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2. Hydrant Meter/Water Usage Application
4. Date*
   Date
5. Company Name*
7. Billing Address*
9. Address2
11. City*
12. State*
13. Zip*
15. Phone Number*
16. Email Address*
18. Location of Project (Include Nearest Intersection)*

22. It is a violation to haul or use Colorado-Big Thompson (C-BT) water outside the boundaries of Northern Water District (NW).

     Information on how to determine if your lands are within the boundaries can be found on the Northern Water Website.

    
    

    By submitting this form, I certify that I have the authority to represent the Company listed above, and that this company will comply with the NW Rules Governing the Use of Colorado-Big Thompson and Windy Gap Project and Windy Gap Project Water for the Development of Oil and Gas Wells and all regulations of the Town. This Company agrees that the Town shall have the right to perform an audit of the Company’s water billing and/or usage records at any time. I agree that at the sole discretion of the Town, if any water is hauled outside the district boundary, the meter deposit will be forfeited and future water rental may be stopped.

    Indemnification: Hauler hereby expressly agrees to indemnify, defend and hold Town and all of its agents, employees, officials, licensors and licensees (collectively, “Indemnified Parties”) harmless from and against any and all liability and costs, including, without limitation, attorneys’ fees and costs, incurred by the Indemnified Parties in connection with any claim arising out of any breach by Hauler of this Agreement, or any of the representations, warranties, disclaimers and covenants contained herein, including but not limited to any liability for use of water provided under this Agreement outside the boundaries of the Northern Colorado Water Conservation District. Town reserves the right at its own expense, to assume the exclusive defense and control of any matter otherwise subject to indemnification by Hauler, subject to reimbursement by Hauler, and Hauler shall not in any event settle any matter without the written consent of the Town.

    
    

    I understand that it is a violation to haul Colorado-Big Thompson (C-BT) water outside the boundaries of Northern Water District.

24. Confirmation*

    1. I agree that at the sole discretion of the Town, if any water is hauled outside the district boundary, the meter deposit will be forfeited and future water rental may be stopped.
28. Authorization to Bind
30. The Owner(s)/Member(s)/Board of Directors of *
32. Hereby resolve to authorize:
34. Name*
35. Title*
37. Name
38. Title
40. Name
41. Title
43. Please read*

    1. Confirmation

    To negotiate and enter into on behalf of the Company any water hauling arrangement, including any associated indemnification of the Town of Frederick Colorado, for the use of water pursuant to such terms as may be required by the Town. By submitting this form affirms he/she is duly authorized agent of the company and that the statements contained in this document are true and complete to the best of his/her knowledge. This submission further affirms that the applicant accepts, as a condition of the grant, the obligation to comply with all applicable State and Local requirements, policies, standards and regulations regarding water use. This submission further affirms that the Company shall be bound by any agreement he/she executes pursuant to reliance of any third party on this document. Theis submission recognizes this is a public document and is open to public inspection.

    When changes to this authorization occur, please submit an updated Authorization to Bind form within ten (10) working days.

47. Hydrant Meter Rental Process

    Hydrant Meter Fee Schedule

    • A $4,500 deposit is required for each hydrant meter. The deposit less any damages resulting from misuse will be issued after meter is returned and final bill payment is received.
    • Additional charges will be assessed for any damages that occurred while in applicant’s possession.
    • Water is charged at the hydrant meter rate established by the Town of Frederick Fee Schedule.
49. Please read and check the following:*

    1. Complete the necessary paperwork and provide deposit.
    2. On the 20th of each month (or the Friday before if the 20th falls on a weekend), the meter read needs to be called in to Town Hall (720.382.5500). If the read is not called in when due, a Town employee will read the meter and an additional service charge will be added to the bill.
    3. When the hydrant meter is no longer needed, return the meter to the Public Works office. After the meter is removed, a final reading will be taken and the meter and hydrant will be inspected and assessed fees for damages.
    4. Deposit is returned after final billing payment is received less any damage charges.
51. Directions for Operating a Fire Hydrant

    Failure to follow these instructions may result in damage to the fire hydrant, water system, and could cause bodily injury.  Contractor is responsible for proper operation and care of the hydrant.  Financial penalties may be assessed if instructions are not followed.

    • All trucks must have airgap top fill or direct fill; contractors must have a tested reduced pressure back flow device to use hydrants owned by the Town.
    • A hydrant wrench must be used to operate a fire hydrant.  No other tool can be used.
    • The meter must be connected using the proper nozzle.
    • The gate valve on the hydrant meter should be slightly cracked open on shut down.  This will keep the hydrant from freezing during winter.
    • Hydrant must be opened slowly until water starts to flow.
    • Once the water has started to flow, open the fire hydrant fully.  It cannot be left only partially open.  It must be completely open or closed.
    • Operate the flow rate using the gate valve on the hydrant meter.
    • Slowly shut down the fire hydrant.  Do not cinch down!

    Water usage from Town of Frederick fire hydrants requires authorization.  Contractors must complete all paperwork and provide the Town with a hydrant deposit before authorization will be considered.
    

53. Confirmation*

    1. By submitting this document, I accept and acknowledge responsibility and liability for any damage or loss that occurs as a result of the use of a hydrant meter.
Leave This Blank:


55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit

* indicates a required field