Hold Harmless and Indemnification Agreement

The undersigned agrees to indemnify the BLAYNEY RANCH, including its owners, agents and employees (hereafter referred to as “Owner”) from and against any damages or loses of any nature whatsoever, including actions by third parties, caused by omissions of acts of the undersigned, his servants, agents or employees (hereafter referred to as “Undersigned”) unless such damages or loses are caused by the negligence or willful misconduct of Owner. Further, the Undersigned agrees to defend, indemnify and keep and hold the BLAYNEY RANCH, including its Owners, harmless from any and all costs, liabilities, damages or expenses (including but not limited to, the costs of any legal suits, fees or expenses) claimed by anyone by reason of injury to, or death of persons, or damages to, or destruction of property, including property of the Undersigned, arising out of the Undersigned's activities on BLAYNEY RANCH property unless such costs, liability, damage or expenses (including but not limited to, the costs of any legal suits, fees or expenses) claimed by anyone by reason of injury, death, damage, or destruction of property is caused by the negligence or willful misconduct of Owner.

Production Company

Authorized Rep.

Representative's Phone

Date Signed

By submitting this form the Production Company agrees to all terms and conditions within the Blayney Ranch Hold Harmless & Indemnification Agreement.