Common Contracts
1 similar Hydrant Agreement contracts
CITY OF BLOOMFIELD - HYDRANT AGREEMENTHydrant Agreement • September 29th, 2020
Account No.: Deposit:$850.00 Setup Fee:$30.00 Corporate/Company Name: Date: Doing Business as: Mailing Address: City: State: Zip: Location of Hydrant: Hydrant No.: (MOC assigns) Business Ph: Fax Ph:: Cell Ph: Own: ❑ Rent ❑ E-Mail Address: Types of Ownership ❑ Individual/Sole Proprietorship ❑ Corporation ❑ Partnership ❑ General ❑ Limited ❑ Limited Liability Company (LLC) ❑ Non Profit Organization Exempt505(C) # ❑ Other (please list) Nature of Business/Project: City Project Driver’s License: State: Social Security No.: Other I.D.: Birthdate: Applicant is: Property Owner ❑ Tenant: ❑ Contractor: ❑ Other: List Owners, Partners, Corporate Officers, Association Members or Shareholders Name: Title: Social Security/CRS/FEIN (required) Address: City: State: Zip: Home Ph: Cell Ph: Email: Name: Title: Social Security/CRS/FEIN (required) Address: City: State: Zip: Home Ph: Cell Ph: Email: Do you currently have or have had Utility Service with the City of Bloomfield? Yes ❑ No ❑ Servi
