Sample of CCTV Re-Inspection Form

SERVICE CONTRACT FOR CCTV RE-INSPECTION OF WASTEWATER LINES
Date of request: ______Requested date of Inspection: ______

Project or Subdivision Name: ______

Project No. ______RMS No.______

Contractor/Developer:______

(Print or Type and circle, Name of Contractor/Developer)

Address: ______

Reason for Inspection: Third Inspection Additional Inspection

Comments: ______

As provided in the Wastewater Line Extension and Service Standards, a fee shall be charged for any additional inspections (i.e. a third trip or more), that are scheduled to be made by the Colorado Springs Utilities Inspector to inspect wastewater lines that have not been corrected of all deficiencies found during the original or second Closed Circuit Television (CCTV) Inspection. The fee shall be charged to the Contractor/Developer for expense incurred by the Colorado Springs Utilities for these services (Chapter 10, Section 10.01, current edition). The following terms and conditions shall apply.

  1. Time will be charged for time and materials at the rate of $85.00 per hour (Charges include administration, truck/equipment and crew charges).
  2. There will be a minimum charge for 4 hours per project inspection (includes travel time) of $340.00, payable with this submittal of this Service Contract.
  3. Colorado Springs Utilities will calculate total charge for Time and Materials for CCTV Inspection and will invoice Contractor/Developer.
  4. Receipt for the minimum charge must be presented to CCTV inspector prior to commencement of services.
  5. CCTV services will be provided on normal business days and hours and no earlier than receipt of this contract and minimum payment.
  6. The Contractor/Developer agrees to make payment of the total charge for Time and Materials for CCTV Inspection for the above, upon receipt of billing. Service charges for unpaid bills or late payments, at the rate of (defined in the Colorado Springs Utilities tariffs) will occur 30 days after receipt of billing.
  7. The City of Colorado Springs and Colorado Springs Utilities shall not be subjected to any liability for any deficiency or defect which is not discovered by inspection nor shall the owner or developer of the premises be absolved from liability for the deficiency or defect and any resulting damage or from responsibility to correct the deficiency or defect.
  8. Additional terms and conditions:______

The undersigned representative for the Contractor/Developer represents that he/she has the legal authority to bind the Contractor/Developer for purposes of this Service Contract.

FOR THE CONTRACTOR/DEVELOPERFOR COLORADO SPRINGS UTILITIES

______

SignatureSignature

______

Printed or typed name and positionPrinted or typed name and position

______

DateDate

______

Telephone numberTelephone number

Contact Name if different than above:

______