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Borrowed Equipment Agreement

2. Application Date
   Application Date

4. First Name

5. Last Name

7. Address1

9. Address2

11. City

12. State

13. Zip

15. Phone

16. Date to Pick Up
    Date to Pick Up

18. Purpose

20. All equipment pick-up and returns located at: <BR>Waconia Public Services Facility<BR>310 10th St. E.<BR><BR>Equipment may be obtained between the hours of 7 a.m. – 3 p.m., Monday through Friday.<BR><BR>A $100.00 deposit is required. The deposit will be refunded upon return of all equipment in good condition.<BR><BR><b>Note</b>: 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.

    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.

22. Equipment Needed

24. Cones

    Cones

25. Number Needed

27. Type II Barricades (A-Frame)

    Type II Barricades (A-Frame)

28. Number Needed

30. 8-Foot Barricades

    8-Foot Barricades

31. Number Needed

33. Sandbags

    Sandbags

34. Number Needed

36. Flashers

    Flashers

37. Number Needed

39. Construction Fencing

    Construction Fencing

40. Number Needed

42. Posts

    Posts

43. Number Needed

45. Post Pounder

    Post Pounder

46. Number Needed

48. Other, specify

49. Number Needed

51. Equipment Return Date
    Equipment Return Date

53. 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.

    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.

55. Signature of Applicant

56. Date
    Date

60. Checked Out By

61. Date
    Date

63. Checked In By

64. Date
    Date

66. 1. Deposit Returned
    2. Billing Required
    3. Missing / Damaged

67. Date Returned
    Date Returned

69. Specify

71. Completed By

Leave This Blank:


73. 1. Receive an email copy of this form.
74. Email address

    This field is not part of the form submission.

75. Submit Submit and Print

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