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2. 
3. Hold Harmless Agreement for District Facilities in a Sidewalk or Driveway
   (CVWD-275)
   
   
   
   
   
5. This agreement is to be completed by Coachella Valley Water District (district) customers requesting a Special Box and Traffic Cover for a driveway or sidewalk.

    

7. Account Number
   First 6 Digits*
8. Account Number
   Second 6 Digits*
9. Assessor's Parcel Number (APN)*
10. Property Type*

    1. Residential
    2. Commercial
12. Property Owner First Name*
13. Property Owner Last Name*
15. Property Owner Title*
16. Business Name*
18. Property Address Line 1*
20. Property Address Line 2
22. City*
    -- Select One --Cathedral CityDesert Hot SpringsIndian WellsIndioLa QuintaMeccaNilandPalm DesertRancho MirageSalton CitySky ValleyThermalThousand Palms
23. Zip Code*
25. Email Address*
27. Primary Telephone Number*
28. Primary Telephone Number Type*

    1. Cell phone
    2. Home
    3. Work
30. Secondary Telephone Number
31. Secondary Telephone Number Type

    1. Cell phone
    2. Home
    3. Work
33. Terms & Conditions
    
    Please refer to the CVWD Regulations Governing Domestic Water Service, Section 3.05.070(B)(1) for the regulations governing service connections.

    https://cvwd.district.codes/CVWDC/3.05.070(B)

35. 1. I am the property owner for this address.
37. I agree to pay the fee for a Special Box and Traffic Cover as listed on the district's rate sheet in the section Residential & Commercial Fees - Other Meter & Service Fees prior to the submittal of a work order to complete the installation.*

    Residential & Commercial Fees - Other Meter & Service Fees

    1. Agree
39. I agree that the installation of a Special Box and Traffic Cover shall be subordinated to any use and operations which the district may conduct in the location, construction, enlargement, reconstruction, removal and replacement, operation, inspection, maintenance, repair, improvement or relocation of the meter. The property owner shall not cause delay to or interfere with the district's operations.*

    1. Agree
41. I agree that the district shall have the right to remove the Special Box and Traffic Cover if the district considers reasonably necessary, without reimbursement to me to conduct the district's operations as set forth in the item above.*

    1. Agree
43. I agree to waive the right of claim, loss, damage or action against the district arising out of or resulting in destruction (in whole or in part), damage to, or removal of the Special Box and Traffic Cover or any action of the district, its officers, agents or employees taken in accordance with the terms hereof. The property owner, as a material part of the district's decision to install the Special Box and Traffic Cover, hereby assumes all risk of damage to the improvement in, upon, or about the property arising from any cause attributable to the district's exercising its rights hereunder and the property owner waives all claims in respect thereof against the district.*

    1. Agree
45. I agree to waive any and all rights of any type of express or implied indemnity against the district, its officers, employees, directors, administrators, or agents.*

    1. Agree
47. I agree that in the event of any controversy, claim or dispute relating to this agreement, or the breach thereof, which the district is or shall attempt to enforce, the district shall be entitled to recover from the property owner reasonable expenses, attorneys' fees and costs.*

    1. Agree
49. I agree that all of the provisions of this agreement shall be binding upon and inure to the benefit of the successors, legal representatives and assigns of the parties. Every person who now or hereafter owns or acquires any right, title or interest in or to the property shall be conclusively deemed to have notice of this agreement, whether or not reference to the agreement is contained in the instrument by which such person acquires an interest in the property. Therefore, each and every contract, deed or other instrument hereinafter executed, covering or conveying the property shall conclusively be deemed to have been executed, delivered and accepted subject to this agreement.*

    1. Agree
51. I acknowledge and agree to comply with all District Regulations, Ordinances, Policies and Rules, or amendments thereto. I attest that I am the property owner, or duly authorized agent, with authority to execute this agreement. *

    1. I understand that checking this box constitutes a legal signature.
53. By typing or signing my name, I certify that I understand the terms and conditions outlined above and that to the best of my knowledge the information I provided is true and correct.*

55. 
    

    COACHELLA VALLEY WATER DISTRICT
    Post Office Box 1058
    Coachella, California 92236

    (760) 391-9600

    (760) 398-3190 - fax

    rev 8/2023

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

    This field is not part of the form submission.

58. Submit

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