Owner Name. Home Phone Cell: Email: Address City, State ZIP Code Emergency Contact Name: Home Phone Cell: Email: Address City, State, ZIP Code OWNER’S Insurance Co. Agent Phone E-mail Boat Data (enter detailed information for the boat stored pursuant to this Agreement (the “Boat”)) Length Overall Beam Brand Model Year Name Hull No. Registration No. Inboard Engine Data Brand Model Gas Diesel Year # of Cylinders Storage (please check one) OWNER’s Trailer SMB Rental Trailer ($125 ea.) # Do you leave your engine seacock open ( ) or closed ( )? Lock combination WINTER STORAGE OPTIONS: Inside Storage (Minimum Charge 18 feet)1 $ INSIDE storage on a trailer ($35/ft. overall length; fee Includes physical storage only.) Note: Overall length will be rounded up to the next foot. Swim platforms, motors and pulpits, trailers etc. are included in the overall length measurement. (18ft, or $630.00 minimum charge) Select the Additional Services you wish SMB to Perform Service Engine $ (Includes winterize and summarize services. Does not include oil change.) $215 per inboard engine $290 per inboard engine with outdrive No engine service Change Oil/Filter (Includes environmental disposal charges.) $ $125 per engine Store Battery (ies) $ $25 per battery (Heated) Pressure Wash Bottom $ $25.00/ft. OVERALL LENGTH (painted bottom) $32.00/ft. OVERALL LENGTH (unpainted bottom (Extra scrubbing, where needed, will be billed on a time and materials basis.) Total Storage and Service Fees $ _ OWNER(S) REPRESENTS AND WARRANTS TO SMB THAT THE OWNER INFORMATION PROVIDED ABOVE TRUE AND CORRECT. THE OWNER HAS READ THE TERMS AND CONDITIONS THAT FOLLOW AND BY EXECUTING THIS AGREEMENT THE OWNER AGREES TO BE LEGALLY BOUND BY THIS AGREEMENT AND TO ENGAGE SMB TO PROVIDE THE SERVICES SET FORTH ABOVE. OWNER SIGNATURE: Date: OWNER NAME (Please print) SMB hereby accepts and agrees to this Agreement. SNAKE MOUNTAIN BOATWORKS, LLC By: Date: Xxxxxxx Xxxxxxx, a duly authorized agent 1 Boats arriving before October 1, or remaining at SMB after May 1 will be charged a monthly storage rate. Said rate will be 1/6 of the pre-determined winter storage fee, as determined by overall length.
Owner Name. Date: Address: Phone: Email: *a copy of the Owners Driver License, valid insurance (see paragraph 9) and current Boat State Registration must be on file Boat-year/make/model: Location: Motor-year/make/model: Key #: I authorize services up to a limit of (check one dollar amount): ❑ $250 ❑ $400 ❑ $550 ❑ $725 ❑ $1,000 ❑ $1,500 ❑ $2,500 ❑ $ ❑ Save parts, all parts will be discarded unless this box is checked. Service(s) requested/problem description: I hereby acknowledge receipt of a copy of this service agreement and that I have read the terms and conditions on the back of this document and agree that they shall be incorporated as part of this agreement. Signature Date
Owner Name. Date: Signature: About Mats Everyday activity of a pet can cause tangles. When the tangles get snarled together, a mat forms. Dead hair and debris (sticks, burrs, barbs, etc.) can hold the mat together, also causing it to grow in size by entangling hair around and into the mat. Water will cause a mat to tighten, pulling on the skin causing the pet discomfort. • Mats can cause and hide red, irritated, swollen, or cracked skin. Removing a mat may reveal this. • Mats can conceal the presence of fleas or other pests. • Xxxx can make it impossible to determine the presence of any moles, scabs, or other conditions of the pet’s skin. Removing a mat may reveal this. • Xxxx prevent a pet’s skin from completely drying if it becomes wet, a situation that is also conducive to causing skin problems/irritations. • Grooming may aggravate the pet’s skin due to the tenderness caused by the mats. This includes but is not limited to the following: redness on or around the matted area, irritated skin, excessive itching or scratching, bumps, infection (may or may not include puss, blood) on or around the previously matted area.
Examples of Owner Name in a sentence
Must Be Submitted Annually for Health Permit Issuance Mobile Food Facility (MFF) Information: Business Name on Vehicle: License Plate Number: Owner Name: Mailing Address: City: Zip: Phone: Fax: Email: _ I, the MFF owner/operator, will operate out of the commissary listed below and report to the commissary at least once each operating day for cleaning and servicing.
The following principals of Vendor (“Principals”) are hereby designated as being the principals and representatives of Vendor authorized to act in its behalf with respect to the work specified herein and make all decisions in connection therewith: Xxxx Xxxxxx Xxxxx Owner (Name) (Title) (Name) (Title) (Name) (Title) It is expressly understood that the experience, knowledge, capability, and reputation of the Principals were a substantial inducement for City to enter into this Agreement.
More Definitions of Owner Name
Owner Name. Date: Signature: Hold Harmless Agreement I understand that the Grooming Salon Staff is trained and experienced and will, to the best of their abilities, ensure the safety and well being of my pet while in the Grooming Salon’s care. I agree to hold harmless and indemnify Care-A-Lot® Grooming Salon (also known as Care-A-Lot®, Inc. and Care-A-Lot® Pet Resorts) and its employees, invitees, and guests from liability, claims and damages, including reasonable attorneys’ fees, for loss, injury, illness and/or death caused by my pet to persons, other pets, or property. I further release Care-A-Lot® Grooming Salon and its employees from liability, claims, and damages, including reasonable attorneys’ fees, for any illness, injury and/or death caused to my pet, unless resulting from gross negligence or willful misconduct. While my pet is in the care and custody of Care-A-Lot® and I am unreachable in the event of an emergency, I hereby authorize Care-A-Lot®, its employees and/or representatives to seek immediate veterinary care for my pet. I understand that all costs in connection therewith, including transportation, veterinary, medical, and otherwise, shall be my responsibility. I will be responsible to reimburse Care-A-Lot® for any medical expenses. I fully understand the financial terms of the grooming services requested. I am aware of the pet abandonment statue in Virginia. I understand that legal action will be taken against any owner for abandonment statue in Virginia. I understand that legal action will be taken against any owner for abandonment or failure to pay in full my financial obligation to Care-A-Lot®, Inc. I certify that I have read and understand this agreement. I agree to accept all the terms, conditions, and statements of this agreement.
Owner Name. Lincolnway Energy, LLC SSN/TIN: 20-1118105 The Borrower authorizes and appoints the following to act on behalf of all owners, to vote the Class D stock, and to accept, receive and receipt for any dividends declared on the stock, unless otherwise agreed to in writing by the parties: Xxxx Xxxxxx , Board President, voter
Owner Name. Owner Address: Business Name: City, State, Zip: Electrical hook-up Toilet & handwashing facilities Waste tank/sewage disposal Garbage disposal Warewashing facility Dry food storage Waste grease removal Chemical storage Enclosed overnight parking (pushcart) Refrigeration/frozen food storage Equipment/utensil storage Food product supply source Length of contract: 6 Months 1 Year Not applicable. I am the owner of the approved facility/commissary. I, the above-mentioned owner/operator will operate out of the approved facility/commissary identified below. For mobile food trucks/trailers: I will report to the facility at least once per operating day for cleaning and servicing. I will store the vehicle and equipment at the facility or another location approved by the Health Department. I understand that the use of the approved facility/commissary is required. If the use of the approved facility/commissary is discontinued, I will notify the Health Department at (000) 000-0000 to make necessary changes. Applicant Signature Date APPROVED FACILITY/COMMISSARY INFORMATION Facility Type: Name: Commissary Restaurant Rental Kitchen Other: Address: City, State, Zip: Email: Telephone: Mobile: Permit #: Permit issued by: (Regulatory Agency) I, the approved facility/commissary owner/operator, can and will provide the necessary support services, as indicated by the applicant, at my facility. I acknowledge that I am ultimately responsible for the maintenance and sanitation of this approved facility/commissary. In addition, I will notify the Health Department when this agreement is terminated. Approved Facility/Commissary Owner Signature Date OUT-OF-COUNTY APPROVED FACILITY/COMMISSARY If the approved facility/commissary permit is issued by any agency other than the Fairfax County Health Department, please provide copies of the approved facility/commissary permit to operate and last inspection report along with this agreement. Office Use Only APPROVED NOT APPROVED DATE WAIVER: Failure to comply with the Fairfax County Food and Food Handling Code may result in suspension of your operation. Fairfax County Health Department • Division of Environmental Health 000-000-0000 TTY 711 xxxxx@xxxxxxxxxxxxx.xxx 00000 Xxxx Xxxxxx, Xxxxxxx XX 00000
Owner Name. Owner Name: _____________________________ Signed: Signed: ___________________________________ Date: Date: _____ ******************************************STAFF USE ONLY**************************************************************************** WATER BODY NAME: BUFFER YARD REQUIREMENT: (dimensions of buffer area proposed) Date: Approved: Denied: Conditions of Approval/Reason for Denial: WALWORTH COUNTY SHOREYARD MITIGATION INFORMATION As required by State Statute 59.692(1v) and Walworth County Zoning effective 10-27-99, waterfront property owners wishing to construct (or alter) a structure within the shoreyard setback requirement are required to comply with the following: The part of a structure that is nearest to the water is located at least 35 feet landward from the ordinary high-water xxxx. The total floor area of all the structures in the shoreyard setback shall not exceed 200 square feet in area (excluding boathouses). The structure has no sides or has open or screened sides. The County must approve a plan that will be implemented by the owner of the property to preserve or establish a vegetative buffer zone that covers at least 70% of the half of the shoreyard setback area that is nearest to the water. What is a vegetative buffer zone? The buffer zone can be established, either by natural recovery (letting the area grow back naturally) or by accelerated recovery (assisting in restoration by planting). Vegetation removal and filling or land disturbing activities are prohibited. The duff layer, made up of fallen leaves and pine needles, if present, must be left intact. This layer covers soil, conserving moisture and preventing erosion. What are the area requirements of a buffer zone? The buffer zone is required to equal 70% of the shoreline and half of the required shoreyard setback. For instance, a property with 75' of lake frontage and a required 75' shoreland setback for structures will require roughly a 53' x 38' buffer area total, leaving a 22' view corridor. Likewise, if a property has 50' of lake frontage and has a required average shoreland setback of 50', the required buffer would be required to be 35' x 25' in area total, leaving a 15' view corridor. Be aware that these dimensions are in total area. The buffer area can be divided up to allow a view corridor as well as for the placement of a stairway if required to access the shore. In order to process your application in the shortest time possible, the following will be required with...
Owner Name. Owner Phone: Owner Mailing Address: Owner (“Applicant(s)”) hereby requests that the City of Xxxxxxx provide utility services. Applicant(s) agrees to pay for the services at the rate, at the time and in the manner required by the Payette City Code and rate resolutions of City Council. Pursuant to Payette City Code there is no reduction in monthly water and sewer base rate fees while the water meter is turned off. The failure to receive a bill does not diminish or eliminate applicant’s obligation to pay the rates for water, sewer, garbage and cart. Charges for water, sewer, garbage and cart shall continue for the above premises until notice is given by the above Account Holder(s) to the City to discontinue service. Should the utility account for said premises not be paid on or before the 10th day of the month following the accrual thereof, the City of Xxxxxxx reserves the right to discontinue all water, sewer, garbage and cart service for said premises and charge the balance of the utility account against the deposit herein receipted for. Applicant(s) agrees that only a representative of the City be allowed to turn on or off any City utility service. The Applicant(s) further agrees to take no action to obstruct, cover meters, or shut off devises or otherwise prevent the City’s authorized representative from making records, readings, and inspections of the location, condition and sufficiency of pipes, fittings, valves, fixtures and appliances.
Owner Name. Phone: Address: Email: Year & Make of Cart: Serial Number: Insurance Company: Policy Number: