Bicycle Locker Rental Agreement New
Instructions: Before completing this form, call 863-9094 for locker availability. Then complete
this form and return it with total fees to the Department of Public Works, 645 Pine Street,
Burlington VT 05401. You should receive your locker key and a copy of this agreement within ten
business days after receipt of this completed agreement.
Non-refundable rental fee Refundable key deposit Total fee
$30 + $50 = $80
* lockers are only available for 6-month rentals, but may be eligible for renewal.
* key deposit is only required with a new rental, or with a renewal that expended the key deposit
Name (print clearly) Phone
Address City State Zip
Termination of Agreement: Inspection:
Failure to renew will result in termination of this The City of Burlington reserves the right to open and inspect
agreement. In the event you wish to terminate this bike lockers at any time, for any reason and without notice in
agreement before the end of your rental period, contact order to ensure they are being used in a manner consistent
DPW and arrange a time to return the key. Upon receipt with their intended use. Lockers may also be opened at any
of the key, the key deposit will be returned to you by time without notice in order to perform necessary
mailed check. The rental fee is non-refundable. maintenance.
Permitted Use: Liability Limits:
Your assigned locker shall be used only for the purpose While bicycle lockers provide an additional level of security
of securing a bicycle and bicycle-related equipment. over regular bicycle racks, they are not guaranteed against
Under NO circumstances may the bicycle locker be used theft or damage. The City of Burlington is not responsible for
for any other purpose. Any items stored within the any damages to any items left in t he locker resulting from
locker that are not bicycle related may be removed by any cause. You are responsible for ensuring the locker is
the City your expense and may be subject to disposal properly secured.
without your consent. Items removed from your locker
may be subject to a reasonable storage fee that must be
paid prior to the release of any item.
The undersigned has read this Bicycle Locker Rental Agreement and agrees to its terms and conditions.
Signature of renter Date
Terms of Agreement Locker/Key Assignment
DEPARTMENT Agreement Start Date Agreement End Date
/ / / /
Locker number Key number