Common Contracts

CITY OF BLOOMFIELD HYDRANT AGREEMENT

Hydrant Agreement • January 31st, 2017

• Contract Type
  Hydrant Agreement
• Filed
  January 31st, 2017

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