Fillable HYDRANTUSEPERMITCONTRACT s tateofGeorgiahereaftercalledthecontractor,andtheCityofAugustaapoliticalsubdivision o ftheStateofGeorgia,hereinafterreferredtoasAugustaUtilities. (City of Augusta)

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HYDRANTUSEPERMITCONTRACT s tateofGeorgiahereaftercalledthecontractor,andtheCityofAugustaapoliticalsubdivision o ftheStateofGeorgia,hereinafterreferredtoasAugustaUtilities. (City of Augusta)

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The HYDRANTUSEPERMITCONTRACT s tateofGeorgiahereaftercalledthecontractor,andtheCityofAugustaapoliticalsubdivision o ftheStateofGeorgia,hereinafterreferredtoasAugustaUtilities. (City of Augusta) form is 2 pages long and contains:

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
HYDRANTUSEPERMITCONTRACT
Thiscontractmadethis__________dayof__________________20_____,byandbetween
___________________________________,acorporationorganizedandexistingunderthelawsofthe
tateofGeorgiahereaftercalledthecontractor,andtheCityofAugustaapoliticalsubdivision
ftheStateofGeorgia,hereinafterreferredtoasAugustaUtilities.
s
o
1. Termsofagreement:
Thisagreementshallbecomeeffective______________________,andshallremainineffectuntil
________________________,unlesscancelledpreviouslybyeitherpartyorpermanentwater
service.
2. TheContractorassertsthatanon‐refundablepaymentintheamountof$_____________
asbeenmadetoAugustaUtilitiesinconsiderationofitsallowancetodrawpotablewaterh
fromCityofAugustaFirehydrantorfirehydrants.
OnlyannualcontractcustomerswillnotifyAugustaUtilities’Dispatcherpriortousage
fromAugusta,Ga.firehydrants,eachandeverytimethehydrantistobeoperated.During
peration,theAugustaUtilitiesHydrantUsePermitwillbedisplayedonthehydrantbeingo
used,alsoonthevehicleortanker.
ontractorwillcertifythattheirfieldstaffwillbetrainedintheproperoperationofaCityC
ofAugustaownedfirehydrant.
Contractorwillberesponsibleforanyandalldamagetoprivateorpublicpropertyasa
resultofoperatingAugustaGeorgiahydrantuseassemblyandforanynegligentdamageto
heassemblyitself.Additionallycontractorherebyacknowledgesreceiptofhydrantt
operatinginstructions.
ContractoragreestofollowtheapplicableportionsofAugusta,Georgia’sWaterRulesand
egulationsintheexecutionofthisAgreement.FailuretofollowtheserequirementscouldR
resultinpenaltiesforunauthorizedhydrantusage.
hepartyhereto,hascausedthisContracttobeexecutedonthedayandyearfirstabove
ri
T
w tten.
________Title:_____________________Date_______________
By:_________________
(CustomerName)
Print Form
HYDRANTUSEPERMITAPPLICATION
Movable
eunderstandingofrequirementslistedbelow.RequirementsofUse:________CustomerInitialsacknowledg
llfeesmust 
A

bepaidinadvanceandarenon‐refundable:
$1,500.00
HydrantUsePermitTag(Goodfor1
st
Year).
$750.00

HydrantUsePermitTagExtension(Requestfor2ndYear).
$125.00
FailuretoproperlydisplayPermit Tag/DecalonVehicle&Hydrant.
$1,000.00
FinewillbeappliedfordrawingwaterfromanAUDHydrantwithouttheuseofameteror
cewithHydrantUsePermitpolicies.complian
AdditionalInformation:
Customermustprovideproofofknowledgeandcompetencytooperatehydrant(s)properly;andmaybe
requiredtoattendCityofAugustasponsoredHydrantOperationTraining.Forbillingpurposescustomerwillbe
requiredtocallintheirmonthlyconsumptiontotheAUDMeteringDivisionbythe1
st
dayofthemonth.If
paymentisnotreceivedbytheindicatedduedate,a$25delinquentfeeandlatepenaltiesmaybeapplied,meter
mayalsobesubjecttoremoval.Customerwillbechargedforreplacementmeterorrepairsintheeventthatthe
meterisdamaged,stolenorlost.TheAUDMeteringDivisionmustbenotifiedat(706)821‐1857todiscontinue
serviceandpreventfurtherbilling.MaximumuseofHydrantPermitTagis2years.Meterswillbeissued
Monday‐Fridayduringnormalbusinesshoursbyappointmentonly.
Today’sDate____/_____/_________DesiredDateofService_____/_____/_________
Name
___________________________________________________________________________________
(Last) (First) (MiddleInitial)
Company_____________________________________________________SSN/FedTaxID#______________________________
PhysicalAddress___________________________________________________________________________________
(PleaseIncludeCityStateandZipCode)
BillingorMailingAddress__________________________________________________________________________
(PleaseIncludeCityStateandZipCode)
ContactNumber____________________________________________________________________________________
(Office )(Cell) (Pager)
CallCityofAugustaUtilitiesDe 8423060whenhydrantisoperatepartmentDispatcherat(706) d.
L
C
ocationofhydranttobeused__________________________________
ityofAugustaHydrantNumber_______________________________
__________________________________
Durationofuseindays:________
Howwillwaterbedistributed(Checkallthatapply.First2selectionsrequirefunctioning&approvedairga
ter
pseparation):
WaterTruck ToWaterTank AppliedDirectlyfromHydrantMe
Other(pleasedescribeindetail):____________________________________________________________________________
ate ent
in
Theundersignedapplicantacceptsresponsibilityforpaymentofallchargesforw rservicesprovidedbytheAugustaUtilitiesDepartm
ndagreestocomplywithallAUDregulationsgoverningsuchservicesasoutlined theFireHydrantUsePolicy.
ignature:______________________________________________________________________ Date:______________________________________________
a
S
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HYDRANTUSEPERMITCONTRACT s tateofGeorgiahereaftercalledthecontractor,andtheCityofAugustaapoliticalsubdivision o ftheStateofGeorgia,hereinafterreferredtoasAugustaUtilities. (City of Augusta)

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Completed 21 January 2021

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