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131030 Sewer Insurance Policy
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131030 Sewer Insurance Policy
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Last modified
11/21/2013 8:53:53 AM
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11/21/2013 8:53:34 AM
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Board of Public Works
Document Date
11/12/2013
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Exhibit B <br /> SEWER REPAIR REIMBURSEMENT AGREEMENT <br /> City of South Bend, Indiana <br /> Billing Address: Date: <br /> Borrower's SSN: <br /> I, (Borrower) of_ South <br /> Bend, Indiana promise to pay to the order of the Sewer Repair Fund, South Bend Water Works, 125 West <br /> Colfax Avenue, P.O. Box 1714, South Bend, Indiana 46634, the sum of$500 as follows: <br /> One hundred dollars ($100) at the time of the execution of this <br /> note,followed by 11 monthly payments of$33.34, and one <br /> final payment of$33.26(total 12), all added to my South Bend <br /> water bill at the address listed above which I a ree to pay. <br /> I understand that there will be no interest charged on the amount due pursuant to this note as long as my <br /> payments are current, but that during any period of delinquency, I will be charged interest at the rate of <br /> eight percent per annum. I hereby waive presentment for payment, protest, notice of protest, and <br /> nonpayment of this note, and agree that upon default in payment of this note, or any part when due, the <br /> whole amount remaining unpaid shall, without notice or nonpayment or demand of payment, immediately <br /> become due and payable, with attorney's fees and without relief whatsoever from valuation of <br /> appraisement laws. <br /> I understand that if the total cost of repair is less than $500, that Water Works shall amend my payment <br /> schedule to match the actual cost of the repairs. <br /> Contact Person for Borrower(excluding spouse): <br /> BORROWER: <br /> Name&relationship to Borrower(Please print) (Signature) <br /> Telephone No: <br /> Telephone No: <br /> State of Indiana ) <br /> SS: <br /> St. Joseph County ) <br /> Subscribed and sworn to before me, a Notary Public in and for said County and State this day of <br /> 20 <br /> Notary Public <br /> Commission Expiration Date <br /> 10 <br />
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