GENERAL RELEASE OF LIABILITY AND INDEMNIFICATION AGREEMENT 1, ?ank 26139 in consideration for payment by the City of Chicago o?the sum of $2,500 plus reimbursement of my airfare to and from Chicago, car rental, and hotel expenseby the City of Chicago agree to provide my services in trapping and removing the alligator currently in the Humboldt Park Lagoon in the City of Chicago. In consideration of such sums, I release and hold harmless the City of Chicago and its current, former, or future of?cers, agents, employees, and volunteers as well as the Chicago Park District and its current, former, or future of?cers, agents, employees,and volunteers from any and all claims, damages, compensation, injuries, losses, costs, expenses, and liabilities, including but not limited to property damage,personal injury or death, as well as attorneys? fees and costs arising directly or indirectly out of my performance of such services, regardless of whether said claims result in whole or in part from the negligence of the City of Chicago, its current, former, or future of?cers, agents, and employees and volunteers, or the Chicago Park District, its current, former, or future of?cers, agents, and employees and volunteers. I further agree to defend and indemnify the City of Chicago and its current, former, or future of?cers, agents and employees, as well as the Chicago Park District and its current, former, or future of?cers, agents, employees, and volunteers from any and all claims of damages, compensation, injuries, losses, costs, expenses, and liabilitieswhich may be incurred by me or any third party arising directly or indirectly out of my performance of such services, regardless of whether such claims result in whole or in part from the negligence ofthe City of Chicago, its current, former, or future of?cers, agents, employees and volunteers, or the Chicago Park District, its current, former, or future of?cers, agents, and employees and volunteers. I understand and acknowledge that the services I have agreed to provide subjectme to risk of physical injury, drowning, and illness, including permanent disability and death. I hereby expressly agree that if any portion ofthis Agreement is found to be void, unenforceable, or invalid, the remaining portions of this Agreement will remain in full force and effect. I have completely read this Agreement and fully understand its terms. My signature below evidences my full, knowing, and voluntary acceptance of the terms of this Agreement. Print Name: an ?655 Signature/5% [a Date: ?4 4?3 Witness: A bnlcago A?lmal bare ana an rim: 2741 S. Western Ave. 3' a 1 Chicago, IL 60608 The Homeward Bound Animal Placement Program is a partnership with private agencies to place all adoptable animals. Partners visit our facility daily and take animals that have met the legal holding period. Some of these animals may not have been evaluated by our shelter or veterinary staff, but are available for transfer by any shelter partner that chooses to take them. OF PROGRAM GOALS REPTILES As a partner agency, we ask that you state your goal for the number of animals you will attempt to transfer annually: As many as are requested of us ORGANIZATIONIAGENCY INFORMATION Name of Organization: CHICAGO HERPETOLOGICAL SOCIETY 2430 CANNON DRIVE City: CHICAGO ILLINOIS Zip: 60614 Address: State: 312-409-4456 E?mail Address:_ . Phone: Fax: LICENSE INFORMATION (Please attach a cepy of your State Licence and/or 501c3 and City of Chicago Business License) State of Illinois License Number:_IRS City of Chicago License Number: certi?cate number 2257 20 935 745 CONTACT (Please complete for each person acting on behalf of the organization/agency. No more than 4 agents are allowed. Name: BOB BAVIRSHA AGENT OF CHS Namezw? JOHN ARCHERW Address;? Address; cerFax 773? .. Fax: Name. RICH CROWLEY ADOPTIONS Name. LINDA MALAWAY ADOPTION CHAIR Address: Address: w? ct? 708- 630 Fax: ml Ema": PRESIDENT Phone: Phone: Fax: TYPES OF ORGANIZATION List species, speci?c breed and/orifmixed breeds are accepted: WE TAKE REPTILES AND AMPHIBIANS ONLY THE FOUR STATES OF THE MIDWEST BUT A WORLDWIDE MEMBERSHIP Geographic area covered: . Number of years in operation: 40 Staff Members: 0 Volunteers: ABOUT 600 of housing fogr?z (check all that apply) Foster Homes Indoor Kennels Cl Outdoor Kennels XI Boarding at Vet Kennel/Cattery Other ANIMALS ARE KEPT IN PRIVATE HOMES 1W (check all that apply) 0 Breeder XI Rescue Foster XI Referral Other EDUCATION AND CONSERVATION Does your organization have an age requirement? CI Yes ix No If yes, please specify age limit: UNKNOWN List capacdy for: Mam Cats: Other: Are there circumstances under which you would deem an animal to be non-placeable with the general public? IX Yes Cl No If yes, is euthanasia an option at your organization? XI Yes CI No Does your organization have animal tracking technology? (Please explain) 0 Do you spay/neuter all animals before releasing to a new adoptive home? I3 Yes No ALL OF THEM If no, what animals do you release unsterilized? What is your adoption fee and what services do you provide for that fee? NONE BUT DONATIONS ARE ACCEPTED ANIMALS ARE ONLY GIVEN TO VETTED SOCIETY MEMBERS OR STATE APPROVED FACILITIES Veterinary ReferenchER?NON HILLS ANIMAL MUNDELEIN ANIMAL HOSP. Name of Clinic: STEVE BARTEN Name of Clinic: GERY HERRMANN Address: 1260 BUTTERFIELD ROAD Address: 650 MIDLOTHIAN DR City: VERNON HILLS IL Zip: 60023 CWMUNDELEIN State: IL Zip60060 Phone: 847?367-4939 Phone: 708?566-5750 Fax: c: Mama? Re HOUSE OF CHICAGO PARK ZOO Name of Clinic; BYRON DE LA NAVARRE Name ?Clinic: GAMBLE Addfess: 2752 LAWRENCE Av. Address: 2001 CLARK (my: CHICAGO State: IL Zip: 60625 cm: CHICAGO Slate: IL Zip: 60614 phone; 773-878-8002?; Phone: 31 2742-7722?: Animal Shelter References - (Please provide name of other that also place animals in your care) MIWAUKEE AREA DOMESTIC Name of Shelter: MADACC ANIMAL CONTROL Name ?Shaken WINNEBAGO COUNTY ANIMAL CONTROL Address: 3839 BURHAM ST Address: 4517 MAIN City: WIS m: 5321 5 City: ROCKFORD State: IL Zip: 51 103 Phone: 414-649?8640 Fax: Phone: 815-319-4100 Fax: Name of Name Of Shelter: ANIMAL WELFARE LEAGUE Address:_ONE NATURAL RESOURCE Address: 5224 5 WABASH State: IL Zip: 62702 City: CHICAGO State: Zip: 60637 217-785-8266 6: 773?667?0088 Fax: Fax: Phon Phone: Please be aware that all references will be checked and statistical information mav be requested on transferred animals. I attest that information in this document is true and accurate to the best of my knowledge. . JANUARYIOTH 2010 Authorized Signature: Date: - . BOB BAVIRSHA . AGENT FOR THE Pnnted Name. Title: A NAEGEWLOYEE - . THAT meme: AMICATIQ {a $722042 3% RECEIVED APPLICATDN: ?lo A STATE Lunar.- some ?13 CITY LICENSE mom grits . Duo .0. DATE (if/1W? ~4wlk. {43 Gel tificdte Numbm __22_57_ g. .memsw (53? 1135 m53?9 ??e?cMm Ww0/m/0?wzx CHICAGLQ. QC IETY mew/0013 30/0/ .320 ?fe ecg/gew?ez?p/g/g?grleem 33,0 . 15th Augus x/Q .69 m/az) ?eez-zc/ecJ/ ?fe GENERAL NOT F93 PRO FIT CORPORATION ACLW?zoe?/?mw M?x/Z/??o/Jiwa 0200 ?0322 (30020 M0 Were/ore, PA PO WELL u, Cee?ee?wm ??IJgrl/?nw} ?Ma?a/0M 0,0 0,1030% :3 2275033 13/0/00, ?eef/wee?en?/y eye/ewmc/eez/ekez?we Jim 1, M/q/eeu/ 00/0 000/ c/ 000/ WOJJ dry/0 Qumtw__ 0730/ o, 730/ ezw?ezaee/e/ 1/3 ??ea?ej?J?czz?e? x/?eyeree/Kaww?zer?wym? .. 94th. g? SECRETARY OF STATE xiv "35-5? Internal Revenue ServiCe Department of the Treasury District Director . Person to Contact: Chicago Herpetological Telephone Nunber: 1-800-424?1040 Society 312?455?1040 2001 North Clark Street Chicago. IL 60614 Refer Reply to: Date: January 17, 1990 RE: Chicago Herpetological Society This is in response to the letter dated January 17, 1990 regarding your siatus as an organization exampt from Federal income tax. Our records indicate that a ruling letter was issued in July, 1970, granting your organization an exemption from Federal income ta: under the provisions of Section 501(c)(3) of the Internal Revenue Code of 1954. Our records also indicate that your organization is not a private foundation but one that is described in Section of the Internal Revenue Code. Contributions made to you are deductible by donors in computing their taxable income in the manner and to the extent provided in Section 1?0 of the Internal Revenue Code. If your receipto each year are normally $25,000.00 or more, you are required to file Form 990, Return of Organizations Exempt from Income Tax by the fifteenth day of the fifth month after the end of your annual accounting period. You are not required to file Federal income tax returns unless you are Subject to the tax on unrelated business income under Section 511 of the Code. If you are subject to this tax, you must file an income tax return on Fw99onT. If any question arises with resPect to your status for Federal income tax purposes, you may use this letter as evidence of your exemption. Thin is an advisory letter. Sincerely yours, R. 8. wintrode, Jr. District Director 01/30/01 TUE 09:53 N0 57751.002