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Statement to Hold Harmless

  1. Statement of Agreement

    I/We , the undersigned, will not hold, The Public Works Department, Billings, Montana, responsible for any damage incurred if the TENANTS/OCCUPANTS are not home, IN ALL UNITS, when the water is turned back on after being shut off.

  2. Signature Acknowledgement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  3. Enter your full legal name

  4. Leave This Blank:

  5. This field is not part of the form submission.