PROPERTY INFORMATION

OWNER INFORMATION

TERMS & CONDITIONS:

I have requested water service be restored to the service location listed on this form. I have been informed of the water service restoration policies by Merrimack Village District Water Works (MVD) as follows: It is the property owner(s) or tenant(s) responsibility to ensure that no damage occurs as a result of the established or restored service. I acknowledge that, as a condition of water service being restored, it is my responsibility to ensure that all indoor and outdoor plumbing fixtures and/or valves are in the “Off” position prior to restoration of service. I understand that MVD and its representatives are not and will not be responsible for fixtures or piping which discharge water through the property at any time after restoring service. Any water damaged caused by the restoration of water service is not the responsibility of the MVD or their representatives. Further, I shall indemnify and hold harmless MVD, its officers, agents and employees, from any and all claims, damages, losses, liabilities and expenses direct, indirect, or consequential, arising out of or alleged to have arisen out of or in consequence of the restoration of water service, including but not limited to damage from plumbing fixtures left in the “on” position, water leaks, proper and/or improper plumbing. This includes any new and/or ongoing construction or repairs of internal/external plumbing fixtures which may have been removed; it is the customer’s responsibility to have the valves corresponding to these fixtures operating/installed and in the “off” position. I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A LEGALLY BINDING RELEASE OF LIABILITY AND HOLD HARMLESS AND I SIGN IT OF MY OWN FREE WILL. I HEREBY ACKNOWLEDGE RECEIPT OF A COPY OF THIS AGREEMENT.