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Borrowed Equipment Agreement
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Application Date
Application Date
First Name
Last Name
Address1
Address2
City
State
Zip
Phone
Date to Pick Up
Date to Pick Up
Purpose
All equipment pick-up and returns located at:
Waconia Public Services Facility
310 10th St. E.
Equipment may be obtained between the hours of 7 a.m. – 3 p.m., Monday through Friday.
A $100.00 deposit is required. The deposit will be refunded upon return of all equipment in good condition.
Note
: Upon return,equipment may not be left anywhere at the facility without first checking in with city staff. Not checking in may result in the loss of your deposit.
Equipment Needed
Cones
Number Needed
Type II Barricades (A-Frame)
Number Needed
8-Foot Barricades
Number Needed
Sandbags
Number Needed
Flashers
Number Needed
Construction Fencing
Number Needed
Posts
Number Needed
Post Pounder
Number Needed
Other, specify
Number Needed
Equipment Return Date
Equipment Return Date
Please Note
Any lost or damaged equipment will be the responsibility of the company / individual borrowing the equipment. The City of Waconia, or any of its employees, shall not be held responsible for any improperly used equipment that causes injury or damage to property.
Signature of Applicant
Date
Date
Checked Out By
Date
Date
Checked In By
Date
Date
Deposit Returned
Billing Required
Missing / Damaged
Date Returned
Date Returned
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Completed By
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