{"id":907,"date":"2024-09-05T15:17:13","date_gmt":"2024-09-05T22:17:13","guid":{"rendered":"https:\/\/www.yakimawa.gov\/services\/utility-services\/?page_id=907"},"modified":"2024-09-05T15:24:20","modified_gmt":"2024-09-05T22:24:20","slug":"water-hydrant-rental-agreement-2","status":"publish","type":"page","link":"https:\/\/www.yakimawa.gov\/services\/utility-services\/water-hydrant-rental-agreement-2\/","title":{"rendered":"Water Hydrant Rental Agreement"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_5' ><form method='post' enctype='multipart\/form-data'  id='gform_5'  action='\/services\/utility-services\/wp-json\/wp\/v2\/pages\/907' data-formid='5' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_5_1\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Water Hydrant Rental Agreement<\/h3><div class='gsection_description' id='gfield_description_5_1'>**PLEASE SPEAK TO STAFF AT PUBLIC WORKS ABOUT YOUR ACCOUNT STATUS BEFORE FILLING THIS FORM OUT.** Before a hydrant can be rented, we require a $200.00 deposit to be paid for these scenarios: 1) for all new customers; 2) current customers with delinquent accounts, whose delinquent bills must also be paid in full; and 3) current customers who haven&#8217;t rented a hydrant for 3 or more years. \nThis deposit amount will be applied to your bill amount once the hydrant is returned. \nIf the deposit paid is more than the bill amount, a refund will be issued from the Finance Department.<\/div><\/div><div id=\"field_5_59\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Water Hydrant Rental Rates:<\/h3><div class='gsection_description' id='gfield_description_5_59'>Daily rental rate: $7.10 per day &#8211; 2026 rate.\nWater consumption cost: $2.47 per cc ft &#8211; 2026 rate. Late fee: $50.00 per day. Additional fees may be applied. <\/div><\/div><fieldset id=\"field_5_53\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-seven-twelfths field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><legend class='gfield_label gform-field-label' >Have you spoken to staff at Public Works today before filling out this form?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_53'>\n\t\t\t<div class='gchoice gchoice_5_53_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='Yes'  id='choice_5_53_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_5_53\"   \/>\n\t\t\t\t\t<label for='choice_5_53_0' id='label_5_53_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_53_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='No'  id='choice_5_53_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_53_1' id='label_5_53_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_5_53'>**PLEASE DO NOT FILL THIS FORM OUT BEFORE SPEAKING TO STAFF AT PUBLIC WORKS.** You can contact them at (509) 575-6154 during normal business hours. <\/div><\/fieldset><div id=\"field_5_54\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-seven-twelfths field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_5_54'>Name of City of Yakima staff you spoke to before filling out this form today:<\/label><div class='ginput_container ginput_container_text'><input name='input_54' id='input_5_54' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_9\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_9'>Today&#039;s Date:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_9' id='input_5_9' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_5_9_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_5_9_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_5_9' class='gform_hidden' value='https:\/\/www.yakimawa.gov\/services\/utility-services\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_5_66\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_66'>Date Hydrant Rented Out (if not today&#039;s date)<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_66' id='input_5_66' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_5_66_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_5_66_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_5_66' class='gform_hidden' value='https:\/\/www.yakimawa.gov\/services\/utility-services\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_5_62\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">CURRENT EXISTING CUSTOMER<\/h3><div class='gsection_description' id='gfield_description_5_62'>If you are a current customer in our system, please select your business\/customer name from this list. If your info is not there, fill out the required fields below and your info will be added for next time. Also, if your contact info on your last billing was incorrect, fill out the fields below to provide the correct info. <\/div><\/div><fieldset id=\"field_5_61\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-seven-twelfths gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >CUSTOMER NAME &amp; ACCOUNT NUMBER<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_61'>\n\t\t\t<div class='gchoice gchoice_5_61_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='New or Existing Customer not on this list - I will fill out the contact info fields below.'  id='choice_5_61_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_5_61\"   \/>\n\t\t\t\t\t<label for='choice_5_61_0' id='label_5_61_0' class='gform-field-label gform-field-label--type-inline'>New or Existing Customer not on this list &#8211; I will fill out the contact info fields below.<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='ABC Fire Control Inc  -  753209'  id='choice_5_61_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_1' id='label_5_61_1' class='gform-field-label gform-field-label--type-inline'>ABC Fire Control Inc  &#8211;  753209<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Albas Excavating  -  782666'  id='choice_5_61_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_2' id='label_5_61_2' class='gform-field-label gform-field-label--type-inline'>Albas Excavating  &#8211;  782666<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='American Rock Products  -  781256'  id='choice_5_61_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_3' id='label_5_61_3' class='gform-field-label gform-field-label--type-inline'>American Rock Products  &#8211;  781256<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Apollo Inc  -  791095'  id='choice_5_61_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_4' id='label_5_61_4' class='gform-field-label gform-field-label--type-inline'>Apollo Inc  &#8211;  791095<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Ascent Excavation  -  788663'  id='choice_5_61_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_5' id='label_5_61_5' class='gform-field-label gform-field-label--type-inline'>Ascent Excavation  &#8211;  788663<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Barefoot Communications Inc  -  793167'  id='choice_5_61_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_6' id='label_5_61_6' class='gform-field-label gform-field-label--type-inline'>Barefoot Communications Inc  &#8211;  793167<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Bore Construction Inc  -  787010'  id='choice_5_61_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_7' id='label_5_61_7' class='gform-field-label gform-field-label--type-inline'>Bore Construction Inc  &#8211;  787010<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_8'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Boyer Mountain pool &amp; excavation inc  -  789415'  id='choice_5_61_8' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_8' id='label_5_61_8' class='gform-field-label gform-field-label--type-inline'>Boyer Mountain pool &amp; excavation inc  &#8211;  789415<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_9'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Brulotte Construction  -  793164'  id='choice_5_61_9' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_9' id='label_5_61_9' class='gform-field-label gform-field-label--type-inline'>Brulotte Construction  &#8211;  793164<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_10'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Budinger &amp; Associates  -  762161'  id='choice_5_61_10' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_10' id='label_5_61_10' class='gform-field-label gform-field-label--type-inline'>Budinger &amp; Associates  &#8211;  762161<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_11'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='CA Precision Drilling LLC  -  789416'  id='choice_5_61_11' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_11' id='label_5_61_11' class='gform-field-label gform-field-label--type-inline'>CA Precision Drilling LLC  &#8211;  789416<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_12'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Catalyss Homes LLC  -  750151'  id='choice_5_61_12' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_12' id='label_5_61_12' class='gform-field-label gform-field-label--type-inline'>Catalyss Homes LLC  &#8211;  750151<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_13'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Central Washington Asphalt  -  799637'  id='choice_5_61_13' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_13' id='label_5_61_13' class='gform-field-label gform-field-label--type-inline'>Central Washington Asphalt  &#8211;  799637<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_14'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='C-More Pipe Services  -  791093'  id='choice_5_61_14' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_14' id='label_5_61_14' class='gform-field-label gform-field-label--type-inline'>C-More Pipe Services  &#8211;  791093<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_15'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Chervenell Construction Co  -  750843'  id='choice_5_61_15' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_15' id='label_5_61_15' class='gform-field-label gform-field-label--type-inline'>Chervenell Construction Co  &#8211;  750843<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_16'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='CM Excavating Services  -  782026'  id='choice_5_61_16' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_16' id='label_5_61_16' class='gform-field-label gform-field-label--type-inline'>CM Excavating Services  &#8211;  782026<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_17'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Columbia Reach Pack  -  792091'  id='choice_5_61_17' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_17' id='label_5_61_17' class='gform-field-label gform-field-label--type-inline'>Columbia Reach Pack  &#8211;  792091<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_18'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Crown Utilities LLC  -  783658'  id='choice_5_61_18' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_18' id='label_5_61_18' class='gform-field-label gform-field-label--type-inline'>Crown Utilities LLC  &#8211;  783658<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_19'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Don Riddle Excavating  -  750216'  id='choice_5_61_19' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_19' id='label_5_61_19' class='gform-field-label gform-field-label--type-inline'>Don Riddle Excavating  &#8211;  750216<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_20'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Elegant Landscaping  -  750765'  id='choice_5_61_20' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_20' id='label_5_61_20' class='gform-field-label gform-field-label--type-inline'>Elegant Landscaping  &#8211;  750765<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_21'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='ESF Solutions LLC  -  767657'  id='choice_5_61_21' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_21' id='label_5_61_21' class='gform-field-label gform-field-label--type-inline'>ESF Solutions LLC  &#8211;  767657<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_22'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Granite Construction  -  751349'  id='choice_5_61_22' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_22' id='label_5_61_22' class='gform-field-label gform-field-label--type-inline'>Granite Construction  &#8211;  751349<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_23'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Graymar Environmental Services  -  793171'  id='choice_5_61_23' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_23' id='label_5_61_23' class='gform-field-label gform-field-label--type-inline'>Graymar Environmental Services  &#8211;  793171<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_24'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Hansen Drilling Co LLC  -  751056'  id='choice_5_61_24' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_24' id='label_5_61_24' class='gform-field-label gform-field-label--type-inline'>Hansen Drilling Co LLC  &#8211;  751056<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_25'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='High Desert Utilities lie  -  787351'  id='choice_5_61_25' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_25' id='label_5_61_25' class='gform-field-label gform-field-label--type-inline'>High Desert Utilities lie  &#8211;  787351<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_26'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Hurst Construction LLC  -  788666'  id='choice_5_61_26' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_26' id='label_5_61_26' class='gform-field-label gform-field-label--type-inline'>Hurst Construction LLC  &#8211;  788666<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_27'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='lnsituform Technologies  LLC  -  753380'  id='choice_5_61_27' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_27' id='label_5_61_27' class='gform-field-label gform-field-label--type-inline'>lnsituform Technologies  LLC  &#8211;  753380<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_28'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='lnterwest Construction Inc.  -  792953'  id='choice_5_61_28' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_28' id='label_5_61_28' class='gform-field-label gform-field-label--type-inline'>lnterwest Construction Inc.  &#8211;  792953<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_29'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Iron Horse LLC  -  788664'  id='choice_5_61_29' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_29' id='label_5_61_29' class='gform-field-label gform-field-label--type-inline'>Iron Horse LLC  &#8211;  788664<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_30'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='ltalstone Marble &amp; Granite  -  788630'  id='choice_5_61_30' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_30' id='label_5_61_30' class='gform-field-label gform-field-label--type-inline'>ltalstone Marble &amp; Granite  &#8211;  788630<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_31'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='John I Haas  -  773133'  id='choice_5_61_31' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_31' id='label_5_61_31' class='gform-field-label gform-field-label--type-inline'>John I Haas  &#8211;  773133<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_32'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Ken Leingang Excavating  -  750695'  id='choice_5_61_32' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_32' id='label_5_61_32' class='gform-field-label gform-field-label--type-inline'>Ken Leingang Excavating  &#8211;  750695<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_33'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Kitt Construction and Development  -  799799'  id='choice_5_61_33' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_33' id='label_5_61_33' class='gform-field-label gform-field-label--type-inline'>Kitt Construction and Development  &#8211; 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 761376<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_37'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='LS Networks  -  787986'  id='choice_5_61_37' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_37' id='label_5_61_37' class='gform-field-label gform-field-label--type-inline'>LS Networks  &#8211;  787986<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_38'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Lunder Underground Services  -  793168'  id='choice_5_61_38' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_38' id='label_5_61_38' class='gform-field-label gform-field-label--type-inline'>Lunder Underground Services  &#8211;  793168<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_39'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='M.C. Lundgren Inc  -  751078'  id='choice_5_61_39' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_39' id='label_5_61_39' class='gform-field-label gform-field-label--type-inline'>M.C. Lundgren Inc  &#8211;  751078<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_40'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='McNamara Pools LLC  -  773347'  id='choice_5_61_40' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_40' id='label_5_61_40' class='gform-field-label gform-field-label--type-inline'>McNamara Pools LLC  &#8211;  773347<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_41'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='MJ Hughes Construction  -  787676'  id='choice_5_61_41' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_41' id='label_5_61_41' class='gform-field-label gform-field-label--type-inline'>MJ Hughes Construction  &#8211;  787676<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_42'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Motion State  -  793170'  id='choice_5_61_42' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_42' id='label_5_61_42' class='gform-field-label gform-field-label--type-inline'>Motion State  &#8211;  793170<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_43'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='N.A. Degerstrom Inc  -  788665'  id='choice_5_61_43' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_43' id='label_5_61_43' class='gform-field-label gform-field-label--type-inline'>N.A. 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 788786<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_50'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Powerhouse Flats Apts  -  783028'  id='choice_5_61_50' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_50' id='label_5_61_50' class='gform-field-label gform-field-label--type-inline'>Powerhouse Flats Apts  &#8211;  783028<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_51'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Precision Paving  -  750206'  id='choice_5_61_51' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_51' id='label_5_61_51' class='gform-field-label gform-field-label--type-inline'>Precision Paving  &#8211;  750206<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_52'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Riddco Inc  -  791729'  id='choice_5_61_52' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_52' id='label_5_61_52' class='gform-field-label gform-field-label--type-inline'>Riddco Inc  &#8211;  791729<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_53'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Russell Crane Service Inc  -  751058'  id='choice_5_61_53' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_53' id='label_5_61_53' class='gform-field-label gform-field-label--type-inline'>Russell Crane Service Inc  &#8211;  751058<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_54'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Stephens and Sons Inc  -  801900'  id='choice_5_61_54' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_54' id='label_5_61_54' class='gform-field-label gform-field-label--type-inline'>Stephens and Sons Inc  &#8211;  801900<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_55'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Stone Church  -  732569'  id='choice_5_61_55' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_55' id='label_5_61_55' class='gform-field-label gform-field-label--type-inline'>Stone Church  &#8211;  732569<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_56'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Superior Grading &amp; Paving LLC  -  747176'  id='choice_5_61_56' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_56' id='label_5_61_56' class='gform-field-label gform-field-label--type-inline'>Superior Grading &amp; Paving LLC  &#8211;  747176<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_57'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Swofford Excavating  -  791492'  id='choice_5_61_57' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_57' id='label_5_61_57' class='gform-field-label gform-field-label--type-inline'>Swofford Excavating  &#8211;  791492<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_58'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='The Perfect Clean  -  792095'  id='choice_5_61_58' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_58' id='label_5_61_58' class='gform-field-label gform-field-label--type-inline'>The Perfect Clean  &#8211;  792095<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_59'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Total Site Services  -  762979'  id='choice_5_61_59' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_59' id='label_5_61_59' class='gform-field-label gform-field-label--type-inline'>Total Site Services  &#8211;  762979<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_60'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Tri Valley Construction  -  750202'  id='choice_5_61_60' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_60' id='label_5_61_60' class='gform-field-label gform-field-label--type-inline'>Tri Valley Construction  &#8211;  750202<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_61'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='TTC Construction  -  750282'  id='choice_5_61_61' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_61' id='label_5_61_61' class='gform-field-label gform-field-label--type-inline'>TTC Construction  &#8211;  750282<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_62'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='VFS Excavating  -  738102'  id='choice_5_61_62' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_62' id='label_5_61_62' class='gform-field-label gform-field-label--type-inline'>VFS Excavating  &#8211;  738102<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_63'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='WA State DNR Wildland Fire MGMT Div  -  800392'  id='choice_5_61_63' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_63' id='label_5_61_63' class='gform-field-label gform-field-label--type-inline'>WA State DNR Wildland Fire MGMT Div  &#8211;  800392<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_64'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Westrock Longview, LLC  -  799406'  id='choice_5_61_64' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_64' id='label_5_61_64' class='gform-field-label gform-field-label--type-inline'>Westrock Longview, LLC  &#8211;  799406<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_65'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Westwood Company LLC  -  792093'  id='choice_5_61_65' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_65' id='label_5_61_65' class='gform-field-label gform-field-label--type-inline'>Westwood Company LLC  &#8211;  792093<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_66'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Yakima Landscape Mgmt  -  788662'  id='choice_5_61_66' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_66' id='label_5_61_66' class='gform-field-label gform-field-label--type-inline'>Yakima Landscape Mgmt  &#8211;  788662<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_67'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Yakima Pressure Cleaning  -  750162'  id='choice_5_61_67' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_67' id='label_5_61_67' class='gform-field-label gform-field-label--type-inline'>Yakima Pressure Cleaning  &#8211;  750162<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_61_68'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Yakima School District #7 - 750657'  id='choice_5_61_68' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_61_68' id='label_5_61_68' class='gform-field-label gform-field-label--type-inline'>Yakima School District #7 &#8211; 750657<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_5_61'>Please select your business name. By selecting this field and not filling out the info below for your account info you are saying that all of your contact info we have on file is current and accurate. If you need to update any of your info, please also fill out those fields below. <\/div><\/fieldset><fieldset id=\"field_5_3\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Applicant Name:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_5_3'>\n                            \n                            <span id='input_5_3_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.3' id='input_5_3_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_5_3_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_5_3_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.6' id='input_5_3_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_5_3_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><div class='gfield_description' id='gfield_description_5_3'>Person who is on site to rent hydrant.<\/div><\/fieldset><div id=\"field_5_16\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_16'>Applicant Phone Number:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_16' id='input_5_16' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_65\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_65'>Customer Drivers&#039; License Number (Required)<\/label><div class='ginput_container ginput_container_text'><input name='input_65' id='input_5_65' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_21\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-two-thirds field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_21'>Customer Drivers&#039; License Photo<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='65536000' \/><input name='input_21' id='input_5_21' type='file' class='large' aria-describedby=\"gfield_upload_rules_5_21 gfield_description_5_21\" onchange='javascript:gformValidateFileSize( this, 65536000 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_5_21'>Max. file size: 63 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_5_21'><\/div> <\/div><div class='gfield_description' id='gfield_description_5_21'>Please take a photo of your ID and attach here. ** If the form doesn&#8217;t allow you to submit it with this photo, remove the photo.**<\/div><\/div><div id=\"field_5_63\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">NEW CUSTOMER INFO<\/h3><div class='gsection_description' id='gfield_description_5_63'>If you are a new customer without an existing account number, or if you are an existing customer and your account name and number aren&#8217;t on the list above, fill out the fields below. Your account will be added to the list above for next time. <\/div><\/div><fieldset id=\"field_5_5\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-two-thirds field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >NEW CUSTOMER &#8211; Organization\/Company Name<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name no_last_name no_suffix gf_name_has_1 ginput_container_name gform-grid-row' id='input_5_5'>\n                            \n                            <span id='input_5_5_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_5.3' id='input_5_5_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_5_5_3' class='gform-field-label gform-field-label--type-sub '>Business Name<\/label>\n                                                <\/span>\n                            \n                            \n                            \n                        <\/div><div class='gfield_description' id='gfield_description_5_5'>Name of business, if applicable and if it&#8217;s different than the customer name.<\/div><\/fieldset><fieldset id=\"field_5_64\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Applicant Name:<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_5_64'>\n                            \n                            <span id='input_5_64_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_64.3' id='input_5_64_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_5_64_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_5_64_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_64.6' id='input_5_64_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_5_64_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><div class='gfield_description' id='gfield_description_5_64'>Person who is on site to rent hydrant.<\/div><\/fieldset><div id=\"field_5_56\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-seven-twelfths field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_56'>Customer ID: Tax ID number, UBI number, or Drivers&#039; License Number &#8211; REQUIRED<\/label><div class='ginput_container ginput_container_text'><input name='input_56' id='input_5_56' type='text' value='' class='large'  aria-describedby=\"gfield_description_5_56\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_5_56'>Enter your tax ID number, UBI number, or government issued ID number such as a driver&#8217;s license. <\/div><\/div><div id=\"field_5_6\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-seven-twelfths field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_6'>Customer Phone Number:<\/label><div class='ginput_container ginput_container_phone'><input name='input_6' id='input_5_6' type='tel' value='' class='large'    aria-invalid=\"false\" aria-describedby=\"gfield_description_5_6\"  \/><\/div><div class='gfield_description' id='gfield_description_5_6'>If it&#8217;s different than the applicant phone number provided above.<\/div><\/div><div id=\"field_5_25\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-seven-twelfths field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_25'>Email Address:<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_25' id='input_5_25' type='email' value='' class='medium'     aria-invalid=\"false\" aria-describedby=\"gfield_description_5_25\" \/>\n                        <\/div><div class='gfield_description' id='gfield_description_5_25'>Entering your email will send you a copy of this form and your bill once the hydrant is returned and your account is billed.<\/div><\/div><fieldset id=\"field_5_7\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-two-thirds field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Mailing Address:<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_5_7' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_5_7_1_container' >\n                                        <input type='text' name='input_7.1' id='input_5_7_1' value=''    aria-required='false'    \/>\n                                        <label for='input_5_7_1' id='input_5_7_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_5_7_2_container' >\n                                        <input type='text' name='input_7.2' id='input_5_7_2' value=''     aria-required='false'   \/>\n                                        <label for='input_5_7_2' id='input_5_7_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_5_7_3_container' >\n                                    <input type='text' name='input_7.3' id='input_5_7_3' value=''    aria-required='false'    \/>\n                                    <label for='input_5_7_3' id='input_5_7_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_5_7_4_container' >\n                                        <select name='input_7.4' id='input_5_7_4'     aria-required='false'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_5_7_4' id='input_5_7_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_5_7_5_container' >\n                                    <input type='text' name='input_7.5' id='input_5_7_5' value=''    aria-required='false'    \/>\n                                    <label for='input_5_7_5' id='input_5_7_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_7.6' id='input_5_7_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_5_17\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-two-thirds field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Street Address:<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_5_17' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_5_17_1_container' >\n                                        <input type='text' name='input_17.1' id='input_5_17_1' value=''    aria-required='false'    \/>\n                                        <label for='input_5_17_1' id='input_5_17_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_5_17_2_container' >\n                                        <input type='text' name='input_17.2' id='input_5_17_2' value=''     aria-required='false'   \/>\n                                        <label for='input_5_17_2' id='input_5_17_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_5_17_3_container' >\n                                    <input type='text' name='input_17.3' id='input_5_17_3' value=''    aria-required='false'    \/>\n                                    <label for='input_5_17_3' id='input_5_17_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_5_17_4_container' >\n                                        <select name='input_17.4' id='input_5_17_4'     aria-required='false'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_5_17_4' id='input_5_17_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_5_17_5_container' >\n                                    <input type='text' name='input_17.5' id='input_5_17_5' value=''    aria-required='false'    \/>\n                                    <label for='input_5_17_5' id='input_5_17_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_17.6' id='input_5_17_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><div class='gfield_description' id='gfield_description_5_17'>If different from mailing address. <\/div><\/fieldset><div id=\"field_5_55\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-three-quarter field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_5_55'>Customer Account Number:<\/label><div class='ginput_container ginput_container_number'><input name='input_55' id='input_5_55' type='number' step='any'   value='' class='large'      aria-invalid=\"false\" aria-describedby=\"gfield_description_5_55\" \/><\/div><div class='gfield_description' id='gfield_description_5_55'>Account number will be provided by City of Yakima staff if you don&#8217;t know it. Account numbers are 6 digits long and start with a 6 or 7. If you are not on site at a City of Yakima facility, call the Water Dept. at 509-575-6154 or Utility Services at 509-575-6080 for your account number. <\/div><\/div><div id=\"field_5_14\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-two-thirds field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_5_14'>Customer Account Number:<\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_5_14' type='text' value='' class='medium'  aria-describedby=\"gfield_description_5_14\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_5_14'>Account number will be provided by City of Yakima staff if you don&#8217;t know it. If you are not on site at a City of Yakima facility, call the Water Dept. at 509-575-6154 or Utility Services at 509-575-6080 for your account number. <\/div><\/div><div id=\"field_5_60\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">DEPOSIT<\/h3><div class='gsection_description' id='gfield_description_5_60'>**PLEASE ONLY SELECT YES IF YOU HAVE OR ARE REQUIRED TO PAY A DEPOSIT AT PUBLIC WORKS **FOR THE HYDRANT YOU&#8217;RE RENTING TODAY** AND THEY GAVE YOU THE RECEIPT NUMBER FOR THAT PAYMENT.** DO NOT SELECT YES IF YOU HAVE PREVIOUSLY PAID A DEPOSIT FOR A PREVIOUS HYDRANT RENTAL.<\/div><\/div><fieldset id=\"field_5_22\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-five-sixths gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Deposit Paid:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_22'>\n\t\t\t<div class='gchoice gchoice_5_22_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Yes - ONLY CHECK THIS BOX IF YOU PAID A DEPOSIT TODAY.'  id='choice_5_22_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_5_22\"   \/>\n\t\t\t\t\t<label for='choice_5_22_0' id='label_5_22_0' class='gform-field-label gform-field-label--type-inline'>Yes &#8211; ONLY CHECK THIS BOX IF YOU PAID A DEPOSIT TODAY.<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_22_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='No - No deposit was required or paid.'  id='choice_5_22_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_22_1' id='label_5_22_1' class='gform-field-label gform-field-label--type-inline'>No &#8211; No deposit was required or paid.<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_5_22'>\nIf you don&#8217;t know if you are required to pay a deposit today or if your account is delinquent, please contact City of Yakima water dept. at 509-575-6154 or Utility Services at 509-575-6080 for those inquiries. All new customers, any customers with delinquent amounts owing on their existing account, and customers who have an existing account but haven&#8217;t rented a hydrant in 3 or more years will be required to pay a $200.00 deposit. All delinquent amounts must also be paid before a new hydrant will be rented. This deposit amount will be applied to your bill amount once the hydrant is returned. <\/div><\/fieldset><div id=\"field_5_32\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-seven-twelfths field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_32'>Deposit Receipt #:<\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_5_32' type='text' value='' class='large'  aria-describedby=\"gfield_description_5_32\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_5_32'>Receipt number will be provided by Public Works Admin staff after payment is received each time  you have to pay a deposit.<\/div><\/div><div id=\"field_5_11\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_11'>Hydrant Use Location:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_5_11' type='text' value='' class='large'  aria-describedby=\"gfield_description_5_11\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_5_11'>List location\/s hydrant will be used at.<\/div><\/div><fieldset id=\"field_5_18\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-two-thirds gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Reason for Rental:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_18'>\n\t\t\t<div class='gchoice gchoice_5_18_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Car Wash'  id='choice_5_18_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_18_0' id='label_5_18_0' class='gform-field-label gform-field-label--type-inline'>Car Wash<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_18_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Construction'  id='choice_5_18_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_18_1' id='label_5_18_1' class='gform-field-label gform-field-label--type-inline'>Construction<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_18_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Dust Control'  id='choice_5_18_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_18_2' id='label_5_18_2' class='gform-field-label gform-field-label--type-inline'>Dust Control<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_18_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='gf_other_choice'  id='choice_5_18_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_18_3' id='label_5_18_3' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_5_18_other' class='gchoice_other_control' name='input_18_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_5_19\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >RENTAL AGREEMENT<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_19.1' id='input_5_19_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_5_19\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_5_19_1' >I agree to the rental agreement terms below and confirm the information provided is correct.<\/label><input type='hidden' name='input_19.2' value='I agree to the rental agreement terms below and confirm the information provided is correct.' class='gform_hidden' \/><input type='hidden' name='input_19.3' value='5' class='gform_hidden' \/><\/div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_5_19' tabindex='0'>I.  The hydrant meter assembly must be utilized to measure all water dispensed from fire hydrant. <br \/>\n2.  The hydrant meter assembly and accessories must be returned in good serviceable condition.<br \/>\n3.  Water meter assemblies shall not be rented for more than 30 consecutive days (day I is first day of rental). Water meter assemblies shall be returned to the Water\/ Irrigation Division for a read and inspection at the end of the rental period. A late fee of $50.00 per day will be assessed for water meter assemblies kept longer than 30 days per Y MC 7.68.25 1.<br \/>\n4.  Payment will be made by the applicant\/company for all water dispensed and rental dates listed on Hydrant Meter Rental Agreement.<br \/>\n5.  If the hydrant meter assembly is lost, broken, or altered by the applicant, the applicant shall be responsible for the necessary repairs or charges for replacement of the meter, meter fittings, accessories or sign.<br \/>\n6.  If the hydrant meter is stolen or lost, please contact the Water\/ Irrigation Division at 575-6154 by the next business day.<br \/>\n7.  Only City Personnel are authorized to make any modifications, adjustments, or repairs to the hydrant meter assembly or hydrant. For any malfunctions return the assembly to the City of Yakima Water\/Irrigation Division at 2301 Fruitvale Blvd, Yakima.<br \/>\n8.  The Permitted Fire Hydrant Use sign must be clearly visible on the fire hydrant.<br \/>\n9.  If left unattended, the meter will be removed by the Water\/ Irrigation Division. If the meter is kept more than ten (I0) days after the Date of Return listed above, the Water\/ Irrigation Division may remove the meter (including the sign) and charge the applicant the cost of removal, including labor and time spent costs in addition to the late fee and any other costs associated with this Agreement.<br \/>\nI0.  Prior to using a City fire hydrant, please inform the Fire Department 248-2 103 of the location and day(s) for use.<br \/>\n11.  Upon return of the Hydrant Meter Assembly a meter read will be recorded and the assembly assessed for damage. A billing statement will be sent by the Finance Division to the mailing address listed above. If you have any questions or require assistance please contact the City of Yakima Water\/ Irrigation Division at 575-6154.<br \/>\n12.  If the meter is not returned within fifteen (15) days of the end of this rental agreement, the City may enter the property on which the meter is located and repossess the meter with no notice, or enter the property on which the applicant is located and repossess the meter. In the event the meter is not located as indicated in this agreement, the City may charge the applicant with theft.<\/div><\/fieldset><div id=\"field_5_20\" class=\"gfield gfield--type-signature gfield--input-type-signature gfield--width-three-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_20'>Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><input type='hidden' value='' name='input_20' id='input_5_20_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_5_20_Container' class='gfield_signature_container ginput_container' style='height:180px; width:300px; ' ><canvas id='input_5_20' width='300' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#FFFFFF; cursor: url(https:\/\/www.yakimawa.gov\/services\/utility-services\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_5_20_toolbar' style='margin:5px 0;position:relative;height:20px;width:300px;max-width:100%;'><img id = 'input_5_20_resetbutton' src='data:image\/png;base64,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' style='cursor:pointer;float:right;height:24px;width:24px;border:0px solid transparent' alt='Clear Signature' \/ ><\/div><input type='hidden' id='input_5_20_data' name='input_5_20_data' value=''><\/div><\/div><div id=\"field_5_48\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">FOR OFFICIAL CITY OF YAKIMA USE ONLY<\/h3><div class='gsection_description' id='gfield_description_5_48'>All fields below are for City Of Yakima staff use only. <\/div><\/div><div id=\"field_5_39\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">HYDRANT #: ______________________________<\/h3><\/div><div id=\"field_5_49\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">HYDRANT DUE DATE: ______________________________<\/h3><\/div><div id=\"field_5_40\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">CHECK OUT DATE: ______________________________<\/h3><\/div><div id=\"field_5_46\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">CHECK IN DATE: ______________________________<\/h3><\/div><div id=\"field_5_45\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">METER READ AT CHECK OUT: ______________________________<\/h3><\/div><div id=\"field_5_44\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">METER READ AT CHECK IN: ______________________________<\/h3><\/div><div id=\"field_5_43\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">CHECKED OUT WITH WRENCH:  YES  \/  NO<\/h3><\/div><div id=\"field_5_42\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">CHECKED OUT WITH SIGN:  YES  \/  NO<\/h3><\/div><div id=\"field_5_41\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">RENTED SIGN #: ______________________________<\/h3><\/div><div id=\"field_5_50\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">CHECKED IN WITH WRENCH:  YES  \/  NO<\/h3><\/div><div id=\"field_5_51\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">CHECKED IN WITH SIGN:  YES  \/  NO<\/h3><\/div><div id=\"field_5_47\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">ADDITIONAL CHARGES OR NOTES:<\/h3><div class='gsection_description' id='gfield_description_5_47'>_____________________________________________________________________________<\/div><\/div><div id=\"field_5_67\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">** If the form doesn&#039;t allow you to submit it due to the file size of the drivers license photo, remove the photo and submit again.**<\/h3><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_5' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' 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