Service Turn‐On Waiver of Liability

and Hold Harmless Agreement

By submission of this form, I understand that it is the BGJWSC preference to turn on water service only when the customer is present. Notwithstanding this, I request and authorize the BGJWSC to turn water service on without my presence at the property listed above. I will ensure that all water connections are properly closed, including but not limited to all interior and exterior water faucets, sinks, tubs, showers, toilets, appliances and all other such connections on the premises. I acknowledge that BGJWSC staff will turn on service giving no attention to continuous water flow through the meter.

I understand that the BGJWSC will not assume responsibility for any leaks or overflows of fixtures or appliances or any damage resulting from any such leaks or overflows and I therefore agree to hold the BGJWSC, their commissioners, employees, and agents, harmless for any and all damages that may result from the actions outlined herein. I further understand that the BGJWSC is immune from liability resulting from damage that may be caused by this activity and that this waiver will not alter this immunity regardless of its enforceability. Furthermore, I agree that the BGJWSC and their employees shall not be held responsible or liable for any injury, damage, or loss in any case whatsoever to the undersigned as a customer for merchandise, property, personnel or for lost income from water service turn‐on in my absence.

I further understand that service is not conditioned upon the execution of this document, but instead that this form is required by the BGJWSC when the customer requests the BGJWSC to act contrary to their preferred practices in performing work outside of the presence of the customer.

Additionally, I understand that no billing adjustments will be allowed for any water loss except those that qualify under the terms of the existing leak adjustment ordinance.

I have read this Waiver of Liability and Hold Harmless Agreement and fully understand its provisions. I acknowledge that I am the legal owner of the above‐identified premises or have been bound to terms of a formal lease agreement with the legal owner and that I am signing this document of my own free and voluntary act, without any duress, coercion or threats by any person. I also declare that no other person’s consent is necessary to authorize the execution of the Agreement.

You may also download and complete our Service Turn-On Waiver of Liability and Hold Harmless Agreement instead.

    To reduce the risk of unauthorized turn on, you must include the following item: