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Name Address 2016 Lamppost Lighting Project APPLICATION AND AGREEMENT This Application is made to the City of South Bend, Indiana, Department of Public Works, for the installation of yard lamp post(s). Black ❑ o zE ❑ i9 a ❑ q f a0 a 0 ❑ O .� U Rustic L Bronze ❑ cc Q Daytime Phone Number Mailing Address (Include Zip Code) Email METHOD OF PAYMENT (submit payment with application) ❑ Cash: hand deliver to the office ❑ Check: payable to "City of South Bend" ❑ Credit Card: for details, please contact our office at 574-235-9251. We accept Visa and MasterCard. 1. PROPERTY OWNER RESPONSIBILITIES The Property Owner agrees to provide Two Hundred Fifty and 00/100 Dollars ($250.00) as its portion of this program directly to the City for payment of said yard light(s). The Property Owner shall provide an additional One Hundred Twenty and 00/100 ($120.00) for the purchase of a Dark -Sky Compliant yard light. The Property Owner assumes full responsibility for maintenance of said installed yard light(s). The Property Owner will provide light bulbs, as needed, for said installed yard light(s). The Property Owner will cooperate with the contractor in all reasonable ways for the installation of said yard light(s). The Property Owner assumes responsibility for payment of wiring in excess of fifty (50) feet. This is a residential front yard light program that requires an accessible landscaped area within fifty (50) feet of the power hookup without extraordinary site improvements, including but not limited to sidewalk, driveway, landscaping, and irrigation systems. While applications are accepted for installations in non -conforming sites, such as commercial or residential sites with extraordinary site issues, there may be a cost share above the previously stated $250.00. Such rare issues will be identified through pre -installation site review. Customers and the Public Works Director will be notified in advance of extra costs and either party will have the opportunity to decline the yard light if they find the extra costs unacceptable or unreasonable, in their sole discretion. Acceptance of any additional costs prior to installation, are made upon agreement of the parties. 2. CITY RESPONSIBILITIES The City will provide the remaining costs for material and installation for said yard light(s) as part of the program. The City will provide a contractor in accordance with Indiana Law. The City will pay the Property Owner's portion directly to the contractor. The Contractor agrees to provide all permits required for the installation of said yard light(s). Included as part of the program the Contractor will install wiring up to fifty (50) feet. The property owner will be charged for wire exceeding fifty (50) feet on a per foot basis. 3. INDEMNIFICATION The Property Owner agrees to defend, indemnify and hold harmless the City, its agents and employees from any and all claims of any nature which arise from the installation of said yard light. 4. DEFAULT If the Property Owner fails to comply with any of the terms or conditions of this agreement, the City may withhold any funds not yet distributed to the Contractor and the Property Owner shall repay all unexpended funds to the City. Any future project and/or grant applications and awards may also be affected if the Grantee fails to comply with any terms or conditions of this agreement. 5. MISCELLANEOUS The number of lampposts available under this program is limited and such lampposts will be distributed on a first come first serve basis while supplies last. Requests for additional lampposts will be considered after June 1 st. Eligibility for additional lampposts will depend on frontage length and is subject to City approval. Lampposts will be installed beginning June through November 2016. The undersigned certifies that he/she is authorized to bind the Property Owner to the terms hereof. Signature Date