the purpose of demolishing, removing andlor clearing any or all disaster generated debris of whatever nature from the above described property, Hold Harmless I understand that this permit is not an obligation upon the government to perform debris removal. I agree to indemnify and hold harmless the United States Government,the Federal Emergency Management Agency(FEMA),the State of Florida, Indian River County,and any of their agencies, agents,contractors, and subcontractors,for damages of any type whatsoever,either to the above-described 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 removing disaster-generated debris from the property. I will mark any sewer lines, septic tanks,water lines, and utilities located on the described property. I (have have not )(will will not ) received any compensation for debris removal from any other source including Small Business Administration(SBA), National Resource Conservation Service (NR S), private insurance, individual and family grant program or any other public assistance program. I will report for this property any insurance settlements to me or my family for debris removal that has been performed at government expense. For the considerations and purposes set forth herein, I hereby acknowledge this agreement by my dated signature below. Signed this day of 12010. (Owner or Owners—All must sign) (Witness) Print Name Print Name Signature Signature (Witness) Print Name Print Name Signature Signature Notary Signature Stamp Indian River County Comprehensive Emergency Management Plan Annex IA- Page 32