APPLICATION FORM
I understand that THIS AGREEMENT IS NOT A LEASE
I understand that SAFE HAVEN SERVICES, LLC provides and pays for Utilities, furnishings, cleaning services and controls all keys to the premises and individual rooms
I understand that if I violate any rules of the licensee agreement, I may be considered a criminal trespasser and subject to arrest under State Penal Code, “Criminal Trespass”
I understand that rooming homes and innkeepers have broad authority to lien all property contained within the rented room.
I have read and understand the house rules provided to me
I understand that SAFE HAVEN SERVICES is NOT an assisted living facility or a nursing home and that LANDLORD & PROPERTY MANAGER DOES NOT provides assistance with activities of daily living, medicine management, bathing, brushing, shaving, cutting food, toileting, transportation, supervision outside of the residence, incontinence care, dressing, movement or other daily activities. Outsourced 3rd parties may stop by and provide these services to the “licensee” if the “licensee” has a relationship with this outsourced 3rd party however under no circumstances does Safe Haven Services, LLC provide these services directly.
I understand that any damages (other than normal wear) will be my financial responsibility.
I understand that rooming home operator will have a lien for unpaid rent against all of Licensee's nonexempt personal property that is in the Property and may seize such nonexempt property if Licensee fails to pay rent. Property Code governs the rights and obligations of the parties regarding Landlord's lien. Landlord may collect a charge for packing, removing, or storing property seized in addition to any other amounts Landlord is entitled to receive. Landlord may sell or dispose of any seized property in accordance with the provisions of the Property Code.
Anyone/ person who is a prevailing party in any legal proceeding brought under or related to the transaction described in this lease is entitled to recover a maximum of $500 attorney’s fees from the non-prevailing party.
The licensee, licensee’s representative and/or licensee’s legal representative agree that the Resident
or other specified party) will pay the basic rate as of the date of this agreement, which is $
per month or $__________ Per day.
Payment is due the 1st - 4th of each month depending on the date that the licensee receives their income.
II. PEST CONTROL AND INFESTATION
Bed bug addendum AND other infestation:
A. This addendum addresses situations related to bed bugs and other infestations (roaches, gnats etc.) which may be discovered infesting the dwelling or personal property in the dwelling. You (licensee) understand that we relied on your representations to us in this addendum.
B. INSPECTION. You agree that you:
Have inspected the dwelling prior to move-in and that you did not observe any evidence of bed bugs, roaches or other infestation
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C. INFESTATIONS. Prior to move-in, Licensee is certifying that they have examined the property for bed bugs, rodents and other bug infestations and did not observe any evidence of bed bugs or bed bug infestation or any other infestations including roaches, gnats etc. Therefore, in signing this addendum, Licensee certifies that if bed bugs or other bug infestations are later found in this unit, they will be deemed to have been introduced by the Licensee or one of the Licensee’s guests and that the LICENSEE (TENANT) WILL BE RESPONSIBLE FOR THE PEST TREATMENT, including all reasonable costs of cleaning and pest control treatments. If we must move other residents in order to treat adjoining or neighboring dwellings to your dwelling unit, you will be liable for payment of any lost rental income and other expenses incurred by us to relocate the residents. If you fail to pay us for any costs you are liable for, you will be in default, and we will have the right to terminate your right of occupancy and exercise all rights and remedies under the lease contract. You will be held directly liable and will deal directly with city officials including but not limited to section 8 inspectors, code compliance inspectors, police officers and any other party that deems the unit unclean and infested and will hold landlord/property manager harmless for bed bug, roach or other pest infestations.
D. COOPERATION. If we confirm the presence or infestation of bed bugs or other bugs or rodents, you must cooperate and coordinate with us and our pest control agents AT YOUR EXPENSE. You must follow all directions from us or our agents to clean and treat the dwelling that is infested. You must remove or destroy personal property that cannot be treated or cleaned as close as possible to the time the dwelling is treated. We have the right to require you to temporarily vacate the dwelling and remove all furniture, clothing and personal belongings in order for us to perform pest control AT YOUR EXPENSE. If you fail to cooperate with us, you will be in default and we will have the right to terminate your right of occupancy and exercise all rights and remedies under the lease contract. YOU ALSO AGREE TO ALLOW US TO EXTERMINATE THESE PESTS IMMEDIATELY UPON DETERMINATION THAT INFESTATION HAS OCURRED AND THAT YOU WILL REIMBURSE US FOR THIS EXTERMINATION.
- (Initial on line to left to certify the above paragraphs regarding pest control and infestation)
III. RESPONSIBILITIES OF LICENSEE, LICENSEE’S REPRESENTATIVE AND/OR LEGAL REPRESENTATIVE
A. You, your representative and/or legal representative, to the extent specified in this agreement, are responsible for the following:
1. Payment of the monthly fees
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2. Supply of personal clothing, activities of daily living, medicine, medicine management and other normal day-to-day items and tasks including but not limited to doctor visits, transportation, case management and social worker appointment meetings and scheduling’s.
IV. RESPONSIBILITIES OF LICENSEE, LICENSEE’S REPRESENTATIVE AND/OR LEGAL REPRESENTATIVE
A. You, your representative and/or legal representative, to the extent specified in this agreement, are responsible for the following:
1. Payment of the monthly fees
2. Supply of personal clothing, activities of daily living, medicine, medicine management and other normal day-to-day items and tasks including but not limited to doctor visits, transportation, case management and social worker appointment meetings and scheduling’s.
A. Licensee’s General Responsibilities: Licensee, at Licensee’s expense, must:
(1) Keep the Property clean
and sanitary;
(2) Promptly dispose of all garbage in appropriate receptacles;
(3) Take action to promptly eliminate any dangerous condition on the Property and/or room;
(4) Certify that they will perform all activities of daily living without the help or assistance of any of Safe Haven Services, LLC representative such as showering, taking medications, shaving, cutting and preparing food, toileting, transportation, dressing and any other activity performed on a daily basis.
(5) Certify that they have inspected their room and that the room is clean and well-maintained
- (Initial on line to left to certify the above paragraphs regarding pest control and infestation)
Each party hereby agrees to indemnify the other and the other’s employees, officers, directors, agents, family members
members and other related parties against all damages for bodily injury, including death, or damage to real or tangible personal property to the extent proximately caused in the course of performing this Agreement
It is my intention and I understand that I am binding myself, my heirs, agents, relatives, executors, administrators, assigns
and successors in interest, and understanding this, so hereby expressly release and discharge Safe Haven Services, LLC, its agents, owners, landlords, directors, executives, successors, administrators, assigns, affiliates and agents from any claims against Safe Haven Services, LLC created or arising out of, or in any way whatsoever related to the service or housing space provided. I hereby waive any claim for damages to persons or property, which may occur as the result of the use of the said premises. This waiver includes any negligent acts or omissions caused directly or in-directly by Safe Haven Services, LLC or the owners of said Property, including its officers, directors, or employees and understand that my claims, which may in the future arise out of personal injuries, accident, death, hurricanes, tornadoes, rain, fire or other acts of God to the residence, myself or damage to my property of any kind, are hereby waived.
I, and any and all family, relatives, attorneys, assignees and any others acting on my behalf hereby further
agree to indemnify and hold harmless Safe Haven Services, LLC its owners, representatives, agents or Owners of said Property, including its officers, directors, or employees, from any claims or damages, which may occur to the undersigned licensee or to any child, invitee, or guest of the undersigned.
It is understood and agreed that this agreement includes, but is not limited to, injuries occurring due to:
slipping and falling on any surfaces wet or dry, transportation to and from the premises or any other location, fires, sprained or broken limbs, cuts, abrasions, eye injuries, bacterial infections, death, fights, riots, stabbings, tornados, hurricanes, floods, hail storms, acts of terrorism and any other acts of God, accidents or injuries on the property or off the property.
Each party agrees to indemnify and hold harmless the other party and its employees, members, land-lord,
successors, attorneys, family members, agents and assigns, from any claims, liabilities, losses, damages, and expenses asserted against the other party and arising out of the indemnifying party’s negligence, willful misconduct, and negligent performance of, or failure to perform, any of its duties or obligations under this Agreement. The provisions of this indemnification are solely for the benefit of the parties hereto and not intended to create or grant any rights, contractual or otherwise, to another person or entity.
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