1111 W. Main St. Suite K

Greenfield, IN 46140

317-462-4469

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CONTRACT FOR RESIDENTIAL SEWER AND/OR WATER SERVICE 

CUSTOMER NAME: _________________________________

SERVICE ADDRESS: _________________________________

PHONE NUMBER: ___________________________________

BILLING ADDRESS: __________________________________________

(If different from above)

Application is hereby made to Gem Utilities, Inc. and Gem Water, Inc. at 1111 W. Main St., Suite K, Greenfield, IN 46140, for connection of sewage disposal and/or water services to be provided at the premises indicated above. Applicant agrees:

(a)                 To be responsible and pay for all sewage and/or water services furnished on the above-mentioned premises until the expiration of seventy-two (72) hours notice has been duly given at the office of the Company to discontinue the provision of services;  

(b)                That the meter furnished by the Company (if one is furnished) is, and shall remain, the property of the Company, and the Company’s agents shall have access to the meter at all times to read, repair, lock off, seal or remove the same;

(c)                 That the Company’s agents shall have access to any meter, pipes and other appurtenances at all times, for any purpose necessary to render service or to stop the supply of service for the non-payment of bills, when due, for sewage disposal and/or water services furnished to the Applicant at said premises, or elsewhere, or for any other lawful cause or purpose which the Company may deem sufficient, and said agents are hereby authorized to enter the said premises of the Applicant, at all times, for any such lawful cause or purpose or for the purpose of disconnecting or adjusting any meter or appurtenances or for the purpose of removing any meter or any other connections, or any other property shall be required to inspect or examine, or in any way be responsible for the condition of the pipes or appurtenances on Applicant’s premises;

(d)                Without limiting the generality of Rules 69 and 70 of the Company’s Rules and Regulations, to hold harmless the Company and its affiliates, directors, shareholders, officers, employees, agents and contractors against any liability to any person for injuries, damages, costs, and expenses arising from, or cause by, in the whole or in part, the back-up of sewage in Applicant’s service pipe or on Applicant’s premises, unless such back-up is a direct result of the Company’s gross negligence or willful misconduct;

(e)                 To the terms and conditions of the Company’s Rules and Regulations, which have been approved by the Indiana Utility Regulatory Commission and which are on file in the offices of the Commission and the office of the Company;

(f)                  To pay all tariffs and charges for the service. I understand the Company’s current monthly Sewer user fee is $58.00 per month. I understand the Company’s current monthly water fee is $15.00 base rate plus $4.73 per thousand gallons of water used. These services will commence on ______________________.

Customer Signature________________________________ Date________________