Agreement Relating to Identification of Utility Equipment and Other Equipment and Devices

Name*

First NameLast Name

Phone Number*

(###)###-####)

Email*

example@example.com

Address*

Street Address

Street Address 2

CityState

Zip Code

I, (We) {name}, am the owner or the person in charge of the real estate located at {address5}, and I(we) hereby agree that, prior to Randolph Communications commencing to perform work or services on my real estate, I (we) will meet with a representative of Randolph Communications for the purpose of locating and identifying any utility equipment, structures, or devices or any other equipment, structures, or devices in order to avoid Randolph Communications’ accidental damage to or destruction of any equipment, structures, or devices. I (we) further agree that in the event damage or destruction to any equipment, structures, or devices occurs to any equipment, structures, or devices which I (we) have failed to locate and/or identify and which were not otherwise clearly apparent, that I (we) will hold Randolph Communications, its employees, and agents harmless and free from liability for any damage and/or destruction it may cause in that event.

I (We) agree to (check one of the following):*

Schedule a meeting with a Randolph Communications representative so that I (we) can identify and locate any equipment, structures, or devices which Randolph Communications employees or agents should be made aware of before they commence performing work or services on my (our) premises.Waive the meeting with Randolph Communications’ representatives and my (our) opportunity to identify and locate any equipment, structures, or devices described above, and thereby hold Randolph Communications, its employees, and agents harmless and free of any liability resulting from damage or destruction to any equipment, structures, or devices which would not be apparent to a reasonable person.

Check any items that you believe exist on your property: (Select all that apply)*