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: 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.
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
Examples of Owner Name in a sentence
None or List: Owner (Name of State Agency or 3rd Party) Description Nature of restriction: University: Restrictions in Preexisting IP/Data included in Deliverables identified in Exhibit A1, Deliverables.
None or List: Owner (Name of University or 3rd Party) Description Nature of restriction: Anticipated restrictions on use of Project Data.
This Property is owned by [Owner Name] (“Owner”), [with a place of business located] at [Address of Owner].
APPROVED BY: TEXAS DEPARTMENT OF TRANSPORTATION By: Authorized Signature OWNER [Print Owner Name] By: Duly Authorized Representative Printed Name: Xxxxxx X.
Owner Name By ____________________________ Date When completely executed, this form is to be sent by certified mail to the Contractor by Owner Name.
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. 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:
Owner Name. Street address: City: State: Zip: Business phone: Home phone: Cell: Email: Website: Please describe the materials used to create your product, and how sourced: Do you sell at other outlets? yes ❏ no ❏ If yes, list the name and how long you have sold at each: Is your business a GoTexan Member? yes ❏ no ❏ 2017 MEMBER AGREEMENT By providing your initials and signatures within this application, you acknowledge and agree to each of the above Rules of Rose City Farmers Market, and understand that any disregard of these rules may be grounds for removal of your membership. Please initial each item to indicate your agreement: I have read and agree to abide by all of the Rose City Farmers Market Rules and Regulations. Upon acceptance, I agree to indemnify and hold Rose City Farmers Market, Farm and Food Coalition, Inc., and its officers, directors, employees and agents harmless from and against any and all claims and demands, whether for injuries to persons, loss of life or damage to property, on or off the premises, arising out of the use or occupancy of the Market by me or my family, employees or agents and shall defend at my expense any actions brought against Rose City Farmers Market, Farm and Food Coalition, Inc., and any of their officers, directors, employees or agents by the acts or omissions of me or my employees or agents. I will arrive to market each day no later than 7:30 a.m. and will be set up and ready to sell no later than 7:45 a.m. I will not set up my canopy if I do not have the required weights. I will only sell products that I have produced or made myself. I understand my photograph, name of my farm or business, and images of my farm or manufacturing process may be used in promotional materials. I will do my personal best to ensure our market is a clean, family-friendly, inclusive gathering space for everyone to enjoy. Signature of Member: Printed Name of Signing Person: Title (if sole proprietor, please so indicate): 2017 LEGAL INDEMNITY AGREEMENT I am requesting permission to sell at Rose City Farmers Market, located at 0000 Xxx Xxxxxxxxxxxx Xxx., Xxxxx, Xxxxx, 00000. I have read and agree to abide by the Rules and Regulations, as well as all laws, codes and regulations, and to cooperate with all market management and volunteers. For and in consideration of receiving permission to sell at the market, I agree to indemnify and hold harmless Farm and Food Coalition, Inc., Rose City Farmers Market, SDS Dining Concepts LLC – DBA Juls, and all of the...
Owner Name. Phone: Mailing Address: email: (If different from above) Contractor Name of Firm: Phone: Mailing Address: email: Contact: Applicant (if not Owner) Name of Firm: Phone: Mailing Address: email: Contact: 24hr Contact Phone: Permit Requirements
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