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<br /> <br />FOR OFFICE USE ONLY: <br />Employee Initials <br />Deposit Amount Paid: <br />Receipt#: <br />Deposit Receipt #: <br />Account #: <br />Service Order #(if any) <br /> <br />FIRE HYDRANT METERRENTAL APPLICATION <br />Applicant agreestopay a depositof$1,500.00for a firehydrantmeter to besetbytheCityattherequestedaddress.An <br />initial setup fee of $25.00 will be required at each location. Readingswill be obtained monthly by a meter technician.The <br />water usage rates will be charged at the commercial rate for a 3meter as outlined in Exhibit A of the Citys Code of <br />”’ <br />Ordinances. A daily fee of $15 per day will be charged monthly in addition to the monthly consumption billed. Incase <br />Waterservice will not <br />a meterisreportedaslostorstolen,the deposit of $1,500 will be forfeited toreplacesuchmeter. <br />beprovideduntilthisfeehasbeenpaid. <br />Date of Application:/ / <br />ContractorInformation <br />ContractorName: <br />FederalTaxpayerID: <br />Billing Address:StreetAddress: <br />City:State:ZipCode: <br />ServiceAddress/Installation Location <br />(ifnostreetaddressisassigned please providenameofsubdivision and/ornamesofnearest <br />: <br />streetintersection(s)) <br />Authorized Representative/Contact Person: <br />Title of Authorized Representative:Mobile Phone #: <br />Office Phone #:Fax #: <br />E-mail Address: <br />Purpose of fire hydrant usage: <br />Estimateperiod oftimeused: <br />Meter#:Beginning Read: <br />IfthisisforaCityofLa Portejob,pleasefilloutthefollowing: <br />Cityof La Porte Ordinance # or CIP#: <br />Cityof La Porte Contact Name/Title: <br />Bysigningbelow,thecontractorunderstandsthatthemeterremainsthepropertyofthecity. The contractor <br />understands that the meters are not to be moved from one location to another without authorization from City <br />personnel. A $25.00 moving fee will be required to relocate the meter to a new site. Thecontractorisliablefor <br />thelossoranydamagesustainedtothemeter, valve orconnectionsduringitsperiodofuse. <br /> <br />SignatureofAuthorizedRepresentativeDate <br /> <br /> <br /> <br />