City of Santa Cruz : Online Forms

Survey/Form Review

SCMU Application - Special Events

SANTA CRUZ MUNICIPAL UTILITIES (SCMU)

SPECIAL EVENTS

REFUSE AND RECYCLING SERVICE SIGN-UP

1. SERVICE LOCATION INFORMATION

Event Name:*

Event Date(s):*

Service Address - Street, Location:*

Service Address - City, State, Zip Code:*

The applicant agrees to comply with the Conditions of Use issued by the City Manager's Special Event Office.*

The applicant agrees to comply with the Container Rental and Indemnification Agreement: I hereby agree to indemnify, defend and hold the City of Santa Cruz, its agents and employees harmless from any claims for damage, death or personal injury which may result from the dumpster's use, movement or placement during the course of its rental through this account with the City of Santa Cruz. This agreement does not extend to liability arising from the negligence or intentional misconduct of city staff, as determined by court judgement.*

2. APPLICANT INFORMATION

Last Name, First Name:*

Business Name (if applicable):

Billing Address - Street, Apt/Ste:*

Billing Address - City, State, Zip Code:*

Mobile Phone Number:*

Alternate Phone Number:

E-mail Address:

Identification - Document Type:*

Document Number (ID):*

Issued By (State or Country):*

I DECLARE UNDER PENALTY OF PURJURY THAT 1) I AM THE RESPONSIBLE PARTY AT THE SERVICE ADDRESS AND/OR AN AUTHORIZED REPRESENTATIVE OF THE BUSINESS, AND 2) THE INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT.

3. OFFICE USE ONLY

Account # --- Meter # --- Location

Deposit Receipt # --- Field Remarks