City of West Lake Hills Grinder Authorization

The City of West Lake Hills

GRINDER PUMP REPAIR - AUTHORIZATION AND AGREEMENT TO PAY
Date*

MonthDayYear
Date
Customer Name*

First NameLast Name
Service Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Customer Authorization

By initialing this section, I understand and agree to allow employees, agents, contractors, and subcontractors of Crossroads Utility Services, LLC and/or the City onto and/or within my property or residence to investigate, troubleshoot and repair the grinder pump wastewater system for my property.
Initials*
Customer Responsibility

By initialing this section, I understand and agree to the following:

1.       Any damage incurred to my private property, cleanup costs, or customer health/safety matters due to my failure to cease water usage or prevent a sewage overflow within my private property in the event of a grinder system failure or suspected failure will be my responsibility to correct/repair. All costs associated with damage caused by my willful, intentional or unwilful actions will be my responsibility to pay.

2.       I am responsible for taking immediate and emergency measures to prevent the backup of wastewater on any private property by reducing/eliminate water usage and/or relieving the sewer system. I agree to cease all water usage until Crossroads Utility Services, LLC, its agents, employees, contractors, and/or subcontractors notify me that the system is repaired.

3.       I have relieved the grinder system to prevent an unauthorized discharge of wastewater on an ongoing basis into the home or onto private property while Crossroads, its agents, employees, contractors or subcontractors investigates and/or repairs the system.

4.       I have removed any private cleanout caps or pressure relief valves or ports on the grinder wastewater system until the system can be fully repaired.
Initials*
Fees

By initialing this Section, I understand and agree to the following:

I authorize the City's general management company, Crossroads Utility Services or its agents, employees, contractors, and/or subcontractors, to proceed to make the repairs.

I understand that the City has negotiated a contract with Crossroads Utility Service concerning the prices of the repair and the final cost to me will be as determined under the terms of that contract.

I understand that this authorization supersedes any verbally guarantees, commitments, instructions, and/or offers by Crossroads employees, agents, contractors and subcontractors.
Initials*
By signing the below, I agree to the terms and conditions as presented.
Customer Signature*

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The City of West Lake Hills