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South Toledo Bend Water District

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    South Toledo Bend Water District

     3260 Little Flock Road ? Many, LA. 71449

    (318) 586-9836

    METER CONNECTION

_________________________ Date:__________________________

    _________________________

    _________________________

REFERENCE: Customer Account No.________________________

     Meter Serial No. ________________________

Dear Customer:

     You are required to fill out the attached user’s agreement and return it to our office at the above address

    before any connection or transfer can be completed. Failure to return user’s agreement is just cause for meter to be disconnected. A meter reconnect fee is $ 50.00. Any question may be directed to (318) 586-9836.

INFO: (Check appropriate box)

     ? BASIC RATE: $22.00 includes 1,000 gallons; $ 4.20 for every 1,000 gallons thereafter; $3.20

     annual state administration fee of $3.20 billed on August bills.

     ? Annual Plan: $264.00 includes 12,000 gallons to be used in a year period starting in June

     plus $4.20 per 1,000 gallons thereafter.

    ? Commercial rate plan: (CUSTOMER MUST CHOOSE ONE OF TWO OPTIONS)

    ? FOR 0-5000 GALLONS USE = $ 44.00

    ? FOR 0-14000 GALLONS USE = $ 70.00

    FOR OVER REQUIRED USAGE PER 1,000 = $ 4.20

     Meters are read on the 6th through the 10th of every month

     Billing is prepared and mailed out around 15th of every month

     th Bill becomes due the 1st of the following month. 10% or Minimum $4.00 late charge after the 10; subject to thdisconnect if not paid by the 30; reconnect fee is $ 50.00; Administration fee of $25.00 for NSF checks and

    transfers.

     A surety deposit of $100.00 is required on all rental units or sites. The surety deposit will be waived with a

    land deed or letter of credit.

    785218033.doc Revised By: Dianne Lampman 2-1-13

     Bills are paid to: SOUTH TOLEDO BEND WATER DISTRICT

     P.O. BOX 60

     MANY, LA 71449

     Questions about billings or collections: 1-318-256-2725 or 256-5714

     Address problems to: SOUTH TOLEDO BEND WATER DISTRICT

     3260 LITTLE FLOCK RD

     MANY, LA 71449

     TEL: (318) 586-9836

    "KEEP THIS LETTER FOR REFERENCE"

    785218033.doc Revised By: Dianne Lampman 2-1-13

    South Toledo Bend Water District

     3260 Little Flock Road ? Many, LA. 71449

    WATER USER AGREEMENT

    PLEASE COMPLETE AND RETURN

    This Agreement, between SOUTH TOLEDO BEND WATER DISTRICT, organized and existing under and by

    virtue of the laws of the State of Louisiana, hereinafter called the District and____________________________________ hereinafter called the Member,

    WITNESSETH

     WHEREAS, the Member desires to purchase farmstead, domestic and/or commercial water from the District and to enter into a water users agreement as required by the By-laws of the District.

     NOW THEREFORE, in consideration of the mutual covenants, promises, and agreements herein contained, it is hereby understood and agreed:

     The District shall furnish, subject to the limitations set out in Rules and Regulations and By-laws and those hereinafter provided for, such quantity of water for domestic, livestock, garden, and industrial and commercial purposes as the Member may desire in connection with his occupancy of the following described property:

    PLEASE PRINT LEGAL PROPERTY DESCRIPTION OF SUBDIVISION & LOT # (or attach a copy of the legal

    description in your Bill of Sale).

     Provided, however, that:

     The Member hereby grants the District, its successors or assigns, a perpetual easement in, over, under, and upon the above described land with the right to erect, construct, install, and lay, and hereafter use, operate and inspect, repair, maintain, replace and remove water pipelines and appurtenant facilities, together with the right of ingress and egress over adjacent land for the purpose mentioned above. The width of said easement shall not be less than 10’ from the road right-

    of-way.

     This servitude is made and accepted for and in consideration of the value of the availability of a water supply to GRANTORS’ property together with other good and valuable consideration.

     TO HAVE AND TO HOLD said easements, rights, and right-of-way unto said GRANTEE, its successors and assigns until said easement be exercised, and so long thereafter as the same shall be useful for the above named purpose.

     The Member shall install and maintain at his own expense a service line that shall begin at the meter and extend to the dwelling or places of use. The service line shall connect with the distribution system of the District at the nearest place of desired use by the Member, provided the District has determined in advance that the District Water is of sufficient capacity to permit delivery of water at that point.

    785218033.doc Revised By: Dianne Lampman 2-1-13

     The Member agrees to pay for water at such rates, time, and place as shall be determined by the District, and agrees to the penalties for noncompliance with the above non-payment of water charges as set out in the current Rules and ndRegulations. If a Member has more than one home located on his premises, the second (2) home would require its own

    meter and own water line to connect it to the water system and $100.00 surety deposit would be required for that residence.

     The District shall purchase and install a cutoff valve and may also include a water meter in each service. The District shall have exclusive right to use cutoff valve and water meter, and to turn it on and off.

     The District shall have final jurisdiction in any question of location of any service line connection to its distribution system; shall determine the allocation of water to Members in the event of a water shortage; may shut off water to a Member who allows a connection or extension to be made to his service line for the purpose of supplying water to another user. In the event the total water supply shall be insufficient to meet all the needs of the Members, or in the event there is a shortage of water, the District may prorate the water available among the various Members on such basis as is deemed equitable by the Board of Commissioners, and may also prescribe a schedule of hours covering the use of water for garden and lawn purposes by particular Members and require adherence thereto or prohibit the use of water for garden and lawn purposes; provided that, if at any time the total water supply shall be insufficient to meet all the needs of the Members, the District must first satisfy all of all Members for both domestic and livestock purposes before supplying any water for garden and lawn purposes.

     The Members agrees to comply with the requirements of the Louisiana State Board of Health that no other present or future sources of water will be connected to any water lines served by the District’s water lines and will disconnect

    from his present water supply prior to connecting to and switching over to the District’s system.

     The Member shall connect his service lines to the District’s distribution system and shall commence to use water

    from the system on the date the water is made available to the Member by the District. Water charges to the Member shall commence on the date that the service is made available.

     The Board of Commissioners shall have the authority to sell the membership of any Member in the event of nonpayment of any charges or assessments owing by said Member within thirty (30) days after demand for payment by mail, properly addressed to the last known address of such delinquent Member. The proceeds of any sale of membership over and above the amount due the District shall be returned to the delinquent Member. In lieu of such sale of membership, the Board of Commissioners may purchase the membership on behalf of the District at a price determined by the Commissioners to be fair value of the membership, provided that in the event of either a sale of the membership or the purchase thereof by the District the proceeds shall be first applied to the payment of any indebtedness due the District by the delinquent Member.

     In the event the Member shall breach this contract by (1) refusing or failing, without just cause, to connect his service line to the District’s distribution system as set forth above, or (2) refusing or failing, without just cause, to pay the

    minimum monthly water rate as established by the District, upon the occurrence of either of said events the Member agrees to forfeit his membership fee.

     The failure of a customer to pay water charges duly imposed shall result in the automatic imposition of the following penalties:

    1. Nonpayment within ten (10) days from the due date will be subject to a penalty of ten (10) percent of the

    delinquent account balance or $4.00.

    2. Nonpayment within thirty (30) days from the due date will result in the water being shut off from the

    Member’s property.

    3. In the event it becomes necessary for the District to shut off the water from a Member’s property, a fee of

    fifty ($50.00) Dollars will be charged for a reconnection of the service.

785218033.doc Revised By: Dianne Lampman 2-1-13

    4. If a customer issues more than one (1) NSF or HOT CHECK to South Toledo Bend Water District within a ndsix (6) month period of time, the customer shall be notified upon the second (2) occurrence that CHECKS

    WILL NO LONGER BE ACCEPTED AND ONLY A MONEY ORDERS WILL BE ACCEPTED as ndpayment of all future customer bills. Proper notice will be sent to the customer with the second (2) NSF

    check received.

    The Notice will state that non-payment within fifteen (15) days shall cause the NSF check amount and

    collection fee of $25.00 to be added back to the customer’s account, causing the account balance to become

    past due and subject to disconnection. Furthermore, if customer service is disconnected, a $50.00 reconnect

    charge will also be assessed to the customer account and reconnection will only be approved after full

    payment of all charges or proper arrangements for payment have been made for service to be reconnected.

    Water service will only be reconnected during regular business hours (Monday-Friday 7:00 a.m. to 3:00 p.m.).

I have read and fully understand this WATER USER AGREEMENT

     __________________________________

     Member’s Signature

Number of Family Members at this meter’s location: ______________

Address of meter location:____________________________________

Telephone number at meter location: ___________________________

    Telephone number at your residence, if different than telephone number at meter location:_________________________

Cell phone number:________________________________________________________

EMAIL ADDRESS: _______________________________________________________

    Note: Please keep us up to date on your email address in case we need to issue a BOIL ADVISORY for your meter

    location.

IN WITNESS WHEREOF,

    We have hereunto executed this agreement this _____ day of _______________, 20_____ in duplicate of original.

ATTEST: BY: __________________________________

    "South Toledo Bend Water is an Equal Opportunity Employer"

785218033.doc Revised By: Dianne Lampman 2-1-13

    South Toledo Bend Water District

     3260 Little Flock Road ? Many, LA. 71449

    (318) 586-9836

    November 9, 2010

    Dear New Member:

    South Toledo Bend Water District shall assess an administrative fee of $100.00 per occurrence for any non-compliance of

    the WATER USER’S AGREEMENT.

    The Water District shall file criminal theft charges on any individual bypassing a meter, meter locktying into a line ,

    without a meter, or stealing water by any other means.

    Any unauthorized individual who tampers with any lines, meters, etc. is also in violation of public health regulations of the

    State of Louisiana.

    Please help us maintain the integrity of our water system and the quality of the water you drink and use. Any violations may be

    reported to the South Toledo Bend Water District at 318?586?9836 or to any board member.

    Sincerely,

    SOUTH TOLEDO BEND WATER DISTRICT

    Dianne Lampman

    Dianne Lampman, President Board

    CONSUMER CONFIDENCE REPORT (CCR) INFORMATION:

    OUR 2011 ANNUAL WATER QUALITY REPORT WAS PUBLISHED IN THE SABINE INDEX ON 4-25-12. IN THE EVENT

    THAT YOU DID NOT GET AN OPPORTUNITY TO REVIEW THE REPORT, YOU MAY FIND IT ON OUR WEBSITE:

    www.toledo-bend.net/stbwd

    OUR WEBSITE ALSO PROVIDES VALUABLE INFORMATION REGARDING OUR BOARD OF COMMISSIONERS,

    OPERATORS AND OPERATIONS, RATES AND FEE SCHEDULE, TIPS FOR WATER CONSERVATION, ANNUAL

    PAYMENT PLAN, CUSTOMER INFORMATION AND SEVERAL MORE TOPICS.

    785218033.doc Revised By: Dianne Lampman 2-1-13 SHOULD YOU HAVE A QUESTION OR CONCERN, PLEASE CALL OUR PLANT (318) 586-9836 AND SOMEONE

    WILL ASSIST YOU. WE APPRECIATE OUR CUSTOMER AND YOU ARE ALWAYS WELCOME AT THE MEETING OF OUR BOARD MONTHLY AT THE WATER PLANT ON THE SECOND TUESDAY OF EACH MONTH AT 9:00 A.M.

     "South Toledo Bend Water is an Equal Opportunity Employer"

    South Toledo Bend Water District

     3260 Little Flock Road ? Many, LA. 71449

    Applicant Questionnaire

South Toledo Bend Water District is required by State and Federal Regulations to provide information on

    applicants that is used to compile statistical data and maintain records of certain characteristics of customers, employees and board of directors. This information is to be available for Rural Development to review at compliance reviews and also for the Civil Rights Coordinator to review at his/her discretion. To enable us to meet these requirements, we request your cooperation in completing this form. This information will be used for the specific purposes stated above and will be kept separate from your application. None of the information will be used to discriminate against or give preference to any individual.

    PLEASE COMPLETE AND RETURN

Printed Name: ______________________________________

A. Racial Data:

    O White

    All persons having origins in any of the original people of Europe, North Africa, or the Middle East.

    O Africa American

    All persons having origins in any of the racial groups of Africa.

    O Hispanic

    All persons of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or

    origin, regardless of race.

    O Asian or Pacific Islander

    All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian

    Subcontinent of the Pacific Islands. This area includes China, India, Japan, Korea, Philippine Islands,

    and Samoa.

    O American Indian or Alaskan Native

    All persons having origins in any of the original peoples of North America and who maintain cultural

    identification through tribal Affiliation or community recognition.

B. Sex: O Male O Female

C. Ethnic Group: O Hispanic O Non Hispanic

    South Toledo Bend is an Equal Opportunity Employer”

    785218033.doc Revised By: Dianne Lampman 2-1-13

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