Acknowledgement and Release of Liability for Water Service Connection/Reconnection

In consideration for the St. Lucie West Services District “SLWSD” turning on water service for the service address located at 	,
(insert service address)

I, 	,

(insert name of property owner or person authorized by property owner)

hereby release SLWSD, its officers, employees and agents from any and all liabilities, claims, damages, injuries, judgments, demands and expenses, including court costs and attorney's fees that may arise out of or in connection with turning on water service to the above mentioned service address. I am aware of the risks, which include but are not limited to, damage to or loss of personal property due to water damage from water leaks at the service location. This Acknowledgement and Release shall apply to any and all initial connections and reconnections of water service to the service address requested by the undersigned.

 	_

(Signature of Property Owner or Authorized Representative)	(Date)

Updated 3-13-13

450 S.W. Utility Drive ● Port St Lucie, FL 34986 ● Office (772) 340-0220 ● Fax (772) 871-5771