Applicant InformationCustomer Name* First Last Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* FaxCustomer Contact* First Last Usage InformationLocation of Use*Specific AddressCross StreetsLocation Address* Street Address Address Line 2 City ZIP Code Cross Streets* Example: 6th and Massachusetts Purpose of Use*This is a general description of how the hydrant will be used (i.e. general construction or dust control)Duration of Use*Specific DateDate RangeApproximate Length of TimeDate of Usage* Start Date* End Date* Approximate Length of Time**DaysWeeksMonthsIs this a City Project?*NoYesProject Name*City Contact* First Last Hydrant Meter Size: 3-inch Deposit Per Meeter: $600 Communication Preference*EmailFax1st Class MailDeposits payments are not accepted on applications. A Hydrant Meter Rental agreement will be sent to you for signature and deposit payment upon approval of your Rental Application, and identification of an appropriate meter for your rental use.Hydrant Meter Rental Conditions*By making application, Customer agrees to comply with all rental conditions and other requirements of the City of Lawrence, Kansas. Hydrant meters rentals are subject to the following conditions: Hydrant meters are available for rent during each calendar year when access to large quantities of potable water from the City of Lawrence KS water distribution system is needed for construction purposes and there is no other readily available source. Hydrant meters are rented to applicants with the understanding that they are to be used for filling privately owned bulk water storage tanks from which water is distributed for the approved purpose as stated on the Hydrant Meter Rental Agreement. Hydrant meters are provided with Reverse Pressure Zone (RPZ) backflow assembly to protect the public water supply from contamination due to instances of back-pressure or back-siphonage. Renters must ensure that the filling mechanism for the bulk water tank is properly equipped with appropriate backflow prevention measures to minimize the potential for contamination of the public water supply system. Deposit must be paid in full prior to rental. Deposit applies to hydrant meter and any other equipment provided to CUSTOMER as part of rental such as backflow devices. CUSTOMER sends deposit and signed Rental Agreement to City of Lawrence KS, Attn: Finance, P.O. Box 708, Lawrence, Kansas 66044, payable to “City of Lawrence.” Finance/Utility Billing also has a service window in City Hall, 2nd floor, 6 East 6th Street, Lawrence KS. Finance will verify payment on the Agreement to serve as CUSTOMER receipt. Hydrant meters are provided by appointment scheduled with the Utilities’ representative at least one (1) day in advance of desired date. CUSTOMER must provide receipt of payment. CUSTOMER must make hydrant meter available for usage readings on a quarterly basis for billing purposes in coordination with the Utilities’ representative. CUSTOMER is charged a $15.00/day late fee for each calendar day after which the meter is not made available as requested. After 5 calendar days the meter may be considered missing property, the deposit may be subject to forfeiture and property loss may be reported to Lawrence KS Police Department. CUSTOMER pays all applicable billings for water usage and other charges in effect during rental period. A $25 administrative processing fee will be accessed upon return of the meter for all hydrant meter rentals other than City projects. Rentals with zero usage readings over the previous quarter are subject to recall. Rental renewals are conditioned upon meter inspection and verification of ongoing project needs. CUSTOMER bears all risk of loss or damage and is responsible for all replacement/repair costs. Such costs may be charged against the deposit and/or billed to CUSTOMER as needed. CUSTOMER must identify the location of use. Usage location must be within Lawrence KS city limits. Hydrant meter must be removed from hydrant by CUSTOMER at the end of each working day and kept in a secure place. Hydrant meter must not be left unattended at any time. Assignment or sublease of hydrant meter is prohibited. Utilities may take possession of rented equipment at any time to meet system needs. Violation of any rental condition is grounds for termination of the rental, immediate recall of the meter and/or retention of remaining deposit funds as liquidated damages. CUSTOMER is responsible for all outstanding charges. 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