FORM 110


AGREEMENT entered into between _________________ County, a political subdivision of the state of Idaho (hereinafter referred to as "ENTITY"), and ____________________________ (hereinafter referred to as "OWNER").  The parties agree as follows:

1.     USE OF FACILITIES.  OWNER hereby grants to ENTITY the right to use the facilities described on the attached Exhibit "A" to be used as a polling place at the election which will be held on ____________________, 20___.

2.            TERMS.  This Agreement is for the period from ________ a.m., ____________________, 20___, until ________ p.m., ____________________, 20____.

3.     USE FEE.  ENTITY agrees to pay to OWNER a Use Fee in the amount of $__________, for the use of the facilities for a polling place.

4.     USE OF FACILITIES.  ENTITY agrees that the facilities will be used as a polling place pursuant to Idaho Code 34-302 for the election to be held on the date described above.  Such use shall include time to prepare the facilities for use as a polling place and time to remove all voting booths and equipment following the close of the polls.  OWNER understands and agrees that the public shall be invited to the above-described facilities to vote on the designated election day.

5.            EQUIPMENT.  ENTITY shall have the responsibility to provide any equipment necessary for the public to vote at the described facility.

6.            INDEMNIFICATION.  ENTITY agrees to indemnify and hold OWNER harmless from any liability for any property damages or personal injury claim, of any description, arising out of the use of premises by ENTITY as a polling place which result from the negligence of ENTITY and its employees, officers and/or agents.  OWNER agrees to indemnify and hold ENTITY harmless from any liability which results from the negligence of OWNER.

7.            HOUSEKEEPING.  ENTITY agrees to keep the premises clean during the above-described period and to return the premises in a good and clean condition.

DATED this _____ day of ____________________, 20____.



(Governmental Entity)


Its __________________________________



Clerk of _____________________________

(County, City or other Governmental Entity)





    (Title or Office)


_____________________________________(Signature of Witness or Notary Public)

  Form and content approved by ____________________, as attorney for ____________________ (Governmental Entity).