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8980 Jeffem0n Tr W, Inver Grove Heights. MN 55077 <br /> Telephone (612) 454-9215 Fax (612) 454-8345 SCHEDUL1NG/RESERVA]'iON FORM <br /> <br />~]us~omel-./'/~gency~ C,itv of IRamsey <br /> <br />[-Z.r_~n tO. r2 t PePson Name: <br /> <br />'t i t Ir.>: <br /> <br />F'hone: <br /> <br />Offi. ce tBi ]. ]. J ng) Ad~ress; <br /> <br />Collection Site Ad~reEs: <br /> <br />Collection Dav~.s) /Date(.s): (Spring) <br /> IFal i ) <br /> <br />Collec'l';ion Hour's: From: <br /> <br />Soecia] ] n st ~-uc t i o~ls/F(emarx: <br /> <br /> r <br /> <br />Appliances will .~.n~lude, butt not li. mited 'bo: refrigerator-s, freezer's, wasl~ers, <br />Orvers~ a:~rconditi~ners, dehumidifeps, stoves, trash compactors, dishwashers, <br />aarbaQe d:~.sposals,' water heaters, microwaves, furnaces, humidifiers. Appli- <br />ances will be in a square (non-compact:ed) conditior~, and not contain food. <br />debris, o1' o'tlner' i:~r'ei(]r'~ material. <br /> <br />J.R. 'S Appliance D~sposa. l~ inc. (Recycler) is solely responsible for' the safe <br />removal of all PCB;s. mercur'y~ CFC's~ appliance megal, s~ and other Inazardous <br />wastes, in accordance with Federal law and the law~ of the State o'f Minnesota. <br />The Recvcler shall~ secure an~ maintain all necessary PERMITS and APF:'ROVALS <br />necessary gu) process said appliances. The Recvcler mill also provide any <br />necessar, v CERTIFIC~TES OF INSURANCE to the Customer~ prior- to start of work. <br />INSURANCE sha].] remain in effect at all times and not be materially chanoed. <br /> <br />Customer' ~ha].l pay-to the F..'.ecycler an amount of Seven .~: no/1OO's dollars, <br />~Dlus an .q~8..O0 surfzhar~e for each air conditioner) , for each appliance accep- <br />zed by ~:lne Customer' and tendered to the Recycler. Any special clnarges will <br />be agreed ~zr.) by basin parties prior to acceptance by either par'ry. Customer <br />shall pay within 30 days of the invoice date. <br /> <br />The Recvcler shal. l-INDEMI',IIFY and HOLD the Custo. mer and its employees HARMLESS <br />from all claims: di~mands, and causes of action.of any I.::ind~ character~ includ- <br />ina ~zhe co~t of de~ense ther-eof, resulting from the acts~ omissions, of the <br />Recvc' ~',.'~ f the ~ ' a0ents employ~s and/of <br /> i...~ , o o ganization s respective officers, .. , __ , <br />the individuals reCezving benefit from the funds or items exchanged relatinO <br />~o the activities ~or',ducted under thls agreement. <br /> <br />~ccepted for Customer:: <br /> <br />Accepted 'for J.R. 'E~ Appliance: <br /> <br />its: <br /> <br />· Primed on Recycled Paper, <br /> <br /> <br />