Sample of CCTV Re-Inspection Form - DOC

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					                         Sample of CCTV Re-Inspection Form


Date of request: __________________ Requested date of Inspection: ________________

Project or Subdivision Name: _______________________________________________

Project No. _____________ RMS No._________

                       (Print or Type and circle, Name of Contractor/Developer)

Address: _________________________________________________________

Reason for Inspection:               Third Inspection             Additional Inspection

Comments: ______________________________________________________________

As provided in the Wastewater Line Extension and Service Standards, a fee shall be
charged for any additional inspections (i.e. a third trip or more), that are scheduled to be
made by the Colorado Springs Utilities Inspector to inspect wastewater lines that have not
been corrected of all deficiencies found during the original or second Closed Circuit
Television (CCTV) Inspection. The fee shall be charged to the Contractor/Developer for
expense incurred by the Colorado Springs Utilities for these services (Chapter 10, Section
10.01, current edition). The following terms and conditions shall apply.

1. Time will be charged for time and materials at the rate of $85.00 per hour (Charges
   include administration, truck/equipment and crew charges).
2. There will be a minimum charge for 4 hours per project inspection (includes travel
   time) of $340.00, payable with this submittal of this Service Contract.
3. Colorado Springs Utilities will calculate total charge for Time and Materials for
   CCTV Inspection and will invoice Contractor/Developer.
4. Receipt for the minimum charge must be presented to CCTV inspector prior to
   commencement of services.
5. CCTV services will be provided on normal business days and hours and no earlier
   than receipt of this contract and minimum payment.
6. The Contractor/Developer agrees to make payment of the total charge for Time and
   Materials for CCTV Inspection for the above, upon receipt of billing. Service charges
   for unpaid bills or late payments, at the rate of (defined in the Colorado Springs
   Utilities tariffs) will occur 30 days after receipt of billing.
7. The City of Colorado Springs and Colorado Springs Utilities shall not be subjected to
   any liability for any deficiency or defect which is not discovered by inspection nor
   shall the owner or developer of the premises be absolved from liability for the
   deficiency or defect and any resulting damage or from responsibility to correct the
   deficiency or defect.
8. Additional terms and

The undersigned representative for the Contractor/Developer represents that he/she has the
legal authority to bind the Contractor/Developer for purposes of this Service Contract.


___________________________________ _________________________________

Signature                                            Signature

Printed or typed name and position         Printed or typed name and position

Date                                       Date

Telephone number                           Telephone number

Contact Name if different than above: