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Encroachment & Revocable Permit - 129 N. Michigan St. - Cool Runnings Restaurant & Bar No. 2
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Encroachment & Revocable Permit - 129 N. Michigan St. - Cool Runnings Restaurant & Bar No. 2
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1/10/2023 2:23:36 PM
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1/10/2023 2:23:17 PM
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Board of Public Works
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Recommendations
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1/10/2023
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Service Agreement <br />Non‐Hazardous Wastes <br />A Waste‐Away Group, Ltd. Company <br />Customer Account No. <br />NAICS Code <br />Reason Code <br />EffecƟve Service Date <br />Max Weight Per Yard <br />Himco Waste‐Away Service, Inc. <br />707 North Wildwood Ave Post Office Box 1278 <br /> Elkhart, Indiana 46514 Elkhart, Indiana 46515 <br />Phone: (574)293‐8534 (800) 634‐4626 <br />Fax: (574) 294‐7010 <br />Website: www.WasteAwayGroup.com <br />Account Name <br />Billing Address <br />City, State, Zip Code <br />Tel # Fax # <br />E‐mail <br />Contact <br />Equipment & Service SpecificaƟons <br />Site Address <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Qty Size Type Lids Wheels Lock Freq <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Service Day(s) <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />Charge(s) <br />$ <br />Special InstrucƟons <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />THE UNDERSIGNED INDIVIDUAL SIGNING THIS AGREEMENT ON BEHALF OF THE CUSTOMER ACKNOWLEDGES <br />THAT HE/SHE HAS READ AND UNDERSTANDS THE TERMS AND CONDITIONS OF THIS AGREEMENT, ON THE <br />REVERSE SIDE, AND THAT HE/SHE HAS THE AUTHORITY TO SIGN ON BEHALF OF THE CUSTOMER. <br />Schedule of Charges <br />Casters / Locks per Month $ ___ <br />Extra Pick‐Up Charges <br /> Per LiŌ $ ___ <br /> Per LiŌ $ ___ <br /> Per LiŌ $ ___ <br />TransportaƟon Per Load $ ___ <br />TransportaƟon Per Load $ ___ <br />TransportaƟon Per Load $ ___ <br />Disposal Per Ton $ ___ <br />Loose Yard Extra Per Yard $ ___ <br />Container Delivery, Removal, Exchange Fee $ ___ <br />Container RelocaƟon Fee $ ___ <br />Minimum Monthly Charge $ ___ <br />Demurrage Charge Per Minute AŌer ___ Minutes $ ___ <br />Monthly Equipment Service Charge $ ___ <br />Customer <br /> <br />(AUTHORIZED SIGNATURE) <br /> <br /> (TITLE) (DATE) <br />NAME (Print or Type) <br />Himco RepresentaƟve <br /> <br />(AUTHORIZED SIGNATURE) <br /> <br /> <br /> (TERRITORY) (DATE) <br />(Rev 08/2017) White (Original) ‐ File Yellow ‐ Customer Pink ‐ Sales <br />Terms: Net 10 Days <br />Total: <br />NEW <br />NEW <br />Cool Runnings Restaurant and Bar <br />SAME <br />129 N Michigan Street <br />South Bend, IN <br />574-202-1893 <br />j.smithnasb@gmail.com <br />Jason Smith <br />1 3 T /2x/w 195.00 <br />Waive Delivery Fee <br />Site: In the sabe Cubby as Woochie's containers <br />Fuel & Compliance surcharge is posted on our website. <br />If needed 100.00 <br />50 <br />150 <br />75 <br />30 <br />Austin Maddux <br />// <br />f Smith <br />GM 09 10 2022 <br />Jayson Smith
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