SCHEDULE "A't

THE CORPORATION OF THE CITY OF PORT COQUITLAM

(the "City")
PERMISSION

Names
(the "Owner")

Address:

(the "Property")

oe “The, City requests permission to enter the Property for the following purposes:

WHEREAS the Owner is the registered owner in fee simple of the Property and the City
has requested that the Owner allow the City to enter the Property with men and
equipment for the abave~mentioned purposes;

NOW THEREFORE in consideration of the City being responsible for all costs and for
s restoring the Property in respect to any damage caused by the City entering the
Property.

1. The Owner grants to the City the right to enter on and under the Property for
the above-mentioned purposes and to do all acts which in the opinion of the City are
incidental to those purposes. .

2. This permission is binding upon the Owner and his respective successors and
assigns, and every reference in this Agreement to the Owner and the City includes
where the context so requires the officers, employees, agents, servants, successors
and assigns of each.

IN WITNESS WHEREOF having first read and fully understanding this Permission and
with the knowledge and understanding that the Permission constitutes my agreement to
allow the City to enter on the Property, I have hereunto set my hand on the day
first written above.

SIGNED by the Owner in the )
Municipality of Port Coquitlam)
in the Province of Sritish

Columbia in the presence of:

Name Signature of Owner

Address

Signature of Witness

Occupation

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