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             GRAFFITI FREE NYC PROGRAM
           - CONSENT TO ENTER AND RELEASE OF LIABILITY -
* - Required fields

  STEP 1: CONSENT
 
As a Property Owner or Authorized Representative of the Property Owner, I grant consent to the City to enter the property noted below for the purpose of removing graffiti. For the purpose of this Consent, “the City” means personnel and equipment of the City of New York, its agents and employees and/or a community organization designated by the City. The City may remove graffiti in the manner it deems appropriate, including but not limited to, by power-washing, painting or use of chemical solvents.<br/><br/> The City will, in good faith, attempt to remove the graffiti from the property. However, by signing below, I understand that: 1) the graffiti removal services shall be performed as deemed appropriate by the City; 2) the City does not in any way obligate itself to perform any graffiti removal services other than those deemed appropriate by the City; and 3) the City assumes no responsibility if the area cleaned or painted by the City does not match the remainder of the property, or if some residue of existing graffiti remains.<br/><br/> I indemnify and hold the City harmless from any liability for physical injury, death, or property damage arising from the performance of graffiti removal services on the property pursuant to this Consent, unless such liability arises entirely from actions or conduct of the City, its agents, employees, or independent contractors. This Consent shall be effective until terminated in writing by the Property Owner, or by the Authorized Representative of the Property Owner.
 
* I Agree


* Form filled out by(select one):
* Representative Name

Representative Phone

Representative Email
* Owner Name

Owner Phone

Owner Email

  STEP 2: PLEASE PROVIDE ADDRESS OF PROPERTY TO BE CLEANED
 
* Street#

* Street Name

* Borough

Example: 150 East 33rd Street Manhattan


Graffiti currently on property
No Graffiti currently on property
On a Roll-Down Gate? Yes No
Is the graffiti on ?

  STEP 3: PLEASE PROVIDE ON-SITE CONTACT INFORMATION
 
On-site Contact Name On-site Contact Phone On-site Contact Email Business Name (if applicable):

  STEP 4: CHOOSE CLEANING METHOD
 
* Cleaning Method:
Paint
Powerwash
Paint Color
Color Comment

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