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14199jasper St NW • Ramsey, MN 55303 <br />Public Works Facility 763.433.9839 <br />www„cutyoframsey.com <br />1...11 d Ir.alnt ;""'tel.. .!P; ,;�;' :, , C:'ll <br />It <br />4 Pr Ont iCs 11"' Il' 'n cV 11 d:u 11"� <br />Company Name: <br />Address: <br />Email: <br />Phone: <br />.uo c::nl <br />Name: <br />Project Title: <br />Mobile Phone: <br />1114:^ta=:^Ir IluII <br />Meter ID #: Meter Size: <br />Beginning Reading: Ending Reading: <br />Gallons Used: Hydrant Wrench ❑ <br />Irrn s 3 Ind 4:::OIrnc:Niitiic: s <br />By signing below, I, the undersigned contractor, agree to abide by the terms of the Hydrant Meter Lease Agreement <br />and acknowledge receipt of a copy of this agreement. <br />A deposit of $800.00 is required at the time of rental. The deposit will be cashed and held by the City of Ramsey <br />until the meter is returned. If the meter or hydrant is damaged, the cost of repairs or replacement will be deducted <br />from the deposit. If the meter is lost or stolen, the deposit will not be refunded. <br />I further agree to hold harmless the City of Ramsey from any injury or damage to myself, my staff, my personal <br />property, customers' property, and/or equipment that may occur as a result of the use of the rented equipment <br />listed above. <br />Al u.,u'tlh 0 rii',:'t ii o In <br />Signature: Date: <br />Printed Name: <br />It is our mission to work together to .responsibly grow our community, and to provide quality, cost- ei c a.nd efftcientgove.rnment <br />services. <br />