*Meter Charge $9.00
*0-60,000 gallons $2.00/1,000 gallons ($54.50 maximum)
*Over 60,000 gallons additional $2.00/1,000 gallons
*Meter Charge $17.00
*Plus gallons based on Jan & Feb average water usage - $3.00/1,000 gallons
Small Business $24.00
APPLICATION FOR CITY UTILITIES
Date _________________________ #_________________
Terms and Conditions:
The City of Atkinson (the City) is hereby requested to provide utility service at the location herein described (the premises), and to furnish, own and maintain metering equipment located up to and on the premises. As a condition to such service, it is understood and agreed as follows:
All private service lines, piping, electric appliances or equipment (excluding metering equipment) located on or within the premises shall be owned, maintained and controlled by the Customer and/or premises’ owner. Except as otherwise required by law, the City does not undertake to, or assume the obligation for, the inspection, testing, maintenance, or repair of equipment or facilities not owned by the City.
The Customer agrees to pay for water, sewer and sanitation services at the City’s established rates as amended and changed from time to time, plus all sales tax. The Customer further agrees to abide by the City’s present and future rules as a condition of utility service. The utility bills are due upon receipt each month and delinquent the tenth (10th) day of the following month. The policy for disconnection of services for non-payment is adopted within Nebraska State Statutes.
The Customer agrees that the City will have the right of access to the Customer’s premises at reasonable times for the purpose of installing, reading, inspecting, testing, maintaining or repairing metering and regulation equipment, or for the purpose of removing its property, and for all other proper and lawful purposes.
The City shall not be liable for damages due to interruptions in service and the Customer shall hold the City harmless from any and all claims or liabilities for damage or injury to persons or property which may arise out of or caused by the construction, maintenance, use or operation of service lines, piping, facilities, equipment or appliances which are located on the premises.
The Customer shall properly protect the City’s property located on the premises from damage or loss.
In the event the Customer moves to a different location than stated below, the customer will be held liable to the city for all service received at the vacated location until payment has been made.
Date of Application________________________ Date Service Requested________________________
Business Name (if applicable) ___________________________________________________________
Customer Name as Requested for Billing___________________________________________________
Service Address _________________________
Social Security Number/Photo ID Document # of Applicant ____________________________________
Home Phone_______________________ Owner of Premises _________________________________
Occupation _______________________________________ Business Phone ______________________
Do you presently have City Utility services? Yes No Address___________________________________
Do you want to discontinue your present service? Yes No What Date? ____________________________
OPTIONAL: AUTO-PAY INFORMATION (attach voided check)
Name of Bank ________________________ Account # ____________________________
Routing #_____________________Withdrawals will be processed around the 8th of each month
_______________ ____________________________________________ ____________________
Date Customer Signature Deposit Paid ($75.00)
The City routinely receives requests from Welcome Wagon, area churches, etc. for lists of new residents within the community. It is the policy of the City to give these names to organizations that request the information. If you would prefer that your name not be given out, please indicate by signing below.
Date Customer Signature
City of Atkinson Utilities
This document designates the Landlord or Property Owner below as a party to receive notification of a proposed discontinuance of service under non-routine circumstances at the address listed on this Notification.
Name of Landlord (print) _____________________________________________________
Address of Landlord _____________________________________________________
Phone Number of Landlord _____________________________________________________
*In signing this form, I understand that my Landlord will be notified prior to my water/sewer service being disconnected under non-routine circumstances.
Customer (Tenant) Name (print) ___________________________________________________
Customer (Tenant) Signature *
Customer (Tenant) Address ___________________________________________________
FOR OFFICE USE ONLY:
Customer (Tenant) Account No.______________
City = 1 1/2%
Nebraska = 5 1/2%
Atkinson Utility Rates
104 s. Main St., / PO Box 519 / Atkinson, NE 68713 / Ph: 402-925-5313 / Fax: 402-925-5780
This institution is an Equal Opportunity Provider and Employer.