Skip to content
Home
Information
News
Forms
New Service
Contact
Pay Online
Home
Information
News
Forms
New Service
Contact
Pay Online
New Service
First & Last Name
Phone Number
Email Address
Service Start Date
Service Address
City/State/ZIP
Billing Address Same As Service Address?
Yes
No
Please list different billing address here if applicable (including city/state/ZIP)
Type of Property?
Own
Rent (Please Attach Signed Rental Lease)
Commercial
Signed Rental Lease (If Renting)
Drivers License
Water Service Activation Waiver & Release of Liability
I, the undersigned, am the homeowner or other person with authority, associated with the referenced property and request that the City of Mt. Washington activate/turn on water and sewer (if applicable) service at said property.
I understand and agree to the following risks associated with activation: City personnel will access the meter, curb stop, valve, or other equipment to restore/activate service. This may involve entering the property, opening panels, or operating shut-off devices. Potential issues could include (but are not limited to), undetected leaks, faulty wiring, plumbing issues, or other hazardous conditions inside the property, damage to appliances, pipes, wiring, or other systems due to sudden restoration of service (e.g., water hammer, electrical surges, frozen pipes bursting), property damage, personal injury, or other losses that may occur as a result of service activation.
2. Waiver and Release: In consideration of the City agreeing to activate service, I hereby waive, release, and forever discharge the City, its officers, employees, agents, contractors, and affiliates from any and all liability, claims, demands, actions, causes of action, damages (including property damage, personal injury, or wrongful death), costs, expenses, or losses of any kind arising from or related to the activation of service at the property, whether caused by negligence or otherwise, to the fullest extent permitted by law.
3. Indemnification: I agree to indemnify, defend, and hold harmless the City from any claims, liabilities, or expenses (including reasonable attorney fees) brought by third parties arising from or related to A) the activation of service, AND B) any claim that I did not have authority to enter into this agreement on behalf of any property owner or other entity with an interest in the property.
4. Assumption of Responsibility: I acknowledge that I am solely responsible for ensuring the property's internal systems (plumbing, electrical, gas lines, appliances, etc.) are in safe, working condition and ready for service activation, inspecting the property after activation for any issues and addressing them immediately, any damages or consequences resulting from pre-existing conditions or sudden service restoration.
5. No Guarantee of Service Quality or Safety: The Utility Company makes no representations or warranties regarding the condition of the property's internal systems or the safety/outcome of activation in my absence. Service is provided "as-is" to the point of delivery (meter or curb stop).
6. Revocation and Contact: I understand this authorization applies to all activation requests unless specified in writing. I will notify the City immediately in writing of any revocation, recission, or other withdrawal of my consent herein given.
7. Authority: I warrant, promise, and otherwise guarantee the City I have the authority to enter to this agreement on behalf of the property owner or any other person who has an interest in the property where the City is to provide services. I will indemnify and hold harmless the City from any claim that I did not have authority to execute this document by any entity so alleging
A security deposit of $200.00 is required for all accounts. A representative will reach out to you to collect the deposit and activate your account. How would you like to be contacted?
Cell
Email
Send
