To: Susan Baumbach
Title: Utility Billing Specialist
Phone: 407-585-1448

BUSINESS UTILITIES APPLICATION

City of Lake Mary
Post Office Box 950715
Lake Mary, FL 32795-0715

Business Name:

Service Address:

Billing Address:

Phone:

Contact Person:

Federal Tax ID #:

Are you the Owner or Renter?

Deposit Amount:

Dumpster Size:

How Many Pickups per week?:

City of Lake Mary Solid Waste Monthly Charges

Effective date 3/01/09; Billing Cycle 02/25/09

I AM APPLYING FOR CITY OF LAKE MARY UTILITY SERVICE AT THE ABOVE ADDRESS. I AGREE TO FOLLOW ALL CITY RULES FOR UTILITY SERVICE AND TO PAY CHARGES IN EFFECT AT THE TIME OF DELIVERY.

I AM ALSO RESPONSIBLE FOR MAKING SURE THAT ALL FAUCETS ARE IN THE OFF POSITION BEFORE THE SERVICE IS ESTABLISHED. THE CITY IS NOT LIABLE FOR DAMAGESCAUSED BY WATER FAUCETS OR OUTLETS LEFT ON.

I UNDERSTAND THAT NON-PAYMENT OF MY ACCOUNT WILL STOP SERVICE.

LAKE MARY UTILITY AGREEMENT

The City of Lake Mary agrees to provide the indicated utility services to 00000 (hereinafter "Owner") for the property located at 00000. In consideration of the City providing said services, and pursuant to City Code Chapters 50 through 52, and Florida Statutes Section 180.13 and .135, the Owner agrees to timely pay the established rates or charges for said services and further consents to the City imposing a lien against the aforesaid property for unpaid utility service fees, plus all fees and costs including attorneys fees incurred in the collection of unpaid utilty sevice fees or foreclosure of liens for unpaid utility service fees.

UTILITY SERVICES TO BE PROVIDED

Water, Garbage, Sewer, Storm water, Reclaimed water

BILLING AND COLLECTION

Utility Services will be billed on a regular basis. The Owner will pay for services as billed. Every attempt will be made by the City to accurately bill for utility services provided, however, occasionally errors occur in the billing process or in the meters and monitoring systems from which fees are calculated. Accordingly, the City will periodically audit services actually supplied versus services billed and submit a supplemental statement for any services not billed. The Owner shall be responsible for all services provided, whether billed or not, and shall be responsible for promptly paying any supplemental statements.

The owner is responsible for providing the City accurate data upon which to calculate utility service fees. For example, Storm water fees are calculated based upon an Equivalent Drainage Unit (EDU) calculation. EDU's are determined based upon a ratio of previous square footage versus impervious square footage. The Owner is responsible for providing accurate square footage figures. Should an audit of utility services to a property reveal an error in fees charged due to an inaccuracy in the information supplied by the Owner, the Owner will be responsible for any additional charges due based upon accurate calculations.

I, THE UNDERSIGNED, UNDERSTAND AND AGREE THAT I AM RESPONSIBLE FOR ALL CHARGES FOR UTILITY SERVICES AT THE ABOVE ADDRESS, AND WILL CONTINUE TO BE RESPONSIBLE FOR SAME UNTIL I REQUEST TERMINATION OF SERVICE IN WRITING.

Signature of Owner:

Date: 02/11/2012

Printed Name of Owner: