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Resident Name: ___________________________________________________________


Address: _________________________________________________________________


Phone number(s) ___________________________________________________________

Size of pool being filled:   __ under 3000 gallons            __ over 3000 gallons


Residents and the Village agree that:


1. Fees - the resident will pay for use of fire hose rental water used as follows:


$25 for pools that hold up to 3000 gallons

$50 for pools that hold over 3000 gallons


2. Village Employee Monitoring


Property owner agrees that the fire hose use will be monitored by a village employee

Property owner agrees that the fire hose use will be between 7:00 am and 3:30 pm on a weekday


(the employee will not be on site during the complete filling of the pool but is required to connect hose and start use, check the hose occasionally to maker sure it is being properly used and disconnect hose when use is done)


3. After hours use


I wish to use the village fire hose after regular village employees working hours or on non-workdays and agree to pay an additional rate of _________ per hour required to have a village employee monitor the filling of my swimming pool.


Yes ____    No ____   (if yes, will require a minimum of two hours of overtime pay per hose use)


4. Village not liable


The village will not be liable (responsible) if a non-village employee is hurt or their property is damaged, while using the village fire hose for any reason other than a defect in the fire hose that was there before the use started.


I understand and will abide by the conditions set forth in the above agreement.


__________________                                                Amount Paid $_________________



_____________________________                _________________________________

Residents signature                                             Village Clerk’s signature