HomeMy WebLinkAbout2015 - Consent for City GasLocal Business Point of Contact Information
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{� Name:
Florida City Gas Y Primary Phone:
An AGL Resources Company
PROPERTY OWNER'S CONSENT FORM
as the owner(s) of the property
Owner / Tenant
A/�'Ey�/%�`L,
located at
/
Street
Address arty or i own aiaie
1 6)1,J,J 'lei hereby grant Pivotal Utility Holdings, Inc. d/b/a Florida City
County
Gas the right to install at the above property address the natural gas facilities required to provide gas service to
the property and the right of ingress and eggress to maintain, repair and operate said installed gas facilities
provided, however, that Florida City Gas shall upon completion of construction, be responsible for restoring that
portion of the property used to facilitate the installation to a safe and usable condition similar or equal to that
which existed prior to construction.
Property owner acknowledges that Florida State law requires that prior to the installation of underground
facilities, Florida City Gas or its contractor must contact 'Sunshine State One Call of Florida' to have all public
utilities marked. Property owner and Florida City Gas shall agree prior to construction of gas facilities as to the
condition of the property used to facilitate the installation.
It shall be the sole responsibility of the Property Owner to have all privately owned utilities marked out or
identified prior to the contractor performing the installation. Property Owner shall hold Florida City Gas and its
contractors harmless with regard to any facilities not properly located or identified prior to construction. Further,
this document shall signify that it is agreed upon by both parties that the installed gas service facilities shall
remain forever the property and responsibility of Florida City Gas, its successors or assignees.
Consent Granted by: /
/G � A -S T, iy tel/
� Property Owner /
. �� 4
Attested by:
Version 2 (4.11.12)
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