RIGHT OF ENTRY AND RELEASE FOR LEAD SERVICE LINE REPLACEMENT

The City of Racine ("City") is initiating a program to replace lead service lines on your property. The service lines run from the water main to the inside of your home. The City requests that you, as the owner ("Owner") of your property ("Property Owner"), sign, complete, and return this document ("Right of Entry") to grant the City's Water Utility representatives ("City Representatives") a right of entry onto your property, which has the street address of (the "Property"), so the City may inspect Your Property for potential "Lead Service Line Replacement".

REASON FOR THE CITY'S REQUEST FOR A RIGHT OF ENTRY:

LEAD SERVICE LINE REPLACEMENT: The City's records indicate that the pipe from the City's water main to Your Property may be made of lead or galvanized iron/steel. A water service line that is made of lead, also known as a lead service line, can increase your risk of exposure to lead through drinking water and should be replaced if possible. The City is preparing to replace the full water service line that serves Your Property from the City's water main onto and in Your Property. This is referred to as "Lead Service Line Replacement."

The City Representatives will need access to the Property to perform an inspection and possible work associated with the Lead Service Line Replacement ("Work" The City Representatives will show you their respective identification prior to entering the Property.

If work is to be performed, it involves shutting off water service for an estimated four (4) hours, replacement of existing lead or galvanized iron/steel water service, installation of a new copper service from the street to the Property and into the basement to the existing water meter connection to the City water main and flushing the new service.

Before beginning any work, the City Representatives will notify you when they will be on the Property to perform the work. It is your responsibility to provide reasonable access and a working area for the City Representatives at the service line and water meter location as requested by the City Representatives. The City Representatives may continue to enter onto the Property until construction is completed and you and the City accept the work.

By signing and returning this Right of Entry, you grant the City and its City Representatives the right to enter the Property betweenbetween the hours of 7:00 a.m. through and 6:00 p.m. The right to enter the Property is for the following purposes:

Survey and take photographs and videos of the interior and exterior of the Property; and Potential replacement of your lead or galvanized iron/steel Service Line.

The City Representatives will suitably identify themselves prior to entering the Property.

LSLR RIGHT OF ENTRY AND RELEASE

PLEASE NOTE: You and the City agree and understand that Lead Service Line Replacement cannot begin until the City has on file your signed Right of Entry.

In consideration of the foregoing, you affirm that you have a property interest in the Property, by ownership or are otherwise authorized to grant to the City a Right of Entry to allow the City and City Representatives to enter the Property, to take photographs and videos of the interior and exterior of the Property in the area of the water service line before and after installation, to bring workers, material, equipment, and supplies onto Your Property and to perform the Lead Service Line Replacement on the Property.

Restoration to preconstruction conditions will not always be possible, and the extent of reconstruction will be discussed with you and agreed upon prior to beginning the work. At that time, you will be asked to sign a separate Property Owner's Agreement that lists the extent of work and restoration.

The City Representatives will connect the new copper service line to the existing plumbing at the entry point into the Property. The City is not responsible for any interior plumbing nor for compliance with the Wisconsin or Racine Plumbing Code requirements or other codes once the service line enters the Property. It is the property owner's responsibility to replace interior plumbing when and where necessary or required by the local regulations.

While the City will pay to replace the full water service line, this work does not change ownership or maintenance obligations from the existing requirements as defined in 98-64 of the City of Racine Municipal Code.

IN CONSIDERATION OF AND AS A CONDITION TO THE PERFORMANCE OF THE LEAD

SERVICE LINE REPLACEMENT AND METER INSTALLATION, YOU, THE UNDERSIGNED, HEREBY RELEASE AND FOREVER DISCHARGE THE CITY, CITY REPRESENTATIVES, ITS EMPLOYEES, AND LEGAL REPRESENTATIVES (COLLECTIVELY THE "CITY") FROM ALL LIABILITY INCLUDING BUT NOT LIMITED TO INJURY, DEATH, DAMAGE, OR LOSS TO YOUR PROPERTY, PERSONS, REAL PROPERTY, OR PERSONAL PROPERTY (COLLECTIVELY, "CLAIMS") IN CONNECTION WITH THE PERFORMANCE OF THE LEAD

Property Owner or Authorized Representative

Mailing Address (If different than property address)

LSLR RIGHT OF ENTRY AND RELEASE

Engineering Department Racine Water Utility 100 Hubbard Street Racine, WI 53402

Mid City Corporation 12930 W Custer Avenue Butler, WI 53007

Thomas.Johnson@cityofracine.org

**YOUR PRESENCE DURING WORK: Someone 18 years or older must be present during the work to provide access to the City Representatives in the area where your water service line enters Your Property up

LSLR RIGHT OF ENTRY AND RELEASE